Objective To investigate the diagnosis and management of AIDS patients accompanied with surgical diseases. Methods The clinical data of 40 AIDS patients accompanied with surgical diseases were analyzed retrospectively . Results Sixteen of the 40 patients with AIDS accompanied with surgical diseases were operated on,and the condition of the patients became better or cured after operation. Conclusions surgical operation is safe and beneficial to the AIDS patients accompanied with surgical diseases, if the operation is proformed in time.

Objective To evaluate the clinical application of CT perfusion imaging (CTPI) and CT subtraction angiography (CTSA) in the diagnosis of acute ischemic cerebrovascular disease (AICVD). Methods 24 cases with AICVD onset within 24 hours were examined with regular CT, CTPI and CTSA. Some of them took CTPI, MRI, MRA, DSA, SPECT by follow up examinations. Results In 24 cases 11 had regular CT negative results after onset of stroke 3～6 hours in 6 cases,6～12 hours in 3 cases,12～24 hours in 2 cases. Ten cases of them were confirmed by CTPI as having ischemic lesions, 2 cases had middle cerebral artery occlusion (MCAO), and 1 had transient ischemic attack (TIA) with CTPI negative. In 24 cases 13 had regular CT positive rseults, 9 cases had ischemic lesions larger in CTPI than in regular CT,1 case had MCAO and 1 case had internal carotid artery occlusion(ICAO). There were 4 cases with ischemic lesions on regular CT almost having the same range as that of lacunar infarction in CTPI. The peak value of time(PT), mean transit time(MTT), relative flow (RF) in all 24 cases were found obviously changed. The side of ischemic lesion as compared with the opposite side, and the core of ischemic lesion as compared with peripheral zone were found changed significantly ( P

Objective: To study the causes of misdiagnosis of patients with POEMS syndrome and to discuss the clues for its early diagnosis. Methods: The clinical and laboratory data of 26 inpatients with POEMS syndrome, who were treated in Changhai hospital over the last decade, were retrospectively analyzed. Results: The misdiagnosis rate of our group was 100%. The misdiagnosis was made in (3.31±0.97) hospitals and in (3.31±0.93) clinical departments; the misdiagnosis period was (19.42±10.86) months and it had been misdiagnosed as 18 other diseases. The initial symptoms included polyneuropathy in 21 (80.8%) cases, edema of lower extremity in 22 (84.6%) cases, and body weight loss in 8 (30.8%) cases. The typical clinical symptoms included polyneuropathy in 26 (100%) cases and organomegaly in 24 (92.3%). Two cases had newly identified uterine hypertrophy, one had adrenal gland hypertrophy, and one had gastric wall thickening mimicking advanced gastric cancer. Hypothyroidism, impotence, skin pigmentation and sclerosis occurred in 76.9% (20/26), 60% (6/10), 92.3% (24/26) and 65.4% (17/26) cases, respectively. Monoclonal plasma cell proliferation was documented in 18 (81.8%); M proteins were positive in 14 (63.6%) cases by serum immunofixation, and only 2 (9.1%) cases also positive by serum protein electrophoresis. One patient was positive of M protein by urine immunofixation and one had abnormal infiltration of plasma cells in the gastric wall. Lymph node biopsy were performed in 8 patients and 3 were found to have Castleman disease; the other 5 cases had lymphocyte infiltration, with 3 complicated with plasma cell proliferation. Nerve biopsy in 4 cases all revealed axonal degeneration and one patient complicated with demyelination. Bone marrow biopsy in 5 cases revealed plasmacytosis in 2 cases and myeloma in one. Excessive radioactivity resorption was found in 10 of the 16 cases (62.5%) and abnormal plasma cells were detected in 2 cases by bone aspiration guided by radioisotope hone scan. Conclusion: Misdiagnosis of POEMS syndrome is very common. Polyneuropathy, edema of lower extremity and body weight loss are the common early symptoms of POEMS syndrome. Early diagnosis can be made by having an intimate knowledge of the progression of the disease and by detecting M protein through various approaches.

Objective To investigate clinical characteristics of patients with ST-elevation myocardial infarction (STEMI) and hypokalemia and the effects of hypokalemia on prognosis. Methods Consecutive 216 cases with STEMI who underwent emergency PCI were divided into group A (serum potassium ＜ 3.5 mmol/L) and group B (serum potassium＞3.5 mmol/L). Infarct site, infarct interrelated artery, peak level of CK-MB and cTnT were compared between two groups. Post-infarctional angina pectoris, arrhythmia, heart failure and cardiac death were compared. Results (1 )The percentage of anterior wall myocardial infarction , left anterior descending artery (LAD) lesions in group A were significantly higher than those in group B [61.2%(41/67) vs. 44.3%(66/149),55.2%(37/67)vs. 38.9%(58/149),P = 0.022,0.026]. The peak levels of CK-MB and cTnT in group A were significantly higher than those in group B [(194.39 ± 101.27) μg/L vs. (115.35 ±78.62)μg/L,(19.16 ±11.48)μg/L vs. (9.07 ±7.65) μg/L,P = 0.004,0.002].(2)Left ventricular ejection fraction in group A was significant lower than that in group B (P - 0.003). The incidence rates of post-infarctional angina pectoris, ventricular tachycardia, ventricular fibrillation and heart failure were significantly higher in group A [43.3%(29/67),32.8%(22/67), 11.9%(8/67),37.3%(25/67)] than those in group B [24.8%(37/149),18.1%(27/149),4.0%(6/149),20.8%(31/149)](P = 0.006, 0.017, 0.029, 0.010). Conclusions Hypokalemia is associated with infarct site and infarct interrelated artery. Hypokalemia has bad effect on prognosis of STEMI.

Adult ; Ambroxol ; administration & dosage ; therapeutic use ; Expectorants ; administration & dosage ; therapeutic use ; Female ; Glycoproteins ; therapeutic use ; Humans ; Lung ; pathology ; Lung Injury ; drug therapy ; pathology ; Male ; Paraquat ; poisoning ; Respiratory Distress Syndrome, Adult ; drug therapy ; etiology ; Retrospective Studies ; Young Adult

ObjectiveTo assess malignant trophoblastic neoplasia with the standards of the clinical stage and prognostic factor scoring system. MethodsThrough assessing the high-risk factors except clinical stages for 223 patients before treatment according to International Federation of Gynecology and Obstetrics(FIGO) scoring system published in 2000, appropriate treatments were selected for the different patients. ResultsForty-three of 78 cases of choriocarcinomas were with high-risk factors, the other 35 cases were with low-risk factors; 7 of 145 cases of invasive moles were with high-risk factors and the others were with low-risk factors. The primary chemotherapy principle was that one agent was used for those patients with low-risk factors and two or multiple-agents were used for those patients with high-risk factors. Among all patients, the one-year, three-year and five-year survival rates were 98.6%,98.1% and 97.1% respectively. No patient died of drug toxicity or complication. ConclusionSelection of treatment approaches according to the prognostic assessment of malignant trophoblastic neoplasia could lead to promising survival rate with no uncurable complication and toxic effects.

Objective To observe the learning and memory changes in coal-burning type of fluorosis rats, detect the expressions of neuronal nicotinic acetylcholine receptor(nAChR) at mRNA and protein levels in rat brains and to reveal the mechanism of changed learning and memory ability. Methods Twenty-four healthy SD rats, weighting 100 - 120 g, were randomly divided into three groups(8 in each). Control group was fed with normal diet, and low- and high-dose fluoride groups were fed with corn polluted with high fluoride (fluoride were 11.30,104.20 mg/kg, respectively) during drying processes with local burning-coal from the areas of endemic fluorosis to established rat model of chronic fluorosis. After exposed to fluoride for 6 months, behavioral changes were measured by Morris water maze. Animals were sacrificed, the brain was taken, after homogenizing the fluoride content of brain tissue was determined by fluoride ion selective electrode. The α3, α4 and α7 nAChR subunits at mRNA and protein levels were analyzed by real-time PCR and Western blotting, respectively. Results For rats in low- and high-fluoride groups, the escape latency time[(12.42 ± 8.03),(17.48 ± 8.05)s] was significantly longer than that in the control[(7.04 ± 3.29)s, all P< 0.05]. For rats in high-fluoride group, the numbers of crossing the platforms (1.62 ± 0.87) and the time of staying at the platforms[(16.70 ± 5.02)s] were significantly decreased as compared to that of control[3.53 ± 1.67, (23.33 ± 5.35)s, all P < 0.05]. The fluoride content in rat brain tissue in low- or high-fluoride groups [(1.14 ± 0.04), (1.79 ± 0.04)mg/kg] was significantly higher than that of control [ (0.52 ± 0.05) mg/kg, all P < 0.05]; in addition, the amount of fluoride in brain tissue of high-fluoride group was significantly higher than that of low-fluoride group(P < 0.05). In high-fluoride group, the mRNA expressions of α3, α4 and α7 nAChR subunits in rat brains(1.51 ± 0.20,1.45 ± 0.06,1.63 ± 0.08) were significantly lower as compared to controls (1.79 ± 0.11,1.66 ± 0.14,1.83 ± 0.06, all P< 0.05); whereas there were no significant changes in mRNA levels of these receptor subunits of the rat brains between low-fluoride group(1.65 ± 0.17,1.59 ± 0.09,1.71 ± 0.03) and controls (all P > 0.05). Furthermore, the protein levels of α3, α4 and α7 nAChR subunits in rat brains of highfluoride group(0.58 ± 0.13,0.16 ± 0.03,1.41 ± 0.38) and low-fluoride group(0.56 ± 0.23,0.08 ± 0.02,0.51 ± 0.16) were significantly lower than those of controls( 1.48 ± 0.42,0.57 ± 0.21,2.56 ± 0.26, P<0.05 or < 0.01). Conclusions Decreased ability of learning and memory in coal-burning type of fluorosis rats may be associated with declined expressions of nAChR at proteins and mRNA levels, which might be the main mechanism of the behavior change.

Objective To evaluate the application effects of mind map in community health education of rheumatoid arthritis patients. Methods 65 rheumatoid arthritis patients from Shunqing district of Nanchong City, Sichuan Province were randomly divided into an observation group (n=33) and a control group(n=32). Both groups received six-month health education. Health educators utilized mind map for the observation group and traditional health education for the control group. Before and after implementation, the two groups' mastery of disease knowledge was compared. During the period of 1, 3, 6 months, two groups received compliance evaluation respectively. During the study period, a questionnaire was given to the observation group to collect their attitude towards the mind map health education and their evaluation about it. Measurement data was represented by x ± s, using group t-test design information and single-sample t-test. χ2test was used in the count data for compar-ison between groups with test levelα=0.05. Results The scores of disease knowledge were as follows. Before implementation there was no statistically significant difference between two groups (P=0.921);After implementation, the score of observation group was(19.97±3.03), while the score of control group was(17.59±3.11), the difference was statistically significant(t=3.122,P=0.003). The difference of 1,3,6-month compliance scores was statistically significant(t=2.173,P=0.034;t=2.371,P=0.021;t=2.615,P=0.011) with the observation group's scores(18.24±3.44),(18.94±3.25),(19.64±3.06) respectively,and the control group's scores(16.47±3.13),(16.97±3.45),(17.44±3.70). Observation group's attitude questionnaire scores of each project are > 3, and there was significant difference be-tween two groups (P=0.000). Conclusion Mind mapping method can be used in community health education for rheumatoid arthritis patients to help patients master the knowledge of the disease and improve the compliance. Its effect is better than traditional methods.

Objective To investigate the influence of social support on the depression and anxiety of standardized training residents.Methods Three hundred and eighteen standardized training residents selected by random sampling method from 4 training bases in Shanghai participated in this survey.ResultsThe average score of PHQ-9 was(7.24±5.20), and 67.30%(n=214)of participants had different degrees of depression;the average score of GAD-7 was(5.57±4.55), and 55.03%(n=175)of participants had different degrees of anxiety.One-way analysis of variances showed that standardized training residents who had work experience, longer training years and less salary satisfaction got higher scores in PHQ-9 and GAD-7.Male physicians had higher scores in GAD-7 than female ones.The scores of PHQ-9 (r=-0.390, P<0.01) and GAD-7 (r=-0.376, P<0.01) were both negatively correlated with social support.Regression analysis showed that training years,salary satisfaction,objective social support and the availability of support were significant for predicting the scores of PHQ-9(adjusted R2=0.242,F=17.893), work experience, salary satisfaction,objective social support and the availability of support were significant for predicting the scores of GAD-7(adjusted R2=0.228,F=14.390).After controlled the demographic variables, social support explained the variation rate of 0.119 to the score of PHQ-9 and 0.126 to the score of GAD-7.Conclusion The depression and anxiety of standardized training residents in this study is in a serious situation.Providing the objective social support and the availability of support as well as improving the salary satisfaction of standardized training residents may relieve the depression and anxiety and enhance their mental health.

Objective To evaluate the efficacy and safety of methotrexate(MTX)on the hip involve ment in patients with ankylosing spondylitis(AS).Methods Among the AS patients with hip joint involvement admitted to the department from 1999—2002,50 patients were treated with sulfasalazine(SSZ)(control group, CG)and 48 MTX(observation group,OG).One kind of NSAIDs was taken by the patients in both groups as the basic therapy.The treatment was maintained in both groups after being discharged.Patients were followed-up for three years.The observation parameters included symptoms,signs,Bath AS disease activity index(BASDAI), Bath AS functional index(BASFI),hip joint function score,the CT staging of hip joint involvement,serum in- flammation markers,laboratory tests and side effects.The data were analyzed with SPSS10.0 statistics software. Results At the 1st,2nd and 3rd year,44,38 and 32 cases in the OG and 45,38 and 31 cases in the CG were followed up respectively.During the three-year follow-up period,the hip joint function score of the OG was significantly higher than that of the CG(P