Objective    To evaluate the diagnostic value of various severity assessment scoring systems for sepsis after cardiac surgery and the predictive value for long-term prognosis. Methods    The clinical data of patients who underwent cardiac sugeries including coronary artery bypass grafting (CABG) and (or) valve reconstruction/valve replacement were extracted from Medical Information Mark for Intensive Care-Ⅲ (MIMIC-Ⅲ). A total of 6 638 patients were enrolled in this study, including 4 558 males and 2 080 females, with an average age of 67.0±12.2 years. Discriminatory power was determined by comparing the area under the receiver operating characteristic (ROC) curve (AUC) for each scoring system individually using the method of DeLong. An X-tile analysis was used to determine the optimal cut-off point for each scoring system, and the patients were grouped by the cut-off point, and Kaplan-Meier curves and log-rank test were applied to analyze their long-term survival. Results    Compared with the sequential organ failure assessment (SOFA) score, acute physiology score-Ⅲ (APS-Ⅲ, P<0.001), the simplified acute physiology score-Ⅱ (SAPS-Ⅱ, P<0.001) and logistic organ dysfunction score (LODS, P<0.001) were more accurate in distinguishing sepsis. Compared with the non-septic group, the 10-year overall survival rate of the septic group was lower (P<0.001). Except for the systemic inflammation response score (SIRS) system, the 10-year overall survival rates of patients in the high risk layers of SOFA (HR=2.50, 95%CI 2.23-2.80, P<0.001), SAPS (HR=2.93, 95%CI 2.64-3.26, P<0.001), SAPS-Ⅱ (HR=2.77, 95%CI 2.51-3.04, P<0.001), APS-Ⅲ (HR=2.90, 95%CI 2.63-3.20, P<0.001), LODS (HR=2.17, 95%CI 1.97-2.38, P<0.001), modified logistic organ dysfunction score (MLODS, HR=2.04, 95%CI 1.86-2.25, P<0.001) and the Oxford acute severity of illness score (OASIS, HR=2.37, 95%CI 2.16-2.60, P<0.001) systems were lower than those in the low risk layers. Conclusion    Compared with SOFA score, APS-Ⅲ score may have higher value in the diagnosis of sepsis in patients who undergo isolated CABG, a valve procedure or a combination of both. Except for SIRS scoring system, SOFA, APS-Ⅲ, SAPS, SAPS-Ⅱ, LODS, MLODS and OASIS scoring systems can be applied to predict the long-term outcome of patients after cardiac surgery.

Objective    To identify the risk factors of postoperative blood loss among pediatric patients following corrective operation of tetralogy of Fallot (TOF) and to develop nomogram predicting the risk of postoperative blood loss. Methods    A retrospective case-control study was conducted in pediatric TOF patients who underwent corrective operation in our hospital from November 2018 to June 2019. And the clinical data from each enrolled patient were gathered and analyzed. Clinically significant postoperative blood loss was defined as drainage volume from chest tube ≥ 16 mL/kg during the first 24 h after surgery, which corresponded to the 75th percentile of the blood loss in our population. The primary outcome was to determine the independent predictors of postoperative blood loss by the least absolute shrinkage and selection operator (LASSO) regression, univariate and multivariate logistic regression analysis. On the basis of the independent predictors of postoperative bleeding, nomogram was developed and its discrimination and calibration were estimated. Results    A total of 105 children were selected (67 males and 38 females aged 3-72 months). The drainage volume from chest tube in the bleeding group was significantly higher than that in the non-bleeding group during the first 24 h (P<0.000 1). Multivariate logistic regression analysis showed that low body weight (OR=0.538, 95%CI 0.369-0.787, P=0.001), high preoperative hemoglobin concentration (OR=1.036, 95%CI 1.008-1.066, P=0.013) and prolonged intraoperative aortic cross clamp time (OR=1.022, 95%CI 1.000-1.044, P=0.048) were independent risk factors for postoperative blood loss. In the internal validation, the model displayed good discrimination with a C-index of 0.835 (95%CI 0.745-0.926) and high quality of calibration plots in nomogram models was noticed. Conclusion    The nomogram demonstrated good discrimination and calibration in estimating the risk of postoperative blood loss among pediatric patients following corrective operation of TOF.

Objective    To explore the hemodynamic effects of inhaled nitric oxide (iNO) on postoperative hemodynamic in patients with cyanotic congenital heart disease (CHD) combined with decreased pulmonary blood flow. Methods    From 2014 to 2018, there were 1 764 patients who received corrective repair of cyanotic CHD with decreased pulmonary blood flow in the Department of Pediatric Cardiac Surgery of Fuwai Hospital. We included 61 patients with the ratio of right ventricular systolic pressure to systolic blood pressure (SBP) ≥75% after weaning from cardiopulmonary bypass. There were 41 males and 20 females, with the age of 20.5 (9.0, 39.0) months and weight of 12.5±7.8 kg. The patients were divided into two groups: a conventional group (33 patients, conventional therapy only) and a combined therapy group (28 patients, iNO combined with conventional therapy). The hemodynamics during the first 24 hours after iNO therapy and the in-hospital outcomes of the two groups were investigated and compared. Results    There was no statistical difference between the two groups in demographic characteristics and surgical parameters (P>0.05). The hemodynamic effects of iNO within 24 hours included the decrease in the vasoactive inotropic score (VIS, 21.6±6.6 vs. 17.3±7.2, P=0.020) along with the increase in blood pressure (SBP: 73.7±9.7 mm Hg vs. 90.8±9.1 mm Hg, P<0.001) , the decrease in central venous pressure (10.0±3.1 mm Hg vs. 7.9±2.1 mm Hg, P=0.020), the decrease in lactate (2.2±1.7 mmol/L vs. 1.2± 0.5 mmol/L, P<0.001) and increase in urine output [2.8±1.7 mL/(kg·h) vs. 4.9±2.2 mL/(kg·h), P<0.001]. The decrease of VIS at 24 h after the surgery in the conventional therapy group was not statistically significant (22.1±7.9 vs. 20.0±8.5, P=0.232). Besides, we discovered that the need for renal replacement therapy (RRT) was less in the combined therapy group than that in the conventional therapy group, especially in the moderate complicated surgery [risk adjustment in congenital heart surgery (RACHS-1) ≤3] subgroup (9.5% vs. 40.7%, P=0.016). Conclusion    In pediatric patients after corrective repair of cyanotic and pulmonary blood follow decreased CHD with increased pulmonary vascular resistance, iNO combined with conventional therapy can improve the hemodynamics effectively. Compared with the conventional therapy, the combined therapy with iNO can decrease the VIS and the need for RRT, which is beneficial to the postoperative recovery of patients.

Objective To investigate the changes of erythrocyte parameters and the value of differential diagnosis in pregnant women with β-mediterranean anemia.Methods A total of 300 pregnancy women from July 2014 to December 2015 in Center Hospital of Longgang were recruited in this study,100 pregnant women with β-mediterranean anemia in β-mediterranean anemia pregnancy group,100 healthy pregnant women in normal pregnancy group,100 pregnant women with iron deficiency anemia in iron deficiency anemia pregnancy group.Mean red cell volume(MCV),mean erythrocyte hemoglobin(MCH),reticulocyte percentage(Ret%) were detected and compared in the three groups.Results Compared with the normal pregnancy group and iron deficiency anemia pregnancy group,the MCV,MCH significantly reduced,and Ret% significantly rised in the β-mediterranean anemia pregnant group,the differences were significant(P<0.05).The best cut-off value of Ret% was 1.7% in differential diagnosis of β-mediterranean anemia pregnancy and iron deficiency anemia pregnancy,the sensitivity was 63.00%,the specificity was 74.00%,the area under of receiver operating characteristic curve was 0.841.The sensitivity of joint detection including MCV,MCH and Ret% in differential diagnosis of β-mediterranean anemia pregnancy and iron deficiency anemia pregnancy was 84.00%,the specificity was 90.00%.Conclusion MCV,MCH and Ret% in pregnancy women with β-mediterranean anemia changes significant compared with normal pregnancy group and iron deficiency anemia pregnancy group,the joint detection including MCV,MCH and Ret% could significantly improve the differential diagnosis of β-mediterranean anemia and iron deficiency anemia in pregnancy women.

Objective To evaluate the heritability explanation degree of schizophrenia by all known susceptibility variants in schizophrenia. Methods The GWAS catalog of National Human Genome Research Institute (NHGRI) was queried to retrieve all the susceptible gene variations of schizophrenia. Sixty-two variants with risk allele frequency and odds ratio (OR ) were selected from 347 susceptible gene variants of schizophrenia. The heritability explanation degree of each susceptibility variants was calculated using the multifactorial liability threshold model. Results The total heritabili-ty explanation degree of schizophrenia by 62 known susceptible variants was 25.66%. In contrast, 74.34%of heritability, which could not be explained by known susceptibility variants, were then defined as the missing heritability of schizophre-nia. Conclusions The results demonstrate that the heritability explanation degree of schizophrenia by all known suscepti-bility variants in schizophrenia is low, indicating that there may be many unknown schizophrenia molecular genetic mech-anisms need to be further clarified.

Objective To discuss the diagnostic value of cytokeratin 19 fragment(CYFRA21-1) in non small-cell lung cancer (NSCLC) .Methods The serum CYFRA21-1 levels were tested in 1 046 healthy adults(healthy group) ,244 benign pulmonary dis-ease patients(benign disease group) and 90 NSCLC patients(NSCLC group) .The results were analyzed statistically .Results There was not significantly difference between man and women in healthy group for CYFRA21-1 level(P>0 .05) .The CYFRA21-1 level in more than 60 years cases was obviously higher than that in less than 18-40 years group and >40-60 group .The upper limit of serum CYFRA21-1 was 4 .00 ng/mL according 95% confidence interval of benign disease group .A cut-off value of 4 .70 ng/mL in NSCLC group was suggested when compared with receiver operating characteristic curve(ROC curve) ,and its sensitivity and speci-ficity were 62 .1% and 92 .6% respectively .Conclusion The diagnostic value for serum CYFRA21-1 in NSCLC was 4 .70 ng/mL .

ObjectiveTo investigate the serum soluble urokinase-type plasminogen activator (suPAR)in patients with multiple myeloma,its relationship with the 2-year survival rate and its clinical significance in predicting the disease prognosis.MethodsEnzyme-linked immunosorbent assay was applied to determine the levels of suPAR of 40 initial diagnosed patients with MM and 30 healthy persons as healthy control group.The patients were divided into three groups:effective (13 cases),remission (19 cases) and invalid (8 cases).ResultsUsually there was suPAR expression [(233.47±83.22) pg/ml] in serum of the healthy adults.There was no statistical difference of the suPAR expression in effective group or remission group before treated [(257.60±32.47) pg/ml,(331.00±99.80) pg/ml] compated with healthy group (t =2.04,t =1.83,P ＞ 0.05),and that in the invalid group,serum levels of suPAR [(562.20±291.0) pg/ml] was statistically significant with that of the effective group and that of the healthy control group (t =3.92,t =1.93,P ＜ 0.05).Through monitoring 17 patients,the suPAR of patients before treatment [(437.65±131.43) pg/ml] was statistically significant with that of healthy control group (P ＜0.01) and effective group after treatment [(298.76±108.59) pg/ml] (P ＜0.01).Serum suPAR of more than 2-year-survival patients [(333.02±85.37) pg/nl] during initial diagnosis was not statistically difference with that of the healthy control group (t =1.81,P ＞ 0.05).Serum suPAR of less than 2-year-survival patients [(646.01±103.97) pg/ml] was statistically different with that of healthy control group (t =3.84,P ＜0.01) and that of more than 2-year-survival patient group (t =3.50,P ＜0.01).ConclusionThe suPAR value was correlated to the stability of multiple myeloma,and can be used for disease prognosis and estimation of survival time.And the high expression of suPAR was related to the adverse prognosis.

ed to construct a series of positive control materials that are applicable to many other immunoassays.

Objective To explore the relationship of the expression, regulation and adhesion of PTA1 in pregnancy induced hypertension(PIH). Methods The expression,regulation and adhesion of PTA1 on vascular en- dothelial cells incubated by sera from 10 PIH patients and 10 normal pregnant women repectively was detected by flow cytometry. Results The positive rate of PTA1 15.51% (24h) and 6.32 % (48h) in PIH group is significantly higher than that 7.81% (24h) and 4.72 % (48h) in normal pregnant woman group( P < 0.01 ). After the incubation with platelets,the positive rate of PTA1 6.64% (24h) and 4.13% (48h) in PIH group is lower than before(P< 0.05). The PTA1 expression 8.11% (24h) and 4.28% (48h) in PIH group is much lower after blocking with PTA1/IgG than that before(P < 0.01 ). Conclusion There are some abnormal stimulated factors in PIH patients, which activate vascular endothelial cells. PTA1 plays an important role in the adhesion of platelets to vascular en- dothelial cells, PTA1 is closely related to the progress of PIH which indicates that PTA1 directly or indirectly takes part in the pathophysiologic consequences of PIH.

Objective To discuss adhesion blocking experiment of vascular endotelial cells with platelets.Methods The expression,regulation and adhesion of CD226 on vascular endothelial cells incubated by sera from 10 PIH patients and 10 normal pregnant women repectively was detected by flow cytometry,then incubated with interacted platelets by PTA1/Ig protein.Results The positive rate of CD226 in PIH group was significantly higher than that in normal pregnant woman group(P