Adrenomedullin ; metabolism ; Child ; Endothelin-1 ; metabolism ; Female ; Heart Defects, Congenital ; complications ; Humans ; Hypertension ; metabolism ; Hypertension, Pulmonary ; metabolism ; Male ; Nitric Oxide ; metabolism

Objective To assess the various features of Budd-Chiari syndrome(BCS)on three- dimensional contrast-enhanced magnetic resonance angiography(3D CE MRA)and to evaluate the potential value of this new technique.Methods Thirty-three patients with BCS underwent 3D CE MRA examination. In 23 cases,BCS was secondary to hepatocellular carcinoma(21 patients)or right adrenal carcinoma (1 patient)or thrombophlebitis(1 patient).Ten patients had primary BCS.The patency of the hepatic veins,inferior vena cava(IVC)and portal veins were assessed.The presence of intra-and extrahepatic collaterals,liver parenchymal abnormalities and porto-systemic varices were evaluated.The diagnosis on 3D CE MRA was correlated with that on inferior vena cavography and right hepatic venography,which were available in 10 and 2 cases respectively.Results Various features of BCS were displayed on 3D CE MRA. Hepatic venous findings included tumor thrombosis(19 patients),tumor compression(2 patients), nonvisualization(4 patients)and focal stenosis(4 patients)of the hepatic veins.IVC findings were severe stenosis or occlusion(10 cases),tumor direct invasion(2 cases),tumor thrombosis(3 cases), thrombophlebitis(1 case)and web formation(3 cases).Intrahepatic collaterals were demonstrated in 9 patients including 2 with "spider web" sign.Detected extrahepatic collaterals included dilated azygos and hemiazygos veins(13 cases)and left renal-inferior phrenic-pericardiophrenic collaterals(2 cases).The occlusion of the left portal vein and the presence of porto-systemic varices were depicted in 2 and 10 patients respectively.Liver parenchymal abnormalities identified by 3D CE MRA consisted of caudate lobe enlargement(7 cases),heterogenous enhancement(18 cases)and associated tumors(18 cases). Compared with inferior vena cavography and hepatic venography,the accuracy of 3D CE MRA in the diagnosis of IVC obstruction or hepatic venous stenosis was 100%.Conclusion 3D CE MRA can display various features of BCS and has the potential to provide an accurate diagnosis.

Objective To explore the methods of the nutritional support of children with severe sepsis.Methods The biochemical index,nutrition index,blood gas,blood routine and 24 hours urinary urea nitrogen of 198 children with severe sepsis were detected after hospitalization.Enteral nutrition,parenteral nutrition,or enteral and parenteral nutrition at the same time were selected for every children according to patients status.Children with parenteral nutrition were divided into glutamine (Gln) group and non-Gln group.Nutrition and metabolism indexes of survival and dead children were detected,including blood glucose,C-reactive protein,hemoglobin (Hb),pH,blood sodium,blood potassium,alanine transaminase,blood urea nitrogen,creatinine,blood lacticacid,lactate clearance rate,blood triglycerides,blood total cholesterol,serum pre-albumin (PA),retinal-binding protein (RBP),serum albumin (ALB) and 24 hours urinary urea nitrogen.The intake of calories were compared between survival and dead children before nutrition support (0 d),3 d and 7 d after nutrition support.Immunoglobulins of Gln group and non-Gln group were compared.Results The nutrition indexes of the survival group were higher than those of dead group [PA (130.0 ± 30.0) mg/L vs (50.8 ±20.5) mg/L,RBP(22.3 ±10.3) mg/L vs (15.7 ±6.7) mg/L,ALB(35.3 ±8.1) g/L vs (28.7 ±6.2) g/L,Hb(113.2 ±27.7) g/L vs (95.3 ±10.6) g/L,IgA(0.40 ±0.03) g/L vs (0.40 ±0.03) g/L,IgM(0.52 ±0.18) g/L vs (0.49 ±0.03) g/L] (P ＜0.05).The intake calories of survival group in 3 d and 7 d after nutrition support were (50.32 ±2.76) kcal/(kg·d) and (65.70 ±3.25) kcal/(kg·d),which were significantly higher than those of dead group [(32.54 ± 1.72) kcal/(kg·d) and (46.12 ± 1.08) kcal/(kg·d)).Among the survival children with parenteral nutrition,the levels of immunoglobulin in Gln group were higher than non-Gln group [IgG(4.93 ± 2.1) g/L vs (4.01 ± 1.03) g/L,IgA (0.31 ± 0.07) g/L vs (0.19 ±0.03) g/L,IgM(0.52 ±0.08) g/L vs (0.32 ±0.10) g/L] (P ＜0.05).Negative nitrogen balance was better in Gln group as(-2.5 ± 1.4) g/d than non-Gln group as (-5.3 ± 1.3) g/d(P ＜0.05).Conclusion Children with severe sepsis manifeste significantly increased metabolic rate and energy consumption,the protein decomposition utilization is greater than the synthetic with negative nitrogen balance.Children with more severe sepsis have lower metabolic indexes,nutrition indexes,and immunoglobulin.It is necessary for children with severe sepsis to use glutamine while having parenteral nutrition.

Bone Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; Cafe-au-Lait Spots ; diagnosis ; pathology ; Child ; Diagnosis, Differential ; Female ; Fibroma ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Neurofibromatosis 1 ; diagnosis ; Radiography ; Syndrome

Acute Kidney Injury ; etiology ; Adult ; Diagnosis, Differential ; Female ; HELLP Syndrome ; pathology ; Hemolytic-Uremic Syndrome ; complications ; pathology ; therapy ; Humans ; Plasma Exchange ; Postpartum Period ; Pregnancy ; Purpura, Thrombotic Thrombocytopenic ; pathology ; Young Adult

Obgective To explore the antimicrobial resistance genotypes and molecular epidemic features of Klebsiella pneumoniae (K.pneumoniae) producing extended spectrum 3-lactamases (ESBLs) in the Pediatric Intensive Care Unit (PICU) of Guiyang Children' s Hospital.Methods Disc diffusion technique (Kirby-Bauer method) and automatic microbiology analysis system were employed to determine the antimicrobial resistance,and Double-disk Diffusion was adopted in the phenotype confirmatory test of ESBLs,and PCR was used to determine the antimicrobial resistance genotypes.Results Among 44 straits of non-repetitive-K.pneumoniae,isolated from the children during hospitalization since April to December of 2013,29 straits (65.9％) were detected.The findings of sensitivity tests showed that 29 strains of ESBLs-producing K.pneumoniae presented a higher rate of sensitivity to carbapenems,cephamycin and quinolones,100％ resistance to penicillin and cephalosporins of the first and the second generations.Fifteen non-ESBLs-producing K.pneumoniae presented 100％ resistance to penicillin.The rate of resistance to 9 kinds of antibiotics (Ampicillin/Sulbactam,Cefazolin,Cefuroxime,Cefamandole,Cefiriaxone,Ceftazidime,Cefepime,Gentamicin,Aztreonam) in ESBLs-producing K.pneumoniae strains(79.3％,100.0％,100.0％,100.0％,100.0％,79.3％,65.5％,41.4％,79.3％) was significantly higher than that of non-ESBLs-producing K.pneumoniae trains (13.3％,6.7％,20.0％,20.0％,0,0,0,6.7％,0) (x2 =17.54,35.51,28.00,28.00,44.00,24.93,17.30,4.18,24.93,all P ＜ 0.05).In 29 strains of ESBLs-producing K.pneumoniae,3 genotypes were detected respectively:93.1％ of SHV (27/29 strains),51.7 ％ of TEM (15/29 strains) and 37.9 ％ of CTX-M (11/29 strains).Five forms of genotype distribution were presented:14 (43.8％) strains carrying single ESBLs gene,5 (17.2％) strains carrying 2 types,19 (31.0％) strains carrying 3 types,and 1 strain had not been genotyped.Conclusions ESBLs-producing K.pneumoniae had been epidemic in PICU of Guiyang Children's Hospital,with multiple antimicrobial resistances and diversification of antimicrobial resistance genotypes.

Objective A scientific evaluation of hospital culture with the Dimension organizational culture model, in view of features of China's general public hospitals.Methods Based on Denison model, according to the characteristics of the public general hospitals in China, the authors developed a tool for organizational culture assessment (TOCA) by using the survey data from 87 hospitals in three provinces from the East, Central, and West areas in China.Results This tool, an evaluation scale, comprises the four cultural characteristics of direction, consistency, participation, and adaptability, as well as 13 cultural dimensions of social responsibility and competitive consciousness. The tool is tested as having good internal reliability and validity.Conclusion The TOCA provides hospital administrators with a tool for hospital culture evaluation, diagnosis and improvement.

Objective To study the prevalence of food intolerance and to explore its related factors among adult health check-up receivers.Methods A total of 863 adults who took physical examinations in our hospital from April to October 2011 were enrolled in this investigation.Height,body weight and blood pressure were measured,and serum IgG level was measured by enzyme-linked immunosorbent assay (ELISA).Results The total positive rate of food intolerance was 73％,and the leading intolerance items were crab (40.1％ ),egg (29.8％ ),cod fish ( 21.6％ ),milk ( 20.0％ ) and soybean ( 14.4％ ).Females showed significantly higher prevalence of food intolerance than males.Various positive rate of milk or soybean intolerance was found in different age groups.No correlations of serum specific IgG with body mass index and systolic or diastolic blood pressure were observed.In logistic regression analysis,the odds ratio of food intolerance of women was 1.67 ( 95 ％ confidence interval 1.190 to 2.607 ).ConclusionsThe prevalence rate of food intolerance was high.The risk for food intolerance was significantly increased in women.Specific IgG antibody detection may help to early prevent and diagnose food intolerance-related diseases.

Objective To investigate vascular endothelial growth factor receptor-2(VEGFR-2)and its phosphorylated state in cancerous and peri-cancerous tissues of hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE).Methods Forty-three cases of second-stage surgery of HCC after TACE(TACE & surgery group)and twenty cases of surgery without TACE(direct surgery group)were performed.Surgical specimens were made into paraffin-embedded slices.VEGFR-2,phosphorylated VEGFR-2,hypoxia induced factor-1α(HIF-1α)and microvessel density(MVD,labeled by CD31)were detected using immunohistochemical method.All data was statistically processed with SPSS for Windows.Results The absorption factor(A factor)of phosphorylated VEGFR-2 and HIF-1α in the cancerous tissue of HCC were(0.034±0.016)and(0.047±0.021)in TACE & surgery group,and(0.024±0.009)and(0.035±0.016)in direct-surgery group,which showed statistically significant difference(F=6.75,4.77,P＜0.05).The A factors of VEGFR-2,phosphorylated VEGFR-2 and HIF-1α in the peri-cancerous tissue were(0.040±0.017),(0.031±0.011)and(0.037±0.015)respectively in TACE & surgery group,and(0.030±0.015),(0.020±0.008)and(0.024±0.014)respectively in direct-surgery group,all of which showed statistically significant difference(F=4.60,13.72,11.65,P＜0.05).MVD of the peri-cancerous tissue was(58.3±15.2)/HP in TACE & surgery group and(44.4±10.5)/HP in direct-surgery group,which showed statistically significant difference(χ2=13.64,P＜0.05).Conclusion The cancerous and peri-cancerous tissues in HCC after TACE showed more hypoxic changes.Both expression and function of VEGFR-2 were enhanced following TACE.

Objective To investigate the factors predicting endoscopic stone extraction complications during operation and 1 week within operation. Methods The clinical data of 136 patients with common duet stones during endoscopic procedures and 1 week within procedures were collected, and the impacts of the number, size of stones, and the first-attack versus recurrent-attack stone, with or without cholangeitis on the complications during operation and 1 week within operation were analyzed, and the effect of nasobiliary drainage was investigated. Results The success rate in single-stone group was high, the incidences of complications during endoscopy including sphincter hemorrhage, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the multi-stones group ( P < 0. 05 ). The group of < 2 cm stone also had high success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, cardiac laceration, hyperamylasemia, acute pancreatitis were significantly lower than those in the ≥2 cm group. The first-attack group had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, stone impaction, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those in the recurrent-attack group. The patients with cholangeitis had low success rate of stone extraction, the incidences of complications including sphincter hemorrhage, hypoxemia, hyperamylasemia, acute pancreatitis and biliary infection were significantly higher than those without cholangeitis. After nasobiliary drainage, the incidences of hyperamylasemia, acute pancreatitis and biliary infection significantly decreased while the incidence of sphincter hemorrhage significantly increased. Conclusions The number, size of stones, and the first-attack versus recurrent-attack stone, symptoms with orwithout cholangeitis could predict the complications of stone extraction;post-ERCP nssobiliary drainage could decrease the complications, but increase the possibility of sphincter hemorrhage.