Objective To explore the evaluation value of dynamic monitoring of neutrophil/lymphocyte ratio(NLR)in severity of illness and prognosis of bacterial sepsis.Methods Clinical data and laboratory index of 72 cases of patients with bacterial sepsis in ICU of Yangpu Hospital Affiliated to Tongji University were retrospectively analyzed.According to the severity of illness,patients were divided into sepsis group(n=20),severe sepsis group(n=30)and septic shock group(n=22).According to the mortality within 28 d,patients were divided into survival group(n=47),death group(n=25).The 0 h NLR,48 h NLR and change rate of NLR between two groups were compared,and the influence factors of prognosis were analyzed.Results With the increase of severity of illness,the time of mechanical ventilation was shortened((8.8±1.9)d,(4.6±0.6)d,(3.9±0.4)d),and PLT((146.4±45.8)×109/L,(110.6±41.3)×109/L,(102.5±38.6)×109/L),NLR rate(0.61±0.26,0.26±0.11,0.22±0.09)were decreased significantly,APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were increased obviously((18.5±2.3)points,(20.4±3.6)points,(23.1±3.9)points;(72.6±10.4)mg/L,(78.2±11.6)mg/L,(85.2±12.5)mg/L;(1.5±0.4)μg/L,(2.3±0.6)μg/L,(2.7±0.9)μg/L;11.3±2.6,14.2±3.4,15.7±3.5;3.4±0.9,9.7±2.4,11.2±2.6),the differences were statistically significant(P＜0.05).Compared with death group,the time of mechanical ventilation in survival group was prolonged((4.1±0.3)d vs.(8.7±1.4)d),APEACHE Ⅱ score,CRP,PCT,0 h NLR,48 h NLR were decreased obviously((21.4±3.5)points vs.(18.3±2.6)points,(78.2±11.6)mg/L vs.(71.5±10.8)mg/L,(2.5±0.7)μg/L vs.(1.4±0.6)μg/L,(15.0±3.3)vs.(11.6±2.4),(10.5±2.8)vs.(3.2±0.8)),and PLT,NLR rate were increased significantly((106.5±41.5)×109/L vs.(148.4±50.8)×109/L,0.24±0.10 vs.0.65±0.24),the differences were statistically significant(t=16.18,4.26,2.44,6.99,5.01,16.73,3.54,8.15,P＜0.05).Multivariate logistic regression analysis showed that APEACHE Ⅱ score,0 h NLR were the independent risk factors of death in patients with bacterial sepsis(OR=3.99,3.01,95％CI:1.65-2.38,1.99-4.54,P＜0.05),and NLR rate was independent protection factor(OR=0.95,95％CI:0.91-0.97,P＜0.05).Conclusion Dynamic monitoring of peripheral blood NLR can help to judge the prognosis and severity of illness of patients with bacterial sepsis,and NLR before treatment and change rate of NLR are an independent predictors of death.

Objective To investigate the clinical significance of serun procalcitonin (PCT) and adrenomedullin(ADM) levels in elderly patients with pneumonia diagnosis.Methods Thirty-eight elderly patients with pneumonia who were admitted to our hospital were collected as the study group.Thirty-two cases of non-pneumonic patients hospitalized in respiratory department at the same period for lung tumor,non-infective interstitial lung diseases and pulmonary edema were chosen as the control group.According to CURB-65 score,the study group was divided into three subgroups as mild,moderate and severe group.Levels of serum PCT and ADM at the 1st day,3rd day and 7th day were measured by ELISA,and data were statistically analyzed.Results Serum PCT ((1.98 ± 0.32) μg/L vs.(1.63 ± 0.44) μg/L,t =3.989,P =0.040) and ADM levels ((0.92±0.31) μg/L vs.(0.52±0.12) μg/L,t =5.987,P ＜0.001) on the first day of the treatment was significantly higher than in the control group.Serum PCT and ADM levels in the three subgroups decreased after treatment,and at each time point serum PCT (1st day:(2.19 ±:0.36) μg/L vs.(1.80 ± 0.28) μg/L vs.(1.83 ±0.22) μg/L;3rd day:(2.08 ±0.34) μg/L vs.(1.73 ±0.35) μg/L vs.(1.75 ±0.24) μg/L;7th day:(2.05 ±0.32) μg/L vs.(1.65 ±0.30) μg/L vs.(1.61 ±0.31) μg/L) and ADM levels (1st day:(1.08 ± 0.31) μg/L vs.(0.80 ± 0.25) μg/L vs.(0.77 ± 0.22) μg/L; 3rd day:(1.09 ± 0.32) μg/L vs.(0.77 ±0.23) μg/L vs.(0.75 ±0.21) μg/L;7th day:(1.08 ±0.33) μg/L vs.(0.66 ±0.18) μg/L vs.(0.72 ±0.25) μg/L) in the severe group were significantly higher than in the other two subgroups (P ＜0.05).Serum PCT and ADM levels in survived patients on the 1 st day,3rd day,and 7th day after treatment were significantly lower than in patients who were deceased (PCT:1 st day:(1.82 ± 0.26) μg/L vs.(2.16 ± 0.37)μg/L;3rd day:(1.74 ± 0.29) ~L vs.(2.06 ±0.31) μg/L;7th day:(1.62 ± 0.30) μg/L vs.(2.03 ±0.30) μg/L;P ＜0.05 ;ADM:1st day:(0.78 ± 0.23) μg/L vs.(1.06 ± 0.29) μg/L;3rd day:(076 ± 0.21)μg/L vs.(1.08 ± 0.30) μg/L; 7 th day:(0.70 ± 0.20) μg/L vs.(1.09 ± 0.35) μg/L; P ＜ 0.05),and serum PCT and ADM levels did not change significantly in deceased patients after treatment.Conclusion Serum PCT and ADM levels can serve as serum markers in early diagnosis,the severity of pneumonia and estimating prognosis in elderly patients.

BACKGROUND:Our previous studies have shown that the poly(hydroxybutyrate- co-hydroxyvalerate) - sol-gel bioactive glass (PHBV-SGBG) has good biocompatibility and promote bone tissue repair, but its specific role in periodontal tissue regeneration has not been investigated. OBJECTIVE:To investigate the periodontal regenerative effects of a PHBV-SGBG scaffold in beagle dogs. METHODS:Alveolar bone defects (5 mm×5 mm) were surgicaly created bilateraly at the buccal side of the mandibular third and fourth premolars of four beagle dogs. PHBV-SGBG scaffold was randomly filed in the defects as experimental group and nothing was put into the contralateral as control group. Histological and scanning electron microscopy observations, cone-beam CT evaluation and the Ca/P concentration ratio analysis were processed at 2, 4, 8 and 12 weeks after surgery. RESULTS AND CONCLUSION:After surgery, the height of the regenerated tissue increased with time in both groups, and the regenerated tissue height in the experiment group was higher than that in the control group (P < 0.05). At 12 weeks after surgery, the Ca/P concentration ratio of the experiment group was close to that in the normal tissue (P > 0.05), but higher than that of the control group (P < 0.05); the histological observation showed that the regenerated tissue of the experimental group was close to the normal tissue, and the regenerated tissue of the control group tended to be mature, with a smal amount of new blood vessels. Under the scanning electron microscope, no scaffold structure was visible in the experimental group with the presence of bone lacuna at 8 weeks after surgery, while in the control group, there was no bone lacuna and obvious osteoblasts; at 12 weeks after surgery, the structure of the regenerated tissue of experimental group was more regular and close to the normal tissue with no remarkable osteoblasts, and in the control group, the regenerated tissue was disordered, with several cavity. These results show that the PHBV-SGBG scaffold can enhance periodontal bone regeneration effectively.

AIM: To demonstrate the effects of telmisartan on the proliferation and apoptosis of U937 cells.METHODS: The proliferation ability of the U937 cells was assessed by CCK-8 assay and colony formation test with methylcellulose.The CD11b expression rate of the U937 cells was identified by flow cytometry.The apoptotic rate was analyzed by flow cytometry with Annexin V-PI double staining and Hoechst 33342 staining.The protein levels of cleaved PARP and cleaved caspase-3 were determined by Western blot.RESULTS: The results of CCK-8 assay confirmed that the viability of U937 cells was inhibited by telmisartan.The colony formation capacity of U937 cells was also significantly inhibited by telmisartan.The differentiation of U937 cells was induced by telmisartan with the expression of CD11b.The results of flow cytometry analysis with Annexin V-PI double staining and Hoechst 33342 staining identified that the apoptosis of U937 cells was induced by telmisartan in dose-dependent and time-dependent manners with the up-regulation of cleaved PARP and cleaved caspase-3 proteins.CONCLUSION: Telmisartan inhibits the proliferation and induces the differentiation of U937 cells.Telmisartan also induces the apoptosis of U937 cells through the caspase pathway.

Objective To explore the diagnostic consistency and correlation between MR discography (MRD) and CT discography (CTD) in diagnosing chronic low back pain. Methods Guided by C - arm fluoroscopy the mixed solution of gadoterate meglumine (GD-DOTA) and Iohexol (GD-DOTA at a dilution of 1 ∶ 400 with Iohexol) was injected into 96 lumbar intervertebral discs of the 36 patients. CT scanning was performed at 15 minutes after the injection of contrast, and axial together with sagittal SE T1WI MR scanning was carried out one hour after the injection. CTD and MRD images were randomly numbered and were independently evaluated by two experienced radiologists according to Dallas discogram scale in order to assess the diagnostic consistency and correlation between (MRD) and (CTD). In addition the diagnostic value of MRD was evaluated. Results The results revealed that in determining disc degeneration grade CTD and MRD were highly consistent with each other(Kappa = 0.836, P < 0.01), and the diagnostic results judged by the two reviewers were essentially in agreement (ICC = 1.00, P < 0.01; r = 0.997, P < 0.01). Higher consistency (Kappa = 0.836, P < 0.01) and correlation(ICC = 0.90, P < 0.01; r = 0.869, P < 0.01; Kappa =0.836, P < 0.01) in determining annulus rupture extent were also obtained. Conclusion MRD is an accurate diagnostic method for the determination of disc degeneration and the severity of annulus rupture, and this technique has greater consistency and correlation with CTD in diagnosing chronic low back pain.

Objective To compare the therapeutic effects of 3 operative options with selective high level ligation of spermatic veins, transinguinal canal and renovated Potomo's laparoscopic manage-ment of varicocele. Methods From January 1990 to November 2006, 1075 primary varicocele above grade Ⅱ patients accepted the operations, of them, 685 patients had follow up data and were recruited into this study. These patients were divided into 3 groups according to the operative methods:group A (n=369) was treated with open selective high level ligation of spermatic veins, group B (n=218) was treated with open transinguinal canal operation, and group C (n=98) was treated by renovated Polo-mo's laparoscopic management of varicocele. The complications of the 3 operative methods were com-pared, such as recurrence rate, testicular atrophy rate, scrotal edema rate and semen analysis. The therapeutic effects of these 3 methods were evaluated. Results The recurrence rates of the 3 groups were 3.3%, 7.3% and 5.1%, respectively. Group A had significantly lower recurrence rate than group B, P<0.05. The testicular atrophy rates of 3 groups were 0.5%, 17.9% and 9.2%, respec-tively. There were significant differences among the 3 groups (P<0.05). The scrotal edema rates of the 3 groups were 1.4%, 17.4% and 16.3%, respectively. Group B and C had higher risk of scrotal edema than group A, P<0.05. For patients with ages younger than 30, the improved semen quality rate in group A was higher than in group B and C. The improved semen quality rate in each group of patients younger than 30 was higher than patients with age over 30. Conclusion The open selective high level ligation of spermatic veins is the best choice in the treatment for patients with primary sper-matic varicocele.

Objective To research the effect to the semen quality of the three operation methods of superiority of highly selective varicocele high ligation,transinguinal canal and laparoseopic of renovated polomo management of varicocele.Methods 561 patients in our hospital who charged by infertility had the operation were analyzed retrospectively and were recruited with primary varicocele above grade II for this study.These patients were divided into three group according to three kinds of operation methods of varicocele :group A was treated with highly selective varicocele high ligation and had 300 patients;group B was treated with transinguinal canal operation and had 181 patients; and group C was treated by laparescopic of renovated polomo operation with 80 patients.Through the comparing of the fertility ability of the three operation methods,to evaluate the therapeutic effect of the three methods.Results The increasing rates of the quality of semen in group B was higher than other groups if patients' ages were lower than 30.The increasing rates of the quality of semen in every group was also higher if patients' ages were lower than 30.No difference was found between three groups in natural conception rate (P＞0.05).Conclusion The methods of highly selective varieecele high ligation would be a better choice in the management of patients with primary varicecele because of higher quality of semen.

Objective:To explore the efficacy of precision hepatectomy in the treatment of single hepatocellular carcinoma with microvascular invasion (MVI) of and the risk factors of positive incisal margin after operation.Methods:The clinical data of 212 patients with single hepatocellular carcinoma with MVI treated in Affiliated Hospital of Panzhihua University from July 2016 to July 2019 were analyzed retrospectively. 152 patients were treated with precision hepatectomy and 60 patients with traditional hepatectomy. According to the pathological results of postoperative liver resection, the patients treated with precision hepatectomy were divided into two groups: negative group ( n=129) and positive group ( n=23). The operation-related indexes, postoperative complications and disease-free survival rate of precision hepatectomy and traditional hepatectomy were compared, and the general data of patients with negative and positive liver cutting edge were compared. multivariate analysis of the factors affecting the positive liver cutting edge after operation; to construct a line chart prediction model to predict the positive liver cutting edge after operation, and to evaluate its predictive efficiency. Normally distributed measurement data are represented by mean±standard deviation ( Mean± SD), independent t-test is used for comparison between groups; count data are represented by the number of cases and percentages, and χ2 test is used for comparison between groups. Results:The operative time, intraoperative blood loss, postoperative hospital stay, positive rate of surgical margin, total incidence of postoperative complications, AFP negative conversion rate 6 months after operation, and 1-year disease-free survival rate of precision hepatectomy were (328.62±38.74) min, (496.83±59.76) mL, (15.28±3.61) d, 15.13% (23/152), 3.95% (6/152), 81.58% (124/152), 67.11% (102/152), respectively. The mean values of traditional hepatectomy were (315.29±40.95) min, (681.46±58.27) mL, (23.87±4.65) d, 28.33% (17/60), 21.67% (13/60), 66.67% (40/60) and 46.67% (28/60), respectively, the difference was statistically significant ( P<0.05). Univariate analysis showed that the positive liver resection margin after precision liver resection was related to the maximum diameter of the tumor, vascular tumor thrombus, TNM staging, BCLC staging, liver cirrhosis, AFP 2 months after surgery, and the distance between the tumor and the resection margin ( OR=3.645, 5.248, 4.285, 4.462, 3.883, 3.964, 3.872; 95% CI: 2.875-4.415, 4.426-6.070, 3.271-5.299, 3.354-5.570, 3.062-4.704, 3.248-4.680, 2.987-4.757; P<0.05). Maximum tumor diameter >5 cm, vascular tumor thrombus, TNM stage Ⅲ, BCLC stage C, liver cirrhosis, postoperative AFP ≥20 μg Uniql, the distance between the tumor and the resection margin was <1 mm were the risk factors of positive incisal margin after precision hepatectomy in patients with single liver cancer with MVI( OR=6.685, 8.425, 7.758, 7.854, 7.124, 7.246, 6.926; 95% CI: 5.828-7.542, 7.6385-9.212, 6.926-8.590, 7.062-8.646, 6.583-7.665, 6.618-7.874, 6.028-7.824; P<0.05). The constructed line chart prediction model had better differentiation and higher accuracy. Conclusions:Precision hepatectomy in the treatment of single hepatocellular carcinoma with MVI has the advantages of less intraoperative bleeding, faster postoperative recovery, less postoperative complications, low positive rate of liver incisal margin and high disease-free survival rate. The construction of a risk prediction model with positive surgical margin provides a reference for improving the survival rate of patients in clinic.

Lumbar brucellar spondylitis is an infectious disease caused by the invasion of brucella. The incidence has been on the rise in recent years. And it threatens people's health seriously. Early and proper diagnosis and treatment is the key to cure patients with lumbar brucella spondylitis. However, in the early stage of the disease, there are only nonspecific symptoms such as back pain, fever, and sweating. If the patient has the above symptoms and epidemiological history of direct or indirect livestock contact, and inflammatory signals of the vertebrae or intervertebral space are visible on MRI, the possibility of early infection of lumbar brucella spondylitis should be considered. It is not difficult to make the diagnosis of lumbar brucella spondylitis in the middle and late stages by taking into account the epidemiology, symptoms, signs, laboratory tests, and the imaging features such as narrowing of the intervertebral space, abnormal signals of the vertebral body and disc, bone destruction and sclerosis, "lace-like" appearance, sequestrum formation and limited paraspinal abscess. Patients in these stages often present with serious manifestations such as lumbar instability due to bone destruction, and the focus is on surgical intervention. The basic principle of surgical treatment is lesion removal combined with fixation. Intraoperative reduction of damage to bone and ligamentous structures such as the posterior ligamentous complex and strong fixation will contribute to the complete cure of the disease. By referring to the literature on lumbar brucellar spondylitis, this paper focuses on the etiology, pathogenesis, clinical manifestations, imaging features, laboratory tests and conservative and surgical treatment of the disease, aiming to provide a basis for clinical diagnosis and treatment.

Objectives:To compare the HbA 1c results on capillary electrophoresis (CE), cation exchange-high performance liquid chromatography (CE-HPLC), and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods:902 normal samples without hemoglobin variants and 83 samples with hemoglobin variants were collected in 2020. The variants were divided into α-chain, β-chain, γ-chain, and δ-chain variants. The 902 samples without hemoglobin variants were measured by CE, CE-HPLC, and MALDI-TOF MS. Three methods were used for measuring α-chain, β-chain, and γ-chain compared with the liquid chromatography-tandem mass spectrometry (LC-MS/MS) reference method. According to the EP9-A3 guideline, Passing-Bablok regression and concordance correlation coefficient (CCC) were performed for correlation and consistency, respectively. The imprecision was assessed by coefficient of variance (CV). The mean relative bias was calculated and compared with the lowest biological variation bias of 2.3%.Results:All three methods met the acceptance of imprecision requirements (<2%). The R 2 and CCC for the normal samples were all above 0.95 between the pairwise comparison of CE, CE-HPLC, and MALDI-TOF MS. The mean relative bias between MALDI-TOF MS and CE-HPLC was higher than the lowest biological variation bias of 2.3%. The R 2 results between CE and LC-MS/MS results of α-chain, β-chain, γ-chain variants were>0.95, and the mean relative biases for γ-chain variants exceeded the lowest biological variation bias of 2.3%. A bad correlation ( R2=0.66) for β-chain variants was shown between CE-HPLC and LC-MS/MS and the mean relative biases of all variant samples exceeded 2.3%. MALDI-TOF MS showed good correlations with LC-MS/MS for three groups, and the mean relative biases for γ-chain variants were higher than 2.3%. Conclusion:MALDI-TOF MS and CE-HPLC with CE had good comparability in the measurement of HbA 1c in normal samples, butthe three methods showed interferences from different types of Hb variants and the CE method was affected with less interference.