A total of 850 patients undergoing the 3-field esophagectomy were retrospectively recruited and divided into tubular stomach reconstruction group (n =453) and whole stomach reconstruction group (n =397).They underwent esophagectomy through right thorax,left cervical part,abdominal triple incisions and esophageal reconstruction by hand-sewn two-layer anastomosis.In comparison with whole stomach,esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage,less manifestation of intrathoracic syndrome and less occurrence of reflux esophagitis (P ＜ 0.05).However,the incidence of anastomotic stricture showed no significant difference between two groups (P ＞ 0.05).It suggests that,for esophageal cancer patients undergoing the 3-field esophagectomy,tubular stomach is better than whole stomach for esophageal reconstruction as reflected by reduced occurrences of postoperative anastomotic leakage,intrathoracic syndrome and reflux esophagitis.

Objective Inflammation and calcification are common phenomenons in human atherosclerotic plaque.The objective of this study was to determine the gene expression of some proteins and anti-inflammatory factors as well as bone formation mediators in the fibrous cap and shoulder region of non-calcified and calcified carotid endarterectomy(CEA) plaques.Methods Twenty-two CEA plaques were classified as Va(non-calcified,n=11) and Vb(calcified,n=11) in accordance with the AHA consensus in 1995.Mean percent in carotid stenosis and calcification area was 76.4% and 0% in Va and 74.2% and 33.6% in Vb respectively as determined by quantitative histomorphometry.Using laser capture microdissection,the fibrous cap and shoulder regions were excised from 22 frozen sections/plaques.After total RNA extraction and reverse transcription,gene expression of proteins(IL-1,IL-8,and MCP-1),anti-inflammatory factor(IL-10) and bone formation protein(BMP-6 and Osteocalcin) were detected by Real-time PCR.Results mRNA expression of MCP-1,IL-8 and IL-1 in Va plaques were 1.8 fold higher than that in Vb plaques,mRNA expression of anti-inflammatory factor IL-10 and osteogenic related genes BMP-6 and Osteocalcin were 3.8,4.2,and 6.9 fold higher in Vb plaques compared to Va plaques.Conclusions Our findings indicate that fibrous cap inflammation and susceptibility to disruption is more likely to occur in non-calcified plaques.

Objective To investigate the accuracy and efficiency of hand-held echocardiography (VSCAN) used by intensivist for the diagnosis and treatment decisions in emergency consultation for patients getting worse at risk of life-threatening setting in non-ICU ward.Methods A prospective study in acutely deteriorated patients needed the intensivist for emergency consultation in general wards was carried out.The consultation process was executed as follows:(1) The intensivist established an initial diagnosis based on medical history,physical examination and laboratory findings,and assessed the hemodynamics and the cause of acute respiratory failure and cardiac arrest according the documented information.The data recorded as control group (Pre-VSCAN) for comparison with the later available data in subsequent analysis.(2) Problem-based ultrasound examination was performed with VSCAN.For patients suffered cardiac arrest,the FEEL protocol was used to find the potential cause of cardiac arrest such as pericardial tamponade and massive pulmonary embolism screened.For the other patients,a simplified eFATE or BLUE-plus protocols were used based on clinical requirement.With the findings of ultrasound examination the intensivist established an final diagnosis and identified the hemodynamics and the lung pathologies.The consultation advice was then provided to the attending doctors of the patient.The intensivist kept the records of echo results,final diagnosis and consultation advice as data of study group data (Post-VSCAN).The response of the treatment and outcome were followed up.Two attending ICU doctors analyzed these data and judged the correctness of Pre-VSCAN and Post-VSCAN based on the response to treatment and the outcome.Results Ninety patients were finally included in statistical analysis.Sixteen (17.8％) cases,40 (44.4％) cases,29 (32.2％) cases and 5 (5.6％) were consulted for acute circulation dysfunction,acute respiratory failure,both reasons and cardiac arrest,respectively.Compared to pre-VSCAN,VSCAN verification can significantly improve the accuracy of the diagnosis (81.1％ vs.58.9％,P =0.001),assessment of hemodynamics (78.3％ vs.52.2％,P =0.009) and can find more accurate judgment of acute respiratory failure (71.0％ vs.43.5％,P =0.001).Conclusion The hand-held echocardiography used by intensivist is valuable for the diagnosis and the assessment of cardiopulmonary status in case of request for emergency consultation in general wards.

OBJECTIVETo investigate the clinical value of Paroxetine combined with mid-frequency electrical pulse acupoint stimulation (EPAS) in the treatment of premature ejaculation (PE).

METHODSTotally 69 PE patients were equally assigned to receive oral Paroxetine 20 mg/d, mid-frequency EPAS, or oral Paroxetine 10 mg/d combined with mid-frequency EPAS (P + EPAS) , all for 8 weeks. We obtained the intravaginal ejaculation latency time (IELT) and Chinese Index of Premature Ejaculation (CIPE-5) scores of the patients before and after treatment, and compared adverse reactions among the three groups of patients.

RESULTSOne patient of the Paroxetine group gave up treatment because of abdominal pain and nausea. Compared with the baseline, the patients in the Paroxetine, EPAS, and P + EPAS groups all showed markedly increased IELT ([0.92 ± 0.11] vs [4.07 ± 0.11] min, P < 0.01; [0.92 ± 0.12] VS [2.78 ± 0.17] min P < 0.05; [0.91 ± 0.09] vs [5.31 ± 0.13], P < 0.01) and decreased CIPE-5 scores (12.5 ± 3.0 vs 22.0 ± 2.1, P < 0.01; 12.8 ± 2.9 vs 19.5 ± 1.9, P > 0.05; 13.1 ± 2.8 vs 25.2 ± 2.1, P 0.01), with statistically significant differences between the P + EPAS group and the other two (P < 0.05). The total effectiveness rate was 95.7% in the P + EPAS group, remarkably higher than in the Paroxetine (72.7%, P < 0.05) and the EPAS group (47.8, P < 0.01).

CONCLUSIONOral Paroxetine combined with mid-frequency EPAS has a higher safety and efficacy than either Paroxetine or EPAS alone in the treatment of PE.

Acupuncture Points ; Aged ; Combined Modality Therapy ; methods ; Ejaculation ; Electroacupuncture ; methods ; Humans ; Male ; Paroxetine ; therapeutic use ; Premature Ejaculation ; therapy ; Serotonin Uptake Inhibitors ; therapeutic use ; Treatment Outcome

OBJECTIVETo determine the relationship of chlamydia pneumonia (CP) infection and coronary heart disease (CHD).

METHODSStudies published before 2004 that had reported on correlations between CHD and CP were collected. Studies were sorted into four sorts according to different testing methods. We determined to use either fixed effect model or random effect model according to the result of heterogeneity test. Meta-analysis was done by RevMan 4.2.

RESULTSTotally 29 studies were included into the review. The odd ratio (OR) to review all literature enzyme-linked immunosorbent assay (ELISA), dot-immunogdd filtration assay (DIGFA), and micro-immunofluorescence (MIF) was 4.00 (3.07, 5.22), 2.86 (1.89, 4.32), 14.89 (1.46, 151.57), and 4.46 (3.15, 6.32).

CONCLUSIONCP infection is associated with CHD, CP infection may be one of the risk factors of CHD.

Antibodies, Bacterial ; blood ; Chlamydia Infections ; Chlamydophila pneumoniae ; Coronary Disease ; microbiology ; Enzyme-Linked Immunosorbent Assay ; Humans ; Risk Factors

OBJECTIVETo observe the different effects of Puerarin and Daidzein on the expression of proliferating vascular smooth muscle cells, and to discuss the mechanism.

METHODMT was used to detect the state of VSMC (vascular smooth muscle cell) activity. The expression levels of Survivin, Bcl-xl, Bax and glyceraldehyde-3-phosphate dehydrogenase (GAPDH) messenger RNA (mRNA) were analyzed quantitatively by reverse transcriptase polymerase chain reaction (Rt-PCR).

RESULTCompared with Puerarin groups, VSMC activity in daidzein groups was lower, and the ratio of Bax/Gapdh/Bcl-xl/Gapdh was higher.

CONCLUSIONThe inhibition effect of daidzein on VSMC proliferation is stronger than that of puerarin.

Cells, Cultured ; Gene Expression Regulation ; drug effects ; Glyceraldehyde-3-Phosphate Dehydrogenases ; biosynthesis ; genetics ; Humans ; Inhibitor of Apoptosis Proteins ; Isoflavones ; isolation & purification ; pharmacology ; Microtubule-Associated Proteins ; biosynthesis ; genetics ; Muscle, Smooth, Vascular ; cytology ; Myocytes, Smooth Muscle ; drug effects ; metabolism ; Neoplasm Proteins ; Plants, Medicinal ; chemistry ; Proto-Oncogene Proteins c-bcl-2 ; biosynthesis ; genetics ; Pueraria ; chemistry ; RNA, Messenger ; biosynthesis ; genetics ; Vasodilator Agents ; pharmacology ; bcl-2-Associated X Protein ; bcl-X Protein

OBJECTIVEThe National Institutes of Health (NIH) category IIIa chronic prostatitis syndromes (non bacterial chronic prostatitis) were common disorders but with few effective therapies. Alpha-blockers and bioflavonoids had recently been reported in randomized controlled trials to improve the symptom of these disorders in a significant proportion of men. The aim of this study was to confirm these findings in a prospective randomized, placebo-controlled trial.

METHODSForty-five men with category IIIa chronic non bacterial protatitis were randomized into three groups as follows: (1) placebo; (2) phenoxybenzamine-hydrochloride:10 mg two times a day for one month; (3) flavoxate HCI-neptumus: 200 mg three times a day for one month. The NIH chronic prostatitis symptom score was used to grade symptoms at the beginning and conclusion of the study.

RESULTSAll the patients in three groups completed the study except three dropout patients in placebo group because of sever symptoms. The three groups were similar in age, duration of symptoms and initial symptom score. Patients taking placebo had a mean improvement in NIH-CPSI from 21.85 to 19.55 (not significant), while the phenoxybenzamine-hydrochloride group had a mean improvement from 21.95 to 13.75 (P < 0.01), and those taking flavoxate HCI-neptumus had a mean improvement from 21.75 to 16.95 (P < 0.05). The decrease in NIH-CPSI was associated with significant improvement in patients' clinical manifestations.

CONCLUSIONTherapy with alpha-blockers was well tolerated with significant symptomatic improvement in most men having chronic non-bacterial chronic protatitis while the bioflavonoids group had no significant improvement. Mechanism of both medicines needs further study.

Adrenergic alpha-Antagonists ; administration & dosage ; therapeutic use ; Adult ; Chronic Disease ; Flavonoids ; administration & dosage ; therapeutic use ; Flavoxate ; therapeutic use ; Humans ; Male ; Parasympatholytics ; therapeutic use ; Prospective Studies ; Prostatitis ; drug therapy ; Treatment Outcome

OBJECTIVETo systematically assess the effect of early enteral nutrition support after gastrointestinal operation on prognosis.

METHODSThe Cochrane Library, PubMed, CBM, CNKI, Wanfang, and VIP databases were retrieved via computer system for randomized controlled trails(RCTs) with early enteral nutrition support to patients undergoing gastrointestinal operation. Quality of studies was evaluated by the Cochrane Jadad rating scale. Nutrition indexes, bowel function indices, postoperative complications, health-economics indices were collected. Meta-analysis was conducted with RevMan 5.2.

RESULTSEleven relevant RCTs studies with 1087 cases were enrolled, including 541 patients in the study group(early enteral nutrition) and 546 in the control group. Meta-analysis showed that patients in the study group had significantly higher levels of plasma albumin and prealbumin than those in the control group(WMD=2.87, 95%CI:1.03-4.71; WMD=0.04, 95%CI:0.02-0.05). The time of postoperative bowel ventilation in the study group was significantly shorter than that in the control group(WMD=4.10, 95%CI:-5.38--2.82). The postoperative complication rate in the study group was significantly lower as compared to the control group(RR=0.64, 95%CI:0.44-0.93).

CONCLUSIONEarly enteral nutrition support after gastrointestinal operation is safe and effective, which can improve the nutritional status, promote bowel function return, and reduce postoperative complication rate.

Digestive System Surgical Procedures ; Enteral Nutrition ; Gastrointestinal Diseases ; surgery ; Humans ; Postoperative Complications ; Prognosis ; Randomized Controlled Trials as Topic

Objective To investigate the effect and feasibility of early enteral nutrition support on postoperative nutrition assessments and clinical outcomes in children patients with congenital heart disease. Methods From October 2013 to October 2014, a number of 100 cases congenital heart disease aged six months to two years old were treated with early enteral nutrition support after operation. According to gender, fifty patients were randomly divided into the intervened group, who were treated with the early enteral nutrition support program. The other fifty patients were divided into control group with no nutrition sup-port. The detailed early enteral nutrition support project were( a) withdraw breathing machine at the same day, giving enteral nutrition 6 hours later after postoperation;( b) patients assist with long-term breathing machine, giving enteral nutrition 12-24 hours later after postoperation. The age, heigth, weight, serum C- reactive protein(CRP), serum retinoic binding protein ( RBP) , serum prealbumin( Pre-ALB) were recorded before operation. Seven days after operation, above indicators were ob-served again. In addition, the first time of excrete, the number of feeding interruption, the time of feeding, the time of ventila-tor, and the related complications were also recorded at hospitalization period. Results No difference of basic information and accompanying complications were observed between control and nutritional intervention group. As to nutritional status, weight-for-age z-score(WAZ) were significant higher in the nutritional intervention group than the control group( -0. 22 ± 1. 16 vs. 0.73 ±1.29, P=0.019) after operation. However length/height-for-age z-score(LAZ/HAZ) and weight-for-length/height z-score( WLZ/WHZ) were similar between control and nutritional intervention group whatever pre-operation and postoperation. Preoperative CRP, RBP, and Pre-ALB were no significant difference between early enteral nutrition and control group. After operation CRP levels in the early enteral nutrition group were significantly lower than that of control group[(45.2 ±16.2)mg/L vs.(67.3±35.5)mg/L,P<0.001],whileRBP[(0.3±0.1)mg/Lvs.(0.2±0.1)mg/L]andPre-ALB[(35.2±12.2)g/Lvs.(25.2±14.2)g/L] weresignificantlyhigherthanthoseofcontrolgroup(Pvaluewere0.031and0.029,respective-ly) . In the early nutritional intervention group and control group, the first time of excrete were remarkable in advance in nutri-tionalinterventiongroupcompredtocontrolgroup[(36±12)hvs.(65±15)h,P=0.008],whilethedifferenceoffeeding interruption times, intensive care unit( ICU) time and mechanical ventilation time in the two groups were not statistically signif-icant(P>0. 05). Conclusion Early nutritional intervention can help gastrointestinal function, enhance nutritional status, lower serum CRP levels and increased serum RBP and Pre-ALB concentrations. It did not add ICU time and ventilation time.

BACKGROUNDThe extended spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the major pathogens causing pneumonia and have a significant impact on the clinical course. Limited data exist on molecular characterization of ESBL-producing E. coli and K. pneumoniae that cause pneumonia. The aim of this study was to investigate the comprehensive multilevel characteristics of E. coli and K. pneumoniae causing pneumonia in China for the first time.

METHODSE. coli (17) and K. pneumoniae (21) isolates responsible for pneumonia were isolated from 1270 specimens collected in a prospective multi-center study in eight teaching hospitals in China from June to December in 2007. The susceptibilities, ESBL confirmation, sequence typing, blaCTX-M and blaSHV genes, their genetic environment and plasmid Inc/rep types were determined.

RESULTSSixteen E. coli (94.1%) and eleven K. pneumoniae (52.4%) isolates were ESBL producers. About 77.8% and 66.7% of them were resistance to ciprofloxacin and levofloxacin, and 100% were susceptible to imipenem. The most prevalent ESBL gene was CTX-M-14, followed by SHV-2, CTX-M-15, CTX-M-3, CTX-M-65, SHV-12, SHV-26 and SHV-28. SHV-1 and SHV-11 were also detected and coexisted with blaCTX-Ms in five strains, and three strains contained only SHV-1. All CTX-M-14 were detected ISEcp1 upstream and nine were found IS903 downstream and the majority of them (64.3%) were carried by IncF plasmids. All blaSHV were flanked by recF and deoR, located on IncF, IncN, IncX and IncH plasmids. Two SHV-2, one SHV-1 and the only SHV-28 were further preceded by IS26. Genes lacY and lacZ were detected at further upstream of two blaSHV-1. The K. pneumoniae carrying SHV-28 was susceptible to β-lactams, and no mutations or deletions in gene or promoter sequences were identified to account for susceptibility. Multilocus sequence typing experiments showed the ESBL-producing strains were genetically diverse.

CONCLUSIONSThe rate of occurrence of blaESBL in E. coli and K. pneumoniae causing pneumonia was high, and blaCTX-M-14 was dominant and probably mobilized by ISEcp1 mainly on IncF plasmids. Importantly, unexpressed blaESBL genes may occur in susceptible isolates and hence may have clinical implications.

Blotting, Southern ; Escherichia coli ; enzymology ; genetics ; Klebsiella pneumoniae ; enzymology ; genetics ; Plasmids ; genetics ; Pneumonia ; microbiology ; Promoter Regions, Genetic ; genetics ; Prospective Studies ; beta-Lactams ; metabolism