ObjectiveTo study the way for establishing prediction model of acute pancreatitis with secondary multiple organs dysfunction syndrome (MODS) in the early stage.MethodsThe linical data were collected from 113 hospitalized patients with acute pancreatitis admitted from October 2008 to October 2011.Some biomarkers within 48 h after the onset of acute pancreatitis were statistically analyzed by univariate and multivariate binary logistic regression analysis in order to establish the prediction model evaluated by the ROC curve. ResultsThere were statistically significant differences in lactate dehydrogenase ( LDH ),serum creatinine ( CR),serum albumin ( P ＜ 0.05 ) identified by univariate regression analysis.These independent risk factors in the regression model were:ln (P/1 -P) =2.243 +0.002 × LDH + 0.014 × CR - 0.186 × ABL,likelihood ratio test ( x2 =66.46,P =0.000) ; in the ROC curve analysis:AUC 0.927 (95％ CI:0.875 -0.980),the best cut- off value of the model predicting probability was 0. 177 (sensitivity 82. 14％,specificity 85.88％,correctly classified 84.96％ ).ConclusionsEfficient prediction model could be set up by the logistic regression analyzing the early risk factors in multiple organ dysfunction syndrome following acute pancreatitis.

Objective To investigate the value of SPECT imaging in the evaluation of rCBF improvement after bypass surgery in patients with moyamoya disease (MMD).Methods Retrospective analysis was conducted in 13 patients with MMD (5 children aged 3-8 years and 8 adults aged 45-55 years).The SPECT cerebral perfusion imaging data before and after operation were analyzed.Age matched subjects who underwent cerebral perfusion imaging for accidental headache (10 children,10 adults) were taken as control group.Two-sample t test or paired t test was used to compare rCBF of different groups.The brain DSA and MRI results during follow-up were taken as the reference of perfusion improvement.Results Based on visual judgment of SPECT,11/13 in MMD group showed significant improvement in the blood perfusion reduction area after surgery.The coincidence rates of SPECT-DSA and SPECT-MRI was 8/11 and 9/11,respectively.The rCBF of the control group and MMD group before surgery was (51.19±1.63) ml · 100 g-1 · min-1 and (38.83±2.22) ml · 100 g-1 · min-1 respectively (t=-18.465,P＜0.05).The rCBF of MMD group before and after surgery was significantly different ((38.83±2.22) ml · 100 g-1 · min-1 vs (45.03±2.63) ml · 100 g-1 · min-1,t=-11.707,P＜0.05).The rCBF of MMD group after surgery and the control group was significantly different (t =-8.313,P＜0.05).There was no significant difference of rCBF between the children and adults in the control group ((51.81±1.82) ml · 100 g-1 · min-1 vs (50.55±1.18) ml · 100 g-1 · min-1 ;t=0.081,P＞0.05).Conclusions Brain perfusion SPECT may effectively reflect the regional distribution and changes of blood flow in the ischemic tissue before and after MMD surgery.Thus it may be helpful in evaluation of the effect of surgical treatment.

Objective To observe the effect of 5 fluorouracil (5 FU) on regulating the inflammatory and anti inflammatory cytokines in acute pancreatitis(AP) in rats, and to investigate the mechanism of treatment of AP with 5 FU. Method SD male rats were divided randomly into 3 groups:false operation group (n=6), AP group(n=24) and 5 FU treatment group(n=24). Then, AP group and 5 FU treatment group redivided respectively into 3 subgroups: After the AP model sut up or after 5 Fu treatment 2, 6 and 24 h subgroups (n=8). The animals were killed at the blood samples were taken for measurement of TNF ?, IL 1, IL 6, IL 10 and TGF ?. The wet weight of pancreatic tissue and blood amylase also were observed. Results Both serum inflammatory cytokines (TNF ?,IL 1 and IL 6) and anti inflammatory cytokines (IL 10 and TGF ?) in AP group increased significantly (P

Objective To study retrospectively the outcome and failing factors of nasopharyngeal carcinoma(NPC) treated with late-course unconventional fractionation radiotherapy(LCUCFR). Methods From January 1996 to December 2000, 133 such patients were analyzed retrospectively. All had been confirmed by histopathology as poorly differentiated squamous cell carcinoma, including 101 males and 32 females. All were treated by LCUCFR. The nasopharyngeal lesion radiation schedule was as follows; 1.An initial conventional fractionation 34.5Gy/18f for face and neck port, with 1.92Gy per daily fractionation;2.The above regimen was followed by 1.25-1.50Gy per fraction twice daily in 6-8 days for pre-auricular port;3.The above regiment was then followed by conventional boosting dose 1.90Gy and 1.30Gy(morning 1.90Gy and afternoon 1.30Gy) twice daily(with interval of 6-8 hours) in 6-8 days. The whole course was 5 fractions per week with the median of 78Gy over a median of 47days. The positive and negative lymph node in the neck were treated by conventional radiotherapy with a median of 67Gy and a dose of 50-55Gy in median interval of 43 days. Results The 5-year nasopharyngeal lesion and neck metastasis lymph node control rate was 92.9% and 96.4%, respectively. T1,T2,T3 and T4 stage local control rate was 100%,96.6%,96.6% and 78.4%,respectively. The overall 5-year survival and disease-free survival rate was 73.3% and 70.8%,respectively. The 5-year distant-free metastasis rate was 80.2%. Fourteen varietes were used to analyze the prognosis. Both univariate and multivariate analyses revealed that the distant metastasis, lower neck and superclavicle area as well as both neck lymph node metastases and local recurrence were prognostic factors for 5-year survival rate(Logrank test all P

Objective To investigate the changes in serum hyaluronic acid level at different periods of experimental piggyback liver transplantation and its significance. Methods Fifteen pairs of healthy pigs of both sexes weighing (28.3 + 5.0)kg undergoing liver transplantation were studied. The donor pigs were slightly smaller than the recipient pigs. The recipient pigs were premedicated with intramuscular ketamine 8mg kg-1 and atropine 0.02mg-kg-1 .Anesthesia was induced with propofol 2mg-kg-1 , fentanyl 0.002mg-kg-1 and vecuronium 0.1mg-kg-1 iv. After tracheal intubation the animals were mechanically ventilated. CVP line was placed via internal jugular vein. Carotid artery was cannulated for continuous BP monitoring. Anesthesia was maintained with iv propofol, fentanyl and vecuronium. Circulatory stability was maintained by infusion of crystalloid, colloid, plasma and whole blood of pig. Blood samples were taken from peripheral vein before operation (T0), pre-anhepatic phase (T1), anhepatic phase (T2) and neohepatic phase (T3) for determination of serum hyaluronic acid concentration by radioimmunoassay. At the same time liver function tests, ALT, AST, y-GT were also examined. Results The average time of liver transplantation was (343+74) min. SBP decreased by (23.51+5.87 ) mm Hg and DBF by (11.35+7.81) mm Hg after induction of anesthesia. Serurn hyaluronic acid level was 267ug-L-1 before operation (T0) and rose to 1743ug-L-1 at T1 , and 9530ug-L-1 at T2 (P

Objective To explore the method of the major hospital indexes examination using clinical pathway as an opportunity.Methods Based on the material of our hospital from 2008 to 2010,reference the data of the same level hospital in Xinjiang Uygur Autonomous Region,we set the benchmark and formulated the examination standard of three examination indexes:average length of stay (ALOS),average hospitalization expense and drug proportion.Meanwhile,we took the subentry incentives to give the corresponding reward to clinical departments according to the decreases rate compared with the benchmark monthly.Results ALOS,average hospitalization expense and drug proportion of department and the whole hospital were obviously decreased compared with the same period last year,and the differences were statistically significant (Medical system:t =27.479,14.462,11.362,all P ＜ 0.01 ; Surgical system:t =18.944,16.029,12.071,all P ＜ 0.01).Conclusion After using the examination methods and combining clinical pathway,the effects are obvious,which can effectively shorten ALOS,reduce average hospitalization expense and drug proportion,so as to relieve the patients' economic burden.

Objective To investigate the relationship between the serum high sensitive c-reactive protein (hs-CRP) and prealbumin (PAB) and the acute heart failure during the early stage of acute myocardial infarction (MI) patients.Methods A total of 181 MI patients (male:n =154,85.1％ vs.female:n =27,14.9％),admitted between Seppember 2010 and September 2012,were enrolled.They were divided into heart failure group (n =114,63.0％) with Killip classification recorded and control group (n =67,37.0％) without heart failure.The levels of serum hs-CRP and PAB were determined from the venous blood in the followed morning after admission.The clinical data were analyzed by logistic regression,Spearman correlation,and ROC curve.Results The serum level of hs-CRP (mg/L) in the heart failure group was significantly higher than that in the control group (P =0.000),while the serum level of PAB (mg/L) in the heart failure group was significantly lower than that in the control group (P =0.000).High level of hs-CRP and low level of PAB were significantly correlated with Killip classification (rhs-CRP =0.234,Phs-CRP =0.003 ; rPAB =-0.321,PPAB =0.000).Serum hs-CRP (P =0.023,OR 1.086,95％ Cl 1.012-1.167) and PAB (P =0.038,OR O.991,95％ CI O.983-0.999) were the independent risk biomarkers of acute heart failure subsequent to myocardial infarction determined by multivariate logistic regression analysis.The area under the ROC curve:AUChs-CRP =0.722,95％ CI 0.651-0.786; AUCPAB =0.723,95％ CI 0.652-0.787.Conclusions With high level of serum hs-CRP or low level of serum PAB during the early stage of acute myocardial infarction,patients were predisposed to the development of acute heart failure consequently.Both of them are the independent risk biomarkers of acute heart failure subsequent to myocardial infarction.Furthermore,they were significantly correlated with severity of the heart failure in terms of Killip classification.

Pemphigus is a severe chronic autoimmune mucocutaneous bullous disease. Glucocorticoids are considered as the first line of treatment for this disease. Dysfunctional uterine bleeding is also observed as a result of hypothalamic-pituitary-ovary axis dysfunction. This study reported one female patient with pemphigus vulgaris complicated with dysfunctional uterine bleeding upon systemic glucocorticoid usage. Before this disease was diagnosed, the patient experienced normal menstruation. The mechanism of dysfunctional uterine bleeding triggered by glucocorticoids is elucidated on the basis of case studies and literature review.
Female ; Glucocorticoids ; adverse effects ; Humans ; Metrorrhagia ; chemically induced ; Pemphigus ; drug therapy

BACKGROUND: Hyperuricemia (HUA), serving as a component of metabolic syndromes (MS), has a major regulatory role in inflammatory responses. However, the correlation between G-308A tumor necrosis factor-α (TNF-α) and MS is still controversial.OBJECTIVE: To study the correlation among G-308A TNF-α genotype distribution, TNF-α mRNA expression and C-reactive protein (CRP) in patients with HUA.DESrGN: Patients with HUA were selected as the subjects, while normal peoplewere taken as the controls.SETTING: Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology.PARTICIPANTS: Subjects were selected from 5 003 people, including 188 patients with HUA and 51 healthy people.Patients with HUA included 40 patients with simple HUA, 42 patients with HUA and dyslipidemia, 80 patients with HUA and dyslipidemia and hypertension, and 26 patients with gout (administration of allopurinol was stopped at one week before the experiment).METHODS: TNF-α gene promoter G-308A genotype was determined by using PCR application followed by Nco/digestion.TNF-α mRNA expression was studied by RT-PCR with semi-quantitative analysis. Antibody sandwich method and enzyme linked immunosorbent assay (ELISA) were adopted to determine the CRP concentration. And the serum uric acid was measured by uricase method, while the insulin resistance index (IRI) was evaluated with homeostasis model.MArN OUTCOME MEASURES: ① Hardy-Weinberg equilibrium test of genotypic frequency. ② Changes in distribution of G-308A TNF-α genotypes and TNF-α mRNA expression in patients with HUA. ③ Changes in TNF-α mRNA expression and other parameters in G-308A TNF-α AA+GA and GG groups. ④ Multiple stepwise regression analysis.RESULTS: A total of 188 patients and 51 normal people were involved in the analysis of results. ① G-308A TNF-α genotypes distribution in 239 enrolled subjects accorded with Hardy-Weinberg equilibrium. ② AA+GA was compared with GG due to lower frequency of AA in population. The results revealed the HUA with dyslipidemia and hypertension group displayed a greater prevalence in G-308A TNF-α AA+GA genotype (30%) than that in the control group (12%) (P ＜ 0.05),while there were no significant differences among other groups. ③ TNF-α mRNA expression and CRP concentration were the highest in the gout group, and HUA accompanied by dyslipidemia and hypertension group listed the second,and then was the HUA and dyslipidemia group, while simple HUA group listed the last, all of which were higher than those in the normal control group (P ＜ 0.05-0.01). TNF-α mRNA expression in HUA accompanied by dyslipidemia and hypertension group, gout group was higher than that in the normal control group (P ＜ 0.05-0.01). The WHR, SBP, DBP,serum uric acid, triglycerides, TNF-α mRNA expression and CRP concentration in AA+GA group were remarkably higher than those in the GG group (P ＜ 0.05-0.01). ④ After adjustment of age, gender, systolic pressure, diastolic pressure,fasting blood glucose, and multiple variable linear stepwise regression showed that triglycerides, uric acid, TNF-α 308 A carrier were related with quantityof TNF-α mRNA expression. Meanwhile, the uric acid concentration, WHR and the quantity expression of TNF-α were significantly in positive association with CRP concentration.CONCLUSTON:The genotype of TNF-α 308 A carriers is associated with TNF-α expression and plasma CRP levels in HUA patients.

Objective To investigate the value of extravascular lung water (EVLW) in predicting the prognosis of sepsis acute lung injury (ALI) / acute respiratory distress syndrome (ARDS).Methods Relevant published articles concerned with EVLW both in Chinese and in English from 1991-2011 were searched,and Meta-analysis was carried out with Stata software. Results Seven articles were selected for Meta-analysis according to the inclusion and exclusion criteria.The results indicated EVLW of dead patients group kept in a high level,while EVLW showed a down-trend in the survival group.The difference in level of EVLW between the two groups became more obvious with the day ( SMDd1＜ SMDd2 ＜ SMDd3 ) ( the 1st day:SMDd1=0.29,95％CI:0.047-0.532; the2nd day:SMDd2=1.64,95％CI:0.14-3.13; the 3rd day:SMDd3 =1.83,95％ CI:0.56-3.10).Conclusions EVLW and its dynamic change in the early stage of sepsis ALI/ARDS could predict the prognosis.This suggested the sustained high level would lead to high mortality.