Sepsis is thought to be systemic inflammatory response syndrome that is activated by invasive infection and characterized by the involvement of inflammation,infection,immunological reaction,coagulation and tissue damage.The imbalance between the pro-and anti-inflammatory response mediated by immunologic disorder plays an important part in the progress of sepsis.Therefore,the immunological mechanisms and changes of Toll-like receptors,neutrophils,dendritic cells and regulatory T cells in sepsis are briefly focused on in the article.

Most nosocomial bloodstream infections among pediatric patients are related to the usage of an intravascular device.This article reviewed catheter related bloodstream infections from aspects of epidemiology,pathogenesis,diagnosis,prevention and care based on guidelines and new research both in abroad and at home.

Objective To investigate the effects of ventilation strategy of permissive hypercapnia on the expression of inflammatory mediators in the patients received laparoscopic radical gastrectomy. Methods Thirty-six patients received laparoscopic radical gastrectomy were randomly divided into two groups: control group and experiment group. The patients in control group received conventional ventilation strategy [partial pressure of carbon dioxide in endexpiratory gas (P<,ErCO2) 34.5-45.0 mm Hg (1 mm Hg =0.133 kPa),pH7.35-7.45], and patients in experiment group received ventilation strategy of permissive hypercapnia(PErCO2 49.5-60.0 mm Hg,pH7.20). Blood samples were collected respectively from the peripheral vein before anesthesia induction (T0), 1 h (T1), 3 h (T2) after operation and when operation finished (T3) for the assessment of interleukin(IL)-8, IL-6,tumor necrosis factor (TNF)- α. Results The levels of IL-8, IL-6, TNF-α at T2, T3 were higher in control group [(96.732±3.173) μg/L and (107.767±3.654) μg/L, (0.273±0.009 ) ng/L and (0.287±0.008) ng/L,(1.443±0.086)μg/L and (1.614±0.107) μg/L] than those in experiment group [(91.771±4.332) μ g/L and (97.682±4.998) μg/L, (0.231±0.008 ) ng/L and (0.241±0.006) ng/L,(1.268±0.066) μg/Land (1.428±0.058) μg/L](P<0.05 or <0.01), mean arterial pressure, partial pressure of oxygen in artery and heart rate were relative stabilization. Conclusions Ventilation strategy of permissive hypercapnia can reduce the released amount of inflammatory mediators and may be advantageous for the patients received laparoscopic radical gastrectomy.

OBJECTIVE:To establish a method for the simultaneous determination of paeoniflorin and ferulic acid in Naoxuesh-uan pill. METHODS:HPLC was performed on the column of Waters SunfireTM C18 with mobile phase of acetonitrile-water-glacial acetic acid(17:82:1,V/V/V)at a flow rate of 1.0 ml/min,detection wavelength was 230 nm,column temperature was 35 ℃,and the volume injection was 20 μl. RESULTS:The linear range was 0.024-0.240 mg/ml for paeoniflorin(r=0.999 9)and 0.009 4-0.141 0 mg/ml(r=0.999 9);RSDs of precision,stability and reproducibility tests were lower than 2%;recoveries were 95.00-97.90%(RSD=0.59%,n=6) and 95.29-98.24%(RSD=0.54%,n=6),respectively. CONCLUSIONS:The method is simple and repro-ducible,and can be used for the quality control of Naoxueshuan pill.

Objective To evaluate the effect of high volume hemofiltration (HVHF) treatment on inflammatory cytokine clearance and hemodynamics in children with sepsis.Methods Thirty-four cases of septic children were randomly divided into two groups:the control group(17 cases) was administrated with the routine therapy,while the observation group(17 cases) was underwent with HVHF treatment on the basis of routine therapy.The inflammatory cytokines and hemodynamics were analyzed before and after the treatment.Results (1) Before treatment,the levels of tumor necrosis factor (TNF)-α in the control group and observation group were (103.6 ±26.1) ng/L and (106.6 ±31.6) ng/L,and the levels of interleukin(IL)-6 were (772.8 ± 92.4) ng/L and (761.3 ± 89.2) ng/L,respectively.The concentration of TNF-α and IL-6 were markedly reduced in both two groups after treatment (P ＜ 0.05),with TNF-α and IL-6 reducing to (85.6±23.7) ng/L,(63.6 ±26.4) ng/L and(109.7 ±38.5) ng/L,(78.1 ±24.7) ng/L,respectively.Most importantly,the reduction in the observation group were significantly higher than that in the control group(P ＜ 0.05).(2) Before treatment,no significant differences between the observation group and the control group were observed in hemodynamics,including mean arterial pressure,saturation oxygen,and heart rate(P ＞ 0.05),whereas after the treatment,mean arterial pressure and saturation oxygen in the observation group were significantly elevated compared with those of the control group [(100.4 ± 12.1) mmHg vs.(82.2±11.7) mmHg(l mmHg=0.133kPa),(94.2±5.3)％ vs.(91.4±3.2)％,P＜0.05],andheart rate in the observation group[(85.1 ± 17.3) times/min] was significantly lower than that of the control group [(98.7 ± 18.5) times/min] (P ＜ 0.05).Conclusion HVHF treatment on septic children efficiently promotes the clearance of inflammatory cytokines and improves hemodynamic property,and thereby leads to protection of organ function and the better prognosis for septic children.

Objective To explore the effect of family cohesion and adaptability on coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.Methods 96 patients suffered high paraplegia caused by cervical spine fracture were questionnaired by family cohesion and adaptability scale and bricf fatiguc assessment scale after 1 week of operation.And they were divided into the fatigue group and non-fatigue group,the scores of family cohesion and adaptability were compared between the two groups,and thepearson correlation analysis and multivariate linear regression analysis were used to explore the effect of family cohesion and adaptability on coping with fatigue.Results ①65.63％ (63/96) patients suffered coping with fatigue in high paraplegia patients caused by cervical spine fracture.②The scores of teal family cohesion and real family adaptability in the fatigue group were significantly lower than those in the non-fatigue group(P＜0.05) ; the scores of dissatisfaction of family cohesion and dissatisfaction of family adaptability in the fatigue group were significantly higher than those in the non-fatigue group(t=-2.630,-3.359,10.469,17.821,P＜ 0.05).③Pearson correlation analysis showed that the score of coping with fatigue was negatively correlated with the real family cohesion(r=-0.463,P=0.015) and real family adaptability(r=-0.486,P=0.021),and positively correlated with the score of dissatisfaction of family cohesion (r=0.395,P=0.036) and dissatisfaction of family adaptability (r=0.524,P=0.020).④Multivariate linear regression analysis showed that the real family cohesion,real family adaptability,dissatisfaction of family cohesion and dissatisfaction of family adaptability were the influencing factors of coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.Conclusions Family cohesion and adaptability was correlated with the coping with fatigue in patients suffered high paraplegia caused by cervical spine fracture.

Objective To explore the relationship between family care and postoperative cognitive dysfunction(POCD) in patients undergoing spinal surgery.Methods Patients undergoing spinal surgery were questionnaired by Family APGAR Index and Mini-Mental State Examination (MMSE) 1 week after operation.They were divided into the POCD group and non-POCD group,and the scale of Family APGAR Index was compared between the two groups.Then the pearson correlation analysis and multivariate linear regression analysis were used to explore the effect of family care on POCD.Results ①35％ (35/100) patients undergoing spinal surgery sufferd POCD.②The partnership,affection,resolve and the total score of Family APGAR Index in the POCD group ((1.25 ± 0.45),(1.36 ± 0.41),(1.27 ± 0.42),(5.85 ± 1.30)) were significantly lower than that in the nonPOCD group((1.63 ± 0.56),(1.63 ± 0.52),(1.65 ± 0.51),(6.74 ± 1.56)) (P ＜ 0.05).③Pearson correla tion analysis showed that the MMSE was negatively correlated with the partnership,affection and resolve(r=-0.426,-0.382,-0.482,P ＜ 0.05).④Multivariate linear regression analysis showed that the resolve,partnership,affection were the influence factor of POCD in patients undergoing spinal surgery.Conclusions The decline of family care can lead to POCD.

Objective　To study the effect on the proliferation of vascular smooth muscle cells(VSMC) after transferring angiotensin Ⅱ(AngⅡ) type 2 receptor(AT2R) gene.Methods　The recombinant adenoviral vector AdcCMV-AT2R, containing rat AT2 receptor gene which was constracted by homologous recombination, was used to transfer AT2 receptor gene to rat VSMC in vitro. The expression of AT2R mRNA was detected by RT-PCR. The rate of expression and the change of cell cycle in VSMC were analysed by flow cytometry. Cell devision index, incorporation of bromodeoxyuridine(BrdU)and 3-(4,5-dimethyl-thiazol-2-yl)2,5-diphenytetrazolium bromide(MTT) were used to determine the proliferation of VSMC, respectively.Results　RT-PCR showed that the expression of AT2R mRNA increased obviously in transferred VSMC, and the peak value of expression rate was about 89.51% at 48 hours. When the expression of AT2R was at peak value, the ratio of S and G2-M periods was reduced from 31.7% to 13.9%(P<0.05) and the index of cell division from 37.4% to 9.6%(P<0.01). The OD values of MTT and BrdU incorporation were reduced by 61.4% and 51.6% respectively(P<0.01).Conclusion　Our study indicates that AdCMV-AT2R can generate high level expression of AT2 receptor in cultured rat VSMC and its expression can significantly inhibit the proliferation of rats VSMC in vitro. It may be a new selection for the gene therapy of restenosis after angioplasty.

Objective To study and compare the clinical and MR imaging characteristics of common intracranial ring enhanced lesions.Methods MR imaging studies of 65 intracranial ring enhanced lesions were reviewed retrospectively. The lesions included 17 glioblastomas, 17 metastasises, 12 brain abscesses, 8 acoustic neurinomas, 7 craniopharyngiomas, 3 neurocysticercosises, 1 malignant lymphoma. All cases were confirmed by surgery and pathology. Results The ring enhancement of tumors presented heterogenous thickness of thick walls and irregular forms. Among them, the highly malignant tumors appeared very obviously heterogeneous thickness of the walls, especially the inner walls were uneven and coarse. While the ring enhancement of the non-tumor lesions usually were of homogeneous thickness of the walls, regular shapes and smooth inner walls. Conclusion The different patterns of intracranial ring enhanced lesions on MR can supply important diagnostic information. Combining the patients' history, age, location and the information of magnetic resonance imaging, we may make correct diagnosis.

Minimally invasive techniques for venous operation have evolved over the last decade and revolutionized the management of venous disease especially for venous varicosity of lower extremity. Endoscopic, endovascular and mechanical methods including transilluminated powered phlebectomy, endovenous laser occlusion,radiofrequency endovenous occlusion, subfascial endoscopic perforator ligation, endovenous vascular sclero-therapy, and percutaneous venous valvular bioprosthesis have supplanted the longstanding traditional procedures. For comprehension, these techniques decrease the number and size of incisions, operative and recovery time; and furthermore increase the efficient rates.