Comparison of Surgical Outcomes and Recovery of Neurologic and Linguistic Functions in the Dominant Hemisphere After Basal Ganglia Hematoma Evacuation by Craniotomy versus Endoscopy.

OBJECTIVE: Hemorrhage in the basal ganglia is a common type of intracerebral hemorrhage and has high mortality and poor prognosis. In our study, we aimed to evaluate surgical outcomes and functional recovery after evacuation of hematoma using either craniotomy or endoscopy. METHODS: We analyzed retrospective data from 58 patients with basal ganglia hemorrhage who were treated with hematoma evacuation using either craniotomy or endoscopy. Magnetic resonance imaging and a navigation system were used for calculating hematoma volume and for navigation during surgery. Clinical information and surgical outcomes were recorded. At 6-month follow-up, the recovery of neurologic function and the results of the Aphasia Battery of Chinese test were assessed. RESULTS: The endoscopy group showed lower intraoperative blood loss (75.36 ± 45.56 vs. 462.67 ± 120.08 mL, P < 0.001), shorter operation time (1.59 ± 0.30 vs. 4.17 ± 0.86 hours, P < 0.001), and a higher hematoma clearance rate (0.93% ± 0.05% vs. 0.88% ± 0.13%, P = 0.04) than the craniotomy group, respectively. No significant differences in mortality were identified, but a trend toward lower mortality in the endoscopy group was apparent (7.14% in the endoscopy group vs. 16.67% in the craniotomy group, P = 0.43). Assessment of neurologic recovery indicated significant differences in the modified Rankin Scale grades between the 2 groups (χ2 = 4.381, P = 0.036). Listening comprehension and speaking ability were also better in the endoscopy group than the craniotomy group (χ2 = 4.693, P = 0.03). CONCLUSIONS: Evacuation by endoscopy had better surgical outcomes, recovery of neurologic function, and aphasia recovery than evacuation by craniotomy. It appears that endoscopy is the surgical treatment of choice for middle-aged and elderly patients with a basal ganglia hemorrhage volume of >35 mL.

Evaluation of spontaneous intracerebral hemorrhage by using CT image segmentation and volume assessment based on deep learning / 中华放射学杂志

Objective@#To evaluate the feasibility and accuracy of deep learning in CT image segmentation and further lesion-volume assessment of spontaneous intracerebral hemorrhage.@*Methods@#A total of 1 223 cases of spontaneous intracerebral hemorrhage including parenchymal hemorrhage, ventricular hemorrhage, subarachnoid hemorrhage and mixture hemorrhage, from April 2016 to April 2018 in Tianjin Medical University General Hospital, were retrospectively enrolled and analyzed. The patients were randomly divided into training set (905 cases), validation set (156 cases) and test set (162 cases), among each group, the number of parenchymal hemorrhage was 498, 107 and 100, respectively. The bleeding area manually outlined by physician was served as the reference standard to build the segmentation model and to evaluate the performance of the validation set. Patients were divided into 3 groups according to the volume calculated by reference standard. The volume of hematoma in group 1 was less than 5 ml, while group 2 was 5-25 ml, and group 3 was more than 25 ml. Comparison of the hematoma volume calculated by segmentation model and that calculated by ABC/2 formula was conducted in 97 simple intraparenchymal hemorrhage cases.@*Results@#In 162 cases of test set, the Dice coefficients of the segmentation model were 0.87, 0.85, 0.67 and 0.77 in parenchymal hemorrhage, intraventricular hemorrhage, subarachnoid hemorrhage and mixture hemorrhage, respectively. The estimated hematoma volume in the 97 intraparenchymal hemorrhage cases calculated by the segmentation model was (29.55±37.69) ml, and that calculated by the ABC/2 formula was (24.04±31.22) ml. Compared with reference standard, the absolute errors of three segmentation model were (0.52±0.54), (1.53±1.22) and (7.93±8.49) ml in group 1, 2 and 3 respectively. The absolute errors of the ABC/2 formula were (0.68±0.60), (3.16±2.90) and (19.31±17.23) ml in group 1, 2 and 3.@*Conclusion@#Deep learning based segmentation model improved detection of intraparenchymal hematoma volume, compared with ABC/2 formula.

Effects of spautin-1 on autophagy and apoptosis of acute pancreatitis cell model induced by cerulein / 中华胰腺病杂志

Objective To investigate the potential of Spautin-1 to treat acute pancreatitis by inhibiting impaired autophagy and promoting apoptosis using an acute pancreatitis cell model induced by cerulein in vitro.Methods Pancreatic acinar cells AR42J were treated with sterile saline,100 nmol/L cerulein,and 100 nmol/L cerulein combined with 10 μmol/L spautin-1 for 24 h,respectively,and then western blot was used to detect the expression of LC3,p62 and Beclin1 in the cells to reflect autophagy;the trypsin activity in cells was detected by BGAM.Flow cytometry was used to detect the apoptosis;LDH cytotoxicity assay kit was used to detect cell necrosis.Results The expression of LC3 Ⅰ (0 h-24 h:4.32±0.46,4.68±0.41,5.22± 0.38,5.88 ±0.63),LC3 Ⅱ (0 h-24 h:0.36 ±0.02,0.64 ±0.05,0.93 ±0.08,2.43 ±0.23) and p62 (0 h-24 h:0.24 ± 0.01,0.22 ± 0.02,0.84 ± 0.09,1.25 ± 0.13) was increased in AR42J cell model treated with cerulein (P ＜ 0.05),indicated that cells undergo autophagy,but autophagy flux is blocked.The expression of LC3 Ⅰ (0.65 ± 0.06 vs 0.24 ± 0.01),LC3 Ⅱ (1.26 ± 0.15 vs 0.71 ± 0.08) and p62 (1.06 ± 0.09 vs 0.56 ± 0.06) were decreased after incubated with spautin-1,with the decreased trypsin activity (1.65 ±0.18 vs 1.13 ±0.14),increased apoptosis (6.58 ±4.01 vs 23.64 ±2.12) (P ＜0.05) and reduced cellnecrosis (27.58± 3.46vs7.64 ± 2.12) (P＜0.05).Conclusions Inthe AR42 Jcellmodel ofacute pancreatitis induced by cerulein in vitro,spautin-1 can inhibit impaired autophagy induced by cerulein,decrease trypsin activity,increase apoptosis and reduce cell necrosis to protect pancreatic cells from damage,which has a certain value for remissing and even curing acute pancreatitis.

Atg7 in development and disease: panacea or Pandora's Box?

Macroautophagy is an evolutionarily conserved intracellular degradation system used by life ranging from yeasts to mammals. The core autophagic machinery is composed of ATG (autophagy-related) protein constituents. One particular member of the ATG protein family, Atg7, has been the focus of recent research. Atg7 acts as an E1-like activating enzyme facilitating both microtubule-associated protein light chain 3 (LC3)-phosphatidylethanolamine and ATG12 conjugation. Thus, Atg7 stands at the hub of these two ubiquitin-like systems involving LC3 and Atg12 in autophagic vesicle expansion. In this review, I focus on the pleiotropic function of Atg7 in development, maintenance of health, and alternations of such control in disease.

Reflection on Opening of Section for Outpatients for Risk Assessment and Communication of Medication Use in Pregnancy by Pharmacists / 中国药师

Objective:To discuss the necessity of the opening of a pharmacist section for outpatients for risk assessment and com-munication of drugs in pregnancy by surveying the use situation and risk reasons of the drugs was in pregnancy. Methods:Referring to the risk classification of medicines in pregnancy formulated by FDA and integrating various factors in pregnant women, such as drug dosage, administration time, genetic factors, prenatal care and potential diseases et al, pharmacists established the section for outpa-tients for risk assessment and communication of drugs in pregnancy. Results:The visiting number of pregnant women was gradually in-creased after the establishment by reviewing the clinical data from the hospital information system. The new pharmacy service mode pro-vided by pharmacists for obstetrical patients was positively recognized by physicians and patients. Conclusion:The section for outpa-tients for risk assessment and communication of drugs in pregnancy should be established in order to promote the pharmaceutical knowl-edge in pregnancy and improve the medication safety.

Dynamic changes of platelets and white blood cells in patients with traumatic brain injury and its clinical sigulficance / 中华创伤杂志

Objective To investigate the dynamic changes of platelets (PLT) and white blood cells (WBC) after traumatic brain injury (TBI) and discuss its clinical significance. Methods The number of PLT and WBC were examined in 63 patients with TBI by using cytoanalyze and also analyzed together with Glasgow Outcome Scale and concurrent infection, in the meantime, enzyme-linked immu-nosorbent was used to investigate concentration changes of C reactive protein (CRP) and thrombospondin 1 (TSPI) and analyze the correlation between CRP and TSP1. Results The number of WBC in all pa-tients, whether concurred with infection or not, was significantly increased within 24 hours after TBI (P < 0.01), with no statistical difference between patients without infection at day 4 and normal patients (P >0.05). However, the number of WBC was decreased to below 10 × 109/L in patients without infec-tion, which was significantly higher than that in normal patients (P < 0.05). In patients with infection and unfavorable prognosis, the number of WBC was increased again ay days 7-14, whereas that of PLT rose significantly at days 14-21 (P <0. 01). The concentration of TSPI was positively correlated with that of CRP (r = 0.720, P < 0.01). Conclusions Monitoring the dynamic changes of PLT and WBC is promising. The change of WBC at day 4 post injury is a key indicator to provide evidences of prophylactic antibiotic usage. Much attention should be paid to the dynamic change of PLT at days 14-21 post injury so as to evaluate the condition of hypercoagulability that can be potentially caused by inflammation response. Secondary increase of WBC and later increase, of PLT may affect prognosis of the patients. TSP1 and CRP may participate in thrombosis formation induced by inflammation.

Pathogen Distribution and Drug Resistance in Infection of Operative Incision / 中华医院感染学杂志

OBJECTIVE To investigate pathogen distribution and drug resistance in infection of operative incision and provide the reference for clinical prevention and cure.METHODS Referring to National Rules of Operation in Clinical Laboratory,strains were isolated and identified,and drug-sensitivity test was performed by DADE BEHRING panel.RESULTS Among total 140 strains of pathogenic bacteria,the most were Gram-negative bacilli that accounted for 58.6%(82 strains),followed by Gram-positive cocci that accounted for 41.4%(58 strains).Staphylococcus aureus and Pseudomonas aeruginosa had the higher detection rate.The former was 29.3% and the latter was 27.1%.Among the total S.aureus,meticillin-resistant S.aureus(MRSA) accounted for 31.7%.Detection rate of extended-spectrum beta-lactamases(ESBLs) producing Escherichia coli and Klebsiella pneumoniae was 40.9%.CONCLUSIONS Effective measurement should be taken to prevent and control infection of operative incision.

Monitoring of Drug-resistance in Mycoplasma Isolated from Female Genitourinary Tract / 中华医院感染学杂志

OBJECTIVE To investigate the infection status and drug resistance of Ureaplasma urealyticum (Uu) and Mycoplasma hominis (Mh) isolated from female genitourinary tract. METHODS The specimens of 1890 cases were collected from Jan 2003 to Dec 2006. The results of mycoplasma cultivation and susceptibility test were analyzed retrospectively. RESULTS Among 1890 cases, there were 756 cases with positive mycoplasma cultivation. Positive rate was 40.0%. Positive rate was the highest at the age of 21 to 40. Among 11 commonly used antibiotics, sensitivity of tetracyclines was the highest,followed by macrolides. Four quinolones all showed the higher resistance. CONCLUSIONS The resistance of commonly used antibiotics in mycoplasma isolated from female genitourinary tract is greatly severe.We should think highly of it.