ObjectiveTo investigate the correlation between procalcitonin (PCT), C-reactive protein (CRP) and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score and sequential organ failure assessment (SOFA) score, and to investigate the value in assessment of PCT and CRP in prognosis in patients with sepsis.Methods Clinical data of patients admitted to intensive care unit (ICU) of Changzheng Hospital Affiliated to the Second Military Medical University from January 2011 to June 2014 were retrospectively analyzed. 201 sepsis patients who received PCT and CRP tests, and evaluation of APACHEⅡ score and SOFA score were enrolled. The values of PCT, CRP, APACHEⅡ score and SOFA score between survivals (n = 136) and non-survivals (n = 65) were compared. The values of PCT and CRP among groups with different APACHEⅡ scores and SOFA scores were compared. The relationships between PCT, CRP and APACHEⅡ score and SOFA score were analyzed by Spearman correlation analysis. Receiver operating characteristic (ROC) curve was plotted to assess the prognostic value of PCT and CRP for prognosis of patients with sepsis.Results Compared with survival group, the values of PCT [μg/L: 11.03 (19.17) vs. 1.39 (2.61), Z= -4.572,P< 0.001], APACHEⅡ score (19.16±5.32 vs. 10.01±3.88,t = -13.807,P< 0.001) and SOFA score (9.66±4.28 vs. 4.27±3.19,t = -9.993,P< 0.001) in non-survival group were significantly increased, but the value of CRP was not significantly different between non-survival group and survival group [mg/L: 75.22 (110.94) vs. 56.93 (100.75),Z = -0.731,P = 0.665]. The values of PCT were significantly correlated with APACHEⅡ score and SOFA score (r1 = 0.373,r2 = 0.392, bothP< 0.001), but the values of CRP were not significantly correlated with APACHEⅡscore and SOFA score (r1 = -0.073,P1 = 0.411;r2 = -0.106,P2 = 0.282). The values of PCT rose significantly as the APACHEⅡ score and SOFA score became higher, but the value of CRP was not significantly increased. When APACHEⅡ score was 0-10, 11-20, and> 20, the value of PCT was 1.45 (2.62), 1.96 (9.04), and 7.41 (28.9)μg/L, respectively, and the value of CRP was 57.50 (83.40), 59.00 (119.70), and 77.60 (120.00) mg/L, respectively. When SOFA score was 0-5, 6-10, and> 10, the value of PCT was respectively 1.43 (3.09), 3.41 (9.75), and 5.43 (29.60)μg/L, and the value of CRP was 49.30 (86.20), 76.00 (108.70), and 75.60 (118.10) mg/L, respectively. There was significant difference in PCT between any two groups with different APACHEⅡ and SOFA scores (P< 0.05 orP<0.01), but no significant differences in CRP were found. The area under the ROC curve (AUC) of PCT for prognosis was significantly greater than that of CRP [0.872 (95% confidence interval 0.811-0.943) vs. 0.512 (95% confidence interval 0.427-0.612),P< 0.001]. When the cut-off value of PCT was 3.36μg/L, the sensitivity was 66.8%, and the specificity was 45.4%. When the cut-off value of CRP was 44.50 mg/L, the sensitivity was 82.2%, and the specificity was 80.3%.Conclusions Compared with CRP, PCT was more significantly correlated with APACHEⅡ score and SOFA score. PCT can be a better indicator for evaluation of degree of severity, and also prognosis in sepsis patients.

Objective To report long term results of 30 patients with primary intracranial germinoma and evaluate the treatment policy. Methods After the tumor of these 30 patients was completely or partially removed they were routinely given radiation therapy with the conventional extenal irradiation. Of these 30 patients, 28 received prophylactic whole brain irradiation followed by the cone down technique to the local site to an effective dose except 2 patients who were treated locally without prophylactic irradiation.Nineteen patients received prophylactic spinal cord irradiation.Results The overall 5 ,10 , 15 ,19 year survival rates were 93.1%, 87.6% ,87.6% and 68.2%,respectively.The two patients who did not receive prophylactic whole brain irradiation (1 patient) or too low a dose of that (1 patient) developed metastasis in the brain and spinal cord were given a second course of radiotherapy. One survived for 17 years and the other is living now over 10 years. The overall response rate (CR + PR) was 95%.Conclusions While surgery is indicated to reduce the tumor volume, shunt the hydrocrania and obtain a pathologic diagnosis, radiotherapy is invaluable to cure germinoma. Prophylactic whole brain irradiation of 26～30 Gy is necessary and the curative local dose should be 50～55 Gy. Prophylactic spinal cord irradiation is not indicated routinely except some appropriate patients. For patients younger than 14 years, shielding of the pituitary is necessary while the prophylactic whole brain is being irradiated. The tumor dose at the sella turcica region should be limited to 56 Gy, and the spinal cord need not be irradiated prophylactically.

Objective To explore the MRI findings of Wernicke encephalopathy so that to improve the knowledge of this disease.Methods MRI data of Wernicke encephalopathy in 7 cases were retrospectively analyzed.Results Symmetrical abnormal signal intensity was appeared in bilateral thalamus and the area around the third cerebral ventricle in 6 cases,in the area around aqueduct and pontine in 7 cases and in mammillary body,hypothalamus,fornix and the four cerebal ventricles in 2 cases.Above mentioned lesions showed long T1 and long T2 signal intensity and high signal intensity on fluid-attenuated inversion recovery(FLAIR),and high signal intensity on DWI in 2 cases.The lesions were enhanced in 2 cases and small vessels were radial enhancement around lateral ventricle in 1 case after administration of Gd-DTPA.Conclusion Wernicke encephalopathy has definite MR imaging findings,which is of important value in clinical diagnosis and treatment.

Objective To investigate clinical effect of surgical treatment of complex scapular fracture with improved minimally invasive Judet approach and annularity internal fixation.Methods In this retrospective study,17 patients with complex scapular fracture accepted open reduction and internal fixation with improved minimally invasive Judet approach complying with the three points-two lines annularity internal fixation principle.After postoperative rehabilitation training,the curative effect was evaluated by the neer shoulder joint function score evaluation.Results All the 17 patients were followed up for 14 months on average (12-25 months).According to neer score evaluation,the percent of patients with excellent and good results was 88.2％ (excellent:12 cases;good:3 cases;middle:2cases;unsatisfactory:no case).Conclusions Improved minimally invasive Judet approach hase simple operation,adequate exposure and less injury.Annularity internal fixation complying with the three points-two lines principle is a safe and effective method for the treatment of complex scapular fracture.

Objective To investigate the effects of rhubarb combined with glutamine on repair of gut mucosal barrier injury after gastrointestinal surgery in rats. Methods Fifty male healthy Sprague-Dawley(SD)rats were randomly divided into five groups:control(C group),enteral nutrition(EN group),rhubarb with EN(R-EN group), glutamine with EN(G-EN group)and rhubarb combined with glutamine and EN(R-G-EN group)groups(each n=10). The rats of C group received no treatment and were fed normally. Cecectomy and gastrostomy were performed in EN,R-EN,G-EN and R-G-EN groups,and in 24 hours after surgery,they were interfered with the use of amoxicillin 50 mg/d and metronidazole 20 mg twice a day. From the first day after operation,each group was treated with the same prescription of enteral isocaloric and isonitrogenous nutrition for consecutive 7 days. Seven days later, under anaesthesia,laparotomy was performed,and a specimen of 1 cm intestinal segment was taken from the terminal 5 cm long ileum for all the groups;under the light microscope,the morphological examination of intestinal mucosal epithelial tight junctions(including villus height and mucosal thickness)was carried out. For each group,enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of plasma citruline and D-lactate,and the serum concentration of TNF-αwas detected by utilizing double antibody ABC-ELISA. Results The levels of D-lactate and TNF-αin EN,R-EN,G-EN and R-G-EN groups were obviously higher than those in C group(all P<0.01). The level of plasma citruline(μmol/L:16.13±0.58 vs. 14.52±0.28)of R-G-EN group was remarkably higher than that in R-EN group(P<0.05),and its levels of serum D-lactate(mmol/L:3.12±0.56 vs. 3.62±0.52)and TNF-α(ng/L:2.82±0.62 vs. 3.54±0.49)were markedly lower than those of G-EN group(both P<0.05). The mucosal villus height(μm:126.50±6.31 vs. 175.67±11.91),mucosal thickness(μm:223.67±11.94 vs. 277.00±14.06)and the level of plasma citruline(μmol/L:13.25±0.36 vs. 15.67±0.55)in EN group were obviously lower than those of C group(all P<0.01);the above indexes of R-EN,G-EN and R-G-EN groups were higher than those of EN group (P<0.05 or P<0.01),but in the comparisons of the villus height and mucosal thickness among the three groups there were no statistical significant differences(all P>0.05). Conclusion The application of rhubarb combined with glutamine can protect gut mucosa,reduce the level of inflammatory reaction and elevate the level of plasma citruline, that is beneficial to the repair of gut mucosal barrier injury and its functional recovery after gastrointestinal surgery in rats.

Objective To observe apoptosis and proliferation of intestinal epithelial cells and to explore the mechanism of protective effects of rhubarb monomers on intestinal epithelial cells in septic rats.Methods Eighty male Sprague-Dawley (SD) rats (230-250 g) under anesthesia and sedation were subjected to cecal ligation and perforation (CLP).After surgical preparation,rats were randomly (ramdom number) divided into 8 groups (n =10 each):a sham group (A) [normal saline (NS) gavage];a sepsis group (B) (NS gavage);group C (ip dexamethasone 0.5 mg/kg immediately after CLP) (C);and rhubarb monomer 100 mg/kg in NS treated groups including:rhein group (D),emodin group (E),3,8-dihydroxy-1-methyl-anthraquinone-2-carboxylic acid group (F),1-O-caffeoyl-2-(4-hydroxy-O-cinnamoyl)-D-glucose group (G),and 3,8-dihydroxy-1-methyl-anthraquione group (H).Animals were sacrificed 24 hrs after treatment.Intestinal histopathology,apoptosis (TUNEL) and proliferation of intestinal epithelial cells (proliferating cell nuclear antigen,PCNA) were measured.Multiple comparisons were carried out with one-way analysis of variance (ANOVA).Results Histopathology revealed injury to the intestinal mucosal villi induced by sepsis in group B compared with group A.The injury was significantly ameliorated in groups C,D,E,F,G,and H compared with group B.The apoptosis index in group B was significantly higher than that in group A (P ＜ 0.05) and the apoptosis index in groups C,D,E,F,G,and H was significantly lower than that in group B (P ＜ 0.05).The PCNA positive index in group B was significantly lower than that in group A (P ＜ 0.05),but was significantly higher in groups C,D,E,F,G,and H than that in group B (P ＜ 0.05).Conclusion Rhubarb monomers can promote the proliferation of mucosal cells and prevent apoptosis of intestinal mucosal cells.In addition,rhubarb monomers may play a role in protecting the intestinal barrier function.

PurposeTo establish sensitive and reliable serum marker on liver fibrosis for early clinical diagnosis. MethodsSerum hyaluronate acid,type Ⅲ procollagen and type Ⅳ procogen of 48 patients with viral hepatitis were analyzed by radioimmunoassay and ELISA respectively. ResultsThe serum HA, PCⅢ and PCⅣ level increased gradually with the progress of the disease. Their levels were correlated distinctly with the index of hepatic activity of inflammation and that of fibrosis.ConclusionsThe value of serum HA,PCⅢ and PCⅣ in predicting liver fibrosis will be enhanced ff the effect of inflammation could be excluded.

Medical consumables is the indispensible material foundation for diagnosis and treatment in hospital.The management of medical consumables is rather complicated for the multiplicity of its manufacture factories,suppliers and marketing ways.ISO9001 certification is extensively applied to the management of medical consumables,which can effectively ensure the consumables quality,prevent medical accident and protect consumer's privilege.

Objective To improve our understanding of localized Castleman's disease ( Localized Castleman's disease, LCD) ,and to improve its diagnosis and treatment. Methods Clinical characteristics and treatment of 26 LCD cases were retrospectively analyzed, and its clinical features and treatment strategies were reviewed. Results Among the 26 cases, there were 10 cases with clinical symptoms, which mainly showed local pain induced by the compression of the tumors, and 3 in the 10 cases associated with paraneoplastic pemphigus. The swollen lymph node was at a localized area, which was mostly at retroperitoneal (10 cases) and mediastinum (7 cases). The CT scan of LCD had its special characters including local calcification and necrosis. 22 cases were of hyaline vascular type, and the other 4 cases were of plasma type based on histopathologic examination. Twenty-five patients received complete tumor resection and 2 cases of them recurred after a follow-up of 5 to 206 months averaging at 48 ± 13 months. In one case the tumor adjoining vital organs deep in the mediastinum couldn't be completely resected. This patient and another with complete tumor resection recurred and received combined chemotherapy with complete tumor disappearance and were all alive without recurrence as found by follow up to May, 2010. The other patient with recurrent tumor after tumor resection didn't receive chemotherapy and died 11 years later. Conclusions LCD patients mainly have isolated lymphadenectasis, and some patients may have systemic symptom and show abnormal laboratory results. CT scan is helpful in establishing a diagnosis of LCD.Complete surgical resection offers a favorite result for this disease.

Objective To investigate the MRI features of supratentorial solid hemangioblastoma and to improve its diagnostic accuracy.Methods MRI image manifestations of 7 cases with supratentorial solid hemangioblastoma confirmed by operation and pathology were analyzed retrospectively.Results 7 cases of supratentorial solid hemangioblastoma were solitary.All tumors appeared as round or quasi-round masses with clear boundary, and showed equal or long T1 signal and slight long or long T2 signal,the obvious enhancement was seen in all tumors.There was mild to moderate edema around the tumors.The blood vessel was found within or around the tumors.Conclusion MRI manifestations of supratentorial solid hemangioblastoma have certain characteristics.