ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(P<0.05). After 4 weeks of treatment,compared with model group,body weight and serum content of ADH increased in Ootheca Mantidis groups,while urinary volume and renal index decreased (P<0.05);serum content of ALD increased in treatment groups;there was statistical significance in the serum content of ALD in those groups except Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group and steamed Ootheca Mantidis group (P<0.05);except for ALD,those index were in descending order of steamed Ootheca Mantidis group>Ootheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.

Actinomyces ; growth & development ; Coinfection ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; diagnosis ; microbiology

Chronic hepatitis B infection is a very important health problem in China, which is carrying an enormous economic and social burdens. The major routs of chronic hepatitis B infection in China are mother-infant vertical transmission and early childhood horizontal transmission. After more than 10 years implementation of universal vaccination against hepatitis B in newborns and safety injection in health care settings, the prevalence of HBsAg in general population has decreased from 9.75% to around 7%. In China, patients with hepatitis are cared by either hepatologists or physicians of infectious diseases. The Chinese Society of Hepatology, and Chinese Society of Infectious Diseases jointly issued an evidence-based guideline on the prevention and treatment of chronic hepatitis B in 2005. This guideline concisely describes the virology, epidemiology, natural history and prevention, as well as diagnosis and management of chronic hepatitis B. It also highlights the importance of active viral replication in disease progression in chronic HBV infection and explicitly states the necessity of antiviral therapy in patient care. The cornerstone of anti-hepatitis B therapy is optimal use of interferons or nucleos(t)ide analogs in those patients with active viral replication and elevated serum transaminase levels. Through an independent continue medical educational agency, a panel of selected speakers were trained to give well-formatted talks on the key points of the guideline in over 60 major cities across China. This educational campaign among health care providers has greatly improved the awareness and the stand of care for antiviral therapy.

Galectin-3 (gal-3),a member of the galectin family,is directly associated with cardiac fibrosis and cardiac remodeling.Recently it has been approved by the US Food and Drug Administration as a prognostic aid in patients with heart failure (HF).Gal-3 is associated with age,kidney function and B-type natriuretic peptide (BNP).Compared with the diagnostic utility of BNP,the long-term prognosis value of gal-3 is higher than the value of diagnosis.Higher concentration of Gal-3,a marker of cardiac fibrosis,is associated with increased risk for incident CHF and mortality.

Objective To research the treatment of cervical HR-HPV infection by vaginal douching with eight kinds of antiviral herbs such as Radix Arnebiae and patrinia.Methods 42 patients with 13 types of cervical HR-HPV infection were selected from Outpatient.27 patients were recruited into a treatment group and 15 patients were recruited into a control group voluntarily.The treatment group was applied with antiviral herbs and the control group was applied with policresulen vaginal suppositories for 3 courses (one course for 7 days per month).The clearance rate and loading dose of 13 types of cervical HR-HPV were observed.Results The negative conversion ratio of the treatment group and the control group was 88.5％ and 15.4％ respectively,and the total efficiency was 100％ and 46.2％ in the treatment group and the control group respectively.The total efficiency between the two groups were significantly different(x2=17.062,P＜0.01).Conclusion The therapeutic effect of antiviral herbs for cervical HR-HPV infection was definite and with no side reactions.

Medical liability insurance is a latecomer in China,and faced with many challenges ever since.This paper picked medical liability insurance in Nanjing as an empirical study example,as the author analyzed the insurance,underwriting and premiums of medical liability insurance,as well as the insurance programs and claim settlements from 2008 to 2012.In addition to noting problems found in medical liability insurance in Nanjing,the author proposed the roadmap for China' s medical liability insurance,with reference to experiences of overseas medical liability insurance industry.

Objective To compare the efficacy of suspended laparoscope and traditional laparotomy in the treatment of tubal pregnancy.Methods 160 cases of tubal pregnancy were treated by traditional laparotomy (A group,n =100) and suspended laparoscope(B group,n =60).The curative effect was compared between the two groups.Results In group B,the operation time was (45.70 ± 3.76) min,the volume of bleeding during the operation was (29.10 + 6.17) ml,anal exhaust time after operation was (17.70 + 7.75) h,post-operative off-bed time was (23.13 ± 7.55) h,postoperative hospitalization time was (4.52 ± 1.10) d,postoperative pain observed in 12 cases,10 cases had postoperative fever,postoperative poor wound healing in 0 case.Those in group A were (47.01 ± 3.83)min,(40.07 ±6.02)m1,(23.90 ±7.86)h,(27.87 +9.06)h,(6.26 ± 1.14) d,38 cases,35 cases,9 cases,the differences between the two groups were statistically significant(t =2.1101,11.0477,4.8568,3.4022,9.4835,x2 =5.6199、6.1961、4.1521,P ＜0.01).The decline of blood human chorionic gonadotropin had no significant difference between the two groups after operation.Conclusion Suspended laparoscope in treatment of tubal pregnancy is better than traditional laparotomy,it is effective,minimally invasive and safe.

Objective To explore the influence of hypertension on acute myocardial infarction.Methods According to patients with or without previous history of hypertension,100 patients with acute myocardial infarction were divided into the observation group(with previous history of hypertension) 58 cases and control group (without previous history of hypertension) 42 cases.The onset of chest pain,cardiac function classification,complications,hospital mortality were compared between the two groups.Results The probability of the onset of chest pain of the observation group(77.59％) was significantly higher than that of the control group(47.62％) (χ2 =9.616,P ＜0.05).The patients with heart function of class I in the observation group(29.31％) was significantly less than that in the control group(54.76％) (χ2 =6.575,P ＜ 0.05).The incidence of heart failure (46.55％) and arrhythmia (51.72 ％) of the observation group was significantly higher than those in the control group (23.81％,2 8.57 ％)(χ2 =5.405,11.152,all P ＜ 0.05) ； The hospital mortality of the observation group (20.69％) was significandy higher than that of the control group(14.29％) (χ2 =10.952,P ＜ 0.05).Conclusion Hypertension may have an obvious effect on acute myocardial infarctiont.Controlling hypertension actively,giving comprehensive nursing to patients and health education can help to control the fatality rate.

Objective To investigate the relationship of the single nucleotide polymorphism (SNP) of interleukin-18 (IL-18) gene promoter region-607C/A and-137G/C loci and response to interferon (IFN) treatment in patients with chronic hepatitis C (CHC).Methods A total of 199 CHC patients received combination therapy of IFNα or PegIFNα and Ribavirin in the First Affiliated Hospital,Shanxi Medical University from September 23rd,2005 to August 20th,2012 were enrolled.And 180 healthy subjects were recruited as controls.The SNPs of IL-18 gene promoter region-607C/A and-137G/C loci were detected by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP).Genotype distribution,allele frequency,and the relationships between SNPs in-607C/A and-137G/C loci and response to IFN treatment were analyzed byx2 test.Results-137GG genotype distribution and-137G allele frequency were significantly higher in CHC patients than those in healthy controls (x2 =6.612 and 6.476,P =0.010 and 0.011),whereas-137GC genotype was the opposite (x2 =5.548,P =0.019).Patients with -607AA genotype had higher sustained virological responses (SVRs) to IFN treatment compared with those with-607CA or-607CC genotypes (x2 =4.195 and 5.230,P =0.041 and 0.022).And patients with -607A allele had higher SVRs to IFN treatment compared with those with-607C allele (x2 =5.903,P =0.015).Patients with-137GC genotype had higher SVR to IFN treatment compared with those with-137GG genotype (x2 =5.869,P =0.015),and patients with-137C allele had higher SVRs to IFN treatment compared with those with-137G allele (x2 =3.885,P =0.049).Conclusions Patients with-607AA and -137GC genotypes have higher SVRs to IFN treatment than those with other genotypes.-137G allele seems to be associated with the susceptibility to HCV infection,while-607A and-137C alleles may be correlated with higher SVR to IFN treatment.