Objective To observe the effect of angiotensin-converting enzyme inhibitor(ACEI) on insulin sensiti-(vity) in dogs with acute myocardial infarction(AMI) after thrombolytic treatment. Methods Twenty dogs were made as AMI models and then underwent thrombolytic treatment.The dogs were divided into the control group(n=10) and the captopril group(n=10) randomly.Insulin,plasma glucose,erythrocyte insulin receptor(EIR),nitrogen(NO) and angiotensin Ⅱ(AT Ⅱ) were(detected) and insulin sensitivity index(ISI) was calculated.The changes of these values in the two groups were contrasted. Results After reperfusion for 120 min,in the control group,ISI and AT Ⅱgot much more rise while EIR and NO fell much more(P

There are more than 50 species of Zanthoxylum (Rutaceae) plants in China, which are very important Chinese meteria medica and natural medicines. It has a variety of pharmacological activities, among which one of the important activities is to inhibit the growth of pathogenic microorganisms and parasites, which can be used as the source of anti-infection drugs. This paper reviews the progress on anti-infective activities of the plants of genus Zanthoxylum in recent years, covering infectious pathogens from bacteria, fungi, viruses to parasites, in order to provide references for the search of novel structural compounds and antiinfective drugs with new mechanisms.

Objective: To observe the clinical efficacy of acupuncture plus medicine in treating laryngopharyngeal reflux due to liver-qi stagnation and spleen deficiency. Methods: A total of 70 patients were divided into a control group and an observation group by the random number table method, with 35 cases in each group. Both groups were treated with conventional medications, and the observation group was treated with additional acupuncture therapy. The reflux symptom index (RSI) and reflux finding score (RFS) were evaluated. Esophageal motility indicators such as lower esophageal sphincter pressure (LESP) and upper esophageal sphincter pressure (UESP), and salivary pepsin level were measured. The clinical efficacy was also compared. Results: The total effective rate of the observation group was higher than that of the control group (P<0.05). After treatment, the RSI and RFS scores in both groups decreased significantly (all P<0.05), and the RSI and RFS scores in the observation group were significantly lower than those in the control group (both P<0.05). There were no significant changes in the LESP and UESP in the control group (both P>0.05), while LESP and UESP in the observation group increased significantly (both P<0.05), and higher than those in the control group (both P<0.05). The salivary pepsin levels in both groups decreased (both P<0.05), and the salivary pepsin level in the observation group was significantly lower than that in the control group (P<0.05). Conclusion: Acupuncture plus medicine can improve symptoms and signs in patients with laryngopharyngeal reflux due to liver-qi stagnation and spleen deficiency, and regulate esophageal motility and salivary pepsin level. Its efficacy is more significant compared with medicine alone.

OBJECTIVETo evaluate the value of ascitic bacterial 16S rRNA gene determination in the rapid diagnosis of spontaneous bacterial peritonitis (SBP).

METHODS16S rRNA gene from bacterial DNA in ascites was determined by quantitative fluorescent polymerase chain reaction (PCR) in 76 patients with suspected SBP and 6 patients with non-infectious ascites. The results were compared with those obtained from bacterial culture.

RESULTSThe positive rate of SBP was 22.4% among patients detected with ascitic bacterial 16S rRNA gene determination-based quantitative fluorescent PCR, which was significantly higher than that (7.9%) in patients only received bacterial culture (P<0.05). In addition,in 6 patients with non-infectious ascites,both the 16S rRNA gene determination-based quantitative fluorescent PCR and bacterial culture showed negative results.

CONCLUSIONS16S rRNA gene determination-based quantitative fluorescent PCR can be an effective tool for the rapid diagnosis of SBP. It is more sensitive than the bacterial culture.

Adult ; Aged ; Ascitic Fluid ; microbiology ; Bacterial Infections ; diagnosis ; DNA, Bacterial ; analysis ; Female ; Humans ; Male ; Middle Aged ; Peritonitis ; diagnosis ; microbiology ; RNA, Ribosomal, 16S

OBJECTIVETo evaluate the significance of determining ascitic bacterial 16S rRNA by quantitative PCR combined with microarray (PCR-microarray) in the diagnosis of spontaneous bacterial peritonitis (SBP).

METHODSAscitic bacterial 16SrRNA was determined by real time fluorescent quantitative PCR-microarray in 76 cases of suspected SBP and 6 cases of non-infectious ascites with chronic liver diseases. The results were compared with ascitic bacterial culture simultaneously.

RESULTSOf 76 ascitic samples, 17 were detected bacteria positive by PCR-microarray, including 8 Grams positive(G+) and 9 Grams negative(G-), which was higher than that by bacterial culture which had only 6 ascitic samples detected positive (all G-); the positive rates were 22.4% vs 7.9%, respectively (P < 0.01). The bacterial strains detected by both methods in 6 cases had a consistency with each other. No bacteria were detected in another 6 cases of non-infectious ascites with chronic liver diseases.

CONCLUSIONSDetermination of ascitic bacteria 16S rRNA by PCR-microarray has a higher specificity and sensitivity in the diagnosis of SBP as compared with the bacteria culture. Application of this novel method can not only accelerate SBP diagnosis but also stratify the different pathogens.

Adult ; Aged ; Ascitic Fluid ; microbiology ; Bacterial Infections ; diagnosis ; microbiology ; Female ; Humans ; Liver Cirrhosis ; diagnosis ; microbiology ; Male ; Middle Aged ; Oligonucleotide Array Sequence Analysis ; Peritonitis ; diagnosis ; microbiology ; Polymerase Chain Reaction ; methods ; RNA, Bacterial ; isolation & purification ; RNA, Ribosomal, 16S ; isolation & purification

OBJECTIVETo investigate the limiting effect of pelvic diameters on the technical difficulty of total mesorectal excision(TME) for rectal cancer by computed tomography pelvimetry.

METHODSFrom January 2009 to January 2011, 69 patients with rectal cancer underwent TME in the Department of Proctology at the Changhai Hospital in Shanghai. There were 55 males and 14 females. Using three dimensional reconstruction software, pelvic dimensions of rectal cancer patients were measured based on pelvic MDCT thin-slice computed tomography. All the patients were measured for 15 pelvic parameters, including the length of pelvic inlet, the length of pubic symphysis, the interspinous distance, the distance from sacral promontory to tip of coccyx, etc. All the procedures were open surgery, including anterior resection(n=19), low anterior resection and ileostomy(n=29) and abdominal perineal resection(n=21). Duration of the operation and blood loss at surgery were recorded as evaluation indicators of the technical difficulty of total mesorectal excision. By univariate analysis significant pelvic parameters were selected. Multiple regression analysis was used to investigate the relationship between pelvic parameters and blood loss or duration of operation.

RESULTSThe mean operative time was(139.9±32.4) min and the mean intraoperative blood loss was (228.8±150.6) ml. Multivariate analysis showed that the interspinous distance, the length of pelvic inlet, the distance from sacral promontory to the tip of coccyx were the main factors affecting the operation time, and that the length of pubic symphysis and the distance from sacral promontory to the tip of coccyx were the main factors affecting the amount of blood loss (all P<0.05). Among the 3 procedures, the multivariate analysis for low anterior resection appeared to be most valuable, in which operative time was associated with the distance from sacral promontory to the tip of coccyx and the interspinous distance (adjusted coefficient of determination of the regression equation, Rc(2)=0.460, P=0.003). Factors associated with intraoperative blood loss were the length of pelvic inlet, the distance from sacral promontory to the tip of coccyx, and the sacrum-pubis angle(Rc(2)=0.358, P=0.022). Comprehensive analysis of the measurement parameters showed that the ratio between the length of pelvic inlet and the distance from sacral promontory to the tip of coccyx was associated with the operative time and blood loss. This ratio was significantly higher in female patients than that in males. In females with a ratio greater than 1, the operative time was significantly shorter(P=0.050), and the intraoperative blood loss was significantly less in males with a ratio greater than 0.9(P=0.021).

CONCLUSIONSOperative time and intraoperative blood loss for total mesorectal excision are more favorable in patients with a wide and shadow pelvis. Surgical difficulty is increased in deep and narrow pelvis or those with major sacrum curvature. The difficulty of total mesorectal excision procedure can be predicted by measuring the length of pelvic inlet and the distance from sacral promontory to the tip of coccyx.

Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Imaging, Three-Dimensional ; Male ; Mesentery ; diagnostic imaging ; surgery ; Middle Aged ; Pelvis ; diagnostic imaging ; Rectal Neoplasms ; diagnostic imaging ; surgery ; Tomography, Spiral Computed ; methods

BACKGROUNDAlthough three-dimensional MRI (3D-MRI) of short T1 inversion recovery turbo spin-echo (STIR TSE) has showed superior to two-dimensional MRI (2D-MRI) in showing the spinal cord and lumbar nerve roots, it remains difficult in demonstrating radicular vein at present. We have found that short T1 inversion recovery long time echo (STIR LONG TE) was better in showing radicular vein. To further study the methods and character of the 3D-MRI of lumbar nerve root, ganglions and radicular vein in normal and lumbar disc herniation (LDH) adults, in the present study, we evaluated two 3D-MRI techniques, STIR TSE and STIR LONG TE for demonstrating lumbar nerve roots and especial radicular vein in normal and LDH adults.

METHODSTwelve normal adult persons and 19 LDH patients were included in this study; special oblique coronal location was adopted. STIR TSE and STIR LONG TE were performed in all participants, and the detection rates of radicular vein and nerve root of L3, L4, L5, S1 were calculated. The grading system was used in grading compromise of the intraspinal extradural lumbar nerve root, ganglion and radicular vein in LDH patients, and all the grading injury of nerve root, ganglion and radicular vein had been evaluated.

RESULTSThe definite rate of radicular vein (DRRV) of 3D-MRI of STIR LONG TE was significantly different from that of STIR TSE. DRRV of STIR LONG TE was L3, 91.7%, L4, 100%, L5, 100%, S1, 100% and that of STIR TSE was L3, 33.3%, L4, 37.5%, L5, 58.3%, S1, 45.8% in normal adults. It showed no difference between STIR LONG TE and STIR TSE in the detection rate of nerve root. The different patho-injuries of nerve root, ganglion and radicular vein could be seen in all LDH patients by the 3D-MRI of STIR LONG TE. The mean score of Japanese Orthopaedic Association (JOA) was 16.16, and 29 nerve roots were calculated in all the study. The mean grading injury of nerve root was 2.17, that of nerve root ganglion was 1.28, that of radicular vein was 1.83, and the mean co-grading injury of nerve root, ganglion and radicular vein was 5.31. The correlation coefficient was 0.478 (P = 0.010) between the score of JOA and that of radicular vein.

CONCLUSIONThe 3D-MRI of STIR LONG TE is superior to STIR TSE for not only detecting the lumbar nerve root, ganglion and especial radicular vein in normal adults, but also displaying their patho-injuries degree in LDH patients.

Adult ; Aged ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; Lumbar Vertebrae ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Spinal Nerve Roots ; blood supply ; pathology ; Veins ; pathology

OBJECTIVETo study the clinical features and prognosis of gastrointestinal injury caused by foreign bodies in the upper gastrointestinal tract in children.

METHODSA retrospective analysis was performed for the clinical data of 217 children who were diagnosed with foreign bodies in the upper gastrointestinal tract complicated by gastrointestinal injury by gastroscopy from January 2011 to December 2016, including clinical features, gastroscopic findings, complications, and prognosis.

RESULTSAmong the 217 children, 114 (52.5%) were aged 1-3 years. The most common foreign body was coin (99/217, 45.6%), followed by hard/sharp-edged food (45/217, 20.7%) and metal (35/217, 16.1%). The most common gastrointestinal mucosal injury was ulceration (43.8%), followed by erosion (33.2%). Compared with other foreign bodies, button cells were significantly more likely to cause esophageal perforation (P<0.01). The esophagus was the most commonly injured organ (207/217, 95.4%). Of all the 217 children, 24 (11.1%) experienced infection. The children with perforation caused by foreign bodies had a significantly higher incidence rate of infection than those with ulceration caused by foreign bodies (P=0.003). Of all the 217 children, 204 (94.0%) underwent successful endoscopic removal of foreign bodies. Among these children, 98 were hospitalized due to severe mucosal injury and were given anti-infective therapy, antacids, and supportive care including enteral nutrition through a nasogastric tube and/or parenteral nutrition. Of all the children, 10 left the hospital and were lost to follow-up, and all the other children were improved and discharged.

CONCLUSIONSMost cases of foreign bodies in the upper gastrointestinal tract occur at 1-3 years of age. Coin, hard/sharp-edged food, and metal are the most common foreign bodies. Button cells are more likely to cause esophageal perforation. The incidence rate of secondary infection increases with the increasing severity of gastrointestinal mucosal injury. Children undergoing endoscopic removal of foreign bodies and enteral nutrition through a nasogastric tube tend to have a good prognosis.

Female ; Food ; adverse effects ; Foreign Bodies ; diagnosis ; etiology ; therapy ; Humans ; Infant ; Male ; Metals ; adverse effects ; Prognosis ; Retrospective Studies ; Upper Gastrointestinal Tract ; injuries

OBJECTIVE:To explore an effective method to formulate management-related strategies for off-lable use of drugs by the evidence-based medicine. METHODS:The process of guideline formulation included seven procedures,i.g. establishment ofguideliesformulation workgroup;investigation and selection of the status quo on off-label drug use;identification of the clinical problems;retrieval and evaluation and comprehensing of evidence;applification of GRADE in evidence quality grading;formation of the recommendations consensus;peer review and result publication. And eventually guidelines were formed based on the steps. This study took off-label use of rheumatoid immunoprotective subjects as a case to explore. RESULTS & CONCLUSIONS:Based on the evidence evaluation system and above 7 steps,the methods and process of guideline formulation on off-label use of rheuma-toid immunoprotective subjects that integrated administration,law,clinical medicine,pharmacy subjects were made .The process of guideline formulation fully reflects multidisciplinary characteristics of the workgroup,the advanced nature of the process,the comprehensiveness of evidence ,the rigor of evidence quality grading,and the normalization of consensus. It provides reference in methodology for establishing a comprehensive evidence-based evaluation and management system of off-label use of drugs for all clinical specialist disease. Therefore,this scientific research results may promote the standardization and legalization of the off-label use of drugs management in China.

OBJECTIVES: To investigate the clinical application of endoscopic esophageal dilation in the treatment of corrosive esophageal strictures in children. METHODS: A retrospective analysis was performed on the clinical data of 15 children with corrosive esophageal strictures who underwent endoscopic esophageal dilation in Children's Hospital, Zhejiang University School of Medicine. The clinical features, treatment modality of endoscopic esophageal dilation, number of dilations, complications, and prognosis were reviewed. RESULTS: A total of 96 esophageal dilations were performed in the 15 children with corrosive esophageal strictures, with a median of 6 dilations per child. Among them, 9 children (60%) underwent 6 or more dilations. The children with a stricture length of >3 cm had a significantly higher number of dilations than those with a stricture length of ≤3 cm (P<0.05). The children with strictures in a single segment had a significantly better treatment outcome than those with strictures in multiple segments (P=0.005). No complication was observed during all sessions of dilation. The overall effective rate (including significant improvement and improvement) of endoscopic esophageal dilation treatment was 87%, with 2 cases of failure. CONCLUSIONS Endoscopic esophageal dilation is an effective and relatively safe treatment method for corrosive esophageal strictures in children, and children with strictures in a single segment tend to have a better treatment outcome than those with strictures in multiple segments.
Child ; Humans ; Esophageal Stenosis/therapy* ; Constriction, Pathologic/complications* ; Dilatation/methods* ; Caustics ; Retrospective Studies ; Treatment Outcome