OBJECTIVETo evaluate the risk factors of chronic liver failure (CLF) complicated invasive fungal infections (IFI) and prevention and treatment.

METHODSThe clinical data and risk factors of 52 patients with CLF complicated IFI were analyzed retrospectively and were compared with those not complicated IFI. Risk factors were analyzed by chi-square test and Logistic regression test and Ridit test.

RESULTSIn 52 patients with CLF complicated IFI, there were 69 fungal infections in different tissue and organs, the most were in oral cavity, but other tissue and organs especially bellows infections were rising. Candida albicans infections were the most, but cryptococcus neoformans infections and aspergillus infections were rising. The risk factors included species of bacteria infections, serum total bilirubin, hospital days, times of antibiotics using, number of invasive operation, species of antibiotics and degrees of ascites. The mortality of patients with CLF complicated IFI were much higher than those not complicated IFI.

CONCLUSIONPatients with CLF complicated IFI have poor progress and prognosis. The effective prevent methods are treating primary disease actively, reducing hospital days, detecting patients' body fluids closely, identifying source of infection as early as possible, using antibiotics correctly, reducing or avoiding invasive operation, using immunoactivators and disinfecting air regularly.

Adult ; Aged ; Aged, 80 and over ; Female ; Hospitalization ; Humans ; Liver Failure ; complications ; Male ; Middle Aged ; Mycoses ; drug therapy ; epidemiology ; etiology ; mortality ; Retrospective Studies ; Risk Factors

Objective To evaluate the clinical efficacy and safety of metallic hemoclips in the treatment of gastric defects during endoscopic full-thickness resection. Methods Patients with submucosal tumors derived from the muscularis propria and adhesion of the gastric serosa diagnosed by EUS and CT were enrolled in the study.A total of 62 patients,22 males and 40 females,mean age 58.5 years,were recruited into the present study from June 2009 to December 2010,in which 37 patients were with tumors in gastric fundus,20 in gastric body and 5 in antrum.All patients were treated with endoscopic full-thickness resection.After the operation,metallic hemoclips were used to close the defects through endoscopic biopsy channel.The closure success rate with metallic hemoclips were assessed.The patients were followed up endoscopically for evaluation of efficacy and safety of the procedures.Results All patients underwent endoscopic full-thickness resection.Uncontrollable bleeding occurred in 1 patient,who subsequently underwent emergent laparoscopic surgery and was excluded from the study.Metallic hemoclips were applied to close defects in 57 patients,and metallic hemoclips combined with omentum obstruction in 4 patients.The overall success rate was 100％ in 61 patients.Endoscopic follow-up was completed in all patients in average of 4.4 months.The clinical wound healing rate was 100％.No complications such as fever,abdominal pain were found in 2months after the procedures.Conclusion Application of metallic hemoclips during endoscopic full-thickness resection for gastric defects is a safe and effective technique.

Objective To assess the clinical significance of fetal pyelectasis and its changing in utero. Methods One hundred and ninty-seven isolated pyelectasis cases were retrospective reviewed from Jan 2012 to Jul 2014.Isolated pyelectasis was defined as a renal pelvis anteroposterior diameter (RPAPD)of ≥5 mm without other fetal anomaly in second trimester.Persistent or progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery.They were divided into two groups according to the size of renal pelvis in second trimester:group A (RPAPD 5 - 10 mm)and group B (RPAPD ≥ 10 mm).As the same,there were two groups after 32 weeks of gestation:group C (RPAPD < 10 mm)and group D (RPAPD ≥ 10 mm).Results Totally 1 54 cases were followed up.There were 1 88 cases (95.4%)in group A,with 41 cases lost,141 cases (95.9%)RPAPD <10 mm,6 cases (4.1 %)RPAPD ≥10 mm before delivery.There were 9 cases (4.6%)in group B,with 2 cases lost,remained 7 cases RPAPD ≥ 10 mm before delivery. Conclusions Although most of the fetuses with RPAPD 5 - 10 mm in second trimester will remain the same or resolved before delivery,those with RPAPD ≥ 10 mm may persistent or progress.Prenatal assessment of fetal renal pelvis may provide properly consultation.

OBJECTIVETo investigate the efficacy of PEG-interferon alpha (PEG-IFN alpha) treatment of HBeAg-positive chronic hepatitis B and HBV genotypes and liver tissues effect of HBeAg seroconversion.

METHODS54 cases confirmed by liver biopsy, genotype clear HBeAg positive chronic hepatitis B (CHB) patients according to body weight, respectively, subcutaneous injection of PEG-IFN-alpha2a 135 microg or 180 microg, or PEG-IFN-alpha2b 50 microg, 80 microg or 100 microg once weekly treatment for 48 weeks and followed for 24 weeks after discontinuation. Statistics of HBeAg seroconvertion, HBV genoty pes and liver histology e antigen seroconversion after the end of treatment.

RESULTS54 patients were followed up at the end of HBeAg seroconversion rate was 29.63% (16/54). Genotype B patients with HBeAg seroconversion rate was 35.29%, 27.03% higher than the C-type patients, but the difference was not statistically significant (chi2 = 0.382, P = 0.537). Inflammation of the liver activity highter ( > G2) , the degree of fibrosis heavier ( > S1) HBeAg seroconversion rate (50.00% vs. 25.00%, 40.90% vs. 21.88%), but were not statistically significant (chi2 = 1.391, 1.444, P = 0.238, 0.229). Activity of HBV genotype, liver inflammation, liver fibrosis and other factors by multivariate Logistic regression analysis, only liver inflammation activity of the important factors of HBeAg seroconversion.

CONCLUSIONImportant factors, liver inflammation activity of PEG-interferon alpha treatment of HBeAg-position chronic hepatitis B patients and HBV genotypes and liver fibrosis may be of little significance.

Adult ; Antiviral Agents ; therapeutic use ; Female ; Genotype ; Hepatitis B e Antigens ; analysis ; Hepatitis B virus ; genetics ; Hepatitis B, Chronic ; drug therapy ; pathology ; virology ; Humans ; Interferon-alpha ; therapeutic use ; Liver ; pathology ; Logistic Models ; Male ; Middle Aged ; Polyethylene Glycols ; therapeutic use ; Recombinant Proteins ; therapeutic use

Objective With multi?center investigation, to assess the life quality of patients with maintained hemodialysis (MHD) in Liaoning Province and to explore the relationship among the mineral metabolism, the life quality of the patients with MHD, and the repeated hospitalization within the latest three years. Methods 1192 patients with hemodialysis (at least 3 months) from January to March in 2015 at ten blood purification centers in Liaoning Province were selected for the cross?————————sectional survey. The Kidney Health?related Quality of Life (HRQOL) version 1.3 was used to evaluate the MHD patients' life quality. The total length of hospitalization was divided into four groups: 0 days, 3 to 15 days, 16 to 30 days and above 30 days. Results When serum calcium value ranged from 2.1 to 2.5 mmol/L, kidney?disease component summary (KDCS), mental component summary (MCS), physical component summary (PCS) and SF?36+KDCS corresponded to a higher value (P<0.05). When serum phosphorus value ranged from 1.13 to 1.78 mmol/L, KDCS and SF?36+KDCS corresponded to a higher value (P<0.05). When the calcium phosphorus product value ranged from 40.68 to 49.94, MCS corresponded to a higher value (P<0.05). KDCS showed a linear correlation with age (P<0.001), dialysis age, serum calcium (less than or equal to 2.5 mmol/L) (P<0.05); PCS showed a linear correlation with age (P<0.001) and dialysis age (P<0.05); SF?36+KDCS showed a linear correlation with age (P<0.001), and serum calcium (less than or equal to 2.5 mmol/L) (P<0.05), while age and dialysis age were negatively correlated. The hospitalization days showed a linear correlation with age, dialysis age (P<0.001) and serum phosphorus, calcium phosphorus product value (P<0.05), while dialysis age and calcium phosphorus product value were negatively correlated. Among different groups of total hospitalization days in three years, age, hemodialysis age, serum calcium, serum phosphorus, calcium?phosphorus product value and quality of life values were all statistically significant (P<0.05). Conclusions The life quality of patients with MHD were correlated with serum calcium, phosphorus, calcium and phosphorus product value, iPTH, dialysis age and age, while age and dialysis age were of negative correlation. The total number of hospitalization days in 3 years was closely linearly correlated with age and dialysis age, significantly correlated with serum phosphorus, calcium and phosphorus product value, while dialysis age, calcium and phosphorus product value were in a negative correlation. The total number of hospitalization in 3 years was correlated with the patients' age, dialysis age, serum calcium, serum phosphorus, calcium and phosphorus product value and quality of life.

Purpose To describe the clinicopathologic features, diagnosis and differential diagnosis, and prognosis of secretory breast carcinoma (SBC). Methods Clinicopathological and follow-up data of six SBC patients were collected. Histopathologic analysis was performed on hematoxylin and eosinstained (HE) section. Immunohistochemical staining was performed by En Vision two-step method and ETV6 gene detected by fluorescence in situ hybridization (FISH), then relevant literatures were reviewed. Results The ages of the patients ranged from 6 to 76 years with a mean age of 38.7 years, including one male and five female patients. The right breast was involved in 4 cases, and the left, in 2 cases. Five cases showed painless breast mass while one presented with a nipple discharge. The tumor size ranged from 1.0 to 3.1 cm with a mean size of 2.0 cm. Most of the tumors were circumscribed, solid gray white to light brown. Histologically, tumor showed solid nested microcystic, glandular or papillary pattern separating by hyaline fibrous tissue and growed in multiple nodular from. The cytoplasm contains abundant eosinophilic secretions or secretory vesicles. Immunhistochemistry, all cases were positive for CK7, S-100 and CEA, but negative for estrogen and progesterone receptors (ER and PR) and HER-2, and the proliferation index Ki-67 ranged from 10％ to 40％. Molecular testing confirmed the presence of the EVT6 gene translocation in one case. Lumpectomy was performed in 2 cases and modified radical mastectomy in 4 cases, two of them had lymph node metastasis (3/15, 1/16). Five cases were followed up for 6 months to 20 years, 1 case had lung metastasis. Conclusion SBC is a rare breast tumor with relatively indolent clinical and good prognosis. It can be diagnosed according to typical pathological morphology and immunohistochemical characteristics. The characteristic EVT6 gene translocation also has important differential diagnostic value.

BACKGROUND:Previous studies on immunosuppression and anti-rejection after organ transplantation mainly focused on effects of T lymphocytes-mediated immune response and immunosuppressive agents on T lymphocytes. Effects of dendritic cel s were unclear. The manifestation and mechanism of immunosuppressive agent effects on dendritic cel s are not identical. OBJECTIVE:To compare the effects of different immunosuppressive agents on expression and function of costimulatory molecules of dendritic cel s, and to explore the mechanism of action of immunosuppressive agents. METHODS:20μg/L rapamycin, 0.04 mg/L mycophenolate, 10μg/L tacrolimus and 1 mg/L cyclosporine A were separately added during bone marrow cel s of C57BL/6 mice were differentiated into dendritic cel s. RESULTS AND CONCLUSION:Flow cytometry results revealed that CD40 expression in each group:rapamycin0.05). One-way mixed lymphocyte reaction results displayed dendritic cel costimulatory T cel proliferation in each group:rapamycin

ObjectiveTo evaluate the efficacy and safety of submucosal tunneling endoscopic resection (STER) for upper gastrointestinal (GI) submucosal tumors (SMTs) originating from the muscularis propria (MP) layer.MethodsA total of 26 upper GI-SMTs originating from the MP layer were treated by STER after endoscopic ultrasonography (EUS) and CT examination.The lesions were localized endoscopically and a submucosal tunnel was created to expose the tumor.The lesion was then resected under direct endoscopic view and the mucosal incision site was closed with hemostatic clips.ResultsOf the 26 SMTs,14 were located at esophagus,7 at cardia and 5 at stomach,with 11 originated from superficial MP layer and 15 from deep MP layer ( including 2 gastric SMTs adherent with serosa).All lesions were successfully resected by STER with an en bloc resection rate of 100％.The average operation time was 68.5 min ( range 25-145min).Four to six (mean five) hemostatic clips were used to close the mucosal incision site.The average lesion size was 1.8 cm ( range 1.0-3.2 cm).The pathology results were 17 leiomyomas,7 stromal tumors (GISTs),1 glomus tumor and 1 Schwannoma.All resected lesions showed both lateral and vertical tumorfree margins.Subcutaneous emphysema occurred in 2 patients (7.7％ ).One patient (3.8％ ) developed left pneumothorax and subcutaneous emphysema,and 2 others (7.7％) pneumoperitoneum.All of them recovered uneventfully on conservative treatments.No delayed bleeding,GI tract leakage or secondary peritoneal/thoracial infection occurred.None of the 26 cases developed submucosal hematoma or infection.No tumor residual or recurrence was found during follow-up period (range 3-9 months).ConclusionSTER is a safe,efficacious and feasible new method for providing accurate histopathological evaluations,as well as radical treatments for upper GI-SMTs from the MP layer.It can regain the mucosal integrity of the GI tract,preventing leakage and secondary infection.

Objective To evaluate the efficacy and the feasibility of peroral endoscopic myotomy (POEM) for achalasia (AC). Methods The clinical data of 8 patients diagnosed as having AC and receiving POEM at our center from August 2010 to December 2010 were reviewed. The patients were 16-62 years old, mean 43yr, whose disease courses lasted for 2-20 years, mean 8.4 years. The key procedures of POEM were as the following, esophageal mucosal incision, submucosal tunneling by endoscopic submucosal dissection ( ESD), endoscopic myotomy of the circular muscle and closure of mucosal entry by hemostatic clips. Results All the 8 patients underwent POEM successfully. The mean operation time was 68.5 min ( ranging 45-115 min). The mean submucosal tunneling length was 9.5 cm ( ranging 8-13 cm). The average length of endoscopic myotomy of inner circular muscle was 8.5cm ( ranging 7-11 cm). No severe complications related to POEM occurred. Patients were followed up for 1-4 months ( mean 2. 5 months). Dysphagia was relieved significantly during the follow-up in 7 patients. But dysphagia and vomiting re-occurred in one patient 15 days after the operation. Endoscopy revealed a submucosal fistula, which was managed by incision. Conclusion As a new minimally invasive therapy for AC, POEM is very effective to relieve dysphagia in a short term. However, further observation is needed to evaluate long-term efficacy and complications.

OBJECTIVETo evaluate mesenteric vascular anatomy using 256 multi-slice computed tomography (MSCT) before laparoscopic colorectal surgery.

METHODSEleven patients with colorectal cancer underwent 256 MSCT from February 2010 to December 2010. The evaluation items were visualization of mesenteric artery and vein by 3-dimensional CT angiography, which was compared with findings on laparoscopic surgery.

RESULTSThree-dimensional CT angiography correctly demonstrated variations of the mesenteric artery and vein and were consistent with laparoscopic findings. Of the 3 patients undergoing right hemicolectomy, ileocolic artery (ICA) ran ventrally to the superior mesenteric vein(SMV) in 1 patient, whereas ICA ran dorsally to the SMV in 2 patients; the right colic artery (RCA) branched directly from superior mesenteric artery(SMA) in 2 patients; RCA was absent and the left branch of middle colic artery(MCA) fed the tumor in 1 patient. In the patients who had transverse colon resection, MCA branched from SMA. In 2 of 3 patients who underwent sigmoidectomy, sigmoid artery (SA) branched from left colic artery(LCA); in 1 of 3 patients of sigmoid resection, SA branched from inferior mesenteric artery(IMA). In 4 patients with rectal cancer, the superior rectal artery (SRA) fed the tumor.

CONCLUSIONThe 256 MSCT is effective for evaluating mesenteric vascular anatomy variation before laparoscopic surgery for colorectal cancer.

Aged ; Angiography ; methods ; Colorectal Neoplasms ; blood supply ; diagnostic imaging ; Female ; Humans ; Imaging, Three-Dimensional ; Laparoscopy ; Male ; Mesenteric Arteries ; diagnostic imaging ; Mesenteric Veins ; diagnostic imaging ; Mesentery ; blood supply ; Middle Aged ; Tomography, Spiral Computed