Role of cholinergic anti-inflammatory pathway in Ghrelin regulation of peptide transporter 1 expression in small intestinal epithelium of septic rats / 中华危重病急救医学

Objective:To investigate the role of cholinergic anti-inflammatory pathway in the regulation of peptide transporter 1 (PepT1) expression in small intestinal epithelium of septic rats by Ghrelin.Methods:One hundred adult male Sprague-Dawley (SD) rats were randomly divided into sham operation group, sepsis group, sepsis+vagotomy group, sepsis+Ghrelin group, and sepsis+vagotomy+Ghrelin group, with 20 rats in each group. In the sham operation group, the cecum was separated after laparotomy, without ligation and perforation. In the sepsis group, the rats received cecal ligation puncture (CLP). In the sepsis+vagotomy group, the rats received CLP and vagotomy after laparotomy. In the sepsis+Ghrelin group, 100 μmol/L Ghrelin was intravenously injected after CLP immediately. The rats in the sepsis+vagotomy+Ghrelin group received CLP and vagotomy at the same time, then the Ghrelin was intravenously injected immediately with the same dose as the sepsis+Ghrelin group. Ten rats in each group were taken to observe their survival within 7 days. The remaining 10 rats were sacrificed 20 hours after the operation to obtain venous blood and small intestinal tissue. The condition of the abdominal intestine was observed. The injury of intestinal epithelial cells was observed with transmission electron microscopy. The contents of tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) in serum and small intestinal tissue were detected by enzyme-linked immunosorbent assay (ELISA). The brush border membrane vesicle (BBMV) was prepared, the levels of mRNA and protein expression of PepT1 in the small intestinal epithelium were detected by real-time fluorescence quantitative polymerase chain reaction (RT-qPCR) and Western blotting.Results:All rats in the sham operation group survived at 7 days after operation. The 7-day cumulative survival rate of rats in the sepsis group was significantly lower than that in the sham operation group (20% vs. 100%, P < 0.05). The cumulative survival rate of rats after Ghrelin intervention was improved (compared with sepsis group: 40% vs. 20%, P < 0.05), but the protective effect of Ghrelin was weakened after vagotomy (compared with sepsis+Ghrelin group: 10% vs. 40%, P < 0.05). Compared with the sham operation group, in the sepsis group, the small intestine and cecum were dull red, the intestinal tubules were swollen and filled with gas, the intestinal epithelial cells were seriously injured under transmission electron microscopy, the levels of TNF-α and IL-1β in serum and small intestinal were significantly increased, and the expression levels of PepT1 mRNA and protein in the small intestinal epithelium were significantly decreased. It indicated that the sepsis rat model was successfully prepared. After vagotomy, the intestinal swelling and gas accumulation became worse in septic rats, leading to the death of all rats. Compared with the sepsis group, the abdominal situation in the sepsis+Ghrelin group was improved, the injury of intestinal epithelial cells was alleviated, the serum and small intestinal TNF-α and IL-1β were significantly decreased [serum TNF-α (ng/L): 253.27±23.32 vs. 287.90±19.48, small intestinal TNF-α (ng/L): 95.27±11.47 vs. 153.89±18.15, serum IL-1β (ng/L): 39.16±4.47 vs. 54.26±7.27, small intestinal IL-1β (ng/L): 28.47±4.13 vs. 42.26±2.59, all P < 0.05], and the expressions of PepT1 mRNA and protein in the small intestinal epithelium were significantly increased [PepT1 mRNA (2 -ΔΔCt): 0.66±0.05 vs. 0.53±0.06, PepT1 protein (PepT1/GAPDH): 0.80±0.04 vs. 0.60±0.05, both P < 0.05]. Compared with the sepsis+Ghrelin group, after vagotomy in the sepsis+vagotomy+Ghrelin group, the effect of Ghrelin on reducing the release of inflammatory factors in sepsis rats was significantly reduced [serum TNF-α (ng/L): 276.58±19.88 vs. 253.27±23.32, small intestinal TNF-α (ng/L): 144.28±12.99 vs. 95.27±11.47, serum IL-1β (ng/L): 48.15±3.21 vs. 39.16±4.47, small intestinal IL-1β (ng/L): 38.75±4.49 vs. 28.47±4.13, all P < 0.05], the up-regulated effect on the expression of PepT1 in small intestinal epithelium was lost [PepT1 mRNA (2 -ΔΔCt): 0.58±0.03 vs. 0.66±0.05, PepT1 protein (PepT1/GAPDH): 0.70±0.02 vs. 0.80±0.04, both P < 0.05], and the injury of small intestinal epithelial cells was worse. Conclusion:Ghrelin plays a protective role in sepsis by promoting cholinergic neurons to inhibit the release of inflammatory factors, thereby promoting the transcription and translation of PepT1.

Clinical study of Guben-Tiaoping Decoction in improving the success rate of inhaled corticosteroid stepwise treatment in asthma / 国际中医中药杂志

Objective:To evaluate the effect of combined use of Guben-Tiaoping Decoction on the success rate of stepwise treatment and life quality of asthma patients. Methods:A total of 76 patients with asthma in remission stage who were using ICS were divided into treatment group (38 cases) and control group(38 cases) according to random number table. Both groups were treated with ICS reduction based on the 2017 Gina Protocol. The treatment group was treated with Guben-Tiaoping Decoction for 12 weeks. The number of patients who were able to successfully complete the stepwise treatment after the end of the trial was calculated, the relevant indexes of Asthma Control Test (ACT), TCM Syndrome score, St. George’s respiratory questionnaire (SGRQ) and lung function were collected before and after treatment. Result:After 12 weeks’ treatment, the success rate of stepwise was 89.5% (34/38) in the treatment group and 78.9% (30/38) in the control group ( χ2=14.862, P=0.001). Meanwhile, the ACT score of the treatment group were better than those in the control group (Daytime symptoms t=-3.860, P=0.001, Dyspnea t=-2.007, P=0.40, Night waking t=-2.732, P=0.009, Reliever needed for symptoms t=-2.262, P=0.031, Control situation t=-6.994, P=0.001, Total Score t=-9.562, P=0.001). The score of TCM Syndrome in the treatment group was significantly lower than that of the control group ( P=0.001); PEF in treatment group [(6.92 ± 1.71) L vs. (5.84 ± 1.22) L; t=-2.880, P=0.005] was significantly better than that of the control group. Conclusion:Guben-Tiaoping Decoction is helpful to improve the success rate of ICS stepwise treatment and the life quality of patients.

Effect of early enteral feeding on clinical outcome in critically ill patients with hemodynamic instability / 中华急诊医学杂志

objective:To investigate the tolerability of early enteral nutrition (EN), and to further explore the association of early EN with clinical outcome in critically ill patients with hemodynamic instability.Methods:The adult patients from Zhejiang Provincial People’s Hospital with an expected admission to ICU for at least 24 h were consecutively recruited from May 2014 to May 2016, and all clinical, laboratory, and survival data were prospectively collected. The AGI grade was daily assessed on the first week of ICU admission. Enteral nutrition (EN) started after 6 h of hemodynamic stability (MAP ≥ 65 mmHg) when the patients took vasoactive medication. The patients were divided into three groups based on the timing of EN initiation: early EN group (EN initiation within 48 h of ICU admission), late EN group (EN initiation at more than 48 h of ICU admission), and no initiation of enteral feeding within 7 days of ICU admission.Results:Of 201 patients enrolled, the mean age was 65.3 ± 16.4 years, APACHE II score was 22.4 ± 6.85, and 191 patients (95.0%) took mechanical ventilation. There were no differences in high gastric residual volume, diarrhea, and gastrointestinal (GI) bleeding between the early EN group and late EN group ( P>0.05). Whereas, patients in the no initiation of EN within 7 days of ICU admission had a lower prevalence of gastric residual volume (16.7% vs. 33.3%, P=0.05), but higher prevalence of GI bleeding (47.2% vs. 26.1%, P=0.02). Compared with those in the late EN group and in no initiation of EN within 7 days of ICU admission, patients in the early EN group had lower 28- (30.4% vs. 47.9% vs. 55.6%, P=0.01) and 60-day mortality rates (38.0% vs. 53.4% vs. 63.9%, P=0.017). Multivariate Cox regression analysis showed that the timing of EN initiation on the admission to ICU (early EN vs. late EN, χ 2≥5.83, P<0.05; early EN vs. no initiation of EN, χ 2≥7.90, P<0.01), serum creatinine ( χ 2=5.06, P<0.05), plasma albumin ( χ 2≥6.41, P<0.01), AGI grade ( χ 2≥8.15, P<0.01), and APACHE II score ( χ 2≥9.62, P<0.01) were independent predictors for 28- and 60-day mortality. Conclusions:Early EN on admission to ICU could be tolerated, and is significantly associated with lower risk of 28- and 60-day mortality in critically ill patients with vasoactive medication to maintain hemodynamic stability.

Related risk factors for the prognosis of hospital-acquired carbapenem-resistant Klebsiella pneumoniae bloodstream infections in elderly patients with critical illness / 中华老年医学杂志

Objective:To investigate the related risk factors for the prognosis of hospital-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections in elderly patients with critical illness.Methods:Clinical data of elderly patients with nosocomial CRKP bloodstream infection in intensive care unit (ICU) from Jan. 2010 to Dec. 2016 were retrospectively analyzed. Patients were divided into the death and survival groups according to the prognosis. Clinical characteristics were compared between the two groups. Influencing factors for the prognosis of nosocomial CRKP bloodstream infections in elderly ICU patients were screened by multivariate Logistic regression analysis.Results:A total of 119 elderly ICU patients with nosocomial CRKP bloodstream infection were enrolled. The overall ICU mortality rate was 62.2% (74/119 patients), among which the ICU mortality was lower in patients treated with tigecycline than without tigecycline treatment (50.0% or 25/50 vs. 71.0% or 49/69, χ2=4.770, P=0.029). And the ICU mortality was lower in patients with combination therapy than with mono-therapy (54.9% or 39/71 vs. 72.9% or 35/48, χ2=3.940, P=0.047). Multivariate Logistic regression analysis revealed that the administration of vasoactive drugs ( OR=25.545, 95% CI: 9.743-52.242, P=0.001), and the resistance to tigecycline ( OR=8.990, 95% CI: 0.957-24.488, P=0.049) were independent risk factors for ICU mortality. While the early initiated appropriate antibiotics treatment, which was defined as using at least one susceptible antibiotic within 48 hours ( OR=0.081, 95% CI: 0.014-0.463, P=0.005), and appropriate antibiotics and adequate duration ( OR=0.785, 95% CI: 0.631-0.977, P=0.030), were protective factors for the good outcome. Conclusions:Nosocomial CRKP bloodstream infection in elderly ICU patients leads a high ICU mortality rate. The early initiated appropriate antibiotics treatment and optimum antibiotics duration could reduce the risk for death.

Primary Amebic Meningoencephalitis: A Case Report

Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.

A meta-analysis of Yupingfeng powder in conjunction of western medicine on cough variant asthma / 国际中医中药杂志

Objective@#To evaluate the efficacy and safety of Yupingfeng powder in conjunction treatment of western medicine on cough variant asthma (CVA).@*Methods@#We searched CNKI, Wanfang database, VIP database and PubMed through computer from the database building to October 31st 2017. The randomized controlled trails (RCT) with the comparison in the treatment of CVA with Yupingfeng powder and western medicinal were identified and included. The quality of RCTs was assessed by Jadad scores, and meta-analyses were performed by Review Manager 5.3 software.@*Results@#Totally 15 RCTs involving 1 318 patients were included into the study, which all belonged to the low methodological quality. The meta-analysis results showed that compared with the western medicine alone, the treatment in conjunction of Yupingfeng powder can significantly improve the clinical effective rate [OR=3.45, 95% CI (2.38-5.02), P<0.01], reduce the recurrence rate [OR=0.25, 95% CI (0.16-0.38), P<0.01]. There were no statistical significant differences with untoward effect between above two treatment groups [OR=0.70, 95% CI (0.34-1.46), P=0.35].@*Conclusions@#The Yupingfeng powder combined with the routine therapy may improve the clinical effective rate, and reduce the recurrence rate for CVA patients. However, we need more high-quality RCTs to comfirm such results.

Real-time virtual navigation system combined with CEUS guided radiofrequency ablation therapy of neonatal or recurrent hepatocellular carcinoma lesions / 中国医学影像技术

Objective To investigate the value of real-time virtual navigation system (RVS) combined with CEUS in guiding radiofrequency ablation (RFA) therapy of neonatal or recurrent lesions of hepatocellular carcinoma (HCC).Methods Totally 111 patients with neonatal or recurrent lesions of HCC after RFA therapy were enrolled.Seventy-eight patients with 86 lesions (77 neonatal lesions and 9 recurrent lesions) underwent RFA guided by RVS combined with CEUS (RVS combined with CEUS group),and 33 patients with 38 lesions (26 neonatal lesions and 12 recurrent lesions) underwent RFA guided by CEUS alone (control group).The precise localization,inactivation rate and local recurrence rate between the two groups were compared.Results Eighty-four lesions (84/86,97.67％) in RVS combined with CEUS group and 25 lesions (25/38,65.79％) in control group were clearly showed and localized (P＜0.001).One month after RFA therapy,the tumor inactivation rate in RVS combined with CEUS group and control group was 95.35 ％ (82/86) and 76.31％ (29/38),respectively (P=0.003).The local recurrence rate in RVS combined with CEUS group was 8.14％ (7/86),while was 36.84％ (14/38) in control group (x2 =15.434,P＜0.001).Conclusion RVS combined with CEUS guidance can improve the accurate position rate and early inactivation rate of RFA therapy for neonatal or recurrent lesions of HCC.

Observation of several physiological indexes of rhesus monkeys by implantable telemetry technology / 中国比较医学杂志

Objective To observe the changes of circadian characteristics and stress-response-related physiological parameters including respiration, blood pressure, electrocardiography and body temperature of conscious rhesus monkeys by implantable telemetry technique. Methods Surgery was performed on 8 rhesus monkeys (half male and half female, 3-5 years old) for implantation of a telemetry transmitter. After 3 weeks of recovery, the physiological parameters of respiration, blood pressure, electrocardiography and body temperature of the conscious rhesus monkeys without binding were automatically recorded by a DSI telemetry system and the data were analyzed by the Ponemah software. Results Some electrocardiographic indexes showed significant differences at daytime and nighttime (P＜ 0. 05 or P＜ 0. 01) including mean heart rate (HR) ( 155. 0-122. 4 times/min), respiratory rate interval (RR-I) (410. 8-535. 7 ms), T-wave amplitude (T-A) (0. 181-0. 157 mV), PR interval (PR-I) (80. 4-87. 4 ms), QT interval (QT-I) (224. 8-263. 9 ms), and corrected QTcb interval (QTcb) (352. 3-366. 7 ms). The indexes of blood pressure and respiration at daytime were significantly higher than those at nighttime (P＜ 0. 01), including the mean systolic pressure (SYS) at daytime and nighttime (144. 6-131. 6 mmHg), diastolic pressure (DIA) (99. 8- 89. 9 mmHg), mean arterial pressure (MAP) (121. 5-110. 2 mmHg), tidal volume (TV) (64. 5-36. 6 mL), minute ventilation (MV) (1931. 9-920. 1 mL/min), and respiratory rate (RR) (32. 3-25. 4 times/min). Cleaning and feeding activities of the laboratory staff at 9: 00 a.m. and 2: 00 p.m. had a certain effect on the stress-responses in the monkeys. Conclusions The parameters of respiration, blood pressure, electrocardiography and body temperature of the conscious rhesus macaques observed by implanted telemetry system show obvious circadian changes, which can truly reflect the changes of physiological indexes at daytime and nighttime, and avoid the stress in hungry monkeys caused by the feeding and cleaning activities of laboratory staff. This technique can improve the efficiency of drug safety pharmacology studies, reduce the number of animals used and meet the requirements of 3R principles.

Incidence and risk factors of liver abscess after radiofrequency ablation for liver cancer / 中国介入影像与治疗学

Objective To investigate the incidence and risk factors of liver abscess after radiofrequency ablation (RFA) for liver cancer.Methods A retrospective study was performed on 1 643 patients from January 2000 to June 2016.All the patients were diagnosed with hepatocellular carcinoma (HCC,n =942),cholangiocellular carcinoma (CCC,n =31) or metastatic liver carcinoma (MLC,n=670).Univariate and multiple Logistic regression analysis were used to evaluate the risk factors of liver abscess.Results The incidence of liver abscess after RFA was 0.79％％ (13/1 643).Univariate analysis indicated that the liver abscess was significantly correlated with the history of diabetic mellitus (DM),Child-Pugh level,history of surgery and tumor location (all P＜0.05).Multivariate analysis showed that the history of DM,history of surgery and tumor location were independent risk factors of liver abscess after RFA for liver cancer.Conclusion History of DM,surgery and tumor location are important factors that result in liver abscess after RFA.

Outcome of percutaneous ultrasound-guided radiofrequency ablation for liver metastases from gastric cancer / 中国介入影像与治疗学

Objective To investigate the efficacy and prognostic factors of percutaneous ultrasound-guided radiofrequency ablation (RFA) for liver metastases from gastric cancer.Methods Clinical and imaging data of 55 patients with liver metastasis from gastric cancer who underwent percutenous ultrasound-guided RFA were retrospectively analyzed,and the overall survival rates and prognostic factors were assessed.Results The overall survival rates of 1-,2-,3-and 5-year was 70.45％,42.90％,20.32％ and 10.16％,respectively.The ablation rate was 94.12％ (96/102) 1 month after RFA,and the local recurrent rate was 15.69％ (16/102),the new metastasis rate was 52.73％ (29/55).Age (P=0.015),tumor number (P=0.011),extrahepatic metastasis before RFA (P=0.026) and chemotherapy after RFA (P=0.031) were significantly prognostic factors.Age (P=0.033),tumor number (P=0.004) as well as chemotherapy after RFA (P=0.001) were independent prognostic factors.The severe complication rate was 1.82％ (1/55),while no treatment-related death occurred.Conclusion Percutaneous ultrasound-guided RFA is a safe and effective therapeutic option for liver metastases from gastric cancer.Age,tumor number,chemotherapy after RFA are independent prognostic factors.

Radiofrequency ablation in treatment of large hepatic carcinoma adjacent to diaphragm / 中国介入影像与治疗学

Objective To investigate the value of percutaneous radiofrequency ablation (RFA) in the treatment of large hepatic carcinoma adjacent to diaphragm.Methods Totally 176 patients with larger hepatic carcinoma adjacent to diaphragm (adjacent diaphragm group) and 157 patients with larger hepatic carcinoma not adjacent to the diaphragm (control group) underwent ultrasound-guided percutaneous RFA treatment,and the data of these patients were retrospectively analyzed.The patients,age,gender,the largest diameter of lesions,ablation information,early necrosis rate,recurrence rate,new tumor rate and survival rate were analyzed and compared between the two groups.Results Cases of injection physiological saline below the diaphragm during RFA were significantly higher in adjacent diaphragm group than that in control group (P=0.016).The recurrence rate of adjacent diaphragm group was significantly higher than that of control group (P=0.028).There was no significant difference of patients,age,gender,the largest diameter of lesion,RFA instrument,RFA needles,early necrosis rate,new tumor rate,nor complications rate between the two groups (all P＞0.05).There was no significant difference of the 1-,2-,3-,4-and 5-year survival rate between the two groups (P=0.203).Conclusion Large hepatic carcinoma adjacent to diaphragm is more likely to recur after ultrasound-guided percutaneous RFA.The method of injection physiological saline below diaphragm and other individualized treatment plan and strategy should be used during RFA treatment.

Strategy radiofrequency ablation for treatment of refractory liver cancer / 中国介入影像与治疗学

The safety and efficacy of radiofrequency ablation (RFA) in the treatment of liver tumors are widely recognized.However,for refractory liver cancer,RFA treatment had more difficulties and risks.Focusing on standardized operation under imaging guidance and individualized treatment,relatively good efficacy and safety can also be achieved in patients with refractory liver cancer.

Value of contrast-enhanced ultrasound in early diagnosis of liver cancer and radiofrequency ablation treatment / 临床肝胆病杂志

Early identification and effective treatment of hepatocellular carcinoma plays an important role in improving survival rate.The establishment of simple and effective procedures for early diagnosis, census methods, and effective minimally invasive treatment is an important project in China to improve the diagnosis and treatment level of liver cancer.Contrast-enhanced ultrasound plays an important role in the early diagnosis of liver cancer and radiofrequency ablation treatment.This article describes how contrast-enhanced ultrasound helps with the identification of small hepatocellular carcinoma and degree of tumor differentiation in patients with liver cirrhosis, as well as the differential diagnosis of hyperplasia/canceration and precancerous lesion.It also introduces the important role of contrast-enhanced ultrasound in standard radiofrequency ablation and development of therapeutic regimens and strategies and clarifies that it can be used before, during, and after radiofrequency ablation treatment.

Clinical effect ofShumu-Yuntu-Zhike decoction with converntional treatment for the gastroesophageal feflux cough / 国际中医中药杂志

Objective To observe the clinical effect of Shumu-Yuntu-Zhike decoction with conventional treatment for the Gastroesophageal Reflux Cough (GERC).Methods A total of 64 patients with GERC were randomly divided into the conventional treatment group and the combined treatment group, 32 in each. The conventional treatment group took the Rabeprazole capsule and Mosapride Citrate Tablets, and the combined treatment group received the traditional prescription of Shumu-Yuntu-Zhike decoction on the basis of the conventional therapy. Two groups were treated for 8 weeks and evaluated the effect with the Visual analogue scale (VAS), Reflux diagnostic questionnaire (RDQ) and Chronic cough impact questionnaire (CCIQ) before and after 4 and 8 weeks' treatment.Results After 4 week treatment, the VAS (4.47 ± 1.32vs. 6.22 ± 1.34;t=-5.859,P<0.01), CCIQ (32.60 ± 5.83vs. 47.32 ± 5.56,t=-11.548,P<0.01) in the combined treatment group decreased significantly than the conventional group, but the RDQ (13.62 ± 2.89vs. 13.67 ± 2.77;t=-0.079, P=0.937) showed no significant difference between the two groups. After 8 weeks' treatment. After 8 week treatment, the VAS (2.57 ± 1.69vs. 4.55 ± 2.06;t=-4.676,P<0.01), CCIQ (12.47 ± 3.41vs. 23.47 ± 3.55;t=-14.126,P<0.01) in the combined treatment group decreased significantly, but the RDQ (9.18 ± 2.77vs. 9.3 ± 2.43,t=-0.202,P=0.841) showed no significant difference between the two groups. After the treatment, the total effective rate of combined treatment group was 90.6% (29/32), while the control group was 68.7% (22/32). There was significant difference between the two groups (χ2=4.730,P=0.030).Conclusions The therapy of Shumu-Yuntu-Zhike decoction combined with conventional therapy can relieve the symptom of gastroesophageal reflux cough.

Effect of early initiation of continuous renal replacement therapy based on the KDIGO classification on the prognosis of critically ill patients with acute kidney injury / 中华危重病急救医学

Objective To investigate the impact of early initiation of continuous renal replacement therapy (CRRT) based on Kidney Disease: Improving Global Outcomes (KDIGO) classification on the prognosis of critically ill patients with acute kidney injury (AKI). Methods A retrospective analysis of clinical data of patients diagnosed as AKI in Department of Critical Care Medicine of Zhejiang Provincial People's Hospital from January 2011 to January 2015 was conducted. All patients included should be 18 years old or older, having stayed in intensive care unit (ICU) for more than 48 hours, and received CRRT. All subjects were divided into three groups according to their renal function before CRRT according to the KDIGO-AKI guideline: AKI-stage 1 group, AKI-stage 2 group and AKI-stage 3 group. The general condition, original disease, severity of disease, duration of mechanical ventilation, the length of ICU or hospital stay, 28-day survival rate and in-hospital mortality rate were compared among these three groups. Additionally, risk factors for the 28-day survival rate and hospital mortality of critically ill patients with AKI were screened by logistic regression analysis. Results A total of 258 critically ill patients with AKI were enrolled, with 64 cases in AKI-stage 1 group, 62 cases in AKI-stage 2 group, and 132 cases in AKI-stage 3 group. 116 patients survived with 28-day survival rate of 44.96%. 154 patients died with hospital mortality 59.69%. The precipitating factors of AKI in all three groups (stage 1, stage 2, and stage 3) were similar, with sepsis, heart failure and poisoning (drugs or poison) being the main triggers for AKI, accounting for 35.66%, 19.38% and 13.18%, respectively. There were significant differences in the rate of vasoactive agent usage (31.25%, 41.94%, 50.00%, χ2 = 6.241, P = 0.044), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (20.87±7.37, 17.19±7.02, 22.58±7.95, F = 5.292, P = 0.006) and sequential organ failure assessment (SOFA) score (8.41±3.46, 6.22±2.43, 9.58±3.71, F = 10.328, P = 0.000), while there was no significant difference in gender, age, primary disease, time from ICU admission to the beginning of CRRT, mean arterial pressure (MAP), lactate level or 24-hour lactate clearance rate (LCR), mechanical ventilation time, the length of ICU or hospital stay, 28-day survival rate or hospital mortality among these three groups (all P > 0.05). According to the logistic regression analysis, time from ICU admission to start of CRRT and lactate level were the independent risk factors for 28-day survival rate or hospital mortality of critically ill patients with AKI [odds ratio (OR) for 28-day survival rate was 0.850 and 0.774, 95% confidence interval (95%CI) was 0.752-0.960 and 0.638-0.940, P value was 0.009 and 0.010, respectively; OR for hospital mortality was 0.884 and 0.756, 95%CI was 0.781-1.000 and 0.610-0.939, P value was 0.049 and 0.011, respectively]. Conclusion Early initiation of CRRT based on KDIGO-AKI classification could not improve the prognosis of critically ill patients with AKI, the optimal timing of RRT for such patients remains to be further explored.

Assessment of left atrial function in patients with rheumatic mitral stenosis by real time three-dimensional echocardiography / 重庆医学

Objective To evaluate of left atrial(LA) function in patients with rheumatic mitral stenosis(MS) by real time three‐dimensional echocardiography (RT‐3DE) .Methods Thirty patients with MS and 50 healthy volunteers underwent RT‐3DE . The left atrial end‐diastolic volume (LAVmax ) ,end‐systolic volume (LAVmin ) and pre‐systolic volume (LAVpre ) were measured to calculate the total ,passive and active atrial stroke volume (TASV ,PASV ,AASV) ,left atrial expansion index (LAEI) ,left atrial to‐tal ,passive ,active ejection fraction (LAEF ,LAEFpassive ,LAEFactive ) .The volume data were corrected by body surface area (BSA) to gettheleftatrialend‐diastolicvolumeindex (LAVmaxI),end‐systolicvolumeindex(LAVminI),pre‐systolicvolumeindex(LAVpreI) and the total ,passive and active atrial stroke volume index (TASVI ,PASVI ,AASVI) .The correlations between the LA volume , stroke volume ,function indices and the mitral valve area (MVA) were analyzed .Results (1)LAVmaxI ,LAVminI and LAVpreI were significantly greater in patients with MS than the controls(all P0 .05) .(3) LAEI ,LAEF ,LAEFpassive and LAEFactive were significantly lower in patients with MS than the controls(all P0 .05) .Conclusion LA function in patients with mitral stenosis decreased .RT‐3DE can be used to evaluate LA function in patients with MS and sinus rhythm .

The clinical data used for conventional indications of initiating renal replacement therapy and for predicting the prognosis of critically ill patients with acute kidney injury / 中华急诊医学杂志

Objective To investigate the value of clinical data used for conventional indications of initiating renal replacement therapy (RRT) such as serum creatinine (SCr),blood urea nitrogen (BUN) and acute renal injury (AKI) stage and in estimating the prognosis of critically ill patients with AKI.Methods A retrospective analysis of 258 AKI adult inpatients treated with continuous renal replacement therapy (CRRT) in ICU from Jan.2011 to Jan.2015.According to the outcomes,all subjects were divided into survival group (n =104)and death group (n =154).The general condition,AKI causes,results of renal function (urine output,SCr,BUN and AKI stage),homeostasis (acid-base balance and electrolyte level),severity of disease (APACHE Ⅱ score and SOFA score) and others were compared between two groups.Additionally,risk factors for the prognosis of critically ill patients with AKI were screened by the multivariate Cox's proportional hazard models and the receiver operating characteristic (ROC) curve.Results There were no significant differences in gender,age,primary disease,AKI causes,APACHE Ⅱ score,renal function (urine output,SCr,BUN and AKI stage),serum potassium level and phosphorus level between two groups before CRRT (P ＞ 0.05),but more patients in death group had severe sepsis (31.17％ vs.19.23％,P =0.033),lower pH value [(7.27 ±0.34)vs.(7.41 ±0.34),P =0.024] and higher level of lactate [(3.97 ±2.87) vs.s (2.64 ± 2.30),P =0.006].After the analysis with multivariate Coxg proportional hazard models,it was found that the levels of serum phosphorus (P =0.043) and lactate (P =0.009) were the independent risk factors for prognosis of critically ill patients with AKI,and other conventional indications for initiating RRT such as SCr,BUN,AKI stage,urine output,pH,bicarbonate level or potassium level were not closely associated with the prognosis of patients (P ＞ 0.05).Therefore,a composite of these six variables (pH,bicarbonate level,phosphorus level,potassium level,urine output and AKI stage) was analyzed.According to the analysis result of ROC curve,the diagnostic value of combined six different variables in predicting in-hospital mortality of AKI patients [area under the curve (AUC) 0.669,95％ CI:0.577-0.762] was almost as high as that of lactate (AUC:0.683,95％ CI:0.590-0.777),and significantly higher than SCr (AUC:0.460,95％ CI:0.358-0.562),BUN (AUC:0.469,95％ CI:0.366-0.571).Conclusions This composite of six different variables is more useful than any other conventional indications for initiating RRT in predicting post-AKI mortality.As a result,a composition of six different variables should be considered rather than any single variable alone for indication of initiating RRT in critically ill patients with AKI.

Crystal form identification of dasatinib in tablets / 中国药科大学学报

The aim of this study was to establish the methods to identify crystal form of dasatinib in tablets.X-ray powder diffraction(XRPD)and solid-state nuclear magnetic resonance(ssNMR)were used to analyze the crystal form of dasatinib in Sprycel? tablets and Yinishu? tablets.The results showed that monohydrate and anhydrate were identified in Sprycel? and Yinishu? tablets respectively;with no detectable anhydrate in Sprycel? tablets and no detectable monohydrate in Yinishu? tablets.The results of XRPD and ssNMR were consistent;and could be both applied in the crystal form identification of dasatinib in tablets.

Contrast enhanced ultrasonogrphy patterns in papillary thyroid carcinoma and correlation between degree of enhancement and tumor invasiveness / 中华超声影像学杂志

Objective To study the enhanced patterns of papillary thyroid carcinoma (PTC)on contrast-enhanced ultrasound(CEUS),and explore the relationship between the degree of enhancement and extracapsular invasionand cervical lymph node metastasis of the tumor.Methods Seventy-three PTCs in 61 patients selected for thyroid surgery underwent conventional ultrasound andcontrast-enhanced ultrasound. The enhanced patterns were analyzed.The differences between different degree enhancement and extracapsular invasion and cervical lymph node metastasis of PTCs were compared.Results Seventy-three PTCs enhanced patterns showed that 52(71 .2%)nodules with hypoenhancement,13(1 7.8%)nodules with isoenhancement,8 (1 1 .0%)nodules with hyperenhancement.Twenty-three (44.2%,23/52 )nodules with extracapsular invasion in hypoenhancing patterns,and 1 5 (71 .4%,1 5/21 ) nodules with extracapsular invasion in isoenhancing or hyperenhancing patterns.There were significant differences between them(P 0.05 ).Conclusions The degree of enhancement are correlate to invasiveness in PTCs,PTCs with isoenhancement or hyperenhancement patterns were more often with extracapsular invasion.

Application of contrast enhanced ultrasound in the diagnosis of pancreatic cystic lesions:comparison with MRI and pathology / 中华超声影像学杂志

Objective To explore the diagnostic value of contrast enhanced ultrasound (CEUS) by comparison with enhanced MRI.Methods Thirty-two cases with pancreatic cystic lesions confirmed by surgery or biopsy were enrolled.Ultrasound,CEUS and MRI were applied respectively for the diagnosis of 32 cases.The diagnostic ability of different imaging methods were compared according to pathological results as the gold standard.Results The 32 cases include 8 cases of serous cystadenoma,6 cases of mucinous cystic neoplasm,3 cases of intraductal papillary mucinous neoplasm,4 cases of solid pseudopapillary tumor,3 cases of neuroendocrine tumor,6 cases of pancreatic carcinoma,1 case of cyst and 1 case of inflammatory myofibroblastic tumor.The diagnostic accuracies of ultrasound,CEUS and MRI were 46.88％ (15/32),75.00％ (24/32) and 78.13％ (25/32) respectively.There was no significant difference between the diagnostic accuracies of CEUS and MRI (P =0.768).The diagnostic accuracies of CEUS and MRI were higher than that of ultrasound (P ＜0.05).Conclusions CEUS has obvious superiority over ultrasound in the diagnostic accuracy of pancreatic cystic lesions.The diagnostic ability of CEUS is similar to that of MRI.