Objective To explore the relationship between early changes of central venous-toarterial carbon dioxide difference (Pcv-aCO2) and the prognostic in patients with septic shock.Methods One hundred and three patients with septic shock were retrospectively analyzed.The patients were divided into death group (37 cases) and survival group (66 cases) according to prognosis.The patients were divided into four groups according to the changes of 0 and 6 h Pcv-aCO2:Pcv-aCO2 persistently high group (16 cases),Pcv-aCO2 increased group (19 cases),Pcv-aCO2 decreased group (22 cases),Pcv-aCO2 persistently normal group (46 cases).All the patients were treated with early goal-directed therapy (EGDT),and central venous oxygen saturation (ScvO2) ≥0.70 was the target.The acute physiology and chronic health evaluation (APACHE) Ⅲ score,sepsis related organ failure assessment (SOFA) and mortality were compared.Results There was no statistical difference in 0 h Pcv-aCO2 (P ＞ 0.05).The Pcv-aCO2 in 6,12 and 24 h in survival group was significantly lower than that in death group [(5.0 ± 1.8) mmHg (1 mmHg =0.133 kPa) vs.(6.8 ± 2.3) mmHg,(4.7 ± 2.3) mmHg vs.(7.2 ± 3.0) mmHg,(3.2 ± 1.5) mmHg vs.(7.5 ± 3.3) mmHg],and there was statistical difference (P ＜ 0.05 or ＜ 0.01).The APACHE Ⅲ score in survival group was significantly lower than that in death group [(51.6 ± 23.8) scores vs.(87.7 ± 35.9) scores],and there was statistical difference (P ＜ 0.05).The time of mechanical ventilation,APACHE Ⅲ score,SOFA,length of stay in hospital and mortality in Pcv-aCO2 persistently high group and Pcv-aCO2 increased group were significantly higher than those in Pcv-aCO2 decreased group and Pcv-aCO2 persistently normal group,and there were statistical differences (P ＜ 0.05 or ＜ 0.01).Conclusion The Pcv-aCO2 persistently high during the early resuscitation of septic shock is associated with multi-organ dysfunction and worse prognosis,and provides guidance for clinical treatment.

Objective To investigate the coagulant function of Thrombomodulin-Protein C-EPCR System in rats with hemorrhagic shock in virto study.Methods In this study,30 rats were divided into three groups,with each group 10 rats:control group,the sham shock group,hemorrhagic shock group.Hemorrhagic shock model was subjected to computer-controlled arterial hemorrhage to 40 mm Hg for 60 min The rat blood serum samples were obtained from rats in sham shock group and shock group after maintaining 3 hours,and fetal bovine serum (FBS) was used as control group.Then medium contained fore-mentioned serums cultured with SV40-transformed aortic rat endothelial cells for 6 hours,12 hours and 18hours.The messenger RNA (mRNA) expression of thrombmodulin (TM),Endothelial cell protein C receptor in the SV40-transformed aortic rat endothelial cells which were treated with serums were detected by reverse-transcription polymerase chain reaction.Results Compared to control group,SVARECs were incubated for 6hrs with shock serum,the mRNA expression of TF,TM and t-PA was significantly higher,and continued elevating at the time of 18 hours (P ＜ 0.01).Conclusions Serums from hemorrhagic shock rats upregulate TMmRNA EPCRmRNA expression on the endothelial cells surface.It is suggested that Thrombomodulin-Protein C-EPCR System pay a key role of anticoagulation,the protection of endothelial function.

objective To evaluate the prognostic value of five scoring systems including acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ ),Ranson score,sepsis-related organ failure assessment (SOFA),Balthazar CT severity index (CTSI) and modified early warning score (MEWS) in early prognosis of severe acute pancreatis.Methods One hundred and fifty-four patients with severe acute pancreatitis from January 2004 to January 2010 were studied retrospectively,and data pertinent to five scoring systems were recorded from day 1 to day 3 after admission in hospital All patients were divided into early non-survival group (43 cases) and early survival group ( 111 cases) by survival time after admission in hospital.Five scoring systems during first 3 days aftter admission and their prognostic value in early prognosis of severe acute pancreatitis was compared between two groups.Results Compared with that of early survival group,every day five scoring systems of early non-survival group were significantly higher in the first 3 days after admission (P ＜ 0.05 or ＜ 0.01 ).On day 1 after admission,APACHE Ⅱ was the most accurate predict of early mortality with area under curve (AUC) value of 0.879,closely followed by MEWS (AUC 0.858).On day 2 and 3 after admission,the MEWS was the most accurate predict of early mortality with AUC 0.900 and 0.942,respectively.Conclusion MEWS is more accurate predict of early mortality in severe acute pancreatitis among different scoring systems,worthy of generalization in clinic.

Objective To evaluate the early effect of Wallis interspinous dynamic stabilization system (Wallis system) in treatment of lumbar degenerative disease. Methods From January 2008 to Jan-uary 2009,21 patients(23 intervertebral spaces) with early lumbar disc herniation and lumbar spinal stenosis were treated with Wallis system. Four intervertebral spaces of L_(3-4) 19 intervertebral spaces of L_(4-5). Observed the time of total operation and implantation,the blood loss,and early recovery. The patients' visual analogue scale (VAS) and Oswestry disability index (ODI) scores were evaluated before and after operation. Results All patients were followed up for average (12.5 ± 0.4) months (7-18 months) after operation. The VAS and ODI scores at 7 days after operation dropped from (7.5 ± 1.5), (40.0 ± 2.0) scores before operation to (2.5 ± 0.5), (23.0 ± 1.5) scores (P < 0.01). Conclusion It is safe and easy to use Wallis system in the treatment of lumbar degenerative disease, with the advantage of mini-invasion and early effect.

ObjectiveBy studying acupuncture at Neiguan (PC6), Shuigou (GV26), and Baihui (GV20) in septic shock patients, to observe the effect of acupuncture on T cell subsets, vital signs, white blood cell (WBC) count, and procalcitonin (PCT) level in septicshock patients.MethodSixty patients were randomized into a treatment group and a control group. The control group was intervened by symptomatic managements including supplementing blood volume, anti-inflammation, nutrition support, and organ protection, and the treatment group was by acupuncture at Neiguan, Shuigou, and Baihui in addition to the intervention given to the control group. The T cell subsets contents were detected before and after intervention, and serum PCT level, APACHEⅡscore, vital signs, and WBC count were determined on day 1, 3, 5, and 7.ResultIn the treatment group, T cell subsets including CD3﹢, CD4﹢, and CD4﹢/CD8﹢increased significantly after intervention (P<0.01,P<0.05), while CD8﹢dropped significantly afterintervention (P<0.05), and the changes in the treatment group were all markedly superior to that in the control group (P<0.05). The decrease of PCT level in the treatment group was more significant than that in the control group after treatment, the PCTlevel dropped significantly on the 5th day in the treatment group compared to that before treatment, and the inter-group difference was statistically significant after the 3rd day (P<0.01); the APACHEⅡscore in the treatment group was different from that in the control group after 3 d treatment, and the score was significantly changed in the treatment group after 5 d treatment (P<0.05); the body temperature, heart rate, inspiration, WBC count all showed decrease or improvement, and the improvements of vitalsigns in the treatment group were more significant than that in the control group (P<0.01,P<0.05).ConclusionAcupuncture at Baihui, Shuigou, and Neiguan can improve the immune function of septic shock patients, and its treatment effect is confirmed.

Objective To explore the clinical effect of acupuncture on acute renal injury of sepsis.Methods From January 2015 to May 2017,adult patients with sepsis who received ≥ 7 days of treatment were collected from the Central Hospital of Zhuzhou.The participants were randomly divided into the control group (n =35) and the treatment group (n =37),and the control group was given routine treatment according to the sepsis guidelines.On the basis of control group,the treatment group was given acupuncture treatment,acupoints Shenshu and Sanyinjiao,Taixi,Zusanli.The clinical effects of the two groups of patients were compared.Results The levels of cystatin C,blood urea nitrogen and creatinine in the treatment group were significantly lower than those in the control group (P ＜ 0.05).There was no significant difference in the number and proportion of patients with blood purification between the two groups (P ＞ 0.05),while the frequency and time of blood purification treatment in the treatment group were significantly lower than those in the control group (P ＜ 0.05).The levels of blood interleukin-6 and tumor necrosis factor-alpha in the treatment group were significantly lower than those in the control group (P ＜ 0.05).From the fourth day of treatment,the Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score in the treatment group was significantly lower than that in the control group (P ＜ 0.05).There was no significant difference in mortality between the two groups at 28 days (P ＞ 0.05).Conclusions Acupuncture of Shenshu,Sanyinjiao,Taixi,Zusanli can improve sepsis patients with acute kidney injury in renal function.

Objective To investigate the efficacy and safety of early goal-directed sedation with dexme-detomidine in patients with septic shock.Methods This study is selected from August 2015 to December 2016 in our department 70 patients receiving treatment of septic shock,and through random sample table method divided into the control group and the study group two,there were 32 cases in control group,the control group selected ob-ject according to the conventional sedation treatment,namely the application of midazolam extraction treatment, the study group of 38 patients with septic shock in patients with application of dexmedetomidine sedation,analysis and application of different sedation method analysis of two groups of patients with septic shock. The efficacy and safety of observation and etc. Results Two groups of patients with different treatment methods,The onset time of the study group of patients with septic shock after sedation,h recovery time and time of mechanical ventilation was obviously better than the control group,the effect of difference(P < 0.05),has significant research value. Conclusions For patients with septic shock early goal orientation selection and application of sedation of dexme-detomidine can play a better effect,the more safe and effective,sedation score is high,it is worth of application in clinical treatment.

OBJECTIVETo investigate the effect of smoking cessation on the risk of cancer among male subjects.

METHODSParticipants of this study were derived from the workers in Kailuan Group who took the health check-up examination in its 11 affiliated hospitals. The check-up examinations were given biennially based on uniformed standard. From May 2006 to December 2011, health examinations were given for 3 rounds and a total of 104 809 male workers involved. The date of being enrolled in this study was defined as that of taking first check-up, and the date of end-of-observation was defined as that of cancer diagnosis, death or end of follow-up.

INCLUSION CRITERIAage ≥18 while being enrolled in this study, and there was no information missing in the questionnaire for age (or date of birth), smoking status, the age of starting smoking, the age of quitting smoking, and smoking amount. The information of smoking status was collected by questionnaires, and the information of newly-diagnosed cancer cases was obtained by follow-up. After adjusted for age, education background, drinking habits, working environment and BMI, multi-variate Cox proportional hazard regression models were used to analyze the association between smoking cessation and cancer risk (all sites of cancers, smoking-related cancers, and lung cancer) by calculating the values of HR (hazard ratio) and 95% CI (confidence interval).

RESULTSTotally, 104 809 subjects were followed up for 450 639.6 person-years, including 46 013 smokers (43.90%), 51 624 never-smokers (49.26%), and 7 172 smoking quitters (6.84%). Among all these subjects, 1 323 were diagnosed as cancer cases, including 1 082 smoking-related cancers, of which 378 were lung cancer cases. The results showed that, compared with never-smokers, smokers had increased risks for all sites of cancers (HR=1.38, 95% CI: 1.20- 1.59), smoking-related cancers (HR=1.45, 95% CI: 1.24- 1.69) and lung cancer (HR=1.70, 95% CI: 1.31- 2.21). While compared with the smokers, smoking quitters had decreased risk of lung cancer (HR=0.36, 95% CI: 0.20- 0.65). For the smokers with smoking history ≥20 pack-years, HR (95% CI) of lung cancer incidence was 0.09 (0.01- 0.65). For people age ≥60 smoke quitter, HR (95% CI) of lung cancer incidence was 0.33 (0.16- 0.68). For people who quit ≥10 years, HR (95% CI) of lung cancer incidence was 0.19(0.06- 0.58).

CONCLUSIONSmoking cessation might decrease the risk of lung cancer among male smokers. The risk of lung cancer was lower among the smoking quitters with longer history of smoking, older age, and longer years of quitting smoking.

Humans ; Incidence ; Lung Neoplasms ; epidemiology ; Male ; Neoplasms ; epidemiology ; Proportional Hazards Models ; Prospective Studies ; Risk Factors ; Smoking ; adverse effects ; Smoking Cessation ; Surveys and Questionnaires

OBJECTIVE: To explore the protective effect of electroacupuncture against acute lung injury (ALI) in septic rats and explore the mechanism. METHODS: Sixty male SD rats were randomly divided into cecal ligation and puncture (CLP)-induced sepsis group ( RESULTS: Compared with those in the sham operation group, the rats in ALI group showed obvious lung pathologies with significantly increased lung W/D ratio ( CONCLUSIONS Electroacupuncture can inhibit the release of inflammatory mediators and cell apoptosis via the JAK1/STAT3 pathway to reduce lung injuries in septic rats.
Acute Lung Injury/therapy* ; Animals ; Electroacupuncture ; Lung ; Male ; Rats ; Rats, Sprague-Dawley ; Sepsis/therapy* ; Tumor Necrosis Factor-alpha