Objective To investigate the joint value of early peak temperature and 48 h-△sequential organ failure assessment (SOFA) score in predicting the prognosis for patients with sepsis in emergency department.Methods Two hundred and thirty-one patients with sepsis admitted from January 2013 to January 2015 in Emergency Intensive Care Unit of the First Affiliated Hospital of China Medical University were enrolled.Clinical features,early peak temperature,SOFA scores,the length of stay in EICU and the mortality in 28 days were studied.The patients were divided into two groups according to the 48 h-△SOFA.Each group were divided into three subgroups according to the early peak temperature.For example,hypothermia subgroup had temperature below 36 ℃,normothermia subgroup had temperature between 36 ℃ and 38 ℃,and hyperthermia subgroup had temperature above 38 ℃.The relationship between peak temperature plus 48 h-△SOFA and the length of stay in EICU as well as mortality were analyzed.Results Of 231 patients,in 48 h-△SOFA＞0 group (n =142) 27 (19.0％) patients died,and in 48 h-△SOFA≤0 group (n =89) 33 (37.1％) patients died (P ＜ 0.05).Hypothermia subgroup had a higher odds ratio value in predicting nonsurvival in 48 h-△SOFA≤0 group (OR =4.51,95％CI:1.33-2.17,P =0.01).Hyperthermia subgroup had a longer stay in EICU than hypothermia subgroup and normothermia subgroup (P ＜ 0.05).Conclusion The combination of the early peak temperature and 48h-△SOFA score is an effective indicator to evaluate the prognosis and to stratify patients with sepsis in emergency department.More attention should be paid to the patients with an early peak temperature ＜ 36 ℃ and 48 h-△SOFA ≤0 because of higher mortality.The condition of patients should be reassessed and try to make a more rational treatment for the patients with an early peak temperature ＞38 ℃ and 48 h-△SOFA ＞0 because of its longer stay in EICU.

Objective To investigate the clinical value of combining early urine paraquat early clearance rate (UPCR) with severity index of paraquat poisoning (SIPP) in predicting the prognosis for paraquat poisoning patients.Methods In this retrospective research,a total of 425 cases diagnosed with acute paraquat poisoning from March 2014 to March 2016 in Emergency Intensive Care Unit,First Affiliated Hospital of China Medical University were enrolled.The general data of patients,the results of rapid qualitative test of paraquat in blood and urine,the concentration of paraquat in blood / urine,the poisoning time,the concentration of blood lactic acid and the APACHE Ⅱ score were collected.The early UPCR and SIPP were measured at different time intervals,and the ratio of 6-SIPP and 12 h-UPCR were calculated.These patients were divided into death groups and survival groups according to the 28-day mortality.The relationship between these factors and the mortality were analyzed.Results Of all the 425 patients,268 cases (63.1％) died,157 cases (36.9％) survived;the blood concentration of paraquat,the lactate concentration,SIPP values and the APACHE Ⅱ scores were significant difference between the two groups (P ＜ 0.05).The mortality of 2-6 hour paraquat rapid qualitative test result positive patients was higher (96.4％) than that of the negative patients (3.6％) (P ＜ 0.05);the mortality of 12-24 hour paraquat rapid qualitative test result negative patients was lower (11.5％) than that of the positive patients (88.5％) (P＜0.05).The 2-6 hour SIPP value was 19.8 ±6.7 in death group,which was higher than that in survival group (4.9±3.1) (P＜0.05);the 2-6 hour UPCR value was (41.7±9.3) indeath group,which was lower than that in survival group (86.3 ± 15.8) (P ＜ 0.05).There was no significant difference in the 2-6 hour UPCR value and 12-24 hour UPCR value between two groups (P ＞0.05).The 6 h-SIPP/12 h-UPCR value was (41.94 ±5.9) in death group,which was higher than that in survival group (5.27 ± 3.6) (P ＜ 0.05).Conclusion The combined use of early UPCR and SIPP values is an effective indicator of the prognosis of patients with acute paraquat poisoning and is helpful for the early stratification.We should pay more attention to the patients whose rapid qualitative blood test is positive because of their high mortality risk;for the patients whose 12 h urinequalitative test was negative,the hemoperfusion therapy might be stopped because the toxin was completely excluded,and the medical resources can be saved reasonably.The UPCR might indicate the excretion of toxins,and SIPP might indicate the severity of poising.

Objective To compare the efficacy of video-assisted thoracoscopy plus minithoracotomy(VAMT) and limited axillary thoracotomy(LAT) for the treatment of lung cancer.Methods 85 consecutive lung cancer patients were treated by either VAMT or LAT.The operative time,blood loss during operation,postoperative chest drainage time,and hospital stay time and postoperative complication were compared between the two groups.Results There was no death in two groups.The operative time and blood loss during operation were significant less in VAMT than inLAT(t =6.514,2.413,all P ＜0.05).But postoperative chest drainage time,and hospital stay time and postoperative complication were no significant difference between the two groups (t =0.490,0.338,all P ＞ 0.05).Conclusion VAMT is a safe and less traumatic procedure in the treatment of lung cancer,which is worthy of promotion and application.

Medicine, Chinese Traditional ; methods ; trends

Coronary Disease ; diagnosis ; Humans ; Medicine, Chinese Traditional ; methods

Objective To explore the clinic effect of arthroscopic in the treatment of Haglund deformity.Methods Sixteen patients with Haglund deformity were treated with arthroscopy from June 2009 to December 2011,including 7 males and 9 females,with an average age of 28.8 years (range,17-39 years).All 16 patients were suffered ankle back pain,exacerbations of pain during active and passive plantar flexion.This group of patients was chosen arthroscopic surgery to treat Haglund deformity as conservative treatment was invalid.With the prone position for surgery,we selected two approaches next to the Achilles tendon.Use the C-arm X-ray fluoroscopy observed calcaneus orthopedic during the operation.From the posteromedial approach to the posterolateral approach to alternately use the shaver and ArthroCare to clean up the front of the inflammation of the Achilles tendon bursa,by which could form arthroscopic operations security zone.All operating equipment was on the back toward the Achilles tendon,which could maximize the protection Achilles tendon.Postoperative plaster or brace short brake was used for two weeks.16 cases of postoperative patients were followed up； the mean follow-up time was 13 months (9-18 months).According pain visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle (AOFAS),the clinic effects were evaluated.Results At the last follow-up,the AOFAS hindfoot score of 91.5±2.8 was significantly higher than the preoperative 71.0±3.7 (t=17.38,P=0.014),postoperative VAS score 1.3±0.6 was significantly lower than the preoperative 5.10±0.44 (t=19.20,P=0.022).Conclusion The treatment of Haglund deformity by means of arthroscopic minimally invasive,with smaller trauma,faster recovery and lower complications,is effective and safe in clinical practice.However,dues to its steep learning curve,this method requires doctors to carry out who had relatively large arthroscopic surgery experience.

CD98 is a transmembrane heterodimer of cell surface.It regulates cell signaling pathway by activating some correlated proteins,and controls cell polarization,proliferation,adhesion and migration.CD98 plays an important role in the development of cancer and may be a novel tumor marker for diagnosis and prognosis in lung cancer.

Hepatic cavernous hemangioma is the most common benign tumor of liver.Hepatic artery embolism chemotherapy is one of the commonly used treatment methods,but more and more related complications and sequelae have been reported recently,including obstructive jaundice caused by damaged biliary tract.Because the symptoms are not typical,obstructive jaundice might be misdiagnosed as malignant biliary tumor,which brought troubles to subsequent treatment.In this article,the clinical data of 2 patients with obstructive jaundice following transcatheter hepatic arterial chemoembolization for hepatic cavernous hemangioma were retrospectively analyzed,and the experience in the diagnosis and treatment of this disease was summarized.

Objective To investigate and analyze the state of injury and treatment for the patients with maxillofacial injuries in Wenchuan earthquake, and search for more effective methods for treating maxillofacial injury. Methods One hundred and sixty-five patients wounded in Wenchuan earthquake were admitted to authors' hospital, and they received specialized diagnosis and treatment. In this paper, the emphasis was put on those patients with severe ear-nose-throat and maxillofacial injuries. Based on the analysis of the state of injuries, the patients were treated with debridement and suture, reshaping and suture, reduction and fixation of fracture, or local or systematic anti-infection therapy. All the treated patients were followed up 2 weeks after treatment. Results Thirty-three of the 165 admitted patients suffered from various degrees of maxillofacial injury (20.0%), including 10 cases of ear injuries (6.1%), 8 cases of nasal trauma (4.8%) and 2 cases of lip laceration (1.2%). All the wounds healed by primary intention after the treatment with no disfiguration. 8 cases of nasal sinus and zygomatic fractures (4.8%) and 5 cases of mandibular fracture (3.0%) recovered nicely after the treatment. No trauma was found in throat, neck, trachea and esophagus. 6 patients (3.6%) were complicated with infection after injury (onset of infection outside of hospital). There was no death. Conclusion Patients with maxillofacial injury should receive early and appropriate treatment. Besides restoration of function, it is also important to restore the physiognomy

During the last decade a lot of new learning about asthma was arisen along with the development of modern immunology and molecular biology,and asthma had been one hotspot in the studies of molecular biological and administer medical field.One of the new viewpoints was that airway neurogenic inflammation took important role in asthma development.For years scholars had suspected that airborne pollutants had an synergistic effect on the attack of asthma and could cause asthma attack,but they did not know the molecular mechanism.In 1991 Denish scholar Nielsen GD advanced a new hypothesis that airway irritation was mediated by capsaicin receptor.The pathological process included a molecular chain of message transfer as air pollutants_capsaicin receptor_Ca2+_substance P_neurokinin receptor.Airway neurogenic inflammation was the result of activation of the receptors.In 1997 American scholar Caterina MJ and his colleagues successfully obtained the cloned capsaicin receptor in expressing cells,this will make Nielsen GD's hypothesis living.