The 2012 version of international guidelines for management of severe sepsis and septic shock got re-revised on the basis of the 2008 version.For pediatric severe sepsis,the 2012 version enforces initial resuscitation;develops detailed ant-infection measures;stresses isotonic crystalloid fluid resuscitation and the use of albumin,hetastarch is no longer recommended ;reduces the value of early use of dopamine,and clears the use of corticosteroids indications and the use of blood products;mechanical ventilation is recommended to use lung protective ventilation strategy; standardizes sedation and analgesia applications; clears the level of blood glucose control;others include blood purification,nutrition,stress ulcer prevention recommendations.

Objective To explore the role of granzyme B( GzmB) in infiltrated myocardial cells of mice with viral myocarditis( VMC) induced by coxsackievirus B3(CVB3) during the injury of myocardium and further to elucidate the pathogenesis of VMC. Methods Thirty-six BALB/c male mice, 5 to 6 weeks old, were randomly divided into two groups: the normal group, 10, and the model group, 26. On the eleventh day all mice were killed and the hearts were taken out for inspection whether there were pathological changes in the myocardium by macroscopy and microscopy. The expression of GzmB was detected in myocardium with immunohistochemistry and hemi-quantitive reverse transcript-polymerase chain reaction ( RT-PCR). Results GzmB positive cells in the mice myocardial cells infiltrated were detected by immunohistochemistry in the model group,and the number of GzmB positive cells is remarkable positive correlation to myocardial pathological score(r =0. 859, P =0.000) , however, no such cells were discovered in the normal murine hearts. Test of RT-PCR showed markedly high expression of GzmB mRNA in mice myocardium of the model group, however, no expression of GzmB mRNA in the normal group. Conclusion The expression of GzmB in the infiltrating myocardiocytes probably plays some role during the injury of myocardium, which mediated cytotoxicity effect is one of important mechanisms of myocardial injury in viral myocarditis. The expression quantity of GzmB in the infiltrating myocardiocytes is significant positive correlation to the severity of myocardial injury.

Adolescent ; Body Constitution ; China ; Health Behavior ; Healthy People Programs ; Humans ; Nutrition Surveys ; Obesity ; prevention & control ; Sickness Impact Profile ; Students ; statistics & numerical data

Autologous liver transplantation,a type of ex situ liver surgery along with hypothermic organ preservation,a venovenous bypass and complicated vascular reconstructions,allows better access to unresectable tumor and is considered as an effective strategy to overcome the shortage of donors.However,the high complication incidence and mortality related with the technique limit its wide application.To popularize this technique,based on our current experience,we review the key parts of the surgery and the treatment strategy for the complications.

Objective To analyze the biochemical effect of cryosugery on residual bronchial tissue and the adjacent organs in dogs. Methods Bronchial stumps of 18 dogs after lobectomy and the adjacent tissues and organs(including 4 samples of esophagi, 3 diaphragms, 3 stomachs, 2 livers, 7 tracheae and 3 superior saphenous vein sinuses) of 22 dogs after thoracectomy were frozen. The observation from 1～212 d was conducted after surgery. Results Cryonecrosis and fibrosis were found in all 18 samples of the frozen bronchial stumps, but no fistula of bronchial stump was found. Three cryodamaged esophagi in 4 dogs developed fine sheet of fibrous membrane like scars in the situs of cryosurgery. Perforation was found in 2 dogs, one in the esophagus, another in stomach. No perforation was found in dogs with diaphragm cryosurgery. Cartilaginous ring disappeared in 7 dogs by cryosurgery of the trachea and a membrane like scar developed in the inner wall of trachea. There were yellow scars on the liver after cryosurgery. Conclusion Exfoliation of the necrotic tissues is slow due to the slowly developed cryonecrosis and good tolerance to cryosurgery of the fibrotic tissues. The original construction disappears but fibrosis develops. At the edge of cryo necrotic area, proliferation of capillary can be found.

【Objective】 To explore the therapeutic mechanismof arsenic trioxide(AS2O3),the active component of arsenolitumininhibitingtumor.【Methods】Humanlung adenocarcinoma cells(LAC) at logarithmic growth phase were culturedin vitro for 24 hours,and then were cocultured with arsenic trioxide(AS2O3) in the dosages of 0.75,1.0,1.5 and 2.0 mg/Lrespectively.Meanwhile,model control group was set up.The morphological features of LAC in different groups were observed under reverse microscope,growth-inhibitory rate of LAC was examined by methylthiazolyltetrazolium(MTT) assay,andthe expression of p53 gene was detected by enzyme-linked immunosorbent assay(ELISA) method.【Results】AS2O3in different dosages obviously inhibited the proliferation of LACin a time-effect manner,and markedly increased the expression of p53 gene(P

Chromosome Aberrations ; Environmental Exposure ; adverse effects ; Humans ; Magnetic Fields

Objective To investigate the effect of artifictal circadian rhythm of melatonin on the postoperative cellular immune function in patients undergoing gynecological operation Methods Eighteen ASA Ⅰ or Ⅱ patients,aged 25-50 yr,weighing 45-80 kg,scheduled for elective gynecological operation,were randomly divided into 3 groups (n =6 each):control group (group C),placebo control group (group P) and melatonin group (group M).In group M.melatonin 6 mg was given orally at 10 min before lights-out (21:00) on 1 day before operation,on the day of operation and on 1 day after operation,while placebo was given orally instead of melatonin in group P.The operation was performed under epidural anesthesia.Patient-controlled epidural analgesia with ropivacaine was used for postoperative analgesia.VAS score was maintained ＜ 5.Blood samples were collected from the peripheral vein at 1 day before operation (baseline),the end of operation and 1 day after operation to measure CD4+,CD8+ and CD3+ cell count by flow cytometry.The ratio of the number of CD4+ cells to the number of CD8+ cells was calculated.Results There were no significant differences in the number of CD4+,CD8+ and CD3 + cells and ratio of the number of CD4 + cells to the number of CD8 + cells between groups C,P and M (P ＞0.05).Conclusion Artificial circadian rhythm of melatonin exerts no influence on the postoperative cellular immune function in patients undergoing gynecological operation.

Objective To evaluate the correlation of interval from injury to surgery with outcome for central cervical spinal cord injury syndrome.Methods A retrospective analysis was done for 31 patients with central cervical spinal cord injury syndrome treated surgically between March 2007 and March 2011.According to the timing of surgical intervention,the patients were divided into early operative group (＜7 days from injury,n =14) and late operative group (≥7 days from injury,n =17).Japanese Orthopedic Association (JOA) score on admission,at postoperative half-year and at final follow-up were recorded and compared between the two groups.JOA recovery rate was determined and analyzed for correlation with operation time point.Results Mean follow-up was (16.1 ± 4.5) months (range,12-25 months).All patients had different degree of neurological recovery.JOA recovery rate in early operative group was apparently better than that in late operative group at final follow-up (P ＜ 0.01).JOA recovery rate at follow-up was negatively correlated with intervals between injury and surgery (r =-0.763,P ＜ 0.01).Conclusion For patients with central cervical spinal cord injury syndrome,time from injury to surgery is negatively correlated with outcome,indicating that early surgery may be associated with better outcomes.

Heart ; drug effects ; Heart Failure ; drug therapy ; Humans ; Hydrogen Bonding ; Nitrogen Oxides ; pharmacology ; therapeutic use