[The 497th case: fever, anterior hypopituitarism, lymphadenopathy].

A 57-year-old woman was admitted to hospital with fever. She still had fever treated with multiple antibiotics, and no definite evidence for infection was found. Hypothermia and hypotension developed, and magnetic resonance imaging (MRI) examination showed enlarged anterior pituitary and multiple small nodular lesions with mild enhancement on the left side. Hormone replacement and anti-infection treatment were administrated, but fever did not improve. Remarkable lymphadenopathy was found in left supraclavicular area. The pathology of lymph node biopsy indicated peripheral T-cell lymphoma (not otherwise specified, NOS). Positron emission tomography-computed tomography (PET-CT) revealed hypermetabolism in multiple lymph nodes, infiltration of the liver and spleen. The final diagnosis were peripheral T-cell lymphoma with involvement of liver and spleen (stage Ⅳ) and anterior hypopituitarism. After chemotherapy, fever alleviated and the function of anterior pituitary recovered gradually.

[Application of adaptive statistical iterative reconstruction V (ASIR-V) in contrast-enhanced abdominal scanning with low-dose for liver cirrhosis].

Objective: To investigate the application of adaptive statistical iterative reconstruction-V (ASIR-V) in contrast-enhanced abdominal CT scanning with low-dose for liver cirrhosis. Methods: From June 2017 to May 2018, a total of 112 liver cirrhosis patients who underwent contrast-enhanced abdominal CT scanning were collected prospectively as the study group. According to Child-Pugh grading of liver function, the study group was divided into A, B and C groups. Thirty examiners with normal liver function who underwent contrast-enhanced abdominal CT scanning no abdominal diseases were collected as the control group. The control group applied 0 pre-ASIR-V. The study group applied 30%, 40% and 50% pre-ASIR-V in plain scanning, arterial and portal vein phase, respectively. The control and study group both combined with 60% post-ASIR-V. The difference of qualitative parameters (contrast to noise ratio of the liver, pancreas, spleen, abdominal aorta and portal vein), image noise and radiation dose were compared by One-way ANOVA. Subjective score of images were compared by Kruskal-Wallis H test. Results: The volume computed tomography dose index (CTDI(vol)), dose length product (DLP) and the effective dose (ED) of study group were lower than the control group in the same phase (F=13.354-28.192, P<0.01). And the ED were decreased by 1.12 (23.9%), 1.54 (33.5%), 2.14 mSv (46.7%). The CNR values of liver and portal vein in Child C group was 0.34-0.42 and 0.43-0.49 lower than that of Child A and control group, respectively (q=2.851-4.658, P<0.05). Image noise had no difference in study and control group. There were no statistical differences between each group of subjective score in arterial and portal vein phase. The mean score of Child C in portal phase was lower than 3, which affected the diagnosis. And there were significant difference among the control, Child A and Child C group(Z=26.734-29.218, P<0.05). Conclusions: According to the classification of liver function, liver cirrhosis combined with ASIR-V can ensure the image quality while reduce the radiation dose. When liver function is Child-Pugh A or B, preset 50%ASIR-V is recommended; 40%ASIR-V is recommended for Child-Pugh C.

[Application of DDI in prediction of fertility outcome after laparoscopic myomectomy].

Objective: To analyze the application of difficulty degree index (DDI) in predicting patients's fertility outcome after laparoscopic myomectomy. Methods: A retrospective study was carried out on 118 patients with subserous myoma or intramural myoma undergoing laparoscopic myomectomy from January 2005 to December 2014. The rate of post-operative pregnancy, delivery outcome and disease recurrence were investigated. Logistic regression analysis was used to analyze the impact of DDI, the age of patients undergoing surgery, presence of infertility history etc, on the patients' reproductive outcome following the surgery. Results: Follow-up for 1 to 10 years,118 cases were included in the study, the rate of post-operative pregnancy, live birth, vaginal delivery were 72.9% (86/118) , 52.5% (62/118) and 24.2% (15/62) respectively. No cases of uterine rupture and obstetric complications occurred. Univariate analysis showed that the independent variables of post-operative pregnancy rate were DDI, patient's age at the time of surgery, presence of infertility history and myoma recurrence (all P<0.05) . In multivariate analysis, the factors of post-operative pregnancy rate were DDI (OR=3.131, 95%CI:1.012-8.894) , patient's age at the time of surgery (OR=2.722, 95%CI:1.048-7.067) and presence of infertility history (OR=8.509, 95%CI: 2.102-34.445) . Conclusions: DDI could be applied to predict post-operative pregnancy rate, with the increasing of DDI the post-operative pregnancy rate decreasing. The patients with high DDI scores, age>35 years old or presence of infertility history should get ready for pregnancy positively.

[Comparative study on image quality of third-generation dual-source CT pulmonary angiography combined with advanced modeled iterative reconstruction].

Objective: To quantitatively evaluate the quality of advanced modeled iterative reconstruction (ADMIRE) combined with 70 kVp and linear blending images in low dose dual energy (70 kVp/sn150 kVp) pulmonary angiography. Methods: A total of 74 cases with normal BMI underwent dual-source CT dual-energy pulmonary angiography with small amount of contrast medium (30 ml) from 2015 to 2017 from the First Affiliated Hospital of Zhengzhou University were randomly assigned to protocol Ⅰ(100 kVp/sn140 kVp) or protocol Ⅱ(70 kVp/sn150 kVp). 70 kVp+ ADMIRE (group 1), linear blending+ ADMIRE (group 2), 100 kVp+ SAFIRE (group 3) images were obtained. CT value and noise standard deviation (SD) of pulmonary arteries were measured in pulmonary trunk artery, left pulmonary artery and left superior pulmonary artery, then SNR and CNR were calculated. Radiation dose parameters (CTDIvol, DLP) were recorded. Results: CT values of pulmonary artery of group 1 were significantly higher than those in group 2 and 3 (both P<0.05). In group 2, SD value of pulmonary artery was lower than that of group 1 and 3(both P<0.05). SD value of pulmonary trunk and left pulmonary artery in group 1 was higher than that in group 3 (P<0.05), SD value of left superior pulmonary artery had no significant difference between group 1 and group 3 (P>0.05). SNR and CNR value in group 1 and group 2 had no statistical difference, but they were both higher than that in group 3 (both P<0.05). The effective dose of protocolⅠwas 46% lower than protocol Ⅱ. Conclusion: ADMIRE combined with 70 kVp and linear blending images are better than SAFIRE combined with 100 kVp images, and radiation dose is reduced.70 kVp/sn150 kVp with small amount of contrast medium (30 ml) is a feasible dual energy pulmonary artery scanning protocol.

An Individualised Strategy and Long-Term Outcomes of Endovascular Treatment of Budd-Chiari Syndrome Complicated by Inferior Vena Cava Thrombosis.

OBJECTIVES: The aim was to evaluate individualised treatment and long-term outcomes of endovascular treatment of Budd-Chiari syndrome (BCS) complicated by inferior vena cava (IVC) thrombosis. METHODS: Between April 2005 and December 2015, 108 consecutive patients with BCS complicated by IVC thrombosis underwent endovascular treatment. According to the type, size, extent, and degree of organisation of the thrombus, agitation thrombolysis (n = 7), agitation thrombolysis combined with retrieval stent filter (n = 5), pre-dilation (n = 32), retrieval stent filter (n = 56), or direct large balloon dilation (n = 8) was performed. Peri- and post-operative follow-up data were recorded. RESULTS: The endovascular treatment was technically successful in 107 of the 108 patients (99.1%). The incidence of thrombosis related complications was 7.4% (8/108). Major and minor complications occurred in four patients. The mean follow-up duration was 61.7 ± 39.3 months (range 3-140 months). The cumulative 1, 2, 5, and 10 year primary patency rates were 91%, 88%, 79%, and 79%, respectively, and the cumulative 1, 2, 5, and 10 year secondary patency rates were 100%, 100%, 97%, and 97%, respectively. The cumulative 1, 5, and 10 year survival rates were 95%, 86%, and 81%, respectively. Serum albumin and total bilirubin values were independent predictors of survival. CONCLUSIONS: For patients with BCS complicated by IVC thrombosis, an individualised endovascular treatment strategy based on the type, size, extent, and degree of organisation of the thrombus is associated with long-term patency of the IVC and favourable survival and complication rates.

[Long-term effect of environmental cadmium exposure on human body's mineral metabolic balance].

OBJECTIVE: To investigate the effect of long-term exposure to environmental cadmium on eight mineral element's metabolic balance of human body. METHODS: To choose a high cadmium area polluted by smelting and mining north of Guangdong province and a cadmium-free area with a similar economic level, and living and eating habit of residents as a contrast from April 2011 to August 2012. Stratified random sampling and clustered sampling method were adopted to choose the non-occupationally cadmium-exposed respondents who have lived in local area for more than 15 years, older than 40 years, having local rice and vegetable as the main dietary source, with simple and relatively stable diet, and without diabetes, kidney disease, thyroid disease, liver disease or other history of chronic disease. This study included 298 respondents, of whom 155 were in cadmium exposure group and 143 in control group. Questionnaires was used to acquire their health status and their morning urine samples were collected. Electrolytically coupled plasma mass spectrometry (ICP-MS) was used to test the concentrations of sodium(Na), magnesium (Mg), phosphorus (P), potassium (K), calcium (Ca), copper (Cu), zinc (Zn) and iodine (I). The Mann-Whitney U test method was used to compare the differences of concentrations of urinary cadmium, Na, Mg, P, K, Ca, Cu, Zn, I, and the ratio of Na to K (Na/K), Ca to P (Ca/P) between exposed group and control group.χ(2) test was used to compare the abnormal rate of urinary cadmium between exposed group and control group. Pearson correlation and multiple regression method were used to investigate the relationship between urinary cadmium levels, gender, age, smoking, passive smoking, and minerals. RESULTS: The urinary cadmium level P50 (P25-P75) in exposed group was 5.45 (2.62-10.68) µg/g·cr, which was higher than that of the control group, which was 1.69 (1.22-2.36) µg/g·cr (Z=-10.49,P<0.001). The abnormal rate of urinary cadmium was 51.6% (80/155), which was higher than that of the control group (2.8 %(4/143)) (χ(2)= 87.56, P<0.001). The urinary Ca, Cu, Zn, and I level P50 (P25-P75) of exposed group were 173.80 (114.40-251.70), 20.55 (14.95-28.44), 520.23 (390.25-647.15), and 246.94 (203.65-342.97) µg/g·cr, which were higher than those in control group (142.42 (96.87-179.11), 15.44 (12.26-20.98), 430.09 (309.85-568.78) and 213.85 (156.70-281.63) µg/g·cr, respectively) (Z values were-4.33,-5.04,-3.47 and-4.24, all P values <0.001). The urinary P, K level P50 (P25-P75) of exposed group were 582.50 (463.20-742.8), 890.10(666.00-1 305.40) µg/g·cr, which were lower than control group (694.50 (546.20-851.17), 1 098.58(904.53-1 479.18) µg/g·cr) (Z values were-3.36,-4.02, all P values <0.001). on Based the results of Pearson correlation analysis, urinary cadmium was positively correlated with urinary Ca, Cu, Zn, and I, and the correlation coefficients were 0.31, 0.61, 0.38, and 0.25, respectively (all P values <0.05). Based on the results of multiple regression analysis, urinary cadmium levels contributed most to the metabolic balance of urinary Ca, Cu, Zn and I. The standardized regression coefficients were 0.31, 0.59, 0.39, and 0.24, respectively (all P values<0.001). CONCLUSION: Long-term environmental exposure to cadmium affected the metabolic balance of Ca, Cu, Zn and I in human body.

[Cadmium burden and renal dysfunction among residents in cadmium-polluted areas: A 3-year follow-up study].

OBJECTIVE: To investigate dynamic change of cadmium body burden and renal dysfunction among residents living in cadmium-polluted areas. METHODS: From April to July of 2011, the cadmium-polluted areas of northern Guangdong province in China was chosen as the study site. Based on the levels of cadmium pollution in soil and rice, the survey areas were divided into low exposed group (average concentration of cadmium was 0.15-0.40 mg/kg, 0.5-1.0 mg/kg in rice and soil, respectively) and high exposed group (average concentration of cadmium was >0.40 mg/kg, >1.0 mg/kg in rice and soil, respectively). Stratified random sampling and cluster sampling method of epidemiological investigations were carried out among 414 local residents who lived in cadmium exposure areas for more than 15 years, aged above 40, and without occupational cadmium exposure, including 168 and 246 residents in low and high exposed group, respectively. From March to June of 2014, 305 respondents of those who participated in 2011 were successfully traced, including 116 and 189 respondents in low and high exposed group, respectively. We used health questionnaires to acquire their health status. Home-harvested rice and vegetable samples were collected using quartering method for detection of cadmium level, including 190 rice samples, 161 vegetable samples in 2011 and 190 rice samples, 153 vegetable samples in 2014. Urine specimens of residents were collected for the detection of urinary cadmium and creatinine as well as renal dysfunction biomarkers, namely, N-acetyl-beta-D-glucosamidase (NAG) and ß2-microglobulin (ß2-MG), respectively. In 2011 and 2014, Chi-square test was used to investigate the differences of abnormality of cadmium concentration in rice, vegetables and urinary cadmium, ß2-MG, and NAG that were expressed as odds ratio(OR) and 95% confidence intervals (95%CI). RESULTS: In 2011 and 2014, cadmium concentration P50 (P25-P75) in rice was 0.43 (0.17-1.10) mg/kg, and 0.42 (0.20-1.14) mg/kg, respectively (Z=-0.77,P=0.440). In 2011 and 2014, cadmium concentrations P50 (P25-P75) in vegetables were 0.13 (0.07-0.34) mg/kg, and 0.25(0.12-0.59) mg/kg, respectively, with abnormal rates of 38.5%(62/161) and 60.8%(93/153), respectively. In 2014, both average concentration and abnormal rate of cadmium in vegetables were higher than those in 2011 (Z=-4.69, P<0.001 and χ(2)=15.58,P<0.001). Concentrations of urinary cadmium P50 (P25-P75) in high exposed group were 7.90 (3.96-14.91) µg/g creatinine, 8.64 (4.56-17.60) µg/g creatinine in 2011 and 2014, respectively. Contrary to that in 2011, urinary cadmium of high exposed group was significantly increased in 2014 (Z=-2.80, P=0.005). In 2011 and 2014, concentrations of ß2-MG, NAG P50 (P25-P75) were 0.15(0.07-0.29) µg/g creatinine, 0.15 (0.07-0.45) µg/g creatinine, and 7.12 (5.05-10.65) U/g creatinine, 13.55(9.1-19.84) U/g creatinine, respectively, with abnormal rates of 7.5% (23/305), 15.1% (46/305), 8.2% (25/305) , and 33.8% (103/305), respectively. Compared with baseline in 2011, average concentrations of ß2-MG, NAG significantly increased in 2014 (Z=-2.263, P=0.024 and Z=-12.52, P<0.001), and abnormal rates of ß2-MG, NAG were also higher in 2014 (χ(2)=15.61 , P<0.001 and χ(2)=64.72, P<0.001), with odds ratio(OR) of 2.00 (95%CI:1.23-3.24) and 4.12 (95%CI:2.87-5.92). CONCLUSION: Environmental cadmium pollution of crops such as rice and vegetables in survey areas continued to remain high. Body burden of cadmium might kept at sustainably high levels and renal dysfunction was worsened after continuous, long-term cadmium exposure. Our results suggested that NAG might be more sensitive than ß2-MG to serve as an indicator for an individual's future tubular function.

Evaluation of pilot-scale microencapsulation of probiotics and product effect on broilers.

This study was conducted to evaluate the pilot-scale production of microencapsulated in a 500-L fermenter using emulsion and gelation and to assess the effect of the products on the growth performance, antioxidant activity, immune function, and cecal microbiota in Arbor Acres broilers. A total of seven hundred 1-d-old male Arbor Acres broilers were randomly assigned to 7 dietary treatments with 5 replicate pens per treatment and 20 broilers per pen. The dietary treatments were as follows: 1) basal diet (CON), 2) basal diet containing 0.1% Aureomycin (ANT), 3) basal diet containing unencapsulated at a dose of 1 × 10 cfu/kg of feed (P1), 4) basal diet containing unencapsulated at a dose of 1 × 10 cfu/kg of feed (P2), 5) basal diet containing 0.01% empty microcapsules (CAP), 6) basal diet containing microencapsulated at a dose of 1 × 10 cfu/kg of feed (CAPP1), and 7) basal diet containing microencapsulated at a dose of 1 × 10 cfu/kg of feed (CAPP2). The feeding experiment included 2 phases: the starter phase from d 1 to 21 and the grower phase from d 22 to 42. The results showed that a 500-L fermenter could produce 20.73 ± 4.05 kg of microcapsules with an approximate diameter of 549 µm. The feeding experiment showed that ADG of broilers in CAPP1 was significantly ( < 0.05) greater than that in CON and CAP throughout the feeding period, whereas the ratio of feed to gain (G:F) was significantly ( < 0.05) lower. Broilers in P1, P2, CAPP1, and CAPP2 had significantly ( < 0.05) greater levels of total superoxide dismutase, catalase, IgG, and cluster of differentiation 3 than those in CON. Furthermore, broilers in CAPP1 had significantly ( < 0.05) greater richness and diversity of intestinal microorganisms, particularly of , than those in all other dietary treatments. In summary, our results indicate that large-scale microencapsulation of microbial cells can be achieved using emulsion and initial gelation and that the dietary administration of microencapsulated can significantly enhance the growth performance, immune function, cecum microbial community, and overall health of broilers.

Effects of pre-encapsulated and pro-encapsulated Enterococcus faecalis on growth performance, blood characteristics, and cecal microflora in broiler chickens.

The effects of microencapsulation of Enterococcus faecalis on the growth performance, antioxidant activity, immune function, and cecal microbiota in broilers were investigated. Broilers (1-day-old) were assigned randomly as follows: 5 treatments, 5 replicate pens per treatment, and 20 broilers per pen. Treatments included (1) a basal diet (CON), (2) CON + Aureomycin (1 g/kg of diet) (ANT), (3) CON + free non-encapsulated probiotics (1 × 10(9) cfu/kg of diet) (FREE), (4) CON + pro-encapsulated probiotics (1 × 10(9) cfu/kg of diet) (PRO), and (5) CON + pre-encapsulated probiotics (1 × 10(9) cfu/kg of diet) (PRE). Feedings included starter (1 to 21 d) and grower (21 to 42 d) phases. In the starter phase, the ANT and the PRE groups had greater (P < 0.05) ADG than the CON groups, and the feed conversion ratio (FCR) for these 2 groups was decreased (P < 0.05). In the finisher phase, the PRE and PRO groups had greater (P < 0.05) ADG than the CON group and their FCR was decreased significantly (P < 0.05). During the entire feeding period, only the PRE group showed greater (P < 0.05) ADG and lower (P < 0.05) FCR. On day 21, only birds in the PRE group had greater (P < 0.05) total antioxidant capacity and number of Lactobacillus than the CON group. On day 42, The PRE group showed greater (P < 0.05) superoxide dismutase than the CON group. Serum IgA and IgM concentrations were increased (P < 0.05) in the PRE group. Serum IL-6 in the PRE group was greater (P < 0.05) than in the other groups with the exception of ANT. At the phylum level, Firmicutes was enriched (P < 0.05) and Proteobacteria was depleted (P < 0.05) only in the PRE group. At the genus level, only the PRE diets increased (P < 0.05) the number of both Lactobacillus and Enterococcus. The results indicate that pre-encapsulation assists the efficient functioning of probiotics in broilers.

Prognostic impact of family history in southern Chinese patients with undifferentiated nasopharyngeal carcinoma.

BACKGROUND: Family history of cancer is associated with developing nasopharyngeal carcinoma (NPC); however, the impact of it on survival among established NPC patients remains unknown. METHODS: We retrospectively analysed 1773 southern Chinese patients. Associations between a first-degree family history of NPC and overall survival (OS), locoregional relapse-free survival (LRFS) and distant metastasis-free survival (DMFS) were estimated by Cox regression. RESULTS: Among 1773 patients, 207 (11.7%) reported a first-degree family history of NPC. Compared with patients without a family history, the adjusted hazard ratios among those with it were 0.60 (95% confidence interval (CI), 0.37-0.98; P=0.040) for OS, 0.52 (95% CI, 0.24-1.12; P=0.096) for LRFS and 0.51 (95% CI, 0.27-0.97; P=0.040) for DMFS. There were trends for improving OS, LRFS and DMFS with increasing number of affected relatives (Ptrend: 0.050, 0.114 and 0.044, respectively). But no significant benefits of family history in second- or third-degree relatives were observed. In subgroup analysis, we observed the effects of family history with restriction to male patients and those of advanced stage and treated with conventional radiotherapy and addition of chemotherapy. CONCLUSION: A first-degree family history of NPC is associated with improved survival of patients.

Significant efficacies of neoadjuvant and adjuvant chemotherapy for nasopharyngeal carcinoma by meta-analysis of published literature-based randomized, controlled trials.

BACKGROUND: We carried out this meta-analysis to demonstrate efficacies of neoadjuvant chemotherapy (NACT) and adjuvant chemotherapy (AC) for nasopharyngeal carcinoma (NPC) patients based on randomized, controlled trials (RCTs). PATIENTS AND METHODS: We comprehensively searched electronic databases and manuscripts for RCTs and extracted data from eligible studies for meta-analysis. Overall survival (OS) with hazard ratios (HRs), locoregional recurrence rate (LRR) and distant metastasis rate (DMR) with relative risks (RRs) were concerned using random and/or fixed-effects models. Subgroup and sensitivity analyses were also carried out. RESULTS: Six trials in NACT group (n = 1418) and five in AC group (n = 1187) were eligible. HR of death for NACT was 0.82 [95% confidence interval (CI) 0.69-0.98, P = 0.03], corresponding to an absolute survival gain of 5.13% after 3 years. Significant reduction of DMR (P = 0.0002; RR 0.69, 95% CI 0.56-0.84) was also found from NACT. But no decrease in LRR (P = 0.49; RR 0.90, 95% CI 0.66-1.22) was observed. Patients receiving additional AC had lower LRR (P = 0.03; RR 0.71, 95% CI 0.53-0.96). But no benefit of OS and DMR were seen in AC. CONCLUSIONS: NACT can effectively enhance OS and reduce DMR, not LRR in NPC. And AC only helps to better control locoregional recurrence of NPC.

Thrombolysis effect with FIIa from Agkistrodon acutus venom in different thrombosis model.

AIM: A fibrinolytic enzyme from Agkistrodon acutus venom, called FIIa, was tested for thrombolytic activity in animals. METHODS: Carotid thrombosis model in rats and rabbits and middle cerebral artery (MCA) thrombosis model in rats were used. RESULTS: Intravenous administration of FIIa, at a dosage of 0.625 mg/kg, resulted in thrombolysis of carotid thrombi. However, in middle cerebral artery thrombosis, the effective thrombolysis dose was 1.25 mg/kg. When the dosage of FIIa increased, the thrombolytic effect was stronger. Histological examination of kidney, liver, heart, and lung tissue showed no hemorrhage. CONCLUSION: It shows that FIIa from Agkistrodon acutus venom is able to solubilize thrombus in vivo without hemorrhage at an effective dose for thrombolysis.

Purification and properties of bilirubin oxidase from Myrothecium verrucaria.

Bilirubin oxidase was purified from a culture filtrate of Myrothecium verrucaria Mv 2, 1089 by DEAE-cellulose and Sephadex G-100 column chromatographies. The purified enzyme had a specific activity of 30 U/mg protein and showed a single band on polyacrylamide gel electrophoresis. Some of the general properties of this bilirubin oxidase were as follows: the optimum pH for the enzyme reaction was 7.5 and the optimum temperature was 50 degrees C. The enzyme was stable at pH ranging from 9.0 to 9.5. The mol wt was calculated to be 61,900-62,700 by SDS-PAGE and gel-filtration technique. The apparent Km value of the bilirubin oxidase was calculated to be 9.4 x 10(-5) mol/L. The enzyme activity was greatly reduced by incubation of bilirubin oxidase with Fe2+, Hg+, NaN3, NH+4, and Zn2+. The enzyme reaction was inhibited in the presence of Ca2+, Hg+, Zn2+, Fe2+, and BSA.