Objective To study the risk factors and clinical features on acute hepatic dysfunction induced by sepsis.Methods One hundred and sixty-eight patients with sepsis were divided into 2 groups according to liver function:simple sepsis group (control group,142 cases) and acute hepatic dysfunction induced by sepsis group (observation group,26 cases).The biochemical indicators,plasma endothelin (ET)-1,sepsis-related organ failure assessment (SOFA) were compared between 2 groups.The risk factors of inducing acute hepatic dysfunction were analyzed.Results The incidence of acute hepatic dysfunction in 168 patients with sepsis was 15.5％ (26/168).The total bilirubin,direct bilirubin,creatinine,range of blood glucose variation,arterial blood lactic acid,plasma ET-1,SOFA,fatality rate in observation group were significantly higher than those in control group [(35.9 ±9.8) μμmol/L vs.(27.8 ±6.7) μmol/L,(17.7 ± 8.0) μ mol/L vs.(12.3 ± 5.9) μ mol/L,(219.6 ± 156.4) μ mol/L vs.(159.4 ± 125.3) μ mol/L,(7.6 ±4.9) mmol/L vs.(3.0 ± 1.6) mmol/L,(3.8 ± 1.3) mmol/L vs.(2.0 ± 1.2) mmol/L,(79.6 ±25.7)μg/L vs.(60.8 ± 12.6) μg/L,(8.8 ±2.6) scores vs.(5.7 ± 1.8) scores,38.5％ (10/26) vs.17.6％(25/142)],there were statistical differences (P ＜ 0.01 or ＜ 0.05).Multifactor Logistic regression analysis results showed that long-term drinking,cardiac insufficiency and hypotension were independent risk factors of acute hepatic dysfunction induced by sepsis.Conclusions The arterial blood lactic acid,plasma ET-1 and SOFA in patients with acute hepatic dysfunction induced by sepsis are higher.Long-term drinking,cardiac insufficiency and hypotension are the risk factors of acute hepatic dysfunction induced by sepsis.

Objectives To explore the decade-feature of military personnel' s psychosomatic health and Its Influence factors.Methods By random cluster sampling,a total of 11362 military personnel ( including army,navy and air-force) were tested by Chinese Psychosomatic Health Scale (CPSHS) from 80' ( n=1100),90' ( n=8000),2000' ( n =2262)then employing SPSS statistic 17.0 program for data analysis by using ANOVA,LSD multiple-comparison,and stepwise regression analysis.Results The factor of eye-ear( 80s' ( 1.17 ± 1.68),90s'( 1.19 ± 1.64 ),2000s' ( 1.12 ± 1.48 ) ) had no significant difference in three decades (P ＞ 0.05 ) ; military personnel' s respiratory system,cardiovascular system,alimentary system,bone-muscle,skin,reproductive-endocrine system,nervous system,anxiety,depression,psychotic traits,family history,mental heath,physical health,and total psychosomatic health psychosomatic health had significant differences in the three decades (P＜ 0.05 ～0.01 ).The stepwise regression analysis revealed that decade,length of military service,urban-rural,marital state had significant effect on total psychosomatic health( decade:t =- 12.452,length of military service:t =-0.024,urban-rural:t=-0.066,marital status:t=0.119,P＜0.012 ～0.000).Conclusions The level of military personnel's psychosomatic health is improved from 80' s,90' s of last century to the year of 2000; the influenced factors of military personnels' psychosomatic health are including decade,length of military service,rural-urban,and marital status.

ObjectiveTo explore the decade-feature of military personnel' mental maladjustment and its influenced factors.MethodsBy random cluster sampling,a total of 10883 military personnel( including army,navy and air-force) were tested by military mental maladjustment scale (MMMS) in three decades (80s' 90s',2000),then employing SPSS 17.0 for data analysis by using ANOVA,LSD multiple-comparison,and stepwise regression analysis.ResultsThe single scores for behavioral disorders( (2.79 ±2.96),(3.42 ± 2.98 ) vs (2.85± 2.93 ) ),affective disorders ( ( 1.50 ± 1.47 ),( 1.76 ± 1.50 ) vs ( 1.51 ± 1.47 ) ),interpersonal relationship( ( 1.78 ± 1.93 ),( 2.44 ± 2.14) vs (2.30 ± 2.18 ) ),environmental adjustment( (0.63 ± 0.94 ),( 0.89 ± 1.02 )vs ( 1.02 ± 1.18) ),and total score ( ( 6.71 ± 6.01 ),( 8.50 ± 6.20) vs ( 7.69 ± 6.89 ) ) had significant differences in the three decades (P ＜ 0.01 ).The changing disposition of behavior,emotion,interpersonal relationship and total mental maladjustment seemed as reversed V in three decades,but environmental adjustment revealed linear increase; stepwise regression analysis revealed that total scores of mental maladjustment had significant decadeeffect after introducing other four independent variables( t =5.96,P =0.000 ) ; the educational level,urban-rural also had significant influence on military mental maladjustment( t =- 3.15,- 9.02,P =0.002 ～ 0.000 ).ConclusionThe mental maladjustment of military personnel reveale a decreasing disposition from 80s',90s' of last century to the year of 2000 ; the influencing factors are decade,educational level and rural-urban.

Objective To evaluate the significance of oxygen stress test in 10 minutes after fluid resuscitation in the incidence and prognosis of acute kidney injury (AKI) in septic shock patients.Methods From January 2014 to December 2017,fifty-eight patients with septic shock were enrolled.The 10 min oxygen challenge test was conducted using transcutaneous oximetry just before (T0) and 6 h (T1) after initiation of fluid resuscitation,and 10 min oxygen challenge test data(10 min OCT) at TO and T1 were then calculated,respectively.The enrolled patients were divided into L group (10 min OCT＜66 mmHg,32 cases) and H group (10 min OCT ≥66 mmHg,26 cases)according to the 10 min OCT value at T1.The hemodynamic variables and oxygen metabolism indexes,dose of vasoactive agents,10 min OCT at T0 and T1 were recorded,incidence and severity of septic shock-associated AKI,frequency of continuous renal replacement therapy,ICU mortality and 28 d mortality were compared between two groups,the risk factors associated with prognosis were analyzed using COX regression model.Results The hemodynamic variables and oxygen metabolism indexes and dose of vasoactive agents were comparable between two groups at TO and T1 (P ＜ 0.05).The incidence of septic shock-associated AKI (78.1％ (25/32) vs.50.0％ (13/26),x2 =6.365),proportion of phase 3 AKI (53.1％ (17/32) vs.26.9％ (7/26),x2 =8.016) and frequency of continuous renal replacement therapy (46.9％ (15/32) vs.23.1％ (6/26),x2 =5.764) was higher in L group than those in H group(P＜0.05),and similarly were the ICU mortality (23.1％ (6/26)vs.53.1％ (17/32),x2 =7.134,P ＜ 0.05) and 28 d mortality (30.8％ (8/26) vs.62.5％ (20/32),x2 =6.067,P ＜0.05).Therefore,the 6 h 10 min OCT≥66 mmHg was a protective factor to improve the ICU mortality(RR =0.013,95％CI:0.021-0.396,P＜0.05) and 28 d mortality(RR=0.018,95％CI:0.009-0.280,P＜0.05) in patients with septic shock-associated AKI.Conclusion 10 min OCT imposes substantial imquence on the incidence,severity and prognosis of patients with septic shock-associated AKI,oxygen challenge test could improve the treatment of septic shock-associated AKI.

OBJECTIVE: To investigate the clinical characteristics and common etiology of vertigo. METHOD: The clinical data of 168 patients with vertigo in the department of otolaryngolology and neurology from December 2007 to March 2009 were retrospectively analyzed The patients were inquired and examined by pure tone average thresholds, videonystagmography, Dix-Hallpike test, cervical spine X-ray, skull CT and (or) MRI and transcranial Doppler. RESULT: One hundred and thirty-four patients with vertigo were of peripheral origin, with 66 cases benign paroxysmal positional vertigo, 30 cases Meniere's disease, 24 cases sudden deafness, 5 cases vestibular neuritis, 5 cases otitis media ,2 cases ear herpes zosters and 2 cases ototoxicity. Among 26 patients with vertigo of central, 20 patients were vertebrobasilar TIA. CONCLUSION The most common etiology of the vestibular peripheral vertigo is the benign paroxysmal positional vertigo. Detailed history and the features of vertigo, particular about the duration of vertigo and hearing change, may provide the important evidences for the accurate diagnosis and differential diagnosis of vertigo.
Adolescent ; Adult ; Aged ; Electronystagmography ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Vertigo ; diagnosis ; etiology ; physiopathology ; Young Adult

Objective To evaluate the value of contrast-enhanced ultrasound (CEUS) in detection of synovial hyperplasia in wrist joint of patients with rheumatoid arthritis (RA) and to explore the correlation with disease activity . Methods Thirty-nine RA patients with their wrist involved were examined by CEUS . The imaging features of synovitis were observed and the analysis of time intensity curve ( TIC ) was performed by contrast dynamic software . Some quantitative parameters were obtained from these fitting curves including basic intensity ( a0 ) ,increased intensity ( a1 ) ,descending slope ( a2 ) ,ascending slope ( a3 ) , timetopeak(TTP),peakintensity(PI),actualpeakintensity(PI-a0),arrivaltime(AT),andareaunder the curve ( AUC) . And the correlation between these parameters with clinical activity index was analyzed . Results 35 .9％ (14/39) synovitis showed a centripetal enhancement pattern supplied by ring-like or arc-shaped arterials peripherally while 64 .1％ (25/39) showed diffusely entire enhancement . All the lesions were heterogeneous enhanced ,87 .2％ (34/39) of which exhibited hyperenhancement . The detection rate of perfusion defects was 41 .0％ (16/39) . The disease activity in the diffuse enhancement group was higher than that in the centripetal enhancement group ( 4 .64 ± 1 .09 vs 3 .69 ± 0 .67 , P = 0 .005 ) . CEUS quantitative parameters a3 and ( PI-a0 ) were positively correlated with erythrocyte sedimentation rate ( ESR) ( r =0 .465 , P =0 .006 ;r =0 .325 , P =0 .043) ,however TTP had a negative relationship ( r = -0 .352 , P =0 .041) . Conclusions Active synovitis usually represents as a diffuse enhancement pattern . A higher a3 and PI ,and a shorter TTP indicate a higher disease activity . CEUS plays a great role in monitoring RA disease activity both from qualitative and quantitative aspect .