OBJECTIVE To investigate the pertinency between acute physiology and chronic health evaluation Ⅱ scores(APACHEⅡ)and nosocomial infection.METHODS The clinical data from 1 007 ICU patients were evaluated with APACHEⅡ scores system,and made a prospective survey of nosocomial infection.RESULTS Along with the increase in APACHEⅡ scores,nosocomial infection rate and mortality showed rising trend and they were in linear relationship.CONCLUSIONS APACHEⅡ scores system not only can appraise the degrees of severity of illness,evaluate medical treatment,and estimate the prognosis,but also forecast nosocomial infection.

Objective:To investigate the effects and mechanisms of curcumin on insulin resistance in streptozocin-induced diabetic rats.Methods:Diabetic rats were induced by intraperitoneal injection of STZ, then all the rats were randomly divided into diabetes (DM), diabetes+ curcumin (DM+ Cur), and diabetes + buffer control (DM+ NC) groups. Normal SD rats were used as control group (NC). The DM+ Cur group was treated with curcumin, while the DM+ NC group was treated with equal-volume buffer. The test lasted 12 weeks. The blood glucose was detected, and hyperinsulinemic-euglycemic clamp test was performed to estimate peripheral insulin resistance. At the end of the experiments, rats were killed and the total protein and cell membrane protein were extracted from skeletal muscle. The levels of phosphorylated PI3K, phosphorylated AKT, total PI3K, and total AKT were measured by Western blot. The levels of total GLUT4 and GLUT4 of cell membrane were also detected by Western blot, GLUT4 levels in skeletal muscle cell membranes were detected by immunofluorescence.Results:Blood glucose levels of DM+ Cur group were lower than those of DM group [(18.67±1.99 vs 24.38±2.88) mmol/L, P<0.05], and insulin resistance was also improved[the average GIR(14.69±0.29 vs 10.25±0.30) mg·kg -1·min -1, P<0.01]. The phosphorylation levels of PI3K and AKT were increased, and GLUT4 translocation to the cell membrane was increased. Conclusion:By activating the PI3K/AKT pathway, curcumin promotes GLUT4 translocation, increases skeletal muscle glucose uptake, and finally improves insulin resistance.

Objective To evaluate negative lymph node count (NLNC) in prediction of prognosis of T3 gastric cancer after radical resection.Method 214 T3 patients of radical gastrectomy with complete clinical and follow-up data between Jan 2003 to Dec 2007 were enrolled.Survival was determined by the Kaplan-Metier method and univariate analysis was done by Log-rank test,Multivariate analysis was performed using the COX proportional hazard regression model.-2loglikelihood value and the hazard ratio (HR) value were used to compared the value of number of lymph node-negative (NLNC) staging and pN staging and lymph node metastasis rate (MLR) in gastric cancer prognosis evaluation.Results Univariate analysis showed that,pN stage (x2 =31.664),MLR stage (x2 =34.123),tumor size (x2 =5.025),type of differentiation (x2 =5.993),Borrmann classification (x2 =5.401),NLNC stage (x2 =37.256) were related to survival (P ＜ 0.05).COX multivariate analysis showed that-2loglikelihood of pN staging is 1 336.761,HR value is 1.464,-2loglikelihood value of MRL staging is 1 335.821,HR value is 1.441.-2loglikelihood value of NLNC staging is 1 326.902,HR value is 1.725.The N0 and N1 staging prognosis in different NLNC staging was significant (P =0.008,P =0.014).Conclusions Sufficient number of negative lymph node prolongs survival and reduces the risk of early recurrence in advanced gastric cancer.

Phosphorylation is the most common way of p 53 post-translational modifications .However , gaps still exist in our knowledge regarding the role and mechanism of phosphorylation of p 53 at Ser392 in carcinogenesis and cancer prevention.In the present study, we summarized the effect of phos-p53-Ser392 to wild-type and mutant p53, the regulation by DNA damage agents and protein kinase , and the significance of phosphorylation of p 53-Ser392 in cancer treatment .

Objective To explore gene polymorphism of G/A genotype of Fok Ⅰ rs2228570 (G/A) of vitamin D receptor (VDR) gene in Han male population of Chinese coastal area,and thus to investigate the relationship between the gene polymorphism of VDR and gout.Methods Altogether 504 gout patients and 523 healthy controls were enrolled.The possible association between the polymorphism of VDR rs2228570 and gout in Chinese coastal area was investigated and genotype frequencies and allelic frequencies were calculated by realtime PCR with Taqman(R)probe method.Hardy-Weinberg was used to verify the representativeness of the sample.Comparison between the groups were performed withx2 test and t-test.Results The frequencies of GG,AG,and AA genotypes were 32.1％,50.0％,and 17.9％,respectively among gout patients,while they were 27.9％,50.5％,and 21.6％ respectively among the controls.There was no statistically significant difference in VDR rs2228570 genotype frequencies between gout patients and controls(x2 =3.366,P＞0.05).The allele frequencies of G and A in gout cases were different from those in the controls(57.1％,42.9％;53.2％,46.8％;x2 =3.300,P＞0.05).Conclusions Results of the present study suggest that the G/A genotype of VDR Fok Ⅰ rs2228570 of the VDR gene is not associated with gout in male population of Chinese coastal area.

Objective To compare the clinicopathological features of Borrmann type Ⅳ gastric cancer with other gastric cancer and explore prognostic factors of the patients with Borrmann type Ⅳ cancer.Methods We retrospectively reviewed the clinical data of 671 advanced gastric cancer patients.They were divided into 2 groups:Borrmann type Ⅳ (64 cases) and other macroscopic Borrmann types of cancer (607 cases).Their clinicopathologic characteristics and overall survival data were analyzed.Results Age,sex,tumor size,tumor location,lymph node metastasis,distant metastasis,TNM classification were discrepant between Borrmann type Ⅳ and other macroscopic Borrmann types of cancer.The 5-year survival rate of Borrmann type Ⅳ cancer patients was 20.1％,while it was 40.3％ for other types of cancer (P ＜ 0.05).The 5-year survival rate for Borrmann type Ⅳ gastric cancer and the other type gastric cancer was 50.0％ and 72.0％ at stage Ⅰ,30.0％ and 57.9％ at stage Ⅱ,18.0％ and 28.4％ at stage Ⅲ,and 16.4％ and 20.0％ at stage Ⅳ (all P ＜ 0.05),respectively.Multivariate analyses revealed age,histology differentiation type,tumor size,the Borrmann type carcinoma and tumor stage to be independent prognostic factors for survival.Conclusions Borrmann type carcinoma has unique clinicopathological features compared with other types of gastric carcinoma and is an important independent prognostic factor.

Objective:The characteristics of lymph node metastasis were investigated to guide the range of lymph node dissection during the radical operation of distal gastric cancer. Methods:The clinical data of 773 patients with distal gastric cancer who under-went radical distal subtotal gastrectomy at the Tianjin Medical University Cancer Institute and Hospital between February 2010 and September 2014 were reviewed and analyzed to infer the potential clinical mechanisms of lymph node metastasis. Results:Among the included patients, 423 (54.72%) had lymph node metastasis. The proportion of metastasis in the patients from the highest to the lowest rate was observed in group NO. 6, 3, 4sb, and 5 lymph nodes. The metastasis rates of the N1 lymph nodes from the highest to the low-est were observed in group NO. 3, 6, 5, and 4d lymph nodes, whereas those of the N2 lymph nodes occurred in group NO. 8a, 7, and 1 lymph nodes. Group NO. 8a lymph node with skipped metastasis was observed in 50.68%of the patients. Conclusion:During radical distal gastric cancer surgery, attention should be given to the possibility of metastasis in group NO. 8a lymph node. Appropriate exten-sion of the lymph node dissection should be conducted when necessary.

Objective:To report a family of Zellweger spectrum disorders (ZSD) caused by mutations in the PEX10 gene and to increase the level of awareness of the disease among clinicians. Methods:The clinical and genetic data of a brother-sister co-morbidity family with ZSD due to PEX10 gene mutation admitted to the Department of Neurology, Qilu Hospital of Shandong University in July 2022 were collected and a literature review was performed. Results:The proband was a 24-year-old female who was admitted to the Qilu Hospital of Shandong University due to unstable walking for 8 years and aggravated for 1 year with squatting effort. Cranial magnetic resonance imaging (MRI) showed cerebellar atrophy, electromyography suggested peripheral neuropathy with motor and sensory involvement, and pure tone hearing threshold measurement showed neurogenic deafness. The 15-year-old brother of the proband presented with "unsteadiness in walking and difficulty in squatting for 2 years". His cranial MRI and electromyography were similar to those of the proband, and his laboratory results suggested abnormal liver function. The whole exon sequencing results of the proband suggested a compound heterozygous mutation in the PEX10 gene with c. 992G>A(p. R331Q) and c. 988T>C(p. C330R) mutations and both were likely pathogenic mutations and respectively from her parents. And her brother also carried the above variants. A total of 9 case reports in English literature (1 of which was published by domestic scholars) were retrieved from major domestic and international databases on PEX10 gene mutations causing ZSD, with a total of 15 patients, most of whom had childhood and adolescent onset. The most common initial symptom was slowly progressed ataxia. The majority of patients showed cerebellar atrophy on cranial MRI and peripheral neuropathy was found in the most patients.The 2 patients were suggested to have phytic acid-free food, at the same time, they bagan taking L-arginine and ursodeoxycholic acid. Fortunately,both the ataxia symptom and liver function of them were dramatically alleviated 3 months later. Conclusions:For the patients with unexplained ataxia with polyneuropathy and abnormal liver function,the possibility of ZSD should be considered. Phytic acid-free food, L-arginine and ursodeoxycholic acid supplement may be beneficial for the ZSD patients.

BACKGROUND: Mild cognitive impairment (MCI) in elderly people is becoming increasingly a new hot spot for the clinical study of Alzheimer disease at present, and it is still unknown how many cases of MCI will convert into Alzheimer disease. OBJECTIVE: To analyze the incidence rate of mild cognitive impairment and the conversion rates into dementia and Alzheimer disease among elderly people.DESIGN: A prospective cohort study based on diagnosis. SETTING: Second Department of Cadre's Ward, Bethune International Peace Hospital of Chinese PLA.PARTICIPANTS: The subjects were 216 MCI patients and 2 302 subjects with normal cognition selected in the baseline investigation to the retired cadres aged 60 years and above, in 26 military cadres' sanatoriums of Shijiazhuang city between August and September 2001.METHODS: The MCI diagnosis was according to the MCI diagnostic standard in Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-Ⅳ), and the diagnosis of dementia was according to the standard in DSM-Ⅳ revised by American Psychiatric Association. Alzheimer disease was diagnosed according to the standards of National Institute of Neurological and Communicative Disorders and Stroke/the Alzheimer Disease and Related Disorders Association (NINCDS-ADRDA). All the 216 MCIpatients and 2 302 subjects with normal cognition were enrolled in the 3-year cohort study. MAIN OUTCOME MEASURES: The incidences of MCI among subjects with normal cognition; the annual conversion rates into Alzheimer disease in MCI patients and subjects with normal cognition; the relative risks (RR) and 95% confidence interval (95% CI) of MCI and normal cognition developing into Alzheimer disease. RESULTS: The MCI group and normal cognition group were followed up once every year for 3 years. Of the 216 MCI patients, 7 died, and 209 were followed up actually, and the follow-up rate was 96.8%. Of the 2 302 subjects with normal cognition, 36 died, and 2 266 were followed up actually,and the follow-up rate was 98.4%. ① In the elderly subjects with normal cognition, the annual incidence of MCI was 4.8%, and those of dementia and Alzheimer disease were 1.3% and 0.8 respectively. ② The annual in cidence rates of dementia and Alzheimer disease in MCI patients were 8.1% and 5.6% respectively, which were insignificantly different between males and females (P ＞ 0.05). ③ The incidence rates of dementia and Alzheimer disease showed a descending trend with the elevation of educational level in both the MCI patients (trend x2 =5.57, P=0.02; trend x2 =4.92, P=0.03) and the subjects with normal cognition (trend x2 =23.1, P＜ 0.001; trend x2 =18.0, P ＜ 0.001). ④ The annual incidence rates of dementia and Alzheimer disease showed an ascending trend with aging in both the MCI patients (trend x2 =14.6, P ＜ 0.01; trend x2 =13.9, P ＜ 0.01) and the subjects with normal cognition (trend x2 =32.3, P ＜ 0.01; trend x2=23.8, P ＜ 0.01). ⑤ The relative risks of the conversion into dementia and Alz heimer disease in MCI patients were 6.4 and 7.4 times as many as those in the subjects with normal cognition.CONCLUSION: The risks of conversion into dementia and Alzheimer disease in elderly MCI patients are far higher than those in elderly people with normal cognition. It should be reinforced to monitor elderly MCI patients, who are the of high risk group of dementia.

Objective To explore the state of cardiac autonomic nerve function in schizophrenia patients with metabolic syndrome and analyze its influence factors and to reduce the occurrence of sudden cardiac death of the patients. Methods A total of 168 cases of patients according with the ICD-10 schizophrenia diagnostic criteria were divided into group A(78 cases of schizophrenia with metabolic syndrome),group B(90 cases of schizophre-nia without metabolic syndrome)and another 92 normal cases were included as control group(group C). Twenty-four hours dynamic electrocardiogram was conducted respectively and the heart rate variability (HRV) was ana-lyzed. Results Values of LF,HF,SDNN,SDANN,RMSSD and PNN50 in group A and group B were much low-er than those in group C and they were statistically significant(P < 0.05). Values of LF,HF,SDNN,SDANN, RMSSD and PNN50 in group B were much higher than those in group A and they were statistically significant(P<0.05). Excluding the influence of schizophrenia ,logistic regression analysis showed that the influence factors of HRV values were course of the disease(OR = 1.864,95%CI 1.110~3.128),age(OR = 1.170,95%CI 1.018~2.491),types of antipsychotic drugs(OR=2.419,95%CI 0.976~1.835),abdominal obesity(OR=2.425,95%CI 1.347~4.366),blood pressure value(OR=1.263,95%CI 1.575~3.937),blood glucose value(OR=3.376, 95%CI 1.359~2.923)and blood lipid value(OR = 2.178,95%CI 1.492~6.756). Conclusions Schizophrenia patients with metabolic syndrome have obvious cardiac autonomic nerve dysfunction. Excluding the influence of schizophrenia itself,the other possible risk factors include course of the disease,age,types of antipsychotic drugs,abdominal obesity,blood pressure value,blood glucose value and blood lipid value.