Showing papers in "National Medical Journal of China in 2019"

[Comparison of ultrasound-guided serratus anterior plane block and erector spinae plane blockperioperatively in radical mastectomy].

Abstract: Objective: To compare the perioperative effects of ultrasound-guided serratus anterior plane block (SAPB) and erector spinae plane block (ESPB) in radical mastectomy. Methods: One hundred and fifty patients,undergoing radical mastectomy from May 2016 to Jan 2019,the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, were randomly divided into SAPB group, ESPB group and control group. Patients in SAPB group and ESPB group were received corresponding blocks before induction of general anesthesia. The control group was only received routine general anesthesia without any block. Patient-controlled intravenous analgesia (PCIA) was performed in all the patients postoperatively. The VAS score at rest or coughing and Ramsay score at 2, 4, 8, 12, 24, 48 h after operation were compared among the three groups. The intraoperative dosages of propofol and remifentanil,press times and sufentanil cumulative dosage of PCIA in 48 hours after operation, postoperative rehabilitation indicators and adverse effects were all compared. Results: In all the three groups,the VAS scores at rest and coughing increased first and then decreased 2 h to 48 h after operation. The VAS scores in SAPB group and ESPB group were lower than that in control group (P 0.05). For Ramsay score, among the three groups, there were no significances of the main effects of group and time point, as well as interaction effect (all P>0.05). The intraoperative dosages of propofol and remifentanil in SAPB group and ESPB group were lower than those in control group (P 0.05). The times of first anal exhaust, ambulation and hospitalization after operation in ESPB group and SAPB group were significantly shorter than those in control group (P 0.05). The incidences of skin itching and nausea in ESPB and SAPB groups were lower than those in control group (P 0.05). Conclusions: Both SAPB and ESPB can provide good and safe analgesia for radical mastectomy,with equivalent performances in analgesia and adverse effect.

[Intervention effect of biofeedback combined with pelvic floor muscle exercise on low anterior resection syndrome in patients with low anus-preserving rectal cancer].

Abstract: Objective: To explore the effect of biofeedback training combined with pelvic floor muscle exercise on the recovery of anorectal function in patients with middle and low rectal cancer undergoing sphincter-preserving surgery, and to find the best way to prevent low anterior resection syndrome. Methods: A single-center prospective randomized controlled study was conducted. One hundred and nine patients with mid-low rectal cancer in Sun Yat-sen University Cancer Centre from June 2015 to December 2016 were enrolled in the study, who were going to undergo sphincter-preserving surgery or preventive ostomy after preoperative chemoradiotherapy. They were divided into three groups: blank control group, pelvic floor muscle exercise group and biofeedback training combined with pelvic floor muscle exercise group. Intervention and follow-up were conducted for 16 months. High-resolution anorectal manometry was used to measure the objective anorectal pressure and sensory index of patients, and the Chinese version of MSKCC Intestinal Function Questionnaire was used to evaluate the intestinal function of patients. The differences of objective anorectal manometry index and subjective intestinal function between the three groups were compared, and the occurrence of low anterior rectal resection syndrome was evaluated. Results: At the end of the intervention, the total scores of anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time, initial rectal volume, rectal fecal sensory capacity, rectal maximum tolerance capacity, rectal compliance, anorectal hypertensive zone and total score of intestinal function in the biofeedback training combined with pelvic floor muscle exercise group were (44.83±9.01) mmHg, (4.31±1.75) mmHg, (130.46±10.00) mmHg, (19.94±4.30) s, (32.71±5.00) ml, (74.26±8.30) ml, (188.4±12.68) ml, (5.69±1.18) ml/kPa, (3.31±0.96) cm and (68.09±6.38) points respectively. The main effects of the changes of five indices, including anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time and anal high pressure zone, were time. Significant differences were found in initial rectal capacity, sensory capacity of rectal defecation, maximum tolerance capacity of rectum, rectal compliance and total score of intestinal function in every time point of measurement in the biofeedback training group combined with pelvic floor muscle exercise group. They were significantly higher than those in the blank control group (P<0.05); the score of the biofeedback training group combined with pelvic floor muscle exercise group at one month after operation, perioperative period and 3 months after operation were significantly higher than those in pelvic floor muscle exercise group (P<0.05). Biofeedback training combined with pelvic floor muscle exercise reduced the incidence of low anterior resection syndrome of rectum (P<0.05). Conclusion: Biofeedback training combined with pelvic floor muscle exercise can significantly improve the sensory indicators of patients with mid-low rectal cancer, promote the recovery of intestinal function, and alleviate low anterior resection syndrome of rectal cancer patients, which is worthy of popularization and application.

[Effect of esmolol in septic shock patients with tachycardia: a randomized clinical trial].

Abstract: Objective: To investigate the effect of esmolol in septic shock patients with tachycardia. Methods: A prospective randomized controlled trial was conducted. Screening septic shock patients that admitted to Department of General Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from June 2016 to August 2017. After 24 h resuscitation therapy, 100 cases of septic shock patients with tachycardia (heart rate>100 bpm) were divided into esmolol group (n=50) and control group (n=50) with random number table. Patients in esmolol group accepted standard treatment plus esmolol injection with an initial dose of 25 mg/h. Heart rate target is 80 to 100 bpm. Patients in esmolol group continued to use esmolol for 7 days or to the day the patient left the ICU when the heart rate didn't achieve the target. Patients in control group were given standard treatment. Primary outcome was 28 d mortality. Secondary outcomes included heart rate, norepinephrine dosages, lactate level, inflammatory markers in per day during the trial; acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on day 1, 3, 5, 7; length of hospital stay, length of mechanical ventilation, medication time of vasoactive agent. The data were compared with t test or rank sum test between the two groups. Results: The 28 d mortality of esmolol group and control group was 62%, 68%, respectively(χ(2)=0.529, P=0.529). Logistic regression analysis showed that primary heart rate (increase of 10 bpm, OR=1.568, 95%CI: 1.039-1.238, P=0.027), primary APACHEⅡ (OR=1.134, 95%CI: 1.026-1.239, P=0.005), integral heart rate (per 10 bpm, OR=2.207, 95%CI: 1.400-3.479, P=0.001) were independent risk factors for 28 d mortality. Compared with control group, the esmolol group had a lower heart rate on day 1-7; but over all, there was no statistically significant difference in heart rate between the two groups (P>0.05). There was no significant difference in total does of norepinephrine, lactate level, inflammatory markers, APACHE Ⅱ, SOFA, length of hospital stay between the two groups (all P>0.05). Conclusion: Tachycardia significantly increases the risk of death in patients with septic shock, esmolol may decrease the mortality by controlling heart rate.

Tetracycline and metronidazole based quadruple regimen as first line treatment for penicillin allergic patients with Helicobacter pylori infection

Abstract: Objective: To evaluate the efficacy and safety of tetracycline and metronidazole based quadruple regimen as first line treatment for penicillin allergic patients with Helicobacter pylori (H.pylori) infection. Methods: The clinical data of 120 patients who had infected with H. pylori and were allergic to penicillin in out-patient clinic of Peking University First Hospital was retrospectively collected from January 2014 to June 2016. The regimen included: lansoprazole 30 mg twice a day+ Bismuth 150 mg three times a day+ tetracycline 500 mg three times a day+ metronidazole 400 mg three times a day, for 14 days. All patients were followed up 7 days, 14 days, at least 4 weeks after the treatment. Symptoms and side effects were recorded. The H.pylori status was evaluated by (13)C urease breath test at least 4 weeks after the end of the treatment. Results: All patients included 86 female and 34 male, and the average age is 59 years. There are 104 of the 120 cases who got success in eradication treatment. Mild to moderate adverse effects occurred in 56 cases (46.7%). 10 female patients dropped out because of headache, rash, vomiting and fatigue. The eradication rates were 86.7% (104/120, ITT) and 94.5% (104/110, PP). Conclusions: Tetracycline and metronidazole based 14-day quadruple regimen is effective as first line treatment for penicillin allergic patients with H. pylori infection because of its relatively high eradication rate. Patients should be watched closely during the treatment since the adverse effects of this regimen happen frequently,especially for female patients.

[An epidemiologic study of pelvic organ prolapse in urban Chinese women: a population-based sample in China].

Abstract: Objective: This study aimed to assess the prevalence and factors associated with pelvic organ prolapse (POP) in a representative sample of Chinese urban women. Methods: A total of 29613 Chinese urban women were recruited to this cross-sectional study between February 2014 and March 2016. The prevalence of POP, defined as any stage Ⅱ or higher POP resulting in symptoms, was assessed using questionnaires and physical examinations. Multivariable logistic regression was used to assess factors associated with POP. Results: 2 864 of 29 613 women (9.67%) had POP. The prevalence of POP increased with age ranging from 1.23% (82/6 646) of women aged between 20 and 29 years to 26.11% (727/2 784) for those aged 70 years or older (P<0.000 1). Overweight and obese women were more likely to have POP than normal weight women [AOR=1.56, 95%CI 1.42-1.72 vs AOR=1.74, 95%CI 1.48-2.03]. In the multivariate analysis, the independent risk factors were cough (AOR=1.70, 95%CI 1.44-2.02), constipation (AOR=2.05, 95%CI 1.82-2.32), physical disease (AOR=1.27, 95%CI 1.15-1.41), and gynecological diseases (AOR=2.08, 95%CI 1.89-2.29). Nulliparous (AOR=0.12, 95%CI 0.06-0.22) and caesarean section (CS) (AOR=0.55, 95%CI 0.47-0.64) were protective factors for POP. Conclusions: POP affects nearly 10% of women in Chinese urban region. The prevalence of POP increases significantly with age. The independent risk factors for POP are body mass index, cough, constipation, physical disease and gynecological diseases. Nulliparous and CS are protective factors for POP.

The application of rapid rehabilitation model of multidisciplinary cooperation in cesarean section and the evaluation of health economics

Abstract: Objective To explore the application value of multiple disciplinary team Enhanced recovery after surgery (MDT-ERAS) in cesarean section and evaluate its health economic benefits. Methods A total of 572 cases of pregnant women undergoing cesarean section in obstetrics department of Jiaxing Maternity and Child Health Care Hospital from March 2018 to March 2019 were selected and randomly divided into experimental group and control group, 286 cases in each group. The control group was treated with traditional rehabilitation mode, and the experimental group was treated with MDT-ERAS intervention to compare the difference of rehabilitation index and health economics index between the two groups, and to evaluate the application value and health economics benefit of MDT-ERAS. Results The VAS scores of the two groups at 1 day after operation were higher than those at the time of returning to the ward after operation(1.81±0.40 VS. 1.58±0.39, 3.78±0.89 VS. 3.22±0.83, all P<0.05). The VAS scores at 2 days and 3 days after operation were lower than those at the time of returning to the ward(0.58±0.09 VS. 1.58±0.39, 1.02±0.15 VS. 1.58±0.39; 1.88±0.37 VS. 3.22±0.83, 2.67±0.44 VS. 3.22±0.83, all P<0.05). The VAS scores of the experimental group at each time point after operation were lower than those of the control group(1.58±0.39 VS. 3.22±0.83, 1.81±0.40 VS. 3.78±0.89, 1.02±0.15 VS. 2.67±0.44, 0.58±0.09 VS. 1.88±0.37), and these differences were statistically significant (P<0.05). The anal exhaust time, indwelling catheterization time, first time out of bed and first time eating time of the experimental group were lower than those of the control group, with statistical significance (P<0.05). Postpartum hemorrhage rate and neonatal milk addition rate in the experimental group were significantly lower than those in the control group (all P<0.05). The hospitalization time and hospitalization expenses of the experimental group were lower than those of the control group(all P<0.05), and the health economics benefit of the experimental group was significantly higher than that of the latter (P<0.05). Conclusion MDT-ERAS can effectively improve the recovery rate of the parturient after cesarean section, ensure the analgesic effect and improve the maternal and infant outcomes, and has higher health and economic benefits, which is worthy of promotion. Key words: Multidisciplinary cooperation; Enhanced recovery after surgery; Cesarean section; Health economics

Effect of artesunate on airway responsiveness and airway inflammation in asthmatic mice

Abstract: Objective: To observe the effects of artesunate on airway responsiveness and airway inflammation in asthmatic mice. Methods: Thirty female BALB/c mice aged 6-8 weeks were randomly divided into control group, asthma group and artesunate group. In the asthma group and the artesunate group, the mice were sensitized by intraperitoneal injection of 20 μg of ovalbumin (OVA) and 0.2 ml of aluminum hydroxide suspension (2 mg) on day 0 and 14, respectively, and 1% OVA 10 ml dissolved in sterile phosphate (PBS) buffer was aerosolized for 30 min from the 21st to 28th day. The control group was sensitized with 0.2 ml of 2 mg suspension of aluminum hydroxide on day 0 and 14, and aerosolized by 10 ml of sterile PBS from the 21st to 28th day. Before the challenge, the artesunate group was intraperitoneally injected with 0.2 ml of artesunate. Artesunate was replaced with the same amount of normal saline in the control group and the asthma group. The mice were treated after 24 hours of last stimulation. The airway responsiveness of mice was measured by airway intubation and the changes of airway resistance and compliance were observed. Bronchoalveolar lavage fluid (BALF) was classified by cytology, and pathological changes of left lung tissue were observed and scored. Results: The airway resistance of the three groups increased and the lung compliance decreased with the increase of methacholine (Ach) concentration. The airway resistance and lung compliance of the three groups were different under the same concentration (P<0.05). The airway resistance of the artesunate group at Ach 6.25, 12.5, 25, 50, 100 mg/ml was lower than that of the asthma group at the same concentration [(1.01±0.48) vs (1.30±0.22), (1.06±0.44) vs (1.70±0.31), (1.30±0.64) vs (2.66±0.79), (1.82±0.55) vs (3.38±1.35), (2.49±0.85) vs (4.07±1.34) cmH(2)O·s(-1)·ml(-1)(1 cmH(2)O=0.098 kPa); t=3.862, 7.376, 9.113, 7.051, 6.685, all P<0.05]; the degree of lung compliance decrease at the concentration of Ach 3.125, 6.25, 12.5, 25, 50, 100 mg/ml was lower than that of the asthma group at the same concentration [(3.89±0.55)×10(-2) vs (3.07±0.63)×10(-2), (3.61±0.52)×10(-2) vs (3.04±0.58)×10(-2), (3.48±0.38)×10(-2) vs (2.78±0.57)×10(-2), (3.09±0.52)×10(-2) vs (1.73±0.62)×10(-2), (2.32±0.60)×10(-2) vs (1.29±0.54)×10(-2), (1.87±0.59)×10(-2) vs (1.15±0.44)×10(-2) ml/cmH(2)O; t=-6.295, -4.921, -6.533, -11.135, -8.48, -6.319, all P<0.05]. The proportion of eosinophils in artesunate group in BALF was significantly lower than that in asthma group [(16.63±8.58)% vs (40.44±12.94)%; t=4.336, P<0.05]. In the asthma group, the inflammatory cells infiltration of the bronchi and the perivascular area, the bronchial epithelial edema and degeneration can be observed, and the artesunate could reduce the infiltration of inflammatory cells around the bronchus and blood vessels, and the mucus secretion was also reduced in the artesunate group. Conclusion: Artesunate can improve airway hyperresponsiveness and airway inflammation in asthmatic mice and has a certain therapeutic effect on asthma.

Comparison of cortical bone trajectory screw fixation and pedicle screw fixation in posterior lumbar fusion

Abstract: Objective To evaluate the efficacy and safety of cortical screw fixation in posterior lumbar spine fixation with cortical bone trajectory (CBT) fixation or pedicle screw (PS) fixation in posterior lumbar fusion. Methods It was a prospective study and CBT or PS for the treatment of lumbar disease from August 2015 to August 2017 in Beijing Chaoyang Hospital were analyzed. There were 53 males and 51 females, aged 56-78 years (mean age, (67±5) years). The patient′s gender, age, operative time, intraoperative blood loss, postoperative bleeding, postoperative hospital stay, and postoperative patient satisfaction were collected. The Oswestry disability index (ODI) and visual analogue scale (VAS) of back pain were used to evaluate preoperative and half-year, one-year and two-year postoperative function and quality of life. Complications such as wound infection, cage displacement, screw extraction and fixation fracture were compared between the two groups. The data of normal distribution were compared with Student t test between the two groups. Results There was no significant difference in the operation time between the CBT group (n=50) and the PS group (n=54) ((223±17) min vs (221±16) min, t=0.74, P=0.46). The intraoperative blood loss and wound drainage volume were significantly lower in the CBT group than those in the PS screw group (t=-24.20, -57.62, both P<0.05). The average length of hospital stay in the CBT group was significantly shorter than that in the PS group (t=-7.65, P=0.00). Patients with CBT screws had better postoperative satisfaction than patients in PS group (91±6 vs 86±7, t=3.89, P=0.00). The ODI score in the CBT group was significantly lower than that in the PD screw group half a year after the operation (3.9±1.9 vs 5.8±3.1, t=-3.66, P=0.00). The VAS and ODI scores in the CBT group were significantly lower than those in the PS group 1 year after the surgery (t=-3.03, -4.09, both P<0.05). There was no significant differences in wound infection, cage displacement, screw extraction and fixation fracture between the two groups. Conclusion CBT screw technique is minimally invasive, with short operation time, less intraoperative blood loss, rapid postoperative recovery and low complications. It can be effectively used in posterior lumbar cone fusion. Key words: Posterior lumbar interbody fusion; Cortical bone trajectory; Pedicle screw

[Comparison of preoperative planning of radioactive seed implantation for pelvic wall recurrent gynecological malignant tumors between 3D-printing non-coplanar template and 3D-printing coplanar template].

Abstract: Objective: To compare the difference of preoperative planning parameters between 3D-printing non-coplanar template (3D-PNCT) and 3D-printing coplanar template (3D-PCT) in the treatment of pelvic wall recurrent gynecological malignant tumor with radioactive seeds implantation, and to guide the clinical application. Methods: From January 2016 to March 2018, 33 patients with pelvic wall recurrent gynecological malignant tumor were treated with radioactive seeds implantation assisted by 3D-printing template and in Peking University Third Hospital. All patients underwent 3D-PNCT and 3D-PCT preoperative planning. The D(90) of target remained similar for the same patient. The parameters were compared with Wilcoxon test or Kruskal-Wallis test. Results: D(90) was similar between the two groups (P>0.05). The number of inserting needles through intestine and bone in 3D-PNCT group was less than that in 3D-PCT group (0 (0-13), 0 (0-25), Z=-2.941, P<0.05;0 (0-3), 0 (0-25), Z=-2.232, P<0.05). Conclusion: For patients with gynecological malignancies with pelvic recurrence, both of the two peroperative plans could achieve prescription dose, but 3D-PNCT is more safer.

[Jinghuaweikang capsules combined with Quadruple therapy in the treatment of Helicobacter pylori infection:a multicenter,randomized,controlled,clinical study].

Abstract: Objective: To explore the efficacy of Jinghuaweikang capsules combined with Quadruple therapy in the treatment of Helicobacter pylori (H.pylori)infection. Methods: Patients who were infected with H.pylori in 7 centers in Gansu Province were recruited in this prospective simple randomized study. All the patients are divided into four groups randomly: patients in Group A1 were treated with esomeprazole (20 mg, twice a day) + pectin bismuth (200 mg, three times a day) + amoxicillin (1 000 mg, twice a day) + clarithromycin (500 mg, twice a day), while Group A2 with Jinghuaweikang capsules(160 mg, three times a day) based on group A2, Group B1 with esomeprazole (20 mg, twice a day) + bismuth pectin (200 mg, three times a day) + amoxicillin (1 000 mg, twice a day) + furazolidone (100 mg, twice a day) and Group B2 with Jinghuaweikang capsules(160 mg, three times a day) based on group B2. The treatment time was 14 days for all 4 groups. In the course of treatment, abdominal pain, acid reflux, abdominal distension, belching, hiccups were observed at the time before treatment, 14 days and 30 days after treatment and were scored. Finally, all patients received (13)C or (14)C for H.pylori at the time of 30 days after the treatment. Result: A total of 455 patients were included in 7 hospitals from February 2016 to May 2017 in Gansu province, and there were 189 male patients. Group A1 included 129 cases, group A2 96 cases, group B1 112 cases and group B2 118 cases. The eradication rates that accorded with program data analysis (PP) were A1[46.9%(60/128)], A2[63.8%(60/94)], B1[60.7%(68/112)], B2[68.6%(81/118)] (P<0.004). Compared with group A1, the eradication rate of H.pylori in group B1 and group A2 increased (P<0.001, P=0.032), there was no statistical difference between group B2 and group A2, group B1 and group B2 (P=0.208, P=0.461). According to intentional analysis (ITT), the eradication rates of H.pylori in group A1 were 46.5% (60/129),group A2 were 62.5% (60/96),group B1 were 60.7% (68/112),and group B2 were 68.6% (81/118).The radical rate of A2 was higher than A1 (P=0.017), group B2 was not higher than group B1 (P=0.208), and there was no significant difference among the other groups. The symptoms of abdominal pain, abdominal distention, acid reflux, belching and hiccup in the group A2 and group B2 were improved than those in group A1 and group B1 (P<0.05). No serious adverse reactions occurred in all groups. Conclusion: Jinghuaweikang capsules can improve the eradication rate of Helicobacter pylori, and improve the symptoms of patients.

Efficacy and safety of compound betamethasone cocktail therapy in primary unilateral unicompartmental knee arthroplasty

Abstract: Objective: To evaluate the efficacy and safety of an intraoperative betamethasone periarticular injection in patients undergoing primary unicompartmental knee arthroplasty (UKA). Methods: Seventy patients with knee anteromedial osteoarthritis who underwent the primary unilateral UKA in China-Japan Friendship Hospital from July 2017 to October 2018 were randomized into two groups with random number table. In the group A, an analgesic mixture of morphine, ropivacaine, epinephrine, ketorolac and betamethasone was infiltrated intraoperatively into the soft tissue. While in the group B, a same volume of mixture without betamethasone was injected alternatively. The visual analogue scale (VAS) of pain and analgesic consumption were evaluated to compare the effectiveness of pain control between the two groups. In addition, maximal flexion of the knee andinitial time of the straight leg raising were monitored. Complications were assessed too. The data were compared with independent-sample t test. Results: No significant differences in VAS score was found between the groups at 6 h and 12 h after the operation (t=-1.154, -1.108, both P>0.05), but the pain level and analgesic consumption were significantly lower in the group A from 18 h to 72 h post operation (t=-2.959, -2.808, -2.080, -2.519, -3.378, -3.237, all P 0.05). Conclusions: The cocktail analgesics injection containing small dose of betamethasone during UKA can provide effective acute pain control early after the surgery, which is conducive to knee joint function, and it does not increase the incidence of postoperative complications.

[Contrast-enhanced CT and texture analysis of mass-forming pancreatitis and cancer in the pancreatic head].

Abstract: Objective: To explore the value of contrast-enhanced CT combined with texture analysis in differentiating pancreatic cancer from mass-forming pancreatitis in pancreatic head. Methods: A retrospective study collected 21 patients with pancreatic head mass-forming pancreatitis confirmed by surgery or biopsy and 47 patients with pancreatic ductal adenocarcinoma confirmed by surgery. The patients visited the Affiliated Hospital of Nanjing University of Chinese Medicine and the First Affiliated Hospital of Wannan Medical College between January 2014 and December 2017. Gender, age and CT findings were collected. The parenchymal phase was selected for texture analysis. The minimum absolute shrinkage and selection operator (LASSO) method was applied for dimensionality reduction.Two independent sample t-tests or Mann-Whitney U test were used for continuous variables based on the Shapiro-Wilks normality test results. Categorical variables were tested by Chi-square or Fisher test. By multivariable regression analysis, CT findings, CT texture analysis, CT findings combined with texture analysis prediction models were established. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of individual indicators and each prediction model. The Delong test was used to compare the area under the curve (AUC) of each model. Results: The CT findings prediction model consisted of CT value of lesion on pancreatic parenchymal phase and pancreatic duct penetrating sign. The texture analysis prediction model consists of root mean square and low grey level run emphasis_angle135. The AUC of them were not statistically different (Z=0.150,P>0.05). The combined predictive model had the better diagnostic performance (AUC 0.944, sensitivity 83.0%, specificity 95.2%, +LR 17.43, -LR 0.18) than CT sign prediction model (Z=2.008, P<0.05) and texture analysis prediction model(Z=2.236, P<0.05) were significantly different. Conclusions: The CT findings model and the texture analysis model have equivalent diagnostic performance in the differentiation of mass-forming pancreatitis and pancreatic cancer. The enhanced CT combined with texture analysis model has the best diagnostic efficiency and can further improve the diagnostic ability.

Clinical features of 20 patients with phytosterolemia causing hematologic abnormalities

Abstract: Objective: To investigate the clinical and laboratory features of Phytosterolemia with hematological abnormalities. Methods: A retrospective study was performed on 20 patients with phytosterolemia admitted to the hematology department of the First Affiliated Hospital of Suzhou University during 2004-2017. History of patients was collected and the platelet counts, lipidomic analysis of plasma and osmotic fragility of erythrocytes were carried out. The erythrocyte and platelet morphology was examined by light microscope. Phytosterol levels in serum were measured by high performance liquid chromatography method. All of ABCG5/8 exons and intron-exon boundaries were amplified by PCR and directly sequenced to identify mutations. Results: All patients had been misdiagnosed as immune thrombocytopenia (ITP), or Evans syndrome with a mean delay of 21 years between symptom onset and accuracy diagnosis. The clinical manifestations of the patients were variable, but most of them presented with thrombocytopenia, anemia, splenomegaly from early ages, and xanthomas. Other major features were also observed, such as impaired liver functions (9 cases), premature atherosclerosis (5 cases) and/or arthritis (4 cases). Interestingly, all patients displayed an increased osmotic fragility of red cells and unique blood film features: large unequal platelets surrounded by a circle of vacuoles and various abnormal erythrocyte shapes, especially stomatocyte. Serum levels of the sitosterol and stigmasterol in the patients were remarkably elevated up to 331.05(276.00, 670.20)mg/L and 244.60(193.78,399.40)mg/L, about 10 and 24 times higher than those of normal subjects. There were 14 mutations in ABCG5/8 genes found in the patients. Among them, 2/3 of the mutations were in ABCG5 gene, including p.(E22X), p.(R446X),g.ISV7+3G>A, p.(R446X), p.(R419H), g.ISV7+3G>A, p.(G90E), p.(R389H) and g.7+2G>A), and 1/3 in ABCG8 gene involving p.(M614-K628del), p.(E25X), p.(L86P fs X185), p.(R263Q), p.(E500D fs X604) and p.(G674R) mutation. The ABCG5 p.(R446X) mutation was found in 3 separate families. Conclusions: The phenomena of thrombocytopenia/ stomatocyte/splenomegaly represents a special clinical manifestations of phytosterolemia, and distinct changes of blood cell morphology are the typical characters. Plasma plant sterols and ABCG5/ABCG8 genes should be analyzed when such hematologic abnormalities are unexplained.

[The diagnostic value of serum KL-6 in connective tissue disease associated interstitial lung disease]

Abstract: Objective: To evaluate the diagnostic value of the serum Krebs von den Lungen-6 (KL-6) for the interstitial lung disease associated with connective tissue diseases (CTD-ILD). Methods: 84 patients with CTD-ILD (CTD-ILD group) and 91 patients with connective tissue disease (CTD group) who visited the department of rheumatology and immunology of People's Hospital of Xinjiang Uygur Autonomous Region between January, 2016 and December, 2017 were included. Serum KL-6 levels were measured by commercially available enzyme linked immunosorbent assay (ELISA) kits. Results: The significantly higher levels of KL-6 were determined in the CTD-ILD group than CTD group [1 239 (577, 2 094) vs 152 (89, 280) U/ml] (P<0.001). The optimal cutoff value of serum KL-6 for diagnosis of CTD-ILD was 402 U/ml, and the sensitivity and specificity were 82.1% and 86.8%, respectively. Area Under the Curve (AUC) was 0.905. Logistic regression analysis revealed that elevated KL-6 and decreased Carbon monoxide diffusion capacity were independently correlated with the occurrence of CTD-ILD, the decreased of DLcoSB% (OR=0.928, 95%CI: 0.891-0.968) and increase of KL-6 level (OR=1.005, 95%CI: 1.003-1.007) was the independent risk factor for the occurrence of ILD. Conclusion: The serum KL-6 is an important biomarker for the diagnosis of CTD-ILD and when the level of KL-6 is increased, the ILD should be alert.

[Knee stability after anterior cruciate ligament reconstruction with weight-bearing magnetic resonance imaging].

Abstract: Objective To investigate the application value of the weight-bearing magnetic resonance imaging (MRI) in evaluating the stability of knee joint after anterior cruciate ligament reconstruction. Methods From July 2011 to August 2013, a total of 25 patients with anterior cruciate ligament rupture and reconstruction surgery in the Second Affiliated Hospital of Soochow University were enrolled in this study, including 18 males and 7 females, with an average age of (32±5) years. All the patients underwent the weight-bearing MRI, knee joint passive relaxation test (Kneelax 3), and Lysholm score before the surgery and 3 and 6 months after the surgery. The three examinations before and after the operation were analyzed by repeated measures of general linear model, and paired t test was used to compare the results before and after the operation. The correlation between the three preoperative examinations was statistically analyzed. Results The relaxation data measured by Kneelax 3 after the surgery was significantly lower than that before the operation [(1.1±0.9) mm vs (6.1±1.3) mm, t=16.9, P<0.01]. The post-operative lateral tibial plateau anterior shift score was less than the pre-operative score [(3.0±0.7) mm vs (4.8±1.2) mm, t=6.2, P<0.01]. The post-operative Lysholm score was significantly higher than that before the operation (89±6 vs 64±14, t=-8.3, P<0.05). There was a negative correlation between the anterior displacement of the lateral platform and Lysholm score (r=-0.902, P<0.01). There was no correlation between anterior displacement and passive relaxation of the lateral platform in preoperative weight-bearing MRI. Conclusions Anterior cruciate ligament reconstruction can improve the knee stability. The stability of knee joint can be evaluated by weight-bearing MRI. The anterior tibial displacement measured by the weight-bearing MRI is correlated with the clinical score. Key words: Anterior cruciate ligament reconstruction; Knee stability; Weight bearing magnetic resonance imaging

[Diagnostic value of HBP, PCT combined with APACHE II score respectively in ventilator-associated pneumonia].

Abstract: Objective: To evaluate the diagnostic value of the heparin-binding protein (HBP), procalcitonin (PCT) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in ventilator-associated pneμmonia (VAP). Methods: A total of 160 patients who required tracheotomy or intubation and assisted breathing with invasive mechanical ventilator from the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2017 was included in this prospective study,and divided into VAP group and no-VAP group based on if VAP happened or not; the VAP group was further divided into deterioration group and improvement group based on the curative effect after anti-infective treatment for 1 week. A total of 40 community acquired pneumonia (CAP) patients and 30 healthy volunteers were also included as control groups. The levels of HBP and PCT in blood of the subjects were tested with enzyme-linked immuno sorbent assay (ELISA) and chemiluminescence immunoassay (ECLIA) respectively, APACHE Ⅱ score was utilized to assess the severity of illness. The difference of HBP, PCT levels and APACHE Ⅱ score among the groups were analyzed. Receiver operating characteristic(ROC) curve was utilized to analyze the diagnostic value of HBP, PCT, APACHE Ⅱ score in VAP. Results: A total of 230 subjects participated in this study, including 68 VAP patients, 92 non-VAP patients, 40 CAP patients and 30 healthy volunteers. Before administration of mechanical ventilation, there were no statistically significant differences in HBP, PCT and APACHE Ⅱ score between VAP group and non-VAP group (all P>0.05). The levels of HBP,PCT and APACHE Ⅱ score were (41.4±21.3) μg/L,(0.355±0.254) μg/L,(13.4±2.5) respectively when the VAP was diagnosed,which were higher than those within the first 12 h of mechanical ventilation (7.3±2.7) μg/L, (0.080±0.038) μg/L, (8.4±2.0), all P 0.05). The levels of HBP was positively correlated with PCT and APACHE Ⅱ score (r=0.82, 0.68, all P<0.001). In deterioration group,the HBP,PCT and APACHE Ⅱ score after 1 week of anti-infective treatment were higher than those when the VAP was diagnosed (all P<0.001). No matter it is when the VAP was diagnosed or after anti-infective treatment for 1 week,the levels of HBP, PCT and APACHE Ⅱ score in deterioration group were higher than those in the improvement group (all P<0.001). The area under curve (AUC) of HBP+APACHE Ⅱ score, PCT+APACHE Ⅱ score for VAP diagnosis was 0.98, 0.95 respectively. The sensitivity of HBP+APACHE Ⅱ score in the diagnosis of VAP was lower than PCT+APACHE Ⅱ score (94.1% vs 95.6%),and the specificity was higher (92.4% vs 82.6%). Conclusion: The diagnostic value of HBP+APACHE Ⅱ score for early VAP is superior to PCT+APACHE Ⅱ score.

Risk factors associated with systemic inflammatory response syndrome after flexible ueteroscopic lithotripsy based on enhanced recovery after surgery

Abstract: Objective: To investigate the risk factors of systemic inflammatory response syndrome (SIRS) in patients undergoing flexible ureteroscopic lithotripsy based on enhanced recovery after surgery (ERAS). Methods: The clinical data of 243 kidney stone cases who underwent flexible ureteroscopic lithotripsy based on ERAS in the First Affiliated Hospital of Wannan Medical College from January 2016 to December 2017 were analyzed retrospectively. The cases were divided into two groups according to whether they had SIRS after surgery: SIRS group (26 cases) and non-SIRS group (217 cases). The age, gender, laterality of kidney stone, history of previous kidney stone surgery, degree of hydronephrosis, multiple kidney stones, length of operation time, white blood cell count of preoperative urine routine, result of preoperative urine culture, use of preoperative antibiotics, diabetes and other chronic diseases in the groups were collected and analyzed. Results: SIRS occurred in 26 cases in this study, which accounted for 10.7% (26/243). Multivariate analysis found that, moderate and severe hydronephrosis (OR=6.711, P=0.008), stone burden ≥2 cm (OR=10.353, P<0.001), length of operation time ≥ 60 min (OR=5.583, P=0.011), white blood cell count of preoperative urine routine ≥25×10(6)/L (OR=6.195, P=0.005), positive preoperative urine culture (OR=4.216, P=0.011), diabetes and other chronic diseases (OR=4.532, P=0.006) were the independent risk factors for postoperative SIRS (P<0.05). Conclusions: The occurrence of SIRS after flexible ureteroscopic lithotripsy based on ERAS is closely correlated with hydronephrosis, stone burden, length of operation time, white blood cell count of preoperative urine routine, positive preoperative urine culture, diabetes and other chronic diseases.

[The expression of long non-coding RNA-LINC01410 in pancreatic cancer and its effect on proliferation and migration of pancreatic cancer cells].

Abstract: Objective: To explore the expression of long non-coding RNA-LINC01410 in the pancreatic cancer tissues, corresponding paracancerous tissues, human pancreatic cancer cell lines and normal pancreatic ductal epithelial cell line, and analyze the effect of LINC01410 on pancreatic cancer cell proliferation and migration. Methods: Real-time fluorescent quantitative PCR (RT-qPCR) was used to detect the expression level of LINC01410 in 16 cases of pancreatic cancer tissue and its adjacent tissues. RT-qPCR was performed to analyze LINC01410 expression in the pancreatic cancer cell lines AsPC-1, CAPAN-1, SW1990, BxPC-3 and CFPAC-1, and human normal pancreatic ductal epithelial cell line HPDE6-C7. Transfection of interference plasmid (shRNA) in the pancreatic cancer cell line with the highest expression level of LINC01410 were used to knock-down the expression of LINC01410. CCK-8 assay, colony formation assay, and transwell chamber assay were performed to detect the proliferation and migration of pancreatic cancer cells. The complementary paired miRNAs and downstream genes of LINC01410 were predicted by bioinformatics. The expression of miRNA and downstream genes was detected by RT-qPCR, and the protein expression of downstream genes was determined by Western blot. Results: The expression of LINC01410 in the pancreatic cancer tissues was significantly higher than that in the adjacent tissues [(3.46±0.32) vs (0.65±0.08), P<0.01]. The expression levels of LINC01410 in the pancreatic cancer cell lines were significantly higher than that in the normal human pancreatic ductal epithelial cells (P<0.05). The expression of LINC01410 was highest in BxPC-3 cells (P<0.01). After knock-down of the LINC01410 expression in the pancreatic cancer cell line BxPC-3, the cell proliferation was significantly inhibited (P<0.05), and the cell migration ability was decreased (P<0.05). LINC01410 complementarily paired with miR-497-5p, and miR-497-5p complementarily paired with IFITM3. After inhibiting the expression of LINC01410, the expression of miR-497-5p was increased [(1.04±0.17) vs (5.79±0.43), P<0.01], the mRNA expression of IFITM3 was decreased [(0.39±0.05) vs (1.00±0.03), P<0.01], and the protein expression of IFITM3, CDK6, Cyclin D2, PCNA, Vimentin, and N-cadherin was decreased. Conclusions: The expression of LINC01410 was increased in pancreatic cancer tissues and cell lines. Down-regulation of LINC01410 expression inhibits the proliferation and migration of pancreatic cancer BxPC-3 cells, and its mechanism may be closely related to regulating the miR-497-5p and IFITM3 gene expression.

[Brain gray matter volume alterations and cognitive function in first-episode childhood-and adolescence-onset schizophrenia].

Abstract: Objective: To investigate the abnormal changes of gray matter volume and its relationship with cognitive function in first-episode childhood- and adolescence-onset schizophrenia. Methods: A total of 39 (aged 10-16 years) first-episode childhood- and adolescence-onset schizophrenia (patient group) were recruited from the inpatient departments of Second Affiliated Hospital of Xinxiang Medical University between 2014 and 2016, meanwhile, 30 age-, sex- and education years-matched healthy children and adolescents (control group) were also enrolled. All the subjects underwent 3.0 T magnetic resonance imaging (MRI) scan. The volume of gray matter in two groups was compared by voxel based morphometric method (VBM). MATRICS Consensus Cognitive Battery (MCCB) and the Stroop Color and Word Test (SCWT) were employed to evaluate the cognitive function of the two groups, and the relationship between the abnormal gray matter region and the cognitive function in the two group was analyzed. Results: Compared with the control group, brain gray matter volume in the right insula, left inferior frontal gyrus, the left limbic edge were significantly decreased (t=-5.303, -5.302, and -6.211; all P<0.05). Trail making test scores in the patient group were higher than those of the control group (t=3.22, P<0.01). However, scores of symbol coding, HVLT-R, BVMT-R, word fluency, digital span, maze test, word, color and color word were lower than those of the control group (t=-6.41, -5.42, -7.77, -5.59, -8.78, -6.99, -6.98, -6.47 and 4.84, all P<0.01). Pearson correlation analysis showed that the right insula was positively correlated with the BVMT-R and maze test scores, and the left inferior frontal gyrus was positively correlated with the maze scores in the patient group (r=0.32, 0.50 and 0.45, all P<0.05). The left inferior frontal gyrus was positively correlated with the digital span in control group (r=0.46, P<0.05). Conclusion: The first-episode childhood-and adolescence-onset schizophrenia exhibits abnormal changes of gray matter volume and cognitive function, and the pathophysiological mechanisms of a wide range of cognitive impairments may be related to abnormal volume changes of gray matter.

[Predictive value of G-FAST score for acute anterior circulation stroke patients with large artery occlusion].

Abstract: Objective: To investigate the accuracy of Gaze-face-arm-speech-time (G-FAST) score in the early diagnosis of acute anterior circulation stroke patients with large artery occlusion. Methods: A retrospective study was conducted to investigate the anterior circulation infarction (ACI) cases with complete vascular imaging data within 6 hours of onset in the Department of Neurology of Beijing Shijitan Hospital, Capital Medical University from May 2010 to April 2018. According to the results of digital subtraction angiography (DSA) or computed tomography angiography (CTA), the patients were divided into two groups: large artery occlusion group and non-large artery occlusion group. Accuracy of G-FAST score in predicting acute large artery occlusive stroke was analyzed by area under receiver operating characteristic curve (AUC). The predictive value of G-FAST score, National Institutes of Health Stroke Scale (NIHSS) score and Alberta stroke early CT score (ASPECTS) in predicting large artery occlusion was compared. Results: A total of 138 patients with acute anterior circulation ischemic stroke were included in the study, and 82 of them had large artery occlusion (59.4%). Univariate analysis showed that baseline NIHSS score (12.0 vs 8.9, P=0.000) and G-FAST score (3.1 vs 2.2, P=0.000) were significantly higher in patients with large artery occlusion than those without large artery occlusion, and ASPECTS was significantly lower than patients without large artery occlusion (7.4 vs 8.2, P=0.001). The results from ROC showed that G-FAST, NIHSS and ASPECTS were with the AUC of 0.781, 0.733 and 0.664, respectively. G-FAST score had the highest accuracy in predicting the anterior circulation arterial occlusion. The optimal threshold of G-FAST score was 2.5, with a sensitivity of 79.3% and a specificity of 64.3%. Further univariate analysis showed that percentage of large anterior vessel occlusion (LAVO) in G-FAST (≥3) group was significantly different from that in G-FAST (≤ 2) group [76.5%(65/85)∶32.1%(17/53), P=0.000]. Conclusions: G-FAST score has predictive value for acute anterior circulation arterial occlusive stroke. Endovascular treatment may need to consider in patients with high G-FAST score as early as possible when conditions permit.

[NVP-BKM120 in combination with letrozole inhibit human breast cancer stem cells via PI3K/mTOR pathway].

Abstract: Objective: Breast cancer stem cells (BCSC) have been suggested to have clinical implications for cancer therapeutics because of their proposed role in chemo-resistance. The aim of this study was to investigate effects of BCSC on endocrine therapy response by regulating PI3K/Akt/mTOR signaling pathway. Methods: We evaluated the susceptibility of BCSC to NVP-BKM120 (BKM120), a new generation of PI3K-specific inhibitor, when used individually or in combination with letrozole in vivo. For this, a stem-like cell population (SC) was enriched from breast cancer cell line MCF-7 after mammosphere cultures. We have constructed high aromatase expression BCSC (BCSC-CYP19) and non-stem cells (MCF-7-CYP19) subcloning. We demonstrate BKM120 inhibits growth, generation of drug-resistant derivatives and SC formation in BCSC-CYP19 and MCF-7-CYP19. Result: BKM120 could inhibit BCSC-CYP19 growth by dose-dependence, reduce migration and colony formation of BCSC-CYP19, and also significantly reduced expression of PI3K, Akt1 and S6. Combined BKM120 and letrozolecaninhibit BCSC-CYP19 growth and proliferation, make BCSC-CYP19 stayed in G0-G1 phase increasing significantly to induce early apoptosis, and down-regulate expression of PI3K, Akt1 and S6. Conclusion: PI3K/Akt/mTOR pathway effects on letrozole resistance by regulating BCBSs characteristics. Combination of PI3K inhibitor BKM120 and letrozole could reduce letrozole resistance.

[Complications of transperineal template-guided prostate mapping biopsy].

Abstract: Objective: To assess the complications of transperineal template-guided prostate mapping biopsy (TTMB). Methods: Between May 2017 and March 2018, 142 consecutive patients with prior negative transrectal biopsy results and persistently elevated prostate-specific antigen (PSA) were divided into the observation group and the control group randomly. The observation group underwent TTMB and the control group underwent transperineal template-guided prostate saturation biopsy (TTSB). Bleeding, infection, urinary function were recorded after prostate biopsy. Erectile function (ED) was measured at baseline, 1 month, 3 months and 6 months after prostate biopsy using the International Index of Erectile Function (IIEF-5). Results: A mean of 59 cores (from 33 to 116 cores) were obtained in TTMB, and a mean of 23 cores (from 11 to 44 cores) were obtained in TTSB. The positive rate was 50.0% (30/60) in TTMB, and 32.9% (27/82) in TTSB, and there were significant differences between two groups (P 0.05). Rectal bleeding was not observed. In TTMB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.1±4.5), (17.4±4.8), (18.6±4.5), (19.0±4.0), respectively. In TTSB group, the IIEF-5 scores at baseline, 1 month, 3 months and 6 months were (19.7±4.3), (18.2±4.5), (19.1±4.1), (19.6±4.2), respectively. There were significant differences between baseline and 1 month after prostate biopsy in two groups (P 0.05). Conclusions: TTMB can improve the positive rate for patients with prior negative transrectal biopsy results and persistently elevated PSA. TTMB has low complication rates, and most side-effects are self-limited. Compared with TTSB, the incidence of urinary retention and severe hematuria increases, but they can be recovered after clinical intervention. ED is transient, and affected for 1 month after the biopsy, but it will be recovered to the baseline after 3 to 6 months. Therefore, TTMB is a safe and reliable procedure.

[Effect of Dexmedetomidine Combined with Propofol or Sevoflurane General Anesthesia on Stress and Postoperative Quality of Recovery(QoR-40) in Patients Undergoing Laparoscopic Surgery].

Abstract: Objective: To explore the effects of dexmedetomidine combined with propofol or sevoflurane general anesthesia on stress and postoperative quality of recovery (QoR-40) in patients undergoing laparoscopic surgery. Methods: Two hundreds patients with laparoscopic gastrointestinal tumor resection (100 cases of gastric tumor and 100 cases of colon tumor) from March 2016 to January 2018 at Henan Cancer Hospital,were randomly divided into 4 groups(n=50): group SP (gastric neoplasm + propofol anaesthesia), group SS (gastric tumor + sevoflurane anaesthesia), group CP (colon tumor+ propofol anaesthesia), and group CS (colon tumor + sevoflurane anaesthesia). The four groups were all induced by dexmedetomidine, etomidate, sufentanil and cisatracurium. The patients in group SP and group CP were administered with propofol, and the patients in group SS and group CS were given general anesthesia with sevoflurane. The results of the operation and the quality of recovery were compared. The heart rate, mean arterial pressure change, norepinephrine, epinephrine and cortisol were measured in T0 (before anesthesia started), T1 (30 min after surgery), T2 (10 min after tracheal catheter extraction), T3 (24 h after surgery), T4 (postoperative 48 h), respectively. The postoperative recovery quality after operation was evaluated by QoR-40. Results: There were no significant differences in operation time, bleeding volume and other operation conditions between each group (all P>0.05), and also no significant differences in heart rate and mean arterial pressure from T0 to T4 time points (all P>0.05). There were significant differences in the levels of norepinephrine and cortisol among the four groups at T1 and T2 time points (F=54.135,140.733,12.037, 21.644,all P 0.05). The scores of VAS and RS in SP group were (0.9±0.4) and (0.8±0.4), which were lower than that of SS group(1.4±0.5,1.4±0.5,all P<0.05).At the same time, the time of regain consciousness was (9.3±1.4) min, which was also lower than SS group [(10.1±1.4)min,P<0.05]. The scores of VAS and RS in CP group were (0.8±0.5) and (0.8±0.4), which were lower than that of CS group(1.4±0.5,1.4±0.4,all P<0.05).At the same time, the time of regain consciousness was (9.2±1.2)min,which was also lower than CS group [(10.1±1.2)min,P<0.05]. The recovery quality scores of the SP and CP group were (164±11) and (168±11) after 24 hours, which were greater than that of the SS and CS group(146±10, 143±12, all P<0.05). Conclusion: Dexmedetomidine combined with propofol in laparoscopic surgery can effectively suppress intraoperative stress, reduce postoperative pain and agitation, and improve the quality of postoperative recovery.

[Dual therapy with rabeprazole and amoxicillin four times daily for 14 days for the first-line eradication of Helicobacter pylori infection]

Abstract: Objective: To investigate the efficacy, safety and compliance of dual therapy for the first-line eradication of Helicobacter pylori infection through a prospective, single-center and open-label cohort study. Methods: From March 2014 to September 2018, 200 naive patients with Helicobacter pylori infection and dyspepsia received 14-day dual therapy (rabeprazole 10mg and amoxicillin 500 mg, four times daily orally). Safety and compliance were assessed 1-3 days after eradication. The therapeutic outcome was determined by (13)C-urea breath test 4-8 weeks after eradication. Some patients underwent strain culture, antibiotic sensitivity testing and CYP2C19 polymorphism assay. Results: The eradication rates of dual therapy: intention-to-treat analysis 87.5% (95% confidence interval 82.5%-91.5%), modified intention-to-treat analysis 90.2% (86.1%-94.3%) and per-protocol analysis 91.0% (86.3%-94.7). 21.2% of patients had adverse reactions, the majority were mild to moderate, and only 1.5% of patients discontinued medication because of intolerance to adverse reactions. Patients with good compliance accounted for 96.0%. Variate analyses showed that poor compliance and amoxicillin resistance were the independent risk factors for eradication failure. Conclusions: 14-day dual therapy with rabeprazole and amoxicillin (four times daily) achieved good efficacy, safety and compliance for the first-line eradication of Helicobacter pylori infection.

[Diagnostic value of contrast-enhanced ultrasound for accessory renal artery among patients suspected of renal artery stenosis].

Abstract: Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in the diagnosis of accessory renal artery (ARA) in patients suspected of renal artery stenosis. Methods Cases were derived from patients suspected diagnosis of renal artery stenosis during October 2017 and July 2018 by CEUS.A total of 28 kidneys with ARA in 25 cases were diagnosed by dynamic continuous observation by two ultrasound physicians separately. If there was disagreement, the superior physician would made the judgment. DSA or CTA examination was performed at the same period, and its consistency with CEUS diagnosis of ARA was analyzed. Results DSA or CTA identified RAS in 32 ARA, color-coded duplex ultrasonography (CCDS) in 12 and CEUS in 28. The sensitivity in detecting ARA was 37.5% for CCDS and 84.4% for CEUS, the specificity was 0% for CCDS and 94.4% for CEUS, while the accuracy was significantly different with CCDS compared with CEUS (60.0% vs 88.0%). Thus, CEUS significantly improved the ARA detection rate compared with CCDS (84.4% vs 37.5%, χ2=15.56, P<0.01). Compared with CTA or DSA, CEUS showed good consistency in ARA diagnosis (kappa value was 0.752, P<0.05). Conclusion CEUS can display and evaluate ARA in real time accurately, which provides a new technology for further clinical research of ARA. Key words: Ultrasonography; Accessory renal artery; Diagnosis

[Influence of Toll-like receptor 7 on CD8(+) T lymphocytes in patients with breast cancer].

Abstract: Objective: To investigate the effect of Toll-like receptor 7 (TLR7) in CD8(+) T cells activity from patients with breast cancer. Methods: Thirty-three patients with breast cancer, twenty-three patients with benign breast tumor, and twenty healthy individuals were collected from The First Affiliated Hospital of Xinxiang Medical University between December 2017 and March 2018. Peripheral blood mononuclear cells (PBMCs) were isolated, and CD8(+) T cells were purified. TLR7 protein and mRNA relative expression in CD8(+) T cells was measured using flow cytometry and real-time PCR, respectively. mRNA relative expressions corresponding to perforin, granzyme B, and FasL in CD8(+) T cells were measured in response to TLR7 agonist stimulation. Direct/indirect contact co-culture system of CD8(+) T cells and breast cancer cell line MCF-7 was also used to assess cytolytic and noncytolytic function in response to TLR7 agonist CL097 stimulation. Results: The mean fluorescence intensity corresponding to TLR7 protein in CD8(+) T cells from breast cancer patients was 124.0±15.32, which was significantly down-regulated in comparison with benign breast tumor patients (255.5±54.91) and healthy individuals (261.9±68.65) (P 0.05).Furthermore, TLR7 agonist CL097 stimulation enhanced the cytolytic and noncytolytic function of CD8(+) T cells to MCF-7 cells, which presented as the elevation of target cell death and increase of interferon-γ production in direct and indirect contact co-culture system. Conclusion: TLR7 agonist promoted CD8(+) T cells function from breast cancer patients.

Modified Western Ontario and McMaster University Osteoarthritis Index Scale used in patients with knee osteoarthritis

Abstract: Objective: To modify Western Ontario and McMaster University Osteoarthritis Index (WOMAC) for more accurate evaluation of patients with knee osteoarthritis in China,and its reliability and validity were measured. Methods: The WOMAC was modified through reviewing relevant literatures and practical survey.Total of 120 patients were enrolled in this study. The subjects completed the WOMAC,the modified WOMAC and Medical Outcomes Study 36-item Short Form(SF-36), and 113 of the questionnaires were valid for analysis [27 males (23.9%), 86 females (76.1%), aged (59±10) years]. Intraclass correlation coefficient and Cronbach α reliability coefficient were used to analyze the modified WOMAC's reliability; exploratory factor analysis was adopted to analyze the validity of WOMAC and the modified WOMAC; Spearman rank correlation coefficient was used to make a correlation analysis among SF-36, WOMAC and the modified WOMAC. Results: For the four dimensions: pain, stiffness, function and life quality in the modified WOMAC, the intraclass correlation coefficient values were 0.861-0.910 and Cronbach α values were 0.751-0.936. In the content validity analysis, the number of extracted common factors for the four dimensions: pain,stiffness,function and life quality in the modified WOMAC were 1,1,2 and 1 respectively. The total variance interpretation rate was 65.684%, 84.367%, 67.252% and 67.572%, respectively. In the construct validity analysis, 4 common factors were extracted for WOMAC and the modified WOMAC respectively. The total variance interpretation rate was 70.100% and 67.213%, respectively. Both WOMAC and the modified WOMAC had a significant correlation with SF-36. Conclusion: The modified WOMAC is more suitable for Chinese living habits, but it still needs to be further evaluated with larger samples.

[Association between mixed sleep apnea and treatment-emergent central sleep apnea].

Abstract: Objective: To examine the association between mixed sleep apnea (MA) and treatment-emergent central sleep apnea (TE-CSA). Methods: A total of 256 patients meeting the diagnostic criteria of moderate to severe obstructive sleep apnea (OSA) based on overnight polysomnography (PSG) and receiving continuous positive airway pressure (CPAP) therapy in West China Hospital, Sichuan University during the period from August 2013 to November 2018 were enrolled in the study. Based on the mixed apnea index (MAI) and apnea-hypopnea index (AHI) in the baseline PSG study during non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep, the subjects were categorized into three groups of A (MAI=0/h, n=110), B (NREM-MAI≥5/h and REM-MAI<5/h, n=72) and C (REM-MAI≥5/h and NREM-MAI< 5/h, n=74). Sleep and breathing related parameters before and after CPAP therapy among three groups and the difference of TE-CSA incidence were analyzed. Results: The AHI [(44.2(26.8,64.5)/h,66.6(56.0,81.7)/h, 79.8(63.6, 88.3)/h], REM-AHI [50.0(34.7, 64.7)/h, 60.1(49.1, 70.0)/h, 66.3(56.1, 74.6)/h] and NREM-AHI[43.5(25.9, 65.1)/h,67.6(53.7, 82.4)/h,81.3(64.2, 91.5)/h]) were higher in group B and C compared to group A (all P<0.05),while the mean and lowest oxygen saturation [(92.6%±3.5%),(90.8%±3.6%),(87.3%±5.1%) and (70.6%±14.1%), (61.0%±16.0%), (47.9%±17.0%)] were lower in group B and group C compared to group A (all P<0.05). The incidence of TE-CSA after initial CPAP was 7.8% in all patients, and the incidence was significantly higher in group B of 14.1% compared to group C of 4.1% and group A of 2.7% (all P<0.05). Conclusions: TE-CSA is correlated with baseline MA, and baseline MA in NREM sleep can predict the incidence of TE-CSA after initial CPAP.

Effect of Modic changes on fusion rate and cage subsidence after transforaminal lumbar interbody fusion

Abstract: Objective: To investigate the effects of Modic changes on the fusion rate and cage subsidence after transforaminal lumbar interbody fusion (TLIF). Methods: From January 2015 to January 2018, a total of 186 patients with degenerative lumbar disease who received lumbar instrumentation fusion and monosegmental TLIF with single polyetheretherketone (PEEK) cage in Nanjing Drum Tower Hospital were retrospectively reviewed. Patients with Modic changes at the level where the cage was placed were enrolled as Modic group, and the remaining were assigned into non-Modic group. Disk height, lumbar lordosis and segmental lordosis of the level with TLIF were measured based on the preoperative, postoperative and latest follow-up lateral radiograph. The fusion rate and cage subsidence (more than 2 mm on either endplate) were recorded based on CT scan at the latest follow-up. The Oswestry disability index (ODI) and visual analogue scale (VAS) of pain was used to evaluate the clinical outcome. The data were compared with paired t test between the two groups. Results: In this study, there were 70 males and 116 females with an average age of (55±13) years. There were 99 patients in the Modic group (25 with type 1, 66 with type 2, 8 with type 3), and 87 patients in the non-Modic group. There was no significant difference between Modic group and non-Modic group in demographics and postoperative radiographs. The patients were followed-up for (19±4) months (13 to 48 months). All patients achieved grade 1 or 2 fusion. Cage subsidence was detected in 34 patients (18.3%, 34/186). The incidence of subsidence in Modic group (24.2%, 24/99) was significantly higher than that in non-Modic group (11.5%, 10/87) (χ(2)=5.038, P 0.05). Conclusion: Preoperative Modic changes have no impact on fusion rate after transforaminal lumbar interbody fusion, but both type Ⅰ and Ⅱ Modic changes do increase the risk of cage subsidence.

[Comparative analysis of superb microvascular imaging and contrast-enhanced ultrasound in diagnosis of small renal masses].

Abstract: Objective: To explore the value of superb microvascular imaging (SMI) and contrast- enhanced ultrasound (CEUS) in differential diagnosis of small renal masses. Methods: A total of 84 patients with 86 lesions of renal masses were collected from October 2016 to March 2018 in Tianjin Medical University Cancer Institute and Hospital. There were 56 males and 28 females,aged from 29 to 76 years old,with an average age of (54±10) years old. These tumors were all examined by using SMI and CEUS. And the imaging diagnostic results were compared based on the pathological results. Adler semi quantitative analysis of blood flow grading of the tumors were evaluated in SMI,and the evaluation standard was as follows:0-1 grade was benign, 2-3 grade was malignant. Besides,the patterns and enhancement of the small renal masses were observed in CEUS. The main diagnostic criteria of malignant tumors were "fast forward" , "rapid regression" and "high perfusion" . Some special types of renal cell carcinoma were diagnosed by "slow in" , "rapid regression" and "hypo-perfusion" . Benign tumors were diagnosed by "slow in" , "slow down" and "hypo-perfusion" . Results: Among 86 cases, 76 cases were confirmed as malignant masses and 10 cases were confirmed as benign masses by pathological diagnosis. By SMI, Adler grade of 89.5% (68/76) malignant tumors were 2-3, Adler grade of 6/10 benign tumors were 0-1. By CEUS, 77.6% (59/76) of malignant tumors were "fast forward" , 82.9% (63/76) were "rapid regression" , 76.3% (58/76) were "high perfusion" ; 7/10 of benign tumors were "slow in" , 5/10 were "slow down" and 6/10 were "low perfusion" . The accuracy, sensitivity, specificity, positive predictive value, negative predictive value and AUC of SMI were 86.0%,89.5%, 60.0%, 94.4%,42.9% and 0.747 respectively. The values for CEUS were 89.5%, 92.1%, 70.0%,95.9%, 53.8% and 0.811 respectively.There was no statistical difference in diagnostic efficacy between CEUS and SMI (P=0.288). Conclusions: Although there is no statistical significance between SMI and CEUS, the accuracy, sensitivity and positive predictive value of SMI in the diagnosis of small renal masses are higher,which can clearly show micro-vessels and exquisitely detect the low-velocity blood flow in small renal masses. In brief,SMI provides a new method in the differential diagnosis of small renal masses.