Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Sepsis is a serious problem among the elderly population as its incidence and mortality rates dramatically increase with advanced age. More importantly, the elderly has increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence and frequent instrumentation. Those who survive severe sepsis are more likely to have irreversible organ damage, cognitive impairments, and diminished overall function. Additionally, elderly patients with sepsis often present with atypical symptoms which further complicates and potentially delays diagnosis. Although sepsis is a serious life-threatening disease, recognition of this problem is very low compared to other age-associated diseases. Therefore, the purpose of this review is to analyze the challenges facing this cohort and how to optimize their management.

ObjectiveTo investigate the pattern of the relationship of craniopharyngiomas with pituitary stalks and hypothalamus. Furthermore, based on different patterns affirmed during the operations, surgical strategies were designed for radical excision. MethodsA series of 66 patients with primary suprasellar craniopharyngiomas were treated with microsurgical techniques and the relationships of the craniopharyngiomas with pituitary stalk and hypothalamus were analyzed prospectively. Appropriate surgical approaches were selected preoperatively according to the lesion's sizes and expanding directions. The relationships of the lesions to the pituitary stalks and hypothalamus were identified in detail and dissected carefully with protection of perforating vessels. ResultsThe patterns that pituitary stalks were involved by craniopharyngiomas were identified in 36 cases and divided into four types: no relation (5 cases), adhesion (10 cases), partial invasion (8 cases) and total invasion (13 cases). The anterior floor of the third ventricle was involved in 42 cases, in which it disappeared totally in 10 cases. Total resection was achieved in 58 case, subtotal resection in 8 cases. Diabetes insipidus (DI) was identified in 44 cases postoperatively. No surgical mortality, no recurrence was found during follow-up of mean 35 months. ConclusionThe appropriate selection of surgical approaches preoperatively, careful identification and according treatment of the relationships of the tumors with pituitary stalks and hypothalamus are the keys to protect the pituitary stalk; hypothalamus in craniopharyngiomas resection in adults.

Brachytherapy ; adverse effects ; Female ; Humans ; Iodine Radioisotopes ; administration & dosage ; therapeutic use ; Male ; Medical Staff, Hospital ; Occupational Exposure ; analysis ; Radiation Dosage ; Radiation Monitoring

The contents of coumarins in the sulfur fumigated Angelicae Dahuricae Radix (Baizhi, ADR) were reduced significantly. To achieve the quality control of ADR, the qualitative identification of sulfur fumigated ADR and quantitative model of imperatorin content should be established. The near-infrared (NIR) spectrograms of non-sulfur and sulfur fumigated ADR were collected by NIR diffuse reflectance spectroscopy technology and pretreated by the method of first derivative derivation and vector normalization. The Ward's Algorithm method was used for the cluster analysis. The non-sulfur and sulfur fumigated ADR can be quickly identified in the range of 8,806. 0-3 811.0 cm(-1) based on the cluster analysis. The NIR quantitative model of imperatorin was established by the contents of imperatorin determined by HPLC in combination with partial least squares regression analysis. According to the calibration model established in this study, correlation coefficients (R2), the root-mean-square error of cross-validation (RMSECV), and the root-mean-square error of prediction (RMSEP) for imperatorin were 0.982 8, 0.006 8, 0.011 8, respectively. The quantitative model of imperatorin can be applied to determine the content of imperatorin in ADR accurately.
Angelica ; chemistry ; classification ; China ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; Quality Control ; Spectroscopy, Near-Infrared ; methods ; Sulfur ; chemistry

Adult ; Aged ; Anthracosis ; complications ; Humans ; Male ; Middle Aged ; Pulmonary Emphysema ; diagnosis ; etiology ; Respiratory Function Tests ; Tomography, X-Ray Computed

Adolescent ; Child ; Child, Preschool ; Colitis, Ulcerative ; diagnosis ; therapy ; Crohn Disease ; diagnosis ; therapy ; Female ; Humans ; Male ; Prognosis ; Retrospective Studies

Objective To study the epidemiological characteristics of diabetes mellitus and to provide effective prevention and intervention methods in rural area in Kunming.Methods A cross-sectional study was conducted among 3 440 permanent residents aged 20～74 years in kunming rural districts.Results The general prevalence rate of diabetes was 4.01% and the standardized rate was 2.90%.The standardized prevalent rate for male(3.55%) was higher than that for female(2.61%),and the prevalence rates varied among different groups of rural inhabitants.Conclusion It is necessary to take effective methods to prevent and control diabetes in rural area.

Objective To investigate the diagnostic and therapeutic experience in children with ulcerative colitis(UC) from clinical data.Met-hods The literature on UC in children publicated from 1995 to 2004 were retrieved by CBM,CNKI and VIP database.The clinical manifestations,X-ray,endoscopic and histologic features,management and prognosis of 172 patients in this hospital correspond with the inclusion criteria were retrospectively investigated and a definite diagnosis with UC was made.Results Of 172 patients,the ratio of maleold female was 1.07:1.0,and the age of patients ranged from 2 months to 15 years old.Thirty-six patients(36.7%)were less than 3 years-old;the course ranged from 3 days to 4 years.One patient had family history.The main manifestations were chronic diarrhea,mucus bloody stool,bloody purulent stool and abdominal pain.The systemic symptoms were fever,weight loss,malnutrition and anemia,no enteral symptoms and complications.The lesions were mainly seen in the whole colon with moderate to severe degree.The therapies based on salicylaxosulfapyridine(SASP) or 5-acetylsalicylic acid(5-ASA) together with corticosteroid in the short period have clinical remission in different levels.From long follow-up,the complete remittence was less than one third.Conclusions It is not rare to see UC in infantile.The clinical characteristics of UC in children are different from those in adults,the same is true before and after 3 year-old.The UC in children has high misdiagnosis and is difficult to manage.It is very necessary to establish a diagnostic and therapeutic guideline for children with UC in China.

Objective To observe the expression of leukocyte-function-associated antigen-1(LFA-1)immunoreaction in children with febrile seizures(FS),and explore the neuroimmunomodulation mechanisms in the pathogenesis of FS.Methods Adopting flow cytometry(FCM),the levels of LFA-1 contained in blood serum and peripheral blood mononuclear cells(PBMC)of 60 cases [simple FS(SFS)30 cases;complex FS(CFS)30 cases] with febrile convulsion were analyzed,and compared with those in a normal group(30 cases).Out of 60 children with FS group,the LFA-1 mRNA in 20 cases with SFS and 20 cases with CFS was analyzed,and LFA-1 mRNA in19 health children taken out from control group(30 cases)was analyzed.The real-time PCR was used to detect the expression of PBMC LFA-1 mRNA.Results The expression of LFA-1 in the surface of PBMC of the 3 groups,the highest LFA-1 level was in the SFS group(50.89?21.36),the lowest LFA-1 level was in the CFS group(34.35?11.45),and control group was(41.39?16.30).Significant differences were found in 3 groups(Pa