Adult ; Female ; Femoral Fractures ; diagnostic imaging ; physiopathology ; surgery ; Fibula ; transplantation ; Humans ; Male ; Middle Aged ; Time Factors ; Tomography, X-Ray Computed ; Transplantation, Autologous

To investigate the effect of GST-KGDX (glutathione S-transferase-Lys-Gly-Asp-X) fusion protein, GP IIb/IIIa receptor antagonist, on platelet function in vitro. The KGDX (Lys-Gly-Asp-X) gene was assembled from 2 synthetic oligonucleotides, 36 bp in length, using BamH I and Xho I restriction enzyme sites at the end of the gene for cloning into the expression vector pGEX4T-1. Expression of fusion protein was directed by the tac promoter. The Escherichia coli DH5a contained the plasmid pGEX-4T-1-KGDX was expressed by 37 degrees C heat induction. The fusion protein of KGDX with glutathione S-transferase (GST-KGDX) was purified in one step from the bacterial lysate by glutathione-agarose beads for affinity chromatography. GST-KGDX was found to be soluble and abundant, the yield of 35 mg/L of cultures was obtained. The GST-KGDX was expressed in E. coli to a level of 48.02% of total cellular protein. GST-KGDX inhibited ADP-induced human platelet aggregation stronger than GST (P < 0.05 or < 0.01). In flow cytometry assay for fibrinogen binding, both GST and GST-KGDX inhibited platelet aggregation by binding with high affinity to GPIIb/IIIa. Mean fluorescence intensity of GST-KGDX fusion protein was significantly higher than that of GST. It is concluded that the GST-KGDX fusion protein can be produced by E. coli and used as an antiplatelet agent.
Adult ; Escherichia coli ; genetics ; Female ; Fibrinogen ; metabolism ; Flow Cytometry ; Glutathione Transferase ; pharmacology ; Humans ; Male ; Oligopeptides ; pharmacology ; Platelet Aggregation ; drug effects ; Platelet Aggregation Inhibitors ; isolation & purification ; pharmacology ; Platelet Glycoprotein GPIIb-IIIa Complex ; antagonists & inhibitors ; metabolism ; Recombinant Fusion Proteins ; biosynthesis ; isolation & purification ; pharmacology

OBJECTIVETo evaluate the correlation between standardized uptake valus (SUV) of 18F-fluorodeoxyglucose (18 F-FDG) of tumor at PET/CT examination and the expression of glucose transporter-1 (Glutl) and Ki-67 in esophageal cancer.

METHODS56 patients with esophageal cancer were evaluated with 18 F-FDG PET/CT examination before operation. The expression of Glut1 and Ki-67 antigen in the tumor tissues was detected by immunohistochemistry after operation.

RESULTS(1) Positive rate of Glutl and Ki-67 expression in esophageal cancer tissues was 100% , respectively. There was a positive correlation between the expression of Glutl and Ki-67 and the clinical stages and differentiation of the tumor. The more the tumor and the clinical stages were advanced and the lower was the tumor differentiation, the more Glutl and Ki-67 were expressed. (2) There were abnormal radioactive high uptake regions on PET/CT imaging of esophagus in the 56 patients, which were confirmed by pathology as the primary carcinoma. The SUV was higher than 2. 5. There was a gradually increasing tendency in SUV along with the lowering of the tumor differentiation and the advance of clinical stages. (3)There was a correlation between the expression of Glutl, Ki-67 and the SUV, the more Glutl and Ki-67 were expressed, the higher the SUV of tumor 18F-FDG at PET/CT examination was in esophageal tumor tissues.

CONCLUSIONThere is a widespread expression of Glutl in esophageal cancer tissues, and the SUV may be used to indirectly evaluate the proliferative capacity of esophageal cancer.

Adenocarcinoma ; metabolism ; pathology ; Adult ; Aged ; Carcinoma, Squamous Cell ; metabolism ; pathology ; Cell Differentiation ; Esophageal Neoplasms ; metabolism ; pathology ; Female ; Fluorodeoxyglucose F18 ; pharmacokinetics ; Glucose Transporter Type 1 ; metabolism ; Humans ; Immunohistochemistry ; Ki-67 Antigen ; metabolism ; Male ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; methods ; Tissue Distribution ; Tomography, X-Ray Computed ; methods

OBJECTIVETo compare the feasibility of bone and calcified plaque subtracted dual-energy CT angiography (CTA) with time of flight magnetic resonance angiography (TOF MRA) in evaluation of internal carotid artery atherosclerosis.

METHODSTotally 32 patients received a dual-energy CTA scan, along with a cerebral TOF MRA scan before or after CTA examination from one day to one month. Dual-energy software was used for bone and calcified plaque subtraction. Five anatomical segments were described for each internal carotid artery according to Fischer (1938). Ratings were based on a 1-4 scale for the dual-energy CTA maximum intensity projection (MIP) image: 1 not diagnostic, 2 partially diagnostic, 3 diagnostic, and 4 excellent. Lesions were categorized as mild (0-29%), moderate (30%-69%), severe (70%-99%), or occluded (no flow detected). Stenosis of internal carotid artery was evaluated based on post-subtracted CTA images and TOF MRA images.

RESULTSIn 320 arterial segments, 99% of arterial segments were > or = 3 score. Grading of stenosis on dual-energy CTA agreed with grading of stenoses on MRA images in 98% of arteries. In the mild and occlusion group, the agreement was 100% respectively. In the moderate and severe group, dual-energy CTA showed more severe stenosis than MRA in 7 vessels and there was significant difference between the results from the two different modalities (Z = -3.071, P = 0.002).

CONCLUSIONDual-energy CTA can be used to assess the stenosis of internal arteries around skull base, but may exaggerate the severe stenosis of cerebral arteries compared with TOF MRA.

Aged ; Angiography, Digital Subtraction ; methods ; Carotid Artery, Internal ; pathology ; Carotid Stenosis ; diagnosis ; Cerebral Angiography ; methods ; Cerebral Arteries ; diagnostic imaging ; pathology ; Female ; Humans ; Intracranial Arteriosclerosis ; diagnosis ; Magnetic Resonance Angiography ; Male ; Middle Aged ; Radiographic Image Enhancement ; methods ; Tomography, X-Ray Computed ; methods

OBJECTIVETo study the prevention and treatment of postoperative diabetes insipidus after removal of pituitary tumor through transsphenoidal operation, to decrease the incidence of postoperative complications and improve the treatment of pituitary tumor.

METHODSThe clinical data of 86 cases of transsphenoidal resection of pituitary tumor in recent 8 years were retrospectively reviewed, including 35 endoscopic operation and 51 microscopic operation. The incidence, prevention and treatment of diabetes insipidus were statistically analysed.

RESULTSThere were 18 cases of postoperative diabetes insipidus in total of 86 operations, including 15 acute cases, 3 delayed cases. Twelve were temporary , which recovered within 1 week. After prompt treatment, 14 recovered within 1 week, 4 recovered within 2 weeks. No persistent diabetes insipidus was found.

CONCLUSIONSThe key points to prevent postoperative diabetes insipidus lay in the improvement of operative skills, careful protection during operation and avoidance of unnecessary injury. In case of diabetes insipidus occurred, rational use of antidiuretics and correction of electrolyte balance were effective in the treatment of postoperative diabetes insipidus.

Adult ; Diabetes Insipidus ; etiology ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Pituitary Neoplasms ; surgery ; Postoperative Complications ; etiology ; Retrospective Studies ; Sphenoid Sinus ; surgery

Objective To evaluate the image quality of coronary CT angiography (CTA) and the diagnostic accuracy for the assessment of coronary artery stenosis with a 64-slice CT scanner.Methods 120 patients with suspected coronary artery disease were studied by ECG-gated 64-slice spiral CT (120 kV, 850 mAs,0.33 s-rotation time,0.6 mm collimation);60 of them also underwent conventional coronary angiography(CCA).Patients with heart rates above 70 bpm received oral?-blockade before the scan. Enhanced scan was performed with an intravenous injection of 60-70 ml contrast agent (370 mg l/ml) and 50 ml saline chaser bolus at 4 ml/s.Images were retrospectively reconstructed under different reformations multiplanar reconstruse-tion(MPR),maximum intensity projection(MIP)and volume rendering technology (VRT)and reviewed by two observers.Image quality was assessed using a 3-point grading scale(excellent, sufficient and non-diagnostic)and the visibility of coronary branches was evaluated.The left main,left anterior descending,left circumflex and right coronary arteries were screened for the presence of over 50% stenosis.Results Sixty-nine percent of the included patients received?-bloekade.The average heart rate was 61?8 bpm and the scan time was 11.9?1.3 s.In the evaluation of image quality with VRT images, 77% patients′images were excellent,18% sufficient,and 5% non-diagnostic.All of the first,most of the second and third,and parts of the fourth subsegment branches could be shown with MPR,MIP and VRT reconstruction images.MPR and MIP displayed better visualization than VRT in showing small branches. Compared with CCA,the sensitivity,specificity,positive and negative predictive value of CTA to identify over 50% stenosis were 93%,98%,87% and 99%,respectively.Conclusion 64-slice spiral CT coronary angiography is a noninvasive and fast method that allows reliable diagnosis of coronary artery stenosis with high image quality.

BACKGROUNDSentinel lymph node (SLN) biopsy has become a common procedure for early breast cancer patients. The GeneSearch(TM) Breast Lymph Node (BLN) Assay is a real-time RT-PCR assay for the detecting nodal metastases larger than 0.2 mm. China Breast Cancer Clinical Study Group (CBCSG)-001a is a prospective multi-center clinical trial that was conducted to validate the GeneSearch(TM) BLN Assay in China.

METHODSThe SLNs from 90 consecutive patients were identified and dissected, and then sectioned along the short axis into multiple blocks. Intra-operatively, the odd blocks were tested by BLN assay and the even ones were used for frozen section, while all the blocks were evaluated by touch imprint cytology. Post-operatively, the remaining tissues were assessed by histological evaluation.

RESULTSA total of 189 SLNs was tested by BLN assay. The sensitivity, specificity, positive predictive value, and negative predictive value were 88.9%, 97.4%, 88.9% and 97.4%, respectively, for BLN assay, 75.0%, 100%, 100% and 94.4%, respectively, for frozen section, and 63.9%, 100%, 100% and 92.2%, respectively, for touch imprint cytology. The sensitivity of BLN assay was higher than that of touch imprint cytology (P = 0.01) and frozen section (P = 0.13). When assessing the nodes with micro-metastases, BLN assay had a significant higher sensitivity than frozen section (P = 0.023) and touch imprint cytology (P = 0.005).

CONCLUSIONThe GeneSearch(TM) BLN Assay is an accurate and rapid intra-operative assay for breast SLNs and it is suitable for application in general medical practice.

Adult ; Aged ; Breast Neoplasms ; complications ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; diagnosis ; Middle Aged ; Sentinel Lymph Node Biopsy ; methods

OBJECTIVETo investigate the effect of temperature on hospital admission among patients with chronic systolic heart failure (CSHF).

METHODSData regarding in-hospital patients with CSHF were gathered from 12 hospitals in Hubei province, between 2000 and 2010. Patients with a history of congenital heart disease and the history of cancer from this series, were excluded. Chi-square (χ(2)) tests and t tests were used for descriptive analysis. Univariate and multivariate logistic regression methods were performed to determinate the risk of hospital admission of every month to compare with the previous one. We used 2-tailed 95% confidence interval (CI), and tests with P < 0.01 to consider the significant levels, statistically. We also used the SPSS 13.0 for Windows, release 15, 2006 (SPSS Inc, Chicago, Ill) for data analyses.

RESULTS(1) 48 964 patients were enrolled in the present study. The numbers of admission increased 18.71%, 13.84%, -21.90%, -34.62%, -21.97%, -3.81%, -2.04%, 10.13%, -17.13%, -0.85%, 21.54% and 42.70% from January to December when compared to the average number of admission. (2) The odds ratios (ORs) (95% CI, P values) of hospital admission in January, February and December were 1.09 (0.96 - 1.23, 0.54), 0.98 (0.84 - 1.10, 0.46) and 0.96 (0.84 - 1.08, 0.59), respectively in females which did not show any significant differences when compared to the number in August. However the ratios were 0.61 (0.54 - 0.69, < 0.01), 0.80 (0.68 - 0.92, < 0.01) and 0.73 (0.64 - 0.83, < 0.01), respectively, in males that showed significant differences when, compared to the figures in August. (3) The OR of admission increased more when temperature got lower for patients with coronary artery disease, hypertension heart disease or rheumatic heart disease, but not with dilated cardiomyopathy. (4) The OR of admission showed a different impact on patients with different occupation, along with the change of temperature. Low or high temperature did not seem to have different effects on the OR of admission in patients who were free-lanced or unemployed.

CONCLUSIONTemperature seemed to have significant effects on the risk of admission, which related to gender, etiology or occupation.

Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Climate ; Female ; Heart Failure ; Humans ; Inpatients ; statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Temperature

OBJECTIVETo evaluate the clinic information of coronary artery bypass grafting (CABG) combined with concomitant valve operation.

METHODSRetrospectively analyze the information of morbidity and mortality of 126 cases patients who underwent combined valve and bypass procedures between December 2000 and January 2005. These patients had been divided into 2 groups according to sex.

RESULTSThere were significant differences in the clinic characteristic such as weight and diabetes mellitus and mitral valve stenosis and three disease vessels of coronary artery between 2 groups (P < 0.05). The rate of the number of bypass grafts and morbidity and mortality of complication were significant differences (P < 0.05). The number of mitral valve replacement of female was more than that of male (P < 0.05). Five males died after operation, 1 case of heart failure, 1 case of high blood sugar, 2 cases of arrhythmia, 2 cases of organs failure; Seven females died after operation, one case of heart failure, one case of alimentary tract haemorrhage, three cases of arrhythmia, two cases of organs failure.

CONCLUSIONSCoronary artery bypass grafting (CABG) combined with concomitant valve operation is safe and effective. The rate of morbidity and mortality of complication of female is more than that of male. The study demonstrates that female gender is an independent risk factor for combined morbidity and mortality during and after combined valve and coronary bypass surgery. That is related to low weight and mitral valve stenosis of female.

Adult ; Aged ; Body Weight ; Coronary Artery Bypass ; Extracorporeal Circulation ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Myocardial Revascularization ; Retrospective Studies ; Risk Factors ; Sex Factors

Objective To evaluate the usefulness of narrow-band imaging with magnification in differentiating colorectal lesions, and assess for a learning curve, to gave help for the clinician, who want to carry out the technique. Method We retrospectively analyzed the clinical data of 289 patients who underwent NBI combined with magnification by four endoscopic physician, from June, 2015 to June, 2016, all the lesions were biopsied, endoscopic treatment or postoperative pathology and pathological examination, and the Sano classification control. All lesions were divided into three groups according to the NBI combined with magnifying endoscopy, these three sets included both lesions requiring endoscopic treatment (e.g. target lesions) and lesions that were not, or could not be, treated by endoscopy (e.g. nontarget lesions). Each physician examined the target or non-target lesion reached 15 cases as a group. By assessing the diagnostic accuracy of the four physicians for each group of lesions, an associated learning curve of NBI combined with magnifying endoscopy was developed. Result In 289 patients, 372 lesions were found by colonoscopy. NBI combined with magnifying endoscopy was 95.1%, 98.0% and 92.0%, respectively, in the identification of tumor and non-neoplastic lesions. The accuracy of the diagnosis of target and non-target lesions was significantly higher in group 2 than in group 1 [81.7% vs 95.1% (P = 0.010) and 71.7% vs 93.4% (P = 0.000)]. There was no significant difference in the diagnostic accuracy between group 2 and group 3 (P = 0.984 and P = 0.117). Conclusion It is very useful to use narrow-band imaging and Sano CP analysis in the differential diagnosis of colorectal lesions. The endoscopists who had never used NBI or no knowledge of NBI can have effective and stable diagnostic accuracy after using NBI with magnification to diagnose 15 target and non-target lesions respectively.