Objective To investigate the clinical effect of internal medicine medical treatment on primary sclerosing cholangitis disease.Methods Patients with primary sclerosing cholangitis in the study group were given ursodeoxycholic acid and glucocorticoid combined with the comprehensive drug treatment on the basis of conventional therapeutic measures.Patients with primary sclerosing cholangitis in the control group were simply given corticosteroid drugs prednisone therapy,The clinical symptoms,results of clinical medical imaging examination,laboratory examination indexes and liver histological recovery were recorded and analyzed in two groups before and after treatment.Results The total effective rate of the study group was 86.96％,which was significantly higher than that of the control group 65.22％ (P ＜ 0.05).The curative effect between the two groups had statistically significant difference.Conclusion Ursodeoxycholic acid and lucocorticoid combined with drug treatment can improve the clinical symptoms and physical indexes in treatment of patients with primary sclerosing cholangitis,which is worthy of clinical application,but still need to give liver transplant operation.

Objective To investigate the applicative value of acoustic radiation force impulse imaging (ARFI) in the differential diagnosis of small hypoechoic thyroid nodules.Methods 31 patients were pathologically confirmed as having a total of 44 small hypoechoic thyroid nodules ≤ 1 cm in diameter,followed by analyses of the characteristics of their ARFI images,including virtual touch tissue imaging (VTI) and virtual touch tissue quantification (VTQ).Based on VTI images of the nodules,the hardness of small hypoechoic thyroid nodules was respectively scored,and the ratios of VTI images to gray scale image areas were calculated.With pathological diagnosis as the gold standard,VTI scores,area ratios and VTQ values of the ROC curve in diagnosis of thyroid malignant nodules were sketched so as to explore the optimal cut-off points in VTI scores,area ratios and VTQ values in the diagnosis of malignant nodules.Results By the ROC curve test,VTI score of 3 was determined as the cut-off point of areas ratio,with the sensitivity and specificity of diagnosing thyroid cancer being 96.0 ％ and 94.7％,respectively.There were 34 nodules with VTI score greater than 3 (including 9 benign nodules and 25 malignant nodules) and 10 nodules with VTI score of 3 or less (all benign nodules).Malignant thyroid nodules had higher ratio of VTI images to gray scale image area than that of the benign nodules (1.58 ± 0.18 vs 1.30 ± 0.10,P ＜0.05).When 1.47 was set as the cut-off point of areas ratio,the sensitivity and specificity of diagnosing thyroid cancer were 80.0％ and 94.7％,respectively.The VTQ value of 2.76 m/s in diagnosis of thyroid malignant nodules was designated as the cut-off point,with a sensitivity of 88.0 ％,specificity of 94.7 ％.Conclusions The ARFI technique is able to provide information of thyroid nodule hardness,which guarantees its high applicative value in the differential diagnosis of small hypoechoic thyroid nodules.

Objective To evaluate the curative and prophylactic effects of pulmonary surfactant (PS) on neonatal respiratory distress syndrome (NRDS) by two different administration means. Methods 35 neonates with NRDS were divided into groups Ⅰ and Ⅱ randomly, prophylactic group were randomly divided into groups Ⅲ and Ⅳ, the means of administration in all patients was through tracheal tube. Neonates in group Ⅰ and Ⅲ, were given curosurf in several times with different posture, group Ⅱ and IV were given in one time with supine position. Blood gas analysis, index of mechanical ventilation, the duration of mechanical ventilation, hours of oxygen requirement and hospitalization between Ⅰ and Ⅱ group, the incidence of NRDS between Ⅲ, and IV group were analyzed and compared before and after treatment. Results After treatment for 6 and 24 hours, the oxygenation and lung function of group Ⅰ and Ⅱ improved respectively (P<0.05), the total times of assisted ventilation, Supplemental oxygen therapy and hospitalization were significantly decreased, the differences of those index were no significant between Ⅰ and Ⅱ group (P0.05), the incidence of NRDS have no different between Ⅲ and IV group. Conclusion Pulmonary surfactant is effective and safe for treating and prophylacting NRDS, and have no relationship with the means of administration.

Objective To analyze the clinical manifestation of diffusive alveolar hemorrhage in acute leukemia induction therapy.Methods Clinical data of two diagnosed cases of diffusive alveolar hemorrhage secondary to acute leukemia were collected.Clinical data of eight cases of diffusive alveolar hemorrhage secondary to acute leukemia which were published were also collected by searching in Medline database.The clinical manifestation,diagnosis,strategy of differential diagnosis and treatment of diffusive alveolar hemorrhage secondary to acute leukemia were analyzed.Results Diffusive alveolar hemorrhage was a rare but fatal complication of acute leukemia.The common clinical manifestations included hemoptysis,progressive dyspnea and progressive decrease in concentration of hemoglobin.The analysis of blood gas showed type Ⅰ respiratory failure.The manifestations of chest computed tomography included diffusive ground glass opacity and infiltration of parenchyma.The bronchoalveolar lavage fluid was bloody.And lung biopsy showed congestion of alveoli and capillaritis.The detection for pathogens,vasculitis related antibodies,brain natrium peptide were negative.The mortality of those cases was 40 ％ (4/10).Corticosteroids therapy was effective.The mortality of patients received corticosteroids therapy was 25 ％ (2/8).Conclusion Diffusive alveolar hemorrhage is a rare but fatal complication of acute leukemia.The mortality is high.The key points of therapy are early diagnosis and corticosteroids therapy.

Objective To investigate the dynamic changes of neutrophil gelatinase-associated lipoca-lin(NGAL) and kidney injury molecule 1(KIM-1) in children after contrast media administration and evalu-ate the effect of hydration therapy. Methods A total of 58 patients with urinary system diseases who were admitted to Shengjing Hospital of China Medical University from March 2012 to March 2014 for intravenous pyelography(IVP) in pediatric department were enrolled. The 58 patients were randomly divided into hydra-tion group of 28 patients and non-hydration group of 30 patients. Contemporaneous 24 patients received respiratory system enhanced CT examination without urinary tract diseases and hydration were enrolled as control group. Urine NGAL and KIM-1 of the three groups at 0 h,24 h,48 h,72 h,96 h after using intravenous contrast media were detected by ELISA. Serum creatinine of the three groups at 0 h,48 h,96 h after using intravenous contrast media were detected. Results All of the 82 subjects in this study didn′t occur contrast- induced acute kidney injury. The urinary NGAL of non-hydrated group significantly increased at 24 h and 48 h after contrast media administration ( P < 0. 05 ) and the urinary NGAL of hydrated group significantly increased at 48 h and 72 h(P<0. 05). But the urinary NGAL at 24 h and 48 h of the hydration group were lower than these of the non-hydrated group,there were statistically significant differences(P<0. 05). At 24 h,48 h and 72 h after contrast media administration,the level of urine KIM-1 in the non-hydration group sig-nificantly increased(P<0. 05). Urine KIM-1 at 48 h and 72 h in the hydration group significantly increased (P<0. 05). But the urine KIM-1 at 24 h,48 h and 72 h of the hydration group were lower than these of the non-hydration group,the differences were statistically significant(P<0. 05). Comparison of urine NGAL and KIM-1 at different times before and after contrast media administration in children receiving enhanced CT examination who without urinary tract disease showed no statistically significant differences ( P >0. 05 ). Conclusion The urine NGAL and KIM-1 of children with urinary system diseases increase after contrast media administration and there is a trend of spontaneous recovery. Hydration intervention can alleviate the up-ward trend of urine NGAL and KIM-1. For children receiving enhanced CT examination but without urinary system diseases,the change of urine NGAL and KIM-1 are not significant.

OBJECTIVETo evaluate the efficacy and safety of anagrelide in essential thrombocythemia (ET).

METHODSPatients who diagnosed as ET according to the World Health Organization classification were enrolled. Each patient was assigned to take anagrelide hydrochloride capsule or hydroxyurea tablet by random 1∶1 ratio. Dose of anagrelide started at 2 mg/d, then increased gradually and the maximum dose was 10 mg/d until the platelet counts dropped to (100-400) × 10⁹/L, one month later gradually reduced to maintain dose. The dose of hydroxyurea was 1000 mg/d at beginning, then increased gradually, when platelet counts dropped to (100-400)×10⁹/L and kept for one month, reduced to maintain dose as 10 mg·kg⁻¹·d⁻¹. The observation period was 12 weeks.

RESULTSA total of 222 patients were enrolled in seventeen centers (including 113 patients treated with anagrelide and 109 with hydroxyurea). Therapy efficacy can be evaluated in 198 patients (including 97 patients administered with anagrelide and 101 with hydroxyurea). At 12th weeks of therapy, the hematologic remission rate was 87.63% (85/97) in anagrelide group and 88.12% (89/107) in hydroxyurea group, the differences between the two groups were not significant (P=0.173). Treatment with anagrelide lowered the platelet counts by a median of 393 (362-1 339) × 10⁹/L from a median of 827 (562-1657) × 109/L at the beginning of the observation to 400(127-1130)×10⁹/L after 12 weeks (P<0.001), which were similar to the treatment result of hydroxyurea by a median drop of 398 (597-1846)× 10⁹/L (P=0.982). The median time to achieving response of anagrelide group was 7 (3-14) days, superior to that of hydroxyurea for 21 (14-28) significantly (P=0.003). Frequency of anagrelide related adverse events was 65.49 % (74/113), including cardiopalmus (36.28% ), headache (21.24% ), fatigue (14.16% ) and dizzy (11.50% ).

CONCLUSIONAnagrelide was effective in patients with ET which had similar hematologic remission rate to hydroxyurea and could take effect more quickly than hydroxyurea. Incidence of adverse events was undifferentiated between anagrelide and hydroxyurea, but anagrelide treatment had tolerable adverse effects and no hematologic toxicity.

Humans ; Hydroxyurea ; administration & dosage ; therapeutic use ; Platelet Aggregation Inhibitors ; administration & dosage ; therapeutic use ; Platelet Count ; Quinazolines ; administration & dosage ; therapeutic use ; Thrombocythemia, Essential ; drug therapy ; Treatment Outcome

Adult ; Humans ; Heart Arrest/therapy* ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Out-of-Hospital Cardiac Arrest/therapy* ; Treatment Outcome