Objective To investigate the protective mechanisms of ulinastatin (UTI) in lung injury in septic rats.Methods Thirty healthy SD rats of clean grade were randomly (random number) divided into saline control group,lipopolysaccharide (LPS) group and lipopolysaccharide + ulinastatin (LPS + UTI) group (n =10,in each).The lung tissues were obtained for morphological observation at the 24th-hour after LPS injection.RT-PCR or Western blot,ELISA methods were applied to measure the expressions of Toll-like receptor 4 (TLR4),nuclear factor (NF)-κB,tumor necrosis factor (TNF)-α mRNA and their protein levels.Results LPS injection could result in lung injury.UTI could down-regulate the expressions of TLR4 mRNA (t =3.563,P =0.032),TNF-α mRNA (t =5.147,P =0.028),TLR4 protein (t =2.692,P =0.041),NF-κB protein (t =2.459,P =0.024) and TNF-α protein (t =3.336,P =0.037) in lung,and could in turn alleviate lung injury.Conclusions UTI showed protective effects on LPS induced lung injury,and one of the mechanisms was perhaps associated with the inhibition of TLR4-NF-κB signal transduction pathway.

Objective To investigate the distribution and resistance of positive pathogens isolated from blood culture and guide the use of antibiotics for clinical treatment and prevention treatment of bacteremia.Methods Collected the blood samples from 201 4 to 201 5 and cultivate by Bact ALERT 3D,pathogenic bacteria identification and antimicrobial susceptibility testing was carried out by VITEK 2 compact.The bacterial data were analyzed by WHONET 5.6 software,according to the breakpoints of CLSI 2014.Results Among the 16 751 blood culture samples, 893 cases showed positive and the positive rate was 5.3%.Among the strains,the percentage of the gram -positive bacteria was 423,including coagulase -negative Staphylococcus (62.9%),S.aureus (8.6%),Enterococcus (1 3.8%);the percentage of the gram -negative bacteria was 41 9,including Escherichia coli(47.0%),Klebsiella pneumonia(1 6.5%),Pseudomonas aeruginosa(4.9%),Stenotrophomonas maltophilia(4.5%)and Brukhoderial. cepacia(3.8%);the percentage of fungi was 5.7%,including Candida albicans(76.5%)and candida parapsilosis (23.5%).The prevalence of ESBLs producing strains was 56.0% in E.coli and K.pneumoniae.The average prevalence of methicillin -resistant strains in S.aureus(MRSA)and coagulase -negative Staphylococcus(MRCNS) was 25.0% and 67.8% respectively.Enterobacteriaceae strains were still highly susceptible to the carbapenem drug. The rate of CRE was zero.The resistance to vancomycin,linezolid and quinupristin/Dafoe leptin was not found in Staphylococcus.VRE was not found.Conclusion There was a variety of pathogens leading to bloodstream infection which show a relative sensitive resistance to many antimicrobial agents.Meanwhile,the multi -drug resistant strains may have serious consequences,and the monitoring and rational use of antibiotics should be strengthened.

Ascites formation represents a hallmark of decompensated liver cirrhosis.It predicts a poor outcome.Patients with ascites are at high risk of developing complications such as SBP (spontaneous bacterial peritonitis),hyponatremia and HRS (hepatorenal syndrome).Adequate treatment of cirrhotic ascites increases survival and betters quality of life.Despite improved current medical treatment of ascites,liver transplantation remains the ultimate treatment of refractory ascites.This paper summarizes the treatment of liver cirrhosis with ascites.

Objective:To develop a method of quantitative analysis of multi-components by single marker ( QAMS) for 4 kinds of saponins in spina date seed.Methods:Using jujuboside A as a reference, an HPLC method with a Kromasil C18 column (250 mm × 4.6 mm, 5 μm) was applied, the mobile phase was acetonitrile-0.1% phosphoric acid (30 ∶70), the flow rate was 1.0 ml · min-1 , the detection wavelength was 280 nm, the column temperature was 32℃and the injection volume was 20μl.The relative cor-rection factors among the four kinds of saponins were detected by QAMS .An external standard method was also used to determine the contents of the four saponins ( Wf ) , and the results were compared with those of QAMS ( Ws ) , and then the relative errors were calcu-lated between W f and Ws to evaluate the accuracy of QAMS , and the reproducibility was investigated as well .Results:The established QAMS was used to determine the four kinds of saponins in spina date seed , and totally 14 batches of spina date seed were determined . No significant differences were found out between the calculated values and the determined ones ( RSD<5%) .Conclusion:The vali-dated HPLC method shows the advantages of precision ,reproducibility and reliability .The established QAMS method is feasible , and suitable for the quality control of saponins in spina date seed .

The present review concluded remarkable globe clinical achievements in the field of critical care medicine during 2013.Briefly,new international sepsis management guideline,high frequency oscillatory ventilation,hydroxyethyl starch,immune-nutritional therapy,fecal transplantation and infection controlling became the highlighting topics.Additionally,it is also worthy to note the apparent disparity in the resuhs between meta-analyses suggesting a treatment advantage and following large-scale randomized trials that have failed to detect such differences in treatment outcomes.Nonetheless,we still expect the emerging of ongoing investigations may provide clarity in these area.

Objective To study the extraction,registration and fusion of the image contour of liver CT scan sequence.Methods Filtering method was used to remove the noise and enhance the edge of the image,and then the contour of the CT image was extracted.According to the optimal registration parameters,the hepatic arterial phase and venous phase images were registered,and the corresponding relationship between the arterial and venous images was determined.At last,the CT images of the arterial and venous phase were fused.Results After fusing the corresponding arterial and venous images,condition of liver artery and vein of the same cross section in different phase periods could be observed.Conclusions Fused image can offer richer image information to doctors for diagnosis.

Objective To study the efficacy of laparscopic operation in the treatment of repeated ectopic pregnancy. Methods 42 patients with repeated ectopic pregnancy were treated by salpingotomy, salpingectomy and adhesiotomy. Results All cases were managed under laparoscopy successfully, and no complication occurred. 28 cases were followed up for ( 6～50) months after operation, and postoperative pregnancy rate was 25%(7/28). Conclusions Laparoscopic operation can be the first choice of treatment of repeated ectopic pregnancy with minimal invasion and quicker recovery.

Objective To investigate the potential risk factors of organ dysfunction and mortality in the early resuscitation of severe sepsis and septic shock patients.Methods Data were retrospectively analyzed from patients with severe sepsis and septic shock receiving non-cardiac operation and admitted to Department of Critical Care Medicine of the Second Affiliated Hospital of Kunming Medical University from January 1st,2013 to December 31st,2015.The patients were divided into the senior group (≥ 65 years old) and the younger group (＜ 65 years old),the high-procalcitonin (PCT) group (PCT ＞ 100 μg/L) and the control group (PCT ≤ 100 μg/L).The stage of early resuscitation was set to the first 6 hours.The diagnostic time and the incidence of acute respiratory distress syndrome (ARDS),acute kidney injury (AKI),and cardiac insufficiency were observed,which also included the usage of continuous renal replacement therapy (CRRT).The total fluid volume and the time of vasopressor usage during the first 6 hours of early goal-directed therapy (EGDT) were also recorded,which aslo included the 28-day mortality.Results 512patients with severe sepsis and septic shock receiving non-cardiac operation were treated according to the guidelines of Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock:2012.EGDT was used during the early resuscitation.The incidence of ARDS,AKI,and cardiac insufficiency was 80.9％ (414/512),71.3％ (365/512),and 61.9％ (317/512) respectively.There were 205 senior patients and 307 younger,as well as 154in high-PCT group and 358 in control group.The 28-day mortality was 30.3％ (155 died).90.8％ of patients (376/414)combined with ARDS were diagnosed before EGDT.95.1％ of patients (347/365) combined with AKI were diagnosed before EGDT,among whom 14.0％ (51/365) were treated with CRRT.153 senior patients combined with cardiac insufficiency were diagnosed no longer than 12 hours after EGDT.Compared with the younger group,the incidences of ARDS and cardiac insufficiency were higher in the senior group [85.9％ (176/205) vs.77.5％ (238/307),82.9％(170/205) vs.32.9％ (147/307),both P ＜ 0.05],so were the time of vasopressor usage during EGDT (hours:5.81 ±0.28vs.5.68 ± 0.52,P ＜ 0.05) was prolonged markedly and the 28-day mortality [42.9％ (88/205) vs.21.8％ (67/307),P ＜0.05] was increased significantly.But the incidence of AKI and the total fluid volume during EGDT were not significantly different between the senior group and the younger group [incidence of AKI:74.1％ (152/205) vs.69.4％ (213/307),total fluid volume (mL):2 769 ± 1 589 vs.2 804± 1 611,both P ＞ 0.05].Compared with the control group,the incidence of ARDS was higher in the high-PCT group [86.4％ (133/154) vs.78.5％ (281/358),P ＜ 0.05].But the incidences of AKI and cardiac insufficiency were not significantly differentiated between the high-PCT group and the control group [77.9％ (120/154) vs.68.4％ (245/358),58.4％ (90/154) vs.63.4％ (227/358),both P ＞ 0.05].Multiple logistic regression analysis showed that the risk factors of increase in mortality in patients with severe sepsis and septic shock included old age [odds ratio (OR) =1.782,95％ confidence interval (95％CI) =1.173-2.708,P =0.007],ARDS (OR =1.786,95％CI =1.028-3.102,P =0.040),AKI (OR =1.878,95％CI =1.145-3.079,P =0.012),and cardiac insufficiency (OR =4.177,95％CI =2.505-6.966,P =0.000),except for gender (OR =1.112,95％CI =0.736-1.680,P =0.614).Conclusions In the senior postoperative patients with severe sepsis or septic shock,the incidence of ARDS and cardiac insufficiency,and the mortality were increased.The incidence of ARDS was correlated to the severity of infection.Old age,surgery,and EGDT could be the potential risk factors of cardiac insufficiency.

Objective To develop a more effective method to treat proximal tubal obstruction. Methods In a total of 89 cases, there were 113 oviduct lesions diagnosed by hysterosalpingogram (HSG) and then by laparoscopy as proximal tubal obstructions. Intubations and recanalizations were performed by means of laparoscopy combined with hysteroscopy. Results Out of the 113 oviduct lesions in 89 cases, 73 (64.6%) were recanalized. In follow-up of 20 days～58 months, there were 20 cases of successful pregnancies and labours, 2 inevitable abortions and 1 ectopic pregnancy, with the rate of pregnancy 25.8% (23 of 89). Conclusions It is an effective approach to treat proximal tubal obstruction by using laparoscopy combined with hysteroscopy. It can also be used to identify the true proximal tubal obstruction from the false one.

Objective To study the efficacy of laparoscopic operations in endometriosis associated with infertility. Methods Video laparoscopic operations of ovariocystectomy, adhesiotomy, electrocoagulation, salpingoplasty and hydrotubotion were completed in 378 cases of endometriosis associated with infertility. Results A total of 198 cases were followed up for 4～50 months after operations, with the pregnancy rate 61 1%(121/198) and remission rate 92 4%(183/198). Recurrence was found in 5 cases. Conclusions Laparoscopic operations, characterized by minimal invasion, rapid postoperative recovery and better clinical effect, can be used in the treatment of endometriosis associated with infertility.