BACKGROUNDHemodynamic evaluation is crucial for the management of patients with pulmonary hypertention. Clinicians often prefer a rapid and non-invasive method. This study aimed to examine the feasibility of transthoracic echocardiography for the measurements of hemodynamic parameters in patients with pulmonary hypertension.

METHODSA prospective single-center study was conducted among 42 patients with pulmonary hypertension caused by different diseases. Transthoracic echocardiography and right-heart catheterization were performed within 24 hours. Pulmonary artery systolic, diastolic and mean pressure (PASP, PADP and PAMP), cardiac output (CO), and pulmonary capillary wedge pressure (PCWP) were measured by both methods. A linear correlation and a Bland-Altman analysis were performed to compare the two groups of hemodynamic parameters.

RESULTSA good correlation was found between invasive and non-invasive measurements for PASP (r = 0.96), PADP (r = 0.85), PAMP (r = 0.88), CO (r = 0.82), and PCWP (r = 0.81). Further agreement analysis done by the Bland-Altman method showed that bias and a 95% confidence interval for PASP, PADP, and CO were clinically acceptable while great discrepancies existed for PAMP and PCWP.

CONCLUSIONSThe non-invasive measurements by PASP, PADP, and CO in patients with pulmonary hypertension correlate well with the invasive determinations. Transthoracic echocardiography (TTE) was inappropriate for estimating PCWP and PAMP.

Adolescent ; Adult ; Cardiac Catheterization ; Cardiac Output ; Echocardiography ; Female ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; physiopathology ; Male ; Middle Aged ; Prospective Studies ; Pulmonary Wedge Pressure

OBJECTIVETo investigate a new method to construct tissue-engineering bone that will be applicable clinically.

METHODSThe cultured 5th generation rabbit bone marrow stroma osteoblasts (MSO) was dissolved in 3% sodium alginate solution (the final concentration of sodium alginate in the solution being 1%, and MSO, 5x10(6)/L), and then inoculated into prepared true bone ceramic (TBC) and gelatinized the bone by dribbling with calcium gluconate. The standard bone defect models were made in 48 adult New Zealand rabbit's both radius. Among the 48 rabbits, 24 were in Groups A and B, in which the left radius was implanted with gelatinized MSO-TBC (Group A) and right radius implanted with autograft-bone (Group B); and the other 24 were in control group whose left radius was implanted with non-gelatinized MSO-TBC (Group C) and right radius implanted with gelatinized TBC (Group D). Outcomes of the implanted bones were assessed by radiology, pathological histology, osteogenetic quantitative analysis, and biomechanics at 2, 4, 8, 12 weeks postoperatively.

RESULTSIn Groups A and B, a satisfactory bone reparation and bony union was noted within 12 weeks. In Groups C and D, bone reparation was not satisfied compared with Group A in terms of ostogenetic quantity and biomechanics.

CONCLUSIONSGelatinized MSO-TBC is an ideal artificial active bone that overcomes TBC shortcomings of fragileness and smooth surface that is not eligible for seed cell's adhesion. It is promising to put into clinical use extensively.

Animals ; Biomass ; Bone Diseases ; diagnostic imaging ; pathology ; therapy ; Bone Marrow Cells ; cytology ; Bone Substitutes ; Ceramics ; Disease Models, Animal ; Female ; Gelatin ; Male ; Osteoblasts ; cytology ; transplantation ; Osteogenesis ; Rabbits ; Radiography ; Radius ; diagnostic imaging ; injuries ; pathology ; surgery ; Stromal Cells ; cytology ; transplantation ; Tissue Engineering ; methods ; Treatment Outcome

BACKGROUNDCD44v6 plays an important role in invasion and metastasis of tumor, Livin has anti-apoptotic effects. The present study aimed to explore the expression and clinical significance of CD44v6 and Livin in gastric cancer tissue.

METHODSStreptavidin-peroxidase linked immunohistochemical method was used to determine the expression of CD44v6 and Livin in gastric cancer tissue and adjacent normal gastric tissues from 59 patients with histopathologically confirmed gastric cancer, and in gastric tissue specimens of 15 patients with gastric polyps, and 15 patients with chronic non-atrophic gastritis. The chi-square test was used for comparison of the relevant factors, Spearman's rank correlation test was applied for relationship among positive expression of the proteins.

RESULTSThe expresion of CD44v6 was positive in 64.4% of the gastric cancer patients; 5.1%, 0 and 13.3% in specimens of normal tissues adjacent to the cancer tissues, in gastric tissue specimens of patients with gastric polyps, and patients with chronic non-atrophic gastritis, respectively. The expression of Livin was positive in 52.5% of the gastric cancer tissues, 6.8%, 0 and 6.7% in the adjacent normal gastric tissue, specimens of patients with gastric polyps and chronic non-atrophic gastritis, respectively. The expression of CD44v6 was significantly correlated with the depth of invasion, the degree of differentiation, and lymphnode metastasis of gastric cancer (P < 0.05). The positive expression rate of Livin protein was also significantly correlated with degree of differentiation of gastric cancer cells and metastasis to lymphnodes (P < 0.05), but not correlated with the depth of invasion and pathological types (P > 0.05). The expression of CD44v6 and Livin in the gastric cancer tissue was positively correlated (r(s) = 0.286, P = 0.028).

CONCLUSIONSThe increased expression of CD44v6 and Livin in gastric cancer tissue may be closely related with development and progression of gastric cancer. CD44v6 and Livin may be new biological markers of gastric cancer.

Adaptor Proteins, Signal Transducing ; analysis ; physiology ; Aged ; Female ; Humans ; Hyaluronan Receptors ; analysis ; physiology ; Immunohistochemistry ; Inhibitor of Apoptosis Proteins ; analysis ; physiology ; Male ; Middle Aged ; Neoplasm Proteins ; analysis ; physiology ; Stomach Neoplasms ; chemistry ; metabolism ; pathology

Objective To observe the clinical efficacy and safety of re-bamipide combined with rabeprazole sodium enteric -coated tablets in the treatment of chronic atrophic gastritis .Methods A total of 94 pa-tients with chronic atrophic gastritis were randomly divided into control and treatment groups with 47 cases per group.Control group was given riberazole 20 mg per time, qd, orally.Treatment group received rabe-prazole 0.1 g per time, tid, orally, on the basis of control group.Two groups were treated for 8 weeks. The clinical efficacy, pepsinogen (PG), endothelin (ET) and adverse drug reactions were compared be-tween two groups.Results After treatment, total effective rates of treat-ment and control groups were 93.62%( 44 cases/47 cases ) and 70.21%(33 cases/47 cases) with significant difference ( P<0.05 ) . After treatment, the main indexes of treatment and control groups were compared: PGⅠ were ( 127.38 ±13.96 ) and ( 103.84 ±13.58 ) μg· L-1, ET were (65.49 ±5.99 ) and ( 74.20 ±9.79 ) ng· L-1, there were statistically significant differences (all P<0.05).The adverse drug reactions of treatment group were liver dysfunction and skin rash , which in control group were diarrhea , rash and nausea and vomiting .The total incidence of adverse drug reactions were 6.38%and 14.89%without significant difference (P>0.05).Conclusion Rebamipide combined with rabeprazole sodium enteric-coated tablets has a definitive clinical efficacy in the treatment of chronic atrophic gastritis , which can effectively regulate the levels of PG and inhibit the expression of ET , without increasing the incidence of adverse drug reactions.

Objective To observe the clinical features and cardiac magnetic resonance imaging (CMR) characteristics of patients with endomyocardial biopsy (EMB)-proven cardiac amyloidosis (CA).Methods EMB proven CA patients underwent CMR examination from September 2006 to December 2010 were included.The findings of clinical manifestation,electrocardiogram,echocardiography and CMR were analyzed.Results Among the 18 patients with EMB verified CA,5 patients underwent CMR.All 5 patients had heart failure symptoms and electrocardiogram was abnormal.Echocardiogram showed concentric left ventricular hypertrophy,granular appearance of the myocardium,left atrial enlargement and moderate to severe left ventricular diastolic dysfunction.CMR revealed increased thickness of the left ventricular wall (especially at the inter-ventricular septum),enlarged bilateral auricle,restricted left ventricular filling with normal or mild to moderate reduced systolic function.Pleural and pericardial effusions were observed in 2 patients.Abnormal late gadolinium enhancement (LGE) was detected in all 5 patients.CMR revealed different patterns of LGE.Left ventricular global subendocardial delayed gadolinium enhancement or transmural delayed gadolinium enhancement were found,and patients also showed line-,granular- or patchylike enhancement.The degree and range of LGE paralleled the disease course and were consistent with electrocardiogram changes.Conclusions As a noninvasive diagnostic tool,CMR is valuable in the diagnosis of CA.For patients with clinical suspicion of CA,CMR could be a helpful diagnostic tool,especially in the hospitals where EMB is not available.

Objective To summarize the electrocardiography and echocardiography features of patients with cardiac amyloidosis (CA) diagnosed by endo-myocardial biopsy (EMB). Methods A total of 20 consecutive patients [7 men, mean age (50 ± 12 )years] referred for EMB because of clinical suspicion of CA from September 2006 to October 2009 were included in the study. Primary CA was diagnosed in 11 out of 20 patients (55% ) by EMB and biomarkers examination. The electrocardiography and echocardiography features were analyzed. Results The voltage of all the limb leads were low in the 11 CA patients [mean values of (0. 33 -0. 51) mV], the incidence of low voltage and pseudo-infarction patterns were 45% and 45% , respectively. Concentric hypertrophy and normal left ventricular diameters were evidenced in all CA patients on echocardiography, left atrial enlargement (n = 10, 91% ) , granular/sparking appearance of the myocardium (n = 9, 82% ) and moderate to large pericardial effusion (n = 7, 64% ) as well as left ventricular systolic dysfunction ( n = 8, 73% ) were often presented in CA patients. Conclusions The diagnosis of primary CA should be considered in patients with unknown origin of heart failure, concentric hypertrophy and normal left ventricular diameters with granular/sparking appearance of the myocardium or pericardial effusion presented on echocardiography and low voltage of limb leads or pseudo-infarction pattern presented on electrocardiography. EMB and serum (urine) biomarkers examinations should be then performed to confirm or exclude the diagnosis of CA.

Objective To evaluate the necessity of bedside echocardiography ( ECG) in patients with dif-ferent clinical conditions and to investigate its values in diagnosis and treatment .Methods We analyzed the clinical conditions of all the patients who applied for and received bedside ECG in Peking Union Medical College Hospital from July 1 to 30, 2013.The necessity of this examination and its values in the diagnosis and treatment were evaluated.Results Fifty-eight patients were included (33 males, 56.9%), aged (56.4 ±19.9 ) years. Thirty-seven (63.8%) patients were from emergency department , 16 (27.6%) were from intensive care units , and 5 (8.6%) from other departments.In 36 (62.1%) patients, the purpose of applications for bedside ECG was in compliance with the consensus of the American Society of Echocardiography ( ASE) and American College of Emergency Physicians (ACEP).The purposes of bedside ECG were accomplished in 53 (91.4%) applica-tions.The bedside ECG confirmed or altered the initial diagnosis in 13 (22.4%) cases, supported the initial diagnosis in 40 (69.0%), but offered no diagnostic information in 5 (8.6%).Based on the ECG results, the treatment was adjusted in 16 patients (27.6%).After the examination, 23 (39.7%) applications for bedside ECG were considered necessary by cardiologists , the other 35 ( 60.3%) were unnecessary .Compared with the applications not conforming to the consensus of ASE and ACEP , those conforming to the consensus were signifi-cantly more likely to provide valuable diagnostic information ( P =0.01 ) , to result in treatment adjustment ( P=0.06 ) , and to be necessary ( P<0.01 ) .Conclusions The indications of bedside ECG should be strictly observed .To make full use of the limited medical resources , bedside ECG should be applied in accordance with the consensus of ASE and ACEP to ensure its values in diagnosis and treatment .

OBJECTIVETo explore the effect of minimally invasive Ivor-Lewis esophagectomy on acute phase responses in patients with esophageal carcinoma.

METHODSForty-eight patients with middle or low thoracic esophageal carcinoma underwent Ivor-Lewis esophagectomy. The patients were divided into small incision group (n = 25) and conventional group (n = 23) according to the patients' will. Serum levels of acute phase proteins C reactive protein (CRP), haptoglobin (HPT), α₁-acid glycoprotein (α₁-AG), ceruloplasmin (CER), transferrin (TRF), β₂-microglobulin (β₂-MG), album protein (ALB), interleukin-6 (IL-6) and tumor necrosis factor α (TNF-α) were measured and compared on 1st day before operation, at 18 hours as well as 3rd and 7th day after operation.

RESULTSThere was no significant difference in all the acute phase proteins indicators and IL-6 between the small incision and conventional groups at each time points after operation (P > 0.05). In both groups the levels of CRP, α₁-AG and HPT were significantly higher after operation than before operation (P < 0.05). The levels of ALB and TRF were significantly lower after operation than before operation (P < 0.05). The levels of CER and β₂-MG were not significantly different during perioperative period (P > 0.05). The level of TNF-α was significantly higher in the small incision group than that in the conventional group at the 18 hours postoperationally (P < 0.05), and were not significantly different on the other time points between the two groups (P > 0.05).

CONCLUSIONCompared with conventional operation, the small incision Ivor-Lewis esophagectomy do not significantly alleviate the stress of the surgical trauma in patients. Unchanging the essence of operation, if one is trying to minimize the stress caused by surgery on patients, the key factor is not the size of incision. An effective approach should be found in other operation-related factors.

Acute-Phase Proteins ; metabolism ; Aged ; C-Reactive Protein ; metabolism ; Carcinoma, Squamous Cell ; blood ; surgery ; Ceruloplasmin ; metabolism ; Esophageal Neoplasms ; blood ; surgery ; Esophagectomy ; methods ; Female ; Haptoglobins ; metabolism ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Orosomucoid ; metabolism ; Perioperative Period ; Serum Albumin ; metabolism ; Serum Albumin, Human ; Transferrin ; metabolism ; Tumor Necrosis Factor-alpha ; blood ; beta 2-Microglobulin ; blood

BACKGROUND AND OBJECTIVEThe primary submucous type of nasopharyngeal carcinoma (NPC) or the recurrent NPC in the parapharyngeal space is difficult to be diagnosed histologically by conventional biopsy because of the obstruction of the surrounding structures. This study was performed to evaluate the needle biopsy approach through the madibular area into the parapharyngeal space under the guidance of computed tomography (CT) for NPC.

METHODSBetween July 6, 2005 and October 23, 2009, a total of 6 patients were enrolled into the study. Two patients with cervical lymph node metastasis were clinically suspicious of NPC according to their clinical manifestations. However, no cancer cell could be found by repeated nasopharyngeal biopsies followed by histologic examinations. The other 4 patients were diagnosed with recurrent NPCs by magnetic resonance imaging (MRI) or/and positron emission tomography (PET)-CT scan, showing tumors in the parapharyngeal spaces in 3 patients and enlarged retropharyngeal lymph node in 1 patient. The CT-guided puncture was performed through the mandibular skin and the cutting needle biopsy was taken at the parapharyngeal space focus.

RESULTSAll the cutting needle biopsies of projected locations have been performed safely. Finally, all the 7 specimens met the requirement of pathologic diagnosis and the cases were all confirmed histologically to be NPCs. The main complication was mild ache at the puncture point. No blood vessel or nerve was injured and no patient needed special treatment.

CONCLUSIONSThe CT-guided puncture biopsy of the parapharyngeal space through the mandibular area is simple and feasible. It can be an additional option for routine nasopharyngeal biopsy.

Adult ; Aged ; Biopsy, Needle ; methods ; Female ; Humans ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Mandible ; Middle Aged ; Nasopharyngeal Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Neoplasm Recurrence, Local ; Pharynx ; pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

OBJECTIVETo observe the incidence of elimination delay in high dose methotrexate (HDMTX) therapy, its side effects and influence to next course of chemotherapy and analyze the relationship between the dosage, the duration of MTX infusion and the morbidity of the elimination delay.

METHODSA total of 121 childhood acute lymphoblastic leukemia (ALL) (497 infusions of HDMTX) were analysed in this study. The elimination delay rate and the adverse effects in different dose groups (3 g/m2 vs 5 g/m2) and different infusion duration groups (7 h vs 24 h) were compared. The adverse effect evaluation was based on the World Health Organization (WHO) Toxicity Grading Criteria. The rescue dosages of calcium folinate (CF) among these groups were compared through CF/MTX index.

RESULTSThe overall morbidity of elimination delay was 12.1% with a relative risk of 30.6% for the first time. The relative risk for the second time of occurrence was increased to 45.9% (P < 0.01) and it was not significantly increased for the third time (35.3%). Children with elimination delay had lower platelet count (P < 0.01) and higher CF rescue dosage (P < 0.01), while the damage of oral mucous membrane was more severe (P < 0.05) and the next course of chemotherapy would be postponed for a median of 4 days in 3 g group. There was no significant difference in elimination delay rates between 3 g and 5 g groups (12.1% vs 12.0%, P > 0.05), and between 7 h and 24 h MTX infusion groups (13.6% vs 11.9%, P > 0.05). The only side effect occurred in 5 g group was gastrointestinal morbidity. The CF/MTX index of 5 g group without elimination delay was less than that of 3 g group (P < 0.01).

CONCLUSIONElimination delay in HDMTX therapy accompanies the suppression of bone marrow and damage of oral mucous membrane, which need more CF rescues and will postpone the following course of chemotherapy. Elimination delay is not associated with the duration of the infusion and the dosage of MTX within the range of 3 approximately 5 g/m2 but there are individual differences.

Adolescent ; Antimetabolites, Antineoplastic ; adverse effects ; pharmacokinetics ; therapeutic use ; Child ; Child, Preschool ; Dose-Response Relationship, Drug ; Female ; Humans ; Infant ; Male ; Metabolic Clearance Rate ; Methotrexate ; adverse effects ; pharmacokinetics ; therapeutic use ; Nausea ; chemically induced ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy ; Retrospective Studies ; Treatment Outcome ; Vomiting ; chemically induced ; Young Adult