OBJECTIVETo sum up the experience in diagnosis and treatment of Fournier's gangrene and find an optimal evaluation tool for its prognosis by comparing currently used prognostic scoring systems.

METHODSWe retrospectively analyzed 16 cases of Fournier's gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), Age-Adjusted Charlson Comorbidity Index (ACCI), and Surgical Apgar Score (sAPGAR) , we obtained the prognostic scores of the patients and made comparisons among different scoring systems.

RESULTSFGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score.

CONCLUSIONBoth ACCI and UFGSI are useful for evaluating the prognosis of Fournier's gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.

Age Factors ; Aged ; Fournier Gangrene ; diagnosis ; mortality ; surgery ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index

Objective To investigate the effect of PCIA with low-dose fentanyl on plasma endothelin (ET) after craniotomy. Methods 47 cases of selected craniotomy were divided randomly into two groups :experimental group (26cases) and control group (21cases) . Patients in experimental group were treated with PCIA (fentanyl 15ug/kg +ondansetron 8 mg+100 mL NS) but patients in control group were not given PCIA. Then HR,MBP, VAS, ET and side-effects were observed and compared between two groups before treatment and 0, 2, 4, 8, 12, 24, 48 h after treatment.Results In experimental group, HR was lower at 2, 4, 8, 12, 24 and 48 h after treatment than control group. MBP was lower at 0 and 2h after treatment in experimental group than control group. Plasma levels of ET were lower at 8, 24 and 48h after treatment in experimental group than control group. There were significant differences in VAS scores at 2,4,8,12,24 and 48 h after treatment between two groups. There was no significant differences in side reactions including consciousness, respiratory depression, vomiting and sedation between two groups. The incidence of nausea was higher in experimental group than control group. Conclusion PCIA with low-dose fentanyl after craniotomy has good analgesic effect and few side reactions, can reduce the formation of plasma endothelin, and then alleviate brain damage.

0.05).(2) Compared with NC group,there was a significant decrease in GG fatigue resistance in CIH group(P

The hospital grade assessment is an effective approach to measure the comprehensive strength and the overall level of a hospital, and it is also an effective carrier which can promote the standardized management , improve the quality of connotation and accelerate the development of the hospital .This article aims to expound the effective and concrete methods for preparation in the hospi -tal grade assessment by introducing the practice and experience of Jinling Hospital in grade assessement .It also points out that:defi-ning the purpose of the assessment is the fundation , having a thorough grasp of the assessment criteria is the basis , having a compre-hensive knowledge of the hospital is the premise , establishing and implementing the plan strictly is the crux .All these might be helpful to promote the hospital grade assessment .

Objective To investigate the effect of tongue tie corrective surgery on the development of language in children with short lingual frenulum.Methods 94 children with short lingual frenulum were selected,and under the permission of the patients'family they were randomly divided into two groups.The treatment group received ankylotomy and language training.The control group was only given language training.The clinical efficacy,improvement time of pronunciation and adverse reactions were compared between the two groups.Results The total effective rate of the treatment group was 91.49％,which was significantly higher than 72.34％ of the control group (x2 =5.816,P ＜0.05).The improvement time of pronunciation in the treatment group was significantly shorter than the control group(t =21.250,P ＜ 0.01).There were no serious adverse reactions observed in two groups.Conclusion Tongue tie correction surgery can significantly affect the language development in children with short lingual frenulum,the improvement time of pronunciation is short,which is worthy of clinical application.

Chlorides ; metabolism ; Diarrhea ; congenital ; Humans

Objective To establish and evaluate animal model of adult rats with vitamin D deficient and assess the association of vitamin D deficiency and hypertension .Methods Adult SD rats were divided into 3 groups :normal controls group(feed with ordina-ry forage) ,vitamin D deficient groups(feed without vitamin D)and vitamin D control group(feed with vitamin D) ,which were fed with different diets under 12 h:12 h without ultraviolet light bulb(UV-B) .After treatment for 6 weeks ,Retinal blood was collect-ed ,and Serum vitamin D levels was tested by EIA every 2 weeks .Results After treatment for 10 weeks ,Serum level of vitamin D in vitamin D deficient group were reduced to 2 .07 nmol/L ,while vitamin D group and normal control group were measured as 56 .74 nmol/L and 57 .61 nmol/L ,there was no statistically significant difference between vitamin D group and normal control group (P>0 .05) .hypertension of vitamin D deficient group was significantly higher than other two groups .Conclusion It is feasible to estab-lish model of adult rats with vitamin D by UV-B free light and diets control ,hypertension of rats vitamin D deficiency has a signifi-cant rise compared with the control group .

[ ABSTRACT] AIM:To investigate whether the increase in PTEN expression is related to apoptosis, and whether it is regulated by reactive oxygen species( ROS) .METHODS: The rat islet cells were divided into constant low glucose group ( group L) , constant high glucose group ( group H) , glucose fluctuation group ( group F) , low glucose after high glucose group (group HL) and low glucose after fluctuation group (group FL).The ROS level, apoptotic rate, intracellu-lar calcium, insulin release and PTEN protein expression were analyzed.RESULTS:Compared with groups H and L, the insulin secretion decreased, and intracellular calcium, ROS level, PTEN protein expression and apoptotic rate increased in group F ( P<0.05) .Compared with group H, the intracellular calcium, ROS level, PTEN protein expression and apoptot-ic rate in group HL decreased, but were still higher than those in group L (P<0.05).Compared with group F, the intra-cellular calcium, ROS level, PTEN protein expression and apoptotic rate in group FL decreased, but were still higher than those in group L (P<0.05).CONCLUSION:Glucose fluctuation can cause the apoptosis of islet cells more easily than constant high glucose.This may be related to the change of intracellular calcium and increase in oxidative stress which pro-motes PTEN expression.The recovery of glucose level to some extent relieves oxidative stress, decrease PTEN expression and reduce cell damage.

Objective To evaluate the value of 99Tcm-MDP uptake by left femoral neck for diagnosing osteopomsis.Methods A total of 58 cases (23 males,35 females,mean age:(66.15±8.45) years) with spondyloarthmpathies from May to December of 2012 were selected.Serum concentrations of type Ⅰ collagen telopeptide (sCTX-1) and bone ALP (BALP) were determined.All patients underwent dual-energy X-ray absorptiometry (DXA) to detect bone mineral density (BMD).According to the T scores,patients were divided into 2 groups:normal group (NG) (T＞-1.0) and osteoporosis group (OG) (T≤-2.5).99TcmMDP bone scan was further performed.The average radioactive ratio of the left femoral neck to the medial soft tissue of left femur (T/N) was measured.Data differences between the 2 groups were compared by twosample t test and Pearson correlation analysis.Results According to BMD,13 patients (7 males,6 females) were included in NG and 28 patients (10 males,18 females) were included in OG.The mean ages of OG and NG were significantly different ((68.82± 10.41) years vs (62.46± 11.77) years; t =3.560,P＜0.05).The BMD of left femoral neck in OG was significantly lower than that in NG ((0.67±0.08) g/cm2 vs (0.91±0.10) g/cm2 ; t=9.917,P＜0.01).Although BALP level of OG was significantly higher than that of NG ((35.92±11.58) U/L vs (22.38±6.34) U/L; t=-3.397,P＜0.05),no significant difference was observed on sCTX-1 between the 2 groups (t=-0.463,P＞0.05).T/N ratio of OG (11.63±6.22) was higher than that of NG (9.74±4.44) (t =-3.027,P＜ 0.05).There were significant correlations between the T/N ratio of the left femoral neck and the sCTX-1 and BALP concentrations (r=0.376,0.483,both P＜0.01).No correlations between the T/N ratio of the left femoral neck and age,BMI and BMD were observed (r=-2.031,-0.017,0.134,all P＞0.05).Conclusion The uptake ratio of the left femoral neck in 99Tcm-MDP bone scan could evaluate the metabolism of bone,and it is useful for the early diagnosis of osteoporosis.

Objective Cerebral small vessel disease is closely related to kidney disease .Chronic kidney disease ( CKD) may increase the risk of hemorrhage stroke .However, its impact on hemorrhage-prone small vessel disease represented by cerebral microb-leeds( CMBs) remains unclear .The purpose of this study was to investigate the relationship of CKD with the presence and location of CMBs in patients with acute lacunar stroke . Method Consecutive patients with acute lacunar stroke within 7 days from onset were enrolled retrospectively from January 2014 to July 2016 and scanned by gradient-echo T2*-weighted imaging (GRE-T2*WI).Their demographic, clinical, laboratory and imaging data were collected .Estimate glomerular filtration rate (eGFR) was calculated individu-ally by the following chronic kidney disease epidemiology collaboration (CKD-EPI) equation for the Asian population .CKD was defined as the level of eGFR<60 mL/min/1.73 m2. Results Finally, 308 patients (mean age:65.79±8.67 years; median NHISS:3(2-5);42.2%Female) with lacunar ischemic stroke were enrolled in the final analysis .Among these patients, CMBs were present in 116 patients ( 37.7%) and CKD in 62 patients ( 20.1%) .Patients were divided into CKD group and normal group according to GFR level . The result of univariate analysis showed that patients with CKD had higher prevalence of diabetes ( P=0.014) and higher degrees of CMBs (P=0.001) compared with normal group.CMBs were refined by its location .The result of multivariable analysis showed that CMBs in deep brain [ OR=7.61, 95%CI 4.18-16.55, P=0.001] were sig-nificantly associated with CKD incidence , while no significant rela-tionship was found in CKD incidence and CMBs in the lobe and mixed location of brain . Conclusion The CKD incidence in patients with acute lacunar stroke is in dependent relationship with CMBs in deep brain and without significant correlation with CMBs in the lobe and mixed location of brain .