Objective To determine the levels of blood pancreatic stone protein/ regenerating protein(PSP/reg)and to explore the value of PSP/ reg in assessing severity and predicting prognosis of sepsis with or without panc-reatic damage. Methods In this prospective study,the clinical data and blood samples to measure PSP/ reg levels in 1,3 and 7 days after admission in the Pediatric Intensive Care Unit,Hunan Children's Hospital,from the children with sepsis from September 2013 to September 2014 were collected. According to levels of pancreatic trypsin(amylase or li-pase),the children were divided into normal group,mildly elevated group(1 - 3 times),and severely elevated group (more than 3 times);based on the condition of sepsis,the children were divided into sepsis group and severe sepsis group. Chi - square test,nonparametric rank sum test,Spearman correlation and area under the receiver operating cha-racteristic curve(AUC),Kaplan - Meier survival curves were used for statistical analysis. Results (1)A total of 226 children with sepsis were included in this study,among them pancreatic trypsin was normal in 159 cases(70. 4% ), pancreatic trypsin mildly elevated in 44 cases( 19. 4% ),and pancreatic trypsin severely elevated in 23 cases (10. 2% );125 cases(55. 3% )were sepsis,and 101 cases(44. 7% ,of which 29 cases were sepsis shock)were severe sepsis.(2)The correlation between PSP/ reg and serum amylase was maximum,while PSP/ reg had some correlation with serum lipase,but there was no correlation with C - peptide,insulin,glucose.(3)When pancreatic trypsin was normal or mildly elevated,severe sepsis group had higher levels of PSP/ reg than that of sepsis group(Z = - 7. 627,- 2. 965,P =0. 000,0. 003);while pancreatic trypsin was severe elevated,there was no significant difference in PSP/ reg levels be-tween sepsis group and severe sepsis group(Z = - 0. 134,P = 0. 894).(4)The AUC of PSP/ reg and procalcitonin to assess severity of sepsis were greater than 0. 7 in the children whose pancreatic trypsin was normal or mildly elevated, and there was no significant difference between them(P ﹥ 0. 05);while the AUC of C - reactive protein and WBC were less than 0. 7.(5)PSP/ reg levels gradually increased in non - survival children in 3 and 7 days,while survival children gradually declined. The AUC of PSP/ reg to predict prognosis was 0. 775,and 60 μg/ L was viewed as the critical point, sensitivity 89% ,specificity 67% . Children with PSP/ reg levels ≤60 μg/ L had higher rate of survival than children with ﹥ 60 μg/ L(χ2 = 36. 874,P = 0. 000). Conclusions PSP/ reg is closely associated with pancreatic exocrine func-tion,but PSP/ reg still can assess severity and predict prognosis in children with sepsis and pancreatic damage.

Objective To intervene and appraise the health literacy of diabetic patients entering contracts with family doctors in pilot communities,and learn the effect and feasibility of health literacy management by family doctors for diabetic patients.Methods By means of community intervention study and questionnaire survey,560 diabetic patients as mentioned above in Shanghai were subject to a baseline assessment on their health literacy,followed by management and routine follow-up on their diabetic health literacy.At the end of six months of comprehensive intervention,their health literacy was appraised again to observe the effects of such management.Results Six months of guidance and management found the average scoring of the health literacy of these patients 23.46 over the baseline,an increase of 36.8% of the patients in their compliance of the four basic diabetic diet behaviors,and an increase of 27.8% of them in regular and quantitative exercises.Conclusions It is feasible for community family doctors to carry out the health literacy management for diabetic patients contracted,and health literacy management can change the awareness and behaviors of such patients to some extent.

Objective To evaluate the effect of modified Maze lines plus pulmonary vein (PV) isolation created by radiofrequency catheter ablation (RFCA) on atrial wall guided by a novel geometry mapping system in the treatment of elderly patients with paroxysmal atrial fibrillation (PAF). Methods After regular electrophysiological study, transseptal punctures were achieved twice with Swartz L1 and R1 sheaths. PV angiographies were conducted to evaluate their orifices and branches. A balloon electrode array catheter with 64 electrodes was put in the middle of the left atrium. Atrium geometry was constructed using Ensite 3000 Navx system. Two RFCA lesion loops and three lines (modified Maze) were created on left and right atrial walls. Each lesion point was ablated for 30 seconds with preset temperature 50 (ae) and energy 30W. The disappearance or 80% decrease of the amplitude of target atrial potential and 10 to 20(|), decrease of ablation impedance were used as an index of effective ablation. Results A total of 11 patients (7 male and 4 female, mean age, 68.7±5.1 years) were enrolled. PAF history was 7.9±4.5 years. PAF could not be prevented by mean 3.1±1.6 antiarrhythmic agents in 6.3±3.4 years. None of the patients had complications with structural heart disease or stroke. Left atrial diameter was 41.3±3.6 mm and LVEF was 59.2±3.7% on echocardiography. Two loops and three lines were completed with 67.8±13.1 (73-167) lesion points. Altogether 76-168 (89.4±15.3) lesion points were created in each patient. PAF could not be provoked by rapid burst pacing up to 600 beat per minute delivered from paroxysmal coronary sinus electrode pair.Complete PV electrical isolation was confirmed by three-dimensional activation mapping. Mean procedure time was 2.7±0.6 hours and fluoroscopy time was 17.8±9.4 minutes. Patients were discharged with oral aspirin and without antiarrhythmic agents. During follow up of 6.5±1.8 months, seven patients were PAF symptom free (63.6%). PAF attacks were decreased more than 70% in two patients (18.2%). PAF frequency did not change in another two patients (18.2%). Conclusions Ensite 3000 Navx guided modified Maze lines plus PV isolation on the atrial wall is safe and feasible in the elderly patients. It has the advantages of exact procedural endpoint, shorter X-ray exposure, fewer complications and satisfied long-term effect PAF control.

Objective To explore the therapeutic effect of rhIL-11 and rhG-CSF on mouse bone marrow injury induced by neutron irradiation.Methods 130 male BALB/c mice were irradiated by 3.0 Gy neutron and mice peripheral blood cells,bone marrow pathological changes,bone marrow nucleated cell counts,AgNOR content,apoptosis and necrosis rates and Bax protein content were observed by means of blood cells automatic analyzer,HE staining,AgNOR staining,flow cytometry,immunohistochemistry staining and image analysis.Results In the irradiation group and the rhIL-11 group,the mice peripheral blood white blood cells,bone marrow nucleated cell counts and AgNOR content was decreased progressively.The Bax protein was positively or strongly positively expressed in the cytoplasm of the hematopoietic cells and the Bax protein content was increased progressively at 6 h,1 d,3 d after irradiation.In the irradiation group,the rates of apoptosis and necrosis in the mice hematopoietic cells were greatly increased and that of necrosis was significant at 6 h after irradiation.In the rhIL-11 + rhG-CSF group,the counts of bone marrow nucleated cell and AgNOR were increased and the Bax protein content was decreased at 3 d after irradiation,while in the rhIL-11 group,the indexes mentioned above were not obviously different compared with those of the irradiation group.Conclusions The mice bone marrow hematopoietic function is seriously damaged by 3.0 Gy neutron irradiation,rhIL-11 and rhG-CSF could improve the mice hernatopoietic function after neutron irradiation,and combination of them is more effective to stimulate the hematopoitic function than either of them alone.

Objective To study the effect of hypothemah on the early inflammatory reaction in acute lung injury induced by intestinal ischemia-repeffusion(IlR)in rabbits.Method Seventy-two healthy rabbits provided by Peking Union Medical Colege Hospital Anhnal center were randomly divided into four groups(n=18 pergroup):(1)normothermia control group (rectal temperature 37-38 C;sham group);(2)normothermia IlR group(rectal temperature 37-38 C);(3)mild hypothermia HR group(rectal temperature 32-35℃);and (4)moderate hypothermia IIR group(rectal temperature 28-31.9C).Acute lung injury was induced by claIllp.ithe superiornteric artery(SMA)for 1 hour and declamping the SMA for 6 hours.Hypothermia WaS induced by surface cooling.Before and 2.4 and 6 hours after IIR,the Olasmlevels o,IL-,IL-6 and IL10 were measured.All rabbits were killed 6 hours after IIR and water content in lung tissue Wttk'assessed.Iaght mieropic examination was performed tbr morphological assessment of the hmg.The data were analyzed by AN()VA.Statistical significance wag dned as a P of<0.05.Results In the IIR groups,the plasma levels ofTHE-a.IL-l,IL-6 and IL-10 and lung water were increased.There Was evidence of acute lung injury from morphologi-cal assessment of the lung.The acute lung injury induced by IIR was improved by hypethennia.Mild hypothermia Was similar to moderate hypothermia for the treatment of acute lung injury induced by IIR.ConclusiotMild hy-pothermia and moderate hypothermia Can significantly improve acute lung injury induced by IIR in rabbits.Mild hypothea had similar efficacy to moderate hypothermia for the treatment of acute lung injury induced by IIR.

Objective To investigate the clinicopathological features and prognostic factors in patients with low grade glioma. Methods Eighty- seven patients with low grade glioma confirmed by cytological examination were retrospectively analyzed. Results Among 87 patients, male accounted for 62.1%(54/87), and the average age was 36.2 years. The average followed- up time was 51.4 months (3-135 months), and 5 cases were lost in follow-up. The follow- up rate was 94.3% (82/87). The 3- year survival rate was 84.1%, and the 5- year survival rate was 66.7%. The 3- year survival rate was related to clinical symptoms, maximum diameter of tumor and the extent of resection (P<0.01 or<0.05);and the 5- year survival rate was related to years, Karnofsky score, clinical symptoms, maximum diameter of tumor, the pathology classification and extent of resection (P<0.05 or<0.01). Conclusions Low grade glioma is more common in male patients and patients under the age of 40 years. Age below 40 years, Karnofsky score ≥ 70 scores, only epilepsy symptom, tumor diameter below 6.0 cm, oligodendrogliomas, complete resection or subtotal resection are positive prognostic factors. Postoperative radiotherapy can reduce the rate of tumor progression.

An electronic medical record(EMR)system is built at urban community health centers to optimize services,achieving information integration of outpatient medical services based on the doctors' workstation.This system has optimized service at the outpatient clinics in the following:1.Digitizing service processes for higher efficiency and service quality; 2.Using EMR templates to save doctors' time in writing medical records for more of their time in patient inquiries and checks; 3.Using LIS,PACs and ECG/EKC systems to check lab results and imaging diagnostics of patients; 4.Using the diagnostic and therapy record sub-system to check electronic records of the patients for consulting their health history;5.Using the Shanghai Medical Alliance's(SMA)shared sub-system to acquire patients' medical records at SMA medical institutions,learning their conditions for their therapies.EMR,when it is built and put into use,can help improve GP's diagnostics and therapeutics,and provide better care to the outpatients as well.

Purpose To compare the CT features of hepatic angiomyolipoma (HAML) and primary hepatocellular carcinoma (HCC) and improve diagnostic accuracy for HAML. Materials and Methods The CT findings of 9 patients with HAML confirmed pathologically and 20 patients with HCC were retrospectively analyzed in terms of lesion location, appearance, size, margin, CT value at each phase, cirrhosis and vessel presence inside tumor. Results Mean CT value on plain scan and at arterial phase on contrast enhanced scan of HAML was significantly lower than that of HCC (t=-2.885, P<0.05;t=-3.307, P<0.01). At portal vein phase, difference in CT value showed no statistic significance (t=-0.293, P>0.05). CT value on plain scan and at arterial phase of both HAML and HCC was not significantly different (t=1.289, P>0.05) whilst that at portal vein phase was significantly different (t=2.516, P<0.05). Central vessels were shown in 7 cases of HAML and 3 cases of HCC, pseudocapsule appeared in 1 case of HAML and 13 cases of HCC with statistical difference (χ2=10.828, 7.219;P<0.01). Conclusion CT scan of HAML reveals the component of fat and presentsfast in and slow outpattern, large shadow of vessel and absence of capsule on contrast enhanced scan, which can be helpful in the differential diagnosis from HCCs.

Objective To explore the therapeutic effect of recombinant human interleukin(rhIL-11) and curcumin on jejunal damage in mice after neutron irradiation.Methods 140 male BALB/c mice were randomly divided into 4 groups:20 mice in healthy control group,60 mice in mere irradiation group,30 mice in IL-11 treatment group and 30 mice in curcumin treatment group.The mere irradiation group mice were wholly exposed to 3 Gy neutron irradiation.The treatment groups mice were intraperitoneally enterocoelia once a day for 5 d after irradiation.The mortality of the mice were observed.The mice in the control and mere irradiation groups were killed 6 h,1,3,and 6 d post-irradiation,respectively,and the mice of the 2 treatment groups were killed 3 and 6 d post-irradiation,respectively and the samples of jujunum were colleted.HE staining,argyrophilic of nucleaolar organizer regions staining,Feulgen staining,and image analysis were used to observe the pathology and levels of argyrophilic proteins and DNA.Results The mice in the mere irradiation group all died at 5 d post-irradiation,while 2 mice in the IL-11 treatment group and 3 in the curcumin group survived.Large area necrosis and exfoliation were found in the intestinal epithelial mucosa of the mere irradiated group mice since 6 h to 3 d after irradiation.Crypt cell regeneration was seen occasionally found 3 days later and much more 5 days later.Crypt cell regeneration was obviously found in the intestinal epithelial mucosa and lots of new villi were observed 5 d after irradiation in both treatment groups,however,the amounts of crypt cells and new villi of the curcumin treatment group were less than those of the IL-11 treatment group.The contents of AgNOR and DNA in the intestinal epithelial cells 5 days after irradiation of the 2 treatment groups were all significantly higher than those of the mere irradiation group (F = 0.015-0.035,all P ＜ 0.05) but without significant differences between them.Conclusions Jejunal damage in mice could be induced after 3 Gy neutron irradiation.rhIL-11 and curcumin might reduce the damage and promote the regeneration and repair of the intestinal epithelium.

Objective To study the expression of tumor necrosis factor alpha (TNF-α) in the intestine of mice irradiated by neutron and γ rays.Methods 350 male BALB/c mice were irradiated with neutron and γ rays of different doses, and sacrificed at 6 and 12hours, 1, 2, 3, 4, 5, 7, 10, 14, 21 and 28 days after irradiation.The TNF-α in the mice intestinal tissue was detected by means of immunohistochemistry and image analysis.Results In normal control mice, TNF-α was expressed in the cytoplasm of macrophages in intestinal villus interstitium, submucosa and lymph tissue.After 2.5Gy neutron radiation, TNF-α was decreased progressively within 2 days, increased obviously in macrophages and crypt cells during 3rd～7th day, reached the peak at 5th day and recovered to normal level at 14th day and TNF-α was decreased progressively within 4 days after 4.0 and 5.5Gy neutron and 12Gy ray irradiation.TNF-α was increased obviously in 6～12 hours, decreased at 1st day, increased at 2nd～5th day, peaked at 3rd day and recovered at 10th day after 5.5Gy ray irradiation.Conclusion Neutron and ray radiation induce different expression profile of endogenous TNF-α in small intestine, which may be related with the pathologic courses of irradiation-induced damage and repair of intestine.