Objective To evaluate the efficiency and toxicities of Gemcitabine combined with S -1 cap-sule in the treatment of advanced esophageal cancer .Methods Twenty-nine patients with advanced esophageal cancer were treated with S-1 capsule 80 mg/m2 ,twice daily for 14 days and Gemcitabine (1 000 mg/m2 ) was in-travenously administrated on day 1 and 8.The chemotherapy was repeated every 21 days.After two consecutive treatment circles ,the short term efficacy ,adverse effects and follow -up condition were evaluated .Results One case showed complete remission (CR),11cases showed partial remission (PR),9 cases showed stable disease (SD),8 cases showed progressive disease(PD).The responsive rate(CR+PR)was 41.4%;the illness control rate(CR+PR+SD)was 72.4%.The major adverse events were myelosuppression ranging from grade Ⅰto Ⅲ, hand-foot syndrome,disgusting and the damage of liver function .Some patients displayed the damage of liver function.The median time to progress ( mTTP) was 6.9 months.The median 1-year survival rate was 64.3%. Conclusion The combination of Gemcitabine and S -1 capsule is an effective and well -tolerated method for the patients with advanced esophageal cancer .

Objective To study the significance of the cerebrospinal fluid(CSF)lactate level in diagnosing neonatal bacterial meningitis(BM). Methods The CSF samples were collected from neonates admitted to Neonatal Ward of Children's Hospital of Fudan University between January 2014 and March 2015. CSF lactate and glucose con-centrations were measured with blood - gas analyzer. CSF and serum glucose levels were measured with glucometer. The enrolled neonates were divided into 2 groups based on CSF culture,CSF white blood cells(WBCs)and clinical presenta-tion:observation group(neonates with BM)and control group(neonates without BM). Statistical analysis of data was performed with Stata 12. 0. Results A total of 93 infants(16 assigned to observation group and 77 assigned to control group)met the inclusion criteria. Neonates in observation group had higher median CSF lactate level(4. 2 mmol/ L)and CSF lactate/ glucose ratio(L/ Gcsf)(2. 32 mmol/ L),than those in control group(1. 3 mmol/ L,0. 52),and there were significant differences(Z = - 6. 19,- 5. 92,all P ﹤ 0. 05). CSF glucose levels were lower in observation group(me-dian,1. 25 mmol/ L)than those in control group(median,2. 5 mmol/ L),and the difference was significant(Z = 4. 97, P ﹤ 0. 05);CSF/ serum glucose ratio(CSF/ Sglu)were lower in observation group(median,0. 44 vs 0. 81 in control group),and the difference was significant(Z = 4. 43,P ﹤ 0. 05). The optimal CSF lactate cutoff point of 2. 2 mmol/ L had a positive predictive value(PPV)of 72. 7% and negative predictive value(NPV)of 100. 0% for bacterial meningi-tis. The optimal L/ Gcsf cutoff point of 1. 24 had a PPV of 94. 1% and NPV of 100. 0% . The optimal CSF glucose cutoff point of 2. 0 mmol/ L had a PPV of 65. 0% and NPV of 95. 9% . The optimal CSF/ Sglu cutoff point of 0. 6 had a PPV of 60. 0% and a NPV of 96. 9% . Conclusion CSF lactate may be an excellent biomarker for early diagnosis of neo-natal BM.

Objective To study the clinical value of neonatal arterial blood pH,base excess and lactate levels within 72 h after birth in assessing early brain injury in asphyxia neonates.Method From June 2015 to November 2016,a retrospective study was performed on the asphyxia newborn admitted to newborn department of Children's Hospital of Fudan University.The data of brain magnetic resonance imaging (MRI),video electroencephalogram (VEEG),and artery blood gas analysis (within 12 h and 72 h) were all collected.The neonates were assigned into brain injury group (severe or moderate injury) and control group (normal or mild injury) according to MRI and VEEG results.The differences of arterial blood pH,base excess and the level of lactate between the two groups were analyzed and indicators of brain injury were evaluated using ROC curves.Result A total of 63 cases were included in the study.Thirty patients were in the control group and 33 patients the brain injury group.The pH within 12 h was lower [(7.32 ±0.09) vs.(7.38 ±0.08)],and the lactic acid level in 12 h and at 24-72 h were significantly higher in the brain injury group than the control group [(7.9 ±4.2) mmol/L vs.(4.9 ±2.4) mmol/L and (3.7 ±3.2) mmol/L vs.(2.2 ± 1.1) mmol/L].The differences were statistically significant (P ＜0.05).The areas under the ROC curve of pH,lactate within 12 h and at 24-72 h were 0.323,0.715,0.643 (P =0.016,0.003,0.051).The cut-off value of lactic acid within 12 h in assessing of brain injury was 7.5 mmol/L,with the sensitivity of 0.46 and the specificity of 0.97.Conclusion The artery lactate level within 72 h after birth can be used to evaluate the severity of brain injury in neonatal asphyxia infants.

Objective:To investigate the correlation between preoperative platelet parameters and clinicopathological features of renal cell carcinoma.Methods:The data of 452 patients with renal cell carcinoma treated in the Peking University Third Hospital from January 2015 to December 2016 were retrospectively analyzed, including 308 males and 144 females, and the mean age was 56.5(15-86) years. There were 178 cases, 72 cases, and 42 cases combined with hypertension, diabetes, and coronary heart disease, respectively. Preoperative platelet parameters were the mean PLT of 218.56(72-568)×10 9/L, MPV of 9.65(6.2-20.5)fl, PDW of 14.44(7.9-23.1) fl, and PCT of 20.72%(8%-49%). The data of 253 patients with simple renal cysts were selected as the controls, including 140 males and 113 females, and the mean age was 58(9-84) years. There were 178 cases, 72 cases, and 42 cases combined with hypertension, diabetes, and coronary heart disease, respectively. Preoperative platelet parameters were the mean PLT of 207.08(84-362)×10 9/L, MPV of 9.50(6.9-13.9)fl, PDW of 14.59(8.9-21.6)fl, and PCT of 19.49%(9%-36%). Propensity score matching method was used to balance the baseline differences between the two groups, and the differences of platelet parameters between the two groups were compared. The correlation between different clinicopathological characteristics of renal cell carcinoma and platelet parameters was analyzed. Multivariate logistic regression model was used to explore the risk factors of renal cell carcinoma with lymph node or distant metastasis. Results:After matching the baseline data, PLT( t=1.993, P=0.047) and PCT( t=2.396, P= 0.017) in renal cell carcinoma group were significantly higher than those in controls. Among 452 cases in renal cell carcinoma, there were 395 cases (87.4%) with clear cell renal cell carcinoma and 57 cases (12.6%) with non-clear cell renal cell carcinoma. For pathological stage, there were 325 cases (71.9%) of T 1-T 2 stage and 127 cases (28.1%) of T 3-T 4 stage. In addition, there were 444 cases (98.2%) of N 0 stage, 8 cases (1.8%) of N 1 stage, 428 cases (93.6%) of M 0 stage, and 24 cases (6.4%) of M 1 stage. There were 320 cases of nuclear grade Ⅰ-Ⅱ, 99 cases of nuclear grade Ⅲ-Ⅳ, and 33 cases without nuclear grade. Preoperative high PLT was significantly correlated with T 3-T 4( t=3.409, P=0.001), M 1( t=2.772, P=0.011) and nuclear grade Ⅲ-Ⅳ( t=2.859, P=0.005). Low MPV was significantly correlated with M 1( t=2.981, P=0.003). Low PDW was correlated with T 3-T 4( t=2.567, P=0.011). High PCT was significantly correlated with T 3-T 4( t=2.722, P=0.007) and nuclear grade Ⅲ-Ⅳ( t=3.011, P=0.003). Multivariate logistic regression analysis showed that PLT( OR=1.007, 95% CI 1.002-1.012, P=0.009), clear cell renal cell carcinoma( OR=4.467, 95% CI 1.574-12.679, P=0.005)and nuclear grade Ⅲ-Ⅳ( OR= 5.554, 95% CI 2.399-12.856, P<0.001)were independent risk factors for lymph node or distant metastasis of RCC. Conclusions:PLT and PCT are higher in patients with renal cell carcinoma compared to simple renal cysts. High PLT, PCT, and low MPV, PDW are correlated with the poor clinicopathological characteristics of renal cell carcinoma. Preoperative PLT can be used as an independent risk factor for lymph node or distant metastasis of renal cell carcinoma.

Objective:To establish the high performance liquid chromatography (HPLC)fingerprints of Zhuanggu Guanjie Pills, which provided the basis for its quality evaluation.Methods:HPLC was used with Agilent Eclipse XDB-C 18 column (4.6 mm×250 mm, 5 μm);mobile phase was acetonitrile-0.1% acetic acid water; gradient elution; flow rate was 1 ml/min; column temperature was at 35 ℃; detection wavelength was 254 nm; injection volume was 10 μl. The HPLC fingerprints of 15 batches of Zhuanggu Guanjie Pills were established and similarity analysis was carried out, and the contents of 18 components were estimated. Results:In the fingerprint study, isopsoralen was used as the reference peak, 40 common peaks were marked and 18 peaks were identified and the similarity between the fingerprints of 15 batches of Zhuanggu Guanjie Pills and the control fingerprints was greater than 0.99.Conclusion:This method is easy to operate and has high accuracy, which can provide basis and reference for the quality evaluation of Zhuanggu Guanjie Pills.

Objective:To investigate the application value of carbon nanoparticle tracer in lymph node dissection for Siewert type Ⅱ and Ⅲ adenocarcinoma of esophagogastric junction (AEG).Methods:The retrospective cohort study was conducted. The clinicopathological data of 147 patients with Siewert type Ⅱ and Ⅲ AEG who were admitted to Shengli Petroleum Central Hospital from June 2015 to July 2020 were collected. There were 109 males and 38 females, aged (65±9)years. All the patients underwent laparoscopic-assisted radical resection of AEG via esophageal hiatus. Of 147 patients, 61 cases not injected with carbon nanoparticle tracer preoperatively were allocated into control group and 86 cases injected with carbon nanoparticle tracer preoperatively were allocated into experimental group. Observation indicators: (1) surgical and postoperative situations; (2) influencing factors analysis of No.10 lymph nodes metastasis. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed by the chi-square test. Univariate analysis was conducted by statistic methods based on data type, and multivariate analysis was conducted by the Logistic step-wise regression model. Results:(1) Surgical and postoperative situations. Patients of the experimental group and control group completed laparoscopic-assisted radical resection of AEG via esophageal hiatus successfully. There was no significant difference in the operation time, volume of intraoperative blood loss, the total number of lymph node dissection, the number of the first station, the second station and positive lymph nodes between the two groups ( P>0.05). For the experimental group, the black staining rate of lymph nodes was 57.937%(1 365/2 356), the black staining rate of the first station and second station lymph nodes was 77.989%(1 024/1 313) and 43.691%(232/531), the black staining rate of Siewert type Ⅱ and Ⅲ AEG patients was 56.855%(423/744) and 58.437%(942/1 612), respectively. The lymph node metastasis rate was 19.091%(815/4 269) of 147 patients, 18.573%(242/1 303)of Siewert type Ⅱ AEG patients and 19.319%(573/2 966) of Siewert type Ⅲ AEG patients. For Siewert type Ⅱ AEG patients, the metastasis rate of No.1, 2, 3, 4sa, 4sb, 7, 8a, 11p lymph nodes was more than 10%, the metastasis rate of No.4d, 5, 6, 9, 10, 11d, 12a lymph nodes was lower than 10%. For Siewert type Ⅲ AEG patients, the metastasis rate of No.1, 2, 3, 4sa, 4sb, 7, 8a, 10, 11p and lower mediastinal lymph nodes was more than 10%, the metastasis rate of No.4d, 5, 6, 9 11d, 12a and lower mediastinal lymph nodes was lower than 10%. There was no significant difference in the Clavien Dindo classification of postoperative complications between the two groups ( P>0.05). (2) Influencing factors analysis of No.10 lymph nodes metastasis. Results of multivariate analysis showed that tumor T staging and degree of tumor differention was an independent influencing factor for No.10 lymph nodes metastasis ( P<0.05). Conclusions:For Siewert type Ⅱ and Ⅲ AEG patients, the application of carbon nano-partide tracer can not increase the number of lymph node dissection. The second station lymph node dissection should be paid attention for Siewert type Ⅱ AEG. Tumor T staging and degree of tumor differentiation are independent influencing factors for No.10 lymph nodes metastasis.

To study the effects of nucleoside antiviral drug zidovudine (AZT) on the flexibility of global metabolism and liver glucolipid metabolic balance in mice, male ICR mice were given zidovudine intragastric administration for 12 weeks, and their water and food intake was recorded daily.Serum glucose (GLU) and triglyceride (TG) levels and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were detected after 12 weeks of administration.Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed.HE staining was used to observe the pathological changes of liver.The gene levels of glucose transporter (Glut2), carnitine palmitate transferase (Cpt1α), medium chain acyl-coa dehydrogenase (Mcad), phosphoenolpyruvate carboxykinase (Pepck) and glucose-6-phosphatase (G6pase) were detected by RT-PCR.Western blot was used to detect the protein levels of insulin signaling Akt, P-Akt, Glut2, Mcad and Cpt1α in liver.The results showed that zidovudine significantly decreased lipid metabolism, impaired glucose tolerance, increased liver cell volume, significantly increased liver triglyceride (TG) and non-esterified fatty acid (NEFA) content, increased Glut2 gene expression, down-regulated fatty acid oxidative metabolism genes Cpt1α, Mcad and gluconeogenesis related genes after fasting, and down-regulated protein expression of Cpt1α.The results suggest that zidovudine can induce the disorder of glucose and lipid metabolism after fasting in a dose-dependent manner.

Objective:To study the characteristics of video electroencephalogram (VEEG) and cranial magnetic resonance imaging (MRI) in neonates with inborn errors of metabolism (IEM) and to determine the predictive value for prognostic.Method:From June 2016 to December 2018, a retrospective study was performed on newborns diagnosed with IEM receiving VEEG examinations at the Neonatology Department of our hospital. VEEG and cranial MRI were used as prognostic indicators and the follow-up results were used as criteria predicting the accuracy of prognosis. The accuracy of the prediction was calculated using a 4 × 4 table.Result:A total of 21 eligible cases with 14 types of IEM were included. The most common type of IEM was organic acidemia (47.6%, 10/21). 16 cases (76.2%) had abnormal VEEG background patterns, including 8 cases of organic acidemia, 3 cases of urea cycle disorders, 1 case of energy metabolism disorder and 4 cases of other IEMs. No significant differences existed in the abnormality rate of VEEG background patterns among these groups ( P=0.882). VEEG showed 3 cases of seizures including 2 cases of electrographic-only seizures. Interburst interval durations were shortened on VEEG background with the decrease of blood ammonia level. The positive predictive values of the moderate-to-severe abnormal VEEG background and the presence of major cerebral lesions on MRI in predicting poor prognosis were 90.0% (95% CI 55.5%~99.7%) and 100% (95% CI 66.4%~100%), respectively, and the negative predictive values were 50.0% (95% CI 18.7%~81.3%) and 85.7% (95% CI 42.1%~99.6%), respectively. Conclusion:Neonates with IEM have higher incidences of abnormal VEEG. Continuous VEEG may accurately diagnose neonatal seizures and effectively monitor brain function. VEEG is a useful tool monitoring infants with IEM and predicting adverse outcomes, especially when used in combination with brain MRI.

The incidence of parathyroid hyperfunction is high and its clinical manifestations are diverse. Some patients develop chest tightness and palpitations as the main discomfort, which may be caused by the hypocalcemia and hypercalcemia related to negative calcium balance and parathyroid hyperfunction. We report a case of 53 years old male with parathyroid hyperfunction who was diagnosed with osteoporosis before and received conventional regular supplementation of vitamin D and calcium supplements. However, his condition worsened and he developed chest tightness and palpitation. After 1 month of sufficient supplementation of calcium, the symptoms of chest tightness and palpitation disappeared completely. Then we continued to provide the patients enough vitamin D and calcium supplementation actively. After 1 year of follow-up, the patient's condition was stable. His discomfort of chest tightness and palpitation never recurred, and all the bone metabolism indicators returned to normal.