Objective To evaluatethe clinical value of procalcitonin(PCT)in the diagnosis and assessment of community-acquired pneumonia(CAP).Methods Ninety-six patients with CAP(CAP group)who hospitahzed during the period of November 2005 to August 2006 were admitted.Meanwhile,30 people were taken as control group.The levels of PCT,CRP and WBC were detected on the next day and the 8th day of hospitalization.Results(1)The receiver operating characteristic(ROC)curve was made through setting the threshold value of PCT,CRP and WBC as 1.5 μg/L,10 md/L and 10×109/L respectively in AP group and control group.The RFea undering ROC curve was 0.979.0.831 and 0.736 respectively.(2) The mean value of PCT in the patients of bacterial pneumonia.atypical pathogen pneumonia and viral pneumonia was(9.74±6.20),(7.81±5.70)and(12.20±6.50)μg/L respectively.There were no statistical differences in those patients.(3)There was correlation between PCT and CURB-65 score(r=0.258.P=0.011).The value of serum PCT showed significant differences in the patients with mild pneumonia.moderate pneumonia and severe pneumonia. Conclusions Serum PCT has higher sensitivity and specificity than CRP and WBC in the diagnosis of CAP.There is correlation between PCT and the severity of CAP,so it indicates that PCT has a certain practical value in the iudgement of the condition of CAP.

Objective To study the relationship between chronic obstructive pulmonary disease (COPD) and osteoporosis by measuring the bone mineral density (BMD),lung function,blood gas analysis,calcium ion,high sensitive C reactive protein (hs-CRP) and the quality of life.Methods BMD measuring was performed by ultrasound dry bone densitometer in 32 patients with COPD (COPD group) and 35 healthy controls (control group).The ultrasonic transmission speed (SOS),SOS T,fracture risk factor (OSI) and bone strength (TI) were measured at the sites of the left calcaneus.COPD group was divided into three groups according to lung function,3 cases of mild,14 cases of moderate and 15 cases of severe.According to the level of BMD,there were another three groups,3 cases with normal BMD,24 cases with lower BMD,and 5 cases with osteoporosis.According to the history of systemic glucocorticoid application,COPD group was divided into two groups,10 cases with glucocorticoid application and 22 cases without glucocorticoid application.The levels of BMD between COPD group and control group were compared,and the correlation between BMD and lung function,blood gas analysis,calcium ion,hs-CRP and the quality of life in patients with COPD was analyzed.Results COPD group had lower BMD than that in control group (P ＜ 0.05).In COPD group,the severe patients had lower BMD than the moderate patients (P ＜ 0.05),and the severe patients had only lower SOS than the mild patients(P ＜ 0.05),but there was no statistic significant difference in BMD between the moderate and mild patients(P ＞ 0.05).According to the level of BMD,the osteoporosis patients had lower arterial oxygen tension (PaO2) and higher hs-CRP and COPD assessment test (CAT) than the normal BMD and lower BMD patients,and the lower BMD patients had lower PaO2 and higher CAT than the normal BMD patients (P ＜ 0.05),but there was no statistic significant difference in calcium ion among them(P ＞ 0.05).According to the history of systemic glucocorticoid application,the patients with glucocorticoid application had lower level of BMD than the other patients (P ＜ 0.05).SOS,SOS T,OSI and TI was correlated with one second forced expiratory volume percent predicted (FEV1％) (r =0.389,0.262,-0.295,0.265; P＜0.05),also correlated with PaO2 (r =0.391,0.100,-0.374,0.122;P＜0.05),and also correlated with CAT (r =-0.659,-0.463,0.175,-0.178 ; P ＜ 0.05).There was only a negative correlation between SOS and hs-CRP (r =-0.390,P ＜ 0.05).Further in Logistic regression analysis,the results showed that both PaO2 and FEV1％ were the risk factors of BMD reduction.Conclusions Patients with COPD have lower BMD than their peers of healthy.The reduction of blood oxygen pressure and lung function are the risk factors of BMD reduction.There is a conjecture that the reduced BMD is correlated with chronic inflammation in patients with COPD.

Objective To observe the effects of smoking on lung mucociliary movement and pulmonary function in patients with chronic obstructive pulmonary disease (COPD) and healthy people. Methods Ninety-two patients with COPD (COPD group) were selected, including 48 smoking patients (COPD smoking group) and 44 non-smoking patients (COPD non-smoking group). Another 76 healthy people (control group) were selected, including 37 smokers (control smoking group) and 39 non-smokers (control non-smoking group). The saccharin test and pulmonary function were carried out respectively, including mucociliary clearance time (MCT), forced vital capacity (FVC) and forced expired volume in 1 s (FEV1), and the ratio of FEV1 and FVC (FEV1/FVC) and FEV1 percentage of predicted (FEV1%pre) were calculated. Results The MCT in COPD group was significantly higher than that in control group:(26.17 ± 19.23) min vs. (15.28 ± 11.34) min, the FEV1/FVC and FEV1%pre were significantly lower than those in control group:(54.25 ± 12.76)%vs. (83.04 ± 5.98)%and (53.26±9.84)%vs. (85.38 ± 5.72)%, and there were statistical differences (P<0.05). The MCT in COPD smoking group was significantly higher than that in COPD non-smoking group and control smoking group: (30.72 ± 27.37) min vs. (18.25 ± 8.19) and (18.31 ± 8.17) min, the FEV1/FVC and FEV1%pre were significantly lower than those in COPD non-smoking and control smoking group: (49.98 ± 11.38)% vs. (58.00 ± 6.85)% and (80.15 ± 4.67)%, (50.24 ± 8.77)%vs. (61.31 ± 4.62)%and (82.13 ± 4.58)%, and there were statistical differences (P<0.05). The MCT in COPD non-smoking group was significantly higher than that in control non-smoking group, the FEV1/FVC and FEV1%pre were significantly lower than those in control non-smoking group, and there were statistical differences (P<0.05). The MCT in control smoking group was significantly higher than that in control non-smoking group: (18.31 ± 8.17) min vs. (11.26 ± 7.53) min, and there were statistical differences (P<0.05). There were no statistical differences in FEV1/FVC and FEV1%pre between control smoking group and control non-smoking group (P>0.05). The Pearson correlation analysis result showed that there was positive correlation between MCT and smoking intensity, age (r = 0.346 and 0.256, P<0.05), and there was negative correlation between MCT and FEV1/FVC, FEV1%pre (r = -0.327 and -0.414, P<0.05). Conclusions Smoking can destroy the mucociliary function and aggravate the deterioration of lung function in patients with COPD.

Objective:To determine the relationship between nocturnal oxygen desaturation and ventricular ectopy and study the effect of sleep stages on the frequency of ventricular ectopy in patients with chronic obstructive pulmonary disease (COPD).Method:Twenty two clinically stable patients with mild moderate COPD underwent overnight polysomnography,arterial oxygen saturation (SaO2) and ECG were recorded simultaneously.The relationship between the frequency of ventricular ectopy (VE) and SaO2,sleep stages and compared the results with those of twelve normal control subjects.Result:The prevalence of nocturnal VE in patients with COPD was 59.1 percent which was obviously higher than that of control group.The frequency of VE had no correlation with the frequency and the degree of oxygen desaturation,the duration of SaO2 below 90 percent,nocturnal mean SaO2 and nadir SaO2.The frequency of nocturnal VE during wake stage,REM stage and NREM stage had no difference.Conclusion:These results suggest that mild moderate nocturnal oxygen desaturation and sleep stages had no apparently influence on the events of VE in stable patients with COPD.

Based on the analysis of the current situation of memorial hall construction for the donator of cada-ver, this paper discussed the significance of memorial hall construction:respecting the donor′s personal dignity, in-carnating humanistic care to the donators′relatives, guiding and promoting the cadaver donation, and becoming the medical ethics education base for medical students.

Objective To investigate the differences in the inhibition of return (IOR) capacity of attention between expert and novice pilots.Methods Compared the capacity of IOR of 10 expert pilots and 10 novice pilots under the conditions of adjacent and spaced clueing positions by experiment and by means of simultaneous cueing processes.Results These data suggested that in simultaneous cueing processes,no matter that the clueing positions were adjacent or spaced,the reaction time of expert pilots( adjacent:(428.01 ± 64.89) ms,spaced:(425.24 ± 63.94 ) ms) was slower novice pilots ( adjacent:( 363.05 ± 38.95 ) ms,spaced:( 360.61 ± 41.70 ) ms )(P ＜ 0.01 ) ; the capacity of IOR in no matter that the clueing positions were adjacent or spaced.The expert pilots showed IOR at only one location when the 5 clues all appearance in simultaneous cueing processes (P＜ 0.05 ),and no IOR could be see in the other locations.The novice pilots showed IOR when the from 3 to 5 of clues appearance in simultaneous cueing processes,the disparity was significantly predominance(P＜ 0.01 ).Conclusion The expert pilots of stability of capacity of IOR is better than novice pilots,and show solidly and highly efficient space searching ability.

Objective To study the correlation between the level of serum high sensitivity C-reactive protein (hs-CRP) and induced sputum cell counts,pulmonary function and asthma control test (ACT) in order to investigate the clinical application value of serum hs-CRP for the acute exacerbation bronchial asthma patients.Methods Thirty acute exacerbation bronchial asthma patients were collected as asthma group,14 healthy people during the same period were collected as control group.The fasting serum hs-CRP was examined in control group and before and after treatment of 5-7 d in asthma group.The induced sputum was obtained by ultrasonic atomizer 4.5％ sodium chloride,and the percentage of eosinophils (EOS％),neutrophil,macrophages,lymphocytes was calculated.The pulmonary function index was determined in control group and before and after treatment in asthma group.ACT score was performed in asthma group.The correlation between the serum hs-CRP and induced sputum differential leukocyte count,the pulmonary function index and ACT score was analyzed by Spearman correlation analysis.The effect of the serum hs-CRP and induced sputum EOS％ on inflammatory response of acute exacerbation bronchial asthma was evaluated by receiver operating characteristic (ROC) curve analysis.Results Two cases were excluded in asthma group.The serum hs-CRP before and after treatment in asthma group was higher than that in control group[4.18(2.12-11.12) and 3.40(2.02-8.91) mg/L vs.1.48(1.03-4.81) mg/L,H =18.939,P＜ 0.01].The serum hs-CRP before treatment was higher than that after treatment in asthma group (P ＜ 0.01).In asthma group,the serum hs-CRP had positive relationship with induced sputum EOS％ (r =0.849,P =0.000).There were negative correlations between the serum hs-CRP and the pulmonary function index such as one second forced expiratory volume percent predicted,one second forced expiratory volume occupied vital capacity ratio,maximum mid-expiratory flow percentage of predicted (r =-0.617,-0.559,-0.398,respectively,P =0.000,0.002,0.036,respectively).It was also found that the serum hs-CRP and ACT score had the remarkable Spearman linear correlation (r =-0.511,P =0.005).The area under the ROC curve of the serum hs-CRP was 0.713 (P =0.003).Conclusions There are significant correlations between the serum hs-CRP and induced sputum EOS％,pulmonary function,ACT score in the acute exacerbation bronchial asthma patients.It is found that hs-CRP could be considered as one of the potential marker to evaluate the systemic inflammation level of bronchial asthma.

Objective To evaluate the diagonosis value of serum procalcitonin(PCT),C-reactive protein(CRP)and lipopolysaccharide(LPS)in patients with community acquired pneumonia(CAP).Methods From Nov.2004 to Feb.2005,PCT were determined by Brahms PCT-Q;CRP were measured by using immunity-turbidity method;LPS were measured by enzyme linked immunosorbant assay(ELISA)and white blood cells were counted in serial blood samples from 36 patients with community acquired pneumonia and compared with the 18 healthy people.Results For PCT,CRP,LPS,WBC count,the sensitivities were 80%,92%,94% and 47.2%,and the specificities were 88%,64%,30%and 95%respectively for the diagnosis of 36 patients with CAP.The mark of PCT in the medium and serious CAP group(Ⅰ、Ⅱ Fine's risk classification)were significantly higher than those in the light CAP group(Ⅲ、Ⅳ、Ⅴ Fine's risk classification)(P

Objective To determine the drug-resistance rates of bacteria isolated from 7 hospitals located at different areas of China.Methods 1 111 pathogenic strains were isolated for susceptibility test using agar dilution method from Sep 1,204 to Aug 3 1,2005.According to the criteria of guideline of CLSI (2007),MIC50 and MIC90 were detected for antibacterial activity of antimicrobial agents and resistant rate (R%),intermediate rate(I%)and sensitive rate(S%)were calculated based on susceptibility tests.Results The detectable rates of methiciltin-resistant Staphylococcus anreus(MRSA)and methicilllin- resistant Staphylococcus epidermidis(MRSE)were 39.3%and 74.0% respectively.The total resistant rate of penicillin resistant Streptococcus pneumoniae(R%+I%) was 33.3%(R%=5.6%,I%=27.7%). 91 strains of Enterococcus were isolated.The resistant rate of penicillin resistant E.faecalis Was 40.8%.and E.faecium Was 100%.Neither strains of S.aureus nor strains of S.epidemidis were found resistant to vancomycin.No strains of Enterococcus were found resistant to vancomycin.644 strains of gram-negative bacilli were isolated.The most common gram-negative bacilli were E.coli,k pneumoniae,Acinetobacter spp,P.aeruginosa,and E.cloacae,respectively.The ESBLs-producing strains accounted for 38.6% and 26.7% in E.coli and K. pneumoniae.respectively.Meropenem and imipenem were the most potent antimicrobial agents.Cefoperazone/sulbactam demonstrated excellent activity agent of gram-negative bacilli.Most of the gram-negative bacillus still susceptible to ceftazidime.The new fluroquinotones, moxifloxacin and levofloxacin showed strong and broad spectrum activity against the most gram-positive and gram-negative bacteria.Conclusions This surveillance in 2004-2005 together with the surveillance in 2002-2003,were similar in the bacterial resistance pattern and the trend of rising resistant rates for some pathogens.

To investigate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) for di-agnosing low choledochal joint and its complications. MRCP results of 29 low choledochal joint patients con-firmed were analyzed retrospectively, and then compared with those by endoscopic retrograde cholaniopancreatography (ERCP). MRCP could display clearly the location of low choledochal joint, and the patients with complications involved 4 ones with cholecystolithiasis, 5 ones with cholangiolithiasis, 15 ones with cholecystolithiasis and cholangiolithi-asis, 3 ones with Mirizz syndrome, 2 ones with pancreatitis, 1 case with carcinoma of head of pancreas after cholecystec-tomy and 1 case of Vater ampullary carcinoma. Interoperative and ERCP findings proved that MRCP could be used for the diagnosis of low choledochal joint and its complications with no missed diagnosis. MRCP can be involved for the diagnosis of low choledochal joint and its complications, and thus can be used for preoperative planning and treat-ment of the complications.