Background and Purpose:The objective of this study was to assess the value of tumor markers and clinical characteristics in making a differential diagnosis between mature cystic teratoma(MCT) and its malignant transformation(MT).Methods:176 patients with mature cystic teratoma of the ovary diagnosed by postoperative pathology were treated in our hospital between 1997 and December 2004,the authors studied their clinicopathologic data and tested several serum tumor markers.Results:170 were MCT,the mean age was 35.8,the mean tumor size was 8.8cm,153 were tested for CA125,the mean serum CA125 level was 33u/ml,37 with serum CA125 level over 35u/ml;140 for tested CA19-9,the mean serum CA19-9 level was 217u/ml,77 with serum CA19-9 level over 37u/ml;112 tested for SCC,the mean serum SCC level was 1.82ng/ml,29 with serum SCC level over 1.5ng/ml;115 tested for CEA,the mean serum CEA level was 1.42ng/ml,8 with serum CEA level over 5ng/ml;6 cases were malignant transformation,the mean age was 47,the mean tumor size was 17.6cm,the mean serum CA125 level was 500u/ml,5 with serum CA125 level over 35u/ml,the mean serum CA19-9 level was 609.8u/ml,5 with serum CA19-9 level over 37u/ml,the mean serum SCC level was 23.4ng/ml,5 with serum SCC level over 1.5ng/ml,the mean serum CEA level was 22.8ng/ml,4 with serum CEA level over 5ng/ml.There were significant differences in age,tumor size and levels of the serum tumor markers between MCT and MT.(P

Objective To explore the effects of glucocorticoid(GC)and lipid metabolism on the pathogenesis of avascular necrosis of femoral head(ANFH).Methods Thirty-two New Zealand rabbits were randomly assigned into two groups as experiment group(n=24)and control group(n=8).Each rabbit in experiment group was given injection with 8.0mg/kg of hydrocortisone acetate for two times per week,while rabbits in control group were given normal saline in same quantity.Serum glucocorticoid(GC)concentration,total cholesterol(TC)and triglyceride(TG)were determined respectively before and 2,4,6 and 8 weeks after treatment.Rabbits were sacrificed at the 2nd,4th,6th and 8th week.The rabbits,sacrificed at the same time point,were stratified into group A(low concentration group)and group B(high concentration group)according to the GC concentration,in an attempt to observe the rate of empty bone lacuna and glucocorticoid receptor(GR)expression in the soft tissue around hips.Results The concentration of TC of experiment group began to increase since the 6th week,and that of TG since 2nd week(P0.05).In addition,the rate of bone lacuna and OD scores of GR were positively correlated at the 4th and 8th week(r=0.699 0,0.605 0,P

Objective To study the intercellular adhesion molecule-1(ICAM-1)and fat metabolism in the contribution of the incidence of steroid avascular necrosis of femoral head(ANFH).Methods 32 New Zealand rabbits were randomly divided into two groups:animals in experiment group(n=24)were given an injection of hydrocortisone acetate(8.0mg/kg)two times per week,and animals in control group(n=8)were given an injection with the same volume of normal saline.Serum total cholesterol(TC),triglyceride(TG)and ICAM-1 were quantitated before and 2,4,6,8 weeks after the treatment.2,4,6 and 8 weeks after treatment,6 animals of the experiment group and 2 of the control group were randomly chosen and sacrificed.ICAM-1 expression in soft tissue around hip was determined immunohistochemically,and pathohistological changes in femoral head were observed by light microscopy.Results Serum TC and TG levels of the animals in experimental group were significantly higher than those before treatment and those in control group in the 6th week after treatment(P

0.05,X 2 =0.45),and the focus stability ratio were42.5%and32.4%respectively.Compared with the FOLFOX4group,the hospitalization course in capecitabine group is significantly shorter(8.5days vs25.3days,P=0.000)and the total medical cost was significantly lower(5941.7RMB vs13304.6RMB,P=0.001).The cost structure analysis showed that the direct and indirect medical costs of the FOLFOX4group increased more significantly(P=0.001)and the incidence for adverse effects of this group was lower than that of the capecitabine group.CONCLUSION:From the perspective of pharmacoeconomic evaluation,capecitabine is better than FOLFOX4in treating the digestive malignant tumor.

Objective To study the influence of mild hypothermia on pulmonary vascular permeability in patients with acute respiratory distress syndrome (ARDS) induced by infection.Methods A prospective randomized controlled trial was conducted.Patients with ARDS induced by infection satisfied criteria including age 18-70 years,endotracheal intubation and mechanical ventilation (MV),and without severe coagulation disorder admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangxi Medical University from May 2012 to November 2015 were enrolled,excluding tumor,burn,cardiac disease,vascular disease,and endovascular surgery within 3 months.The patients enrolled were randomly divided into non-temperature controlled group and mild hypothermia group.The primary diseases in all patients were treated according to the treating principles,including respiratory support,integrated treatment of organ support and symptomatic treatment.Besides,the patients in the mild hypothermia group were administered with systemic hypothermia,and the patients' core body temperature (nasopharyngeal temperature) was rapidly decreased to 34-35 ℃ within 1 hour.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in two groups at 1,24,48,and 72 hours after treatment or core temperature up to standards were monitored respectively.Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of vascular endothelial growth factor (VEGF) in venous blood as well as tumor necrosis factor-α (TNF-α) and surfactant apoprotein A (SP-A) in bronchoalveolar lavage fluid (BALF),and circulating endothelial cell (CEC) was counted.The duration of mechanical ventilation and 7-day survival rate were recorded.Results Fifty-six patients were enrolled,with 32 in non-temperature controlled group and 24 in mild hypothermia group.There was no difference in baseline variables including gender,age,APACHE Ⅱ score,PaO2/FiO2 between two groups.APACHE Ⅱ score,EVLWI,PVPI,VEGF,CEC,and TNF-α in both groups were gradually increased with treatment time prolongation,and PaO2/FiO2 and SP-A were gradually decreased.Compared with non-temperature controlled group,APACHE Ⅱ score (16.34±4.27 vs.19.24 ± 5.95),EVLWI (mL/kg:12.17 ± 2.26 vs.12.39 ± 4.71),PVPI (15.40 ± 10.95 vs.16.08 ± 10.24),VEGF (ng/L:127.92 ± 31.49 vs.159.12 ± 40.67),CEC (cells/μL:4.15 ± 1.79 vs.5.70 ± 2.38),and TNF-α (ng/L:147.18 ± 48.85 vs.257.17 ±40.84) in mild hypothermia group were significantly decreased from 24 hours (all P ＜ 0.05),and PaO2/FiO2 [mmHg (1 mmHg =0.133 kPa):175.03± 12.64 vs.162.53 ± 14.15] and SP-A (μg/L:80.85 ± 16.18 vs.62.06 ± 17.28) were significantly increased (both P ＜ 0.05),the duration of mechanical ventilation was significantly shortened (days:10.38 ± 1.50 vs.15.74 ± 3.06,P ＜ 0.01),and 7-day survival rate was significantly increased (75.0％ vs.46.9％,P ＜ 0.05).Conclusion Mild hypothermia can reduce the pulmonary vascular permeability,and improve pulmonary function in early phase in patients with ARDS,as well as shorten the duration of mechanical ventilation,and decrease short-term mortality.

Objective To investigate the effect of hypothermia on the expression Toll-like receptor 2 (TLR2),myeloid differentiation factor 88(MyD88),nuclear factor-κBp65(NF-κBp65),plasminogen activator inhibitor-1(PAI-1)in the TLR2/MyD88 pathway in rats with acute lung injury(ALI)induced by lipopolysaccharide (LPS)inhalation. Methods Ninety male Sprague-Dawley(SD)rats were randomly divided into control group (n=18),hypothermia group(n=24),temperature controlled group(n=24),and temperature-uncontrolled group(n=24). The ALI model was reproduced by 0.5 mL/kg LPS intratracheal instillation,while only normal saline was instilled intratracheally for control group. Arterial blood was collected and physical cooling was started 1 hour after instillation. The body temperature was lowered to 32-34 ℃in hypothermia group and 36-37 ℃in temperature controlled group,and no intervention was used for temperature-uncontrolled group and control group. The arterial blood gas was determined in all the groups before and 1 hour after instillation of saline or LPS and 1,6, 12 hours after intervention. Rats were sacrificed respectively at 1,6 and 12 hours after temperature control therapy, the morphological changes in lung tissue were observed under light microscope. The protein expression of PAI-1 in bronchoalveolar lavage fluid(BALF)was determined by enzyme linked immunosorbent assay(ELISA). TLR2 mRNA and MyD88 mRNA transcriptional level were determined by reverse transcription-polymeras chain reaction (RT-PCR). NF-κBp65 protein level was determined by Western Blot. Results After instillation of LPS,the oxygenation index(PaO2/FiO2)of each group was decreased obviously,the damage of lung tissues was aggravating,the lung injury score was increased significantly,PAI-1 protein in BALF and the expressions of TLR2 mRNA,MyD88 mRNA, NF-κBp65 protein in lung tissues were increased obviously. Each index was improved by therapeutic Hypothermia, the effect of which was best in using a cooling period in the 1-6 hours,while might be benefit at 6-12 hours. Compared with temperature controlled group,PaO2/FiO2(mmHg,1 mmHg=0.133 kPa)at 1 hour and 6 hours of hypothermia group was improved(1 hour:402.49±38.61 vs. 324.36±28.93,6 hours:349.72±98.20 vs. 284.35±13.68, both P<0.01),the lung injury score at 1,6 and 12 hours were significantly decreased(1 hour:6.04±0.74 vs. 7.96±0.65,6 hours:9.09±0.80 vs. 13.13±1.02,12 hours:10.79±1.42 vs. 13.42±0.68,all P<0.01),the PAI-1 protein(ng/L)in BALF at 1,6 and 12 hours were significantly decreased(1 hour:121.36±4.62 vs. 197.74±9.42, 6 hours:230.53±10.76 vs. 294.06±16.60,12 hours:270.48±13.20 vs. 319.40±10.24,all P<0.01),TLR2 mRNA and MyD88 mRNA expressions(2-ΔΔCt)in the lung tissues at 1,6 and 12 hours were significantly decreased (TLR2 mRNA 1 hour:2.18±0.26 vs. 3.04±0.39,6 hours:4.09±0.29 vs. 4.90±0.35,12 hours:6.02±0.43 vs. 7.10±0.54;MyD88 mRNA 1 hour:2.25±0.41 vs. 3.04±0.30,6 hours:5.67±0.55 vs. 7.01±0.76,12 hours:7.14±0.60 vs. 8.87±0.54,all P<0.01),NF-κBp65 protein expression(A value)at 6 hours and 12 hours was significantly decreased(6 hours:0.31±0.08 vs. 0.53±0.12,12 hours:1.05±0.17 vs. 1.76±0.35,both P<0.01). There was no difference in each index between temperature controlled group and temperature-uncontrolled group. Conclusion Hypothermia can down-regulate the expression of TLR2 mRNA,MyD88 mRNA,NF-κBp65 protein and PAI-1 in the TLR2/MyD88 pathway to protect lung tissue of rats with ALI induced by LPS inhalation from injury.

OBJECTIVE: To evaluate the effect of the vestibular diagnosis and treatment system (SRM-IV ) in diagnosis and treatment of patients with benign paroxysmal positional vertigo (BPPV). METHOD: Patients who were diagnosed as BPPV by SRM-TV in the clinic of our hospital from November 2013 to October 2014 were retrospectively analyzed in this study. RESULT: Among 425 suspected cases, 230 BPPV-positive patients were diagnosed including 131 cases of posterior SC (57.0%), 95 cases of horizontal SC (41.3%) and 4 cases of more than two SC (1.7%). The cure rate by SRM-V was 94.6% and the effective rate was 100.0%. The relapsed occurred in 10 patients (4.8%), which contained 4 men and 6 women. CONCLUSION SRM-V can realize 360° reasonable repositioning procedure while Canalish reposition procedure cannot. SRM-V can improve both the corrective rate of diagnosis and the cure rate, especially for the patients who suffered from complex BPPV.
Benign Paroxysmal Positional Vertigo ; diagnosis ; therapy ; Female ; Humans ; Male ; Patient Positioning ; Retrospective Studies ; Vestibule, Labyrinth ; physiopathology

Objective To observe the difference among the patients with chronic fatigue syndrome (CFS), mild-to-moderate depression or anxiety disorders in symptoms of fatigue, depression and anxiety. Methods Fatigue Scale-14 (FS-14), Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA) were used to evaluate 182 cases with CFS, mild-to-moderate depression or anxiety disorders. Results There was no significant difference in physical fatigue, mental fatigue and comprehensive fatigue among 3 groups (P>0.05). There were 39 (62.9%) CFS patients perhaps with depression symptoms and 23 (37.1%) patients with mild-to-moderate depression symptoms. There were 46 (74.2%) CFS patients perhaps with anxiety symptoms and 16 (25.8%) patients with mild-to-moderate anxiety symptoms. The score of HAMD was significant lower in the CFS group than in the mild-to-moderate depression disorder group (P<0.001). There were significant differences in the anxiety/somatization and hysteresis (P<0.01), as well as in cognitive disturbance, diurnal variation and hopelessness (P<0.05) between the CFS group and mild-to-moderate depression disorder group. The scores of HAMA was significant lower in the CFS group than in the mild-to- moderate anxiety disorder group (P<0.001). There was significant difference in mental-anxiety (P<0.01), as well as in body-anxiety (P<0.05) between the CFS group and the mild-to-moderate anxiety disorder group. Conclusion The symptoms of emotion disorders and fatigue symptoms were both presented in patients with CFS, mild-to-moderate depression and anxiety disorders. They share common clinical features.

Objective To explore the clinical application value of left atrial function with feature tracking cardiac magnetic resonance imaging (FT-CMR) by evaluating preliminarily left atrial strain and strain rate in patients with atrial fibrillation. Methods Thirty patients with paroxysmal atrial fibrillation, thirty patients with persistent atrial fibrillation and twenty-two healthy subjects were enrolled. All the subjects underwent cardiac magnetic resonance imaging with the real steady-state free precession(SSFP) sequence. FT-CMR parameters included left atrial strain and strain rate parameters, left atrial volume and function parameters were detected by using offline cardiovascular analysis software, respectively. Left atrial strain and strain rate parameters included left atrial total strain(Εs), passive strain(Εe), active strain(Εa), peak positive strain rate(SRs), peak early negative strain rate(SRe)and peak late negative strain rate(SRa). Volume and function parameters included maximum of left atrial volume(LAVmax), minimum of left atrial volume(LAVmin), total left atrial emptying fraction(LATEF), passive left atrial emptying fraction(LAPEF)and active left atrial emptying fraction(LAAEF). The differences in the general data among the paroxysmal atrial fibrillation group, the persistent atrial fibrillation group and the control group were compared by usingχ2 test or ANOVA analysis. The differences in all parameters between the atrial fibrillation group and the control group, the paroxysmal atrial fibrillation group and the persistent atrial fibrillation group were compared by using independent t test. Left atrial strain and strain rate parameters on an intra-observer and inter-observer were determined by intraclass correlation coefficient(ICC)analyses. Results Compared to control group, LAVmax and LAVmin in atrial fibrillation group were significantly increased(t=9.737,7.889,P<0.001);The LATEF and LAPEF had no significant difference, the LAAEF in two groups had statistically significant difference(t=-4.762,P<0.001).The absolute value of Es, Ee, Ea, SRs, SRe, SRa in atrial fibrillation group were significantly reduced than in control group(t=-7.732,-6.610,-6.493,-7.546, 6.864, 5.917,P<0.001). Compared with paroxysmal atrial fibrillation group, LAVmax and LAVmin in persistent atrial fibrillation group were increased obviously, LATEF and LAPEF were significantly decreased, and the differences were statistically significant(t=-4.575,-5.524, 4.002, 4.028,P<0.001).The LAAEF in two groups had no statistically significant difference. Compared with strain and strain rate in two groups, absolute value of Es, Ee, Ea, SRs, SRe, SRa in persistent atrial fibrillation group significantly decreased than in paroxysmal atrial fibrillation(t=4.310, 3.128, 4.465, 5.496,-3.290,-3.863,P<0.001). The intra-group and inter-group had well correlation coefficients between the observers in the left atrial strain and strain rate parameters of the subjects(ICC=0.85—0.94,0.81—0.90). Conclusions FT-CMR technique can be used to assess the left atrial strain and strain rate in patients with atrial fibrillation;Left atrial reservoir, conduit and booster-pump functions in patients with atrial fibrillation were impaired. Patients with persistent atrial fibrillation had worse left atrial function throughout the entire cardiac cycle compared with those with paroxysmal atrial fibrillation.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) leads to high mortality of infected patients. How to deal with CRKP is an urgent problem in clinical practice, and it is imperative to carry out researchon carbapenem resistance mechanism of CRKP. The two-component systems (TCSs) areassociated with the development of drug resistance in a variety of bacteria, and TCSs were expected to be important therapeutic targets for CRKP. Therefore, this article reviewed the mechanisms of TCSs in the regulation of CRKP from the following several aspects: common mechanisms of carbapenem resistance of CRKP, research progress in drug resistance of TCSs, relationships between Klebsiella pneumoniae and TCSs, and so on. It may provide some research ideas for future research and the references for clinical diagnosis and treatment.