Objective To compare the efficacy and safety between Bivalirudin and Heparin during emergency percutaneous coronary intervention(PCI)in elderly patients with acute ST segment elevation myocardial infarction(STEMI).Methods Retrospective analysis of 80 patients diagnosed with ST-segment elevation myocardial infarction in elderly patients was conducted.The treatment group(n=40) received a bolus intravenous injection of Bivalirudin 0.75 mg/kg before emergency percutaneous coronary intervention,then 1.75 mg · kg 1 · h-1 continuous intravenous drip till the end of the operation from March 2011 to March 2015.Activated clotting time (ACT)was detected at 10 minutes after drug application.If ACT＜225 s,0.3 mg/kg were append.The control group received a bolus intravenous injection of Heparin 100 U/kg during emergency PCI,and after 10 minutes ACT was detected.If ACT＜ 225 s,300 U was appended.When operation extended,1 000 U was appended every 1 hour.Immediate postoperative blood flow,early stent thrombosis,target vessel reconstruction at 30 days after operation,recurrent myocardial infarction,non-fatal cerebrovascular accident,all causes mortality and bleeding conditions at 7 days after operation were compared between two groups.Results The immediate postoperative thrombolysis in myocardial infarction (TIMI)blood flow was significantly improved(P＜0.05) in the treatment group as compared with control group.There was no significant difference in target vessel reconstruction at 30 days after operation,recurrent myocardial infarction,non-fatal cerebrovascular accident,and all-cause mortality between two groups (all P＞ 0.05).The bleeding conditions at 7 days after operation were significant lower in the treatment group [2.5％(1 case)]than in the control group[22.5％ (9 cases)] (x2 =7.31,P＜0.01).Conclusions Bivalirudin treatment does not reduce the major cardiovascular events,but improves the TIMI blood flow after surgery and the incidence of bleeding as compared with control group,which suggests that Bivalirudin is safer in emergency PCI therapy in elderly patients with acute ST-segment elevation myocardial infarction

OBJECTIVE: To study the prevalence of BRAF(V600E) mutations in small (≤ 2 cm) papillary thyroid carcinoma (PTC), explore the correlation with occult central nodal metastasis (CNM) of clinically-nodal negative (cN0) neck for small (≤ 2 cm) papillary thyroid carcinoma (PTC). METHOD: Primary tumor tissue (paraffin-embedded) from 72 patients with small (≤ 2 cm) cN0 PTC who underwent prophylactic central neck dissection (pCND) was tested for BRAF mutation. by nested PCR, the factors of lymph node metastasis such as clinicopathologic including tumor size, multifocality, extrathyroidal invasion, and BRAF mutations were analyzed. Prediction scores were generated using logistic regression models and BRAF was evaluated to see if it was a risk factor for CNM. RESULT: The prevalence of BRAF was 47.22% (34/72) while the rate of CNM was 36.11% (26/72). Univariate analysis showed that the risk factors of lymph node metastasis for cN0 PTC were significantly correlated with tumor size (P = 0.016), bilateral tumor (P = 0.010), multifocality (P = 0.026), extrathyroidal invasion (P = 0.024), and BRAF mutations (P = 0.041). Univariate analysis showed that tumor size (OR = 2.674, 95% CI = 1.702-3.997), multifocality (OR = 1.371, 95% CI = 1.065-2.087), extrathyroidal invasion (OR = 0.540, 95% CI = 0.396-0.794) and BRAF (OR = 1.647, 95% CI = 1.101-2.463) were risk predictors of CNM. CONCLUSION The incidence of central neck micrometastatic disease is 36.11% in patients with PTC deemed N0 preoperatively by clinical examination and ultrasound of the neck lymph nodes and intraoperatively by inspection of the central compartment. The factors of high risk of CNM included tumor size, multifocality, extrathyroidal invasion, BRAF mutations. When a patient has the risk factors of lymph node metastasis should be electived prophylactic CCND.
Axilla ; Carcinoma ; genetics ; Carcinoma, Papillary ; Humans ; Logistic Models ; Lymph Nodes ; Lymphatic Metastasis ; genetics ; Mutation ; Neck ; Neoplasm Micrometastasis ; diagnosis ; Neoplasm Staging ; Polymerase Chain Reaction ; Proto-Oncogene Proteins B-raf ; genetics ; Risk Factors ; Thyroid Cancer, Papillary ; Thyroid Neoplasms ; genetics

PURPOSE: To assess the safety and efficacy of an ultramini nephrostomy tract, which we were using for the first time, combined with flexible ureterorenoscopy (URS) in the treatment of pediatric patients with multiple renal calculi. MATERIALS AND METHODS: Twenty pediatric patients (age, < or =6 years) underwent ultramini percutaneous nephrolithotomy (PCNL) combined with flexible URS. The group had multiple renal calculi, which were bilateral in 3 cases and were located in a total of 23 sites. The calculi were located in 2 calyces in 10 cases, scattered in more than 2 calyces in 7 cases, and limited to 1 calyx in 3 cases. The average patient age was 37.35 months (range, 14-68 months). The average stone diameter was 2.0 cm (range, 1-3.0 cm). In all patients, an ultramini nephrostomy tract was established under ultrasound guidance (dilated to F10) with simultaneous sheath placement. The flexible URS was placed into the collecting system during holmium laser lithotripsy. RESULTS: When ultramini PCNL was combined with flexible ureterorenoscopic holmium laser lithotripsy, the complete stone-free rate was 87% (20/23). The average level of hemoglobin decreased to 1.0 g/dL after the operation. No blood transfusions were needed. Levels of blood urea nitrogen, creatinine, and C-reactive protein were not significantly different before and after the operation. The average duration of hospitalization was approximately 4.85 days, and all cases were followed up for 6 to 12 months. No complications were found. CONCLUSIONS: Ultramini PCNL combined with flexible ureterorenoscopic holmium laser lithotripsy is a safe and effective treatment for children with multiple renal calculi.
Adolescent ; Adult ; Aged ; Female ; Humans ; Kidney Calculi/pathology/*surgery/ultrastructure ; Length of Stay/statistics & numerical data ; Lithotripsy, Laser/methods ; Male ; Middle Aged ; Nephrostomy, Percutaneous/*methods ; Retrospective Studies ; Treatment Outcome ; Ultrasonography, Interventional/methods ; Ureteroscopy/*methods ; Young Adult

Objective:To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage (PTBD) in patients with pancreatic cancer and obstructive jaundice.Methods:A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital. The possibly correlated 9 factors were analyzed, including gender, age, hemoglobin level, total bilirubin level, degree of pancreatic duct dilatation, degree of pancreatic atrophy, degree of biliary stenosis, the pancreatic duct visualization, and drainage mode.Results:Univariate analysis suggested that pancreatic duct dilatation, pancreatic atrophy, visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD ( P<0.05). Logistic regression analysis showed that visualization of pancreatic duct ( OR=6.33) was a risk factor for pancreatitis, while pancreatic duct dilatation ( OR=0.14), pancreatic atrophy ( OR=0.12) and external drainage ( OR=0.11) were protective factors for pancreatitis. Conclusion:In pateints with pancreatic cancer and obstructive jaundice, pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.

In recent years，with the change in lifestyle and social environment and the increase in pressure in both life and work，male fertility has decreased significantly in China，and the incidence of male infertility has increased year by year，which has brought great challenges to andrologists. Traditional Chinese medicine （TCM） has a definite curative effect in the treatment of male infertility and is widely applied in clinical practice. In order to clarify the role of TCM in different types and each stage of male infertility，the China Association of Chinese Medicine （CACM） invited outstanding young andrologists in the clinic of TCM and western medicine to discuss topics such as idiopathic oligospermia and teratospermia，abnormal semen liquefaction，varicocele，immune infertility，improving success ratio of assisted reproductive technology，and ameliorating depression or anxiety. They conducted in-depth discussions on the advantages，characteristics，disadvantages，diseases responding specifically，and advantageous aspects of TCM treatment. The causes of male infertility and related links of treatment were summarized. Due to the unclear etiology and complex pathogenesis of male infertility，western medicine cannot achieve a good curative effect，while TCM，taking the holistic view as the core，specializes in improving functional diseases and can correspond to multiple targets and factors，with comprehensive treatments such as internal treatment and external treatment. This study summarized the advantageous diseases and advantageous stages of TCM treatment alone and integrated TCM and western medicine treatment and put forward suggestions for the treatment of the diseases by TCM and western medicine in order to promote the therapeutic effects and advantages of TCM among andrologists，increase mutual learning and communication between TCM and western physicians，provide patients with excellent and personalized treatment plans in clinical practice，and improve the curative effect of male infertility and fertility of males in China.