Objective: To investigate the clinical value of plasma presepsin level in early severity evaluation for acute pancreatitis (AP) patients. Methods: The clinical data of 67 patients with AP admitted in Second Affiliated Hospital of Wenzhou Medical University from December 2016 to January 2019 were prospectively selected. The patients were divided into mild AP group (MAP, n=36) and moderately severe and severe AP group (MSAP+ SAP, n=31) according to CTSI and with or without organ dysfunction and local or systemic complications on admission. Another 20 healthy normal subjects were selected as the control group. Plasma presepsin, C-reactive protein (CRP), procalcitonin (PCT), white blood cell count (WBC), serum amylase and calcium levels were measured within 2 hours, and the APACHEⅡ score was calculated within 24 hours of admission. Receiver operating characteristic curves(ROC) were plotted and the area under the curve (AUC) was calculated to assess the clinical value of presepsin, CRP, PCT, WBC, serum amylase and calcium for predicting the severity of AP patients, respectively. Results: The plasma presepsin level in MAP, MSAP+ SAP and control group was (439.59±74.23)ng/L, (1097.82±93.15)ng/L and (97.31±21.57)ng/L, respectively. Plasma presepsin level in MAP and MSAP+ SAP patients with biliary pancreatitis were obviously higher than those patients with other etiological factors, and plasma presepsin level in MSAP+ SAP patients with hyperlipidemia-associated pancreatitis was significantly higher than those in the MAP group, and the difference was statistically significant (P<0.05). The AUC of plasma presepsin in the diagnosis of MSAP+ SAP was 0.873(95% CI 0.734-0.922), which was greater than the AUC values of CRP, PCT, WBC and serum calcium; the optimal cut-off value was 951.94 ng/L; the diagnostic sensitivity was 85.6%, which was superior to CRP, PCT, WBC and serum calcium; and the specificity was 76.2%, which was second to 78.9% of serum calcium. Conclusions Plasma presepsin level can be used as a sensitive indicator for early severity evaluation of AP patients, with a specificity only second to serum calcium.

Objective To survey the current status of professional value among health workers in grass-roots medical institutions of Wenzhou city and to analyze the influencing factors.Methods A survey on professional value was conducted from October to December 2017 among health workers from 14 primary medical institutions in 4 urban districts of Wenzhou City selected by stratified random sampling method.The self-designed questionnaires were used for the survey.A total of 350 questionnaires were distributed and 331 were returned,of which 302 were valid.The status and influencing factors of professional value were analyzed.Results The overall score of professional value was (96.66 ± 14.94).The univariate analysis showed that the professional value scores were associated with educational level (F=3.851),income(F=2.660),professional title(F=8.030),position(F=11.658) and specialty (F=4.667) of the health workers(all P＜0.05).The multivariate analysis showed that the gender(male:OR=0.53,95％ CI:-1.077--0.192,P=0.005),educational level (high school and below:OR=3.06,95％ CI:0.007-2.233,P=0.049),income (2 000-4 000 Yuan:OR=0.07,95％ CI:-4.783-0.627,P=0.011),professional title (no title:OR=0.27,95％CI:-2.397--0.232,P=0.017;Junior title:OR=0.31,95％CI:-2.197--0.153),P--0.024;intermediate title:OR=0.23,95％ CI:-2.533--0.366,P--0.009),position (doctor:OR=0.13,95％ CI:-3.235--0.815,P=0.001;nurse:OR=0.20,95％ CI:-2.883--0.368,P=0.011;technician:OR=0.15,95％ CI:-3.076--0.723,P=0.002)were influencing factors of professional value(all P＜0.05).Conclusion The professional values among health workers in Wenzhou grass-roots medical institutions are relatively low.The male gender,low educational level,low income,low professional title or no title and positions are influencing factors of professional value.

AIM:To study the effects of noninvasive delayed limb ischemia preconditioning ( NDLIP) on ani-mal cardiac function , myocardial morphology and myocardial apoptosis after myocardial infarction ( MI ) .METHODS:Healthy SD male rats [n=45, weighing (250 ±10) g] were randomly divided into 3 groups:MI group:the animal model of MI was established by surgical ligation of left anterior descending artery ( LAD) after 2 weeks;NDLIP group:after the success of the MI animal model , NDLIP was carried out every other day until the 4th, 6th and 8th weeks;sham group:as the negative control group , the animals were taken heart LAD threading but no ligation .All rats were fed conventionally .At the end of the 4th, 6th and 8th weeks, all rats were made ventricular intubation , and then the hemodynamic parameters were recorded .The blood samples were withdrawn from the abdominal aorta and the serum was separated via centrifugation . The serum contents of Bcl-2 and Bax were measured by ELISA .Left ventricular anterior wall was homogenized .The mito-chondrial respiratory chain complexes Ⅰ,Ⅱ,Ⅲand Ⅳin the myocardial tissues were detected by ELISA .RESULTS:At the end of the 4th, 6th and 8th weeks, compared with MI group, left ventricular systolic pressure in NDLIP group was significantly increased , while left ventricular end-diastolic pressure in NDLIP group was significantly decreased ( both P<0.05).Mitochondrial respiratory chain complexesⅠ, Ⅱ, Ⅲ and Ⅳ in NDLIP group were significantly increased (P<0.05).The serum level of Bcl-2 in NDLIP group was significantly increased and Bax level was reduced remarkably (both P<0.01) .CONCLUSION:NDLIP improves the hemodynamic indexes , promotes the mitochondrial respiratory function and inhibits cell apoptosis , thus improving the prognosis of MI .

Objeetive To observe the clinical efficacy of hyperbaric oxygen (HBO) associated with ganglioside-1 (GM-1) on severe brain injury.Methods In accordance with different treatment methods,158 cases of severe craniocerebral injury were divided into group A (the routine therapy group),group B (the routine therapy + HBO group),group C (the routine therapy + GM-1 group) and group D (the routine therapy + HBO + GM-1 group).Therapeutic efficacy was evaluated by the approaches of Glasgow coma scale (GCS) scores and Glasgow outcome scale (GOS) grades and total effective rate.Results The GCS scores and total effective rate (93.48％)of the HBO associated with GM-1 group after treatment and 6 months after injury were obviously better than those of the other groups (77.14％,77.78％,53.13％),and statistical significance could be noted,when comparisons were made between them (P ＜ 0.05) Conclusions HBO combined with GM-1 in the treatment of severe brain injury could enhance clinical efficacy,improve prognosis and reduce incidence of sequelae.

Objeetive To observe the clinical efficacy of hyperbaric oxygen (HBO) associated with ganglioside-1 (GM-1) on severe brain injury.Methods In accordance with different treatment methods,158 cases of severe craniocerebral injury were divided into group A (the routine therapy group),group B (the routine therapy + HBO group),group C (the routine therapy + GM-1 group) and group D (the routine therapy + HBO + GM-1 group).Therapeutic efficacy was evaluated by the approaches of Glasgow coma scale (GCS) scores and Glasgow outcome scale (GOS) grades and total effective rate.Results The GCS scores and total effective rate (93.48％)of the HBO associated with GM-1 group after treatment and 6 months after injury were obviously better than those of the other groups (77.14％,77.78％,53.13％),and statistical significance could be noted,when comparisons were made between them (P ＜ 0.05) Conclusions HBO combined with GM-1 in the treatment of severe brain injury could enhance clinical efficacy,improve prognosis and reduce incidence of sequelae.

Aim To study the preventative effects of noninvasive delayed limb ischemic preconditioning ( NDLIP) on sudden cardiac death in rats with myocar-dial infarction. Methods Thirty healthy SD male rats weighting ( 250 ± 10 ) g were randomly divided into 3 groups:① myocardial infarction ( MI ) group: animal model of MI was established by making surgical ligation of animal LAD. ② MI plus NDLIP group: after the success of the animal model of MI, NDLIP was carried out every other day until 4th week. ③Sham group:as the negative control group, animals were taken heart LAD threading but no ligation. All rats were fed con-ventionally. At the end of 4 weeks, three groups of rats were administered with metaraminol ( 0. 2 mg · min-1 ) . ECG, drug cumulant of sudden death and death onset time were recorded. After sudden death, blood samples were withdrawn from abdominal aorta and serum was separated via centrifugation. ELISA method was used to measure serum caspase-3 , HSP70 and SOD concentration. Results While metaraminol led animal cardiac sudden death, the rats heart rate ( HR) kept declining with the increase of dosage of metaraminol during the administration period. Rat HR of MI+NDLIP group [ ( 479 ± 8 ) vs ( 416 ± 19 ) beat ·min-1 , ( 446 ± 32 ) vs ( 370 ± 20 ) beat · min-1 , (376 ± 53) vs (305 ± 29) beat·min-1, (307 ± 63) vs (244 ± 33) beat·min-1, (283 ± 45) vs (121 ± 35 ) beat · min-1 , P <0. 01 ] was markedly higher than that of MI group at 0 , 5 , 10 , 30 , 50 min before death. Compared with MI group, drugs cumulant to sudden death and death onset time of MI + NDLIP group [ ( 14. 58 ± 3. 03 ) vs ( 10. 76 ± 2. 73 ) mg, (72. 9 ± 15. 2 ) vs ( 53. 8 ± 13. 6 ) min, P <0. 01 ] were significantly increased. Compared with MI group, serum caspase-3 content of MI+NDLIP group was sig-nificantly reduced [ ( 2. 01 ± 0. 52 ) vs ( 2. 34 ± 0. 38 )μg·L-1 , P<0. 01 ]; HSP70 levels were remarkably increased [ ( 3. 01 ± 0. 58 ) vs ( 2. 70 ± 0. 43 ) μg · L-1 , P <0. 05 ]; SOD levels were significantly im-proved [(1. 99 ± 0. 65) vs (1. 70 ± 0. 58) mg·L-1, P<0. 01 ] . Conclusion NDLIP can prevent sudden cardiac death after myocardial infarction in rats, which may be mediated by reducing the myocardial cell apop-tosis, increasing protective protein expression and en-hancing antioxidant capacity.

Objective To compare the treatment effects between minimally invasive transthoracic device closure and traditional surgery on ventricular septal defect (VSD) in infants. Methods Data of 91 infants of VSD, who were less than 6 years old, were retrospectively analyzed from October 2013 to February 2015 in the department of cardiac surgery in Tianjin Chest Hospital. According to the operation mode, patients were divided into minimally invasive transthoracic device closure of VSD (closure) group (n=13) and traditional VSD repair under cardiopulmonary bypass (CPB, repair group, n=78) group. The preoperative cardiac ultrasound was used to determine the type of VSD, the distance from the margin of VSD to aortic and tricuspid valve, pulmonary artery pressure and other cardiac malformations. The intraoperative and postoperative monitoring included blood transfusion volume, valve regurgitation, mechanical ventilation time, intensive care unit (ICU) residence time, hospitalization time and hospitalization cost. The patients were followed up regularly after surgery to collect data including arrhythmia, hemolysis, valve regurgitation and residual shunt of VSD. Results There was no operative mortality in 91 patients. In closure group 1 case was converted to traditional repair surgery under CPB. There were significantly less values in ICU residence time and hospitalization time in closure group than those of the repair group[(13.2±11.7) h vs. (77.2±55.8) h, and (10.0±3.2) d vs. (15.8± 6.7) d, P<0.05]. In closure group 1 case (7.7%) underwent median sternotomy and CPB. All cases in repair group underwent median sternotomy and CPB. The infusion amount of suspended red blood cells, plasma and the time of mechanical ventilation were less in closure group than those in repair group (P < 0.05). There were no significant differences in the incidence of complications during early postoperative and the follow-up period, including arrhythmia, VSD residual shunt, valve regurgitation, hemolysis, and the cost of hospitalization between two groups (P>0.05). Conclusion In the comparison of the recent or short-term clinical curative effect of VSD treatment in infants, the minimally invasive transthoracic VSD device closure is better than the traditional VSD repair treatment. Long term effects need to be further observed and followed up.

Objective To evaluate whether an intervention with a health promotion program can reduce prevalence of the health risk factors of non-communicable chronic diseases (NCD) and improve the knowledge awareness of NCD prevention of employees from a security corporation in Beijing selected by the study team. Methods A cross-sectional study was conducted by selecting 157 employees of a security corporation in Beijing, and a quasi-experiment method and a self-developed Questionnaire of Intervention for Health Risk Factors were used. Based on the results of the distribution of risk factors for NCD and the focus-group discussion, one year health promotion program intervention was performed. According to the comparison of prevalence of risk factors between baselines and after intervention of the studied employees, the intervention effectiveness was evaluated. Results After the health intervention, rate of reported unhealthy diet reduced from 75.0%to 56.8%, which showed statistically significant (?2=8.53, P<0.05);rate of reported less physical activity reduced from 35.5%to 17.4%, with statistical significance (?2=19.60, P<0.05);rate of reported cigarette smoking reduced from 16.8%to 11.6%with statistically significance. There was no statistically significant reduction in the rate of the other health risk factors (P>0.05). The median value of health knowledge awareness of the studied employees was significantly improved from 10.20 to 11.33(S=-2 545, P<0.05) and awareness of recommended daily intake of dietary salt increased significantly from 46.20%to 67.09%after intervention (χ2=17.85, P<0.05). Conclusion The non-communicable chronic diseases intervention program can reduce the health risk factors and improve health knowledge awareness of the studied population.

Objective To investigate the effect of rhBNP in treating pulmonary hypertension after mitral value replacement (MVR) compared with PGE1.Methods 60 patients with pulmonary hypertension after MVR were randomly divided into 3 groups(control group, PGE1 group and rhBNP group).Hemodynamic factors(MAP, CVP, mPAP, etc.) were monitored before and after taking medicine at 1 h, 6 h, 24 h, respectively including drug withdrawal 2 h.TXA2 and cGMP were analyzed by ELISA.To observe the levels of TXA2 and cGMP in plasma before and after treatment with rhBNP and PGE1 for three times (24 h, 1 week and 3 months).Information about patients'mechanical ventilation time was also recorded.Results Patients' mechanical ventilation time in PGE1 group was the shortest.MAP, mPAP, PRVI, PAWP were reduced after treatment by medicine 1 h for in PGE1 group.However, these indexes were rebound after drug withdrawal.mPAP, PRVI, PAWP in rhBNP group decreased after treatment by medicine at 6 h.The decreased level of mPAP was less than that in PGEI group.In control group, TXA2 went down and cGMP went up after operation.After taking medicine at 24 h, TXA2 decreased and cGMP increased in both PGE1 and rhBNP group.The increased level in rhBNP group was higher than that of control group.With medicine, the decreased level of TXA2 in PGE1 was also higher than that in rhBNP group.The going-up of cGMP in rhBNP was higher than that in PGE1.Conclusion Both rhBNP and PGE1 can reduce pulmonary artery pressure, PGE1 is more effective than that of rhBNP.

Objective To study in vitro hydrodynamics of a pneumatic pulsatile ventricular assist device developed ex?clusively by China, and establish an animal model for the detection by the device. Methods The hydromechanics experi?ment was performed on an in vitro test loop using MEDOS-System to drive the ventricular assist device, and lycerl-water so?lution was used as circulating medium. The changes of afterload pressure and the output of the pump were monitored, and the impermeability and stability were also assessed after the experiment. Six adult dogs were used as the experimental animals. The device worked in the left heart assistance mode for 1 hour then the ventricular fibrillation was induced by potassium chloride, and then defibrillated after 5 min while the device remained working. The hemodynamics data were monitored con?secutively during the trial. Results The ventricular assist device worked stably and reliably during the hemodynamic exper?iment. The pump can generate more than 4 L/min flow against the afterload pressure of 100 mmHg. There were no significant changes in heart rate at different time points in experimental dogs after left ventricular assist. Comparison between after auxil?iary immediately and former auxiliary, the diastolic blood pressure of dogs increased 30 mmHg with the ventricular assist, and the diastolic pressure increased 19 mmHg. No obvious fluctuation in blood pressure was found during the auxiliary pro?cess. The diastolic blood pressure stayed at 60 mmHg when the heart was in ventricular fibrillation, and returned to normal after electrical defibrillation. Conclusion The ventricular assist device works stably in vitro test, and the pump can meet the need of adult’s ventricular assist. It is effective and security to dogs in short term. The effects of long-term use need to be future proved.