Objective To study the value of 18F-fluoro-deoxy-D-glucose positron emission tomography-computed tomography (18F-FDG PET/CT) in diagnosis of patients suspected with gastric malignant tumors. Methods Ten women and fourteen men, with a mean age of (56±15) years (ranged from 28 to 83 years) suspected of gastric malignant tumors were enrolled from May 2007 to July 2007. According to the results of the first time endoscopy and biopsy, patients were divided into gastric cancer group (n=9) and suspected group(n= 15). 18F-FDG PET/CT whole body scan was performed in gastric cancer group for assistant operation and suspected group for further diagnosis. The results of PET/CT for suspected group were all confirmed by the endoscopy later. The final diagnosis was based on pathology and follow-up. The sensitivity, specificity, positive predictive value and negative predictive value of 18F-FDG PET/CT in diagnosis of gastric malignant tumors were analyzed, as well as the tumor staging before operation. Results The malignant tumor was found in 16 out of 24 patients who received 18F-FDG PET/CT scan, including 9 in gastric cancer group and 7 in suspected group. Sixteen tumors originated from stomach,and 1 infiltrated the liver, pancreas and omentum. Liver (1 case) and lung (1 case) metastases were found. Three lesions limited in intestine and 13 had positive lymph nodes. Two patiens in suspected group were not diagnosed by PET/CT, one was negative and the other, who suspected as gastric cancer by PET/CT, was pathologicaly confirmed as benign gastrointestinal stromal tumor. The sensitivity, specificity, positive predictive value and negative predictive value of 18F-FDG PET/CT in diagnosis of gastric malignant tumors were 16/17, 6/7, 16/17 and 6/7, respectively. Six patients of stage Ⅲ and Ⅳ were all detected. Conclusions 18F-FDG PET/CT whole body scan is not only a feasible, safe, noninvasive and promising diagnostic tool in detecting and differentiating gastric cancer from benign tumor, but also can assist the management of disease.

Objective To explore the structure of violent attitude and the predictive character of the passionate criminal and recidivist. Methods This study used FMMU-Abnormal Personality Risk Factors Inventory (FMMU-APRI) for measuring explicit violent attitude of the passionate criminal and recidivist in prison; while used the picture Attitude Activation paradigm (AAP) for assessing implicit violent attitude. Results The AAP results showed that parts of passionate criminal and recidivist had reversed priming effect, according to whether reversed, there were divided into four types: no-reversal passionate criminals, reversal passionate criminals, no-reversal recidivists and reversal recidivists, VIO scores of no-reversal passionate criminals and recidivists recidivist were significantly higher than the norm, as reversal passionate criminals and recidivists had no significance; in noreversal passionate criminals, compatible response rate was 1.104, incompatible response rate was 1.053; in reversal passionate criminals, compatible response rate was 1.042, incompatible response rate was 0.997; in no-reversal recidivists, compatible response rate was 1.059, incompatible response rate was 1.097; in reversal recidivists , compatible response rate was 1.039, incompatible response rate was 0.998, as each group had strong priming effect, and each group had a dissociation of implicit and explicit violent attitude. Conclusion The results suggest that offenders who have committed a crime in the same category also had a different violent attitude; and integrating indirect methods with direct methods would predict a crime more accurately.

Objective To study the diagnosis and treatment of cytomegalovirus (CMV) infection after liver transplantation. Methods The clinical data of 111 patients who received liver transplantation from November 2000 to December 2007 in our hospital were analyzed retrospectively. The recipients were diagnosed as having CMV infection by the predisposing factors, clinical symptoms and detection of CMV-PP65 and CMV-IgM in peripheral blood specimens in combination with chest X-ray. The treatment of CMV infection was administration of Ganciclovir. Results Five recipients were diagnosed as having CMV infection, with the incidence of 4.5%. Two were diagnosed as having CMV pneumonitis, with the incidence of 1.8% (40% of the recipients having CMV infection). Two were both improved. Three were diagnosed as having CMV active infection. Two of them were cured and one was improved. Conclusion The detection of CMV-PP65 is necessary for early diagnosis and guiding treatment of CMV infection. Ganciclovir can exert significant therapeutic effects on CMV infection.

ObjectiveTo investigate the protective effect and mechanism of Artemisia capillaris Thunb. decoction (YCHT), a classic heat-clearing and cholagogic traditional Chinese medicine (TCM) prescription, on rats with severe acute pancreatitis (SAP) induced by sodium taurocholate. MethodsA total of 30 Sprague-Dawley rats were randomly divided into sham-operation (SO) group, SAP model group, and YCHT (4.0 g/kg) treatment group, with 10 rats in each group. At 24 hours after successful modeling, pancreatic tissue and plasma samples were collected for analysis. HE staining was used to observe pathological injury of the pancreas; ELISA was used to measure the plasma levels of amylase, tumor necrosis factor-α (TNFα), and interleukin-1β (IL-1β); immunofluorescent staining was used to measure the fluorescence intensity of LC-3 protein, and TUNEL was used to measure cell apoptosis. Western blot was used to measure the protein expression of LC-3, Beclin-1, X-linked inhibitor of apoptosis protein (XIAP), caspase-3, and nuclear factor-kappa B (NF-κB) in the pancreas, and quantitative real-time PCR was used to measure the expression levels of lncRNA PVT1 and miRNA-30a-5p. A one-way analysis of variance and the Tukey’s test were used to analyze the differences between multiple independent samples. ResultsYCHT significantly alleviated the pathological injury of the pancreas of SAP rats, such as edema, necrosis, hemorrhage, and inflammatory cell infiltration. Compared with the SO group, the SAP group had significant increases in the plasma levels of amylase and the inflammatory factors TNFα and IL-1β, and there were significant reductions in the plasma levels of amylase, TNFα, and IL-1β after YCHT treatment (all P＜0.05). Compared with the SO group, the SAP group had significant increases in LC-3II/LC-3I ratio and the protein expression of Beclin-1, XIAP, caspase-3, and NF-κB, and compared with the SAP group, the YCHT group had significant reductions in LC-3II/LC-3I ratio and the protein expression of Beclin-1, XIAP, and NF-κB (all P＜0.05). Compared with the SO group, the SAP group had a significant increase in the expression of lncRNA PVT1 and a significant reduction in the expression of miRNA-30a-5p in the pancreas (both P＜0.05), and compared with the SAP group, the YCHT group had a significant reduction in the expression of lncRNA PVT1 and a significant increase in the expression of miRNA-30a-5p (both P＜0.05). ConclusionCell autophagy and apoptosis mediated by lncRNA PVT1/miRNA-30a-5p may be a drug target for YCHT treatment of SAP, which provides experimental and theoretical bases for further development of the TCM prescription YCHT for the treatment of SAP.

Objective To investigate the epidemiology characteristics of crawfish related rhabdomyolysis (RM) in Nanjing, 2016.Methods Outpatient and inpatient electronic medical system of 21 hospitals in Nanjing during 2016 were retrospectively searched, and all the patients diagnosed with RM were selected. The patients with none crayfish-related RM was excluded. The epidemiology characteristics were depicted. The geographic information system (GIS) was used to collect, manage and analyze the spatial data, to visualize it, to analyze the spatial distribution features of the disease, and to explore the cause of disease prediction. GeoDa 1.8 software was used to analyze the global and local spatial auto-correlation.Results A total of 1183 patients with crawfish related RM were initially screened, excluding 59 patients with RM caused by trauma, severe exercise, heat stroke, myositis, poisoning, drugs, and genetic diseases, and 1124 patients were enrolled. The proportion of men was 36.48% (410/1124) with an incidence of 12.54/100 thousands; while of women was 63.52% (714/1124) with an incidence of 21.86/100 thousands. The median age at onset was 34 (28, 43) years. From July to August, the incidence of crawfish related RM was the highest, accounting for 96.53% of the total number of cases. The top four incidence areas were Pukou (41.54/100 thousands), Jianye (25.94/100 thousands), Qixia (25.73/100 thousands), Gulou (25.04/100 thousands), all of which were adjacent to the Yangtze River. Global spatial autocorrelation analysis showed: MoranI = 0.427,Z = 2.646,P = 0.003, suggesting that the crawfish related RM had positive spatial autocorrelation. The results showed that the spatial structure of crawfish related RM existed in Nanjing in 2016. Local spatial autocorrelation analysis showed that the high-high concentration areas were Pukou, Jianye and Liuhe. The incidences of above three areas which were the Nanjing section of the lower reaches of the Yangtze River flowed through the region and surrounding areas were higher than the overall incidence of Nanjing.Conclusion The prevalence of crawfish related RM in Nanjing during 2016 had an obvious region-concentrated character and global spatial autocorrelation with the high prevalent regions mainly concentrated in the urban areas adjacent to the Yangtze River.

Objective To summarize the efficacy of extracorporeal membrane oxygenation (ECMO)utilization in Emergency Department (ED),as well as the establishment of emergency ECMO team.Methods A retrospective analysis was carried out in 16 patients treated with ECMO between April 2015 to December 2016 in ED.The clinical data including demographics,diagnosis,initiating ECMO timing,place of ECMO establishment,intubation approaches,duration of ECMO,complications and outcomes were collected and analyzed.Results Eight patients were successfully weaned from ECMO,and 7 of them survived to discharge from hospital.The duration of ECMO support was 4 to 384 hours.The emergency ECMO team was set up.Conclusions Emergency medical team can successfully operate the ECMO process.The emergency medical team-initiated ECMO can provide effectively adjuvant measures to support patients with respiratory failure,circulatory failure and cardiac arrest.

Objective:To analyze the effectiveness and annual cost-effectiveness of extracorporeal cardiopulmonary resuscitation, ECPR) in adults.Methods:Totally 60 patients received ECPR from April 2015 to March 2020 in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The patients were grouped by discharge survival/hospital death and shockable/unshockable initial rhythm. Age, gender, initial rhythm, survival rate, ECMO treatment time, time-to-death, length of stay and hospitalization costs were analyzed. All discharged survivors were followed up for 1 year, then cost-effectiveness analysis was performed using total cost of ECPR as the cost and 1-year survival rate as the effect.Results:Fifty-four adult patients with ECPR were enrolled, and 17 (31.5%) patients survived and discharged, of whom 15 (88.2%) patients had good neurological outcomes and survived at 1-year follow-up. The median ECMO time was 5 ( IQR 1-8) d, time-to-death was 4 ( IQR 1-9) d, length of stay was 10 ( IQR 3-18) d, total hospitalization cost was 209 122 ( IQR 121 431-303 822) RMB, and the daily cost was 23 587 ( IQR 13 439-38 217) RMB. The rate of shockable initial rhythm was significantly higher in the discharge survival group than the hospital death group. The survival rate of ECPR patients with shockable initial rhythm was significantly higher than that of patients with unshockable initial rhythm, and there was no difference in cost. Conclusions:ECPR is a resource-intensive treatment with a total cost of about 200 000 RMB. Moreover, the effectiveness and annual cost-effectiveness are superior for patients with shockable initial rhythm.

Objective:To explore the effect of pediatric critical illness score (PCIS), pediatric risk of mortality Ⅲ score (PRISM Ⅲ), pediatric logistic organ dysfunction 2 (PELOD-2), pediatric sequential organ failure assessment (p-SOFA) score and Glasglow coma scale (GCS) in the prognosis evaluation of septic-associated encephalopathy (SAE).Methods:The data of children with SAE admitted to the Pediatric Intensive Care Unit (PICU), Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences from January 2010 to December 2020 were retrospectively analyzed. They were divided into the survival and death groups according to the clinical outcome on the 28th day after admission. The efficiency of PCIS, PRISM Ⅲ, PELOD-2, p-SOFA and GCS scores for predicting death were evaluated by the area under the ROC curve (AUC). The Hosmer-Lemeshow goodness-of-fit test assessed the calibration of each scoring system.Results:Up to 28 d after admission, 72 of 82 children with SAE survived and 10 died, with a mortality rate of 12.20%. Compared with the survival group, the death group had significantly lower GCS [7 (3, 12) vs. 12 (8, 14)] and PCIS scores [76 (64, 82) vs. 82 (78, 88)], and significantly higher PRISM Ⅲ [14 (12, 17) vs. 7 (3, 12)], PELOD-2 [8 (5, 13) vs. 4 (2, 7)] and p-SOFA scores [11 (5, 12) vs. 6 (3, 9)] ( P<0.05). The AUCs of PCIS, PRISM Ⅲ, PELOD-2, p-SOFA and GCS scores for predicting SAE prognosis were 0.773 ( P=0.012, AUC>0.7), 0.832 ( P=0.02, AUC>0.7), 0.767 ( P=0.014, AUC>0.7), 0.688 ( P=0.084, AUC<0.7), and 0.692 ( P=0.077,AUC<0.7), respectively. Hosmer-Lemeshow goodness-of-fit test showed that PCIS ( χ2=5.329, P=0.722) predicted the mortality and the actual mortality in the best fitting effect, while PRISM Ⅲ ( χ2=12.877, P=0.177), PELOD-2 ( χ2=8.487, P=0.205), p-SOFA ( χ2=9.048, P=0.338) and GCS ( χ2=3.780, P=0.848) had poor fitting effect. Conclusions:The PCIS, PRISM Ⅲ and PELOD-2 scores have good predictive ability assessing the prognosis of children with SAE, while the PCIS score can more accurately evaluate the fitting effect of SAE prognosis prediction.

Objective:To evaluate the accuracy of an ultrasound-guided robot-assisted system for percutaneous facet joint puncture in an animal experiment by registration of ultrasound images and two-dimensional X-ray fluorescence images.Methods:Six specimens of fresh adult sheep lumbar spine were prepared and soaked in gelatin solution. The specimens contained a total of 48 facet joints with 24 ones respectively on the left and right sides. Half of the joints were assigned by the random number table method into a robot-assisted group which were subjected to percutaneous facet joint puncture assisted by the ultrasound-guided robot-assisted system while the contralateral ones into a freehand group which were subjected to percutaneous facet joint puncture by freehand. In the robot-assisted group, the left facet joints were 3 L 1, 3 L 2, 3 L 3 and 3 L 4 ones while the right facet joints were 2 L 1, 3 L 2, 5 L 3 and 2 L 4 ones. In this self-control animal experiment, both the robot-assisted punctures and the freehand punctures were carried out in the same specimen. The puncture success rate, puncture needle adjustment, positioning deviation, orientation deviation and operation time were recorded. Results:The positioning deviation and orientation deviation in the robot-assisted group [(2.21 ± 1.12) mm and 1.51° ± 0.47°] were significantly lower than those in the freehand group [(3.26 ± 1.44) mm and 2.24° ± 0.89°] ( P < 0.05). All the articular facet joint punctures were successfully accomplished for the first time in the robot-assisted group while those required multiple adjustments in the freehand group. In the robot-assisted group, the total operation time [(463.84 ± 34.93) s] was significantly longer than that in the freehand group [(298.40 ± 27.48) s], but the puncture time [(37.97 ± 6.87) s] was significantly shorter than that in the freehand group [(261.61 ± 33.15) s] ( P < 0.05). Conclusion:The ultrasound-guided robot-assisted system for percutaneous facet joint puncture can lead to accurate puncture with limited needle adjustments.

Objective:To investigate the prognostic value of early lactate in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:A retrospective analysis was performed on the clinical data of patients with ECPR in the Emergency Medicine Department of The First Affiliated Hospital of Nanjing Medical University from March 2015 to August 2021. The age, sex, etiology, initial rhythm, prognosis, blood lactate and pH of patients with ECPR were collected, and their difference between the deceased and survived patients was compared.Results:Totally 95 patients were enrolled, with an average age of 47 years; male accounted for 69.5%, and the survival rate was 29.5%. There was no significant difference in age and sex ratio between the deceased and survived patients. However, the deceased patients had a significant lower rate of shockable rhythms (31.3% vs. 60.8%), a higher level of lactate [16.4 (11.2, 19.1) vs. 9.2 (3.2, 15.0), mmol/L], and a lower pH [7.01 (6.88, 7.23) vs. 7.37 (7.10, 7.43)] than the survived patients. Multivariate binary logistic regression analysis showed that shockable rhythm [odds ratio ( OR) = 0.295, 95% confidence interval ( CI): 0.118-0.739), lactate ( OR=1.159, 95% CI: 1.068-1.258) and pH ( OR= 0.017, 95% CI: 0.002-0.157) were independent risk factors for poor prognosis. Furthermore, a lactate level >24 mmol/L was the best threshold to predict mortality with a specificity of 100%. Combined application, the cutoff point was lactate level>16 mmol/L and pH <6.828. Conclusions:Shockable rhythm, higher early lactate and lower pH value are independent risk factors for prognosis in patients with ECPR. Early lactate > 24 mmol/L or lactate > 16 mmol/L companied with pH < 6.828 are novel indicators of the termination of ECPR.