Objective To evaluate the effects of delayed remote limb ischemic preconditioning (DRLIP) on myocardial injury in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB).Methods A total of 41 patients of both sexes,aged 55-70 yr,weighing 50-75 kg,scheduled for elective cardiac valve replacement under CPB,of ASA physical status Ⅱ or Ⅲ (NYHA Ⅱ or Ⅲ),were randomly divided into 2 groups using a random number table:control group (group C,n =20) and group DRLIP (n =21).In group DRLIP,the patients underwent three 5-min cycles of unilateral lower limb ischemia,induced by a manual cuff-inflator placed on the left thigh and inflated to 200 mmHg starting from 24 h prior to surgery.Blood samples were taken from the central vein before aortic clamping,at 6 h of reperfusion and at 24 h after surgery for determination of plasma cardiac troponin Ⅰ concentrations.Before aortic clamping and at the end of CPB,myocardial tissues were obtained from the right auricle for determination of the expression of caspase-3 and cell apoptosis.Apoptotic index was calculated.The recovery of spontaneous heart beats was recorded.Results Compared with group C,plasma troponin Ⅰ concentrations were significantly decreased at 6 h of reperfusion,and the expression of caspase-3 was downregulated,apoptotic index was decreased at the end of CPB,and no significant change was found in the incidence of recovery of spontaneous heart beats in group DRLIP.Conclusion DRLIP can protect myocardium against injury in the patients undergoing cardiac valve replacement under CPB,and inhibition of cell apoptosis is involved in the mechanism.

Objective To investigate the useful parameters of transthoracic echocardiography (TTE) for the diagnosis of stroke subtypes in patients with acute cerebral infarction.Methods One hundred and one acute ischemic stroke patients met all of the following criteria including ≥50 years of age,normal sinus rhythm on admission,and transesophageal echocardiography (TEE) within 7 days from the onset.The clinical significance of the TEE parameters on admission was examined for identifying intracardiac thrombus formation as follows; left atrial dimension,left ventricular end-diastolic dimension,percentage fractional shortening,left ventricular mass index,ratio of the transmitral inflow velocities (E/A),and the deceleration time of the E wave.Results There were 28 patients with E/A ≥ 1.0 (70 ± 12) years old and 73 with E/A ＜ 1.0 (73 ± 10) years old.No patients showed pulmonary congestion on chest radiography.There were no significant differences in age,TTE parameters,and plasma levels of brain natriuretic peptide between the two groups.Patients with E/A≥ 1.0 had higher incidence of left atrial appendage (LAA)thrombus formation and/or spontaneous echograhic contrast than those with ＜ 1.0 (25.0％ vs 5.5％,x2 =7.95,P ＜0.01).A significant relationship was found between E/A and emptying flow velocity of the LAA (r =-0.569,P ＜0.01).Multivariate logistic regression analysis showed E/A was an independent predictor for LAA thrombus (risk ratio 1.531 per0.1 increase,95％ confidence interval 1.129-2.076,P =0.0002).Conclusions Increased level of E/A on admission was associated with the occurrence of left atrial appendage thrombus formation in patients with acute ischemic stroke.

Objective To explore the pathologic changes in the brain areas corresponding to specific cognitive function and underlying mechanism of cognitive impairment in patients with epilepsy by DTI study.Methods Forty-four Patients and 20 control subjects received the test of Wechsler Adult Intelligence Scale and the Diffusion-Tensor Imaging examination.Mean diffusivity (MD) and fractional anisotropy (FA) in the normal appearing white matter of interested area were measured.T test was employed to compare the MD and FA between patients and healthy controls,patients with normal and impaired FIQ respectively.The relationships between FIQ and DTI value were analyzed by Bivariate correlations.Results VIQ (100.52?17.63),PIQ (95.10?16.72) and FIQ (98.19?17.76) of the patients with epilepsy were significantly lower than those of health controls (VIQ,PIQ and FIQ were 109.77?13.54,108.11? 12.17 and 109.81?10.57,respectively).Significant reduction of FA in both side of posterior limb of internal capsule (P

Objective:To observe the clinical efficacy of point application with Da Huang (Rhizoma Rhei Cruda) powder at Shenque (CV 8) plus moxa-salt hot compress on the umbilicus for preventing gastrointestinal adverse reactions after chemotherapy for non-Hodgkin lymphoma (NHL).Methods:A total of 60 cases with NHL under chemotherapy were divided into two groups by hospitalization order,with 30 cases in each group.The control group was treated with routine nursing and the observation group was additionally given point application with Da Huang (Rhizoma Rhei Cruda) powder plus moxa-salt hot compress on the umbilicus,to compare the effect in preventing gastrointestinal adverse reactions after chemotherapy between the two groups.Results:The occurrence rates of constipation,nausea,vomiting and poor appetite on the second day and fifth day after chemotherapy were obviously lower in the observation group than those in the control group,with statistically significant differences between the two groups (all P＜0.05).Conclusion:The point application with Da Huang (Rhizoma Rhei Cruda) powder at Shenque (CV 8) plus maxa-salt hot compress on the umbilicus can produce more significant efficacy in preventing the gastrointestinal adverse reactions after chemotherapy for NHL than routine nursing.Moreover,it is simple and easy to be used and popularized.

The purpose of this study is to explore the feasibility of wheat germ agglutinin (WGA) modified liposome as a vehicle for ophthalmic administration. Liposome loaded with 5-carboxyfluorescein (FAM) was prepared by lipid film hydration method. WGA was thiolated and then conjugated to the surface of the liposome via polyethylene glycol linker to constitute the WGA-modified and FAM-loaded liposome (WGA-LS/FAM). The amount of thiol groups on each WGA molecule was determined, and the bioactivity of WGA was estimated after it was modified to the surface of liposome. The physical and chemical features of the WGA-modified liposome were characterized and the ocular bioadhesive performance was evaluated in rats. The result showed that each thiolated WGA molecule was conjugated with 1.32 thiol groups. WGA-LS/FAM had a mean size of (97.40 +/- 1.39) nm, with a polydispersity index of 0.23 +/- 0.01. The entrapment efficacy of FAM was about (2.95 +/- 0.21)%, and only 4% of FAM leaked out of the liposome in 24 h. Erythrocyte agglutination test indicated that after modification WGA preserved the binding activity to glycoprotein. The in vivo ocular elimination of WGA-LS/FAM fitted first-order kinetics, and the elimination rate was significantly slower than that of the unmodified liposome, demonstrating WGA-modified liposome is bioadhesive and suitable for ophthalmic administration.
Absorption, Physicochemical ; Adhesiveness ; Administration, Ophthalmic ; Animals ; Drug Carriers ; Eye ; metabolism ; Fluoresceins ; chemistry ; Liposomes ; administration & dosage ; chemistry ; pharmacokinetics ; Male ; Particle Size ; Polyethylene Glycols ; chemistry ; Rats ; Rats, Sprague-Dawley ; Wheat Germ Agglutinins ; administration & dosage ; chemistry ; pharmacokinetics

Objective To investigate the intermediate and long-term efficacy of endoscopic submucosal dissection (ESD) for early esophageal cancer(EEC).Methods A total of 56 patients with EEC underwent ESD at Jiangsu Province People's Hospital between April 2010 and June 2015.Among the 56 cases,there were 39 cases of intramucosal cancer,17 cases of submucosal cancer.Intravascular cancer embolus was found in 2 patients.The en bloc and complete resection rates,the residual,local tumor recurrence and new occurrence rates of EEC after ESD were evaluated.The average follow-up time was 24.4 months,ranging from 1 to 62 months.Results The en bloc and complete resection rates were 92.9％(52) and 87.5％ (49),respectively.Four patients were treated by additional esophagectomy.The cases of residual lesions,local tumor recurrence,new occurrence and second primary extra-esophageal cancer (gastric cancer) was 1 (1.8％),2 (3.6％),2 (3.6％) and 2 (3.6％),respectively.No additional surgical operations were performed in the 7 patients or no recurrence was found,and there was no death during the follow-up period.Conclusion ESD has the advantage of high complete resection rate,low residual and local tumor recurrence rate in treatment of EEC,and the intermediate and long-term outcomes are satisfactory.

Objective To analyze the features of nerve conduction in patients with amyotrophic lateral sclerosis (ALS),and explore the correlation between compound muscle action potential (CMAP)amplitude and disease duration and revised amyotrophic lateral sclerosis functional rating scale (ALSFRSR).Methods Standard motor and sensory nerve conduction studies were performed in 154 patients with ALS.The following parameters were collected including CMAP amplitude,distal motor latency (DML),motor conduction velocity,sensory conduction velocity and sensory nerve action potential amplitude.Regression study was done to explore the correlation between CMAP amplitude and disease duration and ALSFRS-R.Results Motor nerve conduction abnormalities were presented in a majority of the patients with prolonged DML in the tibial nerve,median nerve and ulnar nerve as the most common form (61.06％-81.42％),followed by decreased CMAP amplitude (30.12％-53.98％),decreased MCV (12.05％-16.81％) and absence of CMAP (2.65％-9.73％).Sensory nerve conduction abnormalities were detected in a small proportion of patients and the decreased SCV,decreased SNAP amplitude and absence of SNAP in the sural nerve,median nerve and ulnar nerve were found in 1.22％-2.73％,0-1.82％ and 0-1.22％patients respectively.No correlation was found between CMAP of the common peroneal nerve,tibial nerve,median nerve and ulnar nerve and the disease duration (P ＞ 0.05),while significant positive correlation was established between CMAP amplitude of the median nerve and ulnar nerve and ALSFRS-R (r =0.273,P =0.016;r =0.357,P =0.001).Conclusions Motor nerve conduction is abnormal in a majority of ALS patients with prolonged DML as the most common form,while abnormal sensory nerve conduction is only found in a few of ALS patients.CMAP amplitude of the median nerve and ulnar nerve might be of certain clinical value in evaluating the severity of ALS.

Objective To explore the expression and clinical significance of caudal homeobox gene CDX2 in acute myeloid leukemia(AML) patients .Methods Bone marrow (BM )and peripheral blood (PB)samples were colleted in 114 cases of donor AML patients and 56 patients undergoing chemotherapy .The CDX2 gene expression in every patient′s mononuclera cells were de‐tected by RT‐PCR .Among these patients ,19 cases were detected the gene continuous every three months .Eight healthy PB and five patients with iron deficiency anemia BM as control .Results CDX2 gene transcript levels were detectable in bone marrow mononu‐clear cells from 114 AML patients and 13 healthy donors ,but the level of gene expression was higher in AML patients(90/114 , 78 .9% ) .There was a statistically significant difference between the AML patients and normal donor (P< 0 .01) .The higher or lower expression of CDX2 gene showed no correlation with CR rate .CDX2 gene expression level had a positive correlation in BM and PB mononuclera cells(the correlation coefficient r= 0 .656 ,P< 0 .01) .The expression of CDX2 in patients with CR was 10 .3% -86 .2% of pre‐chemotherapy ,wihch decreased with the treatment course ,while elevated in recurrence .19 cases of patients underwent half a year of follow‐up ,there was no significant difference of the rate of early recurrence in two groups(P>0 .05) .Con‐clusion Higher expression level of CDX2 gene is mostly in AML patients ,but its expression has no relation with CR rate .CDX2 gene may be a prognostic molecular marker in AML patients ,and can be used to monitor the minimal residual disease of Normal chromosome karyotype AML .

Objective To clarify the intravenous thrombolysis utilization of acute ischemic stroke patients in Huashan hospital,and to analyze the factors affecting thrombolytic therapy compliance.Methods The data from a prospective cohort were analyzed.Consecutive acute stroke and transient ischemic attack patients from Huashan Hospital emergency room were recruited in 2014.Eligible ischemic stroke patients were divided into two groups according to intravenous thrombolysis or not.Results Totally 220 patients from emergency room were assessed in 2014.Among eligible patients,43 patients refused intravenous thrombolysis,whereas 59 patients chose this therapy.After multiple analysis,age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were significantly different between the two groups (U =936.000,P =0.024;U =284.500,P ＜ 0.01;x2 =8.824,P =0.003;x2 =7.732,P=0.005;x2 =5.169,P=0.038;x2 =5.040,P=0.025).Patients with NIHSS score ＜7 tended to refuse thrombolysis therapy in the receiver operating characteristic curve analysis (sensitivity 0.93,specificity 0.71).From 2008 to 2014,244 cases were analyzed in the thrombolysis database.Compared with patients with higher baseline NIHSS score,intracranial hemorrhage rate (2.6％ vs 19.4％;x2 =12.466,P ＜0.01),7-day mortality rate (1.3％ vs 16.9％;x2 =12.308,P ＜0.01) and 3-month mortality rate (3.8％ vs 21.1％;x2 =11.993,P ＜0.01) were lower in patients whose baseline NIHSS score ＜ 7 (minor group).A higher rate of excellent outcome (3-month modified Rankin Scale score ≤ 1)was observed in minor group (78.2％ vs 38.0％;x2 =34.403,P ＜ 0.01).Conclusions Intravenous thrombolysis was performed in 54.6％ of eligible ischemic stroke patients.Age,baseline NIHSS score,limb weakness,hemiplegic paralysis,facial paralysis or speech symptoms were associated with patients' decision of thrombolysis.The effectiveness and safety of intravenous thrombolysis were promising for patients with mild stroke.