Objective: To improve the chemo therapeutic effect through bronchial artery perfusion. Method: The angiographies of the bronchial arteries in 54 cases and pulmonary arteries in 10 cases of patients with advanced lung cancers were analized. Results showed: The bronchial arteries were divided into four subtype blood supply from intercostal artery, 30 cases; from bronchial artery 20 cases; from left and right bronchial arteries, 2 cases; from single intercostal artelry 2 cases. The blood vessels of pulmonary carcinomas were divided into three types: rich blood suppety 50. 2% (28 cases), poor blood supply 49.8% (26 cases) and from pulmonary artery else. Conclusion: The dual chemotherapeution pesfusion method by bronchial and pulmonary arterial approach should be considered as the proper procedure in treating advanced lung cancer of various kinds of different tissues.

Objective To investigate whether early goal-directed therapy ( EGDT ) could lower the mortality rate in patients with severe sepsis and septic shock. Methods Articles with items sepsis, severe sepsis, septic shock, EGDT were retrieved from MEDLINE, EMBASE, Cochrane, Wanfang Data and CNKI. Inclusion criteria included randomized controlled trial, subjects concerning patients with severe sepsis or septic shock, endpoints with short-term mortality [ in-hospital, intensive care unit ( ICU ) or 28-day ] and long-term mortality ( 60-day or 90-day ). Related risk ( RR ) and 95% confidence interval ( 95%CI ) were used as indices to judge the difference in mortality rate between EGDT group and standard treatment group. RevMan 5.2 software was used for Meta analysis. Results There were 8 studies meeting inclusive criteria with a total of 4 853 patients. For patients with severe sepsis and septic shock, compared with the group with routine treatment, EGDT showed a decrease in the short-term mortality ( RR = 0.74, 95%CI=0.66-0.82, P<0.000 01 ), but did not decrease the long-term mortality ( RR=0.99, 95%CI=0.92-1.06, P=0.81 ). Conclusion EGDT strategy may decrease the short-term mortality in patients with severe sepsis and septic shock, but it showed no influence on the long-term mortality.

Objective To investigate the effects of ω-3 fish oil lipid emulsion via vein on the inflammatory response,immune and organ function in patients with severe acute pancreatitis.Methods A total of 53 patients with severe acute pancreatitis were randomized into conventional therapy plus fish oil group (FO group) and conventional therapy group (CON group).The patients in FO group were treat with ω-3 fish oil lipid emulsion (0.2 g · kg-1 · d-1,10％) based on conventional therapy for 14 days.The level of C-reactive protein (CRP),TG and TC were detected before treatment and at day 7 and day 14 after treatment.CD4+,CD4+/CD8+ and C3,C4 were also detected at day 1 and day 14 after treatment.At the same time,acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ score),intra-abdominal pressure,negative fluid balance time,enteral nutrition start-time and ICU stay time were observed and recorded.Results Forty-five out of 53 patients were finally recruited into results statistics.The level of CD4+,CD4+/CD8+ and C3 at day 14 after treatment in FO groups improved significantly than that in the CON group (P ＜0.05).The levels of CRP,intra-abdominal pressure and APACHE Ⅱ score at day 7 and day 14in FO group descended more obviously than that in the CON group (P ＜ 0.05).The negative liquid balance time in FO group (3.55 ±0.86) days was obvious shorter than that in CON group (4.61 ± 1.12) days,while enteral nutrition start-time (3.86 ± 1.17) days was significantly earlier compared with CON group (5.30 ± 1.61) days (P ＜ 0.05),however ICU stay time and 28 days mortality rate had no significant difference between the two groups.Conclusions ω-3 fish oil lipid emulsion can decrease the inflammatory response and the negative liquid balance time,improve the immune function and restore bowel function in severe acute pancreatitis patients.Therefore,it maybe provide a new and effective means for severe acute pancreatitis.

Objective To systematically evaluate the effects of left ventricular global longitudinal strain (GLS) determined by two dimensional speckle tracking imaging technology (2D-STI) and left ventricular ejection fraction (LVEF) on the prognosis of patients with sepsis/septic shock.Methods Databases such as the National Library of Medicine PubMed database, Dutch medical abstracts Embase, Cochrane Library, Netherlands Elsevier, Springer and China biomedical literature database (CBMdisc), China National Knowledge Internet (CNKI), Wanfang database, China science and technology journal full-text database, Vip Chinese biomedical journal database were searched from the establishment of literature database to April 2018 to study GLS, LVEF and their relationships with mortality of septic/septic shock patients. The literatures screening and data collecting were independently conducted by two researchers, and the quality of the included literature was evaluated. The sensitivity and heterogeneity analysis were performed with RevMan 5.3 software, and the combined effects were calculated. Funnel plot was used to evaluate publication bias.Results A total of 6 articles including 5 English articles and 1 Chinese article were enrolled. There were 503 patients, 333 in the survival group and 170 in the death group. The quality of the literature was high, and the Newcastle-Ottawa scale (NOS) score was 8-9. Meta-analysis showed that short-term mortality was associated with higher GLS in patients with sepsis/septic shock [standardized mean difference (SMD) = -0.47, 95％ confidence interval (95％CI) = -0.76 to -0.18, Z = 3.16,P = 0.002], and there was no significant difference in LVEF between the survival group and the death group (SMD = 0.18, 95％CI = -0.03-0.39,Z = 1.64, P = 0.10). Sensitivity analysis was carried out for each effect index by removing each document one by one, and the results showed that there was no significant change in the combined effect before and after each document, indicating that the results were stable. The funnel plot showed that the effect points of each literature were roughly in the form of "inverted funnels" with a large symmetric distribution centered on the combined effect, but the number of studies included in this study was too small, so the publication bias could not be completely excluded.Conclusion Compared with LVEF, GLS might be a more sensitive indicator for detecting myocardial dysfunction in patients with sepsis/septic shock and might have important predictive value for short-term mortality.

Objective To establish a severe sepsis/septic shock prognosis prediction model based on randomize forest law (RF model), and to evaluate the prognostic value of this model for patients with severe sepsis/septic shock. Methods 497 patients with severe sepsis/septic shock admitted to intensive care unit (ICU) of Zhejiang Hospital from September 2013 to May 2017 were enrolled. The basic data, vital signs and symptoms, biochemical indexes and blood routine indexes on the 1st, 3rd, 5th day and prognosis were collected. According to the 28-day prognosis, the patients were divided into death group and survival group, and the specific indicators about the prognosis of severe sepsis/septic shock were screened. A RF model was constructed by using the specificity indicators. The assessment effectiveness of RF model, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) were evaluated by receiver operating characteristic (ROC) curve analysis. Results In 497 cases of severe sepsis/septic shock, 201 cases died, 28-day mortality was 40.4%. ① According to the index difference of death group and survival group, 19 specific parameters of the RF model were selected, which included the age; 24-hour urine output, urea nitrogen (BUN), serum creatinine (SCr), platelet count (PLT) on the 1st day; heart rate (HR), mean arterial pressure (MAP), cyanosis and clammy skin on the 3rd day; temperature, HR, MAP, 24-hour urine output, PLT, fever, cyanosis, dyspneic, clammy skin, piebald on the 5th day. ② ROC curve analysis showed that the area under the ROC curve (AUC) of RF model predicting 28-day mortality was higher than that of SOFA and APACHE Ⅱ score on the 1st, 3rd, 5th day (AUC: 0.836 vs. 0.643, 0.554, 0.766 and 0.590, 0.670, 0.758). The sensitivity of RF model to predict the 28-day mortality was 86.1%, the specificity was 77.0%, the accuracy was 80.7%. Conclusion The evaluation model based on random forest can effectively predict the death risk of 28-day in patients with severe sepsis/septic shock, and its predictive efficiency is better than that of the SOFA and APACHE Ⅱ score.

BACKGROUNDFew studies have reported the effect of different volume responsiveness evaluation methods on volume therapy results and prognosis. This study was carried out to investigate the effect of two volume responsiveness evaluation methods, stroke volume variation (SVV) and stroke volume changes before and after passive leg raising (PLR-ΔSV), on fluid resuscitation and prognosis in septic shock patients.

METHODSSeptic shock patients admitted to the Department of Critical Care Medicine of Zhejiang Hospital, China, from March 2011 to March 2013, who were under controlled ventilation and without arrhythmia, were studied. Patients were randomly assigned to the SVV group or the PLR-ΔSV group. The SVV group used the Pulse Indication Continuous Cardiac Output monitoring of SVV, and responsiveness was defined as SVV ≥12%. The PLR-ΔSV group used ΔSV before and after PLR as the indicator, and responsiveness was defined as ΔSV ≥15%. Six hours after fluid resuscitation, changes in tissue perfusion indicators (lactate, lactate clearance rate, central venous oxygen saturation (SCVO2), base excess (BE)), organ function indicators (white blood cell count, neutrophil percentage, platelet count, total protein, albumin, alanine aminotransferase, total and direct bilirubin, blood urea nitrogen, serum creatinine, serum creatine kinase, oxygenation index), fluid balance (6- and 24-hour fluid input) and the use of cardiotonic drugs (dobutamine), prognostic indicators (the time and rate of achieving early goal-directed therapy (EGDT) standards, duration of mechanical ventilation and intensive care unit stay, and 28- day mortality) were observed.

RESULTSSix hours after fluid resuscitation, there were no significant differences in temperature, heart rate, blood pressure, SpO2, organ function indicators, or tissue perfusion indicators between the two groups (P > 0.05). The 6- and 24-hour fluid input was slightly less in the SVV group than in the PLR-ΔSV group, but the difference was not statistically significant (P > 0.05). The SVV group used significantly more dobutamine than the PLR-ΔSV group (33.3% vs. 10.7%, P = 0.039). There were no significant differences in the time ((4.8±1.4) h vs. (4.3±1.3) h, P = 0.142) and rate of achieving EGDT standards (90.0% vs. 92.9%, P = 0.698), or in the length of mechanical ventilation and ICU stay. The 28-day mortality in the SVV group (16.7% (5/30)) was slightly higher than the PLR-?SV group (14.3% (4/28)), but the difference was not statistically significant (P = 0.788).

CONCLUSIONSIn septic shock patients under controlled ventilation and without arrhythmia, using SVV or PLR-ΔSV methods to evaluate volume responsiveness has a similar effect on volume therapy results and prognosis. The evaluation and dynamic monitoring of volume responsiveness is more important for fluid resuscitation than the evaluation methods themselves. Choosing different methods to evaluate volume responsiveness has no significant influence on the effect of volume therapy and prognosis.

Adult ; Female ; Fluid Therapy ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; methods ; Shock, Septic ; pathology ; therapy ; Stroke Volume ; physiology