Objective To evaluate the clinical efficacy and safety of endoscopic metal stenting in lef t colon malignant obstruction as decompression bridging therapy and palliative t herapy. Methods Twelve pathologically confirmed and surgically indicated patients with left colo n malignant obstruction underwent metal stent placement as decompression treatme nt. Permanent metal stent placement was performed in 5 left colon cancer obstru ction patients without surgical indication. The successful rate of stent deploym ent, procedure-related complication, stent patency and long-term complication were observed in treated patients. Results ①Stent placement was successful on the first occasion in 15 of 17 (88%) cases, and total successful rate was 100%. No severe procedure-related complication wa s found. ②The mean duration of placed stent in bridging cases was 6.1 days(4-9 days), and all patients were transferred to one-stage tumor resection after d ecompression by bridging stent and bowel preparation without complications of fi stula development and intraperitoneal infection. One case developed colon perfor ation 4 days after stent insertion and received immediate operation. ③ The mean effective patency duration of placed stent in palliative cases was 81.7 days(61 -119 days). Tumor ingrowth and reobstruction were noticed in 2 cases, within 62 and 119 days respectively. Stent migration within 61 days in 1 patient was deve loped. Conclusions As an effective and safe bridging palliative therapy, decompression metal stent p lacement may be applied to unresectable and metastatic left colon malignant canc er patients without surgical indication.

Anthropometry ; methods ; Humans ; Sleep Apnea, Obstructive ; diagnosis

Objective To observe the short term therapeutic effects of continuous subcutaneous insulin infusion (CSII) in treatment of type 1 diabetic and type 2 diabetic patients,and compared with intensive therapy of insulin multiple subcutaneous injection by conventional scheme.Methods 48 diabetic patients including 14 cases of type 1 and 34 cases of type 2,were randomly divided into CSII group and control group. In CSII group,the short acting Novolin was subcutaneously infused using insulin pump continuously. In control group,the short acting Novolin was subcutaneously injected before three meals a day and medium acting Novolin was subcutaneously injected before sleep at night.Results Hyperglycemia of the CSII group was depressed,and decreasing degree was similar to that of the control group.However,therapeutic time,insulin dosage and insulin induced hypoglycemia reaction incidence in the CSII group were obviously lower than thoses in control group(P

Objective The prosthesis used for aortic valve replacement (AVR) may be too small in relation to the body size, thus causing valve prosthesis-patient mismatch (PPM) and abnormally high transvalvular pressure gradients. The aim of this study was to evaluate the prevalence of PPM and the impact of PPM on hemodynamic and early mortality after AVR. Methods A total of 292 patients ( 167 males, 125 females; mean age of ( 52.8 ± 14.6 ) years, with ranging 22 - 82 years) who underwent AVR between January 2007 and December 2009 were retrospectively evaluated. Etiologies were: rheumatic in 243 cases, degenerative in 36, congenitally bicuspid aortic valve in 8, and infective endocarditis in 5. Combined operations with AVR including mitral valve replacement ( 172 cases), mitral valve repair (56 cases), tricuspid valve repair (238 cases), and coronary artery bypass grafting (32 cases). The aortic valve prosthesis effective valve orifice area (EOA) was divided by the body surface area (BSA) to obtain the EOA index (EOAI). PPM was then defined as none or mild if EOAI was ＞0.85 cm2/m2, as moderate for 0.65 -0.85 cm2/m2 and as severe for ＜0.65 cm2/m2. The mean flow rate through aortic prostheses and mean transvalvular pressure gradients were measured by color Doppler after AVR. The prevalence of PPM was compared between the different type ( mechanical or bioprosthetic valve) and the different size ( ＞21 mm or ≤21 mm) of aortic valve prostheses. The effect of PPM on hemodynamic and early mortality after AVR was also studied. Results 219 patients received mechanical AVR and 73 bioprosthetic AVR. Moderate PPM occurs more frequently with bioprosthetic AVR (6.25% versus 48.22%, P ＜0. 01 ). Bigger than 21mm prostheses were used in 191 patients and ≤21 mm prostheses in 101 patients. The prevalence of PPM was 13.61% and 33.66% respectively ( P ＜ 0. 05 ). According to the EOAI of the aortic valve prostheses,all the 219 patients were divided into two group, PPM group and non-PPM group. The mean flow rate of aortic prostheses and mean transvalvular pressure gradients in PPM group was significantly higher than those in non-PPM group [(2.66 ± 0.87 ) m/s versus ( 1. 58 ± 0.47 ) m/s, ( 26.50 ± 6.25 ) mm Hg versus ( 16.75 ± 3.46 ) mm Hg, P ＜ 0. 01]. There were 9 deaths during early period of operation, and the total 30-day operative mortality was 3.08%. The postoperative early mortality of PPM group and non-PPM group was 6.67% and 2.16% respectively, and there were significantly difference between the two group ( P ＜ 0. 05 ). Conclusion Prosthesis-patient mismatch is common present after AVR, especially in patients with bioprostheses and small size valve prostheses. PPM has a negative impact on postoperative hemodynamic and early mortality. PPM results in higher transvalvular pressure gradients and higher early mortality.

Pediatric drug accessibility has become a global problem,pediatric drug shortages and off-label uses are very seri?ous. In China,lack of suitable varieties,appropriate dosage forms and specifications,weak foundations on clinical trials,irregular prescribing behavior and irrational drug use and other issues on pediatric drugs are still outstanding. To improve pediatric drug accessi?bility,it may need all aspects work together,that is,cooperation of the national macro-policy support,participation of enterprises and medical institutions,to establish realistic goals and programs to address pediatric drug problem. This paper studies the foreign pediat?ric regulation measures and policies and by comparing foreign policies to China′s current situation,we can find out the problems and defects,give appropriate advice,in order to provide advice and reference to promote the development of pediatric drug.

Objective To investigate the role of glucose-regulated protein 78 (GRP78) in sevoflurane preconditioning-induced inhibition of apoptosis in cardiomyocytes of rats.Methods The cultured cardiomyocytes of Sprague-Dawley rats were randomly divided into 5 groups (n =30 each) using a random number table:control group (group C),hypoxia-reoxgenation (H/R) group,sevoflurane preconditioning group (group S),siRNA-GRP78 group and siRNA control group.H/R was produced by 2 h exposure of cells to 95％ N2-5％ CO2 in an air-tight chamber at 37 ℃,followed by reoxygenation with 95％ O2-5％ CO2 in an air-tight chamber at 37 ℃ for 1 h.In group S,the cells were incubated with 2.5％ sevoflurane for 20 min,followed by 10-min washout before H/R.In siRNA-GRP78 group,the cells were transfected with siRNA-GRP78 100 nmol/L,and 24 h later preconditioning with sevoflurane was performed and H/R was produced.In siRNA group,cells were transfected with siRNA,and the other treatments were similar to those previously described in siRNA-GRP78 group.After treatment in each group,the expression of GRP78 in myocardial cells and cytochrome c in cytoplasm and mitochondria was detected by Western blot.Lactic dehydrogenase (LDH) and creatine kinase (CK) activities in the culture medium of each group were determined by ELISA.The apoptosis in myocardial cells was assessed by flow cytometry.Apoptotic rate was calculated.Intracellular free Ca2+ concentration ([Ca2+]i) was measured with the fluorescent probe Fura-2/ AM.The opening of mPTP was measured by fluorescence spectrophotometry.Results Compared to group C,the expression of GRP78 in myocardial cells and cytochrome c in cytoplasm was significantly up-regulated,LDH and CK activities in the culture medium,apoptotic rate and [Ca2+]i were increased,and the expression of cytochrome c in mitochondria was down-regulated in H/R group.Compared to group H/R,the expression of GRP78 in myocardial cells and cytochrome c in mitochondria was significantly up-regulated,LDH and CK activities in the culture medium,apoptotic rate,[Ca2+] i and opening of mPTP were decreased,and the expression of cytochrome c in cytoplasm was down-regulated in group S,and no significant change was found in the parameters mentioned above in siRNA group.Compared to group S,the expression of GRP78 in myocardial cells and cytochrome c in mitochondria was significantly down-regulated,LDH and CK activities in the culture medium,apoptotic rate,[Ca2+] i and opening of mPTP were increased,and the expression of cytochrome c in cytoplasm was up-regulated in group siRNA-GRP78.Conclusion GRP78 is involved in sevoflurane preconditioning-induced inhibition of apoptosis in cardiomyocytes of rats,and the mechanism is related to maintenance of intracellular Ca2+ stability and inhibition of opening of mPTP.

Objective To investigate the effect of fusidic acid cream on inflammatory reaction caused by skin barrier damage.Methods Eight male SKH-1 hairless mice were included in this study.The back of each of these mice were equally divided into six regions measuring 1 cm × 2 cm in size,which were then assigned into six groups:blank control group remaining untreated,barrier-impaired group,barrier-impaired and fusidic acid-treated group,barrier-impaired and vehicle-treated group,barrier-unimpaired and fusidic acid-treated group,barrierunimpaired and vehicle-treated group.Stratum corneum was removed by adhesive tape stripping to establish an animal model of acute skin barrier damage in the corresponding skin regions of these mice,and fusidic acid cream or vehicle was topically applied to the corresponding regions once.Twelve hours later,skin surface swab samples were collected from the back of these mice followed by bacterial culture and colony counting.Mice were then sacrificed,and skin tissue specimens were resected from these mice,and subjected to real-time fluorescence-based quantitative PCR for the measurement of the mRNA expressions of myeloid differentiation factor 88 (MyD88),interleukin-1α (IL-1α),IL-6,epidermal antibacterial peptides S100a8 and S100a9.Statistical analysis was carried out by repeated-measures analysis of variance (ANOVA) and least significant difference (LSD) test.Results The mRNA expressions of MyD88,IL-1α,IL-6,S100a8 and S100a9 were all significantly higher in the barrier-impaired group than in the blank control group (all P ＜ 0.05).Specifically,the mRNA expression level of MyD88 in the barrier-impaired group was 8 times that in the blank control group (8.3 ± 3.0 vs.0.8 ± 0.4).Compared with the barrier-impaired group,the barrier-impaired and fusidic acid-treated group showed a significant decrease in the mRNA expressions of IL-1α (2.8 ± 0.3 vs.20.1 ± 10.0,F =47.11,P ＜ 0.01),IL-6 (1.6 ± 2.3 vs.9.4 ± 4.0,F =16.18,P＜ 0.01),S100a8 (1.5 ± 1.4 vs.5.0 ± 1.6,F=59.71,P＜ 0.05) and S100a9 (1.2 ± 0.7 vs.3.4 ± 1.6,F=21.94,P ＜ 0.05).Conlusions Fusidic acid cream could attenuate the inflammatory reaction caused by acute skin barrier damage,which might partly explain its action mechanism in the treatment of inflammatory skin diseases.

Objective To evaluate the clinical safety and efficacy of HIFU treatment of hepatic metastases from colorectal cancer.Methods 20 tumor lesions in 14 patients with hepatic metastases from colonectal cancer were treated with HIFU therapy.The vital signs,main organs'functions,examination of MRI and complications were observed.Results Vital signs of all the 14 patients were stable.The function of liver and kidney were normal and life quality were improved with elevation of Karnofsky in 5 patients.On MRI examination,the MRI signals of treating area of 20 tumor lesion in 14 patients decreased remarkably with disappearance of blood supply and a thin layer of edematous intensified zone was detected on the margin of lesion.6 patients were found to have cord-like burning scar on skin.Conclusion HIFU treatment is safe and effective in treatment of hepatic metastases from colorectal cancer.

Objective: To explore the emergency treatment of acute respiratory tract injury caused by inhalation of phosphorus trichloride.Methods: The clinical data of 16 patients with acute respiratory tract injury caused by inhalation of phosphorus trichloride were analyzed.Intratracheal inhalation of salbutamol sulfate solution and pulmicort repules atomized liquid by aerosol rebreathing method was performed immediately after the diagnosis was made.Anti-inflammatory,fluid replacement,and other symptomatic treatment were given at the same time.Treatment lasted for 3-5 days.Results: The symptoms and signs improved significantly after 3-5 times of inhalation.Among the 16 patients,15 were cured and one improved;the cure rate was 93.75%.The shortest observation period was 2 days and the longest 7 days with an average period of 2.38 days.All cases were followed up for 3 months.No complications were found except one with pleural thickening.Conclusion: Early treatment of acute respiratory tract injury with intratracheal corticosteroid and?2 receptor activator is satisfactory for patients with inhalation of phosphorus trichloride.The method is fast-acting,efficient,with less side-effects,convenient,and easily accepted by patients.

Objective: To study the effects of chromium on glucose and lipid metabolism and gene expression in diabetic rats.Methods: Male Wistar rats were assigned to three groups:normal control(NC), alloxan-induced diabetic control group(DM), and DM with chromium supplementation group(DM+Cr). Cr 200 ?g/(kg bw?d) was supplemented orally for 60 days. At the end of the treatment, the blood glucose, lipid and serum insulin were measured, and the changes in gene expression among three groups were studied by mRNA differential display technique.Results: Blood glucose in DM+Cr group decreased significantly than that before experiment. The levels of serum TG, TC, LDL-C and AI in DM+Cr group were lower than those of DM group, while the serum HDL-C levels were higher. Serum insulin was not improved obviously in DM+Cr group. 11 cDNA fragments larger than 400 bp expressed differences in skeletal muscles between DM+Cr group and DM group and were isolated, 4 of which expressed higher in DM+Cr group, while the rest expressed higher in DM group.Conclusion: Chromium supplementation could partially improve the disorders of glucose and lipid metabolism, and have an impact on some gene expression in diabetic rats, which may contribute to the regulating effects on its disorders of metabolism.