Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.
Male ; Female ; Humans ; Aged ; Natriuretic Peptide, Brain ; Simendan/therapeutic use* ; Non-ST Elevated Myocardial Infarction ; Heart Failure/drug therapy* ; Peptide Fragments ; Arrhythmias, Cardiac ; Biomarkers ; Prognosis

Objective: To explore the effect of perioperative chemotherapy on the prognosis of gastric cancer patients under real-world condition. Methods: A retrospective cohort study was carried out. Real world data of gastric cancer patients receiving perioperative chemotherapy and surgery + adjuvant chemotherapy in 33 domestic hospitals from January 1, 2014 to January 31, 2016 were collected. Inclusion criteria: (1) gastric adenocarcinoma was confirmed by histopathology, and clinical stage was cT2-4aN0-3M0 (AJCC 8th edition); (2) D2 radical gastric cancer surgery was performed; (3) at least one cycle of neoadjuvant chemotherapy (NAC) was completed; (4) at least 4 cycles of adjuvant chemotherapy (AC) [SOX (S-1+oxaliplatin) or CapeOX (capecitabine + oxaliplatin)] were completed. Exclusion criteria: (1) complicated with other malignant tumors; (2) radiotherapy received; (3) patients with incomplete data. The enrolled patients who received neoadjuvant chemotherapy and adjuvant chemotherapy were included in the perioperative chemotherapy group, and those who received only postoperative adjuvant chemotherapy were included in the surgery + adjuvant chemotherapy group. Propensity score matching (PSM) method was used to control selection bias. The primary outcome were overall survival (OS) and progression-free survival (PFS) after PSM. OS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the last effective follow-up or death. PFS was defined as the time from the first neoadjuvant chemotherapy (operation + adjuvant chemotherapy group: from the date of operation) to the first imaging diagnosis of tumor progression or death. The Kaplan-Meier method was used to estimate the survival rate, and the Cox proportional hazards model was used to evaluate the independent effect of perioperative chemo therapy on OS and PFS. Results: 2 045 cases were included, including 1 293 cases in the surgery+adjuvant chemotherapy group and 752 cases in the perioperative chemotherapy group. After PSM, 492 pairs were included in the analysis. There were no statistically significant differences in gender, age, body mass index, tumor stage before treatment, and tumor location between the two groups (all P>0.05). Compared with the surgery + adjuvant chemotherapy group, patients in the perioperative chemotherapy group had higher proportion of total gastrectomy (χ(2)=40.526, P<0.001), smaller maximum tumor diameter (t=3.969, P<0.001), less number of metastatic lymph nodes (t=1.343, P<0.001), lower ratio of vessel invasion (χ(2)=11.897, P=0.001) and nerve invasion (χ(2)=12.338, P<0.001). In the perioperative chemotherapy group and surgery + adjuvant chemotherapy group, 24 cases (4.9%) and 17 cases (3.4%) developed postoperative complications, respectively, and no significant difference was found between two groups (χ(2)=0.815, P=0.367). The median OS of the perioperative chemotherapy group was longer than that of the surgery + adjuvant chemotherapy group (65 months vs. 45 months, HR: 0.74, 95% CI: 0.62-0.89, P=0.001); the median PFS of the perioperative chemotherapy group was also longer than that of the surgery+adjuvant chemotherapy group (56 months vs. 36 months, HR=0.72, 95% CI:0.61-0.85, P<0.001). The forest plot results of subgroup analysis showed that both men and women could benefit from perioperative chemotherapy (all P<0.05); patients over 45 years of age (P<0.05) and with normal body mass (P<0.01) could benefit significantly; patients with cTNM stage II and III presented a trend of benefit or could benefit significantly (P<0.05); patients with signet ring cell carcinoma benefited little (P>0.05); tumors in the gastric body and gastric antrum benefited more significantly (P<0.05). Conclusion: Perioperative chemotherapy can improve the prognosis of gastric cancer patients.
Chemotherapy, Adjuvant ; Female ; Gastrectomy ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Stomach Neoplasms/surgery*

OBJECTIVE: To explore the clinical effects of convolution method in treating displaced midshaft clavicle fracture. METHODS: From January 2018 to July 2019, 32 patients (21 males and 11 females) with displaced midshaft clavicle fracture were treated, ranging in age from 18 to 65 years old, with a median age of 41.5 years old. Nineteen patients had fractures on the left side and 13 patients had fractures on the right side. The duration from injury to treatment ranged from 30 minutes to 5 days. The patients were treated with convolution method and repeated push and rotation of the affected upper limb, followed by external fixation of clavicle band. The reduction and healing of the fracture and the functional recovery of shoulder joint were observed. RESULTS: After operation, fracture reduction was evaluated by X ray film. Seven patients had an excellent result, 20 good and 5 fair. All the patients were followed up, and the duration ranged from 14 to 18 weeks. The mean Neer score was 89.75±6.88, which included pain score of 32.66±2.54, functional score of 26.44±2.91, range of motion score of 22.38±2.06, and anatomy score of 8.43±0.84;17 patients receive an excellent result, 14 good and 1 fair. CONCLUSION The rotation method combined with the repeated pushing and rotating of the upper limb of the affected side can well reduce the displaced fracture of the middle clavicle. Bandage and clavicle band can be performed after reduction. Functional exercise runs through the whole course of treatment. Functional recovery of shoulder joint is good and satisfactory therapeutic effect is achieved.
Adolescent ; Adult ; Aged ; Bone Plates ; Clavicle ; Female ; Fracture Fixation ; Fracture Fixation, Internal ; Fracture Healing ; Fractures, Bone ; Humans ; Male ; Middle Aged ; Shoulder Joint ; Treatment Outcome ; Young Adult

Chemical investigation on the rice culture of Corynespora cassiicola J9, an endophyte inhabiting in Blumea balsamifera (L.) DC. resulted in isolation of eight compounds, including a new depsidone derivative, corynether C (1), and seven analogues, corynether B (2), corynetherlactone A (3), corynether A (4), diaryl ether (5), corynesidone C (6), corynesidone D (7), and corynesidone A (8). Their structures were deduced based on 1D and 2D NMR spectroscopy, and HR-ESI-MS data. All of the isolated compounds were evaluated for inhibitory activities against Lissorhoptrus oryzophilus Kuschel by the leaf spray assay. Unfortunately, none of them showed inhibitory effects.

Objective To explore the treatment effect of group cognitive behavioral therapy (GCBT) for patients with insomnia.Methods Two hundred and forty-one cases of insomnia were collected in the department of Sleep and Neurology Psychological in D aping Hospital and Field Surgery Research Institute of Army Medical University from March 2016 to June 2017.They were randomly divided into GCBT group (n=128) and pharmacotherapy group (n=113),and the treatment last for 8 weeks for each group.Then the differences of the sleep parameters,Insomnia Severity Index (ISI) scores,Hamilton Depression Scale (HAMD)scores and Hamilton Anxiety Scale (HAMA) scores were compared in two groups at per-treatment,four-week treatment time point and eight-week treatment time point.Results At the four week treatment time point,the differences of sleep onset latency (SOL),total sleep time (TST),time in bed (TIB),number of awakenings (NOA) and insomnia severity index (ISI) in GCBT group compared to pharmacotherapy group were statistically significant (P＜0.05).While the differences of sleep efficiency (SE),HAMA and HAMD were of no statistically significant difference (P＞0.05).At the eight week treatment time point,the differences of SOL,SE,NOA,HAMA,HAMD and ISI in GCBT group compared to pharmacotherapy group were statistically significant (P＜0.05),and there is no significant difference in TST and TIB (P＞0.05).Conclusion GCBT and pharmacotherapy can improve insomnia symptoms,reduce the level of anxiety and insomnia severity.GCBT can also reduce the level of depression,although GCBT improve insomnia symptoms were slower than pharmacotherapy,but curative cffect is superior to pharmacotherapy,and it should be popularized in clinic.

Objective:To investigate the level and prognostic significance of RNF87 in human hepatocellular carcinoma.Methods:Detected the expression of RNF87 in 98 HCC tissues by immunohistochemistry and Western Blot.According to the clinical data of the patients,we analyzed the relationship between RNF87 level and the prognosis of the HCC patients.Results:The level of RNF87 in HCC tissues is down-regulated,compared with the adjacent tissues.And the expression of RNF87 was significantly related to the prognosis of HCC patients.Besides,the lower level of RNF87 was also obviously related with microvascular invasion.Conclusions:The down-regulated level of RNF87 may be one of the risk factors of human hepatocellular carcinoma progression;RNF87 maybe one of potential tumor suppressors;the level of RNF87 can be used as an indicator to predict the prognosis of HCC patients.

Objective To investigate the characteristic of subtypes and genetic diversity of HIV-1 circulating in Hubei province and its molecular epidemiological linkages with regard to risk factors of viral transmission.Methods plasma samples of 80 diagnosed individuals was characterized.The gene fragments of gag were amplified by reverse transcriptase polymerase chain reaction (RT-PCR) and HIV-1 genotypes were determined based on the nucleotide sequences of gag region.Results Seven HIV-1 group M subtypes or CRF including B,B',G,CRF01-AE,CRF07-BC,CRF08-BC and CRF15-01B were identified.CRF01-AE was found to be the most dominant subtype (48.4％) followed by CRF7-BC (22.6％) and B' (12.9％).Conclusion The data from this study indicate the existence of multiple HIV-1 subtypes or CRFs in Hubei province and the surveillance of HIV-1 gene variation should be paid more attention to.

OBJECTIVETo summarize and analyze the clinical features of bladder tumor patients who received transurethral partial cystectomy by 2 microm continuous wave laser, in 1 year post operation follow-up visits.

METHODSFrom December 2007 to May 2008, 47 bladder carcinoma patients were treated with 2 microm laser transurethrally under sacral block. Operation characteristics, operation time, intraoperative hemorrhages and postoperative complications, and pathology staging of the tumor were observed and postoperative follow-up visits were performed.

RESULTSAll of the operation procedures were successful. The surgery time was 5 to 15 minutes. Blood loss in the operation was minimal. There was no obturator nerve reflection, and no hemorrhaging was detected after the operation. The pathological stages can be judged correctly with the obtained specimens. There was one case with peritoneum perforation. The patients received 12 to 17 months of postoperative follow-up visits, and there was no recurrence at the resection site. The survival rate was 100%.

CONCLUSIONSTransurethral partial cystectomy in the treatment of bladder tumor by 2 microm continuous wave laser is a safe, efficient and effective method. The tumor and all the basal part of bladder wall could be excised completely and the pathological stages can be judged correctly using these specimens to fulfill partial cystectomy for the treatment of bladder carcinoma.

Adult ; Aged ; Aged, 80 and over ; Cystectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder Neoplasms ; surgery

OBJECTIVETo observe the histopathologic characteristics of 2 micron continuous wave laser transurethral partial cystectomy for the treatment of bladder tumor.

METHODSA total of 54 patients with 65 bladder tumors underwent 2 micron laser via transurethral by caudal or surface anesthesia from October 2007 to December 2008. It included 41 male and 13 female cases, and the age ranged from 27 to 81 years old with a mean of (66.2 +/- 12.4) years old. The operation evaporated and exsected the wall of urinary bladder, including tumor, submucosa and all muscular layers. Specimens were sent for pathology examination. The histomorphologic changes of raw surfaces were observed 1 week, 1 month, 3 months, 6 months and 1 year postoperation by cystoscopic and pathologic examinations.

RESULTSAll the patients tolerated in the operation. Clinical stages of the tumor: T1 for 42 cases, T2 for 12 cases. All cases were followed-up for 1 to 14 months, with a mean of 8.5 months. Tumor recurrences were found in 2 cases, no one had recurrence in situ. The tumor, submucosa and all muscular layers can be resected completely by 2 micron continuous wave laser transurethral partial cystectomy. Pathologic staging can be judged correctly. The umbilication raw surface were infiltrated by fibrous connective tissue and chronic inflammatory cells 1 week postoperation. The umbilication changed shallow and transitional epithelial cells began to cover it 1 month postoperation. The umbilication disappeared and transitional epithelial cells cover the raw surface 3 months postoperation. There was no difference between the raw surface and normal bladder mucosa.

CONCLUSIONS2 micron continuous wave laser for the treatment of bladder tumor can get the same clinical result as partial cystectomy. The pathologic staging can be judged correctly by the specimens.

Adult ; Aged ; Aged, 80 and over ; Cystectomy ; methods ; Female ; Humans ; Laser Therapy ; Male ; Middle Aged ; Neoplasm Staging ; Prospective Studies ; Treatment Outcome ; Urinary Bladder Neoplasms ; pathology ; surgery

OBJECTIVETo analyze the clinical characteristics of partial cystectomy in treatment of bladder tumor by 2 microm continuous wave laser.

METHODSA total of 18 patients with 21 bladder tumors treated by 2 microm laser via transurethral under sacral block. The diameters of tumors were between 1-3 cm. In the operation, we vaporized and cut whole wall of bladder, dissected the muscular layers from connective tissue, and sent them for pathology inspection. We reviewed these following variables: operation time, blood loss, complications during and after the operation, pathology staging of the tumor and follow-up visit.

RESULTSAll the patients were tolerated in the operation. The mean operative time was (7.4 +/- 3.3) min (range, 5-12 min). Blood loss in the operation was minimal. No patient experienced an obturator nerve reflection or a hemorrhage after the operation. One case has urine leakage. The pathology staging of the tumors were as follows: T1 stage 15 cases, total 18 tumors; and T2 stage 3 cases, total 3 tumors. The followup periods were between 3 to 6 months, and the mean period was 4.5 months. There was no recurrence in situ.

CONCLUSIONSThe 2 microm laser not only can vaporize and cut the wall of bladder finely, but also can dissect the muscular layers from connective tissue efficiently. So it can be partial cystectomy in the treatment of bladder tumor.

Adult ; Aged ; Cystectomy ; methods ; Female ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Urinary Bladder Neoplasms ; surgery