Objective To compare the newer antifungal agents micafungin and voriconazole for prophylaxis effects on the clinical outcomes.Methods We electronically searched the database of Cochrane Central Register of Controlled Trials,Pubmed,EMbase,China Biology Medicine (CBM),China National Knowledge Infrastructure(CNKI),and relevant database articles (1996.01-2014.12).Comparative studies were carried out on proved fungal infections,mortality,and adverse effects.Meta-analysis was performed by Review Manager 5.3 software.Results We found 1 564 records and 16 studies totaling 4 234patients included in analyses.Pooled comparisons of studies found that antifungal prophylaxis with the new agents did reduce the incidence of invasive fungal infections and transplant related mortality than fluconazole or itraconazole [OR =0.41 (0.21 ～ 0.80) and OR =0.40 (0.24 ～ 0.66),respectively,P ＜ 0.01].Voriconazole had higher rates of liver dysfunction,lower gastrointestinal side effects over fluconazole,and lower rates of nephrotoxic effects than amphotericin B.Voriconazole had significant decrease in adverse events requiring drug discontinuation compared to itraconazole [OR =0.43 (0.27 ～ 0.68),P ＜ 0.01].Conclusions This analysis indicated the 2 agents appear to be well tolerated with manageable side effects and beneficial in the prophylaxis of invasive fungal infection (IFI).

Objective To investigate the feasibility and image quality of coronary artery angiography with 640-slice CT system in the pacemaker patients. Methods ECG-triggered 640-slice CT coronary angiography was performed in 16 pacemaker patients. Image quality of the fifteen coronary segments and metal-related artifact originating from pacemaker were assessed by two experienced radiologists in consensus.Image quality was assessed using a 4-point grading scale. ECG trigger information was recorded. Results The rate of available diagnostic images was 99. 07% ( Grade 1 in 83.64%, Grade 2 in 15.42%, Grade 3 in 0. 47% and Grade 4 in 0. 47% of patients, respectively). Image quality and the effect of streak artifact were similar between the high heart rate group and low heart rate group ( P ＞ 0. 05 ) and between normal pacing group and arrhythmia group ( P ＞ 0. 05 ). In coronary MSCT angiography, streak artifact of the pacemaker can render segments of the coronary artery uninterpretable, especially on S1, S2, S3, S4 and S8 segments of the coronary artery. Small shifts in the reconstruction window resulted in significance reduction of streak artifact ( x2 = 151. 818, P ＜ 0. 01 ). Conclusions 640-slice gated CT coronary angiography could provide excellent image quality for patients with pacemaker. The streak artifact induced by pacemaker on some segments of the coronary artery could be improved by small shifts in the reconstruction window.

Objective To compare the efficacy of ultrasound-guided fine-needle aspiration(US-FNA)biopsy in diagnosing solid and complex thyroid nodules with different size. Methods One hundred and seventy-five thyroid FNA biopsies were prospectively performed on 168 patients ranging from 4 to 75 years of age. Sixty-three nodules were surgically excised and the others were clinically followed-up. The cytology diagnoses were categorized into four groups: benign, malignant, suspicious and unsatisfactory. Results There was no significant complication in the all 115 solid and 60 complex thyroid lesions and there were 36and 3 malignant nodules respectively in solid and complex thyroid nodules. The nondiagnostic rates of solid and complex nodules were 7％ and 8％. The accuracy of US-FNA in diagnosing complex thyroid nodules was comparatively equal to that of in solid thyroid nodules. In solid thyroid nodules, the sensitivity and accuracy in ≤1 cm group were similar to that of in ＞1 cm group. Conclusions US-FNA was an accurate and reliable method to diagnose thyroid solid and complex lesions.

OBJECTIVETo investigate the effects of curcumin on release of cytochrome c and expressions of Bcl-2, Bax, Bad, Bcl-xL, caspase-3, poly ADP-ribose polymerase (PARP), and survivin of HT-29 cells.

METHODSHT-29 cells were treated with curcumin (0 approximately 80 micromol/L) for 24 h. The release of cytochrome c from the mitochondria and the apoptosis-related proteins Bax, Bcl-2, Bcl-xL, Bad, caspase-3, PARP, and survivin were determined by Western blot analysis and their mRNA expressions by reverse transcriptase-polymerase chain reaction (RT-PCR).

RESULTSCurcumin significantly induced the growth inhibition and apoptosis of HT-29 cells. A decrease in expressions of Bcl-2, Bcl-xL and survivin was observed after exposure to 10 approximately 80 micromol/L curcumin, while the levels of Bax and Bad increased in the curcumin-treated cells. Curcumin also induced the release of cytochrome c, the activation of caspase-3, and the cleavage of PARP in a dose-dependent manner.

CONCLUSIONThese data suggest that curcumin induced the HT-29 cell apoptosis possibly via the mitochondria-mediated pathway.

Antineoplastic Agents ; pharmacology ; Apoptosis ; drug effects ; Caspase 3 ; genetics ; metabolism ; Cell Nucleus ; drug effects ; Cell Survival ; drug effects ; Curcumin ; pharmacology ; Cytochromes c ; secretion ; HT29 Cells ; Humans ; Inhibitor of Apoptosis Proteins ; Membrane Potential, Mitochondrial ; drug effects ; Microtubule-Associated Proteins ; genetics ; Mitochondria ; physiology ; Proto-Oncogene Proteins c-bcl-2 ; genetics ; RNA, Messenger ; analysis ; bcl-2-Associated X Protein ; genetics ; bcl-X Protein ; genetics

OBJECTIVETo evaluate the clinical effects of implants supported magnet-retained overdenture.

METHODSFrom November 1999 to March 2005, 25 cases with edentulous jaws underwent implant-supported magnet-retained overdenture. Among them, 14 patients were male, 11 patients were female. The average age of the patients was 67.6 years. (Range 45 - 79 years). Ninety-five implants used included Komet (18), IMZ (11), Frialit-2 (12), Ankylos (10), Camlog (44). The fellow-up time was from 6 months to 70 months. Clinical examination and radiographs were conducted.

RESULTSNo infections, nerve or sinus damage or other sequelae occurred. The overdentures were stable and functioned effectively. From November 1999 to March 2005, One Komet abutment was fracture and 1 Frialit-2 implant was lost because of overloading during follow-up. The remaining implants achieved successful osseointegration. Patients were satisfied with the treatment.

CONCLUSIONSImplant-supported magnet-retained overdenture was a predictable and reliable method, especially for old patients with edentulous jaws.

Aged ; Dental Implantation ; methods ; Dental Prosthesis, Implant-Supported ; Denture, Overlay ; Female ; Follow-Up Studies ; Humans ; Jaw, Edentulous ; rehabilitation ; Magnetics ; instrumentation ; Male ; Middle Aged

OBJECTIVERecent studies showed that adenosine played important roles in vasodilation. This study aimed to investigate the effects of adenosine, its A1 and A2b receptor agonists on pulmonary artery hypertension (PAH) induced by chronic hypoxia in rats by continuously subcutaneous administration with an osmotic pump for 14 days, and to see if rennin angiotensin system and inducible nitric oxygen synthase (iNOS)/nitric oxide (NO) mediate the effects.

METHODFifty-six male SD rats were randomly assigned to seven groups. Each group included eight rats. They were normoxic group, hypoxic group, adenosine-treated group [adenosine was administered at a dose of 150 µg(kg·min) under the hypoxic condition], adenosine A1 receptor agonist CPA-treated group [CPA was administered at a dose of 20 µg/(kg·min) under the hypoxic condition], CPA plus selective adenosine A1 antagonist DPCPX-treated group [CPA and DPCPX were administered simultaneously under the hypoxic condition, the dose of CPA was the same as the above, and the dose of DPCPX was 25 µg/(kg·min)], adenosine A2b receptor agonist NECA-treated group [NECA was administered at a dose of 30 µg/(kg·min) under the hypoxic condition], NECA plus selective adenosine A2b receptor antagonist MRS-treated group[ NECA and MRS1754 were administered simultaneously under the hypoxic condition, the dose of NECA was the same as the above, and the dose of MRS1754 was 50 µg/(kg·min)]. Osmotic pumps containing adenosine or selective adenosine A1 receptor agonist (CPA), or nonselective but potent adenosine A2b receptor agonist (NECA) were placed subcutaneously 7 days after hypoxia and continuously administered the agents for 14 days.Mean pulmonary artery pressure (mPAP) was detected after administration of the agents. Then blood samples were taken from heart for measurement of renin activity, angiotensin II (AngII) and endothelin-1 (ET-1) concentration by radioimmunoassay, NO by measuring nitrate. Small pulmonary arteries were prepared for immunoreactivity staining of proliferating cell nuclear antigen (PCNA) and iNOS.

RESULT(1) Chronic hypoxia induced PAH [mPAP: (31.38 ± 3.42) mm Hg]. Adenosine or CPA or NECA administered for 14 days by subcutaneous route attenuated the mPAP [(21.17 ± 3.56) mm Hg, (22.88 ± 2.95) mm Hg, (19.81 ± 2.39) mm Hg, respectively], which showed significant difference when compared with hypoxia group (P < 0.05 respectively). (2) Plasma rennin activity and AngII level in hypoxia group [(2.51 ± 0.25) ng/(ml·h), (83.01 ± 9.38) pg/ml] were significantly higher than that in normoxic group (P < 0.05, respectively).(3) Adenosine treatment decreased the rennin activity and AngII level when compared with hypoxic group(P < 0.05, respectively);CPA and NECA attenuated respectively the rennin activity and AngII level of rats induced by chronic hypoxia (P < 0.05, respectively). (4) Adenosine administration for 14 days attenuated the wall thickness induced by chronic hypoxia (P < 0.05). CPA showed no effect on wall thickness, but NECA significantly attenuated the wall thickness (P < 0.05). (5) The number of iNOS staining positive cells in small pulmonary artery was higher in hypoxia group than in that in normoxic rats (23.75 ± 7.91 vs. 8.00 ± 2.20, P < 0.05). Adenosine or CPA, or NECA administration increased respectively the iNOS expression in rats treated with chronic hypoxia. Chronic hypoxia caused significant decrease of nitric oxide level. Adenosine treatment increased the nitric oxide level in rats treated with chronic hypoxia. CPA and NECA also increased respectively the nitric oxide level in rats treated with chronic hypoxia. Chronic hypoxia caused significant increase of ET-1 level. The ET-1 level in rats treated with adenosine, CPA or NCEA respectively were lower than that in chronic hypoxia rats (P < 0.05). (6) Adenosine treatment partially attenuated the number of PCNA-positively stained cells. NECA treatment also attenuated the PCNA expression, but CPA showed no effect.

CONCLUSIONAdenosine and its agonists CPA, NECA administered continually by subcutaneous route attenuate mPAP of rats induced by chronic hypoxia. CPA attenuates mPAP through reduction of RA/AngII activity and balance of NO/ET-1 level. NECA attenuates mPAP by inhibiting PCNA expression and proliferation of mooth muscle of pulmonary artery.

Adenosine ; administration & dosage ; pharmacology ; Angiotensin II ; blood ; Animals ; Disease Models, Animal ; Endothelin-1 ; metabolism ; Hypertension, Pulmonary ; drug therapy ; etiology ; metabolism ; Hypoxia ; complications ; Male ; Nitric Oxide ; blood ; Nitric Oxide Synthase Type II ; metabolism ; Proliferating Cell Nuclear Antigen ; metabolism ; Pulmonary Artery ; drug effects ; physiopathology ; Purinergic P1 Receptor Agonists ; administration & dosage ; pharmacology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Renin ; blood

OBJECTIVETo investigate the clinical feasibility and technical characteristics of immediate loading and to access the short-term clinical results of treatment.

METHODSThis study included 3 completely edentulous patients and 24 patients who were partially edentulous from March 1999 to December 2003. 21 implants were immediately loaded and provided support for mandibular overdenture for 3 fully edentulous patients. 30 implants were placed in 21 partially edentulous patients and implants were immediate loaded in edentulous mandibular providing support for fixed provisional prosthesis within 6 months. Then, metal-ceramic crowns were completed. All patients were followed up by 1, 3, 6, 12 months and the patients were checked every 12 months.

RESULTSA total of 42 implants were loaded immediately. From March 1999 to December 2003, no implants were lost during follow-up (range 3 to 49 months, mean of 28 months). No infections, nerve or sinus damage or other sequelae occurred. No implants exhibited peri-implant radiolucencies. Moreover, immediate loading seems to increase the ossification of the alveolar bone around endosseous implants. Patients were satisfied with the treatment.

CONCLUSIONSThe data and the experience described in this study indicate that immediate loading with restorations using appropriate surgical and restorative techniques can predicate the completely edentulous and partially edentulous mandible in some cases. Further study is needed to determine the long-term result of immediately loaded implants.

Adult ; Dental Abutments ; Dental Implantation, Endosseous ; methods ; Dental Implants ; Dental Prosthesis Design ; Dental Prosthesis Retention ; instrumentation ; Dental Prosthesis, Implant-Supported ; Denture, Complete, Immediate ; Denture, Partial, Immediate ; Female ; Humans ; Jaw, Edentulous ; surgery ; Jaw, Edentulous, Partially ; rehabilitation ; surgery ; Male ; Middle Aged

OBJECTIVETo provide reliable evidence of "J in three-needle therapy" for treatment of stroke.

METHODSMulti-central randomized controlled trials were adopted, 180 hemiplegia patients of ischemic stroke were randomly divided into a fin three-needle group (90 cases) and a routine acupuncture group (90 cases). Two groups were both treated with basic neurology therapies, and J in three-needle group was treated with J in three-needle therapy, three acupoints of tempora, hand and foot etc. were selected; the routine acupuncture group was treated with traditional acupuncture, Quchi (LI 11), Huantiao (GB 30), Futu (ST 32) etc. were selected. Both groups were treated with acupuncture for 5 weeks. The cognitive function score of functional comprehensive assessment scale (FCA), the scores of mini-mental state examination scale (MMSE) and modified Barthel index (BI) were compared before and after treatment between two groups. Results After treatment, the scores of FCA, MMSE and BI in both groups were significantly improved compared to those before treatment (P < 0.01, P < 0.05); the improvement of FCA score, MMSE score and BI score in the J in three-needle group were superior to those of the routine acupuncture group after treatment (P < 0.01, P < 0.05). The total effective rate of 85.4% in the J in three-needle group was superior to tohat of 70.0% in the routine acupuncture group (P < 0.05).

CONCLUSIONJ in three-needle acupuncture treatment can obviously improve the cognitive function and activity ability of daily life of hemiplegia patients after stroke, and the therapeutic effect of J in three-needle therapy is superior to that of traditional acupuncture treatment.

Activities of Daily Living ; Acupuncture Therapy ; Adult ; Aged ; Cognition ; Female ; Hemiplegia ; etiology ; psychology ; rehabilitation ; therapy ; Humans ; Male ; Middle Aged ; Stroke ; complications

OBJECTIVETo investigate the effect and safety of the implantation of a new type of testicular prosthesis in the treatment of testis loss.

METHODSWe recruited for this study 18 patients with testis loss treated by testicular prosthesis implantation, including 10 cases of prostate cancer, 3 cases of anorchia, 2 case of orchiatrophy, 2 cases of hermaphroditism and 1 case of cryptorchidism. The prosthesis was a hollow silicone elastomer YH-G1 made in China, selected according to the volume of the scrotum and the size of the contralateral testis.

RESULTSThirteen of the patients received testicular prosthesis implantation with orchiectomy, and the other 5 underwent the procedure 6 months later. The operation time of testicular prosthesis implantation was (22.6 +/- 4.6) min, ranging from 15 to 30 minutes. All the patients were discharged after 12 hours of postoperative observation, with a mean hospital stay of (1.3 +/- 0.4) days. A follow-up after 6 months revealed no complications in 17 cases. Rejection occurred in 1 case at 3 months after the implantation, ending in the removal of the prosthesis. Of the 17 successful cases, 15 were very satisfied with the size of the prosthesis, 14 with its weight, 12 with its comfortableness, and all with the appearance of the scrotum and the position of the prosthesis, while 5 found the implant too rigid.

CONCLUSIONThe implantation of the new home-made silicone elastomer testicular prosthesis YH-G1 was safe and effective for the treatment of testis loss, and could meet the esthetic and psychological requirements of the patient. But further observation is needed for its long-term complications and influence on the patient's quality of life.

Adolescent ; Adult ; Aged ; Gonadal Dysgenesis, 46,XY ; surgery ; Humans ; Male ; Middle Aged ; Orchiectomy ; Patient Satisfaction ; Prostheses and Implants ; Prosthesis Implantation ; adverse effects ; Silicone Elastomers ; Testis ; abnormalities ; surgery ; Treatment Outcome ; Young Adult

OBJECTIVETo assess the safety and advantages of robotic pancreatic surgery (RPS) based on the single-team experience with 1010 cases.

METHODSThe clinical data of 1010 cases of RPS performed by a single team from November, 2011 to September, 2017 in our hospital were collected prospectively and analyzed. In most of cases the surgeries were performed using the third-generation da Vinci robotic surgical system.

RESULTSThe 1010 cases receiving RPS included 417 cases of robotic pancreatoduodenectomy (RPD), 428 cases of robotic distal pancreatectomy, 60 cases of robotic central pancreatectomy, 53 cases of robotic pancreatic tumor enucleation, 3 cases of Appleby procedure, and 49 cases of other operations (including 4 cases of innovative robotic retroperitoneal laparoscopic surgery, 4 cases of robotic pancreatic tumor enucleation combined with main pancreatic duct bridging repair, 1 case of single incision robotic pancreatic tumor enucleation, and 2 cases of robotic central pancreatectomy combined with end-to-end anastomosis reconstruction). The median operative time was 210 min (30-720 min) with a median intraoperative blood loss of 80 mL (10-2000 mL), a conversion rate of 4.06% (41/1010), a blood transfusion rate of 6.7% (68/1010), a mean post-operative stay of 10.87∓6.70 days, a complication rate (beyond grade III according to Clavien-Dindo scoring system) of 8.0% (81/1010), and a pancreatic fistula rate (beyond) grade B of 9.21% (93/1010). The mortality rate of the patients was 0.69% (7/1010) in 30 days and 1.31% (12//934) in 90 days. The application of RPS in total pancreatectomy increased steadily from the rate of 10.44% in 2012 to 72.06% in 2017.

CONCLUSIONThis represents to our knowledge the world largest series of robotic pancreatic resections. RPS is expected to gradually replace open procedure and laparoscopic procedure to become the primary choice of approach for pancreatectomy. After the learning curve, RPS procedure including distal pancreatectomy, robotic Appleby procedure and other operations can be safely performed, and the experiences from other centers can be beneficial to reduce severe complications in the early stage of learning.