Objective To evaluate the application value of serum endotoxin combined with integrated model for end-stage liver disease (iMELD) in evaluating the short and medium term prognosis of patients with decompensated liver cirrhosis.Methods The clinical data of 68 patients with decompensated liver cirrhosis were retrospectively analyzed.The patients were divided into survival group and death group according to the result of follow-up at the 3,6 and 12 months.The iMELD score and Child-Turcotte-Pugh (CTP) score were calculated according to relevant indicators,and the serum endotoxin level was detected.The correlation between serum endotoxin and iMELD score was analyzed in the short and medium term prognosis in patients with decompensated liver cirrhosis.Results After 3 months' follow-up,5 patients died.The iMELD scores in survival group and death group were (39.26 ± 7.29) and (49.29 ± 8.63) scores,CTP scores were (9.32 ± 2.12) and (12.03 ± 2.75) scores,serum endotoxin levels were (9.21 ± 2.24) and (15.39 ± 5.12) ng/L,and there were statistical differences (P ＜ 0.05).After 6 months'follow-up,12 patients died.The iMELD scores in survival group and death group were (41.35 ± 8.03) and (52.18 ± 10.37) scores,CTP scores were (9.78 ± 2.05) and (12.93 ± 1.99) scores,serum endotoxin levels were (8.96 ± 2.41) and (16.43 ±6.03) ng/L,and there were statistical differences (P ＜0.05).After 12 months' follow-up,19 patients died.The iMELD scores in survival group and death group were (40.74 ± 6.38) and (52.29 ± 8.53) scores,CTP scores were (10.01 ± 2.23) and (13.27 ± 1.69) scores,serum endotoxin levels were (8.53 ± 2.34) and (16.52 ± 6.08) ng/L,and there were statistical differences (P ＜ 0.05).The area under curve of receiver operating characteristic (ROC) was 0.952,standard error was 0.048,and 95％ confidence interval was 0.790-1.022.The best critical value of iMELD score to predict death was ≥48.00 scores,and the risk of death would rise if iMELD score was increased.The best critical value of serum endotoxin to predict death was ≥ 11.00 ng/L.Conclusion iMELD score and serum endotoxin have important value in predicting prognosis in patients with decompensated liver cirrhosis.

Objective To develop a new type fusion apparatus for scaphoid-trapezium-trapezoid (STT) arthrodesis.Methods The apparatus was designed on the basis of the anatomic data of STT measured from Chinese cadaveric wrists.Simulated arthrodeses of STT joints were conducted to test the fixation performance of the apparatus made of titanium alloy on the STT joint specimens.Several modifications were made before the apparatus was made into a finished product.Results The fusion apparatus consists of a plate and screws.The fusion plate for STT arthrodesis is made into a taper one connected to a cylinder.On the plate are three screw holes through which the three carpal bones (STT) are fixed by three screws respectively.The hollow cylinder is designed for bone grafting,and its outer threads ensure a very tight contact between the fusion plate and the carpal bones.Auxiliary tools are also made.Conclusions As the novel design of the fusion apparatus improves the mechanical strength of fixation of STT and prevents the possible rotation and collapse of fused STT,the apparatus is a reliable internal fixation device for the limited intercarpal arthrodesis.

Antigens, CD34 ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Hemangioma ; metabolism ; pathology ; surgery ; Hemangiosarcoma ; pathology ; Humans ; Median Nerve ; pathology ; Median Neuropathy ; metabolism ; pathology ; surgery ; Melanoma ; pathology ; Middle Aged ; Peripheral Nervous System Neoplasms ; metabolism ; pathology ; surgery ; S100 Proteins ; metabolism

Objective To explore the effect of mosapride combined with polyethylene glycol electrolyte powder on cleaning intestinal tract before colonoscopy in patients with chronic constipation.Methods A total of 127 patients with chronic constipation for colonoscopy were randomly divided into observation group of 64 cases,oral administration of mosapride 10 mg and polyethylene glycol electrolyte powder; control group of 63 cases,oral polyethylene glycol electrolyte powder for bowel preparation for colonoscopy.The intestinal cleanness,first defecation time and adverse reaction was compared between two groups.Results The Boston bowel preparation score was (8.32 ± 0.86) scores in observation group,and (7.69 ± 0.95) scores in control group,and there was significant difference between two groups (t =3.918,P＜ 0.05).The first defecation time after taking the medicine was (45.69 ± 13.57) min in observation group and (54.63 ± 11.78) min in control group,and there was significant difference between two groups (t =3.966,P ＜ 0.05).After taking the medicine,5 cases of nausea and vomiting and 11 cases of abdominal distension in observation group,13 patients of nausea and vomiting and 23 cases of abdominal distension in control group,and there was significant difference between two groups (x 2 =4.29,6.04,P ＜0.05).Conclusion Mosapride combined with polyethylene glycol electrolyte powder can improve the intestinal tract cleaning quality,shorten the time of first defecation time,and reduce adverse reaction.

Objective:To evaluate the efficacy and safety of continuous intrathecal morphine infusion system for patients with refracto-ry cancer pain. Methods:Seventeen patients with refractory cancer pain were implanted with intrathecal catheters and connected with a continuous external electronic patient-controlled analgesia (PCA) pump for intrathecal morphine analgesia. Visual analogue scales (VAS) score, the dose of routine opioids, and the score for quality of life before and after intrathecal analgesia were recorded. Adverse reactions were observed. Results:After the application of continuous intrathecal morphine analgesia, the VAS score of pain was 2.9±1.8, which is lower than 7.2±2.5 before intrathecal analgesia (P<0.001). Moreover, the dose of routine opioids (i.e., equianal-gesic dose of morphine) was 42.1 ± 7.5 mg/day, which is significantly lower than 282.9 ± 95.5 mg/day before intrathecal analgesia (P=0.004). The scores of general activity, mood, and sleep after intrathecal analgesia were significantly lower than those before intrathe-cal analgesia (P<0.05). However, the analgesic satisfaction of patients considerably increased after intrathecal analgesia (P<0.001). Ad-verse reactions included withdrawal syndrome, headache, urinary retention, and intrathecal infection. Conclusion:The continuous in-trathecal morphine infusion with PCA is effective and safe on analgesic treatment for patients with refractory cancer pain.

Objective:To investigate the correlation between sarcopenia and post-stroke cognitive impairment(PSCI)in elderly patients with first-time acute minor ischemic stroke.Methods:This was a prospective study.Elderly patients over 60 years of age with first-time acute minor ischemic stroke admitted to the Department of Neurology of the General Hospital of Western Theater Command from October 2018 to June 2019 were continuously enrolled.Patients received the SARC-F score assessment within 24h after admission and were divided into two groups according to their SARC-F scores: the non-sarcopenia group(SARC-F score<4)and the sarcopenia group(SARC-F score≥4). Cognitive function was assessed by using the Mini-Mental State Examination(MMSE)within 24 h of admission and at 3-month follow-up.Results:A total of 211 patients were enrolled in this study, including 31 patients(31/211, 14.69%)in the sarcopenia group and 180 patients(180/211, 85.31%)in the non-sarcopenia group.The incidence of PSCI was higher in the sarcopenia group than in the non-sarcopenia group(83.87% or 26/31 vs.55.56% or 100/180, χ2=8.814, P=0.003). The total MMSE score, orientation, immediate memory, attention, calculation and language functions were lower in the sarcopenia group compared with non-sarcopenia group( P<0.05). Logistic regression analysis showed that sarcopenia was an independent risk factor for PSCI( OR=3.478, 95% CI: 1.039-11.642, P=0.043)in the elderly with first-time acute minor ischemic stroke. Conclusions:Sarcopenia is an independent risk factor for PSCI in elderly patients with first-time acute minor ischemic stroke.Sarcopenia assessment in the acute phase of stroke might help doctors to assess the risk of PSCI and reduce the incidence of PSCI in stroke patients.

Objective To evaluate the value of breast molybdenum target radiography in evaluating the enlarged axillary lymph nodes in breast diseases.Methods 79 patients underwent breast molybdenum target radiography,including conventional laxial and oblique projection. Some of them were examine furtheremore in compress projection in axillary fossa. The X-ray findings were analysis. And radiologic-pathologic correlation were carried out.Results There were 46 cases of brease carcinoma, 20 cases of hyperplasia,7cases of fibroadenoma,2 cases of plasmacytic mammitis,2cases of lipoma and 2 cases of papilloma in 79 patients. In the 33 cases of breast benign lesion , the enlarged axillary lymph nodes were seen bilaterally in 12 cases, sum was 1 to 5 in each case, smaller than 2 cm in diameter in 31 cases and uneven density in 13 cases were showed. In the 46 cases of brease carcinoma, the enlarged lymph nodes were seen laterally in 43cases, sum was 1 to 4 in each cases, larger than 2 cm in diameter was showed in 17 cases, and all were even density. There were statistical differences in number, diameter and density of enlarged lymph nodes between two groups. Conclusion The enlarged axillary lymph nodes are of different X-ray features in breast benign lesion and malignant lesion,it is helpful in differential diagnosis of breast diseases.

ObjectiveTo observe β cell function in newly diagnosed diabetic patients with ketosis before and in remission period and evaluate its classification and predictive value.MethodsA total of 206 patients newly diagnosed as diabetic ketosis who had been treated with intensive insulin therapy in our hospital and entered in the honeymoon after the withdraw of insulin therapy were followed for 36 months from onset of diabetes.They were divided into two groups of type 1 and type2 diabetes ( group A and B),according to the dependence or independence on insulin treatment. The β cell function of the two groups before and in remission period was compared by oral glucose tolerance test (OGTF).β cell function was measured with the AUC of insulin and C-peptide and homeostatic model assessment β-cell function (HOMA-β),while homeostatic model assessment insulin resistant (HOMA-IR) for insulin resistant.The duration of the honeymoon and the change of insulin and C-peptide curve before and in honeymoon were also observed.ResultsThe AUC of insulin and C-peptide,the HOMA-β and the HOMA-IR before and after the intensive insulin treatment were lower in group A than that in group B [ before the insulin treatment:(10.18 ±2.36)mIU · h · L-1 vs (20.28 ±6.89)mIU · h · L-1,(1.56 ±0.53) μg · h · L-1 vs (3.75 ±0.67) μg · h · L-1,3.68 ± 1.08 vs 18.20 ±6.59,1.22 ±0.49 vs 3.06 ± 1.54,respectively;after the insulin treatment:(29.86 ± 8.65 ) mIU · h · L-1 vs (93.35 ± 19.42 ) mIU · h · L-1,( 3.99 ± 0.79 )μg · h · L-1 vs ( 12.54 ±3.83) μg · h · L-1,8.50 ±2.46 vs 56.17 ± 19.42,0.63 ±0.56 vs 1.42 ±0.78,respectively ].The duration of the honeymoon in group A was significantly shorter than in group B [ (7.9 ±5.2) months vs (20.9 ± 9.9 ) months ].In oral glucose insulin and C-peptide release test,the peak of insulin and C-peptide releasing curve in group A was brought forward by a half to 1 hour after intensive treatment while delayed in group B by 1 or 2 hours.The releasing peak of insulin and C-peptide in group A was less than two folds of the basic value,while four to ten fold of the basic value in group B.The positive ratio of glutamic acid decarboxylase antibody,insulin autoantibody and insular cellular antibody in group A and group B were 21.2％ vs 4.8％,18.1％ vs 3.3％,9.2％ vs 10.6％,respectively.ConclusionsOf all the patients newly diagnosed as diabetes ketosis who had entered into the honeymoon after intensive insulin therapy,91％ were type 2 diabetes.Inferior β cell function before insulin therapy,weaker remission after insulin therapy and shorter duration of remission period suggest the classification of type 1 diabetes.

ObjectiveTo observe the efficacy of a Levofloxacin-containing 10-day sequential therapy for Helicobacter pylori eradication.Methods Totally 86 Helicobacter pylori-infected patients with chronic gastritis or peptic ulcer diagnosed by gastroscopy were randomized into two groups: the trial group and the control group (n =43 in each group).The trial group was treated with Esomeprazole 20 mg bid plus Amoxicillin 1000 mg bid at the first 5 days,and followed by Esomeprazole 20 mg bid,Levofloxacin 500 mg qd and Furazolidone 100 mg bid,at the last 5 days;The control group was treated with standard triple regimen: Esomeprazole 20 mg,Amoxicillin 1000 mg and Clarithromycin 500 mg,all bid for 7 days.The eradication rates of Helicobacter pylori in the two groups were compared after completion of treatment.ResultsAfter treatment,the eradication rates of Helicobacter pylori were significantly different between the trial and control group(93.0％ vs 74.4％,P ＜0.05)Conclusion The 10-day sequential therapy with.Levofloxacin-containing regime can achieve a higher eradication rate of Helicobacter pylori infection.

BACKGROUND: It has been proved that interleukin-18 (IL-18) involves in the development of acute cerebral infarction (ACI) and is positively correlated with the time of brain stroke onset, erythrocyte sedimentation rate (ESR), as well as neurological deficit and low-density value of brain CT.OBJECTIVE: To investigate the dynamic changes of serum IL-18 in the course of ACI.DESIGN: Verification analysis with patients as subjects and healthy volunteers as controls.SETTING: Department of neurology of a municipal hospital.PARTICIPANTS: Totally 46 inpatients (29 males and 17 females) with ACI were randomly selected from the Department of Neurology of People's Hospital, Maoming City, between December 2002 and January 2004.Meanwhile, 40 healthy controls (27 males and 13 females) were recruited from those who came to the hospital for routine physical examination. All the participants signed informed consent.METHODS: Fasting peripheral vein blood of 2 mL was collected from the patients on the 1st, 7rh, 14th and 21st days of ACI onset, and from healthy controls on the day of routine examination. The blood samples were centrifuged at 3 000 r/minute for 15 minutes at 4 ℃, and then the supernatant was collected for detecting IL-18 level by ELISA.MAIN OUTCOME MEASURES: The serum IL-18 level of patients on the 1st, 7th 14th and 21st days of ACI onset and that of healthy controls on the day of routine examination.RFSULTS: Totally 46 patients and 40 healthy controls were enrolled in this study and all data were statistically analyzed. The level of serum IL-18 was significantly higher in the patients with ACI than in normal controls on the 1st and 7th days of onset [(178±41) ng/L, (104±34) ng/L, (65±14) ng/L, P ＜ 0.01],but was similar on the 14th and 21st days [(88±36) ng/L, (72±33) ng/L,(65±14) ng/L, P＞ 0.05]. The level of serum IL-18 in ACI patients was significantly higher on the 1st day than on the 7th, 14th and 21 st days of the onset (P ＜ 0.05-0.01); moreover, it was also significantly higher on the 7th day than on the 21st day of the onset (P ＜ 0.05).CONCLUSION: The level of IL-18 increases obviously on the 1st day of ACI onset, and gradually decreases with the extended course of disease and time of treatment.