Objective To assess the chest X-ray radiographic findings in children with influenza A (H1N1) virus infection. Methods The chest X-ray radiographies in 67 children with influenza A(H1N1) virus infection were reviewed in this study. The chest radiographies were obtained 3-8 days after the onset of symptoms and for the follow-up. Results The abnormalities were bilateral in 53 patients and unilateral in 7 patients. The predominant radiographic findings were bilateral patchy consolidation (n=42) with rapid confluence in 10 patients, lobular consolidation (n=7) with interstitial hyperplasia in 1 patient 3 month later, diffuse consolidation (n=11) with interstitial hyperplasia in all patients after 3 month. ConclusionThe predominant chest X-ray radiographic findings are bilateral patchy consolidation and diffuse consolidation with interstitial hyperplasia afterward.

Warfarin is one of the most widely used anticoagulants in clinical setting.There are great interindividual differences in both therapeutic efficacy and dose requirement,which greatly limits its application in clinic.This article summarizes the influence of genetic factors on interindividual and interethnic differences of warfarin,providing sufficient guidance for personalized medicine.

Objective To explore the effects of lamotrigine on the cognitive function and the quality of life in epilepsy patients.Methods This was a prospective study and 91 newly diagnosed epilepsy patients were enrolled.The neuropsychological tests score and the quality of life in epilepsy inventory(QOLIE-31) were obtained before and after the treatment with lamotrigine.A battery of neuropsychological tests comprised the auditory verbal learning test(AVLT), the logical memory test(LMT), the digital symbol test(DST), the stroop color word test(SCWT), the trail making test(TMT), the verbal fluency test(VFT), the WAIS block design test(WBDT), the WAIS digital span test(WDST)and the Boston naming test(BNT). Results The repeated assessments in the patients taking lamotrigine were associated with significant improvements in many domains.The greatest changes were observed in the immediate and delayed recall of AVLT, DST, the time consuming of SCWT card C and TMT test A and B, the immediate and delayed recall of LMT, VFT, WBDT and BNT.For the quality of life, significant improvements were recorded in the fields of the seizure worry(38.81?16.06 vs 45.68?15.18), the overall quality of life(59.12?13.50 vs 64.99?13.33), the social function(64.59?25.14 vs 69.41?22.70)and the self-health evaluation (71.18?13.73 vs 76.75?11.30).Conclusion Improvements of the cognitive function and the quality of life can be observed in the initial period of medication with lamotrigine in epilepsy patients.

Adult ; Aged ; Airway Management ; Cyanides ; poisoning ; Female ; Humans ; Male ; Middle Aged ; Poisoning ; nursing ; Young Adult

Objective To investigate the effect of active vitamin D (VD) on macrophage M1 and M2 phenotype and its role in protecting podocyte impairment in diabetic nephropathy (DN).Methods Diabetes mellitus rats were established by intraperitoneal injection with streptozocin.Rats were randomly divided into four groups:normal-1 (NC-1,n=8),normal-2 (NC-2,n=8,normal rats treated with calcitriol 0.1 μg· kg-1 · d-1 by gavages),DN (n=24) and VD (n=24,DN+calcitriol 0.1 μg· kg-1 · d-1 by gavages).Blood glucose and body weight were assessed,and 24-hour urine was collected regularly.Blood and urine samples were taken for biochemical study,and kidney tissues were used for PAS staining to assess histological changes.Immunohistochemical staining was used to detect number of CD68 + macrophage.Western blotting was used to detect protein expressions of nephrin,podocin,CD68,M1 specific marker of inducible nitric oxide synthase (iNOS),TNF-α and M2 specific marker of CD163,arginase 1 (Arg-1),mannose receptor (MR).Results (1) In DN group,levels of BUN,Scr,urinary protein and glomerular mesangial matrix proliferation were significantly higher (P ＜ 0.05),and the expressions of nephrin,podocin were significantly decreased compared with NC groups (P ＜ 0.05).These above changes were significantly improved in VD group (P ＜ 0.05).(2)Number of CD68 + macrophage infiltration in DN group was increased in a time dependent manner compared with NC groups,which was significantly reduced in VD group (P ＜ 0.05).(3)To further definite M1 and M2 macrophage activation phenotype,the protein expressions of iNOS and TNF-α was increased in DN group at 8th,14th,18th weeks compared with NC groups (P ＜ 0.05),which were significantly decreased in VD group (P ＜ 0.05).Although,there were no significant difference of protein expressions of CD163,Arg-1 and MR between VD and DN group at both 8th and 14th week (P ＞ 0.05),the protein expressions of CD163,Arg-1 and MR were higher in VD group at 18th week than that in DN group (P ＜ 0.05),and the ratio of CD163/CD68 was also enhanced in VD group (P ＜0.05).(4)Moreover,the protein expression of iNOS was negatively correlated with expression of either nephrin or podocin (r =-0.707,P ＜ 0.01; r =-0.712,P ＜ 0.01),whereas the protein expression of CD163 was positively correlated with expression of either nephrin or podocin (r =0.627,P＜ 0.01; r=0.613,P ＜ 0.01).Conclusion Vitamin D can regulate macrophage phenotype,via inhibiting M 1 macrophage activation and enhancing M2 macrophage activation to protect podocyte impairment.

The drug zero-profit reform in place has changed the compensation channels for China's public hospitals at the county level.In view of this situation,the paper probed into the present landscape of the compensation mechanism at such hospitals.The authors analyzed five compensation channels,i.e.,the special government budget subsidy,adjustment of medical service charges and rates,health insurance payment,social financing,and income/expenditure management.The study aimed at providing policy proposals and references for sustainable reform at such hospitals.

Purpose:To explore the preventive effect of hepatic arterial infusion (DDS) against recurrence of hepato- cellular carcinoma (HCC) after radical resection.Methods:From Jan,1996 to May,1998,287 patients of HCC after radical resection were randomly divided into four groups:intra-hepatic arterial infusion(97),intra-portal vein(80),intra-hepatic artery and portal vein (60),control (50).All patients received chemotherapy for two years and observed for postoperative recurrence of HCC.Results:The postoperative recurrence rate of HCC with intra-hepatic arterial infusion was significantly lower than that of intra-portal vein (P0.05).The 1～、2～ and 3～year survival rate of intra-hepatic arterial infusion was significantly higher than any of the other groups.Conclusions:Intra-hepatic arterial infusion (DDS) through gastro-duodenal artery can effectively pro- long the postoperative survival and decrease the post-operative recurrence rate of HCC.The preventive method of DDS through gastro-duodenal artery was safer and effective.

Critical Care ; methods ; trends ; Critical Illness ; therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Integrative Medicine ; Multiple Organ Failure ; therapy

Objective To provide clinical evidence for the optimal acupuncture time in acupuncture treatment of hearing disorder in kids with cerebral palsy.Method Ninety eligible patients were randomized into 3 groups, 30 in each group. Group A was treated for 30 min, group B for 45 min, and group C for 1 h. The hearing improvement was evaluated by using brain-stem auditory evoked potential (BAEP).Result The detection of BAEP showed that the latent and peak periods of wave I,Ⅲ, and V were significantly shortened in the 3 groups after intervention (P<0.01), suggesting that acupuncture can produce a marked efficacy in treating hearing disorder in cerebral palsy. The inter-group comparisons showed that the efficacy of group A was significantly higher than that of group B and C (P<0.05); there was no significant difference in comparing the efficacy between group B and C (P>0.05). It’s indicated that the optimal acupuncture time span should be 30 min.Conclusion With the same acupuncture skills, acupuncture for 30 min can produce a comparatively higher efficacy in treating infantile hearing disorder.

ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P< 0.001], younger than 50 years old (40-49 years old:OR = 1.397, 95%CI = 1.251-1.703,P = 0.002;< 40 years old:OR = 1.701, 95%CI = 1.253-1.836,P< 0.001), PQ plasma concentration≥ 2 mg/L (OR = 3.140, 95%CI = 1.511-3.091,P< 0.001), white blood cell (WBC)> 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P< 0.001), AKI on admission (stage 2:OR = 2.350, 95%CI = 2.160-3.910,P< 0.001; stage 3:OR = 2.821, 95%CI = 1.932-3.651,P< 0.001), accompanying hypoxia (OR = 2.420, 95%CI = 2.131-2.662,P = 0.003) were more likely to receive higher intensity of HP. Furthermore when compared with patients survived for 28 days, patients who were older, with higher levels of PQ concentration at admission or after 4 hours of HP, accompanied by AKI, increased serum creatinine (SCr), WBC, Lac, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, lower arterial partial pressure of carbon dioxide (PaCO2) and lower pH value were more likely to die. After adjusted for con-variables in COX regression model, HHP was associated with lower 7-day mortality after admission [hazard ratio (HR) = 0.843, 95%CI = 0.732-0.971, P = 0.032], but devoid of lowering effect on 28-day mortality rate (HR = 0.930, 95%CI = 0.632-1.411,P = 0.423). In addition, age> 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P< 0.001), WBC>10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.