OBJECTIVE:To observe clinical efficacy and safety of salvianolate in the treatment of acute exacerbation of chron-ic obstructive pulmonary disease(AECOPD). METHODS:80 AECOPD patients were selected and randomly divided into observa-tion group and control group,with 40 cases in each group. Both groups received mechanical ventilation. Control group was given routine treatment of theophyllinum,bronchodilators and glucocorticoid;treatment group was additionally given Salvianolate injec-tion 200 mg,qd,ivgtt,on the basis of control group. Clinical efficacy was observed in 2 groups,blood hemorheology indexes were also observed before and after treatment. The mechanical ventilation time,ICU residence time and ADR were recorded in 2 groups. RESULTS:Clinical total effective rate of observation group was 95.00%,which was significantly higher than 70.00% of control group,with statistical significance(P<0.05). Before treatment and 2 d after treatment,blood rheology indexes of treatment group were improved significantly(all P>0.05),and whole blood reduction viscosity of control group was improved significantly(P<0.05). Mechanical ventilation time and ICU residence time of treatment group was significantly shorter than that of control group (P<0.05). No ADR was found in 2 groups. CONCLUSIONS:Salvianolate can significantly improve the blood coagulation status of AECOPD patients receiving invasive mechanical ventilation,and has the advantages of good clinical efficacy and low cost of medical treatment.

Identification of the native habitat of Chinese medicine decoction pieces plays an important role in the use of Chinese Heber medicine. However, the traditional method always based on subjective description, lack of quantitative information. In this study, nanomechanical analysis of Ophiopogonis Radix, Polygonati Odorati Rhizoma and Curcumae Aromaticae Radix coming from different districts was carried out by using the force-distance curve of atomic force microscopy (AFM), including stiffness (represented by the slope of the force curve) and adhesion work (calculated via the adhesion area of the retrace line in force-distance curve). The results showed that the Ophiopogonis Radix from Sichuan province (slope 0.03 +/- 0.001) was significantly stiffer but less sticky [adhesion work 393.98 +/- 49.21 x 10(-10)) J] in comparison with that from Hubei province [slope 0.018 +/- 0.001, adhesion work (985.67 +/- 91.61) x 10(-10) J]; the Polygonati Odorati Rhizoma Hunan province was stiffer (slope 0.03 +/- 0.002) and stickier [adhesion work (413.67 +/- 92.58) x10(-10) J] than that from Dongbei province [slope 0.019 +/- 0.002, adhesion work (27.37 +/- 11.05) x 10(-10) J]; the Curcumae Aromaticae Radix from Sichuan province was also stiffer (slope 0.019 +/- 0.0017) but less stickier [adhesion work (1179.79 +/- 225.05) x 10(-10) J] than that from Hubei province [slope 0.013 +/- 0.0006, adhesion work (2831.27 +/- 93.71) x 10(-10)]. It is indicated that changes in mechanical properties of Chinese medicine decoction pieces correlate well with their origin. This method may provide quantitative information for the identification of the native habitat of Chinese medicine decoction pieces.
Drugs, Chinese Herbal ; chemistry ; Ecosystem ; Medicine, East Asian Traditional ; methods ; Microscopy, Atomic Force ; methods

When faced with a case of bilateral breast cancer (BBC), understanding how to differentiate bilateral primary breast cancer from contralateral metastatic breast cancer is essential for treatment, but clear identification criteria have not been established to date. Diverse events play different roles in the therapy and prognosis of BBC; hence, it is of great significance to detect a more comprehensive and convincing technique to make an accurate differential diagnosis. We report a rare case of synchronous BBC in a 61-year-old Chinese woman. Based on her clinical and pathological features and the use of whole exome sequencing and cancer genome analysis, we concluded that the patient developed contralateral metastatic breast cancer which metastasized from left to right. Therefore, together with clinical, pathological and cancer genomics information, we could precisely define the origin and evolution of BBC.
Asian Continental Ancestry Group ; Breast Neoplasms ; Breast ; Diagnosis ; Diagnosis, Differential ; Exome ; Female ; Genome ; Genomics ; Humans ; Middle Aged ; Neoplasm Metastasis ; Prognosis

Surgical resection is the best method for patients with colorectal cancer liver metastases. However, tumor recurrence rate is still high after surgery. Preoperative chemotherapy can help shrink the tumor, test biological behavior, and reduce recurrence rate; but it may also cause liver injury and delay surgery. There is still controversy whether neoadjuvant chemotherapy should be performed and how to select patients from chemotherapy before surgery. Thus, in this article, combined the research progress and the clinical experience of author's center, we discuss this issue in 4 aspects: the development of neoadjuvant chemotherapy; the indications and guideline recommendation for neoadjuvant chemotherapy; the selection of neoadjuvant chemotherapy regimens; common problems in neoadjuvant chemotherapy.

Objective:To investigate the drug-resistant mutations of human immunodeficiency virus-1 (HIV-1) in patients who received highly active antiretroviral therapy (HAART) from 2014 to 2018.Methods:A total of 880 patients with HIV-1 infection who had been treated with HAART for more than six months in Chongqing Infectious Disease Medical Center from May 2014 to December 2018 were enrolled. Plasma samples were collected, and one-step reverse transcription-polymerase chain reaction (PCR) and nested PCR were taken to amplify protease and reverse transcriptase regions of HIV-1 pol gene region. The obtained amplified nucleotide sequences were compared with the drug resistance database for antiviral drug resistance analysis. Viral genotyping tool software was used to analyze HIV-1 subtype distribution. The categorical variables were compared using chi-square test. Results:Among 880 patients, the plasma HIV-1 viral load was (4.12±0.63) lg copies/mL, the CD4 + T lymphocyte count was (251±124)/μL, and the median duration of antiviral therapy was 26 months. In the subtypes analysis, the circulating recombinant form (CRF) 01-AE subtype was the largest proportion of HIV-1 subtypes, accounting for 38.9%(342/880), and the CRF07-BC subtype accounted for 28.5%(251/880), B+ C subtypes accounted for 16.2%(143/880). Drug-resistant mutations were detected in 534 patients, with a total drug resistance rate of 60.7%. The drug resistance rates of nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse transcriptase inhibitors (NNRTI) and protease inhibitors (PI) were 51.0%(449/880), 58.6%(516/880) and 1.7%(15/880), respectively. The drug resistances to lamivudine, emtricitabine, efavirenz, and nevirapine were serious, and the medium/high resistance rates were 46.8%(412/880), 46.8%(412/880), 51.3%(451/880), and 53.6%(472/880), respectively, while those to zidomidudine (6.0%, 53/880), etravirin (9.0%, 451/880) and PI were not serious. M184IV (47.3%), K65R (22.2%) and K70RE (12.6%) were the most frequent mutations for NRTI. K103NS (25.1%), V106A (19.7%) and V179DE (14.4%) were the most frequent mutations for NNRTI. The most common drug-resistant mutations for PI were L10FIV (7.4%) and A71IVT (6.5%). The drug resistance rate of CRF01-AE subtype (69.3%, 237/342) was higher than those of CRF07-BC subtype (49.8%, 125/251) and B+ C subtype (51.0%, 73/143), the differences were statistically significant ( χ2=22.6 and 14.6, respectively, both P<0.05). Conclusions:The incidence of drug resistance is high among HIV-1 infected patients after six-month HAART treatment in Chongqing City. The drug resistance to NNRTI is the most common, followed by NRTI, while PI is less resistant. Drug resistance is the main reason for the virological breakthrough in HIV-1 infected patients.

Objective To evaluate the clinical efficacy of different combinations with "Shugan Jianpi" acupuncture and Yintang acupoint magnetic stimulation in the treatment of depression with liver depression and spleen deficiency type.Methods 160 patients with depression treated in hospital from December 2013 to June 2017 were divided into 4 groups according to the random number table,with 40 cases in each group.Group A received basic drug therapy," Shugan Jianpi" acupuncture combined with Yintang acupoint magnetic stimulation,group B received basic drug therapy combined with Yintang acupoint magnetic stimulation,group C received basic drug therapy combined with " Shugan Jianpi" acupuncture treatment,group D was treated with basic medicine only for 4 weeks.Hamilton Depression Scale (HAMD) was used to assess the short-term and long-term efficacy for 4 groups before treatment,after 2 weeks of treatment,after 4 weeks and 2 months after treatment and the safety of these 4 types of therapy was evaluated with the side effects scale (TESS).2 months after the treatment,the quality of life universal scale (SF-36) was evaluated for patients in 4 groups.Results After 2 weeks,4 weeks and 2 months of treatment,HAMD scores in the 4 groups were significantly lower than those before treatment (P＜0.05).After 2 weeks of treatment,HAMD score of A group was (15.28±3.45),and HAMD score of B,C,D group were ((18.30±3.57),(22.50±3.71),(27.30±4.82)) respectively.HAMD score of A group was significantly lower than those of B,C,D group (P＜0.05).After 4 weeks of treatment,HAMD scores in A,B group were significantly lower than those in C,D group (P ＜0.05).After 2 months of treatment,HAMD scores in all the 4 groups were further declined compared with those after 4 weeks of treatment (P＜ 0.05),however,there was no significant difference between the four groups (P＞0.05).The scores of each dimension of SF-36 in group A were significantly higher than those of group B,C and D (P＜0.05),and which in group B and C were significantly higher than those in D group after 2 months of treatment.(P＜0.05).There was no statistical difference among the 4 groups in TESS scores (P ＞0.05).Conclusion The results suggest that there is a synergistic effect in combination of the " ShuganJianpi" acupuncture combined with Yintang acupoint magnetic stimulation in the treatment of depression of liver qi stagnation and spleen deficiency type,and it can effectively reduce the degree and improve their quality of life in patients with depression.

OBJECTIVETo explore the clinicopathological characteristics, efficacy, and prognostic factors for patients with rectal gastrointestinal stromal tumor(GIST).

METHODSClinicopathological and follow-up data of 61 patients with rectal GIST in our department from January 1990 to October 2012 were analyzed retrospectively and pathology specimens were reviewed. Kaplan-Meier method was used to calculate the survival. Univariate analysis and multivariate analysis were performed to investigate the influencing factors of prognosis with Log-rank test and Cox regression model.

RESULTSThere were 42 male and 19 female patients with a median age of 59 years old. Eighteen cases(29.5%) were confirmed preoperatively as GIST by biopsy and 46 cases were diagnosed as GIST by first pathological examination. Fifteen cases(24.6%) were revised as GIST after re-examination of specimes among whom 14 cases had been diagnosed as leiomyoma or sarcoma, and 1 as neurolemmoma. Tumor location was above peritoneal reflection in 12 cases(19.7%) and below peritoneal reflection in 49(80.3%). Fifty-two patients underwent surgery, including 21 extended resections(lymph nodes clearance and combined organs resection simultaneously) and 31 local resections(tumor rejection or partial resection of rectal wall). Eleven patients received preoperative imatinib(400 mg/d). Forty-one cases received imatinib therapy after operation or biopsy diagnosis, including 25 cases who received palliative treatment for postoperative recurrence. Median follow-up time was 55(6 to 391) months and follow-up longer than 2 years was carried out in 46 patients. Overall survival rates of 1-, 2-, 3- , 5-year were 98%, 95.6%, 86.0% and 73.7% respectively. There were no significant differences between local resection group(96.4%, 92%, 83.3% and 77.3%) and extended resection group (100%, 94.7%, 89.50% and 82.6%)(χ(2)=0.004, P=0.947). Univariate analysis showed that survival was only associated with recurrence and metastasis (χ(2)=4.292, P=0.038). Multivariate Cox analysis showed postoperative survival was not associated with any factors(all P>0.05). The 3-year survival rate of patients with postoperative recurrence or metastasis receiving imatinib therapy was better as compared to those who did not received imatinib(82.7% vs. 71.4%).

CONCLUSIONSRectal GIST are more common in the lower rectum. Surgery is the main treatment for rectal GIST. Local complete resection is the mainstay treatment. Extensive resection and lymph node clearance may not improve survival. Imatinib can improve the prognosis of patients with recurrence or metastasis.

Benzamides ; Female ; Gastrointestinal Stromal Tumors ; therapy ; Humans ; Imatinib Mesylate ; Male ; Neoplasm Recurrence, Local ; Piperazines ; Prognosis ; Pyrimidines ; Rectal Neoplasms ; pathology ; therapy ; Retrospective Studies ; Survival Rate

Bacteremia induced by periodontal infection is an important factor for periodontitis to threaten general health. P. gingivalis DNA/virulence factors have been found in the brain tissues from patients with Alzheimer's disease (AD). The blood-brain barrier (BBB) is essential for keeping toxic substances from entering brain tissues. However, the effect of P. gingivalis bacteremia on BBB permeability and its underlying mechanism remains unclear. In the present study, rats were injected by tail vein with P. gingivalis three times a week for eight weeks to induce bacteremia. An in vitro BBB model infected with P. gingivalis was also established. We found that the infiltration of Evans blue dye and Albumin protein deposition in the rat brain tissues were increased in the rat brain tissues with P. gingivalis bacteremia and P. gingivalis could pass through the in vitro BBB model. Caveolae were detected after P. gingivalis infection in BMECs both in vivo and in vitro. Caveolin-1 (Cav-1) expression was enhanced after P. gingivalis infection. Downregulation of Cav-1 rescued P. gingivalis-enhanced BMECs permeability. We further found P. gingivalis-gingipain could be colocalized with Cav-1 and the strong hydrogen bonding between Cav-1 and arg-specific-gingipain (RgpA) were detected. Moreover, P. gingivalis significantly inhibited the major facilitator superfamily domain containing 2a (Mfsd2a) expression. Mfsd2a overexpression reversed P. gingivalis-increased BMECs permeability and Cav-1 expression. These results revealed that Mfsd2a/Cav-1 mediated transcytosis is a key pathway governing BBB BMECs permeability induced by P. gingivalis, which may contribute to P. gingivalis/virulence factors entrance and the subsequent neurological impairments.
Animals ; Rats ; Bacteremia/metabolism* ; Blood-Brain Barrier/microbiology* ; Caveolin 1/metabolism* ; Gingipain Cysteine Endopeptidases/metabolism* ; Permeability ; Porphyromonas gingivalis/pathogenicity* ; Transcytosis ; Virulence Factors/metabolism*

OBJECTIVE: To investigate the evaluation value of preoperative peripheral blood lymphocyte-to-monocyte ratio (LMR) on the prognosis of patients with stage III colon cancer undergoing radical resection and postoperative adjuvant chemotherapy. METHODS: Electronic medical record were retrospectively retrived for stage III colon cancer patients who underwent radical surgery at Sun Yat-sen University Cancer Center from December 2007 to December 2013. Inclusion criteria were pathologically comfirmed colon adenocarcinoma, complete clinicopathological data, and postoperative XELOX (oxaliplatin + capecitabine) chemotherapy with follow-up of at least 3 months. Patients with neoadjuvant anti-tumor therapy, infectious disease, other malignant tumors and death of non-tumor causes within 3 months after operation were excluded. A total of 258 patients were included in this retrospective cohort study, including 146 males and 112 females with median age of 55 (22 to 85) years. Tumors of 100(38.8%) patients were located in the right hemicolon, and of 158 (61.2%) in the left hemicolon. Tumors of 194(75.2%) patients were highly and moderately differentiated, and of 64 (24.8%) were poorly differentiated. According to the TNM tumor pathological stage of AJCC 7th edition, 196 (76.0%) patients were stage IIIA to IIIB, and 62(24.0%) patients were stage IIIC. The median preoperative CEA was 3.8 (0.3 to 287.5) μg /L and the median cycle of the adjuvant chemotherapy was 6 (1 to 8). The cut-off value of preoperative LMR in prediction of 3-year overall survival (OS) outcome was determined by receiver operating characteristic (ROC) curve analysis. All patients were divided into low LMR group and high LMR group according to the critical value. Clinicopathological characteristics between the two groups were compared by using chi-square test or Fisher's exact test as appropriate. The 3-year disease-free survival and overall survival rate were estimated with the Kaplan-Meier method, and differences between two groups were assessed with the log-rank test. Univariate and multivariate analyses were performed through Cox regression model. RESULTS: ROC curve showed that the cut-off value of preoperative LMR in predicting 3-year overall survival was 4.29. Then 143 patients were divided into low LMR group (LMR<4.29) and 115 patients into high LMR group (LMR ≥ 4.29). Compared with high LMR group, the low LMR group presented higher proportions of male [62.2%(89/143) vs. 50.4%(58/115), χ²=4.167, P=0.041], right hemicolon cancer [44.8% (64/143) vs. 31.3% (36/115), χ²=4.858, P=0.028], and the largest tumor diameter>4 cm [60.1% (86/143) vs. 33.0% (38/115), χ²=18.748, P<0.001]. During a median follow-up of 46.0 (range, 3.0 to 74.0) months, 3-year disease-free survival rate was 83.8% in high LMR group and 78.9% in low LMR group, which was not significantly different (P=0.210). While 3-year overall survival rate in low LMR group was significant lower than that in high LMR group (86.6% vs. 97.2%, P=0.018). Univariate analysis revealed that preoperative low LMR (HR=2.841, 95%CI: 1.146 to 7.043, P=0.024), right hemicolon cancer (HR=2.865, 95%CI: 1.312 to 6.258, P=0.008) and postoperative adjuvant chemotherapy≥6 cycles (HR=0.420, 95%CI: 0.188 to 0.935, P=0.034) were the risk factors for poor overall survival. Multivariate analysis identified that preoperative low LMR (HR=2.550, 95%CI: 1.024 to 6.347, P=0.004) and right hemicolon cancer (HR=2.611, 95%CI: 1.191 to 5.723, P=0.017) were the independent risk factors for overall survival. CONCLUSIONS Preoperative peripheral blood LMR level represents an effective prognostic predictor for patients with stage III colon cancer receiving radical therapy. Low LMR indicates the poor prognosis and such patients require aggressive postoperative treatment strategy.
Adenocarcinoma ; blood ; drug therapy ; surgery ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols ; administration & dosage ; Chemotherapy, Adjuvant ; Colonic Neoplasms ; blood ; drug therapy ; surgery ; therapy ; Female ; Humans ; Kaplan-Meier Estimate ; Leukocyte Count ; methods ; Lymphocytes ; Male ; Middle Aged ; Monocytes ; Preoperative Care ; Prognosis ; Retrospective Studies ; Young Adult