0. 05); lung field Az_1=0.6964, Az_2=0.7958, showing significant difference (?~2=4.9947, P

Objective To improve the level of early detection and treatment of pyonephrosis. Methods This study included 41 cases(17 men and 24 women;mean age,49 years)of pyonephrosis.A variety of examinations,including urinary analysis,blood analysis,kidney nuclear medicine scan,ultrasonog- raphy,intravenous urography(IVU),and CT were used for the early diagnosis of pyonephrosis.Pereutaneous nephrostomy(PCN)drainage was done for the interim management of pyonephrosis,then phase 2 operation was performed in 28 cases.The double-J tube was placed in ureter by ureteroscope for drainage,and then phase 2 operation was done in 2 cases.Emergency operation was done in 10 cases.The remaining 1 case un- derwent ESWL after anti-infective therapy.Results Definite diagnosis of pyonephrosis before operation was made by invasive examinations in 31 cases(75.6%),and by percutaneous drainage in 4 cases;the other 6 cases were detected during operation.Only 6 cases(14.6%)underwent nephrectomy;the other 35 cases (85.4%)underwent kidney-sparing operation.Follow-up of 3 months to 9 years was available in 37 cases. No nephrectomy was needed in 33 cases with spared kidney.Serum creatinine was normal in the 4 cases un- dergoing nephrectomy.Conclusions The key to the treatment of pyonephrosis by kidney-sparing surgery is early diagnosis,timely drainage and relief of obstruction.Ultrasonography plays an important role in the early diagnosis of pyonephrosis,and CT has a high sensibility in the diagnosis.Pereutaneons nephrolithotomy (PCNL)secondary to drainage through pereutaneous nephrostomy was beneficial to the patients with kidney stones or upper ureter stones.

Objective To investigate the effect of workplace violence on psychological health in nurse of emergency department.Methods 96 nurses of emergency department from 6 third-grade class-A hospitals in Guangzhou who had experienced workplace violence since the last six months were investigated by means of SCL-90 and self-designed questionnaire according to WHO' definition of workplace violence.Results 42.16％ of workplace violence happened between late night and early dawn.The incidence of psychological violence was 72.55％.The patients and their family were the main troublemakers.The risk factors of violence were:needs not met,dissatisfaction of service,heavy drinking,in sequence.On account of workplace violence,the average score of somatization,compulsion,depression,anxiety,hostility,fear and mental disease was significantly higher than the Chinese norm (t =4.676,3.745,2.892,8.236,2.796,8.012,5.177,23.801;P ＜ 0.01 or P ＜ 0.05 ).Conclusions Workplace violence severely affects psychological health of nurse in emergency department and should be prevented and controlled by effective measures.

Humans ; Deglutition ; Time Factors ; Language

Objective To compare the histologic grade between biopsy and postoperative specimen in bladder urothelial carcinoma,and approach the state and the reasons of underestimate the histologic grade preoperative.Methods We retrospectively 82 cases of urothelial carcinoma at the Third Affiliated Hospi- tal of the Sun Yat-Sen University.For all the cases in this study,the histologic grade,using the 1998 World Health Organization and International Society of Urological Pathologists(WHO/ISUP)classification,was i- dentical when the biopsy specimen and postoperative specimen were compared.Results In this study,35 cases,28 cases and 19 cases were G_1、G_2、G_3 by biopsy preoperative,respectively;while 22 cases,32 cases、28 cases were G_1、G_2、G_3 postoperative,respectively.There were 24 cases(29.3%)underestimate the histo- logic grade by biopsy preoperative in the 82 cases,while 4 cases(4.9%)overestimate preoperative.The state of underestimate the histologic grade is correlated with the location of biopsy,tissue dose and the conser- vation of pathology judgment.Conclusions There were 24 cases(29.3%)underestimate the histologic grade by biopsy preoperative.We should pay more attention to this state of underestimate the histologic grade preoperative in the treatment of bladder urothelial carcinoma.

OBJECTIVEMany children were found to have low free carnitine level in blood by tandem mass spectrometry technology. In some of the cases the problems occurred secondary to malnutrition, organic acidemia and other fatty acid oxidation metabolic diseases, and some of cases had primary carnitine deficiency (PCD). In the present article, we discuss the diagnosis of PCD and evaluate the efficacy of carnitine in the treatment of PCD.

METHODWe measured the free carnitine (C0) and acylcarnitine levels in the blood of 270 000 neonates from newborns screening program and 12 000 children with suspected clinical inherited metabolic diseases by tandem mass spectrometry. The mutations of carnitine transporter protein were tested to the children with low C0 level and the diagnosis was made. The children with PCD were treated with 100 - 300 mg/kg of carnitine.

RESULTSeventeen children were diagnosed with PCD, 6 from newborn screening program and 11 from clinical patients. Mutations were found in all of them. The average C0 level [(2.9 ± 2.0) µmol/L] in patients was lower than the reference value (10 µmol/L), along with decreased level of different acylcarnitines. The clinical manifestations were diverse. For the 6 patients from newborn screening, 4 were asymptomatic, 1 showed hypoglycaemia and 1 showed movement intolerance from 2 years of age. For the 11 clinical patients, 8 showed hepatomegaly, 7 showed myasthenia, 6 showed cardiomyopathy, 1 showed chronic abdominal pain, and 1 showed restlessness and learning difficulty. Among these patients, 14 cases were treated with carnitine. Their clinical symptoms disappeared 1 to 3 months later. The C0 level in the blood rose to normal, with the average from (4.0 ± 2.7) µmol/L to (20.6 ± 8.3) µmol/L (P < 0.01). However, the level was still lower than the average level of healthy children [(27.1 ± 4.5) µmol/L, P < 0.01].

CONCLUSIONSeventeen patients were diagnosed with PCD by the test levels of free carnitine and acylcarnitines in blood with tandem mass spectrometry, and gene mutation test. Large dose of carnitine had a good effect in treatment of the PCD patients.

Cardiomyopathies ; diagnosis ; drug therapy ; genetics ; Carnitine ; analogs & derivatives ; blood ; deficiency ; genetics ; Child, Preschool ; DNA Mutational Analysis ; Female ; Follow-Up Studies ; Humans ; Hyperammonemia ; diagnosis ; drug therapy ; genetics ; Infant ; Infant, Newborn ; Male ; Muscular Diseases ; diagnosis ; drug therapy ; genetics ; Mutation ; Neonatal Screening ; methods ; Organic Cation Transport Proteins ; deficiency ; genetics ; Reference Values ; Tandem Mass Spectrometry

OBJECTIVETo investigate the clinical value of pleural effusion lung ProGRP, neuron specific enolase (NSE), cytokeratin fragment 19 (CYFRA21-1), carcino-embryonic antigen (CEA), carbohydrate antigen 153 (CA153), carbohydrate antigen 19 - 9 (CA19-9) in differential diagnosis and histological typing of malignant pleural effusion caused by lung cancer.

METHODSAll the 171 patients with malignant hydrothorax caused by lung cancer were from coal-mine area of Kailuan. They were divided into the small cell lung cancer (SCLC) group (n = 39), the adenocarcinoma group (n = 99) and the squamous cell carcinoma group (n = 37). The patients with benign pleural effusion served as the controls (n = 30). The diagnostic value of pleural effusion ProGRP, NSE, CYFRA21-1, CEA, CA153 and CA19-9 was compared for each group.

RESULTSYouden index and the accurate rate of pleural effusion ProGRP + NSE (sequence test) were the highest in the diagnosis of malignant hydrothorax caused by SCLC. CEA + CA153 + CA19-9 (sequence test) was the highest in the diagnosis of malignant hydrothorax caused by adenocarcinoma. CYFRA21-1 + CEA + CA153 (on parallel test) were the highest in the diagnosis of malignant hydrothorax caused by squamous cell carcinoma. The Yonden index and the accurate rate were the highest by the single detection of CYFRA21 (0.5514 and 0.6878), and by the combined detection of ProGRP + CYFRA21-1 + CEA (on parallel test) (0.7029 and 0.8878).

CONCLUSIONThe first pleural effusion tumor markers of malignant hydrothorax caused by the SCLC, adenocarcinoma of lung, and lung squamous cell carcinoma are ProGRP, CEA and CYFRA21-1, respectively. The best combinations of pleural effusion tumor marker in diagnosis of malignant hydrothorax caused by the SCLC, adenocarcinoma of lung, lung squamous cell carcinoma and lung cancer are the combined detection of ProGRP + NSE (sequence test), combined detection of CEA + CA153 + CA19-9 (sequence test), the combined detection of CYFRA21-1 + CEA + CA153 (on parallel test) and ProGRP + CYFRA21-1 + CEA (on parallel test), respectively.

Adult ; Aged ; Aged, 80 and over ; Antigens, Neoplasm ; analysis ; Biomarkers, Tumor ; analysis ; CA-19-9 Antigen ; analysis ; Diagnosis, Differential ; Female ; Humans ; Keratin-19 ; analysis ; Lung Neoplasms ; complications ; diagnosis ; Male ; Middle Aged ; Peptide Fragments ; analysis ; Pleural Effusion, Malignant ; diagnosis ; etiology ; Recombinant Proteins ; analysis

OBJECTIVETo study the association of human epidermal growth factor receptor family molecules expression in gastric cancer tissues with the prognosis of patients with gastric cancer.

METHODSClinical data of 161 patients with gastric cancer undergoing gastrectomy in Jiangsu Cancer Hospital between January 2006 and January 2007 were analyzed retrospectively. The expression of HER1, HER2, HER3 and HER4 was detected by immunohistochemistry. Association of the expression of HER family with the prognosis of patients was examined. Kaplan-Meier method was used to analyze the survival.

RESULTSHigh expression rates of HER1, HER2, HER3 and HER4 were 46.0% (74/161), 10.6% (17/161),55.9% (90/161) and 68.3% (110/161) respectively. Univariate analysis revealed that high expression of HER3 was associated with tumor invasion depth, lymph node metastasis, stage, neurovascular invasion, and overall 4-year survival. High expression of HER4 was associated with tumor distant metastasis and stage. High co-expression of HER2 and HER3 was associated with overall 4-year survival (P=0.023). Multivariate analysis revealed that high expression of HER3 and stage were prognostic independent factors.

CONCLUSIONUp-regulated expression of HER3 is associated with the poor prognosis in gastric cancer patients.

Adult ; Aged ; Aged, 80 and over ; Female ; Gene Expression Regulation, Neoplastic ; Humans ; Male ; Middle Aged ; Prognosis ; Receptor, Epidermal Growth Factor ; metabolism ; Receptor, ErbB-2 ; metabolism ; Receptor, ErbB-3 ; metabolism ; Receptor, ErbB-4 ; Retrospective Studies ; Stomach Neoplasms ; metabolism ; pathology

BACKGROUNDDuloxetine is approved for the treatment of generalized anxiety disorder (GAD) in the United States and elsewhere. This study aimed to assess the efficacy, tolerability, and safety of duloxetine in Chinese patients with GAD.

METHODSThis 9-site study consisted of double-blind treatment for 15 weeks either with duloxetine 60 - 120 mg or with placebo. Patients with at least moderately severe GAD and a Sheehan Disability Scale (SDS) global functioning impairment total score ≥ 12 were included in this study. Patients who were randomly assigned to duloxetine received 60 mg for 7 weeks; at that point, for nonresponders the dose was increased to 120 mg for the remaining 8 weeks. The primary efficacy measure was mean change from baseline to endpoint on the Hospital Anxiety and Depression Scale-Anxiety subscale score (HADS-A). Secondary efficacy measures included the Hamilton Anxiety Rating Scale (HAMA), the SDS, and pain measures. Safety and tolerability were assessed.

RESULTSBaseline characteristics did not differ significantly between treatment groups. Mean age of the subjects (n = 210) was 37.6 years, 50.5% were female, and 74.3% completed the 15 weeks treatment. Patients treated with duloxetine had significantly greater improvement compared to placebo on the HADS-A (mean change -6.6 vs. -4.9, respectively, P = 0.022). Improvement in anxiety was greater with duloxetine treatment at 7 weeks and continued through 15 weeks for both the HADS-A and the HAMA total score (0.01 ≤ P < 0.05). Compared with placebo, duloxetine was also associated with greater improvement on most secondary measures, but not on the SDS global functioning score. Nausea, dizziness, and somnolence occurred significantly more frequently as treatment-emergent adverse events with duloxetine treatment compared with placebo treatment.

CONCLUSIONSDuloxetine 60 - 120 mg once daily is effective and well-tolerated for the treatment of patients with GAD in China.

Adult ; Antidepressive Agents ; adverse effects ; therapeutic use ; Anxiety Disorders ; drug therapy ; Double-Blind Method ; Duloxetine Hydrochloride ; Female ; Humans ; Male ; Middle Aged ; Thiophenes ; adverse effects ; therapeutic use ; Treatment Outcome

OBJECTIVETo make a comparison between the antitumor effect and the chemical constituents of Huanglian Jiedu decoction (HLJDT) and that of serum containing HLJDT.

METHODBased on the established chromatographic fingerprint of HLJDT, analysis and comparison were made between the HPLC fingerprints of rat serum samples obtained after orally taking HLJDT and those of control rat serum samples. The different effects on NCI-H446 and Bel-74024 cancer cells from human were investigated in vitro using HLJDT and its serum. The inhibitory effects of HLJDT and its serum were observed by MTT assay.

RESULTTen compounds of HLJDT and some metabolites were detected after oral administration of HLJDT, and however some main compounds of HLJDT were not detected in serum. Both HLJDT and its serum in different dosage groups could inhibit the proliferation of NCI-H446 and Bel-7402 cancer cells from human in a dose-dependent manner, but inhibitory grade was different in the two cancer cell lines. HLJDT had more inhibitory effect on Bel-7402 than on NCI-H446, on the other hand serum containing HLJDT had the same inhibitory effect on Bel-7402 and NCI-H446.

CONCLUSIONThe reason for inhibitory grade change was that the proportion of concentration of many compounds in serum containing HLJDT was different to that in HLJDT, which should be subject to thorough investigation so as to illuminate the pharmacology and active mechanism of HLJDT.

Animals ; Antineoplastic Agents, Phytogenic ; administration & dosage ; isolation & purification ; pharmacology ; Cell Line, Tumor ; Cell Proliferation ; drug effects ; Dose-Response Relationship, Drug ; Drug Combinations ; Drugs, Chinese Herbal ; administration & dosage ; analysis ; isolation & purification ; pharmacology ; Humans ; Male ; Plants, Medicinal ; chemistry ; Rats ; Rats, Wistar ; Serum ; chemistry