Objectives To investigate the incidence of the heparin-induced thrombocytopenia (HIT) and positivity of anti-heparin/platelet factor 4 complex antibody (HIT-antibody) in inpatients treated with heparin preparations.Methods A total of 197 consecutive patients,including 120 men and 77 women,who were treated with unfractioned heparin (UFH) or low molecular weight heparin (LMWH),were enrolled in this study.HIT-antibody was detected by enzyme-linked immunosorbent assay (ELISA).All patients were classified into subgroups based on 4Ts (Pretest Clinical Scoring System) and types of underlying disorders.The incidence of HIT and positivity of HIT-antibody among different groups were analyzed.Results The overall incidence of HIT was 3.0％ (6/197),and the positivity of HIT antibody was 12.2％ (24/197).The positivity of HIT-antibody was 10.1％ (18/178),7.7％ (1/13) and 83.3％(5/6) in low,moderate and high HIT probability group respectively.There were significant differences of HIT positivity and mean level of HIT-antibody between the high HIT probability group and the low or moderate HIT probability group (P =0.000).Both the incidence of HIT and positivity of HIT-antibody were higher in surgical patients than in medical patients (5.8％ vs 0.9％,P =0.047 and 19.8％ vs 6.3％,P =0.004).Conclusions The incidence of HIT and positivity of HIT-antibody were 3.0％ and 12.2％ respectively,both of which were related with the types of disorders.Detection of HIT-antibody has a better applicable value in patients with high HIT probability.

Objective To investigate the changes of pathogens distribution and antimicrobial resistance in children with urinary tract infection (UTI) in 10 years. Methods The results of urine culture and drug sensitivity in children with UTI from January 2001 to December 2003, and from January 2011 to December 2013 were retrospectively analyzed.Results In recent 10 years, there was no obvious change in the ratio of gram-negative bacteria to gram-positive bacteria. Escherichia coli was still the main bacteria causing UTI in children. The detection rate of enterococcus was signiifcantly increased from 18.3%in 2011-2013 to 7.5%in 2001-2003 (P<0.05) and it had become the second pathogenic bacteria. The isolation rate of ESBLs producing strains was signiifcantly higher in 2011-2013 than in 2001-2003 (P<0.05). The rate of Escherichia coli sensitive to imipenem re-mained at 100%and it is also sensitive to enzyme inhibitors antibiotics and nitrofuranto. Sensitivities to antibiotics were changed in different species of enterococcus. Conclusions The distribution of pathogens and antimicrobial resistance in children with UTI are constantly changing. The clinician should pay close attention to changes of epidemiology in the region and hospital and rational use of antimicrobial drugs.

OBJECTIVE To observe the influence of XueBiJing on apoptosis,apoptosis-associated proteins and activity of caspase 3 in spleen of sepsis rats.METHODS The sepsis models were produced by cecal ligation and puncture(CLP).Ninety-six Wistar rats were randomly divided into four groups:control group(n=8),sham operation group(n=8),model group(n=40),and XueBiJing treatment group(n=40).TUNEL method was used to assess the apoptosis,the activity of caspase 3 and the percent of CD3+ lymphocyte in spleen were tested,and the expressions of FasL and Bcl-2 in spleen were detected by immunohistochemistry methods.RESULTS The integrated optic density(IOD) of FasL expression in spleen for sham operation group was 4.54?1.41,but in model group was much higher(757.96?188.10 at 48 h) and the IOD of Bcl-2 in sham operation group was 594.05?183.32,but in model group was only 22.71?9.22 at 48 h.There were a few apoptosis appeared in sham operation group(0.87?0.51),the activity of caspase 3 was low(4.34?1.34),and the percent of CD3+ lymphocyte in spleen was 63.49%.At 4 h after the CLP operation,there were more apoptosis appeared in model group(8.88?3.68),the activity of caspase 3 reached to 12.22?3.15,and the percent of CD3+ lymphocyte in spleen decreased to 52.09%.After the intervention of XueBiJing,the expression of FasL reduced and Bax raised.The intervention also lightened the activity of caspase 3 and the apoptosis,and made the percent of CD3+ lymphocyte returned to normal level.CONCLUSIONS The activation of apoptosis pathway makes the apoptosis over-appeared,also induces the immune system out-of-balance.The intervention of XueBiJing can ameliorate the immune paralysis of sepsis by regulating the expression of apoptosis-associated proteins and lighten the apoptosis of lymphocyte.

Objective To evaluate the efficacy and safety of rhTPO (recombinant human thromobopoietin) employed for the treatment of sepsis-associated thrombocytopenia. Method There were 47 patients with sepsis-associaiod thrombocytopcnia eligible for the prospective, randomized (random number) and controlled clinical study from January 2009 to November 2009 in ICU of the Tianjin First center Hospital. According to the principle of minimum distribution imbalance index, these patients were randomly divided into the rhTPO group (n = 21) and the IVIG (intravenous immunoglobulin) control group (n = 22). In the rhTPO group, rhTPO was given subcutaneously to patients in a dose of 300 U/kg/d for 2 ～ 8 d, and in the IVIG control group, IVIG was used instead of rhTPO in a dose of 400 mg/kg/d for 5 days. Laboratory tests included blood routine examination, hepatic function, kidney function, coagulation function. The amount of blood products used, bleeding events, the days of ICU and hospital stay, total therapy cost and 28-day mortality were compared between two groups. Results The maximal platelet count in the rhTPO group was significantly higer than that in the contral group (t = 2.21, P =0.032). The mean value of difference between minimal and maximal platelet counts in the rhTPO group was much higher than that in the control group (t =7.40, P ＜0. 001). The average platelet count was no statistical difference between two groups before treatment (t =0. 458, P ＞ 0.05), but the average platelet counts in the rhTPO group were significantly higer than those in the contral group on the second and third day after treatment(t = 2. 166 and t = 2. 132, P =0. 036 and P =0.041. There were no statistical differences in incidence of bleeding, length of ICU stay and mortality between two groups (χ2 =0.720, t =0.91 and χ2 =0.264, P ＞0.05) , but the amounts of plasma and platelet transfusion were significantly less in the rhTPO group than those in the control group (t = 2.038 and t =2.252, P=0.048 and P=0.030) and the medical cost was cut down significantly in rhTPO group (t = 16.93, P ＜ 0.001). There was no adverse reaction occurred during period of observation. Conclusions The rhTPO can significantly increase platelet count, and decrease the amount of blood transfused and the medical cost. The administration of rhTPO is safe and efficient for the treatment of sepsis-associated thrombocytopenia.

Objective To observe the influence of Xuebijing injection on apoptosis, apoptotic related gene mRNA levels and activity of caspase3 in activated T lymphocyte. Methods The T lymphocytes were obtained from the spleens of BALB/c mice and be induced to be activated and apoptotic by cultured with Con A + IL-2. Apoptosis was investigated by flow cytometry. RT-PCR was used to detect the expression of Fas, FasL, Bcl-2, Bax, IL-2 mRNA, and the activity of caspase3 in T lymphocyte was also detected by spectrophotometric method. In the mean time, the effect of Xuebijing injection on those parameters was observed. Results After the induction, T lymphocyte apoptosis raised at 18 h. At 6 h after the induction, there was no expression of FasL, Bax mRNA, and no change in the expression of Fas and Bcl-2 mRNA. At 18 h, the expressions of Fas, FasL, Bax mRNA rised and the expression of Bcl-2 mRNA lessened. The activity of caspase3 also ascended. Xuebijing injection can cut down the apoptosis induced by induction, make the expression of Fas, FasL, Bax mRNA decreased and Bcl-2 mRNA improved. The activity of caspase3 also fallen after the Xuebijing injection treated. It can promote the expressions of IL-2 mRNA at early phase of AICD (6 h) and depress the expressions at the late period (18 h). Conclusion The apoptosis of T lymphocyte induced by activation was regulated by the change of Fas, FasL, Bcl-2, Bax mRNA expression. Xuebijing injection can ameliorate the apoptosis through regulating the expression of IL-2 and apoptotic related gene mRNA, improve the proliferation activity of T lymphocyte.

Objective To investigate the effects of different doses of dexmedetomidine(Dex) on rabbit sinus node and atrioventricular node.Methods A total of 24 healthy male rabbits weighing 1.5-2.8 kg,were divided into 3 groups randomly according to random number table (n =8).Group C (control),critical dosage of Dex causing sinus bradycardia D1 (loading dose of Dex was 10 μg/kg, continual pumping dose was 5 μg · kg-1 · h-1 ),six times of critical dosage of Dex causing sinus bradycardia D2 (loading dose of Dex was 60 μg/kg,continual pumping dose was 30 μg·kg-1 ·h-1 ). Rabbits were anesthetized,the right femoral artery was separated and catheterized followed by real-time monitoring of arterial blood pressure.Right external jugular vein was searched and separated,bi-polar stimulating electrode were inserted to the junction of superior vena cava and right atrium,the index of sinus node and atrioventricular node were observed by means of programmed stimulation.Si-nus node recovery time (SNRT),corrected sinus node recovery time (CSNRT),total recovery time (TRT),and atrioventricular node 2∶1 point were recorded before Dex infusion (T0 ),1 5-20 min after infusion of Dex (T1 )and 50-60 min after perfusion of Dex (T2 ).Results SNRT,CSNRT,TRT and 2∶1 point had no statistical significance.Compared with T0 ,SNRT,CSNRT and CSNRT were signifi-cantly prolonged at T1 and T2 .2∶1 point in group D1 and D2 was shortened obviously at T1 than that at T2 (P <0.05).SNRT,CSNRT and TRT of group D1 at T2 were significantly prolonged,2∶1 piont was shortened compared with T1 (P <0.05).SNRT,CSNRT and TRT of group D1 and D2 were pro-longed both at T1 and T2 than those of group C.2∶1 point was shortened in group D1 and D2 at T1 than that in group C (P <0.05).Compared with group D1,SNRT,CSNRT and TRT of group D2 at T1 and T2 were prolonged,2∶1 point was shortened obviously (P <0.05).Conclusion Load capacity of 10 μg/kg Dex apparently inhibits the function of rabbit sinus node and atrioventricular node,which is partially recovered within a short time (≤ 1 h).The inhibiting effect is more continously and re-markably in load capacity of 60 μg/kg Dex.

Objective To investigate the impact of relevant factors in mechanical ventilation on intraabdominal pressure in patients with ALI/ARDS by continuous monitoring of intra-abdominal pressure.Methods A total of 116 ALI/ARDS patients treated with mechanical ventilation in ICU were enrolled in this study.Intra-abdominal pressure (IAP) was recorded continuously.Meanwhile ventilator parameters, arterial blood gas analysis, hemodynamic variables, and as well as the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid (BALF) were determined and recorded.The detection of risk factors for intra-abdomen hypertension (IAH) were carried out using multivariate stepwise logistic regression.ROC curve analysis used to estimate the diagnostic performance of these parameters for IAH.Results The oxygenation index (PaO2/FiO2) in patients with IAH after 2 hours' mechanical ventilation was significantly lower than that in patients with normal intra-abdomen pressure (IAP) (P ＜ 0.01);PEEP and RR in mechanical ventilation were higher in IAH group (P ＜ 0.01 or P =0.001);Mean artery pressure (MAP), ejection time percent (ET), stroke volume (SV), cardiac index (CI) were lower in IAH group than those in normal IAP group (P ＜ 0.01);the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid were higher in IAH group than those in normal IAP group (P ＜ 0.01);IAH patients have a higher mortality on 28 d (Log rank test, P =0.023).Poor oxygenation index (PaO2/ FiO2) after 2 hours' ventilation, high PEEP setting, low MAP, ET, SV, CI and elevated IL-4 in the BALF were resulted in increasing risk of IAH for ARDS patients under mechanical ventilation support.Conclusions The monitoring of intra-abdominal pressure should be emphasized for ALI/ARDS patients when mechanical ventilation was employed.PaO2/FiO2, SV and IL-4 in BALF might be the independent risk factors of IAH.

Objective To search specific biomarkers of pathogenic bacteria in patients with sepsis so as to guide early using rationally antibiotic treatment.Methods Prospective survey of 147 patients with sepsis in ICU was carried out from Jan 2012 to Mar 2015.When patients blood culture was positive, clinical data including age, gender, vital signs, blood and, urine routine examination, DIC, blood biochemistry, c-reactive protein (CRP), procalcitonin (PCT), microbial detection, etc were recorded.Cultured blood samples were from central venous catheter and peripheral vessel.ELISA method was employed to detect soluble toll-like receptor 2 ( sTLR2 ) and interleukin-8 ( IL-8 ) , and the Acute Physiology and Chronic Health Evaluation Ⅱ( APACHEⅡ score ) was calculated.The chi-square test and analysis of variance were performed where necessary.Receiver operating characteristic ( ROC ) curves were used to calculate cut-points ( CP ) and area under the curve ( AUC) .Results According to the results of blood culture, patients were divided into three groups:GP group [ gram-positive bacteria ( G+) group];GN group [ gram-negative bacteria ( G-) group];FG group ( fungi group) .There were no significantly statistical differences in age, APACHEⅡ score, vital signs and markers of inflammation among three groups (P>0.05).Gram negative pathogenic bacterium was the most common microbe.Compared with GN group, the level of sTLR2 in the GP group was obviously higher ( P=0.000); but there was no significant difference in sTLR2 level between GP group and FG group (P=0.187). The amount of (1, 3) -beta glucan in the FG group was significantly higher than that in the GP group ( P=0.000).The sTLR2 level in FG group was obviously higher than that in the GN group (P=0.000).There were no significantly statistical differences in PCT, CRP and IL-8 among the three groups (P>0.05).For the diagnosis of gram negative bacteria infection, sTLR2 area under the curve was 0.768, and the sensitivity and specificity were 88.90%and 59.60%, respectively and the best cut-off point was 8.083 pg/mL.Namely, the diagnosis of gram negative bacteria infection was less likely, when level of sTLR2 was higher than 8.083 pg/mL.The markers of PCT, CRP, (1, 3) -beta glucan and IL-8 were less valuable for the diagnosis of Gram negative bacteria infection because the area under the curve was less than 0.5.Conclusions The combination of inflammatory indicators such as sTLR2 and (1, 3) -beta glucan etc, can imply the kind of pathogenic microorganisms partly.

Objective To evaluate the effects of different doses of dexmedetomidine on atrioventricular node (AVN) conduction function in the healthy volunteers.Methods Sixteen healthy volunteers of both sexes,aged 18-30 yr,with body mass index of 19-26 kg/m2,were included in the study.Dexmedetomidine was infused in a loading dose of 1.0 μg/kg over 10 min,followed by an infusion of 0.5 μg · kg-1 · h 1 for 50 min (Dose Ⅰ);1-2 weeks later,dexmedetomidine was infused in a loading dose of 1.5 μg/kg over 10 min,followed by an infusion of 0.75 μg · kg-1 · h-1 for 50 min (Dose Ⅱ).Before infusion of dexmedetomidine (T0) and at 15 and 35 min of infusion (T1.2),AVN Wenckebach point,AVN 2 ∶ 1 block point,AVN relative refractory period (AVNRRP),and AVN effective refractory period (AVNERP) were measured.Results AVN Wenckebach point and AVN 2 ∶ 1 block point were significantly decreased,and AVNRRP and AVNERP were significantly prolonged at T1,2 compared with those at T0 (P＜0.05).Compared with Dose Ⅰ,AVN Wenckebach point at T2 and AVN 2 ∶ 1 block point at T1,2 were significantly decreased,and AVNRRP and AVNERP were significantly prolonged at T1,2 in the subjects receiving Dose Ⅱ] (P＜0.05).Conclusion Dexmedetomidine can inhibit AVN conduction function in the healthy volunteers,and the inhibitory effect is enhanced with the increasing doses.

Objective To evaluate the effect of dexmedetomidine on heart rate (HR) of rabbits through in vitro and in vivo experiments, and investigate the mechanism by which dexmedetomidine lowered HR.Methods In vitro experiment Healthy adult rabbits of both sexes, weighing 2.0-2.5 kg, aged 8-10 weeks, were studied.The 24 isolated hearts passively perfused in a Langendorff apparatus were randomly divided into 3 groups (n =8 each) using a random number table: control group (group C) , and dexmedetomidine 3 and 30 ng/ml groups (D1 and D2 groups).The isolated hearts were continuously perfused with K-H solution for 45 min in group C.After 15 min of equilibration, the isolated hearts were perfused for 30 min with K-H solution containing dexmedetomidine 3 and 30 ng/ml in D1 and D2 groups, respectively.At 15 min of equilibration, and at 15 and 30 min of perfusion with K-H solution containing dexmedetomidine, HR and left ventricular systolic pressure (LVSP) were recorded.In vivo experiment Twenty-five healthy adult rabbits of both sexes, weighing 2.0-2.5 kg, aged 8-10 weeks, were randomly divided into 5 groups (n=5 each) using a random number table: dexmedetomidine 3, 6, 9, 12, and 15 μg/kg groups (D3, D6, D9, D12, D15groups), to receive the corresponding doses of dexmedetomidine which was intravenously infused over 10 min.HR and mean arterial pressure were monitored and recorded before administration (T0) , and at 15 and 40 min after administration (T1,2).The correlation between doses of dexmedetomidine and change rate of HR was tested by Spearman correlation analysis.Results In vitro experiment Compared with group C, no significant changes were found in HR and LVSP at each time point in D1 and D2 groups (P＞0.05).In vivo experiment Compared with those at T0 , HR at T1 in D6 and D9 groups, HR at T1,2 in D12 and D15 groups, and mean arterial pressure at T1,2in D6, D9, and D12 groups were significantly decreased (P＜0.05) , and no significant change was found in HR at each time point in group D3 (P＞0.05).The correlation coefficient between doses of dexmedetomidine and change rate of HR was 0.944 (P＜0.05).Conclusion The mechanism by which dexmedetomidine lowers HR of rabbits is not related to direct inhibition of sinoatrial nodes, but associated with the balance of autonomic nervous system.