Objective To make clear glial acidic protein and excitatory amino acid levels in the early expression of neonatal brain injury and the mechanism of brain injury,and the value of early diagnosis and prediction of serum glial fiber acidic protein and excitatory amino acid in neonatal cerebral palsy.Methods This study chose high-risk infants with cerebral palsy as the research object,the concentration of excitatory amino acid and enzyme linked immunosorbent assay were detected by reverse phase high performance liquid chromatography,followed up for 12 months,the occurrence of cerebral palsy was analyzed statistically.Results Compared with the normal group of glial fibrillary acidic protein,glutamic acid and aspartic acid levels,three indexes of children with cerebral palsy were higher than normal group(glial fibrillary acidic protein:(119.46±43.68),(119.46±43.68),(62.57±35.31),(134.02±32.79) ng/L;glutamic acid:(7.52±3.94),(6.49±2.88),(8.15 ±2.03),(1.72±0.59) μmol/L;aspartic acid:(3.81±1.09),(4.23±1.91),(3.67±2.14),(1.35±0.71) μmol/L;F=4.117,4.117,4.117;P<0.05).Glial fibrillary acidic protein,glutamic acid and aspartic acid levels in the high-risk group,the perinatal high-risk group and the pre birth high-risk group had no significant difference (P>0.05).The levels of serum glial fiber acidic protein,glutamic acid and aspartate in children with cerebral palsy were higher than those in the normal group,comparison between spastic group,athetotic group and mixed group(F=5.032,6.004,3.792),there was no significant difference in the levels of glial acidic protein,glutamic acid and aspartate(P>0.05).Conclusion The concentration of excitatory amino acids and acidic protein in the serum of the patients with high risk of cerebral palsy has some value,the concentration of serum excitatory amino acid and the concentration of glial fiber acidic protein are correlated with the degree of brain injury and the time in children with cerebral palsy.

Objective To assess the morphological characteristics of bone marrow in patients of severe fever with thrombocytopenia syndrome ( SFTS) and its value in diagnosis.Methods The bone marrow morphology was retrospectively reviewed in 28 laboratory confirmed patients with SFTS from Zhoushan Hospital during January 2012 and December 2015.The correlation between bone marrow -derived macrophage and peripheral blood cells was analyzed with t test.Results All patients presented leukocytopenia and thrombocytopenia.Poor bone marrow hematopoietic function was observed in 23 patients (82%) showing granulocyte, erythrocyte and megakaryocyte hypoplasia , but no pathological hematopoietic disorder was observed.Eighteen patients (64%) had various degrees of increased amount of macrophage in the bone marrow; peripheral white blood cell count and platelets in patients with macrophage ≥0.5% were lower than those with macrophage <0.5%, and the difference was of statistical significance (t =3.836 and 4.499, P<0.01).Conclusion SFTS patients have characteristic bone marrow morphology , and bone marrow examination is beneficial for differentiation of SFTS from blood lymphatic system diseases and other virus infection.

BACKGROUND: A skull defect is inevitable after decompression treatment for traumatic brain injury. Titanium mesh as the most recognized skull repair material has good biocompatibility and has been widely used in clinical practice. However, the timing for skull repair after brain injury is still in dispute.OBJECTIVE: To compare the changes of brain perfusion and the recovery of neurological function in patients with skull defects before and after early and late-stage titanium mesh repair based on CT perfusion technique.METHODS: This was a single-center, prospective, observational clinical trial that was completed at the Taihe Hospital,Hubei University of Medicine in Hubei Province, China. Eighty-six patients with craniocerebral injury who had undergone decompression with removal of bone flap from January 2013 to January 2016 were recruited and subjected to skull repair using titanium mesh. All the patients were randomized into two groups: test group (n=40) with early skull repair within 1-3 months after decompression and control group (n=46) with late-stage skull repair within 6-12 months after decompression. CT perfusion technology was used to observe changes of brain perfusion at 3 days operatively and at 10 days postoperatively. The Barthel index was evaluated at 30 days postoperatively. The trial was registered with ClinicalTrial.gov (identifier: NCT03222297) on July 12th, 2017. The study protocol was approved by the Ethics Committee of Taihe Hospital with the approval No. 2012 (08), and performed in accordance with the Declaration of Helsinki,formulated by the World Health Organization and the hospital's ethical requirements for human research. All the patients and their families were voluntary to participate in the trial, were fully informed of the trial process, and then signed the informed consent prior to the initialization of the trial.RESULTS AND CONCLUSION: The postoperative cerebral blood volume and cerebral blood flow at the parietal cortex on the side of skull defect and at the cortex in the defect region were significantly higher in the two group than the baseline (P < 0.05), while the time to peak was lower than the baseline (P < 0.05). Compared with the control group,significantly higher cerebral blood volume and cerebral blood flow as well as shorter time to peak were observed in the test group (P < 0.05). The Barthel index of the test group was also significantly higher than that of the control group at 30 days postoepratively (P < 0.05). Overall, early skull repair with titanium mesh is helpful to improve the cerebral blood perfusion at the affected side and the recovery of neurological function. In addition, CT perfusion technology is a safe and effective method to monitor hemodynamic changes in the brain.

Objective:To investigate the efficacy of nourishing feeding in patients with acute respiratory failure.Methods:One hundred patients with acute respiratory failure who received treatment in the First Affiliated Hospital of Wenzhou Medical University, China from December 2018 to March 2020 were included in this study. They were randomly divided into a control group and an observation group ( n = 50/group). After admission, all patients were actively treated and given enteral nutritional support. The gastric tube was indwelled. The head of the bed was elevated by 30-40°. The control group was given enteral nutrition which could reach the target dose within 2 days. The observation group was given nourishing feeding. Before and after 7 days of treatment, serum levels of hemoglobin (Hb), albumin (ALB) and total plasma protein as well as white blood cell and lymphocyte counts were determined. Intestinal tolerance was monitored during the treatment period. Mechanical ventilation time, length of intensive care unit stay, total hospital stay, and infection were compared between the control and observation groups. The number of deaths within 60 days after admission was recorded. Results:After treatment, serum levels of ALB, Hb and total plasma protein in the observation group were (49.86 ± 2.41) g/L, (134.96 ± 9.23) g/L, (54.18 ± 3.96) g/L, respectively, which were significantly higher than those in the control group [(42.34 ± 2.29) g/L, (127.49 ± 6.11) g/L, (42.86 ± 2.88) g/L, ( t = 15.99, 4.77, 16.35, all P < 0.01). After treatment, serum levels of ALB, Hb and total plasma protein in each group were significantly increased compared with before treatment (all P < 0.05). After treatment, white cell count in the observation group was significantly lower than that in the control group [(7.96 ± 1.06) × 10 9/L vs. (10.27 ± 2.35) × 10 9/L, t = 6.34, P < 0.01]. Lymphocyte count in the observation group was significantly higher than that in the control group [(1.19 ± 0.47) × 10 9/L vs. (1.02 ± 0.34) × 10 9/L, t = 2.07, P = 0.04]. After treatment, white cell count in each group was significantly decreased, and lymphocyte count in each group was significantly increased compared with before treatment (both P < 0.05). Intestinal intolerance rate in the observation group was significantly lower than that in the control group (22.0% vs. 52.0%, χ2 = 9.65, P < 0.01). The duration of mechanical ventilation, intensive care unit stay and total hospital stay in the observation group were (14.75 ± 5.36) d, (15.81 ± 6.28) d and (24.94 ± 7.18) d, respectively, which were significantly shorter than those in the control group [(18.69 ± 8.64) d, (27.96 ± 8.44) d and (29.84 ± 8.65) d, t = 2.74, 8.17 and 3.08, all P < 0.01]. The infection rate in the observation group was significantly lower than that in the control group (24.0% vs. 44.0%, χ2 = 4.46, P = 0.03). Conclusion:Nourishing feeding for enteral nutrition in patients with acute respiratory failure can better improve the nutritional status, reduce the level of systemic inflammation, improve the immune function, can be tolerated by the intestine, avoid infection, and promote the rehabilitation of patients with acute respiratory failure.

Objective To identify regular roots for medical disputes by case studies for providing evidences for hospital management..Methods 200 cases of medical malpractice were selected consecutively and categorized according to the causes,dispute focus and expert opinions.Results The main factor to trigger medical disputes is dissatisfaction of the outcome,accounting for 50.5％.48.15％ of the disputes,however,result from dissatisfaction of the therapy process which constitutes a medical malpractice.Neglect or defects in treatment,surgical operation,information notice and medical papers were highly common causes.Conclusion Medical disputes result from a variety of causes,so are the roots of medical malpractice.Medical institutions are recommended to enhance medical quality management,make sufficient doctor-patient communication,and make high quality documentation of key medical activities,in an effort to minimize medical disputes and medical malpractice.

Objective To study the clinical,cardiopulmonary functional and hemodynamic profiles of systemic sclerosis patients with pulmonary hypertension (SSc-PAH) compared with those of idiopathic pulmonary hypertension (IPAH).Methods Patients diagnosed with SSc-PAH or IPAH by right heart catheterization were consecutively enrolled into the study between 2011 and 2013 in Peking Union Medical College Hospital (PUMCH).Cases with pulmonary hypertension related to other diseases were excluded.Demographic data,laboratory parameters,6 minutes walk distance (6MWD),pulmonary function and hemodynamic variables at the time of diagnosis were collected and compared between the two groups.Results A total of 20 SSc-PAH patients including 19 females and one male with age of (43.1 ± 12.2) years,and 18IPAH patients including 16 females and 2 males with age of (38.4 ± 12.4) years were enrolled in this study.Subjects in both groups had similar mean pulmonary arterial pressure,cardiac index and pulmonary vascular resistance (PVR) when recruited.Compared with IPAH patients,SSc-PAH patients showed significantly decreased all parameters including forced vital capacity (FVC)％ [(77.1 ± 13.2)％ vs (88.6 ± 14.9)％,P =0.026],diffusing capacity of the lung for carbon monoxide (DLCO) ％ [(46.2 ±13.1) ％ vs (66.6± 13.3)％,P ＜0.001],DLCO/alveolar ventilation(VA) [(55.1 ± 14.3)％ vs (75.1 ± 11.5)％,P ＜0.001],and 6MWD [(365.6 ±85.1) m vs (454.3 ± 136.8) m,P =0.034].In subgroup analysis of SSc-PAH patients,elevated PVR (OR 2.122,95％ CI 1.093-4.119,P =0.026) and decreased DLCO％ (OR 0.916,95％ CI 0.842-0.996,P =0.040) were independently associated with reduced 6MWD.Conclusions Under the similar hemodynamic condition,SSc-PAH patients had more severe restrictive ventilation dysfunction and diffusion capacity dysfunction.Decreased 6MWD in SSc-PAHpatients was probably related to the impairment of pulmonary function.

To explore the relationship between serum 1,25(OH)2D3 and oxidative stress in patients with diabetic nephropathy (DN).The serum levels of 1,25(OH)2D3 in DN patients were significantly lower than those in DM and healthy controls.And the 1,25(OH)2D3 level was negatively correlated with advanced oxidation protein products ( AOPP ) , reactive oxygen species ( ROS ) and positively correlated with superoxide dismutase (SOD) in DN patients.1,25(OH)2D3, low density lipoprotein-cholesterol (LDL-C), body mass index ( BMI) , serum creatinine and age were associated with the level of oxidative stress in DN patients.With the progression of CKD , the serum levels of AOPP and ROS increased significantly while those of SOD and 1,25(OH)2D3 decreased markedly.

Objective To investigate the prevalence of anti-endothelial cell antibody fAECA) in the sera of patients with connective tissue diseases(CTD)complicated with pulmonary arterial hyperten-sion (PAH)and to detect the specific antigens of AECA which may be related to clinical manifestations.Methods AECA was detected with Western blotting in 39 CTD patients with PAH.22 CTD patients without PAH and 30 healthy donors.Results The prevalence of AECA was 82%in CTD patients with PAH.73%in CTD patients without PAH and 20%in healthy donors.Anti-22 000 AECA was only detected in CTD patients with PAH(15%).Anti-75 000 AECA was more frequently detected in CTD patients with PAH than in thosewithout PAH(51%vs 23%.P＜0.05).In CTD patients complicated with PAH.anti-75 000 AECA was morefrequently detected in those with Raynaud's phenomenon or with positive anti-RNP antibody.Conclusion AECA can be more frequently detected in CTD patients with or without PAH.Furthermore,anti-22 000 and anti-75 000 AECA may play a special role in CTD patients with PAH.

objecfive To analyze ventricular myocardial function in patients with systemic sclerosis (SSc).Methods Thirtv female SSc patients and fifteen age-and sex-comparable healthy subjects underwent standard echo and tissue Doppler imaging(TDI)examination.T-test and Pearson's analysis were used.Results Both left and right atrial and ventricular diameters,left ventricular eiection fraction and right ventricular fraction of area change were comparable between the two groups.Mitral and tricuspid inflow E/A ratio was almost the same in both groups,while systolic pulmoHary pressure was increased in SSc [(38±16)vs (23.9±4.8)mm Hg,P=0.008].TDI detected impaired right ventricular myocardial function in SSc:eartydiastolic peak velocity Em [(10.7±4.8)vs(15.0±2.1)cm/s,P=0.01],peak systolic strain[(-16.3±3.9)%vs (-20.9±2.0)%,P=0.001]and strain rate[(-1.4±0.4) vs(-2.4±0.5)/s,P<0.01] were reduced significantly.Left ventricular myocardial function was not impaired in SSc patients.Conclusion TDI iS a valuable noninvasive tool for early detecting of ventricular myocardial involvement caused by SSc.

Objective To explore the association between Doppler echocardiography parameters and pulmonary capillary wedge pressure (PCWP) obtained by right heart catheterization (RHC) in patients with pulmonary hypertension (PH).Methods RHC and a simultaneous echocardiography were performed in 86 PH patients.The correlation between the echocardiographic parameters and PCWP was analyzed.Results The early diastolic velocity(E) of mitral valve blood flow was significantly correlated with PCWP ( γ =0.36,P ＜0.01 ).Tissue Doppler imaging measured the diastolic velocity of mitral annulus on the lateral(E'L)and the septal (E'S) wall.Then the average E'M was calculated.The ratio of E to E'L,E'S and E'M showed a strong correlation with PCWP ( γ =0.62,0.34 and 0.47 respectively,P ＜ 0.01 ).E/E'L ＜ 6 accurately predicted 100％ PCWP≤ 15 mm Hg (1 mm Hg =0.133 kPa),and E/E'L ＞ 15 could predict PCWP ＞ 15 nun Hg with specificity of 98.5％.Conclusion There are positive correlation between E/E' and PCWP obtained by RHC in PH patients.