This study was aimed to investigate the correlation between the serum levels of IL-18 and acute graft versus host disease (aGVHD) in patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and to explore the role of serum IL-18 levels in the pathogenesis of aGVHD so as to provide a reliable and early indicator for the diagnosis of aGVHD. 62 patients received allo-HSCT were enrolled in this study. Before and after transplantation, as well as at onset of aGVHD. The serum levels of IL-18 were analyzed by ELISA. 62 patients were divided into 5 groups: group A without aGVHD (28 cases) referred to the patients who had no aGVHD after transplantation and whose specimen were collected before transplantation; group B with aGVHD before transplantation (34 cases) referred to the patients who had aGVHD after transplantation and whose specimen were collected before transplantation; group C before the onset of aGVHD (34 cases) referred to patients with I - II grade a GVHD whose specimen were collected before 3 - 4 days, and according to whether the I - II grade aGVHD patients developed III - IV grade or not after treatment, these patients were divided into two subgroups retrospectively, one subgroup had good curative effect (18 cases) and the other subgroup had not (16 cases); group D with I - II grade aGVHD; group E with III - IV grade aGVHD (16 cases). The results showed that 34 patients developed I - II grade aGVHD, then out of them 16 patients (16/34) developed III - IV grade aGVHD. The serum levels of IL-18 in these patients with aGVHD were higher than that in patients without aGVHD. About 3 days before onset of aGVHD, the serum levels of IL-18 started to increase. The serum levels of IL-18 were correlated with the severity of aGVHD, but no correlation was found with infection, conditioning regimens and disparity of HLA-typing. The serum levels of IL-18 in the early stage of aGVHD were correlated with prognosis. The aGVHD of patients with higher serum levels of IL-18 easy developed to III - IV grade aGVHD. It is concluded that the serum level of IL-18 in the patients received allo-HSCT is related to the occurrence of aGVHD. Detections of serum IL-18 are helpful for the early diagnosis of aGVHD, and the serum levels of IL-18 may be considered as a reliable indicator to evaluate the prognosis and severity of aGVHD.
Adolescent ; Adult ; Child ; Female ; Graft vs Host Disease ; blood ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Interleukin-18 ; blood ; Leukemia ; blood ; therapy ; Male ; Middle Aged ; Young Adult

OBJECTIVE: To analyze the forensic pathological characteristics of sudden death caused by pulmonary thromboembolism and the chronological transformation of thrombus and explore the assessment method of the causal relationship between previous trauma and the following fatal PTE episode. METHODS: All the 23 cases reviewed here were collected from our institute files from the year of 1998 to 2008. RESULTS: Trauma, surgery and braking etc. were all risky factors of PTE. Of these cases, 12 cases were caused by trauma, 21 cases were caused by surgery and 22 cases died in hospitals which were often happened one or two weeks after injury or one week's postoperative time. Of all the cases, 6 cases had single attack of thrombus and the rest 17 cases had the recurrence of thrombus. The number of the leg deep vein to be the embolic source was 16 cases which were often seen in the left leg. CONCLUSION It is important to confirm the embolic source, trauma, surgery and chronological events in determing the sudden death with PTE.
Adolescent ; Adult ; Aged ; Autopsy ; Cause of Death ; Child ; Death, Sudden/etiology* ; Expert Testimony ; Female ; Forensic Pathology ; Humans ; Leg/blood supply* ; Male ; Middle Aged ; Pulmonary Artery/pathology* ; Pulmonary Embolism/pathology* ; Retrospective Studies ; Risk Factors ; Venous Thrombosis/pathology* ; Wounds and Injuries/complications* ; Young Adult

OBJECTIVETo explore the methods of surgical treatment and preservation of laryngeal function in senile patients with advanced laryngeal carcinoma.

METHODSA retrospective data review of 87 advanced laryngeal carcinoma patients aged over 65 years was carried out. Of these 87 patients treated by different modes of surgery, 48 had supraglottic cancer, 35 glottic cancer and 4 subglottic cancer. The surgery modes consisted of major partial laryngectomy in 36 patients, subtotal partial laryngectomy with laryngoplasty in 21 and total laryngectomy in 30. All patients received postoperative radiotherapy to a dose of 50-60 Gy. Kaplan-Meier method was used to analyze the survival.

RESULTSThe overall 3- and 5-year survival rate was 73.2% and 67.4%, respectively. The ultimate rate of larynx preservation was 65.5%. Of 57 patients with partial laryngectomy, 46 were decannulated with a decannulation rate of 80.7%. Yet, in all patients, the nasal feeding tube was removed and food intake per os was resumed. All patients who underwent partial laryngectomy regained their phonation function.

CONCLUSIONIt is safe and effective to treat and preserve laryngeal function surgically in the senile patients with advanced laryngeal carcinoma. The key points to achieve this are selection of proper patient, renovation of surgical procedure and improvement of surgical skill.

Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell ; pathology ; radiotherapy ; surgery ; Female ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Laryngeal Neoplasms ; pathology ; radiotherapy ; surgery ; Laryngectomy ; methods ; Larynx ; pathology ; surgery ; Lymphatic Metastasis ; Male ; Neck Dissection ; methods ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Postoperative Period ; Radiotherapy, Adjuvant ; Retrospective Studies

Adult ; Female ; Heart Diseases ; diagnosis ; Humans ; Mitral Valve Stenosis ; diagnosis ; Postpartum Period ; Pregnancy ; Thrombosis ; diagnosis

Objective To evaluate the effectiveness of minimally invasive therapy on treating hypertensive cerebral hemorrhage.Methods 40 cases hypertensive cerebral hemorrhage were randomly divided into two groups, 20 cases were received the minimally invasive drainage therapy and 20 cases medicine therapy.Results Effective rate was high(P

Global longitudinal strain (GLS) at rest on two-dimensional speckle tracking echocardiography (2D STE) was demonstrated to help detect coronary artery disease (CAD).However,the optimal cut-off point of GLS and its diagnostic power for detecting critical CAD in non-diabetes mellitus (DM) patients are unknown.In the present study,211 patients with suspected CAD were prospectively included,with DM patients excluded.All patients underwent echocardiography and subsequently coronary angiography within 3 days.Left ventricular (LV) GLSs were quantified by 2D STE.Territorial peak systolic longitudinal strains (TLSs) were calculated based on the perfusion territories of the 3-epicardial coronary arteries in a 17-segment LV model.Critical CAD was defined as an area stenosis ≥70％ in ≥1 epicardial coronary artery (≥50％ in left main coronary artery).Totally 145 patients were diagnosed as having critical CAD by coronary angiography.Significant differences were observed in all strain parameters between patients with and without critical CAD.The area under the receiver operating charcteristic (ROC) curve (AUC) for GLS in the detection of left main (LM) or threevessel CAD was 0.875 at a cut-off value of-19.05％ with sensitivity of 78.1％ and specificity of 72.7％,which increased to 0.926 after exclusion of apical segments (cut-off value-18.66％;sensitivity 84.4％ and specificity 81.8％).The values of TLSs were significantly lower in regions supplied by stenotic arteries than in those by non-stenotic arteries.The AUC for the TLSs to identify critical stenosis of left circumflex (LCX) artery,left anterior descending (LAD) artery and right coronary artery (RCA),in order of diagnostic accuracy,was 0.818 for LCX,0.764 for LAD and 0.723 for RCA,respectively.In conclusion,in non-DM patients with suspected CAD,GLS assessed by 2D STE is an excellent predictor for LM or three-vessel CAD with high diagnostic accuracy,and a higher cut-off point than reported before should be used.Excluding apical segments in the calculation of GLS can further improve the predictive accuracy of GLS.It is unsatisfactory for TLSs to be used to identify stenotic coronary arteries.

OBJECTIVE: To analyze the pathological characteristics and the death reasons due to postpartum hemorrhage, and to help to deal with the obstetrical medical tangles. METHODS: Thirty-two cases of death caused by postpartum hemorrhage encountered in our department since 1995 had been collected and retrospectively analyzed. RESULTS: Death caused by postpartum hemorrhage could be divided into single factor and multi-factor, with 81.25% due to single factor, 12.50% multi-factor, and 6.25% unknown reason. The single factors included uterine atony, retained placenta, placenta increta, laceration of the lower genital tract, and coagulation defects. The multi-factor included a combination of two or more factors mentioned above. CONCLUSION The causes of death due to postpartum hemorrhage should be analyzed according to the clinical characteristics of the postpartum hemorrhage and the autopsy examination.
Autopsy ; Blood Coagulation Disorders/complications* ; Cause of Death ; Female ; Forensic Pathology ; Humans ; Placenta, Retained ; Postpartum Hemorrhage/etiology* ; Pregnancy ; Retrospective Studies ; Uterine Inertia

Objective To explore the clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo (BPPV). Methods A total of 48 patients with BPPV of posterior semicircular canal in vertigo clinic of our hospital from May 2007 to December 2008 were retrospectively analyzed in this study. All patients underwent the inspection of caloric test, static posturography, and dynamic posturography. The vestibular tests were performed at two different time points: at onset when patients had typical nystagmus provoked by the Dix-Hallpike maneuver before treatment with the Epley maneuver (canalith repositioning maneuver, CRM ), and at one week after treatment with CRM as their nystagmus disappeared. And results at theses two time points were compared.Eight patients whose dynamic balances were still abnormal after CRM accepted vestibular rehabilitation exercise using dynamic posturography, and re-examined 3 weeks later with dynamic posturography. Results Among 48 cases of BPPV, the abnormal rates of caloric test, static posturography, and dynamic posturography before CRM were 25.0%, 33.3% and 70.8%, respectively. The abnormal rate of dynamic posturography was much higher than that of caloric test or static posturography, and the differences were statistically significant ( χ2 = 4.84, 7.88; P ＜ 0. 05 ). After CRM, the abnormal rates of caloric test, static posturography, and dynamic posturography were 14.6%, 8.3% and 16.7%, respectively. After CRM, the abnormal rate of static and dynamic posturography showed signi? Cant reduction (χ2 = 24.04, 10.08; P ＜0.05 ), however, the results of caloric test showed no significant change (χ2 = 3.20, P ＞ 0. 05 ). Eight patients whose dynamic balances were still abnormal after CRM, accepted vestibular rehabilitation exercise lasting 3 weeks using dynamic posturography. The dynamic balances were all improved to normal after vestibular rehabilitation. Conclusions Dynamic posturography can quantitatively analyze postural balance,and is helpful in comprehensive evaluation of the vestibular function of BPPV patients. Impaired balance often presents in patients with BPPV. Treatment of BPPV using the canalith repositioning maneuver results in improved postural stability in static and dynamic posturography. However, not all patients have normal dynamic stability after successful CRM. The vestibular rehabilitation exercise using dynamic posturography is a helpful adjunct to the treatment for these patients.

Objective To investigate the short-term efficacy and safety of triple semicircular canal occlusion (TSCO) in the treatment of intractable Meniere's disease ( MD),so as to provide an alternative surgical procedure for treating MD.Methods Seventeen patients,who had received standardized conservative treatment for at least one year with poor effect,underwent TSCO were retrospectively analyzed.Vertigo control and auditory function were evaluated.Pure tone audiometry,caloric test,and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular function.Postoperative follow-up period was 6-13 months,with an average of ten months.Results According to the preoperative staging of hearing,among the 17 patients,there were 2 cases in stage Ⅱ ( with an average hearing threshold of 25-40 dBHL) and 15 in stage Ⅲ (41-70 dBHL).No vertigo was found during the follow-up period,with 100％ control rate of vertigo.During the same period,we had performed endolymphatic sac decompression operation in 25 MD patients.The control rate of vertigo was 72.0％.The vertigo control rate of TSCO was significantly higher than that of endolymphatic sac decompression operation ( x2 =3.87,P ＜0.05 ).Three months after surgery,12 patients showed no significant change in comparison to primary status,5 patients presented with an mild increase in the average hearing threshold of less than 20dBHL,with 29.4％ of hearing loss rate.Post-operatively,all patients suffered from temporary vertigo and balance disorders.Vertigo was disappeared in all patients within 3 days,while,balance disorders were disappeared in 10 patients within 1-2 weeks after surgery,and in another 7 patients within 2 months,with an average recovery time of 12.6 days.Three months after treatment,loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in VEMP test was noted.All patients had no facial paralysis,cerebrospinal fluid leakage,and other complications.Conclusions TSCO,which can reduce vertiginous symptoms in patients with intractable MD,represents an effective and safe therapy for this disorder.TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from moderate to severe hearing loss.

Objective To evaluate the feasibility of Blocker PCR assays in monitoring T790M mutations in plasma of non-small-cell lung cancer (NSCLC) patients with epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) acquired resistance.Methods Blocker PCR assays were employed to identify mutations in plasma for 127 advanced NSCLC with acquired EGFR-TKI resistance.In addition,the paired tumor re-biopsy or PE samples were obtained to analyze EGFR mutations.Meanwhile,we evaluated the detection accuracy of Blocker PCR assays in comparison with the next generation sequencing (NGS).Results Among the 127 patients,40.15％ (51/127) EGFR T790M was detected in the plasma,78.44％ (40/51) coexisted with an EGFR activating mutation.Additionally,54.54 ％ (6/11) EGFR T790M was identified in re-biopsy tissues,while 43.75 ％ (14/32) were detected in the plasma.Furthermore,the concordance rate of Blocker PCR and NGS in identifying EGFR sensitizing mutations and EGFR T790M mutations was 100％.Conclusions Blocker PCR is a highly sensitive and reliable method in monitoring EGFR T790M mutations in the plasma of NSCLC patients with EGFR-TKI acquired resistance.