Acute Disease ; Adult ; DNA, Viral ; blood ; Female ; Genotype ; Hepatitis B virus ; genetics ; Humans ; Male

Adult ; Female ; Hepatitis B ; immunology ; Humans ; Interferon-gamma ; blood ; Interleukin-12 ; blood ; Male ; Middle Aged ; Tumor Necrosis Factor-alpha ; analysis

OBJECTIVETo investigate the clinical characteristics, diagnostic methods and minimally invasive treatment of prostatic utricle cyst.

METHODSWe retrospectively analyzed the clinical data of 9 cases of prostatic utricle cyst, of whom 5 presented with frequent or urgent micturition, 3 with difficult urination or thinning urinary stream, and the other 1 with hemospermia. All the cases underwent ultrasonography and MRI. Transurethral cyst deroofing was performed for 3 of the patients with smaller cysts close to the prostatic urethra, and laparoscopic excision of the prostatic utricle was conducted for the other 6 with bigger cysts behind the prostatic urethra.

RESULTSThe duration of transurethral cyst deroofing ranged from 30 to 50 min and intraoperative bleeding was 20 -70 ml; the mean time of laparoscopic excision of the prostatic utricle was 100 - 150 min and intraoperative bleeding was 30 -50 ml. All the patients were followed up for 3 - 12 months, which revealed normal penile erection and ejaculation, and no urinary tract irritation or difficult urination.

CONCLUSIONUltrasonography and MRI are excellent imaging modalities for accurate depiction of prostatic utricle cyst. Transurethral cyst deroofing is valuable for prostatic utricle cyst close to the prostatic urethra. Laparoscopic excision of the prostatic utricle, owing to its safety, effectiveness, minimal invasiveness, fewer complications and rapid recovery, can be used as the first option for the treatment of prostatic utricle cyst.

Adult ; Cysts ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Prostatic Diseases ; diagnosis ; surgery ; Retrospective Studies ; Ultrasonography

OBJECTIVETo evaluate the use of clinical nutritional support in critical SARS patients, and the relationship between blood glucose levels/insulin administration amount and outcome.

METHODSTwenty-one SARS patients who reached the standard of Ministry of Health's "critical level" were transferred into our ICU in an average of 11 days after onset and enrolled in this clinical trial. All patients underwent respiratory support and clinical nutrition support as scheduled. For about 60 kg patient per day 3347.2 kJ(800 kcal), 36 g protein, and 125 g carbohydrate was given intravenously; 4184 kJ(1000 kcal), 38 g protein, and 125 g carbohydrate was provided by enteral route. MCT/LCT as fat resource shared 50% calories intake. All patients received similar doses of intravenous Methylprednisolone(about 200 mg/d). Blood glucose, serum albumin, blood lymphocyte counts, and serum alanine transminase (ALT) were checked on the first admission day in ICU and on the 12th day after nutrition therapy was started. Insulin was started to pump in to maintain the blood glucose levels between 4.44-7.78 mmol/L (80-140 mg/dl) when the levels exceeded normal range.

RESULTSUpon admission into ICU, all patients had poor nutrients intake for an average of 11 days and 16 patients (76.2%) were diagnosed as malnutrition. Parenteral and enteral nutrition therapy were then offered for an average of 12 days. On the 12th day, the serum albumin increased [(28.5 +/- 2.2)] g/L vs (37.0 +/- 4.1) g/L] (P = 0.0001) and so did the lymphocytes count [(0.74 +/- 0.47)] x 10(9)/L vs (1.22 +/- 0.73) x 10(9)/L] (P = 0.02). The blood glucose maintained at lower level in the surviving patients when compared with those who died [(9.5 +/- 2.3) mmol/L vs (6.3 +/- 1.8) mmol/L] [(196 +/- 70) mg/dl vs (110 +/- 21) mg/dl] (P = 0.0002), and the abnormally high ALT levels presented in some of the patients decreased but not significantly (81.0% vs 57.1%) (P = 0.18). In order to keep blood glucose within the range 4.44-7.78 mmol/L (80-140 mg/dl), only 18.8% of the surviving patients needed insulin intervention as opposed to 80.0% of those who died (P = 0.03). The amount of insulin used in the surviving group was significant lower than that in the group who died [(24 +/- 2) IU/d vs (72 +/- 9) IU/d] (P = 0.01).

CONCLUSIONSEleven days after SARS onset, most of the critical patients presented with malnutrition. Some improved nutrition related parameters may be associated with clinical nutritional support. The surviving patients required less insulin when compared to those who died. 80.0% of the patients who died need insulin versus only 18.8% of the surviving patients. Due to the difficulty of SARS management, this study was not a randomized controlled clinical trial. More clinical trials will be needed for checking the results of this investigation.

Adult ; Blood Glucose ; metabolism ; Enteral Nutrition ; Female ; Humans ; Insulin ; administration & dosage ; Male ; Malnutrition ; blood ; etiology ; therapy ; Middle Aged ; Nutritional Support ; Parenteral Nutrition ; Severe Acute Respiratory Syndrome ; blood ; complications ; therapy ; Treatment Outcome

OBJECTIVETo investigate operation skills, therapeutic effects and indications of racapping laminoplasty for the treatment of severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis.

METHODSIn the study, 41 patients with severe burst fractures of thoracolumbar vertebra complicated with spinal stenosis were treated with recapping laminoplasty. After the treatment, the size of vertebral canal, spinal stability, altitude recovery of vertebral body and rehabilitation of nerve function were observed.

RESULTSAll the patients were followed up and the duration ranged from 1 to 3 years. The anterior height of compressed vertebral bodies restored from preoperative 58% to postoperative 97%, posterior height was from preoperative 76% to postoperative 98.7%. The Cobb angle was corrected from preoperative 24.6 degrees to postoperative 1.8 degrees, and the size of vertebral canal restored from preoperative 43% to postoperative 93%. According to Frankel classification, 1 patient who were at A grade had no changes and others improved by 1 to 3 degrees.

CONCLUSIONThis is an ideal operation method for treating burst fractures of thoracolumbar vertebra with spinal stenosis, which is simple, safe and enlarging vertebral canal, at the same time completely decompressing the dura mater and nerve roots. This method eliminated secondary spinal stenosis, reconstructed posterior column and increased spinal stability.

Adult ; Female ; Humans ; Laminectomy ; methods ; Lumbar Vertebrae ; injuries ; surgery ; Male ; Middle Aged ; Spinal Fractures ; surgery ; Spinal Stenosis ; surgery ; Thoracic Vertebrae ; injuries ; surgery

OBJECTIVETo explore the association between high-sensitivity C-reactive protein (hs-CRP) and contrast-induced nephropathy (CIN) in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) .

METHODSA total of 220 STEMI patients undergoing primary PCI from Guangdong general hospital were recruited. Patients were divided into four groups according to the quartile of hs-CRP (Q1 group:hs-CRP < 6.26 mg/L,Q2 group:6.26-14.44 mg/L, Q3 group:14.45-33.08 mg/L, Q4 group:hs-CRP > 33.08 mg/L) . Baseline data, CIN incidence and other in-hospital outcomes were compared among groups. CIN was defined as an increase in serum creatinine of more than 5 mg/L from baseline within 48-72 hours after contrast media exposure. Receiver operator characteristics (ROC) curves and multivariate logistic regression were used to assessed the correlation between hs-CRP and CIN.

RESULTSCIN occurred in 21 (9.8%) patients. CIN incidence of hs-CRP quartitles were 1.8%(1/55), 1.8% (1/55), 14.5% (8/55) and 20.0% (11/55) (P-trend < 0.01), respectively. In-hospital death (P-trend > 0.05) , required renal replace therapy (P-trend > 0.05) were similar among groups. ROC analysis revealed that the optimal cutoff value of hs-CRP to predict the onset of CIN was 16.85 mg/L (sensitivity: 81.0%, specificity: 61.8%, AUC: 0.748). Univariate logistic analysis showed that hs-CRP was strongly related with CIN incidence (OR = 6.88,95%CI:2.23-21.21, P < 0.01). Multivariate logistic regression analysis showed that after adjusting other traditional risk factors including female gender, anemia, ACEI/ARB use, IABP support, LVEF < 40%, age > 75 years, baseline eGFR and diabetes, hs-CRP > 16.85 mg/L was still a significant independent predictor of CIN in patients with STEMI undergoing primary PCI. Additionally, age > 75 years (OR = 7.27,95%CI:1.85-28.63, P < 0.01), eGFR (OR = 6.38,95% CI:1.48-27.41, P < 0.05) were also independent risk factors of CIN.

CONCLUSIONShs-CRP is positively correlated with CIN incidence. STEMI patients with higher hs-CRP level post PCI is at higher risk of developing CIN.

Aged ; C-Reactive Protein ; metabolism ; Contrast Media ; adverse effects ; Female ; Humans ; Kidney Diseases ; chemically induced ; Logistic Models ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; ROC Curve

BACKGROUND: There are various treatment methods for osteonecrosis of the femoral head (ONFH) and collapse, but conservative treatment is invalid. Once femoral head collapse occurs, the development is irreversible. Our previous research has shown that local administration of zoledronic acid can prevent necrotic femoral head collapse. Moreover, bone marrow mononuclear cells obtain satisfactory short-term efficacy in the treatment of ONFH. OBJECTIVE: To investigate the curative efficacy of local administration of mononuclear cell, platelet-rich plasma and zoledronic acid for the prevention and treatment of early ONFH and collapse. METHODS: This prospective, single-center, randomized, parallel, controlled clinical trial was conducted at the Chinese PLA General Hospital, Beijing, China. One hundred patients with ONFH (stages I-II by Ficat and Arlet classification) were enrolled and randomly assigned into either the treatment group or control group (n=50 per group). Patients were given an injection of mononuclear cell, platelet-rich plasma and zoledronic acid into the necrotic femoral head, or drilling decompression at the necrotic area. Patients in both groups were then followed up for 4, 8, 12, and 18 months. The primary outcome measures were the blood supply, osteogenesis and appearance of the necrotic femoral head observed on hip perfusion by dynamic MRI, CT restruction of the hip joint and radiography of the hip joint, as well as Harris hip scores and numerical rating scale scores. Secondary outcome measures included SF-36 Health Survey and Activities of Daily Living scores. DISCUSSION: The outcomes of this trial have provided quantitative data for analyzing the effectiveness of local administration of mononuclear cell, platelet-rich plasma and zoledronic acid on ONFH and collapse. Written approval for this protocol was obtained from the Ethics Committee of the Chinese PLA General Hospital in China (approval No. S2015-082-01). Participants and their families are informed of the study protocol and procedures, and signed an informed consent. The study was in accordance with the guidelines of the Declaration of Helsinki, formulated by the World Medical Association. Trial began in January 2015 and will be completed in December 2017. Trial results will be published in scientific reports, or in peer-reviewed journals. This trial was registered with the ClinicalTrials.gov identifier: NCT02721940. Patient recruitment is ongoing.

Objective To investigate the outcomes of fetuses with hemolytic anemia caused by red cell alloimmunization following intrauterine transfusion (IUT),and to analyze the influence of hydrops fetalis on IUT treatment.Methods A retrospective analysis was conducted on 70 fetuses,who were admitted to the Fetal Medicine Center,the First Affiliated Hospital of Sun Yat-sen University from January 2005 to May 2018,with hemolytic disease requiring IUT.Clinical data of the fetuses and the gravidas were collected and divided into hydrops group (17 cases) and non-hydrops group (53 cases) based on their conditions before IUT.Results of routine blood tests before and after the first IUT,gestational age at the first IUT,prognosis and outcomes of the fetuses were compared between two groups.t-test,rank-sum test,Chi-square test (or Fisher's exact test) and multivariant logistic regression analysis were used for data analysis.Results Totally,the 70 fetuses underwent 231 times of IUT.Compared with the non-hydrops group,the hydrops group had a significantly increased incidence of severe anemia [14/17 vs 47.2％ (25/53),x2=6.458,P=0.011],but decreased hemoglobin [(38.5 ± 21.4) vs (68.7± 19.3) g/L,t=5.471,P＜0.001] and hematocrit level [0.110 (0.044-0.246) vs 0.222 (0.077-0.299),Z=-4.390,P＜0.001] before the first IUT.After the IUT,the survival rate of the fetuses in hydrops group was significantly lower than that of the non-hydrops group [11/15 vs 94.3％ (50/53),P=0.038].There was no significant difference in gestational age at birth,birth weight,neonatal hemoglobin level at birth,the incidence of exchange transfusion,the number of blood transfusions required or the incidence of severe neonatal complication between the two groups (all P＞0.05).Logistic regression analysis indicated that the fetal hydrops was an independent risk factor for fetal survival (OR=12.8,95％CI:1.2-136.4,P=0.035).Conclusions Hydrops fetalis might reduce the survival rate of fetal hemolytic disease after 1UT.

Objective::To analysis the effect of Huayu Qutan recipe on myocardial fibrosis in atherosclerotic rabbits based on mitochondrial fusion-lysis. Method::The 36 SPF healthy male rabbits were selected, and 6 rabbits were selected randomly as the normal group, and given normal pellet feed, another 30 rats were fed with high fat diet to establish atherosclerosis model.After successful replication of animal models, they were randomly divided into model group, Huayu Qutan recipe low-dose, medium-dose and high-dose group (4.0, 8.0, 16.0 g·kg^-1) and simvastatin group (1.4 mg·kg^-1), 6 rats each.Each group was given corresponding drugs according to the dosage, continuous administration for 4 weeks.The serum lipid levels in rabbits of each group were detectived by automatic biochemical analyzer, the degree of myocardial fibrosis was measured by Masson staining, and expression levels of mitochondrial fusion protein 1 (Mitofusin 1), mitochondrial fusion protein 2 (Mitofusin 2), optic atrophy protein 1 (Opa1), promoter protein 1 (Drp1), mitogen 1 (Fis1) in myocardial tissue were detected by immunohistochemistry. Result::Compared with normal group, the levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) in model group were significantly increased, levels of density lipoprotein cholesterol (HDL-C) were significantly decreased, the expression levels of Mitofusin 1, Mitofusin 2 and Opa1 in myocardial tissue were significantly decreased, the expression levels of Drp1 and Fis1 were significantly increased(P<0.05, P<0.01), compared with model group, the levels of serum TC, TG, LDL-C in simvastatin group and Huayu Qutan recipe low-dose, medium and high-dose group were significantly decreased, levels of HDL-C were significantly increased, the expression levels of Mitofusin 1, Mitofusin 2 and Opa1 in myocardial tissue were significantly increased, the expression levels of Drp1 and Fis1 were significantly decreased (P<0.05, P<0.01), compared with the Huayu Qutan recipe high-dose group, the levels of serum TC, TG, LDL-C in simvastatin group and Huayu Qutan recipe low, medium-dose group were significantly increased, the expression levels of Mitofusin 1, Mitofusin 2 and Opa1 in myocardial tissue were significantly decreased, the expression levels of Drp1 and Fis1 were significantly increased(P<0.05, P<0.01). Conclusion::Huayu Qutan recipe can effectively regulate blood lipid and inhibit myocardial fibrosis in atherosclerotic rabbits, and the higher the dose of Huayu Qutan recipe, the more obvious the effect is, it is speculated that its effect may be related to the regulation of the expression of mitochondrial fusion-lysis related proteins such as Mitofusin1, Mitofusin2 and Opa1, Drp1 and Fis1 in myocardial cells.