Objective To evaluate the effects of early and late tracbeostomy on patients with acute severe cerebral trauma.Methods In the retrospective study,167 patients with severe brain trauma ( GCS ＜ 9 ) requiring prolonged mechanical ventilation ( MV ) were managed by percutaneous dilational tracheostomy (PDT) from May 2001 to December 2010.According to the transoral incubation MV duration,the patients were divided into the early tracheostomy (ET) group ( MV duration≤7 d,81 cases)and late tracheostomy (LT) group (MV duration ＞ 7 d,86 cases).The basic clinical characteristics,pre-and post-PDT MV period,total MV duration,length of post-PDT ICU stay,length of ICU stay,length of hospital stay and mortality were compared between the two groups.Results The two groups showed no statistical differences in aspects of age,sex,acute physiology and chronic health evaluation Ⅱ (A-PACHE Ⅱ ) score,GCS,trauma index and craniotomy rate (P＞0.05).Compared with LT group,ET group significantly shortened the pre-PDT MV period [ (5.16 ± 1.33 ) d∶ ( 1 1.64 ± 4.25 ) d,P ＜ 0.01 ],post-PDT MV period ( median:15.0 d∶ 17.0 d,P ＜ 0.05 ),total MV duration ( median:18.0 d∶26.0 d,P＜0.05),length of post-PDT ICU stay (median:16.0 d∶21.0 d,P＜0.01 ) and length of ICU stay (median:21.0 d∶32.0 d,P ＜0.01 ).But the two groups had no statistical differences concerning the length of hospital stay ( P ＞ 0.05 ),ICU mortality ( 17％ ∶ 14％,P ＞ 0.05 ) and in-hospital mortality (25％∶28.4％,P ＞0.05).Kaplan-Meier curves showed that the frequency of MV and ICU stay rate within 60 days in ET group were significantly lower than those in LT group.Conclusions For patients with severe brain trauma,early tracheostomy shortens the duration of MV and length of ICU stay without affecting their prognosis.Thereby,tracheostomy can be performed at early stage when managing acute severe brain injury.

Objective To study the relationship between the expression level of PLK1 in castration-resistant prostate cancer (CRPC) tissues, and its relationship with pathological features. Methods Forty-four CRPC specimens including 28 samples from patients with prostate adenocarcinoma, 14 samples from patients with neuroendocrine prostate cancer (NEPC) and 2 samples from patients with other types of prostate cancer, and 10 normal prostatic hyperplasia specimens were collected from January 2010 to September 2016 in the Second Hospital of Tianjin Medical University. The expression levels of PLK1 in these tissues were detected by S-P immunohistochemistry. The relationship between PLK1 expression and pathologic factors was discussed. Results The positive expression of PLK1 was located in cytoplasm of carcinoma cells, and no express of PLK1 was found in benign prostatic hyperplasia tissues. The expression levels of PLK1 showed no significantly differences between different groups of age, local tumor invasion and regional nodal status, and the level of prostate-specific antigen (PSA, P>0.05). The expression level of PLK1 in patients with Gleason score>8 was higher than that in patients with Gleason score≤8. The PLK1 expression level was positively correlated with Gleason score (rs=0.441,P<0.05). Conclusion PLK1 protein is over-expressed in CRPC tissues, which can reflect the proliferation and differentiation of cancer cells and may be a potential marker of CRPC.

Aim To establish insulin resistance cell model on HepG2 cells (human embryonic liver tumor cells )and investigate the effect of berberine hydro-chloride on insulin-resistant HepG2 (IR-HepG2 ) cells.Methods ① IR model was induced by respec-tively using 10 -9 ,10 -8 ,10 -7 ,10 -6 ,10 -5 ,10 -4 mol ·L-1 insulin with 25 mmol · L-1 glucose in HepG2 cells.② HepG2 cells were incubated with 2-NBDG (fluorescent labeled glucose)in a series of concentra-tion:50,100,200,400,600,800 μmol·L-1 and a series of incubation time:20,40,60,80,100 min, to select the optimum concentration of insulin and the optimum incubation concentration and time of 2-NBDG in HepG2 cells.The success of the model was deter-mined by detecting the consumption of glucose in the cell supernatant and the uptake of glucose in HepG2 cells.③To study the effect of berberine hydrochloride on improving insulin resistance on the cell level,met-formin and berberine hydrochloride were used in the IR cells.Results Six concentrations of insulin induced the IR model in different degrees.Although 10 -4, 10 -5 mol·L-1 insulin was significant,a large amount of cells died.10 -6 mol·L-1 insulin was effective and had high survival rate of HepG2 cells,which had sta-tistical significance compared with the normal group. When the incubation concentration of 2-NBDG was more than 100 mol·L-1 ,the fluorescence intensity of the cells was significantly different from the normal group.When the incubation time of 2-NBDG was more than 20 min,fluorescence intensity was significantly different from the normal group.When the incubation time of 2-NBDG was more than 100 min,the fluores-cence quenching phenomenon was obvious in the cells. Berberine hydrochloride and metformin significantly in-creased the glucose consumption and glucose uptake in cell supernatant, which had statistical significance compared with the model group.Conclusions Using 10 -6 mol · L-1 insulin induced IR model in HepG2 cells,the optimum incubation concentration and incu-bation time of 2-NBDG is 200 μmol·L-1 and 80 min, respectively.Berberine hydrochloride and metformin have obvious effect on improving IR in HepG2 cells.

Objective To investigate the incidence of contrast-induced nephropathy (CIN) in the elderly undergoing coronary angiography and the correlated clinical risk factors.Methods 0.90% sodium chloride (1 ml · kg~-1 · h~-1 ) was administered 6 hours before and 12 hours after contrast media administration for 195 elderly patients,and the dose of sodium chloride was half when the patients were suffering from severe congestive heart failure.The levels of serum creatinine (Scr) and cystatin C were measured 3 days before and on the 2nd,5th day after the administration of contrast,respectively .Results(1) The incidence of CIN was 8.7% (17/195).The renal function of 11 cases recovered to baseline level 3 months after the use of contrast,2 cases had transformation to chronic renal failure but without undergoing maintenance hemodialysis,and 3 cases were dependent on maintenance hemodialysis,while 1 case developed multiple organ dysfunction until death.(2) There was no significant difference between pre-and post-contrast administration in the level of cystatin C (t=O.137,P= 0.891). But the concentration of Scr was reduced significantly on the 2nd day compared with the baseline (t=4.776,P = 0.000).Both the cystatin C and Scr recovered to the baseline on the 5th day.(3) There were no significant differences between the CIN and non-CIN group in gender,the dose of contrast,the baseline Scr,and the proportion of coronary heart disease.But there were significant differences in age,the baseline serum cystatin C,the proportions of diabetes mellitus,hypertension and congestive heart failure.(4) The clinical risk factors of CIN were the baseline Scr (OR = 1.039),the baseline serum cystatin C (OR=6.654),diabetes mellitus (OR=8.104) and congestive heart failure (OR=9.597) according to the analysis of logistic regression.ConclusionsWith the hydration and the use of low-osmolar nonionic contrast,it is safe to receive contrast examination for the elderly patients.The baseline serum levels of Scrand cystatin C,diabetes mellitus and congestive heart failure are the clinical risk factors of CIN.Compared with Scr,serum cystatin C is the more powerful predictor for the development of CIN.

Objective To systematically evaluate the efficacy and safety of 125I seed implantation for treatment of advanced pancreatic cancer.Methods An electronic literatuire search was performed about randomized controlled trials(RCTs) of 125I implantation for treamtent of advanced pancreatic cancer in CNKI,Wanfang Data,CBM,Cochrane Library,PubMed and Embase (from the date of building the database to November 2016).Two investigators independently screened literature,extracted data and assessed the risk bias of included studies,and the Meta-analysis was performed by using Revman 5.3software.Results There were 12 RCTs (n =689) included.Meta-analysis showed that the objective respond rate(ORR) (OR =3.24,95％CI2.33-4.52,P＜0.001),the 6-month survival rate(OR =3.61,95％ CI 1.53-8.52,P =0.003),the 12-month survival rate(OR =4.80,95％ CI 2.40-9.57,P ＜ 0.001) and the relief rate of pain were higher than those in the control group.However,there were no significant differences between both groups in the 2-year survival rate and the adverse reaction rate,which were (OR=2.36,95％ CI 0.47-11.74,P =0.29) and (OR =4.94,95％ CI 1.05-23.23,P =0.04),respectively.Conclusions The limited current evidence showed that 125I implantation for treatment of advanced pancreatic cancer is effective and safety.125I implantation can improve the ORR,short-time survival rate and pain relief rate.In addition,there was no significant increase in the incidence of related adverse events except for seed malposition.Although the quality and quantity of evidences is limited,it merits further study to provide high quality evidences.

Objective To evaluate the clinical effectiveness and safety of stents loaded with 125I seeds compared to conventional stents.Methods Literatures were searched in PubMed,EMbase,Cochrane Library,CBM,CNKI,Wanfang Data and other electronic databases from inception to November 2016.Two reviewers independently screened the literature according to the inclusion and exclusion criteria,extracted data and assessed quality of the included studies independently.Meta-analyses were performed using RevMan 5.3.Results A total of five RCTs and 14 CCTs involving 1 211 patients were included.The mean survival time of the 125I stent group was significantly higher than that of the control group [mean difference =4.11,95％ CI (2.16-6.07)P ＜0.001].The incidence of restenosis after 3:The available data showed that the incidence of re-staging of 125I stent in the treatment group was lower than that of the normal stent group [RR =0.23,95％ CI(0.12-0.62),P =0.002].Postoperative bleeding [RR =0.80,95％CI (0.52-1.23),P=0.30];Postoperative pain[RR=1.06,95％CI(90.88-1.27),P=0.55];postoperative stent shift [RR =0.53,95％ CI(0.27-1.05),P =0.07].The difference of incidence of complications was not statistically significant.There was no difference in the incidence of complications between the two groups.Conclusions The available data suggest that 125I stent is superior to common stent in the treatment of advanced esophageal cancer.There are no differences found in the incidence of complications between 125I stent and conventional stent.However,due to the limited quality of the included studies,more high-quality and multicenter-based studies are needed to verify the above conclusion.

Objective To explore the safety,effectivity and dosimetric continence of 3D-printing coplanar template(3D-PCT)combined with CT-guided 125I seed implantation in the treatment of non-small cell lung cancer(NSCLC).Methods From May 2014 to November 2016,a total of 20 NSCLC patients who were suitable for 125I seed implantation were recruited in this study.Of all the patients,10 received 125I seed implantation treatment by CT-guided combined with 3D-PCT (3D group),and the rest,by freehand puncture combined with CT-guided 125I seed implantation (free-hand group).During two days before the surgery,the patients received the CT scan.Then the digital imaging and communications in medicine (DICOM) was collected to input to the Brachytherapy Treatment Planning System (BTPS).The dose parameters including D90,D100,V100,V150,conformal index(CI),external index(EI),and homogneneity index(HI) were compared between pre-operation and post-operation.Pair t-test and single sample t-test were performed.Results V150 in 3D group between preoperation and postoperation showed statistically significant difference (t =-2.916,P ＜ 0.05),and there was no significant difference in the rest parameters(P ＞ 0.05).However,the number of seeds,V100,EI,HI in free-hand group between preoperation and postoperation showed statistically significant difference (t =-2.516,2.492,4.725,7.258,P ＜0.05),and there was no significant difference in the rest parameters(P ＞0.05).Comparison of indicuted that there was significant difference in V100,V150,CI,EI,HI and dose error rate between the 3D group and the free-hand group with single sample t test,the result showed V100,CI,EI,HI between two groups(t =2.598,2.278,4.637,4.616,-4.785,P ＜0.05),and there was no significant difference in V150 (P ＞ 0.05).Conclusions CT-guided 125I seed implantation brachytherapy combined with 3D-PCT for treatment of NSCLC safe is feasible,and dose controllable,and there is a certain advantage in the spatial distribution of seed compared with free-hand puncture.

Objective:To investigate the feasibility, efficacy, and safety of CT- and bronchoscopy-guided 125I seed implantation in the treatment of central lung cancer complicated with atelectasis. Methods:Retrospective analysis was conducted on twenty-nine patients who were treated from May 2016 to Oct 2019 in the Second Hospital of Tianjin Medical University for central non-small-cell lung carcinoma complicated with pulmonary atelectasis that was inoperable due to medical reasons. 125I seeds were implanted into the trachea under the guidance of bronchoscopy first.The 125I seeds were then implanted into the hilum of the lungs by percutaneous puncture under the guidance of the CT and template.The seed activity was 18.5-29.6 MBq, and the prescription dose was 120 Gy.TPS planning and quality verification were performed before and after the operations.The rate of atelectasis recanalization, the satisfactory rate of dose verification, the improvement of dyspnea index, the survival time, and the adverse events during and after operation were observed. Results:All 29 patients with lung cancer complicated with atelectasis successfully completed the seed implantation, and the satisfactory rate of quality verification was 93.1%.The rate of atelectasis recanalization at 2, 6, 12, 18, and 24 months was 93.1%, 89.7%, 78.6%, 76.2%, and 60%, respectively.Their dyspnea and anoxia symptoms were significantly relieved in 5-28 months after treatment.The results showed that the patients′ dyspnea index was 2.8-0.8 before treatment and 1.4-0.9 after treatment.The median follow-up period was 20 months and median survival was 21 months.Adverse events associated with the radiation therapy included pneumothorax, hemoptysis, cough, fever, and particle displacement.No level-3 or more serious adverse events occurred.Conclusions:The CT- and bronchoscopy-guided 125I seed implantation is a safe and effective therapy option for the treatment of central non-small-cell lung carcinoma associated with atelectasis.It contributes to a high rate of local recanalization, and can rapidly improve clinical conditions and quality of life of the patients with few adverse reactions.

Objective:To investigate the application effect of dexmedetomidine combined with propofol and remifentanil in fiberoptic bronchoscopy in elderly patients with chronic obstructive pulmonary disease(COPD).Methods:From October 2018 to November 2019, 112 elderly patients with COPD who were examined by fiberoptic bronchoscopy in the Affiliated Hospital of Medical College of Ningbo University were divided into control group and observation group, with 56 cases in each group.Propofol and remifentanil were used for anesthesia induction in both two groups.Dexmedetomidine (0.5μg/kg) was injected intravenously into observation group, and later 0.5μg·kg -1·h -1 continuous infusion, the control group was given the same dose of 0.9% sodium chloride injection.The OAA/S scores, propofol dosage, remifentanil dosage, wake-up time, heart rate, oxygen saturation, mean arterial pressure, pulmonary function changes and adverse reactions were compared between the two groups. Results:At the fiberbronchoscope entered immediately and 10 min after examination, the OAA/S scores in the observation group were (1.03±0.35)points, (4.42±0.28)points, respectively, which in the control group were (1.22±0.22)points, (3.01±0.22)points, respectively, the differences between the two groups were statistically significant( t=3.439, 29.631, all P<0.05). The dosages of propofol and remifentanil in the observation group were (3.00±0.28)μg/kg and (1.65±0.29)μg/kg, respectively, which were less than those in the control group [(3.70±0.39)μg/kg, (2.42±0.45)μg/kg], the recovery time was (8.40±1.58)min, which was shorter than that in the control group [(13.31±2.02)min], the differences were statistically significant( t=10.911, 10.763, 14.327, all P<0.05). The heart rate, oxygen saturation, mean arterial pressure, pulmonary function(FEV 1, MVV) in the observation group were significantly better than those in the control group( t=9.757, 11.981, 11.486, 11.913, 40.189, all P<0.05). The incidence of adverse reactions in the observation group was 7.14%(4/56), which was lower than 19.64%(11/56) in the control group(χ 2=6.737, P<0.05). Conclusion:Dexmedetomidine(0.5μg/kg, followed by 0.5μg·kg -1·h -1 continuous infusion) and target controlled infusion of propofol and remifentanil are safe for elderly patients with COPD, and the use of anesthetic drugs is small, which can shorten the recovery time after operation, and will not have a great impact on respiratory circulation.

Objective:To analyze the efficacy and the adverse reactions of conventional treatment-failed advanced refractory ovarian cancer cases after treatment with apatinib.Methods:Six patients enrolled in the Second Hospital of Tianjin Medical University from June 2015 to October 2015 received treatment with apatinib. Treatment efficacy was evaluated by imaging and analysis of tumor markers,including CA125,CEA,and NSE.Results:The age range of the six patients was 48-71 years(median:55 years).Their histopath-ological subtypes included poorly differentiated serous cystadenocarcinoma(4/6),borderline papillary adenoma(1/6),and clear cell carcinoma(1/6).Clinical evaluation of patients revealed no cases with complete remission,two cases with partial response,one case with stable disease,and three cases with progressive disease.The objective response rate was 33%(2/6)and the disease control rate was 50%(3/6).In all patients,the main side effects were hypertension and hand-foot syndrome,which were controlled.Conclusions:The treatment of conventional treatment-failed advanced refractory ovarian cancer with apatinib has better exact effects,and medical toxicity can be controlled.In the future,to seek more effective treatment strategies,the mechanism of apatinib in the treatment of ad-vanced ovarian cancer should be further explored.