Objective To evaluate the changes of blood coagulation and their clinical significance in pa-tients with severe acute pancreatitis (SAP). Method Two hundred and seven patients with acute pancreatitis ad-mitted from January 2005 to Deeember 2008 in People' s Hospital, Peking University, were recruited in this study. Patients were divided into two groups, severe acute pancreatitis (53 cases) and mild acute pancreatitis (154 cas-es), according to the diagnostic criteria set by the Chinese Medical Association in 2004. Plasma coagulation pa-rameters including prothrombin time (PT), prothrombin activity (PTA), international normalized ratio (PT-INR), activated partial thromboplastin time (APTT), fibrinogen (FIB) and D-dimmer were redorded. Results Com-pared with MAP group, there were significant differences on PT, PTA, PT-INR, FIB, and D-dimmer in SAP group [in MAP group, (12.45 ± 1.13) s,(94.01±21.21)% ,(1.08±0.14),(4.81±1.86)g/L,340.38 ng/ mL, respectively;in SAP group, (13.08±1.47)s,(86.92±17.36) %, (1.14±0.20), (5.49±2.30)g/L, 943.82 ng/mL, respectively; P <0.05]. There was no significant difference on APTT between the two groups (P > 0.05). D-dimmer was correlated to the APACHE Ⅱ score , and it was also correlated to the SIRS score (P < 0.05). The rate of systemic inflammatory response syndrome (SIRS) and the mortality were higher in patients with SAP patients than those in the MAP patients (in SAP group, 35.5%, 5.6%, respectively; in MAP group, 10.4%, 0, respectively; P < 0.05). Conclusions Disorders of coagulation and microcirculation disturbances were observed in patients with severe acute pancreatitis. These alterations may be useful in the assessment of the disease severity and prognosis of patients with acute pancreatitis.

OBJECTIVETo investigate the clinical value of pleural biopsy in the etiological diagnosis of pleurisy in children.

METHODTotally 213 cases with pleurisy, who underwent pleural biopsy and hospitalized in Children's Hospital of Chongqing Medical University from January 2007 to April 2014 were enrolled into this study. Clinical symptoms, imaging manifestations, pleural fluid characteristics, the results of pleural biopsy and postoperative complications were retrospectively analyzed to evaluate the clinical value and security of pleural biopsy in making the etiological diagnosis of pleurisy.

RESULT(1) Of the 213 cases, 144 were boys and 69 were girls, their mean age was (6. 5 ± 4. 1) years. (2) Two hundred and thirteen patients had a surgical pleural biopsy under general anesthesia, the cause of 97 cases (45. 5%) were made clear by histopathological examination, including 35 purulent pleurisy, 55 tuberculous pleurisy and 7 paragonimus infection. For the remaining 83 (41. 3%) cases a final diagnosis was made based on the full analysis of clinical data, including 63 cases of purulent pleurisy, 3 cases of tuberculous pleurisy and 17 cases of paragonimiasis pleurisy but for 33 patients no exact cause was found at the end. (3) The mean operating time of the biopsy was (1. 4 ± 0. 6) hours. Seventy one (33. 3%) patients required blood transfusion during or after the operation. Thirty one (14. 6%) cases used the ventilator after surgery, and the ventilator supporting time was (6. 6 ± 5. 8) hours on average. The wound healing reached grade A in 200 cases (93. 9%), grade B in 13 cases (14. 6%). Postoperative complications included pneumothorax in 92 cases (43. 2%), subcutaneous emphysema in 18 cases (8. 5%), bronchopleural fistula in 3 cases(1. 4%). The average days of hospitalization was (17. 7 ± 7. 1) d.

CONCLUSIONPleural biopsy is of great diagnostic value in the etiological diagnosis and differential diagnosis of pleurisy in children, and it is considered reasonable to be used in the clinical practice when appropriate.

Biopsy ; Child ; Diagnosis, Differential ; Female ; Humans ; Infection ; diagnosis ; Male ; Pleura ; Pleurisy ; diagnosis ; etiology ; Retrospective Studies ; Tuberculosis, Pleural ; complications ; diagnosis

Objective To determine whether chronic constriction injury (CCI) to sciatic nerve is associated with changes in the phosphorylation of CREB in dorsal root ganglia ( DRG) and superficial dorsal horn neurons of the spinal cord.Methods Thirty-two adult female SD rats weighing 230-270 g were randomly divided into 4 groups (n = 8 each): Ⅰ blank control;Ⅱ sham operation; Ⅲ CCI 2w and Ⅳ CCI 4w. The animals were anesthetized with intraperitoneal pentobarbital 40 mg?kg-1. Right sciatic nerve was exposed and 4 ligatures were placed on the right sciatic nerve at 1 mm interspace with 3-0 silk suture. Paw withdrawal threshold to mechanical stimulation (von Frey filament) applied to plantar surface ( MWT) and paw withdrawal latency to thermal stimulation (radiant heat) (TWL) were measured before operation (baseline) and 14 days (group Ⅰ,Ⅱ and Ⅲ) or 28 days (group Ⅳ) after nerve ligation. The animals were killed the next day and the L4,5 segment of the spinal cord and L5 dorsal root ganglion were removed for determination of expression of phosphorylated-CREB-immuno-reaction(pCREB-IR) using immuno-histochemistry. The pCREB-IR cells both in DRG and superficial dorsal horn neurons were quantified and analyzed. Results The animals developed mechanical and thermal hyperalgesia on the 14th day after CCI (in group CCI 2w) . The hyperalgesia was greatly attenuated on the 28th day after CCI. Interestingly enough the animals in sham operation group (Ⅱ) also developed mechanical hyperalgesia to some extent on the 14th day after operation. The number of pCREB-IR cells was significantly increased in the ipsilateral L5 DRG and superficial dorsal horn in group Ⅲ(CCI 2w) as compared to sham operation group ( P

Objective To assess the clinical value of low-frequency mini - probe sonography ( LFMPS) in preoperative localization of pancreatic endocrine tumors comparing with other imaging methods. Methods Twenty one cases with suspected pancreatic endocrine tumors were enrolled from June 2000 to June 2002, we compared the diagnostic results of LFMPS, transcutaneous ultrasonography ( US) , helico-computed tomography ( HCT) and magnetic resonance imaging (MRI) with surgical localization and histopathological results by using Fujinon 7. 5 MHz miniature probe and SP-701 ultrasonic system. Results Sixteen pancreatic insulinomas and 1 extra pancreatic VIPoma (vesoactive intestinal polypeptide tumor) were confirmed by surgery and histopathological examination in 17 of the 21 patients, and the rest 4 patients didn't receive surgical procedure because of the negative results in all imaging studies. Among pancreatic lesions, they located on head, body and tail in 9, 3 and 4 cases respectively; the average diameter of all 17 lesions was 2. 02cm. LFMPS correctly localized the tumor in 14 of 17 patients (82. 4% ) while CT in 15 of 17 patients (88. 2% ) , MRI in 12 of 17 patients (70. 6% ) and US in 9 of 17 patients (52. 9% ). Besides, the diagnostic accuracy of LFMPS in detection of small size (

To study the characteristics and preventive methods of road traffic accidents (RTA) in different regions of Chongqing, 2 police teams of traffic management in downtown, 2 teams at the arban suburb junction, 1 team in the county and 1 freeway team were selected randomly, and RTA occurring in the respective listrict, above middle RTA between 1988 to 1997 were investigated and analyzed. In a total of 13121 cases of RTA, there were 6201 RTA with casualties, 14 catastrophic RTA, and 977 serious RTA. In these RTA there were 1086 deaths, 3165 severely wounded and 7327 mildly wounded. Pedestrians and passenger weres constituted 44 0% and 42 5% of total casualties respectively. 57 9% of severely wounded and deaths occurred in pedestrians. As a whole,there was a tendency of rise in RTA every year, having a significant characteristic of time distribution. The majority RTA occurring in Chongqing was related with violation of driving regulations and recklessness in crossing roads. causes of RTA, time distribution and casualties were different in different regions. In order to decreese the rate of RTA,it is deemed essential to enhance propaganda to raise the awareness of traffic accidents and to reinforce traffic management appropriate for respective district of the city.

The amount of superoxide anions released by polymorphonuclear leukocytes (PMNs)and malonyldialdehyde (MDA) level in plasma,lung homoge-nate and bronchoalveolar lavage fluid (BALF) were determined in pigs after they were inflicted with gunshot wounds of steel-ball pellets.It was found that the amount of superoxide anions released spontaneously and after the stimulation of zymosa was increased and reached the peak in the 4th and 8th hour after injury respectively,and then returned to the preinjury level gradually.The changes of plasma MDA level was similar to those of superoxide anions released by PMNs.MDA level of lung homogenate and BALF was also significantly increased in the 24th hour postinjury.In addition,the relationship between PMNs function and lipid peroxidation in the plasma and the lungs was discussed.

Respiratory distress syndrome was produced in dogs with the combination of oleic acid injection and gunshot wounding,and the therapeutic effects of naloxone(NAD and positive end expiratory pressure ventilation(PEEP)were assessed with the examinations of macropatholo-gy of the lungs,lung water ratio.respiratory rate(RR)and blood gas analysis.It was found that RR was rapidly and significantly increased tPaO2 decreased and Qs/Qt increased and there was severe pulmonary hemorrhage,edema and atelectasis in the controls after injury.NAL treatment could slightly alleviate the increase of RR and prevent the early of PaCO2,but it had no effects on the changes of PaO2,Qs/Qt and increase pulmonary hemorrhage,edema and atelectasis.PEEP could improve the decrease of PaO2 and the increase of Qs/Qt and prevent pulmonary atelectasis and alveolar edema from occurring,but it could not significantly stop the increase of lung water ratio.

Clinically rare with an acute or subacute onset,Hashimoto's encephalopathy (HE) is characterized as autoimmune encephalopathy with elevated anti-thyroid autoantibodies.If timely diagnosed and treated,its prognosis is often fair.Four HE cases admitted from January 2012 to June 2014 were analyzed with a literature review.HE 4 cases had a significantly higher level of thyroperoxidase (TPO) while the lowest increase over four folds.There were cognitive decline,memory loss and even coma.And 50％ had abnormal electroencephalogram (EEG) consistent with radiographic lesions.In short,EEG may aid an early diagnosis of HE.

Objective To investigate pharmacodynamics of propofol for smooth exchange of tracheal tube for u laryngeal mask airway after surgery in elderly patients. Methods Twenty elderly patients, ASA Ⅰ or Ⅱ, aged 65-70 yr, scheduled for elective laparoscopic cholecystectomy were enrolled in this study. Anesthesia was induced with propofol, atracurium and remifentanil. The patients were mechanically ventilated after the trachea was intubated. Anesthesia was maintained with propofol combined with remifentanil. After surgery, a predetermined propofol concentration was achieved and a steady state maintained for at least 5 min. The target plasma concentration of propofol at which the laryngeal mask airway following tracheal extubation was attempted was determined by Dixon's up-and-down method with 0.5 μg/ml as the step size, The probit model was used to calculate the EC_(50) and EC_(95) and 95% confidence interval (95% CI) of propofol for inhibiting patient's response induced by smooth excharge of tracheal tube. Results The EC50 of propofol to achieve laryngeal mask airway following tracheal extubation was 2.79 μg/ml (95% CI 2.44-3.04 μg/ml) and EC_(50) 3.61 μg/ml (95% CI 3.27-4.78 μg/ml). Conclusion The target plasma concentration of propofol for laryngeal mask airway following tracheal extubation in elderly patients is 3.61 μg/ml.

Objective To explore the risk factors for acute kidney injury (AKI)in patients with acute myocardial infarction (AMI).Method The medical data of hospitalized patients with AMI admitted from October 2013 to May 2014 were reviewed.All patients were divided into AKI group and non-AKI group.The univariate comparison analysis were performed to obtain the AKI risk factors.Results A total of 565 patients were enrolled.The incidence of AKI (n =91 )was 16.1% and there were 474 non-AKI patients.The mortality of AKI group was 19.8% and mortality of non-AKI group was 0.4% (P <0.01). Univariate analysis demonstrated that the risk factors of AKI were age,hypertension,previous myocardial infarction,heart failure history,chronic kidney disease,cerebral infarction history,peripheral vascular disease;ventricular fibrillation,heart rate,Killip grade ≥3 stage,left ventricular ejection fraction,serum creatinine,eGFR,hemoglobin,blood urea nitrogen,troponin I,B-type natriuretic peptide and C-reactive protein,fasting glucose,albumin,maximum daily dose of furosemide,non-use of ACEI /ARB and statins, the use of intra-aortic balloon pump, temporary pacemaker and pulmonary mechanical ventilation, implementation of PCI and coronary artery bypass graft surgery.Conclusions These risk factors for AKI after AMI were found to identify high-risk patients,helping the clinicians to make decision for preventive intervention.