Objective To evaluate the effects of inhaled nitric oxide (iNO) therapy combined with conventional ventilation in the infants with persistent pulmonary hypertension of the newborn (PPHN).Methods NO inspiration was added for 22 infants with PPI-IN ventilated with FiO2≥0. 9,PIP≥30 cm H2O,PEEP≥3 cm H2O,RR≥50 bpm for 4～6 hours,with SpO2 still < 90% and PaO2 <55 mm Hg. The iNO concentration started at (10～20)×10-6 for 20 infants,and (20～40)×10-6 for 2 infants. The iNO would be stopped when the concentration reached 40×10 -6 without any sign of improvement. The SpO2 ,blood gas analyses,blood pressure, heart rate and NO: concentration were moraitored during therapy and the resulting data compared to readings before administration of int. Results Clinical situation were significantly improved in 20 (91%) of the infants with SpO2 gradually going up after 10 minutes of int. Before iNO,mean Fit2 was 0. 9±0. 1 ,SpO2 was(76. 3±13.3)% ,and Pat2 was (46. 4±10. 1 ) man Hg. From 1 to 6 hours after iNO,SpO2 increased to(95. 1±3.8)% ,Pat2 increased to(92. 8±24.7) mm Hg,FiO2 decreased to 0.6 s0. 1.The differences were significant (P < 0. 01 ). Eighteen of 22 (82%) infants surviving. Conclusion iNO is effective in alleviating PPHN in infants. There are no remarkable side effects. It is more beneficial to start the iNO concentration at (10～20)×10-6 while some infants may need NO concentration at up to (20～40)×10-6.

Anticoagulants ; therapeutic use ; Child, Preschool ; Fontan Procedure ; adverse effects ; Heparin ; therapeutic use ; Humans ; Male ; Protein-Losing Enteropathies ; drug therapy ; etiology

Adult ; Cytokines ; metabolism ; Female ; Gene Expression ; Humans ; Interleukin-2 ; blood ; Interleukin-4 ; blood ; Male ; Semaphorins ; genetics ; metabolism ; T-Lymphocytes, Helper-Inducer ; metabolism ; Thrombocytopenia ; genetics ; metabolism

Objective To investigate the clinical efficacy and side effects of sequential and concurrent chemoradiation in the treatment of colorectal cancer.Methods 90 patients with colorectal cancer were divided into ⅡAof 21 cases (Ⅱa group),Ⅲa of 24 cases (Ⅲa group),Ⅱb of 23 cases (Ⅱb group),Ⅲb of 22 cases (Ⅲa group) according to the stage of the disease.Group Ⅱa and Ⅲa were treated by sequential chemoradiation therapy,Ⅱb group and Ⅲb group were treated by concurrent chemoradiation therapy.The clinical efficacy and toxicity were observed and compared.Results All patients were followed up at 1 and 3 years,no one lost and died.1-year and 3-year OS and PFS between group Ⅱa and group Ⅱb had no significant differences (P ＞ 0.05).1-year OS had no significant difference between Ⅲa group and Ⅲb group (P ＞ 0.05),1-year PFS,3-year OS and PFS had significant differences (x2 =3.993,4.224,4.304,all P ＜ 0.05).The incidence rate of toxicities between Ⅱa group +Ⅲa group (28.89％) and group Ⅱb+ Ⅲb (51.11％) had significant difference (x2 =4.629,P ＜ 0.05) ; while for each system specific incidence rate of side effects had no significant difference (P ＞ 0.05).Conclusion Compared with sequential chemotherapy in the treatment of colorectal cancer,concurrent chemoradiotherapy can effectively prolong overall survival and progression-free survival time,and can reduce the costs of treating,although increasing the treatment toxicity,but still within the acceptable range of patients,it has better application value in clinical.

Objective To investigate the expression of interleukin-18(IL-18) and signal transducers and activators of transcription 5(STAT5)in retina of 4-24-week-old diabetic rats, and explore the potential molecular mechanisms involved in diabetic retinopathy (DR). Methods Retinal gene expression profile of healthy and 8-week-old diabetic rats was established with restriction fragment differential display-polymerase chained reaction (RFDD-PCR), and the differences was analyzed by bioinformatics. IL-18 and STAT5 were filtrated as the candidate genes of DR. The expression of IL-18 and STAT5 in retina of diabetic rats with the age of 4, 8, and 24 weeks was observed by semi-quantitative reverse transcriptase-polymerase chain reaction(RT-PCR). Results The result of RFDD-PCR showed:expression of IL-18 was higher in healthy retina than that in diabetic one; expression of STAT5 was not found in healthy rats but in diabetic ones. The result of RT-PCR showed:compared with the normal, high expression of IL-18 was found in 4-week diabetic retina, reduced in 8-week one, and decreased to the lowest in 24-week one. The expression of STAT5 was not observed in healthy or 4-week diabetic retina, but occurred in 8-week one, and increased in 24-week one. Conclusion The expression of IL-18 and the activation of STAT5 may relate to the occurrance of DR. The expression of IL-18 doesn′t depend on the activation of STAT5.

Objective This study aimed to understand the experience of family caregivers of elderly people,explore the relationship between responsibility and burden,provide reference and theoretical guidance to the health care provider.Methods Exploratory,descriptive,qualitative design was used and a semi-structure interview Was conducted in a convenience sample of 11 participants.The Colaizzi method of empirical phenomenology Was used for interviewing and anaIyzing data obtained from 11 caregivers.Results Four major themes were found and labeled:husbands and wives,be accompanied till they are old;learning to be filial from confucius;avoiding trouble other family member as less as possible;this is my destiny.Conclusions The findings of the study pointed out that service providers should fully consider the cultural factors and develop support services that better meet the traditional culture.

Objective To investigate the diagnostic value of breast MRI in patients presenting with microcalcifications on mammography.Methods Eight four patients were retrospectively analyzed,who had mammographically detected BI-RADS (breast imaging reporting and data system) 3 to 5 microcalcifications and underwent breast MRI before surgical biopsy.All mammography and MR images were reviewed with BI-RADS.With histopathological diagnosis as golden standard,the sensitivity,specificity and accuracy of the two methods were calculated and compared with x2 test or Fisher exact test.The diagnostic efficacy of the two methods was compared with ROC curve.Results Pathologic examination revealed 91 lesions in 84 patients including 49 benign lesions and 42 malignant lesions.For 21 lesions of category 3 microcalcifications,the specificity of mammography and MR was 100.0％ (21/21) and 95.2％ (20/21),which had no significant difference (P=1.000).For 51 lesious of category 4,sensitivity,specificity and accuracy of mammography were 100.0％(23/23),0 and 45.1％(23/51).The corresponding values for MR were 91.3％(21/23),82.1％ (23/28) and 86.3％ (44/51).The difference for specificity and accuracy between the two methods was statistical significant(x2 value was 30.030 and 19.182,respectively,with P＜0.01),but not for sensitivity(x2=0.523,P=0.470).Nineteen lesions of category 5 were all correctly diagnosed on mammography and MRI.For all the 91 lesions,the sensitivity,specificity and accuracy of mammography were 100.0％(42/42),42.9％(21/49) and 69.2％(63/91),respectively.The corresponding values for MRI were 95.2 ％(40/42),87.8％(43/49) and 91.2％(83/91).There was significant difference for specificity and accuracy between the two methods (x2 value was 21.798 and 13.851,respectively,with P＜0.05),but not for sensitivity (x2=0.512,P=0.474).The areas under ROC curve for mammography and MR were 0.844,0.945(P＜0.01),for the estimation of the benign and the malignent.Conclusions Compared with mammography,breast MRI significantly improved the diagnosis of category 4 microcalcifications with increased specificity and accuracy.But for microcalcifications of category 3 and 5,MR didn't improve the diagnostic effect.

Objective:To investigate the value of indocyanine green retention rate at 15 minutes (ICG R15) on postoperative day 3 combined with standard remnant liver volume (SRLV) in predicting the occurrence of liver dysfunction after hepatectomyin hepatocellular carcinoma (HCC).Methods:The clinical data of 61 HCC patients undergone hepatectomy in Xiangya Hospital of Central South University from January 2015 to February 2016 were collected and analyzed.The patients were divided into 2 groups:a normal liver function group (n=40) and a liver dysfunction group (n=21).Univariate analysis was used to evaluate the risk factors for postoperative liver dysfunction.Logistic regression was used to assess the independent risk factors for postoperative liver dysfunction,and the regression equation between independent risk factors and postoperative liver dysfunction was established,The receiver operating characteristic (ROC) curve was used to examine the regression equation and compare the value difference in predicting postoperative liver dysfunction between single and combined independent risk factors.Results:Postoperative liver dysfunction occurred in 21 of the 61 patients,with an incidence rate at 34.4％.There was no significant difference in the time of operation,time of hepatic portal occlusion,volume of tumor and volume of resected liver between the 2 groups (all P＞0.05),but there were significant differences in the ICG R15 on postoperative day 3,intraoperative blood loss and SRLV between the 2 groups (all P＜0.05).The ICG R15 on postoperative day 3,intraoperative blood loss,SRLV were the risk factors for postoperative liver dysfunction.Logistic regression analysis showed ICG R15 on postoperative day 3 and SRLV were the independent risk factors for postoperative liver dysfunction,and the regression equation between independent risk factors and postoperative liver dysfunction was as follows:logit(P)=1.277+0.140×ICG R15 on postoperative day 3-5.125×SRLV.The area under the ROC curve ofICG R15 on postoperative day 3 combined with SRLV was more than that of single ICG R15 and single SRLV.Conclusion:ICG R15 on postoperative day 3 and SRLV are the independent risk factors for postoperative liver dysfunction.The regression equation,which is established by combination of ICG R15 with SRLV,can predict the occurrence of postoperative liver dysfunction.The accuracy of ICG R15 on postoperative day 3 combined with SRLV is better than that of single ICG R15 or single SRLV.

0.05),but the t1/2 was longer and the AUC and the Cmax were lower in group B than in other groups(P

BACKGROUND: Studies have shown that mild hypertension and hypothermia both offer cerebral protection against focal cerebral ischemia,and their possible synergistic effect may provide even better neuroprotective effects.OBJECTIVE: To investigate the mechanism of cerebral protection by induced hypertension combined with mild hypothermia against focal cerebral ischemia and reperfusion, through observation of the changes in the infarct volume and blood-brain barrier(BBB) in rats.DESIGN: A randomized controlled experimental study based on experimental animals.SETTING: The departments of neurology of two university hospitals and department of dermatology in a municipal hospital.MATERIALS: The study was carried out in the Laboratory of Department of Neurology, Union Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology and Laboratory of Department of Neurology, People' s Hospital of Wuhan University from March to July 2001. Sixty-four Wistar rats weighing 180 to 230 g were purchased from the Experimental Animal Center of People' s Hospital of Wuhan University.INTERVENTIONS: Sixty-four rats were randomly divided into control group, hypertension group, mild hypothermia group, and combined therapy group, each group consisting of 16 rats. Reperfusion was initiated after a 3-hour focal cerebral ischemia of the 16 rats, and at 2 hour during the ischemia, the rats in the hypertension and mild hypothermia group were treated with hypertension for 3 hours and mild hypothermia, respectively, and those in the combined therapy group received both treatment. The rats in the control group received no treatments for ischemia and reperfusion. Twenty-four hours later, all rats were killed for examination.MAIN OUTCOME MEASURES: The scores of neurological deficits, infarct volume and degree of BBB damage.RESULTS: The scores for neurological deficits, infarct size and volume of Even' s blue staining were 2. 12 ±0. 54, (17.65 ±4.78)%, and(56.63± 10.70) mm3, respectively, in hypertension group, and 2. 14 ±0.69,(16. 21 ± 3.79)%, and(53.52 ± 8.44) mm3 in mild hypothermia group,and 1.78 ±0. 61, (11, 31 ±3.64)%, and 38.45 ±5.25 mm3 in combined therapy group, which were all decreased significantly as compared with the control group[2.70 ±0. 64, (28.34 ±4. 13)%, and(94.87 ± 15.34) mm3].The combined therapy group had the smallest infarct size and volume of Even's blue staining among the three treatment groups( P ＜ 0.05).CONCLUSION: Hypertension and mild hypothermia may reduce the infarct volume and alleviate BBB damage during focal cerebral ischemia and reperfusion in rats, and the effects of combined treatment are more obvious.