Objective To analyze the levels of serum total bilirubin in patients and healthy con-trols, eatablish a method of using the mean of total bilirubin in serum of patients to control internal quality, and validate the reference range. Methods Frequencies mode of SPSS13.0 statistic software package was applied to performing analysis of all data, and then the analytic interval was determined based on the frequencies of the data. The daily data mean in the analytic interval was calculated. With the daily data mean as the testing data, the quality control was carried out by the same way of quality control for quality control sample. At the end of each month, the means of various analyzers were compared. Based on the results of healthy controls, the formula mean±1.96s was used to validate the current reference range. Results With the daily data mean as the testing data for quality control, its coefficient variation was within the accepatable limit, and the 95% distribition range was the same as the current reference interval. Conclusion It is necessary to establish suitable interval in which the da-ta mean was used for internal quality control. The current reference range in our hospital is proper.

[Objective]To study the repair of articular cartilage defects with combined bone morphogenetic protein(BMP)/basic fibroblast growth factor(bFGF)biomaterial in order to supply experimental basis for repairing cartilage defects biologically.[Method]Twenty-four 14-week-old rabbits were randomly divided into four groups,BMP/bFGF biomaterial gel(group A),BMP biomaterial gel(group B),bFGF biomaterial gel(group C)and simple fibrin glue treated group(group D).A couple of knees of each rabbit experienced 5 mm-diameter-full cartilage resection and drilling throuth of bone marrow.Gross appearance,histologicol section and electron microscope were axamined at 8,12,24 weeks after operation.[Result]In group A the cartilage defects were smoothly repaired by white translucent hard tissue at 8 and 12 weeks,and defect boundary was hard to be indentified with normal cartilage at 24 weks.No smooth repairing was observered in B,C and D groups.Group A got a better histological score than B,C and group D(P0.05).[Conclusion]Combined BMP/bFGF biomaterial is good for repair of articular cartilage defects and has better result than using BMP or bFGF alone.These results may provide a therapy for articular cartilage defects.

Objective To investigate the distribution and drug resistance of Pseudomonas aeruginosa(PAE) in the hospital ,so as to provide the reference for the rational drug use and the infection control in clinical .Methods The infection distribution and drug resistance of 822 isolates of PAE were analyzed .The drug sensitivity test was proceeded by dilution method ,and the results were judged according to the relevant documents of the CLSI .The data was analyzed by WHONET 5 .6 software .Results 822 isolates of PAE were mainly distributed in intensive care unit ward ,general surgical department and respiration department .The sample was 82 .1% from sputum .The infection rate was the highest in autumn(30 .0% ) .The drug resistance rate of PAE to cefperazone/sul-bactam was the lowest(7 .6% ) ,and which to amikacin was 19 .1% .The resistance rates of PAE to other drugs were all higher than 20 .0% .Conclusion PAE is a common pathogen of respiratory tract infection ,which has a high resistance rate to the current clini-cal antibacterial agents ,and doctors should pay attention to the infection caused by PAE .

Objective To study the effects of human bronchial epithelial cells (BEAS-2B cells ) coculture together with human eosinophils on intercellular adhesion molecule (ICAM-1) expression on BEAS-2B cell surface.Methods BEAS-2B cells cocultured contact with eosinophils for 4 h and 12 h,total RNA was extracted and ICAM-1 gene in BEAS-2B cells were analyzed by reverse transcription polymerase chain reaction (RT-PCR); ICAM-1 protein on BEAS-2B cell surface was assayed by fluorescent antibody in flow cytometry.Results ICAM-1 gene expression in BEAS-2B cells was upregulated and ICAM-1 protein on BEAS-2B cell surface increased by coculture with eosinophils.Conclusion Coculture of BEAS-2B cells and eosinophils might induce BEAS-2B cells to express ICAM-1.

Objective To compare the screening effects between Wells and revised Geneva scores on suspected acute pulmonary thromboembolism (APTE),and to explore a optimum screening method for APTE in the emergency department of China.Methods The study was carried out by using random,crossed,prospective methods to compare the screening effects between Wells and revised Geneva scores for 167 suspected APTE patients in the emergency department of the First Affiliated Hospital of Xiamen University.Results The areas under the receiver operating characteristic curve of Wells and revised Geneva scores for screening APTE in the emergency department were (0.917 ± 0.022 ) and (0.927 ± 0.020),respectively ( P ＜ 0.05 ).The diagnostic concordance between the two score systems for predicting APTE was poor (Kappa value =0.276 ). In addition, the difference between their hierarchical discrimination for the possibility of APTE was statistically significant ( P ＜ 0.05 ).Compared with revised Geneva score,fewer patients were diagnosed with low clinical probability of APTE and more patients were diagnosed with intermediate or high clinical probability of APTE through Wells score.The patients with low chnical probability of APTE were excluded from pulmonary embolism in Wells or revised Geneva score.At intermediate clinical probability,the accuracy rate of Wells score for predicting APTE (9.64％) was lower than that (32.84％ ) of revised Geneva ( P ＜ 0.05 ).At high clinical probability,there was no significant difference between their accuracy rate [ (67.24％ vs.86.21％),P＞0.05]. Conclusions Revised Geneva score is more suitable than Wells score in screening suspected APTE patients in the emergency department in our country.

A total of 192 patients with sepsis were tested by Montreal Cognitive Assessment (MoCA) for a preliminary diagnosis of whether or not there was sepsis associated encephalopathy (SAE) according to their test results.SAE was diagnosed or excluded after consultations and comprehensive analysis on the basis of clinical manifestations and auxiliary examination results.The scores of the patients in this group were (25.7 ± 3.3) points.The sensitivity of MoCA for screening SAE was 0.776 and its specificity 0.963.The rate of diagnostic coincidence between MoCA and comprehensive analysis for SAE was 0.880.The diagnostic concordance between two diagnostic methods of SAE was excellent (kappa value =0.753 ± 0.048,P =0.000).The area under the receiver operating characteristic (ROC) curve of MoCA for screening SAE was 0.929 ± 0.019 (P =0.000) ; the optimal cutoff value was 25.5 points; and its sensitivity was 0.779 and specificity 0.962.And negative correlations existed between score of MoCA and age,disease course and co-existing shock or multiple organ dysfunction syndrome (P ＜ 0.05).

Objective:To establish an early prediction model with multiple indicators to predict the risk of severe acute pancreatitis (SAP) in hyperlipidemic acute pancreatitis (HLAP).Methods:The clinical data of 92 patients with HLAP admitted to the Emergency Department of our hospital from March 2018 to February 2020 were analyzed retrospectively. Among them, 29 cases deteriorated to SAP and 63 cases did not. Univariate analysis was used to screen predictive indicators related to hyperlipidemic severe acute pancreatitis (HL-SAP), and logistic regression analysis was used to screen independent predictive indicators related to HL-SAP. Then a prediction model was established. The area under (AUC) the receiver operating curve (ROC) was used to evaluate the predictive ability of each predictive indicator and the model for HL-SAP. Bootstrap resampling technology was used to validate the predictive ability of the model.Results:Univariate analysis showed that procalcitonin, D-dimer, C-reactive protein, albumin, cholesterol and CT grade had influence on the progression of HLAP to SAP ( P<0.05). Logistic regression analysis showed that D-dimer ( OR=2.112, 95% CI: 1.022-4.366; P<0.05), CT grade ( OR=5.818, 95% CI: 2.481-13.643; P<0.01) and cholesterol ( OR=1.146, 95% CI: 1.004-1.308; P<0.05) were independent risk factor of HL-SAP. The AUC of D-dimer, CT grade, cholesterol and the model were 0.802, 0.875, 0.665 and 0.927, respectively. Internal validation of the predictive ability of the model showed that the C-index was 0.927. Conclusions:In the early phase, application of the prediction model that composes D-dimer, CT grade and cholesterol has a good predictive effect on HL-SAP.

Objective:To compare the efficacy of 3D-printed guide plate assisted versus freehand placement of cannulated screws for the treatment of Sanders type II and III calcaneal fractures.Methods:A retrospective cohort study was conducted to analyze the clinical data of 29 patients with Sanders type II and III calcaneal fractures admitted to Chonggang General Hospital from June 2020 to October 2022. Among them, there were 18 males and 11 females, with an age range of 22-69 years [(40.1±11.5)years]. Nineteen patients were treated with individualized 3D-printed guide plate assisted placement of cannulated screws (3D-printed group) and 10 were treated with freehand placement of cannulated screws (freehand group). The surgical time, fluoroscopy times, postoperative 6-month calcaneal morphology (length, width, height, B?hler angle and Gissane angle), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Maryland functional score assessed at 3, 6 months after operation and at the final follow-up were compared between the two groups. The incision healing and complications were observed.Results:The patients were followed up for 6-24 months [(11.3±2.5)months]. The surgical time and fluoroscopy times in the 3D-printed group were (53.4±9.1)minutes and (7.3±1.1)times, respectively, which were shorter than (90.2±16.0)minutes and (16.0±3.2)times in the freehand group (all P<0.01). At 6 months after operation, there was no significant difference in calcaneal length between the two groups ( P>0.05); the calcaneal width, height, B?hler angle and Gissane angle in the 3D-printed group [(34.0±1.8)mm, (47.2±1.6)mm, (27.8±1.0)°, (129.2±2.8)°] were superior than those in the freehand group [(37.5±2.0)mm, (43.0±2.7)mm, (25.8±1.5)°, (125.9±2.5)°] (all P<0.01). At 3, 6 months after operation and at the final follow-up, the values of AOFAS ankle-hindfoot score in the 3D-printed group [(72.2±2.3)points, (79.7±2.3)points, (86.5±4.4)points] were higher than those in the freehand group [(64.2±6.9)points, (73.4±4.2)points, (81.8±3.1)points] (all P<0.05); the values of Maryland score in the 3D-printed group [(71.4±7.7)points, (84.7±2.6)points, (91.5±2.5)points] were higher than those in the freehand group [(65.2±5.6)points, (79.1±3.8)points, (87.1±2.9)points] (all P<0.05). All surgical incisions were healed in stage I. In the 3D-printed group, there were no complications regarding infection, iatrogenic vascular or nerve injury, or fixation failure after surgery. In the freehand group, one patient with lateral sural cutaneous nerve injury was resolved spontaneously without specific treatment. Conclusion:Compared with freehand placement of cannulated screws, 3D-printed guide plate assisted placement of percutaneous placement has the advantages of shorter surgical time, fewer fluoroscopy times, lower reduction loss, better ankle joint function recovery, and less complications in treating Sanders type II and III calcaneal fractures.

Anesthesia was done for 36 patients undergoing orthotropic heart transplantation in Bei-jing Anzhen Hospital from April 2015 to November 2016. Anesthesia management for orthotropic heart transplantation and related problems were analyzed and investigated. Anesthesia management protocol for patients with end-stage heart disease was aimed at reducing fluctuation of hemodynamics and avoiding malig-nant arrhythmia. Anesthesia was induced by intravenously injecting diazepam 5-10 mg, etomidate 0. 2-0. 3 mg∕kg or ketamine 1 mg∕kg, sufentanil 1. 0-1. 5 μg∕kg or fentanyl 10-15 μg∕kg and rocuronium 0. 6 mg∕kg. Anesthesia was maintained by continuously infusing dexmedetomidine 0. 3-0. 5μg·kg-1 ·h-1 , ci-satracurium 10 mg∕h and sufentanil 0. 5-1. 0 μg·kg-1 ·h-1 . Pulmonary arterial pressure and donor heart function were monitored using the flow-directed pulmonary artery catheter. Dopamine, epinephrine and iso-prenaline were intravenously infused after cardiopulmonary bypass to maintain circulation stable. Nitroglyc-erin and prostacyclin were intravenously infused to decrease pulmonary arterial pressure. Immunosuppressive therapy was performed with methylprednisone, mycophenolate mofetil and cyclosporine∕FK506. Thirty-two patients were discharged from hospital, and 4 cases died. Among the 4 patients died, 1 patient died of pul-monary hypertension ( pulmonary arterial systolic pressure>67 mmHg) and right heart failure and, 1 patient showed difficulty in weaning from cardiopulmonary bypass and 2 patients died of refractory low cardiac outputand multi-organ failure. Anesthetic management for heart transplantation required an appreciation of the pathophysiological mechanism of heart failure. Invasive monitoring, steady anesthesia induction and mainte-nance, stable hemodynamics in the perioperative period and good donor heart protection were the keys to ensuring anesthesia management for orthotropic heart transplantation.