Objective To evaluate the value of multi-slice CT(MSCT)classification in the assessment of the hilar cholangiocarcinoma resectahility.Methods Thirty patients with surgically and histopathologically proved hilar cholangiocarcinomas who underwent preoperative MSCT and were diagnosed correctly were included in present study.Transverse images and reconstructed MPR images were reviewed for Bismuth-Corlette classification and morphological classification of hilar cholangiocarcinoma.Thcn MSCT classification was compared with findings of surgery and histopathology.Curative resectabilty of different types according to Bismuth-Corlette classification and morphological classification were analyzed with chi-square test.Results In 30 cases,the numbers of Type Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳ according to BismuthCorlette classification were 1,3,4,5 and 17.Seventeen patients underwent curative resections,among which 1,2,1,4 and 9 belonged to Type Ⅰ,Ⅱ,Ⅲa,Ⅲb and Ⅳ respectively.However,there was no significant difference in curative resectability among different types of Bismuth-Corlette classification(X2=0.9875.P＞0.05).In present study,the accuracy of MSCT in Bismuth-Corlette classification reached 86.7%(26/30).The numbers of periducatal infiltrating,mass forming and intraductal growing type were 13,13 and 4,while 6,8 and 3 cases of each type underwent curative resections.There was no significant difference in curative resectability among different types of morphological classification(X2=1.2583,P＞0.05).The accuracy of MSCT in morphological classification was 100%(30/30)in this study group.Conclusion MSCT can make accurate diagnosis of Bismuth-Corlette classification and morphological classification.which is helpful in preoperative respectability assessment of hilar cholangiocarcinoma.

Age of Onset ; Aged ; China ; epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Pneumoconiosis ; epidemiology ; mortality

Objective: To investigate the current status of knowledge and practice pertaining to nosocomial infection control among medical professionals in grassroots healthcare institutions, so as to provide the evidence of improving the level of infection control in grassroots healthcare institutions. Methods: All medical professionals working in grassroots healthcare institutions in Pukou District, Nanjing City, were enrolled. The participants' demographic features and knowledge and practice of nosocomial infection control were collected using self-designed questionnaires and descriptively analyzed. Results: A total of 402 participants were enrolled, included 116 men ( 28.86% ) and 286 women ( 71.14% ). The respondents were predominantly at ages of 41 years and older ( 187 subjects, 46.52% ), with bachelor and above as the predominant educational level ( 200 subjects, 49.75% ) and intermediate title and above as the predominant professional title ( 168 subjects, 41.79%) , and there were 236 participants ( 58.71% ) with the length of service for more than 10 years. The awareness rate of nosocomial infection control knowledge was 56.22% among medical professionals working in grassroots healthcare institutions, with the highest awareness for COVID-19 prevention and control ( 89.55% ) and the lowest awareness for the key aspects in nosocomial infection control ( 39.55% ). The formation rate of implementing nosocomial infection control practices was 84.08%, with a low rate for “Implement satisfactorily the isolation interventions for patients with multidrug resistant bacteria” ( 71.14% ) and “Implement satisfactorily the control measures for nosocomial infections in key departments and key aspects”( 64.68% ). Conclusions Low levels are seen in the awareness of nosocomial infection control, behaviors of multidrug resistance management and key aspects in nosocomial infection control among medical professionals in grassroots healthcare institutions in Pukou District.

Objective To explore the effect of early intervention on patients with severe illness deterioration induced multiple organ dysfunction syndrome(MODS). Methods 184 severe patients were randomly divided into conventional treatment and intervention groups(each,92 cases). Active treatment of primary disease and symptomatic treatment were given to the patients in the control group,and based on the treatment of the above group, low dose heparin was additionally given to the observation group for anticoagulation to change hemorheology. Before and after treatment for 1 week,life signs,blood routine test,blood biochemistry,blood coagulation index,D-dimer, hemorheology,blood gas analysis and acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score were observed in two groups to judge the overall changes of disease situation. The length of stay in intensive care unit(ICU), the incidence of MODS and mortality after 1 week treatment were compared between the two groups. Results The levels of platelet count(PLT),fibrinogen(Fib),D-dimer,whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity,white blood cell count(WBC),arterial blood lactate(Lac),alanine aminotransferase (ALT),serum creatinine(SCr),APACHE Ⅱ score in two groups after the treatment were decreased significantly, while oxygenation index(PaO2/FiO2),mean arterial pressure(MAP)were increased significantly,and the observation group improvement was better than that of the control group〔PLT(×109/L):180.74±85.59 vs. 214.33±78.68,Fib (g/L):3.15±0.83 vs. 3.22±1.89,D-dimer(g/L):0.35±0.17 vs. 0.72±0.25,whole blood high shear viscosity (mPa · s):5.54±2.26 vs. 6.73±2.48,whole blood low shear viscosity(mPa · s):8.56±2.12 vs . 11.76±3.45,plasma viscosity(mPa · s):1.35±0.24 vs. 1.82±0.50,WBC(×109/L):10.75±5.53 vs. 14.34±8.66,PaO2/FiO2(mmHg, 1 mmHg=0.133 kPa):288.52±85.34 vs. 216.34±97.72, MAP(mmHg):99.52±20.85 vs. 90.73±21.86, Lac (mmol/L):2.72±1.08 vs. 4.46±2.87, ALT (U/L):89.73±22.45 vs. 125.23±77.48, SCr (μmol/L):110.19±35.26 vs. 140.23±68.96,APACHEⅡscore:13.29±3.74 vs. 18.45±3.52,all P<0.05〕;in the control group,the activated partial thromboplastin time(APTT)after treatment was decreased significantly(s:40.76±9.89 vs. 42.39±12.47),while in the observation group,increased(57.50±7.12 vs. 41.74±13.62). Compared with the control group,the length of stay in ICU was shortered(days:4.1±1.5 vs. 4.6±2.3,P<0.05),the incidence of MODS (22.8% vs. 46.7%,P<0.05)and mortality(6.5% vs. 14.1%,P<0.05)were reduced significantly in observation group. No serious complications occurred in two groups. Conclusion Anti-coagulant used for early intervention can control the disease progress and prevent the patients with severe disease from further deterioration,thus it may reduce the incidence of secondary MODS and mortality,shorten the duration of hospitalization in ICU and save the cost.

The expression of paired immunoglobulin-like receptor B (PirB) in normal and injured spinal cord of rats was investigated. The SD rat hemi-sectioned spinal cord injury (SCI) model was established. Before and 1, 3, 7, 10 days after SCI, the spinal cord tissues were harvested, and Western blot and immunohistochemistry were used to examine the expression and location of PirB. The results showed that the expression level of PirB in the normal spinal cord of SD rats was low. At the first day after SCI, the expression of PirB was obviously increased, and that in the injured spinal cord from the first day to the 10th day was significantly higher than in the normal spinal cord. The positive expression of PirB in neurons from different regions of gray matter of the injured spinal cord was seen. It was concluded that the expression of PirB in the normal spinal cord of rats was low. The expression of PirB in SCI was significantly increased till at least the 10th day.

Aim: To establish an HPLC method for the determination of 3-methyl-7, 8-dihydroxy-isochroman-4-one in the peel of Musa sapientum. Methods: A column of Shimadzu ODS-C_(18) column (250 mm × 4. 6 mm,5 μm), and a mobile phase of acetonitrile-water-phosphoric acid(9:91:0. 1) were adopted. A detect wavelength of 283 nm, a flow rate of 1 mL/min, and a column temperature of 35 ℃ were set. Results: The content of 3-methyl-7,8-dihydroxy-isochroman-4-one in the peel of Musa sapientum was 0.029 5%-0.036 7%. Calibration curve was linear over the range 1. 09-13. 08 μg. The average recovery was 100. 0%. The assay variability value was 0. 64 %(n=9). Conclusion: The method can be used for the quality control of Musa sapientum.

AIM: To establish an LC-MS/MS method for determination of evodiamine concentration in rat plasma and to study its pharmacokinetic profile in rats. METHODS: Six rats were administrated (i.g.) evodiamine at the dose of 100 mg/kg. Blood samples were collected from eye socket. Evodiamine concentration in rat plasma was determined by LC-MS/MS method. The pharmacokinetic parameters were calculated using DAS program. RESULTS: A good linear relationship was obtained in the concentration range (0.2-50.0 ng/mL) studied (r2=0.9997). Average recoveries ranged from 96.12% to 99.46%. Intra-and inter-day relative standard deviations were 4.61%-13.51% and 5.65%-11.49%, respectively. The main pharmacokinetic parameters of evodiamine were as follows: Cmax (5.3±1.5) ng/mL; tmax (22±8) min; t1/2 (451±176) min. CONCLUSION: A selective and sensitive liquid chromatography-tandem mass spectrometric (LC-MS/MS) method for the quantification of evodiamine in rat plasma is developed and validated. This method is successfully applied for the pharmacokinetic studies of evodiamine in rats.

AIM: To determine the concentration of escitalopram in human plasma by HPLC-MS/MS and investigate the pharmacokinetics of escitalopram. METH-ODS: The method involved protein precipitation with methanol. The chromatographic separation was achieved within 6.0 min by using methanol-water with 15 mmol·L-1 ammonium acetate-formic acid (72:28:O.1, v/v/v) as mobile phase and a Lichrospher CN 150 mm×4.6 mm analytical column. The analytes were detected using an electrospray ionization tandem mass spectrometry in SRM mode. Detection of the ions was performed by monitoring the transitions of m/z 325.0 to 234.0 for escitalopram and m/z 409.1 to 238.1 for amlodipine (intemal standard), respectively. RESULTS:The standard curve was linear ( r = 0. 999) over the concentration range of 0.20 - 50.00 ng· ml- 1. Accuracy and precision were below the acceptance limits of 15%. The recoveries of escitalopram ranged from 96.0% to 103.6%. The lower limit of quantification for escitalopram was 0.20 ng· ml-1 using 200 μl plasma sample.The pharmacokinetic parameters of escitalopram after a single oral dosing of escitalopram oxalate tablet (10 rog)to ten healthy male volunteers were achieved. The Cmax, Tmax, AUC0-t, AUC0-∞, t1/2 and Ke of escitalopram were 9.21±2.10 ng·ml-1 , 3.75±1.04 h, 514.6±152.3 ng·h·ml-1 ,540.5±162.3 ng·h·ml-1 , 34.06±7.71 h and 0.021±0.004 h-1,respectively. CONCLUSION:The determination of concentration of escitalopram in human plasma by HPLC-MS/MS method was repid, sensitive and reliable. It can be used for clinical pharmacokinetic study of escitalopram.

Objective To investigate the protective effect of sirolimus pretreatment against liver ischemia-reperfusion(I/R)injury in rat model and the possible mechanism.Methods Forty-eight male SD rats were randomized into four groups (12/group):A:sham group with saline,B:sham group with sirolimus,C:saline-operated group,D:sirolimus-operated group.The rats were pretreated with either saline or sirolimus (2 mg·kg~(-1)·d~(-1))by oral gavage for two weeks．The rat partial liver model of I/R injury was established,and the samples were collected at the 24th h after the I/R The serum ALT and AST levels were determined,the histologic changes were observed by HE staining under the light microscopy,the frequency of CD4~+ CD25~+ T cells among mononuclear cells in liver tissue was analyzed by using flow cytometry,the expression of Foxp3 mRNA was detected in liver tissue by real-time PCR,and the serum TGF-β,IL-10 levels were measured by enzyme-linked immunosorbent assay (ELISA).Results Serum ALT and AST levels were significantly decreased and the histological damage was significantly alleviated in the sirolimus-operated group as compared with saline-operated group(P<0.05).The percentage of CD4~+ CD25~+ T cells among mononuclear cells in groups A,B,C,and D was(6.12±1.87)%,(22.36±6.75)%,(4.53±1.02)% and(13.29±3.16)% respectively in liver tissue The expression levels of the Foxp3 mRNA were significantly higher in sirolimus group than in saline group(P<0.05).The ELISA showed that sirolimus could significantly increase the levels of TGF-β and IL-H)(P<0.05).Conclusion Pretreatment of sirolimus can effectively protect against liver ischemia-reperfusion injury in rats,which may be related to induction of CD4~+ CD25~+ Foxp3~+ T regulator cells by sirolimus,and the increase of TGF-β and IL-10 secretion to inhibit the imflammatory response.