Objective To discuss the diagnostic methods and management of ruptured abdominal aortic (aneurysm)(AAA) and to analyse the main factors that influence prognosis.Methods The clinical data of 15 cases of ruptured infrarenal AAA treated in our hospital from 1998~2004 were retrospectively analysed. The main clinical manifestations were abdominal pain and/or back pain,low blood pressure or shock, and (pulsating) abdominal mass. 8 cases were diagnosed by DSA and/or sCTA; Doppler ultrasonic examination (suggested) rupture of abdominal aortic aneurysm in 2 cases; 2 cases had known history of AAA prior to (rupture); and 3 cases were diagnosed during operation. All of the patients underwent surgical operation. (Successful) clamping of the abdominal aorta above the neck of AAA was accomplished in 13 cases. Of these, the aorta was occluded below the diaphragm in 4 cases, and below the renal arteries in 9 cases.Results Seven cases(46.6%) died in the perioperative period. 2 died of blood loss from aneurysm that ruptured into the free abdominal cavity, 1died of myocardial infarction 5 days postoperatively, 2 died of respiratory failure 3 days and 7 days postoperatively, and 2 died of renal failure 4 days and 8 days after operation. Severe (complications) did not develop in the remaining patients.Conclusions Patients who present with the trilogy of abdominal pain and/or back pain, low blood pressure or shock and pulsating abdominal mass can be (diagnosed) easily. CT and Doppler ultrasonic examination are indicated for patients with questionable diagnosis and have stable vital signs. Operation is effective treatment for ruptured AAA. The crux of the operation is to mack an aortic occlusion proximal to the site of rupture of aorta to effectively control bleeding. Patients with rupture of AAA into the free peritoneal cavity or those with acute myocardial infarction, acute renal failure or respiratory complications had poor prognosis.

ObjectiveTo investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors.MethodsFrom January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. ResultsPancreatic tumors (5/8) and retroperitoneal tumors(3/8)were the primary etiology,andthe main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain.Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence.ConclusionRegional portal hypertension caused by malignant tumor was relatively rare,aggressive resection of multi-viscera combined with devascularization was an effective therapy.

Objective To study the liver protection of crocetin against paraquat (PQ) poisoning induced acute liver injury in rats. Methods Fifty-four male Wistar rats were randomly divided into control group, exposure group and treatment group, and the rats in each group were subdivided into the 0.5th, 2nd, and 6th day after exposure subgroups (n = 6). The model of acute liver failure induced by PQ poisoning was reproduced by intraperitoneal injection of 20 mg/kg of 20% PQ, and the rats in control group was injected with the same amount of normal saline. The rats in treatment group were given with intraperitoneal injection of 50 mg/kg crocetin after 0.5 day, once a day until they were sacrificed; the other two groups were injected with the same amount of normal saline. The rats in all groups were sacrificed at the corresponding time points, and blood was collected from inferior vena cava and hepatic tissue was harvested. Hematoxylin and eosin (HE) staining was used to observe the pathological changes in liver tissue on the 6th day under light microscope. Enzyme linked immunosorbent assay (ELISA) was used to detect the serum tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels. Reverse transcription-polymerase chain reaction (RT-PCR) was used to detect the mRNA expressions of inducible nitric oxide synthase (iNOS) and nuclear factor-κB (NF-κB). The activities of apoptosis related factors, including caspase-8, -9, -12, in hepatic tissue were determined on the 6th day with chromogenic substrate method. Results In the liver tissue of exposed group, extensive infiltration of the inflammatory cells and the diffuse fragments necrosis were visible, and the regeneration of the liver cells was not obvious, and severity of the injury in a time dependent way. In the treatment group, the structure of hepatic artery was visible, and the infiltration of necrosis, congestion and inflammatory cells were not obvious. On the 0.5th, 2nd, and 6th day, serum levels of IL-6 and TNF-α, the mRNA expressions of iNOS and NF-κB in liver tissue, and the caspase-8, -9, -12 activities on the 6th day in the exposure group and treatment group were significantly higher than those in the control group. And the parameters in treatment group were significantly lower than those of the exposure group [IL-6 (ng/L): 188.37±64.21 vs. 376.61±82.42 on the 0.5th day, 287.18±58.69 vs. 432.77±96.28 on the 2nd day, 234.24±10.17 vs. 375.41±37.59 on the 6th day; TNF-α (ng/L): 472.36±76.43 vs. 688.33±102.19 on the 0.5th day, 189.32±87.54 vs. 296.21±89.77 on the 2nd day, 99.28±16.13 vs. 168.41±66.78 on the 6th day; iNOS mRNA (gray value): 2.998±0.801 vs. 3.453±0.026 on the 0.5th day, 3.126±0.306 vs. 5.259±0.153 on the 2nd day, 0.841±0.135 vs. 1.225±0.057 on the 6th day; NF-κB mRNA (gray value): 1.569±0.818 vs. 2.361±0.063 on the 0.5th day, 2.345±0.489 vs. 4.668±0.368 on the 2nd day, 2.348±0.316 vs. 3.972±0.449 on the 6th day; caspase-8 (pmol/mg): 126.77±9.97 vs. 199.18±66.48 on the 6th day; caspase-9 (pmol/mg): 213.12±69.06 vs. 321.62±89.39 on the 6th day; caspase-12 (pmol/mg): 183.46±70.52 vs. 219.68±53.93 on the 6th day, all P < 0.05]. Conclusion Crocetin has protective effect on liver in rats with PQ poisoning, which role is related with reducing the blood level of inflammatory factors, inhibiting the hepatic caspase-8, -9, -12 activities and gene expressions of iNOS and NF-κB.

Objective To retrospectively compare the safety and local efficacy of multiple-electrode switching based radiofrequency ablation (RFA) and the conventional RFA in treating single early-stage hepatocellular carcinoma (HCC).Methods A total of 82 patients with single early-stage HCC received either RFA with a multiple-electrode switching system (n =43) or conventional RFA (n =39) as the first-line treatment.The rate of initial local complete response,major complications and local tumor progression (LTP) were compared between two groups.Results The total ablation time was significantly shorter in the switching-RFA group [(16.7 ± 3.4) mins] than in the conventional RFA group [(29.8 ± 10.4) mins] (P ＜ 0.05).The rate of initial local complete response was 100％ (43/43) in the switching-RFA group and 94.9％ (37/39) in the conventional RFA group (P ＞0.05).After a mean follow-up period of (26.4 ± 21.8)months (ranging 3.0-91.6 months),the rates of LTP in the switching-RFA group and conventional RFA group were 16.3％ (7/43) and 17.9％ (7/39),respectively.The LTP rates in two groups were 16.1％ versus 11.2％ atyear1,and20.5％ versus 20.6％ at year2 (P=0.666).Conclusions The multiple-electrode switching based RFA is safe and effective with shorter ablation time in treating single early-stage hepatocellular carcinoma.

One way to increase the concentration of drug in diseased tissue is to attach drug to a suitable carrier such as proteinor peptides,which can improve the pharmacokinetic properties of drug and decrease it's side-effect on normal tissue. The developments of receptor-mediated transporting of drug assotiated with proteinor peptides are reviewed in this paper. The most frequently used receptors and drug carriers and the bonds between the drug and the carrier are introduced. The machanism of transporting and the factors that affect the efficiency of the drug carrier are discussed as well.

Objective To observe the change of serum leptin in different risk stratifications of coronary heart disease (CHD) and to investigate its relationship with the severity of coronary artery lesion and the coronary artery Gensini score and its value in the coronary heart disease risk stratification .Methods According to coronary angiography ,120 research subjects were enrolled and di-vided into 4 groups :the non-CHD group ,stable angina(SAP) group ,unstable angina pectoris(UAP) group and myocardial infarc-tion group(AMI) ,respectively .The serum leptin levels in 4 groups were determined by immunoassay and the correlation between the leptin level with the coronary heart disease risk factor and biochemical markers of risk assessment was analyzed .Results The serum leptin level in the AMI group was significantly higher than that in the non-CHD group and the SAP group ,the leptin level showed the increasing trend with the increase of the coronary lesion severity and the Gensini scores and was positively related with the CHD risk stratification indicators cTnT and smoking index ,and negatively related with blood uric acid .Conclusion The serum leptin may be used as the valuable marker for evaluating the occurrence of acute coronary event and has good correlation with usual biochemical markers of CHD risk stratification and the severity of coronary artery lesion .

Objective To observe Rongxin Pills in the treatment of viral myocarditis in children (deficiency of both qi and yin and heart meridian stasis syndrome) and the effectiveness and clinical application of safety.Methods Viral myocarditis patients (280 cases,deficiency of both qi and yin and heart meridian stasis syndrome),according to 3:1 ratio as the test group (n =21 0) and control group (n =70).The test group took orally Rongxin pills each time 4.5～9 g,3 times daily;the control group oral coenzyme Q10 capsule each time 10 ～ 20 mg,twice daily.The course of treatment was 28 d.The experiment was carried out with the random and double blind method.The symptoms of myocarditis,integrated and electrocardiogram,echocardiography,myocardial enzymes,as well as the efficacy of traditional Chinese medicine and improvement of the effect of the disease were observed.Results The results of FAS (PPS) analysis showed that 28 d after treatment,the symptom score and mean of experimental group and control group were 5.975 (6.000) and 4.721 (4.788).The syndromes of the total effective rates were 91.62％ (90.59％) and 70.59％ (71.21％),curative effect the total effective rates were 90.14％ (92.08％) and 72.06％ (72.73％).The total effective rate of experimental group was higher than that of the control group,the difference was statistically significant.In this experiment,three cases of clinical adverse events were reported,which were not related to the experimental drug.It also not belongs to adverse drug reactions.Conclusion Rongxin Pill in the treatment of viral myocarditis in children (deficiency of both qi and yin and heart meridian stasis syndrome) is more effective than coenzyme Q 10 capsule,and there was no indication of higher risk of clinical application.

Amongst the survivors of an episode of acute kidney injury, there is an increasing understanding of long-term consequences that may include the development of renal tubulointerstitial fibrosis in chronic kidney disease (CKD) and the progression from CKD to end-stage renal disease (ESRD).The underlying mechanism include maladaptive repair of tubular epithelial cells, immune inflammation overactivation, capillary rarefaction, oxidative stress, etc.As the understanding of the mechanism of chronic outcome after acute kidney injury, the related new intervention targets and strategies have appeared in recent years which create a good prospect for human beings to conquer the problem of poor prognosis of acute renal injury.

Objective To evaluate the role of nutritional parameters in prognosis,especially in the early and late mortality of hospital-acquired acute kidney injury (AKI) patients.Methods This study was a prospective cohort study conducted in a hospital comprising 1500 beds in Shanghai, China. One hundred ninety-four patients with hospital-acquired AKI, as determined using the RIFLE staging criteria,were enrolled as subjects after obtaining informed consent.Patients with AKI caused by postrenal obstruction,glomerulonephritis,interstitial nephritis or vasculitis were excluded.Nutritional evaluation,including subjective global assessment (SGA),anthropometric and laboratory examination,was conducted. Other laboratory measurements and clinical data were recorded.The primary outcome was early mortality (≤ 7 days) and late mortality (8-28 days) after enrolling into the study. Results AKI patients at enrollment were characterized by a high prevalence of malnutrition as determined by SGA, anthropometric and laboratory examination.Univariate analysis showed that the SGA,the serum levels of prealbumin,cholesterol and total lymphatic cells, and the Maastricht index were significantly different among early mortality,late mortality and survival groups.The serum prealbumin and cholesterol levels in the early death group were significantly lower than those in the survival and late death groups (P＜0.05).Multivariate analysis revealed that SGA,albumin,prealbumin and cholesterol remained independently and significantly associated with early mortality after adjusting for age,sex,dialysis,ventilation,hemoglobin,platelets,bilirubin,and Glasgow coma score.The areas under the receiver operating characteristic curve to predict early mortality for albumin,prealbumin and cholesterol were 0.591,0.736 and 0.603,respectively,with that of prealbumin significantly higher than others (P＜0.05). Conclusion Low levels of serum prealbumin,albumin and cholesterol at enrollment are independtly associated with increased early mortality in hospital-acquired AKI patients.

Objective To elucidate the malnutrition in patients with hospital-acquired acute kidney injury(AKI), and to examine the association betweensubjective global assessment (SGA) and prognosis.Methods Adult patients with hospital-acquired AKI were prospectively enrolled in this cohort study.Nutritional evaluations, including SGA, anthropometric and serum nutritional markers were conducted at enrollment.Overall survival at 90 days among different SGA scores was analyzed using Kaplan-Meier methods, and differences were tested using the log-rank test.The Cox model was used to analyze the relationship between SGA scores and all-cause mortality after adjusting for confounders.Results A total of 170 patients were enrolled.The prevalence of moderate malnutrition(SGA B) and severe malnutrition(SGA C) was 51.8％ and 22.9％ respectively, while patients with normal nutrition(SGA A) accounted for 25.3％.After 90 days follow-up, all-cause mortality was 9.8％ in SGA A group, 34.9％ in SGA B group and 56.8％inSGACgrouprespectively. Afteradjustingforage,sex,dialysis,ventilation, hemoglobin, platelets and bilirubin, the hazard ratio(HR) of 90 days all-cause mortality was 4.0(95％ CI 1.42-11.22, P=0.008) in malnutrition group (SGA B group and SGA C group) compared with SGA A group.The Kaplan-Meier curve also revealed that the worse the SGA score was, the lower the cumulative survival became (P＜0.01).Conclusion SGA score is an independent risk factor for all-cause mortality within 90 days in patients with hospital-acquired acute kidney injury.