Objective:To study the clinical significance of early detection of soluble growth stimulating gene 2 protein (sST2) and prealbumin (PAB) in patients with chronic pulmonary heart disease (CPHD) complicated with refractory heart failure.Methods:From September 2017 to June 2019, 112 CPHD patients complicated with refractory heart failure were admitted to Hengshui People's Hospital. The selected patients met the revised guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (2013 revision) and the cardiac function grade Ⅲ-Ⅳ according to the grading criteria of the New York Cardiology Society. Cardiogenic shock, severe liver and kidney dysfunction, malignant tumors, anemia, and autoimmune diseases were excluded. Patients were divided into the high PAB group (≥200 mg/L) and the low PAB group (<200 mg/L) according to the PAB level on admission. The pulmonary artery systolic blood pressure (PASP), pulmonary artery mean pressure (MPAP), and left ventricular ejection fraction (LVEF) were observed in the two groups before and after the treatment. PAB, total bilirubin (TBIL), hypersensitive C reactive protein (hs-CPR), N-terminal B type brain natriuretic peptide (NT-proBNP) and sST2 levels were detected. Measurement data were expressed in terms of mean ± standard deviation, the counting data were compared using χ 2 test. Correlation analysis was conducted using Spearman correlation test. Results:There were 40 cases in the high PAB group and 72 cases in the low PAB group. There were no statistically significant differences in general data between the high PAB and low PAB groups ( P>0.05). Hospitalization time was significantly different between the two groups ( P<0.05). Before the treatment, there were no significant differences in PASP, MPAP, NT-proBNP and LVEF between the two groups ( P>0.05). High sST2 was significantly different between the two groups ( P<0.05). After the treatment, PASP, MPAP, NT-proBNP and sST2 were decreased in both groups, and the improvement was more obvious in the high PAB group than in the low PAB group, with statistical significance ( P<0.05). Before the treatment, the levels of TBIL and hs-CPR were not statistically different between the high PAB and low PAB groups ( P>0.05). However, the levels of TBIL and hs-CPR were beyond the normal range. After the treatment, TBIL and hs-CPR were decreased in both groups, and there was statistically significant difference between the two groups ( P<0.05). Spearman correlation analysis showed that PAB was negatively correlated with sST2 ( r=-0.778, P=0.001). There was a positive correlation between cardiac function and sST2 ( r=0.569, P=0.034), hospitalization time ( r=0.572, P=0.033) in patients with refractory heart failure. The higher the sST2 of CPHD with refractory heart failure, the longer the patient hospitalization time, and the more serious the heart failure was. The area under the combined ROC curve of PAB and sST2 was 0.756. CPHD patients with refractory heart failure had the greatest predictive value. Conclusion:The combined test of sST2 and PAB can evaluate the condition and outcome of CPHD patients with refractory heart failure, and guide the clinic.

Objective To investigate the clinical value of prenatal MRI in the diagnosis of fetal bowel obstruction.Methods Pregnant women suspected to have fetal abdominal abnormalities by ultrasonography were suggested to undergo MRI examinations within two days.Scanning sequence included FIESTA,SSFSE and T1WI SPGR sequence,with field of view focused on the fetal abdomen.After the final diagnoses of the cases were obtained by induced labor pathological examination or postpartum imaging or operation,the imaging data and the clinical data were reviewed and analyzed retrospectively.Results A total of 23 cases with bowel obstruction were included in the study.Four fetuses with duodenal atresia showed low T1 signal,high T2 signal characterized by double-bubble sign on MRI.There were 10 fetuses with jejunoileal atresia,showing bowel dilatation and hyperintense micro-colon on T1WI.Five cases of them depicted expansion of the terminal ileum with high T1 meconium signal.One each fetus had colonic atresia,intestinal malrotation with double-bubble and whirl sign.Annular pancreas with double-bubble sign and pressure trace of the bracket shape was detected in 3 fetuses.Meconium peritonitis was present in 4 fetuses,with 2 of them showing dilatation of intestine,ascites and pseudocysts.Conclusions According to the signal characteristics of amniotic fluid and meconium in the gastrointestinal tract on MRI,the obstructive level and development status of the distal bowel can be determined with MRI.It can provide additional information to ultrasonography,which brings clinical significance to prenatal diagnosis and intrapartum surgical operation.

Objective To investigate the current situation of medical students' individual career management and its educational status.Methods Self-made questionnaire was used to investigate the present situation of individual career management and education of medical students in a medical college in November 2016.SPSS 20.0 was used for analyzing descriptive statistical analysis,t test and rank test in questionnaire data.From April to May 2017,30 students were randomly selected for interviews to explore the current situation of medical students' individual career management.Result 900 questionnaires were issued and 816 valid questionnaires were collected,and the recovery rate was 90.67％.Whether medical students accept the relevant education had significant difference in their career management ability (P＜ 0.05),30.15％ of the students who received the relevant education (246) had a higher total score of their own career management than those who had not received,which was reflected in social work environment cognition level,participation in extracurricular activities,consideration of graduation and stage goals setting.It is learned from the interview that most medical students lack clear self-awareness and professional goals are vague,and they fail to form a good personal career management atmosphere.Conclusion Individual career management education promotes the cognitive level of social work environment of medical students and then develops their self-awareness.At the same time,it urges medical students to participate in extracurricular activities,to consider the whereabouts after graduation,to set phased goals,and to carry out targeted self-improvement.The comprehensive development of self-cognition and self-improvement finally make the medical students' individual career management ability continuously improved.

The pelvis is one of the most likely affected areas of the human body in case of side impact, especially while people suffer from motor vehicle crashes. With the investigation of pelvis injury on side impact, the injury biomechanical behavior of pelvis can be found, and the data can help design the vehicle security devices to keep the safety of the occupants. In this study, a finite element (FE) model of an isolated human pelvis was used to study the pelvic dynamic response under different side impact conditions. Fracture threshold was established by applying lateral loads of 1000, 2000, 3000, 4000 and 5000 N, respectively, to the articular surface of the right acetabulum. It was observed that the smaller the lateral loads were, the smaller the von Mises stress and the displacement in the direction of impact were. It was also found that the failure threshold load was near 3000 N, based on the fact that the peak stress would not exceed the average compressive strength of the cortical bone. It could well be concluded that with better design of car-door and hip-pad so that the side impact force was brought down to 3000 N or lower, the pelvis would not be injured.
Accidents, Traffic ; Biomechanical Phenomena ; Computer Simulation ; Finite Element Analysis ; Fractures, Bone ; physiopathology ; prevention & control ; Humans ; Pelvis ; injuries ; Stress, Mechanical

Objective:To investigate the high resolution CT (HRCT) features of COVID-19 in children.Methods:A retrospective analysis was performed on the chest HRCT findings of 22 children who were diagnosed as COVID-19 by clinical and nucleic acid testing in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 25 to February 5, 2020. There were 12 boys and 10 girls, aged from 2 months to 14 years old, with a median age of 4 years, and 14 patients were under 5 years old. The characteristics of lung lesions on HRCT such as distribution, shape, density and so on and whether there were hilar and mediastinal lymph node enlargement and pleural changes were evaluated by 2 radiologists.Results:In all of the 22 patients, the chest CT manifestations were normal in 3 patients (3/22) , meanwhile the lung involvement of the lesion was found in 19 patients (19/22). Among them, 7 patients had unilateral lung involvement, and 12 patients had bilateral involvement. The HRCT manifestations were as follows. The HRCT showed the ground glass opacity (GGO) in 6 patients, including 4 cases with light opacity and 2 with typical crazy paving sign. Four patients had lung consolidation, with local fibrous stripes and patchy hyperdensity. Six patients had mixed GGO, including 1 case with right white lung. The bronchopneumonia-like changes were seen in 3 cases with scattered spot-like or mixed patchy. The lesions in the lower lobe were more serious than those in the upper lobe, and the lesions in the lateroposterior zone of the lung were more common than those in the apical and central area of the lung. No enlarged lymph nodes and pleural effusion were seen in all patients, but 1 case had thickened interlobar pleura.Conclusions:The HRCT manifestations of COVID-19 in children are varied, and the comprehensive assessment need to be made in combination with epidemiological data, clinical manifestations and laboratory tests. However, the chest HRCT plays an important role in early diagnosis, prevention and management of COVID-19.

Objective:To establish the reference for serum metabolomics profiles among healthy Han adults in China, and explore the variation on metabolomics profiles by geographic regions, sex, and age.Methods:Cross-sectional data and serum samples were obtained from the China National Health Survey. A total of 1 039 male and 1 032 female healthy adults(≥30 years) were included in this study. Serum metabolomics analyses were conducted with ultra-performance liquid chromatography-mass spectrometry(UPLC-MS). Orthogonal partial least squares discriminant analysis(OPLS-DA) was performed to compare the differences of metabolomics among different region, sex, and age.Results:Significant differences on metabolomics profiles were identified among region, sex, and age. A total of 114 region-related metabolites were spotted, including 53 metabolites that involved in human metabolic pathways, mainly peptides(20 metabolites) and glycerophospholipid metabolism-related(14 metabolites). Fifty-nine metabolites were pinned down to be sex-related, among which cotinine was significant in all 7 provinces. Age-related metabolites were only found in Shaanxi and Hainan, with 22 metabolites were recognized.Conclusion:Serum metabolomics varies by geographic regions, sex, and age. When metabolomics is applied for diagnosis or biomarker screening in various studies, it shall take into consideration of setting tailored references.

Objective: To investigate the high resolution CT (HRCT) features of novel coronavirus pneumonia (NCP) in children . Methods: A retrospective analysis was performed on the chest HRCT findings of 22 children diagnosed with 2019-nCov pneumonia by clinical and nucleic acid testing in Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 25, 2020 to February 5, 2020. There were 12 boys and 10 girls, aged from 2 months to 14 years old, with a median age of 4 years, and 14 patients were under 5 years old. The characteristics of lung lesions on HRCT imaging such as distribution, shape, density, etc. and whether there were hilar and mediastinal lymph node enlargement and pleural changes were observed by 2 radiologists. Results: In all of the 22 patients, 3 patients (3/22) had normal chest CT, and 19 patients (19/22) had infiltrated lesions in lung. Among them, 7 patients had unilateral lung involvement, 12 patients had bilateral involvement. The HRCT manifestations were as follows. Six patients showed ground glass shadow, including 4 cases showed light ground glass shadow and 2 had typical crazy paving sign. Four patients showed lung consolidation, with localized strip shadow and patchy high-density shadow. Six patients showed patchy lesions with surrounding ground glass shadow, including 1 case with white lung in the right. The bronchopneumonia-like changes in 3 cases, showed scattered spot-like or patchy uneven high-density shadows. The lesions in the lower lobe were more serious than those in the upper lobe, and the lesions in the lateroposterior zone of the lung were more common than those in the apical and central area of the lung. No enlarged lymph nodes and pleural effusion were seen in all patients, and 1 case had thickened interlobar pleura. Conclusions The HRCT manifestations of NCP in children are diversified, comprehensive judgments need to be made in combination with epidemiological data, clinical manifestations, and laboratory tests, but the chest HRCT can be used as an important basis for early clinical diagnosis and prevention and control interventions.