The urban comprehensive park is the main body of the urban environment construction, and the plant landscape is the most important landscape element of the comprehensive park. It is helpful for the landscape design of...The urban comprehensive park is the main body of the urban environment construction, and the plant landscape is the most important landscape element of the comprehensive park. It is helpful for the landscape design of the comprehensive park to improve the environmental quality and the sustainable development of the city. Taking the "Nanjiang Park" in Xiaoshan District of Hangzhou as the research object, the landscape design of plants was explored and analyzed. The results showed that there were significant differences in the application forms of plant land- scapes in different functional zones in comprehensive parks. The specific forms of the garden elements had different needs of plant landscape construction. According to the results of case studies, it found that comprehensive parks could improve the functions, create the aesthetic sense, enhance the atmosphere and enhance the taste through plant landscape design. In addition, corresponding suggestions were put forward according to the current situation with the aim to provide references for the future plant landscape design related with garden greens.展开更多
AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on phys...AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.展开更多
The pathophysiology of IBS is complex and still incompletely known. Both central and peripheral factors, including psychosocial factors, abnormal GI motility and secretion, and visceral hypersensitivity, are thought t...The pathophysiology of IBS is complex and still incompletely known. Both central and peripheral factors, including psychosocial factors, abnormal GI motility and secretion, and visceral hypersensitivity, are thought to contribute to the symptoms of IBS. Several studies have demonstrated altered GI motor function in IBS patients and the pattern differs between IBS subgroups based on the predominant bowel pattern. Few studies have so far addressed GI secretion in IBS, but there are some evidence supporting altered secretion in the small intestine of IBS patients. Visceral hypersensitivity is currently considered to be perhaps the most important pathophysiological factor in IBS. Importantly, several external and internal factors can modulate visceral sensitivity, as well as GI motility, and enhanced responsiveness within the GI tract to for instance stress and nutrients has been demonstrated in IBS patients. Today IBS is viewed upon as a disorder of dysregulation of the so-called brain-gut axis, involving abnormal function in the enteric, autonomic and/or central nervous systems, with peripheral alterations probably dominating in some patients and disturbed central processing of signals from the periphery in others.展开更多
AIM: To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome (IBS) patients. METHODS: Twenty-two IBS patients selected according to the Rome II criteria ...AIM: To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome (IBS) patients. METHODS: Twenty-two IBS patients selected according to the Rome II criteria (F 15, M 7; mean age 29.3±6.8, range 22-44 years) were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS: The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa (P〈0.0001) connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL (P〈0.05) and urge sensation from 61±19 mL to 68±18 mL (P〈0.01) was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION: 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.展开更多
Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation (AF) receiving oral anticoagulations (OACs) therapy. Many patients with AF are elderly and may suf...Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation (AF) receiving oral anticoagulations (OACs) therapy. Many patients with AF are elderly and may suffer from some form of cognitive impairment. This study was conducted to investigate whether cognitive impairment affects the level of adherence to anticoagulation treatment in AF patients. Me- thods The study involved 111 AF patients (mean age, 73.5±8.3 years) treated with OACs. Cognitive function was assessed using the Mini Mental State Examination (MMSE). The level of adherence was assessed by the 8-item Mot^sky Medication Adherence Scale (MMAS-8). Scores on the MMAS-8 range from 0 to 8, with scores 〈 6 reflecting low adherence, 6 to 〈 8 medium adherence, and 8 high adherence. Re- sults 46.9% of AF patients had low adherence, 18.8% had moderate adherence, and 33.3% had high adherence to OACs. Patients with lower adherence were older than those with moderate or high adherence (76.6 ±8.7 vs. 71.3 ~ 6.4 vs. 71.1 ± 6.7 years) and obtained low MMSE scores, indicating cognitive disorders or dementia (MMSE = 22.3 ± 4.2). Patients with moderate or high adherence obtained high MMSE test results (27.5 ±1.7 and 27,5 ± 3.6). According to Spearman's rank correlation, worse adherence to treatment with OACs was determined by older age (rs = -0.372) and lower MMSE scores (rs = 0.717). According to multivariate regression analysis, the level of cognitive function was a significant independent predictor of adherence (b = 1.139). Conclusions Cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with AF. Lower adherence, beyond the assessment of cognitive function, is related to the age of patients.展开更多
To evaluate the effects of acupuncture for treatment of climacteric syndrome.Methods:The 65 cases in this series were randomly assigned to the acupuncture group (N=35) and the control group (N=30), with the former tre...To evaluate the effects of acupuncture for treatment of climacteric syndrome.Methods:The 65 cases in this series were randomly assigned to the acupuncture group (N=35) and the control group (N=30), with the former treated by acupuncture and the latter by medication respectively.The therapeutic effects were evaluated by means of the clinical outcome,improvement in the symptom scores and the results of radioimmunoassays.Results:In the acupuncture group,12 cases were cured,16 cases markedly effective,and 6 cases improved,the total effective rate being as high as 97.14%.The decrease in the symptom scores,and especially the elevation of the decreased E_2 level and the decrease of the increased FSH and LH levels, demonstrated that acupuncture therapy was superior to medication.Conclusion:Acupuncture for regulating the mental activities and reinforcing the kidney is an effective therapy for climacteric syndrome.展开更多
Tako-tsubo cardiomyopathy (TTC), also known as "stress-induced cardiomyopathy", "broken heart syndrome" or "apical ballooning syndrome", often presents as an acute coronary syndrome (ACS) with ST segment cha...Tako-tsubo cardiomyopathy (TTC), also known as "stress-induced cardiomyopathy", "broken heart syndrome" or "apical ballooning syndrome", often presents as an acute coronary syndrome (ACS) with ST segment changes and shows transient left ventricular dysfunction.展开更多
AIM: To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment s...AIM: To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).METHODS: Patients (η = 44) with AP recruited in this study were divided into two groups (ACS and non-ACS) according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems: Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score, and Multiorgan Dysfunction Score (MODS). The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic (ROC) curve analysis.RESULTS: The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 (18.5-25.0) mmHg and 9.25 (3.0-12.4) mmHg in the non-ACS group (P 〈 0.01). Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores (APACHE Ⅱ, Glasgow-Imrie and MODS) on admission and higher maximal scores during hospitalization (P 〈 0.01). ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis (SAP).CONCLUSION: IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP (APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3).展开更多
Time-domain state-domain methods are common approaches in modern financial analysis.Economic conditions vary time,drift function depends on time and price level for a given state variable.In this paper,to consistently...Time-domain state-domain methods are common approaches in modern financial analysis.Economic conditions vary time,drift function depends on time and price level for a given state variable.In this paper,to consistently estimate the bivariate drift function,our purpose a new dynamic integrated estimator by combing time-and state-domain methods for estimating drift function.And we establish its asymptotic properties and illustrates it outperforms some old ones by simulations.展开更多
Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the respons...Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression, anemia, cardiovascular disease, and renal failure.展开更多
Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertens...Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.展开更多
AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration fo...AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical practice.In 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line treatment.Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory ascites.Although still debated,albumin administration in refractory ascites is accepted by the Italian health care system.We analyzedalbumin prescription and related costs before and after implementation of the new guidelines.RESULTS:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 years.Complications of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and plasmapheresis.Albumin consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the hospital.Lastly,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.展开更多
In this paper, we studied the combined effect of concave and convex nonlinearities on the number of positive solutions for a semilinear elliptic system. We prove the existence of at least four positive solutions for a...In this paper, we studied the combined effect of concave and convex nonlinearities on the number of positive solutions for a semilinear elliptic system. We prove the existence of at least four positive solutions for a semilinear elliptic system involving concave and convex nonlinearities by using the Nehari manifold and the center mass function.展开更多
A 36-residue peptide is designed to cure acquired immunodeficiency syndrome(AIDS), and is synthesized by the manual solid phase peptide synthesis technique. Different reaction conditions of the synthesis process were ...A 36-residue peptide is designed to cure acquired immunodeficiency syndrome(AIDS), and is synthesized by the manual solid phase peptide synthesis technique. Different reaction conditions of the synthesis process were discussed. Stirring efficiency of mechanics and nitrogen was compared. The mechanical method displays a predominant performance. Although the coupling efficiencies of diisopropylcarbodiimide(DIC) and dicyclohexylcarbodiimide(DCC) are virtually identical, DIC offers several advantages over DCC in practice due to different physical characters. Wash conditions after deprotection and coupling were investigated to monitor washing efficiency. 0.369 2 g crude peptide was obtained.展开更多
Objective: To assess the therapeutic effect of Caspase-1 inhibitor on liver injury in experimental severe acute pancreatitis (SAP). Methods: Forty-two SD rats were randomly divided into 3 groups: healthy controls (HC,...Objective: To assess the therapeutic effect of Caspase-1 inhibitor on liver injury in experimental severe acute pancreatitis (SAP). Methods: Forty-two SD rats were randomly divided into 3 groups: healthy controls (HC, n=6); SAP-S group (n=18); SAP-ICE-I group (n=18). SAP was induced by retrograde infusion of 5% sodium taurocholate into the bili-pancreatic duct in SD rats. HC rats underwent same surgical procedures and duct cannulation without sodium taurocholate. In SAP-S group, rats received the first intraperitoneal injection of isotonic saline 2 h after induction of acute pancreatitis, which was repeated after 12 h. In SAP-ICE-I group, rats were firstly given ICE inhibitor intraperitoneally 2 h after induction of pancreatitis. As in SAP-S group, this was repeated at 12 h. Survied rats were killed at certain time points, and all samples were obtained for subsequent analysis. Results: The serum levels of ALT, AST and IL-1β in SAP-S group were (215.50±58.52)U/L, (372.17±38.05)U/L, (276.77±44.92)pg/ml at 6 h, (396.67±70.29)U/L, (548.50±75.29)U/L, (308.99±34.95)pg/ml at 12 h, (425.17±86.33)U/L, (665.83±84.05)U/L, (311.60±46.51)pg/ml, respectively, which were increased significantly (P<0.01, vs HC). In SAP-ICE-I group, their levels were decreased significantly (P<0.01, vs SAP-S). Intrahepatic expressions of Caspase-1, IL-1β and IL-18 mRNA could be observed in HC, which were increased significantly in SAP-S group (P<0.01, vs HC). The expressions of IL-1β and IL-18 mRNA were decreased significantly in SAP-ICE-I group (P<0.01, vs SAP-S), whereas Caspase-1 mRNA expressions had no significant differences (P>0.05). Caspase-1 inhibition had no effect on the severity of liver tissue damage. Conclusion: Caspase-1 activate cytokines, IL-1β and IL-18, play a pivotal role in the course of liver injury in SAP. Caspase-1 inhibitor can improve liver functions effectively.展开更多
Objective: To study the function in cellular immunity of patients with hyper-IgE syndrome (HIE). Methods: T-lymphocyte subtypes of the peripheral blood and cutaneous delayed-type hypersensitivity (DTH) to two recall a...Objective: To study the function in cellular immunity of patients with hyper-IgE syndrome (HIE). Methods: T-lymphocyte subtypes of the peripheral blood and cutaneous delayed-type hypersensitivity (DTH) to two recall antigens, tetanus toxoid (TT) and purified protein derivative(PPD), were measured in 5 patients with HIE and 15 healthy controls, respectively. Results: The CD4 + cell counts in HIE group were significantly lower than those in the control group (P<0.01). In contrast, CD8 + cells were significantly higher in HIE group than those in the controls. The induration sizes of DTH to two recall antigens were smaller in HIE group than those in controls (P<0.01). Conclusion: There is an immunologic dysfunction of T lymphocytes in the patients with HIE and T cells play an important role in the pathogenesis.展开更多
The lack of emotional relations is not replaced by the "savant" characteristics (see Asperger syndrome) but by their immersing into stereotypic instincts. In other words, they compensate their divergent intrinsic ...The lack of emotional relations is not replaced by the "savant" characteristics (see Asperger syndrome) but by their immersing into stereotypic instincts. In other words, they compensate their divergent intrinsic emotions with imitated convergences (eg., the monotonous "convergence obsessed" logic of hammering, wringing hands etc.) Today's science cannot declare this to be convergent, especially for the fact that psychotic autist patients prove to be weak at convergence, but the male/female proportion reflects on notable facts (with Kanner syndrome it is 3:1 or 4:1, while Rett syndrome only affects females). Can we declare Kanner and Rett syndromes to be basically female brain disorders? Asperger-autism has been scientifically considered as a type of "male-brain disorder" since 199l (Baron-Cohen theory). The proportion of male-female is approximately 6:1 with this disease. The author would like to demonstrate a very special case, the Asperger-autism as a "cognitive autism." It is common to address autistic disorder as "pervasive" or "comprehensive" ontogenetic disorders because they affect all areas of adolescent psychological development negatively. But as the expression itself suggests, we are not aware of the specific disorders directly. As it will turn out we cannot deal with autism as on complex disorder, we should rather use the term in plural, i.e., autisms and autistic disorders.展开更多
This paper first analyzes the benefits offered by the American Black Fraternities to the black college students in terms of improving academic achievement, cultivating leadership abilities, and enhancing social involv...This paper first analyzes the benefits offered by the American Black Fraternities to the black college students in terms of improving academic achievement, cultivating leadership abilities, and enhancing social involvement on campus. Based on the successful experience of the American Black Fraternities, this paper further explores solutions to the serious problems existing in the Fellow Townsmen Association in Chinese universities to make it the same valuable asset for the development of the members' personality and comprehensive quality. The Association should be leveled up to an official student society to solve many of its managerial problems, and set a group goal to direct its members to the right track of serious study and completely transform the form and the content of its activities to improve the social skills of its members.展开更多
Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease caused by HIV It has been epidemic formore than 20 years, but there is no cure of it. Health educationand behavioral interventions are some of the mo...Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease caused by HIV It has been epidemic formore than 20 years, but there is no cure of it. Health educationand behavioral interventions are some of the most effectiveapproaches in the control and prevention of AIDS. China isone of the countries with the fastest growing HIVseroprevalence rate, and is facing a widespread epidemic ofAIDS. Currently, high-risk populations such as individualswith multiple sexual partners and intravenous drug users arethe main foci of health education and behavioral interventionsin China. Encouraging results have been observed in manyforms of health education and behavioral intervention. Theapplication of health education and behavioral interventionsmust emerge from scientific evidence, follow a series ofstrategies, be carried out from various perspectives, andrequire the participation of all societal communities.展开更多
文摘The urban comprehensive park is the main body of the urban environment construction, and the plant landscape is the most important landscape element of the comprehensive park. It is helpful for the landscape design of the comprehensive park to improve the environmental quality and the sustainable development of the city. Taking the "Nanjiang Park" in Xiaoshan District of Hangzhou as the research object, the landscape design of plants was explored and analyzed. The results showed that there were significant differences in the application forms of plant land- scapes in different functional zones in comprehensive parks. The specific forms of the garden elements had different needs of plant landscape construction. According to the results of case studies, it found that comprehensive parks could improve the functions, create the aesthetic sense, enhance the atmosphere and enhance the taste through plant landscape design. In addition, corresponding suggestions were put forward according to the current situation with the aim to provide references for the future plant landscape design related with garden greens.
文摘AIM: To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period ofthe first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is a frequent finding in patients admitted to the ICU because of AP. Patients with IAP at approximately 10-12 mmHg and early signs of changes in physiologic variables should be seriously considered for urgent decompression to improve survival.
文摘The pathophysiology of IBS is complex and still incompletely known. Both central and peripheral factors, including psychosocial factors, abnormal GI motility and secretion, and visceral hypersensitivity, are thought to contribute to the symptoms of IBS. Several studies have demonstrated altered GI motor function in IBS patients and the pattern differs between IBS subgroups based on the predominant bowel pattern. Few studies have so far addressed GI secretion in IBS, but there are some evidence supporting altered secretion in the small intestine of IBS patients. Visceral hypersensitivity is currently considered to be perhaps the most important pathophysiological factor in IBS. Importantly, several external and internal factors can modulate visceral sensitivity, as well as GI motility, and enhanced responsiveness within the GI tract to for instance stress and nutrients has been demonstrated in IBS patients. Today IBS is viewed upon as a disorder of dysregulation of the so-called brain-gut axis, involving abnormal function in the enteric, autonomic and/or central nervous systems, with peripheral alterations probably dominating in some patients and disturbed central processing of signals from the periphery in others.
基金Supported by the grant from GlaxoSmithKline Pharmaceuticals S.A.
文摘AIM: To evaluate the effect of sumatriptan, a selective 5-HT1 agonist, on anorectal function in irritable bowel syndrome (IBS) patients. METHODS: Twenty-two IBS patients selected according to the Rome II criteria (F 15, M 7; mean age 29.3±6.8, range 22-44 years) were examined. The study was blind, randomized and placebo-controlled with a crossover design. Anorectal manometry and rectal balloon distension test were performed before and after the administration of placebo and sumatriptan. RESULTS: The administration of sumatriptan caused a significant increase in the resting anal canal pressure from 9.2±2.0 kPa to 13.1±3.3 kPa (P〈0.0001) connected with the increase in the anal sphincter length and high pressure zone. After sumatriptan injection a remarkable increase in the threshold for the first sensation from 27±9 mL to 34±12 mL (P〈0.05) and urge sensation from 61±19 mL to 68±18 mL (P〈0.01) was observed. Sumatriptan did not affect either the volume evoking the rectoanal inhibitory reflex or the results of the straining test. CONCLUSION: 5-HT1 receptors participate in the regulation of anorectal function. Elucidation of the role of 5-HT1 receptors in the pathophysiological mechanisms of IBS may have some therapeutic implications.
文摘Background Medication adherence is an integral part of the comprehensive care of patients with atrial fibrillation (AF) receiving oral anticoagulations (OACs) therapy. Many patients with AF are elderly and may suffer from some form of cognitive impairment. This study was conducted to investigate whether cognitive impairment affects the level of adherence to anticoagulation treatment in AF patients. Me- thods The study involved 111 AF patients (mean age, 73.5±8.3 years) treated with OACs. Cognitive function was assessed using the Mini Mental State Examination (MMSE). The level of adherence was assessed by the 8-item Mot^sky Medication Adherence Scale (MMAS-8). Scores on the MMAS-8 range from 0 to 8, with scores 〈 6 reflecting low adherence, 6 to 〈 8 medium adherence, and 8 high adherence. Re- sults 46.9% of AF patients had low adherence, 18.8% had moderate adherence, and 33.3% had high adherence to OACs. Patients with lower adherence were older than those with moderate or high adherence (76.6 ±8.7 vs. 71.3 ~ 6.4 vs. 71.1 ± 6.7 years) and obtained low MMSE scores, indicating cognitive disorders or dementia (MMSE = 22.3 ± 4.2). Patients with moderate or high adherence obtained high MMSE test results (27.5 ±1.7 and 27,5 ± 3.6). According to Spearman's rank correlation, worse adherence to treatment with OACs was determined by older age (rs = -0.372) and lower MMSE scores (rs = 0.717). According to multivariate regression analysis, the level of cognitive function was a significant independent predictor of adherence (b = 1.139). Conclusions Cognitive impairment is an independent determinant of compliance with pharmacological therapy in elderly patients with AF. Lower adherence, beyond the assessment of cognitive function, is related to the age of patients.
文摘To evaluate the effects of acupuncture for treatment of climacteric syndrome.Methods:The 65 cases in this series were randomly assigned to the acupuncture group (N=35) and the control group (N=30), with the former treated by acupuncture and the latter by medication respectively.The therapeutic effects were evaluated by means of the clinical outcome,improvement in the symptom scores and the results of radioimmunoassays.Results:In the acupuncture group,12 cases were cured,16 cases markedly effective,and 6 cases improved,the total effective rate being as high as 97.14%.The decrease in the symptom scores,and especially the elevation of the decreased E_2 level and the decrease of the increased FSH and LH levels, demonstrated that acupuncture therapy was superior to medication.Conclusion:Acupuncture for regulating the mental activities and reinforcing the kidney is an effective therapy for climacteric syndrome.
文摘Tako-tsubo cardiomyopathy (TTC), also known as "stress-induced cardiomyopathy", "broken heart syndrome" or "apical ballooning syndrome", often presents as an acute coronary syndrome (ACS) with ST segment changes and shows transient left ventricular dysfunction.
文摘AIM: To assess the value of widely used clinical scores in the early identification of acute pancreatitis (AP) patients who are likely to suffer from intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS).METHODS: Patients (η = 44) with AP recruited in this study were divided into two groups (ACS and non-ACS) according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter. On admission and at regular intervals, the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems: Glasgow-Imrie score, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE-Ⅱ) score, and Multiorgan Dysfunction Score (MODS). The diagnostic performance of scores predicting ACS development, cut-off values and specificity and sensitivity were established using receiver operating characteristic (ROC) curve analysis.RESULTS: The incidence of ACS in our study population was 19.35%. IAP at admission in the ACS group was 22.0 (18.5-25.0) mmHg and 9.25 (3.0-12.4) mmHg in the non-ACS group (P 〈 0.01). Univariate statistical analysis revealed that patients in the ACS group had significantly higher multifactorial clinical scores (APACHE Ⅱ, Glasgow-Imrie and MODS) on admission and higher maximal scores during hospitalization (P 〈 0.01). ROC curve analysis revealed that APACHE Ⅱ, Glasgow-Imrie, and MODS are valuable tools for early prediction of ACS with high sensitivity and specificity, and that cut-off values are similar to those used for stratification of patients with severe acute pancreatitis (SAP).CONCLUSION: IAH and ACS are rare findings in patients with mild AR Based on the results of our study we recommend measuring the IAP in cases when patients present with SAP (APACHE Ⅱ 〉 7; MODS 〉 2 or Glasgow-Imrie score 〉 3).
基金Supported by the Natural Science Research Foundation of Education Department of Guizhou Province(20090080,2010076)Supported by the Project of Kaili University(Z1004)Supported by the Key Discipline Construction Program of Kaili University(KZD2009001)
文摘Time-domain state-domain methods are common approaches in modern financial analysis.Economic conditions vary time,drift function depends on time and price level for a given state variable.In this paper,to consistently estimate the bivariate drift function,our purpose a new dynamic integrated estimator by combing time-and state-domain methods for estimating drift function.And we establish its asymptotic properties and illustrates it outperforms some old ones by simulations.
文摘Several studies have demonstrated that the outcome of chronic hepatitis C (CHC) infection is profoundly influenced by a variety of comorbidities. Many of these comorbidities have a significant influence on the response to antiviral therapy. These comorbidities negatively affect the course and outcome of liver disease, often reducing the chance of achieving a sustained virological response with PEGylated interferon and ribavirin treatments. Comorbidities affecting response to antiviral therapy reduce compliance and adherence to inadequate doses of therapy. The most important comorbidities affecting the course of CHC include hepatitis B virus coinfection, metabolic syndrome, and intestinal bacterial overgrowth. Comorbidities affecting the course and response to therapy include schistosomiasis, iron overload, alcohol abuse, and excessive smoking. Comorbidities affecting response to antiviral therapy include depression, anemia, cardiovascular disease, and renal failure.
文摘Hepatorenal syndrome(HRS) is defined as a functional renal failure in patients with liver disease with portal hypertension and it constitutes the climax of systemic circulatory changes associated with portal hypertension.This term refers to a precisely specified syndrome featuring in particular morphologically intact kidneys,where regulatory mechanisms have minimised glomerular filtration and maximised tubular resorption and urine concentration,which ultimately results in uraemia.The syndrome occurs almost exclusively in patients with ascites.Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output.Type 2 HRS is characterised by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure,but refractory ascites,and its impact on prognosis is less negative.Liver transplantation is the most appropriate therapeutic method,nevertheless,only a few patients can receive it.The most suitable "bridge treatments" or treatment for patients ineligible for a liver transplant include terlipressin plus albumin.Terlipressin is at an initial dose of 0.5-1 mg every 4 h by intravenous bolus to 3 mg every 4 h in cases when there is no response.Renal function recovery can be achieved in less than 50% of patients and a considerable decrease in renal function may reoccur even in patients who have been responding to therapy over the short term.Transjugular intrahepatic portosystemic shunt plays only a marginal role in the treatment of HRS.
文摘AIM:To assess the impact of guidelines for albumin prescription in an academic hospital,which is a referral center for liver diseases.METHODS:Although randomized trials and guidelines support albumin administration for some complications of cirrhosis,the high cost of albumin greatly limits its use in clinical practice.In 2003,a multidisciplinary panel at Sant'Orsola-Malpighi University Hospital(Bologna,Italy)used a literature-based consensus method to list all the acute and chronic conditions for which albumin is indicated as first-or second-line treatment.Indications in hepatology included prevention of post-paracentesis circulatory dysfunction and renal failure induced by spontaneous bacterial peritonitis,and treatment of hepatorenal syndrome and refractory ascites.Although still debated,albumin administration in refractory ascites is accepted by the Italian health care system.We analyzedalbumin prescription and related costs before and after implementation of the new guidelines.RESULTS:While albumin consumption and costs doubled from 1998 to 2002,they dropped 20%after 2003,and remained stable for the following 6 years.Complications of cirrhosis,namely refractory ascites and paracentesis,represented the predominant indications,followed by major surgery,shock,enteric diseases,and plasmapheresis.Albumin consumption increased significantly after guideline implementation in the liver units,whereas it declined elsewhere in the hospital.Lastly,extra-protocol albumin prescription was estimated as<10%.CONCLUSION:Albumin administration in cirrhosis according to international guidelines does not increase total hospital albumin consumption if its use in settings without evidence of efficacy is avoided.
文摘In this paper, we studied the combined effect of concave and convex nonlinearities on the number of positive solutions for a semilinear elliptic system. We prove the existence of at least four positive solutions for a semilinear elliptic system involving concave and convex nonlinearities by using the Nehari manifold and the center mass function.
文摘A 36-residue peptide is designed to cure acquired immunodeficiency syndrome(AIDS), and is synthesized by the manual solid phase peptide synthesis technique. Different reaction conditions of the synthesis process were discussed. Stirring efficiency of mechanics and nitrogen was compared. The mechanical method displays a predominant performance. Although the coupling efficiencies of diisopropylcarbodiimide(DIC) and dicyclohexylcarbodiimide(DCC) are virtually identical, DIC offers several advantages over DCC in practice due to different physical characters. Wash conditions after deprotection and coupling were investigated to monitor washing efficiency. 0.369 2 g crude peptide was obtained.
文摘Objective: To assess the therapeutic effect of Caspase-1 inhibitor on liver injury in experimental severe acute pancreatitis (SAP). Methods: Forty-two SD rats were randomly divided into 3 groups: healthy controls (HC, n=6); SAP-S group (n=18); SAP-ICE-I group (n=18). SAP was induced by retrograde infusion of 5% sodium taurocholate into the bili-pancreatic duct in SD rats. HC rats underwent same surgical procedures and duct cannulation without sodium taurocholate. In SAP-S group, rats received the first intraperitoneal injection of isotonic saline 2 h after induction of acute pancreatitis, which was repeated after 12 h. In SAP-ICE-I group, rats were firstly given ICE inhibitor intraperitoneally 2 h after induction of pancreatitis. As in SAP-S group, this was repeated at 12 h. Survied rats were killed at certain time points, and all samples were obtained for subsequent analysis. Results: The serum levels of ALT, AST and IL-1β in SAP-S group were (215.50±58.52)U/L, (372.17±38.05)U/L, (276.77±44.92)pg/ml at 6 h, (396.67±70.29)U/L, (548.50±75.29)U/L, (308.99±34.95)pg/ml at 12 h, (425.17±86.33)U/L, (665.83±84.05)U/L, (311.60±46.51)pg/ml, respectively, which were increased significantly (P<0.01, vs HC). In SAP-ICE-I group, their levels were decreased significantly (P<0.01, vs SAP-S). Intrahepatic expressions of Caspase-1, IL-1β and IL-18 mRNA could be observed in HC, which were increased significantly in SAP-S group (P<0.01, vs HC). The expressions of IL-1β and IL-18 mRNA were decreased significantly in SAP-ICE-I group (P<0.01, vs SAP-S), whereas Caspase-1 mRNA expressions had no significant differences (P>0.05). Caspase-1 inhibition had no effect on the severity of liver tissue damage. Conclusion: Caspase-1 activate cytokines, IL-1β and IL-18, play a pivotal role in the course of liver injury in SAP. Caspase-1 inhibitor can improve liver functions effectively.
文摘Objective: To study the function in cellular immunity of patients with hyper-IgE syndrome (HIE). Methods: T-lymphocyte subtypes of the peripheral blood and cutaneous delayed-type hypersensitivity (DTH) to two recall antigens, tetanus toxoid (TT) and purified protein derivative(PPD), were measured in 5 patients with HIE and 15 healthy controls, respectively. Results: The CD4 + cell counts in HIE group were significantly lower than those in the control group (P<0.01). In contrast, CD8 + cells were significantly higher in HIE group than those in the controls. The induration sizes of DTH to two recall antigens were smaller in HIE group than those in controls (P<0.01). Conclusion: There is an immunologic dysfunction of T lymphocytes in the patients with HIE and T cells play an important role in the pathogenesis.
文摘The lack of emotional relations is not replaced by the "savant" characteristics (see Asperger syndrome) but by their immersing into stereotypic instincts. In other words, they compensate their divergent intrinsic emotions with imitated convergences (eg., the monotonous "convergence obsessed" logic of hammering, wringing hands etc.) Today's science cannot declare this to be convergent, especially for the fact that psychotic autist patients prove to be weak at convergence, but the male/female proportion reflects on notable facts (with Kanner syndrome it is 3:1 or 4:1, while Rett syndrome only affects females). Can we declare Kanner and Rett syndromes to be basically female brain disorders? Asperger-autism has been scientifically considered as a type of "male-brain disorder" since 199l (Baron-Cohen theory). The proportion of male-female is approximately 6:1 with this disease. The author would like to demonstrate a very special case, the Asperger-autism as a "cognitive autism." It is common to address autistic disorder as "pervasive" or "comprehensive" ontogenetic disorders because they affect all areas of adolescent psychological development negatively. But as the expression itself suggests, we are not aware of the specific disorders directly. As it will turn out we cannot deal with autism as on complex disorder, we should rather use the term in plural, i.e., autisms and autistic disorders.
文摘This paper first analyzes the benefits offered by the American Black Fraternities to the black college students in terms of improving academic achievement, cultivating leadership abilities, and enhancing social involvement on campus. Based on the successful experience of the American Black Fraternities, this paper further explores solutions to the serious problems existing in the Fellow Townsmen Association in Chinese universities to make it the same valuable asset for the development of the members' personality and comprehensive quality. The Association should be leveled up to an official student society to solve many of its managerial problems, and set a group goal to direct its members to the right track of serious study and completely transform the form and the content of its activities to improve the social skills of its members.
文摘Acquired Immune Deficiency Syndrome (AIDS) is an infectious disease caused by HIV It has been epidemic formore than 20 years, but there is no cure of it. Health educationand behavioral interventions are some of the most effectiveapproaches in the control and prevention of AIDS. China isone of the countries with the fastest growing HIVseroprevalence rate, and is facing a widespread epidemic ofAIDS. Currently, high-risk populations such as individualswith multiple sexual partners and intravenous drug users arethe main foci of health education and behavioral interventionsin China. Encouraging results have been observed in manyforms of health education and behavioral intervention. Theapplication of health education and behavioral interventionsmust emerge from scientific evidence, follow a series ofstrategies, be carried out from various perspectives, andrequire the participation of all societal communities.