2013年 · 第126卷第19期

Abstract：Background The Borg scale is most commonly used to measure dyspnea in China.However,many patients that find it is difficult to distinguish the labeled numbers corresponding to different dyspnea scores.We developed a new method to rate dyspnea,which we call the count scale (CS).It includes the count scale number (CSN) and count scale time (CST).The aims of the present study were to determine the reproducibility and sensitivity of the CS during exercise in patients with chronic obstructive pulmonary disease (COPD).Methods Fourteen male patients with COPD (aged 58.00±7.72 years) participated in this study.A progressive incremental exercise and a 6-minute constant work exercise test were performed every 2 to 3 days for a total of 3 times.The CS results were evaluated at rest and at 30％ and 70％ of maximal workload (Wmax) and Wmax.The Borg scales were obtained during exercise.Results No significant differences occurred across the three trials during exercise for the CS and Borg scores.The CSN and CST were more varied at Wmax (coefficient of variation (CV)=(22.28±16.96)％ for CSN,CV=(23.08±19.11)％ for CST) compared to 30％ of Wmax (CV=(11.92±8.78)％ for CSN,CV=(11.16±9.96)％ for CST) and 70％ of Wmax (CV=(9.08±7.09)％ for CSN,CV=(12.19±12.32)％ for CST).Dyspnea ratings with either CSN or CST tended to decrease at the higher workload compared to the lower workload.CSN and CST scores were highly correlated (r=0.861,P ＜0.001).CSN was negatively correlated with Borg scores (r=0.363,P=0.001).Similar results were obtained for the relationship between CST and Borg scores (r=0.345,P=0.003).Conclusion We concluded that the CS is simple and reproducible when measuring dyspnea during exercise in patients with COPD。

To the editor:Endobronchial mucormycosis is a rare disease.Here,we report a very rare case with endobronchial mucormycosis showing as a bronchial tumor. A 61-year-old man with type 2 diabetes mellitus presented to our hospital after 3 days of cough and dyspnea.On admission.physical examination showed his temperature being 38.60℃,cyanosis of oral lips,moist rales and wheezing rales in left infraclavicular.He had severe respiratory distress and metabolic acidosis (pH 7.26,partial pressure of carbon dioxide (PC02) 22 mmHg (1 mmHg=0.133 kPa),partial pressure of oxygen (P02) 52 mmHg in 41% 02,HC03-12.5 mmol/L)。

Abstract：Background Acute myocardial infarction (AMI) is a common cardiac emergency with high mortality.Serum soluble ST2 (sST2) is a new emerging biomarker of cardiac diseases.The present study is to investigate the predictive value of sST2 and interleukin-33 (IL-33) for risk stratification and prognosis in patients with AMI.Methods Fifty-nine patients with AMI,whose chief complaint was chest pain or dyspnea,were selected for our study.Physical examination,chest radiograph,electrocardiograph (ECG),biomarkers of myocardial infarction,NT-proBNP,echocardiography and other relevant examinations were performed to confirm the diagnosis of AMI.Thirty-six healthy people were chosen as the control group.Serum samples from these subjects (patients within 24 hours after acute attack) were collected and the levels of sST2 and IL-33 were assayed by enzyme-linked immuno-sorbent assay (ELISA) kit.The follow-up was performed on the 7th day,28th day,3rd month and 6th month after acute attack.According to the follow-up results we defined the end of observation as recurrence of AMI or any causes of death.Results Median sST2 level of the control group was 9.38ng/ml and that of AMI patients was 29.06ng/ml.Compared with the control group,sST2 expression in the AMI group was significantly different (P＜0.001).In contrast,the IL-33 level showed no significant difference between the two groups.Serum sST2 was a predictive factor independent of other variables and may provide complementary information to NT-proBNP or GRACE risk score.IL-33 had no relationship to recurrence of AMI.Both sST2 and the IL-33/sST2 ratio were correlated with the 6-month prognosis; areas under the ROC curve were 0.938 and 0.920 respectively.Conclusions Early in the course (＜24 hours) of AMI,sST2 usually increases markedly.The increase of sST2 has an independent predictive value for the prognosis in AMI patients and provides complementary information to NT-proBNP or GRACE risk score.The IL-33/sST2 ratio correlates with the 6-month prognosis of AMI patients.However,there is no significant relationship between IL-33 and the prognosis of AMI patients。

Abstract：Background Budd-Chiari syndrome (BCS) is characterized by liver sinusoidal congestion,ischemic liver cell damage,and liver portal hypertension caused by hepatic venous outflow constriction.The aim of this research was to investigate the clinicopathological features of BCS-associated hepatocellular carcinoma (HCC) and explore its surgical treatment and prognosis.Methods Clinical data from 38 patients with BCS-associated HCC who were surgically treated in our hospital from July 1998 to August 2010 were retrospectively analyzed.The clinicopathological features and prognosis of patients with BCS-associated HCC and surgical treatment for BCS-associated HCC were investigated.Results Compared to the patients with hepatitis B virus (HBV)-associated HCC,the patients with BCS-associated HCC showed a female predominance,and had significantly higher cirrhosis rate,higher incidence of solitary tumors,lower incidence of infiltrative growth,higher proportion of marginal or exogenous growth,lower rate of portal vein invasion,and higher degree of differentiation.Median survival was longer in patients with BCS-associated HCC (76 months) than in those with HBV associated HCC (38 months).Of 38 patients with BCS-associated HCC,22 patients who received combined surgery mainly by liver resection plus cavoatrial shunts exhibited hepatic venous outflow constriction relief,while the other 16 patients only underwent liver resection.The combined surgery group had significantly longer survival and lower incidences of post-operative lethal complications (P ＜0.05).Multivariate analysis showed that relief of hepatic venous outflow obstruction was a protective factor for survival of patients with BCS-associated HCC,whereas portal vein invasion was a risk factor.Conclusions BCS-associated HCC has a more favorable biological behavior and prognosis than HBV-associated HCC.For patients with BCS-associated HCC,tumor resection accompanied with relief of hepatic venous outflow obstruction can reduce the incidence of complications and extend survival。

Abstract：Background Cor pulmonale is often associated with changes of structure and function of the right ventricle (RV) and thus further affects functional changes of the left heart.Our study aimed to assess the left ventricular (LV) and RV function in patients with cor pulmonale using high-definition CT (HDCT).Methods We prospectively studied 18 cor pulmonale patients determined by the pulmonary function test,clinical examination,chest radiograph,electrocardiogram,and echocardiogram.The subject group was compared to a control group consisting of 18 subjects.The RV and LV functions and RV myocardial mass (MM) were obtained by HDCT in the two groups.The results were compared between the two groups using the independent sample t test.Echocardiographic examination for cardiac function analysis was performed on the same day.Results The RV end-diastolic volume (EDV),RV end-systolic volume (ESV) and RV myocardial mass were significantly larger in the 18 cor pulmonale patients than in the control group (P＜0.05).The right ventricular ejection fraction (RVEF) was significantly lower in the 18 cor pulmonale patients than in controls (P＜0.01).The left ventricular EDV (LVEDV) and LVEF were significantly lower in cor pulmonale patients than in controls (P＜0.01).There were strong correlations between MDCT and echocardiography,rRVEF=0.839 and rLVEF=0.916,respectively.Conclusions HDCT can accurately quantify RV and LV function.The right ventricular function is impaired in patients with cor pulmonale,while at the same time the left ventricular function is also impaired。

Abstract：Background Different strategies for hepatocellular carcinoma (HCC) may have distinct effects on the immune system.The aim of this research was to investigate changes in the immunological function after transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) in HCC patients.Methods A total of 51 consecutive HCC treatment-naive patients was enrolled in this study and 20 healthy subjects served as controls.The therapeutic strategy was selected according to the tumor stage and general conditions.TACE was performed in 25 cases,TACE plus RFA in 17 and RFA in nine.All the patients underwent routine examinations and peripheral blood was harvested for the detection of lymphocyte subset by flow cytometry 1 day before,and 2 and 4 weeks after the treatment.The serum levels of alpha-fetoprotein (AFP),ALT and AST were also measured before and 4 weeks after treatment for the evaluation of therapeutic efficacy and liver function impairment.Results When compared with healthy controls,the CD4/CD8 ratio and the number of B cells and natural killer (NK) cells were significantly decreased in HCC patients before treatment (P ＜0.05).When compared with before treatment,the CD4+ cells and CD4/CD8 ratio decreased but CD8+ cells increased in the TACE group (P ＜0.05); the CD4/CD8 ratio and NK cells decreased but CD8+ cells increased in the TACE-RFA group (P ＜0.05); the CD3+ cells,CD4+ cells,CD4/CD8 ratio and NK cells increased in the RFA group (P ＜0.05).Significant differences in the CD3+ cells,CD8+ cells,CD4/CD8 ratio and NK cells were observed among groups (P ＜0.05).Moreover,the AFP level decreased and transaminase level increased in all groups (P ＜0.05).Differences of pre and post treatment between groups were statistically significant (P =0.016,0.025,0.018 respectively).Conclusions Immunity was compromised in HCC patients; TACE and TACE plus RFA lowered immunologic function to a certain extent.RFA improved it accompanied by a protective effect on liver function。

Abstract：Background Alteration in the protein composition of high-density lipoprotein (HDL) has been proposed as a mechanism for the development of coronary heart disease (CHD).In HDL,an increase in serum amyloid A protein (SAA) accompanying the decrease in apolipoprotein A-I (apoA-I) has been found during the acute inflammation period.However,whether this phenomenon persists in CHD patients,a disease related to inflammation,is unknown.The purpose of the present study was to explore the relationship between SAA and apoA-I in HDL isolated from CHD patients.Methods Overall,98 patients with confirmed stable CHD and 90 control subjects matched for age and gender were enrolled in this case-control study.Potassium bromide (KBr) density gradient ultracentrifugation was used to isolate HDL from plasma.The levels of SAA and apoA-I in the HDL samples were detected by enzyme-linked immunosorbent assay kits.Pearson's correlation and general linear models were used in the analysis.Results Compared with controls,patients with CHD had a significant decrease in the amount of apoA-I ((14.21±8.44) μg/ml vs.(10.95±5.95) μg/ml,P =0.003) in HDL and a significant increase in the amount of log SAA (1.21±0.46 vs.1.51±0.55,P ＜0.00001).Differences were independent of age,body mass index (BMI),HDL cholesterol (HDL-C),and other factors.An independently and statistically significant positive correlation between log SAA and apoA-I in HDL was observed only in the CHD group (β =2.0,P =0.026).In the general linear model,changes in Iog(SAA),age,age2,gender,BMI and HDL-C could explain a statistically significant 43％ of the variance in apoA-I.Conclusions This study provides direct evidence for the first time that there was an independent positive correlation between log SAA and apoA-I in the HDL of CHD patients,indicating the alteration of protein composition in HDL.However,the question of whether this alteration in HDL is associated with impairment of HDL functions requires further research。

Abstract：Background Patients with single station mediastinal lymph node (N2) non-small call lung ccancer (NSCLC) have a better prognosis than those with multilevel N2.The molecular factors which are involved in disease progression remain largely unknown.The purpose of this study was to investigate gene expression differences between single station and multilevel N2 NSCLC and to identify the crucial molecular factors which are associated with progress and prognosis of stage N2 NSCLC.Methods Gene expression analysis was performed using Agilent 4x44K Whole Human Genome Oligo Microarray on 10 freshfrozen lymph node tissue samples from single station N2 and paired multilevel N2 NSCLC patients.Real-time reverse transcription (RT)-PCR was used to validate the differential expression of 14 genes selected by cDNA microarray of which four were confirmed.Immunohistochemical staining for these validated genes was performed on formalin-fixed,paraffinembedded tissue samples from 130 cases of stage N2 NSCLC arranged in a high-density tissue microarray.Results We identified a 14 gene expression signature by comparative analysis of gene expression.Expression of these genes strongly differed between single station and multilevel N2 NSCLC.Four genes (ADAM28,MUC4,CLDN1,and IGF2) correlated with the results of microarray and real-time RT-PCR analysis for the gene-expression data in samples from 56 NSCLC patients.Immunohistochemical staining for these genes in samples from 130 cases of stage N2 NSCLC demonstrated the expression of IGF2 and CLDN1 was negatively correlated with overall survival of stage N2 NSCLC.Conclusions Our results suggest that the expression of CLDN1 and IGF2 indicate a poor prognosis in stage N2 NSCLC.Further,CLDN1 and IGF2 may provide potential targeting opportunities in future therapies。

Abstract：Background Early stage (FIGO stage Ⅰ-Ⅱ) endometrioid endometrial adenocarcinoma (EEA) is very common in clinical practice.However,patients with the early stage EEA show various clinical behaviors due to biological heterogeneity.Hence,we aimed to discover distinct classes of tumors based on gene expression profiling,and analyze whether the molecular classification correlated with the histopathological stages or other clinical parameters.Methods Hierarchical clustering was performed for class discovery in 28 eady stage EEA samples using a special cDNA microarray chip containing 492 genes designed for endometrial cancer.Correlations between clinicopathologic parameters and our classification were analyzed.And the significance analysis of microarrays (SAM) array was used to identify the signature genes according to the tumor grade and myometrial invasion.Results Three tumor subtypes (subtypes Ⅰ,Ⅱ and Ⅲ) were identified by hierarchical clustering,each subtype had different clinicopathological factors,such as tumor grade,myometrial invasion status,and FIGO stage.Moreover,SAM analysis showed 34 up-regulated genes in high grade tumors,and 38 up-regulated genes and 1 down-regulated in deep myometrial invasive tumors.The overlap genes between these two high-risk factors were markedly up-regulated in subtype Ⅰ,but down-regulated in subtype Ⅲ.Conclusion We have identified novel molecular subtypes in early stage EEA.Differential gene signatures characterize each tumor subtype,which could be used for recognizing the tumor risk and providing a basis for further treatment stratification。

Abstract：Background Von HippeI-Lindau disease (VHL),a heritable autosomal dominant disease characterized by neoplasia in multiple organ systems,has rarely been reported in Asia.We genetically investigated a unique Chinese family with VHL disease and performed an analysis of the VHL protein stability.Methods Genomic deoxyribonucleic acid (DNA) extracted from peripheral blood was amplified by polymerase chain reaction (PCR) to three exons of the VHL gene in 9 members of the Chinese family with VHL disease.PCR products were directly sequenced.We estimated the effects of VHL gene mutation on the stability of pVHL,which is indicated by the free energy difference between the wild-type and the mutant protein (△△G).Results The Chinese family was classified as VHL type 1.Three family members,including two patients and a carrier,had a T to G heterozygotic missense mutation at nucleotide 515 of the VHL gene exon 1.This missense mutation resulted in the transition from leucine to arginine in amino acid 101 of the VHL protein.There was low stability of the VHL protein (the △△G was 12.71 kcal/mol) caused by this missense mutation.Conclusions We first reported a family with this VHL gene mutation in Asia.This missense mutation is predicted to significantly reduce the stability of the VHL protein and contribute to the development of the renal cell carcinoma (RCC) phenotype displayed by this family.The genetic characterization and protein stability analysis of families with VHL disease are important for early diagnosis and prevention of the disease being passed on to their offspring。

Abstract：Background A pharmacokinetic study in an Asian population showed that tiotropium 5 μg via Respimat leads to the same plasma levels compared to 18 μg via HandiHaler.The objective of the trial was to compare the efficacy and safety of longterm treatment (1 year) with tiotropium bromide (5 μg) via Respimat（R） with placebo in patients with chronic obstructive pulmonary disease (COPD).Methods A total of 3991 patients were randomized in this double-blind,placebo controlled,parallel group study,while in China 338 patients (309 males,29 females) received either tiotropium bromide (n=167) or placebo (n=171).Tiotropium bromide solution or matching placebo was delivered via Respimat（R） at a dosage of 5 μg (2 x 2.5 μg/puff) once daily for 48 weeks.Co-primary endpoints were trough forced expiratory volume in one second (FEV1) and the time to first exacerbation.Results Statistically significant improvements in trough FEV1 and trough forced vital capacity (FVC) in the tiotropium group were achieved at weeks 4,24,and 48 compared with those in the placebo group.A statistically significant difference (P=0.0027) in favour of tiotropium was also observed for the time to first exacerbation.The total numbers of exacerbations during treatment were 90 and 128 in the tiotropium and placebo groups,respectively,with a rate ratio of 0.69 (P=0.0164).The difference between the treatment groups in the adjusted mean changes from baseline of St.George Respiratory Questionnaire (SGRQ) total score was-3.9 (95％ Cl:-7.5,-0.2) and was of statistical significance (P=0.0367).The incidences of serious adverse events (SAEs) in the tiotropium and placebo groups were 16.2％ and 17.0％,respectively.Seven deaths occurred whilst patients were on treatment,four in the tiotropium group and three in the placebo group,all of which were assessed as non-related study drugs by the investigators.Conclusions Tiotropium significantly improved lung function and quality of life,delayed the time to first exacerbation,reduced the number of exacerbations.Overall,tiotropium was well tolerated。

Abstract：Background Cigarette smoke induces an acute but persisting inflammation in peripheral blood and airway in chronic obstructive pulmonary disease (COPD),and CD8+ Tc-lymphocytes are considered as a key role in this process.We aimed to investigate the Tc-lymphocytes immunodeviation in system and local airway of COPD patients and changes of the immunodeviation after short-term smoking cessation.Methods Peripheral blood (PB) and bronchoalveolar lavage fluid (BALF) were collected from 42 patients (14 COPD patients,16 smokers with normal lung function and 12 nonsmokers),while PB and induced sputum (IS) were obtained from other 19 patients (10 quitting smokers and 9 continuing smokers) at baseline and follow-up respectively of 4-week smoking cessation.Percentages of CD8+ Tc-lymphocytes (％CD3+) and Tc1/Tc2 ratios were measured by flow cytometry.Results Percentages of CD8+ Tc-lymphocytes were higher in COPD patients than those in smokers and nonsmokers in both PB and BALF.Tc1/Tc2 ratio in PB and in BALF from COPD patients was greater than that from smokers and nonsmokers and negatively correlated with FEV1％pre.When comparing the ratios between PB and BALF,significantly positive correlation was found in COPD patients.Furthermore,after 4-week smoking cessation,percentages of CD8+ Tc-lymphocytes in PB and IS in quitting smokers were decreased compared to that in baseline and continuing smokers,whereas Tc1/Tc2 ratios were not influenced.Conclusions CD8+ Tc1-trend immunodeviation profiles occurred in both system and local airway of COPD patients.This exceptional immunodeviation could not be relieved by short-term smoking cessation。

Abstract：Background The relationship between inflammation and delirium remains to be determined.The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium in elderly patients after major noncardiac surgery.Methods A total of 338 elderly patients (60 years of age and over) undergoing major noncardiac surgery were enrolled.Blood samples were obtained before anesthesia and in the first postoperative morning and serum interleukin-6 concentrations were measured.Delirium was assessed twice daily by the confusion assessment method for the Intensive Care Unit during the first three postoperative days.Survival analyses were performed to assess the relationship between the serum IL-6 level and the occurrence of postoperative delirium.Results Postoperative delirium occurred in 14.8％ (50 of 338) of patients.High serum interleukin-6 levelsafter surgery were significantly associated with increased risk of the occurrence of postoperative delirium (hazard ratio 1.514,95％ confidence interval 1.155-1.985,P=0.003).Other independent predictors of delirium included increasing age,poor preoperative New York Heart Association classification,low preoperative Mini-Mental State Examination score,and high total postoperative Visual Analogue Scale pain score.Patients who developed delirium had a prolonged hospital stay after surgery.Conclusions Delirium is a frequent complication in elderly patients after noncardiac surgery.High serum interleukin-6 level after surgery is associated with increased risk of the occurrence of postoperative delirium。

Abstract：Background Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease which lacks satisfactory treatment so far.Sinomenine (SIN) is an alkaloid and has recently been utilized in treating multiple rheumatic diseases including AS in China,but its exact mechanism remains to be explored.This study investigated the alteration of proteome in peripheral blood mononuclear cells (PBMCs) from AS patients.Methods Thirty AS patients were enrolled in this study.PBMCs from each AS patient were cultured in medium with or without SIN respectively.Then PBMCs proteins from both groups were separated by two-dimensional electrophoresis (2-DE) and analyzed by mass spectrometry (MS).Two differentially expressed proteins were then chosen to be verified using Western blotting.Results Seven proteins,including α-synuclein (SNCA),calmodulin (CALM),acidic leucine-rich nuclear phosphoprotein 32 family member A (ANP32A),chloride intracellular channel protein 1 (CLIC1),guanine nucleotide-binding protein G(I)/G(S)/ G(T) subunit beta-1 (GNB1),gelsolin (GSN) and histone H2B type 1-M (HISTH2BM)were over-expressed,while coronin1A (CORO1A) was under-expressed in the SIN-treated PBMCs.Further bioinformatics search indicated that the changes of SNCA,ANP32A and CLIC1 pertained to apoptosis,while changes of GSN and CORO1A were associated with both apoptosis and inhibition of immunological function.Subsequently GSN and CORO1A were selected to validate by Western blotting and the results were consistent with those of 2-DE.Conclusion There were 8 differentially expressed proteins in the SIN-treated PBMCs,which might shed some light on the mechanism of SIN in the treatment of AS。

Abstract：Background In county-level tuberculosis (TB) dispensaries in China,the accurate diagnosis of sputum smear-negative pulmonary tuberculosis (SNPT) needs to be improved by developing and validating clinical and radiographic predictors.Methods The study was conducted simultaneously in three counties per province in Chongqing Municipality and Liaoning Province in China between May 2005 and May 2006.A total of 432 new SNPT patients who are HIV-negative and more than 15 years old diagnosed by expert panels in county-level TB dispensaries were recruited.Their sputum samples were collected for culture before anti-TB treatment,and the treatment outcomes (changes of X-rays) were followed up at the end of the 6th month.Results Of the 432 SNPT patients,sputum culture positive (9.7％) or culture negative with good changes of X-rays at the end of the 6th month (73.6％) was validated as SNPT.Four predictive variables were associated with validated SNPT in the multivariate logistic regression model:age ≤55 years old (odds ratio (OR) 5.66; 95％ CI 2.69-11.91),＞60 days of cough (OR 3.73; 95％ CI 1.10-12.65),≥10％ of pulmonary consolidation in the lungs (OR 5.40; 95％ CI 2.90-10.06),and pulmonary consolidation in the upper lobe anterior segment (OR 3.00; 95％ CI 1.57-5.72).The area under the receiver operating characteristic curve of the model was 0.77 (95％ CI 0.71-0.83).Conclusion Four predictors of clinical and radiological characteristics that had a good diagnostic performance of SNPT deserve to be recommended as index indicators of SNPT diagnosis in county-level TB dispensaries in China。

Abstract：Background Although most patients with tetralogy of Fallot undergo radical repair during infancy and childhood,patients that remain undiagnosed and untreated until adulthood can still be treated.This study aimed to evaluate longterm outcomes of adult patients with tetralogy of Fallot who were treated surgically,and to determine the predictors of postoperative pulmonary regurgitation.Methods Fifty-six adult patients underwent complete surgical repair.Forty-three patients (76.8％) required a transannular patch.Systolic,diastolic,and mean pressure in the main pulmonary artery were measured after repair.Results The early mortality rate was 3.6％.The 16-year survival rate was (84.4±11.5)％.Late echocardiography revealed 41 patients with transannular patch who had pulmonary regurgitation,consisting of mild pulmonary regurgitation in 28 patients,moderate in eight,and severe regurgitation in five patients.In addition,there was right ventricular outflow tract stenosis in nine patients,moderate/severe tricuspid valve regurgitation in seven,and residual ventricular septal defect in five.Logistic regression analysis demonstrated that the mean pulmonary pressure measured just after repair predicted late pulmonary regurgitation.Conclusions The long-term survival of surgically treated adult patients with tetralogy of Fallot is acceptable.The mean pressure ＞20 mmHg in the main pulmonary artery measured right after surgical repair may be a feasible reference to time the reconstruction of the pulmonary valve。

Abstract：Background Postoperative hospital stay after pancreaticoduodenectomy (PD) is relatively longer than after other gastrointestinal operations.The aim of the current study was to investigate the risk factors associated with prolonged hospital stay after PD.Methods Patients who had PD at the Cancer Hospital of Chinese Academy of Medical Sciences between December 2008 and November 2012 were selected for this retrospective study.Clinical and pathological data were collected and analyzed.The primary outcome was postoperative length of stay.Normal discharge or recovery was defined as a postoperative hospital stay of no more than 10 days; otherwise it was defined as delayed discharge or recovery (including hospital death).Results Atotal of 152 patients were enrolled in the present study.Postoperative hospital stay was (19.7±7.7) days (range 7-57).Of the 152 patients,67 were discharged within the normal time and 85 had delayed discharge.Postoperative complications occurred in 62.5％ (95/152),and the mortality rate was 3.29％ (5/152).Multiple regression analysis showed that delayed discharge was significantly associated with postoperative complications (adjusted odds ratio (OR) 10.40,95％ confidence interval (CI) 3.58-30.22),age (adjusted OR 4.09,95％ CI 1.16-14.39),body mass index (BMI) (adjusted OR 4.40,95％ CI 1.19-16.23),surgical procedure (adjusted OR 26.14,95％ CI 4.94-153.19),blood transfusion (adjusted OR 7.68,95％ Cl 2.09-28.27),and fluid input (adjusted OR 3.47,95％ CI 1.24-11.57).Conclusions Postoperative complications increase the time to postoperative hospital discharge.The length of hospital stay after PD is also associated with age,BMI,blood transfusion,surgical procedure,and fluid input.Further studies with more patients are needed in future。

Abstract：Background Juvenile Fibromyalgia Syndrome (JFMS) is a chronic health condition characterized by widespread musculoskeletal pain and multiple tender points (TP).The objective of this study was to determine the prevalence of JFMS in the urban population of Samsun and to determine the impact of JFMS on depression symptoms,school performance and quality of life (QOL).Methods A cross-sectional study was conducted in 1109 children (mean age (14.8±2.0) years old).A questionnaire was applied to the children and a medical examination including TP was performed.Yunus and Masi's criteria were used for diagnosis of JFMS.The children with JFMS were compared with an age and sex matched non-JFMS group.Depression was assessed with Children's Depression Inventory (CDI) and QOL was evaluated with Pediatric Quality of Life Inventory 4.0 (PedsQL4.0).Results Sixty-one (5.5％) (13 boys and 48 girls) of 1109 children met the diagnostic criteria of JFMS.While PedsQL scores of children with JFMS were lower than the non-JFMS group for physical,emotional,social,school functioning and total score (P=0.001),CDI total score was higher in the JFMS group than in the non-JFMS group (P=0.001).The JFMS group reported more school absences (P=0.001) and the average school grade was lower in the JFMS group than in the non-JFMS group (P=0.03).Conclusion The prevalence of JFMS is high in school age children.Since JFMS is a common problem of childhood,early diagnosis and identification of the disorder and more comprehensive and successful treatment approaches with appropriate psychological assistance may prevent more complex and severe problems in adulthood。

Abstract：Background The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) maybe changed by strict infection control measures,and the impact of empirical antibiotic therapy on the outcomes of MRSA infection was not clear.We aimed to investigate the present epidemiological status of MRSA infection and empirical antibiotic therapy for MRSA infection in university teaching hospitals in mainland China.Methods The present study was a multicenter prospective observational study conducted in five university teaching hospitals.Patients who were consecutively admitted to the intensive care unit and signed a consent form from March 3,2011 to May 31,2011 were included.Patients with age ＜18 years or with a length of hospital stay ＜48 hours were excluded from this study.The following variables were collected or recorded:demographic data,general status,APACHE Ⅱ score of the patient at the time of admission,infections,and the use of antibiotics during a stay.Primary outcomes and prognostic indicators included length of hospital stay and 28-day and 90-day mortality.The differences between the patients with appropriate empirical therapy and patients with inappropriate therapy were analyzed to detect the influences of antibiotic therapy on the prognosis of MRSA infection.Results A total of 682 cases were enrolled.Thirty (66.2％) of 88 MRSA cases were treated with effective antibiotics for MRSA infection; only 20％ received appropriate empirical antibiotic treatment.The empirical therapy group compared with the target therapy group had a shorter length of stay,but there were no significant differences in mortality rates.There were no significant differences in the length of hospital stay,length of stay,and 28-day and 90-day mortality between MRSA-infected patients who received or not received effective antibiotics.Two hundred and eighteen cases received sensitive antibiotics for MRSA.Conclusions The MRSA infection rates are at relatively low levels in university teaching hospitals in China.The empirical use of sensitive antibiotics for MRSA infection was at relatively high rate,and there is a tendency of overusing in patients without MRSA infection.On the other hand,the rate of appropriate empirical antibiotic therapy for patients with MRSA infection is relatively low。

Abstract：Background Many studies indicated the human cytochrome P450 2D6 (CYP2D6) gene polymorphism was associated with acute leukemia (AL) susceptibility,however,the results were inconsistent.So we performed this meta-analysis to evaluate the relationship between CYP2D6*3 or CYP2D6*4 polymorphism and AL susceptibility.Methods We searched PubMed database up to February 20,2013,and finally yielded 9 case-control studies including 1343 cases and 1843 controls which tested the association between CYP2D6*3 or *4 polymorphism and AL.After data extraction,we conducted a meta-analysis using the Comprehensive Meta Analysis software.Results Overall,no significant association between CYP2D6*3 or *4 polymorphism and AL risk was found in this metaanalysis (+ vs.-:OR=1.13,95％ CI=0.79-1.63; +/+ vs.-/-:OR=1.73,95％ C/=0.99-3.02;-/+ vs.-/-:OR=1.03,95％ C/=0.68-1.56; (-/+ and +/+) vs.-/-:OR=1.08,95％ C/=0.72-1.63; +/+ vs.(-/+ and-/-):OR=1.76,95％ C/=0.98-3.17).Similar results were also been found in stratified subgroup analysis.There was no publication bias.Conclusion CYP2D6*3 or *4 polymorphism might not be associated with AL susceptibility.However,the results need to be further confirmed by well-designed and high quality randomized controlled trials with larger sample sizes。

Abstract：Objective To determine whether the prosthesis-patient mismatch has a deleterious impact on survival after mitral valve replacement.Data sources A comprehensive literature search of PubMed,Embase,and ScienceDirect was carried out.References and cited papers of relevant articles were also checked.Study selection All articles published after January 1980 was initially considered.Non-English and non-human studies,case reports,and reviews were excluded from the initial search.References and cited papers of relevant articles were also checked.Results A total of 8 retrospective cohort studies were identified for this review.The overall incidence of prosthesis-patient mismatch (＜1.3 to ＜1.2 cm2/m2) after mitral valve replacement ranged from 3.7％ to 85.9％ (moderate prosthesis-patient mismatch (0.9 to 1.2 cm2/m2) in 37.4％ to 69.5％,severe prosthesis-patient mismatch (＜0.9 cm2/m2) in 8.7％ to 16.4％).Four studies demonstrated an association of prosthesis-patient mismatch with reduced long-term survival,but the other four studies found no significant deleterious impact of prosthesis-patient mismatch after mitral valve replacement.No definite conclusion could be derived from these conflicting results.Conclusions Current evidence is insufficient to derive a definite conclusion whether mitral prosthesis-patient mismatch affects long-term survival because of the biases and confounding factors that interfere with late clinical outcomes.Good-quality prospective studies are warranted to evaluate the impact of mitral prosthesis-patient mismatch after mitral valve replacement in the future。

Abstract：Objective To reveal interventions for chronic cyclosporine A nephrotoxicity (CCN) and provide new targets for further studies,we analyzed all relevant studies about interventions in renal cell apoptosis.Data sources We collected all relevant studies about interventions for cyclosporine A (CsA)-induced renal cell apoptosis in Medline (1966 to July 2010),Embase (1980 to July 2010) and ISI (1986 to July 2010),evaluated their quality,extracted data following PICOS principles and synthesized the data.Study selection We included all relevant studies about interventions in CsA-induced renal cell apoptosis no limitation of research design and language) and excluded the duplicated articles,meeting abstracts and reviews without specific data.Results There were three kinds of intervention,include anti-oxidant (sulfated polysaccharides,tea polyphenols,apigenin,curcumin,spirulina,etc),biologics (recombinant human erythropoietin (rhEPO),a murine pan-specific transforming growth factor (TGF)-beta-neutralizing monoclonal antibody1D11,cartilage oligomeric matrix protein (COMP)-angiopoietin-1 and hepatocyte growth factor (HGF) gene),and other drugs (spironolactone,rosiglitazone,pirfenidone and colchicine).These interventions significantly improved the CCN,renal cell apoptosis and renal dysfunction through intervening in four apoptotic pathways in animals or protected renal cells from apoptosis induced by CsA and increased cell survival through respectively four pathways in vitro.Conclusions There are three group interventions for CCN.Especially anti-oxidant drugs can significantly improve CCN,renal cell apoptosis and renal dysfunction.Many drugs can improve CCN through intervening in Fas/Fas ligand or mitochondrial pathway with sufficient evidences.Angiotensin Ⅱ,nitric oxide (NO) and endoplasmic reticulum (ER) pathways will be new targets for CCN。

Serotherapy has assumed different clinical roles over the years.With the development of antibiotics,the use of serotherapy to treat bacterial diseases declined.However,interest in viral serotherapy increased due to the lack of a specific therapy for viral infections.Human convalescent sera have been used to treat and prevent measles,mumps,polio,Spanish flu,vaccinia and varicella viral infection,among others。