Objective To investigate the impact of relevant factors in mechanical ventilation on intraabdominal pressure in patients with ALI/ARDS by continuous monitoring of intra-abdominal pressure.Methods A total of 116 ALI/ARDS patients treated with mechanical ventilation in ICU were enrolled in this study.Intra-abdominal pressure (IAP) was recorded continuously.Meanwhile ventilator parameters, arterial blood gas analysis, hemodynamic variables, and as well as the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid (BALF) were determined and recorded.The detection of risk factors for intra-abdomen hypertension (IAH) were carried out using multivariate stepwise logistic regression.ROC curve analysis used to estimate the diagnostic performance of these parameters for IAH.Results The oxygenation index (PaO2/FiO2) in patients with IAH after 2 hours' mechanical ventilation was significantly lower than that in patients with normal intra-abdomen pressure (IAP) (P ＜ 0.01);PEEP and RR in mechanical ventilation were higher in IAH group (P ＜ 0.01 or P =0.001);Mean artery pressure (MAP), ejection time percent (ET), stroke volume (SV), cardiac index (CI) were lower in IAH group than those in normal IAP group (P ＜ 0.01);the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid were higher in IAH group than those in normal IAP group (P ＜ 0.01);IAH patients have a higher mortality on 28 d (Log rank test, P =0.023).Poor oxygenation index (PaO2/ FiO2) after 2 hours' ventilation, high PEEP setting, low MAP, ET, SV, CI and elevated IL-4 in the BALF were resulted in increasing risk of IAH for ARDS patients under mechanical ventilation support.Conclusions The monitoring of intra-abdominal pressure should be emphasized for ALI/ARDS patients when mechanical ventilation was employed.PaO2/FiO2, SV and IL-4 in BALF might be the independent risk factors of IAH.

ObjectiveTo study the roles of cytokeratin-19 ( CK-19 ),vimentin,vascular endothelial growth factor-C( VEGF-C ),and cyclooxygenase-2 ( COX-2 ) played in the occurrence and development of Graves'disease(GD) and Hashimoto's thyroiditis(HT).Methods57 cases of GD and 58 cases of HT were enrolled in our study.Immunohistochemistry using SP method was carried out for assessment of the expression of CK-19,vimentin,VEGF-C,and COX-2 in the thyroid tissues.Results CK-19,VEGF-C,and COX-2 were expressed in the cytoplasm of thyroid follicular epithelial cells.Vimentin was expressed both in the mesenchyma and in the cytoplasm of thyroid follicular epithelial cells.The positive rates and expression intensities of CK-19 and VEGF-C in HT ( 86.2％,96.6％ ) were significantly higher than those in GD ( 43.9％,56.1％,all P＜0.05 ).The expression intensities of vimentin and COX-2 in GD ( 100.0％,93.1％ ) were similar to those in HT ( 100.0％,91.2 ％ ),while the expression intensity of COX-2 in HT was significantly higher than that in GD( all P＜0.05 ).The positive rates of CK-1 9 were much higher in type Ⅲ ( 81.3％ ) of GD than in type Ⅰ ( 1 5.8％ ) and type Ⅱ ( 40.9％ ) of GD,and also higher in type P( 100％ ) of HT than in type L(66.7％ ) of HT.The positive rates of VEGF-C were much higher in type Ⅲ ( 87.5％ ) of GD than in typeⅠ ( 36.8％ ) and type Ⅱ ( 50.0％,all P ＜ 0.05 ) of GD.ConclusionImmunohistochemical detection of the expression of CK-19,vimentin,VEGF-C,and COX-2 may carry clinical significance in revealing the occurrence and development as well as evaluating the prognosis of Graves'disease and Hashimoto's thyroiditis.

The pathogenic effects of crops from Keshan disease area were studied by rat-feeding. As double controls, another two groups were fed with crops from non-endemic area and synthetic diet. Those from disease area caused necrosis of heart muscle vascular changes of myocardial mitochondria and fatty degeneration of liver. Compared with the controls, the free radical and lipid peroxide content in heart and liver were significantly higher, while the ATP and AN contents in these organs were apparently lower. The multielement contents and its constituent patterns in the feeds, whole blood, heart, liver, kidney and brown adipose tissue of rats in experimetal group were apparently different from those in the control groups. The statistic analysis of multiple factors showed that eight elements Se, Mo, Cu, Mn, Cr, Fe, Zn and Pr might be the perilous factors, that is, under the condition of low selenium, the constituent pattern of selenium and the eight elements might be the complicated factors of endemic crops.

Objective To compare the short-term efficacies of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity and type 2 diabetes mellitus,and to investigate the relationship between the body weight loss and the decrease of glucose of the 2 treatment methods.Methods The clinical data of 40 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Changhai Hospital of the Second Military Medical University from January 2010 to December 2011 were retrospectively analyzed.There were 14 patients treated by LAGB (LAGB group) and 26 by LSG (LSG group).The body weight loss and the decrease of glucose at postoperative year 1 of the 2 groups were compared.The differences in the body weight and glucose before and after operation within groups were compared using the paired t test,and the differences in the body weight and glucose between the 2 groups were compared using the multiple analysis of variance.The correlation between the body weight loss and the decrease of glucose was analyzed using the linear regression analysis.Results Laparoscopic surgery was successfully done without conversion to open surgery or intraoperative complications.The operation time and volume of blood loss were (69 ± 16)minutes and (31 ± 14)mL in the LAGB group,(120 ± 15) minutes and (148 ± 48) mL in the LSG group.Complications including postoperative malnutrition,electrolyte disturbance,delayed gastric emptying,bleeding,anastomotic leakage did not occurr in the 2 groups.Two patients were complicated with abdominal incision fat liquefaction,and were cured by symptomatic treatment.(1) The body weight,body mass index (BMI) and waistline had a decrease trend.The body weight,BMI and waistline in the LAGB group were decreased from (117 ± 28)kg,(40 ± 8)kg/m2 and (118 ± 15) cm before operation to (94 ± 28) kg,(33 ± 8) kg/m2 and (92 ± 15) cm at postoperative week 48.The body weight,BMI and waistline in the LSG group were decreased from (119 ± 25)kg,(42 ± 6)kg/m2 and (123 ± 14)cm before operation to (74± 16)kg,(26± 4)kg/m2 and (86 ± 13)cm at postoperative week 48.The EWL had an increase trend in the 2 groups.The EWL in the LAGB group was increased from 7％ ± 2％ at postoperative week 1 to 53％± 24％ at postoperative week 48,and the EWL in the LSG group was increased from 11％ ± 4％ at postoperative week 1 to 90％ ± 20％ at postoperative week 48.There were significant differences in the changes of body weight,BMI,waistline and EWL between the 2 groups (F =60.660,74.490,57.650,90.020,P ＜ 0.05).(2) The levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein in the LAGB group were decreased from 8.1％± 0.8％,(8.4±0.6)mmol/L,(21±8)μmol/L,7.9 ±2.9,(1.68±0.50)mmol/L,(6.0±1.1)mmol/L (4.1 ± 0.8) mmol/L,(1.09 ±0.15)mmol/L to 6.4％ ±0.8％,(6.3 ±0.3) mmol/L,(10 ± 3) μmol/L,2.7 ±0.9,(1.04 ± 0.09) mmol/L,(4.3 ± 0.8) mmol/L,(2.3 ± 0.4) mmol/L,(1.22 ± 0.09) mmol/L at postoperative week 48 ; the levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein in the LSG group were changed from 7.9％ ± 1.0％,(9.0±1.0)mmol/L,(21 ±9) μ mol/L,8.5 ±3.5,(2.09 ± 0.70) mmol/L,(6.0 ± 1.2)mmol/L,(3.9 ± 1.1) mmol/L,(1.06 ± 0.21) mmol/L before operation to 5.1％ ± 0.8％,(5.2 ± 0.4) mmol/L,(4 ± 1)μmol/L,0.9±0.2,(1.22±0.17)mmol/L,(4.2±0.8)mmol/L,(2.3 ±0.6)mmol/L,(1.30±0.13)mmol/L at postoperative week 48.There was a decrease trend of the glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,trigluceride,total cholesterol and low density lipoprotein and a increase trend of the high density lipoprotein in the 2 groups.There were significant differences in the levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein between the 2 groups (F =57.650,74.270,36.750,42.960,10.870,30.650,32.560,11.490,P ＜0.05).The levels of glucose of the LAGB group at postoperative month 1 and 3 were influenced by BMI (b =0.543,0.753,P ＜ 0.05),while the levels of glucose of the LAGB group did not be influenced by BMI at postoperative month 6 and year 1 (b =0.130,0.222,P ＞0.05).The levels of glucose of the LSG group did not be influenced by BMI at postoperative month 1,3,6 and year 1 (b =0.185,0.035,0.212,0.126,P ＞0.05).Conclusions The efficacy of LSG is superior to LAGB for the treatment of obesity combined with type 2 diabetes mellitus.The efficacy of LAGB is correlated with the change of body weight,while the efficacy of LSG does not correlated with the change of body weight.

Purpose To explore the value of direct CT venography (CTV) for the diagnosis of varicose veins of lower limb. Materials and methods Forty patients diagnosed as varicose veins of lower limbs were enrolled. 40 patients with 56 involved limbs underwent direct CTV examination, and their images were stratified and evaluated according to the severity and the scope of the disease. Main assessment:definition and scope of CT axial scans combined with volume rendering (VR) and maximum intensity projection for the display of the varicose veins; situation for the display of perforating veins, deep veins and iliac veins;diagnostic compliance between CTV and DSA. Results All of the 56 involved limbs underwent laser intra-cavity occlusion surgery, among them 7 cases with 11 limbs underwent venous angiography under DSA at the same time. In the evaluation of the VR, excellent proportion was 92.86%(52/56), moderate proportion was 7.14%(4/56). Among the deep veins, ratio of the imaging that was able to meet the diagnostic standard was 94.34%, 88.46%and 27.27%, respectively for calf vein, femoral vein and external iliac vein. The total demonstration rate of perforating veins was 98.21%(55/56). Diagnostic compliance between CTV and DSA was 100.00%. Conclusion Lower extremity direct CTV imaging is convenient and noninvasive for patients with varicose veins, with high compliance with DSA results, thus is significantly valuable for the guide of clinical treatment.

Objective To explore the clinical values of applying contact-mode argon plasma coagulation (APC) for retroflex colonoscopic treatment of ultra-lower rectal polyps. Methods 46 wide outsole and applanate polyps smaller than 1.0 cm located at ultra-lower rectum in 17 cases of patients were treated by contact-mode APC under U-type retroflex colonoscopy after failure in regular colonoscopic treatment. Then observe the contacting rate of APC probe with polyps, success rate of curing polyps, rate of probe being adhered and blocked by the solidification structures, incidence of submucosal emphysemas, and incidence of colonoscope ambustion. Results Under U-type retroflex colonoscopy, the probe could contact with polyps in 17 patients. The polyps in every patient were cured by APC in the first time of colonoscopic treatment, whereas all 46 polyps were cured by 97 times of APC spurt. Mild adhesions occurred between the probe and solidification structures at 5 times (5.15 %) among 97 times of APC spurt, without injuries to the coagulation surface from which when the probe separated. The solidification structures blocked the probe only twice (2.06 %). When the solidification structures were cleared, efficiency of the probe restored. No sub-mucosal emphysemas and colonoscope ambustion happened. Conclusion Applying contact-mode APC for retroflex colonoscopic treatment of ultra-lower rectal polyps is safe and effective, it can prevent the damage of colonoscope from the argon knife.

The objective of this study was to elucidate the association of various risk factors with dengue cases reported in Lundu district, Sarawak, by analyzing the interaction between environmental, entomological, socio-demographic factors. Besides conventional entomological, serological and house surveys, this study also used GIS technology to generate geographic and environmental data on Aedes albopictus and dengue transmission. Seven villages were chosen based on the high number of dengue cases reported. A total of 551 households were surveyed. An overall description of the socio-demographic background and basic facilities was presented together with entomological and geographical profiles. For serological and ovitrap studies, systematic random sampling was used. Serological tests indicated that 23.7% of the 215 samples had a history of dengue, either recent or previous infections. Two samples (0.9%) were confirmed by IgM ELISA and 49 samples (22.8%) had IgG responses. A total of 32,838 Aedes albopictus eggs were collected in 56 days of trapping. Cluster sampling was also done to determine whether any of the risk factors (entomological or geographical) were influenced by geographical location. These clusters were defined as border villages with East Kalimantan and roadside villages along Lundu/Biawas trunk road. The data collected were analyzed using SPSS version 10.01. Descriptive analysis using frequency, means, and median were used. To determine the association between variables and dengue cases reported, and to describe the differences between the two clusters of villages, two-sample t-test, and Pearson's Chi-Square were used. Accurate maps were produced with overlay and density function, which facilitates the map visualization and report generating phases. This study also highlights the use of differential Global Positioning System in mapping sites of 1m accuracy. Analysis of the data revealed there are significant differences in clusters of villages attributable to container density, house density, distance of the house from the main road, and number of Ae. albopictus eggs from ovitraps set indoor, outdoor and in dumping sites (Person's Chi-Square = 6.111, df = 1, p < 0.01). Further analysis using t-test showed that house density, container density, indoor mosquitoes egg count, outdoor mosquitoes egg count, and dumping sites mosquitoes egg count were higher at the roadside villages compared to border villages. A number of potential risk factors including those generated from GIS were investigated. None of the factors investigated in this study were associated with the dengue cases reported.
Dengue ; seconds ; physical density ; Risk Factors ; Analysis of substances

ObjectiveTo investigate the diagnoses of somatic diseases of inpatients with psychosis and hospitalized more then 2 years.MethodsThe material of all 350 inpatients were investigated and analyzed.ResultsThe first three psychiatric diagnoses were schizophrenia (61.32%), Alzheimer's disease (15.26%), mood disorder (4.74%). The first three diagnoses of accompanying somatic diseases were heart disease (8.68%), diabetes mellitus (8.42%), and hypertension (4.47%).ConclusionWith the changes of social environment, the disease pedigree of inpatients with psychosis changes, senile patients become more and more, and the incidence of concurrent somatic diseases gradually increases.

According to the analysis of 9 237 hospitalized type 2 diabetic patients, the prevalence of diabetic retinopathy ( DR )was 32.9％ , with the prevalence of mild, moderate, and serious non-proliferative DR and proliferative DR being 10. 1％, 18. 3％, 3.2％, and 1.3％ respectively. The prevalence of diabetic macular edema ( DME ) was 3.56％ in type 2 diabetics and i 0. 8％ in patients with DR. Diabetes duration and proteinuria were the common risk factors of DR and DME.

Objective To explore the clinical effect of traditional Chinese medicine (TCM) dialectical therapy for treatment of gastrointestinal dysfunction in patients with acute lung injury / acute respiratory distress syndrome(ALI/ARDS)undergoing mechanical ventilation. Methods A prospective,randomized controlled trial was conducted. Ninety-six ALI/ARDS patients admitted in intensive care unit(ICU)and treated with mechanical ventilation in Tianjin First Central Hospital were chosen and randomly divided into traditional Chinese medicine(TCM) group and conventional therapy group using a random number table,48 patients in each group. Conventional therapy alone was used in conventional therapy group,and TCM therapy of primarily using Dachengqi decoction combined with conventional therapy was applied in TCM group〔Dachengqi decoction was composed of mongolian milkvetch root 15 g, pilose asiabell toot 15 g,Chinese angelica 10 g,officinal magnolia bark 10 g,tangerine peel 10 g,immature tangerine fruit 10 g,peach seed 10 g,white peony root 12 g,red peony root 12 g,immature bitter orange 6 g,mongolian dandelion herb 30 g,radish seed(stir-fried)30 g,foxtail millet sprout 20 g,barley sprout 20 g,glauber salt 9 g (with water),rhubarb 10 g(added in water at last)〕,one dose orally taken daily for 28 days. The intra-abdominal pressure(IAP),gastrointestinal diseases in TCM symptom score and the incidence of gastrointestinal dysfunction were compared between the two groups before treatment and on the 3rd,6th and 8th day after treatment. Results There were no statistical significant differences in IAP and TCM symptom scores between the two groups before treatment (both P>0.05),but after treatment with the prolongation of therapeutic time the IAP and TCM symptom scores were decreased gradually compared with those before treatment,having reached the valley value on the 18th day and the changes in TCM group were more remarkable〔IAP(mmHg,1 mmHg=0.133 kPa):0.91±0.69 vs. 2.08±0.92, TCM symptom score:48.33±10.41 vs. 88.33±20.21,both P<0.05〕. In the TCM group,the incidences of the untoward symptoms and signs of gastrointestinal dysfunction such as bleeding of stress ulcer,toxic intestinal paralysis, abdominal distension,diarrhea and so on were lower than those in conventional therapy group〔stress ulcer bleeding:16.7%(8/48)vs. 39.6%(19/48),toxic intestinal paralysis:16.7%(8/48)vs. 43.8%(21/48),abdominal distension:10.4%(5/48)vs. 37.5%(18/48),diarrhea:6.3%(3/48)vs. 33.3%(16/48),all P<0.05〕. Conclusion Addition of TCM Dachengqi decoction on conventional treatment can effectively lower the incidence of gastrointestinal dysfunction in treatment of patients with ALI/ARDS undergoing mechanical ventilation.