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    Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine
    2015, 35 (12):  1771. 
    Abstract ( 682 )   PDF (34678KB) ( 829 )  
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    Expert forum
    Discussion on innovative development modes of public hospitals
    WANG Yu
    2015, 35 (12):  1773. 
    doi: 10.3969/j.issn.1674-8115.2015.12.001

    Abstract ( 650 )   PDF (1902KB) ( 783 )  

    With the further reform of medical and health system in new historical era, the sustainable development of public hospitals faces new challenges and opportunities accompanying the science and technology society, information society, and market competition of diversified capital investment. For public hospitals, how to persist in the commonweal nature, constantly exploit advantages, strengthen the connotation construction, and improve the core competitiveness based on the overall requirement of public hospital reform have been key issues of government at all levels and hospitals. As an experimental unit of the Shanghai public hospital reform, the new suburb third level public hospital South RenJi Hospital have performed helpful explorations in terms of innovations of medical technologies, diagnosis and treatment modes, scientific research, talent training modes, service modes, and the systems and mechanisms, which provides replicable and promotable practical experiences for the innovative development of public hospitals.

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    Original article (Basic research)
    Regulation of the proliferation of leukemia cells HL-60 by G-CSF via the signaling pathway of miR-146a/Smad4
    LI Xin, SHENG Xianfu, CAI Jiayi, et al
    2015, 35 (12):  1779. 
    doi: 10.3969/j.issn.1674-8115.2015.12.002

    Abstract ( 712 )   PDF (2389KB) ( 900 )  

    Objective  To investigate the effects of granulocyte colony stimulating factor (G-CSF) on the expression level of miR-146a/Smad4 of leukemia cell line HL-60 and proliferative activity of leukemia cells. Methods  Human leukemia cell line HL-60 was treated 48 h in advance and controls were untreated leukemia cells. CCK8 was applied to detect the cell proliferation and flow cytometry was used to detect the changes of cell cycle. The mRNA expressions of miR-146a and Smad4 were detected by realtime quantitative PCR. The total protein expression of Smad4 was detected by Western blotting. Results  G-CSF upregulated the expression of leukemia cells miR-146a, down-regulated the mRNA expression and total protein expression of Smad4, and increased the proliferative activity of leukemia cells. Both mRNA expression and total protein expression of Smad4 of leukemia cells transfected by plasmids with overexpressed miR-146a decreased. The increase of expression of miR-146a and decrease of expression of Smad4 of transfected cells that were treated by G-CSF were more significant. Conclusion  G-CSF affects the expression of Smad4 via regulating the signal pathway of miR-146a/Smad4 and stimulates leukemia cells in quiescent state entering the proliferating phase.

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    Effects of Notch2 and Notch3 on the migration and invasiveness of trophoblast cell lines
    ZHAO Wei-xiu, LIN Jian-hua
    2015, 35 (12):  1785. 
    doi: 10.3969/j.issn.1674-8115.2015.12.003

    Abstract ( 678 )   PDF (1187KB) ( 675 )  

    Objective  To investigate the effects of Notch2 and Notch3 on the migration and invasiveness of trophoblast cell lines BeWo and JAR. Methods  The changes of migration and invasiveness of two trophoblast cell lines were observed by over-expression and intervention of Notch2 and Notch3 of BeWo and JAR cells. Results  The migration of BeWo cells at 48 h significantly decreased after the intervention of Notch2, while the migration at 72 h and invasiveness after the intervention of Notch2 did not change remarkably. The migration of BeWo cells at 48 h significantly increased after the over-expression of Notch3, while significantly decreased at 72 h. The invasiveness at 48 and 72 h significantly increased after the over-expression of Notch3. The migration of JAR cells at 48 and 72 h significantly decreased after the intervention of Notch3, while the invasiveness after the intervention of Notch3 and the migration and invasiveness after the over-expression of Notch2 didn’t change remarkably. Conclusion  Notch2 and Notch3 can affect the migration and invasiveness of trophoblast cell lines BeWo and JAR.

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    Effects of histone deacetylase 6 on α-synuclein-positive inclusion bodies in the cell model of Parkinson's disease
    WANG Fei, DU Yun-lan, LI Yan-sheng
    2015, 35 (12):  1790. 
    doi: 10.3969/j.issn.1674-8115.2015.12.004

    Abstract ( 696 )   PDF (1903KB) ( 744 )  

    Objective  To investigate the expression of histone deacetylase 6 (HDAC6) and its effects on α-synuclein-positive inclusion bodies in the cell model of Parkinson's disease (PD). Methods  The human neuroblastoma cells SK-N-SH with stable over-expressed wild type α-synuclein were constructed via Lipofectamin 2000. The PD model with abnormal aggregation of α-synuclein was established by adding the proteasome inhibitor lactacystin. The expression of HDAC6 was detected by Western blotting. After being treated with HDAC6 specific inhibitor tubacin, the level of α-synuclein-positive inclusion bodies was detected by immunofluorescence staining. Results  Compared with the controls, the expression of HDAC6 of lactacystin-treated cells was significant higher and α-synuclein-positive inclusion bodies were more. Treatment by tubacin reduced the amount of inclusion bodies and the difference was statistically significant (P<0.05). Conclusion  In the PD cell model established by proteasome inhibitor, inhibition of increased HDAC6 can reduce the amount of α-synuclein-positive inclusion bodies, which may be relevant to the involvement of HDAC6 in the conversion of α-synuclein from oligomers to inclusion bodies, so as to play a role of protection.

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    Study on alleviating forebrain ischemia-induced brain edema of rats by kappa-opioid receptor agonist salvinorin A via regulation of vascular endothelial growth factor
    ZHANG Lei, DONG Hai-ping, HE Zhen-zhou, et al
    2015, 35 (12):  1795. 
    doi: 10.3969/j.issn.1674-8115.2015.12.005

    Abstract ( 862 )   PDF (2059KB) ( 665 )  

    Objective  To investigate the effects of kappa-opioid receptor (KOR) agonist, salovinorin A (SA), on alleviating brain edema and neurological function of rats with forebrain ischemia/reperfusion (I/R) injury and relevant mechanisms. Methods  A forebrain I/R injury model was established by colligating the bilateral common carotid arteries of SD rats combined with hypotension. The rats were divided into I/R group, I/R+DMSO group, I/R+SA group, I/R+SA+norBIN (KOR agonist) group, and sham operation group according to different processing methods. The protein expression of VEGF in brain tissues of rats was detected by Western blotting and immunohistochemical method. The brain edema of rats was evaluated. The neurological function of rats was evaluated 1, 2, and 5 d after I/R injury. Results  After forebrain I/R injury, the brain water content of I/R group and I/R+DMSO group was significantly higher than that of sham operation group (P<0.05); the brain water content of I/R+SA group was significantly lower than that of I/R group (P<0.05); and the brain water content of I/R+SA+nor-BIN group was significantly higher than that of I/R+SA group (P<0.05). Detection results of the protein expression of VEGF in brain tissues showed that the protein expression of VEGF of I/R+SA group was significantly higher than that of I/R group (P<0.01) and the protein expression of VEGF of I/R+SA+nor-BIN group was significantly lower than that of I/R+SA group (P<0.05). Scores of neurological motor function of I/R+SA group 1, 2, and 5 d after I/R injury were significantly higher than those of I/R group, I/R+DMSO group, and I/R+SA+norBIN group (P<0.05).  Conclusion  SA can alleviate the brain edema caused by I/R injury and improve the neurological function. The mechanism may be relevant to the up-regulation of the protein expression of VEGF via KOR.

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    Effects of sevoflurane pretreatment on expression of HIF-2α for renal ischemia reperfusion injury
    ZHANG Yan, ZHAN Qiong-hui, CHEN Jue, et al
    2015, 35 (12):  1800. 
    doi: 10.3969/j.issn.1674-8115.2015.12.006

    Abstract ( 582 )   PDF (1202KB) ( 783 )  

    Objective  To investigate the mechanism of alleviating renal ischemia/reperfusion injury by pretreatment with sevoflurane and the correlation with the expression of hypoxia-inducible factor-2α (HIF-2α). Methods  Wild type mice and HIF-2α knockout (HIF-2α-/-) mice were randomly divided into sham operation group (control group), renal ischemia/reperfusion group (I/R group), and sevoflurane pretreatment+renal ischemia/reperfusion group (Sev+I/R group). Levels of blood urea nitrogen (BUN) and serum creatinine (SCr) were detected in blood samples after operation. Renal tissues were harvested to detect the pathological changes and the protein expression of HIF-2α in renal tissues was detected by Western blotting. Results  Compared with the control group, BUN and SCr levels of wild type mice and HIF-2α-/- mice of I/R group were significantly higher (P<0.001). For Sev+I/R group, BUN and SCr levels of wild type mice were significantly lower than those of HIF-2α-/- mice (P<0.001). Results of pathological examination indicated that all mice of I/R group showed pathological characteristics of severe acute renal injury. However, for Sev+I/R group of wild type mice, only mild pathological injury was found and the expression of HIF-2α  was significantly higher than that of control group and I/R group. But for Sev+I/R group of HIF-2α-/- mice, the pathological injury of kidneys was not alleviated compared with that of I/R group. Conclusion  Sevoflurane pretreatment can protect the renal function for renal ischemia/reperfusion injury, which may be relevant to up-regulating the expression of HIF-2α in renal tissues.

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    Regulation of hypoxia-induced autophagy by hypoxia-inducible factor-1α
    TANG Zhong-yuan, ZHANG Ning, DI Wen, et al
    2015, 35 (12):  1804. 
    doi: 10.3969/j.issn.1674-8115.2015.12.007

    Abstract ( 954 )   PDF (1291KB) ( 886 )  

    Objective  To verify the regulation of autophagy related molecules by hypoxia-inducible factor-1α (HIF-1α) through observation in vitro. Methods  Changes of expressions of HIF-1α and autophagy related molecules after human epithelial ovarian cancer cell lines being transfected by plasmids or intervened by drugs under normoxic or hypoxic culture condition were detected by Western blotting and immunofluorescence. Results  After being transfected by HIF-1α plasmids, HIF-1α was over-expressed, the expression of Beclin 1 increased, and LC3-Ⅰ converted to LC3-Ⅱ under the normoxic condition. After knockout of HIF-1α under the hypoxic condition, the expression of Beclin 1 decreased and LC3-Ⅱ induced by hypoxia was inhibited. Camptothecin drug NSC606985 inhibited the autophagy level of HIF-1α of high metastatic ovarian cancer cell lines. Conclusion  The hypoxic microenvironment can activate HIF-1α and induces the autophagy of epithelial ovarian cells. NSC606985 can regulate HIF-1α at nanomolar concentrations, but the effects on different cell types are different. The regulation may be positive or negative.

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    Construction of lentiviral vector with over-expression of Porf-2 gene and transfection of neural cells
    HUANG Guo-hui, YANG Xi-tao, CHEN Kui, et al
    2015, 35 (12):  1809. 
    doi: 10.3969/j.issn.1674-8115.2015.12.008

    Abstract ( 752 )   PDF (2620KB) ( 840 )  

    Objective  To construct a co-expressing lentiviral vector of preoptic regulatory factor-2 (Porf-2) and green fluorescent protein (GFP), package the lentiviruses, and transfect neural cells in vitro. Methods  Primers of Porf-2 were designed according to the gene information of GenBank. Gene fragments of Porf-2 were amplified by polymerase chain reaction (PCR). By using the gene recombinant technology, Porf-2 was double digested and cloned to pLVX-IRES-ZsGreen1 vector. Recombined plasmids were identified by enzyme digestion and DNA sequencing. The 293T cells were transfected with constructed plasmids, packaging system VSVG, and Δ89 plasmids. Lentiviruses were packaged and the titer was determined. Results  Enzyme digestion and DNA sequencing confirmed that the gene recombinant lentiviral vector of pLvx-Porf-2-IRES-ZsGreen1 had been successfully constructed. After NG108, primary hippocampal neurons, and neural stem cells were transfected by the packaged lentiviruses, a large number of 293T cells with green fluorescence were observed. Western blotting confirmed that Porf-2 was successfully over-expressed. Conclusion  The co-expressing lentiviral vector of Porf-2 and GFP is successfully constructed; lentiviruses are packaged; and NG108, primary hippocampal neurons, and neural stem cells are transfected.

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    Effects of curcumin on expressions of TGF-β1, Smad3, and Smad7 of fibroblasts
    QIN Kai-xiu, JIAN Hua-gang
    2015, 35 (12):  1814. 
    doi: 10.3969/j.issn.1674-8115.2015.12.009

    Abstract ( 669 )   PDF (1003KB) ( 743 )  

    Objective  To explore the inhibitory effect of curcumin on the growth of human skin fibroblast (HSF) and possible mechanisms. Methods  HSF were cultured in vitro and treated with different concentrations of curcumin for different time periods. The viability of HSF was detected by MTT, changes of cell cycle were detected by flow cytometry; and mRNA and protein expressions of transforming growth factor-β (TGF-β1), Smad3, and Smad7 were detected by RT-PCR and Western blotting. Results  The viability of HSF treated with curcumin of 40 μmol/L obviously decreased (P<0.001). The curcumin of 40 μmol/L significantly decreased the number of cells in the S phase but increased the number of cells in the G1 phase (P<0.001). Furthermore, mRNA and protein expressions of TGF-β1 and its downstream factor Smad3 were significantly inhibited, while mRNA and protein expressions of Smad7 significantly increased in a concentration dependent manner (P<0.001). Conclusion  Curcumin inhibits the signaling pathway of TGF-β1 and further inhibits the proliferation of HSF by up-regulating the protein expression of Smad7 and down-regulating the protein expression of Smad3, which provides new ideas for clinically improving the wound healing.

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    Original article (Clinical research)
    Clinical study on inpatients with chronic kidney disease and hypertension
    ZHU Min-xia, NI Zhao-hui, ZHANG Wei-ming, et al
    2015, 35 (12):  1819. 
    doi: 10.3969/j.issn.1674-8115.2015.12.010

    Abstract ( 760 )   PDF (603KB) ( 783 )  

    Objective  To investigate the clinical characteristics of inpatients with chronic kidney disease (CKD) and hypertension. Methods  A cross-sectional and retrospective epidemiological study was carried out. The rates of incidence, awareness, treatment, and control of hypertension of inpatients with CKD admitted by the Department of Nephrology of Renji Hospital, Shanghai Jiao Tong University School of Medicine from November 2009 to February 2010 were surveyed and risk factors and the use of antihypertensive drugs were investigated. The control of hypertension and adverse events of patients with CKD and hypertension was surveyed by telephone from June to August 2015. Results  A total of 439 patients with CKD were enrolled. The rates of incidence, awareness, treatment, and control of hypertension were 69.5% (305/439), 95.4% (291/305), 92.8% (283/305), and 36.4% (111/305), respectively. 61.3% (187/305) of inpatients with CKD and hypertension were administrated with more than one antihypertensive drug. Follow-up after 5 years revealed that the rate of adverse events of patients with poor control of hypertension was significantly higher than that of patients with well control of hypertension (P<0.001). Conclusion  ①The rates of incidence, awareness, and treatment of hypertension of patients with CKD are high, while the rate of well control of hypertension is low. ②Most patients with CKD use more than one antihypertensive drug to control the blood pressure. ③Well control of hypertension can remarkably reduce the incidence of adverse events.

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    Correlation between expression of orosomucoid 1-like 3 and wheezing of children under 5 years old
    LI Ya-qin, LU Yan-ming, XUE Hai-yan, et al
    2015, 35 (12):  1824. 
    doi: 10.3969/j.issn.1674-8115.2015.12.011

    Abstract ( 723 )   PDF (1363KB) ( 721 )  

    Objective  To investigate the correlation between the gene expressive quantity of orosomucoid 1-like 3 (ORMDL3) and wheezing of children under 5 years old. Methods  A total of 89 children with wheezing who were under 5 years old and treated at the Department of Pediatric of Renji Hospital South Campus affiliated to Shanghai Jiao Tong University School of Medicine from August 2013 to December 2014 were enrolled. According to the strict criteria of asthma predictive index (API), children were divided into API+ group (n=42) (the number of onsets of asthma ≥4 in the past year) and API- group (n=47) (the number of onsets of asthma between 1 and 3 in the past year). Health children aged less than 5 years old were selected as controls (API0 group, n=51). The gene expressive quantity of ORMDL3 of three groups was detected. The correlations of the expression level of serum ORMDL3 and API, wheezing, rhinitis, total IgE, family history, eczema, age, inhalation allergens such as dust mite, and intake allergens such as milk were analyzed. Results  The expression level of serum ORMDL3 of API+ group was significantly higher than that of API- group and API0 group. The expression level of ORMDL3 was positively correlated with API (r=0.405, P=0.000), wheezing (r=0.492,P=0.000), eczema (r=0.454, P=0.000), house dust mite (r=0.298, P=0.000), dog hair and scurf (r=0.251, P=0.000), and total IgE (r=0.170, P=0.002). The expression level of ORMDL3 was not correlated with sex, family history, rhinitis, age, dermatophagoides, cat hair and scurf, tree, penicillium notatum, Piptocephalis, aspergillus fumigatus, alternaria, and dietary factors (milk, egg white, beef, cashew nut, crab, shrimp) (P>0.05). Conclusion  The gene expressive quantity of ORMDL3 positively correlates with API of children, which suggests that combination of the gene expressive quantity of ORMDL3 and API can be regarded as one of evidences for the diagnosis of asthma for children under 5 years old.

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    Evaluation of life quality of patients with axial spondyloarthritis and analysis of influencing factors
    CHEN Yu-Ling, LI Ting, YE Shuang
    2015, 35 (12):  1829. 
    doi: 10.3969/j.issn.1674-8115.2015.12.012

    Abstract ( 746 )   PDF (1500KB) ( 864 )  

    Objective  To evaluate the life quality of patients with axial spondyloarthritis (SpA) and discuss the influencing factors in terms of demography, inflammation level, disease activity, and the degree of functional impairment. Methods  A total of 213 patients with axial SpA were selected. Patients' quality of life was evaluated by SF12-v2 health survey and factors influencing the quality of life were analyzed. Results  Compared with normal people, the quality of life of patients with axial SpA significantly decreased (P<0.05). Scores of all dimensions (except the vitality) of SF12-v2 and physical component summary (PCS) of the normal erythrocyte sedimentation rate (ESR) group were higher than those of increased ESR group (P<0. 05). Scores of all dimensions (except the vitality) of SF12-v2, PCS, and mental component summary (MCS) of the low disease activity group (BASDAI<4, ASDAS<2.1) were higher than those of high disease activity group (BASDAI≥4, ASDAS≥2.1) (P<0. 05). Scores of all dimensions (except the vitality) of SF12-v2, PCS, and MCS of the good functional status group (BASFI<5) were higher than those of poor functional status group (BASFI≥5) (P<0. 05). Scores of all dimensions of SF12-v2, PCS, and MCS were significantly correlated with ASDAS and BASFI (P<0.05). Scores of all dimensions of SF12-v2 and PCS were significantly correlated with ESR, CRP, BASDAI, and BASMI (P<0.05). Multiple linear stepwise regression analysis showed that PCS was linearly correlated with ASDAS and BASFI. Conclusion  The quality of life of patients with axial SpA is markedly lower than that of normal people. The quality of life is significantly correlated with inflammation level (ESR and CRP), disease activity (BASDAI and ASDAS), and the degree of functional impairment (BASFI and BASMI).

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    Comparative study on evaluating brain perfusion of patients with ischemic stroke by intravoxel incoherent motion perfusion imaging and three-dimension arterial spin labeling imaging
    ZU Jin-yan, SUO Shi-teng, ZHOU Zi-en, et al
    2015, 35 (12):  1837. 
    doi: 10.3969/j.issn.1674-8115.2015.12.013

    Abstract ( 694 )   PDF (1607KB) ( 789 )  

    Objective  To compare and analyze the clinical application value of intravoxel incoherent motion perfusion imaging MRI (IVIM-MRI) and three-dimension arterial spin labeling (3D-ASL) imaging for evaluating changes of brain perfusion of patients with ischemic stroke. Methods  A total of 46 patients with ischemic stroke underwent routine MRI with DWI, 3D-ASI, and IVIM. Stroke areas indicated by DWI and contralateral normal areas were selected as regions of interest and changes of bilateral local cerebral blood flow (CBF) were measured by 3D-ASL. Parameters measured by IVIM were apparent diffusion coefficient (ADC), diffusion coefficient of pure diffusion (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f). Paired t test was performed for stroke areas and contralateral areas. The relative values of all parameters were also calculated (r=stroke area/contralateral area). Spearman correlation analysis was performed for changes of relative values (rADC, rf, rD*, and rD) of parameters of IVIM and rCBF. Results  The CBFASL of stroke areas was lower than that of contralateral areas and the difference was significant (P<0.05). The differences of ADC, f, and D* between stroke areas and contralateral areas were significant (P<0.05). The D* of stroke areas was lower than that of contralateral areas and the difference was not statistically significant (P<0.05). Except rD*, the differences between rADC, rD, and rf of stroke areas and rCBFASL were statistically significant (P<0.05). Conclusion  The results of IVIM-MRI and 3D-ASL for the diagnosis of changes of brain perfusion of patients with ischemic stroke are consistent, which can be used for evaluating changes of brain perfusion after the incidence of ischemic stroke and are helpful for clinical diagnosis and treatment.

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    Analysis of risk factors of bleeding complication of cytological biopsy of thyroid nodules under guidance of ultrasonography
    LIU Yi, XIA Jian-guo, LI Feng-hua, et al
    2015, 35 (12):  1842. 
    doi: 10.3969/j.issn.1674-8115.2015.12.014

    Abstract ( 597 )   PDF (783KB) ( 994 )  

    Objective  To explore and analyze risk factors of bleeding complication of cytological biopsy of thyroid nodules under guidance of ultrasonography. Methods  A total of 402 patients(416 thyroid nodules) underwent the cytological biopsy from May 2013 to May 2015 in our hospital. Risk factors of bleeding were experience of examiners, needle size, and size, echo, vascularity, calcification, and location of nodules, and gender, age, and blood pressure of patients. Correlations between risk factors and bleeding rate were analyzed by χ2 test, Fisher P test, t test, t’ test, and multivariate logistic regression. Results  Among 416 thyroid nodules undergoing cytological biopsy, 23 of them occurred bleeding complication. The bleeding rate significantly correlated with thicker needles (P=0.005), hypervascular nodules (P=0.001), nodules under the capsule (P<0.001), and increase of systolic blood pressure (P<0.001). The bleeding rate did not significantly correlate with size, echo, and calcification of nodules, experience of examiners, and gender and age of patients. Conclusion  The bleeding complication of cytological biopsy of thyroid nodules under guidance of ultrasonography has relevant independent risk factors.

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    Risk factors of tubal ruptures of patients with eccyesis
    XIAO Shi-jin, WU Yu-peng, LIU Wei
    2015, 35 (12):  1847. 
    doi: 10.3969/j.issn.1674-8115.2015.12.015

    Abstract ( 564 )   PDF (1187KB) ( 694 )  

    Objective  To explore the risk factors of tubal ruptures of patients with eccyesis. Methods  Clinical data of 209 patients with tubal pregnancy who were admitted by Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine from 2013 to 2014 were collected and retrospectively analyzed. Among them, 58 cases were diagnosed with ruptured tubal pregnancy (rupture group) and 151 cases were diagnosed with un-ruptured tubal pregnancy (un-rupture group). Diagnoses were made depending on the results of surgical and pathological examinations. Risk factors of ruptured fallopian tubal pregnancy were statistically analyzed. Results  The differences of reproductive history, abdominal pain, presence of tear abdominal pain, vaginal bleeding days, hemoglobin level before operation, the biggest diameter line of the lump under B ultrasound, and pelvic cavity effusion between two groups were statistically significant (P<0.05). According to multiple factors logistic stepwise regression analysis, age, history of abortion, contraceptive ring, tear abdominal pain, pelvic cavity effusion, and the biggest diameter line of the lump under B ultrasound were introduced as variables of regression equation. Conclusion  Age, contraceptive ring, tear abdominal pain, the biggest diameter line of the lump under B ultrasound, and pelvic cavity effusion are risk factors of ruptured tubal pregnancy, while abortion history is the protection factor. Above factors should be considered for clinical decisions to avoid ruptured tubal pregnancy and endangering patients' lives.

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    Correlation between malnutrition-inflammation complex syndrome and prognosis of patients undergoing maintenance hemodialysis
    DUAN Shao-xia, CAI Hong, ZHANG Wei-ming, et al
    2015, 35 (12):  1851. 
    doi: 10.3969/j.issn.1674-8115.2015.12.016

    Abstract ( 637 )   PDF (1726KB) ( 960 )  

    Objective  To explore the correlation between malnutrition-inflammation complex syndrome (MICS) and the prognosis of patients who undergo maintenance hemodialysis (MHD) by retrospective analysis of relevant indexes of malnutrition and inflammation. Methods  A total of 527 patients who underwent MHD for more than 3 months at the Hemodialysis Center of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 1, 2007 to December 31, 2014 were enrolled and divided into MICS group and non-MICS group. Logistic regression analysis was adopted to analyze risk factors of the incidence of MICS of patients who underwent MHD. The survival rate of patients was analyzed by Kaplan-Meier method. Risk factors of all-cause death and death of cardiovascular diseases of patients with MICS were analyzed by the Cox proportional hazards models. Results  Among 527 patients, there were 441 patients (83.63%) with MICS. Patients of MICS group were older with higher body mass index, longer time of dialysis, and lower level of hemoglobin. Multivariate logistic regression analysis showed that older age, longer time of dialysis, and hemoglobin level less than 100 g/L were independent risk factors of the incidence of MICS of patients who underwent MHD. Kaplan-Meier analysis indicated that all-cause mortality (Log-Rank test, P=0.040) and cardiovascular disease (CVD) mortality (Log-Rank test, P=0.038) of patients with MICS were significantly higher than those of patients without MICS. Cox regression analysis showed that older age, longer time of dialysis, lower levels of hemoglobin and total cholesterol, and higher level of low density lipoprotein were independent risk factors of predicting all-cause death and death of cardiovascular diseases of patients with MICS. Conclusion  The incidence of MICS of patients who undergo MHD is high. The prognosis of patients with MICS is poorer than that of patients without MICS. Anemia is closely correlated with the incidence and prognosis of MICS.

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    Application of selective laser trabeculoplasty combined with medication to the treatment of open-angle glaucoma
    TAN Hai-Bo, ZHU Li-na, SHEN Jie
    2015, 35 (12):  1858. 
    doi: 10.3969/j.issn.1674-8115.2015.12.017

    Abstract ( 807 )   PDF (591KB) ( 822 )  

    Objective  To investigate the effects of selective laser trabeculoplasty (SLT) combined with anti-glaucoma eye drops and medication alone on decreasing the intraocular pressure (IOP) of patients with primary open-angle glaucoma or ocular hypertension and types of medication. Methods  A total of 78 patients (156 eyes) of primary open-angle glaucoma or ocular hypertension whose IOPs met the target IOP after medication were selected. The SLT combined with medication group (39 patients, 78eyes) underwent 360° SLT combined with medication and medication alone group only underwent medication. Both groups adjusted the medication according to the IOP. Results  The differences of IOP and types of medication between SLT combined with medication group and medication alone group before treatment were not statistically significant (P>0.05). After 6 months of treatment, IOP of SLT combined with medication group (17.73±3.40) mmHg were lower than those of medication alone group (19.89±2.90) mmHg and the difference was statistically significant (P<0.05). IOP of SLT combined with medication group after treatment were lower than those before treatment (P<0.001). After 6 months of treatment, types of medication of SLT combined with medication group (2.19±0.30) were less than those of medication alone group (3.22±0.40) and the difference was statistically significant (P<0.001). Types of medication of SLT combined with medication group after treatment were less than those before treatment (P<0.001). Conclusion  SLT combined with medication can further decrease the IOP and types of anti-glaucoma medication.

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    Evaluation of maturity of autologous arteriovenous fistula after surgery
    YUAN Kai, WANG Peng, LIANG Wei
    2015, 35 (12):  1862. 
    doi: 10.3969/j.issn.1674-8115.2015.12.018

    Abstract ( 1065 )   PDF (825KB) ( 795 )  

    Objective  To observe hemodynamic changes by color Doppler ultrasound technique after the construction of wrist arteriovenous fistula (AVF) and evaluate the maturity of AVF. Methods  The prospective study was carried out for patients with chronic renal failure who would undergo the construction of autologous wrist radiocephalic AVF. The internal diameters and blood flow of radial artery and cephalic vein, the intimal thickness of cephalic vein, and the depth of cephalic vein from the skin were measured by color Doppler ultrasound technique before and 1, 14, 28, and 56 d after surgery. The value change tendency was observed and maturity of AVF was assessed. Results  A total of 21 patients were enrolled from May 2014 to December 2014. Among them, 12 patients were male and 9 patients were female with ages of (54.3±13.2) years. Patients were followed up for 70 d and their autologous AVF all reached the clinical maturity criteria. Results of color Doppler ultrasound scan showed that internal diameters and blood flow of radial artery and cephalic vein 1 and 14 d after surgery increased most (P<0.01) and the increase slowed down afterwards. The differences of internal diameters and blood flow between 28 and 56 d after surgery were not statistically significant (P>0.05). The internal diameter and blood flow of cephalic vein 28 d after surgery were (5.0±1.0) mm and (1593.7±572.9) mL/min, respectively. The difference of the depth of cephalic vein from the skin after surgery was not statistically significant (P>0.05). Conclusion  The maturity of AVF is based on the perfect evaluation of radial artery and cephalic vein before surgery. The results of ultrasound scan have shown that the internal diameter and blood flow of cephalic vein 1 month after surgery can meet the requirements of hemodialysis. So for cephalic vein, the internal diameter >4 mm and blood flow >500 mL/min can be regarded as the maturity criteria of AVF for Chinese people. However, determination of the final criteria still needs prospective study based on large samples.

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    Study on the effect of stellate ganglion block on the treatment of laryngopharyngeal reflux
    ZHAO Hui, JIN Xiao-jie
    2015, 35 (12):  1867. 
    doi: 10.3969/j.issn.1674-8115.2015.12.019

    Abstract ( 658 )   PDF (681KB) ( 656 )  

    Objective  To investigate the effect of stellate ganglion block (SGB) on the treatment of patients with laryngopharyngeal reflux(LPR). Methods  Ninety patients were enrolled according to Reflux Symptom Index (RSI) and Reflux Finding Score (RFS) and randomly divided into stellate ganglion block group (SGB group, n=45) and proton pump inhibitor group (PPI group, n=45). Patients of PPI group were orally administrated with 20 mg of PPI for 8 weeks. Patients of SGB group underwent SGB by 5 mL lidocaine (1%) for 8 weeks, once a week. Scores of RSI and RFS 4 and 8 weeks after treatment were recorded. The differences of scores of each group and between every two groups before and after treatment were compared. Results  After 4 weeks of treatment, the scores of RSI and RFS of PPI group were 15.45±5.05 and 8.35±1.92, respectively. The differences of scores of RSI and RFS before and after treatment were not statistically significant (P>0.05). The scores of RSI and RFS of SGB group were 12.32±4.02 and 8.48±1.65, respectively. The differences of scores of RSI before and after treatment were statistically significant (P<0.05).Compared with PPI group, the scores of RSI of SGB group decreased and the differences were statistically significant (P<0.05). After 8 weeks of treatment, the scores of RSI and RFS of PPI group were 9.02±3.34 and 8.12±2.05, respectively. The scores of RSI decreased compared with those before treatment and the differences were statistically significant (P<0.01). The scores of RSI and RFS of SGB group were 8.85±3.62 and 6.17±1.22, respectively. The scores of both RSI and RFS decreased compared with those before treatment and the differences were statistically significant (P<0.01,P<0.05). After 8 weeks of treatment, the differences of scores of RSI of SGB group and PPI group were not statistically significant (P>0.05). Compared with PPI group, the scores of RFS of SGB group decreased and the differences were statistically significant (P<0.05). Conclusion  SGB is a safe and effective method for the treatment of LPR. Especially at the early stage of treatment, the therapeutic effect of SGB is even better than that of PPI.

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    Value of serum IgG4 for the diagnosis of IgG4-related diseases and the ocular manifestations of IgG4-related disease
    YANG Hui-min, WANG Xiao-dong, YE Shuang, et al
    2015, 35 (12):  1871. 
    doi: 10.3969/j.issn.1674-8115.2015.12.020

    Abstract ( 762 )   PDF (1036KB) ( 729 )  

    Objective  To evaluate the value of serum IgG4 level for the differential diagnosis of IgG4-related disease (IgG4-RD) and investigate the ocular manifestations of IgG4-RD. Methods  A total of 29 patients with IgG4-RD, 161 patients with other diseases and elevated serum IgG4 levels (among them, 47 patients with autoimmune liver disease, 15 patients with acute pancreatitis, 61 patients with primary glomerulopathy and renal insufficiency, and 38 patients with inflammatory bowel disease), and 190 normal controls were enrolled. Serum IgG4 and IgG levels were measured by immunonephelometry and results of groups were compared. The receiver operating characteristic (ROC) curve was drawn based on the serum IgG4 levels of patients. The diagnostic value of serum IgG4 level was evaluated and the optimal cutoff value of serum IgG4 level for diagnosing IgG4-RD was determined. Patients with IgG4-RD underwent ophthalmologic tests and their ocular manifestations were evaluated. Results  The differences of serum IgG4 level between IgG4-RD group and primary glomerulopathy and renal insufficiency group, inflammatory bowel disease group, autoimmune liver disease group and acute pancreatitis group were statistically significant (P<0.01). According to the analysis of ROC curve, the Youden index reached the biggest when the IgG4 level was 2.37 g/L. The sensitivity and specificity of this cutoff value for the diagnosis of IgG4-RD were 93.1% and 84.3% and the area under the curve was 0.939. Among 29 patients with IgG4-RD, two of them had orbital occupying lesion and others had no special ocular manifestations. Conclusion  The sensitivity and specificity of serum IgG4 level for the diagnosis of IgG4-RD are high and can be regarded as one of evidences for the diagnosis of IgG4-RD. The serum IgG4 level indicates the possibility of IgG4-RD. Patients with IgG4-RD have no special ocular manifestations.

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    Original article (Public health)
    Analysis of use of glucose lowering drugs for outpatients with diabetes
    CHEN Bin, WU Bin, CHENG Hua-feng
    2015, 35 (12):  1877. 
    doi: 10.3969/j.issn.1674-8115.2015.12.021

    Abstract ( 764 )   PDF (1318KB) ( 765 )  

    Objective  To evaluate the rationality of the use of glucose lowering drugs for the Renji Hospital South Campus, Shanghai Jiao Tong University School of Medicine. Methods  The drug use and evaluation method was adopted and drug use information of patients with type 2 diabetes who were admitted by the Renji Hospital South Campus from the first quarter of 2013 to the second quarter of 2015 was collected and statistically analyzed. Results  The prescriptions of glucose lowering drugs increased annually. The sales amount of the second quarter of 2015 was about 3 times higher than that of the first quarter of 2013. Insulin drugs accounted for about 50% and both the sales amount and defined daily dose (DDD) of general insulin injection (domestic) were ranked as No.1 among all drugs. According to DDDs, commonly used oral glucose lowering drugs were gliclazide (imported), metformin (imported), and voglibose (imported). There were 6 drugs (24%) and 16 drugs (64%) with the ratio of ranks of sales amount and DDD larger than 1 and smaller than 1. Conclusion  The prescriptions and sales amount of glucose lowering drugs of Renji Hospital South Campus increase significantly with the number of outpatients with type 2 diabetes. Basically, the use of the glucose lowering drugs is reasonable, but drugs with better synchronization of the cost and the frequency should be used.

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    Analysis of cognition and satisfaction of medical staffs in public hospitals in Shanghai towards construction of hospital culture
    SHEN Wan-wan, BAO Yong
    2015, 35 (12):  1882. 
    doi: 10.3969/j.issn.1674-8115.2015.12.022

    Abstract ( 676 )   PDF (605KB) ( 691 )  

    Objective  To understand the cognition and satisfaction of medical staffs in public hospitals in Shanghai towards the construction of hospital culture, explore the construction of hospital culture, and propose countermeasures and recommendations. Methods  A total of 1 200 medical staffs of 6 public hospitals from urban districts (Xuhui District and Huangpu District), districts between urban and suburb (Minhang District and Yangpu District), and suburb districts (Qingpu District and Jinshan District) were selected by stratified random sampling method. Questionnaire was designed and medical staffs were surveyed to obtain their cognition and satisfaction towards the construction of hospital culture. A total of 1 128 valid questionnaires were returned and the return rate was 94%. The differences of satisfaction towards the construction of hospital culture of medical staffs with different genders, ages, education levels, positions, titles, and lengths of service were compared. Results  37.8% of the medical staffs understood the exact composition of the construction of hospital culture and the differences of the cognition of medical staffs with different genders, education levels, positions, titles, and lengths of service were statistically significant (P<0.05). 39.0% of the medical staffs understood the objective and significance of the construction of hospital culture and the differences of the cognition of medical staffs with different titles were statistically significant (P<0.05). 43.1% of the medical staffs understood the concept and meanings of their hospitals and the differences of the cognition of medical staffs with different education levels and positions were statistically significant (P<0.05). 48.9% of the medical staffs were satisfied with the construction of hospital culture and 41.6% of the medical staffs felt just so so. The differences of the satisfaction of medical staffs with different genders, education levels, and positions were statistically significant (P<0.05). Conclusion  Hospital culture should be promoted hierarchically according to different characteristics of medical staffs, so as to cultivate their consciousness of hospital culture, let medical staffs fully understand and accept the hospital culture, and effectively promote the development of hospital culture.

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    Evaluation of application effect of infectious disease reporting system based on hospital information system
    LENG Shu-fang, WANG Jian, YANG Xiao-qing, et al
    2015, 35 (12):  1888. 
    doi: 10.3969/j.issn.1674-8115.2015.12.023

    Abstract ( 593 )   PDF (979KB) ( 715 )  

    Objective  To evaluate the application effect of infectious disease reporting system. Methods  Rates of missing report, delaying rates, and completion rates in six months before and after the application of infectious disease reporting system were compared, as well as changes of the number of medical records of infectious diseases viewed by epidemic management personnel and the number of positive cases after the application of infectious disease reporting system.  Results  The rate of missing report decreased by 1.1% (P<0.05), delaying rate decreased by 0.18% (P>0.05), and the completion rate of reporting card increased by 37.99% (P<0.05) after the application of infectious disease reporting system. The system processed 38.06% of infectious cases automatically, which reduced the work of epidemic management personnel. Conclusion  Application of infectious disease reporting system realizes the information management of infectious diseases for the hospital, reduces the work of medical staff, improves work efficiency, and increases the quality of infectious disease report.

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    Review
    Advances of involvement of BKCa in dorsal root ganglions in pathogenesis of visceral hypersensitivity of post inflammatory irritable bowel syndrome
    YAN Xiu-juan, CHEN Sheng-liang
    2015, 35 (12):  1892. 
    doi: 10.3969/j.issn.1674-8115.2015.12.024

    Abstract ( 669 )   PDF (1195KB) ( 686 )  

    The persistent low-grade mucosal inflammation in the gastrointestinal tract is a main pathophysiological basis of the pathogenesis of post-infectious or inflammatory irritable bowel syndrome (PI-IBS) and visceral hypersensitivity is the core mechanism of PI-IBS. The sensory facilitation caused by the increase of neuronal excitation of spinal afferent nerve pathway plays the most important role in abnormal visceral nociception, but the underlying mechanisms have not been fully understood. Review of recent studies suggests that under the condition of chronic inflammation, the large conductance calcium-activated potassium channel (BKCa) of the cell membrane of neurons of spinal afferent nerve in dorsal root ganglions is vital in the reaction mechanism of visceral hypersensitivity of PI-IBS by changing the excitation of neurons and involving the regulation of gastrointestinal sensitivity.

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    Effects of NLRP3 inflammasome  on cerebral ischemia-reperfusion injury
    GAO Li, SHEN Fei, LI Yan-sheng
    2015, 35 (12):  1896. 
    doi: 10.3969/j.issn.1674-8115.2015.12.025

    Abstract ( 591 )   PDF (512KB) ( 860 )  

    Ischemia-reperfusion injury is an inflammatory cascade process involving the interaction of multiple factors. In recent years, numerous studies have shown that as an important pattern recognition receptor of innate immune,  NLRP3 inflammasome involves in the inflammatory injury of cerebral ischemia-reperfusion. Thus blockage or inhibition of the activation of NLRP3 may be a new therapeutic target for the treatment of ischemic cerebrovascular diseases. However, the mechanisms of NLRP3 during the occurrence and development of cerebral ischemia are still unclear. This paper reviews the role and significance of NLRP3 inflammasome in cerebral ischemia-reperfusion injury.

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    Advances of diagnosis and treatment of androgen insensitivity syndrome
    ZHANG Mei-ying, DI Wen
    2015, 35 (12):  1900. 
    doi: 10.3969/j.issn.1674-8115.2015.12.026

    Abstract ( 841 )   PDF (557KB) ( 810 )  

    Androgen insensitivity syndrome is a disease of sexual abnormality. The major cause is the mutation of androgen receptor gene. The karyotype is 46, XY. The syndrome is male pseudohermaphroditism and clinical manifestations are different levels of women posture changes and significant decrease of fertility, which remarkably affect the quality of life and mentality of patients. At present the treatment of patients with this syndrome is the comprehensive treatment based on sex assignment. This paper reviews advances of diagnosis and treatment of androgen insensitivity syndrome with the purposes of increasing the rate of early diagnosis, facilitating individualized and multidisciplinary therapies, and improving patients' quality of life.

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    Research progresses of phosphodiesterase 10A
    YAN Jun-hao, SHEN Qian-cheng, WANG Zheng
    2015, 35 (12):  1904. 
    doi: 10.3969/j.issn.1674-8115.2015.12.027

    Abstract ( 674 )   PDF (836KB) ( 825 )  

    Phosphodiesterase 10A (PDE10A) is the only member of the tenth family of phosphodiesterases and hydrolyzes the ubiquitous second messengers, i.e. cyclic adenosine 3′,5′-monophosphate (cAMP) and cyclic guanosine 3′,5′-monophosphate (cGMP), thus involves in the regulation of a number of intracellular signal transduction pathways. High expression in striatum of brain suggests that PDE10A involves in the development of diseases related to striatal dysfunction. In addition, the PDE10A level of patients with some peripheral diseases significantly increased in the tissue cells. So PDE10A is likely to play an important role in the genesis and development of many diseases. Despite medicine researches and drug development pay more and more attention on PDE10A, a lot of problems still exist in terms of studies on its structure, functions, and regulatory mechanisms of physiology and pathology. Especially the failure of a specific inhibitor of PDE10A, PF-2545920 (MP-10), for the treatment of schizophrenia in phaseⅡ clinical trials drives people to reexamine the roles of PDE10A in central nervous system and whether PDE10A is a suitable therapeutic target. So this paper summarizes the basic characteristics, structure, and functions of PDE10A and related diseases and hopes to be helpful for further study and application.

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    Brief original article
    Surgical treatment and molecular biological analysis of patients with glioma in cerebral midline area
    MIAO Yi-feng, WANG Ran, JIN Yi-chao, et al
    2015, 35 (12):  1911. 
    doi: 10.3969/j.issn.1674-8115.2015.12.028

    Abstract ( 580 )   PDF (1258KB) ( 698 )  

    Objective  To explore the operative strategy of resection of gliomas in cerebral midline area and conduct the molecular biological analysis. Methods  Data of 28 patients with glioma in cerebral midline area who underwent resection under microscope with the assistance of neuroendoscopy if necessary were analyzed. Tumor samples were stored after operation IDH1/2 mutation and MGMT promoter methylation were detected by PCR. The survival time of all patients was statistically analyzed by Kaplan-Meier analysis. Results  Histopathological examination after operation revealed that 2 patients with pilocytic glioma (7%), 11 patients with WHO grade Ⅱ glioma (39%), 5 patients with WHO grade Ⅲ glioma (19%), and 10 patients with WHO grade Ⅳ glioma (35%). Kaplan-Meier analysis indicated that the mean overall survival of all patients was 15 months. The mean overall survivals of patients with low grade glioma and high grade glioma were 26 and 9 months, respectively, and the difference was statistically significant (P<0.01). PCR analysis of tumor samples after operation showed that only 3 patients with positive mutation of IDH1/2 (11%) and 4 patients with positive MGMT promoter methylation (14%). Conclusion  Combination of various technologies such as neuroendoscopy and intra-operative navigation is a major method to improve the prognosis of patients with glioma in cerebral midline area.

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    Analysis of safety of laparoscopy-assisted distal gastrectomy on elderly patients
    QIAN Chang-lin, LIU Hua, ZHANG Jie, et al
    2015, 35 (12):  1915. 
    doi: 10.3969/j.issn.1674-8115.2015.12.029

    Abstract ( 589 )   PDF (1172KB) ( 704 )  

    Objective  To evaluate the safety of laparoscopy-assisted distal gastrectomy on elderly patients (≥70 years old). Methods  The prospective cohort study was adopted. A total of 100 elderly patients with malignant gastric cancer were selected and randomly divided into laparoscopy group (n=50) and open surgery group (n=50). The operation time, intra-operative blood loss, post-operative flatus time, hospital stay, complications (anastomotic leakage and post-operative cardiopulmonary complications), peripheral blood leukocyte count, and C reactive protein of two groups were compared. Results  The difference of operation time of two groups was not significant (P=0.086), while the differences of intra-operative blood loss (P=0.016), post-operative flatus time (P=0.000), and hospital stay (P=0.000) of two groups were statistically significant. For laparoscopy group, there were 2 cases of anastomotic leakage and 6 cases of cardiopulmonary complications. For open surgery group, there were 3 cases of anastomotic leakage and 5 cases of cardiopulmonary complications. The differences of C reactive protein and leukocyte of two groups 1, 3, and 7 d after surgery were significant (P=0.000). Conclusion  Laparoscopy-assisted distal gastrectomy is more safe and feasible than open surgery for the treatment of elderly patients with distal gastric cancer in terms of intra-operative blood loss, postoperative flatus time, post-operative hospital stay, and post-operative inflammatory factors.

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    Observation on curative effect of elderly patients with cervical pain by ultrasound-guided selective cervical nerve root block
    ZHU Mei-juan, WU Wei, WANG Xiang-rui
    2015, 35 (12):  1919. 
    doi: 10.3969/j.issn.1674-8115.2015.12.030

    Abstract ( 669 )   PDF (655KB) ( 661 )  

    Objective  To observe the curative effect of elderly patients with cervical pain by ultrasound-guided selective cervical nerve root block. Methods  A total of 83 elderly patients with cervical pain underwent ultrasound-guided selective cervical nerve block according to involved cervical nerve root segments. Patients were followed up and their scores of visual analogue scale (VAS) and neck disability index (NDI) before treatment and 1 and 6 months after treatment were compared. The therapeutic effect was evaluated according to Odom criteria.  Results  The follow-up was completed for 50 patients. Scores of VAS and NDIs 1 and 6 months after treatment were significantly better than those of before treatment (P<0.05). According to the Odom criteria, the overall excellent and good rates 1 and 6 months after treatment were 90% and 82%, respectively. Adverse reactions were not found among all patients. Conclusion  Ultrasound-guided selective cervical nerve root block is a safe and effective method for the treatment of elderly patients with cervical pain.

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    Effect of the bone mass of old patients with intertrochanteric fracture on the internal fixation surgery
    XU Rui-da, FU Xiao-dong, ZHANG Ling, et al
    2015, 35 (12):  1922. 
    doi: 10.3969/j.issn.1674-8115.2015.12.031

    Abstract ( 529 )   PDF (1213KB) ( 686 )  

    Objective  To explore the effect of osteoporosis of old patients with intertrochanteric fracture on the internal fixation surgery. Methods  A total of 64 old patients with ipsilateral intertrochanteric fracture who underwent intramedullary fixation surgery were enrolled. The osteoporosis of hips of patients before surgery was obtained by measuring the bone density of healthy hip after surgery. There were 11 patients with normal bone mass, 21 patients with osteopenia, and 32 patients with osteoporosis. Then patients were divided into 3 groups accordingly. The hip joint function of patients after surgery was evaluated by Merle D’Aubigne and Salvati-Wilson hip joint function scales, and the time of being able to walk was recorded. Results  All 64 patients were followed up for 4-19 months. The healing time was (2.5±0.8) months and the time of being able to walk was (2.6±0.7) months. No cases of infection at fracture site, secondary fracture, nail penetration, or fixation breakage were found. According to the Merle D’Aubigne hip joint function scale, 9 cases were excellent, 48 cases were good, and 7 cases were passable. According to the Salvati-Wilson hip joint function scale, 8 cases were excellent, 49 cases were good, and 7 cases were passable. Scores of hip joint function of osteoporosis group were significantly lower than those of other two groups (P<0.05). The difference of the time of being able to walk among three groups was not statistically significant (P>0.05). Conclusion  The osteoporosis of old patients with intertrochanteric fracture influences the therapeutic effect of surgical treatment. For patients with osteoporosis, it is recommended to postpone the time of walk.

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    Analysis of theraputic strategies of obstructive renal failure caused by advanced cervical cancer for patients failing to place the ureteral stent
    JIANG Chen, ZHONG Yi-cun, FU Qi-bo, et al
    2015, 35 (12):  1926. 
    doi: 10.3969/j.issn.1674-8115.2015.12.032

    Abstract ( 730 )   PDF (1195KB) ( 723 )  

    Objective  To explore the theraputic strategies for patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent. Methods  Clinical data of 32 patients with bilateral ureteral obstruction caused by advanced cervical cancer who had failed to place the ureteral stent was retrospectively analyzed. Patients were divided into three groups that underwent hemodialysis (hemodialysis group), percutaneous nephrostomy (PCN group), and laparoscopic cutaneous ureterostomy (urinary diversion group), respectively. The 24 h urine volume, renal function, electrolyte, quality of life (QOL), further treatment of cervical cancer, and 2 year survival rate of three groups before and after treatment were compared. Results  The 24 h urine volume of urinary diversion group one week after treatment was the most, followed by PCN group, then the hemodialysis group. The differences were statistically significant (P<0.01). The serum creatinine level of urinary diversion group was remarkably lower than that of PCN group and hemodialysis group and the differences were statistically significant (P<0.01). The differences of blood potassium level among three groups were not statistically significant (P>0.05). The rate of undergoing radical radiotherapy and survival time of urinary diversion group were remarkably better than those of other groups and the differences were statistically significant (P<0.05). The two-year survival rate of urinary diversion group was better than that of hemodialysis group (P<0.05), while the difference of two-year survival rate between urinary diversion group and PCN group was not statistically significant (P>0.05). The postoperative QOL score of urinary diversion group was remarkably better than that of other two groups (P<0.05). Conclusion  For patients with bilateral ureteral obstruction caused by advanced cervical cancer who has failed to place the ureteral stent, theraputic strategies should be chosen according to different conditions in order to effectively improve the renal function of patients, create conditions for further treatment of advanced cervical cancer, prolong the survival time of patients, and improve the quality of life.

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    Case report
    Report of a case of overwhelming post-splenectomy infection caused by severe sepsis
    WANG Li-feng, MA Jun, CHEN Yi
    2015, 35 (12):  1931. 
    doi: 10.3969/j.issn.1674-8115.2015.12.033

    Abstract ( 707 )   PDF (443KB) ( 717 )  

    Objective  To explore the clinical characteristics of overwhelming post-splenectomy infection (OPSI) with main manifestation of severe sepsis. Methods  Clinical data of a patient with severe sepsis caused by OPSI was reported and analyzed and the clinical characteristics were investigated. Results  A 35-year-old male patient who underwent splenectomy two years before was admitted by the Department of Emergency of Renji Hospital South Campus due to headache and emesis. Examination results showed severe sepsis and the patient was diagnosed with OPSI and underwent anti-infectious treatment and symptomatic supportive treatment. After one week, the symptoms tended to be stable and the prognosis was good. Conclusion  The incidence of OPSI is low but the mortality is high. Clinicians should be fully aware of this disease, so as to make early diagnose and treatment and avoid delay.

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    Hydrochloric acid-induced acute respiratory distress syndrome: one case report
    ZHANG Li-yan, TAN Xiao-ming, LI Yan-qin, et al
    2015, 35 (12):  1934. 
    doi: 10.3969/j.issn.1674-8115.2015.12.034

    Abstract ( 805 )   PDF (877KB) ( 754 )  

    Objective  To explore the clincial characteristics and therapy of hydrochloric acid gas inhalation-induced acute respiratory distress syndrome (ARDS). Methods  Clinical date of an ARDS following inhalation of hydrochloric acid gas treated by bilevel positive airway pressure (BIPAP) vetilation with pirfenidone (PFD) was reported. Literature was reviewed to investigate the treatment characteristics. Results  A 33-year-old male patient was admitted to our department due to cough, expectoration, chest distress and shortness of breath after hydrochloric acid gas inhalation. Lung CT showed diffuse interstitial pulmonary damage. Oxygen saturation decreased to 75%. The patient was diagnosed as “aspiration pneumonia and ARDS”. The oxygenation and clinical symptoms were improved via BIPAP ventilation combined with PFD. The fibrous foci of two lungs reduced. Conclusion  Early application of BIPAP can significantly reduce the intubation rate and mortality of ARDS.  PFD can delay the process of pulmonary fibrosis, and even reversed.

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    Treatment of multiple gingival recession with coronally advanced modified tunnel technique combined with connective tissue graft
    NI Jing, SHU Rong
    2015, 35 (12):  1937. 
    doi: 10.3969/j.issn.1674-8115.2015.12.035

    Abstract ( 1329 )   PDF (1552KB) ( 820 )  

    Objective  To evaluate the clinical effect of treatment of multiple gingival recession with coronally advanced modified tunnel technique combined with connective tissue graft. Methods  A case of multiple gingival recession was treated with coronally advanced modified tunnel technique combined with connective tissue graft. The clinical effect of the surgical procedure was evaluated by comparing clinical images, clinical examinations, and subjective feeling of the patient. Advantages and disadvantages of different surgical methods for the treatment of multiple gingival recession were discussed according to reviewing literature. Results  Comparison of clinical images and clinical examinations indicated that by adopting this surgical method, the root surface of recession area was almost completely covered, the color and texture of the gum matched surrounding tissue, and ideal appearance was achieved. At the same time, the hot and cold sensitive symptoms of the patient were also alleviated remarkably. Conclusion  The coronally advanced modified tunnel technique combined with connective tissue graft is a safe and effective surgical method for the treatment of multiple gingival recession.

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