Objective To evaluate the therapeutic effect of early fluid resuscitation under the guidance of pulse indicator continuous cardiac output (PiCCO) on patients with severe acute pancreatitis (SAP).Methods Clinical data of 18 SAP patients (research group),who had undergone fluid resuscitation under the guidance of PiCCO in the Department of Critical Care Medicine of the Second Affiliated Hospital of Anhui Medical University from October 2011 to October 2013,were analyzed prospectively.At the same time,clinical data of 25 cases (control group) that had undergone fluid resuscitation without the guidance of PiCCO from January 2009 to September 2011 were collected retrospectively.The volume of fluid and clinical data were compared between two groups.Results During the first 6 hours,0-24 hours,24-48 hours,and 0-72 hours after intensive care unit (ICU) admission,the research group received larger volume of fluid than that of the control group (mL:2 133 ± 1 593 vs.1 024 ± 421,t=3.337,P=0.002; 5 960 ±2 951 vs.3 767 ± 854,t=3.531,P=0.001; 4 709 ± 1 508 vs.3 863 ± 1 122,t=2.112,P=0.031 ; 14 601 ± 5 095 vs.11 409 ± 2 667,t=2.673,P=0.007).Compared with the control group,the incidence of application of blood purification was lowered [5.56％ (1/18) vs.44.00％ (11/25),x2=7.688,P=0.006],the duration of the systemic inflammatory response syndrome (SIRS) was shortened (days:3.54 ± 2.44 vs.5.62 ± 3.62,t=2.113,P=0.041),acute physiology and chronic health Ⅱ (APACHE Ⅱ) score was significantly declined at 24 hours after admission (11±4 vs.14 ± 5,t=2.104,P=0.042),the blood lactic acid was decreased more significantly after 72 hours (mmol/L:3.10 ±0.55 vs.2.40 ± 1.12,t=2.442,P=0.019),and the length of ICU stay was shortened (days:10 ±9 vs.20 ± 10,t=3.371,P=0.002) in research group.But there was no significant difference in the percentage of the use of vasoactive drugs [16.67％ (3/18) vs.24.00％ (6/25),x2 =0.340,P=0.560],the incidence of invasive mechanical ventilation [50.00％ (9/18) vs.52.00％ (13/25),x2 =0.017,P=0.897],72-hour urea nitrogen changes (mmol/L:-0.33 ± 4.71 vs.-0.09 ± 5.37,t=0.152,P=0.880),and the percentage of abdominal infection [16.67％ (3/18) vs.16.00％ (4/25),x2=0.003,P=0.953] between research group and control group.The mortality in research group was lower than that in control group [5.56％ (1/18) vs.20.00％ (5/25)] without statistical difference (x2=1.819,P=0.178).According to the 2012 Atlanta classification,patients were re-evaluated after 48 hours fluid resuscitation.Six patients in research group developed moderately severe acute pancreatitis,and the incidence was significantly higher than that in control group [33.33％ (6/18) vs.8.00％ (2/25),x2=4.435,P=0.034].The time of mean PiCCO installation was 4.5 days in 18 cases of the research group,and no related complications occurred.Conclusions The PiCCO device may be a useful adjunct for fluid resuscitation monitoring in patients with SAP within 72 hours.Early fluid resuscitation under the guidance of PiCCO may be helpful in improving tissue perfusion,reducing the application of blood purification,as well as shortening length of ICU stay.This program did not increase the risk of invasive mechanical ventilation,and no obvious change in mortality rate was observed.

Objective To characterize the features of breast mucinous carcinoma on T2WI, dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion weighted imaging (DWI) and correlate the MR features with histopathology. Methods MR imaging in 8 women (aged 33--65 years old) with mncinous carcinoma of the breast verified histopathologically was performed on 1.5 T scanner with T1WI, FS T2 WI, 3D DCE-MRI using volume imaging for breast assessment(VIBRANT) sequence, DWI with b value of 500 and 1000 s/mm2 by single-shot EPI sequence. According to the lexicon of BI-RADS-MRI designed by ACR, the MR findings were retrospectively studied, including morphology, signal intensity on T1WI and FS T2WI, mass enhancement, the patterns of dynamic enhancement curve, and the mean ADC on DWI. The pathologic diagnosis was made according to the standard criteria by the World Health Organization Classification of Tumors. Results Five patients were pure mucinous carcinoma and 3 patients were the mixed. The amount of mucus ranged from 60% to 90%. All 8 tumors presented as a mass on MRI with low signal intensity on T1WI, high or strongly high signal intensity on FS T2WI and high signal on DWI. The tumor size ranged from 1.3 to 3. 2 cm in diameter. Five tumors showed rim enhancement in early phase and the central part was gradually enhanced in delayed phase. One tumor presented slightly heterogeneous enhancement. Two tumors showed progressively heterogeneous enhancement. The mean ADC values of tumor were (2.41±0.28) ×10-3 mm2/s with b value of 500 s/mm2 and (2.06 ±0. 14) × 10-3 mm2/s with b value of 1000 s/mm2, and higher than that of the normal breast tissue [ ( 1.71 ±0. 32) × 10-3 and ( 1.43 ± 0. 24) × 10-3 mm2/s]. Conclusions The MR features of breast mucinous carcinoma on T1WI, DCE-MRI, and DWI are different from that of invasive ductal carcinomas and may reflect its distinct histological type. The combination of these MR sequences may lead to a pre-operative diagnosis of this tumor.

BACKGROUND:Bone nonunion is a common complication in the orthopedic treatment, and its morbidity reached 5%-10%, which results in the long-term functional disturbance of the limbs, and even disability. Autogenous iliac crest graft has been commonly used to treat bone nonunion, but some limitations stil exist.
OBJECTIVE:To investigate the treatment outcomes of autogenous iliac crest graft combined with autologous bone marrow stem cel transplantation for bone nonunion after fracture surgery.
METHODS:Clinical and fol ow-up data from 69 patients with bone nonunion were analyzed retrospectively. Al patients were al otted to combination (n=37) and iliac (n=32) groups, fol owed by treated with autologous iliac crest graft combined with autologous bone marrow stem cel transplantation or autologous crest graft, respectively. Afterwards, the hospitalization time, fracture healing time, bone mineral density and Fereadez-Esteve cal us scores were detected and compared between groups.
RESULTS AND CONCLUSION:The hospitalization time did not differ significantly between groups (P>0.05). The fracture healing time in the combination group was significantly shortened compared with the iliac group (P<0.05). The bone mineral density and Fereadez-Esteve callus scores in the combination group were significantly higher than those in the iliac group at 3 and 6 months after surgery (P<0.05). The excellent and good rate of the affected limb function in the combination group was significantly higher than that in the iliac group (P<0.05). These results suggest that autogenous iliac crest graft combined with autologous bone marrow stem cell transplantation for bone nonunion can accelerate fracture healing, promote porosis and improve the functional recovery of affected limbs.

Objective To evaluate the mammographic characteristics of primary lymphoma of the breast and to correlate the imaging features with the histopathologic findings.Methods We retrospectively reviewed records in 27 patients with histologically proven primary malignant lymphoma of the breast.Mmammography was performed before surgery in 14 cases.The clinical, pathologic, and imaging features were retrospectively reviewed and correlated in these 14 patients.All patients were female, with the mean age of 41.5 years (range 28-56).The lesion was in the right breast in 7 patients, the left in 6, and bilateral in 1.Results Histology revealed 13 Non-Hodgkin lymphoma (NHL) and 1 Hodgkin lymphoma (HL).In primary lymphoma, mammography revealed a unilateral solitary mass in 9 cases, unilateral multiple masses in 2 cases, bilateral multiple masses in 1 case, and unilateral diffusely increased opacity with skin thickening in 2 cases.The diameter of the masses ranged from 0.7 cm to 5.0 cm (mean 2.6 cm). Of the total 18 masses, the margins of the masses were well defined in 13, and partially defined in 5.Neither calcifications nor spiculations nor adjacent skin retraction were seen.Of the 13 NHL, histologic examination showed diffuse NHL in 12 cases and follicular NHL in 1.No mammographic features were identified that could helped distinguish follicular from diffuse NHL.Conclusion Primary lymphoma of the breast usually presents with clinical and mammographic findings mimicking a carcinoma or benign tumor.Although the clinical and imaging characteristics may suggest the possibility of breast NHL, none of the findings are pathognomonic.The final diagnosis depends on histopathology.

Many anorectal opearations may result in damage to anal sphincter function and,as a result,patients have problems when they are defecating.Measuring anal sphincter function not only benefit for operating,but also may help prevent operating complications and do good for rehabilitation.Therefor,measuring anal sphincter function is important.This article will review those measures about anal sphincter function.

Objective To evaluate the safety and effectiveness of bedside nasointestinal nutritional tube insertion with specific guiding techniques in critically ill patients.Methods Critically ill patients who could not take oral or gastric feeding were collected from September 1st, 2013 to September 10th, 2015 in Intensive Care Unit of The Second Hospital of Anhui Medical University.In these patients, bedside nasointestinal tube insertion was performed according to the relevant standard operating procedure in our department, and guiding technique was chosen based on patients' clinical characteristics.Operation time, position of tube tip and complications associated with the bedside operations were recorded for retrospective analysis.Results A total of 21 patients were collected in this study, in whom 23 bedside insertions were preformed.In 21 insertions (91.3％), the tip of the tube was successfully inserted across the transpyloric plane;and in 20 insertions (87.0％), 10 cm distal to the ligament of Treitz.The average operation time was (14.10 ± 1.80) min.The average cost was (297.01 ± 35.26) yuan.No severe complications were occurred.Conclusions The bedside nasointestinal feeding tube insertion without visual guiding is simple, safe, low-cost, and of high success rate.It may be a good choice for establishing enteral nutrition channel in order to implement early enteral nutrition in patients unable to take oral or gastric feeding.

OBJECTIVEThe aim of this study was to observe the change of bacterial adhesion on pure titanium coated with nitrogen-diamond like carbon (N-DLC) films and to guide the clinical application.

METHODSN-DLC was deposited on titanium using ion plating machine, TiN film, anodic oxide film and non-deposition were used as control, then made specimens adhering on the surface of resin denture base for 6 months. The adhesion of Saccharomyces albicans on the titanium surface was observed using scanning electron microscope, and the roughness was tested by roughness detector.

RESULTSThe number of Saccharomyces albicans adhering on diamond-like carbon film was significantly less than on the other groups (P < 0.05), and the growth of bacterial cell was inhibited and in a poor state. The largest number of adhesion and cell strains grew well on anodic oxide film group and non-deposition control group. The change of surface roughness of N-DLC film was less than other group (P < 0.05).

CONCLUSIONPure titanium coated with N-DLC film reduced the adhesion of Saccharomyces albicans after clinical application, thereby reduced the risk of denture stomatitis.

Bacterial Adhesion ; Carbon ; Coated Materials, Biocompatible ; Diamond ; Humans ; Nitrogen ; Titanium

Cross-talk of intracellular signaling pathways that share common components (hubs) is organized in form of a bow-tie network topology.Signaling cross-talk is functionally pleiotropic for target genes regulation, resulting in functional redundancy, synergism and antagonism, which should be precisely controlled to prevent signaling 'leaking' or 'spillover'.Thus, the biological system has evolved multiple insulating mechanisms to achieve stimulus-specific response that maintains intracellular homeostasis.The insulation mechanism of signaling cross-talk suggests: (1) the functional duality of cross-talk molecules that determine cell fate requires selectively targeting dysregulated cross-talk molecules while protecting the normal ones from off-target or unintended effects, and we propose them as the targetable cross-talk molecules;(2) cross-talk molecules are usually carried on the macromolecular complex as their functional platforms, thus the structural plasticity of conformational changes at the interaction surface of cross-talk molecules asks for intensive work on the relationship study between drug binding and biological activity, which we propose as the accessible cross-talk molecules.Therefore, signaling cross-talk and its insulation mechanism play instructive leading roles in resolving the bottlenecks of current drug R&D and improve the clinical outcome.

OBJECTIVETo observe the three-dimensional distribution of vessels, and to establish a new method for measurement of blood flow velocity in mice cerebral cortex using two-photon laser scanning microscopy and fluorescence probe labeling technique.

METHODSThe mouse was made cranial window surgery and injected Texas-Red through tail vein after anesthetized. The three-dimensional imaging of vessel was obtained through z-stack scanning, and blood flow velocity was quantified through line scanning.

RESULTSWe could detect vascular distribution for more than 500 µm depth using two-photon microscopy. The velocity of blood flow was (0.59 ± 0.12) mm/s in capillary.

CONCLUSIONThe method for observing the brain blood flow by two-photon microscopy was established, which could achieve quantification of single vascular blood flow velocity and provide experimental evidence for basic research and medical applications.

Animals ; Blood Flow Velocity ; Brain ; blood supply ; Capillaries ; Cerebrovascular Circulation ; Fluorescent Dyes ; Hemodynamics ; Mice ; Microscopy, Fluorescence