Objective To examine the expression of Toll-like receptor(TLR)4 protein and the transcription of TLR4 mRNA in the peripheral blood mononuclear cells(PBMC)from patients with hepatitis B virus(HBV)infection and explore the relationship between TLR4 and chronic HBV infec- tion.Methods The expression level and transcription level of TLR4 were determined by flow cytometre and reverse transcriptase polymerase chain reaction respectively in PBMC from 37 chronic hepatitis patients,28 liver cirrhosis patients,31 severe hepatitis patients and 27 healthy controls. Meanwhile,liver function,as well as blood routine test,prothrombin test activity(PTA)and HBV DNA was measured.Results The expression level and transcription level of TLR4 in patients were higher than those in healthy controls(P

Objective To compare the effect of traditional open surgery and laparoscopic repair of gastric perforation on postoperative pulmonary function.Methods Fifty patients were divided into two groups according to therapeutic method.Group A underwent traditional open gastric perforation repair(n=25).Group B underwent laparoscopic repair of gastric perforation(n=25).The pulmonary functions were examined at 1 day,3 days and 7 days postoperatively.Results All patients had different degrees of postoperative pulmonary function decline.After operation,the forced vital capacity(FVC)and forced expiratory volume in 1 second(FEV1)and vital capacity(VC)in group A were significantly lower than those in preoperation(P<0.05).The patients in laparoscopic operation group decreased significantly only on the first day postoperative.The postoperative pulmonary function of patients undergoing open surgery was significantly lower than that of patients undergoing laparoscopic surgery(P<0.05).Conclusion Laparoscopic repair of gastric perforation has less damage to the lung function than traditional open gastric perforation repair.Laparoscopic surgery plays an important role in the recovery of postoperative pulmonary function.

Objective:To explore the correlation among plasma levels of fibrinogen (Fg) ,D-dimer (DD) and antithrombin III (ATIII ) and carotid atherosclerosis (CAS) in AMI patients .Methods:A total of 147 AMI patients treated in our de‐partment from Jan 2012 to Dec 2014 were enrolled as AMI group ,another 120 patients without myocardial infarction (MI) were treated as control group .According to ACS severity ,AMI group was further divided into normal group (n=22) ,mild group (n=30) ,moderate group (n=40) and severe group (n=55) .Plasma levels of Fg ,DD and ATIII ,and carotid inti‐ma-media thickness (IMT) were measured and compared among all groups .Results:Compared with control group ,there were significant rise in plasma levels of Fg [ (3.12 ± 0.87) g/L vs .(5.01 ± 1.38) g/L] ,DD [ (317 ± 50)μg/L vs .(1530 ± 218)μg/L] and carotid IMT [(0.86 ± 0.41) mm vs .(1.12 ± 0.29) mm] ,and significant reduction in plasma AT Ⅲ level [ (87 ± 18)% vs .(76 ± 19)% ] in AMI group , P<0.01 all. Compared with normal group ,there were significant rise in plasma levels of Fg and DD ,and significant reduction in plasma ATIII level in moderate group and severe group , P<0.05 or <0.01. Spearman correlation analysis indicated that plasma Fg and DD levels were significant positively correlated with CAS severity (r=0.426 ,0.535 ,P<0.01 both) ,ATIII level was significant inversely correlated with CAS severity in AMI patients ,(r= -0.438 ,P=0.005) .Multi-factor Logistic regression analysis indicated that plasma Fg and DD levels were independent risk factors for MI (OR=2.836 ,2.231 , P<0.01 both) ,and plasma ATIII level was independent protective factor for MI (OR=0.899 , P=0.014 ) .Conclusion:Plasma Fg and DD levels are independent risk factors for MI and plasma ATIII level is independent protective factor for MI .

Background and purpose: Neck lymph node metastasis, most of which presents in central neck compartment, is common in patients with papillary thyroid carcinoma (PTC). The objective of this study was to investigate the relationship between the number of dissected central neck lymph nodes and clinical outcome after radioactive iodine (RAI) ablation in pN1a PTC with no more than 5 lymph nodes involvement. Methods: A total of 167 PTC patients who had 1-5 proven metastatic lymph nodes according to postoperative pathological diagnosis were retrospectively analyzed, all of whom underwent total or near total thyroidectomy and central lymph node dissection. After a median follow-up period of 26 months, the clinical outcome of each patient was evaluated as excellent response (ER), indeterminate response (IDR), bio-chemical incomplete response (BIR), or structural incomplete response (SIR) according to the new American Thyroid As-sociation guidelines. The accumulative ER rate (ERn) was calculated in patients with different numbers of dissected lymph nodes (ERn was defined as the proportion of patients who achieved ER with the dissected lymph node number of ≤n). The relationship between the number of dissected central neck lymph nodes and ERn were investigated. Results: As the increase in the number of dissected central neck lymph nodes,there was also an overall increase in ERn, especially when n rose from 1 to 10. The values of ER1, ER5, ER10 and ER30 were 25.0%, 66.7%, 74.7% and 79.1%, respectively. Besides, the proportion of patients who achieved ER was higher in those with 10 or more dissected lymph nodes than in those with less than 10 (85.7% vs 73.3%, P=0.05). In the multivariate logistic regression analysis, both the dissected central lymph node number of ≥10 (OR=2.720, 95%CI: 1.052-7.033, P=0.039) and the level of preablation stimulated thyroglobulin (OR=0.955, 95%CI: 0.926-0.984, P=0.003) were shown to contribute independently to ER. Conclusion: As the increas-ing number of dissected central neck lymph nodes, the percentage of pN1a PTC patients that achieved ER after RAI ablation generally rises. In pN1a PTC patients with no more than 5 lymph nodes involvement, a central compartment dissection with 10 or more lymph nodes might help them achieve ER after RAI ablation.

This article analyzes and summaries the problems and difficulties existing in the first-aid medicine's clinical teaching.Combined with his own teaching experience,the author has made some exploration on the teaching time,the way of teaching and inspection form,which has got a good teaching effect.It provids the reference and development for the clinical teaching of first-aid medicine.

Objective To investigate early changes of angiopoietin-2(Ang-2)in multiple trauma patients and assess its clinical significance.Methods Forty-five multiple trauma patients aged 2060 years admitted to the hospital within one hour after injury were randomly divided into three groups according to injury severity score(ISS).Blood specimens were obtained immediately upon arrival in the emergency department and plasma samples were assayed for comparing changes of Ang-2,TNF-a and IL-6.Meanwhile,plasma level of Ang-2 was measured and analyzed under different oxygenation index,shock index and base deficit.Results Plasma level of Ang-2 was positively correlated with ISS(P ＜ 0.01)and was concordant with the plasma levels of TNF-a and IL-6(P＜0.01).Furthermore,plasma level of Ang-2 was elevated upon increase of shock index or decrease of oxygenation index(P ＜ 0.01).Plasma level of Ang-2 was elevated with the increase of base deficit(P ＜ 0.01).Conclusions High level of Ang-2 is a marker of endothelial activation and dysfunction early after trauma.Ang-2 is related tightly with the injury severity,inflammation factors,systemic oxygenation and tissue hypoperfusion and may have a tight relation with pathophysiological development and clinical outcome after trauma.

Humans ; Medicine ; Medicine, Chinese Traditional ; methods

Objective:To explore the application and safety of visual endotracheal tube in tracheal intubation in patients with gen eral anesthesia operation.Methods:220 patients with general anesthesia operation in Department of Anesthesiology,Guangdong No.2 provincial people's hospital firom October 2014 to December 2016 were selected,110 patients were treated with visual endotracheal intubation as observation group,110 patients were treated with general endotracheal intubation as control group.The number of intubation,intubation times and complication rate in the two groups were contrasted,compared the heart rate (HR),systolic blood pressure (SBP),diastolic blood pressure (DBP) and oxygen saturation (SpO2) in the two groups at before induction of anesthesia (T0),after induction of anesthesia (T1),airway intubation (T2),5 min after intubation (T3).Results:The number of intubation and intubation times in the observation group were significantly less than those in the control group,the differences were statistically significant (P＜0.05);At each time point,the HR,SBP,DBP and SpO2 in the two groups were no significant difference (P＞0.05);The HR,SBP,DBP and SpO2 in the two groups at T1 were significantly less than T0,T2,T3,the differences were statistically significant (P＜0.05);The incidence of throat pain in the observation group (0.91％) was significantly less than that in the control group (7.27％),the difference was statistically significant (P＜0.05).Conclusion:Use visual endotracheal tube in tracheal intubation in patients with general anesthesia operation is satisfactory,can effectively reduce the time of intubation and intubation times,and has good security,it is worthy of clinical application.

Objective To investigate the predictable value of susceptibility weighted imaging (SWI)in hemorrhagic transforma-tion (HT)of ischemic stroke.Methods 48 patients with ischemic stroke were involved.The presence and features of HT on CT, T1 WI,DWI and SWI were observed,as well as the distribution and signal features of cerebral microbleeds (CMBs),abnormal visi-bility of venules on SWI sequence.The correlation between those imaging findings and HT were analyzed.Results HT was detected in 19 of 48 patients (39.6%).The sensibility of T1 WI,DWI,SWI in detecting HT were 68.4%,36.8%,100%,respectively.HT was significantly associated with abnormal visibility of venules within the infarction region.The incidence of HT greatly increased with the aggravation of CMBs.Conclusion SWI can be a sensitive predictor for HT,and it’s helpful in making clinical strategy for ischemic stroke.

Objective To investigate the protective effect of endotoxin pretreatment on hippocampal neurons in rat forebrain following ischemia reperfusion and its possible mechanism. Methods Rat forebrain ischemia reperfusion model was used. The effects of endotoxin pretreatment on the changes of superoxide dismutase (SOD), glutathione peroxidase (GSH PX) and malondialdehyde (MDA) activities and the neuron count in CA1 region were observed. Results Pretreament with endotoxin before cerebral ischemia enhanced the activities of SOD and GSH PX but decreased MDA level and the number of ischemic neurons in CA1 region. Conclusion Endotoxin pretreatment can protect the neurons in rat forebrain against ischemia reperfusion injury. The mechanism may be associated with the enhancement of endogenous antioxidant activity in central nervous system.