Asbestos ; toxicity ; Humans ; Occupational Exposure ; adverse effects ; Pulmonary Alveolar Proteinosis

Objective To explore the risk factors of prognosis for children with acute kidney injury (AKI). Methods Clinical data of 118 children with AKI, including the causes,clinical characteristics, laboratory features, renal pathological findings, treatment and outcome, were reviewed retrospectively. Association between risk factors and prognosis was analyzed. AKI was defined by the new classification criteria of the Acute Kidney Injury Network. Prognostic factors were determined by univariate methods and stepwise multiple logistic regression analysis. Results One hundred and eighteen patients (83 male, 35 female) were enrolled in the study, who admitted in our department between January 1, 2005 and May 31, 2008. Median age at the time of AKI children was 7.5 years (range 1 day-14 years), among whom 28.0% (33 cases) was less than 3.0years, 17.8% (21 cases) between 3.0 and 7.0 years and 54.2% (64 cases) more than 7.0 years.Patients' AKI was classified according to the staging system as follows: 52.5% stage 1, 32.2%stage 2 and 15.3% stage 3. The common causes of AKI children were infectious and autoimmune diseases (39.8%), renal vascular disease (27.1%) and circulatory disturbance (11.9%). Hospital mortality was 21.2%. Multivariate analysis showed that independent risk factors for death were need for mechanical ventilation (OR=51.75, P＜0.01＝, sepsis/septic shock (OR=14.76, P＜0.01＝, severe acidosis (OR=11.38, P＜0,01＝, and white blood cells (WBC) count more than 20.0×109/L (OR=8.51, P＜0.01＝. Conclusion Infectious and autoimmune diseases, renal vascular disease and circulatory disturbance are the common causes of AKI children. The important risk factors of death in AKI children are need for mechanical ventilation, sepsis/septic shock, severe acidosis, and WBC count more than 20.0×109/L.

BACKGROUND:Currently, there are many studies on colapsed repair, but a systematic and horizontal comparison is not reported yet. OBJECTIVE: To compare the effect of conventional resin adhesive, resin adhesive+silane coupling agent and adjacent surface open part of the crown on colapsed repair through clinical trial and in vitro experiment. METHODS: (1) Clinical trial: 90 patients with porcelain colapse were randomized into three groups, and respectively treated with conventional resin adhesive, resin adhesive+silane coupling agent and adjacent surface open part of the crown. Success rate was measured and compared among three groups at 1 year after repair. (2) In vitro test: Twenty test specimens were equaly divided into two groups, and treated with conventional resin adhesive and resin adhesive+silane coupling agent, respectively. Then, shear strength was detected in the two groups. Twenty double-crown specimens were equaly divided into four groups. The first three groups were treated with sand blasting, silane coupling agent and their combination treatment, respectively; the rest group had no treatment (control group). After repair, the tensile strength of each specimen was detected.RESULTS AND CONCLUSION:The success rate of colapsed repair was 37% for conventional resin adhesive, 90% for resin adhesive+silane coupling agent and 100% for adjacent surface open part of the crown. The shear strength was (13.978±0.343) MPa for the conventional resin adhesive and (10.058±0.64) MPa for resin adhesive+silane coupling agent, and there was a significant difference between two methods (P < 0.01). The tensile strength was (0.68±0.04) kN in the control group, (1.00±0.02) kN in the sand blasting group, (1.31±0.08) kN in silane coupling agent group, and (1.09±0.04) kN in the combination group, and there was a significant differences between groups (P < 0.01). Experimental results show that the silane coupling agent+resin adhesive treatment and adjacent surface open part of the crown are superior to conventional resin adhesive.

Objective To investigate the effect of early low-glucocorticoid on hemodynamics and prognosis in the patients with septic shock.Methods Sixty patients with septic shock failing in active fluid resuscitation and vasoactive drugs in our hospital from June 2013 to August 2015 were selected and divided into the control group,early-hormone group and late-hormone group.MAP,HR,PO2/FIO2 and serum lactic acid levels were monitored in all selected patients before treatment and at 12,24,48 h after treatment.Apache Ⅱ,SOFA scores were assessed before treatment and on 1,3,7 d after treatment.The ventilation time,ICU stay time,hospital stay time and intravenous use time of vasoactive agents(VDNT) were recorded.Results The Apache Ⅱ scores and SOFA scores on 3,7 d after treatment in the early-hormone group were significantly decreased compared with the late-hormone group and control group (P＜0.05).MAP and HR at 24,48 h after treatment in the early-hormone group were significantly improved compared with the late-hormone group and control group (P＜0.05).The level of serum lactic acid at 12,24 h after treatment in the early-hormone group and late-hormone group were obviously lower than that in the control group,the levels of serum lactic acid at 12,24 h after treatment in the early-hormone group were obviously lower than those in the late-hormone group (P＜ 0.05).PO2/FIO2 at 12 h after treatment in the early-hormone group and late-hormone group were obviously better than that in the control group,and PO2/FIO2 at 12 h after treatment in the early-hormone group was obviously better than that in the late-hormone group(P＜0.05).The ventilation time,ICU stay time,hospital stay time and VDUT in the early-hormone group were significantly shortened compared with the late-hormone group and control group.The ventilation times,ICU stay time and VDUT in the latehormone group were significantly shortened compared with the control group (P＜0.05).Conclusion Early using low-dose glucocorticoid may restore hemodynamics more quickly,protects the organ function and improves the prognosis in the patients with septic shock.

Objective To investigate safety and efficiency of anti-coagulation therapy in patients with high-risk of bleeding and multiple organ dysfunction syndrome (MODS) during continuous veno-venous hemofiltration (CVVH). Meth-ods Forty patients with high-risk bleeding MODS during CVVH in our hospital were divided into heparin-free group (A group) and low-dose heparin group (B group). Blood coagulation function, platelets counts, blood urea nitrogen, serum creati-nine, PaO2/FIO2 and Apache Ⅱ scores in two groups were tracked before treatment and 24 h, 48 h after treatment. Filter lifespan, median ventilation time, ICU admission time and bleeding complications were observed. Results (1)There was significant difference in levels of blood urea nitrogen, serum creatinine, PaO2/FIO2 and ApacheⅡscores at 24 h, 48 h after treatment between in low-dose heparin group and those in heparin-free group (P＜0.05). (2)Levels of activated partial thromboplastin time(APTT), thrombin time (TT) were prolonged. Platelets count were significantly lower at 24 h after treat-ment than that before treatment in low-dose heparin group. Levels of APTT, TT and platelets count had no changes with pro-longed time of CVVH therapy.(3)Average ventilation time, ICU admission time were obviously shorter in low-dose heparin group than that in heparin-free group. Filter lifespan was significant longer in low-dose heparin group than that in heparin-free group, (P＜0.05).(4)Bleeding in skin and mucosa was observed in 1 case in low-dose heparin group without other se-vere bleeding complications. Conclusion The results of monocentric study show that low dose of heparin ensure smooth op-eration of CVVH in patients with MODS and high-risk bleeding. The clinical application is safe and efficient.

Objective To investigate the application potentiality of dynamic three-dimensional contrast-enhanced ultrasound (3D-CEUS) in showing vascular patterns of hepatic tumors.Methods Total of 65 hepatic tumors were examined with two-dimensional contrast-enhanced ultrasound (2D-CEUS) and dynamic 3D-CEUS and make statistical comparison between two imaging modes in aspects of enhancement patterns,spatial relationships of tumors and vascularity of different hepatic tumors.Results Dynamic 3D-CEUS showed the same enhancement patterns with 2D-CEUS.However,Dynamic 3D-CEUS was superior to 2D-CEUS in the display of spatial relationships of hepatic tumors and vascularity(P ＜0.05).The vascularity between benign and malignant hepatic tumors was statistically significant (P ＜ 0.05).Conclusions Dynamic 3D-CEUS is a useful technique in the differential diagnosis of hepatic tumors as well as 2D-CEUS,and dynamic 3D-CEUS displays the spatial relationship of hepatic tumors and vascularity more visually and comprehensively,which provides additional beneficial information for the diagnosis and therapy of hepatic tumors.

Objective To study the levels of CD62P and CD44 in the peripheral blood of children with lupus nephritis (LN) and their clinical significances were investigated. Methods Twenty-two children with active LN were divided into two groups by their clinical features,nephritic syndrome group (NS group,12 patients) and nonnephritic syndrome group (non NS group, 10 patients). Those patients were also divided into two groups according to their pathologic grading,grade Ⅱ+Ⅲ group (6 patients) and grade Ⅳ+Ⅴ group(16 patients).According to their tubulointerstitial lesions (TIL), those patients were divided into three groups, TIL grade 0 group (5 patients), grade Ⅰ group (13 patients), grade Ⅱ group (4 patients). The blood of the 18 patients who were in inactive state after treatment were retested blood again. The levels of CD62P and CD44 in the peripheral blood were assayed by radioimmunoassay (RIA) and enzyme-linked immunoabsorbant assay (ELISA) in LN children and in 20 normal age and sex-matched controls, and their correlation with clinical peripheral blood levels of CD62P and CD44 in NS group, grade Ⅳ+Ⅴ group were significantly higher than CD44 were positively correlated with 24-hour proteinuria,ESR, urine NAG, urine β2-MG and the TIL grade (P<0.05 and P<0.01, respectively), but negatively correlated with the levels of serum complement 3 (C3) and albumin (ALB) (P<0.05).The levels of CD62P was positively correlated with those of CD44 (P<0.05). Conclusion CD62P and CD44 may be involved in the pathogenesis of LN. The peripheral blood levels of CD62P and CD44 in LN children could be used as one of the indicators for lupus activity, severity, treatment effectiveness and prediction of outcome.

Objective To study the relationship between lumbar and proximal femoral bone mineral density (BMD) with gender,age and body mass index (BMI) in adolescents ranged from 12 to 19 years of age in Tianjin city,and provide preliminary reference to understand the bone health status of adolescent in the city.Methods The BMD values of lumbar spine (L1-L4,),femoral neck and total hip were detected by the dual-energy X-ray absorptiometry (DXA) in 221 adolescents from Tianjin Hospital,and the Z value was used for clinical diagnosis standard.Simultaneously the height and weight of adolescents were measured,and BMI was calculated.The differences of BMD values in the lumbar,femoral neck and total hip were compared between different age,gender and BMI groups.Results The BMD values of femoral neck and total hip were significantly higher in males than those in females (P ＜ 0.01).The BMD values of lumbar spine,femoral neck and total hip were gradually increased with age.The BMD was correspondingly increased in adolescents with higher BMI in the lumbar spine,femoral neck and total hip.Conclusion There is a close relationship between BMD with age,gender and BMI in adolescents.We should pay more attention to the nutrition health and the level of BMI in adolescents.

ObjectiveTo assess the effectiveness and safety of target-controlled infusion (TCI) of remifentanil during remedial endoscopic retrograde cholangiopancreatography (ERCP) in the elderly patients.Methods390 patients (aged 65 years and over) undergoing ERCP were divided into two groups: remifentanil group (n =175) and lidocaine group (n =215). Remifentanil group were anaesthetized by TCI with remifentanil as method of sensible analgesia,while lidocaine group were anaesthetized by lidocaine as conventional local anesthesia.Arterial blood pressure,heart rate and oxygen saturation (SpO2) were monitored during ERCP.The memory and feeling of pain during operation and side effects after operation were followed up. ResultsThe statistical differences in changes of blood pressure,heart rate and SpO2 were not found between the two groups.There were 165 cases(94.3 ％) with satisfactory anaesthetization,10 cases (5.7 ％ ) with mild and endurable pain and 7 cases(6.7％) with side effects of circulation and respiration during operation,while these symptoms improved after symptomatic treatment in remifentanil group.In lidocaine group,there were 25 cases(8.6 ％ ) with side effects of circulation and respiration during operation,most of patients were obviously uncomfortable,2 cases (1.8％) were intolerant of operation. Conclusions Targetcontrolled infusion of remifentanil during ERCP in the elderly is safe,effective and worthy of clinical popularization.

Fatal Outcome ; Herbicides ; poisoning ; Humans ; Injections, Intravenous ; Paraquat ; poisoning ; Poisoning ; mortality