Objective To investigate the effects of antioxidant on the gene expression of ?1-adrenergic receptors (AR) during endotoxic shock. Methods Forty male SD rats weighing 200-250 g were anesthetized with intraperitoneal (i.p.) pentobarbital. The animals kept spontaneous breathing. Femoral artery and vein were cannulated for BP monitoring and drug administration. The animals were randomly divided into 5 groups ( n = 8 each) : (1) control group; (2) LPS group received IPS 15 mg?kg-1 i.v. ; (3) LPS + propofol group received at 1h after LPS a bolus of propofol 10mg?kg-1 i.v. followed by continuous infusion of propofol at 10 mg?kg-1?h-1; (4) LPS + uric acid (UA) group received uric acid 200 mg i.p. 1 h after LPS and (5) LPS + melatonin (MLT) group received MLT 10 mg?kg-1 i.p. 1h after LPS. The animals were killed at 6 h after LPS. Total RNA was extracted from the heart, aorta, vein, lung, liver and kidney. ?1A-,?1B-,?1D- AR mRNA and ?-actin mRNA were measured using reverse transcription polymerase chain reaction (RT-PCR) .Results The expression of ?1A-AR and ?1B-AR mRNA in all the organs and the ?1D-AR mRNA expression in aorta, liver, lung and kidney were strongly down-regulated in LPS group. In group 3 (LPS + propofol) the expression of ?1A-AR mRNA in the lung and kidney, the ?1B-AR mRNA expression in all of the organs and ?1D-AR mRNA expression in aorta, liver, lung and kidney were significantly increased as compared with LPS group. There was no significant difference in ?1-AR mRNA expression between LPS group and LPS + MLT group. The expression of ?1A-AR mRNA in kidney, the ?1B-AR mRNA expression in all of the organs except the lung and the ?1D-AR mRNA expression in aorta, liver, lung and kidney were significantly higher in LPS + UA group than in LPS group. Conclusion Circulatory failure induced by endotoxic shock is related to the down-regulation of ?1-AR gene expression. The therapeutic effects of antioxidant on the endotoxic shock is partly due to up-regulation of ?1-AR gene expression.

Objective To evaluate the clinical efficacy and toxicity of rituximab combined with CHOP (R-CHOP) in the treatment of relapsed or refractory diffuse large B cell lymphoma (DLBCL).Methods 30 patients were enrolled.All patients,pathologically confirmed to be CD20 positive DLBCL (all in stages Ⅲ-Ⅳ ), were relapsed or refractory after received 2-6 cycles of chemotherapy. Then all of them received R-CHOP schedule for 4 to 6 cycles, each cycle was 21 days. Clinical data before and after R-CHOP were collected.A retrospective analysis of the R-CHOP therapy,either compared to the literature or self-control was performed to evaluate the efficacy and toxicity. Results All the 30 patients were evaluable, induding 15 cases were complete remission (CR), 10 cases were partial remission (PR), 3 cases were stable disease (SD),and 2 cases were progressed disease (PD).The CR rate was 50.0 ％ (15/30),the total response rate (RR) was 83.3 ％ (25/30).All patients were well tolerated to the therapy.Only 3 cases were Ⅱ degree neutropenia,1 case was Ⅰ degree thrombocytopenia, and 2 cases suffered nausea and other mild gastrointestinal discomfort. Conclusions R-CHOP regimen could also achieve good response for relapsed or refractory DLBCL significantly.The common adverse effects of rituximab were mild.All the patients were well tolerated.

Objective To explore the clinical and coronary angiographic characteristics in acute myocardial infarction (AMI) patients with new-onset atrial ifbrillation in early or later stages. Methods From Jun. 2010 to Jun. 2013, 1358 cases of AMI were hospitalized in which 88 were proved to have AMI complicated with new-onset atrial ifbrillation. Eligible patients were divided into early onset group (group1, n=40 cases) and the later onset group (group2, n=48 cases) according to the occurrence of atrial ifbrillation within or after 24 hours of admission. The clinical characteristics and the pathological changes of coronary arteries of the two groups were compared respectively. Results The incidence of inferior wall AMI was signiifcantly higher in group 1. The incidence of anterior wall AMI was signiifcantly higher in group 2 (P<0.05). The incidence of congestive heart failure, the incidence of three-vessel lesions and the in-hospital mortality in group 2 were higher than which in group 1 (P < 0.05). Conclusions The new-onset atrial ifbrillation in different stages may be regarded as a useful indicator for evaluating the clinical characteristic and the infarct-related coronary artery lesions and prognosis of patients with AMI.

ObjectiveTo investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous veno-venous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.Results The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9±7.3)% vs. (26.4±6.7)%,P>0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9±8.6)% vs. (29.3±7.1)%, 5 days: (42.7±9.2)%vs. (31.4±6.5)%, 7 days: (40.9±8.5)% vs. (29.4±6.7)%, allP< 0.05]. There was no significant difference in APACHEⅡ score before treatment between experimental group and control group (22.4±5.3 vs. 21.7±6.2,P>0.05). APACHEⅡ score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6±3.6 vs. 20.5±4.3, 5 days: 15.8±3.9 vs. 21.1±4.4, 7 days: 14.9±4.2 vs. 19.8±3.7, allP< 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3±3.4 vs. 19.8±3.7,t = 6.432,P = 0.003) and length of ICU stay (days: 20.7±3.9 vs. 26.8±4.7,t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%,χ2 = 3.121,P = 0.016).Conclusion Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.

Objective To explore the correlation and clinical diagnostic significance between EGF ,PAF‐AH on henoch‐schonlein purpura (HSP) renal damage in children ,in order to provide a new way of thinking for early diagnosis and clinical prog ‐nosis for HSP nephritis(HSPN) .Methods Totally 86 cases of children with HSP from September 2013 to January 2014 in hospital were collected .According to the presence of renal damage ,the patients were divided into non‐HSPN group and HSPN group ,50 ca‐ses of healthy children as control group ,and 30 casea were diagnosied as bronchial pneumonia .Using PCR technique to detect the change of blood EGF and PAF‐AH ,and using ELISA to detect the change of blood EGF ,PAF‐AH and urine EGF .Results Detec‐tion of blood PAF‐AH mRNA ,EGF mRNA in case group obviously higher than control group ,and detection of blood PAF‐AH mRNA in HSPN group were also hgher than non‐HSPN group(P< 0 .05) .Detection of blood EGF mRNA in HSPN group higher were than non‐HSPN group ,but there was no statistically significant difference (P> 0 .05) .Detection of serum PAF‐AH ,EGF and urine EGF in case group obviously higher than control group and the case group significantly lower recovery than acute stage (P<0 .05) .Conclusion Blood EGF ,PAF‐AH and urine EGF process involved in the pathogenesis of HSP ,and is related to renal dam‐age .

Objective To investigate the association between inflammatory biomarkers and survival in patients with stable chronic obstructive pulmonary disease(COPD).Methods A total of 1038 patients with stable COPD from January 2008 to December 2009 were included in a prospective cohort study.Clinical characteristics,pulmonary function tests,6 min walk test and a modified British Medical Research Council dyspnea scale (MMRC) were completed.Fasting blood was obtained to detect inflammatory biomarkers including neutrophils,C-reactive protein(CRP),fibrinogen,TNF-a,IL-6 and IL-8.Participants were evaluated every 3 months,all-cause mortality was used as the end event.Results 120 patients (9.2％) died in the period of follow-up.Kaplan-Meier analysis showed that 1 year,2-year-and 3-year survival rates were 94.4％,88.3％ and 84.0％,respectively.Compared with survivors,those who died had a higher level of inflammatory biomarkers.Cox multivariate regression analysis demonstrated that the independent risk factors for death were neutrophils (HR:1.262,95％CI:1.143-1.512,P=0.035),CRP (HR:1.234,95％CI:1.097-1.624,P=0.029),fibrinogen (HR:1.327,95％CI:1.141-1.619,P=0.026),TNF-α (HR:1.124,95％CI:1.043-1.659,P=0.045),IL-6 (HR:1,429,95％CI:1.237-1.816,P=0.014) and IL-8 (HR:1.188,95％CI:1.024-1.383,P=0.042).C statistical analysis showed that no single biomarker significantly improved the C statistic value on the base of clinical model,but it was further improved by the addition of all biomarkers (C =0.764,P =0.010).Conclusions The level of inflammatory biomarkers in the death with stable COPD is significantly increased.Age.BODE index,neutrophils,CRP,fibrinogen,TNF-α,IL-6 and IL-8 are independent risk factor for the prediction of mortality in patients with COPD.

Objective To investigate the relationship between body mass index (BMI) and long-term survival in patients with chronic obstructive pulmonary disease (COPD).Methods A retrospective cohort study was conducted in 1124 patients with completed data among 1528 hospitalized patients with COPD.Vital status was ascertained at death registry and civil affairs department.Clinical characteristics were acquired from medical record.Patients were divided into 4 groups according to the quartile of BMI:BMI＜18.9 kg/m2 (group A),BMI from 18.9 kg/m2to 22.7 kg/m2 (group B),BMI from 22.8 kg/m2 to 26.2 kg/m2 (group C),BMI＞26.2 kg/m2 (group D).The differences in survival curves were compared between groups by using log-rank test.The relationship between all-cause mortality and BMI was evaluated by Cox proportional hazards regression model.Results The median BMI of 1124 patients was 22.7 kg/m2 [(18.9-26.2) kg/m2].270 patients (24.0％) had BMI＜18.5 kg/m2.162 patients (14.4％) died during follow-up.There was significant difference in the survival curves in the four groups (x2 =7.97,P＜0.05).Survival rate was highest in group C and lowest in group A.After adjustment for other factors,BMI was an independent risk factor for predicting long-term survival.The survival rate was respectively decreased by 41 ％ and 35 ％ in group C and D as compared with group A.Conclusions Weight loss is comman in COPD patients.BMI is an independent risk factor for predicting long-term survival.BMI is easily acquired and stable,which is especially suitable to evaluate the prognosis of patients with acute exacerbation.

Objective To investigate the perioperative outcomes of robot-assisted laparoscopic partial nephrectomy in solitary kidney.Methods From September 2014 to September 2015, 9 patients underwent robot-assisted laparoscopic partial nephrectomy in solitary kidney.6 of these patients were male, while the others were female.The average age of these patients was 60 years, ranged from 46-78 years.The lesion was located in left kidney of 5 cases, and the remaining in right kidney.The average diameter of lesion was 4.5 cm, ranged from 2.8-7.6 cm.One case was congenital solitary kidney, one was contralateral atrophic kidney, 2 cases were performed nephrectomy due to benign lesion, 5 cases were performed radical nephrectomy due to malignancy.All the cases were performed by robot-assisted laparoscopic surgery transperitoneally.Results The surgery of all 9 cases were successfully completed, and no conversion to open surgery.The median operation time was 104-215 min, with an average of 129 min.The estimated blood loss was 50-350 ml, with an average of 120 ml, and there was no blood transfusion.The warm ischemia time was 10-28 min, with an average of 18 min.There was no intraoperative complication occurred.The postoperative length of hospitalization was 8-17 d, with an average of 12 d.One case of urine leakage and another one of secondary hemorrhage were found after operation.The drainage tube and urinary catheter were removed in 3-5 days postoperation.The pathology analysis confirmed that 7 cases were renal clear cell carcinoma, one case was papillary carcinoma and one was angiomyolipoma, the tumor surgical margin was negative in all cases.The follow up duration was 1-12months, no recurrence or metastasis occurred.Conclusions Robot-assisted partial nephrectomy represents a safe and effective minimallyinvasive treatment option for kidney neoplasms in patients with a solitary kidney, which provided reliable cancer control and renal function preservation.

Objective:To explore influence of holistic nursing on serum levels of N terminal pro brain natriuretic peptide (NT‐proBNP) , high sensitive cardiac troponin T (hs‐cTnT ) and quality of life in patients with chronic heart failure (CHF) .Methods:A total of 108 CHF patients treated in our hospital from Jan 2015 to May 2016 were randomly and e‐qually divided into routine nursing group and holistic nursing group (received holistic nursing based on routine nursing group) .Serum levels of NT‐proBNP ,hs‐cTnT and score of Chinese questionnaire of quality of life in patients with cardio‐vascular disease (CQQC) were compared between two groups before and after nursing .Results:There were no significant difference in serum levels of NT‐proBNP and hs‐cTnT and CQQC score between two groups before nursing , P>0.05 all . Compared with before nursing ,after nursing ,there were significant reductions in serum levels of NT‐proBNP and hs‐cTnT , and significant rise in CQQC score in holistic nursing group , P<0.01 all .Compared with routine nursing group after nurs‐ing ,there were significant reductions in serum levels of NT‐proBNP [(2.65 ± 0.53)μg/L vs .(2.07 ± 0.52)μg/L] and hs‐cTnT [ (0.42 ± 0.12)μg/L vs .(0.31 ± 0.09)μg/L] ,and significant rise in CQQC score [ (52.87 ± 9.56) scores vs . (57.43 ± 10.20) scores] in holistic nursing group ,P<0.05 or <0.01. Conclusion:Holistic nursing contributes to reducing serum levels of NT‐proBNP and hs‐cTnT , it can improve cardiac function and quality of life in patients with chronic heart failure ,which is worth clinical application and extending .

Objective To determine the incidence of lung infection and associated factors in patients with traumatic brain injury for the sake of improving the clinical outcomes.Methods A retrospective analysis was made on records of 325 patients who hospitalized between January 2014 and June 2014.There were 198 male and 127 female patients,aged 11-78 years [(38.4 ±8.3) years].A total of 172 patients were injured in traffic accidents,80 in high falls,56 in blow accidents,and 17 in others.Lung infection status was documented and related risk factors were analyzed.Results Thirty-two patients (9.8％) had lung infection.Pseudomonas aeruginosa amounting to 12 strains was the most common pathogenic bacteria.Univariate analysis showed mechanical ventilation,airway open,and aspiration were significantly related to lung infection.Logistic regression identified aspiration (OR =2.891,P ＜ 0.05) and mechanical ventilation (OR =1.323,P ＜ 0.05) as the independent risk factors for lung infection.Conclusions Lung infection is a serious complication of traumatic brain injury,affected largely by aspiration and mechanical ventilation.Active preventions,reductions of risk factors,and early treatments should be done to get the best efficacy.