Objective To investigate the ultrasound measured inferior vena cava (IVC) caliber used as an objective indicator to assess water retention of patients with acute heart failure (AHF).Methods A total of 72 consecutive patients with acute heart failure admitted in the emergency department between December 2013 and April 2014 were enrolled.Acute heart failure was defined by the presence of symptoms such as asthmatic embarrassment and nocturnal paroxysmal dyspnea with or without signs of tracheobronchchial rale and edema of lower limbs,and by objective evidence of cardiac dysfunction as well,either a left ventricular ejection fraction (LVEF) ≤ 45％ or the combination of both left atrium dilation (≥ 4 cm diameter in the parasternal long axis) and a plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) ＞ 450 pg/mL (patients under 50 years old) or ＞ 900 pg/mL (patients over 50 years old and under 75 years old) or ＞ 1800 pg/mL (patients over 75 years old) or ＞ 1200 pg/mL (patients with renal dysfunction,glomerular filtration rate ＜ 60 mL/min).Exclusion criteria were chronic hepatic disease and acute myocardial infarction.Another 22 patients were enrolled as control.Independent t tests were used to compare normally distributed continuous variables between two groups,while nonparametric tests were used to compare non-normally distributed continuous ones,and chi-squared tests were used for categorical variables.The relations between IVC inner diameter and other normally distributed variables were assessed by Pearson correlation coefficients.A 2-sided P value ＜ 0.05 was considered statistically significant.Results The congestion score and IVC inner diameter were significantly higher in patients with AHF (P ＜ 0.05 ; P ＜ 0.01).The IVC inner diameter was correlated with NT-proBNP concentration (r =0.339,P =0.01 3) and congestion score (r =0.431,P =0.002).There was no relation between IVC inner diameter and LVEF (r =-0.241,P =0.102).IVC inner diameter had significantly positive correlations with pulmonary artery pressure and tricuspid regurgitation (r =0.414,P =0.004 ; r =0.359,P =0.015).Creatinine,blood urea nitrogen,and bilirubin were independently associated with increasing IVC inner diameter (r =0.313,P =0.032 ; r =0.379,P =0.009 ; r =0.385,P =0.007),while IVC inner diameter had negative relation with glomerular filtration rate (r =-0.337,P =0.021).Conclusions The IVC inner diameter can be used as a measurable and objective indicator to estimate the magnitude of access water retention in patients with AHF.

Objective To retrospectively analyze the correlation between the glucose variability and the recent prognosis of acute coronary syndrome.Methods Eight hundred and seventy-eight patients with acute coronary syndrome(ACS)were enrolled in present study,of them 298 cases had history of diabetes mellitus and 580 patients had no history of diabetes mellitus.All ACS patients were divided into 4 groups according to glucose variability [blood glucose coefficient of variation(CV)as index] or mean blood glucose during hospitalization.The baseline data,such as characteristics,clinical features,outcome and adverse event,of all patients with ACS were collected,and the mean blood glucose and glucose variability were calculated.Other indices of blood glucose,such as maximum blood glucose concentration during hospitalization(GluMax)and blood glucose concentration on admission(GluAdm)were also collected.The correlations between these variables and hospital mortality were analyzed retrospectively.Results Eighty-two patients died during hospitalization.The incidence of myocardial infarction and cardiogenic shock as well as hospital mortality in the patients with ACS increased significantly along with the elevation of both mean blood glucose and glucose variability during hospitalization(P

Purpose:To investigate the expression of site specific markers and to identify the primary site of tumor origin in brain metastatic carcinoma (BMC). Methods:31 cases of BMCs were clinicopathologically studied, and TTF 1、TG、CK7、CK20 as markers of BMCs were detected by EnVision immunohistochemical staining. Results:In 31 BMC patients, there were 19 men and 12 women, and the male:female ratio was 1.58∶1. Their age ranged from 32 to 82 years (mean, 61.7 years); 23 cases of them arose from primary lung carcinoma, of which in 19 cases (82.6%) positive staining for both TTF 1 and CK7 metastases were detected, one case negative staining for TTF 1 but positive for both CK7 and CD20, 1 case positive staining only for CK7 and one cases negative staining fully for TTF 1、CK7 and CK20 were also diaplayed;Two cases from thyroid carcinoma expressing TTF 1 and TG were noted in BMCs. One tumor from gastric adenocarcinoma and one tumor from esophageal adenocarcinoma, positive staining for CK7 and CK20, wwere presented. One case from rectal adenocarcinoma expressing only CD20 and one from breast carcnoma staining for CK7 were included in the metastatic carcinomas. Two cases without positive staining for all antibodies above did not responded to the follow up. The primary sites of BMCs were not identified in 41.9% before operation, but only 6.7% of the primary sites of BMCs were not determined after immunnohistochemical staining was used for the differentiation among them,as well as other further examinations. Conclusions:Metastases of primary origin from lung were the most common in the BMCs. Immunohistochemical staining used by a monoclonal antibody panel combining TTF 1、TG、CK7、CK20 could help identify the primary site of tumor origin in BMC.

Objective To discuss the value of amplitude integrated electroencephalographic(aEEG) monitoring in early neonatal brain injury and prognosis of asphyxia neonatal.Methods Seventy-two subjects of asphyxia children were divided into mild asphyxia group and severe asphyxia group.We selected 45 cases of full-term healthy children born in our hospital as control group in the same term.All the objects were observed by aEEG monitoring within 6 hours.According to the aEEG results,all the samples were redivided into normal aEEG group,mildly abnormal aEEG group and severely abnormal aEEG group.All subjects were followed-up to observe their physical growth and the nervous system development at one-year-old.Results Incidence of abnormal aEEG in mild asphyxia group and severe asphyxia group was significantly higher than that of control group(x2 =26.996,47.07,P ＜ 0.01,respectively),and incidence of abnormal aEEG in severe asphyxia group was significantly higher than that of mild asphyxia group (x2 =7.76,P ＜ 0.05).There was no significant difference in all subjects about physical development (height and weight) (P ＞ 0.05),all of their mental index and developmental quotient were lower in severely abnormal aEEG group (x2 =13.450,15.285,P ＜ 0.01,respectively).Conclusion aEEG can be used to assess the early neonatal brain injury of asphyxia neonatal,and it can be used to predict the prognosis of neonatal asphyxia based on the abnormal degree of aEEG.

Objective To conduct a prospective,randomly controlled trial,evaluating the combination of tacrolimus,corticosteroids and entecavir for the treatment of adult patients with biopsyproven hepatitis B virus-associated membrane nephropathy (HBV-MN).Methods A total of 38 patients with biopsy-confirmed HBV-MN were randomized to the tacrolimus group (n=19) and the control group (n=19).Patients in tacrolimus group received combination therapy of tacrolimus (0.05 mg·kg-1 · d-1),corticosteroids (prednisone acetate,0.5 mg· kg-1 · d-1) and entecavir (0.5 mg/d),whereas patients in control group received entecavir mono-therapy (0.5 mg/d).The primary end point was the percentage of patients reaching complete remission (CR) or partial remission (PR).Results The probability of remission in the treatment group was 88.89％ and 94.44％ after 6 and 12 months,but only 38.89％ and 58.82％ in the control group,respectively.The decrease in proteinuria was significantly greater in the treatment group.Entecavir was used for the treatment of hepatitis in all patients,which caused the disappearance of serum hepatitis B viral DNA(HBV-DNA) and the normalization of ALT and AST levels in 3 months.Notably,two patients in the control group and one patient in the treatment group reached the secondary end point.One patient in the tacrolimus-treated group showed a relapse during the taper period.Conclusion This treatment protocol not only can control the replication of HBV-DNA but also can reduce proteinuria and preserve renal function,it is one of useful therapeutic options for patients with HBV-MN.

Objective To analyze the clinical data of children with Langerhans cell histiocytosis (LCH),to discuss the therapeutic effect,and to analyze the factors related to prognosis.Methods A total of 45 children diagnosed as LCH were divided into group A (18 cases with bone lesion only),group B(6 cases with soft tissue lesion),and group C (21 cases with viscera lesion) according to Shanghai Children's Hospital-LCH-2007 scheme [SCH-LCH-2007 (modified DAL-HX83/90) scheme].(1) Initial treatment:group A was treated with Prednisone (Pred) + Vincristine (VCR) for 28 weeks,and group B was treated with Pred + VCR + Etoposide (VP16) + Mercaptopurine (6MP) for 43 weeks,and group C was treated with Pred + VCR + VP16 + Methotrexate (MTX) +6MP for 52 weeks.(2) Re-treatment scheme after relapse included:①upgrading treatment,group A to group B,group B to group C.②Individual treatment for group C included VP16 modification,and maintained Thymosin and/or Ciclosporin etc.Results The total survival rate was 93.3％ (42/45 cases) and recurrence rate was 26.7％ (12/45 cases).Children in group A and B were all effective,while 2 patients in group C died,and 1 case missed follow-up.Multi-factor analysis showed that the factors like age,sex,group,skeleton,soft tissue,erythra,lymph gland,lung,mouth,ears,hypophysis pituitary had no statistical significance,but liver,spleen and blood involvement had statistical significance in disease relapse:liver (P=0.007 1),spleen (P=0.016 9),and blood (P=0.011 1).Conclusion LCH can affect several organs of children and relapse,and modified DAL-HX83/90 scheme is very effective.The liver,spleen and hematopoiesis system involvement is correlates with the relapse.

Animal medicine is an important part of traditional Chinese medicine with a long application history in China. Systematically understanding the history of the development of animal medicine is of great significance to scientific protection and rational use of animal medicine resources. It has certain guiding significance to protection of wild resources, exploitation of new substitutes, standardization and summary of artificial breeding, and artificial reproduction technology. Taking the development of bezoar as an example, this article expounded the following four aspects:the development history of animal medicine, national animal protection, technical development, and prospect forecast by summarizing the Chinese ancient medical books and consulting the relevant laws and regulations. The entire above are about to offer new ideas for the sustainable development, the development of new medicine resources, and the development of animal medicine related preparation product.

Objective To evaluate the efficacy and toxicities of gemcitabine combined with ifosfamide and anthracycline chemotherapy for recurrent platinum resistant ovarian epithelial cancer.Methods Gemcitabine 800 mg/m2 ( day 1, 8 ), ifosfamide 1.5 g/m2 ( day 1 - 3 ), adriamycin 40 mg/m2 or epirubicin 60 mg/m2 (day 1 ) or mitoxantrone 10 mg/m2 (day 1, 8 ) were used in recurrent platinum resistant/refractory ovarian cancer patients, the cycle was repeated at interval of 21 to 28 days.Results A total of 60 patients received 172 cycles combined chemotherapy.There were no one cases complete response, while partial response 22 (37%, 22/60), stable 23 (38%, 23/60) and progression 15 (25%,15/60) were observed, with clinical benefit rate 75% (45/60).The median time of progression-free survival was 7 months, and the median overall survival time was 20 months.The main side effect was hematologic toxicity with leukopenia rate of 82% (49/60), among which Ⅲ - Ⅳ accounted for 31%(15/49).Digestive reaction was all in Ⅰ - Ⅱ , accounted for 42% (25/60).Conclusion The regimen of gemcitabine combined with ifosfamide and anthracycline is feasible, tolerable and effective in patients with recurrent platinum resistant/refractory epithelial ovarian cancer.

Objective To explore the efficacy and safety of glucocorticoids+cyclophosphamide+tacrolimus capsules (GC+CTX+FK506) in the treatment of patients with type Ⅲ+V and Ⅳ+Vlupus nephritis. Methods The 31 cases with first diagnosis as systemic lupus erythematosus (SLE) with type Ⅲ+V and Ⅳ+Vlupus nephritis (LN) were selected, then divided into group A (CTX+GC) with 16 cases and group B (FK506+CTX+GC) with 15 cases. The group A received CTX+GC during treatment, group B received GC+CTX+FK506 for the first three months, and received FK506+GC for the last three months. The patients were followed up once monthly to observe the efficacy and safety,the efficacy was analysed after 6 months. Results After treatment, the total efficacy in group B was significantly higher than group A (86.7%vs.50.0%, P<0.05). The 24 h urine protein of group B was lower than group A(P<0.05). The plasma albumin of group B was higher than group A (P<0.05). After treatment, the systemic lupus erythematosus disease activity index (SLEDAI) in two groups were lower and C3 level was higher than those pre-treatment(P<0.05), but there was no significant difference in above indicators between two groups. There was one case menelipsis in group A, and one case with transient increasing of creatinine. Conclusion The FK506+CTX+GC could reduce urine protein sifnificantly compared with CTX+GC without serious adverse reaction.

Objective To investigate the efficacy and safety of Tripterygium wilfordii Hook F (TwHF) combined with renin-angiotensin system (RAS) blockers in chronic kidney disease (CKD) stages 2~3 of IgA nephropathy. Methods 109 patients were randomized into the observation group and the control group. On the basis of taking RAS blockers, patients in the observation group received TwHF, and patients in the control group received methylprednisolone. The proteinuria, renal function and adverse effect were observed during treatment. Results At 3, 6, 9 and 12 months of treatment, proteinuria in the two groups was lower than the baseline(P <0.05). During follow-ups, there was no significant difference of eGFR between the two groups and baseline (P >0.05). Besides, there was no significant difference in terms of proteinuria, eGFR and effective rate in the two groups. The occurrence rate of adverse effects was 9.8% vs 27.4% and there was significant difference in the two groups (P < 0.05). Conclusions TwHF combined with RAS blockers can decrease proteinuria, protect renal function and have less adverse effects, and it is a useful therapeutic options for CKD stages 2 ~ 3 of IgAN.