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Objective:To investigate the relationship between tophi detected by ultrasound and smoking.Methods:A total of 863 male gout patients over 18 years old in Shanghai Jiaotong University Affiliated Sixth People′s Hospital were selected. According to the results of ultrasound, patients were divided into two groups: non-tophi group ( n=527) and tophi group ( n=336). Independent sample t-test, Mann-Whitney U test or chi-square test were used for between-group comparison. Binary logistic regression was used to analyze independent influencing factors. Results:The proportion of smokers in non-tophi group and tophi group was 43.3% vs 65.5% respectively. There was significant difference between two groups ( P<0.01). With the increase of smoking index, the prevalence of tophi increases gradually ( P<0.05), so did the prevalence of multiple tophi as well as the number and size of gouty stone ( P<0.05). The proportion of tophi in other joints of foot in smokers was significantly higher than that in non-smokers ( P<0.05). The stratified analysis of smoking index showed that when 0<smoking index≤400 and smoking index>400, the risk of developing gout was increased by 1.195 and 1.779 times, respectively ( OR=2.195, 95% CI 1.507-3.197, P<0.01; OR=2.779, 95% CI 1.761-4.385, P<0.01). Conclusion:Smoking is a risk factor for the occurrence of gouty stone. Patients with gout who smoke should quit smoking as soon as possible to reduce the risk of tophi.
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Objective To assess the efficacy and safety of morinidazole combined with appendectomy in treating purulent or gangrenous appendicitis.Methods Double-blind randomized controlled multicenter clinical trial was designed and conducted.Totally 437 patients were included,219 in the control group and 218 in the experimental group.Cases of purulent or gangrenous appendicitis were enrolled and assigned to each of the two groups.The control group received ornidazole injection for 5 to 7 days while the experimental group received morinidazole injection.Both groups underwent appendectomy.Clinical response,micrombiological outcomes,overall response were evaluated.Adverse events and side effects were recorded.Results No significant difference was observed between the two groups regarding the clinical healing rate at 5-10 days after medicine withdrawal,anaerobia clearance and overall healing rates.Adverse events occurred in 140 patients (32.1％).Incidence of adverse events in the control group and the experimental group was 34.7％ and 29.4％,respectively (P ＞ 0.05).The overall incidence of side effects was 15.1％ (66 cases).Side effects were less seen in the experimental group compared with that in the control group (11.5％ vs.18.7％,P ＜ 0.05).The most frequent side effects were aminotransferase rising,thrombocytosis,nausea,vomiting and electrocardiographic abnormality.Conclusions The effect of morinidazole plus operation was comparable with ornidazole in treating purulent or gangrenous appendicitis.The safety of morinidazole is better than ornidazole.
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OBJECTIVE:To investigate the effects of low molecular weight heparin calcium and rivaroxaban combined with atorvastatin on related indexes in patients with acute pulmonary embolism(APE). METHODS:The data of 72 APE patients were analyzed retrospectively. According to treatment plan,the patients were divided into group A(21 cases),group B(26 cases)and group C(25 cases). Group A was treated with intramuscular injection of Low molecular heparin calcium injection immediately after admission;2 days later,they were given Warfarin sodium tablets;7 days later,Low molecular heparin calcium injection was stopped while warfarin was still administrated,lasting for 3-6 months. Group B was given Low molecular heparin injection(same usage and dose as group A);2 days later,they were additionally treated with Rivaroxaban tablets;7 days later,Low molecular heparin calcium injection was stopped while rivaroxaban was still administrated,lasting for 3-6 months. Based on the treatment in group B,group C was treated with Atorvastatin calcium tablets 20 mg orally,once a day in the evening,lasting for 3-6 months. The time of dyspnea,chest pain and cyanosis disappearance were observed in 3 groups as well as the levels of HR,pa(O2),pa(CO2), CRP,D-dimer,TNF-α,IL-1,IL-6,ET-1 and NO before and after treatment. The occurrence of clinical outcome events and ADR were also observed. RESULTS:The time of dyspnea,chest pain and cyanosis disappearance in group A were longer than group B, and the group B was longer than the group A,with statistical significance(P0.05). After treatment ,HR of 3 groups were all lower than before ,and they showed group Agroup B>group C,with statistical signif-icance(Pgroup A and group B,with statistical significance (P0.05). ET-1 levels in 3 groups were significantly lower than before,and the levels showed group group group B>group A,with statistical significance (P<0.05). The incidence of clinical outcome events in group A was significantly higher than group C, the incidence of ADR in group B was significantly lower than that group A,with statistical significance(P<0.05). CONCLUSIONS:Low molecular weight heparin calcium and rivaroxaban combined with atorvastatin can significantly im-prove clinical symptoms and blood gas indexes,relieve vascular endothelial damage,reduce the levels of inflammatory cytokines and improve the prognosis of patients with APE,without increasing the incidence of ADR.
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Objective To evaluate the diagnostic value and clinical significance of 1.5T MR multiple sequence for atrial septal defect (ASD) and ventricular septal defect (VSD).Methods To collect the data of MRI and transthoracic echocardiography(TTE)of 46 patients with ASD/VSD,Among them,12 patients had surgical treatment,27 patientsDSA treatment and 7 patients no surgery or DSA treatment. The biggest defect diameter was recorded which measured by TSE,GRE,PC-MR and TTE,and the main deformity,valvular regurgitation, atrioventricular enlargement,cardiac function,maximum aperture of ASD/VSD were recorded which were confirmed by surgery.Al-so,myocardial delayed reinforcement was recorded.Results Multiple sequence check of MRI found different number of defects in 39 patients(7 patients without surgery or treatment removed );the largest defect aperture of ASD/VSD measured by TSE、GRE、PC-MR had no statistically significant(P >0.05)with TTE measurements,they had good correlation with TTE (r=0.86,0.94,0.99) (P >0.05),and PC-MR had the highest consistency with TTE.The measured results of GRE,TTE,surgical in 14 ventricular sep-tal defects of 12 cases had no statistically significant(P >0.05).the largest defect aperture between myocardial delayed reinforce-ment and not delayed reinforcement had statistically significant in 41 cases of ASD(P <0.05).MRI had more advantage in the right heart enlargement and right heart function than TTE,the differences between the two had statistically significant(P <0.05).And MRI could find intracardiac deformity and outside the heart malformation in ASD/VSD,especially outside the heart malformation. Conclusion 1.5T MR multiple sequence inspection have high diagnostic value for ASD/VSD,which can display ASD/VSD clearly, measure the defect aperture accurately,find merged deformity accurately,and can also show myocardial delayed reinforcement and judge heart function.
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Objective To discuss the application of cephalocervical CT angiography (CTA) and ABCD2 score in evaluating arterial characteristics and interventional curative effect for patients with transient ischemic attack (TIA). Methods During the period from Jan. 2010 to Jan. 2012, a total of 64 patients with clinically-diagnosed TIA were admitted to authors’ hospital. ABCD2 score evaluation and cephalocervical CTA examination were performed in all patients. The correlation of stenotic degree and distribution of the cephalocervical arteries with the ABCD2 score was analyzed. According to the stenotic degree of the cephalocervical arteries, the patients were divided into low-risk group and mid-to-high-risk group. Twenty-two patients in mid-to-high-risk group received stenting angioplasty treatment. Follow-up was made at 3, 6 and 12 months after the treatment. Results Of 64 TIA patients, cephalocervical artery stenosis was found in 52(81.25%) A total of 149 arterial segments were involved, including intracranial segment (n=81, 54.36%) and extracranial segment (n = 68, 45.64%). Patients in low-risk group mainly suffered slight or moderate arterial stenosis, while patients in mid-to-high-risk group had moderate or serious arterial stenosis (χ2 =10.126, P=0.018). The preoperative ABCD2 score was (6.41 ± 0.50). The ABCD2 scores determined at 3, 6 and 12 months after the treatment decreased to(2.88 ± 0.69), (2.82 ± 0.63) and(3.00 ± 0.71), respectively. The differences were statistically significant (F = 86.657, P < 0.05). Conclusion Cephalocervical CT angiography and ABCD2 score can reliably evaluate the arterial stenosis and interventional curative results in TIA patients.