Chemotherapy with laparoscope-assisted continuous circulatory hyperthermic intraperitoneal perfusion for malignant ascites

AIM:To investigate the procedure, feasibility and effects of laparoscopeassisted continuous circulatory hyperthermic intraperitoneal perfusion chemotherapy (CHIPC) in treatment of malignant ascites induced by peritoneal carcinomatosis from gastric cancers. METHODS: From August 2006 to March 2008, the laparoscopic approach was used to perform CHIPC on 16 patients with malignant ascites induced by gastric cancer or postoperative intraperitoneal seeding. Each patient underwent CHIPC three times after laparoscopeassisted perfusion catheters placing. The first session was completed in operative room under general anesthesia, 5% glucose solution was selected as perfusion liquid, and 1500 mg 5 fluorouracil (5FU) and 200 mg oxaliplatin were added in the perfusion solution. The second andthird sessions were performed in intensive care unit, 0.9% sodium chloride solution was selected as perfusion liquid, and 1500 mg 5FU was added in the perfusion solution alone. CHIPC was performed for 90 min at a velocity of 450600 mL/min and an in flow temperature of 43 ± 0.2℃.RESULTS: The intraoperative course was uneventful in all cases, and the mean operative period for laparoscopeassisted perfusion catheters placing was 80 min for each case. No postoperative deaths or complications related to laparoscopeassisted CHIPC occurred in this study. Clinically complete remission of ascites and related symptoms were achieved in 14 patients, and partial remission was achieved in 2 patients. During the followup, 13 patients died 29 mo after CHIPC, with a median survival time of 5 mo. Two patients with partial remission suffered from port site seeding and tumor metastasis,and died 2 and 3 mo after treatment. Three patients who are still alive today survived 4, 6 and 7 mo, respectively. The Karnofsky marks of patients (5090) increased significantly (P < 0.01) and the general status improved after CHIPC. Thus satisfactory clinical efficacy has been achieved in these patients treated by laparoscopic CHIPC. CONCLUSION: Laparoscopeassisted CHIPC is a safe, feasible and effective procedure in the treatment of debilitating malignant ascites induced by unresectable gastric cancers.

Resection of a giant hepatocellular carcinoma weighing over ten kilograms

The authors report a giant hepatocellular carcinoma(HCC)with a diameter over 30 cm and weight over 10 kg that was resected completely.A 62-year-old man was admitted because of continuous abdominal uplift.A computed tomography scan demonstrated that the entire abdomen was filled with a giant tumor containing both cystic and solid components with a size of 29 cm×22 cm.The huge tumor was successfully resected without any complication,such as massive hemorrhage or visceral injuries.The size and weight of the tumor were 35 cm×30 cm×15 cm and 10050 g,respectively.Pathological examination showed that the tumor was a well-differentiated HCC,and α-fetoprotein was positive.Postoperative syndrome,characterized by hypovolemic shock,diarrhea and urine retention,was observed and induced by abdominal decompression.This syndrome was resolved with expectant treatment.The patient was still alive without recurrence after a 27-mo follow-up.

Mechanisms and significance of lipoprotein(a) in hepatocellular carcinoma

BACKGROUND: The liver plays a key role in the metabolism of plasma apolipoproteins, endogenous lipids and lipoproteins. Hepatocellular carcinoma is one of the most common fatal malignant tumors in China and in other Southeast Asian countries. It has been demonstrated that plasma lipid profiles are changed in liver cancer. DATA SOURCES: A MEDLINE database search was performed to identify relevant articles using the keywords 'hepatocellular carcinoma' and 'lipoprotein(a)'. The search was conducted and research articles were reviewed from 1960 to 2008. RESULTS: Production and homeostasis of lipids, apolipoproteins and lipoproteins depend on the integrity of hepatocellular functions, which ensures normal lipid and lipoprotein metabolism in vivo. When hepatocellular injury or liver cancer occurs these processes can be impaired. It has been suggested that plasma levels of apolipoprotein(a) (apo(a)) and/or lipoprotein (a) (Lp(a)) may be considered as sensitive markers of hepatic impairment. CONCLUSIONS: Plasma levels of apo(a) and Lp(a) display significant correlations with hepatic status. Most studies demonstrated that the plasma levels of apo(a) and Lp(a) can be considered as an additional clinical index of liver function.

THE EVOLUTION OF SMALL LAKE BASINS IN THE GOBI DESERT IN MONGOLIA

In order to investigate pluvial lakes in the Gobi two places were selected for field studies: Khongoryn Els inSouth- and Mongol Els in West-Mongolia. In the eastern and central parts of Khongoryn Els two small endorheic basins,Bayan Tukhem and Khongoryn Gol depressions were studied. Pluvial lake deposits and beach ridges both supposedly mid-Holocenein age give evidence of a 9m and a 15m deep freshwater lake,respectively. Today both depressions are nearlydried out and exposed to wind deflation. A different situation was found at Uujin Sair river valley which cuts through thedune field at its lowest and narrowest (3 km) part. Here, a 22.5 m thick fossil accumulation of at least 20 layers of fine sand(dune sand)alternating with silt(fluvial playa sediment)was exposed and OSL dated. 12 dates ranging between 14ka and17ka reveal the accumulation as Late Glacial which correlates well with the aridity at that time reported for Central Asia byseveral authors. Interpreting the dates it seems obvious that the whole sediment was quickly deposited in a period of about16ka,and shortly after dissected by the Uujin Sair during a similar short time due to increasing humidity of the climate.Another situation was found at the eastern rim of Mongol Els. Two rivers,Shurgiyn Gol and Zavran Gol are impinging hereon the high dunes which have damed both rivers in the past. A younger, shallow lake existed during mid-Holocene( ^(14)C-dated to some 5.5ka)and a large, 17m deep lake( ^(14)C -- dated to some 39ka) probably during stage 4. Expected OSLdates will hopefully support this hypothesis. Anyhow, the palaeogeography of the dune field was different from today; itmoved eastward daming the large river Shurgiyn Gol.

Heterogeneous Photooxidation of Phenol by Catalytic Membranes

In this work the heterogenization in polymeric membranes of decatungstate,a photocatalyst for oxidation reactions,was reported.Solid state characterization techniques confirmed that the catalyst structure was preserved within the polymeric membranes.The catalytic membranes were successfully applied in the aerobic photo-oxidation of phenol,one of the main organic pollutants in wastewater,providing stable and recyclable photocatalytic systems.The dependence of the phenol degradation rate by the catalyst loading and transmembrane pressure was shown.By comparison with homogeneous reaction,the catalyst heterogenized in membrane appears to be more efficient concerning the rate of phenol photodegradation and mineralization.

Inhalation of shin-I essential oil enhances lactate clearance in treadmill exercise

Objective:To evaluate the effect of Shin-I essential oil inhalation on blood lactate changes in rats subjected to treadmill exercise.Methods:Adult male Sprague Dawley rats(n=12) were randomly divided into the control or the Shin—1 group.Rats were subjected to a treadmill exercise program(15 m/min for 30 mim.After exercise,rats were exposed to 200 ui.of water or Shin—I essential oil.res|ieclively.using a nebulizer for 180 min during the recovery period.Blood samples were collected every 15 min.Blood glucose and lactate concentrations were determined in a CMA 600 analyzer.Results:The basal glucose and lactate levels wen? no significantly different between two groups.After exercise,glucose levels were slightly increased to about 110%-120%of the basal level in both groups.lactate levels of both groups reached to 110%-140%of basal levels during exercise.In the recovery period,lactate levels further increased to 180%of the basal level and were maintained at a plateau in the control group.However,lactate levels gradually decreased to 609—657 of the basal level in the Shin-I group.Lactate clearance was significantly enhanceil after Shin-I essential oil inhalation.Conclusions:Our results provide evidence that Shin-I essential oil inhalation may accelerate recovery after exercise in rats.

Checkpoint inhibitor-induced hepatotoxicity:Role of liver biopsy and management approach

Immunological checkpoint inhibitors(ICIs)have revolutionized therapy of many different malignanices.Concomitant immune-mediated adverse effects are common and can affect many organs such as the skin,lungs,gastrointestinal and endocrine organs as well as the liver.Liver injury has been reported in 3%-8%of patients with grade III-IV hepatitis in retrospective studies.The liver injury is characterized by hepatocellular injury resembling autoimmune hepatitis biochemically but not immunologically as patients with ICI induced hepatoxicity rarely have auto-antibodies or IgG elevation.The role for liver biopsy(LB)in patients with suspected liver injury due to ICIs is controversial and it is not clear whether results of a LB will change clinical management.LB can be helpful when there is diagnostic uncertainty and pre-existing liver disease is suspected.Although there are no distinctive histological features,the finding of granulomas and endothelitis may suggest a specific type of hepatitis induced by ICIs.The natural history of hepatotoxicity of ICI therapy is not well known.Recent studies have demonstrated that 33%-50%of patients improve spontaneously with discontinuation of ICIs.In patients with jaundice and/or coagulopathy corticosteroids are used.The high doses of corticosteroids with 1-2 mg/kg/d of methylprednisolone recommended by the oncological societies are controversial.Recently it has shown that initial treatment with 1 mg/kg/d provided similar liver tests improvement which was also associated with a reduced risk of steroid-induced adverse effects in comparison with higher-dose regimens.Secondary immunosuppression mostly with mycophenolate mofetil has been reported to be helpful.

结节性硬化症患者癫痫手术的筛选

The authors reviewed preoperative MRI and EEG findings in relation to postsurg ical outcome in 17 patients with refractory epilepsy due to tuberous sclerosis c omplex (TSC). Resecting concordant MRI (main tuber) and EEG abnormalities offere d seizure freedom (8/9, 89%; median follow-up 25 months) comparable to other f ocal etiologies. Patients with nonconcordant MRI and EEG findings did less well (3/8, 38%, seizure free; p=0.027, OR=13).

老年人抑郁和认知障碍的暂时联系:前瞻性人群研究

Objective: To examine the temporal relation between depression and cognitive i mpairment in old age. Design: Prospective, population based study with four year s of follow up. Setting: City of Leiden, the Netherlands. Participants: 500 peop le aged 85 years at recruitment Main outcome measures: Annual assessments of dep ressive symptoms (15 item geriatric depression scale), global cognitive function (mini mental state examination) , attention (Stroop test), processing speed ( letter digit coding test), and immediate and delayed recall (12 word learning te st). Results: At 85 years old, participantsdepressive symptoms and cognitive i mpairment were highly significantly correlated (P<.0.001). During follow up,an a ccelerated annual increase of depressive symptoms was associated with impaired a ttention (0.08 points (95%confidence interval 0.01 to 0.16)), immediate recall (0.17 points (0.09 to 0.25)), and delayed recall (0.10 points (0.02 to 0.18)) at baseline. In contrast, depressive symptoms at baseline were not related to an a ccelerated cognitive decline during follow up (P >.0.05). Conclusion: Care giver s should be aware of the development of depressive symptoms when cognitive impai rment is present. However, the presence of depression only does not increase the risk of cognitive decline.

老年患者甲状腺功能状态、失能和认知功能与生存率的关系

Context: Despite the equivocal outcomes of randomized controlled trials, general clinical opinion favors screening and treatment of elderly individuals with subclinical thyroid disorders. Objectives: To determine whether subclinical thyroid dysfunction should be treated in old age and the long- term impact of thyroid dysfunction on performance and survival in old age. Design, Setting, and Participants:A prospective, observational, population- based follow- up study within the Leiden 85- Plus Study of 87% of a 2- year birth cohort (1912- 1914) in the municipality of Leiden, the Netherlands. A total of 599 participants were followed up from age 85 years through age 89 years (mean [SD] follow- up, 3.7 [1.4] years). Main Outcome Measures: Complete thyroid status at baseline; disability in daily life, depressive symptoms, cognitive function, and mortality from age 85 years through 89 years. Results: Plasma levels of thyrotropin and free thyroxine were not associated with disability in daily life, depressive symptoms, and cognitive impairment at baseline or during follow- up. Increasing levels of thyrotropin were associated with a lower mortality rate that remained after adjustments were made for baseline disability and health status. The hazard ratio (HR) for mortality per SD increase of 2.71 mlU/L of thyrotropin. was 0.77 (95% confidence

足月低体重儿与妊娠期健康危害行为的关系

OBJECTIVE:To estimate the association between term-gestation low birth weight (term-LBW) rates and increasing numbers of health-compromising behaviors during pregnancy. METHODS: Retrospective cohort study of 78,397 term live births in Kansas City, Missouri, 1990-2002. Information on maternal and newborn characteristics was obtained form birth certificate records. Health-compromising behavior, specifically, smoking, alcohol, and drug use, was classified by the numbers and combinations of behaviors engaged in during pregnancy. Covariates included race, age, interconception interval, education, Medicaid status, medical risk factors, adequacy of prenatal care, and marital status. RESULTS: The cohort was 61%white, 16%less than 20 years of age, 45%on Medicaid, 24%with medical risk factor, and 45%single pregnant women. Overall term-LBW rate was 3.3%, and it increased with numbers of health-compromising behaviors: 2.6%(none), 5.5%(1), 10.8%(2), and 18.5%(3), P <.001. Unadjusted odds ratio (OR) for term-LBW increased with increasing numbers of behaviors (OR 1.0 [none]; 2.3, 95%confidence interval 2.0-2.4 [smoking]; 0.9, 0.6-1.4 [alcohol]; 2.1, 1.5-3.0 [drugs]; 4.6, 3.6-5.8 [smoking +alcohol]; 4.4, 3.6-5.4 [smoking +drugs]; 4.2, 1.5-11.9 [drugs +alcohol]; 8.4, 6.2-11.5 [smoking +alcohol +drugs]). However, on adjusting for covariates, smoking, alone (OR 2.3, 2.0-2.5) or in combinations with other behaviors (OR 4.4, 3.4-5.7 [smoking +alcohol]; 2.0, 1.6-2.6 [smoking +drugs]; and 3.3, 2.2-4.7 [smoking +alcohol +drugs]) remained the major risk factor for term-LBW. CONCLUSION: Smoking alone or in combination with alcohol and/or drug use is associated with term-LBW among women who engage in health-compromising behaviors. The effect is especially pronounced when smoking is combined with alcohol consumption.

Synthesis of Chitosan Quaternary Ammonium Salts

A series of N-alkyl or N-aryl chitosan quaternary ammonium salts were prepared via Schiffs base intermediates. Quaternization of N-substituted chitosan derivatives was carried out using methyl iodide to produce water-soluble cationic chitosan quaternary ammonium salt. The products were characterized by IR, (HNMR)-H-1 and elemental analysis. The degree of substitution of chitosan quaternary ammonium salt was calculated by elemental analysis.

EFFECT OF ACUPUNCTURE ON BRAIN ACTIVATION: A fMRI STUDY

Functional brain mapping in motor task and somatosensory stimulation using echo planar MRI Functional brain mapping was performed with a 1.5T clinical MRI apparatus. Single shot gradient echo echo-planar imaging (EPI) sequence was employed. Normal volunteers were studied with the task of grasping hand or opposition of fingers at the frequency of 3 Hz, median nerve electro-stimulation, pure

基于一种优化算法的大坝变形性态模型

大型水库大坝安全监测系统的监测数据可用来建立多种重要的结构安全状态参数下的预测模型。提出了一种基于基因算法的非线性、退化性态模型。以大坝顶部的上、下游位移作为状态参数为例,以倒垂数据作为数据输出,库水位和气温以及前7,15,30和60d的平均值作为外在影响因子。选取坝高58m、坝长190m的Herculane拱坝的332个数据集作为输入-输出参数,时间序列为2000年1月—2007年6月。从这个数据序列获得回归系数,并进行检验确认。同理,可得其他参数下性态预测模型。这些模型能够解释实时监测中的数据,并能迅速辨识某些情况下的大坝安全潜在风险。

Physiology and interaction of in sects with environmental factors

Annual loss of crop yields due to agricultura I in sect pests are approximately 10%.Effective and safe management of insect pests would reduce the loss of crop production.In sects live in an environment where they need to deal with biological and non-biological factors that impact their physiological and developmental activities to survive and expand their population.These environmental factors in elude,but not limited to,phytochemicals in the host plants they feed on,toxic compounds,such as insecticides sprayed by human,parasitoid,microbes,temperature and drought stress.In the Ion g-term evolution,in sects have developed sophisticated strategies to adapt the harmful factors against them.For example,to feed on different host plants,in sects develop effective and comprehensive olfactory and gustatory receptor systems and detoxification enzyme systems to deal with the secondary toxic phytochemicals.These olfactory and gustatory receptor and detoxification enzyme systems contain multiple superfamilies of proteins and enzymes,such as cytochrome P450s,glutathione S-transferases(GSTs)and esterases,together to form multiple preventive and protection barriers along with the regulation and function of the endocrine systems,which synthesize and secrete hormones and neuropeptides circulating to the different target tissues and organs to guarantee the normal growth and development.On the other hand,in sects also adjust their feeding behaviors and metabolism pathways,as well as even the nutrient components in the host plants by cha nging the expression patter ns of related genes to promote the nutrie nt intake and utilization.In sects and their host plants ultimately establish a cooperative and antagonistic relationship during evolution.

肠易激综合征患者精神应激时内脏感觉和神经内分泌应答的变化

Background and aims: Stress often worsens the symptoms of irritable bowel syndrome (IBS).We hypothesised that this might be explained by altered neuroendocrine and visceral sensory responses to stress in IBS patients. Subjects and methods:Eighteen IBS patients and 22 control subjects were assessed using rectal balloon distensions before, during, and after mental stress. Ten controls and nine patients were studied in supplementary sessions. Rectal sensitivity (thresholds and intensity-visual analogue scale (VAS)) and perceived stress and arousal(VAS) were determined. Plasma levels of corticotropin releasing factor (CRF), adrenocorticotropic hormone (ACTH),cortisol, noradrenaline, and adrenaline were analysed at baseline,immediately after stress, and after the last distension.Heart rate was recorded continuously. Results: Thresholds were increased during stress in control subjects (p< 0.01) but not in IBS patients. Both groups showed lower thresholds after stress (p< 0.05). Repeated distensions without stress did not affect thresholds. Both groups showed increased heart rate(p< 0.001) and VAS ratings for stress and arousal (p< 0.05)during stress. Patients demonstrated higher ratings for stress but lower for arousal than controls. Basal CRF levels were lower in patients (p < 0.05) and increased significantly during stress in patients (p < 0.01) but not in controls. Patients also responded with higher levels of ACTH during stress (p < 0.05) and had higher basal levels of noradrenaline than controls (p < 0.01).Controls, but not patients, showed increased levels of adrenaline and noradrenaline in response to stress (p < 0.05). Conclusions:Stress induced exaggeration of the neuroendocrine response and visceral perceptual alterations during and after stress may explain some of the stress related gastrointestinal symptoms in IBS.

意大利阴道镜门诊患者中生殖器单纯疱疹病毒脱落细胞的患病率及其决定因素

Objectives: To determine the prevalence of herpes simplex virus (HSV) shedding among women attending Italian colposcopy clinics and describe their lifestyle, demographic characteristics, genital symptoms and signs. Study design: A cross- sectional study was performed to assess shedding of HSV among 4565 women requiri ng a gynecological consultation. An amplified enzyme immunoassay that detects an HSV type-common glycoprotein D was used to reveal HSV shedding in cervical spe cimens. Statistical analysis was performed using Chi-square test and Student’s t test. Results: A prevalence of 7.8%was found among colposcopy clinic patient s. No significant differences regarding patients’average age, age at first sexu al intercourse, contraceptive method used, and number of sexual partners in the previous year were found between subjects with and without viral shedding (P >0. 05). The detection of a concomitant genital infection with Trichomonas vaginalis as well as the report of previous episodes of genital herpes (GH) were signific antly higher in the positive group (P <.0.01). Only 2.8%of the patients sheddin g HSV presented with vesicles and ulcers, with the majority of them being asympt omatic. Conclusion: This is the first Italian survey on genital herpes conducted among colposcopy clinic patients. Our data show that the prevalence of HSV shed ding in this study population is high and confirms that the disease is often asy mptomatic. The demographics and behavioural variables of women shedding HSV seem to differ from the ones assessed in high risk patients.

体外受精周期中卵泡内雌二醇减少可降低卵巢对重组人卵泡刺激素的反应性

Objective: To correlate serum and intrafollicular E2 levels in women receiving GnRH agonist and recombinant human (h)-FSH for IVF. Design: Prospective study. Setting: Academic IVF center. Patient(s): Twenty-three nonhirsute ovulatory wo men. Intervention(s): In vitro fertilization cycles were classified as high-or low-normal response, according to whether the amount of recombinant hFSH admini stered was below or above, respectively, the mean recombinant hFSH given to all women combined. Serum bioactive LH and immunoreactive FSH were measured during p ituitary desensitization preceding recombinant hFSH and repeated at oocyte retri eval. The first mature follicle aspirated from either ovary had a mean diameter >15 mm. Main Outcome Measure(s): Serum and follicular fluid (FF) insulin, bioact ive LH, immunoreactive FSH, and steroid levels. Result(s): Basal serum gonadotro pin levels were comparable between female groups. Serum immunoreactive FSH level s, but not bioactive LH levels, at oocyte retrieval were greater in cycles of lo w-normal vs. high-normal response, whereas maximum serum E2 levels and total o ocyte counts were similar between both groups. Despite elevated FF immunoreactiv e FSH levels, FF E2 was decreased in low-normal response cycles. Intrafollicula r T and P also were decreased and increased, respectively, in cycles of low-nor mal response, although FF bioactive LH levels were comparable in both groups. Co nclusion(s): Intrafollicular E2 is decreased in cycles of reduced ovarian respon siveness to GnRH agonist and recombinant hFSH and is not predicted by maximal se rum E2 or number of oocytes retrieved.

短肠综合征患儿的长期胃肠外营养支持和肠道适应性的改变:25年临床经验回顾

目的:对于短肠综合征(SBS)患儿长期接受胃肠外营养(PN)后的愈复状况进行分析。方法:搜集1975- 2000年间的短肠综合征病例,其中78例患儿接受胃肠外营养3个月以上,对其病例资料进行回顾性分析。统计分析:采用单变量分析,Kaplan-Meier法和Cox比例回归模型。结果:确诊了78例患者。患者具备如下情况时,其存活状况较好:小肠长度(SBL)大于38 cm。

区分住院儿童中意外伤害和虐待造成的脑损伤特征

Objective.To describe the clinical features that distinguish accidental from abusive head injury in hospitalized children < 24 months of age.Methods.Prospective study of children < 24 months of age hospitalized for head injury between August 1, 2000, and October 31, 2002.During hospitalization, children had computed tomographic scans of the brain, serial neurologic examinations, dilated ophthalmoscopic eye examinations, evaluation by a social worker, and, in some cases, a child abuse specialist.Outcome Measures.The main outcome measure was the proportion of children in each group with retinal hemorrhages (RHs).Secondary outcome measures were the proportion of children in each group who had vitreous hemorrhage; abnormal mental status on presentation; seizures; scalp hematomas; need for anticonvulsants; and operative pro-cedures such as subdural tap, craniotomy, ventriculostomy, tracheostomy, and gastrostomy.Results.Eighty-seven children were prospectively enrolled.Fifteen children were classified as having abusive head injury, and 72 were classified as having accidental head injury.Five children, all in the accidental head injury group, were excluded from statistical analysis, because they did not have a dilated ophthalmoscopic examination during their hospitalization.Thus 82 children were included in the statistical analysis.There were no significant differences between the 2 groups with respect to mean age, gender, or ethnicity.RHs were more likely to be seen in children with abusive head injury (60%vs 10%) and were more likely to be bilateral (40%vs 1.5%).Pre-RHs were more likely to be seen in children with abusive head injury (30%vs 0%).Premacular RHs and RHs that extended to the periphery of the retina were alsomore likely to be seen in children with abusive head injury (20%vs 0%and 27%vs 0%, respectively).Of the 7 children with accidental head injury who had RHs, 6 had unilateral RHs.Children with abusive head injury were more likely to have seizures (53%vs 6%) and an abnormal mental status on initial presentation (53%vs 1%).Children with accidental head injury were more likely to have scalp hematomas (6.7%vs 49%).Conclusions.RHs are seen more often in abusive head injury and often are bilateral and involve the preretinal layer.Children with abusive head injury were more likely to have RHs that cover the macula and extend to the periphery of the retina.Unilateral RHs can be seen in children with accidental head injury.Children with abusive head injury were more likely to present with abnormal mental status and seizures, whereas children with accidental head injury were more likely to have scalp hematomas.Such characteristics may be useful to distinguish accidental from abusive head trauma in children < 24 months of age.