Objective To evaluate the relationship between changes in B-type natriuretic peptide(BNP) and cardiac troponin I(cTnI)levels and prognosis of critically ill patients with sepsis. Methods This study retrospectively reviewed the clinical data of 75 patients with severe sepsis and septic shock admitted into Emergency Intensive Care Unit(EICU)of the First Affiliated Hospital of Wenzhou Medical University in Zhejiang Province. According to the severity of the cases,they were divided into two groups:severe sepsis group(34 cases)and septic shock group(41 cases),and based on the difference in prognosis,they were divide into survivor group(32 cases) and non-survivor group(43 cases). Electrocardiogram(ECG)was performed within 24 hours after admission in all the patients. Acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)score and biochemical markers showing organ dysfunctions as BNP, cTnI, creatine kinase (CK), creatine kinase MB mass(CK-MB), and lactate were compared between severe sepsis and septic shock groups and between survivor and non-survivor groups. Results The septic shock group had significantly higher baseline BNP,cTnI,lactate and APACHE Ⅱscore and mortality rate than those in severe sepsis group〔BNP(μg/L):1.90(1.08,2.79)vs. 0.41(0.31,0.75),cTnI (μg/L):1.15(0.92,1.28)vs. 0.58(0.40,0.79),lactate(mmol/L):6.63±3.72 vs. 3.28±1.66,APACHEⅡscore:26.00(24.00,28.00)vs. 21.50(20.00,29.25),mortality rate:70.73%vs. 41.18%,P<0.05 or P<0.01〕. Compared with survivor group,the ages of non-survivor group were older with more males and higher BNP,cTnI,lactate and APACHEⅡscore〔males(cases):30 vs. 13,age(years old):66.49±14.97 vs. 58.19±17.05,BNP:1.60(0.62, 2.51)vs. 0.57(0.37,1.79),lactate:4.10(3.00,9.00)vs. 3.10(2.13,4.18),cTnI:1.02±0.49 vs. 0.62±0.37, APACHE Ⅱ score:28.00(25.00,30.00)vs. 21.00(20.00,25.75),P<0.05 or P<0.01〕. However,there were no statistically significant differences in the levels of CK and CK-MB between the above compared groups(both P>0.05). The patients' ECGs had no obvious changes. Conclusions High plasma BNP and cTnI levels in patients with sepsis may suggest myocardial damage and relatively bad prognosis. The examination of BNP and cTnI levels may help clinicians to early detect the high-risk patients with septic cardiac dysfunction and assess their prognoses.

Objective To investigate the incidence and relevant information of preterm birth and the outcomes of preterm infants delivered at various gestational weeks and for different causes. Methods Totally 955 women, who ended their pregnancies before term, and 1066 neonates of the previous mothers were enrolled in this survey, among 15 197 deliveries at Peking University First Hospital, Beijing Gynecological and Obstetric Hospital, Women's and Children's Hospital of Haidian District and Peking University Third Hospital, respectively, from December 1~(st), 2006 to May 31~(st), 2007. Results (1)Incidence of preterm birth: The overall incidence of preterm birth of the 4 hospitals was 6. 3% (955/15 197), and it was 8.1% (125/1549) in Peking University First Hospital, 13.1% (150/1142), which was the highest (P<0.01), in Peking University Third Hospital, 5.5% (369/6656) in Beijing Gynecological and Obstetric Hospital and 34.0% (311/5850) in Women's and Children's Hospital of Haidian District.The preterm birth rate at the two comprehensive hospitals was significantly higher than that of the two specialized hospitals [10.2% (275/2691) vs 5.4% (680/12 506), P <0.01]. (2) Gestational weeks at delivery: The incidence of preterm birth before 34 weeks was 28.5% (272/954) and the number changed to 71.5% (682/954)for those preterm deliveries after 34 weeks. However, this number varied among the 4 hospitals. Peking University First Hospital had the highest incidence of preterm birth before 34 weeks(P< 0.05), and the lowest was found in Women's and Children's Hospital of Haidian District(P<0.01), but no difference was found between Peking University Third Hospital and Beijing Gynecological and Obstetric Hospital. (3) Etiology of preterm birth: Preterm premature rupture of membranes (PPROM) accounted for the most proportion of all preterm birth cases, followed by iatrogenic preterm birth and spontaneous preterm birth. But the causes of preterm birth in the 4 hospitals were different. Peking University Third Hospital had a higher incidence of iatrogenic preterm birth than the others (P<0.01), and Peking University First Hospital had a higher incidence of preterm birth caused by PPROM and lower incidence of spontaneous preterm birth. The first four reasons of iatrogenic preterm birth were preeclampsia (143, 42.0%), fetal distress (58, 17.1%), placenta previa (43, 12.6%) and placenta abruption (33,9.7%). (4) Neonatal outcomes in different hospitals: The neonatal outcomes were quite different among the 4 hospitals due to different causes and different delivery weeks. The highest neonatal mortality rate was found in Beijing Gynecological and Obstetric Hospital (5.4%, 22/408) compared to that in Women's and Children's Hospital of Haidian District (1.3%,4/320) and Peking University Third Hospital (0. 6%, 1/170) (P< 0.01), but without any difference when compared to that in Peking University First Hospital (2.4%, 3/ 124) (P>0.05). (5) Neonatal outcomes at different gostational age: The recovery rate of preterm infants delivered at <32 weeks was lower than those delivered ≥32 weeks (P<0.01), and this number rose to 99. 6% in those delivered ≥34 weeks. More infants delivered <32 weeks were given up for treatment or died during the perinatal period than those delivered ≥32 weeks, with the neonatal mortality rate of 22.1% for those delivered at <32 weeks and only 0.3% for those delivered at ≥ 34 weeks (P<0.01). (6) Neonatal outcomes for various causes: The premature neonatal mortality rate for iatrogenic preterm births was higher than that of PPROM (4.9% vs 1.6%, P<0.05). But the neonatal recovery rates were similar among the PPROM, spontaneous and iatrogenic preterm birth group (P>0.05). Conclusions Preterm birth is associated with high perinatal mortality rate, especially for those delivered before 32 weeks which would be highlighted in prevention. Reduction of the iatrogenic preterm birth, combined with proper prevention of PPROM, is an important issue in decreasing the prevalence of preterm birth.

OBJECTIVE: We explore the deformity degrees of external ear, mastoid process, tympanic cavity and auditory ossicle by the HRCT features of bilateral and unilateral patients of congenital abnormality of external and middle ear for preoperative analysis and selection for surgical approaches. METHOD: Twenty-nine patients were enrolled in our study, and HRCT were performed on all patients. There were 23 unilateral ears deformity (13 right and 10 left), 6 patients with bilateral ears deformity in the study group. Nineteen patients (19 ears) were treated with operations. RESULT: The deformity degree of auricle was correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. We got data of shortest distance from tympanic cape to atresia board in HRCT, (0.59 +/- 0.13)cm in comparison group, (0.45 +/- 0.19)cm in unilateral deformity group, (0.32 +/- 0.12)cm in bilateral deformity group, and there were significant differences compared the two deformity groups with the comparison group. There were 1 ear with normal auditory ossicle (2.86%), 5 ears with fixation of stapes foot board (14.29%), 3 ears with no auditory ossicle (8.57%); 26 ears with malleus and incus abnormality (74.29%). Abnormality of malleus was always concomitant with that of incus. Degeneration of malleus, the joint amalgamation of malleus and incus were discovered mostly in this research. CONCLUSION The deformity degree of auricle is correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. The shortest distance from tympanic cape to atresia board in HRCT in unilateral ears deformity group are shorten 0.15 cm in that of comparison group. And that of bilateral ears deformity group are shorten 0.25 cm in that of comparison group. The main abnormality of auditory ossicle in our research present in both malleus and incus, and degeneration of malleus and the joint amalgamation of malleus and incus are main types.
Adolescent ; Child ; Child, Preschool ; Ear Ossicles ; abnormalities ; Ear, External ; abnormalities ; diagnostic imaging ; Ear, Middle ; abnormalities ; diagnostic imaging ; Humans ; Malleus ; abnormalities ; Radiography ; Temporal Bone ; diagnostic imaging ; surgery ; Young Adult

Objective To investigate the short-term clinical effect of CT guided 125Ⅰ radioactive particle therapy in superficial malignant tumor. Methods The clinic data of 28 patients with metastatic superficial malignant tumor in our hospital were analyzed retrospectively.All patients were treated with CT guided 125Ⅰ radioactive particle therapy.The short-term effects,1 year survival rate and 1 year progression free survival rate of the patients were compared.Results Objective remission rate(ORR)and disease control rate(DCR)after 6 months were 92.86% and 100.00%.1 year overall survival and 1 year progression free survival were 96.43%(27/28)and 82.14%(23/28), respectively.The median overall survival and median progression free survival were 26.978 months (95%CI:22.558-31.399)and 16.932 months (95 % CI:14 .471-19.393).There were 27 cases of 0-Ⅱ degree adverse reactions,1 case of grade Ⅲ adverse reactions and no grade Ⅳ adverse reactions.No signs of 125Ⅰ radioactive particle translocation,vascular embolism and vascular rupture were found. Conclusion 125Ⅰ radioactive particle treatment of superficial malignant tumor has a definite short-term curative effect,with overall survival and progression free survival longer and higher safety,which can be considered in clinical application.

OBJECTIVETo investigate the distribution and expression of transforming growth factor beta (TGF-β) receptors I and II, p38 mitogen-activated protein kinase (p38 MAPK), and type I and type III collagen in the lungs of rats with silicosis and cultured pulmonary fibroblasts, and to investigate the relationship of the anti-fibrosis effect of N-acetyl-seryl-aspartyl-lysyl-proline (AcSDKP) with its inhibition of TGF-β receptor-mediated p38 MAPK pathway activity.

METHODSRats were randomly divided into control group, silicosis model group, and AcSDKP treatment group (n = 10 for each group). For the model group and AcSDKP treatment group, rats were intratracheally instilled with silica to establish a silicosis model. Cultured pulmonary fibroblasts from neonatal rats were divided into control group, TGF-β1 stimulation group, TGF-β receptor inhibition group, p38 MAPK pathway inhibition group, and AcSDKP treatment group. The protein expression of TGF-β receptors I and II, p38 MAPK, and type I and type III collagen were determined by immunohistochemistry and Western blot. The mRNA expression of TGF-β receptors I and II were determined by real-time PCR. The distribution and nuclear translocation of phospho-p38 MAPK in cultured fibroblasts were determined by laser scanner confocal microscopy.

RESULTSIn the AcSDKP treatment group, AcSDKP reduced the expression of TGF-β receptors I and II, phospho-p38 MAPK, and type I and type III collagen to 86.12%, 41.01%, 42.63%, 89.05%, and 52.71%, respectively, of those of the silicosis model group (P < 0.05). In cultured fibroblasts, AcSDKP reduced the mRNA expression of TGF-β receptors I and II to 42.26% and 54.33%, respectively, of those of the TGF-β1 stimulation group; the protein expression of TGF-β receptors I and II, phospho-p38 MAPK, and type 1 and type III collagen was reduced to 58.14%, 51.40%, 45.6%, 58.04%, and 44.74%, respectively, of those of the TGF-β1 stimulation group. The phospho-p38 MAPK translocation from plasma to the nucleus was also inhibited; the nucleus/plasma ratio of p38 MAPK and the protein expression of type I and type III collagen were reduced to 68.60%, 58.04%, and 44.74%, respectively, of those of the TGF-β stimulation group (P < 0.05).

CONCLUSIONAcSDKP can inhibit the expression of collagen through inhibition of TGF-β receptor-mediated p38 MAPK pathway activity, and is thus able to exert anti-fibrosis effect in rats with silicosis.

Animals ; Cells, Cultured ; Collagen ; metabolism ; Disease Models, Animal ; Fibroblasts ; drug effects ; metabolism ; MAP Kinase Signaling System ; drug effects ; Male ; Oligopeptides ; pharmacology ; Protein-Serine-Threonine Kinases ; metabolism ; Rats ; Rats, Wistar ; Receptors, Transforming Growth Factor beta ; metabolism ; Silicosis ; metabolism ; Transforming Growth Factor beta ; metabolism ; p38 Mitogen-Activated Protein Kinases ; metabolism

Objective:To investigate the clinical characteristics of family clustering pediatric and adult cases with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection in Shanghai City.Methods:A field investigation among the pediatric cases with Omicron variant infection and their household contacts from April 4 to April 30, 2022 in Children′s Hospital of Fudan University was conducted. The informations on case finding, clinical manifestations and SARS-CoV-2 vaccination status were collected. The epidemiological and clinical characteristics were compared between pediatric cases and adult cases. The independent sample t test or chi-square test was used for statistical analysis, and the relative risk ( RR) and 95% confidence interval (95% CI) were used to evaluate the protective effect of vaccination on the infection of Omicron variant. Results:There were 1 274 family members in 297 families including 370 children and 904 adults of whom 1 110(87.13%) were infected with Omicron variant, with 989(89.10%) symptomatic and 121(10.90%) asymptomatic. There were 355 children infected with Omicron variant, of whom 337(94.93%) were symptomatic, and the main manifestations were fever (96.74%(326/337)) and cough (40.36%(136/337)). Only one pediatric case with Rett syndrome developed critically severe pneumonia. A total of 194 pediatric cases had imaging examination, 64(32.99%) showed pulmonary inflammatory lesions. There were 755 adult cases infected with Omicron variant, of whom 652(86.26%) reported symptoms, and the main manifestations were fever (73.16%(477/652)) and cough (49.85%(325/652)). Among symptomatic cases, fever was more common in pediatric cases than in adult cases, while cough was more common in adult cases than in pediatric cases, and the differences were both statistically significant ( χ2=80.87 and 8.04, respectively, both P<0.01). The fever spike was higher in pediatric cases than in adult cases ((39.3±0.7) ℃ vs (38.6±0.6) ℃), and the difference was statistically significant ( t=9.85, P<0.001). The interval from the onset of symptoms to cycle threshold (Ct) value of the nucleic acid of Omicron variant≥35 was longer in pediatric cases than in adult cases ((13.0±3.1) d vs (10.9±3.6) d), and the difference had statistically significance ( t=2.97, P=0.004). Among 160 children aged 3 to 18 years, 54 (33.75%) received two-dose vaccination. Among the 904 adults, 388 (42.92%) received two-dose vaccination and 293 (32.41%) received a booster dose. In the adult cases, the risk of symptomatic infection was reduced by only 8% ( RR=0.92, 95% CI 0.86 to 0.98, P=0.014) following two-dose vaccination, and the risks of fever and cough following booster vaccination were reduced by 42%( RR=0.58, 95% CI 0.49 to 0.67, P=0.001) and 50% ( RR=0.50, 95% CI 0.34 to 0.78, P=0.001), respectively. Conclusions:Secondary attack rate and symptomatic rate of household infection are high in the context of the Omicron variant outbreak in Shanghai. Symptomatic infection is common in children and adults in household setting. Fever is the most common symptom and fever duration is short. Booster vaccination may provide certain protection against common symptoms caused by Omicron variant infection.

Objective:To understand the clinical characteristics of children with SARS-CoV-2 Omicron infection imported from Hong Kong Special Administrative Region.Methods:This retrospective study was conducted to collect the data including clinical manifestations, outcomes and vaccination of 107 children with SARS-CoV-2 Omicron infection imported from Hong Kong Special Administrative Region to be admitted to the designated referral hospital in Shanghai from February to March 2022. According to the occurrence of clinical symptoms, the cases were divided into asymptomatic group and symptomatic group. According to the age of diagnosis, the cases were divided into <3 years group, 3-<6 years group and 6-<18 years group, and the clinical manifestations in different age group were analyzed with t-test and Mann-Whitney rank-sum test. Besides, to analyze the effectiveness of vaccination against SARS-CoV-2 Omicron infection in different age group, the cases aged 3-<18 years were also subdivided into unvaccinated group, 1-dose group and 2-dose group, and the relative risk ( RR) was used to demonstrate the effectiveness. Results:Among the 107 cases, 66 were male and 41 were female, with infection age of 10 (5, 14) years. There were 29 cases in the asymptomatic group, and 78 cases in the symptomatic group, and no significant difference in the age of infection was observed between the 2 groups (11 (6, 14) vs. 10 (5, 14) years, Z=0.49, P>0.05). And there were no severe cases in symptomatic group. The length of hospitalization was (18±6) days, and was longer in symptomatic group than that in asymptomatic group ((19±6) vs. (16±7) d, t=0.17, P=0.030). Eight-two cases (76.6%) had a history of epidemiological exposure and, among whom, 81 cases (75.7%) were associated with household transmission. Among symptomatic group, 57 cases (73.1%) had fever and 20 cases (25.6%) had cough. Of the 74 cases undergoing chest CT examination, 17 cases (23.0%) showed mild abnormalities. Of the 83 cases who received the lab tests, 23 cases (27.7%) had white blood cell counts<4×10 9/L, 3 cases (3.6%) had C-reaction protein >8.0 mg/L, and 6 cases (7.2%) had slightly elevated aspartate transaminase and alanine aminotransferase. Among the 92 children aged 3-<18 years, 31 cases were unvaccinated, 34 cases received 1 dose, and 27 cases received 2 doses. The interval between the last vaccination and infection was 2.2 (0.6, 6.0) months; the interval between the last vaccination and infection in the 2-dose group was longer than that in 1-dose group (6.0 (4.5, 7.3) vs. 0.7 (0.3,2.0) months, Z=3.59, P<0.001).The risk of symptomatic infection was reduced by 45% (RR=0.55, 95% CI 0.35-0.87) with two-dose vaccination compared to non-vaccination in cases aged 3-<18 years. All these cases recovered completely. Conclusions:Children infected with SARS-CoV-2 Omicron are usually mild or asymptomatic. Household transmission is the main pattern of infection with SARS-CoV-2 Omicron in children. Two-dose SARS-CoV-2 vaccination in children aged 3-<18 years can provide partial protection against disease caused by SARS-CoV-2 Omicron.

Objective To explore the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI T1 mapping,R2*quantitative parameters,and their combined indicators in assessing liver function in patients with hepatitis B cirrhosis.Methods The data from 52 patients with hepatitis B cirrhosis who underwent Gd-EOB-DTPA enhanced MRI and modified Dixon quantification(mDixon-Quant)scans were analyzed retrospectively.Patients were divided into three groups based on Child-Pugh scores:Child-Pugh A,B,and C.T1 mapping images were obtained pre,mid,and HBP.Quantitative values of T1 relaxation time reduction rates(△T1 mid and △T1 HBP),liver-related T1 relaxation times(T1 pre,T1 mid,and T1 HBP),fat fraction(FF),and R2* were measured and calculated.One-way ANOVA was used to compare the differences in MRI quantitative parameters between different Child-Pugh grading groups.Spearman's rank correlation analysis was performed to assess the correlation between MRI quantitative parameters and Child-Pugh grading.The receiver operating characteristic(ROC)curve was used to evaluate the performance of distinguishing liver function classification by statistically significant MRI parameters.Results Between different Child-Pugh grading groups,the differences in T1 mid,T1 HBP,△T1 mid,△T1 HBP,and R2*were statistically significant(P＜0.05),however T1 pre and FF were not statistically significant(P＞0.05).T1 mid,T1 HBP and R2*were positively correlated with Child-Pugh grading(rs=0.365,0.566,0.597,respectively;P＜0.05),meanwhile △T1 mid and△T1 HBP were negatively correlated with Child-Pugh grading(rs=-0.680,-0.771,respectively;P＜0.05).There were no significant correlations between T1 pre,FF and Child-Pugh grading(P＞0.05).The area under the curve(AUC)of T1 HBP,△T1 mid,△T1 HBP,R2*and their combined indicators for distinguishing Child-Pugh A grade from Child-Pugh B grade were about 0.888,0.784,0.955,0.764,and 0.961,respectively(P＜0.05).The AUC of △T1 mid,△T1 HBP,R2* and their combined indicators for distinguishing Child-Pugh B grade from Child-Pugh C grade were about 0.853,0.860,0.797,and 0.941,respectively(P＜0.05).Conclusion Gd-EOB-DTPA enhanced MRI T1 mapping and R2*quantitative parameters can be used to independently evaluate the status of liver function in hepatitis B cirrhosis,and the combined evaluation of the two kinds of parameters has a higher diagnostic efficiency.