Volume 90  ·   Issue 11  ·  2010

Septic shock is the leading cause of death in intensive care unit (ICU) patients. In recent years, the treatment of septic shock has made great progress. In 2004, the American Society of Critical Care Medicine (SCCM), the European Society of Critical Care Medicine (ESICM) and the International Forum on Systemic Infections (ISF) developed the surviving sepsis campaign guideline based on the results of several prospective clinical trials.

Objective To investigate the expression and significance of phosphtidylinositol 3-kinase/protein kinase B (PI3K/PKB) signal transduction pathway in severe acute pancreatitis-associated lung injury. Methods Twenty-four healthy male Changbai pigs were randomized into four groups: sham operation group (n = 6), ALI group (n = 6), ALI plus LPS (lipopolysaccharide) group (n = 6) and ALI plus Wortmannin group (n =6). The expression levels of PI3K and PKB were determined by both RT-PCR and Western blot. Activity changes of NF-κB were detected by electrophoretic mobility shift assay (EMSA). Contents of TNF-α and IL-1β in bronchoalveolar lavage fluid (BALF) were examined by ELLSA. The histopathological changes of lung were observed. Results The expressions of mRNA and protein PI3K and PKB, NF-κB activity and TNF-α, IL-1β3 in BALF in ALI group were higher than those in sham operation group(P <0.05 or P <0.01). In ALI plus LPS group, they increased significantly in comparison with ALI group and sham operation group after injection of LPS(P <0.05 or P <0.01). In ALI plus Wortmannin group, these parameters were significantly inhibited by Wortmannin in comparisons with ALI group and ALI plus LPS group (P < 0.05 or P < 0.01). Conclusion The phosphtidylinositol 3-kinase/protein kinase B signal transduction pathway is found to participate in the pathological process of severe acute pancreatitis-associated lung injury through the up-regulations of NF-κB activity, TNF-α and IL-1β.

Objective To evaluate the effect of aspiration of coronary thrombus upon the outcome of in-hospital primary percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) patients. Methods A total of 202 AMI patients undergoing primary PCI and receiving aspiration thrombeetomy catheter during from December 2007 to November 2008 were enrolled into the study group. And 148 receiving only routine PCI but with similar coronary angiography and basic characteristics were enrolled into the control group. The immediate and in-hespital outcomes were compared between two groups. Results There were no significant baseline differences between two groups. Compared with the control group, no-reflow/slow flow (3.5% vs 8.8%, P =0.038), acute and subacute stent thrombosis (0.5% vs 4.7%, P=0.011), heart failure(11.4% vs 19.6%, P=0.035), re-infaretion (1.0% vs 6.1%, P = 0.010), in-hospital mortality (3.5% vs 8.8%, P = 0.038), peak level of serum CK-MB (152.0 U/L±73.6 U/L vs 171.0 U/L±71.2 U/L,P =0.015)and TnI (44.7 μg/L ±31.2 μg/L vs 51.9 μg/L ± 33.6 μg/L, P =0.041) decreased in the study group. However, stent was directly implanted (44.1% vs 24.3%, P =0.002), TIMI flow grade 3 was obtained(90.1% vs 81.8%, P =0.027) and faster ST segment resolution (67.8% vs 53.4%, P =0.008) improved in the study group. Conclusion Application of thrumbas aspiration in patients with acute myocardial infarction is effective to decrease no-reflow/slow flow and achieve a better clinical prognosis during hospitalization.

Objective To investigate the role of cardiac troponin Ⅰ (CTN Ⅰ) for predicting 28-day mortality of non-cardiogenic critically ill patients at emergency department (ED). Methods A total of 431 non-cardiogenic critically ill patients at ED were prospectively enrolled and blood samples obtained for CTN Ⅰ measurements. A variety of laboratory variables and the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores were recorded. At Day 28, the survival status of each patient was ascertained and the association between CTN Ⅰ at presentation and mortality assessed. Results Two hundred patients had elevated CTN Ⅰ levels and 231 had normal levels. Compared with those with normal levels, the patients with elevated CTN Ⅰ levels had a higher 28-day mortality. The CTN Ⅰ concentration alone had an area under the receiver operating characteristic curve (AUC) of 0.733 for mortality prediction. The optimal CTN Ⅰ cut-off point for predicting the 28-day mortality was 0.05 ng/L By multivariate analysis, an elevated CTN Ⅰ level(>0.05 ng/L, HR 1.979,95% CI 1.398-2.802, P <0.001), a high APACHE Ⅱ score(> 16, HR 4. 428,95% CI 3.019-6.494, P < 0.001) and hypoalbuminemia (< 25 g/L, HR 1.812, 95% CI 1.276-2.573, P = 0.001)were the three most important independent predictors for a shorter survival. Combination analysis showed a shorter survival in patients with a high APACHE Ⅱ score plus elevated CTN Ⅰ levels than those with a high APACHE Ⅱ score or an elevated CTN Ⅰ level alone. Conclusion An elevated serum CTN Ⅰ level is a independent predictor of 28-day mortality in non-cardiogenic critically ill patients. And CTN Ⅰ level and APACHE Ⅱ score have an additive effect in outcome prediction.

Objective To evaluate whether administration of Flurbiprofen Axetil before elective laparoscopic eholecystectomy can affect the BIS index and hemodynamics. Method Sixty patients scheduled for elective laparoscopic cholecystectomy were randomized into two groups. Flurbiprofen axetil 1 mg/kg was used intravenous 15 minutes before induction of general anesthesia in group B, while group A without premedication. Total intravenous anesthesia was maintained with propofol TCL BIS index, bloodpressure and heartrate were recorded at the time just before induction, after endotracheal intubation, 5 minutes before incision, incision, 5, 10 , 15, 20 and 25 mins after incision. Result There were no significant difference between two groups in BIS index during period of anesthesia and awakeness (all P >0.05). Compared with group A, both systolic and diastolic blood pressure in group B at time of incision (T_1)are apparently lower (P < 0.05). While, blood pressures were no significant different at other time (all P >0.05). ConclusionIn this study, administration of flurbiprofen before surgery of laparoscopic cholecystectomy did not alter BIS and the degree of sedation during total intravenous anesthesia. But it can reduce the harmful stimulation to cardiovascular reaction from surgery and make hemodynamic status more stable. Flurbiprofen can be safely and effectively used on elective laparescopic cholecystectomy.

Objective To study the clinical features, neuro-radiology and treatment of intracranial subepondymomas. Methods A total of 22 subependymomas were reviewed with regards to clinical presentation, neuro-imaging features, treatment, histopathological features and long-term follow-up. There were 13 males and 9 females with an age range of 5 to 54 years old. Fourteen tumors were located in lateral ventricles, 1 located on frontal-parietal lobe, 1 on mesencephalon, 2 on ports, 2 in fourth ventricle and 1 on cerebellum. One tumor was located in temporal lobe, mesencephalon, thalamus and pons. Results All tumors were surgically removed, including 18 totally removed (including 14 supra-tentorial and 4 infra-tentorial tumors) and 4 partially removed(including 1 supra- and infra-tentorial and 3 infra-tentorial tumors). During the follow-up, there was 1 recurrent case. Conclusion Intracranial subepondymoma is a rare benign tumor. And microsurgery represents the most effective therapy. Total resection can be expected for supra-tentorial tumors, but partial resection is often performed for infra-tentorial tumors. The prognosis is excellent and there is a rare tumor recurrence.

Objective To investigate the feasibility of contrast-enhanced sonography in the evaluating renal cortical perfusion. Methods Thirteen patients with renal artery stenosis(RAS)≥50% were included. Technos Du8 and CnTI technology were used in the pre and post treatment of percutaneous translumiual renal artery angioplasty with stent(PTRAS). Differences in area under curve(AUC) were used to quantitate renal cortex peffusion change during follow up of PTRAS. Results Contrast-enhanced sonography showed significantly reduced peak flow rate by improving the renal trunk artery patency with FIRAS. AUC ratio was (6.41±38.14)% in PTRAS renal vs (-9.65±24.35)% in contralateral renal during 3-6 months follow up(P >0.05). They had no statistical difference. Otherwise,Severe stenosis of renal artery(≥75%) show the decreased AUC ratio of (-5.19±45.88)% in 7 cases vs (19.95 ±23.61)% with midrunge stenosis(50% -75%) in 6 cases (P <0.05). Conclusion Contrast-enhanced aonography may provide a sensitive detection of change of the renal cortical microcirculation with the helpful to estimate therapeutic effect of PTRAS.

Objective To investigate the relationship between abdominal obesity and intracranial artery stenosis and the underlying mechanism. Methods By cluster sampling, 1405 adult Han people were selected from the residential communities. Among them, 1035 people conformed to the inclusion criteria. Medical history was documented and body height, body weight,waist circumference, hip circumference and blood pressure were measured. Venous blood samples were collected to detect the serum concentrations of fasting glucose, total cholesterol and triglycerides. Serum nitric oxide (NO) level was determined by cadmium reduction method. Middle cerebral artery stenosis (MCAS) was diagnosed by transcranial Doppler. The SPSS 11.0 software package was used for data analysis. Results MCA stenosis was found in 66 subjects (6.4%). Univariate analysis showed history of hypertension, history of ischemic heart disease, systolic blood pressure and diastolic blood pressure were the risk factors for MCAS and waist-to-hip ratio (WHR) was a risk factor only in males. Logistic regression demonstrated history of hypertension was an independent risk factor for MCAS beth in males and females (P =0.011, P =0.009) and WHR for MCAS only in males (P = 0.030). Among males and females over 55 years old, the NO levels were higher in people with a higher WHR and the difference was statistically significant (P = 0.042, P = 0.016) ; however the NO levels for people with a varying WHR showed statistically insignificant difference among females under 55 years old (P = 0.228). Conclusion Hypertension and abdominal obesity are important risk factors for MCAS. Endothelial cell dysfunction and an elevated level of oxidative stress may be involved in the atherogenetic mechanism of abdominal obesity while estrogen may play a protective role in it.

Objective To evaluate retrospectively the treatment effects and side effects of malignant vertebrate metastasis who had received radiotherapy or percutaneous verterbreplasty (PVP) or PVP combined with radiotherapy. Methods Two hundred and sixty-three patients who had been diagnosed as malignant tumor with vertebrate metastasis received PVP (87 paitents)or radiotherapy(111 paitents) or PVP combined with radiotherapy (65 paitents). Radiotherapy was done one week after PVP procedure in PVP combined with radiotherapy group. All patients received regular follow-up. The changes of pain scale were analyzed by NRS. The improvement of quality of life was evaluated by inquiry questionnaire of EORTC QLQ-C30. The side effects were also observed. Results All defects in vertebrate metastasis in PVP treating were fully filled by polymethylmethacrylate (PMMA) under CT examination. The NRS number decreased significantly after 6 hours after treating in PVP Group and PVP combined with radiotherapy Group (P < 0.01), which shows easement of pain was rapid. The NRS number decreased significantly after one month after treating in radiotherapy Group (P < 0.01), which shows easement of pain was slow. The score of EORTC QLQ-C30 inquiry questionnaire in three Groups reduced ,which indicated that the quality of life had been improved. In PVP Group and PVP combined with radiotherapy Group, the score of EORTC QLQ-C30 changed most significantly(P < 0.01). There were no severe clinical complications. Conclusions It is safe and effective to treat malignant tumor patients with vertebrate metastasis by PVP combined with radiotherapy and quality of life had been improved significantly with long catabasis.

Objective To explore the genetic association of PKCγgene rs3745406 polymorphism with maior depressive disorder(MDD)and their clinical pbenotypes. Methods A total of 453 Chinese Hall MDD patients with an initial episode were recruited from our hospital.The symptonmtic phenotypes of these cases were evaluated by HAMD.Polymerase chain reaction (PCR) and difeet sequencing analysis were used to detect the genotype of rs3745406.Associations of allele.genotype and quantitative character were analyzed using the UNPHASED software. Results (1) The distributions of genotypes in both study and control samples were in a Hardy-Weinberg equilibrium(X~2=1.46,P=0.25);(2)No significant allelic and genotypie association Was found in these samples(P>0.05);(3)Further analyses revealed a significant association between rs3745406 locus and HAMD suicidal phenotypes(X~2=4.746,P=0.0360). Conclusion The PKC,rs3745406 polymorphism is not significantly associated with MDD whereas it has a marked association with suicidal symptoms in MDD.

Objective To investigate the effect of hydroxyethyl starch (HES, 130/0.4) on lipopolysaccharide (LPS) - induced endothelial injury in rat mesenteric venules. Methods Thirty-six Wistar rats weighing 200-250 g were randomly divided into 3 groups, n = 12 for each group. Rats were given LPS(2mg/kg) and followed by normal saline 16 ml· kg~(-1)·h~(-1) in LPS group or HES 16 ml·kg~(-1)·h~(-1) in HES group for 60 min. Rats in control group received equal volume of saline. The dynamic changes in diameters of postcapillary venules, red blood cell velocities in venules, and hydrogen peroxide released from venules were evaluated. The uhrastructure of postcapillary venule was observed by electron microscopy. Results Mesenteric venular RBC velocities, vascular diameters and shear rates on the venular wall remained constant in any of the groups during the observation (P > 0.05). The hydrogen peroxide generation from venules increased in both HES and LPS groups (P < 0.05). In HES group, the hydrogen peroxide generation and cytoplasmic caveolae in postcapillary venule induced by LPS were significantly inhibited compared with LPS group (P < 0.05). Conclusions Hydroxyethyl starch (130/0.4) could reduce the LPS-induced endothelial injury in rat mesentery. The effect was related to the inhibition of hydrogen peroxide generation on venular wall.

Objective To construct a latent human soluble tumor necrosis factor receptor Ⅰ(hsTNFR Ⅰ) using the latency associated protein (LAP) of transforming growth factor-β1 (TGF-β1) fused via a matrix metalloproteinase (MMP) cleavage site to hsTNFR Ⅰ so as to detect the latent biological activity of LAP-MMP-hsTNFR Ⅰ fusion protein. Methods A double-stranded deoxyoligonucleotide coding for MMP cleavage site was cloned into plasmid pcDNA3.1. LAP and hsTNFR Ⅰ cDNA were then inserted into both two sides of MMP cleavage site. After being transferred by LAP-MMP-hsTNFR Ⅰ fusion gene with liposome, the expression of fusion protein in COS-7 cells was detected by RT-PCR and Western blot. The inhibitory effect of fusion protein upon cytotoxicity of TNF-α was detected by methyl thiazolyl tetrazolium (MTT) assay before and after the fusion protein incubated in MMP or peritoneal fluid from endometriosis patients. Results The recombinant plasmid LAP-MMP-hsTNFR Ⅰ -pcDNA3. 1 was constructed successfully and was expressed effectively in COS-7 cells. The MTT assay showed that there was no difference in the mortality rote of L929 cells between LAP-MMP-hsTNFR Ⅰ -pcDNA3.1 and empty vector transfection groups (P>0.05). The mortality rates of L929 cells with 800 ng/L TNF-α in LAP-MMP-hsTNFR Ⅰ -pcDNA3.1 transfection group after incubation with MMP or peritoneal fluid from endometriosis patients were(44.5 ±2.4) % and(33.8±1.9) % respectively. And it was lower than the pre-incubation period (58.1± 2.4) %(P<0.05). Conclusion The biological activity of LAP-MMP-hsTNFR Ⅰ fusion protein can be made latent by LAP and activated by peritoneal fluid from endometriosis. Thus a new method has been provided for a targeted therapy of endometriosis.

Objective To investigate gene expression of astroeytes under the actions of amyloid peptide Aβ_(1-42) and α-antichymotrypsin (ACT) and to explore the characteristics of inflammatory reactions occurring in brain of Alzheimer's patients. Methods Human primary astrocytes were cultured to the second passage and then treated with lipopelysaccharide (LPS), Aβ_(1-42) (50 μmol/L) and Aβ_(1-42)/ACT (50:5 μmol/L) respectively. At 24 h, cells were harvested for total RNA extraction. Gene expression profile was screened by microarray technique. And the function enrichment of differentially expressed genes and the Aβ_(1-42)/ACT had demonstrated marked effects on altering the astrocyte gene expression. And the gene up-regulation was predominant. But the gene expression spectrum varied between different groups. Gene ontology analysis showed that Aβ_(1-42) up-regulated genes modulated inflammation, oxidative stress and immune response. But Aβ_(1-42)/ACT had significant effects on genes related with mitochondrial impairment, apoptosis, oxidative stress, epithelial differentiation and vasculogenesis. The analysis of up-regulated genes, such as interleukin 6 (IL-6) and tumor necrosis factor α (TNFα), showed that transcriptional factors and downstream genes of signal transduction pathways potentiated further the inflammatory response and cell apoptosis and increased the production of abnormal Aβ. Conclusion Aβ_(1-42) induces the inflammation of astrocytes. And the Aβ_(1-42)/ACT complex has diverse effects on the gene expression of astrocytes. Thus both proteins play important roles in the activation of astrocytes. In addition, IL-6, TNFα and their signal pathways are important in the pathogenic process of Alzheimer's disease.

With the rapid development of social economy and the change of people's lifestyle, the disease spectrum and death spectrum of residents have changed significantly, infectious diseases have gradually declined, and cardiovascular diseases have become the main diseases that seriously endanger people's health and life.In order to grasp the death status and its law of cardiovascular diseases in Dandong City, Liaoning Province, and provide scientific basis for formulating corresponding prevention and treatment measures, we made a comprehensive analysis of the death surveillance data of cardiovascular diseases in Dandong City from 1997 to 2006.

A 29-year-old female was admitted to the hospital on September 19, 2007 due to dry mouth and eyes for 7 years, limb weakness for more than 1 year and edema for 1 month. In the summer of 2000, the patient began to show dry mouth, flaky tooth loss, dry eyes and frosted feeling, accompanied by repeated swelling of bilateral parotid glands, and purpura-like rash on both lower limbs.

The Human Genome Project has brought the research of molecular biology into a completely new field. The method of studying gene by gene has been unable to cater to the massive genomic data. A high-command and highly efficient research method is emerging and gradually developing- -biochip technology. This technology can discover the function, action process and signal pathway of genes through high-throughput detection of gene expression activity, and then obtain and speculate the specific biological mechanism. The application of biochip technology has really brought mankind into the genome age.

Objective To study the apphcation of DEI technique in imaging the small structures of rabbit eyeball. Method DEI technique was used to image the eyeball of New Zealand white rabbit in vitro. The experiments were performed using beamline 4W1A at the topography station of Beijing Synchrotron Radiation Facility (BSRF). Result DEI image showed clearly the fine structures of the rabbit eyeball, such as the transparent cornea, the sclera, the ciharis, and the ciliary body. Conclusion DEI is a new X-ray imaging medality which achieves high contrast and spatial resolution. It also showed obvious effect of edge enhancement. DEI has good potential in observing the micro-structures of eyeballs and other small organs.

A few days ago, the reporter learned from the Ministry of Health that Tianjin, Liaoning, Shanghai and other places have made progress in the construction of resident physician system, program implementation and assessment management. The Ministry of Health is working with relevant departments to formulate guidance opinions on the standardized training of resident physicians, which will be issued soon.

A 54-year-old male was admitted to hospital due to chest tightness after activity for 6 years and aggravated for 15 days. The patient had no clear history of fever, trauma, hypertension, diabetes and other medical histories before consultation. Physical examination showed that the heart boundary was enlarged, the heart rhythm was uniform, and the systolic murmur of grade 2/6 was heard in the auscultation area of aortic valve, and the systolic murmur of grade 3/6 was heard in the apical area, but no abnormalities were found.

Case 1: A 43-year-old female was admitted to the Department of Nephrology, Tongde Hospital of Zhejiang Province on February 15, 2008 due to repeated dizziness and chest tightness for 1 year, aggravated for 5 days, limb weakness and slurred speech for 1 day. The patient began to develop chest tightness with dizziness without obvious trigger more than a year ago, and was treated in a local hospital with ominous details.

Patient 1, female, 42 years old. During physical examination, retroperitoneal mass was found by B-ultrasound for 15 days, without abdominal pain, fever, frequency, urgency and pain in urination. No abnormalities were found in physical examination and laboratory examination. Abdominal B-ultrasound detected a heterogeneous cystic-solid mass of-8.9cm ×5.0cm ×7.7cm in the left retroperitoneum, with irregular shape.