Objective: To investigate the clinical value of plasma brain natriuretic peptide (BNP) levels in predicting the severity of hand, foot and mouth disease (HFMD) in children with coxsackie virus A6 (CV-A6) infection. Methods: A total of 305 children with CV-A6 type HFMD admitted to Xi′an Children′s Hospital from January 2017 to December 2018 were divided into general group (200 cases) and severe group (105 cases) according to the severity of the disease.The receiver operating characteristic curve was used to calculate the value of plasma BNP levels to predict the severe CV-A6 HFMD.Multivariate logistic regression analysis was used to analyze the correlation between the related factors and the severity of CV-A6 HFMD. Results: Compared with the normal group, children in the severe group had statistically significant differences in WBC level, BNP level, neurological symptoms, circulatory disorders, and blood glucose levels(all P<0.05). The optimal cut-off value of the receiver operating characteristic curve for BNP level to predict severe HFMD was 294.85 ng/L.Multivariate logistic regression analysis found that WBC>15×10⁹/L, blood glucose> 8.3 mmol/L, and BNP>294.85 ng/L were related to the severity of CV-A6 HFMD(OR=2.275, P=0.013; OR=6.057, P=0.028; OR=1.008, P<0.001). Conclusion BNP>294.85 ng/L is closely related to the severity of CV-A6 HFMD and has predictive value.It is an early warning factor for the severity of CV-A6 HFMD.

Accurate preoperative staging of gastric cancer is of great significance for choosing an optimal therapeutic schedule and for evaluating the prognosis. Accurate preoperative preparation can avoid unnecessary treatment and help with selecting optimal treat-ment modalities. In recent years, the preoperative staging of gastric cancer has been greatly improved owing to the use of diagnostic methods such as endoscopic ultrasonography, multi-slice spiral computed tomography, positron emission computed tomography, and staging laparoscopy, among other such modalities. However, all diagnostic methods are associated with advantages and limitations. Thus, a combination of various diagnostic modalities is essential for accurate preoperative staging. This paper reviews the research progress in the aforementioned diagnostic methods for preoperative staging.

Objective To evaluate Aptima HPV E6 and E7 mRNA assay (Aptima HPV) combined with Aptima HPV 16 and 18 or 45 (18/45) genotype assay (Aptima HPV-GT) as a means of cervical cancer opportunistic screening. Methods From October 2016 to October 2017, a total of 23 258 women aged 25-65 years were enrolled in the physical examination center and gynecological clinic of Huzhou Maternity and Child Health Care Hospital. All the women had Aptima HPV tested, further Aptima HPV-GT testing for positive women and liquid-based thin layer cytology Thinprep cytologic test (TCT). Women with Aptima HPV (+) or ≥low-grade squamous intraepithelial lesion (LSIL) or obvious clinical symptoms (including vaginal bleeding after intercourse and watery, bloody vaginal discharge) were referred for colposcopy and further biopsy with or without endocervical curettage (ECC) if indicated. Expression of Aptima HPV, HPV 16 and HPV 18/45 with different cytological diagnostic groups and histological diagnosis groups were compared respectively. Sensitivity, specificity, positive predictive value and negative predictive value of Aptima HPV detection and TCT in identifying histological diagnosis of high-grade squamous intraepithelial lesion (HSIL) or worse (HSIL+) were compared. Results (1) The positive rates of Aptima HPV, HPV 16 and HPV 18/45 were 14.00% (3 257/23 258), 1.85% (430/23 258) and 0.86% (199/23 258) respectively.The positive rates of Aptima HPV, HPV 16 and HPV 18/45 increased with cytology grading in squamous epithelium [negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASCUS), LSIL, atypical squamous cell cannot exclude HSIL (ASC-H), HSIL and squamous cell carcinoma (SCC), all P=0.000)]. According to histology results, the positive rates of Aptima HPV, HPV 16 and HPV 18/45 increased with histology grading in squamous epithelium (normal cervical tissue, LSIL, HSIL and SCC, all P=0.000). The positive rate of Aptima HPV was significantly higher in HSIL+group than that in the LSIL or better (LSIL-) group [98.11% (311/317) vs 12.84% (2 946/22 941), P=0.000]. The positive rate of Aptima HPV-GT was significantly higher in HSIL+group than that in LSIL-group [58.36% (185/317) vs 1.91% (439/22 941), P=0.000]. (2) Compared with cytology, Aptima HPV resulted in significant higher sensitivity (98.11% vs 59.62%, P=0.000) and negative predictive value (99.97% vs 99.42%, P=0.000), significant lower specificity (87.16% vs 95.37%, P=0.000) and positive predictive value (9.55% vs 15.10%, P=0.000) when identified HSIL+. Conclusions Women with Aptima HPV positive, especially those with Aptima HPV-GT positive, are more likely to have histological diagnosis of HSIL+. Aptima HPV combined with Aptima HPV-GT is feasible as a means of cervical cancer opportunistic screening in tertiary hospitals.

Objective: To understand the etiological and clinical characteristics of children with severe hand, foot and mouth disease (HFMD) in Xi′an in 2018, and to provide the evidence for clinical diagnosis and treatment. Methods: The children with severe HFMD admitted at Xi′an Children′s Hospital from January to December 2018 were selected as the research objects.Clinical data were collected, and the anal swab were detected by adopting real time(RT)-polymerase chain reaction(PCR). Results: Ninety-five cases of HFMD were treated in Xi′an Children′s Hospital in 2018, of which 92 cases were severe and 3 cases were critical.Eighty-seven cases were positive for enterovirus nucleic acid, 30 cases were enterovirus 71(EV71)(31.6%), 39 cases were coxsackievirus A6(CA6) (41.0%), 3 cases were CA16(3.2%), 2 cases were CA10(2.1%) and 13 cases were other enteroviruses (13.7%). Among 95 patients, the ratio of male to female was 1.1∶1.0; the peak period of incidence of HFMD was from May to July, and the main age of onset of severe HFMD was under 3 years old.The main clinical manifestations were mental retardation, vomiting, irritability, lethargy and convulsion.Severe cases of CA6 are prone to convulsion.The main form of rash in CA6 cases was bullous rash, and demethylation may occur in recovery period.The rash in EV71 cases was small, thick, hard and few.After active treatment, only one child with EV71 infection died because of severe cerebral dysfunction, frequent convulsions and neurogenic pulmonary edema.The other child was discharged with hemiplegia and language dysfunction.The other severe children were cured and discharged from hospital. Conclusions In 2018, CA6 was the main pathogen of severe HFMD in Xi′an, with bullae was the main manifestation of skin rash, and nail removal could occur during convalescence.Critical and death cases were still caused by EV71.

Objective To detect the plasma calcitonin gene-related peptide ( CGRP ) in children with enterovirus 71(EV71) infected hand foot and mouth disease(HFMD),and explore the relationship be-tween CGRP and the severity of EV71 infected HFMD. Methods Two hundred children with EV71 infected HFMD in Xi'an Children's Hospital from January 2017 to December 2017 were selected as the research group,and 50 healthy children were selected as control group in the same period. According to the severity of the disease,the research group was divided into the mild group (n=142) and the severe group (n=58). The level of plasma CGRP was detected by ELISA. Results In acute stage,the level of CGRP in children with EV71 infected HFMD was lower than that in control group, and the difference was statistically significant (t=4. 235,P<0. 001). The level of CGRP in acute stage in severe group[(29. 90 ± 5. 10)pg/ml] was sig-nificantly lower than that of the mild group[(35. 51 ± 5. 48)pg/ml],and the difference was statistically sig-nificant (t=6. 615,P=0. 001). The level of CGRP in mild group[(35. 51 ± 5. 48)pg/ml] was slightly low-er than that of the control group[(36. 63 ± 5. 65)pg/ml],but the difference was insignificant (t=1. 120, P=0. 086). In recovery stage,the level of CGRP in the severe group was obviously higher than that in the acute stage(t=5. 924,P=0. 003). According to the ROC curve of CGRP in mild and severe EV71 infected HFMD,the critical value of CGRP in mild and severe HFMD was 28. 12 pg/ml, and the sensitivity was 80. 0％ and the specificity was 50. 0％. Conclusion The CGRP is associated with the progression of EV71 HFMD,and when CGRP is lower than 28. 12 pg/ml,suggesting the possibility of severe HFMD. The decrease of plasma CGRP may be a risk factor for the progression of EV71 infected HFMD.

Objective To investigate the construction and application in practice of information process management system in the treatment of acute ischemic stroke (AIS).Methods From August 2017 to November 2017,the clinical data of the 597 patients with suspected stroke received green channel treatment for stroke and incorporated into the information process management system at the Cerebrovascular Disease Center,Changhai Hospital,the Second Military Mcdical University were analyzed retrospectively.The operation status and operational efficiency of each link in the AIS treatment process were evaluated.The performance assessment indicators for stroke nurses and visiting doctors were developed.The accuracy and missed diagnosis of stroke determined by the stroke nurses were calculated.The operation ability of stroke nurses was evaluated by the doctor's arrival at triage desk to establishment of intravenous access time and signing of informed consent to rt-PA bolus time,with less than 10 min as the standard.The emergency response capability of consultation physicians was evaluated by calling consultation physician to arriving at the triage desk and establishing venous channel to transport to the CT room time,with less than 5 min as the standard.The standard-reaching rate was calculated.Results A total of 597 patients were prechecked as suspected stroke.Among them,549 patients with stroke were judged by doctors,430 established venous access,443 were transported to CT room,441 completed CT scan,and 52 were treated with venous thrombolysis.In the process,the median time of patients to hospital to doctor to triage desk,doctor to triage desk to establishment of venous channel,establishment of venous channel to transportion to CT room to completion of CT scan,completion of CT scan to rt-PA bolus,patients to hospital to completion of CT scan and patients to hospital to rt-PA bolus was 3 (1,5),8 (3,16),3 (2,5),3 (2,9),9 (3,22),20(10,30) and 27 (19,55) min,respectively.The stroke nurses determined the accuracy and misdiagnosis rate of stroke were 92.0％ (549/597) and 8.4％ (50/597) respectively.The standard-reaching rate of doctor to triage desk to establishment of venous channel,signing informed consent to rt-PA bolus time were 82.1％ (353/430) and 80.8％ (42/52) respectively.The standard-reaching rates of calling consultation doctor to doctor to triage desk,establishment of venous channel to transportion to CT room time were 94.5％ (564/597) and 91.4％ (405/443) respectively.Conclusion A process management system centered on "time management" may help analyze the efficiency of various links and personnel in the AIS treatment process,and optimize the process continuously.

Objective To analyze the clinical characteristics in children with pertussis,and to provide a scientific basis for treatment of pertussis.Methods Retrospective analysis of general data,symptoms,signs,auxiliary examinations,treatment and prognosis was performed on the patients with pediatric pertussis in Xi'an from January 2015 to December 2016;the epidemiological data were analyzed by using descriptive approach.Results In a total of 857 patients with pertussis,there were 469 males and 388 females (the gender ratio of 1.21 ∶ 1.00),183 cases (21.3％) from the urban areas and 674 cases (78.7％) from the rural areas.The cases were reported throughout the year,indicating 2 peak times of onset:355 cases (41.5％) from July to September and 218 cases (25.4％) from February to April.And 473 cases (55.2％) were younger than 6 months;479 cases (55.9％) were inoculated with diphtheria,tetanus and pertussis combined vaccine(DTP) vaccine;492 cases (57.4％) were exposed to their family members who coughed at that time.Cough was the main symptom,and the median duration of pertussis from onset to diagnosis was 20 days.Concomitant symptoms included spasmodic cough was relieved in 836 cases (97.5 ％),facial suffusion in 806 cases (94.0％),peri-oral cyanosis in 308 cases (35.9％),asthma in 269 cases (31.4％),crow-like echo in 248 cases (28.9％),and apnea in 46 cases (5.4％);pulmonary moist rale was found by check-up in 761 cases (88.8％),and fever was observed in 159 cases (18.5％).The increased proportion of the peripheral blood lymphocytes was found in 702 cases (81.9％),the increased total count of leukocytes in 505 cases (58.9％),the increased procalcitonin(PCT) in 36 cases (4.2％) and the elevated level of high sensitivity C reactive protein(hsCRP) in 17 cases (2.0％);pneumonia was suggested by chest radiography in 673 cases (78.5％);in the blood-gas analysis,hypoxemia was suggested in 50 cases (5.8％) and respiratory failure in 9 cases (1.1％).In the 857 patients with pertussis,59 cases (6.9％) were with severe-type pertussis.At 1 week of the treatment,no spasmodic cough was reported in 515 cases (60.1％) and obviously relieved spasmodic cough in 198 cases (23.1％),and no deaths occurred.Conclusions The cases of pertussis occur throughout the year in Xi'an,predominately from July to September and February to April.A higher incidence is reported in the rural areas,compared with the urban areas,particularly in those younger than 6 months with incomplete DTP vaccination,who usually have severe conditions.In many cases,those with pediatric pertussis are infected by family members;most of them have spasmodic cough with good prognosis,without typical clinical signs.

Objective To investigate the influence of straightening phenomenon caused by stent implantation on biomechanical environment changes in vascular lesions, so as to explore biomechanical mechanism of restenosis and stent optimization. Methods Based on the computed tomography (CT) images of a patient, the balloon model, the left anterior descending coronary(LAD) artery model and two stent models (idealized stent and straightened stent) were reconstructed by Mimics, Geomagic and Pro/E software. The balloon-stent-LAD artery mechanical models were then established with the ABAQUS software. Based on the numerical simulation results, the influence of straightening phenomenon on mechanical environment at vascular lesions was analyzed. Results When the stents were expanded under the same inflation pressures (1.013 MPa), the Von Mises stress increased on vascular wall of the straightened stent model compared with the idealized stent model, and stress concentration occurred especially at the proximal and distal area of the stented regions and on the myocardial surface. The average and the maximum Von Mises stress on vascular wall of the idealized stent model were 0.39 MPa and 5.12 MPa, respectively. The average and the maximum Von Mises stress on vascular wall of the straightened stent model were 0.45 MPa and 7.43 MPa, respectively. Conclusions The straightening phenomenon caused by stent implantation would change the distribution of Von Mises stress and induce stress concentration. This kind of mechanical environment would cause greater damage to vascular wall, then might cause mechanical injury and vascular remodeling, leading to a higher risk of neointimal hyperplasia and subsequent restenosis. The research findings will be helpful for explaining the mechanism of in-stent restenosis, and may provide clinical guidance for the interventional surgery and optimization of stent design.

Objective:To build a social aging scale for healthy people,and get the accuracy and feasibility of the scale to judge the aging of healthy people on the basis of the empirical research.Methods:Stratified random sampling was conducted according to the nine different age groups,and the age-related social function information was collected for healthy people by using the scale,which was made in our own plant;the distribution of the score,the correlations between the score and age or telomere length were analyzed by statistical software.Results:A total of 2 297 subjects were collected for the analysis.The ratio of male to female was 0.8:1.Social function of aging score was in the range of 3.00-12.90;aging score of personal ability was in the range of 1.00-4.45;aging score of social participation was in the range of 1.00-4.52;and aging score of organizational communication was in the range of 1.00-5.00.The correlation coefficient of aging scores with age was 0.696 (P＜0.001).The result of telomere length showed that the relative telomere length was 1.056±0.261.The telomere length in different groups were significantly different (F=35.803,P＜0.001).The telomere length was negatively correlated with aging (r=-0.964,P＜0.001) and social function of aging (r=-0.857,P＜0.001),respectively.Conclusion:The scores of age-related social function,personal ability,social participation,and organizational communication are increased with age.The telomere length is negatively correlated to aging score.The scale is applicable to measure social function of aging,which can provide reference for evaluation of the comprehensive of aging.

Objective:To explore the possibility of using peritoneal alternatively activated M2 macrophages to prevent rejection after islet allotransplantation in a murine model.Methods:Peritoneal monocytes from C57BL/6 mice were induced and modulated to M2 and M0 macrophages in vitro,then the phenotype of macrophage was assessed by flow cytometry.C57BL/6 mice were induced diabetic by streptozotocin (STZ) injection and transplanted with islets isolated from BALB/c mice under the left kidney capsule.The recipients were randomly divided to 3 groups (n=8).A total of 2.5× 106 M2 macrophages were injected intravenously at 0,3,7 d after transplantation in islet+M2 group;2.5×106 M0 macrophages were injected intravenously at 0,3,7 d after transplantation in islet+M0 group;the mice in islet+PBS group were injected with PBS.Blood glucose was monitored after transplantation.On day 10 after transplantation,2 recipients in each group were randomly selected and sacrificed,and the left kidneys were resected for pathological examination.Results:Achievement of euglycemia was significantly prolonged after islet transplantation in the islet+M2 group than that in the other two groups (P＜0.01).The median survival time of islet allografts in the islet+PBS group,the islet+M0 group,and the islet+M2 group were 6.5 (4-10),7.5 (4-10),and 24(＞ 15) d,respectively.Pathological examination also showed that the grafts in islet+M2 group remained an intact structure with positive insulin stain and no apparent lymphocytes infiltration,while the graft was rejected in other 2 groups with negative insulin stain and massive lymphocytes infiltration.Conclusion:Peritoneal alternatively activated M2 macrophages can prevent rejection after islet allotransplantation,prolong the survival time of islet allografts and enhance the tolerance of the recipient to blood glucose in mice.