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28 November 2015, Volume 35 Issue 11 Previous Issue    Next Issue
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Original article (Clinical research)
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Original article (Clinical research)
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Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine 2015, 35 (11):  1590.  Abstract ( 2482 )   PDF (16647KB) ( 1266 )   Related Articles | Metrics

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XU Tian-le research team gets new progress in  itch sensation mechanism 2015, 35 (11):  1591.  Abstract ( 758 )   PDF (397KB) ( 1093 )   Related Articles | Metrics

Original article (Clinical research)

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Analysis of characteristics of complete genomic sequence of isolated strains of influenza virus H3N2 and clinical significance WEI Dong, ZHANG Bo, ZHANG Dong-hua, et al 2015, 35 (11):  1593.  doi: 10.3969/j.issn.1674-8115.2015.11.001 Abstract ( 1103 )   PDF (4608KB) ( 1341 )   Objective  To analyze the correlation between the complete genomic sequence of prevalent strains of influenza virus H3N2 and clinical characteristics. Methods  Nasal swab samples of patients with respiratory tract infection collected from December 2014 to March 2015 were used to perform the complete genomic sequencing for strains of influenza virus H3N2 after PCR amplification. Characteristics of nucleic acid sequence and amino acid variations were analyzed. Results  Compared with reference strains of 2014-2015 influenza virus strains recommended by WHO, the epitope of HA1 protein of 14 strains from different patients varied. For hosts with significant structural changes of epitope, their body temperature was higher and clinical manifestations were severer. The amino acid E190D of HA1 protein of all 14 strains varied. A new glycosylation site appeared in NA protein of 6 strains. One strain has the V27A variation of M2 protein that caused the amantadine resistance. All 14 strains had the I18T variation of PB1-F2 protein. Conclusion  Drug resistance variation of M2 protein and amino acid variation of PB1-F2 protein suggest that isolated strains of influenza virus H3N2 have combined with gene fragments of influenza virus H1N1 during the course of evolution. The increase of variations of the epitope of HA1 protein may cause stronger immune response of patients. Related Articles | Metrics

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Analysis of ureteroscopic treatment of small renal stones in upper ureter PAN Jun-wei, WANG Xiang-hui, XU Da, et al 2015, 35 (11):  1602.  doi: 10.3969/j.issn.1674-8115.2015.11.002 Abstract ( 912 )   PDF (735KB) ( 975 )   Objective  To analyze correlationship between transverse diameter, longitudinal diameter, and the longest diameter of small upper ureteral stones (transverse diameter ≤0.6 cm and longitudinal diameter ≤1.0 cm) and clinical events or factors and provide evidences for the treatment of patients with small upper ureteral stones. Methods  A total of 56 patients with small upper ureteral stones (transverse diameter ≤0.6 cm and longitudinal diameter ≤1.0 cm) who were treated by ureteroscope were selected. Patients were divided into groups according to transverse diameter ＜0.5 cm and ≥0.5 cm, transverse diameter ≤0.5 cm and ＞0.5 cm, transverse diameter ≤0.55 cm and ＞0.55 cm, longitudinal diameter ≤0.6 cm and ＞0.6 cm, longitudinal diameter ≤0.5 cm, and ＞0.5 cm, the longest diameter ≤0.6 cm and >0.6 cm, the longest diameter <0.6 cm and ≥0.6 cm, and ratio of transverse diameter and longitudinal diameter ≤1 and ＞1. The differences of stone history, course of disease, displacement, symptom of pre-operative waist pain, degree of hydronephrosis, combined ureteral ureterostenosis, combined ureteral polyp, combined ureteral ureterostenosis or polyp, and success rate of ureteroscopic treatment of groups were compared and the linear correlation between transverse diameter and longitudinal diameter was studied. Results  For the transverse diameter ＜0.5 cm group (n=21) and transverse diameter ≥0.5 cm group (n=35), the differences of course of disease, combined ureteral ureterostenosis, and combined ureteral ureterostenosis or polyp were statistically significant (P<0.05 or P<0.01). For the transverse diameter ≤0.5 cm group (n=31) and transverse diameter >0.5 cm group (n=25), only the difference of combined ureteral ureterostenosis was statistically significant (P<0.05). For the transverse diameter ≤0.5 cm group (n=24) and transverse diameter >0.5 cm group (n=32), and the longest diameter ＜0.6 cm group (n=23) and the longest diameter ≥0.6 cm group (n=33), only the difference of course of disease was statistically significant (P<0.05). For the transverse diameter ≤0.55 cm group (n=42) and transverse diameter ＞0.55 cm group (n=14), longitudinal diameter ≤0.6 cm group (n=37) and longitudinal diameter ＞0.6 cm group (n=19), the longest diameter ≤0.6 cm group (n=36) and the longest diameter ＞0.6 cm group (n=20), and ratio of transverse diameter and longitudinal diameter ≤1 group (n=31) and ratio of transverse diameter and longitudinal diameter＞1 group (n=25), the differences of all items were not statistically significant (P>0.05). The rate of patients with no stone displacement and the course of disease ≤10 d of the transverse diameter ＜0.5 cm group was higher than that of the transverse diameter ≥0.5 cm group (P＜0.05), and patients were all combined with ureteral ureterostenosis or polyp and the transverse diameter linearly correlated with the longitudinal diameter. Conclusion  The transverse diameter, rather than longitudinal diameter or the longest diameter, is the simplified measure index with important clinical significance for the treatment of small upper ureteral stones. For upper ureteral stones with transverse diameters ＜0.5 cm, the main factor is mechanical obstruction that is irrelevant to the stone volume and no stone displacement in a short period of time (10 d) can be considered as one of intervention indications. Ureteroscope is important for examination and treatment. Related Articles | Metrics

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Systemic assessment of prevention and treatment of oral candidiasis relevant to inhaled corticosteroids based on Chinese population CHENG Ting, CHENG Qi-jian, TU Jin, et al 2015, 35 (11):  1607.  doi: 10.3969/j.issn.1674-8115.2015.11.003 Abstract ( 1006 )   PDF (2011KB) ( 1268 )   Objective  To systemically summarize clinical studies on prevention and treatment of oral candidiasis relevant to inhaled corticosteroids (ICS) based on Chinese population. Methods  Clinical studies on prevention and treatment of oral candidiasis relevant to ICS based on Chinese population were retrieved from Wanfang periodical databases, China National Knowledge Infrastructure, VIP Journal Integration Platform, Medline and Cochrane databases. The meta analysis was performed to combine studies of the same kind. Results  A total of 19 papers were included. Compared with conservative methods, active prevention significantly decreased the incidence of oral candidiasis of the patients who inhaled corticosteroids and the relative risk (RR) was 0.221 (P<0.001). Compared with normal saline or boiled water, performing mouth wash or oral care with sodium bicarbonate or drugs significantly decreased the incidence of oral candidiasis and the detection rate of Candida albicans in oropharynx for the patients who inhaled corticosteroids. The RR of the incidence was 0.180 (P<0.001) and the RR of the detection rate was 0.157 (P<0.001). Mouth washing or oral care with sodium bicarbonate solution, compound preparation of ketoconazole, or compound vitamin B12 solution spray were all effective for treating patients with oral candidiasis relevant to ICS. Conclusion  Patients should wash their mouths 2-3 times with sodium bicarbonate solution or perform oral care immediately after inhalation of corticosteroids to reduce the incidence of oral candidiasis. The nystatin solution can be used if necessary. Medical staff should supervise patients to wash their months if possible. Related Articles | Metrics

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Comparison of four CT indexes for evaluation of emphysema and effects of section thickness and reconstruction algorithm CHENG Ting, LI Yong, CHENG Qi-jian, et al 2015, 35 (11):  1613.  doi: 10.3969/j.issn.1674-8115.2015.11.004 Abstract ( 1558 )   PDF (1562KB) ( 1181 )   Objective  To explore the correlation between CT indexes of emphysema and lung function of patients with chronic obstructive pulmonary disease (COPD) and effects of section thickness and reconstruction algorithms. Methods  Thirty-nine COPD patients at stable phase were selected and underwent chest CT (deep inspiratory phase) and lung function test. CT images were reconstructed by standard algorithm with section thicknesses of 0.625, 1.25, 5, 7.5, and 10 mm and by bone algorithm with section thicknesses of 0.625 and 1.25 mm. Low attenuation area percent (LAA%), the lowest 15th percentile of the histogram of attenuation values (Perc 15), mean lung density, and lung volume were measured using the best threshold and default threshold. The effects of different section thicknesses and reconstruction algorithms on indexes and the correlation between indexes and lung function were analyzed. Results  LAA% decreased with the increase of section thickness and bone algorithm was higher than standard algorithm. Perc 15 and mean lung density increased with the increase of section thickness and bone algorithm was lower than standard algorithm, while section thickness and algorithm had little effect on the measurement of lung volume. For each section thickness and reconstruction algorithm, FEV1, FEV1%pred, FEV1/FVC, MMEF%pred, DLCO, DLCO%pred, DLCO/VA%pred negatively correlated with LAA% (P<0.05) and positively correlated with Perc 15 (P<0.05). FEV1%pred and FEV1/FVC positively correlated with mean lung density (P<0.05). RV, TLC, and RV/TLC positively correlated with lung volume on CT (P<0.05). For pulmonary ventilation indexes and diffusing capacity, their correlations with LAA% and Perc 15 were higher than those with mean lung density and lung volume. For lung volume indexes, the correlations with lung volume on CT were higher than those with other parameters. The section thickness did not have obvious effect on the correlation between CT assessment of emphysema and lung function. The correlations between LAA% or Perc 15 and some pulmonary ventilation index (such as FEV1) of bone reconstruction were higher than those of standard reconstruction. Conclusion  LAA% and Perc 15 measured from chest CT images can ideally reflect the ventilation indexes and diffusing capacity of lung function. The lung volume on CT can ideally reflect the volume indexes of lung function. Attention should be paid to the consistency of section thickness and reconstruction algorithm when performing CT emphysema evaluation and comparison. Modifications are needed if inconsistency exists. Related Articles | Metrics

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Correlation between chronic kidney disease and arterial stiffness of primary hypertensive patients ZUO Jun-li, CHANG Gui-li, GE Qian, et al 2015, 35 (11):  1619.  doi: 10.3969/j.issn.1674-8115.2015.11.005 Abstract ( 1036 )   PDF (1342KB) ( 1071 )   Objective To investigate the value of noninvasive arterial stiffness indexes for predicting the risk of primary hypertensive patients with chronic kidney disease (CKD). Methods  A total of 541 patients with primary hypertensive were selected and 330 of them were simple primary hypertensive patients (hypertension group) and 211 of them were primary hypertensive patients with CKD (hypertension+CKD group). The carotid-femoral pulse wave velocity (cfPWV) and large and small artery elasticity indexes (C1 and C2) were measured by noninvasive test method of arterial stiffness. The pulse wave analysis (PWA) was performed and inter-media thickness (IMT) was measured by carotid ultrasonography. Results  Compared with the hypertension group, patients of the hypertension+CKD group were older, and had longer duration of hypertension, higher urine protein/creatinine ratio (P<0.01), and lower estimated glomerular filtration rate (eGFR) (P<0.05). After age, heart rate, duration, smoking, use of antihypertensive drugs, and brachial systolic blood pressure were adjusted, the cfPWV of the hypertension+CKD group was significantly higher than that of hypertension group (P<0.05). With the decrease of eGFR, cfPWV and IMT of two groups gradually increased (P<0.01) and C2 decreased (P<0.01). After cardiovascular risk factors were adjusted, cfPWV negatively correlated with the eGFR (r=-0.0851, P=0.02). Taken the primary hypertension combined with CKD as a binary categorical variable, multiple logistic analysis showed that the risk of CKD of patients with simple primary hypertension increased by 1.50 times with the increase of cfPWV by 1 SD (3 m/s). Conclusion  The cfPWV of primary hypertensive patients with CKD significantly increases, which can be used as a index for predicting the risk of CKD of primary hypertensive patients. Related Articles | Metrics

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Establishment and assessment of glomerular filtration rate estimation equation based on cystatin C for diabetes mellitus patients LI Li, LU Yi-de, CHEN Shi-kai, et al 2015, 35 (11):  1625.  doi: 10.3969/j.issn.1674-8115.2015.11.006 Abstract ( 1015 )   PDF (1896KB) ( 978 )   Objective  To establish the glomerular filtration rate (GFR) estimation equation based on cystatin C (Cys C) for type 2 diabetes mellitus patients and assess the applicability for predicting the renal function. Methods  Clinical data of 856 type 2 diabetes mellitus patients were collected and levels of serum creatinine (SCr), Cys C, and plasma glycosylated hemoglobin concentration (HbA1c) were detected. The 99mTc-diethylenetriamine pentaacetic acid-deoxyglucose (99mTc-DTPA) renal dynamic imaging was conducted to obtain the isotopic GFR (iGFR), which was used as the reference of GFR. Among 856 patients, 660 of them were randomly selected for establishing the estimation equation and other 196 patients belonged to the validation group. The GFR values (eGFR) estimated by self-established equation, modification of diet in renal disease (MDRD), chronic kidney disease epidemiology collaboration Cys C equation, and Cys C/SCr combined equation (CKD-EPICys C, CKD-EPISCr/Cys C) were compared by statistical methods, including paired t test, Bland and Altman procedures, χ2 test, Spearman correlation analysis, and receiver operating characteristic (ROC) curves. Results  The self-established equation based on Cys C for type 2 diabetes mellitus patients was 87.2×Cys C-1-4.6. For the validation group, compared with iGFR, the bias, consistency, and coincidence rate of eGFR estimated by the self-established equation were better than those of eGFRs estimated by MDRD and CKD-EPISCr/Cys C equations, and the bias and coincidence rate of eGFR estimated by the self-established equation were better than those of eGFR estimated by CKD-EPICys C equation. The percentages of correct staging of chronic kidney disease for diabetes mellitus patients with mildly to moderately decreased renal function by the self-established equation and CKD-EPICys C equation were significantly higher than those by MDRD and CKD-EPISCr/Cys C functions. The differences of bias and coincidence rate between the self-established and CKD-EPICys C equations among patients with different blood glucose controlled levels were not statistically significant (P>0.05). Conclusion  The self-established Cys C equation is applicable for estimating the GFR of diabetes mellitus patients with different renal function levels and different blood glucose controlled levels. Related Articles | Metrics

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Value of protective mechanical ventilation for alleviating symptoms of general anesthesia patients with high risk of postoperative pulmonary complications SHEN Zi-jin, DONG Rong 2015, 35 (11):  1632.  doi: 10.3969/j.issn.1674-8115.2015.11.007 Abstract ( 975 )   PDF (529KB) ( 1056 )   Objective  To explore the effects of protective mechanical ventilation on the respiratory mechanics and pulmonary oxygenation function of general anesthesia patients with high risk of postoperative pulmonary complications. Methods  A total of 120 general anesthesia patients with high risk of postoperative pulmonary complications were enrolled and randomly divided into the research group (n=60) with a tidal volume of 6.00 mL/kg, respiratory rates of 15/min, PEEP of 6 cmH2O, I∶E of 1∶1.5, one recruitment maneuver per hour after operation, spontaneous mode, pressure of 30 cmH2O for 30 s and then resuming the original mode, and the control group (n=60) with a tidal volume of 10.00 mL/kg, respiratory rates of 12/min, PEEP of 0 cmH2O, and I∶E of 1∶1.5. Arterial blood samples of two groups were drawn after mechanical ventilation of 30 min (T1) and end of operation (T2) for blood gas analysis. According to the results, oxygen partial pressure, tidal volume, peak airway pressure, and plateau pressure were recorded and oxygenation index, static compliance, and dynamic compliance were calculated. Results  Compared with the control group, the plateau pressure of the research group during T2 was significantly lower, static compliance and oxygenation index were higher, postoperative pulmonary complications were much less, and ICU stay was shorter (P<0.05). Conclusion  Protective mechanical ventilation can improve lung compliance and oxygenation and reduce postoperative pulmonary complications. Related Articles | Metrics

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Characteristics and rare CT findings of hyaline vascular type Castleman's disease ZHANG Jing, LIN Xiao-zhu, PAN Zi-lai, et al 2015, 35 (11):  1636.  doi: 10.3969/j.issn.1674-8115.2015.11.008 Abstract ( 1346 )   PDF (1417KB) ( 1146 )   Objective  To explore and analyze the CT findings of hyaline vascular type Castleman’s disease and improve the accuracy of diagnosis. Methods  Data of 23 patients who were definitely diagnosed with hyaline vascular type Castleman’s disease by CT dual phase enhanced scan and pathological examination from July 2010 to May 2015 were retrospectively analyzed. Results  Among 23 cases of hyaline vascular type Castleman’s disease, focuses of 21 cases significantly and evenly enhanced, all located along main blood vessels, and were included in curving thick blood vessels. The focus of one case slightly and evenly enhanced, located nearby the ascending colon, and there were on main blood vessels nearby. Pelvic bones of one case showed osteogenetic and osteolytic destruction. Four cases had calcified focuses and the central area of one calcified focus was star shaped and edges of other three calcified focuses were linear, arc, and spotty, respectively. The focus of one case located in left neck and recurred in the same area one year after operation. Conclusion  Tumors of hyaline vascular type Castleman’s disease significantly enhance if they locate nearby main blood vessels and are included in curving thick blood vessels. Continuous, significant and even enhancement and calcification characteristics revealed by CT arteriovenous dual phase are important for diagnosis of hyaline vascular type Castleman's disease. Osteogenetic and osteolytic destruction and recurrence after operation are rare for limited hyaline vascular type Castleman's disease. Related Articles | Metrics

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Clinical study on the early prediction of the remission rate and survival of patients with recurrent metastatic NSCLC by 18F-FDG PET/CT XU Hai-yan, XU Yuan-fan, YAN Ning-ning, et al 2015, 35 (11):  1641.  doi: 10.3969/j.issn.1674-8115.2015.11.009 Abstract ( 833 )   PDF (2801KB) ( 1000 )   Objective  To explore the application value of the 18F-FDG PET/CT for early prediction of the remission rate and survival of recurrent metastatic non-small cell lung cancer (NSCLC). Methods  A total of 24 patients with recurrent or metastatic NSCLC were selected. All patients underwent the PET/CT examination before and after the first cycle of chemotherapy. The differences of SUVmax1, SUVmax2, ΔSUVmax, and the change rate of SUVmax between the objective response (OR) group and non-objective response (non-OR) group were analyzed, as well as the effect of metabolic response on the overall survival (OS). Results  ΔSUVmax of the OR group (2.415±0.266) was significantly higher than that of the non-OR group (0.854±0.316, P=0.001 7). The change rate of SUVmax of the OR group (31.320±0.723) was remarkably higher than that of the non-OR group (9.909±3.592, P<0.001). The survival analysis showed that the overall survival of the OR group was obviously longer than that of the non-OR group (P<0.05). The overall survival of the metabolic response group was significantly longer than that of the non-metabolic response group (P<0.05). The remission response rates of the metabolic response group and non-metabolic response group were 76.92% and 0%, respectively (χ2=13.901, P<0.001). Conclusion  18F-FDG PET/CT is valuable for early prediction of the remission rate and survival of patients with recurrent or metastatic NSCLC and further clinical study and verification are needed. Related Articles | Metrics

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Changes and clinic significance of Th17, Treg, and Th17/Treg in peripheral blood of patients with viral hepatitis E SUN Wei, ZHU Hai-chao, GAN Jian-he, et al 2015, 35 (11):  1647.  doi: 10.3969/j.issn.1674-8115.2015.11.010 Abstract ( 999 )   PDF (625KB) ( 1042 )   Objective  To observe changes of T helper 17 (Th17), regulatory T cells (Treg), and  the ratio of Thl7/Treg in peripheral blood of patients with acute hepatitis E (AHE) and hepatitis E virus related liver failure (HEV-LF) patients and explore the clinic significance. Methods  The flow cytometry was used to detect the percentages of Treg and Thl7 cells in peripheral blood of 20 healthy controls (control group), 25 patients with AHE (AHE group), and 14 patients with HEV-LF (HEV-LF group). The percentage of Th17/Treg was calculated and indexes such as TBiL, ALT, AST, and PTA were determined. Results  The percentages of Th17 and Treg cell and Th17/Treg of the HEV-LF group were the highest, followed by those of the AHE group and those of the control group were the lowest. Part of differences were statistically significant (P<0.05). For the HEV-LF group, percentage of Th17 positively correlated with ALT and TBiL (r=0.591, 0.539; P<0.05) and negatively correlated with PTA (r=-0.565; P<0.05), while ratio of Th17/Treg positively correlated with ALT (r=0.777; P<0.05) and negative correlated with PTA (r=-0.653; P<0.05) and no other correlations were found (P>0.05). The increase of the percentage of Th17 cells in peripheral blood of patients of HEV-LF group was the risk factor of prognosis （OR=4.301, P<0.05）. Conclusion  Acute infection of HEV results in different degrees of immune dysfunction of patients with different clinical courses. Th17/Treg and Th17 in peripheral blood correlate with the hepatic inflammation and necrosis. The increase of the percentage of Th17 cells in peripheral blood may be a pathogenesis of severe hepatitis E and can be used as an indicator to assess the prognosis of patients with HEV-LF. Related Articles | Metrics

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Detection of rifampicin and isoniazid resistant Mycobacterium tuberculosis by DNA micro-array method ZHAO Jing, WANG Feng-ping, SUN Qing-qing, et al 2015, 35 (11):  1651.  doi: 10.3969/j.issn.1674-8115.2015.11.011 Abstract ( 940 )   PDF (941KB) ( 1063 )   Objective  To explore the application value of DNA micro-array method for quick detection of drug resistant genes of Mycobacterium tuberculosis (M.tuberculosis). Methods  DNA micro-array method was adopted to detect the M.tuberculosis in sputum samples of clinically suspicious TB patients. The wild genotypes and different mutant genotypes of promoters of three genes relevant to resistance of rifampicin (RFP) and isoniazid (INH), i.e. rpoB, katG, and inhA, were detected. BACTECTM MGIT 960 system was used to cultivate M.tuberculosis and the modified Roche proportion method was adopted to perform drug susceptibility for positive liquid cultures. Results  Among 174 positive liquid cultures, 15 of them were rpoB mutant genotype. The mutation frequency of locus 531 was the highest and mutation rate was 66.7%. Seventeen cultures were katG/inhA mutant genotype and 12 of them were single mutation of katG with the mutation rate of 70.6%. Compared with the results of 68 cultures detected by the modified Roche proportion method, the detection rate of DNA micro-array method for detecting RFP and INH resistance was more than 90%. Conclusion  DNA micro-array method can quickly and reliably detect the gene mutation of rpoB, katG, and inhA in most clinical samples of suspicious TB patients. This method can be used to detect clinical drug resistance and guide clinical medication and diagnosis. Related Articles | Metrics

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Correlation between supportive care needs and quality of life of first-visit patients diagnosed with gynecologic cancer CAO Shuai, XIE Li-ling, WANG Fu-lan, et al 2015, 35 (11):  1655.  doi: 11.3969/j.issn.1674-8115.2015.11.012 Abstract ( 654 )   PDF (754KB) ( 988 )   Objective  To understand the supportive care needs and quality of life of first-visit patients diagnosed with gynecologic cancer and explore the correlation between supportive care needs and quality of life. Methods  The convenience sampling method was adopted to select 123 first-visit patients who were diagnosed with gynecologic cancer from June 2014 to February 2015 in 3 grade A tertiary general hospitals. Patients were surveyed by questionnaires of supportive care needs survey (SCNS) and functional assessment of cancer therapy (FACT-G, V4.0).  Results  The average score of supportive care needs of first-visit patients diagnosed with gynecologic cancer was 2.63±0.65 and the unsatisfactory rate of health information needs was the highest. The total score of quality of life was 71.53±10.74. Dimensions of supportive care needs (except social/family circumstances) negatively correlated with those of quality of life (P<0.01) and physical and daily living needs and psychological needs significantly affected the quality of life. Conclusion  The degree of supportive care needs of first-visit patients diagnosed with gynecologic cancer is different. Physical and daily living needs and psychological needs are key influencing factors of the quality of life. Medical staff should provide personalized assistance and psychological guidance to improve the quality of life. Related Articles | Metrics

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Treatment of malignant obstructive jaundice by biliary stent and biliary stent combined with 125I seed implantation ZHAO Su-ming, ZHAO Hui, GU Wei-wei, et al 2015, 35 (11):  1661.  doi: 10.3969/j.issn.1674-8115.2015.11.013 Abstract ( 1025 )   PDF (1556KB) ( 1041 )   Objective  To investigate the difference of clinical therapeutic effect between percutaneous transhepatic cholangial drainage (PTCD) by biliary stent and biliary stent combined with 125I seed implantation for the treatment of patients with malignant obstructive jaundice. Methods  A total of 62 patients with malignant obstructive jaundice were randomly divided into the control group (n=31) and treatment group (n=31) after undergoing PTCD. Patients of the control group underwent biliary stent implantation and those of the treatment group underwent biliary stent combined with 125I seed implantation. The subsidence of jaundice, tumor recurrence, level of serum tumor marker CA199, and survival time of two groups before and after treatment were compared. Results  Operations of all patients were successful. The differences of the level of serum total bilirubin between two groups before PTCD and 1 week after stent implantation were not statistically significant (P>0.05). The levels of serum total bilirubin of the treatment group 1 and 3 months after operation were significantly lower than those of the control group (P<0.05). Three patients of the treatment group and 14 patients of the control group suffered the biliary obstruction recurrence during the follow-up period (P>0.05). The level of serum tumor marker CA199 of the treatment group 1 or 2 weeks after operation was significantly lower than that before operation (P<0.05). The median survival time of the treatment group and control group was 11 and 7 months and the difference was statistically significant (P<0.05). Conclusion  Compared with treatment of PTCD by biliary stent, the combination of biliary stent and 125I seed implantation is better in terms of subsidence of jaundice, inhibition of tumor growth, and increase of survival time and is hopeful for clinical applications. Related Articles | Metrics

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Therapeutic effect of 5 drugs on Chinese patients with schizophrenia by using network meta-analysis GU Wen-jie, ZHANG Wu-fang, WANG Chao, et al 2015, 35 (11):  1666.  doi: 10.3969/j.issn.1674-8115.2015.11.014 Abstract ( 1014 )   PDF (2776KB) ( 1330 )   Objective  To comprehensively assess the therapeutic effect of 5 antipsychotic drugs, i.e. aripiprazole (Ari), olanzapine (Ole), paliperidone (Pla), quetiapine (Que), and risperidone (Ris), on patients with schizophrenia by using the network meta-analysis. Methods  Papers were retrieved from PubMed, Cochorane Library, CNKI, China Science and Technology Journal Database, China Science Periodical Database, and Chinese Science Citation Database according to the predefined inclusion and exclusion criteria and quality assessment was conducted. The Bayesian network model was established by WinBUGS1.4.3 and the priority of recommendation levels was estimated by the OR value of drugs. Results  A total of 5280 patients were enrolled in 60 clinical tests. The results of network meta-analysis showed that compared with Pal, Ari, Ola and Ris, Que significantly improved the clinical efficiency. OR (Pal, Que)=0.415 4 (95%CI: 0.252 9-0.636 7), OR (Pal, Ris)=0.674 4 (95%CI: 0.521 7-0.855 5), OR (Ari, Que)=0.5491 (95%CI: 0.298 8-0.909 6), OR (Ola, Que)=0.474 6 (95%CI: 0.280 5-0.755 8), and OR (Que, Ris)=1.694 (95%CI: 1.115-2.495). The differences were statistically significant. Conclusion  Based on the results of network meta-analysis, the recommendation level of Que is higher than that of other drugs. But further evidences are needed to verify the therapeutic effect due to lack of studies. Related Articles | Metrics

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Systematic analysis of adults with hemophagocytic lymphohistiocytosis and combined with central nervous system #br# involvement GAO Mei-chun, LU Qin-chi 2015, 35 (11):  1671.  doi: 10.3969/j.issn.1674-8115.2015.11.015 Abstract ( 855 )   PDF (793KB) ( 1099 )   Objective  To retrospectively analyze the literature and summary the clinical features of adults with  hemophagocytic lymphohistiocytosis (HLH) and combined with central nervous system (CNS) involvement. Methods  Reports of adults with HLH and combined with CNS involvement from January 1950 to December 2014 were retrieved from databases of Wanfang, VIP, China National Knowledge Infrastructure (CNKI), PubMed, and Ovid and systematically analyzed. Results  A total of 21 cases of adults with HLH and combined with CNS involvement were collected. Their clinical manifestations varied and the most common ones were altered consciousness (66.7%), epilepsy (33.3%), dysarthria (19.0%), and ataxia (19.0%). The image changes were not specific and the most frequently involved areas were deep brain white matter (53.3%), followed by brain stem (40.0%) and cerebellum (26.7%) and some cases showed enhancement of lesions by enhanced scan. The features of cerebrospinal fluid were mild to moderate pleocytosis, different degrees of elevated protein content, and normal glucose level. The HLH secondary to autoimmune diseases was more likely to involve the CNS (38.1%) and the total mortality was 81.0%. Conclusion  Adults with HLH and involved CNS have high mortality and poor prognosis. Early diagnosis and treatment and prevention of CNS infiltration are key factors. Related Articles | Metrics

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Changes of expression of complement receptor 1 protein of patients with cerebral amyloid angiopathy WANG Cheng, CHU Xing-kun, LI Gen, et al 2015, 35 (11):  1677.  doi: 10.3969/j.issn.1674-8115.2015.11.016 Abstract ( 995 )   PDF (3202KB) ( 985 )   Objective  To observe the expression of complement receptor 1 (CR1) protein of patients with cerebral amyloid angiopathy (CAA). Methods  APP-PS1 transgenic mice (Tg6799) were used as the animal model of CAA. The hippocampus and temporal cortex tissues of mice were harvested and the CR1 protein was detected by Western blotting and enzyme-linked immune sorbent assay (ELISA). CD31 was regarded as the marker of vascular endothelial cells and co-localization of CR1 and CD31 was performed by immunofluorescence. Changes of the expression of CR1 protein in blood vessels were observed. Aβ40 was regarded as the marker of CAA and immunofluorescence staining of CR1 and Aβ40 was performed by immunofluorescence. The expression of CR1 of Tg6799 mice was observed. Results  The results of Western blotting and ELISA showed that the expression of CR1 protein of APP-PS1 transgenic mice was significantly higher than that of normal mice. The results of immunofluorescence showed that CR1 protein in blood vessels of APP-PS1 transgenic mice was granular or lumpish and Tg6799 mice expressed CR1 protein. Conclusion  CR1 may play an important role in the pathogenesis of CAA. Related Articles | Metrics

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Experimental study on establishing mouse model of nonalcoholic steatohepatitis by different diet structures LI Yang, XIAO Li, GENG Ai-wen, et al 2015, 35 (11):  1682.  doi: 10.3969/j.issn.1674-8115.2015.11.017 Abstract ( 1059 )   PDF (2930KB) ( 1110 )   Objective  To establish the mouse model of nonalcoholic steatohepatitis induced by high fructose diet, high fat diet, and compound high fructose diet and explore the best diet structure. Methods  A total of 60 C57BL/6J mice were randomly divided into the high fructose group, high fat group, compound group, and control group. Differences of basic data, liver function, lipid metabolism, TNF-α, IL-6, and pathological changes of groups were compared after the model was established for 4, 8, and 12 weeks. Results  Compared with the control group, the body weight, wet liver weight, and Lee’s index of other groups were significantly higher (P<0.01). The increase of body weight of the compound group was more significant than that of the high fat group and high fructose group after 12 weeks (P<0.05). H-E staining indicated that except the control group, mice of other three groups had different degrees of macrosteatosis and significant intralobular inflammatory cell infiltration was only observed in mice of the compound group. Results of serum test showed that after 12 weeks, TG and CHO levels of the compound group and high fat group significantly increased and increases of ALT, AST, TNF-α, and IL-6 of the compound group were more significant than those of the high fat group and high fructose group. Conclusion  High fat and fructose diet for 12 weeks can successfully establish the mouse model for studying the nonalcoholic steatohepatitis. Related Articles | Metrics

Original article (Clinical research)

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Effect of ghrelin on the colonic motility of morphine induced bowel dysfunction of mice ZHAO Jing, WANG Yan,XU Tao, et al 2015, 35 (11):  1687.  doi: 10.3969/j.issn.1674-8115.2015.11.018 Abstract ( 1094 )   PDF (660KB) ( 938 )   Objective  To investigate the effect of growth hormone secretagogue receptor agonist ghrelin on the colon motility of morphine induced bowel dysfunction of mice. Methods  Phenolsulfonphthalein pushing test in vivo and contraction test of colonic muscle strips in vitro were conducted for 50 C57 mice. For in vivo test, 25 mice were divided into five groups. One group was the control group and mice of other four groups were intraperitoneally injected with saline or different doses (50, 100, and 200 μg/kg) of ghrelin after the model of morphine induced intestinal paralysis was established. The colonic transit of mice was measured by phenolsulfonphthalein pushing test. For in vitro test, 25 mice were also divided into 5 groups, i.e. the control group, morphine group, and three ghrelin groups (ghrelin of 0.1 μmol/L,1 μmol/L, and 10 μmol/L). Mouse colons were harvested and the spontaneous contraction amplitude of colonic muscle strips was recorded by the biological signal system. Results  For in vivo test, colonic propulsive rates of the morphine group were (33.77±0.49)%. After being injected with ghrelin of 50, 100, and 200 μg/kg, colonic propulsive rates were (41.42±1.66)%, (45.86±0.86)%, and (56.84±0.84) %, respectively, which were significantly higher than those of the morphine group (P<0.05). For in vitro test, contractions amplitudes of colon muscle strips of the morphine group were (0.568±0.014) g. After being treated with ghrelin of 0.1 μmol/L, 1 μmol/L, and 10 μmol/L, contraction amplitudes increased to (0.624±0.118), (0.673±0.014), and (0.712±0.125) g, respectively, which were significantly higher than those of the morphine group (P<0.05).  Conclusion  Ghrelin can significantly improve the colonic motility of morphine induced bowel dysfunction of mice. Related Articles | Metrics

Original article (Public health)

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Practice and exploration of clinical virtual beds pre-hospitalization mode GU Wei-min, WANG Ya-zi, FENG Qing, et al 2015, 35 (11):  1691.  doi: 10.3969/j.issn.1674-8115.2015.11.019 Abstract ( 1259 )   PDF (1365KB) ( 1061 )   Objective  To explore optimization of diagnosis and treatment procedure and implementation of virtual beds pre-hospitalization mode for reducing average hospital stay before clinical operation, decreasing medical expenses, and improving the management efficiency of hospital. Methods  According to business process reengineering (BPR) and appropriateness evaluation protocol (AEP) and combined with domestic medical situations, new mode was established. The difference analysis of four pilot diseases of the department of general surgery and department of urinary surgery was conducted by independent sample T-test. Results  The differences of actual hospital stay, average hospital stay before operation, and nursing expense of three pilot disease groups, i.e. great saphenous vein surgery group, thyroid surgery group, and laparoscopic cholecystectomy group, were significant after adopting the virtual beds pre-hospitalization mode in 2014 (P<0.05). The differences of total medical expense of great saphenous vein surgery group, thyroid surgery group, and endoscopic holmium laser surgery group were significant (P<0.05). Conclusion  The domestic medical industry can reference the AEP and BP. The virtual beds pre-hospitalization mode has certain practical significance and achieves good results for pilot diseases. The mode can be continuously optimized and can provide applicable evidences for studying the virtual pre-hospitalization mode. Related Articles | Metrics

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Study on effect of zero-profit medicine policy on medical expenses and compensation mechanisms PAN Yue-hua, CUI Meng-di, LI Xue-hui 2015, 35 (11):  1696.  doi: 10.3969/j.issn.1674-8115.2015.11.020 Abstract ( 1102 )   PDF (1152KB) ( 1002 )   Objective  To track and investigate the difference in cost after zero-profit medicine policy was implemented in Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, prepare the principal component analysis table of outpatient expenses, emergency expenses, and hospitalization expenses before and after adjustment of prices, analyze the impact of each factor on medical expenses, and propose compensation mechanism. Methods  The difference evaluation of outpatient expenses, emergency expenses, and hospitalization expenses before and after adjustment of prices was analyzed by the paired samples t test. The influencing factors of outpatient expenses, emergency expenses, and hospitalization expenses before and after adjustment of prices and the degree of their impact were analyzed by the principal component analysis. Results  Outpatient expenses, emergency expenses, and hospitalization expenses were remarkably different before and after adjustment of prices and the importance of each factor changed significantly. The zero-profit medicine policy caused a substantial reduction in hospital’s overall income and surplus and payment imbalance. Conclusion  The zero-profit medicine policy can rationalize the structure of medical expenses, reflect the labor value of medical staff, and effectively ease the contradiction between doctors and patients. However, it is still necessary to develop a series of scientific compensation mechanisms, such as pharmaceutical service fee and reasonably adjusting the charging structure, so as to compensate the payment imbalance and ensure the orderly and healthy development of public hospitals. Related Articles | Metrics

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Satisfaction survey of reengineering rehydration process of hospital GAO Yang, JIANG Li-juan, GU Wei-min, et al 2015, 35 (11):  1702.  doi: 10.3969/j.issn.1674-8115.2015.11.021 Abstract ( 782 )   PDF (718KB) ( 1042 )   Objective  To understand the difference of satisfaction towards rehydration process between patients and medical staff and influencing factors after reengineering the rehydration process by lean management and explore and perfect strategies according to deficiencies. Methods  The questionnaire of satisfaction towards the rehydration process was designed and patients and medical staff were surveyed. A total of 606 patients and 103 medical staff were selected by the stratified random sampling method. The difference analysis was conducted by independent samples t test and univariate analysis of variance and hospital running data was also analyzed. Results  The degree of satisfaction towards the rehydration process of patients and medical staff after reengineering was high, but their focuses were slightly different. Male patients were more likely to accept the new mode than female patients. The degree of satisfaction towards the rehydration process of patients under 30 years old and patients of 51 to 60 years old was higher. Pharmacy and nursing staff were more sensitive to phases of rehydration process. The stability of intelligent railway logistics system needed improvement. Conclusion  Introduction of lean management to the hospital management is important. Attention should be paid to actual experiences of patients and medical staff during the course of reengineering the rehydration process. Satisfaction tracking should be adopted to achieve continuous optimization. The rehydration model after reengineering is worth promoting. Related Articles | Metrics

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Preliminary study on occupational values of nursing staff in newly-built hospitals and influencing factors FENG Qing, YU Li, GU Wei-min, et al 2015, 35 (11):  1707.  doi: 10.3969/j.issn.1674-8115.2015.11.022 Abstract ( 1033 )   PDF (1321KB) ( 1080 )   Objective  To investigate the current status of professional values of clinical nursing staff in two new third level hospitals, analyze the influencing factors, and take effective measures to improve the work satisfaction of nursing staff. Methods  A professional values inventory for medical staff was designed and 547 registered nurses in two new third level hospitals in Shanghai were surveyed. Results  The occupational values and work satisfaction of nursing staff were good, but the intention of demission also existed. The leisure value and external work satisfaction of nursing staff between 26 and 35 years old were better. The occupational values of married nursing staff with household income above 200000 RMB were better. The work satisfaction of nursing staff whose education levels were college or below was better. The occupational values correlated with the work satisfaction and the work satisfaction correlated with the intention of demission. Conclusion  Nursing administrators should focus on fostering correct professional values of nursing staff, create an ideal and harmonious work environment by establishing fair and open payment and promotion systems, and improve the professional identity of clinical nursing staff. Related Articles | Metrics

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Analysis of influence rules of demographic variables towards occupational value of medical staff JIANG Li-juan, YUAN Qing, GU Wei-min, et al 2015, 35 (11):  1712.  doi: 10.3969/j.issn.1674-8115.2015.11.023 Abstract ( 953 )   PDF (653KB) ( 1012 )   Objective  To investigate the current status of occupational value of medical staff and analyze the influence rules of demographic variables towards the occupational value. Methods  Questionnaire was designed according to the work value inventory (WVI) and characteristics of Chinese medical staff. Then 516 staff of a new tertiary grade A hospital in Shanghai were surveyed. The independent sample t test or univariate variance analysis was performed to determine the correlations between the occupational value and demographic variables, including gender, age, position, title, education level, and marital status. Results  The differences of occupational value of medical staff with different genders, education levels, and marital statuses were not statistically significant (P>0.05), but the differences of occupational value of medical staff with different ages, positions, and titles were statistically significant (P<0.05). Conclusion  Demographic variables have certain influence on the occupational value of medical staff. To satisfy the needs of medical staff with different background can maintain the work enthusiasm, improve the work performance, and enhance the quality of medical service. Related Articles | Metrics

Review

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Antiviral therapy in patients with hepatitis B virus-related liver cirrhosis GU Lei-lei, ZHANG Xin-xin 2015, 35 (11):  1717.  doi: 10.3969/j.issn.1674-8115.2015.11.024 Abstract ( 903 )   PDF (619KB) ( 1137 )   Chronic hepatitis B virus (HBV) infection is one of the major causes of liver cirrhosis. The progression of cirrhosis is associated with the HBV DNA level. The antiviral therapy can inhibit the viral replication, reduce complications of cirrhosis, and improve the survival rate of patients with cirrhosis. It is important to provide effective antiviral therapy for the treatment of HBV-related liver cirrhosis. Currently, antiviral drugs include nucleos(t)ide analogues (Nucs) and IFNα. This paper briefly introduces the application of these antiviral drugs to patients with cirrhosis and particularly highlights the recommendations in native and foreign practice guidelines for the treatment of HBV-related liver cirrhosis. Related Articles | Metrics

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Applications and research progresses of new immunosuppressive agents for the treatment of IgA nephropathy HUANG Wei, WANG Wei-ming 2015, 35 (11):  1722.  doi: 10.3969/j.issn.1674-8115.2015.11.025 Abstract ( 1273 )   PDF (718KB) ( 1111 )   IgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world. 20%-40% of IgAN patients will eventually progress to chronic renal failure and end stage renal disease (ESRD). Sometimes complete remission cannot be achieved through rigorous blood pressure and proteinuria control or the use of renin-angiotensin system blockers, thus corticosteroids and immunosuppressive agents are needed. The effects of classic immunosuppressive agents such as azathioprine and cyclophosphamide have been proven by many studies, while their limitations lead to more studies on new immunosuppressive agents. This paper reviews applications and research progresses of new immunosuppressive agents for the treatment of IgAN. Related Articles | Metrics

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Research progresses of exosomes for diagnosis and treatment of central nervous system diseases CHEN Ya-jing, LIU Jian-rong, YANG Guo-yuan 2015, 35 (11):  1727.  doi: 10.3969/j.issn.1674-8115.2015.11.026 Abstract ( 1194 )   PDF (1545KB) ( 1568 )   Exosomes are 30-100nm vesicles secreted automatically from multivesicular bodies into extracellular environment after multivesicular bodies fusing with plasma membrane. Enriched of bioactive substances such as lipid, protein and miRNA, exosomes exert various biological functions by binding to the receptor of target cells or through horizontal transfer of contents. As a novel way of cell-cell communication, exosomes may mediate inter-neuronal signaling through the neuro-glia interaction in central nervous system (CNS). Exosomes secreted by brain cells and stem cells play an important regulatory role in pathogenesis and damage repair mechanism of CNS diseases. Abundant researches have proven that exosomes can be regarded as biomarkers and have good potential for treatment. This paper reviews general characteristics and functions of exosomes, as well as research progresses of exosomes for diagnosis and treatment of CNS diseases. Related Articles | Metrics

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Predictive values of tumor markers in colorectal cancer JIANG Yi-mei, ZHAO Ren 2015, 35 (11):  1734.  doi: 10.3969/j.issn.1674-8115.2015.11.027 Abstract ( 939 )   PDF (488KB) ( 1052 )   Colorectal cancer (CRC) is the most common malignant tumor of digestive system. At present, it is generally accepted that CRC is still curable if it can be early diagnosed. Tumor markers are molecules that reflect the biological behaviors of tumors and can predict tumors to a certain extent. Test of tumor markers is less invasive, but the sensitivity and specificity need to be improved. In recent years, many tumor markers of CRC have been detected not only at the protein level, but also at the gene level. This article reviews research progresses. Related Articles | Metrics

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Research progresses of norovirus gastroenteritis YU Yi 2015, 35 (11):  1738.  doi: 10.3969/j.issn.1674-8115.2015.11.028 Abstract ( 957 )   PDF (1273KB) ( 1096 )   Norovirus has been recognized as an important cause of epidemic or sporadic viral gastroenteritis, which results in heavy economic burden and health problems all over the world. Noroviruses can be classified into 6 genogroups, including more than 35 genotypes. GI and GII are main pathogenic genogroups. Human histo-blood group antigens (HBGAs) and intestinal microbial ecosystem play important roles in norovirus infection. Norovirus cannot be cultured in vitro and currently real-time RT-PCR is considered as the gold standard test for identifying the norovius. Norovirus mainly spreads via the fecal-oral route and outbreaks may occur in community or healthcare institutions. Old people and immune suppressed persons may be severely infected. Effective vaccine is not available and the main treatment is symptomatic treatment such as fluid infusion to alleviate clinical symptoms. Related Articles | Metrics

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Advances of radionuclide imaging for cell apoptosis LIU Qiu-fang, SONG Shao-li 2015, 35 (11):  1743.  doi: 10.3969/j.issn.1674-8115.2015.11.029 Abstract ( 870 )   PDF (816KB) ( 1038 )   Radionuclide imaging for the cell apoptosis is a direct, noninvasive, and real-time imaging technique. It is a hopeful method for observing brain and myocardial ischemic reperfusion injury, detecting allograft rejection, and evaluating the effects of tumor chemotherapy and radiotherapy. This paper introduces the design, mechanisms, and applications of radionuclide agents based on preclinical studies. Related Articles | Metrics

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Research progresses of extended lymphadenectomy for patients with pancreatic adenocarcinoma YANG Yu-chen, ZHAN Qian, SHEN Bai-yong 2015, 35 (11):  1749.  doi: 10.3969/j.issn.1674-8115.2015.11.030 Abstract ( 952 )   PDF (1150KB) ( 1004 )   Lymph node metastasis and staging of pancreatic adenocarcinoma are the most important factors for analyzing the prognosis of patients who underwent pancreaticoduodenectomy and have important clinical significance. There has been debated on the extent of lymphadenectomy during pancreaticoduodenectomy. Results of evidence based medicine researches show that extended lymphadenectomy has little positive effect on the post-operative survival of patients with pancreatic cancer. No studies support the extended lymphadenectomy according to recurrence and metastasis of pancreatic cancer and the survival quality of patients. This paper reviews the standardized surgical treatment of patients with pancreatic adenocarcinoma. Related Articles | Metrics

Brief original article

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Brief original articleTherapeutic effect of subtalar arthroereisis on flatfoot without posterior tibial tendon disfunction XU Yang, LI Xing-chen, XU Xiang-yang 2015, 35 (11):  1753.  doi: 10.3969/j.issn.1674-8115.2015.11.031 Abstract ( 1211 )   PDF (1655KB) ( 1009 )   Objective  To explore the feasibility of treatment of flatfoot without posterior tibial tendon disfunction by subtalar arthroereisis and evaluate the therapeutic effect. Methods  Data of 28 patients (40 feet) with flatfoot without posterior tibial tendon disfunction who underwent subtalar arthroereisis were retrospectively analyzed. Changes of hind foot valgus angle and talar-first metatarsal angles on lateral films before and after surgery were measured and analyzed. Changes of foot function before and after surgery were compared by American Orthopedic Foot and Ankle Society-Ankle Hindfoot (AOFAS-AH) Scale. Results  All 28 patients were followed up for 14-48 months. All indexes improved significantly. Only one patient underwent calcaneal osteotomy due to poor alignment of hind foot. Other patients did not undergo second surgery. Conclusion  Subtalar arthroereisis is an effective treatment for flatfoot without posterior tibial tendon disfunction. It is simple and minimal invasive and can relieve pain and realign foot with fewer complications. Related Articles | Metrics

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Comparative study on intravesical hyaluronic acid instillation and heparin-lidocaine instillation for the treatment of interstitial cystitis LU Guo-liang, WANG Da-wei, SHAO Yuan, et al 2015, 35 (11):  1757.  doi: 10.3969/j.issn.1674-8115.2015.11.032 Abstract ( 1055 )   PDF (1321KB) ( 1338 )   Objective  To explore the therapeutic effect and prognosis of treating patients with interstitial cystitis by intravesical hyaluronic acid instillation and heparin-lidocaine instillation. Methods  A total of 24 patients with interstitial cystitis who were admitted in Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine from February 2013 to April 2015 were selected. The patients, randomly divided into hyaluronic acid (HA) group and heparin sodium-lidocaine (HL) group, underwent the intravesical chemotherapy after bladder hydrodistention, and were followed up every 3 months for 12 months. Frequency of daily voiding and vision analogue scale (VAS) of pelvic pain of two groups before and after treatment were compared. Results  All 24 patients completed the follow-up and no obvious complications of intravesical instillation were recorded during the course of treatment. For the remission rate, only the complete remission rates of two groups by the end of 12 months were significantly different (HA group was 4/13 and HL group was 2/11, P<0.05). For symptom control, the urinary frequency, urinary urgency, and subabdominal pain of both groups were significantly alleviated at the early phase of treatment. But at the time point of 12 months after instillation, the differences of frequency of daily voiding and VAS of HL group before and after treatment were not statistically significant (P>0.05), while the therapeutic effect of the HA group remained. The difference between two groups was statistically different (P<0.05). Conclusion  The effect of treating interstitial cystitis by hyaluronic acid intravesical instillation lasts 12 months in terms of symptom control and is better than that of treating interstitial cystitis by heparin sodium-lidocaine intravesical instillation. Related Articles | Metrics

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Feasibility of continuous intravenous transfusion of etomidate monitored by Narcotrend ZHOU Shan-shan, LAN Hai-zhen, DONG Rong, et al 2015, 35 (11):  1762.  doi: 10.3969/j.issn.1674-8115.2015.11.033 Abstract ( 1408 )   PDF (626KB) ( 1078 )   Objective  To evaluate the effects of etomidate on general anesthesia induction and continuous intravenous transfusion during maintenance. Methods  Seventy ASAⅠorⅡ patients undergoing selective operations and general anesthesia were enrolled. Anesthesia was induced with the order of intravenous injection of midazolam 0.03 mg/kg, etomidate 0.3 mg/kg, sufentanil 0.2 μg/kg, and cisatracurium 0.2 mg/kg. The injection pain and myoclonus during induction were recorded. During anesthesia maintenance, etomidate of 10-15 μg/(kg·min) was infused continuously and the depth of anesthesia was monitored by Narcotrend. Infusion speed was adjusted according to the Narcotrend index (NT value). During the operation, remifentanil was infused with the speed of 0.1-0.2 μg/(kg·min) and cisatracurium was injected at intervals. Mean artery pressure (MAP), heart rate (HR), and NT values were recorded before induction (T0), 1 min after induction (T1), endotracheal intubation (T2), the start and end of surgery (T3,T4), and extubation (T5). Surgery time, anesthesia time, awakening time after surgery, extubation time, and adverse events were recorded, as well as dosages of etomidate, cisatracurium, and remifentanil. Results  The NT level of patients maintained at D1-D2 grade with NT value of 40-60 by continuous intravenous infusion of etomidate of 10-15μg/(kg·min) during surgery. Compared with T0, the NT value at T1 decreased rapidly to meet the requirement of intubation. MAP at T1 decreased but the fluctuation was less than 15%. MAP and HR significantly increased at T5. NT values of most patients maintained at ideal level by continuous intravenous infusion of etomidate of 10-15μg/(kg·min). NT values of most patients recovered back to 85 (A-B1 grade) within 16-22 min after stopping transfusion of etomidate. The incidence of myoclonus during induction was 14.3%. Conclusion  Anesthesia induction of ASAⅠ or Ⅱ adult patients by etomidate is safe and quick and hemodynamics is stable. It can maintain ideal depth of anesthesia by continuous intravenous infusion of etomidate of 10-15 μg/(kg·min) during anesthesia maintenance. Patients wake up quickly and completely without delay after stopping transfusion and adverse events are rare. Related Articles | Metrics

Technique and method

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Preparation of an urine internal quality control substance for fluorescence PCR detection of cytomegalovirus DNA CHEN Ke-ping, XU Yu-rong, LI Li 2015, 35 (11):  1766.  doi: 10.3969/j.issn.1674-8115.2015.11.034 Abstract ( 1037 )   PDF (1632KB) ( 1084 )   Objective  To prepare an urine internal quality control substance for fluorescence PCR detection of cytomegalovirus DNA and observe the stability. Methods  Urine samples with positive CMV-DNA were collected, filtered, and preserved at -80℃ to observe its stability. The effect of preservation conditions of -80 ℃ and -20 ℃ on the stability of quality control substance was compared. Results  Among 120 tests, first 20 tests adopted the instance method and the results were under control. Levey-Jennings quality chart was plotted after 20 tests and the results were all under control according to Westgard rules. The preservation conditions of -80 ℃ and -20 ℃ did not affect the stability of prepared internal quality control substance. Conclusion  The urine internal quality control substance prepared by simple method is stable and can be used as internal quality control substance for fluorescence PCR detection of cytomegalovirus DNA. Related Articles | Metrics

Case report

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Report of a case of intracranial aneurysm combined with pituitary adenoma with the initial symptom of subarachnoid hemorrhage CHEN Kui, JIANG Xiu-feng, YANG Xi-tao, et al 2015, 35 (11):  1770.  doi: 10.3969/j.issn.1674-8115.2015.11.035 Abstract ( 937 )   PDF (836KB) ( 1068 )   Objective  To explore the diagnosis and treatment of intracranial aneurysm combined with pituitary adenoma with the initial symptom of subarachnoid hemorrhage. Methods  The clinical data and results of physical and assistant examinations of one case of intracranial aneurysm combined with pituitary adenoma were analyzed and relevant literature was reviewed. Results  A 53-year old male patient visited hospital due to a sudden headache with stiff neck for 4h. Physical examination showed that the blood pressure was 203/123 mmHg and the patient was sane with a face of acute illness, normal visual acuity and visual field, and Kerning sign (+). The preoperative cranial computed tomographic (CT) scan showed intracranial subarachnoid hemorrhage and high density shadow in the suprasellar cistern. The computed tomographic arteriography (CTA) showed a tumor like lump at the anterior communicating artery, which was confirmed by the whole brain DSA examination on the admission day. The patient underwent an anterior communicating aneurysm clipping 24h after the onset. A round mass in the prechiasmatic cistern was observed during surgery. The mass was enveloped with a clear boundary with tough texture. The color of the mass was grey red and the diameter was about 3 cm. According to preoperative imaging, the mass was considered to be a pituitary adenoma and partial excision was performed. The exploration of the far side along the left internal carotid artery showed an anterior communicating artery aneurysm with the diameter of 3 mm. A Yasargil aneurysm clip was used to clip the aneurysm. One week after the surgery, the head CTA showed that the tumor like lump at the anterior communicating artery disappeared. Conclusion  For the patients with subarachnoid hemorrhage and high density shadow in the suprasellar cistern, the possibility of intracranial aneurysm combined with pituitary tumor should be considered besides the ruptured intracranial aneurysms. Related Articles | Metrics