Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM-1) and urinary neutrophil gelatinase-associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis.Methods A total of 141 eligible patients were enrolled in this prospective study.Blood and urine samples were collected at different time points as soon as sepsis was diagnosed.The concentrations of serum creatinine (Scr),urine sTREM-1 and NGAL were measured.According to AKI criteria,patients were divided into the AKI group and non-AKI group.Dynamic changes of levels of Scr,urine sTREM-1 and NGAL were observed in two groups.The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL.Results Among 141 septic patients,44 (31.2％) cases had concomitant AKI.Twenty four hours after sepsis diagnosed,the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6± 15.3) μmol/L,P ＜ 0.05],which met the diagnostic criteria of AKI.In the AKI group,urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9± 14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L,both P ＜ 0.05].And at the following time points,urinary concentrations of sTREM-1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P ＜ 0.05).At 8 h time point,thearea under the curve of urine sTREM-1 was 0.877 (95％CI 0.756-0.914),the sensitivity was 89.1％ and specificity was 82.0％ with a cutoff value of 70 ng/L.At 8 h time point,the area under the curve of urine NGAL was 0.862 (95％ CI 0.703-0.958),the sensitivity was 87.4％ and specificity was 85.5％ with a cutoff value of 90 μg/L.Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr.Therefore,urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.

Objective To evaluate the value of Kidney Disease:Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected.Clinical characteristics,prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.Results Of the enrolled 703 AKI patients,395 (56.2％) were caused by sepsis (septic AKI),which indicated that sepsis mainly contributed to the causes of AKI.For septic AKI stratified by KDIGO classification,146(37.0％) patients belonged to AKI Ⅰ,154(39.0％) to AKI Ⅱ,and 95 (24.1％) to AKI Ⅲ.Compared with the patients with non-septic AKI,septic AKI patients had greater APACHE Ⅱ and SOFA score (25.1 ±4.9 vs 20.5 ±6.4,12.9 ±2.6vs 10.4 ± 4.5 ; all P values ＜ 0.05).Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) μmol/L vs (83.1 ± 30.O) μmol/L,P ＞ 0.05] between the two groups,patients with sepsis had higher serum creatinine [(143.5 ± 21.6) μmol/L vs (96.2 ± 15.5) μmol/L; P ＜ 0.05],a higher proportion fulfilled KDIGO categories for both AKI Ⅱ and Ⅲ (63.0％ vs 33.1％ ; P ＜ 0.05),a higher renal replacement therapy (RRT) rate (22.3％ vs 6.2％ ; P ＜ 0.05) and a lower proportion of complete renal recovery(74.4％ vs 82.8％) (all P values ＜ 0.05).The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2％ vs 34.1％ ; P ＜ 0.05).Septic AKI,graded by KDIGO,was associated with an increased mortality.Logistic regression analysis showed that APACHE Ⅱ score (OR =5.451,95％ CI:3.095-9.416),SOFA score (OR =2.166,95％ CI:1.964-4.515) and RRT (OR =4.021,95％ CI:2.975-6.324) were independent risk factors for mortality of septic AKI patients.Conclusion Septic AKI patients have a higher burden of illness,worse renal function and higher mortality.APACHE Ⅱ score,SOFA score and RRT are independent risk factors to septic AKI mortality.

Objective To observe the effects of low frequency electrical nerve stimulation on sensory and motor functioning in patients with hemiplegia and hemianesthesia caused by acute cerebral infarction.Methods Sixty-one acute cerebral infarction patients with both hemiplegia and hemianesthesia were randomly divided into a treatment group and a control group.Thirty patients in the control group received conventional treatment.Thirty-one patients in the treatment group were treated with low frequency electrical stimulation of the peripheral nerves of the affected extremities in addition to the conventional treatment.Sensory function,motor function and performance in the activities of daily living(ADL)were evaluated before and 14 days after treatment.Results Sensory function,motor function and ADL performance in both groups improved significantly over the 14 days.Furthermore,the difference between the two groups after treatment was significant.Conclusion Low frequency electrical nerve stimulation can improve sensory function,motor function and ADL performance in acute cerebral infarction patients with both hemiplegia and hemianesthesia.

Objective To observe the influences of valsartan on maintenance of sinus rhythm and left atrial contraction function after cardioversion of permanent atrial fibrillation, and discuss if angiotensin Ⅱ (AT-Ⅱ)receptor blockade could reverse atrial remodeling and remove the basis of permanent atrial fibrillation relapse. Methods Seventy-two patients with permanent atrial fibrillation were divided into control group (36 patients)and valsartan group(36 patients)by random digits table. The two groups were given amiodarone of 200 mg oral once every 8 hours on the eardioversion day. Five days later, the dose was decreased to 200 mg once every 12 hours. And another 5 days later, the dose was again decreased to 200 mg once a day. And 1 month later, the dose was decreased to 100 mg once a day which would be kept for 8 months. On the electrical conversion day and after 8 months, the patients of the two groups were performed echocardiography, and the left atrial dimension(LAD), end diastolic area(EDA), end diastolic volume (EDV), end systolic area(ESA)and end systolic volume(ESV)were compared. Results In 72 patients,59 patients were successful in recovering from sinus rhythm, and duration time was(18±6)h,3 patients were given electrical conversion after 72 h, and 10 patients were directly given electrical conversion and successful. Three patients didn't finish follow-up,and 2 patients died. Sixty-seven patients finished follow-up,among whom 33 patients were in control group and 34 patients were in valsartan group. After followed up for 8 months, 36.4%(12/33)patients recurred in control group, and 17.6%(6/34)patients recurred in valsartan group(P＜0.05).The levels of LAD, EDA, ESA, EDV and ESV in valsartan group were significantly decreased(P＜0.05 or＜0.01), but they showed no significantly difference in control group(P ＞ 0.05). The systolic pressure and diastolic pressure decreased in two groups, but there were no significant difference (P＞0.05). Conclusion Valsartan combines with amiodarone is superior to amiodarone in maintaining sinus rhythm and improving left atrial contraction function after cardioversion of permanent atrial fibrillation.

Objective To observe the sub-clinical inflammation and insulin resistance (IR) in patients with cerebral infarction(CI). Methods The levels of serum C-reactive protein (CRP),interleukin-6 (IL-6),fasting insulin (Fins),fasting plasma glucose (FPG),blood lipids and blood pressure were measured in 114 patients with CI (CI group). The insulin sensitivity index (ISI) was observed and the correlation between ISI and indexes of inflammation were analysed. The results were compared with 70 patients without CI(control group). Results (1) The levels of serum CRP [(2.73?0.87) mg/L]and IL-6[(0.14?0.03) ng/ml] in CI group were significantly higher and ISI(-4.31?0.53) was significantly lower compared with control group[CRP(1.63?0.93) mg/L,IL-6(0.12?0.03) ng/ml,ISI(-3.92?0.43)] ( all P8.2 mg/L was significantly lower than that in the patients with the CRP≤8.2 mg/L (-4.18?0.54)(P

We report the treatment of one patient with pharynx anastomotic stenosis after cervical esophagealresection by stent implantation. The patient suffered from serious pharynx anastomotic stenosis after gastric-pha-ryngeal anastomosis. After balloon-dilatation,a domestic self-expanding Z-stents was implanted in the stricture ofthe esophagus under the X-rays. After stent implantation, the patient has been leading a normal life for threeyears. Balloon dilatation and stent implantation is an effective and safe method in the treatment of patients withpharynx anastomotic stenosis.
Anastomosis, Surgical ; Catheterization ; Constriction, Pathologic ; Esophageal Stenosis ; surgery ; Esophagus ; surgery ; Humans ; Pharyngeal Diseases ; Pharynx ; surgery ; Stents

OBJECTIVE:To improve the accuracy of the Cetirizine hydrochloride syrup pediatric dose for children. METH-ODS:The dosage of Cetirizine hydrochloride syrup for children with chronic urticaria was accurately measured and compared with before and after pharmacists’intervention. RESULTS:The dosage before and after pharmacists’intervention was significantly high-er than prescribed dosage,the dosage after intervention was lower than before intervention,the differences were statistically signifi-cant(P<0.05). CONCLUSIONS:It is commonly existed that the dosage to children is higher than the prescribed dosage. It is sug-gested that doctors should strictly follow the printed label to make a prescription,pharmacists should strengthen the guidance and in-tervention on medication,and pharmaceutical manufacturers can manufacture suitable Cetirizine hydrochloride preparations special-ly for children to improve drug compliance and dosage accuracy.

Objective To study the thyroid hormone receptor β(TRβ)gene mutation types and characteristics in children with congenital hypothyroidism(CH)and thyroid dysgenesis(TD)from Shandong Province,and to provide theoretical basis for gene diagnosis and prenatal diagnosis. Methods Sixty cases of TD patients of which genomic DNA were isolated from peripheral blood leukocytes were selected by neonatal screening system in Shandong Province. The exon 6 to 12 of TRβ gene were amplified with 8 pairs of sequence specific primers using PCR and the first generation of sequencing method(Sanger method)to detect mutation. The sequencing results were compared with the TRβ gene reference sequence[National Center for Biotechnology Information(NCBI)Reference Sequence:NC 000003. 12]to see whether there was a mutation. Results Analysis of TRβ in 60 cases of CH patients with TD revealed no mutation was demonstrated in exons 6 - 12,but 2 single nucleotide polymorphism(SNP)( rs 3752874,c. 735C ﹥ T;rs79220627, c. 162G ﹥ A)were detected. Through the analysis,the 2 SNP were all synonymous mutations(Phe→Phe;Ser→Ser), without the change of the amino acids. Conclusions TRβ mutation rate is very low,which may not be the main mutation type in CH patients with TD in Shandong Province.

Objective To evaluate prognostic significance of early lactate clearance rate for cardiogenic shock patients on extracorporeal membrane oxygenation(ECMO).Methods Forty-seven patients with cardiogenic shock supported by venoarterial ECMO were prospectively enrolled from May 2010 to May 2013.Arterial blood lactate at pre-ECMO support(0 h),at post-ECMO 6 hours(6 h) were measured and then 6 h lactate clearance rate was calculated.90 days after admission was the endpoint of research.Patients were divided into the survival group(n =25) and the death group(n =22).6 h lactate clearance rate was compared between groups.The 6 h lactate clearance rate for predicting death was evaluated by receiver operating characteristic(ROC) curves.The surviving curve was drawn using the Kaplan-Meier method,and the survival of the patients was analyzed by the Log-rank test.Factors influencing the prognosis were analyzed by applying the multiplelogistic regression analysis.Results The 6 h lactate clearance rate was higher in survivors than in nonsurvivors [(38.6 ± 15.1) ％ vs.(14.4 ± 13.8) ％,P ＜ 0.05].The area under the ROC curve of 6 h lactate clearance rate for predicting death was 0.869 ± 0.075 (95％ CI:0.753-0.991).The best cutoff point was 20.0％ with a sensitivity of 92.0％ and specificity of 85.0％.KaplanMeier survival analysis showed that 90 days survival rate of high lactate clearance rate group and low lactate clearance rate group were 66.7％ and 35.0％,with significant difference between the two groups(Log-rank test,P ＜ 0.05).Multivariate logistic regression analysis showed that 6 h lactate clearance rate (OR =3.156,95 ％ CI:2.326-7.253,P ＜ 0.05) was one of the independent risk factors associated with mortality of patients on ECMO.Conclusion Early lactate clearance rate could be used as an important maker for evaluating the prognosis of cardiogenic shock patients on ECMO.

OBJECTIVE: To introduce the research progression of fMRI in brain functional localization in China or abroad in the recent 15 years, so as to further comprehend the effect and value of fMRI.DATA SOURCES: A computer-based online search of Medline database was undertaken to identify English articles about fMRI published from 1990 to 2005 with the keywords "functional magnetic resonance imaging (fMRI), brain".STUDY SELECTION: The articles about experimental studies of fMRI articles irrelative to motor function, sensory function, hearing function, visuEnglish title.DATA EXTRACTION: Totally 6 144 relevant articles were collected, 18 articles were involved according to the inclusive criteria, and the others were excluded. cles about sensory function, including 1 about simple tactile stimulation,ry function, including 2 about simple visual stimulation, and 1 about binoction, including about hearing stimulation by various methods, and 1 about comparison between normal and abnormal subjects by the same stimulation.language function, 1 about visual language function, and 1 about listening basic principle.CONCLUSION: fMRI was more accurate, convenient and direct than other methods. It can not only show localization, size and dimension of the activated areas in different cerebral regions, but also show accurate anatomical position. Many aspects still need to be consummated, for example, exploration of the stimulating method, design of advanced hardware, post processing of the image and the effect of visualization. With the development of hardware, software and the endless endeavor of scientists, fMRI dooms to play an important role in illustrating the function of human brain.