Objective To observe the impact of diabetes and stress hyperglycemia on thrombolytic effect and short-term prognosis in patients with acute cerebral infarction. Methods A total of 127 patients with acute cerebral infarction (≤4. 5 h) who received thrombolytic therapy with alteplase at General Hospital of Beijing Military Command from January 2012 to August 2013 were enrolled retrospectively. They were divided into three groups:Diabetes group (n=35),stress hyperglycemia group (n=49),and normal glucose group (n=43) according to whether they had a history of diabetes,random glucose on admission, and oral glucose tolerance test at day 7. At 24 h after thrombolysis,the National Institute of Health Stroke Scale (NIHSS) scores,recanalization rate,and the modified Rankin Scale (mRS) scores at day 90 were compared between the 2 groups. Results Before thrombolysis,the NIHSS scores of the diabetic group, stress hyperglycemia group,and normal glucose group were 14. 2 ± 5. 1,12. 8 ± 5. 6,and 13. 0 ± 4. 6,respectively (P>0.05);at 24 h after thrombolysis,they were 14.7 ±6.0,11.9 ±4.9,and 8.0 ±2.9,respectively (P<0.05);compared with before thrombolysis,the NIHSS scores of the diabetes group and the stress hyperglycemia group had no significant change (P>0. 05);the NIHSS score of the normal glucose group was lower than before thrombolysis. There was significant difference (P <0. 05). After thrombolysis,the patients with good recanalization were 54. 3% (n=19),57. 1% (n=28),and 67. 4% (n=29),respectively in the three groups;the hemorrhagic conversion rate was 14. 3% (n=5),6. 1% (n=3),and 2. 3% (n=1),respectively. There were no significant differences. At day 90 after thrombolysis,the mRS scores in the 3 groups showed that the good prognosis rate of the normal glucose group was 72. 1% (n=31);it was significantly higher than 51. 0% (n=25) of the stress hyperglycemia group and 29. 6% (n=10) of the diabetes group. There were significant differences (P<0. 05,P<0. 01). There was also significant difference between the stress hyperglycemia group and the diabetes group. Conclusion Diabetes and stress hyperglycemia have varying degrees of adverse effects on the efficacy and prognosis of the thrombolytic therapy for acute cerebral infarction.

Objective To probe into the role of nursing classification and marking management in ICU nursing management. Methods According to the admission date,the first 87 patients hospitalized in our department were assigned into the control group and another 84 into the intervention group.Then the human resources were divided based on the ABCD nursing classification and marking management for ICU.The two groups were compared in terms of adverse events.Results The incidences of pressure sores, non-planned extubation,improper clinostatism for using respirator,hypoglucycaemia during reinforced treatment with insulin, respirator-associated pulmonary pneumonia,tube-associated infection,and multidrug resistant bacteria in the intervention group were all significantly lower than those in the control group (allP<0.05).Conclusion The nursing classification and marking management for ICU nursing management can enhance the nursing quality.

Objective To study the clinical value of orbital magnetic resonance imaging(MRI) in diagnosis and making a judgment about the curative effect of glucocorticoid in patients with Graves' ophthalmopathy (GO).Methods A total of 106 patients with GO were divided into active GO group or inactive GO group according to whether clinical activity score(CAS) ≥3 or not,respectively.T2 relaxation times(T2RTs) (ms) and areas(mm2) of four extra-ocular muscles (EOMs) (superior,inferior,medial,and lateral rectus) were directly measured by MRI T2-Mapping.Correlation analysis of T2 RTs and areas with eyeball motility,diplopia,exophthalmus,visual acuity and intraocular pressure (IOP) were also performed.The T2RTs and areas of EOMs before and after intravenous methylprednisolone(iv MP) pulse therapy were recorded,respectively.Results The mean T2RTs (88.9 ± 13.8)and mean areas(58.1 ± 23.8) of EOMs in active GO were significantly greater than those in inactive GO (80.6 ± 10.0and 46.2 ± 18.6,respectively),bing both significantly greater than those in volunteers with normal eyes(76.2 ±4.7and 30.3 ± 6.1,respectively) (P＜0.01).Maximal T2RTs and maximal areas of EOMs showed significant positive correlation(P＜0.01),and both were positively correlated weakly with CAS,reduced movement of eyeball,diplopia,exophthalmus and loss of visual acuity (P＜0.01).On the contrary,maximal T2RTs and maximal areas of EOMs showed negative correlation or no correlation with spontaneous retrobulbar pain,painful eye movement,redness of eyelids and abnormal IOP.Even if 1 ≤ CAS＜3,ophthalmic symptoms and signs also showed a positive responses to iv MP in patients with moderate to severe GO as long as prolonged T2RTs occurred at least in one of EOMs.The maximal T2RTs,maximal areas,mean T2RTs and mean areas of EOMs were significantly decreased at the end of iv MP treatment,meanwhile ophthalmic symptoms and signs were obviously improved.Conclusions Prolonged T2RTs,especially accompanied by enlarged area on the identical EOMs is an remarkable symbols of acute inflamed muscles.The findings suggested that the use of prolonged T2RTs can improve diagnostic sensitivity and predict the curative effect of iv MP in patients with moderate to severe GO and CAS ≥ 1.

Objective To explore the effect of continuous aspiration of subglottic secretion at different negative pressure levels on mechanical ventilation. Methods Toally 142 patients were randomized by way of lottery into the control group (n=70) and the experiment group ( n = 72 ): the control group received continuous negative pressure aspiration of subglottic secretion at a negative pressure of 60 mmHg while the experiment group did 30~40 mmHg for grade I of the sticky secretion , 40~60 mmHg for gradeⅡ~Ⅲof the sticky secretion, respectively. The two groups were compared in terms of the rate of ventilator associated pneumonia (VAP), airway mucosal injury and cough. Result There was no significant difference in the rate of ventilator associated pneumonia (P>0.05), but the rates of airway mucosal injury and cough were lower in the experiment group than those of the control group (P < 0.05). Conclusion It is reasonable to choose different negative pressure levels based on stickiness of the secretions for mechanical ventilation, for it can prevent the ventilator associated pneumonia and airway mucosal injury.

Objective To identify and analyze the effective compositions of Schistosoma japonicum 31-32 kDa proteins by using the techniques of proteomics.Methods The total proteins were prepared from 32-day adult worms of Schistosoma japonicum.After two-dimensional(2-D)gel electrophoresis,the distinct protein spots from 2-D gels were isolated and analyzed by MALDI-TOF-MS.Results A total of 13 protein spots,within the range of 31-32 kDa,were detected in the 2-D gels.Three of them had high homology with Actine-2 of S.mansoni,glycerol-3-phosphate dehydrogenase of S.japonicum and cathepsin B endopeptidase of S.mansoni.Conclusions The 31-32 kDa antigens contain 3 important antigens:actine-2,glycerol-3-phosphate dehydrogenase and cathepsin B endopeptidase,which have been demonstrated to have certain protective effect against S.japonicum.Our findings can facilitate the development of multi-epitope vaccine against S.japonicum.

ObjectiveTo evaluate the local failure and the impact on survival by prospectively comparing involved field radiotherapy (IFRT) and elective nodal irradiation (ENI) in combination with concurrent chemotherapy for locally advanced non-small cell lung cancer ( LA-NSCLC ).Methods LANSCLC patients were treated with 2 cycles of carboplatin ( AUC =5 - 6,d1 ) combined with paclitaxel ( 175mg/m2 ),followed assessment without distant metastasis,then randomized into IFRT (45 patients) or ENI (54 patients) arm.IFRT included primary tumor,ipsilateral hilar and positive mediastinal lymph nodes;ENI included the primary lesion,ipsilateral hilar,hilateral mediastinal lymph node drainage and bilateral supraclavicular area.The prescription dose was given as high as possible with V20 ≤35％ and spinal cord dose ≤50 Gy,combined weekly paclitaxel 40 mg/m2 concurrent chemotherapy.The Kaplan-Meier method was used to estimate survival data and the log-rank method was used to test distribution of survival time between arms.ResultsThe follow-up rate was 99％.49,29 and 17 patients were followed-up for 1-,2-and 3-year,respectively.More patients from group IFRT received ＞60 Gy than ENI (49％ vs.26％,x2 =5.59,P =0.018 ).The local failure rates were 29％ and 36％,respectively ( x2 =0.46,P =0.497 ).The 1-,2-and 3-year local tumor progression-free survival rates were 76％,69％,65％ and 80％,53％,49％ ( x2 =0.74,P =0.389),respectively; the 1-,3-and 5-year overall survival rates were 80％,41％,33％ and 69％,32％,13％ (x2 =3.97,P =0.046),respectively.There were no significant differences in acute and late toxicities between the arms ( x2 =3.910 - 0.155,P =0.142 - 0.925 ).ConclusionsIFRT improved radiation dose and survival rate and did not increase the failure of elective lymph node region compared with ENI.The toxicities were no differences between IFRT and ENL Further investigation with big size sample is warranted.

Background:From April to July in 2009 and 2010,unexplained severe hemorrhagic fever-like illnesses occurred in farmers from the Huaiyangshan mountains range.Methods:Clinical specimens (blood,urine,feces,and throat swabs) from suspected patients were obtained and stored.Mosquitoes and ticks in affected regions were collected.Virus was isolated from 2 patients and characterized by whole genome sequencing.Virus detection in additional patients and arthropods was done by virus-specific reverse transcription (RT) PCR.Clinical and epidemiological data of RT-PCR confirmed patients were analyzed.Results:An unknown virus was isolated from blood of two patients and from Haemaphysalis ticks collected from dogs.Whole genome sequence analysis identified the virus as a novel member of the family Bunyaviridae,most closely related to the viruses of the genus Phlebovirus within which it forms a separate lineage.Subsequently,infection was confirmed by RT-PCR in 33 of 58 suspected patients.The illness in these patients was characterized by fever,severe malaise,nausea,vomiting,and diarrhea.Prominent laboratory findings included low white cell- and platelet counts,coagulation disturbances,and elevation of liver enzymes.Hemorrhagic complications were observed in 3 cases,5 (15%) patients died.Conclusions:A novel tick-borne Bunyavirus causing life-threatening hemorrhagic fever in humans has emerged in the Huaiyangshan mountain areas of China.Further studies are needed to determine the epidemiology,geographic distribution and vertebrate animal ecology of this virus.