Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.

Objective To analyze the correlation of vertebral osteophyte and lumbar disc degeneration in the elderly people and explore the possible mechanism of osteophyte formation. Methods X-ray and MRI data of 120 elderly people with backache or leg pain were retrospectively analyzed. Osteophyte was classified into four grades by X-ray according to the method proposed by Nathan. Discs with osteophyte were defined as occurring when osteophyte of grade II or greater were present. Lumbar disc degeneration was classified into five grades by MRI according to the method proposed by Pfirrmann. The obtained parameters were statistically treated and analyzed. Results Osteophyte and age were positively correlated at every lumbar disc level (P < 0.05). The proportion of osteophyte in L3/4 (76.7%) and L4/5 (70.08%) were more severe than that in L1/2 (31.7%) and L2/3 (46.7%). Osteophyte and lumbar disc degeneration were positively correlated at every lumbar disc level (P < 0.01). Conclusion Osteophyte becomes more severe with the increasing of lumbar disc degeneration. The vertebral stress after lumbar disc degeneration may be the main cause of osteophyte.

OBJECTIVE:To prepare nifedipine (NF) hollow controlled-release microspheres and evaluate the quality. METH-ODS:Solvent diffusion volatilization method was used to prepare microspheres,using comprehensive scores of cumulative release in 2,12,24 h(Q2 h,Q12 h,Q24 h)as indexes,orthogonal test was designed to screen the carrier material ethyl cellulose(EC),poly-vinyl pyrrolidone(PVP)and main drug NF amounts;appearance,particle size distribution,drug loading,floating and cumulative release of the microspheres prepared by optimal formulation were evaluated and compared of in vitro release behavior with imported preparation of Nifedipine controlled-release tablets (Adalat?). RESULTS:The optimal formulation was as follow as NF 3.00 g, PVP 1.60 g,EC 15.65 g. Prepared NF hollow controlled-release microspheres were spherical in shape with particle size distribution of 24-40 mesh and drug loading of 8.66%;24 h floating rate in release medium was 97.93%,Q2 h,Q12 h,Q24 h were 20.49%, 52.90%,91.00%(RSD<10%,n=3). Compared with the imported preparation,similarity factor f2 values of cumulative release were higher than 50,showing in vitro drug-release was consistent with the zero-order kinetic equation (r=0.9993);n of Rit-ger-Peppas equation (r=0.9807) was 0.478. CONCLUSIONS:Prepare NF hollow controlled-release microspheres show similar drug-release behavior with the imported preparation,the drug is released by the combination of diffusion and erosion.

Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.

Objective To compare the normal thickness of the esophageal wall measured by contrast?enhanced three?dimensional ( 3DCT ) , four?dimensional ( 4DCT ) , and cone beam computed tomography ( CBCT) ,and to provide a basis for target volume delineation in esophageal cancer. Methods From 2009 to 2016,thoracic contrast?enhanced 3DCT and 4DCT simulations were performed in 50 patients with lung cancer or metastatic lung cancer. Contrast?enhanced CBCT scans were acquired during the first three?dimensional conformal radiotherapy. The normal esophageal wall was contoured on 3DCT images, the end?exhalation phase of 4DCT images ( 4DCT50 ) , the maximum intensity projection of 4DCT images (4DCTMIP),and CBCT images. The wall thickness was measured on each segment and the average thickness of esophageal wall was obtained. Comparison of the thickness of a fixed segment of esophageal wall between different CT images was made by paired t test. Comparison of thickness on the same type of CT images between different segments of esophageal wall was made by one?way analysis of variance. Results For the thoracic and intra?abdominal segments,there was no significant difference in the thickness of esophageal wall between 3DCT and 4DCT50 images ( P= 0?056?0?550 );however, the thickness of esophageal wall was significantly smaller on 3DCT images than on 4DCTMIP or CBCT images (P=0?000?0?004).For the upper and middle thoracic segments,the thickness of esophageal wall was significantly larger on CBCT images than on 4DCTMIP images ( P= 0?008, P= 0?001 ) . On 3DCT, 4DCT50 , and 4DCTMIP images, the thickness of esophageal wall was significantly larger in the lower thoracic segment than in the upper or middle thoracic segments ( P=0.008~0?041);the intra?abdominal segment had a significantly larger thickness of esophageal wall than the thoracic segments ( all P=0?000 ) . There was no significant difference in wall thickness on CBCT images between three thoracic segments ( P=0.088~0?945) . Conclusions A uniform criterion can be adopted to judge the normal thickness of esophageal wall in gross tumor volume ( GTV ) delineation on 3DCT and 4DCT50 images for thoracic esophageal cancer. However,caution should be taken when 5 mm is used as a criterion for normal thickness of esophageal wall in GTV delineation on 4DCTMIP and CBCT images.

Objective: To identify the avian influenza virus subtype from the avian and environmental samples using the Ion Torrent new-generation semiconductor sequencing technology and to establish a high-throughput sequencing method to identify unclassified influenza A virus. Methods: Virus RNA was extracted from the nine avian swab and environmental samples and real-time RT-PCR was carried out to detect universal fluA, H5N1, H7N9 and H9N2. The whole genome of influenza A virus was amplified by PathAmpFluA kit. Sequencing library was prepared using Next Fast DNA Fragmentation & Library Prep Set for Ion Torrent kit and high-throughput sequencing was done by Ion Torrent Personal Genome Machine(PGM). Data from the PGM was processed and quality evaluated using Ion TorrentSuite v3.0 software. Sequence assembly and influenza database blast were carried out by FluAtyping v4.0 and PathogenAnalyzer bioinformatics software to identify the influenza A virus subtype of these nine samples. Results: The results of real-time RT-PCR for universal fluA of these nine samples were positive but the results for H5N1, H7N9 and H9N2 were negative. Seven subtypes of influenza A virus were identified by high-throughput sequencing and bioinformatics analysis: six samples were H2N3, H5N6, H5N8, H7N1, H7N7, H11N3 subtype respectively and three samples were H6N6 subtype. Conclusions Avian influenza virus has many subtypes in the environment of Zhejiang province. Ion Torrent semiconductor sequencing technology is suitable for fast identification of unclassified influenza virus for avian influenza environment monitoring.

Objective:To explore the automated external defibrillator (AED) configuration optimization strategy in line with the characteristics of the rapidly developing cities by analyzing the actual coverage of AED in Bao'an District based on the real world data of out-of-hospital cardiac arrest (OHCA) in Bao'an District, Shenzhen City.Methods:The data of cardiac arrest database registered in Bao'an District of Shenzhen City from March 1, 2019 to February 29, 2020 were included in a retrospective observational study. The AED coverage of public and non-public areas was analyzed by calculating the minimum distance between the occurrence place of each OHCA event and the nearest AED. The minimum distance ≤100 m was set as AED coverage, and the minimum distance > 100 m was set as non-AED coverage. It was assumed that one AED was configured for each OHCA hotspot area, then the AED coverage changes were analyzed. Based on the actual situation that the AED in schools, governments, sports venues, subways, tourist attractions and parks of public areas in Bao'an District could not be obtained at any time within 24 hours, it was assumed that all AED in the public areas could be obtained at any time within 24 hours, the impact of AED available at any time on AED coverage was analyzed.Results:A total of 525 cases of OHCA were enrolled. The highest incidence of OHCA was found in residential and industrial areas [54.5% (286/525) and 14.3% (75/525), respectively]. There were 252 AED in Bao'an District, Shenzhen, and 115 OHCA events occurred within the coverage area of AED. Even if all AED met the ideal state that could be obtained at any time within 24 hours, the coverage rate was only 21.9% (115/525). The AED coverage rate of the public areas and non-public areas was 31.6% (37/117) and 19.1% (78/408) respectively, with uneven distribution, and the AED coverage rate of non-public areas was low. Assuming that the residential community and industrial zone with more than 2 OHCA cases were respectively equipped with one AED, the coverage rate of AED in the non-public areas increased from 19.1% (78/408) to 28.2% (115/408), basically meeting the requirement that AED could be obtained at any time when OHCA events occurred. Some AED in the public areas of Bao'an District were not available at any time within 24 hours. If the ideal state that all AED in the public area could be obtained at any time within 24 hours could be achieved, the AED coverage rate of all regions increased from 16.8% (88/525) to 21.9% (115/525), the AED coverage rate of the public areas increased from 29.1% (34/117) to 31.6% (37/117), the AED coverage rate of the non-public areas increased from 13.2% (54/408) to 19.1% (78/408).Conclusions:AED configuration in Bao'an District was unevenly distributed, and the coverage rate of AED in non-public areas was low. The allocation strategy for AED in fast-growing cities like Shenzhen should be as follows: on the premise of ensuring AED availability for 24 hours, priority should be given to covering the number of AED in the non-public areas including residential communities and industrial zones; AED is available in the public areas for 24 hours.

Out-of-hospital cardiac arrest (OHCA) with high mortality and disable rate is a public health problem of common concern all over the world. In order to improve the survival rate of OHCA, developed countries such as Europe and the United States have established regional and even national OHCA registration database for continuous monitoring and quality improvement of OHCA, identifying the weaknesses in each link of the survival chain, and evaluating effective measures to enhance the survival rate. At present, China still lacks of registration database that can comprehensively collect the information of OHCA and effectively reflect the treatment status and research direction of OHCA. In order to shorten the huge gap of OHCA survival rate between China and developed countries such as Europe and the United States, we should learn from the experience of foreign registration databases and establish OHCA registration database suitable for China's national conditions, so as to promote the improvement of OHCA survival rate in China. This paper presents several major OHCA registry databases of the internationally recognized, such as cardiac arrest registry to enhance survival (CARES), resuscitation outcomes consortium (ROC), European registry of cardiac arrest (EuReCa), Pan-Asian resuscitation outcomes registry (PAROS), and Australian resuscitation outcome consortium (Aus-ROC), aims to provide a reference for promoting the construction of the cardiac arrest registration database in China.

Objective To investigate the clinical characters and treatment strategies of differentiated thyroid carcinoma in children and adolescent.Methods The clinical data of 75 cases of thyroid carcinoma in children and adolescents(≤ 18 years old)from Jan.2004 to Mar.2017 in the First Hospital of China Medical University were retrospectively analyzed.Clinical pathology characters and prognosis between patients ＜13 years old (group A) and those ≥ 13 years old (group B) were compared.Results There were 74 cases with papillary carcinoma and 1 with follicular carcinoma.The rate of lateral neck lymph node metastasis(100％ vs 54.5％,x2=6.818,P=0.025) and bilateral location (55.6％ vs 18.2％,x2=6.311,P=0.037) in group A were higher than in group B.There were no significant differences in central lymph nodes metastasis (88.9％ vs 69.7％,x2=1.758,P=0.420),gender composition ratio (22.2％ vs 31.8％,x2=0.343,P=0.841),extra-thyroid extension (33.3％ vs 18.2％,x2=1.136,P=0.534),distant metastasis(11.1％ vs 1.5％,x2=2.810,P=0.566) and recurrent disease(25％ vs 7.8％,x2=1.141,P=0.183) between the two groups.Conclusions Papillary carcinoma is the most common pathology type in children and adolescent thyroid carcinoma.Patients＜13 years old are more likely to present lateral neck lymph node metastasis and bilateral location.

Objective To evaluate the changing trend of serum thyrotropin (TSH) levels for hemithyroidectomy patients,and to discuss the necessity and strategy of TSH suppression for low-risk differentiated thyroid carcinoma(DTC). Methods One hundred and twenty-seven patients with benign thyroid nodules undergoing hemithyroidectomy between January 2013 and June 2014 were retrospectively studied. Serum thyroid hormones levels FT3,FT4,TSH,thyroid peroxidase antibody(TPOAb),and thyroglobulin antibody(TGAb)were detected at 1 month after surgery for all patients and at 3 month for 54 patients. Results (1)Mean TSH level at 1 month after surgery was significantly higher than preoperative TSH level(2.45 mIU/L vs 2.20 mIU/L,n=127,P<0.01). The mean TSH level at 3 month after operation was significantly higher than preoperative ones(2.46 mIU/L vs 2.35 mIU/L,n=54, P<0.05). (2)TSH<2. 0 mIU/L was found in 52 patients(40. 9%) and TSH>4. 94 mIU/L in 18 patients (14.17%) at 1 month after operation. TSH<2.0 mIU/L was found in 28 patients(51.85%)and TSH>4.94 mIU/L in 8 patients(14.81%) at 3 month after operation. (3)A preoperative TSH≥2.0 mIU/L and the coexistence of Hashimoto's thyroiditis were found to be independent risk factors for the TSH levels higher than 2.0 mIU/L. Among the patients with TSH≥2. 0 mIU/L at 1 month, 13 exhibited spontaneous recovery at 3 month, coexistence of Hashimoto's thyroiditis was related to this phenomenon. Among the patients with TSH<2.0 mIU/L at 1 month,TSH levels were elevated over 2. 0 mIU/L in 7 patients by 3 month comparing to that by 1 month. Coexistence of Hashimoto's thyroiditis was independent risk factor for the TSH elevation. Conclusion TSH suppression may still be performed to patients with low risk DTC after operation especially to whom the preoperative TSH≥2.0 mIU/L and the coexistence of Hashimoto's thyroiditis. Suppression therapy should be carefully considered with close follow-up.