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Objective To investigate the predictive value of serum lactate combined with PIRO (Predisposition,Infection,Response and Organ dysfunction) score in the development of multiple organs dysfunction syndrome (MODS) in septic patients and to study procalcitonin (PCT),in order to provide guidelines for clinical care.Methods From April 2015 to July 2016,a total of 752 sepsis patients were enrolled and divided into MODS group (n =488) and non-MODS group (n =264) according to the criteria of MODS.At 28 d after admission,these patients were divided into survival group (n =477) and death group (n =275).PCT and lactate levels in serum were measured,and PIRO score of these patients was calculated.Then the differences in levels of PCT and lactate in serum were compared among patients at different PIRO score categories.ROC was constructed to observe the clinical values of the biomarkers,PIRO score and lactate combined with PIRO score in predicting prognosis.Result PCT,lactate levels in serum and PIRO score were significantly higher in MODS group and death group,showing significant positive correlation.The areas under ROC curves (AUCs) of serum lactate combined with PIRO score for predicting MODS were 0.906,which was significantly higher than that of serum PCT (0.716),serum lactate (0.851) and PIRO score (0.840) alone (all P ＜ 0.05).Serum PCT,serum lactate and PIRO score were the independent predictors of MODS.Conclusions Serum lactate in combination with PIRO score was a valuable indicator in predicting development of MODS in septic patients.
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Objective To investigate the effects and mechanisms of bone marrow mesenchymal stem cells (BMSCs) on pancreatic fibrosis in rats of chronic pancreatitis. Methods Thirty healthy male SD rats were randomly divided into three groups:control group, model group and transplanted group (n=10 for each group). Chronic pancratitis rat model was induced by retrograde injection of oleic acid into the biliopancreatic duct. The sham operation group was treated only with solvent. Transplanted group was given BMSCs through caudal vein injection at 1 week and 5 weeks after the model induction. All rats were weighed at 1 week, 4 weeks and 8 weeks in three groups. After 8-week feeding,pancreatic tissues were harvested for HE and picric-sirius staining. The contents of transforming growth factorβ1 (TGF-β1), typeⅠcollagen and typeⅢcollagen were detcted by using ELISA. Results Compared with the control group, the weights of rats were decreased at 4 weeks and 8 weeks in model group and transplantated group (P0.05). The pancreatic fibrosis score and pathological injury were ameliorated signicantly in transplanted group. The contents of TGF-β1, typeⅠcollagen and typeⅢcollagen in pancreas were increased in model group than those of control group and transplanted group (P<0.05). Conclusion BMSCs transplantation can reduce the collagen secretion and reduce the degree of pancreatic fibrosis in rats with chronic pancreatitis, which may be related to the inhibition of the release of TGF-β1.
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Objective To analyze MRI findings of cesarean scar pregnancy (CSP). Methods The MR findings in 18 patients who were diagnosed as CSP by surgery from March 2010 to November 2011 were retrospectively analyzed,and comparison was made between the MRI findings and surgical results.Results All Gestational sacs (18) were clearly detected by MRI.Among the 18 cases,gestational sac presented as cystic mass with smooth margin located within the scar of uterine wall at the lower anterior uterus in 16 cases.In 2 of the 16 cases,gestational sac was found within the myometrium,whereas in the remaining 14 cases,gestational sac was found partially within the myometrium with extension into the uterine cavity.The anteior wall of isthmus uteri became thinner.In the remaining 2 of the 18 cases,gestational sac presented as irregular,multilobolated mass,growing deep inot the myometrium as well as into the uterinecavity. On T2WI,the mass showed heterogeneous signal intensity. A small amount of hemorrhage within the mass and uterine cavity could be seen on T1 WI. An enhancing solid component with a heterogeneous mass could be seen. All gestational sacs in 18 cases were located at or adjacent to the previous cesarean scar.In the area of cesarean scar,the signal of the uterine wall was disconnected,with focal indentation or thinning and the previous cesarean scar exhibited hypointensity on both T1WI and T2WI.Conclusion CSP has its unique findings on MRI,these specific features can provide useful information in the management of CSP.
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In order to study MR features of the regenerative nodule (RN) and dysplastic nodule (DN) of the cirrhotic liver, 26 cases of cirrhotic liver with RNs and DNs, of which 8 cases accompanied with hepatocellular carcinoma, were subjected to MRI. Eighteen of 26 cases underwent additional enhanced MRI with administration of Gd-DTPA on TlWI and 10 of the 18 cases did additional SPIO (Feridex) enhancement on T2WI. Clinical data showed normal level of α-fetoprotein in 18cases except 8 cases accompanied with HCC. The results showed that 12 cases had RNs with nodules measuring ＜1 cm. The MR appearance of those RNs showed isointensity on T1WI and hypointensity on T2WI. The intensity of those RNs was isointense to the surrounding hepatic parenchyma on enhanced MRI with administration of Gd-DTPA or SPIO. Among the 14 cases of DNs, 8cases had nodules measuring 1-3 cm in size and 6 had macroregenerative nodule measuring ＞3 cm.In 8 cases with DNs measuring 1-3 cm in size, 5 cases appeared hyperintense on T1WI and hypointense on T2WI as well as the enhancement as that of nodules with ＜1 cm in size; and the remaining 3 cases appeared hypointense on T1WI and hyperintense on T2WI, and were not isointense to the surrounding hepatic parenchyma on enhanced MRI but hyperintense on SPIO enhanced MRI.In 6 cases of macroregenerative nodule measuring ＞3 cm in size, 2 cases appeared hyperintense to the surrounding hepatic parenchyma on T1, T2WI and enhanced MRI; 4 cases showed hyperintense on T1WI, and hypointense on T2WI and enhanced MRI. Sometimes, normal vessels were seen to pass through the surface of macroregenerative nodules. It was suggested that RNs of cirrhosis had features on MRI that usually allow distinction from hepatocellular carcinoma but not always from dysplastic nodules (DNs). A helpful distinction between HCC and DNs is that the latter are almost never hyperintense on T2WI. Additionally, low grade DNs appear hypointense on SPIO enhanced MRI.
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Objective To explore the therapy efficacy of gamma knife on pituitary adenoma based on the changes of MR imagings and hormone levels before and after gamma knife treatment .Methods MR imagings and hormone levels, clinical material were retrospectively analysed on 45 patients(altogether 59 times MR examinations)followed up from 1～28 months. Both plain and enhancement MR scans were performed on each MR examination. Results 59 cases were followed up for 1～28 months . The tumor size shranked in 31 cases (52.5%), no changs in 25 cases (42.4%), increased in 3 cases(5%). Of the 59 cases , intratumoral cyts were observed in 15 cases (25%). Functional pituitary adenomas were followed up in 23 cases. The hormone levels droped in 13 cases (56.5%), the number of hormone levels droped in about the sixth month after gamma knife treatment was 8.6% , in 1 year was 13% and in 2 years was 34.8%. Conclusion Gamma knife can effectively keep the pituitary adenomas from their growing up; avoid the overproduce of functional pituitary adenomas . The treatment effects of gamma knife can be enlarged with the time gone.