Objective To investigate the evaluation significance of plasma D-dimer level for the prognosis in acute exacerbation of chronic obstructive pulmonary disease(AECOPD) excluding pulmonary embolism(PE).Methods The patients with AECOPD were collected from the respiration department and emergency internal medicine department of the Affiliated Hospital of Nantong University during 2007-2011.Thirty-five AECOPD cases of D-dimer positive and excluding PE and lower extremity deep venous thrombus(DVT)by CT angiography served as the experimental group and 35 cases of D-dimer negative as the control group.The differences in the first time hospitalization duration,GOLD grade,mortality rate,re-hospitalization times within 4 years,times of admission to ICU,times of intracheal intubation,rehospitalization and outside-hospital mortality rate were compared between the two groups.The receiver operatingcharacteristic(ROC)curve was applied to evaluate the short-term and long-term prognostic capacity of D-dimer.The t test at the follow up end point was used to analyze the D-dimer level in the death group and the survival group.Results The D-dimer level,length of hospital stay,death number of first time hospitalization,times of re-hospitalization,times of admission to ICU,times of intubation,re-hospitalization and outside-hospitalization mortality rate and total mortality rate had statistical differences between the experimental group and the control group(P＜0.05);but the differences in the age,gender and GOLD grade between the two groups had no statistical significance(P＞0.05).The sensitivity of D-dimer＞1 165 μg/L for predicting the death number of the first time hospitalization was 87.5 ％,and the specificity was 80.6 ％.The sensitivity of D-dimer＞ 865μg/L for predicting the mortality rate of re-hospitalization and outerside-hospital was 78.9 ％,and the specificity was 74.5 ％.The survival curve graph during the follow up period in the two groups revealed that the survival time and survival rate had statistical difference between the two groups.The D-dimer level in the death group was significantly higher than that in the survival group with statistical difference(P＜0.05).Conclusion The D-dimer level is an independent risk factor affecting the short-term and longterm prognosis of AECOPD.

Objective:To discuss the scientificity and feasibility of risk-based monitoring strategies in Investigator initiated Trials.Methods:" Guideline for Good Clinical Practice" promulgated by NMPA, " Oversight of Clinical Investigations-a Risk-based Approach to Monitoring" and " A Risk-Based Approach to Monitoring of Clinical Investigations Questions and Answers Guidance for Industry DRAFT GUIDANCE" promulgated by the US FDA and other documents were analyzed, the practical experience of Investigator initiated Trials was also summarized.Results:It was recommended that clinical investigators use risk-based monitoring strategies in Investigator initiated Trials. The main idea of risk-based monitoring is to determine the key process and key data of the study, carry out risk rating on the project, and adopt corresponding monitoring methods according to the risk level when formulating the monitoring plan. At the same time, during the clinical trial development process, the risk and data quality of the research center should be regularly evaluated to grasp the risk changes of different centers. In accordance with trends, adjust the method, content and frequency of monitoring.Conclusions:To apply risk-based monitoring strategies in Investigator initiated Trials is scientificity and feasibility. Risk based monitoring can meet the data quality requirements of clinical trials, without affecting the analysis results of the main outcomes, and can further improve the efficiency and effectiveness of monitoring.

OBJECTIVETo determine the correlation of the CYP1A1 (rs4646422) gene polymorphisms with male infertility in the Chinese Han population.

METHODSUsing the Mass ARRAY iPLEX GOLD technique, we conducted a case-control study on theCYPlA1 (rs4646422) gene polymorphisms in 636 infertile males aged 21-49 years (case group) and 442 normal healthy men aged 23-47 years (control group) of the Chinese Han population. We analyzed the genotypes and allele frequencies in the two groups ofsubjects with the SPSS 20.0 software.

RESULTSCompared with the wild homozygous genotype GG, the heterozygous genotype AG (OR = 1.06, 95% CI 0.81-1.38) and homozygous genotype AA (OR = 1.11, 95% CI 0.56-2.21) showed no correlation with male infertility, nor did the mutant allele A (OR = 1.06, 95% CI 0.85-1.32) in comparison with the wild allele G.

CONCLUSIONThe CYP1A1 (rs4646422) gene polymorphisms might not be correlated with male infertility in the Chinese Han population.

Adult ; Alleles ; Case-Control Studies ; China ; Cytochrome P-450 CYP1A1 ; genetics ; Gene Frequency ; Genotype ; Homozygote ; Humans ; Infertility, Male ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic ; Young Adult

OBJECTIVETo analyze the effect and safety of bronchoscopic cryosurgery in children with lower airway stenosis caused by granulation and fiber hyperplasia.

METHODTwenty-two patients had undergone bronchoscopic examination and cryosurgery, 18 patients with atelectasis caused by Mycoplasma pneumoniae pneumonia, 2 patients with endobronchial tuberculosis (EBTB), 1 patient with atelectasis caused by granulation tissue after bronchial foreign body, and 1 case who had severe dyspnea, with tracheal stenosis after long-term endotracheal intubation during surgery for heart disease. All the patients under went bronchoscopic cryosurgery for several times, 1 case with severe tracheal stenosis was operated by electric coagulation before cryosurgery. Before and after the treatment, all the patients were evaluated based on clinical symptoms, tracheal lumen by bronchoscopy, chest CT for atelectasis and pulmonary function for tracheal stenosis.

RESULTThe patients were treated with cryosurgery for 1-4 times. Sixteen cases were markedly improved, clinical symptoms disappeared completely, no granulation and fiber hyperplasia were found during bronchoscopy, and all the atelectasis were cured. After the treatment, the bronchial lumen diameter of the patient with tracheal stenosis was increased from 2 mm to about 5 mm, the tidal volume increased from 3.0 ml/kg to 8.8 ml/kg. Five cases were effectively improved, the clinical symptoms also disappeared, during bronchoscopy and bronchial alveolar lavage (BAL), no granulation and fiber hyperplasia were found, but some distal bronchial tubes were atresia or narrowed, the lumen was patent, the atelectasis recovered partially. In 1 case the treatment was ineffective, as the clinical symptoms and granulation disappeared, but because almost all distal bronchi were atresia or narrow, the lumen was not patent during BAL, there was no change on chest CT. The total effective rate was 21/22 (95.5%). No severe complications occurred during and after the procedures. All the patient were followed up for 1 - 12 months, no case had recurrence.

CONCLUSIONTreatment with bronchoscopic cryosurgery is a safe and effective methods to tracheal stenosis caused by granulation tissue and fiber hyperplasia in children.

Bronchial Diseases ; etiology ; surgery ; Bronchoscopy ; Child ; Child, Preschool ; Cicatrix ; complications ; Constriction, Pathologic ; Cryosurgery ; Female ; Granuloma ; complications ; Humans ; Lung Diseases ; etiology ; surgery ; Male ; Tracheal Stenosis ; etiology ; surgery

OBJECTIVETo evaluate the effect of bronchoalveolar lavage (BAL) through bronchoscopy in diagnosis and treatment of accidental inhalation of liquid and powdery foreign bodies in children.

METHODTwenty-one cases of accidental inhalation were classified into the following 4 groups according to the materials inhaled: 3 cases inhaled the lipidic material; 2 cases inhaled chemical material; 15 cases inhaled hydrosoluble materials; 1 case inhaled powdery material. Eighteen cases were hospitalized within 3 days after the accidents, which included 16 cases treated within 1 day in hospital. And 3 cases were hospitalized 3 days after the accident. After hospitalization, all patients were immediately treated with direct aspiration and lavage clearance method through bronchoscopy. The inhaled foreign materials were cleared as soon as possible, which reduced the absorption, stimulation and infection of respiratory mucosa. The therapeutic effect was evaluated by endoscopic findings, clinical manifestation, laboratory examination and chest imaging. At the same time, decision was made on the second BAL and the prognosis was estimated.

RESULTTwenty-one cases had dyspnea of certain degree. The bronchial mucous membrane of all the 21 cases showed hyperemia, edema and exudate attached. Lavage fluid looked like broth and contained much of the inhaled material. After two to five times treatment, 18 cases were cured (86%), but 3 cases died (14%). One of these 3 cases fell into an oil well, 1 into mosquito repellent solution, another into manure pit. The patients who could not survive had severe airway obstruction, which was difficult to clean and made the problem deteriorated progressively. One of the patients was sent to a hospital 3 days after the accident and another case developed fungal infection, pneumothorax and finally respiratory failure.

CONCLUSIONBAL through bronchoscopy is necessary for children who accidentally inhaled liquid and powdery materials. This treatment is safe and effective in diagnosis and treatment of such problems in children. The effect of treatment is influenced by types of inhaled material, the time of lavage clearance through bronchoscopy, and certain complications, such as infection etc.

Bronchoalveolar Lavage ; Bronchoscopy ; Child ; Child, Preschool ; Female ; Foreign Bodies ; therapy ; Humans ; Infant ; Inhalation Exposure ; Male ; Powders

OBJECTIVETo assess the efficacy and safety of balloon dilatation through flexible bronchoscopy in the management of inflammatory stenosis of grade 4-5 bronchus.

METHODThirty patients with inflammatory bronchial stenosis caused by mycoplasmal pneumonia complicated with pulmonary atelectasis were treated with balloon dilatation through fiberoptic bronchoscopy. Before the procedure and after the last operation, therapeutic effect on pulmonary atelectasis were evaluated with CT and all of the patients were followed-up for 1 - 6 months.

RESULTOne to three operations were required to achieve satisfactory dilatation. After balloon dilatation, the average airway diameter increased obviously and the farther airways were opened after the therapy with irrigation. In 25 of 30 cases satisfactory immediate effects were obtained, a narrow airway diameter above expansion significantly increased as compared with preoperative diameter. In 5 children treated with balloon dilatation, the stenosis could not be improved significantly. In 3 patients with hyperplasia of granulation tissue, cryotherapy had to be applied. The operations were ineffective in the other two patients whose course of disease exceeded 3 months. After follow-up periods of 1 - 6 months, chest CT manifestation of expanded sites was improved in 28 patients and atelectasis disappeared. No severe complication was found in any patients.

CONCLUSIONBronchoplasty by balloon dilatation through flexible fiberoptic bronchoscopy is a simple, effective and safe method to treat childhood tracheobronchial stenosis after pulmonary infections.

Bronchial Diseases ; therapy ; Bronchoscopy ; Catheterization ; methods ; Child ; Child, Preschool ; Female ; Humans ; Male ; Pneumonia, Mycoplasma ; therapy ; Pulmonary Atelectasis ; microbiology ; therapy ; Tracheal Stenosis

OBJECTIVETo observe the therapeutic effect of acupuncture and moxibustion on takayasu arteritis of brachiocephalic artery type and the mechanism.

METHODSThirty-one cases were treated by acupuncture and moxibustion at main acupoint Renying (ST 9) and adjuvant acupoints selected according to the symptoms. The therapeutic effect and changes of color Doppler's ultrasonic flow image (CDFI) of relevant arteries in patients before and after treatment were investigated.

RESULTSThe clinical total effective rate was 90.3%. Of the 31 cases, 5 cases were clinically cured, 16 cases were markedly effective, 7 cases improved and 3 cases were ineffective; and it was showed that acupuncture and moxibustion could enlarge the inner diameter of the injured blood vessel, increase the volume of blood flow and the elastic index of the injured blood vessel, and improve the abnormal velocity and the abnormal crest form of blood flow.

CONCLUSIONAcupuncture and moxibustion has a good therapeutic effect on takayasu arteritis of brachiocephalic artery type; acupuncture and moxibustion can improve the stenotic degree of the injured blood vessel and abnormal hemodynamics of blood flow in the limb and brain.

Acupuncture Therapy ; Adolescent ; Adult ; Aged ; Blood Flow Velocity ; Blood Vessels ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Moxibustion ; Takayasu Arteritis ; physiopathology ; therapy ; Treatment Outcome

Objective To explore the mechanisms of different cholic acid for reducing damage to human liver cells lines L-O2 induced by amanita toxic peptides (amataxins).Methods According to different concentrations of amataxins,the experiment was conducted with different dosages in 5 groups:0.00 g/L,0.26 g/L,0.40 g/L,1.40 g/L and 2.80 g/L.The human liver cells lines L-O2 in the exponential growth phase were cultured into 96-well plates,1 ×103 cells per well After 24 hours,the concentrations of amanita toxic peptides mentioned above were added.The minimum concentration of mushroom toxins keeping the liver cells alive was determined after 24,48 and 72 hours,respectively,and MTT method was used to test each group's liver cell activity.The experiment included 3 groups:the control group,the damage group,and the cholic acid group.Each group had 3 time points:24,48 and 72 hours after being attacked.Twenty four hours after attack,in cholic acid group,cholic acid drugs including taurocholic acid gca,goose deoxycholic acid,gansu ammonia goose deoxycholic acid and bovine goose deoxycholic acid were given,respectively,to protect the injured liver cells.Cells' morphology changes were observed under the inverted phase contrast microscope,living cells were counted by using MTT method,and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activities in the culture supernatant were tested by the biochemical method.Results The minimum attack concentration of lamanita toxic peptides keeping liver cell survival in vitro was 1.40 g/L.Seventy-two hours after attack by amanita toxic peptides,the absorbance value was 0.812 ± 0.035,0.345 ± 0.021,0.363 ± 0.018,0.387 ± 0.027,0.431 ± 0.018,0.465 ± 0.015 and 0.452 ± 0.030,respectively in the control group,the damage group,the taurocholic acid group,the goose deoxycholic acid group,the glycocholic acid group,the glycochenodeoxycholic acid group and the sodium deoxycholic acid group.Compared with the damage group,absorbance value 72 hours after attack in each cholic acid group gradually increased,and compared with damage group,the differences were statistically significant among goose deoxycholic acid group,glycocholic acid group,glycochenodeoxycholic acid group and sodium deoxycholic acid group(P ＜ 0.05).AST and ALT activity in each cholic acid group declined,and that in glycochenodeoxycholic acid group was the lowest.Compared with the damage group,the difference was statistically significant (P ＜ 0.01).Conclusions Cholic acid can protect human liver cells from the damage induced by amanita toxic peptides.Such effect may be related to the fact that both amanita toxic peptides and cholic acid are the substrates of NTCP and OATP.

[Objective] To explore whether the triglyceride level is associated with incidence of acute kidney injury in patients with acute pancreatitis. [Methods] From Jan 2015 to March 2017, 184 patients with acute pancreatitis were selected and divided in to 3 groups based on different triglyceride levels: ideal triglyceride group (n = 89) , mild high triglyceride group (n = 53) and severe high triglyceride group (n =42). The incidence of acute kidney injury and its severity were compared between the three groups.[Results]The incidence of acute kidney injury in severe high triglyceride group was 33.3％, significantly higher than that in ideal triglyceride group (12.3％). The surgical treatment (16.7％ vs 4.5％) , average hospitalization days (20 days vs 14 days) and systemic inflammatory response syndrome score (3.0 vs2.3) in severe high triglyceride group were higher than those in ideal triglyceride group, and all differences between the two groups were significant. After adjusting for factors such as age, sex, body mass index and other confounders, the risk of acute kidney injury occurring in severe high triglyceride group was 2.35 times that in ideal triglyceride group (95％CI: 1.32-4.29). [Conclusion] High triglyceride level proves to be associated with high risk of acute kidney injury in patients with acute pancreatitis.

Objective: To assess the significance of DDAVP use in the diagnosis and treatment of VWD. Methods: An analysis of 15 VWD cases who referred to Hematology Division of First affiliated Hospital of Soochow University and treated with DDAVP from March 2016 to August 2018 was conducted. Efficacy and treatment response of DDAVP were monitored by observations of changes in factor Ⅷ procoagulant (FⅧ∶C) and von Willebrand Factor (VWF) related indicators before and 2 h after DDAVP injection. Results: Of 15 cases with VWD, 7 males and 8 females with a median age of 23 (6-46) years, 7 of 9 type I VWD patients achieved complete response (CR) , 1 type 2A VWD case CR, 5 type 3 VWD ones no response (NR) . The VWF multimer analysis in 5 patients combined with other plasma VWF values were in accordance with the known diagnosis. Conclusions: DDAVP was effective in most type 1 patients, and ineffective in some type 2 and almost all type 3 cases. It was helpful for diagnosis and subsequent treatment planning.
Adolescent ; Adult ; Child ; Deamino Arginine Vasopressin ; Female ; Hemostatics ; Humans ; Male ; Middle Aged ; Young Adult ; von Willebrand Diseases ; von Willebrand Factor