Objective To observe the therapeutic efficacy and safety of recombinant tissue plasminogen activator (rt-PA) for treatment of patients with acute cerebral infarction and investigate the prognostic factors of thrombolysis. Methods The clinical data of 60 patients with acute cerebral infarction from January 2009 to November 2013 in Department of Emergency, Hangzhou Traditional Chinese Medicine Hospital were retrospectively analyzed;of them, 30 cases received intravenous rt-PA thrombolytic treatment, being in the thrombolytic group, 0.9 mg/kg rt-PA was given to the patient within 4.5 hours after the disease onset, the total dosage could not exceed 90 mg, in which 10%was intravenously injected and the rest 90%was intravenously dripped slowly within 60 minutes. That another 30 cases did not undergo thrombolytic therapy was assigned as the control group, and they took aspirin, etc anti-platelet aggregation routine treatment. Before and after thrombolytic treatment for 1 hour, 24 hours and 14 days, the National Institutes of Health Stroke Scale (NIHSS) score was evaluated in the two groups;before and after thrombolytic therapy for 0.5, 1.0, and 1.5 hours, the patient's scores of Barthel index (BI) were observed in the two groups. In thrombolytic group, the situations of hemorrhage transformation, symptomatic hemorrhage and modified Rankin scale (mRS) score in 3 months of the patients with different ages, complications and NIHSS scores were observed. Results Before treatment, no statistically significant differences were found in the NIHSS score (15.2±3.6 vs. 15.5±3.3) and BI score (45.0±8.8 vs. 44.1±7.6) between the control group and thrombolytic group (both P>0.05);after treatment with the extension of time, the NIHSS score was gradually reduced, reaching the lowest level on the 14th day after thrombolytic treatment, while the BI score was gradually increased, reaching its peak at 1.5 hours after thrombolytic treatment, the changes being more prominent in thrombolytic group (NIHSS score:9.7±2.6 vs. 12.8±4.2, BI score:82.6±7.8 vs. 69.6±9.8, both P<0.05). In thrombolytic group, there were cerebral hemorrhage transformation 2 cases, gum bleeding 3 cases, skin bleeding 1 case, urethral bleeding 1 case, gastrointestinal bleeding and black stool 1 case. In control group, cerebral hemorrhage transformation was seen in 1 case. There was no obvious systemic hemorrhage in the two groups. In the 30 cases in thrombolytic group, the baseline NIHSS score of patients>80 years old was higher than that in cases≤80 years old (15 vs. 12); the age (years: 71.0±4.1 vs. 61.5±2.6), baseline NIHSS score (14 vs. 11) and bleeding conversion rate [37.50% (3/8) vs. 18.18% (4/22)] of cases with atrial fibrillation were higher than those not complicated with atrial fibrillation; the NIHSS score of cases with elevated international normalized ratio (INR) was lower than those without elevated INR (11 vs. 14);The bleeding conversion rate [16.67%(1/6) vs. 29.17%(7/24)] with NIHSS score≤4 were lower than those with NIHSS score>4;the mRS score in 3 months (4 vs. 2), and percentage of 3-month mRS score≤2 [11.1%(1/9) vs. 52.38%(11/21)] in cases with NIHSS score≥20 was higher than that in cases with NIHSS score<20 (all P<0.05). The fatality rate of two groups was 3.33%. Conclusions The intravenous rt-PA thrombolytic treatment can significantly promote the early recovery of neurologic impairment for patients with acute cerebral infarction. The therapy can improve the prognosis and its safety is relatively good. Meanwhile it is similarly effective for cases over 80, with complications such as atrial fibrillation, raised INR, and with different degrees of severity.

Objective To observe the effect of Shenfu injection on intestinal function in rats with sepsis. Methods Forty Sprague-Dawley (SD) rats were randomly divided into four groups: sham operation, sepsis model, low and high concentration Shenfu injection groups, each groupn = 10. The sepsis model was replicated by cecal ligation and puncture (CLP), while the rate in sham operation group just underwent abdominal incision without CLP. Ten minutes after CLP, the low and high dose Shenfu injection groups were given 5 mL/kg and 10 mL/kg Shenfu intravenous injection via a tail vein respectively. The rats in the model group were treated by intravenous injection of 10 mL/kg normal saline through a tail vein in 10 minutes after CLP. Twelve hours later, the rats were sacrificed. The levels of Ghrelin, Gastrin, tumor necrosis factor-α (TNF-α), high mobility group B1 protein (HMGB1), myeloperoxidase (MPO) and diamine oxidase (DAO) activity in serum were detected by enzyme linked immunosorbent assay (ELISA). The levels of protein of Ghrelin and gastrin receptor (GHSR) were detected by Western Blot. Under light microscope, the histopathological changes in intestinal mucosa were investigated, and Chiu score was determined, and the apoptosis index (AI) of intestinal mucosal epithelial cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL).Results Compared with sham operation group, in model group, the levels of Ghrelin and Gastrin in serum were significantly decreased [Ghrelin (ng/L): 121.23±3.53 vs. 146.28±5.43, Gastrin (ng/L): 81.78±3.27 vs 102.78±4.07], the serum levels of TNF-α and HMGB1 were markedly increased [TNF-α (mg/L): 93.71±3.66 vs. 11.69±1.44, HMGB1 (mg/L): 76.25±4.12 vs. 22.41±3.08], the DAO activity and protein expressions of Ghrelin and GHSR of intestinal tissue were obviously decreased [DAO (U/mL): 14.64 ±0.68 vs. 25.13±1.98, Ghrelin (grey value): 0.12±0.02 vs. 0.23±0.04, GHSR (grey value): 0.18±0.02 vs. 0.32±0.03], the MPO activity in intestinal tissue, Chiu score of intestinal mucosa and AI of ileum mucosal epithelial cells were remarkably increased [MPO (mg/L): 175.98±6.95 vs. 45.64±4.48, Chiu score: 3.90±0.52 vs. 0.30±0.30, AI: 29.31±1.65 vs. 5.45±1.35, allP < 0.01]. Compared with model group, in low and high Shenfu injection groups, the levels of Ghrelin in serum and protein expressions of Ghrelin and GHSR in intestinal tissues were significantly increased (P < 0.05 orP < 0.01), the activity of DAO of intestinal tissues, the Chiu score and AI were significantly decreased, the degrees of changes being more significant in high Shenfu injection group than those in low Shenfu injection group [Ghrelin (ng/L): 143.54±3.89 vs. 136.58±4.91, TNF-α (mg/L): 75.13±4.69 vs. 83.70±4.40, HMGB1 (mg/L): 57.47±4.53 vs. 65.41±4.63, protein expression of Ghrelin (grey value): 0.18±0.03 vs. 0.15±0.03, protein expression of GHSR (grey value): 0.28±0.03 vs. 0.23±0.03, MPO (mg/L): 154.05±5.75 vs. 162.64 ±5.73, DAO (kU/L): 19.70±1.51 vs. 16.67±0.92, Chiu score: 2.30±0.52 vs. 3.20±0.48, AI: 20.38±1.34 vs. 26.40±1.32, allP < 0.05]. The levels of serum Gastrin in low and high Shenfu injection group were higher than those in model group, but no statistically significant differences were found (83.59±3.24, 86.54±5.93 vs. 81.78±3.27, bothP > 0.05). Under light microscope, the pathological changes were seen as follows: destruction and obvious edema of intestinal mucosal villi, ulcer formation, significant perivascular hemorrhage, presence of neutrophil infiltration and fracture of basement membrane in model group, while in low and high Shenfu groups, the intestinal villi had little defect, focal necrosis, small amounts of hemorrhage and neutrophil infiltration. Conclusions Shenfu injection can significantly improve the abnormal expressions of serum Ghrelin, reduce the levels of serum TNF-α and HMGB1, lowered MPO activity and enhance DAO activity in intestinal tissue, alleviate pathological changes in ileum mucosa, and decrease AI of ileum mucosal epithelial cells in rats with sepsis. And the degree of therapeutic effect is proportional to the Shenfu injection dose.

Objective To study the feasibility of applying nanometer ceramics artificial bone in clinical repair of bone defects. Methods The animal models of bone defect was made on the unilateral radius of 45 New Zealand white rabbits, which were divided into experimental group(repair with nanometer ceramics artificial bone), control group (repair with ceramics artificial bone) and blank group (unrepaired) randomly. The reconstructive effect in each group was evaluated by gross observation, alkaline phosphatase(ALP) detection of blood serum, histopathological observation, X-ray examination and SEM detection at 4th, 8th and 12th weeks postoperatively. Results In the experimental group there was more bone formation than in the control and the blank groups. The differences in reconstructive effect were statistically significant ( P

Objective To explore the capability of diffusion weighed imaging (DWI) in differentiating malignant cervical lymph nodes from benign ones in nasopharyngeal carcinoma (NPC) patients, and to assess the appropriate b value in 3.0T MR DWI. Methods Conventional MR and DWI scan were performed in 50 patients with histopathologically proven NPC and 20 healthy volunteers with GE 3.0T MR scanner, and neurovascular array 8 channels head and neck unite coil. DWI was performed with single shot spin-echo echo-planar imaging (SE-EPI) sequence at 4 different b values (600, 800, 1000,1200 s/mm~2). The apparent diffusion coefficient (ADC) values between metastatic lymph nodes of NPC patients and benign nodes of volunteers were compared. Results The mean ADC value (×10~(-3) mm~2/s) of metastatic cervical lymph nodes of NPC at different b value (600, 800, 1000, 1200 s/mm~2) was 0.808±0.112, 0.769±0.098, 0.732±0.095 and 0.696±0.083, respectively; the mean ADC value (×10~(-3) mm~2/s) of lymph nodes of volunteers was 0.993±0.172, 0.967±0.165, 0.903±0.157 and 0.855±0.122, respectively (P<0.05). When b value was 800 s/mm~2, and ROC cut-off point was 0.873×10~(-3) mm~2/s, the diagnostic sensitivity, specificity and accuracy was 88.41%, 69.43%, and 75.22%, respectively. Both the satisfying images and the accurate measurement were acquired. Conclusion As a rapid and sensitive new MR technique, DWI can offer help in discriminating benign and malignant cervical lymph nodes in NPC patients.

ObjectiveTo evaluate analytical performance of NT-proBNP on Electro-Chemiluminescence Immunoassay system.MethodsThe precision,accuracy,limit of blank ( LoB ),limit of detection (LoD),functional sensitivity (FS),analytical measure range (AMR),maximal dilution rate,clinical reportable range(CRR) and the analytical anti-interference ability of NT-proBNP were evaluated according to EP documents issued by CLSI and related references.The analytical performance data were compared to quality standards declared by the manusfacturers.According to CLSI C28-A2,80 healthy volunteers,aged from 18 to 74, were chosen and divided into 4 groups on average for biological reference intervals verification.Results The within-run CV and total CV were 1.1％ -2.2％and 1.5％ -2.9％ respectively.The deviations from controls distributed by National Center for Clinical Laboratory and affiliated calibrators were 2.7％ -5.9％ and 2.7％ -7.5％,respectively.The results of LoB,LoD and FS were 2.5,7.8 and 8.8 pg/ml,respectively.AMR was 8 -35 126 pg/ml,and the most suitable dilution rate was 1∶ 2,so the CRR was 9 -70 252 pg/ml.428 μmol/L bilirubin,2 g/L haematoglobin and 2 200 FIU chyle didn't interfere with the NT-proBNP assay.Moreover,almost all the data from different age groups were in the range of biological reference intervals declared by the manusfacturers, except one test data (167 pg/ml).Conclusions The analyticalperformance of NT-proBNP analyzed on Roche Cobas E601electrochemiluminescence immunoassay systemisconsistentwiththestandarlswhichmanufacturershas proclaimed.The establishment of LoD,FS,maximal dilution and CRR for NT-proBNP assay could provide the quality assurance for clinical use and the biological reference intervals declared by manusfacturers could meet the clinical needs.

OBJECTIVETo evaluate the clinical value of diffusion-weighted imaging (DWI) with 3.0 T magnetic resonance scanner for nasopharyngeal carcinoma (NPC) and to explore the appropriate b value during this procedure.

METHODSTotally 50 patients with histopathologically confirmed NPC and 20 volunteers underwent DWI using single-shot echo-planar imaging technique were enrolled in this study. Four groups of b value (600, 800, 1000 and 1200) were applied. The apparent diffusion coefficients (ADC) between the primary tumor of NPC and the metastatic lymph nodes were compared in each group. ADC between the metastatic lymph nodes and benign nodes were also compared.

RESULTSAlthough the mean ADC were not significantly different between NPC and those of metastatic cervical lymph nodes in each group, the mean ADC of the metastatic lymph nodes were significantly lower than those of benign nodes (P<0.05). When b value was 800, both satisfying images and accurate measurements were acquired.

CONCLUSIONDWI is helpful in the diagnosis of primary lesions and their lymph node metastases of NPC.

Adolescent ; Adult ; Aged ; Carcinoma ; Child ; Diffusion Magnetic Resonance Imaging ; methods ; Female ; Humans ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; Young Adult

Objective To analyze the classification,MR manifestations,and the pathological basis of solitary necrotic nodule of the liver(SNN)in order to evaluate MRI as a diagnosing tool Methods The MR appearances of 9 cases with pathologically proved SNN were analyzed and correlated with the classification and pathological appearances.Relevant literature was reviewed.Results(1)Simple coagulative necrosis type(5 cases):The signal of lesions was hypo-intense or iso-intense on both T_1-and T_2- weighted images.After Gd-DTPA administration,the internal part of the lesions showed no enhancement,while the thin capsule of the lesions demonstrated mild or moderate delayed enhancement. These lesions,proved by pathology,were composed of central coagulative necrotic core and a peripheral hyaline fibrosis capsule.(2)Coagulative necrosis aceompanied by liquefactive necrosis type(1 case):On T_1-weighted images,the signal of hypo-intensity was found within these lesions and even lower signal intensity was found in the central area of larger lesions.On T_2-weighted images,the lesions had a bright core and a peripheral hypointensive or isointensive area.After Gd-DTPA administration,the internal part of the lesions showed no enhancement,while the thin capsule of the lesions demonstrated mild or moderate delayed enhancement.These lesions had a central coagulative necrosis core interleaved by slit- like liquefactive necrosis foci,and peripherally a thin capsule of hyaline fibrosis proved by pathology.(3)Multi-nodular fusion type,(3cases):On T_1-weighted images,the lesions were of hypointensive or isointensive signal and had multiple septa of isointensive signal.On T_2-weighted images,the lesions were of hypointensive or isointensive signal and had multiple septa of hyperintensive or isointensive signal.After Gd-DTPA administration,No enhancement was found except mild or moderate delayed enhancement found in the thin capsule and septa.These lesions were composed of central coagulative necrosis area and a peripheral hyaline fibrosis capsule with multiple internal septa proved by pathology.Conclusion MRI apperances can reflect the classification and pathological features of solitary necrotic nodule of the liver.

Objective To investigate the relationship of pathological response of breast cancer after neoadjuvant chemotherapy with the imaging findings in dynamic contrast-enhanced MRI.Methods Forty- five patients with pathologically confirmed breast carcinoma who finished courses of neoadjuvant chemotherapy had breast MRI prior to operation.Dynamic contrast-enhanced MRI scans were performed on a 1.5 T scanner using 3D SPGR sequence before and repeated 6 times after administration of Gd-DTPA. Pathological response was assessed by a pathologist according to Miller & Payne five points classification blinded to breast MRI results.Grade 5 was defined as pCR(pathological complete response).Grade 4 and 5 were defined as major histopathological response(MHR).The type of time signal intensity curve(TIC) (three types),pattern of residual enhancement of each breast cancer were recorded and correlated with pathological findings.Fisher exact test was used for statistical analysis.Results Grade 5 responses were achieved in seven patients;grade 4 in sixteen patients;grade 3 in sixteen patients and grade 1—2 in six patients.70.0%(14/20)of type Ⅰ time signal intensity curve correlated with MHR,while all 6 type Ⅲ curves showed non-MHR response.The type of time signal intensity curve and pathological response grades had statistically significant correlation(P=0.001).18 of the 23 cases with MHR exhibited residual enhancement,while the remaining 5 cases showed no enhancement.Of the 18 MHR cases with residual enhancement,11 showed non-mass-like enhancement and 7 showed mass-like enhancement.The mass(non- mass)morphological pattern in dynamic contrast enhanced-MRI had statistically significant differences in pathological response(P=0.012).Conclusions Pathological response of breast carcinoma after neoadjuvant chemotherapy could be characterized using dynamic contrast-enhanced MRI by identifying patterns of residual contrast enhancement and kinetic curve.Favorable pathological responses correlated with Type Ⅰ TIC,non-enhancement,and non-mass-like residual enhancement.

OBJECTIVE: To monitor the changes of plasma asymmetric dimethylarginine (ADMA), nitric oxide (NO), and von Willebrand factor (vWF) levels in patients with stable angina pectoris (SAP) or acute coronary syndrome (ACS) and to evaluate the correlation between ADMA and different types of coronary heart disease. METHODS: A total of 143 subjects were divided into a non-CHD group, a SAP group and an ACS group. Plasma levels of ADMA, NO and vWF were examined and their correlation with SAP or ACS was analyzed. RESULTS: Compared with the non-CHO or the SAP group, ADMA level was elevated in the ACS group (P<0.05). The ADMA level tended to increase in the SAP group compared with the non-CHD group, but had no significant difference (P>0.05). Compared with the non-CHD group, NO level was decreased in both the SAP and ACS group (P<0.05), and it decreased more in ACS group than that in the SAP group (P<0.05); vWF levels were increased in both the SAP and ACS group compared with the non-CHD group (P<0.05). There was no significant difference in the plasma levels of vWF in the SAP and the ACS group (P>0.05). CONCLUSION The change of plasma ADMA level is closely correlated with acute coronary syndrome. ADMA might be a clinical marker for acute coronary syndrome.
Acute Coronary Syndrome ; blood ; Aged ; Angina Pectoris ; blood ; Arginine ; analogs & derivatives ; blood ; Biomarkers ; blood ; Coronary Disease ; blood ; classification ; Female ; Humans ; Male ; Middle Aged ; Nitric Oxide ; blood ; von Willebrand Factor ; metabolism