ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(P<0.05). After 4 weeks of treatment,compared with model group,body weight and serum content of ADH increased in Ootheca Mantidis groups,while urinary volume and renal index decreased (P<0.05);serum content of ALD increased in treatment groups;there was statistical significance in the serum content of ALD in those groups except Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group and steamed Ootheca Mantidis group (P<0.05);except for ALD,those index were in descending order of steamed Ootheca Mantidis group>Ootheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.

BACKGROUND:Coronary drug-eluting stent implantation is the best treatment for acute ST-segment elevation myocardial infarction, but because of many combined risk factors in elderly patients, the mortality rate is increased with aging. OBJECTIVE:To analyze whether age differences is a significant independent predictor of in-hospital clinical outcomes in patients with acute ST-elevation myocardial infarction treated with domestic rapamycin drug-eluting stent implantation. METHODS:A retrospective analysis was done in 307 patients with first acute ST-elevation myocardial infarction treated with emergent rapamycin drug-eluting stent implantation for primary percutaneous coronary intervention. According to the age, there were three groups: non-elderly group (< 65 years old,n=175), low-elderly group (65-74 years old,n=83), and high-elderly group (≥ 75 years old,n=49). Clinical features, mortality, cardiac events during in-hospital stay were compared among three groups. RESULTS AND CONCLUSION: Compared with the non-elderly group, the proportion of female patients and the history of hypertension were higher in the low-elderly or high-elderly group (P < 0.05). The history of smoking was higher in the non-elderly group than the other groups (P < 0.05). The incidences of Kilip classification≥II, three-lesion or left main coronary artery disease were higher in the high-elderly group than the other groups (P < 0.05). Hemoglobin, total cholesterol, triglycerides, low-density lipoprotein, and cholesterol levels were higher in the non-elderly group than the other groups (P < 0.05). Serum creatinine level, incidence of malignant arrhythmia and incidence of in-hospital cardiac death were increased with aging. Successful reperfusion was higher in the high-elderly group than in the low-elderly or non-elderly group. Rate of acute heart failure and combined cardiovascular events were higher in the high-elderly group than in the low-elderly or non-elderly group (P < 0.05). Multivariate logistic regression analysis show that age is an independent risk factor for in-hospital mortality in patients with acute ST-elevation myocardial infarction treated with rapamycin drug-eluting stent implantation.

Objective To investigate the effect of combined use of acupuncture and medicine on T cell subgroups in ulcerative colitis patients. Methods Sixty-four patients with ulcerative colitis were randomly allocated to treatment and control groups, 32 cases each. The treatment group received acupuncture plus medication and the control group, medication alone. After two months of treatment, changes in T cell subgroups were observed in the two groups and the clinical therapeutic effects were compared between the two groups. Results The total efficacy rate was 87.5% in the treatment group and 75.5% in the control group; there was a statistically significant difference between the two groups (P<0.05). There were statistically significant pre-/post-treatment differences in CD3, CD4 and CD4/CD8 in the treatment group (P<0.05). There were statistically significant post-treatment differences in T cell subgroup indices (CD3, CD4 and CD4/CD8) between the treatment and control groups (P<0.05). Conclusions Combined use of acupuncture and medicine is an effective way to treat ulcerative colitis. It can regulate the numbers of CD3 and CD4 and improve bodily immunologic function in the patients.

Taking Shengjing Hospital of China Medical University as an example, informatization management measures are applied to outpatient surgical nursing process, including one-card-through outpatient information diagnosis and treatment model, cell-phone APP clinical message diagnosis and treatment model, electronic queuing system, sub-period and multi-channel reserved registration, medical material receiving, online reporting of the repair work, so as to optimize nursing service process, increase effective treatment time, improve efficiency and quality of nursing service.

BACKGROUND:Studies have reported that underin vitro experimental environment, antisense endothelin nucleic acid nanometer carrier can express target nucleic acid and produce RNA interference effect after enfolding by 12-alkylated chitosan nanoparticles, which can effectively inhibit the excessive generation of endothelin from inflammatory cytokines induced by alergen. OBJECTIVE:To investigate the effect of 12-alkylated chitosan nanoparticles enfolding antisense endothelin converting enzyme RNA expression plasmid on airway hyperresponsiveness in asthmatic mouse models. METHODS: Forty Balb/c mice were randomly divided into four groups: control, chitosan nanoparticles, normal saline and plasmid groups. Mice in the chitosan nanoparticles, normal saline and plasmid groups were subjected to sensitization by an intraperitoneal injection with ovalbumin (0, 14 days) and motivation by aerosol inhalation of ovalbumin (24, 25, 26 days) to induce asthma models. Mice in the control group were subjected to sensitization and motivation by the perfusion of normal saline. At 24hours before the first excitation, mice in the control, chitosan nanoparticles, normal saline and plasmid groups were perfused with normal salinevia airway, 12-alkylated chitosan nanoparticles, normal saline and antisense endothelin converting enzyme RNA. At 48 hours after the last excitation, the airway reactivity of mice was detected. After 28 days, bronchoalveolar lavage fluid cytology, lung histopathology, cytokines in spleen cel culture supernatant were detected. RESULTS AND CONCLUSION:Compared with the control group, the total number of plasmid cels, the percentage of eosinophils, eosinophil absolute counts, interleukin-4 levels, endothelin levels and airway hyperresponsiveness of mice in chitosan nanoparticles, normal saline and plasmid groups were increased (P < 0.05), and the lung inflammation was more severe. These indicators in the chitosan nanoparticles group were al lower than those in the normal saline and plasmid groups (P < 0.05) and the degree of inflammation was lighter than that in the saline and plasmid groups. These results demonstrate that 12-alkylated chitosan nanoparticles enfolding antisense endothelin converting enzyme RNA expression plasmid can reduce the synthetic amount of asthma endothelin and inhibit airway responsiveness.

BACKGROUND:Pancreas or islet cel transplantation and stem cel transplantation bring hope to cure diabetes, but pancreas or islet transplantation appears to have a lack of donors as wel as immune rejection problems, limiting their clinical development. Therefore, stem cel transplantation therapy has become the current hotspot.
OBJECTIVE:To study the therapeutic effects of huaman telomerase reverse transcriptase (hTERT)-modified bone marrow mesenchymal stem cel s transplantation on diabetes mel itus in SD rats.
METHODS:Bone marrow mesenchymal stem cel s were transfected with PLXSN carrying hTERT. Thirty-six male SD rats were randomly divided into control group (n=6), stem cel group (n=10), hTERT transfection group (n=10), diabetes mel itus group (n=10). Except the control group, the rats were injected with stretozotocin (45 mg/kg) to make diabetes mel itus models. After modeling, rats in the stem cel group and hTERT transfection group were respectively intravenously injected with 1 mL of bone marrow mesenchymal stem cel s (1.5×1010/L) and 1 mL of hTERT-modified bone marrow mesenchymal stem cel s (1.5×1010/L).
RESULTS AND CONCLUSION:At 24 hours after modeling, the fasting blood-glucose level was significantly increased in the diabetes mel itus group, which was higher than the normal value (6.7 mmol/L). At 15 days after cel transplantation, the fasting blood-glucose levels were signficiantly decreased in the stem cel group and hTERT transfection group as compared with the diabetes mel itus group (P<0.05), but the body mass of rats was increased in these two group (P<0.05), especial y in the hTERT transfection group. At 45 days after cel transplantation, the fasting blood-glucose level and body mass in the stem cel group and hTERT transfection group were close to those in the control group (P>0.05), and moreover, the hTERT group had better outcomes than the stem cel group. Meanwhile, in the diabetes mel itus group, the fasting blood-glucose level was stil at a higher level, and the body mass decreased continously. These findings suggest that hTERT-modified bone marrow mesenchymal stem cel transplantation is effective for treatment of diabetes mel itus in rats.

Lymphoma is one of the diseases that could be cured through chemoradiotherapy, so the early efficacy evaluation can help us to realize the optimal treatment and individualized treatment.CT perfusion is a functional imaging technology which can indirectly reflect the changes in tissue in physiologica and metabolic, and provide the reliable biomarkers for early efficacy evaluation of tumors.This paper focuses on the relevant research of CT perfusion imaging in the early efficacy evaluation of lymphoma at home and abroad in recent years.

BACKGROUND:Sagittal split ramus osteotomy is one of the most popular surgical procedures for correcting various mandibular deformities. There have been numerous modifications to this technique on the basis of clinical experiences and observation, but relevant anatomical data are very limited. A lot of anatomic studies on the mandible have been performed during the recent 20 years. OBJECTIVE:To entirely understanding the morphology of the mandibular ramus in the sagittal split ramus osteotomy and to explore the research progress in the sagittal split ramus osteotomy. METHODS:An electronic search of CMB and Medline was performed for relevant reviews and papers published from 1991 to 2011. Progress in the sagittal split ramus osteotomy was also analyzed. RESULTS AND CONCLUSION:Total y 26 articles related to the sagittal split ramus osteotomy were enrol ed. The keys to avoiding complications due to the sagittal split ramus osteotomy are as fol ows:distribution of cancel ous bone in the mandibular uvula area, distribution of cancel ous bone between the mandibular canal and buccal cortical bone during splitting progress, as wel as location and trend of the mandibular canal. Pre-operative CT test contributes to a successful sagittal split ramus osteotomy and a reduction in complications, and the anatomical measurement can be applied clinical y to a greater extent.

With the advances of medical management and surgical techniques during cardiopulmonary bypass,children with congenital heart disease are increasingly surviving to adulthood.Research into their neurodevelopmental outcomes in the past 20 years had revealed sobering realizations about the adverse impact on the quality of life of these surgical survivors.A multitude of factors contribute to the incidence and severity of neurodevelopmental abnormalities and can be separated into preoperative,intraoperative,and postoperative events,in addition to genetic contributions and socioeconomic factors.This article highlight some of current understanding of these protean factors.Understanding should lead to modification of current techniques and management strategies,all with the ultimate goal of improving patients' quality of life.