ObjectiveTo assess the value of legs passively lifted as an indicator of fluid responsiveness in mechanically ventilated patients with severe sepsis.Methods Twenty-eight mechanically ventilated patients with severe sepsis admitted from May 2010 to May 2011 for volume resuscitation were collected.Patients with non-sinus rhythm or arrhythmia and parturients were excluded. Variation of hemodynamics of the patients in a semi-recumbent position,after passive leg raising (PLR) and after volume expansion (500 ml 6％ hydroxyethyl starch infusion within 30 mins) was studied by using the technique of pulse indicator continuous cardiac output (PiCCO) system.The volume resuscitation were resulted into two groups,responder and non-responder,as per △SVI (stroke volume index) over 15％.HR,arterial systoicblood pressure (ABPs),arterial diastolic blood pressure (ABPd),mean arterial blood pressure (ABPm),mean central venous pressure (CVPm) and cardiac index (CI) were compared between two groups.The changes of ABPs,ABPm,CVPm and SVI after PLR and after fluid resuscitation werc compared with those before PLR and fluid resuscitation.The ROC curve was drawn to evaluate the value of △SVI and △CVPm in predicting volume responsiveness. SPSS 17.0 software was used for statistic analysis. ResultsOf 28 patients,8 were responders and 10 were non-responders.In responders after PLR,some hemodynamic variables including ABPs,ABPm and CVPm were significantly increased [(100.1 ± 18.1) vs.(115.9 ±13.1),P=0.005; (68.1±12.4) vs.(77.8±13.0),P=0.03and(7.2±3.4) vs.(10.1±4.1),P=0.03,respectively ].After PLR,the area under curve (AUC) of the ROC curve of △SVI and △CVPm to predict the responsiveness after fluid resuscitation were 0.897 ± 0.059 (95 ％ CI 0.762-1.000) and 0.819±0.081 (95％CI 0.661-0.977),respectively.When the cut-off levels of △SVI and △CVPm were 10.5％ and 12.7％,the sensitivities were 72.2％ and 72.2％,the specificities were 90％ and 80％.Conclusions Changes in △SVI and △CVPm induced by passive leg raising are accurate indices for predicting fluid responsiveness in mechanically ventilated patients with severe sepsis.

Acupuncture Points ; classification ; Acupuncture Therapy ; Adult ; Aged ; Female ; Hiccup ; therapy ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Objective To investigate the indicative value of Neutrophils /lymphocyte ratio in the progress of colorectal cancer .Methods Fifty one patients with colorectal cancer ,63 cases with adenomatous polyps ,75 cases with inflammatory and hyperplastic polyps ,48 case of another digestive system tumors and 21case of inflam-matory bowel diseases were enrolled in this study in the Affiliated Hefei Hospital of Anhui Medical University .We also chose sixty people as control group whom were conduct enteroscope as physical examination but didn 't find any abnormal lesions and compared the date of NLR CEA and CA 199 between six groups and different stages of colorectal cancer .The ROC curve was carried out to establish the cut off of NLR and the area under curve (AUC).Furthermore,we compared the diagnostic efficiency of the three tumor markers .Results The level of NLR in patients with colorectal cancer was obviously higher than that of adenoma group ,the polyp group ,another digestive system tumor group,inflammatory bowel disease group and normal control group (P<0.05),despite the NLR value in another digestive system tumor and inflammatory bowel disease patients was elevated slightly ,while there was no obvious differences between the another groups (P>0.05).The levels of NLR in patient with Dukes A and B stages were lower than Dukes C and D stages (P<0.05).The cut off of NLR was 2.73,AUC=0.727, suggesting an accurate diagnostic value .The diagnostic sensitivities of the three markers in order of NLR >CEA>CA199,and the specificities in order of CA199>CEA>NLR.Moreover,the diagnostic sensitivity and specificity of the combined detections of three markers were higher than either of screening respectively or two indicators of arbitrary joint .Conclusion The elevated value of NLR is corresponding to the high state of inflammation in colo-rectal cancer ,when used NLR as a potential marker for diagnosis of colorectal cancer ,the sensitivity is superior to the conventional tumor markers ,but the specificity is not high ,therefore,we should combined with the other tumor markers to improve the diagnostic accuracy .

Objective To evaluate the effects of levosimendan on hemodynamics and cardiac function in patients with septic shock. Methods A prospective single-center randomized controlled trial was conducted. The patients with septic shock admitted to the Department of Critical Care Medicine of the Third Hospital of Hebei Medical University from June 2011 to October 2013 were enrolled. The patients with septic shock received the conventional treatment according to international guidelines for management of severe sepsis and septic shock. Thirty-six patients received the examination of echocardiography and left ventricular ejection fraction (LVEF)≤0.45 after fluid resuscitation were enrolled the study ,who were divided into two groups according to random number table ,with 18 cases in each group. After the conventional treatment,the patients in dobutamine group received intravenous injection of 5μg·kg-1·min-1 dobutamine for 48 hours immediately after fluid resuscitation,and those in levosimendan group received a 24-hour infusion of 5μg·kg-1·min-1 dobutamine followed by a 24-hour infusion of 0.2μg·kg-1·min-1 levosimendan. The hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output (PiCCO) and ultrasound during treatment. Results Compared with dobutamine group,after the treatment in the levosimendan group,stroke volume index (SVI),cardiac index (CI)and left ventricular stroke work index(LVSWI) were significantly increased〔SVI(mL/m2):39.8±5.4 vs. 37.5±4.5,t=-2.762,P=0.020;CI(L·min-1·m-2):4.6± 0.7 vs. 3.6±0.7,t=-9.829,P=0.000;LVSWI (kg·min-1·m-2):33.7±2.4 vs. 28.2±1.2,t=-6.307,P=0.000〕, and central venous pressure (CVP),intrathoracic blood volume index (ITBVI)and extravascular lung water index (EVLWI)were significantly decreased〔CVP(mmHg,1 mmHg=0.133 kPa):8.2±0.9 vs. 12.1±0.8,t=3.928,P=0.002;ITBVI (mL/m2):820±42 vs. 978±69,t=9.472,P=0.000;EVLWI (mL/kg):6.1±1.6 vs. 8.9±1.7,t=4.467,P=0.001〕. Cardiac ultrasound showed that compared with dobutamine group,in the levosimendan group,left ventricular end-systolic volume (LVESI) and end-diastolic volume (LVEDI) were significantly lowered〔LVESI (mL/m2):32.7±9.2 vs. 48.2±13.4,t=0.882,P=0.000;LVEDI (mL/m2):61.7±11.4 vs. 78.6±13.6,t=2.453, P=0.032〕,and the LVEF was significantly increased (0.463 ±0.068 vs. 0.383 ±0.085,t=-2.439,P=0.035). Levosimendan also could decrease the lactic acid(mmol/L:3.4±1.1 vs. 5.2±1.2,t=3.346,P=0.007),and increase the lactate clearance rate(mL/min:73.2±13.5 vs. 47.6±11.8,t=-4.079,P=0.002),24-hour urinary output(mL:2 213.4±354.0 vs. 1 533.8±402.0,t=6.342,P=0.000)and 24-hour cumulative intake (mL:5 746.6±420.0 vs. 4 156.7 ±215.0,t=7.126,P=0.000). There were no significant differences in total volume of norepinephrine, mortality in intensive care unit (ICU)and 28-day mortality between two groups. Conclusion Levosimendan can increase cardiac ejection function,reduce the heart blood and vascular preload,intrathoracic lung water,improve heart function and systemic hemodynamic indexes of patients with septic shock.

Objective To evaluate the effect of methylene blue pertreatment on acute kidney injury induced by sepsis in rats.Methods Ninety male Sprague-Dawley rats,aged 1.5-2.5 months,weighing 200-250 g,were randomly assigned into 3 groups (n =30 each) using a random number table:sham operation group (S group),cecal ligation and puncture (CLP) group and methylene blue group (MB group).The rats were anesthetized with 10％ chloral hydrate 350 mg/kg.Normal saline 0.8 ml was injected via the caudal vein in and CLP groups,while 10％ methylene blue 15 mg/kg (in normal saline 0.8 ml) was injected via the caudal vein in group MB.Sepsis was induced by CLP after the end of administration in CLP and MB groups.Twenty animals in each group were chosen and observed for 72 h survival rate.Ten animals were sacrificed in each group at 18 h after operation and kidney specimens were removed for microscopic examination and for determination of the expression of poly (ADP-ribose) polymerase (PARP-1) using immunohistochemistry and Western blot.Blood samples were taken from the heart for determination of serum concentrations of blood urea nitrogen (BUN),creatinine (Cr),cystatin C and neutrophil gelatinase-associated lipocalin (NGAL).Results Compared with group S,the survival rate was significantly decreased at 24,48 and 72 h after operation,and the serum concentrations of BUN,Cr,cystatin C and NGAL and expression of PARP-1 in kidney tissues were increased in CLP and MB groups (P ＜ 0.05).Compared with group CLP,the survival rate was significantly increased at 24 and 48 h after operation,and the serum concentrations of BUN,Cr,cystatin C and NGAL and expression of PARP-1 in kidney tissues were decreased in group MB (P ＜ 0.05).The pathological changes were significantly attenuated in group MB as compared with group CLP.Conclusion Methylene blue pertreatment can attenuate acute kidney injury induced by sepsis in rats through down-regulating the expression of PARP-1.

OBJECTIVE:To explore the risk factors for nosocomial infection of multidrug-resistant organism (MDRO) in ICU,and to provide reference for preventing and controlling MDRO in ICU. METHODS:In retrospective study,246 patients with nosocomial infection from ICU of Xi'an Aerospace General Hospital (hereinafter referred to asour hospital) during Jan. 2011-Dec. 2015 were selected and divided into non-MDRO infection group (140 cases) and MDRO infection group (106 cases). The detection and drug resistance of MDRO were analyzed in MDRO group. Univariate analysis and binary Logistic regression anal-ysis were used to explore risk factors for nosocomial infection of MDRO. RESULTS:During 2011-2015,435 strains of MDRO were isolated from 106 MDRO infection patients,in which Gram-negative bacteria accounted for 89.43%,showing severe drug re-sistance. Univariate analysis showed that the following 13 factors were related to nosocomial infection of MDRO,such as ICU ad-mission time,hypoproteinemia,acute cerebrovascular diseases,renal abnormalities,mechanical ventilation time,arterivenous cath-eterization time,urethral catheterization time,indwelling gastric tube time,type and time of using antibiotics,combined use of an-tibiotics,application of carbapenems and the third generation caphalosporins(P<0.05). Binary Logistic regression analysis showed that acute cerebrovascular diseases,type and time of using antibiotics were the independent risk factors for nosocomial infection of MDRO in ICU [odds ratios were 2.816,1.582,1.265,95%CI were (1.540,5.151),(1.085,2.306),(1.131,1.415)]. CONCLU-SIONS:Some prevention and control measures should be taken actively for high-risk MDRO infection patients in ICU to reduce the incidence of nosocomial infection of MDRO and improve the quality of health care.

Evaluation methods of chronic sinusitis ( Visual Analogue Score and Lund-Kennedy Score) were recom-mended by the 2009 Chinese Medical Association otolaryngology head and neck surgery to nasal Science Group,and retrospective analysis of the functional endoscopic sinus surgery for noninvasive fungal sinusitis treatment effect of 143 patients. VAS of preoperative was 5.8±1.0,postoperative score was 3.9±1.0, 2.4±0.9 after 3 months,6 months, respectively (P<0.01). Lund-Kennedy Score of preoperative was 7.7±2.1, postoperative score was 3.7±1.9, 1.6±1.4 after 3 months,6 months respectively (P<0.01).

Objective To investigate the effects of special siRNA targeting TLR4 gene (TLR4-siRNA) on hyperoxia-induced secretion of inflammatory factors from human alveolar epithelial cell line A549.Methods Human alveolar epithelial cell line A549 was purchased from Chongqing Children Hospital and cultured in six-well tissue culture plates and randomly divided into 4 gorups:A549 cells + ambient air group (group C) ; A549 cell + hyperoxia group (group H); A549 cells transfected with TLR4-siRNA + hyperoxia group (group TR) and A549 cells transfected with control-siRNA + hyperoxia group (group NR).TLR4-siRNA and control-siRNA were transfected into A549 cells through lipofectamine 2000.The efficiency of transfection was assessed by detection of FAM expression using flow cytometry.The cells were exposed to 95％ O2-5％ CO2 delivered at 1 L/min for 30 min in groups H,TR and NR.TLR4 mRNA and protein expression was detected by RT-PCR and cytometry respectively.The NF-κB activity in A549 cells was measured by EMSA and the IL-6 and IL-8 levels in supernatant were determined by ELISA.Restults Hyperoxia significantly up-regulated TLR4 mRNA and protein expression and increased NF-κB activity in cells and IL-8 and IL-6 concentrations in supematant in group H as compared with group C.Transfection with TLR4-siRNA significantly attenuated hyperoxia-induced up-regulation of TLR4 mRNA and protein expression and increase in NF-κB activity in the cells and IL-6 and IL-8 concentrations in supernatant in group TR as compared with group H,but transfection with control-siRNA did not.Conclusion TLR4-siRNA could significanly inhibit hyperoxia-induced secretion of inflammatory factors from human alveolar epithelial cell line A549.