Objective To investigate the diagnostic value of serum amyloid A(SAA)in diagnosing acute exacerbations of chronic obstructive pulmonary disease(AECOPD).Methods A total of 86 patients with AECOPD and 46 patients with stable COPD were recruited.SAA determined with ELISA was compared between AECOPD patients and stable COPD patients.The changes of SAA,WBC,the percentage of neutrophils and C-reactive protein (CRP) of AECOPD patients Was compared before and immediately after the last treatment procedure.Results The SAA levels in AECOPD patients were higher than those in stable COPD patients [(182.33±50.12)mg/L vs (6.24±3.05)mg/L,P<0.05].The change of SAA was more evident than that of serum WBC and the percentage of neutrophils before and after the treatment procedure. SAA was more sensitive than CRP in diagnosing lung function severity of AECOPD patients.Conclusion SAA has great diagnostic value in AECOPD diagnosis and evaluation of lung function severity.

Objective To investigate the situation ,influencing factors and demands of hospital health professional personnel′s participation in continuing medical education (CME) in Nanning city and provide a scientific basis for further development of CME . Methods A total of 936 health professional personnel from 18 hospitals were selected .Self designed questionnaires were adopted to investigate the situation ,influencing factors and demands of hospital health professional personnel′s participation in CME .Results Among all the health professional personnel ,14 .85% had not taken part in CME in 2011 .The content of CME activities was still carried out with the basic theory and basic skills mainly .The form of CME activities was still face‐to‐face teaching mainly ,and the utilization rate of resources in distance medical education was lower .Furthermore ,the fees of CME activities were still mostly self‐supported .Time (30 .04% ) and fees (21 .33% ) were the leading factors influencing the participation of CME activities .Clinical set‐ting and education level were significantly related to the participation rate of CME (P<0 .05) .The percent of choosing face to face teachingas CME form was 35 .22% .The percent of choosing acquire new knowledge and skillsas CME content was 36 .60% . Health professional personnel considered the ratio of the fees of CME activities paid by individual should be without payments (52 .78% ) ,or below 20 .00% (40 .06% ) .Conclusion Governments and CM E administrators at all levels should take individual characters of health professional personnel into consideration and various measures should been adopted to assure the sustained and healthy development of CM E .

Objective Investigate the significance of the antibody and antigen detection of Rh blood group.Methods Detecting Rh blood group antigen phenotypes and screen Rh blood group antibodies in 2 700 inpatients from August 2012 to May 2013.Re-sults Rh blood group antigen phenotypes in descending order of propotion were as follows:CCDee,CcDEe,CcDee,ccDEE,CCDEe. 5 antigen genes in descending order of frequency were D,e,C,c,E.Conclusion For donors and donees,in addition to routine tests, the other 4 types of antigen and antibodies in Rh blood group should be detected too,which helps avoid secondary transfusion diffi-culty because of the immunity antibodies generated in blood transfusion.

Objective To analyze the findings of recurrent/residual caner after thyroidectomy for thyroid cancer in both ultrasonography (US) and contrast-enhanced CT (CECT),and to assess the diagnostic value of combination of these two modalities.Methods Forty-six patients with recurrence/ residue of thyroid cancer underwent both high-frequency US and CECT examinations and were enrolled in this study.The imaging features on US and CECT were reviewed and diagnostic accuracies for local residual lesions and cervical lymph node metastasis were evaluated according to pathological results.Results In 46 patients,the average period between thyroidectomy and diagnosis of recurrent/residual cancer was (14.6 ± 12.1) months(range,7 days-10 years).Twenty patients had local recurrent tumors at the surgical bed and the average size of tumors was 2.1 cm(range,0.5-4.6 cm).On US finding,the recurrent/residual tumors were hypoechoic in 60 ％ of cases,had microcalcification in 40 ％.Cervical lymph node metastasis were found in 40 patients,and 75％ of them were located in zone V[.The smallest size of abnormal lymph node which can be detected by US was 3 mm.In cases of lymph node metastasis,12 cases (30％) became cystic,10 (25 ％) presented microcalcifications,and 5 (12.5 ％) showed microcalcifications and cystic change within a lymph node.Microcalcifications,cystic change and hyperechoic appearance within a lymph node suggested malignant.The detection rate of US and CECT in the local recurrent/residual cancer were 90％ and 90％,respectively.The detection rate of cervical lymph nodes metastasis were 80 ％ and 72.5 ％,respectively.The diagnostic accuracy of US and CECT in local recurrence,cervical lymph node metastasis and both were 65％,67.5％ and 65.2％ vs 75％,55％ and 65.2％,respectively (P ＞ 0.05 for all comparisons).the diagnostic accuracy of combination of US and CECT were increased to 86.4％,77.5％ and 91.3％,respectively.US combined with CECT significantly improved the diagnostic capability compared with US or CECT alone(P ＜0.05).Conclusions US should be used as the first choice of imaging examination for post-thyroidectomy of thyroid cancer.US combined with CECT could further increase the diagnostic accuracy in recurrent/residual thyroid cancer.

Sufficient embryos are needed for the preservation of Beagle dogs germplasm resources and the prepara-tion of gene?modified human disease animal models. Up to now, the induced ovulation technique has no effect on dogs,it is hard to obtain mature oocytes in vivo, although the scientists try a lot in many aspects, but still could not make a break?through. The in vitro maturation rate is too low to support the preservation of germplasm resources, application in gene?modified disease models and biomedical research. Aiming to provide useful information on breakthrough in dog oocytes mat?uration, this review will summarize the effect of different age and reproductive stage,different morphology and size of the oo?cytes and lipid droplet on the in vitro maturation of dog oocytes.

Objective To investigate the impact of early initiation of continuous renal replacement therapy (CRRT) based on Kidney Disease: Improving Global Outcomes (KDIGO) classification on the prognosis of critically ill patients with acute kidney injury (AKI). Methods A retrospective analysis of clinical data of patients diagnosed as AKI in Department of Critical Care Medicine of Zhejiang Provincial People's Hospital from January 2011 to January 2015 was conducted. All patients included should be 18 years old or older, having stayed in intensive care unit (ICU) for more than 48 hours, and received CRRT. All subjects were divided into three groups according to their renal function before CRRT according to the KDIGO-AKI guideline: AKI-stage 1 group, AKI-stage 2 group and AKI-stage 3 group. The general condition, original disease, severity of disease, duration of mechanical ventilation, the length of ICU or hospital stay, 28-day survival rate and in-hospital mortality rate were compared among these three groups. Additionally, risk factors for the 28-day survival rate and hospital mortality of critically ill patients with AKI were screened by logistic regression analysis. Results A total of 258 critically ill patients with AKI were enrolled, with 64 cases in AKI-stage 1 group, 62 cases in AKI-stage 2 group, and 132 cases in AKI-stage 3 group. 116 patients survived with 28-day survival rate of 44.96%. 154 patients died with hospital mortality 59.69%. The precipitating factors of AKI in all three groups (stage 1, stage 2, and stage 3) were similar, with sepsis, heart failure and poisoning (drugs or poison) being the main triggers for AKI, accounting for 35.66%, 19.38% and 13.18%, respectively. There were significant differences in the rate of vasoactive agent usage (31.25%, 41.94%, 50.00%, χ2 = 6.241, P = 0.044), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (20.87±7.37, 17.19±7.02, 22.58±7.95, F = 5.292, P = 0.006) and sequential organ failure assessment (SOFA) score (8.41±3.46, 6.22±2.43, 9.58±3.71, F = 10.328, P = 0.000), while there was no significant difference in gender, age, primary disease, time from ICU admission to the beginning of CRRT, mean arterial pressure (MAP), lactate level or 24-hour lactate clearance rate (LCR), mechanical ventilation time, the length of ICU or hospital stay, 28-day survival rate or hospital mortality among these three groups (all P > 0.05). According to the logistic regression analysis, time from ICU admission to start of CRRT and lactate level were the independent risk factors for 28-day survival rate or hospital mortality of critically ill patients with AKI [odds ratio (OR) for 28-day survival rate was 0.850 and 0.774, 95% confidence interval (95%CI) was 0.752-0.960 and 0.638-0.940, P value was 0.009 and 0.010, respectively; OR for hospital mortality was 0.884 and 0.756, 95%CI was 0.781-1.000 and 0.610-0.939, P value was 0.049 and 0.011, respectively]. Conclusion Early initiation of CRRT based on KDIGO-AKI classification could not improve the prognosis of critically ill patients with AKI, the optimal timing of RRT for such patients remains to be further explored.

Objective To observe the effect of balance training on cerebral cortex and balance function of mouse.Methods Forty-five C57BL/6J female mice were randomly divided into the control group, two-week training group and four-week training group with 15 animals in each group. An new model of balance function training was copied. The balance function, brain index, and the content of malondialdehyde (MDA) and activity of superoxide dismutase (SOD) in the mouse cerebral cortex were tested after training.Results The total time passing balance beam of the four-week training group significantly shorten compared with the control group and two-week training group ( P<0.01). Compared with the control group, the brain index of two-week training group increased ( P<0.05), and four-week training group also increased significantly ( P<0.01). Compared with the control group, the SOD activity of cerebral cortex significantly increased (P<0.01), and MDA decreased ( P<0.05) in the four-week training group.Conclusion This new balance training can improve balance function, increase the brain index and decrease lipid peroxidation level in the cerebral cortex of the mice.

Objective To compare of the clinical using effect of implantable venous -access port(VAP) among different methods and the postoperative complication.Methods From 2011 to 2014,a total of 359 patients with VAP were included in this study.All patients were divided into two groups according to the surgery approaches methods,307 cases were implanted through internal jugular vein,and other 52 cases were through subclavian vein intubation.Statistics of postoperative flow conditions and complication between the two groups were gathered and com-pared.Results There were 3 cases of postoperative infected,and 13 cases were not free of transfusion,while 2 cases catheter were shed and shifted in the 307 cases of implantation through internal jugular vein,the complication rate was 5.86%;In other group,which in total of 52 cases of implantation through subclavian vein,including 2 cases were post-operative infected,6 cases were not free of transfusion,2 cases are of catheter fracture and5 cases were local hemato-ma,the complication rate was 28.85%.There was difference in rate of catheter leakage,catheter tip dystopy and cath-eter related infection between two groups[the proportion of through internal jugular vein vs that the group through sub-clavian vein:5.86%(18 /307)vs 28.85%(15 /52),χ2 =28.140,P =0.000].Conclusion The study suggests that the two ways of different operation methods of VAP are safe and reliable for long term intermittent venous access.The internal jugular vein implanted group has a slight advantage over the group of subclavian vein implanted,when it comes to develop the patients′living quality.

Objective To explore pathological characterization of the enlarged contrast enhanced area of hepatocellular carcinoma ( HCC) on contrast enhanced ultrasonography ( CEUS). Methods Thirty-five HCC patients underwent conventional ultrasonography and CEUS before hepatectomy. The tumor sizes were measured on conventional ultrasonography,CEUS and postoperative resected specimen at the largest section. The infiltration depth of the HCC was observed under microscope in the peripheral area of the tumors. HCC with the size of contrast enhancement area on CEUS 0. 3 cm larger than that on conventional ultrasonography was defined as group A, and the others as group B. The pathological character of the tumor and tissues surrounding the tumor were analyzed and compared between the two groups. Results Among 35 HCC, 40% (14/35) HCC increased in size on CEUS compared with ultrasonography. Of them,9 tumors with increased area on CEUS were confirmed to be invasive HCC on pathology. Using the enlarged contrast enhanced area on CEUS as the diagnostic criteria of invasive HCC, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 90%, 80%, 82.9%, 64.3%, 95. 2%, respectively. Conclusions The contrast enhanced area on CEUS can reflect the infiltrative tumor size more accurately compared with conventional ultrasonography.

Objective To analyze the characteristics and influencing factors of sleep disorders and nocturnal hypoxemia of patients with different degrees of obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Four hundred and twenty-five patients with snoring were scored by Epworth Sleepiness Scale ( ESS), and monitored by polysomnography (PSG). The possible correlations between sleep structure, hypoxia parameters, ESS and clinical features were analyzed and compared in those patients. Results Four hundred and twenty-five patients were divided into 4 groups according to the apnea-hypopnea index (AHI). There were 65 primary snoring patients (15.3%) and 360 OSAHS patients (84. 7% ) including 187 patients (44. 0% ) in severe OSAHS group. ESS was increased as aggravation of OSAHS. There were significant statistical differences in ESS among each group. Compared with primary snoring group, sleep efficiency, NREM1 + 2, oxygen desaturation index ( ODI), time with pulse oxygen saturation below 90% (T(SpO2 <90% ) ) were significantly higher in the OSAHS groups, and NREM3 +4, lowest pulse oxygen saturation level ( LSpO2 ) were lower. ESS was correlated positively with AHI (r= 0. 474,P <0. 01 ). They were both correlated positively with ODI, T (SpO2 <90% ) and NREM1 + 2( ESSr =0. 392, 0. 356,0. 194;AHI r = 0. 714, O. 682, 0. 365, all P < 0. 01 ), and correlated negatively with LSpO2, NREM3 + 4 ( ESS r = - 0. 414, - 0. 196; AHI r = - 0. 740, - 0. 385, both P < 0. 01 ). LSpO2, ODI and T (SpO2 < 90% ) were the primary influencing factors. Common clinical presentations and subjective symptoms were presented including daytime sleepiness, impaired memory, fatigue, dry mouth, oppressive wake and morning headache, etc. Percentage of individuals with daytime sleepiness in the severe OSAHS group was 73. 3% (137/187). These had serious impact on the patients' quality of life, leading to difficulty concentrating, poor memory and cognitive impairment. Conclusions Sleep disorders are found in the patients with different degrees of OSAHS. The excessive daytime sleepiness interrelated partly with the structure of sleep, and totally with hypoxia parameters. The more severity the patients have, the more nocturnal hypoxia, sleep disorders and higher ESS are found.