Objective The management of fluid infusion is crucial in severe sepsis/septic shock patients.The correlation of extravascular lung water index(EVLWI) versus oxygenation index ( PaO2/FiO2 ) and EVLWI versus intrathoracic blood volume index(ITBVI) were analysed in this present study. Method Totally 24 patients,admitted to the Intensive Care Unit of Second Affiliated Hospital of Zhejiang University, College of Medicine and diagnosed as severe sepsis/septic shock with acute lung injury and/or acute respiratory distress syndrome,were enrolled. ITBVI and EVLWI were detected with PiCCO technique. Correlation of EVLWI and PaO2/FiO2, ITBVI and EVLWI were analysed,respectively. Simple correlation and simple linear regression were used for statistical analysis. Results Significant negative correlation was found of EVLWI and PaO2/FiO2 ( r = - 0. 45, P ＜ 0.01).EVLWT = 14 mL/kg was defined as the cutoff value for the subgroup analysis. No correlation was found between EVLWI and PaO2/FiO2 in the subgroup with EVLWI≤ 14 mL/kg ( r = 0. 12, P = 0.243), but in the subgroup with EVLWI ＞ 14 mL/kg, significant negative correlation was found ( r = - 0. 47, P ＜ 0. 01 ). When EVLWI was higher than 14 mL/kg,EVLW should be decreased to improve oxygenation and other aspects should be taken into account. No significant correlation was found between ITBVI and EVLWI. A ITBVI value 1000 mL/m2 was also defined as the cutoff value for the subgroup analysis. No significant correlation was found in the subgroup with ITBVI≤ 1000 mL/m2( r = 0.13, P = 0.17), while significant positive correlation was found in the subgroup with ITBVI ＞ 1000 mL/m2. This result suggested that in patients of severe sepsis/septic shock with ALI/ARDS, when the blood volume is high, ITBV should be decreased to improve the oxygenation,however,it is not useful in the situation of high pulmonary vascular permeability. Conclusions Extravascular lung water has a important role in the fluid management in patients of severe sepsis/septic shock with ALI/ARDS.

With the continuous development of imaging techniques,patients with congenital heart dis-ease,especially in complicated congenital cardiac malformations,have more choices for detection methods of ear-ly diagnosis. Nowadays,the widely used diagnostic imaging methods included echocardiography,CT,MRI,cardi-ac catheterization,and prenatal ultrasound examination. Clinicians should choose the appropriate means of ima-ging test depending on the situation. This article will focus on the clinical application of imaging diagnosis in complicateol congenital heart disease.

Objective To investigate the developmental profiles on surface expression and distribution of NMDA receptor clusters especially on dendritic structures in cultured hippocampal neurons of rats. Methods A vector expressing green fluorescent protein N-terminally tagged NR1a subunit(GFP-NR1a) was generated and transfected into cultured hippocamplal neurons at 5 days in vitro (DIV 5).Surface expressed GFP-NR1a containing NMDA receptor clusters was then labeled in living neurons by using anti-GFP primary antibody followed by Cy3-conjugated secondary antibody.Furthermore,distribution of the surface clusters was observed on the detailed dendritic structures visualized with co-expression of cyan fluorescent protein(CFP). Results Punctate green flourescence clusters can be seen throughout the neurons transfected with GFP-NR1a and surface staining of living neurons showed that the most of these flourescence clusters on dendritic arbors were surface expressed in mature neurons.In parallel,no significant difference was found in terms of density of the surface NMDA clusters on dendritic trees in neurons at different developmental stage.Interestingly,at DIV 7,surface NMDA receptor clusters were mostly observed on the dendritic shafts,but rarely on filopodia.In contrast,two weeks later about 50% of clusters were found located at the dendritic spines.Conclusion This study shows that surface NMDA receptor clusters are distributed in a differentiated way related to dendritic structures during neural development.Especially at very early developmental stage,no clusters was found presented on filopodia,instead they were extensively clustered with a density estimated to be not significantly different from mature neurons.Therefore,our results suggested that NMDA receptors are likely to be incorporated or recruited to postsynaptic sites in the form of pre-expressed surface cluster on dendritic shafts during glutamatergic synapse formation.

Adenocarcinoma, Clear Cell ; pathology ; Adult ; Female ; Humans ; Thyroid Neoplasms ; pathology

OBJECTIVE: To evaluate the efficacy of endoscopic minitrephination combined with endoscopic frontal sinusotomy in the management of complex chronic frontal sinusitis. METHOD: Twenty-six patients suffering from chronic frontal sinusitis with complex frontal drainage approach were analyzed. Eleven patients (13 sides) received endoscopic minitrephination combined with endoscopic frontal sinusotomy, while the other 15 patients (18 sides) received endoscopic frontal sinusotomy only. Postoperatively all cases were followed up to evaluate the efficacy. RESULT: The ostia of frontal sinus were successfully opened in the group of patients received endoscopic minitrephination combined with endoscopic frontal sinusotomy without any complications. In the endoscopic frontal sinusotomy only group, three cases of complications were observed, one with the injury of anterior ethmoidal artery and the other two with the injury of papyraceous lamina. After 10 to 24 months of follow up postoperatively, the symptoms were relieved in all cases without recurrence. The combined surgery group with endoscopic minitrephination showed an endoscopic frontal sinus patency rate of 85%, and the endoscopic frontal sinusotomy only group exhibited an endoscopic frontal sinus patency rate of 83%. CONCLUSION Endoscopic minitrephination combined with endoscopic frontal sinusotomy is a simple, convenient, safe and effective method for management of complex chronic frontal sinusitis.
Adult ; Endoscopy ; Female ; Follow-Up Studies ; Frontal Sinus ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Retrospective Studies ; Trephining ; methods ; Young Adult

Objective To retrospectively analyze diagnosis and treatment of chronic pancreatitis. Methods One thousand and seven hundreds patients with confirmed chronic pancreatitis in 21 hospitals were retrospectively studied,including their associated etiological factors,diagnostic and therapeutic methods.Results Among these patients,601 were alcoholic,576 were biliary diseases origin,which ac- counted for 35.4% and 33.9%,respectively.The most common symptom of chronic pancreatitis was abdominal pain.Some of patients accompanied by steatorrhoea and decreased body weight.Part of pa tients(239 cases)were diagnosed by histopathologic examination.Others were diagnosed by imaging techniques.Alleviation of symptoms was achieved with conservative management.Conclusions Alcohol consumption was the most common predisposing factor for chronic pancreatitis.Imaging techniques play the most important role in diagnosis of the disease,and non-operation managements were the main meth- ods for treatment of chronic pancreatitis.

Objective To observe the effect of PaCO_2 modulating during operation on post-operative cognitive function of patients undergoing off-pump coronary artery(OPCAB). Methods Thirty patients undergoing OPCAB were randomly divided into traditional group (G_ 1 , n=15) and modulated group (G_ 2 , n=15). During operation, PaCO_ 2 in G_ 1 maintained 35 mmHg to 39 mmHg with relatively fixed ventilation parameters setting, and PaCO_ 2 in G_ 2 ranged from 40 mmHg to 45 mmHg by adjusting ventilation parameters. Continuous cardiac output index (CCI), SvO_ 2 , regional cerebral O_ 2 saturation (rSO_ 2 ) and PaCO_ 2 were recorded before distal anastomosis(T_ 1 ), at 5 min of the first distal vessel anastomosis(T_ 2 ), second distal vessel anastomosis(T_ 3 ) and third distal vessel anastomosis(T_ 4 ), and 20 min after the completion of coronary artery anastomoses. HDS-R and ADL were used to examine the patients' cognitive function. Results There were no significant differences in pre- and post-operative HDS-R and pre-operative ADL scores between groups. The score of post-HDS-R in G_ 1 was obviously lower than that of pre-HDS-R (P

21 mmHg.The side effects,IOP and application of anti-glaucoma drugs were examined 1 h,1 d,1 week,1 month,3 months and 6 months after SLT. Results The IOP was significantly decreased 1 week,1 month,3 months and 6 months after SLT compared with that before treatment(P21 mmHg using two anti-glaucoma drugs,respectively. Conclusion SLT is a safe and effective method for IOP control in early CPACG after treatment with laser peripheral iridoplasty and laser iridectomy.

Objective To evaluate the therapeutic effects of needling revision with mitomycin C(MMC) subconjuctival injection on early failed filtering blebs after trabeculectomy for glaucoma. Methods Needling revision with MMC 0.2 mL(0.04 mg) subconjuctival injection was performed on 86 eyes of 76 patients with failed filtering blebs 2 to 6 weeks after trabeculectomy for glaucoma.An average of 1.88 times of treatment was performed.The intraocular pressure(IOP),blebs and side effects were observed,and follow-up was conducted for 6 months. Results Two to six weeks after trabeculectomy,there were 50 eyes with thickened and focalized blebs,32 eyes with encapsulated blebs and 4 eyes with no bleb.Six months after needling revision with MMC subconjuctival injection,blebs of 61 eyes turned into functional ones.The blebs were thinned and multicysted in 24 eyes,diffused and elevated in 37 eyes,thickened and focalized in 6 eyes,encapsulated in 13 eyes and disappeared in 6 eyes.Three months after treatment,the mean IOP was(15.2?6.1) mmHg,and there were 57 eyes with IOP

Objective To analyze the diagnosis and therapy of pemphigus and pemphigoid.Methods Clinical data were retrospectively analysed for 648 patients with pemphigus or pemphigoid admitted in Huashan Hospital,Fudan University from 2003 to 2007.Results The mean age of onset of pemphigus was younger than that of pemphigoid(47.0±16.9 years vs 65.1±13.9 years.P＜0.001).Of 175 patients with pemphigus confirmed by direct immunoflorescence(DIF),100%were positive for IgG,and 92.0%for C3,while out of 223 patients with pemphigoid,51.12%were positive for IgG,99.1%for C3.For pemphigus,the consistency reached 68.8%among clinical diagnosis.pathological diagnosis and immunological(DIF)diagnosis,80.7%between pathological and immunological diagnosis.In the case of pemphigoid,the consistency was 62.8%among clinical,pathological and immunological diagnosis,and 78.1%between pathological and immunological diagnosis.Corticosteroids were primary treatment strategy for both pemphigus and pemphigoid.and prednisone of 0.5-1.5 mg per kilogram bodyweight per day could control the condition of most patients.Conclusions DIF could be used as an important diagnostic means for patients with pemphigus or pemphigoid which can not be confirmed by clinical manifestation or pathology.In primary hospitals,IgG and C3 are recommended for DIF testing when pemphigus is suspected,and C3 is recommended for suspected pemphigoid.