Objective To evaluate the diagnostic value of CT guided percutaneous transthoracic core needle biopsy (TCNB). Methods CT guided TCNB were performed on 121 cases who had suffered from pulmonary diseases. Cook QC 18G, 19G, or 20 gauge needles were used. The diameter of the pulmonary lesions was ranged from 0.8cm to 9.5cm, mean (3.4?1.9)cm. Postbiopsy complications were observed by routine CT scan. Results According to the Westcott's method, the final diagnosis of 86 cases of malignancy and 35 cases of benignancy had been established. Seventy nine malignant and 32 benign ones could be accurately diagnosed by TCNB. The overall diagnostic accuracy was 91.7%(111/121). The sensitivity of TCNB in the malignancy was 91.9%(79/86) with 7 cases of false negative, and the specificity was 100%. Seventy cases of malignancy could be made definitely. The sensitivity of benignancy was 91.4%(32/35). Complication of pneumothorax in 22 cases (18.2%) and pulmonary hemorrhage in 19 cases (15.7%) resolving spontaneously. Conclusions CT guided TCNB is a safe, reliable method with high accuracy in diagnosis and less complications, especially for non lung cancer malignancy and benign lesions.

ObjectiveTo assess the clinical value of procalcitonin (PCT) in the diagnosis of sepsis in adults.Methods An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.Results A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooledDOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity,P = 0.20). TheDOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33,P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showedP values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95%CI = 72%-76%), the pooled specificity was 70% (95%CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95%CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95%CI = 0.28-0.41), and the pooled AUC was 0.83 (95%CI = 0.79-0.87). AUC in medical patients was 0.80 (95%CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95%CI = 0.65-0.81)].Conclusions Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.

ObjectiveTo investigate whether early goal-directed therapy (EGDT) could improve the mortality rate in patients with severe sepsis or septic shock.Methods Articles were retrieved from PubMed, Cochrane Library, Embase data, Wanfang data, and CNKI from January 1980 to May 2015. Inclusion criteria included the subjects concerning patients with severe sepsis or septic shock reported as randomized controlled trial (RCT), clinical controlled trial (CCT), case-control studies, cohort studies with complete data, which endpoints were the short-term mortality [in-hospital, intensive care unit (ICU) or 28-day] and long-term mortality (60-day, 90-day or 1 year). RevMan 5.2 software was used for Meta analysis of effect of EGDT on mortality rate in patients with severe sepsis or septic shock, and funnel plot was drawn to evaluate the quality of enrolled literature.Results There were 12 studies meeting inclusive criteria including 5 528 patients, 4 RCTs, 3 case-control studies, 4 cohort studies, and 1 quasi-experimental research. It was shown by Meta analysis that EGDT was associated with significant decrease in the short-term mortality [relative risk (RR) = 0.72, 95% confidence interval (95%CI) = 0.64-0.80,P< 0.000 01], but not associated with decrease of long-term mortality (RR = 0.99, 95%CI = 0.92-1.06,P = 0.81). The funnel plot showed that there was no publication bias. EGDT was recommended as grade C.Conclusions EGDT was associated with significant improvement in short-term mortality but not with long-term mortality in patients with severe sepsis or septic shock. Grade C was recommended by our study.

Objective To evaluate the value of 18F-fluorodeoxyglucose (FDG) PET/CT in evaluation of curative effect and progression-free survival (PFS) for lymphoma patients.Methods The data of 85 lymphoma patients were retrospectively analyzed.Before and after 4-8 cycles standardized chemotherapy,the patients were evaluated with 18F-FDG PET/CT.The two-year PFS rate was compared.The value of 18F-FDG PET/CT in evaluation of curative effect and PFS for lymphoma patients received chemoradiotherapy was analyzed.Results The non Hodgkin lymphoma (NHL) was the common type,and the common pathogenic sites were head and neck lymph nodes,mediastinum and retroperitoneum.The majority of patients were accompanied with spleen enlargement and local lesions with high metabolism.The complete remission (CR) rate of Hodgkin lymphoma (HL)patients in PET/CT negative group was significantly higher than that in positive group (86.4％ vs.42.9％,P =0.038).The two-year PFS rates in PET/CT positive group and negative group were 42.9％ and 81.8％,and the difference was statistically significant (x2 =7.70,P =0.006).Thirty-five NHL patients achieved CR,13 achieved partial remission (PR),and 8 achieved stable disease (SD) or disease progression (PD).The two-year PFS rates in the CR group,PR group,SD or PD group were 89.7％,65.3％ and 19.4％ respectively,and the difference was statistically significant (x2 =12.41,P =0.002).PET/CT imaging had a strong PFS predictive effect on T cell lymphoma (TCL) patients (x2 =13.85,P =0.001) and diffuse large B cell lymphoma (DLBCL)patients (x2=13.51,P =0.001),and had no predictive effect on follicular lymphoma (FL) patients (x2 =4.63,P =0.099).Conclusion 18 F-FDG PET/CT can evaluate the curative effect of lymphoma effectively and early predict prognosis,and has great guiding significance in choosing therapeutic schedule.

0.5D) were 21.4%,1.8%,19.5%,36.0%,and 22.5%, respectively.The prevalence of myopia and high myopia significantly decreased with age (P=0.001).The prevalence of hyperopia, astigmatism,anisometropia tended to increase with age (all P

The therapeutic effects and mechanisms of traditional Chinese kidney-tonifying drugs in treating osteoporosis have become the focus under study. Pharmacological studies have shown that traditional Chinese kidney-tonifying drugs are promoters for the proliferation of osteoblasts, inhibitors for the activity of osteoclasts, regulators for the estrogen level and its receptor, plays important roles in promoting osteogenesis and suppressing adipogenesis of marrow mesenchymal stem cells (MSCs), modulating the function of OPG/RANK/RANKL system and the metabolism of calcium and phosphorus, as well as antioxidation. The anti-osteoporotic active ingredients and pharmacological action mechanism of traditional Chinese kidney-tonifying drugs are summarized from the perspective of molecular and cell biology in this paper, so as to provide references for the study of their mechanism of anti-osteoporosis and for the development of traditional Chinese kidney-tonifying and bone-strengthening drugs.
Animals ; Bone and Bones ; drug effects ; physiopathology ; Drugs, Chinese Herbal ; pharmacology ; Humans ; Kidney ; drug effects ; physiopathology ; Osteoporosis ; drug therapy ; physiopathology

Objective To detect the correlation of the expression of microvessel density(MVD) and vascular endothelial growth factor (VEGF) with the semi-quantivative indices of susceptibility weighted imaging(SWI) and perfusion imaging (PI)in astrocytic tumor.Methods SWI and PI were performed in 98 patients with varing grades of astrocytic tumors.According to the World Health Organization (WHO) classification of central nervous system tumors and grading criteria:8 cases of pilocytic astrocytoma (grade Ⅰ,1 case of pleomorphic xanthoastrocytoma (grade Ⅱ),23 cases of astrocytoma (grade Ⅱ),22 cases of anaplastic astrocytoma (grade Ⅲ) and 44 cases of glioblastoma (grade Ⅳ) were included.Intra-tumor susceptibility hypo intensity area (ITSHIA) acquired by SWI was observed and semi-quantitative data were calculated.Maximum relative rCBV values of solid part of the tumor (rCBVintra),surrounding area of tumor (rCBVperi) were calculated.The MVD and VEGF expression were quantified from the excised tumor tissues and were correlated with PI and SWI indices.Kruskal-Wallis H test was used to assess the difference of the MVD and VEGF in different grade astrocytic tumor.Results The MVD count (r =0.550,P ＜ 0.01) and VEGF expression(r =0.456,P ＜ 0.01) were positively correlated with pathologic grading of astrocytic tumor.Spearman correlation analysis indicated that semi-quantivative indictors of SWI (r =0.340 to 0.497,P＜0.01),as well as rCBVintra(r =0.467,P ＜0.01) and rrCBVperi(r =0.374,P ＜0.01)of PI were positively correlated with MVD.All indices of SWI (r =0.202 to 0.334,P ＜ 0.01),except for ITSHIA frequency and ITSHIA area ratio score,were correlated with VEGF expression,while the rCBVintra (r =0.301,P ＜ 0.01) and rCBVperi (r =0.311,P ＜ 0.01) of PI were positively correlated with VEGF.Conclusion The indices of PI and SWI are obviously correlated with MVD and VEGF in astrocytic tumor.PI and SWI could be effective in evaluating angiogenesis preoperatively.

Objective To assess the efficacy and adverse reaction of Lanthanum carbonate in patients with hyperphosphatemia and high calcium times phosphate product receiving maintenance hemodialysis.Methods Twenty-three hemodialysis patients with serum phosphate ≥ 2.0 mmol/L and/or the serum calcium times phosphate product ≥ 4.52 mmol2/L2 were prescribed Lanthanum carbonate chewed with meals for 4 weeks.Blood (Hb), serum albumin (ALB), alanine amino shift enzyme (ALT), aspartic acid transaminase (AST) ,calcium(CA), phosphorus (P) calculated the product of calcium and phosphorus (Ca×P) and intact parathyroid hormone (iPTH) level were checked before and after Lantharum carbonate therapy.The adverse reactions were recorded concomitantly.Results Serum phosphate and the serum calcium time phosphate product significantly decreased after 1 month Lanthanum carbonate therapy((2.48±0.55) mmol/L vs.(1.83 ±0.37) mmol/L, (5.21 ± 1.35) mmol2/L2 vs.(4.10±0.96) mmol2/L2;t =2.742,2.936;P＜0.05).Serum calcium, iPTH level and blood cells count remained no change(P＞0.05), while serum ALT, AST concentration within normal range.Five patients complained affordable abdomen discomfort or upset.Conclusion Lantharum carbonate show to effectively and quickly control serum phosphorus levels and calcium time phosphate product in hemodialysis patients without inducing changes in serum calcium and should be considered an ideal phosphate binder.

Objective To investigate the early diagnostic value of traditional scoring systems in critical acute pancreatitis.Methods From Jan 2007 to Ju12013,consecutive 184 patients with AP who were admitted to the surgical intensive care unit of the Institute of General Surgery,Nanjing Generai Hospital of Najing Militery Region within 72 h from the onset of the disease were studied.Patients were assigned to four groups,including mild,moderate,severe and critical AP according to the determinant based classification and the receiver operating characteristics(ROC) curve was used to predict the presence of critical AP,and Z test and logistic regression was applied to determine the diagnostic value of traditional scoring systems.Results The area under ROC (AUC) of Sofa,BISAP and CTSI score for early diagnosis of critical AP was 0.896,0.877 and 0.862;the best cut off value was 4.5,9.5 and 2.5.Moreover,the AUC of APACHE Ⅱ and Ranson score was 0.807 and 0.707,and the best cut off value was 8.5 and 3.5,respectively.Z test showed early diagnosis rate of Sofa,BISAP,CTSI score was significantly higher than that in Ranson score,and the difference between the two groups was statistically significant (P ＜ 0.05);though they were higher than APACHE Ⅱ score,the difference between the two groups was not statistically significant (P ＞ O.05).Logistic regression showed that high APACHE Ⅱ,Sofa,BISAP and CTSI score were independent risk factors for the development of critical AP (P ＜ 0.05).Conclusions Sofa,CTSI and BISAP score may be clinically important for early diagnosis of critical AP.

Objective To build a complete medical capability evaluation system for hospital's clinical departments,based on the data of a public general hospital in Beijing,using simplified DRGs-related indexes as a risk-adjustment tool.Methods Select with literature review,corresponding medical capacity evaluation indexes to build a primary index data base,and establish the evaluation index system of clinical medical indexes of a hospital based on DRGs analysis using Delphi method and AHP method.Conduct the sequence comparison and paired t test using the evaluation method mentioned above as well as the traditional evaluation method.Results Establishing the evaluation system of medical ability for clinical departments composed of 3 first level indexes and 12 two level indexes based on DRGs related indicators The 3 composing first level indexes are productivity,efficiency and quality whose corresponding weighting coefficients were 0.363,0.479,0.158 respectively.Outcomes of the sequence comparison from both this method and the traditional method are basically the same,and the paired t test shows no significant difference between the two.Conclusion This evaluation system facilitates data collection and accurately indicate the medical capacity of a hospital's clinical department,making it an ideal tool for hospital's day-to-day management.