Bilirubin ; analysis ; Child ; Electric Impedance ; Esophagus ; metabolism ; Gastroesophageal Reflux ; diagnosis ; therapy ; Humans ; Hydrogen-Ion Concentration ; Surveys and Questionnaires

Objective: To evaluate the value of multi slice computed tomography (CT) in differential diagnosis of renal clear cell carcinoma and renal papillary carcinoma. Methods: The CT images of 47patients with renal cell carcinoma (RCC) were reviewed. The RCC patients were divided into 2 groups pathologically, including 37 cases of clear cell RCC and 10 cases of papillary RCC. Plain scan and three phase (corticomedullary, nephrographic and excretory phases) CT were performed in all patients. Age and sex of patients, tumor size, enhancement degree and pattern (homogeneous, heterogeneous and predominantly peripheral), the presence of calcification or cystic degeneration (necrotic or hemorrhagic areas within the tumor) and tumor spreading (including perinephric change, venous invasion and lymphadenopathy) were compared between the 2 subtypes. Results: The degrees of enhancement were significantly different between the 2 subtypes in the corticomedullary, parenchymal and excretory phases (P<0.05). Necrosis and cystic degeneration were more evident in the clear cell RCC than in papillary RCC regardless of tumor size (P<0.05). A hypervascular pattern (higher tumor enhancement after contrast material injection due to higher vascularity) was noted in 21.6% of clear cell RCC cases and in 10% of papillary RCC (P<0.05). Half of the clear cell RCC and 2.7% of papillary RCC patients showed homogeneous enhancement (P<0.05). Calcification was evident in 21.6% of clear cell RCC patients and 20% of papillary RCC patients. Conclusion: The degree of enhancement is the most valuable parameter for differentiation of clear cell RCC and papillary RCC. The presence of cystic degeneration, hemorrhage, vascularity and enhancement patterns can also contribute to the differentiation of the 2 subtypes.

Animals ; Communicable Diseases ; genetics ; Epstein-Barr Virus Infections ; genetics ; Genetic Predisposition to Disease ; HIV Infections ; genetics ; Helicobacter Infections ; genetics ; Hepatitis B ; genetics ; Humans ; Mycobacterium Infections ; genetics

Anti-Bacterial Agents ; therapeutic use ; Bacterial Infections ; drug therapy ; Cephalosporins ; adverse effects ; pharmacokinetics ; pharmacology ; therapeutic use ; Humans ; Microbial Sensitivity Tests ; Randomized Controlled Trials as Topic

Objective To investigate the effect of mechanical ventilation in acute organophosphorous pesticide poisoning(AOPP) with respiratry failure. Methods Forty from forty-two AOPP patients with respiratry failure were treated with mechanical ventilation(MV) ,gastrolavage and other methods. Five minutes before mechanical ventilation and two hours after mechanical ventilation, patients' heart rate (HR), systolic blood pressure (SBP), arterial partial blood pH, oxygenation index, the pressure of carbon dioxide (PaCO2) were compared. Results Patients' HR was increased ( P＜0. 05 ), SBP was increased ( P＜0. 01 ), arterial partial blood pH was increased( P＜0. 01 ), oxygenation index was increased(P＜0. 01 ) ,PaCO2 was decreased(P＜0.01 ). Thirty nine cases were cured,three cases dided. Conclusion Mechanical ventilation can effectively treat the AOPP patients with respiratry failure.

Humans ; West Nile Fever ; West Nile virus

Objective To investigate the effects of altered deceleration capacity of heart rate (DC) and heart rate deceleration runs(DRs) on the short-term prognosis of patients with acute myocardial infarction (AMI) .Methods 115 patients confirmed with AMI within 7 days as AMI group ,50 persons without MI were selected as control group .The deceleration capacity of heart rate and heart rate deceleration runs were detected by the 24 hours Holter within 7 to 14 after onset of AMI ,all the patients were divided in-to high risk group ,medium risk group and low risk group through the Holter results .Left ventricular ejection fraction (LVEF) was evaluated by echocardiography .Compare the risk of the AMI group with the control group .Meanwhile the AMI patients were fol-lowed up for mean(9 .2 ± 1 .7)months .Observe the presence of major adverse cardiovascular events (MACE) .All AMI patients were classified into MACE and non-MACE groups according to the presence of MACE .Analysis the risk factors of MACE .Results AMI group had a significant increase risk but decrease in deceleration capacity of heart rate (P<0 .05) as compared with the control group .In MACE group ,the rate of high risk was significant increasing(P=0 .005) ,but the rate of low risk was significant decrea-sing(P=0 .039) .The Logistic regression analysis showed that LVEF ,high risk group ,age and percutaneous transluminal coronary intervention(PCI) were independent risk factors on presence of MACE .Correlation r was 0 .33 ,0 .30 ,0 .23 ,0 .18 respectively ,and odds ratio was 4 .83 ,4 .28 ,2 .22 ,1 .58 respectively ,the correlation with deceleration capacity of heart rate was a little weaker than LVEF .The coefficient of determination r2 was 0 .528 when the LVEF and ages went into regression ,whereas that was 0 .635 when the LVEF ,high risk group and age went into regression together .Conclusion Capacity of heart rate decelerate was significantly weakened in AMI patients .LVEF ,the significantly decreased deceleration capacity of heart rate ,age and PCI were independent risk factors on presence of short-term MACE in AMI patients .The prognostic value of the DC and DRs was a little weaker than the LVEF .The better predictive value was obtained if the LVEF ,the significantly decreased deceleration capacity of heart rate ,age were combined .

ObjectiveTo report the treatment of the first imported Middle East respiratory syndrome (MERS) in China, and to investigate the clinical features and treatment of the patient.Methods On May 28th, 2015, the first patient of imported MERS to China was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital. The clinical features and treatments of this patient were analyzed.Results①A 43 years old male of South Korean nationality was admitted with the complaint of back ache for 7 days and fever 2 days with the following characteristics: back ache 7 days ago, without fever or cough or expectoration. He had been suspected to suffer from infection of Middle East respiratory syndrome coronavirus (MERS-CoV) by the Disease Control Department of South Korea, but no specific treatment was given. He had fever for 2 days with maximum body temperature of 39.7℃. He had no chills, cough, expectoration, short of breath, abdominal pain, diarrhea, frequent micturition, or urgency or pain of urination, and no sore throat. The patient had a history of exposure to MERS-CoV patient. He was considered to be a patient of the second batch of South Korean epidemic.② Auxiliary examination: 3 copies of throat swab specimens for virus nucleic acid detection were performed by the Disease Prevention Control Center of China (China CDC), and they were positive on May 29th, 2015, and also for serum, sputum and stool. Based on the results of whole genome sequence analysis, the virus strains were implicated to be derived from Riyahh and Jeddah regions of Saudi Arabia. On admission, the patient's blood test showed that the white blood cell count was low (3.22×109/L), the proportion of the neutrophils was high (0.73), and that of the platelet was low (81×109/L). On admission, the patient's chest X-ray showed that a small amount of infiltration in the lung.③ Treatment: a high-flow nasal cannula (HFNC) with oxygen concentration of 0.50-0.80 was given, with a flow rate was set at 60 L/min if tolerated. It was changed to a low flow oxygen inhalation nasal cannula on the 20th day, and oxygen treatment was stopped on the 24th day. Ribavirin 2.0 g was given as the first dose, and was switched to 600 mg every 8 h (q8h), and it was reduced to 600 mg q12h after 10 days, and extenuated since the 13th day. Ceftriaxone was added on the 4th day with 2.0 g a day , and it was changed to meropenem 2.0 g, q8h on the 7th day for 2 weeks. Gamma globulin was given for 7 days (20 g, qd). Thymosin-α1 was given on the 8th day for 2 weeks. Interferon was given once a week, but only one dose was used. At the same time symptomatic treatment such as methimazole and liver protection therapy were given.④ Patient began to cough at admission, and it disappeared on the 18th day. There was no sputum at first, then a small amount of sputum with a little blood appeared after the admission. Then there was cough without sputum. Mild shortness of breath and diarrhea after exertion were noticed. He had no chest pain, difficulty in breathing or other symptoms. There was dullness on percussion in both sides of chest, and it disappeared gradually. Fine moist rales were detectable in scapular area and interscapular area on the 5th day, and they disappeared after 3 days. Breath sounds on both sides was weak, and it became more obvious in the right lung after 5 days, and returned to normal after 18 days. He had a sustaining fever for 1 week with the maximum temperature of 39.5℃, then the body temperature returned to normal. The viral nucleic acid test as performed by the Center for Disease Control of Guangdong (CDC, Guangdong) showed that the pharyngeal swab cultured turned negative on the 3rd day, that of serum specimens turned negative on the 8th day, that of stool specimen after 2 weeks, and it was persistently positive for sputum culture until 5 days before discharge. The oxygenation index gradually increased, and it was over 300 mmHg (1 mmHg = 0.133 kPa) after 15 days. Pleural effusion was rapidly increased during the first week as shown by chest X-ray films, and it began to be absorbed gradually in the second week, but it was not completely absorbed until discharge.Conclusions The disease course of the reported patient was short, with an acute onset, with fever as the chief complaint, but there were no respiratory symptoms, though there were high fever, cough, shortness of breath, diarrhea and other clinical symptoms after admission. Virus in sputum disappeared after treatment, but pleural effusion was not completely absorbed. Negative test for virus in sputum was late, indicating that clearance of virus was slow from the lungs. It is the first case of MERS in China, therefore, the clinical manifestations and the treatment strategy need to be further explored.

Objective To investigate the effects of Panax notoginseng saponins(PNS,三七总皂苷) on extra-vascular lung water(EVLW) and respiratory dynamics in dog with oleic acid induced acute lung injury(ALI).Methods Eighteen Beagle dogs,intubated and mechanically ventilated with intermittent positive pressure ventilation(IPPV) mode(tidal volume(VT) 10 ml/kg, positive end-expiratory pressure(PEEP) 0,inspiratory oxygen concentration(FiO2) 1.00),were randomly assigned into three groups(each n=6): normal control group,ALI model group(induced by intravenous injection of oleic acid) and PNS group(received PNS after the ALI model was constructed).PNS 10 mg/kg being dissolved in 100 ml 5% glucose solution(GS) was pumped into central vein (2.5 ml/min) after ALI model was formed in the PNS group.Similar amount of glucose solution was given to the normal control and model groups.Respiratory dynamics and arterial blood gas(ABG) were monitored every hour.Four hours after the establishment of ALI,the dogs were sacrificed and extra-vascular lung water index(EVLWI) was quantified by a gravimetric measurement.Results In ALI dogs,PNS significantly decreased the index of EVLWI((14.10?1.45) ml/kg vs.(17.97?0.85) ml/kg,P0.05).Conclusion PNS has certain protective effect on dog with oleic acid induced ALI,it may lower EVLW and elevate the Cst total,that is beneficial to the improvement of hypoxemia.