ABSTRACT:Objective To a rare case of double primary cancer (hepatocellular carcinoma with gallbladder)to guide clinical application.Methods and Results We reported one case of primary hepatocellular carcinoma and gallbladder.A male patient,54 years old,had main complaints of intermittent right upper quadrant pain for 4 days. The abdominal CT of the local county hospital showed gallstones,gallbladder with liver infiltration.And then he went to the First Affiliated Hospital of Xi’an Jiaotong University for further treatment.Laboratory examination revealed:HBsAg(+),HBcAb(+),alpha-fetoprotein (AFP)> 60 500 ng/mL,carcinoembryonic antigen (CEA) 5.25 ng/mL.Abdominal CT showed hilar slightly stronger light echo groups:liver cancer or gallbladder cancer? Hepatic artery and portal vein CT imaging (CTA+CTV)examination showed the malignant tumor shadow in the inside of the left hepatic lobe huge,uneven thickening of the gallbladder wall,suspected liver disease with gallbladder infringement or gallbladder disease with liver infringement. With the preoperative preliminary consideration of primary liver cancer with infiltration of the gallbladder,we chose the operation as the resection of segment Ⅳ b and Ⅴ of the liver,cholecystectomy and T tube drainage.Pathological examination postoperative showed the bulky liver carcinoma grade Ⅲ and the poorly differentiated adenocarcinoma of gallbladder.A month later,abdominal CT showed the tumor spread intrahepatic,prompting the poor prognosis.Conclusion The two which are not continuous,which is the standard of double primary cancer,are not suitable for all double primary cancers.This case provides useful experience for future similar diagnosis and treatment of disease,and also helps us with timely and accurate identification of “metastatic”or “primary”,which is the key point for clinicians to give patients an effective treatment.

Central Nervous System ; pathology ; Humans ; Infant ; Leigh Disease ; pathology ; physiopathology

Objective To analyze the voice quality of children post operation for complete cleft palate through subjective and objective evaluation and explore the correlation between them. Methods Electroglottography analysis was used in the natural sound/a/of 30 postoper-ative children with complete cleft palate and 34 normal children, and the difference was compared. The natural prolonged sound/a/was as-sessed with GRBAS (grade, roughness, breathiness, asthenia, strain) in the children with complete cleft palate, and the correlation between the subjective and objective results was analyzed. Results F0, harmonic to noise ratio (HNR) were less, and the shimmer, jitter, normalized noise energy (NNE) and nasalance was greater in postoperative children with complete cleft palate than in normal children. For the children with complete cleft palate, G and R mainly rated as levels 1 and 2, B also rated as levels 1 and 2 in less than half of the children. There were low or very low correlation between all subjective and objective results, excepted G, R, B and F0, which showed moderate correlation. Con-clusion The vocal cords vibrate slowly and irregularly in postoperative children with complete cleft palate, suggesting mild and moderate voice disorder, and they sound hoarsely with roughness and breathiness. There are poor correlations between the subjective and objective as-sessment, and need to be used in combination for the children with complete cleft palate.

According to the characteristics of four basic P morphologies, combining the wavelet transform and the amplitude and slope of transformed P wave, a new P-wave detecting method based on "wavelet-amplitude-slope" algorithm is presented: First search out all modulus maximum pairs to satisfy the threshold after wavelet transform, and then applying the amplitude and slope criterion exclude the interferes and detect the P peak and its shape, last determine the onset and end of P wave respectively which should be separately calculated for single-peak and double-peak P wave (or biphasic P wave). The approach is applied in experiments of data from MIT/BIH database and randomly collected data of clinical ECG. The experimental statistical results shows that the correct detecting rate is as high as 96% compared to manual annotation.
Algorithms ; Electrocardiography ; Humans ; Sensitivity and Specificity ; Signal Processing, Computer-Assisted

OBJECTIVETo study the potential risk factors for severe acute respiratory syndromes (SARS)-related deaths in Beijing.

METHODSEpidemiological data were collected among the confirmed SARS patients officially reported by Beijing Centers for Disease Control and Prevention (BCDC), and information was also supplemented by a follow-up case survey. Chi-square test and multivariate stepwise logistic regression analysis were performed.

RESULTSOld age (over 60 years) was found to be significantly associated with SARS-related deaths in the univariate analysis. Also, history of contacting SARS patients within 2 weeks prior to the onset of illness, health occupation, and inferior hospital ranking as well as longer interval of clinic consulting (longer than 1 day) were the risk factors for SARS-related deaths. Multivariate stepwise logistic regression analysis found four risk factors for SARS-related deaths.

CONCLUSIONOld age (over 60 years) is the major risk factor for SARS-related deaths. Moreover, hospital health workers, the designated hospitals for SARS clinical services and the interval of consulting doctors (less than 1 day) are protective factors for surviving from SARS.

Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; China ; epidemiology ; Humans ; Infant ; Middle Aged ; Multivariate Analysis ; Risk Factors ; Severe Acute Respiratory Syndrome ; epidemiology ; mortality

OBJECTIVETo describe the specific features of the contact history of probable cases of severe acute respiratory syndrome (SARS) in Beijing.

METHODSData of SARS cases notified from the Beijing Municipal Center for Disease Control and Prevention (BCDC) and supplemented by other channels were collected. All the data were analyzed by descriptive epidemiology.

RESULTS(1) The number of probable cases with contact history was significantly higher than the excluded cases. (2) The proportion of probable cases with contact history descended with epidemic development, but this situation did not occur in health care workers (HCWs). (3) The fatality rate of probable cases with contact history was significantly higher than the cases without contact history (OR = 1.489). (4) The proportion of probable cases with contact history was 85.86% among health care workers, which was significantly higher than that of non-health care workers (85.86% v.s. 56.44%, OR=4.69).

CONCLUSIONS(1) The susceptible persons with contact history may not get infected, and the contact history is just a sufficient condition of infecting SARS; (2) There are 3 conceivable reasons for the descending trend of the proportion in probable cases with contact history; (3) The contact history is one of the risk factors of the death of SARS cases; (4) The risk of contacting with SARS among health care workers is approximately 5 times higher than that of non-HCWs.

China ; Contact Tracing ; Data Interpretation, Statistical ; Disease Outbreaks ; Health Personnel ; Humans ; Medical History Taking ; Occupational Exposure ; Risk Factors ; Severe Acute Respiratory Syndrome ; epidemiology ; prevention & control ; transmission

Objective To evaluate the diagnostic advantage of the ratio of ligamentum flavum(LF) thickness to oblique canal diameter(TODR)measured on CT images in patients with lumbar canal stenosis. Methods Seventy-one patients underwent CT and MRI examinations respectively,and they were divided into two groups,the positive group and negative group,according to the presence or absence of dural sac notch caused by the LF on bilateral parasagittal MR images.Meanwhile,50 volunteers without any symptom in the lumbar region or legs were examined by CT.TODRs were measured at the L3—S1 levels of the inferior margin of the intervertebral disc on transverse CT images,respectively.The results were further analyzed with the positive findings on MR images,clinical symptoms and physical examination,so as to find out the statistical correlation between them.Results LF thickness was(3.01?0.72)mm and TODR was 0.19?0.04 in the negative group,(3.94?0.84)mm and 0.28+0.06 in the positive group,and(3.16? 0.85)mm and 0.19?0.04 in the control group.There was significant difference between positive group and negative group or control group for LF thickness(P0.24, the sensitivity,specificity and positive predictive value were 74.8%,89.6% and 73.6% respectively. Positive correlation existed between LF thickness or TODR and clinical symptom(r=0.72,0.86,P

Objective To investigate the effects of 3 different ventilation methods,including conventional mechanical ventilation (CMV),high frequency oscillatory ventilation(HFOV) and partial liquid ventilation (PLV),on the changes of inflammatory factors and pulmonary surfactant associated protein A (SP-A) in bronchoalveolar lavage fluid (BALF) in newborn piglets with acute lung injury(ALI).Methods Twenty-four newborn piglets,no more than 3 days old,were enrolled.After ALI made with saline lavage(38 ℃,35 mL/kg),newborn piglets were randomly assigned to 4 groups:control group (n =6,no ventilation),CMV group(n =6),HFOV group(n =6),and PLV group(n =6).Piglets were sacrificed after being ventilated for 24 h.Tumor necrosis factor-α (TNF-α),interleukin-8 (IL-8),interleukin-1 (IL-1) and SP-A in BALF were measured quantitatively by using enzyme-linked immunosorbent assay.Results In 3 groups using different ventilation methods,the population mean of TNF-o,IL-8,IL-1 and SP-A were statistically different (all P =0.000).SP-A in PLV group and HFOV group were higher than that in CMV group (all P ＜ 0.05),while IL-8,IL-1 and TNF-α in PLV group were lower than those in CMV group (all P ＜ 0.05),IL-8 and TNF-α in PLV group were lower than those in HFOV group (all P ＜ 0.05),IL-8 and TNF-α in HFOV group were lower than those in CMV group (all P ＜ 0.05).Conclusions Pulmonary inflammatory reaction was different in 3 ventilation groups.Compared with CMV and HFOV,PLV attenuated inflammatory reaction,so it could increase the expression of SP-A and decrease the degradation of SP-A.

Objective To investigate the role and mechanism of matrix metalloproteinase 9(MMP-9) and tumor necrosis factor α (TNF-α) in the pathogenesis of allergic rhinitis (AR) and asthma (AS). Methods The rat models of AR and AS were made by injecting ovalbumin. The infiltration of eosinophils and mast cells were detected by hematoxylin-eosin (HE) staining and toluidine blue staining respectively, and the expression of MMP-9 and TNF-α in nasal mucosa and lung tissue were examined by immunohistochemical staining ( SP method). The relationship of their expression with upper and lower respiratory tract inflammation was analyzed. SPSS 13.0 software was used to analyze the data. Results The numbers of MMP-9 positive inflammatory cells in nasal mucosa and lung tissue of AR were ( 154.8±12.0)and (124. 0 ±8.2), (43. 2 ±7.6) and (34. 5 ±5.0) in the control groups, the difference was significant (t value were 24. 260, 29. 525 respectively, all P＜0.05). The numbers of MMP-9 positive inflammatory cells in nasal mucosa and lung tissue of AS were (149.9±11.7)and(120.1±7.3), (48.6 ± 7. 6) and (39.1±5.2)in control groups, the difference was significant (t value were 22. 929 and 28. 530respectively, all P＜0.05).The numbers of TNF-α positive inflammatory cells in nasal mucosa and lung tissue of AR were (188.8±17.0), and (134.8±7.9), (57.6±23.3)and(40. 3 ± 8. 2 ) in control groups, the difference was significant (t value were 13. 836 and 26. 220, all P ＜0.05). The numbers of TNF-α positive inflammatory cells in nasal mucosa and lung tissue of AS were (179. 2 ± 15.4 ) and ( 153. 5 ± 10. 1 ), (70. 5 ±33. 1 ) and ( 33.8 ± 14. 0) in control groups, the difference was significant ( t value were 9. 412 and 21. 858, all P ＜0. 05). There was a correlation between the expression of MMP-9 and TNF-α in nasal mucosa and lung tissue of AR ( r values were 0. 893 and 0. 700 respectively, P values were 0. 001 and 0. 024, respectively ) and AS ( r values were 0. 692 and 0. 644 respectively, P values were 0. 027and 0. 044 respectively) groups. Conclusions The inflammation is similar between AR and AS. The MMP9 and TNF-α may play an important role in the pathogenesis of upper and lower respiratory tract inflammation.

Objective： This study was designed to explore the relationship between clinicobiological acting and expression of p21 protein and estrogen receptor(ER) in colorectal cancer. Methods： The intensity of expression of p21 protein and ER for 206 patients with colorectal cancers were determined by labeled-streptokinase avidin-biotin(LSAB) assay. Results： The expression of p21 protein is negatively correlated with that of ER in colorectal cancer(r=-0.6613, P<0.01). The intensity of expression of p21 protein and ER in colorectal cancers were not related with the patients age, sexuality, tumor position, pathological type, histological type, Dukes stage etc.(r< 0.4,P>0.05). Both the expressions were related to the prognosis of colorectal cancer(P<0.01). Higher the intensity of expression of p21 protein worse the patients prognosis, and higher the intensity of expression of ER better the patient s prognosis. Conclusions： The abnormal expression of p21 protein is related to the dysbolism of estrogen in colorectal cancer. The detection of p21 protein and ER are helpful for diagnosis and prognostic evaluation for colorectal cancer.