Objective Summarizing single clinical experience with extracorpomreal membrane oxygenation(ECMO) as a supplement to extracorporeal cardiopulmonary resuscitation(ECPR) in adult patients with cardiac arrest to explore new ideas.Methods We retrospectively analyzed the characteristics of 17 patients who underwent ECMO as part of ECPR from July 2005 to September 2014 at Fuwai Hospital,and analyzed the differences between the survival group(n =6) and the in-hospital death group.Results The mean CPR time was(44.53 ± 21.39) min.The support duration of ECMO was(106.38-± 70.43) h.12 patients of all were successfully weaned from ECMO,and 6 patients survived to hospital discharge.There were significant differences between the two groups in terms of the last serum creatinine and blood lactate acid level before ECMO,and the time to lactate normalization.11 patients died,7 patients developed bleeding,and 8 cases developed infection.Conclusion Single-center data showed that applying ECMO as a means of ECPR improved the survival rate in cardiac arrest patients.Additionally,creatinine and lactic acid were good indicators for assessing prognosis.Refractory circulatory dysfunction and neurologic complications have an adverse impact on the survival of cardiac arrest patients.

Objective To report therapeutic effects of patients with bladder cancer treated by intra-operative radiation and to recommend an effective method for the treatment of bladder cancer.Methods During the operation,when the tumor of bladder had been removed,a boost dose of electric beam from a linear accelerator was irridiated to the tumor bed.28 cases were follawed-up in a long period.Results Lower local recurrence was observed in patients received intra-operative radiation therapy,only 2 cases had a small recurrent tumor in the bladder during the follow-up period.26 cases had bean followed up,no tumor recurred.Conclusion The intraoperative radiation therapy is a useful treatment for the bladder cancer.

Objective Extracorporeal membrane oxygenation is a cardiopulmonary supportive therapy. Since 2004, our institution has adopted venoarterial ECMO for adult patients who otherwise could not be weaned from cardiopulmonary bypass and patients experiencing postcardiotomy cardiogenic shock and/or pulmonary dysfunction unresponsive to conventional treatment algorithms. In this study, we reviewed our experience with ECMO support and tried to identify measurable values which might predict in-hospital mortality. Methods From January 2004 through December 2008, 50 of 21,298 adult patients received VA ECMO. We retrospectively analyzed clinical records of these 50 consecutive patients. Demographics, preoperative measurements, clinical characteristics at the time of ECMO implantation, ECMO related complications and in-hospital mortality were collected. Logistic regression analyses were performed to investigate predictors of mortality. A p value ≤0. 05 was accepted as significant. Results Mean ECMO duration was ( 110 ± 17 ) hours. 38 patients were weaned from ECMO and 33 patients survived upon discharge. The overall survival was 66%. In univariate analyses, duration of ECMO support, receiving cardiopulmonary resuscitation prior to ECMO setup, ECMO setup in ICU, pre-ECMO plasma lactate level, infection, lower limbs ischemia, renal failure, experiencing at least one ECMO related complications were all associated with in-hospital death. In a multiple logistic regression adjusted for other factors mentioned above, blood lactate level before initiation of ECMO was a risk factor associated with in-hospital mortality (OR 1. 27 95% CI 1. 042-1. 542 ). To evaluate the utility of pre-ECMO lactate in predicting mortality, a conventional receiver operating characteristic curve was produced. Sensitivity and specificity were optimal at a cut-off point of 12.6 mmol/L, with an AUC of 0. 752. The positive and negative predictive values were 73.3% and 83.9% respectively. Conclusion ECMO is a justifiable alternative treatment for postoperative refractory cardiac and pulmonary dysfunction which could rescue more than 60 percent of otherwise fatal patients. Patients with pre-ECMO lactate above 12.6mmol/L are at higher risks for in-hospital death. Evidence based therapy for this group of high risk patients is needed.

Objective To investigate whether diffusion kurtosis imaging(DKI)can be predictive in high-aggressive prostate cancer (PCa).Methods 51 patients with pathologically confirmed PCa underwent preoperative DK-MR imaging(b of 0,700,1 400 and 2 100 s/mm2).Data was post-processed by mono-exponential and non-Gauss DK model,respectively,for quantitation of apparent diffusion coefficient(ADC),apparent non-Gaussian diffusion coefficient(Dapp)and apparent non-Gauss kurtosis coefficient(Kapp). The ability of Dapp,Kapp and ADC for predicting high-aggressive(Gleason score>4+3)PCa was analyzed by ROC regression.Results There were 29 low-aggressive and 33 high-aggressive PCa on pathologic findings.High-aggressive PCa had significantly lower ADC[(0.764 ± 0.114)×10-3mm2/s vs(0.825 ± 0.116)×10-3mm2/s,P=0.004],lower Dapp[(1.212 ± 0.194)×10-3mm2/s vs (1.472 ± 0.297)×10-3mm2/s,P< 0.001],while higher Kapp(1.114 ± 0.177 vs 0.835 ± 0.192,P<0.001)than that for low-aggressive PCa.Dapp and Kapp had significantly higher sensitivity(Dapp:75.3%;Kapp:74.1%),specificity(Dapp:85.4%;Kapp:86.7%)and area under curve(AUC)(Dapp:0.889;Kapp:0.894)than that for ADC(64.1%;76.4%;0.738;P<0.01)in differentiating low-aggressive from high-aggressive PCa.Conclusion DKI can be a reliable way for predicting high-aggressive PCa.

Objective To investigate the correlation between hepatic fat fraction(HFF)and some clinical indicators by measuring HFF and summarize its clinical significance.Methods A total of 95 patients were included in this study.MR data were acquired with Dixon technique,and the HFF of liver were measured.According to the HFF,all patients were divided into high-fat group and low-fat group.Subcutaneous fat area(SA),visceral fat area(VA)and total fat area(TA)were also measured.The age of patients,blood pressure, fasting blood glucose(FPG),total cholesterol (TC),triglyceride (TG),low density cholesterol (LDL-c)and high density cholesterol (HDL-c) were recorded and the body mass index(BMI)was calculated.Results The levels of FPG,TG,LDL-c,systolic blood pressure,diastolic blood pressure,BMI,VA,TA and visceral fat percentage (VFP)in high-fat group were significantly higher than those in low-fat group (P<0.05), while the abdominal subcutaneous fat percentage (SFP)was significantly lower than that in low-fat group (P<0.05).HFF was positively correlated with FPG,TG,LDL-c,VA,TA,VFP,age and BMI (r=0.354,0.370,0.415,0.299,0.285,0.238,0.203,0.221,respectively;P<0.05).Conclusion Semi-quantitative analysis of hepatic fat using MR Dixon technique can reflect the degree of hepatic fatty infiltration, and can be used as a quantitative indicator for early diagnosis and treatment evaluation of nonalcoholic fatty liver disease.

Salidroside, the 8-O-beta-D-glucoside of tyrosol, is a novel adaptogenic drug extracted from the medicinal plant Rhodiola sachalinensis A. Bor. Due to the scarcity of R. sachalinensis and its low yield of salidroside, there is great interest in enhancing the production of salidroside by biotechnological process. Glucosylation of tyrosol is thought to be the final step in salidroside biosynthesis. In our related works, three UGT clones were isolated from the roots and the cultured cells. Our intention was to combine the catalytic specificity of these UGTs in vitro in order to change the level of salidroside in vivo by over-expression of the above UGTs. However, as the aglycone substrate of salidroside, the biosynthetic pathway of tyrosol and its regulation are less well understood. The results of related studies revealed that there are two different possibilities for the tyrosol biosynthetic pathway. One possibility is that tyrosol is produced from a p-coumaric acid precursor, which is derived mainly from phenylalanine. The second possibility is that the precursor of tyrosol might be tyramine, which is synthesized from tyrosine. Our previous work demonstrated that over-expression of the endogenous phenylalanine ammonia-lyase gene (PALrs1) and accumulation of p-coumaric acid did not facilitate tyrosol biosynthesis. In contrast, the data presented in our recent work provide in vitro and in vivo evidence that the tyrosine decarboxylase (RsTyrDC) is most likely to have an important function in the initial reaction of the salidroside biosynthesis pathway in R. Sachalinensis.
Genetic Engineering ; Glucosides ; biosynthesis ; Glycosylation ; Phenols ; Phenylethyl Alcohol ; analogs & derivatives ; chemistry ; metabolism ; Rhodiola ; metabolism ; Tyrosine ; metabolism ; Tyrosine Decarboxylase ; metabolism

Thirty nine patients with pathologically confirmed parotid tumors,including 18 cases of pleomorphic adenomas,12 cases of papillary cystadenoma lymphomatosum and 9 cases of malignant tumors,were enrolled in the study.Characteristics on routine MR image,diffusion weighted imaging (DWI),timesignal intensity curve (TIC) and apparent diffusion coefficient (ADC) value in different types of tumors were evaluated.There were significant differences in imaging features between benign and malignant tumors (P ＜ 0.01).The TIC types were A,B and C for pleomorphic adenomas,papillary cystadenoma lymphomatosum and malignant tumors,respectively.The mean ADC value of pleomorphic adenomas was significantly higher than that of papillary cystadenoma lymphomatosum and malignant tumors (P ＜ 0.01).No significant difference in ADC values between papillary cystadenoma lymphomatosum and malignant tumors was detected (P =0.73).The study indicates that MR plain scan combined with dynamic contrast enhanced MRI and DWI may be helpful in pre-operative differentiation of common parotid tumors.

Objective To evaluate the value of CT plus CTA in emergency surgical treatment of spontaneous intracerebral hemorrhage caused by brain arteriovenous malformations(AVM). Methods A total of 15 cases diagnosed with spontaneous intracerebral hemorrhage by emergent CT examination in the Second Affiliated Hospital of Wenzhou Medical University were retrospectively reviewed from May 2015 to June 2018, and subsequent emergent CTA examination was adopted to verify whether the patients had brain AVM that was responsible for the hemorrhage. After diagnosis, emergency surgical resection of the brain AVM and evacuation of hematoma were performed. Glasgow outcome score (GOS) was used to evaluated the outcome. A secondary DSA or CTA was performed from 2 weeks to 6 months post the operation. Results All 15 cases exanimated by emergent CT plus CTA were demonstrated to have brain AVM and intracranial hematoma. All the patients received emergency brain AVM resection and hematoma evacuation. The surgical finding during operation was in line with what was seen on emergent CT plus CTA, and all cases got total hematoma evacuation. Twelve cases received total brain AVM resection, and the other 3 cases received partial resection because the residual AVM foci existed in deep brain structures . After the operation, none had rebleeding at the surgical site. Follow-up DSA or CTA confirmed the 12 cases had total resection and the other 3 cases had partial resection. All patients were alive after the surgery and GOS scores during the follow-up time, from 2 weeks to 6 months after emergency surgery, were: 5 in 6 patients, 4 in 4 patients, 3 in 4 patients and 2 in 1 patient. Conclusions CT plus CTA can better show the relationship between vascular malformation, hematoma, and the adjacent anatomical structure, and therefore may contribute to intraoperative judgment and complete resection of vascular malformation. It is a practical imaging tool for the preoperative evaluation and emergency surgical treatment of spontaneous intracerebral hemorrhage caused by brain AVM.

Objective Big endothelin-1(big ET-1) is associated with the prognosis of various cardiovascular diseases. This study is to explore the predictive value of plasma big ET-1 level for long-term outcome after mitral valvuloplasty in patients with moderate to severe chronic ischemic mitral insufficiency .Methods A total of 142 consecutive patients with moderate to severe chronic ischemic mitral regurgitation who underwent coronary artery bypass grafting and mitral valvuloplasty were enrolled at our center from January 2009 to December 2015.The clinical baseline data were collected and recorded.All patients were followed up.The mortalities and major adverse cardiovascular and cerebrovascular events during the follow-up period were re-corded.Results A total of 142 patients were enrolled, with mean age of(59.4 ±8.3) years.During(51.9 ±22.6) months follow-up, 19 cases(13.4％) died and 35 cases(24.6％) had major adverse cardiovascular and cerebrovascular events.Uni-variate and multivariate Cox regression analysis showed that big ET-1 was an independent risk factor for all-cause mortality (HR=3.970, 95％CI:1.535-10.268) and major adverse cardiovascular and cerebrovascular events(HR=2.754, 95％CI:1.238-6.129).In addition, left ventricular ejection fraction, pulmonary hypertension and stroke history were independent risk factors for all-cause mortality , while left ventricular ejection fraction , stroke history were independent risk factors for major adverse cardiovascular and cerebrovascular events.Conclusion Long-term outcomes of simultaneous coronary artery bypass grafting and mitral valvuloplasty for moderate to severe ischemic mitral insufficiency are satisfactory and big ET-1 is an inde-pendent risk factor for long-term outcomes of these patients.

Objective To explore the feasibility,importance,and pediatric characteristics of the construction modules and scenarios of pediatric smart wards,as well as the priority level of construction in different scenarios,in order to provide a basis for the phased construction of pediatric smart ward scenarios.Methods A systematic evaluation of the scenario construction of smart wards was conducted through literature review,key informant surveys.Results By systematically scoring and ranking the construction of 15 projects and 57 application scenarios under the three modules of smart management,smart services,and smart healthcare,it is clear that in the practice of pediatric smart wards,priority should be given to the construction of certain scenarios based on the high and low scores and actual conditions,and gradually promote the construction of other scenarios.Conclusion The pediatric smart ward scene has both the universality of traditional smart ward construction needs and its own disciplinary characteristics.Therefore,in the construction process,it is necessary to widely understand the actual needs and carry out targeted smart scene construction that is in line with pediatric characteristics.