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Objective:To present the clinical characteristics and treatment on patients with ectopic adrenocorticotropic hormone(ACTH) syndrome (EAS) caused by the retroperitoneal paraganglioma.Methods:The clinical data of a case of EAS caused by retroperitoneal paraganglioma were analyzed retrospectively, and the related literature at home and abroad was reviewed.Results:The 53-year-old female patient was admitted to endocrinology department due to a fifteen-year history of hypertension, accompanied by fatigue for three months, headache and dizziness for one month. The laboratory data demonstrated severe hypokalemia, high level of serum and urinary cortisol, while the ACTH level remained unsuppressed. The 24 h urinary vanillyl mandelic acid (VMA) and serum free methoxyepinephrine (MNs) level were elevated. The abdominal computed tomographic scan suggested a retroperitoneal mass next to the abdominal aorta. After the retroperitoneal tumor resection was performed, immunohistochemical staining of the tumor revealed Syn (+ ), CgA (+ ), ACTH (focal + ). By the retrospective analysis of 22 similar cases from 16 papers and the case summarized above, we found that most patients with EAS caused by the paraganglioma could demonstrate the typical clinical features of Cushing′s syndrome, while lack of the manifestation of paraganglioma. Therefore, preoperative preparations for paraganglioma were usually neglected.Conclusions:Ectopic ACTH syndrome (EAS) originating from paraganglioma is very rare. To improve the diagnosis rate, examination for catecholamine, MNs and 24 h urinary VMA before surgery in patients with EAS is suggested. Considering surgical resection as the optimal treatment, comprehensive preoperative preparations for both paraganglioma and Cushing′s syndrome are significant. A genetic test for pheochromocytoma/ paraganglioma and lifelong postoperative follow-up are also recommend.
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【Objective】 To analyze the risk factors related to the number of RBCs transfusion in neonates with neonatal respiratory distress syndrome (NRDS), and to explore the complications and the predictive indicators related to the increase of RBCs transfusion frequency. 【Methods】 NRDS newborns admitted to our hospital from January 2017 to January 2019 were selected and divided into three groups according to the number of RBCs transfusion, namely, non-transfusion group, 1~ 2 times group, and ≥3 times group. The clinical data and complications of the three groups were compared, and the risk factors leading to the increase of the number of blood transfusion were analyzed. 【Results】 Such factors as maternal age ≥35 years old, gestational age, birth weight, hemoglobin(Hb) at admission, non-invasive ventilation time, hospitalization time in neonatal intensive care unit(NICU), total enteral feeding time affected the blood transfusion frequency of the three groups(χ2=14.24, F=28.44, 41.70, 60.05, 3.83, 5.97, 4.40, P<0.05). The incidence of necrotizing enterocolitis (NEC), septicemia and feeding intolerance in blood transfusion ≥3 times group was significantly higher than that in 1~2 times group and non-transfusion group (χ2=19.30, 18.68, 6.98, P<0.05). Multivariate logistic regression analysis showed that birth weight, Hb at admission, length of stay in NICU and time of reaching total enteral feeding were independent risk factors for≥ 3 times of blood transfusion (OR=-3.942, -0.186, 0.530, 0.324, P<0.05). The ROC curve showed that birth weight and Hb at admission were effective in predicting blood transfusion ≥3 times, and the area under the ROC curve were 0.846 and 0.802, respectively, and the truncation values were 2.315 kg and 157.5 g/L. 【Conclusion】 Feeding intolerance, NEC and septicemia are the complications of the increased transfusion frequency in children with NRDS, and birth weight and hemoglobin at admission are effective in predicting blood transfusion ≥ 3 times.
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Objective:To evaluate the immunogenicity of Madin-Darby canine kidney (MDCK) cell-based quadrivalent influenza split vaccine (MDCK-Va) combined with different adjuvants.Methods:Different doses of MDCK-Va and chicken embryo-based quadrivalent influenza split vaccine (egg-Va) were intramuscularly immunized BALB/c mice twice with an interval of three weeks. Serum samples were collected to detect antibody titers using hemagglutination inhibition (HI) assay. BALB/c mice were immunized with different doses of MDCK-Va combined with QS21, AddVax, PolyI∶C, CpG ODN 1826 and AddVax/PolyI∶C (Add/Poly), respectively. HI and microneutralization assays were used to detect antibody titers 21 d after the first and booster immunization. Spleen tissues were collected from the mice immunized with 10 μg MDCK-Va combined with the above adjuvants 5 d after the booster immunization to analyze spleen index and the types of spleen cells.Results:The immunoprotective effect of MDCK-Va was not inferior to that of egg-Va. MDCK-Va combined with each of the above adjuvants could induce higher HI antibody titer than MDCK-Va alone, especially the QS21/Va and Add/Poly/Va groups, and the differences were statistically significant. For H1N1 vaccine, the Pearson′s correlation coefficient ( r) between HI antibody and neutralizing antibody was 0.737-0.910, and for H3N2 subtype vaccine, the value of r was 0.839-0.947. Compared with the MDCK-Va group, the QS21/Va group showed significantly increased spleen index and decreased proportion of single lymphocytes. QS21 and Add/Poly were much better than other adjuvants in stimulating mouse splenic neutrophils and CD4/CD8 cells. Conclusions:Add/Poly had a stronger immune enhancement effect on MDCK-Va, suggesting that it was a potential adjuvant for MDCK-Va. The antibody titer detected by HI and MN assays had a strong positive correlation.
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Objective:To compare the optimal conditions, virus yield, viral titer and cell metabolism between culturing influenza virus H1N1 vaccine strain in MDCK and MDCK-G1 cells.Methods:The optimal culture conditions were investigated using chessboard method. The hemagglutination titer, half of the tissue infection dose (TCID 50) and the metabolism of glucose and lactic acid were monitored and compared between the two cell lines. Results:After MDCK-G1 cells were inoculated with H1N1 at the multiplicity of infection (MOI) of 0.001 with the presence of 1 μg/ml of trypsin, the hemagglutination titer reached the peak of 1∶512 at 72 h and the viral titer was 10 7.4TCID 50/ml. In the MDCK cell line group, the hemagglutination titer reached the peak of 1∶256 at 72 h and the viral titer was 10 6.6TCID 50/ml when using H1N1 at MOI=0.0001 and 1 μg/ml of trypsin. Conclusions:MDCK-G1 cells were more suitable than MDCK cells for the proliferation of influenza virus. This study provided reference data for further research on cell-derived influenza vaccine.
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Objective To observe the effect of body temperature protection on enhanced recovery after surgery of patients undergoing laparotomy radical gastrectomy.Methods Sixty of patients ASA physical status Ⅰ or Ⅱ,aged 45-76 years,scheduled for elective radical gastrectomy were ran domly divided into 2 groups (n=30 each):heating blanket group and control group.In the heating blanket group,patients were warmed up during the whole perioperative period using the warmblanket until discharge from PACU;exposed skin as covered with clean surgical dressing;infusion,irrigation fluids and blood transfusions were warmed to 40℃;the bacteriological and viral filters were placed between the Y-piece of the breathing circuit and the tracheal tube.In the control group,patients were not given special heat preservation measures.For temperature measurements,an infrared tympanic ear thermometer was used.The core temperature of two groups were recorded at the pre-operative period (T1),before induction (T2),1 h after induction (T3),closing (T4),extubation （T5),discharging from PACU (T6).The dosage of anesthetic drug,volume of fluids infused,peritoneal fluid flushing volume,operation time,anesthesia time,ambient temperature,amount of bleeding,intrao perative blood transfusion,shivering,extubation time,incision infection and hospitalization time were recorded.Results There was no statistical difference in terms of temperature at T1 between the two groups.Compared with the T1,the core temperature of two groups of patients in T2-T6 were signifi cantly decreased (P ＜0.05).The perioperative core body temperature at T2-T6 was significantly higher in the heating blanket group than in the control group.The amount of bleeding and blood transfusion in perioperative period was significantly less that in the heating blanket group (P＜0.05).The incidence of shivering and surgical-wound infection were significantly lower in the heating blanket group (P＜0.05).The extubation time and hospitalization time were shorter in the heating blanket group (P＜0.05).Conclusion Combined body temperature protection measures can significantly reduce the incidence of inadvertent perioperative hypothermia (IPH) and improve postoperative outcomes for patients undergoing laparotomy radical gastrectomy.
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Objective To investigate the effects of Rosa Laevigata Michx Flavoid( RLMF) and Rosa laevigata Michx Polysaccharose (RLMP) on expression of TRPV5 in IgA Nephropathy (IgAN) rat renal tissue. Methods Forty Sprague-Dawley rats were randomly assigned to four groups.The rat model of IgA nephropathy was induced by intragastric administration of bovine serumalbumin and injections of LPS and CC14.Eight weeks later,the rats with IgAN were treated with RLMF or RLMP (4 weeks), or normal saline.Rats was sacrificed at thirteenth weeks, and RNA was extracted from the kidney.Expression of TRPV5 in tubulointerstitial tissues were analyzed by fluorescent quantitative RT-PCR. Results After RFLP intervention,the expression levels of TRPV5 were markedly increased (P<0.01) than model control group,while decreased (P<0.05) than normal control group but had no significance with model control group after RFLF intervention. Conclusion TRPV5 expression is decreased in IgAN,and RLMP can adjust TRPV5 expression and improve renal function of IgAN.
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Objective To investigate the mechanisms of hypoxia inducible factor-2 alpha (HIF-2a) regulating human umbilical vein endothelial cells (HUVECs) under hypoxic conditions.Methods The experimental study was adopted.(1) HUVECs in logarithmic growth phase were taken:HUVECs without any disposals as control group,HUVECs with shRNA transfection control as shRNA control group,HUVECs with HIF-2α shRNA transfection as HIF-2α shRNA group and HUVECs with HIF-2α shRNA transfection then added rhAng-2 as HIF-2α ± rh-Ang-2 group.(2) Western blot testing:the expressions of Ang-2 and HIF-2α proteins in HUVECs were cultured under hypoxia conditions at 0,2,4,8,12,16,20 hours,and the levels of which were detected in the control group,shRNA control group and HIF-2α shRNA group.(3) Enzyme-linked immunosorbent assay(ELISA):the level of Ang-2 protein in supernatant of HUVECs was detected in the control group,shRNA control group and HIF-2α shRNA group.(4)The amounts of endothelial cell tubes in HUVECs among the 4 groups were detected by tube formation experimental testing.(5) Transwell method was performed to detect the amounts of cells migration in HUVECs and hepatoma cells SMMC-7721 migration intervened by supernatant of HUVECs among the 4 groups.Measurement data with normal distribution were presented as x ± s,repeated measurement data were analyzed by the repeated measures ANOVA,comparison among groups and pairwise comparison were conducted respectively by the one-way ANOVA and Dunnett's test.Results (1) Western blot test:the expression levels of Ang-2 and HIF-2α proteins in HUVECs under hypoxia conditions at 0,2,4,8,12,16,20 hours were 0.110 ±0.011,0.120 ±0.020,0.210 ±0.070,0.410 ±0.100,0.520 ± 0.090,0.790±0.130 1.010 ±0.220 and 0.180 ±0.090,0.410 ±0.070,0.470 ±0.110,0.470 ±0.070,0.580 ± 0.120,0.690 ± 0.140,0.920 ± 0.130,respectively,and which were increased after culturing under hypoxia conditions and had an ascending tendency as the hypoxia time extended,with statistically significant differences (F =403.550,3 265.587,P ＜ 0.05).The expression levels of Ang-2 and HIF-2α proteins in the control group,shRNA control group and HIF-2α shRNA group were 1.030 ±0.180,1.070 ±0.120,0.210 ± 0.070,and 0.940 ± 0.110,0.930 ± 0.190,0.170 ± 0.021,respectively,showing statistically significant differences (F =290.242,26.688,P ＜ 0.05).(2) The results of ELISA:the expression levels of Ang-2 in the control group,shRNA control group and HIF-2α shRNA group were (433.2 ±9.7)ng/L,(438.3 ± 2.6)ng/L,(114.6 ± 4.2) ng/L,with a statistically significant difference (F =2 642.180,P ＜ 0.05).(3) The results of tube formation experiments:the number of endothelial cell tubes in the control group,shRNA control group,HIF-2α shRNA group and HIF-2α ± rh-Ang-2 group were 48.3 ± 2.5,47.4 ± 3.1,19.7 ± 1.5 and 38.3 ± 2.1,respectively,with a statistically significant difference (F =148.196,P ＜ 0.05).(4) The results of Transwell method:① the number of HUVECs migration in the control group,shRNA control group,HIF-2α shRNA group and HIF-2α + rh-Ang-2 group were 140.3-± 3.5,142.7 ± 2.1,42.7 ± 3.1 and 78.1 ± 4.2,respectively,showing a statistically significant differences (F =212.205,P ＜ 0.05).②The results of Transwell method:the number of SMMC-7721 cells migration after intervening using four different supernatant in the control group,shRNA control group,HIF-2α shRNA group and HIF-2α ± rh-Ang-2 group were 106.7 ± 5.5,102.7 ± 6.6,63.0 ± 3.3 and 96.7 ± 2.1,respectively,showing a statistically significant difference (F =55.122,P ＜ 0.05).Conclusion HIF-2a could not only affect HUVECs formation but also promote SMMC-7721 cells migration via regulating Ang-2 expression.
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<p><b>OBJECTIVE</b>To investigate the awareness of occupational low back pain and knowledge of related prevention and healthcare measures among midwives, and to determine the incidence of low back pain among them.</p><p><b>METHODS</b>A questionnaire survey was carried out with the use of Roland-Morris Disability Questionnaire (Chinese version) (CRMDQ) among 244 midwives from second- and third-class hospitals in Tianjin, China. Related indices were statistically analyzed.</p><p><b>RESULTS</b>Among 244 midwives who participated in the survey, only 18.4% knew the definition of occupational low back pain, 28.3% knew the pathogenic mechanism, and 54.1% knew its harm. About 9.4%∼85.2% of midwives mastered at least one method for prevention and health care against occupational low back pain. Proper or improper use of human body mechanics was closely related to the development of occupational low back pain (P < 0.01). There was a high proportion of midwives with a demand for application of human body mechanics principle in operation, and the proportion was as high as 99.2%. All the 24 items in CRMDQ were scored, with the lowest score of 1, the highest score of 24, and an average score of 8.5 ± 7.2.</p><p><b>CONCLUSION</b>The awareness rate of occupational low back pain was low among the 244 midwives in this study. The incidence of low back pain, which had influenced the health status and occupational practice, was high among them.</p>
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Adult , Humans , Middle Aged , Health Knowledge, Attitudes, Practice , Low Back Pain , Epidemiology , Midwifery , Occupational Diseases , Epidemiology , Surveys and QuestionnairesABSTRACT
Objective To observe the influence of combined spinal and epidural anesthesia( CSEA) of different po-sitions on the anesthesia effect, anesthesia operation and hemodynamic index during cesarean section of obese par-turients. Methods Eighty obese parturients[BMI≥30] undergoing cesarean section were randomly divided into two groups, that was group A and B, with 40 cases each. In group A, the parturients were required to undergo lat-eral decubitus position with 0.5% ropivacaine hydrochloride of 2. 4 ml. In group B, the parturients were required to undergo sitting position with the same ropivacaine hydrochloride as group A. The following data was recorded, which were the percentage of one-attempt's successful epidural needle placement, the anesthesia level,the anesthe-sia effect and the hemodynamic change. All the complications were also observed,such as the supine hypotension syndrome during operation,headache after spinal anesthesia and postoperative spinal nerve stimulation. ResultsThe difference of anesthetic effect between the two groups was insignificant in statistics while group B's rate of one-attempt successful puncture was higher than gruop A ( P <0.05 ) . The difference of hemodynamic index between them was significant in statistics ( P<0.05 ) with group B's rate of supine hypotension syndrome lower than group A. Conclusion Both body positions have the same anesthtic effect for obese parturients during cesarean section while the puncture operation of sitting positon is easier than lateral decubitus position and the hemodynamic change is also more stable.
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Objective To investigate the effects of parecoxib pretreatment on the intrapulmonary shunt during one-lung ventilation in patients undergoing esophageal cancer resection.Methods Forty ASA Ⅰ or Ⅱ patients of both sexes,aged 25-64 yr,weighing 45-70 kg,with body height 156-178 cm,undergoing elective esophageal surgery,were randomly divided into 2 groups (n =20 each):normal saline group (group NS) and parecoxib group (group P).Parecoxib 40 mg (in normal saline 10 ml) was injected intravenously 30 min before anesthesia in group P,while the equal volume of normal saline was given instead of parecoxib in group NS.Anesthesia was induced with iv injection of propofol,fentanyl and rocuronium.Bronchial blocker was inserted after tracheal intubation and the correct position was confirmed by bronchoscopy.Anesthesia was maintained with iv infusion of propofol and remifentanil and intermittent iv boluses of atracurium.HR,MAP,SpO2 and mean airway pressure (Pmean)were determined at 5 min of two-lung ventilation,at 40 min of one-lung ventilation,and at 30 min after re-expansion of the collapsed lung (T0-2).Blood samples were taken simultaneously from jugular vein and radial artery for blood gas analysis.Intrapulmonary shunt (Qs/Qt) was calculated.Results There were no significant differences in hemodynamic parameters and Pmean between the two groups (P ＞ 0.05).PaO2 was significantly lower,while Qs/Qt was significantly higher at T1,2 than at T0 in groups NS and P (P ＜ 0.05).PaO2 was significantly higher,while Qs/Qt was significantly lower at T2 than at T1 in groups NS and P (P ＜ 0.05).Qs/Qt was significantly lower at T1,2 and PaO2 was significantly higher at T2 in group P than in group NS (P ＜ 0.05).Conclusion Parecoxib 40 mg injected intravenously at 30 min before anesthesia can reduce the intrapulmonary shunt during one lung ventilation in patients undergoing esophageal cancer resection.
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Objectives To investigate the incidence of brain injuri in premature infants in ten hospitals of seven large cities in China sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association. Methods All premature infants with gestational age less than 37 weeks in ten hospitals were given routine cranial ultrasound within three days of birth, and then repeated every 3-7 days till the discharge from the hospital during January 2005 to August 2006. Results Incidence of intraventricular hemorrhage (IVH) and severe IVH were 10.8% (406/3 768) and 2.4% (92/3 768) with 22.6% (92/406) for grade 1, 54.7% (222/406) for grade 2, 17.2% (70/406) for grade 3 and 5.4% (22/406) for grade 4 in nine hospitals; incidence of periventricular leukomalacia (PVL) and cystic PVL were 2.3% (112/4 933) and 0.3% (16/4 933) with 85.7% (96/112) for grade 1, 12.5% (14/112) for grade 2, and 1.8% (2/112) for grade 3 including all ten hospitals, respectively. Risk factors associated with increased severity of IVH were vaginal delivery (OR = 1.874, 95% CI = 1.172 - 2.997, P < 0.01), perinatal asphyxia (OR = 1.598, 95% CI = 1.077 - 2.372, P < 0.05), mechanical ventilation (OR = 3.988, 95% CI= 2.448 -6.948, P< 0.01), and amniotic fluid contamination (OR = 2.192, 95% CI = 1.054 - 4.544, P< 0.05). Risk factors that might result in the development of cystic PVL were vaginal delivery (OR = 1.400, 95% CI = 1.186 - 1.652, P < 0.001) and mechanical ventilation (OR = 3.000, 95% CI = 1.015 - 8.864, P < 0.05). Conclusions These data reflect basically the prevalence of brain injuriy in premature infants in major cities of China. However, more than 60% of population lives in the rural area, further multicenter investigation including the rural area is expected to be undertaken in future.
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Objective To study the prevalence of intraventficular hemorrhage(IVH)in premature infants using bedside cranial ultrasound scans and to analyze the associated laboratory results.Methods 114 patients admitted between February 2003 and March 2004 were eligible for the study.NAS-2000A 3D ultrasound instrument for bedside ultrasound detection were used.All the premature infants were detected for blood gas analysis,blood cell analysis(red blood cell counting,haemoglobin and haematocrit),prothrombin time (PT),fibrinogen(FIB)and activated partial thromboplastin time(APTT)in the first 24 hours of life.Results There were 34 IVH cases in 114 patients(29.8%).The ineidence of IVH of premature infants below 34 weeks gestation was 43.8%,which was higher than that of infants above 35 weeks gestation.The incidence of IVH of infants whose birth weight were below 1 500 g is 58.8%,which was higher than that of infants whose birth weight were above 1 500 g.The incidence of IVH increased with decreasing gestational age and birth weight.As compared with the values of infants without IVH,HB and HCT of the IVH infants were higher (P＜0.05);PT and APTT of the IVH inrants were longer(P＜0.01);hypoxia,hypercapnia and acidosis were more common in IVH infants(P＜0.05).Conclusion Risk factors such as short gestational age,low birth weight,increased HB and HCT,prolongation of PT and APTT,hypoxia,hypercapnia and acidosis may be associated with the IVH in premature infants.
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Seven cases of typical salpingian diverticulum were identified by hysterosalpinography (HSG). The differentiation diagnosis of the disease was discussed. HSG is believed to be the method of choice for the diagnosis of this disease.
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Adult , Female , Humans , Adnexal Diseases , Diagnostic Imaging , Diagnosis, Differential , Diverticulum , Diagnostic Imaging , Fallopian Tubes , HysterosalpingographyABSTRACT
Seven cases of typical salpingian diverticulum were identified by hysterosalpinography (HSG). The differentiation diagnosis of the disease was discussed. HSG is believed to be the method of choice for the diagnosis of this disease.
Subject(s)
Adnexal Diseases/diagnostic imaging , Diagnosis, Differential , Diverticulum/diagnostic imaging , Fallopian Tubes , HysterosalpingographyABSTRACT
Objective To investigate the frequency of type 2 diabetes and diabetic complications. Methods The clinical and laboratory data of 1433 cases of patients with type 2 diabetes mellitus were retrospectively analyzed. Results The frequency of diabetic complications of patients with type 2 diabetes mellitus were 88.28%(1626/1433). The rates of complicated hypertension, coronary heart disease, peripheral neuritis, diabetic renopathy, diabetic retinopathy, hyperlipoidemia, urethritis, diabetic acidosis, pneumonia, fatty liver, diabetic foot gangrene, cholecystitis, skin infection, brain vessel disease and vegetative nerve disease were 46.9%, 33.2%, 29.7%, 25.4%,22.0%,13.0%,7.5%,4.2%,4.0%,4.0%,3.5%,3.5%,3.3%,2.9%,and 2.0%, respectively. Conclusion The frequency of diabetic complications of patients with type 2 diabetes mellitus were much high, and the distrubution of diabetic complications was different in different ages, course of disease and syndromes.