Objective: To observe the effect of cooling on systemic and regional oxygen metabolism in febrile critically ill patients. Method: Twenty-five critically ill patients with fever were cooled by ice blankets or by ibuprofen/indomethacin. Oxygen metabolism in whole body and regional organ and hemodynamics were measured. Result: As the temperature was reduced form 38.9?1.1℃ to 37.8?1.5℃,HR,cardiac index (CI),oxygen delivery (DO_2I),and oxygen consumption (VO_2I) decreased significantly,but gastric intramucosal pH increased from 7.26 to 7.37 and the PCO_2 difference between gastric rnucosa and arterial blood decreased markedly. PO_2 and oxygen content in cardiac coronary venous blood and oxygen exrtaction remained unchanged. Conclusion: After cooling the febrile pateints,CI, DO_2I and VO_2I decrease but tissue hypoxia can be improved.

Objective To determine the changes of blood cytokines values and inductions of cytokines expressions after CPB and cardiac valve replacement. Methods Thirty patients undergoing cardiac valve replacement were randomly selected, The plasma cytokines levels or activities and inductions of cytokine expressions were measured before CPB, 1st, 3rd, 7th, 14th d after operation.Results Compared with the baselines, IL 1 activity and souluble interleukin 2 receptor(SIL 2R) level increased on the 1st, 3rd d , then decreased significantly on the 7th d, plasma IL 8 level increased in 14 d after CPB, but IL 2 activity decreased during 7 d postoperatively(P0.05); induction of IL 1 expression increased significantly on the 1st d and decreased on the 3rd d (P

In order to evaluate the expression of HLA-DR antigen in glandular cells in eutopic and ectopic endometrium in patients with endometriosis, 19 infertile patients with endometriosis were analyzed immunohistochemically by labelled streptavidin biotin (LSAB) method. Nineteen infertile patients without endometriosis were studied as controls. The results showed that the expression of HLA-DR antigen in the glandular cells in both eutopic and ectopic endometrium was increased significantly as compared with that in the controls (P < 0.01). It is likely that aberrant expression of HLA-DR antigen in endometriotic tissue is involved in abnormal immunogenesis of endometriosis.
Endometriosis/complications ; Endometriosis/*immunology ; Endometrium/*immunology ; HLA-DR Antigens/*immunology ; Immunohistochemistry ; Infertility/complications ; Infertility/*immunology ; Pelvis

ObjectiveTo assess the efficacy of subglottic secretion drainage for preventing ventilatorassociated pneumonia.MethodsData of relevant randomized controlled trials (RCT) from January 1991 to June 2010 were collected,and data were split into two groups,namely draining group and non-draining group.Meta analysis of ventilator-associated pneumonia was carried out for finding the incidence and mortality in patients with mechanical ventilation using the methods recommended by the Cochrane Collaboration.ResultsSeven RCTs met the inclusion criteria and 1647 patients were enrolled.Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia ( OR =0.45,95％ confidence interval [CI]:0.32 - 0.63 ),primarily by reducing early-onset pneumonia.But the mortalities of ventilator associated pneumonia were not significantly different between the two groups ( OR =1.03,95％ confi dence interval [CI]:0.75 - 1.41 ).ConclusionsSubglottic secretion drainage appeared effective in preventing ventilator associated pneumonia among patients expected to require ＞48 hours of mechanical ventilation,but the mortality was unchanged.

Objective To study the expression of P57kip2 and its clinical significance in hilar bile duct adenocarcinoma.Methods The expressions of P57kip2 in hilar bile duct adenocarcinoma tissues (37 cases) and normal bile duct tissues (32 cases) were determined by immunohistochemical SP methods.The relations between the expression levels of P57kip2 with clinicopathologic parameters were analyzed.Results The positive rate of P57kip2 was 43.2％ (16/37) in bile duct adenocarcinoma,while it was 87.5％ (28/32) in normal duct tissues (P ＜0.01).The expression level of P57kip2 in adenocarcinoma showed no significant association with gender,age or CA19-9 level (P ＞0.05),but they were significantly related with lymph node metastasis,invasion and degree of differentiation (P ＜ 0.05).Conclusions P57kip2 is associated with the occurrence and development of hilar bile duct adenocarcinoma.It may play an important role in invasion and metastasis of hilar bile duct adenocarcinoma.The P57 protein can be used as an index to diagnose hilar bile duct adenocarcinoma.

Objective To investigate the kinetics and phenotype of spleen dendritic cells (DC) in lipopolysaccharide (LPS)-induced acute lung injury (ALI) mice.Methods Thirty-six C57BL/6 mice were randomly (random number) divided into two groups:control group and ALI group.Spleens were harvested at the following intervals of 6,12,and 24 h after LPS or PBS administration.Lung wet weight / body weight ratio (LW/BW) was recorded to assess lung injury.Meanwhile,pathological changes were examined under optical microscope.The IL-6 level in the lung was measured by using ELISA (enzymelinked immuno sorbent assay).The DC in the spleen was measured by flow cytometry (FCM).Results (1) LPS-ALI resulted in a significant increase in LW/BW ratio.(2) Histologically,extensive alveolar wall thickening resulted from edema,severe hemorrhage in the interstitium and alveolus,and marked and diffuse interstitial infiltration with inflammatory cells were observed in the ALI group.(3) Meanwhile,the levels of IL-6 in lung tissue were significantly increased in the LPS-induced ALI mice.(4) LPS-induced ALI led to divergent kinetics of spleen DC in ALI mice.In ALI mice,spleen DC only showed a transient increase at 12 h.(5) All DC within spleens had a modest maturation in ALI mice.Conclusions LPS-induced ALI provokes a transient increase as well as modest maturation of spleen DC.

Objective To evaluate the effects of sedation with propofol or dexmedetomidine on volume responsiveness in critically ill patients with acute circulatory failure. Methods Ninety?one critically ill patients with acute circulatory failure, aged 20-90 yr, weighing 40-80 kg, requiring sedation with propofol or dexmedetomidine, of Acute Physiology and Chronic Health Evaluation Ⅱ scores 12-47, of Sequential Organ Failure Assessment scores 1-18, and of NYHA Ⅰ or Ⅱ, were included. The patients were randomly divided into 2 groups using a random number table: propofol group ( n = 45 ) and dexmedetomidine group ( n=46) . Before and after propofol or dexmedetomidine sedation, when Richmond Agitation Sedation Scale score reached -2 or -1 ( BIS value 60-75) ( after sedation) , passive leg?raising (PLR) test was performed to evaluate volume responsiveness. An increase in cardiac index (ΔCI) ≥10% after PLR was considered to be a positive response, whereas ΔCI<10% after PLR was considered to be a negative response. The patients who presented with negative responses before sedation served as negative volume responsiveness subgroups ( N subgroups ) , that was PN subgroup and DN subgroup. Results The positive rates of volume responsiveness were 64% ( 14 cases) and 25% ( 5 cases) in PN and DN subgroups, respectively. The positive rates of volume responsiveness were significantly higher after sedation than before sedation in PN and DN subgroups. Compared with DN subgroup, the positive rates of volume responsiveness were significantly increased after sedation in PN subgroup. Conclusion For the critically ill patients with acute circulatory failure, both propofol and dexmedetomidine sedation can improve volume responsiveness, and propofol provides better efficacy than dexmedetomidine.

Objective: To explore the clinical efficacy of a new drug for acute coronary syndrome (ACS), ticagrelor in treating the patients with acute ST-segment elevation myocardial infarction (STEMI), and to compare the effect between ticagrelor and clopidogrel in order to obtain the prospective information of ticagrelor in clinical practice.
Methods: A total of 307 STEMI patients were divided into 2 groups, Treatment group, the patients received ticagrelor with aspirin, n=157 and Control group, the patients received clopidogrel with aspirin, n=150. With a period of treatment, the major adverse cardiac events (MACE), rate of thrombosis re-formation and routine blood test result were compared between 2 groups.
Results: Treatment group presented the better LVDD, LVEF, platelet level and ST-segment recovery than those in Control group, P<0.05 or P<0.01. Treatment group showed slightly higher rate of side effect such as dififcult breathing and bleeding, while those reaction did not affect the treatment or special management for the patients.
Conclusion: The clinical effect of ticagrelor is similar to clopidogre for improving the platelet level and cardiac function in STEMI patients, while the clinical advantage reported in abroad should be further studied.

Objective To investigate the situation of visual memory impairment in patients with myasthenia gravis (MG).Methods Thirty MG patients and 28 normal control subjects were tested with a battery of computerized tests (modified Smith working memory software), which was designed to assess visual-spatial and visual-object working memory.Results There was no significant difference in the accuracy rate of visual-object working memory test between the MG group and normal controls (MG group 73.4% ±9.7%, normal controls 72.7% ±8.5%).The accuracy rate of the visual-spatial working memory test in the MG group (76.6% ± 16.5%) was significantly lower than that in the normal controls (86.6% ±7.5%, Z = -2.204, P = 0.028).Conclusion The visual-spatial working memory is probably impaired while the visual-object working memory is relatively spared in MG patients.

Objective To systematically review the efficacy of dexmedetomidine or midazolam for sedation in critically ill patients. Methods We searched the PubMed, EMBaes, Cochrane Library, Wanfang Database,CNKI and VIP for all randomized controlled trials (RCTs) about the efficacy of dexmedetomidine versus midazolam for sedation in severe cases. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software. Results Six RCTs involving 613 patients were included in our Meta-analysis. The results of Meta-analysis showed that the length of ICU stay was significantly shorter in group dexmedetomidine than in group midazolam. There were no significant differences in the duration of mechanical ventilation, incidences of bradycardia, hypotension and delirium and mortality rate between the two groups. Conclusion Dexmedetomidin can shorten the length of ICU stay and is beneficial for the outcome in critically ill patients.