Cumulated Research Articles

Impact of diabetes and stroke on long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Objective To investigate the impact of diabetes mellitus (DM) and stroke on long-term outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods Total 411 consecutive ACS patients undergoing PCI at the Ninth People′s Hospital of Zhengzhou between December 2014 and June 2018 were recruited, including 319 males and 92 females with a mean age of (64.7±10.1) years. These patients were divided into 4 groups according to the presence or absence of history of diabetes or stroke: non-DM non-stroke group (n=192) , DM group (n=140), stroke group (n=41), and DM+stroke group (n=38). The data of baseline demographic characteristics, clinical feature, coronary angiographic findings, and cardiovascular adverse events during long-term follow-up were obtained. Kaplan-Meier curves were used to investigate the long-term clinical outcomes among groups. Results The mean interval of follow-up was (24.1±13.8) months. Patients with DM+stroke had the highest rates of non-fetal myocardial infarction (χ2=24.932) , non-fetal stroke (χ2=9.434) , hospitalization due to heart failure/angina (χ2=69.290) , revascularization (χ2=22.918) , cardiovascular death(χ2=13.473)and all-cause death(χ2=17.724)as well as hard endpoint events (the sum of non-fetal myocardial infarction, non-fetal stroke, and all-cause death) (χ2=30.268)and combined major adverse cardiovascular events (MACE) (the sum of hard endpoint events, hospitalization due to heart failure/angina, and revascularization) (χ2=119.556)among 4 groups(all P 0.05) . Meanwhile, patients with DM+stroke presented significantly lower cumulated ratio free from combined MACE than patients with non-DM non-stroke (HR=5.423, 95%CI:2.941-10.036, P<0.01), and the cumulated ratio free from combined MACE also decreased significantly in DM+stroke group as compared to DM group or stroke group respectively (HR=1.859,95%CI: 1.167-2.962; HR=1.991,95%CI: 1.178-3.364; all P<0.01) . Conclusions ACS patients with combined history of DM and stroke have a worse long-term outcomes after PCI than those with DM alone or stroke alone or without DM or stroke. DM and stroke seemed to have an additive effect on decrease in the cumulative ratio free from combined MACE in ACS patients following PCI. Key words: Diabetes mellitus; Stroke; Acute coronary syndrome; Major adverse cardiovascular events; Percutaneous coronary intervention

Cumulation of Cross-Section Surveys: Evaluation of Alternative Concepts for the Cumulated Continuous Household Budget Surveys (LWR) 1999 Until 2003 Compared to the Sample Survey of Income and Expenditures (EVS) 2003

Im Rahmen der Weiterentwicklung des Systems von Haushaltsstatistiken und unter Berucksichtigung der EU-Erfordernisse mit neuen EU-SILC Ansatzen wird die Kumulation von Querschnitts-Stichproben zu einem integrierten Informationssystem diskutiert und gefordert. Insbesondere sollen bei dem Umbau der Haushaltsbudgeterhebungen einerseits jahrliche Ergebnisse produziert werden, sowie andererseits in mehrjahrigem Abstand ausreichend hohe Stichprobenumfange zur Verfugung stehen, um tiefgegliederte Analysen zu ermoglichen. Die vorliegende Studie ist dazu ein Beitrag mit einer generellen konzeptionellen Fundierung fur die Kumulation von Querschnitten und einer Anwendung, die im Besonderen das neue Kumulationskonzept evaluiert mit grosen offiziellen Stichproben/Umfragen: der Querschnitts-Kumulation von funf jahrlichen Laufenden Wirtschaftsrechnungen (LWR), die verglichen wird mit der funfjahrigen Einkommens- und Verbrauchsstichprobe (EVS) des deutschen Statistischen Bundesamtes. Dabei wird die Sensitivitat des Kumulationskonzeptes mit seinen Alternativen evaluiert fur ausgewahlte Gruppen von Konsumausgaben privater Haushalte. Eine Empfehlung beschliest diese Studie.

Microdosimetry study of a multicellular model with mono-energetic electrons using Geant4-DNA simulation toolkit

Introduction: The goal of any type of radiation therapy in the treatment of tumors, in addition to destroying cancer cells, is to minimizing radiation to nearby healthy cells and thus reducing side damages. For this purpose, targeted radiation therapy (TRT) is more effective in treating of single cells or small cluster of cells. The main factor in the success of this method is that the range of charged particles used in treatment does not exceed the cellular dimensions; this justifies the use of electron emitters with the energy as low as possible (especially Auger electrons). Materials and Methods: In this study, the Monte Carlo simulation toolkit, Geant4-DNA, has been used due to the accurate computational models used to simulate the transport of charged particle at the cellular scale (micrometer and lower). So, with the help of this code, a multicellular model (cell cluster) consisting of five spherical cells (containing the nucleus) of liquid water, has been simulated in the medium of tissue material. One of the cells is considered as the source, and with the uniform random sampling of 100,000 mono-energetic electrons with an initial energy of 1-20 keV within this cell, energy deposition and the S-value (mean absorbed dose in the target per unit cumulated activity in the source) in each cell is calculated using microdosimetry approach and the proposed formulation of MIRD committee. Results: A comparison of the values obtained for the source cell with the corresponding MIRD values indicates a good agreement, which implies the high ability of Geant4-DNA in microdosimetry simulations. The evaluation of the results suggests that a large part of the energy emitted within the source cell is deposited in the cell itself, which is lowered by increasing energy so that for the energy of 20 keV, it reaches less than 50%. Also, the cell that is far from the source cell (compared to other cells) has a lower energy deposition and S-value. Conclusion: From the assessment of the calculated values and their comparison with each other, it is understood that the less the energy of the primary electron is, the less energy is delivered to the adjacent healthy cells. Due to the very low threshold excitation of liquid water (7.4 eV) which is the main compartment of the cells, this is meant to reduce the risk of damage to adjacent healthy cells. Of course, the electron energy should not be so low that reduces its fatality for cancer cells and thus the efficacy of treatment. Therefore, attention to the mentioned cases, as well as the dimensions of the cell studied and its distance with adjacent cells, is crucial for the selection of an efficient electron-emitter radionuclide.

Determination of internal absorbed dose from radiation of111In-Rituximab in body

Introduction: There are many ways to treat cancer and pain relief. One of the methods is radiopharmaceutical therapy. Indium 111-rituximab contains the radioisotope indium-111 and rituximab. The Indium-111, after decay, emits gamma rays with energies of 245 KeV and 171 KeV, and beta-radiation of 26 KeV. In this study, the absorbed dose of 111In-Rituximab in human body was calculated using mice data and MCNPX simulation code for the organs of heart, lung, liver, spleen, kidney, stomach, intestine and pancreas. Materials and Methods: Male phantom was used for this simulation. The source and target organs were defined in code and absorbed dose obtained for per particle with error of 5 percent. The source organs were determined as volume source in SDEF card of MCNP code. Simulations were done in two steps for gamma and beta sources and the final absorbed dose of each organ were multiplied by the amount of cumulated activity of 1MBq. Results: The results showed that the absorbed dose due to injection of 111In-Rituximab for organs of spleen and stomach are 2.2252E-02, 5.5979E-03 respectively. so these organs are at risk in treating cancer with this radionuclide. The errors for were less than 5 percent. Conclusion: Monte Carlo method and MCNPX simulation code are important methods for calculation of the absorbed dose after the distribution of rradionuclides in the body. Also the results show that two organs spleen and stomach are at risk in Indium 111-rituximab therapy.

Dosimetry of Nano-Radio-Ytterbium Therapy by MIRD and MCNP methods for humans’ organs

Introduction: Nano radio-pharmaceutical therapy (NRPT) is a new method for solid tumor therapy. The treatment uses a radioactive form of radionuclide encapsulated in the poly amido amine dendrimers. The poly (amidoamine) (PAMAM) dendrimers have attracted attentions for cancer treatment by their characteristics of targeted drug carriers, delivery agents, and imaging agents in human systems. We have reported the preparation of dendrimer encapsulated ytterbium-175 radio- nanoparticles and its biodistribution in tumor bearing rats.175Yb (T1/2=4.2 days), decays to stable 175Lu with a β- emitter with 470 keV maximum energy (86.5%) and γ photons of 113 keV (1.9%), 282keV (3.1%) and 396 keV (6.5%) that are appropriate for imaging. This paper aims at comparing dosimetric assessments in human performed with Monte Carlo codes and MIRD based on the experimental results of biodistribution of dendrimer encapsulated ytterbium-175.Materials and Methods: All chemical materials including, Ytterbium (III) oxide (Yb2O3), PAMAMG5-NH2 dendrimer in 5% methanol solution and HNO3, Sodium boro- hydride (NaBH4) were purchased from Sigma Aldrich Chemical Co. USA and Merck, Germany. For biodistribution study 20 female Balb/c mice were purchased from Pasteur Institute of Iran. To estimate the absorbed dose by both methods, MCNP and MIRD, the cumulated activity in source organs were calculated by the percentage of injected dose in humans’ organs. The residence times (τ) in the source organs were obtained by integration of respective fit functions, on biokinetics curve, after accounting for the physical decay of the 175Yb. The dose calculation was done for a certain group of organs of human following the MIRD technique. To simulate the problem with MCNP, the ORNL phantom was used. The desired result for this study is absorbed doses of vital organs (liver, spleen, lung and kidney). Results: The maximum uptake of radio-compound are in the liver, lung and spleen. The biodistribution shows the characteristics of nanoparticles such as size and surface hydrophobicity that determine the amount of adsorbed radiopharmaceuticals in organs. The initial fast distribution of radiotracer is throughout liver, lung, and Bone, with slower accumulation in blood and spleen. The result of 2 methods (MIRD versus MCNPX) reveals that MIRD underestimate the absorbed dose for bladder, bone, lung, and ovaries while overestimate for liver, muscle and spleen. In this study the absorbed dose from 175Yb- PAMAM estimated by MCNPX for liver, lung, spleen, kidney and bone are 1.266, 8.081E-01, 8.347E-01, 3.979E-02 and 1.706E-02 mGy/MBq respectively Conclusion: Owing to the stability of PAMAM encapsulated Yb-175 and the size of nano- particle the concentrations are mostly in liver and lungs. State of- the-art dosimetry depends on the duration of the biokinetics of the radiopharmaceutical and a calculation of residence times including an analysis of the errors associated with the respective calculation that aimed in this study. The results showed that this nano-radiopharmaceutical has potential of application for liver and lung tumors.

A 12-week combination of clarithromycin and prednisone compared to a 24-week prednisone alone treatment in cryptogenic and radiation-induced organizing pneumonia.

Background: Some data suggest that anti-inflammatory macrolides may be effective to treat organizing pneumonia (OP) and prevent relapses, but no formal comparison with prednisone alone is available. To explore this issue, we retrospectively compared the efficacy of a 12-week combined regimen of clarithromycin and prednisone with a 24-week prednisone alone regimen in OP. Methods: A standard 12-week regimen of combined clarithromycin and prednisone was designed for the treatment of cryptogenic or radiation-induced OP, aiming at reducing the cumulated prednisone dose and the relapse rate. Its use was left to the discretion of the treating physicians, members of the Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires. Data were compared to a historical control group treated with a standard 24-week prednisone alone regimen. Results: 16 patients were treated with combined therapy and 21 with prednisone alone. Complete radiological remission was achieved in 63% of the combined therapy group and 81% of the prednisone alone group (p=0.38). Symptomatic relapses occurred in 81% of the combined therapy group, and 52% of the prednisone alone group (p=0.14). No side effect of clarithromycin was reported. Conclusions: In patients with cryptogenic or radiation-induced OP, a 12-week regimen of clarithromycin and prednisone showed no benefit on remission rate and relapse rate as compared to a 24-week prednisone only regimen. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 230-238).

Abass Alavi: A giant in Nuclear Medicine turns 80 and is still going strong!

Abass Alavi: A giant in Nuclear Medicine turns 80 and is still going strong!

Effects of two medicines for prevention of acute radiation skin injury in radiation field among liver cancer patients with Cyberknife therapy

Objective To explore the protective effect of DWK skin protectant and Sanyrene for prevention of acute radiation skin injury in radiation field among liver cancer patients with Cyberknife therapy. Methods A total of 100 liver cancer patients with Cyberknife therapy were selected by convenience sampling from March to November 2016. They were randomly divided into the group of DWK and the group of Sanyrene with 50 cases in each group. Skins in radiation field on hepatic region of patients in two groups used DWK skin protectant and Sanyrene respectively since one day before radiotherapy. The acute radiation skin injury of radiation field on hepatic region was observed from one day before treatment to two weeks the end of treatment during Cyberknife therapy. Results The scores of The Radiation Induced Skin Reaction Assessment Scale (RISRAS) , an instrument for assessing the degree of acute radiation skin injury of radiation field on hepatic region, of patients in two groups increased with the increasing cumulated dose of irradiation with significant differences (F=3.780, 12.325; P<0.05) . There were statistically significant differences in evaluations at the fifth and beyond between two groups (t=5.213, 12.437, 16.846; P<0.05) . Conclusions Intervention for local prevention can alleviate the acute radiation skin injury in radiation field on hepatic region among liver cancer patients with Cyberknife therapy. The protective effect of DWK skin protectant on skin in radiation field on hepatic region among liver cancer patients with Cyberknife therapy is better than that of Sanyrene. Key words: Liver neoplasms; Cyberknife; Radiation damage; Skin protection

Compilation of the Elderly Functional Constipation Health Education Scale and its reliability and validity test

Objective To prepare the Elderly Functional Constipation(FC) Health Education Scale, and verify its reliability and validity. Methods The Elderly FC Health Education Scale was prepared by qualitative interviews, literature review, and Delphi method. The elderly patients who were over 60 years old and at Chinese PLA 181st Hospital were recruited by the purposive sampling method from January 2013 to August 2015.The diagnostic criteria of Roman Ⅲ was used to diagnose FC, the data of preliminary investigation and large sample test was used to form the formal scale, and its reliability and validity were further verified. Results The Elderly FC Health Education Scale was compiled with 6 dimensions and 28 items, and the Cronbach alpha coefficient which was the internal consistency reliability of the 6 factor was 0.965; the correlation coefficient analysis of equality reliability Kendall tau-b rank and various index variables score were positive correlation significantly. Both item level content validity index and scale level content validity index of the content validity were as a result of 1. The structure validity of the cumulated variance contribution ratio of the 6 factors were 60.15%. All factor loading coefficients between the items were more than 0.5, which indicated the fitting was good. Conclusions The reliability and validity of the Elderly FC Health Education Scale are good, and the scale may be used as a tool to prevent the elderly FC health education, and also be applied to the elderly FC patients in self-management and continue nursing after leaving hospital. Key words: Aged; Constipation; Scale; Reliability; Validity

In vitro Research Concerning Effect of Clopidogrel Alone and on Combination with Aspirin and Dypiridamoleon Sedimentation of Erythrocytes.

Based on extended theory of Derjaguin, Landau and Overbeeck (xDLVO) concerning aggregation of colloids and biological cells it was hypothesized that platelet antiaggregant agents have to reduce the aggregation of erythrocytes also. Applying Einstein-Stokes theory of sedimentation of spheres in viscous media it was concluded that sedimentation of erythrocytes is in fact sedimentation of aggregates of the approximately same size. Consequently, an expected outcome was that addition of antiaggregants in vitro to blood samples from patients with rheumatic or cardiovascular diseases will be the decrease of erythrocytes sedimentation. Starting from usual practice of dual antiaggregant therapy (aspirin and clopidogrel) effects of clopidogrel were compared with effects of clopidogrel plus small concentrations of aspirine and dipyridamole (smaller that their concentrations in plasma after in vivo administration) in order to put in evidence a possible synergic effect at platelet membrane level. Whole blood (0.8ml) was collected on 0.1ml 1% EDTA and then was added 25 or 50µl normal saline solution of clopidogrel or of the combination acetylosalycilic acid, clopidogrel and dypyridamole. The final concentrations were 1, 2 and µg/ml, of the same order as cumulated concentration of clopidogrel and its metabolites in clinical pharmacokinetics. Experiments were performed on a number of 40 human blood samples obtained from 2 groups of 20 patients. Sedimentation of erythrocytes was recorded using a camera and captured data were stored on a computer. Global analysis evidenced that in presence of antiaggregants the clusters of the sedimentation curves shifted down and into right, indicating a decrease and delay of sedimentation. Initial slopes and extent of sedimentation decreased linearly on clopidogrel concentration within the 1-3µg/ml range. For comparison of mean curves corresponding to different clopidogrel concentrations it was applied a metric from biopharmacy: areas under plasma concentrations curves (AUC) of drugs. The areas under average sedimentation curves decreased linearly at clopidogrel concentration within the 1-3µg/ml range. The same experiments were performed and similar results were obtained with the triple antiaggregant combination (clopidogrel, acetylosalycilic acid and dipyridamole). Apparently, a synergism between the tested antiaggregants appeared at studied concentration but the number of data was not sufficient to prove the statistical significance of the difference between clopidogrel alone and in triple combination.

The influence of the cumulated deformation energy in the measurement by the DSI method on the selected mechanical properties of bone tissues.

The goal of the study was to determine the influence of DSI test conditions, i.e., loading/unloading rates, hold time, and the value of the maximum loading force on selected mechanical properties of trabecular bone tissue. The test samples were resected from a femoral head of a patient qualified for a hip replacement surgery. During the DSI tests hardness (HV, HM, HIT) and elastic modulus (EIT) of trabecular bone tissue were measured using the Micro Hardness Tester (MHT, CSEM). The analysis of the results of measurements and the calculations of total energy, i.e., elastic and inelastic (Wtotal, Welastic, Winelastic) and those of hardness and elasticity made it possible to assess the impact of the process parameters (loading velocity, force and hold time) on mechanical properties of bone structures at a microscopic level. The coefficient k dependent on the EIT/HIT ratio and on the stored energy (ΔW = Wtotal - Welastic) is a measure of the material reaction to the loading and the deformation of tissue.

Specified data for tonsil surgery in Germany.

Background: Tonsillectomy rates vary considerably among different states, regions, and times. This study was conducted to identify the prevalence of “chronic” tonsillitis, peritonsillar abscess, hypertrophy of the tonsils with and without adenoids in absolute and relative numbers in an 80 million people nation. Moreover, the number and rates of different surgical procedures to resolve either “chronic” tonsillitis, peritonsillar abscess, or upper airway obstruction due to (adeno)tonsillar hypertrophy over several years was evaluated in this study (tonsillectomy, adenotonsillectomy, tonsillotomy, abscess tonsillectomy, transoral incision and drainage). Finally, the post-tonsillectomy hemorrhage rate was calculated and analyzed in relation to age and gender.Material and methods: Calculations were based on data as published by the Federal Institute of Statistics or on request, if needed. The latest data were provided for 2013.Results: The total number of the aforementioned diseases (stratified by ICD-10) decreased from 142,574 (in 2000) to 87,624 in 2013 (38.5%). Tonsillectomy, with or without adenoidectomy, was performed in a total of 833,896 patients between 2006 and 2013 in Germany. The yearly number decreased continually from 120,993 in 2006 to 84,332 procedures in 2013 (30.3%). The most significant decrease was registered in patients younger than 20 years of age for this time period: 70.92 per 10,000 in 2010 to 58.68 per 10,000 in 2013. If all age groups were included, the rate decreased from 13.34 per 10,000 to 10.90 per 10,000. In contrast, an increasing number of tonsillotomies was observed between 2007 (4,659 procedures) and 2013 (11,493). The cumulated number of procedures was 59,049. A constant number of 15,000 cases with peritonsillar abscess were diagnosed per year in Germany (19 patients per 100,000). The prevalence increased significantly at an age of 15 years and there was a preponderance of female patients below that age. Compared to the transoral incision and drainage, a 2.8-fold greater number of abscess tonsillectomies were performed annually. Post-tonsillectomy hemorrhage was experienced in 5.98% of all patients after 245,721 procedures in 2010 and 2013 (all indications, except tonsillotomy). Bleeding complications had occurred less frequently in female patients (5.06% vs. 7.02%). Finally, a considerable increase of post-tonsillectomy hemorrhage in patients older than 10 years of age was registered in male patients only.Conclusion: Chronic tonsillitis was less frequently diagnosed and surgically treated in terms of tonsillectomy (with or without adenoidectomy), particularly in female patients. In contrast, the number of tonsillotomies increased continually, particularly in male patients. Peritonsillar abscess was diagnosed and surgically treated in a constant number of patients in the yearly comparison. Most of these patients were scheduled for abscess tonsillectomy, and only a 2.8-fold smaller number for transoral incision and drainage. Independent from the indication for surgery, post-tonsillectomy hemorrhage was clearly associated with male gender and age (>10 years). The study reveals a dramatic change mandating further surveillance in insurance companies and authorities in the national health system of an 80 million people nation. (Tab. 1)

Suprapubic-assisted laparoendoscopic single-site nephrectomy: analysis of learning curve in one center

Objective To evaluate the learning curve of Suprapubic-assisted laparoendoscopic single-site surgery (SA-LESS) nephrectomy in our center. Methods From April 2013 to April 2016, 60 patients underwent SA-LESS nephrectomy performed by two associate chief physicians (group B and C, 30 patients in both groups). There were 25 males and 5 females with mean age (48.4±9.4)years in group B, and 23 males and 7 females with mean age (52.6±12.0)years in group C. Operative time, estimated blood loss, converting to conventional laparoscopy or open surgery, intra and postoperative complications in both groups were recorded , The data from both group B and C were compared with those of group A [Standard group with 30 patients who underwent SA-LESS nephrectomy performed by a skillful chief physician, 26 males and 4 females with mean age (50.8±12.3)years]. All the patients in the three groups were diagnosed with upper urinary tract calculus or ureteral stricture with severe ipsilateral hydronephrosis (no-function kidney) and a normal contralateral kidney. The sum of the Cumulative Summation(CUSUM)was also cumulated. Individual learning curve and total learning curve were established. Result All the 30 procedures in group A were successfully completed with an average operative time [(123.3±28.4)min(85~175 min)] and an average estimated blood loss[(121.7±43.1)ml(65~280 ml)]. There were 28 procedures successfully finished in group B and 29 in group C, respectively. The average operative time was [(141.7±49.4)min(90~260 min)] and the average estimated blood loss was [(165.2±81.9)ml(70~450 ml)] in group B, and the average operative time was [(133.1±33.7)min(90~235 min)]and the average estimated blood loss was [(140.0±72.3)ml(75~500 ml)] in group C. There was 1 case converted to conventional laparoscopy and 1 case converted to open surgery in group B with 4 (13.3%) complications (Satava Ⅰ 2 cases, Satava Ⅱ 1 case, Clavien-Dindo Ⅰ 1 case) in all. There was 1 case converted to conventional laparoscopy in group C with 4 (13.3%) complications (Satava Ⅰ 1 case, Satava Ⅱ 2 cases, Clavien-Dindo Ⅱ 1 case) in all. Statistical analysis showed that the number corresponding to the slope changed into negative was 15 and 11 for group B and C, respectively, and 13 was confirmed in the total learning curve. Conclusions SA-LESS nephrectomy could be feasible and safe for an experienced laparoscopic surgeon, who may master it after he finished 13 cases of SA-LESS nephrectomy. Key words: Laparoendoscopic single-site surgery; Nephrectomy; Learning curve; Cumulative summation

Reliability and validity of Chinese version of Quality-of-Life Questionnaire for Mechanically Ventilated Patients

Objective To test the reliability and validity of the Chinese version of Quality-of-Life Questionnaire for Mechanically Ventilated Patients (QOL-MV). Methods The English version of QOL-MV was revised and translated into Chinese version. The reliability and validity of the Chinese version of QOL-MV was tested in 120 mechanically ventilated patients. Results The Cronbach α coefficient of the Chinese QOL-MV was 0.904. The item-level content validity index of Chinese QOL-MV were 0.86-1.00 and the scale-level content validity index of Chinese QOL-MV was 0.92. Two factors were extracted by factor analysis and the cumulated variance was 80.18%. The dimensional factor loading of each item was greater than 0.565. The correlation coefficient between the score of Chinese QOL-MV and the Euroqol Group's 5-domain 3 Level Questionnaire (EQ-5D) and Richards Campbell Sleep Questionnaire (RCSQ) was 0.947 and 0.561 respectively (P <0.01). Conclusions The Chinese version of QOL-MV has been proved to be reliable and valid.It can be used to measure the quality-of-life for mechanically ventilated patients. Key words: Quality of life; Mechanical ventilation; Reliability; Validity

13C-methacetin breath test for evaluating of children's liver disorder

Objective To explore the clinical value of 13C-methacetin breath test for the assessment of liver disorder and to analyze its predictive value to the severity of liver function injury in children. Methods Eighteen healthy children served as healthy control group, and 40 patients with different etiology and severity served as experimental group, and then the latter were divided into 2 subgroups, 28 patients in Child-Pugh classification A, and 12 cases in below B(11 cases in B and 1 case in C). An oral dose of 2 mg/kg tracer 13C-methacetin was administered to each subject for the 13C-methacetin breath test.At the same time, serum liver function markers including serum tran-saminase, bilirubin, albumin and prothrombin time were measured.The acquired data were analyzed by SPSS 17.0 software. Results (1)Metabolisation velocity (MV)max30 and cumulated dose (CUM)120 in experimental group (46.64±27.93, 59.29±30.73) were much lower than those of the healthy control group(73.56±26.03, 102.97±41.80)(t=2.450, 3.165, all P<0.05); (2) MVmax30 and CUM120 were closely correlated with the liver function markers of albumin, total bilirubin, direct bilirubin, prothrombin time(P<0.05); (3) MVmax30 and CUM120 could predict liver diseases in children, especially the CUM120.With CUM120=85.80 as a cut-off value to predict liver diseases, the Youden index was 0.578 at its maximum, and the sensitivity and specificity were 77.8% and 80.0%; (4)Compared with the Child-Pugh classification A, the CUM120 in Child-Pugh classification B and lower B was significantly lower(P<0.001); (5)CUM120 could predict the severity of liver diseases.With CUM120=56.15 as a cut-off value to predict the severity of liver diseases, the Youden index was 0.857 at its maximum, and the sensitivity and specificity were 85.7% and 100.0%. Conclusion 13C-methacetin breath test index of CUM120 could predict liver diseases in children and the severity of liver function. Key words: 13C-methacetin breath test; Liver disorder; Liver function; Child

Quantitative Assessment of Global Literature on ‘Web 2.0 and Libraries’ during 2006-15

The present study examines global publications output on ‘Web 2.0 and Libraries’ published during the period 2006-15. The data for the study was sourced from Scopus database. The total global research output on ‘Web 2.0 and libraries’ comprising 482 publications, registered 14.02 % CAGR growth, cumulated 3234 citations with an average of 6.71 citations per paper. The global contributions on ‘Web 2.0 and libraries’ originated from 77 countries, 179 organizations, and 159 authors. Top 10 countries accounted for 75.10 % global publications share, 90.75 % global citations share during 2006-15. Top 15 organisations contributed 13.69 %, cumulated 15.18 % citations share. Top 21 authors contributed 14.94 % publications share, cumulated 14.81 % citations share of the global output during 2006-15. ‘Web 2.0 and libraries’ as a subject, interacts highly with other disciplines. Social sciences accounted for the largest share (72.61 %), followed by computer science (52.28 %), and 6 other disciplines. Of the total 482 global publications on the subject, 351 appeared in 94 journals, with top 19 journals accounting for 39.21 % share. The top 30 highly cited papers registered 20 to 475 citations each, cumulated 1776 citations, averaging to 59.2 citations per paper.

Cumulated bibliography

Cumulated bibliography

The Defensive Patent Playbook

After the dot-com bubble collapsed, non-practicing entities (“NPEs”) emerged on the patent playing field. Patent thickets and aggressive litigation by non-practicing entities turned the patent system on its head. As a result, companies developed an array of defensive options and strategies to counter the changing use of patents. However, the tactics needed to navigate the patent system evolved as the landscape shifted. The analysis below follows the chronological evolution of defensive strategies and sets forth a defensive patent playbook for practitioners in the patent field.The analysis below follows the chronological evolution of defensive strategies and sets forth a defensive patent playbook for practitioners in the patent field.This Note proceeds in four parts. Each Part reviews the development of the patent landscape as a necessary backdrop for an analysis of various defensive patent plays. The issues from each era cumulated to shape the current patent landscape. Part I evaluates early defensive methods used to navigate webs of overlapping patent rights. Part II describes the rise of NPEs, changes in substantive doctrines, and additional strategies introduced in the wake of the dot-com bubble. Part III discusses the current trend towards increased monetization, and assesses defensive options in the current landscape. Part IV explores defensive tactics that may become widely used in the future.

The reliability and validity of the Chinese version of Profile of Fatigue Scale among the patients with sjogren's syndrome

Objective To test the reliability and validity of the Chinese version of Profile of Fatigue Scale (PROF) among the patients with Sjogren's syndrome. Methods The English version of PROF was translated into Chinese according to Brislin Translation Model. 107 patients with Sjogren's syndrome were investigated to test its reliability and validity. Results The Cronbach α coefficient , Guttman split-half coefficient, test-retest reliability and content validity of Chinese version of PROF were 0.976, 0.953, 0.872 and 0.875. Two factors were extracted by factor analysis and the cumulated variance was 80.75%. The structure of PROF was in line with the original scale. The criterion-related validity was 0.621 measured by comparing with visual analog scale of fatigue, and was -0.707 measured by comparing with vitality domain in the MOS item Short From Health Survey (SF-36). Conclusions The Chinese version of PROF has been proved to be reliable and valid. It can be used to measure the fatigue in Chinese patients with Sjogren's syndrome. Key words: Sjogren's syndrome; Fatigue; Reliability; Validity

Experimental study on concentrations and pharmacokinetics of antibiotics in bile and evaluation of their microbicidal potential

To study the concentrations and pharmacokinetics of 6 different kinds of antibiotics in rabbit bile, and evaluate their microbicidal potential. Thirty-six health rabbits were randomly divided into 6 groups, and each group was 6 rabbits. After anaesthesia, the common bile duct of rabbit was isolated and cumulated with a silicone tube. The rabbits were administered intravenously with the equal-effect dose of antibiotics. Bile (1.5 ml) was collected at different time points after administration, and the concentration of antibiotics of bile was assayed by high performance liquid chromatography. The bile drug concentration-time data were processed by software to figure out the pharmacokinetic parameters such as maximum concentration (C(max)), peak time (T(max)), half-life time (T(1/2)), clearance (CL) and apparent volume of distribution (VD). The bile antibiotics concentration contrasted to the minimum inhibitory concentration (MIC), and attained the bactericidal index (C(max)/MIC) and the time when the drug concentration exceeded the MIC (T(>MIC)). The C(max) and T1/2 of each antibiotic were as the followings: piperacillin (7 950 ± 3 023) mg/L and (1.97 ± 1.23) h, ceftriaxone (1 104 ± 248) mg/L and (3.14 ± 0.57) h, cefoperazone (5 215 ± 2 225) mg/L and (0.89 ± 0.13) h, meropenem (31.97 ± 12.44) mg/L and (0.36 ± 0.11) h, levofloxacin (66.3 ± 36.9) mg/L and (3.32 ± 2.57) h, metronidazole (28.2 ± 10.2) mg/L and (0.81 ± 0.33) h, respectively. Piperacillin/tazobactam and cefoperazone/sulbactam had the largest bactericidal index and the longest T(>MIC), and their bactericidal indexes were (62.1 ± 23.6) - (993.8 ± 377.9) and (164.8 ± 69.0) - (659.3 ± 275.9), their T(>MIC) were (6.00 ± 2.53) - (8.00 ± 0.00) h and (6.33 ± 1.97) - (8.00 ± 0.00) h. The bactericidal index and T(>MIC) of levofloxacin were the smallest, which were (2.1 ± 1.2) - (8.3 ± 4.6) and (0.54 ± 0.25) - (2.67 ± 1.03) h . Ceftriaxone and meropenem were as the medium, and their bactericidal indexes and T(>MIC) were (4.3 ± 1.0) - (69.2 ± 15.5) , (1.42 ± 0.65) - (8.00 ± 0.00) h and (2.0 ± 0.8) - (1 031.3 ± 401.4) , (0.29 ± 0.10) - (1.83 ± 0.26) h. The bactericidal index of metronidazole to anaerobic ranged from 7.4 to 294.9, and the T(>MIC) ranged from 1.88 to 5.00 h. The bile concentrations of six antibiotics all exceed their effective bactericidal concentrations. The concentration-time curves of piperacillin, cefoperazone, meropenem and metronidazole conformed to one-compartment model, and ceftriaxone and levofloxacin are conformed to two-compartment model. Piperacillin/tazobactam and cefoperazone/sulbactam have the largest bactericidal index and the longest T(>MIC), so they can be chosen as the first choice for the therapy of hepatobiliary infection.For the anaerobic, the microbicidal potential of metronidazole is high.