Objective To explore the clinical value of myocardial enzyme on diagnosis of cardiac insufficiency in patients with severe acute pancreatitis (SAP). Methods Fifty patients with SAP were classified as cardiac insufficiency group (n=14) and non-cardiac insufficiency group (n=36). The serum biochemical markers, such as cardiac troponin I (cTnI), myoglobin (MYO), creatine kinase, MB form (CK-MB), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) were examined in two groups. ROC curve was used to evaluate the diagnostic sensitivity and specificity for cardiac insuffi-ciency using myocardial enzyme. The APACHEⅡscore was also calculated. The relationship between myocardial enzyme and APACHEⅡscore was analyzed in two groups. Results The levels of cTnI, LDH and AST were significantly increased in cardiac insufficiency group than those in non-cardiac insufficiency group (P<0.05). There were no significant differences in MYO and CK-MB between two groups of patients. The area under ROC curve for cTnI was 0.940, with a cut-off value of 0.07μg/L. The sensitivity and specificity of cTnI for diagnosing cardiac insufficiency in patients with SAP were 0.857 and 1.000, respectively. The area under ROC curve for LDH and AST was more than 0.7, with the low sensitivity for LDH (0.571) and the specificity for AST (0.778). The area under ROC curve for MYO and CK-MB was less than 0.7. APACHEⅡscore was positively correlated with cTnI, CK-MB and LDH (r= 0.639, 0.451 and 0.552,respectively, P<0.05). Conclusion The serum cTnI level can be used as the index for the diagnosis of cardiac insufficiency in patients with SAP, and can prefer-ably reflect the severity of SAP.

Objective To investigate the prevention of intestines adhesion about sodium hyaluronic acid in postoperative intestines adhesion.Methods Eighteen cases of adhesive intestine obstruction were done intestinal release or bowel resection.2～4mL sodium hyaluronic acid was put to the wound,anastigmatic and rough surface of peritoneal.Gastrointestinal decompression,anti-infective and infusion were taken after oper-ations.Followed up 8～24 months.Results Obstructive symptoms haven't happened,the effective rate is 100%.Only 2 cases have intermittent abdominal pain without obstruction,the incidence was 11%.Conclu-sion Sodium hylauronic acid is effective to prevent the adhesion of postoperative intestines adhesion,simp-ler use,fewer side-effects and great value to appliance.

Objective To study the clinical features of thyroid carcinoma and to explore the approach of early diagnosis for the disease.Methods The data of patients with thyroid carcinoma confirmed by pathology during January of 1999 to January of 2005 in the First Hospital affiliated to Shanghai Jiao Tong University were retrospectively reviewed,including clinical appearance,thyroid ultrasonography and radioisotope scanning.Results One hundred and twenty-seven consecutive patients,30 males and 97 females,mean age(48.9?13.6)years,were diagnosed with thyroid carcinoma by surgery and pathology.A total of 127 cases of thyroid carcinoma were included,which were 105 papillary thyroid carcinomas,14 follicular thyroid carcinomas,2 undifferentiated thyroid carcinomas and 6 medullary thyroid carcinomas.Thyroid ultrasonography findings showed the majority(85.1%)thyroid nodules were low echo nodules and the proportions of solid and mixed nodules were 81.8%and 17.4%,respectively.The proportion of cold nodules was 88.9% by radioisotope scanning.Mean values of serum triiodothyronine,thyroxine and thyrotropin were all within the normal range.Conclusion In the present study the thyroid carcinomas are predominant in females and the incidence of papillary thyroid carcinomas is very high.The diagnosis of thyroid carcinoma can not just depend on findings of ultrasonography,radioisotope scanning and serum thyroid hormone.

Objective To summarize the clinical experience of laparoscopic repair of acute perforation for gastroduodenal ulcer. Methods From June 2003 to December 2007, 13 patients underwent laparoscopic repair of pedorated peptic ulcers. Results Five patients were suffered from pedorated duodenal bulbar ulcer, one patient was suffered from pyloric canal ulcer, and seven patients were suffered from perforated gashie antrum ulcer. The diameter of the perforation was 0. 3-0. 7cm, peritoneal fluid 600-1200ml, the operafive time was 80-180min, only one was shifted to open surgery diagnosed gastric cancer by pathology examination, another twelve laparoscopic operations were successful. Postoperative recovery was smooth, ten surgical incisions were class A healing and two were class B healing, the length of hospitalization were 7-10 days after surgery. With one year followed-up, all deers had healed well by Gastroscopy, we hadn't found reperforation, abdominal infection, ankylenteron, ileac passion ect. operative complications. Conclusions Laparoscopic repair of acute perforated gastroduodenal ulcer is as safe and effective as the open repair. We must do intraoperative rapid pathologic examination, if it was malignant disease we shifted to open surgery.

Kawasaki disease (KD) is an acute systemic vasculitis that primarily affects young children between 6 months and 4 years old. Coronary arteritis is an important clinical feature of KD because it is associated with aneurysms and thromboembolic events that can lead to severe complications, even sudden death. To date, the etiology and pathogenesis of Kawasaki disease has not been understood completely. In this paper, we will review the recent advances in epidemiology, etiology, pathogenesis and genetic susceptibility of Kawasa-ki disease.

Objective To investigate the clinical characteristics, diagnosis and treatment of placenta increta.Methods A retrospective analysis was carried out on 13 admitted cases of placenta increta from 1989～2006. Results Among the 13 cases analysed, 5 cases with a history of Caesarian section had a 0% success rate of treatment with conservative care (0/5), 100% less than that of cases with no history of Caesarian section (8/8), P＜0.05; the success rate of treatment of partial placenta increta with methotrexate with Jia Wei Sheng Hua Tang was 100%. Conclusion Caesarian section is a risk factor of placenta increta, and its prognosis is poor; however, Jia Wei Sheng Hua Tang has proven satisfactory as a supplementary treatment for placenta inereta.

Objective To explore the early diagnosis and risk factors for judging prognosis of acute respiratory distress syndrome (ARDS),and to provide references for clinical intervention.Methods Using the method for prospective cohort study,clinical data were collected from 64 ARDS and 66 high-risk ARDS patients in Department of Respiratory Diseases of Xinqiao Hospital from January 2013 to March 2016.They included patients' demographic data,Acute Physiology and Chronic Health Evaluation system Ⅱ (APACHE Ⅱ) score,oxygenation index,blood routine test,coagulation function and inflammatory markers (procalcitonin,C-reaction protein,tumor necrosis factor and interleukin-6) within 24h and the state of survival or death of the 24th day.Risk factors for predicting progression of the high-risk ARDS patients into ARDS patients and influencing the prognosis of the ARDS patients were analyzed by using logistic regression.Results Univariate logistic regression analysis found that the independent risk factors for progression of ARDS were APACHE Ⅱ score (OR=6.764,P=0.001),hypoproteinemia (OR=10.54,P=0.002),white blood cell count (OR=3.912,P=0.012),fibrinogen (OR=9.953,P=0.064),and D-dimer (OR=4.239,P=0.029).The mortality rate was 43.75％ (36/64) in ARDS group,and the oxygenation index (OR=6.573,P=0.014),platelet count (OR=9.376,P=0.003),hypoproteinemia (OR=10.738,P=0.056) were the independent risk factors of death in ARDS patients.Multivariate logistic regression showed that combination of multiple indicators for predicting ARDS improved the specificity,but reduce the sensitivity.APACHE Ⅱ and hypoproteinemia (sensitivity 62.50％,specificity 92.42％) and APACHE Ⅱ and D dimmer (sensitivity 62.07％,specificity 93.33％) had better specificity and sensitivity.The specificity and sensitivity of combining hypoproteinemia and platelet count to predict the risk of death in these patients were 77.78％ and 60.71％.Conclusions In high-risk ARDS patients,combining hypoproteinemia or APACHE Ⅱ score with D-dimer to judge the development of ARDS has good specificity but poor sensitivity.For ARDS patients,low oxygenation index,thrombocytopenia and hypoproteinemia indicate a poor prognosis.

Objective To evaluate the application of matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) technology in the identification of filamentous fungi,and analyze the susceptibility of filamentous fungi to commonly used antibiotics.Methods A total of 100 strains of filamentous fungi were collected and identified rapidly by MALDI-TOF MS.The obtained results were compared with those from microscopic examination.The susceptibility of filamentous fungi was detected by the Etest method.Results Among 100 strains of filamentous fungi identified by MALDI-TOF MS,61 reached to the species level(score≥2.000),36 to the genus level(score between 1.700 and 1.999),and 3 failed to be identified (score ＜ 1.700).There was inconsistent results for one strain of filamentous fungi between MALDI-TOF MS and microscopic examination.The MIC90 of amphotericin B against Epidermophytonfloccosum was 0.19 μg/mL,while that against Aspergillus flavus was above 32 μg/mL.The MIC90 of itraconazole against Trichophyton tonsurans,Microsporum canis and Epidermophytonfloccosum were all below 0.38 μg/mL,while that against Aspergillus niger was above 32 μg/mL.The MIC90 of fluconazol were above 256 μg/mL for most of strains.The MIC90 of voriconazole and caspofungin against Aspergillus fumigatus,Aspergillus flavus,Aspergillus niger,Trichophyton rubrum,Trichophyton tonsurans and Microsporum canis were ≤0.38 μg/mL and ≤ 1 μg/mL,respectively.Conclusion The MALDI-TOF MS technology may be used to identify the filamentous fungi isolated from clinical specimens quickly,accurately and high-throughput.Voriconazole and caspofungin have effective anti-filamentous fungi activity.

Objective To explore the value of minute ventilation recovery time (VERT) as a weaning predictor in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD).Methods A prospective study was performed from March 2008 to July 2012.Fifty-two COPD patients under mechanical ventilation for more than 48 hours in our RICU tolerated a spontaneous breathing trial (SBT) and were ready for planned extubation.After SBT,these patients were placed back on their pre-SBT ventilator settings for up to 25 minutes,during which VERT was obtained.VERT was defined as the time for minute ventilation to return to baseline measured before SBT.Respiratory rate,tidal volume,minute ventilation and respiratory rate/tidal volume ratio were also obtained before SBT and just after SBT.Arterial blood gas data were measured and recorded before weaning.According to the weaning outcome,the patients were classified as successful group (40 cases) or failed group (12 cases).VERT and other quantitative variables were compared using t test.A multiple logistic regression was performed to explore possible factors associated with the weaning outcome.The sensitivity and specificity of VERT for predictive capacity in weaning were assessed using ROC cure.Results VERT and respiratory rate after SBT were significantly different between two groups.Multiple logistic regression revealed that VERT was the only predictor associated with weaning outcome (b =0.282,P ＜0.001).The area under ROC curve for VERT was 0.957 (95％ CI:O.907-1.008).With a cut-off value of 10.5 minutes,the sensitivity and specificity of VERT for predicting weaning failure were 1.0 and 0.85,respectively.Conclusions VERT may be a new predictor for extubation and determination of mechanical ventilation weaning in patients with COPD.VERT is a variable to be easily measured thereby being conveniently used in clinical practice.

BACKGROUND:It has been proved that miR-34a plays an inhibitory role in the growth of lung cancer stem cels, but the underlying mechanism remains unclear.
OBJECTIVE:To explore the inhibitory effect of miR-34a on lung cancer stem celsand the underlying mechanism.
METHODS:The CD133+lung cancer stem cels were separated from lung cancer A549 cel lines using magnetic activated cel sorting method. And miR-34a-overexpressing CD133+lung cancer stem cels were established by liposome transfection technology. Besides,the targeted relationship between miR-34a and Notch1 was analyzed by the dual-luciferase reporter. Afterwards, Notch1 silencing was performed by gene knockout, and its effect on lung cancer stem cels was determined.
RESULTS AND CONCLUSION:After sorted and detected by immunomagetic selection and flow cytometry assay respectively, a high rate of CD133+lung cancer stem cel was obtained. And qRT-PCR detected that the expression level of miR-34a in CD133+lung cancer stem cels was significantly lower than that in CD133-lung cancer stem cels. Moreover, miR-34a-overexpressing CD133+lung cancer stem cels were successfuly constructedandmiR-34a significantly inhibited proliferation and induced apoptosis of lung cancer stemcels. Dual-luciferase reporter assay indicated that Notch1 mRNA was a target of miR-34a. In addition, Notch1 silencing obviously inhibited proliferation and induced apoptosis of lung cancer stem cels. These findings suggest that miR-34a can inhibite lungcancer stem celsviathe Notch1 signaling pathway.