Humans ; Mineral Fibers ; toxicity ; Respiratory Tract Neoplasms ; chemically induced

Objective To study the causes of early death of patients with acute severe cervical spinal cord injury.Methods A retrospective analysis was done on 78 cases of acute severe cervical spinal cord injury,who were treated in our hospital between January 2003 and December 2007.The patients were divided into death group and survival group(survived more than 30 days after the injury).The clinical data including age,level of spinal cord injury,time of injury and admission,surgical treatment,duration between injury and surgery,neurogenic shock,central hyperthermia,hyponatremia,serum level of albumin,percentage of lymphocytes in serum,tracheotomy,and pulmonary infection,were recorded and analyzed. Results The proportion of high-level spinal cord injures(C1-C4) in death group(8/9) was significantly higher than that in the survival group(49/69,?2=18.086,P=0.000).Whereas the duration between injury and surgery in the death group was significantly shorter than that in the survival group(1-12 d,median 2 d vs 1-39 d,median 3 d;Z=-2.664,P=0.008).In the death group,4 of the 9 patients had neurogenic shock,and 4 developed hyponatremia,which were significantly more than those in the survival group(6/69,?2=12.392,P=0.000;19/69,?2=4.526,P=0.033).The percentage of peripheral lymphocyte on admission was(11.84?5.80)% in the death group,which was significantly lower than that of the survival group(19.17?16.64)%(t=-4.006,P=0.000).In the death group,7 patients received tracheotomy,and 8 patients showed pulmonary infection,the proportions were significantly higher than those in the survival group(10/69,?2=29.749,P=0.000;and 15/69,?2=17.266,P=0.000).Conclusions Several factors,including high-level injury(C1-C4),neurogenic shock,pulmonary shock,and tracheotomy,may cause the death of patients with acute severe cervical spinal cord injury in an early stage.

Objective To summarize the clinical experience of operation treatment of Lisfranc fracture dislocation,and evaluate its clinical effect.Methods Thirty-nine patients with Lisfranc joint injuries (46 sides) were managed with open reduetlon as well as internal fixation with serews and Kirsehnerwlres.Results All the patients were followed up from12.0 to 42.0 months,the average was (21.1 ± 1.8) months.Evaluated the clinical effect according to the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score standard,there were 29 cases of excellent,8 cases of good,and 3 cases of aceeptable.Conclusion By Kirschner wire combining with screw fixation,open reduction and internal fixation may achieve satisfactory clinical results for the treatment of Lisfranc joint injurie.The operation is simple and fast,small trauma,less complications and can obtain good effects.

Objective To evaluate the interactive relationship between inflammation detected by single photon emission computed tomography combined with computed tomography (SPECT/CT) and magnetic resonance imaging (MRI) detection of synovitis,bone marrow edema (BME) in the early rheumatoid arthritis (RA) patients.Methods Twenty patients with early RA were included into this study.All patients were diagnosed based on the 2010 ACR/EULAR classification criterion.Patients' unilateral hands (MCP 2-5 and PIP 2-5 joints) were inspected by SPECT/CT (label:99Tcm-MDP) and MRI (3.0 T).SPECT/CT and MRI images were analyzed by two reviewers blinded to other clinical information.Increased bone metabolism of the regional area of interest (ROI) was analyzed and the uptake ratio was calculated.MRI quantitative evaluation was completed by RAMRIS score system.Statistical analysis was performed using SPSS 17.0 software.Student's t-test,analysis of variance (ANOVA),x2 test and post-hoc analysis (Scheffe) were used for comparison of datas,correlation analysis was carried out with Spearman rank correlation test.Results Twent ypatients with a total of 160 joints were examined.MRI examination revealed synovitis (39,24.4％),or BME (24,15.0％) in 63(39.4％) joints.99Tcm-MDP uptake increased in 79(49.4％) joints,and the uptake ratio was higher than normal joints (1.59±0.26 vs 1.15±0.09,t=6.408,P＜0.01).The uptake ratio between the graded synovitis level and RAMRIS synovitis score had a moderate correlation (r=0.535,P=0.001).The uptake ratio of BME level and BME score was well correlated (r=0.765,P=0.001).Conclusion In early RA patients,MRI is sensitive for synovitis and BME.SPECT/CT can detect early abnormal bone metabolism associated with inflammation,which is more sensitive than MRI.SPECT/CT can be used to detect changes of RA at the molecular level.Compared with synovitis,BME is more closely related to bone metabolism changes,which may suggest that BME may play a major role in the bone destruction in RA.However,further studies are needed to verify this hypothesis.

Objective To investigate the relevant factors of early stage hyponatremia in patients with complete cervical spinal cord injury (CSCI). Methods A retrospective study was conducted in consecutive 49 individuals with complete CSCI from January 2010 to December 2015.The diagnostic criteria for hyponatremia was two consecutive tests (interval <24 h) of serum sodium <135 mmol/L.Twenty-six patients with hyponatremia were classified as hyponatremia group , and the other 23 patients without hyponatremia were classified as control group .Ten factors were included in the univariate analysis: age, gender, the highest level of CSCI , the degree of CSCI , the blood albumin when transferred to ICU , the serum sodium when transferred to ICU , the use of glucocorticoid , the incidence of neurogenic shock , the average daily urine output , and the average daily liquid balance .The variables with significance (P<0.05) in the univariate analysis then entered stepwise logistic regression analysis .The optimal critical point of the continuous variables with statistical significance in the univariate analysis was determined by drawing the receiver operator characteristic curve . Results There were differences in two variables between the two groups ( P<0.05 ) .The incidence of neurogenic shock before the occurrence of hyponatremia was 57.7% ( 15/26 ) in the patients with hyponatremia and 26.1% ( 6/23 ) in the patients without hyponatremia(χ2 =6.516,P=0.011).The average daily urine output was (2225 ±389) ml in the patients with hyponatremia and (1936 ±289) ml in the patients without hyponatremia (t=2.924,P=0.005).The stepwise logistic regression analysis indicated that these two factors may be the independent relevant factors (OR =13.708 and 0.996, P =0.004 and 0.002, respectively).The receiver operator characteristic curve demonstrated the average daily urine output more than 2331 ml was the optimal critical point . Conclusion The neurogenic shock and the average daily urine volume more than 2331 ml are the independent relevant factors of early stage hyponatremia in patients with complete CSCI .

Objective To study the optimal timing of tracheotomy in patients with acute cervical spinal cord injury who need ventilation for a long time . Methods A retrospective research on seventy-nine patients with acute cervical spinal cord injury who underwent tracheostomy in our hospital from January 2011 to December 2015 was conducted .The 79 patients were divided into two groups.The patients with a duration from intubation to tracheostomy less than or equal to 10 days were enrolled in group A , and the duration more than 10 days, group B.The duration of ventilation , the length of ICU stay , and the incidence rate of lung infection were compared between the two groups . Results The duration of ventilation in the group A (192 ±58) h was less than that in the group B (348 ±53) h (t=-12.490, P=0.000).The length of ICU stay in the group A (9.8 ±2.7) d was less than that in the group B (15.9 ±2.2) d (t=-11.058, P=0.000).The incidence of pneumonia in the group A (16.2%, 6/37) was lower than that in the group B (38.1%, 16/42,χ2 =4.686, P=0.030).Mechanical ventilation was successfully withdrawn in 34 and 38 cases of group A and B, without significant difference (χ2 =0.000, P=1.000). Conclusion Early tracheostomy in patients with acute cervical spinal cord injury who need ventilation for a long time could shorten the duration of ventilation and the length of ICU stay , and decrease the incidence of pneumonia .

ObjectiveTo investigate the correlation between ineffective esophageal motility (IEM)and gastroesophageal reflux disease (GERD).MethodsA total of 90 GERD patients were enrolled in our study,including 62 patients with reflux esophagitis (RE) and 28 with non-erosive reflux disease (NERD).All the patients underwent gastroscopy,24-hour esophageal pH monitoring and esophageal manometry.ResultsIn the RE group 30 (48.4％) patients were diagnosed as having IEM,which was significantly higher than the NERD group (6 patients,21.4％ ) (P＜0.05).Positive esophageal acid exposure was more often seen in patients with IEM than in those with normal esophageal motility (91.7％ v.s.57.2％,P ＜0.01 ).The values of total percentage of time with pH ＜4,percentage of reflux time in supine position,long-duration episodes ( ＞5 min) and the longest reflux time and DeMeester score were significantly higher in the IEM cases than those in the normal esophageal motility cases ( P ＜ 0.01 ),so was the values of number of reflux episodes (P ＜ 0.05).ConclusionIEM is the most common esophageal dysmotility in patients with GERD and closely related to distal esophageal acid exposure and RE.

OBJECTIVE　To develop an HPLC method for the determination of floxuridine in human serum.METHODS　With metronidazole as the internal standard,200 μL of serum was extracted by n-propyl alcohol/methyl t-butyl ether in a two-step extraction.The organic layer was evaporated under nitrogen stream and the residual was reconstituted with the mobile plase.A Shim-Pack CLC-ODS column was selected and the mobile phase was consisted of acetonitrile-phosphate buffer-water (75∶100∶900) at a flow rate of 0.6 mL*min-1.The detection wavelength was 268 nm.RESULTS　A linearitywas obtained from 0.005 to 0.5 mg*L-1 of floxuridine in serum with a good correlation coefficient (r=0.9999,n=8).The intra-run and inter-run coefficients of variation were less than 4.09%.The mean recoveries were 103.00%,107.00% and 100.88% for the low,middle and high concentrations of check samples,respectively.The limit of detection was 0.001 mg*L-1.CONCLUSION　The method was sensitive,specific and simple.It is suitable for clinical pharmacokinetic study.

Objective To investigate associate chief physician the clinical effects of Jiawei Jinhuang powder with fumigation -washing on hand -foot skin reaction(HFSR)caused by sorafenib.Methods 48 patients who received sorafenib were randomly divided into two groups.24 patients in the treatment group were administered Jiawei Jinhuang powder with fumigation -washing,and another 24 patients in the control group were given VitB6 orally.After 8 weeks,the incidence and grade of HFSR were statistically studied between the two groups.Results There was significant differences of hand -foot reaction between the treatment group and the control group (incidence rate:29.17% vs 70.83%,χ2 =8.375,P <0.05;The incidence rate of Ⅱ -Ⅲ:12.50% vs 33.33%,P <0.05 ). Conclusion Jiawei Jinhuang powder with fumigation -washing could remarkably reduce the incidence rate of HFSR caused by sorafenib.

Objective To collect the main contents of research in critical care medicine in foreign countries with the purpose of providing references for domestic research. Methods A two-way clustering analysis of foreign literature in PubMed concerning critical care medicine was conducted from 2004 to 2015 in this study, and the subjects of greatest interest were collected through the information visualization analysis pathway. Results Eight areas of most popular interest critical care medicine from January 1st, 2004 to November 8th, 2015 were found: blood sugar control in intensive care unit (ICU), acute kidney injury (AKI) and renal replacement therapy (RRT), nutritional support, the impact of ICU practice on reducing mortality, the assessment of critical patients, study of antibiotic resistance, the assessment of the life quality of critically ill patients, and home care and the rehabilitation of critically ill patients. According to the related literature, research in the field of critical care medicine has been growing steadily. USA, Japan, and Europe are the most developed countries or area in the field of critical care medicine. The four major research networks concerning research in critical care medicine were found: the control of blood glucose, monitor of circulatory function, nutritional support, and studies on AKI. Conclusion The most popular topics in research concerning critical care medicine research from 2004 to 2015 were blood glucose control, monitoring of circulatory function, nutritional support and AKI.