Objective To evaluate the technical feasibility and safety of upper arm vein approach in the implantation of totally implantable venous access port(TIVAP)under the guidance of ultrasound combined with DSA.Methods The clinical data of 1 546 patients with malignant tumors,who received TIVAP implantation via upper arm vein access under the guidance of ultrasound combined with DSA at the Affiliated Renji Hospital,School of Medicine of Shanghai Jiao Tong University of China between January 2020 and January 2022,were retrospectively analyzed.The implantation success rate,single-puncturing success rate,operation time,and complications were compared between the PICC catheterization room and the DSA operating room.Results The technical success rate in the 1546 patients was 100％,with a single-puncturing success rate of 99.48％.In 766 patients the TIVAP implantation was performed in the PICC catheterization room(PICC group),and in 780 patients the TIVAP implantation was carried out in the DSA operating room(DSA group).The mean operation time in the DSA group was(20.1±1.3)min,which was obviously shorter than(25.4±1.9)min in the PICC group,and the incidence of primary catheter misplacement in the DSA group was 0％,which was remarkably lower than 0.78％in the PICC group(P＜0.05).No statistically significant differences in the incidences of complications,including infection,thrombosis,upper limb movement disorder,catheter occlusion,exposure of infusion port body,and overturn of infusion port body,existed between the two groups(P＞0.05).Conclusion Ultrasound-guided TIVAP via upper arm vein approach is a safe and effective infusion route for patients with malignancy receiving chemotherapy.The combination use of ultrasound guidance and intraoperative DSA guidance can reduce the operation time as well as the incidence of operation-related complications.

A case of idiopathic hypertrophic spinal pachymeningitis is reported. The patient was a middle-aged female, with the course of disease more than 1 year. Clinical manifestations included recurrent fever,headache and backache, and the magnetic resonance imaging showed diffuse enhancement and thickening of the spinal dura mater. Dural biopsy pathology finally confirmed hypertrophic spinal pachymeningitis. After treatment with surgery and immunotherapy, the patient′s clinical symptoms improved.

OBJECTIVE: To observe the clinical efficacy of vitamin B1 in patients with ICU-acquired weakness (ICU-AW). METHODS: A retrospective analysis was conducted to select ICU-AW patients treated with vitamin B1 in the intensive care unit (ICU) of Shanghai East Hospital, Tongji University from July 2022 to December 2023. Propensity score matching was used to match the control group and observation group at a 1 : 1 ratio, considering differences in patient age, gender, and acute physiology and chronic health evaluation II (APACHE II). The control group received conventional treatment, while the observation group received vitamin B1 in addition to conventional treatment. Comparisons were made between the two groups in terms of basic information, APACHE II scores, Medical Research Council muscle strength score (MRC), interleukin-6 (IL-6), C-reactive protein (CRP), and serum creatinine (SCr) levels before and after treatment, mechanical ventilation time, and length of ICU stay were collected and compared between the two groups. RESULTS: A total of 30 patients with ICU-AW were included, both 15 in each group. There were no significant differences in gender, age and APACHE II score between the two groups. There were no significant differences in APACHE II score, MRC score, IL-6, CRP, SCr levels, and the duration of ventilator-assisted ventilation and ICU stay between the two groups of patients before treatment. Both groups showed improvements in APACHE II scores and MRC scores after treatment, with the observation group showing significantly greater improvement compared to the control group (APACHE II score: 10.80±1.47 vs. 12.20±1.52, MRC score: 50.40±7.10 vs. 42.00±8.78, both P < 0.05). After treatment, both groups showed significant reductions in IL-6, CRP, and SCr levels, but there were no significant differences between the observation group and control group. The observation group had significantly shorter durations of mechanical ventilation (days: 7.67±1.54 vs. 9.67±2.44, P < 0.05) and ICU stay (days: 13.33±1.72 vs. 15.13±2.56, P < 0.05) compared to the control group. CONCLUSIONS The use of vitamin B1 during the treatment of ICU-AW significantly improves muscle strength and reduces the duration of mechanical ventilation and ICU stay.
Humans ; Intensive Care Units ; Retrospective Studies ; APACHE ; Muscle Weakness/drug therapy* ; Respiration, Artificial ; Thiamine/therapeutic use* ; C-Reactive Protein ; Interleukin-6/blood* ; Length of Stay ; Male ; Female ; Treatment Outcome ; Propensity Score ; Middle Aged

ObjectiveTo study the effect of Bushen Huoxuetang on the apoptosis and the expression of B-cell lymphoma （Bcl-2）-associated X protein （Bax）/ Bcl-2 and cleaved cysteine-containing aspartate proteolytic enzyme-3 （cleaved Caspase-3） in the nude mouse model of bone metastasis of breast cancer， and explore the mechanism of Bushen Huoxuetang in inhibiting bone destruction. MethodThirty BALB/c female nude mice were randomly assigned into blank group （n=6） and model group （n=24）. The suspension of 4T1 breast cancer cells was injected into the tibia of mouse right lower limb to establish model of bone metastasis of breast cancer. The successfully modeled nude mice were randomly assigned into model group， Bushen Huoxuetang group， zoledronic acid group， and combined drug group， with 6 mice in each group. Bushen Huoxuetang was administrated at a dose of 36.67 g·kg^-1， once a day， and zoledronic acid was administrated by subcutaneous injection at a dose of 100 μg·kg^-1， twice a week. The combined drug group was administrated with the same doses of Bushen Huoxuetang group by gavage and zoledronic acid by subcutaneous injection. The mice in the blank group and the model group were administrated with the same volume of distilled water by gavage for 14 days. On the next day at the end of drug administration， the mice were sacrificed by cervical dislocation. The general situation and weight changes of the mice were examined. The right lower limb was collected， and X-ray scanning and hematoxylin-eosin （HE） staining methods were used for observation of pathological changes in the bone. The terminal deoxynucleotidyl transferase dUTP nick-end labeling （TUNEL） was employed to detect the apoptosis of bone tissue in nude mice， and Western blot to determine the expression of Bax/Bcl-2 and cleaved Caspase-3 in the bone tissue. ResultCompared with the blank group， the modeling reduced the body weight （P<0.01） and increased the right lower limb weight of the nude mice （P<0.01）. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination increased the body weight （P<0.01） and decreased the right lower limb weight （P<0.01）. Compared with the blank group， the other groups showed obvious tumor cell atypia， deep nuclear staining， and clear bone metastasis， and the model group showed obvious osteolytic damage in right lower limb and loss of proximal tibia and knee joint. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination reduced the osteolytic lesions in the right lower limb and recovered part of the bone structure， demonstrating an inhibitory effect on bone destruction. The TUNEL assay showed that the model group had lower apoptosis rate of bone metastatic tumor cells than the blank group， Bushen Huoxuetang group， zoledronic acid group， and combined drug group （P<0.01）. Compared with the blank group， the modeling down-regulated the expression of Bax and cleaved Caspase-3 （P<0.01） and up-regulated the expression of Bcl-2 （P<0.01）. Compared with the model group， Bushen Huoxuetang， zoledronic acid， and their combination up-regulated the expression of Bax （P<0.01） and cleaved Caspase-3 （P<0.05， P<0.01） and down-regulated the expression of Bcl-2 （P<0.05， P<0.01）. ConclusionBushen Huoxuetang may inhibit bone destruction in the nude mouse model of bone metastasis of breast cancer by up-regulating the expression of Bax， down-regulating the expression of Bcl-2， activating cleaved Caspase-3， and further inducing apoptosis.

Objective:To survey the prevalence and comorbidity of patients with chronic thromboembolic pulmonary hypertension (CTEPH) in Shanxi province from 2018 to 2021.Methods:The data of patients with CTEPH from 2018 to 2021 were extracted from the Health Statistics Direct Reporting System of Shanxi Provincial Health Commission; the population data of Shanxi Province was obtained from the Statistical Yearbook of Shanxi Province. The prevalence rate of CTEPH in Shanxi Province in 2018, 2019, 2020 and 2021 was calculated. The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) was used to identity the specific Charlson comorbidity from other diagnosis on the medical record. The severity of the comorbidity scale was classified as mild (aCCI≤2 points), moderate (aCCI=3-5 points), moderate-severe (aCCI=6-8 points), and severe (aCCI≥9 points).Result:A total of 300 patients with CTEPH were identified in the whole province during the period with the mean age of(65.5±11.5)years, there were 31, 65, 83 and 121 cases in 2018, 2019, 2020 and 2021, and the corresponding prevalence rates were 0.9/10 6, 1.9/10 6, 2.4/10 6 and 3.5/10 6, respectively showing an increasing trend. The patients with CTEPH in this study involved 14 Charlson comorbidities, among which the chronic lung disease was in the highest proportion (198/300, 66.0%), followed by peripheral vascular disease (126/300, 42.0%) and chronic congestive heart failure (121/300, 40.3%). There were 16.3% (49/300) of patients with mild comorbidity, 56.3% (169/300) with moderate comorbidity, 22.3% (67/300) with moderate-severity comorbidity, and 5.0% (15/300) with severity comorbidity. Conclusions:The prevalence of CTEPH in Shanxi province from 2018 to 2021 was 0.9-3.5/10 6 showing an upward trend. The chronic lung disease, peripheral vascular disease and chronic congestive heart failure are the main comorbidities of patients with CTEPH, and mostly with moderate comorbidity.

Objective According investigate the expression of NLRP3 in liver tissues of mice with hepatic ischemia-reperfusion injury (HIRI),to determin the role of NLRP3 in the process of HIRI.Methods Established mice model of partial HIRI.Forty-two male C57BL/6 mice (aged 7 to 8 weeks,weight 20 to 25 g) were respectively divided into 7 groups:no-treatment control group,sham operation group,HIRI groups (2、6、12、24 h) and CY-09 group,6 mice in each group.The injury of the hepatic tissues in the 7 groups was analyzed based on detecting the levels of alanine transaminase (ALT),aspartate transaminase (AST),interleukin-1β (IL-1β),interleukin-18 (IL-18),tumor necrosis factor-α (TNF-α) by ELISA.HE and TUNEL staining were used to observe the pathological changes of liver tissues after HIRI.Western blotting assay were carried out to detect the expressions of NLRP3 and Caspase-1.Measurement data were expressed as mean ± standard deviation (Mean ± SD),and one-way variance analysis was used for comparison between groups.If the variance was not uniform,Dunnett C test was used.Results Serum ALT,AST,IL-1 β,IL-18 and TNF-α of mice detected in HIRI groups were higher than no-treatment control group and sham operation group at all endpoints (P ＜ 0.05).The relative expression of NLRP3 and Caspase-1 in the liver tissues of mice in the HIRI groups were significantly higher than that in the no-treatment control group and sham operation group.Serum ALT,AST,IL-1β,IL-18 and TNF-α of mice detected in CY-09 group were lower than HIRI groups at all endpoints (P ＜ 0.05).Less hepatocellular necrosis were exhibited in CY-09 group,comparing to HIRI groups.The hepatocyte apoptosis rate of mice in the CY-09 group was significantly lower than that in the 12 h HIRI group (P ＜ 0.05).The relative expression of NLRP3 in the liver tissues of mice in the CY-09 group was significantly lower than that in other groups.The relative expression of Caspase-1 in the liver tissues of mice in the CY-09 group was significantly lower than that in other groups except the no-treatment control group and sham operation group.Conclusions HIRI cause an increase in NLRP3 expression.The inhibition of NLRP3 can reduce HIRI.

Objective To investigate the incidence of venous thrombosis related to totally implantable access port (TIAP) in upper arm in cancer patients, and to discuss its risk factors. Methods The clinical data of a total of 1 724 patients, who received upper arm TIAP for deliverance of chemotherapy at authors' hospital during the period from February 2014 to April 2018, were collected. The general data of patients, catheterization, disease progression and incidence of venous thrombosis in upper limbs were analyzed. The univariate analysis and multivariate logistic regression analysis were used to determine the risk factors related to symptomatic thrombus. Results A total of 17 patients developed symptomatic venous thrombosis of the upper extremities, the incidence rate was 0.99％ (17/1 724) . The mean time interval from the implantation of upper arm TIAP to the diagnosis of thrombosis was 55.6 d (2-334 d) . Univariate analysis indicated that infection (P<0.01) and spontaneous catheter dislodgment (P<0.01) were significantly related to the risk of upper extremity venous thrombus (UEVT) . Multivariate binary logistic regression analysis revealed that infection (RR =16.85, P <0.01) and catheter spontaneous dislodgment (RR =101.09, P <0.01) were two important independent predictors for UVTE related to upper arm TIAP. Conclusion Infection and spontaneous catheter dislodgment are independent risk factors for upper arm TIAP-related thrombosis.

Objective: To evaluate the acute effects of air pollutants (PM2.5,SO2 and NO2) on hospital visits for upper respiratory tract infection in children,and provide the reference for goverment to make effective interventional measures and to instruct prevention and protection of children’s health. Methods: Daily meteorological data, air pollutants levels and hospital visits for upper respiratory tract infection in children between 2016 and 2018 were collected for analysis. The generalized linear model (GLM) based on Quasi-Poisson regression was used for estimating the acute effects of each pollutant on hospital visits for upper respiratory tract infection in children. The confounding factors of seasonal trend, long-term trends, meteorological factors, week effect were controlled in the model. The lag pattern of lag days (lag0-lag5) and moving average effect (lag01-lag05) was conducted. The excessive risk (ER) of hospital visits for upper respiratory tract infection in children with 95% confidence interval (95%CI) was calculated with an increase of 10 μg/m3 of PM2.5，SO2 and NO2 respectively. Results: Seasonality was showed in the daily pollutants and hospital visits for upper respiratory tract infection in children from 2016 and 2018 in Xining. The average of annual PM2.5，SO2 and NO2 concentration were (47±28)(15+9)(35±17) μg/m3 respectively. The average number of hospital visits for upper respiratory tract infection in children was seventytwo persons. With an increase of 10 μg/m3 of PM2.5,SO2 and NO2 hospital visits for upper respiratory tract infection in children increased by 0.78% (95%C=0.39%-1.17%), 4.19% (95%CI=3.05%-5.34%) and 1.93% (95%CI=1.15%-2.71%) respectively. The three kinds of air pollutants all had certain lag effect. Conclusion The main air pollutants PM2.5，SO2 and NO2, have acute effects on hospital visits for upper respiratory tract infection in children in Xining district,thus,the work of preventing and controlling air pollution need to be furthur strengthened.

Objective The aim of this study was to investigate the value of ultrasound in diagnosis of benign and malignant thyroid nodules with rim calcification. Methods Sixty thyroid nodules with rim calcifications from Sun Yat-sen University Cancer center which were detected on ultrasound from January 2008 to December 2015 were included in this study, and all the thyroid nodules had pathological results. Ultrasonic features of thyroid nodules, including the size, border, internal echo, growth pattern, rear echo, interruption or inner sink of the rim calcification and hypoechoic soft tissue extrusion around rim calcification were analyzed. Results Thirty-seven nodules (61.7%) were confirmed to be benign, and twenty-three nodules (38.3%) were malignant. The ultrasonic features of interruption or inner sink of rim calcifications and hypoechoic soft tissue extrusion around rim calcification, were more often in malignant nodules than benign nodules. The sensitivity, specificity, the positive predictive values and the negative predictive values for interruption or inner sink of rim calcifications were 85.7%, 89.4%, 85.7% and 89.4%, respectively. The sensitivity, specificity, the positive predictive values and the negative predictive values for hypoechoic soft tissue extrusion around rim calcification were 81.3%, 94.4%, 92.9% and 85.0%, respectively. Internal hypoechogenicity was more frequently observed in the malignant nodules (82.6%) than in benign nodules (40.5%). The longitudinal growth pattern of thyroid was more frequently observed in malignant nodules (30.4%) than in benign nodules (2.7%). The differences of this two ultrasound features were statistically significant(χ2=9.958 and 9.440,both P<0.01).There were no significant differences in size,border and the rear echo between malignant and benign nodules (all P>0.05). Conclusion The interruption or inner sink of the rim calcification could be useful in differential diagnosis of thyroid nodules with rim calcification.