OBJECTIVE:To provide reference for rational use of antidepressant drugs in the clinic. METHODS:The utilization of antidepressant drugs in Nanjing during the period of 2011-2013 were analyzed statistically in respect of DDD,DDDs,DDC,av-erage annual growth rate and ratio of ranking method . RESULTS:From 2011 to 2013,consumption sum and DDDs of antidepres-sant drugs increased year by year in 31 hospitals of Nanjing;paroxetine occupied the first place in the list of consumption sum. Se-lective serotonin reuptake inhibitors (SSRI) got the top place ranked by DDDs,followed by serotonin/norepinephrine reuptake in-hibitors and special serotonin antidressant. CONCLUSIONS:The application of antidepressant drugs in Nanjing area is basically rea-sonable. SSRIs,such as fluvoxamine,fluoxetine,citalopram,sertraline and paroxetine,are still the first-line antidepressant drugs recent years in Nanjing.

As a new type of intercellular signaling rector, extracellular vesicles (EV) are involved in almost the whole process of tumorigenesis, progression, metastasis, and drug resistance. Therefore, EV have become the ideal biomarker candidates and research hotspots for cancer diagnosis and treatment. However, EV tumor biomarker research mainly focused on RNA and protein, and a small part of the research focused on lipids at the early stage. EV DNA has received little attention and its diagnostic value has gradually been recognized in recent years. Study on the biological characteristics and function of EV DNA may highlight its potential in tumor diagnosis.

Objective To compare the diagnostic value of dual-phase 99Tcm-MIBI scintigraphy and color Doppler ultrasonography for localizing ectopic parathyroid lesions in patients with HPT secondary to chronic renal failure (CRF-HPT).Methods Medical records of 368 CRF-HPT patients (204 males,164 females,age range:12-76 years) from January 2011 to April 2015 were retrospectively analyzed.Pathological results was used as the gold standard for the diagnosis of HPT.The sensitivity and specificity of dualphase 99Tcm-MIBI scintigraphy and color Doppler ultrasonography for the diagnosis and localization of ectopic parathyroid lesions were studied and compared by x2 test.Results A total of 1 398 positive lesions were found in 356 patients by dual-phase 99Tcm-MIBI scintigraphy,and 54 ectopic lesions occupying 3.9％(54/1 398) of positive lesions were detected by delayed planar imaging or SPECT/CT fusion imaging in 45 patients.Most of them (n =53) were confirmed by pathology.While only 966 positive lesions were found in 254 patients and no ectopic lesions were identified by color Doppler ultrasonography.The diagnostic sensitivity and specificity of dual-phase 99Tcm-MIBI scintigraphy for CRF-HPT lesions were 97.2％(1 375/1 415) and 53.1％(26/49),respectively.The corresponding parameters of color Doppler ultrasonography were 66.4％ (940/1 415) and 46.9％ (23/49),respectively.The specificity of ectopic lesion localization by radionuclide imaging was 98.1％ (53/54).The accuracy of dual-phase 99Tcm-MIBI scintigraphy was significantly higher than that of color Doppler ultrasound in lesion localization (x2 =20.8,P ＜ 0.05).Conclusion Compared to color Doppler ultrasonography,99Tcm-MIBI scintigraphy is more sensitive in identifying the positive lesions and more specific in localizing the ectopic parathyroid lesions in patients with CRF-HPT.

Objective:To investigate the application of in vitro fenestration endovascular aortic repair(fEVAR) in the juxtarenal abdominal aortic pseudoaneurysm and its up to mid-term results.Methods:The clinical data of 5 cases of juxtarenal abdominal aortic pseudoaneurysm from Oct 2016 to Jul 2019 at the Department of Vascular Surgery, Henan Provincial People′s Hospital was retrospectively analyzed, including therapy options, accesses, techniques of fenestration, bundle of the stent-graft, near to medium-term effects.Results:All patients were treated with fEVAR, the technical success rate was 100%. Stent modify time ranged from 50 to120 minutes, fEVAR time ranged from 75 to 210 minutes. The follow-up period was 15~42 months. All of the stents are in good position, there is no stent-related complications, and no deaths. Primary diseases are well controlled.Conclusion:The treatment for juxtarenal abdominal aortic pseudoaneurysms with fEVAR , as a full-intraluminal method, is of minimal invasion, few perioperative complications, low mortality. Result of up to mid-term follow up is satisfactory.

ObjectiveTo compare the safety and efficacy of combined thrombolysis and systemic anticoagulation therapy for the treatment of cerebral venous and sinus thrombosis (CVST).MethodsA retrospective review of consecutive inpatients with CVST was undertaken. Patients were divided into two groups,combined thrombolysis group (CTG) and systemic anticoagulation group (SAG).CTG underwent improved thrombolysis scheme which included mechanical thrombus maceration and unremitting microdosis urokinase injection into the venous sinus besides low molecular weight heparin anticoagulation.Neurological deficits before and after treatment were graded with the National Institute of Health Stroke Scale (NIHSS).Functional outcomes at discharge were graded on the modified Rankin Scale (mRS).ResultsThere were 30 cases in CTG ( male =9) and 86 cases in SAG ( male =23 ).There was no significant difference of neurological deficits before treatment between two groups(0-19 vs 0-17,Z =-0.474,P =0.636).After treatment,NIHSS and mRS at discharge were significantly decreased in CTG compared to SAG.There was no significant difference on the incidence of intracerebral hemorrhage.Conclusions Combined thrombolysis is better than systemic anticoagulation in improving neurological function.Combined thrombolysis does not increase incidence of ICH compared to systemic anticoagulation.

ABSTRACT:Objective To investigate the roles of Ku70,epidermal growth factor receptor (EGFR),nuclear factor-kappa B (NF-κB)and Bcl-2 genes in the pathogenesis of Graves’disease.Methods Fine needle biopsies of 59 patients [M:F 1 6:43;mean age (44.66 ± 12.94)y)]diagnosed as having Graves’disease and 27 [M:F 6:21;mean age (44.64± 14.27)y]control normal tissues were collected.The mRNA expressions of EGFR,Ku70,NF-κB,and Bcl-2 were detected by Real-time polymerase chain reaction (RT-PCR).The Student’s t test was performed to analyze differences between patients with Graves’disease and control subjects.Pearson correlation analysis was applied to detect the relationship between gene mRNA expression and serological indexes.Results Compared with those of control subjects,the mRNA expression levels of EGFR (0.859 ±0.125 vs .1.752 ±0.660,P <0.05)and Ku70 (0.768±0.102 vs .3.304±0.402,P <0.001)were significantly higher in Graves’disease patients.However, the mRNA expressions of Bcl-2 (1.235±0.261 vs .0.834±0.086,P <0.05)and NF-κB (0.578±0.066 vs .0.884 ±0.085,P <0.05)were much lower in Graves’disease patients.Furthermore,the mRNA expression of Bcl-2 was positively correlated with that of NF-κB (r =0.399,P <0.05 ).The Pearson correlation analysis showed that the higher expression of Ku70 was positively associated with the serum TgAb level (r = 0.263,P < 0.05 ),but expressions of the other target genes were not significantly related to the serological indexes (all P > 0.05 ). Conclusion The signal transduction pathways mediated by Ku70,EGFR,NF-κB and Bcl-2 may participate in the occurrence and development of Graves’disease.

Objective To evaluate the value of 99mTc-MIBI SPECT positive tumor imaging and MRI in the diagnosis of recurrence and postoperative residual of glioma. Methods Of 30 cases of glioma, 21 cases were residual or recurrent of glioma, while 9 cases were not, confirmed by pathology or follow-up. 99mTc-MIBI SPECT positive tumor imaging and MRI were performed on all patients. Results The sensitivity of 99mTc-MIBI SPECT positive tumor imaging (80.1%)was lower than that of MRI (90.5%) (χ2 = 0.006 4,P = 0.035), while the specificity of 99mTc-MIBI SPECT(88.9%) was much higher than that MRI(77.8%)(χ2= 3.827,P = 0.006). The accuracy in diagnosing residual or recurrent glioma between the two imaging has no significant difference. The sensitivity, specificity and accuracy were 95.2%, 100% and 93.3% when the two imaging methods were combined. Conclusions 99mTc-MIBI SPECT positive tumor imaging has higher specificity in the diagnosis of recurrence and postoperative residual of glioma. The combination of 99mTc-MIBI SPECT positive tumor imaging and MRI has great clinical significance.

Objective To explore the diagnostic value of 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging in early diagnosis of diabetes-induced myocardial damage. Methods 32 patients with diabetes and 26 healthy volunteers received 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging for assessing myocardial ischemia, viability status, and cardiac function. Results Myocardial perfusion abnormalitieswere observed in 47 regions on myocardial perfusion imagingin 21 of 32 (65.6%)patients with diabetes, showing perfusion/metabolism mismatched and suggesting viable myocardium. All the volunteers were normal on DISA. As compared with the normal control group, the positive rate of DISA in diabetic patients was significantly higher (P < 0.01). Left ventricular ejection fraction (LVEF) was (54.3 ± 7.2%) and (67.3±4.9%) respectively, the difference was statistically significant (P < 0.05). Conclusions 18F-FDG/ 99mTc-MIBI dual-isotope SPECT and gated myocardial imaging can assess myocardial ischemia ,viability and cardiac function in diabetic patients, and it is helpful for the early diagnosis of cardiac damage in patients with diabetes mellitus.

Objective To study the changes of soluble intercelluar adhesion molecule-1 (sICAM-1) in serum of neonates with hy-poxic-ischemic encephalopathy (HIE),and significance of changes of serum sICAM-1 in HIE pathogenesis. Methods There were 17 controls of neonates and their sICAM-1 concentrations in serum were detected with enzyme-linked immunosorbent assay (ELISA) at the critical stage and at the beginning of convalescent stage in 36 cases of HIE neonates and 17 normal neonates. The data were analyzed with analysis of variance, Newman-Keuls q test. Results The concentrations of sICAM-l[(216.64?85.32)?g/L] at the critical stage of 36 cases HIE neonates were significantly higher than those [(6. 16?4.05) ?g/L ] of control group (q = 17. 42 P

Objective:To study and compare the prognosis of different pathological subtypes of renal cell carcinoma (RCC).Methods:Clinicopathological and prognostic data of 1 346 cases of postoperative renal cell carcinoma during July 2002 to June 2014 in West China Hospital were collected retrospectively.There were 839 males and 507 females, aged (55.1±13.4)years, including 1 120 cases of clear cell RCC, 62 cases of papillary RCC, 79 cases of chromophobe RCC and 85 cases of the other pathological types respectively. ECOG 0 and ≥1 were 911 and 435 cases, with; T 1, T 2, T 3 and T 4 of 1 019, 177, 102 and 48 cases respectively; WHO nuclear grade for well, intermediate, poor differentiation and unknown were 587, 530, 85 and 144 cases separately.Tumor size <5cm, 5-10cm, ≥10cm and unknown were 685, 541, 104 and 16 cases.Combined with necrosis or sacromatoid differentiation were 200/1 146 and 27/1 319 cases separately. Meanwhile, data of 80 439 cases from Surveillance, Epidemiology, and End Results Program (SEER) were also collected.There were 51 371 males and 29 068 females, aged (60.9±12.4) years; , with 66 261, 8 680, 5 022 and 476 cases of White, Black, Asian, American native, or unknown race separately. There were 62 600 of clear cell RCC, 12 170 of papillary RCC, 4 354 of chromophobe RCC and 1 315 of other pathological types, with T 1, T 2, T 3 and T 4 of 55 332, 8 687, 15 516 and 904 cases respectively; WHO nuclear grade for well, intermediate and poor differentiation were 52 323, 22 700 and 5 416 cases separately.Tumor size <5cm, 5-10cm, ≥10cm were 46 741, 25 760 and 7 938 cases respectively. Kaplan-Meier survival analysis were performed on these two group of cases, with different factors between subgroups (gender, age, pathological types, tumor stage, size and nuclear grade) evaluated by log-rank test. To evaluate accuracy of outcome prediction models of SSIGN, Leibovich and UISS score, concordance index of these models were evaluated. Results:In 1 346 cases of our cohort, those with chromophobe RCC were well prognostic, survival were relatively better in clear cell RCC than that of papillary RCC, and worst prognosis were demonstrated in those with other types of RCC (5 year overall survival rate: 97.5%, 87.9%, 79.7% and 68.4% separately). Poor prognosis were seen in those older than 50 years, with poor T stage or nuclear grade, large tumor size and tumors with necrosis or sacromatoid differentiation ( P<0.05). In 80 439 seer cases, the best prognosis was also seen in chromophobe RCC and the worst in other type of RCC separately (5 year overall survival rate: 96.3% and 85.3%). In addition, longer survival was seen in papillary RCC than clear cell RCC (5 year overall survival rate: 92.5% and 88.9%). However, similar results with our cohort were seen in Asian and American native subgroup of SEER cases (95.1%, 88.6%, 86.7%, 80.2% for chromophobe, clear cell, papillary and other types of RCC respectively). Poor prognosis were seen in those older than 50 years, males, Asian/ American Indian, poor T stage or nuclear grade and large tumor size ( P<0.05). Concordance index for SSIGN, Leibovich and UISS models in our cohort were 0.763-0.781, 0.725-0.752 and 0.641-0.660, respectively. The chromophobe RCC subgroup was relative better based on predictive value of prognosis models(c-index of UISS of 0.670-0.781, SSIGN and Leibovich of 0.733-0.903). Conclusions:In Asian RCC population, prognosis of chromophobe RCC is best, clear cell RCC is slightly better than papillary RCC, and the prognosis of other types of RCC is the worst. Concordance index of SSIGN and Leibovich in our cohort were higher than that of UISS, and the use value for predictive model was better in the chromophobe RCC subgroup.