Objective To study clinical feature,pathology,treatment and outcome of acute renal failure(ARF) in idiopathic nephrotic syndrome(IDNS).Methods History-taking of 38 cases were carried out all detailly 24-hour urine protein,biochemistry markers,hemorheology,renal histopathology were detected.Results The study fandings that 82 percent of patients were less than 40 years old,76 3 percent were male,74 percent(28 patients) were non-oliguria and 52 6 percent were minimal change glomerulonephritis through the renipuncture,most of the cases had edema of interstitium, by give prednisone of standard dosage,symptomatic treatment or dialysis the satisfying efficacy was got.Conclusions The main features of IDNS complicated with ARF are usual,it is non-oliguria type in clinic minimal glomerulonephritis in pathology,and deficient blood volume leads to occurrence of ARF,but the renal function could be recovered by give prednisone of routine dosage,symptomatic treatment and hemodialysis therapy.

Objective To investigate the clinical value of serum soluble intercellular adhesion molecule-1 (sICAM-1 )in patients with primary biliary cirrhosis (PBC)and autoimmune hepatitis (AIH).Methods Sixty-one PBC patients and 59 AIH patients,who were hos-pitalized or visited the outpatient department from June 2012 to September 2013,as well as 50 healthy controls,were included in the study. The PBC patients included 29 incipient cases,21 cases in remission,and 11 recurrent cases;the AIH patients included 26 incipient cases, 20 cases in remission,and 13 recurrent cases.Serum sICAM-1 level was measured by double-antibody sandwich enzyme-linked immu-nosorbent assay,and serum levels of alanine aminotransferase (ALT)and total bilirubin (TBil)were determined by biochemical enzyme as-say.Comparison between groups was made by analysis of variance;Pearson correlation analysis was performed.Results Among PBC pa-tients,the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.484);the remission group had a significantly higher serum sICAM-1 level than the control group (P=0.000).Among AIH patients, the incipient group and recurrent group had significantly higher serum sICAM-1 levels than the remission group and control group (P=0.000 for all);there was no significant difference in serum sICAM-1 level between the incipient group and recurrent group (P=0.802);no significant difference in serum sICAM-1 level was seen between the remission group and control group (P=0.281).For patients with PBC and AIH,serum sICAM-1 level was positively correlated with serum levels of ALT (r=0.664,P=0.000;r=0.784,P=0.000) and TBil (r=0.715,P=0.000;r=0.580,P=0.000).Conclusion Serum sICAM-1 may be involved in the immunologic injury in PBC and AIH.In patients with PBC and AIH,the elevation of serum sICAM-1 level is closely correlated with the severity of liver damage. Clinical monitoring of serum sICAM-1 level may play an important role in severity assessment,prognostic evaluation,and therapy guidance among patients with autoimmune liver diseases.

Objective To explore the common clinical features and mechanism of HenochSchonlein purpura (HSP) in children,and provide evidence and guidance for clinical diagnosis,therapy and prognosis of HSP.Methods Prospective study.Totally 1 232 HSP children blood samples were collected during January 2010 to December 2013 in the Children's Hospital of Zhejiang University School of Medicine,and the levels of immunoglobulin,complement,T lymphocyte subsets and CRP were detected in the acute phase of HSP.The clinical data were analyzed with these indexes to explore the function of cellular and/or humoral immunity in the pathogenesis of HSP.In addition,this study detected serum IgA levels in 200 cases of sepsis rash,200 cases of urticarial and 200 cases of thrombocytopenic purpura patients and 400 cases of healthy children over the same period to our hospital respectively,in order to find out whether IgA is capable of differentiating allergic purpura rash from other similar skin rashes.Results Compared with healthy children,the IgA level was significantly higher [IgA:2.0 (0.6-7.5) g/L vs 1.1(0.6-2.1) g/L,Z =5.928,P =0.03].When IgA ＞ 1.44 g/L,the diagnostic sensitivity and specificity to differentiate allergic purpura patients from sepsis patients were 77.43 ％ (954/1 232) and 80.00％ (160/200),respectively.When IgA ＞ 1.53 g/L,the diagnostic sensitivity and specificity to distinguish from allergic purpura with urticaria patients were 72.57％ (894/1 232) and 74.51％ (149/200).When IgA ＞0.91 g/L,it had a 95.14％ sensitivity (1 172/1 232) and a 79.45％ specificity (159/200) for the differential diagnosis of allergic purpura and thrombocytopenic purpura patients.When IgA ＞ 1.33 g/L,the sensitivity of distinguishing allergic purpura patients from healthy children was 81.25％ (1 001/1 232),while the specificity was 95.00％ (380/400).Conclusions HSP children show cellular immune dysfunction.Th1/Th2 imbalance and over-activation of Th2 cells result in the increased synthesis and release of immune globulin,causing abnormalities in humoral immune.An increase in serum IgA level of HSP patients can differentiate HSP from other similar rashes.

OBJECTIVETo analyze the relationship between Chinese medical constitutions and chemotherapy-induced leucopenia (CIL) of primary breast cancer patients.

METHODSTotally 306 breast cancer patients undergoing adjunctive chemotherapy for the 1st time, and effective 291 breast cancer patients were recruited in this study.Nine Basic Constitutional Scale was used before first chemotherapy. Chinese medical constitutions were classified and quantitatively scored. The highest grading for any item of adverse reactions in each case during the whole chemotherapy course was recorded after chemotherapy. Data were statistically analyzed using SPSS16.0.

RESULTSThere was no significant difference in CIL between different chemotherapy regimens and various Chinese medical constitutions of breast cancer patients (P > 0.05). Yang deficiency constitution is one risk factor for CIL. The higher the score of yang deficiency constitution, the more severe the CIL.

CONCLUSIONSYang deficiency constitution was correlated with the degree of CIL. The higher the score of yang deficiency constitution, the greater the risk of III-IV grade CIL in breast cancer patients.

Breast Neoplasms ; complications ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Leukopenia ; chemically induced ; Medicine, Chinese Traditional ; Yang Deficiency

Objective To analyze risk factors and antimicrobial use for hospital-acquired pneumonia (HAP)due to multidrug-resistant organisms (MDROs)in an intensive care unit(ICU),so as to perform risk assessment and guide antimicrobial use.Methods From January 2012 to December 2013,HAP patients were conducted retrospective co-hort study,risk factors for MDRO-HAP and rationality of antimicrobial use were analyzed.Results A total of 110 cases of HAP occurred in ICU,63 cases (57.27%)were MDR-HAP.Logistic regression analysis revealed that re-cent hospital stay ≥5 days (OR=19.94),transference from other hospitals (OR =19.33),infection type of late-onset HAP (OR=7.98),and antimicrobial use in recent 90 days (OR =3.42)were independent risk factors for MDR-HAP.Initial empirical anti-infective treatment revealed that there were no significant difference in timing of antimicrobial administration within 24 hours after clinical diagnosis was confirmed,and rationality of antimicrobial selection between MDR-HAP group and non-MDR-HAP group (both P >0.05);The isolation rate of pathogens in MDR-HAP group was lower than non-MDR-HAP group (73.02% vs 91 .49% P <0.05 ).Targeted antimicrobial therapy revealed that there were no significant difference in selection,dosage,and frequency of antimicrobial use be-tween two groups(all P >0.05 );the rationality rate of therapy course in MDR-HAP group was higher than no-MDR-HAP group,but rationality rate of combination use of antimicrobial agents was slightly lower than the latter (both P < 0.05 ).Conclusion Patients in ICU should be conducted risk factor assessment,and according prevention and control measures should be formulated,so as to reduce the occurrence of MDR-HAP,health care workers should standardized the initial empirical anti-infective treatment.

Objective To evaluate the effect of plan-do-check-act (PDCA)cycle method in improving disinfection efficacy of object surface in intensive care unit (ICU).Methods On the basis of management of healthcare-associat-ed infection (HAI)and prevention of multidrug-resistant organisms,disinfection efficacy of object surface in an ICU was intervened,data about surface object specimens taken before,during,and after intervention,HAI in patients, as well as detection of MDROs were collected.Results The total qualified rate of specimens taken before,during, and after intervention was 58.24%,76.74%,and 88.71 %,respectively,there was an increased tendency,the difference was significant (χ2 =17.41 ,P =0.009);the incidence of HAI was 3.72%,2.42%,and 1 .78%,respec-tively,there was a decreased tendency(χ2 =6.03,P =0.039),case infection rate was 4.36%,2.75%,and 2.37%respectively,there was a decreased tendency (χ2 = 7.24,P = 0.046 );detection rate of MDROs was 34.03%, 27.45%,and 14.05%,respectively,there was a decreased tendency (χ2 =33.84,P =0.007),the percentage of pa-tients who were detected MDROs and HAI caused by MDROs showed a decreased tendency(χ2 =6.14,6.02,both P<0.05).Conclusion The implementation of PDCA cycle can effectively improve disinfectant efficacy of ICU object surface,and reduce the incidence of MDRO HAI.

Objective To use tri-operator breast blood oxygen imaging in diagnosis of early stage breast cancer.Methods To analysis and diagnosis eighty cases with the technology of breast blood oxygen imaging.Results The accurate rate of the diagnosis made by technology of breast blood oxygen imaging was 93.75%,the sensitivity of diagnosis was 90.63%,the specificity was 95.83%.Conclusions The technology of breast blood oxygen imaging without the radiation may be a better methods to diagnosis the breast diseases,which has the higher sensitivity than infrared rays examination on breast cancer diagnosis.

Objective The hearing and speech rehabilitation effects by hearing aid use and cochlear implanta‐tion in hearing -impaired children were compared .Methods A total of infants aged from 6 months to 3 years with severe hearing loss of prelingual nature were included .They were divided into 2 groups :group 1 (18 with hearing aids) and group 2 (14 with cochlear implantation) .There was no significant difference in the degree of hearing loss and age between the 2 groups .They received rehabilitation education of the same content for a year .Their unaided and aided thresholds were tested in sound field while the IT -MAIS was used for evaluating hearing ability of two groups before and after 3 ,6 ,9 ,and 12 months of hearing aid use and cochlear implantation .Results In both groups ,hearing were better in aided conditions than those of in unaided ,while those from the cochlear group were significantly improved at more frequencies than those of the hearing aid group .In general ,the longer use and train‐ing ,the better hearing improvement .The mean scores of auditory performance in the cochlear implantation group at 6 months were significantly higher in comparison with those at 3 months (P<0 .05) .There were significant differ‐ences in mean scores between the two groups at 6 ,9 ,12 months after fitting (P<0 .05) .The verbal ability scores ,hearing and speech rehabilitation levels in the cochlear group were higher than those of in the hearing aid group (P<0 .05) .Conclusion For severe hearing loss children ,cochlear implantation could produce more noticeable effects than hearing aids .

Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.

Objective To evaluate the diagnostic role of multi-slice CT(MSCT)angiography for tumors of intra-abdominal testes.Methods MSCT angiography of 5 cases with seminoma of intra-abdominal testes proved by surgery and pathology was analyzed.All patients were male,and the age ranged from 33 to 59 years with the mean of 43.6 years.Results(1)The arterial-supply of tumors completely came from the testicular artery of the same side.The arteries went into tumors from the posterior side.(2)The tumors had comparatively large volume with complete or incomplete amicula.The tumor density of 3 cases was inhomogeneous.The degree of entity augmentation of 5 patients was about 14—25 HU.Conclusion MSCT angiography can reveal the tumor vessel and is essential for the diagnosis of tumors of intra-abdominal testes.