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Objective To investigate the curative effect of mesalamine combined with trimebutine maleate in the treatment of diarrhea predominant irritable bowel syndrome .Methods According to the digital table ,112 patients with diarrhea predominant irritable bowel syndrome were randomly divided into control group and observation group , 56 cases in each group .The two groups were given conventional symptomatic treatment ,on this basis ,the control group recieved mesalamine treatment ,the observation group recieved mesalamine combined with trimebutine maleate treat -ment.The two groups were treated for 4 consecutive weeks.The main indicators,clinical efficacy and adverse reaction of the two groups were compared .Results The total effective rate of the observation group was 94.6％,which was significatnly higher than 78.6％of the control group (χ2 =3.925,P<0.05).The antidiarrheal time,stool recovery time between the two groups had statistically significant differences (t=19.337,18.068,all P<0.05).The mental status,emotional status,diet and sleep status in the two groups were all improved ,the differences were statistically significant(all P<0.05),which in the observation group improved more significantly than that in the control group , the differences were statistically significant(all P<0.05).The two groups had no other serious adverse reactions . Conclusion On the basis of conventional treatment ,mesalamine combined with trimebutine maleate in the treatment of diarrhea predominant irritable bowel syndrome can significantly improve clinical symptoms ,improve clinical curative effect,and it has good safety and great clinical significance .
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Objective To investigate the correlation of endoscopic and pathological diagnosis of chronic atrophic gastritis( CAG) . Methods 108 patients diagnosed as CAG by gastroscopy were selected. Whether the results were consistent with the diagnosis between gastroscope and pathology were observed, and the diagnosis relationship between gastroscopic and histopathological features,and the relationship between CAG and Hp were observed,and the coincidence rates of the diagnostic results by using these two methods were calculated. Results 19 cases of chronic superficial gastritis( CSG) and 89 cases of CAG were diagnosed by pathologic biopsy,and 42 cases of CAG with intes-tinal metaplasia,13 cases with dysplasia. The coincidence rate of CAG between gastroscopic and pathological diagnosis was 82. 41%. 9 cases showed the gastric mucosa in rough and showed granular or nodular changes,meanwhile,7 cases of them with CAG were confirmed by histopathology , following 3 cases of them with intestinal metaplasia ( 33 . 33% ) and 1 case of them with heterosexual hyperplasia(11. 11%). 18 cases showed the change of the color of the gastric mucosa with red and white,and mainly in white,following vascular exposure tested by gastroscope. 13 cases of them (72. 22%) with CAG were confirmed by histopathology,4 cases of them with intestinal metaplasia(22. 22%) and 1 case of them with heterosexual hyperplasia(5. 56%). 14 cases showed gastric mucosal folds flat,thinning or even disappear tested by gastroscope. 10 cases of them(71. 43%) with CAG were confirmed by histopathology,following 4 cases of them with intestinal metaplasia(28. 57%) and 2 cases of them with heterosexual hyperplasia(14. 29%). When the three manifestations of gastroscope were presented,the CAG coincidence rate was more than 70. 00%,and the highest was the rough gastric mucosa with the rate of 77. 78%. When the any two of the manifestations of gastroscope were simultaneously presented,the CAG coincidence rate was more than 80. 00%,and the highest was the rough gastric mucosa and the color of red and white combination with the rate of 88. 00%. When the three of the manifestations of gastroscope were simultaneously presented,the CAG coincidence rate was more than 80. 00%. Hp was positive in 55 cases(50. 93%). 89 cases were diagnosed by pathology,48 cases of them(53. 93%) were Hp positive. In the 42 cases with intestinal metaplasia,24 cases of them(57. 14%) were Hp positive. In 13 cases with dysplasia,9 cases of them(69. 23%) were Hp positive. Conclusion It should be combined with gastroscopy and pathological examination in clinic,and should pay more attention to the typical site biopsy and strengthen the identify of endoscopic morphology, and also standardize the endoscopic operation. It can ultimately improve the diagnostic coincidence rate of the two methods.
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Objective To investigate the correlation of endoscopic and pathological diagnosis of chronic atrophic gastritis( CAG) . Methods 108 patients diagnosed as CAG by gastroscopy were selected. Whether the results were consistent with the diagnosis between gastroscope and pathology were observed, and the diagnosis relationship between gastroscopic and histopathological features,and the relationship between CAG and Hp were observed,and the coincidence rates of the diagnostic results by using these two methods were calculated. Results 19 cases of chronic superficial gastritis( CSG) and 89 cases of CAG were diagnosed by pathologic biopsy,and 42 cases of CAG with intes-tinal metaplasia,13 cases with dysplasia. The coincidence rate of CAG between gastroscopic and pathological diagnosis was 82. 41%. 9 cases showed the gastric mucosa in rough and showed granular or nodular changes,meanwhile,7 cases of them with CAG were confirmed by histopathology , following 3 cases of them with intestinal metaplasia ( 33 . 33% ) and 1 case of them with heterosexual hyperplasia(11. 11%). 18 cases showed the change of the color of the gastric mucosa with red and white,and mainly in white,following vascular exposure tested by gastroscope. 13 cases of them (72. 22%) with CAG were confirmed by histopathology,4 cases of them with intestinal metaplasia(22. 22%) and 1 case of them with heterosexual hyperplasia(5. 56%). 14 cases showed gastric mucosal folds flat,thinning or even disappear tested by gastroscope. 10 cases of them(71. 43%) with CAG were confirmed by histopathology,following 4 cases of them with intestinal metaplasia(28. 57%) and 2 cases of them with heterosexual hyperplasia(14. 29%). When the three manifestations of gastroscope were presented,the CAG coincidence rate was more than 70. 00%,and the highest was the rough gastric mucosa with the rate of 77. 78%. When the any two of the manifestations of gastroscope were simultaneously presented,the CAG coincidence rate was more than 80. 00%,and the highest was the rough gastric mucosa and the color of red and white combination with the rate of 88. 00%. When the three of the manifestations of gastroscope were simultaneously presented,the CAG coincidence rate was more than 80. 00%. Hp was positive in 55 cases(50. 93%). 89 cases were diagnosed by pathology,48 cases of them(53. 93%) were Hp positive. In the 42 cases with intestinal metaplasia,24 cases of them(57. 14%) were Hp positive. In 13 cases with dysplasia,9 cases of them(69. 23%) were Hp positive. Conclusion It should be combined with gastroscopy and pathological examination in clinic,and should pay more attention to the typical site biopsy and strengthen the identify of endoscopic morphology, and also standardize the endoscopic operation. It can ultimately improve the diagnostic coincidence rate of the two methods.
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Objective To observe the incidence of acute gastrointestinal injury (AGI) in intensive care unit (ICU) patients, and to approach the value of serum citrulline and intestinal fatty acid binding protein (IFABP) on diagnosis of AGI in critical patients. Methods A prospective study was conducted. 576 critical patients admitted to ICU of Yantai Yuhuangding Hospital from February 2016 to February 2017 were enrolled. According to the AGI classification proposed by European Society of Intensive Care Medicine (ESICM) in 2012, the AGI and severity of the patients were observed. The general data, severity and prognosis of patients with different AGI grades were recorded. According to the random number table, 20 patients with normal kidney function from AGI Ⅰ to Ⅳ were selected. The femoral artery blood was collected within 12 hours of ICU admission, and serum citrulline level was detected by high performance liquid chromatography (HPLC). Serum IFABP level was determined by enzyme-linked immunosorbent assay (ELISA). Twenty healthy subjects were selected as controls. The receiver operating characteristic curve (ROC) was drawn, and the predictive values of citrulline and IFABP for AGI diagnosis were evaluated. Results ① 576 patients were enrolled in the analysis. Of which 530 patients (92.0%) had AGI, and 289 patients with gradeⅠ (54.5%), 154 with grade Ⅱ (29.1%),64 with grade Ⅲ (12.1%), and 23 with grade Ⅳ (4.3%). With the increase in AGI classification, acute physiology and chronic health evaluation system Ⅱ (APACHE Ⅱ) score, sequential organ failure score (SOFA), the length of ICU stay and 28-day mortality were gradually increased. ② Compared with health control group, the levels of serum citrulline in patients with different AGI grades were significantly decreased, and IFABP was significantly increased. With the increase in AGI classification, the citrulline level was gradually decreased, and IFABP level was gradually increased [citrulline levels (μmol/L) in AGIⅠ,Ⅱ,Ⅲ,Ⅳ groups were 14.1±3.6, 12.7±3.1, 8.3±2.7, and 5.6±3.4, F = 3.287, P = 0.027, and IFABP levels (ng/L) were 526.7±204.9, 698.4±273.8, 894.7±455.9, and 1 062.8±532.2, F = 2.903, P = 0.043]. ROC curve analysis showed that citrulline had a higher predictive value for AGI diagnosis. The area under the ROC curve (AUC) was 0.927. When the cut-off value of citrulline was 9.7 μmol/L, the sensitivity and specificity were 87.5% and 87.5%, respectively. The AUC of IFABP was 0.043, which has no predictive value for the diagnosis of AGI. Conclusions The AGI is extremely common in ICU. The higher the AGI grade is, the worse the prognosis is. Citrulline has high diagnostic value for AGI in critical patients, but IFABP has no predictive value on the diagnosis of AGI.
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Objective To prepare a novel ultrasound contrast agent , targeted phase-shift lipid nanoparticles mediated by tumor homing and penetrating peptide tLyP-1 ,and to evaluate its characteristics . Methods The nanoparticles were prepared by filming-rehydration and acoustic-vibration methods .The morphology ,distribution ,particle size and zeta potential were detected . After heating and irradiating of low intensity focused ultrasound ( LIFU) ,the phase-shift characteristic and the enhancement effect in vitro were observed . The tumor homing and cell-penetrating properties of the nanoparticles were examined by confocal laser scanning microscopy and flow cytometry . The cytotoxicity of the nanoparticles was evaluated by CCK 8 assay . Results The size and distribution of nanoparticles were uniformed . The size and zeta potential of nanoparticles were ( 399 .50 ± 29 .98) nm and ( 3 .28 ± 1 .72) mV ,respectively . When the nanoparticles were heated to a temperature of 45 ℃ or after irradiated by LIFU ,nanoparticles generated phase-shift and enhanced ultrasound imaging in vitro ( P 0 .05 ) . Conclusions A novel ultrasound contrast agent , targeted phase-shift lipid nanoparticles mediated by tumor homing and penetrating peptide tLyP-1 ,is prepared successfully . It can target to MDA-MB-231 cell and penetrate into the cell in vitro ,and enhance ultrasound imaging in vitro after LIFU irradiation ,which expected to become a novel tumor targeted ultrasound contrast agent and achieve ultrasound molecular imaging at the level of tumor cell .
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Objective To investigate the effect of blood hemoperfusion with resin adsorption connected in series to continuous veno-venous hemofiltration ( HP + CVVH) on plasma cytokines such as TNF-α,IL-1β,IL-6 as well as cellular immunity and prognosis of patients with multiple organ dysfunction syndromes (MODS). Methods It was a prospective,randomized clinical trial.A total of 30 patients diagnosed as MODS were randomly (random number) divided into routine treatment + HP + CVVH group (treatment group) and routine treatment + CVVH group (control group).In treatment group,patients received blood hemoperfusion with resin adsorption for 2 hours,and then CVVH for 10 hours every day for 3days.In control group,patients received CVVH for 12 hours every day for 3 days.The plasma samples of patients in treatment group were obtained 0 h,2 h,12 h,24 h,26 h,36 h,48 h,50 h,60 h,5 days,7 days and 10 days after renal replacement therapy.The plasma samples of patients in control group were obtained 0 h,12 h,24 h,36 h,48 h,60 h,5 days,7 days and 10 days after renal replacement therapy.All of these patients were monitored with APACHE Ⅱ score,T-lymphocytes subpopulations,blood lactate acid concentration,heart rate,respiration rate and oxygenation index. Results Plasma levels of TNF-α,IL-1β and IL-6 decreased dramatically after HP (P ＜ 0.01 ) and T-lymphocytes subpopulations CD3+,CD4 +,CD8 + and CD4 +/CD8 + increased after both HP + CVVH and CVVH.The differences in plasma levels of TNF-α,IL-1βand IL-6 of patients between two groups were not noticeably obvious at the intervals of 12 h,36 h,and 50 h after renal replacement therapy. But on the 5 th day after renal replacement therapy,plasma levels of TNF-α,IL-1βand IL-6 of patients in HP + CVVH group were lower than those in control group (P ＜ 0. 05 ).There were 5 fatal patients in HP + CVVH group and 6 patients died off in CVVH group during 28 days after treatment.Conclusions Both HP + CVVH and CVVH could lower the levels of plasma TNF-α,IL-1β and IL-6,and improve cellular immunity and clinical symptoms as well as signs.Compared with CVVH,plasma levels of TNF-α,IL- 1β and IL-6 were lower on the 5th day and increase rate of 28-day survival in HP + CVVH group.
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OBJECTIVE To observe the type of nosocomial infections in our comprehensive ICU,the prevalence and the vicissitude characteristic of infection strains,and the change of antibiotic-resistance.METHODS To summarize the 10 year results of the monitoring which were divided into three stages to compare the changes with time.RESULTS Gram-negative bacilli were 987(76.4%),Gram-positive cocci 216(16.7%) strains,and 89 strains were fungi(6.9%).The top six strains were in turn:Pseudomonas aeruginosa,Acinetobacter baumannii,Staphylococcus aureus,Klebsiella pneumoniae,Escherichia coli,and Stenotrophomonas maltophilia.Distribution of infection sites: 92.3% infection was in lungs,5.2% in urinary tract infection,2.5% in other sites included lungs,abdomene,CSF,blood etc.CONCLUSIONS The main nosocomial infective pathogens in our ICU are Gram-negative bacilli(75.0%),Gram-positive bacterial infection shows a slight increasing,whereas fungi infection decreasing.In addition to S.maltophilia,the great majority of Gram-negative bacilli,ESBL-producing K.pneumoniae and E.coli maintain a higher sensitivity to carbapenem antibiotic.All Gram-positive cocci to vancomycin and teicoplanin maintain a good sensitivity.In the fungal infection,Candida albicans infection ratio is decreased,while non-C.albicans increases.
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OBJECTIVE To assess the diagnostic and prognostic value of C-reactive protein(CRP) levels,body temperature and white blood cell(WBC)count for hospital-acquired pneumonia(HAP).METHODS Temperature,and concentration of CRP and WBC count of the patients were determined daily,and fixed a day for sequential organ failure assessment(SOFA).Then observed the prognosis be cured,stable out of ICU or death.Patients were divided into death and survival groups according to the prognosis and analyzed retrospectively.RESULTS There were four response modes of CRP ratio after antibacterial treatment:fast response,slow response,nonresponse and biphasic response.All patients with fast response and most patients with slow response survived,whereas all patients with nonresponse and biphasic response were died(P