Objective To determine if the fibrinogen/C reactive protein (CRP) ratio could be used in sepsis patients as a predictor for disseminated intravascular coagulation.Methods A total of 61 patients with sepsis admitted to emergency intensive care unit (EICU) were enrolled.C reactive protein (CRP) and variables of coagulation such as Platelet (PLT),prothrombin time (PT),activated partial thrombopastin time (APTT),fibrinogen and D-dimer were analyzed during 24 hours after admission to EICU.APACHE Ⅱ score,ISTH score and JAAM score were evaluated.According to DIC score (JAAM score and ISTH score),the patients were divided into two groups:overt DIC and no overt DIC.Data were expressed in mean ±standard deviation and were statistically analyzed by SPSS 17.0.The differences of CRP,PLT,PT,APTT,fibrinogen and D-dimer of patients in each group were analyzed by independent samples t test.The receiver-operating characteristics (ROC) analysis was performed to predict the diagnostic power of the variables fibrinogen,CRP,and fibrinogen/C reactive protein (CRP) ratio.In addition,the odds ratios (OR) were estimated by chi-square test and the 95％ confidence intervals were calculated.Results In overt DIC group fibrinogen/C reactive protein (CRP) ratio was significantly lower.The receiver-operating characteristic analysis showed for the fibrinogen/C reactive protein (CRP) ratio (area under the curve:ISTH criteria 0.691 and JAAM criteria 0.814) significantly better discriminative power than for fibrinogen (area under the curve:ISTH criteria 0.608 and JAAM criteria 0.429) and CRP (area under the curve:ISTH criteria 0.561 and JAAM criteria 0.788).The odds ratio for fibrinogen/C reactive protein (CRP) ratio (＜ 45) was 11.14 and CRP (＞ 70 mg/L) was 8.05.Conclusions We suggest that the fibrinogen/C reactive protein (CRP)ratio could be a diagnostic factor for the occurrence of disseminated intravascular coagulation in sepsis patients.

Objective To investigate the value of endoscopic ultrasonography (EUS) and abdominal CT (CT) in diagnosis of periampullary lesions and to make comparison between the two procedures. Methods The patients suspected of surrounding lesions of ampullary from 2009 to 2013 in our hospital were included in this study. All the patients received both EUS and abdominal CT. The accuracy rate of these two examination methods was compared. Results 151 patients were confirmed as surrounding lesions of ampullary, including choledocholithiasis, ampullary tumors, ampullary inflammation, tumors of the pancreatic head and pancreatic cysts. The accuracy rate of these diseases was 83.6%, 90.6%, 6.5%, 100.0%, and 100.0%for EUS;while was 52.2%, 56.3%, 43.5%, 91.3%, and 100.0%for abdominal CT. The tatal accuracy rate for diagnosing periampullary lesions by EUS was significantly higher than that by abdominal CT (84.1% vs. 59.6%). Conclusions Endoscopic ultrasonography has higher value in diagnosis of periampullary lesions, and its accurate rate was higher than that of abdominal CT.

AIM: To investigate the effects of berberine (Ber) on ion transport and hypersecretion induced by cholera toxin(ChT) in ileum and its mechanism. METHODS: Ussing Chamber technique was used to measure the potential difference(PD), short-circuit current(SCC), and the resistance(R) in isolated guinea-pig ileum. The effects of Ber on PD, SCC and R in glucose Tyrode solution or glucose-free Tyrode solution were examined. The secretory diarrhoea model was made by ChT to investigate the effects of ChT and ChT+Ber on PD, SCC and R. RESULTS: (1)The PD and SCC were decreased in glucose Tyrode solution by the Ber added in mocosal side or in serosal side in ileum of normal guinea-pig and which was with secretory diarrhoea ( P

Objective To investigate the prognostic significance of serum lactate level and lactate clearance rate for critical illness patients.Methods Two hundred and eighty-six patients with hyperlactacidemia were investigated by analyzing the clinical data,laboratory data and outcomes.Comparison of mortality rate and APACHE Ⅱ score between different stratified levels of serum lactate was carried out.The blood pH,HCO3-,BE,and Lac were compared between survivors and non-survivors in terms of in-hospital death in seven days after admission.The above variables of blood gas analysis were studied in patients with severe hyperlactacidemia as well as the different lactate clearance rates and APACHE Ⅱ scores were compared between survivors and non-survivors.The mortality rates and APACHE Ⅱ scores were compared between high and low lactate-clearance rate groups.Results The mortality rates of different stratified levels of serum lactate (≥2,＜4 mmol/L; ≥4,＜ 10mmol/L; ≥ 10 mmoL/L) were 14.04％,46.67％,78.79％,respectively.As the serum level of lactate increased,the decompensation rate of pH,APACHE Ⅱ score and mortality rate increased consequently.Compared with non-survivors,survivors had a higher lactate clearance rate (P ＜ 0.01),and lower APACHE Ⅱ score (P ＜ 0.01).The high-clearance group had lower mortality rate and 6-hour APACHE Ⅱ score compared with the low-clearance group (P ＜ 0.01),but the initiate levels of serum lactate and APACHE Ⅱ scores were not noticeably different between the two groups (P ＞ 0.05).Serum lactate level had a significant positive relationship with APACHE Ⅱ score (r =0.868,P ＜ 0.01),but lactate clearance rate had a significant reverse relationship with APACHE Ⅱ score (r =-0.823,P ＜ 0.01).Conclusions Both serum lactate levels and early lactate clearance rate had high prognostic value for critical illness patients,and in combination with changes in APACHE Ⅱ score,they could guide clinical treatment and give precise evaluation of the prognosis.

Objective:To evaluate the effect how Subtilisin FS33 affect thrombotic and fibrinolytic systems in vitro and in vivo. Method:Activity of Subtilisin FS33 was measured by clot liquefaction time(CLT) . On the model of 10% FeCl3 induced thrombi of carotid arteries in rats,various doses of Subtilisin FS33 were injected to the rats,and the fibrinolytic effect was observed. Results:0.5 g of the unheated blood clots gradually dissolved within 45 min,whereas the blood clots heated at 80℃ for 30 min dissolved within 3 h. This indicated that the enzyme was able to degrade blood clots in the absence of endogenous fibrinolytic factors. The experiment in vivo indicated that high dose subtilisn group could significantly prolong CT(coagulation time ) ,PT(prothrombin time) ,TT(thrombin time ) ,APTT(activated partial thromboplastin time) ,reduce ELT(euglobulin lysis time) ,decrease the content of FIB(fibrinogen) ,increase the content of FDP(fibrinogen degradation products) . D-dimer of all experimental groups waspositive. The venous thrombus in lung and kidney was dissolved totally or partly as observed by pathological section. Conclusion:Both thrombolytic effects of Subtilisin FS33 in vitro and in vivo were significant and the mechanisms might be associated with enhancing anticoagulation activity and fibrinolysis.

A novel fibrinolytic enzyme subtilisin FS33, which exhibits much higher activity for decomposing fibrin than urokinase, was purified from Douchi, a traditional soybean-fermented food in China. In order to increase bio-utilization and thrombus targetability of subtilisin FS33 labeled by fluorescein isothiocyanate (FITC), the surface modified liposomes encapsulating subtilisin FS33 and FITC with a synthetic peptide Arg-Gly-Asp-Ser (RGDS), being putatively a specific antagonist of fibrinogen receptor on platelet membrane, were prepared and used to evaluate the therapeutic efficacy in a rat model thrombotic carotid artery. The arterial thrombosis was induced by applying two pieces of filter paper (1 x 2 cm) saturated with 10% of ferric chloride (FeCl3). The rats were infused via the jugular vein with either liposomes carrying BSA (control group) or RGDS-liposomes carrying subtilisin FS33 at doses of 2000 and 4000 U/kg. The plasma of the group infused with RGDS-liposomes showed higher antithrombotic and fibrinolytic activity than did the control group within 15-120 min after infusing. The higher the dose was gived, the higher the activity was shown. APTT(activiated partial thromboplastin time), PT (prothrombin time) and TT (thrombin time) were extended remarkably (P < 0.05, P < 0.01), and FDP (fibrinogen degradation products) also increased greatly (P < 0.01), while ELT (euglobulinlysis time) decreased obviously (P < 0.05). FITC content in heart and brain evidently increased (P < 0.05), and results of D-dimer test were all positive. In addition, the venous thrombi in brain and kidney were dissolved totally or partly as observed by patholgical section. All these indicated that subtilisin FS33 enhanced the antithrombotic and fibrinolytic activities in rat, and RGDS-liposomes improved, in a certain degree, the thrombolytic specificity for targeting to thrombus.
Animals ; Carotid Artery Thrombosis ; drug therapy ; etiology ; Drug Carriers ; Drug Delivery Systems ; Female ; Fibrinolytic Agents ; administration & dosage ; Liposomes ; administration & dosage ; chemistry ; Male ; Oligopeptides ; administration & dosage ; chemistry ; Random Allocation ; Rats ; Rats, Wistar ; Subtilisins ; administration & dosage ; isolation & purification

Objective To investigate the clinical characteristics and associated prognostic factors of the acute aortic syndrome. Methods The clinical data of 391 patients with acute aortic syndrome (AAS) admitted to Beijing University People's Hospital from January 2000 to December 2015 were analyzed. Results In 391 patients with AAS, the average age was (52.7 ±13.3) with a male/female ratio of 4.3:1, and 73.4％ patients had hypertension. The most common clinical manifestation of patients with AAS was pain accounting for more than 90.0％, and the nature of pain was expansible and/or transitive pain. The level of D-dimer was elevated in 91.1％ of patients with AAS (ELISA), and significantly higher in type A patients than type B patients. Ultrasound/echocardiography was used to diagnose AAS with a sensitivity of 88.4％, of which the sensitivity of type A patients was 99.1％; the mortality of type A patients was significantly higher than type B patients (34.3％ vs. 0.9％, P <0.01). The mortality was declined obviously (11.7％ vs. 28.0％, P <0.01) when patients were treated with stent. Compared with the in-hospital surviving group, the in-hospital mortality group had decreased platelet counts and FIB, higher level of D-dimer, FDP and NLR (neutrophil to lymphocyte ratio). Conclusions Transitive and(or) expansible pains were the characteristic clinical manifestations of acute aortic syndrome,which usually happened suddenly or tearing;D - dimer and ultrasound were valueble and simple methods in AAS patients; Compared with In-hospital surviving group,the In-hospital mortality group had decreased platelet counts and FIB,higher level of D-dimer, FDP and NLR.The mortality of type A was significantly higher than type B,operation can lower the mortality of AAS patients obviously.

Objective To investigate the clinical characteristics and prognosis of patients with acute aortic dissection (AAD) and hypertension,and explore other related prognostic factors in AAD.Methods The present study enrolled consecutive patients diagnosed with AAD who were admitted to Peking University People's Hospital between January 2000 to December 2015.Patients diagnosed with AAD by CT angiography,aortography or magnetic resonance imaging within 14 days of onset were included.Patients with infectious diseases,haematological diseases,malignancies,autoimmune diseases and patients without clearly clinical diagnosis or incomplete data were excluded.The patients were initially divided into two groups based on their history of hypertension,and their clinical characteristics were compared and analyzed.We further divided AAD patients into survival group and death group according to their in-patient outcomes,and factors related to their prognoses were analyzed.Logistic regression analysis was applied to analyze the independent risk factors related to hospital death in AAD patients with P＜0.05 as the significant value.Results The hypertensive group contained 237/346 cases included (68.45％),patients in this group were generally older than their non-hypertensive counterparts,accompanied by increased prevalence of comorbidities (coronary heart diseases or diabetes) and a statistical significant elevated admission blood pressures (systolic and diastolic,P＜0.05).No significant difference were found between the groups in terms of white blood cell and platelet count,D-dimer,neutrophil to lymphocyte ratio(NLR),fibrinogen,serum creatinine and serum lipid profiles (P＞0.05).Hypertensive patients were less likely to receive surgical treatment compared with those without hypertension(P＜0.05),with increased risk of in-hospital mortality (P＞0.05).Further logistic regression analysis revealed the presence of hypertension did not independently predict in-hospital mortality of AAD patients.Factors such as age,Stanford classification of the AAD,NLR and platelet counts were found to have independent predictive values for in-hospital mortality (P＜0.05).Conclusion AAD patients with hypertension are generally older,have more comorbidities such as coronary heart diseases and diabetes.The presence of hypertension itself is not directly associated with in-hospital mortality in AAD patients,while the Stanford classification,age,NLR and platelet counts are independent risk predictors.

To study alkaloid constituents in Corydalis decumbens,thirteen compounds were isolated from 95％ ethanol extracts of Corydalis decumbens (Thunb) Pers.by silica gel,RP-C1s,Sephadex LH-20 column chromatographer,recry stallization,thin-layer chromatography and HPLC.Their structures were elucidated on the basis of spectral data combined with physiochemical properties as tetrahydropalmatine (1),oxyhydrastinine (2),doryanine (3),palmatine (4),bicuculline (5),canadine (6),tetrahydrocoptisine(7),corydaldine (8),epicorynoxidine (9),N-methylcorydaldine (10),(+)-corlumine (11),N-methyl-6,7-dimethoxyisoquinolone (12) and oxysanguinarine (13).Compounds 2,3,6,7,and 9-13 were isolated from this plant for the first time.In addition,compounds 2,3,and 9-13 were obtained firstly from this genus.Pharmacological experiments showed that tetrahydropalmatine (1) might have analgesic or sedative effects,and the bicuculline (5) could probably induce epilepsy.

Objective To investigate the clinical pathological characteristics and prognosis of primitive neuroectodermal tumor (PNET) of breast.Methods Patients with breast PNET were retrieved from CNKI,Pubmed,Europe PMC and other databases from Jan.1980 to Dec.2016.The clinical data of one patient with breast PNET in our hospital were analyzed retrospectively.Results 18 cases had painless,rapid growth mass as the main clinical features.The pathological morphology showed small round cell tumors,PAS staining positive.Immunohistochemistry CD99 and Fli-1 characteristic expression were the main indexes for the diagnosis of breast PNET.The positive expression of Vimentin,NSE,Syn and negative expression of CK,EMA,Desmin,CgA,LCA,S-100 also played an important role in the diagnosis of breast PNET.The positive expression of genetic marker EWSRI was the golden standard for diagnosis of breast PNET.The size of the tumor,surgical treatment,lymph node metastasis,distant metastasis and chemotherapy were the important factors that affect the prognosis of the PNET.The survival rates of 1 and 3 years were 71.4％ and 33.3％ respectively.Conclusions Breast PNET is a rare tumor with poor prognosis,and its diagnosis is highly dependent on pathology.Surgery can significantly improve the prognosis of the patients.Surgery should be the main treatment,combined with radiotherapy and chemotherapy.The current study does not show evidence of effectiveness in terms of endocrine or targeted drug therapy for breast PNET patients.