Research progress in cognition, attitude and willingness for organ donation among ICU staff in China / 器官移植

In recent years, organ donation and transplantation have entered a stage of steady development in China. Nevertheless, the shortage of transplant organs and the contradiction between supply and demand of organs are still the bottlenecks to achieve the strategy of "self-sufficiency in organ transplantation" advocated by the World Health Organization (WHO). The key reasons for donor loss described in the "critical pathway of organ donation" defined by the WHO include the identification and referral of potential donors and the maintenance and repair of organs. Smooth development, high efficiency and high-quality development of organ donation cannot be achieved without the support of intensive care medicine, which are highly associated with the cognition, recognition and participation of intensive care unit(ICU) staff. In this article, research progress in ICU staff’s cognition, attitude and willingness for organ donation were reviewed and relevant influencing factors were discussed, aiming to offer targeted suggestions on how to resolve these difficulties.

Development and validation of a predictive model for treatment failure of peritoneal dialysis-related peritonitis in elderly patients / 中华老年医学杂志

Objective:To establish and validate a predictive model for treatment failure of peritoneal dialysis-related peritonitis(PDAP)in elderly patients.Methods:Clinical data of peritoneal dialysis(PD)patients who were followed up from January 1, 2013 to December 31, 2019 at four Grade A tertiary hospitals in Jilin Province were collected.A total of 362 elderly patients with PDAP were eventually included as study subjects.Subjects recruited from 2013 to 2017 were used for model construction and the logistic regression model was used to screen risk factors for treatment failure of PDAP in elderly patients.A nomogarm was constructed to predict treatment failure of secondary PDAP using R language.The receiver operating curve(ROC)and calibration curve were used to evaluate discrimination accuracy of the model.Subjects from 2018 to 2019 were used as the cohort for validation of discrimination accuracy of the model.Results:Of 258 PDAP patients in the modeling cohort, 29 experienced treatment failure, including 15 PDAP-related deaths and 14 cases requiring catheter removal.The multivariate logistic regression model showed that types of pathogens( OR=8.849, 95% CI: 1.656-47.269, P=0.011), long dialysis age( OR=1.023, 95% CI: 1.005-1.042, P=0.013), pre-hospitalization antibiotic treatment( OR=5.123, 95% CI: 1.338-19.610, P=0.017), and dialysate white blood cell count on day 5>100×10 6/L( OR=7.085, 95% CI: 2.162-23.217, P=0.001)were independent risk factors for treatment failure of PDAP in elderly patients.For the nomogarm predictive model, the areas under the ROC curve(AUC)in the modeling cohort and the validation cohort were 0.818(95% CI: 0.735-0.902)and 0.762(95% CI: 0.656-0.889), respectively, and the calibration curves were close to a straight line with a slope of 1. Conclusions:Our nomogram predictive model based on types of pathogens, months of dialysis, pre-hospital admission antibiotic treatment, and dialysate white blood cell count on day 5 has demonstrated satisfactory discrimination accuracy for treatment failure of PDAP in elderly patients.

Quantitative perfusion histogram parameters of dynamic contrast-enhanced MRI to identify different pathological types of uterine leiomyoma / 浙江大学学报·医学版

:To explore the value of quantitative perfusion histogram parameters of dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） in pathological classification of uterine leiomyoma and its correlation with Ki-67 protein expression. Thirty five patients with uterine leiomyoma confirmed by operation and pathology at Shaoxing People's Hospital from October 2015 to September 2017 were analyzed retrospectively，including 15 cases of ordinary type，8 cases of cellular type and 12 cases of degenerative type. All patients were examined by pelvic DCE-MRI before operation，and the histogram parameters （median，mean，skewness，kurtosis，energy，entropy） of various quantitative perfusion parameters，including volume transport constant （K），rate constant （K），extravascular extracellular space distribute volume per unit tissue volume （V），blood plasma volume per unit volume of tissue （V） were calculated，and the efficacy of different parameters in pathological classification of uterine leiomyoma was evaluated by ROC curve. The expression of Ki-67 protein in uterine leiomyoma was detected by immunohistochemical method，and the correlation between histogram parameters and Ki-67 protein expression was analyzed by Pearson and Spearman correlation analysis. The median and mean values of K，K，V and V in the cellular group were higher than those in the degenerative group and the ordinary group（<0.05 or <0.01），while the skewness of V，the skewness and kurtosis of K in the cellular group were lower than those in the ordinary group （all <0.05）. The entropy of K in the cellular group was higher than that in the degenerative group and the ordinary group （all < 0.05）. The entropy of V in the cellular group was higher than that in the ordinary group （<0.01）. The median，mean，skewness of K，median and mean of K，median and mean of V，median，mean，energy and entropy of V were correlated with Ki-67 expression（all <0.05）. The results of ROC curve analysis showed that the median threshold of K was 0.994/min，the sensitivity and specificity for the diagnosis of cellular uterine leiomyoma were 100.0% and 77.8% respectively，and the area under the ROC curve was 0.949. When the mean threshold of K was 1.170/min，the sensitivity and specificity for diagnosing cellular uterine leiomyoma were 100.0% and 77.8% respectively，and the area under the ROC curve was 0.958. The area under the ROC curve of K （entropy），K （median，mean），V （median，mean，entropy） in the diagnosis of cellular uterine leiomyoma were 0.755-0.907. :DCE-MRI quantitative perfusion histogram parameters have high diagnostic value in differentiating pathological types of uterine leiomyoma，especially for cellular uterine leiomyoma.

Risk factors for the occurrence and treatment failure of peritoneal dialysis-associated E. coli peritonitis / 中华临床感染病杂志

Objective:To investigate the clinical characteristics of E. coli peritoneal dialysis-associated peritonitis (PDAP) and the risk factors for its occurrence and treatment failure.Methods:The clinical data of patients with episodes of PDAP in four general hospitals in Jilin Province from 2013 to 2019 were retrospectively reviewed. According to the pathogenic bacteria, the patients were divided into E. coli and non- E. coli groups. The incidence of E. coli PDAP in the last seven years was calculated and the clinical characteristics were compared between two PDAP groups. Logistic regression was used to analyze the risk factors for the occurrence and treatment failure of E. coli PDAP. Results:A total of 693 PDAP episodes/cases were enrolled in this study, including 100 episodes/cases in the E. coli group and 593 episodes/cases in the non- E. coli group. The incidence rate of E. coli PDAP in the four hospitals showed a decreasing trend during 2013 to 2019. Compared with the non-E.coli group, the proportion of diabetic patients and the average blood albumin levels in the E. coli group were lower ( χ2=5.006, Z=-2.992, P<0.05), while the proportion of refractory peritonitis was higher, and the duration of antibiotic therapy was longer ( χ2=6.350, Z=-2.779, P<0.05). Multivariate Logistic regression analysis showed that history of PDAP ( OR=1.577, 95% CI: 1.015-2.448) and low baseline serum albumin level ( OR=0.958, 95% CI: 0.923-0.995) were independent risk factors for the development of E. coli PDAP, while concomitant diabetes was an independent protective factor for E. coli PDAP ( OR=0.538, 95% CI: 0.330-0.876). Moreover, long-term dialysis was an independent risk factor for treatment failure of E. coli PDAP ( OR=1.047, 95% CI: 1.018-1.076). Conclusion:The incidence rate of E. coli PDAP in study institutions has declined in the past 7 years, but the rate of refractory PDAP is still high. The history of PDAP and low blood albumin level are independent risk factors for the occurrence of E. coli PDAP, while concomitant diabetes is an independent protective factor for the occurrence of E. coli PDAP. Long-term dialysis is an independent risk factor for treatment failure of E. coli PDAP.

A multicenter clinical study of 280 cases of staphylococcal peritoneal dialysis-associated peritonitis / 中华肾脏病杂志

Objective:To investigate the incidence, drug sensitivity and drug resistance characteristies, and theraputic effect of staphylococcal peritoneal dialysis-associated peritonitis (PDAP), aim to provide clinical evidences for standardizing treatment therapy of staphylococcal PDAP. Methods:Clinical data of PDAP patients admitted to the Second Hospital of Jilin University, the First Hospital of Jilin University-the Eastern Division, Jilin Central Hospital and Jilin First Automobile Work General Hospital during January 1, 2013 and December 31, 2019 were retrospectively collected. The results of etiology, drug sensitivity and drug resistance of staphylococcal PDAP patients were collected. According to the pathogenic bacteria, patients were divided into staphylococcus aureus group ( n=48) and coagulase-negative staphylococcus group ( n=232). According to the results of methicillin resistance, patients were divided into drug-resistant group ( n=71) and drug-sensitive group ( n=30). The prognosis of antibiotic therapy in each group were compared. Poisson regression was used to test the changing trend of the incidence of staphylococcal PDAP. The changes of drug sensitivity and drug resistance of staphylococcus were compared between 2013 and 2019 by linear trend χ2 test. Results:A total of 1 085 cases of PDAP occurred in 625 patients were screened, and 280 cases of staphylococcal PDAP were finally included. The incidences of staphylococcal PDAP, staphylococcus aureus PDAP and coagulase-negative staphylococcal PDAP were 0.063 times per patient year, 0.010 times per patient year and 0.053 times per patient year respectively. In addition, the incidence of PDAP caused by staphylococcus, staphylococcus aureus and coagulase-negative staphylococcus decreased year by year (all P<0.05). With the change of years, the sensitivity rate of staphylococcus to rifampicin increased, while the sensitivity rate of staphylococcus to moxifloxacin decreased (both P<0.05). The drug resistance rate of staphylococcus to levofloxacin increased ( P<0.05). The staphylococcus aureus group was more prone to refractory PDAP and catheter removal than that in coagulase-negative staphylococcus group, and the recurrence rate was higher than that in coagulase-negative staphylococcus group (all P<0.05). The proportion of vancomycin used during the whole course of antibiotic therapy in drug-resistant group was higher than that in drug-sensitive group ( P<0.05). Conclusions:The incidence of staphylococcal PDAP decreases year by year, and the drug sensitivity characteristics of staphylococcus also change. The therapeutic outcomes of staphylococcus aureus PDAP are worse than that of coagulase-negative staphylococcus.

Effect of injection of recombinant human prourokinase during percutaneous coronary intervention on bleeding degree, plasma fibrinolytic factor and vascular recanalization in patients with ST segment elevation acute myocardial infarction / 中国综合临床

Objective:To explore the effect of coronary injection of recombinant human prourokinase (rhPro-UK) during PCI for ST-segment elevation acute myocardial infarction (STEMI) patients.Methods:A total of 124 STEMI patients treated in Tangshan Gongren Hospital, Hebei Province from November 2018 to November 2019 were selected as the research objects.They were simply randomized by random number table method into the observation group(63 cases) and the control group(61 cases). Thrombus aspiration was used.The control group was treated with 25 μg/kg tirofiban, and the observation group was injected with 20 mg rhPro-UK into the coronary arteries.After that, both groups underwent emergency PCI treatment.The bleeding degree, myocardial microcirculation indexes, plasma fibrinolytic factor changes, vascular recanalization, ST segment fall of electrocardiogram and changes in left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left ventricular ejection fraction (LVEF), cardiac index (CI) were recorded.Results:The peak value of creatine kinase isoenzymes MB (CK-MB) (184.64±21.47) U/L and the peak time of CK-MB (14.32±2.02) h in the observation group were significantly lower than those in the control group((258.94±31.64) U/L, (16.58±2.09) h), the differences were statistically significant ( t=15.345 and 6.123, all P<0.001). After treatment, human tissue plasminogen activator (t-PA) (0.85±0.28) kU/L in the observation group was significantly higher than that in the control group (0.74±0.24) kU/L, human plasminogen activator inhibitor (PAI-1) (0.16±0.05) kU/L.compared with the control group (0.32±0.08) kU/L significantly decreased ( t=2.345, P=0.021; t=13.401, P<0.001); 77.78% (49/63) of the ST-segment complete fall in observation group was significantly higher than 54.10% (33/61) of the control group ( Z=7.758; P=0.005), and 4.76% (3/63) in the observation group without a fall in ST segment was significantly lower than 19.67% (12/61) of the control group ( Z=6.480; P=0.011). The LVEDD at 7 days, 14 days and the LVESD at 7 days and 14 days in the observation group were (49.37±3.14) mm, (48.34±3.03) mm, (33.19±2.23) mm and (32.05±2.23) mm respectively, which were significantly lower than those in the control group at 7 days, (50.64±3.03) mm, (49.66±2.83) mm, (34.86±1.73) mm and 14 days, (33.74±1.97) mm respectively ( P<0.05 or P<0.001). The LVEF of 7 days and 14 days after treatment were (56.32±4.97)% and (59.23±5.11)%, which were significantly higher than those of the control group (54.46±4.87)% and (57.18±4.33)% ( P<0.05 or P<0.001). CI at 7 days and 14 days after treatment were (3.65±0.22) L/ (min·m 2) and (3.76±0.21) L/(min·m 2), which were significantly higher than those of the control group (3.48±0.25) L/(min·m 2) and (3.56±0.24) L/(min·m 2)( P<0.05 or P<0.001). Conclusion:STEMI patients treated by intraoperative coronary injection of Rhpro-UK versus tirofeban, can further improve the total bleeding rate and the vascular recanalculation rate, and also significantly improve plasma fibrinolysis factor, myocardial microcirculation and cardiac function.This provides an alternative to the treatment of myocardial infarction in patients with STEMI.

Analysis of a child with carnitine palmitoyl transferase 1A deficiency due to variant of CPT1A gene / 中华医学遗传学杂志

OBJECTIVE@#To report on the clinical, metabolic and genetic characteristics of a child with carnitine palmitoyl transferase 1A (CPT1A) deficiency.@*METHODS@#Clinical data and the level of acylcarnitine for a child who initially presented as epilepsy were analyzed. Genomic DNA was extracted from peripheral blood samples of the child and her parents and subjected to next-generation sequencing (NGS).@*RESULTS@#Mass spectrometry of blood acylcarnitine indicated increased carnitine 0 (C0) and significantly increased C0/ (C16+C18). DNA sequencing revealed that the child has carried compound heterozygous variants of the CPT1A gene, namely c.1846G>A and c.2201T>C, which were respectively inherited from her mother and father.@*CONCLUSION@#CPT1A presenting initially as epilepsy was unreported previously. Analysis of blood acylcarnitine C0 and C0/ (C16 + C18) ratio and NGS are necessary for the identification and diagnosis of CPT1A deficiency. The c.1846G>A and c.2201T>C variants of the CPT1A gene probably underlay the disease in this child. Above finding has also enriched the spectrum of CPT1A gene variants.

Research on the teaching of standardized residency training based on the skill module tutorial system / 中华医学教育探索杂志

Objective:To explore the application and effect of the teaching of standardized residency training based on the skill module tutorial system.Methods:Through the selection and employment of skill module tutorial system, 45 pediatric residents of batch 2016 in Hunan Children's Hospital were trained from such aspects of their professional theoretical knowledge, the skill operation ability and comprehensive ability were compared and analyzed. In addition, through the questionnaire survey, the training residents gave feedback to the skill mentors, and the passing rates of graduation skills examination in 2017, 2018 and 2019 of Pediatric residents in our hospital were analyzed and compared. T test and chi-square test were performed by SPSS 17.0.Results:After the training of the skill module tutorial system, the professional theoretical knowledge score (86.45±7.59), skill operation score (89.78±6.04) and comprehensive ability score (84.09±8.43) were significantly higher than those before the training ( P<0.05). The passing rate of the first graduation skills examination in 2019 was 93.33%, which was significantly higher than 57.14% in 2017, with a significant difference between the two groups ( χ2=28.45, P<0.01), compared with the rate of 2018(80.00%), which also had a statistical difference ( χ2=6.365, P<0.05). Conclusion:The training method of skill module tutorial system is not only helpful to rapidly improve the professional skills and post competency for the residents, but also benefit for training of teachers and improvement of their comprehensive quality, which is worth popularizing and applying.

Clinical characteristics and treatment outcomes of relapsing, recurrent and repeat peritoneal dialysis-associated peritonitis: a multicenter study / 中华肾脏病杂志

Objective:To explore the clinical characteristics and treatment outcomes of different types of peritoneal dialysis-associated peritonitis (PDAP).Methods:The clinical data of PDAP patients admitted to the Second Hospital of Jilin University, Second Part of the First Hospital of Jilin University, Jilin Central Hospital and Jilin First Automobile Work General Hospital in Jilin province from 2013 to 2019 were reviewed. According to the type of PDAP, the patients were divided into relapsing group, recurrent group, repeat group and control group, and the baseline data, pathogens culture and treatment outcomes among the four groups were compared.Results:A total of 542 patients with PDAP were enrolled in the study, including 43 cases in relapsing group, 32 cases in recurrent group, 27 cases in repeat group and 440 cases in control group. The median follow-up time was 30.5 (16.0, 50.0) months. The rate of Gram-positive bacteria in repeat group was higher than that of control group (70.37% vs 42.95%, P=0.030); the rate of fungi in recurrence group was higher than that of control group (21.88% vs 3.86%, P=0.006). Compared with control group, relapsing group had a lower cure rate (67.44% vs 83.64%, P=0.048) and a higher relapse rate (23.26% vs 2.27%, P=0.002), and recurrent group had a higher catheter removal rate (28.13% vs 8.18%, P=0.012). Multivariate logistic regression showed that recurrence was an independent risk factor for catheter removal ( OR=5.137, 95% CI 2.105-12.539, P<0.001). The technical failure rates in relapsing group and recurrent group were both higher than those in control group (41.86% vs 17.05%, P=0.002; 46.88% vs 17.05%, P=0.002). Multivariate Cox regression showed that relapse and recurrence were both independent risk factors for technical failure ( HR=2.587, 95% CI 1.525-4.389, P<0.001; HR=3.571, 95% CI 2.022-6.306, P<0.001), and also were independent risk factors for composite endpoint ( HR=1.565, 95% CI 1.045-2.344, P=0.030; HR=2.004, 95% CI 1.269-3.164, P=0.003). Conclusion:Compared with common PDAP, the therapeutic effects and prognosis of relapsing and recurrent PDAP are worse.

The application value of the tissue dispersion quantitative analysis technique in differentiating thyroid nodules / 中华超声影像学杂志

Objective:To investigate the application value of the ultrasonic elastic tissue dispersion quantitative analysis technique in differentiating thyroid nodules.Methods:A total of 164 nodules in 143 patients with thyroid nodules were examined by elastography ultrasound at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January to November 2014. Eleven parameters were obtained by the tissue dispersion quantitative analysis software. These parameters were compared between benign and malignant groups by Mann-Whitney U test. The correlations between all the parameters and the pathologic results of thyroid nodules were analyzed by Spearman analysis. The receiver operating characteristic(ROC) curve of the parameter with the highest correlation coefficient was constructed. The cut-off value was calculated. Results:All parameters except correlation (CORR) had statistically significant differences between the groups of benign and malignant thyroid nodules(all P<0.01). Moreover, except CORR, the other parameters were correlated with the pathologic results of thyroid nodules(all P<0.05), with the highest coefficient in area ration of low-strain region (%AREA)( r s=0.818). ROC curves were constructed to estimate the clinic values of %AREA in diagnosis of thyroid cancer, the area under ROC curve was 0.991 for %AREA, the cut-off point was 74.83%, the sensitivity and specifity was 98.1% and 89.8%, respectively. Conclusions:The tissue dispersion quantitative analysis technique has high value in the differential diagnosis of benign and malignant thyroid nodules.

Muscular pathological features and morphological analysis of facioscapulohumeral muscular dystrophy / 中国医师杂志

Objective:To analyze the pathological features of facioscapulohumeral muscular dystrophy (FSHD). For better characterization of inflammatory response in FSHD, we performed histochemical morphological analysis for FSHD and polymyositis (PM) muscle biopsies.In order to provide a reference for guide targeted therapeutic interventions.Methods:The clinical and myopathological data of 30 patients with FSHD from January 2006 to January 2019 in the Sixth Hospital of Shanxi Medical University and the first hospital of Jilin University were retrospectively analyzed. The patients were divided into non-inflammatory infiltration group (16 cases) and inflammatory infiltration group (14 cases) according to the presence or absence of inflammatory cell infiltration. For better characterization of inflammatory response in FSHD, we performed histochemical morphological analysis for two groups of muscles: FSHD and PM muscle biopsies, using Image-Pro plus bioanalytical software.Results:In 30 cases of FSHD, 14 cases showed intramuscular and interstitial inflammatory cell infiltration, especially around the blood vessels. Immunohistochemical staining confirmed that the infiltration of inflammatory cells was mainly CD4 + T lymphocytes. Morphometric analysis showed that there were no significant differences in muscle fiber surface area, density, diameter, inflammatory cell infiltration, regeneration and necrosis between FSHD patients and PM patients ( P>0.05). The total area of myointerstitium in FSHD group was significantly larger than that in PM group ( P=0.03). Conclusions:The pathological morphometric analysis showed that the proliferation of interstitial connective tissue in FSHD inflammatory cell infiltration group was significantly more than that in PM group. Clinicians can identify the two from pathology and provide help for clinical practice.

Clinical characteristics and treatment outcomes of first peritonitis in patients receiving long-term peritoneal dialysis: a multicenter study / 南方医科大学学报

OBJECTIVE@#To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis.@*METHODS@#The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (< 36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events.@*RESULTS@#A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (@*CONCLUSIONS@#Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.

Diagnostic value of bedside echocardiography with simple A-F mnemonic within 5 minutes by beginners in patients with acute chest pain / 中华急诊医学杂志

Objective To evaluate the diagnostic value of A-F mnemonic performed by sonographers with limited experience in patients with acute chest pain. Methods This was a prospective observational study. Bedside cardiac ultrasound for patients with chest pain was performed by six sonographers with limited experience using A-F mnemonic, evaluating indexes including aortic dissection(A), both ventricles (B), regional wall motion abnormality (RWMA), left ventricular ejection fraction (LVEF) ≤ 50％ (C ,contractility), dimensions (D), pleural and pericardial effusion (E) and further abnormalities (F). Afterwards, experienced cardiac sonographers performed the same examinations, and the difference in the time of ultrasound examination was calculated. The diagnosis of experienced sonographers were referred as the control group, and kappa test was applied to analyze the sensitivity, specificity, positive predictive value and negative predictive value. Results There were 245 cases eligible for study, and 20 cases were excluded. Finally 225 cases of acute chest pain were included in the analysis, containing 158 fatal chest pain and 67 low-risk chest pain. The experienced sonographers diagnosed 20 cases of ascending aortic dissection, 5 cases of right ventricular dilatation, 72 cases of RWMA, 12 cases of LVEF ≤ 50％, 45 cases of left ventricular dilatation, 6 cases of hydropericardium, and 6 cases of other abnormalities. The consistency between beginners and experienced sonographers were as follows:completely same (hydropericardium, Kappa=1.000), highly consistent (ascending aortic dissection, Kappa=0.853, right ventricular dilatation, Kappa=0.931, and other abnormalities, Kappa=0.829), moderately consistent (RWMA, Kappa=0.768, LVEF ≤ 50％, Kappa=0.713 and left ventricular dilatation, Kappa=0.766). The sensitivity and negative predictive value of RWMA and LVEF ≤ 50％ and the positive predictive value of left ventricular dilatation in the beginner sonographers were lower than those in the experienced sonographers. Conclusions A-F mnemonic was a simple and practical way for the beginner sonographers to perform bedside cardiac ultrasound. It was of significant value in making correct diagnosis of most acute chest pain patients and providing quick and reliable information for clinicians.

ThevalueofDCEGMRIparametersofReferenceRegionandExtendedToftsmodel indifferentiatehyperGcellularuterineleiomyoma / 实用放射学杂志

Objective ToanalyzethevalueoftheDCE-MRIparametersofReferenceRegionandExtendedToftsmodleinthedifferential diagnosisofhyper-cellularuterineleiomyoma.Methods 59patientswithuterineleiomyomaconfirmedbysurgeryandpathologywere enrolledinthestudyfromSeptember2015toSeptember2016,including28casesofclassicalleiomyoma,12casesofcellularleiomyoma and19casesofdegenerativeleiomyoma.AllpatientsunderwentDCE-MRIbeforesurgery.Thequantitativeperfusionparameters (transferconstant(Ktrans),extravascularextracellularspacevolumeratio(Ve),effluxrateconstant(Kep),andbloodplasmavolume ratio(Vp)weremeasuredviaReferenceRegionmodel(RR model)andExtendedToftsmodel(ET model)respectively.ROCcurve wasusedtoevaluatetheefficiencyofthequantitativeperfusionparametersindifferentialdiagnosisofhyper-cellularuterineleiomyoma. Pearsoncorrelationanalysiswasalsoappliedtoobservethecorrelationsamongallequivalentparameters.Results KtransandKepinRR modelandKtrans,Kep,VeandVpinET modelshowedstatisticalsignificancesamongthreetypesofuterineleiomyoma (P＜0.05), meanwhile,theAUCsofKtrans,KepandVpderivedfrom RR modelandKtrans,Kep,VeandVpcalculatedbyET modelindiagnosisof cellularuterineleiomyomawere0.835,0.752,0.706,0.956,0.871,0.656and0.754.TheKtransintheRR modelwascorrelatedwith KtransintheET model(r＝0.600,P＜0.001),KepintheET modelwaspositivecorrelatedwithKepandVpinRR model(r＝0.275, P＝0.035;r＝0.376,P＝0.003).Conclusion Thevalueof Ktrans ,Kep and Vp in RR and Ktrans ,Kep ,Ve and Vp in ET modelcan be useful inthedifferentiationofhyper-cellularleiomyoma,especiallythevaluesofKtransandKepinET modelhavehigherdiagnosticefficacy thanthoseinRR model.

Sonographic features and clinical factors associated with skip metastasis in papillary thyroid carcinoma / 中华普通外科杂志

Objective To explore the sonographic features and clinical factors associated with skip metastasis in papillary thyroid carcinoma (PTC).Methods We reviewed 276 PTC cases pathologically confirmed after operation in our hospital,analyzing the ultrasonographic features and clinical characteristics of primary site and risk factors of skip metastasis.Results The rate of skip metastasis was 16.6％,and level Ⅱ or level Ⅲ were the most common area.In univariate analysis,skip metastasis was associated with tumor location,tumor maximum size,and calcification.Multivariate analysis showed the primary tumor location in the upper portion,tumor size ≤ 10 mm,and microcalcification were independent predictive factors for skip metastasis.Conclusions In papillary thyroid carcinoma,skip metastases rate is high when primary tumor location in the upper portion,tumor size ≤ 10 mm,and there is microcalcification.

Transcutaneous electrical acupoint stimulation on inflammatory response and intestinal permeability in perioperative period of laparoscopic intestinal surgery / 中国针灸

OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the inflammatory response and intestinal permeability after laparoscopic radical surgery for colon cancer, so as to explore the protective mechanism for perioperative organs.@*METHODS@#Sixty patients with laparoscopic intestinal resection were randomly assigned into an observation group and a control group, 30 cases in each group. TEAS at Zusanli (ST 36), Neiguan (PC 6) and Hegu (LI 4) was used in the observation group on the day of operation and within 3 days after surgery, 2 Hz, within 2 mA. The interventions in the control group were the same as those in the observation group, except opening the current source. Central venous blood was collected before TEAS and 12 h, 24 h, 48 h, 72 h after surgery. The level of the inflammatory indexes of tumor necrosis factor-α(TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6) and intestinal mucosal barrier response indexes of endotoxin (LPS) and D-lactate were detected.@*RESULTS@#Compared with the control group, the levels of IL-1, IL-6 and TNF-α decreased in the observation group 24 h, 48 h and 72 h after surgery (all 0.05).@*CONCLUSION@#TEAS can reduce the inflammatory reaction after laparoscopic radical surgery for colon cancer, but has no effect on the intestinal permeability.

Influencing factors of serum complement C3 、C4 in children with myasthenia gravis / 国际儿科学杂志

Objective Complement plays an important role in the pathogenesis of myasthenia gravis.The formation of membrane attck complex and the damage of neuromuscular junction are inseparable from the activation of complement.Then to investigate the influencing factors of serum complement C3,C4 in children with myasthenia gravis and investigate the degree of influence of related factors.Methods One hundred sixty seven cases of hospitalized or outpatient myasthenia gravis children from the Department of Neurology in Hunan Children's Hospital were collected,including 33 cases of general MG,134 cases of ocular MG,and 36 cases of normal children as control group.The concentrations of serum C3,C4,IgG,IgM,IgA,IgE were detected by immune compare turbid.The influencing factors of complement C3,C4 were investigated and compared.Results The serum C3 levels were 1.07 ± 0.22 g/L,and the serum C4 levels were(0.17 ± 0.05)g/L in the general MG.The serum C3 levels were (1.01 ± 0.20)g/L,the serum C4 levels were(0.20 ± 0.08)g/L in the ocular MG.There were(1.36 ± 0.28) g/L for C3 levels,(0.25 ± 0.11) g/L for C4 levels in the control group.Compared with the control group,there were significant difference in C3 and C4 between the general MG and ocular MG(P ＜0.01 or 0.05).The partial correlations coefficients of C3 and course of disease,IgG and C3,C3 and C4 were-0.162,0.135,0.446(P ＜0.01 or 0.05).The multiple linear regression equations were as followed:C4 =0.420 × C3,C3 =0.655 + 1.148 × C4 + 0.008 × body weight-.005 × course of disease.Using univaruate analysis,the effect factors of C4(F =18.151,P =0.000),body weight(F =6.420,P =0.003),course of disease (F =3.015,P =0.039),age × course of disease × body weight (F =2.997,P =0.042) to C3 were significant (P ＜ 0.05,or P ＜ 0.01).Conclusion The C3 levels are mainly affected by C4,body weight,duration and some interaction effects among several impact factors in children with MG.C4 is mainly affected by C3.

A preliminary study of Fetal Intelligent Navigation Echocardiography in the prenatal diagnosis of conotruncal defects / 中华超声影像学杂志

Objective To investigate the application of fetal intelligent navigation echocardiography ( FINE ,5D Heart) in the diagnosis of conotruncal anomalies ( CTD ) . Methods For prospective study , volume transducer was used to collect the three-dimensional data of fetal heart at 20th - 30th week of gestation . The STIC volume images were processed by three independent physicians of different hierarchies via 5D Heart software afterwards ,and the quality of the STIC diagnosis as well as the consistence among the physicians were analyzed according to the gold standard of postpartum ultrasonic follow-up or surgery results . Results Twelve out of 16 CTD cases were finally included in the study ,and the volume data were analyzed . Senior physicians A could apply 5D Heart diagnosis to achieve 2D-US diagnosis efficiency and gold standard consistently( P = 0 .157 ,0 .083) ,medium and low seniority physician B and C got roughly equal score using 5D Heart diagnosis( P = 0 .705) ,but the diagnostic performance could not reach 2D-US ( P =0 .000 ,0 .000) and gold standard( P = 0 .000 ,0 .000) . Conclusions Fetal cardiac anomalies of CTD can be diagnosed correctly by an expert using 5D Heart ,which has important application prospects in remote consultation , training and scientific research and teaching of congenital heart disease of fetus .

The clinical efficacy and follow-up study of ketogenic diet adding treatment for refractor epilepsy in children / 中国医师杂志

Objective To study the clinical efficacy and follow-up study of ketogenic diet adding treatment for refractor epilepsy in children.Methods Cluster sampling method was employed to select children in children's hospital from January 2015 to June 2017,a total of 25 cases were diagnosed refractor epilepsy and adding ketogenic diet.Engel grade was used to evaluate the efficiency,the side effects,electroencephalogram (EEG) changes and intellectual development at 3 months,3-6 months,and more than 6 months.Results The effective rate of epileptic seizure control was 0,66.7％ and 87.5％ at 3 months,3 -6 months and ＞ 6 months respectively.The improvement rate of EEG discharge index was 33.3％,50％ and 81.3％ respectively.The improvement of intelligence development was 33.3％,50％ and 68.8％ respectively.Gastrointestinal disturbances were the main side effects.Severe side effect occurred in two cases--they had severe food refusal and were stopped the ketogenic diet adding treament.Conclusions The ketogenic diet is effective,safe,few side effects and tolerable in infants and children with refractory epilepsy.The ketogenic diet may improve cognition and behavior in addition to reducing seizure frequency,the interical epileptiform discharges (IED) index and improve the quality of life of epileptic children.However,the acceptance of ketogenic diet therapy for children is not satisfactory.The sample size is small and needs further promotion.While large samples and long-term observations are still desired to better recipes,and to provide possibly effective altemative to other therapies for refractor epilepsy.

The clinical value of pentraxin3 in community-acquired pneumonia of children / 中国小儿急救医学

Objective To investigate the clinical value of pentraxins 3 ( PTX3) in children's com-munity-acquired pneumonia ( CAP ). Methods We collected 122 inpatients diagnosed with CAP from Department of Respiratory Medicine and Intensive Care Unit ( ICU) of Hunan Children's Hospital from March 2016 to January 2017,whose ages were between 28 days and 18 years old. We collected 20 healthy subjects as control group. According to the severity of illness,122 inpatients were divided into mild group and severe group. According to respiratory failure or not,122 inpatients were divided into the respiratory failure group and the non-respiratory failure group. According to the optimal thresholds of PTX3 in the study on respir-atory failure,122 inpatients were divided into group A (≤165. 30 ng/ml) and group B (>165. 30 ng/ml). Results (1) There was significant difference in the PTX3 level within 24 h after admission of patients among mild group, severe group and control group [72. 56 (96. 02) ng/ml,211. 00 ( 110. 72 ) ng/ml,9. 45 (3. 29) ng/ml,H＝87. 99,P<0. 001]. The PTX3 level of patients with respiratory failure was higher than non-respiratory failure group and the difference was statistically significant[225. 60(189. 56)ng/ml,138. 49 (144. 40) ng/ml,U ＝494. 00,P <0. 001]. (2) Receiver Operating Characteristic analysis with TNF-α, CRP,PCT and PTX3 showed that the area under the curve of PTX3 was largest in diagnosis of respiratory failure. The top three of accuracy were PTX3,PCT and TNF-α respectively to diagnose the severe pneumonia with respiratory failure. The sensitivity and specificity were 0. 826 and 0. 657,0. 783 and 0. 566,0. 730 and 0. 586,respectively. ( 3 ) The correlation analysis between PTX3 and other inflammatory biomarkers and clinic opathological features of patients with CAP showed that TNF-α,PCT were positively correlated with PTX3 level,the correlation coefficients were 0. 59,0. 18 respectively. PTX3 level was positively correlated with respiratory frequency (r＝0. 388),and negatively correlated with pulse oximetry ( r ＝ －0. 251) and PaO2(r＝ －0. 316). The D-dimer level of PTX3 severe group (group B) was higher than that of the mild group (P＝0. 022). There was a positive correlation between the PTX3 level and the D-dimer line ( r ＝0. 228,P＝0. 012). (4) Dynamic observation of PTX3 level in children with CAP:PTX3 level [M(IQR), ng/ml] was highest at 24 h after hospital admission,equaling to 152. 55(152. 22); PTX3 equaled to 89. 12 (111. 44) after 3 days'treatment; and decreased to 47. 26(68. 51) after 7 days'treatment,and the difference among these time points were statistically significant(P<0. 01). The difference of PTX3 level between mild group and severe group in distinct time points(less 24 h,3 days and 7 days after hospital admission) was also statistically significant(P<0. 001). Conclusion The level of serum PTX3 in children with CAP was posi-tively correlated with TNF-α,PCT and D-dimer. Serum PTX3 is a potential new biomarker to revel the sever-ity of community-acquired pneumonia of children.