Objective: To study the rescue strategy for patients with severe multiple injuries after sudden disaster under field condition. Methods and results: A 53-year-old female patient was referred to us after hit on the pelvis in the China Wenchuan earthquake. Her symptoms included large volume of hematuria, difficult breath, tenderness of the whole abdomen, and bedsore. Portable B ultrasound revealed effusion of abdomen and left chest cavity, and bladder rupture. Portable blood-gas analyzer indicated severe anemia + hypoxemia + hypokalemia + acidosis. Drainage was done through left chest cavity aspiration and bladder aspiration. Abdominal examination found rectal rupture (perforation), which was managed by Harttman + cystostomy followed by anti-infection treatment. The patient recovered 18 days after operation. Conclusion: The rich experience and skillful surgical management, the full play of portable equipment, the help from the local hospital, together with timely anti-infection management, are the keys to successful rescue of patients with severe multiple injuries under field condition.

Objective To evaluate the feasibility of perfusion weighted imaging (PWI) in the differentiation of recurrent glioma and radiation-induced brain injuries. Methods Fifteen patients with previously resected and irradiated glioma, presenting newly developed abnormal enhancement, were included in the study. The final diagnosis was determined either histologically or clinicoradiologically. PWI was obtained with a gradient echo echo-planar-imaging (GRE-EPI) sequence. The normalized rCBV ratio[CBV(abnormal enhancement)/CBV(contralateral tissue)], rCBF ratio[CBF(abnormal enhancement)/CBF(contralateral tissue)]and rMTT ratio[(MTT abnormal enhancement)/MTT(contralateral tissue)]were calculated, respectively. The regions of interest (ROIs) consisting of 20-40 mm2 were placed in the abnormal enhanced areas on postcontrast T1-weighted images. Ten to fifteen ROIs measurements were performed in each lesion and the mean value was obtained. Mann-Whitney test was used to determine whether there was a difference in the rCBV/rCBF/MTT ratios between glioma recurrence and radiated injuries. Results Nine of the 15 patients were proved recurrent glioma,6 were proved radiation-induced brain injuries. The mean rCBV ratio[2.87(0.70-4.91)]in glioma recurrence was markedly higher than that[0.70(0.12-1.62)]in radiation injuries (Z=-2.55,P＜0.05). The mean rCBF ratio[1.89(0.64-3.96)]in glioma recurrence was markedly higher than that[0.56(0.12-2.08)]in radiation injuries (Z=-2.08,P＜0.05). The areas under rCBV and rCBF ROC curve were 0.893 and 0.821. If the rCBV ratio ≤0.77, the diagnosis sensitivity of radiation-induced brain injuries was 100.0%;If ≥2.44, the diagnosis specificity of recurrent glioma was 100.0%. Conclusion PWI was an effective technique in distinguishing glioma recurrence from radiation injuries and rCBV and rCBF ratios were of great value in the differentiation.

Objective To investigate the incidence and relation to primary diseases of the nonbronchial systemic arteries (NBSA) supply to the pulmonary lesions, and to evaluate the clinical value of transcatheter arterial embolization (TAE) of the responsible NBSA for hemoptysis. Methods The aortography and subclavian artery angiography were performed in 139 patients with hemoptysis, including pulmonary tuberculosis in 66 cases (2 cases with post-thoracoplasty, 1 case with post-lobectomy, and 1 case with ventricular septal defect), bronchiectnsis in 41 ( 1 ease with post-lobectomy and 1 case with post- ligation of patent ductus arteriosus), bronchiogenic carcinoma in 15, unknown hemoptysis in 7, silicosis in 3, broncholithiasis in 3, bronchial cysts in 1, empyema in 1, postoperative lung cancer in 1, and chronic pulmonary embolism in 1, respectively. TAE was performed in patients with the discoverable responsible NBSA. The frequency, distribution and relation to primary diseases of the responsible NBSA were evaluated and the clinical results and complications were observed. Follow-up time ranged from 6 months to 5 years. Results Seventy-three patients (52. 5% ) had nonbronchial systemic contributions, including 5 cases of post-thoracotomy with pulmonary lesions, 1 case complicating with ventricular septal defect, 1 ease with post-ligation of patent ductus arterinsns, and 1 case of chronic pulmonary embolism. The total number of NBSA were 181 including posterior intercostal arteries (n = 88), internal thoracic arteries (n = 27 ), inferior phrenic arteries ( n = 21 ), proper esophageal arteries ( n = 20 ), lateral thoracic arteries ( n = 9 ), subscapular arteries ( n = 7 ), eostocervical trunks ( n = 5 ) and thyrocervical trunks ( n = 4 ) . Main responsible NBSA were posterior intercostal arteries (n = 75 ) and branches of subclavian and axillary artery (n =44) in patients with pulmonary tuberculosis, and proper esophageal arteries (n = 16 ) and inferior phrenic arteries (n = 17 ) in bronchiectasis. The clinical result was satisfactory and the bleeding ceased immediately in 69 eases including 19 cases of failed or repeated bronchial artery embolization (the arteries had been obstructive) and 4 cases of the normal bronchial arteries. No severe complications occurred except ipsilateral cerebellar infarction after subclavian artery angiography in 1 case and respiratory failure after internal thoracic artery embolization in another case. Sixty patients were followed up for more than 6 months. The result demonstrated episodic bloody sputum in 16 patients, re-bleeding in 11 and non-bleeding in another after TAE. Eight patients had non-bleeding and 2 patients had episodic bloody sputum who were re- bleeding and underwent repeated TAE. Conclusions The stimulation of adjacent lesions and the cardiovascular diseases with weakened or defected pulmonary perfusion can lead to the responsible NBSA supply to the lung in hemoptysis. During TAE for hemoptysis, the integrity angiograpby and TAE can improve the curative effect.

Aqueous dispersion and stability of Fe3O4 nanoparticles remain an issue unresolved since aggregation of naked iron nanoparticles in water. In this study, we successfully synthesized different Fe3O4 super-paramagnetic nanoparticles which were modified by three kinds of materials [DSPE-MPEG2000, TiO2 and poly acrylic acid (PAA)] and further detected their characteristics. Transmission electron microscopy (TEM) clearly showed sizes and morphology of the four kinds of nanoparticles. X-ray diffraction (XRD) proved successfully coating of the three kinds of nanoparticles and their structures were maintained. Vibrating sample magnetometer (VSM) verified that their magnetic properties fitted for the super-paramagnetic function. More importantly, the particle size analysis indicated that Fe3O4@PAA had a better size distribution, biocompatibility, stability and dispersion than the other two kinds of nanoparticles. In addition, using CNE2 cells as a model, we found that all nanoparticles were nontoxic. Taken together, our data suggest that Fe3O4@PAA nanoaparticles are superior in the application of biomedical field among the four kinds of Fe3O4 nanoparticles in the future.

OBJECTIVETo study a family with Bw subtype of ABO blood group system, and to review safety issues in relation with clinical transfusion.

METHODSThe molecular basis for the blood type was studied with serological assay, polymerase chain reaction-sequence specific primer (PCR-SSP) and DNA sequencing, TA clone and haplotype analysis in one blood donor whose ABO blood group were difficulty typed and her family. The bioinformatics analysis was carried out by biological analysis software to investigate the change of structure and function of enzymes influenced by the change amino acid. A retrospective survey was carried out to investigate what is the actual position that the donor blood was used in the clinical transfusion.

RESULTSThree members from the family were found to have a Bw subtype. A substitution of nucleotide C by T at position 721 in exon 7 was discovered, which resulted in replacement of amino acid Arg to Trp. Review of clinical record suggested that there has been no significant abnormality association with past three blood transfusions.

CONCLUSIONA 721C>T mutation of the ABO gene probably underlies the Bw subtype. Further research is needed for understanding the clinical significance of this subtype in the blood transfusion.

ABO Blood-Group System ; classification ; genetics ; Adult ; Amino Acid Sequence ; Base Sequence ; Blood Transfusion ; Exons ; Female ; Humans ; Male ; Molecular Sequence Data ; Pedigree ; Polymerase Chain Reaction ; Retrospective Studies

OBJECTIVETo clarify three-grade criteria of curative resection for primary liver cancer (PLC) and evaluate their clinical significance.

METHODSCriteria of curative resection of PLC were summed up to three grades. Grade I: complete removal of all gross tumors with no residual tumor at the excision margin. Grade II: on the basis of Grade I, there was no extrahepatic metastasis, no hilar lymph node metastasis, no tumor thrombus in the main trunks and their primary tributaries of the portal vein, common hepatic duct, hepatic vein and vena cava inferior, and the tumor was not more than two in number. Grade III: in addition to the above criteria, AFP dropped to normal level (in patients with elevated AFP before surgery) within 2 months after operation, and no residual tumor upon diagnostic imaging. A total of 354 cases with PLC who had their liver resected was reviewed. Patients in each grade were divided into two portions depending on whether the treatment was curative or palliative.

RESULTSThe survival of patients receiving curative treatment was better than those receiving palliative treatment (P < 0.01). This was true for patients whose treatment belonged to anyone of the three-grade criteria. The survival was improved along with the promotion of curative criteria used. The 5-year survival rate of Grade I, II and III patients undergone curative resection was 43.2%, 51.2% and 64.4%, respectively (P < 0.01).

CONCLUSION1. The three-grade criteria may be used for judging the radicality of tumor resection for PLC. 2. The more stringent the criteria used, the better the survival would be. 3. Adopting high-grade criteria to select cases, to guide operation and postoperative follow-up would improve the results of liver resection for PLC.

Female ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; mortality ; surgery ; Male ; Middle Aged ; Survival Rate

Aqueous dispersion and stability of Fe3O4 nanoparticles remain an issue unresolved since aggregation of naked iron nanoparticles in water. In this study, we successfully synthesized different Fe3O4 super-paramagnetic nanoparticles which were modified by three kinds of materials [DSPE-MPEG2000, TiO2 and poly acrylic acid (PAA)] and further detected their characteristics. Transmission electron microscopy (TEM) clearly showed sizes and morphology of the four kinds of nanoparticles. X-ray diffraction (XRD) proved successfully coating of the three kinds of nanoparticles and their structures were maintained. Vibrating sample magnetometer (VSM) verified that their magnetic properties fitted for the super-paramagnetic function. More importantly, the particle size analysis indicated that Fe3O4@PAA had a better size distribution, biocompatibility, stability and dispersion than the other two kinds of nanoparticles. In addition, using CNE2 cells as a model, we found that all nanoparticles were nontoxic. Taken together, our data suggest that Fe3O4@PAA nanoaparticles are superior in the application of biomedical field among the four kinds of Fe3O4 nanoparticles in the future.
Ferric Compounds ; chemistry ; Magnetite Nanoparticles ; chemistry ; Microscopy, Electron, Transmission ; Spectroscopy, Fourier Transform Infrared ; Surface Properties ; Water ; chemistry ; X-Ray Diffraction

Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.

BACKGROUNDThe role of plasma high sensitivity C-reactive protein (hs-CRP) in in-stent restenosis (ISR) remains controversial. We investigated plasma hs-CRP level at both admission and follow-up in patients with stable angina (SA) after successful coronary stenting in order to clarify the predictive value of hs-CRP for ISR.

METHODSWe summarized 303 consecutive chronic SA patients with coronary drug-eluting stent (DES) implantation. The ISR was analyzed by quantitative coronary analysis (QCA) at a mean follow-up of 8 months, and the patients were divided into two groups according to the detected ISR as ISR group (n = 48) and non-ISR group (n = 255). Plasma hs-CRP was examined at both admission and 8-month follow-up in all patients, standard medication continued throughout the investigation period.

RESULTSQCA presented that 48 patients (15.8%) suffered from ISR at follow-up. The basic clinical characteristics were similar between the two groups, while plasma hs-CRP was higher in ISR group than that in non-ISR group at both admission and follow-up, P < 0.001 respectively. Multivariate regression analysis indicated that plasma hs-CRP level at either admission or follow-up could independently predict ISR occurrence (OR = 5.581, 95%CI 2.532-12.302, P < 0.001 and OR = 6.299, 95%CI 2.722-14.577, P < 0.001, respectively).

CONCLUSIONSOur data indicate that plasma hs-CRP level may independently predict ISR at both admission and follow-up in SA patients with coronary DES implantation, which implies that a chronic, sustained systemic inflammatory response might be involved in ISR pathogenesis.

Aged ; Angina Pectoris ; therapy ; C-Reactive Protein ; metabolism ; Coronary Restenosis ; blood ; therapy ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis

OBJECTIVETo evaluate laparoscopic radical gastrectomy for early gastric cancer.

METHODSA total of 204 patients with early gastric cancer undergoing laparoscopic-assisted radical gastrectomy or open radical gastrectomy between October 2004 and December 2009 were retrospectively reviewed and analyzed. Patients were divided into laparoscopic group(LAP, n=78) and open group (OPEN, n=126). Operative time, blood loss, time to passage of flatus, postoperative hospital stay, complications and pathologic findings were compared between the two groups.

RESULTSCompared to the OPEN group, operative time in the LAP group was significantly shorter[(202.9±45.6) min vs.(219.8±45.2) min, P<0.05], blood loss was less[(144.5±146.5) ml vs. (245.0±146.4) ml, P<0.05], time to passage of flatus was shorter[(3.1±1.1) d vs.(4.5±1.6) d, P<0.05], postoperative hospital stay was shorter[(10.8±1.2) d vs. (12.4±3.8) d, P<0.05]. However, the two groups were comparable with regard to postoperative complication rate(10.3% vs. 12.7%, P>0.05), proximal resection margin[(4.0±1.9) cm vs. (4.2±1.7) cm, P>0.05], distal resection margin [(3.6±1.7) cm vs. (3.5±1.8) cm, P>0.05], number of harvested lymph node(13.1±6.5 vs. 14.5±8.2, P>0.05). The median follow up was 22(2-64) months. There were no tumor recurrences or metastases in the LAP group. In the OPEN group, only 1 patient died from peritoneal metastasis. Total hospital costs between the two groups were similar(P>0.05).

CONCLUSIONLaparoscopic radical gastrectomy is a safe, feasible, effective, and less invasive surgery for early gastric cancer.

Adult ; Aged ; Aged, 80 and over ; Female ; Follow-Up Studies ; Gastrectomy ; methods ; Humans ; Laparoscopy ; Laparotomy ; Lymph Node Excision ; Male ; Middle Aged ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Treatment Outcome