Objective To evaluate the value of revised Geneva score, Daniel ECG score and age-adjusted D-dimer for predicting pulmonary embolism(PE).Methods A total of 91 cases suspected as pulmonary embolism were collected, and 52 cases were diagnosed as pulmonary embolism by computed tomographic pulmonary angiography(CTPA) results.Receiver operating characteristic(ROC) curves and diagnostic test evaluation indexes were used to evaluate the probability of PE predicted by the revised Geneva score,Daniel ECG score, age-adjusted D-dimer and combination of these two clinical scores and age-adjusted D-dimer.Results The confirmed PE was 21.4% with a low probability(revised Geneva score 0~3 points),55.4% in intermediate probability(4~10 points),85.7% in high probability(score≥11 points).The prevalence of PE was 33.3% with a low clinical probability (Daniel ECG score<2 points)and 70.7% with a high clinical probability(Daniel ECG score≥2 points).The sensitivity and specificity of age-adjusted D-dimer in predicting pulmonary embolism were 92.3%,69.2%.The area under curve of the ROC curve(AUC)in the revised Geneva score and Daniel ECG score has no significant difference(Z=0.979).The negative predictive value of the revised Geneva score, Daniel ECG score combined with D-dimer in pulmonary embolism were 100.0% and 87.5%.Conclusion All of revised Geneva score, Daniel ECG score and age-adjusted D-dimer have certain predictive value on pulmonary embolism , and the revised Geneva score combined with age-adjusted D-dimer can be more safely exclude pulmonary embolism.

AIM:To discuss the changes of IL-17, IL-21 in glucocorticoid therapy of active thyroid associated ophthalmopathy (TAO) and analyze the relation with results.METHODS:The 67 patients (134 eyes) of TAO in our hospital, were divided into activity group(32 patients 64 eyes) and atypical activity group(35 patients 70 eyes) according clinical activity score (CAS) grading standard, and 30 cases of healthy as control group at the same time.The activity group were treated by glucocorticoid therapy treatment, and proceed the CAS scores before and after treatment, measured the degree of exophthalmus and width of palpebral fissure.At the same time, compared the expression level of IL-17 and IL-21 in all groups, and analyzed the correlation between the IL-17 and IL-21 and CAS score.RESULTS:Compared with control group, expressions of IL-17 and IL-21 in TAO patients were significantly higher (P<0.05).The expressions of IL-17 and IL-21 in active period TAO patients were higher than atypical activity (P<0.05).After glucocorticoid treatment, the expressions of IL-17 in active period TAO patients decreased significantly(P<0.05), and it was significantly positive correlation with CAS score (before treatment:r=0.8847,P=0.042;after treatment:r=0.8886,P=0.0439) the expression of IL-21 in active period TAO patients was significantly positive correlation with CAS score (before treatment:r=0.8893, P=0.0435;after treatment:r=0.8876,P=0.045).CONCLUSION:IL-17 and IL-21 is closely related to the TAO disease activity, and glucocorticoids impact treatment by reducing IL-17 and IL-21 in activity TAO, IL-17 and IL-21 can be used as one of indexes of predicted curative effect and condition in patients with TAO.

Objective To detect the changes in DNA loads of human papillomavirus (HPV) type 6/11 in lesions of patients with condyloma accuminatum (CA) before and after 5-aminolevulinic acid photodynamic therapy (ALA-PDT).Methods After removal of warts by electrocautery,HPV6/11-positive patients with CA were divided into two groups:treatment group (32 cases) receiving two sessions of ALA-PDT with intervals of 7-10 days,and control group (29 cases) remaining untreated.Exfoliated cells were collected from the lesional sites of these patients before and 3 months after the first session of ALA-PDT,and fluorescence-based quantitative PCR was conducted to estimate the DNA loads of HPV 6/11 in these cells.Results Three months after the first session of ALA-PDT,89.7％ (26/29) of the patients in the treatment group and 68.4％ (13/19) in the control group became HPV DNA negative,with significant differences between the treatment group and control group in the DNA loads of HPV ((1.70 ± 7.86) × 105 vs.(1.27 ± 2.21) × 106 copies/ml,P ＜ 0.05).Conclusion ALA-PDT can reduce HPV DNA loads in lesions of CA in patients.

Humans ; Integrative Medicine ; Medicine ; Medicine, Chinese Traditional

China ; Foundations ; Integrative Medicine ; Natural Science Disciplines

Myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) are important inhibitory immune cells.Research finds that MDSCs and Tregs increase in a large number under the conditions of inflammation,infection and tumor and they are able to suppress the immunity system and promote tumorigenesis and metastasis through multiple mechanisms.Finding the causes resulting in the increase of MDSCs and Tregs in tumor microenvironment and the eliminating methods have become new focuses in the field of antitumor immunotherapy.

Objective To summarize the experience of nursing patients with mandibular fractures treated by micro rigid internal fixation.Method The following nursing methods including psychological interventions,pain intervention,dietary intervention, rehabilitation,intervention and prevention of complications were applied in the nursing care to 56 patients with mandibular fractures treated by micro rigid internal fixation.Results The surgical procedures of micro rigid internal fixation were successful,and all of them were cured and discharged.One case contracted gingivitis and another one oral ulcers,both cured by rinse with mouthwash. Conclusion Nursing intervention can improve the rehabilitative effect on patients with titanium mandibular fracture fixation,reduce the complications and improve clinical outcomes.

BACKGROUND:Current research has shown that tumor necrosis factorαstimulated gene 6 (TSG-6) has anti-inflammatory effect, and the scar formation can be inhibited by local injection of TSG-6 protein at the early stage of trauma. However, the mechanism of this effect is stil unclear. OBJECTIVE:To construct the lentiviral expression vector and shRNA vector for human TSG-6, with stable overexpression, transfection and interference, and to explore the effect of TSG-6 on proliferation and apoptosis of keloid fibroblast cel lines. METHODS:Human keloid fibroblast cel s were isolated from the keloid’s tissue by enzyme digestion and identified by immunocytochemistry assay. Lentiviral vectors pLVX-puro-TSG-6 and pLVX-shRNA1-TSG-6 were constructed and transfected into human keloid fibroblast, exclusively. Expression levels of TSG-6 mRNA and protein were detected by RT-PCR and western blot assay. MTT assay and flow cytometry were used to estimate the cel proliferation and apoptosis in each group after transfection. In addition, expression of Bcl-2, p53 and active-caspase-3 were detected by western blot assay in each group. RESULTS AND CONCLUSION:(1) Human keloid fibroblasts were separated successful y. Under the light microscope, cel s were spindle. Immunohistochemical staining for vimentin was performed in the fifth passage of cel s, with the positive rate of 100%. Cel s were negative for cytokeratin. (2) Recombinant lentiviral vectors and stably transfected cel lines were successful y established. TSG-6 gene expression was altered apparently. Compared with the control group, cel proliferation was delayed and apoptotic rate was noticeably increased in TSG-6 gene overexpression group. Cel proliferation increased and apoptotic rate decreased in the TSG-6 gene intervention group (P<0.05). (3) Western blot assay results demonstrated that Bcl-2 expression reduced, P53 and Active-caspase-3 expression significantly increased in the TSG-6 gene overexpression group (P<0.05). (4) These finding showed that TSG-6 could inhibit proliferation and induce apoptosis in keloid fibroblasts. Its mechanism may be associated with the down-regulation of Bcl-2 protein expression, up-regulation of P53 protein expression and increased Caspase-3 activity.

Objective To explore the clinical and imaging features of reversible posterior leukoencephalopathy syndrome(RPLES).Methods The data of clinic five cases with RPLES were analyzed retrospectively.Results The primary diseases in this group were hypertension for one case,uraemia for three cases and lupus nephropathy for another.Clinical features of five patients include acute onset of hypertension,headache with vomiting.Neurological symptoms were conscious disturbance,seizures(in 5 cases)and visual disorder(in 3 cases).The movement of limbs were normal.The abnormal laboratery data was renal inadequacy in 5 cases.The findings of imaging of all cases included bilateral white matter of parietal and occipital lobe abnormalities,which appeared as large areas of low density on CT scan,hypo-intense in T1 and hyper-intense in T2 on MRI scan.Four cases presented clinical symptoms improvement in a short time and radiological recovery obviously after anti-hypertensive and anhydration therapy.One patient died caused on brain herniation.Conclusions Clinical features of RPLES is brain damage associated with malignant hypertension or the use of immunosuppressive agents.The most important pathogenesis is considered to be failure of the self regulation of cerebral vascular circulation.The imaging findings are bilateral symmetry cortical and subcortical edema in the posterior areas of the brain.Most patients can be recovery by timely therapy,otherwise the irreversible neuronal injury even death can be also found in very few serious cases.

Objective To investigate the expression of TIMP-1 in brain tissue of perihematoma and the relationship between TIMP-1 and brain edema in experimental intracerebral hemorrhage(ICH). Methods ICH models of rats were established by autologous blood injection. Then the brain water content was measured by comparion of wet and dry weight,the permeability of blood-brain barrier (BBB) was evaluated by evans blue contents,and the expression of TIMP-1 in brain tissue of perihematoma was detected by Western Blot at 1 h,3 h,6 h,12 h,24 h,36 h,48 h,72 h and 7 d total 9 time points after ICH. The relationship among the results were analysed,and compared with the sham operation group. Results Compared with the sham operation group,the brain water contents and evans blue contents were significantly increased at all the time points in ICH group (P