Objective On the basis of the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ), to establish and appraise a new prognostic evaluation system for elder patients with respiratory failure undergoing mechanical ventilation in order to predict hospital mortality in the respiratory intensive care unit. Methods Two hundred and thirty-eight senile patients with respiratory failure having had mechanical ventilation during their hospitalization were retrospectively analyzed. Patients were randomly divided into 2 groups: model group (n=138) and validation group (n=100). Data of model group were analyzed by monofactorial and multifactorial regression analysis to screen the risk factors. Risk factors were given numerical values according to different grades, and complementary scoring system was then established. APACHE Ⅱ system was combined with complementary scoring system with Logistic multiple regression to form SRFMV system, a special evaluation system for the senile patients with respiratory failure undergoing mechanical ventilation. One hundred patients from validation group were evaluated by both SRFMV system and APACHE Ⅱ system, and the results were then compared to assess the validity and reliability of SRFMV system. Oxygenation index, positive end expiratory pressure (PEEP), tidal volume, phlegm quantity and character, and pulmonary auscultation were selected to serve as standard for complementary scoring system. Mortality equation was set up with logistic multiple regression analysis. Results The predication sensitivity and specificity evaluated by SRFMV system in validation group (0.878 and 0.821, respectively) outstripped that evaluated by APACHE Ⅱsystem (0.818 and 0.771, respectively); the area under ROC curve in SRFMV system and the X2 value in Lemesshow-Hosmer statistic (0.911 and 13.77, respectively) also outstripped that in APACHE Ⅱsystem (0.860 and 11.808, respectively). Conclusions SRFMV system is of better sensitivity and specificity, in which the prediction of mortality is closely consistent with the reality. SRFMV system can be applied to obtain valid predictions of relevant outcomes in senile patients with respiratory failure underwent mechanical ventilation.

[Objective]Analyzing clinical experience and academic view of Pro. LIAN Jianwei for the treatment of eructation in order to completely learn and master his experience.[Method] Analyzing 4 belching cases of Pro. LIAN, and combining his therapeutic experience and view. [Result] According to the view of Pro. LIAN Jianwei, there are 4 common types in clinic, the type of accumulation in stomach and intestine, the type of spleen and stomach deficiency, the type of liver qi stagnation, the type of liver and spleen disharmony. Promoting digestion and harmonizing stomach to treat the type of food accumulation in stomach;benefiting qi and strengthening spleen to treat the type pf spleen and stomach qi deficiency;smoothing liver and regulating qi to treat type of liver and stomach disharmony; regulating liver and spleen to treat type of liver and spleen disharmony;eliminating damp to treat type of spleen deficiency with damp;activating blood to treat stasis caused by prolonged diseases. Prescriptions of Pro. LIANbased on methods which changed with syndromes. He insisted that treatments base on differentiation;prescriptions base on methods, which make effect well. [Conclusion] It is worthy for our students to learn and imitate clinical experience and academic view of Pro. LIAN Jianwei for the treatment of eructation.

Child ; Evidence-Based Medicine ; Humans ; Nephrotic Syndrome ; diagnosis ; etiology ; therapy ; Practice Guidelines as Topic ; Recurrence

Objective To study the prevalence of metabolic syndrome (MS) in patients with type 2 diabetes according to three different diagnostic criteria and the effects of accumulation of MS components on blood lipid profile and to explore possible causes of their increased morbidity of cardiovascular diseases. Methods Components of MS and blood lipid profile were observed cross-sectionally in 157 patients with type 2 diabetes and analyzed using recommended diagnostic criteria by the World Health Organization (WHO, 1999), the National Cholesterol Education Program-Adult Treatment PanelⅢ( NCEP-ATPⅢ, 2001) and the Chinese Diabetes Society under Chinese Medical Association (CDS, 2004). Results Prevalence of MS was 73. 9% , 49. 7% and 52. 9% , and that of dyslipidemia was 54. 8% , 61. 2% and 54. 8% , with the criteria by WHO, NCEP-ATPⅢand CDS, respectively. Dyslipidemia was included in the most common combinations of MS. Blood level of triglycerides increased significantly, that of high density lipoprotein cholesterol ( HDL-C) decreased significantly, and size of low density lipoprotein cholesterol (LDL-C) particles decreased with the increase of the number of MS components, with a more significant coefficient of correlation by the criteria of CDS than that by the other two criteria. Conclusions In patients with type 2 diabetes, prevalence of MS could be more than 50% , most of them complicated with dyslipidemia, one of the most common components of MS, including elevated triglycerides, decreased HDL-C and decreased size of LDL-C particles, which could easily cause cardiovascular disease. The criteria by CDS could reflect the change in blood lipid profile in Chinese population more objectively.

Objective To investigate the clinical significance of serum lactate dehydrogenase (LDH) and its isoenzymes,M or H subunits in the retreated patients with multiple myeloma(MM).Methods 141 medical records of retreated patients with multiple myeloma were collected,and the relationship of LDH and its isoenzymes,subunits with DS staging system,ISS staging system,creatinine,bone marrow plasma cell percentage,immunoglobulin and microglobin was analyzed.Results Serum total LDH activity was not significantly related to DS staging system and ISS staging system.LDH1 percentages was negatively correlated with ISS staging system (P＜0.01),and LDH4 percentages positively associated with ISS staging system (P＜0.05).LDH activity,absolute value of LDH1 ,LDH2,LDH3,LDH4,and H subunits were positively linked to serum creatinine in myeloma kidney disease patients with renal inadequacy (P＜0.05).Both percentage and absolute value of LDH5 were negatively correlated with bone marrow plasma cell percentage (P＜0.01 and P＜0.05 respectively).Conclusion The detection of serum LDH isoenzyme is more valuable than total LDH activity in retreated patients with multiple myeloma.

Objective To detect anti-heterogeneous nuclear ribonucleoprotein A2 (hnRNP A2)/RA33 antibody by ELISA with the purified recombinant hnRNP A2 antigen. Methods The serum of 179 patients with RA, 141 patients with SLE, 97 patients with other diffused rheumatic diseases, 30 patients with seronegative spondyloarthropathies, 10 patients with osteoarthritis, 59 patients with arthralgia/arthritis and 40 controls were detected. In addition, clinical characters and laboratory indexes were compared to study the significance of anti-hnRNP A2/RA33 antibody in RA. Results The sensitivity and specificity of anti-hnRNP A2/RA33 antibody in RA were 36.9% and 87.1%. The positive rates of anti-hnRNP A2/RA33 antibody in SLE, other CTD, seronegative spondyloarthropathies and OA were 19.2%, 7.2%, 6.8% and 0. The positive rate of anti-hnRNP A2/RA33 antibody was 43.3% in early RA patients. Conclusion Detection of anti- hnRNP A2/RA33 antibody with purified recombinant hnRNP A2 antigen is a reliable method for early diagnosis of RA.

PurposeArtifacts of metal implantation severely affect image quality of CT or MRI examination, which restricts the display of local soft tissue lesions after orthopaedic surgery. This study aims to explore the application value of ultrasound examination in local soft tissue lesions after metal implant surgery.Materials and Methods Seventy patients with metal implantation after various orthopedic surgeries received US examination, and such sonographic features were recorded as lesion morphology, size, internal echo, edge, with/without capsule and calcification, and blood flow. Moreover, the clinical and radiologic data of patients like X-ray, CT and MRI were compared with the US results so as to determine the sensitivity of ultrasonic examination.Results The peripheral nerve injury might lead to thickened swelling and echo reduction. Ultrasonography revealed 20 cases of hematoma formation, 5 cases of abscess, 5 cases of pseudoaneurysm, 3 cases of myositis ossificans, 15 cases of bone tumor recurrence and 12 cases of peripheral nerve injury in operative region. Compared with the clinical results , the sensitivity, specificity and accuracy of ultrasound diagnosis of the study reached 89.4%, 75.0% and 88.6%, respectively, which were signiifcantly higher than those of X-ray, CT and MRI (χ2=78.642, 46.596 and 61.371,P<0.01). The ultrasonic results showed that most hematomas had clear boundary with homogenous echo inside to echo-free zone. Abscesses mostly displayed cystic or hybrid echo with floatable intracavitary pus spots echo, and no blood flow signal existed in the central area of color Doppler. Pseudoaneurysm in the US showed cystic mass around artery, blood flow rotating in capsule, and the typical two-stage bi-spectrum signal in the neck of capsule. Myositis ossiifcans showed intramuscular irregular hyperecho with acoustic shadow. When bone tumor recurred, US showed hypoechoic soft tissue mass with moth-eaten bone destruction, and blood flow signals within the mass were often detected.Conclusion Ultrasonography has relatively high accuracy in observing soft tissues around metal implantation, which can be used as a premier method.

Objective To evaluate the diagnostic value of endoscopic ultrasonography(EUS) in the eminence lesions of gastrointestinal tract.Methods The clinical data of 420 patients with gastrointestinal eminence lesions subsequently received EUS were analyzed.Results In 420 cases,235 cases lesions were located in the stomach,129 cases in the esophagus,29 cases in the duodenum and 27 cases in the colon.Occurred in the wall itself of the digestive tract lesions was 85.00％ (357/420),and 73.10 ％(307/420) of submucosal neoplasm,and gastrointestinal stromal tumor,leiomyoma or leiomyosarcoma was seen [60.24％ (253/420)].Lesions was not found in the digestive tract wall external oppression and lesions accounted for 14.52％(61/420),external lesions and infiltrated digestive tract was 0.48％(2/420).Conclusions EUS is an ideal diagnostic modality in distinguishing different layers of the wall of the gastrointestinal tract,and thus of important value in precise localization of lesions beneath the mucosa.And be able to hint the nature of the lesion.Meanwhile,this may be associated with colonic mucous membrane structure.

Angiotensin II ; pharmacology ; Calcium ; metabolism ; Cell Hypoxia ; drug effects ; physiology ; Cells, Cultured ; Endothelial Cells ; drug effects ; metabolism ; physiology ; Humans ; Membrane Potential, Mitochondrial ; drug effects ; physiology ; Oxygen ; metabolism

Objective To investigate the effects of ketamine on anoxia-reoxygenation(A/R)induced glutamate release from cerebral cortex neurons.Methods Primary cultured neurons obtained from cerebral cortex of fetal Wistar rats(16-18 d)were randomly divided into 3 groups:Ⅰcontrol group;ⅡA/R group andⅢketamine pretreatment+I/R group.The control group was not subjected to A/R while A/R group was exposed to anoxic air(95% N_2+5% CO_2)for 5 h followed by 24 h reoxygenation.In groupⅢdifferent doses of ketamine were added to the culture media before anoxia and the final ketamine concentrations were 1,20 and 100?mol?L~(-1) respectively.The extracellular glutamate concentration was detected at the end of 24 h reoxygenation.Results The extracellular glutamate concentration was significantly higher after 24 h reoxygenation in A/R group than in control group.Ketamine 20 and 100?mol?L~(-1) significantly inhibited glutamate release from the neurons induced by A/R in a dose-dependent manner.Conclusion Ketamine can inhibit glutamate release from neurons induced by A/R in a dose-dependent manner.