Volume 95  ·  Issue 19  ·  2015

Vitamin D is not only related to calcium and phosphorus metabolism, but also has the functions of immune regulation and inflammation control. Studies have shown that vitamin D deficiency in critically ill patients is closely related to poor prognosis, and vitamin D supplementation may benefit critically ill patients. Therefore, vitamin D may play a positive role in the treatment of critically ill patients, and may become a new target for the treatment of critically ill patients. Its application value and application prospect for the treatment of critically ill patients deserve our attention.

Sudden out-of-hospital cardiac arrest (OHCA) is the main cause of death in developed countries, with an annual incidence rate of 36~128/100,000, and the incidence of sudden cardiac death in China is 41.8/100,000^[1,2,3]With the improvement of the pre-hospital "survival chain", the number of hospitalizations of resuscitation patients has gradually increased. Autopsy and emergency coronary angiography (CAG) studies have revealed that more than 70% of patients have obvious coronary lesions, and registered and observational studies have shown that emergency coronary diagnosis and treatment strategies [referring to CAG aimed at percutaneous coronary intervention (PCI)] significantly improve mortality and neurological recovery in patients with OHCA^[2]。 Although both European and American guidelines have made recommendations on coronary diagnosis and treatment strategies for surviving patients with OHCA, some key questions of clinical concern have not been answered^[2,4,5]。 It is necessary to explore some key issues when making clinical decisions about coronary diagnosis and treatment strategies in patients with OHCA.

To investigate the ideal persistence time of prone position ventilation in patients with severe acute respiratory distress syndrome(ARDS).

Collect 78 cases of severe ARDS admitted to the ICU unit of Sichuan Provincial People's Hospital from October 2012 to June 2014, all the ARDS patients needed to receive 8 h/day prone position continuous 5 day. For each of the prone position ventilation, ultrasound patterns were recorded and the aeration scores were calculated at the beginning of the prone position(T0)and 2 h(T1), 4 h(T2), 6 h(T3), 8 h(T4) later. The correlation of the aeration score variation (ASV) and the arterial blood gas indexes (pH, PaO₂, PaCO₂, PaO₂ /FiO₂) were recorded also.The adverse reactions, ventilator situation and oxygen fraction after 7 days, 28-day mortality were monitored.

The aeration score of the lung at T1, T2, T3, T4 was significantly reduced than T0 all, the ventilation situation of mainly areas was improved after 2 h PPV (P<0.05), 4 h later it was not distinguished(P>0.05); the value of PaO₂, PaO₂ /FiO₂ was greater at T1, T2, T3, T4 than T0(P<0.05), the value of the oxygen fraction was significant increased at T2 than T1(t=2.840, P<0.05); the number of patients with oxygen fractions>300 mmHg after 5 days PPV was 65(83.3%); there were 30(38.5%)patients free of mechanical ventilation after 7 days; the 28-day mortality was 7(8.97%).

In patients with severe ARDS, applicating 2-4 hours validity of prone position ventilation significantly improves the pulmonary ventilation, more than 4 h PPV do not better for patients probably.

To assess the reliability of the variability of the inferior vena cava diameter as an indicator of fluid responsiveness in critically ill patients with atrial fibrillation.

Adult critically ill patients with atrial fibrillation requiring mechanical ventilation were enrolled. The variability of the inferior vena cava diameter(V_IVC) was measured during a breath and then calculated as the maximum diameter (Dmax) minus minimum diameter (Dmin) divided by Dmin. All the hemodynamic parameters were collected at baseline and after a manoeuvre of passive leg raising(PLR). A 15% of VTI increase after the PLR was the criterion to identify the patients with or without fluid responsiveness. ROC curve was used to assess the sensitivity and specificity of V_IVC as an indicator of fluid responsiveness for critically ill patients with atrial fibrillation.

There were 34 patients enrolled in our study, with 14 of them responsed to PLR and the rest 20 did not. For patients with fluid responsiveness V_IVC was significantly higher than patients without fluid responsiveness. The sensitivity and specificity of V_IVC≥16% to predict fluid responsiveness in patients with atrial fibrillation were 57.1% and 89.9% respectively.

V_IVCproved to be a reliable predictor of fluid responsiveness in critical ill patients with atrial fibrillation.

To research the early diagnosis value of Semaphorin3A as a biaomarker on acute kidney injury(AKI) in adult intensive care unit(ICU), and explore the relationship between Sema3A and sepsis.

The objects of the study are patients who were enrolled from July 2013 to December 2013 in XiangYa Hospital ICU. After admission and study enrollment, clinical data were recorded, and every 12 h serum, urinary samples were collected for Sema3A and neutrophil gelatinase associated lipocalin (NGAL) detected by enzyme linked immunosorbent assay(ELISA). According to the development of AKI, patients were divided into AKI group and non-AKI group. According to whether the AKI induced by sepsis, patients were divided into AKI-sepsis group, AKI-non-sepsis group, non-AKI-sepsis-group, non-AKI-and-non-sepsis group. The samples were selected in AKI group when AKI was diagnosed and 24 h before, the time when AKI diagnosed was counted asT(0)h, the other times were counted as T (-12) h, T (-24) h. In non- AKI group, the samples of the first three time points after admission were selected, and counted as T (0) h, T (-12) h, T (-24) h, respectively. Date was collected for statistical analysis.

Compared with non-AKI group, AKI urinary Sema3A, urinary NGAL is higher, and the difference was statistically significant. In group AKI urinary Sema3A, urinary NGAL concentration change over time and there is an increasing trend, where the T (-24) h and T(0)h, T (-12) h and T (0) h respective comparison, the difference was statistically significant.Correlation Analysis: T (-24) h urinary Sema3A and urinary NGAL were positively correlated with serum creatinine, APACHEⅡ. The AUC of urinary Sema3A with T (-12)h had the largest area of 0.885 (95%CI 0.774-0.997, P<0.05); the AUC of urinary NGAL with T (-24) h had the largest area of 0.878 (95%CI 0.788-0.993, P<0.05). There was no significant difference between sepsis group and non-sepsis group Sema3A, but there is significant difference between the two groups NGAL.There was no significant difference between S-AKI group and non-S-AKI group urinary Sema3A, but urinary NGAL were significantly different between the two groups.Compared with survival group, urinary Sema3A of death group was higher, and the difference was statistically significant.

Urinary Sema3A can help early diagnose of adult AKI. Compared to urinary NGAL, the concentration of urinary Sema3A was not affected by sepsis, and will be more useful for prediction.

To explore the correlation of severity classification of acute respiratory distress syndrome (ARDS) by the Berlin definition with extra vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).

A total of 70 cases with ARDS at intensive care unit of our hospital from July 2012 to July 2014 were divided into three groups of mild (n=20), moderate (n=30) and severe (n=20) according to the Berlin definition. The scores of acute physiology and chronic health evaluation (APACHE) Ⅱ and sequential organ failure assessment (SOFA) within 24 h of admission were recorded. And the values of EVLWI and PVPI of three groups from Day 1-4 were monitored by pulse indicator continuous cardiac output (PiCCO). Receiver operating characteristic (ROC) curve was drawn for these parameters and the area under curve was compared. Meanwhile blood gas was analyzed and oxygenation index (OI) calculated. And the correlations of EVLWI and PVPI with OI were analyzed.

Comparisons of EVLWI, PVPI and OI were made for three groups at different timepoints: As the severity of ARDS aggravated, EVLWI and PVPI of three groups increased significantly at any timepoint while OI decreased sharply (P<0.05). EVLWI and PVPI declined gradually from Day 1-4 in mild ARDS group (P<0.05), PVPI declined dramatically (P<0.05) while EVLWI showed no obvious change in moderate ARDS group (P>0.05). There was no sharp decline of EVLWI or PVPI in severe ARDS group (P>0.05). And OI increased significantly from Day 1-4 in three groups (P<0.01). The area under ROC curve (AUC) for PVPI in evaluating the prognosis of three groups was 0.594, 0.643, 0.723 and 0.816 respectively. PVPI >2.95 at Day 4 of admission was used as the best threshold value for judging prognosis. And the sensitivity was 70% and specificity 92%. OI had negative correlation with EVLWI and PVPI in three groups from Day 1-4 [(r=-0.685, P=0.000) and (r=-0.631, P=0.000)].

Both EVLWI and PVPI reflect adequately the severity of ARDS by the Berlin definition. And the dynamic trend of PVPI is superior to that of EVLWI.

To explore the correlations between early lactate clearance and the prognosis of neural function of patients with cardiac arrest (CA).

The total number of patients with CA and restored spontaneous circulation was 74. Their general clinical data such as gender, age, cause of CA, heart rhythm pre-CA, CA duration, resuscitation time, ApacheⅡscore, mean arterial pressure (MAP) and presence or absence of convulsion or central hyperthermia were recorded. The levels of lactate at admission and after 6 h's therapy were also collected and used for calculating the 6 h lactate clearance rate for each patient. According to the cerebral performance category, they were divided into two groups of better neural function (CPC1-2, A,n=24) and worse neural function (CPC3-5, B, n=50). General clinical data, lactate level and lactate clearance rate of two groups were compared to determine whether or not there was a significant difference. Logistic regression analysis was also used to select independent prognostic factors of neural function.

No significant differences existed in gender, age, cause of CA, heart rhythm before CA, ApacheⅡscore, MAP, number of cases with concurrent convulsion or central hyperthermia (P>0.05). And CA duration and save resuscitation time had significant inter-group differences (7.92 vs 11.16, 17.47 vs 23.80,P<0.05). The lactate level at admission had no significant inter-group difference (10.7 vs 11.2,P>0.05) while the 6 h's lactate level of group A was significantly less than that of group B (7.05 vs 5.26,P<0.05). And the 6 h lactate clearance rate in group A was also significant higher than that in group B (48.79% vs 33.67%,P<0.05). Logistic regression analysis revealed that 6 h lactate clearance rate and CA duratio were independent prognostic factors for neurological function in post-cardiac arrest patients.

Early lactate clearance may be associated with the prognosis of neural function for CA patients.

To explore the clinical efficacy and safety of ulinastatin plus octreotide for patients with severe acute pancreatitis (SAP).

During January 2011 to January 2014 at our hospital, 120 SAP patients were randomly divided into control and observation groups (n=60 each). The control group received an injection of octreotide injection while the observation group had a combination of ulinastatin and octreotide. After treatment, clinical efficiency, serum indicators and their improvements and complications were compared for two groups.

The overall efficiency of observation group was significantly higher than that of control group (83.3% vs 65.0%, P<0.05). And abdominal pain relief time, decompression time, surgical intervention rate, length of stay and mortality rate of observation group (1.9±0.9 d, 6.3±2.2 d, 1.7%, 11.8±0.5 d, 5%) were significantly lower than those of control group (3.6±0.7 d, 10.4±3.1 d, 8.3%, 23.7±2.1 d, 15.0%) (P<0.05). After treatment, the levels of blood amylase, white blood cell (WBC), C-reactive protein (CRP) and interleukin 6 (IL-6) of observation group (107.2±9.1 U/L, 6.2±1.0×10⁹/L, 7.3±3.4 mg/L, 28.3±4.3 pg/ml) were significantly lower than those of control group (430.8±20.2) U/L, (11.2±1.2)×10⁹/L, (16.3±5.2) mg/L, (45.3±5.9) ng/L, (P<0.05). And the incidences of such complications as acute respiratory distress syndrome (ARDS), acute renal failure and shock of observation group (10.0%, 5.0%, 13.3%) were significantly lower than those of control group (36.7%, 21.7%, 33.3%) (P<0.05).

Ulinastatin plus octreotide can significantly improve the serum and clinical parameters and reduce the incidence of complications in SAP patients. And it is worthy of wider popularization.

To explore the effects of L-carnitine and bisoprolol on endoplasmic reticulum stress-mediated myocardial injury after cardiopulmonary resuscitation in rats.

A total of 75 Sprague-Dawley rats were randomly divided into 5 groups of sham operation (sham); cardiopulmonary resuscitation (CR), L-carnitine (L), bisoprolol treatment (B) and L-carnitine and bisoprolol treatment (LB). Myocardial pathological changes were detected by hematoxylin and eosin, myocardial apoptosis by terminal deoxynucleotidyl transferase mediated dUTP nick and the expressions of key factors in endoplasmic reticulum (ER) by Western blot.

Compared with sham group, apoptosis and pathological lesions significantly increased in other groups (P<0.05). And the levels of GRP78, CHOP and Caspase-12 were significantly higher (P<0.05). The expression of ER factor protein and the degrees of myocardial injury in LB and B groups decreased compared with CR group. And LB group was the most obvious.

Combined use of levocarnitine and bisoprolol exerts protective effects on cardiopulmonary resuscitation in rats. And the mechanism may be related to an inhibition of ER stress.

To investigate the influence of rosiglitazone on tumor necrosis factor-α (TNFα) of rats in sepsis with acute kidney injury.

Sepsis models were established using male Sprague-Dawley rats by cecal ligation puncture (CLP). Ninety six healthy rats were randomly divided into 4 groups: cecal ligation puncture and rosiglitazone group (group CLP+ ROSI), cecal ligation puncture group (group CLP), Sham and rosiglitazone group (group Sham+ ROSI), Sham group (group Sham). Blood samples of 6 rats in each group were collected at postoperative 0, 6, 12, 24 h, to detect TNFα levels in serum. Observe and compare the mobility of rats in each group and the level of serum creatinine and H&E staining was applied to detect renal pathological histology changes. Statistics was analyzed by SPSS 13.0 software application of independent samplest test.

The creatinine level of Group CLP was increased with the extension of time, the creatinine level of group CLP was significantly higher than that of group Sham at 12 h and 24 h (P₁₂=0.047, P₂₄=0.001). The creatinine level of group CLP + ROSI was significantly higher than that of group Sham+ ROSI at 12 h and 24 h (P₁₂=0.033, P₂₄=0.039). The increased creatinine level of group CLP + ROSI was significantly lower than that of group CLP at 12 h and 24 h (P₁₂=0.04, P₂₄=0.006). The TNFα concentration of group CLP was significantly higher than that of group Sham at 6 h, 12 h and 24 h (P<0.05). The TNFα concentration of group CLP+ ROSI was significantly higher than that of group Sham+ ROSI at 6 h, 12 h and 24 h (P<0.05). The increased TNFα concentration of group CLP+ ROSI was significantly lower than that of group CLP at 6 h, 12 h and 24 h (P₆=0.01, P₁₂=0.02, P₂₄=0.01). Compared with group Sham and group Sham+ ROSI, in rats of group CLP and group CLP+ ROSI the symptoms of sepsis and organ dysfunction were observed. The symptoms of sepsis and organ dysfunction of group CLP+ ROSI were significantly reduced than that of group CLP.

Rosiglitazone can inhibit the expression of TNFα in serum of septic rats, reduce the inflammatory reaction, reduce kidney injury, improve the renal function. Rosiglitazone on septic rats with acute kidney injury has a protective effect.

To explore the effects of hydrogen-rich saline on Akt/GSK3β signaling pathways and cardiac function during myocardial ischemia-reperfusion (I/R) in rats.

A total of 150 healthy male Sprague-Dawley rats were selected and divided randomly into 5 groups of normal control (Ⅰ), sham operation (Ⅱ), myocardial ischemia-reperfusion (Ⅲ), hydrogen-rich saline (Ⅳ) and normal saline group (Ⅴ) (n=30 each). Group Ⅰ had no treatment at all. In group Ⅱ, anterior descending branch was merely exposed but not ligated. Myocardial I/R was induced by 30-min occlusion of anterior descending branch of left coronary artery followed by 12/24 h reperfusion of Bimbaum. Hydrogen-rich saline 1 ml/100 g were injected intraperitoneally 5 min before reperfusion in group Ⅳ.Normal saline 1 ml/100 g was injected intraperitoneally 5 min before reperfusion in group Ⅴ. The values of ±dp/dt max, left ventricular diastolic pressure (LVDP) and left ventricular systolic pressure (LVSP) during the procedure were recorded by BL - 420 biological function experimental system at pre-ischemia, ischemia 30 min, 60 min and 120 min of reperfusion. The animals were sacrificed at 60 min, 120 min of reperfusion and hearts harvested. The pathological changes of myocardial tissue were detected by hematoxylin and eosin staining. And the expressions of Akt and GSK3β in myocardial tissue were examined by Western blot.

Compared with groups Ⅰ and Ⅱ, the values of ±dp/dt max, LVDP and LVSP significantly increased. And the expressions of Akt and GSK3β in myocardial tissue significantly increased in groups Ⅲ, Ⅳ and Ⅴ. Compared with groups Ⅲ and Ⅴ, the values of ±dp/dt max, LVDP and LVSP significantly decreased. And the expressions of Akt and GSK3β in myocardial tissue significantly decreased in group Ⅳ. Compared with T₀, the values of ±dp/dt max, LVDP and LVSP significantly decreased at T_1-3 in groups Ⅲ, Ⅳ and Ⅴ. Compared with T₁, the values of ±dp/dt max, LVDP and LVSP significantly increased at T_2-3 in group Ⅳ. Compared with T₂, the expressions of Akt and GSK3β in myocardial tissue significantly decreased at T₃ in group Ⅳ.

Hydrogen-rich saline can reduce myocardial reperfusion injury and improve heart function. The mechanism may be due to associated with the down-regulated expressions of Akt and GSK3β in myocardial tissue.

Ischemia-reperfusion (I/R) is a main cause of acute kidney injury (AKI). The renal expression profiles of microRNA (miRNA) and time course of their changes after renal I/R were explored to screen acute AKI prognostic-related microRNAs and biomarkers.

The expression profile of miRNA was analyzed for detecting miRNAs in kidney after renal I/R injury. Real-time polymerase chain reaction (PCR) was performed to validate the results of microarray. And the relationship was examined between kidney injury and time course of changes in selected miRNAs.

Twenty-one miRNAs were differentially expressed in kidney of rats with renal I/R injury. And 5 miRNAs had prominent differences. miR-17-5p, miR-21 and miR-106a were selected for further confirmation by quantitative real-time-PCR. And the results were consistent with those of microarry. During early stage (4 h) after I/R, the expression level of miR-17-5p significantly increased (P<0.05). And it occurred earlier than those of BUN level and plasma concentration of neutrophil gelatinase-associated lipocalin (NGAL). Renal expressions of miR-21 and miR-106a were significantly elevated in ischemia 20 min and 30 min groups at 12 h and 24 h post-reperfusion (P<0.01). And the trend was in accordance with those of BUN and NGAL.

miR-21, miR-17-5p and miR-106a are differentially expressed during different phases of renal I/R injury. And miR-17-5p is more sensitive than BUN and NGAL so that it is a more ideal biomarker for AKI.

To explore the effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit (ICU).

A total of 72 ICU patients with severe acute pancreatitis were recruited and divided randomly into observation and control groups (n=36 each). Both groups were treated conventionally. And the observation group achieved stable blood glucose at 6.1-8.3 mmol/L with intensive glucose control. The length of ICU and hospital stays, ICU mortality rate, transit operative rate, concurrent infection rate, admission blood glucose, glycosylated hemoglobin, mean insulin dose, mean blood glucose, blood glucose value standard deviation (GLUSD), glycemic liability index (GLUGLI) and mean amplitude of glycemic excursion (GLUMAGE) of two groups were compared. At the same time, the relationship between blood glucose variability, ICU mortality rate and its predictive value were analyzed by correlation analysis and receiver operating characteristic curve (ROC).

The lengths of ICU and hospital stays of observation group were all significantly less than those of the control group [(11.7±9.9) vs (15.9±8.02) days, (21.8±10.8) vs (28.2 ±12.7) days, P<0.05]. In observation group, the rates of pulmonary infection (27.78%) and hematogenous infection (5.56%) were all significantly lower than those of control group (72.22%, 38.89%,P<0.05). The values of mean blood glucose value and GLUSD of observation group were significantly lower than those of control group [(7.4±1.1) vs (9.6±1.2), (1.8±1.0) vs (2.5±1.3) mmol/L]. The differences were statistically significant (P<0.05). While the dose of insulin [(70.2±47.6) vs (34.4±38.6) U/d] was significantly higher than that of control group (P<0.05). Bivariate correlation analysis showed that ICU mortality rate was positively correlated with GLUGLI (r=0.368, P<0.05). ROC curve analysis showed that, AUC of GLUGLI was 0.748 and 95%CI 0.551-0.965 (P<0.05).

Intensive glucose control in patients with severe acute pancreatitis helps reduce the blood sugar fluctuations, lower the risks of infectious complications and promote the patient rehabilitation. And GLUGLI is positively correlated with ICU mortality rate. It has good predictive values.

To explore the application of enteral immune nutrition preparation for chronic obstructive pulmonary disease (COPD) patients and examine the improving effects on nutritional status, immune status and acute inflammatory reaction.

A total of 60 cases of hospitalized COPD patients on mechanical ventilation in intensive care unit (ICU) were randomly divided into immune nutrition group (containing essential fatty acids, omega-3 fatty acids, energy 1.3 kcal/ml) (study, n=30) and standard nutrition group (self-made homogenized diet 1.2 kal/ml) (control, n=30). Two groups received an equal calorie of enteral nutrition via a nasointestinal tube. On the day of admission and every 2 weeks, venous blood samples were drawn for measuring the serum levels of albumin (ALB), prealbumin (PA), C-reactive protein (CRP) and interleukin-6 (IL-6). And the values of upper arm muscle circumference (MAMC) were recorded simultaneously bedside. The levels of mechanical ventilation and weaning rate were compared between two groups at Day 14.

The weaning rate within 14 days in study group was higher than that in control group (73.3% vs 43.3%, P<0.05). And PA at Day 14 in study group was higher than that in control group [(188.4±57.5) vs (174.6±65.7) mg/L,P<0.05], ALB at Day 14 also higher than control group [(32.7±4.6) vs (30.2±3.8) g/L,P<0.05], MAMC at Day 28 better than control group [(25.5±2.1) cm vs (24.3±1.8) cm,P<0.05]. No significant inter-group difference in IL-6 existed at Day 14 [(250.1±110.3) vs (266.1±97.3) ng/L,P>0.05]. The study group was lower than control group at Day 28 [(108.5±59.6) vs (165.7±76.3) ng/L,P<0.05]. The CRP levels at Day 14 [(12.2±7.3) vs (13.2±6.9) mg/L,P<0.05] and at Day 28 [(7.5±5.0) vs (9.6±5.6) mg/L,P<0.05] were lower than those of control group at Days 14 and 28.

Compared with homogenized diet, immune enteral nutrition may improve the nutritional status of COPD patients, lower the levels of acute inflammatory reactions and boost the success rate of early weaning.

To explore the safety of plasma exchange (PE) therapy in patients with anti-NMDA receptor encephalitis.

Prospective reviews were conducted for the adverse events and therapeutic efficacies of PE therapy in 9 patients with anti-NMDA receptor encephalitis admitted into neuro-intensive care unit from January 2012 to January 2015.

A total of 54 PE procedures were performed. The NMDA receptor antibody titer of cerebrospinal fluid (CSF) and/or sera in 9 patients (100%) decreased or turned negative. Five patients (55.5%) demonstrated clinical improvement after PE therapy. And clinical complications included frequent involuntary movements, hypotension, coagulation of PE channel, febricity, allergic response and errhysis around peripheral venous access.

PE is effective, safe and well-tolerated in patients with anti-NMDA receptor encephalitis.

To explore the efficacies of resuscitation fluid volume after combined burn-blast injury versus a simple burn.

A total of 24 beagle dogs were randomly assigned into 3 groups of normal volume (N), decreased volume (D) and increased volume (I). Fluid volume for group N was calculated with the Parkland formula while groups D and I decreased or increased by 20% respectively.Urinary output (UOP), hemoglobin concentration (HB), cardiac output (CO), intrathoracic blood volume (ITBV), extravascular lung water index (ELWI), oxygen delivery (DO₂) and oxygen consumption (VO₂) were determined before and 4, 8, 24, 48 h after injury to evaluate the sufficiency of resuscitation in each group and examine the superiority.

UOP were [(0.41±0.13), (0.77±0.17), (0.30±0.13)] ml·kg^-1·h^-1 at 4 h post-injury in groups N, I and D respectively.Group I was significantly higher than groups N and D (P<0.001). It were [(0.59±0.05), (0.88±0.05), (0.53±0.06)] ml·kg^-1·h^-1 at 24 h post-injury in groups N, I and D respectively.Group I was significantly higher than groups N and D (P<0.001). CO in group I was remarkably higher than those in groups N and D at 4 h and 8 h post-injury [(1.57±0.19) vs (1.25±0.17), (1.05±0.17) L/min; (1.87±0.20) vs (1.57±0.24), (1.20±0.19) L/min respectively] (P<0.05); ITBV also significantly increased in group I than two other groups at 4 h and 8 h post-injury [(169±16) vs (140±12), (121±12) ml; (161±14) vs (135±22), (112±12) ml] (P<0.05). VO₂ in group I was significantly higher than that in group N at 24 h post-injury [(129±10) vs (106±12) ml·min^-1·m^-2] (P<0.05). No differences were detected among 3 group in ELWI (P>0.05).

Larger fluid volume may compensate circulatory volume loss sooner, alleviate declining cardiac output better, maintain adequate organ perfusion, promote tissue oxygenation and improve anti-hypervolemia and anti-hypoxia.

To evaluate the association between serum levels of angiopoietins (Ang) during an early period (within 72 h) and clinical outcomes after aneurysmal subarachnoid haemorrhage (aSAH).

This prospective study was conducted at Department of Neurosurgery, Tianjin Medical University General Hospital. Blood samples from 37 aSAH patients were collected at 8 h (or<8 h), 24 h, 72 h after an onset of SAH. The serum levels of Ang-1, Ang-2 and Tie-2 were measured by enzyme-linked immunosorbent assay (ELISA). They were followed up for 3 months by Glasgow outcome score extended (GOSE). Those with GOSE >5 were counted as a good outcome while those with GOSE ≤5 had a poor outcome.

A total of 37 patients with aSAH and 39 healthy controls (HC) were enrolled. The aSAH patients showed a significant rise of Ang-1 within 8 h as compared with HC. The outcomes were good (n=15) and poor (n=22). Serum Ang-1 at 8 h (or<8 h), 24 h and 72 h in good outcomers showed significantly higher than that in poor outcomers [(52±24) vs (37±17) mg/L, (62±26) vs (45±17) mg/L, (107±27) vs (72±18) mg/L]. The serum level of Ang-1 at 8 h and 24 h was one of independent risk factors for aSAH patients by multiariable Logistic regression analysis [adjectedOR (95% CI) 1.095 (1.015-1.181) and 1.109 (1.016-1.211)] (P<0.05). High serum level of Ang-1 during an early period (within 72 h) was associated with good outcomers (r=0.627, P<0.001).

The serum levels of angiopoietins are significantly altered in aSAH patients, especially higher in good outcomers. And abnormal levels of angiopoietins may affect early brain injury (EBI) after SAH, structural integrity and recovery of blood-brain barrier (BBB) and long-term outcomes in aSAH patients.

To investigate the association of two β2-adrenergic receptor (β2-AR) polymorphisms (Arg16Gly, Gln27Glu) with Myasthenia Gravis (MG) associated with thymus abnormality.

Among the 74 MG patients in analysis, 24 cases were associated with thymoma, 40 cases with thymic hyperplasia, 12 with normal thymus. The genotypes of β2-AR in 76 MG (MGG) and 75 age and gender-matched healthy controls (HCG) were determined by polymerase chain reaction and nucleotide sequence determination.

The frequencies of three genotypes (Arg/Arg, Arg/Gly, Gly/Gly) and alleles (Arg, Gly)in position 16 between MGG with thymoma and HCG (genotype χ ²=0.460, P=0.895; allele χ ²=0.137, P=0.711), MGG with thymic hyperplasia and HCG were not statistically insignificant (genotype χ ²=2.585, P=0.278; allele χ ²=0.300, P=0.584). The difference in distribution of the genotypes (Gln/Gln, Gln/Glu, Glu/Glu) and alleles (Gln, Glu) between MGG with thymoma and HCG (genotype P=0.866; allele χ ²=0.030, P=0.860), MGG with thymic hyperplasia and HCG (genotype P=0.907; allele χ ²=0.373, P=0.542) were statistically insignificant. The genotypes distribution of position 27 in different thymus histology (thymoma, thymic hyperplasia, normal thymus) of MGG were significantly different (P=0.041). The genotype frequencies in all groups were both in Hardy-Weinberg equilibrium (P>0.05).

Arg/Gly and Gln/Glu polymorphisms of β2-AR might have no relationship with the risk of MG associated with thymus abnormality. The genotypes polymorphism of position 27 may related with the different thymus histology of MG.

To explore the presence of subclinical upper motor neuron (UMN) dysfunction in Kennedy disease (KD) patients with triple stimulation technique (TST).

At our hospital from July 2013 to July 2014, a total of 20 KD patients with clinical manifestations, genetic testing and routine electrophysiological tests were examined by triple stimulation technique (TST) combining transcranial magnetic stimulation (TMS) of motor cortex with peripheral collision studies. And the results were expressed by TST amplitude ratio (TST test/TST control).

All patients had typical presentations and were genetically proved. The expansion size of polymorphic tandem cytosine-adenine-guanine (CAG) repeat in the first exon of androgen receptor gene was(44±5). Electromyography showed acute and chronic neurogenic damage. Sensory nerve action potentials declined in amplitude. TST amplitude ratio was normal for 13 KD patients and 7 cases were significantly altered. Tendon hyperreflexia was found in 1 patient with normal TST. In patients with abnormal TST, central motor conduction time (CMCT) was normal in 4 patients and tendon hyperreflexia was found in 5 patients. The possible reasons for 7 patients with abnormal TST were concurrent lacunar infaction (n=2), concurrent spondylotic myelopathy (n=2) and KD alone (n=3).

Subclinical involvement of UMN may be present in KD patients while other potential causes must be excluded.

We compared the dosimetric differences between the target and surrounding tissues/organs of the 5-field and 7, 9-field (Hereinafter referred to as F5, F7, F9) treatment plan in non-small cell lung cancer (NSCLC) by the dynamic intensity-modulated radiotherapy (dIMRT), to provide reference for clinical application.

Using Varian planning system(Eclipse 7.3), we randomly selected 30 cases of patients who received dIMRT to study, all patients were 5, 7, 9 fixed field dynamics intensity-modulated radiotherapy plans to meet the target prescription requirements(95% dose curve enveloping 100% of the PTV), by comparing dose-volume histogram DVH evaluation, and the maximum dose D_max, the minimum dose D_min, and the mean dose D_mean, and conformal index CI of PTV, organs at risk of spinal cord the maximum dose D_max, lung V₅, V₁₀, V₂₀, V₃₀, heart V₃₀ and esophageal V₅₀, V₆₀ of F5, F7 and F9 dIMRT plans, and compare the mu of the three treatment programs.

The D_max, D_min and D_mean values of F5's PTV are (7 203±128)、(5 493±331)、(6 900±138) cGy respectively; the D_max, D_min and D_mean values of F7's PTV are (7 304±96)、(5 526±296)、(6 976±130)cGy respectively; and the D_max, D_min and D_mean values of F9's PTV are (7 356±54)、(5 578±287)、(7 019±56)cGy respectively. The data shows that while we increased the numbers of fields, the isodose line surrounding the target area would also promote slightly.The conformity index CI of target became better with the increase of radiation fields.The whole lung V₅ and V₁₀slightly became larger with increase of fields and the V₂₀showed no significant difference in three models, V₃₀ of double lungs slightly decreased with the increase of fields.The above date was statistically meaningless (P>0.05). With the increase of fields esophagus V₅₀ were reduced by 3% and 5% respectively, V₆₀ of the esophagus were reduced by 6% and 11%, the average dose reduced by 5% and 10% and spinal cord D_max decreased by 9% and 13%.In the F7 and F9, heart V₅ were lower than F5 plan by 11%, 19%.The mu of them were increased with the increase of radiation fields, Treatment time of F7 and F9 plan were longer by 15% and 25%.

Through comparing the three fixed dIMRT plans, we could draw a conclusion that the three multi-field intensity-modulated radiotherapy in non-small cell lung cancer can meet the clinical target volume dose requirements. If the treatment is required to protect the patient's spinal cord, esophagus and heart, we can choose 7or 9 fields. While other ordinary patients should be treated with 5 fields plan, to shorten the treatment time and improve the biological effectsof lesions, and lower mu of plans to avoid unnecessary irradiation of normal tissues.

To explore the efficacies and side effects of neoadjuvant chemotherapy with DN (docetaxel plus cisplatin) and FP (nedaplatin plus cisplatin) regimens for patients with upper or middle thoracic locally advanced esophageal squamous cell carcinoma.

From January 2008 to January 2012, a total of 124 patients with upper or middle thoracic locally advanced esophageal squamous cell carcinoma were randomized into DN group (n=64) and FP group (n=60). Both groups received neoadjuvant chemotherapy. The treatment schedule was recycled every 3 weeks. After 2 cycles, those with potential surgical resection underwent surgery.

The 2-year overall, locoregional relapse-free and distant metastasis-free survival rates in DN and FP groups were 71.1% and 66.7%, 65.0% and 63.0%, 78.3% and 74.3% respectively (P>0.05). The incidence of leucopenia was higher in DN group than that in FP group (P<0.05). And the occurrence rates of gastrointestinal toxicity and mucositis were significantly higher in FP group than those in DN group. No perioperative mortality occurred with a low incidence of postoperative complications. The rates of overall response, resection, postoperative complications and pathological complete rates response were similar in two groups. And the rates of downstage and R0 resection were significantly higher in DN group than those in FP group (P<0.05).

For patients with middle or lower thoracic locally advanced esophageal squamous cell carcinoma, neoadjuvant chemotherapies of docetaxel and nedaplatin may achieve excellent outcomes in clinical response and 2-year survival rate. And the side effects are clinically acceptable.

To discussion of hand malformations imaging features and clinical classification, tentatively proposed radiological classification.

A retrospective analysis of the clinical data and image of 101 cases of hands developmental deformity and admitted to hospital affiliated to 1971-2014 years in The Affiliated Hospital of Hangzhou Normal University and the Third Hospital of Hebei Medical University.It is divided into five types base on imaging features: no formation, hypoplasy, over formation, segmental abnormal or joint, bend or abnormal and comparing with classification of Swanson.

101 cases of hand deformity in a total of 14 kinds of deformity, respectively in phalanx 12 kinds, 1 kind of metacarpal, 1 kind of carpal. With imaging features classification: 4 kinds of no formation (ectrodactyly, cleft hand, ectrometacarpia, aphalangia), 1 kind of hypoplasy (brachydactyly), 3 kinds of over formation (macrodactyly, long finger malformations, polydactyly), 3 kinds of segmental abnormal or joint (syndactyly, symphalangism, carpal coalition), 3 kinds of bend or abnormal (clinodactyly, camptodactyly, Kirner deformity).

There are many different kinds of hand malformations, the classification according to the cause or the gene would be more confusing, but with imaging features as the basis for classification is more ideal, and it is good for memory and orthopedic surgery.

To establish the reference values of thalamus, caudate nucleus and lenticular nucleus diameters through fetal thalamic transverse section.

A total of 265 fetuses at our hospital were randomly selected from November 2012 to August 2014. And the transverse and length diameters of thalamus, caudate nucleus and lenticular nucleus were measured. SPSS 19.0 statistical software was used to calculate the regression curve of fetal diameter changes and gestational weeks of pregnancy. P<0.05 was considered as having statistical significance.

The linear regression equation of fetal thalamic length diameter and gestational week was: Y=0.051X+ 0.201, R=0.876, linear regression equation of thalamic transverse diameter and fetal gestational week was: Y=0.031X+ 0.229, R=0.817, linear regression equation of fetal head of caudate nucleus length diameter and gestational age was: Y=0.033X+ 0.101, R=0.722, linear regression equation of fetal head of caudate nucleus transverse diameter and gestational week was: R=0.025-0.046, R=0.711, linear regression equation of fetal lentiform nucleus length diameter and gestational week was: Y=0.046+ 0.229, R=0.765, linear regression equation of fetal lentiform nucleus diameter and gestational week was: Y=0.025-0.05, R=0.772.

Ultrasonic measurement of diameter of fetal thalamus caudate nucleus, and lenticular nucleus through thalamic transverse section is simple and convenient. And measurements increase with fetal gestational weeks and there is linear regression relationship between them.

To explore the in vitro effects of thioridazine (THIO) plus medroxyprogesterone (MPA) on the proliferation and apoptosis of endometrial cancer cell lines (Ishikawa & KLE) and examine the mechanism in the treatment of endometrial cancer.

CCK-8 assay was employed for detecting the influence of THIO plus MPA on the proliferation and apoptosis of endometrial cancer cells (ISK & KLE). And the concentration and timepoints of drugs were determined according to the results.Real-time polymerase chain reaction (PCR) and Western blot were used to detect the expression levels of PRB, DRD2 and p-AKT/AKT in PI3K/AKT signal pathway.Flow cytometry was applied for detecting the apoptosis of combination (THIO+ MPA) and MPA groups.

Compared to MPA group, the proliferation inhibiting effect of combination group increased significantly in ISK and KLE cells (52.5%±2.6% vs 37.3%±0.3%, P<0.05; 97.7%±0.7% vs 50.0%±0.4%,P<0.001); the apoptotic rates increased (34.0%±1.4% vs 50.5%±2.4%,P<0.01; 5.5%±3.6% vs 11.3%±0.7%,P<0.01); the expression levels of PRB and DRD2 were up-regulated (allP<0.05). And the ratio of p-AKT/AKT decreased obviously.

Thioridazine significantly enhances the effects of MPA on proliferative inhibition and apoptotic promotion in endometrial cancer cells. And it may be associated with the PRB/DRD2-mediated PI3K/AKT signal pathway.

Acute respiratory distress syndrome (ARDS) is one of the leading causes of death in critically ill patients. Although the mortality rate of ARDS has decreased with the in-depth research and the continuous progress of clinical treatment measures, the research shows that the mortality rate of ARDS is still as high as 40%^[1]。 However, the clinical treatment of ARDS still stays at the level of supportive treatment such as mechanical ventilation and restricted fluid rehydration, and there is no effective drug treatment so far. Mesenchymal stem cells (MSC) have multidirectional differentiation potential. After migrating to the site of lung injury, they can differentiate into alveolar epithelial cells and pulmonary microvascular endothelial cells, thus repairing the damaged lung tissue structure and protecting lung function. In recent years, many studies have found that MSC can also paracrine a variety of protective factors^[2]Including growth factors, anti-apoptotic factors, anti-inflammatory and pro-inflammatory factors, chemokines, antimicrobial peptides, and the like^[3]They all play an active role in maintaining lung tissue structure and function^[4], is considered to be an extremely important mechanism for MSC to treat ARDS.

Sepsis and its caused septic shock are the most important causes of infection death worldwide, and the mortality rate of severe sepsis exceeds 20%^[1]。 Organ insufficiency caused by sepsis and its shock is the direct cause of threatening the life and quality of life of patients. Among them, the proportion of acute kidney injury (AKI) in patients with septic shock can be as high as 40% ~50%, the mortality of patients can be increased by 6~8 times, and the probability of renal fibrosis and progression to chronic kidney disease in patients is greatly increased^[2,3]。 The pathophysiological mechanisms of sepsis-associated AKI, or infectious acute kidney injury (SAKI), are not fully understood and may be responsible for its high morbidity and mortality. Renal hypoperfusion is one of the main causes of ischemic AKI. However, more and more animal and clinical evidence show that renal blood flow does not decrease or even increases when SAKI occurs^[4,5]。 Meanwhile, Murugan et al.^[6]In the study of nosocomial acquired pneumonia, it was found that in many patients with mild sepsis, although hemodynamics were not affected, SAKI could still occur. Therefore, the renal hypoperfusion of SAKI may be relative, and many previous studies have attempted to improve the prognosis of SAKI by moderately increasing the relative hypoperfusion. Unfortunately, it remains difficult to determine the degree of perfusion that can improve patient prognosis. Multiple large-scale RCT studies on fluid resuscitation in sepsis have shown that increased fluid infusion, increased red blood cell transfusion, more vasoactive drug use, or increased mean arterial pressure, although theoretically increased blood perfusion in the kidney, did not reduce the incidence and associated prognosis of AKI^[1,7,8]。 Obviously, in addition to hemodynamics, there are many factors involved in the pathophysiological process of SAKI. Probability of acute tubular necrosis (ATN) in renal epithelial cells in AKI<5%^[9,10]It can be seen that ATN is not the main pathological change of SAKI. After AKI, there were no obvious structural changes in renal tubular epithelial cells, but the pathological manifestations were heterogeneous changes in renal tubular epithelial cells, vacuolation in the brush margin of epithelial cells, less cell necrosis and apoptosis^[9,10,11]。

calpastatin (CAST) is an endogenous and specific inhibitor of calpain (CAPN). It can identify CAPN versus Ca^2＋Binding to the conformational changes caused by binding and specifically binding to it, plays a negative regulatory role. CAST is involved in the signal transduction process of numerous physiological and pathological changes, and is closely related to various diseases of the nervous system. In recent years, the role of CAST in neurological diseases has been widely paid attention to, and it is closely related to the pathogenesis of neurological diseases. The latest progress in this field is reviewed.