Objective To investigate the effect and safety of thoracic drainage by central venous catheter in critical patients with pleural effusion. Methods A prospective study was carried out,in which 46 critical patients with pleural effusion admitted to department of critical care medicine were included,and according to the types of their primary diseases to make matched pairs,and they were divided into two groups:conventional drainage control group and central venous catheter drainage observation group(each 23 cases). The drainage effect and complications were compared between the two groups,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score, quantitative pleural effusion and the counts of white blood cells(WBC)and of platelets(PLT),the levels of prothrombin time(PT),procalcitonin(PCT)and C-reactive protein(CRP),etc. were measured on the baseline and 24 hours after the operation. Results There were no significant differences in the APACHEⅡ score,quantitative pleural effusion,amount and duration of drainage,as well as the levels of WBC,PLT,PT and PCT between group control and observation(all P>0.05). The post-drainage CRP(μg/L)level in group observation was much lower than that in group control(77.26±67.20 vs. 106.13±66.23,P<0.01). There was a trend that the incidence of complication in group control was higher than that in group observation(26.1%vs. 4.3%),but the difference was not statistically significant(P>0.05). Conclusions In the comparison between the conventional drainage and thoracic drainage with central venous catheter,the therapeutic effects for treatment of critical patients with pleural effusion were similar, but the stress was milder and the incidence of complications was lower in the latter group. Therefore,the thoracic drainage with central venous catheter is a safe,effective and alternative method to substitute the conventional drainage for critical patients with pleural effusion.

Atomoxetine is a noradrenaline transmitter reuptake inhibitor which can selectively inhibit presynaptic noradrenaline transport protein,strengthen noradrenaline's resupination effect,and increases noradrenaline's activity released by synaptic cleft to improve the symptoms of the attention deficit hyperactivity disorder(ADHD)patients.ADHD patients often accompany with other psychological diseases like oppositional defiant disorder,anxiety disorder,which may hinder the diagnosis of ADHD.There is still no accepted effective medicine nowadays.Currently,research on the treatment of the ADHD is more and more popular.Good therapeutic effect of atomoxetine to treat ADHD has been found in resent studies.This article summarized the current management of using atomoxetine to treat ADHD.

Objective To explore the relationship between cat fur or dog fur allergens and clinical presentation, as well as allergenic cross-reactivity between cat fur or dog fur allergens and other allergens. Methods Totally 548 children with allergic disorders were assayed with 13 international standard allergen agents by means of SPT. The results were denominated according to the size of skin areola or welt, reference histamine as positive, isotonic Na chloride as negative. Results In 143 children with cat fur allergenic SPT position, 98 cases were boys and 45 cases were girls with an average age of 5. 84 years. In 96 children with dog fur allergenic SPT positive,60 cases were boys and 36 cases were girls with an average age of 6.06 years. The most had occurred in summer. Of them,a large number of cases presented asthma,secondly presented mild cough. Besides, the cross- reactivity of cat fur and dog fur allergenic SPT positive in 64 cases with acarid was most common, followed by latex, which exceeded animal protein, while the cross - reactivity of mold, plant farina and chomophyte allergens were rare. Conclusions About 20% children with allergic disorders are cat fur or dog fur allergenic SPT positive. Cat fur or dog fur allergenic SPT positive results are significantly correlative to age and season, however they are not relative.to sex. Cat fur or dog fur allergens exist correlations with other allergens.

Objective To report the clinical and genetic characteristics of a dentatorubralpallidoluysian atrophy (DRPLA) pedigree with an onset of cognitive impairment.Methods Clinical data of this pedigree was collected.The numbers of CAG repeats in the exon 5 of atrophin-1 (ATN1) gene were analysed in the proband and the other 4 healthy family individuals.The polymerase chain reaction (PCR) products of the proband underwent cloning-sequencing using an original TA cloning kit.Results There were 5 patients in this family,4 with onset in adult and one in childhood.The proband had an onset manifestation of cognitive impairment,while the other 3 adult patients presented with ataxia.The two-year-old child in the pedigree had myoclonic epilepsy.The proband had 61 CAG repeats in the exon 5 of ATN1 gene.After TA cloning-sequencing of the proband ' s PCR products,there were 2 different numbers of CAG repeats,including 61 and 64.Conclusions The clinical manifestations of DRPLA can have obvious heterogeneity in one family.Some patients present with cognitive impairment.It is very important to test the numbers of CAG repeats of ATN1 gen for DRPLA diagnosis.Somatic mosaicism may be also observed in Chinese DRPLA patients.

Adolescent ; Adult ; Aged ; Blood Coagulation Disorders ; Blood Coagulation Factors ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Vitamin K ; Vitamin K Deficiency ; Young Adult

Objective To investigate the effect of ulinastatin on acute lung injury in rats with severe heatstroke.Methods Fourty-eight rats were randomly (random number) assigned into control group (HS group,n =12),low dose Ulinastatin group (LUTI group,n =12),high dose Ulinastatin group (HUTI group,n =12) and non-thermal group (Sham group,n =12).Rats were prepared with pre-warm chamber to initiate heatstroke.The change of rectum temperature (Tc),heat-rate (HR) and mean arterial pressure (MAP) under heat-stress were recorded.The time-point of heatstroke onset and Tc ＞42 ℃ was observed.Arterial blood samples were draw at 0 min,20 min,40 min and 60 min for testing partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2).Bronchoalveolar lavage fluid (BALF) were collected at 60 min,and the concentrations of tumor necrosis factor-α (TNF-α),interleukin-1β (IL-l β) and interleukin-6 (IL-6) in BALF were measured with enzyme linked immunosorbent assay kit.Lung tissues were harvested for observing pathological change and measuring the expression of iNOS with Western blot test.Results Compared with HS group,the time-point of Tc ＞ 42℃ (P =0.00),severe heat-stroke (P =0.00) and the median of survival time (P =0.00) in LUTI and HUTI groups were significantly increased.At 60min after heat-stress,the level of PaO2 in HS group was much lower than those in other groups (P =0.00).But there were no differences between LUTI and HUTI groups (P =0.91).The value of PaCO2 in HS group was much higher than those in other groups (P =0.00).And the differences between LUTI and HUTI groups were no significant (P =0.79).The concentrations of TNF-α,IL-1β and IL-6 in HS group was the highest in four groups (P =0.00,P =0.04 and P =0.04),followed by LUTI,HUTI and Sham group.The concentrations of proinflammatory cytokine in LUTI were higher than those in HUTI group (P =0.02,P =0.00,P =0.00).Compared with HS group,the pathological injuries were alleviated in LUTI and HUTI group (P =0.00).The expression of iNOS in lung tissue of HS group was strengthened than LUTI and HUTI group (P =0.00),and there was a significant difference between LUTI and HUTI group (P =0.03).Conclusion Ulinastatin improves respiratory dysfunction and the prognosis of severe heatstroke rats through reducing the inflammatory and oxidative injury in lung tissue.

OBJECTIVE: To explore the methods of the larygeal recurrent nerve dissection in different and difficult thyroid surgery, so as to minimize damage and improve the safety of the operation. METHOD: The process and methods in different laryngeal recurrent nerve dissection about 52 hospitalized patients from 2010 to 2012 were retrospectively analyzed. These cases include large nodular goiter, nodular goiter behind the sternum or located in the lower pole of the thyroid gland, thyroid cancer, tumors of parathyroid gland, etc. We studied the conditions of lesions involving the laryngeal recurrent nerve and the defensive measures to protect the nerve. RESULT: The laryngeal recurrent nerve was dissected successfully in 50 cases, except 2 cases whose laryngeal recurrent nerve were violated by thyroid cancer. CONCLUSION When we dissect the laryngeal recurrent nerves in different and difficult thyroid, the glands and tumors were mostly needed to be freed and turned inward and forward. After that, the laryngeal recurrent nerves can be dissected successfully with the markers of tracheoesophageal groove, inferior thyroid artery and/or angle under the thyroid cartilage.
Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Recurrent Laryngeal Nerve ; surgery ; Retrospective Studies ; Thyroid Gland ; surgery

Objective To detect fibrillin-1 gene (FBN1) mutations in patients with Marfan syndrome (MFS) by denaturing high-pedormance liquid chromatography (DHPLC) and DNA sequencing. Methods Genomic DNA was extracted from whole blood sample of 22 MFS patients. All 65 exens of FBN1 were amplified by polymerase chain reaction(PCR) respectively. Mutations were screened by DHPLC followed by DNA sequencing of the PCR products which showed different DHPLC profiles from the normals. Results Ten mutations of the FBN1 were found in 9 MFS patients. The mutations comprised four missense[5015G > C(C1672S),5309G > A(C1770Y),7241G > A(A2414G) and 7769G > A(C2590Y)], four nonsense [3295G > T ( E1099X ), 430"/insTCGT (G1441X), 4621C > T ( R1541X ) and 8080C > T (A2694X)], and two splice site mutations (IVS29 + 4A > T and IVSSO + 1G > A). Conclusion It is suggested that DHPLC coupled with DNA sequencing is an efficient method for the detection of FBN1 gene mutations, and it may be useful in diagnosis of MFS.

Objective To explore the role of interleukin-15(Il-15)in pathogenesis of Kawasaki disease(KD)and its potential cli-nical value.Methods Thirty patients with KD were selected in Xinhua hospital from Oct.2004 to Jan.2006.The serum concentration of IL-15 was measured by enzyme linked immunosorbent assay(ELISA)in acute stage and convalescent stage of KD,and 30 children with low respiratory inflection and 20 healthy children were studied as controls.Results Serum IL-15 level in acute KD was significantly higher than that in normal control,and the two sides were remarkably different in statistics(q=25.64 P

ObjectiveTo observe the effect of Xuebijing injection pretreatment on systemic inflammatory response induced by severe heat-stroke, and to investigate the mechanism of alleviation of intestinal injury in rats. Methods Thirty-six healthy adult male Wistar rats with grade SPF were randomly assigned into three groups with randomized number method, namely sham group, severe heat-stroke model group, and Xuebijing pretreatment group (XBJ group), with 12 rats in each group. The animals were placed in a pre-warm chamber [temperature (40±2)℃, humidity (65±5)%] in order to induce typical heat-stroke. The duration of heat-stress was 60 minutes, while the animals in sham group were exposed to ambient temperature of 25℃. Arterial blood samples were collected at the beginning and the end of heat-stress, the concentrations of tumor necrosis factor-α(TNF-α), interleukins (IL-1β, IL-6), and lipopolysaccharide (LPS) in peripheral blood were determined by enzyme linked immunosorbent assay (ELISA). The intestinal tissues were harvested after heat-stress, and the pathological changes in intestine tissues were observed after hematoxylin-eosin (HE) staining and under optical microscope. The pathological injury scores were calculated. Immunohistochemistry was performed to determine inducible nitric oxide synthase (iNOS) expression in intestinal tissue. Apoptosis was determined by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) staining. Western Blot was used to measure the tight junction protein occludin expression.Results The concentrations of TNF-α, IL-1β, IL-6 and LPS in blood of the rats after heat-stress in model group were significantly higher than those of sham group [TNF-α (μg/L): 443.00±110.10 vs. 98.36±44.61, IL-1β (μg/L): 436.37±163.64 vs. 64.24±16.15, IL-6 (μg/L): 342.70±92.42 vs. 54.40±13.22, LPS (μg/L): 0.68±0.22 vs. 0.09±0.02, allP< 0.01], but the levels of these parameters in XBJ group were significantly lower than those of model group [TNF-α (μg/L):340.45±68.57 vs. 443.00±110.10, IL-1β (μg/L): 191.33±82.78 vs. 436.37±163.64, IL-6 (μg/L): 192.21±37.89 vs. 342.70±92.42, LPS (μg/L): 0.43±0.17 vs. 0.68±0.22, allP< 0.01]. Infiltration of inflammatory cells, necrosis and hemorrhage in intestinal mucosa were found in the intestine of heat-stroke animals in model group. The pathological lesions in XBJ group were milder than those of model group, with a decreased pathological injury score compared with model group (2.10±1.15 vs. 3.20±0.67,P< 0.01). The expression of iNOS and apoptosis of cells in intestinal tissue in model group were increased compared with that of sham group, but they were significantly less marked in XBJ group compared with model group [iNOS (adjustedA value): 0.32±0.15 vs. 0.74±0.17, apoptotic index: 0.23±0.08 vs. 0.56±0.07, bothP< 0.01]. The order of expression for occludin protein from high to low was sham group, XBJ group and model group (A value was 0.96±0.25, 0.62±0.20, 0.33±0.11, respectively). Furthermore, there was significant difference in the expression of occludin protein between model group and both XBJ group and sham group (bothP<0.01).Conclusions Xuebijing injection alleviates inflammation and endotoxemia produced by severe heat-stroke in rats. The mechanism may be related to amelioration of oxidative injury, apoptosis, and dysfunction of tight junction protein occludin expression.