Objective To investigate the relationship between the changes of serum total bilirubin(TBil) and hybrid muscle crea-tine kinase isozyme(CK-MB),and its clinical implication in neonates with hypoxic-ischemic encephalopathy (HIE). Methods The levels of TBil and CK - MB were measured in 49 neonates with HIE (15 mild cases, 20 moderate cases and 14 serious cases), and 31 normal neonates on the first day and the fourth day after birth. Results The levels of TBil on the first day after birth were significantly higher than those in normal neonates;the levels of TBil were correlated with the severity of HIE(P

Objective To assess whether it have difference between mannitol combined with glycerin fructose and only use mannitol for the treatment of cerebral hemorrhage ,which provides relevant evidence‐based basis for guiding clinical treatment of cerebral hemorrhage .Methods We used literature retrieval through to the China national knowledge internet (CNKI) ,China biolo‐gy medicine disc ,VIP Chinese periodical database ,Wanfang data knowledge service platform and manual retrieval ,and formulate the inclusion and exclusion to screening literature ;and using the Jadad quality evaluation method to evaluate literature which had been included ,heterogeneity inspection at the same time .If the effect of multiple resulted ,we used fixed effect model ;on the other hand , used a random effects model .Results Mannitol combined glycerol fructose significantly improved symptoms and nervous function in patients with cerebral hemorrhage ,and the difference was statistically significant (RR=1 .12 ,95% CI:1 .03 -1 .22 ,P<0 .01);mannitol combined glycerol fructose significantly decreasd impaired renal function and complications (RR=0 .34 ,95% CI:0 .25-0 . 47 ,P<0 .01);mannitol combined glycerol fructose significantly decreasd severe unbalance of electrolyte after taking the medicine (RR=0 .31 ,95% CI:0 .19-0 .49 ,P<0 .01) .Conclusion Compared to use mannitol only ,combination with mannitol and glycerin fructose could effectively improve the prognosis of patients with cerebral hemorrhage ,and reduce the side effects .

Objective To investigate the changes of serum osteocalcin and bone micro-structure in ovariectomized mice exposed to low-iron environment.Methods Twenty-four 12-week-old female C57BL/6 mice were divided equally into sham operation (SHAM) group,model(OVX) group,and low iron(OVX+DFO) group.In low-iron group,deferoxamine(DFO) was injected 3 times per week for 5 weeks after operation ; the other groups were injected with the same dose of 0.9％ normal saline for 5 weeks.The serum,left femur,uterus were harvested after five weeks of treatment.The serum osteocalcin and ferritin levels were measured by ELISA kit,the weight of the uterus was recorded by analytical balance.A high resolution micro-CT was used to scan the left femur for cortical bone and cancellous bone analysis.Results (1) The serum osteocalcin and serum ferritin levels in low-iron group were significantly lower than those in the other 2 groups (P＜0.01) ; (2) Compared with the sham group and ovx group,there were significant decrease of the BMD、BV/TV and Tb.N,but increase of Tb.Th and Tb.Sp in low-iron group (P＜0.01).Conclusion A certain dose of DFO (30 mg/kg) can decrease the serum ferritin levels as well as the bone formation index in ovariectomized mice.

Objective To develop a scientific system of core information of health and evaluation index for the elderly Chinese people,which is suitable for the situation of our country.Methods The framework was established by extensive literature review and topic discussions.The index system was constructed with the Delphi method.Results 58 experts in different fields of health were selected in the two rounds of Delphi consultation research.The effective response rates in the two rounds were 96.88％ and 100％ respectively.The average value of the authoritative coefficient was between 0.80 and 0.96.And coefficients of variation were between 6.20 and 12.13.Based on the Delphi consultation research,the core information of health and evaluation index system for the elderly Chinese people were composed of 8 primary indicators closely associated with the positive awareness of aging and senescence and 31 other indicators.Conclusions The architecture of the core information of health and evaluation index system for the elderly Chinese people is stable,and the consultant experts tend to reach a consensus.The evaluation index system contains the most influential factors for the elderly Chinese people,and has the affirmative scientificity,applicability and feasibility.

Objective To evaluate the clinical value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions. Methods Thirty-four patients with 36 pancreatic lesions in Shanghai First People′s Hospital Afifliated to Shanghai Jiao Tong University from February 2012 to November 2013 underwent conventional ultrasound-guided percutaneous core needle biopsy using automatic gun and 18-gauge biopsy needles. The site, size, internal and surrounding vascularity, the sampling number of the lesions, and whether the specimens′ quality was satisfied were recorded. Then specimens were sent for pathological examination, and all above observations were compared with the ifnal diagnosis. Results The number of lesions with 2, 3 and 4 samplings was 32, 2 and 2, respectively. The average number of sampling was 2.2 (mean, 2.17;standard deviation, 0.51) and the acquisition rate of satisifed specimens was 89%(32/36). The pathological results of biopsy were malignant in 31 of 36 lesions including 27 cases of ductal adenocarcinoma, 2 cases of lymphoma, 1 case of small cell neuroendocrine carcinoma and 1 case of uterine leiomyosarcoma metastasis. The other 5 lesions were non-malignant including 3 cases of benign lesion, 1 cases of atypical hyperplasia and 1 cases of granulation tissue. The 36 lesions were ifnally diagnosed as 34 cases of pancreatic malignancy, 2 cases of non-malignant neoplasm. The sensitivity, speciifcity, accuracy, positive predictive value and negative predictive value of ultrasonography guided percutaneous core needle biopsy in pancreatic lesions were 91%(31/34), 100%(2/2), 92%(33/36), 100%(31/31) and 40%(2/5), respectively. Youden index was 0.91. Two patients had mild upper abdominal pain and 1 patient had transient elevated serum amylase. No pancreatitis, pancreatic fistula, peritonitis, bleeding or dispersion of malignant cells along the penetrating channel or other serious complications occurred. Conclusion Ultrasonography guided percutaneous core needle biopsy is a simple, rapid, safe and effective diagnostic method in pancreatic lesions with high clinical value.

Objective To explore the hierarchical chain management model in blood glucose control and its influence factors in patients with diabetes mellitus.Methods Health management database of diabetic patients was established in 2007 and managed by hierarchical chain management.The number of the patients reached to 1010 till 2011.The blood glucose control of diabetic patients was analyzed and its influence factors were analyzed by multivariate unconditional Logistic regression method.Results The concentration of glycosylated hemoglobin( HbA1c ) of 1010 patients with type 2 diabetes was (8.21 ±:2.70)％.Four hundred and eighty-seven cases (48.22％) reached the blood glucose standard,303 cases (30.00％)reached the blood pressure standard,245 cases (24.26％) reached the blood lipids standard,and 76 cases (7.52％) reached all three standards.Multivariate analysis showed that occupation (OR =2.521,95％ CI:1.871 - 3.397),education level (OR =1.890,95％ CI:1.642 - 2.174),disease course (OR =1.035,95％CI:1.016 -1.055),systolic pressure (OR =1.016,95％ CI:1.007 -1.025) and triglyceride (OR =1.204,95％CI:1.063 - 1.365) were the risk factors of blood glucose control (P ＜0.01).Conclusions Hierarchical chain management model is helpful for the blood glucose control in patients with type 2 diabetes.The comprehensive control and treatment of type 2 diabetes should be taken combined with related risk factors,such as blood pressure,blood lipids and diabetes disease course.

Objective To explore the incidence and risk factors of bacterial infection after othtotopic liver transplantation (OLT). Methods Altogether 56 OLT recipients from January 2005 to October 2007 were included in the study. The incidents and the related variables of the infection were analyzed retrospectively. The related variables were evaluated using multivariate logistic regression model to identify the significant risk factors. Results Bacterial infection was confirmed in 29 recipients (51.8%). Among them, the lung infection was the most common site (53.7%). The Gram-positive cocci were 46.3%, while the Gram-negative bacilli were 53.7%. The risk factors for bacterial infection included duration of the operation and detained respirator using. Conclusion Bacterial infection is a major complication following OLT. Surveillance for the risk factors, enhancement the skill of operation, and improving the recovery of respiratory function is the key to decreasing the incidence of bacterial infection after transplantation.

ObjectiveTo investigate the changes of serum creatine kinase isoenzyme (CK-MB) and creatine kinase (CK) ratio(CK-MB/CK) and cardiac troponin I(cTnI) simultaneously in patients with acute organophosphorus pesticide poisoning (AOPP) and the clinical value in disease condition judgment.Methods Eight hundred and sixty-eight AOPP patients without disease history of heart,lung,brain,kidney,muscle and other connective tissue were extracted 4 ml of fasting venous blood to determine CK,CK-MB and cTnI simultaneously at 2,12,24,48,96 and 120 hours after poisoning,and the CK-MB/CK was calculated.There were 279 mild poisoning cases (mild poisoning group),289 moderate poisoning cases (moderate poisoning group) and 300 severe poisoning group (severe poisoning group) ; and 208 cases with intermediate myasthenia syndrome (IMS)(IMS group) and 660 cases without IMS (non-IMS group).The result was compared with 288 healthy people (control group) in the same period.Results ( 1 ) The CK,CK-MB and cTnI of mild,moderate and severe poisoning groups between 2 to 12 h,13 to 24 h,25 to 120 h after poisoning were significandy higher than those in control group,CK-MB/CK was obviously lower (P ＜ 0.01 ).The CK,CK-MB,cTnI and CK-MB/CK had significant differences between each two of mild,moderate and severe poisoning groups (P＜ 0.01 or ＜ 0.05).The CK,CK-MB and cTnI of IMS group in 2 to120 h after poisoning were significantly higher than those in non-IMS group,and CK-MB/CK was lower (P ＜ 0.05 or ＜ 0.01 ).In IMS group,the rates of sudden cardiac death (SCD) and multiple organ dysfunction syndrome (MODS) were 23.08％(48/208),37.50％(78/208) respectively,while 4.24％(28/660),9.85％(65/660) in non-IMS group.The incidence of SCD and MODS of two groups had statistical significance (P ＜ 0.01 ).(2) According to IMS and non-IMS group,discriminant equation with independent variables of cTnI (X1), CK (X2) and CK-MB/CK (X3) was established:Y =-0.0014X1 + 0.0225X2 + 65.2376X3,F=21.4911,P ＜ 0.01.The discriminant critical value(Y0) was 2.8124.If Y ＜ 2.8124 belonged to IMS group and Y ≥2.8124 was in non-IMS group,the contribution rates of X1,X2 and X3 were 34.5％,25.4％ and 40.1％ respectively.The coincident rate of return was 91.26％.ConclusionsCK-MB/CK change has negative correlation with poisoning degree of AOPP;cTnI level is positively correlated with AOPP poisoning degree.they may be used to assist the clinical classification,disease judgement and to guide the emergency,treatment and prognosis assessment of AOPP.The function equation with cTnI,CK and CK-MB/CK can be used as effective prediction indexes of IMS,MODS and SCD in early period.

Objective To analysis the influence factors of standardization in the hierarchical chain management of type 2 diabetes and to enhance the hierarchical chain management of type 2 diabetes.Methods ( 1 ) Six hundred and ninty patients with type 2 diabetes completed 1 years management were divided into well-controlled glycosylated hemoglobin ( HbAlc ) group (＜7.0％ ) and bad-controlled glycosylated hemoglobin (HbAlc) group ( ≥ 7.0％ ).The conditions of diet,physical activity,medication,self-blood sugar monitoring and participation in health seminars were investigated and analyzed.(2) The patients were divided into standardized management group and not standardized management group.Their age,sex,educational background,occupation,monthly income per person,medical security,the course,cognition for glycuresis,two-way transfer,and chronic complications were investigated and statistically analyzed.Results ( 1 ) The proportions of physical activity (70.1％ vs 54.2％,x2=6.163,P=0.018),self-blood sugar monitoring(60.4％ vs 43.8％,x2=6.268,P=0.016) and participation in health seminars (56.0％ vs 41.7％,x2=4.577,P=0.045) in the well-controlled HbAlc group were significantly higher than those in the bad-controlled HbAlc group.(2) Their age [(61.08 ±10.04) years old vs ( 57.75 ± 9.89 ) years old,t=2.539,P=0.012],educational background ( ratio of low educational attainment:8.3 ％ vs 17.2％,x2=6.426,P=0.041 ),medical security (own expense ratios:4.6％ vs 11.5％,x2=3.543,P=0.048 ),awareness of diabetes ( ratio of poor awareness of diabetes:19.4％ vs 41.0％,x2=17.518,P=0.000 ),two-way transfer ( ratio of not transfer treatment:4.6％ vs 14.8％,x2=7.662,P=0.022) and chronic complications ( ratio of chronic complication:41.7 ％ vs 26.2％,x2=6.130,P=0.017) were significantly different between the standardized management group and not standardized management group.(3) Logistic regression analyses indicated that the age ( OR=0.954,P=0.006),monthly income per person ( OR=4.101,P=0.018 ),medical security ( OR=7.617,P=0.003 ),cognition for glycuresis ( OR=0.030,P=0.000),two-way transfer ( OR=9.079,P=0.000) and chronic complications ( OR=0.456,P=0.031 ) were the risk factors of standardized management.Conclusion We should focus on the impact factors affecting the standardized management of patients including age,monthly income per person,medical security,awareness of diabetes,ratio of not transfer treatment,positive strategies for chronic complications,improve the hierarchical chain management of type 2 diabetes,and then make the diabetic patients to early participate in standardization management of diabetes mellitus and delay the appearance of complications.

ObjectiveTo explore the application of diffusion-weighted magnetic resonance imaging (DWMRI) in precise radiotherapy of esophageal carcinoma.MethodsThirty-seven patients with biopsy proven esophageal cancer from March 2010 to January 2011 were included.To delineate the gross tumor volume (GTV) using CT and DWMRI images,each patient was examined by DWMRI and CT scan using the same position before radiotherapy.To compare the maximum diameters and volumes of tumor between CT and DWMRI. The tumor lengths measured by esophagogram,esophagoscope,CT and DWMRI were compared.ResultsTumor lengths under esophagogram,esophagoscope,CT and DWMRI were 5.70 cm,6.06 cm,7.97 cm and 5.79 cm respectively. The lengths between CT and esophagogram,CT and esophagoscope,CT and DWMRI had statistical significance respectively (F=4.88,P=0.003).The maximum diameters of tumor shown on CT and DWMRI were 3.79 cm and 3.81 cm respectively ( t =-0.32,P=0.751 ).The GTV were 45.75 cm3 and 38.05 cm3 in CT and DWMRI respectively (t=5.30,P =0.001 ).53 lymph nodes were assessed positive on both CT and DWMRI.DWMRI excluded 25 positive lymph nodes assesed by CT; also confirmed 15 negative lymph nodes excluded by CT,6 of which were paraesophageal lymph nodes.The addition of DWMRI information altered the clinical stage in 6 patients.ConclusionsTumor lengths measured on DWMRI and esophagogram had the optimal approximation.It was easy to find paraesophageal lymph nodes via DWMRI.With the addition of DWMRI information,the target range and clinical stage were alerted in some patients.