Objective To investigate the clinicial significance of continuous glucose monitoring(CGM)of patients with severe traumatic brain injury(sTBI). Methods By glucose monitoring method,80 patients with sTBI〔Glasgow coma score(GCS)3-8〕in Department of Critical Care Medicine of Qingyuan People's Hospital in Guangdong Province from January 2012 to December 2012 were divided into two groups:41 patients in CGM group and 39 in regular glucose monitoring(RGM)group. The continuous glucose monitoring system(CGMS)was applied to monitor glucose level in the CGM group,and the finger blood was taken by portable blood glucose meter in the RGM group. The two groups were treated with insulin on the basis of glucose level,respectively. The relationships between the condition of glycemic excursions and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score or prognosis and between the incidence of hypoglycemia and prognosis were seen in the two groups. Results The close linear correlations between APACHEⅡ score and glycemic excursion in two groups,i.e. mean amplitude of glycemic excursions(MAGE)and coefficient of variation of glucose(GluCV),were documented(both P<0.05). The MAGE of the especially severe patients(GCS 3-5)was obviously higher than that of severe ones(GCS 6-8),and with the increase of APACHEⅡ score,the MAGE of patients was gradually elevated,the difference being statistically significant(both P<0.05). The incidence of hypoglycemia(7.32%vs. 23.08%)and fatality rate of 30 days(12.20%vs. 30.77%)in CGM group were lower than those of RGM group(both P<0.05). The MAGE and fatality rate of 30 days were positively correlated in CGM group(r=0.597,P=0.007),and the GLuCV and fatality rate of 30 days were positively correlated in RGM group(r=0.622,P=0.019). Conclusion CGM is beneficial to timely observe condition of glycemic excursions in sTBI patients and avoid occurrence of hypoglycemia or hyperglycemia,guiding the treatment of insulin and improving patients' prognosis.

Objective To explore factors associated with emergency room(ER)length of stay and provide basis for the emergency managers about the development of relevant measures.Methods Data of critically ill patients from the emergency room in a tertiary teaching hospital from January 2010 to June 2011 were retrospectively studied.Binary Logistic regression analysis was used to determine possible factors and further compare the clinical characteristics of the patients.Results(1)From January 2010 to June 2011 a total of 11 468 patients were seen in the emergency department,the median ER length of stay was 11 h,a number of 6 525 patients(56.9％)stayed in ER more than 6 h.(2)Binary Logistic regression analysis showed that the main factors contributing to length of stay more than 6 hours were types of wards,green channel,treatment time,followed by admitted to ICU,traffic,sent by 120,the number of initial diagnosis,destinations of disposition,sex,holiday visit,visit month.While age,occupation,residence were not factors.Conclusions The patients in this hospital has a prolonged length of stay.The associated factors included types of wards,green channel,treatment time deserves a further study.

Objective To study a quick and effective assessing method used in the emergency trauma patients in order to prevent delaying treatment for patients from overlook or misdiagnosis during triage. Method From 1 January 2006 to 31 September 2006, there were 4023 patients evaluated with trauma assessment method, which was composed of CRAMS scale and trauma assessment program. Results Of 4023 patients, there were 2430 cases with CRAMS below 1( < 7) ,of whom 1979 cases assessed with trauma assessment program were found to be injuried severely to threaten their lives. And more noticeably,of 1593 patients with CRAMS ≥7 there were 46 patients found to have life-threatening injuries assessed with trauma assessment method. Conclutions CRAMS score can be used for triage, and trauma assessment program can be used to evaluate the injuries anatomically. Trauma assessment program and CRAMS employed conjointly can increase the sensitivity and specificity for the stratification of the severity in the injuried patients in order to get a successful triage and lo take advantage of the resources of e-mergency care appropriately.

Objective To observe the therapeutic efficacy and safety of recombinant tissue-type plasminogen activator (rt-PA) combined with edaravone on acute cerebral infarction (ACI).Methods 60 cases of ACI were divided into rt-PA group (30 cases, treated by rt-PA only) and trial group (30 cases, treated with rt-PA combined with edaravone). The nerve function deficits of patients in both groups were evaluated by European Stroke Scale (ESS) and Barthel Index (BI) before and after treatment respectively.Results The ESS scores at 21st day and 90th day after treatment in the trial group were significantly higher than those of the patients in the rt-PA group. The effective rate of patients in the trial group was significantly higher than those in the rt-PA group (P＜0.05).Conclusion The treatment of rt-PA combined with edaravone is effective and safe in patients with ACI.

Objective : To learn the characteristics of second-line drug resistance and related gene mutations of multidrug-resistant Mycobacterium tuberculosis ( MDR-TB ) Beijing genotype strains. Methods: The MDR-TB isolates in Hwa Mei Hospital from 2017 to 2019 were enrolled and detected using RD105 deletion-targeted multiplex polymerase chain reaction (PCR). The proportion method for drug susceptibility test was used to detect the drug-resistant profiles against kanamycin, amikacin, capreomycin, ofloxacin and levofloxacin. The gene sequencing of rrs, tlyA, eis, gidB, gyrA and gyrB was conducted by PCR compared with H37RV strain. The differences in the rates of drug resistance and mutation between Beijing and non-Beijing genotype strains were examined to understand the characteristics of Beijing genotype strains. Results: There were 106 Beijing genotype and 27 non-Beijing genotype strains in 133 MDR-TB isolates. The drug resistance rates of kanamycin, amikacin, capreomycin, ofloxacin and levofloxacin in Beijing genotype strains were 9.43%, 7.55%, 3.77%, 32.08% and 32.08%, respectively. The rates of quasi-extensive and extensive drug resistance in Beijing genotype strains were 30.19% and 7.55%. The gene mutation rates of rrs, tlyA, eis, gidB, gyrA and gyrB in Beijing genotype strains were 7.55%, 7.55%, 1.89%, 2.83%, 36.79% and 2.83%, respectively. There were no significantly differences between Beijing and Non-Beijing genotype strains in the factors above ( P>0.05 ). The gene rrs, tlyA, eis, gidB, gyrA and gyrB had 2, 1, 2, 2, 5 and 3 mutation types, respectively, with single base substitution as the main type. Conclusion Beijing genotype strains are dominant in MDR-TB, with high resistance to fluoroquinolones and mainly gyrA gene mutation.

AIM:To investigate the autophagy induced by sepsis and acute kidney injury , and the regulation of phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in this process.METHODS: The rats were subjected to cecal ligation and puncture ( CLP) or sham operation .Histopathologic changes of the renal tissues were examined by HE staining .Blood urea nitrogen ( BUN) and serum creatinine ( SCr) were measured by chemical colorime-try.The protein expression of microtubule-associated protein light chain 3 I/II (LC3 I/II), beclin-1 and p-Akt at different time points after CLP was detected by Western blotting .In vitro, human proximal tubular epithelial cell line HK-2 were treated with LPS to induce autophagy .The protein expression of LC 3 I/II and p-Akt in the HK-2 cells after LPS treatment at different time points and different concentrations was detected by Western blotting .These molecules in HK-2 cells and apoptosis of HK-2 cells treated with LPS plus PI3K inhibitor or Akt inhibitor were also detected .RESULTS: Compared with sham group , the severe changes of renal histopathological injuries in CLP groups were observed , the levels of BUN and SCr in CLP groups were significantly increased .LC3 I/II, beclin-1 and phosphorylation of Akt gradually increased after CLP.After treatment with LPS, the expression of p-Akt (308) in the HK-2 cells gradually increased in a dose-and time-dependent fashion.The expression of beclin-1 and p-Akt (472) reached a peak at 8 h or 10 mg/L LPS treatment.Treat-ment with PI3K or Akt inhibitor down-regulated the expression of LC3 and promoted the apoptosis of HK-2 cells.CON-CLUSION:Autophagy in the kidney is induced by sepsis and acute kidney injury .PI3/Akt signaling pathway may be in-volved in this process .

Objective To investigate the correlation between carotid intraplaque neovascularization and acute ischemic cerebrovascular disease. Methods The patients examined with contrast-enhanced ultrasound were enroled and divided into either a symptomatic group or an asymptomatic group according to their cerebral ischemic symptoms. The patients were also divided into a low-echo group, an equal-echo group, and an heterogeneous echo group according to the plaque echo characteristics on conventional ultrasound. The carotid intraplaque neovascularization was evaluated with contrast-enhanced ultrasound. Multivariate logistic regression analysis was used to identify the correlation between carotid intraplaque neovascularization and acute ischemic cerebrovascular disease. Results A total of 73 patients with acute ischemic cerebrovascular disease were enroled, 32 patients in the symptoms group (19 ischemic stroke, 13 transient ischemic attack), 41 patients in the asymptomatic group. Plaque echo characteristics: low-echo 15, equal-echo 41, and heterogeneous echo 17. The proportions of the patients with plaque enhancement (84. 4% vs. 61. 0% ; χ2 = 4. 802, P = 0. 028) and enhanced intensity (21. 78 ± 8. 50 dB vs. 15. 93 ± 8. 82 dB; t = 2. 440, P = 0. 018) in the symptomatic group were significantly higher than those in the asymptomatic group. The proportions of the patients with enhanced plaque in the low-echo, equal-echo and heterogeneous echo group were 93. 3% , 58. 5% , and 82. 4% , respectively (χ2 = 7. 826, P = 0. 020 ). The low-echo group and heterogeneous echo group were significantly higher than the equal-echo group (al P < 0. 05), but there was no significant difference between the low-echo group and the heterogeneous echo group (P > 0. 05). The intraplaque enhanced intensities in the low-echo group, equal-echo group, and heterogeneous echo group were 22. 62 ± 9. 33 dB, 14. 38 ± 8. 02 dB, and 18. 15 ± 9. 64 dB, respectively (F = 3. 877, P = 0. 027). The low-echo group was significantly higher than the equal-echo group (P = 0. 024 ). Multivariate logistic regression analysis showed that carotid intraplaque neovascularization (odds ratio 3. 456, 95% confidence interval 1. 103 - 10. 828; P = 0. 033) was independently associated with acute ischemic cerebrovascular disease. Conclusions Carotid intraplaque neovascularization is closely associated with acute ischemic cerebrovascular disease.

Objective: This study aims to investigate the impact of individual and family factors on anxiety and loneliness of middle school students during quarantine in the COVID-19 pandemic and to provide reference for discussing the possible effective intervention paths in the stress process of public health emergencies. Methods: A total of 11 596 students from junior and high schools in Shanghai were selected to complete the questionnaire with the stratified random cluster sampling method. Generalized Anxiety Disorder(GAD-7) and UCLA Loneliness Scale, University of California at Los Angeles(ULS-6) were used for the survey. Results: The prevalence of anxiety and loneliness were 34.78% and 52.44% respectively. The rate of anxiety and loneliness in girls (36.13%, 54.62%) was higher than that of boys (33.44%, 50.28%)(χ 2=17.03, 21.82, P<0.05). Logistic regression analysis showed that graduates (OR=1.34, 95%CI=1.18-1.52), students ranking in the middle (OR=1.25, 95%CI=1.08-1.45) or in the bottom 25% (OR=1.76, 95%CI=1.50-2.05), non only children in the family (OR=1.25, 95%CI=1.09-1.43) and low socioeconomic status (OR=1.42, 95%CI=1.23-1.65) were associated with increased risk of moderate and severe level of anxiety(P<0.05). Girls(OR=1.20, 95%CI=1.12-1.30), graduates(OR=1.13, 95%CI=1.04-1.24), non residents(OR=1.20, 95%CI=1.09-1.33), lower level of grades(OR=1.72, 95%CI=1.55-1.91) and not living with parents(OR=1.32, 95%CI=1.18-1.48) were associated with increased risk of loneliness(P<0.05). Conclusion During the quarantine period caused by the COVID-19 pandemic, negative emotions such as anxiety and loneliness among adolescents need attention, especially females, graduates, only children and students with low rankings or low socioeconomic status.

Objective:To investigate the levels and the clinical signficance of matrix metalloproteinase 3 (MMP-3) in different activities of rheumatoid arthritis (RA).Methods:Case-control study. A total of 130 patients [24 cases of male, 106 cases of female, age (52.98±13.24)years, the median age was 51 years] with RA diagnosed in the Department of Rheumatology from the Second Affiliated Hospital of Soochow University, Suzhou Hospital of Traditional Chinese Medicine and Suzhou Ninth People′s Hospital from 2017 to 2018, and 100 healthy controls [28 cases of male, 72 cases of female, age (45.04±11.55) years, the median age was 44 years] from the physical examination center of the Suzhou Ninth People′s Hospital. The basic clinical data was used to determine the MMP-3 on groups of RA patients and healthy controls by immunoturbidimetry. The discriminating validity of MMP-3 in disease was evaluated using receiver operating characteristic (ROC) curve analysis.Results:Compared with that in healthy controls[28.0 (21.7-36.1)ng/mL], the MMP-3 in the low groups [51.8(41.8-73.1)ng/mL] increased dramatically ( Z=2.942, P<0.01). However, there was no significant difference between the MMP-3 in remission patients [28.8 (21.9-38.7)ng/mL] compared with the healthy controls ( Z=1.09, P>0.05). The area under the curve (AUC) of MMP-3 for diagnosis of RA was 0.877. the sensitivity was 73.1%, and the specificity was 93%.The AUC of MMP-3 diagnosis of low groups was 0.906, the sensitivity was 77.8%, and the specificity was 88%. In addition, the MMP-3 level was correlated with CRP and ESR ( r=0.242, r=0.243), and it was significantly correlated with DAS 28 ( r=0.361). Conclusions:It was indicated that the level of MMP-3 increased with the severity of rheumatoid arthritis. And the clinically low level of MMP-3 in RA patients could be used to indicate the remission condition. Meanwhile, the serum MMP-3 was closely related to DAS28.

Objective To analyze the efficacy and safety of CyberKnife combined with temozolomide (TMZ) in treatment of brain metastasis of non-small cell lung cancer (NSCLC). Methods From March 2013 to March 2016, 62 NSCLC patients with brain metastases in department of oncology of the 187th Hospital of PLA were divided into two groups according to the random number table method, the CyberKnife combined with TMZ group (CyberKnife + TMZ group, 31 cases) and simple CyberKnife group (CyberKnife group, 31 cases). Hypofractionated radiation of CyberKnife was given 18-36 Gy in 1-5 fractions of 5-25 Gy. CyberKnife+ TMZ group was given temozolomide 150 mg·m-2·d-1 for 5 days in first cycle, then every 28 days they received temozolomide therapy from the second to the sixth cycles: 200 mg·m-2·d-1 for 5 days. The clinical symptom remission rate after the treatment of CyberKnife in one week, the effective rate after CyberKnife in 3 months, the median intracranial progression-free survival time, overall survival, and the incidences of adverse reaction were comparatively analyzed. Results The clinical symptom remission rates of CyberKnife+TMZ group and CyberKnife group after the treatment of CyberKnife in one week were 93.6 ％ (29/31) and 96.8 ％ (30/31). There was no significant difference in the clinical symptom remission rates (χ2= 1.207, P=0.547). The effective rates of the two groups after CyberKnife in 3 months were 93.6 ％ (29/31) and 90.3 ％(28/31). There was no significant difference in the effective rates (χ2 = 0.695, P= 0.706). The median intracranial progression-free survival time in CyberKnife + TMZ group (14.0 months) was significantly higher than that in the CyberKnife group (9 months) (χ2=8.977, P=0.003), and the median overall survival time in CyberKnife + TMZ group (15.0 months) was also significantly higher than that in the CyberKnife group (12.0 months) (χ2 = 5.190, P= 0.023). There was no significant difference in the adverse reaction of the central nervous system between the two groups (χ2=0.746, P=0.689), but the adverse reactions of the digestive system (χ2 = 6.062, P= 0.014) and the hematologic system (χ2 = 6.613, P= 0.010) in CyberKnife + TMZ group were significantly higher than those in the CyberKnife group. Systemic adverse reactions of the two groups were tolerated by most patients. Conclusions CyberKnife combined with TMZ is a feasible therapeutic option for NSCLC patients with brain metastases. This therapy can improve the median survival time to cerebral progression of the disease and the median overall survival time.