Objective To analyze the prognostic value of baseline serum free light chain (sFLC) in light-chain (AL) cardiac amyloidosis.Methods Twenty-seven patients with AL cardiac amyloidosis were retrospectively reviewed from January 2014 to January 2015.sFLC was measured by immuoturbidimetric assay.Baseline characteristics,echocardiographic parameters and electrocardiogram data were analyzed.According to the median baseline dFLC (involved sFLC minus uninvolved sFLC),patients were categorized into either the low dFLC(≤307mg/L) or the high dFLC group (＞307mg/L).Results More subjects in the high dFLC group with early/late diastolic mitral velocity ratio (E/A ratio) over 2 (71.4％ vs 30.8％,P =0.035),and subjects in this group had a shorter median survival time than those in the low dFLC group (3 months vs 17 months,P =0.004).A similar phenomenon for median survival time was observed when the subjects were redivided either by a new cut-off value of 180mg/L for dFLC (low dFLC group:17 months;high dFLC group:4 months,P =0.014) or a κ/λ ratio,in which subjects with κ type sFLC-ratio ≤ 19.6 and λ type sFLC-ratio ＞0.065 were in the low sFLC-ratio group (17 months) and those with κ type sFLC-ratio ＞ 19.6 and λ type sFLC-ratio ≤0.065 were in the high sFLC-ratio group (4 months,P=0.023).In multivariate analysis,dFLC and New York Heart Association (NYHA) classification of cardiac function were two risk factors associated with all-cause mortality in patients,among which the hazard ratio for higher dFLC was 4.28 (95％ CI 1.55-11.8,P =0.005).Conclusion The level of sFLC could be a marker for the prognosis of AL cardiac amyloidosis.

Objective To discuss clinical characteriistics of APE and therapeutic effect of thrombolysis or anticoagulation so as to reduce false or misdiagnosis rate and improve survival rate.Methods The clinical data of 122 inpatients with APE were reviewed.Results The most common risk factors were deep venous thrombosis,age over 60 years old,cardiac disease,surgical operation,diabetes,fracture,long-term immobilization,etc.The most frequent symptom was dyspnea.D-dimmer measure had high sensitivity.By means of color Doppler echocardiography,spiral computed tomography,pulmonary ventilation/perfusion scanning,the cases were finally diagnosed.Positive treatment of thrombolysis and anticoagulation could reduce mortality.Conclusion As clinical manifestations of APE are non-specific,clinician should be alert.D-dimmer measue could be screening.The standardized treatment can improve prognosis significantly.

Amyloidosis ; Heart Diseases ; Humans

Objective To investigate the effect of maximal sterile barrier precaution during deep venous/arterial catheterization on preventing catheter-related bloodstream infection (CRBSI)in patients in the department of critical care medicine.Methods 996 patients who were hospitalized in Beijing Friendship Hospital and underwent deep ve-nous/arterial catheterization from September 2011 to April 2014 were analyzed retrospectively,patients were divided into standard sterile barrier precaution group (SSB group,September 2011-December 2012,n=560)and maximal sterile barrier precaution group (MSB group,January 2013-April 2014,n=436)based on whether they received maximal sterile barrier precaution,incidence of CRBSI and mortality were compared between two groups.Results There was no statistical difference in constitute of intubation sites between patients in SSB group and MSB group(χ2=6.750,P=0.08).The incidence of CRBSI per 1000 catheter days in SSB group and MSB group were 2.41‰(1.64‰-4.02‰)and 1.91‰(0‰-4.56‰)respectively,rank test revealed no significant difference(Z=-0.057, P>0.05);24 (4.29%)patients in SSB group and 26(5.96%)patients in MSB group developed CRBSI,difference between two groups was not statistically significant(χ2=1.447,P>0.05).The mortality in SSB group and MSB group were (18.43±5.53)% and (11.68±4.14)% respectively,independent sample t-test revealed that difference was significant(t=3.907,P<0.05).Conclusion Maximal sterile barrier precaution did not reduce the incidence of CRBSI.

Objective To survey the scientific research integrity situation of community health care organizations in Yangpu district in Shanghai,meanwhile,provide a reference for scientific research integrity management in any community health care organization.Methods Using the convenience sampling method,we sampled 200 health staff from 4 community health service centers.They were surveyed with uniform questionnaires.Results No dramatically relationship existed in health staff's knowledge about scientific research integrity breach and their age.However,education background,their academic titles,how many times they have learned relative information,publicity about science research integrity would impact their awareness on research integrity.Conclusions There is dramatically discrepancy on the scientific research integrity among these community health staff.

Objective To evaluate the outcome of open repair of Bankart lesion in the treatment of anterior instability of shoulder.Methods From March 2001 to June 2005,34 cases (36 shoulders) of anterior instability of shoulder underwent open repair of Bankart lesion.Twenty-seven shoulders with Bankart injury were diagnosed by CT scan.Nine shoulders were diagnosed as ALPSA(anterior labrum periosteal sleeve avulsion).Twenty-five shoulders presented with anterior instability only,and 11 combined anterior and inferior instability.Twenty-seven cases had a definite history of injury.Twelve cases presented with Hill-Sachs sign.We used open incision to repair lesions to the capsule glenoid labrum complex with suture anchors.Results The average duration of follow-up was 2.2 years (six months to four years).By Walch-Duplay score system,the good to excellent rate was 86.1%,the moderate rate 8.3%,and the poor rate 5.6%.Redislocation occurred in one case after operation due to injury.The rate of recurrence was 3%.Conclusion Open repair of Bankart lesion in the treatment of anterior shoulder in- stability can lead to good recovery of shoulder function,few complications and a low rate of recurrence.

Bring up high quality medical talents with innovative consciousness and practical ability is the aim of high medical ed- ucation.Improving the innovative ability of teachers and quality of teaching with the perfect combination of science and humanities, so as to improve our understanding of the importance and necessity of innovation education,and carry out an overall quality edu- cation which chiefly works for the training of students' innovative consciousness and practical ability during practicing period.

Objective To investigate the surgical method and clinical curative results of acetabulum top compression fractures with sea gull sign. Methods Data of 14 patients who had acetabulum top compression fractures with sea gull sign were retrospectively analyzed and were accepted surgical therapy and followed up. There were 5 females and 9 males, aged from 28 to 71 years (average, 49.9 years). The pre-operative time was from 4 to 14 days (average, 9 days). Letournel-Judet fracture classifica-tion:eight cases for the anterior column+posterior semi-transverse, six cases for a simple anterior column. Three patients with lum-bar compression fracture, two patients with tibial plateau fracture, one patient with multiple rib fractures. All patients were accept-ed open reduction and bone graft and internal fixation through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach. The quality of fracture reduction was assessed according to the Matta reduction criterion after operation. The hip func-tion was evaluated according to Matta. Results 14 patients were followed up from 6 to 60 months (average, 36 months). All pa-tients reached bone healing;healing time was from 3 months to 4 months (average, 3.4 months). According to the Matta reset stan-dard after operation, there were 6 excellent cases, 5 good cases, 2 fair cases, 1 poor case, the excellent and good rate was 78.5%(11/14). The Matta was from 10 to 18 scores (average, 16.4 scores), 5 excellent cases, 5 good cases, 3 fair cases, 1 poor case, the ex-cellent and good rate was 71.4%(10/14). Traumatic arthritis occurred in 3 patients. Pain was serious in two patients and disap-peared after total hip joint replacement. Pain was mild for one patient and disappeared after accepted non steroidal painkiller. One patient had heterotopic ossification after operation, which was not treatmented because of no obvious symptom. Conclusion The appropriate operation time of acetabular roof compression fracture with sea gull sign was from 5 to 10 days after fracture, which was no more than two weeks had best. Through ilioinguinal approach or ilioinguinal approach+Kocher-Langenbeck approach, the articular surface could be reduced excellent and got sufficient bone graft. The clinical efficacy was satisfactory after operation.

The acute phase of ischemic stroke patients are often treated with both Chinese patent medicine:and western medicine therapies in clinical practice. This research included 27,678 cases of the acute phase of ischemic stroke came from 14 3A level hospitals. We collected data from patients with ischemic stroke who used both Chinese patent medicine and western medicine and were hopitalized within 14 days from hospital information system (HIS). Constructing complex network of Chinese patent medicine and western medicine were found to show scale-free network. Hierarchical structure of the core algorithm was used to analyze the characteristics of combined core Chinese patent medicine and western medicine in admission condition of "acute", "critically", and "general" of ischemic stroke acute phase patient within one day, 2-3 days, 4-7 days and 8-14 days. We found that the core Chinese patent medicine mainly used for activate blood and resolve stasis medicine, and phlegm eliminating brain refreshing medicine in all kinds of patients, but the phlegm eliminating brain refreshing medicine were used to reduce with time elapsing. The core western medicine mainly used for anti-platelet medicine, improve circulation medicine, neuroprotective medicine, anticoagulants medicine and dehydration medicine. The dehydration medicine as the core western medicine for critically patients within 14 days, but the patients for general admission as core western medicine within 3 days. The neuroprotective medicine was used to decreases after 7 days in hospital. Combination of Chinese patent medicine and western medicine were mainly for neuroprotective medicine + activate blood and resolve stasis medicine, and anti-platelet medicine + activate blood and resolve stasis medicine, and improve circulation medicine + activate blood and resolve stasis medicine. The phlegm eliminating brain refreshing medicine was mainly combined with neuroprotective medicine by urgent and general admission condition patients, and it was more combined with dehydration medicine by critically admission condition patients. This research found that the dynamic characteristics for the combination of Chinese patent medicine and western medicine of acute phase of ischemic stroke patients by big data analytics and complex networks modeling, and provide basis for acute phase of ischemic stroke patients, it provide basis for ischemic stroke treatment strategy making.
Acute Disease ; Adult ; Aged ; Aged, 80 and over ; Brain Ischemia ; drug therapy ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Stroke ; drug therapy

Objective To explore the feasibility,efficacy and safety of endoscopic submucosal dissection (ESD) for tumors originating from gastric muscularis propria.Methods A total of 20 patients with tumors originating from gastric muscularis propria confirmed by EUS and CT scan underwent ESD.Laparoscopic intervention was applied in 3 cases when difficulties in en bloc removal or perforation occurred.Results The mean ESD procedure time was 74.8 min (40-120 min),and the mean resected tumor size was 2.6 cm (1.5-3.5 cm).No severe complication occurred.Pathological findings were 17 cases of gastrointestinal stromal tumors and 3 cases of leiomyoma.Conclusion ESD is an effective method for treating the tumors originating from gastric muscularis propria,and laparoscopic intervention is necessary for en bloc resection in some cases.