OBJECTIVE:To observe the clinical efficacy and safety of Qingkailing injection combined with naloxone in the ad-juvant treatment of chronic obstructive pulmonary disease (COPD) with pulmonary encephalopathy. METHODS:80 COPD pa-tients with pulmonary encephalopathy were randomly divided into control group and observation group. Control group was treated with conventional treatment,including bi-level noninvasive positive pressure ventilation,conventional oxygen inhalation,anti-infec-tion,resolving sputum and relieving asthma,etc;based on the treatment of control group,observation group was additionally treat-ed with Qingkailing injection 40-60 ml by intravenous infusion,30-40 drops/min,qd+Naloxone hydrochloride injection 0.8 mg by intravenous infusion,and then Naloxone hydrochloride injection 2 mg by microinfusion pump for continuous 24 h. After 3 d,the clinic data was observed,including clinical efficacy,and pO2,pCO2,pH,CO,CI,GCS coma score before and after treatment,av-erage hospitalization time,endotracheal intubation rate and incidence of adverse reactions. RESULTS:The total effective rate in ob-servation group was significantly higher than control group,average hospitalization time and incidence of adverse reactions were significantly lower than control group(P<0.05). After treatment,pO2,pH and GCS scores in 2 groups were significantly higher than before,observation group was higher than control group,pCO2 was significantly lower than before,observation group was lower than control group(P<0.05). There were no significant differences in the CO and CI before and after treatment and endotra-cheal intubation rate between 2 groups (P>0.05). CONCLUSIONS:Based on the conventional treatment,Qingkailing injection combined with naloxone has good efficacy and safety in the adjuvant treatment of COPD with pulmonary encephalopathy.

Objective To investigate the value of MRI combined with serum CA125 test in the diagnose of ovarian tumor.Methods To investigate the MRI and serum CA125 level of healthy control group (40 cases),benign tumor group (52 cases),and the malignant tumor group (43 cases).Results Of 95 patients with ovarian masses,CA125 was detected in the malignant patients with the sensitivity of 79.3 ％,specificity of 72.6 ％ and accuracy of 75.1％.MRI was 73.8 ％,81.2 ％,and 82.6 ％ respectively.Combined with CA125 and MRI was 69.4 ％,97.3 ％,and 88.6 ％.Youden' s index of combined detection was significantly higher than single detection (MRI combined with CA125 and single MRI u =1.97,P =0.012 5,and CA125 u =1.96,P =0.012 0).Conclusion MRI combined with CA125 could improve the accuracy of diagnosis ovarian neoplasm in clinic.

Objective The risk for coronary artery bypass surgery is reported to be increased with age and associated with diabetes. We examined the outcomes of coronary artery bypass grafting (CABG) in patients with diabetes who were older than 70 years of age and evaluate the effect of diabetes on CABG in those patients. Methods From March 2000 to March 2008, the data of 649 patients older than 70 years of age were collected retrospectively and divided into diabetic group or non-diabetic group based on pre-operative diagnosis. The blood glucose level of patients was maintained between 7.0 mmol/L ( 126mg/dl) and 10.0 mmoL/L ( 180 mg/dl) porioporatively. Stats 7.0 was used for statistical analysis. The t test and χ~2 test were used to determine the differences in the numerical variables and categorical variables respectively. Results No statistical differences were observed between the two groups in the baseline variables, such as age [ ( 74.78±3.67 ) years for diabetic group vs. ( 75.00±3.65 ) years for non-diabetic group, P = 0. 4877 ], female patients ( 34.76% vs. 29.22%, P =0. 1663 ), ejection fraction [ ( 57.02±10. 10 ) % vs. ( 58.49±10. 39 ) %, P = 0. 1004 ) ], myocardial infarction history (26.20% vs. 28.35%, P =0. 5795), though there were more left main diseases in the diabetic group (52.41% vs.26.41%, diabetic vs. non-diabetic, P = 0. 0000 ). The overall in-hospital mortality was 6.32% (8.02% in the diabetic group vs. 5.63% in the non-diabetic group, P = 0. 2571 ). The main causes of death were sudden respiratory and cardiac arrest,low cardiac output syndrome ( LCOS), malignant arrhythmia, respiratory failure, renal failure, central nervous system compli-cations, and multiple organ failure. Major post-operative complications were bleeding, atrial fibrillation, plural effusion and pulmonary infection. Post-operative variables, such as EF (0.59±0. 13 in the diabetic group vs. 0. 61±0.15 in the non-dia-betie group, P =0. 1807), re-revascularization due to bleeding (2. 14% vs. 4.76%, P = 0. 1232), blood transfusion (89.84% vs. 84.63%, P = 0.0820) and the administration of vasoactive agent (21.93% vs. 27.71%, P= 0. 1286),were found no significant difference between the two groups. Conclusion Conclusions The early outcomes of CABG in aged patients are acceptable. The surgical consequences in diabetic patients may be similar to those in non-diabetic patients.

The objectives of this study are to prepare resveratrol loaded mixed micelles composed of poloxamer 403 and poloxamer 407, and optimize the formulation in order to achieve higher drug solubility and sustained drug release. Firstly, a thin-film hydration method was utilized to prepare the micelles. By using drug-loading, encapsulation yield and particle size of the micelles as criteria, influence of three variables, namely poloxamer 407 mass fraction, amount of water and feeding of resveratrol, on the quality of the micelles was optimized with a central composite design method. Steady fluorescence measurement was carried out to evaluate the critical micelle concentration of the carriers. Micelle stability upon dilution with simulated gastric fluid and simulated intestinal fluid was investigated. The in vitro release of resveratrol from the mixed micelles was monitored by dialysis method. It was observed that the particle size of the optimized micelle formulation was 24 nm, with drug-loading 11.78%, and encapsulation yield 82.51%. The mixed micelles increased the solubility of resveratrol for about 197 times. Moreover, the mixed micelles had a low critical micelle concentration of 0.05 mg · mL(-1) in water and no apparent changes in particle size and drug content were observed upon micelles dilution, indicating improved kinetic stability. Resveratrol was released from the micelles in a controlled manner for over 20 h, and the release process can be well described by Higuchi equation. Therefore, resveratrol-loaded poloxamer 403/407 mixed micelles could improve the solubility of resveratrol significantly and sustained drug release behavior can be achieved.
Drug Carriers ; chemistry ; Fluorescence ; Kinetics ; Micelles ; Particle Size ; Poloxamer ; chemistry ; Solubility ; Stilbenes ; chemistry ; Water

Objective To discuss the value of echocardiography for the assessment of structure and function of right heart in normal Chinese adults Methods The structure and function of right heart was assessed by echocardiography according to 2010 guideline of American Society of Echocardiography (ASE). The echocardiographic data of right heart of 130 normal Chinese adults were analyzed to acquire the normal reference values of echocardiographic parameters and evaluate the differences of these results among different age groups. Results There were significant differences among different age groups for some of the parameters. Right atrium (RA) transverse diameter was greater in the middle-aged group than that in the young-aged group [(36.90±5.10) mm vs (33.90±5.20) mm, t=-2.79, P=0.006]. RA longitudinal diameter (RAL) and RA area (RAA) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(40.10±5.10) mm vs (42.90±5.10) mm, (43.40±5.60) mm, t=-2.51 and-2.91, P=0.013 and 0.004;(11.90±3.20) mm2 vs (13.40±2.90) mm2, (13.90±3.60) mm2, t=-2.24 and-2.90, P=0.027 and 0.004]. Parasternal long-axis right ventricule outflow tract (PLAX RVOT), parasternal short-axis right ventricule outflow tract (PSAX RVOT) and pulmonary artery diameter (PAD) were smaller in the young-aged group than those in the middle-aged and old-aged groups [(24.20±3.00) mm vs (26.20±2.30) mm, (25.90±2.90) mm, t=-2.80 and-2.32, P=0.006 and 0.022;(24.70±3.00) mm vs (27.20±2.50) mm, (26.90±2.60) mm, t=-4.40 and -3.84, P=0.000 and 0.000; (20.60±2.00) mm vs (22.10±2.70) mm, (21.90±2.10) mm, t=-3.12 and-2.67, P=0.002 and 0.008]. RV lateral wall thickness was smaller in the young-aged group than that in the middle-aged and old-aged groups [(5.10±0.60) mm vs (5.60±0.60) mm, (5.40±0.70) mm, t=-3.12 and-2.22, P=0.02 and 0.028];DTI e wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(14.90±3.70) cm/s vs (10.90±3.10) cm/s, (11.10±2.60) cm/s, t=5.82 and 5.49, P=0.000 and 0.000]. DTI a wave was smaller in the young-aged group than that in the middle-aged and old-aged groups [(12.50±3.90) cm/s vs (14.60±3.70) cm/s, (16.60±3.60) cm/s, t=-2.79 and -5.04, P=0.007 and 0.000] and DTI a wave was smaller in the middle-aged group than that in the old-aged group (t=-2.26, P=0.02). Tricuspid E wave was greater in the young-aged group than that in the middle-aged and old-aged groups [(0.61±0.11) m/s vs (0.51±0.11) m/s, (0.48±0.08) m/s, t=4.58 and 5.44, P=0.000 and 0.000]. E/A was greater in the young-aged group than that in the middle-aged and old-aged groups (1.45±0.30 vs 1.12±0.33, 1.10±0.27, t=4.58 and 5.44, P=0.000 and 0.000). No significant differences were found among different age groups in RV systolic function parameters, whereas a trend of decrease in RV diastolic function was detected. Conclusion Echocardiography can be useful in assessing the structure and function of right heart quantitatively.

Objective To analyze our clinical results of head and neck reconstruction using microsur- gical free flap transfer techniques.Methods The free flap donor sites with long vascular pedicle and large diameter of vessel were routinely chosed,and chose receipt vessels with large diameter and proper position, and perform vessel ananstomosis under surgical loups instead of microscope.The un-buried free flap with a mo- nitoring window were harvest,and do double venous anastomoses in some flaps to ensure adequate venous out- flow.Results From May 1999 to March 2005,1066 consecutive free flap transfers were used to reconstruct head and neck defects.The overall success rate of free flap was 98.3%.The vessel thrombosis rate was 3.1%,and the flap salvage rate was 45.5%.Conclusion Head and neck reconstruetion using microsurgi- cal free flap transfer technique is safe and reliable,and good clinical results can be obtained.

Objective To explore the effect of general intervention in improving the psychological condition of healthy pregnant women. Methods Totally 96 pregnant women who made prenatal visits in our obstetrics and outpatient department were divided into the control and the intervention group stochasti-cally. The intervention group started from first prenatal visit. The general intervention measures included cognitive intervention, the behavioral intervention, family coping intervention and psychological intervention with self-designed relaxation exercises. While conventional prenatal visit, propaganda and nursing were im-plemented to the control group.Self-made general questionnaire and symptom checklist 90 (SCL-90)were used to survey and analyze the results. Results Post-natal depression and anxiety of the control group was obviously higher than that of the prenatal. The Post-natal obsessive-compulsive symptom, interpersonal sensitivity, depression, hostility, terror and bigotry in the intervention group were greatly alleviated. Com-pared with the control group, obsessive-compulsive symptom, interpersonal sensitivity, depression, hostility and terror of the intervention group were significantly different (P<0.05). The depression improved while the difference was not evidently differenL Conclusions Delivery had great influence on the psychological status of women,especially anxiety and depression. General intervention measures like psychological relax-ation exercises can improve the psychological condition of healthy pregnant women obviously,especially de-pression.

Objective To investigate the clinical value of bile reinfusion combined with enteral nutrition before R0 resection of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma who underwent R0 resection at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2010 to January 2014 were analyzed retrospectively.The clinical data of 21 patients (the experimental group) who received bile reinfusion by preoperative percutaneous transhepatic cholangiography and drainage (PTCD) combined with enteral nutrition with nasojejunal tube were compared with 25 patients (the control group) who received neither PTCD nor enteral nutrition.The differences in the clinical indicators between the 2 groups were analyzed.Results In the experimental group,the levels of ALT,AKP,TBil and DBil decreased significantly after PTCD as compared with the original levels (t =4.433,4.547,5.648,4.681,P ＜ 0.05).The operation time and blood loss in the experimental group was reduced significantly when compared with the control group (t =-2.810,-2.047,P ＜ 0.05).The volume of postoperative albumin transfusion and the postoperative hospitalization in the experimental group was significantly reduced when compared with the control group (t =-3.083,t =-3.083,P ＜ 0.05).Conclusion Bile reinfusion combined with enteral nutrition facilitated the recovery of preoperative hepatic function in patients who underwent R0 resection of hilar cholangiocarcinoma,thus improving the safety of surgery and facilitated postoperative rehabilitation.

Objective To investigate the clinical value of enhanced recovery after surgery (ERAS) in patients undergoing postoperative early enteral nutrition (EEN) with radical resection for hilar cholangiocarcinoma.Methods The clinical data of 48 patients with hilar cholangiocarcinoma who were admitted to the Drum Tower Clinical Medical College of Nanjing Medical University from July 2006 to September 2014 were retrospectively analyzed.All the 48 patients underwent radical resection for hilar cholangiocarcinoma,including 24 patients receiving postoperative EEN (EEN group) and 24 patients receiving total parenteral nutrition (TPN group).The serologic indices and liver function were detected regularly after operation.Ten percent of albumin (Alb) 10 g was administered by intravenous infusion when Alb ＜ 30 g/L.The indexes of all the 48 patients were compared in the 2 groups at postoperative day 3 and 7,including the serologic indices and liver function,the exhaust time,the volume of Alb infusion,the complications (incisional infection,abdominal infection,pleural effusion,peritoneal effusion and bile leakage) and the duration of hospital stay.The patients were followed up by outpatient examination and telephone interview till September 2014.The measurement data with normal distribution were presented as x ± s,comparison between groups and count data were analyzed using the t test and chi-squared test,respectively.Results Patients in the 2 groups were cured successfully and discharged,and no patient died perioperatively.Patients in the EEN group had a good tolerance for EEN and no occurrence of EEN-related complications was detected.The level of the GGT was (108 ± 73) U/L in the EEN group,which was significantly lower than (225 ± 121) U/L in the TPN group at postoperative day 3 (t =4.041,P ＜ 0.05).The level of the GGT was (142 ± 86) U/L in the EEN group,which was no significantly different from (183 ± 107)U/L in the TPN group at postoperative day 7 (t =1.477,P ＞ 0.05).The postoperative time to anal exsufflation and the duration of hospital stay were (73 ± 18) hours and (15 ± 4) days in the EEN group,which were significantly different from (97 ± 21) hours and (18 ± 4) days in the TPN group,and the volume of Alb infusion was (44 ± 29)g in the EEN group,which was significantly lower than (101 ± 92) g in the TPN group (t =4.295,2.615,2.916,P ＜ 0.05).All the 48 patients were followed up for 1 to 71 months (mediantime,10 months),no patients received reoperation or re-admitted to the hospital due to complications.Conclusion The application of postoperative EEN in enhanced recovery of patients undergoing radical resection for hilar cholangiocarcinoma is safe and effective,it could accelerate the recovery of enteral function,shorten the postoperative duration of hospital stay and reduce the supplement of extrinsic Alb,which is helpful for the fast recovery of patients.

BACKGROUND:Prefabricated customized bone flaps have the advantages of few trauma, good vascularization, ossification with predetermined shape, and can be used to restore bone defects with compromised blood bed.
OBJECTIVE:To establish animal models of mandibular reconstruction with prefabricated, customized bone flaps.
METHODS:After computed tomography scanning of nine rhesus’ head, customized meshes were made. After loading with recombinant human bone morphogenetic protein-2-incorporated demineralized freeze-dried bone al ograft (DFDBA) or coral ine hydroxyapatite (CHA), the constructs were implanted in latissimus dorsi muscle. Meanwhile, segmental mandibular defects were created, and the customized meshes loaded with DFDBA, CHA, or recombinant human bone morphogenetic protein-2-incooperated DFDBA and CHA were implanted in situ. At 13 weeks, prefabricated bone flaps with recombinant human bone morphogenetic protein-2-incorporated DFDBA or CHA were transferred to repair segmental mandibular defects. Clinical and histological analyses were used to evaluate the ossification and vascularization of the prefabricated implants in ectopic and orthotopic sites.
RESULTS AND CONCLUSION:Segmental mandibular defects were successful y restored with prefabricated bone flaps and recombinant human bone morphogenetic protein-2-incorporated CHA in situ, but other segmental mandibular defects remained with recombinant human bone morphogenetic protein-2-incorporated DFDBA, DFDBA and CHA in situ. Moreover, mandibles reconstructed with prefabricated bone flaps revealed more regenerated and homogeneous bone formation than other reconstructions. These findings suggest that the animal model of mandibular reconstruction with prefabricated, customized bone in rhesus monkey is applicable.