Objective To investigate the dynamic level changes and significance of triggering receptor expressed on myeloid cells-1 (TREM-1) in the injury brain tissues of rats caused by pneumolysin (PLY).Methods Sixty-four SD rats were randomly and equally divided into PLY group and control group,0.1 mL PLY and isopyknic normal saline was given through left internal carotid artery respectively.Brain tissue gross and histological changes were observed at different time(4 h,6 h,12 h,24 h),meanwhile the expression levels of neurocyte damage marker glial fibrillary acidic protein (GFAP) and neuron-specific enolase (NSE) protein were detected by immunohistochemistry;and the expression levels of TREM-1,tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were detected respectively by enzyme-linked immunosorbent assay.Results The observation of brain tissue gross and histological changes indicated the existence of brain injury,and the expression levels of GFAP,NSE,TNF-α and IL-6 protein increased from 4 h after PLY were injected and augmented dynamically as time went on,compared with the control group at corresponding time points,the differences were statistically significant (all P ＜ 0.05).The level of TREM-1 in the PLY group reached a peak at the 4 h time point,but decreased somewhat at the 6 h time point,the level of TREM-1 was still higher than that in control group,the differences were statistically significant(all P ＜ 0.05).However,the level of TREM-1 in the PLY group declined obviously at 12 h and 24 h time points,compared with that in control group,there were no significant differences (all P ＞ 0.05).Conclusions The expression levels of TREM-1 up-regulated obviously in the early stage of brain damage induced by PLY,which might be involved in the pathological process of brain damage by promoting the expression of TNF-α and IL-6.

ObjectiveTo investigate the effects of psychological intervention on patients with acute coronary syndrome (ACS) accompanied by psychogenic disturbance.Methods112 patients with ACS were evaluated with depression status inventory (DSI) and symptom checklist-90 (SCL-90). The cases accompanied with depression were randomly divided into the psychological intervention group (group A) and drug group (group B). Patients of group A were treated with psychological intervention besides routine therapy. The curative effects of the two groups were compared.Results79 cases (70.5%) had depression. Their scores of somatization, depression, anxiety, fear, paranoid ideation, and total score and positive symptom distress level of SCL-90 were significantly different compared with the normal group. After psychological intervention, to patients of the group A, the DSI score fell and symptoms improved significantly (P<0.01), the in-patient duration shorten (P<0.05).ConclusionPsychogenic factors is not neglectable in the process and prognosis of ACS. Effective psychological intervention can promote the patient's healing.

Objective:To explore influence of different guide wire on transradial coronary angiography (CAG). Methods:A total of 238 patients,who received successful transradial CAG in our hospital from Nov 2009 to Jan 2013,were selected.According to kinds of guide wire,they were divided into group A (n=119,used ordinary J type exchange guide wire)and group B (n=119,used loach exchange guide wire.Trafficability,supporting force and incidence rate of complications were compared between above two groups.Results:The trafficability of loach exchange guide wire was significantly better than that of ordinary J type exchange guide wire,the pass rates of elbow joint (98.3% vs.87.4%)and brachiocephalic trunk (100% vs.96.2%)were significantly higher than those of or-dinary J type exchange guide wire (P<0.01 or <0.05).For guide wire support to rotate catheter,ordinary J type exchange guide wire had obvious advantages,its success rate of left CAG (98.3%)was significantly higher than that of loach exchange guide wire (89.1%),P<0.01.There were no significant differences in incidence rate of compli-cations between two groups.Conclusion:Ordinary J type exchange guide wire could be preferred in coronary angiog-raphy,and loach exchange guide wire can be considered if the former can't pass.

Objective To investigate the change and clinical significance of soluble triggering receptor expression of myeloid cells-1 (sTREM-1) and soluble urokinase plasminogen activator receptor (suPAR) expression in children with sepsis.Methods There were 80 systemic inflammatory response syndrome (SIRS)patients who were included in the study,60 cases in the sepsis group,20 cases in the non-infectious SIRS group and 30 cases in the healthy control group.By using the enzyme-linked immunosorbent assay (ELISA)to dynamically monitor the levels of serum sTREM-1,suPAR in children with sepsis,the differences of sTREM-1,suPAR levels between children with sepsis and non-sepsis were observed,the correlation with the pediatric critical illness score(PCIS) was analyzed,and the sensitivity and specificity of sTREM-1,suPAR,C-reactive protein (CRP)and procalcitonin (PCT)and other biochemical markers were compared,and the value of sTREM-1,suPAR,CRP,PCT in the early determination and prognosis of sepsis were investigated.Results Serum sTREM-1,suPAR,PCT levels in sepsis group were significantly higher than non-infectious SIRS group and the healthy control group,and the difference was statistically significant (P ＜ 0.05),but the differences of serum CRP levels in non-infectious SIRS group and sepsis group were not statistically significant(P ＞ 0.05).In sepsis subgroup,serum sTREM-1,suPAR,PCT levels between the three groups were of statistically significant difference (P ＜ 0.05).Through dynamic monitoring of sepsis group,serum sTREM-1,suPAR,CRP,PCT levels had a gradual downward trend in 1,4,7 day,at each time point difference was statistically significant (P ＜ 0.05).Serum sTREM-1,suPAR levels in sepsis group had significant negative correlation with PCIS (r =-0.322,-0.333,P ＜ 0.05).The sensitivity and specificity of sTREM-1,suPAR,CRP,PCT on diagnosing sepsis were in a descending order,and sTREM-1 combined with suPAR has the highest sensitivity and specificity.Conclusions sTREM-1 and suPAR all can serve as indicators of infection and inflammation,as their expression level can reflect the severity of sepsis.sTREM-1 combined with suPAR diagnostic sensitivity and specificity of sepsis was significantly better than a single indicator of sTREM-1,suPAR,CRP,PCT.Combining multiple indicators can improve the accuracy of diagnosis.

Objective To explore the application effect of modified early warning score ( MEWS ) information system based on nursing electronic medical records .Methods A total of 725 patients were chosen as the research objects, and were allocated to observation group (n=360) and control group(n=365) according to their hospitalized wards . Patients in control group received routine monitoring record and observation according to orders while patients in observation group had an extra MEWS information system grading and different levels of care and treatment scheme based on Early Warning Process .Level of patients care and corresponding MEWS score of observation group and incidence of accident , rescue success rate and mortality rate for patients of two groups were observed and compared .Results MEWS of critical care patients of observation group was the highest (6.81 ±2.19), while MEWS of tertiary care patients was the lowest (1.80 ±0.72). Accident rate in observation group was obviously lower than the control group , rescue success rate was higher than control group(P<0.05);mortality rate of two groups had no difference (P<0.05).Conclusions On the basis of nursing electronic medical records , development of MEWS information system could help clinical nurses assess elderly patients rapidly and accurately , identify potential critical care patients early , and improve patients safety management to ensure patients safety .

Objective To explore the application effects of the construction of the pain management decision and quality monitoring system in big data era.Methods A total of 114 patients who were in Oncology Department ward from January to June 2016 when the system of pain management decision and quality monitoring had not been applied were selected as the control group. After the application of pain management decision and quality monitoring system, from July to December 2016, 132 patients of Oncology Department ward were selected as the observation group. The qualified rate of pain nursing record, the degree of pain relief and pain management satisfaction were statistically analyzed and compared between the two groups. Results After application of pain management decision and the quality monitoring system software, the pain assessment accuracy, the qualified rate of pain nursing records and pain management satisfaction of the observation group increased significantly than those of the control group, and the difference was statistically significant (P<0.05). The degree of pain relief in patients was significantly improved than that before the application, and the difference was statistically significant (P<0.05).Conclusions The application of pain management decision and quality monitoring system promotes the standardization of pain care and improves the efficiency of pain management.

Objective To summarize the cLinicaL features of cerebraL venous sinus thrombosis (CVST) in 6 chiLdren, and to improve the understanding of CVST in chiLdren. Methods The risk factors, cLinicaL presentations, Laboratory findings, imaging manifestations, treatments and outcomes of 6 chiLdren (3 maLes, 3 femaLes) with CVST admitted to the Department of Pediatrics, First AffiLiated HospitaL of Zhengzhou University from January 2012 to December 2017 were anaLyzed retrospectiveLy. ResuLts The risk factors of disease were found in 5 cases, incLuding 3 cases of infection, 1 case of L?asparaginase and dexamethasone chemotherapy and 1 case of oraL prednisone aLone. No definite risk factor was found in 1 case. The cLinicaL presentations were headache in aLL cases, vomiting in 3 cases, convuLsion in 2 cases, hemipLegia, photophobia, phonophobia and Limitation of eyebaLL abduction in 1 case respectiveLy. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) showed 2 cases of intracraniaL hemorrhage, 2 cases of cerebraL parenchymaL infarction and 2 cases of abnormaL signaL in venous sinus. Thrombus Located in superior sagittaL sinus in 4 cases, transverse sinus in 4 cases, sigmoid sinus in 3 cases and straight sinus in 1 case. After anticoaguLation treatment, headache and vomiting were aLLeviated, and veins were recanaLized in 6 cases. Two cases were diagnosed with eyebaLL abduction Limitation and hemipLegia but did not improve in the short term after treatment. ConcLusions Infection is the main risk factor of CVST in chiLdren and headache is often the cause of medicaL consuLtation. Brain MRI and MRV are heLpfuL in diagnosis and timeLy treatment can improve prognosis.

ObjectiveTo review the efficacy and safety in secondary prevention of ischemic stroke with cilostazol or aspirin.Methodswe searched Cochrane Library(the 4th issue, 2009 ), PubMed(1980.1～2009.11), EMBASE(1980.1～2009.11), CBM(1978.1～2009.11), CNKI(1979.1～2009.11) and some other databases, then collected all of the studies describing the outcomes in curing the ischemic stroke after taking cilostazol or aspirin. According to the strict inclusion and exclusion criteria, two reviewers independently selected trials, extracted datas, made cross-checking and methodological quality assessment of the homogeneity studies by using the Cochrane systematic review methods, then made Meta analysis using RevMan 5.0 software.ResultsThis systematic review study included two randomized controlled trials and a cross-over trial, which contained a total of 838 participants. The evidence quality of one of the randomized controlled trials was high, however, the evidence quality of another randomized controlled trial and the cross-over trial was poor. Meta analysis results suggested that the effectiveness of cilostazol and aspirin in the secondary prevention of ischemic stroke performed no significantly statistical difference: primary endpoint(30 d［RR=3.00, 95%CI(0.31,28.70)］; 90 d［RR=1.67, 95%CI(0.40,6.92)］; 180 d［RR=1.25, 95%CI(0.50, 3.13)］; 360 d［RR=0.65, 95%CI(0.33, 1.29)］; 540 d［RR=0.80,95%CI(0.54, 1.18)］); combined endpoint(30 d［RR=4.00, 95%CI(0.45,35.61)］; 90 d ［RR=1.75,95%CI(0.52,5.93)］; 180 d［RR=1.00, 95%CI(0.48, 2.07)］; 360 d ［RR=0.77, 95%CI(0.45, 1.29)］; 540 d［RR=0.66,95%CI(0.40,1.09)］); the recurrence of ischemic stroke: cilostazol group: RR=0.64, 95%CI(0.31,1.30)，aspirin group: RR=0.21, 95%CI(0.04,1.06); PDMP［RR=1.00, 95%CI(0.39, 2.58)］. But in terms of the probability of intracranial hemorrhage (［RR=7.14, 95%CI(0.7,58.33)］) and other safety standards, taking cilostazol performed lower than taking aspirin.ConclusionThe side effects of cilostazol and aspirin in the treatment for ischemic stroke were similar to each other, but in terms of the probability of dizziness, headache, tachycardia and palpitation, taking cilostazol performed higher than taking aspirin, however, taking cilostazol performed lower in the probability of intracranial hemorrhage and other organ hemorrhage than taking aspirin. Since this study included a small amount of studies, in which the evidence quality of one of the randomized controlled trials and the cross-over study was poor, therefore, it would be necessary to make a further validation with lots of high-quality clinical trials.

Objective:To explore the genetic basis for a newborn with familial hemophagocytic lymphohistiocytosis type 3 (FHL3).Methods:Clinical and laboratory data of the newborn and his family members were reviewed. Whole exome sequencing (including and flanking intronic regions) was carried out. Candidate variants were verified by Sanger sequencing. Wild type and mutant minigene vectors containing exon 23, intron 23 and exon 24 of the UNC13D gene were constructed and transfected into HEK293T cells by lipofectamine reagent. Reverse transcription PCR was carried out to verify the splicing of the minigenes. Results:Pedigree analysis and clinical examinations indicated that the child has autosomal recessive FHL3. DNA sequencing revealed that he has harbored c. 118-308 (IVS1)C>T and c. 2298+ 1 (IVS23)G>A variants of the UNC13D gene, which were respectively inherited from his father and mother, which constituted compound heterozygosity and were both predicted to be pathogenic. Minigene experiment confirmed that the c. 2298+ 1(IVS23)G>A variant has resulted skipping of exon 23 (-207nt) resulting in a truncated protein. Conclusion:The c. 118-308(IVS1)C>T and c. 2298+ 1(IVS23)G>A compound heterozygous variants of the UNC13D gene probably underlay the FHL3 in this child, which has resulted in low expression as well as abnormal splicing of UNC13D mRNA.