Objective To explore the effective molecular mechanism of PPAR-γligands rosiglitazone to biliary ischemia-reperfusion injury in autologous liver transplantation. Method A total of 40 SD rats were randomly (random number) divided into sham operation group (SO), ischemia - reperfusion group (Ⅰ/R), rosiglitazone (ROS) and GW9662 group, with 10 ones in each. The models, rat biliary ischemiareperfusion injury of autologous liver transplantation, were made by modified two-cuff technique. Tissues of the liver and bile ducts and blood of those models were evaluated by pathological and biochemical methods to make sure the models were made successfully or not. SO group suffered autologous orthotopic liver transplantation, and L/R group suffered both that and ischemia-reperfusion. ROS group were injected rosiglitazone (0.3mg/kg) via portal vein after having been done all as I/R. GW9662 group suffered all as ROS, and 10min later ,they were injected GW9662(0.3mg/kg) via portal vein. 4h after the experiment, tissues of livers and bilary ducts were taken to be tested by immunohistochemistry method, and the blood punctured from the right ventricular were taken to be determined by ELISA. ANOVA was used for statistical analysis.Results IL-1β, TNF-α and IL-6 were mainly expressed in the cytoplasm of hepatocytes and bile duct cells,while NF-κB was expressed both in the cytoplasm and nuclei. Expression of those proteins in L/R and GW9662 group was increased, significantly higher when compared to the SO and ROS (P ＜ 0.05). IL-1β,TNF-α and IL-6 in rat serum were simultaneously increased, and significantly higher than SO(P ＜0.05).Compared with the SO, expressions of the IL-1 β,TNF-α and IL-6 were not significantly changed in ROS (P＞ 0.05 )but significantly increased in GW9662. Conclusions PPAR-γ ligand rosiglitazone took protective role in biliary ischemia-reperfusion injury in autologous liver transplantation. The mechanism correlates with the release of the IL-lα, IL-1β and TNF-α and other inflammatory mediators, which decreased as the expression of NF-κB inhibited by its antagonist.

Objective To explore the clinical efficacy of Qingyi decoction (a preparation of Chinese herbal medicine) combined with DAR (combined use of dexamethasone,anisodamine and rhubarb) for the treatment of acute pancreatitis.Methods A total of 387 eligible patients met the criteria of acute pancreatitis were enrolled from January 2005 to April 2012 for prospective study.All patients,mild acute pancreatitis (MAP) or severe acute pancreatitis (SAP),were divided (random niumber) into four groups,namely conventional therapy (T),DAR therapy (DAR),Qingyi decoction therapy (Q) and Qingyi decoction combined with DAR therapy (Q + DAR).Outcome,fasting time,serum amylase,abdominal pain relief time,pancreatic or peri-pancreatic complications and average hospital-stay were analvzed with SPSS 13.0 statistic software.P ＜ 0.05 was considered statistically significant.Results None of MAP patients died.Of SAP patients,there was no difference in mortality among different groups (P ＞ 0.05).length of fasting time,tine elapsed for abdominal pain relief,time required for normalized serum amylase level and length of hospital stay in MAP patients were significantly shorter than those in SAP patients regardless of different therapies (P ＜ 0.05).Either patients of SAP or MAP treated with Q + DAR or DAR suffered shorter length of time than those treated with T or Q in respect of fasting,abdominal paiu relief,serum amylase level normalization and hospital stay (P ＜ 0.05).For SAP or MAP patients,there was no difference in abdominal pain relief time between receiving DAR and Q + DAR treatment (P ＞ 0.05),but the fasting time in Q + DAR was shorter than that in DAR (P ＜ 0.05).Patients with SAP were more likely to suffer pancreatic or per-pancreatic complications than those with MAP,but there was no difference for SAP or MAP with different treatments.Conclusions DAR or Q + DAR was an alternative to conventional treatment for MAP or SAP,and they were both superior to conventional treatment.And Q + DAR was more advantageous than DAR when fasting time,hospital-stay time and cost were considered.

Objective:To investigate the efficacy and safety of continuous blood purification in the treatment of severe acute pancreatitis.Methods:60 cases of severe acute pancreatitis were selected and divided into two groups.The control group (29 cases) was given routine treatment and the observation group (31 cases) was given continuous blood purification.The efficacy of continuous blood purification in the treatment of severe acute pancreatitis was evaluated by CRP,ALT,PaO2/FiO2,HCO3-,Scr,APACHE Ⅱ and MODS scores before and after treatment,complications and survival situation during treatment.Results:Before treatment,there was no statistical significance in the CRP,ALT,PaO2/FiO2,HCO3-,Scr levels between two groups (P＞0.05).After treatment,the CRP,ALT,HCO3-,Scr levels of two groups were decreased.These indexes of observation group were lower than those of the control group (P＜0.05).The PaO2/FiO2 of both groups were increased.The PaO2/FiO2 of observation group was high than that of the control group (P＜0.05).Before treatment,there was no statistical significance in the APACHE Ⅱ and MODS scores between two groups (P＞0.05).After treatment,the APACHE Ⅱ and MODS scores were lower than those before treatment.The APACHE Ⅱ and MODS scores in the observation group were lower than those of the control group (P＜0.05).During treatment,there was no statistical significance in the complications and survival rate between two groups (P＞0.05).Conclusion:Continuous blood purification had a good therapeutic effect on the severe acute pancreatitis.It could improve the organ function,reduce inflammation and regulate the balance of water and electrolyte with high safety.

Through stating the current situation of the doctor -patient relationship , and combining with its characteristics in emergency ICU (EICU), to analyze the application basements and skills of progressive doctor -patient communication in EICU , in order to explore the present stage to build a harmonious doctor -patient rela-tionship , a feasible way to safeguard the rights and interests of both doctors to provide the reference .

Objective:To investigate the bacterial composition and antimicrobial resistance profile of clinical isolates from bloodstream infections in China.Methods:The clinical bacterial strains isolated from blood culture were collected during January 2020 to December 2020 in member hospitals of Blood Bacterial Resistant Investigation Collaborative System (BRICS). Antibiotic susceptibility tests were conducted by agar dilution or broth dilution methods recommended by Clinical Laboratory Standards Institute(CLSI, USA). WHONET 5.6 was used to analyze data.Results:During the study period, 10 043 bacterial strains were collected from 54 hospitals, of which 2 664 (26.5%) were Gram-positive bacteria and 7 379 (73.5%) were Gram-negative bacteria. The top 10 bacterial species were Escherichia coli (38.6%), Klebsiella pneumoniae (18.4%), Staphylococcus aureus (9.9%), coagulase-negative Staphylococci (7.5%), Pseudomonas aeruginosa (3.9%), Enterococcus faecium (3.3%), Enterobacter cloacae (2.8%), Enterococcus faecalis (2.6%), Acinetobacter baumannii (2.4%) and Klebsiella spp (1.8%). The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus aureus were 27.6% and 74.4%, respectively. No glycopeptide- and daptomycin-resistant Staphylococci were detected. More than 95% of Staphylococcus aureus were sensitive to rifampicin and SMZco. No vancomycin-resistant Enterococci strains were detected. Extended spectrum β-lactamase (ESBL) producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were 48.4%, 23.6% and 36.1%, respectively. The prevalence rates of carbapenem-resistance in Escherichia coli and Klebsiella pneumoniae were 2.3% and 16.1%, respectively; 9.6% of carbapenem-resistant Klebsiella pneumoniae strains were resistant to ceftazidime/avibactam combination. The prevalence rate of carbapenem-resistance in Acinetobacter baumannii was 60.0%, while polymyxin and tigecycline showed good activity against Acinetobacter baumannii. The prevalence rate of carbapenem-resistance of Pseudomonas aeruginosa was 23.2%. Conclusions:The surveillance results in 2020 showed that the main pathogens of bloodstream infection in China were gram-negative bacteria, while Escherichia coli was the most common pathogen, and ESBL-producing strains declined while carbapenem-resistant Klebsiella pneumoniae kept on high level. The proportion and the prevalence of carbapenem-resistant Pseudomonas aeruginosa were on the rise slowly. On the other side, the MRSA incidence got lower in China, while the overall prevalence of vancomycin-resistant Enterococci was low.