Objective To investigate the dynamic changes of myocardial enzymes and it's isoenzyme,eletrocardiogram(ECG) for suffering children of ARI accompanied with myocardial damage and to determine the sensitive indexes of confirmed diagnosis of ARI accompanied with myocardial damage.Methods 117 cases with ARI accompanied with suspected or confirmed myocardial damage were studied,60 healthy age matching children were arranged as control group.Myocardial enzymes and it's isoenzyme ECG in the two groups were dynamic monitored.Then comparing the activities of serum myocardial enzymes and it's isoenzyme.Results Serum CK-MB,LDH-1,AST were significantly higher in ARI group than that in control group(P

Objective To investigate the value of ISS in predicting mortality after multiple trauma.Methods A total of 550 patients with multiple trauma treated from March 2007 to May 2011 were divided into survivor group (n =473) and death group (n =77) according to the outcome.ISS and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ]) were used to predict patients' risk of death.Receiver operation characteristic curve (ROC) was developped to compare the area under the curve (AUC),optimal cut-off point,and prediction index for the two scoring systems.Results ISS and APACHE Ⅱ score were higher in death group than in survivor group (P ＜ 0.05).ISS showed the diagnostic cut-off point of ≥20,with a sensitivity of 76.7％,specificity of 83.7％,concordance rate of 82.7％,and AUC of 0.835.With regard to APACHE Ⅱ,the diagnostic cut-off point was ≥20,with a sensitivity of 80.5％,specificity of 89.2％,concordance rate of 88.0％,and AUC of 0.922.ISS and APACHE Ⅱ were equivalent in predicting mortality (P ＞ 0.05).Conclusion ISS presents a moderate value for predicting the mortality of multiple trauma patients and it is more rational to set ISS≥20 points as the criteria for severe multiple trauma.

Objective To study the utility and feasibility of CRAMS score to assess prognosis of patients with acute trauma.Methods A retrospective review of 1 802 patients with acute trauma was conducted to calculate CRAMS and ISS score.Receiver operation characteristic curve (ROC) was used to measure the prognostic role of CRAMS in comparison with ISS.Results Area under the curve (RUC) was 0.885 for CRAMS (95 ％ CI 0.870-0.900) and was 0.792 for ISS (95％ CI 0.773-0.811),with statistical difference of the two scoring systems (Z=4.280,P ＜0.01).To identify patients with potential critical illness,optimal cut-off point was≤7 for CRAMS and≥24 for ISS.CRAMS presented better sensitivity (x2 =16.910,P ＜ 0.01),but lower specificity (x2 =5.260,P ＜ 0.05) and accuracy (x2 =0.693,P ＞ 0.05) for predicting mortality when compared with ISS.Conclusions CRAMS is better than ISS in predicting prognosis for patients with acute trauma and exhibits a high discrimination.RAMS has advantages of simple operation,easy grasping and accurate and timely reflection of illness severity,which facilitates the early detection and treatment of critical illness in inhospital trauma patients.

Objective To evaluate the application value of prehospital index (PHI) in hospitalized patients with acute trauma.Methods A study was done in 1802 hospitalized patients with acute trauma by random sampling.PHI and injury severity score (ISS) were made respectively.Receiver operating characteristic curve (ROC curve) was used for detecting optimal cut-off point by taking the date of discharge as the endpoint and the outcome as observed indicator.In order to compare the predicting prognosis value of PHI in hospitalized patients with acute trauma,the corresponding predicting indicators were calculated and ISS was used for reference.Results The area under the ROC curve was 0.871 (95％ CI:0.855-0.886) by the score of PHI and 0.792 (95％ CI:0.773-0.811) by the score of ISS,and there was statistically difference between the two scoring systems (Z =2.674,P =0.007),and the optimal cut-off point was used for judging the potential for critically ill patients when PHI was ≥ 4,ISS ≥ 22.The sensitivity predictors of critically ill patients death of PHI was superior to ISS (x2 =6.975,P =0.008),the specificity and the accuracy of PHI and ISS showed no significant difference (P ＞ 0.05).Conclusions PHI has high potential for assessing patient condition and predicting the death of hospitalized patients with acute trauma,and it is equivalent to ISS in prediction value.The advantages of PHI are simple in operation,easy to learn,reflecting the condition timely and reliably,suitable for dynamic evaluation and comparison,which is suitable for critical patients with trauma of preliminary screening.

BacKground:Acetic acid spray combined with narrow-band imaging ( NBI ) endoscopy can improve the earIy diagnosis of coIorectaI cancer and precancerous Iesions. Aims:To assess the vaIue of acetic acid spray combined with NBI in diagnosis of earIy coIorectaI cancer and precancerous Iesions. Methods:A totaI of 236 coIorectaI cancer and precancerous Iesions in 180 patients detected by screening endoscopy from Nov. 2011 to JuIy 2013 were enroIIed in this study. Acetic acid spray combined with NBI( combination group),singIe NBI,and indigo carmine staining were used to observe pit pattern,bIood capiIIary forms of the Iesion and mucosa whitening time,and vaIues of the three methods in diagnosis of earIy coIorectaI cancer and precancerous Iesions were evaIuated. Results:Image cIarity of pit pattern in combination group was significantIy improved than that in NBI group and indigo carmine group(χ2 =15. 113,P=0. 000;χ2 =6. 128,P=0. 013);image cIarity of bIood capiIIary forms in combination group was significantIy improved than that in NBI group(χ2 =7. 384,P =0. 007). The overaII coincidence rates of diagnosis in combination group,NBI group, indigo carmine group were 91. 9%,89. 0%,86. 9%,respectiveIy. The diagnosis rate of pit pattern in combination group was significantIy higher than that in NBI group(χ2 =4. 490,P=0. 034),but no significant difference in bIood capiIIary forms was found between combination group and NBI group. The sensitivity of type Ⅲ,Ⅳ,Ⅴ pit pattern,type Ⅱ,ⅢbIood capiIIary forms,mucosa whitening time <30 seconds for diagnosis of coIorectaI cancer and precancerous Iesions in combination group were 94. 0%,92. 8%,92. 2%,respectiveIy,the specificity were 87. 4%,88. 1%,88. 0%, respectiveIy,and the accuracy were 91. 5%,91. 1%,90. 7%,respectiveIy. The sensitivity,specificity and accuracy of type ⅤN or highIy irreguIar ⅤI pit pattern,type ⅢB bIood capiIIary forms and mucosa whitening time 0-5 seconds for predicting invasive carcinoma in combination group were aII quite weII. Conclusions:Acetic acid spray combined with NBI can cIearIy show the pit pattern and bIood capiIIary forms of earIy coIorectaI cancer and precancerous Iesions,and is fairIy consistent with the pathoIogicaI diagnosis. It is heIpfuI for diagnosing the nature of Iesion and depth of invasion.

Objective: To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF). Methods: Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 (n=350), were randomly divided into intervention group (n=175) and control group (n=175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively. Results: Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P>0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P<0.01). Meanwhile, the LVEF and 6 minutes walk distance were significantly increased, while NT-proBNP was significantly reduced at 6 months post discharge compared to one day before discharge in the intervention group (all P<0.01). The LVEF was also significantly improved (P=0.035), but the NT-proBNP and 6 minutes walk distance were similar (P were 0.328 and 0.807 respectively) at 6 months after discharge compared to one day before discharge in the control group. The NYHA classification was significantly lower in intervention group and in control group at 6 months after discharge compared to one day before discharge (Z=5.154, P<0.01 and Z=10.497, P<0.01), and the NYHA classification improved more in the intervention group than in control group at 6 months after discharge (Z=9.235, P<0.01). The re-hospitalization rate of CHF patients in intervention group was 11.83% (20/169), which was significantly lower than the control group (33.14% (56/169), χ²=21.99, P<0.01). At 6 months follow up, body weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge. Conclusion The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.