Objective To investigate the seruln levels of solubl B7-H3(sB7-H3)in patients withbacteremia and in those with chronic hepatitis B(CHB),and its clinical significance.Methods Serumlevels of sB7-H3 from 50 bacteremia patients,78 CHB patients and 50 healthy individuals wero detected byEUSA,and its correlations with the quantities of leucocytes,neutrophils,lymphocytes and monocytes wereanalyzed.Results The average level of sB7-H3 in serum of bacteremia patients was(50.69±26.43)μg/ml which was higher than that of healthy group(P＜0.01);serum sB7-H3 level of patients with CHB was(18.07±7.28)μg/ml,and it had no significant difference compared with that in the healthy group(P＞0.05).Besides,positive correlations between the scrum sB7-H3 level in and the quantities of leucocytesand granulocytes were observed in bacteremia patients.Conclusions It suggests that sB7-H3 misht bepotentially used as a new parameter to improve the clinical diagnosis of bacteremia.

〔Abstract〕 Based on investigating construction and utilization status of hospital Electronic Medical Records ( EMR ) in Shandong province, the paper understands the current development status of EMR in various level hospitals in Shandong province.In view of the problems it puts forward some countermeasures and suggestions, so as to provide references for promoting the development of EMR of the hospitals at all levels scientifically, optimizing the allocation of health resources.

Objective To explore if Ulinastai reverses hepatofibrosis in rats.Method Rat hepatofibrosis models were induced by TAA subcutaneously injection.18 rats with hepatofibrosis were divided into 2 groups,Ulinastai treatment group (9 rats),normal saline control group (9 rats).AST,ALT,HA,SOD,MDA,LN level were measured and compared between the 2 groups and that of healthy rats (3 rats).Rats liver morphology was observed using HE,Masson stain and type-B ultrasonic.TGF-β1、caspase-3 were detected by immunohistochemistry.Result After 3 weeks Ulinastai treatment,elastic index and SSS score in Ulinastai group decreased significantly compared to pretreatment (t =2.472,P ＜0.05).ALT,AST,SOD,MDA,HA and LN level significantly improved (F =3.862,5.774,3.442,4.157,4.173,3.674,P ＜ 0.05).Compared with NS treatment group HE and Masson staining showed fewer inflammatory cells infiltration in central vein,ballooning degeneration of liver cells,collagen proliferated,hepatic lobules degradation and pseudolobule arise after 3 weeks intervenion.Also in Ulinastai group,TGF-β1、caspase-3 positive cells were much less than that in NS treatment group.Conclusions Ulinastai can reverse rat hepatic fibrosis and alleviate fibrosis degree and collagen fiber deposit.

OBJECTIVE:To understand the prophylactic antibiotics use in general surgeries performed in the hospital where the authors work.METHODS:500copies of discharge record of common surgical cases written between Jul.2005and Feb.2006were checked randomly,and the questionnaires about the general data and medication of the patients were filled out.Then the collected data were analyzed statistically.RESULTS:The prophylactic drug use rate in TypeⅠincision operations reached up to98.8%,of which58.5%cases lacked clear indications of medication.The high rate of prophylactic drug use,improper time of drug use,and the prolonged continuous drug use were among the problems that existed in TypeⅠand TypeⅡincision operation.CONCLUSION:There remain many problems in the use of prophylactic antibiotics in the general surgeries performed in our hospital,which requires the strengthening of standardized administration of prophylactic antibiotic use.

Objective·To analyse the outcomes of tricuspid valve replacement (TVR) for secondary tricuspid regurgitation (STR) late after left-sided valve surgery during perioperative period and mid-term follow-up,investigate mechanisms of STR and surgical risk factors.Methods·A total of 85 consecutive patients who underwent the TVR surgery were analyzed.The perioperative and mid-term clinical outcomes were retrospectively investigated.The data were divided into bioprosthesis group (n=50) and mechanical prosthesis group (n=35) according to the prosthesis used,and divided into right anterolateral thoracotomy(RALT) group (n=51) and stemotomy(S) group (n=34) according to the surgical incision.Results·In-hospital mortality was 8.2％ (7/85).There was no significant difference in the mortality with different choice of bioprosthetic or mechanical valve (4/50 vs 3/35,x2=0.009,P=1.000);while there was significant difference between S group and RALT group (6/34 vs 1/51,x2=6.642,P=0.015).Seven cases all died of right heart failure and severe low cardiac output syndrome.Five (5.9％) cases died in perioperative within 30 in-hospital days and 2 (2.4％) cases died after 30 in-hospital days.Seventy-four cases were followed up.With the follow-up of (31.5±23.1) months,there were 4 case of late deaths(5.4％),all of whom were mechanical prosthesis,of whom 3 died in cardiac related death and 1 died in later period bowel cancer.Seventy cases survived in New York Heart Association (NYHA) class Ⅰ-Ⅱ with no coagulated accident and redo-TVR.Conclusion·The perioperative and mid-term clinical outcomes are satisfied in timely and reasonable TVR with the standard follow-up for STR late after left-sided valve surgery.Right anterolateral incision is recommend for isolated TVR.

Objective To detect the changes of serum integrinβ4 level during both exacerbation and clinical remission of asthmatic patients, and observe the correlation between the changes and balance of Th1/Th2,and to explore the relationship between integrinβ4 and the immune function in asthmatic patients.Methods Thirty?five cases patients who were hospitalized in the Seventh People's Hospital of Shenzhen from May 2013 to June 2015 were collected into this study.Serum interleukin?4(IL?4),interferonγ(IFN?γ),and integrinβ4 were measured with ELISA and western?blotting methods during both exacerbation and remission of asthmatic patients. Then the level of IL?4, IFN?γand integrinβ4 of the two groups were compared. Results The level of serum integrinβ4 protein in the remission stage of asthma was significantly higher than that in the acute attack period, and the difference was statistically significant(0.633±0.032 vs. 0.375±0.107,t=3.31,P<0.01).The level of ser?um IFN?γ in the remission stage of asthma was significantly higher than that in the acute attack period,and the difference was statistically significant((49.3±6.4) g/L vs. (16.7±7.2) g/L,t=3.11,P<0.05),and the level of IL?4 was (25.3±3.6) ng/L and (43.7±11.2) ng/L respectively,the difference between the two groups had sta?tistical significance(t=3.23,P<0.05).The serum level of integrinβ4 and IL?4/IFN?γratio were passively corre?lated(the acute attack period:r=0.749,P=0.05;the remission stage of asthma:r=0.745,P=0.015).Conclu?sion The serum level of integrinβ4 is passively related to IL?4/IFN?γ. Integrinβ4 may play an important role between immune function and the development in airway inflammation of asthmatic patients.

Objective To evaluate the colonoscopy surveillance in colorectal cancer patients after surgical removal of the tumor.Methods From June 1986 to June 2007,2762 asymptomatic patients who had underwent operation for colorectal cancer were put into colonoscopy surveillance.They had the first examination 3-6 months after the operation,and were re-examined once a year thereafter for 3 years.The follow-up findings were compared with those from the 218 symptomatic patients who had colorectal cancer surgery from September 1981 to May 1986.Results In 2762 asymptomatic patients,48 cases of multiple primary cancer were detected,in which 39 cases(1.4%) were found at one examination and 9 cases(0.3%)at different examination.The TNM staging of these lesions included stage Ⅰ in 6,stage Ⅱ in 31 and stage Ⅲ in 11.During the surveillance,583 cases(21.1%) of adenoma were detected and endoscopically resected,in which 17(3.2%) were invasive early cancer and 58(9.9%) were high grade dysplasia.In 218 patients with symptoms,29 cases(13.3%) of adenoma and 27 cases( 12.4%) of cancer were detected,including 4 cases of stage Ⅰ cancer,6 of stage Ⅱ and 16 of stage Ⅲ.Conclusion Colonoscopy surveillance in colorectal cancer patients after surgery is important in finding precancerous lesion and early stage cancer,and is recommended in all patients.

Objective To evaluate the effect on the reversal of left ventricular aneurysm (LVA) and on heart function of percutaneous coronary intervention (PCI) therapy at different time of acute myocardial infarction (AMI). Methods A total of 326 patients with primary anterior AMI-accompanied LVA diagnosed by left ventriculography (LVG) from January 2001 to July 2004 were enrolled in this study. They were randomized into 4 groups according to the time of accepting PCI:≤3 h group, 4-6 h group, 7-12 h group and one week group. At the baseline and 6 months after AMI, the parameters of left ventricular diastolic volume index (LVEDVI), left ventricular systolic volume index (LVESVI), left ventricular ejection fraction (LVEF), left ventricular wall motion score (LVWMS) and left ventricular end diastolic pressure (LVEDP) were measured by LVG. The paradox volume index (PVI) was measured by equilibrium radionuclide at one week and 6 months after AMI.At 3 year following up to, the major adverse cardiac events (MACE) were recorded. Results At 6 months after PCI, the LVESVI, LVEDVI, WMS and LVEDP were all decreased while LVEF was increased in the four groups as compared with pre-PCl (P<0.05, respectively). Those parameters changed most obviously in ≤3 h group. At the 6th month after PCI, the PVI was lower in ≤3 h group (12.1±2.1)% than in 4-6 h, 7-12 h and one week group [(15.4±2.4)%, (16.5±2.5)% and (20.4±3.7)%, all P<0.05]. Within the 3 years follow-up, the MACE was significantly lower in 3 h, 4-6 h and 7-12 h groups than in one week group, and the mortality was lower too [(2.8%, 3.0% and 3.1% vs. 17.9%, all P<0.05]. Conclusions The early, fully and permanent open of the infraction-related artery can effectively inhibit the left ventricular remodeling process, prevent LVA formation, improve LV function and prognosis.

BACKGROUND: Subsequent to liver transplantation, pulmonary infection and new drug resistant strain frequently appear due to complex pathophysiological changes and abuse of antibiotics.OBJECTIVE: To collect the clinical data of 6 cases who underwent liver transplantation, and analyze the prevention and treatment measures of pulmonary infection after liver transplantation.DESIGN, TIME AND SETTING: Retrospective case analysis, performed in the Department of Hepatobiliary Surgery,First People's Hospital of Guangzhou between January and December 2004.PARTICIPANTS: Six cases that underwent liver transplantation and received treatment in the First People's Hospital of Guangzhou were recruited in the present study. All 6 cases underwent selective homologous whole liver transplantation, 5cases underwent modified orthotopic piggyback liver transplantation, and only 1 underwent classical orthotopic liver transplantation.METHODS: The clinical data of the 6 cases were retrospectively analyzed. After transplantation, basic disinfection,isolation, infection-protection measures should be taken. In addition, etiological information was collected. Chest X-ray was underwent to know the lung at the early stage. Aseptic manipulating was strictly performed during sputum aspiration.Gastrointestinal decompression and non-obstructed drainage were maintained to prevent aspiration. Moreover, preventive anti-infective treatment against the bacteria, fungi, and viruses was performed.MAIN OUTCOME MEASURES: Pulmonary infection and curative effects subsequent to liver transplantation.RESULTS: Of the 6 cases, 5 presented with pulmonary infection, including 1 at 4-11 days after transplantation and 1 at 1day after transplantation. One case died of respiratory failure. The remaining 5 cases were cured after standardized anti-infection, respiratory therapy, sputum aspiration, and nutritional support.CONCLUSION: Application of effective antibiotics, aseptic operation in sputum aspiration, and unobstructed respiratory tract drainage are important measures for treating pulmonary infection subsequent to liver transplantation.

Objective To observe the RAS gene mutations in papillary thyroid carcinoma,and to analyse the effects of mutation on clinical characteristics and prognosis.Methods In this study,354 papillary thyroid carcinoma patients were divided into 2 groups according to RAS mutation by DNA sequence analysis.The pathological type,disease progression,recurrence and prognostic difference between the two groups were compared,and regression analysis was performed to evaluate the relationship between different variables and RAS mutation.Results There were 86 patients with RAS positive mutation.A significant difference was found with primary sites (P =0.004),distant metastasis (P =0.027),AJCC stage (P =0.004) and ATA risk stratification (P =0.000) between two groups.RAS positive patients have higher recurrence rate and shorter recurrence-free survival time (P ＜ 0.005) than the negative patients.Furthermore,in the multivariate analysis,the RAS mutation was significantly associated only with the ATA stratification.Conclusions RAS mutation increases risk of recurrence,RAS mutation and ATA stratification might be a valuable diagnostic and prognostic marker of papillary thyroid carcinoma.