Objective To explore the relationship between the overexpression of P glycoprotein (P GP) multidrug resistance (MDR) gene in the epileptic patient's peripheral blood lymphocytes and the drug resistance of the intractable epilepsy Methods This is a prospective, observational study. First, the overexpression of P GP MDR in 85 epileptic patients' (M 39, F46,overage age 24 years) peripheral blood lymphocytes were investigated by using immunocytochemistry (ICT) or flow cytometer (FCE). Then, patients were given a single or a combining of two antiepilepstic drugs which they did not received before (including carbamazepine, valproic acid, phenobarbitone,phenytoin), when the single drug was not effective in observing the clinical efficacy Results In FCE study group, results showed that the 11 patients with overexpression of P GP MDR in the epileptic patient's peripheral blood lymphocytes became tolerant to antiepileptic drugs. Eighteen out of 32 patients without overexpression of P GP MDR are effective. In the ICT study group, it is effective that there are only 2 out of the 22 patients with overexpression of P GP MDR. Seven of 12 patients without overexpression of P GP MDR are effective Conclusion It is suggested that the overexpression of MDR in the intractable epileptic patient's peripheral blood lymphocytes might be a significant drug resistance marker. The sensibility of ICT method should be better than the FCE,though the latter may be more accurate.

Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18％),43 gram-positive strains (28.29％),and 16 fungal strains (10.53％).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52％) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The receiver operating characteristic (ROC) curve of inflammatory cytokines was made for the diagnostic value in bloodstream infections.ROC curve used to distinguish between gram-positive bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP =0.791.When PCT cut-off value was 0.92 ng/mL,and CRP cut-off value was 68.00 mg/L,the sensitivity was 50％ and the specificity was 95.5％.ROC curve used to distinguish between the gram-negative bacterial bloodstream infections group and fungal group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.16 ng/mL and CRP cutoff value was 94.10 mg/L,and endotoxin was positive,the sensitivity was 82.8％ and the specificity was 100％.ROC curve used to distinguish between gram-negative bacterial bloodstream infections group and gram-positive bacterial group showed that AUCPCT+CRP+LPS =0.947.When PCT cut-off value was 2.68 ng/ mL,CRP cut-off value was 106.5 mg/L,endotoxin was positive,the sensitivity was 74.2％ and the specificity was 97.7％.Conclusions Gram-negative bacteria were the most common microorganisms in bloodstream infections in ICU patients.Compared with single inflammatory cytokine,the serum concentrations of PCT,CRP and endotoxin used together could provide more sensitivity and specificity for the early diagnosis of bloodstream infection with different microorganisms.

The calcaneus bone strength was assessed by quantitative ultrasonography in 47 postmenopausal women with type 2 diabetes mellitus (T2DM group) and 30 healthy postmenopausal women (control group).Speed of sound (SOS),broadband ultrasound attenuation (BUA) and stiffness index (SI) in T2DM patients were (1 015 ± 170)m/s,(84 ± 14) dB/MHz and 45 ± 8,respectively,which were significantly lower than those of control group (1 403 ± 232) m/s,(111 ± 18) dB/MHz and 66 ± 12 (all P ＜ 0.001).Stepwise multiple regression analysis showed that homeostasis model assessment of insulin resistance (IR) was independently correlated with the parameters of quantitative ultrasonography in T2DM patients.The results suggest that calcaneus bone strength is reduced in postmenopausal women with T2DM.

BACKGROUND:Single fracture or colapse of the posterolateral tibial plateau fractures is relatively rare in the clinical work. Rational choice of surgical approach and internal fixation for posterolateral plateau fracture is significant to restore the lower limb force line, maintain the joint stability and obtain good biocompatibility.
OBJECTIVE:To compare the stability and biocompatibility of Carlson posterolateral and posterior midline approaches for the treatment of posterolateral tibial plateau fractures with “T” shaped locking plate.
METHODS:From July 2011 to July 2014, 43 patients with posterolateral tibial plateau fractures, who were treated in the Affiliated Hospital of Jining Medical University, were retrospectively analyzed. Al patients were assigned to two groups according to approaches. In the Carlson posterolateral approach group, 22 cases received “T”-shaped plate insertion by Carlson posterolateral approach. In the posterior midline approach group, 21 cases received “T”-shaped plate insertion by posterior midline approach. After repair, perioperative data, fixation effects and knee function score were compared and analyzed between both groups.
RESULTS AND CONCLUSION:(1) 43 cases (43 knees) of posterolateral tibial plateau fractures were folowed up strictly. (2) No significant difference in operation time, fracture healing time, total load time, Hospital for Special Surgery score at 12 months postoperatively, tibial plateau angle and posterior slope angle immediately and 12 months postoperatively was detected between both groups (P > 0.05). (3) Significant differences in fracture exposure, blood loss, and excelent and good rate of Rasmussen at 12 months postoperatively were identified in both groups. Moreover, above indexes were better in the Carlson posterolateral approach group than in the posterior midline approach group (P< 0.05). (4) These findings confirmed that for a single fracture or colapse of the posterolateral tibial plateau fractures, two kinds of surgical approaches can achieve ful and direct exposure. Carlson posterolateral approach has good repair effect, fixation effect and biocompatibility.

Objective To observe the effect of different doses of butorphanol and sufentanil repeatedly epidural injected on the neurobehavior function in bone cancer model rats.Methods A PE-530 catheter was inserted into the epidural space of all male Sprague-Dawley rats(not mated,weighting 150-180 g) at L1-2 level.Three days after operation,64 rats without any motor dysfunction were randomly divided into eight groups (n=8):sham operated group (group C),normal saline with bone cancer pain group (group N),butorphanol groups(group B 1,B2,B3)and sufentanil groups (group S1,S2,S3).Bone cancer pain model was constructed in group N,B and S when rats in group C were sham operated.Rats in group C and N were epidurally injected NS 30μl each,and rats in group B1,B2 and B3 were respectively epidurally injected butorphanol 25,50,100 μg (all diluted to 30 μl with NS),when rats in group S1,S2 and S3 were respectively cpidurally injected sufentanil 1,2,4 μg (all diluted to 30 μl with NS) on time per day for 10-14 days after modeling.The neurobehavior paw withdrawal threshold (MWT) of the left hind claw was recorded to observe the changes in pain behavior.The neurobehavior function of rats were recorded by BBB (BASSO,BEATTIE and BRESNAHAN) score and the inclined plane test.Results Compared with group C((67.65±9.29) g),the MWT of the model groups obviously decreased before the first time of injection (N (15.23± 2.46) g,B 1 (16.14±2.28) g,B2(15.42±3.22) g,B3(14.35±2.32) g,S1 (15.37±2.11)g,S2(15.22±2.93) g,S3(16.25± 2.36) g) (all P＜0.05)).Compared with group N((16.13±2.37) g),the MWT of group B2,B3 and S3 increased obviously after the first time of injection ((35.12±5.16) g,(35.63± 1.53) g and (34.24±5.93) g) (P＜ 0.05).At the first day of injection,there was no significant difference in the BBB scores and the inclined plane test between the model groups (P＞0.05).At 6 h after the forth injection the inclined plane test and the BBB scores of group B3 were obviously decreased compared with group N ((34.72 ± 4.56) ° and (10.64 ± 1.82) points to (43.15±4.67)° and (14.05±1.78) points (P＜0.05)).Conclusion The results provide evidence that repeatedly epidural injection of butorphanol 50 μg or 100 μg or sufentanil 4 μg can reduce the pain of the rats with bone cancer pain.But repeated epidural injection of butorphanol 100 μg can injure the neurological function.

Objective: To discuss the clinical features of basaloid squamous carcinoma(BSC)and the factors relating to its prognosis and to compare patient survival between poorly differentiated squamous cell carcinoma(PDSC)and BSC. Methods: Clinical and pathological data of BSC and PDSC cases seen in our hospital between January 2004 and December 2008 were reviewed. Results: There were no statistical differences in demographic and clinical features between PDSC and BSC patients,with the exception that a larger proportion of BSC patients were female(P=-0.001).Additionally,higher tobacco consumption was observed among BSC male patients (P=0.003).There were no significant differences in survival rate between BSC and PDSC groups(X2=0.03,P=0.5470).The median survival time of BSC and PDSC patients was 19 months and 30 months，respectively.The 4-year survival rate was 22.4%and 36.1%，respectively(u=0.740,P=0.230).No significant difference was found in survival rate between stage Ⅰ and stage Ⅱ patients(X~2=0.109，P=0.2974).The median survival time of stage Ⅰ and stage Ⅱ patients was 19 months and 46 months，respectively；and the 4-year survival rate of stage Ⅰ and stage Ⅱ patients was 47.3% and 45.2%，respectively(u=0.122，P=0.450).Using Cox proportional hazard model，we found that surgical types and clinical stages of BSC were correlated with its prognosis.Compared with that of patients who received lobectomy,the postoperative mortality hazard of patients who received pneumonectomy and segmentectomy was increased by 1.379 times(P=0.031)and 1.634 times(P=0.061)，respectively.A more advanced clinical stage was associated with an increase in the postoperative morta,ty hazard ratio(X~2=14.12,P=0.000).The postoperative mortality hazard of patients of stage Ⅲ and stage Ⅳ was 2.437 times higher than that of stage Ⅰ patients(P=0.018).There were no statistical differences in postoperative mortality risk between stage Ⅰ patients and stage Ⅱ patients(P=0.057). Conclusion: Compared with that of PDSC,the incidence of BSC is higher among females.However,there is no difference in the prognosis between BSC and PDSC.BSC can be treated with the same therapies as those for other types of non-small cell lung cancer(NSCLC).

Objective:To study the relationship between gastric fundus size and postoperative gastroparesis and to find effective ways to prevent postoperative gastroparesis in high-risk patients.Methods:We retrospectively reviewed the clinical data of 276 gastric cancer patients undergoing radical gastrectomy from 2015 to 2016. The gastric fundus volume/total gastric volume (FV/TV) ratio was measured by computed tomography (CT) and comparative study between the gastroparesis group and the non-gastroparesis group was carried out in terms of postoperative gastroparesis. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance. Single-factor and multiple-factor analyses were performed to filter clinically significant predictive factors of gastroparesis. Then, we increased the sample size to 304 patients whose FV/TV ratio was >19.4%. The different surgical methods and perioperative management of these patients were analysed. The chi-square test and logistic regression analysis were performed to identify effective independent factors for preventing gastroparesis.Results:The FV/TV ratio in the gastroparesis group was significantly higher than that in the non-gastroparesis group ( P<0.05). A cut-off value of 19.4% was selected by ROC curve analysis, at which the FV/TV ratio had a sensitivity of 76.2% and a specificity of 53.7%. In 304 patients in the second retrospective study, the incidence of gastroparesis was 9.2%. Gastroparesis was significantly reduced in patients with residual gastric size <1/3 ( P<0.05) and early postoperative gastrointestinal decompression ( P<0.05). Conclusions:The FV/TV ratio can effectively predict the risk of postoperative gastroparesis preoperatively. Small residual stomach and early postoperative gastrointestinal decompression are effective measures to prevent gastroparesis in high-risk patients.

Objective To discuss the differences of inflammatory parameters such as procalcitonin ( PCT ), C-reactive protein ( CRP ), endotoxin, white blood cell ( WBC ), neutrophil ratio ( Neut%) in blood of septic patients caused by bacterial bloodstream infection, and their correlation with the severity of disease. Methods 292 septic patients with positive blood culture were enrolled in Beijing Shijitan Hospital Affiliated to Capital Medical University from February 2012 to March 2015, and their gender, age, acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) score, bacterial species and other general information were retrospectively collected. The differences in inflammatory parameters ( PCT, CRP, endotoxin, WBC, Neut%) in septic patients caused by bacterial bloodstream infection were compared, their correlations with APACHEⅡ scores within 24 hours were analyzed, and their diagnostic efficacies were also analyzed. Results ①It was shown by Pearson correlation coefficients that positively statistical correlation was found between PCT ( r=0.638 ), CRP ( r=0.620 ), endotoxin ( r=0.284 ), WBC ( r=0.209 ) and APACHEⅡscore ( all P=0.000 ) in bacterial bloodstream infective patients ( n=292 ), and positively statistical correlation was found between PCT ( r=0.626 ), CRP ( r=0.616 ), Neut%( r=0.297 ) and APACHEⅡscore ( all P<0.01 ) in Gram positive bacterial ( G+) group ( n = 86 ), and positively statistical correlation was shown between PCT ( r=0.631 ), CRP ( r=0.616 ), endotoxin ( r=0.301 ), WBC ( r=0.226 ) and APACHEⅡscore ( all P<0.01 ) in Gram negative bacterial ( G-) group ( n=206 ).②It was shown that PCT and CRP of both G+/G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup, respectively [ G+ group: PCT (μg/L ):0.92 ( 0.38, 4.75 ) vs. 0.43 ( 0.22, 1.00 ), CRP ( mg/L ):118.45±62.60 vs. 57.97±32.41;G-group:PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 1.28 ( 0.27, 4.12 ), CRP ( mg/L ):130.99±60.18 vs. 49.18±26.87, all P<0.01 ], and the endotoxin and WBC in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those of sepsis subgroup [ endotoxin ( ng/L ): 19.40 ( 9.62, 33.87 ) vs. 10.00 ( 5.00, 18.52 ), WBC ( ×109/L ): 12.13±6.72 vs. 9.61±5.01, both P<0.01 ]. The PCT and endotoxin in G-bacterial severe sepsis and septic shock subgroup were significantly higher than those in G+severe sepsis and septic shock subgroup [ PCT (μg/L ):6.92 ( 1.94, 25.90 ) vs. 0.92 ( 0.38, 4.75 ), endotoxin ( ng/L ):19.40 ( 9.62, 33.87 ) vs. 2.56 ( 1.11, 4.01 ), both P<0.01 ].③The diagnostic efficacy of inflammatory parameters for severe sepsis and septic shock subgroup were: PCT area under receiver operating characteristic ( ROC ) curve ( AUC ) = 0.683, the cut-off point = 0.55 μg/L, sensitivity 63.2%, specificity 69.0%; CRP AUC = 0.802, the cut-off point = 92.25 mg/L, sensitivity 73.7%, specificity 86.2%; WBC AUC = 0.614, the cut-off point = 7.35×109/L, sensitivity 75.4%, specificity 48.3%; Neut% AUC = 0.622, the cut-off point = 0.882, sensitivity 43.9%, specificity 79.3%in G+group. At the same time, it was shown that PCT AUC=0.780, the cut-off point=6.80μg/L, sensitivity 51.0%, specificity 93.9%; CRP AUC = 0.907, the cut-off point = 90.10 mg/L, sensitivity 73.2%, specificity 95.9%;endotoxin AUC=0.694, the cut-off point=17.54 ng/L, sensitivity 57.3%, specificity 75.5%;WBC AUC=0.611, the cut-off point = 10.54×109/L, sensitivity 54.1%, specificity 69.4%; Neut% AUC = 0.621, the cut-off point = 0.843, sensitivity 65.6%, specificity 61.2%in G-group. Conclusions The plasma PCT and CRP have the best correlation between inflammatory parameters and severity of disease in bloodstream infective sepsis patients. CRP has the best diagnostic effect in severe sepsis/septic shock patients with bloodstream infection.

Objective To analyze retrospectively the relationship between protein nutrition index (PNI) and survival conditions in patients with peritoneal dialysis (PD).Methods Various clinical and laboratory indexes of patients with chronic kidney disease from January 2004 to January 2014 were analyzed retrospectively.PNI score was determined by serum albumin (ALB),normalized protein nitrogen presentation rate (nPNA),lean body mass (LBM).According to PNI score,PD patients were divided into four groups:good nutrition status,nutrition status in general,poor nutrition,PEW status.Linear regression analysis was used to analyze determine factors of PNI;analysis of Kaplan-Meier was applied to examine relationship between the protein nutrition status and survival rate;COX regression analysis was used to analyze the risk factors for survival in patients with PD.Results All the indexes,age,complications index,serum Cr,K-Kt/V,T-Kt/V had a linear relationship with PNI.5-year survival rate in the four groups were respectively 95％,92％,65％,23％.Age,complications,PNI index were the survival risk factors of PD patients.Conclusions According to PNI score,evaluation of protein nutritional status of patients with PD could predict survival conditions of PD patients,the higher PNI score,the higher survival rate.

Objective To evaluate the effect of combination therapy with milrinone and esmolol on hemodynamics and cardiac function in patients with septic myocardial depression. Methods From October 2010 to October 2013,after the hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PICCO),74 sepsispatients withCI < 2.2 L/min · m2 after fluid resuscitation were enrolled in the study and were divided into group A with intravenous injection of dobutamine hydrochloride ,and group B with intravenous injection of milrinone and esmolol,with 37 cases in each group. The patients'PICCO indicators, echocardiography and cardiac biomarker(CK,CK-MB,MYO,cTnI and ProBNP)in two groups were compared before and after 3-day treatment. Results (1)CI and GEF were significantly increased in group B after 3-day treatment when compared with those in group A.(2)Compared with those in group A,early diastolic mitral flow velocity/end diastolic mitral velocity (E/A) and right ventricular diastolic diameter(RVD) in group B had statistical significance.(3) CK-MB,cTnI and ProBNP decreased significantly in group B when compared with those in group A. Conclusion Combination therapy with milrinone and esmolol can increase cardiac ejection function,slow down the heart rate,reduce the heart blood and vascular preload,lessen the injury of myocardial and improve heart function.