Objective To analyze the common reasons for misdiagnosis of atypical pulmonary embolism (APE) ,and to im‐prove the identification of APE .Methods The risk factors ,clinical manifestations ,laboratory examinations and radiographic data of 120 cases of APE diagnosed from January 2006 to December 2013 in the department of cardiovascular medicine and respiratory medicine of Xinqiao Hospital and the Affiliated Hospital of Luzhou Medical College were studied retrospectively .Results Among those 120 cases of APE ,39 cases were misdiagnosed on admission (32 .5% ) .8 cases were misdiagnosed as acute coronary syn‐drome ,7 cases as stable angina pectoris ,7 cases as chronic cor pulmonale ,5 cases as pneumonia ,3 cases as pleural effusion ,3 cases as tuberculosis ,3 cases as asthma ,1 case as atrial septal defect ,1 case as acute heart failure ,and 1 case as cardiogenic syncope .Con‐clusion APE is easy to be misdiagnosed for its non‐specific clinical manifestation .Pulmonary enhanced CT or CTPA should be car‐ried out in time for those highly suspected patients ,in order to reduce the misdiagnosis of APE .

Objective To study the color Doppler ultrasound image characteristics and ultrasonic diagnosis classification of Budd-Chiari syndrome (BCS),so as to facilitate the treatment choice.Methods The clinical material of 126 BCS patients were retrospectively analyzed.All patients were proved by angiography,intervention or surgical treatment,and were classified according to the main color Doppler ultrasound images.Results According to the image characteristics of color Doppler ultrasound,BCS patients were divided into eight types:type Ⅰ,incomplete membrane of inferior vena cava in 30 cases; type Ⅱ,complete membrane of inferior vena cava in 3 cases;type Ⅲ,stenosis of inferior vena cava in 8 patients;type Ⅳ,inferior vena cava obstruction in 3 patients;type Ⅴ,stenosis of big hepatic vein in 20 cases;type Ⅵ,big hepatic vein obstruction in 15 cases; type Ⅶ,extensive obstruction of small hepatic vein in 9 cases; type Ⅷ,38 cases of mixed lesions.Conclusions Color Doppler ultrasound can display the stenosis or obstruction of the inferior vena cava,hepatic vein with property,position,degree and the hemodynamic changes,which are accurate and reliable to the diagnosis and classification of BCS.

OBJECTIVETo investigate the effect of edaravone on expression of interleukin-1beta (IL-1beta), nuclear factor-kappaB (NF-kappaB) and neuron apoptosis in the juvenile rat hippocampus after status convulsion (SC).

METHODSOne hundred and ninety-five juvenile male Sprague-Dawley (SD) rats were randomly divided into normal saline (NS) control group, status convulsive group and edaravone treatment group. Each group was further divided into five subgroups for different time points. The rats in status convulsive group were kindled into epilepsy by lithium-pilocarpine chemical method. Expressions of IL-1beta and NF-kappaB proteins were detected with immunohistochemistry methods. Expression of NF-kappaB mRNA was detected with reverse transcription-polymerase chain reaction (RT-PCR). The neuron apoptosis was observed by TdT-mediated dUTP nick end labeling (TUNEL).

RESULTS(1) Measured by immunohistochemistry the value of IOD of IL-1beta (30.83 +/- 3.81, 41.00 +/- 5.61, 36.32 +/- 6.78 and 28.48 +/- 4.61, respectively, 12-72 h points) and NF-kappaB (67.60 +/- 5.81, 74.61 +/- 7.94, 82.43 +/- 10.67, 70.70 +/- 5.85 and 68.22 +/- 9.67, respectively, 4-72 h points) positive cells in the SC group increased,there was significant difference compared with NS group (IL-1beta: 11.74 +/- 2.32, 12.93 +/- 2.49, 13.02 +/- 2.83 and 12.98 +/- 5.29, respectively, 12-72 h points. NF-kappaB: 48.67 +/- 16.14, 44.62 +/- 7.82, 53.16 +/- 114.45, 54.27 +/- 5.25 and 55.56 +/- 7.56, respectively, 4-72 h points) (P < 0.01, or P < 0.05). By ED intervention in IL-1beta (22.01 +/- 4.45, 28.28 +/- 4.50 and 26.00 +/- 5.34, respectively, 12-48 h points) and NF-kappaB (58.56 +/- 6.37, 59. 86 +/- 6.73, 70.00 +/- 10.09, 64.78 +/- 7.56 and 64.45 +/- 6.51, respectively, 4-72 h points) positive cells value of the IOD decreased as compared with SC group (P < 0.01, or P < 0.05). (2) Measured by RT-PCR, the expression of NF-KB mRNA and protein trend was similar. (3)The TUNEL positive cells in hippocampus, CA1 of SC group (11.41 +/- 2.37) were more than that of NS group 12 h after the SC (P < 0.01), reached its highest level at48 h (28.78 +/- 5.11), after the intervention with edaravone (8.98 +/- 2.22, 13.09 +/- 2.54 and 20. 57 +/- 4.89, respectively, 12-48 h points) ,TUNEL positive cells showed a significant drop in SC group at 12-48 h time points (P < 0.01, or P < 0.05), but still significantly higher than that of the NS group (6.22 +/- 1.50, 6.57 +/- 1.61 and 6.72 +/- 1.14, respectively) (P < 0.01, or P < 0.05), at the 4 h time point(NS group 6.29 +/- 1.49, SC group 6.61 +/- 1.71, ED group 5.75 +/- 1.41) among the three groups, no significant difference in TUNEL positive cells was found (P = 0.759).

CONCLUSIONSEdaravone inhibited expression of IL-1beta and NF-kappaB in pilocarpine-induced seizures in rat hippocampus, reduced the number of neuronal apoptosis. These results suggest that edaravone may have protective effect against the damage caused by status convulsion.

Animals ; Antipyrine ; analogs & derivatives ; pharmacology ; Apoptosis ; drug effects ; Hippocampus ; drug effects ; metabolism ; pathology ; Interleukin-1beta ; metabolism ; Male ; NF-kappa B ; metabolism ; Neurons ; cytology ; drug effects ; Rats ; Rats, Sprague-Dawley ; Seizures ; metabolism ; pathology

OBJECTIVETo describe the impact of the global economic crisis on the nutritional status of children in China during and after the crisis.

METHODSData from 1990 to 2010 were sourced from the National Food and Nutrition Surveillance System. Approximately 16 000 children under 5 years old were selected using a stratified random cluster method from 40 surveillance sites. Anthropometric and hemoglobin measurements for children under 5 were conducted. Nutritional status was determined according to WHO child growth standards.

RESULTSPrevalence of underweight and stunting in children under 5 had a downward trend. Underweight prevalence was close to normal (less than 5%), with prevalence of stunting 12.6% in 2009 and 12.1% in 2010 in rural areas. Prevalence of stunting in infants under 6 months and 6-12 months old in poorer rural areas increased from 5.7%-9.1% and 6.7%-12.5%, respectively, in 2008-2009. This trend also continued post-crisis in 2010. Prevalence of stunting in children left behind by mothers was 20%-30% higher than in children the same age in general and poorer rural areas. Prevalence of anemia in children did not change in rural areas, but prevalence of anemia in all age groups increased in poorer rural areas, especially in children under 24 months old. Level reached 30%-40% in 2009, and fluctuated in 2010.

CONCLUSIONThe nutritional status of children under 5 was comparatively stable during and after the global economic crisis, attributable to the Chinese government's policy response. The nutritional status in poorer rural areas fluctuated in response to the economic crisis and, thus, relevant action and intervention must be taken immediately to help the most vulnerable population in poorer rural areas. A proper national nutritional strategy for children under 2 years old, including nutrition supplementation for pregnant women and in-home fortification for complementary feeding, should be initiated.

Aging ; Anemia ; economics ; epidemiology ; Child Development ; physiology ; Child Nutrition Disorders ; economics ; epidemiology ; Child, Preschool ; China ; epidemiology ; Economic Recession ; Female ; Humans ; Infant ; Infant Nutrition Disorders ; economics ; epidemiology ; Male ; Nutritional Status ; physiology ; Population Surveillance ; Poverty ; Pregnancy ; Prevalence ; Rural Population ; Thinness ; Time Factors

The relationship between Bcl-2, Bax, Fas, caspase-3 and development of hemangioma and the molecular mechanism was investigated. By using immunohistochemical S-P method, proliferating cell nuclear antigen was detected. According to the classification of Mulliken in combination with PCNA expression, 27 cases were identified as proliferating hemangioma and 22 cases as involutive hemangioma. Five normal skin tissues around the tumor tissue served as controls. By using immunohistochemical technique, the expression of Bcl-2, Bax, Fax and Caspase-3 was detected. The cells expressing Bcl-2, Bax, Fax and cappase-3 were identified as hemangioma endothelia by immunohistochemical staining of Ⅷ factor. The average absorbance (A) and average positive area rate of Bcl-2, Bax, Fas and caspase-3 expression were measured by using HPIAS-2000 imaging analysis system. The results showed that the expression of Bcl-2 in the endothelia of proliferating hemangioma was significantly higher that in involutive degenerative hemangioma endothelia and vascular endothelia of normal skin tissue (P＜0.01). The expression of Bax, Fas and Caspase-3 in the endothelia of involutive hemangioma was obviously higher than in the endothelia of proliferating hemangioma and normal skin tissue (P＜0.01). The expression of BAx and Fas in endothelia of proliferating hemangioma was higher than in those of normal skin tissue (P＜0.05). It was suggested that Bcl-2,Bax, Fas and caspase-3 might be involved in the development and involution of hemangioma. Bcl-2 could promote the growth of hemangioma by inhibiting apoptosis of endothelia. Bax, Fas and caspase-3 promote the switch of hemangioma from proliferation to involution by inducing the apoptosis of hemangioma endothelia.

OBJECTIVETo investigate the expression of the key marker of endoplasmic reticulum stress (ERS) IRE1 mRNA and neuronal apoptosis in the rat hippocampus after status convulsivus (SC), and the intervention effects of edaravone, a novel free radical scavenger.

METHODSSprague-Dawley (SD) rats aged 19-21 days were randomly assigned to three groups: normal control, SC and edaravone-treated SC. SC was induced in the later two groups. The two groups were subdivided into 5 groups sacrificed at 4, 12, 24, 48, and 72 hrs after SC induction. IRE1 mRNA expression in the hippocampus was detected by RT-PCR. Neuronal apoptosis was observed by TdT-mediated dUTP nick end labeling (TUNEL). The ultramicrostructural changes of neuron were observed by electron microscopy.

RESULTSIRE1 mRNA expression was obviously up-regulated 4 and 12 hrs after SC compared with the normal control group (P<0.01). IRE1 mRNA expression in the edaravone-treated SC group was notably higher than the untreated SC group 4, 12 and 24 hrs after SC and the normal control group (P<0.01). TUNEL positive cells in the hippocampus in the untreated SC group were significantly more than those in the normal control group (P<0.01). The number of TUNEL positive cells increased with the prolonged convulsion time. TUNEL positive cells in the edaravone-treated SC group were significantly reduced compared with those in the untreated SC group 12, 24, 48 and 72 hrs after SC (P<0.05 or P<0.01), but remained higher than the normal control group (P<0.05 or P<0.01). The peri-nucleus cell organ injuries were observed 4 hrs after SC and karyopycnosis and cytoplasm condensation were observed 12 hrs after SC in the SC and the edaravone-treated SC groups. The edaravone-treated SC group demonstrated less severe apoptosis than the untreated SC group.

CONCLUSIONSEdaravone may have neuroprotections against SC by an up-regulation of IRE1 expression. It might serve as an effective agent for reducing ERS in vivo.

Animals ; Antipyrine ; analogs & derivatives ; pharmacology ; therapeutic use ; Apoptosis ; drug effects ; Disease Models, Animal ; Hippocampus ; drug effects ; metabolism ; ultrastructure ; In Situ Nick-End Labeling ; Male ; Membrane Proteins ; genetics ; Neurons ; drug effects ; ultrastructure ; Protein-Serine-Threonine Kinases ; genetics ; RNA, Messenger ; analysis ; Rats ; Rats, Sprague-Dawley ; Status Epilepticus ; drug therapy ; metabolism ; pathology

Objective To analyze the precipitating factors for,clinical manifestations of,laboratory findings in and therapeutic effect on acute urticaria.Methods Clinical data were collected from 185 inpatients with acute urticaria in Shanxi Dayi Hospital from January 2013 to December 2016.Clinical features,laboratory examination results,treatment,prognosis and adverse reactions were analyzed retrospectively.Statistical analysis was carried out by chi-square test.Results There were 63 male patients and 122 female patients in this study,with an average age at onset of 32.87 ± 14.18 years.Of the 185 patients,78 (42.2％) were able to report the aetiological agents accurately,33 (17.8％) were induced by infection or drug therapy following infection,and 82 (44.3％) had fever.Blood cell analysis showed increased white blood cell count in 132 (71.4％) cases and increased proportion of neutrophils in 128 (69.2％) cases.The level of C reactive protein increased in 118 (69％) of 171 cases.A total of 185 patients received routine anti-anaphylactic treatment.Of 183 cured patients,153 (83.6％) were treated with antibiotics,26(14.2％)with antibiotics alone,and 24(13.1％) with azithromycin.There were 127 (69.4％) patients receiving combined treatment with glucocorticoids,antibiotics,and so on,and the antibiotic used in 111 (60.7％) cases was azithromycin.Of 88 cured patients with simultaneous signs of infection,85 (96.6％) showed increased levels of part or all of infection markers (including the white blood cell count,proportion of neutrophils and level of C reactive protein),and 69 (78.4％) were treated with azithromycin.Of 95 cured patients without signs of infection,83 (87.4％) showed increased levels of infection markers,and 61 (64.2％) were treated with azithromycin.Moreover,there were significant differences in the proportion of patients with increased levels of infection markers and that of patients treated with azithromycin between the cured patients with and without signs of infection (x2 =5.164,4.476,both P ＜ 0.05).Conclusions Infection is a common cause of acute urticaria,and laboratory examinations including white blood cell count,proportion of neutrophils and level of C reactive protein are of important reference value to the diagnosis of infection in patients with acute urticaria.Patients with signs of infection or increased levels of infection markers need to be treated with combined anti-infective therapy,and in the cured patients,the proportion of patients administrating azithromycin was higher than that of those administrating other antibiotics for the treatment of acute infectious urticaria.

Objective To investigate the therapeutic methods of hyperpotassemia induced by excessively high blood concentration of tacrolimus (FK506) caused by drug use after renal transplantation. Methods Clinical data of 10 patients diagnosed with hyperpotassemia induced by excessively high blood concentration of FK506 after administration of antifunga l medication following renal transplantation were collected and retrospectively analyzed. Results At 1-2 months after renal transplantation, 10 patients suffered from pulmonary infectiono r pneumonia complicated with pulmonary fungal infection . An appropriate dose of compound sulfamethoxazole, micafungin, cefoperazone sodium-sulbactam sodium and moxifloxacin was administered for antifungal infection. After potassium-lowering therapy, termination of antifungal medication and FK506 dose adjustment (replaced by cyclosporin for certain cases), the serum level of potassium was declined and maintained within normal range for 10 cases. The serum concentration of FK506 was within normal range. No sign of excessively high level of potassium was observed without any potassium-lowering intervention. Conclusions Postoperative administration of drugs is likely to cause excessively high level of FK506 and hyperpotasesmia. Potassium-lowering therapy, termination of drug use and adjustment of immunosuppressive agents should be adopted to avoid the incidence of adverse pharmacologic interaction.

Objective To summarize clinical characteristics, prevention and treatment of postoperative chronic hyponatremia after liver transplantation(LT). Methods Clinical data of 26 patients presenting with chronic hyponatremia after LTwereretrospectivelyanalyzed.BaselinedataandmaincomplicationsofpatientswithhyponatremiaafterLTwererecorded. Thecorrelationbetweenpostoperativelengthofhospitalstayandthedurationofhyponatremiawasanalyzed.Clinicaltreatment and prognosis were summarized. Results Among 26 patients, the median blood sodium concentration was 131 mmol/L (range 125 to 133 mmol/L). Al patients were diagnosed with mild or moderate degree of hyponatremia. Main complications included pulmonary infection (n=13, 50%), acute rejection of liver graft (n=7, 27%) and digestive tract hemorrhage (n=7, 27%). Postoperative length of hospital stay was correlated with the duration of hyponatremia. After ful evaluation of patient's conditionandexcludingthepotentialinducers,aportionof3%ofhypertonicsalinewasadministeredviagastro-intestinaltract and/or vein. After positive treatment, 23 cases (88%) were healed and 3 (12%) died from infection complicated with multiple organ failure. Conclusions After LT, the incidence of chronic hyponatremia is low with mild severity. Postoperative length of hospitalstayiscorrelatedwiththedurationofhyponatremia.Thekeyoftreatmentistotimelyexcludetheinducers,correctthe low level of sodium based upon the individual principles and prevent the incidence of postoperative complications.

Objective To compare ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) and chemiluminescence immunoassay(CLIA) measurement of human serum androgen levels in polycystic ovarian syndrome(PCOS). Methods 160 PCOS patients and 146 healthy subjects(control group) were recruited and their serum androgen levels——measurements of testosterone and dehydcoepiandrosterone sulfate (DHEA-S) were tested by UPLC-MS/MS and CLIA. The androgen results combined with body mass index(BMI) were analyzed by ROC curve. According to area under curve(AUC) calculated by SPSS, a better method will be selected to provide accurate test results for physicians. Results (1)AUC of DHEA-S tested by UPLC-MS/MS was significantly higher than the one tested by CLIA(P<0.01). There was no significant difference between the AUC of T tested by UPLC-MS/MS and the one tested by CLIA. (2)AUC of T combined with DHEA-S tested by HPLC was not only significantly higher than the AUC of two combined indicators tested by CLIA(P<0.01),but also significantly higher than the AUC of a single indicator——either T(P<0.01) or DHEA-S(P<0.01) tested by UPLC-MS/MS. (3)The AUC of T,DHEA-S combined with BMI tested by HPLC was not only significantly higher than the AUC of three combined indicators tested by CLIA(P<0.01),but also higher than the AUC of two combined indicators tested by UPLC-MS/MS(P<0.05). Conclusion T and DHEA-S tested by UPLC-MS/MS combined with BMI has a certain reference value in the diagnosis of PCOS.