Objective To evaluate the diagnostic value of multi-slice spiral CT(MSCT)perfusion imaging in chronic obstructive pulmonary disease(COPD).Methods Twenty COPD patients and20 volunteers underwent 8-row detector spiral CT(MSCT)perfusion imaging using cine scan mode with5 mm slice thickness.0.5 s rotation time and a total scan time of 45 s with 5 s intervals.60 ml contrast agent(300 mg I/ml)were administered at a rate of 4 ml/s from the forearm superficial vein.The imaging data were transferred to a workstation.A time-density curve and pseudo-color map were generated automatically with GE CT perfusion 3 software,the blood flow(BF),blood volume(BV),mean transit time(MTr)and permeability surface(PS)were measured.Results Time-density curve was flatter and the peak of the curve was obviously lower in COPD patients than the volunteers.The BF.BV.PS in COPD volunteers was(10.58 ±4.85)s and(4.50 ±1.71)s respectively.The BF,BV and PS in COPD patients Was lower than the volunteers,the MTY was higher(P＜0.01).Conclusion MSCT perfusion imaging is helpful for the diagnosis of COPD.

Objective To evaluate the effect of dexmedetomidine on brain injury in the patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).Methods Eighty patients of both sexes, aged 18-64 yr, with body surface area of 1.6-2.0 m2, with left ventricular ejection fraction＞30％, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ (New York Heart Association Ⅱ or Ⅲ), scheduled for elective cardiac surgery with CPB, were equally and randomly divided into control group (group C) and dexmedetomidine group (group D) using a random number table.Before induction of anesthesia, dexmedetomidine was given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery in group D, and the equal volume of normal saline was given in group C.After induction and before skin incision (T0) , at 30 min after beginning of CBP (T1) , at 30 min after the end of CBP (T2) , at the end of surgery (T3) , and at 24 and 72 h after surgery (T4.5) , blood samples from jugular bulb were drawn for determination of serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), IL-10, S-100β protein and neuron-specific enolase (NSE).Results Compared with group C, the serum concentrations of TNF-α and S100β at T1-3 and IL-6 and NSE at T1.4 were significantly decreased, and the serum concentrations of IL-10 at T1-4 were increased in group D (P＜0.05).Conclusion Dexmedetomidine given as a bolus of 1 μg/kg over 10 min followed by an infusion of 0.5 μg · kg-1 · h-1 throughout the surgery can reduce the brain injury in the patients undergoing cardiac surgery with CPB, and the mechanism is related to inhibited inflammatory responses.

Objective To analyze the phenotypes of lymphocytes in cerebrospinal fluid derived from the patients with neurosyphilis. Methods Samples of cerebrospinal fluid from 12 patients with neurosyphilis and 20 patients with latent syphilis were collected and analyzed by flow cytometry for CD4 and CD25 expression. Results There was a significant increase in the number of white blood cells in the cerebrospinal fluid of patients with neurosyphilis. FACS analysis showed that most leukocytes were lymphocytes predominated with CD4 + T cells in neurosyphilis patients which were almost 4 times more than that in latent syphilis. However, there was a significant decrease in the proportion of CD4+ CD25high regulatory T cells (Tr) in neurosyphilis patients compared with that in latent syphilis patients. Conclusion A dramatic increase in CD4+ T cell frequency suggested its pathogenic role in neurosyphilis, whereas a decrease in CD25high Tr frequency indicated that CD4 + CD25high Tr cells might play an important role in immune homeostasis of central nervous system.

Objective To assess the clinical presentations and treatment of neurosyphilis with mania as the first manifestation. Methods A retrospective study was performed. Clinical data on neurosyphilis patients with mania as the first manifestation collected from July 2009 to June 2010 were analyzed. Results Twenty cases of neurosyphilis were included in this study, which were all misdiagnosed as schizophrenia, anxiety,cerebral infarction, etc. All the patients had manic symptoms at onset, such as irritability, bad temper, impulsive behavior, disturbance in thinking, and so on. Some patients also suffered from a marked decrease in memory, calculation and cognitive ability. Rapid plasma reagin (RPR) test, Treponema pallidum hemagglutination (TPHA)test and cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test were positive in all the patients. Varying degrees of symptomatic improvement was achieved after anti-syphilis and anti-psychotic treatment. CSF was retested in 13 patients 3 months after the end of treatment, and CSF VDRL titer decreased in 10 patients, remained unchanged in 2 patients, and turned negative in 1 patient. Conclusions Neurosyphilis lacks distinctive clinical characteristics. For patients with poor response to conventional antipsychotic therapy,neurosyphilis should be considered, and serology and cerebrospinal fluid tests for syphilis are warranted.

Objective To analyze the clinical features and laboratory data of 10 patients with macrophage activation syndrome (MAS) complicating systemic onset juvenile idiopathic arthritis (soJIA),which were characterized by acute severe liver injury.Methods Data of 10 patients with soJIA/MAS from Nanjing Children's Hospital were collected retrospectively.The clinical features,laboratory findings,treatment,outcomes and prognosis were analyzed.Results In the total 10 patients,female (6/10) outnumbered male.Their age ranged from 1.5 to 9.5 years old (average 5.2±2.6).The most remarkable clinical manifestations were severe liver injury without systemic features,representing as hepatomegaly (10/10),splenomegaly (2/10) and strikingly increased transaminase (10/10,median:ALT 1 445 U/L,AST 885 U/L).Central nervous system dysfunction and hemorrhages were recorded in 20％ of the patients.Two patients had pulmonary infection.Laboratory data showed that platelet count was less than normal or precaution value (10/10,≤262×10g/L).Hyperferritinaemia (10/10,median:17 329 mg/ml) and soluble CD25 elevation (median:3 140 U/ml) were common in the soJIA/MAS patients.Evidence of macrophage hemophagocytosis was found in 90％ of the patients (9/10) who underwent bone marrow aspiration.Pathological findings of liver biopsy from 1 patient revealed massive infiltration of mononuclear cells in the portal tracts.Nearly all patients (9/10) received intravenous pulse methylprednisolone therapy,combined with cyclosporine A and high-dose intravenous immunoglobulin.Eight patients had good outcome.Only 2 patients were complicated with severe interstitial lung disease during 12-months follow-up.Conclusion MAS should be considered when patients with soJIA represents acute severeliver injury without systemic features combined with other laboratory data.Intravenous pulse methylprednisolone and cyclosporine A therapy may improve the prognosis of soJIA/MAS.

Objective To explore the values of detecting anti-Saccharomyces cerevisiae antibody (ASCA) IgA,ASCA IgG,anti laminaribioside carbohydrate antibody (ALCA),anti-chitobioside carbohydrate antibody (ACCA) and anti mannobioside carbohydrate antibody (AMCA) and antibody against outer membrane porin C of Escherichia coli (anti-OmpC) in the diagnosis of Crohn's disease (CD).Methods From October 10th 2012 to January 24th 2013,63 patients diagnosed as CD were selected.At the same period 30 patients diagnosed as ulcerative colitis (UC) were set as disease control group and 25 individuals without abnormal findings under endoscope and imaging examination were set as healthy control group.Fasting blood of all the subjects were drawn in the morning and serum was isolated after centrifuge.The level of ASCA IgG,ALCA,AMCA,ACCA,ASCA IgA,anti OmpC and I2 was detected by indirect enzyme linked immunosorbent assay.The sensitivity,specificity,positive predictive value and negative predictive value of each antibody were calculated and its value in the diagnosis was evaluated by receiver operating characteristic (ROC) curve.Results In the differential diagnosis of CD and UC by single antibody test,the accuracy of AMCA was the highest and the area under ROC curve was 0.739.In the screening of CD with single antibody examination,the diagnosis accuracy of I2 antibody was the highest and the area under ROC curve was 0.751.In multi antibodies joint examination,the accuracy of either ASCA IgA or AMCA positive was the highest in the differential diagnosis of CD and UC,also in the screening of CD and the area under ROC curve was 0.612 and 0.633,respectively.Conclusion In clinical practice,CD screening and the differential diagnosis of CD and UC may be achieved through detecting AMCA,ASCA IgA and I2 antibody.

Objective To study the effects of experiment-related factors on hematological parameters in SD rats, analyze the data difference and causes, understand the effects of anesthetics and stress responses on the physiological aspects of animals, and to provide a reference for the standardization of animal welfare and compound toxicity testing methods.Methods According to gender (A), fasting time (B), anesthesia (C) and blood collection mode (D), SPF SD rats were divided into 24 groups.Blood samples were collected from each group.Then, red blood cell count, hemoglobin levels, white blood cell count and classification indicators were measured.Results The primary and secondary order of the factors affecting the white blood cell count was D > C > A > B, and the levels of white blood cell count of each factor were male rats > female rats, and venous blood > arterial blood, chloral hydrate > pentobarbital sodium > no anesthesia.The primary and secondary order of the factors affecting the white blood cell classification was C > D=A=B, and factors affecting the levels of white blood cell classification were chloral hydrate > pentobarbital sodium > no anesthesia.The primary and secondary order of the effects of the factors on the red blood cell count and hemoglobin level was C > D=A=B, and the levels of red blood cell count and hemoglobin level were pentobarbital sodium > chloral hydrate> no anesthesia.There was no significant difference in the blood indexes between the different fasting time groups.Conclusions There is no effect of fasting on hematological parameters, but there are differences in the blood parameters between arteries and veins.The effect of chloral hydrate anesthesia on the count and classification of white blood cells is greater than that of pentobarbital sodium.The effect of chloral hydrate anesthesia on the red blood cell count and hemoglobin level is greater than that of pentobarbital sodium.The two kinds of anesthesia methods have their own advantages and disadvantages.

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

Objective To analyze the clinical characteristics,diagnosis,treatment and outcome of patients with cardiac amyloidosis (CA).Methods Clinical data from 18 patients diagnosed as CA by endomyocardial biopsy (EMB) from 1995 to 2005 were retrospectively analyzed.Results Among the 18 patients with CA,all patients had reduced diastolic dysfunction; 12 had mitral valve early diastolic blood flow peak velocity/late diastolic blood flow peak velocity (E/A) ＞ 2.0 and ventricular diastolic early filling deceleration time (DT) ＜ 150 ms; 12 had left ventricular ejection fraction (LVEF) ＜50％ ; and 13 had New York Heart Association (NYHA) classification Ⅲ or Ⅳ.The 1-year,3-year and 5-year survival rates of 18 patients with CA were 67％,44％ and 17％,respectively.Kaplan-Meier analysis showed,NYHA functional class ＞ Ⅱ,E/A ＞ 2.0 and DT ＜ 150 ms were associated with increased mortality (log-rank statistic P =0.026 and 0.001,respectively).CA patients with chemotherapy before heart failure were associated with decreased mortality and extend survival.Conclusions The mortality rate goes up and survival rate gradually descends as prolonged onset time.NYHA functional class ＞ Ⅱ and E/A ＞ 2.0 (DT ＜150 ms) are associated with mortality.

Objective To investigate prognostic predictors of long-term survival of patients with cardiac amyloidosis (CA), and to determine predictive value of high-sensitivity cardiac troponin T (hs-cTnT) in CA patients. Methods We recruited 102 consecutive CA cases and followed these patients for 5 years. We described their clinical characteristics at presentation and used a new, high-sensitivity assay to determine the concentration of cTnT in plasma samples from these patients. Results The patients with poor prognosis showed older age (56 ±12 years vs. 50 ±15 years, P=0.022), higher incidences of heart failure (36.92%vs. 16.22%, P=0.041), pericardial effusion (60.00%vs. 35.14%, P=0.023), greater thickness of interventricular septum (IVS) (15 ±4 mm vs. 13 ±4 mm, P=0.034), higher level of hs-cTnT (0.186 ±0.249 ng/mL vs. 0.044 ±0.055 ng/mL, P=0.001) and higher NT-proBNP (N-terminal pro-B-type natriuretic pep-tide) levels (11,742 ± 10,464 pg/mL vs. 6,031 ± 7,458 pg/mL, P=0.006). At multivariate Cox regression analysis, heart failure (HR:1.78, 95%CI:1.09-2.92, P=0.021), greater wall thickness of IVS (HR:1.44, 95%CI:1.04-3.01, P=0.0375) and higher hs-cTnT level (HR:6.16, 95%CI:2.20-17.24, P=0.001) at enrollment emerged as independent predictors of all-cause mortality. Conclusions We showed that hs-cTnT is associated with a very ominous prognosis, and it is also the strongest predictor of all-cause mortality in multivariate analysis. Examination of hs-cTnT concentrations provides valuable prognostic information concerning long-term outcomes.