Sepsis constitutes a serious threat to human health and represents a major burden to the health care system.Recent years have witnessed a deeper insight into the mechanism of the onset of sepsis,together with some new therapeutic strategies,including early aggressive volume therapy,activated protein C,potentiated insulin therapy,adrenal function replacement therapy,and some new therapeutic targets,which have offered some hope for the management of sepsis.

Objective To establish a method for the quantitative determinations of the ingredients in yiqi hewei capsules. Methods RP-HPLC method was used. The separation was performed on a Thermo C18 column with mobile phase consisting of acetonitrile-water (20: 80) (pH was adjusted to 3 with glacial acetic acid) at the flow rate of 1. 0 mL·min-1. The detection wavelength was 283 nm. Results The linear ranges were ( 0. 5735 -5. 7360) × 10 -2 mg·mL-1 for baicalin, (0. 1940-1. 9395) × 10 -2 mg·mL-1 for hesperidin, (0. 2051 -2. 0510) × 10 -3 mg·mL-1 for naringin and (0. 2020 -2.0200) ×10 -2 mg·mL-1 for neohesperidin;RSD =0.28%,0.54%,0.54%,0.31%(n =5),respectively. The average recoveries were 103. 94%, 98. 06%, 103. 09%, 95. 67%, respectively. Conclusion The established method is simple, sensitive and accurate,which can be used for the quality control of yiqi hewei capsules.

Objective To investigate the single nucleotide polymorphism of 5,10-methylenetetrahy-drofolate reduetase gene and its association with the treatment of methotrexate in rheumatoid arthritis (RA).Methods A total of 184 patients with RA were divided into methotrexate (MTX) treatment group, MTX+other DMARDs treatment group, and treatment with other DMARDs but not MTX group. The clinical and laboratory data were evaluated before treatment and 24 weeks later. Efficacy and toxieities of each medication were also analyzed. Real-time fluorescent quantitative PCR was conducted to test gene mutations in RA patients and 100 healthy controls. Results There was no significant difference in the frenqueney of 677CC,CT, "IT and 1298AA, AC, CC between RA patients and the healthy controls. There was significant difference in the frenqueney of 677CC, CT, Tr between RA patients with cardiovascular eomplieations and the healthy controls. In the MTX treatment group, there was significant difference in the frenqueney of 1298AC, CC between the group in which MTX was effective and the other groups in which MTX was not effective, the occurrence rate of side effects of MTX in the patients with 677TT was higher than those without mutation(CC).In MTX+other DMARDs group, the occurrence rate of side effects of MTX in the patients with 677TT and CT was higher than that without mutation (CC). Conclusion There is no relationship between the pathogenesis of RA and the 677C/T, 1298A/C mutation of MTHFR gene. MTHFR gene 677C/T mutation is probably one of the genetic risk factors for cardiovascular complications of RA patients and the side effects of MTX. MTHFR gene 1298A/C allel is associated with the efficacy of MTX.

Objective We make a retrospective analysis , to compare to COPD group and discuss the risk factors and the clinical features in acute exacerbation in patients with ACOS to follow-up the exacerbating frequency after regular treatment in both two groups in one year. Methods There were 56 patients with ACOS and 80 patients with COPD from 2013 to 2015 in our hospital in 30%≤FEV1<80% in the stable phase. The common data of the enrolled patients included the age,sex,smoking, and allergic rhinitis or other allergic diseases in family. We analyzed laboratory index including PaO2,PaCO2,CRP,white blood cells,IgE of serums and compared the proportion of antibiotics,system used of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation and followed up exacerbating frequency after using ICS united LABA/LAMA. Results The age and smoking index in the ACOS group were lower than the COPD group (P < 0.05). The allergic rhinitis or other familial allergic diseases,lower age of 60,the high IgE in serum were risk factor, in ACOS. In acute exacerbation, the PaCO2,IgE and WBC in serum were higher than that of the COPD group(P <0.05). The midian length of stay in hosipital was 12 days in the ACOS group and 8 days in the COPD group. The proportion of antibiotics,systemic administration of glucocorticoid and noninvasive ventilation in hospitalization of acute exacerbation in the ACOS group were higher than that of the COPD group (P < 0.05). The exacerbating frequency was decreased after using ICS united LABA/LAMA(1.2±0.6 vs 3.8±1.3,P < 0.05)in both ACOS and COPD groups. Conclusions The allergic diseases may participate in ACOS, in which it has familial tendency. In acute exacerbation, ACOS patients had even more inflammation and faster course than COPD patients. Using ICS united LABA/LAMA can reduce exacerbating frequency in ACOS.

Objective To detect the plasma level of osteopontin (OPN)in systemie lupus erythematosus (SLE) patients,and its correlation with disease activity as well as organ damage was analyzed.Methods The plasma level of osteopontin was measured by enzyme-linked immunosorbent assay in 68 SLE patients and 36 healthy controls.Results The plasma level of OPN was significantly higher in SLE Datients than in healthy control group(P＜0.01).In SLE patients,the plasma OPN level was significantly higher in patients with renal damage than in patients without renal damage(P＜0.01).Patients with lung interstitial disease and gastrointestinal tract involvement,their plasma level of OPN was significantly higher than those of patients with inactive lupus (P＜0.01).The plasma level of OPN correlated positivelv and significantly with SLEDAI score(r=O.523,P＜0.001)and 24-hour urine protein excretion(r=0.403,P=0.001),but negativelycorrelated with serum C3 level (r=-0.398,P=0.001).There was no correlation between the Dlasma level of OPN and anti-dsDNA antibody,Sm antibody,erythrocyte sedimentation rate,serum IgG,IgA,IgM levels(P＞0.05 ). Conclusion OPN may be involved in the pathogenesis of SLE,and may be a potential marker for dis-ease activity and organ damage.

During percutaneous coronary intervention,thrombotic storm which is mediated by hypercoagulable state,mechanical distension induced-plaque rupture,platelet activation and adhesion is still the main cause of cardiovascular adverse events.The mortality rate is extremely high if not treated properly.Thrombotic storm can be diagnosed quickly through coronary artery angiography and myocardial blush grades.Once coronary thrombosis occurs,medicine including platelet Ⅱ b/Ⅲ a receptor antagonist tirofiban or vasodilators can rapidly improve coronary flow and effectively treat it.

Objective To explore the efficacy and postoperative survival times of stereotactic radiosurgery by X-knife in the treatment of brain metastatic tumors.Methods Between March 1996 and March 2008,520 patients with brain metastatic tumors were treated in our hospital by stereotactic radiosurgery using X-knife.Among the cases,336 had single metastatic lesions,and 184 presented with multifocal tumors(2 lesions in 51 patients,3-5 lesions in 63,and 6-10 lesions in 70).The tumors sized 5 to 35 mm in diameter with a mean of 16.4 mm.Stereotactic radiosurgery was carried out in the cases with a mean central dose of 22 Gy(20 to 25 Gy),and mean marginal dose of 12 Gy(10 to 14 Gy).Over 80% of the lesions were encircled with the dosage.Results The 520 patients were followed up for 8 to 36 months(mean,20 months).CT and MRI performed in the 6th months postoperation showed complete response in 218 patients(41.9%),partial response in 182(35.0%),no response in 78(15.0%),and progressed disease in 42(8.1%).The overall control rate of the tumors were 91.9%(478/520).In this series,the 6-months survival rate was 85.0%(442/520),12-month survival rate was 68.1%(354/520),and the 1-year and 3-year survival rates were 40% and 5.5% respectively.The medium survival time was 12.6 months.Conclusions Stereotactic radiosurgery is an effective method for brain metastatic tumors.It can improve the life quality and survival time of the patients.

Objective To investigate the efficacy of tumor necrosis factor alpha (TNF-α) antagonists therapy and the possible eauses of new onset or exacerbation of psoriatic skin lesion in patients with arthritides treated with TNF-α atagonists therapy. Methods One patient with definite psoriatie arthritis and one patient with definite ankylosing spondylitis, who were treated with TNF-α antagonist therapy developed an unexpected exacerbation or new onset of psoriatic skin lesion, were investigated in this study. Furthermore, the literatures associated with psoriasis induced by anti-TNF-α therapy were reviewed. Results The patient with psoriatic arthritis experienced exacerbation of psoriatic skin lesion and the skin lesions subsided after discontinuation ofetanereept therapy. The skin lesions recurred with re-introduction of etanereept, which improved after withd-rawal of etanercept therapy. The patient with ankylosing spondylitis unexpectedly developed psoriasis vulgaris after receiving etanercept therapy. The skin lesion waxed and waned followed the administration or discon-tinuation of etanercept therapy. The same settings were reported in patients with rheumatoid arthritis receiving different types of anti-TNF-α therapy. Conclusion Blockage of TNF-α is highly effective in arthritides. Ho-wever, some patients with arthritides can unexpectedly develop either a new onset or exacerbation of psoriatic skin lesions after initiation of TNF-α antagonist therapy. The skin lesions subside after discontinuation of the TNF-α antagonist therapy, but the causes remain unclear.

Purpose:To detect the expression of MDR 1 / P-gp,C-erbB-2 in breast cancer and study the correlation between MDR 1 /P-gp and C-erbB-2. Methods:Expression of MDR 1 gene was measured with the flu orogenic quantitative RT-PCR method in 57 cases of breast cancer and 20 cases o f control group (including 10 cases of benign breast lesions and 10 cases of adj acent breast tissues). In addition, immunohistochemical analyses was used to det ect the expression of P-gp and C-erbB-2 protein in the above mentioned tissu es. Results:The amplification rate of MDR 1 gene and the expre ssion of P-gp protein in breast cancer group was 50.88% (29/57) and 42.11% (24/ 57), which had a significient difference as compared to the control group. The a mplification of MDR 1 gene were higher than the expression of P-gp protein ,there was close correlation between them but not complete correspondence.The p ositive rate was 28.07%(16/57) in detecting the overexpression of C-erbB-2 pro tein in breast cancer group, nevertheless, no positive case was found in the con trol group. The expression of MDR 1/P-gp was also correlated with the over expression of C-erbB-2. Conclusions:Multidrug resistance gene1(MDR 1)and protoonco gene C-erbB-2 were co-expressed in breast cancer,and their expression were po sitively related. The expression of above mentioned two genes have a relationshi p with multidrug resistance in breast cancer.

Objective To study on gastric varices bleeding treated by tissue adhesive, D-TH glue injection. Methods Fifty-nine consecutive cirrhotic patients with gastric varices were undergone endoscopic D-TH glue injection with sandwich approach. Among these 59 patients, bleeding was present in 46 patients (acute bleeding in 37, recent bleeding in 9) , no previous of gastric variceal bleeding in 13. Follow-up study on therapeutic results and complications were conducted. Results Ninety-six injections were performed in all patients with a mean of 1. 63 injections (1-2ml) per patient. Recurrent bleeding never occurred in 37 patients with acute gastric varices bleeding 72 hours after injection, and the rale of emergency endoscopic he mostasis was 100 per cent. Thirty (65. 2% ) of 46 patients with bleeding gastric varices were followed for 12 36 months, 24. 9 months on average. Recurrence of bleeding occurred in 2(6. 7% ) , 5 ( 16. 7% ) and 8 (26. 7% ) cases at 3 , 12, and 36 months respectively. The rate of survival was 86. 5 per cent. Besides fever occurred postoperatively in 2 cases, other severe complications never happened. Conclusion Endoscopic D-TH glue injection is a safe and effective method for treating gastric varices bleeding.