20(S)-9-nitrocamptothecin was synthesized from camptothecin by nitration reaction using mixed nitrate salts in sulfuric acid medium.The yield was raised from 31% to 40% after chromatographic purification treatment.The best reaction conditions was as follows:0.5 g of camptothecin;30ml of sulfuric acid;0.007mol of nitrate salts(NH4NO3/CaNO3=1/1).The reaction was completed in 24h at 20℃.The advantage of this method is high yield and easily purification.

Objective:To explore the effect of locking compressing plates (LCP) internal fixation under arthroscopy combined with Zhuyu Tongluo method in the treatment of distal radius fractures (DRF) and its effects on joint function, hemorheology, serum basic fibroblast growth factor (bFGF) and bone morphogenetic protein 2 (BMP-2).Methods:A total of 78 patients with DRF admitted to the Second Hospital of Tangshan City from June 2017 to January 2020 were selected and grouped according to the random number table method, with 39 cases in each group. The control group was treated with LCP internal fixation under arthroscopy, and the study group was treated with Zhuyu Tongluo method on the basis of the control group. The recovery, hemorheology (plasma viscosity, whole blood viscosity high cut, whole blood low cut, hematocrit), serum bFGF, BMP-2 levels, before and after the operation were compared between the two groups. They were followed up for 6 months and the range of motion of the wrist joints before and after the operation and the excellent and good rate of wrist joint function between the two groups were compared.Results:The swelling subsidence time, pain disappearance time, ecchymosis disappearance time, and fracture imaging healing time in the study group were shorter than those in the control group: (10.37 ± 3.13) d vs. (14.62 ± 3.38) d, (12.39 ± 2.97) d vs. (17.14 ± 4.02) d, (19.15 ± 2.35) d vs. (24.36 ± 3.27) d, (68.21 ± 7.12) d vs. (80.07 ± 8.24) d, and the differences were statistically significant ( P<0.05). The plasma viscosity, whole blood viscosity high-cut, whole blood low-cut, and hematocrit in the study group were lower than those in the control group at 1 and 2 weeks after operation ( P<0.05). The levels of serum bFGF and BMP-2 in the study group were higher than those in the control group at 1 and 2 weeks after operation: at 1 week after operation: (356.27 ± 46.29) μg/L vs.(236.51 ± 37.42) μg/L, (614.28 ± 61.47) μg/L vs. (487.39 ± 48.24) μg/L; at 2 weeks after operation:(502.07 ± 113.21) μg/L vs. (381.59 ± 82.75) μg/L, (910.77 ± 97.20) μg/L vs. (731.35 ± 92.13) μg/L, and the differences were statistically significant ( P<0.05). The palm flexion, back extension, radial deviation, and ulnar deviation in the study group were better than those in the control group at 6 months after operation ( P<0.05). The excellent and good rate of wrist joint function in the study group was higher than that in the control group at 6 months after operation: 89.5%(34/38) vs. 70.3%(26/37), and the difference was statistically significant ( P<0.05). Conclusions:LCP internal fixation under arthroscopy combined with Zhuyu Tongluo method in the treatment of patients with DRF can increase the expression of serum bFGF and BMP-2, reduce inflammation, improve blood rheology, promote fracture healing, and improve wrist range of motion and wrist function.

Objective To analyze the clinical efficacy of pre-extensive drug resistant tuberculosis (pre-XDR-TB), and to explore the feasibility of using the standard multidrug resistant tuberculosis (MDR-TB) therapeutic regimen to treat the patients with pre-MDR-TB. Methods A retrospective analysis was made for 126 cases of the MDR-TB patients who were received the treatment in Guangzhou chest hospital from 2009 to 2013. It was divided into MDR-TB group, pre-XDR-TB group and XDR-TB group according to the drug sensitive test (DST) of quinolone(levofloxacin, moxifloxacin) and aminoglycoside (amikacin). All patients were treated for 6-months with the standard therapeutic regimen including Am(Cm), Lfx(Mfx), Pto, PAS and PZA. Results (1) There were 126 cases of the MDR-TB patients in the study, 31 cases (24.6%) complicate with aminoglycosides-resistance, 69 cases (54.7%) complicate with quinolone-resistance. (2) The negative rate of MDR-TB group, pre-XDR-TB group and XDR-TB group was 82.0%, 55.8% and 29.2% respectively (χ2 = 20.110, P < 0.001). (3)The negative rate of pre-XDR-TB group significantly lower than MDR-TB group (χ2 = 8.146, P = 0.004). The negative rate of pre-XDR-TB group higher than XDR-TB group (χ2= 4.661, P = 0.031). Conclusions The situation of quinolone and aminoglycoside resistance was high in the patients with MDR-TB. We should carry out the detection of quinolone and aminoglycoside resistance in clinical treatment. The clinical efficacy for the patients with pre-XDR-TB was significantly poorer than the patients with MDR-TB using the standard MDR-TB therapeutic regiment treated.

Objective To investigate the effects of different liver protective drugs on preventing liver injury induced by anti-tuberculosis drugs. Methods Retrospective analysis was made on 355 patients with primary pulmonary tuberculosis during intensified time. The patients received silibinon and bicyclol to prevent liver injury. 82 patients with TB were treated as control group during the same time. Results The number of patients with liver injury in silibinon group and bicyclol group were 16 cases (14.7%) and 55 cases (22.4%) respectively. The number of control group with liver injury was 9 cases (11.0%) (χ2 = 3.627,P > 0.05). The liver injuries within 4 weeks were mainly counted in. There is no difference between intervention and control groups(χ2 = 0.414,P > 0.05). There is no difference between three groups in liver injury degree (U = 0.288,P> 0.05). Conclusion Without high risk factors, anti-inflammatory and enzyme reduction drugs have no significant protective effects on liver injury caused by anti-tuberculosis drugs.

Objective To evaluate the feasibility and the clinical value of MRI in the diagnosis of small-bowel disease. Methods Sixty-three patients with suspected small-bowel diseases and 3 volunteers without signs of small bowel disease underwent MRI examination. Thirty-one patients whose diagnoses were confirmed by pathology or clinical results were categorized into two groups (neoplastic and normeoplastic). The conspicuity of bowel wall, the sensitivity of MRI in detecting small-bowel lesions, and the accuracy rate of diagnosis were calculated. The average bowel wall thickness between the two groups was assessed by using Wilcoxon signed-rank test. Enlarged mesenteric lymph nodes, mesenteric infiltration, and small-bowel stenosis were analyzed by using Fisher's exact test in each group respectively. Results MRI examinations of all 66 subjects were successfully performed. Images were rated on a continuous 4-peint scale. Sixty-two cases (93.9%) were scored as 2 or 3. The diagnoses of 31 patients (neoplastic group (n = 10) and nonneoplastic group (n = 21) were confirmed by pathology or clinical results. The sensitivity, accuracy of MRI in identifying small bowel diseases were 100% (31/31) and 77.4% (24/31) respectively. The average bowel wall thickness of the two groups was 23 mm(7.0-65.0 mm) and 5 mm(2.0-35.0 mm) respectively, and there was a statistically significant difference between the two groups (Z = - 2.949, P < 0.01). Enlarged lymph nodes in mesentery were found in 7 cases in neoplastic group and 4 cases in nonneoplastic group, and there was a statistically significant difference between the two group (P < 0.05). Small-bowel stenosis was depicted in 10 cases in both groups and there was a statistically significant difference between the two groups (P <0.01). The mesenteric infiltration sign was seen in 5 cases and 17 cases respectively, and showed no significant difference between the two groups (P > 0.05). Conclusion MRI can depict the location and extension of the small-bowel disease accurately and it is an effective method in the diagnosis of small-bowel disease.

OBJECTIVE: To introduce the efficacy of three surgical options for juvenile nasopharyngeal angiofibroma (JNA) resection, and causes of operative bleeding. METHOD: Retrospective analysis of 36 JNAs,three surgical options were used to resect the tumor. There were 15 cases of Class I tumors , using endoscopic nasal cavity approach. Eighteen cases of class II tumors, via extended Caldwell-Luk incision, using the transantral-infratemporal fosse-nasal cavity combined approach for tumor resection. Three cases of class III tumors, the combined intracranial and extra-cranial approach was used to resect the tumor. Meanwhile, report six typical cases for reference. RESULT: Fifteen (15/36) cases of class I tumors, 14 cases were completely resected for the first time without recurrence, 1 recurrence case was re-resected using the same approach. Eighteen (18/36) cases of class II tumors, 13 cases were completely resected for the first time without recurrence, 5 recurrence cases were re-resected totally. Three (3/36) cases of class III were not completely removed, and underwent about 40 Gy radiotherapy with good effects. CONCLUSION Using these three surgical options can effectively remove different types of JNA. When necessary, the intracranial residue can use radiotherapy. Under direct vision to separate the tumor, and effective hemostasis play crucial roles for complete removal of the tumor.
Adolescent ; Angiofibroma ; surgery ; Blood Loss, Surgical ; Child ; Female ; Humans ; Male ; Nasopharyngeal Neoplasms ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult

Objective To explore the effect of calycosin(CAL)on neuronal autophagy and apoptosis in rats with spinal cord injury(SCI)by regulating PI3K/Akt signaling pathway and its mechanism.Methods A total of 32 male or female adult SD rats were randomly divided into the sham group,the SCI group,the CAL low(20 mg/kg)dose group and the CAL high(40 mg/kg)dose group with 8 rats in each group.The rat model of moderate SCI was established by modified Allen's method.After successful modeling,rats were injected intraperitoneally immediately with different dosage of CAL or equal amount of saline once a day for 7 consecutive days.Basso,Beattie and Bresnahan(BBB)scores were used to evaluate the recovery of motor function of rats at 1,3 and 7 d after surgery.At 7 d after surgery,Nissl staining was used to detect the surviving number of motor neurons in anterior horn of spinal cord.Western blot assay was used to assess expression levels of p62,Beclin-1,microtubule-associated protein 1 light chain 3(LC3B),phosphatidylinositol 3-kinase(PI3K)/protein kinase B(Akt)pathway,Cleaved-Caspase-3,B-cell lymphoma-2(Bcl-2)and Bcl-2-associated X protein(Bax)proteins.Immunofluorescence staining was used to measure the expression of LC3B in anterior neurons of spinal cord.Results Compared with the sham group,BBB scores,the surviving number of motor neurons and levels of Bcl-2,Bcl-2/Bax,p-PI3K,p-PI3K/PI3K,p-Akt and p-Akt/Akt were significantly decreased(P＜0.05),and levels of p62,Beclin-1,LC3B Ⅱ,LC3BⅡ/Ⅰ,Cleaved-Caspase-3 and Bax were significantly increased in the SCI group(P＜0.05).Compared with the SCI group,BBB scores,the survival of anterior horn motor neurons and levels of LC3B Ⅱ,LC3B Ⅱ/Ⅰ,Bcl-2,Bcl-2/Bax,p-PI3K,p-PI3K/PI3K,p-Akt and p-Akt/Akt were increased in the CAL low dose group and CAL high dose group,and levels of p62,Cleaved-Caspase-3 and Baxcould were significantly decreased(P＜0.05).Conclusion CAL could promote autophagy and inhibit apoptosis of neurons through activating PI3K/Akt signaling pathway,thereby conferring a protective role following SCI in rats.

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Objective:To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars.Methods:A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test.Results:Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment ( Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment ( Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment ( Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period. Conclusions:The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.

OBJECTIVE: To our knowledge, study of the intraoperative profuse bleeding of pterygoid venous plexus (PVP) in large nasopharyngeal angiofibroma resection has not yet been reported. Attention should be paid to this topic in clinical practice. METHOD: From 1981 to 2009, 44 cases of JNAs were treated in our hospital. Twenty-six of 44 cases were large nasopharyngeal angiofibromas according to the Fisch classification system(Fisch type III 16, type IV 10). The amount of intraoperative blood loss in these 26 cases varied from 200 ml to 5200 ml. Factors influencing intraoperative bleeding of 26 large nasopharyngeal angiofibroma resections were analyzed retrospectively. The intra-operative observations and imaging data of three typical cases were hereby studied. RESULT: After embolization of the tumor-supplying branches of the external carotid artery(ECA), both the intraoperative observations and imaging data demonstrated that the pterygoid venous plexus (PVP) played a crucial role in intraoperative hemorrhage. CONCLUSION PVP in the infratemporal fossa communicates with craniofacial veins. There is no valve between these veins. Once PVP is seriously damaged, venous blood of all craniofacial veins will flow out profusely. In the first operation, the intact PVP in the fatty pad generally can be identified and separated from the tumor by delicate surgical managements. If an unsuccessful operation due to serious hemorrhage had been done previously, then scar tissue might tightly adhere with PVP, tumor and the pterygoid muscles, and separation of the tumor from PVP without bleeding is more difficult. Appropriate surgical approach and correct hemostatic procedure of every bleeding point should be done carefully under direct vision. Using finger or instrument for quick blind dissection should be prohibited.
Adolescent ; Angiofibroma ; pathology ; surgery ; Blood Loss, Surgical ; Hemorrhage ; prevention & control ; Humans ; Male ; Nasopharyngeal Neoplasms ; pathology ; surgery ; Retrospective Studies ; Veins ; surgery ; Young Adult