Objective To evaluate the effect of methylprednisolone on hepatic ischemia-reperfusion (I/R) injury in the patients undergoing hepatolobectomy.Methods Sixty ASA physical status Ⅱ or Ⅲ patients,aged 30-64 yr,weighing 45-75 kg,scheduled for elective hepatolobectomy,were randomized to control group or methylprednisolone group (n =30 each).After induction of anesthesia,methylprednisolone 500 mg (in 100 ml of normal saline) was infused intravenously at 5 ml/min before skin incision in group M.Anesthesia was induced with propofol,fentanyl and cisatracurium.The patients were endotracheally intubated and mechanically ventilated.PETCO2 was maintained at 35-45 mmHg.Anesthesia was maintained with 1％-3％ sevoflurane inhalation,remifentanil infusion,and intermittent iv boluses of fentanyl and cisatracurium.MAP was maintained at 70-100 mmHg and HR at 50-90 bpm.At 10 min before induction of anesthesia,and on postoperative day 1,3 and 5,venous blood samples were collected for determination of the plasma levels of alanine aminotransferase (ALT),aspartate amminotransferase (AST),total bilirubin (TBIL),tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results Compared with group C,the plasma levels of ALT,AST and TBIL were significantly decreased on postoperative day l and 3,and the plasma concentrations of TNF-α and IL-6 were decreased on postoperative day 1,3 and 5 in group M.Conclusion Methylprednisolone can reduce hepatic I/R injury in the patients undergoing hepatolobectomy and inhibition of systemic inflammatory responses is involved in the mechanism.

This article is dedicated to present a comprehensive review on the latest progress and future trends in developing detection methods of CTCs and cancer biomarkers. The article especially analyzes the methods to isolate, quantify and detect cancer cells via their distinctively different physical properties. The advantages and disadvantages of different detection approaches are also evaluated. The target towards cancer early detection was discussed. The important direction for developing comprehensive multi-mode detection method was emphasized.
Biomarkers, Tumor ; Early Detection of Cancer ; methods ; Humans ; Neoplasms ; diagnosis ; Neoplastic Cells, Circulating

Objective To observe the effect of electroacupuncture on urodynamic alteration in rats after complete T10 spinal cord transection.Methods Thirty-one female Sprague-Dawley rats were divided randomly into a sham operation group (n=10),a model group (n=11) and an electroacupuncture (EA) group (n=10).The spinal cords of the rats in the latter two groups were completely transected at the T10 level.Pressure was applied to the rats'lower abdomens every day while in the EA group electroacupuncture with continuous wave electricity was applied to the guanyuan (RN4) and sanyinjiao (SP6) acupoints for 15 min.The treatment was carried out daily for consecutive 7 days.Urodynamic examinations were carried out after the treatment course had finished.Results At the 9th day after the operation,average residual urine volume and bladder capacity in the EA group were both significantly lower than in the model group.Residual urine volume and bladder capacity were lowest in the sham operation group.Average voided volume and voiding rate in the EA group were significantly higher than in the model group.The average voiding rate was highest in the sham operation group.The average vesical pressure of the urine leak point and bladder compliance of the EA group rats were significantly lower than those of the model group The average vesical pressure of the urine leak point and bladder compliance of the sham operation group were lowest of all.All of these differences were statistically significant at the 1％ level of confidence.Conclusion EA can improve the lower bladder's detrusor reflex state and urinary tract function soon after complete T10 spinal cord transaction,at least in rats.

OBJECTIVE:To explore the method for the scientific and standard management of clinical trial drugs. METHODS:By theory analysis and empirical analysis,the management model of clinical trial drugs in our hospital was introduced in terms of software and hardware construction of clinical trial pharmacy,the formulation of drug management system and standard operation procedure,regular quality control and drug information management platform construction,etc. RESULTS:In the experience of our hospital,it could safeguard the safety of drug use in subjects and scientificity and preciseness of drug clinical trial results through the concentrated administration trial drugs by full-time pharmacists according to national laws and regulations,management system and standard operation procedure,and regular quality control inspection by quality control group. CONCLUSIONS:Drug clinical trial institute strictly abide the requirements of Good Clinical Practice,strengthen the management of trial drugs and im-prove information management continuously,which is of important significance to construct standardized,detailed and high-effi-ciency centralized management system of clinical trial drugs.

Objective Pemetrexed and β-elemene can inhibit the growth of tumor cells .This study was to investigate the effect of pemetrexed combined with β-elemene on the proliferation and apoptosis of cervical cancer HeLa cells. Methods Cervical cancer HeLa cells were treated with pemetrexed at the concentrations of 38, 76, 152, 228, and 304μg/mL, and at 24 and 48 hours of treatment subjected to MTT for detection of their proliferation .The experiment included four groups , with the cells treated with β-elemene ( 125μg/mL) , pemetrexed ( 76 μg/mL ) , β-elemene ( 125 μg/mL ) +pemetrexed (76μg/mL), and nothing (blank control) for 24 hours, followed by determination of their proliferation and apoptosis by MTT and flow cytometry, respectively. Results Pemetrexed at 38, 76, 152 and 228μg/mL inhibited the proliferation of the HeLa cells in a concentration-dependent manner, with the inhibition rates of (7.24 ±3.78), (7.94 ±4.37), (11.10 ±2.86) and (15.88 ± 3.38)%at 24 hours, and (16.69 ±0.95), (22.54 ±1.53), (24.48 ±0.92) and (25.54 ±3.61)%at 48 hours, both with statis-tically significant differences between any two groups (P<0.05).Significant differences were also found in the proliferation rate of the same concentration of pemetrexed at the two time points (P<0.05).The combination of pemetrexed and β-elemene showed an inhibi-tion rate of (49.95 ±5.76)%at 24 hours, remarkably higher than (24.36 ±5.59)%in theβ-elemene group and (10.69 ±1.37)%in the pemetrexed group (P<0.01). Conclusion Pemetrexed combined with β-elemene can significantly inhibit the proliferation and synergistically accelerate the apoptosis of HeLa cells .

Objective To investigate the implementation effect of the situation-background-assessment-recommendation (SBAR) communication mode in hospital surgical teams from the elaborate perspective. Methods Since 2015, the surgical teams of Wuxi No.2 People's Hospital, Affiliated to Nanjing Medical University combined the elaborate management with the SBAR communication mode. The elaborate SBAR report mode was established in the surgeries. Security check reports were carried out in the surgeries. The quality of the nurses' shifting of duty, the incidence of adverse events and the satisfaction of patients after the implementation of the mode were compared to before the implementation.Results The time of the nurses' shifting of duty was shortened from (13.1±4.5)min to(7.4±2.1)min significantly (t=10.737,P<0.01). The incidence of adverse events due to poor communication decreased from 50% to 13.33% significantly (χ2=4.950,P<0.05). The patients' satisfaction on the work of operating rooms increased from 84.44% to 95.74% significantly (χ2=6.652, P<0.05).Conclusions The implementation of the hospital surgical team SBAR communication mode in operating rooms from the elaborate perspective effectively upgrades the meaning of specialist care, optimizes the service procedure and reduces the incidence of adverse events due to poor communication, which guarantees the safety of surgical patients.

This article reports one case of adult COVID-19-associated acute necrotizing encephalopathy(ANEC).The patient developed disturbance of consciousness and seizure on the 12th day after SARS-CoV-2 infection.Imaging showed significant swelling and signal changes in the bilateral thalamus,brainstem,cerebral hemisphere and cerebellar hemisphere,which were consistent with the characteristic images of Acute necrotizing encephalitis(ANE).Although methylprednisolone shock therapy and high-dose human immunoglobulin therapy were given early,the patient died.ANEC often starts quickly and progresses rapidly,unconsciousness and seizure are the main manifestations.Imaging features of thalamic and subtentorial symmetry and multifocal lesions are specific for diagnosis,but the treatment and prognosis still face challenges and need further study.

Objective: To explore the relationship between genotype and phenotype of ABCB11 deficiency. Methods: Clinical data of two siblings with ABCB11 deficiency were retrospectively analyzed. Related literature from PubMed, CNKI and Wangfang databases was reviewed to date (up to August 2017) with 'ABCB11 gene’ or 'bile salt export pump’, 'cholestasis’ and 'child’ as key words. Results: The patients were siblings. Both of them presented as jaundice, pruritus and hepatosplenomegaly since 3 days after birth. Significant laboratory findings on admission of the older sister included high total bilirubin, 170 µmol/L;conjugated bilirubin, 115.8 µmol/L;alanine aminotransferase, 168 U/L;total bile acid 186.3 µmol/L and normal gamma-glutamyl transpeptidase. While routine laboratory data of the younger brother were as follows: total bilirubin, 148.8 µmol/L;conjugated bilirubin, 96.3 µmol/L;alanine aminotransferase, 232.8 U/L;total bile acid 226 µmol/L, and normal gamma-glutamyl transpeptidase.Both received ursodeoxycholic acid and fat-soluble vitamins. Liver pathology of the younger brother showed giant hepatocytes with ballooning degeneration, focal necrosis and intrahepatic cholestasis. Both the patients harbor the same compound heterozygous mutations in ABCB11 gene, c.145C>T (p.Q49X) and c.1510G>A (p.E504K). The sister is 9 years old now, with normal liver function. Jaundice faded around 3 months after birth, pruritus relieved at age 5, and medications was stopped since then. The brother progressed to liver failure after an operation on perianal abscess when he was 8-month-old, and received living-related liver transplantation when he was 9 month and 20 days old (from his mother). Now he is 1 year and 5 months old, with normal liver function. Both are under our follow-up. Literature review revealed 18 ABCB11 deficiency patients from 7 families who had apparent different prognoses, within each family the siblings had the same ABCB11 gene mutation. Seven cases relieved after ursodeoxycholic acid therapy and/or partial external biliary diversion, 5 received orthotopic liver transplantation, 2 developed hepatocellular carcinoma and 4 cases died in childhood. Conclusions The clinical manifestations of ABCB11 deficiency may vary greatly in patients carrying the same genotype, even in siblings. Patients should be managed in individualized maner.

Objective To conduct concordance test on Life Event Scale reported by different informants and the suicide-attempters themselves in Chinese suicide research. Methods In this retrospective study, 104 attempted suicide cases and 147 suicide cases were included. Each case had two informants. One was family member, and the other was associate (friends, neighbors, etc.). Suicide attempters (only for attempted suicide cases) were also interviewed by qualified psychiatrists. Life Event Scale was administered to each respondent to obtain life events experienced by the case before the suicidal behavior. Kappa and Intraclass Correlation Coefficient (ICC) were used to compare the suicide attempters' self-reports with two informants' reports, and to present the concordance of two informants' reports for suicides. Results For attempted suicide group, agreements were nearly moderate or better for life events on marital relation, physical illness, family relation, love, birth or death of family members (Kappa≥0.39); Proxy-based chronic stress and acute stress scores were significantly lower than subject-reports (ICC:0.11~0.24, P<0.01).For suicide group, the agreements between the two informants' reports were moderate or better on death of spouse, work/study or physical illness (Kappa≥0.49); The agreement for chronic stress score was fair (ICC=0.47). Conclusions The results have demonstrated that proxy-based data on life events are valid if structured and objective scales are used.

Objective:To evaluate narrow band imaging-magnifying endoscopy (NBI-ME) for the further assessment of lesions of low-grade intraepithelial neoplasia (LGIN) in the gastric biopsy.Methods:Data of 180 patients who underwent NBI-ME before endoscopic submucosal dissection (ESD) for biopsy of gastric LGIN at the First Affiliated Hospital of Soochow University from January 2017 to October 2020 were analyzed retrospectively. Taking the pathological results after ESD as the gold standard, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were calculated, and the receiver operator characteristic (ROC) curve was drawn.Results:Among 180 gastric LGIN lesions, 115 (63.89%) were pathological upgraded and 65 (36.11%) were not after ESD. There were 10 missed diagnoses, 19 misdiagnoses, and 151 correct diagnoses in NBI-ME examination before ESD. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were 91.3% (105/115), 70.8% (46/65), 84.7% (105/124), 82.1%(46/56) and 83.9% (151/180), respectively. The area under the ROC curve was 0.810 (95% CI: 0.737-0.883). Conclusion:Further NBI-ME examination of gastric LGIN lesions diagnosed by biopsy pathology can accurately predict whether the lesions have pathological upgrading after ESD, which is of important guiding significance for the patients to choose the treatment strategy of further follow-up or endoscopic resection.