Objective To evaluate the abilities and thresholds of stroke volume variation (SVV) and pleth variability index (PVI) in predicting fluid responsiveness during increased intra-abdominal pressure.Methods 28 patients undergoing laparoscopy-assisted radical gastrectomy were selected.PV1 was continuously displayed by the Masimo.Radical 7.All patients were also monitored with Vigileo/FloTrac system.Haemodynamic data such as MAP,HR,SVI,SVV,PI,PVI and C VP were recorded before and after volume expansion(HES 6％,7ml/kg).Fluid responsiveness was defined as an increase in SVI≥ 15％ (△ SVI ≥ 15).Results The SVV threshold of 9.5％ before volume expansion was able to diserimihate the responders from the non-responders with a sensitivity of 100％,and a specificity of 63.6％.The threshold for PVI was 14.0％,the sensitivity of 100％ and specificity of 81.8％ were obtained.There was no significant difference between the area under the receiver operating characteristics (ROC) curves of SVV and PVI(0.981,0.939,respectively),and there was significant correlation between the baseline SVV and the baseline PVI(r =0.740,P ＜ 0.01).Conclusion SVV and PVI can predict fluid responsiveness accurately during increased intra-abdominal pressure,the baseline SVV is correlated well with baseline PVI,and the ability of SVV and PVI in predicting fluid responsiveness is similar.

OBJECTIVE To investigate the antibiotic resistance and the genetical marks in Pseudomonas aeruginosa(PAE) strains in two hospitals of Jiangsu and Zhejiang.METHODS The drug-resistance in PAE strains was detected with K-B test,four kinds of genetical marks of integron and transposon(qacE△1-sul1,mer,tnpA and tnpU) were detected by PCR.RESULTS The strains were only sensitive to cefoperazone/sulbactam,imipenem,meropenem and amikacin.There was a high resistance rate to ?-lactamases,ciprofloxacin,and sulfamethoxazole.Genes of qacE△1-sul1(48.6%,45.0%) and merA(11.4%,5.0%) were detected from PAE strains in the two hospitals.There were no tnpA and tnpU too.CONCLUSIONS Multiple-drug-resistance in Pseudomonas aeruginosa(PAE) strains is caused mainly by qacE△1-sul1 and merA.

OBJECTIVE To investigate the drug-resistance and the existence of genes in 16S rRNA methylases and aminoglycoside modifying enzymes in strains continuously isolated from Pseudomonas aeruginosa(PAE) in two hospitals of Jiangsu and Zhejiang Provinces.METHODS The drug-resistance of the strains continuously isolated from PAE was detected with K-B test,five kinds of genes in 16S rRNA methylases(rmtA,rmtB,rmtC,rmtD and armA) and six kinds of aminoglycoside modifying enzymes [aac(3)-Ⅰ,aac(3)-Ⅱ,aac(6′)-Ⅰb,aac(6′)-Ⅱ,ant(3″)-Ⅰ and ant(2″)-Ⅰ] were detected by PCR.RESULTS The strains were just sensitive to cefoperazone/sulbactam,imipenem,meropenem and amikacin(hospital A:74.2%,80.0%,82.9% and 68.5%;hospital B:90.0%,50.0%,50.0% and 95.0%,respectively).There was a high rate in the drug-resistance to ?-lactamase medicines,ciprofloxacin and sulfamethoxazole co.Genes in 16S rRNA methylases were not detected from PAE strains in the two hospitals.CONCLUSIONS The rates of genes in aminoglycoside modifying enzymes detected from strains in continuously isolated from PAE are different in different hospitals.

Objective To investigate the effect of levothyroxine(L-T4) intervention on premature delivery occurrence risk in early pregant women complicating subclinical hypothyroidism.Methods The databases of PubMed,EMBASE,EBSCO,Cochrane library,CBM and Wanfangdata were retrieved for collecting the related literatures on pregnancy complicating subclinical hypothyroidism published from January 1980 to March 2017.The undesirable studies were deleted according to the inclusion standard.The meta analysis was performed by using the RevMan5.3 software.Results (1) The 12 articles on premature delivery occurrence risk in pregnan women complicating subclinical hypothyroidism without intervention were included(accumulated 5 612 cases of samples and accumulated 368 cases of premature delivery),802 pregnant women received L-T4 intervention,the control group (4 810 cases) was the pregnant women of normal thyroid.The merged OR was 3.46,95%CI 2.64-4.54,P<0.05.(2) Twenty-one articles on premature delivery occurrence risk in pregnan women complicating subclinical hypothyroidism treated by L-T4 in meta analysis were included(accumulated 2561 cases of samples and accumulated 286 cases of premature delivery).The merged ORwas 5.37,95%CI 3.90-7.38,P<0.05).Conclusion Early pregnancy complicating subclinical hypothyroidism can increase the risk of preterm birth,whereas adopting the L-T4 intervention therapy can significantly reduce the risk of premature delivery occurrence.

Objective To predict the incidence of birth defects in Xi'an using the auto-regressive integrated moving average product seasonal model.Methods In Xi'an,the trend of the incidence of birth defects was analyzed and tested from October 2009 to August 2015.Using the data from September to December 2015,the actual birth defects were compared with the model fitting data to evaluate the predictive performance of the model.Multiple seasonal ARIMA model was then fitted under time series to predict the incidence of birth defects in 2016.Results Seasonal effect was seen in the incidence of birth defects in Xi'an.A multiple seasonal ARIMA(0,0,1) (0,1,1)12 was established.The mean of absolute error and the relative error were 9.5 and 0.084,respectively,when compared to the simulated number of patients from September to December in 2015,suggesting that ARIMA (0,0,1) (0,1,1)12 has a better predictive ability.Results under the prediction of multiple seasonal ARIMA model showed that the number of patients in 2016 was similar to that of 2015 in Xi'an,with a slight increase and a decrease in the peak value.Conclusion Multiple seasonal ARIMA(0,0,1)(0,1,1)12 model could be used to successfully predict the incidence of birth defects in Xi'an.

Objective To investigate the dynamic epidemiological characteristics of perinatal birth defects in Xi'an so as to provide scientific evidence for the priority of future birth defect prevention.Methods We made a statistical description of the data of perinatal birth defects from 2010 to 2015 reported by all the maternity hospitals in Xi'an.Results The incidence of birth defects in Xi'an from 2010 to 2015 was 89.62/104 (87.60/104,91.74/ 104) and had an annual ascending tendency (x2-157.13,P＜0.01).The top five main birth defects in a descending order were congenital heart disease (26.53/104),polydactyly (13.10/104),total cleft lip (11.42/104),neural tube defects (6.06 /104),and congenital hydrocephalus (5.08/104),accounting for 69.39％ of the total number of birth defects.And the incidence of congenital heart diseases showed a year-by-year ascending trend (x2=837.65,P＜ 0.01).The incidence of birth defects was higher in urban areas than in rural areas (OR 1.108,95％ CI:1.056-1.162).The birth defects were more frequently seen in males than in females (OB=1.151,95％ CI:1.097-1.208).Mother's age ＜20 (OR=1.764,95％ CI..1.532-2.032) and mother'sage≥35 (OR=1.283,95％ CI:1.179-1.395) also were risk factors for birth defects.Up to 72.54％ of the defects were live births.There were 52.83％ cases diagnosed by ultrasound and 46.24％ ones by clinical examination.The prenatal diagnosis rate was 33.20％.Conclusion The incidence of perinatal birth defects in Xi'an from 2010 to 2015 showed an annual ascending trend.We should improve the prenatal diagnosis level of all monitored hospitals in order to reduce incidence of birth defects and increase the quality of population.

Objective To study the effects of air pollution including sulphur dioxide (SO2),nitrogen dioxide (NO2) and PM10 in Xi'an on birth defects.Methods We collected the birth defects data from Xi'an Maternal and Child Health Hospital,meteorological data from Xi'an Bureau of Meteorology,and the air pollution data from Xi'an Environment Monitoring Station from 2010 to 2015.Generalized additive model (GAM) was used to explore the relationship between air pollution and birth defects after adjusting the effects of long-term and seasonal trend,temperature,and relative humidity.Results The monthly average birth defects were 89 cases;the monthly average concentration of SO2,NO2 and PM10 was 34.05 μg/m3,45.13 μg/m3,and 96.77 μg/m3,respectively.In the GAM,the monthly average temperature was 13.57 ℃ and the relative humidity was 63.20％.The three kinds of air pollutants all had a certain lag effect in 10 months,which reached the maximum.With an increase of concentration by 10 μg/m3 in three air pollutants,the relative risks and confidence interval of SO2,NO2,and PM10 were 1.060 (1.023-1.097),1.033 (1.014-1.052) and 1.018 (1.007-1.029),with significant differences (P＜0.05).Conclusion Exposure to SO2,NO2,and PM10 may be associated with the risk of birth defects.

Objective To analyze the spatial distribution characteristics of birth defects and air pollution in Xi'an and the correlation between air pollution exposure and birth defects.Methods In this study,we calculated the mean and median concentration of air pollutants in Xi'an between 2010 and 2015 to describe their concentration trends.Then we analyzed quartile range to describe their discrete trend.The spatial distribution of air pollution in the whole study area was calculated by inverse distance weighted spatial interpolation method to describe its overall occurrence level.The global trend was analyzed to describe the main body change pattern in the birth defect space.The total number of birth defects in the districts and counties of Xi'an between 2010 and 2015 was calculated and the incidence of birth defects was calculated according to the monitoring data of live births.Correlation between birth defects and air pollution was analyzed by rank correlation analysis.Results The spatial distribution of air pollutants in Xi'an between 2010 and 2015 was as follows:the concentration of SO2 was relatively high in Lianhu District,Yanta District,Baqiao District,Beilin District,and Xincheng District.The concentration of NO2 was relatively high in Yanta District,Baqiao District,Lianhu District,Beilin District,and Xincheng District.The concentration of PM10 was relatively high in Baqiao District,Yanta District,Xincheng District,Weiyang District,and Yanliang District.In Baqiao District,Xincheng District,Lianhu District,Weiyang District,and Gaoling District,the concentration of PM2.5 was relatively high.The total number of birth defects was 6 858 cases in Xi'an between 2010 and 2015,and the total number of perinatal births was 752 142 cases,with the incidence of 91.18 (1/10 000).The spatial distribution of birth defects from the west to the east direction and from south to north direction was generally characterized of inverted U type.The birth defects were positively correlated with NO2 concentration.Conclusion There are obvious regional differences in air pollution and birth defects in Xi'an.Birth defects may be related to NO2.

Objective To analyze the trend of birth defects and air pollution in Xi'an and discuss the correlation between air pollution exposure and birth defects.Methods Time series multiplication model was used to decompose the time series of birth defects and concentration of air pollutants to describe their long-term trend and seasonal variations.The rank correlation and cross-correlation between birth defects and air pollutants were analyzed by ecological approach.Results During 2010-2015,the results of air pollution analysis in Xi'an showed that the overall trend of NO2 increased in 2013 and then fluctuated at a high level.Generally,SO2 showed a trend of slow decline,but there were two peaks in 2012 and 2013.The overall trend of PM10 had two small peaks in 2013 and 2014,and during the rest of the time the change was stable.The overall trend of PM2.5 showed a slow decline,but after 2015 it showed a slight increase.Analysis of the birth defects during 2010-2015 in Xi'an showed that the long-term trend of total birth defects and congenital heart disease increased in 2010-2014,but then decreased rapidly.The long-term trend of cleft lip and palate and neural tube defects fluctuated at a low level.Analysis of the correlation between air pollutants and birth defects showed that total birth defects and congenital heart disease were positively correlated with NO2 at 3 months before pregnancy and early 3 months of pregnancy.Congenital heart disease 3 months before pregnancy had a positive correlation with PM10.Conclusion Birth defects and air pollution in Xi'an have trend variations and seasonal regularity.There is a positive correlation of women's exposure to NO2 3 months before pregnancy and the first 3 months of pregnancy with the incidence of congenital heart disease.

Objective: To assess the association between lupus nephritis disease activity and anti-C1q antibodies. Methods: The study analyzed the medical records of 98 patients with lupus nephritis (LN), 35 patients without lupus nephritis. LN disease activity was measured by the systemic lupus international collaborating clinics (SLICC) renal activity score of 2008. All biopsied tissues were scored based on the International society of nephrology/Renal pathology society (ISN/RPS) 2003 LN pathological typing standards, acute and chronic index scores were used to evaluate the activities of lupus. All patients were test for the levels of anti-dsDNA and anti-C1q antibodies using the enzyme-linked immuno sorbent assay (ELISA), C3, C4, 24-hour urinary protein performed in parallel. For normally distributed quantitative parameters, the differences between groups were assessed by t test. Mann-Whitney U test was performed for non-normally distributed data. The cut-off values were evaluated by using receiver operating characteristic (ROC). The Spearman methods were used to test correlations. Results: Patients with LN had a higher levels of anti-C1q antibodies than patients without lupus nephritis [3.94 (10.2, 91.3) AU/ml与6.9 (2.0, 15.4) AU/ml; Z=-4.299, P<0.01]. Patients with inactive lupus nephritis had higher levels of C1q, C3, C4 than active LN (t=2.393, 3.777, 2.557; P<0.05). Patients with active lupus nephritis had higher levels of anti-C1q antibodies than inactive LN (Z=-4.632, P<0.01). Anti-C1q antibody levels were positively correlated with levels of 24-hour urinary protein, AI score (r=0.327, P<0.01) and SLICC score (r=0.493, P<0.01), and were negatively correlated with serum C1q (r=-0.373, P<0.01), C3 (r=-0.532, P<0.01) and C4 (r=-0.463, P<0.01). The optimal cutoff value of Anti-C1q for a diagnosis of active LN was 48.9 RU/ml, and the sensitivity and specificity were 62.5% and 80%, respectively. The area under the curve (AUC) was 0.771. Conclusion Anti-C1q antibodies are more closely correlated with renal disease activity, and anti-C1q antibody is an important serum marker for monitoring LN activity, but its pathological mechanism in the pathogenesis of LN still needs to be further explored.