Brain ; metabolism ; Brain Chemistry ; Creatine ; deficiency ; Humans ; Syndrome

Objective To investigate the feasibility and clinical significance of D2 lymphadenectomy for distal gastric cancer in which the pancreas were regarded as the central landmark. Methods 26 patients of advanced distal gastric cancer were performed D2 lymphade-nectomy centered on the pancreas from March 2012 to February 2013. The operation time, amount of bleeding,number of lymph nodes,and postoperative complications were recorded. Results All the 26 patients underwent the operation successfully. The amount of bleeding was 50~200 mL(averagely 110 mL),and the number of lymph nodes which were cleaned was 16~35 (averagely 26). One patient had intra-ab-dominal hemorrhage and one patient had lymphorrhagia after the operation,and they were cured finally. There was no local recurrence,no dis-tant metastasis,and no death case occurred during the follow-up. Conclusion D2 lymphadenectomy for distal gastric cancer with pancreas as the central landmark is safe and feasible, and it is of lower incidence of complications .

Objective To compare effects of compound Xueshuantong capsule and benazepril on inflammatory cyto-kines in type 2 diabetic patients with early diabetic nephropathy (DN), and its therapeutic mechanism thereof. Methods Ninety-four patients with type 2 diabetes were divided into diabetes without albuminuria group (DM,n=24) and early DN group (DN,n=70). DN group was then divided into three subgroups:group A (n=24) treated by benazepril alone, group B (n=22) treated by compound Xueshuantong capsule and group C (n=24) treated by compound Xueshuantong capsule combined with benazepril for 3 months. Levels of fasting blood glucose, glycosylated hemoglobin, serum creatinine, blood urea nitro-gen, lipid profiles, fibrinogen and urinary albumin excretion rate (UAER) were examined before and after treatment. The se-rum levels of hypersensitive c-reactive protein (hs-CRP), interleukin-6 (IL-6) and tumor necrosis factor-α(TNF-α) were determined as well. Results The serum levels of hs-CRP, IL-6 and TNF-αwere significantly higher in DN group than those of DM group (P<0.01). After treatment, the serum levels of UAER, hs-CRP, IL-6 and TNF-αwere significantly re-duced in groups A, B and C compared with those before treatment (P<0.01), and which were decreased more significantly in group C. The levels of blood lipids and fibrinogen decreased obviously in group C compared with those of group A and B ( P<0.01). Conclusion Compound Xueshuantong capsule combined with benazepril not only can improve the blood fat and high coagulation state in patients, but also impossibly retard the development of early DN through decreasing serum concen-trations of hs-CRP, IL-6 and TNF-αand inhibiting inflammatory reaction.

Germany ; Hazardous Substances ; analysis ; Workplace

Objectivo To analyze urine organic acids in the urine using gas chromatography-mass spectrometry(GC/MS)for diagnosis of inherited metabolic diseases,especially for organic acids metabolic disorders.Methods 195 clinical urine samples from the patients with suspected organic acids metabolic disorders and 5 normal urine from adults were collected.After mixing some urine with intemal standards according to the concentration creatinine and adding hydroxylamine hydrochloride to mixture,the organic acids with hydroxyl group were oximated to the ketobodies.Organic acids were extracted twice with ethyl acetate and ethyl ether and derivatized with BSTFA-TMCS.An the organic acids were determined with Agilent GC/MS 6890/5973i with scan model.the mass-to-charge ratio range is 50-550 m/z,all data were nalyzed with Agilent GCMSD ChemStationG1701DA.We also investigated the linearity, accurate,precision.recovery and Carry-over by determining the internal standards in normal samples and positive organic acids in spiked control samples.Results More than one hundred kinds of organic acids in urine samples can be analyzed with this method.According to the two internal standards in normal urine samples,the minimal detection limit MMA and 2.PA was 2.5-2.8 μmol/L.Intra-and interassay coefficient of variation for MMA and 2-PA are both less than 10%.Pre-processing Interassay coefficient by sequential preparations of the same sample was 14%.The recoveries of the spiked samples were 95%-105%.Carryover analysis was less than 1%.All the parameters meet the requirement for clinical diagnosis.12 samples demonstrated positive including 6 cases of methylmalonic acidemia,1 case of propionic acidemia,3 cases of tyrosinemia Ⅰ,1 case of maple syrup urine disease and 1 cases of ketosis.Conclusions The method for the determination of organic acids in urine by GC/MS has been successfully established.It can be used for clinical screening and diagnosis for inherited genetic metabolic diseases.

Objective To investigate the molecular mechanisms of cross-resistance to azoles in a clinical isolate of Aspergillus fumigatus. Methods A. fumigatus was isolated from a patient with invasive aspergillosis.Clinical Laboratory Standard Institute M38-A2 broth microdilution method and E-test method were used to determine the minimum inhibitory concentrations (MICs) or minimum effective concentration (MEC) of itraconazole, voriconazole, amphotericin B, posaconazole and caspofungin for the A. fumigatus isolate. DNA was extracted from the isolate and subjected to the amplification of cyp51A gene encoding the target enzyme of azole antifungal agents followed by sequence analysis. Results The broth microdilution test showed that the MEC of caspofungin was 0.5 mg/L, and MICs of itraconazole, voriconazole and amphotericin B were ≥ 16 mg/L,8 mg/L and 1 mg/L, respectively, for this isolate; while E-test assay revealed that the MICs of caspofungin,itraconazole, voriconazole, amphotericin B and posaconazole were 0.047 mg/L, ≥32 mg/L,≥32 mg/L, 12 mg/L and ≥32 mg/L, respectively. Sequence analysis showed an insertion of a 34-bp tandem sequence in the promoter region of the cyp51A gene as well as a T364A point mutation causing the substitution of leucine 98 (L98H). In addition, there were some other mutations in the cyp51A gene of this isolate, such as A137T,G585A, C814A, G836C, T991C and A1350G, which could result in corresponding amino acid substitutions.Conclusions An A. fumigatus strain with cross-resistance to azole antifungal agents is isolated. There is an insertion of a 34-bp tandem sequence into the promoter region as well as a T364A point mutation in the cyp51A gene, which contribute to the cross resistance to azole antifungal agents including itraconazole, voriconazole,and posaconazole. In addition, other mutations causing amino acid substitutions have also been detected in the cyp51 A gene of this isolate.

Objective To investigate the in vitro susceptibility of 16 strains of Exophiala dermatitidis to 6 commonly used antifungal agents. Methods The Glinical and Laboratory Standards Institute (CLSI)M27-A2 protocol was carried out to determine the MIGs of terbinafine (TRB), itraconazole (ITC), amphotericin B (AMB), fluconazole (FLC), voriconazole (VRC), and caspofungin (GAS) to 16 strains of E. dermatitidis, and E-test was performed to determine those of VRG, ITC and AMB. Besides, the minimal fungicidal concentrations (MFGs) of the above antifungal agents to the 16 strains of E. dermatitidis were further assessed.The activity of TRB in combination with ITC and VRG against E. dermatitidis was also estimated. Results The MIC ranges of TRB, VRC, ITC, AMB, FLC, and CAS were 0.125 - 0.25 mg/L, 0.25 - 0.5 mg/L, 2.0 mg/L,2.0 mg/L, 16 - 32 mg/L and 16 - 64 mg/L respectively as shown by M27-A2 microdilution assay, while the MIC ranges of VRG, ITG and AMB, as determined by E-test, were 0.032 - 0.094 mg/L, 0.047 - 0.5 mg/L and 0.125 - 3.0 mg/L, respectively. The MFC ranges of TRB, VRC, ITG, AMB and FLG were 0.125 - 0.5 mg/L,0.25 - 0.5 mg/L, 2.0 - 4.0 mg/L, 2.0 - 4.0 mg/L and 16 - 64 mg/L, respectively. No synergism in the acitivity against E. dermatitidis was observed for the combination of TBR with ITC or VRC. Conclusion E. dermatitidis is susceptible to TRB, ITC, AMB, and VRC, but less sensitive to both FLC and GAS.

Objective To observe the incidence of acute radiation pneumonitis (ARP) in patients with nonsmall cell lung cancer treated by three-dimensional conformation radiotherapy or intersity-modulated radiation therapy,and investigate the predictive value of high dose volume and low dose volume of the total and ipsilateral lung on ARP.Methods 174 patients with non-small-cell lung cancer verified by pathology who received radical radiotherapy in our hospital from Aug 2013 to Nov 2015 were screened.Radioactive dose was 60 Gy-70 Gy,with 97 patients' dose of 60-64 Gy and 77 patients' dose of 65-70 Gy.Chemotherapy was done by paclitaxel + pentium first line treatment.155 patients were treated with radiotherapy alone and 19 with radiotherapy combined with chemotherapy.The V5～ V30,MLD (mean lung dose),V5ipis ～ V30ipsi,MLDipsi were calculated from the dose volume histogram system.The ARP was evaluated according to Common Toxicity Criteria 4.0 (CTC4.0).Univafiate and nultivariate analysis and receiver operating characteristic (ROC) curves were performed to assess the correlated factors of ARP.Results Of 174 patients,26 patients (14.94％) developed radioactive pneumonia at grade 2,11 patients (6.32％) at grade 3,2 patients (1.15％) at grade 4.The correlative factors included the radiochemotherapy regimen (sequential chemotherapy to radiotherapy or concurrent radiochemotherapy),V5,V10,V20,V30,MLD of the total lung and ipsilateral lung according to univariate analysis.Multivariate analysis of all the factors mentioned above showed the V5,V20ipsi and MLD were the independent predictive factors associated with ARP.ROC analysis indicated that the cut-off point of V5,V20ipsi,MLD were 62.38％,47.14％and 16.85Gy respectively.According to the V5,V20ipsi value,174 patients were divided into three groups:B group V5＜62％+V20ipsi≥47％,C group V5≥62％+V20ipsi＜47％,D group V5≥62％+V20ipsi≥47％.The chisquare test between the C group and D group has statistical significance.Conclusion V5,V20ipsi,and MLD are the independent risk factors of ARP.Compared with V5,limiting V20ipsi threshold is more likely to result in ARP.

OBJECTIVE: To study the status quo and future trend of digestive system drugs used in our hospital. METHO-DS: The digestive system drugs used in our hospital between 2001 and 2005 were analyzed retrospectively in respect to drug kinds, consumption sum, DDDs, daily costs etc. RESULTS: Drugs for peptic ulcer and hepatobiliary diseases took a big proportion and experienced a year- on- year increase. No significant change was noted for the top 10 drugs on the lists of DDDs and consumption sum before and after the medical insurance reform, but their order changed a little. The DDDs of most of the cheap and effective drugs increased after the medical insurance reform. CONCLUSION: The consumption of antiulcer drugs and drugs for hepatobiliary diseases in our hospital assume an increasing tendency.

Background and purpose:The traditional 3 incision surgery is an important means of esophageal cancer treatment, however, accompanied by more postoperative complications and higher mortality. Minimally invasive esophagectomy is a prospective technology with advantages, such as little trauma and quick recovery. This study retrospectively analyzed the perioperative effect of the esophagus cancer patients who accepted thoracoscopic-laparoscopic esophagectomy (TLE), open-laparoscopic esophagectomy (OLE) and open esophagectomy (OE) from Jan. 2013 to Jan. 2015. Methods:In this study, 72 patients received TLE, 76 patients received OLE and 115 patients received OE, respectively. One-way ANOVA, Kruskal Wallis test and Chi-square test were used to compare the differences of general clinical data, perioperative recover index, the number of lymphadenectomy and the postoperative complication among TLE, OLE and OE. Results:There were differences in the area of operative blood loss, duration of ICU stay and first standing time among the 3 groups. Pairwise comparison demonstrated that TLE group was signiifcantly better than OE group (P<0.012 5). The total number of lymphadenectomy among the 3 groups had no differences. However, the number of lymph node of the upper esophagus in the TLE groups was more than those in OLE group and OE group (P<0.001). The laryngeal recurrent nerve injury incidence in TLE group was signiifcantly higher than those in OLE group and OE group (P=0.012, 0.003). The total surgical complication had no differences among 3 groups. In areas of the cardiorespiratory system severe complication, 3 groups had statistical differences. Pairwise comparison showed TLE group was significantly less than OLE and OE group (P<0.0125). The first day and third day incidences of SIRS rate in TLE group were less than those in OLE group and OE group (P<0.0125). Conclusion:Comparing to OE group, with the same safety and feasibility, TLE had more advantages such as trauma, quick recovery, less complications. With the same effect of total lymphadenectomy to OE, TLE had the more advantage in upper mediastinal and recurrent laryngeal nerve lymph node cleaning.