Sepsis is a serious problem among the elderly population as its incidence and mortality rates dramatically increase with advanced age. More importantly, the elderly has increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence and frequent instrumentation. Those who survive severe sepsis are more likely to have irreversible organ damage, cognitive impairments, and diminished overall function. Additionally, elderly patients with sepsis often present with atypical symptoms which further complicates and potentially delays diagnosis. Although sepsis is a serious life-threatening disease, recognition of this problem is very low compared to other age-associated diseases. Therefore, the purpose of this review is to analyze the challenges facing this cohort and how to optimize their management.

Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Objective To investigate if the quantum resonance spectrometer(QRS) can detect the schizophrenic symptoms in clinical applications.Methods According to the result of QRS test and ICD-10 diagnostic criteria and exclusion criteria, subjects were divided into patient( n = 65 ) and control groups( n = 100).11 schizophrenia-related symptoms were detected by QRS.Data was analyzed using SPSS13.0 statistical software statistical significance was set at P＜0.05.Results Sensitivity and specificity of QRS in the schizophrenic symptoms detection respective were hallucinations (0.887,0.851 ), lenovo undisciplined (0.847,0.868 ), thought insertion (0.800,0.843 ), logical thinking perversion ( 0.813,0.879 ), delusions ( 0.873,0.884 ), apathy ( 0.603,0.891 ), will decrease (0.883,0.886), environmental disorientation ( 0.574,0.837 ), self-disorientation ( 0.609,0.802) , double disorientation (0.603,0.843 ) and insight (0.862,0.869).Conclusion QRS detection possess higher authenticity, consistency and the high diagnostic value in the schizophrenic symptoms, special in hallucinations,thought disorder,insight symptoms.

Neovascularization is one of the early pathologic changes of rheumatoid arthritis(RA)synovium and is the major players in the promotion and perpetuation of pannus.Endostatin has antiangiogenic effect via inhibition of endothelial cell proliferation,migration and induction of apoptosis.The inhibition of angiogenesis in synovium by endostatin appears to be a promising means for the future treatment of RA.Also,endostatin has a therapeutic effect on RA by the inhibition of proliferation and induction of apoptosis in fibroblast-like synoviocytes.

Aim To observe the effects of recombinant human endostatin(rhEndostatin) on cell cycle and the expression of proliferating cell nuclear antigen(PCNA) in fibroblast-like synoviocytes in rats with adjuvant arthritis(AA),and to explore the molecular mechanisms of the inhibitory effect of rhEndostatin on proliferation of fibroblast-like synoviocytes(FLS) in AA rats.Methods Adjuvant arthritis was induced by Freund′s complete adjuvant in rats.Flow cytometry was applied to measure the effects of rhEndostatin on the cell cycle in AA FLS.The effect of rhEndostatin on the expression of PCNA mRNA and protein in synovial tissue in AA rats was examined quantitatively by real-time fluorescent quantitative PCR and Western blot assays,respectively.Results The percentage of cells in G1 phase in AA FLS decreased significantly(P

Objective To preliminarily explore the effects of human microRNA-181a on migration of gastric cancer cells and its mechanism.Methods The expression of miRNA-181a-5p in gastric cancer cell line GC9811 and peritoneal high metastasis gastric cancer cell line GC9811-P were tested by quantitative real-time polymerase chain reaction (qRT-PCR ). GC9811 cell line was transfected byendogenous synthetic analog mimic and its homologous negative control of miRNA-181a-5p,which were considered as up-regulated group and its control group respectively;GC9811-P were transfected by miRNA inhibitor and its homologous negative control of miRNA-181a-5p,which were considered as down-regulated group and its control group respectively.After miRNA-181a-5p was up or down-regulated,cell proliferation,migration and apoptosis capabilities of gastric cells were detected by matrix thiazolyl tetrazollium (MTT)assay,cloning-forming assay,Transwell migration test,wound healing assays and apoptosis test.After miRNA-181a-5p was up or down regulated,the changes of matrix metalloproteinase (MMP)14 expression were determined by Western blot.Independent sample t test was performed for mean comparison between samples and chi square test was used for rate comparison.Results The results of qRT-PCR showed the relative expression quantity of miRNA-181a-5p in GC9811 was 1 .000 00 ± 0.021 26 and in GC9811-P was 3.175 61 ±0.106 76,and the difference was statistically significant (t =34.620,P <0.01 ).The results of MTT assay indicated that the cell proliferation rate of up-regulated group was higher than that of up-regulated control group,and that of down-regulated group was lower than down-regulated control group.The cloning-forming assay demonstrated that the number of clone forming and clone forming rate of up-regulated group,up-regulated control group,down-regulated group and down-regulated control group were 234.00±10.12 and 46.8%,93.00±9.61 and 18.6%,51 .00 ±7.96 and 10.2%,99.00±8.05 and 19.8%,respectively.The differences between up-regulated group,down-regulated group and their control group were statistically significant (t = 17.500,7.344,χ2 = 12.27, 9.51 ,all P <0.01).The results of Transwell migration experiment showed the number of cells migrated through membrane hole of up-regulated group was 164.00±19.31 ,and which was higher than that of up-regulated control group (87.00±23.04,t=4.436,P <0.05);that of down-regulated group was 157.00± 11 .50,and which was lower than that of down-regulated control group (234.00 ±12.12,t =7.982,P <0.05).The result of wound healing assays indicated that the rate of migration distance of up-regulated group,up-regulated control group,down-regulated group and down-regulated control group were 2.09 ± 0.18,1 .27 ±0.23,1 .15 ±0.15 and 1 .67 ±0.12,respectively.The differences between up-regulated group,down-regulated group and their control group were statistically significant (t =4.863 and 4.689, both P <0.05).The results of apoptosis experiments demonstrated that the apoptosis rate of up-regulated group,up-regulated control group,down-regulated group and down-regulated control group were (6.10± 1 .02 )%,(9.10 ± 2.13 )%,(12.70 ± 1 .23 )%,(8.70 ± 2.54 )%,respectively,and there was no statistically significant difference between up-regulated group,down-regulated group and their control group (both P *0.05).The results of Western blot showed that the grey value of up-regulated group was 561 .881 ±35 .740,which was higher than that of up-regulated control group (275 .784±23.520);that of down-regulated group was 579.565 ±37.950,which was lower than that of down-regulated control group (1 312.760±51 .270),and the differnces were statistically significant (t =11 .580 and 19.910,both P <0.01).Conclusion miRNA-181a-5p highly expresses in peritoneal high metastasis gastric cancer cell line GC9811-P and promoted the proliferation and migration of gastric cancer cell line GC9811 and GC9811-P with a tendency to suppress apoptosis.

Objective To investigate the influence of circadian rhythm,gender and stain on the tail suspension test in mice.Methods The immobility time of male and female Kunming,BALB/C and C57BL/6 mice in daytime or night were analyzed.Results ① The immobility time of Kunming mice during the day ( ( 114.24 ±11.18)s) was significantly more than that at night ( (65.39 ± 19.17)s).② The immobility time of male BALB/C mice( (68.57 ± 11.27 ) s) was significantly less than that of female BALB/C mice( ( 113.33 ± 3.87 ) s).③ The immobility time of C57BL/6 mice was significant more than that of Kunming and BALB/C mice under the same condition.Conclusions Circadian rhythm,gender and strain could significantly affect the immobility time of mice in tail suspension test.To increase the sensitivity and reliability of the tail suspension test,male Kunming and female BALB/C mice should be tested during the daytime.Compared to Kunming and BALB/C mice,the results of C57BL/6 mice were more stable.

Objective To investigate the Du moxibustion therapy in the treatment of chronic obstructive pulmonary disease (Chronic obstructive pulmonary disease,COPD)at stable phase.Methods 60 cases of lung COPD patients in stable stage who received treatment from January to December 2010 in Taihe Hospital of Traditional Chinese Medicine outpatient were randomly divided into two groups in,according to the case of tail number,with 30 patients in each.The control group was taken oral doxofylline tablets,0.2 g/time,2 time/d and ambroxol hydrochloride,30 mg/time,3 time/d.The treatment group was treated with Du moxibustion two times on the basis of the control group.One year follow-up and pulmonary function and BODE index assessment were performed in each group.Results ① the pulmonary function of the treatment group after the treatment (65.58±7.90) ％ was significantly improved than the same group before the treatment (53.20± 7.37) ％ (P＜0.05),and had significant difference compared with the control group after the treatment (57.53 ± 7.22)％ (P＜0.05).The recurrence rate was significantly different in the treatment group (1.79±0.32) and the control group (2.09±0.38) (P＜0.05).② BMI,MMRC,6MWD,BODE index,shortness of breath,wheezing,anorexia was significantly improved after the treatment in the treatment group [after treatment were (21.98 ± 1.32)kg/m2,(2.09±0.37)％,(350.68±88.70),(3.82±2.18) meters,(0.38±0.27),(0.32±0.25)％,(0.35±0.27) respectively; before treatment were (18.21±2.49)kg/m2,(2.50±0.43)％,(324.88±70.92),(4.66±1.40) meters,(1.49±0.62) ％,(1.42±0.56)％,(1.77±0.35),P＜0.01 respecitively].Compared with the control treatment after the treatment [(18.20 ± 1.79) kg/m2,(2.36 ± 0.64) ％,(320.03 ± 68.53),(4.43 ±1.62) meters,(1.22± 0.71),(1.28±0.67)％,(1.73±0.24) respectively] (P＞0.01),the difference was statistically significant(P＜0.01).Conclusion Du moxibustion therapy was effective in treating chronic obstructive pulmonary diseases in stable phase.

Objective Studies have shown that low concentrations of nicotine can promote neovascularization and promote wound healing.This article aimed to investigate the influence of low concentration collagen membrane slow-release system on the hard palate trauma of rats.Methods Using poly(lactic acid-co-glycolic acid) (PLGA) copolymer as carrier materials, low concentration nicotine sustained-release particles were prepared by emulsion evaporation method (w/o/w), using collagen membrane as the brace and establish a low concentration collagen membrane system.48 Wistar rats were divided into experimental group and blank group, 3 mm diameter circular wound was made in the forepart palate.Low concentration of nicotine collagen membrane sustained-release particle system and blank collagen membrane (control) were sutured on the wound with 6-0 absorbable thread.Then, observed the wound healing of 0, 3, 7, 10 days and compared the healing differences between each groups.Results Under the electron microscope, the nicotine sustained-release particles were circular, similar size with rough surface, the average diameter were 3.0±0.2μm, the encapsulation efficiency and drug loading rate was 50.2% and 4.12% respectively.In vitro, nicotine sustained-release particles released much more nicotine on the first day, less on the second day, tends to stable and fluctuate within a certain range from the third day on, and declined sharply after about 10 days, nicotine concentration from 3rd to 10th day was fluctuate within 10-5-10-4mol/L.Postoperative wound healing, no significant difference in 3 days(P>0.05), after 7 days, the wound healing of experimental group significantly greater compared with the control (P=0.015).The wound was healed in 10 days after operative, there was no significant difference between two groups(P>0.05).The epithelial proliferation in the experimental group was significantly greater than that in the blank group, there were many fibroblasts, inflammatory cells and new capillaries, the epithelial process is short, the submucosa is loose, and a large number of collagen fibers are produced.The lamina propria is closely connected with the periosteum, and the wound is healed Conclusion Low concentration of nicotine sustained-release particles collagen membrane system may promote wound healing in the hard palate mucosa of rats.

ObjectiveTo evaluate reliability and psychiatric clinical value of quantum resonance spectrometer (QRS) application in depression symptoms detection.MethodsThe psychiatric symptoms of 97 cases respectively obtained from QRS test and psychiatrist check were performed comparative analysis.The detecting order and checking order was under an order of go to see doctor random.ResultsSensitivity and negative predictive value of QRS were 100％ same as psychiatrists'examination in eating disorders; also specificity and positive predictive were 100％ in depressed mood,will weaken and sleep disorders.Kappa values were all greater than 0.8 of QRS in slow thinking,depressed mood,will weaken and other symptoms.The AUC of ROC line were all greater than 0.9 of QRS in slow thinking,depressed mood,will weaken,et al.11 symptoms.ConclusionQRS could be used as secondary depression diagnostic tools,provide a new basis for clinical diagnosis.