Objective To study clinical signiifcance of single tidal breathing testing in bronchiolitis. Methods Infants with bronchiolitis at ifrst wheezing (bronchiolitis group, n=756), and 115 infants with bronchopneumonia (bronchopneumonia group) hospitalized were enrolled. Tidal breathing parameters were analyzed in two groups. Bronchiolitis group was divided according to percentiles of the fraction of exhaled time at peak tidal expiratory lfow to total expiratory time (TPTEF/TE). The episodes of recurrent wheezing of infants below the 20th or above the 80th percentile of TPTEF/TE were followed up by phone calls within 1 year after discharge from the hospital. Results There were signiifcant differences in TPTEF/TE, VPEF/VE, Ti, Ti/Te, TEF75 and TEF50 between bronchiolitis group and bronchopneumonia group. The recurrent wheezing rate of infants with bronchiolitis below the 20th percentile of TPTEF/TE was signiifcantly higher than that above the 80th percentile of TPTEF/TE (37.5%vs 11.3%). Conclusions There is the greater possibility of recurrent wheezing in the infants with the more serious airway obstruction relfected by single tidal breathing testing in bronchiolitis.

Objective To discuss the diagnostic methods and management of ruptured abdominal aortic (aneurysm)(AAA) and to analyse the main factors that influence prognosis.Methods The clinical data of 15 cases of ruptured infrarenal AAA treated in our hospital from 1998~2004 were retrospectively analysed. The main clinical manifestations were abdominal pain and/or back pain,low blood pressure or shock, and (pulsating) abdominal mass. 8 cases were diagnosed by DSA and/or sCTA; Doppler ultrasonic examination (suggested) rupture of abdominal aortic aneurysm in 2 cases; 2 cases had known history of AAA prior to (rupture); and 3 cases were diagnosed during operation. All of the patients underwent surgical operation. (Successful) clamping of the abdominal aorta above the neck of AAA was accomplished in 13 cases. Of these, the aorta was occluded below the diaphragm in 4 cases, and below the renal arteries in 9 cases.Results Seven cases(46.6%) died in the perioperative period. 2 died of blood loss from aneurysm that ruptured into the free abdominal cavity, 1died of myocardial infarction 5 days postoperatively, 2 died of respiratory failure 3 days and 7 days postoperatively, and 2 died of renal failure 4 days and 8 days after operation. Severe (complications) did not develop in the remaining patients.Conclusions Patients who present with the trilogy of abdominal pain and/or back pain, low blood pressure or shock and pulsating abdominal mass can be (diagnosed) easily. CT and Doppler ultrasonic examination are indicated for patients with questionable diagnosis and have stable vital signs. Operation is effective treatment for ruptured AAA. The crux of the operation is to mack an aortic occlusion proximal to the site of rupture of aorta to effectively control bleeding. Patients with rupture of AAA into the free peritoneal cavity or those with acute myocardial infarction, acute renal failure or respiratory complications had poor prognosis.

ObjectiveTo investigate the etiology, clinical characteristics, diagnosis and treatment of regional portal hypertension caused by left upper abdominal malignant tumors.MethodsFrom January 2006 to December 2009, a total of 8 patients presenting regional portal hypertension were treated at our hospital, whose clinical data were analyzed retrospectively. ResultsPancreatic tumors (5/8) and retroperitoneal tumors(3/8)were the primary etiology,andthe main symptoms included upper gastrointestinal bleeding and irregular left upper abdominal pain.Isolated gastric varices were the most distinct clinical features. All patients underwent multi-visceral resection including pancreatic body and tail and spleen. Tumor involved stomach, left kidney, left adrenal and splenic flexure of colon were also removed en bloc. During the follow-up period there was no recurrent upper gastrointestinal bleeding, one patient died and two patients developed metastasis or tumor local recurrence.ConclusionRegional portal hypertension caused by malignant tumor was relatively rare,aggressive resection of multi-viscera combined with devascularization was an effective therapy.

Objective To evaluate the safety and rationality of total/near total bilateral thyroidectomy(TBT) for patients with bilateral multinodular goiter(BMG). Methods From January 2003 to December 2006,311 BMG cases were preoperatively divided into two groups, 130 cases in group A underwent TBT, and 181 cases in group B were treated with subtotal/partial bilateral thyroidectomy. Results There were 6 and 2 eases in group A and group B respectively diagnosed by intraoperative frozen biopsy as BMG, but identified as papillary carcinoma by final pathology. Hence the 6 cases in group A avoided reoporation, while the 2 cases in group B underwent a resection of the remnant gland. Transient hoarseness developed in 3 (2.42%, 3/124) and 3 (1.68%, 3/179) eases in group A and group B respectively (P =0.48). Transient hypocalcemia developed in 11 (8.87% ,11/124) and 9(5.03% ,9/179) cases in group A and group B respectively(P =0.16). There was no postoperative goiter recurrence in group A, but recurrence developed in 12 cases (6.70%,12/179) in group B(P=0.02). Conclusions Total bilateral thyroidectomy is safe and rational for the management of bilateral thyroid goiter.

Objective To discuss how to identify the nerve and prevent the injury of the nonrecurrent laryngeal nerve during thyroid surgery. Methods The clinical data of 3078 patients undergoing thyroid resection were retrospectively analyzed. Results From January 1981 to December 2001,3078 thyroidectomy was performed at our department with the routine exploration of the recurrent laryngeal nerve.4241 recurrent laryngeal nerves were identified,among them there were 12 nonrecurrent laryngeal nerves(0.28%,12/4241),ofwhich all were right-sided.One patient was male and 11 female.Of these 12 cases,there were 2 of type Ⅰ(16.67%,2/12),6 of type Ⅱ(50%,6/12)and 4 of type Ⅲ (33.33%,4/12).One ofthe type Ⅰ patients suffered from intraoperative injury of his nonreurrent laryngeal nerve.Conclusions The careful intraoperative identification of the nonrecurrent laryngeal nerve helps prevent it from the inadvertent injury.

OBJECTIVETo analyze the frequency of beta-fibrinogen (beta-Fg) gene -455G/A, -148C/T and 448G/A polymorphism, fibrinogen molecular reactivity and their association with plasma fibrinogen levels in health adults, myocardial infarction and cerebral infarction disease.

METHODSThe beta-Fg gene -455G/A, -148C/T and 448G/A polymorphisms were analyzed by restriction fragment length polymorphism (RFLP). Fibrinogen molecular reactivity was analyzed for the conversion kinetics of fibrinogen into fibrin by a computer assistant procedure. Plasma fibrinogen levels were determined by Clauss method.

RESULTSThe frequencies of -455A, -148T, 448A allele in health adults were 0.185, 0.194 and 0.192, in myocardial infarction disease 0.295, 0.318 and 0.307, in cerebral infarction disease 0.177, 0.193 and 0.182, respectively. The frequencies of -455A, -148T, 448A alleles in myocardial infarction disease were apparently higher than that of health adults. There were close linkage between -455G, -148C and 448G or -455A, -148T and 448A, the correspondence was over 98%. There are no differences in the plasma fibrinogen levels of the three polymorphisms in two genotype groups. The fibrinogen molecular reactivity was significantly increased in cardiocerebral vascular disease and related with plasma fibrinogen level.

CONCLUSIONThe three polymorphisms loci are strong linkage disequilibrium. There are no significant differences in the plasma fibrinogen levels of the three polymorphisms in two genotype groups. The frequencies of -455A, -148T, 448A alleles in myocardial infarction disease were apparently higher than that of health adults. It suggest that there was no association between beta-Fg gene -455G/A, -148C/T and 448G/A polymorphisms and plasma fibrinogen levels, but did in myocardial infarction disease. The fibrinogen molecular reactivity was significantly increased in cardiocerebral vascular disease and related with plasma fibrinogen level.

Adult ; Aged ; Aged, 80 and over ; Caenorhabditis elegans Proteins ; Cerebral Infarction ; genetics ; Female ; Fibrinogen ; analysis ; Gene Frequency ; Humans ; Linkage Disequilibrium ; Male ; Middle Aged ; Muscle Proteins ; genetics ; Myocardial Infarction ; genetics ; Polymorphism, Genetic

Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.