Volume 97  ·  Issue 04  ·  2017

Tumor treatment decision-making has undergone a transformation from empirical medicine, evidence-based medicine to precision medicine. The maturity of clinical trials, the progress of omics technology and the emergence of big data analysis tools are the core elements that promote the development of previous medicine^[1]。 Traditional clinical studies, especially randomized controlled studies (RCTs), have optimized treatment plans, promoted the formulation and revision of treatment guidelines, and brought thinking about new medical strategies, but their extrapolation efficacy in the real world still needs to be tested. Real-world research (RWS) emerged as the times require to build a big data platform with small randomization to improve clinical treatment decision-making.

Accelerated rehabilitation surgery (ERAS) refers to the optimization of multimodal perioperative pathways and the adoption of effective measures proved by evidence-based medical evidence to alleviate the psychological and physiological traumatic stress response of patients to accelerate the recovery of preoperative body composition and organ function, and achieve the goal of early rehabilitation. Through the integration of perioperative intervention measures to promote the recovery of postoperative organ function, reduce complications, shorten hospital stay, reduce the risk of readmission and death. The concept of ERAS started from general surgery, but in recent years, it has been extended to other surgical specialties and even the whole medical and health industry, but it is still the most convincing in its application in colorectal surgery. Today, the development of ERAS is no longer a discussion of whether the ERAS treatment model is superior to traditional perioperative management, but how to further standardize, optimize and implement the related strategies of ERAS^[1]。 Although ERAS has developed rapidly, it has encountered some practical problems in the process of clinical application, including traditional habits and some questions that ERAS is still difficult to solve. While seeing the achievements of ERAS, we should also see some existing problems and future research directions.

In 2015, the British Biotechnology and Biological Sciences Research Council (BBSRC) issued the Strategic Research Framework 2015-2020 for Biosciences in the Health Field, proposing four development directions for Biosciences in the Health Field: lifelong health, nutrition and health, integrated health and health Biotechnology. This paper will interpret and analyze the plan, in order to provide reference and reference for the related work in China.

Diabetic foot is one of the serious chronic complications that lead to disability and death of diabetic patients in China. Its incidence is high, the treatment is difficult and the cost is huge. At present, China mainly refers to the guidelines formulated by international podiatrists and the American diabetic foot group. However, because China's diabetic foot has its own characteristics, China Medical Care International Exchange Promotion Association organized national podiatry experts to draft guidelines for the diagnosis and treatment of diabetic foot.

To investigate the inducing effect and mechanism of semimature dendritic cell (smDCs) on transplantation tolerance of hepatocytes differentiated from mouse embryonic stem cells (ESCs), and to study the connections between smDCs and regulatory dendritic cells (regDCs).

ESCs of 129 mouse labelled green fluorescent protein (GFP) were induced to hepatocytes by using previous methods. Meanwhile, bone marrow mononuclear cells of 129 mouse were induced to smDCs and regDCs. Moreover, the hepatocytes differentiated from 129 mouse ESCs were transplanted into liver of BALB/c mouse 3 days after infusing smDCs and regDCs suspension of 129 mouse into BALB/c mouse by tail vein respectively. After that, the growth status and survival time of transplanted cells in the recipient and infiltration of lymphocytes in transplant sites were observed. Furthermore, Foxp3 expression of peripheral blood CD4+ T cells was also tested.

In the control group, the transplanted cells in liver of BALB/c mouse survived only about 1 week. In contrast, the transplanted cells of smDC groups and regDCs groups survived about 4 weeks and the transplant sites of smDC groups also had less CD3⁺ T cells. The morphology of smDCs were similar with regDCs. The expression of MHC-Ⅱ, CD40, CD80 and CD86 on smDCs and regDCs were moderate. Moreover, the Foxp3 expression of peripheral blood CD4+ T cells in smDC groups was higher than that in the control groups, from 1.11% up to 5.38%. The Foxp3 expression in regDC groups rose to 3.87%.

The smDCs could induce transplantation tolerance of hepatocytes differentiated from 129 mouse ESCs in the recipient. The mechanism was associated with high level of Foxp3⁺ Tregs, which could be increased by means of smDCs appropriate expression of MHC-Ⅱ, CD40, CD80 and CD86. The smDCs and regDCs were the same type of tolerance dendritic cells.

The intact rat liver decellularized scaffolds were preparedand repopulated hepatocytes by continuous perfusion technology.Toprovideexperimental support for the application of decellularized liver scaffolds in liver engineering.

Decellularized liver scaffolds were obtained by perfusing method. The composition and structure was examined by HE, Masson, Sirius red stain and immunofluorescence. The ultrastructure was examined by scanning electron microscope (SEM). DNA content was used to confirm the effect of decellularization. The circulation perfusion device was established. Hepatocytes were recellularized into the scaffolds by multiposition parenchymal injection method and infusion method, thenthe scaffolds were cultured in the circulation perfusion device in vitro. After cultivation, HE staining, immunofluorescence and SEM were conducted to observe the growth situation of hepatocytes in the scaffolds.

The rat decellularized liver scaffolds were successfully obtained by perfusion method. Histological staining demonstrated the remove of cellular component and the reservation of extracellular cellmatrix. Immunofluorescence staining demonstrated the retention of collagen I. SEM showed that the ultrastructure of the extracellular cell matrix presented thereticular structure. DNA content of the scaffolds was 47.5±18.1 ng/mg. The circulation perfusion device was composed of a peristaltic pump, oxygenator, chamber and the convey tubes. The multipositional parenchymal injection method resulted in a better engraftment rate. HE staining, immunofluorescence and SEM revealed that the growth and function of hepatocytes were goodin the scaffold.

The decellularized rat liver scaffolds have favorable biochemical properties. The liver decellularized scaffolds applied with the circulation perfusion device could provide a well 3D plat form for culture of hepatocytes.

To investigate the clinical significance of accurate assessment of "volume and quality" of functional liver in Autologous liver transplantation (ALT) in the treatment of the advanced hepatic alveolar echinococcosis (HAE).

The clinical data of 12 patients with advanced HAE who underwent ALT at the First Affiliated Hospital of Xinjiang Medical University from May 2015 to July 2016 were retrospectively analyzed.

The preoperative hepatic functions of 12 patients were 8 Child-Pugh Grade A, 1 Grade B, and 3 Grade C. Three of the patients had moderate or severe jaundice. Three of the patients calculated functional liver graft volume (GV) and standard liver volume (SLV) ratio (GV/SLV) were <30%. After the protection of liver function, anti-infection, percutaneous transhepatic cholangiography drainage (PTCD), selective portal vein embolization (PVE), and staging liver resection, liver function Child-Pugh grade of 11 patients was raised to A grade, and the other patient was B grade, meanwhile the bilirubin was reduced to 2 times the normal value. The GV/SLV ratios of 3 patients with low GV/SLV ratio had reached 44.4%, 47.2% and 56.2% respectively. In this study, the GV/SLV ratios of the 12 patients were between 73.2% and 40.8% with an average of 55.6%. Operation time was 11.5-20.5 h, with an average of 12.3 h. Anhepatic phase time was 193-375 min with median 253.5 min. The red blood cell suspension was 0-6 U during the operation. The average hospitalization was 10-42 d, with the average 22.7 d. Total hospital costs were 121 600-434 800 Yuan, with the median cost of 174 400 Yuan. One patient died of septic shock a week after surgery.

(1)ALT may provide feasibility for the advanced HAE. (2)Accurate assessment of functional liver "volume and quality" appeared as the key points to the ALT. (3)Precise surgery and individualized treatment could improve and protect the functional liver "volume and quality" .

To investigate the clinical efficiencies of the three surgical patterns in the treatment of cholecysto-choledocholithiasis (CCL).

A total of 157 patients with CCL, during the period from Janury 2012 to Janury 2016 at the Affiliated Hospital of Inner Mongolia Medical University, were divided into three groups according to surgical patterns: LC-LCBDE Group (laparoscopic cholecystectomy+ laparoscopic common bile duct exploration, n=49), ERCP-LC Group (endoscopic retrograde cholangiopancreatography+ laparoscopic cholecystectomy, n=51) and OC-OCBDE Group (open cholecystectomy+ open common bile duct exploration, n=57). Simultaneously, the intraoperative, postoperative and follow-up results of all the patients were compared.

There were significantly differences among three groups in intraoperative blood loss[LC-LCBDE Group: (18.16±3.88) ml, ERCP-LC Group: (17.37±3.79) ml, and OC-OCBDE Group: (60.39±8.73) ml, P=0.000], operation time[LC-LCBDE Group: (118.27±8.89) min, ERCP-LC Group: (124.27±9.48) min, and OC-OCBDE Group: (94.25±6.39) min, P=0.000], surgical successful rate (LC-LCBDE Group 89.20%, ERCP-LC Group 86.93%, and OC-OCBDE Group 100%, P=0.02), intestine function recovery[LC-LCBDE Group (42.35±3.44) h, ERCP-LC Group (43.61±3.34) h, and OC-OCBDE Group (53.86±4.76) h, P=0.000], hospitalization cost[LC-LCBDE Group (18 600±1 300) yuan, ERCP-LC Group (33 300±2 000) yuan, and OC-OCBDE Group (13 800±1 900) yuan, P=0.000], serum amylase elevation (LC-LCBDE Group 1 case, ERCP-LC Group 14 cases, and OC-OCBDE Group 2 cases, P<0.01) and postoperative hospital stay (LC-LCBDE Group 5.20±0.77 d, ERCP-LC Group 4.85±0.51 d, and OC-OCBDE Group 8.55±0.71 d,P=0.000). There were no differences among three groups in postoperative biliary leakage (LC-LCBDE Group 2 cases, ERCP-LC Group 0 case, and OC-OCBDE Group 2 cases) and residual bile duct stone rate (LC-LCBDE Group 4.08%, ERCP-LC Group 5.88%, and OC-OCBDE Group 3.50%).

All three types of surgical pattern are both efficacious and safe in the treatment of CCL. But no single pattern has absolute advantage over the other two. LC-LCBDE could preserve the function of Oddis sphincter, ERCP-LC could retain the integrity of common bile duct (CBD), and OC-OCBDE could serve as remedial measure for LC-LCBDE and ERCP-LC.

To explore the expression of serum interleukin-13 (IL-13) and significance of its gene polymorphism on the patients with acute exacerbation of bronchiectasis in acute exacerbation period.

Forty-three patients with bronchiectasis in acute exacerbation period admitted into the respiratory ward of Fujian Provincial Hospital from December, 2014 to March, 2016 were included as bronchiectasis group. Thirty-three healthy controls from normal people of health examination were included as control group during the corresponding period. A total of 5 ml fasting peripheral blood sample was extracted from each individual. The IL-13 levels were determined by enzyme-linked immunosorbent assay (ELISA). IL-13 gene polymorphisms in+ 1923 C/T site and+ 2044 site were genotyped in these two groups by using polymerase chain reaction (PCR) combined with gene sequencing methods. About 7 days after admission, thirty patients with improved condition among the 43 patients were included as bronchiectasis improvement group, all had the extraction of 3 ml peripheral blood for IL-13 detection determined by ELISA. The expression of serum IL-13 and gene polymorphisms between bronchiectasis group and control group were analyzed statistically. The changes of serum IL-13 between bronchiectasis group and bronchiectasis improvement group were also analyzed statistically.

The serum IL-13 level was lower in the bronchiectasis group in acute exacerbation period than that of the healthy controls [(31.1±26.3) vs (70.6±53.6) μg/L, P<0.05]. There was no significant difference of the genotype distribution in + 1923C/T site of IL-13 gene between the two groups (χ²=0.915, P>0.05). In the bronchiectasis group, the C and T allele frequencies at+ 1923 site of IL-13 gene were 79.1% and 20.9%, respectively, and its single nucleotide polymorphism (SNP) was in strong linkage disequilibrium with the SNP IL-13+ 2044G/A site (R²=0.835, P<0.001). There was no significant difference of the serum IL-13 between allele T_ groups and allele CC group, and also no significant difference between allele A_ groups and allele GG group (P>0.05).

The IL-13 levels decreased specifically in the bronchiectasis group in acute exacerbation period, but IL-13+ 1923C/T and+ 2044G/A polymorphisms are not significantly related to the susceptibility of bronchiectasis.

To investigate the value of HLA-B27 antigen, antinuclear antibody (ANA), anti-dsDNA and Anti-Neutrophil Cytoplasmic Antibodies (ANCA) detection in diagnosis of rheumatism with uveitis.

Seven hundred and twenty four newly diagnosed patients with non-infection uveitis in Beijing Tongren Hospital from March 2012 to March 2016 who long-term lived in Beijing and its surrounding areas were continuously enrolled. HLA-B27 antigen expressions in peripheral blood lymphocytes and ANA, anti-dsDNA and ANCA levels in serum were tested. The detailed clinical data, imaging examinations and pathological examinations were recorded to define whether the patients had rheumatism and the types of rheumatism.

There were 285 patients were diagnosed with rheumatism in 724 patients (39.4%), with 135 male (47.4%) and 150 female (52.6%). The mean age of male (41±14) was lower than that of female (44±14), with statistically significant (t=2.18, P<0.05). There were 176 patients with Spondyloarthropathies, 48 patients with primary systemic vasculitis, 22 patients with systemic lupus erythematosus, 18 patients with primary Sjogren′s syndrome, 16 patients with rheumatoid arthritis and 5 patients with juvenile idiopathic arthritis in 285 rheumatism patients. The positive rate of HLA-B27(57.2%), ANA(15.8%), anti-dsDNA (5.3%) and ANCA(9.1%) in rheumatic uveitis patients were obviously higher than those of non-rheumatic uveitis patients [HLA-B27(1.1%), ANA(1.6%), anti-dsDNA (0.0%) and ANCA(0.9%)], with statistically significant (Fisher′s exact test, P<0.01). The HLA-B27 positive antigen were mainly in patients with Spondyloarthropathies, rate was 92.1%; the positive ANA were mainly in patients with systemic lupus erythematosus, rate was 95.5%; the positive anti-dsDNA were mainly in patients with systemic lupus erythematosus, rate was 59.1%; the positive ANCA were mainly in patients with primary systemic vasculitis (besides Behcet disease), rate was 57.1%.

The detections of HLA-B27 antigen, ANA, anti-dsDNA and ANCA are valuable for primary screening of some rheumatic uveitis. There fore, clinicians should select targeted laboratory examination combine with the patients′ clinical manifestations. This will be helpful in the auxiliary diagnosis of some types of rheumatic uveitis.

To study the role of ApoE gene polymorphism on efficacy of atorvastatin in lowering the lipid and its clinical significance.

A total of 962 patients with hypercholesterolemia were selected between January 1 st and December 31 st 2014. The ApoE genepolymorphism in patients with hyperlipidemia was performed by using polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) method in translational medicine center of Huaihe Hospital. Patients with ApoE genotype E3/3 and E3/4 were selected and treated with atorvastatin 10 mg/d for 4 weeks. Before and after treatment, triglycerides (TG) and total cholesterol (TC) was detected by enzyme colorimetry method. High-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were performed by Clearance method. Lipoprotein(a) (Lp(a)) was performed by turbidimetric inhibition immunoassay. ApoE gene expression was performed by real-time PCR.

In the 6 gene types, the frequencies of E3/4 and E3/3 were 30.6% (294 cases) and 59.1% (569 cases) respectively. After treatment with atorvastatin, the change percent of TC, LDL-C, HDL-C, TG, Lp(a) in E3/4 and E3/3 group were -(23.0±4.7)% vs -(12.0±3.1)% (P<0.001), -(33.0±4.8)% vs -(20.0±3.9)% (P<0.001), (18.0±3.8)% vs (6.0±2.6)% (P<0.001), -(23.0±3.9)% vs -(13.0±2.7)% (P<0.001), -(21.5±4.5)% vs -(20.9±4.0)% (P=0.054), respectively. ApoE gene expression in E3/3 and E3/4 groups were down-regulated in both groups, and the change in E3/3 group was obvious than that of E3/4 group.

After treatment with atorvastatin, levels of lipids and ApoE gene expression in ApoE genotype E3/3 patients decreased, which were more evident than E3/4 patients.

To investigate the effect of dexmedetomidine alone for postoperative analgesia after laparoscopic cholecystectomy.

Forty patients scheduled for elective laparoscopic cholecystectomy in First Hospital of Ninghai County, American Society of Anesthesiologists (ASA) gradeⅠor Ⅱ, were randomly divided into dexmedetomidine group (Group D, n=20) and fentanyl group (Group F, n=20). The patient controlled analgesia (PCA) pumps were used after the operation. In the group D, the intravenous PCA protocol was dexmedetomidine 0.2 μg·kg ^-1·h^-1 diluted to 100 ml in 0.9% saline. In the group F, the PCA protocol was fentanyl 20 μg /kg diluted to 100 ml in 0.9% saline. Mean arterial pressure (MAP) and heart rate (HR) were recorded at the following time points: before induction of anaesthesia, end of operation and 4, 6, 8, 24, 48 hours after the operation. The pain score on a visual analogue scale (VAS) and the Ramsay sedation score were recorded at 4, 6, 8, 24, 48 hours after the operation. The incidences of postoperative nausea and vomiting (PONV), respiratory depression, dizziness, time to recovery of gastrointestinal function (time to first passage of flatus) and satisfaction with pain control were also recorded.

There were no significant difference in the general data of patients, duration of surgery, total dose of intraoperative propofol, fentanyl and sevoflurane, and total fluids during the operation (P>0.05). No patients received rescue analgesic. The MAP and HR values at different time points showed no significant difference between the groups (P>0.05). Similarly, the VAS scores and Ramsay sedation scale at 4, 6, 8, 24, 48 hours after the operation were not significantly different between the groups (P>0.05). The incidence of PONV was significantly reduced in group D, rating as 5%, comparing with 40% in Group F (P<0.05). Patients of Group D experienced a faster gastrointestinal function recovery, and the time to the first passage of flatus were (41.3±10.1) h in Group D and (55.6±11.4) h in Group F (t=-4.195, P<0.05), respectively. The pain treatment satisfactory score (PTSS) in Group D was (8.1±1.3) points, higher than that in Group F (6.1±1.5) points (t=4.426, P<0.05). Meanwhile, there was no statistic difference in the incidence of respiratory depression and dizziness in both groups (P>0.05).

Intravenous infusion of dexmedetomidine alone at 0.2 μg·kg ^-1·h^-1 after laparoscopic cholecystectomy not only reduces postoperative pain, but also enhances satisfaction with pain control and improves the recovery of gastrointestinal function.

To evaluate the efficacy of ultrasound guidance for fascia iliaca compartment block in pediatric femoral surgery.

This study was a prospective study, thirty children who were American Society of Anesthesiologists (ASA) statusⅠ with 5-10 years old scheduled for femoral surgery were selected in orthopedics department in Second Affiliated Hospital of Wenzhou Medical University from May to December in 2014. After induction of general anesthesia, all the children were inserted the laryngeal mask. Then they were received fascia iliaca compartment block using ultrasound guidance under sevoflurane inhalation anesthesia. The indicators including heart rate(HR), mean arterial pressure(MAP), oxygen saturation(SpO₂) and exhaled sevoflurane concentration were recorded before skin incision(T₁), at 1, 5, 10 min after incision(T₂-T₄)and at the end of the surgery(T₅). Postoperative pain were assessed using the pain behavior assessment scale at awake time, 2 h and 4 h after surgery. The efficacy of postoperative analgesia and the satisfaction of parents at 2 h and 4 h after surgery were recorded.

The differences between HR、MAP and SpO₂ in children at T₁-T₅ were no statistical significance (all P>0.05). Exhaled sevoflurane concentration at T₁-T₅ were(2.50±0.51)%, (2.51±0.42)%, (2.50±0.41)%, (2.54±0.31)% and(0.61±0.20)%, respectively, the differences were statistically significant(F=13.503, P<0.05), among them that at T₅ was significantly lower than at T₁-T₄(all P<0.05). The pain score at awake time, 2 h and 4 h after surgery were (1.6±0.7), (3.3±1.4) and (3.9±1.3) scores, respectively. The parents satisfaction were 87% and 73% at 2 h and 4 h afer surgery respectively.

The way of ultrasound guidance for fascia iliaca compartment block combined with general anesthesia can be safely and effectively used in pediatric femoral surgery. Using the technique of ultrasonic imaging, the fascia iliaca compartment can be directly observed and then the local anesthetics is injected, therefore the efficacy of block is improved.

To explore the effect of acellular normal and fibrotic lung matrices on alpha smooth muscle actin (α-SMA) expression in human lung adenocarcinoma cell line A549.

Twenty adult SD rats were randomly divided into normal group and idiopathic pulmonary fibrosis(IPF)group (n=10 each). The pulmonary fibrosis was induced by Bleomycin. Normal and fibrotic decellularized lungs were made, then sections with 500 μm thick were cut by a standard Vibratome. None scaffold was set as control group. A549 cells were seeded dropwise into different slices (normal and fibrotic scaffolds), and cultured for one week in vitro. The expression of α-SMA was measured by immunofluorescence staining and quantitative real time polymerase chain reaction (qRT-PCR).

In control group, the expression of α-SMA protein was positive in A549 cells by immunofluorescence staining. However, it expressed weakly both in normal and fibrotic scaffold group, and the fluorescence intensity in fibrotic scaffold group was significant lower than that in normal group ( P<0.05). The relative expression amount of α-SMA mRNA in normal and fibrotic scaffold group were (0.70±0.11) and (0.55±0.12), which were significant lower than that of control group (1.28±0.21) (P<0.05). Moreover, the relative expression of α-SMA mRNA in fibrotic scaffold group was decreased compared to that in normal scaffold group (P<0.05).

Acellular normal and fibrotic lung scaffold can downregulate the expression of α-SMA in human lung adenocarcinoma cell line A549. It may inhibit the movement of A549 cells in acellular normal and fibrotic lung matrices, especially in acellular fibrotic lung scaffold.

To investigate the repair mechanisms of the wounds with bone exposed by artificial dermis transplantation.

Seventy two rabbits were randomly divided into 3 groups of 24 rabbits, the wound model was made on the top of head. In the skin defect group (SD group), skin was removed and skull periosteum was retained. In the periosteal defect group (PD group), the skin and skull periosteum were both removed, and the skull was exposed. In the skull burn group (SB group), after the periosteum was removed, the exposed skull bone was burned out with electric iron to cause skull surface necrosis, then the artificial dermis transplantation were performed in each group. In 1, 2, 3 and 4 weeks after transplantation, 2 specimens including artificial dermis and the underlying tissue in each group were cut for biopsy with HE staining to observe the angiogenesis in artificial dermis. Evans Blue perfusion was performed in four animals from each group to quantify angiogenesis in artificial dermis.

One week after transplantation, in SD group, a few microvessels can be observed in artificial dermis, but in the rest of the two groups, only a small amount of inflammatory cells can be seen. Two weeks after transplantation, in SD group, a large number of new blood vessels and fibroblasts can be seen filling in the artificial dermis, but angiogenesis delayed obviously in the PD and SB group. Three weeks after transplantation, the angiogenesis of artificial dermis in the PD and SB group accelerated obviously, and a thin layer of blood rich tissue membrane can be seen over the burned skull. The Evans Blue perfusion showed that the content of dye perfusion in the artificial dermis was closed to the peek value at 2 weeks after transplantation in the SD group, which was significantly higher than that in PD and SB group [(2 741±976) vs (1 039±590) and (403±209) μg/g, P<0.01]. Three weeks after transplantation, the content of Evans Blue in artificial dermis reached the peek value in SD and PD group, no significant difference was found between this two groups, but both significantly higher than that in SB group [(2 943±793) and (2 255±316) vs (1 125±404) μg/g,P<0.01]. Four weeks after transplantation, the content of Evans Blue in artificial dermis reached the peek value in SB group, although the value was still lower than that in SD and PD group, the difference was not significant [(1 609±787) vs (2 298±778) and (2 141±385) μg/g,P>0.05].

Lack or injury of periosteum can cause vascularization delay after artificial dermis transplantation. The vascularization of artificial dermis mainly originates from the normal tissues surrounding the wound when artificial dermis is transplanted on the wound with periosteum defect or bone exposed.

Venous thromboembolism (VTE) ranks first among preventable and controllable fatal causes in hospital^[1]。 Although the death risk of fatal pulmonary embolism is high, the morbidity can be significantly reduced by correct medical intervention, so the prevention and treatment of venous thromboembolism has been highly paid attention to in clinical work in recent years. However, the misconception and perception of venous thromboembolism also brings new problems to clinical work. This study summarized the clinical characteristics of 98 cases of solitary intermuscular vein thrombosis of lower limbs, pointed out some misunderstandings in the current prevention and treatment of VTE, and provided reference for the prevention and treatment of VTE.

A 38-year-old male was admitted to Guangdong Nongken Central Hospital on May 30, 2015 mainly due to high fever, coma, convulsions, shortness of breath and anuria for 4 h. At 3 o'clock in the afternoon, when working in the open air in a high temperature and high humidity environment, I complained of dizziness, palpitation, nausea and fatigue. Then I collapsed, refused to respond, and my limbs twitched and vomited. I was sent to the local hospital for emergency department nearby. At that time, the body temperature was as high as 42℃, and he was given emergency physical cooling with ice pack, intravenous injection of dexamethasone 10 mg and fluid rehydration treatment. The body temperature dropped, but he was comatose with shortness of breath and anuria. No hemorrhage or infarction was found on brain CT scan, so he was transferred to our hospital. Usually introverted, likes sweet drinks, rarely drinks water. Deny history of diagnosis and treatment of other diseases. Physical examination: Body temperature: 39.3 ℃, blood pressure: 106/68 mmHg (1 mmHg =0.133 kPa), heart rate: 142 beats/min, breathing: 35 beats/min, blood oxygen saturation 54%, deep coma, dry and burning skin, severe edema of conjunctiva in both eyes, harmonic heart rhythm, coarse breathing sound in both lungs, cyanosis of lips and extremities, and no edema in both lower limbs. Auxiliary examination: white blood cells 17.2×10⁹/L, hemoglobin 117 g/L, platelets 79×10⁹/L. Reexamination after 6 h: white blood cells 7.6×10⁹/L, hemoglobin 139 g/L, platelets 25×10⁹/L. Urinary specific gravity>1.030, urine occult blood + + +. Gastric vomit occult blood + +. Blood sodium 133 mmol/L, blood potassium 2.67 mmol/L, blood calcium 1.78 mmol/L, blood phosphorus 0.28 mmol/L, urea nitrogen 8.4 mmol/L, creatinine 237 μ mol/L, uric acid 735 μ mol/L, blood glucose 20.10 mmol/L, albumin 32 g/L, globulin 19 g/L. There was no abnormality in bilirubin, aspartate aminotransferase 161 U/L (reference value: 8-40 U/L), alanine aminotransferase 93 U/L (reference value: 0-40 U/L), γ-glutamyltransferase 75 U/L (reference value: 7-45 U/L), alkaline phosphatase 75 U/L (reference value: 45-125 U/L), creatine kinase 8 480 U/L (reference value: 24-194 U/L), creatine kinase isoenzyme 480 U/L (reference value: 0-25 U/L), lactate dehydrogenase 652 U/L (reference value: 109-245 U/L), C-reactive protein 14.1 mg/L (reference value: 0-8 mg/L). High-flow mask oxygen inhalation (8 L/min), oxygen concentration in inhaled air (FiO₂) Blood gas at 53%: pH 7.34, partial pressure of carbon dioxide 46.5 mmHg, partial pressure of oxygen (PaO₂) 30.8 mmHg, HCO₃^-26 mmol/L, Blood oxygen saturation 56%. Oxygenation index (PaO₂/FiO₂) 58.1 mmHg (reference value: 400-500 mmHg). Plasma prothrombin time 13.6 s, international normalized ratio 1.15, activated partial prothrombin time 27.0 s, fibrinogen 1.50 g/L, D-dimer 2 270 μ g/L. Hepatitis viruses of various types (-). Electrocardiogram: Sinus tachycardia with mild changes in ST. Abdominal color ultrasound: liver enlargement and fatty liver. CT scan of the brain: extensive diffuse swelling of the gyrus. CT scan of the chest: sign of infection and edema in both lungs. Diagnosis: exertion heat stroke with multiple organ dysfunction syndrome (MODS), acute cerebral edema, severe acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), rhabdomyolysis, acute renal failure, acute liver damage, hypothalamic-pituitary-adrenal axis (HPA axis) hypofunction, pneumonia, stress ulcer, stress hyperglycemia?

The cytokine signaling inhibitor molecule (SOCS) 3 protein is a member of the SOCS protein family. SOCS protein feedback regulates cytokine responses, thereby regulating immune balance. Many studies have shown that SOCS3 protein is overexpressed in patients with allergic asthma, which plays an important role in the pathogenesis of asthma by affecting the differentiation of helper T lymphocytes (Th) and the airway infiltration of eosinophils. The mechanism of down-regulating SOCS3 protein in regulating immune balance in asthma is reviewed below.