OBJECTIVETo investigate the clinical value of pleural biopsy in the etiological diagnosis of pleurisy in children.

METHODTotally 213 cases with pleurisy, who underwent pleural biopsy and hospitalized in Children's Hospital of Chongqing Medical University from January 2007 to April 2014 were enrolled into this study. Clinical symptoms, imaging manifestations, pleural fluid characteristics, the results of pleural biopsy and postoperative complications were retrospectively analyzed to evaluate the clinical value and security of pleural biopsy in making the etiological diagnosis of pleurisy.

RESULT(1) Of the 213 cases, 144 were boys and 69 were girls, their mean age was (6. 5 ± 4. 1) years. (2) Two hundred and thirteen patients had a surgical pleural biopsy under general anesthesia, the cause of 97 cases (45. 5%) were made clear by histopathological examination, including 35 purulent pleurisy, 55 tuberculous pleurisy and 7 paragonimus infection. For the remaining 83 (41. 3%) cases a final diagnosis was made based on the full analysis of clinical data, including 63 cases of purulent pleurisy, 3 cases of tuberculous pleurisy and 17 cases of paragonimiasis pleurisy but for 33 patients no exact cause was found at the end. (3) The mean operating time of the biopsy was (1. 4 ± 0. 6) hours. Seventy one (33. 3%) patients required blood transfusion during or after the operation. Thirty one (14. 6%) cases used the ventilator after surgery, and the ventilator supporting time was (6. 6 ± 5. 8) hours on average. The wound healing reached grade A in 200 cases (93. 9%), grade B in 13 cases (14. 6%). Postoperative complications included pneumothorax in 92 cases (43. 2%), subcutaneous emphysema in 18 cases (8. 5%), bronchopleural fistula in 3 cases(1. 4%). The average days of hospitalization was (17. 7 ± 7. 1) d.

CONCLUSIONPleural biopsy is of great diagnostic value in the etiological diagnosis and differential diagnosis of pleurisy in children, and it is considered reasonable to be used in the clinical practice when appropriate.

Biopsy ; Child ; Diagnosis, Differential ; Female ; Humans ; Infection ; diagnosis ; Male ; Pleura ; Pleurisy ; diagnosis ; etiology ; Retrospective Studies ; Tuberculosis, Pleural ; complications ; diagnosis

Objective To investigate the relationship between maternal serum lipid levels and newborn weight in pregnant women with single positive diabetic screening test. Methods On the basis of 75 g oral glucose tolerance test (OGTT), 406 pregnant women during 24-28 gestational week whose 50 glucose challenge test (GCT)≥7.8 mmol/L were separated to gestational diabetes mellitus (GDM) group with 115cases, gestational impaired glucose tolerant (GIGT) group with 60 cases,and GCT (+) group with 231 cases.The serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol(LDL-C), apolipoprotein A1 (ApoA1) and apolipoprotein B (ApoB) were measured at the same time. Results Serum TG concentration was significantly higher in GDM group than that in GIGT group and GCT(+) group(P＜0.01).The level of HDL-C, ApoB in GDM group were lower than those in GIGT group and GCT(+) group (P＜0.01). In the 231 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of macrosomia was significantly higher in those with TG levels higher than 3.5 mmol/L (25.0%, 11/44) than in mothers who TG levels were lower than 3.5mmol/L (11.2%, 21/187) (P=0.017). Multiple regression analysis (stepwise) showed that the independent risk factors of macrosomia was the level of TG and ApoB (F=7.677,P=0.006;F = 7.842,P = 0.001 ).Conclusion Among pregnant women with single positive diabetic screening test,maternal serum TG and ApoB are independently associated with neonatal birth weight.

In order to enhance their core competitiveness,hospitals will deal with medical service suppliers,patients,counterpart hospitals and other stakeholders constantly.Such multiple value activities constitute a patient-oriented and hospital-centered value group.Hospitals have to constantly meet the demand of patients in the provision of medical services,and patients will be satisfied through their own participation in medical activities,thus realize the increase of their value.The pattern of mutual value creation between hospitals and patients forms the new hospital-patient relationship.It is an important condition for the hospitals to gain competitive advantages in the medical service provision through the two models of value maximization and organization minimization,and is also profitable for the formation of a harmonious relationship between doctors and patients.

With the continuous economic development,the environment in which we live is undergoing change.Environmental pollution has greatly affected our physical and mental health.The occurrence of many diseases is derived from the environmental change.The health management of health problems caused by environmental pollution is of great significance in monitoring the impact of environmental pollution on people's health,timely detecting and preventing the occurrence of diseases,improving people's health,and building up a harmonious and healthy society.

Objective To investigate the role of oxidized LDL and coronary endothelial dysfunction in the development and progress of coronary heart disease(CHD).Methods 29 patients with unstable angina(UA),25 patients with stable angina(SA) and 20 patients without coronary heart disease(control) were studied.Oxidized low-density lipoprotein(ox-LDL)、 Nitric oxide(NO),and circulating endothelial cells(CEC) were measured in both coronary sinus and peripheral blood during percutaneous coronary intervention(PCI).Results The level of NO in coronary sinus in patients with CHD was lower,while the level of ox-LDL and CEC was markedly higher than those in the control group.In CHD patients,the level of NO in coronary sinus blood was lower,while the level of ox-LDL and CEC was higher than that in peripheral blood.It was no siginificant difference between coronary sinus and peripheral blood was observed in the control group.Conclusion Oxidized LDL not only plays an important role in coronary endothelial dysfunction,but also contributes to the progress in the cornornary heart disease.It may be one of the pathophysiological basis of acute coronary incidents.

Objective To investigate the clinical effect of adductor magnus tendon transposition with arthroscopic in reconstruction medial patellofemoral ligament (MPFL) for the treatment of patellofemoral joint instability of adolescents. Methods Eighteen juvenile patients (21 knees) with patellofemoral joint instability (including chronic patellar dislocation and recurrent patellar dislocation) were treated with adductor magnus tendon transposition for MPFL reconstruction, combined with lateral patellofemoral ligament release. They were followed up for 12- 30 months. The complications, patellofemoral angles and Lysholm scores before and after operation were recorded and compared. Results There was no complications such as wound infection, redislocation, patellofemoral joint instability and epiphyses injured. All patients got excellent knee flexion and extension function. Patella fear tests were all negative. The patellofemoral angles and Lysholm scores after operation were improved significantly than those before operation:(10.3 ± 4.1)° vs. (-3.8 ± 4.9)°, (92.7 ± 3.6) scores vs. (61.5 ±2.4) scores, P<0.01. Conclusions Adductor magnus tendon transposition with arthroscopic in reconstruction MPFL can significantly improve the stability of patellofemoral joints. This is one of the effective methods for the treatment of patellofemoral joint instability of adolescents.

AIM:To investigate the effect of different oxygen concentrations on the differentiation of marrow stroma cells into osteoblasts and to evaluate the expression of Cbf?1 /Runx2,bone-morphogenesis protein 2 (BMP2) and peroxisome proliferator-activated receptor ?2 (PPAR-?2) in bone marrow stromal cells. METHODS:The bone marrow stomal cells obtained from 4-month-old female SD rats were cultured in growth medium and were used between passages 3 to 5. The cells were divided randomly into 4 groups,each group has 8 samples. The cells in all 4 groups were used for the following experiments after cultured with different oxygen concentrations for 3 d in osteoblastic differentiation medium:total cellular RNA was isolated using total RNA kit; RT -PCR was performed to detect the mRNA expression of Cbf?1 /Runx2,BMP2 and PPAR?2. The protein expression of Cbf?1 /Runx2 and BMP2 was assayed by Western blotting. RESULTS:Compared to the cells in normoxia condition (20% ),the mRNA and protein expressions of Runx2 were enhanced significantly,the mRNA expression of BMP2 was also enhanced significantly,the protein expression of BMP2 increased and the mRNA expression of PPAR?2 decreased significantly in the cells cultured with lower oxygen concentrations. The lower oxygen con-centration was in the culture,the more Runx2 mRNA,BMP2 mRNA,BMP2 and Runx2 protein were expressed. On the contrary,hypoxia significantly decreased the expression of PPAR?2 mRNA in bone marrow stronmal cells and the lower the oxy-gen concentration was used,the less expression of PPAR?2 mRNA was achieved. CONCLUSION:Hypoxia promotes the mRNA and protein expressions of Runx2 and BMP2,also significantly decreases the expression of PPAR?2 mRNA in bone marrow stronmal cells in an oxygen concentration dependent manner,indicating that hypoxia significantly stimulates the differentiation of bone marrow stromal cells into osteoblasts instead of lipocytes.

Objective To explore the diagnostic value of prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),D-Dimer(DD),antithrombin Ⅲ(ATⅢ),platelet(PLT)in activity and severity assessment of ulcerative colitis(UC),and to analyze whether they could evaluate the degree of activity UC in children.Methods The data of UC patients in the Department of Gastroenterology,Children's Hospital of Nanjing Medical University from January 2012 to September 2016 were analyzed,25 cases of remission and 36 cases of active UC patients were selected as the study subjects.Thirty healthy children were selected as healthy control group,combined with the coagulation function indicators for analysis.Results Receiver operating characteristic area under the curve(AUC)of PT,APTT,FIB,DD,ATⅢ and PLT in UC patients was 0.659,0.840,0.744,0.776,0.599 and 0.792,the activity of UC patients was 0.849,0.889,0.836,0.912,0.964 and 0.966,respectively.The results of PT,APTT,FIB,DD and PLT in children with active UC were significantly higher than those in the healthy control group,and ATⅢ was significantly lower than that in the healthy control group.Compared with the healthy controls,the levels in remission UC patients were not significantly different(P>0.05).The 3 subgroups of activity UC had no significant differences among PT and APTT(F=0.652,1.755,all P>0.05),However,there were significant differences among FIB,DD,ATⅢ and PLT(F=66.495,32.817,88.284,22.892,all P<0.05).FIB,DD and PLT were moderately positively correlated with severity of activity UC patients(r=0.857,0.648,0.654,all P<0.05),and ATⅢ had moderately negative correlation(r=-0.789,P<0.05).Progressive regression analysis showed that the severity of UC was associated with FIB,DD and ATⅢ(R2=0.830,F=39.962,P<0.05).Conclusion FIB,DD and ATⅢ can be used as index for the activity and evaluation of UC.

Objective To know about the current status of the work engagement of the clinical nurses and its influencing factors,to explore the influencing factors of work engagement of clinical nurses so as to provide basis for improving the level of the work engagement of the clinical nurses.Methods The work engagement scale,hardiness scale,role pressure scale,perceived organizational support scale and questionnaire of family care index were used to investigate a total of 630 clinical nurses.The results were analyzed.Results The average score of work engagement,hardiness,role pressure and perceived organizational support were showed respectively as following:(3.28±0.51),(2.60±0.53),(3.00±0.50),(3.43± 1.04) scores.Clinical nurses number of the total point between 7 and 10 of family support accounted for 70.9％(447/630).Hardiness,perceived organizational support,family support and work engagement were in obvious positive correlation,whereas role pressure was in obvious negative correlation with work engagement.Hierarchical regression analysis showed after the variable of demographic was controlled,the hardiness and perceived organizational support respectively had significant positive predictive function on work engagement as respective independent variables.Role pressure had obvious negative predicative function on work engagement.Conclusions Hospital managers should create a good working environment for clinical nurses,measures should be taken from individual and organizational aspects so as to improve the hardiness and perceived organizational support,reduce role pressure and the work positivity of the clinical nurses,so that the nurse more positively devoted to their work.It has important practical significance to improving the quality of their services and stabilizing nursing troop.

Objective To observe the expressions of thyroid-stimulating hormone receptor (TSHR) protein and mRNA in thyroid gland of lactating rats.Methods Eighty adult Wistar rats (60 females and 20 males),weighting 210-250 g were selected.The 60 female Wistar rats were divided into 6 groups according to their body weight by means of random number table:normal non-pregnant group,lactating for 5,10,15 and 20 days groups and weaning for 5 days group,10 rats in each group.All rats were fed with conventional fodder and tap water freely,and the rats of lactating groups except the normal non-pregnant group cohabited with male rats (3 ∶ 1).Then all rats were killed on the 5th,10th,15th and 20th day after lactation and on the 5th day after weaning to get thyroid tissues.The expressions of TSHR protein and mRNA were determined by immunohistochemical staining and realtime quantitative PCR.Results TSHR protein was expressed in cytoplasm and membrane of rat thyroid follicular cells.The expression of TSHR protein in thyroid gland was significant different statistically between groups (x2 =11.227,P ＜ 0.05); the staining intensity of rat thyroid tissues in the normal non-pregnant gruop (weak,n =2; moderate,n =5; strong,n =3) was stronger than that of rats lactating for 5 days (weak,n =7; moderate,n =3; x2 =5.895,P ＜ 0.05).But the expression of TSHR protein in thyroid tissues in the normal non-pregnant group was not significantly different statistically compared with the expression of TSHR protein in other groups (lactating for 10,15and 20 days) and weaning for 5 days group (all P ＞ 0.05).The expression of TSHR mRNA in thyroid gland was significantly different statistically between groups (F =2.970,P ＜ 0.05); the expression of TSHR mRNA in lactating for 5 days group (0.74 ± 0.13) was lower than that of the non-pregnant group (1.02 ± 0.24,P ＜ 0.05); and the expression of TSHR mRNA in the normal non-pregnant group was not significantly different statistically compared with those of other groups (lactating for 10,15 and 20 days) and weaning for 5 days group (all P ＞ 0.05).Conclusion TSHR is widely expressed in thyroid gland of lactating rats,but relatively lower in early lactation period.