Objective To investigate the clinicial significance of continuous glucose monitoring(CGM)of patients with severe traumatic brain injury(sTBI). Methods By glucose monitoring method,80 patients with sTBI〔Glasgow coma score(GCS)3-8〕in Department of Critical Care Medicine of Qingyuan People's Hospital in Guangdong Province from January 2012 to December 2012 were divided into two groups:41 patients in CGM group and 39 in regular glucose monitoring(RGM)group. The continuous glucose monitoring system(CGMS)was applied to monitor glucose level in the CGM group,and the finger blood was taken by portable blood glucose meter in the RGM group. The two groups were treated with insulin on the basis of glucose level,respectively. The relationships between the condition of glycemic excursions and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score or prognosis and between the incidence of hypoglycemia and prognosis were seen in the two groups. Results The close linear correlations between APACHEⅡ score and glycemic excursion in two groups,i.e. mean amplitude of glycemic excursions(MAGE)and coefficient of variation of glucose(GluCV),were documented(both P<0.05). The MAGE of the especially severe patients(GCS 3-5)was obviously higher than that of severe ones(GCS 6-8),and with the increase of APACHEⅡ score,the MAGE of patients was gradually elevated,the difference being statistically significant(both P<0.05). The incidence of hypoglycemia(7.32%vs. 23.08%)and fatality rate of 30 days(12.20%vs. 30.77%)in CGM group were lower than those of RGM group(both P<0.05). The MAGE and fatality rate of 30 days were positively correlated in CGM group(r=0.597,P=0.007),and the GLuCV and fatality rate of 30 days were positively correlated in RGM group(r=0.622,P=0.019). Conclusion CGM is beneficial to timely observe condition of glycemic excursions in sTBI patients and avoid occurrence of hypoglycemia or hyperglycemia,guiding the treatment of insulin and improving patients' prognosis.

OBJECTIVE:To observe the clinical effect and safety of Xuebijing injection in the treatment of moderate and se-vere infection of stage Ⅲ-Ⅳ pressure ulcer. METHODS:A total of 130 cases of moderate and severe infection of stage Ⅲ-Ⅳ pres-sure ulcer admitted to our hospital from Jul. 2011 and Jun. 2016 were randomly divided into observation group and control group, with 65 cases in each group. Control group was treated with 0.5%Iodophor disinfectant to disinfect the sore surface,given wet ster-ile gauze soaked with 0.5% Iodophor disinfectant to compress sore surface for 30 min,and then given Aikangfu absorptive silver ion antibacterial healing dressing to fill wound,changed dressing after 2/3 was soaked. Observation group was additionally given Xuebijing injection 50 mL added into normal saline 100 mL intravenously for 30-40 min,2-3 times a day,for consecutive 7 days,on the basis of control group. Treatment course of both groups lasted for 4 weeks. The clinical efficacy,the score of pres-sure ulcer scale for healing(PUSH),debridement time,the time of local symptom and SIRS disappearance as well as the occur-rence of ADR were compared between 2 groups. RESULTS:The total response rate of observation group(93.85%)was signifi-cantly higher than that of control group (80.00%),and debridement time,the time of local symptom and SIRS disappearance were all significantly shorter than control group,with statistical significance(P<0.05). Before treatment,there was no statisti-cal significance in PUSH score between 2 groups (P>0.05). After 1-4 weeks of treatment,PUSH score of 2 groups was de-creased significantly compared to before treatment,and the score of observation group was significantly lower than that of con-trol group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:For moderate and severe infection of stage Ⅲ-Ⅳ pressure ulcer,Xuebijing injection effectively reduces inflammatory exudation,improves the ab-sorption of necrotic tissue,relieves local symptom and systematic inflammatory reaction,promotes the healing of pressure ulcers and has good clinical effect and safety.

AIM:To investigate the autophagy induced by sepsis and acute kidney injury , and the regulation of phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway in this process.METHODS: The rats were subjected to cecal ligation and puncture ( CLP) or sham operation .Histopathologic changes of the renal tissues were examined by HE staining .Blood urea nitrogen ( BUN) and serum creatinine ( SCr) were measured by chemical colorime-try.The protein expression of microtubule-associated protein light chain 3 I/II (LC3 I/II), beclin-1 and p-Akt at different time points after CLP was detected by Western blotting .In vitro, human proximal tubular epithelial cell line HK-2 were treated with LPS to induce autophagy .The protein expression of LC 3 I/II and p-Akt in the HK-2 cells after LPS treatment at different time points and different concentrations was detected by Western blotting .These molecules in HK-2 cells and apoptosis of HK-2 cells treated with LPS plus PI3K inhibitor or Akt inhibitor were also detected .RESULTS: Compared with sham group , the severe changes of renal histopathological injuries in CLP groups were observed , the levels of BUN and SCr in CLP groups were significantly increased .LC3 I/II, beclin-1 and phosphorylation of Akt gradually increased after CLP.After treatment with LPS, the expression of p-Akt (308) in the HK-2 cells gradually increased in a dose-and time-dependent fashion.The expression of beclin-1 and p-Akt (472) reached a peak at 8 h or 10 mg/L LPS treatment.Treat-ment with PI3K or Akt inhibitor down-regulated the expression of LC3 and promoted the apoptosis of HK-2 cells.CON-CLUSION:Autophagy in the kidney is induced by sepsis and acute kidney injury .PI3/Akt signaling pathway may be in-volved in this process .

BACKGROUND:Extensive studies have shown that transcutaneous electrical nerve stimulation (TENS) plays a positive role in relieving the pain caused by a variety of diseases. However, its exact effect to manage pain in patients with knee osteoarthritis is stil controversial. TENS is classified into h-TENS and l-TENS, but currently its respective role in relieving the pain caused by knee osteoarthritis is not clear yet. OBJECTIVE: To compare the efficacy of h-TENS and l-TENS on pain relieving among patients with knee osteoarthritis. METHODS: A computer-based search was performed on PubMed, Embase and Cochrane database for randomized controled trials on TENS for the treatment of knee pain in patients with knee osteoarthritis which were reported before February 2014. Methodology quality of the trials was criticaly assessed and relative data were extracted. These studies were selected independently by two reviewers according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman5.2 software. RESULTS AND CONCLUSION:A total of 10 randomized controled trials involving 519 cases were included. The results of meta-analysis showed that the h-TENS group had significant effects on pain relief in knee osteoarthritis patients in comparison to the control group [MD=-0.56, 95%CI(-0.98,-0.15),P=0.008]; the l-TENS group had no significant effect on pain relief in knee osteoarthritis patients in comparison to the control group [MD=-0.13, 95%CI(-1.63, 1.38),P=0.87]; the h-TENS group had significant effect on pain relief in knee osteoarthritis patients in comparison to the l-TENS group [MD=-0.85, 95%CI(-1.32, -0.37), P=0.000 5]. These findings indicate that h-TENS performs something positive to reduce pain in knee osteoarthritis patients that l-TENS cannot do. Owing to the limitations of this study, further work is needed to determine the role of TENS in pain management among patients with knee osteoarthritis.

Objective To evaluate the efficacy of surgical management combined with chemotherapy in the treatment of drug-resistant gestational trophoblastic neoplasm(GTN)patients,and investigate factors influencing the outcome of the surgery combined with chemotherapy.Methods Medical records of 42 patents with drug-resistant GTN who were treated by chemotherapy combined with surgical management at Peking Union Medical College Hospital from Jan 1996 to Jan 2006 were reviewed.Results Among 42 patients,32 achieved serologically complete rendssion(SCR)with an SCR rate of 76%,and 10 patients had a treatment failure.Treatment failure was more frequently geen in patients who also had metastasis of other sites except for lungs and vagina and patients with antecedent non-molar pregnancy (P=0.023 and 0.017,respectively).Preoperative human chorionie gonadotropin-beta subunit(β-hCG)titer>10 U/L (P=0.020),failure to reach normal serum titers of β-hCG during treatment(P=0.003),age ≥35 years (OR:12.6,95%CI:2.4-66.0,P=0.002)and preoperative chemotherapy regimens≥4(OR:4.5,95% CI:1.0-20.1.P=0.059)were also correlated with treatment failure.All the 10 patients with treatment failure had at least 3 of 6 above mentioned predictors of treatment failure.Conclusions Surgical management combined with chemotherapy is effective in the treatment of drug-resistant GTN.Age≥35 years,antecedent non-molar pregnancy,metastasis of other sites except for lungs and vagina,preoperative β-hCG titer>10 U/L,failure to reach normal serum titers of β-hCG during treatment,and preoperative chemotherapy regimens≥4 are significant predictors of treatment failure.Patients with 3 or more predictors of treatment failure usually have poor prognosis.Therefore,surgical management should not be performed for these patients.

Forensic Psychiatry ; Homicide ; Humans

Objective To study the changes of somatostatin(SOM) in plasma and cerebrospinal fluid (CSF) of children with convulsive diseases.Methods Sixty-seven children with convulsive diseases were studied as following:obtaining the samples of plasma in the 1st and 7th day after being in hospital,and the samples of CSF in the 1st after being in hospital.We investigated the changes of SOM in plasma and CSF with radioimmunoassay(RIA).Results 1.Convulsive group:the concentration of SOM in plasma in the 7th day(29.47?9.40 ng/L) was significant lower than that in the 1st day(39.23?11.00 ng/L)(t=21.530 P0.05).The concentration of SOM in plasma in the 1st day in control group was(19.58?6.04) ng/L.There were significant differences in convulsive group and encephalitis group without convulsion, control group(t= 6.847,7.921 P

Objective To discuss the feasibility and curative effect of broncho-alveolar lavage(BAL)through bronchofiberscope in the treatment of severe toxic pulmonary edema caused by irritative gas.Methods 16 cases se- vere toxic pulmonary edema caused by irritative gas were performed BAL through bronchofiberseope.The index of oxygen in arterial blood,clinical and radiological changes before,during and 2 hours after BAL were observed.Results 2 hours after BAL through bronchofiberscope,the partial pressure of oxygen in arterial blood(PaO2)obviously in- creased,the partial pressure of carbon dioxide in arterial blood(PaCO_2)did not change much.PaO_2 and PaCO_2 had no obvious change before and during BAL.The shadow area in the X-ray film of chest obviously decreased 24 hours af- ter BAL.In all 16 cases,13 cases were cured,1 case got improvement,and 2 cases died.The curative rate was 81%. Conclusion BAL through bronchofiberscope could clear the noxious substance in airway and improve the ventilation function.It was safe and had confirmed curative effect.

The roles of voltage-dependent K(+) channels during activation and damage in alveolar macrophages (AMs) exposed to different silica particles were examined. Rat AMs were collected by means of bronchoalveolar lavage, and were adjusted to 5x10(5)/mL. After AMs were exposed to different concentrations (0, 25, 50, 100, 200 mug/mL) of quartz particles and 100 mug/mL amorphous silica particles for 24 h, the voltage-depended K(+) current in AMs was measured by using patch clamp technique. Meanwhile the leakage of lactate dehydrogenase (LDH) and the viability of AMs were detected respectively. Patch clamp studies demonstrated that AMs possessed outward delayed and inward rectifying K(+) current. Exposure to quartz particles increased the outward delayed K(+) current but it had no effect on inward rectifier K(+) current in AMs. Neither of the two K(+) channels in AMs was affected by amorphous silica particles. Cytotoxicity test showed that both silica particles could damage AM membrane and result in significant leakage of LDH (P<0.05). MTT studies, however, showed that only quartz particles reduced viability of AMs (P<0.05). It is concluded that quartz particles can activate the outward delayed K(+) channel in AMs, which may act as an activating signal in AMs to initiate an inflammatory response during damage and necrosis in AMs induced by exposure to quartz particle. K(+) channels do not contribute to the membrane damage of AMs.

Objective To observe the therapeutic effect of Yougui Pills and its separate formula for the treatment of kidney-yang deficiency syndrome. Methods A total of 60 patients of kidney-yang deficiency syndrome were randomly divided into treatment group and control group, 30 cases in each group. Treatment group was treated with Yougui Pills, and the control group was given the separate formula from Yougui Pills which had the actions of warming kidney yang. Four weeks constituted one treatment course and the treatment covered 2 courses. The changes of major clinical symptom scores, total effectives rate and associated indexes such as peripheral white blood cells, serum antibodies, and complements were compared between the two groups following the treatment for 8 weeks. Results The total effective rate, and improvement of major clinical symptoms and the peripheral white blood cells in the treatment group were superior to those in the control group ( P<0.05 or P<0.01) . However, there were no significant differences of the levels of serum antibodies and complements between the two groups (P>0.05) .Conclusion Yougui Pills show better effect than its kidney-yang-warming separate formula for the treatment of kidney-yang deficiency syndrome, indicating that the method of generating yang by activating yin is superior to the method of simply nourishing kidney yang.