OBJECTIVE:To evaluate the feasibility of using CYP2C19 gene to guide the use of antiplatelet agents in acute cor-onary syndrome(ACS)patients undergoing interventional operation in China from the viewpoint of pharmacoeconomics. METH-ODS:Based on global PLATO trial data,the patients were divided into 3 groups according to treatment strategies(clopidogrel group,ticagrelor group,genetic test group). By applying Treeage Pro 2011 software,short-term decision tree model and long-term Markov model were established,and related data were imported to evaluate cost-effectiveness of different treatment strategies. RE-SULTS&CONCLUSIONS:For ACS patients,according to the level of GDP in China,conventional use of ticagrelor is of pharma-coeconomic advantage for in Shanghai and uninsured patients insured patients;the use of antiplatelet agents guided by CYP2C19 gene test is of pharmacoeconomic advantage among nationwide insured patients.

Objective To explore the optimal method and condition for controlling release of vincristine (VCR) from VCR-loaded erythrocytes and enhancing the stability of carrier erythrocytes. Methods Erythrocytes were loaded into human erythrocytes using the modified hypotonic pre-swelling and isotonic resealing technique, and then with VCR, and they were treated with glutaraldehyde in concentration of 0.16% and 0.25% respectively. After storing at 4℃ for indicated time, the amount of VCR was determined with HPLC to compare their drug-release rate, and the degree of hemolysis in the supernatants was observed to compare the fragility of VCR-loaded erythrocytes treated with 0.16% glutaraldehyde with that with 0.25%, VCR-loaded erythrocytes treated with PBS, and VCR-loaded erythrocytes exposed to different hypotonic sodium chloride in different concentrations. Results The VCR-accumulated release rate increased in glutaraldehyde-treated VCR-loaded erythrocytes as well as untreated group during preservation. The VCR-accumulated release rate of 0.25% glutaraldehyde-treated group decreased by 71.67?4.20%, which was significantly slower than untreated VCR-loaded erythrocytes and 0.16% glutaraldehyde-treated group. After storing at 4℃ for 21 days, no significant changes at erythrocyte morphology was found in VCR-loaded erythrocytes treated with 0.25% glutaraldehyde, whereas untreated VCR-loaded erythrocytes and those treated with 0.16% glutaraldehyde can be stored only for 5d and 7.5d respectively. As compared to un-treated VCR-loaded erythrocytes, no significant change of osmotic fragility was seen in 0.25% glutaraldehyde-treated group, but significant increase in osmotic fragility was seen in 0.16% glutaraldehyde-treated group. Conclusion 0.25% glutaraldehyde could optimally block the membrane of VCR-loaded human erythrocytes and enhance their stability.

Objective To study the imaging value in diagnosis of congenital cholangiectasis.Methods The clinical and imaging (CT and ultrasonics) data of 6 patients with congenital cholangiectasis were restrospectively analyzed with literature review.Results According to Todani's classifications of cholangiectasis,there were type I in one case,CT showed cystic hypodense shadow with thin and smooth wall;type IV in 4 cases,CT showed cystic or fusiform extension of intra-and extra-hepatic bile ducts;type V in one case,CT showed cystic extension of intra-hepatic bile ducts,and the central spot enhancement could be seen on contrast-enhanced CT scan.6 cases underwent ultrasonic examinations,ultrasound showed extension of intra-and extra-hepatic bile ducts in 6 cases,choledochal cyst in one.4 cases suspected with congenital cholangiectasis,and misdiagnosed in one.In company with cholecystitis and cholelithiasis in one,biliary carcinoma in one and cirrhosis in one.Conclusion CT and US are of important value in diagnosis of congenital cholangiectasis.

Objective To investigate the clinical value of damage control resuscitation ( DCR) in the treatment of severe multiple injuries combined with traumatic hemorrhagic shock. Methods A retrospective analysis was done on 27 patients with severe multiple injuries combined with traumatic hemorrhagic shock treated by DCR. Another 32 patients treated with traditional aggressive/normotensive fluid resuscitation were used as control. Lactic acid clearance time, coagulation, diffuse intravascular coagulation (DIC) morbidity, and mortality were observed and compared between two groups. Results Compared with traditional aggressive/normotensive fluid resuscitation, DCR had better curative effect, shorter clearance time of lactic acid, more rapid recovery of blood coagulation function and lower incidence of DIC morbidity and lower mortality for patients with severe multiple injuries combined with traumatic hemorrhagic shock. Conclusions In the treatment of severe multiple injuries combined with traumatic hemorrhagic shock, the use of DCR can remarkably improve the survival rate of patients and also provide a new way for resuscitation and rescue of other types of shock patients.

Animals ; Cardiovascular System ; drug effects ; Curcuma ; Plant Extracts ; pharmacology

Angina, Unstable ; diagnosis ; Humans ; Medicine, Chinese Traditional ; Severity of Illness Index

Objective To compare the perioperative outcomes and short-term efficacy of three-port extraperitoneal laparoscopic radical prostatectomy (ELRP) and four-port ELRP.Methods Two hundred patients who had undergone ELRP for prostate cancer by a single surgeon from November 2010 to October 2014 were retrospectively analyzed.Among them,95 cases underwent three-port ELRP and 105 cases underwent four-port ELRP.On the basis of traditional four-port ELRP,three-port ELRP was characterized by the omission of the trocar on the inner side of right anterior superior iliac spine.The mean age was 66.8 ± 15.5 years,and mean total prostate specific antigen (tPSA) was 15.3 ± 12.4 μg/L.There were no significant differences including age,body mass index,tPSA,clinical stages,acceptance of neoadjuvant hormone therapy,history of transurethral resection of the prostate,history of diabetes mellitus between the 2 groups (P ＞ 0.05).Patients in three-port ELRP group had significantly smaller prostate volume than fourport group (35.6 ± 16.7 ml versus 42.2 ± 24.7 ml,P ＜ 0.05).The clinical factors as operative time,estimated blood loss,hospital stay,drainage tube keeping days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates were compared between the 2 groups.Results The three-port group had significantly shorter operative time than the four-port group (81.0 ± 18.6 min versus 103.6 ±34.6 min),less estimated blood loss (102.6 ±75.8 ml versus 217.5 ± 182.9 ml),less positive surgical margin rates (13.7％ versus 27.6％).There were 9 patients having Gleason scores more than 7 in the three-port ELRP group and 29 patients in four-port ELRP group (P ＜ 0.05).There were no significant differences of hospital stay,drainage tube keeping days,pathological stages between the 2 groups (P ＞ 0.05).Eighty-three cases in the three-port ELRP group (87.4％) were followed up for 5-19 months with the median time of 11 months.Ninety-two cases in fourport ELRP group (87.6％) were followed up for 17-52 months and the median time was 27 months.There were no significant differences of biochemical recurrence rates and urinary incontinence rates between the 2 groups(P ＞ 0.05).Conclusions Compared to four-port ELRP,three-port ELRP can provide shorter operative time,less blood loss,better negative surgical margin rates,similar oncological control and recovery of postoperative continence.In experienced hands,three-port ELRP could be a feasible and effective option for localized prostate cancer.

Objective To evaluate the learning curve of three-port extraperitoneal laparoscopic radical prostatectomy(ELRP) and to minimize operative time and blood loss about this procedure.Methods From August 2013 to October 2014,the data from 95 consecutive patients,who had undergone three-port ELRP for prostate cancer,were retrospectively analyzed.The mean age was 65.9 ± 7.7 years,mean total PSA level was 15.4 ± 12.7 μg/L,and mean body mass index(BMI) was 24.8 ± 3.2 kg/m2.According to the number of procedures performed by the surgeon,all patients were classified into three chronologic groups,including group A (No.1-32),group B (No.33-64) and group C (No.65-95).There were no significant differences including age,BMI,tPSA,estimated prostate volume,clinical stages,history of neoadjuvant endocrine therapy,history of transurethral resection of the prostate (TURP) among group A,B and C (P ＞ 0.05).The operative outcomes analyzed were operative time,estimated blood loss,hospital stay,drainage tube indwelling days,pathological Gleason scores,pathological stages,positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates.Among these 95 patients,the results of the first 32 cases were compared with those of the remaining 63 cases,the first 64 with the remaining 31.Results The average operative time in 95 patients was 81.0 ± 18.6 min.The sloping learning curve for this surgeon showed that the operative time for all 95 cases was strongly correlated with additional experience (| rs | =0.612,P＜0.01).Operative time,however,was not strongly correlated with the surgeon's experience in each group of A,B and C(P ＞0.05).Group A had longer operative time than that of Group B plus C(96.4 ± 11.3 min vs 73.2 ± 16.7 min,P ＜0.01).Group A plus B had longer operative time than that of group C (87.6 ± 17.2 min vs 67.5 ± 13.8 min,P ＜ 0.01).For all cases,the estimated blood loss was strongly correlated with additional experience (| rs | =0.677,P ＜ 0.01).Estimated blood loss was strongly correlated with the accumulation of experience for the initial 32 cases(| rs | =0.619,P ＜ 0.01).However,no strong correlation was observed over the next 63 cases.Group A had more blood loss than that of Group B plus C (158.7 ± 81.3 ml vs 74.1 ± 54.4 ml,P ＜ 0.01).Group A plus B had more blood loss than that of group C (125.5 ± 71.6 ml vs 55.3 ± 61.6 ml,P ＜ 0.01).But hospital stay,drainage tube keeping days were not strongly correlated with additional experience in each group(P ＞ 0.05).There were no significant correlation between the accumulation of experience and positive surgical margin rates,biochemical recurrence rates and urinary incontinence rates.Conclusion Our experience of three-port ELRP cases appears to be favorable with decreasing tendency in operative time,estimated blood loss with experience accumulation.Exposure to 32 surgeries,operative time and estimated blood loss reduced significantly,and after 64 cases operative time and estimated blood loss further reduced.

Objective To explore the effect of Fas and caspase-3 on apoptosis in the white matter damage(WMD) neonatal rats.Methods The pups(45 in each group) were perfused at 30 min,1 h,4 h,12 h,1 d,3 d,7 d,14 d,21 d of recovery from hypoxia-ischemia(HI).Immunohistochemical technique was applied to investigate the changes in the expression of Fas and caspase-3 in periventricular white matter tissues.Apoptotic cells were detected in these tissues by TUNEL.Results Apoptosis index(AI) in the experimental group increased significantly at 4 h and reached the peak at 3 d after HI.No expression of Fas was found in the control group.The expression of Fas in the experimental group appeared at 30 min after HI,increased at 1 h,reached the peak at 12 h and lasted till 3 d.Caspase-3 in the experiment group was up-regulated,peaked at 1 d,demonstrating significant differences at 1 h,4 h,12 h,1 d,3 d and 7 d compared with the control group(P

Blue laser imaging (BLI) is a new endoscopic system equipped with the laser beam emitting two different wavelengths.It produces bright and high resolution images for observation of microvascular and microsurface patterns of esophageal and gastric mucosa, helping the diagnosis of early upper gastrointestinal cancer.Compared with the existed endoscopic techniques, BLI shows its unique advantages.In this article, advances in application of BLI in diagnosis of early upper gastrointestinal cancer were reviewed.