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Objective ToinvestigatethevalueoftheoptimalCNR monoenergeticimagesofportalveininpredictingesophagealGgastric varicealbleeding(EVB).Methods FortypatientswithlivercirrhosisandportalhypertensionunderwentcontrastGenhancedspectral CTscan.TheoptimalCNR monoenergeticimagesand70keV monoenergeticimagesoftheportalveinphasewereselectedtocompare theimagingquality.TheconsistencyoftheoptimalCNR monoenergeticimageswithendoscopyforesophagealGgastricvaricealwas analyzed by Kappa test.A ccording to the E V B history ,the patients w ere divided into bleeding group and nonGbleeding group.T he ROCcurveswerecalculatedtoassessthevaluesofthemainportalvein(MPV)anditstributariesdiameterstopredictingEVB.Results TheCNRandobjectivescoreoftheoptimalCNR monoenergeticimagesweresignificantlyhigherthanthoseofthe70keVimages(P＜0.05).TheoptimalCNR monoenergeticimageshadgoodconsistency withgastroscopeintheclassificationofesophagealGgastric variceal(k＝0.769).ThereweresignificantdifferencesofthediametersofMPV,intrahepaticleftbranchofportalvein(LPV),splenic vein(SV)andleftgastricvein (LGV)betweenthebleedinggroupandnonGbleedinggroup (P＜0.05).ROCcurveanalysisshowed thattheincidenceofEVBwashighestwithasensitivityof76.92%andaspecificityof85.71%,whentheLGVwasgreaterthan6.1mm. Conclusion TheoptimalCNR monoenergeticimagesofportalveincouldimprovetheimagingquality,andLGVdiametershouldbe ariskindicatorforpredictingEVBinlivercirrhosis.
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Objective To identify the risk factors for postoperative short-term cognitive dysfunction ( STCD) in the patients undergoing carotid endarterectomy. Methods A total of 158 patients with carotid artery stenosis, aged≥18 yr, without preoperative cognitive dysfunction, undergoing carotid endarterecto-my from January 1, 2014 to May 30, 2017 in our hospital, were selected. Factors including age, sex, height, weight, education, presurgical complications ( hypertension, type Ⅱ diabetes mellitus, myocar-dial infarction and brain infarction) , degree of internal carotid artery stenosis, preoperative mean arterial pressure ( MAP ) , amount of dexmedetomidine, duration of operation, time of carotid artery occlusion, MAP during occlusion period, intraoperative volume of fluid infused ( crystalloid solution and colloid solu-tion), urine volume, blood loss, significant change in electroencephalogram (EEG) and visual analogue scale scores at 24 h after surgery were collected. Mini-Mental State Examination was used to evaluate the cognitive function at 24 h after surgery. The patients were divided into STCD group and non-STCD group ac-cording to whether or not patients developed postoperative STCD. The risk factors of which P values were less than 0. 05 would enter the bivariate logistic regression analysis to stratify the risk factors for postopera-tive STCD. Results Forty-nine patients developed postoperative STCD ( 31. 0％) . The intraoperative a-mount of colloid solution infused＜5 ml/kg, increase in MAP＜20％ of the baseline value during the occlu-sion period, and significant change in EEG during the occlusion period were independent risk factors for postoperative STCD ( P＜0. 05) . Conclusion The intraoperative amount of colloid solution infused＜5 ml/kg, increase in MAP＜20％ of the baseline value during the occlusion period, and significant change in EEG during the occlusion period are independent risk factors for postoperative STCD in the patients undergo-ing carotid endarterectomy.
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OBJECTIVE:To explore the efficacy and safety of leflunomide combined with prednison in the treatment of membra-nous nephropathy. METHODS:43 patients with primary membranous nephropathy were randomly divided into control group(21 cas-es) and test group (22 cases). Control group given cyclophosphamide interrupted shocks combined with prednison,test group re-ceived leflunomide combined with prednison,the treatment course for both groups was 12 months. 6 months after the treatment,clini-cal efficacy,changes in renal function and serum lipids indexes before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in test group was 63.64%,which was significantly higher than control group (23.81%),the difference was statistically significant (P0.05). CONCLUSIONS:Compared with cyclophosphamide interrupted shocks combined with prednison,the efficacy of lefluno-mide combined with prednison in the treatment of membranous nephropathy is more definite,and the improvement of renal function and serum lipids indexes is more obvious.
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Objective To investigate the incidence and etiological factors of hyponatremia following traumatic brain injury (TBI) and analyze the relationship between hyponatremia and the patient’s age, gender, type of injury, Glasgow coma scale (GCS), operation and computerized tomography (CT) scan of head. Methods Clinical data of 136 pa-tients with moderate or severe TBI in our hospital were analyzed retrospectively, including patient’s age, gender, type of injury, GCS, operation, brain edema and basal skull fracture. The relationship between clinical data and hyponatremia were analyzed statistically by Chi-square test and multivariate Logistic regression analysis. Results There were 56 pa-tients with hyponatremia in 136 patients (81 males) with moderate or severe TBI. Multivariate Logistic regression analysis showed that hyponatremia secondary to TBI was not associated with patient’s age, gender, type of injury and operation or not. However, there was a high correlation between hyponatremia following TBI and clinical characteristics of TBI at ear-ly stage, such as GCS, brain edema and basal skull fracture. Conclusions Patients with TBI is more likely to develop hy-ponatremia when they have the following clinical factors, such as GCS≤8, brain edema or basal skull fracture. Preven-tive measures should be given to these patients in advance.
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OBJECTIVE:To investigate the effect of Shuxuening on interleukin 18 (IL-18) in patients with early diabetic nephropathy.METHODS:68 patients with early diabetic nephropathy were randomly divided into 2 groups (n=34).Both groups were given conventional diabetes therapy and oral dose of irbesartan (150 mg,qd).Treatment group were additionally treated with Shuxuening injection 20 mL and sodium chloride injection 250 mL (i.v.qd) for 3 weeks.The levels of IL-18 of 2 groups before and after treatment were determined by enzyme-linked immunosorbent assay,and the albumin excretion rate (UAER),fasting plasma glucose (FPG),serum creatinine (Scr) and other indicators were also detected.RESULTS:Compared with before treatment,the levels of IL-18 of 2 groups decreased after treatment (P0.05).CONCLUSION:Shuxuening can inhibit inflammatory cytokines IL-18 in peripheral blood of patients with diabetic nephropathy and have protective effects on kidney,which may be adjuvant therapy for diabetic nephropathy.