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Objective:To investigate the value of combined detection of neutrophil gelatinase-associated lipocalin(NGAL), cystatin C(CysC)and heme oxygenase-1(HO-1)in the early diagnostic of acute kidney injury(AKI)caused by acute paraquat poisoning(APP)in elderly patients.Methods:One hundred and two elderly APP patients admitted to the emergency department of our hospital from May 2015 to June 2019 were assigned to the observation group, and 50 patients who took physical examinations served as the control group.The observation group was divided into the AKI sub-group(n=59)and the non-AKI sub-group(n=43)based on whether AKI occurred within 72 h of admission.Serum levels of NGAL, CysC, HO-1 and creatinine(Scr)were detected in all APP patients at 0 h(admission), 12 h, 24 h, 48 h and 72 h. Measurements of the same parameters were made on the day of physical examination for the control group.The correlations of serum levels of NGAL, CysC and HO-1 with the occurrence of AKI were analyzed.Relative operating characteristic curve(ROC)was drawn to analyze the diagnostic value of NGAL, CysC, HO-1 and the combination of the three for the early diagnosis of renal injury in APP patients.Results:Serum levels of NGAL, CysC, HO-1 and Scr at admission showed no significant difference between the AKI sub-group, non-AKI sub-group and control group( P>0.05). After admission, all the parameters showed an upward trend in the observation group.Serum levels of NGAL, CysC and HO-1 at 12 h after admission( P<0.05)and Scr levels at 72 h after admission( P<0.05)were significantly different between the AKI sub-group and the non-AKI sub-group.Correlation analysis showed that serum NGAL, CysC and HO-1 levels were positively correlated with the occurrence of AKI in APP patients at 12 h, 24 h, 48 h and 72 h after admission, with the best correlation at 48 h after admission(NGAL: r=0.203, 0.545, 0.707 and 0.560, P<0.05; CysC: r=0.242, 0.340, 0.754 and 0.467, P<0.05; HO-1: r=0.249, 0.536, 0.677 and 0.509, P<0.05). The area under ROC curve predicted by NGAL, CysC, HO-1, Scr and NGAL+ CysC+ HO-1 for AKI at 48 h after admission was 0.777, 0.718, 0.888, 0.602 and 0.969, respectively. Conclusions:Serum levels of NGAL, CysC and HO-1 are significantly elevated at 12 h after admission in elderly APP patients, and reach the peak at 48 h after admission.Each of them can give an earlier diagnosis for AKI than Scr, and the combination of the three provides a higher diagnostic accuracy for AKI.
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ObjectiveTo observe the effects of extract of Ginkgo biloba, Ginaton, on cerebral oxygen utilization coefficients (O2UCc) and lactate clearance rate (LCR) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).Methods The 196 patients with DEACMP admitted to Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to March 2016 were enrolled, and they were randomly divided into a control group and an observation group, 98 cases in each groups. The control group received routine treatments such as hyperbaric oxygen, measures to prevent and treat cerebral edema, and promote brain cell metabolism, etc routine therapies: while in the observation group, besides the above routine treatments, additionally intravenous drip of Ginaton 70 mg (with 0.9% sodium chloride injection 250 mL added), once a day, for consecutive 2 weeks to complete one therapeutic course. At ambient air, before treatment and 6, 24 and 72 hours after treatment, the O2UCc and LCR and the changes of mini-mental state examination (MMSE) score, clinical efficacy and hospital mortality were observed and compared between two groups. Pearson correlation test was used to analyze the correlations between O2UCc, LCR and MMSE score.Results On the day of admission before treatment, there were no differences in O2UCc, lactate and MMSE score between the two groups (allP > 0.05). At 6 hours, 24 hours after treatment, the levels of O2UCc in observation group were obviously lower than those in control group [6 hours: (40.64±9.50)% vs. (45.78±7.94)%, P = 0.000; 24 hours: (30.51±6.76)% vs. (33.34±8.19)%,P = 0.009], while the levels of LCR were significantly higher than those in control group [6 hours: (14.93±2.27)% vs. (11.45±1.88)%,P = 0.000; 24 hours: (19.86±3.42)% vs. (13.73±2.35)%,P = 0.009]. There were no statistical significant differences in O2UCc and LCR at 72 hours after treatment between the two groups (P > 0.05). The MMSE scores at 6, 24 and 72 hours after treatment in observation group were higher than those in control group (6 hours: 15.52±3.61 vs. 11.60±2.49, 24 hours: 20.05±5.79 vs. 14.85±5.71,72 hours: 23.87±5.96 vs. 18.07±6.97, allP < 0.05). The total effective rate in observation group was significantly higher [77.55% (76/98) vs. 61.22% (60/98),P < 0.05], and the mortality [3.06% (3/98) vs. 10.20% (10/98),P < 0.05] was obviously lower than their own counterparts in control group. The correlation analysis showed that at different time points, the levels of O2UCc were negatively correlated to the corresponding MMSE scores (r6 h = -0.153,r24 h = -0.158, P6 h = 0.032,P24 h = 0.027), and there were positive correlations between the levels of LCR and MMSE scores (r6 h = 0.473, r24 h = 0.242,P6 h = 0.000,P24 h = 0.001) in patients with DEACMP.Conclusions The treatment of Ginaton in patients with DEACMP can effectively elevate the LCR and MMSE score, reduce O2UCc, decrease mortality and improve the prognosis, thus the clinical curative effect is distinct.
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[Absract] Objective To investigate the imaging features of CT and MRI of echinococcosis, and improve the imaging knowledge of the disease. Methods Clinical and radiological findings of echinococcosis of ribs were retrospectively analyzed by reviewing the seventeen cases confirmed by clinical and pathological findings. All patients had CT scan, eight had X?ray plain film and five had MR examination, while 4 patients underwent additional contrast?enhanced CT examination. Results All lesions were unilateral. There were 33 ribs involved, and single involved rib was seen in 7 cases. On CT scans, 10 cases showed cystic, swelling and osteolytic bone destruction, and 7 cases showed moth?eaten osteolytic bone destruction. There were 13 cases of hydatid cyst, 3 cases of a single sac watery density shadow and 10 cases of polycystic separating wheels form. There were 4 cases of fractured ribs, 2 cases of the longitudinal fracture and 2 cases of the transverse fracture. On MRI, there was one case of rib medullary cavity expansion destruction. It was a single cyst with hypointensity on T1WI, hyperintensity on T2WI and hyperintensity on short time inversion recovery (STIR) images. There were one case of rib medullary cavity expansion destruction and 3 cases of hydatid erosion ribs cortex among 4 cases of polycystic type. Polycystic type echinococcosis appeared hypointensity on T1WI, hyperintensity on T2WI and hyperintensity on STIR images. Polycystic type had mother sac and ascus structure, and signal intensity of ascus was higher. STIR sequence showed more clearly polycystic structure. Conclusions CT and MRI can clearly show location of echinococcosis of ribs. There are the imaging features of cystic, swelling and osteolytic bone destruction or complicating cyst of polycystic type which can help the qualitative diagnosis of rib echinococcosis.
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ObjectiveTo observe the effect of rhubarb as the main composition in the therapy for patients with acute paraquat poisoning (APP).MethodsA prospective randomized controlled trial was conducted. 128 patients with APP admitted to Harrison International Peace Hospital from March 2011 to December 2013 were randomly divided into western medicine control group (n = 64) and western medicine and traditional Chinese medicine (TCM) combination group (n = 64). All the patients were treated with repeated gastric lavage and oral kaolin. The patients in western medicine control group were given 20% mannitol and (or) magnesium sulfate for catharsis, early (within 8 hours of admission) hemoperfusion (HP), and also given the routine combined therapy. In TCM combination group, in addition to the above treatment patients were given oral paraquat poisoning detoxification prescription No.1 every 2 hours for catharsis, which was composed of rhubarb 10 g, glauber salt 12 g, agrimony 12 g, and licorice 6 g. When green stool disappeared, detoxification therapy was changed to No. 2 compound once a day for 14 days, which was consisted of rhubarb 10 g, ginseng 6 g, agrimony 15 g, rhizoma chuanxiong 10 g, licorice 6 g. The poison volume, first dose of oral drug, time for the first HP, time of the first defecation, the time of last green stool, decontamination time, white blood cell count (WBC), C-reactive protein (CRP), arterial blood gas analysis, blood lactic acid (Lac), liver and kidney functions, myocardial enzyme spectrum, chest CT, adverse reaction, days of hospitalization, and mortality rate were observed in both groups. The levels of paraquat in plasma and urine were determined before treatment and 12 hours after poisoning in both groups. Sixty days after discharge, chest CT was taken for observation of pulmonary fibrosis. ResultsThere were no significant differences in the poison volume, ingestion time and the time for the first HP between the two groups. Compared with western medicine control group, the first defecation time (hours: 3.94±1.14 vs. 6.17±1.52), the last time of green stool (hours: 36.90±4.10 vs. 51.63±4.91), and poison clean-up time from plasma (hours: 19.48±3.63 vs. 23.84±3.29) in combination with TCM group were significantly earlier (allP< 0.01). WBC, CRP, alanine aminotransferase (ALT), blood urea nitrogen (BUN), and serum creatinine (SCr) levels were gradually increased after admission in combination with TCM group, and they peaked on 5th day [WBC (×109/L): 15.35±2.17 vs. 17.47±2.09, CRP (mg/L): 32.62±2.76 vs. 39.51±2.45, ALT (U/L): 270.88±11.06 vs. 334.67±7.85, BUN (mmol/L): 13.29±1.90 vs. 17.63±1.42, SCr (μmol/L): 203.54±18.40 vs. 251.53±14.38, allP< 0.05], and then they declined; Lac after admission was gradually increased, and peaked at 7 days (mmol/L: 3.53±0.21 vs. 3.82±0.14, P< 0.05), and then it was decreased. Myocardial enzyme spectrum was increased after admission, and peaked on 3rd day [creatine kinase (CK, U/L): 192.09±16.26 vs. 216.20±11.96, creatine kinase isoenzyme enzyme (CK-MB, U/L):39.03±3.75 vs. 47.22±5.84, bothP< 0.05), and then they declined gradually. Arterial partial pressure of oxygen (PaO2) and base excess (BE) were gradually decreased after admission, down to trough on the 7th day after admission [PaO2 (mmHg, 1 mmHg = 0.133 kPa): 87.04±2.37 vs. 84.93±2.44, BE (mmol/L): -7.31±2.31 vs. -9.18±2.49, bothP< 0.05], and then they were increased. At 12 hours after poisoning, paraquat contents in plasma and urine in combination with TCM group were significantly lower than those of the western medicine control group [plasma (ng/L):0.83±0.08 vs. 0.96±0.10, urine (ng/L): 0.88±0.09 vs. 0.97±011, bothP< 0.05]. The injury to lung tissue was significantly improved in combination with TCM group compared with that in the western medicine control group, and no serious adverse reactions was found, and the hospital stay time (days: 20.46±6.07 vs. 29.73±9.16) was significantly shortened (P< 0.01), and the mortality rate [35.9% (23/64) vs. 45.3% (29/64)] was significantly lowered compared with western medicine control group (P< 0.05). In the combination with TCM group pulmonary fibrosis was lighter than that in the western medicine control group during the 60-day follow-up. ConclusionThe sequential treatment of No. 1 and No. 2 detoxification of APP, using rhubarb as the main drug, can effectively eliminate paraquat, reduce absorption of the toxin, prevent the development of multiple organ dysfunction syndrome (MODS) induced by the toxin, shorten the hospital stay days, and improve the prognosis of APP.
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BACKGROUND:Different races, genders, heredity, geographical environment can cause different bone ages. Therefore, an assessment of hand-wrist bone age has been done in the Han and Uygur adolescents and children in Xinjiang region. OBJECTIVE: To investigate the actual conditions of hand-wrist bone age in Han and Uygur adolescents and children in Urumqi. METHODS: 760 children and adolescents (aged 4.0-4.0 years) of Uighur and Han nationalities were enroled in this study. Two years acted as an age group. The hand-wrist bone age was estimated by hand-wrist X-ray using theChinese Wrist Skeletal Development Standard CHN Method. The correlation between bone age and chronological age was analyzed statisticaly as wel as difference in the bone age and chronological age between two ethnic groups. RESULTS AND CONCLUSION: (1) A close correlation was found between hand-wrist bone age and chronological age for two ethnic groups (P < 0.05). (2) Thirteen age group showed higher bone ages than chronological ages, including four age groups of Han nationality girls aged 4.0-11.9 years, three age groups of Han nationality boys aged 4.0-9.9 years, three age groups of Uygur girls aged 4.0-9.9 years, and three age groups of Uygur boys aged 4.0-9.9 years. (3) The bone and chronological ages were higher in the Han girls aged 10-11.9 year than the Uygur girls aged 10-11.9 years as wel as in the Han boys aged 12-13.9 years than the Uygur boys aged 12-13.9 years. Results show that the two ethnic groups of children and adolescents exhibit the early mature trend of skeletal development in multiple age groups; and there is a difference in skeletal and chronological age between Han and Uygur adolescents in some age groups.
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Base on the development of picture archiving and communication system (PACS) of teaching hospital and imaging database,medical imaging resource center (MIRC) software of Siemens was used in medical imaging teaching.It is beneficial to increasing the effectiveness of teaching system,stimulating enthusiasm of students,reforming the traditional exam model and improving the standard of teaching.
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ObjectiveTo explore the treatment efficacy and feasibility of large dose of cytidine diphosphate choline (CDPC) in cardiopulmonary cerebral resuscitation.MethodsOne hundred and thirtytwo patients with sudden cardiac arrest successfully treated by the cardiopulmonary cerebral resuscitation were divided into treatment group ( 75 patients) and control group (57 patients) by random number tables.Two groups of patients were given adrenaline resuscitation drugs,reducing the intracranial pressure drugs,hypothermia,hormones and other basic treatment.Control group used CDPC 0.25 g with glucoseinjection 300 ml to do intravenous drip (once a day,21 days as a period of treatment),and treatment group added CDPC to 2.00 g.The patients were treated by basic traditional analeptic.The Glasgow coma scale (GCS) was carried out in two groups in admission to hospital and 3,7,14,21 days after treatment,and the changes of lysophosphatidic acid (LPA) and phosphatidic acid (AP) level were monitored.ResultsThe GCS score was significantly higher in treatment group 7,14,21 days after treatment(P ＜ 0.05 or ＜ 0.01 ),but GCS score had no significant difference before and after treatment in control group(P ＞ 0.05).The level of LPA in treatment group was significantly decreased 14 days after treatment [ (2.98 ± 0.28) μmol/L ] and 21 days after treatment[ (1.85 ± 0.21)μmol/L],and had significant difference compared with that admission to hospital [ (3.75 ± 0.22) μ mol/L ] (P ＜ 0.05 or ＜ 0.01 ).In control group,there was no significant difference before and after treatment (P ＞0.05).The level of AP in treatment group 21 days after treatment was significantly decreased compared with that in control group [ ( 3.45 ± 0.23 ) μ mol/L vs.( 5.20 ± 0.21 ) μ mol/L ](P ＜ 0.01).ConclusionLarge dose of CDPC can improve neurological function of cardiopulmonary cerebral resuscitation,which is a safe,effective and easy way to be popularized.
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The isolated working heart of guinea pig perfused with Tyrode's solution could work normally for at least 60 min. It was shown that berbamine ( BA ) could depress the function of isolated working heart of guinea pig in dose-dependent manner. BA 3 mol/L could decrease the left ventricular pressure, aortic pressure, -dP/dtmax, aortic blood flow and coronary blood flow, and increase left ventricular end-diastolic pressure. BA 100 mol/L could result in the ventricular asystole, however, no obvious influence the contraction of atrium.It was also demonstrated that BA could antagonise the arrhythmias induced by the adrenaline in isolated working heart of guinea Pig.
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Aim To investigate the gender differences in electrophysiology and neuroanatomy of myelinated and unmyelinated visceral and baroreceptor afferent neurons(VANs and ABNs) of adult rats.Methods VANs and ABNs were isolated enzymatically and Vagus-nodose slice preparation was also applied in this study.For identification of ABNs,aortic depressor nerve(ADN) was labeled using fluorescent dye.Whole-cell patch technique was used to record action potential(AP).Electronic microscopy was selected for morphological analysis of ADN.Results(1) A-and C-type VANs were identified and significant differences of AP discharge profiles between female and male were not established;(2) except for the traditionally classified A-and C-types,myelinated Ah-type VGNs were also identified with faster conduction velocity,lower firing threshold,and higher neuronal excitability.Importantly,these Ah-types were found in female rats with a similar frequency like A-types but rarely seen in males.(3) Ah-type ABNs were also identified by fluorescence.(4) Morphological data showed that myelinated fiber in ADN was ~25% of total and this result was consistent with our electrophysiological data.(5) Firing frequency of Ah-types(20~40 Hz) was lowered than that of A-types(40~150 Hz,P