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Since 2010, the incidence of severe fever with thrombocytopenia syndrome (SFTS) has been increased. Owing the progress in diagnosis and treatment, the overall mortality of SFTS in China has decreased, while the mortality in critical SFTS patients is still high. In order to provide guidance and working procedures for clinicians to diagnose and treat critical SFTS, the National Medical Center for Major Public Health Events invited experts to discuss and formulate this consensus based on their experience and up-to-date knowledge on SFTS.
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Objective:To evaluate the accuracy of lung recruitment maneuver (LRM) combined with brachial artery peak velocity variation (ΔVp) in predicting fluid responsiveness.Methods:Sixty-four patients of both sexes, aged 18-64 yr, with body mass index 19-26 kg/m 2, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with New York Heart Association class Ⅰor Ⅱ, scheduled for elective open gastrointestinal surgery under general anesthesia, were enrolled in this study.LRM (positive airway pressure was maintained at 30 cmH 2O for 10 s) and volume loading test were performed in sequence after anesthesia induction.ΔVp was measured by ultrasonography at the beginning of LRM.Mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP) and stroke volume (SV) were recorded before LRM (T 1), during LRM (T 2), before volume expansion (T 3) and after volume expansion (T 4). The changing rate of each index before and after LRM (ΔMAP LRM, ΔHR LRM, ΔCVP LRM, ΔSV LRM) and before and after volume expansion (ΔMAP VE, ΔHR VE, ΔCVP VE, ΔSV VE) were calculated.ΔSV VE≥15% was considered to be a positive response after volume expansion, and patients were divided into response group (≥ 15%, R group) and non-response group (< 15%, NR group). Results:There were 34 cases in R group and 30 cases in NR group.Compared with NR group, MAP at T 2 and SV at T 1, 2 were significantly decreased, ΔMAP LRM, ΔMAP VE, ΔSV LRM and ΔSV VE were increased, and ΔVp was increased in group R ( P<0.05). There was a positive correlation between ΔVp and ΔSV VE ( r=0.829, P<0.05), a negative correlation between ΔSV LRM and ΔSV VE ( r=-0.876, P<0.05), and a negative correlation between ΔVp and ΔSV LRM ( r=-0.819, P<0.05). The area under the receiver operating characteristic curve of LRM combined with ΔVp was 0.808, and the cut-off value was 32.3%, the sensitivity 75.3%, and the specificity 88.2%. Conclusion:LRM combined with ΔVp (≥32.3%) can accurately predict the intraoperative fluid responsiveness in patients.
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Objective·To eliminate the effects of intraperitoneal injection of transmembrane activator and calcium modulator and cyclophilin ligand interactor-Ig (TACI-Ig) on the opitc neuritis and the integrity of myelin sheath in mice.Methods·Twenty-four C57BL/6J mice were randomly divided into 4 groups,which were blank control group,saline control group,low-dose (0.4 mg/kg) TACI-Ig group and high-dose (4 mg/kg) TACI-Ig group,with 6 mice in each group.All groups were received intraperitoneal injection every other day.The saline control group received 0.2 mL saline injection in the same way,and the blank control group was not given any intervention.After 20 d of treatment,the eyeballs and optic nerve tissues were collected from each mouse under anaesthesia,embedded in paraffin and stained with hematoxylin-eosin (H-E) and Luxol fast blue (LFB),respectively.Results·H-E staining indicated that optic nerve fibers arranged closely both in blank and saline control groups and the staining of tissues was uniform.The optic nerve structure of low-dose TACI-Ig group was similar to blank and saline control groups,while in high-dose of TACI-Ig group,the infiltration of inflammatory cells was observed.The inflammatory cell infiltration scores were not significantly different in all groups (P=0.610 3).The retinal structures of all groups were clear and distinct to observe,and single ganglion cells arranged tightly with complete cell shape,visible nucleus and uniform distribution.There was no difference in the retina structure among 4 groups.LFB staining indicated that there was no significant loss of the optic nerve myelin in 4 groups by microscope observation (P=0.473 6).Conclusion·Low-dose (0.4 mg/kg) TACI-Ig injection wouldn't damage the normal structure of optic nerves and retinal ganglion cells,meanwhile high-dose (4 mg/kg) of TACI-Ig injection might cause minor infiltration of inflammatory cells into retina.
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Objective To observe the contrast sensitivity (CS) of patients with branch retinal vein occlusion (BRVO) without involving the macular region.Methods 92 BRVO patients (93 eyes) and 56 cases (112 eyes) without eye diseases (control group) were included in the study.According to different region,BRVO patients were divided into the nasal BRVO group (31 eyes) and temporal BRVO (62 eyes) group,and the average corrected visual acuity was 1.02 ± 0.13 and 0.98 ± 0.12 respectively.According to the type of ischemia,BRVO patients were divided into the nonischemic BRVO group (58 eyes) and ischemic BRVO group (35 eyes),the average corrected visual acuity was 1.01 ± 0.14 and 0.99 ± 0.12 respectively.The average corrected visual acuity of the control group was 1.03 ± 0.11.There was no statistically significant difference of the average corrected visual acuity between nasal BRVO group,temporal BRVO group and control group (F=3.03,P =0.06),and between nonischemic BRVO group,ischemic BRVO group and control group (F=1.60,P=0.20).Contrast sensitivity (CS) was measured by OPTEC 6500 vision tester (Stereo Company,USA) under the standard lighting conditions and different spatial frequencies including low (1.5 and 3.0 c/d),medium (6.0 c/d) and high frequencies (12.0 and 18.0 c/d).Results The CS under each spatial frequency of the nasal BRVO group was the same as the control group (t=4.25,9.48,3.08,5.86,0.94;P＞0.05),but the CS under each spatial frequency of the temporal BRVO group was different from the control group (t=8.59,19.11,10.38,17.28,6.01;P＜0.05).The CS under high spatial frequency of the temporal and nasal BRVO group was statistically different (t=11.42,6.95;P＜0.05).The CS under each spatial frequency of the ischemic BRVO group was different from the control group (t=8.88,10.56,11.64,19.06,6.67;P＜0.05).The CS under 6,12 and 18 c/d spatial frequency of the nonischemic BRVO group was statistically different with the control group (t =10.14,11.54,2.82;P＜0.05).The CS under 12 and 18 c/d spatial frequency of the nonischemic BRVO group was statistically different with the ischemic BRVO (t=7.52,3.84;P＜0.05).Conclusions The CS of the temporal BRVO and ischemic BRVO decreased more significantly under each spatial frequency.CS is a better indicator to evaluate the visual function than the visual acuity in BRVO without involving the macular region.
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Objective To study the effects of Trichinella spiralis (T.spiralis) infection on mice with oxazolone (OXZ)-induced colitis and the possible immunologic mechanism.Methods Female BALB/c mice at age 6-8 weeks were randomly divided into four groups (A to D).Each mouse in groups B and D was infected with T.spiralis strains.Twenty-one days after T.spiralis infection,the mice in groups A and B were treated with 50％ ethanol solution,while those in groups C and D were treated with OXZ to induce the murine model of colitis.Several parameters including survival rate,disease activity index (DAI),macroscopic damage and histological score,myeloperoxidase (MPO) activity and the expression of cytokines (IFN-γ,IL-4 and IL-10) in colonic and splenic tissues at mRNA and protein levels were measured 3 and 7 days after modeling.Results No significant differences in the survival rate,DAI score,macroscopic damage score,histological score,MPO activity were observed between mice from groups C and D (P＞0.05).Pre-exposing the mice to T.spiralis strains neither alleviated the mucosal damages nor aggravated the condition of colitis.Compared with group C,the expression of IFN-γ on the third day and the expression of IFN-γ,IL-4 and IL-10 on the seventh day at mRNA and protein levels in colon and spleen tissues were significantly increased in mice treated with T.spiralis and OXZ (P＜0.05).The expression of IL-10 at transcriptional level in spleen tissues on the third day was higher than that of group C (P＜0.05).The expression of IL-4 and IL-10 at protein level in colon tissues on the third day were significantly up-regulated as compared with those of group C (P＜0.05).Conclusion The severity of OXZ-induced colitis in the murine model was neither alleviated nor aggravated by pre-exposing the mice to T.spiralis strains.High doses of IL-10 not only weakened the regulatory effects on Th2 responses,but also induced the production of proinflammatory cytokines,resulting in a new drift of Th1/Th2 without aggravating Th2 responses.Further investigation on the mechanism of T.spiralis-induced over-expression of IL-10 should be conducted,which might increase the practicability of using T.spiralis strains against OXZ-induced colitis.
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Objective:To observe influence of statins on antiplatelet activity of clopidogrel and provide basis for ra‐tionality of statins combined clopidogrel treatment .Methods :According to random number table ,a total of 90 pa‐tients diagnosed as acute coronary syndrome were equally divided into clopidogrel group ,clopidogrel + simvastatin group and clopidogrel + pravastatin group . Three groups received corresponding routine medication treatment . Plasma levels of platelet αgranule membrane protein (CD62P) ,lysosomal granule membrane glycoprotein (CD63) and maximum platelet aggregation rate (MPAR) were measured and compared among three groups before and 3d af‐ter treatment .Results:Compared with before treatment ,after treatment ,there were significant reductions in plas‐ma levels of CD62P and CD63 and MPAR in three groups , P0.05 all .Conclusion:Short‐term and routine dose of statins combined clo‐pidogrel is feasible in treatment of acute coronary syndrome .The combined use of them will not affect antiplatelet function of clopidogrel .
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@#Objective To investigate the relationship between RELN gene single nucleotide polymorphism (SNP) and childhood autism in Jiamusi, Heilongjiang. Methods Polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP) was used to determine allele and genotype of SNP (exon 6) of RELN in 30 children with autism and 30 normal children. Autism Behavior Checklist (ABC) was used to evaluate the children. Results There was a significant difference in the distribution of the allelic frequencies and genotype in exon 6 between these groups (P<0.05). There was a significant difference in the communication factors between patients with genotype of A/A and A/G or A/A and G/G (P<0.05), as well as in the total scores of ABC between A/G and G/G (P<0.05). Conclusion The SNP of RELN (exon 6) associated with the childhood autism. There is a more serious communication disorder in children with genotype of G/G, A/G than that of A/A.
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Objective To compare the planning systems of the simplified manual intensity modulated (SMIM) irradiation and standard tangential (ST) irradiation,in order to explore the application of SMIM technique in clinic.Methods In 64 cases of breast cancers after breast conserving surgery,each underwent both SMIM and ST planning systems.SMIM planning was designed by copying additional fields for shielding the high dose areas from internal or lateral tangential field.The high dose areas were reduced by adjusting the size of the additional field and open tangential field.To optimize the SMIM planning,3 high dose areas (＞ 103% ,＞ 105% and ＞ 107%) were shielded and 3 protocols carried out.The wedges were also optimized in ST plan.The target coverage and dose homogeneity and dose of organ at risk were compared between SMIM and ST planning systems.Results When the dose was normalized to cover the volume of 95% CTV,85% of the shielded areas in optimal SMIM planning were that of ＞ 103% high dose area,and 94% of target area was covered.The study on the volume of breast CTV showed that,in the large breast group,SMIM could not only significantly reduce the high dose areas,and the maximum dose as well as the dose of organ at risk,but also enhance the dose homogeneity index.However,no such effect was not significant in the small breast group.Conclusions The simplified manual intensity modulated technique can improve target dose homogeneity in the large breast cases instead of the standard tangential technique.
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Objective To evaluate the prognosis and side-effects of three-dimensional conformal radiotherapy (3 DCRT) and intensity modulated radiotherapy (IMRT) for prostate carcinoma. Methods From 2001 to 2009, 62 patients with prostate carcinoma treated with radiotherapy were included in the retrospective analysis. Among them, 60 patients received IMRT while the other two received 3DCRT. There were 56 patients receiving androgen deprivation therapy before radiotherapy. The median dose was 78 Gy to 95% planning target volume (PTV) of the prostate and seminal vesicles, and the median dose to 95% PTV of the pelvic lymph nodes was 48 Gy. Results The median follow-up was 15.4 months. The 3-and 5-year overall survival (OS) rates were 92% and 83%, with the corresponding biochemical disease-free survival rates of 87% and 69%, and the distant metastasis-free survival (DMFS) rate of 77% and 55%, respectively. Patients with a PSA nadir ≤ 2 ng/ml had a 3-year OS of 94% and DMFS of 88%, compared with 56% and 11% (χ~2 = 16. 39, P < 0.01 for OS ; χ~2 = 28. 87, P < 0. 01 for DMFS) for those with a PSA nadir > 2 ng/ml. The incidence of grade 1 and 2 urinary toxicity was 32% and 0% for acute damage, 10% and 0% for late damage, respectively. The incidence of grade 1 and 2 intestinal toxicity was 19% and 3%. for acute damage, 5% and 3% for late damage, respectively. Conclusions Radiation therapy for patients with prostate carcinoma shows satisfactory outcomes with a good toleration. Monitor of PSA after radiotherapy has benefit for prognosis evaluation.
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Objective To analyze the prognostic factors of patients with leukemia treated with single fraction total body irradiation (SFTBI) followed by hernatopoietic stem cell transplantation (HSCT).Methods From January 2001 to September 2008, 102 patients received HSCT. The differences of the survival rate, relapse rate and incidence of interstitial pneumonia (IP) between groups regarding different genders, ages, pathological types, transplantation methods and TBI parameters were compared and the factors related with the survival rate, relapse rate and incidence of IP were analyzed. Results The followup time ranged from 15 to 1482 days (median, 406 days). The follow-up rate was 95.1%. 86 and 55patients were followed up more than one year and three years. The 1-and 3-year survival rates were 59.0%and 44.0%. In univariate analysis, the 3-year survival rate was signifcantly different between the groups with and without relapse before transplantation (20% vs. 55%, χ2 = 6.33, P = 0. 012), allogeneictranplantation versus autologous tranplantation (39% vs. 68%, χ2 = 8.06, P = 0.005), grade 3 or more acute graft versus host disease (aGVHD) and grade 0 -2 aGVHD (0% vs. 54%, χ2 = 7.52, P = 0.006),with and without relapse after transplantation (19% vs. 58%, χ2 = 10.13, P =0.001), with and without IP (23% vs. 58%, χ2 =8.35, P=0.004). Multivariate analysis showed that grade 3 or more aGVHD was the only statistically significant prognostic factors (χ2 = 12. 74 ,P =0. 000). The l-and 3-year relapse rateswere 30. 0% and 50. 0%. The incidence of relapse was obviously higher in the group with relapse before transplantation than that without (47% vs. 16%, χ2 =7. 32, P=0. 007). Multivariate analysis showed thatrelapse before transplantation was a significant factor predicting relapse after transplantation (χ2 = 9. 39,P =0. 020). The cumulative incidence of IP was 35.0%. The incidence of IP was different between groups with dose homogeneity > 3% and ≤ 3% (27% vs. 4%, χ2 = 5. 21, P = 0. 023), with and without acute parotitis (34% vs. 3%, χ2 = 14. 15, P= 0.000), allogeneic transplantation group and autologous transplantation group (31% vs. 8%, χ2= 7.70, P= 0.006). Multivariate analysis showed that transplantation methods, acute parotitis and dose homogeneity were statistically significant factors in predictingIP (χ2 = 10. 08 , 10. 08 and 7.69 , P = 0. 002 , 0. 002 and 0. 010 , respectively) . Conclusions Patients who develop grade 3 or higher aGVHD have poor prognosis. Dose homogeneity influences the incidence of IP. Patients undergoing allogeneic transplantation are apt to have IP. Acute parotitis is related with IP and might be a predictor.
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Objective To study the levels of Th1 and Th2 type cytokines in 3-nitrobenzene sulfonate(TNBS) and oxazolone(OXZ) colitis without or with Trichinella spiralis( T. spiralis) infection. Methods Female BALB/c mice were randomly divided into 4 groups: 50% Ethanol, T. spiralis only, TNBS or OXZ,T. spiralis +TNBS or OXZ(at least 6 in each group when mice were killed). The levels of IFN-γ, IL-12,IL-4, IL-10 in colon in mice with colitis induced by TNBS or OXZ without or with T. spiralis infection 3 d and 7 d post-induction were assessed using ELISA method. Results Colonic protein levels of IFN-γand IL-12 were significantly increased 3 d and 7 d after intra-colonic injection of TNBS( P ＜0.05 ). Concurrent infection with T. spiralis prevented this rise in IFN-γand IL-12 secretion and tended to induce a rise in colonic IL-4 and IL-10 content(P ＜0. 05). The levels of IFN-γ, IL-4 and IL-10 protein in colitic mice colon with prior nematode infection on days 3 and 7 post-induction of colitis were significantly higher than that seen in colitic mice without prior nematode infection ( P ＜ 0.05 ). Conclusion T. spiralis infection significantly attenuates TNBS-induced colitis in mice. The local immunologic mechanism is that T. spiralis can down-regulate strongly Th1-type immune response of colitis and up-regulate Th2 response, Tr1-cytokines. According to the change of Th1/Th2 cytokines, prior T. spiralis infection doesn't reduce the severity of OXZ-induced colitis, but without aggravating colitis. The exactly immunologic mechanism deserve to be explored deeply.
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In order to screen antigenic genes of Clonorchis sinensis (C.sinensis).Firstly,a cDNA expression library from adult worms of C.sinensis was successfully constructed with lambda ZAP express vector.Total RNA of C.sinensis adult worms were extracted by the Trizol reagent and mRNA were further purified through oligo-dT cellulose.The first strand eDNA was synthesized by using MMLV reverse transcriptase.After the synthesis of the second strand,the cDNA were purified by CHROMA SPIN-400 kit and then ligated with lambda ZAP express vector,then packaged in vitro and amplified.The original library contained 1.5 × 106 pfu cDNA clones,the titer of amplified library reached 1.5 × 1010 pfu/mL,in which about 99% clones were recombinants and most of insert DNA fragments were 0.4-2.0 kb.Secondly,immunoscreened using the naturely infected man serum from C.sinensis.The positive clones were sequenced and analyzed.From 2.0 × 105 recombinant clones of the eDNA library,41 positive clones were obtained.Sequence analysis indicated that the cDNAs encoded proteins including glycine rich antigen 2,proline rich antigen 2 and antigen Cs44 from C.sinensis,anothers were lower similarity to predicted protein from Nematostella vectensis,transcription elongation factor GreA from Bartonella quintana str.Toulouse and NM_132090 CG3446 gene product in Drosophila melanogaster from Schistosoma japonicum.These data may form a foundation for identifying recombinant antigens that can be used in the diagnosis or vaccination against clonorchiasis.
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Objective To evaluate the radiation method and resuh of 450 patients received TBI(total body irradiation).Methods Single-dose Measurement was used to mark dose of TLD(thermo luminescence dosimeter).The values of actual dose in body midline were evaluated by calculating and correcting mean dose of incidence and emergence.Radiation methods:In four-field Irradiation.diagonals of fields coinside with the longitudinal axis of the patients,patient in supine and lateral positions received two pairs of parallel opposite radiation.Scheme of TBI came from a preparative radiation about one week before,and this four-field and equal-in-dose(about 10%of TBI)preparative radiation offered US the optimal scheme with aminimal dose non-uniformity by adjusting different dose proportion of supine and lateral position.In small field irradiation,patients received one pair of parallel opposite radiation from lateral side sitting on a special stool with backrest,the stool can be rotated CW or CCW,pedals can be move forward or backward and fixed.In opposite lateral irradiation,similar to four-field irradiation,patients received one pair of horizontal opposite radiation only in supine position.Five of these patients received FTBI(Fractional TBI). Results The average non-uniformity in midline of patients in four-field irradiation group(87 patients).small field irradiation group(91patients)and opposite lateral irradiation group(272 patients)is respectively ±8.1%,±7.4% and ±4.9%. Conclusions It iS a important process for QA and Qc to measure the dose of incidence and emergence real-timely with TLD or semiconductor dosimeter.We can adopt small field irradiation when the field iS not large enough to contain the patient from head to foot,and it showed advantages over four-field irradiation in treatment process and outcomes.We found the uniformity in body midline would be much better in supine position with diagonal＞180 cm than that in four-field irradiation and small field irradiation with diagonal＜110 cm.We compared supine position irradiation with opposite lateral irradiation,only to find which has its strong point.And actually we considered that FTBI treatment booth can be used more often in anterior and posterior parallel fields irradiation,patient semi-sitted,repeatedly received forward and backward radiation. In spit of not possessing radio-biological advantages as FTBI,STBI(Single TBI)is still a practical form of TBI.
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0.05).(2)The plasma GMP-140 levels of both groups was remarkably increased immediately and a decreased trend 24 h after PCI,but did not return to normal(P
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5 ml groups were 95.5% and 81.1% respectively. This difference was statistically significant (P5 ml groups were 4.5 % and 32.1%, respectively (P50 Gy was increased statistically, but the occurrence of complications was also increased. Conclusions Stereotactic radiosurgery improves the outcome of the elderly patients with brain metastases. Radiation dosage and tumor volume are significantly related with the therapeutic efficacy and the occurrence of complications.
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The treatment of systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) is difficult in ICU. In addition to traditional methods, immunologic therapy has been used recently to treat SIRS and MODS through adjusting inflammatory responses and redressing abnormal responses. This article reviews the progress in treatment of SIRS and MODS,including blocking inflammatory activation, modifying the activation of inflammation, giving gene therapy and combination therapy of TCM and western medicine.
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Objective:To investigate the effect of the intact parathyroid hormone (iPTH) on residual renal function (RRF). Methods: The relationship between iPTH and calcium, phosphorum, product Ca?P, hypertension, triglycende, cholesterol,left ventricular mass index(LVMI) and RRF in 120 hemodialysis patients with chronic renal failure. Results: The results showed that 95. 9% of the hemodialysis patients with chronic renal failure had secondary parathyroldism. It was found that iPTH was positively correlated with SBP,DBP, product Ca?P, triglycende and LVMI, and negatively correlated with endogenous creatinine clearance rate and KT/V. RRF had positive correlation with KT/V and SBP,DBP, calcium, product Ca?P, triglyceride, cholesterol and LVMI. Conclusion: iPTH level is elevated in hemodialysis patients, which may lead to RRF loss.
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Objective To explore the curative effect of extracorporeal lipoprotein filter from plasma Delipid Plus(DELP) system therapy on acute cerebral infarction(ACI). Methods 36 patients with ACI were divided into DELP group (12 cases) and control group (24 cases). All of them received basic treatment including Aspirin and Pravastatin sodium etc. The DELP group also treated by DELP therapy twice. The scores of National Institute of Health Stroke Scale (NIHSS),Barthel Index (BI) and Modified Rankin Scale (mRS),and the levels of plasma fibrinogen (Fib),blood lipid and the indexes of hemorheology were compared pre and post treatment in the two groups.Results The reduction value of NIHSS between pre and post treatment in DELP group was bigger than this in control group(P
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Fouty-four patients with craniopharyngioma were admitted trom Junuary 1982 to February 1993 for post-operative radiotherapy. The 5-year survival was 78.9%. Among these 44 patients, 15 were adults and 29 were children. The children gave a higher 5-year survival rate but poorer quality of life as compared with the adults though without statistical significance in the survivals. Among the children, a dose of 56.1～60.0Gy gave better survival as compared with the 45～56Gy group without significance though causing obviously sequelae, eg: amenorrhea and hampered sex development (P
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Purpose: To evaluate the influence of lung corrections on the target volume dose in radiation treatment of esophageal carcinoma by TPS HEVAPLAN. Materials and Methods: Three radiation field technique to middle esophagus were used as the model of this investigation .target volume doses were calculated with photons in different energies to compare with the divergence when the lung density were set to 1.0(without lung correction) 0.33 and 0.2 (with lung correction).Results: If no lung correction was performed, the actual radiation dose in target volume were 24%～28%, 18%～21%, 13%～15% and 7%～9% which were radiated with 60 Co, X-ray of 5MV, 8MV and 19MV. Conclusion: The lung density must be corrected in treating 60 Co unit.