ObjectiveTo investigate the effect on improving immune function by hemofiltration combined with hemoabsorption in septic patients with low human leukocyte antigen DR (HLA-DR) expression.Methods A prospective randomized controlled trial was conducted. Sixty sepsis patients aged over 18 years, with HLA-DR expression lower than 30% were enrolled, and they were randomly divided into experimental group and control group, n = 30 in each group. The patients were treated with standard operating procedure for sepsis, and hemofiltration combined with hemoabsorption were added in addition in the experimental group within 1-3 days. The continuous veno-venous hemofiltration (CVVH) mode was performed, with former dilution volume 4 L/h, and the hemofilter HF2000 was carried out with blood absorber HA-330H. The expression of HLA-DR in peripheral blood mononuclear cells was determined before the treatment and 3, 5, 7 days after treatment. Acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, duration of mechanical ventilation, length of intensive care unit (ICU) stay, and 28-day survival rate were evaluated in both groups.Results The HLA-DR expression before treatment in experimental group and control group was both lower than 30%, and there was no statistical difference [(25.9±7.3)% vs. (26.4±6.7)%,P>0.05]. The HLA-DR expression at 3, 5, 7 days after treatment in experimental group was gradually increased, and it was significantly higher than that of the control group [3 days: (38.9±8.6)% vs. (29.3±7.1)%, 5 days: (42.7±9.2)%vs. (31.4±6.5)%, 7 days: (40.9±8.5)% vs. (29.4±6.7)%, allP< 0.05]. There was no significant difference in APACHEⅡ score before treatment between experimental group and control group (22.4±5.3 vs. 21.7±6.2,P>0.05). APACHEⅡ score at 3, 5, and 7 days after treatment was gradually decreased in experimental group, and it was obviously lower than that of the control group (3 days: 18.6±3.6 vs. 20.5±4.3, 5 days: 15.8±3.9 vs. 21.1±4.4, 7 days: 14.9±4.2 vs. 19.8±3.7, allP< 0.05). Compared with the control group, the duration of mechanical ventilation (days: 13.3±3.4 vs. 19.8±3.7,t = 6.432,P = 0.003) and length of ICU stay (days: 20.7±3.9 vs. 26.8±4.7,t = 5.452, P = 0.006) in experimental group were significantly shortened, and the 28-day survival rate was significantly elevated (83.3% vs. 73.3%,χ2 = 3.121,P = 0.016).Conclusion Hemofiltration combined with hemoabsorption can improve the expression of HLA-DR in sepsis patients with low expression of HLA-DR, and it can improve immune function and prognosis of sepsis patients in certain degree.

Objective To evaluate whether an early change in 18F-fluorodeoxyglucose (18F-FDG) uptake can predict tumor response to epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) and prognosis in patients with non-small cell lung cancer (NSCLC). Methods From August 2009 to April 2015, 22 patients with NSCLC who were eligible to EGFR-TKI treatment were enrolled. PET-CT scan was performed before (baseline) and 1 month after EGFR-TKI administration. Up to 5 hottest single tumor lesions (no more than 2 per organ) were considered to be target lesions. Maximum standardized uptake values (SUVmax) were measured, and post-treatment percentage changes in SUVmax (ΔSUV%) were calculated. PET responses were classified using PET response criteria in solid tumors (PERCIST). Then conventional CT scan was performed every 2 months for follow-up. Kappa statistic was used to compare agreement between the RERCIST recommendations-based therapeutic response evaluation and those based on RECIST1.1 criteria. Fisher exact test was used to compare the probability of disease progression in the early metabolic response and non-response groups. Predictive accuracy of ΔSUV% with respect to response or non-progression at CT scan was evaluated by ROC analysis. Progression-free survival (PFS) was determined by Kaplan-Meier survival analysis, and between-group comparison was performed by log-rank test. Results After 1 month of EGFR-TKI treatment, 12 patients (55%) showed partial metabolic response (PMR), 6 (27%) had stable metabolic disease (SMD), and 4 (18%) had progressive metabolic disease (PMD). There was a moderate agreement(Kappa=0.506,P<0.05) between PET response at 1 month based on PERCIST recommendations and CT response at 3 months according to RECIST 1.1. Non-progression was significantly more frequent in patients with an early PMR (χ2=11.941, P=0.005). Progression had been confirmed later during therapy in all patients with PMD . By using ROC analysis, the area under the curve for prediction of response was 0.906 (95% CI, 0.766—1.000; P=0.002), corresponding to a sensitivity of 88.9% and specificity of 84.6% at a cut-off of 40.36% in ΔSUV%. Using a cut-off value of 25.84% in ΔSUV%, highΔSUV% group (ΔSUV% ≥ 25.84%) had significantly longer PFS than low ΔSUV% group (ΔSUV%<25.84%). Conclusion Early assessment of PET-CT at 1 month of EGFR-TKI treatment could be useful to predict tumor response and clinical outcome in patients with NSCLC.

Objective To evaluate development of gastro-esophageal reflux (GER) during laparoscopic surgery in lateral jack-knife position under general anesthesia through comparing with reverse Trendelenburg/ Trendelenburg position in the patients lying supine.Methods Ninety patients of both sexes,aged 18-64 yr,of ASA physical status Ⅰ or Ⅱ,with body mass index of 18-30 kg/m2,scheduled for elective laparoscopic surgery under general anesthesia,were randomly divided into 3 groups (n =30 each):lateral jack-knife position group (group L),Trendelenburg position group (group T) and reverse Trendelenburg position group (group Tre).Anesthesia was induced with midazolam,sufentanil,propofol and cisatracurium besylate and maintained with propofol and remifentanil given by target-controlled infusion.A pH-sensitive probe was inserted through nose into the lower esophagus and pH value was continuously recorded until 1 min after extubation.GER was defined as pH value ≤ 4 lasting for ≥ 1 min in the lower esophagus during surgery.The development of GER during surgery and the lowest pH value in the lower esophagus when GER developed were recorded.Results Compared with group Tre,the incidence of GER (27％) and total number of times GER had occurred were significantly increased in group L,and no significant changes were found in the indices mentioned above in L and T groups.When GER developed,the lowest pH value in the lower esophagus was 2.1 ± 1.3,2.6 ± 1.2 and 3.5 in L,T and Tre groups,respectively.Conclusion The incidence of GER is 27 ％ during laparoscopic surgery when the patients are in lateral jack-knife position and it is higher than that obtained with reverse Trendelenburg position in the patients lying supine.

Objective To determine the perioperative risks of partial hepatectomy by determining the preoperative liver functional reserve in patients with hepatocellular carcinoma (HCC),and to compare the model for end-stage liver disease (MELD) score with the Child-Pugh classification in predicting prognosis.Methods We reviewed the clinical data of 202 patients with HCC who underwent partial hepatectomy.The MELD score and the Child-Pugh classification were determined preoperatively.Results The incidence of postoperative liver dysfunction happened in 44.0％ of Child A patients,50％ in Child B patients,41.6％in patients with a MELD score below 14,and 91.7％ in patients with a MELD score of ＞ 14.The difference between the rates of postoperative liver dysfunction in patients with a preoperative MELD score above 14 and below 14 was significant (P ＜ 0.05),while that between patients with Child-Pugh A and B was insignificant (P ＞ 0.05).The incidences of postoperative liver dysfunction in patient with a MELD ＜ 8,8 ≤ MELD ≤ 14,MELD ＞ 14 were 38.2％,57.6％ and 91.7％,respectively,indicating that there was a positive co-relationship between the MELD score and the incidences of liver dysfunction.The Spearman rank correlation test showed the MELD score was significant correlated with the Child-Pugh score (r =0.404 ; P ＜ 0.05).The areas under the ROC curves of the MELD score and the Child-Pugh score were 0.703 and 0.587 (P ＜ 0.05).Conclusions The MELD score predicted postoperative liver dysfunction more accurately than the Child-Pugh classification.HCC patients undergoing partial hepatectomy with a preoperative MELD score ＞ 14 had a high perioperative risk.To ensure the safety of partial hepatectomy,HCC patients with a preoperative MELD score ＞ 14 requires active preoperative preparation,bringing the score near to or less than 14.

Objective To investigate the feasibility and plan quality of the image-guided volumetric modulated arc therapy (VMAT) based voluntary deep exhale breath-holding technique in the stereotactic ablative body radiotherapy (SABR) for liver tumors.Methods Fifteen patients with liver tumors were involved in this study.All patients were immobilized with voluntary deep exhale breath hold (vDEBH) combined with real-time position management (RPM) respiratory gating system.Treatment was planned using VMAT with 2 modified partial arc and re-planned using intensity modulated radiation therapy (IMRT) technique for comparison.Dosimetric parameters were calculated for plan quality assessment.Quality assurance studies included absolute dose and multiple planar dose verifications,total monitor units and delivery time analysis.Daily cone beam computed tomography imaging was used to verify the motions.Results There were no significant dosimetric differences between VMAT and conventional IMRT plans (P ＞0.05).Both techniques were able to minimize doses to organs at risk including normal liver,kidneys,spinal cord,and stomach.However,the average monitor units with VMAT were significantly lower 28.1％ than those with IMRT(t =3.064,P ＜0.05).The average beam-on time in VMAT plans was 31.6％ shorter than that in IMRT plans(t =2.278,P ＜ 0.05).Conclusions The utilization of VMAT in the treatment planning of SABR for liver tumors under breath control mode has better dosimetrics.In comparison to conventional IMRT plans,VMAT plans have higher efficiency and feasibility.

Objective To investigate the clinical efficacy of combination therapy of ambroxol with vibration? expectoration machine on ventilator-associated pneumonia Methods A total of 96 patients from the Department of Critical Care Medicine were selected and randomly divided into 3 groups:control group,ambroxol group and ammonia ambroxol + vibration expectoration machine group (n=32,each).The ventilator-associated pneumonia (VAP) was randomly divided into three groups (n =32,each).All patients were treated with conventional therapy including anti-inflammatory,suction,airway humidification,nutritional support.On this basis,ambroxol group was given ambroxol 30 mg in 100 ml normal saline,intravenously dripped 3 times a day.On the basis of treatment in the ambroxol group,ammonia ambroxol + expectoration machine were given G5 vibration expectoration machine to expectorate sputum 2 times every other day.Results There were significant differences in acute physiology and chronic health evaluation (APACHE Ⅱ),PaO2/FiO2,respiratory rate (RR),heart rate (HR) before versus after the treatment of the three groups (F =5.736,9.432,6.361,5.862,respectively,all P＜0.05).After treatment in the three groups,APACHE Ⅱ,PaO2/FiO2,RR and HR showed statistically significant differences inter-group among three groups (F=4.674,8.665,7.351,6.562,respectively,all P＜0.05).Clinical effective rates of the three groups were 71.9％,84.4％,93.8％ respectively,and showed statistically significant differences inter-group among three groups (all P＜0.05).Conclusions Combination therapy of ambroxol and vibration expectoration machine shows significant effects on VAP,and it is better than ambroxol alone.

Objective To evaluate the development of aortic arch in children with coarctation of aorta (CoA) using CT. Methods CT data of 47 children with histopathologically proved CoA (CoA group) and 47 children with non-cardiovascular diseases (control group) were retrospectively analyzed. The maximum internal diameter of ascending aorta (AOA), the proximal arch segment (D1), the distal arch segment (D2) and isthmus (D3), the maximum inner diameter of the descending aorta at the diaphragm (DA) were measured. The ratio of D1/AOA, D2/AOA, D3/AOA and DA/AOA were calculated. The differences of the above parameters were compared between the two groups, and the correlation between the above parameters and age were analyzed. Results The ratio of D1/AOA, D2/AOA and D3/AOA in CoA group were lower than those in control group (all P<0.01). There was no significant difference in DA/AOA between the two groups (P=0.3263). In CoA group, aortic arch dysplasia was found in 26 children, including 11 of D1/AOA≤0.6, 15 of D2/AOA≤0.5 and 13 of D3/AOA≤0.4. No obviously correlation was found between D1/AOA, D2/AOA, D3/AOA, DA/AOA and age in both two groups (all P>0.01). The ratio of D1/AOA, D2/AOA and D3/AOA greater than the congenital heart disease database classification standard in 5 children with active arch dysplasia who were followed up. Conclusion Children with CoA often have aortic arch dysplasia, and dysplasia in the posterior arch is common.

Objective To analyze the overall deployment of Class-A large medical equipments in China.Methods Data of Class A large medical equipments deployed from 2007 to 2015 were collected and classified regionally,for the purpose of measuring the overall deployment,growth level and plan performance.Results There were 403 large medical equipments in China,a rapid rise of deployment,yet still far below developed countries in terms of per capita deployment.Regional differences were significant.With PET-CT as an example,the plan performance in the east(92.19%)was much higher than the west of China(68.57%);plan performance of Class-A equipments was better,conducive to regulating the increase and distribution.Conclusions The deployment level of Class-A equipments in China is low in general,and calls for better regulation regardless of the planning and management progress.

Objective To explore the roles of MircroRNA-217 ( Mir-217 ) , silent information regulator 1 (Sirt1), and hypoxia-inducible factor-1α(HIF-1α)in high glucose-induced inflammation and fibrosis in rat glomerular mesangial cells( RMCs) . Methods RMCs were pre-incubated with a Sirt1 activator resveratrol prior to high glucose treatment or transfected with Sirt1 small interfering RNA( siRNA) , HIF-1αsiRNA, and Mir-217 inhibitor. Real-time PCR was used to analyze the expressions of Mir-217, Sirt1 mRNA, and HIF-1α mRNA; Western blot was used to observe the protein expressions of Sirt1, HIF-1α, connective tissue growth factor(CTGF), endothelin-1(ET-1), and fibronectin( FN) . Enzyme-linked immunosorbent assay was applied to detect protein expression of transforming growth factor-β1(TGF-β1)and vascular endothelial growth factor(VEGF). Results High glucose increased Mir-217, HIF-1α, CTGF, ET-1, FN, TGF-β1, and VEGF expressions(all P<0. 01), while decreased Sirt1 expression. In addition, Mir-217 gene silencing or 25μmol/L resveratrol suppressed high glucose-stimulated expressions of HIF-1α, CTGF, endothelin-1, FN, TGF-β1, and VEGF(all P<0. 01). Conclusion Mir-217 mediates high glucose-induced inflammation and fibrosis in RMCs via Sirt1/HIF-1αsignal pathway. This study provides new evidence to clarify the protective mechanisms of Sirt1 in diabetic nephropathy.

Objective To explore the efficacy and safety of biological mesh during female anterior pelvic organ reconstruction.Methods The 68 consecutive women with symptomatic anterior vaginal wall prolapse in Beijing hospital from January 2010 to June 2013 were divided into two groups:6 cases underwent anterior vaginal wall repair with biological mesh,and 32 cases underwent vaginal approach to paravaginal repair.Preoperative and postoperative pelvic evaluations were performed with the POP-Q system.Patients were followed up at 1,3,6,12,24 months after operation.Objective cure was defined if the lateral sulci of the anterior vaginal walls were at grade 0 and firmly apposed to the lateral pelvic sidewalls.Results Among 68 patients,38 had grade Ⅲ and 30 had grade Ⅳ anterior vaginal wall prolapse.In all patients the anterior vaginal repair was performed successfully.The indexes of operation time,amount of bleeding,the postoperative retention time of catheter and hospital stay had no difference between biological mesh and vaginal approach groups [(88.1±18.3)min vs.(88.0±17.4)min,(140.3±77.6) ml vs.(141.3±64.9) ml,(5.30±1.79) d vs.(4.90±2.34) d,(5.53±2.00)d vs.(5.50±2.08)d,t=0.01,0.05,0.64,0.06,respectively,all P＞0.05].No complication happened during and after operation.No one relapsed in biological mesh group and 4 cases relapsed in paravaginal repair group.The relapse rate between two groups is statistically different(x2 =4.79,P＜0.05).Conclusions The anterior vaginal repair with biological mesh is effective during female anterior pelvic organ reconstruction,but the long-term outcome of biological mesh in pelvic floor construction needs further study.