Objective To investigate the prognostic value of National Early Warning Scores (NEWS) combined with arterial lactate level in elderly patients with critical illness in emergency department.Methods A total of 413 elderly patients with critical illness randomly (random number) selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study.NEWS system was employed to determine the patients' condition.Arterial lactate level was detected.The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group.Multivariate logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level in patients without survival.Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group.The results of multiple factor regression showed that NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were all independent predictors of 30-day death (P ＜ 0.05,OR ＞ 1).The AUCs of the three evaluation modalities were 0.721,0.746 and 0.762,respectively.There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level.The optimal cut-off point of NEWS score was 7,and arterial lactate level was 2.7 mmol/L.Conclusions NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department.They all had some predictive value,and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.

Objective To investigate the value of serum soluble leukocyte differentiation antigen 14 subtype (sCD14-ST,presepsin) combined with national early warning score (NEWS) for predicting the prognosis of emergency patients with sepsis.Methods To select 119 patients who came to the emergency department of Beijing Hospital with sepsis from September 2009 to July 2015 as the objects of the study.The serum samples were collected immediately as they came,the presepsin was measured,and the NEWS scorescalculated.Patients were divided into survival group (81 cases) and death group (38 cases) according to the 30-day prognosis,and the value of the presepsin,NEWS score and presepsin + NEWS score in the assessment of prognosis were compared.Results Presepsin and NEWS scores both were higher in the death group than the survival group.Presepsin and NEWS were the independent risk factors of the 30-day mortality of patients with sepsis.Under the ROC curve area (AUC) of presepsin and NEWS were 0.842 and 0.823;the combination of Presepsin and NEWS was 0.906.When presepsin ＞ 927.5 pg / mL and NEWS ＞ 6.5 points,it can significantly improve the efficacy of predicting prognosis.Conclusions Serum presepsin is a good indicator to judge the prognosis of patients with sepsis,and the combination with NEWS can improve the ability to predict the risk of septic death.

Objective: To investigte the lipogenic and lipolytic metabolism at dynamic phase of obesity in ventromedial hypothalamus-lesioned obese rats. Methods: Female SD rats were divided into two groups, one group received bilateral electrolytic lesions of ventromedial hypothalamus(VMH),and the other one was used as sham control. Samples of blood, livers and subcutaneous, parametric and mesenteric adipose tissues were collected one week after VMH lesions and sham operations. Results: Activities of microsomal triglyceride transfer protein(MTP) in hepatocytes, and phosphatidate phosphohydrolase (PAP), malic enzyme(ME), glucose-6-phosphate dehydrogenase(G6PDH)in liver, parametric and mesenteric adipose tissue in VMH-lesioned rats were increased as compared to their sham counterparts. Activity of hormone sensitive enzyme(HSL) in parametric and mesenteric adipose tissue in VMH-lesioned rats was not changed when compared to sham group. Activity of HSL in subcutaneons adipose tissue was increased, while activity of HSL in gastrocnemius was decreased. Activity of lipoprotein lipase(LPL) in parametric and mesenteric adipose tissue and gastrocnemius were enhanced significantly compared to sham group. Conclusion: In dynamic phase of obesity of VMH-lesioned rats, hepatic production and transportation of triglyceride in these rats were increased significantly ,and lipogenic metabolism and storage of triglyceride in adipose tissues such as parametric and mesenteric adipose tissues were also enhanced.Meanwhile, lipolytic metabolism in subcutaneous adipose tissue and gastrocnemius was also increased.

BACKGROUND:Previous studies have shown that chitosan can promote the repair of peripheral nerve injury and methylprednisolone can improve the microenvironment around nerve injuries, which are commonly used in clinical treatment of acute central nervous system injury.
OBJECTIVE:To observe the effects of modified chitosan and methylprednisolone combination on repair of sciatic nerve injury in rats.
METHODS:The rat sciatic nerve was transected and microscopical y anastomosed immediately. Then, modified chitosan, methylprednisolone, methylprednisolone+modified chitosan, and saline were injected respectively around the anastomosis site, compared with the sham surgery group.
RESULTS AND CONCLUSION:Compared with other groups, the combination group showed shorter claw extending reflex recovery time (P<0.05). Significant differences were found between the combination group and other groups in nerve conduction velocity, the remnant rate of gastrocnemius wet weight, the diameter and section area of gastrocnemius cells (P<0.05). The nerve fibers through the anastomotic site were significantly increased, with consistent thickness and arrangement and less neurodegeneration when observed 12 weeks after operation. In conclusion, the modified chitosan combined with methylprednisolone could significantly promote the sciatic nerve repair.

BACKGROUND:In recent years, studies have shown that mesenchymal stem cells can secrete various growth factors, and has certain application prospect in the treatment of liver fibrosis.
OBJECTIVE:To explore the different sources of mesenchymal stem cells in the treatment of liver fibrosis in rats. METHODS:Fifty Sprague-Dawley rats were given intraperitoneal injection of carbon tetrachloride to construct the model of liver fibrosis. Another 10 normal Sprague-Dawley rats were used as normal controls. Model rats were randomly divided into five groups, 10 rats in each group, including model control group, normal saline group, bone marrow mesenchymal stem cellgroup, umbilical cord mesenchymal stem cellgroup, and umbilical cord blood mesenchymal stem cellgroup. After 8 weeks of modeling, different sources of mesenchymal stem cells at a density of 2×106 were injected via tail vein into model rats. After 12 weeks, the rats were kil ed, and serum alanine aminotransferase, aspartate aminotransferase and albumin levels were detected as wel as the expression of type I col agen and glial fibril ary acidic protein in liver tissue was detected by fluorescence quantitative PCR method.
RESULTS AND CONCLUSION:We have successful y established the SD rat model of hepatic fibrosis. Bone marrow mesenchymal stem cells aggravated hepatic fibrosis, umbilical cord blood and umbilical cord mesenchymal stem cells could reduce the level of hepatic fibrosis in rats. Umbilical cord mesenchymal stem cells had the most obvious effect that significantly reduced expressions of alanine aminotransferase, aspartate aminotransferase and type I col agen and glial fibril ary acidic protein. The results showed different sources of mesenchymal stem cells have different effects on rat fibrosis. Bone marrow mesenchymal stem cells aggravate hepatic fibrosis, and umbilical cord and umbilical cord blood stem cells can al eviate hepatic fibrosis in rats.

Specific to the existing problems of uneven distribution of resources in the medical industry,especially the shortage of grass-root high-quality medical resources,the paper introduces the construction objective,overall architecture and construction contents of regional medical collaboration,and normalizes the medical service process through informationalized technological means,in order to promote standardized construction of the regional medical information system and information interconnection and intercommunication.

To meet the challenges of the current evaluation system for the residents , the department of internal medicine of Peking Union Medical College Hospital (PUMCH) developed a new on-line system.This new system, not only solved the problems of the current system , but also had several advantages as manpower saving , real-time update , back-to-back evaluation , convenience in comparison .This promising system is a possible solution to simi-lar problems in other institutions .

Objective To investigate the feasibility of Wilms’tumor gene 1 (WT1)-specific CD8+T cells from periph?eral blood for the treatment of breast cancer by detecting the killing activity of WT1 specific CD8+T cells on breast cancer cells. Methods Flow cytometry was used to detect WT1-specific CD8+T cells in the peripheral blood of 20 samples from HLA-A2 seropositive healthy donors, which were isolated by WT1/MHC streptamer magnetic beads and cultured. The func?tion of WT1-specific CD8+ T cells were analysis by cytotoxicity assay. Results Twelve of 20 healthy donors had naive WT1-specific CD8+T-cell frequencies of>0.5%, and 4 of 20 even>1.0%of all CD8+T cells. After positive selection by magnetic cell separation, a purity of up to 80%can be achieved. WT1 specific CD8+T cells can specifically kill breast can?cer cell line with WT1 polypeptide. Conclusion WT1 specific CD8+T cells can be detected in peripheral blood of healthy volunteers. WT1 specific CD8+T cells have killing effect on breast cancer cells, suggesting the feasibility of adoptive immu?notherapy for breast cancer.

Objective: To investigate the prevalence of overweight and obesity and relation of body mass index (BMI) to body fat percentage and waist circumference in Chinese healthy adults. Methods: 1005 healthy adults were divided into five groups by BMI,which was made by WHO's recent classification of BMI for Asian adults. Anthropometric measurements (waist and hip circumference , skinfold thickness and ratio of waist and hip circumference) and bioelectrical impedance analysis (BIA) were done in subjects. Results: The prevalence of overweight and obesity classⅠin males were significantly higher than in females. The prevalence of obesity classⅡwas lower both in males and in females. Females had higher percent body fat than males measured by BIA and by skinfold thickness measurements. BMI was significantly correlated with waist circumference in all age groups. Waist circumference was more than 80 cm in overweight females, and more than 90 cm in obesity classⅠin males. Conclusion: The age of overweight and obesity in males was younger than in females. The body fat in females was higher than in males. BMI cut off points for obesity diagnosis are over estimated much more than BIA and skinfold thickness measurements for percent body fat in adults. It should be noted that age, sex and physical activity need to be considered besides BMI when obesity is diagnosed.

Objective: To investigate how fatty liver was developed in ventromedial hypothalamus(VMH)-lesioned obese rats. Methods: Two groups of rats were prepared: (1)VMH-lesioned obese rats, and (2)sham VMH-lesioned rats. One week after VMH lesions, livers of all rats were isolated for morphological observation and for determination of microsomal triglyceride transfer protein(MTP), phosphatidate phyosphohydrolase (PAP), malic enzyme (ME), and glucose-6-phosphate dehydrogenase(G6PDH). Results: Triglyceride contents in livers of VMH-lesoned obese rats increased significantly, and were about 1.8-fold of control group. Activities of ME, G6PDH and PAP in the livers were also enhanced markedly compared to their controls. Many lipid droplets in cytoplasm of hepatocytes from VMH-lesioned obese rats were observed, while there was no similar finding in hepatocytes of control rats. MTP activity in livers of VMH-lesioned obese rats was higher than that in livers of sham-operated non-obese rats [0.201?0.013 vs. 0.175?0.014 ?g/(mg protein?h),[WTBX]P0.05). Conclusion: Hepatic triglyceride production and activity of MTP were increased in VMH-lesioned obese rats, but magnitude of the latter did not exceed the former. This resulted in hepatic triglyceride accumulation in spite of increase in transport of triglyceride out of liver by MTP. This may contribute to the development of fatty liver in VMH-lesioned obese rats.