Objective To develop a noninvasive diagnostic model comprising of transabdominal ultrasonography and serum markers for assessing esophageal varices in liver cirrhosis.Methods Totally 230 liver cirrhosis patients were randomly allocated to either an estimation group(161 cases)or a validation group(69 cases).Gastroscope was performed and whether esophageal varices existed or not was assessed in every patient.Seventeen common ultrasonographic and serum markers were analyzed initially in the estimation group to derive a predictive model.The model created was then assessed with ROC analysis.It was also applied to the validation group to test its accuracy.Results Among seventeen variables associated with esophageal varices selected by univariate analysis,splenic thickness,diameter of portal vein,prothrombin time were indentified by multivariate Logistic regression analysis as independent risk factors of varices.A varices index constructed from the above three markers was established.In ROC analysis,the AUC was 0.853(0.764,0.942)for predicting existence of varices using the optimal cutoff score 6.3.The diagnostic sensitivity,specificity,positive predictive value,negative predictive value and accuracy were 81.2%,85.7%,92.35%,68.21%,82.77% respectively.For the validation group,the AUC and diagnostic accuracy were 0.889(0.814,0.965)and 82.86% respectively.Conclusion A noninvasive model consisting of splenic thickness,diameter of portal vein and prothrombin time is helpful in predicting existence of esophageal varices in cirrhosis.

Objective To investigate the value of magnetic resonance imaging (MRI)-based intravenous thrombolysis in patients with wake-up ischemic strokes (WUIS).Methods Patients presenting within 12 hours of acute stroke symptom onset and those with WUIS confirmed by CT,excluding intracranial hemorrhage,were encouraged to perform an emergent brain MRI scan to confirm the diagnosis of hyperacute ischemic stroke (hyper-intense in DWI without hyper-intense change in T2WI or fluid attenuated inversion recovery (FLAIR)).These patients then received intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA).All patients were divided into either stroke presenting within 12 hours or WUIS.The clinical outcomes were assessed by the modified Rankin scale (mRS) and the Barthal index (BI) at baseline and at 90 days after the thrombolysis therapy.Results Two hundred and sixty-one patients (261/563,56.4％) had confirmed diagnosis of hyperacute ischemic stroke (WUIS,n =73,73/121 =60.3％ vs within 12 hours,n =188,188/342 =55.0％).Altogether,192 patients (139 in within 12 hours group,and 53 in WUIS group) received intravenous thrombolytic therapy with rt-PA.No significant differences were found between the 2 groups at the baseline characteristics and at 90 days outcomes after the thrombolysis therapy(x2 =1.296 and 1.473,P =0.538 and 0.489,respectively).Also no significant differences were found in the incidence rate of secondary hemorrhage (including both of asymptomatic and symptomatic) and mortality rate between the 2 groups.Conclusion MRI-based intravenous thrombolysis is safe and effective in the treatment of patients with hyperacute WUIS.

Objective To study the preventive effects of Nitroglycerin (NTG) on post-ERCP pancreatitis (PEP) and hyperamylasemia.Methods A total of 150 patients were enrolled and randomly divided into 2 groups to receive buccal NTG 0.5mg (NTG group) or buccal Vitamin C 0.1 g (control group).Incidence of PEP and hyperamylasemia and adverse reactions were observed.Results Three patients were excluded according to the exclusion criteria. The overall incidcnces of PEP and hyperamylascmia were 16.3％ (24/147) and 28.6％ (42/147),respectively.The incidence of hyperamylasemia in NTG group (15/74,20.3％) was significantly lower than that of control group (27/73,37.0％) (x2=5.032,P=0.025).Incidence of PEP in NTG group (12.2％) was lower than that of control group (20.5％) without significance (x2=1.892,P=0.169).No severe adverse effects was observed.Conclusion NTG can effectively prevent post-ERCP hyperamylaemia,but its effect on PEP is limited.

Objective:To study the effects of combination of rhubarb and early enteral nutrition on severe acute pancreatitis(SAP).Methods:A total of 73 patients with SAP were randomly divided into one of the three groups: 21 patients treated with total parenteral nutrition(TPN),27 patients treated with early enteral nutrition(EEN),and 25 patients treated with combination of rhubarb and early enteral nutrition(REN).The hospitalization cost,length of stay,mortality,recovery time of intestinal function and score of APACHE Ⅱ were observed.The plasma procalcitonin(PCT),the levels of C-reactive protein(CRP)and prealbumin were detected.Results: In REN group,there was no death.There was 1 patient died in EEN group and 2 patients in TPN group.The recovery time of intestinal function in REN group was(2.49?0.59) days,the length of stay was(25.13?4.35) days,and the hospitalization cost was(56.9?7.2) thousand yuan.They were obviously shorter than those in the other groups(TPN group,P

Objective To summarize the safety and efficacy of Sunitinib in the treatment of metastatic renal clear cell carcinoma. Methods Fifteen patients with clear cell metastatic RCC were treated with Sunitinib,with 11 males and 4 females,aged from 26 to 74 years with median age of 55 years.Thirteen cases of 15 were T3 to T4 stage,and 8 cases underwent radical nephrectomy,while 5 other cases underwent renal biopsy with the pathological diagnosis of renal cancer.The other two cases (one man and one woman)with the solitary kidney renal cell carcinoma ( stage T1a) and renal insufficiency,were diagnosed as metastatic renal cell carcinoma by biopsy.Sunitinib monotherapy was administered by the regimen of 6 weeks per cycle with daily oral Sunitinib 4 weeks,followed by 2 weeks off ( from 1 - 10 cycles).Response was evaluated by RECIST.Renal tumor was 9.52 ± 3.3 cm in diameter at baseline,and the assessment of metastases included retroperitoneal lymph nodes (6 cases),mediastinal lymph nodes (3 cases),brain (2 cases),lung (6 cases),bone (2 cases) and liver (2 cases).Karnofsky score,tumor changes,adverse events and the survival of each patient was assessed and recorded. Results The follow-up duration was from 1.5 - 15months,with median follow-up of 6 months,and tumor response was evaluated by RECIST.Seven of 15 patients (46.7％) treated with Sunitinib achieved partial responses (PR),7 patients (46.7％) demonstrated stable disease (SD),and 1 patient (6.7％) developed progressive disease (PD) during the follow-up.Objective Response Rate (ORR) was 46.7％,PR + SD was 93.3％,6 months PFS was 93.3％,and median PFS was 12 months,respectively.Renal tumor was 8.7 ± 4.0 cm in diameter after therapy.Two PR patients with the obvious effectiveness had experienced progressed hypertension,and one cases with hypertension that could be controlled below 140/90 mm Hg ( 1 mm Hg =0.133 kPa) by a single drug before treatment,showed increased blood pressure ( ＞ 160/105 mm Hg) following the second cycles treatment,who were administered increased dosage and combination therapy.The other case without history of hypertension,showed high blood pressure ( ＞ 150/100 mm Hg) in the third cycle,and could be controlled well by antihypertensive drugs.Fortunately,the tumor of these two cases reduced obviously by more than 50％. 1/2 adverse reactions of 12 cases:yellowing of the skin and yellow sweat ( 12 cases,80％ ),fatigue ( 12 cases,80％ ),4 cases of hypothyroidism (26.7％),bilirubin and triglyceride levels elevated in 7case (46.7％); Four cases showed 3/4 degree adverse events with the emergence of gastrointestinal bleeding in one case secondary to platelets reduction (6.7％).Three cases (20％) showed serious fatigue,nausea,vomiting and severe hand-foot skin reaction. Conclusions Sunitinib is recommended for the treatment of metastatic renal clear cell carcinoma with good efficacy and safety.

OBJECTIVETo evaluate the role of nuclear factor-kappa B (NF-kappaB) and inhibitory kappaB alpha (IkappaBalpha) in hepatocellular cacinoma (HCC) SMMC7721 cells, the consequence of NF-kappaB inhibition in SMMC7721 cells transfected with mutated IkappaBalpha (mIkappaBalpha) plasmid and the effect of stable inhibition of NF-kappaB activity in combination with Doxorubicin.

METHODSWestern blot was used to determine the expression of NF-kappaB and IkappaBalpha in SMMC7721 cells and normal liver cells. Nuclear protein was used to evaluate the binding of the (32)P-labeled tandem kappaB sequence using electrophoretic mobility shift assay and the expression of NF-kappaB using Western blot between SMMC7721 cells transfected with mIkappaBalpha plasmid (SMMC7721-MT) and control cells. Furthermore, cell viability was plotted between SMMC7721-MT and control cells. The binding of kappaB sequence and cell viability between SMMC7721-MT and control cells at different concentrations of Doxorubicin were also investigated.

RESULTSWestern blot analysis for nuclear extract showed more P50 (NF-kappaB1) and P65 (RelA) expression in SMMC7721 cells compared with normal liver cells. The expression of cytosolic IkappaBalpha protein in SMMC7721 cells was less than that in normal cells. SMMC7721-MT cells inhibited NF-kappaB nuclear translocation at 0, 24, 48 and 96 hours. Furthermore, NF-kappaB cannot be detected in the nuclear protein of SMMC7721-MT cells by Western blot. By calculating cell viability, the proliferation of SMMC7721-MT cells was shown to be suppressed more significantly than that of control cells. NF-kappaB in untransfected cells was activated by Doxorubicin in a dose-dependent manner, but that in SMMC7721-MT cells was not induced at low concentrations of Doxorubicin. Compared with untransfected cells, the viability of SMMC7721-MT cells was significantly suppressed at the same concentration of Doxorubicin (P < 0.01).

CONCLUSIONSThe present study demonstrates that upregulation of NF-kappaB and downregulation of inhibitory kappa B (IkappaBalpha) in SMMC7721 cells are related with the growth of hepatocellular cacinoma cells. Stable expression of mIkappaBalpha in SMMC7721-MT cells can inhibit NF-kappaB nuclear translocation and suppress cell growth. Furthermore, stable inhibition of NF-kappaB activity in combination with Doxorubicin can significantly inhibit cell proliferation in SMMC7721-MT cells. Thus, modulation of NF-kappaB may represent an improvement in the efficacy of HCC therapies and be worthy of further research and investigation.

Antineoplastic Agents ; pharmacology ; Blotting, Western ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Cell Division ; Doxorubicin ; pharmacology ; Electrophoretic Mobility Shift Assay ; Humans ; I-kappa B Proteins ; biosynthesis ; Liver Neoplasms ; metabolism ; pathology ; NF-kappa B ; biosynthesis ; physiology ; Tumor Cells, Cultured

Objective To investigate the value of MRI in thmmbolytic thempy of hyperacute cerebral arterial thrombosis.Methods One hundred and sixteen patients with acute cerebral arterial thrombosis were recruited.plain CT and multi.modal MRI were performed in all patients.Thirty-three patients with hyperacute cerebral infarction were treated bv recombinant tissue plasminogen activator(rt-PA) and followed-up periodically using MRI.Results The 33 patients with thrombolysis selected by MRI demonstrated clinical improvement.90 d moclified Rankin scale scores(mRs)were less than 2 and life quality Barthal indexes(BI)were from 80 to 100.The complication included one asymptomatic parenchymal hematoma(PH1)one weeks after thrombolytic therapy and 4(12.2%)hemorrhagic infarction(HI)6 to 24 hours after thrombolytic therapy.Condusions MRI has significant clinical value for the screening and follow-up of intravenous thrombolytic therapy of hyperacute ischemic stroke.MRI-based thrombolysis is a safe and effective method for hyperacute ischemic stroke.

Objective To systematically evaluate the efficacy and safety of magnesium isoglycyrrhizinate (MgIG) in the treatment of viral hepatitis based on clinical studies. Methods Searches were conducted in the databases of Cochrane, PubMed,Science Direct,CNKI,CMCI and Wanfang (until Dec.2016 since database setup) to identify randomized controlled tri-als (RCTs) evaluating clinical effects of MgIG vs Compound Glycyrrhizin(CG).Literatures according to inclusion and exclusion criteria were screened.All meta-analysises were conducted with RevMan version 5.3. Results A total of 3 790 patients enrolled in 32 studies were included in the meta-analysis.Firstly,the comparison of curative effect in two groups favors MgIG for the treat-ment of viral hepatitis[OR=2.87,95% CI=(2.29,3.61),P<0.000 01].Secondly,MgIG showed statistically significant benefit in reducing ALT [MD=-17.27,95%CI=(-28.87,-5.66),P=0.004],AST [MD=-14.18,95%CI=(-18.29,-10.08),P<0.000 01] and T-BiL[MD=-4.53,95%CI=(-6.38,-2.68),P<0.000 01].Lastly,comparative trials demonstrated a significant safety advantage of MgIG over CG [OR= 0.29,95%CI=(0.19,0.44),P<0.000 01]. Conclusion MgIG has a significant beneficial effect for the treatment of viral hepatitis by means of both decreasing transaminase and normalizing liver function.Fur-thermore,it is worth for the application in clinical use with less adverse drug reactions.

OBJECTIVETo compare the surgical effect of three-dimensional (3D) versus 2D laparoscopic surgery in ureter lithotomy.

METHODSFrom January 2014 to 2015 May, 45 patients with ureteral calculi were randomly allocated into 2 groups to undergo ureter lithotomy under 3D laparoscopy (25 cases) and 2D laparoscopy (20 cases). The time used for each surgical process (including the exposure, D-J tube discharge, suture and other surgical procedures) was recorded and compared between the two groups.

RESULTSThe operation was completed smoothly in all the 45 patients. In this cohort, the wound drainage tube was removed in a mean of 3.0mnplus;0.8 days after the operation, the catheter was removed after a week, and the double J tube was removed at 1 month. Follow-up intravenous pyelography at 3 months after the operation reveal ureteral stricture in none of the cases. Comparison of the surgical data showed that the time used in each surgical process was significantly shorter in the 3D group than in the 2D group (P<0.05). 3D laparoscopic surgery allowed more precise operation by providing a good sense of depth as in an open surgery to reduce the operation time.

CONCLUSIONSAs a minimally invasive surgical technique, 3D laparoscopic surgery facilitates more precise and easier operation compared with 2D laparoscopy in ureter lithotomy.

Humans ; Imaging, Three-Dimensional ; Kidney Pelvis ; Laparoscopy ; methods ; Operative Time ; Retroperitoneal Space ; Ureter ; Ureteral Calculi ; surgery