Surgical experiences with inflammatory arterial aneurysms due to Takayasu's arteritis

This report shows clinical manifestations and provides aspects of surgical strategy for inflammatory aneurysms due to Takayasu's arteritis. Fourteen cases of inflammatory aneurysms among 81 patients with Takayasu's arteritis who underwent surgery in our institute were reviewed. The patient group consisted of six males and eight females, ages from 20 to 61 (mean 39.6±3.5) years. Aneurysmal lesions were located in the ascending aorta or aortic arch (type I) in six (42.9%) patients and the thoracic and/or abdominal aorta (type II) in six patients (42.9%). Type III distribution was determined for two patients (14.3%). Operative procedures for aneurysms included aortic replacement using prosthetic graft (n=6), aneurysmorraphy (n=1), patch angioplasty (n=1), Hardy operation (n=1), aortic valve replacement (AVR) (n=2), and AVR associated with mesh wrapping or aneurysmorraphy (n=3). Operative mortality was 21.4% (three cases) at initial operation and late deaths were found in five cases. Causes of late deaths included rupture of suture aneurysms, rupture of the aortic aneurysm at other aortic lesions, and sudden death due to acute perivalvular leakage. Aggressive surgical approach prior to rupture is required for cases with progressive aortic dilatation even if inflammation signs appear to be controlled. Careful long-term follow-up using periodical angiogram or computed tomography are essential to the best prognosis in pre- and postoperative periods.     

Endoscopic appearance of the colon and small intestine of a patient with hemorrhagic enteric graft-vs.-host disease

Endoscopic appearance of the gastrointestinal tract of a patient with severe hemorrhagic enteric graft-vs.-host disease (GVHD) is presented. A 29-year-old man with chronic myelogenous leukemia suffered from severe enteric GVHD after allogeneic bone marrow transplantation. Endoscopy showed hemorrhagic ulceration of the upper jejunum, terminal ileum, and colon at the onset of melena. Sections of biopsies were compatible with acute GVHD. Repeat endoscopy showed gradual healing of the lesions after steroid pulse and antilymphocyte globulin therapy, but the patient died of cytomegalovirus pneumonitis 14 months later. Autopsy revealed submucosal fibrosis of the small intestine and colon.     

Terlipressin versus norepinephrine as infusion in patients with septic shock: a multicentre,randomised, double-blinded trial

Purpose

Recent clinical data suggest that terlipressin, a vasopressin analogue, may be more beneficial in septic shock patients than catecholamines. However, terlipressin’s effect on mortality is unknown. We set out to ascertain the efficacy and safety of continuous terlipressin infusion compared with norepinephrine (NE) in patients with septic shock.

Methods

In this multicentre, randomised, double-blinded trial, patients with septic shock recruited from 21 intensive care units in 11 provinces of China were randomised (1:1) to receive either terlipressin (20–160 µg/h with maximum infusion rate of 4 mg/day) or NE (4–30 µg/min) before open-label vasopressors. The primary endpoint was mortality 28 days after the start of infusion. Primary efficacy endpoint analysis and safety analysis were performed on the data from a modified intention-to-treat population.

Results

Between 1 January 2013 and 28 February 2016, 617 patients were randomised (312 to the terlipressin group, 305 to the NE group). The modified intention-to-treat population comprised 526 (85.3%) patients (260 in the terlipressin group and 266 in the NE group). There was no significant difference in 28-day mortality rate between the terlipressin group (40%) and the NE group (38%) (odds ratio 0.93 [95% CI 0.55–1.56]; p?=?0.80). Change in SOFA score on day 7 was similar between the two groups: ??7 (IQR ??11 to 3) in the terlipressin group and ??6 (IQR ??10 to 5) in the NE group. There was no difference between the groups in the number of days alive and free of vasopressors. Overall, serious adverse events were more common in the terlipressin group than in the NE group (30% vs 12%; p?<?0.001).

Conclusions

In this multicentre, randomised, double-blinded trial, we observed no difference in mortality between terlipressin and NE infusion in patients with septic shock. Patients in the terlipressin group had a higher number of serious adverse events.

Trial registration

This trial is registered at ClinicalTrials.gov: ID NCT01697410.

     

HSP60 overexpression increases the protein levels of the p110α subunit of phosphoinositide 3‐kinase and c‐Myc

Heat shock protein 60 (HSP60) is a chaperone protein which plays an essential role in facilitating the folding of many newly synthesized proteins to reach their native forms. Increased HSP60 expression is observed in various types of human cancers. However, proteins induced by HSP60 to mediate transformation remain largely unknown. Here we show that HSP60 overexpression increases the protein levels of the p110α subunit of phosphoinositide 3‐kinase (PI3K). The amino acid domain 288‐383 of HSP60 is used to increase the protein levels. Overexpression of HSP60 also induces the levels of phosphorylated Akt. In addition, the amino acid domain 288‐383 of HSP60 is used to induce c‐Myc expression. Finally, a mono‐ubiquitinated form of β‐catenin has a higher activity to activate β‐catenin downstream targets compared to wild‐type β‐catenin. These results indicate that HSP60 overexpression induces the levels or activity of multiple oncogenic proteins to mediate transformation.     

创建天津国际卫生机场的SWOT分析

目的分析天津机场创建国际卫生机场的前景。方法运用SWOT分析法全面分析天津创建国际卫生机场面临的优势、劣势、机遇及风险。结果天津机场基础设施较为完善,检验检疫机构技术储备充分,基本满足创建标准要求。结论创卫工作是未来发展大势所趋,口岸检验检疫机构应积极争取地方政府支持,努力调动创建主体积极性。     

The predictive value of intraoperative transit-time flow measurement parameters for early graft failure in different target territories

BackgroundEarly graft failure can affect the short- and long-term outcomes of patients undergoing coronary bypass grafting surgery (CABG). The aim of our study was to explore the predictive value of transit-time flow measurement (TTFM) parameters for early graft failure (before discharge) after CABG in different coronary territories and calculate the TTFM cut-off values.MethodsWe analyzed a total of 761 grafts (360 patients) that were evaluated by intraoperative TTFM and computed tomography angiography prior to discharge. Logistic model was established to detect the parameters of TTFM to predict early graft failure and receiver operating characteristic curve analysis was used to calculate the cut-off values.ResultsThe overall early graft failure was 3.5%. The results demonstrated that compared with off-pump CABG, mean graft flow volume was higher (28.0 vs 21.0 mL/min, p = 0.000), but pulse index (PI) (2.3 vs 2.5, p = 0.049) and diastolic flow fraction (DF) (68.0% vs 71.0%, p = 0.001) were lower in on-pump CABGs. DF (73.0% vs 65.5%, p = 0.000) of arterial grafts was higher than that of venous grafts. DF (72.0% vs 62.0%, p = 0.000) in left was higher than that in the right coronary artery territories. The results of multivariate logistic analysis showed that not only in the overall (OR 1.18, 95% CI 1.07–1.30, p = 0.001), but also the left (OR 1.21, 95% CI 1.03–1.41, p = 0.017) and right (OR 1.15, 95% CI 1.03–1.29, p = 0.017) coronary artery target territories, PI was a risk factor for early graft failure and the cut-off value was 3.4, 3.4, and 3.6, respectively. For grafts in left target territories, the results showed that DF (OR 0.94, 95% CI 0.91–0.97, p = 0.000) just in the univariate analysis was a risk factor that affected graft failure.ConclusionsThe overall early graft failure was about 3.5%. High PI value is a risk factor for early graft failure in not only overall grafts but in grafts of different target territories. DF might be more useful for the quality evaluation of grafts in left than in right target territories.     

90Y树脂微球治疗患者尿液中90Y放射性活度检测和分析

目的研究患者接受90Y树脂微球选择性内放射治疗(SIRT)后48 h内所排泄尿液中90Y的放射性活度, 为术后患者排泄物的管理提供建议。方法收集3名患者在术后0～24 h和24～48 h两个时间段内排泄的尿液, 并对尿液中的90Y放射性活度进行检测和分析。结果 3名患者术后0～24 h和24～48 h尿液中的90Y放射性活度排泄量分别为(1 266±258)kBq/GBq和(140±106)kBq/GBq, 90Y放射性活度浓度分别为(640±113)kBq/L和(53±12)kBq/L。结论 90Y树脂微球治疗术后肝癌患者0～24 h排泄尿液中的90Y放射性活度比24～48 h高。术后患者可通过增加排泄尿量的方式来加速排出体内游离的90Y;患者住院期间的排泄物应按照HJ 1188-2020《核医学辐射防护与安全要求》的要求处理。     

90Y树脂微球选择性内放射治疗放射防护检测与剂量评估

目的对90Y树脂微球选择性内放射治疗过程进行放射防护检测和剂量评估, 为放射防护工作提供参考。方法对90Y树脂微球介入手术治疗各操作环节和患者体表的外照射水平进行检测, 估算相关人员的受照剂量水平。结果 90Y树脂微球分装及转运过程的剂量率水平为1.12～454 μSv/h, 手术操作过程为2.06～58.2 μSv/h;3名患者术后0.5 h, 体表5 cm和1 m处的剂量率分别为22.7～64.1和0.82～2.55 μSv/h。按照每年200例患者的工作量, 90Y树脂微球药物操作对工作人员年个人有效剂量贡献为0.12～1.03 mSv/年, 术后患者对公众、家属及陪护志愿者的个人有效剂量贡献为0.02～0.24 mSv/年。结论在患者治疗、护理和出院过程中, 工作人员、陪护志愿者和公众的照射剂量均低于(GB 18871-2002《电离辐射防护与辐射源安全基本标准》)中的剂量限值和医疗机构设定的管理目标值。     

Clinicopathologic evaluation of the trend toward histologically poor differentiation with submucosal invasion in superficial early colorectal adenocarcinomas

We examined differences in the degree of differentiation in intramucosal and submucosal areas of involvement in early colorectal adenocarcinomas of 131 patients and compared these findings with tumor morphology. In addition, K-ras and p53 protein expression was determined in cases where poorly differentiated adenocarcinoma was detected in the submucosa. We identified 6 patients with both intramucosal differentiated (well-to-moderately differentiated) adenocarcinoma and submucosal poorly differentiated adenocarcinoma (MwSp). The morphological tumor type was superficial in all MwSp cases. The observed MwSp adenocarcinomas had a significantly higher frequency of lymphatic invasion than the more common superficial type of adenocarcinoma. Genetic analysis of these MwSp lesions was carried out using the polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP) method to detect the presence of K-ras codon 12 point mutations, and an immunologic staining technique was used to identify the presence of p53 protein overexpression. The K-ras mutation rate was 33.3%, and the p53 overexpression rate was 66.7% for the MwSp adenocarcinomas. Our findings suggest that the rapidly reduced histologic differentiation observed in some of these superficial colorectal adenocarcinomas may play a role in their higher degree of invasiveness. Received: November 17, 1999 / Accepted: July 7, 2000     

Natural history of patients with unexplained syncope and a nondiagnostic electrophysiologic study

The purpose of this study was to define the natural history of 99 patients with unexplained syncope who underwent an electrophysiologic test that either was entirely normal or demonstrated nonspecific abnormalities that were nondiagnostic (inducible polymorphic ventricular tachycardia or ventricular fibrillation, a mildly prolonged sinus node recovery time of less than 2 s, a His-ventricular interval of 55 to 99 ms or supraventricular tachycardia not associated with hypotension). The mean age (+/- SD) of the patients was 56 +/- 19 years; structural heart disease was present in 47 patients and absent in 52. Complete follow-up was available in 95 patients. During 20 +/- 11 months of follow-up, 2 patients (2%) died suddenly, 19 patients (20%) had recurrent syncope and 74 patients (78%) had no further episodes of syncope. Among the 19 patients who continued to have syncope after the electrophysiologic testing, the cause of syncope was established clinically in 4 and was found to be high degree atrioventricular (AV) block (2 patients) or sinus node dysfunction (2 patients). No clinical or laboratory findings distinguished patients who had sudden death or syncope during follow-up from patients who did not. In conclusion, in patients with unexplained syncope who undergo an electrophysiologic test that is nondiagnostic 1) the incidence of sudden death is low (2%); 2) the remission rate of syncope is high (80%); 3) the electrophysiologic test may be documented to have been falsely negative in greater than or equal to 20% of patients who continue to have syncope, syncope in these patients being caused by AV block or sinus node dysfunction; and 4) patients at risk of sudden death or recurrent syncope, or both, cannot be readily identified prospectively.