Objective To establish the correlation between tissue factor pathway inhibitor 2 (TFPI-2) and the progression of pancreatic carcinoma(PC) after detecting the expression level of TFPI-2 in PC,and to evaluate the value of TFPI-2 as prognostic index in PC.Methods Expression levels of TFPI-2 in 10 normal and 25 cancerous/juxta-cancerous pancreas were testified with Western blot and RTPCR analyses respectively.Expression density of TFPI-2 in each group was analyzed with HPIAS image analyzer and compared with ANOVA.The correlation between the expression level of TFPI-2 and malignancy was tested with Spearman rank correlation.Disease-specific survival curves were calculated according to Kaplan Meier algorithm,and log rank test was used to compare survival curves.Then,Cox regression analysis was applied to determine the single contribution of each covariate on survival rate.Results The expression level of TFPI-2 decreased along with progression of PC with significant difference among groups (P <0.05),and there was a significantly negative correlation between TFPI-2 protein and progression (r= -ft 816,P <0.001).Among the 13 studied variables,such as the expression level of TFPI-2 protein, tumor stage,portal vein resection,lymph node metastasis,only lymph node metastasis was a predictor of outcome.However,when we analyzed the survival without considering lymph node metastasis,a stepwise Cox analysis showed that expression level of TFPI-2 protein and combined organ resection were significantly associated to survival.Conclusion The data showed that there was strongly correlation between the expression level of TFPI-2 and the progression and survival of PC,which suggested that TFPI-2 could be a newly prognostic factor and a novel approach for gene therapy for PC.
Objective To investigate the level of knowledge and attitudes related to diabetic foot （DF） in the elderly in Shanghai.Methods A total of 502 older residents in Shanghai were interviewed and 493 were included in analysis.A questionnaire specifically designed for this study was used.The knowledge and attitudes with sociodemographic variables were explored by Chi-square analysis and Mann Whitney U test.The contribution of the variables to DF knowledge and attitudes towards DF was explored by both univariate and multivariate analysis.Results Knowledge of DF was limited.Only 183 people （37.1%） achieved adequate DF knowledge while 310（62.9%） had inadequate knowledge.There were no significant differences between people with diabetes and those without diabetes in many questions pertaining to DF knowledge.Encouragingly,a majority of respondents expressed their willingness to receive more information on DF.Both knowledge about and attitudes towards DF were significantly associated with "education level","the willingness to visit doctors regularly",and "whether people have diabetes". Conclusion Findings highlight a need to focus resources and education on improving people’s knowledge of DF,which may be helpful to reduce the occurrence of DF.Nonetheless,the effect of education on decreasing DF incidence still requires verification through future studies.
Objective To investigate minimizing dilation times of percutaneous nephrolithotomy (PCNL)in treating large renal stones.Methods A total of 105 consecutive patients undergoing minimal PCNL by using the two-step dilation protocol(GroupⅠ)and step by step dilation protocol(GroupⅡ) were reviewed.Two groups were compared in terms of stone size,dilating time,operation time,and blood loss.Results In all patients,the dilating of channel was finished and the success rate was 100%.The stone-free rate was 88.7%(47/53)in GroupⅠand 84.6%(44/52)in GroupⅡ.There were significant differences in the time of dilating and the blood loss in dilating channel(P=0.000).But there was no significant difference in the operation time of PCNL.Conclusion PCNL of the urinary calculi is safe in Chinese patients.Two-step dilation in PCNL has advantages of shorter dilating time and lower blood loss in different types of calculi during dilating.
ObjectiveTo describe the clinical manifestations and radiographic characteristics of fibrodysplasia ossificans progressiva （FOP）. MethodsThe radiographs and lesion photographs of five patients aged between 23 months and 17 years diagnosed as FOP were presented and the literatures were reviewed. ResultsClinical features were shortened great toes at birth, episodic soft tissue swellings, pain in the subcutaneous tissues of neck, back, shoulders, and extremities, hard lumps at back and spine, and restricted mobility of neck and arms. Radiological findings included short digit with hallus valgus, scoliosis, exostoses on many bones, and ossification of ligament. The characteristic subcutaneous soft tissues included masses or ossifications of neck, back, extremities, and shoulders. ConclusionThe short terminal phalanges of the thumbs and intermittently progressive heterotopic ossifications of the striated muscles and soft tissues suggest that FOP should promptly get early genetic consultation.
Objective To investigate relationships of polymorphisms in six genes（GHR,IGF-1, IGF-1R,IGFBP-3,JAK2,and STAT5b）in the growth hormone（GH）/insulin-like growth factor-1 （IGF-1）axis with idiopathic short stature（ISS）in the Chinese Han population.Methods A casecontrol study was carried out on a cohort of 198 ISS patients and 306 healthy controls.A total of 106 tagging single nucleotide polymorphisms（tagSNPs）from the six genes were selected from the HapMap（haplotype map of the human genome）Han Chinese in the Beijing subset.Results of genotyping conducted by highthroughput Illumina GoldenGate ? Assay were analyzed by statistical software.Results Both individual tagSNPs and haplotypes showed an association with ISS in the Han Chinese population（P ＜0.05）.For each single test,both allele and genotype were tested.By allele frequency analysis,six positive SNP sites （rsNo.l,rsNo.2,rsNo.3,rsNo.4,rsNo.5,and rsNo.6）of 3 genes（JAK2,IGF-1 R,and GHR）were found having associations with ISS.By genotype frequency analysis,there were significant differences between the patient and control groups in the following SNP sites;4 sites in JAK2 gene（rsNo.1,rsNo.2, rsNo.3,and rsNo.4）and 1 site in GHR gene（rsNo.6）.The risk which affected ISS was found related to the JAK2 gene in 4 sites（increase in rsNo.1 and decrease in rsNo.2,rsNo.3,and rsNo.4）and to the GHR gene in 1 site（decrease in rsNo.6）.They were four haplotypes in gene of IGF-1 R as "TGC","CGCT", "TA",and " CA",one haplotype in IGFBP-3 as "TA",and one haplotype in JAK2 as " CTG",which revealed high significance for risks of affecting ISS.At last,multivariate logistic regression analysis of specific site rsNo.6 of the GHR gene revealed that the serum IGF-1 was related to genotypes AA and AC, with genotype CC as the reference（P=0.015）.Conclusion Genetic variances in six genes within the GH/IGF-1 axis may be important etiological factors for ISS in the Chinese Han population.
Objective To investigate the clinical outcomes of children with congenital heart disease(CHD)requiring extracorporeal membrane oxygenation(ECMO)and left ventricular assist device (LVAD)support after cardiac surgery.Methods A total of 22 patients with CHD who required postcardiotomy mechanical circulatory support between March 2004 and March 2011(85 months)were analyzed retrospectively.Median age of the patients was 420 d(15 d-4 years)and median weight was 3.4 kg(2-14.5 kg).Eight patients were put on ECMO,while 14 patients were placed on LVAD. Results Thirteen(59%)patients died and 9(41%)survived to discharge.In survivals,the duration of LVAD and the duration of ECMO were both shorter than those of nonsurvivals(P
An old patient was admitted to the hospital with chronic bronchitis and type 2 diabetes mellitus. The patient developed progressive left calf swelling and pain. With the ultrasound findings of the blood vessels of the lower extremities, it was concluded that the swelling and tenderness on his left calf resulted from the diffuse micro-hemorrhage into the calf, which might be provoked by the self-massage on the basis of long-term use of aspirin. This case serves as a reminder that when presented with unilateral leg swelling in which the common causes such as deep vein thrombosis have been excluded, the rarer causes of limb swelling should not be neglected.
Objective To investigate the effect and safety of the treatment of renal cysts with color Doppler ultrasound guided percutaneous puncture catheterization drainage and repeated 99% ethanol perfusion. MethodsFifty-eight patients with primary renal cysts were treated with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol perfusion. If the cyst volume was＜500 mL, the complete evacuation of the cyst was followed by injection with 99% ethanol in a volume equal to 25% of the total cyst volume, twice per day, 10 min for each injection. If the cyst volume was＞500 mL, injection was given three times per day, 20 min for each injection, and the patient was asked to move in different positions to help distributing the ethanol over the cyst wall. ResultsFifty-eight cysts were detected in the 58 patients. Puncture was performed and the success rate was 100%. Central venous catheter was introduced into the cysts. After follow-up for 0.5 to 3 years, 56 renal cysts were disappeared. The cure rate was 96.6%, and the complications such as bleeding, infection, and organ injuries were not found. ConclusionThe treatment of renal cyst with color Doppler ultrasound guided percutaneous puncture catheterization drainage and 99% ethanol injection is an effective and safe method for the patients with renal cysts.
ObjectiveTo investigate the myopia rate of students in Minhang District of Shanghai and to take effective measures in preventing and controlling myopia. MethodsA total of 5 809 students （2 904 boys and 2 905 girls） from 41 schools （29 middle schools and 12 high schools） who were going to take National College Entrance Examination of China （NCEE） and High School Entrance Examination of Shanghai （HSEE） in 2012 in Minhang District were included in this investigation. The eyesight data of the students, including myopia rates, the disturbing of myopia degree, the differences of myopia rate between different schools, the relationship between the myopia rate and sex, and the relationship between myopia rate and right or left eye, were analyzed. ResultsMyopia was found in 80.3% of the total students. The rate of myopia in high school was 84.0% （90.2% in key high school and 85.1% in general high school with significant difference between them）. The rate of myopia in middle school was 78.2% （78.5% in key middle school and 77.9% in general high school without significant difference between them）. The myopia rate of high school was higher than that of middle school （P＜0.001）. In high school, the myopia rate of girls （86.8%） was higher than that of boys （80.8%） （P＜0.001）. Among all students, the right eyesight （4.361） was lower than the left （4.389） （P＜0.001）. ConclusionThere is a poor situation in the eyesight of middle school students. The government should take effective measures to publicize the importance of the eyesight health. The education departments and the hospitals must establish the termly examination to decrease the occurrence rate of myopia.
Objective To analysis the current conditions of the main chronic disease,satisfaction,reactive and trust,then to make the control policy in community health management base in China.Method Using the questionnaire by oneself,which the contents include prevalence,understand rate,management rate,behavior correct rate,control rate,medicine obey and satisfaction,reactive and trust of 2009 the chronic disease in 2009.Results The total investigate people was 1 189 456.The hypertension prevalence is 8.01％,the diabetes prevalence is 4.41％.To compare with Shanghai and Jilin in 6 aspects,the prevalence,understand rate,management rate,control rate,medicine obey rate is higher in Shanghai.But behavior correct rate is lower in Jilin.Survey of hypertension prevalence rate was decreased,awareness,management,rates,rates of behavior modification,medication compliance rates and control rates of growth from 2009 to 2010.Satisfaction,responsiveness and trust indicators investigated a total of 2268 people,the process of service satisfaction to 93.43％,93.78％ overall satisfaction; to have the privacy of reactivity to 94.41％ of the basic amenities and clean comfortable response of the 90.45％ ; of treatment services for the 92.59％confidence,the confidence of the cost for the 93.98％ of the overall trust in institutions is 92.76％.Conclusions The government must take main principle in chronic disease control.We must enhance base construct of community health management and increase management level of chronic disease.We must enhance practitioner's culture ang increase knowledge of chronic disease management.
Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors for complications. MethodsA retrospective investigation of CT-guided percutaneous lung biopsy carried out between 2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patient demographics, lung lesions, and biopsy procedures. ResultsA total of 281 biopsy procedures were enrolled. The total complication rate was 55.9% with pneumothorax 32.4% （91/281） and bleeding 34.5% （97/281）. The risk factors affecting pneumothorax rate were lesion location, lesion depth, and time of pleural pierce; and the risk factors affecting bleeding complications were lesion depth, lesion size, and age. Predictive models for pneumothorax and bleeding were established by logistic regression. The pneumothorax model had a sensitivity of 80.0% with a specificity of 62.4%,and the bleeding model had a sensitivity of 67.4% with a specificity of 88.8%. ConclusionLesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factor for bleeding. The predictive models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.
Objective To study the effects of 1%tetracaine hydrochloride jelly for pain control of patients receiving transrectal ultrasound(TRUS)-guided prostate biopsy.Methods A total of 100 patients receiving TRUS-guided prostate biopsy were divided into two groups with 50 in each.In Group 1, patients received liquid paraffin,and in Group 2,patients were given 1%tetracaine hydrochloride jelly before biopsy.Pain score was measured by horizontal visual analogue scales(VAS),and pain and discomfort were compared between the two groups.Results The average pain scores at the time of insertion of the ultrasound probe were 2.9±1.7 and 1.4±1.8(P=0.000)and the average pain scores at the time of performing biopsy were 5.2±1.5 and 3.1±1.7(P=0.000)in Group 1 and Group 2, respectively.There were no significant differences between the two groups in terms of age,serum prostate specific antigen,digital rectal examination,TRUS,and biopsy core number(P > 0.05).There were no significant differences of complications after biopsy,such as hematuria,acute urinary retention,urinary tract infection,rectum bleeding,and fever(P >0.05).Conclusion TRUS-guided prostate biopsy is safe.Use of 1%tetracaine hydrochloride jelly in the rectum and anus before TRUS-guided prostate biopsy is an effective method for relieving TRUS-guided prostate biopsy-induced pain during the procedure.
Objective To investigate the diagnosis and treatment of pheochromocytomas in urinary bladder and review relative literatures.Methods The clinical data of 6 cases of bladder pheochroinocytoma were retrospectively analyzed.Bladder submucosal mass was detected by B-ultrasound in 6 cases, computerized tomography(CT)in 4,and cystoscopy in 3.All patients were treated with surgical operation. Results Two patients showed obvious fluctuation of blood pressure during operation.All patients were pathologically diagnosed as pheochroinocytoma postoperatively.Five patients were followed up {from 3 months to 7 years),and their blood pressure returned to normal.No patient had relapse and malignancy. Conclusion Typical hypertension during urination and hematuria constitute the chief symptoms of bladder pheochroinocytoma.B-ultrasound,CT,and cystoscopy are the main methods for the localization of the lesions.Partial cystectomy or excision of the tumor is the preferred management and postoperative long-term follow-up is necessary.
Objective To compare the efficacy of Ranitidine and Pantoprazole for the prevention of haemorrhage from stress ulcer among critical care patients. Methods A total of 121 critically ill patients were included in this retrospective study. The choice of pharmacologic stress ulcer prophylaxis were either Ranitidine or Pantoprazole. The primary outcome was the incidence of stress-related significant upper gastrointestinal bleeding, and the secondary outcome was the incidence of hospital acquired pneumonia （HAP）. Results A total of 63 patients were given Ranitidine, and 58 patients were given Pantoprazole for stress ulcer bleeding prophylaxis. Nine patients （7.44%, 9/121） developed clinically-important upper gastrointestinal bleeding, including 5 （7.94%, 5/63） in the Ranitidine group, and 4 （6.90%,4/58） in the Pantoprazole group. The rate of HAP was 3.17% （2/63） in the Ranitidine group, and 15.52% （9/58） in the Pantoprazole group. Conclusion Ranitidine was associated with lower rates of HAP as compared with Pantoprazole, with no statistically significant difference in clinically-important gastrointestinal hemorrhage. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted.
We presented a case of chronic recurrent hepatic encephalopathy occurring in a liver cirrhosis patient （Child Pugh A） with a large gastrorenal shunt and a review of the literature focusing on diagnosis and management. Computed tomography （CT） demonstrated an atrophic liver, splenomegaly, varices at the gastric fundic and the splenic hilum, and a highly tortuous shunt vessel between the gastric fundic varices and the left renal vein. Ultrasonography revealed the portal vein diameter was 0.8 cm; and portal vein blood flow velocity was 17.6 mL/s. In practice, the clinician need to ascertain the existence of the large portosystemic shunt when the patients presenting hepatic encephalopathy recurrent or refractory to standard medical treatments.
A 22-year-old man underwent bilateral laser in situ keratomileusis and developed Streptococcus pneumoniae keratitis after surgery.This complication occurred one day after the procedure in both eyes.Topical and systemic antibiotics were promptly administered.Bacterial culture was performed following corneal flap lift and scraping of the lesions.Afterwards,the therapeutic regimen was readjusted according to the culture results.Streptococcus pneumoniae was identified from the culture.Three months after the surgery,corrected distance visual acuity achieved 20/20 in both eyes.Streptococcus pneumoniae can affect the cornea following LASIK.As prompt treatment is crucial,we recommend,for acute and subacute cases,systemic and topical application of vancomycin or moxifloxacin before the culture results come out.
Varicocele caused by diffuse large B-cell lymphoma is rare. Here, we reported our findings in a 48-year-old man, who was admitted to our hospital because of left varicocele for 5 months. The operation of high ligation of the left spermatic vein was performed. However, we found a 6.0 cm×3.0 cm×3.0 cm solid mass in the region of the inside of the left iliac vessels. The lump was removed and the histopathologic diagnosis was diffuse malignant large B-cell lymphoma. The patient was started on a CHOP （cyclophosphamide, adriamycin, vincristine, and prednisolone） definitive therapy.
Objective To evaluate light-guided tracheal intubation using blind intubation device （BID） in adult patients with temporomandibular joint ankylosis. Methods Twenty adult patients, American Society of Anesthesiologists （ASA） physical status Ⅰ or Ⅱ, with temporomandibular joint ankylosis were selected for awake blind nasal intubation. The patients were prepared with nasal decongestants and inhaled 100% oxygen for 3min, then fentanyl （2μg/kg） and midazolam （1-5 mg） were intravenously injected for sedation. Topical anaesthesia for the glottis was performed by using cricothyroid injection of local anaesthesia. A blind intubation device was used to help blind nasal intubation. Three attempts of blind nasal intubation were permitted, otherwise, fiberoptic bronchoscope （FOB） intubation was utilized considering the failure of blind intubation. During the procedure, heart rate, mean arterial pressure, and pulse oxygen saturation （SpO2） were measured. Results Nineteen patients successfully underwent blind nasal intubation by BID. The success ratio for first attempt was only 65.0%, while it reached 95.0% for three attempts. Light-guided catheter failed to be inserted for three attempts in only one patient. However, FOB was successfully used for the first attempt by the same anaesthetist. Conclusion Light-guided tracheal intubation by using blind intubation device is a safe and effective method for blind nasal intubation in the patients with temporomandibular joint ankylosis.
Objective To evaluate the validity of current spirometric reference values for healthy adults in Shanghai.Methods Healthy non-smoking adults without respiratory diseases were randomly enrolled in the study.Gender,age,standing height,body weight and spirometric parameters were obtained.The parameters were compared with reference values from current prediction equations with or without conversion factors.Results A total of 127 healthy adults （60 males and 67 females） aged 18-57 years participated in the study.In the study,pulmonary function parameters of healthy adults,especially of female adults were higher than predicted values,according to prediction equations from Chinese subjects in Shanghai.There were discrepancies between measuring values and reference values from foreign prediction equations with or without conversion factors.Conclusion Spirometric parameters of healthy adults,especially female population in Shanghai might be underestimated by present reference values from Chinese subjects.Foreign reference values and their conversion factors are not able to match measuring values.Validity of spirometric reference values for adults in Shanghai should be reassessed.
Objective To identify the changes in the electroencephalography （EEG） background activities in asphyxiated neonates and to determine the prognostic value of these changes in neurological outcomes.Methods A total of 46 asphyxiated neonates and 31 healthy newborns were studied using standard EEG.Forty-three neonates from the asphyxiated group were followed up and had neurological examinations and developmental assessments at 3,6,9 and 12 months of age.The parameters that had prognostic significance were statistically analyzed,and the correlations of these parameters with neurological outcome were estimated.Results ①Significant EEG changes were found in asphyxiated neonates:a longer maximum duration of interburst interval,lower amplitudes during all states,and a higher incidence of brief burst and sleep-wake cycle disturbance.②There were significant correlations between hypoxic-ischemic encephalopathy （HIE） classification,debased amplitude,positive spikes and sharp waves,and abnormal sleep cycles.③Gestational age,birth weight,EEG amplitude,severity of HIE,occurrence of sleep-wake cycle disturbance,and imaging abnormality were found to be important markers for predicting the outcome of neonates with asphyxia.Conclusion The study suggested that changes in the EEG background activities correlated with the prognosis of neonates with asphyxia.EEG is an effective tool for predicting the neurologic outcome of asphyxiated newborns.
