Objective To explore the value of early arterial blood lactate clearance rate and central venous oxygen saturation (ScvO2 ) monitoring in patients with severe pneumonia .Methods A total of 56 patients with severe pneumonia treated during the period from January 2012 to December 2013 were reviewed retrospectively .The arterial blood lactate concentration and ScvO2 were determined immediately after admission to hospital and 6 hours after admission to calculate the 6‐hour lactate clearance rate .APACHE II score was evaluated at the same time .The patients were divided into three groups according to APACHE II score:10 to ＜20 (group A) ,20 to ＜30 (group B) ,≥30 (group C) .The three groups were compared in terms of early arterial blood lactate clearance rate and ScvO2 and estimate their association with the prognosis of patients .Results The initial arterial blood lactate concentration did not show significant difference between the three groups (P>0 .05) .The early lactate clearance rate and ScvO2 at 6 hours in group C were significantly lower than in group B .The values in group B were significantly lower than in group A (P＜0 .05) .The mortality rate in group C was significantly higher than in group B ,and the mortality rate in group B was significantly higher than in group A (P＜0 .05) .The APACHE II score of the dead patients was higher than that of the suevivors ,but early lactate clearance rate and ScvO2 level were lower than those of the survivors (P＜0 .05) .APACHE II score was negatively correlated to early lactate clearance rate (r=0 .661 ,P＜0 .01) and early ScvO2 level (r=0 .579 , P＜ 0 .01) .Conclusions Early lactate clearance rate and ScvO2 level are good indicators to reflect the severity of disease and predict the outcome in the patients with severe pneumonia .

Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma, Non-Small-Cell Lung ; diagnostic imaging ; drug therapy ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lung Neoplasms ; diagnostic imaging ; drug therapy ; Male ; Middle Aged ; Positron-Emission Tomography ; Small Cell Lung Carcinoma ; diagnostic imaging ; drug therapy ; Tomography, X-Ray Computed

One child was hospitalized because of repeated cough and sputum. The biopsy diagnosis in local hospital was cystic lymphangioma in retropharyngeal space. We carried out transoral incision and drainage by catheter under general anesthesia. Put into the surgical cavity a suction drainage tube, and injected 5 mg dexamethasone and 8mg Bleomycin. He had nasogastric liquid diet after operation. We removed the suction drainage tube two weeks later. No recurrence was found following up over two years.
Child ; Humans ; Lymphangioma, Cystic ; diagnosis ; surgery ; Pharynx ; pathology ; surgery

Objective To explore the optimal screw fixation of anterior column lag screw fixation in the treatment of acetabular anterior column fractures by finite element method.Methods Firstly,CT scanning images from one healthy adult volunteer (male 30),were transferred into Materialise Mimics Innovation Suite 16.0 software,then three-dimensional (3D) models of pelvic were reconstructed and stored in stereolithography format.Then Imageware 12.0 software (EDS,USA) was used to produce the optimal and safe channel of the screw for acetabulum anterior column fixation.Three types of screw fixation were generated,i.e.(1) geometric algorithm screw channel,(2) in-out-in channel,(3) free screw channel.Secondly,all model data were transferred into Ansys 12.0 software to establish the finite element model.Gravity load were defined as 600 N,1 200 N,and 2 400 N,and the Von Mises the parameters of peak stress and deformation were recorded.Results Respectively load of 600 N,1 200 N,2 400 N force to normal hip and geometric algorithm screw channel, in-out-inscrew channel,free screw channel,the comparison between groups of hip by stress and hip deformation,with a given loading force of hip by stress and hip deformation increase gradually,the two were positively correlated,including screw by stress at slightly higher than that of normal hip,while the stress of hip by geometric algorithm screw channel andin-out-inscrew channel were similar,and that by free screw channel increased significantly.There was no significant difference between groups in the hip deformation.With a given loading force (600 N,1 200 N,2 400 N) on geometric algorithm screw channel、 in-out-inscrew channel and free screw channel,the deformation is gradually increased,and there were positively correlated.With the stress on geometric algorithm screw channel,it was significantly reduced compared with the latter two,and in-out-in screw channel suffered the biggest stress.Conclusion Through the finite element analysis,the geometric algorithm screw channel can be used as a safe and effective way for acetabulum anterior column fracture.

Objective To detect the expression of genes Her-2/neu,DPC4 and P16 in pancreatic carcinomas and to investigate the role of their alterations in tumorigenesis and progression of pancreatic carcinomas.Methods We studied the immunohistochemical markers Her-2/neu,DPC4 and P16 in 34 adenocarcinomas and 12 nonmalignant specimens of the pancreas,and the relationship between DPC4 alterations and various clinicopathological parameters was evaluated.Results There was a significant difference between normal pancreatic tissues and benign pancreatic lesions and primary pancreatic carcinomas for frequency of Her-2/neu expression and loss of P16 expression(P

Objective To examine the levels of serum adipaneetin in patients with incipient chronic kidney disease (CKD, GFR≥ 60ml/min, and identify the relationship between serum adiponectin and albumin (ALB), urinary protein excretion amount, blood lipid and renal function. Methods Forty-two CKD patients and twenty normal healthy persons were involved in this study. These patients were divid- ed into two groups: nephrotic syndrome and non-nephrotic syndrome. The level of serum adiponectin, serum ALB, urinary protein excretion amount, blood lipid, renal function were measured and compared. Results The level of serum adiponectin in nephritic syndrome patients [(21.9±11.3) mg/L] and non-nephrotic syndrome patients [ ( 11.0±7.0) mg/L] was significantly higher than that in normal healthy per- sons[ (5.6±3.3) mg/L] ( P<0.01 ), and the level of serum adiponectin in nephritic syndrome patients was higher than that in non-ne- phrotic syndrome patients( P <0.01 ). Correlative analyses revealed a negatively correlation between serum adiponectin and serum total pro- tein(TP, ALB, BMI( r=-0.5680, r = -0.6241, r = -0.4083,respectively), and a positive correlation between serum adiponectin and urinary protein excretion amount ( r =0.4083). Stepwise regression analyses showed that serum adiponoctin was highly influenced by BMI, ALB and urinary protein excretion amount. Conclusion Serum adipanectin was markedly increased in incipient CKD, especially in patients with macroalbuminura. The effect of high level adiponectin in CKD was still not clear.

Background Goldmann applanation tonometry (GAT) is a gold standard of intraocular pressure measurement.But its utilization iS limited because of its complexity and high requirement of cooperation.iCare rebound tonometer (iCare RBT) is a new type of applanation tonometry,and its accuracy and safety in clinical application need to be evaluated.Objective Present study was to investigate the reproducibility and tolerability of iCare RBT and its measurement agreement with GAT over a wide intraocular pressure (IOP) range. Methods The IOP were measured in bilateral eyes of 36 glaucoma and glaucoma suspect patients by 2 examinees with iCare RBT at the 1-minute interval to assess the interobserver reproducibility.Then the IOP of both eyes from 56 Subjeets and other 52 subjects were separately measured twice for each by two operators with iCare RBT for the evaluation of intraobserver reproducibility.Finally.IOP of 182 eyes of 92 glaucoma and glaucoma suspect patients was obtained by examiner 2 with RBT first and examiner 1 with GAT subsequently at a 2.minute interval in a masked fashion to perform an agreement evaluation of two readings by using Bland-Ahman method.The tolerance of subjects to iCare RBT measurement were surveyed.Oral informed consent was obtained prior to the IOP measurement. Results Concerning the iCare RBT readings.interobserver correlation coefficients were 0.937 in the right eye and 0.887 in the left eye.Intraobserver correlation coefficients of examiner 1 were 0.986 in the left eyes and 0.969 in the fight eyes.And those of examiner 2 were 0.990 and 0.979.Mcan values of iCare RBT readings and GAT were(18.74±8.36)mmHg and(19.33±8.20)mmHg and the mean difference values(iCare-GAT)was(-0.59 4±2.60)mmHg with the 95%confidence interval of -5.80-4.60 mmHg.The correlation coefficient between two modalities of IOP measurement WaS 0.95 1.No severe pain and discomfort were complained in all the subjects during or after measurement of iCare RBT. Conclusion iCare RBT has good interobserver and intraobserver reproducibility and good tolerance.It was proved that this is a good correlation between iCare RBT readings and GAT readings.

BACKGROUND:The anatomic structures and kinetic characteristics are the bases to establish hand model, and the kinetic characteristics of hand are determined by the anatomic structure. So, numerous scholars have paid close attention to virtual hand models based on the anatomic structures of hand.OBJECTIVE: To construct visible hand model based on anatomic structure.DESIGN: Single sample trial.SETTING: Center Laboratory, Third Military Medical University of Chinese PLA.MATERIALS: This trial was carried out in the Center Laboratory, Third Military Medical University of Chinese PLA in October 2003. Two fresh adult hands, which involved wrist joint, provided by the Department of Anatomy, Third Military Medical University of Chinese PLA, were employed. The two hands had no organic damage by naked observation.METHODS: The specimens were embedded and mill-cut (mill-cut layer thinness 0.2 mm). Cannon (ESO 1OD) digital camera (6.3 million pixel) was used for image collection. Each image was 31.5 MB, Data of 1 200 images were obtained.Adobe Photoshop 7.0 software was used for image treatment and then two-dimensional cross-section images were collected. The bone, flexor tendon and the outline of hand was three-dimensionally reconstructed by using the software,which was developed by the Department of Computer Science and Technology,Tsinghua University and Institute of Computer Medicine, Department of Anatomy, Third Military Medical University of Chinese PLA.MATN OUTCOME MEASURES: Three-dimensional reconstruction of the bone, flexor tendon and outline of hand.RESULTS: ①The outline of hand: After being reconstructed, the outline, which consisted of all fingers and nails, was well displayed, and observed from many directions.② Three-dimensional reconstruction of the bone of hand: The reconstructed bones of hands involved digital bones, metacarpal bones, carpal bones and all joints, and they could be displayed solely or in groups with other reconstructed structures.③ Three-dimensional reconstruction of the flexor tendons of hand:Four superficial flexor tendons, four deep flexor tendons and one flexor pollex Iongus muscle tendon could be seen from the reconstructed images. All the flexor tendons went out together from the carpal canal and went through the palm, then spread out in fan-shape along the direction of each finger. ④ Three-dimensional reconstruction of the metacarpal fascial spaces: It could be observed from the reconstructed three-dimensional models that the proximal end of the thenar space was close, its distal end was open to the 1st web space, and the proximal end of the midpalmar fascial space was open to the posterior space of antebrachial flexor by carpal canal. Its distal end had three little spaces, which were open to the 2nd, 3rd and 4th web space, respectively.CONCLUSION: The visible hand model, which is preliminarily established, can precisely show the main anatomic structure of palm.

Objective To investigate the feasibility and effectiveness of internal jugular vein (IJV) intervention therapy in patients with cerebral venous sinus thrombosis (CVST)with color Doppler ultrasound (CDU). Methods Twelve patients with CVST diagnosed by CDU and the 13 IJV lesions (localized luminal stenosis in 9 cases,venous long-segment slender in 2 cases,and right IJV localized luminal stenosis,and long-segment slender on the left in 1 case)confirmed by magnetic resonance venography (MRV)and/ or digital subtraction angiography (DSA)were enrolled retrospectively. CDU examinations were used at 1 week before and after IJV intervention therapy,6 months,1 year,and 2 years. The changes of the maximum diameter and the maximum velocity (V max )of the IJV were compared. The success rate and the long-term efficacy of the intervention therapy were analyzed. Results One week after treatment,the CDU examinations showed that the diameter of IJV stenosis in 13 IJV were increased significantly compared with those before procedure (4. 7 ± 2. 1 mm vs. 2. 3 ± 1. 3 mm;t = 5. 325,P < 0. 01). The velocity of blood flow of IJV was improved compared with before procedure (localized stenosis in 10 IJV[50 ± 15 cm/ s vs. 87 ± 24 cm/ s];t = 6. 285,P < 0. 01). Six of the 12 patients were followed up for a mean of 18 ± 7 months, two patients had restenosis after balloon dilatation. Conclusions For CVST patients with IJV lesions,the preliminary observation has indicated that IJV intervention therapy may improve the lesion lumen and hemodynamics. However,the intervention therapy,especially after balloon dilatation,the incidence of restenosis is higher. CDU can be used as an objective evaluation means for the long-term efficacy of IJV stenosis.

In order to carry out the training objectives ofexcellent doctor education training pro-gram implemented by the Ministry of Education and the Ministry of Health, an integrated organ-system oriented curriculum system of circulatory system was applied in five year clinical medicine education. The teaching contents of circulatory system from traditional Histology and Embryology, Physiology, Pathology, Pathophysiology, and Pharmacology were integrated and optimized to compile the integrated circulatory sys-tem textbook. problem-based learning (PBL) and comprehensive morphology experimental teaching were implemented into the integrated circulatory system curriculum. Diversified examination methods including continuous assessment of PBL were used to evaluate the learning effect of students. As a result, a new cur-riculum model of circulatory system teaching was constructed. And on the base of this curriculum model, an innovation course research experiment was performed, a digital network teaching platform with 4A (anybody, anything, anywhere, anytime) was set up, and diversified teaching methods were applied. This new developing curriculum system is helpful for students to relate what they have learned in the basic sci-ences to clinical medicine, gain clinical thinking competence, lifelong skills of self-directed learning, in-novative thinking, and ability of scientific research and practice.