Objective To investigate cytokine levels in serum and culture medium of peripheral blood mononuclear cells(PBMC) from patients with hepatitis B virus(HBV)infection.Methods PBMCs isolated from fresh heparinized blood were cultured and stimulated with rHBcAg.After 72h at 37℃ 5% CO2 in air,the culture supernatant was collected.Levels of interferon-gamma(IFN-?) and interleukin(IL)-4 in blood serum in spontaneous and supernatant were measured by enzyme-linked immunosorbent assay(ELISA).Results Serum IFN-? levels in patients with acute self-limited hepatitis B(AH) and chronic hapetiti B(CHB) were significantly higher than those in normal control(NC)(P

Objective To study the serum and gastric juice levels of epidermal growth factor (EGF) in response to early minimal enteral nutrition (MEN) in premature infants with severe illness and evaluate the clinical significance of early MEN. Methods Premature infants with critical score

Objective To analyze the differences of ADC values in breasts of women of different ages and different menstrual phases, so as to direct the choice of the examination time of MR DWI. MethodsThe breasts of 65 healthy volunteers were scanned with the routine MRI plain scan and DWI in the menstrual, proliferative and secretary phases. DWI was conducted with single shot echo planar imaging technique and b value were 0, 1000 s/mm2. The women were divided into three groups: Group 1(aged 20 to 29 years, 21 cases), Group 2 (aged 30 to 39, 21cases), and Group 3 (aged 40 to 49, 23 cases). The ADC values of all 130 breasts at nipple level in the different phases were measured. The ADC values in the three age groups and in the different menstrual phases were compared using ANOVA. Results The mean ADC values of Group 1 were (2.14±0.14) ×10-3, (2.03±0.18) ×10-3and (2.10±0.19)×10-3mm2/s for left breast, and (2.08±0.17) ×10-3, (2.02±0.16) ×10-3and (2.09±0.17) ×10-3mm2/s for right breast in the menstrual, proliferative and secretary phases. They were slightly higher than Group 3, which were (2.02±0.27) ×10-3, (1.97±0.25) ×10-3and (2.03±0.22)×10-3 mm2/s for left breast and (1.99±0.29) ×10-3, (1.93±0.26) ×10-3and (2.03±0.28)×10-3 mm2/s for right breast. The mean ADC values of Group 2 [left breast: (1.94±0.25) ×10-3, (1.91±0.21) ×10-3and (1.97±0.21)×10-3 mm2/s ; right breast: (1.97±0.26)×10-3, (1.89±0.25)×10-3and (1.96±0.22)×10-3 mm2/s) were the lowest among the three age groups. There were significant differences in different menstrual phases (F= 23.600, P＜0.01), but no statistical difference was found among the three age groups or between left breasts and right breasts (F= 1.683, 2.248;P＞0.05).Conclusions The mean ADC values of breasts decrease markedly in the proliferative phase.The effects of the menstrual cycle on the breast ADC values should be considered in the evaluation of breast diseases with DWI.

ObjectiveTo estimate the applications of ADC value and rADC value in the diagnosis of nodular lesions of breasts.Methods Fifty-two cases with 66 nodular lesions of breasts confirmed by histopathology underwent diffusion-weighted magnetic resonance imaging.Three b values (0,800 and 1000 s/mm2) were applied.The mean ADC values of the breast nodules,the ADC values of ipsilateral breast( rADC1 )and ADC values of contralateral breast (rADC2 )were respectively measured.The independent-samples t-test and chi-square test were used for statistical analyses.ResultsOf the 52 patients,there were 18 patients with infiltrating ductal carcinoma and 34 patients with fibroadenoma.50 patients with 64 lesions were examined by DWI.( 1 ) at b = 800 s/mm2,the mean ADC values of malignant nodules [ ( 1.01 ±0.09) × 10-3 mm2/s],rADC800-1 (0.52 ±0.07)and rADC800-2 (0.51 ±0.06) were lower than that of the benign nodules [ ADC value = ( 1.54 ± 0.28 ) × 10 -3 mm2/s,t = 8.217,P ＜ 0.01 ; rADC800-1 =0.77 ±0.15,t =9.339,P＜0.01 ; rADC800-2 =0.76 ±0.14,t = 10.394,P ＜0.01 ].The one-side upper limits of 95％ medical reference value of mean values of infiltrating ductal carcinoma were adopted as the threshold point to distinguish the malignant from the benign.The threshold value of breast malignant nodule ADC,the rADC800-1 and rADC800-2 were respectively 1.05 × 10-3 mm2/s,0.55 and 0.53.The sensitivities of the three methods were 75.0％,65.0％ and 60.0％ ; the specificities were 100.0％,95.7％ and 97.8％ ;the positive predictive values were respectively 100.0％,86.7％ and 92.3％ ; the negative predictive values were 90.2％,86.3％ and 84.9％; the diagnosis accordance rates were respectively 92.4％,86.4％ and 86.4％.( 2 ) at b = 1000 s/mm2,the mean ADC values of malignant nodules [ ( 0.93 ± 0.08 ) ×10-3 mm2/s],rADC1000-1 (0.53 ±0.09) and rADC1000-2 (0.52 ±0.07) were also lower than that of the benign nodules[ ADC value= (1.45 ±0.28) ×10-3 mm2/s,t=11.844,P＜0.01; rADC1000-1 =0.75 ±0.16,t=5.820,P ＜ 0.01 ; rADC1000-2 = 0.74 ± 0.15,t = 8.082,P ＜ 0.01 ].The threshold value points breast malignant nodule ADC,the rADC1000-1 and rADC1000-2 were respectively 0.97 × 10-3 mm2/s,0.58,0.55.The sensitivities were all 70.0％ ; the specificities were respectively 100.0％,95.7％ and 93.5％ ;the positive predictive values were 100.0％,87.5％ and 82.4％ ; the negative predictive values were 88.5％,88.0％ and 87.8％ ; the diagnosis accordance rates were 90.9％,87.9％ and 86.5％ respectively.There were no significant differences in specificities and the diagnosis accordance rates ( x2 = 1.232,2.263 ; P =0.942,0.812 ).Conclusions ADC value and rADC value are both important parameters of MRI in differentiating benign and malignant breast diseases.The study indicated that ADC value ( at b =800 s/mm2) was the most valuable parameter.

OBJECTIVE:To explore the role of clinical pharmacists participating in anti-infective treatment for a child with complex infection. METHODS:Clinical pharmacists participated in treatment process of one child with pulmonary infection and brain abscess after a near-drowning incident,assisted physicians to adjust antibiotics therapy plan,and put several suggestions as the adjustment of anti-gram-positive and anti-gram-negtive bacterium drugs,the dosage adjustment of vancomycin,vancomycin-induced ADR and disposal,the selection of anti-Pasteurella pneumotropica drugs,the enhancement of anti-fungal infection therapy,accord-ing to pathogen characteristics,treatment effect and ADR. RESULTS:Physicians partly adopted the advice of clinical pharmacists, the child’s pulmonary and brain infection were controlled effectively and ADR disappeared after 5 times of adjusting anti-infective the rapy plan. CONCLUSIONS:Clinical pharmacists participate in the treatment process of one child with complex infection,and assist physicians to formulate safe and effective anti-infective plan according to the results of etiological examination;dispose ADR timely and carry out efficacy evaluation of antibiotics and pharmaceutical care,that can give positive effects on patient treatment.

Objective To analyze the 14 indicators of on-site evaluation at 18 hospitals under Beijing hospital authority in 2016 , and to provide technical support and reference for further optimization of medical quality and service .Methods According to the "Beijing Municipal Administration of Hospital 2016 On-site Evaluation Indicators", the results were analyzed using the fuzzy combined method of TOPSIS and rank sum ratio , and the ranking of the indicators was sorted .Results TOPSIS method and rank sum ratio weighted fuzzy joint analysis showed that the top three indicators from high to low were medical technology management , patient identification and verification system , clinical care service management;and the last three indicators were hospital-acquired infection monitoring , medical malpractice reporting and management , critical value report and disposal .Conclusions Hospitals are recommended to strengthen their exchange , popularize the concept of continuous improvement , the use of management tools to solve practical problems , and further improve the hospital medical quality and service quality .

Objective:To conduct data mining on hospital accreditation results for inspirations and clues in hospital management.Methods:The Apriori function contained in the arules package of R software was used to extract the association rules. This practice aimed to analyze association rules of the accreditation results of 56 tertiary hospitals which were made based on tertiary hospital accreditation standard(2011)and Detailed Rules from 2017 to 2019; to explore the correlation between the clauses, and analyze the inspirations for hospital management.Results:A total of 6 566 138 and 247 rules were generated for all clauses and core clauses, receptively. The top 10 rules sorted by lift were selected as strong association rules. Among them, the minimum lift of all clauses and core clauses was 1.41 and 1.53, respectively. There was a strong correlation between the establishment of a quality and safety management team in the hospital and the development & implementation of relevant regulations by the hospital. There were strong correlations among emergency service procedure and regulations, patient rights to know, responsibility system by the first one to receive a complaint, medical safety(adverse)event reporting, development & implementation of antimicrobial management system, as well as training for prevention of multi-drug resistance infection measures, and multi-drug resistance infection hospital infection control system.Conclusions:This study suggested that hospital management should highlight the correlation between regulations development and staffing, that between indicator systems and monitoring feedback systems, and that between indicators in different sectors in the medical process. These correlations can be used as management clues and inspirations for hospital management.

Objective:To characterize tibial plateau fractures using a computed-tomography-based "four-column and nine-segment" classification.Methods:A retrospective analysis was conducted of the 698 adult patients with tibial plateau fracture (704 knees) who had been admitted to Department of Orthopedics, The Affiliated People's Hospital of Jiangsu University from December 2007 to May 2018. They were 377 males and 321 females with an average age of 51.6 years. The left knee was affected in 371 cases (53.2%), the right knee in 321 cases (46.0%) and bilateral knees in 6 cases (0.9%). According to the differentiated morphological characteristics, the tibial plateau and proximal fibula were divided into 4 columns, which were subdivided into 9 segments. Tibial plateau injury index (TPII) was innovatively introduced to represent the extent of injury. Fracture mapping was retrospectively analyzed according to the "four-column and nine-segment" classification based on the CT imaging.Results:The rates of one-column, two-column, three-column and four-column injuries were 30.5% (215/704), 31.5% (222/704), 28.0% (197/704), and 9.9% (70/704), respectively. On average, 2.2 columns ± 1.0 columns and 3.6 segments ± 2.1 segments were affected in each case. The mean TPII was 5.7±3.0. The rates of mild, moderate and severe comminuted fractures were 50.0% (352/704), 37.5% (264/704), and 12.5% (88/704). The columns most frequently affected were the lateral column (572, 81.3%) and the intermedial column (524, 74.4%) while the less frequently involved ones the medial column (219, 31.1%) and the fibular column (218, 31.0%). The sequence of the segments affected was the posterolateral segment (465, 66.1%), the anterolateral segment (453, 64.3%), the posteromedian segment (379, 53.8%) and the tubercle segment (85, 12.1%).Conclusions:The novel "four-column and nine-segment" classification may be a beneficial system for clinical diagnosis, statistical analysis and prognostic judgment of tibial plateau fractures.

Osteoporotic thoracolumbar fracture in the elderly will seriously reduce their quality of life and life expectancy. For osteoporotic thoracolumbar fracture in the elderly, spinal reconstruction is necessary, which should comprehensively consider factors such as the physical condition, fracture type, clinical characteristics and osteoporosis degree. While there lacks relevant clinical norms or guidelines on selection of spinal reconstruction strategies. In order to standardize the concept of spinal reconstruction for osteoporotic thoracolumbar fracture in the elderly, based on the principles of scientificity, practicality and progressiveness, the authors formulated the Clinical guideline for spinal reconstruction of osteoporotic thoracolumbar fracture in elderly patients ( version 2022), in which suggestions based on evidence of evidence-based medicine were put forward upon 10 important issues related to the fracture classification, non-operative treatment strategies and surgical treatment strategies in spinal reconstruction after osteoporosis thoracolumbar fracture in the elderly, hoping to provide a reference for clinical treatment.