Objective To investigate the effect of cetuximab combined with FOLFOX4 chemotherapy on expressions of cancer suppressor gene PTEN and P13K in colon cancer tissue of elderly patients.Methods 62 cases of elderly patients with colon cancer from October 2013 to July 2015 in our hospital were selected and divided into two groups according to the different therapy.The control group (n=27) received pure FOLFOX4 chemotherapy and treatment group(n=35)received cetuximab on the basis of FOLFOX4 chemotherapy, with a consecutive treatment of 4 courses.The clinical curative effect and expressions of PTEN and P13K in colon cancer tissue were compared between two groups.Results There were no significant difference in effective rate and disease control rate between treatment group and control group (51.4% vs.44.4%,χ2 =0.298,P=0.585;80.0%vs.62.9%,χ2 =2.223, P=0.136 ).After treatment, the cells positive rate of PTEN in treatment group was higher than that in control group post-treatment (82.86%vs.59.26%, P<0.05), and the cells positive rate of P13K in treatment group was lower than that in control group (37.14%vs.62.96%, P<0.05). Conclusion Cetuximab combined FOLFOX4 chemotherapy regimen could increase expression of PTEN and reduce P13K expression, which effect is remarkable in the treatment of elderly colon cancer.

Objective To construct the mice pneumonia model with imipenem-resistant Acinetobacter baumannii and provide experimental model in anti-pan-resistant Acinetobacter baumannii therapy study. Methods A total number of 120 4-week-old BALB/C male mice were randomly selected and divided into three groups including micro-intratracheal injection, ultrasonic atomizing and nasal dripping. The mice were treated with methotrexate to induce hypo-immunity in every group. These BALB/C mice of normal immunity and hypo-immunity were infected through Imipenem-resistant Acinetobacter baumannii by microintratracheal injection, ultrasonic atomizing and nasal dripping, respectively. The morbidity, mortality,bacterial clearance rate and histopathology in lung were determined. Results The morbidities of BALB/C mice with hypo-immunity infected by micro-intratracheal injection and ultrasonic atomizing achieved 100%(30/30), while the mortalities were 100% (10/10) and 33.3% (3/10), respectively. Mice in two groups above displayed the influx of neutrophils, lymphocytes and macrophages in the peri-bronchial and alveolar interstitial space 12-24 h after pulmonary infection. In addtion, the mice in micro-intratracheal injection group displayed coUapse of partial alveolar walls, formation of abscesses and bacterial colonies in alveoli. While the lung pathology in mice of ultrasonic atomizing group was characterized by cell degeneration in some regions in the lungs, slight relaxation, congestion in alveolar wall vessels and normal of bronchial and alveolar tissue 24 h after inoculation. Degeneration in peri-tracheal and peri-bronchial areas was observed 24-48 h after inoculation, along with highly expanded pulmonary blood vessels and edems. The inflammation was reduced at 48 hours. There was no obvious pulmonary infection in BALB/C mice with hypo-immunity by nasal dripping with mortality of 0% (0/10) and no significant histopathologic change in lungs. Conclusions BALB/C mice with hypo-immunity pneumonia model with Imipenem-resistant Acinetobacter baumannii can be conducted by micro-intratracheal injection or ultrasonic atomizing, but the latter has the advantages of high-productivity, easy-operation, low-cost, time-saving and usefulness. Mice with normal immunity are not susceptible to imipenem-resistant Acinetobacter baumannii.

AIM: To prepare urokinase-loaded immunoliposomes, with anti-D-dimer mouse monoclonal antibody that can selectively target to thrombotic site and test the thrombolytic effect in the rabbit model of acute pulmonary embolism (PE) in early phase. METHODS: 40 New Zealand white rabbits were randomly divided into five groups: TBS group (TBS buffer, negative control group), urokinase (UK) group (150 000 IU/kg UK, positive control group), Lip group (Lip-UK, containing 50 000 IU/kg UK), Ab group (Ab-Lip-UK, containing 50 000 IU/kg UK) and 2 Ab group (2 Ab-Lip-UK, containing 50 000 IU/kg UK but double DDmAb of Ab group). PE model was established. Five minutes later, five solutions (TBS, UK, Lip-UK, Ab-Lip-UK, 2 Ab-Lip-UK) were transfused through femoral vein respectively. Right ventricular systolic pressure (RVSP) and right ventricular diastolic pressure (RVDP) were estimated within one hour. The pathological changes of lung, heart, liver and kidney were all observed. RESULTS: RVSP in TBS group had no significant changes within one hour after administration. However, RVSP had respective notable decline at 30 min, 40 min, 30 min, 20 min in UK, Lip, Ab and 2 Ab group, respectively. The means of residual emboli were as follows: 4.0±0 in TBS group, 2.4±0.9 in UK group, 3.1±0.6 in Lip group, 2.4±0.9 in Ab group and 1.9±0.6 in 2 Ab group. The lungs in each group showed scattering local congestion, effusion and swelling on the surface. Obvious hemorrhage of heart, kidney and liver was found with HE staining in UK group, no pathologic change was observed in other groups. CONCLUSION: 2 Ab-Lip-UK with early thrombolytic effect and security may be an ideal thrombolytic agent for treating pulmonary embolism.

The clinicopathological data of 13 patients with Langerhans cell histiocytosis (LCH) from January 2004 to January 2014 were retrospectively analyzed.There were 8 males and 5 females with a mean age of 35 (6-63)years.For all 13 cases,there were 15 lesions.Histologically,there was a diffuse distribution of Langerhans cells accompanied by a variable number of eosinophils and some other inflammatory cells.Immunohistochemical study showed tumor cells were positive for S-100 protein,CD1a and Langerin.During a follow-up period of 6-101 months,all survived.The diagnosis of LCH was assisted by immunophenotypic analyses for S-100,CD1a and Langerin.Combination therapy was effective.Most patients had an excellent prognosis.

Objective:To explore the strategies and complications of the submucosal tunneling endoscopic resection (STER) in the treatment of esophageal duplicated cyst (EDC).Methods:From January 2013 to December 2019, at Department of Gastroenterology, Taizhou Hospital of Zhejiang Province, the clinical data of 11 hospitalized patients with EDC diagnosed by pathological examination who underwent STER were collected. The clinical featured, computed tomography (CT) findings, endoscopic findings, postoperative efficacy, complications and pathological results after operation were summarized.Results:Among the 11 patients, there were 6 males and 5 females, the age ranged from 13 to 67 years, and the mean age was (43.0±18.2) years. One case presented with swallowing obstruction, 1 case with belching, 4 cases with upper abdominal pain, and the remaining 5 cases had no specific clinical symptoms. Under endoscopy, the lesions of 11 patients were hemispherical or mound-shaped with smooth surface submucosal masses in the esophageal cavity, which were soft to touch. Under endoscopic ultrasonography, they all appeared as hypoechoic masses with clear boundary located in the esophageal muscularis propria. The results of CT scan of 9 patients showed round low-density cystic masses, among them 7 cases showed mild enhancement. The maximum diameter of the cysts was 1.5 to 4.4 cm, with mean maximum diameter being (2.8±0.8) cm, and the maximum diameter of most patients (7 cases) were 2 to 3 cm. The other two patients showed only slightly thickened esophageal wall on CT. Five lesions occurred in the horizontal mediastinum of the lower esophagus. All the 11 patients underwent STER operation successfully, among them 6 patients received simple STER and the cysts were completely resected, and the other 5 patients received STER and cauterization with argon ion for the residual cyst wall. The pathological results after operation indicated that 6 cases were congenital esophageal cysts and 5 cases were bronchogenic cysts. The median follow-up time (range) of 11 patients was 42 months (12-86 months). Ten patients recovered well after the operation, and local recurrence, malignant transformation or metastasis were not found. One case had recurrence, and was treated with STER and cauterization with argon ion for residual cyst wall and cured. No complications such as bleeding, fistula, mediastinal infection or death occurred during and after operation in all the 11 patients.Conclusions:STER is a minimally invasive, safe and effective treatment for EDC, and may be a new treatment for EDC.

OBJECTIVETo evaluate the feasibility, safety and diagnostic accuracy of pharmacologic stress of (99m)Technetium-MIBI single-photon emission computed tomography (SPECT) with intravenous adenosine triphosphate (ATP) in patients with suspected coronary artery disease.

METHODSThe study group included 263 patients who were suspected of having coronary artery disease. All patients underwent (99m)Tc-MIBI myocardial perfusion imaging with ATP infusion (0.16 mg/kg body weight per min for 5 min). 20 mCi of (99m)Tc-MIBI were injected 3 minutes after the start of ATP infusion. Myocardial SPECT images were obtained 60 minutes later. Then, two days later, 20 mCi of (99m)Tc-MIBI were administered at rest and myocardial SPECT was repeated. 51 patients also underwent coronary angiography within two weeks for evaluation of sensitivity and specificity of ATP-myocardial perfusion imaging in detection of coronary artery disease. The occurrence of cardiac and non-cardiac adverse effects was carefully monitored during and after intravenous ATP infusion.

RESULTSThe ATP infusion protocol was completed in all patients. Although 59% of the patients had various kinds of adverse effects, most of them were mild. No patient required aminophyline. The most severe adverse effect was second degree type II atria-ventricular block (4/263), but all events were transient. The sensitivity and specificity of ATP-myocardial perfusion imaging were 97% and 82%, respectively.

CONCLUSIONSIt is shown that (99m)Technetium-MIBI SPECT with intravenous ATP is a safe and feasible technique for detecting coronary artery disease in patients unable to perform the exercise test.

Adenosine Triphosphate ; adverse effects ; Adult ; Aged ; Aged, 80 and over ; Coronary Angiography ; Coronary Disease ; diagnosis ; Female ; Heart ; diagnostic imaging ; Humans ; Male ; Middle Aged ; Sensitivity and Specificity ; Technetium Tc 99m Sestamibi ; Tomography, Emission-Computed, Single-Photon

OBJECTIVETo explore the association between sleep duration and stroke in adults.

METHODSBaseline data of 57 704 subjects who were aged 30-79 years and enrolled into China Kadoorie Biobank (CKB) study from Tongxiang county, Zhejiang province were analyzed. Multiple logistic regression analysis was conducted to investigate the putative association between sleep duration and stroke after adjusting for potential confounders.

RESULTSThe mean age of the subjects was (53.15 ± 10.20) years in males and (51.72 ± .69) years in females, respectively. There were 14.43% of males and 15.30% of females reporting sleep durations ≤ 6 hours per day and 5.39% of males and 5.95% of females reporting long duration of sleep (≥ 10 hours per day). The prevalence of stroke was 0.92% in males compared with 0.44% in females. The prevalence of stroke showed a U-shaped distribution with sleep duration. Compared with 7 hours sleep duration per day, long sleep duration (≥ 10 hours per day) was associated with stroke. The odds ratios (OR) were 2.11 (95%CI: 1.32-3.37) for males and 2.13 (95%CI: 1.24-3.65) for females after adjusting for age, socioeconomic status, health behaviors and health status. No statistical significant association was found between short sleep duration and stroke. Meanwhile, frequent sleep snoring was found to be associated with stroke in females (OR=1.63, 95% CI: 1.11-2.40).

CONCLUSIONLonger sleep duration was found to be associated with higher risk of stroke in both males and females. Frequent sleep snoring would increase the risk of stroke in females.

Adult ; Aged ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Prevalence ; Risk Factors ; Sleep ; Snoring ; Stroke ; epidemiology ; Time Factors

Osteoporotic vertebral compression fracture (OVCF) can lead to lower back pain and may be even accompanied by scoliosis, neurological dysfunction and other complications, which will affect the daily activities and life quality of patients. Vertebral augmentation is an effective treatment method for OVCF, but it cannot correct unbalance of bone metabolism or improve the osteoporotic status, causing complications like lower back pain, limited spinal activities and vertebral refracture. The post-operative systematic and standardized rehabilitation treatments can improve curative effect and therapeutic efficacy of anti-osteoporosis, reduce risk of vertebral refracture, increase patient compliance and improve quality of life. Since there still lack relevant clinical treatment guidelines for postoperative rehabilitation treatments following vertebral augmentation for OVCF, the current treatments are varied with uneven therapeutic effect. In order to standardize the postoperative rehabilitation treatment, the Spine Trauma Group of the Orthopedic Branch of Chinese Medical Doctor Association organized relevant experts to refer to relevant literature and develop the "Guideline for postoperative rehabilitation treatment following vertebral augmentation for osteoporotic vertebral compression fracture (2022 version)" based on the clinical guidelines published by the American Academy of Orthopedic Surgeons (AAOS) as well as on the principles of scientificity, practicality and advancement. The guideline provided evidence-based recommendations on 10 important issues related to postoperative rehabilitation treatments of OVCF.

Polymyxin B, which is a last-line antibiotic for extensively drug-resistant Gram-negative bacterial infections, became available in China in Dec. 2017. As dose adjustments are based solely on clinical experience of risk toxicity, treatment failure, and emergence of resistance, there is an urgent clinical need to perform therapeutic drug monitoring (TDM) to optimize the use of polymyxin B. It is thus necessary to standardize operating procedures to ensure the accuracy of TDM and provide evidence for their rational use. We report a consensus on TDM guidelines for polymyxin B, as endorsed by the Infection and Chemotherapy Committee of the Shanghai Medical Association and the Therapeutic Drug Monitoring Committee of the Chinese Pharmacological Society. The consensus panel was composed of clinicians, pharmacists, and microbiologists from different provinces in China and Australia who made recommendations regarding target concentrations, sample collection, reporting, and explanation of TDM results. The guidelines provide the first-ever consensus on conducting TDM of polymyxin B, and are intended to guide optimal clinical use.
Humans ; Anti-Bacterial Agents/therapeutic use* ; China ; Drug Monitoring/methods* ; Polymyxin B ; Practice Guidelines as Topic

Since December 2019, the corona virus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (2019-nCoV) has been reported in Wuhan, Hubei Province. Almost 70% of patients susceptible to 2019-nCoV are over age of 50 years, with extremely large proportion of critical illness and death of the elderly patients. Meanwhile, the elderly patients are at high risk of osteoporotic fractures especially osteoporotic vertebral compression fractures (OVCF). During the prevention and control of COVID-19 epidemic, orthopedists are confronted with the following difficulties including how to screen and protect OVCF patients, how to accurately diagnose and assess the condition of OVCF patients with suspected or confirmed COVID-19, and how to develop reasonable treatment plans and comprehensive protective measures in emergency and outpatient clinics. In order to standardize the diagnosis and treatment of patients with OVCF diagnosed with COVID-19, the authors jointly develop this expert consensus. The consensus systematically recommends the standardized emergency and outpatient screening and confirmation procedures for OVCF patients with suspected or confirmed COVID-19 and protective measures for emergency and outpatient clinics. Moreover, the consensus describes the grading and classification of OVCF patients diagnosed with COVID-19 according to the severity of illness and recommends different treatment plans and corresponding protective measures based on the different types and epidemic prevention and control requirements.