Efficacy of Active Charcoal and Mannitol in Patients with Haff Disease Caused by the Consumption of Crayfish (Procambarus clarkii): A Retrospective Cohort Study.

This study evaluates the clinical efficacy of activated charcoal combined with mannitol (ACM) for the treatment of Haff disease. This is a retrospective cohort study conducted at the Emergency Department of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine. Consecutive patients who were hospitalized during a two-year time frame (from June 2016 to August 2017) and diagnosed with Haff disease were reviewed. Clinical symptoms, laboratory findings, pain/anxiety scores, and treatment-related adverse events were collected. Sixty-eight Haff disease patients after boiled crayfish consumption were enrolled in this study. Besides standard treatments for Haff disease, 22 patients had an oral administration of activated charcoal and mannitol within 12 hours of hospital admission (ACM group), while the other 46 patients did not receive such treatment (non-ACM group). Baseline characteristics including clinical symptoms, serum enzyme levels, and pain/anxiety scores were comparable between the two groups. Activated charcoal and mannitol treatment led to lower CK-MB and AST levels from 12 hours to 60 hours, lower ALT and LDH levels from 12 hours to 72 hours, and lower CK levels from 24 hours to 72 hours after hospitalization. Patients in the ACM group had significantly shortened duration of hospital stays (7.5 [6.0-8.0] days vs 8.0 [6.8-10.0] days, p = 0.032) and lower anxiety scores 24 hours after hospital admission (40.7 ± 4.9 vs 44.1 ± 6.3, p = 0.032) than in the non-ACM group. No patient experienced treatment-related adverse events. The overall prognosis of both groups is good. Among patients with Haff disease caused by boiled crayfish, activated charcoal combined with mannitol treatment resulted in shorter hospital stays, lower serum CK, CK-MB, AST, ALT, and LDH levels, and lower anxiety scores.

[Effect of early acupoint electrical stimulation on lower limb muscle strength in patients with septic shock].

OBJECTIVE: To observe the effect of early acupoint electrical stimulation on the decline of lower limbs muscle strength in patients with intensive care unit-acquired weakness (ICU-AW) caused by septic shock. METHODS: A total of 58 patients with ICU-AW caused by septic shock were randomly divided into an observation group (28 cases, 1 case dropped off ) and a control group (30 cases, 2 cases dropped off ). Patients in both groups received routine basic treatment. In the observation group, acupoint electric stimulation therapy was added at Huantiao (GB 30), Futu (ST 32), Zusanli (ST 36), Xuanzhong (GB 39) and Taichong (LR 3). Unilateral point with electrodes were applied, the SDZ-Ⅱ electronic instrument (discontinuous wave, frequency in 2 Hz, strength in 5 mA) was connected and changed to the other side after 30 min of unilateral treatment.The treatment was given 2 times daily, continued for 7 d or until the medical research council (MRC) score being 54 points or more. The changes of lower limb muscle strength MRC score, modified Rankin scale (MRS) score, bilateral quadriceps thickness and gastrocnemius pinnate angle of both groups were observed before treatment and on discharge. The time of admission to ICU, time of hospitalization, mortality during hospitalization, and mortality 28 d after discharge were compared between the two groups. The MRS scores of the two groups were followed up 28 d after discharge. RESULTS: The MRC scores of lower limb muscle strength in the two groups on discharge were higher than those before treatment (P<0.05), and the MRS scores on discharge and 28 d after discharge in the two groups were lower than those before treatment (P<0.05). The MRC scores of lower limb muscle strength on discharge in the observation group were higher than thoes in the control group (P<0.05), and the MRS scores on discharge and 28 d after discharge in the observation group were lower than those in the control group (P<0.05). On discharge, bilateral quadriceps thickness and gastrocnemius pinnate angle in the two groups were increased compared with those before treatment (P<0.05), and thoese in the observation group was higher than the control group (P<0.05). There was no significant difference between the two groups in the time of admission to ICU, time of hospitalization, mortality during hospitalization, and mortality 28 d after discharge (P>0.05). CONCLUSION: Early acupoint electrical stimulation can improve the lower extremity muscle decline in patients with ICU-AW caused by septic shock.

Expression and role of EGFR, cyclin D1 and KRAS in laryngocarcinoma tissues.

Epidermal growth factor receptor (EGFR), cyclin D1 and KRAS proto-oncogene, GTPase (KRAS) genes serve roles in the occurrence and development of tumors. The aim of the current study was to investigate the expression levels of EGFR, cyclin D1 and KRAS in laryngocarcinoma tissues and their association with clinical features. In addition, correlation between the expression levels of EGFR, cyclin D1 and KRAS was analyzed in laryngocarcinoma tissues. The expression levels of EGFR, cyclin D1 and KRAS in 46 patients with laryngocarcinoma and 20 patients with vocal cord polyps as the control group were determined using Super Vision immunohistochemical staining assay kits. The differences in clinical and pathological parameters between groups were statistically analyzed using SPSS software version 16.0. The expression rates of EGFR, cyclin D1 and KRAS were 71.7, 52.2 and 39.1%, respectively in laryngocarcinoma tissues, and 10.0, 5.0 and 10.0%, respectively in vocal cord polyps. There was a positive correlation between the expression levels of EGFR, cyclin D1 and KRAS. The expression of these genes was also closely associated with the clinical stage, treatment response and prognosis of patients with laryngocarcinoma. Multivariate analysis of prognosis using the Cox regression model indicated that EGFR expression in laryngocarcinoma tissues and the clinical stage of patients with laryngocarcinoma were closely associated with patient prognosis. The results of the current study indicated that EGFR, cyclin D1 and KRAS were synergistically involved in the occurrence and development of laryngocarcinoma, directly affecting the prognosis of patients. Additionally, high expression of EGFR, cyclin D1 and KRAS facilitated the invasion and metastasis of laryngocarcinoma cells. The expression of EGFR in laryngocarcinoma tissues and clinical stage were two independent risk factors affecting the prognosis of patients.

[Expressions and correlation of HPA, CK2beta and HIF-1alpha in nasopharyngeal carcinoma].

OBJECTIVE: To investigate the expression of HPA, CK2beta and HIF-1alpha gene in nasopharyngeal carcinoma (NPC) tissues, and the correlation between their expression with the clinical characteristics of NPC and the relativity of HPA, CK2beta and HIF-1alpha gene in NPC tissues. METHOD: HPA, CK2beta and HIF-1alpha were detected with Super-Vision immunohistochemical method using antibody in 49 NPC specimens and 30 specimens with chronic nasopharyngitis tissue (CNT). RESULT: The expression of HPA, CK2beta and HIF-1alpha in NPC tissue were significantly higher than those in CNT tissue (P<0.05, separately). The expression of HPA, CK2beta and HIF-1alpha were significantly related to the TNM stage and whether recurrence or metastasis occur after treatment (P<0.05, separate ly), but there was no obvious correlation between its expression and the sex of NPC patient (P>0.05). The expression of HIF-1alpha was significantly related to the age of NPC patient (P<0.05), while HPA, CK2beta were not. The expression of HPA, CK2beta and HIF-1alpha in NPC tissue was positively correlated with each other (P<0.05, separately). CONCLUSION: HPA, CK2beta and HIF-1alpha play synergetic role in development of NPC, which plays an important role in invasiveness,recurrence and metastasis of NPC. There could be a positive cooperation among HPA, CK2beta and HIF-1alpha in the carcinogenesis and development of NPC.

Clinical outcome of window partial laryngectomy for stage T2-3 glottic laryngeal carcinoma.

OBJECTIVE: To investigate the operative impact and therapeutic value of window partial laryngectomy for the treatment of stage T2-3 glottic laryngeal carcinoma. METHODS: From October 2000 to December 2006, window partial laryngectomy and laryngeal reconstruction were performed on 48 appropriately selected patients with stage T2-3 glottic laryngeal carcinomas. Twenty-nine males and 19 females were included. Before the operation and in the sixth month after the operation, degree of hoarseness, vocal fold mobility and symmetry, glottal width during quiet breathing, degree of glottal closure during phonating, respiratory function, and swallowing function were surveyed. In addition, tumor recurrence and metastasis and patient survival time were monitored. RESULTS: With the exception of vocal fold mobility (P=0.343), there were significant differences between the two treatment groups in all areas that were investigated, including degree of hoarseness (all P<0.01), vocal fold symmetry (P=0.000), glottal width during quiet breathing (P=0.001), degree of glottal closure during phonating (P=0.001), and respiratory function (P=0.001). Swallowing function was not influenced (P=0.310). There was recurrence in one case (2.1%), cervical lymph node metastasis in one case, and hepatic metastasis in one case. The 3- and 5-year overall survival rates were 96.9% and 88.9%, respectively. CONCLUSIONS: This study showed that window partial laryngectomy was successful for treating properly selected stage T2-3 glottic laryngeal carcinoma. This operation was effective for reducing surgical invasion and facilitated the resumption of respiratory and vocal function.

[Window partial laryngectomy for the treatment of stage T2-3 glottic laryngeal carcinoma].

OBJECTIVE: To investigate the operative effect and value of window partial laryngectomy for the treatment of stage T2-3 glottic laryngeal carcinoma. METHODS: From Oct. 2000 to Dec. 2006, the stage T2-3 glottic laryngeal carcinoma of 48 patients by properly selected were performed with window partial laryngectomy and laryngeal reconstruction. Twenty nine males and 19 females were included. Their ages ranged from 43 to 78 years (median 57.0 years). Before operation and in the 6 months after operation, these targets including auditory mental evaluation of hoarse degree, active degree and symmetry of vocal cord, glottic width in the time of quiet breathing, glottic closing degree in the time of phonating, respiratory function and swallowing function were surveyed. In addition, the things of recurrence and metastasis of tumors together with survival time of patients were following investigated. RESULTS: All patients were decannulated successfully and incisions were healed smoothly. No operative complication occurred. Except active degree of vocal cord (P = 0.343), there were respectively significant difference between two group targets of auditory mental evaluation of hoarse degree (all P <0.01), symmetry of vocal cord (P = 0.000), glottic width in the time of quiet breathing (P = 0. 001), glottic closing degree in the time of phonating (P = 0.001) and respiratory function (P=0.001) those were investigated before operation and after operation. The swallowing function wasn't influenced (P= 0.310). There were laryngostenosis in 1 case, recurrence in 1 case (2.1%), cervical lymph node metastasis in 1 case and hepatic metastasis in 1 case. Two cases died. 3-year and 5-year overall survival rate were respectively 96.9% and 88.9%. CONCLUSIONS: The study showed that window partial laryngectomy was successful for treating stage T2-3 glottic laryngeal carcinoma by properly selected. This operation was effective for reducing surgical invasion and beneficial to resume respiratory and vocal function.

[Diagnosis and treatment of serious adult airway obstruction].

OBJECTIVE: To investigate the diagnosis and treatment of serious adult airway obstruction. METHOD: Eighty six adult cases admitted to our hospital for serious airway obstruction from 1995 to 2006, were analyzed retrospectively. RESULT: Among the 86 cases, 34 cases (39.5%) had inflammatory diseases, 32 cases (37.2%) had neoplastic diseases and 9 cases (10.5%) had traumatic diseases. In addition, 3 cases of laryngeal spasm, 6 cases of laryngeal stricture, 2 cases of bilateral laryngeal paralysis and 1 case of asphyxia with aspiration were also include in this study. The patients who had laryngeal or tracheal obstruction were 60 cases (69.8%) and 13 cases (15.1%). In addition, 46 cases (53.5%) and 4 cases (4.7%) had tracheotomy or endotracheal intubation. Twenty six cases were only adopted medical treatment to relieve dyspnea. The final diagnosis of the 86 cases was made and the serious airway obstruction was was relieved within 2 hours. While 14 cases (16.3%) had serious complications and 6 cases (6.9%) had operative complications occurred. One cases (0.2%) died. CONCLUSION: The causes of serious adult airway obstruction could be complicated, the site and character of obstruction would change constantly. Quick diagnosis, timely removal of the obstruction should be critical factors to improve curative effect.

[Resection of invasive head and neck neoplasms involving skull base].

OBJECTIVE: To investigate the operative methods of invasive head and neck neoplasms involving skull base. METHOD: Thirty-two cases with invasive head and neck neoplasms involving anterior and lateral skull base, from 1997 to 2005, were treated with surgical resection. Nine surgical approaches including endoscopic transnasal approach for five cases, combined craniofacial approach for three cases, maxillary resection approach for 15 cases, transpalatal approach for one case, transmandibular approach for one case, lateral neck-mandibular incision approach for two cases, combined retroauricular and neck approach for one case, frontotemporal approach for two cases, and facial translocation approach for two cases were used to resect the tumors. RESULT: Four cases with nasal sinus mucocele were only applied drainage and one case with chordoma was subtotally resected. The tumors of the rest 27 cases were totally removed. Although one case complicated with cerebrospinal fluid leak and recovered within one week, no one died from the operation and no serious cranium-cerebrum complication occurred. Eight cases with benign tumor were followed up for six months to eight years without recurrence and no one died. For 24 cases with malignant tumor, survival rates of three and five years were 63.2% (12/19), 41.7% (5/12) respectively. CONCLUSION: Surgical approach must be designed according to the pathological change's characters, site and invasive range. Favorable curative effect could be achieved by resecting tumors totally as possible, protecting important constitutions, and adopting proper reparative techniques.

[Expressions and correlation with radiotherapy's effect of five kinds of genes in nasopharyngeal carcinoma].

OBJECTIVE: To investigate the expressions of E-cadherin, CD44H, matrix metalloproteinase-3 (MMP-3), nm23H1 and vascular endothelial growth factor (VEGF) in nasopharyngeal carcinoma and its relationship to the effect of radiotherapy. Furthermore, to analyze the predict value of radiotherapy effect. METHODS: The expressions of E-cadherin, CD44H, MMP-3, nm23H1 and VEGF in 62 patients with nasopharyngeal carcinoma were determined by immunohistochemical SP method. There were 62 patients (17 to 70 years old) with nasopharyngeal carcinoma which were treated by radiotherapy from March 1995 to October 1995 and the period of follow-up had full 10 years. RESULTS: The expressions of CD44H (chi2 = 18.739, P = 0.028) and VEGF (chi2 = 18.523, P = 0.030) were closely related with short-term effect after radiotherapy in nasopharyngeal carcinoma. The short-term effect was descent along with enhancement of their expressions. In the group of low expressions in CD44H and nm23H1, 3-year overall survival rate were 65.5% and 45.5%, and 5-year overall survival rate were 47.3% and 22.7%. In the group of high expressions in CD44H and nm23H1, 3-year overall survival rate were 54.6% and 75.9%, and 5-year overall survival rate were 27.8% and 53.2%. There were respectively significant difference between two group of expressions in CD44H (chi2 = 7.31, P = 0.0069) and nm23H1 (chi2 = 15.64, P = 0.0001). CONCLUSIONS: These findings indicated that to detect the expressions of CD44H and VEGF gene may predict short-term effect of radiotherapy. Furthermore, to detect the expressions of CD44H and nm23H1 gene may predict long-term effect of radiotherapy in nasopharyngeal carcinoma.

[Diagnosis and treatment of serious pediatric airway obstruction].

OBJECTIVE: To investigate the diagnosis and treatment of serious pediatric airway obstruction. METHODS: Seventy three pediatric cases with serious airway obstruction, admitted to Shantou hospital from 1995 to 2005, were analyzed retrospectively. RESULTS: Among the 73 cases, 28 cases (38.4%) with inflammatory disease and 33 cases (45.2%) with foreign body. In addition, 8 cases of laryngeal papilloma, 3 cases of laryngotracheobronchial spasm and 1 case of pharyngeal dysembryoma were also included in this study. The patients who had endotracheal intubation or tracheotomy were 39 cases (53.4%) and 27 cases (36.9%) respectively. Ten cases received non-surgery treatment. Seventy two cases diagnosis was confirmed and the related serious airway obstruction condition got stable within 12 hours. While serious complications occurred in 23 cases (31.5%) and operative complications occurred in 3 cases (4.1%). Four cases ( 5.5%) died and 68 cases (93.2%) were cured. One case refused to be treated. CONCLUSIONS: The condition of serious pediatric airway obstruction patients is usually critical, the related causes could be complicated, quick diagnosis and timely removal of the obstruction factors are imperative.

[Expression and correlation with metastasis of E-cadherin, CD44H, matrix metalloproteinase-3, nm23H1 and VEGF in nasopharyngeal carcinoma].

OBJECTIVE: To investigate the expression of E-cadherin, CD44H, matrix metalloproteinase-3, nm23H1 and VEGF in nasopharyngeal carcinoma and its relationship to the metastasis. METHOD: The expression of E-cadherin, CD44H, matrix metalloproteinase-3, nm23H1 and VEGF in 62 patients with nasopharyngeal carcinoma was detected by immunohistochemical SP method. RESULT: In the group of nasopharyngeal carcinoma with lymph node metastasis, the expression of E-cadherin and nm23H1 reduced and the expression of CD44H and MMP-3 increased, and there were respectively significant difference compared to the group of non-lymph node metastasis, but there wasn't significant difference between the two groups in VEGF. Furthermore, expression of E-cadherin was inversely correlated with that of CD44H and MMP-3, and the expression of CD44H was positively correlated with that of MMP-3. In the group of nasopharyngeal carcinoma with distant metastasis, the expression of E-cadherin and nm23H1 also increased and the expression of CD44H, MMP-3 and VEGF all increased. Compared with the group of negative distant metastasis, there were respectively significant difference. In addition, there was a positive correlation between the expression of CD44H and VEGF. CONCLUSION: E-cadherin, CD44H, matrix metalloproteinase-3 and nm23H1 genes are closely related with lymph node and distant metastasis of nasopharyngeal carcinoma, while VEGF gene only relates to lymph node metastasis. They are important factors acting on metastasis of neoplasms.

[Clinical analysis of primary head and neck non-Hodgkin's ].

OBJECTIVE: To research the clinical features of primary head and neck non-Hodgkin's lymphoms (NHL). METHOD: 62 patients with primary head and neck NHL were analyzed in the positions of focuses, clinical aspects, diagnosis and treatment. RESULT: Tonsilla palatina(25.8%), cervical lymphonodi (19.4%), nasal cavity and nasal sinuses(12.9%) were the common place of the origin of NHL which had various clinical manifestations. High-grade malignant lymphomas represented 75.8% of these cases whose I E stage and II E stage were 38.7% and 24.2% respectively. The complete response, partial response, and response rate were 75.8%, 14.5%, and 90.3%, respectively. Some patients had been long-term survival without tumor. CONCLUSION: Head and neck NHL is generally high degree malignancy. It often originates from outside lymph node and easily metastasizes to lymph node. Accurate surgical biopsy linking immunohistochemical test will be advantageous to make a definite diagnosis. Combining Chemotherapy and radiotherapy or operation should be put into practice to improve prognosis.