BACKGROUND: This study aimed to investigate the prevalence rate of critical illness-related corticosteroid insufficiency (CIRCI) and the effect of low-dose glucocorticoid on prognosis of CIRCI in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). METHODS: Since January 2010 to December 2012, 385 patients, who met the criteria of AECOPD, were enrolled in the Intensive Care Unit (ICU) of the First People's Hospital and Municipal Central Hospital of Xiangtan City. The AECOPD patients complicated with CIRCI screened by an adrenalcorticotrophic hormone test within 12 hours after admission to ICU were divided into a treatment group (n=32) and a control group (n=31) for a prospective, randomized and controlled clinical trial. Hydrocortisone (150 mg/d) or normal saline was injected intravenously for 7 days. The patients were followed up for 28 days after injection. The endpoint included 28-day survival time, non-shock time, ICU stay and the period of non-mechanical ventilation. The markers of inflammation C-reactive protein, tumor necrosis factor-α, interleukin 6 and procalcitonin were measured at baseline and 7 days after treatment. The variables were analyzed by Student's t test, the non-parametric statistical test, the Chi-square test or the Kaplan-Meier method with SPSS18.0 statistic software. A P value <0.05 was considered statistically significant. RESULTS: Totally 63 patients were diagnosed with CIRCI by an adrenalcorticotrophic hormone test and the prevalence rate was 16.4％. The shock rate of the AECOPD patients complicated with CIRCI was higher than that of the AECOPD patients without CIRCI (23.8％ vs. 8.7％, P<0.01). Kaplan-Meier analysis revealed that the 28-day survival time of the treatment group was obviously longer than that of the control group (P<0.05). Compared with the control group, shock-free days within 28 days was longer in the treatment group (18.2±9.5 vs. 25.8±4.1, P<0.05). Treatment with low-dose glucocorticoid obviously decreased the markers of infection and inflammation (P<0.01), such as C-reactive protein (13.2±5.5 mg/L vs. 8.3±3.1 mg/L for the control group; 13.5±5.9 mg/L vs. 5.1±2.3 mg/L for the treatment group), tumor necrosis factor-α (26.1±16.2 g/L vs. 17.5±11.7 g/L for the control group; 25.0±14.8 g/L vs. 10.4±7.8 g/L for the treatment group) and procalcitonin (3.88 g/L vs. 2.03 g/L for the control group; 3.77 g/L vs. 1.26 g/L for the treatment group). Furthermore, the markers in the treatment group decreased more obviously than those in the control group (P<0.01). CONCLUSION: The prevalence rate of CIRCI was higher in the patients with AECOPD in the department of critical medicine, and low-dose glucocorticoid treatment for one week reduced the 28-day mortality, shock time and markers of infection and inflammation.

OBJECTIVETo observe the spores germinating process of Cibotium barometz, and understand the growth principle provided for experience for indoor culturing and further research.

METHODThe spores of C. barometz were cultured both in inorganic medium and in the soil from original habitat, and the whole process of spores germination and the development of gametophytic were observed under microscope.

RESULTThe spores germinated about 1-2 weeks after being sowed, and the type of germination belonged to Vittaria-type. The prothallial plates formed in 25 days after being sowed, while hairs developed after the formation of the prothallial plate. The gametophyte formed about 40 days after being sowed. But the type of mature prothalli was cordate. The antheridia formed in 60 days after inoculation, while the archegonia developed in 10 days after the formation of antheridia.

CONCLUSIONSoil based indoor culturing of C. barometz spores is practical and can be used for cultivation of C. barometz.

Culture Media ; pharmacology ; Ferns ; cytology ; physiology ; Plants, Medicinal ; anatomy & histology ; cytology ; physiology ; Soil ; Spores ; cytology ; drug effects ; growth & development

BACKGROUNDStudies of interleukin (IL)-4 and IL-6 in the exhaled breath condensate (EBC) of asthmatic patients are limited. This study was to determine the effect of inhaled corticosteroid (ICS) treatment on IL-4 and IL-6 in the EBC of asthmatic patients.

METHODSIn a prospective, open-label study, budesonide 200 μg twice daily by dry powder inhaler was administered to 23 adult patients with uncontrolled asthma (mean age 42.7 years) for 12 weeks. Changes in asthma scores, lung function parameters (forced expiratory volume in 1 s [FEV1], peak expiratory flow [PEF], forced expiratory flow at 50% of forced vital capacity [FEF50], forced expiratory flow at 75% of forced vital capacity, maximum mid-expiratory flow rate) and the concentrations of IL-4 and IL-6 in EBC were measured.

RESULTSBoth asthma scores and lung function parameters were significantly improved by ICS treatment. The mean IL-4 concentration in the EBC was decreased gradually, from 1.92 ± 0.56 pmol/L before treatment to 1.60 ± 0.36 pmol/L after 8 weeks of treatment (P < 0.05) and 1.54 ± 0.81 pmol/L after 12 weeks of treatment (P < 0.01). However, the IL-6 concentration was not significantly decreased. The change in the IL-4 concentration was correlated with improvements in mean FEV1, PEF and FEF50 values (correlation coefficients -0.468, -0.478, and -0.426, respectively).

CONCLUSIONSThe concentration of IL-4 in the EBC of asthmatic patients decreased gradually with ICS treatment. Measurement of IL-4 in EBC could be useful to monitor airway inflammation in asthmatics.

Administration, Inhalation ; Adult ; Asthma ; drug therapy ; physiopathology ; Breath Tests ; Budesonide ; administration & dosage ; Female ; Forced Expiratory Volume ; Humans ; Interleukin-4 ; analysis ; Interleukin-6 ; analysis ; Male ; Middle Aged ; Peak Expiratory Flow Rate ; Prospective Studies

Objective To investigate the feasibility of complicate myomectomy.Methods Six- seven patients with complicated uterine myomas undergoing laparoscopic myomectomy were retrospectively analyzed.The myomectomy was done using ureteral infravision imaging system or/and with self-made myoma segregate-stick.Among the total,there are 29 cases of multiple myomas(the number of myomas≥5)and 23 cases of single myoma(the diameter of myoma≥7cm,including 19 cases of intramural myoma,4 cases of subserous myoma),6 cases of myoma of broad ligament of uterus and 9 cases of cervical myoma.Results All cases were performed successfully laparoscopically.No intra-operative laparotomy or complications occurred.The average operating time and blood loss were(114?32)min and(114?78)ml respectively. The average time of hospital stay was 5.1 d.The average operating time and blood loss in the group (including multiple myoma group,intramural myoma group and cervical myoma)were significantly exceeded the other groups(including myoma of broad ligament of uterus group and subserous myoma group). Conclusions Laparoscopic complicate myomectomy can be performed and the operation indication is enlarged using Ureteral Infravision Imaging System.Advancement in surgical instruments and expert operating skills are the key to operation success.

Taking Guangdong Province Traditional Chinese Medical Hospital as an example,the paper introduces the study idea of hospital IT intelligent operation maintenance and monitoring platform,expounds on design and realization of the platform,including general technical architecture,functional architecture and core business process,summarizes related practical experiences,and points out that application of the platform is able to enhance operation maintenance level and user satisfaction significantly.

BACKGROUNDA new inhalable insulin aerosol (Inh-Ins) was developed in China. The aim of this multicenter clinical study was to evaluate the efficacy and safety of this new Inh-Ins as a treatment of type 2 diabetes. Regular porcine insulin (RI) was used as a control.

METHODSThis study is a prospective, randomized, open-label, parallel-group multicenter clinical trial in which 253 qualified patients with type 2 diabetes received the insulin Glargine daily at bedtime plus either a pre-meal Inh-Ins or a pre-meal subcutaneous RI for 12 weeks. HbA1c, fasting plasma glucose (FPG), the 1-hour-postprandial blood glucose (1hPBG) and the 2-hour-postprandial blood glucose (2hPBG) were measured. Events were monitored for adverse effects.

RESULTSAfter 12 weeks, the HbA1c decreased significantly from baseline in both treatment groups, with no significant difference between the two regimens. In the Inh-Ins group, FPG, both 1hPBG and 2hPBG significantly declined from baseline after the 8th- and 12th-weeks of treatment. The reduced values of FPG or 1hPBG between the two groups showed a more significant hypoglycemic effect with the Inh-Ins than the RI. After 12 weeks, the pulmonary carbon monoxide diffusing capacity (DLco) was significantly lower in Inh-Ins group than in the RI. The main side effects of Inh-Ins were coughing, excessive sputum, and hypoglycemia.

CONCLUSIONSInh-Ins was effective in decreasing HbA1c like the RI. It was better in lowering the FPG and the 1hPBG than the RI. Its main side effects were coughing, excessive sputum, and hypoglycemia. Also, Inh-Ins slightly impaired DLco.

Adolescent ; Adult ; Aerosols ; Aged ; Blood Glucose ; analysis ; Body Weight ; drug effects ; Cough ; chemically induced ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Hypoglycemia ; chemically induced ; Insulin ; administration & dosage ; adverse effects ; Male ; Middle Aged ; Prospective Studies

OBJECTIVEThe aim of this study is to evaluate the clinical significance of High-risk Human Papilloma virus DNA Detection Kit (Cervista HPV HR) designed to the utilized in cervical cancer screening programs.

METHODSThe investigation for Cervista HPV HR test is designed to detect 437 residual liquid-based cytology specimens collected during routine liquid-based Pap tests at standard care vistis and to identify the presence of HR HPV. We compared Cervista HPV HR Test against standard PCR, in order to examine the performance of Cervista HPV HR Test in populations with cervical intraepithelial neoplasia grade 2+ (CIN 2, CIN 3 and Cancer, CIN 2+), and the capabilities of A5/A6, A7, A9 oligonucleotides of Cervista for predicting CIN2+.

RESULTSThe accuracy of Cervista compared to PCR with bi-directional sequencing was 88.26%. The positive percent of Cervista HPV HR Test and PCR were 38.96% and 29.08%, respectively. The sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of Cervista HPV HR Test for the detection of CIN2+ were 98.46%, 58.49%, 99.54% and 29.68%, respectively. The A9 oligonucleotides positivity percent was significantly higher in CIN2 + (odds ratio: 24.037, 95% CI: 10.086 - 57.283).

CONCLUSIONThe Cervista HPV HR test can be clinically used for detecting HR HPV types during routine cervical cancer screening. A9 oligonucleotides were also strongly associated with CIN2+ diagnosis, which is improtant in cervical cancer screening for triage to colposcopy.

Adult ; Aged ; Aged, 80 and over ; Alphapapillomavirus ; genetics ; isolation & purification ; DNA, Viral ; genetics ; Early Detection of Cancer ; methods ; Female ; Humans ; Middle Aged ; Papillomavirus Infections ; diagnosis ; virology ; Reagent Kits, Diagnostic ; Uterine Cervical Neoplasms ; diagnosis ; virology ; Young Adult

OBJECTIVETo investigate over-expression of wild-type alpha-synuclein inducing the aberrant aggregation of alpha-synuclein in HEK293 cell in vitro.

METHODSThe cDNA encoding the human alpha-synuclein without the stop code was cloned into PGEM T-easy vector. Using enzyme map and DNA sequencing analyzed and determined the recombinant plasmid, and then sub-clone the alpha-synuclein cDNA fragment into pEGFP-N1 vector. The recombinant plasmids alpha-synuclein-pEGFP were transfected into HEK293 cells by lipofectamin 2000. The aberrant aggregation of alpha-synuclein was measured by EGFP fluorescence, anti-alpha-synuclein immunocytochemistry. The inclusions in the cultured cells were identified with HE staining.

RESULTSThe restriction enzyme map suggested that eukaryotic expression vector for human wild-type alpha-synuclein gene was constructed successfully. By EGFP fluorescence, anti-alpha-synuclein immunocytochemistry, it could be observed that the alpha-synuclein protein could aggregate in cytoplasm and the Lewy body-like inclusions found in cytoplasm of cultured cells.

CONCLUSIONThe over-expression of wild-type alpha-synuclein can induce protein aberrant aggregation and Lewy body-like inclusions formation in cytoplasm of HEK293 cell in vitro.

Cells, Cultured ; Gene Expression ; Humans ; Immunohistochemistry ; Inclusion Bodies ; metabolism ; Lewy Bodies ; metabolism ; Parkinson Disease ; genetics ; metabolism ; alpha-Synuclein ; genetics ; metabolism

OBJECTIVETo explore the risk factors of fat necrosis in pectoralis major myocutaneous flaps.

METHODSFrom May 1998 to December 2005, 82 patients underwent reconstruction of oral and maxillofacial defects with pectoralis major myocutaneous flaps in our hospital. Postoperative fat necrosis of the flaps was occurred in 10 cases. Logistic regression analysis was used to investigate the risk factors.

RESULTS(1) Logistic univariate regression analysis indicated that there was a significant correlation between fat necrosis of pectoralis major myocutaneous flap and the following risk facoars: obesity, subcutaneous tissues dissection performed by electrotome, the design of skin island beyond the seventh costal cartilage and smoking. (2) Logistic multivariate regression analysis suggested that there was a significant correlation between fat necrosis of pectoralis major myocutaneous flap and obesity, subcutaneous tissues dissection performed by electrotome, the design of skin island beyond the seventh costal cartilage, whereas there was no significant correlation between fat necrosis of flap and smoking.

CONCLUSIONSObesity, subcutaneous tissues dissection performed by electrotome and the design of skin island beyond the seventh costal cartilage were the risk factors of fat necrosis in pectoralis major myocutaneous flap.

Fat Necrosis ; etiology ; Female ; Humans ; Logistic Models ; Male ; Pectoralis Muscles ; pathology ; Postoperative Complications ; Reconstructive Surgical Procedures ; Risk Factors ; Surgical Flaps ; pathology

OBJECTIVETo assess the feasibility of usage of microbubbles conjugated with RGD peptides and contrast enhanced ultrasound (CEU) in detection of tumor angiogenesis.

METHODSLipid microbubbles (MB) were prepared, and the RGD peptides were covalently conjugated to the lipid shell of MB (MB(RGD)). Six nude mice with tumor created by dorsal inoculation of HepG2 tumor cells were used as the test group. Six nude mice without tumor were served as the control group. 10 minutes after bolus injection of MB and MB(RGD) randomly (30 min interval) via a tail vein catheter, CEU was performed on the tumors of the test group and the thigh skeletal muscles of control group. The video intensity (VI) of tumors and the skeletal muscles were measured. The tumors and the skeletal muscles were harvested for immunohistochemical examination.

RESULTSOnly a slight contrast enhancement of the tumor was seen with MB, and the VI was 5.33 ± 1.71. While a remarkable enhancement of the tumor was observed after injection of MB(RGD). The VI was up to 17.03 ± 3.58, 3.18 folds higher as compared with that obtained by injection of MB (P < 0.05). As expected, there were no obvious contrast enhancement of the skeletal muscles with both MB(RGD) and MB. There was a high expression of αvβ3-integrin in tumor neovascular endothelium, however, no apparent expression of αvβ3-integrin was observed in the skeletal muscle vascular endothelium.

CONCLUSIONCEU with MB(RGD) can be used to effectively evaluate the angiogenesis of tumors, and it may greatly contribute to the early judgement of the nature of tumor.

Animals ; Cell Line, Tumor ; Contrast Media ; Endothelium, Vascular ; diagnostic imaging ; metabolism ; Female ; Humans ; Integrin alphaVbeta3 ; metabolism ; Liver Neoplasms ; blood supply ; diagnostic imaging ; metabolism ; pathology ; Male ; Mice ; Mice, Nude ; Microbubbles ; Muscle, Skeletal ; blood supply ; Neoplasm Transplantation ; Neovascularization, Pathologic ; diagnostic imaging ; metabolism ; pathology ; Oligopeptides ; Ultrasonics ; methods ; Ultrasonography