Objective To determine the effectiveness and safety of prophylactic intravenous ibuprofen compared to placebo/no intervention on the prevention of patent ductus arteriosus(PDA) in preterm infants.Methods Randomized controlled trials(RCT) or quasi-RCT comparing prophylactic intravenous ibuprofen versus placebo/no treatment for prevention of PDA in preterm infants were enrolled. The standard search strategy included electronic search and manual search. Electronic search was carried out in databases including PubMed,ScienceDirect, EMBASE, OVID, Cochrane Library, VIP Chinese Periodical Database and Chinese Digital Hospital Library (www. chkd. cnki. net) without language restriction. As a supplementation,references in previous reviews and studies identified as relevant had been examined by manual search. RevMan 5.0. 21 was used in the statistical analysis. Effects were expressed as weighted mean difference (WMD) and 95% confidence interval (CI) for continuous data while risk ratio (RR) and 95%CI for categorical data.Results Four studies qualified for this meta-analysis including three graded 4 and one graded 3 with Jadad scale. Prophylactic use of ibuprofen significantly decreased the incidence of PDA on day three (RR=0. 40,95 % CI: 0. 31-0. 51, P＜0.01 ), the need for rescue treatment with cyclo-oxygenase inhibitors (RR = 0. 18,95 % CI:0. 07-0. 45, P = 0. 0003) and the need for surgical ligation (RR = 0. 34,95 % CI: 0. 14-0. 81, P =0. 02) in the prophylactic group. No significant difference of pulmonary, cerebral, gastrointestinal, and renal complications were found between the prophylactic and control groups. Conclusions Prophylactic intravenous ibuprofen significantly reduces the risk of PDA on day three, decreases the need for rescue treatment with cyclo-oxygenase inhibitors and surgical ligation without significant pulmonary, cerebral,gastrointestinal, and renal complications were seen in the prophylactic group. Due to the limits of evidences to date, prophylactic ibuprofen intravenously for prevention of PDA in preterm infants is not recommended.

Professor LU Zhi-zheng, one of the first traditional Chinese medicine masters, is good at using tenuifoliain clinical practice, which often brings unexpected surprises. Lu said, tenuifolia is a mild herbal medicine with the nature of upward dispersion and outward penetration but not dryness. Tenuifolia has the following functions: making people conscious, relieving sore throat, diverging incubated diseases, regulating functional activities of qi, sending up Yang, dispelling wind evil and eliminating dampness, and activating collaterals to relieve pain. When well used, it will not only enhance the effect of monarch drug, but also restrict the impetuosity nature in a prescription, achieving better efficacy.
Adult ; Brassicaceae ; chemistry ; Dizziness ; drug therapy ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Male ; Phytotherapy ; Rhinitis, Allergic ; drug therapy ; Stomach Diseases ; drug therapy

Objective To evaluate the value of monitoring circular blood interleukin(IL)-17 for predicting 60 d mortality rate in premature infants with necrotizing enterocolitis(NEC).Methods A total of 85 neonates with surgically or medically treated NEC were retrospectively included.Serum IL-17 level was detected in diagnosing NEC and before preparing operation for evaluating its predictive value.Results The mortality rate after 60 d was 20 ％ (17/85),in which 5 (10 ％)was in the medical treatment group and 12(34％) in the surgical treatment group.The IL-17 level was significantly correlated with mortality rate after 30 d [odds ratio (OR):1.38;CI:1.14-1.67;P=0.001].The preoperative IL-17 level in the surgical treatment group was 27-7 500 pg/mL(median 2 625 pg/mL),which was significantly higher than mean 156 pg/mL in the medical treatment group.The difference in the area under curve(AUC)between the medical treatment group and surgical treatment group was 0.82(CI:0.74-0.90).The critical value of IL-17 for detection significance was 1 783 pg/mL(sensitivity was 90.5％,specificity was 59.2％).Conclusion Serum IL-17 level is correlated with the mortality rate after 60 d.

Objective:To observe the expression of Th1 versus Th2 type cytokines in primary hepatic cancer(PHC)and its adjacent liver tissues.Methods:The gene expression of Th1/Th2 cytokines was detected by RT-PCR using IFN-?and IL-2 as Th1 type cytokine genes,IL-4 and IL-10 as Th2 type cytokine genes.Results:Thl type cytokines were expressed in 7 and 9 cases,while Th0 type cytokines in 4 and 2 among 11 PHC and their adjacent liver tissues,respectively.Conclusion:Th1 type cytokines are expressed predominantly in primary hepatic cancer and its adjacent liver tissue.

BACKGROUND:With the development of industry and agriculture, organotin compounds have been widely used in China. Organotin compounds cause a common occupational poisoning. The toxicity of organotin was reported in animal studies; however the reports about human organotin intoxication are very rare. In this study we retrospectively analyzed the clinical manifestations of 15 organotin-poisoned patients who had been treated at our hospital from 2002 through 2007. METHODS:Fifteen patients with organotin poisoning were admitted to Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine from 2002 to 2007. They were 9 males and 6 females, aged from 25 to 52 years. Clinical manifestations and Glasgow Coma Scales showed that the poisoning was mild in 4 patients, moderate in 6 and severe in 5. The severe patients were given glucocorticoid after hospitalization by intravenous guttae of 500 mg methylprednisolone for the first day, followed by 160 mg methylprednisolone per day for three days, and then 80 mg methylprednisolone per day for another three days. Potassium glutamate and sodium glutamate were intravenously dripped to reduce blood ammonia; intravenous guttae plus oral administration of potassium 9 g/day was used to correct intractable hypokalemia; sodium bicarbonate was used to correct metabolic acidosis, and sedatives were used to control spasm and twitch; mechanical ventilators were used in 4 patients with dyspnea. RESULTS:Most of the patients showed elevated level of blood ammonia, decreased level of blood potassium and metabolic acidosis, but some had demyelination changes shown by CT and MRI. Treatments included correction of metabolic acids, blood potassium and ammonia, and mechanical ventilation when necessary. For patients with injuries of the nervous system, glucocorticoids were given immediately after hospitalization. These patients showed intractable hypokalemia and metabolic acidosis during the treatment. Forteen patients recovered completely without long-term side-effect. One patient in the aphasiac stage restored the linguistic capacity during a 6-month follow-up. CONCLUSIONS:Elevated level of blood ammonia, decresed level of blood potassium, and metabolic acidosis are common in patients with organotin poisoning. Demyelination can be observed in patients with severe poisoning. The abnormalities of the patients are reversible after suitable treatments.

Objective Intrahepatic biliary papillomatosis(IBP)is a rare disease that is characterized by multiple numerous papillary adenomas in the intrahepatic biliary duct(IBD).The clinical features and outcome,however,are not well known.The clinicopathologic features,treatments and follow-up results were retrospectively analyzed in order to improve the efficiency of diagnosis and treatment for the disease.Methods Between August 2006 and October 2008,9 patients were diagnosed with IBP by histological findings at a tertiary referral center,Ningbo Medical Center(University of Ningbo,College of Medicine,Ningbo,China).The authors retrospectively reviewed the medical records to obtain clinical,radiological and pathologic data.The therapeutic results and follow-up data were also reviewed.Results The ratio of male to female was 2:7 and the middle age was 59 years.Repeated episodes of fever and right upper quadrant abdominal pain with or without jaundice were the common clinical manifestations.There were intrahepatic choledocholithiasis and/or history of previous biliary operation in 8 cases.The level of CA19-9 and CEA were almost normal.Imaging workup demonstrated cyst-like dilatation of intrahepatic biliary tree with or without liver atrophy,which were more obvious in the mucin-hypersecreting IBP.All of the 9 cases underwent curative resection with an adequate resection margin.Macroscopic findings demonstrated that the tumors of 9 cases were all located in the left lobe with mucin-hypersecreting type in 7 cases.The diameter of numerous papillary granular was usually less than 10 mm(from 2 to 5 mm.frequently)and friable,that filled the dilated IHD dispersive.Fine fibrovascular cores lined by dysplastic epithelial cells were frequently found under microscope.Few foci of stromalinvasion were noticed in the two cases with malignant transformation.All of the 9 cases survived and there was no recurrence.Conclusion IBP occurs more often in middle and old women who have history of biliary disease. Repeated episodes of cholangitis are the common clinical manifestations. Extra- and intrahepatic biliary tract dilatation is the common imaging finding.MRCP/ERCP is more valuable than others in diagnosis. Clinical and histological finding shows that IBP is a premalignant disease with high malignant potential. Curative resection should be done as earlyas possible for the long-term survival rate. The use of cholangioscopy in operation and rapid biopsy of resection margin will benefit the curative resection.

The present work is to investigate the chemical constitutions of Hyptis rhomboidea and their antifungal activities. The compounds were isolated by Toyopearl HW-40, Sephadex LH-20, MCI-Gel CHP-20, RP-18, PTLC and silica column chromatographic methods and subjected to evaluate some monomers antifungal activity of eight kinds of plant pathogenic bacteria. Eleven compounds were isolated and identified as ethyl caffeate (1), ursolic acid (2), oleanolic acid (3), vanillactic acid (4), methyl rosmarinate (5), kaempferol 3-O-alpha-L-rhamnopyranosyl-(1 --> 6) -beta-D-glucopyranoside (6), kaempferol 3-O-alpha-L-rhamnopyranosyl-(1 --> 6)-beta-D-glucopyranoside (7), ilexgenin A (8), beta-amyrin (9), kaempferol 3-O-beta-D-glucopyranoside (astrgalin, 10) and cholest-5-ene-3beta, 4beta-diol (11). Compound 1 showed the strongest inhibitory effect on Sclerotinia sclerotiorum with the MIC 16.2 mg x L(-1), and compound 5 showed the strongest inhibitory effect on S. minor and Exserohilum turcicum with MIC 16.2, 8.1 mg x L(-1), respectively. All compounds were isolated from the H. rhomboidea for the first time, and compounds 1 and 5 showed antifungal activity.
Antifungal Agents ; chemistry ; isolation & purification ; pharmacology ; Drugs, Chinese Herbal ; chemistry ; isolation & purification ; pharmacology ; Fungi ; drug effects ; Hyptis ; chemistry ; Molecular Structure ; Spectrometry, Mass, Electrospray Ionization

Objective To observe whether appropriate intermittent exercise at the ischemic threshold can safely promote collateral circulation in an ischemic area of the myocardium through the increased expression of vascular endothelial growth factor(VEGF)and its receptor fetal liver kinase-1(Fik-1). Methods A balloon constrictor was surgically implanted in the first obtuse marginal coronary artery(OM1)of miniature pigs.The subjects were divided into 3 groups:a sham-operation group,a pure ischemia group,and an exercise training group.Subjects in the exercise training group performed individualized treadmill programs 30 min daily,5 d per week,for 8 weeks,including 2 two-minute episodes of exercise-induced ischemia.Two pre-exercise episodes of pure ischemia induced by brief OM1 occlusion were also conducted.Only pure ischemia was induced in the pure ischemia group,and the sham-operation group remained sedentary for the experimental period.Relative myocardial blood flow(RMBF)was measured using microspheres.VEGF and Flk-1 expression levels were measured by Western blotting and real time RT-PCR analyses.Cardiac troponin I(ctnI)levels were determined using an enzyme-linked immunosorbent assay(ELISA). Light and electron microscopy were employed to examine myocardia damage in the ischemic area.Results RMBFs in the exercise training group were significantly higher than those in the pure ischemia and sham-operation groups. RMBFs in the pure ischemia group were significantly higher than those in the sham-operation group.The expression of VEGF and Flk-1 proteins and mRNAs in the exercise training group were significantly higher than those in the pure ischemia and sham-operation groups,and the levels in the pure ischemia group were also significantly higher than those in the sham-operation group.After training,no myocardial damage and no ctnI increase was observed in the pure ischemia group.Microscopy revealed no obvious structural changes. Conclusion Intermittent exercise at the isehemia threshold intension can safely promote coronary collateral formation through upregulation of VEGF and Flk-1 expression in the ischemic myocardial area of a porcine model.

Objective To investigate the influence of preoperative diabetes mellitus (DM) on postoperative morbidity of pancreatoduodenectomy for pancreatic ductal adenocarcinoma.Methods The clinical data of 302 pancreatic ductal adenocarcinoma patients who underwent pancreatoduodenectomy from January 1,2005 to August 31,2012 were retrospectively analyzed.Results 113 patients (37.4％)had preoperative DM among the total 302 patients.The percentage of the major complication including pancreatic fistulas,delayed gastric emptying,infections,acute kidney injury and mortality accounted for 19.9％,12.9％,25.9％,36.0％,3.2％ and 3.5％ respectively.In the DM group,firm pancreatic texture was more common than that in non-DM group (x2 =15.175,P ＜ 0.01).While pancreatic fistula in the DM group developed less frequently(x2 =7.811,P =0.005) than that in non-DM group.Delayed gastric emptying,infections,acute kidney injury,hemorrhage,pulmonary,cardiovascular and neurologic complications,as well as length of stay in hospital and mortality were in similar frequency in the two groups (P ＞ 0.05).Binary Logistic regression analysis showed DM(OR =0.358,P =0.035) and firm pancreatic texture(OR =0.395,P =0.032) were protective factors against pancreatic fistula while preoperative jaundice(OR =3.819,P =0.010) and intraoperative blood transfusion (OR =1.268,P =0.001) were predisposing factors for pancreatic fistula.Conclusions With good control of perioperative glucose level,DM does not increase operation risk in pancreatoduodenectomy for pancreatic ductal adenocarcinoma.

BACKGROUND:The morphological and mechanical transfers of unstable intertrochanteric fractures were complicated, so it is difficult to analyze the biomechanical characteristicsof the common experimental methods in a comprehensive way. Moreover, the high cost, long cycle and poor repeatability of common tests limit its application in biomechanics. OBJECTIVE:To analyze the biomechanical characteristics of unstable intertrochanteric fracture in different fixation ways by three-dimensional finite element analysis. METHODS:Intertrochanteric fracture locking dynamic hip fixation model (C1), Gamma nail fixation model (C2) and proximal femoral anatomical locking plate model (C3) were established. The distal end of the femur was fixed, and subjected to the hip reaction force of 2800 N and abduction muscle strength of 1 200 N. Three-dimensional finite element analysis was used to analyze the stress distribution, stress concentration and maximum displacement of unstable intertrochanteric fracture in three different fixation ways. RESULTS AND CONCLUSION:(1) Stress: the anterolateral stress and anteromedial stress of C3 were the maximum. Posterolateral stress and posteromedial stress ofC3 were the minimum. There were significant differences among the three groups (alP< 0.05). (2) Stress of fracture space: significant differences in anterolateral stress, anteromedial stress, posterolateral stress and posteromedial stress were determined in C1, C2 and C3 (P< 0.05). Anterolateral stress of C3 was significantly less than anterolateral stresses of C1 and C2 (P< 0.05). Anteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). Posterolateral stress of C1 was significantly larger than that of C2 and C3 (P<0.05). Posteromedial stress of C1 was significantly larger than that of C2 (P< 0.05). Posteromedial stress of C3 was significantly less than that of C1 and C2 (P< 0.05). (3) Significant differences in bone stress around the screw top were detected among the three groups (P< 0.05). Bone stress around the screw top of C3 was significantly larger than that of C1 and C2 (P< 0.05). (4) Thus, locking dynamic hip screw, Gamma nail and proximal femoral anatomical locking plate have their advantages and disadvantages for treatment of unstable intertrochanteric fracture of the femur. The appropriate internal fixation device should be selected according to the need.