Objective To evaluate the diagnostic accuracy of drug-induced liver injury over a 10-year period . Methods The 112 cases of drug-induced liver injury were retrospectively studied. Inter-national consensus criteria were applied to assess the causality of suspected drug hepatotoxicity,in which the chronological criteria and elimination of other causes were analysed. Results Among 1127 adult inpatients with acute hepatitis over 10-year period, 112 patients(10%) were recorded as drug-induced liver injury. Based on the causality assessment of 112 cases, either incompatible time to apparent onset of the reaction or incompatible course of the reaction was found in 60 cases(53.6%) and 20 cases(17.9%), respectively. The presence of other possible causes for the reaction was found in 34 patients (37.5%). Therefore, 26 cases(23.2%) of liver injury were related to the incriminated drug, 25 cases(22.3%) unrelated,61(54.5%) were considered to indeterminate cause. Conclusions The international consensus criteria were helpful to identify drug-related or unrelated liver injury, but more than half of reported hepatic adverse drug reactions are still in suspected condition. The current diagnostic methods for drug-induced liver injury are needed to be revised in clinical practice.

4 holding time were observed among the three groups.After repeated doses,the PMs showed a significantly higher intragastric pH value than that of the homEMs or hetEMs.Conclusion The pharmacodynamic effects of omeprazole and its pharmacokinetics depend on the CYP2C19 genotype status in Chinese volunteers.

ObjectiveTo observe the clinical effect of low molecular weight heparin calcium in the treatment of chronic obstructive pulmonary disease combined with pulmonary heart disease.MethodsA total of 64 patients with chronic obstructive pulmonary disease combined with pulmonary heart disease from December 2008 to December 2010 were enrolled in this study and divided into treatment group and control group by random digits table with 32 cases each.The control group was given routine treatment and the treatment group was given low molecular weight heparin calcium for 7 days at the basis of routine treatment.ResultsThe total effective rate in treatment group[ 90.6％ (29/32) ] was significantly higher than that in control group [ 68.8％ (22/32) ] (P ＜ 0.05 ).In treatment group,the levels of arterial carbon dioxide tension (PaCO2) and arterial oxygen tension (PaO2) after treatment [(54.64±9.63),(74.21 ± 11.76) mm Hg (1 mm Hg =0.133 kPa)] were significantly decreased compared with before treatment [(78.66 ± 11.22),(53.42 ± 8.84 ) mm Hg ] (P ＜ 0.01 ).In control group,the levels of PaCO2 and PaO2 after treatment [ (61.10 ±7.24),(65.07 ± 8.21 ) mm Hg] were significantly decreased compared with before treatment[ (79.52 ± 12.54),(51.35 ± 7.31 ) mm Hg ] (P ＜ 0.05 ).After treatment the levels of PaCO2 and PaO2 in treatment group were better than those in control group (P ＜ 0.05).ConclusionsThe low molecular weight heparin calcium in treatment of chronic obstructive pulmonary disease combined with pulmonary heart disease can effectively improve the clinical manifestation.It is worth the clinical promoted application.

Objective To analyze the clinical features of recurrent acute pancreatitis (RAP).Methods The clinical data of patients diagnosed as RAP were collected in Changhai Hospital, the Second Military Medical University between January 2016 to July 2016, and chronic pancreatitis(CP) patients and RAP patients to matching, as control group.A prospective cohort study about the clinical features of RAP and CP was set.The survival analysis model was established by Kaplan-Meier′s method, to calculate the cumulative rate of RAP which progressed into CP.Results The morbidity of male patients was 69.0% in the RAP group(n=100) and 60% in the CP group(n=100).The average first onset age of RAP and CP was 38 and 21 years old, respectively;and the teenagers accounted for 12% and 38.6%.The incidence of diabetes was 49.5% and 9%;and the incidence of fatty diarrhea was 46.6% and 19% of the two groups.The cumulative incidence of CP was 2% within 1 year, 4.6% in 3 years, and 12.4% in 5 years.Conclusions Men has higher morbidity in both RAP group and CP group.RAP patients′ first onset age was older than that of CP.Teenagers had a low incidence in RAP group.The risk of diabetes and fatty diarrhea was lower in RAP group than CP group.A certain proportion of RAP patients can progress to CP.

Objective To investigate the effects of precautionary high-flow oxygen therapy on preventing hypoxemia in patients with Stanford type A aortic dissection after intubation.Methods Totally 90 hospitalized patients with Stanford type A aortic dissection in our hospital were enrolled in this study.Forty-five patients were recruited in the control group from January to April 2017,and the common mask-type nebulizer was used for oxygen inhalation.From May to October in 2017,45 patients were recruited in the experimental group.The parameters of highflow oxygen therapy in the experimental group were set as oxygen concentration (FiO2) 40％～60％,oxygen flow rate 35～60 L/min.Then after 72h's therapy,normal mask oxygen therapy was provided as replacement therapy.Results Oxygenation index and oxygen partial pressure were increased in the experimental group than those in the control group,the rate of respiration and carbon dioxide partial pressure were decreased than those in the control group,and the differences were statistically significant(P＜0.05).The scores of oral nasal dryness symptom and sore throat symptom in the experimental group were lower than those in the control group in 24 h,48 h,72 h during therapy,and the differences were statistically significant (P＜0.05).The incidence of hypoxemia and the incidence of secondary intubation were lower in the experimental group than those in the control group(P＜0.05).Conclusion Precautionary high-flow oxygen therapy for patients with Stanford type A aortic dissection can increase PaO2/FiO2,PaO2,reduce PaCO2,respiratory rate,reduce respiratory symptoms,reduce the incidence of hypoxemia,and secondary intubation.

Objective:To analyze the clinical features of patients with pyogenic liver abscess (PLA) and the application of mNGS in PLA, thus to provide reference for clinical diagnosis and treatment.Methods:The demographic and clinical data of 549 patients with liver abscess admitted to Zhongshan Hospital Affiliated to Fudan University from December 2015 to June 2020 were analyzed retrospectively. According to the detection of Klebsiella pneumoniae in 246 patients with positive etiological test results, the patients were divided into two groups: KPLA group and nKPLA group, and clinical characteristics of the two groups were compared. At the same time, the application value of mNGS in PLA was analyzed.Results:Among the 549 patients, the main clinical symptom of PLA was fever ( n= 503, 91.6%) and other clinical symptoms included chills and abdominal pain. Most patients had a single abscess ( n= 464, 84.5%) located in the right lobe ( n = 368, 67.0%), with a size between 5 and 10 cm ( n= 341, 62.1%). A total of 246 patients had positive etiological test results, including 202 KPLA patients which was the main pathogen of liver abscess. The prevalence of diabetes and fatty liver was higher in KPLA patients ( P < 0.05), but there were more culture of liver positive factors in nKPLA patients ( P < 0.001). Among the 109 patients with traditional microbiological results, 92 patients were suspected to KPLA (Klebsiella pneumoniae), of which 14 patients (15.2%) were multidrug resistant (MDR) infection; 17 patients were suspected to nKPLA, of which 10 patients (58.8%) were MDR infection; the incidence of MDR infection in patients with nKPLA was significantly higher than that in patients with KPLA ( P < 0.05). The positive rate of mNGS in plasma was 85.2%, the positive rate of traditional microbial culture in plasma was 14.8%, the positive rate of mNGS in pus was 96.2% and traditional microbial culture in pus was 65.4%. The positive rate of traditional culture was significantly lower than that of mNGS ( P < 0.05). Conclusions:PLA is usually manifested as fever, single and at the right lobe of the liver. Klebsiella pneumoniae is the most common pathogenic bacteria of PLA, which is more common in patients with diabetes and fatty liver, while non-Klebsiella pneumoniae is relatively more common in patients with culture of liver positive factors. The positive detection rate of mNGS is high, which has a unique advantage in pathogen detection.

Acute respiratory tract infection is the most common infectious disease in children, which seriously threatens children′s health.Rapid and accurate etiological diagnosis is of great significance for the clinical treatment and control of these diseases.Pathogen nucleic acid test was applied and became the main method of respiratory tract infection diagnosis for its high sensitivity and specificity.To regulate the application of pathogen nucleic acid amplification test in respiratory tract infection in children, improve the diagnosis level, expert consensus on nucleic acid amplification test of respiratory pathogens in children was prepared to guide the application and promote pathogens diagnosis ability.