Objective: To investigate the changes of hemodynamic parameters by transesophageal doppler echocardiography (TEE) and pulmonary artery catheter (PCA) before and after volume administration in patients receiving off-pump coronary artery bypass (OPCAB) surgery, to analyze the correlation between the two methods, and to discuss the value of TEE in monitoring the preload during OPCAB. Methods: Twenty patients who were to receive OPCAB were enrolled in the present study. TEE was used to determine the mitral valve flow (MVF). Simultaneously, the central vein pressure (CVP), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP), mixed venous oxygen saturation (SvO2), cardiac output (CO), cardiac index (CI), and stroke volume (SV) were examined during OPCAB by PCA. The above parameters were recorded before and immediately after volume infusion (5 ml/kg, in 10 minutes). Patients with SV increased by > 10% were taken as effective responders. Pearson correlation analysis was used to examine the relationship of SV with the results of TEE and PAC. Results: There were 14 effective responders after the first volume load, and only 6 after the second infusion. Compared with the baseline values, PCWP of all the patients, and CO, CI and SV of the effective responders increased significantly after volume DOI: 10.3724/SP.J.1008.2009.01393 loading (P<0.05); the values of MVe, MTIe, and VTIe+a also increased significantly after volume loading (P<0.05); and there were no significant changes in MVa, VTIa, MVedt values after volume loading. The results of correlation analysis of SV with other parameters were, MVe (r=0.36, P<0.05), VTImve (r=0.63, P<0.05), VTIe/VTIa (r=0.67, P<0.01), VTIe+a(r=0.77, P<0.01), and PCWP (r=0.35, P<0.01). SvO2 was increased after infusion (P<0.05). Conclusion: The relationship of TEE parameters with SV is variable. There is a significant positive correlation between SV with VTIe and VTIe+a; and VTI can be used to evaluate the preload of left ventricular, which should be further studied to guide clinical medication.

Objective To compare sensitivity and specificity of the acute physiology,age,and chronic health evaluation system Ⅱ (APACHE Ⅱ),the acute physiology,age,and chronic health evaluation system Ⅲ (APACHE Ⅲ) system in predicting prognosis after cardiac operation.Methods A prospective study of 1 180 consecutive patients entering in a single cardiac postoperative intensive care unit of Anzhen hospital was assigned between November 2013 to January 2014.APACHE Ⅱ and APACHE Ⅲscore was calculated daily at least three days or until death,then compared the calibration and discrimination of the two different system using Hosmer-Lemeshow goodness-of-fit and receiver operating characteristic(ROC) curve.Results In discrimination analysis,ROC value of the first day after operation was(APACHE Ⅱ 0.699 、APACHE Ⅲ 0.734),ROC of the maximum(APACHE Ⅱ 0.836,APACHE Ⅲ 0.862),ROC of the maximum during the first 3 days(APACHE Ⅱ 0.814、APACHE Ⅲ 0.855),ROC of the change between the third day and the first day(APACHE Ⅱ 0.524 、APACHE Ⅲ 0.549).In calibration analysis,we compared the x2 value and overall corrected percentage of the first day value,the maximum value,the maximum value during the first 3 days,the change value between the third day and the first day of the three different system.x2 value of APACHE Ⅱ was(15.688,10.132,8.061,42.253),x2 value ofAPACHE Ⅲ was(13.608,11.196,19.310,47.576).Conclusion APACHE Ⅲ was better than APACHE Ⅱ in prediction of death risk after cardiac surgery.

Objective To investigate the relationship between the infarction area and the changes of serum fibrotic indexes in acute myocardial infarction (AMI) patients.Medthods Serum procollagen type Ⅲ (PCⅢ),collagen IV(IV?C) and laminin (LN) were measured in 42 AMI patients with successful recanalization,22 AMI patients with unsuccessful recanalization and 37 healthy controls.Michelle's method was used to calculate infarction area and correlative analysis was made between indexes and infarction area.Results Serum PCⅢ,IV.C and LN were significantly increased in AMI patients with unsuccessful recanalization as compared with the other two groups,which were positively correlated with the infarction area.However,there was no statistical significance between the indexes in the other two groups and infarction area.Conclusion Serum PCⅢ,IV.C and LN can be serum fibrotic indexes in AMI patients,which can reflect the infarction area indirectly.

Objective To evaluate the effects of tumor-associated macrophages on the proliferation,invasion and migration of human cutaneous malignant melanoma cells.Methods Cultured U937 human monocytic cells at logarithmic phase were classified into three groups to be pretreated with phorbol ester for 48 hours followed by 48-hour activation by phorbol ester (M polarization),lipopolysaccharide (LPS) at 25 mg/L (M1 polarization),and interleukin (IL)-4 at 15 μg/L (M2 polarization) respectively.Then,enzyme-linked immunosorbent assay (ELISA) was performed to determine the levels of IL-12p70 and IL-10 in the supernatant of these activated cells.A375 human malignant melanoma cells were divided into four groups to be cultured alone or with M-,M1-and M2-polarized macrophages respectively.After additional culture for different durations (24,48 and 72 hours),methyl thiazolyl tetrazolium (MTT) assay was conducted to estimate the proliferative activity,and Transwell assay to evaluate the invasion and migration activity,of the A375 cells.Results The proliferation of A375 cells was accelerated by coculture with M-and M2-polarized macrophages,but inhibited by that with M1-polarized macrophages,with significant differences among the four groups in the proliferative activity at 48 and 72 hours (all P ＜ 0.05),but not at 24 hours (P ＞ 0.05).Invasion assay showed that the number of A375 cells that migrated through Transwell chambers was significantly larger in M2 and M groups (147.00 ± 7.92 and 113.22 ± 8.15 respectively),but smaller in the M1 group (56.44 ± 7.55),than in the control group (84.11 ± 6.07,all P ＜ 0.05).Similarly,migration assay revealed a significant increase in the number of A375 cells that migrated through Transwell chambers in the M2 and M(p) groups (198.33 ± 8.22 and 156.00 ± 8.83 respectively),but a significant decrease in the M1 group (97.11 ± 6.75) as compared with the control group (123.89 ± 7.01,all P＜ 0.05).Conclusions The proliferation,invasion and migration of A375 cells can be accelerated by IL-4-activated M2-polarized macrophages,but decelerated by LPS-activated M1-polarized macrophages.Phorbol ester tends to induce monocytic cells to differentiate into M2-polarized macrophages.

Objective This study aimed to assess the effects of active and passive smoking on chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM).Methods Seven hundred and five patients with T2DM were recruited in the study and were divided into three groups based on smoking status as active smokers,passive smokers and non-smokers.Twenty-four hour urinary albumin excretion (24hUAE) was measured,and estimate glomerular filtration rate (eGFR) was calculated with age and blood creatinine levels.Results (1) The proportion of CKD in T2DM in the present study was 31.63％ (223/705) with 28.6％ (22/77),30.0％ (15/50) and 29.6％ (73/247) for non-smokers,passive smokers and active smokers in men,and 29.9％ (40/134),35.9％ (66/184) and 7/13 for non-smokers,passive smokers and active smokers in women,respectively.In comparison with non-smokers,a higher risk of CKD was found in both passive and active smokers (OR =1.07 and OR =1.05 in men ; OR =1.31 and OR =2.74 in women,respectively).(2) Compared with non-smokers,passive smokers had a significant higher risk for albuminuria in women (OR =2.02,P =0.016).(3) After adjusting for gender,age,duration of T2DM,BMI,systolic blood pressure,glycosylated hemoglobin A1C and lipids,there was a significant decrease in eGFR between active and never smokers (P =0.018)or passive smokers (P =0.000) in women.No differences could be found in eGFR between each smoking statues in men.Conclusions Smoking exposure alone confers a high risk for CKD in patients with T2DM.Our results highlight an importance in implementation of a smoke-free environment for patients with T2DM.

Objective To investigate the relative factors of insulin resistance(IR)during elective abdominal surgery and the mechanism of IR induced by surgery.Methods Fourteen patients underging elective abdominal surgery were studied.Fasting blood glucose(FBG),fasting plasma insulin(FPI),plasma TNF-α,IL-6 and CRP were tested for elective surgery patients on the day before,during operation and on one day after surgery.Insulin resistance index(HOMA-IR)and the index of insulin secretion(HOMA-β)were ealculated with homeostasis model assessment(HOMA).Insulin receptor and GLUT4 mRNA expression in skeletal muscle were assessed before operation and at the end of operation by use of RT-PCR.Results Significant differences were found in fasting blood glucose (5.95±1.08)mmol/L vs(8.92±2.41)mmol/L,fasting plasma insulin(19.95±3.33)mU/L vs(25.44±5.36)mU/L,IL-6(33.98±5.01)ng/L vs(45.29±7.81)ng/L and plasma TNF-α(86.70±9.27)ng/L vs(114.46±15.33)ng/L during and after operation(P＜0.01).A significant elevation of HOMA-IR levels was found after operation compared with that before operation[(9.59±2.89)vs(4.111.86)](P＜0.001).However there wag no significant difference in HOMA-β among three points(groups)of time(P=0.103).The result of RT-PCR showed that the expression of GLUT4 in muscle of patients at the end of operation reduced significantly compared with preoperation(t=12.488,P＜0.001)but there was no significance in INSR mRNA expression(P=0.165).ISI showed negative correlation with opermive time(r=-0.736、P＜0.001),blooding during operating (r=-0.594、P=0.032)and post-operative TNF-α(r=-0.641、P=0.018).Conclusion Insulin resistance occurs in elective abdominal surgery patients.The defective site is at postreceptor.To shorten the operation time,control the intensity of surgery and reduce the bleeding is helpful for decreasing IR.

ObjectiveTo assess and compare the resting energy expenditure measured by indirect calorimetry (MREE) and calculated with Harris-Benedict formula adjusted with correction factors (CREE) in critically ill surgical patients receiving mechanical ventilation,and to evaluate the relationship between resting energy expenditure and the severity of diseases.MethodsFrom August 2008 to February 2010,21 patients fitting the inclusion criteria were selected into the present study.The data of the patients were collected to calculate acute physiology and chronic health evaluation Ⅱ score ( APACHE Ⅱ score) and multiple organ dysfunction score ( Marshall score).MREEs were measured using indirect calorimetry of a MedGraphics CCM/D System,and CREEs were calculated at the same time with the Harris-Benedict formula.ResultsWithin the week of nutrition support,the mean CREE of the 21 patients was significantly higher than the mean MREE [ ( 8305.09 ± 1392.76 ) kJ vs.(6544.84 ±2079.65) kJ,P =0.000].The differences between MREE and CREE were statistically significant on the 0 ( P =0.000),1 ( P =0.000 ),2 ( P =0.000 ),and 4 day ( P =0.003 ) of nutritional support.There was no correlation between MREE and CREE (r =0.064,P =0.408 ),nor between MREE and APACHE Ⅱ ( r=-0.045,P =0.563 ).There was a correlation between MREE and Marshall score (P =0.001 ),but the correlation coefficient was low ( r =0.263).ConclusionsThe Harris-Benedict prediction modified with correction factors for severity of diseases overestimates the resting energy expenditure of critically ill surgical patients.Indirect calorimetry is a more accurate method for determining resting enenrgy expenditure.

OBJECTIVE:To provide reference for promoting the prior usage of essential medicines and scientifically selecting of antitumor medicines in the national and local drug reimbursement list. METHODS:Entering the Human Resources and Social Se-curity Bureau websites in 10 cities(Beijing,Shanghai,Guangzhou,Nanjing,Wuhan,Xi’an,Chengdu,Shenyang,Jinan and Gui-yang),drug reimbursement list was downloaded to statistically analyze the containing of antitumor medicines(including 24 essential medicines). RESULTS:In antitumor medicines,there were 5 cities with more than 100 varieties,of which Shanghai had 255 vari-eties,which was far more than other cities;the numbers of medicines in class A were near 30 in all the cities except Beijing(67 va-rieties),and the number of class B was highest in Shanghai and lowest in Beijing. All the drug reimbursement lists in 10 cities con-tained 24 antitumor essential medicines,however,the classification was different according to the dosage forms,among which, parts of formulations of cytarabine(injections),doxorubicin(injections),busulfan (often release oral dosage forms),fluorouracil (often release oral dosage forms,injections),cyclophosphamide(often release oral dosage forms,injections),methotrexate(often release oral dosage forms,injections)and cisplatin were classified as class A medicines in all cities;oxaliplatin(injections)and pa-clitaxel (injections) were classified as class B medicines;busulfan,fluorouracil,cyclophosphamide and methotrexate were classi-fied as class B in Shanghai only. CONCLUSIONS:There are some differences in the distribution of antitumor essential medicines in drug reimbursement list in each city,the varieties in developed cities are relatively more,and developing cities are less. It is sug-gested to consider the tumor epidemiology characteristics and economic situations,reasonably select antitumor essential medicines into drug reimbursement list and reasonably adjust the proportion of class A and B to ensure the basic medication and drugs’reim-bursement.

Objective To investigate the energy expenditure of mechanically ventilated patients,compare the measured energy expenditure (MREE) with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors (PREE). Methods Twenty-four critically ill adult patients who were mechanically ventilated in the intensive care unit were enrolled in this study. Data during the 72 hours of mechanical ventilation were collected for computation of severity of illness. Resting energy expenditures were derived at 72hours after mechanical ventilation by indirect calorimetry. Predicted basal energy expenditure was obtained at the same time using the Harris-Benedict equation and predicted resting energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for illness. Results The Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ)scores and Marshall scores were 14 ± 5 and 6 ± 3, respectively. MREE and PREE were (6 793.64 ± 1 197.15) and (8 041.02 ± 1 971.54) kJ/day, respectively. There was no correlation between MREE and PREE (r2 = 0. 28, P = 0. 07), and the difference between MREE and PREE was statistically significant (t = 7.62, P = 0.04). No statistically significant correlations were observed between both MREE or PREE and APACHE Ⅱ score or Marshall score (r2 = 0. 14, P = 0. 08; r2= 0. 08, P = 0. 63; r2 = 0. 05, P =0. 65; r2 = 0.03, P = 0. 87, respectively). Conclusions In mechanically ventilated patients, the energy expenditure is not correlated with the severity of illness. The Harris-Benedict prediction modified with correction factors for severity of illness systematically overestimates the total energy expenditure.

Acidosis, Renal Tubular ; complications ; diagnosis ; Child ; Diagnostic Errors ; Female ; Humans ; Medullary Sponge Kidney ; complications ; diagnosis ; Rickets ; diagnosis