Objective To determine platelet count (PLT),mean platelet volume (MPV),and hemodynamic changes in patients with cir-rhotic portal hypertension (CPH)post splenectomy plus pericardial devascularization (SPPD),and to assess the surgical effect on coagula-tion function.Methods A retrospective analysis was performed on 83 CPH patients undergoing SPPD in our hospital from January 2008 to December 2012.Results Compared with preoperative levels,postoperative portal venous pressure decreased,blood flow was reduced,and portal vein diameter was significantly reduced;additionally,postoperative hepatic artery diameter was increased,and hepatic artery blood flow increased.Blood alanine aminotransferase,albumin,total protein,and fibrinogen levels,thrombin time,and MPV did not significantly change 30 days postoperatively versus 7 days preoperatively(P>0.05 );the corresponding total bilirubin,activated partial thromboplastin time and prothrombin time relatively declined(P<0.05),whereas PLT and prothrombin time activity increased(P<0.05).There was a significant increase in PLT (P<0.05)but no significant change in MPV 30 days postoperatively versus 7 days preoperatively (P>0.05). Conclusion SPPD can significantly improve liver functional reserve and coagulation function in patients with CPH.

Objective To study the effectiveness and toxicity of ifosfamide(IFO) combined with venorelbine(VRL) in patients with nasopharyngeal carcinoma(NPC) refractory to platinum based chemotherapy. Methods The chemotherapy protocol consisted of intravenous infusion of IFO at the dose of 1200 mg/m2 from day 1 to day 5 with uroprotection of Mesna in infusion at 0,3,6 hours following initiation of IFO and VRL at the dose of 25 mg/m2 at day 1 and day 5. The protocol was repeated every 3 weeks. All patients received at least 2 cycles of chemotherapy. Results Among 25 patients enrolled into the study, 2 patients achieved complete remission, 12 patients achieved partial remission with an total remission rate of 56.0 % and 8 patients had stable disease with clinical benefit rate of 88.0 %. 3 patients had disease progression. Median time to progression was 7.1 months(range:2.0～21.0 months) and 1-year survival rate was 55 %. The main toxicities were myelotoxicity and phlebitis. Conclusion The results indicate that IFO combined with VRL in patients with NPC refractory to platinum based chemotherapy has moderate activity ascompany with tolerable toxicities.

Objective To investigate the effect of milk basic protein (MBP) on bone metabolism in normal and ovariectomized (Ovx) rats. Method Forty-eight female Sprague-Dawley rats were ovariectomized and another 12 rats received sham operation (Sham). After 10 d recovery period, the Ovx rats were randomly divided into 4 groups: control, low-dose, medium-dose, and high-dose MBP group. Another 44 normal female rats without ovariectomy were also divided into 4 groups as above. The MBP dosages for each group were respectively 0, 10, 20, 30 mg/kg bw. All rats were i.g. administered for 90 d. Bone mineral density (BMD) of the femur (at proximal end, middle of diaphysis, and distal end) was measured by dual-energy X-ray absorptiometry in vivo. The amounts of calcium, magnesium and phosphorus were analyzed by ICP-AES. Results BMD at distal end of femur was significantly higher in normal low-dose group than in normal control group while no significant effect was observed in Ovx MBP groups. As for the amounts of calcium, magnesium and phosphorus, there were no significant differences among normal experimental groups and also among Ovx experimental groups. However, some variations in the level of those minerals were observed. Conclusion MBP at 10 mg/kg bw significantly elevated BMD at femoral distal end in normal rats, while no similar effect was observed in Ovx rats. Besides its influence on bone minerals, there may be another mechanism involved in its effect on bone metabolism.

Objective To investigate the effect of EDTA combined with ciprofloxacin on Pseudomonas aeruginose biofilm in vivo.Methods Pseudomonas aeruginosa was inhaled into the lung of guinea pigs and colonized,formed biofilm.After 7 days,the model was treated with ciprofloxacin,EDTA alone,or a combination of both for 7 days.The number of colony in the lungs is measured by agar plate.The pathological change of the lung is observed by hematoxylin and eosin (HE) staining and scanning electron microscope.Results EDTA combined with ciprofloxacin make the number of bacteria in the lungs reduced from l05 CFU/g to 10 CFU/g(t =24.67,P＜0.05),the lung lesion was less-sever histophathologically.Conclusion The combination of EDTA with ciprofloxacin has significant activity to remove mucoid PA biofilm in vivo.

Objective: To quantitatively analyze the chest computerized tomography ( CT ) images of coronavirus disease 2019 ( COVID-19 ) cases by automatic artificial intelligence ( AI ) system, so as to provide the basis for the prediction of severe cases and early clinical intervention. Methods: Eighty-three confirmed cases of COVID-19 from January 23 to February 14, 2020 in Wuchang Hospital of Wuhan were selected and the clinical data were collected. According to the diagnosis and treatment Plan of COVID-19 (seventh trial), the patients were divided into an ordinary group and a severe group. The parameters of chest CT images were quantified by the automatic AI system, and the CT imaging features of two groups were compared. Results: There were 46 cases in the ordinary group and 37 cases in the severe group, with the age of ( 62.68 ±13.69 ) years and ( 50.52 ±12.45 ) years, respectively. The percentages of total pulmonary lesions, the lesion volume of bilateral lungs, the lesion volume of right lower lung, the left lung volume and the right lung volume from -300 to -200 Hu [median (inter-quartile range)] were 19.80% ( 21.69% ), 622.87 ( 1 145.73 ) cm3, 205.73 ( 246.95 ) cm3, 26.50 (21.20) cm3 and 38.02 (48.78) cm3 in the severe group, which were significantly different from 9.78% ( 13.24% ), 333.55 ( 401.77 ) cm3, 126.02 (164.21) cm3, 21.43 (13.11) cm3 and 26.92 ( 18.04 ) cm3 in the ordinary group ( P<0.05 ). The volume of pulmonary lesions reached the peak from 10 to 16 days after infection. Conclusion The lung lesions in severe cases of COVID-19 are large, especially in the right lower lung, and need to be closely monitored from 10 to 16 days after infection for early warning of severe cases.

OBJECTIVE: To investigate the lethal blood level, the target organs and tissues, the toxicant storage depots and the postmortem redistribution in mice died of emamectin benzoate poisoning. METHODS: The mice model of emamectin benzoate poisoning was established via intragastric injection. The main poisoning symptoms and the clinical death times of mice were observed and recorded dynamically in the acute poisoning group as well as the sub-acute poisoning death group. The pathological and histomorphological changes of organs and tissues were observed after poisoning death. The biodistribution and postmortem redistribution of emamectin benzoate in the organs and tissues of mice were assayed by the enzyme-linked immunosorbent assay (ELISA) at 0h, 24h, 48h and 72h after death. The lethal blood concentrations and the concentrations of emamectin benzoate were detected by high performance liquid chromatography (HPLC) at different time points after death. RESULTS: The symptoms of nervous and respiratory system were observed within 15-30 min after intragastric injection. The average time of death was (45.8 ± 7.9) min in the acute poisoning group and (8.0 ± 1.4) d in the sub-acute poisoning group, respectively. The range of acute lethal blood level was 447.164 0-524.463 5 mg/L. The pathological changes of the organs and tissues were observed via light microscope and immunofluorescence microscope. The changes of emamectin benzoate content in the blood, heart, liver, spleen, lung, kidney and brain of poisoning mice showed regularity within 72 h after death (P < 0.05). CONCLUSION The target organs of emamectin benzoate poisoning include heart, liver, kidney, lung, brain and contact position (stomach). The toxicant storage depots are kidney and liver. There is emamectin benzoate postmortem redistribution in mice.
Animals ; Autopsy ; Chromatography, High Pressure Liquid ; Dose-Response Relationship, Drug ; Enzyme-Linked Immunosorbent Assay ; Ivermectin/toxicity* ; Lethal Dose 50 ; Mice ; Postmortem Changes ; Tissue Distribution

Objective To discuss perioperative features, operative approach and surgical effects of spinal tuberculosis in older patients. Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal tuberculosis ranging in age from 61 to 78 years (average, 67 years). The lesion was located in thoracic vertebrae in 9 patients, thoracolumbar vertebrae in 14, lumbar in 16, and lumbosacral in 6. Preoperative Frankel grades were B in 7 cases, C in 21, D in 11 and E in 6. Among them, 21 had cardio-cerebrovascular disease, 10 had diabetes mellitus. With preoperative medicine and chemotherapy for 2-3 weeks, all patients were treated surgically. The surgical procedures included: 1) Posterior focus debridement, bone grafting and one-stage posterior transpedicular screw system fixation in thoracic vertebrae (T2-T7). 2) Anterior debridement, bone grafting and one-stage posterior transpedicular instrumental fixation in lumbosacral vertebrae (L5-S1). 3) Anterior focus elimination, bone grafting and one-stage anterior plate fixation in the other vertebrae. Results Forty-five patients were followed up for 24 to 40 months, with the average of 28.5 months. No severe complication occurred during and after operation. Forty-four cases had recovered and 1 recurred. Spinal fusion occurred 12-18 months after operation. Frankel neurological grades improved significantly. Conclusion With the effective management of comorbidities in perioperative period,the elderly could tolerate surgical treatment. The appropriate approaches, thorough debridement and reasonable bone grafting with internal fixation are key to therapeutic success.

Objective·To investigate correlation of serum acute amyloid A (A-SAA) level and activity of Behcet's disease (BD).Methods·Blood samples from patients with active BD (n=40),remission BD (n=15),Takayasu disease (TA,n=12),rheumatoid arthritis (RA,n=25),systemic lupus erythematosus (SLE,n=25) and healthy donor (HD,n=25) were collected.Serum A-SAA,ESR,and CRP levels were detected and compared among groups.The correlation between A-SAA and its downstream IL-8 or International Society for Behcet's disease (ISBD) disease activity scores was analyzed as well.Results·Serum A-SAA level was significantly increased in the patients with active BD [(115.70±87.78) mg/L],as well as patients with RA and TA,which levels were (68.72±61.50) mg/L and (96.25±87.41) mg/L respectively,but remained unchanged in SLE patients.Moreover,serum A-SAA level was found correlated with ISBD score as well as IL-8 level.Conclusion·A-SAA can work as a detection index for evaluating BD activity.

Objective To make a systematic review of pressure ulcers risk factors in critically ill patients. Methods We systematically reviewed all articles related to the pressure ulcers risk factors in critically ill patients. The Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, CNKI, WANFANG and SinoMed were searched to August 2016. Results In total, 13 eligible articles were included. These studies included 18, 184 critically ill patients, six studies were classified as high quality, and seven were classified as moderate quality. Risk factors for the development of pressure ulcers include age, ICU stay, diabetes, mean arterial pressure<60-70 mmHg (1 mmHg=0.133 kPa), mechanical ventilation and mechanical ventilation, drugs, sedation and postural changes. Conclusions There is no single factor that can explain the occurrence of pressure ulcers. So it is in a variety of factors interaction, the occurrence of a significant increase in risk.

Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.