The incidence of hilar cholangiocarcinoma is very rare worldwide. Radical resection is the only prognostic factor for long survival in patients with hilar cholangiocarcinoma. Postoperative radiation therapy can improve local control and survival rates for patients with palliative resection,but it remains controversial in patients with radical resection. Biliary drainage can effectively release bile duct obstruction for the majority of patients with locally advanced disease,and may even prolong survival when combined with radiation therapy. Radiation therapy includes extrernal beam therapy alone,external beam therapy with intraluminal brachytheapy and new radiation technique,such as three dimentional conformal therapy and intensity modulated radiation therapy. The propective randomized clinical study is needed for further investigation in the role of combined modality therapy especially for hilar cholangiocarcinoma.(J Intervent Radiol,2007,16: 705-709)

OBJECTIVE: To determinate triptolide and wilforlide A in biological samples by liquid chromatography-tandem mass spectrometry (LC-MS/MS) method and to verify the method. METHODS: After 0.4 mL blood, urine or 0.4 g hepatic tissues with internal standard were extracted by ethyl acetate, they were separated on a Allure PFP Propyl (100 mm x 2.1 mm, 5 µm) with a mobile phase of methanol-20 mmol/L ammonium acetate using gradient elution. For mass spectrometric detection, electrospray ionization (ESI⁺) in positive mode was elected and the data was collected using multiple-reaction monitoring (MRM). RESULTS: The linearity was good (r > 0.995 0) and the limit of detection was 2 ng/mL or 2 ng/g for triptolide and wilforlide A. The recovery was 61.08%-102.98%. The intra-day and inter-day precision was less than 12.58% for each biological sample, and the accuracy was 90.61%-105.80%. CONCLUSION This method is simple, convenient and good selective, and could be applied to analysis of triptolide and wilforlide A in different biological samples. And the method may provide technical support for forensic medicine identification, clinical diagnosis and treatment of tripterygium wilfordii Hook. f. poisoning.
Chromatography, High Pressure Liquid ; Diterpenes/urine* ; Epoxy Compounds/urine* ; Humans ; Oleanolic Acid/urine* ; Phenanthrenes/urine* ; Sensitivity and Specificity ; Tandem Mass Spectrometry

Objective To investigate clinical effect of patients with PICU multiple organ dysfunction by continuous blood filtration combined with naloxone.Methods 42 patients with multiple organ function failure were selected and randomly divided into 2 groups.The control group were treated by PICU conventional therapy, the experiment group were treated by continuous blood filtration combined with Naloxone.Vital signs, creatinine, creatine kinase and aspartate aminotransferase levels, length of stay and blood filtration were compared after 1 day and 3 days treatment.ResuIts Compared with control group,heart rate, oxidation index,creatinine and aspartate aminotransferase levels of the experiment group were lower(P<0.05).After 1 day and 3 days, compared with cnontrol group, length of stay and blood filtration of the experiment were lower(P<0.05).ConcIusion Continuous blood filtration combined with naloxone in treatment of multiple organ dysfunction syndrome PICU is effective and reliable.It can significantly improve renal function, shorten the length of hospital stay, and remove inflammatory mediators in plasma of patients.

Objective To evaluate the technique and clinical effect of retroperitoneoscopic adrenalectomy for pheochromocytoma.Methods A total of 78 patients received roperitoneoscopic adrenalectomy for pheochromocytoma from March 2006 to June 2008.Retroperitoneal space was enlarged routinely with patient in lateral decubitus position.After adequate retroperitoneal space was created,three relatively bloodless planes were orderly entered for exposure and separation of the adrenal gland and tumor.The first dissection plane was between the psoas and posterior Gerota's fascia.The subsequent dissections were proceeded in the plane between anterior Gerota's fascia and perirenal fat.The third dissection plane was between the adrenal gland and upper pole of kidney.The tumor and parts of adrenal glands were then excised.Results A1l operations were successful.The mean operative time and estimated blood loss were 145?53min and 100?49 ml,with no blood transfusion,and no conversion to open surgery.The mean postoperative analgesic(pethidine) consumption was 57?38mg.Time for oral intake of food and ambulation after operation were 1.6?0.5d and 1.5?0.3d,respectively.The mean postoperative hospital stay was 5.8?1.9d.No major intraoperative complications occurred.Conspicuous fluctuation of blood pressure(≥50mmHg) was observed in 49 patients during operation.56 patients were followed up,and no recurrence or metastasis of the tumor was found during a follow-up period of 12.3?8.7 months in average(range from 2 to 26 months).Conclusions With adequate preparations,retroperitoneoscopic adrenalectomy for pheochromocytoma(≤6cm) is a safe and effective procedure in the hand of an exparienced surgeon since it gives a clear operative field,adequate space for manipulation,distinct anatomic landmark and minimal agitation.

OBJECTIVE: To develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) screening method for 45 poisonous alkaloids in blood. METHODS: Identification was based on the compound's retention time and two precursor-to-production transitions. The method involved a liquid-liquid extraction (LLE) followed by LC-MS/MS with multiple-reaction monitoring (MRM). When 1 mL of blood was extracted with diethyl ether at pH = 9.2 with SKF525A as the internal standard, the target compounds were analyzed with LC-MS/MS in the positive ionization mode. RESULTS: The target alkaloids had good linearity (r>0.995 1), both the intra-day precision and inter-day precision being less than 14.77%. The limits of detection ranged from 0.05 to 25 ng/mL in blood. CONCLUSION The method is selective and sensitive in detecting poisonous alkaloids with a total running time of 12 minutes; therefore it was successfully applied to some actual cases of suspected alkaloids poisoning.
Alkaloids/chemistry* ; Chromatography, Liquid/methods* ; Forensic Medicine ; Humans ; Liquid-Liquid Extraction ; Mass Spectrometry ; Sensitivity and Specificity ; Tandem Mass Spectrometry/methods*

Brain ; surgery ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Humans ; Postoperative Period

To make a systematic analysis on literatures concerning traditional Chinese medicine (TCM) advices in Treatise on Febrile Diseases, and summarize the main connotations of traditional Chinese medicine advices, relevant TCM advices in Treatise on Febrile Diseases were collected, screened, compared, summarized and analyzed according to TCM dosage form preparation methods, TCM administration methods, medication contraindications and nursing after TCM administration. The literatures concerning medications in Treatise on Febrile Diseases were consulted, summarized and compared to standardize medicine advices and facilitate rational clinical application of TCMs. The standard medicine advices were as follows. The boiling water for TCMs shall be tap water and well water. The decoctions that have effects in promoting blood and meridians can be boiled with wine. The decoctions containing toxic components can be boiled with honey. Some TCMs shall be boiled with special methods, e. g. Herba Ephedra that could be boiled before other medicine and skimmed. Japonica rice could be added in decoctions to measure the duration of decoctions. Different dosages were required for different forms (litre, pill, medicine spoon). Administration times, temperature and frequency shall be adjusted according to target positions, functions and stage of illness. As for dietary contraindications during medication, thick porridges are recommended, where foods impacting medicine efficacy are prohibited. Regarding nursing after medication is important to recover physical functions, particularly warm porridges can go with diaphoretic recipes, while thick porridges can go with purgative recipes. And drug efficacies shall be defined by observing urine and excrements, and blood form. In conclusion, Treatise on Febrile Diseases is the first book that discusses TCM advices and records them in details. In this study, new standard medicine advices were proposed to provide important basis for improving clinical advices of TCMs and supports for developing the TCM dispensing technology.
Chin ; Cooking ; Drug Administration Routes ; Drug Administration Schedule ; Drug Interactions ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; history ; Fever ; drug therapy ; history ; History, Ancient ; Humans ; Medicine in Literature

Adult ; Cerebrospinal Fluid Rhinorrhea ; surgery ; Endoscopy ; adverse effects ; Female ; Humans ; Mucormycosis ; etiology

The producing condition and properties of chitinase secreted by Nomuraea rileyi strain CQ031021 were studied.The optimal conditions for the strain to produce chitinase are 6 days of 28℃ with the initial pH 6.0,and the liquid medium containing 2.0% glucose as its carbon source and 0.6% peptone plus 0.6% beef extract as nitrogen source after inoculating dosage 2mL suspension of conidia(1?107/mL).The optimal temperature and pH for enzyme activity is 50℃ and 6.0,respectively,while the activity can be enhanced by Tween-80 and inhibited by SDS.The enzyme activity is stable under 40℃ and in pH range of 5.5～6.5.

Objective:In this article, pueraria extract combined with glucose tolerance factor(GTF) , extracted from yeast, at molecular level.We studied the mechanism ofnew compatibility ofTCM on target organ in treating obesity and analyzed the TCM's theory ofcompatibility with mutual reinforcement and searched a new breakthrough on grouping prescriptions ofTCM.Methods:We study the pharmacodynamics ofpueraria extract(puerarin)combining with GTF by being compared with puerarin, GTF and control medicine respectively by determining the gene expression ofleptin receptor(OB-R).Results:At the fourth week, compared with the obesity model group, the expression ofOB-R in the puerarin combining with GTF group increased significantly(P