Objective To evaluate the effect of the early goal-directed therapy (EGDT) on mortality in patients with septic shock, and to analyze the risk factors of mortality.Methods A retrospective controlled study was conducted.Complete clinical data of patients with septic shock admitted to emergency intensive care unit (EICU) of Sichuan Provincial People's Hospital from May 1994 to December 2014 were recorded and analyzed.According to the International Guidelines for Management of Severe Sepsis and Septic Shock (SSC) with the time of promulgation as dividing point, the patients were divided into two groups as before and after the publication of the guideline, i.e.early group (from May 1994 to April 2004) and late group (from May 2004 to December 2014).The patients of the late group were subdivided into 6-hour and 24-hour reaching standard groups and non-reaching standard group according to the time of reaching standard of EGDT.All patients were divided into death group and survival group according to the 28-day survival.The patients in early group were not treated according to EGDT guidance, so only age, the case history of chronic disease, the main site of infection, organ dysfunction, vital signs, urine output, the amount of fluid for resuscitation, blood routine, blood gas analysis, time for starting antibiotics treatment, the use of vasoactive drugs and hormone, etc.were recorded.The central venous pressure (CVP), central venous oxygen saturation (ScvO2), blood lactate (Lac), and the monitor of other parameters of patients in late group were consummated late.The relationship of EGDT compliance standard time and tissue perfusion index recovery time between the two groups of patients was observed.The risk factor for mortality was analyzed by multiple factors logistic regression.Results ① 134 patients were included,and the overall 28-day mortality was 49.25％.② The 6-hour EGDT compliance rate of early group was 0 (0/58),and it was 28.95％ (22/76) in late group (x2 =20.087, P =0.000).Compared with the early group, the 6-hour urine volume in the late group was significantly increased (mL·h-1·kg-1: 1.72± 1.04 vs.0.89±0.24, t =11.950, P =0.001),6-hour mean arterial pressure (MAP, mmHg, 1 mmHg =0.133 kPa) was elevated (64.24±3.90 vs.56.21 ±5.95, t =6.444, P =0.012), the use of antibiotics within 1 hour was increased (76.32％ vs.48.28％, x2 =11.250, P =0.001), the use of vasocative drugs (21.05％ vs.89.66％, x 2 =61.942, P =0.000) and hormone (8.57％ vs.34.48％, x 2 =14.871,P =0.000) were lowered, and the 28-day mortality rate was lowered significantly [34.21％ (26/76) vs.68.96％ (40/58),x2 =15.897, P =0.000].The difference was not statistically significant in the total recovery of liquid volume between late group and early group (mL: 1 856.31±805.81 vs.1 903.1 ± 897.11, t =0.101, P =0.752).③ In all patients, it was shown by single factor analysis that the age, infection sites, altered mental status at admission, white blood cell (WBC) before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour, and incidence of acute renal injury (AKI) or acute lung injury/acute respiratory distress syndrome (ALI/ARDS) within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).In the late group, it was shown by single factor analysis that the age, the case history of chronic disease, infection sites, WBC, pH value, Lac, and ScvO2 before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour,and incidence of AKI or ALI/ARDS within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).It was shown by the logistic regression analysis that aging [odds ratio (OR) =4.81, P =0.02], failure of 2 organs (OR =28.63,P =0.00) or ≥ 3 organs (OR =62.69, P =0.00) were the independent risk factors for mortality in patients with septic shock.④ The 76 patients of late group were subdivided into three groups, namely 6-hour reaching standard of EGDT group (n =22), 24-hour reaching standard of EGDT group (n =28), and non-reaching standard of EGDT group (n =28).Compared with those before treatment, the Lac after therapy was decreased obviously both in 6-hour EGDT group and 24-hour EGDT group, and the CVP, MAP, and ScvO2 were increased significantly.The Lac in 6-hour EGDT group was lowered more significantly as compared with that in 24-hour EGDT group (mmol/L: 1.64 ± 0.40 vs.3.01 ± 1.13, P ＜ 0.01),while MAP and ScvO2 were increased significantly [MAP (mmHg): 81.82 ± 8.01 vs.69.01 ± 9.63;ScvO2:0.718 ± 0.034 vs.0.658 ±0.036, P ＜ 0.05 and P ＜ 0.01].The urine output in both reaching standard of EGDT groups was more than 0.5 mL·h-1·kg-1, without statistically different significance.The 28-day mortality rate of 24-hour EGDT group was 14.29％, and it was 0 in 6-hour EGDT group.Conclusions Mortality was as high as 68.96％ during 10 years when the period before the use of 2004 SSC, and the mortality rate was lowered to 34.21％ during 10 years during which the early fluid resuscitation treatment was based on EGDT.Aging and failure of more than 2 organs were independent risk factors for mortality in patients with septic shock.Compared with reaching the standard of EGDT within 24 hours,reaching the standard of EGDT within 6 hours can rapidly reverse hypoxic-ischemic tissue, thereby improving the prognosis of the patient with lowering of mortality rate.

Objective To explore the expression of cathepsin L in hepatocellular carcinoma and to analyze its relationship with clinical and pathological features. Methods Fifty-eight specimens of hepatocellular carcinoma were studied, including 18 well-differentiated, 18 moderately differentiated and 22 poorly differentiated. Classified by TNM clinical stage, 26 were in Ⅰ/Ⅱ stage and 32 in Ⅲ/Ⅳ stage. The expressions of cathepsin L were detected with immunohistochemistry and RT-PCR. Their relationship with the clinical and pathological features of hepatocellular carcinoma was analyzed. Results The positive rate of cathepsin L protein was 72.4% (42/58), and the expressions of cathepsin L protein were significantly different among the specimens of pathological grades of tumor, of TNM clinical stages and with/without metastasis. The positive rate of cathepsin L mRNA was 65.5% (38/58). The expression of cathepsin L mRNA in hepatocellular carcinoma was correlated with pathological grades of tumor, TNM clinical stages and lymph node metastasis. Conclusion Cathepsin L plays an important role in the occurrence of hepatocellular carcinoma for its correlation with infiltration and metastasis of hepatocellular carcinoma. Cathepsin L can be used as a useful marker for the prognosis of hepatocellular carcinoma patients.

Humans ; Lumbar Vertebrae ; surgery ; Spinal Diseases ; surgery ; Spinal Fusion

Objective To investigate the clinical characteristics,treatment and prognosis of myocardial damage presented with abdominal pain in children.Methods The clinical data of 33 children with myocardial damage presented with abdominal pain in Beijing Anzhen Hospital during the past 4 years were analyzed.Emergency conditions were ruled out in all cases.Results Among 33 cases with myocardial damage presented with abdominal pain,there were 10 cases of pneumonia,9 cases of acute bronchitis,7 cases of upper respiratory tract infection,1 case of allergic purpura,1 case of myocarditis and 5 cases of unknown causes.The duration of abdominal pain lasted 2 days to 3 months.The characteristics and the duration of abdominal pain were irregular.Mycoplasma antibodies positive were 5 cases (2 cases of bronchitis,3 cases of pneumonia).Coxvirus antibodies were 2 cases.There were different symptoms and signs of myocardial damage.Holter:there were ST-T changes in 23 children and 17 frequent premature ventricular complex(pattern of bigeminy and trigeminy in 7 children,premature atrial complex in 4 children).Creatine kinase isoenzyme-MB were high in 21 children(30-124 U?L-1).Cardiac troponin I were high in 19 children(0.8-1.2 ng?L-1).Chest X-ray:cardiomegaly was noted in 7 children,and the ratio of cardiac and chest were 0.55-0.58.Echocardiography:the left ventricular end-diastolic diameter was enlarged in 5 children,the right atrium was enlarged in 1 child.Most abdominal pain was relieved with treatment in 5 to 7 days,and 14 days was the longest.Total treatment course was 2 weeks to 1 month,and 3 months was the longest.But 1 case with myocarditis was recurrent abdominal pain treated nearly 3 months,and lasted to 6 months for recovery.Conclusions It is important to pay attention to cardial examination early,when a child becomes inconsolable from abdominal pain but emergency conditions should be ruled out.

No abstract available.
Thymoma*

Sertoli-Leydig cell tumor is a rare sex-cord stromal tumor of the ovary and accounts for less than 0.5% of all ovarian tumors. It is among the most fascinating from pathologic and clinical viewpoints in masculinization. We experience an unusual case of a poorly differentiated Sertoli-Leydig cell tumor in 60-year-old woman who showed masculinization and present it with brief review of literature.
Female ; Humans ; Middle Aged ; Ovary* ; Sertoli-Leydig Cell Tumor*

Carcinoma in Situ ; pathology ; virology ; Carcinoma, Squamous Cell ; pathology ; virology ; Diagnosis, Differential ; Female ; Humans ; Paget Disease, Extramammary ; pathology ; virology ; Papillomavirus Infections ; Precancerous Conditions ; pathology ; virology ; Vulvar Neoplasms ; classification ; pathology ; virology ; Warts ; pathology ; virology

Objective To observe the therapeutic effect and safety of dexmedetomidine for sedation in ICU. Methods We selected 40 patients who transferred to the ICU with retained endotracheal intubation after abdominal surgery under general anesthesia in this study. 40 patients were randomly divided into the dexmedetomidine group (D group,20 cases) and midazolam group (M group,20 cases) . Patients in group D were treated with loading dose 1 μg/kg from central vein pump injection 20 min, 1h according to Ramsay score for each adjustment of drug dose is pumped into 0.2 ~ 0.7 μg/(kg.h). Patients in M group were given a loading dose of midazolam 0.05mg/kg intravenous injection 1 min, depending on the degree of sedation maintenance dose of 0.02 ~ 0.1 mg/(kg.h). Pain scores every 2 h (NRS),when the NRS score>4 sharing,plus fentanyl 1μg/kg. When the patients achieved the offline condition, the endotracheal tube was pulled out. The sedation efficiency, dosage of fentanyl, after discontinuation wake-up time, extubation time, duration of mechanical ventilation, the incidence of cardiovascular events and delirium were compared between two groups.Results The sedation efficacy in Group D sedation was significantly higher than in group M ( <0.05) . Compared with group M, the dosage of fentanyl in patients in D group was significantly reduced ( <0.05), the wake time after stopping, extubation time were significantly shorter ( <0.05) . The incidence of cardiovascular events has no significant difference between two groups during the treatment. The incidence of postoperative delirium in D group was significantly lower than in that in group M ( <0.05) . Conclusions Dexmedetomidine has good sedative effect, and can shorten the time of extubation with hemodynamic stability and low incidence of delirium for patients in the ICU. It is an ideal ICU sedative.

Objective To summarize the nursing experience for three cases of above 1-month-oldinfants with total transposition of the great artery after Switch operation.Methods The vital signs of the infants were monitored,including the respiratory system,circulation system,temperature,urine quantity,feeding and delayed sternal closure.Appropriate measures were adopted to cope with changes in the above mentioned aspects.Results All the 3 infants were cured with good nursing effect.Conclusion Switch operation was a complicated operation.The 3 infants missed the-optimum operation time and left great difficulty for nursing.Close monitoring and delicate nursing proved to be the pivotal process to ensure the successful curement.

Objective To establish content determination of hydroxyl safflower yellow A in Biyangqing.Methods Hhgh-performance liquid chromatography(HPLC)was used in the determination.A C18 column was used for the separation flow rate Was set at 1.0mL/min,the temperature of the column was set at 30℃,and wavelength of diction was set at 403 nm.with 100.08%average recovery and 0.98%RSD.Conclusion This detrmination method is specific and reproducible and can be used to control the quality of Biyangqing.