Objective To investigate the clinical value of the detection of serum procalcitonin (PCT) and plasma D-dimer (D-D) levels in the early diagnosis of infection in critically ill children.Methods Solid-phase immune chromatography and immune nephelometry were used to determine the levels of serum PCT,plasma D-D,plasma C reactive protein (CRP) and WBC count in 302 critically ill children.Results The positive rate of serum PCT and the level of plasma D-D in the infected group (208 children) were significantly higher than those in the non-infected group (94 children)[96.6％(201/208) vs.10.6％(10/94),(1.65 ± 0.73) mg/L vs.(0.45 ± 0.21) mg/L,P ＜ 0.05].But there was no significant difference of plasma CRP level and WBC count between the 2 groups (P ＞0.05).The levels of serum PCT and plasma D-D were positively correlated to the severity of the illness (P ＜ 0.05).Conclusions The levels of serum PCT and plasma D-D are between important sensitivity markers for early diagnosis of critically ill children,illness severity assessment and therapeutic evaluation.The detection of plasma D-D plays an important role in early diagnosis of the degree and the width of coagulation disorder,and also provides the theoretic basis to use anticoagulation drugs for treating the critically ill children with infection.

Objective To investigate the diagnostic value of the combined detection of serum glial fibrillary acidic protein (GFAP)and myelin basic protein (MBP)in the patients with early brain contusion and laceration.Methods ELISA was adopted to detect serum GFAP and MBP.The one-way ANOVA analysis was adopted to conduct the comparison among groups and the q test was adopted to conduct the pairwise comparison for analyzing the differences between the brain contusion and laceration patients with the healthy population.Results The serum GFAP and MBP levels had statistically significant differences among the mild craniocerebral injury group,severe craniocerebral injury group and the healthy control (P <0.05);which had statistically signifi-cant differences between the control group and the mild craniocerebral injury group(P <0.05);which had statistically significant differences between the mild craniocerebral injury group and the severe craniocerebral group (P <0.05 );which had statistically significant differences between the control group and the severe craniocerebral injury group (P <0.05).The serum GFAP and MBP levels in the early stage of brain contusion and laceration were significantly higher than those in the control group,moreover,the more severe the injury,the more obvious the increase of serum GFAP and MBP.Conclusion The combined detection of serum GFAP and MBP can be regarded as the auxiliary indexes for the early diagnosis of early brain contusion and laceration and the eval-uation of the injury degree.

Objective To investigate the diagnostic value of nuron specific enolase( NSE),S100βprotein,glial fibrillary acidic protein( GFAP)and myelin basic protein( MBP)in patients with early brain contusion and laceration. Methods One hundred and twelve cases with brain contusion and laceration diagnosed by CT or MRI were selected as our subjects who hospitalized Harrison international peace hospital from Apr. 2012 to Jul. 2013. Of them,68 cases with mild head injury were served as mild group and 44 cases of severe traumatic brain injury were served as severe group. And 83 healthy people without lung disease and nervous system diseases were served as control group. Electro chemiluminescence assay and ELISA methods were used to measure the level of NSE,S100β,GFAP,MBP. Results the level of serum NSE,S100β protein,GFAP and MBP in mild group were(18. 14 ± 6. 83),(0. 92 ± 0. 45),(0. 78 ± 0. 37))(4. 37 ± 1. 84)μg/ L,respectively, and(32. 11 ± 12. 48),(1. 58 ± 0. 94),(4. 26 ± 1. 96),(14. 72 ± 6. 77)μg/ L,respectively in severe group, and(8. 94 ± 3. 49),(0. 12 ± 0. 08),(0. 13 ± 0. 09),(1. 98 ± 0. 89)μg/ L,respectively in control group. There were significant differences among three groups( F = 137. 520,120. 083,283. 727,205. 569 respectively;P< 0. 01). All indexes were different between control and mild groups( q = 10. 599,13. 296,5. 881,6. 018;P< 0. 01),as well as between the mild and severe groups(q = 13. 600,9. 249,26. 639,22. 029;P < 0. 01),and between control and severe group(q = 23. 408,21. 258,32. 797,28. 134;P < 0. 01). Conclusion The level of serum NSE,S100β,GFAP,MBP can be used as early indicators of brain injury secondary diagnosis and secondary index for evaluating damage degree.

Objective To observe the mechanisms of autophagic eukaryotic cells in Acinetobacter microvilli removal and protein histological study on apoptosis induced by macrophages .Methods A model of Acinetobacter baumannii infection was established in 24 female OCR mice .The mice were randomly divided into control group (n= 12) and observation group (n= 12) .The control group was injected with normal saline ,and the observation group was injected with autophagy eukaryotic cells ,the histopathological changes of Acinetobacter and the induction of macrophage apoptosis were observed .Results There was no significant difference in the bacterial counts between the two groups of mice immediately after implantation (P>0 .05) ,the bacterial counts in the 24 and 48 h in the observation group was significantly lower than that in the control group (P<0 .05) .The lung tissue of mice in the ob-servation group injected after autophagy was normal ,the alveolar cavity was open ,no abnormal substances were found ,the alveolar wall was not obviously thickened ,and no inflammatory cell infiltration was found in the wall .The mice in the control group were in-jected with normal saline and lacked the ability to remove Acinetobacter ,resulting in a large number of inflammatory cell infiltra-tion ,vasodilatation ,and congestion in some mice .Conclusion Autophagic eukaryotic cells injected with Acinetobacter baumannii can increase the clearance rate ,induce apoptosis of macrophages and improve the quality of Acinetobacter baumannii .

Objective To explore the efficacy and safety of 980 nm diode laser therapy for treatment of benign prostatic hyperplasia (BPH). Methods Data of 170 patients with BPH treated with 980nm diode laser system were reviewed. The mean operative time, blood loss, surgical complications, the international prostate symptom score (IPSS), bladder residual urine volume and flow rate changes were collected and analyzed. Results One hundred and seventy cases were safe during the perioperative period. The average operation time was (74 ± 11) min, surgical removal of prostate tissue mass of (54±12) g, blood loss (72±11) ml. There was no TUR syndrome occurred. 170 patients were followed up 2 to 24 months. The IPSS decreased from preoperative 25.0±5.5 to 9.0±2.5. The maximum flow rate increased from preoperative (6.2±2.3)ml/s to post-operative (17.4±3.5) ml/s. The residual urine volume decreased from preoperative (210.0±25.6) ml to postoperative (25.2±4.6) ml. All the differences were statistically significant (P＜0.05). Conclusion Transurethral vaporization of 980 nm diode laser could be a safe and effective treatment modality for BPH.

Objective To investigate the risk factors and prognostic factors of bloodstream infection in intensive care unit(ICU). Methods The data of patients with bloodstream infection in ICU of Harrison International Peace Hospital from October 2014 to October 2017 were retrospectively analyzed and 210 patients with negative blood culture were selected. The physiological and laboratory parameters were compared between patients with positive blood culture and those with negative blood culture. Multivariate logistic regression analysis was used to screen the risk factors of bloodstream infection. Overall, 189 patients with bloodstream infection were classified into survival group(n=121)and death group(n=68)according to the survival status within 30 days after blood culture. The risk factors related to 30-day patient outcome following bloodstream infection were analyzed. Results A total of 189 cases of bloodstream infection were identified in the ICU during the 3-year period, including 118 cases due to gram-negative bacilli, 65 cases caused by gram-positive cocci, and 6 cases due to fungi. Univariate analysis showed that prior use of carbapenem or third generation cephalosporins, central venous catheterization, length of hospital stay≥2 weeks, and mechanical ventilation were the risk factors of bloodstream infection(P<0.05). Multivariate logistic regression analysis showed that prior use of carbapenems or third-generation cephalosporins(OR=20.15), central venous catheterization(OR=25.34), and mechanical ventilation(OR=18.26)were independent risk factors for bloodstream infection in ICU patients. Univariate analysis showed that prior use of carbapenem or third generation cephalosporins, mixed infection or septic shock, multi-drug resistant bacterial infection, and high APACHE Ⅱ(acute physiological and chronic health evaluation system Ⅱ)score were significant risk factors for 30-day mortality following bloodstream infection(P<0.05). Multivariate logistic regression analysis showed mixed infection or septic shock(OR=15.30), multi-drug resistant bacterial infection(OR=10.75)and high APACHE Ⅱ score(OR=13.70)were independent risk factors for 30-day mortality following bloodstream infection. Conclusions Prior use of carbapenem or third generation cephalosporins, central venous catheterization and mechanical ventilation are independent risk factors for bloodstream infection in ICU patients. Mixed infection or septic shock, multi-drug resistant bacterial infection, and high APACHE Ⅱ score are independent risk factors for 30-day mortality following bloodstream infection.

Objective To explore the value of low-dose CT in the diagnosis of congenital heart disease(CHD)with tracheal stenosis (CTS)in infants.Methods Data of low-dose CT and echocardiography in 18 cases of CHD with CTS were analyzed retrospectively, and compared with surgical findings.Results 18 cases of CST were comfirmed by surgical operation.The diagnostic accuracy of low-dose CT was 100%,and there was no statistical difference in the assessment of the range and degree in tracheal stenosis(P=0.76>0.05, P=0.767>0.05).42 cardiac anomalies were comfirmed by operation.The diagnostic accuracies of low-dose CT and echocardiography were 88.1% and 90.5% respectively,which was no statistical difference(P=0.825>0.05).15 cases of CTS(15/18,83.33%)were caused by the compression of the vessels,in which there were 9 cases by pulmonary artery sling,3 cases by vascular ring,3 cases by double aortic arches.Conclusion Low-dose CT can accurately diagnose CHD with CTS and provide important information for clinical practice.

Objective To investigate the feasibility and safety of laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture. Methods 82 patients who underwent laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture from Hechi People's Hospital from June 2016 to August 2018 were enrolled as study objects. They were divided into study group and control group according to the different treatment methods of common bile duct incision. 40 patients in the study group underwent primary suture of the common bile duct and 42 patients in the control group underwent T-tube drainage. The surgical outcomes and complications of the 2 groups were compared. Results All the patients in the two groups were operated smoothly and there were no cases of conversion to open surgery. The operation time, intraoperative blood loss, postoperative ambulation time, time of removal of abdominal drainage tube, and hospitalization time were lower in the study group than those in the control group, but the difference was not statistically significant (P>0.05). The incidence of electrolyte disturbance, postoperative recovery time, and hospitalization cost in the study group were lower than those in the control group, and the difference was statistically significant (P<0.05). The incidence of surgical complications in the study group was lower than that in the control group, but the difference was not statistically significant (P>0.05). Conclusion Laparoscopic combined with choledochoscopy for choledocholithotomy and primary suture in the treatment of intrahepatic and extrahepatic bile duct stones has good curative effect, rapid recovery, less internal environment disorder and low hospitalization cost. It is safe and feasible.

Objective To analyze the short-term clinical efficacy and influencing factors of ustekinumab monoclonal antibody(UST)in the treatment of Crohn′s disease(CD).Methods Retrospective cohort study was used to collect the clinical data of CD patients treated with UST in the 10th People′s Hospital affiliated to Tongji University from December 2020 to October 2022.The main analysis is the short-term clinical efficacy and influencing factors of UST treatment for CD at weeks 8 and 16,And analyze the endoscopic response rate of some patients.Results A total of 91 CD patients who first used UST were included.The 8-week clinical response rate of UST treat-ment for CD was 61.5%,and the clinical response rate was 45%;The clinical response rate at 16 weeks was 71.4%,and the clinical response rate was 54.9%.56 cases underwent endoscopic re-examination in our hospital,and the endoscopic response rate at 16 weeks was 41.1%.Univariate analysis showed that fistula(including anal fistula,personal history of anal fistula,and intestinal skin fistula)is associated with clinical remission in Crohn′s disease patients at 8/16 weeks.Further multivariate COX regression analysis showed that the presence of a history of anal fistula surgery was an independent protective factor affecting clinical remission in CD patients treated with UST at 8 weeks(HR = 0.04,95%CI:0.00～0.38;P = 0.005)and 16 weeks(HR = 0.04,95%CI:0.01～0.34;P = 0.003)compared to those without fistula;Narrow lesions are an independent risk factor for 16 week clinical remission in CD patients compared to non-narrow and non-penetrating lesions(HR = 1.75,95%CI:1.08～2.84;P = 0.023).No patients were found to have stopped medication due to serious adverse reactions.Conclusions UST can improve the clinical remission and response of CD patients at 8/16 weeks,and has good short-term clinical efficacy.CD patients with a personal history of anal fistula are recommended to use UST monoclonal antibodies,while patients with stenotic lesions should be cautious in using UST monoclonal antibodies.Whether the patient has undergone surgical treatment in the past,as well as whether UST has been used on the first or non-first line,has no significant impact on clinical remission.

BACKGROUND:Hypoxic exercise can promote the degradation of body fat,and changes in the external environment can affect the circadian rhythm of animals,but the mechanisms by which changes in circadian rhythm regulate adipose tissue browning and fat degradation are unclear. OBJECTIVE:To elucidate the mechanism of clock gene regulation on epididymal adipose tissue Browning in obese rats undergoing hypoxia exercise. METHODS:Forty obese rats were randomly selected and divided into four groups(n=10 per group):normoxic sedentary group,hypoxic sedentary group,normoxic exercise group,and hypoxic exercise group for 4 weeks of intervention.The rats in the sedentary groups were not intervened,while those in the hypoxic groups lived in a hypoxic chamber with an oxygen concentration of 13.6%for the whole day.In the exercise groups,adaptive training was performed in the 1st week,and the speed and length of training remained unchanged for the last 3 weeks.The body mass,body length and perirenal fat mass of obese rats were measured.Serum levels of triacylglycerol,total cholesterol,low-density lipoprotein cholesterol,and high-density lipoprotein cholesterol in obese rats were detected by a biochemical assay kit.Liver fat content was observed by oil red O staining.Hematoxylin-eosin staining was used to evaluate the browning of epididymal adipose tissue of rats in different groups.RNA sequencing combined with bioinformatics analysis was used to analyze transcriptome changes in adipose tissue.The mRNA expressions of PGC-1α,Beclin 1,KLF 2 and Perilipin 1 in epididymal adipose tissue were detected by RT-PCR. RESULTS AND CONCLUSION:Hypoxic exercise intervention significantly decreased body mass,body fat percentage,Lee's index,serum triacylglycerol,total cholesterol,and low-density lipoprotein cholesterol levels(P＜0.01),and significantly increased high-density lipoprotein cholesterol level(P＜0.01).Oil red O staining and hematoxylin-eosin staining results showed that hypoxic exercise was more effective in promoting fat mobilization in liver tissue and promoting the browning of parepididymal adipose tissue compared with normoxic sedentary group,hypoxic sedentary group,and normoxic exercise group.RNA-seq results showed that hypoxic exercise significantly upregulated the expression of clock genes Dbp,Nr1d1,Sik1 and adipose tissue browning gene Ppargc1a(PGC-1α)and downregulated the expression of Arntl(Bmal1),accompanied by the enhanced expression of genes related to substance metabolism.qRT-PCR indicated that hypoxic exercise significantly increased the mRNA expression levels of PGC-1α and Perilipin1(P＜0.01).Therefore,these findings indicate that clock genes play an important role in promoting adipose tissue browning during hypoxic exercise.