Objective To compare the efficiency of acute physiology and chronic health evaluation (APACHE)Ⅱ and Ⅳ in mortality risk prediction of severe acute pancreatitis (SAP).Methods From January 2013 to December 2014,SAP patients admitted to intensive care units (ICU) were retrospectively analyzed in single center.The clinical data of the first 24 hours since the patients admitted into ICU were collected.The modified Marshall score,APACHE Ⅱ and APACHE Ⅳ score were calculated.The mortality risk predictive value of each patient was calculated by APACHE Ⅱ and APACHE Ⅳ.According to the final clinical outcome of patients,Hosmer-Lemeshow was performed to compare real mortality rate with predictive mortality rate,and calibration of APACHE Ⅱ and APACHE Ⅳ in the mortality risk of each patients was evaluated.The resoluation of the two scoring systems was compared by the area under the receiver operator characteristic curve (AUC).Results In the end,192 patients (152(79.2％) survivors and 40(20.8％) dead) were enrolled.Modified Marshall score,APACHE Ⅱ score and APACHE Ⅳ score of patients in dead group was 6.30±0.36,21.3±8.0 and 88.1± 30.2,respectively;and those of survival group was 3.70 ± 0.20,12.3 ± 5.6 and 53.4 ± 19.0,respectively,and the differences between two groups were statistically significant (t-6.436、-6.683、-6.913,all P＜ 0.01).The results of Hosmer-Lemeshowin calibration of APACHE Ⅱ and APACHE Ⅳ indicated that both two systems could predict mortality risk of SAP patients well (P＞ 0.05).The AUC of APACHE Ⅱ score (cut-off ≥26) and APACHE Ⅳ score (cut off≥91) was 0.81(95％CI 0.74 to 0.89) and 0.83(95％CI 0.75 to 0.90),respectively,and the difference was not statistically significant (x2 =0.21,P=0.644),which indicated that there was no statistically significant difference in calibration.Conclusions APACHE Ⅳ scoring system is not better than APACHE Ⅱ scoring system in prognosis prediction of SAP patients.The prognosis of SAP patients could be accurately evaluated by APACHE Ⅱ.

Objective To explore possible role of cellular repressor of E1A-stimulated genes(CREG) in the process of phenotypic switching of adventitial fibroblasts(AFs). Methods Immunofluorescent staining was performed with tissue sections from mouse carotid arteries to evaluate the relationship between the expression of CREG and smooth muscle actin-α(α-SMA) in injured arteries, especially in the adventitia. Tissue block pasted culture method was used to isolate and culture AFs. RT-PCR and Western-blot were used to detect the change of CREG andα-SMA mRNA and protein expression in AFs in the presence of different concentrations of AngⅡfor 12 h/24 h or in the presence of 100 nmol/L Ang Ⅱ for different times. Results Normal mouse carotid arteries had little α-SMA expression throughout the tunica adventitia. Arteries at day 1 and day 3 post-injury exhibited significantly higher immunofluorescence of α-SMA compared with non-injured arteries. Alpha-SMA expression began to decrease on day 7 and progressively declined on day 14. In contrast, immunofluorescent staining revealed that CREG was expressed in the adventitia of normal arteries. Expression of CREG in the adventitia of injured arteries was decreased on the 1st day, reached its lowest value on the 3rd day, and increased gradually from the 7th day, and was higher compared with that in non-injured arteries on the 14th day after injury. Similarly, the expression of CREG in AFs was very high, and AngⅡremarkably decreased mRNA and protein expression levels of CREG in a dose-dependent and time-dependent manner. Conclusions The changes in CREG expression correlate with AF phenotypic modulation, and CREG down-regulation may facilitate AF phenotypic switching into myofibroblasts (MFs).

OBJECTIVE:To study in vitro antiviral effect of Junduqing granules. METHODS:Human laryngeal cancer Hep2 cells were inoculated with the Nancy strain of coxsackievirus B3 (CoxB3) and respiratory syncytial virus (RSV) to establish vi-rus-infected cell models. 2 mg/ml original liquid of Junduqing granules and 2 mg/ml original liquid of chlorogenic acid which were diluted according to the ratio of 1∶2-1∶256 were used to act on the virus-infected cells. Reed-Muench method was adopted to calcu-late 50% toxic concentration (TC50) and maximal atoxic concentration (TC0). Virus-infected cells were cultured with solution of Junduqing granules of 1.25,0.625,0.312 5 and 0.156 25 mg/ml and chlorogenic acid solution 0.5,0.25,0.125,0.062 5 mg/ml, and then the degree of cytopathic effect was evaluated with a microscope. Virus-infected cells were cultured with 1.25,0.625, 0.312 5 ,0.156 25,0.078 125 mg/ml solution of Junduqing granules and 0.5,0.25,0.125,0.062 5,0.031 25 mg/ml of chlorogenic acid solution,and Reed-Muench method was adopted to calculate 50% inhibitory concentration (IC50) and therapeutic index (TI) on RSV and CoxB3 cells. RESULTS:TC50 of Junduqing granules was 1.79 mg/ml and TC0 was 1.25 mg/ml,TC50 of chlorogenic ac-id was 0.71 mg/ml and TC0 was 0.5 mg/ml. Virus-infected cells grew normally when the mass concentration of solution of Jundu-qing granules was 1.25 mg/ml. IC50 of Junduqing granules was 0.22 mg/ml and TI was 8.14;IC50 of chlorogenic acid were 0.18 and 0.36 mg/ml,TI were 3.94 and 1.97. CONCLUSIONS:Junduqing granules have in vitro anti-CoxB3 and RSV effect.

Objective To explore the accuracy of bedside arterial blood gas analyzer in detecting electrolytes and anionic gap (AG) in ICU patients, and compare it with auto-analyzer. Methods Results of blood sodium, potassium, chlorine, bicarbonate ions and AG measured by arterial blood gas analyzer and auto- analyzer of 376 ICU adult patients admitted to ICU were retrospectively analyzed. With the outcomes of auto-analyzer as standard, the correlation and difference of electrolytes and AG measured by 2 methods were analyzed. Results The sodium, potassium, chlorine and AG measured by auto-analyzer were 121 - 183 mmol/L, 2.13 - 6.77 mmol/L, 86 - 146 mmol/L and 1 - 62 mmol/L. The blood sodium, potassium, chlorine and AG measured by arterial blood gas analyzer were 114 - 180 mmol/L, 1.78 - 6.36 mmol/L, 94 - 150 mmol/L, -7 - 40 mmol/L. The blood sodium, potassium and AG measured by arterial blood gas analyzer were lower than those measured by auto-analyzer, but the blood chlorine was higher than that measured by auto- analyzer. There were statistical differences in the difference of low, normal and high electrolytes and AG between 2 methods (P<0.01). Conclusions The electrolytes and AG measured by arterial blood gas analyzer and auto-analyzer are significantly different, and the electrolytes measured by arterial blood gas analyzer are unreliable to calculate AG.

Objective To screen for clopidogrel metabolism related gene CYP2C19 in patients with coronary artery disease in Wuhan.Methods 316 patients,from Jan to Dec 2014,after cardiology percutaneous coronary interventional therapy (PCI) for the treatment of coronary artery disease were selected as research object.Clopidogrel metabolism related CYP2C19 geno-types (* 1,* 2,* 3)were detected by the gene chip,and for different types of metabolism of patients according to CYP2C19 gene type:strong metabolize type (*1/*1),intermediate metabolizer types (*1/*2,*1/*3),poor metaboli-zer types (*2/*2,*3/*3,*2/*3).Results According to the CYP2C19 gene polymorphism of metabolic function type, strong metabolic type carrying CYP2C19*1 (*1/*1)accounted was 43.4%,intermediate metabolizers carrying CYP2C19*2 or *3 (* 1/* 2 and * 1/* 3)and poor metabolizers (* 2/* 2,* 2/* 3 and * 3/* 3)accounted was 42.4% and 14.2%,respectively.Different gender had no statistical significance in CYP2C19 genotype differences.Conclusion Clopi-dogrel metabolism functional of CYP2C19 gene in patients with interventional coronary heart disease in Wuhan area had more deletion gene.

Objective To investigate the possible association of serum leptin(Lp)and soluble leptin receptor(sLR)levels in patients with different clinical types of lupus erythematosus(LE)and the disease activity of system lupus erythematosus(SLE).Methods 39 patients with LE were randomly enrolled from Department of dermatology of Sheng Jing Hospital of China Medical University and No.1 Hospital of China Medical University from 2004 to 2005,and 31 normal controls(age-,sex-and body mass index(BMI)-matched)were enrolled in this study.Fasting blood samples were obtained,and serum Lp levels were measured by using radioimmunoassay,and sLR levels were measured by using enzyme-linked immunosorbent assay(ELISA).Results(1)The patients had significantly higher serum Lp levels,but lower sLR levels than that of the control group(P0.05).(2)Lp was in positive relation with BMI,but in negative relation with sLR.The disease activity of SLE showed positive correlation with the serum Lp levels,but negative correlation with sLR levels by Kendall's correlation analysis(P

The paper analyzes and discusses the necessity of integrating computational thinking into basic computer teaching by combining characteristics of medical undergraduates and the current situation and tendency of basic computer teaching,and states the thought and method of solving problems with the computational thinking by taking mind mapping and program design thought as the teaching cases,in order to cultivate the consciousness and ability of students in constructing problem solutions by taking advantage of the computational thinking.

Objective To prospectively assess the diagnostic accuracy of MR inflow inversion recovery (IFIR) fast imaging employing steady-state acquisition (FIESTA) for detection of renal artery stenosis (RAS),as compared with renal artery CT angiography (CTA) performed as the reference standard.Methods Thirty patients [18 males,12 females; mean age (65.0±12.1) years] with arterial hypertension and suspected RAS were examined by 3.0-T 3D MR IFIR-FIESTA and renal artery CTA within a week.The IFIR-FIESTA image quality,the IFIR-FIESTA and CTA in display of second-order and third-order branches of renal artery were assessed by two experienced readers.The sensitivity,specificity,accuracy,and negative predictive value (NPV) of IFIR-FIESTA were calculated on artery-by-artery and patient-by-patient bases by the two readers.The inter-observer agreement between the two readers in determining the presence and grade of renal artery stenosis was assessed.Results The scores of qualification of IFIR-FIESTA image quality by reader A and B were (2.16±1.02) and (2.00 ± 0.14),there was no significant difference between them (Z=-0.037,P=0.971).IFIR-FIESTA and CTA in display of second-order and third-order branches of renal artery had no significant difference (x2 =0.298,P=0.585).In the assessment of all 64 main renal arteries by reader A,IFIR FIESTA on artery-by-artery basis had sensitivity,specificity,accuracy,and NPV of 100％,96％,97％,and 100％,respectively; the above parameters assessed by reader B were 100％,90％,93％,and 100％,respectively.There was excellent inter-observer agreement (Kappa=0.803) with the presence or absence of hemodynamically significant RAS.In the assessment of all 30 patients by reader A,IFIR-FIESTA on patient-by-patient basis had sensitivity,specificity,accuracy,and NPV of 100％,95％,97％,and 100％; the above parameters assessed by reader B were 100％,85％,90％,and 100％,respectively; there was good inter observer agreement (Kappa=0.724) with the presence or absence of hemodynamically significant RAS.Conclusions Compared with CTA,MR IFIR-FIESTA can excellently assess RAS without contrast material and radiation exposure,therefore,it can be used for screening of RAS,especially should be widely applied to elderly patients with arterial hypertension.

Adult ; Arterio-Arterial Fistula ; pathology ; Coronary Vessels ; pathology ; Female ; Humans ; Pulmonary Artery ; pathology

Objective To investigate the value of the dynamic susceptibility contrast enhanced MRI (DSC-MRI) in differential diagnosis of glioblastoma,solitary cerebral metastatic tumors and cerebral lymphoma.Methods Seventeen patients with glioblastoma,15 cases with solitary cerebral metastatic tumor and 17 cases with cerebral lymphoma were analyzed retrospectively.All patients underwent conventional MR imaging,contrast enhancement and DSC-MRI preoperatively.Pseudo color pictures of cerebral blood volume (CBV) and the time signal intensity curve were obtained from the raw data of DSC MRI.The relative CBV (rCBV)were measured from regions of enhanced solid parts of the tumors,peritumoral region and contralateral normal white matter regions respectively.The percentage of signal intensity recovery (PSR) of enhanced solid parts of the tumors were measured.ROC curve analysis was performed to determine optimum indicator in differential diagnosis of three types of tumors,and the sensitivity and specificity were calculated.Results Three types of tumors all showed enhancement of solid area with obvious peritumoral edema.Besides the no difference between glioblastoma and metastasis in rCBV of solid parts of the tumors,there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).Besides the no difference between single brain metastases and lymphoma in rCBV of peritumoral regions,there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).The PSR of the solid parts of the tumors had no difference between glioblastoma and single brain metastases,while there were statistically significant differences in comparisons of two types of tumors (all P＜0.05).ROC curve analysis showed sensitivity and specificity of the PSR values of solid parts of the tumors in differentiating lymphoma and non lymphoma were 100 ％and 81.3 ％.The rCBV of peritumoral regions was the optimum indicator for differentiating glioblastoma and solitary brain metastasis,the sensitivity and specificity were respectively 94.1％ and 86.7％.Conclusion The combination of rCBV and PSR can improve the efficiency for diagnosing the three types of brain tumors.