Volume 96  ·  Issue 28  ·  2016

Since the advent of antibiotics in the 1940s, human infectious diseases have been effectively controlled, and the mortality rate has dropped significantly. However, with the widespread use of antibiotics in medicine, agriculture, animal husbandry and aquaculture, the problem of bacterial drug resistance has become increasingly serious, which has become an important medical and social problem^[1,2,3]。

With the rapid development of modern medicine, the high-tech means of prolonging life are constantly updated. Some medical measures not only prolong life, but also bring more pain to patients. In the face of incurable patients with advanced diseases, medical staff often feel helpless and don't know how to face and comfort such patients and their families. Palliative care aims to provide overall positive medical care to end-stage patients who have not responded to and benefited from curative treatment, with the aim of improving the quality of life of patients in the end-stage. Palliative care is a concept and model of end-of-life care actively promoted all over the world, and there is a complete education and training system. With the aging population and the sudden increase of cancer patients in China, palliative care has been paid more and more attention, and it is urgent to promote palliative care in medical education.

To campare the effect and tolerance beween intensified myeloablative conditioning regime (IMCR) without antithymocyte globulin (ATG) and myeloablative conditioning regime (MCR) for single-unit unrelated umbilical cord blood transplantation (sUCBT) in hematological malignancies.

The clinical data of 190 patients with hematological malignancies undergoing sUCBT between April 2000 and December 2013 at Department of Hematology, Anhui Provincial Hospital were retrospectively analyzed, of whom 156 received IMCR without ATG (IMCR group), including 79 patient receiving total body irradiation (TBI)/cytosine arabinoside (Ara-C)/cyclophosphamide (CY) regime, 47 receiving fludarabine (Flu)/busulfan (Bu)/CY regime, and 30 receiving Ara-C/Bu/CY regime, and all of the 156 received a combination of cyclosporine A (CsA) and mycophelonate mofetil (MMF) for the prophylaxis of graft-versus-host disease (GVHD); the remaining 34 patients received MCR (MCR group), 30 patients receiving Bu/CY regime, and 4 receiving TBI/CY regime, all using CsA/MMF±ATG or methotrexate (MTX) for the prophylaxis of GVHD. The two groups were compared in disease status at the time of transplantation, characteristics of graft, transplantation effect, and transplantation-related complications.

There were no statistically significant differences between the two groups in gender, disease type, human leukocyte antigen match, ABO blood type match, and disease status at the time of transplantation (all P>0.05). The median age and body weight at transplantation in the IMCR group were significantly higher than those in the MCR group (13 years vs 9 years,P=0.003; 44 kg vs 26 kg, P=0.000). The median doses of infused total nucleated cells (×10⁷/kg) and CD34⁺ cells (×10⁵/kg) in the IMCR group were significantly lower than in the MCR group (3.87 vs 4.99, P=0.002; 2.00 vs 3.17, P=0.000). The cumulative incidence of myeloid engraftment on the 42th day and platelet engraftment on the 120th day in the IMCR group were remarkably higher than in the MCR group [96.33%(95%CI: 96.27%-96.39%)vs 82.30%(95%CI: 80.67%-83.93%), P=0.000; 86.44%(95%CI: 86.28%-86.60%)vs 51.17%(95%CI: 49.02%-53.32%), P=0.002]. There were no statistically significant differences in the incidences of grade Ⅱ to Ⅳ acute GVHD, grade Ⅲ to Ⅳ acute GVHD, and 2-year chronic GVHD(P=0.482, 0.928, 0.579). The incidence of pre-engraftment syndrome in the IMCR group was higher than in the MCR group(82.70% vs 47.06%, P=0.000). And 180-day transplantation-related mortality (TRM) in the IMCR group was lower than that in the MCR group [20.50%(95%CI: 20.28%-20.71%)vs 42.20% (95%CI: 41.32%-45.09%), P=0.004]. Up to October 2015, with a median follow-up of 44.2(22.7-188.9)months, the estimated 3-year overall survival and disease-free survival in the IMCR group were both significantly higher than those in the MCR group (62.90% vs 34.10%, P=0.000; 58.60% vs 34.10%, P=0.001).

IMCR without ATG may improve the engraftment without increasing complications, reduce early transplantation-related mortality, and improve survival.

To investigate sleep architecture and blood pressure dynamic change in patients with Sleep apnea syndrome by electrocardiogram-based cardiopulmonary coupling analysis system.

Seventy-nine sleep disorder participants (PSQI≥8) were enrolled. Electrocardiogram-based cardiopulmonary coupling analysis device and ambulatory blood pressure monitoring were synchronously used to evaluate sleep architecture and blood pressure circadian rhythm. The patients were divided into SAS group (47 participants) and non-SAS group (32 participants) according to the Apnea Hypopnea Index (AHI) that calculated by CPC device. The data of sleep architecture and blood pressure variability were compared between two groups.

Compared with non-SAS group, SAS group have less proportion of deep sleep, more proportion of light sleep, higher mean blood pressure in 24 hours and daytime, lower nocturnal blood pressure dipping, faster mean heart rate in night time (P<0.05). AHI has moderate inverse correlation with deep sleep time, wake/dream time (-0.6≤r<-0.3), moderate positive correlation with light sleep time (0.3<r≤0.6), high inverse correlation with nocturnal blood pressure dipping (r=-0.785, P=0.000), moderate positive correlation with mean diastolic blood pressure (r=0.425, P=0.019).

Our study shows that less proportion of deep sleep, more proportion of light sleep, 24 hours mean blood pressure and nocturnal blood pressure increase in the patients with Sleep Apnea Syndrome. The severity of Sleep Apnea Syndrome has a positive correlation with the severity of abnormal sleep architecture and the degree of blood pressure elevation.

To explore the clinical characteristics and prognosis of CD20-positive classical Hodgkin lymphoma (CHL).

Data from CHL patients with CD20 immunohistochemical staining result who were treated in Cancer Hospital of Chinese Academy of Medical Sciences between September 2007 and March 2014 were reviewed. The relationship of CD20 expression in Reed-Sternberg(R-S)cells with CHL subtypes, clinical characteristics, and prognosis were analyzed. Fisher test was used to analyze the differences between groups and Kaplan-Meier for survival analysis.

A total of 263 patients were included in this study. Among the 263 patients, 74 (28.1%) were CD20-postitive. CD20-positive cases showed significantly higher proportions of Epstein-Barr virus (EBV) infection-related, mixed cellularity, and lymphocyte-rich CHL subtypes compared with CD20-negeative patients [52.8% (28/53) vs 19.0% (22/116), 37.9% (25/66) vs 31.6% (54/171), 22.7% (15/66) vs 3.5% (6/171), all P<0.05]. Univariate analysis identified EBV infection, age (≥ 40 years, especially ≥ 60 years), and Ⅲ-Ⅳ stage were correlated with reduced 3-year progression-free survival (PFS) and overall survival (OS) (PFS: 70.3 vs 87.7%, 79.2% vs 89.8%, 56.8% vs 91.5%, 70.4% vs 93.2%; OS: 81.0% vs 100%, 92.1% vs 99.4%, 75.4% vs 99.2%, 90.3% vs 100%; allP<0.05); and CD20-positive and not receiving local radiotherapy were associated with reduced PFS (79.7% vs 90.6%, 68.8% vs 90.6%, bothP<0.05), not with OS (92.4% vs 98.3%, 94.0% vs 99.4%, bothP>0.05). Patients positive in both CD20 expression and EBV-encoded small RNAs (EBER) showed low PFS.

CD20 expression in R-S cells in CHL may be closed related with EBV infection. EBV infection is associated with unfavorable prognosis. The effect of CD20-postitive on prognosis may be mediated by the prognostic effect of EBV infection.

To compare the effect of interscalene brachial plexus block (ISBPB) on the incidence of diaphragmatic paralysis, respiratory function and post-operative pain control using same dosage of local anesthetics diluted into two different volume and concentrations.

Approved by the Peking University Third Hospital ethics committee, sixty patients undergoing elective arthroscopic shoulder surgery in Peking University Third Hospital from November 2013 to April 2014 were randomly allocated into two groups according to random number table method: before induction of general anesthesia, ultrasound-guided ISBPB was performed using 0.5% ropivacaine 10 ml (Group A) or 0.25% ropivacaine 20 ml (Group B). The incidence of diaphragmatic paralysis, respiratory function and reduction of pulse oxygen saturation at 30 min post-block were recorded and analyzed.Patients were interviewed at 4, 8 and 24 h after block for numerical rating pain score, rescue analgesics requirement and sleep quality.

There were no statistically differences between group A and group B for the incidence of diaphragmatic paralysis at 30 min after block (67% vs 70%, χ ²=0.077, P>0.05). The change of forced vital capacity ((78±16)% vs (80±18)%,t=0.435, P>0.05), the change of forced expiratory volume in 1 second ((85±16)% vs (78±22)%,t=1.472, P>0.05) and the reduction of pulse oxygen saturation (1(0-3)% vs 2(0-3)%,Z=-0.538, P>0.05) showed no significant differences between the two groups at 30 min after block.There were no statistically differences in terms of the numerical rating pain score, rescue analgesics requirement and sleep quality at 4, 8 and 24 h after block (allP>0.05).

The use of 0.5% and 0.25% ropivacaine 50 mg for interscalene block provides similar effect on the incidence of diaphragmatic paralysis, changes in respiratory function and postoperative analgesia.

To explore the surgical method of using the modified chevron osteotomy combined distal soft tissue reconstruction to treat high-grade bunionette deformity.

From June 2013 to June 2015, the modified chevron osteotomy combined distal soft tissue reconstruction was used for surgical treatment of high-grade bunionette deformity in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital.Twenty-six patients with 28 feet high-grade bunionette deformity were hospitalized for treatment, with 3 male (3 feet) and 23 female (25 feet) cases, aged 22-73 (mean 47.1) years old.The average fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were measured on the pre-and post- operative anterior to posterior weight-beating X rays of treated feet.The American Orthopaedic Foot and Ankle Society (AOFAS) Lesser Toe Metatarsophalangeal-Interphalangeal Scale was used to evaluate the post-operative outcomes.

All of 26 patients were followed, with a mean 15.7 months (range 8-25 months). Primarily healing of the wound was achieved in all cases.No postoperative infection and nonunion on the osteotomy site was found during the follow-up time.The fracture healing time was 6-15 (mean 12.2) weeks.All the patients had satisfactory appearance and sensory function without callosum and metastatic metatarsalgia at the final follow-up.The post-operative fourth-fifth intermetatarsal angle, lateral deviation of the fifth metatarsal angle and metatarsophalangeal-fifth angle were significantly lesser than the pre-operative at the 6th week after operation, respectively [(5.5±1.7)°, (2.1±0.8)°, (5.7±2.6)°vs (16.4±4.2)°, (6.0±2.2)°, (10.5±7.4)°; all P<0.01]. The post-operative AOFAS score was significantly greater than the pre-operative [(87.1±6.7) vs (62.3±9.8) points,P<0.001].

The modified chevron osteotomy combined distal soft tissue reconstruction is a safe and easy treatment option for the high-grade bunionette deformity and provides patient satisfaction results.

To compare the effectiveness and complications of TVT-Abbrevo (tension-free vaginal tape-Abbrevo) and TVT-Obturator (tension-free vaginal tape-obturator) for the treatment of female stress urinary incontinence (SUI).

From Nov.2012 to Nov.2013, 117 patients suffering from SUI were treated with TVT-Abbrebo (n=79) or TVT-Obturator (n=38) procedure, the clinical efficacy and operation-correlated complications were observed.

A total of 117 cases, 107 cases of urinary incontinence symptoms disappeared completely, 10 cases were improved. 72 cases (91.1%) were cured and 7 cases (8.9%) were improved in TVT-Abbrevo group; 35 cases (92.1%) were cured and 3 cases (7.9%) were improved in TVT-Obturator group. No significant differences could be found for the curing rates between two groups (P>0.05). Compared with the TVT-Obturator group, the TVT-Abbrevo group had less patients complaining of inner thigh pain at 24 h and 1 w after surgery (P<0.05). No significant differences were observed for the incidence of inner thigh pain at 1m and 1y after surgery between TVT-Abbrevo and TVT-Obturator group (P>0.05). No intraoperative complications such as blood vessel, nerve, bladder damage were recorded and no postoperative retropubic hematoma, tape adjustment and other complications occurred in two goups. No recurrence after 1 year follow-up.

The study shows that TVT-Abbrevo procedure is safe and efficacy in treatment of SUI, and associated with low incidence of recent postoperative inner thigh pain.

To explore the effects of fine particulate matter on the level of nuclear factor erythroid-2 related factor 2 (Nrf2) in pulmonary tissues of chronic obstructive pulmonary disease (COPD) mouse models and its relationship with oxidative stress.

Totally 40 BALB/c mice were randomly divided into normal control group, normal PM2.5 group, COPD control group and COPD PM2.5 group.COPD mice were established using exposure of cigarette smoking.PM2.5 (20 mg/kg) was intratracheally instilled in PM2.5 group mice.Mice pulmonary function was measured by mice noninvasive body plethysmograph and lung histopathology was observed in normal control group and normal PM2.5 group mice.The mRNA and protein expression of Nrf2 was measured with real-time polymerase chain reaction (PCR) and Western blot methods.Total antioxidative capacity (TAC) was measured by O-phenanthroline colorimetry.Glutathione peroxidase (GSH-PX) was measured by improved Hafeman colorimetry and malondialdehyde (MDA) by thiobarbiturieacid colorimetry.

Nrf2 mRNA and protein in normal control group, normal PM2.5 group, COPD control group and COPD PM2.5 group were 1.00, 4.46±0.42, 4.93±0.63, 6.41±0.35 and 0.92±0.08, 1.23±0.07, 1.20±0.09, 1.43±0.10.Nrf2 mRNA and protein in COPD control group were increased than those in normal control group while those in normal PM2.5 group and COPD PM2.5 group were respectively higher than each control group.Comparing to normal PM2.5 group, the Nrf2 mRNA and protein in COPD PM2.5 group were increased (all P<0.01). TAC and GSH-PX in each group were (5.1±0.4), (2.9±0.4), (3.3±0.3), (1.8±0.3) and (13.4±0.5), (9.9±0.7), (9.8±0.7), (7.0±0.6) U/mgpro.TAC and GSH-PX in COPD control group were decreased than those in normal control group while those in normal PM2.5 group and COPD PM2.5 group were respectively lower than each control group.Comparing to normal PM2.5 group, the Nrf2 mRNA and protein in COPD PM2.5 group were decreased (allP<0.01). MDA in each group were (2.9±0.4), (4.8±0.5), (4.5±0.3), and (6.2±0.4) nmol/mgpro.MDA in COPD control group were increased than those in normal control group while those in normal PM2.5 group and COPD PM2.5 group were respectively higher than each control group.Comparing to normal PM2.5 group, the MDA in COPD PM2.5 group were increased (allP<0.01). Positive correlations were observed between Nrf2 mRNA, protein and MDA, while negative correlations were observed between Nrf2 mRNA, protein and TAC, GSH-PX in all groups (allP<0.05).

PM2.5 can induce Nrf2 expression and aggravate oxidative stress in COPD mice.The increased expression of Nrf2 is closely associated with oxidative stress.

To investigate the neuroprotective effect of α ₂ adrenergic agonist, dexmedetomidine on tumor necrosis factor α (TNF-α), interleukin-6 (IL-6) in brain tissue and serum S-100β protein level in traumatic brain injury rats.

Seventy-two male Sprague-Dawley rats were randomly divided into sham operation group (group S), traumatic brain injury group (group C), and dexmedetomidine group (group D), 24 rats in each group; each of which was divided into 6, 12, 24 and 48 hours subgroup, 6 rats in each subgroup. Parietal brain contusion was produced by reformed Feeney method. The group S underwent sham operation without blunt force stroke; group D underwent blunt force stroke, then received loading dose of dexmedetomidine, 3 μg/kg with common jugular vein injection and continued infusion with 3 μg·kg ^-1·h^-1 for 2 hours. The total dosage of dexmedetomidine was 9 μg/kg with a volume of 4 ml; group C underwent 0.9% NaCl, 4 ml injection at the same time point with the same method. The S-100 protein activity in arteria cruralis serum was detected at the each time point by ELISA and TNF-α, IL-6 in the brain tissue were detected by ELISA.

There were no significant difference of TNF-α activity among time point of 6, 12, 24 and 48 h in group S ((2.07±0.06), (2.01±0.03), (2.11±0.05), and (2.08±0.04) pg/mg,F=1.147, P>0.05), no significant difference of IL-6 activity among the same time point ((4.03±0.06), (4.07±0.09), (4.06±0.04), and (4.55±0.09) pg/mg,F=1.176, P>0.05), and no significant difference of serum S-100β activity among the same time too ((0.37±0.07), (0.36±0.02), (0.35±0.06), and (0.39±0.11) μg/L,F=1.045, P>0.05). The above indexes in group C were higher than those in group S, and the above indexes in group D were higher than those in group S and lower than those in group C (allP<0.05).

Alpha-2 adrenergic agonist, dexmedetomidine could dramatically inhibit inflammatory reaction induced by traumatic brain injury in rats and protect brain tissue.

To evaluate the feasibility, safety and efficiency of ex situ liver resection (ESLR)technique in patients with hepatocaval region involvement.

A systematic research of the data bases CNKI, Wan Fang, CQVIP, PubMed, CENTRAL, Medline, Embase, Cochrane, International Clinical Transplantation Registration Platform and Transplant Library was performed. All the current data regarding the feasibility, safety, and oncological efficiency of ESLR was systematically reviewed. Feasibility, conversion to allo-transplantation rate, complication and 90-day mortality were analyzed.

A literature search revealed a total of 46 publications with 191 patients who underwent ex situ liver resection (101 autotransplantation, 90 ante-situm liver resection). The most common indication was hepatocellular carcinoma (49), followed by colorectal liver metastasis (37), hepatic alveolar echinococcosis (33) and cholangiocarcinoma (26). The feasibility rate was 84.5% (CI=76.6%-90.1%), the conversion to allo-transplantation rate was 13.5% (CI=8.5%-21.0%). Overall complication rate was 58.1% (CI=48.5%-67.1%), and complications grade Ⅲa or higher occurred in 43.1% (CI=33.6%-53.1%).90-day mortality was 19.5% (CI=12.7%-28.8%).

ESLR and autotransplantation technique is an effective surgical approach for hepatic tumor with hepatocaval region involvement. Strict control of surgical indications, preoperative evaluation and precise surgical technique is essential to success.

Popliteal artery entrapment syndrome (PAES) is a disease in which the popliteal artery is compressed due to anatomical abnormalities in the popliteal fossa, resulting in corresponding lower limb ischemia symptoms. The medial head of gastrocnemius is gradually displaced in the popliteal fossa with embryonic development, and the arterial structure in the popliteal fossa is rearranged. During this process, the abnormal anatomical relationship between the popliteal artery and the surrounding muscles or tendons will lead to the occurrence of PAES^[1]。 The incidence of PAES is about 0.2% ~3.5%^[2,3], patients are generally young males, age<50% of 50-year-old patients with calf claudication are caused by this disease^[2,3,4]。

Mechanical ventilation is a commonly used supportive measure in the treatment of severe respiratory failure. Clinically, pneumothorax related to mechanical ventilation is prone to occur due to underlying diseases such as chronic obstructive pulmonary disease (COPD), diffuse pulmonary interstitial fibrosis, and improper setting of mechanical ventilation parameters^[1]。 Immediately after pneumothorax, closed drainage with intercostal cannula and water-sealed bottle is the most commonly used treatment^[2]。 However, due to the underlying lung diseases, some patients still have difficulty in ensuring ventilation support. We used fiberoptic bronchoscope to explore the segmental bronchus communicating with the visceral pleural rupture with balloon catheter in such patients, and then blocked the segmental bronchus with bio-glue, and received good results, which are reported as follows.

In recent years, the incidence of acid-related diseases has been gradually increasing, and proton pump inhibitors (PPIs) have potent inhibition of H^＋-K^＋-ATPase activity, gastric acid secretion and killing Helicobacter pylori are favored, and are widely used in the treatment of clinical acid-related diseases with remarkable curative effects. With the extensive application of proton pump inhibitors in clinical practice, clinicians have gradually paid attention to the rational application and adverse reactions in clinical practice. However, there are no rational application norms and guidelines for proton pump inhibitors. Therefore, this paper analyzed 200 medical records randomly selected from Linyi People's Hospital of Shandong Province who had used proton pump inhibitors, so as to provide corresponding basis and suggestions for clinical medication, reduce adverse reactions, reduce the risk of medication, and maximize the benefit of patients.

Hepatic ischemia-reperfusion injury (IRI) refers to the phenomenon that liver ischemia caused by lobectomy, liver transplantation, hemorrhagic shock, etc. When blood supply and reperfusion are restored, not only can liver function not be restored, but also aggravate liver cell dysfunction and structural damage. The mechanism of IRI in liver is very complex and has not been completely defined. To explore its mechanism and its prevention and treatment strategies has always been one of the hot spots in clinical and basic medical research for many years. The process of this injury may be related to calcium overload, inflammatory reaction, oxygen free radical (ROS) and lipid peroxidation, etc. The morphological changes are mainly swelling of hepatic sinusoidal endothelial cells, neutrophil infiltration and hepatocyte necrosis^[1,2,3]。 In addition to necrosis, there are also apoptosis and autophagy in the way of death of liver cells^[4,5]。 Apoptosis and autophagy have independent signaling pathways, but recent studies have confirmed that there are many intersections between them, which are both synergistic and antagonistic^[6,7]。

Takayasu arteritis (TA) is a chronic non-specific inflammatory artery disease. The inflammation mainly involves the aorta and its main branches, including the pulmonary and coronary arteries^[1]。 It is more common in young Asian women and was once called "Oriental Beauty Disease". Stenosis or occlusion of the lumen caused by thickening of the vessel wall is the most common type of lesion, and some patients can develop aneurysms due to decreased elasticity of the vessel wall. Therefore, the clinical manifestations are mostly ischemia of the corresponding organs, such as hypertension, asymmetric pulse and blood pressure of the limbs, cerebral ischemia, intermittent claudication and vascular murmur^[2,3]。 Heart failure secondary to the above-mentioned lesions is the main cause of death in TA.

In recent years, tumor immunotherapy has made rapid development, leading a major breakthrough in the field of tumor treatment. The American Society of Clinical Oncology (ASCO) Annual Report on Cancer Research Progress, released on February 4, 2016, ranked immunotherapy as the largest progress in cancer research in 2015^[1]。 At present, the successful fields of tumor immunotherapy and research hotspots mainly focus on immune checkpoint inhibitors. A series of clinical studies have shown that immune checkpoint inhibitors are effective against a variety of malignancies. Three immune checkpoint inhibitors, ipilimumab, nivolumab and pembrolizumab, have been approved by the U.S. Food and Drug Administration (FDA) as standard treatment for the treatment of advanced non-small cell lung cancer (NSCLC), advanced melanoma or advanced kidney cancer^[2,3]。 The relevant research is summarized as follows.

The prevalence of iron deficiency was high in all age groups^[1]It has great influence on human body's intelligence, physical development, immune function, digestion and absorption function and labor ability. Therefore, it is of great clinical and social significance to study and prevent iron deficiency in depth.