Objective To investigatethe clinical value of troponin-I(cTnI)in patientswith septic shocka-nd left ventricular diastolic dysfunction. Methods As a retrospective analysis ,38 patients with left ventricular di-astolic dysfunction and septic shock(Sa group),as well as 20 patients with normal cardiac function(Sn group) were enrolled in this study. Moreover ,20 patients with left ventricular diastolic dysfunction and without septic shock were used as control group(Ca group). The ratio of early diastolic mitral inflow velocity to early diastolic mi-tral annulus velocity(E/e′)was measured as the evaluation index of left ventricular diastolicfunction by echocar-diography within 72 hours after admission to ICU. Level of cTnI was detected in all cases and the relationship was evaluated by E/e′. Receiver operating characteristic curve(ROC)was constructed to indicate the predictable value of left ventricular diastolic dysfunction in patients with septic shock. Results The level of cTnI was significantly elevated in both Sa group and Sn group(P<0.05),while the level of cTnI and E/e′in Sa group were significantly higher than those in Sn group(P < 0.05). cTnI was positively correlated with E/e′(r = 0.367 ,P = 0.004). The area under the curve(AUC)of cTnI was 0.834,with the cut-off value of 0.49 ng/mL(sensibility=77.6,specificity=80.7). Conclusion The level of cTnI was significantly higher in patients with septic shock. cTnI was significantly correlated to left ventricular diastolic dysfunction in patients with septic shock. cTnI ≥ 0.49 ng/mL could be an available predictor for left ventricular diastolic dysfunction in patients with septic shock.

Objective To explore the correlation between the expression of somatostatin (SS), gastrin (GAS), apoptosis index (AI),and p53 gene in colonic carcinoma. Methods The expression of GAS, SS, p53 and apoptosis cell were detected by immunohistochemistry (streptavidin-biotin-pero xidase complex, SABC) and in situ apoptosis detecting technic (TUNEL) . Results AI is higher in SS high and middle expression cases than in low expression cases(q=5.06,q=3.95,P

Objective To explore the effects of tumor necrosis factor-α (TNF-α) on ventricular arrhythmias resulted from acute myocardial infarction (AMI) in rats. Method Two hundred and forty male Wistar rats were randomized (random number) into sham operation group, AMI group and recombinant human tumor necrosis factor receptor (rhTNFR) fusion protein (Fc) group. Acute anterior wall myocardial infarction was produced in rats of AMI group with ligating the left anterior descending coronary artery (LAD) , and the rats were just operated without ligation of LAD in sham group. The rats of Fc group were treated with rhTNFR-Fc (10 mg/kg), a TNF-α antagonist, 24 hours before LAD ligation. The original ECG was recorded 10 min before ligation and the ECGs of ventricular arrhythmias occurred spontaneously or induced by programmed electrical stimulation were recorded 10 min, 20 min, 30 min, 60 min, 3 h, 6 h and 12 hours after ligation. The protein levels and mRNA expressions of TNF-α in rats in different groups were detected with histochemistry and real-time fluorescent quantitative PCR. Results The expressions of TNF-α mRNA and levels of TNF-α protein markedly increased 10 min after infarction, reached the climax 20-30 min later, and then gradually returned to the original level in AMI group and Fc group. The time-windows of spontaneous and induced ventricular arrhythmias were consistent with the time-window of expressions of TNF-α mRNA and levels of TNF-α protein. Compared with AMI group, there were lower levels of TNF-α protein and lower incidence of ventricular arrhythmias in Fc group ( P < 0.05) , but there was no significant difference in TNF-α mRNA between two groups. There was no obvious change in TNF-α in rats of sham operation group. Conclusions The expressions of TNF-α mRNA and levels of TNF-α protein induced by AMI could contribute the initiation of ventricular arrhythmias.

Objective To conduct an epidemiological analysis on the incidence of varicella in Jiading District, Shanghai from 2016 to 2021, and to provide theoretical strategies for the prevention and control of varicella. Methods The data of reported cases of varicella from 2016 to 2021 were collected, and descriptive epidemiological methods were used to analyze the area, time, age and occupational distribution of varicella. Results During 2016-2021, 7261 cases of varicella were reported in Jiading District, including 3993 males and 3268 females. The ratio of male to female incidence was 1.05:1, and the incidence was not statistically different. Anting Town had the largest average annual incidence cases of 227. Malu Town had the highest average annual incidence rate of 92.29/100 000. Varicella occurred every month in Jiading District, of which the peaks were from June to August and from November to January of the following year. The incidence of varicella had periodicity and seasonality, showing ^“double peaks^”. According to the age of onset, the top three groups with the largest number of cases were 0-5 years old group, 6-10 years old group and 26-30 years old group. According to the occupational distribution, the top three groups were students, scattered children and kindergarten children. Conclusion It is necessary to further strengthen the active monitoring of the varicella epidemic and take comprehensive measures to prevent its outbreak. At the same time, it is necessary to increase publicity efforts to improve the vaccination rate of school-age children.

BACKGROUNDThe normal range of red cell distribution width (RDW) level is <15%. Several studies have indicated that a high RDW level was associated with mortality in critically ill patients, and the patients with a high RDW level need increased focus in clinical practice. In view of the difficulty in defining the specific value of high RDW level, the key is to focus on the patient with the level beyond the normal upper limit. This study aimed to determine whether dynamic change of RDW levels, rather than the level itself, is predictive of death in elderly patients with septic shock when RDW level is beyond 15%.

METHODSBetween September 2013 and September 2015, the elderly septic shock patients with RDW level beyond 15% were enrolled in this study. The RDW levels were measured at enrollment (day 1), and days 4 and 7 after enrollment. Sequential Organ Failure Assessment (SOFA) scores were recorded simultaneously.

RESULTSA total of 45 patients, including 32 males and 13 females, were included in the final analysis. Based on their hospital outcomes, these patients were divided into the survivor group (n = 26) and the nonsurvivor group (n = 19). There were no significant differences in age, gender, body mass index, initial level of RDW, Acute Physiology and Chronic Health Evaluation II scores, and SOFA scores between survivors and nonsurvivors. At days 4 and 7 measurement, both RDW level (median [interquartile range]: day 4: 15.8 [2.0]% vs. 16.7 [2.0]%, P= 0.011; and day 7: 15.6 [1.8]% vs. 17.7 [2.5]%, P= 0.001) and SOFA scores (day 4: 7.0 [4.0] vs. 16.0 [5.0], P< 0.001, day 7: 5.5 [4.0] vs. 17.0 [5.0], P< 0.001) were significantly lower in survivors than those in nonsurvivors. Dynamic changes of RDW and SOFA scores in survivor group were significantly different from those in nonsurvivor group (all P< 0.05). Continuous increase in RDW level was observed in 10 of the 13 nonsurvivors, but only in 3 of the 26 survivors. The level of RDW7 and dynamic changes significantly correlated with their counterparts of SOFA scores (all P< 0.05), whereas the levels of RDW1 and RDW4 had no significant correlation with their counterparts of SOFA scores (all P> 0.05).

CONCLUSIONSContinuous increase in RDW level, rather than the level of RDW itself, was more useful in predicting hospital death in elderly patients with septic shock when the level of RDW was >15%. The dynamic changes of RDW were highly correlated with the SOFA score in the patients.

APACHE ; Aged ; Aged, 80 and over ; Critical Illness ; Erythrocyte Indices ; physiology ; Female ; Hospital Mortality ; Humans ; Male ; Observational Studies as Topic ; Organ Dysfunction Scores ; Prognosis ; Shock, Septic ; blood ; mortality

Objective To investigate the expression of cardiac troponin-Ⅰ (cTnⅠ) levels in patients diagnosed with sepsis-associated myocardial dysfunction and explore the relationship between cTn Ⅰ and cardiac systolic and diastolic function.Additionally,we evaluated the prognostic value of cTn Ⅰ as a valuable biomarker.Methods We admitted 65 patients with sepsis.Using echocardiography,the ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e') and the left ventricular ejection fraction (LVEF) were measured as an evaluation index of left ventricular diastolic and systolic function,respectively.Patients were divided into a cardiac dysfunction and a normal cardiac function group.The cTn Ⅰ level was measured and compared between the two groups,and we determined the correlation between cTn Ⅰ levels and cardiac diastolic and systolic function.Based on assessment of 28-day mortality,cases were divided into a survivor and a death group.A receiver operating characteristic curve was constructed to predict the prognostic value of cTn Ⅰ.Results The cTn Ⅰ level in the cardiac dysfunction group was significantly higher than that observed in the normal cardiac function group (P ＜ 0.05) and showed a positive correlation with E/e'(r =0.421,P =0.008).However,there was no correlation noted between the cTn Ⅰ level and LVEF (P ＞ 0.05).Compared to the survivor group,the level of cTn]Ⅰ was significantly higher in the death group (P ＜ 0.05).The prognostic value of cTn Ⅰ area under the curve was 0.892,with a cut-off value of 0.82 ng/mL (sensitivity =88.0％ and specificity =82.5％).Conclusion The cTn Ⅰ level is noted to be significantly elevated in patients with sepsis-associated cardiac dysfunction and shows a positive correlation with left ventricular diastolic function.A cTn Ⅰ level ≥ 0.82 ng/mL can be used as a valuable predictor of mortality in patients with sepsis.

【Objective】 To investigate whether there is a correlation between the differences in ABO blood group distribution in patients with pancreatic cancer, and to evaluate the relative risk. 【Methods】 Patients with pathological diagnosis or discharge diagnosis of pancreatic cancer who underwent ABO blood group typing in our hospital from January 2017 to October 2021 were selected, and the blood group distribution of patients and the correlation were analyzed. 【Results】 There was a statistically significant difference between the pancreatic cancer group and the control group (P<0.05). The study showed that type A may be a relative risk factor for pancreatic cancer patients (χ²=42.44, P<0.001), and type B may play a protective role (χ²=16.28, P<0.01). Significant differences were found in distribution between different gender groups (χ²=64.35, P<0.05). The test results showed that type A may be a risk factor for pancreatic cancer in men (χ²=35.2, OR=1.7, 95%CI=0.59-1.02, P<0.001), and type O may play a protective role in pancreatic cancer(χ²=18.22, OR=0.6, 95%CI=0.25-0.32, P<0.01); type A may be a relative risk factor for female pancreatic cancer patients (χ²=7.06, OR=1.4, 95%CI=0.59-1.02, P<0.001), while type B may play a protective role (χ²=20.32, OR=0.5, 95%CI=0.32-0.43, P<0.01). In pancreatic cancer group, the risk factors of blood type A were higher than those of non-A group, and the protective effect of type B was significantly higher than that of non-B group. 【Conclusion】 The distribution of blood group and relative risk factors in pancreatic cancer patients suggest that A type is predominant; in the population with A blood group, more attention should be paid to early prevention and early treatment, so as to reduce the risk of disease.

Objective To learn the population and infestation rates of cockroaches from 2017 to 2019 in Jiading District of Shanghai, to evaluate the effect of cockroach termination in household, and to provide information for cockroach control. Methods Cockroaches were controlled by dinotefuran baits and clean-up in households.Sticky trap and visual method were employed for density monitoring in farmers markets, supermarkets, hotels, restaurants, hospitals, and residential areas.Visual method was used in households before and after using the insecticide. Results Sticky trap result showed the room infestation rate was 3.24%, mean adhesion rate was 3.29%, the density was 0.06 per board, and the density peak appeared in May.Rate of invasion and density decreased year by year.Blattella germanica was the dominant species, counting for 71.88%.The density, and rate of infestation, as determined by sticky trap method, were the highest in the farmers markets, followed by hospitals and residential areas.Determined by visual method, room infestation rate was 1.16%, and the infestation rate was 4.44%.The peak appeared in January.Infestation rate of the farmers markets was the highest, followed by hospitals and residential areas.By visual method, the room infestation rate was 59.01%, and 48.45% for nymphs.The room infestation and ootheca rates were 54.04% and 17.39%.The rate decreased more than 80% in 30 days after use of the insecticide. Conclusion Infestation rate of cockroach remains at low level in Jiading District.The effect of bait combined with environmental cleaning is remarkable.Future work should strengthen monitoring and control in farmers markets, hospitals and residential areas.

From April 2017 to September 2019, the START (standardized reception, teaching, analysis, research, training) method was adopted to train 50 general practitioners at the community general practice teaching clinic of Shanghai Huangdu Community Health Service Center. After 3 months of training, the progress of clinical competence and teaching ability were assessed. After training, the scores of clinical skills and communication skills were significantly higher than those before training (P<0.01). The scores of medical history taking, clinical thinking and health education were higher than before (all P<0.01). But there was no significant difference in record writing and reception time management between those before and after training (all P>0.05). The scores of the ability for building physician-patient relationship, collecting information and providing feedback, understanding complaints from patients′ perspective, sharing information and obtaining informed consents were higher than that before training (all P<0.01). The teaching ability of plan design and teaching method were significantly improved compared with that before training (all P<0.01). The satisfaction rate of START method was 96.0%(48/50). The START method applied in community teaching clinic can significantly improve the clinical competency and teaching ability of general practitioners.

Objective: To explore the effect of okra extract on gestational diabetes mellitus (GDM) rats and its probable molecular mechanism. Methods: A total of 30 female SD rats were caged with male rats for pregnancy, 27 pregnant rats were obtained and weighed. The pregnant rats were equally randomized into the control group, GDM group and intervention group. Once the pregnancy was verified, GDM group and intervention group were given 45 mg/kg streptozotocin by peritoneal injection for inducing GDM, control group was given equal volume of citrate buffer. Once the model was established successfully, intervention group was administered orally the solution containing 200 mg/kg/d okra extract, the other groups were given the diet and water only. On the 19th day of pregnancy, the blood samples and fetal rats of all groups were collected, fetal rats weight and placental weight was recorded and the serum glucose, lipids, serum insulin and C-peptide of pregnant rats before the delivery were determined. Results: The pregnant rats weight before the delivery, fetal rats weight and placental weight of GDM group were lower than control group and intervention group (P < 0.05). After the treatment of okra extract, serum glucose and lipids levels of intervention group were both improved significantly (P < 0.05), especially, the FBG, HDL, FINS, serum m insulin and hepatic glycogen levels were equivalent to control group (P > 0.05). Antioxidant enzymes levels of GDM group in liver and pancreas tissues were lower than the other groups, and after treatment of okra extract, antioxidant enzymes levels in liver and pancreas tissues were equivalent to control group (P > 0.05). Conclusions: Okra extract, rich in antioxidant substances, could avoid the excessive consuming of antioxidant enzymes, then, suppresses the oxidative stress and insulin resistance, thereby improving blood glucose level of GDM rats.