Objective To evaluate the clinical efficacy of lymphoplasma exchange (LPE) for the treatment of severe refractory immune-related skin diseases.Methods From May 2013 to October 2015,8 patients with toxic epidermal necrolysis,drug-induced hypersensitivity syndrome (DIHS),pemphigus vulgaris,pemphigoid or paraneoplastic pemphigus were enrolled from Department of Dermatology,Xiangya Hospital,Central South University,who showed no response to conventional therapy or presented with multiple organ dysfunction.After the treatment with LPE,the efficacy was evaluated,and adverse reactions were observed.Results After one session of LPE therapy,6 patients received marked improvement,and were cured at last.In 1 patient with pemphigus vulgaris who was resistant to the treatment with high doses of glucocorticoids and immunosuppressive agents,the rashes regressed during the treatment with LPE,but recurred after the end of treatment.One patient with bullous pemphigoid presented with eruptive blisters on the next day after the treatment with LPE,which were considered as allergic reactions to allogeneic plasma.There were no obvious differences in white blood cell count,lymphocyte count,neutrophil count and blood platelet count in the peripheral blood of 8 patients before and after the treatment with LPE.During the follow-up of 3-5 years,all of the patients were recovered without recurrence,except 1 patient with bullous pemphigoid who died of disseminated tuberculosis after 1 year.Conclusion LPE is effective for the treatment of severe immune-related skin diseases,but attention should be paid to potential transfusion reaction and allergic reactions.

Objective To propose a new diagnostic criterion for rosacea based on the analysis of clinical features of rosacea in a large sample.Methods A total of 1 090 Chinese outpatients with rosacea were enrolled from Department of Dermatology of Xiangya Hospital,and their demographic data,clinical manifestations and subjective symptoms were collected.According to results of descriptive analysis,clinical features of rosacea were summarized,and a new diagnostic criterion for rosacea was set up.Then,the sensitivity and specificity of the new diagnostic criterion were verified among 1 200 outpatients clinically characterized by facial erythema.Results Of 1 090 patients with rosacea,131 (12.0％) were male and 959(88.0％) were female,and the average age was 33.5 ± 11.1 years (range,10-66).Among the 1 090 patients,715 (65.6％) had initial lesions on the cheek,of whom,712 (99.6％) had intermittent flushing as the initial symptom,and 689 (96％) had sensitive skin symptoms such as dryness,burning and itching sensations;208 (19.1％) had initial lesions on the perioral region,of whom,204 (98.1％) had persistent erythema as the initial symptom;167 (15.3％) had initial lesions on the nose,of whom,163 (97.6％) had persistent erythema as the initial symptom;in addition,311 (28.5％) had lesions on the ocular region,and only 24 (2.2％) had lesions outside the face on the neck and retroauricular region.Based on these clinical features,a new diagnostic criterion for rosacea was proposed,including 1 major condition (intermittent flushing or persistent erythema on the cheek,perioral region or nose) and 5 minor conditions (1.sensitive skin symptoms such as burning,tingling,drying or itching sensations;2.telangiectasia;3.papules or pustules;4.hypertrophy;5.ocular symptoms).If with the major condition and at least one minor condition were met,patients could be diagnosed with rosacea.After verification among 1 200 patients with facial dermatitis clinically characterized by facial erythema,the new criterion was proved to have a sensitivity of 99.3％ and a specificity of 95.8％.Conclusion A new diagnostic criterion for rosacea with high sensitivity and specificity is proposed,which is worthy of clinical application.

Objective To investigate the characteristic of lipoprotein(a)[Lp(a)]in different phases of chronic kidney disease (CKD ),to provide the basis for clinical prevention and treatment of CKD.Methods 200 patients with CKD in the Republic Hospital of Shifang were collected as study group,including 5 phases (every phase had 40 cases),and 100 healthy people were selected as control group.Measured the serum Lp(a)of both study and control group,analyzed the correlations between Lp(a)and different phase of CKD.All data were analyzed by SPSS version 17.0.The significant level was established at 0.05.Results CKD1 [(146.0 ±95.5)mg/L]and all CKD group [(231.5 ±133.2)mg/L]had higher level of serum Lp(a)than the control group [(115.5 ±70.2)mg/L] (Z=-2.800,P<0.05 and Z=-7.922,P<0.05).CKD3 had higher Lp(a)level than CKD2(Z=-2.069,P<0.05 ),while there were no significant differences between each of the other two groups.CKD4 -5 [(325 .0 ± 194.7)mg/L]also had higher Lp(a)level than CKD1 -3 [(182.0 ±110.5)mg/L](Z=-4.439,P<0.05). Conclusion Patients with CKD always have high level of serum Lp(a),which have been slowly increased since CKD1 ,meanwhile the level of Lp(a)may have a certain correlation with the stage of CKD development,since Lp(a) is an important promoting factor in the progress of CKD.

Objective To assess the value of SPECT/CT lung perfusion imaging (SPECT/CT-LPI) in evaluation of the regional lung function and the correlation between lung perfusion defects (LPD) and the clinical findings in NSCLC patients.Methods A total of 48 NSCLC patients (43 males,5 females;average age 61.06 years) who underwent pulmonary function tests (PFT),CT and 99Tcm-MAA SPECT/CT-LPI from December 2006 to March 2013,were retrospectively studied.LPD were divided into four grades:grade 0 (no lung perfusion defect was identified),grade 1 (the area of lung perfusion defect (LPDA) was similar to the size of local tumor),grade 2 (the LPDA was larger than local tumor and extends to 1 pulmonary lobe),grade 3 (the LPDA exceeded 1 pulmonary lobe).x2 test,one-way analysis of variance and Logistic regression analysis were used to analyze the correlation of the lung perfusion function and clinical findings.Results LPD were found in 44 patients (91.67％,44/48),including 18 with grade 1,15 with grade 2,11 with grade 3.The abnormal results of PFT were found in 16 patients (33.33％,16/ 48).The abnormal findings by SPECT/CT-LPI were more than that by PFT (x2=34.844,P＜0.01).The rates of LPD with grade ≥ 2 were significant different between patients with central lung cancer and those with peripheral lung cancer (x2 =8.392,P＜0.01),and between hilar lymph nodes positive group and negative group (x2=10.801,P＜0.01).The degree of LPD was related to tumor location (1 was assigned for central lung cancer,2 was assigned for peripheral lung cancer),tumor size (1 was assigned for maximum diameter ≤3.0 cm,2 was assigned for ＞3.0 cm and ≤5.0 cm,3 was assigned for ＞5.0 cm) and hilar lymph node (1 was assigned for with metastasis,0 was assigned for no metastasis) (Wald=8.176,5.352,10.100,all P＜0.05).Conclusions Compared with PFT,SPECT/CT-LPI has a more significant value in assessment of the regional lung function in NSCLC patients.Tumor location,tumor size and metastasis of hilar lymph nodes may be helpful for LPD grading.SPECT-LPI may be beneficial for patients with central lung cancer,large tumor and hilar lymph nodes metastasis.

Objective To evaluate prognostic value of pentraxin3 (PTX3) content combining with extravascular lung water index (EVLWI) in patients with sepsis.Methods A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted.These patients were divided into two groups,survival group and death group,according to the outcome on the 28th day.Pulse index continuous cardiac output (PiCCO) was used to record the levels of EVLWI on the 1st,2nd and 3rd day of intensive care unit (ICU) admission.The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay (ELISA).At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) were calculated.Correlation analysis between plasma PTX3 and EVLWI values was performed,receiver operating characteristic curve (ROC) was drawn,and the prognostic value of each parameter was assessed finally.Results A total of 74 septic patients were enrolled,with 41 cases in the survival group and 33 cases in the non-survival group.Blood lactate,APACHE Ⅱ,SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission,and the length of ICU stay was significantly shorter than that of the survival group,while differences of the other clinical characteristics between two groups were not statistically significant.The plasma PTX3 level gradually declined with time in both groups,and plasma PTX3 at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [PTX3 (μg/L) at 1 day:46.3± 10.5 vs.19.4±6.5,t =-13.486,P =0.000; 2 days:34.8± 10.7 vs.17.7±8.4,t =-8.284,P =0.000; 3 days:23.9± 11.2 vs.15.6 ± 7.9,t =-5.036,P =0.000].EVLWI gradually declined in survival group,but increased in death group.EVLWI at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [EVLWI (mL/kg) at 1 day:12.12 ± 4.31 vs.10.02 ± 2.87,t =-2.502,P =0.023; 2 days:13.67 ± 4.95 vs.9.08 ± 2.89,t =-5.188,P =0.000; 3 days:14.51±5.06 vs.8.09±2.50,t =-7.126,P =0.000].PTX3 at 1,2,3 days after ICU admission showed a significant positive correlation with EVLWI (r1 =0.747,r2 =0.719,r3 =0.705,all P =0.000).ROC curve analysis showed that the area under the ROC (AUC) of PTX3 at 1 day was 0.845 ± 0.045,at the cut-off point of 23.0 μg/L,PTX3 showed a sensitivity of 84.8％,a specificity of 74.1％,a negative predictive value of 85.81％,and a positive predictive value of 72.42％.AUC of EVLWI at 3 days was 0.838 ± 0.048,at the cut-off point of 10.5 mL/kg,EVLWI showed a sensitivity of 83.9％,a specificity of 82.9％,a negative predictive value of 86.45％,and a positive predictive value of 79.79％.Their sensitivities and specificities were found to be better than APACHE Ⅱ,SOFA score.AUC of PTX3 combined with EVLWI at 1 day was 0.886 ± 0.038.On the 1st day after ICU admission,with combination of the two indicators,cut-off point was found to be 0.312,a sensitivity of 86.8％,a specificity of 85.4％,a negative predictive value of 88.93％,and a positive predictive value of 82.72％.On the 3rd day after ICU admission,AUC of PTX3 combined with EVLWI was 0.856 ± 0.046,and showed a cut-off of 0.471 for the prognosis of sepsis,a sensitivity of 85.8％,a specificity of 85.4％,a negative predictive value of 87.97％,and a positive predictive value of 82.50％.Compared with other single index,a combination of above mentioned two indexes showed a better sensitivity and specificity.Conclusions PTX3 can serve as a novel prognostic indicator at early stage in septic patients.Combined with EVLWI,it shows important value in predicting prognosis of septic patients,and it also provides guidance in treatment of high-risk patients.

Objective To investigate the general rules and features of drug adverse reaction induced by Reduning injection inorder to provide reference for clinical rational administration.Methods The literatures about the advers reaction induced by Reduning injection published from 2008 -2014 in China were retrieved.The articles were analysed using literature metrology methods.Results 25 articles related to 282 individual cases were retrieved. The adverse reactions were related to sexuality and drug combination.Children were the high risk group.Incidence rate of the adverse reaction of boys was much higher than that of girls.Combination with antibacterials might increase the incidence rate of adverse reaction.The major clincal manifestation was the adverse reaction of dermal system (208 case)and anaphylactic response (36 case).Anaphylactic shock was the serious reaction in clinical (11 case). Conclusion Clinician and pharmacists should understand the rules and characteristic of adverse reaction caused by reduning injection.Using drug must according to the direction in clinical.It must pay more attention to medication mo-nitoring in order to reduce the occurrence of drug adverse reaction.

This study was aimed to preliminarily evaluate the acute toxicity and anti-inflammatory effects of coffee residue extract. The test maximum tolerated dose was applied in mice by gavage to observe the acute toxicity of coffee residue extract. Mice acute inflammation model was induced by xylene and glacial acetic acid. The gavage administration of coffee residue extract (1.00, 2.00, 3.00 g?kg-1, in terms of crude drug) was given 7 days con-tinuously. The ear swelling rate and celiac capillary permeability were measured. The results showed that the ex-tract of coffee residue maximum tolerated dose in mice is 8 . 60 g?kg -1 ( in terms of crude drug ) . The coffee residue extract of 3 . 00 g?kg-1 is able to inhibit ear swelling induced by xylene in mice ( P < 0 . 05 ) and the ex-cessive celiac capillary permeability ( P < 0 . 05 ) . It was concluded that the coffee residue extract have certain an-ti-inflammation activities.

Objective To compare 18 F-FDG PET/CT and electronic endoscopy for measuring the length of esophageal squamous cell carcinoma (ESCC) and to evaluate the optimal SUV threshold for contour determination of the size of the lesion.Methods Twenty-four patients (19 males and 5 females,median age:59 years) with histologically confirmed ESCC were enrolled.Three patients had stage Ⅱ,14 had stage Ⅲ and 7 had stage Ⅳ diseases.PET studies were performed before treatment.The length of ESCC was measured on FDG PET imaging using different SUV thresholds of 2.0 (L2.0),2.5 (L2.5),3.0 (L3.0),3.5 (L3.5),and 35％(L35),40％(L40),45％(L45),50％(L50),55％(L55) of SUVmax.The length of ESCC on PET imaging was compared with the length of gross tumor in vivo measured by electronic endoscopy (Lst) to determine the optimal threshold of SUV using paired t test.Pearson correlation analysis was used to assess the correlation.Results The SUVmax of primary tumor was 14.51±5.72 and the Lst was (5.27± 2.45) cm.The length was in a descending order of L2.0,L2.5,Lst,L3.0,L3.5,L35,L40,L45,L50 and L55 when using different criteria.There were significant differences between the Lst and the lengths measured on PET except those by L2.5 and L3.0((5.65±2.69) cm,(5.11±2.51) cm; t=-1.74 and 0.76,both P＞0.05).The lengths measured on PET by all criteria were significandy correlated with the Lst,respectively,with the better r values by L3.5(0.935),L2.5(0.920) and L3.0(0.919) (all P＜0.01).When SUVm~＜15,there were no significant differences between the Lst ((4.82±2.14) cm) and L2.5((4.95±2.76) cm),L3.0((4.45±2.50) cm) and L35((4.42±1.85) cm),respectively (t=-0.439,1.299,2.011,all P＞0.05).The best correlation (r=0.953,P＜0.05) was between Lst and Lz5.When SUVmax ≥ 15,there was no significant difference between Lst ((5.67±2.64) cm) and L3.0((6.11±2.61) cm; t=-0.897,P＞0.05; r=0.791,P＜ 0.05).Conclusions For better correlation of ESCC lesion size,it is suggested that the optimal threshold of SUV for contouring is 2.5 for tumor SUVmax＜15,and 3.0 for tumor SUVmax ≥ 15.A larger sampling size is needed for further confirmation or modification.

Objective To assess the efficacy and the adverse effects of improved late course accelerated hyperfractionated radiotherapy (LCAHRT) combined with cisplatin-based chemotherapy for locally advanced esophageal squamous cell carcinoma (ESCC).Methods 68 Patients with pathologically confirmed ESCC were enrolled.Conventional fractionation was implemented to 40 Gy/20 fractions,followed by LCAHRT delivered 2 fractions of 1.4 Gy with an interval of 6-8 hours per day to 14 fractions,thus the total dose was 59.6 Gy.Two cycles of cisplatin-based chemotherapy were administered concurrently,followed by two more cycles.The short-term efficacy of treatment,overall survival for 1-,3-,5-year,and treatment-related toxicity were evaluated.Results All patients successfully completed LCAHRT and the overall response rate was 91.6％ (62/68).The overall survival rate of 1-,3-,and 5-year was 75.5％,46.5％,22.7％,respectively.The incidence of radiation esophagitis (grade 3 or greater) was 26.4％,and no patients developed grade 3 or worse radiation pneumonitis.The radiation-induced skin injury were most of grade 0 or 1.Grade 3 of leucopenia and neutropenia were observed in 29.4％ and 7.4％ of patients,respectively,and grade 4 were both in 2.9％.During long-term follow-up,no esophageal stenosis and severe pulmonary fibrosis was developed except for two cases(2.9％)of esophageal mediastinal fistula.Conclusion Late course accelerated hyperfractionated radiotherapy combined with chemotherapy yields promising long-term survival,with lower treatment-related toxicity for patients of locally advanced esophageal squamous cell carcinoma.

Objective To assess the accuracy (ACC),sensitivity (SEN),and specificity (SPE) of dose-volume histogram (DVH) parameters in predicting the radiation pneumonitis (RP) using receiver operating characteristic (ROC) curve.Methods Complete clinical data of 118 non-small cell lung cancer patients treated with three-dimensional conformal and intensity-modulated radiotherapy plus chemotherapy were included.Chi-square and logistic regression were retrospectively applied to analyze the correlations between DVH parameters [relative lung volume received ≥ 5 Gy (V5),10 Gy (V10),13 Gy(V13),20 Gy (V20) and 30 Gy (V30) and mean lung dose (MLD)] and grade 2 (and above) RP defined by the National Cancer Institute Common Terminology Criteria for Adverse Events,version 3.0.ROC curve was adopted to investigate the predictive ACC,SEN and SPE of potential DVH parameters associated with RP.Results Total lungs V5,V10,V13,V20 and MLD were all correlated to the development of RP (x2 =4.786,5.771,6.366,7.367 and 6.945,P ＜ 0.05) according to univariate analysis.However,total lungs V30,patient characteristics (age,sex,KPS,tumor location,pathology) and treatment factors (prescription dose,radiotherapy technique,chemotherapy method and timing) were not contributors to RP.Logistic regression showed that V20 of both lungs remains tight by associated with RP (x2 =10.96,OR =4.16,95％ CI 1.40 ～ 12.36,P ＜0.05),although significant colinearity was found between V20 and other DVH parameters (r =0.767-0.902,P ＜0.05).ROC curve confirmed that V20 of both lungs could act as a predictor for RP (Z =2.038,P ＜ 0.05).The predictive ACC,SEN,and SPE were 0.645 (95％ CI0.498-0.793),0.650 (95％ CI0.408-0.864),and 0.674 (95％ CI0.571-0.765),respectively.However,the positive predictive value was only 28.9％.Conclusions V20 of both lungs was correlated to the development of RP.It could act as a predictor for RP though the predictability is limited.