Objective To analyze the relationship between complement key component C3,C4 and the severity of sepsis in children,in order to explore the role of complement activation in the progression of sepsis and provide a reference for diagnosis and treatment of severe sepsis.Methods Four hundred and twenty-four children diagnosed as sepsis from December 2012 to December 2015 in Children's Hospital of Nanjing Medical University were enrolled in this study,among whom 347 children with sepsis were eligible for the following research including 169 cases of common sepsis and 178 cases of severe sepsis.Blood specimens were collected in 24 hours after their admission into pediatric intensive care unit(PICU) for the analysis of lymphocyte subsets,humoral immunity,blood routine analysis,coagulation,liver and renal function analysis.General information was collected by consulting their medical records,laboratory analysis and clinical treatment.The relationship between complement C3,C4 and the severity of sepsis was analyzed,and the correlation between C3 and coagulation,liver,renal,myocardium damage was also studied.Logistic regression was used to analyze the relationship between C3 and the progression to severe sepsis and multiple organ dysfunction syndrome(MODS),while Cox regression was used for survival analysis.Results Natural killer(NK) cell percentage was lower in severe sepsis group than that in common sepsis group [6.6％ (3.7％,10.7％) vs.8.5％ (4.7％,13.3％),Z =2.635,P =0.008],while C3 decreased in severe sepsis group compared with common sepsis group [0.653 (0.462,0.985) g/L vs.0.991 (0.678,1.265) g/L,Z =5.684,P ＜ 0.001],and C4 decreased in severe sepsis group compared with common sepsis group [0.160(0.102,0.244) g/L vs.0.190(0.121,0.265) g/L,Z =2.513,P =0.012].The proportion of severe pneumonia was higher in severe sepsis group than that in common sepsis group (34.3％ vs.19.5％,x2 =9.540,P =0.002),and liver function damage proportion was increased in severe sepsis group than that in common sepsis group (48.3％ vs.16.0％,x2 =41.28,P ＜0.001),and the duration of PICU treatment was longer in severe sepsis group than that in common sepsis group[10.7(6.5,17.4) d vs.7.5(4.0,12.4) d,Z =-4.039,P ＜0.001].C3 was significantly decreased in children with single organ dysfunction,multiple organ dysfunction and death group compared with common sepsis group (K =33.04,P =0.001),and the median of each group decreased with the severity of sepsis,but C4 had no difference among 4 groups (K =7.36,P =0.061).C3 was positively correlated with coagulation marker platelet (p =0.31,P ＜ 0.001) and fibrinogen (ρ =0.53,P ＜ 0.001),but negatively correlated with international normalized ratio (INR) (ρ =-0.39,P ＜ 0.001) and activated partial thromboplastin time (p =-0.34,P ＜ 0.001).C3 was also negatively correlated with liver damage marker alanine transaminase (ρ =-0.30,P ＜ 0.001) and total bilirubin (ρ =-0.28,P ＜ 0.001),and had a negative correlation with renal function marker creatinine (p =-0.24,P ＜ 0.001) and myocardial damage marker creatine kinase-MB (p =-0.27,P ＜ 0.001).The depletion of C3 was a risk factor of severe sepsis(OR =3.45,P ＜ 0.001) and MODS(OR =3.03,P =0.005) after being adjusted for confounding factors by using Logistic regression.In stratification analysis,C3 depletion was still a risk factor of severe sepsis (OR =2.78,P =0.019) and MODS (OR =3.57,P =0.015) among children less than 1 year old,and was also a risk factor of severe sepsis(OR =4.76,P =0.008) among children more than 1 year old as well.In children without liver function damage,C3 depletion was still a risk factor of severe sepsis(OR =4.17,P =0.002) and MODS(OR =9.09,P =0.002).Cox regression showed that C3 depletion was a hazard in 28-day mortality (HR =3.57,P =0.026) in children with sepsis.Conclusion The decrease of C3 is correlated with coagulation dysfunction and organ damage marker,while C3 depletion was a risk factor of severe sepsis,MODS and 28-day mortality,and could be a potential prognostic marker of children with sepsis.

Objective To study the efficacy and safety of in vitro local drug delivery capsules fabricated with the biodegradable material Osteoset(R)plus vancomycin and recombinant human bone morphogenetic protein-2 (rhBMP-2). Methods In vitro local drug delivery capsules were fabricated with the biodegradable material Osteoset(R) plus vancomycin and rhBMP-2.High-Performance Liquid Chromatography (HPLC) and bacterial inhibition tests were performed to detect the concentration and activity of vancomycin in the capsules.Enzyme-linked immunosorbent assay(ELISA) and alkaline phosphatase(ALP) tests were conducted to detect the concentration and activity of rhBMP-2 in the capsules. Results The capsules could release vancomycin above 55.8 μg/mL for up to 144 hours,with an activity of above 70％.They could release active thBMP-2 for up to 30 days,had no inhibition effects on the proliferation of mesenchymal stem cells(MSCs) and had high biological safety. Conclusion Since the capsules of Osteoset(R) plus vancomyein and rhBMP-2 can release high concentrations of active vancomycin and active rhBMP-2 with no inhibition of the proliferation of MSCs,they have good prospects for clinical use.

Objective To explore the effect of depakine in the treatment of traumatic epilepsy relapse,and compared carbamazepine and lamotrigine combined with depakine in the treatment of traumatic epilepsy.Methods Open trial in 131 patients with traumatic epilepsy relapse treated with depakine,and all patients were aderministered with carbamazepine or lamotrigine combined with depakine.3 months before treatment,the epilepsy seizures frequency was compared,and 6 months after the treatment,the efficacy,adverse reactions and safety was compared between two mothods.Results Application of carbamazepine or lamotrigine combined with depakine treatment for 6 months,the seizure frequency significantly decreased compared with before treatment;The seizure frequency reduction( ≥50％ ) were 72.6％ and 91.3％,the difference was statistically significant between before and after treatment( P ＜ 0.01 ) ;The adverse reactions of carbamazepine combined with depakine was 37.1％,and it of lamotrigine combined with depakine was 8.7％.Conclusion Lamotrigine combined with depakine in the treatment of traumatic epilepsy recurrence was effective,and its side effects was light.

Protein disulfide isomerase (PDI) is one of thiol-disulfide oxidoreductases that mainly located in the endo?plasmic reticulum (ER). It is generally known that PDI caralyzes the formation,rearrangement,breakage of disulfide bonds, and this enzyme is effective in regulation of protein folding. Now it is also known as a biomarker of cardiovascular disease. Protein disulfide isomerase can reduce infarct size and myocardial apoptosis in acute myocardial infarction (AMI). PDI can also improve changes of cardiac vulnerability in diabetic cardiomyopathy (DCM). Further more, it is also shown that PDI play an important role in hypertension and thrombosis. Therefore, this paper review the effects of protein disulfide isomerase in cardiovascular diseases.

Teacher student relationship is the most important part in educational activities.It’s quality and quantity have a significant impact on educational and teaching effectiveness.This article aims to analyze the exiting status of the relationship between the tutors and the postgraduates in Peking Union Medical College Hospital, focusing on the some main factors which affect the said relationship, including education environment factor, tutor factor, postgrad-uate factor and etc., and combining the characteristics of Medical Colleges’studying.On the basis of the concerned survey, this article initially discusses the key issues during the establishment of the harmony relationship between tutors and postgraduates.

Objective To explore the relationship of the severity of coronary-artery stenosis with plasma levels of brain natriuretic peptide (BNP) and Meprin-α.Methods Totally 237 patients in our hospital were divided into control group (CON group), stable angina group (SA group) and acute coronary syndrome group (ACS group), according to coronary artery angiography.Patients with acute coronary syndrome were divided into 3 subgroups: unstable angina (UA) group, non-ST segment elevation myocardial infarction (NSTEMI) group and ST segment elevation myocardial infarction (STEMI) group.Patients with coronary artery disease (CAD) were divided into 3 subgroups: low-score, medium-score and high-score groups, according to coronary angiography and Syntax score.BNP and Meprin-α levels were determined in patients with coronary artery disease, and the degree of coronary artery stenosis was evaluated.The differences in above indexes were analyzed and compared among the three groups.Results Plasma levels of BNP and Meprin-α were higher in ACS group than in CON group [(233.16± 78.22)ng/L vs.(33.48 ± 13.71)ng/L, (26.89 ± 6.45) nmol/L vs.(12.83±0.66)nmol/L, both P＜0.05].Compared with UA group, plasma levels of BNP and Meprin-α were increased in NSTEMI and STEMI groups (all P＜0.05).Compared with the control group, plasma levels of BNP and Meprin-α in the Syntax scores-divided subgroups were increased (all P＜ 0.05).The plasma levels of BNP and Meprin-α in CAD patients were significantly increased along with the increase of Syntax Score.Spearman correlation analysis showed that low density lipoprotein cholesterol, glucose, BNP and Meprin-α levels had positive correlations with the occurrence of coronary heart disease, while high density lipoprotein level was negatively correlated with the occurrence of coronary heart disease (all P＜0.05).Conclusions BNP and Meprin-α levels in peripheral blood are significantly elevated in patients with coronary heart disease, and they are correlated with Syntax score.The risk of ACS is increased along with the increased BNP and Meprinα levels.

Objective To investigate the value of external fixator in the treatment of posttraumatic elbow stiffness.Methods From January 2007 to December 2009,25 patients with posttraumatic elbow stiffness received surgical arthrolysis with assistance of external fixator.There were 10 patients with grade 1 stiffness,12 patients with grade 2 stiffness and three patients with grade 3 stiffness.The range of motion (ROM) was 0°-75° ( average 33.4°) preoperative,with ＜ 30° in 12 patients.For the patients with grade 1 stiffness,intraoperative distraction with an external fixator rather than open arthrolysis was performed ; for the patients with grade 2 stiffness,the heterotopic ossification was removed through a limited approach before the external fixator was applied; for the patients with grade 3 stiffness,additional osteotomy and internal fixation before arthrolysis were performed.After operation,there was a rehabilitation phase,followed by mobilization of the elbow joint under protection of the external fixator for a mean period of six weeks.Results The intraoperative mean ROM was 105.6°,which was significantly improved than that before operation (P ＜0.05).The maximal flexion degree was above 110°in all patients.No instability occurred.Two patients were excluded from the follow-up:one had ulna fracture two weeks after operation due to an incorrect placement of the pin,and additional internal fixation was then carried out;another patient had numbness in the ulna side when flexed the elbow after arthrolysis,and the ulna nerve transposition was performed through another operation.Other patients were followed up for a mean period of six months.At the latest follow-up,the mean ROM was 97.4°( range,70°-130°),significantly improved than that before operation (P ＜ 0.05 ),and lest 8.2°on average (0°-15 °) compared with the intraoperative ROM (P ＞ O.05).The maximal flexion in all patients was above 100° Conclusion With the advantages of minimal invasive or noninvasive,indirect capsular traction,stability maintenance during the movement,and prevention of the motion loss during the rehabilitation,arthrolysis of the elbow joint with the use of external fixation frame can be a good alternative in the treatment of posttraumatic elbow stiffness.

Objective To evaluate the clinical value of adenosine triphosphate (ATP) determination in CD4+ cells in cytomegalovirus pneumonia after renal transplantation.Methods The ATP level of CD4+ T cells was measured by ImmuKnowTM kit.The ATP levels were determined in 187 renal transplant recipients before and 30,60,90,180 days after operation,and at the time of CMV pneumonia and 4 weeks after treatment of CMV pneumonia.The associations between ATP levels and CMV pneumonia were analyzed.Analysis of variance (ANOVA),Pearson-Spearman and relative risks were used for data analysis.Results 17 cases out of 187 renal transplant recipients were diagnosed as CMV pneumonia (9.1％),and the onset of CMV pneumonia started on the (2.8 ±1.2)month after renal transplantation.ATP concentrations in CD4+ T cells were significantly lower after operation than those before operation (P＜0.01).ATP concentrations reached the lowest on the about postoperative day 90 (P＜0.05),then increased gradually.In 17 recipients with CMV pneumonia,the ATP levels before and 30,90 days after operation,at the time of CMV pneumonia and 4th week after treatment of CMV pneumonia were (376 ±182),(283 ± 146),(196 ± 112),(145 ± 102) and (236 ± 117) μg/L respectively.ATP levels at the time of CMV pneumonia were significantly lower than any other time points (P＜0.05).There was close correlation between ATP levels and CMV pneumonia.Conclusion The determination of ATP in CD4+ cells could reflect the status of cell-mediated immunity in renal transplant recipients,and could evaluate the severity and prognosis of CMV pneumonia and guide the clinical treatment.

Objective To quantitatively study right ventricular function in the normal second and third trimester fetuses by M-mode tricuspid annular displacement(TAD).Methods TAD was measured using conventional M-mode echocardiography on 161 normal second and third trimester fetuses with gestation age (GA) between 19-38 weeks,meanwhile multiple parameters for evaluating right ventricular function were obtained using pulsed Doppler echocardiography (PW) and myocardial Dopple tissue imaging (DTI).The correlation between TAD and other parameters were analyzed using SPSS 17.0.Results In normal second and third trimester fetuses,the TAD was (9.38 ± 1.71)mm with a range of 5.79-13.90 mm,and was increased with the growth of GA.TAD was correlated with GA,E,A,Em,Am and Sm significantly (r =0.759,0.547,0.320,0.497,0.483 and 0.598 respectively,all P ＜0.001).TAD was not correlated with HR(P ＞0.05).TAD showed differences between the second trimester fetuses and the third trimester fetuses (P ＜ 0.05).Conclusions In normal second and third trimester fetuses,the TAD is increased with the growth of GA,and has good correlation with GA,E,A,Em,Am and Sm respectively,and may become a new promising modality to evaluate function of RV simply and accurately.The technique will be propitious to use in hospitals (without DTI) because of simplicity of operator and lower requirement on the technology and equipment precision.

Objective To evaluate the frequency and morphological characteristics of the posterolateral articular fracture in tibial plateau fractures.Methods A retrospective analysis of CT images and clinical data was taken among 309 cases of tibial plateau fractures from 2008 May to 2013 January.There are total 264 patients were recorded excluding 45 cases with which the CT image is missing or not compatible with the medical Picture Archiving and Communication Systems (PACS).To determine the occurrence rate of the posterolateral articular fracture in tibial plateau fractures and measure morphological parameters such as the axial angle of fracture line,articular surface area,sagittal fracture angle,fracture height,and amount of displacement.Results 39 cases of posterolateral articular fragments were found in 264 cases of tibial plateau fractures with the 14.8％ incidence (39/264).There were 18 males and 21 females,aged from 31-70 years (mean,52 years).17 left cases and 22 right cases.The mechanism of injury were traffic accident in 22 patients,blow by a heavy object in 2 patients,a fall in 11 patients,and other causes (unknown) in 4 patients.The posterolateral plateau articular fracture fragment has morphological characteristics of a conical shape fragment and the major articular fragment angle was 22° (range,-43°-62°),and an average accounted for 14.1％ of the articular surface of the total tibial plateau (range,8％-32％).The posterolateral fragment exhibits a vertical fracture pattern and an average sagittal fracture angle was 76° (range,58°-97°),suggestive of shear instability and vertical displacement.Maximum posterior cortical height was 28 mm (range,18-42 mm),and average size of the displacement was 10.48 mm (range,2-19 mm).Conclusion The posterolateral plateau articular fracture fragment has morphological characteristics of a conical shape fragment,relative small articular surface area and sagittal fracture angle.