Objective: To discuss the clinical features,diagnosis,pathogenesis and treatment of antiepileptic drug hypersensitivity syndrome(AHS).Methods: A retrospective analysis of one case of AHS was focused on his clinical data.Results: About six weeks after carbamazepine treatment the patient presented fever firstly.The highest temperature is up to 39.6℃.Subsequently he developed diffusible red maculopapular rash and swollen superficial lymph nodes.Physical examination found internal organs involvement(mainly liver and lung).Laboratory examinations showed that the leucocyte increased to 54.21?109/L,and the percentage and absolute count of eosinophil rose,while IgG and IgM decreased.The CT of thoracic part showed the lymph nodes of hilum of lung and mediastina swelled together with pleural effusion.A biopsy study of lymph node suggested the reactive hyperplasia which was not equal to lymphoma.The bone marrow smear showed granulocytic cell line hyperplasia and abnormal lymphocyte were observed.After discontinuing carbamazepine in time and applying corticosteroids,the temperature descended rapidly and the swollen lymph nodes recovered soon.Conclusion: AHS is an idiosyncratic reaction.It usually occurs within 2 to 8 weeks after initiation of antiepileptic drug therapy,and typically manifests itself as fever,eruption and internal organ involvements.Pathogenesis is still not definite.Important basis for diagnosis and differential diagnosis depends on clinical manifestations and laboratory examinations.Early recognition of AHS and timely discontinuing of the suspected drugs are the essential therapy.

Objective To observe the effect of flupentixol and melitracen tablets combined with Yueju pills in the treatment of functional gastrointestinal disorders ( FGID) .Methods According to the digital table ,308 patients with FGID were selected and randomly divided into 4 groups,77 cases in each group.The control group were given conventional treatment .The treatment group was divided into 3 groups:group 1:flupentixol and melitracen tablets was added on the basis of routine therapy;group 2:Yueju pills was added on the basis of routine therapy;group 3:patients in this group used conventional treatment combined with flupentixol and melitracen tablets and Yueju pills .The period of treatment was 6 week,then their clinical symptoms were compared .Results The effective rate in group 1,2,3 was 79.2%,62.3%,94.8%,respectively,which was significantly higher than 19.4% in the control group(χ2 =54.96, 29.24,89.18,all P<0.05);while compared each treatment group ,the total effective rate in group 3 was obviously higher than that in group 1 ang group 2(χ2 =8.27,24.08,all P<0.05),and the total effective rate in group 1 was higher than that in group 1(χ2 =4.09,P<0.05).Conclusion Flupentixol and melitracen tablets combined with Yueju pills are more effective for treating functional gastrointestinal disorders than that of single drugusing .

OBJECTIVE:To observe clinical efficacy and safety of Zishen jianpi huoxue decoction combined with Xiaoxintong capsule in the treatment of type 2 diabetes complicating with silent myocardial ischemia (SMI). METHODS:126 patients with type 2 diabetes complicating with SMI were selected and randomly divided into control group(62 case)and observation group(64 cases). Both group were given diet guidance and hypoglycemic drugs as sulfonylureas,biguanides. Control group was given Xiaox-intong capsule 10 mg,tid;observation group was additionally given Zishen jianpi huoxue decoction 400-500 ml,bid. Both groups received treatment for 7 d. Therapeutic efficacy of thoracic obstruction,improvement of coronary artery branch stenosis and times and duration of electrocardiogram ST segment low voltage outlet were observed in 2 groups. ADR was compared between 2 groups. RESULTS:Therapeutic efficacy of thoracic obstruction and improvement of coronary artery branch stenosis in observation group were significantly better than in control group,with statistical significance(P<0.05);the times and duration of electrocardiogram ST segment low voltage outlet in observation group were significantly lesser shorter than in control group,with statistical signifi-cance (P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Zishen jianpi huoxue decoction complicating with Xiaoxintong capsule shows significantly therapeutic efficacy in the treatment of type 2 diabetes complicating with SMI with good safety.

Breast Neoplasms ; Female ; Humans ; Neoplasms, Second Primary ; Risk Factors

Objective To investigate the expression of CRKL in thyroid papillary micro-carcinoma and its clinical significance.Methods 120 patients with thyroid tissue specimens were collected,in which 30 cases of diam-eter >1 cm of papillary thyroid carcinoma,30 cases of thyroid papillary micro-carcinoma,30 cases of nodular goiter, 30 cases for specimen of thyroid disease patients without diabetes.Immunohistochemical(SP)method was used to de-tect samples in CRKL expression.Results In thyroid papillary micro-carcinoma and thyroid papillary cancer group, CRKL expression positive rates were 30.12% and 29.87% respectively,which were higher than that of nodular goiter and normal thyroid group 30.03% and 28.57%(χ2 =52.102,P <0.05);The average absorbance(A)value in thy-roid papillary micro-carcinoma and thyroid papillary carcinoma group which were respectively (0.516 ±0.100)and (0.496 ±0.201),were higher than that in nodular goiter and normal thyroid group (0.246 ±0.050)and (0.117 ±0.015),the difference was statistically significant(F =149.105,P <0.05).Conclusion CRKL is highly expressed in papillary thyroid micro-carcinoma and the clinical detection of CRKL is helpful to determine the surgical plan for papillary thyroid micro-carcinoma.

Objective To investigate the effect of dexmedetomidine on bispectral index (BIS) value at loss of consciousness (LOC) caused by propofol given by target-controlled infusion (TCI).Methods One hundred and twenty ASA Ⅰ or Ⅱ patients,aged 20-50 yr,weighing 41-68 kg,scheduled for general surgery were randomly divided into 3 groups (n =40 each):propofol group (group P),dexmedetomidine 0.5 μg/kg + propofol group (group D1P) and dexmedetomidine 1.0 μg/kg + propofol group (group D2P).The patients in each group were randomly assigned into 5 subgroups ( n =8 each):groups P0-4 receiving TCI of propofol with the target effect-site concentration (Ce) set at0,1,2,3 and 4 mg/L respectively.Groups D1P0-4 received iv infusion of dexmedetomidine 0.5 μg/kg at a rate of0.05μg·kg-1 ·min-1 and TCI of propofol with the target Ce set at 0,1,2,3 and 4 mg/L respectively at 5 min after the end of dexmedetomidine infusion.Groups D2 P0-4 received iv infusion of dexmedetomidine 1.0 μg/kg at a rate of 0.1μg· kg- 1· min- 1 and TCI of propofol with the target Ce set at 0,1,2,3 and 4 mg/L respectively at 5 min after the end of dexmedetomidine infusion.Three minutes after TCI of propofol was started,OAA/S score and BIS value were recorded.The OAMS score ≤ 2 was defined as LOC.The EC50 and 95％ confidence interval of propofol for LOC and BIS50 and 95％ confidence interval at LOC were calculated by Probit analysis.Prediction probability (Pk) of BIS value at LOC was calculated using Smith method.Results Compared with group P,EC50 was significantly decreased,BIS50 was significantly increased ( P ＜ 0.05 or 0.01 ),and no significant change was found in Pk in groups D2 P and D1 P ( P ＞ 0.05).There were no significant differences in EC50,BIS50 and Pk between groups D2 P and D1P ( P ＞ 0.05).Conclusion BIS value can accurately predict the level of consciousness during anesthesia with dexmedetomidine and TCI of propofol,but BIS value is increased at LOC.

Human cancers arise from an imbalance of cell growth and cell death.Critical factors that control the balance are those regulate the cell cycle.Several molecular effectors have been identified to be able to regulate specific phases of the cell cycle,including cyclins,cyclin-dependent kinases (CDKs) and CDK inhibitors.Notably,deficiency of two G1-checkpoint CDK inhibitors-p21 (CDKN1A) and p27 (CDKN1B)-has been implicated to be correlated with initiation or progression of many human malignancies or cancer cells drug-resistance.However,contradict reports also suggested that p21 and p27 could promote tumor progression.Here,we summarized the historic and recent studies on these two CDK inhibitors,including their identification as well as their roles in carcinogenesis and drug resistance.

Objectives To investigate the associations of serum superoxide dismutase ( SOD) , malondialdehyde (MDA), and uric acid (UA) with blood pressure and the prevalence of hypertension in a Chinese population. Methods We measured serum superoxide dismutase (SOD), malondialdehyde (MDA) and uric acid (UA) in 506 randomly selected participants. For database management and statistical analysis, we used the SAS 9.13 Software. Results Compared with normotensive participants, hypertensive patients had significantly lower serum levels of superoxide dismutase activity ( =0.0002), and higher serum levels of malondialdehyde and uric acid ( <0.05) .Univariate analysis indicated that serum superoxide dismutase activity was negatively associated with blood pressure, and serum levels of uric acid (P 0.0001);while serum levels of malondialdehyde was positively associated with blood pressure, and serum levels of uric acid (P 0.05) . There was significant difference in systolic (Ptrend=0.02) and diastolic blood pressure (Ptrend=0.04) between three groups defined by tertiles of serum levels of superoxide dismutase, with a lower blood pressure in the highest tertile than in the lowest tertile. Furthermore, the systolic (Ptrend=0.01) and diastolic blood pressure (Ptrend=0.003) in the highest tertile, which defied by the serum levels of malondialdehyde, were significantly higher than those in the lowest tertile. Conclusions Hypertensive patients have a disturbed oxidative and anti-oxidative balance. Oxidative stress may play a role in the pathogenesis of hypertension in Chinese.

ObjectiveTo investigate the effect of dexmedetomidine on the median effectivetarget effectsite concentration (EC50) of remifentanil required for preventing body movement in response to skin incision made under propofol sedation.MethodsForty ASA Ⅰ or Ⅱ patients aged 20-50 yr weighing 45-58 kg scheduled for elective breast tumor excision were randomly allocated into 2 groups ( n =20 each):group remifentanil (group R) and group remifentanil + demedetomidine ( group RD).Sedation was induced with propofol TCI at target plasma concentration of 3.0 mg/L in both groups.In group RD dexmedetomidine 1.0 μg/kg was infused iv over 10 min before start of propofol TCI,while in group R equal volume of normal saline was infused instead of dexmedetomidine.Remifentanil TCI was started with target effect-site concentration set at 3.0 and 2.5 μg/L in groups R and RD respective at 13 min after beginning of propofol TCI.Skin incision (3 cm in length) was made when the target concentrations of propofol and remifentanil TCI were reached.Body movement was assessed by a nurse not involved in this study.EC50 and 95％ confidence interval (CI) of remifentanil were determined by up-and-down technique.The target effect-site concentration was increased or decreased by 20％ depending on the response of the previous patient to skin-incision.ResultsThe EC50 of remifentanil for preventing body movement in response to skin incision performed under propofol sedation was 1.7 μg/L (95％ CI 1.5-1.9 μg/L) and 2.5 μg/L (95％ CI 2.2-2.7μg/L) in groups RD and R respectively.The EC50 of remifentanil was significantly lower in group RD than in group R.ConclusionDexmedetomidine 1.0 μg/kg can decrease EC50 of remifentanil for preventing body movement in response to skin incision made under propofol sedation.

Objective To investigate the characteristic of diagnosis and treatment of traumatic diaphragm rupture.Methods The characteristic of diagnosis and treatment of 32 cases with traumatic diaphragm rupture was analyzed retrospectively.14 cases were injured by sharp instrument and the other cases with blunt injury mainly caused by traffic accidents.Results Of 32 cases,19 had diaphragmatic ruptures preoperatively,13 diaphragmatic rupture was found during the operation.28 cases cured and 4 cases died.Conclusions The mechanism of traumatic diaphragm rupture and patients' symptoms and sign are severe and complicate with a high shock and mortality.Correct diagnosis and management of traumatic diaphragm rupture are very important.The treatment principle is thoracic injures first and laparotomy second.