OBJECTIVE: To compare the efficacy and safety of intravenous colistin sulfate combined with nebulized inhalation versus intravenous monotherapy for pulmonary infections caused by carbapenem-resistant organism (CRO). METHODS: A multicenter retrospective cohort study was conducted. Clinical data were collected from patients admitted to the intensive care unit (ICU) of 10 tertiary class-A hospitals in Henan Province between July 2021 and May 2023, who received colistin sulfate for CRO pulmonary infections. Data included baseline characteristics, inflammatory markers [white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), C-reactive protein (CRP)], renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN)], life support measures, anti-infection regimens, clinical efficacy, microbiological clearance rate, and prognostic outcomes. Patients were divided into two groups: intravenous group (colistin sulfate monotherapy via intravenous infusion) and combination group ((intravenous infusion combined with nebulized inhalation of colistin sulfate). Changes in parameters before and after treatment were analyzed. RESULTS: A total of 137 patients with CRO pulmonary infections were enrolled, including 89 in the intravenous group and 48 in the combination group. Baseline characteristics, life support measures, daily colistin dose, and combination regimens (most commonly colistin sulfate plus carbapenems in both groups) showed no significant differences between two groups. The combination group exhibited higher clinical efficacy [77.1% (37/48) vs. 59.6% (52/89)] and microbiological clearance rate [60.4% (29/48) vs. 39.3% (35/89)], both P < 0.05. Pre-treatment inflammatory and renal parameters showed no significant differences between two groups. Post-treatment, the combination group showed significantly lower WBC and CRP [WBC (×10⁹/L): 8.2±0.5 vs. 10.9±0.6, CRP (mg/L): 14.0 (5.7, 26.6) vs. 52.1 (24.4, 109.6), both P < 0.05], whereas NEU, PCT, SCr, and BUN levels showed no significant between two groups. ICU length of stay was shorter in the combination group [days: 16 (10, 25) vs. 21 (14, 29), P < 0.05], although mechanical ventilation duration and total hospitalization showed no significant differences between two groups. CONCLUSIONS Intravenous colistin sulfate combined with nebulized inhalation improved clinical efficacy and microbiological clearance in CRO pulmonary infections with an acceptable safety profile.
Humans ; Colistin/therapeutic use* ; Retrospective Studies ; Administration, Inhalation ; Anti-Bacterial Agents/therapeutic use* ; Carbapenems/pharmacology* ; Male ; Female ; Middle Aged ; Gram-Negative Bacteria/drug effects* ; Aged ; Treatment Outcome ; Respiratory Tract Infections/drug therapy*

Objective To evaluate the feasibility,safety and effectiveness of integrated treatmentwith comprehensively interventional techniques for acute deep venous thrombosis(DVT)of lower extremity. Methods During the period from June 2016 to June 2017,a total of 23 patients with acute DVT ofunilateral lower extremity were admitted to authors' hospital to receive integrated treatment. AngioJetthrombectomy,balloon angioplasty and iliac vein stent implantation were performed in the same setting.Angiography was performed immediately after the procedure. If the thrombus clearance rate was grade Ⅲand there were no large free clots(>5mm)in the lower extremity vein and inferior vena cava,the inferiorvena cava filters would be retrieved through their sheath,otherwise,the inferior vena cava filters would bereleased. All patients received continuous transcatheter infusion of urokinase until the thrombosis wasconfirmed to be completely dissolved. The patients were followed up at outpatient clinic at 1,3,6 and 12months after the treatment,and reexamination of color ultrasound and/or lower limb venography was used toassess the blood flow in the deep veins and in the stents. Results Angiography postoperatively showedthrombus clearance rate of grade Ⅲ was obtained in 20 patients(87%)who were successfully accomplishedintegrated treatment. The inferior vena cava filters had been retrieved after thrombolysis in 3 patients(13%)with thrombus clearance rate of grade Ⅱ. Twenty-one stents were implanted directly after thrombectomy in21 patients with iliac vein stenosis. There were no serious complications such as pulmonary embolism,severe hemorrhage,etc. Venous patency was confirmed by color ultrasound or lower limb venography. Conclusion Integrated treatment with comprehensively interventional techniques is feasible,safe,andeffective for acute DVT of lower extremity

Objective To explore the application value of the liver stiffness measurement (LSM) on complications after hepatectomy.Methods The retrospective case-control study was conducted.The clinical data of 121 hepatocellular carcinoma (HCC) patients who underwent hepatectomy in the Mianyang Central Hospital from January 2011 to April 2017 were collected.All 121 patients received LSM using Fibro Scan,and 81 undergoing laparoscopic liver resection (LR) and 40 undergoing open liver resection (OR) were respectively allocated into the LR and OR groups.Observation indicators:(1) comparisons of intra-and post-operative situations;(2) risk factors analysis affecting postoperative complication of HCC patients;(3) area under the curve (AUC) of LSM and postoperative complications;(4) comparisons of intra-and post-operative situations,when LSM ≤17.5 kPa;(5) comparisons of intra-and post-operative situations,when LSM ＞ 17.5 kPa;(6)comparisons of intra-and post-operative situations between patients with LSM ≤ 17.5 kPa and LSM ＞ 17.5 kPa in the LR group.Measurement data were represented as x±s,and mean comparisons between groups were done using the t test.Comparisons of count data and univariate analysis were analyzed using the chi-square test and Fisher exact probability.The multivariate analysis was done using the logistic regression model,using P＜0.01 as a inclusion criteria in the univariate analysis.The critical value of postoperative complication was calculated using the receiver operating characteristic curve (ROC).Results (1) Comparisons of intra-and post-operative situations:all the 121 patients underwent successful surgery,including 4 with conversion to open surgery in the LR group.Cases with Pringle manner were 51 in the LR group and 17 in the OR group,with a statistically significant difference (x2 =4.555,P＜0.05).Operation time,volume of intraoperative blood loss,case with intraoperative blood transfusion,Ishak score of 1-3 and 4-6 scores,postoperative complications and duration of hospital stay were respectively (248±78)minutes,(292±229)mL,14,14,67,29,(12±7)days in the LR group and (221±78)minutes,(281± 194)mL,9,9,31,10,(13±6)days in the OR group,with no statistically significant difference between groups (t =1.843,0.282,x2 =0.473,0.473,1.431,t =0.075,P＞0.05).(2) Risk factors analysis affecting postoperative complication of HCC patients:39 of 121 patients had postoperative complications.Results of univariate analysis showed that retention 15-minute rate of indocyanine green (ICG R15),LSM,volume of intraoperative blood loss and Ishak score were risk factors affecting postoperative complication of HCC patients (x2 =7.161,32.490,7.725,2.863,P＜0.l).Results of multivariate analysis showed that LSM ＞ 15.0 kPa was an independent risk factor affecting postoperative complication of HCC patients [odds ratio (OR) =6.906,95％ confidence interval (CI):2.307-20.672,P＜0.05].(3) AUC of LSM and postoperative complication:when LSM of postoperative complication ＞ 17.5 kPa,sensitivity,specificity and AUC were respectively 64.1％,85.4％ and 0.749 (95％CI:0.662-0.824,P＜0.05).(4) Comparisons of intra-and post-operative situations,when LSM ≤ 17.5 kPa:duration of hospital stay was respectively (10±5) days in the LR group and (13±7) days in the OR group,with a statistically significant difference between groups (t--2.389,P＜0.05).(5) Comparisons of intra-and post-operative situations,when LSM ＞ 17.5 kPa:operation time,volume of intraoperative blood loss,cases with postoperative complications and hepatic dysfunction were respectively (277±76)minutes,(505±232)mL,21,17 in the LR group and (212-± 109) minutes,(328±250) mL,4,2 in the OR group,with statistically significant differences between groups (t=2.060,2.057,P＜0.05).(6) Comparisons of intra-and post-operative situations between patients with LSM ≤ 17.5 kPa and LSM ＞ 17.5 kPa in the LR group:operation time,volume of intraoperative blood loss,cases with postoperative complications and hepatic dysfunction and duration of hospital stay were respectively (236±76)minutes,(197± 153)mL,8,3,(10±5)days in the LR group and (277± 76)minutes,(505±232) mL,21,17,(16±9)days in the OR group,with statistically significant differences between groups (t=0.657,3.398,x2 =36.547,36.475,t=17.414,P＜0.05).Conclusion LSM is an independent risk factor affecting postoperative compfications after hepatectomy,when LSM ＞ 17.5 kPa,LR is associated with higher incidence of postoperative complications compared with OR.

Objective To explore the application value of 256 slice helical multi phase CT scan-ning and three-dimensional reconstruction in the diagnosis of malignant tumor of colorectal obstruction. Methods Using 256 slice spiral CT scanning and three-dimensional reconstruction of multi period in 42 ca-ses of malignant tumor patients with colorectal obstruction, the results and pathological results were analyzed and the postoperative stage.Results Forty-two cases of malignant tumors of colorectal obstruction, 256 slice spiral CT could well reflect the situation of location, range, degree, peripheral intestinal lymph node and distant metastasis, CTA could show the tumor supplying artery and branch sources, on the tumor loca-tion and overall accuracy.Conclusions 256 layer spiral CT scan and three dimensional reconstruction technology is accuracy for clinical diagnosis on malignant tumor of colorectal obstruction.

Objective To explore the effect of big strain rhodiola injection on levels of leptin and leptin receptor mRNA in serum and liver of rabbit with fatty liver.Methods 120 healthy adult male New Zealand white rabbits were grouped with a random number table method.30 rabbits with normal diet for eight weeks in normal group;90 rabbits in fat group were fed with high fat diet for four weeks to prepare fatty liver model in which 30 rabbits were fed with high-fat diet for four weeks as model group,30 rabbits with high-fat diet and glyburide metformin tablets [150 mg/(kg·d)]for 4 weeks as control group,30 rabbits with high-fat diet and big strain rhodiola injection [40 mg/(kg·d)]for four weeks as experimental group.After the test, levels of serum leptin,hepatic leptin,expression levels of leptin receptor mRNA and levels of liver index were compared among groups.Results Serum leptin and liver leptin in experimental group and control group were all increased to varying degrees,and the serum leptin level [(4.51 ±1.17)ng/mL],liver leptin level [(6.43 ±1.93)ng/mL]of experimental group was lower than that of control group respectively,in which the serum leptin was (7.36 ±1.26)ng/mL and liver leptin was (12.33 ±3.27)ng/mL (P<0.05).Serum leptin and leptin liver receptor mRNA in experimental group and control group were all increased to varying degrees,and the serum leptin mRNA level (0.98 ±0.15),liver mRNA level (1.78 ±0.33)of experimental group was lower than that of control group,in which the mRNA level of serum leptin was (2.57 ±0.29)and liver leptin mRNA levels was (3.31 ±0. 26)(P<0.05).Levels of liver index in experimental group and control group were increased,and liver index of experimental group [(3.98 ±0. 13)%]was lower than that in control group [(4.77 ±0.20)%],and the difference was statistically significant (P<0.05).Conclusion Big strain rhodiola injection could significantly reduce leptin levels in serum and liver of rabbits,reduce expression the leptin receptor mRNA levels and improve liver index,which has guiding significance for the treatment of fatty liver.

Humans ; Neoplastic Stem Cells ; Stem Cell Research ; Stomach ; Stomach Neoplasms

Ferulic acid, an useful compound of Chinese traditional medicine, was used as leading compound. Six ferulic acid derivatives were designed and synthesized based on bioisosterism. Their structures were characterized by IR, 1H NMR, 13C NMR and mass spectra. In vivo experiment showed that ferulic acid derivatives had good inhibitory effects on adenosine diphosphate (ADP) induced platelet aggregation, which were significantly higher than that of Ozagrel.

BACKGROUNDThe main treatment strategy of cancer patients with brain meta- stasis is irradiation, while so far there is few research concerning chemotherapy combined with radiotherapy for these patients. The aim of this study is to evaluate the therapeutic effect and toxicity of chemotherapy with VPC regimen combined with whole-brain radiotherapy (WBRT) in small cell lung cancer (SCLC) with brain metastasis.

METHODSA total of 60 SCLC patients with brain metastasis received a cycle of VPC regimen (teniposide 60mg/m² iv on days 1-5, cisplatin 35mg/m² iv on days 1-3, semustine 80mg/m² PO on day 1) every 3-4 weeks. WBRT was administered on day 6 of the first cycle of chemotherapy at a dose of 2Gy given in 5 fractions per week. Patients with less than 3 brain lesions received WBRT at a dose of 30Gy and then small field radiotherapy up to total dose of 50Gy, otherwise they received WBRT at a total dose of 40Gy. Response was evaluated by brain and chest CT or MRI after WBRT and at least 2 cycles of chemotherapy were completed.

RESULTSAll the patients completed WBRT combined with chemotherapy. Total response rate of primary pulmonary tumor was 46.7%, with 4 cases of CR. The objective brain response rate was 60.0%, with 11 cases of CR and 25 cases of PR. Symptom relief was observed in all 48 patients with neurological symptoms. Main adverse effects were myelotoxicity, nausea/vomiting, constipation and alopecia. The follow-up rate was 93.3% with a median survival duration of 11.3 months. The 1-, 2- and 5-year survival rate was 43.3%, 35.0% and 6.7%, respectively.

CONCLUSIONSChemotherapy combined with WBRT can be safely performed for SCLC with brain metastasis and its short-term response is quite satisfactory. It may be worthy of further clinical investigation.

OBJECTIVETo investigate the factors related to sexual dysfunction among breast cancer patients so as to improve the prevention and treatment of the disorder as well as the life quality of the patients.

METHODSSixty-five breast cancer patients during the rehabilitation period were interviewed by questionnaire on the sexual function before and after treatment.

RESULTSAge and perception of sex were two important factors for the significant difference in the rate of sexual dysfunction among the patients. In the groups of 45-55 and 56-65 years, the rates of sexual dysfunction were 66.7% and 73.9%, respectively. Compared with the < 45-year group (33.3%), the findings were statistically significant (P < 0.01), and the difference was statistically significant between the incorrect perception group (70.3%) and the correct one (47.6%) (P < 0.05). Of all the factors analyzed in the research, the stage of cancer, treatment methods, vaginal dryness, decreased libido, dyspareunia and sex perception had significant correlation with newly developed sexual dysfunction (P < 0.05).

CONCLUSIONThe stage of cancer, treatment methods, sex perception, vaginal dryness et al had significant correlation with sexual dysfunction of breast cancer patients after treatment. To treat and prevent sexual dysfunction among breast cancer patients, oncology professionals should initiate communication about sexual difficulties, perform comprehensive assessments, and educate and counsel patients about the management of these difficulties.

Adult ; Age Factors ; Aged ; Breast Neoplasms ; complications ; psychology ; Female ; Humans ; Incidence ; Middle Aged ; Quality of Life ; Sexual Dysfunctions, Psychological ; epidemiology ; etiology

Objective To evaluate the reason of failure of the interlocking nail.Methods From1998-2001, 72 patients with femur fractures were treated with the interlocking nail.Results 61 cases were followed-up,there were 5 breakages in the locking nail. The failure occurred after operation from 4～9 months.And 3 cases were at the middle of the nail.2 cases were at the first screw of the distal of the fracture.Conclusion The reason of breakage concluded open operation,too much separation of the periosteum,too early full weight bearing and unfit function exercise.