Fisher Exact Probability Method Research Articles

Predictive performance of neutrophil gelatinase-associated lipocalin (NGAL) in acute kidney injury in septic patients

Objective To assess the capability of serum and urine neutrophil gelatinase-associated lipocalin (NGAL) in predicting acute kidney injury (AKI) in septic patients. Methods From July 1, 2014 through December 31, 2014, a prospective observational study of septic patients without AKI was carried out in Renmin Hospital, Tianjin Hospital, and Nankai Hospital, Tianjin. The patients with AKI which was developed after admission to intensive care unit (ICU) were assigned to AKI group and the patients without AKI were assigned to non-AKI group. Clinical data and serum and urine sample were collected at the admission, and at 12, 24, 36, 48, 60, 72 , 84 and 96 hours after admission for detecting creatinine and NGAL. The measurement data accorded with normal distribution were used for t test or variance analysis of repeated measures; comparison of measurement data in non-normal distribution was carried out using the Mann-Whitney U test or Fridman test; comparison of count data was performed using Fisher exact probability method. ROC curve of serum or urine NGAL was plotted and the diagnostic values of serum or urine NGAL in predicting AKI were assessed by calculation of the area under the receiver operating characteristic curve (AuROC). Results Fifty septic patients were included. Thirty-five patients were in AKI group and fifteen in non-AKI group. The median age of AKI group was 73 [interquartile range (IQR), 66-83] and the median age of non-AKI group was 60 (IQR, 47-82). The urine NGAL (uNGAL) concentration in AKI group was higher than that in non-AKI group at the every interval and serum NGAL (sNGAL) was higher in AKI group than that in non-AKI group at only first twointervals. The uNGAL showed the capability of prediction for AKI progression at the 48 hour (AuROC=0.83, 95% CI: 0.70-0.97), 36 hours (AuROC=0.75, 95%CI: 0.59-0.91), 24 hours (AuROC=0.83, 95%CI: 0.70-0.95), 12 hours (AuROC=0.73, 95%CI: 0.60-0.88) prior to AKI occurred. The sNGAL showed capability of prediction at the 48 hours (AuROC=0.69, 95%CI: 0.51-0.88), 36 hours (AuROC=0.69, 95%CI: 0.52-0.87) prior to AKI occurred. Conclusions The sNGAL and uNGAL both were useful biomarker that predicted development of AKI in early stage. But the performance of sNGAL was slightly inferior to that of uNGAL for predicting development of AKI. Key words: Neutrophil gelatinase-associated lipocalin; Acute kidney injury; Sepsis; Receiver operating characteristic curve; Area under receiver operating characteristic curve; Diagnosis; Prognosis

Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic.

Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic.

Monitoring and research on pathogen spectrum in patients with acute diarrhea from sentinel hospital of Zhejiang Province during 2009 to 2014

Objective: To explore pathogen spectrum constitution of acute diarrhea in outpatient and emergency of Zhejiang Province, and provide basis for treatment, prevention and control of the disease. Methods: During January 2009 to December 2014, we selected seven sentinel hospitals in different regions of Zhejiang, monitored and researched on pathogen spectrum in patients with acute diarrhea from outpatient and emergency. We recorded patients' personal basic information, the main symptoms and signs, and collected stool samples (5 g). Eight kinds of bacteria (Vibrio cholerae, Shigella spp., Salmonella spp., Diarrheagenic E. coli, Vibrio parahaemolyticus, Aeromonas hydrophila, Yersinia enterocolitica and Plesiomonas shigelloides) and five kinds of viruses (Rotavirus, Norovirus, Sappovirus, Astrovirus and Adenovirus) were detected. Chi-square test and Fisher's exact probability method were used to compare different characteristics of patients with single bacterial infection, single virus infection and multiple infection (bacteria-bacteria, bacteria-viruses, virus-virus). Results: During 2009 to 2014, 9 364 fecal samples from acute diarrhea patients were collected and tested, among which 3 500 cases were tested positive, with total positive rate of 37.38%. Positive rates of bacteria and viruses were 13.14% (1 230 cases) and 20.75% (1 943 cases), respectively. Mixed infection positive rate of multiple pathogens was 3.49% (327 cases). Positive rate of Vibrio parahaemolyticus (5.96% , 558 cases) was the highest among bacterial pathogens, followed by pathogenic Escherichia coli (3.86%, 361 cases). Viruses were mainly Norovirus (10.73%, 1 005 cases) and rotavirus (8.35%, 782 cases). A big difference existed in diarrheogenic pathogen spectrum between patients less than 15 years old and patients equal or older than 15 years old. Pathogens for patients less than 15 years old were mainly virus, with the positive rate of 32.69% (1 014 cases). However, the positive rate of bacteria was 16.86% (1 056 cases) in patients equal or older than 15 years old. Single bacterial infection was highest in age group of 25-34 years old (18.62%, 302 cases) , single virus infection was highest in age group of 1-4 years old (41.12%, 435 cases) , and mixed infections of multiple pathogens were mainly existed in age group of 1-4 years old (7.37%, 78 cases) . Pathogen positive rate were increasing year by year. Pathogen positive rate of patients with acute diarrhea has obvious seasonality, with single bacterial infection being highest during July to September and single virus infection being highest during December to March. Pathogen spectrum of outpatient and emergency patients with acute diarrhea in Zhejiang Province changed a little from 2009 to 2014, mainly rotavirus (22.34% (782/3 500)), norovirus (28.71% (1 005/3 500)), vibrio parahaemolyticus (15.92% (558/3 500)) and Escherichia coli (10.31% (361/3 500)). However, pathogen spectrums in different years owned different features. Conclusion: Common pathogens in outpatient and emergency patients with acute diarrhea in Zhejiang Province were tested with significant seasonal epidemic law. The composition of pathogenic spectrum was variant in different age group. Constitutes of major pathogen spectrum in different years differed a little.

Concurrent gastrointestinal stromal tumor and digestive tract carcinoma: A clinical study of 17 patients

Objective To explore the clinical characteristics, diagnosis, treatment and prognosis of the concurrent gastrointestinal stromal tumor and digestive tract carcinoma. Methods Two hundred and eigty nine cases of patients who were diagnosed as gastrointestinal stromal tumors in Jingzhou Central Hospital from July 2010 to June 2015 were concluded in this study. Among them, 170 cases were male and 119 were female. Two Hundred and seventy-two cases (94.1%) were the pure gastrointestinal stromal tumors (single group) and 17 cases (5.9%) combined with digestive tract carcinoma (concurrent group). The clinical data, treatment and prognosis were collected and retrospectively analyzed.Mean were compared by t test and rate compared by Fisher exact probability method. The prognosis of the patiets was analyzed by kaplaln-Meier method and Log-rank method. Results There were no significant differences in gender, age and tumor origin, but there were statistically significant differences in tumor diameter(P<0.001), mitotic index, (P<0.05) and NIH risk classification (P<0.05) between the simple group and the concurrent group. The median follow-up time of the two groups was 30 months (8 to 50 months) in concurrent group and 36 months (12 to 60 months) in single group, and their its prognostic difference was statistically significant (P=0.008). Conclusions There is a low incidence rate of gastrointestinal stromal tumors combined with digestive tract carcinoma and its prognosis is more poorer than the pure gastrointestinal stromal tumors . Radical resection is an effective method for gastrointestinal stromal tumors combined with digestive tract carcinoma. Key words: Gastrointestinal stromal tumors; Gastrointestinal neoplasms; Prognosis

Chest CT findings in systemic lupus erythematosus and its correlation with serum markers

ObjectiveThe aim of this study was to assess the CT findings of chest lesions in patients with systemic lupus erythematosus (SLE), and to explore its correlation with the age and serum markers (anti-dsDNA antibodies, anti-Sm antibodies, CRP, ESR, C3, C4 and IgG), in an attempt to speculate the possible mechanism of chest lesions in SLE patients. Materials and methodsThirty nine patients who met the SLE classification criteria were enrolled into this study. All patients underwent serological tests and chest CT examination. The chest CT findings of each patients were analyzed, and its correlation with the age, serum markers were explored. All data were analyzed by using SPSS 19.0 software. Two-sample t-test was used to analyze the age difference between the two groups with or without chest lesions. Relationship between the serum markers and the chest lesions was analyzed by using the Fisher's exact probability method. ResultsAll the 39 patients (34 females and 5 males), aged from 19 to 74 years old, the mean age was 44.13 ± 12.17 years old. Among the serum markers, the positive rate of C3 was the highest (79.49%), ESR positive in 22 patients (56.41%), 9 patients of CRP positive (23.08%). Of all the 39 patients, abnormal manifestations of chest CT were found in 29 patients (74.36%), the most common changes were pulmonary interstitial changes (66.67%), the second were mediastinal/pleural changes (61.54%), then were the pulmonary parenchymal changes (25.64%) and pulmonary vascular changes (12.82%). ESR positive rate difference was found between the two groups with or without pulmonary parenchymal lesions (P < 0.05), and CRP positive rate difference was found between the two groups with or without mediastinal/pleural lesions (P < 0.05). ConclusionChest involvement occurred with high frequency in SLE patients, and the CT manifestations were complex and various, pulmonary interstitial lesions were the most common. Patients with ESR positive were more susceptible to have pulmonary parenchymal lesions, and mediastinal/pleural lesions were more common in patients with CRP positive.

Retrospective analysis of therapeutic effect and prognostic factors on early glottic carcinoma

ObjectiveTo investigate the therapeutic effect of surgery, radiotherapy and photodynamic therapy on early glottic carcinoma and prognostic factors. MethodsRetrospective analysis of 202 cases with early glottic carcinoma (Tis-T2N0M0) underwent surgery (n=152), radiotherapy (n=20) and PDT (n=30) from 2000 to 2013 The KPS score, the disease-free survival (DFS), overall survival (OS), local control (LC), larynx preservation rate, laryngeal function were evaluated. The methods of χ 2test or Fisher's exact probability method, Kaplan Meier method, log-rank test of Kaplan-Meier method, Cox proportional hazards model were used to analyze the data. ResultsThere was no statistical significance in OS, DFS and LC among the three groups. The laryngeal function preservation rate of RT group, PDT group and Surgery group were 90%, 86.7% and 65.1% respectively, with the former two groups significantly superior to Surgery group. While there is no statistical significance between RT group and PDT group. Single factor analysis showed that KPS score before treatment, vocal fold mobility limitation and differentiation degree could have an effect on prognosis. Multivariate regression analyses indicated that anterior commissure invasion, T stage and KPS score before treatment were independent adverse prognostic factors for OS. T stage and differentiation degree were adverse prognostic factors for DFS. T stage was also an adverse factor of LC. Thirty-three cases experienced local recurrence or cervical lymph node metastasis. Three groups showed no statistical difference in local recurrence or lymph node metastasis, with twenty-two cases in Surgery group, four in RT group and seven in PDT group. ConclusionsThe therapeutic effect was approximate in surgery group, radiotherapy group and photodynamic group, and all three treatment regimens achieved good clinical effect. Radiotherapy and photodynamic therapy may be the first or very important treatment on early stage glottic squamous cell cancer (Tis∼T2N0M0). However only 6 patients underwent PDT for T2 disease, making definitive treatment conclusions for this subgroup unclear.

Risk analysis of lymph node metastasis in 285 patients with superficial esophageal squamous cell carcinoma

Objective To identify risk factors of lymph node metastasis in superficial esophageal squamous cell carcinoma (ESCC), and to provide evidence for treatment choice under endoscope. Methods From January 2007 to December 2011, 285 patients with pathologically diagnosed ESCC who received surgery and had clear record of lymph nodes resection were enrolled. The clinical pathological data of these patients were analyzed, including age, gender, smoking and drinking history, history of cancer, family history of cancer, location, tumor size, presence of esophageal, depth of infiltration, differentiation, and vascular cancer embolus. Univariate analysis (chi square test or Fisher exact probability method) and multivariate Logistic regression analysis were performed for risk factors of lymph node metastasis assessment.According to the rates of lymph node metastasis, patients were divided into three groups as follows: low risk, high risk and extremely high risk of lymph node metastasis. Kaplan-Meier method was used to calculate the average survival time and cumulative five years survival rate. Results Among the 285 patients with ESCC, 40(14.0%) patients with lymph node metastasis.The results of univariate analysis showed that location (χ2=9.333), tumor length (Fisher exact probability method), depth of infiltration (χ2=9.327), differentiation degree (Fisher exact probability method) vascular cancer embolus (Fisher exact probability method) were significantly associated with lymph node metastasis (all P<0.05). The results of multivariate analysis indicated that tumor length over 5 cm, invasion to submucosal layer and vascular cancer embolus were independent risk factors of lymph node metastasis, and the odd ratio was 17.408(95% confidence interval (CI) 1.557 to 194.686), 3.471(95%CI 1.440 to 8.365) and 6.256(95%CI 1.787 to 21.910), respectively. The lymph node metastasis rates of patients in low risk, high risk and extremely high risk group were 5.2%(6/115), 15.8%(24/152) and 10/18, respectively; the average survival times were (69.9±2.4), (63.8±2.1) and (51.7±1.7) months, respectively. The cumulative five years survival rates were 59%, 51% and 31%, respectively, and the difference was statistically significant (χ2=6.816, P=0.033). Conclusions The risk of lymph node metastasis is high in ESCC patients with tumor length over 5 cm, invasion to submucosal layer and vascular cancer embolus, and the prognosis is poor. Lymph node metastasis should be considered when endoscopic therapy is chosen. Key words: Superficial esophageal squamous cell carcinoma; Lymphatic metastasis; Predictors; Prognosis

Correlation between food intolerance and colon mucosal mast cells and substance P in 27 patients with diarrhea predominant irritable bowel syndrome

Objective To investigate the significance and possible mechanism of food intolerance in diarrhea-predominant irritable bowel syndrome (IBS-D). Methods Twenty-seven IBS-D patients matched the Rome Ⅲ criteria were selected as IBS-D group. Twenty-seven healthy individuals without gastrointestinal symptoms were assigned to control group. Food intolerance situation of two groups were analyzed with food intolerance status evaluation questionnaire, and detection of 14 food specific IgG antibody. The severity of IBS symptoms of IBS-D group were scored by IBS-symptom severity scale (SSS). Two pieces of mucosal tissues of both ileocecal junction and sigmoid colon were obtained under colonoscopy. The content of mucosal substance P (SP) was determined by immunohistochemistry.The quantity of mast cells were detected by Giemsa staining. Chi square test and Fisher exact probability method were performed for rate comparison between two groups.Measurement data were compared with t test and Mann-Whitney rank sum test.The correlation between IBS-SSS score and mast cells and the expression of SP positive cells were analyzed by Spearman rank correlation analysis. Results There was no statistically significant difference in positive rates of food specific IgG between two groups (χ2=3.085, P=0.389), however according to food intolerance status evaluation questionnaire, the incidence of food intolerance of IBS-D group was 44.4%(12/27) which was higher than that of control group (14.8%, 4/27), the difference was statistically (χ2=5.684, P=0.017). Food intolerance severity index of IBS-D group (median: 0(0, 60)) was higher than that of control group (median: 0(0, 0)), and the difference was statistically significant (U=239.50, P=0.007). In foods that may cause intolerance, the percentage of foods rich in fermentable oligosaccharides and monosaccharides, disaccharides and polyol (FODMAP) such as milk, noodles, soybeans was up to 71.4% (30/42). The expression tates of SP positive cells in the mucosa of ileocecal junction and sigmoid colon of patients with IBS-D were higher than those of the control group (χ2=20.735 and 22.071, both P<0.01). The numbers of mast cell in the mucosa of ileocecal junction and sigmoid colonic of patients with IBS-D (2.40±1.04/high power field(HPF) and 2.35±1.11/HPF) were more than those of the control group (0.97±0.70/HPF and 0.89±0.72/HPF), and the difference was statistically significant (t=-5.850 and -5.629, both P<0.01). The severity of bowel symptom of patients with IBS-D was moderately correlated with the number of mast cells in the mucosa of sigmoid colon (r=0.576, P=0.002), and was moderately correlated with the expression of SP positive cells (r=0.691, P<0.01). Conclusions There may be relation ship among low-grade inflammation of intestinal mucosa, food intolerance and severity of intestinal symptoms in patients with IBS-D. Key words: Food intolerance; Diarrhea-predominant irritable bowel syndrome; Mast cells; Substance P

Clinical and MRI characteristics of hypertrophic cardiomyopathy with restrictive phenotype

Objective To investigate the clinical and MR characteristics of hypertrophic cardiomyopathy(HCM) with restrictive phenotype. Methods Nineteen patients of HCM with obviously restrictive characteristics (HCM with restrictive phenotype) and 19 typical patients with non obstructive HCM, matched with age, gender and suffering time, were retrospectively collected. A short-axis stack, one 4-chamber and 2-chamber views were acquired using black blood sequence and bright blood cine sequence. Ten to15 minutes after injection of contrast medium late gadolinium enhancement images were acquired. The clinical features, the wall thickness and segments of delayed enhancement, and the MR function parameters of the two groups were compared retrospectively. The paired sample t test and Fisher exact probability method were used for the analysis of quantitative data and categorical data respectively. Results Eleven of patients of HCM with restrictive phenotype suffered sustained atrial fibrillation and pericardial effusion, whereas only 0 and 1 cases was found had the same two symptoms in HCM(all P<0.01). The heart function classification was worse compared with controls (P<0.01); The left and right atrium diameter were (55.8±5.3) mm and (61.3±11.0) mm in case group, which were significantly greater than the controls[(37.0± 7.8) and (39.3 ± 5.3)mm respectively] (t=8.82 and 25.55, P<0.01); HCM with restrictive phenotype showed obvious right ventricular long axis shortening, similar to restrictive cardiomyopathy. The segments with late gadolinium enhancement were 7.7±3.0 in patients with restrictivephenotype, which were significantly greater than controls (5.1±2.8, t=2.80, P<0.01). The left ventricular end-diastolic volume index, the cardiac index, and the left heart ejection fraction of patients with restrictive phenotype were all significantly less than those of the controls. Conclusions HCM with restrictive phenotype is a subtype of HCM. The patients often have severe clinical symptoms. MRI has important application value in the diagnosis and evaluation of the disease. Key words: Cardiomyopathy, hypertrophic; Magnetic resonance imaging

Clinical analysis of 18 primary intestinal T cell lymphoma misdiagnosed as Crohn's disease

Objective To analyze clinical features and prognosis of primary intestinal T cell lymphoma (ITCL) which was misdiagnosed as Crohn's disease (CD), and summarized the key points of differentiation between ITCL and CD. Methods From January 2003 to January 2014, clinical data of patients with ITCL once misdiagnosed as CD were retrospectively analyzed, which included demographic, clinical, pathological and prognostic data. The data of 177 patients diagnosed as CD from January 2012 to January 2014 were collected. The demographic, clinical, pathological and prognostic data of these two groups were analyzed and compared. The continuous variables were compared with t test or Mann-Whitney U test, and the differences of classification variables between two groups were analyzed by Chi-square test or Fisher exact probability method. Results A total of 18 patients (17 males and one female) with ITCL misdiagnosed as CD were enrolled in the study, and the median age at diagnosis was 38.5 (28.8 to 42.5) years and the median duration of diagnosis was 6.00 (3.75 to 13.25) months. The common primary symptoms were abdominal pain (12/18), diarrhea (13/18) and anemia (13/18). Intestinal perforation was primary symptom in two cases (2/18). However, B symptoms of lymphoma was observed in 16 patients, which included fever in 13 patients, weight loss in 16 patients and night sweat in one patient. One or more serious complications appeared in 12 patients, which included intestinal perforation in nine patients, severe gastrointestinal bleeding in seven patients and intestinal obstruction in two patients. In 177 patients with CD, 104 patients were male (58.8%), and the median age at diagnosis was 22.0 (18.0 to 29.0) years. The primary symptoms were abdominal pain (88.7%, 157/177), diarrhea (55.9%, 99/177), anemia (63.8%, 113/177), fever (33.3%, 59/177) and weight loss (59.9%, 106/177). During the disease course, 30 patients (16.9%) had intestinal perforation (mainly chronic), 12 patients (6.8%) had intestinal obstruction and seven patients (4.0%) had severe gastrointestinal bleeding. Compared to CD patients, male patients were more common in ITCL (χ2=8.837, P<0.01), age at diagnosis was older (χ2=314.5, P<0.01), the disease course was shorter (U=385.0, P<0.01), weight loss (χ2=5.867, P<0.05) and fever (χ2=10.609, P<0.01) were more common in clinical symptoms and intestinal perforation and severe gastrointestinal bleeding were more common in complications (χ2=9.185, 24.908, both P <0.01). The lesions of ITCL were multiple lesions, small bowel involved in eight cases, colon involved in 14 cases and one case with esophagus involved. Under endoscopy examination, most lesions appeared as ulcerations and were segmentally distributed. Compared to CD, lymphocyte proliferation was more common in the intestinal histopathological findings of ITCL (17/18 vs 19.7%(35/177); χ2=42.844, P<0.01) and granuloma was rare (0 vs 42.8%(76/177), χ2=12.665, P<0.01). Among 18 patients with ITCL, nine received chemotherapy and the median survival time was two months. Conclusions Primary ITCL had non-specific symptoms and was easily misdiagnosed as CD. More attention should be paid to the differential diagnosis of the two disease. Key words: Primary intestinal T-cell lymphoma; Crohn disease; Clinical features

Clinical analysis of pulmonary infection in patients with hepatitis B virus-related acute-on-chronic liver failure

Objective To investigate the clinical features of pulmonary infection in patients with hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF). Methods A total of 666 hospitalized patients with HBV-ACLF in Department of Liver Disease of Fuzhou Infectious Diseases Hospital were retrospectively analyzed. Data of demographic and clinical parameters (sex, age, presence of liver cirrhosis and diabetes), complications (spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy, and upper gastrointestinal hemorrhage), and baseline biochemical parameters were collected from the medical records database. Univariate and multivariate regression analyses were performed to determine the independent risk factors of pulmonary infection in patients with ACLF. Distributions of the pathogenic bacteria were further analyzed. Student t test was used for the means consistent with normal distribution, while non-parametric statistics were used for the data consistent with abnormal distribution. Mann-Whitney U test was used for the data between two groups. Chi square test and Fisher exact probability method were used for comparing the count data. Results A total of 125 out of 666 patients with ACLF developed pulmonary infection. The incidence of pulmonary infection was 18.76% (125/666). Most patients were infected with fungi (54.84%). The incidence rate of pulmonary infection in patients with liver failure over 60 years (41.18%) was significantly higher than that in patients under 60 years (16.91%; χ2=19.136, P<0.01). The incidence of cirrhosis or diabetes in the 125 patients with pulmonary infection was higher than patients with no pulmonary infection. The difference between the two groups was statistically significant (P<0.01). Levels of albumin, cholesterol, alpha-fetoprotein, white blood cell count, hemoglobin, plasma thromboplastin antecedent, international normalized ratio (INR), and serum sodium were all significantly different between the two groups (all P<0.05). The incidence of spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatic encephalopathy in patients with pulmonary infection were significantly higher than those without pulmonary infection (P<0.01). Spontaneous bacterial peritonitis, age, albumin, hemoglobin and serum sodium were important factors in the development of the pulmonary infection. And albumin, hemoglobin and serum sodium were protective factors. Conclusions Pulmonary infection, as one of the common and serious complications, significantly affects the prognosis of liver failure patients. Prediction of pulmonary infection in the early stage is essential. Patients with elder age, spontaneous bacterial peritonitis, low albumin level, low serum sodium level and low hemoglobin level should be timely monitored to prevent the development of pulmonary infection. Key words: Hepatitis B virus; Liver failure; Pneumonia; Prognosis; Regression analysis

Correlation of multidrug resistance genes and clinical risk factors with glucocorticoid response in patients with inflammatory bowel disease

Objective To investigate the correlation of multidrug resistance gene 1 (MDR1),NR3C1 gene polymorphisms and clinical risk factors with efficacy,dependence,and resistance of glucocorticoid (GC) in patients with inflammatory bowel disease (IBD).Methods Anti coagulation blood samples of 196 healthy controls and 105 IBD patients received GC therapy were collected.There were 62 ulcerative colitis (UC) and 43 Crohn's disease (CD) in the IBD patients.The number of GC sensitive,GC dependent and GC resistant of UC patients were 36,13 and 13,respectively,and those of CD patients were 24,11 and eight.GC refractoriness included GC dependence and resistance.The genotype of MDR1 C3435T and NR3C1 Bcl Ⅰ of all the subjects was detected by the restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR).The correlation between each genotype frequency,clinical features of patients with IBD and the efficacy of GC treatment was analyzed by Chisquare test,Fisher exact probability method or t test.Results Among UC patients,the disease course of GC refractory group and GC resistant group was longer than that of GC sensitive group ((6.660±1.523)years,(6.500±1.111) yearsvs (3.350±0.697) years,t=2.211,P=0.031; t=2.930,P=0.005).The serum level of C reaction protein (CRP) of GC refractory group was higher than that of GC sensitive group ((47.628±13.913) mg/Lvs (16.854±4.121) mg/L,t=2.121,P=0.047).The chronic relapse type was more common in GC refractory UC patients (Fisher exact probability method,P=0.035),and severe patients were more common in UC with GC resistance (Fisher exact probability method,P=0.021).The white blood cell count of GC resistant and GC refractory CD patient was lower than that of GC sensitive CD patients ((5.710 ± 0.604) ×109/L,(5.878±0.405) × 109/L vs (7.814 ±0.670) × 109/L,t=2.334,P=0.028; t=2.045,P=0.018).Patients with extraqntestinal manifestations was more common in CD with GC resistance (Fisher exact probability method,P=0.035).There was no statistically significant difference in the frequencies of MDR1 C3435T,NR3C1 Bcl Ⅰ genotypes,allelic genes and gene carrier among control group and GC sensitive dependent and resistant group of IBD patients.However,the frequency of MDR1 C3435T gene carrier was significantly different between GC sensitive group and GC refractory group,especially between GC sensitive group and GC resistance group (68.33％ vs 48.89％,x2 =4.051,P=0.044; 68.33％ vs 42.86％,x2 =4.274,P =0.039).Conclusions GC sensitivity of IBD patients with MDR1 C3435T loci T gene carrier was higher than that of IBD patients without T gene carrier.NR3C1 gene polymorphisms was not related with GC resistance and GC dependence.Compared with GC sensitive IBD patients,in GC resistant and GC dependent IBD pantient UC patients with long disease course,chronic relapse type,severe type,high level of CRP and CD patients with low white blood cell count and extra-intestinal manifestations were more common. Key words: Inflammatory bowel diseases; MDR1 gene; Receptors, glucocorticoid; Polymorphism,genetic

Effect of Shanghai's standardized training of residents on the history taking mode of physicians

Objective To evaluate the needs of performing a standardized communication skill training program for residents according to the differences in history taking mode of residents with different degrees and before and after the standardized training in Shanghai Changhai Hospital in 2010.Methods History taking modes of 81 residents in 2010 before and after the standardized training in Shanghai Changhai hospital were categorized.History taking modes were classified into:no effectiveness mode,traditional mode,disease-sickness mode and Calgary-Cambridge Guide mode.Distribution differences of history taking mode of residents with different medical degrees were analyzed by Fisher exact probability method (α =0.05).Distribution differences of history taking mode of residents before and after standardized training were analyzed by Pearson x2 test (α =0.05).Results 19.8％ residents took no effectiveness mode,53.0％ took traditional mode and 27.2％ used disease-sickness mode.There were significant differences in history taking modes among residents with different medical degrees (P =0.008).After training,history taking modes of residents were significantly changed (P=0.001),only 1.2％ residents used no effectiveness mode,59.3％ used traditional mode and 34.6％ used disease-sickness mode.But residents using the Calgary-Cambridge mode were not increased.Conclusions There are significant differences in history taking modes among residents with different medical degrees.History taking mode of residents changed after standardized training.But some of the residents still use non-optimal history taking modes; therefore a standardized communication skill training program might be needed in the future. Key words: History taking; Standardized training of resident physicians; Communication skills ; Medical education; Evaluation

Efficacy and safety of sanjiuweitai particles combined with omeprazole in treatment of functional dyspepsia: a multicenter, randomized, double-blind, double-dummy, parallel controlled clinical trial

Objective To evaluate the efficacy and safety of sanjiuweitai particles combined with omeprazole in the treatment of functional dyspepsia (FD).Methods A multicenter,randomized,double-blind,double-dummy,parallel-controlled clinical trial was carried out.A total of 405 FD patients were divided into sanjiuweitai group,omeprazole group and combination group.There were 135 cases in each group and were treated with sanjiuweitai particle and omeprazole simulant,omeprazole and sanjiuweitai particle stimulant and sanjiuweitai particle and omeprazole respectively.The medicine was continuously taken for 14 days.The improvement of clinical symptoms of each group was evaluated before and after treatment.Kruskal-Wallis H test was performed for measurement data.Chi-square test or Fisher exact probability method was used for counting material.Pairwise comparisons among three groups,the inspection level was α'=0.0125.Results Two weeks after treatment,clinical symptoms of all the three groups improved significantly.The total efficiency of sanjiuweitai group was 69.2 ％ (90/130),omeprazole group was 65.6 ％ (86/131) and combination group was 83.7％ (103/123).The total efficiency of combination group was higher than those of sanjiuweitai and omeprazole group (x2 =7.3543 and10.9033,P=0.0067 and 0.0010).The total efficiency of sanjiuweitai group was equal with that of omeprazole group (P＞0.05).The main adverse reaction included dizziness,sleepiness,heartburn,abdominal pain and ALT increase.There were no significant differences in the incidence of adverse events among three groups (P＞0.05).Conclusion The efficacy of sanjiuweitai particles with omeprazole combination in the treatment of FD was significant and with few adverse reactions. Key words: Dyspepsia; Gastrointestinal agents (traditional Chinese medicine) ; Omeprazole; Drug therapy, combination; Multicenter study

Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy

Malnutrition has been considered a risk factor for the development of a surgical site infection (SSI). The aim of this study was to determine the relationship between preoperative nutritional screening scores and the development of SSI after pancreaticoduodenectomy. We examined 64 patients who had undergone pancreaticoduodenectomy. Their clinical data, nutritional risk index (NRI), and nutritional risk screening 2002 (NRS-2002) score were recorded. SSIs were diagnosed according to the definitions of wound infection established by the Center for Disease Control and Prevention and were confirmed by a microbiological examination. Data were analyzed using the Fisher exact probability method and a multivariate logistic regression analysis. SSIs developed in 21 patients (33%). Eleven patients had wound infections, and 14 patients had an intra-abdominal abscess. A univariate analysis of perioperative factors revealed that a pancreatic fistula, the NRS-2002, and the NRI were significantly associated with the development of SSI (p<0.05). The multivariate logistic regression analysis revealed that a pancreatic fistula and the NRI were independent risk factors for SSI. By analyzing the pre- and intra-operative factors after excluding the 11 patients with pancreatic fistulas, the NRI was still an independent risk factor for SSI. The present study showed the NRI to be an independent factor for predicting the risk of SSI after pancreaticoduodenectomy.