Objective To investigate the value of pulse-indicate continuous cardiac output(PICCO) in septic shock patients.Methods In a retrospective study,58 patients who were diagnosed to be suffering from septic shock in the intensive care unit (ICU) were enrolled,from January 2010 to December 2011,and were divided into two groups:PICCO group(n =28) and the conventional group (n =30).We compared their 6 h-EGDT compliance rate,the level of lactate and central venous pressure (CVP),the oxygenation index,the characteristics of fluid intake and balance within 72 hours,duration of mechanical ventilation,and ICU stay of the two groups.The incidence of MODS after 72 hours in ICU,28-day mortality were recorded and compared.Results (1) Fluid intake((9565 ±1623) ml vs (12245±2253) ml,t=2.673,P=0.021) and balance ((3656 ± 1904) ml vs (5465 ± 2765) ml,t =2.357,P =0.012) were significantly lower in PICCO group compared the conventional group within 72 hours.(2) The oxygenation index ((252.6 ± 87.4) vs (226.8 ± 69.4),P ＜ 0.05) in PICCO group increased significantly and duration of mechanical ventilation ((134.7 ±42.8) h vs (193.3 ± 92.4) h,t =1.356,P =0.023) reduced significantly compared with the conventional group after 72 hours.(3) There was no difference in the 6 h-EGDT compliance rate,the level of lactate and CVP,6 h EGDT,ICU stay,the incidence rate of MODS after 72 hours,28-day mortality in ICU(P ＞0.05).Conclusion In contrast with classic methods as CVP monitoring,PICCO catheter may assess more accurately the volume status and guide early fluid resuscitation in septic shock patients.

Objective:To evaluate the effect of hydrogen on the immunosuppressive status of septic rats.Methods:SPF healthy adult male Sprague-Dawley rats, aged 7-8 weeks, weighing 220-260 g, were studied.This study was performed in two parts.Part Ⅰ The rats were divided into 2 groups: sepsis group (Sep group, n=36) and sham operation group (Sham group, n=12). The model of sepsis was established by cecal ligation puncture in anesthetized rats.The histocompatibility DR antigen (HLA-DR)/CD14 + monocyte level in peripheral blood was detected by flow cytometry immediately after CLP and at 1, 2, 3 and 4 days after CLP.The establishment of sepsis-induced immunosuppression model was considered successful when the levels of HLA-DR/CD14 + monocyte in peripheral blood were <30%.Part Ⅱ Twelve rats with sepsis-induced immunosuppression were randomly selected and divided into 2 groups ( n=6 each) by a random number table method: sepsis immunosuppression group (Sep-IS group), sepsis immunosuppression plus hydrogen treatment group (Sep-IS+ H group). Another 12 rats were selected and divided into 2 groups ( n=6 each) by a random number table method: sham operation group (Sham group) and sham operation plus hydrogen group (Sham+ H group). In Sep-IS+ H group, 67% hydrogen was inhaled for 1 h starting from the time point immediately after successful establishment of sepsis-induced immunosuppression and from 6 h after establishment, and 67% hydrogen was inhaled for 1 h at the corresponding time points in Sham+ H group.The levels of helper T lymphocytes 17 (Th17 cells), regulatory T lymphocytes (Treg cells) and HLA-DR/CD14 + monocyte in peripheral blood were determined by flow cytometry immediately after the end of hydrogen inhalation mentioned above (T 0, T 1) and at 12 h after establishing the model (T 2). Results:Part Ⅰ Compared with Sham group, the levels of HLA-DR/CD14 + monocyte in peripheral blood were significantly decreased at 1-4 days after CLP in Sep group ( P<0.05). Part Ⅱ Compared with Sham group, the level of HLA-DR/CD14 + monocytes in peripheral blood was significantly decreased, and the levels of Treg and Th17 cells were increased at each time point in Sep-IS and Sep-IS+ H groups ( P<0.05), and no significant change was found in the parameters mentioned above in Sham+ H group ( P>0.05). Compared with Sep-IS group, the level of HLA-DR/CD14 + monocytes in peripheral blood was significantly increased at T 1, 2, the levels of Th17 cells were increased at T 2, and the levels of Treg cells were decreased at T 1, 2 in Sep-IS+ H group ( P<0.05). Conclusion:Hydrogen can improve the immunosuppressive state of septic rats.

Objective To evaluate the synchrony of heart after catheter-based renal denervation by two dimensional speckle tracking imaging.Methods Each renal sympathetic nerve of 20 dogs were ablated,and the index of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views.The times from QRS onset to peak-systolic strain rate and to peak-diastolic strain rate were measured for the longitudinal 16-segments in Qlab software,and the standard deviation were calculated.The time to peak longitudinal strain rate and time to peak contraction strain rate of left atrium were measured for each segment contained septal,latera,anterior and posterior in the level of the basal segments,middle sections and apical in Qlab software,and the standard deviation were calculated.Parameters were compared among the before and after of the ablation.Results The systolic pressure and diastolic pressure had no changes after the ablation of renal sympathetic nerve (P ＞ 0.05).The R-R showed a increasing trend,but no significant differences(P ＞0.05).The peak time of LV systolic and diastolic strain rate had a extended trendency too,but no differences(P ＞0.05),and standard deviations of the peak times had no significant differences(P ＞0.05).The peak time of LA longitudinal strain rate and contraction strain rate had a extended trendency,but no obvious change (P ＞0.05),and the standard deviations of the peak times had no significant differences (P ＞0.05).The size of the heart cavity had no differences(P ＞0.05).Conclusions The systolic pressure and diastolic pressure have no changes after the ablation of renal sympathetic nerve,and the synchrony parameters of LV and LA have no significant differences,demonstrate that the synchrony of heart is not affected by the renal sympathetic denervation.

The aim of the study is to establish a new method of quality evaluation and validate its feasibilities by the simultaneous quantitative assay of four lignanoids in Schisandra chinensis. A new quality evaluation method, quantitative analysis of multi-components by single marker (QAMS), was established and validated with Schisandra chinensis. Four main lignanoids, schisandrin, schisantherin A, deoxyschizandrin and gamma-schizandrin, were selected as analytes and schisandrin as internal reference substance to evaluate the quality. Their contents in 13 different batches of samples, collected from different bathes, were determined by both external standard method and QAMS. The method was evaluated by comparison of the quantitative results between external standard method and QAMS. No significant differences were found in the quantitative results of four lignanoids in 13 batches of S. chinensis determined by external standard method and QAMS. QAMS is feasible for determination of four lignanoids simultaneously when some authentic standard substances were unavailable, and the developed method can be used for quality control of S. chinensis.

Objective To evaluate the security of catheter-based renal denervation by two dimensional speckle tracking imaging.Methods 20 dogs was ablated,whose indicies of heart and blood pressure were detected 6 weeks later.Standard 2D images were acquired in the 2-,3-and 4-apical views as well as the parasternal short-axis views at the level of the mitral valve and papillary muscles.The time to peak-systolic strain of each segment in the level of the mitral valve and papillary muscles,the standard deviation of the time to peak-systolic strain,the peak strain of the longitudinal 12-segment were recorded.Parameters were compared among the before and after ablation.Results Compared with before ablation of renal sympathetic nerve,the systolic pressure and diastolic pressure didn't reduced significantly after the ablation of renal sympathetic nerve (P ＞ 0.05),while there were no significant difference in the peak strain of the longitudinal 12-segment,the dyssychrony parameters and the size of the heart cavity before and after ablation(P ＞0.05).Conclusions The pressure had no change after the ablation of renal sympathetic nerve while without harmful effect on the the size of the heart cavity,the function of the myocardial contraction and the dyssychrony parameters.The ablation of renal sympathetic nerve can' t lower the normal blood pressure and be safe for heart at the same time.

This study was aimed to establish an HPLC method to determine three ginsenosides in Shengmai ultra-micro powder. The kromasil C18 (250 mm í 4.6 mm, 5 μm) was used as analytical column. The mobile phase was composed of acetonitrile (A) and water (B) with gradient elution (0~35 min, 19% A; 35~55 min, 19%~29% A; 55~70 min, 29% A; 70~100 min, 29%~40% A) at a flow rate of 1 mL·min-1. The detection wavelength was 203 nm and the column temperature was 30℃. The injection volume was 10 μL. The results showed that the linear ranges of ginsenoside Rg1, ginsenoside Re, ginsenoside Rb1 were 0.083~0.834 μg, 0.086~0.863 μg, 0.091~0.911 μg, respec-tively. The average recovery rates (n = 6) were 100.7%, 100.5%, 100.5%, respectively. It was concluded that this method was quick, sensitive, repeatable and suitable to determine contents of ginsenoside Rg1, ginsenoside Re and ginsenoside Rb1 in Shengmai ultra-micro powder.

Objective To observe the expression level change of vascular endothelial growth factor (VEGF) in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS), and to explore the relationships of VEGF expression with OSAHS, OSAHS related cardiovascular and cerebrovascular diseases. Methods Polysomnography (PSG) was used to conduct sleep apnea monitoring in 24 OSAHS patients from 6OSAHS popular families and 48 healthy controls with normal physical examination results. The expression of VEGF mRNA was examined by reverse transcriptionpolymerase chain reaction (RT-PCR) analysis, meanwhile, the level of VEGF in plasma was measured VEGF mRNA in PBMC were significantly higher in simple OSAHS group [plasma levels: (205.75±2.79) pg/ml; mRNA: 0. 61±0. 02] than in control group [(168.72±4.64) pg/ml; 0. 47±0. 02,cardiovascular and cerebrovascular diseases group [(288.74 ± 2.73) pg/ml, 1.16 ± 0. 03] than in simple OSAHS group [ ( 205.75 ± 2.79 ) pg/ml, 0. 61 ± 0.02, P ＜ 0. 01]. ( 2 ) There was a positive correlation of the levels of VEGF in plasma and mRNA with AHI as well as systolic and diastolic blood pressure in early morning. There was a negative correlation of the level of VEGF in plasma and VEGF mRNA with the lowest saturation of blood oxygen. There was a positive correlation of the level of VEGF mRNA with AHI as well as systolic and diastolic blood pressure in early morning.Conclusions The level of VEGF in OSAHS significantly increases, which may play a role in the pathophysiology of OSAHS and OSAHS related cardiovascular and cerebrovascular diseases.

Objective To explore the clinical features, treatment and prognosis of mucinous tubular and spindle cell carcinoma of the kidney. Methods Patient 1, a 42-year-old woman presented with space-occupying lesion of the lower pole of the left kidney with no symptoms in physical examination for 1 week. CT revealed a low-enhanced tumor located in the lower pole of the left kidney in cT1b N0M0. Radical left nephrectomy was performed. Patient 2, a 76-year-old woman presented with space-occupying lesion of the middle of the left kidney with no symptoms in physical examination for 10 d. CT revealed a low-enhanced tumor located in the middle of the left kidney in cT1b N0 M0. Laparoscopic radical left nephrectomy was performed. The patient received adjuvant treatment with IL-2 and interferon-α 3 months after nephrectomy. Patient 3, a 50-year-old woman presented with lumbago for 3 months. CT revealed a low-enhanced tumor located in the right kidney in cT2 N0 M0. Radical right nephrectomy was performed. The patient received adjuvant treatment with IL-2 and interferon-α 3months after nephrectomy. Patient 4, a 60-year-old woman presented with lumbago and hematuria for 15 d. CT revealed a low-enhanced tumor located in the lower pole of the left kidney in cT1a N0M0.Radical left nephrectomy was performed. Results Histological examination of the tumors showed that they consisted of spindle cells arranged in tubular and trabecular patterns embedded in a myxoid stroma. Pathologic diagnosis of all 4 patients were MTSCCa. There was no evidence of recurrence in all patients for 9- 46 months. Conclusions MTSCCa is a rare low-grade renal cell carcinoma.There is a female predominance. Early surgical excision is the best treatment and the prognosis is relatively good.

Objective To assess the left ventricular systolic function after renal sympathetic denervation(RSD) in beagles with heart failure by layer-specific two-dimensional speckle tracking imaging.Methods Twenty-three beagles were randomly divided into control group (8 dogs),URSD group (8 dogs)and RSD group (7 dogs).Control group was implanted with pacemakers without pacing,URSD group was implanted with pacemakers and underwent 3 weeks of rapid right ventricular pacing,and RSD group underwent catheter-based RSD bilaterally and was simultaneously implanted with pacemakers.All standard measurements were obtained from the left ventricular short-axis views at the levels of mitral annulus,papillary muscle and apex,and apical four-chamber,two-chamber,and long-axis views.The peak systolic longitudinal strain and circumferential strain of each layer of the left ventricle were measured by layerspecific two-dimensional speckle tracking imaging.Results After 3 weeks,all of the dogs in both the URSD and RSD groups showed lower left ventricular diastolic and systolic function compared with those in the control group,however,the dogs in the RSD group had a higher LV ejection fraction (LVEF) than the dogs in the URSD group(P ＜ 0.05).Compared with the control group,the global longitudinal strain,circumferential strain and radial strain all decreased significantly in URSD and RSD groups.The longitudinal strain of endo-and mid-cardium and the circumferential strain in endo-cardium were significantly higher in RSD group than those in URSD group(P ＜0.05).Conclusions Myocardial systolicfunction is impaired in dogs with heart failure,layer-specific two-dimensional speckle tracking imaging can provide effective tools to assess the left ventricular systolic function.Renal sympathetic denervation can improve the myocardial systolic function in dogs with heart failure.

Objective To construct a stably-performing and high-efficiency regeneration system of Gynostemma pentaphyllum and lay a foundation for the gene transformation of it.Methods The blades of five-leaf G.pentaphyllum were used as the explants and cultured in MS media with different portions of hormone to induce fascicled-bud,root and plantlet regeneration.Results The medium suitable for inducing the blade differentiation of G.pentaphyllum was MS+6-BA 1.0 mg/L and for the frequency of blade differentiation could reach 40%.The cultural medium MS+6-BA 1.0 mg/L was suitable for the sub-multiplication of fascicled-bud and the medium 1/2 MS for root inducement and the plantlet regeneration.Conclusion A stably-performing acceptor system of the direct differentiation for Agrobacterium tumefaciens mediated gene transformation of G.pentaphyllum blades is constructed.