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 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 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 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 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 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 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 evaluate the feasibility of transforaminal endoscopic nerve root decompression for degenerative lumbar spinal stenosis (DLSS).Methods: From July 2011 to April 2016,96 cases of single segment DLSS were involved.All the patients had unilateral lower extremity neurological symptoms,signs,neurogenic intermittent claudication of less than 500 m.Imaging examinations (CT or MRI) or diagnostic nerve root block confirmed single segment degeneration.The mean age was (71.6±5.4) years,male: 55 cases,female: 41 cases.Their intraoperative blood loss,operation time,complications,ambulation time and discharge time were recorded.Leg pain VAS,ODI were used to evaluate the pain and lumbar function of the patients.The clinical efficacy was evaluated by Nakai evaluation.Results: All the patients were performed endoscopic decompression of the lateral recess and nerve root by removing the ventral part of the superior facet joint,the ligamentum flavum and the intervertebral disc.The decompression range was from the inferior edge of the upper pedicle to the superior edge of the lower pedicle.The nerve root was detected to have no compression and the pulse of nerve root returned to normal.The patient got ambulant on the operation day and discharged if he had no discomfort symptom.In the study,68 cases got follow up.The mean follow-up time was 12.1 months (6-63 months).The VAS at dif-ferent follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=491.60,P<0.001).The ODI at different follow-up time points was improved relative to the baseline,and the difference was statistically significant (F=189.91,P<0.001).The excellent and good rates of Nakai evaluation were 79.4％ (excellent in 42 cases,good in 12 cases,fair in 10 cases and poor in 4 cases).The mean intraoperative blood loss was (49.29±11.86) mL.The mean operation time was (92.46±21.34) min.The mean ambulation time was 1.8 h.The mean discharge time was 2.3 days.Postoperative epidural hematoma was found in 1 case.Foot drop was found in 1 case.Second stage open surgery was performed in 6 cases.Conclusion: We can apply transforaminal endoscopic decompression for the patients of lumbar spinal stenosis who have unilateral nerve root irritation.Patients with transforaminal endoscopic decompression can get less surgical trauma,quick recovery and obtain good short-term outcome.

Objective To investigate the current status of screening and management of thyroid diseases during pregnancy,and to provide evidence for further improvement of clinical management.Methods Clinical data of 5 981 pregnant women who delivered at Peking University First Hospital between September 1,2013 and September 30,2014 were analyzed retrospectively.Their average age was (30±4) years (18-47 years) and average gestational week was (39.2± 1.6) weeks (25.5-42.0 weeks).The reference range of thyroid stimulating hormone (TSH) was 0.1-2.5 mU/L recommended by the American Thyroid Association (ATA).The reference range of free thyroxine (FT4) was 11.48-22.70 pmol/L and the cut-off value of thyroid peroxidase antibody (TPOAb) was 34 U/ml both recommended by the kit.The specific reference range of TSH was obtained from normal pregnant women in this study (0.23-4.08 mU/L in the first trimester).Pregnant women with hypothyroidism were divided into two groups according to their TSH level at the first trimester:TSH ≥ 2.5-＜4.08 mU/L group and TSH ≥ 4.08 mU/L group.T test,Chi-square or Fisher's exact test were applied for statistical analysis.Results (1) Screening status:Of the 5 981 pregnant women,there were 13 cases (0.2％) of hyperthyroidism and 146 cases (2.4％) of hypothyroidism diagnosed before conception (133 cases of Hashimoto thyroiditis,eight cases after operation for thyroid cancer,and five cases after 131I therapy because of hyperthyroidism).Among the 5 822 cases requiring screening,4 044 cases (69.5％) received screening tests of TSH,FT4 and TPOAb during early pregnancy according to Chinese Guidelines,and 1 778 cases received neither standard screening nor screening test.(2) Treatment of hypothyroidism:Hypothyroidism treatment rate was only 61.5％ (107/174) according to the reference range recommended by the ATA,lower than that of 88.1％ (52/59) according to the reference range of this study (x2=14.430,P＜0.05).There were 60 cases receiving no treatment in TSH ≥ 2.5-＜4.08 mU/L group.Forty-three of these cases were reexamined,and one of them was abnormal,with a rate of 2.3％ (1/43).There were seven cases without treatment in TSH ≥ 4.08 mU/L group;six of them were reexamined among which one was abnormal,with a rate of 1/6.(3) Thyrotoxicosis:Among the 4 044 pregnant women,99 cases had TSH ＜0.1 mU/L,including 11 cases with FT4 ≥ 22.70 pmol/L (22.82-60.96 pmol/L).Only three cases were positive for thyrotrophin receptor antibody,and then diagnosed as hyperthyroidism and treated with propylthiouracil.(4) Thyroid cancer:Among the 5 981 pregnant women,six cases were diagnosed as thyroid cancer during pregnancy and lactation,with an incidence of 100.3/100 000.Of the six cases,five were diagnosed during pregnancy,and one at one month postpartum.All of the six cases underwent operation and were confirmed to be papillocarcinoma by pathology.Conclusions The screening rate of thyroid diseases during pregnancy is high,but the clinical management is not fully standardized.We suggested that each center should established its own normal reference range for thyroid function test.The incidence of thyroid cancer during pregnancy is increasing,thus attention should be paid to its diagnosis.