ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(P<0.05). After 4 weeks of treatment,compared with model group,body weight and serum content of ADH increased in Ootheca Mantidis groups,while urinary volume and renal index decreased (P<0.05);serum content of ALD increased in treatment groups;there was statistical significance in the serum content of ALD in those groups except Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group and steamed Ootheca Mantidis group (P<0.05);except for ALD,those index were in descending order of steamed Ootheca Mantidis group>Ootheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.

Objective To explore the clinical value of diagnos is value of the dynamic EEG monitoring (AEEG) (24-hour EEG monitoring) in epilepsy diagnosis. Methods 252 cases of clinically diagnosed as epilepsy were received AEEG monitoring, interictal awake and sleep EEG epileptiform discharge detection rates were compared. Results Of 252 cases epileptiform discharges were detected in 191 cases. appear separately in the awake period in 17 cases,sleep alone in 80 cases,both awake and sleep there were 94 cases, 111 cases were found in a sober period(accounting for 58. 1%) ,sleep period was found in 174 cases(91.1%) ,the difference was statistically significant(P ＜0. 01). Epileptiform discharges were seen mainly in NREM sleep Ⅰ -Phase Ⅱ. Conclusion Epileptiform discharges during sleep was significantly higher than those detected in the awakening period, AEEG contribute to the diagnosis of epilepsy,seizures can not be excluded on clinical and conventional EEG in patients without positive findings,can be AEEG monitoring.

Objective To observe the effect of valsartan combined with benazepril in treatment of patients with chronic heart failure. Methods 60 patients with heart failure of New York Heart Association (NYHA) class Ⅱ -Ⅳ and LVEF less than or equal 40% were selected and randomly divided into two groups. The patients in control group were given benazepril(10mg/d) alone,and the patients in treatment group were given valsartan(80mg/d) combined with benazepril(10mg/d). After 8 months therapy, the changes of the parameters of left ventriclular function and ventriclular dimension of the patients with chronic heart failure were compared before and after treatment. And the clinical efficacy was compared between two groups. Results The ventriclular dimension of the patients with chronic heart failure was decreased,and left ventriclular function was improved. The patients of the combination therapy group were improved especially after treatment. Conclusion Angiotensin-converting-enzyme(ACE) inhibitor could improve heart function of patients with chronic heart failure. Therapy of valsartan combined with benazepril was more effective.

Objective To summary Jiangsu Province Hospital of TCM Professor Xia GuiCheng's experience on treatment of infertility by the method of Tonifying the Kidney and Regulating the Period of Menses(TKRPM), meanwhile to observe the clinic curative effect of TKRPM combined with clomiphene for infertility.Methods The patients were randomly recruited into a TCM group and a TCM combined western medicine group by digital randomized methed,30 cases in each group.The TCM treated group was treated by the method of TKRPM, while the other group was treated by TCM combined with clomiphene. Both groups were treated for three months.Syndromes, basal body temperature, results of B ultrasonic, and hormone in serum were observed. Results In TCM treated group , the clinic effective rate was 93.3%, the pregnant ratio was 33.3%, mean-cure-time for pregnant was(8.20±2.35)months; while in TCM combined western medicine group, the clinic effective rate was 100%, the pregnant ratio was 20%, and mean-cure-time for pregnant was (5.17±1.72) months.The clinic effective rates (U=0.358) and the pregnant ratios (x2=1.346) of two groups were not markedly difference (P＞0.05), but the mean-cure-time for pregnant of the two groups was markedly difference(P＜0.05). Conclusion TKRPM combined with induction drugs can cure infertility in a shorter time than using TCM only. Western medicine improves endocrine environment,while traditional Chinese medicine regulates the relationship among kidney, TianGui and the uterus fundamentally. The method will be more acceptable to patients.

BACKGROUND:Coronary drug-eluting stent implantation is the best treatment for acute ST-segment elevation myocardial infarction, but because of many combined risk factors in elderly patients, the mortality rate is increased with aging. OBJECTIVE:To analyze whether age differences is a significant independent predictor of in-hospital clinical outcomes in patients with acute ST-elevation myocardial infarction treated with domestic rapamycin drug-eluting stent implantation. METHODS:A retrospective analysis was done in 307 patients with first acute ST-elevation myocardial infarction treated with emergent rapamycin drug-eluting stent implantation for primary percutaneous coronary intervention. According to the age, there were three groups: non-elderly group (< 65 years old,n=175), low-elderly group (65-74 years old,n=83), and high-elderly group (≥ 75 years old,n=49). Clinical features, mortality, cardiac events during in-hospital stay were compared among three groups. RESULTS AND CONCLUSION: Compared with the non-elderly group, the proportion of female patients and the history of hypertension were higher in the low-elderly or high-elderly group (P < 0.05). The history of smoking was higher in the non-elderly group than the other groups (P < 0.05). The incidences of Kilip classification≥II, three-lesion or left main coronary artery disease were higher in the high-elderly group than the other groups (P < 0.05). Hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, and cholesterol levels were higher in the non-elderly group than the other groups (P < 0.05). Serum creatinine level, incidence of malignant arrhythmia and incidence of in-hospital cardiac death were increased with aging. Successful reperfusion was higher in the high-elderly group than in the low-elderly or non-elderly group. Rate of acute heart failure and combined cardiovascular events were higher in the high-elderly group than in the low-elderly or non-elderly group (P < 0.05). Multivariate logistic regression analysis show that age is an independent risk factor for in-hospital mortality in patients with acute ST-elevation myocardial infarction treated with rapamycin drug-eluting stent implantation.

BACKGROUND:Sagittal split ramus osteotomy is one of the most popular surgical procedures for correcting various mandibular deformities. There have been numerous modifications to this technique on the basis of clinical experiences and observation, but relevant anatomical data are very limited. A lot of anatomic studies on the mandible have been performed during the recent 20 years. OBJECTIVE:To entirely understanding the morphology of the mandibular ramus in the sagittal split ramus osteotomy and to explore the research progress in the sagittal split ramus osteotomy. METHODS:An electronic search of CMB and Medline was performed for relevant reviews and papers published from 1991 to 2011. Progress in the sagittal split ramus osteotomy was also analyzed. RESULTS AND CONCLUSION:Total y 26 articles related to the sagittal split ramus osteotomy were enrol ed. The keys to avoiding complications due to the sagittal split ramus osteotomy are as fol ows:distribution of cancel ous bone in the mandibular uvula area, distribution of cancel ous bone between the mandibular canal and buccal cortical bone during splitting progress, as wel as location and trend of the mandibular canal. Pre-operative CT test contributes to a successful sagittal split ramus osteotomy and a reduction in complications, and the anatomical measurement can be applied clinical y to a greater extent.

The infection caused by bacterial biofilm has becoming one of the most common nosocomial infection and gained much attention recently,with the characteristics of resistant to antibiotics and difficult to be cured.However, the mechanisms of antibiotic resistance of bacterial biofilm is still not very clear.In this paper we reviewed the current possible mechanisms of the antibiotic resistance of bacterial biofilm.

OBJECTIVE To determine the prevalence of antibiotic resistance to macrolide,lincosamide and streptograminB(MLS_B) in Staphylococcus epidermidis caused nosocomial infections and give guide for clinical antibiotics usage. METHODS Totally 126 S.epidermidis isolates were collected to test the minimal inhibitory concentrations(MIC) of erythromycin,clindamycin,clarithromycin,and azithromycin,quinupristin/dalfopristin and cefoxitin.Inducible type of MLS_B resistance(iMLS_B) and MS phenotypes were distinguished by double disk diffusion method(D test) as detailed by the NCCLS. RESULTS Among 126 S.epidermidis isolates,90(71.4%) isolates were meticillin resistant(MRSE),36(28.6%) were meticillin susceptive(MSSE).The rates of antibiotic-resistance to erythromycin,clindamycin,clarithromycin,axithromycin were 92.8%,73.8%,89.7% and 91.3%,respectively.Percentages of strains resistant to erythromycin and clindamycin were 96.7% and 85.6% in MRSE,and 83.3% and 80.6% in MSSE.Constitutive phenotype,inducible phenotype and MS phenotype were detected in 93(73.8%),13(10.3%),and 11(8.7%) isolates,respectively.In constitutive phenotype, the MRSE proportion appeared high(78.5%),in contrast,in inducible phenotype,MSSE proportion appeared high(75%).No resistance to quinupristin/dalfopristin was detected in all isolates(MIC≤1mg/L). CONCLUSIONS The prevalence of antibiotic resistance to MLS_B is high in the collected isolates.The main antibiotic phenotype is constitutive phenotype.MLS_B antibiotics should be used judiciously.

Accurate operation and installation circumstance of medical instruments and equipment directly affect their normal operation. Breakdown of medical instrument due to wrong operation accounts for 43% of all failures. This article makes a discussion on how to train staffs before operation,register utilization and maintenance,manage equipment by dedicated person and mak the best use of medical instrument.