ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(P<0.05). After 4 weeks of treatment,compared with model group,body weight and serum content of ADH increased in Ootheca Mantidis groups,while urinary volume and renal index decreased (P<0.05);serum content of ALD increased in treatment groups;there was statistical significance in the serum content of ALD in those groups except Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group and steamed Ootheca Mantidis group (P<0.05);except for ALD,those index were in descending order of steamed Ootheca Mantidis group>Ootheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.

Objective To research the effect of nimodipine in the prevention and treatment of delayed facial palsy after microvas-cular decompression .Methods A retrospective analysis was taken from January 2009 to March 2012 ,193 cases of patients with fa-cial spasm undergoing MVD in our department .According to whether applied vasodilators after operation ,all cases were divided into two groups :the experimental group(72 cases)with the treatment of nimodipine for two weeks ;the control group(121 cases) ,and not treated with nimodipine .The follow-up time was 6-12 months .Observe and compare the incidence ,level of delayed facial paraly-sis onset time and disease duration time between two groups .Results In the experimental group had 6 cases of late facial paralysis , the incidence was 8 .3% (6/72) ,onset time was (14 .5 ± 5 .2)days ,disease duration was (41 .3 ± 14 .4)days .The incidence of control group was 9 .1% (11/121) ,onset time was (12 .2 ± 7 .4)days ,disease duration was (55 .7 ± 36 .4)days .There was no significant difference between groups(P>0 .05) .According to House-Brackman classification ,there were 4 cases of grade Ⅱ and 2 cases of grade Ⅲ in experimental group .In control group ,there were 2 cases of grade Ⅱ ,6 cases of grade Ⅲ ,3 cases of grade Ⅳ .The differ-ence was statistically significant (P<0 .05) .Conclusion The delayed facial paralysis is influenced by a variety of causes .Vasodila-tor drugs can reduce the incidence of delayed facial paralysis ,and play a certain role in promoting facial paralysis restored .

Objective To investigate the relationship of the single nucleotide polymorphism (SNP) of interleukin-18 (IL-18) gene promoter region-607C/A and-137G/C loci and response to interferon (IFN) treatment in patients with chronic hepatitis C (CHC).Methods A total of 199 CHC patients received combination therapy of IFNα or PegIFNα and Ribavirin in the First Affiliated Hospital,Shanxi Medical University from September 23rd,2005 to August 20th,2012 were enrolled.And 180 healthy subjects were recruited as controls.The SNPs of IL-18 gene promoter region-607C/A and-137G/C loci were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).Genotype distribution,allele frequency,and the relationships between SNPs in-607C/A and-137G/C loci and response to IFN treatment were analyzed byx2 test.Results-137GG genotype distribution and-137G allele frequency were significantly higher in CHC patients than those in healthy controls (x2 =6.612 and 6.476,P =0.010 and 0.011),whereas-137GC genotype was the opposite (x2 =5.548,P =0.019).Patients with -607AA genotype had higher sustained virological responses (SVRs) to IFN treatment compared with those with-607CA or-607CC genotypes (x2 =4.195 and 5.230,P =0.041 and 0.022).And patients with -607A allele had higher SVRs to IFN treatment compared with those with-607C allele (x2 =5.903,P =0.015).Patients with-137GC genotype had higher SVR to IFN treatment compared with those with-137GG genotype (x2 =5.869,P =0.015),and patients with-137C allele had higher SVRs to IFN treatment compared with those with-137G allele (x2 =3.885,P =0.049).Conclusions Patients with-607AA and -137GC genotypes have higher SVRs to IFN treatment than those with other genotypes.-137G allele seems to be associated with the susceptibility to HCV infection,while-607A and-137C alleles may be correlated with higher SVR to IFN treatment.

Metabolic syndrome (MS) is characterized by high blood glucose,high blood lipid,high blood pressure,and abdominal obesity with insulin resistance as the main characteristics.At present,some epidemiological surveys demonstrate the incidence rates of some malignant neoplasms including prostate cancer,hepatocellular carcinoma,colorectal adenoma,and breast cancer among MS patients were obviously increasing.Patients with MS present a high morbidity of certain tumors.This article summarizes the relationship between MS and malignant neoplasms as well as related mechanisms.

Introduced in the paper are the stakeholders in the training mode reform for master degree education of clinical medicine.It is found in the study that these stakeholders are intertwined in a diversified network relationship, with various interest demands and multiple roles.In view of the core stakeholders and focus of the reform, the paper proposed that the reform should pay attention to the interest demands of stakeholders, focus on their major issues, ensure the interests of the first person in charge, and solve the key points in the game of interests.

Objective To investigate whether the high intensity focused ultrasound (HIFU) for treating uterine fibroids and adenomyosis leading to pelvic adhesion .Methods 1 672 patients with definitely diagnosed uterine fibroids or adenomyosis were col‐lected and divided into the non‐HIFU group(1 560 cases) and HIFU group(112 cases) according to whether performing HIFU op‐eration .The pelvic adhesion situation in each case was scored according to pelvic adhesion scoring system .Then the results were performed the statistical process .Results No statistically significant differences were observed in the pelvic adhesion situation and pelvic adhesion degree between the HIFU group and the non‐HIFU group (P>0 .05) .The single factor analysis of factors possibly causing pelvic adhesion showed that the age ,past history of endometriosis ,operation and pelvic inflammatory disease ,lesion size and dysmenorrhea history affected pelvic adhesion ,the differences were statistically significant(P<0 .05) .But in the multi‐factor corre‐lation analysis ,various factors in the HIFU group were excluded(P> 0 .05) ,while the operation history and pelvic inflammation disease history had correlation with pelvic adhesion (P<0 .05) .Conclusion HIFU dose not cause pelvic adhesion in treating uter‐ine fibroids and adenomyosis .

BACKGROUND:Sagittal split ramus osteotomy is one of the most popular surgical procedures for correcting various mandibular deformities. There have been numerous modifications to this technique on the basis of clinical experiences and observation, but relevant anatomical data are very limited. A lot of anatomic studies on the mandible have been performed during the recent 20 years. OBJECTIVE:To entirely understanding the morphology of the mandibular ramus in the sagittal split ramus osteotomy and to explore the research progress in the sagittal split ramus osteotomy. METHODS:An electronic search of CMB and Medline was performed for relevant reviews and papers published from 1991 to 2011. Progress in the sagittal split ramus osteotomy was also analyzed. RESULTS AND CONCLUSION:Total y 26 articles related to the sagittal split ramus osteotomy were enrol ed. The keys to avoiding complications due to the sagittal split ramus osteotomy are as fol ows:distribution of cancel ous bone in the mandibular uvula area, distribution of cancel ous bone between the mandibular canal and buccal cortical bone during splitting progress, as wel as location and trend of the mandibular canal. Pre-operative CT test contributes to a successful sagittal split ramus osteotomy and a reduction in complications, and the anatomical measurement can be applied clinical y to a greater extent.

BACKGROUND:Coronary drug-eluting stent implantation is the best treatment for acute ST-segment elevation myocardial infarction, but because of many combined risk factors in elderly patients, the mortality rate is increased with aging. OBJECTIVE:To analyze whether age differences is a significant independent predictor of in-hospital clinical outcomes in patients with acute ST-elevation myocardial infarction treated with domestic rapamycin drug-eluting stent implantation. METHODS:A retrospective analysis was done in 307 patients with first acute ST-elevation myocardial infarction treated with emergent rapamycin drug-eluting stent implantation for primary percutaneous coronary intervention. According to the age, there were three groups: non-elderly group (< 65 years old,n=175), low-elderly group (65-74 years old,n=83), and high-elderly group (≥ 75 years old,n=49). Clinical features, mortality, cardiac events during in-hospital stay were compared among three groups. RESULTS AND CONCLUSION: Compared with the non-elderly group, the proportion of female patients and the history of hypertension were higher in the low-elderly or high-elderly group (P < 0.05). The history of smoking was higher in the non-elderly group than the other groups (P < 0.05). The incidences of Kilip classification≥II, three-lesion or left main coronary artery disease were higher in the high-elderly group than the other groups (P < 0.05). Hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, and cholesterol levels were higher in the non-elderly group than the other groups (P < 0.05). Serum creatinine level, incidence of malignant arrhythmia and incidence of in-hospital cardiac death were increased with aging. Successful reperfusion was higher in the high-elderly group than in the low-elderly or non-elderly group. Rate of acute heart failure and combined cardiovascular events were higher in the high-elderly group than in the low-elderly or non-elderly group (P < 0.05). Multivariate logistic regression analysis show that age is an independent risk factor for in-hospital mortality in patients with acute ST-elevation myocardial infarction treated with rapamycin drug-eluting stent implantation.

Objective To analyze the curative effect and safety of the estrogen as an adjunctive treatment of senile vaginitis.Methods 100 patients with senile vaginitis in our hospital from June 2011 to September 2012 were divided into observation group (n =50) and control group (n =50).Observation group was given estrogen plus metronidazole and control group was given metronidazole only.Results 45 cases were cured and 4 cases had effective treatment in observation group,and 21 cases were cured and 17 cases had effective treatment in control group.The efficacy rate was 98.0％ (49 cases)in observation group versus 76.0％(38 cases) in control group (x2=11.50,P＜0.01).After the treatment,the recurrence rate was 6.1％ (3 cases)and 26.3 ％ (10 cases)in observation and control groups respectively (x2 =10.66,P＜0.05).After treatment,vaginal health scores,symptom scores of vaginitis,and vaginal PH were significantly higher in the observation group than in the control group (all P＜0.05).In addition,the improvements of signs and symptoms were significantly better in the observation group than in the control group (all P＜0.05).However,there was no significant difference in adverse reaction rate between the two groups (P＞ 0.05).Conclusions Estrogen as an adjunctive treatment of senile vaginitis has better curative effect and safety.It is worthy of generalization in clinical medicine.