Objective:To examine whether the thyroxine treatment can affect the serum lipid levels in patients with subclinical hypothyroidism by Meta analysis.Methods:Pubmed and China National Knowledge Infrastructure(CNKI)were searched for randomized controlled trials reporting the effectiveness of thyroxine treatment on serum lipid levels in subclinical hypothyroidism patients from January 1980 to September 2006;hand-search was also performed.The included trails were analyzed by RevMan4.2 software.Results:Six studies were finally included and five of them found thyroxine to be significantly more effective than placebo in improving the serum lipid disorders;one of them found thyroxine had no obvious effect.The pooled effect sizes(95%CI)of total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),apoprotein A(ApoA),apoprotein B(ApoB)and lipoprotein a(Lp(a))were -0.39(-0.71, -0.07),-0.02(-0.07,0.04),-0.02(-0.06,0.03),-0.22(-0.31,-0.12),-0.08(-0.11,-0.06),-0.05(-0.08, -0.02),and -0.38(-2.41,1.64),respectively.The analysis results showed that thyroxine treatment was significantly effective on serum levels of TC,LDL-C,ApoA,and ApoB,but not on TG,HDL-C,or Lp(a).Conclusion:This Meta-analysis demonstrates that thyroxine treatment can improve thyroid function and lipid metabolism in patients with subclinical hypothyroidism,reducing the prevalence of artherosclerosis and coronary heart disease.

Objective To observe the treatment and outcomes of gastric stump cancer(GSC) after subtotal gastrectomy,and to analyse the possible related factors for the development of GSC. Methods The clinical data of 693 patients with subtotal gastrectomy were retrospectively analysed.The development,treatment and outcomes of GSC were observed,and the possible factors associated with the development of GSC were analysed. Results Seventy-six cases of GSC emerged in the 693 patients with subtotal gastrectomy.Fifty-one of the 76 cases were perfomed radical operations(n=36) or palliative resection(n=15).No death was found during the perioperative period,and the median survival time was 32.7 and 14.2 months,respectively.Those 25 without surgical management died 3 to 11 months after the development of GSC.Among the 76 cases with GSC,stomach was found as the original site of ulcer in 59(22.3%,59/259),and duodenal bulb in the other 17(3.9%,17/434)(P

0.05). Conclusions Low dose continuous infusion of CAZ to treat low respiratory infections is efficacious ,safe and economical.

Objective To observe insulin resistance in first-degree relatives of patients with Graves disease. Methods All subjects in control group and experiment group including first-degree relatives of GD patients underwent oral glucose tolerance tests (OGTT) and insulin releasing tests then the degree of insulin resistance was analyzed. Results Blood glucose at each point of OGTT, insulin level and insulin resistance index 1 (HOMA-IR) of experiment group were higher than those in control group, while insulin activity index (IAI) and HOMA-βwere significantly lower than those in control group. Conclusion Patients insulin resistance could be found among first-degree relatives of GD patients.

Objective To evaluate the curative effect and safety of emergency therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and treatment strategy of mobidity and combined diseases for patients aged over 90.Methods The clinical and follow-up data of 116 cases treated by ERCP from January 2002 to December 2006 were analyzed retrospectively.Results The success rate was 97.41% for biliary drainage.The occurrence rate of mobidity was 21.24%(24/113),of which 6 cases of acute pancreatitis (25.00%),2 cases of upper gastrointestinal bleeding (8.33%),12 cases of electrolyte disorders (50.00%),acid-base balance disorders in 4 cases (16.67%).Except the higher incidence of hypokalemia disorders of emergency group than out-patient group (P=0.003),the rest of the mobidity rates were similar in the two groups.The mortality rate and deterioration rate of combined disease between the two groups were also similar.Conclusion Simplify operations,rapid drainage,positive preoperative preparation can effectively reduce the incidence of mobidity and avoid the aggravation of combined diseases.Emergency ERCP for treatment of patients aged over 90 is safe and effective.

Objective To explore the relationship of dynamic changes between the iodine nutritional condition and growth of children born before and after the implementation of universal iodine.Methods By means of sampling investigation,urinary iodine and goiter,height,weight,intelligence quotient(IQ)were comprehensively evahated in children aged 7～14 years old born before and after the implementation of iodine in 10 counties and 2 cities of Qiannan.Results The median of urinary iodine of children Was 91.88μg/L in 1984,133.33μg/L in 1994,316.00μg/L in 2006;goiter rate was 21.40%(122/570)in 1984,12.86%(107/832)in 1994,5.28%(45/851)in 2006;the average IQ was 89.18±4.10 in 1994,94.26±0.94 in 2006;children in each age group in 2006 has a higher height and a heavier weight compared with those in 1984.Conclusion The physical development and intelligence of children in the areas of iodine deficiency have improved along with the correction of iodine deficiency.

Objective:To determine whether ox-LDL (oxdized low-density lipoprotein) is highly deposited on the uremic vessel wall and its influence on the vascular remodeling. Methods: Segments of radial arteries were obtained from 21 uremic subjects during the operation of A-V fistula prior to hemodialysis. Segments of internal thoracic arteries of similar diameter were obtained from patients with benign chest tumors as control.The vascular lesions and ox-LDL, CD68,MCP-1, eNOS,ET-1, PCNA,FN on the vessel wall were determined by means of H-E stain and immunohistochemistry. Results： With H-E stain,atherosclerotic plaques were found in the radial arteries of 4 uremic patients. The middle layer of the arteries in uremic patients were obviously thickened, and the T/D　(thickness of the wall/external diameter) ratio was significantly higher than those in control group(P<0.01). ox-LDL,CD68,MCP-1, ET-1, PCNA,FN on the vessel wall in uremic patients were much higher than those in control group (P<0.01). Moreover, ox-LDL on the vessel wall was positively related to the expression of other above mentioned substances on the vessel wall (P<0.01). Whereas the expression of eNOS on the vessel wall was lower than control group (P<0.01),and was negatively related to ox-LDL on the vessel wall(P<0.01). Conclusion: ox-LDL is an important factor contributing to uremic vascular remodeling by increasing the migration,adhesion and infiltration of monocyte,the proliferation of vascular smooth muscle cell and dysfunction of endothelia.

Objective:To determine whether ox-LDL (oxdized low-density lipoprotein) is highly deposited on the uremic vessel wall and its influence on the vascular remodeling. Methods: Segments of radial arteries were obtained from 21 uremic subjects during the operation of A-V fistula prior to hemodialysis. Segments of internal thoracic arteries of similar diameter were obtained from patients with benign chest tumors as control.The vascular lesions and ox-LDL, CD68,MCP-1, eNOS,ET-1, PCNA,FN on the vessel wall were determined by means of H-E stain and immunohistochemistry. Results： With H-E stain,atherosclerotic plaques were found in the radial arteries of 4 uremic patients. The middle layer of the arteries in uremic patients were obviously thickened, and the T/D　(thickness of the wall/external diameter) ratio was significantly higher than those in control group(P<0.01). ox-LDL,CD68,MCP-1, ET-1, PCNA,FN on the vessel wall in uremic patients were much higher than those in control group (P<0.01). Moreover, ox-LDL on the vessel wall was positively related to the expression of other above mentioned substances on the vessel wall (P<0.01). Whereas the expression of eNOS on the vessel wall was lower than control group (P<0.01),and was negatively related to ox-LDL on the vessel wall(P<0.01). Conclusion: ox-LDL is an important factor contributing to uremic vascular remodeling by increasing the migration,adhesion and infiltration of monocyte,the proliferation of vascular smooth muscle cell and dysfunction of endothelia.

Objective To evaluate the effect of spleno-left adrenal vein shunt for the treatment of portal hypertensive upper GI bleeding caused by portal vein cavernous transformation in children.Methods Spleno-left adrenal vein shunt was performed in 8 children with portal hypertension due to cavernous transformation.The clinical data was reviewed.Results Portal vein pressure decreased significantly from (30±11)mm Hg to(22±7) mm Hg after shunt.There was no mortality perioperatively and during the follow-up.There were no recurrent hemorrhage nor hepatic encephalopathy occurring in the follow-up and all the children have normal intelligence and normal liver function though blood ammonia level increased significantly from(18±7)μmol/L to (60±17)μmol/L in 4 cases.In 7 cases in which preoperative whole blood cell count significantly decreased,the postoperative WBC,RBC,Hb and PLT was (7.64 ±4.46)×10~9/L,(4.54±0.97)×10~(12)/L,(133±5) g/L and (355.40±107.36)×10~9/L respectively (all P ＜0.05).In one case suffering from preoperative low PLT count the postop PLT reached 333×10~9/L,which was significantly higher than that preoperatively.Esophageal varices ameliorated in 6 cases.No stenosis of anastomotic stoma and thrombosis developed.Conclusion Spleno-left adrenal vein shunt is an effective procedure to treat portal vein cavernous transformation induced portal hypertension in children.

ObjectiveTo evaluate the value of modified early warning score (MEWS) in predicting mortality of critically ill patients admitted to emergency department.Methods A prospective cohort study was conducted. Clinical data of emergency patients admitted to resuscitation room of Peking Union Medical College Hospital from Feburary 13rd, 2014 to April 20th, 2014 were collected, and their MEWS were calculated based on medical records and their clinical outcomes was followed. Incidence of primary outcome (3-day mortality) and secondary outcome [all deaths and composite outcome of intensive care unit (ICU) transfer, cardio-pulmonary resuscitation, and death] were compared between MEWS positive (MEWS≥5) or negative (MEWS 0-4) patients, and multi-regression logistic analysis was done to look for the impact factors of primary outcome in these patients.Results 176 patients, among them 98 (55.68%) were male, were enrolled in the study. Their mean age was (56.86±21.46) years old. Mean MEWS was 4.30±2.74. There was 74 cases in MEWS positive group, and 102 in negative group. Primary endpoint occurred in 41 patients, and the 3-days mortality in MEWS positive group was significantly higher than that in MEWS negative group [37.84 (28/74) vs. 12.74% (13/102), odds ratio (OR) = 4.167, 95% confidence interval (95%CI) = 1.973-8.804,P< 0.001]. At the meantime, incidence of all death [54.05% (40/74) vs. 17.65% (18/102),OR = 5.490, 95%CI = 2.770-10.883,P< 0.001] and the incidence of ICU transfer, cardio-pulmonary resuscitation and death [64.86% (48/74) vs. 25.49% (26/102),OR = 5.396, 95%CI = 2.809-10.366,P< 0.001] were also significantly higher in MEWS positive group as compared with negative group. Multi-regression logistic showed abnormal mental status (OR = 3.606, 95%CI = 1.541-8.436,P = 0.003) but not MEWS≥5 (OR = 1.672, 95%CI = 0.622-4.494,P = 0.308)was the predictor of 3-day mortality in emergency admitted critically ill patients.Conclusions Although the incidence of severe adverse events is significantly increased in patients with MEWS≥5 compared with those with MEWS 0-4, MEWS≥5 cannot be an efficient predictor for 3-day mortality. Abnormal mental status shows some predictive value for early mortality in critically ill patients seen in emergency department.