ObjectiveTo observe the changes in plasma interleukin-33 (IL-33) in patients with sepsis and its regularity, the association between IL-33 and the infection, and the significance of IL-33 in predicting the prognosis of sepsis.Methods A prospective single-center single-blind clinical study was conducted. Forty patients with sepsis in intensive care unit (ICU) of Shengjing Hospital of China Medical University from May 2012 to January 2013 were enrolled. The patients were divided into general sepsis, severe sepsis and septic shock groups according to the severity of systemic infection and presence of organ dysfunction. The sepsis patients were again divided into 28-day death group and survival group. Ten healthy volunteers and 11 patients with systemic inflammatory response syndrome (SIRS) were enrolled as healthy control and SIRS groups. The levels of procalcitonin (PCT), IL-33, IL-6, IL-1β, tumor necrosis factor-α (TNF-α), and IL-33 receptor sST2 were determined with enzyme linked immunosorbent assay (ELISA) within 3 hours, and 24 hours and 5 days after enrollment to ICU. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was calculated. The clinical outcome, length of stay in ICU, and duration of mechanical ventilation were recorded. The relationship between IL-33 and each parameter was analyzed by Spearman analysis. Receiver operating characteristic (ROC) curve was drawn to evaluate IL-33 in predicting the outcome of sepsis.Results Plasma IL-33 in sepsis patients within 3 hours after admission was significantly increased compared with that of the healthy controls and SIRS group (ng/L: 15.43±7.22 vs. 0.67±0.24, 1.25±1.09, bothP< 0.01). Compared with SIRS group, PCT in sepsis group was significantly increased [μg/L: 52.23 (19.69, 73.37) vs. 1.22 (0.69, 3.73),Z = -2.447,P< 0.001]. With exacerbation of illness, APACHEⅡ score, the values of PCT and IL-33 were gradually increased in general sepsis, severe sepsis and septic shock groups, while the length of stay in ICU and the duration of mechanical ventilation were gradually prolonged (P< 0.05 orP< 0.01). The concentration of IL-33 (ng/L) of sepsis patients admitted to ICU within 3 hours, and 24 hours and 5 days of the illness was 15.43±7.22, 11.82±6.16, 5.55±2.25, respectively (F = 4.823,P = 0.004). There was a positive correction between IL-33 within 3 hours after ICU admission and APACHEⅡ score (r = 0.351,P = 0.031), PCT (r = 0.412,P = 0.005), IL-6 (r = 0.535,P = 0.030), IL-1β (r = 0.674,P = 0.030), TNF-α (r = 0.250,P= 0.030), sST2 (r = 0.620,P< 0.001), and length of stay in ICU (r = 0.296,P = 0.013), duration of mechanical ventilation (r = 0.385,P = 0.011). Decreased plasma IL-33 level could be found in the survivors (n = 37,F = 7.798,P< 0.01), and its level in non-survivors (n = 3) was increased (F = 37.283,P> 0.05). The area under the ROC curve (AUC) of IL-33 and PCT in ROC curve were 0.821, 0.829. When the cut-off value of IL-33 was 13.79 ng/L, the sensitivity was 74.2%, the specificity was 79.6%; when the cut-off value of PCT was 4.70μg/L, the sensitivity was 87.5%, and the specificity was 81.4%.Conclusions The concentration of IL-33 3 hours after ICU admission was obviously increased in sepsis patients, and it was positively correlated with PCT, therefore it is valuable in the diagnosis of the infection. In addition plasma IL-33 is related to the severity of sepsis. Its trend of change is valuable in predicting the outcome and in distinguishing sepsis from SIRS.

OBJECTIVE:To compare antidiuretic activity of Ootheca Mantidis before and after processing,and to explore the best medicinal part and mechanism of Ootheca Mantidis. METHODS:96 rats were randomly divided into blank group,model group,positive group,Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group,steamed Ootheca Mantidis group, crude product eggs and egg shell groups,processed product eggs and egg shell groups,with 8 rats in each group,12 groups in to-tal. Except blank group,other groups were given adenine 250 mg/kg,ig,for 4 weeks to induce kidney-yang and diuresis model. From third week,Ootheca Mantidis crude drug group and processed Ootheca Mantidis group were all given relevant medicine 0.11 g(crude drug)/ml i.g,and crude product eggs and egg shell groups and processed product eggs and egg shell groups were given rel-evant medicine,ig,once a day,by mass ratio of eggs to egg shell(cude drug 1∶2.4,salt stir-fried product 1∶1.7,steamed prod-uct 1∶2.1)for consecutive 4 weeks. The urinary volume,body weight,renal index and the serum contents of ADH and ALD were all determined. RESULTS:Compared with blank group,body weight and serum content of ADH and ALD decreased in model group,while renal index and urinary volume increased(P<0.05). After 4 weeks of treatment,compared with model group,body weight and serum content of ADH increased in Ootheca Mantidis groups,while urinary volume and renal index decreased (P<0.05);serum content of ALD increased in treatment groups;there was statistical significance in the serum content of ALD in those groups except Ootheca Mantidis group,Ootheca Mantidis stir-fried with salt group and steamed Ootheca Mantidis group (P<0.05);except for ALD,those index were in descending order of steamed Ootheca Mantidis group>Ootheca Mantidis stir-fried with salt group>Ootheca Mantidis group,and steamed Ootheca Mantidis shell group had best exchange. CONCLUSIONS:The an-tidiuretic activity of Ootheca Mantidis has been enhanced after processing. The egg shell of steamed Ootheca Mantidis is main me-dicinal part. To increase the serum content of ADH might be one of the main mechanism of arresting polyuria.

Actinomyces ; growth & development ; Coinfection ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; diagnosis ; microbiology

In the past few decades, accumulated experimental and clinical evidences suggest that cyclic guanosine monophos-phate (cGMP) plays an important role in atheroselerosis. Vasodilator-stimulated phosphoprotein (VASP), a major downstream compo-nent of the cGMP signaling cascade, is an actin-binding protein which regulates cell adhesion, morphology change, cell motility and cell proliferation. It has shown that VASP is associated with many factors influencing atherosclerosis, and it plays an important role in the genesis and development of atherosclerosis. The relationships between the occurrence of atherosclerosis and risk factors for athero-sclerosis such as hypertension, hyperglycaemia and hyperlipidemia are reviewed in this article.

By analyzing the basic line of medical ethics,this paper points out the collapse of basic line of medical ethics is due to the lack of people-oriented spirit in medical activities.Hospitals and medical staff should build up people-oriented spirit and conscience,strengthen the sense of honor and humiliation,thus to prevent the recollapse of the basic line of medical ethics and build up a harmonious physician-patient relationship.This project is significant in conducting the educational program of social glory and humiliation sense.

In the educational process of medicine,not only medical knowledge and skills,but also the medical ethics of being a good doctor should be taught to medical students.In her teaching course of traditional Chinese medical doctrine of ShangHanLun,besides the curricular content proposed by the Ministry of Education of China,the author also arouses her students the enthusiasm and devotion to traditional Chinese medicine,builds up the spirit of hard working and probity as well.By introducing ZHANG Zhong-jing's respectable medical ethics,she also enlightens uhem with the gracious medical ethics.

Diagnostic Tests, Routine ; Humans ; Liver Cirrhosis ; diagnosis

[Objective]To discuss the experience with locking compression plates fixation combining with autoallergic cancellous bone and Illizarov technique in the management of chronic fracture nonunion,and to further investigate the reason of fracture nonunion and assess the safety and the efficacy of this procedure.[Method]A retrospective analysis was made including 87 consecutive patients with fracture nonunion treated at our hospital with locking compression plates fixation combining with autoallergic cancellous bone(80 cases) and Illizarov technique(7 cases) from January 2002 to July 2007.Patients were evaluated for radiographic bony fusion,complications and clinical outcome.[Result]Mean follow-up period was 14.7 months.Bony union was achieved in all cases after a mean time of 6.8 months after operation.Joint function was improved after operation in 70 patients.No major complications related to the procedure or hardware failure occurred.[Conclusion]Medical factors are main etiopathogenisis of chronic fracture nonunion after operation.Locking compression plates combining with autoallergic cancellous bone and Illizarov technique are safe and effective procedure for the treatment of fracture nonunion.

Objective To explore the early diagnosis and surgical treatment of scapular fractures. Methods Sixteen cases with scapular fractures received operation that had been admitted to our hospital from January 1996 to January 2001 were retrospectively analyzed. AP views of X-ray, two-dimensional CT scannings and three-dimensional CT reconstructions were used to confirm the injuries. According to Hardegger's classification for scapular fractures, There were 9 fractures of the scapular body, 7 fractures of the scapular neck, 2 fractures of the glenoid rim, 1 fracture of the glenoid fossa, 5 fractures of the scapular spine, 3 fractures of the acromion and 2 fractures of the coracoid process. Of the 16 patients, 11(68.8%) cases had complex fractures of the scapula, and 14 cases (87.5%) had associated injuries. On the basis of the fracture patterns, anterior, posterior, posterosuperior approach,and anterior combined posterior approach were performed with plates or(and) lag screws for surgical reconstruction. Results All patients were followed up with an average of 18.6 months. According to Rowes evaluation, 11 cases showed excellent results, 2 good, 1 fair, and 2 poor. The glenohumeral posttraumatic arthritis of the series was found in 2 cases, heterotopic ossification in 1 case, and shoulder joint instability in 1 case. Conclusion 1) Scapular fractures are caused by high-energy violence with a high incidence of serious associated injury. Computerized tomography scanning with three-dimensional imaging is helpful to determine the fracture pattern and degree of displacement; 2) Intra-articular fracture of the glenoid fossa with more than 3 to 5 mm of step-off displacement, the glenoid rim fracture combined with humeral head subluxation, grossly displaced fracture of the scapular neck, some bursting fractures of the body, and floating shoulder injuries should be operated; 3) Open reduction and internal fixation is an useful and safe technique for the treatment of specific displaced fractures of the scapula. It needs at least 12 months to determine the final functional result.

Objective To explore the results of surgical treatment for disp la ced intra-articular glenoid fractures. Methods From June 1997 to June 2002, 19 p atients with more than 5 mms displaced glenoid fractures were open reduced and internally fixed. All fractures were classified according to Ideberg system, ty pe-Ⅰ fractures in 8 cases, Type-Ⅱ in 2, Type-Ⅲ in 3, Type-Ⅳ in 2, and Type-Ⅴ in 4 were retrospectively analyzed. The incidence of associated injuries was 78.9%(15/19). According to their patterns, fractures were exposed through poste rior approach (11 cases), anterior approach (6 cases) and posterosuperior approa ch (2 cases) and fixed with reconstruction plates and lag screws after satisfyin g reduction. Results All patients were followed up for an average of 17.5 months . According to Constant and Murley score, the median score was 93(range 11-100, mean 81). Fractures were manipulated under direct vision and anatomical reductio n was accomplished in 16 fractures. The radiographs showed a residual displaceme nt of more than 2 mm in 3 fractures after operation. The post-traumatic shoulder arthritis was found in 2 cases and the glenohumeral joint instability in 1 case . Conclusion To glenoid rim fractures combined humeral head subluxation, more th an 3-5 mm step-off displaced intra-articular fractures, and superior shoulder su spensory complex injury associated with glenoid fractures, early surgical interv ention is required to restore shoulder joint functions. The prognosis of glenoid fractures is determined by multiple factors such as associated injuries, qualit y of fracture reduction and surgical complications.