Predictive factors for re-bleeding of esophageal varices in hospitalized patients.

Bleeding due to esophageal varices is associated with high mortality and hospital costs. The incidence of morbidity and mortality can be reduced with appropriate treatment measures by identifying the predictors of re-bleeding at admission. Therefore, this study aimed to determine the risk factors for re-bleeding in hospitalized esophageal varices patients using factors included in the Child Turcotte Pugh (CTP) scoring system. In this cross-sectional study, 100 patients were evaluated for bleeding from esophageal varices. Some characteristics and variables were recorded, including age, gender, cause of disease, CTP classification score, and clinical, endoscopic, and laboratory findings. Patients were divided into two groups with and without bleeding from esophageal varices, and predictive factors were identified in both groups. Besides, a genetic predictor factor, i.e. plasminogen activator inhibitor type I (PAI-1), was evaluated by the Real-time PCR technique. Sixty-eight patients in the non-re-bleeding group with a mean age of 49.88 ± 16.42 years and 32 patients with a mean age of 54.22 ± 19.81 years were in the group with re-bleeding. Varicose vein size, encephalopathy, ascites, and CTP classification had a predictive effect on re-bleeding. Twelve people were in class A, 59 people in class B and 29 people in class C had CTP classification. The sensitivity of CTP, PAI-1 gene expression, and bilirubin in prediction through the ROC chart were calculated to be more than 85%, 61.4%, and 62%, respectively. In general, determining the degree and score of CTP at the time of referral of a patient with varicose hemorrhage provides valuable information on the risk of bleeding. Patients with class B CTP were strongly susceptible to re-bleeding in this study. Also, with increased bilirubin or ascites and more severe encephalopathy, the risk of bleeding is higher, and these people should be followed up.

Correlation analysis of the severity of alcoholic fatty liver disease,fat area in the abdominal cavity and serum inflammatory factors / 中国综合临床

Objective To investigate the correlation between the severity of alcoholic fatty liver disease and the amount of fat in the abdominal cavity and the serum inflammatory factor IL-18 and IL-8. Methods From October 2016 to October 2017,one hundred and twenty patients with AFLD in the First Hospital of Hebei Medical University were divided into light,medium,heavy groups according to the severity of fatty lesions by color Doppler Ultrasound. There were 40 mild patients,50 moderate patients and 30 severe patients. Forty healthy subjects were selected as controls. All the participants underwent CT scanning. The intra-abdominal fat area (VAT),abdominal subcutaneous fat area (SAT) and total abdominal fat area (TA) were measured. The liver function was measured by biochemical analyzer and enzyme-linked immunoassay (ELISA). (ELSIA) IL-18 was detected and IL-8 was detected by radioimmunoassay. Results The VAT of the healthy control group and the mild,medium and severe AFLD group were (70. 28±10. 19),(114. 38 ± 9. 97),(146. 73±10. 19),(163. 38±12. 69) cm2. The TA of the healthy control group and the mild, medium and severe AFLD group were ( 256. 72± 34. 56),( 332. 19 ± 33. 28),( 387. 49± 32. 28),( 478. 19 ±31. 02) cm2. The SAT of the healthy control group and the light,medium and severe AFLD group were (156. 23±28. 19),(203. 43±27. 12),(246. 19±26. 89),(271. 19 ±27. 94) cm2,respectively. Aspartate aminotransferase (AST) of the healthy control group and the mild,medium and severe AFLD group were (18. 50±1. 12),(23. 50±1. 21),(25. 50±1. 24),(29. 50± 1. 43) U/L. Alanine aminotransferase (ALT) of the healthy control group and the light, medium and severe AFLD group were ( 18. 50 ± 2. 14), ( 26. 50 ±2. 22),(35. 50±2. 34),(38. 50±2. 11) U/L. γ-glutamyltransferaseof the healthy control group and the light,medium and severe AFLD group were ( 16. 50 ± 2. 11), ( 32. 50 ± 2. 23), ( 47. 50 ± 2. 31), ( 48. 00 ±2. 43) U/L,respectively. Compared with the healthy control group,VAT,TA,SAT,AST,ALT andγ-GT in the light,medium and heavy AFLD group showed statistically significant differences ( P＜0. 05) . Compared with the mild AFLD group, VAT, TA, SAT, AST, ALT and γ-GT in the medium and heavy AFLD group showed statistically significant differences ( P＜0. 05) . Compared with the moderate AFLD group,the VAT, TA,SAT, AST, ALT, and γ-GT of the severe AFLD group showed statistically significant differences ( P＜0. 05). The data of the three AFLD groups showed that the concentration of all indicators were increasing as the severity of fat deepened. IL-18 of the healthy control group and the light,medium and severe AFLD group were (45. 67±4. 51),(52. 18±5. 09),(59. 87±4. 98),(64. 18±5. 12) ng/L; IL-8 of the healthy control group and the light, medium and severe AFLD group were ( 78. 92 ± 5. 07), ( 115. 62 ± 4. 89), ( 223. 76 ± 6. 78),(286. 42±7. 02) g/L. Compared with every group,IL-18 and IL-8 of light,medium and severe AFLD group showed statistically significant differences (F＝1035. 67,2. 93×105,P＜0. 001); compared with mild AFLD group,IL-18 and IL-8 of medium and heavy group showed statistically significant differences;compared with moderate AFLD group,IL-18 and IL-8 of severe group AFLD showed statistically significant differences ( P＜0. 001) . The levels of inflammatory factors IL-18 and IL-8 increased with the severity of steatosis. The severity of AFLD was significantly positively correlated with VAT,TA,SAT,IL-18 and IL-8 ( r 0. 415(P＜0. 001), 0. 435 ( P＜0. 001), 0. 512 ( P＜0. 001), 0. 274 ( P＜0. 001 ), 0. 689 ( P ＜0. 001). Conclusion Fat control is an important measure to prevent AFLD. IL-18 and IL-8 can reflect the severity of liver injury in AFLD and have important significance in judging prognosis.

Effect of peripheral blood neutrophil to lymphocyte ratio and high-sensitivity C-reactive protein on recurrence in patients with paroxysmal atrial fibrillation after radiofrequency ablation / 中国综合临床

Objective To discuss the efficacy of NLR and hs-CRP levels on recurrence in patients with paroxysmal atrial fibrillation after radiofrequency catheter ablation. Methods Eighty-nine cases of paroxysmal atrial fibrillation treated by radiofrequency ablation in Chaoyang Central Hospital from May 2011 to October 2015 were selected and were divided into the recurrence group and non-recurrence group according to the recurrence. The preoperative NLR and hs-CRP levels were observed,and the correlation between NLR and hs-CRP was analyzed. Logistic regression analysis was used to analyze the risk factors of postoperative recurrence of atrial fibrillation. Results 27 cases were recurred after 1 year follow-up,the recurrence rate was 30. 3%( 27/89) . 27 cases in the recurrence group, 62 cases in the non-recurrence group. The disease duration of the recurrence group and the non-recurrence group were (7. 6±3. 4)years and (5. 3±2. 5) years respectively. The left atrial diameter (LAD) were (39. 09±3. 27) mm and (35. 91±3. 95) mm,NLR were(3. 69±0. 67) and (2. 58±0. 40),hs-CRP were (5. 20±2. 45) mg/L and (3. 09±1. 70) mg/L respectively in the two groups,the differences were statistically significant between the two groups (P＝0.001,0.002,0.004,0.001).Pearson correlation analysis showed that there was a positive correlation between NLR and hs-CRP (r＝0. 58,P＜0. 01). Logistic regression analysis showed that NLR,hs-CRP,LAD were risk factors of recurrence (OR(95%CI):2. 071( 1. 689～ 3. 301 ), 1. 760 ( 1. 096～ 4. 286 ), 1. 943 ( 1. 025～ 3. 607 )) ( P ＝ 0. 019, 0. 030, 0. 035). Conclusion The levels of NLR and hs-CRP are associated with the recurrence of atrial fibrillation in patients with radiofrequency ablationts. NLR value and serum hs-CRP increased are the risk factors of recurrent atrial fibrillation after radiofrequency catheter ablation,which can be used as independent predictors of atrial fibrillation recurrence after radiofrequency ablation.

Ultrastructural changes and HSP70 expression in mice liver after microwave irradiation with lethal dose / 局解手术学杂志

Astract:Objective To investigate the ultrastructural changes and HSP70 expression in liver of mice after microwave irradiation with lethal dose and to explore the application of these indexes as the basis of medical identification in microwave irradiation induced death. Methods The mice were divided into the control group and the irradiation group. Mice of the irradiation group were induced death by whole body exposure to 129 W/cm2 microwave irradiation for 30 minutes. The ultrastructure of liver was observed by transmission electron micro-scope;changes of the HSP70 mRNA and protein expression in liver were detected by reverse transcription polymerase chain reaction ( RT-PCR) and Western blotting respectively. Results Liver cytoplasm was observed dissolved with points and sheets and there were mitochondri-al crest and membrane solution in the irradiation group. And the HSP70 mRNA and protein expression level increases significantly compared with the control group with statistically significant difference (P<0. 01). Conclusion Death induced by microwave irradiation could lead to liver cytoplasm dissolution, mitochondria damage, mRNA and protein expression of HSP70 up-regulation, which may be used as important diagnostic indicators of microwave irradiation induced death.