Shanxi Dayi Hospital

BACKGROUNDWavelet index (WLi) and pain rating index (PRi) are new parameters for regulating general anesthesia depth based on wavelet analysis.AIMTo investigate the safety and efficacy of using WLi or PRi in sevoflurane anesthesia. METHODSThis randomized controlled trial enrolled 66 patients scheduled for elective posterior lumbar interbody fusion surgery under sevoflurane anesthesia between September 2017 and February 2018. A random number generator was used to assign the eligible patients to three groups: Systolic blood pressure (SBP) monitoring group, WLi monitoring group, and PRi monitoring group. The main anesthesiologist was aware of the patient grouping and intervention used. The primary endpoint was anesthesia recovery time. Secondary endpoints included extubation time, sevoflurane consumption, number of unwanted events/ interventions, number of adverse events and postoperative visual analogue scale for pain. RESULTSA total of 62 patients were included in the final analysis (SBP group, n = 21; WLi group, n = 21; and PRi group, n = 20). There were no significant differences among the three groups in patient age, gender distribution, body mass index, American Society of Anesthesiologists class, duration of surgery, or duration of anesthesia. Anesthesia recovery time was shorter in the WLi and PRi groups than in the SBP group with no significant difference between the WLi and PRi groups. Extubation time was shorter in the WLi and PRi groups than in the SBP group. Sevoflurane consumption was lower in the WLi and PRi groups than in the SBP group. Nicardipine was more commonly needed to treat hypertension in the WLi and PRi groups than in the SBP group.CONCLUSIONRegulation of sevoflurane anesthesia depth with WLi or PRi reduced anesthesia recovery time, extubation time and sevoflurane consumption without intraoperative unwanted events.

Apatinib, a VEGFR2 receptor tyrosine kinase inhibitor, showed survival benefits in Asian patients with heavily pretreated advanced gastric cancer. However, the adverse event (AEs) profile of apatinib has limited its use. Dosing schedules are used to alleviate toxicities despite no supportive evidence. This study aimed to analyze the toxicity and effectiveness of apatinib alone, especially with different dosing strategies in advanced gastric cancer patients under a real-world setting. Data from the subpopulation of patients who failed ≥2 chemotherapy regimens enrolled in the AHEAD-G202 trial were analyzed. The primary endpoint was safety. The secondary endpoints were overall survival (OS) and progression-free survival (PFS). Totally 120 patients were included into three groups by the initial daily doses: 43 (35.8%) patients in the low-dose (250 mg) group, 67 (55.8%) patients in the mid-dose (425 mg to 500 mg) group, and 10 (8.3%) patients in the high-dose (675 to 850 mg) group. Grade 3/4 treatment-emergent AEs were infrequent (<5%), with the most commonly reported grade 3/4 AEs being hand-foot syndrome (4.2%), hypertension (4.2%,), fatigue (4.2%), and difficulty in swallowing (4.2%) which gradually decreased among the high-, mid-, and low-dose groups. The median OS and PFS were 6.33 months (95% CI, 4.57-7.73) and 3.83 months (95% CI: 1.40-4.20), respectively and were comparable among the three doses groups. We found heavily pretreated advanced gastric cancer patients can tolerate and benefit from lower-doses of apatinib therapy. The lower initial daily dosing strategy represents an alternative approach for optimizing apatinib dosing in clinical practice.

Objectives: To assess the performance of elastography (ES) and ultrasound (US) in predicting the malignancy of breast lesions and to compare their combined diagnostic value with that of magnetic resonance imaging (MRI).Materials and Methods: The study prospectively enrolled 242 female patients with dense breasts treated in 35 heath care facilities in China between November 2018 and October 2019. Based on conventional US and elastography, radiologists classified the degree of suspicion of breast lesions according to the US Breast Imaging Reporting and Data System (BI-RADS) criteria. The diagnostic value was compared between US BI-RADS and MRI BI-RADS, with pathological results used as the reference standard.Results: The results demonstrated that irregular tumor shape, a nonparallel growth orientation, indistinct margins, angular contours, microcalcifications, color Doppler flow and ES score on US imaging were significantly related to breast cancer in dense breasts (P=0.001; P=0.001; P=0.008; P<0.001; P=0.019; P=0.008; P=0.002, respectively). The sensitivity, specificity, PPV, NPV, accuracy and AUC of US BI-RADS category were 94.7%, 90.7%, 95.8%, 88.0%, 93.4% and 0.93 (95%CI, 0.88-0.97), respectively, while those of MRI BI-RADS category were 98.2%, 57.5%, 84.3%, 83.3%, 86.0% and 0.78 (95%CI, 0.71-0.85), respectively. MRI BI-RADS showed a significantly higher sensitivity than US BI-RADS (98.2% vs 94.7%, P=0.043), whereas US BI-RADS showed significantly higher specificity (90.7% vs 57.5%, P<0.001). US BI-RADS showed better diagnostic efficiency in differentiating nodules in dense breasts than MRI BI-RADS (AUC 0.93 vs 0.78, P<0.001).Conclusion: By combining the use of ES and conventional US, US BI-RADS had better diagnostic efficiency in differentiating nodules in dense breasts than MRI. For the diagnosis of malignant tumors in patients with dense breasts, MRI and US BI-RADS can be used as supplemental diagnostic tools to detect lesions, with US BI-RADS considered the preferred adjunctive resource.

Age- and sex-specific reference intervals (RIs) for myocardial enzyme activity of children and adolescents are not available in China. Our study aimed to establish age- and gender-related RIs for AST, LDH, CK, and CKMB activity in healthy Chinese Han population aged 1∼<18 years. Healthy Han children and adolescents (n = 6322, 1∼<18 years old) were assessed from completed questionnaires and defined criteria from communities and schools in 5 administrative districts of Jilin Province from September 2017 to December 2018. Measurements of AST, LDH, CK, and CKMB activity were performed on the VITROS 5600 Integrated System. Percentiles of enzyme activity were completed by LMS. RIs were established by Medcalc according to the EP28-A3c guidelines issued by the Clinical and Laboratory Standards Institute. AST declined rapidly during 1∼<6 years and had been subsided during 11∼<18 years, though LDH decreased at a steady rate. CK activity stabilized while CKMB showed a downward trend. Sex differences started after age 12 when males presented higher results. There were significant differences comparing with domestic and other countries' experiments which applied similar methodologies. Enzymes were associated with age and sex, while age had greater impact. We established age- and sex-specific RIs of serum AST, LDH, CK, and CKMB activities for Chinese children and adolescents using the VITROS 5600 Integrated System for the first time. These data will lay the groundwork for the next horizon in pediatric RIs as well as improve test result interpretation for pediatric illness.

孔兹创伤球菌是一种兼性厌氧菌，最初被认为是人类皮肤、特别是下肢的正常菌。孔兹创伤球菌引起的人类感染较少见，只有少数病例报道。然而，随着糖尿病、肿瘤等慢性疾病及处于免疫力低下的患者增多，这种微生物已被认为是一种条件致病菌，甚至可以导致严重感染。本文报道1例由孔兹创伤球菌引起的严重糖尿病足感染，最终抗感染治疗成功的患者。

Objective To investigate the effects of oxymatrine (OMT) on sphingosine kinase 2 (SphK2) and Claudin-5 (claudin-5) in rats withacute cerebral infarction (ACI) . Methods Rat models of acute middle cerebral artery occlusion (MCAO) were established. They were randomly divided into model group and OMT treatment group (low, medium and high dose groups) , with 10 rats in each group. Another 10 normal rats were enrolled as control group. The low, medium and high dose OMT groups were intraperitoneally injected with 30, 60 and 120 mg/kg OMT, respectively. The model group and the control group were injected with the same volume of normal saline, once per 12h, for a total of 4 times. The rats were sacrificed at 12h after the last injection, and brain tissueswere harvested. The size of infarction in each group was determined by TTC staining. The water content of brain tissues was determined by dry and wet method. The contents of serum interleukin-1β (IL-1β) , interleukin-6 (IL-6) and interleukin-10 (IL-10) in each group were detected by ELISA. The expression levels of SphK2 mRNA and claudin-5 mRNA in each group were detected by RT-PCR. The relative expression quantities of SphK2 and claudin-5 protein were measured by Western blot. Results Compared with model group, percentage size of infarctionand water content in brain tissuesof OMT treatment group were significantly decreased (all P<0.05) , showinga dose-dependencemanner. Compared with control group, the model grouphad increased contents of IL-1β, IL-6 and IL-10, higher relative expression quantities of SphK2 mRNA and SphK2 protein, and lowerrelative expression quantities of claudin-5 mRNA and claudin-5 protein (all P<0.05) . Compared with model group, the OMT treatment groups had lower contents of IL-1β, IL-6 and IL-10, decreased relative expression quantities of SphK2 mRNA and SphK2 protein, and higher relative expression quantities of claudin-5 mRNA and claudin-5 protein (all P<0.05) , showing adose-dependence manner. Conclusion OMT may significantly reduce cerebral infarction sizeand water content of brain tissues in ACI rats, and inhibit inflammatory response. The mechanism of theseactionsmay be related to the down-regulation of SphK2 and up-regulation of claudin-5 by OMT. Key words: Oxymatrine; Acute cerebral infarction; Rat; Sphingosine kinase 2; Claudin 5

We conducted a systematic review and meta-analysis of published randomised controlled trials of dapoxetine for premature ejaculation. We systematically searched Embase, PubMed, Cochrane, Web of Knowledge, FDA.gov and Clinical Trials.gov for studies reporting dapoxetine in men with premature ejaculation. Efficacy endpoints included intravaginal ejaculatory latency times (IELT), personal distress related to ejaculation (PDRE) and treatment-emergent adverse events (TEAEs) was used to evaluate safety. Data were analysed using a random-effects model. Electronic search identified 276 papers. The final analysis included eight papers (n = 8422 subjects). Analysis of the pooled results indicated efficacy in both IELT (weighted mean difference (WMD) = 1.67, 95% confidence interval (CI) 1.45-1.89) and PDRE (relative risk = 1.26, 95% CI 1.18-1.35). Subgroup analysis indicated efficacy (i.e. increase in IELT) for 30- and 60-mg on-demand dapoxetine (WMD 1.38 (95% CI 1.01-1.75) and 1.62 (95% CI 1.40-1.84) respectively), as well as daily use of 60 mg dapoxetine (WMD 2.18, 95% CI 1.71-2.64). The safety profile was acceptable. Based on the different effects of magnitude of the three dosing regimens, we recommend a stepwise approach, starting with 30 mg on demand, then 60 mg on demand and finally 60 mg dapoxetine daily.