Objective To evaluate the effect of intratumor injection of Pingyangmycin for the treatment of superficial hemangioma and venous malformation.Methods From May 2005 to March 2008,42 patients with superficial hemangioma or venous malformation,including 17 men and 25 women(aged 3 months to 51 years)were treated in our hospital by injecting pingyangmycin intratumorally.Among the patients,18 had hemangioma,20 had venous malformation,and 4 had the both.The injection consisted of a mixture of Pingyangmycin(8 mg),2% lidocaine(2 ml),normal saline(2 ml),and dexamethasone(2.5 mg).The volume of the tumor was evaluated before the injection.And then the mixture was injected intratumorally at a density of 0.5 mg/cm2(0.3 mg/cm2 for the patients with ulcers in the skin or mouth).For the patients who had residual tumor after the first injection,a second treatment was performed in 10 days to 3 weeks or longer.The maximum dosage of Pingyangmycin for a single injection was 8 mg,and the maximum total dosage was 70 mg.Results One year after the treatment,85.5%(47/55)of the patients were cured,and 12.7%(7/55)were improved.The total effective rate was 98.2%(54/55).Conclusions Injection of Pingyangmycin is an effective and safe method for superficial hemangioma and venous malformation with low blood flow.The maximum injection density is 0.5mg/cm2.

Objective To investigate the feasibility of gadopentetate dimeglumine as contrast agent for arteriography and interventional procedures.Methods Nine patients received gadopentetate dimeglumine as contrast agent during interventional procedures. Gadopentetate dimeglumine was used in 2 patients with contraindications to iodinated contrast media. In addition to the standard injection sequences with iodinated contrast media, arteriograms were obtained after administration of gadopentate dimeglumine in seven patients. Diagnostic arteriographies were performed in thoracic aorta, common carotid artery, bronchial artery, intercostal artery, hepatic artery, iliac artery and uterine artery. The doses of gadopentetate dimeglumine used in this series were≤0.3 mmol/kg. Vital signs and arterial oxygen saturation were monitored during the procedures. The blood and urine routine examinations, the hepatic and renal functions tests were done after the procedure. Results There were no significant differences between the gadopentetate dimeglumine and the iodinated contrast media examinations for illustrating the main trunk of these arteries. Angiograms obtained with the iodinated contrast media appeared to be better than that of with gadopentetate dimeglumine for visualizing the distal branches of these arteries and the tumor stain. The interventional procedure was completed successfully in the two patients using gadopentetate dimeglumine alone. No patient suffered from complication related to the use of gadopentetate dimeglumine, and also no worsened renal function was shown after the procedure. Conclusions Diagnostic arteriograms can be achieved safely and successfully by using gadopentetate dimeglumine, especially in patients with allergy to iodinated contrast media and chronic renal insufficiency.

OBJECTIVE:To compare the ultrasound method and continuous reflux extraction process of total flavonoids from Radix Astragali.METHODS:The extraction technology was optimized by orthogonal test with the content of total flavonoids of Radix Astragali as index and with the concentration of ethanol,extraction time,solid-fluid ratio,extraction temperature as factors.RESULTS:Ultrasound extraction process was superior to continuous reflux extraction process.Optimal extraction technology was as follows:the concentration of ethanol of 75%,ultrasonic extraction time of 20 min,solid-liquid ratio of 1:10,ultrasonic extraction temperature of 25 ℃ and extraction rate of 0.325%.CONCLUSION:As compared with continuous reflux extraction process,ultrasonic extraction is fast to operate,solvent saving and high extraction.

Objective:To construct the eukaryotic expression plasmid carrying hTERT-P2A-EGFP, and to explore its expression and transfection efficiency in the HEK293FT cells.Methods:The recombinant plasmid was constructed by using pBABE-puro-hTERT and pRRLSIN-cPPT-MSCV-EGFP plasmids.The hTERT,P2A,and EGFP genes were obtained using pBABE-puro-hTERT as template by PCR.And the correct hTERT was inserted into pRRLSIN-cPPT-MSCV-EGFP vector.Then the recombinant plasmid containing hTERT-P2A-EGFP gene was obtained and identified.The HEK293FT cells were transfected by the recombinant plasmid, and the expression of green fluorescence protein(GFP) was observed by fluorescence microscope.Results:The PCR results showed that the fragments of hTERT, P2A, and EGFP were 3 400, 110 and 720 bp.And the length of gene fragment(hTERT-P2A-EGFP)was 4 300 bp by enzyme digestion.The results of sequencing showed that the 1 547 site of the target gene was mutated.Using site-directed mutagenesis, the 1 547 site was successfully mutated.And the target gene sequence was completely identical with the sequence published in GenBank.The recombinant plasmid was transfected into the HEK293FT cells, and GFP was observed in the cells.The results of flow cytometry showed that the transfection efficiency of recombinant plasmid was 44.8%.Conclusion:The recombinant plasmid carrying hTERT-P2A-EGFP gene is successfully constructed, and it can be used for cell transfection.

Objective To investigate the clinical value of argon plasma coagulation (APC)trans-choledochoscopy in biliary tract complications following liver transplantation. Methods All 27 patients underwent T-tube-choledochoscopy or percutaneous transhepatic cholangioscope (PTCS).APC was used to burn the hyperplasia of bile duct stenosis and then expended the stenosis with bougienage. The bile duct foreign bodies were burnt by APC and then eliminated. The granulation tissues of bile duct were burnt by APC after biopsied. The sutures of anastomoses were burnt by APC and then eliminated. Results In general, the therapeutic achievement ratio of stenosis of bile duct in 25 cases of 28 locations was 78. 6% (22/28). The clearance ratio of bile duct foreign bodies was 85. 7% (6/7). The elimination ratio of granulation tissues was 100% (5/5), the same as the elimination ratio of sutures of anastomoses. There were no treatment-related complications about APC. The recurrence ratio of bile duct stenosis was respectively 4.5% (1/22) and 13. 6% (3/22)after follow-up for 3 and 6 months respectively. All the recurrent stenosis was non-anastomotic. The recurrence ratio of bile duct foreign bodies was respectively 16. 7% (1/6) and 33.3% (2/6) after follow-up for 3 and 6 months respectively. Conclusion APC trans-choledochoscopy in treatment of biliary anastomotic stenosis, mural foreign bodies, mural biliary cast, granulation tissues of bile duct and sutures of anastomoses following liver transplantion has a high success ratio and a sure long-term efficacy without treatment-related complications.

Objective To summarize the puncture indications and the pathological type features of renal allografts biopsies in our center for evaluating its safety and diagnostic value .Methods The data of 773 percutaneous renal allograft biopsies in 629 kid‐ney transplants in the Pearl River Hospital of Southern Medical University from January 2005 to June 2014 were retrospectively an‐alyzed .Results The success rate of renal biopsy was 100% ,9 cases(1 .2% ) were complicated postoperative perirenal small hemato‐ma ,33 cases(4 .3% ) with gross hematuria and 1 case(0 .13% )with abdominal pain .Among the indications of 773 biopsies ,protein urine occured 205 cases(26 .5% ) of patient ,blood Cr increased in 187 cases(24 .2% )of patients ,protein urine simultaneously com‐plicating blood Cr increased ,in 313 cases of patients ,53 cases(6 .9% )had postoperative oliguria urinary ,and 15 cases(1 .9% )were get procedural biopsy .In the pathological types ,21 cases(2 .7% ) were normal ,179 cases (23 .2% ) were acute T cell‐mediated rejec‐tion after transplantation ,51 cases (6 .6% )were acute antibody‐mediated rejection ,205 cases (26 .5% ) were chronic T cell‐mediated rejection and 43 cases(5 .6% ) were chronic antibody‐mediated rejection;41 cases(5 .3% ) were drug toxicity ,29 cases(3 .7% ) were acute tubular necrosis(ATN) ,11 cases(1 .4% ) were relapsed or new nephropathy ;9 cases(1 .2% )were HBV related renal disease;39 cases (5 .0% ) were critical lesion and 145 cases(18 .8% )were others .Conclusion Rrenal allograft biopsy is safe ,it is important to the etiological diagnosis of renal disease after renal transplant ,which can guide the clinical treatment and improve the long term survival of renal graft and should be routinely carried out in clinic .

Objective To evaluate the efficacy of healthcare failure mode and effect analysis in enhanced recovery after surgery(ERAS) in thoracic surgery. Methods Establish the healthcare failure mode and effect analysis group and evaluate the possible healthcare failure modes in implementation of ERAS.Calculate the odds ratio and make a decision tree in order to find out the failure modes and make safe schemes for bowel preparation, peri-operative pain monitoring and evaluation, vein thrombosis screening and management, early mobilization and food-taking after surgery and catheter removal for patients with benign prostate hyperplasia. Results Before and after the implementation of ERAS, 237 patients were selected.The risk priority number after the implementation of ERAS had been reduced,all less than 8 points. After the implementation of ERAS, the rate of initial pain score greater than 4 was 53.2%(126/237),the incidence of nausea and vomiting was 13.5%(32/237),and incidences of thrombosis and constipation were all 6.8%(16/237),the urinating patency rate after pulling-out the tube was 100.0%(237/237). Before the implementation of ERAS, the indicators was 96.6%(229/237), 43.0%(102/237), 30.0%(71/237), 36.7%(87/237),79.7%(189/237).There was significant difference before and after the implementation of ERAS (χ2=5.455-15.022, P<0.05). Conclusions The application of healthcare failure mode and effect analysis can reduce the incidence of adverse reaction and complications after thoracic surgery and ensure a secure and high-quality implementation of ERAS,which is worth using widely.

Objective:To carry out nurse-led evidence-based practices to reduce the incidence of pulmonary complications of patients after thoracic surgery.Methods:A multidisciplinary team was set up. The best evidence-based interventions were obtained by adopting evidence-based nursing procedures and were implemented in the clinical practice after localization. Based on the evidence, examination standards were established, and obstacles and promoting factors in the implementation process were evaluated. Then action strategies were formulated to regulate medical staff′s clinical practice. The patients ′ incidence of pulmonary complications, pulmonary function indicators, patient satisfaction and pulmonary rehabilitation knowledge and medical staff′s compliance with examination standards were compared before and after the application of the best evidence. Results:After the application of the best evidence, the incidence of pulmonary complications decreased from 18.2%(6/33) to 0 ( χ2 value was 4.264, P < 0.05). The pulmonary indicators of FEV1/FVC, breath holding test and six minute walking test were (76.1±3.3)%, (27.2±1.5) s and (522.6±13.0) m before the application of best evidence, respectively, and (82.7±2.8)%, (31.0±5.3) s and (561.5±16.4) m after the application of best evidence, respectively. The differences were all statistically significant ( t value was -8.600, -3.007, 10.542, P < 0.01). Meanwhile the medical staff ′s compliance with the 10 examination standards were all increased to over 85% after the implementation of the best evidence ( χ2 value was 16.834-64.000, P<0.01). Patients ′ pulmonary rehabilitation knowledge was 24.2%(8/33) and 83.9% (26/31) respectively before and after the application of the best evidence, the difference was statistically significant ( χ2 value was 22.823, P<0.01). Patients ′ satisfaction improved. Conclusions:By applying the best evidence, nurse-led multidisciplinary team can reduce the incidence of pulmonary complications and improve the care quality for patients after thoracic surgery.

Objective:To evaluate the feasibility of high resolution MRI for the measurement of anterior cartilaginous acetabulum-head-index (A-CAHI) and the value of A-CAHI for predicting hip clinical function after treatment in developmental dysplasia of the hip (DDH).Methods:The imaging data of 92 hips from 61 children with treated DDH were retrospectively reviewed in Shandong Medical Imaging Research Institute from January 2019 to January 2020. All children underwent conservative treatments or surgical interventions 3 years ago. Hip function after treatment was evaluated clinically based on the modified MacKay criteria. The hips were divided into satisfactory clinical function group (McKay rating excellent or good, n=46) and unsatisfactory group (McKay rating fair or poor, n=46). All patients were imaged with conventional MRI, high resolution fat suppressed proton density weighted image (FS-PDWI) of the unilateral hip joint in oblique sagittal view, and anteroposterior hip radiographs. A-CAHI and lateral cartilaginous acetabulum-head-index (L-CAHI) were measured respectively on high-resolution oblique sagittal PDWI and conventional coronal T 1WI. Acetabulum head index (AHI) was also measured on anteroposterior hip radiograph. Mann-Whitney U test or independent-samples t test was used to compare the difference of A-CAHI, L-CAHI and AHI between satisfactory and unsatisfactory clinical function groups. The diagnostic value using A-CAHI, L-CAHI, AHI, or A-CAHI combined with L-CAHI for unsatisfactory clinical function were investigated by the ROC curve. The area under the curve (AUC) and the Z statistic were used to compare diagnostic performance. Results:The values of A-CAHI, L-CAHI and AHI were significantly higher in satisfactory clinical function group compared with the unsatisfactory group ( Z=-7.746, -7.735, t=-7.199, all P<0.001).A-CAHI combined with L-CAHI had the significant highest diagnostic accuracy compared with A-CAHI, L-CAHI and AHI (AUC were 0.994, 0.969, 0.968, 0.861, respectively), with significant differences ( Z=1.975, 2.006, 3.553, P=0.048, 0.051,<0.001). The sensitivity and specificity of A-CAHI combined with L-CAHI for the diagnosis of prognosis were 95.7% and 97.8%, respectively. Conclusions:A-CAHI measured by high resolution MRI was found to have the highest diagnostic accuracy for prediction of hip clinical function in the treated DDH, and combined with L-CAHI can improve the diagnostic accuracy significantly.

OBJECTIVETo analyze a case of cerebrotendinous xanthomatosis (CTX) with mental retardation as the initial neurological symptom.

METHODSMedical imaging, histopathological assay and genetic testing were carried out to analyze the patient.

RESULTSNeurological manifestations of the 27-year-old male patient were initiated by mental retardation and subsequently memory lapses, ataxia, spastic paraplegia and fuzzy language. Other symptoms included cataract, xanthomatosis in Achilles tendon, kidney stones and high arches. The total bile acid in serum has risen to 14.7 umol/L. There were symmetrical abnormal signals in bilateral cerebellar dentate nuclei, hypointensities on T1WI and DWI and mixed signals on T2WI. Cholesterol crystallization and cholesterol granulomatous inflammation were found upon pathological examination of the Achilles tendon. The patient was found to have carried a compound heterozygous mutation of the CTX gene, which consisted of two novel mutations including c.379C>T (p.Arg127Trp) in exon 2 and c.1174G>A (p.Glu392Lys) in exon 6 of the CYP27A1 gene.

CONCLUSIONClinicians should be alert to cerebrotendinous xanthomatosis when the patient has mental retardation caused by genetic and metabolic factors beginning at a young age, particularly accompanied with tendinous xanthomatosis and cataracts. CTX can be readily diagnosed by histopathological assay and sequencing of the CYP27A1 gene.

Adult ; Cholestanetriol 26-Monooxygenase ; genetics ; Humans ; Intellectual Disability ; etiology ; Male ; Xanthomatosis, Cerebrotendinous ; complications ; genetics