Objective To explore the effect of nutritional risk and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ) on the prognosis of critically ill patients. Methods From January 2014 to November 2015, 138 critically ill patients were screened using Nutritional Risk Screening 2002 (NRS-2002) in intensive care unit (ICU) of our hospital. APACHEⅡand nutritional status of the patients were measured at the same time. Patients were divided into the survival group and death group according to the prognosis,the NRS-2002, nutritional status and APACHEⅡscores were compared between the two groups.The effect of NRS-2002 and APACHEⅡon the prognosis of critically ill patients was analyzed. Results Of 138 critically ill patients, 131 cases were found nutritional risk and 82 patients survived (62.60%) ,7 cases were found without nutritional risk and 5 patients survived,There were no significant differences in survival rate of both groups(P=0.714). The APACHEⅡscores in the nutritional risk group were (22.14 ± 6.86) points, which were obviously higher than those of non-nutritional risk group(5.80 ± 1.90)points. There were significant differences(t′=17.47,P<0.01). The RBC, HGB and ALB of patients in the death group were(3.18±0.31)×1012/L,(104.00±12.83)g/L and(28.54±3.83)g/L,respectively, which were significantly lower than those of the survival group, that were(3.52±0.53)×1012/L,(118.00±16.32)g/L and(31.44±4.81)g/L ,respectively. There were significant differences(t/t′=3.67-4.75,P<0.01). The CRP of patients in the death group were(88.59 ± 19.24)mg/L,which were obviously higher than those of the survival group(44.36±17.88)mg/L. There were significant differences(t=13.67,P<0.01), while there were no significant differences for TLC in two groups(P>0.05).Logistic regression analysis showed APACHEⅡ, nutritional risks, RBC,HGB,ALB and CRP were all the risk factors for the prognosis of critically ill patients(P<0.01), while APACHEⅡ, RBC, nutritional risks and ALB were the leading influencing factors. Conclusions There exists higher nutritional risks among the critically ill patients. APACHEⅡ, RBC, nutritional risks and ALB should be given more attention when they are admitted in the ICU. Patients′nutritional status should be comprehensively evaluated and the prognosis of the patients should be predicted.

With the development of society and living condition,the incidences of fatty liver and other diseases like hypertension,cardiovascular disease and diabetes have increasd by several factors.This review discussed the cause,mechanism and therapy of fatty liver.The emphasis was put on the object and principle of nutritional therapy.Generally,the treatment of fatty liver includes control of the underlying causes,nutritional therapy,proper physical exercise,upbeat life-rhythm and a certain workload.Plasmapheresis and oxygen therapy are the new methods.

Objective To evaluate the value of magnetic source imaging(MSI) in localizing the epileptic foci of patients with histologically proved grey matter heterotopia(GMH) and seizure. Methods MSI examinations were performed on 8 patients with GMH and seizure. The location of the epileptic foci defined by MSI was compared with the results of the ECoG. After imaging examinations, all patients received operation with 13-48 months follow up to observe the effectiveness of the operation. Results Among the 8 patients, 1 had hippocampal sclerosis,2 had focal cortical dysplasiaof type Ⅰ B and 1 had focal cortical dysplasia of type Ⅱ B. MRI showed normal findings in 2 cases, subcortical heterotopia in 4 cases, and nodulor heterotopia in 2 cases with one having schizencephaly. The epileptic foci defined by MSI were at right temporal lobe in 2 cases, left frontal lobe in 2 cases, biparietal lobe in1 case, left parietal lobe in 1 case, left temporal lobe in 1 case, and left frontal-parietal lobe in 1 case. The epileptic foci defined by MSI were completely overlaid with area of GMH in 4 cases, closely behind the area of GMH in case, and partly overlaid with area of GMH in 1 cases with size larger than that of the latter. One patient showed two epileptic foci with one located within the area of GMH and the other one 2 centimeters anterior to the area of GMH.One case's epileptic focus located 2 centimeters posteolateral to the area of GMH . The locations of the epileptic foci defined by MSI showed no difference with those defined by ECoG in all patients. According to Engel classification of treatment effect of epilepsy, 6 patients achieved Engle class Ⅰ ( seizure free after operation ), and 2 patients Engel class Ⅳ ( no changes in the frequcenty of occurrence of seizures before and after operation ). Conclusion MSI can noninvasively and precisely localize the epileptic foci before operation in patients with GMH and seizure.

Objective To study the MRI features of pituitary lesions in children with short stature caused by growth hormone de-ficiency.Methods The MRI findings of clinical and pathological confirmed pituitary lesions in 40 children were retrospectively re-viewed.All cases had 3.0T MRI examination.Results The pituitary lesions included hypoplasia of antehypophysis (25 cases),pitu-itary stalk interruption syndrome (3 cases),pituitary atrophy after craniopharyngioma excision (2 cases)and pituitary hyperplasia (10 cases).MRI of antehypophysis hypoplasia showed that the height of antehypophysis was less than normal.Pituitary stalk inter-ruption syndrome showed not only hypoplasia of antehypophysis,but also absence or marked thinning of pituitary stalk and ectopic bright signal of posterior pituitary lobe on T1 WI.Atrophy of the pituitary was seen after resection of craniopharyngioma,and the stalk was unclear.All of the pituitary hyperplasia were caused by hypothyroidism.MRI of pituitary hyperplasia displayed antehy-pophysis enlargement and upward apophysis symmetrically.There were no pituitary stalk interruption,translocation and abnormal signal.The pituitary hyperplasia had obvious homogeneous enhancement.Pituitary gland reduced in size after replacement therapy. Conclusion MRI can show the features of pituitary lesions in children with short stature caused by growth hormone deficiency clear-ly.Correct diagnosis can be made and the therapeutic effect can be monitored combining with clinical manifestation.

Objective To investigate the expression of parathyroid hormone/parathyroid hormone relative protein (PTH/PTHrP) receptor of osteoblast in hemodialysis patients and the effects of calcium channel blocker(CCB) and calcitriol on it. Methods Twenty-one patients on HD were randomly divided into three groups. Six patients were treated with CCB for 8 weeks. Seven patients were given calcitriol for 8 weeks. The rest 8 cases did not take either CCB or calcitriol. Five healthy people were selected as control group. The serum levels of iPTH, BUN, Scr, calcium and phosphorus were measured. The osteoblast was prepared from cultured bone marrow. PTH receptor mRNA expression was detected by semi-quantitive RT-PCR. Results The level of PTH/PTHrP receptor mRNA decreased significantly in patients on HD as compared with control group, and increased in patients with CCB. In calcitriol treated group, and PTH/PTHrP receptor was obviously down-regulated with larger dose of calcitriol(0. 75?g/d), and up-regulated with low dose(0. 25?g/d) . Conclusion Expression of PTH/PTHrP receptor down-regulates in osteoblast of HD patients. CCB can up-regulate the expression of PTH/PTHrP receptor. A large dose of calcitriol may decrease iPTH level and down-regulate PTH/PTHrP receptor expression.

Objective The purpose of the present study was to investigate the effect of peroxisome proliferator-activated receptors δ（PPAR δ）activation with dietary GW610742X on the expression of tenascin-C in the infarcted and remodeling myocardium.Methods Sixty male Wistar rats were divided into four groups,including control group,sham group,myocardial infarction（MI） group,and MI＋GW610742X（GW）group.The left coronary artery was ligated to establish the MI model.PPAR δ activator GW610742X（100mg/kg/d）was administrated into the rats of GW group.At 3 months after procedure,the expression and distribution of tenascin-C in left ventricular free wall from each group were examined by Western blotting and immunofluorescence,respectively.Results After 3 months following procedure,there were obvious necrosis and fibrosis in left ventricular free wall from MI group.The expression of tenascin-C in MI and GW group was significantly higher than those in control and sham group（P 〈 0.01）.Moreover,tenascin-C expression in GW group was remarkably decreased compared to MI group（P 〈 0.05）.Additionally,tenascin-C expression in sham group was similar to that in control group（P 〉 0.05）.Conclusion The tenascin-C is upregulated in infarcted myocardium during the remodeling process,which can be significantly attenuated by PPAR δ activation.

BACKGROUND: Many studies have suggested that angiotensin-converting enzyme inhibitors(ACEI) protect blood vessels through anti-atherosclerosis independent of lowering blood pressure, but its mechanism is still unclear.OBJECTIVE: To investigate the anti-atherosclerotic mechanism of ACEI by observing the effects of Enalapril on lipoprotein(a) and oxygen free radicals in patients with acute myocardial infarction (AMI) .DESIGN: A controlled study based on the observation of the patients with AMI.SETTING: Second Department of the South Building, General Hospital of Chinese PLAPARTICIPANTS: Thirty-five inpatients with AMI(19 males and 16 females, aged 42 -75 years old, and averaged (62 ± 9) years old and hospitalized at the Department of Cardiology of Tianjin Harbor Hospital from April 2001 to August 2002 were chosen. These patients were randomly divided into 2 groups: the therapeutic group(20 cases) and the control group(15cases). Inclusion criteria: the diagnosis of patients with AMI was confirmed by WHO criteria. Exclusion criteria: patients with renal dysfunction, shock,hypotension, a history of allergy to ACEI, and a history of severe cough induced by ACEI. All patients had not taken ACEI in the past 2 weeks and agreed to participate in this study.METHODS: On early morning of the third day after AMI, patients in the treatment group took 5 mg of Enalapril one time. If they had no first-dose reaction of hypotension, on the fourth day after AMI, the patients of the treatment group were given a dose of 5 mg twice per day for the following 2 weeks. Then, they were given the drug at a dose of 10 mg twice per day for 2 weeks. The patients in the control group were not given Enalapril. Blood samples were taken respectvely prior to the administration and 2 weeks and 4 weeks after the administration in the two groups. Serum content of lipoprotein(a), oxygen free radicals, triglyceride, total cholesterol, high density lipoprotein(HDL) cholesterol, Apo(a) were measured.MAIN OUTCOME MEASURES: We compared the level of serum of lipoprotein (a), oxygen free radicals (OFR), triglyceride, total cholesterol,HDL cholesterol, Apo(a) pre-treatment and post-treatment respectively in patients of the two groups.RESULTS: Serum levels of OFR were significantly lowered in the treatment group, which were(1 423.14±216.23), (1 076.62±287.12) and (566.57 ± 138.02) U/mL respectively 2 weeks and 4 weeks before and after the treatment(t =2. 937, 3. 571, P ＜0. 01), but there were no significant changes in serum concentrations of lipoprotein(a) and lipids( P ＞ 0.05) .CONCLUSION: Enalapril improved the prognosis of patients with AMI by antioxidation, but not by lowering the serum levels of lipoprotein(a) and lipids. The study can serve as a theoretical reference that the mechanism of Enalapril might inhibit atherosclerosis in patients with AMI.

Objective To study the association of serum L-kynurenine changes with nutritional status and vascular stiffness in maintenance hemodialysis (MHD) patients. Methods Twenty gender- and age-matched healthy volunteers (healthy group) and 40 MHD patients,including 20 cases with α-keto aicd(α-keto acid group)and 20 cases without α-keto aicd(non-α-keto acid group)were enrolled in the study.Serum L-kynurenine was measured by high performance liquid chromatography.C-reactive protein (CRP)and interleukin 6 (IL-6)were detected.Subjective global assessment(SGA)and malnutrition inflammation score(MIS)were applied to evaluate the nutritional status.Pulse wave velocity(PWV)was used to evaluate arterial stiffness for both groups of MHD patients. Results Serum L-kynurenine was significantly higher in MHD patients than that in healthy subjects[(3.20±1.12)μmol/L vs (1.74±0.27)μmol/L,P<0.01],while such difference was not found between α-keto aicd group and non-α-keto-aicd group [(3.20±0.88)μmol/L vs (3.29±1.34)μmol/L,P>0.05].IL-6 was significantly higher in MHD patients as compared to healthy subjects[(6.45±3.78)ng/L vs(1.38±1.59)ng/L,P<0.01],while such difference was found between α-keto aicd group and non-α-keto aicd group[(3.37±0.82)ng/L vs (9.62±2.48)ng/L,P<0.051.There was no difference of CRP concentration between two MHD groups.As compared to non-α-keto acid group,higher SGA score(26.00±1.75 vs 22.67±2.61,P=0.001),lower MIS score(5.82±2.27 vs 10.00±2.62,P=0.002),lower left side PWV[(21.11±8.21)m/s vs(24.57±5.45)m/s,P=0.244]and lower right side PWV[(19.27±3.22)m/s vs (24.19±5.41)m/s,P=0.015]were observed in α-keto aicd group.Pearson analysis showed positive correlation between serum L-kynurenine and IL-6(r=0.352,P=0.011)and negative correlation between L-kynurenine and pre-dialysis Scr(r=-0.412,P=0.019). Conclusions Inflammation is common in MHD patients.Tryptophan degeneration product L-kynurenine may indicate inflammation status.α-keto acid improves nutritional status,anemia and arterial stiffness maybe through the alleviation of inflammation in MHD patients.

Objective: To investigate oral health related life quality and associated factors of senior primary school students in Bengbu City, so as to provide scientific basis for targeted oral health education for children. Methods: A stratified cluster random sampling method was adopted to select 1 760 senior students (grade 5 to 6) from 12 primary schools in 4 districts of Bengbu City from September to November 2022. A cross sectional survey was conducted on the oral health of students through questionnaires related to oral health. The effect of oral problems on quality of life was assessed by the Child Daily Life Oral Influence Scale (Child-OIDP). Chi square test, non parametric test and binary Logistic regression model were used to analyze the influencing factors of oral health related quality of life in senior primary school students. Results: The prevalence of oral problems affecting the quality of daily life was 70.00%, and the severe impact rate was 15.06%. Oral feeding was the most affected (57.95%). The Child-OIDP score was (7.49±8.57). Binary Logistic regression analysis showed that mother s education level, self rated teeth and oral conditions, bruised tooth, toothache in the past year, and gingival bleeding in the past 2 weeks were significantly associated with the incidence of Child-OIDP ( OR=1.86-5.00, P <0.05). Conclusion It is common that oral problems affect the quality of daily life of senior primary school students in Bengbu. Families and schools should strengthen oral health knowledge education and behavior guidance, so as to reduce the impact of oral problems on daily life among senior primary school students.

Objective To study the Hainan Utstein templates used for cardiac arrest and resuscitation registries to evaluate the epidemiological characteristics and outcomes of the patients with CPR by multi-center study. Methodsccording to the Utstein templates for cardiac arrest and CPR set by International Liaison Committee on resuscitation in 2004, a Hainan Utstein CPR registry chart was designed and a prospective descriptive study was carried out to evaluate the epidemiological characteristics, impact factors and outcomes of the patients with resuscitation attempt in emergency departments of thirteen hospitals in Hainan Island between January 2007 and December 2010.Results Of 1125 patients with cardiac arrest, male accounted for 73. 8％ and female was 26. 2％. The mean ( ± S. D) age of the cardiac arrest patients was 53.9 ± 13. 1 years old.Coronary heart diseases and hypertension were the most common preexisting chronic diseases in the studied patients. The ROSC rate and discharge rates after survival in 1125 patients with CPR were 23. 8％ and 7.4％ respectively. The ROSC rate and discharge rates after survival were 36. 3％ and 11.6％ in the in-hospital cardiac arrest (IHCA) group, respectively whereas 11.5％ and 3. 3％ in out-hospital cardiac arrest (OHCA) group. Of 188 patients with ventricular fibrillation/Pulseless ventricular tachycardia, the ROSC rate and discharge rate after survival were 58.0％and 21.8％,respectively. Of them, 448 (39. 8％ ) of the cardiac arrest patients had underlying cardiac causes, and the ROSC rate and discharge rate after survival were 36. 3％ and 11.5％ respectively in IHCA group whereas 11.6％ and 3. 3％ in OHCA group. The ROSC rate and discharge rate after survival were 69. 8％ and 7. 4％respectively in the tertiary hospitals whereas 30. 2％ and 7. 3％ in the secondary hospitals. Conclusions Patients experienced cardiac arrest were predominantly male. Coronary heart disease and hypertension were the two most common preexisting chronic diseases. The ROSC rate and discharge rate of patients with IHCA were higher than those with OHCA. ROSC rate and discharge rate after survival were higher in the ventriculat fibrillation/Pulseless ventricular tachycardia group than the other cardiac rhythms first witnessed groups. The time delayed of starting CPR after onset of cardiac arrest had a critical impact on survival and discharge rate in both IHCA and OHCA groups.