OBJECTIVETo sum up the experience in diagnosis and treatment of Fournier's gangrene and find an optimal evaluation tool for its prognosis by comparing currently used prognostic scoring systems.

METHODSWe retrospectively analyzed 16 cases of Fournier's gangrene diagnosed and surgically treated in our hospital between 2004 and 2012. Using Fournier's Gangrene Severity Index (FGSI), Uludag Fournier's Gangrene Severity Index (UFGSI), Age-Adjusted Charlson Comorbidity Index (ACCI), and Surgical Apgar Score (sAPGAR) , we obtained the prognostic scores of the patients and made comparisons among different scoring systems.

RESULTSFGSI, UFGSI, ACCI, and sAPGAR were all clinically used scoring systems. Statistically significant differences were found in the scores of ACCI and UFGSI but not in those of FGSI and sAPGAR between the death and survival groups, with the maximum area under the ROC curve and minimum standard error for the ACCI score.

CONCLUSIONBoth ACCI and UFGSI are useful for evaluating the prognosis of Fournier's gangrene. However, ACCI is even better for its higher sensitivity and specificity and easier clinical collection.

Age Factors ; Aged ; Fournier Gangrene ; diagnosis ; mortality ; surgery ; Humans ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity ; Severity of Illness Index

Congresses as Topic ; Otolaryngology ; Otorhinolaryngologic Diseases ; surgery

Objective To analyze the effects of severe neonatal asphyxia on various organ-systems and to identify the risk factors associated with the resultant injuries and death. Methods The data of 170 cases in the last 10 years from January 1993 to March 2004 were analyzed. The risk factors associated with death were subjected to odds ratio (OR)analysis with the SAS software. Results There were 22 deaths in the 170 cases ( 12.5% ). Organ-system injuries were evident in 165 of 170 cases (97. 1% ). In descending orders, the organ-system injuries were central nervous system [ CNS,66.5% (113/170) ], pulmonary [62.9% (107/170) ] and metabolic disorders [50.6% (86/170) ]. The severity of injuries was in the reversed orders from metabolic disorders, pulmonary to CNS. From high risk to low, the factors which affected the mortality of severe asphyxia were, in order, severe CNS injury, ≥ 1 organ/system injury, respiratory failure,metabolic abnormality, electrolyte imbalance, blood-gas abnormality, pulmonary involvement, 10 min Apgar score ≤ 3,gestational age ＜ 37 weeks, hepatic involvement, cardiac involvement, raised PCO2, and hematologic involvement.Conclusions Organ-system injuries in addition to hypoxic-ischemic encephalopathy (HIE) were complications found in the majority of the cases with severe neonatal asphyxia. The risk factors such as CNS injury or HIE, pulmonary dysfunction and failure, and multiorgan dysfunction syndrome (MODS) involving more than three organ-systems should be detected and recognized early so that early intervention can be instituted to reduce the mortality.

UNLABELLEDOBJECTIVE; To evaluate the efficacy and safety of Jiangtang Xiaozhi Capsule (JTXZC) in treating type 2 diabetes mellitus (T2DM) of qi-yin deficiency phlegm-stasis inter-obstruction syndrome (QYDPSIOS), and to observe its effect on inflammatory factors and fibrinolytic factors.

METHODSBy adopting a randomization grouping, parallel control, and prospective study, 73 T2DM patients of QYDPSIOS were assigned to two groups by random digit table, the Pioglitazone Tablet group (36 cases, as the control) and the JTXZC group (37 cases). All patients maintained their basic therapies and lifestyle as previous after recruitment. Patients in the JTXZC group took JTXZC, 4 pills each time, three times per day, while those in control group took Pioglitazone Tablet, 15 mg each time, once daily. The therapeutic course for all was 8 weeks. The body weight (BW), the height, body mass index (BMI), waist circumference (WC), hip circumference, waist-to-hip ratio (WHR), and scoring of Chinese medicine (TCM) symptoms were observed. Levels of fasting blood glucose (FBG), 2 h postprandial blood glucose (2 h PBG), glycated hemoglobin (HbA1c), tumor necrosis factor alpha (TNF-alpha), nuclear factor kappaB (NF-kappaB), and plasminogen activator inhibitor 1 (PAL-1) were detected. The safety indices such as liver and renal functions and adverse reactions were also observed.

RESULTSCompared with before treatment, BW, BMI, HbA1c, and PBG were obviously lower after 8-week treatment than before treatment in the JTXZC group (P < 0.05). There was no statistical difference in post-treatment BW, BMI, HbA1c, or 2 h PBG between the two groups (P < 0.05). Compared with before treatment, levels of TNF-alpha and PAI-1 were lowered after 8 weeks of treatment in both groups (P < 0.01). The level of NF-kappaB was obviously lowered after 8 weeks of treatment in the control groups (P < 0.05), but it also decreased in the JTXZC group with no statistical difference. The scorings of CM symptoms were somewhat improved after treatment in the two groups (P < 0.01). Besides, better effects were obtained in the JTXZC group (P < 0.05). No severe adverse event occurred in either group during the whole therapeutic course.

CONCLUSIONSJTXZC showed similar therapeutic effect to pioglitazone. Both of them could effectively improve patients' clinical symptoms, the inflammation and fibrinolytic activities in different pathways, with no severe adverse reaction.

Adult ; Aged ; Diabetes Mellitus, Type 2 ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Qi ; Thiazolidinediones ; therapeutic use ; Yin Deficiency ; drug therapy

This paper reports a new type of thighbone and cervical bone fraction internal fixing aim di- rector,it has the advantage of entering pin accuratly,simple operating,short time for x-ray irradiating, little suffering to the patient and being economic.

Purpose:To determine the efficacy of paclitaxel in human bladder cancer lines and to investigate the mechanism by which paclita xel induce apoptosis in human bladder cancer cells. Methods:BIU-87, 5637, T24 and EJ bladder cancer cell lines wer e cultured by techniques of cell culture in vitro. The cytotoxic activity an d apoptosis induction abilities of paclitaxel were analyzed by MTT and Annexin- V assay as well as DNA cytometry , respectively. The effects on the cell cycle w ere assessed by flow cytometry of propidium iodide. The expressions of Bcl-2, B ax, p53 and Caspase3 proteins were determined by flow cytometry immunofluorescen ce. Results:Paclitaxel dose-dependent inhibition of cell prolifera tion was seen.Paclitaxel induced G_2/M arrest (71.29% and 64.57%) which was maximal in 5637 and EJ cell lines. While paclitaxel at 1?g/ml concentration ex posure to 5637 12h, 14h and 48h respectively, the apoptosis rates of the respect ive times were 5.0%, 12.9%, 27.6%. The expression of genes p53 and Bcl-2 was no t influenced, whereas the expression of Bax and Caspase3 had increases time-dep endently after exposure to paclitaxel. The analysis of Annexin-V showed a drama tic dose-dependent increase of apoptosis. Conclusions:Paclitaxel inhibited bladder cancer cells prolifera tion and had more effect on those cells whose grade was lower and doubling time was longer. Paclitaxel could block G_2/M arrest, and induce apoptosis by th e path of Bcl-2/Bax in bladder cancer cell lines.

Objective To characterize molecule profiling for hypoxia/hypothermia-conditioned human endothelial cells(EC),and to examine the hypothesis that the interaction between hypoxia/hy- pothermia-conditioned EC and monocytes plays a key role in early hypoxia/hypothermic reperfusion in- jury.Methods Human aortic EC were conditioned in hypoxia/hypothermia chamber at 4℃for 91) rain followed by 4 to 8 h re-warming at 37℃and then analyzed initially by RT-PCR to evaluate RNA transcripts.To examine early cellular interactions,a cellular adhesion study was performed using EC and fluorescence-conjugated DIO labeled purified human monocytes,and CD4~+ T cells as well as PB- MC.Interactions between PKH-26-labeled EC and these cells were carried out to determine EC mem- brane uptake by monocytes.Results RT-PCR analysis demonstrated that hypoxia/hypothermia-con- ditioned EC up-regulated RNA transcripts of inflammatory cytokines,ECE-1 and endothelin,co-stim- ulatory molecules,and adhesion molecules CD54.FACS showed minimal up-regulation of CD54 on hy- poxia-hypothermia-conditioned EC.Low level adhesion of purified CD4~+ T cells to resting and hypoxi- a/hypothermia-conditioned EC was noted.In contrast,high levels of monocyte adhesion to hypoxia/ hypothermia-conditioned EC were observed when compared to resting EC.EC membrane up-take by monocytes but not CD4~+ T cells was revealed by FACS,and the levels of EC membrane up-take were similar to those of the normal EC.Conclusions Hypoxia/hypothermia-conditioned EC demonstrated up-regulation of multiple RNA transcripts associated with inflammatory responses,cellular adhesion and co-stimulation.Human monocyte adhesion to hypoxia/hypothermia-conditioned EC was greater than T cells.Monocytes up-took EC membrane during their interaction.These findings suggest that the initial interaction between monocytes and hypoxia-hypothermia EC,but not T cells,may play a critical role during early reperfusion injury.

Objective To investigate the efficacy of TACE combined with radiofrequency ablation (RFA) in treatment of advanced hepatocellular carcinoma.Methods A total of 72 patients with advanced hepatocellular carcinomas were analyzed retrospectively,including 35 patients underwent TACE combined with RFA (combined group),37 patients underwent single TACE (control group).After the operation,the short-term effect,the changes of liver function,serum alpha-fetoprotein (AFP) level,the complication and the long-term survival rates of the two groups were compared.Results The total effective rate of the combined group (29/35,82.86％) was significantly higher than that of control group (20/37,54.05％;P=0.009).In the combined group,the AFP reduced to (102.19±32.13)μg/L,and the control group reduced to (218.46±49.87)μg/L,which had statistical difference (P＜0.001).The survival rates of 1-year,2-year and 3-year in the combined group were 82.86 ％,54.29 ％,34.29 ％ with a median survival time of 25 months;while in the control group those were 54.05％,32.43％,13.51％ with a median survival time of 16 months;there were statistically significant differences in the survival rate between two groups (P=0.009).After treatment,the hepatic functions of both group had a transient change,and 2 weeks after the operation,there was no significant difference between the two groups (all P＞0.05).Conclusion The combination of TACE and RFA is an effective method for the treatment of advanced hepatocellular carcinoma.

OBJECTIVETo analyzed the relationship between lumbar endplate Modic area changes rate and low back pain by measuring MRI T2 sagittal image of lumbar endplate Modic area changes rate.

METHODSFrom December 2011 to June 2012,70 patients with low back pain in operation were evaluated on pain by VAS and function by JOA,and examined by MRI including 39 males and 31 females with an average age of (51.00 +/- 11.89) years ranging from 29 to 72 years old. Among them, 54 cases had lumbar endplate Modic changes involving 15 cases in types Modic I ,21 cases in type Modic II, 11 cases in type Modic III ,mixed type Modic in 7 cases (eliminated for too few cases). Modic area changes and corresponding vertebral area were measured on MRI T2 median sagittal. The areas of two ways were compared to yield the rate of changes for Modic, for multisegmental Modic changes to calculate the total ratios. A correlation was observed among JOA, VAS and the rate of Modic changes.

RESULTSThe correlation coefficient of change rate of Modic I with JOA score was r = -0.308, P = 0.048 < 0.05, there was a negative correlation;the correlation coefficient of change rate of Modic I with VAS scores was r = 0.428,P = 0.021 < 0.05, there was a positive correlation. The correlation coefficient of change rate of Modic II with JOA score was r = -0.375, P = 0.043 < 0.05, there was a negative correlation;the correlation coefficient of change rate of Modic II with VAS score was r = 0.352, P = 0.041 < 0.05, there was a positive correlation. The area change rate of Modic III had no significant correlation with low back pain degree (P > 0.05).

CONCLUSIONModic I and II area changes rate of of patients with low back pain is closely related to the degree of pain low back pain, Modic III area changes rate is not significant correlated to the degree of lower back pain.

Adult ; Aged ; Female ; Humans ; Low Back Pain ; diagnosis ; diagnostic imaging ; Lumbar Vertebrae ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography