ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P< 0.001], younger than 50 years old (40-49 years old:OR = 1.397, 95%CI = 1.251-1.703,P = 0.002;< 40 years old:OR = 1.701, 95%CI = 1.253-1.836,P< 0.001), PQ plasma concentration≥ 2 mg/L (OR = 3.140, 95%CI = 1.511-3.091,P< 0.001), white blood cell (WBC)> 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P< 0.001), AKI on admission (stage 2:OR = 2.350, 95%CI = 2.160-3.910,P< 0.001; stage 3:OR = 2.821, 95%CI = 1.932-3.651,P< 0.001), accompanying hypoxia (OR = 2.420, 95%CI = 2.131-2.662,P = 0.003) were more likely to receive higher intensity of HP. Furthermore when compared with patients survived for 28 days, patients who were older, with higher levels of PQ concentration at admission or after 4 hours of HP, accompanied by AKI, increased serum creatinine (SCr), WBC, Lac, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, lower arterial partial pressure of carbon dioxide (PaCO2) and lower pH value were more likely to die. After adjusted for con-variables in COX regression model, HHP was associated with lower 7-day mortality after admission [hazard ratio (HR) = 0.843, 95%CI = 0.732-0.971, P = 0.032], but devoid of lowering effect on 28-day mortality rate (HR = 0.930, 95%CI = 0.632-1.411,P = 0.423). In addition, age> 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P< 0.001), WBC>10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.

Objective To evaluate the feasibility and efficacy of catheter-directed thrombolysis (CDT) for the treatment of non-acute (history ＞ 14 days) deep venous thrombosis (DVT) of the lower extremity.Methods Clinical data of 63 patients of non-acute DVT of lower extremities treated by CDT and adjunctive angioplasty and stenting from July 2009 to August 2013 were analyzed retrospectively.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Results A total of 63 limbs with DVT with a mean symptom duration of (22 ± 5) days were treated by a continuous combined with pulse-spray infusion of urokinase of (1.21 ± 0.69) million IU/d for (74 ± 21) hours.Significant recanalization was achieved in 77％ (48 of 63) of the treated limbs.After thrombolysis,percutaneous angioplasty was done for 15 residual lesions and stent placement was performed in 11 iliac veins and 1 femoral vein.Minor bleeding occurred in 6 (10％) patients,no patients suffered from major bleeding or symptomatic pulmonary embolism.During follow up (mean:15 ±6 months),the veins were patent in 45 (71％) limbs.15 (24％) limbs developed mild post-thrombotic syndrome (PTS),and none had severe PTS.Conclusions CDT combined with adjunctive angioplasty and stenting is safe and effective for removal of the clot burden and for restoration of the venous flow in patients with non-acute lower extremity DVT.

Objective With the emerging omnipresence of arthroscopy, the plica syndrome has achieved a clinical recogni-tion as a pathological entity .This study is to investigate the clinical diagnosis and treatment of the medial plica syndrome of the knee . Methods We retrospectively analyzed 198 cases of medial plica syndrome, internal semilunar cartilage and chondromalacia patellae in the knee joints treated in our department from January 2008 to December 2011 .All the patients received physical and MRI examina-tions before admission and underwent plicaectomy, their knee function evaluated according to their Lysholm scores pre-and post-opera-tively. Results The diseased plica synovialis was completely excised in 46 cases diagnosed as simple medial plica syndrome by ar-throscopy.Forty-four of the patients were followed up for 6 to 32 (mean 26) months, and the excellence rate of treatment result was 95.5%. Conclusion Medial plica syndrome of the knee constitutes a larger proportion of knee disorders, for which arthroscopy re-mains the best diagnostic option and total excision of the diseased plica synovialis is an effective treatment .

Objective To investigate the effects of targeted treatment of the carboplatin-Fe@C nanocage-loaded chitosan nanoparticles (C-Fe@CN-CN) combining external magnetic field on rats with transplanted liver cancer.Methods Twenty-four model rats with transplanted liver cancer were established and divided into four groups randomly (n =6).Abdominal exposure was carried out through a midline incision,and a cannula was inserted into the hepatic artery and fixed.Group A:saline water was injected as control,group B:saline water with 10 mg/kg free carboplatin was given,group C:saline water with C-Fe@CN-CN (equivalent dose of free carboplatin 10 mg/kg) was injected in absence of magnetic field,group D:saline water with C-Fe@CN-CN (equivalent dose of free carboplatin 10 mg/kg) was injected in presence of magnetic field for 30 min.All the animals were sacrificed and abdominal exposure was done again after 7 days.After tumors were reselcted,tumor weight and volume was measured,the inhibiting rate of tumor weight was calculated.Tumor and liver tissues were examined for histological changes.Results The growth of tumor was significantly inhibited after therapy with different forms of carboplatin.There was significant difference in the tumor weight of A,B,C,D groups [(0.85±0.12) g,(0.61±0.10) g,(0.48±0.09) g,(0.33±0.06) g,P ＜ 0.05,respectively].The inhibiting rates of tumor weight of B,C,D groups were 28.9 ％,43.4 ％,61.7 ％ respectively.The inhibiting rate of D group was highest which was 1.1 times higher than that of B group.There was also significant difference in the tumor volume of A,B,C,D groups [(1.06±0.24) cm3,(0.72±0.10) cm3,(0.50±0.07) cm3,(0.28±0.05) cm3,P ＜ 0.05,respectively].The tumor volume of group A was largest which was 2.8 times larger than that of group D.In group D,tumor tissues from six rats presented severe necrosis,and nanoparticles were concentrated in the necrotic tissue.In group C,five rats presented middle necrosis,one rats presented severe necrosis.There was no concentration of nanoparticles in the necrotic tissue.In group B,four rats presented middle necrosis,two rats presented mild necrosis.In group A,six rats presented mild necrosis.Conclusion C-Fe@CN-C can significantly increase the therapeutic effects of carboplatin by hepatic artery injection combining with an external magnetic field on the tumor.

Transcranial Doppler can be used for diagnosing,monitoring,identifying the site of arterial occlusion,selecting appropriate cases for thrombolysis,and monitoring arterial recanalization during intravenous thrombolysis,and intra-arterial and intravenous thrombolysis with recombinant tissue plasminogen activator,The continuous monitoring of low frequency transcranial ultrasound has the effect of assisted thrombolysis;however,there are still controversies on the frequencies used in clinical practice.Transcranial Doppler assisted with microbubble contrast agent may further enhance the effect of thrombolysis.

OBJECTIVETo explore the strategy of pediatric intractable epilepsy surgery.

METHODSThe clinical data of 96 pediatric cases with intractable epilepsy and epilepsy syndromes underwent surgical treatment from April 2004 to April 2006 were retrospectively analyzed.

RESULTSThe surgical treatments were performed based on the results of comprehensive data from neurological, neurosurgical and pediatric departments. Among of them, 78 cases were performed with curative procedure, 17 cases with palliative procedure and 1 case with stereotactic damage procedure. The surgical effect was judged with Engel's standard, 58 cases had no seizure during 14 to 26 months follow-up, 26 cases had significantly improved in seizure control and the total efficiency was 87.5%. 81 cases had improvements in neuropsychological tests. 22 cases had postoperative complications such as neuro-dysfunctions and 15 cases were gradually recovered after the period of follow-up ended, 1 case died of CSF over drainage after operation 3 months.

CONCLUSIONSPediatric patients with symptomatic epilepsy and epilepsy syndromes are suitable to surgical treatment, the results are satisfactory in seizure control and neuropsychological function tests.

Adolescent ; Child ; Child, Preschool ; Epilepsy ; surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Retrospective Studies ; Treatment Outcome

BACKGROUND:Bone formation is a dynamic process, and osteoclasts and osteoblasts are involved in this dynamic process. Semaphorins were found first as axonal growth cone guidance molecules, which express in many different tissues and regulate many physiological processes. Recently, Semaphorins are confirmed to play an important role in the regulation of osteoclasts and osteoblasts. OBJECTIVE:To summarize the role of Semaphorins in bone homeostasis. METHODS: A computer-based search of PubMed and Web of Science was performed for articles related to the effect of Semaphorins in regulation of bone metabolism published from June 1993 to January 2014 using the keywords of “semaphorin, sema”. Irrelevant articles or duplicate content articles were excluded, and finaly 48 articles were reviewed. RESULTS AND CONCLUSION:Semaphorins act as a new class of regulatory molecules in the aspect of bone cytobiology. Studies have show semaphorins are actively involved in bone remodeling through some special mechanisms, and semaphorin proteins are crucial for bone homeostasis, which provides a new method and therapeutic target for the treatment of osteoporosis, bone sclerosis, osteolysis adjacent to joint prosthesis and other bone diseases.

Objective To explore the causes of postoperative recurrence in patients of nodular goiter,the selection of method for reoperation and the postoperative complications. Methods The clinical data of 278 nodular goiter patients admitted in the first affiliated hospital of Harbin Medical University between 2001 and 2008 were analyzed retrospectively,including the methods and complications for first operation and reoperation. Results In the first operation,79 eases received simple eminectomy and 167 cases received partial lobectomy,accounted for 28.4% and 60.1%,respectively. Unilateral subtotal lobectomy plus contralateral eminectomy was performed in 23 cases and subtotal thyroideetomy was conducted in 9 cases,accounted for 8.3% and 3.2%,respectively. Postoperative complications occurred in one hundred and twenty-three cases,the incidence being 8.2% (23/278). Unilateral subtotal Iobectomy plus contralateral partial iobectomy was reperformed in 37 cases and bilateral subtotal thyroidectomy in 241 cases. Postoperative complications occurred in 12 cases,the incidence being 4.2%(12/278). No postoperative recurrence of nodular goiter was found. Conclusions Recurrence of nodular goiter is closely associated with the scope of previous surgical treatment,and correct operative manipulation may reduce the recurrent rate.

Objective To study the efficacy and safety of CO2 laser microsurgery for early glottis carcinoma.Methods The data of 96 cases of early glottic laryngeal carcinoma treated with CO2 laser microsurgery were retrospectively analyzed.Surgical specimens were conventionally embedded with paraffin and serially sectioned.Sections were stained by using hematoxylin-eosin for pathologic examination.The local control rate was observed after operation.Results Among the 96 specimens,88 surgical margins were negative and 8 were positive.10 patients (10.4 ％) recurrenced followed up for 3 years.The recurrence rates of Tis,T1a,T1b and T2 were 0 (0/10),4.1％ (2/48),25.0 ％ (4/16) and 18.1％ (4/22),respectively,with significant differences among groups (X2 =6.105,P ＜ 0.05).All of 8 cases with positive margin and 2 cases with negative margin were recurrened.The recurrent rate of patients with involvement of the anterior commissure was 30.0 ％ (6/20),which was higher than that of patients with no tumor invasion [5.3 ％ (4/76)] (X2 =9.624,P ＜ 0.01).Conclusions The safe edges can be obtained by CO2 laser microsurgery for early stage of glottis carcinoma,which have advantages in local control rate,vocal function of the larynx and curative effect.

Objectives To investigate the clinical characteristics of hypoglycemic brain damage, and to assess the ifndings of amplitude-integrated electroencephalography (aEEG) and its predictive value in hypoglycemic brain damage. Methods Twenty-four neonates diagnosed with hypoglycaemia were selected. 12-hour continuous aEEG recordings were performed on the day when hypoglycaemia was diagnosed and second aEEG tracings was performed on the same day or the day after. The variability of aEEG background, appearance of sleep-wake cycling, bandwidth span and amplitude of lower border were analysed and compared with the results of brain MRI. Results Different degrees of epileptic seizures were found in neonates with severe hypoglycemic brain damage and were persisted after the blood sugar was corrected. aEEG in hypoglycemic brain damage was characterized by calyptriform or jagged epileptiform activity, disappearance of the sleep-wake cycle, but little impact on amplitude of lower border and bandwidth span. The recovery of sleep-wake cycle was a sign of brain function recovery. The aEEG and MRI had a good consistency in monitoring the hypoglycemic brain damage. Conclusions aEEG have signiifcant changes in hypoglycemic brain damage and can be used to monitor dynamically hypo-glycemic brain damage.