Objective To examine the usefulness of shock index (Sl) and adjusted shock index (corrected to temperature) (ASI) in predicting prognosis of patients with return of spontaneous circulation after cardiac arrest.Methods A prospective study,which data such as vital signs of the cases were collected by the Utstein template,was conducted in 111 of cases with return of spontaneous circulation after cardiac arrest to assess the value of SI and ASI for predicting their prognoses.Results There was no evidence to show difference between the cases with survival to hospital discharge and the ones who died about systolic blood pressure and heart rate (P ＞0.05).SI and ASI [(1.109 ±0.428) and (1.082 ±0.410)] of the group of death were higher significantly than the ones [(0.899 ± 0.303) and (0.844 ± 0.265)] of the group with survival to hospital discharge,P ＜ 0.05.The risk of death was elevated in the group with ASI ＞ 1.1,which odds ratio (5.4) higher than the ones of systolic blood prcssure ＜90 mm Hg (1.6)and ventricular rat ＞ 100 beat/min (3.1) significantly.The odds ratio of death with AS ＞ 1 was 2.8.Conclusions Shock index and adjusted shock index are easy to derive and conducive to predict effectively diseases prognosis such as survival to hospital discharge or death of patients with ROSC.

Objective To investigate the dynamic expression of SOCS-3, TNF-α in live and spleen of mice induced by AOPP, and to discuss the mechanism of MODS induced by AOPP, so that to give some intervention method over MODS in the future. Method Thirty-six adult BALB/c mice were divided into 3 groups randomly: AOPP group (n=12). Water normal group (n=12) and normal group (n=12). After post poison 2 hours, 6 hours, 12 hours and 24 hours,the fiver and the spleen tissue were taken out. The expression of SOCS-3 and TNF-α were detected by RT-PCR. And data were analyzed with ANOVA. Results After AOPP of 2,6,12,24 hours, the mRNA expression of SOCS-3 increased obviously in the liver and spleen compared with the normal group (P<0.05), it reached peak at the 24th hour in liver,and reached peak at the 12th hour in spleen, then descended at 24th hour (P<0.05). The mRNA expression of TNF-α increased obviously in the liver and spleen than normal group (P<0.05), and reached peak at the 12th hour,then descended at 24th hour (P<0.05), the electro-phoresis image of RNA was 5 s 15 s and 30 s,RT-PCR amplification of β-actin showed,the expression of SOCS-3, reached peak at the 24th hour in liver and it reached peak at the 12th hour in spleen, then descended at 24th hour (P<0.05), TNF-α reached peak at 12th hour in the liver and spleen, then descended at 24th hour. By statistic analysis, positive correlation was indicated among SOCS-3 and TNF-α mRNA expression in liver (y=0.089+0.758x, r=0.939, F=252. 168, P<0.01) positive correlation was indicated among socs-3 and TNF-α mRNA expression in spleen (y=0.057+0.361x,r=0.953,F=336.122, P<0.01). Conclusions At different point of time after Aopp,the mRNA expression of socs-3 and TNF-α showe the same trend in liver and spleen,the levels of SOCS-3, TNF-α all increase significenfly.

Based on the doctor-patient interaction forum of Haodaifu Online,Xunyiwenyao and Youwenbida,taking advantage of the text mining technologies and methods such as Chinese word segmentation,data cleaning and filtering,word frequency statistics,semantic network map and visualization,extract and summarize the symptoms,causes,common drugs,complications,non-drug therapy and nursing method of Deep Vein Thrombosis (DVT),the paper verifies the availability of text mining method in exploring the prevention law and method of diseases and the feasibility of application of doctor-patient interaction Q&A network data source in medical research.

Objective To investigate the clinical value of evaluation of fetal cardiac function in congenital heart disease by brain natriuretic peptide (BNP) and velocity vector imaging (VVI). Methods Fetuses who came from Shenzhen Maternity & Child healthcare Hospital were divided into the congenital heart disease group and the control group. At the same time we collected amniotic fluid and assayed BNP concentration. Using the VVI software, the velocity, strain and strain rate of the global and segmental of the left ventricle were measured. Comparison and correlation were made between the two groups. Results There was significantly difference of BNP concentrations in amniotic fluid between two groups. The gestational age had significant positive correlation with BNP concentrations in disease group. The comparison of global velocity, strain and strain rate of left ventricle between the two groups showed significant differences. All of the left ventricular dynamic parameters in disease group were lower than those of the control group. Conclusions Compared with the control group, the disease group had a high level of BNP in amniotic fluid and a lower level of dynamic parameters of left ventricular. There was a positive correlation between BNP concentration and gestational age in disease group. So we can conclude that theBNP concentration can be a biological parameter for evaluating the latent impairments of fetal cardiac function.

Objective To better understand the clinical management of tumor-induced osteomalacia (TIO) by analyzing the clinical features, diagnosis, treatment, postoperative biochemical changes, and clinical status in 12 cases of TIO. Methods Twelve cases of TIO hospitalized from 2004 to April 2010 were reviewed retrospectively. All cases were diagnosed based on their clinical manifestation, hypophosphatemia, and image study including technetium-99m octreotide scintigraphy (99mTc-Oct). Resuits There were 7 males and 5 females with mean age of (41.8±9.6) years (20 to 56 years). The course of disease was from 2 to 14 years ( median course 4.0 years). They all presented with bone pain, gait disturbance, muscle pain, and muscle weakness. Serum phosphate( Pi)levels were low in 12 cases with a range from 0.30 to 0.56 mmol/L. 99mTc-Oct was performed in 9 cases and it showed that the lesions were located in head of femur, fibula, retrocalcaneal area, foot, humerus,metacarpal, posterior chest wall or near nasal bone (apex partis petrosae ossis temporalis). Subcutaneous soft tissue mass was found in another 3 cases at loin, thigh, and foot by physical examination. The tumors were confirmed by CT, MRI or ultrasonography. Twelve patients underwent operation to remove the tumors and histopathology showed hemangioendothelioma or fibrous angioma (6 cases), giant cell tumor or fibroma of tendon sheath(4 cases), liposarcoma(1case), and phosphaturic mesenchymal tumor(1case). Serum Pi levels returned to normal in 10 patients after resection of tumor. During 2 to 64 months follow up, symptoms of bone pain and muscle weakness were improved obviously. Conclusions Patients with hypophosphatemic osteomalacia should be thoroughly investigated for TIO. 99mTc-Oct and other imaging examinations can effectively locate the tumors. Once the hidden tumor is found and excised, the patient will recover and enjoy normal life with normalized Pi concentrations and marked improvement of symptoms.

Objective:To analyze the dosimetric differences between CT-guided free-hand intracavity/interstitial brachytherapy[image-guided adaptive brachytherapy (IGABT)] and conventional point-A plan (CP) in the treatment of cervical cancer.Methods:Twenty-six cervical cancer patients who received four cycles of IGABT in Sun Yat-sen University Cancer Center were enrolled in this study. Two sets of CT images were obtained before and after applicator adjustment to aid in the design of CP and IGABT plans. The high-risk clinical target volume (HRCTV), point A, and organs at risk (bladder, rectum, and sigmoid colon) were defined on CT images. CP and IGABT plans were designed on CT images. Parameter differences between CP and IGABT plans were analyzed with paired t-test and Wilcoxon test. Results:According to the coverage index (CI) of CP, plans were divided into two groups: in group A (CI≥0.90), 20 CP and corresponding IGABT plans were included, and 84 CP and corresponding IGABT plans in group B (CI<0.90). The mean volume of HRCTV and mean tumor diameter in group A were significantly smaller than those in group B (46.7 cm 3vs. 62.1 cm 3, P<0.001 and 3.1 cm vs. 4.4 cm, P<0.001). Compared with CP, IGABT significantly improved the value of D 90% in all plans and group B, whereas lowered the bladder dose. IGABT also reduced the dose of sigmoid colon in group A. IGABT significantly improved conformal index and dose homogeneity index. Conclusions:IGABT can significantly improve the target coverage, conformal index and dose homogeneity index, protect organs at risk. Compared with CP, IGABT has advantages in the treatment of patients with bulky tumor.

Objective:To evaluate the effectiveness of the course of Laboratory Medicine and Clinical Sciences in the Laboratory Medicine Faculty of Sun Yat-sen University. Methods:Twenty-four undergraduate students in Batch 2016 of Medical Laboratory Faculty were divided into small groups (4-6 students per group). They learned each case in groups before class. In the first session of each class, the case-based study (CBS) tutor would randomly assign case-related questions to the students. Students were required to present their answers in class. The CBS tutor would guide the students to discuss the case further. In the second session, a lecture associated with the case would be given by a special subject lecturer. After the course, students, tutors and lecturers were given questionnaires and were randomly interviewed to comprehensively understand the course's effectiveness. SPSS 19.0 was used for statistics.Results:Most case discussion tutors agreed that they could guide students to discuss clinical cases well in class and give comments according to students' presentations (93.75%, 15/16). Most of the lecturers agreed that they could well guide students to think about the relationship between laboratory and clinical diagnosis and treatment in class (91.67%, 11/12). Both teachers and students had very positive evaluations of the learning mode, learning content, inspiration to students, and teachers' ability of this course. All the teachers and students agreed that the learning mode of combining CBS with special subject lecture was more helpful for the students to systematically learn medical knowledge compared with a CBS session alone or a lecture alone.Conclusion:The course, Laboratory Medicine and Clinical Sciences, which combines the CBS with the traditional lecture mode, integrates the advantages of the two learning modes. It not only stimulates students' enthusiasm for active learning, deepens clinical knowledge memory, and builds a clinical thinking model, but also enriches the teaching modes of medical laboratory education.

OBJECTIVETo detect structural changes in the brain in fetuses with agenesis of the corpus callosum (ACC) and holoprosencephaly (HPE) in the first trimester.

METHODSThe ultrasound data were analyzed retrospectively in 620 normal singleton fetuses between 11 and 13(+6) gestational weeks, 5 fetuses diagnosed to have ACC, and 13 fetuses with HPE. The midbrain diameter (MD) and falx diameter (FD) were measured and their ratio (MD/FD) was calculated for comparative analysis.

RESULTSNo significant difference was found in the MD, FD, and MD/FD ratio between fetuses with ACC and HPE (P>0.05). Compared to the normal fetuses, all the fetuses with ACC and HPE showed significantly increased mean MD and MD/FD ratio (P<0.05); 4 (80%) fetuses with ACC and 11 (84.6%) with HPE had a reduced FD. All the fetuses with ACC and HPE had MD/FD ratios greater than 1, which were below 1 in all the normal fetuses.

CONCLUSIONIn the first trimester, fetuses with ACC and HPE have measurable abnormalities in the midbrain and falx area of the brain, and these changes, represented by abnormal midsagittal MD, FD and their ratio, can be of value in detecting ACC or HPE in fetuses in the first trimester.

Agenesis of Corpus Callosum ; diagnosis ; Corpus Callosum ; diagnostic imaging ; Female ; Fetus ; Gestational Age ; Humans ; Pregnancy ; Pregnancy Trimester, First ; Retrospective Studies ; Ultrasonography, Prenatal

Objective:To investigate the prognostic risk factors of young patients with upper gastrointestinal bleeding (UGIB) in emergency department (ED), so as to improve the efficiency of emergency treatment and diversion of these patients.Methods:A retrospective analysis was performed on the clinical data of young patients with UGIB in the ED of Hainan Provincial People's Hospital from January 1, 2019 to December 30, 2020. In-hospital mortality was the primary endpoint of the study, and admission to the Intensive Care Unit (ICU) and length of hospital stay were the secondary endpoints. Inclusion criteria: (1) patients met the diagnostic criteria of acute UGIB; (2) age ranged from 18 to 40 years old; and (3) complete clinical data. Exclusion criteria: (1) bleeding and hemoptysis from the mouth, nose and throat; (2) gastrointestinal bleeding occurred in hospital; (3) lower gastrointestinal bleeding; (4) incomplete clinical data.Results:Among the 383 patients, 268 (70.0%) underwent upper gastrointestinal endoscopy, and the most frequent endoscopic diagnoses were duodenal ulcer (64.6%) and esophageal-gastric varices bleeding (16.8%). Seventy-one (18.5%) patients required endoscopic treatment, 5 (1.3%) patients required surgical treatment, and 7 (1.8%) patients required intervention treatment. The mortality rate was 2.1%, the ICU admission rate was 2.3%, and the length of hospital stay was 5 (3, 6) d. The ICU admission rate and mortality rate were significantly higher in patients with liver disease and in patients with syncope/coma (all P<0.05). Patients with thrombocyte levels (<120×10 9/L) had a significantly longer length of hospital stay than that of patients with normal platelets [8 (5, 11) d vs. 4 (3, 6) d, P<0.001]. The dead patients had significantly higher white blood cell count, urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase and activated partial thrombin time levels (all P<0.05), and significantly lower hemoglobin, albumin, SpO 2 and Glasgow coma score (GCS) levels (all P<0.05). Low GCS was an independent risk factor of ICU admission ( OR=33.973, 95% CI: 1.582~729.417, P=0.024) and mortality ( OR=20.583, 95% CI: 1.368~309.758, P=0.029). Conclusions:The poor prognostic factors of young patients with UGIB in ED are concomitant liver disease, syncope/coma, co-infection, hyperazotemia, impaired kidney function, liver dysfunction, coagulopathy, anemia, and low SpO 2, low GCS, and low hypoproteinemia on admission.

Objective:To investigate the application value and treatment opportunity of single balloon enteroscopy in children with Peutz-Jeghers syndrome(PJS).Methods:A retrospective analysis was conducted on 33 children diagnosed with PJS in Hunan Children′s Hospital from January 2011 to September 2021.The patient′s age, gender, family history, clinical symptoms, enteroscopy examination and treatment, number of polyps, intraoperative and pos-toperative complications, surgical treatment, recurrence of surgery, and follow-up data were analyzed, and the chi- square test was used for statistical analysis. Results:A total of 33 PJS children aged (9.00±3.13) years, including 21 males and 12 females, were included.All of them received at least once single balloon enteroscopy test.The main manifestations of the children were black spots (33 cases) and multiple polyps in the digestive tract (31 cases). In all the 33 cases, black spots were distributed on lips.Some black spots were also found at the end of fingers (3 cases), at the end of foot toes(2 cases), and at the end of finger toes (6 cases). During the operation, 391 polyps were removed, most of which were jejunum polyps (37.08%, 145/391 polyps). Eleven children with PJS has intussusception, of which intestinal intussusception accounted for 90.91% (10/11 cases). Ten cases (30.30%, 10/33 cases) received surgical treatment, and 72.73% (8/11 cases) underwent surgery for acute refractory intussusception.One case had intestinal perforation and 2 cases were bleeding during the operation, and the 3 cases recovered completely after hemostatic clip sealing and surgical treatment.The incidence of hollow ileum polyps and giant polyps in children aged >8 years was higher than that in children aged ≤8 years[92.55% (149/161 polyps) vs.7.45%(12/161 polyps), 96.20%(76/79 polyps) vs.3.80% (3/79 polyps)]. The differences were statistically significant ( χ2=9.854, 8.711, all P<0.05). There was no significant difference in the incidence of intussusception among different age groups ( P>0.05). Among the 33 children with PJS, 57.58% (19/33 cases) had recurrence 1-3 years after operation, and no cases of cancer have been followed up so far. Conclusions:Intestinal polyps are common in children with PJS, and the application of single-balloon enteroscopy in children with PJS is reliable and safe.Children over 8 years old are more vulnerable to empty ileum polyps and giant polyps.Therefore, it is advised that children aged above 8 years with PJS should undergo at least once enteroscopy.