Objective To explore the diagnosis and treatment of gluten-related disorders (GRD).Methods Anti-gliadin antibodies (AGA),anti-tissue transglutaminase (tTG) antibody,deamidated gliadin peptides(DGP) antibody and serum specific IgG antibodies of 14 kinds of intolerable food were tested in people who developed chronic diarrhea after the intake of gluten diet.HLA-DQ2,HLA-DQ8 and intestinal endoscopic multiple biopsies would be performed further in patients with positive coeliac disease (CD)-specific serology.Gluten free diet was given to patients with positive CD-specific serology.One patient received prednisone (30 mg/d and diminished 5 rmg/w).Results Nine patients were confirmed with celiac disease(CD) and four cases were suspected non-coeliac gluten sensitivity (NCGS) in 13 patients with positive serologic tests.Twelve cases received effective therapy.In CD group,6 cases were accompanied with comorbidities mainly autoimmune diseases and osteoporosis.The positive rates of AGA and tTG antibody were 9/9 and 2/9 respectively in the CD group,while tTG antibody in the NCGS group were both negative.Endoscopic intestinal biopsy was performed in all 13 cases.Plasma cell proliferation and lymphocyte infiltration in the lamina propria without villus atrophy were identified in 4 cases,representing chronic inflammation of the small intestine.Villus atrophy was detected in 9 cases.Two patients with NCGS ingested gluten after 4 and 6 months of gluten-free diet respectively,and the number of bowel movements increased 1-2 times per day.Conclusions The diagnosis of CD is mainly based on serologic tests and characteristic of histological features.CD may be companied by other autoimmune diseases or metabolic disease of bone.Lifelong adherence to a gluten free diet is the most basic and effective therapy.

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Objective To observe the near future curative effect and toxicity of the combination of weekly dose of cisplatin in the treatment of elderly patients with esophageal cancer intensity-modulated radiotherapy observa-tion.Methods 60 patients with locally advanced esophageal cancer patients aged by method randomly were divided into synchronous chemotherapy group( CRT group) and 30 cases of radiotherapy alone group( RT group) 30 cases,the two groups using 6MV-X ray intensity modulated radiotherapy,radiotherapy dose:DT 60 Gy/30/6 week.The CRT treated group was given cisplatin 20-25mg/m2 in the radiotherapy of second day,1 times per week,a total of 6 times. Results Radiotherapy and chemotherapy, radiotherapy group recent effective rate were 80.0% and 63.3%, the difference was statistically significant(χ2 =5.934,P<0.05),P< 0.05).The main toxicity was myelosuppres-sion,radiation esophagitis,basically I and II,no statistically significant difference between the two groups(P>0.05). Conclusion Intensity modulated radiotherapy combined with weekly dose of cisplatin in the treatment of elderly patients with esophageal cancer significant short-term effect,less adverse reactions,patient tolerance is good,which is worth the clinical promotion.

Objective To assess the values of automated breast volume scanner (ABVS) for differentiating of benign and malignant breast masses.Methods A total 174 breast masses in 148 patients were subjected both to conventional handheld B-mode ultrasound (HHUS) and ABVS examinations.The masses were defined as five categories of benign,probably benign,equivocal,probably malignant,and malignant with each method.The results of ABVS and HHUS were compared with pathology.By using the definitive diagnosis and the five levels of suspicion categories,receiver operating characteristic (ROC) curves were drawn to evaluate their diagnostic results.In addition,the diagnostic accuracy for breast masses of futures including retraction phenomenon and hyperechoic rim in coronal plane of ABVS was evaluated.Results The area under the ROC curve of ABVS (0.927) was larger than that of HHUS (0.903) (Z =2.256,P =0.024).The specificity and the positive predictive values both reached to 100％ and false positive rate was 0 with retraction phenomenon,and the specificity and the negative predictive value were 88.89％ and 94.51％ respectively with hyperechoic rim in coronal plane of ABVS.Conclusions ABVS plays an important role in the clinical practice.The retraction phenomenon and hyperechoic rim of breast masses in coronal plane of this new modality have high specialty for differentiating malignant from benign breast masses.

ObjectiveTo investigate the effect of endovascular stent with or without coil graft on intracranial wide-necked aneurysms. Methods12 cases with intracranial wide-necked aneurysms, among whom, 10 cases were treated with stents and coils, 2 C4 aneurysms were treated with graft stent, were analyzed retrospectively. ResultsOf the 10 cases who were treated with stents and coils, 8 patients were completely occluded and other 2 patients were incompletely (>95%) occluded. 2 cases accepted graft stent were obliterated. Follow-up with angiography in 10 patients for 3～12 months revealed that all the aneurysms were completely occluded. 1 patient among them died. ConclusionEndovascular stent with or without coil graft is effective on intracranial wide-necked aneurysms.

Objective:To explore the teaching evaluation of online open course of hematology based on small private online course (SPOC) platform by means of quantitative method.Methods:The fourth-year undergraduates of clinical medicine major were selected to receive online course learning of hematology, including video viewing, rich text browsing, in-class quizzes, and seminars. The teaching contents covered the basis of hematological diseases, anemic diseases, hematological tumors, bleeding and coagulation disorders. Teaching evaluation was conducted through teaching behavior assessment, unit test, course examination and SPOC scoring. Linear regression analysis was used to analyze the correlation between the duration of the teaching video and student learning behavior. The correlation between video learning quantity and viewing time and course test scores and SPOC scores was analyzed. Kruskal-Wallis test was used to compare the differences in curriculum learning behavior (participation rate). T-test was used to compare the differences between the two results of two unit tests and to calculate the alternative-form reliability. Chi-square test was used to compare the differences in scores of different sub-specialty questions in hematology, and the differences of participation rate of different examination points of hematological tumors. Results:The teaching video viewing rate was significantly higher than the participation rate of rich text browsing and in-class quizzes ( P < 0.001; P < 0.001). There was no obvious correlation between video duration and video viewing, rich text browsing, in-class quizzes ( R = 0.168, F = 0.81, P = 0.376; R = 0.057, F = 0.07, P=0.802; R=0.124, F=0.37, P=0.546). There was a significant positive correlation between the participation rate of video viewing and rich text browsing and in-class quizzes ( R =0.890, F=76.41, P<0.001; R=0.934, F=163.67, P < 0.001). The participation rate of anemic disease unit test was significantly higher than that of hematological tumors ( χ2 = 49.08, P<0.001), bleeding and coagulation disorders ( χ2= 25.97, P< 0.001), and the second results were significantly improved ( t=-2.09, P=0.040), and the alternative-form reliability was 0.750. There was no significant difference in the participation rate of different sub-specialty courses ( χ2=5.20, P=0.074); the number of video watching was significantly positively correlated with SPOC scores ( R=0.523, F=196.22, P<0.001); the participation rate of molecular genetics and molecular biology tests of blood tumor was significantly lower than that of general clinical information questions ( P < 0.05). Conclusion:Teaching videos are the foundation of online courses. Increasing the number of video viewing and improving video viewing rate can effectively mobilize the enthusiasm of extensive learning, such as rich text browsing and in-class quizzes, and improve learning participation. It is conducive to the improvement of students' academic performance. Simple behavior factors such as video viewing time are not recommended as performance evaluation indicators. Unit test takes two times to get the highest score, which is conducive to improving professional learning level through learning behavior, without affecting the reliability of the performance evaluation. The online open course based on the SPOC platform is conducive to the balanced development of the course teaching of Hematology.

The development of neuroimaging has led to a high diagnostic rate of cerebral small vessel disease (CSVD).The hemorrhage transformation (HT) and clinical prognosis after intravenous thrombolysis in acute ischemic stroke (AIS) with CSVD have become hot topics in recent years.Relevant studies have shown that different subtypes of CSVD may have different influences in HT and clinical prognoses in AIS.In clinic,each subtype of CSVD may not exist alone in one patient,therefore,some scholars put forward the concept of total burden of CSVD to further quantitatively assess the severity of CSVD in the whole brain and their effects on HT and clinical prognosis after intravenous thrombolysis of AIS.This article reviews the researches on HT and clinical prognosis after intravenous thrombolysis in AIS with CSVD.

OBJECTIVETo study the clinicopathologic features and diagnostic approach of chronic extrinsic allergic alveolitis (EAA).

METHODSSeven cases of chronic EAA diagnosed by open lung biopsy or lung transplant were enrolled into the study. The clinical and pathologic features were analyzed and the literature was reviewed.

RESULTSThere were altogether 4 men and 3 women. The age of the patients ranged from 30 to 65 years (mean = 48 years). All cases represented chronic form and five cases diagnosed by open lung biopsy also showed features of recent aggravation, leading to hospitalization. Four cases had known history of exposure to inciting gases, pollens and pets, and only 2 cases were positive for allergens. High-resolution CT scan showed ground-glass attenuation and reticular pattern that often had a patchy distribution and central predominance. Bronchoalveolar lavage analysis showed marked lymphocytosis, with CD4(+)/CD8(+) ratio less than 1. Lung function test demonstrated a restrictive ventilatory defect, with decreased compliance, reduced diffusion capacity and high airway obstruction. Five cases had open lung biopsy performed and two cases had undergone lung transplantation. Pathologic examination showed bronchiolocentric cellular interstitial pneumonia, interstitial fibrosis, non-caseating epithelioid granulomas, epithelioid histiocytic infiltrate in the respiratory bronchioles and intraluminal budding fibrosis. The five cases with open lung biopsy performed also showed neutrophilic infiltrate in the alveoli. The two lung transplant cases were complicated by severe fibrotic changes.

CONCLUSIONSChronic EAA demonstrates characteristic pathologic features. Definitive diagnosis requires correlation with clinical and radiologic findings due to possible morphologic mimicry of other diffuse parenchymal lung diseases.

Adult ; Aged ; Alveolitis, Extrinsic Allergic ; diagnostic imaging ; pathology ; surgery ; Biopsy ; Bronchoalveolar Lavage Fluid ; CD4-CD8 Ratio ; Chronic Disease ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases, Interstitial ; pathology ; Lung Transplantation ; Male ; Middle Aged ; Sarcoidosis ; pathology ; Tomography, X-Ray Computed

OBJECTIVETo compare the difference of the therapeutic effects between Yang's cotton moxibustion and hormonotherapy on neurodermatitis.

METHODSSixty cases of neurodermatitis were divided into a treatment group and a control group according to random number table. The treatment group were treated with Yang's cotton moxibustion and the control group with triamcinolone and urea cream. After treatment for one week, the therapeutic effect was start to be observed. After the treatment was given for 4 weeks, the therapeutic effect was evaluated.

RESULTSThe total effective rate was 93.3% in the treatment group and 80.0% in the control group, with a significant difference between the two groups (P < 0.05).

CONCLUSIONYang's cotton moxibustion has an obvious therapeutic effect on neurodermatitis with a good safety.

Adolescent ; Adult ; Aged ; Female ; Gossypium ; Humans ; Male ; Middle Aged ; Moxibustion ; methods ; Neurodermatitis ; therapy

BACKGROUNDDecreased platelet (PLT) count is one of the independent risk factors for mortality in intensive care unit (ICU) patients. This study was to investigate the relationship between PLT indices and illness severity and their performances in predicting hospital mortality.

METHODSAdult patients who admitted to ICU of Changzheng Hospital from January 2011 to September 2012 and met inclusion criteria were included in this study. Univariate analysis was used to identify potential independent risk factors for mortality. Multiple logistic regression analysis was used to calculate adjusted odds ratio for mortality in patients with normal or abnormal PLT indices. The relationship between PLT indices and illness severity were assessed by the Acute Physiology and Chronic Health Evaluation II (APACHE II) scores or sequential organ failure assessment (SOFA) scores in patients with normal and abnormal PLT indices. The performances of PLT indices in predicting mortality were assessed by receiver operating curves and diagnostic parameters. The survival curves between patients with normal and abnormal PLT indices were compared using Kaplan-Meier method.

RESULTSFrom January 2011 to September 2012, 261 of 361 patients (204 survivors and 57 nonsurvivors) met the inclusion criteria. After adjustment for clinical variables, PLT count <100 × 10 12 /L (P = 0.011), plateletcrit (PCT) <0.108 (P = 0.002), mean platelet volume (MPV) >11.3 fL (P = 0.023) and platelet distribution width (PDW) percentage >17% (P = 0.009) were identified as independent risk factors for mortality. The APACHE II and SOFA scores were 14.0 (9.0-20.0) and 7.0 (5.0-10.5) in the "low PLT" tertile, 13.0 (8.0-16.0) and 7.0 (4.0-11.0) in the "low PCT" tertile, 14.0 (9.3-19.0) and 7.0 (4.0-9.8) in the "high MPV" tertile, 14.0 (10.5-20.0) and 7.0 (5.0-11.0) in the "high PDW" tertile, all of which were higher than those in patients with normal indices. Patients with decreased PLT and PCT values (all P < 0.001), or increased MPV and PDW values (P = 0.007 and 0.003, respectively) had shortened length of survival than those with normal PLT indices.

CONCLUSIONSPatients with abnormally low PLT count, high MPV value, and high PDW value were associated with more severe illness and had higher risk of death as compared to patients with normal PLT indices.

Adolescent ; Adult ; Aged ; Blood Platelets ; physiology ; Critical Illness ; Female ; Humans ; Male ; Mean Platelet Volume ; Middle Aged ; Platelet Count ; Prognosis ; Retrospective Studies ; Young Adult