BACKGROUND: Serum cytokines in patients with dilated cardiomyopathy are increased obviously, and the expression of interleukin-6mRNA is also observed in myocardial tissues. High epidural anesthesia can block the vicious cycle involving cytokines and improve cardiac function. OBJECTIVE: To observe the changes of interleukin-6 and soluble interleukin-2 receptor in patients with dilated cardiomyopathy after high epidural anesthesia treatment. DESIGN: A case-controlled analysis. PARTICIPANTS: Thirty-five inpatients with dilated cardiomyopathy were selected from the Department of Cardiology, First Hospital Affiliated to Harbin Medical University, from October 2001 to May 2002. All the patients were randomly divided into high epidural anesthesia group and conventianal treatment group. High epidural anesthesia group consisted of 22patients, 15 males and 7 females, whose cardiac function was classified into grade Ⅱ in 4 patients, grade Ⅲ in 9 and grade Ⅳ in 9. Conventional treatment group consisted of 13 patients, 11 males and 2 females, whose cardiac function was grade Ⅱ in 1 patient, grade Ⅲ in 5 and grade Ⅳ in 7. Healthy control group comprised 21 people, 13 males and 8 females,who received physical examination at the same period. INTERVENTIONS: Patients with dilated cardiomyopathy were treated with high epidural anesthesia and conventional method, whereas those in conventional treatment group were treated with conventional method only.Elbow venous blood of 3 Ml was sampled from all patients on empty stomach in the morning before treatment and after 4-week treatment. The level of serum interleukin-6 and soluble interleukin-2 receptor was measured with enzyme-linked immunoadsorbent assay. MAIN OUTCOME MEASURES: The level of serum interleukin-6 and soluble interleukin-2 receptor of patients in eachgroup. RESULTS: Blood samples of the 56 subjects were qualified and entered the final analysis.①The level of serum interleukin-6 was higher in dilated car diomyopathy group (13.9ng/L) than in healthy control group (11.22 ng/L) (z= -3.072, P ＜ 0.05). ② The level of serum interleukin-6 in high epidural anesthesia group was obviously decreased aftertreatment (11.42 ng/L) as compared with that before treatment (20.42ng/L) (z =2.582 9, P ＜ 0.05).The le vel of serum interleukin-6 in conventional treatment group was similar before and after treatmant(12.16 ng/L and 12.80 mg/L, z = -1.89,P ＞ 0.05). The difference of interleukin-6 level in high epidural anesthesiagroup (-2.04 ng/L)was obviously higher than that in conventional treat ment group (0.28 ng/L) (P ＜ 0.01) before and after treatment.③The level of serum soluble interleukin-2 receptor was higher in dilated car diomyopathy group[(1 306.17±1.46)ng/L]than in healthy control group [(1078.95±1.23) ng/L] (t =2.51, P ＜ 0.05). ④ The level of soluble intedeukin-2 receptor in high epidural anesthesia group was decreased after treatment [(1 086.68±1.34)ng/L]as compared with thatbeforetreatment [(1 328.01±1.51) ng/L], (t =2.145, P ＜ 0.05). The level of soluble interleukin-2 receptor in conventional treatment group was similar before and after treatment [(1 473.33±1.66) ng/L and (1 331.07±1.52) ng/L,t=-1.06, P ＞ 0.05]. CONCLUSION:The level of serum interleukin-6 and soluble inter leukin-2 receptor is significantly decreased after high epidural anesthesia, suggesting that high epidural anesthesia can regulate cytokines better than conventional treatment.The regulation of high epidural anesthesia is related to inhibition of sympathetic nervous system and humoral-im mune system.

Objective To investigate if diastolic function could be improved by cardiac sympathetic nerve blockade in patients with dilated cardiomyopathy (DCM). Methods Sixty consecutive cases of DCM were randomed into therapeutic group and control group. Patients in therapeutic group were administered thoracic epidural blockade (TEB) (T 1-5 ) with 0.5 % lidocaine intermittent injection every two hours for four weeks, in addition to some routine medicine, while patients in control group were only administered routine treatment. Then the parameters of left ventricular diastolic function were evaluated with Doppler echocardiography before and after four weeks. Results ①All the patients in TEB group felt better within five minutes after injection of lidocaine within local epidural cavity.Their symptoms were relieved more rapidly than those of the drug therapy alone. Some patients with NYHA class Ⅳ could lie down supine in a short time. Exercise tolerance increased in patients with NYHA class Ⅱ to Ⅲ. But symptoms and signs of patients in control group were relieved very slowly, some patients even got worsen. ② Thirteen of thirty in therapeutic group got improvement on diastolic function after treatment. One of thirty in this group deteriorated. In detail, six of fifteen patients with demonstrated improvement of left ventricular diastolic filling changed from having a restrictive filling pattern to having a pseudonormal left ventricular filling pattern. Four of nine patients with a pseudonormal filling pattern changed to have a delayed filling pattern.Three of six patients, left ventricular filling pattern moved from a pseudonormal left ventricular filling pattern to a normal filling pattern. Only one patient acquired a restrictive filling pattern from a pseudonormal filling pattern. In contrast, in control group one of thirty got improvement on diastolic function after treatment. Nine of thirty in this group deteriorated. Individual changes of left ventricular filling pattern showed that only one patient improved from a delayed filling pattern to normal filling pattern, whereas seven patients had a restrictive left ventricular filling pattern developed from a pseudonormal filling pattern and another two patients achieved a pseudonormal filling pattern from delayed filling pattern. Conclusions Diastolic function in patients with DCM was improved significantly by cardiac sympathetic nerve blockade. The approach has beneficial effects on the patients of DCM.

Objective: To explore whether high epidural blockade(HEB) can lower the elevated serum free fatty acids(FFA) level in the patients with acute myocardial infarction(AMI). Method:In 7 patients with AMI,HEB at T 15 was performed by injecting 5 to 7ml of 0.5%-0.75% lidocaine every 2 to 4 hours for 7 successive days;while the other 7 patients with AMI didn't use HEB as control. only morphine or dolantine was used for relieving angina cordis. Result: The elevated FFA level returned to normal range in 12 hours following HEB in the study group, but in one week in the control group. Conclusion:HEB(T1-5) can lower the elevated FFA level in AMI patients to normal within12 hours.

OBJECTIVE: To explore the factors,general pattern and characteristics of adverse drug reactions(ADR) in children.METHODS: A total of 188 pediatric ADR reports collected in our city from Jan.2002 to Sept.2007 were statistically analyzed in respect of children's age and sex,route of administration,ADR severity,category of drugs involved,organs or systems involved and clinical manifestations etc.RESULTS: Of the 188 pediatric ADR cases,95(50.5%) were induced by intravenous route.A total of 112 kinds of drugs were involved in the ADR,with anti-infective agents showing the highest proportion.Digestive system,neural system,urinary system and skin etc were involved in the ADR.CONCLUSION: Clinic should attach great importance to the monitoring and reporting of pediatric ADR to reduce or avoid the occurrence of ADR.

Objective To discuss the diagnostic value of multi-slice spiral CT 2D and 3D reconstruction for atlantoaxial occult fracture.Methods Multi-slice spiral CT scans were performed in 38 patients who were suspected of fracture but were not detected with radiography,and the images were post-processed with Vitrea workstation(including MPR,MIP,VR and SSD).The images were observed by two experienced radiologists.Results Of 38 cases,28 cases were detected having small fractures with spiral CT reconstruction.Conclusion Multi-slice spiral CT 2D and 3D reconstructions are of important value in diagnosing atlantoaxial occult fracture.

Objective To investigate the value of 18F-FDG PET/CT for differentiating multiple myeloma from bone metastases with undetermined origin.Methods A retrospective study was performed on patients with multiple bone destructions and without extraosseous primary malignant tumor in 18F-FDG PET/CT imaging.A total of 26 patients (12 males,average age 55.4 years) with multiple myeloma and 20 patients (9 males,average age 50.2 years) with multiple bone metastases confirmed by biopsy or histopathology from January 2011 to December 2013 were included into this study.The characteristics of 18F-FDG PET/CT and urine Bence-Jones protein were used to establish the diagnostic criteria.Myeloma was diagnosed if two or more of the following conditions could be satisfied:more than 10 bone lesions,osteolytic or mixed bone destruction,SUVmax＜4.0,and positive urine Bence-Jones protein.Two-sample t test and x2 test were used.Results The average number of bone lesions in multiple myeloma patients was 15.8,which was more than that (7.8) in patients with bone metastases.About 71.8％ (296/412) of bone lesions in multiple myeloma and 28.8％ (45/156) of bone metastases were osteolytic.The percentage of osteolytic lesions was significantly higher in multiple myeloma (x2=87.2,P＜0.05).The SUVmax of bone lesions of multiple myeloma and bone metastases were 3.81 ±2.17 and 5.82± 3.44 (t =8.29,P＜0.05) respectively.According to the diagnostic criteria,the sensitivity,specificity and accuracy of 18F-FDG PET/CT for the differentiation of myeloma from bone metastases were 88.5％ (23/26),85.0％ (17/20) and 87.0％ (40/46).Its diagnostic efficiency was higher than urine Bence-Jones protein (sensitivity:65.4％ (17/26);x2=3.90) and original 18 F-FDG PET/CT evaluation (specificity:10/18,accuracy:64.1％ (25/39);x2 =3.99,6.12) respectively (all P＜0.05).Conclusion Combining the evaluation of structural properties and metabolism on 18F-FDG PET/CT with urine Bence-Jones protein level may provide additional value for the differentiation of multiple myeloma from bone metastases with undetermined origin.

Objective To investigate the application of MSCT three-dimensional digital navigated biopsy in subcarinal lesions.Methods 82 patients were enrolled.Study subjects were randomly divided into control group and research group.Three-dimensional positioning and three-dimensional navigation needle biopsy were used in research groups, while CT cross-sectional image positioning with conventional puncture needle was used in control group.Puncture accuracy, one-time success rate of puncture, complications, diagnosis accuracy and operation time were compared between the two groups.Results Puncture success rate, definite diagnosis rate were 87.80%(36/41) and 97.56%(40/41) for the research group,and 60.97%(24/41) and 80.49% (33/41) for the control group, respectively,which on the research group were higher than that on the control group(χ2=8.945, 6.116;P<0.05).Complication rate and operating time were 14.63% (6/41) and (11.64±2.76) min for the research group, and 41.45% (17/41) and (22.22±6.31) min for the control group, respectively, which were lower on the research group than that on the control group (χ2=7.31,t=-11.70,P<0.05).Conclusion MSCT three-dimensional digital navigated biopsy technique could promote the efficiency of subcarinal space puncture biopsy significantly,which is a novel, convenient, precise and safe method.

Objective To Validate the prognostic significance of the European Organization for Research and Treatment of Cancer (EORTC) risk tables in Chinese patients with non-muscle invasive bladder cancer (NMIBC). Methods According to the scoring standard of the EORTC system, 225 NMIBC patients were reviewed and divided into 3 groups: low, intermediate and high risk groups for recurrence and progression respectively. The probabilities of recurrence and progression at 1 year and 5 year for each group were calculated using life-table analysis and then compared with the EORTC risk tables. Log-Rank test and multivariable analysis were used to analyze the possible differences between risk groups and to find independent prognostic factors. Results For low (n= 32, 25), intermediate (n=109, 128) and high (n=84, 72) risk groups, the probabilities of recurrence and progression at 1 year were 15. 1%, 31.2%, 55.5% and 0. 3%, 2. 0%, 15.5% respectively. The probabilities at 5 year were 28. 2%, 55.2%, 75.0% and 1.4%, 12.9%, 54. 7%. All the results were similar to that of EORTC tables except the probability of progression at 5 year for the high progression risk group.The differences between different risk groups were significant (P＜0.01). In a multivariable analysis for recurrence and progression, the EORTC scores had independent significance (P＜0.01). Conclusions EORTC risk tables could stratify NMIBC patients effectively according to the risk of recurrence and progression. It could be a useful tool for Chinese urologists.

Objective To determine the main CT features and the key points of differential diagnosis of multilocular cystic renal cell carcinoma (MCRCC) classified according to 2004 WHO pathological diagnostic criteria. Methods According to the criteria, 40 patients were divided into two groups: MCRCC group and other subtypes of cystic renal cell carcinoma (CRCC). The CT findings were evaluated and compared between two groups for cystic content, wall, septum, nodularity, calcification and enhancement. ROC curve was used to determine the cut-off value of the possible CT feature which could distinguish MCRCC from other subtypes of CRCC. Results Seventeen cases of MCRCC group and 23 cases of CRCC group were included in this study according to the diagnostic criteria. MCRCC appeared as a well defined multilocular cystic mass with thin wall and sepia and no expansile solid nodules. Thickness of cystic wall and/or septum is was main CT findings to distinguish MCRCC from other subtypes of CRCC (P ＜ 0.01 ). The cut-off value of the thickness was 6 mm and its sensibility, specificity was 89% ,75% respectively. Conclusion Cystic wall and/or septum with a thickness of less than 6 mm are the main CT findings to dis tinguish MCRCC from other subtypes of CRCC.

Objective To investigate the relationship between tumor location and the risk of developing bladder cancer in pafients treated by nephroureterectomy(NU)for upper urinary tract transitional cell carcinoma(UUT-TCC).Methods The clinical data of 168 UUT-TCC patients who underwent NU were reviewed.Univariate and multivariate analysis were carried out to determine the risk factors for intravesical recurrence after NU.Results The recurrence-free survival rate at 1,3 and 5 years after NU were 88%, 76%and 63%.All patients were followed up for a median period of 45(12-107)months During this period, a total of 49 patients developed bladder tamors after surgery,of which 28 cases were renal pelvic carcinoma, 2 cases were rniddle ureter carcinoma and 19 cases were distal ureter carcinoma.The recurrence-free survival of renal pelvic carcinoma and ureter carcinoma had no significant difference by Log-Rank test(P>0.05).On multivariate analysis,only locating in distal ureter carcinoma was the independent risk predictor for intravesical recurrence after NU (P<0.01).Conclusion Pafients with UUT-TCC at distal ureter carry a higher risk for intraeesieal recunerrce after NU than those with TCC at other location of upper urinary tract.