Objective To evaluate the efficacy and mid-term follow-up results of endovascular treatment with Willis covered stent for traumatic pseudoaneurysms located in the internal carotid artery (ICA).Methods ICA angiogmphy was performed in 38 patients with traumatic brain and neck injury.Of the 38 patients.13 delayed traumatic pseudoaneurysms were found.All the pseudoaneurysms were treated with Willis covered stents.Follow-up angiography was performed at 1,3,6 and 12 months after the procedure,and the results were categorized as complete or incomplete occlusion.Clinical manifestations were graded as full recovery,improvement,unchanged and aggravation.Results Willis covered stent placement was technically successful in all traumatic pseudoaneurysms.No procedure-related complications occurred.The initial angiographic results showed a complete occlusion in 9 patients,and an incomplete occlusion in 4.The angiographic follow-up within 3-12 months exhibited a complete occlusion in 12 patients and the parent arteries remained patency in all patients.The clinical follow-up observation demonstrated that full recovery wag obtained in 11 patients,clinical improvement in one,and unchanged condition in one.No morbidity or mortality occurred.Conclusion Willis covered stent implantation iS a feasible and practical treatment for traumatic pseudoaneurysms located in the ICA.This technique can well preserve the parent artery with excellent therapeutic results.

Objective To evaluate the therapeutic effects and complications of modified facial mask for non-invasive ventilation (NIV) in elderly patients with respiratory failure.Methods A total of 132 elderly patients(107 males and 25 female,aged 78.5±8.6 years) treated with NIV from February 2008 to May 2011 were randomized into two groups:modified facial mask(group A,n=68,56 males and 12 females,aged 78.8±22.2 years) and control facial mask(group B,n=64,64 males and 13 females,aged 76.6±20.4 years).Duration of NIV,time in RICU(respiratory intensive care unit),length of hospital stay,risk for hospital acquired pneumonia (HAP),risk for invasive ventilation,cure rates,in-hospital mortality,NIV failure rate and cost were compared between the two groups.The complications of NIV,such as oropharyngeal dryness,skin damage of face and nose,abdominal bloating,gas leakage from mask were also compared between the two groups.Results Compared with group B,duration of NIV(12.2±2.3 d vs.18.4±3.6d),time in RICU(7.3±3.2d vs.14.6t5.4d),length of in hospital stay(16.6±4.2d vs.28.2±6.2)d,and cost(2.23±0.12 ten thousand yuan vs.4.23± 0.24 ten thousand yua) in group A were significantly decreased(t=9.72,14.91,13.08,10.81 respectively,all P＜0.05).The risk for invasive ventilation [2.9％ (2 cases) vs.43.8％(28 cases)],NIV failure rate [5.9％ (4 cases) vs.12.5％ (28 cases)] were also decreased in group A compared with group B(x2 =31.26,25.74,both P＜0.05).Compared with group B,The complications of NIV such as skin damage of face and nose[4.4％ (3 cases) vs.37.5％ (24 cases)],abdominal bloating [2.9％ (2 cases) vs.28.1％ (18 cases)],gas leakage from mask [8.8 ％ (6 cases)vs.50％(32 cases)] in group A were significantly decreased(x2 =31.26,25.74,all P＜0.05).Conclusions Modified facial mask for NIV is effective in the treatment of elderly patients with respiratory failure.The complications and in-hospital mortality are reduced with the application of modified facial mask for NIV and it is highly tolerated by patients.Modified facial mask for NIV is the first choice in the treatment in elderly patients with respiratory failure.

Objective To present our single-center experience in treating traumatic direct carotidcavemous fistulas (TDCCFs)by using detachable balloon,coil and Willis covered stent via arterial route.Methods During the last five years,transarterial endovascular treatment by using detachable balloon,coil and Willis covered stent was performed in fifty-one consecutive patients of traumatic direct carotid-cavernous fistulas.with a total of 54 TDCCFs.The detachable balloon was the material of first choice,while Willis covered stents and coils were regarded as the back-up materials.A clinical and angiographic follow-up for 348 months (mean 20.8 months) was conducted to evaluate the arterial patency and the stability of embolization.The clinical data were retrospectively analyzed.Results By using the detachable balloon alone via transarterial route.85%TDCCFs were successfully treated with good preservation of ICA.A total of 98% TDCCFs in this study were successfully treated by using detachable balloon,coil and/or Willis coveted stent,the fistulas became occluded,and ICAs were preserved except one patient.Forty TDCCFs were treated with detachable balloons alone,two TDCCFs with the Willis covered stent alone,and one DCCF with coils alone.Eight TDCCFs were treated with detachable balloons together with Willis covered stent.Of these eight TDCCFs,two were treated with a single session,three were treated with detachable halloons in combination with coils,and one had to receive Willis covered stent.Second and third times of endovascular treatment were needed in 12 TDCCFs.The TDCCF-rel(at)ed symptoms were gradually relived or improved within 1 day to 6 months after treatment,except for five patients who suffered from ipsilateral moderate visual loss or cranial nerve deficit.No perioperative complications.such as vessel rupture,distal embolization or new neurologic deficits,occurred.During the follow-up period lasting for six months,neither delayed neurologic or vascular complications nor recurrence of the lesions developed.Conclusion Via the transarterial route,using detachable balloon to occlude the fistula and at the same time to preserve ICA remains the optimal treatment for TDCCFs.When the standard treatment fails.various coils and the Willis covered stents can be used as an effective alternative or remedial tool in the treatment of TDCCFs,which can preserve ICA.Willis covered stent deployment seems to be an effective,safe,feasible and economical endovasculal treatment for TDCCF,but more clinical studies are needed before we can further clarify its specifications and indications.

OBJECTIVETo establish a LC-MS-MS method for quantification of cinnamic acid in human plasma and study its pharmacokinetics after administration of Mailuoning injection at a single and the multiple doses to healthy volunteers.

METHODPlasma samples were acidified with hydrochloric acid and extracted with ethyl acetate-ether. Cinnamic acid was determined by LC-MS-MS using a ZOBAX SB C18 column with a mobile phase of methanol-water (containing 2 mmol x L(-1) ammonium acetic) (45: 55) at a flow rate of 0.5 mL x min(-1) and detected using ESI with negative ionization mode. Ions monitored in the multiple reaction monitoring (MRM) mode were m/z 146.8 /103.1 [M - H]- for cinnamic acid and m/z 245.6 /126.0 [M - H] - for tinidazole (IS). After administration of Mailuoning injection at a single and the multiple doses via intravenous guttae (ivgtt) to 10 healthy volunteers, the concentration of cinnamic acid in plasma was determined by LC-MS-MS method. The concentration-time curves were simulated by DASver 1.0 and the pharmacokinetic parameters were calculated.

RESULTThe calibration curve was linear within the range of 0.5400 microg x L(-1). The LLOQ was 0.5 microg x L(-1) and RSDs of intra and inter day were less than 10%. The concentration-time curves of cinnamic acid were consistent with the two-compartment model. The pharmacokinetic parameters after administration of Mailuoning Injection at a single and the multiple injections were as follows: C(max) (microg x L(-1)), 115.73 +/- 44.31 and 113.79 +/- 25.61; T1/2beta (h), 0.41 +/- 0.087 and 0.52 +/- 0.132; V(L x kg(-1)), 0.519 +/- 0.134 and 0.651 +/- 0.322; CL(L x kg(-1) x h(-1)), 0.899 +/- 0.295 and 0.830 +/- 0.222; AUC(0-tn) (microg x L(-1) x h), 158.64 +/- 56.019 and 166.49 +/- 46.788.

CONCLUSIONThe developed LC-MS/MS method was sensitive and selective, and there was no interference from endogenous substances. After administration of Mailuoning injection via ivgtt to healthy volunteers, the pharmacokinetic parameters of cinnamic acid between a single and the multiple doses, and between the male and female were no significant difference. There was no accumulation with multiple injections for cinnamic acid, but there were significant individual differences in the pharmacokinetics of cinnamic acid in volunteers.

Adult ; Chromatography, High Pressure Liquid ; methods ; Cinnamates ; blood ; pharmacokinetics ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Injections ; Male ; Tandem Mass Spectrometry ; methods ; Young Adult

Objective To evaluate the effects,safety and economic cost of long-term home noninvasive ventilation (NIV) therapy in elderly patients with chronic hypercapnic respiratory failure.Methods A total of 128 elderly patients with chronic hypercapnic respiratory failure were randomly assigned to two groups:the NIV group (n=66) with conventional therapy in addition to long-term home NIV therapy,and the control group (n=62) with conventional therapy alone.Compared were parameters before and after two year follow up,which included dyspnea grade,scale for accessory muscle use,scoring for emotional disorders,mean pulmonary pressure (mPAP) by electrocardiography,arterial blood gas,the times of pulmonary infection and hospitalization rates,the duration of hospitalization invasive ventilation,the duration of in RICU and in hospital stay,tracheal intubation rates and mortality.The medical cost was calculated.Results After two years,the differences in the dyspnea grade,scale for accessory muscle use,anxiety scores,depression scores,mPAP,arterial PaCO2 and PaO2,hospitalization rates,the times of pulmonary infection,the days of hospitalization for exacerbation in the home NIV group [2.2± 0.2,2.4 ± 0.3,4 ± 1,5.3 ± 1.2,(36.6±5.2)mm Hg,(50.2±4.5)mm Hg,(63.5±4.2)mm Hg,(1.3±0.2) times/year,(2.4±0.2) times/year,(15.8 ± 4.4) days/times] were statistically significant compared to the control group [4.1±0.2,4.9±0.5,12±3,11.3±1.6,(45.2±5.2)mm Hg,(67.3±4.5) mm Hg,(48.3±4.3)mm Hg,(5.4±0.4)times/year,(8.9 ±0.3) times/year,(38.5± 6.3) days/times] (all P＜0.01).The duration of invasive ventilation,the days in RICU and in hospital stay,tracheal intubation rates on admission to the hospital were significantly decreased in the home NIV group [(8.2 ± 2.2)days,(9.6±3.1) days,(15.8±4.4) days,(2±0.2) times/two years],as compared with the control group [(15.8±3.4) days,(18.6±4.4)days,(38.5±6.3)days,(8.0±0.8) times/two years].The mortality was decreased significantly in the home NIV group (3.0 ％)compared with the control group (29.0％) (P＜0.05).The medical cost in two years was significant lower in the home NIV group [(6.4 ± 0.5) thousand yuan],compared with the control group (18.4 ±0.6) thousand yuan (P＜0.01).Conclusions Long-term home NIV therapy in patients with chronic hypercapinc respiratory failure is effective,safe and can decrease the mortality and medical cost.

OBJECTIVETo ascertain the genetic characterization and genotype of measles viruses isolated in Shanghai region, in 2005.

METHODSMeasles virus was isolated from throat swab specimens collected from suspected measles cases and 450 bp fragment of C terminus of nucleprotein (N) gene was amplified by RT-PCR. Sequence analysis was conducted to ascertain the genotype and to compare the difference of nucleotide with other measles virus strain published in GenBank.

RESULTS4 measles viruses were isolated from 10 throat swab specimens, and the sequence analysis indicated that they belonged to H1 genotype. The homogeneity of 450 nucleotides in the C terminal of the N gene was at 98%-98.2% as compared to H1 genotype (China93-7). They differed from genotype H2 (China94-1) at 6.4%-6.9% and from genotype A (Edmonston) at 6.7%-6.9%, from measles vaccine (Shanghail91) at 7.6%-8.0%. They differed from the other measles viral strain isolated in China in 1993 - 2005 at 0.2%-3.7%. The variation within 4 isolated measles viruses was at 0.7%-1.3%.

CONCLUSIONIt was H1 genotype measles viruses,which are the native viruses in China that led to the outbreak of measles in Shanghai, in 2005.

China ; epidemiology ; Disease Outbreaks ; Genotype ; Humans ; Measles ; epidemiology ; genetics ; Measles virus ; genetics ; isolation & purification ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA

OBJECTIVETo analyze the type and subtype distribution of influenza virus and the genetic evolution of hemagglutinin (HA) in Shanghai area during 2004 to 2008.

METHODSAll 962 throat swabs were collected from influenza-like patients in 5 influenza sentry hospitals and influenza outbreaks. Influenza viruses were isolated in MDCK cell lines, and then viral types and subtypes were identified. The HA of influenza A isolates selected by outbreak or sporadic patients in different areas and epidemic seasons were sequenced and analyzed by phylogenetic trees.

RESULTSA/H3N2, accounting for 54.9% (162/295), was the dominate subtype in recent years, but less popular in the end of 2005 to the middle of 2006 with 0% (0/16)and 23.5% (8/34) of positive specimen, respectively. There were more A/H1N1 isolates in 2005 - 2006 with 21.4% (12/56), 43.8% (7/16) and 76.5% (26/34) of positive specimen, respectively, but declined obviously in 2007 - 2008 accounting for only 0% (0/44) and 5.0% (7/139). Influenza B virus was more popular in 2004 to 2005 with 42.9% (24/56) and 56.2% (9/16), respectively, and not isolated from 2006 to 2007, then increased in 2008 accounting for 34.5% (48/139). Phylogenetic tree of HA showed that A/H1N1 isolates in the same year clustered from 2005 to 2008, and most A/H3N2 isolated were homologous in the same year during 2004 - 2008 while some were inserted to the clusters of near years and more distinguished sequences appeared. A/H1N1 and A/H3N2 isolates were all similar to the vaccine strains recommended by WHO.

CONCLUSIONThe distribution of influenza type and subtype kept on changing each year, but A/H3N2 dominated in most years. A/H1N1 and A/H3N2 in the same year clustered, but some A/H3N2 of near years were and evolved faster with more distinguished strains appeared in same interval. Generally, HA of influenza A isolates in Shanghai during 2004 to 2008 were similar to the WHO reference strains.

China ; epidemiology ; Evolution, Molecular ; Hemagglutinin Glycoproteins, Influenza Virus ; genetics ; Humans ; Influenza A Virus, H1N1 Subtype ; classification ; genetics ; isolation & purification ; Influenza A Virus, H3N2 Subtype ; classification ; genetics ; isolation & purification ; Influenza, Human ; epidemiology ; virology

OBJECTIVEIn order to characterize the feature of stress response induced by stressor with both physical and psychological natures, the effects of water restriction performed in different experimental modes on the physiological parameters, psychological behavioral manifestations and brain c-Fos expressions were observed and compared.

METHODSFifty-eight male Wistar rats were used and randomly divided into three experimental groups (n = 18 for each) and a control group (n = 4). In control group, the rats were allowed to access drinking water freely at all experimental period. In the experimental groups the water supply to the rats was restricted. In timed water supply (TW) group, the water was supplied twice a day, 10 min for each in fixed hours every day. In empty bottle-served (EB) and water-restricted (WR) groups, the water was served only once a day for 10 min, either in the early morning or evening, and in the other time point scheduled for water supply only an empty bottle without water was provided in the EB group and nothing was given in the WR group. The quantities of drank water and eaten food, weight-gaining, and behavior score were observed every day. The serum level of corticosterone was assayed and the rats were sacrificed with fixative perfusion of 3 d, 7 d or 14 d, respectively, following water restriction (n = 6 for each time point in each group). The brain c-Fos expressions were examined with immunohistochemical method.

RESULTSThe slow down of weight-gaining, rise of serum corticosterone level, occurrence of psychological behavioral manifestations of unpeaceful restlessness such as exploring and attacking, enhance of c-Fos expression in the subfornical organ (SFO), median preoptic nucleus (MnPO), area postrema (AP), hypothalamic paraventricular nucleus (PVN), supraoptic nucleus (SON), medial (MeA) and central (CeA) amygdaloid nucleus and ventrolateral septum (LSV) were noticed in both EB and WR groups, except the nucleus of solitary tract (NTS) in which the Fos expression was decreased. The changes of Fos expression in most of nuclei in EB group began at day 3, at least persisted till day 7, and backed down at day 14, while in WR group, similar changes started at day 7 and reached its peak at day 14. In TW group, only the concentration of corticosterone at day 7 was slightly increased and the rest indexes observed were unchanged.

CONCLUSIONThe results indicate that water restriction induces physical as well as psychological stress responses. And the water restrictions experimentally executed in different modes result in different manifestations of behavioral response and brain immediately early gene expression in discrete brain nuclei/regions.

To develop and validate an ultra performance liquid chromatography tandem mass spectrometric (UPLC-MS/MS) method for the simultaneous quantification of baicalin and chlorogenic acid in human plasma after iv infusion of Yinhuang injection, the analytes were isolated from plasma by protein precipitation with methanol. Then they were chromatographied on an Acquity UPLC BEH C18 column (50 mm x 2.1 mm ID, 1.7 microm) at 40 degrees C. The mobile phase A consisted of water and 0.1% formic acid. The mobile phase B consisted of methanol and 0.1% formic acid. The analytes were eluted from the column with a linear gradient from 5% B to 80% B in 5 min, then hold for 0.5 min before returning to initial condition. The flow rate was 0.35 mL x min(-1). A tandem mass spectrometer equipped with electrospray ionization source was used as detector. Multiple reaction monitoring (MRM) using the precursor to product ion pairs of m/z 447-->271 (for baicalin), m/z 353-->191 (for chlorogenic acid) and m/z 287-->287 (for internal standard) were used to quantification. The linear concentration ranges of the calibration curves for baicalin and chlorogenic acid ranged from 9.6 to 1540 ng x mL(-1) and from 7.5 to 1200 ng x mL(-1), respectively. The intra- and inter-day relative standard deviation (RSD) across three validations run over the entire concentration range was less than 10.2% for both baicalin and chlorogenic acid. After iv infusion of Yinhuang injection to the volunteers, the concentration-time curves of baicalin and chlorogenic acid fitted the two-compartment and three-compartment model. T(1/2)alpha were (4.47 +/- 0.89) and (7.65 +/- 4.42) min, T(1/2)beta were (46.22 +/- 10.03) and (34.40 +/- 19.16) min, respectively. The method was proved to be highly sensitive, selective, and suitable for pharmacokinetic investigations of both baicalin and chlorogenic acid.
Area Under Curve ; Chlorogenic Acid ; blood ; pharmacokinetics ; Chromatography, Liquid ; methods ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; isolation & purification ; pharmacokinetics ; Female ; Flavonoids ; blood ; pharmacokinetics ; Humans ; Injections, Intravenous ; Lonicera ; chemistry ; Male ; Plants, Medicinal ; chemistry ; Scutellaria baicalensis ; chemistry ; Spectrometry, Mass, Electrospray Ionization ; methods ; Tandem Mass Spectrometry ; methods ; Young Adult

Child ; Humans ; Facies ; Hyperventilation/genetics* ; Intellectual Disability/genetics* ; Mutation ; Transcription Factor 4/genetics*