Objective To explore the effects of selective intra arterial chemotherapy for preoperative gastric cancer. Methods 35 cases of gastric cancer treated by selective intra arterial perfusion of chemrotherapy before operation, together with clinical manifestations、findings in operation, pathological changes and clinical effects were retrospectively reviewed. Results The total effective rate proved by pathology was 81%, of them slight efficiency was in 14 patients(45%), moderate in 11 patients(36%). The clinical relieve rate was 77%, complete relieve in 5 patients(14%), partial relieve in 14 patients(45%). Conclusions Interventional intra arterial perfusion chemotherapy of gastric cancer before operation is an effective method for elevating resection rate of gastric cancer.

At present,the urinalysis has many puzzles and problems,this paper is proposed consensus of the key problems including standardization method in the urine formed elements examination,the urinalysis screening test,the results of reference intervals between the different examination methods,quantitative of the visible components,using centrifugal or non-centrifugal urine to do urine formed elements examination and the development direction of automatic urine sediment analyzer.These key problems are discussed and the consensus are put forward,in order to cause concern.( Chin J Lab Med,2012,35:790-791 )

Objective By using 18F-deoxyglucose (18F-FDG) positron emission computed tomography (PET-CT) to measure the brain glucose metabolism of patients with severe traumatic brain injury before and after hyperbaric oxygen (HBO) therapy,and to investigate the mechanisms of H BO treating patients with traumatic brain injury.Methods Twenty-six patients suffered form severe traumatic brain injury with stable vital signs within 2 weeks were randomly divided into the HBO group and the control group.The patients of both groups received routine clinical interventions (including neuroprotection,dehydration,reducing intracranial pressure,anti-infection and other symptomatic treatments).Patients of the HBO group received the basic treatment combined with HBO therapy one tine per day for 7 days per week.In early stage and 4 weeks after treatment,all patients were examined with PET-CT scanning and Glasgow coma scale (GCS),disability rating scale (DRS) at the same time.Results There was standard uptake value (SUV) of significant difference between affected and unaffected brain areas in two groups before treatment(P＜0.01),but no significant difference between two groups (P＞0.05).After 4-week of treatment,SUV of affected and unaffected brain areas of two groups improved,the damaged area of HBO group improved obviously and the SUV was much better than before treatment and the control group (P＜0.0l).The GCS and DRS scores of HBO group were also significantly better than that of control group (P＜0.05).Conclusion The 18F-FDG PET-CT examination showed that HBO therapy can significantly improve glucose metabolism function of the brain damaged area,promote the brain functional recovery and awakening,and improve the prognosis in patients with severe traumatic brain injury.

Objective To compare changes in indexes and analyze their values in prognosis of severe burn patients with sepsis.Methods A retrospective analysis was conducted. The patients with severe burn sepsis admitted to the Third Affiliated Hospital of Soochow University from August 2014 to December 2016 were enrolled. The blood culture was positive in the clinical diagnosis of sepsis. According to the prognosis, the patients were divided into death group and survival group. Their general information, vital signs, blood routine examination, serum sodium (Na+), serum glucose (Glu), C-reactive protein (CRP) and arterial partial pressure of carbon dioxide (PaCO2) at the time of admission and diagnosis of sepsis as well as the level of serum procalcitonin (PCT) at admission, diagnosis of sepsis and 1-8 days of post diagnosis were also compared. Receiver operating characteristic curve (ROC) was used to analyze the prognostic value of each index, and multivariate Cox regression analysis was used to analyze the influence of each index on the survival time, and the survival curve of Kaplan-Meier was analyzed for dead patients.Results There were 25 cases of severe burn patients with sepsis, which were admitted to hospital within 12 hours after injury; the time of diagnosis of burn sepsis was (14±6) days; 8 cases of survival; 17 cases died, the mortality rate was 68.0%, the time from diagnosis of sepsis to death was (28±14) days. The age of the death group was significantly higher than that of the survival group (years: 41±12 vs. 29±9,t = 2.598,P = 0.016), but there was no significant difference in the gender, total burn area,Ⅲ degree area, and the time of diagnosis of sepsis between the two groups. The platelet count (PLT) at the diagnosis of sepsis in death group was significantly lower than that of the survival group (×109/L: 69±43 vs. 180±108,t = -2.773, P = 0.023), and the PCT at 1-8 days of post-diagnosis in the death group was significantly higher than that of survival group [μg/L: 4.4 (2.2, 9.0) vs. 1.6 (0.7, 2.3),Z = -2.521,P = 0.012], but there was no significant difference in body temperature, heart rate, white blood cell count (WBC), percentage of neutrophils (Neu), Na+, Glu, CRP, PCT, PaCO2 at the time of admission and diagnosis of sepsis and PLT at the time of admission between the two groups. ROC curve analysis showed that the area under ROC curve (AUC) of age, PLT at the time of diagnosis and PCT at 1-8 days of post-diagnosis of sepsis was 0.808, 0.779, 0.825, respectively, for predicting the prognosis of patients with severe burn sepsis (allP < 0.05). At the cut-off age of 32, the sensitivity was 73.3% and the specificity was 75.0%. As the cut-off of PLT was 138×109/L at the time of diagnosis, the sensitivity was 92.3% and the specificity was 75.0%. As the cut-off of PCT was 2.39μg/L at 1-8 days of post-diagnosis of sepsis, the sensitivity was 73.3% and the specificity was 87.5%. Multivariate Cox regression analysis showed that age and PLT at the time of diagnosis were the favorable factors for the survival time of patients with severe burn sepsis (β value were -1.834, -0.029, respectively, bothP < 0.05). Kaplan-Meier survival analysis for patients in the death group showed that the median survival time of patients ≥32 years old was longer than that of patients < 32 years old (days: 32 vs. 9); 18-day cumulative survival rate was significantly higher than that of patients < 32 years old [83.3% (10/12) vs. 25.0% (1/4),χ2 = 9.705,P = 0.003].Conclusion Age, PLT at diagnosis of sepsis and PCT at 1-8 days after diagnosis of sepsis could be used as prognostic indexes for severe burn patients with sepsis.

Objective To evaluate the heterozygous ambiguity resolution primers (HARPs) method in resolving ambiguous genotyping results of human leukocyte antigen (HLA) genes in Chinese Hart population, and choose some appropriate HARPs primers. Methods HLA-A, HLA-B and HLA-DRB1 genes of 416 southern Chinese Han individuals were genotyped by sequence-based-typing(SBT) method and then the ambiguous genotyping samples were sequenced again by HARPs primers provided by American Atria company. Results The percentage of ambiguous genotyping samples resolved by HARPs for HLA-A, HLA-B and HLA-DRBI locus was 86.3% (132/153), 73.9% (130/176) and 38.1% (85/223) respectively. Among them, 48.5% (64/132)HLA-A, 80.0% (104/130)HLA-B and all HLA-DRB1(85/85)samples only need one primer, 47.7 % (63/132)HLA-A and 20.0% (26/130)HLA-B samples need two primers. Three to six different HARPs primers can resolve more than 90% ambiguities. Conclusion HARPs is a convenient method and could be a routine method to resolve ambiguities for HLA-A, HLA-B and HLA-DRB1 genes genotyped by SBT in Chinese Han population.

Objective To study the molecular genetic polymorphism of exons 1,5, 6, 7 of HLA-C gene in Chinese population and evaluate the significance of additional sequencing based typing at exons 1,5, 6, 7 of HLA-Cw gene in clinical HLA matching, Methods A total of 324 individuals were typed at exons 2,3, 4 of HLA-C gene by sequence-based typing. If ambiguities appeared outside of exons 2 -4, we designed a total of 5 in-house sequencing primers and optimized the sequencing reaction, additional sequencing based typing at exons 1,5, 6, 7 was performed to solove the emerging ambiguities. Results In the three hundred and twenty-four samples typed by PCR-SBT at exons 2, 3 and 4 of HLA-Cw gene, 23.8 % (77/324) of the typed samples were assigned the conclusive genotype in four digital level 76. 2% (247/324) of the typed samples were given with the ambiguous allele combination results, in which 73 kinds of ambiguous allele combinations were detected. Increasing the additional sequencing analysis at exons 1, 5, 6, 7 of HIA-C gene, ten frequent ambiguities including Cw* 030201/030202, Cw* 070201/0750, Cw* 040101/0409N/0430, Cw* 0403/0409N/0430, Cw* 080101/0822 could be distinguished. ConclusionsIncreasing the sequencing anlysis at exons 1, 5, 6 and 7 of HLA-Cw gene will help to make clear the ambiguous SBT results and also improve the accuracy of HLA-Cw typing. It shows important significance in clinical histoeompatibility matching.

OBJECTIVETo study the genetic polymorphisms of human leukocyte antigen (HLA)- A, B, C, DRB1, DQA1, DQB1, DPA1and DPB1among ethnic Hans from southern China.

METHODS481 randomly selected individuals were genotyped using a polymerase chain reaction (PCR) sequence-based typing (SBT) method for the above genes. Their allele frequencies were determined by direct counting.

RESULTSIn total, 28 HLA-A, 57 HLA-B, 28 HLA-C, 40 HLA-DRB1, 18 HLA-DQA1, 17 HLA-DQB1, 6 HLA-DPA1and 21 HLA-DPB1alleles were identified. Among these, common alleles (with allelic frequencies > 0.05) included A*1101, A*2402, A*0207, A*3303, A*0201, B*40:01, B*46:01, B*58:01, B*13:01, B*15:02, C*01:02, C*07:02, C*03:04, C*03:02, C*08:01, C*03:03, C*04:01, DRB1*09:01, DRB1*15:01, DRB1*12:02, DRB1*08:03, DRB1*03:01, DRB1*04:05, DRB1*11:01, DQA1*01:02, DQA1*03:02, DQA1*03:03, DQA1*06:01, DQA1*01:03, DQA1*05:05, DQA1*01:04, DQA1*03:01, DQA1*05:01, DQB1*03:01, DQB1*03:03, DQB1*06:01, DQB1*05:02, DQB1*03:02, DQB1*02:01, DQB1*03:02, DQB1*06:02, DPA1*02:02, DPA1*01:03, DPA1*02:01, DPB1*05:01, DPB1*02:01, DPB1*13:01, DPB1*04:01and DPB1*02:02.For each of the locus, the overall frequencies of common alleles were 75.57%, 52.81%, 78.28%, 62.16%, 86.70%, 77.23%, 95.32% and 81.59%, respectively.

CONCLUSIONThe allelic frequencies of the 8 selected HLA loci among ethnic Hans from southern China may served as a reference for anthropology, legal medicine, transplantation and disease association studies.

Alleles ; Asian Continental Ancestry Group ; genetics ; China ; Gene Frequency ; Genotype ; Genotyping Techniques ; methods ; HLA-A Antigens ; genetics ; HLA-B Antigens ; genetics ; HLA-C Antigens ; genetics ; HLA-DP Antigens ; genetics ; HLA-DQ alpha-Chains ; genetics ; HLA-DQ beta-Chains ; genetics ; HLA-DRB1 Chains ; genetics ; Histocompatibility Antigens Class I ; genetics ; Histocompatibility Antigens Class II ; genetics ; Humans ; Linkage Disequilibrium ; Polymerase Chain Reaction ; Polymorphism, Genetic

Objective To present some new concepts in the treatment of fractures and bone defects of long bones with internal fixation.Methods Animal experiments, mechanical tests and clinical analyses were done.Results and Conclusions Reduction of fracture should be perfect, bone defect can be reconstructed by intramedullary and extramedullary bone graft. Relatively rigid fixation at the early stage and elastic fixation at the later stage are beneficial not only for fracture healing, but also for bone remodeling. In order to avoid complications including non-union, immobilization syndrome of the bone and joint, and implant failure, radiographs should be taken periodically; if there is any bone resorption, weight-bearing should be restricted.

Objective:To construct an early prediction model for post cardiopulmonary resuscitation-acute kidney injury (PCPR-AKI) by machine learning and provide a basis for early identification of acute kidney injury (AKI) high-risk patients and accurate treatment.Methods:It was a single-center retrospective study. The clinical data of patients admitted to Tianjin Medical University General Hospital after cardiopulmonary resuscitation following cardiac arrest from January 1, 2016 to October 31, 2023 were collected. The end-point event of the study was defined as AKI occurring within 48 hours after cardiopulmonary resuscitation. The patients were divided into AKI group and non-AKI group according to the AKI diagnostic criteria, and the differences of baseline clinical data between the two groups were compared. The patients who met the inclusion criteria were randomly (using the train_test_split function, set the random seeds to 1, 2, and 3) divided into training and validation sets at a ratio of 7∶3. Random forest (RF), support vector machine, decision tree, extreme gradient boosting and light gradient boosting machine algorithm were used to develop the early prediction model of PCPR-AKI. The receiver-operating characteristic curve and decision curve analysis were used to evaluate the performance and clinical practicality of the predictive models, and the importance of variables in the optimal model was screened and ranked.Results:A total of 547 patients were enrolled, with age of 66 (59, 70) years old and 282 males (51.6%). There were 238 patients (43.5%) having incidence of AKI within 48 hours after cardiopulmonary resuscitation. In the AKI group, 182 patients (76.5%) were in stage 1, 47 patients (19.7%) were in stage 2, and 9 patients (3.8%) were in stage 3. There were statistically significant differences in the age, time to reach resuscitation of spontaneous circulation, time from cardiac arrest to starting cardiopulmonary resuscitation, proportion of initial defibrillation rhythm, proportion of electric defibrillation, proportion of mechanical ventilation, adrenaline dosage, sodium bicarbonate dosage, proportion of coronary heart disease, proportion of hypertension, proportion of diabetes, serum creatinine, blood urea nitrogen, blood lactic acid, blood potassium, brain natriuretic peptide, troponin, D-dimer, neuron specific enolase, and 24 hours urine volume after cardiopulmonary resuscitation between AKI group and non-AKI group (all P<0.05). Among the five machine learning algorithms, RF model achieved the best performance and clinical practicality, with area under the curve of 0.875, sensitivity of 0.863, specificity of 0.956, and accuracy rate of 90.7%. In the variable importance ranking of RF model, the top 10 variables were as follows: time to reach resuscitation of spontaneous circulation, time from cardiac arrest to starting cardiopulmonary resuscitation, initial defibrillable rhythm, serum creatinine, mechanical ventilation, blood lactate acid, adrenaline dosage, brain natriuretic peptide, D-dimer and age. Conclusions:An early predictive model for PCPR-AKI is successfully constructed based on machine learning. RF model has the best predictive performance. According to the importance of the variables, it can provide clinical strategies for early identification and precise intervention for PCPR-AKI.

OBJECTIVETo report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.

METHODSEighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.

RESULTSWith the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.

CONCLUSIONSBrain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.

Adult ; Aged ; Angioplasty, Balloon ; adverse effects ; methods ; Carotid Stenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Intracranial Embolism ; etiology ; prevention & control ; Male ; Middle Aged ; Protective Devices ; Stents ; adverse effects ; Vertebrobasilar Insufficiency ; therapy