Objective To evaluate the diagnostic and predict value of procalcitonin (PCT) levels in patients diagnosis of sepsis with immune system defect in the intensive care unit (ICU).Methods This is a retrospective analysis.We enrolled 278 patients diagnosis of sepsis in Emergency ICU,general ICU and Respiratory ICU in Renmin Hospital of Wuhan University from October 2011 to September 2012.Among them,122 patients have normal immune function and 156 patients have auto-immune system diseases or/and requiring corticosteroids or chemotherapy.According to the APACHE Ⅱ score,patients were divided into low-risk group,middle-risk group and high-risk group,and their PCT levels were compared.Logistic regression analysis of the multiple factors was used to screen independent risk factors for predicting 7 days' mortality.The predictive ability was also evaluated and compared between the first time of PCT concentration after admission and dynamic change of PCT within the first week with area under receiver operator's characteristic curve (ROC curve,AUC).Result The results of Spearman correlation analysis showed that there was a significant positive correlation between the patients' PCT concentration and APACHE Ⅱ score (r =0.979,P ＜ 0.05).And there was a positive correlation between the first PCT concentration after admission and 7 days' mortality in-hospital (r =0.826,P ＜ 0.05).Multiple factors logistic regression analysis indicated that both the first time PCT concentration after admission and APACHE Ⅱ score of patients were independent risk factors for predicting 7 days' mortality (PCT OR =1.77,95％ CI =1.28-3.83,P =0.0023).The warning value of 7 days' mortality for patients with normal immune function was PCT≥7.18 ng/ml and for those with abnormal immune function was PCT ≥ 3.52 ng/ml.Compared to dynamic monitoring of PCT,there was no significant difference in sensitivity but specificity is less than the dynamic monitoring of PCT.Conclusions The diagnostic and predict value of procalcitonin (PCT) levels were not affected by the immuno-suppressive therapy.The first time PCT concentration after admission was an independent risk factor for predict of 7 days' mortality in ICU patients with sepsis.The PCT warning value of the sepsis patients with abnormal immune function was much lower compared to those with normal immune function.

Objective To investigate the diagnostic and predict vaIue of procalcitonin (PCT) in ICU patients with sepsis and the correlation between PCT concentration and positive results of bacterial culture.Methods A total of 278 patients with sepsis were admitted into emergency ICU,general ICU and respiratory ICU from October 2011 to September 2012.Of them,193 patients had definite microbial infection evidence.Serum PCT levels among groups of different pathogens were compared.The analysis of correlation between the PCT concentration of the first assay was got after admission and short-term prognosis was evaluated.The correlation between PCT level and positive results of bacterial culture was also evaluated.Results Spearman correlation analysis showed that serum PCT levels of bacterial infections in patients with sepsis were significantly higher than those of the non-bacterial infections in patients with sepsis (P =0.001).And there was a positive correlation between the PCT concentration of the first specimen after admission and 7-day in-hospital mortality in patients with sepsis due to bacterial infections (r =0.277,P =0.004).The patients with PCT levels greater than 2 ng/ml had high vulnerability to bacterial infection Conclusions The PCT concentration of the first assay after admission was positively correlated to 7-day mortality in ICU patients with sepsis due to bacterial infections.The serum PCT concentration indicated the severity of host response to the bacterial infection.And etiological evidence directly showed pathogenic factors.Both of PCT and etiological evidence related to bacterial infection,reflected different aspects of bacterial infection.

Objective To investigate the protective effect of nimodipine on neuron of the rats with focal cerebral ischemia-reperfusion injury and the expressions of Bax and Bcl-2,and to clarify their mechanisms.Methods The focal cerebral-ischemia reperfusion model was induced by the middle cerebral artery occlusion(MCAO)method. 30 male Wistar rats were randomly divided into sham operation,model,and nimodipine groups(n=10).The neurological deficit score was performed after 2 h ischemia following 2 h reperfusion.The infarction was observed by TUNEL staining and the expressions of Bax and Bcl-2 were detected by SP immunohistochemistry method. Results Compared with model group, the number of apoptotic cells of the rats in nimodipine group was significantly decreased(P<0.05),the expression of Bax was significantly decreased (P<0.05),and the Bcl-2 expression was increased significantly(P<0.05).The morphological examination showed that the neurons of the rats in model group had serious necrosis and edema while the number of dead cells in nimodipine treatment group was reduced and the edema was improved.Conclusion Nimodipine has a protective effect on brain tissue of the rats with focal cerebral ischemia-reperfusion inj ury, which is closely related to the down-regulation of Bax and up-regulation of Bcl-2 and inhibition of the apoptosis of neuron.

Phase angle (PA), derived by bioelectrical impedance analysis, has been used to evaluate nutritional status.It has a unique advantage in diagnosing early malnutrition related to diseases by the detection of human body cell membrane integrity and fluid composition change, and being associated with bad disease prognosis in part of clinical research.Because of its non-invasive, convenient, accurate and affordable technique, it has a wide prospect of clinical application.However, lack of uniform PA reference value somehow limited its application.We summarize the latest clinical research and application situation of PA, and explore the characteristics and the influence factors of PA in different disease group, in order to provide theoretical basis for the Chinese PA reference range.

Objective To explore the similarities and differences in amplitude of low frequency fluctuation ( ALLF) between patients with first-episode drug-naive schizophrenia and offspring of schizophrenia patients.Methods ALFF values were estimated by measuring the Blood Oxygen Level-Dependent ( BOLD) signal using resting state function-al magnetic resonance imaging ( rs-fMRI) .The fMRI date were acquired from 23 patients with first-episode drug-naive schizophrenia (SZ), 25 offsprings of schizophrenia patients (OS) and 29 age -and gender -matched health controls ( HC) .The ALFF value of each subject was calculated by MATLAB-based DPARSF software.Results Compared with HC, the ALFF values of SZ and OS were significantly different in the left posterior part of the inferior temporal gyrus, left parahippocampal gyrus, left hippocampus, right postcentral gyrus and bilateral precuneus.The ALFF values were not signif-icantly different between these two groups in the aforementioned regions.Compared with OS and HC, the ALFF values of SZ were significantly different in the left anterior part of the inferior temporal gyrus, left temporal pole and bilateral calcarine cortex.But there was no significant difference between OS and HC.Conclusions The brain function is abnormal in pa-tients with early schizophrenia and offspring of schizophrenia patients.The significant difference of ALFF in the left posterior part of the inferior temporal gyrus, left parahippocampal gyrus, left hippocampus, right postcentral gyrus and bilateral pre-cuneus may suggest the heredodiathesis-related brain functional alterations.Significant difference of ALFF in the left ante-rior part of the inferior temporal gyrus and the left temporal pole bilateral calcarine cortex may suggest the disease-related brain alterations.

Objective To increase the awareness of autoimmune pancreatitis (AIP) and correct diagnosis rate of AIP by investigating radiologic characteristic of AIP and small pancreatic cancers.Methods The clinical data and radiologic imaging of 24 AIP patients who met the Asia diagnostic criteria of AIP in 2008 and 25 cases of pathologically condirmed small pancreatic cancer were retrospectively reviewed.All imaging findings were reviewed,especially on the shape,enhancement patterns of mass,pancreatic ducts,peripancreatic and extra-pancreatic manifestations. Chi-square test and Fisher test were used for statistical analysis.ResultsThe imaging signs,including location of masses,distal pancreatic atrophy,enhancing mass during portal phase,truncated duct sign of pancreatic duct,capsule-like rim and renal involvement,was significantly different between AIP and small pancreatic cancer ( x2 =9.010,10.506,15.488,8.688,6.292 and 4.966 respectively,P ＜0.05 ).But only two signs,distal pancreatic atrophy and enhancing mass during arterial and portal phase,were statistically different between local AIP and small pancreatic cancer (P ＜0.05).ConclusionsThe typical imaging features of diffuse AIP is distinct and helpful for the differential diagnosis of AIP from small pancreatic carcinoma,but there is limited value in the differential diagnosis between local AIP and small pancreatic cancer.

The aim of this study is to investigate the therapeutic effect of RegIII-proinsulin-pBudCE4.1 plasmid on streptozotocin (STZ)-induced type 1 diabetes mellitus and its underlying mechanisms. The model of type 1 diabetes mellitus was established by intraperitoneal injections of STZ (40 mg kg(-1)) to Balb/c mice for five consecutive days. Then, ten type 1 diabetic mice were intramuscularly injected with 100 microg RegIII-proinsulin-pBudCE4.1 plasmid for 4 weeks (one time/week) and the blood glucose levels were monitored every week; whereas another ten diabetic mice served as negative control group were injected with pBudCE4.1 vector at the same dose. Normal control and model control mice were treated with normal saline at identical volume under the same way. Western blotting, MTT assay, ELISA, HE staining and Tunel assay were applied to explore the underlying mechanisms. Results showed that RegIII-proinsulin-pBudCE4.1 plasmid ameliorated the hyperglycemia symptoms in diabetic mouse remarkably. It induced an immunological tolerance state in type 1 diabetic mice by inhibiting the proliferation of splenic lymphocytes and recovering Th1/Th2 balance evidenced by MTT and ELISA analysis. Furthermore, it elevated insulin concentration in the serum of type 1 diabetic mice and promoted the regeneration of beta cells supported by the results of HE staining and Tunel assay. In conclusion, RegIII-proinsulin-pBudCE4.1 plasmid possesses powerful anti-diabetic ability, which may be involved in the inducing of immunological tolerance and enhancing beta cells recovery.

Objective To probe the feasibility of susceptibility weighted imaging (SWI) for evaluation of renal blood oxygenation level of healthy volunteers after water loading.Methods SWI of 11 healthy volunteers,acquired before (group 1) and after water loading (group 2),were assessed retrospectively by two radiologists with more than 10 years abdominal work experience independently.In those images of the same section plane derived from two groups,the phase values in cortex ((φ)cor) and medulla ((φ)med),difference between the same vein and surrounding tissue on phase map (△(φ)) were measured using SPIN software package,and the oxygen extraction fraction changes (△OEF) was calculated.The (φ)cor,(φ)med and △(φ) between two groups were compared by paired t test.And the intraclass correlation coefficient (ICC)was used to evaluate the consistency between two radiologists.Results For the radiologist 1,the (φ)cor,(φ)med and △(φ) were (0.046 ±0.019),(-0.014 ±0.003) and (1.3 ±0.4) rad in group 1,and were (0.047 ±0.014),(-0.012 ±0.005) and (1.1 ±0.4) rad in group 2 respectively,and no significant change was found in (φ)cor and (φ)med after water loading (t =-0.589 and-0.206,P ＞ 0.05 in all),except of in △(φ) (t =2.400,P ＜ 0.01).For the radiologist 2,the (φ)cor,(φ)med and △△(φ) were (0.049 ± 0.011),(-0.012 ± 0.004)and (1.5 ±0.4) rad in Group 1,and were (0.046 ±0.017),(-0.011 ±0.003) and (1.3 ±0.2) rad in group 2 respectively,there was no significant change in (φ)cor and (φ)med after water loading (t =0.590 and -0.974,P ＞ 0.05 in all),except of in △(φ) (t =2.760,P ＜ 0.05).Between two radiologists,the ICC of (φ)cor,(φ)med and △(φ) were 0.623,0.472 and 0.328 in group 1 and 0.599,0.442 and 0.445 in group 2 respectively.△OEF decreased about (-4.2 ± 2.3) c％ and (-4.3 ± 2.8) c％ measured by two radiologists respectively,and the consistency is good between two radiologists (ICC =0.784).Conclusion SWI provides a novel method to assess indirectly the oxygenation level of kidney,△OEF is an indicator with suitable reliability.

Objective:To analyze the maternal gestational weight gain (GWG) in women with pre-pregnancy obesity and its relationships with adverse pregnancy outcomes.Methods:This retrospective cohort study recruited 513 obese women (pre-pregnancy body mass index ≥30 kg/m 2) with singleton pregnancy in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January 2014 to December 2016. All participants were divided into three groups according to GWG: inadequate (GWG<5 kg, n=83), adequate (5 kg≤GWG≤9 kg, n=154), and excessive (GWG>9 kg, n=276) groups. Chi-square test, Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney U test were used to compare the clinical data among the three groups, including GWG, pregnancy and neonatal outcomes, and labor process. Multivariate logistic regression was performed to analyze the association between maternal GWG and main pregnancy complications associated with obesity. Results:(1) Among 238 participants who gained more than 2.0 kg in the first trimester, 75.6% (180/238) were in the excessive group, while the rate was 34.9%(96/275) among the participants who gained less than 2.0 kg. (2) Postpartum body mass index retention (body mass index at six weeks postpartum minus pre-pregnancy body mass index) was the highest in the excessive group, followed by the adequate group and the inadequate group [0.8 kg/m 2 (0.0-2.2 kg/m 2) vs -0.7 kg/m 2 (-1.6 to 0.0 kg/m 2) vs -2.5 kg/m 2 (-3.2 to -1.5 kg/m 2), all P<0.05]. (3) The rates of primary cesarean section in the inadequate and adequate groups were 29.9% (20/67) and 32.6% (42/129), which were lower than that in the excessive group [43.3% (104/240), χ2=3.955 and 4.047, both P<0.05]. There were no statistically significant differences in the incidence of gestational hypertension, small/large for gestational age, or other major adverse pregnancy outcomes among the three groups (all P>0.05). The weight gain in the first trimester and before the oral glucose tolerance test were not correlated with gestational diabetes mellitus (GDM) ( aOR=1.038, 95% CI: 0.986-1.094, P=0.157; aOR=1.055, 95% CI: 1.000-1.113, P=0.051). The maternal weight gain of women with GDM during the 2nd, the 3rd, and the whole trimesters were lower than women without GDM respectively [3.0 kg (1.3-4.0 kg) vs 3.0 kg (2.0-5.0 kg), 4.0 kg (2.0-6.0 kg) vs 6.0 kg (4.0-8.0 kg), 9.0 kg (5.0-12.0 kg) vs 10.7 kg (7.5-15.0 kg); Z =-2.938, -6.352 and-4.104, all P<0.01]. Conclusions:In women with pre-pregnancy obesity, the first trimester is the critical window to control maternal GWG. GWG guidelines recommended by the Institute of Medicine could help to reduce the weight retention at six weeks postpartum, but couldn't reduce the risk of GDM, gestational hypertension, small/large for gestational age, or other major adverse pregnancy outcomes.

Objective To study the diffusion tensor imaging (DTI)features in acute cervical spinal cord injury (CSCI)and evaluate its clinical value.Methods Eight patients with acute CSCI (within 72 hours after onset)were performed conventional MRI and fast DTI scans (112 seconds)and diffusion tensor tractography (DTT)at 3.0T Siemens Trio Tim system.Meanwhile,the fractional anisotropy (FA) values and apparent diffusion coefficient (ADC)values were calculated separately in the site of lesions,the upper and lower sections to the lesions.Then the data were analyzed by paired-samples t test analysis with SPSS 13.0 software.Results Cervical spinal cord injury occurred likely in the sites of C5-C6 (account for 4/8)and C4-C5 (account for 3/8).All MRI and DTI images were satisfied for clinical diagnosis.The FA value and ADC value of injury lesions were markedly lower than that of the normal cord.Accordingly,the injury lesions on FA map and ADC map presented low signals.There were no significant differences of FA values and ADC values between the upper and lower sections to the lesions.DTT could help in displaying the disruption of spinal fiber tract in lancination case and distortion fibers in closed cervical spinal cord injury.Conclusion Fast DTI sequence at 3.0 Tesla may obtain the qualified spinal cord images.By calculation of FA values and ADC values in CSCI patients,DTI may play an important role in detecting the changes of anisotropy and water diffusion caused by myelin sheath injury and cytotoxic edema and vasogenic edema respectively.