ObjectiveTo analyze the neurological manifestations of chronic mercury poisoning for the improvement of clinical understanding of this disease.MethodsThe clinical data of 8 cases diagnosed as chronic mercury poisoning admitted in the department of neurology of Xuanwu hospital during the past 5 years were collected and analysed.Results Neurological manifestations of chronic mercury poisoning involved psychological problems,sleep disorders,ataxia,extremities weakness and atrophy,tremor,peripheral neuropathy and paresthesia.ConclusionsThere are various kinds of neurological manifestations of chronic mercury poisoning.Identification of these manifestations in clinical practice and early diagnosis are beneficial for the relief of pains in the patients.

ObjectiveTo evaluate the efficacy and safety of hydroxychloroquine(HCQ) in pregnant patients with systemic lupus erythematosus (SLE).Methods Twenty-four pregnant patients with SLE treated with HCQ during pregnancy from May,2006 to February,2011 were studied retrospectively.All babies were followed up during early infancy for growth development.ResultsOf them,22 patients were treated with HCQ throughout the whole pregnancy with no lupus flare occurred in 21 patients (95.4％),while temporary discontinuation of HCQ precipitated a flare of disease in two patients.Three patients ( 12.5％ ) had premature delivery,and pregnancy induced hypertension happened in 3 patients (12.5％ ).No congenital abnormalities occurred and mean follow-up of 26 months ( range 1 - 47 months) revealed no abnormalities in these children.Conclusion Our findings reinforce the safety of HCQ therapy during pregancy and HCQ should probably be maintained throughout the pregancy in patients with SLE.

ObjectiveTo investigate the possible association of interleukin-23 receptor(IL-23R) polymorphisms with the susceptibility and phenotype of inflammatory bowel diseases (IBD) in Jiangsu Han population.MethodsWe genotyped 178 IBD patients including 135 patients with ulcerative colitis ( UC),43 patients with Crohn's disease (CD),and 134 headthy controls for rs11805303,rs1343151,rs11465804,rs11209032,rs17375018,rs11465788.ResultsComparing with the controls (50.4％ ),there was a significant increase in the carriage of the T allele of rs11805303 in UC (60.4％) ( P =0.020).In genotypephenotype correlation of rs17375018 in UC,clinical severity(UCDAI) was associated with the prevalence of the G allele showed a trend to mild activity.Genotype polymorphisms of rs17375018A was observed more in younger than 25 in the genotype-phenotype correlation in CD(41.7％ vs 22.0％,P =0.050,OR =2.532,95％ CI 0.988-6.494),while rs11805303 was associated with age at diagnose and disease lesion (P =O.039 and 0.044).The risk of extra intestinal manifestation in rs17375018A allele carriers was lower (23.1％ vs46.7％,P=0.040,OR =2.917,95％CI 1.027-8.283).ConclusionsWe confirmed the susceptibility of rs11805303polymorphisms with UC and first demonstrated the genotype-phenot correlation of rs11805303,rs17375018 with UC,CD in Jiangsu Han population.

ObjectiveTo analyze the clinical characteristics of Behcet's disease with intracardiac thrombus.MethodsThe data of 8 patients diagnosed as Behcet's disease with intracardiac thrombus in Peking Union Medical College Hospital from January,1990 to January,2011 were studied retrospectively.ResultsBehcet's disease with intracardiac thrombus was found in 8 patients (5 men and 3 women) with a median age of 28.5 years.Most of them were young men.Thrombus was mostly found in the right side of the heart.Most of the patients had pulmonary thromboembolism with negative anticardiolipid antibody and basically normal C-reactive protein and erythrocyte sedimentation rate.ConclusionIntracardiac thrombus associated with Behcet's disease most commonly occurs in young men and usually involves the right side of the heart.

ObjectiveTo investigate the characteristics of gastroesophageal reflux disease (GERD) with chronic cough by the results of combined multichannel intraluminal impedance and high-resolution manometry (MII-HRM) procedure and 24-hour muhichannel intraluminal impedance combined pH (MII pH) monitoring.Methods From March 2010 to November 2010,consecutive patients of GERD with chronic cough (more than 8 weeks) admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability(SAP) over 95％.Data of lower esophageal sphincter (LES) pressure,LES relaxation,LES residual pressure,esophageal body peristalsis function and swallow bolus transit (liquid/viscous) was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity(acid/nonacid,upright/recumbent),proximal extent,acid exposure and mean acid/bolus clearance time.Seventeen patients of GERD with typical reflux symptom were selected as the control group.ResultsComparing with patients of GERD with typical reflux symptom,patients of GERD with chronic cough showeddecreased upper esophageal sphincter pressure (UESP) [( 122.55 ± 60.48 )mm Hg vs ( 86.37 ± 41.35 ) mm Hg,P ＜ 0.05,1 mm Hg =0.133 kPa ],higher percentage of abnormality peristalsis [(9.47 ± 15.63 ) ％ vs ( 22.16 ± 17.45 ) ％,P ＜ 0.05 ],degraded esophagus transmittability of liquid substance [( 88.82 ± 12.23) ％ vs ( 71.68 ± 23.06 ) ％,P ＜ 0.05 ],more reflux episode activity ( acid/nonacid ) in supine position and proximal reflux episode (nonacid) in supine position (P ＜ 0.05 )and longer mean bolus clearance time( P ＜ 0.05 ).Conclusion Decrease of the UESP,increase of the reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position,lengthened mean bolus clearance time in supine position and the degraded esophagus clearance ability may all correlated with the pathogenesy of GERD with chronic cough.

ObjectiveTo assess the effects of short-term (2-7 d) high-dose (80 mg/d) statins in the prevention of contrast-induced nephropathy ( CIN).MethodsWe searched PubMed, Embase,ScienceDirect,Scopus,Ovid andWileyInterScience with the key wordsof “ statins/statin/HMG-CoA reductaseinhibitor” ,“contrast ” and“ nephropathy/nephrosis/nephrotoxicity/kidneyfailure”inall languages from 1996 t0 2010 for RCT that assessed the preventive effect of short-term (2-7 d)high-dose( 80 mg/d) statins on CIN.ResultsFive trials with a total of 1009 patients were identifiedTwo studies were conducted in patients with CKD 3-5 stages ( GFR≤60 ml/min or serum creatinine≥97.2 μmol/L) and the remaining 3 studies were conducted in patients with CKD l and 2 stages.Analysis of the data in patients with CKD 3-5 stages did not reveal a statistically significant difference in CIN incidence between the statins and placebo groups (6.50％vs 7.2％ ).The relative risk ( RR)was 0.89 without evidence of heterogeneity (12 =Oqo,P=O.79).Analysis of the data in patients with CKD I and 2 stages revealed a significantly lower CIN incidence in the statins group( 3.60-/o )than that in the placebo group( 11.9％ ).The RR was 0.28 without evidence of heterogeneity( I2=0%, P =0.87 ). Conclusion Short-termhigh-dosestatins treatment may be benefical in reducing the incidence of CIN in patients with CKD l and 2 stages,while nobenefit has been shown in the patients with CKD 3-5 stages.

Objective To investigate the risk factors and prognosis influential factors of acute kidney injury (AKI) after cardiac surgery.Methods The clinical data of patients who were hospitalized and underwent cardiac surgery from April 2009 to May 2011 were collected prospectively.Demographic characteristics,types of surgeries,preoperative renal function,pre-and intra-operative conditions and clinical outcomes,etc were recorded.Results A total of 4007 patients underwent cardiac surgery were recruited.The overall incidence of AKI was 31.2％ (1250/4007).The incidence of AKI requiring renal replacement treatment (AKI-RRT) was 2.6％ (104/4007).The overall hospital mortality was 1.9％ (77/4007),and was significantly higher in AKI group than in non-AKI group (5.4％ vs 0.3％,P ＜0.01).The hospital mortality of AKI-RRT group was 36.5％ (38/104).Grouped by type of surgery,cardiac transplantation had the highest AKI incidence (73.0％) and highest in-hospital mortality (18.9％),followed by coronary artery bypass grafting (CABG) combined with valve surgery (AKI incidence 57.8％,in-hospital mortality 6.1％) and aneurysm surgery (AKI incidence 52.0％,in-hospital mortality 5.5％).Multivariate logistic regression analysis showed that man,age,BMI,hypertension,chronic heart failure,pre-operative serum creatinine (SCr) ＞ 106.0 μmol/L,intra-operative cardiopulmonary bypass time,intra-operative hypotension and aneurysm surgery were the risk factors of AKI after cardiac surgery.Multivariate logistic regression analysis showed that pre-operative SCr ＞ 106.0 μmol/L and intra-operative hypotension were independent risk factors of renal recovery after cardiac surgery while recovery of urine output was the favorable factor.Conclusions Cardiac surgery usually induces high AKI incidence and poor prognosis,which closely associated with many risk factors in peri-operative stage.The incidence of AKI is related to a number of perioperative risk factors.Heart transplantation,aneurysm surgery,CABG combined valve surgery are high risk surgeries.

Objective To investigate the effect of the bedside lung ultrasound in emergency (BLUE)-plus lung ultrasound protocol on lung consolidation and atelectasis of critical patients.Methods All patients who need to receive mechanical ventilation for more than 48 hours in ICU from June 2010 to December 2011 in Peking Union Medical College Hospital were included in the study.BLUE-plus and BLUE lung ultrasound,bedside X-ray,lung CT examination were performed on all patients at the same time.The condition of lung consolidation and atelectasis discovered by BLUE-plus lung ultrasound protocol was recorded and compared with bedside X-ray or lung CT.The difference in assessment of lung consolidation and atelectasis between BLUE-plus lung ultrasound protocol and BLUE protocol was compared.Results A total of 78 patients were finally enrolled in the study.The lung CT found 70 cases (89.74％) had different degrees of lung consolidation and atelectasis.The sensitivity,specificity and diagnostic accuracy of lung consolidation and atelectasis by the bedside chest X-ray were 31.29％,75.00％ and 38.46％,respectively.BLUE-plus lung ultrasound protocol found 68 cases with lung consolidation and atelectasis,and its sensitivity,specificity,and diagnostic accuracy were 95.71％,87.50％ and 94.87％,respectively,which were significantly higher than those of lung CT.BLUE protocol found 48 cases of lung consolidation and atelectasis,and its sensitivity,specificity,and diagnostic accuracy were 65.71％,75.00％ and 66.67％,respectively.The position of lung consolidation and atelectasis which hadn't been found by BLUE protocol was mainly proved to be located in the basement of lung by lung CT.Conclusions The incidence of lung consolidation and atelectasis in critical patients who received mechanical ventilation is high.The BLUE-plus lung ultrasound protocol has a relatively higher sensitivity,specificity and diagnostic accuracy for consolidation and atelectasis,which can find majority of consolidation and atelectasis.As BLUE-plus lung ultrasound is a bedside noninvasive method allowing immediate assessment of most lung consolidation and atelectasis,it will be likely the alternative of the CT and play a key role in assessment of lung consolidation and atelectasis.

Objective To evaluate the etiological and clinical characteristics of fungemia in Peking Union Medical College Hospital.Methods Microbial and clinical information of patients with fungemia consulted in Peking Union Medical College Hospital during 2008 to 2010 were retrospectively analyzed.Results A total of 70 patients were diagnosed with fungemia,and 100％ of them had underlying diseases or potential risk factors.Of them,40 (57.1％) patients were monomicrobial fungemia,and the other 30 (42.9％) patients with positive blood cultures were caused by at least two different microbes during hospitalization.Among 122 strains of microbes isolated from blood cultures,72 were fungi and 50 were bacteria.Among the isolated fungi,61 (84.7％) were Candida species,31 (50.8％) were Candida albicans and 30 (49.2％) were non-albicans.According to the colonization or infected sites other than blood of the isolated fungi,35 cases (50.0％) were primary fungemia; 18(25.7％) were colonizing at lower respiratory tract simultaneously; 10 (14.3 ％) caused central-line related fungemia; 3 (4.3％) were secondary to intraabdominal fungal infection; and another 4 (5.7％) isolates had multiple colonization sites.During hospitalization,37 cases died with a crude mortality rate of 52.9％,and 22 (32.9％) died of fungemia itself.In single factor analysis,ICU hospitalization(x2 =15.136,P ＜ 0.001),operation history within 30 days (x2 =3.540,P =0.060) and invasive mechanical ventilation (x2 =4.450,P =0.035) were related to crude mortality.Bacteremia during hospitalization (x2 =5.657,P =0.017),circulatory underlying diseases (x2 =3.399,P =0.065) and ICU treatment (x2 =4.955,P =0.026) increased attributable mortality.In the multivariate analysis,ICU history increased mortality during hospitalization,however,the operation history within 30 days was independently irrelevant to crude mortality during hospitalization.ICU history and bacteremia during hospitalization were independently correlated to attribution mortality of the patients with fungemia.Conclusions Fungemia,usually accompanied with bacteremia,occurs often in the patients with underlying diseases.Patients with fungemia have poor prognosis and more than 50％ patients die.ICU history increases the risk both to crude and attributable mortality.The patients with fungemia who had polymicrobial bloodstream infection have a higher attribution mortality.Operation history within 30 days is independently negatively correlated to attributable mortality.

Objective To characterize the baseline status of Chinese diabetic patients based on data derived from Chinese cohort from SOLVETM study.Methods Patients with type 2 diabetes initiating basal insulin detemir at the decision of the physician were eligible for the study.Data on demographics,medical history,glycemic profile and treatment regimen at baseline were collected by physicians.Results A total of 3272 patients [female 42％,male 58％,mean age (56.2 ± 10.8) years] were included in the study.Their BMI was (25.3 ± 3.3) kg/m2.The duration of diabetes was 4.0 (0.1-27.0) years,and the duration of treatment with oral antidiabetic drugs (OADs) was 3.0(0.0-20.2) years.The proportions of subjects with diabetic macro-and micro-vascular complications were 15.8％ (515 cases) and 27.1％ (866 cases),respectively.The hemoglobin Al c (HbAl c) at baseline was (8.33 ± 1.70) ％,and the fasting blood glucose (FPG) was (9.5 ± 2.6) mmol/L.Conclusions A large proportion of patients with type 2 diabetes remain in poor glycemic control,and the prevalence of diabetic complications is high,which requires optimal therapeutic strategy for the patients with suboptimal glycemic control.