Objective To investigate the clinical characteristics,pathogenic causes and treatment outcomes of acute kidney injury (AKI) in very old patients in order to improving the diagnosis and treatment.Methods 39 AKI patients aged ≥80 years in the department of geriatric medicine of our hospital were enrolled and followed up for 3 months.Clinical and laboratory data were analyzed and the pathogenic causes as well as the treatment outcomes were summarized.Results Among the 39 very old patients,31(79.5％) were male,8(20.5％) were female,and the mean age was (93.5±4.6) years.33 (84.6％)patients had chronic kidney diseases.The pathogenic causes of AKI were mainly as follows:urological infections (71.8％),blood volume deficiency (48.7％),cardiac dysfunction (23.1％) and hypotension (15.4％).2 to 4 pathogenic causes were co present in 64.1％ patients.Renal function was improved and recovered in 69.2 ％ patients and the death rate was 25.6％ after treatment.The main causes of death were septic shock (30.0％),multiple organ failure (20.0％),massive gastrointestinal hemorrhage (20.0％) et al.Conclusions Most of the very old patients may suffer from AKI on the basis of chronic kidney disease.AKI is often induced by multiple pathogenic causes.The main factors leading to AKI are urological infections,followed by blood volume deficiency and cardiac dysfunction.Most patients with AKI can recover after the precipitating factors are removed and supportive treatments are administered in time.Septic shock is the main cause of death.

Objective To explore the clinical characteristics of neonatal-onset carbamoyl phosphate synthetase I deficiency (CPS1D). Methods Clinical data and result of genetic detection of one neonate with CPS1D were retrospectively analyzed. The pertinent literature was reviewed. Results A 3-day old girl, with onset symptoms of nonspecific performance, such as poor feeding, less activity, tachypnea, and seizures. After fasting, anti-infection, and respiratory support etc. the condition was improved. However, the condition deteriorated and developed rapidly after feeding restarted. MRI showed extensive cerebral white matter lesions. Blood ammonia?>?500 μmol/L. Gene detection found two heterozygous mutations in pathogenic gene CPS1 in twentieth exon of c.2407C?>?G (p.803, R, G) and fourth exon C.323G?>?A (p.108, G, E), according to which CPS1D was diagnosed finally. Conclusions For neonate with normal birth, had feeding difficulty, seizures, and consciousness disorder after establishment of normal feeding, if blood ammonia level significantly increased, the blood and urine amino acids analysis and gene detection should be performed to confirm the diagnosis.

OBJECTIVETo compare the differences in clinical efficacy on peripheral facial paralysis at acute stage between the opposing needling technique and routine acupuncture at the affected side so as to provide the evidence on the acupuncture treatment for peripheral facial paralysis at acute stage.

METHODSForty patients were rando- mized into an opposing needling technique group (19 cases) and an affected side needling technique group (21 cases). The basic medication was same in the two groups. The acupoints were Fengchi (GB 20), Yangbai (GB 14) to Yuyao (EX-HN 4) (penetrating needling method), Jingming (BL 1), Chengqi (ST 1), Xiaguan (ST 7), Jiache (ST 6) to Dicang (ST 4), Hegu (LI 4) and Zusanli (ST 36). In supplementation, in the opposing needling technique group, the acupoints were stimulated on the face of healthy side. In the affected side needling technique group, the acupoints were stimulated on the face of the affected side. The treatment was given three times a week, for 4 weeks. House-Brackmann (H-B) facial nerve function assessment was used to evaluate facial nerve function before and after treatment in the patients of the two groups. The efficacy was compared between the two groups.

RESULTSThe facial nerve function was recovered in the two groups and the total effective rate was 100.0% in the two groups (P>0.05). The curative rate was 68.4% (13/19) in the opposing needling technique group and better than 47.6% (10/21) in the affected side needling technique group (P<0.05). On the 7th and 14th day, scores of H-B in the opposing needling technique group were better than those in the affected side needling technique group (both P<0.05). The curative time in the opposing needling technique group was apparently shorter than that in the affected side needling technique group ((23.95 +/- 4.30) days vs. (29.14 +/- 5.43) days, P<0.01).

CONCLUSIONThe opposing needling technique accelerates the recovery of facial nerve function in peripheral facial paralysis at acute stage and apparently shortens the curative time. The efficacy is better than that in acupuncture on the affect- ed side of the face.

Acupuncture Points ; Acupuncture Therapy ; methods ; Adolescent ; Adult ; Child ; Facial Paralysis ; therapy ; Female ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

To construct a scFv library by phage display technique from the spleen cells of mice immunized with B3HM cells. Three mice were immunized with B3HM cells, and their spleen cells were harvested. The genes of VH and Vk were amplified by RT-PCR from the cDNA of the immunized spleen cells and a scFv-phage display antibody library was constructed. The capacity of library was measured,and the variety of the library was analyzed by digesting with restriction endonuclease BstNI.ScFv phage clones were randomly picked and identified phage-scFv clone by binding B3HM cells using immunofluorescein.A scFv library containing 5?106 individual clones which showed different patterns after digested with restriction endonuclease BstNI was produced. Individnal phage-scFv clone showed B3HM cells positive using immunofluorescein. A scFv library of anti-B3HM cell surface molecules has been constructed. It will be useful for finding out some novel genes of causing leukemia, and establishs the infarctate foundation of clarifying the pathogenesis of leukemiagenesis.

Adenocarcinoma ; complications ; Aged ; Humans ; Lung Neoplasms ; complications ; Male ; Pulmonary Embolism ; complications

OBJECTIVE: To explore the effects of Tanreqing injection, a traditional Chinese herbal preparation for clearing heat and resolving phlegm, in treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) by improving airway inflammation and airway mucus hypersecretion. METHODS: A randomized controlled trial (RCT) was designed. Ninety AECOPD patients were randomly divided into Tanreqing group, ambroxol hydrochloride group and control group. The patients in the three groups were all treated with conventional therapy. Furthermore, intravenous drip infusion of 20 ml Tanreqing injection (once daily) and 15 mg ambroxol hydrochloride injection (twice daily) were administered respectively to the patients in the Tanreqing group and ambroxol hydrochloride group. They were all treated for 10 days. Symptom score of traditional Chinese medicine (TCM), plasma concentrations of interleukin-8 (IL-8), IL-10 and neutrophil elastase (NE) were detected before and after treatment. RESULTS: Cough, sputum amount, expectoration, dyspnea, fever, coated tongue and pulse tracings were improved obviously in Tanreqing group (P<0.05), and the effects of Tanreqing on improving cough, sputum amount and expectoration were better than the conventional therapy (P<0.05), while there was no significant difference between Tanreqing group and ambroxol hydrochloride group (P>0.05). Compared with ambroxol hydrochloride group and the control group, the coated tongue was improved obviously in Tanreqing group (P>0.05). After treatment, plasma concentrations of IL-8, IL-10 and NE were decreased in Tanreqing group and ambroxol hydrochloride group (P<0.05), and the levels of IL-8 and IL-10 in the control group were decreased (P<0.05). The change of IL-8 level before and after treatment in Tanreqing group was greater than that in ambroxol hydrochloride group and the control group. The changes of IL-10 and NE levels in ambroxol hydrochloride group were greater than those in Tanreqing group and the control group, while there was no significant difference in the changes of serum levels of IL-8, IL-10 and NE among the three groups (P>0.05). Total response rates in Tanreqing group and ambroxol hydrochloride group were higher than that in the control group (P<0.05), while there was no significant difference in total response rate between Tanreqing group and ambroxol hydrochloride group (P>0.05). There was no significant difference in total response rate among the three groups (P>0.05). CONCLUSION: Tanreqing injection can improve TCM signs and symptoms in AECOPD patients, and the mechanism maybe due to the decrease of serum levels of IL-8 and NE and improvement of IL-10 level.

OBJECTIVE: To evaluate the safety and efficacy of Chaige Qingre Granule, a traditional Chinese compound herbal medicine, in treating acute upper respiratory tract infection of wind heat syndrome. METHODS: A multi-center, double-blinded, randomized controlled trial was conducted. In the phase II, 60 patients with acute upper respiratory tract infection were randomly divided into the trial group (n=30) and the control group (n=30). In the phase III, 112 patients were randomly divided into the trial group (n=84) and the control group (n=28). The trial group received 6 g Chaige Qingre Granule, and the control group received 6 g Fufang Shuanghua Granule (another traditional Chinese compound herbal medicine). The two groups were all treated for 3 days and four times daily. Clinical symptoms, syndromes, adverse effect, blood, urine and stool test, hepatorenal function and electrocardiogram were examined before and after the treatment. RESULTS: After treatment, the overall obvious response rates of the trial group and the control group were 78.57%, 82.14% (by per-protocol analysis) and 75.86%, 79.31% (by intention-to-treat analysis) respectively, and the overall response rates of the two groups were 96.43%, 100% (by per-protocol analysis) and 93.10%, 96.55% (by intention-to-treat analysis) respectively in phase II. There were no significant differences between the two groups (P>0.05). In the phase III, the overall obvious response rates of the trial group and the control group were 90.54%, 73.08% (by per-protocol analysis) and 88.16%, 70.37% (by intention-to-treat analysis) respectively, and the overall response rates of the two groups were 94.59%, 96.15% (by per-protocol analysis) and 92.11%, 92.59% (by intention-to-treat analysis) respectively. There were no statistical differences between the two groups (P>0.05) too. No adverse effects were found in the trial. CONCLUSION: Chaige Qingre Granule is effective and safe in treating acute upper respiratory tract infection of wind heat syndrome.

OBJECTIVE To evaluate whether the IDO1 inhibitor 1- methyl- L- tryptophan (1- MT) combine calcium influx inhibitor carboxyamidotriazole (CAI) could further enhance the suppression of programmed death 1 (PD-1) in CD8 + T cells and investigate the curative effect of the combined use. METHODS CD8 +T cells were isolated from normal mice spleen by negative selection using magnetic cell separation. The isolated CD8 +T cells were cultured in RPMI 1640 medium containing 10% FBS and 100 U·mL- 1 IL-2 and activated by the addition of anti-CD3 and anti-CD28 (1 g·L- 1 each mabs). CD8 + T cells were pretreated for 48 h with drug and the fluo- 3 as a marker of intracellular calcium concentration was detected by flow cytometry. The calcineurin (CaN) levels were assayed with ELISA in CD8+T cells after 48 h incubation with 10 μm CAI. The nuclear translocations of NFAT and AHR were detected by immunofluorescent staining after 48 h of drug treatment. The expression of PD-1 in CD8+T cells was analyzed by flow cytometry. RESULTS Intracellular fluorescent intensity was markedly debase due to CAI treatment(P<0.01). Meanwhile, the changes of CaN content had a resembled correlation (P<0.01). Immunofluorescence experiment showed that after combination therapy the transfer of NFAT and AHR in nuclear substantially reduced. Flow cytometry revealed that after the combination caused a significant decrease in PD-1 expression in CD8+T cells. CONCLUSION CAI and 1-MT could inhibit markedly the expression of PD-1 in CD8 +T cells by inhibiting the nuclear translocation of NFAT and AHR, respectively and the combination of them has synergetic effect.

Objective Data on applications and grants of general program on health science of National Natural Science Fund from Shanghai First People's Hospital,Shanghai Jiao Tong University (SFPH) during 2011-2014 were analyzed with an attempt to explore the ways to promote the funding rate.Methods x2 test and t test were performed,and a binary Logistic regression model was established to determine variables influencing the results of applications.Results There were 367 applications in SFPH during 2011-2014,86 of which were granted.The funding rate was higher than that of Department of Health Science.The total and highest impact factor of SCI articles published by applicants of granted programs were both higher than those of non-granted programs.The significance of these two factors in predicting whether an application will be granted was confirmed by the results of Logistic regression analysis.Conclusions SCI article is an important aspect of academic achievements of applicants,which is a prerequisite for an application to be granted.However,a scientific and innovative project may be critical for the outcome of an application.

Objective To explore the relationship between the fall of postprandial blood pressure and superior mesenteric artery (SMA) blood flow in elderly patients aged 80 years and over.Methods The study included 25 inpatients aged 80 years and over with postprandial hypotension (PPH group) and 27 age matched cases without PPH (control group).The changes in blood pressure and the hemodynamics of SMA at fasting stage and 2 hour after meal were observed.The differences between the two groups were compared.Results The incidence of abnormal glucose metabolism (including diabetes and impaired glucose tolerance) was significantly higher in PPH group than in control group [[92.0％ (23 cases) vs.40.7％ (11 cases), P＜0.05].There were no significant differences in other clinical data between the two groups (all P＞0.05).The blood pressure in two groups at different time points was decreased after meal significantly as compared with that at fasting stage (all P＞0.05).The maximal fall of postprandial systolic blood pressure and diastolic blood pressure was significantly increased in PPH group as compared with in control group [(31.3± 14.8)mmHg(1 mmHg=0.133 kPa) vs.(6.9±16.5) mmHg, (13.1±6.6) mmHg vs.(9.0±3.9)mmHg, both P＜0.05].The postprandial SMA blood flow at different time points was significantly increased after meal as compared with that at fasting stage in two groups (all P＞0.05).The maximal increase of postprandial SMA blood flow was larger in PPH group than in control group [(550.5±149.5) ml/min vs.(312.8±241.4) ml/min, P＜0.05].The maximal fall of postprandial systolic blood pressure was positively associated with the maximal increase of postprandial SMA blood flow (r=0.352, P=0.025).Conclusions The fall of postprandial blood pressure is associated with the increase of the SMA blood flow.Postprandial increase in splanchnic perfusion is one of the mechanisms for the formation of PPH.