Objective To investigate the efficacy and safety of three kinds of immunosuppressant on systemic lupus erythematosus encephalopathy. Methods 44 cases with systemic lupus erythematosus encephalopathy were randomly assigned to receive high dose of Methyllprednisolone, Cytoxan (CTX) or Ifosfamide (IFO). The levels of ESR and serum C_3 were detected at different time after treatments. The effect and safety of these treatments were evaluated. Results (1) After treatment, the levels of ESR decreased significantly ((P)0.05). More decrease of ESR was found in CTX group and IFO group than in Methyllprednisolone group (all (P

BACKGROUND: There is much clinical datum analysis on multi-organ dysfunction syndromes induced by cerebral hemorrhage, but there is lack of experiment on dysfunction of peripheral organs induced by acute cerebral vascular disease.OBJECTIVE: Collagenase of two dosages together with proper amount of heparin were used to duplicate animal model of multi-organ dysfunction syndromes induced by cerebral hemorrhage so as to probe into the best experimental prerequisite.DESIGN: Complete randomized control experiment.SETTING: Departments of Dermatology, Neurology and Cardiac Surgery of Qilu Hospital Affiliated to Shandong University and Department of Neurology of Jinan Railway Center Hospital.MATERIALS: The experiment was performed in Institute of Basic Medicine of Shandong Medical Scientific Academy from September to December 2002. Totally 96 adult healthy male Wistar rats were employed and randomized into normal control (6 rats), sham-operation group (6 rats), first hemorrhage group (42 rats) and second hemorrhage group (42 rats). Seven sub-groups of 4 hours, 8 hours, 12 hours, 24 hours, 36 hours, 48 hours and 72 hours successively were divided in first and second hemorrhage groups respectively, 6 rats in each sub-group.INTERVENTIONS: In the first hemorrhage group, mixed solution 2 μL of Ⅶ collagenase 0.4 U and heparin sodium 3.2 IU was infused slowly to the brain. In the second hemorrhage group, mixed solution 2 μL of Ⅶ collagenase 0.8 U and heparin sodium 3.2 IU was infused slowly to the brain. In sham-operation group, physiological saline of same volume was injected. The general situation of animals at every phasic point was observed after operation, including consciousness, mental state and limb movement, as well as the alternations on body temperature, respiration and heart rate. Examinations were done on blood routine, liver function (alanine aminopherase, ALT;aspartic acid translocase, AST), kidney function (urea nitrogen, BUN; creatinine CRE) and myocardial zymology (creatine kinase, CK; lactic dehydrogenase, LDH). Modified matrix coloration method was used to determine endotoxin content in plasma. Pathological alternations were observed optic microscopically on brain, lung, liver, small intestine and kidney.ternations on main organs of experimental animals.experimental animals after operation: In the first and second hemorrhage groups, body temperature, respiration, heart rate and leukocyte content were all higher remarkably than normal group and sham-operation group (P ＜ 0.05).Those in the first hemorrhage group were higher than second group [(39.56±0.59)C, (37.98±0.52)C;(124.23±4.12) times/minute, (92.56±2.95)times/minute; (325.96±84.53) times/minute, (258.16±75.42) times/minute,(P ＜ 0.05)], and the difference in peripheral leukocyte content was specially nation of ALT activity, AST activity, BUN content, CRE content, CK activity,LDH activity and endotoxin content in plasma: Those in the first and second hemorrhage groups were higher than normal group and sham-operation group (P ＜ 0.05 -0.01). Those in the first hemorrhage group were higher than second hemorrhage group [(35.04±7.54) μkat /L, (24.25±5.42) μkat/L;(51.61±10.47) μkat/L, (33.77±7.44) μkat/L; (21.12±2.93) mmol/L,(9.78±1.45) nmol/L; (68.57±5.24) μnol/L, (40.54±3.95) μmol/L; (706.44±44.92) μkat/L, (189.23±25.08) μkat/L; (357.96±40.95) μkat/L, (149.60±19.10)(P ＜ 0.05)] and the difference was especially remarkable in endotoxin content logical alternations on main organs of experimental animals: Inflammatory damage of various degrees presented in all of animal organ tissues at various phasic points during cerebral hemorrhage in rats. In the first hemorrhage group, pathological change of organs reached the peak in 24-36 hours, which recovered to be normal in 72 hours. In the second hemorrhage group, the inflammatory damage was more remarkable and persistent compared with first group, in which, pathological change of organs reached the peak in 24-48hours and inflammatory damage was still visible in 72 hours.CONCLUSION: It is indicated that 0.8 U collagenase model is a successful model of multi-organ dysfunction syndromes induced by cerebral hemorrhage. Such model is in conformity with the common induced factors in clinic and various index changes of functions in every organ and can reflect dynamically the occurrence of multi-organ dysfunction syndromes.

Objective To study changes of serum endotoxin and its receptor CD14 gene expression in lung, liver, intestines, kidney tissues in model of acute forebrain ischemia complicated by multiple organ dysfunction syndrome(MODS), and to investigate the pathogenesis of cerebrogenic MODS. Methods 54 Wistar rats were randomly divided into seven groups: normal control group(n=6)、sham-operative group(n=8) and 5 ischemia groups(n=40)including 12 h, 24 h, 36 h, 48 h, 72 h five time points. Model of cerebral infarction was established. The content of endotoxin in plasma was evaluated with a test kit. The area density and optical density of positive staining of CD14mRNA expressing were analyzed for the relative content of CD14mRNA using in-situ hybridization and CMIA medical imaging analysis system. Results Plasma endotoxin level were markedly high at 12 h (0.184?0.055)Eu/L after acute forebrain ischemia, peaking at 24 h (0.639?0.064)Eu/L and it was somewhat decreased at 72 (0.117?0.024)Eu/L. The CD14mRNA expression in lung, liver, intestines, kidney tissues increased after brain ischemia, reaching the peak at the 24~36 h, and decreased after 48 h. The highest change of CD14mRNA expression was found in lung(P

Objective To investigate the risk factors for pancreatic fistula after duct-to-mucosa pancreaticojejuuostomy (PD). Methods The clinical data of 101 cases undergoing duct-to-mucosa PD in our hospital from January 1994 to January 2008 were reviewed retrospectively. Results The incidence of pancreatic fistula was 9.9% (10/101). Univariate analysis showed level of preoperative jaundice(χ2=5.814, P= 0.016) , duration of jaundice (χ2= 4.17, P = 0.041 ), texture of the remnant pancreas (χ2=5.286, P = 0.021 ), diameter of pancreatic duct (χ2= 4.165, P = 0.041 ), blood loss during operation (χ2=5.273, P=0.022) were significantly associated with pancreatic fistula after duct-to-mucosa PD. Multivariate analysis regression revealed that texture of the remnant pancreas (OR = 13.355, P = 0.023), level of preoperative jaundice (OR = 12.126, P = 0.006), blood loss during operation (OR = 5.92, P =0.032 ) were independent risk factors. Logistic regression equation was as following: P=1/[<1+e-(-6.378+2.592 texture of the remrant pancress + 2.495 level of preopetative jaundice + 1.778 blood loss during operative)>]. The accuracy of the logistic equation was 92.1%. Conclusion Texture of the remnant pancreas, level of preoperative jaundice, blood loss during operation were the independent risk factors for the occurrence of PD after duct-to-mucosa PD. Improvement of operative technique and reduction of blood loss can decrease the incidence of pancreatic fistula.

BACKGROUND: Leukoaraiosis is a group of changes in image. Since the firm pathogenic mechanism on leukoaraiosis has been unknown, the evaluation at the earlier stage of the disease has not been emphasized commonly and there is rather less recognition of the alternations on its electrophysiological system.OBJECTIVE: To probe into the clinical characteristics and alternations on image and evoked potential in simple leukoaraiosis and subcortical arteriosclerotic encephalopathy(Binswanger' s disease) and carry on the comparison with healthy people.DESIGN: Retrospective comparative study based on patients and healthy people.SETTING: Department of neurological internal medicine of one university hospital and department of neurological internal medicine of one railway central hospital.PARTICIPANTS: Outpatients or inpatients with cerebral vascular disorders in Qilu Hospital Affiliated to Shandong University were collected from August 1995 to March 2000. Totally 114 cases were leukoaraiosis, of which, 79 cases were males and 35 cases females. And 41 cases were Binswanger' s disease,of which, 28 cases were males and 13 cases females. Fifty healthy aged people who received routine physical check were randomized from the clinic of the hospital as the control.METHODS: The analysis was carried on the risk factors, clinical characteristics and CT exam in 114 cases of leukoaraiosis and 41 cases of Binswanger' s disease, of which, 74 leukoaraiosis cases and 35 Binswanger' s disease cases had received cranial MRI exam. Of those, 43 cases of simple leukoaraiosis associated with hypertension, 30 cases of Binswanger' s disease and 50 cases in the normal control were selected to carry on the examinations of body-sensory evoked potential, brain stem auditory evoked potential and visual evoked potential.coronary heart disease, diabetes, hyperlipemia, smoke, cerebral apoplexy,evoked potential and visual evoked potential.RESULTS: According to practical management analysis, 114 cases of leukoaraiosis, 41 cases of Binswanger' s disease and 50 cases in the control were diversification, mainly characterized as slightly declining of memory and loss of gait stability. Hypertension is predominated anong risk factors in Binswanger' s disease group (95.1% ), mainly characterized as physical signs of local neural focus, obvious cognitive disturbance and cerebral in CT exam that 70.2% (80/114) of cases presented brain whiter-matter abnormity in type Ⅰ. It was indicated in MRI exam that 72% (53/74) of cases presented brain whiter-matter abnormity, type Ⅰ, 27% (20/74) presented type Ⅱ and 1% (1/74) presented type Ⅲ. For Binswanger's disease patients, it was indicated in MRI exam that 54% (19/35) of cases presented brain white-matter abnormity, type Ⅲ, and 46% (16/35) presented type Ⅳ.Symmetrical extension of bilateral ventricles presented in Binswanger' s disbody-sensory evoked potential was 84% (36/43), of which, the mild abnormity occupied 60% (26/43) and moderate abnormity 23% (10/43); The abnormity rate of brain stem auditory evoked potential was 63% (27/43) and that of visual evoked potential was 54% (23/43). In Binswanger' s disease group, the abnormity rate of body-sensory evoked potential was 97% (29/30),of which, mild abnormity was 7% (2/30), moderate abnormity was 47%(14/30) and severe abnormity was 43% (13/30); The abnormity rate of brain stem auditory evoked potential was 87% (26/30) and that of auditory evoked potential was 83% (25/30).CONCLUSION: The risk factors of simple leukoaraiosis are diversified,without obvious physical signs of local neural focus. The diagnosis of it is mainly depended on abnormity Ⅰ of brain white matter described in images,manifested as remarkable dysfunction of cerebral eletrophysiology. Binswanger' s disease patients are mainly characterized as hypertension, relevantly obvious cognitive disturbance and common seizure of cerebral apoplexy. Abnormity Ⅲ of brain white matter indicated in CT exam, abnormity Ⅲ or Ⅳ of that in MRI exam are the image evidence for diagnosis. Remarkable abnormity also presents in cerabral electrophysiology, in which, abnormal body-sensory evoked potential is especially significant.

Objective To analyze the inappropriate use of oral drugs in elderly patients admitted in internal medicine, and to guide clinical rational drugs use in elderly patients. Methods One hundred inpatients′ data over 65 years were collected in the department of geriatrics. The potentially inappropriate use of oral drug were analyzed according to the Beers criteria published in 2012 and drugs instructions. Results In 100 patients, (5.81 ± 2.78) kinds of oral drugs had been taken per inpatient. One patient was involved out-of-label usage. There were potentially inappropriate uses of oral drugs in 21 patients. Inappropriate use of oral drugs in three patients were not related to diagnosis or disease, and in 4 patients were related to morbid state, 14 patients used drugs that need to be used with caution in older adults. Conclusions There are off-label uses and potentially inappropriate medications in clinical practice, so clinical doctors should examine and assess the uses of drugs. Clinical doctors should strengthen the understanding and application of the comprehensive geriatric assessment.

Objective To observe the effect of enteral nutrition therapy on metabolic status and adiponectin levels in elderly patients with metabolic syndrome (MS) complicated with nonalcoholic fatty liver disease (NAFLD).Methods 92 elderly hospitalized patients with mild to moderate non-alcoholic fatty liver disease underwent enteral nutrition (EN,n=46) and total parenteral nutrition (TPN,n=46) for 2 months.Body mass index,triceps skin-fold thickness,waist hip ratio,serum high-molecular weight (HMW) form of adiponectin,fasting blood glucose,postprandial 2-hour blood glucose,glycosylated hemoglobin,plasma insulin,alanine aminotransferase,aspartate aminotransferase,γ-glutamyltransferase,total bilirubin,direct bilirubin,total cholesterol,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,the blood pressure and liver ultrasound test were detected.The insulin resistance (HOMA-IR) was used to assess insulin resistance.Results In pre-versus post-treatment,serum level of HMW adiponectin [(6.8 ± 4.0) μg/L vs.(7.1 ± 3.9) μg/L,P ＞ 0.05 in enteral nutrition],and [(6.8 ± 3.5) μg/L vs.(5.0 ± 1.1)μg/L(P＜0.05)] in parenteral nutrition were found.The significantly decreased body mass index in the obese patients (P＜0.05),significantly improved values of 2-hour blood glucose,glycated hemoglobin,liver function,triglycerides,low-density lipoprotein cholesterol levels (all P＜0.05),and no obvious change in HOMA-IR were found after two months of enteral nutrition treatment.There were no significant changes in indicators mentioned above in TPN group after 2 months of treatment.Conclusions Enteral nutrition therapy can improve the glucose metabolism,lipid metabolism,the non-alcoholic fatty liver disease and body mass index,affect the level of adiponectin in the elderly patients with MS and NAFLD.It is vital to body metabolism.

Objective To investigate the clinical value of 3.0T MRI for hilarcholangioc-arcinoma diagnosis.Methods T Totally48 hilarcholangiocarcinoma patients from October 2011 to June 2015 underwent diagnoses by 3.0T MRI and 64-slice spiral CT,and then the diagnosing results were compared with those by surgery and pathological examination to determine the value of 3.0T MRI for hilarcholangiocarcinoma diagnosis.Results 3.0T MRI had the positioning accuracy (100％) and qualitative accuracy (95.83％) significantly higher than the positioning accuracy (79.17％) and qualitative accuracy (81.25％) (P＜0.05).In case of hepatic duct dilatation,CT found 35 cases of hilar masses,14 cases of lymphoma,5 cases of hepatic duct wall invasion and 9 cases of portal vein invasion,while 3.0T MRI displayed 44 cases of hilar masses,26 cases of lymphoma,13 cases of hepatic duct wall invasion and 30 cases of portal vein invasion.Conclusion 3.0T MRI has high positioning and qualitative accuracies when used to diagnosing hilarcholangiocarcinoma,behaves well in displaying hepatic duct dilatation,high resolution of soft tissues,and thus is worthy promoting clinically.

Objective To explore the clinical value of indocyanine green near-infrared fluorescence imaging with methylene blue for the sentinel lymph node biopsy (SLNB) in early breast cancer.Methods SLNB was performed in forty patients by fluorescence navigation with methylene blue.Frozen section was performed,followed by conventional histopathology.Results The identification rate of SLN was 100％.100％ of SLNs were fluorescent,with the average number being 2.88.92.5％ of SLNs were stained blue,with the average number being 1.75.The presence of lymph node metastasis was observed in intraoperative biopsy in 7 patients,and a total dissection of the axillary lymph nodes was performed immediately.Metastatic lesions were not found in the identified lymph nodes by intraoperative biopsy and permanent pathological diagnosis in the other 33 patients.Conclusions Sentinel lymph nodes biopsy by fluorescence navigation with methylene blue was a feasible minimally invasive technology with high detection rate.

Objective To investigate the proliferation,apoptosis and cell cycle and possible mechanisms of different breast cell lines by difluoromethylorithine (DMFO).Methods The growth of breast cancer MDA-435 (ODC GG) cell lines and SK-br3 (ODC AA) cell lines treated with DFMO were observed.The apoptosis and cell cycle were detected by flow cytometry.PCR was applied to detect the changes of A and G alleles of ODC G316A in MCF-7 cells treated with DFMO.Results The growth inhibition rates of MDA-435 and SK-br3 cells treated with 10 mmol/L and 20 mmol/L DFMO after 48 h were 24.1％ and 33.6 ％,46.3 ％ and 53.5 ％,respectively,and there was statistical significance (t =2.134,P =0.021,t =2.213,P =0.019).The growth inhibition rates of MDA-435 and SK-br3 treated with 10 mmol/L and 20 mmol/L DFMO after 72 h were 28.9 ％ and 35.7 ％,54.3 ％ and 65.4 ％,respectively,and there was statistical significance (t =2.434,P =0.015,t =2.489,P =0.013).The apoptosis rates of MDA-435 (ODC GG) and SK-br3 (ODC AA) cells both dealt with 20 mmol/L of DFMO after 24 h,48 h and 72 h were (7.58± 2.06) ％ and (13.88±3.45) ％ (t =2.047,P =0.041),(43.28±14.28) ％ and (59.96±16.42) ％ (t =3.680,P =0.000),(77.87±30.25) ％ and (93.08±32.15) ％ (t =3.293,P =0.000 1),respectively.The proportions of S stage cells MDA-435 (ODC GG) and SK-br3 (ODC AA) cells under the same condition after 24 h,48 h and 72 h were (13.25±2.38) ％ and (12.89±2.21) ％ (P ＞ 0.05),(21.43±3.12) ％ and (12.24±3.55) ％ (t =2.638,P =0.012),(16.32±3.23) ％ and (15.24±3.01) ％ (P ＞ 0.05),respectively.After the treatment by DFMO,the expression of ODC G316A allele A in breast cancer cell line MCF-7 (ODC AG) was reduced (t =3.708,P =0.000),and the expression of G had no significant changes.Conclusion The proliferation inhibition and apoptosis in breast cancer cells treated by DFMO is different in breast cancer cells with different genetic type of ODC G316A.DFMO can inhibit the activity of ODC,and the mechanism may be that DFMO could selectively bind to ODC G316A allele A.