Abstract:Increasingly more people are in a state between health and disease due to different life styles, which modern medicine calls "suboptimal health". If the suboptimal health state lasts too long and not interfered in time, it will eventually progress to disease. Early identification of suboptimal health status and early intervention are important for preventing diseases and restoring a healthy state. There are many ways for detecting suboptimal health. A more objective method to diagnose suboptimal health status is by experimental indicators of laboratory medicine. However, there are difficulties in establishing the parameters and reference value ranges in laboratory detection of suboptimal health, and laboratory medicine needs to combine big data analysis and machine learning to make a scientific evaluation of suboptimal health status.

Abstract:Objective To investigate the pathogen distribution and drug susceptibility profile of isolates from nosocomial infections in burn patients, so as to provide the reference for clinical diagnosis and treatment. Methods A retrospective analysis was carried out for the pathogens isolated from 534 patients in Changhai Hospital of Naval Medical University (Second Military Medical University) during the period from Jan. 2015 to Dec. 2017. The bacteria were identified by VITEK 2 Compact automatic microbiological analyzer or Microflex matrix-assisted laser time-of-flight mass spectrometer. The drug sensitivity was tested by VITEK 2 Compact automatic microbiological analyzer. Results A total of 1 219 strains were isolated, including 877 strains (71.9%) of Gram-negative specimens and 342 strains (28.1%) of Gram-positive pathogens. The top four Gram-negative bacteria were Klebsiella pneumoniae (203 strains, 16.7%), Pseudomonas aeruginosa (183 strains, 15.0%), Acinetobacter baumannii (176 strains, 14.4%) and Escherichia coli (101 strains, 8.3%). The top three Gram-positive bacteria were Staphylococcus aureus (136 strains, 11.2%), Enterococcus faecium (72 strains, 5.9%) and Enterococcus faecalis (60 strains, 4.9%). The pathogens were mainly isolated from wound secretions (577 strains, 47.3%), sputum/bronchoalveolar lavage fluid (341 strains, 28.0%) and urine (147 strains, 12.1%). And 93.5% (319/341) of respiratory pathogens were Gram-negative. Two or more pathogens were isolated from 58.2% (311/534) of the patients. On the top list of Gram-negative pathogens, Klebsiella pneumoniae was observed with a tendency of multi-drug resistance and was resistant to several antibiotics. The drug resistance of Pseudomonas aeruginosa could not be ignored, with a 35.5% resistance rate for carbapenems. The resistance rate of Acinetobacter baumannii to carbapenems could reach as high as 93.2%, with resistance rate >80.0% to most other antimicrobial drugs. The prevalence of methicillin-resistant Staphylococcus aureus in Gram-positive bacteria was 69.1% (94/136). The resistance rate of Enterococcus spp. to antibiotics was 38.9%-66.3%. No Gram-positive pathogens were observed resistant to vancomycin, tigecycline or linezolid. Conclusion The pathogenic isolates causing nosocomial infection in burn patients are multi-bacterium, Klebsiella pneumoniae shows a tendency of multidrug resistance, and Gram-positive pathogens are sensitive to vancomycin, tigecycline and linezolid.

Abstract:Objective To investigate the distribution and drug resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates, so as to provide guidance for reasonable use of antibiotics. Methods Clinical CRKP isolates were collected in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2014 to Dec. 2017, and the antimicrobial susceptibility test was carried out using automated instrument method and Kirby-Bauer method. The results were interpreted according to the standards of America Clinical and Laboratory Standards Institute (CLSI) or America Food and Drug Administration (FDA), and the data were analyzed by WHONET 5.6 software and SPSS 20.0 software. Results A total of 403 clinical CRKP isolates were collected, and 169 (41.9%) strains of CRKP were isolated from the specimens obtained from sputum/bronchoalveolar lavage fluid. The first isolation of CRKP was from different specimens, and there was a significant difference in the incidence of CRKP blood flow infection (P<0.05). The top 3 departments in terms of isolation rates were Burn Intensive Care Unit (30.0%, 121/403), Digestive Department (8.4%, 34/403) and Emergence Intensive Care Unit (7.2%, 29/403). The antimicrobial susceptibility test showed that the drug resistance rate of the CRKP strains was more than 60.0% to all antibiotics, but tigecycline and fosfomycin. Conclusion The CRKP isolates are resistant to most commonly used antibiotics. It is necessary to strengthen the surveillance of drug resistance of CRKP isolates and take effective measures to control the spread of CRKP, especially in departments such as Burn Intensive Care Unit.

Abstract:Objective To establish a new method for detecting Mycobacterium tuberculosis (TB) infection based on flow cytometry fluorescence immunoassay and interferon γ release assay (IGRA). Methods The whole blood samples were stimulated to produce interferon γ (IFN-γ) with phytagglutinin (PHA) and TB specific mixed peptides (early secretory antigenic target[ESAT-6] and culture filtrate protein 10[CFP-10]), and the plasma was analyzed by double antibody sandwich method combined with flow cytometry fluorescence immunoassay. The IFN-γ concentration was evaluated by receiver operating characteristic (ROC) curve for the diagnostic efficacy of TB. The linear range, minimum detection limit, repeatability, anti-interference performance of the established method were observed, and the consistency of detection with similar products on the market was evaluated. Results The linearity of the flow cytometry fluorescence immunoassay ranged from 2 pg/mL to 1 000 pg/mL. The lowest detection limit was 0.3 pg/mL; the repeatability parameters (coefficient of variation) of the samples at 100 pg/mL and 500 pg/mL were 4.58% and 2.46%, respectively. The average recovery rate of recovery assay was 98.0%. There was no interference with flow cytometry fluorescence immunoassay when the highest concentrations of triglyceride, bilirubin and hemoglobin were 50 mg/mL, 0.6 mg/mL and 10 mg/mL, respectively. As the optimum cut-off value of the IFN-γ concontration was 10 pg/mL, the sensitivity of IFN-γ in diagnosis of TB infection was 82.46% and the specificity was 87.30%. The total coincidence rates with T-SPOT, QFT, and Wantai TB-IGRA reagent were 97.2%, 83.0%, and 85.4%, respectively; and the Kappa coefficients were 0.822, 0.622 and 0.630, respectively. Conclusion The method for diagnosis of TB infection established in this study has a good performance, with the accuracy reaching the level of similar products on the market, and our method has obvious advantages in terms of repeatability and detection process.

Abstract:Objective To investigate the clinical value of plasma (1-3)-β-D-glucan test (G test) for diagnosis of fungal bloodstream infection. Methods The blood samples for fungal culturing and G test were collected in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 2015 to Dec. 2017. The department distribution and strain distribution of 264 positive specimens detected by fungal blood culture were analyzed. A total of 1 678 samples were collected during this period for fungal blood culture and plasma G test. Taking fungal blood culture as the criterion, with a cut-off of 100.5 pg/mL for G test, we analyzed the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal bloodstream infection. Statistical analysis was performed using SPSS 19.0 software, and the diagnostic value of G test for bloodstream infection was judged by the receiver operating characteristic (ROC) curve. Results A total of 264 strains of fungal blood culture were positive from 2015 to 2017, mainly from the departments of hepatobiliary surgery (81 strains), cardiac surgery (57 strains), emergency (24 strains), thoracic surgery (22 strains), and hematology (16 strains). Candida is the main genus, of which Candida parapsilosis is the most common one, with 142 strains (53.8%), followed by Candida corneum (36 stains, 13.6%), Candida albicans (20 strains, 7.6%) and Candida tropical (18 strains, 6.8%). Taking fungal blood culture as the criterion, we found that the sensitivity, specificity, positive forecast value, and negative forecast value of G test for diagnosis of fungal infection were 61.3%, 87.9%, 31.1%, and 96.2%, respectively. ROC curve analysis showed that G test was valuable for diagnosis of fungal bloodstream infection, with the area under the curve being 0.771 (95% confidence interval:0.723-0.819). Among 137 cases of bloodstream infection, 102 cases (69.6%) were tested for G test 2-5 d before blood culture, and 71 cases were positive. Conclusion Plasma G test kit is still ideal in terms of specificity and has a certain clinical value for the early diagnosis of fungal bloodstream infection.

Abstract:Objective To explore the roles of type Ⅵ secretion system (T6SS) and quorum sensing (QS) system in the biofilm formation in Pseudomonas aeruginosa. Methods The PAO1 biofilm bacteria and planktonic bacteria were established. The expression levels of T6SS associated genes hemolysin co-regulated protein (Hcp) gene (Hcp1, Hcp2, Hcp3), QS associated gene LasR, exopolysaccharide associated genes polysaccharide synthesis locus A (PslA) and pellicle A (PelA), type Ⅳ pili gene pilus A (PilA) and flagellin C (FliC) were detected by quantitative real-time PCR, and the expression levels of those genes were compared between PAO1 biofilm bacteria and planktonic bacteria using independent t-test. Results The expression levels of PslA, PelA, PilA and FliC genes in PAO1 biofilm bacteria were respectively 714, 274, 604 and 42 folds of those in the planktonic bacteria (all P<0.05), suggesting that PAO1 bacteria formed mature biofilm with flagellum and pili. The expression levels of Hcp1, Hcp2, Hcp3, and LasR genes in PAO1 biofilm bacteria were respectively 1 045, 11 268, 6 654 and 1 226 folds of those in planktonic bacteria (all P<0.05), suggesting that T6SS and QS systems were related to the biofilm formation of PAO1 bacteria. Conclusion T6SS and QS systems might be involved in biofilm formation in Pseudomonas aeruginosa, and its regulatory mechanism needs further study.

Abstract:Objective To investigate the significance of lymphocyte structure parameters of Sysmex XN-9000 hematology analyzer in screening peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs. Methods From Dec. 2017 to Dec. 2018, 370 blood samples with positive alarm of atypical lymphocytes, which were detected by XN-9000 hematology analyzer in outpatient and emergency department of Changhai Hospital, Naval Medical University (Second Military Medical University), were collected in this study. Six lymphocyte structure parameters were recorded, including lymphocyte complexity (L-X), lymphocyte fluorescence intensity (L-Y), lymphocyte size (L-Z), dispersion width of lymphocyte complexity (L-WX), dispersion width of lymphocyte fluorescence intensity (L-WY) and dispersion width of lymphocyte size (L-WZ). According to the atypical lymphocyte proportion detected manually under microscope, the 370 samples were divided into 2 groups:atypical lymphocyte positive group (100 samples with an atypical lymphocyte proportion>5%) and atypical lymphocyte negative group (270 samples with an atypical lymphocyte proportion ≤ 5%), and the significance of each lymphocyte structure parameter was evaluated by receiver operating characteristic (ROC) curve. Then the parameters with high accuracy for screening atypical lymphocytes were analyzed by logistic regression model to study the significance of their combination. Results The lymphocyte structure parameters L-WY, L-X and L-Z had high accuracies in screening atypical lymphocytes, with the ROC area under curve (AUC) being 0.927, 0.939 and 0.931, respectively. The combined predictor was generated using L-WY, L-X and L-Z by logistic regression analysis model, and the ROC AUC of combined predictor was 0.979. When 0.058 1 was selected as the cut-off value, the sensitivity was 100.0% and the specificity was 77.8%. Conclusion Lymphocyte structure parameters L-WY, L-X and L-Z detected by Sysmex XN-9000 hematology analyzer can effectively screen peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs.

Abstract:Objective To evaluate the clinical value of Sysmex XN-9000 hematology analyzer for detecting peripheral blood nucleated red blood cells (NRBC). Methods A total of 16 273 peripheral blood samples were collected and examined by Sysmex XN-9000 hematology analyzer and microscopic manual detection. The sensitivity, specificity and positive prediction value and negative predictive value of NRBC were measured by manual measurement under microscope. The 248 specimens positive by both methods were used as subjects, and the correlation between the two methods for detecting NRBC was analyzed. The disease types of 277 patients positive of NRBC were analyzed by microscopic examination. Results The sensitivity of NRBC detected by Sysmex XN-9000 hematology analyzer was 89.5%, specificity was 99.6%, positive predictive value was 80.5%, and negative predictive value was 99.8%. There was a positive correlation between the percentages of NRBC detected by the two methods (r_s=0.813, P<0.001). Among the 277 NRBC-positive patients, 173 had hematological diseases and 104 had no hematologic diseases, and there were significant differences in NRBC counts between the two groups (median:0.38×10⁹/L vs 0.16×10⁹/L, P<0.05), and the percentages of NRBC were not significantly different (median:2.95% vs 3.60%, P=0.835 1). Among patients with hematological diseases, NRBC was mainly present in patients with acute lymphoblastic leukemia (31 cases), acute myeloid leukemia (55 cases), malignant lymphoma (39 cases) and multiple myeloma (18 cases). Among patients without hematologic diseases, NRBC was mainly present in those with solid cancer (24 cases) and cirrhosis hemorrhage (36 cases). Conclusion The Sysmex XN-9000 hematology analyzer can detect NRBC with high accuracy, and it thus has a promising clinical application value.

Abstract:Objective To explore the relationship between the changes of platelet parameters after renal transplantation and delayed graft function (DGF). Methods A retrospective analysis was conducted with 109 patients who underwent allograft renal transplantation from Jul. 2016 to May 2018 in the Department of Organ Transplantation of Changhai Hospital, Naval Medical University (Second Military Medical University). The patients were divided into DGF group (n=41) and non-DGF group (n=68). Peripheral blood samples were collected from the two groups before and at 1, 3, 7 and 14 d after operation. The platelet parameters, including platelet count (PLT), platelet-large cell ratio (P-LCR), mean platelet volume (MPV), platelet volume distribution width (PDW) and platelet hematocrit (PCT), were dynamically monitored. Receiver operating characteristic (ROC) curve was used to analyze the value of the platelet parameters for predicting DGF after renal transplantation. Results There was no significant difference in platelet parameters between the DGF group and the non-DGF group before operation. At 1, 3, 7, and 14 d after renal transplantation, PLT values in the DGF group were lower than those in the non-DGF group, MPV values were higher than those in the non-DGF group, with statistical significance found at 7 d after renal transplantation (both P<0.05). PCT in the DGF group was decreased first and then increased after renal transplantation. At 7 d after operation, PCT in the DGF group was markedly lower than that in the non-DGF group (P<0.05).PDW and P-LCR in the DGF group and the non-DGF group increased first and then decreased after renal transplantation. At 7 d after operation, PDW in the DGF group was markedly higher than that in the non-DGF group (P<0.05). There was no significant difference in P-LCR between the two groups at 7 d after operation (P=0.184). At 7 d after operation, the area under ROC curve for PDW and PCT were 0.781 and 0.758, with the optimal cut-off values being 16.75 fL and 0.155%, specificity being 92.6% and 63.2%, and sensitivity being 61.0% and 75.6%, respectively. Conclusion Dynamic monitoring of platelet parameters early after renal transplantation is helpful for the early diagnosis of DGF. There is an increased risk of DGF in patients with PDW>16.75 fL and PCT<0.155% at 7 d after operation.

Abstract:Objective To assess the clinical value of neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in diagnosis of ankylosing spondylitis. Methods Eighty patients with ankylosing spondylitis and 100 normal controls from Changhai Hospital, Naval Medical University (Second Militaray Medical University) were enrolled in our study. The fasting venous blood samples were collected in the morning for routine blood examination. The differences of NLR and PLR between the two groups were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of NLR and PLR, and combined diagnostic test was performed. Results The levels of NLR and PLR in ankylosing spondylitis patients were significantly higher than those in the control group (2.25[1.66, 3.35] vs 1.50[1.23, 2.09], P<0.01; 147.94[104.11, 188.80] vs 105.75[89.55, 148.02], P<0.01]. ROC curve analysis showed that the area under curve (AUC) of NLR in diagnosis of ankylosing spondylitis was 0.694 (95% confidence interval[CI]:0.615-0.772, P<0.01), and the sensitivity and specificity of NLR were 77.5% and 58.0%, respectively, when the cut-off value was 1.64. The AUC of PLR in diagnosis of ankylosing spondylitis was 0.662 (95% CI:0.580-0.756), and the sensitivity and specificity of PLR were 66.2% and 63.0%, respectively, when the cut-off value was 120.91. The sensitivity and specificity of NLR and PLR parallel testing (NLR/PLR) were 83.8% and 50.0%, and the sensitivity and specificity of the NLR and PLR tandem testing (NLR+PLR) were 61.2% and 75.0%, respectively. Conclusion NLR and PLR both have clinical value for the diagnosis of ankylosing spondylitis, and the combination of the two can improve the diagnostic sensitivity and specificity.

Abstract:Objective To analyze the difference of the carbohydrate antigen 242 (CA242) results measured by Luminex flow cytometry fluorescence immunoassay with different calibrations and different ambient temperatures, so as to evaluate the effect of ambient temperature on the measurement results. Methods Two CA242 samples with different concentrations (median-and high-value) were selected and the determination was repeated at 11 temperature points (18.3, 20.1, 21.5, 22.2, 24.1, 25.0, 25.4, 26.5, 27.4, 28.5, and 30.0℃) for 5 times by Luminex flow cytometry fluorescence immunoassay. The average value of the detection result at the calibration temperature (25℃) was taken as the reference value, and the biases of the detection results at different ambient temperatures were calculated. Forty-nine CA242 specimens covering high-, median-and low-values were examined at 20, 25 and 30℃ by Luminex flow cytometry fluorescence immunoassay, and the results were compared and correlation analysis was carried out. Results The biases of the median-and high-value samples at 18.3℃ were -35.6% and -29.4%, respectively. The difference between the measurement results at 20℃ and 25℃ was significant for the 49 specimens (P<0.001), and there was a linear correlation between them (Y=0.676 9X+0.374 7, R²=0.990 5). The difference of measurement results was significant between 30℃ and 25℃ (P<0.001), and there was a linear correlation between them (Y=0.896 6X+0.227 0, R²=0.999 4). Conclusion Too low or too high ambient temperature has a negative effect on the determination of CA242 by Luminex flow cytometry fluorescence immunoassay. The ambient temperature should be kept relatively constant and controlled within the range of calibration temperature ±4℃.

Abstract:Objective To explore underwater shock wave-induced injuries of the lung and brain in canines. Methods Eighteen Beagle dogs were randomly divided into six groups according to the distances to the explosion source:control group and 5 experimental groups (5 m, 7 m, 9 m, 11 m and 13 m groups). The animals were exposed to underwater shock wave via a self-designed underwater explosive instrument. The dynamic explosive process was recorded by the underwater high-speed camera. Computed tomography (CT) scans of brain and chest were performed 6 h after injury. Pathological examination and H-E staining for hippocampus and lung were conducted 24 h after injury. The expression levels of interleukin (IL)-6, IL-1β, IL-10, tumor necrosis factor α (TNF-α) and transforming growth factor β (TGF-β) in the hippocampus were measured by immunohistochemical staining. Results The underwater high-speed camera showed that the injury process included blast wave and bubble pulsation. The total mortality of the animals was 40.0% (6/15) in the experimental groups. CT examination revealed no major alterations in the brain of the animals, while there were pleural effusion and pneumothorax in the chest of animals in the experimental groups. H-E staining showed inflammatory cells infiltration in the hippocampal tissue and erythrocyte deposition in the alveoli of animals in the experimental groups. The expression levels of IL-6, IL-1β, IL-10, TNF-α, and TGF-β in the hippocampus of animals in the experimental groups were significantly elevated compared with those in control group (all P<0.05). Conclusion Brain and chest are damaged significantly after underwater explosion, which may be the main causes for the death of animals. It is important to elucidate the underlying mechanisms of brain injury caused by underwater explosive wave for the protection of underwater blast injuries.

Abstract:Objective To explore the association between methylenetetrahydrofolate reductase (MTHFR) rs1801133 polymorphism and lung cancer risk. Methods This case-control study included 974 lung cancer patients and 1 005 healthy controls living in Shanghai and Taizhou, Jiangsu Province. After collecting the peripheral blood samples of the participants, the whole blood genomic DNA was extracted for MTHFR gene rs1801133 genotyping. The effect of rs1801133 on lung cancer susceptibility was analyzed through unconditional logistic regression analysis. Results Compared with CC genotype, MTHFR rs1801133 CT and TT genotypes significantly decreased lung cancer risk (odds ratio[OR]=0.801, 95% confidence interval[CI]:0.651-0.985, P=0.035; OR=0.754, 95% CI:0.582-0.975, P=0.032), but this association became insignificant after adjusting age, gender, smoking status, and family cancer history (OR=0.841, 95% CI:0.677-1.045, P=0.118; OR=0.799, 95% CI:0.609-1.047, P=0.104). However, in dominant model, CT+TT genotypes exhibited a significantly reduced lung cancer risk in males (OR=0.764, 95% CI:0.597-0.977, P=0.032) and those with a family cancer history (OR=0.600, 95% CI:0.385-0.925, P=0.022), and a significantly reduced risk for having squamous cell carcinoma (OR=0.727, 95% CI:0.542-0.976, P=0.033). Conclusion The MTHFR gene rs1801133 C>T mutation might reduce the risk of lung cancer in males and those with a family history of cancer, especially those with squamous cell carcinoma.

Abstract:Objective To evaluate the clinical value of echocardiography and blood lipid level in the diagnosis of coronary heart disease (CAD). Methods A retrospective analysis was conducted on 240 suspected CAD in-patients who were treated in the Second Hospital of Nanjing, Southeast University from Jun. 2013 to Oct. 2014. The patients were divided into non-CAD group (n=58) and CAD group (n=182) according to the results of coronary angiography. The patients in CAD group were further divided into single vessel lesion group (n=84) and multi-vessel lesion group (n=98). The indexes of color Doppler echocardiography and blood lipid levels were compared between non-CAD group and CAD group, and single vessel disease subgroup and multiple vessel disease subgroup. Logistic regression was used to analyze the influencing factors of CAD. Results E-peak velocity (E) in early diastolic phase and the ratio of E peak velocity to late diastolic phase A-peak velocity (E/A) in CAD group were lower than those in non-CAD group; the E-peak deceleration time (DT) and left ventricular isovolumetric relaxation time (IVRT) were longer than those in non-CAD group; the left atrial diameter (LAD), interventricular septal thickness (IVS) and left ventricular posterior wall thickness (LVPW) were higher than those in non-CAD group; and the left ventricular diameter (LVD) was larger than that of non-CAD group (all P<0.05). In patients with CAD, E in multi-vessel lesion subgroup was higher than that in single vessel lesion subgroup; E/A in multi-vessel lesion subgroup was lower than that in single vessel lesion subgroup; DT and IVRT were longer than those in single vessel lesion subgroup; and LAD, IVS, LVPW and LVD were larger than those in single vessel lesion subgroup (P<0.05). The levels of serum total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) in CAD group were higher than those in non-CAD group, and the level of high-density lipoprotein cholesterol (HDL-C) was lower than that in non-CAD group (all P<0.05). The levels of serum TC, TG and LDL-C in multi-vessel lesion subgroup were higher than those in single vessel lesion subgroup, and the HDL-C level was lower than that in single vessel lesion subgroup (all P<0.05). Logistic regression analysis showed that age, TC, IVRT, LAD and LDL-C were independent risk factors for CAD (all P<0.05), and E and HDL-C were independent protective factors for CAD (both P<0.05). Conclusion Abnormal blood lipid and left ventricular diastolic function are closely related to the development and progression of CAD, and their abnormalities are of great significance for the clinical diagnosis of CAD.

Abstract:Calcific aortic valve disease is a process involving complex pathological changes such as endothelial injury, chronic inflammation, extracellular matrix remodeling, cell phenotype differentiation and apoptosis. The aortic valve is mainly composed of internal valve interstitial cells and external valve endothelial cells, and they are all involved in the pathological process of calcific aortic valve disease. Non-coding RNA participates in the pathophysiological process of cardiovascular disease mainly through post-transcriptional regulation mechanism, and may play an important role in the development and progression of calcific aortic valve disease.

Abstract:Atrial fibrillation is one of the most common arrhythmias in clinic. The incidence of atrial fibrillation remains high in recent years, greatly affecting the quality of life of patients. Many factors may lead to atrial fibrillation, and exercise is closely related to the development and progression of atrial fibrillation. Whether exercise can increase the risk of atrial fibrillation and how to formulate a scientific and effective exercise program have now become focuses of clinical research. This review summarizes the latest research progress on the relationship between exercise and atrial fibrillation, systematically expounds the physiological basis of exercise in atrial fibrillation, and objectively evaluates the limitations of the current exercise program.

Abstract:Objective To establish a new, simple method for isolation and culture of fibroblast-like synoviocytes (FLSs) from adjuvant arthritis (AA) rabbits using suspended explant culture method. Methods Sixteen healthy New Zealand white rabbits, weighing 2.0-2.5 kg, were randomly divided into two groups:the normal control group (n=8) and the model group (n=8). Rabbit models of AA were prepared by injection with complete Freund's adjuvant at multiple sites and time points. The joint synovial layers were obtained. The FLSs of rabbits with AA were cultured by suspended explant culture method and explant culture method. The growth and morphological characteristics of cells were observed, and the cell viability was measured by CCK-8 assay. The expression of vimentin was detected by immunocytochemistry. Results The tarsometatarsal joints and toes of rabbits in the model group were swollen more obviously than those in the normal control group. After the toes were dissected, obvious microvascular proliferation and inflammation were observed in the model group. The results of H-E staining showed that synoviocytes in the normal control group were arranged in a regular manner like beads, while those in the model group were arranged in a disordered manner, suggesting that the AA model was successfully prepared. The operating durations required for suspended explant culture method and explant culture method were about 25 min and 1 h, respectively. The morphology and viability were similar for the cells obtained by the two methods. The positive rates of vimentin in the suspended explant culture method and explant culture method group were 98.01% and 98.35%, respectively. Conclusion Isolation and culture of FLSs by suspended explant culture method has been successfully established, and the method is simple and needs a short time.

Abstract:Objective To known about the status of first-aid techniques among naval primary healthcare personnels, providing reference for improving the related first-aid training. Methods A self-made questionnaire was created based on the naval training activities of mass war wound rescue and the requirements of new guidelines and assessment standards. The questionnaire was used to investigate 172 primary naval healthcare personnels. The first aid techniques were divided in well-mastered, mastered, unskilled and un-mastered. And our analysis focused on the first-aid training of war wound and the mastery of first-aid techniques. Results The naval primary healthcare personnel well mastered the six traditional first-aid techniques, including hemostasis, ventilation, bandaging, fixation, handling, and cardiopulmonary resuscitation. Techniques such as infusion via bone, advanced airway management were not well-mastered, or even hard to master. Conclusion To improve war wound rescue capability of primary naval healthcare personnels, we should continue the training activities of mass war wound rescue, improve the related theory, strengthen the related training, and establish a practical war wound rescue training and evaluation system.

Abstract:Objective To study the clinical diagnosis and treatment of parkinsonism (PDS) with freezing of gait (FoG), so as to provide clues to delay the progress of the symptom. Methods A prospective study was designed. The outpatients of PDS with the main complaint of FoG were included and followed up for 2-6 years in the Department of Neurology, Changzheng Hospital, Naval Medical University (Second Military Medical University) from Nov. 2010 to Jan. 2016. The patients were given L-dopa first, and then antidepressants and other therapies (including other medication and surgery) were given if the previous treatments were not effective. The motor function of patients was evaluated by Hoehn-Yahr staging scale and the second and third part of the unified Parkinson disease rating scale (UPDRS); the general mental, behavior and emotional state were evaluated by the first part of UPDRS; the cognition was evaluated by minimum mental state examination (MMSE); depression and anxiety were evaluated by 17-item Hamilton depression scale (HAMD-17) and Hamilton anxiety scale (HAMA); and the severity of FoG was evaluated by the timed up and go test (TUGT). Results Six of the 15 cases with FoG were diagnosed as Parkinson disease (PD), and 9 had other disorders (2 with progressive supranuclear palsy, 3 with primary progressive FoG, 1 with frontotemporal dementia, 1 with vascular PDS, 1 with drug-induced PDS, and 1 with unknown-cause PDS). There were no significant differences in age, gender, severity of symptom or mental state (Hoehn-Yahr stage, UPDRS-Ⅰ score, UPDRS-Ⅱ score, UPDRS-Ⅲ score, MMSE score, HAMD-17 score, HAMA score and TUGT time) between PD group and non-PD group (all P>0.05). At the baseline, the FoG duration of PD patients ([7.50±2.66] years) was longer than that of non-PD patients ([2.56±0.88] years, P<0.01). After treatment with increasing dose of L-dopa, 4 PD patients were improved while non-PD patients had no responses (4/6 vs 0/9, P=0.01). Conclusion The causes of PDS with FoG are heterogeneous. The duration of FoG is helpful for diagnosis of idiopathic PD, while the severity of FoG has little value for etiological analysis. Increasing the dose of L-dopa is effective for FoG in advanced PD, while it has uncertain effect for FoG of other reasons.

Abstract:Objective To evaluate the efficacy and toxicity of dispersing phlegm and eliminating stagnation traditional Chinese medicine (TCM) treatment protocol (Jinlongshe oral liquid combined with Javanica oil emulsion injection) in treating postoperative colorectal cancer, and to observe the immunologic function and quality of life of the patients. Methods Sixty-eight patients with postoperative colorectal cancer were divided into two groups according to the patients' wishes:phlegm elimination group (n=36) received Jinlongshe oral liquid combined with Javanica oil emulsion injection, and chemotherapy group (n=32) received capecitabine combined with oxaliplatin (XELOX) protocol for 6 cycles. The changes of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9), clinical symptoms of TCM, toxicity, immunologic function, and the quality of life (assessed by Karnofsky performance scale[KPS]) were observed. Results After 6 cycles of treatment, there were no significant differences in CEA or CA19-9 between the two groups (P>0.05), and the scores of clinical symptoms of TCM also showed no significant difference between the two groups (P>0.05). The incidences of leucopenia, hand-foot syndrome and allergy in the phlegm elimination group were significantly lower than those in the chemotherapy group (all P<0.05). Immune function examination showed that the proportions of CD4⁺ and CD8⁺ T lymphocytes after treatment were significantly lower than those before treatment in the two groups (both P<0.05), but the proportions of CD3⁺, CD4⁺, and CD8⁺ T lymphocytes, and the ratio of CD4⁺/CD8⁺ lymphocytes showed no significant differences between the two groups (P>0.05). The quality of life in the phlegm elimination group was higher than that in the chemotherapy group, and the difference of KPS scores was significant (P<0.05). Conclusion Compared with XELOX chemotherapy, TCM treatment of dispersing phlegm and eliminating stagnation can alleviate the toxic reaction and improve the quality of life in patients with intestinal cancer after operation.

Abstract:Objective To explore the efficacy of meropenem in the treatment of neonatal carbapenem-resistant Klebsiella pneumoniae (CRKP) sepsis and its influencing factors, so as to provide reference for reasonable use of antibiotics in clinic. Methods A total of 27 neonates who were diagnosed as CRKP sepsis in Shanghai Children's Hospital from Jun. 2014 to Jun. 2018 were included in this retrospective study. The clinical efficacy of meropenem was evaluated and the patients were divided into two groups:meropenem monotherapy effective group and meropenem monotherapy ineffective group who required other antibiotics for combination therapy. The perinatal factors, prior exposure to carbapenems and other clinical characteristics were compared between the two groups. Results The effective rate of meropenem monotherapy in treating neonatal CRKP sepsis was 48.1% (13/27), and the overall effective rate was 74.1% (20/27) when another antibiotic was added. The incidences of open wound after surgery (7/14 vs 1/13), septic shock (7/14 vs 1/13), positive culture of sterile coelomic fluid (6/14 vs 0/13), and invasive mechanical ventilation (10/14 vs 1/13) were higher in meropenem monotherapy ineffective group than in meropenem monotherapy effective group (all P<0.05), and the diameter of CRKP inhibition zone in meropenem monotherapy ineffective group was smaller than that in meropenem monotherapy effective group ([9.14±3.37] mm vs[12.85±5.27] mm, P<0.05). Conclusion Meropenem monotherapy is effective for treatment of neonatal CRKP sepsis. Other antibiotics are recommended when the patients also have open wound after surgery, septic shock, positive culture of sterile coelomic fluid, invasive mechanical ventilation, or smaller inhibition zone of CRKP on meropenem.

Abstract:Abstract: Objectives: This article tries to realize the impact of liver trauma and iatrogenic invasive examination on liver and body through 1 rare clinical case report of hepatic artery portal venous fistula (HAPF). Methods：We combined the data of 19 years after live rupture repair operation which was caused by juvenile trauma with the domestic and foreign literatures to analyzed the cause and the present situation of diagnosis and treatment. Conclusions: Traumatic and iatrogenic hepatic artery portal vein fistula is rare at home and abroad, we explored etiology and diagnosis by high resolution three-dimensional reconstruction of CT and 3D vascular reconstruction technology in the paper. Then, we suspect that it was arterial-portal venous shunt which caused by trauma contributes to portal hypertension, and we conclude that all liver trauma and invasive procedure may result in HAPF. Furthermore, we suggest that the HAPF should be clearly classified as one of complications in liver trauma and iatrogenic invasive procedures. Finally，we learned that neither one of acute renal failure, acute liver failure and acute heart failure is a rare clinical presentation of HAPF.

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