Objective:To study the characteristics,related factors and precautionary measures of ceftriaxone-induced anaphylactic shock,and provide reference for clinical safe medication.Method:The literature between January, 1994 and December,2007 was collected from Chinese Journal Full-text Database,Chinese Science and Technology Journal Full-text Database,and Wanfang Medicine Data China info,70 cases with ceftriaxone-induced anaphylactic shock were reviewed and analyzed.Result:Of the 70 cases,43(61.4%) were male,and 27(38.6%) were female.64(91.4%) received intravenous fusion or intravenous injection and 6(8.6%),intramuscular or prostate capsule injection.Most of the anaphylactic shock cases occurred within 20 minutes(71.2%) after administration.61 cases recovered(87.1%) and 8 cases died(11.4%) and 1 cases became vegetable(1.5%) after treatment.Conclusion:The ceftriaxone-induced anaphylactic shock is rapid so as to be timely rescued.Patients should be asked about their case history and medication history in detail before treatment in order to reduce occurrences of shock.

A flow-injection chemiluminescence ( FI-CL ) reaction system with diperiodatoargentateⅢ was developed for the determination of hydrocortisone in human serum. The weak chemiluminescence signal from the reaction between DPA and sulfuric acid system can be greatly enhanced in the presence of hydrocortisone. The optimal conditions of the CL system were 1. 0 mol/L H2SO4, 2. 5×10-4 mol/L diperiodatoargentateⅢ, and flow rate of 4. 20 mL/min. Under the optimal conditions, the CL intensity was linearly to the concentration of hydrocortisone from 3 . 0 × 10-10 g/mL to 1 . 0 × 10-7 g/mL and the detection limit was 2 . 2 × 10-10 g/mL ( 3σ) . The relative standard deviation ( RSD ) was 0 . 6% ( n =11 ) for 5 . 0 × 10-8 g/mL hydrocortisone solution. The proposed method was successfully applied to the direct determination of hydrocortisone in serum samples with the recoveries of 93 . 0%-110 . 0%, and the relative standard deviations were 0 . 3%-3 . 2%. The possible chemiluminescence mechanism was investigated by measuring fluorescence spectra and UV-vis absorption spectra of the system.

A novel flow-injection chemiluminescence (FI-CL) method free of CL reagent was developed for the determination of captopril based on its enhancing effect on the CL derived from diperiodatoargentate(III)-sulfuric acid system. Compared with the conventional CL system, the CL system based on trivalent silver was characterized of good selectivity for the absence of CL reagent. The CL mechanism was discussed through CL spectra and UV–vis absorption spectra. The conditions of the FI-CL system were investigated and optimized. Under the optimal conditions, the relative CL intensity was linear with the captopril concentration in the range of 0.3–15.0 μg/mL. The detection limit for captopril was 0.05 μg/mL, and the relative standard deviation (n=11) was 2.0% for 5.0 μg/mL captopril. The proposed method was applied to the analysis of captopril in tablet and human urine with the recoveries of 83.1%–112.5%, and the relative standard deviations of 0.5%–4.4%. The results obtained by the proposed method agreed well with those obtained from HPLC method. The proposed method is fast, convenient, and cost-effective for the determination of captopril in medicine and biological samples.

Objective To investigate the significance of an accessory hepatic vein (AHV) in the interventional treatment of Budd-Chiari syndrome (BCS).Methods From Mar.2011 to Jun.2013,35 patients with BCS who also had an AHV were included into this study.The patients were divided into two groups according to whether the AHV was obstructive:21 patients had obstruction to the inferior vena cava (IVC) and to the 3 hepatic veins (HV),but the AHV was open; 14 patients had obstruction to the AHV and the 3 HVs.In 13 of these patients the IVC was open,but 1 patient had obstruction to the IVC.During treatment,the patients in the AHV open group underwent balloon dilation or stent insertion of IVC ; patients in the AHV obstruction group underwent balloon dilation or stent insertion of AHV.The patient with obstruction to the IVC underwent balloon dilation of IVC first.Results All patients were successfully treated without any procedure-related complications.In the AHV open group,the average pressure of the AHV decreased from (28.81 ± 6.23) cmH2 O (1 cmH2O =0.098 kPa) before treatment to (18.62 ± 5.06) cmH2O after treatment (P ＜ 0.01) ; the average serum TBIL decreased from (23.24 ± 6.41) μmol/L before treatment to (19.52 ± 4.31) μmol/L after treatment (P ＜ 0.01) ; the average serum albumin changed from (33.76 ± 3.74) g/L before treatment to (34.05 ± 3.62) g/L after treatment (P =0.485).In the AHV obstruction group,the average pressure of the AHV decreased from (36.29 ± 11.65) cmH2O before treatment to (22.07 ± 7.67) cmH2O after treatment (P ＜ 0.01) ; the average serum TBIL decreased from (31.24 ± 9.54) μmol/L before treatment to (20.93 ±7.26) μmol/L after treatment (P ＜0.01) ; the average serum albumin changed from (32.14 ± 4.55) g/L before treatment to (32.11 ± 4.47) g/L after treatment (P =0.861).During follow-up,no patients experienced recurrence of symptoms in the AHV open group; one patient experienced recurrence of symptoms 5 months after treatment in the AHV obstruction group.This patient received a second balloon dilation of the AHV.Conclusions For patients with BCS with IVC and the 3 HVs obstruction,if the AHV was open,we could only treat the IVC.For patients with BCS with AHV and the 3 HVs obstruction,AHV dilation followed by recanalization of AHV was also effective.

Objective To study the relationship between the risk of malignant tumor and occupational radiation factor among medical diagnostic X-ray workers in Jiangsu province.Methods The retrospective and prospective cohort studies were adopted to investigate the incidence of cancer.Eligible medical diagnostic X-ray workers from the department of radiology in hospitals were selected and assigned into exposure group,while other medical workers from the departments of Internal Medicine,Ear-NoseThroat (ENT) or Pediatrics who attended work at the same period in the same hospital but not engaged in radiation work were regarded as control group during 1950-2011 in Jiangsu province.We calculated the total person-year and analyzed the relative risk (RR) of malignant tumor using Poisson regression model.Results 7 703 participants (3 961 in exposed group and 3 742 in unexposed group) were recruited and followed up,with a total of 315 309 person years and the lost follow-up rate was 6.92％ (533/7 703).During the follow up period,a total of 819 tumor cases were identified (771 were malignant tumors).We found the significant relationship between the risk of malignant tumor and occupational radiation factor,and the RR of solid cancer and total malignant tumor were 1.31 (95％ CI:1.11-1.55) and 1.33 (95％ CI:1.13-1.57),respectively.In addition,the risk of lung cancer in medical diagnostic X-ray workers was significantly higher than that in control group (RR =1.45,95％ CI:1.00-2.09).Conclusions The incidence risk of lung cancer,solid caner and total malignant tumors in medical diagnostic X-ray workers was significantly higher than that in the control group,which might be associated with occupational exposure to ionizing radiation.

Objective To continue following up the cohort members in Jiangsu province who were the largest subgroup in Chinese medical X-ray workers cohort subgroups on radiation carcinogenesis and analysis the cancer risk of medical X-ray workers which might be induced by chronic low-dose ionizing radiation between 1997 and 2011.Methods A retrospective cohort study was utilized to accumulate data.Epicure was applied to compute cumulative person years (with module of Datab) and relative risk (including 95％ CI) of malignant tumor on exposed group(with module of AMFIT) while the factors such as sex and attained-age were adjusted in the cohort members.Results The 7 708 follow-up members included 3 668 medical X-ray workers.The cumulative person-year in the cohort members was 94 651.2 (1997-2011) and its lost rate was 5.79％.During the follow-up period,441 cases had became cancer patients.The relative risk of all cancers was 1.44 (95％ CI:1.18-1.75),so was the solid cancers.Significant elevated risks of cancer were found on lung (RR =1.95,95％ CI:1.30-2.92),esophagus (RR =3.04,95％ CI:1.20-7.70),lymphoma(RR =2.24,95％ CI:0.67-7.48),leukemia(RR =1.57,95 ％ CI:0.33-7.39),throat (RR =2.47) and thyroid (RR =2.80,95 ％ CI:0.24-32.26) among medical X-ray workers.However,The RR of malignant tumors might not be associated with occupational exposure to ionizing radiation if we considered the lost factors (RR =1.2,95％ CI:0.94-1.46)Conclusions The RR of malignant tumors such as the cancer on lung,esophagus,thyroid among the medical X-ray workers in Jiangsu province were enhanced which might be associated with occupational exposure to ionizing radiation.

Establishment of quality management system (QMS) plays a critical role in the clinical data management (CDM). The objectives of CDM are to ensure the quality and integrity of the trial data. Thus, every stage or element that may impact the quality outcomes of clinical studies should be in the controlled manner, which is referred to the full life cycle of CDM associated with the data collection, handling and statistical analysis of trial data. Based on the QMS, this paper provides consensus on how to develop a compliant clinical data management plan (CDMP). According to the essential requirements of the CDM, the CDMP should encompass each process of data collection, data capture and cleaning, medical coding, data verification and reconciliation, database monitoring and management, external data transmission and integration, data documentation and data quality assurance and so on. Creating and following up data management plan in each designed data management steps, dynamically record systems used, actions taken, parties involved will build and confirm regulated data management processes, standard operational procedures and effective quality metrics in all data management activities. CDMP is one of most important data management documents that is the solid foundation for clinical data quality.

Objective To explore the interaction between polymorphisms of rs17222919 which located in the 5-1ipoxygenase-activating protein(ALOX5AP) gene promoter and environmental risk factors in ischemic stroke(IS).Methods We conducted a case-control study involving a total of 622 cases and 631 unrelated healthy controls which were selected from Henan Han populations,and the environment risk factors were recorded.Genotyping aimed at detecting both genetic and environmental factors in relation to IS was performed by TaqMan-polymerase chain reaction technology while interaction indexes (Υ) were calculated to determine interactions and their role models.Results The rs17222919 TG (189/622,30.4％),GG (18/622,2.9％)genotype frequencies and G (225/1244,18.1％)allele frequencies in IS subjects were significantly lower than those in controls (221/631,35.0％ ; 31/631,4.9％ ; 283/1262,22.4％ ; x2 =4.117,P =0.042 ; x2 =4.457,P =0.035 ; x2 =7.294,P =0.007).Negative interactions between TG + GG genotype and hypertension,diabetes or cigarette smoking in the occurrence of IS (Υ =0.943,0.922,0.830) were observed,whose role models were all super-multiplicative models.Conclusions According to our study,ischemic stroke is the result of the interaction of genetic and environmental factors and G allele of rs17222919 may have weakened the role of environmental factors for hypertension,diabetes and cigarette smoking in IS incidence.

Objective To discuss the ventilatory catheter-assisted airway stenting under local anesthesia for airway stenosis.Methods From May 2008 to January 2013,25 consecutive patients with airway stenosis underwent the treatment of ventilatory catheter-assisted airway stenting under local anesthesia.The dyspnea score was grade Ⅱ in 3 patients,grade Ⅲ in 18 patients and grade Ⅳ in 4 patients.During the treatment,a 4 F VER catheter was placed into one of the main bronchi as a ventilatory catheter for oxygen supply in advance,the oxygen flow was set at 2 to 4 L/rmin according to the patients' condition,then the airway stenting was performed,after release of the stent,the ventilatory catheter was removed smoothly.Data on technical success,clinical outcome and follow-up were collected and analyzed respectively.The paired t test was performed to compare variables before and after tracheal stenting.Results Ventilatory catheter-assisted airway stenting under local anesthesia was technically successful in all patients.A total of 25 stents were placed in 25 patients.The stents included I-shaped stents (n=19) and Y-shaped stents (n=6).After the oxygen supply,the patients' SaO2 was increased to 94％ to 97％ rapidly.When the stent introducer sheaths were passing through the stenotic site,the SaO2 could be maintained at 92％ to 97％.The improvement of the respiratory difficulty was achieved in 100％ of our patients.The hypoxia symptom was relieved immediately after stents placement,the dyspnea score decreased to grade 0 in 2 patients,to grade Ⅰ in 19 patients and to grade Ⅱ in 4 patients.Respiratory rate and SaO2 improved from (30.0±2.1) times/min and (6.0±3.8)％ before stenting to (19.7±1.6) times/min (t=23.33,P＜0.01) and (93.0± 1.7)％ (t=23.50,P＜0.01) after stenting,respectively.Through the follow-up,3 patients suffered the stent-related complications after discharge,the complications included re-stenosis (n=2) and fracture(n=1).Conclusion Ventilatory catheter-assisted airway stenting under local anesthesia can be an effective,simple and safe method for airway stenosis.

Objective To investigate the feasibility of computer-aided pancreas segmentation based on three-dimensional (3D) Dixon MRI at 3.0-T.Methods Five volunteers with health pancreas underwent upper abdominal 3D Dixon MRI at 3.0T with the same scan parameters while holding breath.The automatic segmentation of pancreas is based on the Medical Imaging Interaction ToolKit (MITK) with homemade software.A experienced radiologist performed manual segmentation and computer aided segmentation of the pancreas on the opposed phase and water phase images twice.Similarity was analyzed and compared for the manual and automated segmentations for the two group images.Similarity was presented as Dice coefficients.Results Both of the oppose phase and water phase images of Dixon MRI showed that the signal intensity of pancreas was higher than that of the surrounding tissue,the similarity of water phase was obviously higher than that of oppose phase and the differences were statistically significant.Based on Dixon MRI water phase and oppose phase images,the mean dice coefficients for the manual segmentations were 0.81 ± 0.01 and 0.85 ±0.03,respectively,for both the oppose phase and water phase images (P=0.013).For the automated segmentations,the dice coefficients were 0.69 ± 0.08 and 0.75 ± 0.03 for water phase images and the oppose images,respectively,and the difference was not statistically significant (P =0.155).Conclusions 3.0T oppose phase and water phase of Dixon images could clearly show the pancreas,and automated pancreas segmentation based on water phase Dixon MRI obtained higher similarity,which was feasible.