Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure to establish a portosystemic shunt between the hepatic vein and the portal vein via the jugular approach, so as to reduce portal venous pressure and control acute esophagogastric variceal bleeding (EGVB). The prognosis of EGVB has been improved significantly over the past few decades, and endoscopic variceal ligation combined with drug therapy is now recommended as the first-line treatment regimen for this disease. The latest research advances in the management of EGVB over the past decade have focused on the relatively new concept of "early" or "pre-emptive" TIPS, that is to say, early TIPS (within 72 hours after admission, ideally within 24 hours) is recommended for patients with EGVB who are at a relatively high risk of failure in standard treatment. This article briefly introduces the effect of early TIPS on controlling bleeding, mortality rate, and hepatic encephalopathy, the high-risk population for early TIPS, timing of intervention, cost effectiveness, the applications of early TIPS in a real-world setting, and recommendations for early TIPS in international guidelines and consensus statements.

Objective: To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Methods: Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Results: Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Conclusions: Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.
Humans ; Male ; Female ; Young Adult ; Adult ; Middle Aged ; Facial Paralysis/etiology* ; Diagnosis, Differential ; Jugular Foramina ; Retrospective Studies ; Cough ; Hoarseness ; Neoplasm Recurrence, Local ; Chondrosarcoma/surgery*

Due to its own internal laws of development, Chinese medicine (CM) seems more inclined to empirical medicine in a relatively long historical period. It is considered to be lacking objective and unified clinical practice guidelines (CPGs), and the difficulties in diagnosis and therapeutic effect evaluation comes with it, have restricted its further inheritance, development and international communication. Over the years, our research group has been committed to improving the standardization theory and methodology of CM, also perfecting relative techniques for further application, which are all based on the stratified evidence scoring method. We have already applied this method to 45 issued guidelines, including 5 national guidelines, 3 industrial guidelines, and 37 formulation/revision social organization guidelines. The stratified evidence scoring method has been recognized and used widely. It helps scholars and applicators to study, formulate, publish and popularize the acupuncture therapy clinical practice guidelines better, thus further promotes the development of acupuncture therapy.

ObjectiveTo explore the effects of high-salt diet on airway inflammation in mice with allergic asthma. MethodsTwenty 4-week-old female BALB/c mice were randomly divided into four groups， including control group， allergic asthma model group， 4% high-salt diet group and 8% high-salt diet group. Ovalbumin（OVA）was injected intraperitoneally and inhaled to make an asthmatic model. The control group and the model group were fed ordinary diet and drinking water， and the high-salt groups were fed 4% or 8% high-salt diet and 1% saline respectively. After 25 days， the nasal symptoms of each group of mice were observed at the last challenge. The mice were sacrificed 24 hours later. The inflammatory cells of different subtype in the blood were measured by five classification of blood cell analysis. Hematoxylin-eosin （HE） staining was used to observe the infiltration of eosinophils， and periodic acid-schiff （PAS） staining was used to observe the goblet cell proliferation in the lung tissue. Flow cytometry was used to detect the proportion of helper T cells 1（Th1 cells）， Th2， Th17 cells and regulatory T cells （Treg cells） in the lung tissue， and the enzyme-linked immunosorbent assay was used to determine the levels of cytokines interleukin-4 （IL-4）， IL-5， IL-13， and IL-17 of bronchoalveolar lavage fluid （BALF）. ResultsCompared with the allergic asthma model group， 4% and 8% high-salt diet significantly reduced the proportion of eosinophils in blood， the proportion of Th17 cells in lung tissue， and IL-13 and IL-17 levels in BALF， but he effect of 8% high-salt diet on IL-13 was more significant than that of 4% high-salt diet （P<0.05）. However， only 8% high-salt diet significantly relieved nasal symptom， improved eosinophil infiltration and goblet cell proliferation， reduced the proportion of Th2 cells and Th2/ Th1 ratio in lung tissue and the levels of IL-4 and IL-5 in BALF （P<0.05）. ConclusionsShort-term high-salt diet can alleviate airway inflammation in mice with allergic asthma， and the effects of 8% high-salt diet are better than that of 4% high-salt diet.

ObjectiveTo explore the effects of high-salt diet on airway inflammation in mice with allergic asthma. MethodsTwenty 4-week-old female BALB/c mice were randomly divided into four groups， including control group， allergic asthma model group， 4% high-salt diet group and 8% high-salt diet group. Ovalbumin（OVA）was injected intraperitoneally and inhaled to make an asthmatic model. The control group and the model group were fed ordinary diet and drinking water， and the high-salt groups were fed 4% or 8% high-salt diet and 1% saline respectively. After 25 days， the nasal symptoms of each group of mice were observed at the last challenge. The mice were sacrificed 24 hours later. The inflammatory cells of different subtype in the blood were measured by five classification of blood cell analysis. Hematoxylin-eosin （HE） staining was used to observe the infiltration of eosinophils， and periodic acid-schiff （PAS） staining was used to observe the goblet cell proliferation in the lung tissue. Flow cytometry was used to detect the proportion of helper T cells 1（Th1 cells）， Th2， Th17 cells and regulatory T cells （Treg cells） in the lung tissue， and the enzyme-linked immunosorbent assay was used to determine the levels of cytokines interleukin-4 （IL-4）， IL-5， IL-13， and IL-17 of bronchoalveolar lavage fluid （BALF）. ResultsCompared with the allergic asthma model group， 4% and 8% high-salt diet significantly reduced the proportion of eosinophils in blood， the proportion of Th17 cells in lung tissue， and IL-13 and IL-17 levels in BALF， but he effect of 8% high-salt diet on IL-13 was more significant than that of 4% high-salt diet （P<0.05）. However， only 8% high-salt diet significantly relieved nasal symptom， improved eosinophil infiltration and goblet cell proliferation， reduced the proportion of Th2 cells and Th2/ Th1 ratio in lung tissue and the levels of IL-4 and IL-5 in BALF （P<0.05）. ConclusionsShort-term high-salt diet can alleviate airway inflammation in mice with allergic asthma， and the effects of 8% high-salt diet are better than that of 4% high-salt diet.

OBJECTIVETo study a non-drug therapy for hypertension disease by combining percutaneous laser and electric pulse stimulation to acupoint with music, and to test the efficiency of the combining treatment to grade 1 essential hypertension.

METHODSA total of 174 patients with grade 1 essential hypertension were randomly assigned to 3 groups with a random number table after Chinese medicine (CM) syndrome differentiation: the photoelectric and musical treatment group (Group 1, with a self-developed multi-mode audio frequency pulse photoelectric therapeutic apparatus), acupuncture group (Group 2), and oral placebo group (Group 3), 58 cases per group. The curative effect of each group was evaluated by the changes of blood pressure and CM syndrome integral before and after treatment.

RESULTSCompared with Group 3, there were significant decrease of blood pressure and CM syndrome integral in Group 1 and Group 2 (P<0.01). Compared with Group 2, Group 1 showed the highest decrease in systolic pressure (P<0.017). The total effective rate of anti-hypertension in Group 1 (91.38%, 53/58) was significantly higher than that in Group 2 (74.13%, 43/58) and Group 3 (18.97%, 11/58, P<0.05 or P<0.01); and that in Group 2 was also significantly higher than that in Group 3 (P<0.01). There were significant difference in the total effective rate of CM syndrome integral in both Group 1 (93.10%, 54/58) and Group 2 (84.48%, 49/58) as compared with Group 3 (17.24%, 10/58, P<0.01), while there was no significant difference between Group 1 and Group 2 (P>0.05).

CONCLUSIONSThe multi-mode audio frequency pulse photoelectric therapeutic apparatus, combining music, laser and electric pulse stimulation, is clinically useful for grade 1 essential hypertension. This "three in one" therapy method is non-invasive, easy and simple to handle. It is expected to be popularized as a new alternative treatment.

Acupuncture Points ; Blood Pressure ; Electric Stimulation Therapy ; Essential Hypertension ; Female ; Humans ; Hypertension ; physiopathology ; therapy ; Lasers ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Music ; Syndrome ; Treatment Outcome

Objective To evaluate the risks of vaccination operation in order to provide scientific basis for policy makings of vaccination operation.Methods The risk matrix and analytic hierarchy process approach were used to evaluate the risks of vaccination operation,including the possibility,severity,risk weight,and risk level.Results Seven items for the first level and thirty one items for the second level vaccination risk factors were determined.In the first level,E level risk (Extremely serious risk ) was vaccination implementation risk,and H level risk (high risk ) was the risks of pre -notification and health education and risks of vaccine and cold chain management.Vaccination implementation risk accounted the largest weight (weight coefficient=38.95%).In second level,E level risk was three inspection and seven verification before vaccination,and H level risk were personnel professional quality,personnel responsibility,pre -inspection,informed before vaccination, vaccination route, site and dose, vaccination operation, post vaccination notification and retention,and three inspection and seven verification before vaccination,accounted the largest weight (weight coefficient=10.14%).The weight of the logical consistency of the test results were satisfactory (consistency ratio<0.1 ).Conclusion The integrated application of risk matrix and analytic hierarchy process in risk assessment of vaccination operation helps to further regulate vaccination services and has application and promotion value.

BACKGROUNDThree randomised trials have demonstrated that combining bevacizumab with first-line chemotherapy significantly improves progression-free survival versus chemotherapy alone in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). However, data from Chinese populations are limited and possible differences between ethnic and geographic populations are unknown. This study was conducted to determine whether there are differences in safety and efficacy in patients with HER2-negative LR/mRC between Chinese and Western populations after they receive first-line bevacizumab combined with taxane-based therapy.

METHODSIn the single-arm, open-label, Avastin Therapy for Advanced Breast Cancer (ATHENA) study (NCT00448591), patients with HER2-negative LR/mBC received first-line bevacizumab (investigator's choice of 10 mg/kg every 2 weeks or 15 mg/kg every 3 weeks) combined with taxane-based therapy. The primary endpoint was safety profile and the secondary is time to progression (TTP). A subpopulation analysis was conducted to assess safety and efficacy in Chinese patients.

RESULTSOf 2264 patients treated in ATHENA, 202 were enrolled in China. Bevacizumab was combined with docetaxel in 90% of Chinese patients and paclitaxel in 10%. The most common grade 3/4 adverse events were diarrhoea (in 5.0% of patients) and hypertension (in 2.5% of patients). Grade 3/4 proteinuria occurred in 0.5%. After median follow-up of 17.6 months and events in 56% of patients, median TTP was 9.0 months (95%CI, 8.4-11.1). Overall survival data were immature.

CONCLUSIONSWe found no evidence of increased bevacizumab-related toxicity or reduced efficacy in Chinese LR/mBC patients receiving first-line bevacizumab-taxane therapy compared with predominantly Western populations. The safety profile was generally similar to previously reported LR/mBC trials. Subtle differences may be attributable to different lifestyle and cardiovascular risk factors in Chinese patients compared with the overall population. It appears reasonable to extrapolate findings from bevacizumab-based randomised trials to Chinese populations.

Adult ; Aged ; Aged, 80 and over ; Antibodies, Monoclonal, Humanized ; adverse effects ; therapeutic use ; Antineoplastic Agents ; adverse effects ; therapeutic use ; Bevacizumab ; Breast Neoplasms ; drug therapy ; genetics ; metabolism ; Bridged-Ring Compounds ; adverse effects ; therapeutic use ; Female ; Humans ; Middle Aged ; Receptor, ErbB-2 ; genetics ; metabolism ; Taxoids ; adverse effects ; therapeutic use ; Young Adult

Aged ; Coronary Angiography ; Coronary Artery Disease ; Coronary Disease ; diagnostic imaging ; pathology ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Tomography, Emission-Computed, Single-Photon

OBJECTIVETo investigate the effects of nucleoside analogues on hepatitis B virus (HBV) in hepatic lymph nodes of hepatitis B related liver transplantation recipients who were hepatitis B surface antigen (HBsAg) positive but negative for serum HBV DNA.

METHODSFrom June 2010 to March 2011, thirty-six cases of hepatitis B related liver transplantation recipients [32 males, 4 females, average age (54 ± 7) years] were divided into drug treatment group and non-drug treatment group according to the utility of nucleoside analogues. Drug treatment group was divided into two subgroups: drug treatment > 3 months group and drug treatment ≤ 3 months group. The hepatic lymph nodes in the hepatoduodenal ligament were taken during the operation of liver transplant. Using nested or semi-nested PCR, HBV DNA and the replicative form HBV cccDNA in hepatic lymph nodes were detected. Data were analyzed by Fisher's exact test.

RESULTSThe positive rate of HBV DNA: the difference was not statistically significant between drug treatment group (72.7%, 16/22) and non-drug treatment group (14/14) (P = 0.062), the difference was not statistically significant between drug treatment > 3 months group (10/14) and drug treatment ≤ 3 months group (6/8) in the subgroups of drug treatment group (P = 1.000). The positive rate of HBV cccDNA: drug treatment group (22.7%, 5/22) was significantly lower than the non-drug treatment (12/14) (P = 0.000), drug treatment > 3 months group (1/14) was significantly lower than drug treatment ≤ 3 months group (4/8) in the subgroups of drug treatment group (P = 0.039).

CONCLUSIONSHepatic lymph nodes maybe one of the extrahepatic HBV reservoirs. Treating with nucleoside analogues more than 3 months can significantly decrease the replication of HBV in hepatic lymph nodes of HBV associated liver transplantation recipients.

Adult ; Aged ; DNA, Viral ; analysis ; Female ; Hepatitis B ; drug therapy ; Hepatitis B virus ; drug effects ; physiology ; Humans ; Liver Transplantation ; Lymph Nodes ; virology ; Male ; Middle Aged ; Nucleosides ; therapeutic use ; Preoperative Care ; Virus Replication