Objective:To investigate the prognostic value of systemic inflammatory score (SIS) in prognostic assessment of patients with unresectable metastatic colorectal cancer (mCRC).Methods:The clinical data of 130 patients with unresectable mCRC in Affiliated Haikou Hospital of Xiangya Medical College of Central South University from January 2014 to December 2016 were retrospectively analyzed. The relationship between SIS and clinicopathological characteristics of unresectable mCRC patients was also analyzed. The survival analysis was made by using Kaplan-Meier. The risk factors affecting the prognosis of unresectable mCRC patients were analyzed by using Cox regression model to make univariate and multivariate analysis.Results:According to SIS results, patients were divided into 0-score group (40 cases), 1-score group (58 cases), and 2-score group (32 cases). There were no significant differences in different SIS constitution patients stratified by age, gender, primary tumor location, functional status score, tissue type, RAS gene status, number of metastatic organs, peritoneal spread and molecular targeted therapy (all P > 0.05). Kaplan-Meier survival analysis showed that the 5-year overall survival rates of SIS 0-score, 1-score and 2-score group were 37.5%, 19.0%, 6.3%, respectively; and the difference was statistically significant ( χ2 = 3.152, P<0.01). Cox regression survival analysis showed that female, primary tumor location in right side and SIS (scores of 1-2) were independent risk factors for overall survival in patients with unresectable mCRC (all P<0.05). Conclusion:SIS may be an important indicator for prognostic assessment of patients with unresectable mCRC, and patients with high SIS have poor prognosis.

Objective To assess the value of peripheral blood thyroid stimulating hormone receptor(TSHR) mRNA determination in differential diagnosis of benign and malignant thyroid nodules.Methods Fine needle aspiration cytology (FNAC) and (or) postoperative histopathology as the gold standard were carried out,the expression of circulating TSHR mRNA was determined by RT-PCR in 33 patients with benign thyroid nodules,39 patients with thyroid cancer,and 20 normal controls.Results TSHR mRNA signals were not detected in normal controls,the positive rate of TSHR mRNA was higher in the group with malignant nodules than the group of benign nodules (91.2％ vs 48.5％,P＜0.01).TSHR mRNA level in the preoperative malignant group was significantly higher than that in the normal,benign,and postoperative cancer groups (all P ＜ 0.01).Using peripheral blood TSHR mRNA for differentiating benign or malignant of thyroid nodule had a sensitivity,specificity,and accuracy of 91.2％,51.5％ and 71.6％,respectively.The sensitivities of TSHR mRNA,FNAC,and these two methods combined in detecting malignant nodules were 91.3％,86.9％,and 100.0％ respectively,while diagnostic accuracies were respectively 84.0％,80.0％,and 92.0％.TSHR mRNA expression showed no significant relationship with sex,age,size,and number of nodule in these patients (all P ＞ 0.05),but it did exhibit significant difference between benign and malignant nodules(P＜0.01).Conclusion The peripheral blood TSHR mRNA could be used as a molecular marker for thyroid cancer,and it would help enhance the preoperative differentiation of benign and malignant thyroid nodules.

To identify the gene differentially expressed in female Anopheles anthropophagus and to analyze its gene sequence, this gene amplified by PCR was identified by real-time PCR and its cDNA was then amplified with rapid amplification of cDNA ends (RACE) technology. It was found that the expression ratio of the female differentially expressed gene in female and male mosquitoes was 267.49 according to the formula F=2~(-⊿⊿CT).The size of mRNA of the gene was 364 bp, and the amino acid sequence deduced from the open reading frame (ORF) was found to be similar to the sequence of tectin protein of Culex quinquefasciatus and proteins of other species. The mRNA sequence of this gene was submitted to NCBI with a accession number of FJ907236. This gene may provide a foundation for further studies on the biological functions of mosquitoes.

Purpose To evaluate the diagnostic value of diffusion weighted imaging with high b value in acute cerebral microinfarcts.Materials and Methods Conventional MRI and diffusion weighted imaging with standard b value (b=1000 s/mm2) and high b value (b=3000 s/mm2) were performed in the 7 patients with acute cerebral infarction,and all the images were evaluated.The signal to noise ration (SNR) and contrast to noise ration (CNR) were measured.Results Five patients were detected much more microinfarcts in high b value as HB group than that in standard b value as SB group.The SNR and CNR were significantly higher in high b value group than that in standard b value group (P＜0.05),but the apparent diffusion coefficient value showed no significant difference between the two groups (P＞0.05).Conclusion DWI with high b value could sensitively detect acute cerebral microinfarcts with high clinical value.

Objective To explore the application of a three-dimensional simulation system in extended liver resections.Methods A three-dimensional surgical simulation system was used for preoperative assessment and for computer simulation to estimate the resected liver volume,the residual liver volume,and the surgical resection margins.The software virtual liver resection was used to choose the most optimal surgical option.The actual resection,the postoperative liver volume and the actual surgical resection margins were compared.Results 1 patient was diagnosed by ultrasound to develop ascites on post-operative day 2.Another patient was diagnosed by transthoracic ultrasound to have moderate pleural effusion on postoperative day 1.Postoperative liver failure developed in 1 patient.There was no patient who developed bile leakage.The average length of stay was 6 ～ 85 days (average 22 d).There was no recurrence within 1 month after surgery and there was no postoperative deaths.Condusions The three-dimensional surgery simulation system was effective.It gave an accurate evaluation and simulation of the liver surgery.In extended liver resection,it gave good guidance and help.

OBJECTIVETo prepare freeze-dried long-circulation oridonin liposomes with optimized parameters.

METHODSEthanol injection method followed by freeze-drying was used to prepare the liposomes. Sephadex column was used to purify liposomes. Effects of formulation factors on entrapment efficiency of long-circulation oridonin liposomes were studied. The particle size, distribution and in vitro release were determined. Pharmacokinetics of oridonin liposomes in rats was determined by HPLC and the pharmacokinetic parameters calculated by Kinetica(TM) software were compared with conventional oridonin liposomes and solution.

RESULTSThe optimized lipid formulation for long-circulation liposomes was composed of soy lecithin, cholesterol and DSPE-PEG 2000 with a ratio of 1:0.5:1.8(w/w). The ratio of drug to lipid was 1:6. Freeze-drying protectant was a mixture of glucose and mannitol (3:1). The entrapment efficiency (EE) of long-circulation oridonin liposomes was about 65%. The particle size of liposomes after hydrolyzation was 164 nm with good DPI. The liposomes showed a sustained drug release in vitro. Intravenous injected oridonin fitted with two-compartment pharmacokinetic model. The MRT of long-circulation liposomes was 2 times and 6 times and AUC was about 2 times and 3 times of conventional liposomes and oridonin solution, respectively.

CONCLUSIONFreeze-dried liposomes with high EE have been obtained by the proposed approach. This long-circulation liposomes extend oridonin half time and significantly increase AUC in rats.

Animals ; Delayed-Action Preparations ; Diterpenes, Kaurane ; administration & dosage ; pharmacokinetics ; Drug Stability ; Freeze Drying ; Liposomes ; administration & dosage ; pharmacokinetics ; Male ; Rats ; Rats, Sprague-Dawley ; Tissue Distribution

Objective To investigate the effects of IL-12 coexpression level on antigen expression and immune responses induced by HBsAg DNA vaccination. Methods DNA vaccine plasmid pHBV carrying codon-optimized preS2-S gene of reference sequence CHN-HBV07-C in China was constructed. Three DNA vaccine plasmids pHBV-12i, pHBV-12l and pHBV-12h were also constructed by subcloning three different IL-12 expression cassettes with various expression strengths to plasmid pHBV, respectively. Expression levels of IL-12 and HBsAg in vaccine plasmid-tranfected 293T cells were measured by quantitative ELISA. DNA vaccines were administered intramuscularly to BALB/c mice and HBsAg-specific cellular immune responses were determined by IFN-γ ELISPOT. HBsAg-specific antibodies were tested by Chemiluminescence Quantitative Immunoassay. Results The HBsAg expression level in 293T cells was 70 ng/ml when transfected by plasmid pHBV without IL-12 expression cassette, and the HBsAg level was 18 ng/ml when transfected by plasmid pHBV-12l carrying low-level IL-12 expression cassette, whereas the HBsAg level was only 6 ng/ml when transfected by plasmid pHBV-12h carrying high-level IL-12 expression cassette.Results of DNA vaccination revealed that HBsAg-specific humoral and cellular immune responses were significantly decreased in mice administering vaccine pHBV-12h carrying high-level IL-12 expression cassette. Although HBsAg-specific antibody responses in mice inoculated with pHBV-12l were also decreased when compared with those in pHBV-vaccinated mice without IL-12 expression, the HBsAg-specific cellular immune responses were significantly increased. Conclusion High-level coexpression of IL-12 may suppress the expression of HBsAg, Whereas modest coexpression of IL-12 significantly enhanced the HBsAg-specific T cell responses induced by DNA vaccination. Therefore, it is so important to balance the expression between adjuvant and antigen to enhance the immune response.

Objective To investigate the medication adherence and clinical efficacy of inhaled glucocorticoids (ICS) and leukotriene receptor antagonists (LTRA) in the treatment of children with bronchial asthma ,in order to provide references for treatment options.Methods From 2015 to 2016,the clinical data of 140 cases with bronchial asthma who under the age of 14 years were retrospectively analyzed.The patients were randomly divided into the ICS group and the LTRA group according to the treatment methods ,with 70cases in each group.The patients in the ICS group were given aerosol inhalation of budesonide 1 mg added to saline 3 mL,twice per day,and reduced to inhale budesonide 0.5 mg/time,2 times/day after symptom relief.The patients in the LTRA group were given montelukast sodium chewable tablets 4mg/time at bed-time,one time a day for 3 months.According to the MARS-A compliance assessment,the compliance of patients in the treatment process was graded and the therapeutic effect was analyzed . Results In the same medication adherence , the effective treatment samples ( including good control and partial control) of the ICS group were 62 cases,and 8 cases without control and the effective rate was 98.36%.In the LTRA group,the effective treatment samples were 54 cases,and 16 cases without control and the effective rate was 89.09%. There was statistically significant difference in the effective rate between the two groups (χ2＝6.152,P＜0.05).In the same therapeutic efficacy (51 cases effective treatment of the ICS group ,54 cases effective treatment of the LTRA group),there were 50 cases with compliance in the ICS group and 62 cases in the LTRA group.The difference in the compliance was statistically significant (χ2＝7.012,P＜0.05).Conclusion All of the ICS group and the LTRA group can make effective control for childhood asthma.Through statistic process data of this experiment ,we discover that under the good medication adherence condition ,all of the treatment rates and the control level of the ICS group are better than the LTRA group.In the same therapeutic efficacy ,the medication adherence of the LTRA group is superior to the ICS group.

OBJECTIVE:To provide reference for promoting the rational use of Dexamethasone sodium phosphate injection in the clinic. METHODS:Special comment criteria and evaluation rules was formulated,medical records of 1273 inpatients receiving Dexamethasone sodium phosphate injection were collected from our hospital during Jul. 2014-Jun. 2015. Rationality of drug use was evaluated and analyzed retrospectively. RESULTS:The most use amount and case number of Dexamethasone sodium phosphate injection were in the departments of blood/oncology,obstetrics,emergency minimally invasive surgery,gastrointestinal surgery,emergency trauma of orthopedics and thyroid breast surgery;while much less were in departments of new pediatrics, infection and rehabilitation. There were 138 cases of irrational use of Dexamethasone sodium phosphate injection found in special comment, and the total irrational use rate was 10.84％ . The types of irrational use included inappropriate indication (contraindication,59.42％),inappropriate drug combination(18.84％),inappropriate drug selection (15.94％),inappropriate usage and dosage(3.62％)and inappropriate drug dosage forms or drug delivery methods(2.17％),etc. The irrational use rate of Dexamethasone sodium phosphate injection monthly declined steadily by month from 30.35％ in Jul. 2014 to 7.81％ in Jun. 2015 through the special comment;then a consensus of 5 points for the drug use formed in our hospital. CONCLUSIONS:There are irrational situations in the clinical use of Dexamethasone sodium phosphate injection in our hospital,especially in the cases of inappropriate indications. The rationality of the drug can be improved by the development of the special comment. This work should continue to be carried out in the future and perfected.

Objective:To analyze the risk factors of first endotracheal extubation failure and the related poor outcomes of extubation failure in intubated very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.Methods:The VLBW/ELBW infants intubated in the first 24 hours, and admitted from June 2016 to December 2017 in Neonatal Intensive Care Unit of the Children′s Hospital of Fudan University were recruited in the study, and they were divided into 2 groups of the extubation-failure group and the extubation-success group based on whether being reintubated in 72 hours after the extubation.The clinical data of all children were collected, and risk factors and the short-term outcomes were compared between the 2 groups.Results:One hundred and twenty-six VLBW/ELBW infants including 25 extubation-failure infants and 101 extubation-success infants were recruited, the extubation fai-lure rate was 19.8%.Extubation-failure infants had lower gestational age and lower birth weight compared with those of extubation-success group [gestational age: (27.9±2.1) weeks vs.(28.9±1.6)weeks; birth weight: 990(847-1 200) g vs.1 170(1 060-1 350) g], and the differences were statistically significant (all P<0.05). The multiple Logistic analysis demonstrated that lower gestational age was the independent risk factor of extubation failure( OR=0.92, 95% CI: 0.86-0.99, P<0.05). The outcome analysis showed that the combined outcomes of moderate-to-severe bronchopulmonary dysplasia(BPD) and death in the extubation-failure group were significantly higher than those in the extubation-success group ( OR=3.33, 95% CI: 1.28-8.63, P<0.05)after being adjusted by gestational age.The secondary outcomes of brain magnetic resonance imaging(MRI) abnormality rate in the extubation-failure group was significantly higher compared with the extubation-success group ( OR=3.93, 95% CI: 1.22-12.60, P<0.05), and the mechanical ventilation duration was significantly longer as well in the extubation-failure group compared with that in the extubation-success group[10.1 d (6.9 d, 20.9 d) vs.3.6 d(1.1 d, 8.6 d)], and the difference was statistically significant( P<0.05). The rest secondary outcomes were not significantly different between the 2 groups(all P>0.05). Conclusions:A high rate of extubation failure in VLBW/ELBW infants was a common issue, and the lower gestational age is the independent risk factor for extubation failure.Extubation failure potentially increases the risk of moderate-to-severe BPD or death in VLBW/ELBW infants.