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 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.

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 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

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.

In order to understand the alcohol's toxicity to the quantitative alternations of synapses in mouse visual cortex, the expression of synaptophysin after prenatal alcohol exposure was investigated. In present study, the experimental mice at P0, P7, P14 and P30 were grouped, as control, 2 g x kg(-1) alcohol treatment and 4 g x kg(-1) alcohol treatment. The pre-synaptic elements which were used to represent synapses were marked with synaptophysin (a synaptic vesicle associated protein) by immunocytochemistry technique. The synaptophysin positive boutons in layer VI of visual cortex were imaged under laser confocal microscope. With stereological methods, the number cal density of synapse in visual cortex was calculated in different groups at various ages. Moreover, Western blotting was carried out to detect the expression of synaptophysin in visual cortex. The results showed that prenatal alcohol exposure could cause synaptic loss with long-term effect and in a dose dependent manner. For instance, there were significant difference among the different treatment groups of P0, P14 and P30 as well (P < 0.05). Western blotting supported the results of immunofluorescent labeling. In conclusion, prenatal alcohol exposure can induce the synaptic loss dose dependently and with long-term effect. Our findings implicate that the synaptic loss with long-term effect in CNS probably contributes to the lifelong mental retardation and memorial lowliness associated with childhood FAS.

Objective To study any functional changes in the trigeminal nociceptive system in cases of migraine with aura (MWA) using painful heat-evoked potentials (CHEPs),and to explore the value of CHEP in evaluating the trigeminal small nerve fibers of patients with MWA.Methods Sixty patients with MWA were recruited as the MWA group,and 60 healthy persons were selected as a normal control group.Thermal stimulation at 51 ℃ was applied to the skin above the patients' right and left eyebrows.The N wave latencies and N-P amplitudes of the CHEPs were recorded at the vertex (Cz) of the head.The intensity of the stimulus was graded using a visual analogue scale (VAS).Results In the control group the simulation produced no significant differences in the N550 or P750 latencies or in the N-P amplitudes.In the MWA group no significant differences were observed when the headache side was stimulated,but the N550 and P750 latencies were both significantly shorter than those of the control group and the N-P amplitude was significantly greater than that of the control group.The average VAS score on both sides in the patients with migraine was significantly higher than those of the control group.However,there was no significant difference in average VAS scores between the headache and non-headache sides of the patients with migraine.Conclusions CHEP is a reliable method for detecting any pathological changes in the trigeminal small nerve sensory pathway.Increased cutaneous allodynia in acute migraine attacks is detectable using CHEPs.