Objective To investigate the diagnostic value of peptidylarginine deaminase-4 (PADI-4)detected in patients with rheumatoid arthritis (RA).Methods The levels of PADI-4,anti-CCP antibodies,AKA and APF were detected by ELISA in serum samples from 58 patients with RA,40 other rheumatic disease and 30 healthy individuals.The indicators were evaluate by application of ROC curve analysis,analysis of variance and correlation.Results PADI-4 serum level(2.653±2.719 U/L) of patients with RA was significantly higher than other rheumatic diseases group (0.872 ± 0.292 U/L)and the healthy group (0.793±0.243 U/L),the difference was statistically significant (t=22.732,35.371,P<0.01).Receiver operator curve analysis (ROC)showed an opitium cut off level for PADI-4 at 1.284 U/L,the sensitivity of PADI-4 was 62.1%.The specificity was 91.4% in RA.There was no significant difference between the positive rate of PADI-4 (62.1%)and APF (50%),AKA (56.9%)(χ2=0.322,P=0.570;χ2=1.715,P=0.190),and there was asignificant difference between PADI-4 and anti CCP antibody (χ2=4.161,P=0.041);a positive correlation between PADI-4 and APF,AKA (r=0.652,0.666, P<0.01),PADI-4 and between anti CCP antibody showed no correlation (r=0.122,P=0.357).Conclusion PADI-4 was significantly increased in serum of RA patients in part,PADI-4 has good sensitivity and specificity of RA,a new diagnostic markers might become independent of antibody against CCP in RA.

Objective To evaluate the serum 25-hydroxy vitamin D 3 level in newly diagnosed type 2 diabe-tes,and its relationship with function of islet beta cell .Methods 60 newly diagnosed type 2 diabetes patients and 48 normal glucose tolerance healthy control cases were selected .The level of serum 25-hydroxy vitamin D3 of two groups were measured using the way of high performance liquid chromatograph .The difference was compared between two groups.Insulin resistance index(HOMA-IR) and islet beta cell secrete index(HOMA-β) was used to respectively es-timate insulin sensitivity and islet beta cell function in type 2 diabetes group .The correlation was analyzed between 25-hydroxy vitamin D 3 and fasting blood glucose ,HOMA-IR,HOMA-β.Results The level of serum 25-hydroxy vita-min D3 (28.68 ±1.61) ng/mL in type 2 diabetes group was significantly lower than that of control group (41.30 ± 1.12)ng/mL(t=3.47,P<0.01).There is negative correlation between 25-hydroxyl vitamin D3 and fasting glucose (r=0.48,P<0.05).There was positive correlation between 25-hydroxy vitamin D3 and HOMA-IR(r=0.52,P<0.05).There was no correlation between 25-hydroxy vitamin D3 and HOMA-β(r=-0.06,P>0.05).Conclusion The level of 25-hydroxy vitamin D 3 was significantly low in newly diagnosed type 2 diabetes patients .Low serum 25-hydroxyl vitamin D 3 level affects islet beta secretion cell function ,the supplementation of vitamin D 3 may be a simple and effective method to reduce the ocurrence of type 2 diabetes .

Objective:To explore the application value of combined detection of troponin I (cTnI) and creatine kinase isoenzyme mass (CKMBmass), interleukin-6 (IL-6) and fibrinogen degradation products (FDP) in the diagnosis and treatment of acute myocardial infarction (AMI).Methods:A total of 102 AMI patients in Wanbei Coal Power Group General Hospital from July 2019 to June 2020 were selected as the AMI group. In addition, 60 patients diagnosed with chest pain (CP) and chest distress (CD) during the same period were selected as the CPCD group, and 60 healthy patients were selected as the healthy control group. The levels of cTnI, CKMBmass, IL-6 and FDP in the peripheral blood of the three groups were compared, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of cTnI, CKMBmass, IL-6, and FDP. The AMI group was given thrombolytic therapy. The clinical data of patients with different curative effects, the trend of changes in peripheral blood cTnI, CKMBmass, IL-6 and FDP levels before and after treatment were compared, and the relationship between the above indicators and clinical indicators and curative effects were analyzed.Results:The levels of peripheral blood cTnI, CKMBmass, IL-6 and FDP in the AMI group were higher than those in the CPCD group and the healthy control group, and the levels of peripheral blood cTnI, CKMBmass, IL-6 and FDP in CPCD group were higher than those in the healthy control group ( P<0.05). The area under the curve (AUC) values of cTnI, CKMBmass, IL-6 and FDP in the combined diagnosis of CPCD and AMI were 0.898 and 0.926, respectively, which were higher than those of single diagnosis. The time from onset to thrombolysis, infarct location, diabetes, diastolic blood pressure (DBP), systolic blood pressure (SBP), left ventricular end systolic volume (LVESV), left ventricular end systolic diameter (LVESD), left ventricular end diastolic volume (LVEDV), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) on admission of effective patients and ineffective patients were statistically significant ( P<0.05). The levels of peripheral blood cTnI, CKMBmass, IL-6, and FDP of effective patients were lower than those of ineffective patients when they were admitted to the hospital and 6, 12, 24, 48, and 72 h after treatment ( P<0.05). The peripheral blood cTnI, CKMBmass, IL-6, and FDP on admission were positively correlated with DBP, SBP, LVESV, LVESD, LVEDD, LVEDV, and was negatively correlated with LVEF ( P<0.05). Multiple linear stepwise regression analysis showed that after the onset to thrombolysis time, infarct location, smoking, diabetes, SBP, DBP, LVESV, LVESD, LVEDD, LVEDV, LVEF and other factors at admission were controlled, the levels of peripheral blood cTnI, CKMBmass, IL-6, FDP were still significantly related to the efficacy ( P<0.05). Conclusions:The peripheral blood cTnI, CKMBmass, IL-6, and FDP are all abnormally expressed in AMI patients. Combined detection has clinical significance for the diagnosis and treatment of AMI.

OBJECTIVE To investigate the genes associated with the drug-resistance to ?-lactam antibiotics in Pseudomonas aeruginosa(PAE) isolated from clinical patients in Huaibei,Anhui Province.METHODS Antibiotic sensitivity test was performed by VITEK-AMS.The three-dimensional method was taken to differentiate various beta-lactamases.The ?-lactamases and the outer membrane protein D2(oprD2) genes were detected by polymerase chain reaction(PCR) in 36 PAE strains.RESULTS In 36 PAE strains,the positive rates of genes of TEM,DHA,CTX-Ge and CARB were 77.8%,69.2%,27.8% and 25.0%,respectively,that of the OXA-1,OXA-10,VIM-2 and IMP-1 were 16.7%,16.7%,13.9% and 2.8%,respectively.The rate of lacking oprD2 gene was 58.3%,and none possessed VEB,SHV,GES,PER,GIM and SPM-2 genes.CONCLUSIONS P.aeruginosa carries various beta-lactamase genes in clinical patients of Huaibei,and the deletion ratio of oprD2 gene is higher.

Objective To investigate the genotypes of aminoglycoside-modifying enzymes (AMEs) produced by Pseudomonas aeruginosa isolated from Huaibei Miner's General Hospital.Methods Minimum inhibitory concentration of 36 strains of P. aeruginosa to 3 aminoglycoside antibiotics was determined. AME genes were amplified by polymerase chain reaction (PCR). Results The P. aeruginosa isolates were resistant to multiple antibiotics. Most (62.2% to 81.1%) were resistant to aminoglycosides. And 27 strain (75.0%) carried one or more types of AME genes, including ant(3″)-Ⅰ (63.9%), aac(6')-Ⅱ (58.3%), aac(6')-Ⅰ (50.0%), aac(3)-Ⅱ (38.9%) and ant(2″)-Ⅰ (36.1%). The aac(3)-Ⅰ, aac(3)-Ⅲ, aac(3)-Ⅳ, aph(3')-Ⅳ genes were not identified.Conclusions The study indicates that the P. aeruginosa isolates in Huaibei are multi-resistant to aminoglycoside antibiotics. The prevalence of AMEs-positive strains is high.

Objective:To investigate the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma at multiple centers in China.Methods:Between December 2015 and August 2019, the clinical data of 143 patients who underwent LRHC in Affiliated Hospital of North Sichuan Medical College, Second Hospital of Hebei Medical University, Affiliated Hospital of Xuzhou Medical University, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hunan Provincial People′s Hospital, the First Hospital Affiliated to Army Medical University, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, West China Hospital of Sichuan University, Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Chongqing Medical University were collected prospectively. There were 92 males and 51 females with age of (64±11) years (range: 53 to 72 years). Bismuth type: type I, 38 cases (26.6%), type Ⅱ, 19 cases (13.3%), type Ⅲa, 15 cases (10.5%), type Ⅲb, 28 cases (19.6%) and type Ⅳ, 43 cases (30.0%). The patients within the first 10 operation cases in each operation time (the first 10 patients in each operation team) were divided into group A (77 cases), and the patients after 10 cases in each operation time were classified as group B (66 cases); the cases with more than 10 cases in the center were further divided into group A 1 (116 cases), and the center with less than 10 cases was set as group A 2 (27 cases). T test or Wilcoxon test was used to compare the measurement data between groups, and the chi square test or Fisher exact probability method was used to compare the counting data between groups. Kaplan Meier curve was used for survival analysis. Results:All patients successfully completed laparoscopic procedure. The mean operation time was (421.3±153.4) minutes (range: 159 to 770 minutes), and the intraoperative blood loss was 100 to 1 500 ml (median was 300 ml) .Recent post-operative complications contained bile leakage, abdominal bleeding, abdominal infection, gastrointestinal bleeding, and delay gastric emptying, pulmonary infection, liver failure, et al.The post-operative hospital stay was (15.9±9.2) days. The operation time in group B was relatively reduced ( (429.5±190.7)minutes vs. (492.3±173.1)minutes, t=2.063, P=0.041) and the blood loss (465 ml vs. 200 ml) was also reduced ( Z=2.021, P=0.043) than that in group B. The incidence of postoperative biliary fistula and lung infection in patients in group A was significantly higher than that in group B (χ 2=4.341, 0.007; P=0.037, 0.047) .Compared with group A 2, the operation time in group A 1 was relatively reduced( (416.3±176.5)minutes vs. (498.1±190.4)minutes, t=2.136, P=0.034) , the incidence of bile leakage and abdominal cavity infection in group A 1 was lower than that in group A 2 (χ 2=7.537, 3.162; P=0.006, 0.046) . Kaplan Meier survival curve showed that the difference of short-term survival time between group A and group B was statistically significant ( P<0.05) . Conclusions:The completion of laparoscopic hilar cholangiocarcinoma radical surgery is based on improved surgical skills, and proficiency in standardized operation procedures.It is feasible for laparoscopic radical resection of hilar cholangiocarcinoma to well experienced surgeon with cases be strictly screened, but it is not recommended for widespread promotion at this exploratory stage.

Objective:To investigate the feasibility and safety of laparoscopic radical resection of hilar cholangiocarcinoma at multiple centers in China.Methods:Between December 2015 and August 2019, the clinical data of 143 patients who underwent LRHC in Affiliated Hospital of North Sichuan Medical College, Second Hospital of Hebei Medical University, Affiliated Hospital of Xuzhou Medical University, Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Hunan Provincial People′s Hospital, the First Hospital Affiliated to Army Medical University, Sir Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, West China Hospital of Sichuan University, Nanfang Hospital of Southern Medical University and the First Affiliated Hospital of Chongqing Medical University were collected prospectively. There were 92 males and 51 females with age of (64±11) years (range: 53 to 72 years). Bismuth type: type I, 38 cases (26.6%), type Ⅱ, 19 cases (13.3%), type Ⅲa, 15 cases (10.5%), type Ⅲb, 28 cases (19.6%) and type Ⅳ, 43 cases (30.0%). The patients within the first 10 operation cases in each operation time (the first 10 patients in each operation team) were divided into group A (77 cases), and the patients after 10 cases in each operation time were classified as group B (66 cases); the cases with more than 10 cases in the center were further divided into group A 1 (116 cases), and the center with less than 10 cases was set as group A 2 (27 cases). T test or Wilcoxon test was used to compare the measurement data between groups, and the chi square test or Fisher exact probability method was used to compare the counting data between groups. Kaplan Meier curve was used for survival analysis. Results:All patients successfully completed laparoscopic procedure. The mean operation time was (421.3±153.4) minutes (range: 159 to 770 minutes), and the intraoperative blood loss was 100 to 1 500 ml (median was 300 ml) .Recent post-operative complications contained bile leakage, abdominal bleeding, abdominal infection, gastrointestinal bleeding, and delay gastric emptying, pulmonary infection, liver failure, et al.The post-operative hospital stay was (15.9±9.2) days. The operation time in group B was relatively reduced ( (429.5±190.7)minutes vs. (492.3±173.1)minutes, t=2.063, P=0.041) and the blood loss (465 ml vs. 200 ml) was also reduced ( Z=2.021, P=0.043) than that in group B. The incidence of postoperative biliary fistula and lung infection in patients in group A was significantly higher than that in group B (χ 2=4.341, 0.007; P=0.037, 0.047) .Compared with group A 2, the operation time in group A 1 was relatively reduced( (416.3±176.5)minutes vs. (498.1±190.4)minutes, t=2.136, P=0.034) , the incidence of bile leakage and abdominal cavity infection in group A 1 was lower than that in group A 2 (χ 2=7.537, 3.162; P=0.006, 0.046) . Kaplan Meier survival curve showed that the difference of short-term survival time between group A and group B was statistically significant ( P<0.05) . Conclusions:The completion of laparoscopic hilar cholangiocarcinoma radical surgery is based on improved surgical skills, and proficiency in standardized operation procedures.It is feasible for laparoscopic radical resection of hilar cholangiocarcinoma to well experienced surgeon with cases be strictly screened, but it is not recommended for widespread promotion at this exploratory stage.