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

OBJECTIVE:To investigate the effects and safety of Sophoraflavescens preparation combined with Fuzheng huayu capsule on hepatic hemodynamics and fibrosis indexes in patients with hepatitis B liver cirrhosis.METHODS:One hundred and two patients diagnosed as hepatitis B liver cirrhosis in our hospital during Feb.2013-Jun.2014 were divided into combination group and control group according to random number table,with 51 cases in each group.Control group was treated with Adefovir dipivoxil capsules 10 mg,po,qd;combination group was additionally given Fuzheng huayu capsules 1.5 g,po,tid+Sophora flavescens preparation (Matrine glucose injection 250 mL,ivgtt,qd,in the first 3 months,oxymatrine capsules 200 mg,po,tid,after 3 months) on the basis of control group.Both groups were treated for 12 months.The levels of HBV-DNA,liver function indexes (AST,ALT,TBIL),portal hemodynamic indexes [main portal vein inner diameter (D),mean blood flow velocity (Ⅴ)] and liver fibrosis indexes [laminin protein (LN),hyaluronic acid (HA),type Ⅳ collagen (Ⅳ-C)] were observed in 2 groups before and after treatment.The negative conversion rate of HBV-DNA and incidence of ADR were recorded.RESULTS:Three cases lost to follow up,and a total of 48 effective cases were included in control group;5 cases lost to follow up,and a total of 46 effective cases were included in combination group.Before treatment,there was no statistical significance in HBV-DNA levels,liver function indexes (AST,ALT,TBIL),liver fibrosis indexes (LN,HA,Ⅳ-C) and portal vein hemodynamic indexes (D,V) between 2 groups (P＞0.05).After treatment,above indexes of 2 groups were decreased significantly,and the combination group was significantly lower than the control group,with statistical significance (P＜0.05).The negative conversion rate of HBV-DNA in combination group was 93.5％,which was significantly higher than 79.2％ of control group,with statistical significance (P＜0.05).There was no statistical significance in the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Sophora flavescens preparation combined with Fuzheng huayu capsules can promote the recovery of liver function,regulate liver hemodynamics and alleviate hepatic fibrosis in patients with hepatitis B liver cirrhosis with good safety.

Automatic Data Processing ; Data Mining ; Humans ; Medicine, Chinese Traditional ; methods

OBJECTIVETo investigate the application and effects of external fixator under the guidance of damage control therapy in limb open fracture.

METHODSFrom May 2008 to January 2013,72 cases with severe limb open fractures (Unincor- porated shock) were divided into control group and observation group (36 cases in each group). In observation group, 36 patients (including 22 males and 14 females) were treated by external fixator at stage I, as soon as possible after waiting for patients physiology conditions being stable,the stage II fracture operation was performed. In control group, 36 patients (24 males and 12 females) were treated by the first stage open reduction. The hospital admission time, open fracture severity score (OFSS),operation duration,operative blood loss,X-ray expose times, callus appear time, fracture healing time, postoperative infection rate, complications and Johner-Wruhs accceccment were recorded and evaluated.

RESULTSAll patients were followed up for 8 to 12 months (10.4 in averaged). The mean operation duration, operative blood loss, callus appear time, fracture healing time the mean operation duration reespectively were (56.79±8.87) min, (216.16±18.21) ml, (5.32±0.71) weeks, (12.79±2.52) weeks in observation group,and (104.53±9.28) min, (439.93±14.65) ml, (4.97±1.26) weeks, (14.81±2.63) weeks in control group. According to Johner-Wruhs acccecement,there were were 33 cases in excellent,2 in good,and 1 in poor in observation group,non-union of fracture in 1 case,local infection occurred in 1 cases; in control group 25 cases in excellent,6 in good, and 5 in poor, non-union of fracture in 1 case,local infection occurred in 8 cases. There were significant differences in operation duration, operative blood loss, callus appear time, fracture healing time, postoperative infection rate, complications (P<0.05). There were no significant differences in hospital admission time, open fracture severity score and X-ray expose times (P>0.05).

CONCLUSIONUnder the guidance of damage control therapy,using external fixator measures to treat patients with open fractures of limbs is worth popularizing in clinical application because it can shorten the operation time, less blood loss, reduce the infection rate and complications, improve the success rate of surgery and recovery rate.

Adult ; Aged ; External Fixators ; Extremities ; injuries ; surgery ; Female ; Fracture Healing ; Fractures, Open ; surgery ; Humans ; Male ; Middle Aged ; Operative Time ; Postoperative Complications ; epidemiology

Hip fracture patients preoperative and postoperative exist hidden blood loss which often affect patients' wound healing, increase the probability of infection, prolong rehabilitation exercise, influence postoperative effect. At the same time, the body's blood loss increase the activation of the blood clotting mechanism, promote the incidence of deep vein thrombosis, bleeding and deep vein thrombosis has become the main causes of high risk in hip operation. It is very important to stop bleeding, anticoagulation should not be ignored, so how to effectively deal with the prominent contradiction between the postoperative anticoagulation and bleeding or looking for a best balance has become a intractable problems in hip fracture treatment.
Anticoagulants ; therapeutic use ; Blood Loss, Surgical ; prevention & control ; Hip Fractures ; complications ; surgery ; Humans ; Intraoperative Complications ; drug therapy ; etiology ; prevention & control

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.