[Protective effect and mechanism of mild hypothermia on liver injury after cardiopulmonary resuscitation in pigs].

Objective: To investigate the effect of mild hypothermia therapy on liver after cardiopulmonary resuscitation. Methods: Thirty-three inbred Chinese Wuzhishan (WZS) minipigs, weighted (28±2) kg, were used to establish a ventricular fibrillation model. And 30 animals survived after cardiopulmonary resuscitation reached basic life support. The surviving animals were randomly divided into two groups: mild hypothermia group (group M, n=15) and conventional treatment group (group C, n=15). All the animals were observed for 24 hours. Blood samples were extracted at baseline, 0.5, 1, 2, 4, 6, 12 and 24 h after successful resuscitation. The concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected at the time points. The enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of interleukin-6 (IL-6) and tumour necrosis factor-alpha (TNF-α). The data were compared between the two groups, LSD test was used when the variance was homogeneous, and Tamhane T2 test was used when the variance was uneven. Results: Eleven pigs (73.3%) in the group M and 8(53.3%) in the group C survived at 24 h after successful resuscitation, with no statistically significant difference between the two groups (χ(2)=1.229, P=0.225). After successful resuscitation, the AST, ALT increased in both group but less in M group (all P<0.05). After successful resuscitation, the concentrations of TFN-α and IL-6 in the blood increased in both groups, reached the peak at 4h, and then decreased gradually. The concentrations of TFN-α in group M were lower than those in group C at 0.5, 2, 4 and 6 h after successful resuscitation (t=0.01, 0.01, 0.87, 0.86, all P<0.05). The concentrations of IL-6 in the group M were lower than those in group C at 0.5, 1, 2 and 4 h after successful resuscitation (t=0.23, 0.78, 0.11, 0.80, all P<0.05). Conclusions: After successful resuscitation, the release of inflammatory mediators, such as TNF-α and IL-6, and cell apoptosis may involve in liver ischemia reperfusion injury. After successful resuscitation, the liver undergoes ischemia-reperfusion injury, which may be related to the release of inflammatory mediators such as TNF-α and IL-6. Mild hypothermia therapy can prevent the release of TNF-α, IL-6 to reduce the degree of liver damage after resuscitation.

[Mutation of RAS gene in follicular-differentiated thyroid tumors and its significance].

Objective: To investigate the frequency and clinical significance of RAS mutation in thyroid tumors with follicular differentiation. Methods: The samples and clinical data of 207 patients with thyroid follicular-differentiated tumors were collected at Shunyi Region Hospital of Beijing from January 2000 to December 2017, including 60 cases of follicular variant of papillary thyroid carcinoma (FVPTC), 42 cases of classical papillary thyroid carcinoma (CPTC), 26 cases of follicular thyroid carcinoma (FTC), 40 cases of follicular adenoma (FTA) and 39 cases of adenomatoid hyperplasia. BRAF V600E mutations were detected using immunohistochemical staining. FVPTC was divided into BRAF-like (BRAF V600E mutant) and RAS-like (without BRAF V600E mutant). Real-time fluorescence quantitative polymerase chain reaction was used to detect the RAS mutation in RAS-like FVPTC, CPTC, FTC, FTA and adenomatoid hyperplasia. The genetic differences in RAS mutation and their correlation with clinicopathological features were analyzed. Results: The average age of patients with benign and malignant tumors in thyroid with follicular differentiation was 53.2 years and 47.7 years, respectively. In these patients, 42 were male and165 were female. Most of the tumors had a maximum diameter of less than 4 cm, and rarely spread to the surrounding tissues of thyroid and were at early stage (stages Ⅰ and Ⅱ). The diameter of tumors in FTC was significantly larger than that in RAS-like FVPTC and CPTC groups (P<0.01). Peripheral thyroid invasion was rare in the RAS-like FVPTC, CPTC and FTC groups, but the clinical stage of FTC was more advanced than that of RAS-like FVPTC group (P<0.01) or CPTC group (P<0.01). The real-time fluorescence quantitative PCR showed that the RAS mutation rate in FTC was the highest (61.5%), significantly higher than that in others (P<0.01). The RAS mutation rate in CPTC was the lowest (4.8%), while those in RAS-like FVPTC, FTA and adenomatous hyperplasia were similar (about 15%). The Spearman rank correlation analysis showed that the RAS mutation was not correlated with age, sex or tumor size in benign lesions (FTA and adenomatous hyperplasia), nor was it associated with age, sex, tumor size, lymph node metastasis, spreading of tumors to thyroid and clinical stage in malignant tumors (RAS-like FVPTC, CPTC and FTC). Conclusions: RAS mutation can occur in both benign and malignant thyroid tumors with follicular differentiation, in which the incidence is the highest in FTC. Both morphologic and immunohistochemical changes should be taken into account. The molecular genetics of RAS-like FVPTC is similar to FTA and adenomatous hyperplasia. RAS gene mutation appears not to be a prognostic factor for thyroid diseases.

Construction of an evaluation index system for determining the academic impact of military medical scholars.

INTRODUCTION: Academic papers are an essential manner for describing new ideas and consolidating existing concepts in the field of military medicine. The academic impact of military medical publications reflects the extent and depth of recognition, acceptance and utilisation of the concepts transmitted in these publications. The aim of this research was to construct an evaluation index system suitable for evaluating the academic influence of scholars in the field of military medicine. METHODS: Using the Delphi consensus methodology, 30 experts from the field of military medicine, military medical information and library and information science were asked during three rounds of questioning to score the feasibility and importance of indicators that could be used to determine academic impact. An analytic hierarchy process method was used to calculate the relative weighting of each indicator in determining the final level of academic impact. RESULTS: Eight evaluation indicators were agreed on to potentially determine academic impact. These comprised: 'Web of Science documents', 'Citation impact', 'h-index', 'Percentage of international collaborations', 'Percentage of the top 10% of the cited frequency', 'Category normalised citation impact', 'Percentage of documents cited' and 'The number of F1000 Recommended papers'. CONCLUSIONS: The evaluation index system determined from this study combines the advantages of both qualitative and quantitative recognised evaluation indicators, which are subsequently weighted according to their importance in the field of military medicine. It is hoped that this framework will provide a manner in the future for comparing the potential academic impact of military medical scholars.

[The role of four criteria in assessment of the severity and prognosis of hyperlipidemic acute pancreatitis].

OBJECTIVE: To explore the four criteria, including bedside index for severity in acute pancreatitis(BISAP), Ranson score, modified CT severity index(MCTSI) and acute physiology and chronic health evaluation scoring systemⅡ(APACHE Ⅱ) in assessment of severity and prognosis of hyperlipidemic acute pancreatitis. METHODS: A total of 326 patients with hyperlipidemic acute pancreatitis were studied retrospectively from August 2006 to July 2015. The discrepancy of the four criteria in assessment of severity and prognosis of hyperlipidemic acute pancreatitis was compared with chi-square test and receiver operating characteristic curve. RESULTS: The incidences of moderately severe acute pancreatitis and severe acute pancreatitis, local complications and mortality of patients with BISAP score≥3, Ranson score≥3, APACHE Ⅱ score≥8 and MCTSI score≥4 were significantly higher than BISAP score<3, Ranson score<3, APACHE Ⅱscore<8 and MCTSI<4 respectively (all P<0.05). As far as severity was concerned, the sensitivity and AUC of APACHEⅡ were 57% and 0.814, which were higher than the other systems. The second most sensitive criterion was BISAP. In assessment of local complications, the sensitivity and AUC of MCTSI were 68% and 0.791, which were higher than the other three. The most sensitive criterion to predict mortality was BISAP with sensitivity 89% and AUC 0.867, which was followed by APACHE Ⅱ. CONCLUSIONS: All four criteria can be used to determine the severity, local complications and mortality. Generally, BISAP is simple and easy to practice, and better than the other three.