[Outcome of postoperative adjuvant chemotherapy and surgery alone for patients with stage pT1b-3N0M0 squamous cell carcinoma of the thoracic esophagus]

Objective: To compare the outcome of postoperative adjuvant chemotherapy and surgery alone for stage pT1b-3N0M0 squamous cell carcinoma (SCC) of the thoracic esophagus. Methods: Two hundred and thirty-eight patients who underwent esophagectomy for stage pT1b-3N0M0 SCC of the thoracic esophagus in Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University between January 2008 and February 2011 were analyzed retrospectively. These included postoperative adjuvant chemotherapy for 118 patients and surgery alone for 120 patients. In postoperative adjuvant chemotherapy arm, 3 or 4 cycles of taxol+ cisplatin (TP, n=33) or fluorouracil+ cisplatin (FP, n=85) regimens were given commencing from 4 to 6 weeks after surgery. Survival analysis was performed using Kaplan-Meier method. Univariate analysis for prognostic factors was performed by Log-rank test and multivariate by Cox regression model. Results: The 3- and 5-year disease-free survival (DFS) rates were 57.9% and 53.8%, respectively for postoperative adjuvant chemotherapy patients, compared to 40.4% and 32.5% for patients who underwent surgery alone (χ²=11.973, P=0.001). The 3- and 5-year overall survival (OS) rates were 64.4% and 55.9% in postoperative adjuvant chemotherapy patients, and 46.7% and 33.5% in surgery alone patients (χ²=13.110, P=0.000). Stratification analysis showed that there was significant difference in stage T3 patients (χ²=7.895, P=0.006), but not in stage T1b (χ²=0.762, P=0.383) and T2 (χ²=1.259, P=0.262) patients between adjuvant chemotherapy and surgery alone. Both DFS rate (χ²=1.748, P=0.186) and OS rate (χ²=2.200, P=0.138) of TP group were similar with FP group. Conclusion: In lymph node negative esophageal SCC patients, postoperative adjuvant chemotherapy shows survival benefits in stage T3 patients.

Study on physiological and psychological comprehensive nursing of elderly tumor patients after surgery

The aim of this study is to formulate nursing schemes for elderly tumor patients after surgery according to their clinical characteristics, and give effective guidance for alleviating the patients’ psychological anxiety. One hundred elderly tumor patients admitted to the oncology department of the Affiliated Cancer Hospital of Harbin Medical University were included and divided into an intervention group (50) and a control group (50). Nursing intervention was performed on the intervention group, and routine nursing was performed in the control group. One day before surgery, all the patients were asked to fill in a self-rating anxiety scale (SAS) and a self-rating depression scale (SDS), and their blood pressure and heart rate data were measured. After surgery, the patients were asked to fill in a form which investigated their pain degree, recovery situation and satisfaction degree. The heart rate and blood pressure of the patients in the intervention group recovered faster than those of the control group, with lower SAS and SDS scores and shorter recovery time. In conclusion, effective nursing intervention played a crucial role in the postoperative recovery of elderly tumor patients by reducing pain and anxiety degrees, which improved the patients’ satisfaction with the nursing.

[A randomized controlled study of erlotinib versus pemetrexed combined with cisplatin in neoadjuvant therapy of stage ⅢA EGFR-mutant lung adenocarcinoma]

Objective: To evaluate the feasibility, efficacy and safety of epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKIs) for neoadjuvant therapy. Methods: Eighty-six patients with stage ⅢA EGFR-mutant lung adenocarcinoma were assigned to 2 groups (n=43 in each group) according to the random number table method: neoadjuvant targeted therapy group (single oral dose of erlotinib 150 mg per day, for 9 weeks) and neoadjuvant chemotherapy group (2 cycles of pemetrexed combined with cisplatin chemotherapy followed by 3- week discontinuation). Surgical treatment was underwent after imaging efficacy evaluation. Results: In neoadjuvant targeted therapy group, 4 achieved complete response (CR), 25 achieved partial response (PR), giving an objective response rate (ORR) of 67.4%. In pathological response, 8 patients had grade Ⅰ, 20 patients had grade Ⅱ, giving a pathological response rate of 65.1%. The most frequent adverse events (AEs) were rash and diarrhea. In neoadjuvant chemotherapy group, 2 had CR and 17 had PR, giving an ORR of 44.2%. In pathological response, 3 patients had grade Ⅰ, 15 patients had grade Ⅱ, giving a pathological response rate of 41.9%. The main AEs were hematologic toxic effects. The ORR, histological efficacy and hematologic toxicity showed statistical significance between the two groups (P<0.05). The neoadjuvant targeted therapy group had 90.7% resection rate, (299.8±23.4) ml of hemorrhage volume during operation, (5.2±0.4) days of extubation time and 9.3% postoperative complication rate. Corresponding results were 83.7%, (308.9±22.7) ml, (5.4±0.6) days and 11.6% in neoadjuvant chemotherapy group, which showed no statistical significance (P>0.05). Conclusions: Neoadjuvant targeted treatment for stage ⅢA lung adenocarcinoma harboring EGFR mutations. The regimen could be considered as a choice of neoadjuvant treatment for patients with stage ⅢA EGFR-mutant lung adenocarcinoma.

[Comparison of arterial stiffness in non-hypertensive and hypertensive population of various age groups]

Objective: To investigate the impact of blood pressure and age on arterial stiffness in general population. Methods: Participants who took part in 2010, 2012 and 2014 Kailuan health examination were included. Data of brachial ankle pulse wave velocity (baPWV) examination were analyzed. According to the WHO criteria of age, participants were divided into 3 age groups: 18-44 years group (n=11 608), 45-59 years group (n=12 757), above 60 years group (n=5 002). Participants were further divided into hypertension group and non-hypertension group according to the diagnostic criteria for hypertension (2010 Chinese guidelines for the managemengt of hypertension). Multiple linear regression analysis was used to analyze the association between systolic blood pressure (SBP) with baPWV in the total participants and then stratified by age groups. Multivariate logistic regression model was used to analyze the influence of blood pressure on arterial stiffness (baPWV≥1 400 cm/s) of various groups. Results: (1)The baseline characteristics of all participants: 35 350 participants completed 2010, 2012 and 2014 Kailuan examinations and took part in baPWV examination. 2 237 participants without blood pressure measurement values were excluded, 1 569 participants with history of peripheral artery disease were excluded, we also excluded 1 016 participants with history of cardiac-cerebral vascular disease. Data from 29 367 participants were analyzed. The age was (48.0±12.4) years old, 21 305 were males (72.5%). (2) Distribution of baPWV in various age groups: baPWV increased with aging. In non-hypertension population, baPWV in 18-44 years group, 45-59 years group, above 60 years group were as follows: 1 299.3, 1 428.7 and 1 704.6 cm/s, respectively. For hypertension participants, the respective values of baPWV were: 1 498.4, 1 640.7 and 1 921.4 cm/s. BaPWV was significantly higher in hypertension group than non-hypertension group of respective age groups (P<0.05). (3) Multiple linear regression analysis defined risk factors of baPWV: Multivariate linear regression analysis showed that baPWV was positively correlated with SBP(t=39.30, P<0.001), and same results were found in the sub-age groups (t-value was 37.72, 27.30, 9.15, all P<0.001, respectively) after adjustment for other confounding factors, including age, sex, pulse pressure(PP), body mass index (BMI), fasting blood glucose (FBG), total cholesterol (TC), smoking, drinking, physical exercise, antihypertensive medications, lipid-lowering medication. (4) Multivariate logistic regression analysis of baPWV-related factors: After adjustment for other confounding factors, including age, sex, PP, BMI, FBG, TC, smoking, drinking, physical exercise, antihypertensive medication, lipid-lowering medication, multivariate logistic regression analysis showed that risks for increased arterial stiffness in hypertension group were higher than those in non-hypertension group, the OR in participants with hypertension was 2.54 (2.35-2.74) in the total participants, and same results were also found in sub-age groups, the ORs were 3.22(2.86-3.63), 2.48(2.23-2.76), and 1.91(1.42-2.56), respectively, in each sub-age group. Conclusion: SBP is positively related to arterial stiffness in different age groups, and hypertension is a risk factor for increased arterial stiffness in different age groups. Clinical Trial Registry Chinese Clinical Trial Registry, ChiCTR-TNC-11001489.

Structural responses of metallic glasses under neutron irradiation

Seeking nuclear materials that possess a high resistance to particle irradiation damage is a long-standing issue. Permanent defects, induced by irradiation, are primary structural changes, the accumulation of which will lead to structural damage and performance degradation in crystalline materials served in nuclear plants. In this work, structural responses of neutron irradiation in metallic glasses (MGs) have been investigated by making a series of experimental measurements, coupled with simulations in ZrCu amorphous alloys. It is found that, compared with crystalline alloys, MGs have some specific structural responses to neutron irradiation. Although neutron irradiation can induce transient vacancy-like defects in MGs, they are fully annihilated after structural relaxation by rearrangement of free volumes. In addition, the rearrangement of free volumes depends strongly on constituent elements. In particular, the change in free volumes occurs around the Zr atoms, rather than the Cu centers. This implies that there is a feasible strategy for identifying glassy materials with high structural stability against neutron irradiation by tailoring the microstructures, the systems, or the compositions in alloys. This work will shed light on the development of materials with high irradiation resistance.

[Role of adrenal vein sampling in differential diagnosis of primary aldosteronism subtypes]

Objective: To investigate the role of adrenal vein sampling (AVS) in identifying the subtype of primary aldosteronism (PA). Methods: AVS was performed in 50 patients who were confirmed as PA between September 2010 and September 2016 in Nanjing Drum Tower Hospital. Clinical, biochemical and follow-up data were reviewed retrospectively. Bilaterally simultaneous catheterization without cosyntropin stimulation and contemporaneous cortisol measurement during AVS were used. Selectivity index (SI)≥1.5 suggested that the sample was from the adrenal vein.Lateralization index (LI) ≥2 suggested unilateral disease.Clinical data was further compared and the AVS findings were analyzed. Results: AVS was successful performed in 41 cases of 50 patients, and the success rate was 82%. According to the results of AVS and postoperative pathology, 41 cases were divided into aldosterone-producing adenoma (APA)/unilateral adrenal hyperplasia (UAH) group (24 cases) and idiopathic hyperaldosteronism (IHA) group (17 cases). Compared with IHA group, patients with APA/UAH showed longer duration of hypertension[10.0 (5.0, 13.0) y vs 4.0 (2.0, 8.0) y, P=0.046], higher proportion of hypokalemia (95.8% vs 64.7%, P=0.009). Furthermore, patients with APA/UAH demonstrated lower plasma renin activity (P=0.089), higher plasma aldosterone concentration and aldosterone to renin ratio (ARR) (both P<0.05). The diagnostic concordance between CT and adrenal vein sampling was only 48.8%(20/41). Conclusions: The application of bilaterally simultaneous catheterization and contemporaneous cortisol measurement improves success rate and diagnostic accuracy of AVS. AVS is useful in subtype diagnosis of PA with equivocal imaging findings.

[The effect of short-term exposure to ambient NO(2) on lung function and fractional exhaled nitric oxide in 33 chronic obstructive pulmonary disease patients]

Objectives: To investigate the effect of short-term exposure to ambient NO(2) has influence on lung function and fractional exhaled nitric oxide (FeNO) in chronic obstructive pulmonary disease (COPD) patients. Methods: A panel of doctor-diagnosed stable COPD patients (n=33) were recruited and repeatedly measured for lung function and FeNO from December 2013 to October 2014. The patients who lived in Beijing for more than one year and aged between 60 and 85 years old were included in the study. We excluded patients with asthma, bronchial tensor, lung cancer and other respiratory disorders other than chronic obstructive pulmonary disease and occupational exposure and chest trauma surgery patients. Because the frequency of each subject visiting to the hospital was different, a total of 170 times of lung function measurements and 215 times of FeNO measurements were conducted. At the same time, the atmospheric NO(2) data of Beijing environmental monitoring station near the residence of each patient during the study period were collected from 1 day to 7 days lag before the measurement. Effects of short-term NO(2) exposure on lung function and FeNO in COPD patients were estimated by linear mixed-effects models. Results: The subjects' forced vital capacity (FVC), forced expiratory volume in one second (FEV(1)), peak expiratory flow (PEF), and exhaled NO of subjects were (3.26±0.83) L, (1.66±0.61) L, (4.13±1.77) L/s, and (48.99±14.30) μg/m(3), respectively. The concentration of NO(2) was (70.3±34.2) μg/m(3) and the interquartile range (IQR) was 39.0 μg/m(3). Short-term exposure to NO(2) resulted in a significant decrease in FVC among COPD patients' which was most obvious in 2 days lag. Every quartile range increased in NO(2) (39 μg/m(3), 2 day) would cause a 1.84% (95%CI: -3.20%- -0.48%) reduction in FVC. The effects of exposure to higher concentration of NO(2) (≥58.0 μg/m(3)) on FVC estimate was -2.32% (95%CI: -4.15%- -0.48%)(P=0.02). No significant relevance of FeNO and NO(2) was observed in this study. Conclusions: Short term exposure to ambient NO(2) may bring down pulmonary function in COPD patients.

[Three combined imaging studies' diagnostic value for preoperative position of hyperthyroidism]

Objective:To investigatethe diagnostic value of three combined imaging studies' preoperative localization for secondary hyperparathyroidism.Method:This study lies on the retrospective analysis about 72 patients with secondary hyperparathyroidism who had parathyroid gland resection in our hospital from 2010 to 2017. All of 72 cases are examined by color doppler ultrasound,99mTC-MIBI nuclide imaging and magnetic resonance imaging. According to the gold standard pathological diagnosis after surgery, we compute the sensitivity and the specificity of various imaging examination and analyse these statistics by rate card square test with SPSS 19.0 software.Result:The parathyroid gland number of pathological diagnosis is 282. The sensitivities of magnetic resonance imaging, 99mTC-MIBI nuclide imaging, color doppler ultrasound and three combined imaging are 72.70%, 47.52%, 44.33% and 82.27%, respectively. The specificities of the examinations are 78.16%, 91.75%, 95.14% and 67.96%, respectively. The sensitivity of the combined three imaging studies is greater than the sensitivity of each single imaging studies, and there is a statistical significance between them. The specificity of the combined three imaging studies is smaller than the sensitivity of single imaging studies. There is a statistical significance,either.Conclusion:Three combined imaging studies' preoperative localization for secondary hyperparathyroidism has higher diagnostic value for the preoperative localization about secondary hyperparathyroidism. It can be a effective way to SHPT's surgery.

[Clinical application and evaluation of an early non-sedation protocol for critically ill respiratory patients]

Objective: To study the value of an early (mechanical ventilation after 24 h) non-sedation protocol for intubated, mechanically ventilated patients in the respiratory intensive care unit (RICU). Methods: Seventy intubated, mechanically ventilated patients were prospectively enrolled and randomly assigned to management with early non-sedation (intervention group; n=35) or with daily interruption of sedation (DIS) (control group; n=35). The duration of mechanical ventilation, length of the RICU and hospital stay, RICU and hospital mortality, drug consumption, RICU and hospitalization expenses, incidence of complications and adverse events and serum levels of vital organ damage and inflammatory markers after mechanical ventilation for 48 h were recorded and compared. Results: Patients in the intervention group had a shorter duration of mechanical ventilation than those in the control group [(7±5) vs (11±9) d, P<0.05] and were discharged from the RICU [(9±7) vs (18±9) d, P<0.05] and hospital earlier [(17±14) vs (29±22) d, P<0.05] than those in the control group. The doses of midazolam were significantly lower in the intervention group than in the control group [(99±104) vs (482±337) mg, P<0.05]. The RICU and hospitalization expenses were both significantly lower in the intervention group than in the control group [53(84) vs 88(173), 72(195) vs 154(234) thousand CHY, P<0.05]. In the intervention group, the occurrence rates of ventilator associated pneumonia (23% vs 46%), tracheotomy (14% vs 37%) and gastrointestinal adverse reactions (17% vs 40%) were significantly lower than those in the control group (P<0.05). No differences were recorded in RICU and hospital mortality (P>0.05). The occurrence rates of unplanned extubation and reintubation and the need for CT brain scans were similar in the 2 groups (P>0.05). The levels of cardiac, liver and renal damage markers, lactic acid and C-reactive protein were the same in both groups (P>0.05). Conclusions: The early non-sedation protocol decreased the duration of mechanical ventilation and the length of stay in the RICU and hospital, and it did not increase the incidence of complications and adverse events.

[Retrospective analysis of 117 cases of pulmonary cryptococcosis]

The clinical symptoms of PC were diverse and nonspecific. Halo sign and proximal air bronchogram are helpful for the diagnosis of PC. The outcome of most patients was satisfactory after appropriate treatment.

[Study of neuron-protective effect and mechanism of neuregulin1β against cerebral ischemia reperfusion-induced injury in rats]

Objective: Thecurrent study is to explore the neuron-protective mechanism of neuregulin1β (NRG1β) in a rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) through inhibiting the c-Jun phosphorylation. Methods: After 24 h of MCAO/R (referring to Longa's method), neurobehavioral function was measured by modified neurological severity score (mNSS) test; the cerebral infarction volume was detected by triphenyltetrazolium chloride (TTC) staining; the blood brain barrier (BBB) permeability was measured by Evans Blue (EB); the neuron morphology of brain tissue was observed by Nissl stain; the ultra-structures of the neurons were observed by transmission electron microscopy (TEM); the apoptotic neurons were counted by in situ cell death detection kit colocalized with NeuN; the expressions of phospho-c-Jun was determined by immunofluorescent labeling and Western blot analysis. Results: Compared with the sham-operation rats, the rats receiving MCAO/R showed increased mNSS (9.7±1.2), cerebral infarction volume (41.4±3.0)%, permeability of BBB, deformation of neurons, ischemia-induced apoptosis (0.63±0.04), and enhanced expression of phospho-c-Jun protein (0.90±0.07) (all P<0.05). Our data indicated that NRG1β attenuated neurologic deficits (6.4±0.9), decreased the cerebral infarction volume (10.4±0.5), reduced EB extravasation (1.55±0.13) and the deformation of neurons, protected the ultra-structure of neurons, blocked ischemia-induced apoptosis (0.23±0.02), through down-regulated phospho-c-Jun expression (0.40±0.03) in MCAO/R rats (P<0.05). Conclusion: NRG1β exerts neuron-protective effects against ischemia reperfusion-induced injury in rats through inhibiting the c-Jun phosphorylation.

[Comparison of posterior fossa decompression with and without duraplasty for surgical management for adult Chiari malformation type Ⅰ]

Objective: To evaluate and compare the efficacy between posterior fossa decompression without duraplasty (PFD) and posterior fossa decompression with duraplasty (PFDD) in the surgical management for adult Chiari Ⅰ malformation. Methods: Fifty-seven patients suffered from Chiari malformation type Ⅰ were treated in Department of Neurosurgery, Henan Provincial People's Hospital from August 2008 to October 2013. Twenty-three patients received posterior fossa decompression without duraplasty and the other 34 patients received posterior fossa decompression with duraplasty. The clinical results were retrospectively analyzed to compare the efficacy of two different surgical approaches. Results: There was no death or severe neurological dysfunction case in 57 patients of the two groups. Patients undergoing PFD had shorter length of hospital stay[(13.7±3.5) d vs (16.2±4.1) d, P<0.05]and surgical time[(98.7±22.1) min vs (132.3±39.6)min, P<0.05]. Cerebrospinal fluid-related complications and intracranial infection were more common in patients undergoing PFDD[(0/23, 0) vs (8/34, 23.5%), P<0.05]. Clinical improvement was comparable in two groups[(15/23, 65.2%) vs (26/34, 76.5%), P>0.05]at the one-year follow-up. The rate of syrinx regression in patients with Syringomyelia was higher in patients undergoing PFDD[(3/12, 25%) vs (17/22, 77.3%), P<0.05]. Conclusion: For adult patients with Chiari malformation type Ⅰ, PFD has the advantages of simple manipulation, short length of hospital stay and low incidence of cerebrospinal fluid-related complications and intracranial infection, compared with PFDD. It is comparable to PFDD in clinical improvement, but the effect of PFD is not as good as that of PFDD in the aspect of syrinx regression.

[Analysis of the correlation between deep medullary veins and clinical prognosis of middle cerebral artery stroke]

Objective: To investigate the relativity between the distribution of deep medullary vein (DMV) in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging (SWI). Methods: A total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists. Results:Kappa value in DMV symmetry and DMV type were 0.875 and 0.852. Chi-square test analysis revealed a statistically significant difference of DMV symmetry between healthy control and stroke group(χ(2)=31.046, P=0.000). There was correlation between DMV type and NIHSS score in stroke group (r(s)=0.208, P=0.025). There was no statistically significant difference of DMV distribution in the different periods of stroke group (P=0.110). But there was statistically significant difference of DMV distribution between acute and chronic stroke (P=0.018). Among 30 follow-up cases, 18 cases with asymmetry DMV changed into symmetry after stroke therapy. In 8 cases with symmetry DMV, the diameter of DMV became smaller after treatment. In 4 cases, DMV had no changes. Conclusions: DMV in patients of MCA stroke are mostly asymmetry distribution. DMV classification can be used as an imaging standard to predict the prognosis of stroke patients.

Evolving safety practices in the setting of modern complex operating room: role of nurses

Operating room (OR) nursing previously referred to patient care provided during the intra-operative phase and the service provided within the OR itself. With the expansion of responsibilities of nurses, OR nursing now includes pre-operative and post-operative periods, therefore peri-operative nursing is accepted as a nursing process in OR in the contemporary medical literature. Peri-operative nurses provide care to the surgical patients during the entire process of surgery. They have several roles including those of manager or a director, clinical practitioner (scrub nurse, circulating nurse and nurse anesthetist), educator as well as researcher. Although, utmost priority is placed on insuring patient safety and well-being, they are also expected to participate in professional organization, continuing medical education programs and participating in research activities. A Surgical Patient Safety Checklist formulated by the World Health Organization serves as a major guideline to all activities in OR, and peri-operative nurses are key personnel in its implementation. Communication among the various players of a procedure in OR is key to successful patient outcome, and peri-operative nurses have a central role in making it happen. Setting up of OR in military conflict zones or places that suffering a widespread natural disaster poses a unique challenge to nursing. This review discusses all aspects of peri-operative nursing and suggests points of improvement in patient care.

[The fMRI research of vestibular migraine neural pathways]

Objective:To investigate the abnormal functional response of neural pathways of vestibular migraine (VM) patients, located the functional area, and inferred the possible mechanism. Method:Twenty patients of VM, 20 of migraine without aura (MwoA), and 20 of healthy controls (HC), underwent whole-brain blood oxygen level-dependent (BOLD) fMRI during ear irrigation with cold water. We chose the stimulation image and the diapause stimulation image. Analyses explored functional area with BOLD signal change of the three groups. Result:We observed task-positive BOLD signal change in cortical and subcortical pattern in response to ear irrigation of all participants. Such as parietal lobe, temporal lobe, insular lobe, cingulate gyrus, thalamus, caudate nucleus, optic radiation, precuneus. VM patients showed a significantly task-negative in thalamic and fusiform gyrus in comparison with the other groups (P<0.05). Conclusion:fMRI could response the respective functional area objectively. We inferred the possible mechanism of VM was abnormal activation of thalamus and fusiform gyrus, produced crossing between the vestibular sensory pathway conduction and the pain conduction.

[Analysis of compiling date of Huang di nei jing (Huangdi's Internal Classic)]

There are Seven Medical Classics recorded in the Han shu Yi wen zhi(Bibliography in Annals of the Han Dynasty), among which the 18-volume Huang di nei jing (Huangdi's Internal Classic) is not the current edition of Ling shu (Miraculous Pivot) and Su wen(Plain Questions). The present edition of Huang di nei jing containing these two works might be merged in the Eastern Han Dynasty, benefited from the invention of Cai Lun's papermaking technique and the development of Nine needles, especially filiform needle manufacturing. Huang di nei jing was compiled on the basis of two major integrations: The first was joined by some medical experts such as Bian Que and tai yi ling (minister of imperial physicians) of the Qin State by using the language in the Warring States, contributing mainly to the theoretical system and forming its basic academic framework; The second was the second Royal book-collating activity in the Eastern Han Dynasty (100-110), which had revised the seven volumes of Chinese Medical Classics and incorporated them into two parts, Ling Shu and Su Wen, together with Bian Que's medical works and the new contents from the introductory Chapter on Nine Needles and Twelve Yuan(origin) Acupoints.

[Preliminary study on assessment of lexiscan-induced blood-brain barrier opening and its level by CT perfusion imaging]

Objective: To evaluate the level of lexiscan-induced blood-brain barrier opening of healthy rabbits via CT perfusion weighted imaging (PWI) scan. Methods: Between November 2014 and May 2015, thirty New Zealand white rabbits were randomly assigned into three groups: the experimental group A1 which received one injection of lexiscan(1 ml/kg); the experimental group A2 which received three times injection of lexiscan(total dose: 1.5 ml/kg), finished within 15 minutes; the control group B which was injected the same volume normal saline(1 ml/kg), after 30 minutes, CT PWI scan was performed. Then cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and permeability surface(PS) of the region of interest of each group were acquired and compared statistically. Five cases of each group were injected with 2% Evans blue intravenously posterior to imaging. After one hour of infusion, all the animals were killed. Their brains were examined for the determination of Evans blue distribution. Results: Both the values of CBF and CBV and the staining with Evans blue of the group A1(CBF: (89.88±2.21), (81.42±4.28) ml·(100 g)^-1·min^-1; CBV: (3.97±0.43), (3.66±0.16) ml/g)and group A2 (CBF: (75.16±0.84), (63.66±7.21) ml·(100 g)^-1·min^-1; CBV: (4.07±0.01), (3.75±0.05) ml/g) were higher than those of the group B(CBF: (20.08±5.08), (14.58±8.62) ml·(100 g)^-1·min^-1; CBV: (0.85±0.04), (0.65±0.17) ml/g), the differences were all statistically significant (all P<0.01). While there was no statistically difference between group A1 and group A2(P>0.05). The value of PS of the group A2((22.43±8.09), (20.20±7.01)ml·(100 g)^-1·min^-1 )was higher than that of group A1((13.82±4.44), (10.12±2.44)ml·(100 g)^-1·min^-1) and group B(0.00, 0.00)(the lowest one), the differences were all statistically significant(all P<0.01). The value of MTT of the group A1((2.50±0.82, 2.47±0.10) s) had no statistical difference with group A2 and group B, while the value of group A2((4.50±0.17), (4.72±0.15) s) was higher than that of group B((1.88±0.09), (1.99±0.00) s), the differences were all statistically significant (P<0.05). Conclusion: Changes in hemodynamics of lexiscan-induced blood-brain barrier opening can be monitored by CT PWI scan. When the total dose of lexiscan increasing, the level of the BBB opening is higher with significantly increased CBF, CBV, PS and MTT.

[Diagnostic value of enhanced CT/MRI for thyroid cartilage invasion by malignant tumor]

Objective: To evaluate the values of enhanced CT and MRI for the diagnosis of thyroid cartilage invasion by laryngeal and hypopharyngeal cancer. Methods: One hundred and ninety-seven patients with primary laryngeal or hypopharyngeal cancer treated with surgery between January 2013 and December 2014 were included in this study. All patients underwent enhanced CT and MRI before surgery. With MRI using the techniques of fast recovery fast spin echo (FRFSE), spin echo echo planar imaging (SE-EPI) and diffusion weighted imaging (DWI), thyroid cartilage invasion was evaluated and the results of postoperative histopathological examination was used as a gold standard for the determination of thyroid cartilage invasion. The sensitivity, specificity, positive predictive value and negative predictive value of enhanced CT or MRI in detecting thyroid cartilage invasion by laryngeal and hypopharyngeal cancer were evaluated. Data were analyzed with SPSS17.0 software. Results: Among 197 patients, there were 35 cases with supraglottic laryngeal cancer, 92 cases with glottic laryngeal cancer, 9 cases with subglottic laryngeal cancer, and 61 cases with hypopharyngeal cancer. Postoperative pathologycal examinations showed that 63 (32.0%) of 197 patients had thyroid cartilage invasion by tumor. Based on TNM classification of AJCC (American Joint Commission for Cancer, 2010), there were 36 cases at T2 stage, 109 cases at T3 and 52 cases at T4; 117 cases with N0, 46 cases with N1 and 34 cases with N2. The sensitivity, specificity, positive predictive value and negative predictive value of CT for the detection of thyroid cartilage invasion were respectively 57%, 86%, 65% and 81%, and those of MRI were respectively 94%, 87%, 78% and 97%. Kappa values were 0.45 for CT and 0.77 for MRI in diagnosis of thyroid cartilage invasion, with statistically significant difference (χ(2)=6.78, P<0.05). Conclusion: MRI (FRFSE and SE-EPI DWI) has more advantages than CT in the diagnosis of thyroid cartilage invasion by laryngeal or hypopharyngeal cancer.

[Drainage characteristic of the brain interstitial fluid detected by using fluorescence and magnetic tracer method]

OBJECTIVE

Compare the results of molecular diffusion and mass flow in the interstitial space(ISS) displayed by using optical and magnetic probes and study partitioned drainage of the brain interstitial fluid (ISF).

METHODS

In the study, 36 male SD rats were randomly divided into fluorescent inspection group (18), magnetic tracer group (18). Then they were divided equally into caudate nucleus (Cn), thalamus (T) and substantia nigra (Sn) subgroup, 6 rats in each subgroup. Referencing the brain stereotaxic atlas, the coronal globus pallidus as center level, Cn, T or Sn were acted as puncture positioning target. A 10 μL microsyringe was stereotaxically positioned and the lucifer yellow (LY) solution of 2 μL 10 mmol/L was infused into centric position. The coronary slices undergo cardiac perfusion and fix respectively in time point Cn 3 h, T 2 h and Sn 1 h. The rat brain was placed in rat stainless steel brain matrices and cut backward along visual intersection. The injection point of coronal slice as the center level, take 3 slices in front of the center level and 2 slices behind of it. 1 mm for each slice and 6 slices in total. Then slices were detected by laser scanning confocal microscope (LSCM). Simultaneous, in the same coordinate brain regions of another three groups, a gadolinium-diethylene triamine pentaacetic acidm (Gd-DTPA) solution of 2 μL 10 mmol/L was infused into different injection and detected by MRI tracer-based method. Then the Radiant can be used to measure distribution area of Gd-DTPA.

RESULTS

LY and Gd-DTPA have different distribution regions in Cn, T and Sn. After LY and Gd-DTPA were introduced into the Cn subgroup 3 h, compare the 1 to 6 levels distribution area of LY and Gd-DTPA as follows: (10.95±4.27) mm² vs. (8.33±2.25) mm², (18.16±4.74) mm² vs. (16.42±2.88) mm², (24.57±3.65) mm² vs. (20.75±2.29) mm², (34.81±3.32) mm² vs. (28.88±1.51) mm², (30.53±3.12) mm² vs. (20.92±2.75) mm², (12.15±4.92) mm² vs. (10.00±1.89) mm². The statistical analysis of every level was made by T test, and the difference of the distribution area between the two tracers were not statistically significant (t=0.940, P=0.400; t=0.546, P=0.614; t=1.534, P=0.200; t=2.809, P=0.480; t=2.693, P=0.055; t=0.707, P=0.518); After LY and Gd-DTPA were introduced into the T subgroup 2 h, compare the 1-6 levels distribution area of LY and Gd-DTPA as follows: (5.56±4.61) mm² vs. (3.33±2.25) mm², (16.21±3.36) mm² vs. (11.42±2.88) mm², (19.00±5.21) mm² vs. (15.75±2.29) mm², (25.32±5.49) mm² vs. (22.33±3.25) mm², (17.34±5.31) mm² vs. (15.92±2.75) mm², (7.67±6.19) mm² vs. (5.00±1.89) mm². The statistical analysis of every level was made by T test, and the difference of the distribution area between the two tracers were not statistically significant (t=0.753, P=0.493; t=1.875, P=0.134; t=0.990, P=0.378; t=0.810, P=0.464; t=0.413, P=0.701; t=0.716, P=0.514); After LY and Gd-DTPA were introduced into the Sn subgroup 1 h, compare the 1-6 levels distribution area of LY and Gd-DTPA as follows: (6.78±4.56) mm² vs. (4.75±2.00) mm², (12.65±5.04) mm² vs. (10.44±1.13) mm², (19.51±6.54) mm² vs. (17.55±0.30) mm², (28.72±5.45) mm² vs. (24.48±1.32) mm², (21.34±4.42) mm² vs. (17.72±0.25) mm², (13.00±5.46) mm² vs. (12.00±2.88) mm². The statistical analysis of every level was made by T test and the difference of the distribution area between the two tracers were not statistically significant (t=0.705, P=0.519; t=0.743, P=0.499; t=0.517, P=0.656; t=1.310, P=0.260; t=1.416, P=0.292; t=0.281, P=0.793), but the distribution area of LY is slightly more than Gd-DTPA.

CONCLUSION

LSCM imaging technology confirmed partitioned drainage of the brain ISF found by MRI tracer-based method and provided technology and method validation for MRI tracer-based method. LSCM imaging technology with higher contrast and resolution, therefore more sophisticated partitioned drainage of the brain interstitial fluid were got.

[Association between hypertension and serum microRNA21 and microRNA133a in ocean seamen]

OBJECTIVE

To investigate the prevalence of hypertension in ocean seamen and major influencing factors, as well as the association between hypertension and serum microRNA21 and microRNA133a.

METHODS

Health examination and a questionnaire survey were performed for 780 ocean seamen who underwent physical examination in an international travel healthcare center in Fujian, China from January to June, 2014. TaqMan RT-qPCR was used to measure the serum levels of microRNA21 and microRNA133a in seamen with hypertension.

RESULTS

The prevalence of hypertension differed significantly between the ocean seamen with different ages, education levels, marital status, body mass index (BMI) values, drinking frequencies, and numbers of sailing years (P<0.05). The prevalence rate of hypertension in the ocean seamen increased with the increasing drinking frequency (χ(2)=9.02, P<0.05) , decreased with the increase in degree of education (χ(2)=11.578, P<0.05) , and increased with the increase in the number of sailing years (χ(2)=28.06, P<0.05). The hypertensive ocean seamen had significantly higher expression levels of microRNA21 and MicroRNA133a than the healthy ocean seamen (microRNA21: 7.87±5.46 vs 1.03±0.80, P<0.05; MicroRNA133a: 7.45±1.94 vs 4.52±1.15, P<0.05). The multivariate analysis showed that a high level of microRNA21 (OR=1.61, 95% CI: 1.22~2.11) , a high level of microRNA133a (OR=1.52, 95% CI: 1.24~1.87) , drinking (OR=1.64, 95% CI: 1.08~2.50) , overweight based on BMI (OR=1.18, 95%CI: 1.07~1.30) , and many sailing years (OR=2.89, 95% CI: 1.14~7.30) were risk factors for hypertension.

CONCLUSION

The prevention and treatment of hypertension in ocean seamen should be enhanced. Excessive drinking should be controlled, and sailing time should be arranged reasonably. The microRNA21 and microRNA133a may be associated with the development and progression of hypertension in ocean seamen.

Factors associated with Staphylococcus aureus nasal carriage and molecular characteristics among the general population at a Medical College Campus in Guangzhou, South China

BACKGROUND

The nasal cavity is the main colonization site of Staphylococcus aureus (S. aureus) in human body. Nasal carriage may be a strong risk factor for some serious infection. There was still limited information about the nasal carriage for S. aureus in south China.

METHODS

Sought to determine the prevalence and molecular characteristics of S. aureus nasal carriage, 295 volunteers residing on a medicine campus were investigated and sampled the nasal cavity swab. Selected S. aureus isolates were carried through molecular analysis, including pulsed-field gel electrophoresis (PFGE), multilocus sequence analysis, staphylococcal cassette chromosome mec (SCCmec) and virulence gene detection.

RESULTS

A total of 73 S. aureus isolates were recovered from separate subjects (24.7%, 73/295), with one methicillin-resistant S. aureus (MRSA) isolate (0.3%, 1/295). Among the 73 isolates, 71 isolates were successfully grouped into 13 pulsotypes by PFGE analysis, with profiles A and L the most prevalent; 12 sequence types (STs) were found among the 23 isolates which had similar drug resistant spectrum. ST59, ST188 and ST1 were the most prevalent, accounting for 17.4, 13.0 and 13.0% of all isolates, respectively. The MRSA isolate presented ST8-SCCmec III. 56.5% of isolates carried both the staphylococcal enterotoxin A (sea) and enterotoxin B (seb) genes. 83.6% of the S. aureus isolates were resistant to penicillin, all isolates were susceptible to quinupristin/dalfopristin, levofloxacin, teicoplanin and vancomycin. The most common risk factors for S. aureus carriage were being male, age ≤30 years, and nasal cavity cleaning habits.

CONCLUSIONS

Colonization by S. aureus was greater among male and young age (20-30 years) students and those with irregularity nasal cleaning. The S. aureus isolates selected were revealed into various sequence types and pulsotypes, indicating molecular heterogeneity among S. aureus isolates from the populations in the medical college in Guangzhou.

Immunohistochemical localization of sex hormone receptors in two Raillietina tapeworms

Sex hormone receptors play critical roles in development and reproduction. However, it is not known whether they exist in Raillietina tapeworms, and if they do, whether they have a similar function to that in vertebrates. We examined the immunohistochemical distributions of androgen receptors (ARs), estrogen receptors (ERs), and progesterone receptors (PRs) in the tissues of two tapeworm species: Raillietina echinobothrida and Raillietina tetragona. Immunopositive ARs were found in the entire reproductive system of R. echinobothrida, including the testes, ovaries, and oocysts, and weakly immunopositive ERs and PRs were found in the testes, ovaries, and oocysts. Immunopositive ARs were also found throughout the entire reproductive system of R. tetragona, including the testes, ovaries, and oocysts, and weakly immunopositive ERs were in the testes and oocysts; the PRs were distributed in an immunonegative manner. The results show that androgens and their receptors play critical roles in reproductive system development in the two tapeworms. The immunoreactivity and tissue localizations of the sex hormone receptors suggest that, in both species, they have similar functions as in vertebrates, and modulate reproduction.

Multiple perforations and fistula formation following corticosteroid administration: A case report

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic small- and medium-sized-vessel vasculitis. The literature contains only a few reports of gastrointestinal perforation with this condition. We report a patient with EPGA treated with high-dose steroid who underwent emergency surgery for intestinal perforations. We performed a simple repair of the 11 perforations. Intestinal fistulas developed 8 d postoperatively; they healed well after 60 d of continuous washing and negative pressure suction. The clinical data of 14 additional patients with EGPA or Churg-Strauss syndrome complicated with gastrointestinal perforation, which were reported from 1996 to 2014, were also collected and compared. The formation of multiple perforations and fistulas following high dosage steroid administration can have a good outcome with appropriate management. Meticulous attention to abdominal symptoms and appropriate interventions can result in timely management. Corticosteroid administration remains a very important perioperative procedure for EPGA.

[Clinical evaluation of the revised International Prognostic Score of Thrombosis for essential thrombocythemia (IPSET-thrombosis) in a cohort of 746 Chinese adult patients]

Objective: To evaluate the role of the revised International Prognostic Score of Thrombosis (IPSET-thrombosis) in predicting the occurrence of thrombotic events in Chinese patients with essential thrombocythemia (ET) and to develop a thrombosis predicting model more applicable to Chinese ET patients. Methods: Medical records of 746 adult patients with an initial diagnosis of ET were retrospectively analyzed. Results: The median age at diagnosis was 52 (18-87) years, with 305 males and 441 females. According to the revised IPSET-thrombosis model, the number of very low-, low-, intermediate-, and high-risk patients were 271 (36.3%) , 223 (29.9%) , 63 (8.4%) and 189 (25.3%) , respectively. The four groups exhibited significantly different thrombosis-free survival (χ(2)=72.301, P<0.001) . Thirty-six patients were reclassified as intermediate-risk according to the revised IPSET-thrombosis instead of low-risk as per the original IPSET-thrombosis. Nineteen intermediate-risk patients as per the original IPSET-thrombosis were upgraded to high-risk according to the revised IPSET-thrombosis. Fifty-one high-risk patients as per the original IPSET-thrombosis were reclassified as low-risk in the revised IPSET-thrombosis. It suggests that the revised IPSET-thrombosis potentially avoids over- or under-treatment. In low-risk patients as per the revised IPSET-thrombosis, the rate of thrombosis in patients with cardiovascular risk factors (CVF) was higher than that in those without (16.3% vs 5.2%, χ(2)=5.264, P=0.022) , and comparable with intermediate-risk patients as per the revised IPSET-thrombosis (16.3% vs 14.3%, χ(2)=0.089, P=0.765) . As a result, a new revised IPSET-thrombosis model more applicable to Chinese ET patients was developed in which patients with CVF in the low-risk group as per the revised IPSET-thrombosis were reclassified as intermediate-risk group. Conclusion: For predicting the occurrence of thrombotic events, the revised IPSET-thrombosis model was better than the original IPSET-thrombosis model. The revised IPSET-thrombosis was optimized and a new revised IPSET-thrombosis model more applicable to Chinese ET patients was developed, and the new evidence for risk stratification and treatment of ET in Chinese was provided.