Objective To clinically validate the precision of diagnostic Sepsis-3 criteria, and to guide and generalize its clinical application.Methods A multicenter retrospective observational study was conducted. The patients admitted to intensive care unit (ICU) of 6 tertiary hospitals in Zhejiang Province from January to June 2015 were enrolled, and the patients satisfying the diagnostic criteria of Sepsis-2 and Sepsis-3 were screened. Population characteristics between the patients satisfying two editions were compared, and the diagnosis accuracy rate in different degree hospitals were investigated. According to the doctor's diagnosis, the patients who met the criteria of Sepsis-2 were divided into diagnosis group and non-diagnosis group, and the factors influencing the diagnosis of sepsis were analyzed by logistic regression. The patients meeting Sepsis-2 but no meeting Sepsis-3 were served as exclusion group, and those meeting Sepsis-2 and Sepsis-3 were served as enroll group, and the characteristics of patients between the two groups were compared. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of systemic inflammatory response syndrome (SIRS) score, sepsis-related quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) on death, and whether the consistency of qSOFA and SOFA would affect the sensitivity of definition. The patients meeting Sepsis-2 were divided into non-survived group and survived group, and the factors associated with death were analyzed by logistic regression.Results Finally, 1423 patients were enrolled, 3 patients with age < 18 years and 19 patients with missing data were excluded. There were 363 patients and 329 patients met Sepsis-2 and Sepsis-3, respectively. No significant differences were found in populationcharacteristics between the groups of Sepsis-2 and Sepsis-3 (allP > 0.05) except for acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score [19.10 (8.00) vs. 20.28 (8.00),P < 0.05]. It was shown on the clinical data analysis of the hospitals that the patients meeting Sepsis-2 and Sepsis-3 in hospital 3 had the highest 28-day mortality (60.4% and 60.0%) with the lowest rate of diagnosis (0). While in the hospital 1, the patients had the lowest 28-day mortality (22.9% and 27.2%), and the rate of diagnosis was 19.5%. Interestingly, the patients in hospital 4 had the highest diagnosis rate of sepsis (44.8%), but 28-day mortality was both 58.6%. It was shown by logistic regression analysis that the patients with old age [odds ratio (OR) = 0.970,P = 0.021], high blood lactate (OR= 0.443,P = 0.004), high blood pressure (OR = 0.957,P = 0.009) and low oxygenation index (OR = 1.004,P = 0.024) were easy to neglect diagnosis. Compared with Sepsis-3 exclude group, the patients in Sepsis-3 enroll group were older [years: 68.52 (26.00) vs. 53.75 (18.00),P < 0.01] with higher APACHEⅡ score [20.38 (8.00) vs. 7.72 (6.00),P < 0.01], higher blood lactate [mmol/L: 3.45 (3.00) vs. 1.95 (1.20), P > 0.05], longer length of ICU stay [days: 22.42 (22.00) vs. 15.13 (16.00),P < 0.01], and higher 28-day mortality [45.29% (149/329) vs. 14.71% (5/34),P < 0.01], indicating that the diagnostic efficiency of Sepsis-2 was low, the diagnostic specificity of Sepsis-3 was high, and the prognosis of Sepsis-3 patients was worse. It was shown by ROC curve analysis that the prognostic value of SIRS, qSOFA and SOFA to mortality was gradually increased [area under ROC curve (AUC) was 0.567, 0.597, 0.683, respectively], but the prognostic value were all low. Comparing patients meeting qSOFA and (or) SOFA in Sepsis-2, significant differences were found in APACHE Ⅱ score [17.55 (7.00) vs. 23.24 (8.00)] and 28-day mortality [38.75% (31/80) vs. 58.59% (75/128), bothP < 0.01]. The patients who just met the qSOFA or SOFA, their 28-day mortality was up to 38.75%, suggesting that qSOFA should not be ignored. Compared with survived group, the patients in survived group were older with higher APACHE Ⅱ score and shorter length of ICU stay (allP < 0.05). It was shown by logistic regression analysis that APACHE Ⅱ score (OR = 1.199,P = 0.000) and length of ICU stay (OR = 0.949,P = 0.000) were related with death.Conclusion Patients satisfied Sepsis-3 were easier to develop more organ failure, Sepsis-3 and higher death prediction than Sepsis-2 and higher diagnosis specificity, but data shows that there is extra room for improvement.

Objective To investigate the expression of double minutes (DM) in bladder transitional cell carcinoma (TCC) and its significance. Methods 15 control individuals and 14 patients were examined. Whole blood samples from these patients were cultured before and 10-15 days after operations. The relationship between expression of DM and clinic-pathologic factors and prognosis was ana- lyzed by chi-square test. Results There is no DM in control individuals, but there are respectively 35 pairs and 31 pairs DM in preop- erative and optoperative patients with TCC (P 0. 05). Conclusions DM may be an independent prognosis indication of cancer gene amplication. DM always show treatment failure and rapid recurrence.

AIM: To explore the influence of IFN-? on the role of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in inducing apoptosis of RKO cell line. METHODS: Survival fraction and apoptosis were measured by MTT method and flow cytometry (FACS). RESULTS: Survival fraction of IFN-? group, TRAIL and IFN-? 72 h+TRAIL group were 99.28%, 85.45%, 52.60%, respectively. The percentage of apoptotic cells of IFN-? group, TRAIL group, IFN-? 24 h+TRAIL group, IFN-? 48 h+TRAIL and IFN-? 72 h+TRAIL group were 1.51%, 2.38%, 4.97%, 13.30%, 21.00%, respectively. The percentage of apoptotic cells of IFN-? 24 h+TRAIL group was higher than the sum of IFN-? group and TRAIL group (P

@@

Objective The purpose of this study was to investigate the role of p38 mitogen-activated protein kinase ( p38 MAPK) in the lung injury induced by mechanical ventilation.Methods Fifteen healthy 80 day-old pigs weighing (22.5　? 1.5)kg were randomly divided into three groups according to the tidal volume(VT) and PEEP of mechanical ventilation: group A (VT = 16ml?kg-1, PEEP = 0) ; group B (VT = 6 ml?kg-1, PEEP= 16cm H2O) and group C(VT = 16ml?kg-1, PEEP = 8cm H2O). The animals were mechanically ventilated for 3h, then sacrificed by exsanguination. Right lower lobe was immediately removed for identification of intercellular adhesion molecule-1 ( ICAM-1 ) expression using immunohistological technique, determination of phosphorylated p38 MAPK content using Western Blot and microscopic examination. Results There was significant histological changes in the lung tissue in group A and B, but no significant histological changes were found in group C. The expression of ICAM-1 was positive in the lung in group A and B but negative in group C. The level of phosphorylated p38 MAPK among the 3 groups. Conclusion Acute lung injury can be induced by mechanical ventilation with high tidal volume or low tidal volume plus high PEEP, p38 MAPK may mediate the inflammatory response-induced lung injury.

OBJECTIVE:To discusses the influencing factors on the safety and efficacy of pediatric drugs.METHODS:The errors in administration of pediatric drugs were analyzed.The drugs under current use in the pediatric pharmacy of our hospital were classified and compared as per quantity,dosage form,specification,medication safety, direction and medicine evaluation. RESULTS: The influencing factors mainly included the subjective factors(wrong drug treatment) and the objective factors (pharmaceutical factors and social factors) .CONCLUSION: To safeguard the efficacy and safety of pediatric drugs, it' s advisable that an evaluation or control system for rational use of pediatric drugs be established with the participation of the society, the hospital and patients.

OBJECTIVE:To establish evaluation system and quality management of dispensing department in hospital and provide basis for comprehensive and correct assessment of pharmacy dispensing work.METHODS:Based on the platform of human resource management,the flow and job responsibility of drug dispensing were adjusted."Drug dispensing work quality management specification and performance evaluation system" was established and put into practice.RESULTS:Drug dispensing quality management had criteria and principles to go by.The level of management staff were improved dramatically.58.3% of department administrators were younger than 40 years old,who were recruited and went on duty after passing examination.CONCLUSION:"Drug dispensing work quality management specification and performance evaluation system" is the comprehensive requirement of effectively ensuring the quality of drug dispending work and safety of drug utilization and reflects the standard and scientific management of drug dispensing.

Objective To evaluate the expression and activity of GFP/TRAIL gene activated by the hTERT promoter on colon cancer cell line DLD-1. MethodsGFP/TRAIL gene activated by the hTERT promoter was transfected into DLD-1 with adenoviral vector,expression and apoptosis inducing ability of GFP/TRAIL protein was determined by fluorescence-activated cell sorting (FACS). [WT5”HZ]ResultsThe expression of GFP gene is 41.63% and 54.07% with either hTERT promoter or CMV promoter in DLD1 cells;GFP/TRAIL gene was able to inhibit cell growth(93.50%) and induce apoptosis(56.97%) of DLD-1 ,there was significant difference between Ad/hTERT-gTRAIL and the other two control groups (PBS and Ad/hTERT-LacZ)( P

Objective To evaluate the extremity function of patients with intracerebral hemorrhage (ICH)using short-latency somatosensory evoked potentials (SEPs) and a modified intracerebral hemorrhage (MICH) scale.Methods On admission, SEP was applied in the examination of 61 patients with ICH. P40 latency and the amplitude of posterior tibial nerve potentials in both the healthy and affected extremities were measured. Abnormalities were classified based on the margin of lower extremity SEP latency and the main waveform changes. MICH was measured simultaneously to prepare a prognosis. The modified Rankin scale (MRS) score was assessed 3 months after the attack as well.Results Compared with the healthy side, there were significant differences in posterior tibial nerve P40 latency and amplitude on the affected side among patients with ICH. P40 latency and MRS scores on the affected side 3 months after the attack were positively correlated. On the unaffected side, P40 amplitude and the MRS score 3 months after the attack were negatively correlated. The MICH score on admission and the MRS score 3 months after the attack were positively correlated. Based on MRS scores (MRS≥4 indicating a poor prognosis), the predictive sensitivities for a poor prognosis of SEP and the MICH scale in patients with ICH were 80.77% and 84.61% respectively, while the specificities were 62.68% and 88.57% respectively, and the accordance rates were 70.5% and 86.9% respectively. Conclusions SEP and the MICH scale are closely correlated with the prognosis for extremity function in patients with ICH.The combination of SEP with the MICH scale might be helpful in predicting the prognosis of the patients with ICH.

OBJECTIVE: To investigate the ultrastructural changes of the mucosa of eustachian tube in mice and to reveals the influence of eustachian tube on middle ear function and its relavence with otitis media. METHOD: 12 wild type and 12 mutant mice were divided into two groups by age to observe the the ultrastructural changes of the mucosa of eustachian tube. RESULT: Wild type mice exhibited a thick lawn of morphologically normal, distributed cilia in the mucosa of the middle ear at both time points. The cilia of mucosa of middle ear in mutant mice were short, impaired and disrupted. The impairment of the cilia progressed to a much great severity at 6 months compared to 3 months. CONCLUSION Otitis media occurs not only the ciliated cells decreased and the goblet cells increased. More importantly, the ciliary structure was damaged, leading to the dysfunction of the mucociliary transport system and causing otitis media.
Animals ; Cilia ; pathology ; ultrastructure ; Disease Models, Animal ; Ear, Middle ; pathology ; Eustachian Tube ; pathology ; ultrastructure ; Goblet Cells ; Mice ; Microscopy, Electron, Scanning ; Mucociliary Clearance ; Mucous Membrane ; pathology ; ultrastructure ; Otitis Media ; pathology