Objective To evaluate the value of plasma soluble urokinase plasminogen activator receptor (suPAR) and serum pmcalcitonin (PCT) to investigate their assessment of disease severity and prognosis in patients with sepsis.Methods The levels of plasma suPAR and serum PCT were monitored in 77 patients with sepsis.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were recorded.According to the disease severity and their prognosis,the value of plasma suPAR,serum PCT,APACHE Ⅱ and SOFA score on predict the disease severity and prognosis of septic patients were compared.Results The levels of plasma suPAR in septic patients [(7.9 ±6.5) ng/mL] were lower than severe sepsis patients [(8.4 ±4.5) ng/mL] and septic shock patients [(13.9 ± 8.0) ng/mL],allP ＜ 0.05.The levels of serum PCT in septic patients (6.3 ± 3.5) ng/mLwere lower than severe sepsis patients [(23.7 ± 3.9) ng/mL] and septic shock patients [(25.7 ±4.3) ng/mL],allP ＜0.05.But there was no significant difference in the levels of serum PCT between the severe sepsis group and the septic shock group.Receiver operator characteristic curve (ROC)of the level of plasma suPAR could distinguish survivors from non-survivors in septic patients,maximal area under curve (AUC) of plasma suPAR was 0.803.The best cut-off value of plasma suPAR to distinguish survivors from non-survivors was 9.905 ng/mL.And the AUC of serum PCT was 0.61 (P ＞ 0.05) ; the AUCofAPACHEⅡ score was 0.832 (P＜0.05); the AUC of SOFA score was 0.767 (P＜0.05).Conclusion Monitoring of the levels of plasma suPAR and the APACHE Ⅱ score can help to assess the severity and the prognosis of sepsis in the early stage.

Objective To explore changes of anti-HCV antibody and HCV-RNA in patients with HCV infection and its clinical significance in diagnosis and treatment of hepatitis C .Methods Serum samples from patients with HCV infection were collected . HCV antibodies were analyzed with a chemiluminescence micro-particle immunoassay method ,while a PCR-fluorescent probe meth-od was used to detect HCV-RNA .Concentrations of ALT and AST were also determined .Based on the concentrations of ALT , AST and HCV-RNA ,samples were divided into two groups respectively and the changes of different indicators were analyzed and compared .Meanwhile samples from 37 HCV-infected patients were collected continuously .Different indicators after treatment were compared with those before treatment .Results HCV-Ab and logarithm values of RNA load in the group with abnormal concentra-tions of ALT and AST were significantly higher than those in the normal group (P<0 .05) .HCV-Ab ,ALT and AST concentrations in HCV-RNA positive group were significantly higher than those in HCV-RNA negtive group(P<0 .05) .The areas under receiver operating characteristic curve of HCV-Ab and logarithm values of RNA load were 0 .990 and 0 .838 respectively .Concentrations of ALT ,AST and logarithm values of RNA load after treatment were significantly lower than those before treatment (P<0 .05) while there was no significance between HCV-Ab level after treatment and that before treatment (P>0 .05) .Conclusion The diagnostic performance of HCV-Ab is better than that of logarithm values of RNA load .Determination of ALT ,AST and HCV-RNA is of clinical importance in monitoring the effect of hepatitis C treatment .

The serum contents of Cu, Fe, Zn, Pb, Cr, Mn, Ca, Mg, and K in 360 adults from different work in Nanjing were determined by atomic absorption spectrophotometry. The data were analysed by grouped statistical treatment, and the relationships among sex, age and work time were discussed. The results showed that serum Cu, Fe, Zn, Cr, Mn, Pb, Ca, Mg, K differed greatly in the different workers. There was a perfect positive correlations between Cu, Zn, Cd, Mn, Pb, Mg and age, and a negetive correlations berween Cu, Fe, Zn, Cd, Cr, Pb, Mg and work time. The serum Cu, Zn, Ca, K in women were higher than that in men.

With the continuous development of artificial intelligence technology, ChatGPT, as an emerging natural language processing technology, although there is currently no mature application mode, its application prospects in the medical field are becoming increasingly broad. However, its application also faces some possible ethical risks and challenges, including personal privacy data leakage, discrimination and bias in machine algorithms, difficulty in defining responsibility, inexplicability of algorithms, and lack of supervision and so on. It is necessary to strengthen the training of relevant personnel, guide public opinion to pay attention to risks, focus on algorithm validation standards, emphasize multi-party cooperation and co-governance, strengthen medical ethics research, as well as deepen regulatory supervision and standardization construction to solve the above problems.

Objective:To investigate the feasibility and clinical efficacy of posterior vertebral column resection (PVCR) combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column for stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra.Methods:From January 2017 to September 2021, 9 patients with stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra underwent PVCR combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column. Their medical records were retrospectively analyzed. There were 1 male and 8 females, aged (66.9±5.8) years. The injured vertebra was located at T 11 in 2 patients, at T 12 in 4, at L 1 in 2 and at L 2 in 1. X-ray, CT and MRI were performed before operation. The posterior intervertebral heights of adjacent vertebral bodies of the fractured vertebra in the median sagittal position were measured on CT or MRI to evaluate the shortening of the spinal column before PVCR. Recorded were intraoperative bleeding volume, operation time, complications, bone graft fusion, and American Spinal Injury Association (ASIA) grading at preoperation and the last follow-up. The visual analogue scale (VAS) pain scores, Oswestry disability index (ODI) scores, and kyphotic cobb angles at preoperation, 1 week and 3 months postoperation, and the last follow-up were compared to evaluate the clinical efficacy of PVCR. Results:All patients underwent surgery successfully, with tight closure of adjacent vertebrae after resection of the injured vertebra and bone grafting. Operation time was (240.6±23.2) min and intraoperative bleeding (505.6±95.0) mL. The 9 patients were followed up for (17.3±5.6) months. No worsening symptoms of nerve injury, cerebrospinal fluid leakage, or other serious complications were found after operation, nor such complications as loosening or breakage of internal fixation or adjacent vertebral fractures. Bone fusion was achieved at the bone graft sites in all patients by the last follow-up. The VAS and ODI scores and cobb angles at 1 week and 3 months postoperation and at the last follow-up were significantly decreased compared with preoperation ( P<0.05). There were no significant differences in VAS scores or cobb angles among postoperative 1 week and 3 months and the last follow-up ( P>0.05), but pairwise comparisons between different time points after operation showed significant differences in ODI, with postoperative 1 week > postoperative 3 months > the last follow-up ( P<0.05). The ASIA grading at the last follow-up was improved from preoperative grade C to grade D in 2 cases, from preoperative grade C to grade E in 1 case and from preoperative grade D to grade E in 5 cases. Conclusion:PVCR combined with polymethylmethacrylate-augmented pedicle screw instrumentation and shortening of spinal column is a feasible and effective surgical treatment for stage Ⅲ Kümmell's disease with very severe collapse of fractured vertebra, leading to good clinical efficacy.

Objective To assess the efficacy of internal fixation assisted with Halo-vest in the treatment of Anderson-D'Alonzo type Ⅱ and superficial type Ⅲ odontoid fractures.Methods A retrospective case series study was made on 15 patients clinically diagnosed as Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures with a fracture gap over 2 mm,displacement over 5 mm and broken end angel over 11° from January 2007 to January 2015.There were nine males and six females,aged 27-61 years [(44.5 ± 10.9)years].The patients were treated in "three phases" with the assistance of Halo-vest external fixation system and a novel guide pin aiming device.The three phases were as follows:phase Ⅰ:cervical traction reduction and halo-vest external fixation;phase Ⅱ:Halo-vest assisted internal fixation using the novel aiming device;phase Ⅲ:the Halo-vest fixation removal and cervical collar fixation.Operation duration,intraoperative bleeding,and postoperative visual analogue scale (VAS) pain score one month after the operation were recorded.The cervical lateral and open mouth X-ray or atlantoaxial CT scan with sagittal and coronal two-dimensional reconstruction were regularly reviewed,and the location of screws,reduction and fracture healing were evaluated.Results Operation duration ranged from 54 to 96 minutes [(71.3-± 11.9) min].The intraoperative blood loss was 5-60 ml [(32.6 ± 16.8) ml].There was no spinal cord or nerve root injury,cerebrospinal fluid leakage,wound infection or other complications.All patients were followed up for 12-36 months (mean,28 months).Fourteen patients were seen bony union 6 months after the surgery and one patient was seen a false joint.At the last follow-up,the patient with false joint was seen bone sclerosis,and other patients with sound bone healing.The preoperative VAS and that of one month after the operation was (7.3 ± 0.6) points and (1.6 ± 0.7) points,respectively (P ＜ 0.05).Conclusion For Anderson-D'Alonzo type Ⅱ and type Ⅲ odontoid fractures,which have a fracture gap greater than 2 mm,displacement more than 5 mm,broken end angle above 11 degrees,the three-phase Halo-vest assisted internal fixation can provide good stability before operation and promote bone healing and pain relief after operation.