Objective:To investigate the predictive value of serum albumin (Alb) levels in the early postoperative period (within 1 hour) for urosepsis after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods:The clinical data of 160 patients treated by single channel holmium laser mPCNL in urolithiasis treatment center of the second hospital of Tianjin Medical University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into the sepsis group and the non-sepsis group according to whether the patients developed urosepsis after the operation. There were 110 cases of male, and 50 cases of female, with average age of(51.8±11.9), including 68 cases with hypertension, 26 cases with diabetes, 12 patients with history of preoperative fever, 16 cases with history of endoscopic lithotomy surgery, 6 patients with preoperative catheter, 24 patients with positive preoperative urine culture, 12 patients with positive preoperative nitrite volume, 32 cases with preoperative routine urine leucocyte(+ + + ). The operative time and infusion volume were recorded during the operation. Blood samples were collected from all patients within 1 hour after surgery to detect blood routine and serum albumin (Alb), and the change of haemorrhagic white blood cells and serum albumin were calculated. Univariate and multivariate analyses were used to statistically analyze the relevant clinical parameters to identify the independent risk factors for urosepsis after mPCNL surgery. The ROC curve was established and the area under the comparison curve was calculated to analyze the predictive value of independent risk factors for postoperative urosepsis.Results:There were 13 patients (8.1%) in the sepsis group, including 7 males and 6 females, with an average age of (53.1±8.2) years. There were 147 patients (91.9%) in the non-sepsis group, including 103 males and 44 females, with an average age of (51.7±12.1)years. Single factor analysis showed the infectious stones (38.5% and 8.8%), surgery duration [(94.6±26.2)min and(63.6±24.5)min], a positive urine culture (46.2% and 12.2%), positive urinary nitrite (30.8% and 5.4%), strong positive urinary leukocyte (61.5% and 11.3%), postoperative albumin levels [(34.2±2.7)g/L and(40.7±6.2)g/L]and changes of serum albumin levels within one hour after surgery [(18.3±4.6)% and(3.8±14.3)%] between the sepsis group and the non-sepsis group had significant differences ( P<0.05). Multiariable logistic regression analysis showed the strong positive urine leucocyte ( OR=57.704, 95% CI 2.407-1383.427, P=0.012), postoperative blood leucocyte level within one hour after surgery ( OR=2.406, 95% CI 1.154-3.627, P=0.014) and the change of serum albumin levels after surgery ( OR=1.373, 95% CI 1.083-1.740, P=0.009) were independent risk factors for sepsis. ROC curve analysis indicated that the AUC of the change amplitude of serum albumin level was 0.926, which was significantly higher than the AUC of the qualitative results of blood leukocyte and the AUC of urinary leukocyte( P<0.01). Conclusions:The positive urinary leucocyte, the change of serum albumin levels after surgery within one hour and the leucocyte level are independent risk factors for postoperative urosepsis after mPCNL. The change of serum albumin level in the early postoperative period has a strong predictive value for the early diagnosis of postoperative sepsis.

Objective: To evaluate the clinical effects of CGF membrane for repairing the oral mucosa defects. Methods: 39 patients were selected with oral mucosa defects after surgical resections. 19 defects were covered by autologous CGF membranes as the experimental group. 20 defects were not covered by membrane as the control group. Regular follow-up were performed at one week, two weeks, three weeks, one month, two months, three months after the operations. And wound healings were compared in the groups. Results: CGF membranes of the 19 patients in the experimental group survived completely. And no infection occurred. The wound healing rate of the experimental group was higher than that of the control group at two weeks, three weeks and one month after the operations. And the difference was statistically significant(P<0.05). The VAS score of the experimental group was lower than that of the control group at one week, two weeks, three weeks and one month(P<0.05). The mean score of VSS score in the experimental group was lower than that in the control group (P<0.05). Conclusions Repair of the oral mucosa defects with CGF membrane can shorten the period of wound healing, relieve the postoperative discomfort and reduce the scar. It was a safe and effective method worthy to be popularized.

Objective To characterize the CT perfusion parameters of focal pancreatic lesions including pancreatic cancers (PACs) and pancreatic neuroendocrine tumors (pNETs),estimate the confirmity and fungibility of parameters obtained from Deconvolution and Maximum slope+Patlak.Methods From December 2015 to November 2016,22 patients with PACs and 22 patients with pNETs(37 lesions confirmed by surgery and biopsy)underwent preoperative whole-pancreas CT perfusion in our center. The volume perfusion CT of the entire pancreas was performed at 80 kV and 100 mA,using 28 consecutive volume measurements and intravenous injection of 45 ml of iodinated contrast and saline at a flow rate of 5 ml/s. One experienced radiologists measured and recorded the CT perfusion parameters on Siemens post-processing workstation using two mathematical methods:Maximum slope+Patlak analysis versus Deconvolution method.ResultsWilcoxon matched-pairs test revealed significant difference between both pairs of the perfusion measurements by the two methods,PACs(BFM vs. BFD,Z=-3.263,P=0.001;BVD vs. BVP,Z=-3.978,P=0.000); pNETs(BFM vs. BFD,Z=-5.212,P=0.000;BVD vs. BVP,Z=-2.633,P=0.008). Spearman's correlation coefficient showed both pairs of perfusion measurements significantly correlated with each other in PACs (BFM vs. BFD,r=0.845,P=0.000;BVD vs. BVP,r=0.964,P=0.000) and pNETs(BFM vs. BFD,r=0.759,P=0.000),BVD vs. BVP,r=0.683,P=0.000). Geometric mean BFM/BFD ratio in PACs was 0.77 (range:0.61-0.99),while geometric mean BVD/BVP ratio was 1.42 (range:1.13-1.79),within 95% limits of agreement. Geometric mean BFM/BFD ratio in pNETs was 0.66 (range:0.51-0.86),while geometric mean BVD/BVP ratio was 1.15 (range:0.88-1.50),within 95% limits of agreement. Conclusion sSignificantly different CT perfusion values of blood flow and blood volume were obtained by Deconvolution-based and Maximum slope+Patlak-based algorithms in the pNETs and PACs. They correlated significantly with each other. Two perfusion-measuring algorithms are interchangeable because the ranges of the conversion factors are narrow.
Algorithms ; Blood Volume ; Contrast Media ; Humans ; Pancreas ; diagnostic imaging ; pathology ; Pancreatic Neoplasms ; diagnostic imaging ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; methods

Objective To investigate the prevalence of DUOX2 mutations in Chinese patients with congenital hypothyroidism (CH) and to discuss the inheritance pattern of DUOX2 gene.Methods Blood samples were collected from 91 CH children and their genomic DNA was extracted from peripheral blood leukocytes.All exons and exon-intron boundaries of DUOX2 were analyzed by target next-generation sequencing and family trios was established to study the inheritance pattern of DUOX2 gene.Results Fifty-four out of 91 children with CH carried DUOX2 mutation, with a prevalence of 59.34%.Of the 54 CH children, 36 carried DUOX2 biallelic mutations.In all 12 family trios with probands carrying biallelic DUOX2 mutations, the parents carried heterozygous DUOX2 mutations while still showing normal thyroid function, suggesting that CH caused by DUOX2 mutations is inherited in an autosomal recessive manner.Conclusion DUOX2 gene is one of the most frequently mutated genes in Chinese CH patients and its inheritance pattern is an autosomal recessive one.

To study the effect of practice while watching (PWW) teaching method in cardiopul-monary resuscitation training of standardized training residents. 196 standardized training residents were selected, and PWW teaching method was used to carry out cardiopulmonary resuscitation training and as-sessment. The results were significantly higher than that before the training, and the satisfaction rate of the residents to the PWW teaching method was 100%.PWW teaching method could improve the effect of stan-dardized training resident doctors in cardiopulmonary resuscitation,and increase the interest in learning.

Objective To discuss the effect of preposition of intravenous thrombolysis from ward to emergency in the treatment for patients with acute ischemic stroke. Methods A total of 392 patients with ischemic stroke in Xuanwu Hospital Capital Medical University from June 2014 to December 2016 were selected in the study. The control group contained 150 cases treated from June 2014 to June 2015, while the experimental group included 242 cases treated from July 2015 to December 2016. Patients in the control group were given intravenous thrombolysis in the ward, and patients in the experimental group received intravenous thrombolysis in the emergency. The Door-to-Needle Time (DNT) were compared between two groups. Results The DNT were (49.74±12.61) min in the experimental group and (114.95±29.48) min in the control group. The difference between two groups was statistically significant (t=16.659,P< 0.001). Conclusions The preposition of intravenous thrombolysis from ward to emergency can shorten the DNT.

Objective To Investigate the concentration of VILIP-1 and NR2 peptide in the serum of patients with ischemic stroke , and to explore their clinic value in early diagnostic of ischemic stroke patients.Methods The levels of VILIP-1 and NR2 peptide were examined by ELISA ( enzyme linked immunosorbent assay ,ELISA) with suspicious TIA ( defined as a neurological deficit that resolved within 24 hours) or acute ischemic stroke patients ( within 72 hours of onset of symptoms ) 340 cases,102 healthy controls,98 patients with vascular risk factors and 35 patients with hemorrhagic stroke.Among all the groups , VILIP-1 and NR2 peptide level were analyzed using the nonparametric Wilcoxon test.Diagnostic performance were analyzed among the groups with the two biomarkers independently and combinedly .Results Serum levels of VILIP-1 and NR2 peptide in patients with ischemic stroke (IS) were 9.80 (1.90-14.22) μg/L, 14.40 (5.60-27.91) μg/L respectively,which was higher than that of the healthy control group [VILIP-1:0.02 (0.01-0.09),NR2:0.33 (0.02-1.15),χ2 were 5.61 and 9.54,P<0.001],the group with vascular risk factors [VILIP-1:0.03 (0.02-0.16),NR2:0.27 (0.01-1.54),χ2 were 6.74 and 10.62,P<0.001], the group of patients non-stoke [VILIP-1:0.04 (0.03-0.19),NR2:0.53 (0.45-1.21),χ2 were 3.78 and 7.63, P <0.001 ].The levels of VILIP-1 and NR2 peptide was significantly increased in IS patients presenting within 3 h of symptom onset.When differentiating IS from patients with hemorrhagic stroke ,NR2 had a AUC of 0.934,showing a strong distinguishing effectiveness.Differentiating IS from healthy controls , patients with vascular risk factors and non-stroke patients,the AUC of combination of VILIP-1 and NR2 was 0.974,which was higher than the AUC of either VILIP-1(0.849) or NR2(0.862) alone(P <0.05). Conclusions VILIP-1 and NR2 peptide are very sensitive and specific biomarkers to the early diagnosis of IS.The combination of VILIP-1 and NR2 peptide has higher value of clinical applications than one of them independently.

Objective To study the effect of case-based learning(CBL) combined with problem-based learning (PBL) in emergency teaching for foreign students.Methods Totally 33 foreign students were selected in department of emergency,Xuanwu Hospital of Capital University of Medical Sciences and were randomly divided into the observation group (n =17) and control group (n =16).Students in observation group were taught by CBL combined with PBL while those in control group were taught by traditional teaching method.Theory examination,physical examination and Sirm4000 simulated cardiopulmonary resuscitation skill appraisal were given at the end of the internship and achievement differences were compared between 2 groups.Attitude on the teaching method was studied in observation group by questionnaire.SPSS 17.0 software was used for statistical analysis； measurement data were expressed as mean standard deviation ((x) ± s) ； independent sample t-test was applied for comparison between groups； P ＜ 0.05 stands for difference having statistical significances.Results Theory result was (83.5±7.9) in observation group and (76.6 ±8.7) in control group (P=0.012).Cardiopulmonary resuscitation skill score was (84.3 ± 10.1) in observation group and (75.6-± 11.3) in control group (P =0.013).100.0％ students thought that the teaching method could improve the ability of self-learning.Conclusions Teaching method of CBL combined with PBL can stimulate the students' interest in learning and improve students' achievement.

Objective To probe into characteristics of medical assurance for medical service preparation, medical staff deployment and injury treatment/rescue for martial arts competitions in Beijing Olympic Games. Methods Collecting data of all injuries treated onsite of martial art venues and in clinics of such venues, for statistical analysis of the injury occasions, injury location, injury types and post-injury treatment. Results During the test games, injuries found in martial arts repertoire competitions account for 0. 92% of all athletes in the category, mostly waist and lower limbs injury; injuries found in sanshou competitions account for 12.4% of all athletes in the category, mostly blunt trauma on head/face, body, perineum and four limbs, along with skin lacerations and 16 heavily wounded transferred to hospitals for rescue. No injuries are found in official games of martial arts repertoire competitions; in sanshou competitions, injuries account for 5. 5% of all athletes of the category, without heavy injuries for hospital rescue. Conclusion Athletes tend to be exposed to greater risk of injury in sanshou than in repertoire competition, headcount of injuries and injury heaviness in test games are higher than official games, probability of injuries of athletes of middle level is higher than those of other levels. Medical staff of professional surgeons of multidisciplinary skills are recommended.

Objective To investigate the changes of thyroid hormone levels and its relationship with prognosis in old patients with sepsis. Methods APACHE Ⅱ score and SIRS score were documented in 140 old patients with sepsis,who were divided into Multiorgan dysfunction syndrome (MODS) group and non MODS group. Results The levels of FT3 and FT4 descended obviously and APACHE Ⅱ score and SIRS score increased remarkably in old patients with severe sepsis(P <0.05 or P <0.01). The level of FT3 and FT4 in death group and MODS group was much lower than that in the survival group (P < 0.05). Conclusion Inflammatory resction and eytokines may effect the hypothalamic- pituitary-thyroid axis. The levels of thyroid hormone can reflect old patients with sepsis condition. The patients with severer conditions may have lower levels of thyroid hormone who will be more likely to died of MODS.