Objective To develop an improved enzymatic method for assaying creatinine in serum and urine. Methods Cratinine iminhydrolase catalyzes the conversion of creatinine to N-methylhydantoin and ammonia,the later combines with 2-oxoglutarate and NADPH in the presence of glutamate dehydrogenase.Before beginning the reaction sequence,endogenous ammonia is removed by an “ammonia scavenger system”that involves the same auxiliary reaction.The NADPH and 2-Oxoglutarate consumed are restored through a reaction catalyzed by isocitrate dehydrogenase.The activity of this strictly magnesium-dependent enzyme is completely blocked by magnesium-complexing reagent that acts promptly whenever the reaction has started with creatinine iminohydrolase as startor.The reaction is monitored kinetically by measuring the NADPH decrease via its absorbance at 340nm.Results The method affords a simple,rapid,and sensitive assay with good precision and extended linearity.Test results compare closely with the HPLC precedure.The proposed method is not subject to interference from several metablites or from the drugs used commonly in clinics.Conclusion The method is easily automated and is suitable for routine work in clinical laboratories.

Objective:To explore the feasibility and safety of long-term home mechanical ventilation(HMV) in children with chronic respiratory failure.Methods:Clinical data of 11 children with chronic respiratory failure, who underwent HMV with the care of the First Affiliated Hospital of Xiamen University from January 2013 to December 2019, were retrospectively reviewed. The clinical manifestation, growth and development, quality of life, adverse events and prognosis of HMV children were analyzed.Results:There were 8 boys and 3 girls with the onset age of 26 days to 13 years old; and the age at starting HMV was 3 months to 13 years old. Eight children were diagnosed as neuromuscular diseases, and 3 children were diagnosed as respiratory diseases. The duration of institutional mechanical ventilation was 2 weeks to 8 months. Six patients underwent invasive HMV via a tracheostomy, and 5 received non-invasive ventilation via nasal and face masks. Bi-level positive airway pressure ventilation mode was applied in all the patients. The duration of HMV was 3 months to 27 months. During follow-up, no HMV related adverse events were observed. Both the quality of life and nutritional status were improved in all cases. One patient lost follow-up 9 months later and 1 patient died of severe adenovirus pneumonia during hospitalization for examination, the remaining 9 cases survived. Liberation from HMV was obtained in 4 patients. The frequency of readmission was 1 to 2 times.Conclusion:It is suggested that long-term HMV is safe and feasible for children with chronic respiratory failure.

Objective The incidence of complications after esophageal cancer surgery is relatively high.The purpose of this paper was to explore the feasibility of combined thoraco-laparoscopy surgical treatment for senile esophageal cancer(over 70 years old).Methods A total of 526 esophageal cancer cases were retrospectively analyzed in this study.The operative procedures was esophageal carcinoma resection surgery and thoracic and abdominal lymphadenectomy which were operated through video-assisted by thoracoscope and laparoscopic From January 2010 to June 2014 in the Union Hospital of Fujian Medical University,divided into aged groups(≥70 years old,n =132) and non-aged group(＜ 70 years old,n =394).Statistical analysis was carried on the rate of two groups of preoperative risk factors(hypertension,diabetes,cardiac insufficiency,pulmonary insufficiency,cerebral infarction),surgical trauma and the number of lymph node dissection (laryngeal recurrent nerve injury,operation time,intraoperative blood loss),postoperative complications(cardiac complications,chylothorax,pulmonary complications,anastomotic fistula,poor healing of the incision,intrathoracic stomach atony),postoperative recovery and early postoperative mortality.Results Preoperative risk factors:the prevalence of the aged group with hypertension,cerebral infarction,cardiac insufficiency,and pulmonary insufficiency was significantly higher than the non-aged group (P ＜ 0.05) but diabetes (P ＞ 0.05).Surgical trauma and the number of lymph node dissection:no significant difference (P ＞ 0.05).Postoperative complications:the aged group was higher in the incidence of pulmonary complications and cardiac complications than the other (P ＜ 0.05) ; but the chylothorax,anastomotic fistula and poor healing of incision,intrathoracic stomach atony in the two groups seemed no significant difference(P ＞ 0.05).Furthermore,pulmonary complications were highest in the all complications,significantly higher than the others in both groups.Postoperative recovery:significant difference existed in postoperative hospitalization days,the aged group was obviously longer than the non-age groups.Early postoperative mortality rates in the two groups had no significant difference.Conclusion The aged patiences had a higher prevalence in the preoperative risk factors and so was the cardiac complications as well as pulmonary complications among the postoperative complications.However the combined thoraco-laparoscopy in the surgical treatment of elderly patients with esophageal cancer is safe and feasible.

Objective To investigate the angiographic manifestations of renal artery injury caused by percutaneous nephrolithotomy, and to evaluate the therapeutic effect of super-selective renal arterial embolization in treating renal artery injury. Methods A total of 22 patients with persistent or intermittent gross hematuria that occurred after percutaneous nephrolithotomy, who were encountered at authors’ hospital during the period from Jan. 2010 to June 2014, were included in this study. The diagnosis was confirmed by renal angiography in all patients, and super-selective renal arterial embolization with steel micro-coils was carried out in all patients. The patients were followed up for three months. The results were analyzed. Results Of the 22 patients, DSA examination showed that renal artery pseudoaneurysm (RAP) was found in 14 (63.6%), renal arteriovenous fistula (RAVF) in 5 (22.7%) and RAP associated with RAVF in 3 (13.6%). Renal angiography performed after super-selective renal arterial embolization showed that complete obstruction of the bleeding arteries was achieved in all patients, and the active bleeding stopped. Both the technical success rate and the hemostasis rate were 100%. During the follow-up period lasting for three months, no recurrence of hematuria or severe complications occurred. In 20 patients, different degree of embolism syndrome was observed after the treatment. Conclusion Renal artery pseudoaneurysm and renal arteriovenous fistula are the main types of renal artery injury after percutaneous nephrolithotomy. Super-selective renal arterial embolization with micro-coils can be used as the treatment of choice for patients who has failed to respond to conservative therapy.

Abstract: Objective　To analyze the effect of adjuvant to levofloxacin in the treatment of retreatment smear positive pulmonary tuberculosis, as well as its effect on respiratory function, immune function and inflammatory factors. Methods　One hundred cases of retreatment smear positive pulmonary tuberculosis patients admitted to Rudong County People's Hospital in Nantong city in Jiangsu province from 2017 to 2021 were randomly divided into a control group (n=50) and an observation group (n=50) according to random number table method. Both groups received conventional treatment (3 months of isoniazid, rifampicin, ethambutol, pyrazinamide / 6 months of isoniazid, rifampicin, ethambutol), with levofloxacin added to the control group, and thymopentin added to the observation group for the first three months in addition to routine treatment. The treatment effect of the two groups were compared. Results　The sputum smear conversion rate of the observation group was significantly higher than that of the control group after 3 months and 5 months of treatment (χ2=7.142, P<0.05; χ2=6.250, P<0.05). The cavity absorption time and lesion absorption time in the observation group were significantly lower than those in the control group (t=4.006, P<0.05; t=5.165, P<0.05). The turning time of bacteriological culture in the observation group was significantly lower than that in the control group (t=4.220,P<0.05). After 3 months of treatment, CD4+, CD3+, CD4+/CD8+ of the observation group were higher than those of the control group, the differences were statistically significant (t=8.885, P<0.05; t=6.274, P<0.05; t=4.357, P<0.05). After 3 months of treatment, the IFN-γ (interferon-γ) of the observation group was higher than that of the control group (t=8.892, P<0.05), whereas the , IL-10 (interleukin-10) was significantly lower than that in the control group (t=5.986, P<0.05). After 3 months of treatment, forced vital capacity (FVC), forced expiratory volume in one second (forced expiratory volume in one second, FEV 1) and the one-second rate (forced expiratory volume in one second / forced vital capacity, FEV1/FVC) in the observation group were significantly higher than those in the control group (t=11.223, P<0.05; t=10.128, P<0.05; t=4.464, P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups (χ2=0.378, P>0.05). Conclusions　Thymopentin combined with levofloxacin had a significant application effect in the treatment of retreatment smear positive pulmonary tuberculosis, s, which led to improved inflammatory reaction, respiratory function and immune function. Additionally, it can increase sputum smear conversion rate and accelerate patient recovery, improving overall treatment efficacy, with a relatively high clinical application value.

Objective To explore the mechanism of self-awareness in the heavy smokers(HS)by using regional homogeneity(ReHo)combined with resting-state functional MRI(fMRI).Methods Thirty HS and 31 healthy non-smokers(NS)matched for age and sex underwent a 3.0 T resting-state fMRI.The data were post-processed by SPM 5 and then the ReHo values were calculated by REST software.The ReHo values between the two groups were compared by two-sample t-test.The brain map with significant difference of ReHo value was obtained.Results Compared with that in NS group,the regions with decreased ReHo value included the bilateral precuneus,superior frontal gyrus,medial prefrontal cortex,right angular gyrus,inferior frontal gyrus,inferior occipital gyrus,cerebellum,and left middle frontal gyrus in HS group.The regions of increased ReHo value included the bilateral insula,parahippocampal gyrus,white matter of parietal lobe,pons,left inferior parietal lobule,lingual gyrus,thalamus,inferior orbital gyrus,white matter of temporal-frontal lobe,and cerebellum.The difference was more obvious in the left hemisphere.Conclusions In HS,abnormal ReHo on a resting state which reflects network of smoking addiction.This method may be helpful in understanding the mechanism of self-awareness in HS.

Objective: To assess the effectiveness in optimizing resources and shortening critical children′s waiting time in pediatric emergency department (PED) with five-level pediatric emergency triage system (PETS). Methods: This retrospective study was conducted in the First Affiliated Hospital of Xiamen University after PETS was applied. The data of patients who visited the pediatric emergency department from January 2015 to December 2017 were collected and analyzed, including age, sex, diseases, visiting time, triage rate and destination. Results: A total of 375 985 patients were included, among whom males were 225 308 (59.9%) and females were 150 677 (40.1%), all younger than 14 years of age. The number of critical cases (level Ⅰ, level Ⅱ and level Ⅲ) was increased from 4 719 (3.7%) in 2015, 12 209 (10.2%) in 2016 to 16 188 (12.7%) in 2017. The number of non-critical patients (level Ⅴ) decreased year by year, as from 98 213 (76.8%) in 2015 to 75 210 (62.6%) in 2016 and 78 857 (61.7%) in 2017. The patients who classified as level Ⅰ or levelⅡaccording to the PETS were seen immediately by physician (n=1855, 0.5%). Overall, 119 738 patients (98.3%) who were classified as level Ⅲ or level Ⅳ could be seen by physician in a timely manner according to triage guidelines, while 2 112 patients (1.7%) could not. The mean waiting time was 9.09 min in level Ⅲ, 17.7 min in level Ⅳ, and 55.76 min in level Ⅴ patients, respectively. The critical cases admitted to the intensive care units were 175 (36.2%) in 2015, 350 (62.8%) in 2016 and 374 (66.2%) in 2017. The etiologies were respiratory diseases (73.3%), gastrointestinal diseases (15.8%) and infectious diseases (3.1%). Conclusion The application of PETS could optimize emergency resources and shorten the waiting time of critically ill children.

Objective: To investigate potential biomarkers for different types of hand, foot and mouth disease(HFMD). Methods: Nuclear magnetic resonance(NMR)-based metabolomics methods were used to analyze the metabolic differences in serum of HFMD and healthy controls.Partial least squares discriminant analysis(PLS-DA)and orthogonal partial least square discriminant analysis(OPLS-DA)were used for analysis of metabolite profiles.Differential statistical analysis was performed by t tests using GraphPad Prism 5 software. Results: The levels of lipid, leucine, valine, β-hydroxybutyric acid, acetone, glucose, glycoprotein, glycerol, glycine, choline, trimethylamine oxide and lactate in HFMD increased significantly compared with healthy controls, whereas the levels of acetic acid and creatine decreased significantly.Additionally, the level of acetone further increased in the severe type of HFMD compared with the mild type, whereas the levels of lipid and trimethylamine oxide decreased. Conclusion These statistically significant differences are involved in lipid metabolism, glucose metabolism and protein metabolism in different types of HFMD.Lipid, acetone and trimethylamine oxide can be used as potential biomarkers of HFMD.

¹⁷⁷Lu- prostate specific membrane antigen (PSMA) radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China. Based on domestic clinical practice and experimental data and referred to international experience and viewpoints, the expert group forms a consensus on the clinical application of ¹⁷⁷Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.