Objective To evaluate the value of gelsolin for the prognosis of patients with severe sepsis.Methods 50 patients in the emergency intensive care unit of Beijing hospital from January 2015 to July 2015,were determined white blood cell count (WBC),C-reactive protein (CRP),procalcitonin (PCT),gelsolin at admission,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were estimated within 24 hours.According to the 28 days of survival outcome,50 patients were divided into two groups:survival group and death group.The significant difference of these factors was compared.Binary logistic regression analysis was applied for screening independent risk factors for the prediction of death.The receiver operating characteristic (ROC) curve was applied for the evaluation and comparison about prognosis ability.Results 31 patients were in the survival group,19 patients in the death group.The gelsolin [(21.43±10.54) vs.(13.31±8.54),P=0.007] andAPACHE Ⅱ score [(19.2±6.86) vs.(24.6 ± 8.9),P =0.021] in two groups had significance difference.Binary logistic regression analysis indicated that the gelsolin and APACHE Ⅱ score were independent risk factors of predicting death.The area under of ROC curve (AUC) of the gelsolin was 0.745 (95％ CI:0.599-0.851,P =0.004) and the APACHE Ⅱ score was 0.699 (95％ CI:0.537-0.862,P =0.019).Both prognosis ability were equivalent.To combine the tow factors,the accuracy of predition was 90％ and has better complementarity.Conclusions the gelsolin could assess the severity of patients with severe sepsis and predict the prognosis more accurately.

Objective To investigate clinical value of gelsoin level for evaluating severity and prognosis in patients with critical illness. Methods Forty-eight patients with critical illness admitted to the Emergency Intensive Care Unit of Beijing Hospital during February to December 2008 were enrolled in this study, with 23 survivors and 25 deaths. Serum level of gelsolin was measured for 31 of them at least twice during their hospital stay, and for other 17 only once at their admission. They all were evaluated with acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) scores within 24 hours after admission. In addition, serum level of gelsolin was measured for another 307 healthy adults as controls. Results Initial level of gelsolin was significantly lower in 48 patients at critically ill than that in controls [(24 ± 11) mg/L vs. (192 ±39) mg/L, P < 0. 01]. There was significant difference in initial level of gelsolin between surviving group (23 cases) and death group (25 cases) [(28 ± 10) mg/L vs. (21 ±12) mg/L, P = 0. 033]. Fatality of patients at critically ill increased as their level of gelsolin at 22 mg/L or less, with a predicting accuracy of 74. 19% , as well as decreasing trend of their gelsolin levels in continuously minitoring, with a predicting accuracy of 70. 97%. Predicting accuracy of APACHE Ⅱ scores of 30 or more was 67.74%. However, predicting accuracy would reach 93.55% as final level of gelsolin and its decreasing trend combined with APACHE Ⅱ scores in prognostic assessment for critically ill patients. Conclusions Severity of patients at critically ill can be predicted by their gelsolin level, especially in continuously monitoring, which is an indicator better than APACHE Ⅱ scores. Combination of gelsolin level with APACHE Ⅱ scores shows a more accurate prognostic assessment for critically ill patients.

Objective To summarize experience and prognosis of repeat renal transplantation after graft loss due to BK virus nephropathy (BKVN).Methods The clinical data of 4 adult patients undergoing repeat transplantation after previous allograft loss due to BKVN were collected and analyzed retrospectively.Results Three of four patients had documented allograft loss caused by BKVN and underwent retransplantation 5 months,9 months and 9 months respectively after hemodialysis with confirmed clearance of viremia.Allograft nephrectomy was performed on 1 of 3 patients 4 months before retransplantation.Maintenance immunosuppression was CsA + MMF + Pred,Tac + MMF + Pred and CsA + Pred in these 3 patients respectively.During the follow-up period of 9 months,5 months and 26 months,viremia kept negative and allografts function stabled normally without recurrence of BKVN.The cause of allograft loss was not illustrated in the other patient before retransplantation,which was performed without dialysis or allograft nephrectomy.BK virus was not monitored routinely after the operation.Four months later,his serum creatinine rose up to 400μmol/L and BKVN recurrence was proved by pathological analysis of the biopsy samples of the first and the second transplantation.Tac was switched to CsA and his serum creatinine declined to 260 μnol/L at 20th month.Conclusion Retransplantation can be performed on the patients with previous allograft loss due to BKVN.Allograft nephrectomy,clearance of viremia,monitoring BK virus and timely adjustment of immunosuppression were the keys to guarantee successful retransplantation.

OBJECTIVE: To assess the treatment outcome after endoscopic sinus surgery (ESS) in patients with recurrent sinusitis and to research which factors could influence the clinical outcome. METHOD: Endoscopic sinus surgery was performed in 55 patients. The clinical outcome and epithelization of mucosa after ESS were evaluated by Chinese ENT Association criteria. RESULT: The total cure rate was 81.82%, effective rate was 92.73%. The mean period of epithelization after operation was 13.2 weeks. No serious complication occurred. CONCLUTION The treatment efficacy can be greatly improved by the normative combined therapy which include the standard and orderly perioperative treatment ,the overall shape and nasalization of nasal cavity, postoperative follow-up and clearing cav ity after ESS.
Adult ; Aged ; Combined Modality Therapy ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Sinusitis ; therapy ; Treatment Outcome ; Young Adult

OBJECTIVE: To report the experience of canalplasty in treatment of stenosis or atresia of the external auditory canal. METHOD: A retrospective review was performed on 10 patients (10 ears) that underwent canalplasty. The lesions located in bony segment in 1 case, cartilaginous segment in 3 cases, both in cartilaginous and bony segments in 6 cases, in which 4 cases accompanied with the middle ear diseases. All patients received the canalplasty surgery, and tympanoplasty was applied simultaneously if the patient had otitis media. RESULT: Follow-up was conducted for 8-50 months respectively, 8 of the external auditory canal was wide and tympanic membrane gained a good shape, 2 case had stenosis or atresia reoccurrence after the operation. CONCLUSION Appropriate approach and elimination of the lesions thoroughly are key points for the canalplasty.
Adult ; Aged ; Constriction, Pathologic ; surgery ; Ear Canal ; abnormalities ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

ObjectiveTo study a practical individualized computer-aided design project for cranioplasty in Chinese mainland. Methods6 patients with cranial defect was performed superthin skull CT,three-dimension reconstruction. The template for the skull defected was made simulating the shape and contour of cranial defect. after patient,s consent,silicone rubber terylene patch was made as a substrate for the repair of cranial defect. ResultsThis project provides a good result,especial an excellent cosmetic result. No side-effect appears,operation time is shorter than ever.ConclusionAn individual project for computer-assisted cranioplasty has been finished,which can be popularized for its value.

Objective: To examine the causal relationship between inflammatory factors and breast cancer using two-sample Mendelian randomization (MR) approach, so as to provide the basis for the prevention and treatment of breast cancer. Methods: Data of 91 inflammatory cytokines (n=14 824) and 5 subtypes of breast cancer (n=247 173) were collected from genome-wide association studies (GWAS). Single nucleotide polymorphism (SNP) associated with 91 inflammatory factors were selected as instrumental variables. MR analyses were performed using the inverse-variance weighted (IVW) method with inflammatory factors as exposure factors and breast cancer as outcome variables. The risk of type I error and the effect of multiple testing were reduced using the FDR correction method. The stability and reliability of the results were verified using Steiger test of directionality, MR-Egger regression, MR-PRESSO test and leave-one out method. Results: Twenty-three inflammatory factors, including β nerve growth factor, interleukin-5, cystatin D and C-X-C chemokine ligand 1 were statistically associated with breast cancer (all P<0.05). After FDR adjustment, only evaluated abundance of oncostatin-M was found to be statistically associated with an increased risk of Basal-like (triple-negative) breast cancer (OR=1.186, 95%CI: 1.081-1.302, P=0.001, q=0.029), and the other 22 inflammatory factors had a high risk of type I error (all q>0.1). The sensitivity analysis indicated that the results were robust. No instrumental variables were found to have a significant impact on the results, which could exclude the influence of heterogeneity, horizontal pleiotropy, and reverse causality on the outcome. Conclusion The increased abundance of oncostatin-M may increase the risk of Basal-like (triple-negative) breast cancer.

Objective To explore the differences of gene expression of peripheral blood mononuclear cell (PBMC) between the anti-cyclic citrullinated peptide antibody (ACCPA) positive and ACCPA negative patients with rheumatoid arthritis (RA) by microarray analysis.Methods Total RNA was extracted from PBMC of 5 ACCPA positive and ACCPA negative patients with RA,and age-and sex-matched control subjects respectively.Ⅲumina oligonucleotide microarray was used to characterize 47231gene expression profile for each sample.Results Among the target genes,88 differentially expressed genes were identified in RA patients.Fifty-one up-regulated genes and 37 down-regulated genes were found in RA patients compared to those in control subjects (fold change＞1.5).The differential expression of genes were associated with apoptosis,cytokine,signal identification protein,chemotaxis factor etc.There were 20 differential expression genes between the ACCPA positive and ACCPA negative patients with RA,9 up-regulated genes and 11 downregulated genes were found.The differential expression genes were associated with protein biding,,translation control,signal identification protein,cell cycle,metabolism etc.Conclusion There are differential gene expression between the ACCPA positive and ACCPA negative patients with RA.Genes screened from the target such as IFI,KIR,CHI3L1 can provi-de important information for further study and treatment of RA.

Objective To investigate the instant clinical efficacy of intra-arterial infusion of fasudil combined with routine anti-vasospasm for symptomatic cerebral vasospasm (SCVS). Methods The clinical data of 21 patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysm, who were admitted to authors' hospital during the period from May 2010 and February 2014, were retrospectively analyzed. The lesions included Fisher gradeⅡ(n=2), gradeⅢ (n=16) and gradeⅣ (n=3). Endovascular embolization of the aneurysm was carried out within 48 hours after the confirmation of the diagnosis with total cerebral DSA;no bleeding occurred during the operation and routine anti-vasospasm therapy was given. Within 4-9 days after the onset of the disease, all 21 patients presented SCVS. Half dose systemic heparinization, superselective intra-arterial infusion of fasudil (30 mg fasudil+250 ml saline, lasting for 30 min) were adopted. Reexamination of angiography performed at 15 min after fasudil infusion was employed, and the results were evaluated with NIHSS score by comparing the preoperative findings. Results Imaging examination performed after the treatment showed that significant improvement was obtained in 15 patients and no obvious changes in 6 patients. Clinical symptoms were remarkably improved in 11 patients, partially improved in 4 patients and remained unchanged in 6 patients. The mean NIHSS score was improved from preoperative 28.6 to postoperative 21.2. Conclusion For the treatment of symptomatic cerebral vasospasm, superselective intra-arterial infusion of fasudil is effective and safe, and it has good clinical application value.

OBJECTIVE: To improve the diagnosis and treatment of the acute attack of sphenoid and ethmoid fungal ball sinusitis based on the analysis of clinical features. METHOD: Eighteen patients with sphenoid and ethmoid fungal ball sinusitis were reviewed, and the main symptoms included headache and fever during acute attack. Endoscopy, nasal CT and MRI can provide useful information for diagnosis. Endoscopic sinus surgery was performed on thirteen patients after drug therapy, while the other 5 patients chose conservative therapy. RESULT: The pathological examination confirmed the fungal lesions and the 13 patients had a good recovery. The result of CT and MRI scanning had a good accordance with the intra-operative findings. One patient receiving conservative treatment had acute attack again 2.5 months later, and antibiotics and topical nasal drugs improved the symptoms. CONCLUSION Clinical presentation and radiological imaging contribute to the differential diagnosis of the acute attack of sphenoid and ethmoid fungal ball sinusitis, then the targeted therapy can be taken.
Adult ; Aged ; Diagnosis, Differential ; Ethmoid Sinus ; Ethmoid Sinusitis ; diagnosis ; microbiology ; therapy ; Female ; Fungi ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mycoses ; diagnosis ; therapy ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; diagnosis ; microbiology ; therapy ; Tomography, X-Ray Computed ; Treatment Outcome