Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.

Acute respiratory distress syndrome (ARDS) is a common diseases in critical ill patients, which is an acute-onset hypoxic condition with radiographic bilateral lung infiltration. And it can be divided into two phases in pathophysiology: an acute exudative phase combining diffuse alveolar damage and lung edema followed by a later fibro proliferative phase. The early prediction and risk assessment of patients with ARDS is still very poor in the clinical. In recent years, researchers gradually focus their research on exploration of biomarkers of ARDS. The article mainly aims to sum up the development of biomarkers exploration.

Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.

Objective To discover,diagnose and treat colorectal cancer in the early period and further improve the survival rate,reduce morbidity and mortality of the colorectal cancer by early screening for colorectal cancer in Jinjiang.Methods According to “The Guide of Cancer Screening and Early Diagnosis and Treatment in China by the Experts Group of Ministry of Health”,the case history was collected while the stool occult blood and FOBT were detected to discover high risk crowd who then inspected by electron enterscope.Results The screening was practiced in Xibin,Zimao and Neikeng town respectively.The crowd of 40-74 years old was 10 116 and 2631 of them accepted screening(acclimation rate,26％).Two hundred and fifty-seven high-risk people were discovered(9.8％ of 2631)and 86 of them(acclimation rate,33％,86/257)were inspected by electron enterscope.Twenty-two cases were detected with colorectal affection(detection rate,8.6％,22/257),20 cases were diagnosed as colorectal adenoma and 2 cases were diagnosed as adenocarcinoma by pathological section.All of them accepted therapy.Conclusion Carrying out early screening for colorectal cancer is important.It can reduce morbidity and mortality of the colorectal cancer and then improve the cure rate and prolong survival in patients with colorectal cancer.

Objective To discuss the clinical effects of hemiarthroplasty for the treatment of intertrochanteric comminuted fracture in aged patients.Methods From June 2006 to June 2010,91 cases with intertrochanteric comminuted fractures were treated by hemiarthroplasty using Zweymtüller long-stem cementless implant.There were 35 males and 56 females,with an average age of 81.2 years (range,75-94 years).There were fresh fractures in 75 cases and old fractures in 16 cases.According to classification of Evans-Jensen,there were 36 cases with type Ⅲ fracture and 55 with type Ⅳ.Osteoporosis was graded by Singh index,and there were 51 cases with level Ⅲ and 40 with level Ⅱ.The interval between injury and operation was 2-10 d (average,3.5 d).Results The surgery lasted 30-50 min (average,39 min).The blood loss was 320-610 ml (average,405 ml).The hospital stay was 14-21 d (average,16.5 d).Two cases who experienced with the infection of the respiratory system after operation,recovered through routine treatment.Thirty-seven cases were followed up for 15 to 38 months (average,24.5 months).According to the Harris score,the overall rate of excellent or good result was 83.8％ (31/37).Conclusion Hemiarthroplasty using Zweymüller long-stem cementless prosthesis is reliable option for intertrochanteric comminuted fracture in the aged patients.

Objective To screen the 5 EV71 vaccine candidates which were isolated from MRC-5 cells to find one as the vaccine virus. Methods The ICR mother mouse were immunized by intraperitoneal injection with the 5 vaccine candidates which were made from monoclonal EV71 virus. Two weeks after booster immunization, the animals were allowed to mate, another booster was given after 2 weeks, and then attracted the milk mouse within 24 h with different types of virus by cranial cavity injection. The survival condition were recorded everyday, and the antibody titre(IgG) were detected by ELISA, the virus titre of intestine were detected by nest-PCR, and neutralizing antibodies were determined using a microassay with MRC-5 cells, and then the data were analyzed by SPSS16.0. Results The antibody titre of 5 virus immunized ICR mouse were improved with the increase in the immune times, and they got difference in neutralization capacity, the survival rate after fatal attract and the virus titre of the intestine. Conclusion It proved that the five vaccine candidates were different at the molecular level, cellular level and individual level. 123 strain was the best one in immunogenicity and immunoprotective property, which agreed with the vaccine requirement.

Objective To investigate the clinical effect and safety of the cell therapy of inhibition of antigen -presentation attenuators ( iAPA ) combined with adjuvant chemotherapy in the treatment of colon cancer . Methods From February 2014 to October 2015,the clinical data of 40 patients with colon cancer in the People＇s Hospital of Wenzhou were analyzed retrospectively.They were divided into control group and study group by the random digital table,with 20 cases in each group.The control group received mFOLFOX6 chemotherapy(treatment for 6 months),and the study group was treated with iAPA on the basis of the control group (treatment for 6 cycle).The clinical efficacy,levels of immune function indicators ( CD+3,CD+4,CD+8,CD+4/CD+8) before treatment and after treatment,the incidence of toxic and side effects and quality of life (QOL) score of the two groups were recorded.And the survival rates were statistically analyzed.Results The total effective rate of the study group was higher than that of the control group (85.0% vs.55.0%,χ2＝4.286,P＜0.05).After treatment,the serum levels of CD +3,CD+4,CD+8,CD+4/CD+8in the study group were higher than those in the control group,while the serum level of CD +8was lower in the study group than that in the control group,the differences were statistically significant (t＝2.657,3.160,5.700,2.326,all P＜0.05).There were no side effects of the degree of Ⅳin the two groups.The incidence rates of diarrhea(25.0%),vomiting and nausea (20.0%),liver function damage (25.0%) and bone marrow suppression (25.0%) in the study group were lower than those in the control group (χ2＝5.013,5.227,5.013,6.465,all P＜0.05).After treatment,the QOL scores of the two groups were higher than those before treatment (all P＜0.05),and the QOL score of the study group was higher than that of the control group (t＝4.739,P＜0.05).The survival rate of the study group was higher than that of the control group after 24 and 30 months of treatment(χ2＝5.013,4.912,all P＜0.05 ).Conclusion The iAPA combined with adjuvant chemotherapy in the treatment of colon cancer can regulate the immune function of the patients,and improve the treatment effect of the disease.It helps to improve the QOL and prolong the life period of the patients,reduce the incidence of side effects,and it is safe.

OBJECTIVE: To explore the genetic basis for a Chinese pedigree affected with inherited afibrinogenemia. METHODS: For the proband and his family members, prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), Fibrin(ogen) degradation products (FDPs), D-dimer (D-D), plasminogen activity (PLG:A) and the TT mixed experiment with protamine sulfate were determined with a STAGO-R automatic coagulation analyzer. The activity and antigen of fibrinogen (Fg) in plasma were measured with the Clauss method and immunonephelometry method, respectively. All exons and flanking regions of the fibrinogen genes (FGA, FGB and FGG) were amplified by PCR and directly sequenced. Human Splicing Finder software was used to predict and score the change of splicing site caused by the mutation. RESULTS: The proband showed normal FDPs and D-D but significantly prolonged TT, PT and APTT. The activity and antigen of fibrinogen in plasma were significantly decreased (<0.1 g/L). His young sister and parents showed slightly prolonged TT (18.20-18.50 s) and decreased fibrinogen activity (1.27-1.54 g/L) and fibrinogen antigenic content (1.34-1.56 g/L). Genetic testing revealed that the proband has carried homozygous IVS7-12A>G (g.4147A>G) mutations of the FGG gene, for which his parents and young sister were heterozygous. As predicted by Human Splicing Finder and Mutation Taster software, the variant may generate a new splicing site which can extend the sequence of exon 7 by 11 bp, with alteration of the coding sequence. PROVEAN suggested the variant to be deleterious. CONCLUSION The afibrinogenemia of the proband may be attributed to the FGG IVS7-12A>G variant, which was unreported previously.
Adult ; Afibrinogenemia/genetics* ; Female ; Fibrinogen/genetics* ; Heterozygote ; Humans ; Male ; Mutation ; Pedigree

Objective:To analyze the phenotype and genotype of two Chinese family with inherited dysfibrinogenemia and the molecular pathogenic mechanism.Methods:In the probands and their family members, coagulation routine, fibrinogen activity(Fg∶A) and fibrinogen antigen(Fg∶Ag) were detected . To find the mutation and exclude single nucleotide polymorphisms, all the exons and exons-intron boundaries of fibrinogen genes ( FGA, FGB and FGG) were amplified by Ploymerase Chain Reaction (PCR), then sequenced. Bioinformatics prediction softwares were used to predict and score the change of function caused by the variant. PyMol were used to analyze the structure of protein caused by the variant. Clustal X software was used to analyze the conservation of the mutant amino acids. Results:The thrombin time(TT) of the two was slightly prolonged and could not be corrected by protamine sulfate, and the fibrinogen activity was significantly reduced (1.25 g/L and 1.17 g/L), but the fibrinogen antigen content was normal, respectively (3.50 g /L and 3.81 g/L). Genetic analysis showed that both probands were heterozygous missense variants( FGB exon 7 c. 1115 T>A (p.Val372Glu)), both of which originated from the paternal line. The prediction results of the four bioinformatics softwares indicate that this variant could be disease causing. Clustal X software showed that Val372 is highly conserved among homologous species. Based on the guidelines of the American College of Medical Genetics and Genomics, c. 1115 T>A was predicted to be likely pathgenic(PM2+ PP1+ PP2+ PP3+ PP4). PyMol shouwed p. Val372Glu variant changes the secondary structure and three-dimensional structure of fibrinogen protein were changed caused by p. Val372Glu variant. Conclusion:Inherited dysfibrinogenemia of the probands maybe caused by variant of FGB c. 1115 T>A(p.Val372Glu), and the variant was firstly reported.

Objective:To analyze the component ratio of the social emergency training instructors in Baoan District, Shenzhen;Methods:During January 2018 to January 2019,participants, candidate to be social emergency training instructors in Baoan district, Shenzhen, were enrolled in our analysis. they needed orderly pass primary selection and intensive selection to be formal social emergency training instructors. Personal data from candidates including hospital, serving department, degree and professional types were collected. According to serving departments, candidates from pre-hospital emergency, emergency ward and critical care unite is belong to the emergency group and other s who is not from above departments belong to the non-emergency group.Results:Total of 1 270 candidates took part in 7 primary classes and 27 intensive selection until 1131 of them received the formal certifications. 440(38.90%) instructors from emergency group and 691(61.10%) instructors belong to non-emergency group. At category level of hospital, 213 (18.83%) is from three grade, 525 (46.42%) is from two grade, 254 (22.46%) is from specialized hospitals, and 139 (12.29%) is from community health centers. In non-emergency group, ratio of serving departments are consists of: 15.77% from internal medicine, 10.14% from chirurgery, 8.11% from pediatrics, 7.96% from obstetrics and gynecology, 2.62% cases from otorhinolaryngology, 24.29% from medical assistants, 20.11% from community health center and 11.00% from administrative officer. Nurses (64.13%) is the majority professional types of social emergency training instructors. In terms of degree, bachelor mainly occupied at 71.02%. Primary (53.18%) and attending (30.47%) account for majority of position ranks.Conclusions:Our team of social emergency training instructors,mainly from local medical staffers, has a great educational background and competitive team; Among them, emergency team is crucial to provoke other medical staffs from different departments to participate in career at social emergency training.