Objective To investigate the relation between positive fluid balance and the prognosis in severe sepsis patients with acute kidney injury (AKI).Methods A retrospective analysis of clinical data of 90 patients in our department was carried out.According to the final outcome,patients were divided into survival group (n =26) and non-survival group (n =64),in which the relation between patients' positive fluid balance and the prognosis was evaluated.Results (1) There was no statistically significant difference in the age and severity between survival group and non-survival group of patients with severe sepsis and consequent AKI,but the patients in non-survival group had greater volume overload.Compared with the survival group,higher mean fluid balance [(1 112.12±546.85) mLvs.(644.69±474.93) mL,P=0.00],and less urine output [(1 224.07 ± 708.79) mL vs.(2 032.36 ± 723.53) mL,P =0.00) in non-survival group.(2) There was no significant difference in mortality between early and late continuous renal replacement therapy (CRRT) during ICU care.However,the average daily fluid load in late CRRT patients was significantly greater than that in early CRRT patients [(1178.81 ±397.03) mLvs.(287.22 ± ± 433.53) mL,P =0.00] and the lung oxygenation index in late CRRT patients was significantly worse thanthat in early CRRT patients [(211.22±42.56) vs.(169.46±57.40),P=0.04] (3) The relevant variables to 28-day mortality in AKI patients with severe sepsis included CRRT treatment,oxygenation index and the average daily fluid balance ＞ 500 mL.Among them,fluid balance ＞ 500mL was an independent risk factor for AKI patients with severe sepsis.Their prognosis was worse if they had greater positive fluid balance.CRRT was the protective factor which could affect the prognosis of patients with severe sepsis complicated by AKI.Conclusions Patients with severe sepsis complicated by AKI has a high mortality.Persistent fluid overload can lead to increased mortality in patients with severe sepsis complicated by AKI.Early CRRT can reduce fluid retention in patients with renal failure and improve oxygenation index.

BACKGROUND:Recent research has shown that transplanted bone marrow mesenchymal stem cells(BMSCs) migrate to the injured regions and exert their therapeutic effects in cases of intracranial trauma, stroke, inflammation and degenerative disease.The specific mechanisms involved in their migration to lesions are still to be fully elucidated.OBJECTIVE:To explore the effects of stromal cells derived factor-1(SDF-1) and its receptor CXCR4 on the migration of transplanted BMSCs to ischemic brain lesions.DESIGN, TIME AND SETTING:The cytological in vivo study was performed at the Central Laboratory, Xinqiao Hospital, Third Military Medical University of Chinese PLA from February 2008 to February 2009.MATERIALS:Bone marrow samples were obtained from normal or primary affection non-involved bone marrow patients aged 15-40 years at the Department of Hematology, Xinqiao Hospital, Third Military Medical University of Chinese PLA.A total of 72 healthy male Sprague Dawley rats aged 3-4 months were supplied by the Experimental Animal Center, Research Institute of Surgery, Third Military Medical University of Chinese PLA.METHODS:Human BMSCs were isolated by combination of gradient centrifugation and different adherent time method.The transient middle cerebral artery occlusion(MCAO) was induced using intraluminal vascular occlusion in 54 rats, based on the method described by Nagasawa et al.The remaining 18 rats served as sham operation group, only inserted with thread for 10 mm depth.At 2, 4 and 8 days after cerebral ischemia, the expression of SDF-1 in the ischemic brain was determined by real time RT-PCR and immunohistochemistry in 9 rats from either group.The remaining 36 rat models of cerebral ischemia/reperfusion were equally and randomly assigned into a cell transplantation and solution control groups.1 mL human BMSCs(2?109/L cells) or 1 mL phosphate buffered saline were slowly infused through the caudal vein at 24 hours following reperfusion.MAIN OUTCOME MEASURES:CXCR4 mRNA and protein expression in human BMSCs was determined.SDF-1 mRNA and protein expression following ischemia/reperfusion were detected.Migration of transplanted human BMSCs into the damaged region was observed through immunohistochemistry.RESULTS:RT-PCR showed that human BMSCs were positive for CXCR4 mRNA.Immunocytochemistry revealed that CXCR4 mainly expressed in cell membrane and cytoplasm of human BMSCs.At 2, 4 and 8 days following cerebral ischemia/reperfusion, SDF-1 mRNA levels showed an increased tendency, and showed significant difference compared with the sham operation group(P

BACKGROUND: Transplanted bone marrow mesenchymal stem cells (BMSCs) migrate to the injured regions and exert their therapeutic effects. The specific mechanisms involved in their directional migration to lesions remain unclear. OBJECTIVE: To investigate the chemokine receptor CXCR4 and CX3CR1 expression of human BMSCs in hypoxia culture. DESIGN, TIME AND SETTING: The cytology in vitro study was performed at the Central Laboratory, Xingqiao Hospital, Third Military Medical University of Chinese PLA from February 2008 to February 2009. MATERIALS: Cells harvested from the iliac heparinized bone marrow were obtained by iliac crest aspiration from healthy adult volunteers, aged 15 to 40 years old, at the Department of Hematology, Xinqiao Hospital, Third Military Medical University of Chinese PLA. METHODS: Bone marrow was obtained by puncture. Human BMSCs were harvested by combination of density and gradient centrifugation and different adherent method. Cells at passage 3 were incubated in a 25 cm2 flask. When 70%-80% confluence was found, cells were incubated at 37 ℃ and saturated humidity in an incubator containing 3% O2, 5% CO2, 92% N2 for 48 hours, and those incubated under normal oxygen as controls. MAIN OUTCOME MEASURES: Morphology was examined by phase contrast microscopy. Cell surface markers were tested by flow cytometer. The CXCR4 and CX3CR1 mRNA expression were detected by real-time PCR. The CXCR4 and CX3CR1 protein expression were determined by Western blot assay. RESULTS: All of the cells had a fibroblast-like morphology cultured in vitro and reached 90% confluence at 12-14 days, with the presence of polarity arrangement and whirlpool-shape. Cells were uniformly positive for CD105 (99.38%) and CD29 (99.13%), but negative for CD14 and CD45. Exposure of BMSCs to 3% O2 increased expression of the CXCR4 mRNA and CX3CR1 mRNA, which were respectively 2.130 times and 2.361 times of normal culture; expression of the CXCR4 protein and CX3CR1 protein was respectively 1.69 times and 1.93 times of normal culture. CXCR4 and CX3CR1 mainly expressed in membrane and cytoplasm of human BMSCs. CONCLUSION: Hypoxia (3% O2) can upregulate the expression of CXCR4 and CX3CR1 in human BMSCs, which might be one of the machenisms underlying the migration of BMSCs.

Adult ; Humans ; Malocclusion, Angle Class III ; therapy ; Orthodontics ; Orthodontics, Corrective ; methods ; Preoperative Care ; methods

Objective To determine risk factors for the miss rate of colorectal adenomas during colonoscopy.Methods A total of 981 patients,diagnosed as having at least one polyp in colonoscopy,received a second colonoscopy in 6 months from November 2012 to March 2016.All polyps were removed in the second colonoscopy.Bio-information of patients such as sex,age,surveillance interval and features of polyps such as number,size,shape,location,pathology,withdrawal time,bowel preparation was retrospectively analyzed.Factors associated with the miss rates in these patients were analyzed with Chisquare and was also analyzed with Logistic regression model for multiple factors.Results A total of 981 patients were selected according to the inclusion and exclusion criteria,including 604 males and 377 females.Miss rates of males and females were 38.9％ (235/604) and 27.9％ (105/377) (P＜0.01)respectively.Age ranged from 25 to 87 years with mean age being 61.0±9.7 years.Miss rates of senior patients ＜65 and ≥65 years were 31.5％(195/619) and 40.1％(145/362) respectively (P＜0.01).A total of 1 728 adenomas were found in first colonoscopy.A total of 2 267 adenomas were found in the second colonoscopy.The adenoma miss rate was 23.8％ (539/2 267).The miss rate of adenoma whose size ≤ 5 mm was 42.5％ (311/732);and that of larger size of 6 to 9 mm was 17.8％ (194/1 090);that of even larger size,i.e.,≥10 mm,was 7.6％(34/445)(P＜0.01).Miss rates of Is,Isp,Ip,LST and Ⅱ adenomas in shape were 28.4％(489/1 720),9.3％(24/235),6.6％ (12/182),9.0％(6/67) 20.5％ (8/39) respectively (P＞0.05).Location with highest adenoma miss rate were descending colon,ascending colon and transverse colon,27.8％(64/230),25.5％(120/470),25.5％ (161/632) respectively.Miss rates of high and low risk adenoma were 44.8％ (277/618) and 17.4％ (63/363) (P＜0.01).The highest adenoma miss rate of all the pathology type was tubular adenoma.The adenoma miss rate was 26.9％ (449/1 671) (P＜0.01).Miss rates of good and poor bowel preparation were 30.2％ (271/897) and 82.1％ (69/84) (P＜0.01).Miss rates of adequate and inadequate withdrawal time were 24.3％ (174/717) and 62.9％ (166/264) (P＜0.01).Conclusion Male,old-age,diameter ≤ 5 mm,poor bowel preparation and inadequate withdrawal time,high risk adenoma are the risk factors for missed adenoma.But the shape and location of adenoma are not the risk factors.

Background:Colonoscopy is considered as a standard method for detecting various kinds of colorectal polyps. However,conventional colonoscopy( CC)still has the chance to miss some lesions. Literatures have already reported that transparent hood assisted colonoscopy( THAC)can improve the detection of colorectal polyps. However,the effect of black hood assisted colonoscopy( BHAC)on detection of colorectal polyps is still unclear. Aims:To evaluate the effect of BHAC on detection of colorectal polyps. Methods:A total of 1 076 patients underwent CC and BHAC from Sept. 2014 to April 2015 at Huadong Hospital Affiliated to Fudan University were enrolled in this prospective randomized controlled study. Baseline characteristics,cecal intubation time,withdrawal time,number of polyps,detection rate of polyps,location, size,morphology and pathological diagnosis of polyps between two groups were compared. Results:Compared with CC group,cecal intubation time was significantly shorter in BHAC group than in CC group[(6. 31 ± 3. 51)min vs.(7. 05 ± 4. 15)min,P=0. 002]. No significant differences in withdrawal time and rate of cecal intubation were found between two groups(P>0. 05). Detection rate of polyps was significantly higher in BHAC group than in CC group(65. 4% vs. 48. 7%,P=0. 004). No significant differences in size,morphology of polyps were found between two groups(P>0. 05). Conclusions:Compared with CC,BHAC could significantly improve the detection of colorectal polyps,and shorten cecal intubation time.

Objective To explore the clinical significance of blood flow reserve fraction in the treatment of coronary stent implantation.Methods A total of 46 patients with positive coronary angiography were included.Criteria for positive coronary angiography:coronary angiography confirmed at least a coronary artery stenosis was more than or equal to 50%.According to the results,the patients were divided into the control group(24 cases) and observation group(22 cases).Results 1.There was no significant difference in baseline level(P>0.05);2.The operation time,number of stents and the contrast agent dosage of the observation group were (63.20±9.92)min,(0.50±0.65) and (182.94±39.30)mL,which were significantly less than those of the control group,the differences were statistically significant(operation time t=2.69,P=0.01;number of stents t=2.56,P=0.02;contrast agent dosage t=6.98,P=0.00).There was no significant difference between the control group and the observation group in angina pectoris and MACE attack.Conclusion Blood flow reserve score is an important guiding parameter for PCI treatment of coronary artery stenosis.

OBJECTIVE: In order provide important evidences for epidemiologic survey, clinical diagnosis, treatment and preservation of allergic diseases in this area, we investigate the distribution of the common allergens in allergic rhinitis and allergic asthma in Jingmen area and the sensitization condition of the major allergen house dust mite. METHOD: Four hundred and twenty-five patients with suspected allergic rhinitis and asthma in our area accepted skin prick tests of 10 standard allergen agents and specificity IgE detection. The different positivity ratios of allergens in different age groups were compared and the correlation between the two different technique methods testing the dust mite allergen was analyzed. RESULT: Among 425 patients with suspected allergic rhinitis and asthma in our area, 298 patients were positive and 89 patients suffered a combined allergic asthma. House dust mite (292 cases) and dermatophagoides farinae (289 cases) were the commonest allergens. The other common allergens were mugwort (45), ragweed (31), fungus I (19), fungus II (15), spring-pollen II (14), poly-animal hair (14), spring-pollen I (9), poly-feather (3). There was a correlation between skin test and sIgE test for house dust mite, dermatophagoides farinae in children group, and the positivity ratios were significantly higher than the adults group. CONCLUSION Dust mite is the most important allergen in allergic rhinitis and asthma in Jingmen.
Adolescent ; Adult ; Allergens ; analysis ; immunology ; Animals ; Asthma ; diagnosis ; epidemiology ; immunology ; Child ; China ; epidemiology ; Female ; Humans ; Immunoglobulin E ; blood ; Male ; Middle Aged ; Pyroglyphidae ; Rhinitis, Allergic, Perennial ; diagnosis ; epidemiology ; immunology ; Skin Tests ; Young Adult

OBJECTIVE: To investigate the profiles of inhaled allergens in allergic rhinitis patients in district of Jingmen, and to provide basic epidemiologic information for the prevention and treatment of allergic rhinitis in this area. METHOD: Retrospectively analyze 10 allergens skin prick test results of 1800 allergic rhinitis patients recruited. RESULT: The most common inhaled allergens in allergic rhinitis patients in our area were house dust mite (76.83%), dermatophagoides farinae (75.50%), mugwort (10.50%), ragweed (7. 39%), fungus II (6.28%), fungus I (5.83%), spring-pollen I (4.44%), spring pollen II (3.72%), poly-animal hair (3.56%), poly-feather (1.89%). Moreover, the positivity frequencies of house dust mite and dermatophagoides farinae were decreased with age increasing. CONCLUSION House dust mite and dermatophagoides farinae were the most common allergens in allergic rhinitis patients in Jingmen area.
Adolescent ; Adult ; Aged ; Allergens ; analysis ; immunology ; Animals ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Pollen ; immunology ; Pyroglyphidae ; immunology ; Retrospective Studies ; Rhinitis, Allergic, Perennial ; epidemiology ; immunology ; Rhinitis, Allergic, Seasonal ; epidemiology ; immunology ; Skin Tests ; Young Adult

OBJECTIVE: To explore the clinical use of sieving detection among the childhood with allergic disease. METHOD: The sieving detection about allergen inhalant allergens, Fx5 in the CAP anaphylactogen detection system, and serum specific IgE were detected in three hundred and thirty-one cases of children (aged from 1 year to 14 years old) with allergic disease. Patients were divided into group 1, group 2 and group 3 according to the age from 0 to 3, 3 to 6, and 6 to 14 years old. All datas were statistical analysed among different age groups. RESULT: Among the 331 patients, the positive rate of allergic sieving detection was 67.98%, the elevation rate of IgE was 53.78%. Inhalant allergen positive rate was 60.42%, while the food allergen positive rate was 28.10%. Inhalant allergen positive rate of the group 3 (aged from 6 to 14 years old) was significant higher than the other two age groups (68.45%). And the food allergen positive rate of the age group 1 (aged from 0 to 3 years old) was significant higher than the other two age groups (62.50%). Positive rate for simply inhalant allergen was 39.88%, while positive rate for simply food allergen was 7.55% and mixed allergen was 20.54%. CONCLUSION Inhalant allergen was the main allergen of the children with allergic disease aged over 3 years old, while food allergen was the main allergen of the children with allergic disease aged below 3 years old. It was safe, sensible and effective to use Uni CAP anaphylactogen detection system for rapid assay of specific allergens.
Adolescent ; Allergens ; blood ; immunology ; Child ; Child, Preschool ; Female ; Humans ; Hypersensitivity ; blood ; diagnosis ; immunology ; Immunoglobulin E ; blood ; Infant ; Male