Objective To evaluate the value of revised Geneva score, Daniel ECG score and age-adjusted D-dimer for predicting pulmonary embolism(PE).Methods A total of 91 cases suspected as pulmonary embolism were collected, and 52 cases were diagnosed as pulmonary embolism by computed tomographic pulmonary angiography(CTPA) results.Receiver operating characteristic(ROC) curves and diagnostic test evaluation indexes were used to evaluate the probability of PE predicted by the revised Geneva score,Daniel ECG score, age-adjusted D-dimer and combination of these two clinical scores and age-adjusted D-dimer.Results The confirmed PE was 21.4% with a low probability(revised Geneva score 0~3 points),55.4% in intermediate probability(4~10 points),85.7% in high probability(score≥11 points).The prevalence of PE was 33.3% with a low clinical probability (Daniel ECG score<2 points)and 70.7% with a high clinical probability(Daniel ECG score≥2 points).The sensitivity and specificity of age-adjusted D-dimer in predicting pulmonary embolism were 92.3%,69.2%.The area under curve of the ROC curve(AUC)in the revised Geneva score and Daniel ECG score has no significant difference(Z=0.979).The negative predictive value of the revised Geneva score, Daniel ECG score combined with D-dimer in pulmonary embolism were 100.0% and 87.5%.Conclusion All of revised Geneva score, Daniel ECG score and age-adjusted D-dimer have certain predictive value on pulmonary embolism , and the revised Geneva score combined with age-adjusted D-dimer can be more safely exclude pulmonary embolism.

Objective To detect the changes in DNA loads of human papillomavirus (HPV) type 6/11 in lesions of patients with condyloma accuminatum (CA) before and after 5-aminolevulinic acid photodynamic therapy (ALA-PDT).Methods After removal of warts by electrocautery,HPV6/11-positive patients with CA were divided into two groups:treatment group (32 cases) receiving two sessions of ALA-PDT with intervals of 7-10 days,and control group (29 cases) remaining untreated.Exfoliated cells were collected from the lesional sites of these patients before and 3 months after the first session of ALA-PDT,and fluorescence-based quantitative PCR was conducted to estimate the DNA loads of HPV 6/11 in these cells.Results Three months after the first session of ALA-PDT,89.7％ (26/29) of the patients in the treatment group and 68.4％ (13/19) in the control group became HPV DNA negative,with significant differences between the treatment group and control group in the DNA loads of HPV ((1.70 ± 7.86) × 105 vs.(1.27 ± 2.21) × 106 copies/ml,P ＜ 0.05).Conclusion ALA-PDT can reduce HPV DNA loads in lesions of CA in patients.

AIM:To discuss the changes of IL-17, IL-21 in glucocorticoid therapy of active thyroid associated ophthalmopathy (TAO) and analyze the relation with results.METHODS:The 67 patients (134 eyes) of TAO in our hospital, were divided into activity group(32 patients 64 eyes) and atypical activity group(35 patients 70 eyes) according clinical activity score (CAS) grading standard, and 30 cases of healthy as control group at the same time.The activity group were treated by glucocorticoid therapy treatment, and proceed the CAS scores before and after treatment, measured the degree of exophthalmus and width of palpebral fissure.At the same time, compared the expression level of IL-17 and IL-21 in all groups, and analyzed the correlation between the IL-17 and IL-21 and CAS score.RESULTS:Compared with control group, expressions of IL-17 and IL-21 in TAO patients were significantly higher (P<0.05).The expressions of IL-17 and IL-21 in active period TAO patients were higher than atypical activity (P<0.05).After glucocorticoid treatment, the expressions of IL-17 in active period TAO patients decreased significantly(P<0.05), and it was significantly positive correlation with CAS score (before treatment:r=0.8847,P=0.042;after treatment:r=0.8886,P=0.0439) the expression of IL-21 in active period TAO patients was significantly positive correlation with CAS score (before treatment:r=0.8893, P=0.0435;after treatment:r=0.8876,P=0.045).CONCLUSION:IL-17 and IL-21 is closely related to the TAO disease activity, and glucocorticoids impact treatment by reducing IL-17 and IL-21 in activity TAO, IL-17 and IL-21 can be used as one of indexes of predicted curative effect and condition in patients with TAO.

China ; Foundations ; Integrative Medicine ; Natural Science Disciplines

Humans ; Integrative Medicine ; Medicine ; Medicine, Chinese Traditional

1.0 cm) by radiographic examinations, video-mediastinoscopy showed positive results in 30 cases, and negative in 14 cases, in which the surgical exploration found no evidence of metastasis to mediastinal lymph nodes. No postoperative complications and mortality were observed. Conclusions Video-mediastinoscopy offers clear operation field, high resolution, convenient application, safety and reliability. We suggest that it be adopted as a routine method in the diagnosis of mediastinal tumor and the staging of lung cancer.

Objective To explore the clinical and imaging features of reversible posterior leukoencephalopathy syndrome(RPLES).Methods The data of clinic five cases with RPLES were analyzed retrospectively.Results The primary diseases in this group were hypertension for one case,uraemia for three cases and lupus nephropathy for another.Clinical features of five patients include acute onset of hypertension,headache with vomiting.Neurological symptoms were conscious disturbance,seizures(in 5 cases)and visual disorder(in 3 cases).The movement of limbs were normal.The abnormal laboratery data was renal inadequacy in 5 cases.The findings of imaging of all cases included bilateral white matter of parietal and occipital lobe abnormalities,which appeared as large areas of low density on CT scan,hypo-intense in T1 and hyper-intense in T2 on MRI scan.Four cases presented clinical symptoms improvement in a short time and radiological recovery obviously after anti-hypertensive and anhydration therapy.One patient died caused on brain herniation.Conclusions Clinical features of RPLES is brain damage associated with malignant hypertension or the use of immunosuppressive agents.The most important pathogenesis is considered to be failure of the self regulation of cerebral vascular circulation.The imaging findings are bilateral symmetry cortical and subcortical edema in the posterior areas of the brain.Most patients can be recovery by timely therapy,otherwise the irreversible neuronal injury even death can be also found in very few serious cases.

Objective To investigate the expression of TIMP-1 in brain tissue of perihematoma and the relationship between TIMP-1 and brain edema in experimental intracerebral hemorrhage(ICH). Methods ICH models of rats were established by autologous blood injection. Then the brain water content was measured by comparion of wet and dry weight,the permeability of blood-brain barrier (BBB) was evaluated by evans blue contents,and the expression of TIMP-1 in brain tissue of perihematoma was detected by Western Blot at 1 h,3 h,6 h,12 h,24 h,36 h,48 h,72 h and 7 d total 9 time points after ICH. The relationship among the results were analysed,and compared with the sham operation group. Results Compared with the sham operation group,the brain water contents and evans blue contents were significantly increased at all the time points in ICH group (P

Objective To evaluate the role of mediastinoscopy with biopsy on right trachea-bronchial lymph node (R4) in the diagnosis and pathologic staging of lung cancer. Methods From November 1999 to May 2004, sixty-six patients with lung cancer (47 right and 19 left) received mediastinoscopic biopsy on R4 lymph node. 17 patients were preoperative diagnosed and 49 suspected have lung cancer. The approach included cervical mediastinoscopy in 62 cases, parasternal mediastinoscopy in 1 and cervical combined with parasternal mediastinoscopy in 3. Results In total 66 patients, R4 lymph node positive was found in 49 cases, including 38 patients with right lung cancer and 11 with left lung cancer. The metastasis rate in small cell lung cancer, adenocarcinoma and squamous cell carcinoma were 100%, 82.2% and 52%, respectively. For 49 preoperatively suspected lung cancer patients, malignant tumor was confirmed by mediastinoscopy with biopsy in 40 and open thoracic surgery in 9. All the operations were successful and the patients recovered smoothly without severe postoperative complications. Conclusion R4 lymph node is one of the most common and important site for the tumor metastasis in lung cancer. Mediastinoscopy with biopsy on R4 lymph node has incomparable advantages in diagnosis and staging lung cancer over other examinations and biopsy on other sites of lymph nodes.

Objective To evaluate the efficacy and value of mediastinoscopy in the diagnosis of superior vena cava obstruction syndrome (SVCOS). Methods 12 patients with SVCOS underwent mediastinoscopy. This group consists of 9 males and 3 females aged 16 to 71 years. 7 cervical mediastinoscopies and 5 parasternal mediastinoscopies were performed. Results In eleven patients, definite pathological diagnosis was obtained, included: primary lung cancer in 8, lymphoma in 3 and invasive thymoma in 1. There were no operative morbidity and mortality. Only in 1 patient with lymphoma the symptom got worse after cervical mediastinoscopy and soon released by chemotherapy. Conclusion Mediastinoscopy is an effective method in the diagnosis of SVCOS.It can be considered as a routine procedure if other methods failed.