Objective To evaluate the compliance of sepsis bundles and its impact on the mortality rate in patients with sepsis shock.Methods Fifty-eight adult patients with sepsis shock admitted in the intensive care units from January to December 2007 were enrolled in the study,and the compliance with the 6-h bundle was analyzed.Age,gender,sites of infection,acute physiology and chronic health evaluation II (APACHE II)score,duration of mechanical ventilation,ICU stay and the mortality rate were compared between patients completed 6-h bundles and those not completed 6-h bundles.Results Compliance with the 6-h bundle was obtained in 22 out of 58 patients(37.9%).Patients receiving bundle care had shorter duration of mechanical ventilation and shorter length of ICU stay than non-bundle patients(t=-2.225 and -3.702,P=0.037 and 0.001,respectively),and the mortality rate in 6-h bundle patients was also lower (X2=10.236,P=0.000).Conclusion The application of 6-h bundle care can reduce the mortality rate of the patients with sepsis shock.and the compliance should be improved.

Objective To find out some possible risk factors of death postcardiac surgery undergoing cardiopulmonary bypass.Method Totally 36 patients,who underwent postcardiotomy undergoing cardiopulmonary bypass in Subei Hospital of Jiangsu Provience from March 2005 to June 2006,were retrospectively analyzed.The criteria for the selection of patients were as follow:(1)patients underwent on-pump cardiopulmonary bypass;(2)patients with heart function in Ⅰ-Ⅲ degree; (3)all patients didn't have organ dysfunction before operation;(4)patients died within 28 days postcardiotomy.Therefore,6 patients who died were admitted as death group,the other 30 patients were admitted as control group.The analysis included: (1)preoperative factors,including gender,age,diagnosis preoperative,NYHA grade,APACHEⅡscore,left ventricular end-diastolic diameter.(2)operative factors:operation time,block aorta time. (3)postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary arteria wedged pressure(PAWP),cardiac output index(CI),arterial blood lactic acid,partial pressure of oxygen(PaO2),mixed venous oxygen saturation(SvO2),oxygen delivery index(DO2I),oxygen comsume index(VO2I),oxygen extraction ratio (O2ext).Comparisons between two group was made with SPSSl0.0 for windows.Firstly,the data were analyzed with process of single variable analysis and Some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the IDGISTIC regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The single variable analysis showed that the parameters of APACHE Ⅱ score,left ventricular end-diastolic diameter,block aorta time,mechanical ventilation time,arterial blood lactic acid,SvO2 had significant difference betwen groups(P＜0.05).The LOGISTIC regression showed that left ventricular end-diastolic diameter and arterial blood lactic acid ale the two independent risk factors of death(P＜0.05).Conclusions Arterial lactatemia and left ventricular end-diastolic diameter can be used to predict the prognosis of postcardiotomy undergoing cardiopulmonary bypass.

Objective To evaluate the protective effect of astragaloside Ⅳ against ultraviolet B (UVB)-induced photodamage to human HaCaT keratinocytes,and to investigate its mechanisms.Methods Culturedimmortalized human HaCaT keratinocytes were divided into four groups:blank control group receiving untreated,UVB group irradiated with 50 mJ/cm2 UVB,astragaloside Ⅳ group treated with astragaloside Ⅳ,UVB + astragalosideⅣ group treated with astragaloside Ⅳ for 24 hours before and after 50 mJ/cm2 of UVB radiation.The concentration ofastragaloside Ⅳ ranged from 10 to 200 mg/L in cell proliferation assay,and according to the results of proliferationassay,20 mg/L was determined as the optimal concentration in the other assays.At 24 hours after UVB radiation,cellcounting kit-8 (CCK8) assay was performed to evaluate cellular proliferative activity,flow cytometry to determineintracellular reactive oxygen species (ROS) levels,and Western blot to measure the expression levels of p53,p38,matrix metalloproteinase-9 (MMP-9) and high mobility group Al (HMGA-1) protein in HaCaT cells.ResultsCompared with the control group,astragaloside Ⅳ at 10 and 20 mg/L had no inhibitory effect (F =1.32,P ＞ 0.05),while astragaloside Ⅳ at 50,100 and 200 mg/L showed significantly inhibitory effect (F =20.20,P ＜ 0.05),on theproliferation of HaCaT cells.In addition,cellular proliferative activity in the UVB group was significantly lower thanthat in the control group (F =99.00,P ＜ 0.01).Compared with the UVB group,cellular proliferative activityincreased to different degrees in HaCaT cells treated with both UVB and astragaloside Ⅳ of 10-200 mg/L (F =19.08,P ＜ 0.01),with the strongest increase observed in those treated with UVB and astragaloside Ⅳ of 20 mg/L.Further experiments revealed reduced intracellular ROS levels in the UVB + astragaloside Ⅳ (20 mg/L) groupcompared with the UVB group (t =21.12,P ＜ 0.01).Western blot assay showed that the expression levels of p53,p38,MMP-9 and HMGA-1 protein were significantly higher in the UVB group than in the control group (all P ＜0.01),but significantly lower in the UVB + astragaloside Ⅳ (20 mg/L) group than in the UVB group (all P ＜ 0.01).Conclusion Astragaloside Ⅳ can effectively protect keratinocytes from UVB-induced photodamage.

Aim To investigate the effect of baicalin on cell proliferation and cell migration in human skin SCC A431 cell line. Methods The A431 cells were incu-
bated with 50 mg·L-1 baicalin. The protein level of cofilin-1 was assayed by Western blot. Cofilin-1 specific siRNA fragment was designed , synthesized and trans-
fected into A431 cells. The proliferative activity and migration ability of cells were assessed by CCK8 assay and scratch wound healing assay separately. ResultsWestern blot results showed that baicalin treatment in-hibited the cofilin-1 protein expression to 49.3% com-pared with the control group. Single baicalin treatment and cofilin-1 silencing could drease the A431 cell growth and migration. And cofilin-1 silencing signifi-
cantly enhanced the efficacy of baicalin. Conclusions Baicalin could significantly inhibit the tumor cell's growth and migration in the A431 cell line. And cofi-lin-1 might become the potential target gene to enhance the effect of anticancer drugs.

Objective To evaluate the effects of prone position ventilation (PPV) combined with inhalation of NO on oxygenation of acute respiratory distress syndrome (ARDS) patients.Methods A total of 21 patients with ARDS composed of 15 male and 6 female aged ranging from 2 to 74 years with mean age of 39 ± 17.4 years were hospitalized from September 2008 through January 2011.After application of mechanical ventilation with optimal PEEP,patients still needed the high concentration oxygen inhalation (FiO2 ≥ 60％).They were randomly (random number) divided into three groups for controlled study.Patients of group A were given NO in addition to oxygen inhalation for 4 hours,patients of group B were put in prone position ventilation with oxygen inhalation for 2 hours,then they were returned to the supine position ventilation,and patients of group C were put into prone position ventilation with inhalation of oxygen plus NO for 2 hours,and then they were returned to the supine position ventilation,but they were continued to inhaled NO.The oxygenation indexes of three groups of patients were measured before the intervention,2 hours and 4 hours after the procedure of experiment.Results The oxygenation indexes of three groups of patients were improved in terms of comparison between pre-intervention and 2 hours after intervention,but there was no statistically significant difference found in group A (P ＞ 0.05),the differences in group B and group C were statistically significant (P ＜ 0.05).Compared the oxygen index between pre-intervention and 4 hours after intervention,the differences in group A and group B were not statistically significant (P ＞0.05),but the difference in group C was statistically significant (P ＜ 0.05).Conclusions PPV could improve oxygenation in acute respiratory distress syndrome (ARDS) patients.PPV with NO inhalation could improve oxygenation in acute respiratory distress syndrome (ARDS) patients as well as effectively maintain the oxygenation after patients were returned to the supine position ventilation.Therefore prone position ventilation combined with inhalation of NO improved oxygenation and at the same time reduced the prone position time.

Adolescent ; Adult ; Child ; Child, Preschool ; Electrocoagulation ; methods ; Female ; Humans ; Hypothermia, Induced ; Male ; Middle Aged ; Prospective Studies ; Tonsillectomy ; methods ; Young Adult

Objective To compare the effect of 0.9％ NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation.Methods A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled. All eligible patients were randomly divided into 0.9％ NaCl solution group (group N), Ringer solution group (group L) and ASPMCG solution group (group P) with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 mL/kg of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign (SSC) guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess (BE), blood glucose (Glu), lactic acid (Lac), and serum Na+, K+, Cl-, Ca2+ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.Results In this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was [Abstract] Objective To compare the effect of 0.9％ NaCl solution, Ringer solution, and acetate sodium potassium magnesium calcium glucose solution (ASPMCG solution) on internal environment in patients with septic shock receiving early fluid resuscitation.Methods A prospective randomized controlled trial was conducted. From June 2016 to January 2018, a total of 280 patients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital were enrolled. All eligible patients were randomly divided into 0.9％ NaCl solution group (group N), Ringer solution group (group L) and ASPMCG solution group (group P) with random number table. In all patients, catheters were placed in the right internal jugular vein or subclavian vein and were infused with 30 mL/kg of corresponding crystalloid within 3 hours after admission. According to fluid responsiveness, the rehydration rate and fluid volume were determined by the researcher within 6 hours. Other treatments were based on the 2012 Surviving Sepsis Campaign (SSC) guidelines during the study. In this study, 6-hour or 24-hour fluid volume and 7-day exogenous insulin use were recorded. The changes in arterial blood pH, base excess (BE), blood glucose (Glu), lactic acid (Lac), and serum Na+, K+, Cl-, Ca2+ were observed at 0, 3, 6, 24 hours, and 3 days and 7 days of resuscitation.Results In this study, a total of 1082 patients were admitted to the ICU, and patients who did not meet the diagnostic criteria for septic shock, death or discharge within 24 hours of ICU admission were excluded. Finally, 280 patients with septic shock were enrolled in the analysis, with 94 patients in group N, 94 patients in group L and 92 patients in group P. There was no significant difference in the amount of crystalloid, colloidal fluid, total fluid within 6 hours or 24 hours or exogenous insulin dose within 7 days among the three groups. After fluid resuscitation, blood Cl- concentration in the three groups was increased in different degrees, peaked at 24 hours, but it in group N was significantly higher than that in group L and group P (mmol/L: 107.5±5.6 vs. 106.1±4.8, 105.1±4.2, bothP ﹤ 0.05). Moreover, blood Ca2+concentration also showed an increased tendency, it was significantly lower at 3 hours and 6 hours in group N than that in group L and group P (mmol/L: 1.10±0.08 vs. 1.15±0.09, 1.12±0.10 at 3 hours, 1.12±0.10 vs. 1.16±0.08, 1.15±0.09 at 6 hours, all P < 0.05). There was no significant difference in blood Cl- or Ca2+between groups L and P (bothP > 0.05). Arterial blood pH, BE, Glu, Lac, Na+, or K+at each time point during fluid resuscitation also showed no difference among the three groups.Conclusion Among patients with septic shock receiving early fluid resuscitation, compared with Ringer solution and ASPMCG solution, 0.9％ NaCl solution may cause hyperchloremia and hypocalcemia, but has no significant effect on acid-base balance.Clinical Trial Registration Chinese Clinical Trial Registry, ChiCTR-IOR-16009176.

Objective:Sepsis patients usually have a fever, but it is still controversial about whether sepsis patients with fever need cooling treatment. This study aimed to evaluate the effect of external physical cooling on the prognosis of sepsis patients.Methods:This study was a single-center, open-label, randomized clinical trial. Adult sepsis patients with body temperature above 38.3 °C admitted to the Critical Care Medicine of Northern Jiangsu People's Hospital from June 2020 to December 2020 were selected, and randomly assigned in a 1∶1 ratio to the cooling group and control group. Patients in the cooling group used external physical cooling methods to reduce their core body temperature to the normal range (36.5-37.5°C) within 4 h of enrollment and maintained for 48 h. Standard care was implemented in the control group at all times, and all antipyretic treatments were prohibited. The 28-day mortality, 72 h-Δ sequential organ failure assessment (SOFA) score (SOFA score at enrollment–SOFA score after 72 h), length of hospital stay and length of ICU stay were compared between the two groups.Results:A total of 53 patients (32 males and 21 females) were enrolled in the study, including 26 patients in the cooling group and 27 patients in the control group. There were no statistical differences in age, sex, source of infection, SOFA score and body temperature between the two groups (all P>0.05). There was no significant difference in the 28-day mortality between the cooling group and the control group ( RR=1.38, 95% CI: 0.62-3.07, P=0.430). The 72 h-ΔSOFA score of the cooling group was significantly higher than that of the control group, the mean difference between the two groups was 1.90 (95% CI: 0.09-3.71, P=0.040), and there was no significant difference in length of hospital stay, length of ICU stay and 28-day mortality between the two groups. Conclusions:External physical cooling management can not significantly reduce the 28-day mortality of sepsis patients. However, external physical cooling can reduce the 72-h SOFA score in sepsis patients, and improve the organ function of patients.

OBJECTIVETo assess the diagnosis and treatment of venous hypertensive myelopathy (VHM) caused by narrowing of the ascending lumbar vein.

METHODThe data from 3 patients with VHM caused by narrowing of the ascending lumbar vein were analyzed retrospectively.

RESULTSOnce the narrowed site of the lumbar ascending vein was determined by myelographic or angiographic technique, an undetachable balloon was introduced and advanced to the proximal part of the narrowed segment. Satisfactory results were obtained in these patients.

CONCLUSIONNarrowing of the ascending lumbar vein is one of the causes for VHM, and endovascular balloon angioplasty is an optimal treatment.

Aged ; Humans ; Hypertension ; etiology ; Lumbar Vertebrae ; blood supply ; Male ; Middle Aged ; Retrospective Studies ; Spinal Cord Vascular Diseases ; etiology ; Venous Pressure

Objective To evaluate the value of medical treatment in the management of SAP.Methods From January 2000 to December 2011,a total of 1064 cases out of 931 SAP patients were admitted and retrospectively analyzed.The etiologies,severity score,complication rates,therapies,effectiveness and costs of those SAP cases were summarized.Results There were 559 males and 372 females with a mean age of (51 ± 15)years old.The main cause was biliary tract disease (58.3％),followed by fat-rich diet (31.2％),hyperlipidemia (13.6％) and alcohol (7.1％).At the time of admission,95.5％ of SAP patients presented with level D disease according to Balthazar CT severity index,26.0％ had a Ranson score ≥3 and 30.1％ had an APACHE Ⅱ score ≥ 8.There were 42.7％ cases complicated with systemic inflammatory response syndrome (SIRS).Acute lung injury and acute respiratory distress syndrome (ARDS),acute kidney injury,shock or heart failure,acute liver dysfunction,and diffuse intravascular clotting (DIC)occurred in 24.0％,8.1％,5.4％,3.2％,and 1％ of all patients,respectively.Other complications of SAP included abdominal cavity bleeding (n =17),pseudocyst bleeding (n =9),pancreatic abscess (n =78) and gastrointestinal fistula (n =33).Totally 25 (2.3％) patients died in hospital and 36 (3.4％) patients were discharged against advice,with an overall treatment success rate of 94.3％.The mean hospital stay was (23.7 ± 19.2) d,and the average cost was 52.3 thousands of RMB.Conclusions A comprehensive treatment pathway relying on medical treatment,focusing on organ function support and assisted by miniinvasive intervention may improve the treatment success rate of SAP,which is worth of further application.