Abstract:Objective To design and prepare a glass-shaped transthoracic left atrial appendage (LAA) reverse occluder and delivery system, and to evaluate the feasibility of transthoracic left atrial appendage reverse occlusion by in vitro reverse occlusion experiment. Methods We used fresh canine heart specimens and measured the anatomical parameters, including the long diameter, short diameter and perimeter of atrial appendage opening, the thickness of upper 1/3 left atrial appendage, the shortest distances from the edge of the opening of the atrial appendage to the left superior pulmonary vein, the left inferior pulmonary vein, and the mitral valve. A new glass-shaped left atrial appendage occluder was designed using nitinol wire, and the appendage occluder opening disk diameter and waist height were designed according to the average diameter of the opening of the atrial appendage and the thickness of upper 1/3 left atrial appendage. The delivery system comprised 9F delivery sheath, expansion sheath, preload sheath and a pushing cable. Delivery sheath was scaled which can be used to control the depth into the left atrial appendage, and expansion sheath head end had smooth transition shape which exposed only about 0.8 cm when inserted into the delivery sheath to prevent damage internal of tissue of heart. Ten isolated dog hearts were punctured at the center of the upper 1/3 axis of left atrial appendage outside under direct vision, and 9F sheath with scale was used to complete in vitro experiment of occlusion. The location and effect of the occluder were observed. Results Nine of the 10 heart specimens successfully underwent the occluding tests in vitro. It was showed that the occluder was well located, with the disc of the opening of left atrial appendage porting into the opening a little and the opening in an overdistraction state, and there was no influence on blood flow of pulmonary vein or function of the mitral valve. The ideal point of puncture was at the upper 1/3 long axis of left atrial appendage outside, and the purse-string suture should focus on this point. The puncture points located at the center of the left atrial appendage opening after removing the occluder postoperatively. Only 1 case failed because of low puncture point and unsuitable location of the occluder. Conclusion The glass-shaped transthoracic reverse occluder is well-designed and matched the anatomy of left the atrial appendage in experimental canine. The occluding effects are exact and meet the requirements of animal experiments in vivo.

Abstract:Objective To study the effect of nano-silver active carbon fiber dressings on wound healing in bedsore wound animal models. Methods Adult SD rats were used and bedsore wound models were made on their back; the animals were then randomly divided into 5 groups (n=10) according to different materials of the wound dressing and treatment. Groups were treated with nano-silver active carbon dressings, nano-silver dressings, active carbon dressings, Vaseline chlorhexidine dressings, or blank control. The wound healing situation, contents of angiogenic factors and inflammatory factors in wound tissues were compared among the 5 groups. Results Wound healing time and the healing rates were different among the 5 groups, with the healing time of rats in nano-silver active carbon dressing group being significantly shorter than those in the other 4 groups (P<0.05). On the 3^rd, 7^th, 14^th and 21^st days after bedsore wound modeling, the healing rates of nano-silver active carbon dressing group were significantly higher than those of the other 4 groups (P<0.05). The levels of angiogenesis factors and inflammatory factors were different in wound tissues of five groups, with the contents of VEGFA, VEGFB and VEGFC mRNA in nano-silver active carbon dressing group being significantly higher and the contents of TNF-α, IL-2 and IL-8 mRNA being significantly lower than those of the other 4 groups (P<0.05). Conclusion The prepared nano-silver active carbon fiber dressing can help to improve pressure ulcer wound healing, relieve wound inflammation, and promote angiogenesis in the wound; it may serve as an ideal material for treating bedsore wound.

Abstract:Objective To investigate the correlation of uric acid (UA) levels with bone mineral density (BMD) and serum bone metabolic markers in middle-aged Chinese physical examination population, so as to discuss the possible role of UA in bone metabolism. Methods A cross-sectional study with 214 middle-aged (45 to 65 years) Chinese physical examination participants was carried out. The correlation of UA levels with BMD and serum bone metabolic markers was observed. BMD values of the lumbar spine, total hip, femur neck and the whole body were measured by dual energy X-ray method. Bone turnover markers, including bone formation markers osteocalcin (OC) and procollagen type Ⅰ amino-terminal propeptide (PⅠNP), bone resorption marker β-CrossLaps (β-CTX), 25-hydroxyvitamin D₃ (25-OHD₃), and parathyroid hormone (PTH) were measured by ECL immunoassay. Results After adjusting for multiple confounders, serum UA levels were found positively correlated with BMD at the lumbar spine, total hip and whole body (P≤0.001), negatively correlated with OC (P<0.01), and positively correlated with logPTH and log25-OHD₃ (P=0.039, P=0.032). The participants were divided into high UA group (UA≥60 mg/mL) and low UA group (UA<60 mg/L) according to the serum UA level. OC, PⅠNP and β-CTX were found significantly lower in the high UA group than in the low UA group (P<0.01). Then we divided the participants into three groups (T1: UA <47 mg/L,T2: 47 mg/L≤UA <60 mg/L; T3: UA≥60 mg/L) according to the serum UA level, and we found that the odds for osteoporosis and at least osteopenia increased by 41% and 158% in T1 group compared with in T3 group, respectively. Conclusion UA plays a protective role in bone metabolism of middle-aged Chinese population, and the relative conclusions need to be confirmed by further studies.

Abstract:Objective To compare the diagnosis values of the standard apparent diffusion coefficient(ADC_total) that calculated from the monoexponential diffusion-weighted imaging (DWI) and the parameters (slow apparent diffusion coefficient [ADC_slow],fast apparent diffusion coefficient [ADC_fast] and fraction of ADC [f]) derived from the biexponential DWI for central gland (CG) prostate cancer, glandular prostatic hyperplasia(GH) and stromal prostatic hyperplasia (SH). Methods The clinical data of 23 patients with CG prostate cancer, 19 patients with GH and 24 patients with SH, who were proven by magnetic resonance/transrectal ultrasound (MR/TRUS) fusion-guided target biopsy were retrospectively analyzed. All the patients underwent MRI examination including T₂WI, T₁WI and b-value DWI before biopsy. The b-values of DWI were 0,50,100,150,200,500,800,1 000,1 500 and 2 000 s/mm². The match of target biopsy area and DWI images was done based on the pathology results. Then the ADC_total, ADC_slow, ADC_fast and f values were measured for all the pathological types. Kruskal-Wallis test was used for difference comparison, and receiver operating characteristic (ROC) analysis was performed to analyze each parameter and evaluate their diagnostic efficiency for CG prostate cancer, SH and GH. Results The ADC_total (×10^-3 mm²/s) values of CG prostate cancer, GH and SH were (0.46±0.06), (0.87±0.19) and (0.68±0.09); the ADC_slow (×10^-3 mm²/s) values were (0.39±0.13), (0.57±0.15) and (0.49±0.13); the ADC_fast (×10^-3 mm²/s) values were (4.8±2.5), (3.6±0.76) and (4.5±1.8); and the f values were (0.43±0.10), (0.68±0.09) and (0.58±0.08), respectively. There were significant differences in ADC_total, ADC_slow and f values among different groups (P=0.000, 0.001 and 0.000), but not in ADC_fast values (P=0.489). The area under curve (AUC) of ADC_total, ADC_slow and f value for CG prostate cancer and GH were 1, 0.828, and 0.971, respectively. The AUC values of ADC_total, ADC_slow and f value for differential diagnosis of CG prostate cancer and SH were 0.991, 0.719, and 0.861, respectively. The AUC values of ADC_total, ADC_slow and f value for GH and SH were 0.876, 0.650, and 0.831, respectively. Conclusion When b value is 0-2 000 s/mm², the ADC_total that calculated from the monoexponential model for diagnosis of CG prostate cancer, GH and SH is more efficient than the ADC_slow and f value that derived from biexponential model.

Abstract:Objective To evaluate the diagnostic value of non-enhanced magnetic resonance venography (MRV) for deep pelvic vein disease. Methods A total of 50 patients highly suspicious of pelvic and lower extremity vein disease were enrolled in the present study, and they were subjected to lower extremity vascular 2D-TOF MRV(two-dimensional time-of-flight MR venography)examination with the following technical parameter: echo time 5-7 ms, repetition time 35-45 ms, and flip angle 35°-45°. The MRV range included the scanning from low segment of inferior vena cava (IVC) to the popliteal vein (PV); the image quality was scaled into grades, and the results of MRV were compared with those of ultrasound and DSA. Results The images of all 50 patients clearly showed the scanning from low segment of IVC to the PV and its branches, with the diagnostic accuracy reaching 96.0%. The images of 25 patients clearly showed a total of 723 veins, including IVC, common iliac vein (CIV), internal iliac vein, external iliac vein (EIV), common femoral vein, deep femoral vein, superficial femoral vein and PV, with a consistent rate of 96.4%. Thrombosis from inferior segment of IVC to EIV was shown on MRV images of 9 patients, while it could not be clearly and completely manifested by B-ultrasound. Ten patients received DSA simultaneously, and the MRV results of 9 were in accord with those of DSA findings. MRV of one patient with thrombosis at initial segment of CIV was shown normal on DSA. Conclusion MRV for diagnosis of lower extremity vascular lesions has the advantage of non-trauma, greater scanning range, high grade contrast, excellent image delineation and intuitive convincement, making it worth popularizing in clinic.

Abstract:Objective To explore the influence of enoxaparin on clinical events in complicated coronary lesions after percutaneous coronary intervention (PCI). Methods Totally 288 patients with complicated coronary lesions (type B2 and type C), who had no notable complications following PCI, were recruited in the present study. The patients were randomly assigned to receive either enoxaparin or not. Patients were assessed for major adverse cardiac events (MACEs) during hospitalization and at 1 and 12 months after PCI. Results There were no significant differences in the frequency of MACEs between the two groups during hospitalization (2.1% vs 1.4%, P>0.05), at 1 month (2.8% vs 2.8%, P>0.05) or 12 months post-PCI (5.5% vs 6.3%, P=0.780). The cumulative incidence rates of MACEs were not significantly different between the two groups (HR=0.875, 95%CI 0.337-2.273; P=0.79). The two groups had comparable rates of major bleeding (4.8% vs 2.8%, P=0.369), but that of the minor bleeding was significantly higher in the anticoagulation group (26.2% vs 16.1%, P=0.036). The average hospital stay in the anticoagulation group were significantly longer than that in the non-anticoagulation group ([6.04±1.64] d vs [5.43±1.54] d, P=0.001). Conclusion MACEs after PCI is not increased in patients with complicated coronary lesions receiving no anticoagulation compared with those receiving, with less minor bleeding and shorter hospital stay, suggesting that for the patients with complicated coronary lesions, routine anticoagulation therapy is not necessary after PCI without procedure complications.

Abstract:Objective To analyze the efficacy of vaginal disinfection with povidone-iodine before cesarean delivery in preventing postoperative infections. Methods Randomized controlled trials, identified from a systematic search of relevant databases including PubMed, EMBASE, CBM, CNKI, and CQVIP, were screened and evaluated according to standardized criteria. RevMan 5.2 software was used to do the meta-analysis. Results A total of 9 randomized controlled trials with 3 024 participants, with 1 508 in the vaginal cleansing group and 1 516 in the control group, were included in this meta-analysis. The analysis result showed that vaginal disinfection with povidone-iodine before cesarean delivery reduced the incidence of post-cesarean endometritis (RR=0.55, 95%CI 0.36-0.85, P=0.007). The incidence of post-cesarean endometritis was significantly reduced in women with ruptured membranes (RR=0.29, 95%CI: 0.16-0.52, P<0.000 1) and women in labor (RR=0.63, 95%CI 0.41-0.96, P=0.03), but not significantly reduced in the women with intact membranes (RR=0.73, 95%CI 0.50-1.08, P=0.11) or women not in labor (RR=0.79, 95%CI 0.53-1.17, P=0.24). Vaginal disinfection could not help to reduce the incidence of postoperative wound infection (RR=0.80, 95%CI 0.53-1.22, P=0.30) or postoperative fever (RR=0.92, 95%CI 0.76-1.11, P=0.37). Conclusion Vaginal disinfection with povidone-iodine before cesarean delivery can decrease the risk of post-cesarean endometritis, especially for women undergoing cesarean delivery with ruptured membranes or in labor, but vaginal disinfection do not reduce the risk of postoperative wound infection or fever.

Abstract:Objective To investigate the effect of transplantation with the three-dimensional spheroid-cultured mesenchymal stem cells (MSCs) on the expression of Nogo-A and NgR in rats with cerebral ischemia-reperfusion injury. Methods The experimental animals were randomly divided into Sham group, Vehicle group and MSCs treated group. The model of focal ischemia-reperfusion in rats was induced by intraluminal middle cerebral artery (MCA) occlusion with a nylon monofilament suture in Vehicle group and MSCs treated group. The fishing line was unpluged for reperfusion 2 h after ischemia and MSCs were transplanted in MSCs treated group one day later. Equivalent medium solution was given to the Vehicle group 1 d later. On the 1^st day, 3^rd day, and 7^th day after transplantation, the neuromotor function of the animals was detected. The brain tissue of rats was harvested for RT-PCR detection of Nogo-A and NgR mRNA expression in the brain tissue of rats, and Western blotting analysis was used to detect the expression of Nogo-A and NgR protein. Results Compared with the Vehicle group, the neuromotor function was significantly improved in MSCs treated group on the 7^th day; and the expressions of Nogo-A and NgR mRNA and protein were significantly down-regulated in MSCs treated group on the 1^st day, 3^rd day, and 7^th day after transplantation (P<0.05). Conclusion Transplantation of the three-dimensional spheroid-cultured MSCs can improve the neuromotor function following cerebral ischemia/reperfusion injury, and its mechanism may be associated with down-regulation of Nogo-A and NgR in the brain tissue.

Abstract:Objective To lay a foundation for the industrial fermentation and vaccine development of Pseudomonas aeruginosa (P. oeruginosa) outer membrane protein OprH. Methods The OprH expression strain was obtained by molecular cloning. The culture condition and optimal expression of the experiment was obtained by the method of orthogonal design. OprH was purified by gel slice strategy and was used to immunize mice to prepare the polyclonal antibody. The antibody titer and specificity were detected by ELISA and Western blotting analysis, respectively. Mice were immunized by OprH protein and infected with P. aeruginosa, and the immune protection of OprH was detected. Results OprH recombinant vector were digested and sequenced, and the results confirmed the correct construction; and OprH expression and purification of strip size agreed with the prediction. The optimal culture condition was as follows: rotation rate was 230 r/min, glucose concentration was 0%, and the medium volume was 50 mL. The optimal inducing expression condition of OprH was as follows: isopropy-β-D-thiogalactoside final concentration was 0.3 mmol/L, strain D₆₀₀ value was 0.8, inducing temperature was 32℃, and inducing time was 3 h. The OprH antibody titer was 1:1 600 as detected by ELISA, and Western blotting analysis proved that the antiserum had good specificity. Mice specific immune was activated by OprH, and immune protection rate for mice against P. aeruginosa infection was 46.15 %, which had significant differences compared with the control (P<0.05). Conclusion We have successfully cloned OprH expression vector, purified OprH, prepared the polyclonal antibodies of OprH. It is confirmed that OprH protein has significant immune protection against P. aeruginosa, and the culture and induction conditions of the recombinant OprH have been obtained.

Abstract:Objective To apply computer simulation technology for simulating the emergency medical rescue of different conditions and optimizing the rescue strategy and resource allocation. Methods Firstly, according to the characteristics of the arrival of the wounded and the state of injury, four alternative strategies were formulated and simulated. Secondly, the optimal strategy was determined by waiting time of the wounded and the working intensities of rescue unit. Finally, the reasonable suggestions for the rescue strategy and rescue force allocation were put forward by simulation analysis of the relationship between the arrival rate of wounded and the number of rescue units. Results First-leave-first-served and the select-units strategy could effectively reduce the waiting time of the wounded and the working intensity of the rescue unit. When the arrival rate of class A(B) of the wounded increased, the total number of rescue units increased at the same time under the premise of meeting the requirements of the medical rescue, with the number of A(B) rescue units increasing more rapidly. Conclusion By simulating the emergency medical rescue process using different strategies, the optimal rescue strategy can be determined; the number of the rescue units is closely related to the arrival rate of the wounded; estimating the arrival rate of the wounded and the average treatment time can provide reference for rescue force allocation.

Abstract:Identifying patients with rupture-prone intracranial aneurysms and giving pertinent appropriate therapies are the keys to prevent aneurysm rupture and reduce the morbidity and mortality. Progression in magnetic resonance imaging has resulted in increasingly application of it for intracranial aneurysms. This review discussed the recent progress on the role of high-resolution MRI in evaluating intracranial aneurysm rupture risk.

Abstract:The effectiveness and safety of renal denervation for treating resistant hypertension have been demonstrated by previous studies; meanwhile its potential therapeutic role for chronic kidney disease has also been indicated. Recent clinical and animal studies have confirmed that renal denervation did not cause further damage to renal function of patients with chronic kidney disease; conversely, it may have potential benefits for the patients. In this paper, we reviewed the application and effect of renal denervation in chronic kidney disease.

Abstract:Atypical diabetes mellitus (ADM) is characterized by severe hyperglycemia and unprovoked ketosis or ketoacidosis, with insulin resistance but with negative insulin-related antibody. The treatment of ADM firstly needs a short-term insulin therapy, which can be replaced by oral glycemic agent therapy or lifestyle intervention to control the blood glucose. ADM is regarded as a new subtype of diabetes different from typical type 1 diabetes mellitus and type 2 diabetes mellitus. In this paper, we reviewed the latest research progress on ADM, including its prevalence, clinical presentation, pathogenesis, diagnosis and management, hoping to help clinicians to better understand ADM and avoid the missed diagnosis and misdiagnosis.

Abstract:Chronic inflammation plays an important role in cancer evolution and development. Some adjustable factors concerning diet and lifestyles can influence the transition from chronic inflammation to cancer. According to an established standard, food can be classified into pro-inflammatory food and anti-inflammatory food, which may affect the occurrence and progression of some cancers via promoting or inhibiting inflammatory microenvironment. Obesity caused by unhealthy diet and lack of physical activities can create inflammatory microenvironment, together with nutritional factors, they can promote cancer evolution and development. It is of great significance to improve food structure and lifestyle to control the evolution and development of inflammation-associated cancers.

Abstract:Objective To explore the feasibility and effectiveness of establishing an aortic valve regurgitation canine model by minimally invasive peripheral vascular catheter method. Methods A total of 10 healthy canines were selected in this study. An aortic insufficiency animal model was established by percutaneous femoral artery puncture and aortic dilatation. Aortic angiography and transthoracic echocardiography were used to evaluate aortic valve regurgitation immediately after operation. Results Aortic valve regurgitation animal models were successfully established in all the 10 canines. Two canines died of acute left ventricular failure due to the large aortic regurgitation after the operation. Six surviving canines had moderate aortic regurgitation and two had slight aortic regurgitation; they survived for more than 1 month. Conclusion It is feasible to establish an aortic regurgitation canine model by minimally invasive peripheral vascular catheter method.

Abstract:Objective To explore a modified method of cerebellar tonsillectomy combined with posterior fossa decompression via small-size craniotomy for Chiari- Ⅰ malformation associated with syringomyelia and to evaluate its clinical efficacy. Methods The clinical data of 29 Chiari- Ⅰ malformation patients associated with syringomyelia, who underwent modified cerebellar tonsillectomy combined with posterior fossa decompression via small-size craniotomy from January 2012 to January 2014, were analyzed retrospectively.Patients were prone with head and neck in the coaxial position and received surgical intervention including posterior fossa decompression via small-size craniotomy, opening the rear atlas arch, resection of the inner part of cervical canal of the cerebellar tonsil herniation while keeping the integrity of soft meninges, adhesiolysis of median aperture of the fourth ventricle, dissection of the suture of arachnoid and dural edge to avoid latrogenic dead space, and suture of the dura with autologous fascia. The cerebrospinal fluid release rate of the whole process was controlled. Results A total of 24 patients were followed up after operation while 5 patients were lost in follow-up. The clinical symptom of 23 patients was improved within one year after operation. The repression of medulla oblongata and posterior upper part of cervical cord was removed in MRI examination 6 months after operation. The lower edge of cerebellar tonsillar was up to the plane above the foramen magnum and the herniation was resolved. The syringomyelia was shortened or disappeared. Conclusion Modified cerebellar tonsillectomy combined with posterior fossa decompression via small-size craniotomy, as a microscopy neurosurgery, is an effective method for the treatment of Chiari- Ⅰ malformation associated with syringomyelia.

Abstract:Objective To assess the efficacy and safety of low dose short-term tolvaptan in treatment of decompensated heart failure patients with diuretic resistance and hyponatremia. Methods The clinical data of consecutive patients with decompensated heart failure, who were admitted to Changzheng Hospital from April 2012 to March 2014, were analyzed retrospectively. Patients were assigned to receiving tolvaptan (15 mg/d×7 d) or standard therapy (including 3%-4% hypertonic saline×7 d). The efficacy endpoints were heart failure symptoms relief, serum sodium elevation during hospitalization and cardiovascular death at 180 d from discharge. The safety endpoint included adverse effect of thirsty, renal function impairment and symptoms of nervous system. Results A total of 37 patients met the inclusion criteria and were assigned to tolvaptan (n=16) or standard therapy (n=21). There were no significant differences between the 2 groups at baseline. The elevation of serum sodium at day 7, reduction of body weight and NT-proBNP level before discharge, and the ratio of restoration to higher than NYHA class Ⅱin the tolvaptan group were all significantly more than those in the standard therapy group (P<0.05). Tolvaptan, compared with standard therapy, significantly decreased the mean dose of furosemide, serum creatinine elevation and hospital stay (P<0.05), but failed to lower the cardiovascular mortality at 180 d follow-up. Conclusion For Chinese patients with decompensated heart failure with diuretic resistance and hyponatremia, in addition to guideline-recommended therapies for heart failure, low dose short term tolvaptan is associated with more favorable in-hospital effects and less severe adverse effects, but not with long-term cardiovascular mortality.

Abstract:Objective To investigate the effects of soluble CD40L (sCD40L) on proliferation of orbital fibroblasts (OFs) and the expression of three types of hyaluronan synthase (HAS) in vitro, so as to explore the role of sCD40L in the pathogenesis of thyroid-associated ophthalmopathy (TAO). Methods OFs obtained from 5 patients with TAO and 3 normal controls were primarily culutred. The effect of different concentrations of sCD40L (6.25,12.5,25,50,100 and 200 ng/mL) on proliferation of OFs of different sources were examined by MTS after 48 h exposure. OFs were also cultured with different concentrations of sCD40L (12.5, 25, 50 and 100 ng/mL) for 3,6,12 and 24 h, and then the expression levels of HAS 1-3 mRNA were determined by real-time RT-PCR. Results Treatment with sCD40L at concentrations higher than 25 ng/mL for 48 h obviously promoted the proliferation of OFs in patients with TAO (P<0.05). In contrast, treatment with sCD40L only at concentrations higher than 50 ng/mL for 48 h could promote proliferation of OFs from normal control, and the effect was comparatively weak. HAS3 mRNA expression of OFs in TAO patients was increased after exposed to sCD40L (P<0.05), and the increase was in a concentration- and time-dependent manner. Conclusion sCD40L can promote the proliferation of OFs and expression of HAS3 mRNA in patients with TAO, which implies that sCD40L plays an important role in the pathogenesis of TAO.

Abstract:Objective To analyze the imaging features of Castleman disease (CD) and its correlation with histopathologic and clinical features. Methods The images of 20 patients with CD were retrospectively reviewed and compared with their clinical and pathological findings. All the patients received CT or MRI plain scan and dynamic enhanced scan. 12 patients underwent CT examination and 8 underwent MRI examination. Results Locations of the lesions were found in the neck (n=6), abdomen and pelvis (n=6), mediastinum (n=3), retroperitoneum (n=2),multiple locations (n=2) and left subclavicular region (n=1). The clinical subtypes included unicentric type (n=17) and multicentric type (n=3). Histopathologic classification was as follows: hyaline-vascular type (n=16), plasma cell type (n=3) and mixed cell type (n=1). The lesions were manifested as homogeneous masses and well-defined margins of soft-tissue attenuation on the plain scan, apart from three cases with lobular, three cases with unclear margins, five cases with multiple masses and one case with heterogeneous texture. After contrast administration, 19 cases showed marked or persistent enhancement, one showed slight enhancement; 14 showed homogeneous enhancement, six showed heterogeneous enhancement; and 17 showed enlarged blood vessels within or around the mass. Conclusion Imaging features of CD are closely correlated with its clinical and pathological subtypes. A good knowledge of imaging features can contribute to a better understanding of the lesion before operation and a suitable therapeutic regimen.

Abstract:Objective To analyze the clinical values of combined detection of procalcitonin (PCT), interleukin-6 (IL-6), C-reaction protein (CRP), neutrophil CD64, white blood cell (WBC) count and neutrophil ratio for diagnosis of infection in patients with liver cirrhosis. Methods The hospitalized patients with liver cirrhosis were divided into the infection group and the non-infection group according to the bacterial culture and clinical symptoms. The serum levels of PCT and IL-6 were detected by Chemiluminescence immunoassay. The serum CRP was detected by biochemistry analyzer. The neutrophil CD64 was detected by flow cytometer, and WBC count and neutrophil ratio were detected by blood cell analyzer. The collected data were analyzed by logistic regression and receiver operating characteristic (ROC) curves. Results All the markers in the infection group were higher than those in the non-infection group (P<0.01). The results of logistic regression analysis showed that PCT, IL-6 and neutrophil CD64 could predict the infection in patients with liver cirrhosis,with the odd ratio being 7.199 (95%CI, 2.180-23.771),1.010 (95%CI,1.002-1.017)and 2.312 (95%CI,1.485-3.600), respectively. However, CRP, WBC count and neutrophil ratio showed no predictive values. The ROC curves showed that the area under curves (AUC) of PCT, IL-6 and neutrophil CD64 were 0.791 (95%CI,0.727-0.856),0.762 (95%CI,0.693-0.832)and 0.884 (95%CI,0.835-0.933), respectively. The AUC of combined detection of the three markers was 0.932 (95%CI,0.897-0.967), with a diagnostic accuracy of 86.9%. Conclusion PCT, IL-6 and neutrophil CD64 can predict infection in patients with liver cirrhosis, and combined detection of the three markers can improve the diagnostic efficiency.

Abstract:Objective To investigate the correlation of fluid resuscitation volume with intra-abdominal hypertension (IAH) and renal injury in patients with severe acute pancreatitis (SAP). Methods Totally 60 patients with SAP from our ICU were recruited in the present study. The intra-abdominal pressure (IAP) was measured by method AbViser. The patients were divided into the following 3 groups according to the different of IAP: the normal group, IAH group and abdominal compartment syndrome (ACS) group. The general information, mortality rate, fluid resuscitation volumes and renal injury were analyzed and compared in the 3 groups. Results (1) The incidence rates of IAH and ACS in our study were 31.67%(19/60) and 11.67% (7/60), respectively. The mortality rates of normal group, IAH group and ACS group were 5.88%(2/34), 21.05%(4/19) and 57.14%(4/7), respectively. The mortality rate of ACS group was significantly higher than that of normal group (P=0.007). (2) The fluid balance volumes of normal group, IAH group and ACS group were (4 350±892), (5 512±1 246) and (5 974±1 765) mL, respectively, with significant differences found among the 3 groups (P<0.001); the total cumulative fluid volumes of the 3 groups were (8 530±2 384), (9 403±2 064) and (13 172±2 409) mL, respectively, also with significant differences found among the 3 groups (P<0.001). ACS group had the highest fluid balance and total cumulative fluid volumes in the first 3 days. (3) There were significant differences in the levels of blood creatinine and urea nitrogen among the 3 groups (P<0.001). The levels of blood creatinine and urea nitrogen of ACS group was significantly higher than those of normal group and IAH group (P<0.05). Conclusion The cumulative fluid of the first 3 days is associated with IAH and even ACS in pateints with SAP, and IAH can further lead to renal injury in patients with SAP.

Abstract:Objective: To summarize the cable tension band fixation for the treatment of the clinical effect of lumbar spondylolysis, to explore the feasibility and effectiveness of the cable tension band fixation. Methods: in 2011 May to 2013 May received a total of 12 cases of L4 and L5 in patients with lumbar spondylolysis. 12 cases were male; age 18---22 year old, average age is 19.5 years old. Were not associated with lumbar spondylolisthesis. All the patients were Ai Wentai cable tension band fixation and isthmic bone grafting treatment, after 3, 6, 9, 12 months of follow-up. Results: there were no operation complications and sequelae, no secondary lumbar spondylolisthesis was found. Reached the standard of bone healing in 11 cases, bone healing rate was 91.7%, 9 cases achieved healthy players training intensity. At the last follow-up evaluation of curative effect, excellent in 9 cases, good in 2 cases, 1 cases, the excellent and good rate was 91.7%. Conclusion: the cable tension band fixation for the treatment of lumbar spondylolysis is effective, simple operation, little injury and good biological compatibility method. On the prevention of lumbar spondylolisthesis, promote the local fracture of lumbar spondylolysis Union, has a positive meaning to improve the symptoms of waist.

Abstract:Objective To describe the characteristics of primary pulmonary plasmacytoma. Methods One patient with primary pulmonary plasmacytoma was described and relevant literatures were reviewed. Results Primary pulmonary plasmacotyma is a very rare form of extramedullary plasmacytoma.Patients with this disease usually have little symptoms. Primary pulmonary plasmacytoma often presents as solitary or multiple nodular mass lesions, but these lesions lack specific radiographic features and are easily lead to misdiagnosis. The diagnosis of primary pulmonary plasmacotyma is based on the histological confirmation of plasma cell infiltration in lung lesions. Additionally, it requires normal bone marrow, normal skeletal survey, no related organ or tissue impairment, and no M protein in serum and/or urine. Most cases of solitary pulmonary plasmacytoma can be treated with surgical resection and/or irradiation, and combination chemotherapy is effective for cases of diffuse pulmonary infiltration. Conculsion Biopsy and pathologic diagnosis is very important to patients who present as solitary or multiple nodular mass lesions to avoid misdiagnosis and mistreatment.