Totally, 125 elderly inpatients with aspiration pneumonia (AP) were enrolled from departments of respiratory medicine and neurology at Zhongnan Hospital, Wuhan during June 2005 to October 2009 for analysis. Results showed that listlessness was manifested in 70 cases (56%), primary neurological illness in 80 cases (64%), 57 of them (46%) complicated with respiratory failure and 26 died with case-fatality of 21%. Main pathogen for them was Gram-negative bacillus, accounting for 57% of the total. Two kinds or more of antibiotics had ever been administered in 98 cases (78%), with an average length of antibiotics use for 28 days, ranging from one day to 128 days. Nasal feeding was instituted for those with choking over their feeding and coughing, and their inspired feeding was aspirated from the trachea or bronchi and lavished with bronchoscopy, with 38 cases by tracheal intubation, 26 by tracheotomy and 42 with artificial ventilation. Their average duration of hospital stay spanned 28 days with an average cost of 25 000 RMB yuan per capita, significantly higher than that for those with common pneumonia. In conclusion, clinical features of these elderly patients with AP were not so typical, most of them manifest severe, with lots of medical cost and bad prognosis.

Objective · To evaluate the association between the abnormal maternal serum markers of alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG) and unconjugated estriol (uE3) in the second trimester screening and the adverse obstetric outcomes other than trisomy 21 (T21),trisomy 18 (T18) and open neural tube defects (ONTD), and to provide local data for supporting evidence based clinical managements. Methods · A retrospective cohort study was performed in the women who received second trimester maternal serum screening in the International Peace Maternal and Child Health Hospital between 2012 and 2014, with naturally conceived singleton pregnancies. Obstetric outcomes were followed up by searching electronic medical records within the hospital. Abnormal level of marker was defined as a MOM value ≥ 99th (P99) or ≤ 1st percentile (P1) of the overall screened population. Incidence of an adverse obstetric outcome was compared between the groups with abnormal markers and the control with all markers in normal. Results · ① A total of 25616 pregnancies were included in this study, in which 4526 were identified as having various adverse obstetric outcomes. Among them 4143 pregnancies were with isolated and 383 pregnancies were with co-occurring two or more adverse outcomes. ② When compared to pregnancies with normal levels of all three serum markers, pregnancies with decreased AFP or decreased hCG did not show associations with any adverse obstetric outcomes. However, pregnancies with increased AFP, increased hCG or decreased uE3 were at increased risk for a variety of abnormal pregnancy outcome. In 18 pregnancies with an outcome of fetal chromosomal abnormalities other than T21 and T18, 9 presented with either increased AFP, increased hCG or decreased uE3, with relative risk ratios of 13.33、35.00 and 59.00, respectively. ③ The performance of those markers tended to be improved in a subset of adverse obstetric outcomes, including low birth weight

Objective To investigate the clinical value of endoscopy in the treatment of choledocholithiasis. Methods All 227 patients underwent endoscopic treatment. 14 of them with stones less than 1. 0 cm in diameter were treated with endoscopic papillary balloon dilation; 194 patients with stones 1. 0-1. 5 cm in diameter were treated with endoscopic sphincterotomy; and 19 patients with stones up to 1.5 cm in diameter were treated with endoscopic mechanical lithotripsy. Results Choledocholithiasis were not confirmed by choledochography in 34 cases ( 15% , 34/227) , who underwent exploration of common bile duct through EPBD or EST, but no stones were found. In 187 of the 193 choledocholithiasis patients their stones were removed, the overall success rate with complete stones clearance was 96.9% ( 187/193). The incidence of complication was totally 5. 29% ( 12/227) , including acute cholangitis in 3 patients, acute pancreatitis in 8 patients, and bleeding in 1 patient. Conclusions Endoscopic treatment should be the first choice of patient with choledocholithiasis due to its advantages of safety, effectiveness and with less complication. EPBD or EST was not recommended in case of the common bile duct stones were not confirmed by ERCP, in order to avoid the risk of papilla injury.

OBJECTIVETo solve the problem of screw penetrating the joint surface easily by determining the angle of inclination and the mean longth screw plated on the posterior column.

METHODSTen specimens of adult male cadavers, aged 20 to 74 years old, averaged 54.5 years old, were collected. After removal of the bilateral femurs from the hip joints, and sawing through the sacral and pubic symphysis in the median sagittal plane, 20 semi pelvic specimens were used for this study when the osseous abnormalities were excluded. The specimens were air dried naturelly after the soft tissue attaching to the pelvis had been eliminated. The margin of superior acetabular and inferior acetabular were determined, and the serial cross-sections of the acetabular posterior column were made. The width of posterior column,the width of acetabulum,the width ratio of acetabulum to posterior column, the angle of inclination and the mean length of screw on all entry points were measured. Defined the level parallel to 1/2 section of superior acetabulum was cross-section B; 1/2 section of acetabulum was C; 1/2 section of inferior acettabulum was D. At the different levels, defined the entry point on the outer edge of posterior column of the acetabulum or the trailing edge of acetabulum was B0, C0 or D0; lateral 1/2 of posterior column of the acetabulum was B1, C1 or D1; 1/2 of posterior column of the acetabulum was B2, C2 or D2; medial 1/2 of posterior column of the acetabulum was B3, C3 or D3; the inner edge of posterior column of the acetabulum was B4,C4 or D4.

RESULTSOn cross-section B, the angle of inclination and the mean length of screw at B0 was 41 degrees and 44.0 mm; at B1 was 66 degrees and 42.2 mm; at B2 was 91 degrees and 59.5 mm; at B3 was 107 degrees and 64.0 mm; the maximum angle and the mean length at point B4 was 123 degrees and 65.5 mm; the minimum angle and the mean length at point B4 was 109 degrees and 59.0 mm. On cross-section C,the angle and the mean length at point CO was 39 degrees and 39.0 mm; at C1 was 57 degrees and 36.0 mm; at C2 was 74 degrees and 36.0 mm;at C3 was 90 degrees and 36.0 mm; at C4 was 106 degrees and 76.0 mm. On cross-section D,the angle and the mean length at DO was 42 degrees and 35.5 mm; at D1 was 61 degrees and 33.0 mm; at D2 was 81 degrees and 32.0 mm; at D3 was 100 degrees and 31.0 mm; at D4 was 120 degrees and 74.0 mm.

CONCLUSIONWhen using the fixation technique of acetabular posterior column plate, the angles of screw-posterior column are 40 degrees to 60 degrees, 60 degrees to 75 degrees, 75 degrees to 90 degrees and 90 degrees to the angle of parallel to the square area respectively on the region of outer 1/4,outer-middle 1/4,inner-middle 1/4 and inner 1/4 of the acetabulum region, and the screw length is 30 mm.

Acetabulum ; anatomy & histology ; injuries ; surgery ; Adult ; Aged ; Bone Plates ; Bone Screws ; Fracture Fixation, Internal ; instrumentation ; Fractures, Bone ; surgery ; Humans ; Internal Fixators ; Male ; Middle Aged ; Young Adult

Fifty-six patients diagnosed as early stage lung cancer by spiral CT scan,underwent CTguided percutaneous transthoracic biopsy with a successful rate of 100%.Forty nice cases were confirmed pathologically including adenocarcinoma in 30 cases,squamous carcinoma in 14,alveolar cell carcinoma in 2 and small cell lung cancer in 3.Three cases were diagnosed as chronic inflammatory lesion,2 cases as tuberculosis and the diagnosis was not confirmed in 2 cases.The results suggest that CT-guided percutaneous transthoracic biopsy is an effective diagnostic measure for patients with stage Ⅰ-Ⅱ lung cancer.

Objective To evaluate the efficacy of preoperative biliary drainage (PBD) in the pancreaticoduodenectomy for malignant obstructive jaundice.Methods Database including PubMed,EMBASE,Cochrane Central Register of Controlled Trials,Academic Degree Dissertation Database and Conference Database were searched with malignant obstructive jaundice,pancreaticoduodenectomy,preoperative biliary drainage,comparative study.Literatures about the randomized controlled trials of PBD (PBD group) and efficacy of early surgery (ES group) in the pancreaticoduodenectomy were retrieved from January 2001 to December 2013,and then a Meta analysis was carried out based on the data.The count data were analyzed using the odds ratio (OR),relative risk (RR) and 95％ confidence interval (95％ CI),and the measurement data were analyzed using mean difference (MD) and 95％ CI.The heterogeneity of the data was analyzed using the I2 test.Data were integrated by fixed or random effect model.Results Twelve literatures including 1 982 patients were selected.There were 1 029 patients in the PBD group and 953 in the ES group.The results of Meta analysis showed that the operation time,volume of blood loss and rate of postoperative wound infection in the PBD group were significantly different from those in the ES group (MD =10.50,107.92,95％ CI:6.34-14.66,16.43-199.42;RR =1.62,95％CI:1.19-2.21,P ＜0.05).There were no significant differences in the postoperative mortality,incidence of pancreatic fistula,incidence of bile leakage,incidence of delayed gastric emptying and duration of hospital stay between the 2 groups (RR=0.69,95％CI:0.52-0.92;OR =0.68,1.35,95％CI:0.38-1.21,0.93-1.95;MD =0.69,95％CI:-0.67-2.05;RR =0.00,95％ CI:-0.02-0.01,P ＞0.05).Conclusion PBD in the pancreaticoduodenectomy for malignant obstructive jaundice cannot reduce postoperative mortality and incidence of complications in patients,and should not be used as the conventional management in the perioperative period.

We reported a case of cryptogenic organizing pneumonia ( COP) who was admitted to the hospital in July 2008 and reviewed the Chinese literature of COP from 2003 to 2008. The most common symptoms of COP are fever, cough and exertional dyspnea. The imaging characteristics of COP are similar to those of pneumonia, therefore is often misdiagnosed as pneumonia with a high misdiagnosis rate. Lung biopsy is the main method for pathological diagnosis; polypoid growth of granulation tissue was noted within respiratory bronchioles, small airways and alveolar spaces.

Objective To explore the changes of high-sensitivity C reactive protein(hs-CRP) and platelet parameter levels in newborns with hypoxic-ischemic encephalopathy(HIE)and its clinical significance.Methods Thirty-five infants with HIE and 16 healthy newborns were selected as study cases and controls respectively by automantc biochemistry analyzer.Serum hs-CRP content was measured by reaction rate method;Platelet parameter levels were detected by collecting blood samples from peripheral vascular of heel,and the activity of creatine kinase(CK),creatine phosphokinase isoenzyme(CK-MB),lactate dehydrogenase(LDH),alpha-hydroxybntyric dehydrogenase(?-HBDH),alanine transaminase(ALT),aspartate aminotransferase(AST) were assayed as well.Results 1.The hs-CRP levels in newborns with HIE increased obviously in acute stage,and significant difference were observed compared with controls(P0.05).2.PLT in newborns with HIE decreased significantly in acute stage compared with that of controls(P0.05).3.The values of CK,CK-MB,LDH,?-HBDH,AST,ALT in newborns with HIE were significantly higher than those in controls in acute stage(P

Objective To assess the applicability of the Modification of Diet in Renal Disease (MDRD)formula to kidney function impaired Chinese diabetic patients.Methods Glomerular filtration rates(GFRs)in 463 Chinese diabetic patients(219 female,244 male,aged 14 to 88)were estimated by measuring ~(99m)Tc-DTPA clearance and with equations based on serum creatinine(Scr)and cystatin C(Cys C)concentrations.GFRs derived from various equations were compared with the ~(99m)Tc-DTPA clearance GFRs and their relative accuracies were assessed with ROC analysis.All the Scr measurements were performed with both the Roche enzymatic assay and the Beckman LX20 kinetic alkaline picrate assay,and Cys C with immunonephelometric and immunoturbidimetric assays.Results The reciprocals of Cys C and Scr were linearly correlated with ~(99m)Tc-DTPA clearance GFRs(r=0.830 and 0.690,repectively).The correlation of GFR with Scr could be expressed by an adjusted MDRD equation:GFR [ ml?(min?1.73 m~2)~(-1)]=175?(Scr)~(-1.154)?(age)~(-0.203)?0.742(female)?0.827,where 0.827 was a coefficient for Chinese.The adjusted equation showed a better accuracy than the MDRD equation(areas under the ROC curve 0.818 vs 0.644).The adjusted equation was also more accurate than equations obtained in previous Chinese studies.GFRs were also estimated by using Cys(in mg/L)with the following equation:GFR [ ml?(min?1.73 m~2)~(-1)] = 63.24?(Cys C)~(-0.3378).The accuracy of the Cys equation was similar to the Scr equation,or better in patients aged 60 and above.The Roche enzymatic results which were traceable to the isotope dilution mass spectrometry(IDMS)methods were significantly lower than Beckman LX20 results,but the results were closely correlated with each other(Y = 0.94X-0.02).When non-traceable Scr results were used,the coefficient needed to be adjusted.Conclusions GFRs can be estimated with equations based on either Scr or Cys C.GFR estimation should use standardized Scr results and take into account ethnic effects.

Objective To investigate the inhibitory effect of octreotide on transforming growth factor-alpha (TGF-?)-induced cell proliferation of human hepatocellular carcinoma cells and its possible mechanism. Methods The effect of octreotide on TGF-?-induced cell proliferation of the liver cancer cells (LCC) was evaluated by immunohistochemistry method. The effect of octreotide on TGF-? secretion and epidermal growth factor receptor(EGFR) expression in the cells was determined by reverse-transcriptase polymerase chain reaction(RT-PCR). The effect of octreotide on extracellular signal-regulated protein kinase (ERK) expression in the cells was measured by Western-blot and immunohistochemistry method. Results The TGF-?-induced expressions of proliferating cell nuclear antigen (PCNA) in nucleus were obviously increased by TGF-?. TGF-?mRNA index of hepatocellular carcinoma cells was decreased by octreotide. Octreotide inhibited significantly the expressions of EGFR mRNA induced by TGF-?. Octreotide inhibited significantly the expressions of ERK protein induced by TGF-?. There was intense staining in the nucleus of the cells by TGF-? and weak staining in the nucleus of the cells treated simultaneously by octreotide and TGF-?.Conclusions Octreotide can inhibit the secretion of TGF-?, the expression of EGFR, and the signal transduction of EGFR of LCC, and consequently exerts an inhibitory effect on TGF-?-induced hepatocellular carcinoma cells proliferation.