Objective To observe noninvasive bi-level positive pressure ventilation for the treatment of severe acute left heart failure.Methods 16 patients with hypoxemia due to severe acute heart failure with non-reaction to the normal treatment received noninvasive bi-level positive pressure ventilation and were monitored under clinical symptoms,signs,traumatic arterial blood pressure and blood gas analysis.Results 16 patients survived and 1 died with success rate of 93.7%.After two-hour therapy,the patients vital signs were stable and PaO2 and SaO2 went up.Conclusion Noninvasive bi-level positive pressure ventilation can decrease the pulmonary interstitial and alveolar edema,improve left heart function through adjusting pressure support and end-respiratory positive pressure.It also improve the rate of V/Q,facilitate gas exchange,and promote PaO2 and SaO2.

Objective To investigate the effects of intensive insulin therapy on the functions of vascullar endothelial cells in septic patients. Methods One hundred and twenty septic patients were randomly assigned to intensive insulin therapy 1 ,intensive insulin therapy 2 and conventional insulin therapy, serum von Willebrand factor (vWF),thrombomodulin protein(TM),endothelin-1 (ET-1) and nitric oxide(NO) of the three groups of patients were determined by enzyme-linked immunoadsorbent assay double antibody sandwich principle (ELISA) before treatment and the next 3 d,7 d after treatment. At the same time we observed the three groups of patients with 28-d mortality, the days of hospitalized in ICU, number of days for using mechanical ventilation, △ APACHE Ⅱ score and △MODS score. Results After treatment of 3 days,vWF was (142.57 ± 10.07)%, (137.32 ±9.66)% and (138. 32 ± 8. 80) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, vWF was (126.27 ±10.49) %, (116. 55 ± 9. 36) % and (120.72 ± 9. 53) % in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, TM was (6. 87 ± 1.62) μg/L, (5.95 ± 1.60) μg/L and (6. 17 ± 1.33) μg/L in the CIT, IIT1and IIT2 group, respectively. After treatment of 7 days, TM was (4. 55 ± 1.48) μg/L, (3.35 ± 0.94) μg/L and(3. 87 ± 1.20) μg/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 3 days, ET-1 was (61.27 ±9. 20) ng/L, (55.97 ± 9.03) ng/L and (57. 37 ± 7. 70) ng/L in the CIT, IIT1 and IIT2 group, respectively. After treatment of 7 days, TM was (43. 12 ± 6. 17) ng/L, (33.77 ± 6. 20) ng/L and (35.95 ± 5.73) ng/L in the CIT, IIT1and IIT2 group, respectively. Compared with conventional insulin therapy, vWF, TM and ET-1 were significantly decreased (P ＜ 0.05), NO were significantly higher (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups had no significant difference (P ＞ 0.05). In the CIT, IIT1 and IIT2 groups respectively, the mortality at 28 days were 20.0%, 12. 5 % and 45.0%, the days of hospitalized in ICU were (9.50 ± 3. 70) d, (7. 72 ± 3.29) d and (8.02 ±2. 90) d, number of day for using mechanical ventilation were (8. 92 ± 3.79) d, (7.23 ± 3. 32) d and (7. 37 ±3. 29) d, △ APACHE Ⅱ score were 8. 87 ± 3.46,7. 20 ± 2. 81 and 7.42 ± 3. 18, △ MODS score were 4. 15 ± 2. 15,3.20 ± 1.48 and 3.32 ± 1.74, with significant differences (P ＜ 0.05). These indices were significantly decreased (P ＜ 0.05) in IIT1 and IIT2, but the two sub-groups also had no significant differences (P ＞ 0.05). Conclusions Intensive insulin therapy on patients with sepsis has a protective effect of vascular endothelial cells, and the blood glucose controlled in the 6. 6 - 8. 3 mmol/L can significantly decrease the incidence of hypoglycemia, and intensive insulin therapy can also significantly improve the prognosis of patients with sepsis.

Objective To investigate the effect of high volume hemofiltration (HVHF) on expression of miRNA-146 in peripheral blood mononuclear cells in posttraumatic sepsis patients and its therapeutic mechanism.Methods Twenty-five cases of posttraumatic sepsis were included as HVHF group.Another 25 age-and gender-matched traumatic sepsis patients with similar APACHE-Ⅱ who received no HVHF treatment for some reasons were used as controls.Therapeutic measurements were the same of the two groups except for HVHF.At 0-,6-,12-,24-and 48-hour time points,the peripheral blood mononuclear cells were isolated from patients of both groups to detect level of miRNA-146.Peripheral blood mononuclear cells isolated at 24 hours were incubated with lipopolysaccharide (LPS) in vitro.At hours 4,8,12,24 and 48 after incubation,level of miRNA-146 in mononuclear cells was determined and levels of TNF-α,IL-6,and IL-10 in the substrate was detected by ELISA.Results (1) Level of miRNA-146 in HVHF group was decreased significantly over time as compared with that in sepsis group;(2) Before incubation and at 4-and 8-hour after incubation,miRNA-146 level was lowered significantly in HVHF group as compared with that in sepsis group.After LPS stimulation,mononuclear cell also presented a stronger inflammatory response in HVHF group than in sepsis group.Conclusions HVHF provides a definite effect on immune function recovery and a significant improvement in prognosis.Moreover,HVHF may attenuate the impact of miRNA-146 on mononuclear cell inflammatory factor release and enhance the cell ability to respond to external stimuli again via down-regulating miRNA-146,as may be one of the therapeutic mechanisms of HVHF for posttraumatic sepsis.

Objective To investigate the expression of soluble triggering receptors expressed on myeloid cells-1 ( sTREM-1 ) in intraperitoneal drainage fluid of patients with abdorminal trauma and its predictive value for post-traumatic sepsis. Methods A total of 80 abdominal trauma patients were served as the trauma group and 25 patients treated with subtotal gastrectomy as the control group.Intraperitoneal drainage fluid sTREM-1,serum sTREM-1,procalcitonin (PCT) and C-reactive protein (CRP)at 0,24,48,72 hours after admission were determined in two groups for assessing their value in early prediction of post-traumatic sepsis. Results The levels of drainage fluid sTREM-1,serum sTREM-1,PCT and CRP in the trauma group were significantly higher than those in the control group (P ＜ 0.05 ).Drainage fluid sTREM-1 showed the area under the receiver operating characteristic (ROC) curve,sensitivity and specificity for 0.84,77％,and 83％ in the prediction of post-traumatic sepsis,which was superior to the serum sTREM-1,PCT and CRP. Conclusion Intraperitoneal drainage fluid sTREM-1 has high accuracy in predicting the sepsis in abdominal trauma patients.

ObjectiveTo investigate the effects of budesonide inhaled on the levels of interleukin-8 (IL-8), C-reactive protein (CRP) and procalcitonin (PCT) in bronchoalveolar lavage fluid (BALF) of patients with AECOPD treated by using inhalation of budesonide in different doses or by using injection of dexamethasone. MethodsNinety AECOPD patients with mechanical ventilation in ICU ward were enrolled from Jan. 2008 through Sep. 2010. All patients were selected in this study as per the criteria of AECOPD set by the Chinese Medical Association. Ninety AECOPD patients treated with routine therapy were randomly (random number) divided into 3 groups. The patients of group A were given budesonide 2 mg inhaled 1 time/d. The patients of group B was given budesonide 4 mg inhaled 1 time/d. The patients of group C had dexamethasone 2. 5 mg injected 1 time/12h. The changes of IL-8, PCT and CRP in both BALF and serum were respectively detected in three groups at the beginning of treatment, and 3 days and 7days after treatment. The detected data of variables were analyzed by SPSS 13.0 package. ResultsThe level of IL-8 in BALF declined in 3days and 7days after treatment, and the magnitude of decrease in the following order:Group B ( budesonide 4mg/d) ＞ Group A ( budesonide 2 mg/d) ＞ Group C ( intravenous dexamethasone)with significant differences among them ( P ＜ 0. 05 ). The decrease in IL-8 in serum showed the similar trend, but there were no statistical differences among them. The CRP and PCT in both BALF and serum had no significant changes. There was a correlation between the concentration of IL-8 in BALF and the duration of mechanical ventilation.Conclusions The treatment with the inhalation of budesonide could more significantly reduced the IL-8 level in BALF compared with intravenous dexamethasone, whereas the CRP and PCT were not changed. The dynamic changes of IL-8 in BALF might be used as an indicator of prognosis in AECOPD patients with mechanical ventilation.

OBJECTIVETo observe the effect of Xuebijing injection on serum protein level in the early phase of septic rats and explain the mechanism from the perspective of molecular biology.

METHODFifty-four healthy wistar rats were randomly divided into control group, sepsis group and Xuebijing treatment group. The rat model of sepsis was established with injecting lipopolysaccharide (LPS) through caudal vein. Serum total protein (TP) and albumin (ALB) were measured at the point of 6, 12 and 24 h with the established model. The expression of AMPK, eEF2 protein in liver in the three groups were detected by Western blot analysis.

RESULTCompared with control gruop, the concentrations of TP and ALB of sepsis group and Xuebijing group were no significant difference with 6, 12 h treatment TP and ALB in sepsis group was lower (P<0.01) than control group after 24 h, and the expression of phos-AMPK, pho-eEF2 protein in livers was increased (P<0.01) simultaneously. All measured indexes in Xuebijing group has no difference with control group. Compared with sepsis group, TP and ALB of Xuebijing group was significantly higher (P<0.05), but litle lower than control group, the expression of phos-AMPK, pho-eEF2 protein in livers was decreased (P<0.05) simultaneously.

CONCLUSIONThese data suggest that Xuebijing injection prohibits catabolising serum albumin and inhibit liver protein catabolism by method of AMPK way.

Animals ; Blood Proteins ; metabolism ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Injections ; Male ; Random Allocation ; Rats ; Rats, Wistar ; Sepsis ; blood ; drug therapy ; pathology