Objective To investigate the prognostic value of alanine aminotransferase(ALT)/alkaline phosphatase(ALP)ratio,platelet(PLT)count/lymphocyte(LYM)ratio(PLR)in elderly patients with septic shock complicated with liver injury.Methods The clinical data of 116 patients with septic shock complicated with liver injury were retrospectively analyzed.According to the degree of liver injury,patients were divided into the mild group(39 cases),the moderate group(47 cases)and the severe group(30 cases).According to the survival of patients 28 days after admission,patients were divided into the death group(69 cases)and the survival group(47 cases).Acute physiological score,chronic healthⅡ(APACHE Ⅱ)score and sequential organ failure(SOFA)score were collected.PLT and LYM in peripheral blood were detected,and PLR was calculated.ALT and ALP were measured and ALT/ALP ratio was calculated.White blood cell count,blood lactic acid,C-reactive protein and other laboratory indicators were detected.Multivariate Logistic regression was used to analyze prognostic factors of patients with septic shock complicated with liver injury.The predictive values of ALT/ALP ratio and PLR on the prognosis of patients with septic shock complicated with liver injury were analyzed by receiver operating characteristic(ROC)curve.Results Serum ALT and ALP levels,ALT/ALP ratio,PLT and PLR were increased successively in the mild group,the moderate group and the severe group,while LYM was decreased successively in the three groups(P＜0.05).The age,APACHE Ⅱ score,SOFA score,PLR,ALT/ALP ratio and blood lactic acid level were higher in the death group than those in the survival group(P＜0.05).There was no significant difference in liver injury degree between the two groups(P＜0.05).Multivariate Logistic regression analysis showed that high SOFA score,high PLR,high ALT/ALP ratio and moderate to severe liver injury were risk factors for death in patients with septic shock complicated with liver injury.ROC curve analysis showed that the combined ALT/ALP ratio and PLR prediction efficiency[area under the curve 0.915(95%CI:0.849-0.959),sensitivity and specificity 94.20%and 89.36%,respectively]was superior to single prediction(P＜0.05).Conclusion Increased ALT/ALP ratio and PLR are associated with aggravation of liver injury and poor prognosis in patients with septic shock.ALT/ALP ratio and PLR can be used as prognostic markers.

Objective:To investigate the application value of fluorescence imaging in single-port thoracoscopic anatomic segmentectomy.Methods:The clinical data of 280 patients (145 patients with fluorescence method and 135 patients with modified inflation-deflation method) who underwent thoracoscopic anatomic segmentectomy were retrospectively studied in the Anhui Chest Hospital from June 2020 to June 2021. There were 113 patients in the simple segmentectomy group and 167 patients in the complex segmentectomy group. The baseline data of the fluorescence method and the modified inflation-deflation method in the complex segmentectomy group were corrected by propensity score matching, and the perioperative results were compared between the groups.Results:There were no significant differences in segmental resection time, intraoperative blood loss, postoperative drainage, postoperative pain, postoperative extubation time, length of hospital stay, incidence of complications and cost of hand-holding between the fluorescence method and the modified method of the simple segmentectomy group.In the complex segmentectomy group, the time of segmental resection with the fluorescence method was significantly shorter than that with the modified inflation-deflation method( P<0.05), and other indexes had no significant difference. Conclusion:Fluorescence method single-port thoracoscopic anatomic segmentectomy has the same perioperative safety and short-term efficacy as modified inflation-deflation method, which can significantly shorten the operative time and improve the operative efficiency in complex anatomic segmentectomy.

OBJECTIVE：To estab lish the quality standard of Tetrastigma hemsleyanum stem and leaves dispensing granules ， and to determine the contents of 5 active ingredients simultaneously. METHODS ： Chlorogenic acid ， isoorientin and isoorientin-2′-O-rhamnoside in T. hemsleyanum stem and leaves dispensing granules were identified by TLC. The total flavonoids of the 3 batches granules were determined by UV spectrophotometry （by isoorientin ）. The granule sizes ，moisture contents ， dissolvability，and content uniformity were determined. Using isoorientin as internal reference ，relative correction factors of other components were established. QAMS method was adopted to determine the contents of neochlorogenic acid ，chlorogenic acid ， orientin，isoorientin and isoorientin- 2′-O-rhamnoside，which were compared with the results of ESM method. RESULTS ：TLC spots of chlorogenic acid ，isoorientin and isoorientin- 2′-O-rhamnoside were clear and well-separated ，without interference from negative control. The linear range of isoorientin were 7.73-61.82 μ g/mL（r＝0.999 9）. RSDs of precision ，stability and reproducibility tests were all lower than 2％. The recoveries were 93.75％-97.85％（RSD＝1.41％，n＝6）. The average percentages that the 3 batches granules could not pass through sieve No. 1 - moisture contents were 4.63％，5.18％ and 4.03％（n＝3）. were dissolved within 5 min ，and content uniformity were 4.8％-5.0％. Which were all in line with the relevant provi-sions of granules in 2015 edition of Chinese Pharmacopoeia . The linear range of 5 ingredients were 2.325-93 μg/mL（r＝0.999 9），5.125-205 μg/mL（r＝0.999 9），1.150- 46 μg/mL（r＝0.999 3），2.625-105 μg/mL（r＝0.999 9），4.725-189 μg/mL（r＝0.999 9），respectively. RSD of precision ，stability and reproducibility tests were all lower than 3％. The recoveries were 99.78％-106.13％（RSD＝2.33％，n＝6），95.07％-103.32％ （RSD＝2.72％，n＝6），97.17％-105.43％（RSD＝2.98％，n＝6），95.52％-101.33％（RSD＝2.46％，n＝6），99.42％-105.56％ （RSD＝2.34％，n＝6）. Using isoorientin as internal reference ，relative correction factors of neochlorogenic acid ，chlorogenic acid ， isoorientin and isoorientin- 2′-O-rhamnoside were 0.731，0.805，0.821，0.590，respectively. The contents were 0.828-1.123， 2.379-3.118，0.281-0.880，1.039-1.393，2.121-3.209 mg/g by QAMS method ，while the contents were 0.803-1.099，2.345-3.085， 0.269-0.872，1.309-1.393，2.113-3.201 mg/g by ESM method ，there was no significant difference in the content determination results between QAMS and ESM method （P＞0.05）. CONCLUSIONS ：Established quality standard is simple and rapid ，and can be used for quality control of T. hemsleyanum stem and leaves dispensing granules. Established QAMS method is accurate and efficient，and it can be used for simultaneous determination of 5 active ingredients of T. hemsleyanum stem and levels dispensing granules.

Objective To establish a method for determination of the twelve residual organic solvents,including methanol,ethanol,acetone,isopropanol,tert-Butyl methyl ether,dichloromethane,aceticether,tetrahydrofuran,triethylamine,trimethylorthofor-Mate,morpholine,N,N-Dimethylformamide in Apixaban bulks drug.Methods Gas head-space chromatography was applied to this study.The column was DB-624 silica capillary column (30.0 m × 0.53 mm × 3.00 μm) and the carrier gas was high purity nitrogen;The vial temperature was 100 ℃,and the vial time was 20 min.The Column temperature was kept at 40 ℃ for 6 min,then the temperature was raised to 220 ℃ at the rate of 20 ℃/min and subsequently sustained for 10 min.FID detector temperature and injection temperature were both 250 ℃.The N2 flow rate was 2.8 mL/min.Split ratio was 5∶1.Results Twelve kinds of solvents were completely separated and determined with a good linearity (r =0.9994-0.9999).The RSD values of precision experiments and the average recovery was in line with the requirements.Conclusion Theanalytical method is simple,accurate and sensitive,which could be used for determination of residual organic solvents in Apixaban bulks drug.

Objective:To explore the effects of gentiana scabra bage on the expression of hepatic collagen proteins in Paragonimus skrjabinirats with liver fibrosis.Methods:Immunohistochemical technique was used to observe the changes of content of hepatic type Ⅰ, Ⅱ collagen proteins in Paragonimus skrjabinirats with liver fibrosis before and after the gentiana scabra bage treatmeat. Results:Comparing with the model group, changes of hepatic type Ⅰand type Ⅱ collagen proteins in gentiana scabra bage treated group were significantly weakened.Conclusions:Gentiana scabra bage treatment can reduce the content of hepatic type Ⅱ and typeⅠcollagen protein significantly in Paragonimus skrjabinirats with liver fibrosis, thereby, playing the role against hepatic fibrosis.

OBJECTIVETo apply low-dose multi spiral computed tomography (MSCT) chest scans in the early diagnosis and differential diagnosis of pneumoconiosis.

METHODSOne hundred and twenty dust-exposed volunteers were examined by MSCT chest scans at conventional dose and low dose, and the results of conventional-dose scans were set as the gold standard. Comparative analysis was performed on the major CT findings and quality of post-processing images, including 1.5 mm and 5.0∼10.0 mm thick high -resolution reconstructed images, multiplanar reformat images, and maximum intensity projection images.

RESULTSOne hundred and twenty cases of small circular shadows, 36 cases of ribbon shadows in pulmonary parenchyma, 1 case of honeycombing shadow, and 13 cases of big shadows were all showed on low -dose MSCT. But 94 (95.9%) of 98 cases of interlobular septal thickening shadows and 98 (93.3%) of 105 cases of short branched shadows were detected on low-dose MSCT. There were no significant differences in display of the mentioned large and small shadows between low-dose scans and conventional-dose scans (P > 0.05). Eighty-five cases of small airway disease, 8 cases of pulmonary inflammatory lesions, and 47 cases of hilar and mediastinal lymph node swelling were all detected by MSCT. As for the 46 cases of emphysema, 38 (82.6%) were shown. The low-dose MSCT images of 1.5 mm thickness had more artifacts than those of other thickness. The radiation dose of low-dose MSCT was about 1/3-1/5 of that in the conventional-dose MSCT.

CONCLUSIONThere is no difference in display of pneumoconiosis between low-dose and conventional-dose MSCT chest scans. With lower radiation dose, low-dose MSCT can be applied in the diagnosis of pneumoconiosis.

Adult ; Aged ; Dust ; Female ; Humans ; Lung ; diagnostic imaging ; Male ; Middle Aged ; Occupational Exposure ; Pneumoconiosis ; diagnostic imaging ; Tomography, X-Ray Computed ; methods

Objective To study the correlation between the renin-angiotensin-aldosterone system angiotensinogen (AGT) gene M235T,angiotensin Ⅱ type 1 receptor (AGTR1) gene Al166C,aldosterone synthase (CYP11B2) gene -344C/T polymorphisms and large-artery atherosclerotic (LAA) stroke in a southern Chinese Han population.Methods Polymerase chain reaction and gene sequencing technology were used for the genotyping in patients with LAA and normal controls with AGT gene M235T,AGTR1 gene A1166C,and CYP11B2 gene - 344C/T polymorphisms in a southern Chinese Han population,and to determine the correlation between the 3 gene polymorphisms and LAA by binary logistic regression analysis.Results A total of 107 patients with LAA and 142 healthy controls were included in the study.The frequencies of the AGT gene 253TT genotype (66.36％ vs.50.70％,x2 =6.122,P =0.047) and T allele (79.44％ vs.70.07％ ％,x2 =5.581,P =0.018) in the LAA group were significantly higher than those in the control group.The frequencies of the AGTR1 gene 1166CC genotype (0％ vs.0％,x2 =1.494,P =0.222) and C allele (7.48％ vs.4.93％,x2 =1.399,P =0.237) in the LAA group were no significantly differences with those in the control group.The frequencies of the CYP11B2 gene - 344CC genotype (9.35％ vs.4.23％,x2 =3.603,P =0.165) and C allele (27.10％ vs.26.06％,x2 =0.069,P =0.793) in the LAA group were no significant differences with those in the control group.Binary logistic regression analysis showed that there was no significant correlation between the three gene polymorphisms and the simple LAA diseases.The frequencies of AGT gene 235TT genotype (68.00％ vs.41.90％,x2 =12.446,P =0.002) and T allele (79.33％ vs.64.76％,x2 =8.993,P =0.003) in the LAA patients complicated with hypertension were significantly higher than those in the normotensive control group.Logistic regression analysis showed that the odds ratio (OR) exposed to TT genotype was 2.153 (95％ confidence interval [CI] 0.789-5.872).The OR of T allele was 2.089 (95％ CI 1.285-3.396).Conclusions The AGT gene M235T polymorphism is not associated with the simple LAA in the southern Chinese Han population,but it may be associated with the risk of LAA complicated with hypertension;CYP11B2 gene -344C/T polymorphism and AGTR1 gene A1166C polymorphism are not associated with the onset of LAA in the southern Chinese Han population.

Objective To determine the relationship between serum vitamin B_(12)(VB_(12))level and multiple sclerosis(MS).Methods The pertinent articles of the VB12 and the case control studies of MS were retrieved comprehensively by manual retrieval and computer retrieval.The methodology quality of the retrieved artilces were evaluated,and the arcb'cles were screened.Heterogeneity test was performed.The valid data was extracted and analyzed by Stata 10.1.Results In this study,9 studies were included.A total of 807 subjects were enrolled,including 414 patients and 393 controls.The Meta-analysis showed that the serum level of VB_(12) in patients with MS was lower than that in controls(standardized mean difference-0.24,95% CI-0.39 to-0.10).The sensitivity analysis indicated that the result of meta-analysis was reliable.Conclusion The serum level of VB_(12) might be associated with MS,and the deficiency of VB_(12) may contribute to the development of MS.

Objective To discuss the clinical features, diagnosis and therapy of primary adrenal lymphoma (PAL) . Methods Two patients (65-year old and 52-year old respectively) who complained vague pain were analyzed. Occupying lesions in adrenal gland were discovered by computed tomography (CT) and diagnosed by needle biopsy and laparoscopic surgery. Results The two patients in our hospital were diagnosed as nonHodgkin's lymphoma. They were treated with chemotherapy and one of them was partial response. Literatures on PAL were reviewed. In the literature, 7 of the 65 patients achieved complete response, 15 partial response, 43 death or unspecified and the survival duration was 3 days to 26 months. Conclusions Most of PAL are bilateral, without specific clinical characters. Neele biopsy is the first choice to make the diagnosis. The therapeutic modalities for PAL include surgery, chemotherapy, surgery followed by chemotherapy as well as radiation therapy. The prognosis of PAL is poor if other organs are involved.

Objective To report clinical symptoms of a Chinese pedigree of familial paramyotonia congenital (PMC) with progressive myopathy (PM), and investigate the mutations of hot spots in the adult skeletal muscle sodium channel α-subunit (SCN4A). Methods The medical history and clinical phenotype of the patients from this large family with PMC were collected. Insertional and spontaneous activity were recorded by routine electromyograph (EMG), and the exercise test (ET) and cool water test were also performed on some patients during episodes. The mutations of SCN4A were screened by PCR-SSCP and DNA sequencing in affected and unaffected members. Results The family is a four-generation kindred with 15 members affected by severe, homogeneous paralysis periodiea paramyotoniea pheuotype. The onset was early, and almost all patients developed severe progressive myopathy by middle age. Routine EMG shows myotonia discharge in all affected subjects. The compound remarkably motor action potential (CMAP) decreased more than 40% after ET with greater decreases in cool water test than in ET. The mutation screening study revealed a missense mutation (Met1592Val) in SCN4A in patients. Conclusions Autosomal dominant inheritance pattern with complete penetrance was observed in this family. The phenotype is in accord with that reported in other ethnic populations with more severe symptoms. The ET and cool water tests may be used as an easy and reliable diagnostic method. Our research supports that periodic paralysis and paramyotonia can be caused by the same mutation in SCN4A. Mutation Met1592Val is a hotspot for mutation screening in patients with PMC accompanied by PM in the Chinese population.