OBJECTIVE： To study the disease distribution and lethal factors of ADRs in 28 fatal cases,so as to improve the prophylactic measures for diseases and rationality and therapeutic effect of drug-use.METHODS： According to ADRs evaluation standard,the cases who died in this hospital in recent 2 years were analysed with computer internet.RESULTS： 28 cases directly died of ADRs.Insulin and glibenclamidium were the most common lethal agents,accounting for 32.14％ ,and mannitol and azathiopurine were the next ones.Senile patient accounted for 63.28％ of all patients died of ADRs.CONCLUSION： (1)Rational drug-use has clinical significance in reducing mortality of geratic diseases.(2)It will be an important way in reducing the fatality of ADRs that we inquire about patients' illness carefully and handle the indications and dosages of drugs seriously.

Objective Comparison of three different molecular assays for the detection and molecular characterization of circulating tumor cells in breast cancer .Methods The retrospective study compared three different molecular assays to detect CTC in the peripheral blood of 30 healthy individuals and 71 benign breast disease patients and 83 early and 84 metastatic breast cancer patients .All samples were collected at the outpatient , inpatient and physical examination department of Sichuan Provincial People ′s Hospital from January 2011 to June 2014.The same cDNAs were analyzed by:singleplex RT-qPCR assay for BCL-2, multiplex RT-qPCR for BCL-2, HER-2, HMAM, and a commercially available molecular assay (AdnaTest BreastCancer ) for GA733-2, MUC-1, HER-2.The positive of CTC were compared among healthy individuals and benign breast disease patients and breast cancer patients .Chi square test was used to compare the expression of gene markers among the three groups , and the agreement of Kappa test was used to evaluate the method.Results (1) Detection rates of early breast cancer by single RT-qPCR, Adna kits and multiple RT-qPCR were 13.3%, 16.9% and 18.1%, respectively , and the detection of metastatic breast cancer were 31.0%, 42.9%and 35.7%, respectively.There were significant differences in the positive of CTC by three molecular assays between healthy individuals and benign breast disease patients and early breast cancer patients ( The test values were 4.235 and 4.301, 5.367 and 5.474, 5.894 and 6.023 respectively, P<0.05).There were no differences between benign breast disease patients and early breast cancer patients (The test values were 0.891,0.748 and 0.701 respectively,P >0.05) .There were significant differences between metastasis breast cancer patients and healthy individuals and benign breast disease patients and early breast cancer patients ( The test values were 8.429,7.553 and 7.061;10.24, 9.025 and 8.745; 9.658, 8.417 and 8.201 respectively,P<0.05).(2) In early breast cancer: The concordance between AdnaTest and single RT-qPCR was 79.5%while between AdnaTest and multiplex RT-qPCR was 77.1%.No agreement was found among them ( The test values were 1.065 and 1.871, P were 0.371 and 0.258 ) .The concordance between single RT-qPCR and multiplex RT-qPCR was 80.7%.No agreement was found between them (The test values was 2.814, P was 0.156).(3) In patients with overt metastasis:The concordance between AdnaTest and single RT-qPCR was 78.6%( The test values was 10.986).While between AdnaTest and multiplex RT-qPCR was 80.9%( The test values was 9.251 ) . Agreements were found among them ( P was 0.002 and 0.005 respectively ) .The concordance between single and multiplex RT-qPCR was 88.1%( The test values was 12.364 ) .Agreement was found between them (P was 0.001).Conclusions No correlations were found among different molecular methods to detect CTC in the early primary breast cancer , but correlations were found in the metastatic breast cancer , suggesting that different rate of CTC caused by the number of CTC and its heterogeneity should be considered to the clinical diagnosis and treatment of breast cancer while molecular method is used .

Objective To compare the accuracy of cone-beam computed tomography (CBCT ) and periapical radiography in the diagnosis of simulated external apical root resorption (EARR) .Methods The study sample comprised 160 single-rooted premolars for simulating 4 degrees of EARR :no(intact teeth) ,mild(cavity of 1 .0 mm in diameter and depth in root surface) ,moderate(1 .0 mm root shortening) ,and severe(3 .0 mm root shortening) .Two sets of radiographic images were acquired with CBCT and periapi-cal radiography .The severity for all resorption lesions were evaluated blindly by one calibrated examiner .The percentages of correct classification of each degree of EARR were compared between the two imaging techniques using McNemar test .Results With CBCT method ,the percentages of correct classification of no ,mild ,moderate ,severe and all EARR were 95 .0% ,97 .5% ,42 .5% , 87 .5% and 80 .6% ,respectively ;with periapical radiography method ,the percentages were 85 .0% ,42 .5% ,70 .0% ,92 .5% and 72 .5% ,respectively .Significant differences were found between the two imaging techniques for evaluating mild ,moderate ,and all-EARR(P<0 .05) .Conclusion CBCT imaging is more reliable than periapical radiography for detecting EARR ,whereas it is not sensitive to moderate root shortening .In orthodontic practices ,CBCT could be applied to the early diagnosis of EARR ,in order to help make the decision on continuation and modification of orthodontic treatment .

Objective To investigate the echocardiographic features and clinical significance of prenatal diagnosis of total anomalous pulmonary venous connection (TAPVC). Methods Fetal echocardiographic images of 13 fetuses with TAPVC conifrmed by pathology or postnatal echocardiography were reviewed. Echocardiographic features and clinical signiifcance of prenatal diagnosis of TAPVC were summarized. Results Twelve fetuses with TAPVC were diagnosed prenatally by fetal echocardiography, including seven cases of supracardiac type, three cases of infracardiac type and two cases of intracardiac type. The common echocardiographic characteristics of 12 fetuses with TAPVC included slightly size discrepancy of left heart and right heart, large foramen ovale with increased shunting at the atrial level, increased distance between left atrium (LA) and descending aorta, absent insertions of pulmonary veins in the LA, presence of pulmonary venous conlfuence on the top of LA and dilatation of vessels where pulmonary venous conlfuence drained. One case was missed prenatally and intracardiac type TAPVC was diagnosed by postnatal echocardiography. Among the 13 cases, three were isolated and the other ten were all in association with other abnormalities. Conclusions There are fetal echocardiographic characteristics of TAPVC. Fetal echocardiography plays an important role in prenatal diagnosis of TAPVC.

Objective To investigate the levels of serum soluble CDI4(sCD14)in patients early after renal transplantation and the relationship between sCD14 and allograft rejection.Methods This se- ries included 51 consecutive patients undergoing renal transplantation.We prospectively determined levels of serum sCD14 at 1 h before transplantation(d 0)and the first 10 d after transplantation(d 1-10).The ser- um creatinine(Cr)levels were recorded at the same time.The patients were divided into 2 groups(rejection and non-rejection groups)according to whether they experienced acute rejection or not during the first 14 d after transplantation.The levels of serum sCD14 and Cr between the 2 groups were compared.Results Of 51 cases,13 experienced acute rejection,and the mean time from postoperation to rejection start was 7 d;38 cases had no rejection.On d 0,the Cr levels of rejection group[(789?221)?mol/L]and non-rejection group[(742?234)?mol/L]had no significant difference(P＞0.05).The Cr level was higher in rejection group than in non-rejection group on d 1-10.In the 2 groups,the Cr levels of d 3 and d 5 to d 10 were (237?104)vs(160?70),(176?85)vs(117?46),(174?81)vs(112?40),(173?81)vs(112?39),(209?53)vs(112?38),(203?73)vs(103?35),(181?50)vs(102?31)?mol/L,respective- ly,with significant difference between them(P＜0.05).The serum sCD14 levels on d 0 in rejection group [(9.55?5.71)mg/L]and non-rejection group[(8.99?3.89)mg/L]had no significant difference.The sCD14 levels were higher in rejection group than in non-rejection group on d 1-5[(15.52?6.60)vs (9.85?4.11),(15.48?5.85)vs(7.53?3.79),(12.15?4.45)vs(5.88?3.95),(10.84?4.11) vs(4.88?3.17),(7.61?5.37)vs(4.66?1.91)mg/L,respectively]with significant difference(P＜0.05).The sCD14 levels in the 2 groups on d 1 were elevated compared with those on d 0,then decreased gradually.Conclusions It is suggest that the increase in serum sCD14 levels occurs earlier than clinically acute rejection.The serum sCD14 levels on d 1-5 after transplantation can serve as important predictors for acute renal graft rejection.

Objective To construct an in vitro phenotypic analysis technology for evaluating the impact of I233V mutation in the hepatitis B virus(HBV)reverse transcriptase(rt)domain on adefovir (ADV)resistance.Methods A site-directed mutagenesis was used to construct recombinant HBV plasmid containing rtI233V,rtA181V and rtN236T.The culture solution with varied concentration ADV was added after the transient transfection of hepatocyte-derived cell lines with recombinant wild type and mutant HBV clones.Three days later,the cells were harvested and the replicable intermediate was detected by the Southern blot assay.The half maximal inhibitory concentration (IC50) and folds of resistance were calculated by the Table Curve2D software according to the Southern blot results.Results The variant harboring rtI233V mutation exhibited a 6.5-fold decrease of susceptibility to ADV with IC50 of(1.69±0.52)/μmol/L compared to the wild type HBV.Conclusion The findings suggest that the emergence of a single substitution at position rtI233V is sufficient to induce resistance to ADV.

Objective To analyze the risk factors associated with multiple organ dysfunction syndrome (MODS) in children after cardiopulmonary bypass (CPB).Methods Between Jan 2001 and Dec 2010,1 899 patients undergoing open heart surgery were reviewed retrospectively according to the presence or absence of MODS.Univariate and multivariate logistic regression analysis were used to identify the risk factors.Results Thirty-five patients (1.84％) developed MODS,the mortality for MODS was 51.43％ (18/35).Univariate risk factors included complex congenital heart disease,perioperative unexpected events,CPB time,aortic cross-clamping time,mechanical ventilation time,and postoperative spsis.Multivariate logistic regression analysis identified that complex congenital heart disease,perioperative unexpected events,CPB time ＞ 180 min,postoperative spsis were risk factors.Conclusion The results suggest that the patients with MODS risk factors described above need more careful peri and post operative surveillance and preventive management.

Objective To evaluate the effects of inhaled nitric oxide (iNO) in management of postoperative pulmonary hypertension in the patients with congenital heart disease. Methods Thirty-two children with refractory pulmonary hypertension or pulmonary hypertensive crisis after open heart operations for congenital heart disease were treated with iNO. The changes of hemodynamics were observed. Results In iNO therapy group,the mean pulmonary artery pressure(mPAP) decreased from (38.0 ±3.2) mm Hg to (28.0 ±2.1) mm Hg,pulmonary vascular resistance (PVR) decreased from (62.2 ±6.7) kPa/(L·S) to (49.9 ±5.6) kPa/(L·S) ,PaO2/FiO2increased from (67.0 ±30. 1 ) mm Hg to (92. 6 ±25.0) mm Hg,and arterial oxygen saturation increased from 0. 78 ±0. 14 to 0. 84 ±0. 09 respectively. No toxic side effect was observed.Conclusion iNO is effective, safe to reduce pulmonary hypertension. It may play an important role in the treatment of postoperative pulmonary hypertension or pulmonary hypertensive crisis in the patients with congenital heart disease.

OBJECTIVETo observe the clinical effect of Huikangling Tablet (HT, extracted from Scabrous Patrinia root) on peripheral blood micrometastasis of differentiated thyroid carcinoma (DTC) patients.

METHODSTotally 87 DTC patients with positive micrometastasis were randomly assigned to the treatment group (45 cases) and the control group (42 cases). DTC endocrine inhibition treatment standards were executed in all patients. They all took levothyroxine sodium (50 microg/tablet, from low dose, 25 microg each time, once per day, 0.5 h before breakfast), and its dosage was gradually added one week later. The dosage was adjusted according to tested results of TSH combined recurrence risk stratification and endocrine suppression induced adverse reactions risk stratification. Patients in the treatment group took HT (0.4 g per tablet, 3 tablets each time, three times per day for a total of 12 weeks) combined TSH suppression therapy, while those in the control group only received TSH suppression therapy. Peripheral micrometastatic cytokeratin 19 (CK19) and polymorphic epithelial mucin1 (MUC1) were detected by FCM at week 4 and 12. Meanwhile, distant metastasis and adverse reactions were observed.

RESULTSAfter 4-week treatment positive micrometastasis was shown in 18 cases (40%) of the treatment group and 29 cases (69%) in the control group with statistical difference (chi2 = 5.68, P < 0.05). After 12-week treatment positive micrometastasis was shown in 7 cases (15.6%) of the treatment group and 17 cases (44.7%) in the control group with statistical difference (chi2 = 8.49, P < 0.01). Pulmonary metastasis occurred in 2 cases and bone metastasis in 1 case of the control group at follow-ups. Cervical lymph node metastasis without accompanied recurrence of thyroid cancer occurred in one case of the treatment group. No obvious liver or renal abnormalities occurred.

CONCLUSIONHT inhibited peripheral blood micrometastasis of DTC patients and its mechanism needed to be further studied.

Antineoplastic Agents ; pharmacology ; therapeutic use ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Humans ; Neoplasm Micrometastasis ; drug therapy ; Neoplasm Recurrence, Local ; Tablets ; Thyroid Neoplasms ; drug therapy

Sphingosine-1-phosphate(S1P) is an important bioactive lipid produced from cell membrane sphingomyelin metabolism process.S1P and cell membrane surface S1P receptors(S1PR1-5) are G protein coupled receptors(GPCRs), which influence the formation of new blood vessels in the immune system via combining the related inflammatory signaling pathway.This review describes briefly the effects of S1P and S1PRs on autoimmune disease angiogenesis through intracellular signal transduction, such as rheumatoid arthritis, multiple sclerosis, colitis, systemic lupus erythematosus.Further research will be a new therapeutic target on vascular inflammation of autoimmune diseases.