Objective To investigate the etiopathogenesis of exertional heat stroke(EHS)induced by military training of those patients admitted in military hospitals,and analyze the influence of EHS as a predisposing factor on prognosis.Methods Eighteen patients with EHS were admitted in 6 military hospitals from Sep.1995 to Aug.2007,their clinical data were retrospectively analyzed.All cases were evaluated according to Minard's EHS predisposing factors including the individual's physiologic limitations,environmental conditions and the organizational predisposing factors.According to the final treatment outcome,18 cases of EHS were divided into fatal group(Group F)and survival group(Group S).The significance of deviation on the predisposing factors,and of the differences on the accumulated predisposing factors between the two groups,was analyzed.Results All the 18 cases of EHS occurred after military training,and complicated with multiple organ dysfunction syndrome(MODS).Hyposthenia,excessive physical efficiency training,incorrect disease classification to the patients,and inappropriate diagnosis and treatment were found to be the strong predictors to a grave prognosis.The effect of accumulated predisposing factors of EHS in group F was significantly higher than that in group S(10.0?1.41 vs 5.64?1.96,P

Objective To evaluate the clustered characteristics of the components of metabolic syndrome. Methods 483 subjects (242 men, 241 women, aged 53±12 years ) in Beijing area underwent a 75g oral glucose tolerance test (OGTT) for screening of diabetes.203 subjects were diagnosed as diabetes through OGTT.Factor analysis was performed using the variables of insulin/blood glucose, total cholesterol (CHO), LDL-C, HDL-C, triglycerides (TG), systolic blood pressure, diastolic blood pressure, BMI, waist-to-hip ratio and waist circumference. Results Five factors, including obesity, insulin resistance/hyperglycemia, CHO/LDL-C, dyslipidemia (elevated TG and decreased HDL) and hypertension, could explain 72.2% of total variance.The most important component was obesity, which could explain 29.8% of total variance.The obesity factor was associated with dyslipidemia factor through C-reactive protein (CRP).Dyslipidemia factor also associated with insulin resistance/hyperglycemia factor.Hypertension factor and CHO/LDL-C factor were isolated from other factors. Conclusions Obesity factor is the most important component of metabolic syndrome.The pathophysiologic mechanism of metabolic syndrome is complex.Insulin resistance alone could not explain all features of the metabolic syndrome.Its pathophysiology maybe include the factors of obesity, insulin resistance and inflammatory reaction.

ObjectiveTo investigate the influence of internal sphincter deletions on postoperative fecal incontinence in rectal cancer patients after intersphincteric resection (ISR). MethodsSeventy one cases of rectal tumour were respectively treated by low anterior resection (group A, intact internal sphincter),partial ISR (group B,1/3 internal sphincter deletion),subtotal ISR (group C,2/3 internal sphincter deletion) and total ISR (group D,total internal sphincter deletion).Anorectal manometry and Vaizey scoring system were used to trace dynamic changes of fecal incontinence in the four groups in one year follow up. Data were analyzed with repeated-measures analysis of variance and multivariate analysis of variance. ResultsIn all cases the length of postoperative anal high-pressure zone shortened by groups.With time the length of high-pressure zone increased slightly.By the end of postoperative 12 months,there were still significant differences between groups( F =41.873,P =0.000).The maximum resting pressure of anal canal significantly reduced in all groups.By the end of postoperative 12 months,it almost restored to preoperative level in group A,while in group B and C it was about 2/3 of the preoperative level; and 1/3 of the preoperative level in group D.Vaizey score at postoperative 10 days,increased in all groups.In group B and C the score was on continuous decrease until the end of postoperative 12 months(P =0.158) it was close to that in group A.While in group D it was only 13.7 ±3.2 by the end of postoperative 12 months.Multiple regression analysis showed that by the end of postoperative 12 month,the maximum resting pressure of anal canal and postoperative anal high-pressure zone length were significantly and negatively related with the subjective Vaizey score of fecal incontinence ( t =- 4.802,P =0.000 ; t =- 2.011,P =0.048 ).ConclusionsIn patients of ultra-low rectal cancer undergoing intersphincteric resection,fecal incontinence severity indicator vaizey score as evaluated by the end of postoperative 12 months was associated with the maximum resting pressure of anal canal and anal high-pressure zone length.In addition,postoperative fecal incontinence severity carries reversible dynamic changes, and with time, most patients could restore satisfactory stool control function.

OBJECTIVETo investigate the occurrence and associated factors for posttraumatic stress disorder (PTSD) in rescuers and firefighters.

METHODSThe PTSD of 264 rescuers and firefighters who had participated in rescue was evaluated using the self-designed fireman general situation questionnaire and PTSD Checklist-Civilian Version (PCL-C). The factors associated with the occurrence of PTSD were also analyzed.

RESULTSThe incidence rate of PTSD in the subjects was 8.3%. The PTSD rate of special service corps (12%) was significantly higher than that of other subjects (P<0.05). The incidence of PTSD was highest in the rescuers and firefighters above the third rank, but without significant differences (P>0.05). The PTSD rate of married rescuers and firefighters was significantly higher than that of unmarried subjects (P<0.05). The PTSD rate of subjects addicted to drinking was significantly higher than that of non-drinking subjects (P<0.05). Subjects with more frequent attendance were more susceptible to PTSD compared with those with less attendance.

CONCLUSIONThe incidence rate of PTSD is high in rescuers and firefighters who have attended rescues. It is necessary to implement both short-term and long-term counseling programs for stress management and intervention in order to reduce the psychological trauma after rescue and improve the mental health of rescuers and firefighters.

Objective To study the effects of mosapride and domperidone on the pulmonary infection of acute stroke patients lying in bed and with nasal feeding. Methods Eighty-nine acute stroke patients lying in bed and with nasal feeding were divided randomly into the treatment group (47 cases) and the control group (42 cases). The control group was treated routinely,and the treatment group was treated with mosapride 5 mg and domporidone 20 mg thrice a day for 4 weeks, besides routine therapy. The incidence rate of pulmonary infection, gastric residual volume (GRV) and the number of cases with gastric contents remaining after 3 hours of nasal feeding were studied. All data were analyzed statistically. Results In the treatment group, 13 cases had pulmonary infection,and the incidence rate was 27.66%(13/47). In the control group,25 cases had pulmonary infection,and the incidence rate was 59.52% (25/42). There was significant difference between the two groups (P < 0.01 ). Three hours after nasal feeding,24 cases with gastric contents remaining were discovered in the treatment group,and GRV was (50.80±15.38) ml. Two hundred and thirty-seven cases with gastric contents remaining were discovered in the control group, and GRV was (112.17±32.54) ml. Significance differences were also detected between the two groups (P<0.01). Conclusion As for the acute stroke patients lying in bed and with nasal feeding,mosapride and domperidone can remarkably cut down the pulmonary infection upon common treatment.

Objective: To explore risk factors including prostate-specific antigen (PSA) kinetics for the prediction of castration-resistant prostate cancer (CRPC), and to build a practical model for predicting the progression to CRPC after androgen deprivation therapy(ADT) so as to facilitate clinicians in decision-making for prostate cancer patients receiving ADT.Methods: A total of 185 patients with prostate cancer who had received ADT as the primary therapy in Department of Urology of Peking University First Hospital from 2003 to 2014 were enrolled retrospectively.All the patients were diagnosed with prostate cancer via prostate biopsy and followed up every four weeks from the initiation of ADT.All the patients received ADT with luteinizing hormone-releasing hormone agonists (LHRH-A) or surgical castration accompanied with an antiandrogen (bicalutamide or flutamide, combined androgen blockade).The clinical information of the patients were collected including age, clinical TNM stage, Gleason score (GS), risk groups of prostate cancer, PSA at the initiation of ADT, PSA nadir after ADT, PSA decline velocity, and the time to PSA nadir.The end point of this study was the diagnosis of CRPC, which was based on the European Association of Urology (EAU) Guideline 2016.Cox proportional hazards regression models were established to analyze and estimate their effects on the time of progression to CRPC.Results: In this study, 185 patients with prostate cancer who had received ADT as the primary therapy were included.The mean age was (71.02±8.67) years.The median time to progression to CRPC in this cohort was 38 months (ranging from 4 to 158 months).On univariate analysis, we found clinical T stage, N stage, the metastasis state before ADT, risk groups of prostate cancer, PSA decline velocity, and PSA nadir were all related to the time to CRPC progression, P<0.01 for all the above variables.And on multivariate analysis, the presence of distant metastasis before ADT (HR=6.030, 95% CI: 3.229-11.263, P=0.001), higher PSA nadir (HR=1.185, 95% CI: 1.080-1.301, P=0.001), higher PSA decline velocity>11 μg/(L·month) (HR=2.124, 95% CI: 1.195-3.750, P=0.001), and time to PSA nadir ≤ 9 months (HR=3.623, 95% CI: 1.640-4.817, P=0.004) were found to be significantly associated with an increased risk of progression to CRPC.Conclusion: Patients with rapid decreasing of PSA in the initial ADT were more likely to progress to CRPC.

OBJECTIVE:To provide reference for vancomycin-induced neutropenia adverse reactions/adverse events in clinical diagnosis. METHODS:With a case of children with neutropenia treated by long-course and large-dose vancomycin,PubMed and CNKI were retrieved to collect related literature and the literature was analyzed. RESULTS:Neutropenia may be associated with vancomycin,based on causality criterion of adverse reaction in China. CONCLUSIONS:Vancomycin-induced neutropenia in chil-dren is most likely associated with prolonged exposure induced by infusion,vancomycin dosage should be reduced or stopped,and routine blood and plasma concentration should be closely monitored.

Objective To study the method of gray-scale blood flow imaging and image processing in condition of high frequency ultrasound,and the implementation of the system.Methods On the base of research of scattered signals of red blood cells in high frequency ultrasound,20 MHz ultrasound mechanical and linear scanning probe was used to transmit a number of pulses on a scan line.Pulse-echo subtraction method was used to obtain the blood flow information.At the end,simulated blood vascular was used to conduct flow imaging,and the obtained images were analyzed.Results Experiment results showed that clear blood flow images were obtained using this system.The noise from perivascular tissue could be filtered and the signals from blood flow could be enhanced after image processing.Conclusions In the detection of superficial blood vessel,blood flow signals can be obtained even using single pulse emitting via high frequency ultrasound.The blood flow imaging system can be implemented after image processing.

OBJECTIVE: To assess the change of cGMP-PDE and cAMP-PDE activity in a rat lung model of asthma. METHODS: cGMP-PDE and cAMP-PDE activity were determined by HPLC. RESULTS: Both cAMP-PDE activity and cGMP-PDE activity in the lung tissue of antigen-challenged rats were higher than that from the normal rats (P <0.05). CONCLUSION: In the rat lung model of asthma, cyclic nucleotides phosphodiesterase activity was elevated. This may be significant in the pathogenesis of asthma.

Objective To evaluate the curative effect of polyscope modular flexible ureteroscope combined with Holmium laser lithotrip-sy in the treatment of renal calculi. Methods 53 patients with renal calculi were performed CTU to detect the position of renal calculi before operation. The patients were treated with polyscope modular flexible ureteroscope combined with Holmium laser, and the double J tube were routinely indwelled 4 to 12 weeks after surgery. Results All the 52 patients has successfully completed the operation in the frist stage. The mean operative time was about 38 minutes. 6 patients were treated with flexible ureteroscope for second stage operation. One week after oper-ation, the review showed that there were residual calculi existed in 24 cases and there were 56 cases of post-operative infection, including 17 cases of sepsis or sepsis shock. Conclusion Polyscope modular flexible ureteroscope can be used for all kinds of kidney stones surgery and is characterized by safety and mild tissue injury. But we should pay more attention to the post-operative infection especially urosepsis.