Objective To evaluate the accuracy of stoke volume variation (SVV) determined using FloTrac/Vigileo and Picco-plus technologies in prone position for assessment of the blood volume in the patients undergoing spine surgery,Methods Forty-three ASA physical status Ⅰ-Ⅲ patients of both sexes,aged ＞ 18 yr,weighing 40-100 kg,scheduled for elective posterior approach to lumbar spinal fusion or scoliosis surgery were studied.After induction of anesthesia,a volume expansion was performed in supine and prone positions.Hydroxyethyl starch 130/0.4 sodium chloride injection 5 ml/kg was rapidly infused intravenously over 10 min to carry out the test for fluid responsiveness.Picco-plus and FloTrac/Vigileo systems were simultaneously applied in every subject to measure SVV (SVVP and SVVF).Positive fluid responsiveness was defined as the changing rate of stroke volume index ≥ 10％ as measured by using Piccoplus system.The patients were divided into response group (Rs group) and non-response group (NRs group) according to the changing rate of stroke volume index ≥ 10％ and ＜ 10％.The receiver operating characteristic (ROC) curve for SVV was plotted,and the diagnostic threshold,area under the ROC curve and 95％ confidence interval (CI) were calculated.Results Forty-one patients were included for analysis in this study.In supine position,the area under the ROC curve for SVV in predicting the fluid responsiveness was 0.740 (95％ CI:0.568-0.913),the diagnostic threshold was 12％,and the sensitivity and specificity in determining fluid responsiveness were 86％ and 54％,respectively,for SVVF,and the area under the ROC curve was 0.637 for SVVP.In prone position,the area under the ROC curve was 0.451 for SVVF,and 0.634 for SVVP.Compared with Rs group,the baseline value of SVVFwas significantly lower,and no significant change was found in the other hemodynamic parameters before volume expansion in supine position in NRs group.There was no significant difference in the hemodynamic parameters before volume expansion in prone position between the two groups.Conclusion SVV determined by using FloTrac/Vigileo and Picco-plus systems in prone position can not accurately assess the blood volume in the patients undergoing spine surgery.

Single unit activity were recorded from 157 dorsal horn neurons in the spinal rats by stimulation of left surat nerves. Stretching urinary bladder were performed after the neurons were identified by somatic afferents. 32 out of the 157 could also be activated by stretching urinary bladders. These recorded dorsal horn neurons which responded to both somatic and visceral inputs are called somatovisceral convergent neurons (SVCN). The afferent visceral fibers were N group according to conductive velocity in our experiment. It has been shown that C-fiber component in 9 WDR neurons were incresed by stimulating the left sural nerves after stretching urinary bladders. 15 spontaneous- discharge WDR neurons were recorded and 13 out of them were excited, meanwhile, 2 out of them were inhibited after urinary bladders were stretched. The study provides the new data for the convergence from the somatic and visceral afferents in the dorsal horn of spinal cord and supplies the first evidence for central mecha nism of visceral referred pain.

Objective To investigate the expression of peroxisome proliferator-activated receptors (PPARs) in epidermal keratinocytes of patients with psoriasis vulgaris and its significance.Methods Immunohistochemical method was used to examine the expression of PPARα,β/δand.γ in tissue specimens from the normal skin of 5 human controls,lesional and normal skin adjacent to the lesions of 17 patients with psoriasis vulgaris.A semi-quantitative analysis was carried out by image analyzer.Results Different levels of expression of the three PPAR isotypes were observed in the nuclei of epidermal keratinocytes of normal human controls.The expression intensity of PPAR α,β/δand γ was statistically higher in the epidermis of adjacent normal skin than that in psoriatic lesions(all P<0.01)and normal control skin(all P<0.01).Conclusions The decreased expression of PPARα may be associated with the overproliferation and parakeratosis of epidermal keratinocytes in psoriatic lesions,and PPAR β/δ and γ may display a synergistic effect on the maintenance of homeostatic proliferation and difierentiafion of epidermal cells.

Objective To investigate the change in antimicrobial susceptibility of Enterococcus faecalis (E.faecalis) and Enterococcus faecium (E.faecium) isolated from clinical urine specimens, so as to provide laboratory evidence for clinical anti-infective treatment.Methods Antimicrobial susceptibility of E.faecalis and E.faecium isolated from urine specimens from 20 tertiary hosptials in China between 2004 and 2014 were analyzed, drug-resistant genes of vancomycin-resistant Enterococcus(VRE)were detected with polymerase chain reaction (PCR).Results A total of 788 Enterococcus strains were isolated in 2004-2014, 371 strains were E.faecalis strains, 417 were E.faecium strains.Susceptibility rates of E.faecalis to ampicillin, nitrofurantoin, fosfomycin, vancomycin, and teicoplanin were all>90%, susceptibility rates to rifampin, minocycline, and erythromycin were all<20%, there was significant difference in the susceptibility rate of E.faecalis to fosfomycin betwen July 2011-June 2012 and July 2009-June 2010(P<0.0167).Susceptibility rates of E.faecium to vancomycin and teicoplanin were 96.9% and 97.4% respectively, susceptibility rates to nitrofurantoin, minocycline, and fosfomycin were 41.7%, 51.8%, and 78.2% respectively, susceptibility rates to ampicillin, levofloxacin, rifampicin, and erythromycin were all<10%;susceptibility rates of E.faecium to nitrofurantoin had decreased tendency in different years (any two group comparison, all P<0.0167), susceptibility rates to fosfomycin in July 2011-June 2012 and July 2013-June 2014 both decreased compared with July 2009-June 2010(both P<0.0167),there were no significant changes in antimicrobial usceptibility rates in different years.14 strains of VRE all carried vanA resistance gene.Conclusion E.faecalis strains isolated from urine are susceptible to ampicillin, nitrofurantoin, and fosfomycin, E.faecium are not susceptible to most antimicrobial agents;E.faecalis and E.faecium are both susceptible to vancomycin and teicoplanin, only a few strains are resistant to antimicrobial agents.

Objective To investigate the influence of biological rhythm on labor pain,epidural analgesia and delivery mode in parturients.Methods In this retrospective cohort study,3 571 Chinese nulliparas with term singleton cephalic pregnancy who were preparing to deliver vaginally and receive epidural analgesia,were included.Parturients were divided into four groups according to the beginning time of analgesia,i.e.,morning group (7:01 to 13:00,n=955),afternoon group (13:01 to 19:00,n=1 159),evening group (19:01 to 1:00,n=763),and night group (1:00 to 7:00,n=694).Pain scores were assessed using a numeric rating scale (NRS) before and after epidural analgesia.Delivery mode,incidence of adverse events and neonatal outcomes were also compared among the four groups with monovariance analysis,LSD,Chi-square test or Fisher's exact test,Bonferroni,General Linear Model (GLM) and Logistic regression analysis.Results (1) The NRS pain scores of morning,afternoon,evening and night groups before analgesia were 8.6± 1.0,8.8± 1.0,8.9± 1.0 and 8.7± 1.0,respectively.After adjusted by GLM,the NRS pain scores of the four groups were 8.6±0.0,8.8 ± 0.0,8.9±0.0 and 8.7±0.0,respectively.Univariate and multivariable analyses showed that pain scores before analgesia were higher in afternoon group than in morning group (P＜0.01),and they were significantly higher in evening group than in morning and night groups (all P＜0.05).(2) At 10 and 30 minutes after epidural analgesia,the NRS pain scores of the four groups were 4.3± 1.0 and 1.8±0.9,4.8± 1.0 and 2.1 ±0.9,4.9± 1.1 and 2.2± 1.0,and 4.4± l.l and 1.8± 1.0,respectively,which were also significantly higher in afternoon and evening groups than in morning and night groups (all P ＜ 0.01 or 0.05) ; and the proportions of analgesia satisfaction (NRS pain score ≤ 3) were 19.7％ (188/955) vs 97.4％ (930/955),11.6％ (134/1 159) vs96.0％ (1 113/1 159),11.3％ (84/743) vs95.2％ (707/743),18.7％ (130/694) vs 95.6％ (670/694),respectively,which were significantly lower in afternoon and evening groups than in morning and night groups (all P＜0.01 or 0.05).(3) Delivery mode,incidence of adverse events and neonatal outcomes were similar among the four groups.Conclusions More severe labor pain before analgesia occur in parturients who receive epidural analgesia in the afternoon and at night,and less efficient analgesia and a lower rate of satisfaction are observed at 10 and 30 minutes after analgesia.However,delivery mode,neonatal outcomes and incidence of adverse events are not influenced by biological rhythm.

Objective To understand the growth pattern of infants of mothers with maternal glucose metabolism during pregnancy.Methods Totally,7600 infants,born from singleton pregnant women from January 1st,2007 to December 31st,2009 in Peking University First Hospital and were followed up at 6-12 weeks after birth,were included.Altogether,645 mothers were complicated with hyperglycemia and 6955 with normal glucose metabolism during pregnancy.All infants were divided into four groups based on maternal glucose metabolism and their birth weight:Group N1 (n =6432) was consisted of non-macrosomia infants with normal maternal glucose metabolism; Group N2 (n =523) included macrosomia infants with normal maternal glucose metabolism; Group A1 (n =588) were non-macrosomia infants with abnormal maternal glucose metabolism; Group A2 (n =57) were macrosomia infants with abnormal maternal glucose metabolism.Birth weight,body weight at the day of follow-up and average daily weight gain were compared among these four groups.T-test,single variance analysis and LSD was applied in statistics,and the time at follow-up was used as co variance to find out the early growth pattern of infants.Results The birth weight of infants in normal and abnormal glucose metabolism group showed no statistical difference [(3367.0±420.3) g vs (3368.2±475.1) g,t=-0.061,P＞0.05],but body weight at the day of follow-up and the daily weight gain in the former group were lower than in the latter [body weight at follow-up:(5459.3±625.2) g vs (5393.9±647.2) g;daily weight gain:(44.0±9.5) g vs (42.9±9.5) g,t=2.464 and 2.874,all P＜0.05].The birth weight of infants in Group N1,A1,N2 and A2 was (3300.6±359.2) g,(3282.1±397.0) g,(4183.8±203.8) g and (4256.8±248.8) g,respectively;the body weight at the day of follow-up was (5400.5±590.7) g,(5325.8±618.8) g,(6182.7±584.7) g and (6096.5±502.4) g;daily weight gain was (44.1±9.4) g,(43.2±9.4) g,(42.4±10.9) g and (39.6±10.0) g,respectively (F=1140.471,313.376 and 10.830,all P＜0.001).While using co-variance to compare among the four groups,statistically more daily weight gain was shown in Group N1 than in A1,A2 and N2,in Group N2 than in Group A2,in Group A1 than in A2 (all P＜ 0.05).Conclusions The growth speed may slow down in early infantile period for offsprings of mother with hyperglycemia during pregnancy.

Objective To investigate the values and characteristics of 75 g oral glucose tolerance test (OGTT) in pregnant women.Methods A total of 6 103 singleton pregnant women aged (30.4±3.8) years (18-49 years) who delivered in Peking University First Hospital between May 1,2011 and December 31,2012 underwent the 75 g OGTT at gestational age of 24-28 weeks.They were divided into five groups based on maternal age:＜25 years (n=222,3.6％),25-years (n=2 485,40.7％),30-years (n=2 573,42.2％),35-years (n=683,11.2％),and ≥ 40 years (n=140,2.3％).The normal values of the fasting,1 h and 2 h blood glucose were lower than 5.1,10.0 and 8.5 mmol/L.Gestational diabetes mellitus (GDM) was diagnosed when blood glucose of any point was higher than or equal to normal value.Comparison between groups was tested by analysis of variance and LSD test.Logistic regression was used to calculate the risk for GDM in different age groups.Results (1) The fasting,1 h and 2 h blood glucose levels were in Gaussian distribution.The （-x）+2s were 5.51,11.12 and 9.49 mmol/L.The 97.5 percentile were 5.63,11.32 and 9.95 mmol/L.Fasting plasma glucose of ＜ 25,25-,30-,35-,and ≥ 40 years were (4.53±0.40),(4.60±0.40),(4.67±0.43),(4.74±0.46) and (4.82±0.49) mmol/L.The 1 h blood glucose were (6.98± 1.70),(7.55± 1.60),(7.92± 1.63),(8.30± 1.71) and (8.76± 1.86) mmol/L.The 2 h blood glucose were (6.11±1.33),(6.53±1.27),(6.89±1.33),(7.23±1.50) and (7.57±1.60) mmol/L.Therewas statistical difference in the blood glucose levels at a same time-point test among different age groups (F=29.61,60.17 and 72.29,all P＜0.01).(3) The total prevalence rate of GDM was 21.1％ (1 290/6 103) ; and the prevalence rates were 9.9％ (22/222),16.7％ (414/2 485),22.7％ (583/2 573),32.1％ (219/683) and 37.1％ (52/140) among the five age groups,respectively,with significant differences (x2=120.68,P=0.00).Compared with the group aged ＜25 years,the OR (95％CI) of the prevalence among 25-,30-,35-,and ≥40 years group were 1.82 (1.16-2.86),2.66 (1.70-4.18),4.29 (2.69-6.86) and 5.37 (3.08-9.39),respectively.Conclusions Advanced age is a risk factor for GDM.The risk of GDM increases significantly after 35 years old and pregnancy in women aged ＜ 35 years can reduce the risk of GDM.

Objective To analyze the stroke subtypes and influencing factors in four largest economic regions of China.Methods We analyzed the investigation data of QUEST(Quality Evaluation of Stroke Care and Treatment)study conducted in 2006 which included 62 hospitals in a national scale.According to the concept of four economic regions designed by the Development Research Center of the State Council,we performed the univariate and multivariate analysis for the stroke subtypes and its related risk factors in the different economic regions.Results There were 3362(73.5％)ischemic stroke patients and 1214(26.5％)hemorrhagic stroke patients among the total 4576 first-ever stroke patients.Comparison of stroke subtypes in the four different economic regions was statistically significant(P ＜ 0.001),with a percentage of 80.8％ ischemic stroke patients in the northeastern region,78.9％ in the eastern region,68.3％ in the central region and 67.0％ in the western region.The comparisons of risk factors such as history of hypertension,diabetes,hyperlipidaemia,coronary artery event,atrial fibrillation,and overweight in the four different economic regions were also statistically significant(P ＜0.05).Conclusions The subtypes of first-ever stroke vary in the four largest economic regions with a highest proportion of ischemic stroke in the northeastern region and relatively high proportion of hemorrhagic stroke in the central and western economic regions.There are also discrepancies of stroke risk factors in the different economic regions.

Objective To investigate the influence of murine cytomegalovirus on the expansion of CD+CD25+ Foxp3+ regulatory T cell (Treg) and the activation of CD4+ CD25+Foxp3 - effector T cell (TE) in vivo. Methods Forty-two BALB/c mice were intraperitoneally inoculated with appropriate amount ofMCMV Smith strain for establishing the model of infection, another 42 mice served as mocked-infected con-trois. Day 28 post MCMV infection was determined to be the demarcation point of the acute and chronic in- fection based on the viral load of major visceral organs. On day 1,3, 7, 14, 28, 45 and 60 post infection, splenocytes were prepared by means of routine method. The proportions of CD4+CD25+ Foxp3+Treg and CD4+CD25+Foxp3- activated TE in T lymphocyte were measured by flow cytometry. Results The propor- tion of CD+CD25+ Foxp3+ T cells in T lymphocytes was persistently suppressed since day 7 post infection, and fell to the lowest level on day 28 post infection (P <0.01), then zoomed and reached the peak value on day 60 post infection (P < 0.05). CD4+CD25+ Foxp3 - TE proportion was up to the highest on day 3 post infection(P < 0. 01), then suppressed and in significantly lower level since day 45 post infection (P < 0.05). Treg/CD+TE ratio was in lower level on day 3 to 14 post infection(P <0.05) ; but on day 45 and day 60 post infection Treg/CD+ TE ratio was markedly increased (P < 0.05). Conclusion MCMV infec- tion can increase the CD+CD25+Foxp3+ Treg proportion, and inhibit CD4+T cells activation in chronic in- fection phase, which is likely to suppress the function of antiviral immunity in the infected host to cause a persistent latent infection.

Objective To investigate the prevalence of nutritional risk,malnutrition(undemutrition),overweight/obesity,and application of nutritional support in hospitalized patients with endocrine disorders.Methods Adult patients in Department of Endocrine of Peking Union Medical College Hospital(PUMCH)from September to December 2008 were consecutively enrolled.Nutrional Risk Screening 2002(NRS2002)war per-formed on the next morning after admission and nutritional support evaluation was performed on the 14th day of ad-mission or on the discharge day.The relationship between nutritional risk and nutritional support Was analyzed.Nu-tritional risk was defined as NRS2002 score≥3,and body mass index(BMI)<18.5 ks/m2 defined as unclernut-rition.Results A total of 152 patients were enroled,and NBS2002 scoring was performed in all patients.The prevalence of undernutrition Was 7.9%and the nutritional risk was 27.6%.The prevalence of nutritional risk in the elderly inpotients(≥60 years old)was significantly higher than in younger patients(18-59 years old)(36.8%vs 20.2%,P=O.023).Nine patients(21.4%)with NRS2002≥3 received nutrition support,and 12patients(10.9%)with NRS2002<3 received nutritional support.The average PN:EN ratio was 1:3.2.Conclu-siom NRS2002 is afeasible nutritional risk screening tool for inpatients with endocrine disorders.A large propor-tion of inpotients were at nutritional risk or undemutrition in the Department of Endocrine of PUMCH. The application of nutritional support currently is somehow inappropriate.Evidence-based guidelines are required to improve this situation