Objective To explore the feasibility and value of low dose CT scan for the diagnosis of pulmonary tuberculosis.Methods 150 patients with pulmonary tuberculosis underwent three doses CT scan (standard dose:150 mA;low-dose:15 mA and 30 mA) using GE dual slices helical CT.Besides the different tube current,other scan parameters including tube voltage,scan cycle,pitch,and collimation were the same in three dose groups.The scanned extent was from apexes to bases of lung.Image quality in standard group was compared with that in other two low dose groups and analyzed statistically by three radiologists.Results CT characteristics of pulmonary tuberculosis could be detected efficiently using low dose CT scan(30 mA) program,which was no significant as compared with the CT image using standard CT sose(P＞0.05).Howere,CT scan at 15 mA obviously affected on the diagnosis for both active and inactive pulmonary tuberculosis,the difference was significant (P＜0.05).Conclusion Low dose CT scan can replace totally the standard dose CT scan in diagnosing pulmonary tubercrulosis.

Electrocardiography ; methods ; Heart Conduction System ; physiopathology ; Heart Diseases ; diagnosis ; Humans

Objective To compare the efficacy of retroperitoneal laparoscopy with open pyeloplasty for ureteropelvic junction obstruction(UPJO).Methods Retroperitoneal laparoscopy was performed under general anesthesia with the patients placed in lateral position.Three trocars were inserted at the midaxillary line above the iliac crest,and the pre- and post-axillary lines beneath the 12th rib.A fourth port was placed at the preaxillary line above the iliac crest.Over the medial margin of the psoas major,Gerota’s fascia was opened to expose the ureter.And then,the tissues around the ureter were cut to show the lower pole of the kidney.Afterwards,the redundant renal pelvis and the strictured segment of the ureter were resected,pelvi-ureteric anastomosis was completed with absorbable sutures,and a double-J stent was inserted.Open pyeloplasty was also carried out under general anesthesia with the patients in lateral position.An incision was made beneath the 12th rib to expose the ureteropelvic junction,and then the renal pelvis was cut at 2 cm away from the renal parenchyma,and the strictured segment of the ureter was resected.Double-J stent was indwelled after pelvi-ureteric anastomosis.The patient was placed in a lateral position under general anesthesia or epidural anesthesia.Subcostal incision was made.The lower pole of the kidney,the dilated renal pelvis and the upper ureter were mobilized in front of the psoas major.Cut the pelvis 2 cm away from the parenchyma and the PUJ was dismembered.The pelvi-ureteric anastomosis was completed with absorbable sutures and then a D-J stent was inserted.Results Compared with the open surgery group,the laparoscopy group experienced significantly longer operation time [(156.9?69.2) min vs(111.9?78.1) min,t=2.514,P=0.014],but less blood loss [mean:35(20-70)ml vs 110(60-175)ml,t=7.502,P=0.000],and shorter analgesic treatment and postoperative hospital stay [(0.7?0.3) d and(8.5?6.1) d vs(1.3?0.5) d and(15.5?10.8) d;t=-5.842,and -3.193;P=0.000 was found and 0.002].No significant difference in the occurrence of postoperative complications and hydronephrosis between the 2 groups was found [laparoscopy vs open surgery:urinary leakage:3 cases vs 3 cases,?2=0.000,P=1.000;incisional infection:0 vs 1,?2=0.000,P=1.000;and recurrence of UPJO:1 vs 0,?2=0.000,P=1.000;hydronephrosis:?2=5.192,P=0.182].Conclusions The efficacy of retroperitoneal laparoscopic pyeloplasty is comparable to open surgery.The procedure results in less blood loss and quicker recovery.

This study was to investigate the influnce of 4 weeks of living high-training low on exercise performance of rowers. Twenty rowers were divided into two groups: ten subjects spent 8-10h per night in a tabernacle simulated at an altitude of 2500m in normobaric hypoxia; 10 control subjects slept at near sea level. During the 4-week periods, all rowers were trained at the same relative or at the same intensity of work in normoxia state. The red cell volume (RCV) , haemoglobin mass (Hb) and hematocrit (HCT) were measured before test, 15th and 30th day of study,and measurements were done on a rowing ergometer at sea-level, which included an ergometer test at 4 mmol/L lactate anaerobic threshold and performance in exercise tasks of 2km, 5km, and a Wingate Anaerobic Test before test and 30th day of study. The results showed that adaptation to simulated moderate altitude can stimulate red cell production sufficiently: increase in red cell volume (RCV) , haemoglobin mass (Hb) and hematocrit (Hct). And there were significant increases in all important parameters at 4 mmol/L lactate anaerobic threshold as well as performance of 5km, while the performance of 2km showed no significant improvement, the mean values of both mean power per kilogram body weight and peak power per kilogram body weight were not increased significantly. In the control group, there were no significant changes in the all abovementioned parameters. The results of this study indicate that living high-training low can improve the aerobic energy-supply systems. We conclude that 4-week of living high and training low can improve sea level endurance performance in rowers.

The establishment of induced pluripotent stem (iPS) cells is considered as one of the most important progresses in science and technology nowadays. In recent years, the iPS cells have been used in the construction of cellular model for hereditary heart disease, and the successful treatment in animal model of myocardial infarction, which brings a bright future for exploring the pathogenesis and therapy of hereditary heart disease.

Objective To investigate the relationship between the levels of fractional exhaled NO and airway inflammation cells in cough variant asthma(CVA)and the effect of inhaled corticoids .Methods CVA patients were treated with Budesonide and Formoterol Fumarate Powder for Inhalation for 6 months .Before and after treatment ,the provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second(PC20 FEV1 )was tested ,and the levels of fractional exhaled No ,and eo‐sinophil in induced sputum were examined .Results The levels of FeNO ,the percentage of eosinophil in induced sputum were sig‐nificantly higher than control healthy subjects ,and all decreased significantly after treated with ICS/LABA ,together with elevated PC20 FEV1 .The levels of FeNO were significantly correlated with the percentage of eosinophil in induced sputum ,and also negative‐ly correlated to PC20 FEV1 .Conclusion The levels of FeNO in CVA patients were significantly higher than control healthy sub‐jects ,and correlated with the inflammation of airway ,so FeNO may be used as a biomarker to determine the control level of airway inflammation in CVA patients .

Objective To explore the effects of early glucocorticoids (GC) therapy on the outcome of patients with acute respiratory distress syndrome (ARDS). Methods The clinical data of all ARDS patients admitted from January 2008 to December 2011 in Chengdu Military General Hospital of Chinese PLA were retrospectively analyzed. The adult patients whose diagnosis was in accord to the Berlin ARDS diagnostic criteria published in 2012 were enrolled, and based on whether using glucocorticoid or not, they were divided into GC group and non-GC group. All the patients in GC group received low dosage of intravenous GC within 48 hours after the onset of ARDS, including different kinds of GC, methylprednisolone, dexamethasone and hydrocortisone (hydrocortisone dosage < 5 mg·kg-1·d-1, the dosage of former two kinds of GC being converted to that of hydrocortisone), and the therapeutic course of the two groups was 7 to 21 days. The patients in non-GC group received no GC therapy after the occurrence of ARDS. The duration of mechanical ventilation, the length of intensive care unit (ICU) stay and totally in hospital, medical cost and 28-day survival rate were compared between the two groups. Results One hundred and seventeen patients with ARDS were collected, including 56 cases (47.86%) in GC group and 61 cases (52.14%) in non-GC group. The duration of mechanical ventilation in GC group was significantly shorter than that in non-GC group [days:0 (0, 2.50) vs. 2.00 (0, 2.50), Z=2.015, P=0.044]. The 28-day survival rate in GC group was significantly higher than that in non-GC group [71.43%(40/56) vs. 50.82%(31/61),χ2=5.198, P=0.023]. There were no significant differences in the length of ICU stay [days:7.50 (2.00, 11.00) vs. 4.00 (1.00, 9.00), Z=1.879, P=0.060] and stay totally in hospital [days:16.00 (10.00, 27.75) vs. 15.00 (7.00, 28.00), Z=0.592, P=0.552] between GC group and non-GC group. However, the medical cost in non-GC group was significant lower than that in GC group [10 thousand Chinese yuan:3.15 (1.51, 5.78) vs. 4.39 (1.66, 10.88), Z=2.204, P=0.028]. Conclusion The early GC therapy may improve the outcome of patients with ARDS, especially beneficial to the 28-day survival rate.

Objective To investigate the diagnostic value of combined detection of neutrophil CD64 index and C reactive protein (CRP) levels in newborn bacterial infectious diseases .Methods The retrospective analysis was performed on 139 neonates admitted to the neonatal department of our hospital from January to December 2015 ,including 72 cases in the bacterial infection group and 67 cases in the viral infection group ,and 50 healthy neonates were selected as the control group .The levels of CD64 and CRP and the positive rates were compared among 3 groups and analyzed .The sensitivity ,specificity ,positive predictive value and negative predictive value of CD64 and CRP in the diagnosis of bacterial infection were analyzed .Results The CD64 index and CRP levels had statistical difference between the bacterial infection with the viral infection group and normal control group (P<0 .05) ,the CD64 index and CRP levels after treatment in the bacterial infection group were significantly decreased ,the differences were statistieally significant(P<0 .05) .The sensitivity ,specificity ,positive predictive value and negative predictive value of CD64 index in the diag‐nosis of bacterial infection were 91 .7% ,92 .5% ,93 .0% and 91 .2% respectively ,which were significantly higher than those of CRP ,the differences were statistically significant (P< 0 .05).CD64 index was positively correlated with CRP (r= 0 .781 ,P<0 .01) .Conclusion The combined detection of CD64 index and CRP level helps to early diagnosis ,differential diagnosis and the therapeutic effect evaluation of bacterial infection in neonates ,moreover the diagnostic efficiency of CD64 is obviously better than that of CRP .

Objective To explore the application value of serum procalcitonin (PCT ) and amyloid protein A (SAA ) in the early diagnosis and curative evaluation of bacterial infectious diseases among preschool children in order to improve the clinical diagnosis level of early bacterial infection .Methods A total of 120 cases of pediatric infectious diseases in our hospital from January to De‐cember 2015 were selected and divided into the bacterial infection group (60 cases) and viral infection group (60 cases) ,meanwhile 50 children undergoing the physical examination were selected as the control group .The serum levels of PCT and SAA were ob‐served and compared among the three groups ,and the statistical analysis was performed by using the SPSS 19 .0 software .Results The levels of PCT and SAA in the bacterial infection group were significantly increased compared with the viral infection group and the healthy control group(P<0 .05) ,both PCT and SAA levels after effective antibiotic treatment were significantly decreased (P<0 .05);the positive rates of PCT and SAA in the bacterial infection group were 91 .7% and 95 .0% respectively ,which were signifi‐cantly higher than those in the viral infection group and the healthy control group (P<0 .05) ,the sensitivity of PCT in the diagno‐sis of bacterial infection was lower than that of SAA ,but the specificity ,positive predictive value and negative predictive value were all higher than those of SAA ,the correlation analysis showed that PCT level in the bacterial infection group was positively correla‐ted with and the SAA level(r=0 .782 ,P<0 .01) .Conclusion Detecting the PCT and SAA levels is conducive to early diagnosis , judgment of the disease condition and guidance of rational medication in bacterial infection among preschool children ,in which the efficiency of PCT for diagnosing bacterial infection is superior to SAA .

ObjectiveTo evaluate the influence of different hemoperfusion (HP) intensity on 7-day and 28-day mortality for patients with paraquat (PQ) poisoning, and examine the factors that may affect the decision of the clinicians to prescribe a high intensity HP.Methods A retrospective cohort study was conducted. The patients admitted to the department of critical care medicine of Anhui Provincial Hospital Affiliated to Anhui Medical University with the diagnosis of PQ poisoning from August 2012 to August 2014, fulfilling the following criteria were enrolled in the study: older than 18 years, interval from ingestion PQ to hospital admission shorter than 12 hours, and receiving HP treatment within 24 hours, and expecting surviving time exceeding 24 hours after admission, and data of the patients available for at least 28 days after admission. Depending on the intensity of HP, patients were assigned to either lower intensity HP group (LHP, defined as receiving HP for less than 4 hours, 2 columns) or higher intensity HP group (HHP, defined as receiving HP longer than 6 hours, 3 columns). Patients' data were retrieved from hospital's electronic database after hospital admission, and the results at 7th day and 28th day were recorded. Multiple logistic regression model was used to determine factors with which the clinician decided to choose the intensity of HP for the patients, and Cox regression model was used to evaluate 7-day and 28-day mortality.Results Data of 60 patients was finally available for this study. LHP group consisted of 28 patients, with a 7-day mortality of 53.6%(15 patients) and 28-day mortality of 64.3% (28 patients); 32 patients were assigned to HHP group with 7-day mortality of 43.8% (14 patients) and 28-day mortality of 62.5% (20 patients). Twenty-eight patients constituted as the HHP group, with higher PQ concentration in plasma, higher incidence of respiratory alkalosis and acute kidney injury (AKI), and higher level of lactate (Lac) compared with LHP group. However, a lower 7-day mortality was observed in the HHP group. Multiple logistic regression model indicated that at admission, interval from ingestion PQ to hospital admission longer than 4 hours [odds ratio (OR) = 1.461, 95% confidence interval (95%CI) = 1.132-1.435,P< 0.001], younger than 50 years old (40-49 years old:OR = 1.397, 95%CI = 1.251-1.703,P = 0.002;< 40 years old:OR = 1.701, 95%CI = 1.253-1.836,P< 0.001), PQ plasma concentration≥ 2 mg/L (OR = 3.140, 95%CI = 1.511-3.091,P< 0.001), white blood cell (WBC)> 10×109/L (OR = 1.222, 95%CI = 1.032-1.275, P = 0.018), Lac> 2.0 mmol/L (OR = 2.392, 95%CI = 2.090-2.734,P< 0.001), AKI on admission (stage 2:OR = 2.350, 95%CI = 2.160-3.910,P< 0.001; stage 3:OR = 2.821, 95%CI = 1.932-3.651,P< 0.001), accompanying hypoxia (OR = 2.420, 95%CI = 2.131-2.662,P = 0.003) were more likely to receive higher intensity of HP. Furthermore when compared with patients survived for 28 days, patients who were older, with higher levels of PQ concentration at admission or after 4 hours of HP, accompanied by AKI, increased serum creatinine (SCr), WBC, Lac, and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, lower arterial partial pressure of carbon dioxide (PaCO2) and lower pH value were more likely to die. After adjusted for con-variables in COX regression model, HHP was associated with lower 7-day mortality after admission [hazard ratio (HR) = 0.843, 95%CI = 0.732-0.971, P = 0.032], but devoid of lowering effect on 28-day mortality rate (HR = 0.930, 95%CI = 0.632-1.411,P = 0.423). In addition, age> 50 years old (HR = 1.282, 95%CI = 1.050-1.530,P = 0.043), PQ concentration increased by 1 mg/L (HR = 2.521, 95%CI = 2.371-3.825,P = 0.012), AKI on admission (HR = 3.850, 95%CI = 2.071-5.391,P< 0.001), WBC>10×109/L (HR = 1.932, 95%CI = 1.782-2.171,P = 0.006), Lac> 2.0 mmol/L (HR = 2.981, 95%CI =2.210-3.792,P = 0.002), and PaCO2< 35 mmHg (HR = 1.772, 95%CI = 1.483-2.516,P = 0.008; 1 mmHg =0.133 kPa) were independent risk factors for 28-day mortality.Conclusions Though HHP was helpful in lowering mortality rate in patients with PQ poisoning within 7 days, it did not influence on 28-day mortality. Clinicians' decisions on HP intensity need further investigation, and more perfect clinical evaluation system is required for reasonable use of expensive medical resources such as HP.