ObjectiveThe difference of Cys-C ( serum cysteine proteinase inhibitor C) among sepsis group,systemic inflammatory response syndrome (SIRS) group,and non -SIRS group were explored in this study.The significance of mortality and the relationship between Cys-C and acute physiology and chronic health evaluation (APACHE)Ⅱ score were under discussed. Methods After excluding the individual whose survival less than 24 hours,two hundred and fifty patients sought medical care in the emergency department of Beijing Chaoyang Hospital of the Capital Medical University were selected as samples from October 2008 to October 2009.They were classified into three groups:SIRS group ( n =121 ),non-SIRS group (n =74) and sepsis group ( n =55 ).The serum Cys-C level and APACHE Ⅱ score were determined for each patient.The positive detection rate of Cys-C ( ＞ 830 ng/ml) was calculated and then a 28-day mortality was recorded according to this study result.The positive detection rate and 28-day mortality were also compared with chi-square test.The prognostic values of Cys-C,APACHE Ⅱ score for the 28-daymortality were evaluated by logistic regression analysis.Results There was significant change observed between sepsis group and non-SIRS group (41.38％ vs. 13.57％,P =0.007 ) for the positive detection rate of Cys-C,as well as that between SIRS group and non-SIRS group ( 32.79％ vs. 13.57％,P =0.005).However,a contrary result was obtained when compared sepsis group with SIRS group (41.38％ vs.32.79％,P =0.346) ).Significant difference was noticed in the 28-day mortality of the patients from sepsis group and SIRS group in comparison to those of non-SIRS group (41.6％ vs. 17.2％,P ＜ 0.01 ;36.91％ vs. 17.2％,P ＜ 0.05).Cys-C level in patient with sepsis indicated a positive correlation to APACHE Ⅱ score ( P ＜0.0001 ).ConclusionsThe positive rate of Cys-C in SIRS group and septic group were significantly higher than that of non-SIRS patients,and this is an index for poor prognosis in sepsis patients.

ObjectiveTo assess the significance of serum cysteine proteinase inhibitor C (Cys-C) and β2 microglobulin (β2MG) concentrations in the diagnosis and prognosis of sepsis-induced acute kidney injury.Methods Two hundred and fifty patients presenting to the Emergency Department of Beijing Chaoyang Hospital from October 2008 to October 2009 with sepsis were assessed.Serum creatinine (SCr),β2MG and Cys-C concentrations and Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ ) scores were determined when the septic patients presented to the hospital. The 28-day mortality was recorded.The study patients were retrospectively divided into acute kidney injury ( n =63 ) and no acute kidney injury groups (n =187 ).The predictive accuracies of Cys-C and β2MG for acute kidney injury were analyzed by plotting a relative operating characteristic (ROC) curve.The Spearman interclass correlation method was used to analyze the correlation between Cys-C concentration and APACHE Ⅱ score in sepsisinduced acute kidney injury.ResultsCys-C and β2 MG concentrations were significantly greater in the acute than in the no acute kidney injury group [ ( 1189 ± 214) μg/L vs.(678 ± 118) μg/L,P =0.007 ; (3705 ±599)μg/L vs.(2365 ±446) μg/L,P =0.004,respectively].SCr concentrations and APACHE Ⅱ scores were significantly greater in the acute than in the no acute kidney injury group [ (145 ±49) vs.(73 ±25),P=0.013,(19 ±4) vs.(13 ±4),P=0.016].There was a significant correlation between Cys-C concentration and APACHEII score in the acute kidney injury group (P ＜0.01).The 28-day mortality was significantly greater in the acute than in the no acute kidney injury group.The areas under the ROC curve for Cys-C and β2MG concentrations were 0.909 ( OR =1.006,95％ CI =1.002 - 1.009) and 0.82 ( OR =1.001,95％ CI =1.000 -1.001),respectively.ConclusionsMonitoring of Cys-C and β2MG concentrations can effectively predict the occurrence of acute kidney injury in septic patients.Cys-C concentration is a more accurate predictor of this diagnosis than β2MG concentration.An increasing Cys-C concentration is an indicator of poor prognosis.

Objective To evaluate acoustic effects of laryngeal microsurgery on vocal polyp, vocal cyst and vocal leuko- plakia. Methods 300 cases in vocal fold diseases were measured acoustically pre - and post - microsurgery. Results After openation, jitter, shimmer and NNE decreased statistically in vocal polyp and vocal cyst patients, and did not improve in vocal leukoplakia patients. Whether or not the surgery was done, F0 of all patients did not change Conclusion Laryngeal microsurgery had definite effect on clearing benign focus. After surgery, vocal functioin improved in vocal polyp and cyst patients, and in vocal leukoplakia, there was no improvement in such a short time as one week.

[Objective]To explore the result of total hip arthroplasty(THA) performed in patients with osteoarthritis secondary to developmental dysplasia of the hip(DDH) and the degree of hip dysplasia on the treatment result. [Method]Forty-seven cases(55 hips) with osteoarthritis secondary to DDH were treated with THA.According to the classification of Crowe,23 hips were in classⅠ,19 in classⅡand 13 in class Ⅲ/Ⅳ.Before operation,the morphological changes of acetabula and femurs were evaluated with helical CT.During the operation,the acetabula were reconstructed at the level of real acetabula,the femoral canal was carefully enlarged and the small and straight femoral protheses were employed.The Harris hip score was conducted in each patients preoperatively and postoperatively.[Result]The Harris hip score in class Ⅰ,Ⅱand Ⅲ/Ⅳ were from 50.7?7.6,44.9?6.2 and 41.1?8.2 preoperative to 90.6?3.7,87.3?4.5 and 82.7?7.3 postoperative,respectively.There was significant difference between them(P

Objective To investigate influence of nutritional status on prognosis in patients with systemic inflammatory response syndrome (SIRS). Methods Retrospective analysis for clinical data of 533 patients who hospitalized at the Internal Medicine Department of Beijing Social Welfare Hospital and the Emergency Department of Chaoyang Hospital, Beijing during 2005 to 2010 were performed. All the patients were divided into SIRS (323 cases) and non-SIRS (210 cases) groups based on diagnostic criteria of SIRS and pyemia, and groups of the survival (431 cases) and the dead ( 102 cases) based on their end outcomes.Patients of SIRS were further divided into sub-groups of pyemia (287 cases) and non-pyemia (36 cases)based on their infection status. The Acute Physiology and Chronic Health Evaluation Ⅱ ( APACHE Ⅱ ),serum levels of prealbumin ( PAB), albumin ( ALB), total cholesterol (CHOL) and C-creative protein (CRP) were measured for all the patients on the 1st, 3rd, 7th days after admission, before discharge and prior to death, respectively. Results Scores of APACHE Ⅱ were significantly higher in SIRS and the dead groups than those in non-SIRS and the survival groups (P ＜0. 05 ). Serum level of albumin was significantly lower in SIRS and the dead groups than that in non-SIRS and the survival groups on the 7th day after admission (SIRS vs. non-SIRS: F=9.812, P=0.035; the dead vs. the survival: F =45.285, P=0. 003). Change in serum level of prealbumin was the same as the level of albumin, with significant difference between various groups since the 3rd day after admission ( P ＜ 0. 05 ). Significant time effects could be found in the dead and survival groups (for the dead group: F = 19. 188, P = 0. 000; and for the survival group: F = 47. 250, P ＜ 0. 01 ). Multiple regression analysis showed that serum levels of prealbumin and total cholesterol correlated with scores of APACHE Ⅱ[with a regression formula of scores of APACHE Ⅱ = 52.032-21.407 PAB-8.971 CHOL (R2 =0.801, F=48.016, P =0.023)]. Logistic regression analysis showed that low level of prealbumin and high scores of APACHE Ⅱ both were predictors for survival of SIRS patients, with an overall accuracy of 77. 1 percent, 73.5 percent for survival and 79. 5 percent for death prediction. Conclusions Severe malnutrition can be found in patients with SIRS and serum level of prealbumin can be used to evaluate their nutritional status and severity of the disease. High scores of APACHE Ⅱ combined with low serum level of prealbumin can predict prognosis of the patients.

Objective To investigate the changes of serum inflammatory factors and blood glucose in patients with systemic inflammatory response syndrome (SIRS) . Methods Seventy eight SIRS patients were divided into survival subgroup (n =37) and fatal subgroup ( n = 41), 35 non-SIRS patients were designated as control group. Thirty eight out 76 patients whose blood glucose was higher than 6. 1 mmol/L were randomly selected for intensive insulin therapy. Serum IL-6, IL-10, IL-13, TNF-α and blood glucose were measured; HLA-DR expression on monocytes was detected. Results Serum IL-6, TNF-αand blood glucose levels were (80±8) vs. (42±7)×10~3μg/L, (52±20) vs. (17±6) ×10~3μg/L and (11.9±1.1)vs.(6.5±1.5)mmoL/L in SIRS vs.non-SIRS group respectively(all P＜0.05);those were(108±21)vs.(66±22)×10~3μg/L,(28±8)vs.(16±9)×10~3μg/L,(14.4±2.1)vs.(7.0±1.0)mmol/L in fatal vs.survival group,respectively(all P＜0.05).The changes of IL-10,IL-13 and HLA-DR expression intensity of monocyte showed a reverse trend.The intensive insulin therapy reversed the above tendency and reduced the fatality rate.Conclusions Blood glucose levels are corrected with serum cytokines in SIRS patients and reflex the immune status and disease prognosis.Intensive insulin therapy can improve the prognosis of SIRS patients.

Objective To investigate the impacts of long cold ischemic preservation time on the ultrastructural changes of donor heart and to provide the data for expanding the heart donor pool. Methods Heart was obtained from brain dead donor and preserved in the the University of Wisconsin (UW) solution at 4℃. Cardiac tissues were harvested at different time points of cold ischemic preservation (6, 8, 10, 12, 14 h) and observed under electron miscroscope. Results Donor heart did not have significant pathologied and ultrastructural changes when cold ischemic preservation time was 6 h. After that, time related impairment of myocardia and endothelium of coronary artery was seen.When ischemic time was longer than 12 h, focal myocardial necrosis and complete loss of the endothelium were detected. Conclusions Myocardial ultrastructure is an important index to evaluate the donor heart quality. Heart, which underwent 10 h of cold ischemia preservation time, causes no significant irreversible and pathological ultrastructural changes, and could be used for heart transplantation. When ischemia time was over 10 h, the donor heart presented with irreversible change and was nolonger unsuitable for transplantation.

BACKGROUND: Compared with the bone marrow mesenchymal stem cells, umbilical cord blood mesenchymal stem cells (UCB-MSCs) is an ideal source of tissue engineered seed cells, but the culture success rate is low.OBJECTIVE: To explore establish a stable reliable method to isolate and culture UCB-MSCs by optimizing medium choice,centrifugation speed and time, incubation density, choice of growth factor, first time of medium change.DESIGN, TIME AND SETTING: The cytological in vitro study was performed at the Department of Blood Transfusion, Bethune International Peace Hospital of Chinese PLA from January to October 2008.MATERIALS: A total of 20 samples of neonatal UCB by full-term uterine-incision delivery were supplied by Stem Cell Center,Bethune International Peace Hospital of Chinese PLA. Parturient and their family member signed the informed consent.METHODS: Under sterile conditions, UCB-MSCs were isolated by combination of density gradient centrifugation (1 500 r/min, totally 15 minutes) and different adherent time method. UCB-MSCs were incubated in DMEM/F12 medium, supplemented with 10% human UCB serum, 5 μg/L granulocyte-macrophage colony-stimulating factor (GM-CSF), 15 pg/L interleukin-3. MSCs at 1 ×1010/L were incubated in plastic flask coated with human UCB serum at 37℃ and 5% CO2 saturated humidity. The medium was changed following 3 days of culture. Non-adhered cells were removed. Subsequently, the medium was changed once every other 24 hours. When 80% confluence, UCB-MSCs were digested by the mixture of pancreatin-athylenediamine tetraacatic acid.MAIN OUTCOME MEASURES: Morphological changes of UCB-MSCs were observed by inverted phase contrast microscopy. Cell immunophenotypes were determined by flow cytometry.RESULTS: A small quantity of adherent round cells were determined after 24 hours, and adherent cells became more at 48 hours,with a few monopole spindle cells. Cell colonies were detected at day 7. Fibroblast-like cells arranged parallelly, presented whirlpool-shape and unclear boundary, with 80% 80% confluence 2-3 weeks following culture. At the second passage, these calls adhered at hour 12, and reached 80% 90% confluence at day 10. Flow cytometry showed that these calls were positive for CD29 and CD44, but negative for hematopoietic lineage marker CD34.CONCLUSION: MSCs can be successfully isolated from human UCB by using this modified method in vitro, with short culture cycle and high cell purification. Adherent cells have the same immunophenotype as bone marrow mesenchymal stem cells.

Objective To discuss appropriate strategy about treatment of rotatory fixation or dislocation of atlantoaxial articulation in children. Methods 32 cases of rotatory fixation or dislocation of atlantoaxial articulation in children were analyzed retrospectively from January 2000 to March 2005, 24 males and 8 females; patients' age was from 3 to 12 years old with an average of 5.5 years old. The mean course of diseases was 6.5 weeks (range: 2 days to 50 weeks). According to Fielding-Hawkins clinical classification, typeⅠ17 cases(1 case with os odontoideum), type Ⅱ 12 cases(1 case with os odontoideum and 1 case with congenital absence of the arch of posterior atlas), type Ⅲ 3 cases. 26 cases received conservational treatments which were recommended as 2-3 weeks of cervical traction, traction weight should be controlled to 1.0-1.5 kg. After a successful reduction a proper external fixation was required to maintain reduction. And another 6 serious cases received posterior atlantoaxial or occipitocervical autograft fusion. Indications for posterior atlantoaxial or occipitocervical atuograft fusion includes: 1) have difficulty in reduction even under proper traction; 2) with obvious neurological symptoms; 3) combined with compensatory deformity of atlantoccipital articulation or other occiptocervical deformities. Results All of 32 cases were followed up from 3 to 50 months with an average of 32 months. 26 cases who received cervical traction and external fixation resulted in satisfactory outcome in which all the torticollis were rectified, bilateral masses were symmetrical on AP position, and ADI was less than 4 mm in dynamic extension and flexation lateral view. ROM in rotation and extension and flexion were completely recovered. All the 6 cases surgically treated obtained sound bony fusion and neural symptoms were improved obviously and torticollis were rectified completely in 4 cases and others (2 cases) stopped progressing after operation. Conclusion Conservative treatment including Glission traction, cranial traction, collar, cast or cervicothoracic external fixation has been proved to be very effective in most of rotatory fixation or dislocation of atlantoaxial articulation in children; however, operative treatment should be considered in the following situations: patients with difficulty in reduction, with neural involvement and compensatory deformity of atlantoccipital articulation or other occipitocervical deformities.

Objective To investigate the efficiency and safety of the automated external defibrillator (AED); and to compare the defibrillating efficacy between the domestic AED and the imported AED. Method Fourteen Peking white swine weighed (30 ± 1 ) kg, were anaesthetized and arterial cannula was inserted into the left femoral artery for collecting blood samples and measuring artery blood pressure, cardiac output (CO) and external vascular lung water index (EVWI) by using PiCCO monitor, and another cannula was inserted into the left femoral vein to place an electrode as a temporary pace maker, and then ventricular fibrillation (VF) was induced by using a programmed electrical stimulation instrument. The swine were divided into two groups randomly ( random number) after VF was confirmed by electrocardio-monitor,and the domestic made AED (M group, n = 7) or imported AED (Z group, n = 7) were used respectively in 7 swine of each group. The electrodes of defibrillator were stuck to the precordium and sternum separately, and defibrillation was delivered by the AED signal. The entire procedure of defibrillation was repeated four times. The number of defibrillation delivery required to get normal cardiac rhythm was recorded. Twenty minutes after restoration of spontaneous circulation (ROSC), blood sample was taken to measure myocardial enzyme. The CO and EVWI were measured too. Measurement data was analyzed by repeated ANOVA and enumeration data was analyzed by Chi-square test. A value of P ＜0.05 was regarded as being significant statistical difference. Results There were 54 episodes of VF induced in 14 swine and only one swine in Z group was dead after 2nd episode of VF, resulting in 98.1% success rate of resuscitation. There were 37 defibrillation deliveries given to swine of M group, and 75.0% produced normal cardiac rhythm after the first delivery of defibrillation,whereas 80.0% in Z group after 32 defibrillation deliveries. The length of time from AED turned on to the recognition of ECG signal of VF was (29 ± 1 ) s. There were 2 occasions in both groups that the AEDs failed to recognize the VF signal emerged on ECG after the first induction of VF by electrical shock. Similarly, there were 2 occasions in Z group that the AED incorrectly recognized the signal of ventricular tachycardia as that of VF, but no harm was done after defibrillation delivery given following the signal of AED. During the entire course of experiment, heart rate,blood pressure and CO of all survived swine were stable,but the EVWI and myoglobin (MYO) gradually increased as time elapsed until the 3rd or 4th episode of VF leading to significant differences from the original ones. There were no significant differences in all biomarkers between two groups. Conclusions The VF can be ceased by AED safely and efficiently. There are no significant differences in signal recognition, efficacy of defibrillation and myocardial injury found between the domestic made AED and imported AED; but AED may not be good to be recommended to the professional staff of resuscitation because of its incorrect reorganization of ECG owing to over-automation.