Objective:To investigate the effects of body mass index (BMI) levels at different baseline on the risk of new-onset acute pancreatitis (AP).Methods:The subjects were from the Kailuan Study Cohort and divided into 3 groups according to baseline BMI levels: BMI<24 kg/m 2, normal weight; BMI 24-28 kg/m 2, overweight; BMI≥28 kg/m 2, obesity. The incidence of new-onset AP in these three groups was analyzed. The survival curve was plotted by Kaplan-Meier method, the cumulative incidence was calculated and tested by log-rank method. Multivariate Cox proportional hazards regression model was used to calculate HR of baseline BMI levels for AP. Results:A total of 123 841 subjects were included and followed up for (11.94±2.13) years, during which, 395 cases were found with AP. The incidence of AP was 2.67 per 10 000 person years in total population, and the incidences of AP were 2.20, 2.72 and 3.58 per 10 000 person-years in the normal, overweight and obesity groups, respectively. The cumulative incidences of AP was 0.32%, 0.40% and 0.49% in normal, overweight and obesity groups, respectively, which showed a significant inter-group difference by log-rank test ( χ2=13.17, P<0.01). The results of multivariable adjusted Cox proportional hazards regression model analysis indicated that obesity group ( HR=1.45, 95% CI: 1.10-1.92) had a higher risk for AP compared with the normal BMI group. The subgroup analyses by age and sex showed that compared with the normal weight group,the HRs for AP in the obesity group was 1.58(95% CI:1.14-2.19) and 1.40(95% CI:1.03-1.90) among subjects younger than 60 years old and male subjects, respectively. After excluded onset AP within two years from baseline,with a control group from normal weight,the results of multivariate Cox proportional hazards regression model analysis indicated that the AP in the obesity group was 1.60 (95% CI: 1.18-2.15). Conclusion:Obesity may increase the risk of developing AP, particularly among young and middle-aged men.

Objective To explore the predictive value of combined application of the different obesity measures on incident gallstone disease (GD) and find the optimal combination.Methods The retrospective cohort study was conducted.The data of 88 947 participants who participated in health examination at the Kailuan General Hospital,Kailuan Linxi Hospital,Kailuan Zhaogezhuang Hospital,Kailuan Tangjiazhuang Hospital,Kailuan Fan'gezhuang Hospital,Kailuan Jinggezhuang Hospital,Kailuan Lyujiatuo Hospital,Kailuan Linnancang Hospital,Kailuan Qianjiaying Hospital,Kailuan Majiagou Hospital and Kailuan Branch Hospital from July 2006 to December 2015 were collected.All participants received the same-order health examinations by the fixed team of doctors in 2006,2008,2010,2012 and 2014 at the same place.Epidemiological investigation,anthropometric parameters and biochemical indicators were collected.Observation indicators:(1) comparisons of general data between 2 genders;(2) incidence of GD;(3) risk factors analysis of the different obesity measures affecting incident GD;(4) comparisons of the fitting degree and predictive value of combined application of the different obesity measures on incident GD model.Measurement data with normal distribution were represented as (x)±s,and comparisons between groups were analyzed using the t test.Measurement data with skewed distribution were described as M (P25,P75),and comparisons between groups were analyzed using the rank sum test.Comparisons of count data were analyzed using the chi-square test.The incidences of GD between 2 genders were calculated by person-year of follow-up.The hazard ratio (HR) and 95％ confidence interval (CI) of the different obesity measures on incident GD were estimated by the COX proportional hazard model.The fitting degree of different combination of obesity measures on incident GD model was calculated by the likelihood ratio test and akaike information criterion (AIC).Results (1) Comparisons of general data between 2 genders:of 88 947 participants,age,body mass index (BMI),waist circumference (WC),systolic pressure,diastolic pressure,total cholesterol (TC),triglyceride (TG),fasting plasma glucose (FPG),cases with diabetes,hypertension,smoking,drinking and physical exercise were respectively (51± 12) years old,(25±3) kg/m2,(88± 10) cm,(132±20) mmHg (1mmHg=0.133 kPa),(84± 12) mmHg,(4.95± 1.16) mmol/L,1.18 mmol/L (0.81 mmol/L,1.74 mmol/L),(5.5±1.6)mmol/L,6 223,31 816,26 993,15 779,11 063 in male participants and (49± 11)yearsold,(25±4)kg/m2,(83±11)cm,(124±21)mmHg,(7911)mmHg,(4.98±1.08)mmol/L,1.30 mmol/L (0.92 mmol/L,2.00 mmol/L),(5.3±1.6)mmol/L,1 409,5 866,248,87,2 450 in female participants,with statistically significant differences [t=587.20,894.27,1 064.97,813.49,986.22,630.97,H(x2)=642.39,t=452.87,x2=35.10,1 205.40,9 619.42,4 901.75,84.82,P＜0.05].(2) Incidence of GD:88 947 participants were followed up for 713 345 person-year,4 291 participants had incident GD,with a total person-year incidence of 6.02 thousand person / year.The total follow-up time,cases with incident GD and person-year incidence were respectively 562 821 person-year,3 268,5.81 thousand person / year in male participants and 150 524 person-year,1 023,6.80 thousand person / year in female participants.(3) Risk factors analysis of the different obesity measures affecting incident GD:the results of COX proportional hazard model:in male participants,adjusted for age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,BMI was associated with increased risk of incident GD (HR=1.35,1.63,95％CI:1.24-1.46,1.48-1.80,P＜0.05);WC was associated with increased risk of incident GD (HR=1.27,1.53,95％CI:1.15-1.40,1.39-1.67,P＜0.05);waist-to-height ratio (WHtR) was associated with increased risk of incident GD (HR=1.20,1.44,95％CI:1.09-1.32,1.31-1.58,P＜0.05).In female participants,BMI was associated with increased risk of incident GD (HR=1.35,1.77,95％CI:1.16-1.56,1.49-2.10,P＜0.05);WC was associated with increased risk of incident GD (HR=1.38,1.72,95％CI:1.15-1.66,1.44-2.07,P＜0.05);WHtR was associated with increased risk of incident GD (HR=1.34,1.71,95％CI:1.12-1.61,1.43-2.04,P＜0.05).(4) Comparisons of the fitting degree and predictive value of combined application of the different obesity measures on incident gallstone diseases model:multi-factor model of male participants was constructed after adding risk factors of age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,and-2log L and AIC were 71 257 and 71 275.Then BMI,WC,WHtR,BMI+WC,BMI+WHtR,WC+WHtR and BMI+WC+ WHtR were respectively added into the multi-factor model,and-2log L and AIC were respectively 71 156 and 71 178,71 170 and 71 192,71 197 and 71 219,71 134 and 71 160,71 132 and 71 162,71 170 and 71 196,71 132 and 71 162.The minimal mode of AIC was multi-factor model+BMI+WC,with a difference of 123 compared with multi-factor model of-2log L,showing a statistically significant difference (x2 =123.00,P＜ 0.05).The multi-factor model of female participants was constructed after adding risk factors of age,TC,TG,diabetes,hypertension,smoking,drinking and physical exercise,and-2log L and AIC were 19 612 and 19 630.Then BMI,WC,WHtR,BMI+WC,BMI+WHtR,WC+WHtR and BMI+WC+WHtR were respectively added into the multi-factor model,and-2log L and AIC were respectively 19 568 and 19 590,19 575 and 19 597,19 574 and 19 596,19 558 and 19 584,19 557 and 19 583,19 571 and 19 597,19 556 and 19 586.The minimal mode of AIC was multi-factor model+BMI+WHtR,with a difference of 55 compared with multi-factor model of-2log L,showing a statistically significant difference (x2 =55.00,P＜0.05).Conclusions The increased BMI,WC and WHtR are independent risk factors for incident GD,no matter the gender.In males,the combination of BMI and WC can improved the predictive value of the incident GD,while in females,BMI and WHtR are the best combination for predicting incident GD.

Objective To investigate the effects of fasting serum triglycerides (TG) levels at different baseline on the risk of new-onset acute pancreatitis (AP) in in-service and retired employees of Kailuan Group.Methods A total of 125 178 in-service and retired employees of Kailuan Group who received health check-ups from 2006 to 2009 and had no AP history but had complete TG data were prospectively enrolled.According to quantile level,the baseline serum fasting TG level of study subjects were divided into ＜1.01 mmol/L group (n=42 128),1.01 to 1.64 mmol/L group (n=41 711) and ＞ 1.64 mmol/L group (n=41 339).The incidence of new-onset AP of these three groups was analyzed.The survival curve was plotted by Kaplan-Meier method.The cumulative incidence rate was calculated and tested by log-rank method.And multivariate Cox proportional hazards regression model was performed to calculate hazard ratios (HR) of baseline fasting serum TG level for AP.Results After followed up for (7.36±1.23) years,a total of 193 cases of AP occurred.The incidences of AP in ＜1.01 mmol/L group,1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group were 1.43 events/10 000 person-years,2.37 events/10 000 person-years and 2.49 events/10 000 person-years,respectively.The cumulative incidence rates of AP in ＜1.01 mmol/L group,1.01 to 1.64 mmol/L group and ＞1.64 mmol/L group were 0.10％ (44/42 128),0.18％ (73/41 711) and 0.18％ (76/41 339),respectively,and the difference was statistically significant (x2 =9.998,P=0.007).The results of multivariate Cox proportional hazards regression model analysis indicated that the risk of AP increased in 1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group compared with that of ＜1.01 mmol/L group,HR and 95％ confidence interval (CI) were 1.56 (1.07 to 2.29) and 1.57 (1.06 to 2.32),respectively.After excluded onset AP within one year,with a control group of ＜1.01 mmol/L group,the results of multivariate Cox proportional hazards regression model analysis indicated that the HR and 95％CI for AP of 1.01 to 1.64 mmol/L group and ＞ 1.64 mmol/L group were 1.70 (1.11 to 2.58) and 1.69 (1.10 to 2.60),respectively.Conclusion Baseline fasting serum TG levels over 1.01 mmol/L may increase the risk of AP.

Objective:To investigate the relationship between CD 4+CD25+regulatory T cells ( Treg) and monocyte chemoat-tractant protein-1 and its mechanism in KD pathogenesis .Methods:48 patients of KD (28 cases of recovery ,20 cases of acute phase ) were admitted from June 2014 to June 2015 and the other 40 cases of healthy children was admitted to control group .The levels of serum interleukin-15,17,23 (IL-15,17,23) and MCP-1 of two groups were measured with ELISA.The levels of Treg/Th17 cell ratio of two groups were measured with flow cytometry .Results:The levels of IL-15,IL-17,IL-23 and MCP-1 of KD group were higher than control groups(P<0.05) and the levels of IL-15,IL-17,IL-23 and MCP-1 of acute phase groups were higher than recovery groups .The levels of Th17,Treg cells,Th17/Treg of KD group were lower than the control group (P<0.05),while the levels of Th17,Treg cells,Th17/Treg cells in the acute phase of KD patients were higher than stable phase .The levels of IL-15,IL-17,IL-23 and MCP-1 and Treg/Th17 were negative correlation with univariate analysis by Pearson (P<0.05).Conclusion:The imbalance between Treg and Th17 cells and MCP-1 levels continue to rise may be associated with KD onset and progress of the disease is closely related to children in KD vivo by meas -uring children with KD Treg/Th17 cells and MCP-1 ratio of assessment Children with the condition and prognosis has some signifi-cance.

Objective To observe the changes in red cell distribution width (RDW)and plasma N -terminal pro -brain natriuretic peptide(NT -proBNP)in children with chronic heart failure due to congenital heart disease (CHD),and to investigate their correlations with cardiac function.Methods Eighty -four children with chronic heart failure and pneumonia secondary to CHD who were hospitalized in Wuhan Health Care Center for Women and Children from January to December 201 4 were enrolled.According to the modified Ross scoring system,they were divided into 3 subgroups:mild,moderate and severe heart failure subgroups.Forty -five children with pneumonia who were hospitali-zed during the same period were randomly selected as the control group.Then the levels of RDW and plasma NT -proBNP were compared in each group,and the correlation between RDW and NT -proBNP was analyzed.Results The levels of RDW and plasma NT -proBNP in children with heart failure caused by CHD were significantly higher than those of the control group[(1 5.6 ±2.2)% vs (1 3.7 ±1 .5)%,(3 252.9 ±1 061 .5)ng/L vs (67.4 ±1 7.9)ng/L, t =5.51 8,7.838,all P <0.01 ].NT -proBNP levels were gradually increased along with increasing heart failure grade, and there were statistically significant differences[(1 71 8.3 ±456.2)ng/L vs (3 371 .4 ±834.2)ng/L vs (4 681 .2 ± 1 21 4.8)ng/L,F =1 5.961 ,P <0.01 ].RDW levels also increased gradually,while there were no statistically signifi-cant differences[(1 5.2 ±1 .5)% vs (1 5.7 ±2.0)% vs (1 6.0 ±2.8)%,F =2.246,P >0.05].There was no signifi-cant correlation between RDMand NT -proBNP (r =0.1 34,P >0.05).Conclusions For children with CHD,higher RDW and NT -proBNP levels can aid in the diagnosis of chronic heart failure,and NT -proBNP level is associated with the severity of heart failure,yet it is still unclear whether RDW level can reflect the severity of heart failure.

Objective To explore the function of autonomic nerves system in children with congenital heart disease (CHD) combined with paroxysmal supraventricular tachycardia (PSVT). Methods Fifty children having PSVT and no CHD (PSVT group), 30 children with both PSVT and CHD (CHD group), and 50 cases of healthy children (control group) were selected. The difference of 24-hour heart rate variability (HRV) among three groups was analyzed retrospectively. Results There were statistical differences in the long-range time domain HRV indexes, including SDNN, SDANN, SDNN Index, pNN 50 , and RMSSD among three groups (F=80.32-?263.18, P all??0.05). The SDNN, SDANN, SDNN Index, pNN50, and RMSSD were signiifcantly decreased in CHD group compared with PSVT group (P all?

Objective To investigate the safety and efficacy of reducing pulmonary arterial pressure in patients with congeni‐tal heart disease(CHD) complicated with pulmonary hypertension(PAH) .Methods From September 2014 to January 2015 in our hospital ,34 patients with CHD complicated with PAH were selected ,all of them were treated with endothelin receptor antagonist , bosentan ,on the basis of conventional therapy .The hemodynamics observation ,cardiac function detection and six‐minute walking distance test(6 MWD)were performed after pulmonary artery pressure reducing therapy .Results After treatment ,the pulmonary vascular resistance (PVR) ,arterial oxygen saturation(SaO2 ) ,Qp/Qs and right cardiac output(CO) in these patients was (218 .30 ± 91 .25)dyn · s-1 · cm -5 ,(95 .16 ± 7 .84)% ,(1 .10 ± 0 .27) and (5 .20 ± 1 .36) L/min ,respectively ,which were better than those be‐fore treatment(P<0 .05) .There was no statistically significant difference in the pulmonary artery systolic pressure(sPAP) ,pulmo‐nary artery diastolic pressure pulse AI(dPAP) ,mean pulmonary arterial pressure(MPAP) ,heart rate(HR) and central venous pres‐sure(CVP) before and after the treatment(P>0 .05) .There was no statistically significant difference in the right ventricular diame‐ter(RVD) ,left ventricular ejection fraction(LVEF) ,three tricuspid regurgitation velocity(VP) ,three tricuspid valve transvalvular pressure difference(PGTV) ,left ventricular diastolic volume (LVEDV) and left ventricular diastolic diameter(LVEDD) before and after the treatment(P>0 .05) .After 3 months and 6 months of treatment ,6 MWD was (378 .09 ± 40 .12) and (423 .07 ± 35 .32) m respectively ,both of which were higher than those before treatment ,the differences were statistically significant (P<0 .05) .Conclu‐sion The application of bosentan therapy is safe and effective for patients with CHD complicated with PAH ,which could improve pulmonary hemodynamics and 6 MWD .

Objective To analyze the changes of celluar and humoral immunity in children with juvenile idiopathic arthritis(JIA),as well as the changes in different subtypes,and to investigate the role of cellular and humoral immunity in the pathogenesis of JIA.Methods Ninety-two JIA subjects and 82 controls(healthy children) were included into this study.The levels of T lymphocyte subsets,natural killer (NK)cells,and B cells were analyzed by using flow cytometry.The serum interleukin-1 (IL-1),tumor necrosis factor-α (TNF-α),interleukin-l0 (IL-10),transforming growth factor-β(TGF-β) levels were detected by using enzyme-linked imnmunosorbent assay (ELISA).The serum IgG,IgM,IgA and C3,C4 levels were detected by using velocity scatter turbidimetry.Independent t-test,One-Way ANOVA test and Pearson analysis were adopted for data analysis.Results 1.In the group of JIA,the levels of CD3,CD4,IL-1,TNF-α,IgG,IgM,IgA and C3 were higher than those in the control group(all P ＜ 0.05),while the levels of CD4CD25,CD8,NK cells,IL-10 and TGF-β were lower than those in the control group(all P ＜0.05),and the ratio of CD4/CD8 was higher than that in the control group (P ＜ 0.05).2.In the group of systemic-onset JIA (so-JIA),the levels of CD4,IL-1,TGF-β,IgG,IgM,IgA,C3 and the ratio of CD4/CD8 were higher than those in the oligoarthritis JIA group(all P ＜ 0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group(all P ＜ 0.05).In the group of polyarthritis JIA,the levels of IL-1,TNF-α,IgG,IgM and IgA were higher than those in the oligoarthritis JIA group(all P ＜0.05),while the levels of CD4CD25,CD8,IL-10 were lower than those in the oligoarthritis JIA group (all P ＜ 0.05) ; In the group of so-JIA,the levels of CD4,TGF-β,C3 and C4 were higher than those in the polyarthritis JIA group (all P ＜ 0.05).3.The value of IL-1,TNF-α were positively correlated with that of C-reactive protein (CRP),erythrocyte sedimentation rate(ESR) in the JIA group(all P ＜ 0.05),while the value of IL-10,TGF-β was negatively correlated with that of CRP,ESR(all P ＜ 0.05).Conclusions There are cellular immunity and humoral immunity disorders in the JIA.Cellular immunity and humoral immunity are all involved in the pathogenesis of JIA.T helper cells are activated and Th1 cytokines increase,suppressive T cells,regulatory T cells impairment and suppressive cytokines decrease but immunoglobin increase,which involve in auto inflammation reaction and articular destruction in JIA.The immunity disturbances are more striking in so-JIA and polyarthritis JIA.IL-1,TNF-α,IL-10 and TGF-β are correlated with the disease activity.

Objective To determine the etiology and clinical characteristics of children with dilated cardiomyopathy.Methods 112 children with DCM from January 2002 to December 2011 were studied.The age,cause and the clinical manifestations were analyzed.According to the children with heart function,they were divided into four groups,the incidence and type of arrhythmia were compared.Results In 112 cases of DCM in children,＜ 1 year old diagnosed 52 cases (46.42％),107 cases (95.53％) with heart failure,25 cases (22.32％) with chear causes,96 cases(85.71％) children with a variety of arrhythmias.According to cardiac function in Ⅰ,Ⅱ and Ⅲ and Ⅳ level,they were divided into four groups.The incidence of one kind of arrhythrnia were 20.00％,31.25％,36.17％ and 42.85％.The incidence with two or more kinds of arrhythmia was 0,18.75％,38.29％ and 50.00％ respectively.The incidence of malignant arrhythmia was 0,12.50％,40.42％and 67.85％ in different groups.There was significant differences among the groups of Ⅱ and Ⅲ and Ⅳ level (P ＜ 0 05).Conclusion Children with dilated cardiomyopathy disease younger than I year old had the highest incidence.The major causes were myocarditis,hereditary and congenital metabolic diseases.The incidence of arrhythmia in DCM were high and diverse,often exist for a variety of arrhythmia,and arrhythmia have closely relation with heart function.The embolism in children with DCM was very rare.

Objective To explore clinical features and drug sensitivity of Streptococcus pneumoniae (SP) isolated from pediatric patients with lower respiratory tract infection, and to provide evidence for clinical use of antibiotics. Methods A total of 6 358 clinical SP isolates from children with lower respiratory tract infection from January 2008 to December 2012 were col-lected and retrospectively analyzed. The antibiotic sensitivity was done by Kirby-Bauer method and E-test, and all results were in strict accordance with the rules of CLSI. Results The isolated SP strains were mainly from different departments of pediatrics. All clinical cases with SP infection mainly included pneumonia and bronchitis. The resistance rates of 6 358 SP strains to penicil-lin, cefotaxime, erythromycin, clindamycin, cotrimoxazole, tetracycline, chloramphenicol, levolfoxacin, vancomycin were 5.0%, 12.9%, 98.7%, 96.0%, 92.2%, 7.3%, 5.6%, 0.2%and 0.0%respectively, and the resistance rate to penicillin and cefotaxime was signiifcantly different in every years (all P<0.05). The resistance rates of the 318 penicillin-resistant SP strains to the above anti-biotics were 100.0%, 42.6%, 100.0%, 100.0%, 99.2%, 23.6%, 6.8%, 0.6%, 0.0%respectively, and the resistance rate to penicillin and cefotaxime was signiifcantly different (P=0.001). Conclusions The antibiotic resistance rates of SP strains isolated from children with lower respiratory tract infection were higher to erythromycin, clindamycin, cotrimoxazole and tetracycline, and an increasing rate in drug resistance to cefotaxime was observed in recent years. Appropriate antibiotics should be selected for the treatment of infection according to drug sensitivity.