OBJECTIVETo investigate the clinical value of pleural biopsy in the etiological diagnosis of pleurisy in children.

METHODTotally 213 cases with pleurisy, who underwent pleural biopsy and hospitalized in Children's Hospital of Chongqing Medical University from January 2007 to April 2014 were enrolled into this study. Clinical symptoms, imaging manifestations, pleural fluid characteristics, the results of pleural biopsy and postoperative complications were retrospectively analyzed to evaluate the clinical value and security of pleural biopsy in making the etiological diagnosis of pleurisy.

RESULT(1) Of the 213 cases, 144 were boys and 69 were girls, their mean age was (6. 5 ± 4. 1) years. (2) Two hundred and thirteen patients had a surgical pleural biopsy under general anesthesia, the cause of 97 cases (45. 5%) were made clear by histopathological examination, including 35 purulent pleurisy, 55 tuberculous pleurisy and 7 paragonimus infection. For the remaining 83 (41. 3%) cases a final diagnosis was made based on the full analysis of clinical data, including 63 cases of purulent pleurisy, 3 cases of tuberculous pleurisy and 17 cases of paragonimiasis pleurisy but for 33 patients no exact cause was found at the end. (3) The mean operating time of the biopsy was (1. 4 ± 0. 6) hours. Seventy one (33. 3%) patients required blood transfusion during or after the operation. Thirty one (14. 6%) cases used the ventilator after surgery, and the ventilator supporting time was (6. 6 ± 5. 8) hours on average. The wound healing reached grade A in 200 cases (93. 9%), grade B in 13 cases (14. 6%). Postoperative complications included pneumothorax in 92 cases (43. 2%), subcutaneous emphysema in 18 cases (8. 5%), bronchopleural fistula in 3 cases(1. 4%). The average days of hospitalization was (17. 7 ± 7. 1) d.

CONCLUSIONPleural biopsy is of great diagnostic value in the etiological diagnosis and differential diagnosis of pleurisy in children, and it is considered reasonable to be used in the clinical practice when appropriate.

Biopsy ; Child ; Diagnosis, Differential ; Female ; Humans ; Infection ; diagnosis ; Male ; Pleura ; Pleurisy ; diagnosis ; etiology ; Retrospective Studies ; Tuberculosis, Pleural ; complications ; diagnosis

Objective To investigate the factors influencing the incidence of acute pancreatitis (AP) in patients with organophosphorus poisoning and explore the effectiveness of measures for its prevention and treatment. Methods Clinical data of 50 patients with organophosphorus poisoning were reviewed retrospectively in our center between January 2001 and December 2006. Results The incidence of AP in patients with organophosphorus poisoning was 30% (15/50), and 14 patients suffered from MAP, while one patient occurred SAP. 13 of 15 AP patients underwent gastric lavage with cold normal saline; gastric tube was placed in 14 patients; toxic doses over 50 ml were observed in 10 patients; atropine overdose were observed in 11 patients. There were 35 cases of organophosphorus poisoning alone, and 2 of them underwent gastric lavage with cold normal saline; gastric tube was not placed in 1 patient; toxic doses over 50 ml were not observed in all the patients. The toxic dose, water temperature for gastric lavage, gastric tube placement, duration from poisoning to treatment between the two groups were significantly different (P＜0.01). All the patients with organophosphorus poisoning alone survived, while in these 15 patients with AP, 14 patients were cured, 1 patient died. Conclusions Organophosphorus poisoning can induce AP and development of AP was possibly related to organophosphorus poisoning and improper treatment.

Objective:To obtain highly purified recombinant human IGF-Ⅰ(rhIGF-Ⅰ) and identify it.Methods:rhIGF-Ⅰ Was purified through ion-exchange chromatography and gel filtration chromatography after the inclusion bodies of rhIGF-Ⅰ were extracted from Escherichia coli. The recombinant protein was characterized through molecular weight assay, Western-blot, and fluorescent chromatography. The renaturation and biological assay of rhIGF-Ⅰ were investigated. Results and Conclusions: The purity of rhIGF-Ⅰ was higher than 99%. The analysis of molecular weight, Western-blot, fluorescent chromatography and sequences of NH2-terminal 15 amino acids were same as those anticipated. 3-10 mg/ml was the concentration of renatured rhIGF-Ⅰ to support half-maximal stimulation of cell proliferation with BALB/c 3T3 cells.

Objective To observe the effects of penehydidine hydrochloride (PHC) on t acute lung injury ( ALI) . To investigate into the expression of TLR4 on peripheral monocytes, kinetics of inflammatory and anti- inflammatory mediators. To explore the mechanism of TLR4 in ALI. Method A total of 45 patients with ALI were randomly divided into PHC treatment group(experimental group, n =21) and routine treatment group (control group, n = 24) . Patients of both groups were given with the routine treatment,and patients in experimental group were given with PHC in addition (1 mg,im,ql2h) . Therapeutic effects, average length of hospital stay, ICU stay,PaO_2 and PaO_2/FiO_2 > as well as the expression of TLR4 and some cytokines were observed for 48 hours. Results Patients of both groups got better gradually after treatment. The PaO_2 and PaO_2/FiO_2 of patients of both groups progressively increased. At 6 hours, 12 hours, 24 hours and 48 hours after treatment, the PaO_2 and PaO_2/FiO_2significantly increased than 0 hour ( P < 0.05). The improvement in experimental group was obviously better than that in control group at 6 hours, 24 hours and 48 hours after treatment (P < 0.05). There were no differences in average length of hospital stay between the two groups. The ICU stay was significantly shorter in the experimental group ( P < 0.01) . The expressions of TLR4 were higher in patients of both groups than in healthy ones (P <0.01) . TLR4 decreased significantly at 24 hours and 48 hours, while it was lower in experimental group than that in the control group (P < 0.05). The higher level of TLR4in the early stage implied worse prognosis. Most of them deteriorated to ARDS stage. At 24 hours, the incidence of ARDS in experimental group was 23.8 % , and 29.17% in control group. Two patients in control group didn' t become ARDS till 48 hours. Serum IL-1, IL-8 and TNF-α level reduced atr 24 hours in both groups. The reduction of IL-8 and TNF-α in experimental group was more obvious than in control group ( P < 0.05). IL-13 increased gradually from 0 hour to 24 hours, then descended a little at 48 hours. There was no difference in IL-13 some difference between the two groups ( P > 0.05) . Conclusions PHC can improve the arterial oxygen pressure, down-regulate TLR4, restrain inflammatory factors in its signal transduction downstream. This inhibitory action is not accomplished by increase in anti-inflammatory factors,but by down-regulating TLR4. PHC can prevent the development of ALI, and can be considered to act as an effective medicine for the treatment of ALI. TLR4 plays an important role in ALT process, and it is suggested that TLR4 can be used as a prognostic factor.

Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

Objective To explore the change trend and antimicrobial resistance of pathogens causing infection in extensive burn patients,and provide reference for clinical prevention and treatment.Methods Specimens from 9 extensive burn patients who were admitted to a hospital at the same time were performed pathogenic culture and an-timicrobial susceptibility testing, change trend and antimicrobial susceptibility of pathogens were observed. Results The main specimen was wound secretion,accounting for 93.81 %.The major pathogens causing infection were Acinetobacter baumannii (44.85%),Staphylococcus aureus (32.47%),Pseudomonas aeruginosa (12.37%), and Klebsiella pneumoniae (5.15%).With the prolongation of hospital stay,pathogens changed from one kind to multiple strains, and from susceptibility to resistance,multidrug resistance,and extensive drug resistance. Conclusion Itis difficult to avoid infection in burn patients,timely realizing the changes of pathogens causing infec-tion and antimicrobial resistance play an important role in the control of infection.

Objective To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU). Methods The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender,age,amount of bleeding,the bleeding site (basal ganglia,thalamus, brainstem,brain lobe,ventricle,subarachnoid,and cerebellum),disturbance of consciousness,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,systolic blood pressure(SBP),history of hypertension,and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve)was plotted to analyze the independent risk factors and evaluate their power of test. Results 1 185 patients with cerebral hemorrhage were enrolled in the study,293 cases occurred SU,accounting for 24.7%,and 892 cases without SU,which accounted for 75.3%. As shown by univariate analysis,risk factors for cerebral hemorrhage complicated with SU included age,amount of bleeding,the bleeding site,disturbance of consciousness,APACHEⅡscore,SBP. As to the site of bleeding,brain,thalamus,brainstem hemorrhage complicated with SU were higher proportion,45.3%(43/95),39.1%(63/161),36.9%(48/130),which were significantly higher than those of the lobes of the brain 〔26.2% (33/126)〕,cerebellum 〔18.8% (15/80)〕,basal ganglia〔16.1%(78/485)〕,arachnoid the inferior vena cava 〔12.0% (13/108)〕. Multivariate logistic regression analysis showed that amount of bleeding 〔odds ratio (OR)=3.305,P=0.001,95%confidence interval (95%CI)2.213-48.634〕,the bleeding site (OR=1.762,P=0.008,95%CI 0.123-2.743),SBP (OR=1.223,P=0.034,95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC)of amount of bleeding and SBP were 0.846 and 0.597,suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value. Conclusions Cerebral hemorrhage patients with large amount of bleeding,the bleeding site in the ventricle,thalamus or brainstem,high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.

Objective To investigate the occurrence of central venous catheter-related bloodstream infection(CRB-SI)in mass severe burn patients,evaluate related risk factors for infection,and effectiveness of prevention and con-trol measures.Methods In August 2014,9 cases of severe burn patients were rescued in a hospital,all patients re-ceived CVC,infection prevention and control intervention measures were performed during the whole process of catheterization.Results All patients received 30 episodes of CVC,total CVC-days were 227 days,bacterial culture for three-cavity catheters of femoral veins in 2 patients were positive,incidence of CRBSI was 8.81 ‰;1 patient was isolated Enterococcus faecium ,1 isolated both Acinetobacter baumannii and Stenotrophomonas maltophilia .2 CRB-SI patients received femoral vein catheterization,catheterization site was trauma surface,duration of catheterization were both ≥7 days,both used three-cavity catheters,and third degree burns were ≥60%,both patients were cured after timely removal of catheters and receiving of antimicrobial agents.Conclusion CVC is helpful for long term, safe and effective fluid infusion,but it can cause CRBSI;infection prevention and control intervention for patients receiving CVC during the whole process of catheterization can reduce the occurrence of CRBSI.

Objective To investigate the evaluation of high-resolution computed tomography (HRCT) in patients with chronic obstructive pulmonary diseases (COPD), and the relationship with the pulmonary function test and BODE index.Methods 32 COPD patients and 22 normal controls were examined by pulmonary function test (PFT) and HRCT. The data of two groups were compared.Results The volume and pixel index (PI) in forced expiration were higher in the COPD group than those in the control group ( P<0.01), but there was no significant difference in Vin between two groups ( P>0.05). In the COPD group, Vex and Vin were negatively correlated with FEV1/FVC ( P<0.05) respectively. There were no correlation between Vin, Vex and FEV1% pre in the COPD patients ( P>0.05) respectively. Vin and Vex were not correlated with BODE index (all P>0.05) respectively. The ratio of Vex/Vin was positively correlated with BODE index ( P<0.05), and not correlated with FEV1/FVC ( P>0.05). PI910ex was positively correlated with BODE index ( P<0.01), and negatively correlated with FEV1%pre, FEV1/FVC (all P<0.05) respectively.Conclusion The pulmonary function of COPD patients can be evaluated by HRCT, especially by PI910ex.

Objective To investigate the correlation of microembolic signals (MES) and outcome in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled in the study.The MES of middle cerebral artery was monitored dynamically using transcranial color Doppler ultrasound.The early lesions of ischemic stroke were evaluated by MRI.The National Institutes of Health Stroke Scale (NIHSS) was used to evaluate neurological deficits.The modified Rankin scale was used to evaluate the outcome,and the stroke recurrence was recorded.Results A total of 135 patients with acute ischemic stroke were enrolled,in which,33 were cardiogenic cerebral embolism,49 were large artery atherosclerotic stroke,24 were small arterial occlusive stroke,and 29 were other clear causes or cryptogenic stroke.Multivariate logistic regression analysis showed that coronary heart disease (odds ratio [OR],5.862,95％ confidence interval [CI] 2.008-17.114; P =0.000) was the independent risk factor for positive MES within 48 hours after stroke onset,while the history of antithrombotic treatment (OR 0.376,95％ CI 0.141-0.998; P =0.045) was its independent protective factor.In addition,coronary heart disease (OR 4.879,95％ CI 1.257-18.939; P =0.033),hypertension (OR 4.958,95％ CI 1.029-23.882; P =0.030),and diabetes (OR 3.659,95％ CI 1.027-13.034; P =0.050) were the independent risk factors for positive MES within 1 week after stroke onset.The NIHSS scores of the patients of the positive MES at baseline and 1 week and the clinical outcome at 3 months had no significant differences with the patients of negative MES,however,stroke recurrence and deaths increased significantly (P =0.019).Conclusions MES within 48 hours of onset was not associated with the outcome in patients with acute ischemic stroke at 3 months,however,the incidence of endpoint events such as recurrence and death was significantly higher in patients of positive MES within 3 months.