ObjectiveTo assess the clinical value of procalcitonin (PCT) in the diagnosis of sepsis in adults.Methods An extensive search for related literature from the Wanfang data, CNKI, VIP, Medline/PubMed, Embase/OvidSP and the Cochrane Library up to December 2014 was performed. The articles, including prospective observational studies or randomized controlled trials, regarding PCT for the diagnosing of sepsis were enrolled. Only patients older than 18 years were included. Patients with sepsis, severe sepsis, or septic shock served as the experimental group, and those with a systemic inflammatory response syndrome (SIRS) of non-infectious origin as control group. The language of literature included was English or Chinese. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Heterogeneity, pooled diagnostic odds ratio (DOR), pooled sensitivity, pooled specificity, pooled positive likelihood ratio, pooled negative likelihood ratio, the area under the summary receiver operating characteristic curve (SROC) and subgroup analysis were analyzed with the software of Metadisc 1.4.Results A total of 6 385 published reports were collected, and among them 24 met the inclusion criteria, including a total of 3 107 patients. The studies showed substantial heterogeneity (I2 = 69.4%), and random effect model was used for Meta analysis, showing that the pooledDOR was 10.37 [95% confidence interval (95%CI) = 7.10-15.17]. No evidence of a threshold effect was found (Spearman correlation coefficient = 0.27, calculated by logarithm of sensitivity and logarithm of 1-specificity,P = 0.20). TheDOR values of pooled and each study were not distributed along the same line in forest plots, and Cochran-Q = 78.33,P = 0.000 0, showing that there was heterogeneity in result from non threshold effect. Except for partial heterogeneity caused by non threshold effect, the result of Meta regression analysis including PCT detection method, categories of disease, research location and so on showedP values were all higher than 0.05. Thus, the heterogeneity could not be explained by Meta regression analysis. The pooled sensitivity was 74% (95%CI = 72%-76%), the pooled specificity was 70% (95%CI = 67%-72%), the pooled positive likelihood ratio was 2.79 (95%CI = 2.31-3.38), the pooled negative likelihood ratio was 0.34 (95%CI = 0.28-0.41), and the pooled AUC was 0.83 (95%CI = 0.79-0.87). AUC in medical patients was 0.80 (95%CI = 0.75-0.85), which was higher than that in surgical patients [0.71 (95%CI = 0.65-0.81)].Conclusions Our results indicate a moderate degree of value of PCT for diagnosis of sepsis in adult patients. The diagnostic accuracy in medical patients is higher than that in surgical patients. PCT is a good auxiliary biomarker for diagnosis of sepsis.

Objective To compare inter-hospital transport and clinical outcome in severe acute respiratory distress syndrome(ARDS)patients whom were transported either on extracorporeal membrane oxygenation(ECMO) or on conventional ventilation,and to investigate the optimal means of inter-hospital transport. Methods Eleven patients with severe ARDS who were invalid under conventional ventilation and were transported from other hospitals to Tianjin Third Central Hospital from November 2009 to January 2014 were analyzed. Five patients were transported on ECMO(observation group)and 6 on conventional ventilation(control group). The clinical characteristics,outcomes, transportation,vital signs before and after transportation,respiratory parameters,and Murray score between two groups were compared. Results Patients in observation group were significantly older than those in control group〔years:73(46,77)vs. 34(23,46),Z=-2.293,P=0.022〕. There was no significant difference between observation group and control group in acute pathologic and chronic health evaluationⅡ(APACHEⅡ)score,Murray score,oxygenation index(PaO2/FiO2)before transportation,transit time,and transit distance〔APACHEⅡscore:36(33,39)vs. 27(23,35),Z=-1.830,P=0.067;Murray score:3.5±0.3 vs. 3.4±0.2,t=0.667,P=0.524;PaO2/FiO2(mmHg, 1 mmHg=0.133 kPa):61±14 vs. 63±14,t=-0.249,P=0.809;transit time(minutes):24(18,74)vs. 79(41, 86),Z=-1.654,P=0.098;transit distance(km):12.9(8.3,71.8)vs. 72.4(39.5,86.8),Z=-1.651,P=0.099〕. There was no significant difference between two groups in vital signs and respiratory parameters before transportation. When arrived in ECMO centre,heart rate,respiratory rate,fractional inspired oxygen,inspiratory pressure and Murray score in observation group were significantly lower than those in control group〔heart rate(beat/min):102±16 vs. 136±8, t=-4.374, P=0.002;respiratory rate(beat/min):23±3 vs. 37±2,t=-7.967,P=0.000;fractional inspired oxygen:0.40±0.05 vs. 0.96±0.09,t=-12.152,P=0.000;inspiratory pressure(cmH2O, 1 cmH2O=0.098 kPa):21±1 vs. 34±4,t=-6.887,P=0.000;Murray score:2.7±0.2 vs. 3.8±0.2,t=-8.573, P=0.000〕,but PaO2/FiO2 was higher than that of control group(mmHg:278±65 vs. 41±5 ,t=8.075,P=0.001). Four patients were survived in observation group,and one died from the shortage of oxygen induced lung injury deterioration during transportation. Three patients died in control group,which was directly associated with lung injury deterioration. Conclusion For patients with severe ARDS who need the support of ECMO,ECMO-assisted transfer is safer than conventional ventilation,but transfer should be implemented by experienced team.

ObjectiveTo introduce the new method of full reconstruction for Ⅰ to Ⅲ-degree finger defect.MethodsFor reconstruction of Ⅰ to Ⅱ-degree finger defect, the surgery procedure was as follows:Harvest part of nail,skin and dorsal part of distal phalanx from hallux to form a composite flap,and then the flap was transplanted to the finger stump to reconstruct the defect part of the finger.The design of the composite flap was according to the recipient part. For reconstruction of Ⅲ-degree finger defect, the skin included in the flap could be designed according to the recipient part, but the bone can only be harvested from the fibulodoral part of the hallux and far from the insertion of the extensor hallucis longus tendon, which means the length was limited.If the bone length was not enough,one bone mass with appropriate size and shape was harvested from the iliac bone and connected with the bone of the composite flap. Some cases of Ⅲ-degree finger defect were reconstructed by harvesting interphalangeal joints from the second toes to reconstruct distal interphalangeal joints(DIP). The bone defect was reconstituted by bone mass from the iliac bone to conserve the contour of the second toe.The hallux wound was covered by a local flap or free flap transplantation.ResultsOne hundred and eighteen cases (126 fingers) of Ⅰ-degree defect, one hundred and eighty-seven cases (201 fingers) of Ⅱ-degree defect and 90 cases (111 fingers) of Ⅲ-degree finger defect were applied full reconstruction. All the reconstructed fingers survived completely and the configurations were similar to real fingers. Followed up our work on 150 fingers from a number of patients, between 1 and 11 years after the original surgery.Total ranges of motion of the reconstructed fingers got to over 180°.The reconstructed DIP joints had the range of motion of 15°-40°. The donor halluxes and toes were conserved with the normal length,relatively primary appearance and full function. ConclusionFull reconstruction for Ⅰ to Ⅲ-degree finger defect has great advantages in that the reconstructed finger has very realistic configuration as well as ideal function and the donor hallux is conserve well.

ObjectiveTo explore methods of donor repair of the great toe-nail flap in finger reconstruction surgery.MethodsFrom December 1998 to December 2010, various kinds of flaps were used in 511 donor sites to repair the great toe-nail flaps,including:32 dorsal pedal artery flaps;twenty-four first dorsal metatarsal artery flaps;twenty-one second dorsal metatarsal artery flaps;forteen anterior malleolar flaps;seventeen medial tarsal artery flaps;seventy-nine lateral tarsal artery flaps;one hundred and six plantar metatarsal flaps,seventy-nine flaps from second toe;fifteen flaps from mid/lower leg and 124 freed flaps.ResultsAfter postoperative 6 months to 11 years of follow-up, repaired donor sites of great toe-flaps all survived successfully,with ideal outlook and function.ConclusionThere are many kinds of methods for donor site repair of the great toe-nail flap,and each kind of method has its own advantages and disadvantages. Among these flaps, plantar pedal artery flap and free groin flap are amony the best ones.

Objective To evaluate the diagnostic value of contrast-enhanced ultrasound in acute kidney injury (AKI) caused by sepsis. Methods The sepsis patients admitted to intensive care unit of Tianjin Third Central Hospital from January 2015 to June 2017 were enrolled. All of the patients were completed the 6-hour Bundle treatment and the bilateral renal contrast-enhanced ultrasound within 24 hours, and the peak signal intensity (PSI), peak intensity time (PIT), wash internal rate (WIR) and renal function parameters were measured at the same time. The patients were divided into AKI 24 hours group and non-AKI 24 hours group according to Kidney Disease: Improving Global Outcomes (KDIGO)-AKI diagnostic criteria, and the parameters differences were compared between the two groups. The receiver operating characteristic (ROC) curve were used to analyze the diagnostic value of the parameters. Renal function of the non-AKI group patients was measured again 7 days after hospital admission, and patients were divided into AKI 7 days group and non-AKI 7 days group, and the related parameters of the two groups measured within 24 hours were compared. Results ① Ninety-six patients were enrolled, with 39 cases of AKI occurred within 24 hours after admission, and with an incidence of 40.6%. Contrast-enhanced ultrasound showed that the time-intensity curve (TIC) of non-AKI patients manifested as a slow down after rapid rise to the peak, but the AKI patients showed as slow rise to the peak and more slow decrease. Compared with non-AKI 24 hours group, AKI 24 hours group performance as PSI weakened, PIT extended and WIR decreased [PSI (dB): 114.41±19.38 vs. 141.24±24.65, PIT (s): 22.86±4.29 vs. 17.39±3.68, WIR (dB/s): 5.53±4.17 vs. 7.85±1.84, all 1 < 0.01]. ROC curve analysis showed that area under the ROC curve (AUC) of WIR, PIT, PSI was 0.85, 0.84, 0.82 respectively (all 1 < 0.01), the cut-off value of WIR was 7.18 dB/S, the sensitivity, specificity and accuracy were 82.05%, 80.70% and 81.25% respectively; the cut-off value of PIT was 18.45 s, the sensitivity, specificity and accuracy were 74.35%, 73.68% and 73.95% respectively;the cut-off values of PSI was 121.21 dB, the sensitivity, specificity and accuracy were 71.79%, 87.72% and 81.25% respectively. ② The incidence of AKI within 7 days in non-AKI patients was 26.3% (15/57). There were significant differences in PIT, WIR and PSI between AKI 7 days group and non-AKI 7 days group [PSI (dB): 124.97±26.64 vs. 147.02±21.51, PIT (s): 20.61±3.27 vs. 16.24±3.13, WIR (dB/s): 6.81±1.76 vs. 8.22±1.75, all 1 < 0.05]. However, there was no significant difference in serum creatinine (SCr), blood urea nitrogen (BUN) and creatinine clearance rate (CCr). Conclusion Compared to SCr and BUN, contrast-enhanced ultrasound parameters can early response to renal dysfunction, and contribute to early diagnosis of sepsis induced AKI.

Objective:To investigate the relationship between serum albumin(SA)levels and left atrial thrombosis(LAT)in elderly patients with nonvalvular atrial fibrillation(NVAF), and to evaluate the clinical value of SA in predicting LAT in elderly NVAF patients.Methods:Clinical data of 180 elderly patients with NVAF undergone transesophageal echocardiography(TEE)in our hospital were retrospectively analyzed.According to whether there was thrombosis in the left atrium, patients were divided into the thrombus group(n=42)and the non-thrombus group(n=138). Logistic regression was used to analyze factors related to left atrial appendage thrombosis in NVAF patients.The receiver operating characteristic(ROC)curve was used to evaluate the value of serum albumin levels in predicting LAT formation in elderly NVAF patients.Results:The duration of AF was longer in the thrombus group than in the non-thrombus group(all P<0.05). C-reactive protein(CRP)levels and platelet(PLT)counts were higher, and SA levels and the international normalization ratio(INR)were lower in the thrombus group than in the non-thrombus group(all P<0.05). The left atrial diameter(LAD)was larger in the thrombus group than in the non-thrombus group( P<0.05). Multiple Logistic regression analysis showed that the duration of AF and CRP levels were independent risk factors for LAT( P<0.05), and SA levels and INR were independent protective factors for LAT( P<0.05). ROC curve results showed that the area under the curve(AUC)of SA in predicting LAT was 0.778(95% CI: 0.711-0.837, P<0.001). Conclusions:Low serum albumin levels are closely related to LAT in NVAF patients and can be regarded as a predictor of LAT.Serum albumin levels should be monitored in clinical practice to reduce the incidence of stroke events in patients with AF.

In this paper, the domestic and international demand and development trend of clinical diagnostic radionuclides are analyzed, and the medium and high-energy cyclotrons, adequate and systematic facilities, and preparation techniques required for the production of medical radionuclides based on solid targets are introduced. This paper focuses on the research and development carried out by some important medical institutions and scientific research institutes in China over the years in the aspects of medium and high-energy cyclotrons, beam transmission lines, high-power irradiation target stations and new medical isotope production processes etc. It also looks forward to some new directions for the development of medical radionuclides in China during the 14th Five-Year Plan period.

Objective To investigate the effect of different appropriate modes of weaning from mechanical ventilation (MV) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods Patients with AECOPD and mechanically ventilated by orotracheal intubation, suitable for continuous positive airway pressure+proportional pressure support (CPAP+PPS) and CPAP+assisted spontaneous breath (ASB) ventilation mode for weaning from MV, admitted to intensive care unit (ICU) of Tianjin Third Central Hospital form January 1st, 2016 to December 31st, 2017 were enrolled. When the patients recovered to spontaneous respiration and down regulation of ventilator support frequency to 10 bpm, they were taken ventilator weaning in CPAP+PPS and CPAP+ASB mode according to the random number table method, respectively. Basic characteristics, ventilator parameters, the incidence of high man-machine confrontation (man-machine confrontation index > 10%) and clinical outcomes (ventilator weaning time, which was defined as the time from randomization to successful weaning from MV, ventilator weaning failure times, the duration of MV, the length of ICU stay and the length of hospital stay) were compared between the two groups. Results Eighty-seven AECOPD patients were selected, 44 in CPAP+ASB group and 43 in CPAP+PPS group. There was no significant difference in gender, age, acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), sequential organ failure score (SOFA), Glasgow coma score (GCS), Charsen index and the highest arterial blood carbon dioxide partial pressure (PaCO2), the lowest arterial oxygen partial pressure (PaO2) and tidal volume (VT) at the time of onset between the two groups. Compared with CPAP+ASB group, incidence of high man-machine confrontation was significantly decreased in CPAP+PPS group [9.30% (4/43) vs. 27.27% (12/44), P =0.027], and the airway occlusion pressure (P0.1) was significantly decreased [cmH2O (1 cmH2O = 0.098 kPa): 2.21±0.83 vs. 2.63±0.94, P = 0.032], and the failure rate of the first spontaneous breathing trial (SBT) was significantly decreased [6.98% (3/43) vs. 22.73% (10/44), P = 0.039], ventilator weaning time, the length of ICU stay and the length of hospital stay were significantly shortened [ventilator weaning time (hours): 12.73±14.23 vs. 50.64±38.11, the length of ICU stay (hours): 254.53±108.06 vs. 344.93±124.95, the length of hospital stay (days): 18.53±7.59 vs. 26.64±11.22, all P < 0.05]. However, there was no significant difference in PaCO2, duration of MV, ICU mortality and hospital mortality between the two groups. Conclusion Compared with CPAP+ASB ventilation mode, CPAP+PPS ventilation mode can reduce respiratory muscle load, promote respiratory function recovery, and reduce the occurrence of man-machine confrontation, which is beneficial to AECOPD patients taking ventilator weaning, and can significantly shorten the ventilator weaning time of patients and further shorten the hospitalization time.

Chuangxinmycin is an antibiotic isolated from CPCC 200056 in the 1970s with a novel indole-dihydrothiopyran heterocyclic skeleton. Chuangxinmycin showed antibacterial activity and efficacy in mouse infection models as well as preliminary clinical trials. But the biosynthetic pathway of chuangxinmycin has been obscure since its discovery. Herein, we report the identification of a stretch of DNA from the genome of CPCC 200056 that encodes genes for biosynthesis of chuangxinmycin by bioinformatics analysis. The designated cluster was then confirmed to be responsible for chuangxinmycin biosynthesis by direct cloning and heterologous expressing in M1146. The cytochrome P450 CxnD was verified to be involved in the dihydrothiopyran ring closure reaction by the identification of seco-chuangxinmycin in M1146 harboring the gene cluster with an inactivated . Based on these results, a plausible biosynthetic pathway for chuangxinmycin biosynthesis was proposed, by hijacking the primary sulfur transfer system for sulfur incorporation. The identification of the biosynthetic gene cluster of chuangxinmycin paves the way for elucidating the detail biochemical machinery for chuangxinmycin biosynthesis, and provides the basis for the generation of novel chuangxinmycin derivatives by means of combinatorial biosynthesis and synthetic biology.