Objective To observe and analyze the reasons of intra-abdominal hypertension,and to discuss the influence of intra-abdominal hypertension (IAH) on recipients' respiratory function and its changes after disposition.Method During January to June in 2012,50 patients who had performed orthotopic liver transplantation were involved in this study.Intra-abdominal pressure was measured by AbViser Intra-Abdominal Pressure Monitoring Kit.According to the value of intra-abdominal pressure,the patients were divided into two groups (IAH group and control group).The reasons of IAH were observed and analyzed.Respiratory rate,oxygenation index,and the arterial partial pressure of carbon dioxide between IAH and control groups were compared.IAH was dealt with restricting oral input,inserting nasogastric tube,administering enema,inserting ilues tube or placing percutaneous catheter drainage according to reasons.Intra-abdominal pressure,respiratory rate,oxygenation index,and arterial partial pressure of carbon dioxide were also observed after disposition.Result The incidence of IAH was 44％ (22/50).The respiratory rate of patients in IAH group was quicker than that in control group.The oxygenation index in IAH group was lower than that in control group.The arterial partial pressure of carbon dioxide in IAH grade I group was not higher than in control group.However,the arterial partial pressure of carbon dioxide in IAH grade Ⅱ and Ⅲ groups was higher than in control group.After disposition,the intra-abdominal pressure,respiratory rate and arterial partial pressure of carbon dioxide in IAH groups were decreased from 16.4 ± 3.1 mmHg,33.0 ± 5.2 L/min and 47.6 ± 9.4 mmHg to 10.5 ± 1.8 mrnHg,19.7 ± 4.1 L/min and 39.9 ± 2.9 mmHg respectively,while the oxygenation index was increased from 202.7 ± 72.9 mmHg to 350.5 ± 98.5 mmHg.Conclusion The incidence of IAH after orthotopic liver transplantation was high.The influence of IAH on patients' respiratory function was serious.After timely and proper disposition,the respiratory function of patients with IAH could be improved.

Objective:To investigate the different techniques and wave characteristic of applying non-invasive stimulation in blink reflex.Methods:Thirty volunteers participated in this study.Using the electrodiagnostic techniques,the orbital nerve and mental nerve were stimulated and the waves were respectively recorded at orbicularis oculi and levator labli superioris,then concluded the latency and amplitude of R1,R2,R2'.Results:The results of blink reflex were basically identical with the normative criteria.The wave of stimulating the orbital nerve and recording at levator labli superioris resembled BR.The images were steady and repeatable.The waves of stimulating mental nerve and recording at orbicularis oculi and levator labli superioris were unstable and partial R1 absent.Conclusion:The techniques of stimulating orbital nerve and recording at orbicularis oculi and levator labli superioris are valuable in the initial investigation of trigemino-facial reflex.The techniques of stimulating mental nerve and recording at orbicularis oculi and levator labli superioris can be used to examine assistantly.

General practitioners need not only to have comprehensive knowledge and clinical competency, and also to have the soft skill that are social and personal management skills.In the residency training of general practice, it is necessary to pay attention to the soft skill development.The training institutions should adopt various measures: including soft skills cultivation in training contents, emphasizing soft skills training in the traditional teaching practice, establishing a variety of practice platforms and introducing soft skills in the evaluation and examination system.

Objective To explore and clarify the clinical features and management of patients with Castleman disease.Methods The clinicopathological features and therapeutic method of 65 patients with Castleman disease admitted to our hospital continuously from 2005 to 2012 were analyzed retrospectively.The mean follow-up time for the entire series was 40 (15-71) months.Results In contrast to Localized Castleman disease(LCD),Multicentric Castleman disease (MCD) patients were relatively older and exhibit various symptoms and abnormal laboratory tests.We found 44 tumor in LCD group.LCD ones,most of which were hyaline vascular (33/42,78.6％),were more likely originated in retroperitoneum,enterocoelia(10/44,22.7％) or mediastinum(10/44,22.7％).The initial treatment for LCD patients was complete surgical resection and all patients are current alive with no evidence of recurrence.MCD ones always accompanied by fever(9/23,39.1％),anemia(9/23,39.1％)and splenomegaly,and most of MCD patients were plasmacytic variants(14/23,60.9％) or mixed cellular variants (5/23,21.7％).We found 66 tumor in MCD group and they were more likely originated in neck (16/66,24.2％) and groin area (12/66,18.2％).Surgery combined with CHOP-like chemotherapy or CHOP-like chemotherapy alone was the mainstream treatment for MCD ones.21 patients achieved complete remission or partial remission,and only 2 patients died of lung infection.Whether patients could tolerate long-term chemotherapy or not was an important prognostic factor.Conclusions LCD patients had no typical clinical symptoms and could be cured by surgery.Most of MCD patients always had a good prognosis after receiving CHOP-like chemotherapy.

Objective To explore the correlation of S100 protein with the prognosis of patients with primary retroperitoneal liposarcoma. Methods Analyzed the clinical data about 108 patients with primary retroperitoneal liposarcoma managed with surgery from January 2009 to June 2014. All patients were followed up. Patients were divided into S100-positive group(58 patients) and S100-negative group (50 patients) according to the immunohistochemical staining results. The overall survival time and all clinical data between two group were compared. Results All patients with primary retroperitoneal liposarcoma received radical surgical resection for the first time. The overall 5-year recurrence rate were 88.9%(96/108), and the median recurrence time was 32.7 months. The 1-year, 2-year, and 5-year recurrence rates of the S100- positive group were 25.9% (15/58), 53.4% (31/58), 96.6% (56/58), respectively, and the median recurrence time were 26.2 mouths. The 1-year, 2-year, and 5-year recurrence rates of the S100-negative group were 10.0%(5/50), 36%(18/50), 80.0%(40/50) and the median recurrence time were 40.0 mouths. Log-rank test showed that S100 protein expression was significantly associated with postoperative recurrence rates (c2=9.931, P=0.002) and survival time (c2=4.571, P = 0.033). The difference between gender, age, removal of the joint organs and tumor size showed no statistical significance on disease special survival (P>0.05). Cox regression analysis showed that S100 protein expression (OR=1.582, 95%CI:1.005-2.491) and histologic subtype (OR=1.531, 95%CI: 1.254-1.870) were independent risk factors of the prognosis of primary retroperitoneal liposarcoma patients. Conclusions S100 protein played a critical role in retroperitoneal liposarcoma carcinogenesis and its expression may be used as a potential survival predictor in patients with primary retroperitoneal liposarcoma.

Objective To investigate the principles of diagnosis and treatment of breast cancer during pregnancy.Methods Clinical data of twelve patients with breast cancer during pregnancy admitted to Peking Union Medical College Hospital between January 1995 and October 2015 were analyzed retrospectively.Follow-up studies on the prognosis of the mothers and infants and the long-term survival were carried out,and data were analyzed with descriptive statistical analysis.Results Of these twelve patients,eleven were diagnosed with breast cancer preliminarily by ultrasound.In the remaining one who presented with paraneoplastic neurological syndrome,breast tumor was discovered by the whole-body positron emission tomography/computed tomography (PET-CT) examination after emergent cesarean section.The mean gestational age at ultrasonic diagnosis in the eleven patients was (26.3 ±3.0) weeks,and all of them received surgical treatment during pregnancy.The mean gestational age at surgery was (28.2±4.4) weeks.Ten patients with epithelial tumor underwent modified radical mastectomy.One patient with breast malignant phyllodes tumor received local extended lumpectomy.Postoperative pathological staging revealed one patient with stage Ⅰ a,two with stage Ⅱ a,one with stage Ⅱ b,six with stage Ⅲ a,and one with stage Ⅲ b.The patient with paraneoplastic neurological syndrome was diagnosed as having stage Ⅳ breast cancer,and received chemotherapy,radiotherapy and endocrinotherapy.One patient received chemotherapy during pregnancy.None of the patients received radiotherapy during pregnancy.All twelve patients,except one with breast malignant phyllodes tumor,received postpartum adjuvant therapy.All patients were followed up regularly.Five patients were followed up for more than five years,the progressionfree survival rate was 4/5 and the overall survival was 5/5.The other seven patients were followed up for less than five years,the progression-free survival rate was 6/7 and the overall survival was 7/7.Eleven of the twelve patients had live birth.Eleven cases received cesarean section at (36.5±2.8) gestational weeks,and the other one had mid-trimester induction of labor at 27 gestational weeks.Of four premature infants,three were sent to neonatal intensive care unit because of neonatal respiratory distress syndrome,and one died of intracranial hemorrhage.The prognosis of the ten survived infants was good.Conclusions Breast cancer is one of the most common malignant tumors during pregnancy,and it often presents in more advanced stages compared with that in non pregnant women.Multidisciplinary cooperation and detailed assessment of maternal-fetal risks and benefits are necessary.

Acute Disease ; Animals ; Endotoxins ; blood ; Nitric Oxide ; blood ; Pancreatitis ; blood ; Rats ; Rats, Sprague-Dawley ; Tumor Necrosis Factor-alpha ; blood

Common mental health problems from the perspective of prevention among medical stu-dents were discussed in this activity which was learning from the concept and method of PBL. Participants had to find the solutions themselves by small-group discussion so as to improve their mental health. Results showed that most participants confirmed the innovation, interest and intellectuality of this activity. Moreover, students could not only learn knowledge related to mental health, but also improve their friendship as well as communication skills which were beneficial to medical students' mental health.

Objective To evaluate the effect of heparin and argatroban on the coagulating function and the vascular thrombosis in the early period after pediatric living related liver transplantation (LRLT).Method Eighty-four congenital biliary atresia pediatric patients who had performed LRLT were involved in this study.According to the method of anticoagulation,the patients were divided into two groups (heparin group and argatroban group).Antithrombin Ⅲ (AT-Ⅲ) activity,activated partial thromboplastin time (APTT) and international normalized ratio (INR) of two groups were measured in the first 5 days after LRLT.In order to determine whether vascular thrombosis existed,Doppler ultrasound was performed daily.Result There were no significant differences in gender,age,body weight,graft-recipient weight ratio and whether to accept Kassi procedure between two groups.The AT-Ⅲ activity of two groups was low and increased gradually after operation.There was no significant difference between two groups.There were no significant differences in APTT and INR between two groups immediate and at first day after operation.After anticoagulation,the differences in APTT and INR between two groups were significant.The incidence of vascular thrombosis was 4.76％ (3/63) and 0(0/21) respectively in heparin and argatroban groups.There was no significant difference between two groups.During treatment,there were no severe complications in two groups,such as active hemorrhage and allergy.Conclusion Argatroban is a direct anticoagulant.It is independent on the level of AT-Ⅲ activity.It may play an important role for preventing vascular thrombosis after pediatric LRLT.

Objective The international multidisciplinary lung adenocarcinoma classification was published by IASLC/ ATS/ERS in 2011.This study aimed to explore the clinicopathologic characteristics of lung adenocarcinoma based on IASLC/ATS/ERS classification and validate its clinical diagnostic and therapeutic value.Methods 2 056 cases of surgical resection from Shanghai Chest Hospital were classified according to the new classification and clinical information were retrospectively reviewed.The clinicopathologic characteristics based on new classification were analyzed statistically.Results Our data indicated that women were in high risk of lung adenocarcinoma; The average age of onset was 59-year-old; the female patients were younger than the male patients (58.7 years vs 60.2 years,P ＜ 0.01) ; Average tumor diameter was 2.6 centimeter; right lung was more popular than left and superior lobe than the inferior one.Acinar predominant subtype and papillary predominant subtype were frequently observed.Micropapillary predominant subtype and solid predominant subtype were identified to be more aggressive than other histopathologic subtypes.Most patients were classified as stage Ⅰ(71.7％),which were predominantly stage Ⅰa (53.1％).Conclusion The new classification is superior to reflect the clinicopathologic characteristics of lung adenocarcinoma and satisfy clinical needs,especially contributing to change and update the surgical strategy of early stage lung adenocarcinoma.