Objective To investigate the pathogenesis of hepatorenal syndrome(HRS),especially the role of the vasoconstrictor that and vasodilator that played in the process.Methods The patients were divided into two groups for observation:The patients of chronic hepatitis with HRS were observational group,the patients of chronic hepatitis without hepatorenal syndrome were control group.Immunoenzyme technique was used for detecting the quantity of renin、atrial natruretic polypeptide、nitric oxide and endothelin in blood and ascites of all patients in two groups respectively.Then we compared the data of the two groups.Results Compared with those of the control group,rennin and endothelin in blood and ascites of the observational group increased significantly(P

Objective To evaluate the hemodynamic changes and oxygen metabolism during whole body hyperthermia (WBH) therapy in patients with malignant tumor. Methods Twenty ASA Ⅰ - Ⅱ patients with advanced cancer aged 22-58 yr were enrolled in the study. The patients were premedicated with midazolam 0.05 mg ?kg-1 and scopolamine 0.3 mg im. Anesthesia was induced with intravenous droperidol 5 mg, fentanyl 100 ?g, propofol 2 mg?kg-1 and vecuronium 0.15 mg?kg-1 . The patients were mechanically ventilated after tracheal intubation (FiO2 = 100%, RR=10-12bpm, VT = 8-12 ml?kg-1 ) and fentanyl (2?g?kg-1 ? h-1 ), 1%-1.5% isoflurane inhalation and intermittent iv boluses of vecuronium and midazolam. Swan-ganz catheter was placed in the pulmonary artery for hemodynamic monitoring. Radial artery was cannulated for direct BP monitoring and arterial blood gas analysis. ECG and PaO2 were continuously monitored. Body temperature probes were placed in esophagus, rectum, naso-pharynx and body surface. Body temperature was warmed to 41.8t and maintained for 2 h. Stroke volume(SV), cardiac output(CO), mean pulmonary artery pressure (MPAP), vascular resistance index (SVRI), pulmonary vascular resistance index (PVRI), oxygen delivery (DO2), oxygen consumption (VO2) and oxygen extraction rate (O2ER) were calculated before warming (T0), at 39℃ ,40℃ ,41℃ , 41.8℃,41.8 ℃(1 h), 41.8℃(2 h) and when T0 was decreased to 40℃ and 38.5t (T1-8) .Results HR, CI, SI, CVP, MPAP and PCWP significantly increased with increasing body temperature, while MAP, PVRI and SVRI significantly decreased. DO2 and VO2 increased by 35% and 18% at 39℃ , 55% and 23% at 40℃ , 70% and 28% at 41℃ and by 88% and 31% at41.8℃.During WBH O2ER, PvO2 P(a-v)CO2 and pH (a-v) were maintained within normal range. At 41. 8℃ (2h) pH was lower than the normal range, at the end of WBH, hemodynamic and O2 metabolism parameters gradually returned to baseline levels. Conclusion The balance between oxygen delivery and oxygen consumption can be well maintained during WBH therapy under general anesthesia.

Objective To investigate the association between CYP2C19 polymorphisms and efficacy of clopidogrel in Chinese Han patients with coronary atherosclerotic heart disease.Methods A total of 176 Chinese Han patients who underwent percutaneous coronary intervention and were treated with dual antiplatelet therapy with aspirin and clopidogrel were enrolled.Polymorphisms of CYP2C19 * 2,* 3 were measured by PCR-restriction fragment length polymorphism (PCR RFLP).The correlation between the genetic variants and cardiovascular events was analyzed.Results In the 176 patients,the allele frequencies of CYP2C19 * 2 and * 3 were 34.38％ and 5.97％ respectively,the percent of patients with poor metabolizer genotypes (* 2/* 2,* 2/* 3,* 3/* 3) was 14.20％.Among the 176 patients,11 patients reoccured acute coronary syndrome,1 patient suffered from stroke,and 4 patients had stent thrombosis.The incidence of cardiovascular events was 9.09 ％.Thecumulative incidence of cardiovascular events had no significant differences between poor metabolizer genotype carriers and extensive and intermediate metabolizer genotype carriers (16.00％ vs.7.95％,x2 =1.683,P=0.195).Conclusions The frequencies of CYP2C19 poor metabolizer genotypes are higher in Chinese Han population than in Caucasians,but the incidence of cardiovascular events in Chinese Han population is not increased.

Objective To investigate the changes in metabolic indexes and anesthesia administration during perioperation in patients undergoing orthotopic liver transplantation. Methods Eleven patients who underwent orthotopic liver transplantation were selected. Their pH, BE, HCO 3 -, K +, Ca 2+, blood glucose, PT, APTT and FIB were assessed at 60 min of pretransplantation, 20 min and 40 min of liver transplantation, 20 min and 40 min of new liver reperfusion. Results The pH, BE, HCO 3 -, K +, Ca 2+ during 20 min and 40 min of liver transplantation decreased more significantly than those during pretransplantation 60 min, PT and APTT extended markedly, the level of blood glucose did not change markedly; pH, BE, HCO 3-, K +, Ca 2+ and the level of blood glucose during new liver reperfusion 20 min and 40 min increased significantly compared to those during liver transplantation 20 min and 40 min; PT, APTT and FIB did not change markedly. Conclusion Metabolic indexes during liver transplantation change more markedly than those during pretransplantation or new liver reperfusion.

Objective To study the expression and clinical significance of ARHGAP4 in colorectal cancer Method Real?time PCR,Western blot and immunocytochemistry were used to detect the expression of ARHGAP4 in colorectal cancer tissues and cell lines ,and the correlation between its expression and clinical features of patients was analyzed Results ARHGAP4 is overexpressed in colorectal cancer tissues and cell lines and its overexpression is correlated with T stage, N stage, clinical stage, and metastasis. Conclusion ARHGAP4 may promote the progression of colorectal cancer ,and have the potential to be a novel prognosis marker.

This study was aimed to evaluate effect of Qinghua Granules (QHG) on glycometabolism, pancreatic islet function and oxidative stress in type-2 diabetics with heat syndrome. A total of 60 cases of type-2 diabetics with heat syndrome (according to the Syndrome Element Syndrome Differentiation) were enrolled in the clinic of the Department of Endocrinology and Metabolism, Shuguang Hospital Affiliated to Shanghai University of Tradi-tional Chinese Medicine. The average age of enrolled cases was (57.9 ± 6.9) years. Enrolled cases were randomly divided into the treatment group and the control group. The original hypoglycemic plan was continued to use. In the treatment group, QHG was administrated. And in the control group, placebo was given. The administration dosage in both groups was one package per day. The treatment course was 12 weeks. The fasting and postpran-dial (120 min after standard meal) blood samples before and after medication were collected. The main evalua-tion indexes were fasting plasma glucose (FPG), postprandial plasma glucose (PPG) and hemoglobin A1c (HbA1c). The secondary evaluation indexes were homeostasis model assessment (HOMA2-%B, HOMA2-%S, HOMA2%-IR), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), maleic dialdehyde (MDA), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The anal-ysis of variance was used in the comparison of efficacy between two groups . The results showed that HbA1c in the treatment group was obviously reduced, and HOMA2-%B was obviously increased. There was no significant changes in the control group ( P = 0 . 044 , P = 0 . 016 ) . In the treatment group , SOD increased obviously , MDA reduced obviously. There was no significant change in the control group. There was difference b etween two groups (P = 0.011, P = 0.049). There was no change on blood lipids or other evaluation indexes. It was conclud-ed that QHG is effective in the improvement of glycometabolism, islet β-cell functions and oxidative stress in type-2 diabetics with heat syndrome .

Objective To analyze the disease spectrum of patients admitted to the General Internal Medicine Unit at Peking Union Medical College Hospital, which is the first academic division of general internal medicine in the department of medicine within Chinese medical colleges and universities, and the value of general internal medicine unit in comprehensive hospitals. Methods A retrospective data review of patients admitted to the General Internal Medicine Unit from 2004 to 2008 was conducted from hospital information system and partially by chart review manually. Analysis of disease spectrum was performed thereafter. Results A total of 2593 patients were included in our study. It consisted of 1075 men and 1518women, with an average age of 45.1 years old. Forty point three percent of these patients were from Beijing,the local city, and the remaining 59.7% were from outside of Beijing. Sixty-four point nine percent (1683/2593)of these patients did not have a clear diagnosis on admission, including 758 fever of unknown origin (FUO) cases and 925 non-FUO cases. The final diagnostic rate of the FUO cases was 89. 2% [676/758, with the first three leading causes as diseases of the musculoskeletal system and connective tissue (29. 8%), certain infectious and parasitic diseases(26.3%), and neoplasm (14. 5%)] . The final diagnostic rate of the 928 non-FUO cases was 86. 8%(803/925), with the first three leading causes as musculoskeletal system and connective tissue(24.9%), neoplasm (15.5%), and diseases of blood and blood-forming organs(11.4%). Despite most diagnoses fitting into the above categories, the array of diseases was broad with as many as 550 discharge diagnoses from 2004 to 2008. Conclusions During 2004 -2008, there was a high proportion of cases that presented to the General Internal Medicine Unit at Peking Union Medical College Hospital with an unclear diagnosis, and the spectrum of diseases diagnosed was very broad. This kind of patient admitting model might not only benefit patients with no clear admission diagnosis and patients with multidisciplinary medical problems for whom it is usually difficult to be admitted by a specialty unit, but would also benefit medical students and residents by providing a good clinical medicine teaching base. These features show the value of general internal unit in comprehensive hospitals.

Objective To evaluate the clinical effect and efficacy of endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips. Metheds The clinical date of 21 patients who treated tissue glue and metal clips were retrospectively analyzed from Jan 2015 to Dec 2016. Results The treatments were completed successfully and reviewed by endoscopy after 1 week, 1 month, 3 months, 6 months. The gastric varices were reduced, and the serious complications of bleeding, embolism were little. Conclusion The endoscopy treatment for isolated gastric varices 1 with tissue glue and metal clips is contributed to clinical effect, and the treatment provides a reference for clinical treatment.

The central nervous system (CNS) plays a key regulatory role in glucose homeostasis. In particular, the brain is important in initiating and coordinating protective counterregulatory responses when blood glucose levels fall. This may due to the metabolic dependency of the CNS on glucose, and protection of food supply to the brain. In healthy subjects, blood glucose is normally maintained within a relatively narrow range. Hypoglycemia in diabetic patients can increase the risk of complications, such as heart disease and diabetic peripheral neuropathy. The clinical research finds that the use of traditional Chinese medicine (TCM) has a positive effect on the treatment of hypoglycemia. Here the authors reviewed the current understanding of sensing and counterregulatory responses to hypoglycemia, and discuss combining traditional Chinese and Western medicine and the theory of iatrogenic hypoglycemia in diabetes treatment. Furthermore, the authors clarify the feasibility of treating hypoglycemia on the basis of TCM theory and CNS and have an insight on its clinical practice.

OBJECTIVETo investigate clinicopathologic features of succinate dehydrogenase-deficient gastrointestinal stromal tumors (SDH-deficient GIST).

METHODSImmunohistochemical EnVision technique was used to assess the expression of succinate dehydrogenase subunit B (SDHB) in 192 cases of GIST. Cases of SDH-deficient GIST were further evaluated for the presence of CKIT exons 9, 11, 13 and 17 mutations and PDGFRA exons 12 and 18 mutations with clinical followed-up data.

RESULTSSeven of the 192 cases showed SDHB-deficiency (3.6%, 7/192). The patients ranged in age from 35 to 84 years (median=56 years; mean=60 years). Four were male and three were female. Six tumors involved stomach and one involved mesentery. Histopathologic features of SDHB-deficient GIST included four cases of mixed-cell type and three of epithelioid cell type. The tumors commonly involved muscularis propria of the stomach as multiple nodules, creating a plexiform pattern. The tumors had high cellularity with cytoplasmic vacuolization. Five cases developed lymph node metastases including one also metastasizing to liver and pancreas. Two cases showed no evidence of metastasis. None of the 7 cases of the SDHB-deficient GIST had CKIT exons 9, 11, 13 and 17 mutations and PDGFRA exons 12 and 18 mutations. Three of the seven SDHB-deficient GIST cases had followed-up data: two did not recur and one died after 24 months of surgery of unknown cause.

CONCLUSIONSDHB-deficient GIST has characteristic clinicopathologic features with wide-type CKIT gene and a favorable prognosis.

Adult ; Aged ; Aged, 80 and over ; Exons ; Female ; Gastrointestinal Stromal Tumors ; diagnosis ; genetics ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Mutation ; Prognosis ; Succinate Dehydrogenase ; genetics