Objective To assess the value of enhanced MSCT scan for the Crohn's disease of small bowel.Methods Fourty-five patients of small bowel Crohn's disease who were proved by multi-methed were examined by two-phase enhanced scan with MSCT.The images were reformed in ADW 4.2 by MPR mainly.The CT values of the lesion segments in different phases were tested, with one way ANOVA in statistical analysis; the density difference between the lesion segments and normal segments in different phases were tested,the cases were divided according to 10 HU,and compared them with each other by X2 test.Results The average CT value of lesion segments was (39.3±3.7) HU in plain scan, (74.8 ± 13.8) HU in artery phase, (90.2 ± 12.3) HU in portal vein phase, there were sinigicant difference in them(F =258.87,P < 0.01).There were sinigicant difference in CT value of lesion segments between any phase and other two phases (P < 0.05).In 45 cases, there were 44 cases and one case that the difference of CT value were ≤±10 HU and > 10 HU respectively in plain scan, 6 cases and 39 cases in artery phase, 2 cases and 43 cases in portal vein phase, by X2 test, there were sinigicant difference betwwen plain scan and artery phase(X2 =32.49,P <0.01), and significant difference between plain scan and portal vein phase(X2 = 39.22,P <0.01), there were no significant difference between artery phase and portal vein phase (X2 = 1.10,P>0.05).After enhancement, the lesions can display clearly than plain scan, and the detectable rate was raised highly.Conclusion Two-phase enhancement scan can diagnosis the Crohn's disease of small bowel and evaluate it overall.

Objective:To analyze clinical characteristics of cutaneous delayed-type hypersensitivity caused by injection of equine tetanus antitoxin (TAT) or equine anti-tetanus immunoglobulin F (ab′) 2. Methods:Clinical data were collected from 181 outpatients or inpatients with cutaneous delayed-type hypersensitivity caused by injection of equine TAT or anti-tetanus immunoglobulin from 2008 to 2020, and retrospectively analyzed.Results:Before the injection of equine TAT or anti-tetanus immunoglobulin, skin test was negative in 171 (94.47%) of the 181 patients, and the 10 (5.53%) patients with positive skin test responses received desensitization injection. Among the 181 patients, there were 118 males and 63 females aged from 11 to 68 years, with the disease duration of 1 to 7 days and alatency period of 4 to 14 days. There was no significant difference in the clinical manifestations between the patients receiving injection of TAT (130 cases) and those receiving injection of equine anti-tetanus immunoglobulin (51 cases) . Urticaria-like rashes were the main clinical manifestation, and infiltrative erythema occurred at the injection site in 12 patients, of whom 10 developed generalized urticaria all over the body. Of the 181 patients, 163 (90.06%) presented with generalized skin rashes, and 56 (30.94%) had systemic symptoms such as chest tightness, fever, etc, of whom 15 (26.79%) had a history of allergies and 6 with severe symptoms had no history of allergies. Thirty-four (18.78%) patients had single or multiple laboratory abnormalities, such as increased white blood cell counts, elevated C-reactive protein level and urinary glucose, and presence of occult blood in urine. All cases responded well to the treatment with antihistamines and glucocorticoids. The treatment duration ranged from 3 to 10 days, and the outcome was good.Conclusion:TAT-or anti-tetanus immunoglobulin-induced cutaneous delayed-type hypersensitivity may still occur in patients with a negative skin test or after desensitization treatment, and mainly manifests as urticaria-like rashes.

Objective To investigate the effects of crude extracted proteins from lesions of condyloma acuminata on immunophenotypes of dendritic cells.Methods Plastic-adherent mononuclear cells(MNCs)were isolated from umbilical cord blood or peripheral blood and cultured in media containing cytokines(GM-CSF,IL-4and LPS).The morphology and phenotypes of these cells were analyzed by flow cytometry and microscopy in12day's culture.Cells on the fourth day were incubated with crude extracts from lesions of condyloma acuminata,foreskin proteins,and PBS,respectively,followed by phenotypic analysis after9-12days' culture.Results Expression of antigens CD1a,CD80,CD86,MHC-I,MHC-II,CD14,CD54was detected after12days' cul-ture.It was shown that MNCs could be induced to differentiate to mature dendritic cells in our culture system.After incubation with crude extracts from lesions of condyloma acuminata for another9-12days,expression of CD86and HLA-DR was increased on dendritic cells.Conclusions Compared to foreskin and PBS pulsed dendritic cells,expression of CD86and HLA-DR is upregulated on dentritic cells after pulsing with condyloma acuminata lesion proteins.The data suggest that crude extracts from lesions of condyloma acuminata might enhance antigen-pre-senting capacity of dendritic cells and strengthen activation of T lymphocytes.

Objective:To investigate the prognostic factors of severe patients with bloodstream infection (BSI) caused by Enterobacteriaceae bacteria. Methods:Patients suffered from BSI caused by Enterobacteriaceae bacteria admitted to department of critical care medicine of Binzhou Medical University Hospital from October 2016 to October 2019 were enrolled. The information of gender, age, combined shock, acute physiology and chronic health evaluationⅡ(APACHEⅡ), sequential organ failure assessment (SOFA), sensitivity of initial antibiotics, as well as the baseline of procalcitonin (PCT), white blood cell count (WBC), platelet (PLT), albumin (ALB) were collected. The 72-hour PCT clearance rate (72 h PCTc) was calculated after 72 hours' treatment. According to the clinical outcome after 28 days, the patients were divided into recovery group and death group. The differences of clinical indicators between the two groups were compared, and then the statistical significant variables were further performed by Logistic regression to analyze the factors affecting the prognosis of patients. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of the factors in severe BSI. Results:A total of 86 patients were enrolled, among whom 54 cases recovered while 32 cases died, and the 28-day mortality was 37.2%. There was no significant difference in gender, age, sensitivity of initial antibiotics, baseline levels of PCT and WBC between two groups. In the death group, the shock incidence, APACHEⅡscore, SOFA score were significantly higher than those in recovery group [shock incidence: 84.4% (27/32) vs. 46.3% (25/54), APACHEⅡ: 24.94±7.65 vs. 17.02±6.57, SOFA: 11.00±3.27 vs. 6.30±2.65, all P < 0.01]; the PLT and ALB baseline levels, 72 h PCTc were significantly lower than those in recovery group [PLT (×10 9/L): 73.38±49.15 vs. 138.69±101.80, ALB (g/L): 25.47±5.91 vs. 28.59±4.53, 72 h PCTc: -44 (-170, 27)% vs. 63 (40, 77)%, all P < 0.01]. The above 6 variables were included in Logistic regression. The results showed that SOFA score was a risk factor for death in these patients [odds ratio ( OR) = 1.930, P = 0.037], while 72 h PCTc and ALB were protective factors ( OR values were 0.043, 0.783, P values were 0.008, 0.047). The SOFA, 72 h PCTc and ALB can be used to predict the prognosis of severe BSI, and the diagnostic value of the combination of three factors was the largest [area under the ROC curve (AUC) = 0.953, 95% confidence interval (95% CI) was 0.909-0.997], the sensitivity was 100%, and the specificity was 79.6%. Conclusions:Severe patients with BSI caused by Enterobacteriaceae bacteria had a high mortality. Higher SOFA score, and lower ALB and 72 h PCTc predicted the adverse outcome. The combination of the three factors has the greatest prognostic efficacy.

Objective:To investigate the prognostic value of proprotein convertase subtilisin/kexin type 9 (PCSK9) and blood lipid indexes in patients with sepsis.Methods:Patients with sepsis or septic shock who were ≥ 18 years old and met the Sepsis-3.0 diagnostic criteria admitted to the department of critical care medicine of Binzhou Medical University Hospital from January to October 2021 were enrolled. Healthy adults at the same period were selected as healthy control group. Baseline characteristics, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were recorded. Venous blood samples were collected within 24 hours after diagnosis, and serum PCSK9 was determined by enzyme-linked immunosorbent assay (ELISA) at 1, 3 days and 5 days. Meanwhile, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and lipoprotein A were detected. The differences of each index between sepsis group (28-day death group and survival group) and healthy control group were compared. Meanwhile, the indexes of patients with different severity and 28-day prognosis in sepsis group were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of PCSK9 and blood lipid for the prognosis of sepsis. Multivariate Logistic regression was used to analyze the influencing factors for the prognosis of sepsis, and the Kaplan-Meier survival curve at 28th day was drawn.Results:There were 50 patients in sepsis group (including 19 patients with sepsis, 31 patients with septic shock) and 27 patients in healthy control group. In the sepsis group, 19 patients died and 31 patients survived within 28 days. The serum PCSK9 in the sepsis group was significantly higher than that in the healthy control group [μg/L: 223.09 (198.47, 250.82) vs. 188.00 (165.27, 214.90), P < 0.01], and HDL-C, LDL-C, TC and lipoprotein A were significantly lower than those in the healthy control group [HDL-C (mmol/L): 0.82±0.35 vs. 1.45±0.24, LDL-C (mmol/L): 1.53 (1.14, 2.47) vs. 2.89 (2.55, 3.19), TC (mmol/L): 2.03 (1.39, 2.84) vs. 4.24 (3.90, 4.71), lipoprotein A (g/L): 8.80 (5.66, 17.56) vs. 27.03 (14.79, 27.03), all P < 0.01]. PCSK9 in the sepsis death group was higher than that in the survival group [μg/L: 249.58 (214.90, 315.77) vs. 207.01 (181.50, 244.95), P < 0.01], and the HDL-C, LDL-C and TC were lower than those in the survival group [HDL-C (mmol/L): 0.64±0.35 vs. 0.93±0.30, LDL-C (mmol/L): 1.32±0.64 vs. 2.08±0.94, TC (mmol/L): 1.39 (1.01, 2.23) vs. 2.69 (1.72, 3.81), all P < 0.01]. With the progression of the disease, the PCSK9 in the sepsis death group and the survival group was significantly lower than that within 1 day of diagnosis (all P < 0.05). ROC curve analysis showed that PCSK9 had higher predictive value of 28-day death than HDL-C, LDL-C, TC [area under ROC curve (AUC) and 95% confidence interval (95% CI): 0.748 (0.611-0.885) vs. 0.710 (0.552-0.868), 0.721 (0.575-0.867), 0.702 (0.550-0.854)]. Multivariate Logistic regression analysis showed that PCSK9 was an independent risk factor affecting the 28-day prognosis of sepsis (β value was 1.014, P = 0.020). Kaplan-Meier survival curve analysis showed that when PCSK9 ≥ 208.97 μg/L, with the increase of PCSK9, the 28-day survival rate of sepsis patients decreased significantly. Conclusions:PCSK9, HDL-C, LDL-C and TC can all predict the 28-day prognosis of patients with sepsis. The prognostic value of PCSK9 is the highest. PCSK9 is an independent risk factor affecting the prognosis of sepsis. In the early stage of the disease, PCSK9 may have a good predictive value for the prognosis of sepsis. When PCSK9 ≥ 208.97 μg/L, the 28-day survival rate decreased significantly.

Deglutition is one of the basic physiological functions of humans. The surgical treatment of oral cancer can cause impairment in swallowing functions and even dysphagia in serious cases. Currently, there are many types of methods for assessing dysphagia, including bedside evaluation, scale evaluation, radiographic assessment, and stress or electromyographic evaluation during swallowing. However, each of these methods has advantages and disadvantages, and there is no uniform standard. This article briefly introduces the current status of methods for assessing dysphagia related to oral cancer.

Objective:To explore the risk factors for lower extremity deep vein thrombosis (DVT) in patients with a spinal cord injury (SCI).Methods:The medical records of 276 hospitalized SCI patients were analyzed retrospectively. They were divided into a DVT group ( n=63) and a no-DVT group ( n=213). Gender, age, blood type, smoking history, surgical history, the time from SCI to admission, cause of SCI, fracture, SCI segments, American Spinal Cord Injury Association grade and complications were compared between the two groups. Binomial logistic regression was used to isolate the risk factors for lower extremity DVT among such patients. Results:Among 84% of the 63 with a lower extremity DVT, it was a calf muscle venous thrombosis. Anemia, hyponatremia and time from SCI to admission (which ranged from 74 to 195 days) were the most serious DVT risk factors.Conclusions:SCI patients are of high risk for DVT, with anemia and hyponatremia being independent risk factors.

Objective:To explore the risk factors for urinary tract infection (UTI) after a spinal cord injury (SCI).Methods:The medical records of 403 SCI patients were analyzed retrospectively. They were divided into UTI group and no-UTI group according to whether they had a UTI at admission. Gender, age, cause of injury, injury level of the spinal cord, voluntary anal contraction, time from injury to admission, American Spinal Injury Association (ASIA) grade, axillary temperature at admission, complications at admission (diabetes, hypertension, fracture of the pelvis, pressure sores or anemia), white blood cell count and urinary bacteria were compared between the two groups. Binary logistic regression was used to highlight the risk factors for a UTI after an SCI.Results:Of the 354 patients included in the final analysis, 62 (17.51%) had a UTI at admission. The regression showed that UTI after an SCI was closely related to an inability to voluntarily contract the anus, anemia, elevated white blood cell count and a high level of bacteria in the urine.Conclusions:Inability to contract the anus, fever, anemia and an elevated white blood cell count are independent indicators of a UTI after an SCI. A temperature ≥37.3°C is a simple indicator of a concentration of bacteria in the urine ≥1266/μL.