Objective To determine the effect of prone position (PP) ventilation on oxygenation in patients with acute respiratory distress syndrome (ARDS) .Methods Twenty-three patients of both sexes (14 males, 9 females) with ARDS (within 72 h after onset of ARDS) were included in this study. The patients ranged in age from 43-78 years. Ten minutes before the patients were placed in prone position, midazolam 2-5 mg was given i. v. followed by continuous infusion at 2-3 mg?h-1 for sedation and a bolus of vecuronium 4 mg per hour for muscle relaxation. The patients were mechanically ventilated (VT 6-8 ml?kg-1, inspiration-time 1.0-1.2 s, RR 12-20 bpm, FiO2 0.4-1.0, PEEP 6-18 cm H2O) . The patients were placed in prone position for 2 h. Radial artery was cannulated and S-G catheter placed. MAP, CVP, MPAP, PAWP, cardiac output, PaO2 , PaCO2 peak inspiratory pressure (PIP) and airway resistance (Raw) were measured and recorded immediately before (T0) and 0.5, 2 h after the patients were placed in prone position (T1 , T2) and 2 h after supine position was resumed(T3) . PaO2/FiO2 and static compliance of the respiratory system (Cst) were calculated. Results In 87% of the patients PaO2/FiO2 was significantly increased during prone position (T1, T2) as compared to the baseline (T0) (P

Objective To investigate the effect of the genotypic analysis of donor from cardiac death donation on the initial dose of Tac for liver transplant recipients and provide individualized administration for the early use of Tac in liver transplantation patients.Method Thirty recipients with a different genotype of CYP3A5 from cardiac death donors were collected from March 2010 to February 2013.The matched recipients were randomly divided into experiment group and control group.There was an adjustment of initial doses of Tac according to the donors' different CYP3A5 genotypes in experiment group but not in control group.Result In experiment and control groups,the average Tac blood concentrations at the 7th day after operation were (7.47 ± 1.83) and (8.68 ± 5.14) ng/mL,and the percent of recipeints reaching the optimal Tac concentrations was 72.2％ and 38.9％,respectively (P＜0.05).In experiment and control groups,22.2％ and 55.6％ recipients needed adjustments of Tac concentrations respectively (P＜0.05).Conclusion Individualized adjustment of Tac initial doses of recipients according to cardiac death donors' different CYP3A5 genotypes was benefit for reaching optimal concentrations as soon as possible and could decrease the rate of rejection,and reduce the side effects of Tac.

Objective To investigate the effect of intralesional lauromacrogol therapy on infantile hemangioma.Methods 30 cases all received intralesional injection of lauromacrogol.The changes of tumor size,texture and color were monitored and recorded.The adverse effects after medication were observed and managed accordingly.The adverse effects after medication were observed.The times of treatment were determined according to degree of reduction of tumor volume.To assess the efficacy,a 4 scales system was adopted.Results All patients had completed the treatment and followup.The overall response was scale Ⅰ in 2 cases (6.7 ％),scale Ⅱ efficacy in 4 patients (13.3 ％),scale Ⅲ efficacy in 5 cases (16.7 ％) and scale Ⅳ in 19 cases (63.3 ％).The smaller the tumor,the fewer the times of treatment,and the better the results.The effects of treatment were better if patient could be treated by intralesional lauromacrogol therapy in early stage.No severe adverse effects were observed during 6 months of follow-up.Conclusions Intralesional injection of lauromacrogol sclerotherapy is a safe and effective way to treat infantile hemangioma.

Objective To evaluate the effect of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia (VAP) in mechanically ventilated patients.Methods All randomized controlled trials (RCTs),which studied the effect of sucralfate and acid-suppressive drugs on the incidence of VAP in mechanically ventilated patients,were searched from PubMed,Embase and the Cochrane Library during January 1966 to March 2013 via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.2 and the quality of the RCTs was strictly evaluated with the methods recommended by the Cochrane Collaboration.Results A total of 15 RCTs involving 1315 patients in the sucralfate group and 1568 patients in the acid-suppressive drug group were included in this study.The incidence of VAP was significantly reduced in the sucralfate group (RR =0.81,95％ CI 0.7-0.95,P =0.008),while no difference was found between the two groups in the incidence of stress-related gastrointestinal bleeding (RR =0.96,95％ CI 0.59-1.58,P =0.88).No statistical difference was found in the days on ventilator,duration of ICU stay and ICU mortality in the two groups (all P values ＞ 0.05).Conclusion In patients with mechanical ventilation,sucralfate could decrease the incidence of VAP,while has no such effect on the stress-related gastrointestinal bleeding,the days on ventilator,duration of ICU stay and ICU mortality.

Objective To explore the clinical signiifcance of combined detection of thyroid stimulating hormone (TSH) and free thyroxin (FT4) in dried blood spots in screening for congenital hypothyroidism (CH) in neonates. Methods The TSH and FT4 levels in dried blood spot were measured by time-resolved lfuorescence immunity in live born neonates from June to December 2013. If the screening was positive, the blood was drawn and the serum TSH and FT4 were measured and compared with the results from dried blood spots. Results In a total of 31 199 neonates screened, 12 cases were diagnosed with CH and the prevalence rate of CH was 1/2 600;4 cases were hyperthyropinemia and no pituitary CH was detected. There was no signiifcant difference between TSH or FT4 levels in dried blood spot and those in serum in neonates diagnosed with CH (P>0.05). Conclusions Combined detection of TSH and FT4 in dried blood spot can be used for neonatal screening of CH. It can be applied for early distinguishing CH from hyperthyropinemia, and also helpful for early diagnosis and treatment of central CH.

Objective To investigate the effect of stress dose glucocorticoid on patients with acute respiratory distress syndrome (ARDS) combined with critical illness-related corticosteroid insufficiency (CIRCI).Methods All early ARDS patients combined with CIRCI were screened by an adrenal corticotrophic hormone (ACTH) test and randomly divided into treatment group (hydrocortisone 100 mg intravenous,3 times/day,consecutively for 7 days,n =12 ) and control group (equivalent normal saline,n =14 ).General clinical data,changes of arterial blood gas,hemodynamics and respiratory mechanics were observed and recorded at admission and at 7 days after treatment.Ventilator-free and shock-free days,ICU stay within 28 days after admission were recorded and 28-day mortality was used as judge prognosis index.Results CIRCI rate in 45 early ARDS patients was 57.8％ ( 26 patients),and the shock rate was markedly higher in ARDS patients with CIRCI than patients without CIRCI (46.2％ vs 5/19 ).There were no significant differences in baseline parameters,oxygenation and illness severity between the treatment and control groups,except for markedly lower lactic level in the treatment group [ 2.7 ( 1.2,3.9 ) mmol/L vs 4.6 ( 2.5,6.3 ) mmol/L,P ＜ O.05].After 7 days of treatment,PaO2/FiO2 markedly increased,while heart rate obviously decreased in the both groups.Compared with the control group,survival time of patients was significantly longer and shock rate of the patients was markedly lower in treatment group within 28 days (5/12 vs 10/14,P ＜ 0.05).The 28-day mortality,which were adjusted by baseline arterial lactic,was lower in the treatment group (2.6/12 ) than in the control group (5.8/14) while with no significant difference ( P ＞ 0.05 ).There was no significant difference in complication incidence between the two groups.Conclusion Stress dose glucocorticoid could reduce shock incidence and prolong survival time,and has a tendency of lower 28-day mortality in early ARDS patients combined with CIRCI.

Objective To observe the expression of I-Ab/I-E on circulating,lung and splenic dendritic cells (DC) in acute lung injury (ALI) mice.Methods Twenty-four C57BL/6 mice were randomly divided into four groups:control group,ALI 6 h,ALI 12 h and ALI 24 h group.Blood,lungs and spleens were harvested after lipopolysaccharide or phosphate butter solution administration.The expression of I-Ab/I-E on DC was assessed by flow cytometry (FCM).IL-6 level in the lung was measured by enzymelinked immunosorbent assay (ELISA).Lung wet weight/body weight (LW/BW) was recorded to assess lung injury.Meanwhile,pathological changes were examined under optical microscope.Results (1) lipopolysac charide-induced ALI mice resulted in a significant increase in lung LW/BW ratio.(2) Histologically,widespread alveolar wall thickening caused by edema,marked and diffuse interstitial infiltration with inflammatory cells,and severe hemorrhage in the interstitium and alveolus were observed in the ALI groups.(3) The level of IL-6 in lung tissue was significantly enhanced in ALI mice.(4) FCM analysis showed that I-Ab/I-E expressions on lung DC [(73 ±9)％],and splenic DC [(81 ±8)％] were significantly higher than that on circulating DC [(24 ± 7) ％ ; P ＜ 0.05] in control mice.(5) In ALI mice,the expressions of I-Ab/I-E on peripheral blood DC were (34 ± 17)％ at 6 h,(51 ± 16)％ at 12 h,(50 ± 17)％ at24 h respectively; I-Ab/I-E expressions on lung DC were (82 ± 14)％ at 6 h,(88 ±6)％ at 12 h,(90 ±10)％ at 24 h respectively; the expressions of I-Ab/I-E on splenic DC were (88 ± 8)％ at 6 h,(89 ± 4)％ at 12 h,(93 ± 9)％ at 24 h respectively,which were also significantly higher than those on the peripheral blood DC (P ＜ 0.05).(6) The I-Ab/I-E expressions on circulating DC in ALl mice at 12 h and 24 h was significantly higher than that on circulating DC in control mice (P ＜ 0.05).(7) The I-Ab/I-Eexpressions on lung DC and splenic DC in ALI mice at 24 h were significantly higher than those on lung DC and splenic DC in control mice (P ＜ 0.05).(8) There was a significant correlation of I-Ab/I-E expression on respiratory DC with the IL-6 level and lung injury score in LPS-induced ALI group (P ＜ 0.05).Conclusions There is a dynamic characteristic in the expression I-Ab/I-E on circulating,lung and splenic DC populations in ALI mice.I-Ab/I-E on pulmonary DC seems to play an important role in the pathogenesis of ALI.

ObjectiveTo compare the outcomes of 3 modes of weaning,e.g.SmartCare (a computerdriven knowledge-based system),spontaneous breathing trials (SBBT) and empirical methods,used in patients with chronic obstructive pulmonary diseases (COPD) weaned off mechanical ventilation.MethodsSixty-eight COPD patients were enrolled and randomly (random number) assigned to receive SmartCare (SC group,n =24),SBT (SBT group,n=24) or empirical methods (EM group,n =20).The following data were recorded including beginning of weaning:time consumed for weaning,duration of mechanical ventilation,length of ICU stay,success rate of weaning,survival rate during hospitalization and the complications of mechanical ventilation.The patients were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing.ResultsTime required for weaning and total time for mechanical ventilation in SC group were greatly shorter than those in EM group (P =0.002,0.002),but there were no differences between SC group and SBT group (P =0.540,0.573).Though the length of ICU stay (7.5 d) in SBT group was notably shorter than that in EM group (82.5 d) (P=0.015),there was no difference between SBT group and SC group (8.0 d).Weaning success rate was greater in the SC group (88.3％) than that in EM group (50.0％),but there was no difference between SBT group (66.7％ ) and SC group.No significant differences in survival rate during hospitalization,rate of re-intubation,self-extubation and need for noninvasive ventilation were found among three groups.ConclusionsCompared to empirical methods for weaning,SmartCare could greatly increase the success rate of weaning,but it was not superior to SBT.

ObjectiveTo evaluate the value of dead space fraction (VD/VT) guided positive end expiratory pressure ( PEEP ) in acute respiratory distress syndrome ( ARDS ).Methods Twenty-three intubated and mechanically ventilated patients with early ARDS were enrolled in the study.PEEP was titrated by lowest VD/VT.Parameters of oxygenation and respiratory mechanics were observed.Results PEEP titrated by lowest VD/VT and highest static lung compliance ( CLst ) ( P ＞ 0.05 ) respectively,were lower than PEEP titrated by optimal oxygenation ( P ＜ 0.05),but there was no significant difference between lowest VD/VT and highest Ctst method.The VD/VT that ventilated on PEEP titrated by the lowest VD/VT decreased than its basal level.There was no difference significantly between the VD/VT that ventilated on PEEP elected by the other two methods with basal level ( P ＞ 0.05 ).The the ratio of arterial PO2 to the inspired oxygen fraction (PaO2/FiO2)ratios improved significantly than the baseline values in three ventilation strategies,and that ventilated on PEEP targeting the lowest VD/VT was lower than PEEP targeting optimal oxygenation.The plateau airway pressure that ventilated on PEEP targeting optimal oxygenation was higher than the other two methods.The functional residual capacity (FRC) of patients ventilated by PEEP targeting optimal oxygenation was increased than the lowest VD/VT and maximum CLst.Conclusions VD/VT could be one of the methods to titrate the optimal PEEP in patients with early ARDS.Optimal PEEP targeting the highest compliance in conjunction with the lowest dead space fraction indicated a maximumamount of effectively expanded alveoli.

Objective To investigate the effects of isoflurane preconditioning on renal ischemia reperfusion (I/R) injury in rats and the role of TNF-α plays in the mechanism.Methods Male SD rats were used in the study.The animals were randomly divided into 3 groups ( n =12 each):shame operation group; I/R group; Isoflurane preconditioning group (inhaled 1.5％ isoflurane (1 MAC) for 30 min followed by 10 min washout before I/R).At 2 h reperfusion,blood samples were obtained for urea nitrogen (BUN) concentration and creatinine (Cr) content.The level of TNF-α in renal tissues were determined by enzyme-linked immunosorbent assay (ELISA).Observe the pathological changes in H.E.staining slides under microscope.Results BUN concentration and Cr content and the level of TNF-α in I/R group and isoflurane preconditioning group were significantly higher than in shame operation group[ BUN:( 17.69 ±0.99)mmol/L vs (8.37 ±1.12)mmol/L,t =-23.55,P ＜0.01; ( 12.26 ± 1.11 ) mmol/L vs (8.37 ±1.12 )mmol/L,t =- 19.09,P ＜ 0.01 ;Cr:( 103.22 ± 13.42)μmol/L vs (71.48 ± 8.59) μ mol/L,t =-21.45,P ＜0.01;(86.51 ± 11.49) μmol/L vs (71.48 ±8.59) μmol/L,t =-9.87,P ＜0.01 ;TNF-α:(0.51 ±0.07)ng/ml vs (0.43 ±0.00)ng/ml,t =-5.79,P ＜0.01;(0.47 ±0.03)ng/ml vs (0.43 ±0.00)ng/ml,t =-8.86,P ＜0.01 ].BUN concentration and Cr content and the level of TNF-α in Isoflurane preconditioning group were significantly lower than in I/R group [ BUN:( 12.26 ± 1.1 1 ) mmol/L vs ( 17.69 ± 0.99 ) mmol/L,t =15.67,P ＜ 0.01 ; Cr:( 86.51 ± 11.49) μmol/L vs ( 103.22 ± 13.42 ) μ mol/L,t =6.68,P ＜0.01 ;TNF-α:(0.47 ±0.03) ng/ml vs (0.51 ±0.07) ng/ml,t =2.61,P ＜0.05].Therenal I/R injury which located around kidney tubules was increased in I/R group and isoflurane precondi-tioning group compared to shame operation group [ ( 17.26 ± 1.45 ) vs (0.00 ± 0.00 ),t =- 72.38,P ＜0.01;(12.69±1.83) vs (0.00 ±0.00),t =-39.53,P ＜0.01].The renal I/R injury which located around kidney tubules was decreased in isoflurane preconditioning group compared to I/R group [ ( 12.69 ±1.83) vs (17.26±1.45),t =19.87,P ＜0.01].Conclusions Preconditioning with 1.5％ isoflurane 30 min can protect kidney from I/R injury in rats by regulating the level of TNF-α in renal tissues.