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 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 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.

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

In the aromatic amino acid biosynthetic pathway 3-dehydroshikimate (DHS) is a key intermediate. As a potent antioxidant and important feedstock for producing a variety of important industrial chemicals, such as adipate and vanillin, DHS is of great commercial value. Here, in this study, we investigated the effect of the co-expression of aroFFBR (3-deoxy-D-arabino-heptulosonate 7-phosphate synthase mutant with tyrosine feedback-inhibition resistance) and tktA (Transketolase A) at different copy number on the production of DHS. The increased copy number of aroFFBR and tktA would enhance the production of DHS by the fold of 2.93. In order to further improve the production of DHS, we disrupted the key genes in by-product pathways of the parent strain Escherichia coli AB2834. The triple knockout strain of ldhA, ackA-pta and adhE would further increase the production of DHS. The titer of DHS in shake flask reached 1.83 g/L, 5.7-fold higher than that of the parent strain E. coli AB2834. In 5-L fed-batch fermentation, the metabolically engineered strain produced 25.48 g/L DHS after 62 h. Metabolically engineered E. coli has the potential to further improve the production of DHS.
3-Deoxy-7-Phosphoheptulonate Synthase ; genetics ; Amino Acids, Aromatic ; biosynthesis ; Biosynthetic Pathways ; Escherichia coli ; genetics ; metabolism ; Fermentation ; Metabolic Engineering ; Shikimic Acid ; analogs & derivatives ; metabolism ; Transketolase ; genetics

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.

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 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.

The main purposes of translational Medicine is to break the barrier among the basic medicine,clinical medicine and drug R&D in order to establish direct and close connection and cooperation between them.However,so far almost in the world wide,translational medicine is still at the exploration stage and far away from the real transformation.This article reviewed the difficult position of translational medicine cooperation from the three aspects of cooperative resources,sponsor and domestic culture,and then suggested to promote clinical medicine research,set up new assessment systems which focus on classified evaluation and representative work,as well as create the culture of cooperation.

0.05).The eggs per gram feces and liver, eggs in uterus per female, and egg granulomas on the liver surface were(56.68?24.78),(5 826?437),(49.94?12.53) and(10.04?1.13)/0.25 cm2, respectively in immunized group, while in control group these were(89.93?32.18),(10 016?3 541),(76.54? 19.77) and(19.22?2.45)/0.25 cm2 respectively, all with significant difference(P