Objective To evaluate prognostic significance of early lactate clearance rate for cardiogenic shock patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-seven patients with cardiogenic shock supported by venoarterial ECMO were prospectively enrolled from May 2010 to May 2013.Arterial blood lactate at pre-ECMO support(0 h),at post-ECMO 6 hours(6 h) were measured and then 6 h lactate clearance rate was calculated.90 days after admission was the endpoint of research.Patients were divided into the survival group(n =25) and the death group(n =22).6 h lactate clearance rate was compared between groups.The 6 h lactate clearance rate for predicting death was evaluated by receiver operating characteristic(ROC) curves.The surviving curve was drawn using the Kaplan-Meier method,and the survival of the patients was analyzed by the Log-rank test.Factors influencing the prognosis were analyzed by applying the multiplelogistic regression analysis.Results The 6 h lactate clearance rate was higher in survivors than in nonsurvivors [(38.6 ± 15.1) ％ vs.(14.4 ± 13.8) ％,P ＜ 0.05].The area under the ROC curve of 6 h lactate clearance rate for predicting death was 0.869 ± 0.075 (95％ CI:0.753-0.991).The best cutoff point was 20.0％ with a sensitivity of 92.0％ and specificity of 85.0％.KaplanMeier survival analysis showed that 90 days survival rate of high lactate clearance rate group and low lactate clearance rate group were 66.7％ and 35.0％,with significant difference between the two groups(Log-rank test,P ＜ 0.05).Multivariate logistic regression analysis showed that 6 h lactate clearance rate (OR =3.156,95 ％ CI:2.326-7.253,P ＜ 0.05) was one of the independent risk factors associated with mortality of patients on ECMO.Conclusion Early lactate clearance rate could be used as an important maker for evaluating the prognosis of cardiogenic shock patients on ECMO.

Objective To assess the efficacy and safety of argon plasma coagulation(APC) in treating patients with Barrett's esophagus.Methods Two reviewers independently searched the Cochrane Library(Issue 2,2008),MEDLINE(January 1948 to November 2008),and CNKI(January 1999 to November 2008),respectively.The quality of the included studies was assessed according to the guidance in the Cochrane Handbook of systematic reviews of interventions.Results Six randomized controlled trials involving 253 patients with Barrett's esophagus met the inclusion criteria and were included.One trial reported that the ablation rate of patients in the APC group was significantly higher than that in the endoscopic surveillance group.Followed up one year,the ablation rate in APC group was 63% compared with 15% in the control group(P

Objective To study the effects of PM2.5 on reproductive hormone levels and pregnancy outcome in female rats.Methods Thirty healthy 4-week old female Sprague-Dawley rats were randomly divided into the control group (normal saline), low dose of PM2.5(1.5 mg/kg) group and high dose of PM2.5 (37.5 mg/kg) group.After the blood samples were collected, the animals were exposed to PM2.5for 10 days, and then the rats were mated.On the 19th day of pregnancy, the rats were sacrificed for pregnancy outcome observation and blood samples were collected for hormone test.The blood hormone levels were detected using an ELISA kit.Results The live fetus rates in the control, low dose PM2.5 and high dose PM2.5 groups were 90.77%, 59.49% and 60.27%, respectively (P<0.05).The live fetus rates in the low dose PM2.5 and high dose PM2.5 groups were significantly lower than that in the control group (P<0.05).PM2.5decreased the levels of E2, PROG, CG and LH (P<0.05), compared with that in the control group.Although the blood levels of FSH were not significantly different between the low dose and control groups (P>0.05), the level of FSH in the high dose group was significantly decreased (P<0.05).Conclusions PM2.5may affect pregnancy outcome through influencing the hormone levels.

Objective:To investigate the influence of bundled ligation of the pancreatic stump on postoperative pancreatic fistula (POPF) of distal pancreatectomy (DP).Methods:The retrospective case-control study was conducted. The clinical data of 60 patients with diseases in pancreatic body and tail who underwent DP in the Affiliated Hospital of Inner Mongolia Medical University from January 2011 to August 2018 were collected. There were 24 males and 36 females, aged from 19 to 68 years, with a median age of 45 years. Of the 60 patients, 36 cases undergoing dissection of pancreas with Endo-GIA stapler were allocated into non-bundled group, and 24 cases undergoing bundled ligation of the pancreatic stump with No.10 or No.7 suture at the site over 1 cm of the resection site before dissection of pancreas were allocated into bundled group. Observation indicators: (1) postoperative situations; (2) analysis of risk factors for POPF of DP. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test or ANOVA test. Measurement data with skewed distribution were represented as M (range).Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Univariate analysis was conducted using the chi-square test and multivariate analysis was conducted using the Logistic regression model. Results:(1) Postoperative situations: the amylase concentration, cases with biochemical fistula, cases with grade B pancreatic fistula, cases with complications, time to extubation, duration of postoperative hospital stay, total hospital expenses were (2 629±592)U/L, 14, 5, 7, (11.9±0.7)days, (13.6±0.7)days, (49 430±1 626)yuan in non-bundled group and (683±312)U/L, 3, 1, 2, (9.7±0.6)days, (11.3±0.5)days, (44 767±1 163)yuan in bundled group, respectively. There were significant differences in the amylase concentration, cases with biochemical fistula, time to extubation, duration of hospital stay, total hospital expenses between the two groups ( t=2.528, χ2=1.512, t=2.341, 2.311, 2.111, P<0.05), and there was no significant difference in the cases with grade B pancreatic fistula or cases with complications between the two groups ( χ2=1.512, 1.394, P>0.05). (2) Analysis of risk factors for POPF of DP. Results of univariate analysis showed that tumor diameter and bundled ligation of the pancreatic stump were related factors of patients undergoing pancreatic fistula after DP ( χ2=4.462, 5.061, P<0.05). Results of multivariate analysis showed that bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP ( odds ratio=0.187, 95% confidence interval as 0.037-0.954, P<0.05). Conclusions:Bundled ligation of the pancreatic stump was an independent influencing factor of patients undergoing pancreatic fistula after DP. Bundled ligation of the pancreatic stump can effectively reduce the incidence of POPF, especially biochemical fistula, the time to extubation, duration of postoperative hospital stay and total hospital expenses, and promote patient recovery after DP.

Objective To explore the major risk factors of post transplantation diabetes mellitus (PTDM) and analyze the correlation between tacrolimus and PTDM after kidney transplantation. Methods Clinical data of 123 kidney transplant recipients were collected. All recipients were divided into the PTDM group (n=19) and non-PTDM group (n=104). Clinical data of all recipients in two groups were analyzed. The risk factors of PTDM were analyzed by binary logistic regression. Twenty-four mice were evenly divided into the control group (normal saline), low-dose tacrolimus (0.1 mg/kg), medium-dose tacrolimus (0.75 mg/kg) and high-dose tacrolimus groups (1.5 mg/kg). The solutions were given twice a day. The effect of tacrolimus on blood glucose metabolism in mice was evaluated. Results The incidence of PTDM was 15.4% (19/123) within 1 year after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus≥9 ng/mL within 3 months after kidney transplantation were the risk factors for PTDM after kidney transplantation (both P < 0.05). The fasting blood glucose levels of mice after administration in the low-, medium- and high-dose tacrolimus groups were significantly lower than those before administration (all P < 0.05) in a dose-independent manner (P=0.750). In the low-, medium- and high-dose tacrolimus groups, the postprandial blood glucose levels of mice after administration were significantly higher than those before administration (all P < 0.05) in a dose-dependent manner (P=0.012). Conclusions Tacrolimus is intimately correlated with the incidence of PTDM after kidney transplantation. Age≥48 years old and the trough concentration of tacrolimus ≥9 ng/mL within 3 months after kidney transplantation are the independent risk factors of PTDM. Tacrolimus affects the postprandial blood glucose levels of mice in a dose-dependent manner.

To improve thrombolytic effect, a fusion protein SFH composed of staphylokinase (SAK) and hirudin (HV) with blood coagulation factor Xa (FXa) recognition peptide as a linker, was designed. SFH showed improved thrombolytic effect and low bleeding in vivo. Two thrombus-targeting mechanisms might account for the above features of SFH. This study was designed to study the two thrombus-targeting mechanisms of SFH. ELISA and immunohistochemistry assay were used to study the improved thrombus selectivity of SFH and the results showed that SFH, compared with SAK, displayed higher affinity for thrombin and thrombin-rich thrombus. To verify the thrombus-targeting release of anticoagulant activity of SFH, FH-a derivative of HV with only FXa recognition sequence at N terminus of HV was designed and used in animal tests. In inferior vena cava thrombosis model, FH showed equal antithrombotic effect as HV, indicating that HV could be successfully released from FH by FXa cleavage in vivo. More importantly, no prolongation of plasma TT, APTT and PT were found in FH group, but significant prolongations were discovered in HV group. This revealed that the anticoagulant activity of FH was released in thrombus-targeting way and limited in the vicinity of the thrombus, and this could be extrapolated to SFH. In conclusion, the high thrombus affinity and thrombus-targeting release of anticoagulant activity of SFH assigned low bleeding risk to SFH.
Animals ; Anticoagulants ; pharmacology ; Factor X ; pharmacology ; Hirudins ; biosynthesis ; genetics ; Metalloendopeptidases ; biosynthesis ; genetics ; Mice ; Rats ; Recombinant Fusion Proteins ; biosynthesis ; genetics ; pharmacology ; Thrombolytic Therapy ; methods ; Thrombosis ; drug therapy ; Vena Cava, Inferior

With the maturity and development of surgical techniques, as well as the improvement of perioperative management level, the success rate of kidney transplantation has been significantly improved. However, due to evident differences in heredity and antigenicity between donors and recipients, rejection will occur after kidney transplantation, which will affect the survival of renal grafts. Immunosuppression is an important treatment for rejection, which is of significance to reduce the risk of rejection and enhance graft survival rate. Nevertheless, immunosuppressants may cause multiple complications while lowering the incidence of rejection, such as infection, cardiovascular diseases and tumors, etc., which seriously affect the quality of life of patients and may even lead to their death. Reasonable selection of immunosuppressants and continuous optimization of immunosuppressive regimen for recipients play a critical role in improving the survival of recipients and renal grafts. In this article, the development history of organ transplantation, immune induction therapy and immune maintenance therapy was reviewed, and the progress in the optimization of immunosuppressive regimens for kidney transplant recipients was discussed, aiming to provide reference for improving clinical prognosis of kidney transplant recipients.

Objective In view of the controversy over radiotherapy target volume for patients with limited-stage small cell lung cancer ( SCLC), a prospective randomized controlled trial was conducted to compare the impact of different radiotherapy target volumes on prognosis. Methods After 2 cycles of EP chemotherapy,patients without progressive disease were randomly assigned to receive thoracic radiotherapy (TRT) to either the post-or pre-chemotherapy primary tumour extent as study arm or control. Involved field radiotherapy (IFRT) to the entire metastatic lymph node regions was applied for both arms. TRT consisted of 45 Gy/30Fx/19 d administered concurrently with cycle 3 chemotherapy. Prophylactic cranial irradiation was administered to patients achieved complete or partial remission. Kaplan-Meier method was used for survival analysis. Results Between June 2002 and December 2017,159 and 150 patients were randomly assigned to study arm and control respectively. The 1-,2-,and 5-year local/regional control rates were 79. 4%,61. 5% and 60. 1% respectively in the study arm versus 79. 8%,66. 5%,and 57. 3% in the control arm (P=0. 73). The median OS time was 22. 1 months in the study arm (95%CI,18. 2-26. 0 months) and 26. 9 months (95%CI,23. 5-30. 3 months) in the control arm,the 1-,3-,5-,and 7-year OS rates were 81. 1%,31. 6%, 23. 9% and 22. 2% respectively in the study arm versus 85. 3%,36. 6%,26. 1% and 20. 0% in the control arm (P=0. 51).Grade 2-3 acute esophagitis was developed in 32. 9% and 43. 2% of patients respectively in study arm and control arm (P=0. 01),while grade 2-3 pulmonary fibrosis was observed in 2. 0% and 10. 9% of patients ( P= 0. 01 ) respectively. Conclusions For patients with limited-stage SCLC who received induction chemotherapy,thoracic radiotherapy can be limited to post-chemotherapy tumour extent and IFRT can be routinely applied.

Objective To determine the influence of abiraterone acetate (AA) on neuroendocrine differentiation (NED) in metastatic castration-resistant prostate cancer (mCRPC) and the prognostic predicting value of the serum NED markers in mCRPC patients treated with AA.Methods We conducted an analysis in 115 chemotherapy-naive mCRPC patients who were treated with chemotherapy in Renji hospital from 2013 to 2017.The median age was 70,ranged from 65 to 76 years old.The median CgA,NSE and PSA levels were 101.1 ng/ml (78.5-150.0 ng/ml),13.4 ng/ml (10.5-17.6 ng/ml) and 38.8 ng/ml (11.2-123.2 ng/ml),respectively.Among them,48 cases were classified as the group without AA treatment.The other 67 cases were classified as group after AA failure.In group without AA treatment,the median CgA,NSE and PSA levels were 109.1 ng/ml(80-151.5 ng/ml);13.8 ng/ml(10.8-18.2 ng/ml) and 39.2 ng/ml (8.6-200 ng/ml),respectively.In group after AA failure,the median CgA,NSE and PSA levels were 105.4 ng/ml(78.8-175.5 ng/ml),13.8 ng/ml(10.8-17.6 ng/ml) and 39.0 ng/ml(8.4-219.8 ng/ml),respectively.In the group with serial evaluation of NED markers during AA treatment,the median serum CgA,NSE levels at baseline were 115.9 ng/ml(90.1-201.5 ng/ml),13.3 ng/ml (10.4-18.1 ng/ml),respectively.The endpoints were PSA PFS(progression-free survival) and radiographic PFS (rPFS).Results In 34 patients with serial evaluation,serum NED markers level in 19 patients increased after the failure of AA treatment.Median serum CgA and NSE levels were 115.9 ng/ml(90.1-201.5 ng/ml)and 13.25 ng/ml (10.37-18.14 ng/ml) at baseline.Median serum CgA and NSE levels were 129.6ng/ml (75.5-230.5 ng/ml) and 14.7 ng/ml (11.8-19.1 ng/ml) after 6 months treatment,respectively.The median serum CgA and NSE levels were 130.4 ng/ml (95.7-205.7 ng/ml) and 15.2 ng/ml(12.4-18.7 ng/ml) at the time of failure of AA treatment,respectively.There was no significant difference of NED markers between baseline and failure of AA treatment (P =0.243).In logistic univariate analysis,AA treatment and its duration were not independent factors influencing NED(P =0.30;P =0.52).Compared with the NED markers elevation group in the first 6 months of AA treatment and baseline supranormal NED markers group,the NED markers decline group(PSA PFS(17.1 vs.10.4 months,P ＜ 0.001) and rPFS (17.0 vs.10.4 months,P =0.003)) and baseline normal NED markers group(PSA PFS(14.1 vs.9.5 months,P =0.001) and rPFS(16.4 vs.10.5 months,P ＜ 0.001)) has a longer median PSA PFS and rPFS respectively.In multivariate Cox analysis,baseline NED markers level and NED markers variation during the first 6 months of AA treatment remained significant predictors of rPFS(P ＜ 0.05),and PSA-PFS (P ＜ 0.05).Conclusions We found there was heterogeneity in changes of NED markers in different mCRPC patients during AA treatment,and AA might not significantly lead to progression of NED of mCRPC in general.Serial CgA and NSE evaluation might help clinicians guide clinical treatment of mCRPC patients.Serum NED markers elevation during the first 6 months of AA treatment and elevated baseline NED markers levels indicated poor prognosis in mCRPC treated with AA.

ObjectiveTo explore the macroscopic medication pattern of traditional Chinese medicine （TCM） in treating esophageal cancer （EC） and provide medication references for the clinical application of TCM in EC treatment. MethodRelevant literature on TCM treatment of EC was retrieved from three major Chinese databases： China National Knowledge Infrastructure （CNKI）， Wanfang Data， and VIP. Information about Chinese herbal medicines was entered into Excel to establish a prescription database for EC. The data were standardized， summarized， and subjected to frequency analysis， association rules， and cluster analysis of medication in the prescriptions. Based on the TCM classification of EC syndromes， clinical indications corresponding to each syndrome were identified， and high-frequency drugs and drug pairs were analyzed correspondingly with syndromes. ResultA total of 136 prescriptions containing 240 Chinese herbal medicines were screened， with a cumulative frequency of 1 853 times. The top 5 frequently used Chinese herbal medicines were Glycyrrhizae Radix et Rhizoma， Poria， Atractylodis Macrocephalae Rhizoma， Astragali Radix， and Pinelliae Rhizoma. In terms of functions， the Chinese herbal medicines were mainly deficiency-tonifying， urination-promoting and dampness-draining， deficiency-tonifying， deficiency-tonifying， and phlegm-resolving and cough and dyspnea-relieving ones. The statistical analysis of flavor， property， and meridian tropism showed that Chinese herbal medicines were mainly bitter and sweet， warm， cold， and neutral， and acted on the spleen， lung， and stomach meridians. Association rule analysis yielded nine potential drug combinations， and cluster analysis of high-frequency drugs resulted in four combination categories. The four TCM syndromes for EC corresponded to respective clinical indications， treatment drugs， and drug pairs. ConclusionTonifying deficiency， reinforcing healthy Qi， descending adverse Qi， resolving phlegm， activating blood， and resolving stasis are the basic principles of TCM treatment for EC， which are supplemented by clearing heat and dissipating mass while focusing on regulating and smoothing the qi movement. The drug combinations obtained from high-frequency drug and association rule analysis provide references for different TCM syndrome treatments of EC， offering valuable insights for clinical medication.