Aged ; Carcinoma, Squamous Cell ; pathology ; surgery ; Cholecystectomy ; Gallbladder Neoplasms ; pathology ; surgery ; Humans ; Male

Objective To evaluate whether changes in neonatal intensive care have improved outcomes for extremely low birth weight (ELBW) infants in neonatal intensive care unit (NICU). Methods A prospective phase-lag cohort study was performed in a tertiary level NICU. A meticulous nursing strategy based on neonatal individual developmental care assessment program theory and feasible ELBW minimization stimulus was developed. Conventional care was applied in 2013 (period Ⅰ) and gently caring was applied in 2014 (period Ⅱ). The outcomes of ELBW between these 2 periods were compared. Results During these two periods, thirty-seven infants were included in period Ⅰ and 41 infants in period Ⅱ. In periodⅠ46.0%(17/37) of the infants needed oxygen for at least 28 days, but in period Ⅱ it decreased to 24.4%(10/41), there was significant difference (χ2=3.990, P=0.046). The rate of breastfeeding increased from 27.0%(10/37) in periodⅠto 61.0%(25/41) in period Ⅱ, there was significant difference (χ2=9.061, P=0.003). There was no significant difference in the mortality rate and chronic lung disease (P>0.05). The incidence of intracranial hemorrhage decreased from 21.6%(8/37) to 4.9%(2/41), there was significant difference(P=0.041). Conclusions Gently caring may have resulted in less intracranial hemorrhage and improve breastfeeding rate. Parents are satisfied with gentle care and in light of these findings, gentle care deserves further exploration.

Objective To investigate the role of transforming growth factor-β1 (TGF-β1), Smad2/3 and Smad7 expressions in carotid artery remodeling in renovascular hypertensive rats, and also the therapeutic effect of Enalapril and Amlodipine. Methods The renovascular hypertensive rat (RHR) models with two-kidney and one-clip were established, including model group (n = 6), sham-operated group (n = 6), Enalapril group (10 mg/kg per day, n = 6), Amlodipine group (5 mg/kg per day, n = 6) and combination group (Amlodipine 2.5 mg/kg per day + Enalapril 5mg/kg per day, n = 6). The medication were continuous administrated for six weeks. Carotid artery morphological and structural changes in the media were observed by HE staining, Masson staining and immuno histochemical staining. Media thickness (MT), MT and lumen diameter ratio (MT/LD), and the expression levels of media α-smooth muscle actin (α-actin), proliferating cell nuclear antigen (PCNA), TGF-β1, phosphorylated Smad2/3 (p-Smad2/3) and Smad7 in carotid arteries were measured. Results The media of carotid arteries in RHR model group was significantly thickened, the volume of smooth muscle cell was increased, and the array was in disorder; MT, MT/LD, the proliferation index of smooth muscle cell and collagen fiber area percentage of carotid arteries in the model group were significantly higher than those in the sham-operated group (P < 0.01). Compared to sham-operated group, the model group had significantly higher expressions of TGF-β1 and p-Smad2/3 (P < 0.05) and lower Smad7 expression. Both Enalapril and Amlodipine improved smooth muscle hypertrophy and collagen deposition, reduced RHR carotid MT, MT/LD, proliferation index of smooth muscle cell, collagen fiber area percentage and the expressions of TGF-β1 and p-Smad2/3 (P < 0.05), increased Smad7 expression (P < 0.05). Moreover, the combination treatment of Enalapril and Amlodipine had significantly better effects than single Amlodipine group (P < 0.05), but not single Enalapril group. Conclusions TGF-β1/Smads pathway may participate in the mechanism of carotid artery remodeling in RHR; the role of Amlodipine and Enalapril in inversing carotid artery remodeling may be related to the change of TGF-β1/Smads pathway, the combination treatment of Amlodipine and Enalapril had better effects than single administration of Amlodipine.

Objective To investigate the role of dual-source parallel radio frequence (RF) and single-source excitation in liver imaging at 3.0 T MR.Methods This study was a retrospective analysis.One hundred and seven subjects underwent a 3.0 T TX MR scanning including axial spectrally selective attenuated inversion recovery (SPAIR) T2WI,axial DWI and coronal balanced-fast field echo( Balanced FFE).Each sequence was carried out with both single-source and dual-source RF excitation.Student＇s t test was used to compare the differences between single-source and dual-source RF excitation in the image uniformity,signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR).Wilcoxon signed rank test was used to determine whether there was difference between conventional and parallel transmission in the score of image quality.Reader agreement was assessed using the Cohen＇s Kappa test.Results For the image uniformity,there was significant difference between single-source and dual-source excitation (418.40 ± 66.75 for single-source vs.416.26 ± 50.61 for dual-source,t =2.524,P ＜ 0.05 ).There also existed significant difference between single-source and dual-source excitation in SNR and CNR,respectively.The SNR and CNR of parallel transmission (22.03 + 12.16 and 18.33 ± 10.01,respectively) were both higher than those of single transmission (20.36 ± 11.21 and 15.22 ± 8.95,respectively) ( t =- 2.630,P ＜ 0.05 for SNR and t =- 4.238,P ＜ 0.05 for CNR).Image quality comparisons revealed significantly better results with dual-source than single-source RF excitation at SPAIR T2 WI ( 1.40 + 0.42 vs.1.81 ± 0.27 ),DWI ( 1.08 ± 0.40 vs.1.63 ± 0.36 ) and Balanced FFE sequence ( 0.95 ± 0.45 vs.1.65 ± 0.37,Z =- 5.894,- 5.801 and - 6.985,respectively,P ＜ 0.01 ).In the comparison of image quality,the agreement between the two readers was very good ( Kappa ＞ 0.8,P ＜ 0.05 ).Conclusion Dual-source parallel RF excitation MR imaging in liver enables reducing dielectric shading,improving homogeneity of the RF magnetic induction field,and increasing SNR and CNR at 3.0 T.

Recombinant tissue plasminogen activator (rt-PA) is the most effective treatment for acute ischemic stroke and the exclusion criteria of rt-PA has been revised to extend its application. However, in Taiwan, National Health Insurance (NHI) did not follow the latest international consensus due to safety concerns. The present study investigated whether extending the application of rt-PA in Taiwan was safe and effective. The medical records from the Shuang Ho hospital stroke registry between August 2009 and December 2016 were retrospectively reviewed. Post rt-PA intracranial hemorrhage (ICH) and modified Rankin Scale (mRS) score at 3-month after stroke were the primary and secondary outcomes, respectively. Differences were analyzed through Fisher’s exact test and Student’s t test. A p-value of <0.05 was considered statistically significant. Overall, there were 243 patients categorized into two groups: NHI exclusion criteria adherence (n = 160) and non-adherence (n = 83). There was no significant difference in the risk of post rt-PA ICH (12.50% in adherence group, 4.82% in non-adherence group, p=0.07). Among the non-adherence group, 10 patients breached the latest international exclusion criteria and none of them experienced post rt-PA ICH. However, among patients with moderately severe stroke, the odds of mRS < 2 at 3-month were significantly lower in non-adherence group. This study demonstrated that extending administration of rt-PA in Taiwan was safe but the functional outcome after moderate stroke was not as favorable as adherence group. Old age, long onset-to-treatment time and less efficacy of lower dose of rt-PA were the possible factors for the difference in outcome.

No abstract available.
Brain* ; Hydrocephalus*

In this study, the buffering capacity of amphiphilic pH-sensitivity copolymer poly(2-ethyl-2-oxazoline)-cholesteryl methyl carbonate (PEOZ-CHMC) was evaluated. The ammonium sulfate gradient method was used to prepare doxorubicin hydrochloride (DOX x HCl)-loaded liposomes (DOX-L), and then the post-insertion method was used to prepare PEOZ-CHMC and polyethylene glycol-distearoyl phosphatidyl ethanolamine (PEG-DSPE) modified DOX x HCl-loaded liposomes (PEOZ-DOX-L and PEG-DOX-L). The physico-chemical properties, in vitro drugs release behavior, cellular toxicity and intracellular delivery of liposomes were evaluated, separately. The results showed that PEOZ-CHMC has a satisfactory buffering capacity. The sephadex G-50 column centrifugation method and dynamic light scattering were used to determine the encapsulation efficiency (EE) and particle size of liposomes. The EE and particle size of DOX-L were (97.3 ± 1.4) % and 120 nm, respectively, and the addition of PEOZ-CHMC or PEG-DSPE had no influence on EE and particle size. The zeta potentials of three kinds of liposomes were negative. The release behavior of various DOX liposomes in vitro was investigated by dialysis method. In phosphate buffer solution (PBS) at pH 7.4, DOX x HCl was released from PEOZ-DOX-L in a sustained manner. While in PBS at pH 5.0, the release rate of DOX x HCl from PEOZ-DOX-L increased significantly, which suggested DOX x HCl was released from PEOZ-DOX-L in a pH-dependent manner. The intracellular delivery of liposomes was investigated by confocal laser scanning microscopy (CLSM). The CLSM images indicated that PEOZ-DOX-L showed efficient intracellular trafficking including endosomal escape and release DOX x HCl into nucleus, as well as the DOX-L and PEG-DOX-L had no this effect. The cytotoxicity of liposomes against MCF-7 cells was detected by using MTT assay. The results showed that antiproliferative effects of PEOZ-DOX-L enhanced with pH value decreased, whereas DOX-L and PEG-DOX-L did not have any significant difference in inhibitions at different pH conditions. Therefore, the problems of the inhibition of cellular uptake of liposomes and the failed endosomal escape of pH-sensitive liposomes by PEG chain can be overcome by the pH-sensitive liposomes constructed by PEOZ-CHMC.
Cell Nucleus ; Doxorubicin ; analogs & derivatives ; chemistry ; Endosomes ; Formates ; chemistry ; Humans ; Liposomes ; chemistry ; MCF-7 Cells ; Microscopy, Confocal ; Particle Size ; Phosphatidylethanolamines ; Polyamines ; chemistry ; Polyethylene Glycols ; chemistry

Primary pulmonary hypertension is a rar, incurable, and progressive clinical entity. When associated with pregnancy, the prognosis of primary pulmonary hypertension is worsened with maternal mortality rates of at least 50%. The patient was a 29-year-old mother in her 2nd pregnancy, with previous uncomplicated gestation, 5 years ago. She had been well until the 28th week of present gestation when she was admitted because of increasing dyspnea on exertion. She was a housewife with no remarkable family and past histories. We have experienced a patient with primary pulmonary hypertension in pregnancy. She was treated with an oral calcium-channel blocker and low-molecular-weight heparin and was delivered vaginally with good maternal and fetal outcome. So we report a case of primary pulmonary hypertension associated with pregnancy and review literature.
Adult ; Dyspnea ; Heparin, Low-Molecular-Weight ; Humans ; Hypertension, Pulmonary* ; Maternal Mortality ; Mothers ; Pregnancy* ; Prognosis

Objective: To investigate the effect of p38 mitogen-activated protein kinase (p38 MAPK) inhibitor on liver function and tissue in rats with hepatic hydatidosis. Methods: A model of liver echinococcosis was established in 100 female Wistar rats, 60 of 100 were, randomly divided into three groups, Control group (0.3 ml normal saline), Low dose group (50 μmol/L p38MAPK inhibitor SB-202190), High dose group (100 μmol/L SB-202190B). The reagents were given via the hepatic artery 1, 3, 7, 14 and 42 days after the rat model was generated. Rats were sacrificed 42 days after the intervention, liver tissue and blood samples were collected for liver function study. Results: Alanine aminotransferase levels were (49.58±2.38) U/L, (38.35±1.34) U/L and (30.93±1.51) U/L and aspartic aminotransferase levels were (67.45±5.14) U/L, (54.86±1.09) U/L and (45.76±1.04) U/L in the Control group, the Low-dose group and High-dose group, showing a decreasing trend, with statistically significant differences (all P<0.05). Triglycerides in the Low-dose group were higher than those in Control group and the High-dose group, with statistically significant differences (all P<0.05). In the Control group, the hepatocytes were severely injured, with almost no normal hepatocytes left, and the normal hepatocyte boundaries were also disrupted, he normal hepatic lobule was replaced by the pseudolobules. In the Low-dose group, there were more inflammatory cells, and less replacement of normal liver cells by pseudolobules. High dose group of a small amount of inflammatory cells infiltration, roughly normal liver cells, normal liver cell line is clear, visible central vein of liver cells. Conclusion p38MAPK inhibitor SB-202190 improved liver function and reduced liver tissue damage in rats with hepatic hydatidosis.

This systematic review aimed to evaluate the efficacy and safety of assisted hatching (AH) performed in couples with advanced maternal age.We searched for randomized controlled trials (RCTs) in electronic databases,including MEDLINE,EMBASE and CENTRAL (from inception to January 2018);in addition,we hand-searched the reference lists of included studies and similar reviews.We included RCTs comparing AH versus no treatment (control).The meta-analysis was performed by RevMan 5.3 software.The search retrieved 943 records and 8 RCTs were included,comprising 870 cycles (n=440 for AH,and n=430 for control).There was no significant difference in the rates of live birth (RR 0.88,95％ CI 0.65 to 1.18,3 RCTs,n=427,I2=0％),clinical pregnancy (RR 1.00,95％ CI 0.83 to 1.19,8 RCTs,n=870,I2=22％),implantation (RR 1.07,95％ CI 0.83 to 1.39,4 RCTs,n=1359,I2=0％),miscarriage (RR 1.13,95％ CI 0.66 to 1.94,2 RCTs,n=116,I2=0％) and multiple pregnancy (RR 0.89,95％ CI 0.31 to 2.52,1 RCT,n=97,I2=not applicable) between the treatment group and control group.No reasonable conclusions could be drawn regarding reproductive outcomes after AH in patients with advanced maternal age due to the small sample pooled in meta-analyses.Studies of high methodological quality and with adequate power are necessary to further investigate the value of AH in assisted conception of those patients.