Objective To observe the effect of automobile exhaust pollutants in air of underground parking area on immune system of mice. Methods Thirty female Kunming mice were divided into a control(relatively clean) group and a polluted group(each n=15)by a random number table method. The control group was housed on the roof of a mechanical building located at the south campus of Sun Yat-sen University,while the polluted group was housed in the minus second layer of underground parking lot at the First Affiliated Hospital of Sun Yat-sen University. The data of atmospheric pollutants were recorded at both feeding sites. The mice's food-intake and body weight were also observed. After 3 months of observation,the mice were sacrificed and peripheral serum was harvested. Enzyme-linked immunosorbent assay(ELISA)was performed to detect the level of tumor necrotic factor-α(TNF-α),transforming growth factor-β1(TGF-β1)and interleukin-4(IL-4). Results The levels of air pollutants in pollution group were higher than those in control group〔carbonmonoxide(CO,mg/m3:16.784±3.093 vs. 2.249±0.112),nitrogen oxides(NOx, mg/m3:0.318±0.041 vs. 0.065±0.030)and particulate matter(PM2.5,mg/m3:0.309±0.051 vs. 0.055±0.013),all P<0.001〕. The amount of food intake and body weight of the polluted group were obviously lower than those of the control group〔food-intake:670 g vs. 960 g,body weight:(37.13±1.11)g vs.(41.23±1.34)g, both P<0.001〕. There was no abnormal death in both groups. The serum levels of TNF-α(ng/L:247.93±22.25 vs. 143.33±39.01), TFG-β1(ng/L:395.77±41.29 vs. 319.15±20.72) and IL-4(ng/L:231.89±20.04 vs. 194.09±3.57)were significantly higher in the mice of polluted group than those in the control group(all P<0.001). Conclusions The automobile exhaust pollutants in the air of underground parking lot have obvious effects on the levels of serum inflammatory cytokines of mice. It is suggested that the presence of pollutants activate the body's inflammatory process and lead to disturbance of immune system of female Kunming mice.

Objective To investigate the effects of rhubarb combined with glutamine on repair of gut mucosal barrier injury after gastrointestinal surgery in rats. Methods Fifty male healthy Sprague-Dawley(SD)rats were randomly divided into five groups:control(C group),enteral nutrition(EN group),rhubarb with EN(R-EN group), glutamine with EN(G-EN group)and rhubarb combined with glutamine and EN(R-G-EN group)groups(each n=10). The rats of C group received no treatment and were fed normally. Cecectomy and gastrostomy were performed in EN,R-EN,G-EN and R-G-EN groups,and in 24 hours after surgery,they were interfered with the use of amoxicillin 50 mg/d and metronidazole 20 mg twice a day. From the first day after operation,each group was treated with the same prescription of enteral isocaloric and isonitrogenous nutrition for consecutive 7 days. Seven days later, under anaesthesia,laparotomy was performed,and a specimen of 1 cm intestinal segment was taken from the terminal 5 cm long ileum for all the groups;under the light microscope,the morphological examination of intestinal mucosal epithelial tight junctions(including villus height and mucosal thickness)was carried out. For each group,enzyme-linked immunosorbent assay(ELISA)was used to measure the levels of plasma citruline and D-lactate,and the serum concentration of TNF-αwas detected by utilizing double antibody ABC-ELISA. Results The levels of D-lactate and TNF-αin EN,R-EN,G-EN and R-G-EN groups were obviously higher than those in C group(all P<0.01). The level of plasma citruline(μmol/L:16.13±0.58 vs. 14.52±0.28)of R-G-EN group was remarkably higher than that in R-EN group(P<0.05),and its levels of serum D-lactate(mmol/L:3.12±0.56 vs. 3.62±0.52)and TNF-α(ng/L:2.82±0.62 vs. 3.54±0.49)were markedly lower than those of G-EN group(both P<0.05). The mucosal villus height(μm:126.50±6.31 vs. 175.67±11.91),mucosal thickness(μm:223.67±11.94 vs. 277.00±14.06)and the level of plasma citruline(μmol/L:13.25±0.36 vs. 15.67±0.55)in EN group were obviously lower than those of C group(all P<0.01);the above indexes of R-EN,G-EN and R-G-EN groups were higher than those of EN group (P<0.05 or P<0.01),but in the comparisons of the villus height and mucosal thickness among the three groups there were no statistical significant differences(all P>0.05). Conclusion The application of rhubarb combined with glutamine can protect gut mucosa,reduce the level of inflammatory reaction and elevate the level of plasma citruline, that is beneficial to the repair of gut mucosal barrier injury and its functional recovery after gastrointestinal surgery in rats.

Objective To investigate the effects of Xuebijing injection on expression of myeloid cell triggering receptor-1(TREM-1)and the plasma levels of soluble TREM-1(sTREM-1),tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)in patients with severe sepsis. Methods Twenty patients with severe sepsis admitted into Critical Care Medicine Department,Affiliated Hospital of Nantong University were given comprehensive treatments according to the guidelines for management of severe sepsis and septic shock(2004),and they were divided into Xuebijing group and control group(each 20 cases). The Xuebijing injection group was given Xuebijing injection 50 mL,3 times daily for 5-7 days followed by regular treatments. The changes in blood TREM-1 mRNA expression and plasma concentrations of sTREM-1,TNF-α,and IL-6 were detected before and after treatments on the 3rd and 5th day,and the above indexes were compared between the two groups. Results Before treatments,there were no significant differences in TREM-1 mRNA expression and levels of sTREM-1,TNF-α,IL-6 between two groups (all P>0.05). The TREM-1 expression and plasma concentrations of sTREM-1,TNF-α,and IL-6 of two groups were declined after treatments compared to their baselines,the degree of decline being more prominent in Xuebijing group〔TREM-1 mRNA 3 days:1.065±0.277 vs. 1.217±0.301,t=-3.267,P=0.047;5 days:0.912±0.239 vs. 1.071±0.254,t=-5.072,P=0.032;sTREM-1(ng/L):146.93±13.76 vs. 176.22±19.46,t=-5.442,P=0.033;TNF-α(ng/L):77.51±11.28 vs. 107.72±13.17,t=-4.355,P=0.032;IL-6(ng/L):288.35±14.59 vs. 323.89± 24.51, t=-3.941,P=0.028〕. Conclusion Early implication of Xuebijing injection is of great significance in patients with severe sepsis,it may reduce the expression level of TREM-1 and serum levels of downstream inflammatory mediators,that is beneficial to the control of inflammatory responses and improvement of systemic inflammatory response syndrome in such patients.

Objective To analyze patients with acute chest pain as their chief complaint in order to improve our capability of early identifying and diagnosing high-risk patients,give them proper treatment in time and avoid misdiagnosis and improper treatment. Methods The clinical data of 813 patients with chest pain as their chief complaint admitted in the emergency department and critical care medicine department in Guangdong Provincial Traditional Chinese Medicine Hospital from January to December in 2011 were retrospectively analyzed. According to the process of diagnosis and treatment formulated by the chest pain center,all the patients must immediately finish the first electrocardiograph(EEC)examination in 10 minutes and the relevant blood biochemical examinations within 30 minutes after admission. Results In accordance with the relevant examinations,the confirmed diagnoses were as follows:there were 276 cases of unstable angina,accounting for 33.95%;145 cases of stable angina,17.84%;121 cases of acute myocardial infarction,14.88%;103 cases of respiratory system disease,12.67%;78 cases of skeletal muscle disease,9.59%;46 cases of the digestive system disease,5.66% and the high-risk non cardiac chest pain(such as aortic dissection/rupture of tumor or acute pulmonary embolism)12 cases,1.48%.Seven hundred and eighty-five patients finished the first EEC examination in 10 minutes,and 147 patients completed the chest computed tomography(CT)scan within an hour. Conclusions Acute chest pain is a common symptom in emergency department. It is necessary to identify the high-risk patients according to a process as soon as possible in order to get an accurate diagnosis and an effective treatment in time.

Objective To investigate the clinical efficacy of Shenmai injection (SMI) combined with heart transplantation of autologous bone marrow stem cells in the treatment of refractory heart failure(RHF). Methods Two hundred patients with RHF were selected from the Emergency Department of the First Affiliated Hospital of Zhengzhou University and the Cardiology Department of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. They were randomly divided into control group and treatment 1,2 and 3 groups(each 50 cases). In the control group,heart failure standard treatment was given;group 1 received a standard treatment for heart failure combined with autologous bone marrow stem cell heart transplantation;group 2 received a standard treatment for heart failure with SMI;group 3 received a standard treatment for heart failure combined with autologous bone marrow stem cell heart transplantation and SMI. The mean follow-up was 24 months. The prognosis,readmission rate,clinical efficacy,cardiac function and the change in levels of B-type natriuretic peptide(BNP)of patients in each group were observed during the therapeutic course and observation period. Results During the course of treatment,there were 10 cases dead in the control group,4 in each group 1 and 2 respectively,and 3 in group 3. Readmission rates in group 1,2 and 3 were significantly lower than that in control group(38%,36%,24%vs. 48%, P<0.05 or P<0.01). The rates of total efficiency in group 1,2 and 3 were obviously higher than that in the control group(88%,86%,94%vs. 76%,all P<0.05). After treatment,the left ventricular ejection fraction(LVEF),left ventricular fractional shortening(FS)and left ventricular end-systolic diameter(LVESD)in three therapeutic groups were significantly higher than those before treatment,while the left ventricular end-diastolic diameter(LVEDD)and BNP level were significantly lower than those before treatment. All the above indexes in three therapeutic groups after treatment were much more remarkably improved than those in the control group during the same period,and the group 3 being the most significant〔LVEF:0.477±0.099 vs. 0.396±0.098,FS:(30.0±5.1)%vs.(26.8±7.5)%,LVESD (mm):40.6±9.1 vs. 45.8±9.4,LVEDD(mm):44.9±9.8 vs. 52.8±10.1,BNP(ng/L):515±400 vs. 1 875±400, all P<0.05〕. Conclusion SMI combined with heart transplantation of autologous bone marrow stem cells has obvious therapeutic effect for treatment of RHF.

Objective To study the changes in interleukin-32 (IL-32) in rats with Klebsiella bacillus pneumonia and approach its significance. Methods Seventy-two Sprague-Dawley(SD)rats were divide into control group,model group and experimental group by the method of random digits table,then the experimental group was subdivided into 4 hours and 1,3 and 5 days experimental subgroups(each n=6). The rat model of Klebsiella bacillus pneumonia was established by injection of 0.3 mL Klebsiella bacterial suspension into the trachea. Before the establishment of the model in the experimental group,IL-32 inhibitory agent,protease activated receptor-2(PAR2) was injected into the abdominal cavity. After model establishment,at different time points,blood was collected via tail vein to observe the changes in serum levels of IL-32,tumor necrosis factor-α(TNF-α),IL-6 and IL-8 in all the groups. The lungs were removed and stained with hematoxylin-eosin(HE)method to investigate the histopathological changes of the lung tissues under the light microscope. Results Compared to the control group, with the prolongation of time the levels of IL-32,TNF-α,IL-8 and IL-6 were increased gradually in the model group,and reached their peaks at 3 days〔IL-32(ng/L):84.40±28.24 vs. 18.57±3.86,t=5.544,P=0.002;TNF-α(ng/L):79.27±14.64 vs. 17.82±3.86, t=9.994, P=0.000;IL-8(ng/L):55.85±10.90 vs. 16.66±3.76,t=8.544, P=0.000;IL-6(ng/L):56.65±2.57 vs. 28.48±2.11,t=19.693,P=0.000〕;PAR2 could inhibit above indexes significantly,there was statistical difference at 3 days compared with the model group〔IL-32(ng/L):54.13±6.68 vs. 84.40±28.24,t=2.560,P=0.046;TNF-α(ng/L):49.12±3.56 vs. 79.27±14.64,t=4.901,P=0.003;IL-8 (ng/L):22.95±2.52 vs. 55.85±10.90,t=7.204,P=0.000;IL-6(ng/L):36.49±2.63 vs. 56.65±2.57,t=13.443, P=0.000〕. Under the light microscope,the inflammatory changes in the lung tissue in experimental group were milder than those in the model group. Conclusion As a pro-inflammatory cytokine,IL-32 can induce the production of TNF-α,IL-6 and IL-8,and the inhibition of IL-32 production may play a role in suppression of the development of Klebsiella bacillus pneumonia.

Objective To approach the selection of appropriate period and mode of blood purification for treatment of patients with severe acute pancreatitis(SAP)based on acute physiology and chronic health evaluationⅡ(APACHEⅡ)score. Methods The clinical data of 89 patients with SAP were retrospectively analyzed. They were assigned into two groups:the hemoperfusion(HP)and short continuous veno-venous hemodiafiltration(SCVVHDF) group(HP+SCVVHDF,49 cases)and the HP and hemodiafiltration(HDF)group(HP+HDF,40 cases). All the patients were evaluated by APACHEⅡscore. In the HP+HDF group,26 cases with APACHEⅡ<15 were in group A, while 14 cases with 15-25 in group B. In the HP+SCVVHDF group,31 cases with the score 15-25 were in group C, and 18 cases with<15 in group D. One week after the treatment,APACHEⅡscore,oxygenation index(PaO2/FiO2), C-reactive protein(CRP),serum creatinine(SCr),alanine transaminase(ALT)and mortality were observed in all the groups. Results Compared to those before treatment,the APACHEⅡ scores(group A:7.35±2.12 vs. 10.52±3.26,group B:14.35±4.76 vs. 18.43±4.08,group C:11.83±3.85 vs. 19.39±3.64,group D:6.92±2.54 vs. 11.61±2.19),the levels of CRP(mg/L,group A:85.28±23.48 vs. 195.23±56.77,group B:172.67±36.69 vs. 232.65±62.86,group C:112.43±29.48 vs. 257.29±68.39,group D:76.23±29.05 vs. 206.37±65.49),SCr (μmol/L,group A:107.56±73.01 vs. 225.81±119.06,group B:291.49±123.27 vs. 391.76±273.48,group C:254.89±104.37 vs. 403.62±261.53,group D:112.36±55.36 vs. 258.74±128.25)and ALT(U/L,group A:86.93±27.04 vs. 127.56±84.35, group B:116.34±43.98 vs. 189.15±102.85, group C:94.85±74.42 vs. 178.73±87.21,group D:88.49±29.32 vs. 138.24±90.58)after treatment were all decreased markedly in the four groups. The levels of PaO2/FiO2 were obviously higher in the 4 groups after treatment〔mmHg(1 mmHg=0.133 kPa), group A:293.42±31.26 vs. 253.60±26.62,group B:254.12±35.73 vs. 137.56±23.48,group C:283.21±37.48 vs. 131.96±0.45,group D:305.75±29.66 vs. 267.74±31.42〕,but no statistical significant differences in above indexes between group A and group D were found(all P>0.05),while the APACHEⅡ score,PaO2/FiO2,CRP, SCr and ALT were improved more significantly in group C than those in group B(P<0.05 or P<0.01). The mortality rate of those SAP patients with APACHEⅡscore<15 was lower than those in cases with APACHEⅡscore 15-20〔6.82%(3/44)vs. 24.44%(11/45),P<0.05〕. Conclusions Blood purification is an effective measure to save patients with SAP. The APACHEⅡ score used to select the mode of blood purification in appropriate period for treatment of SAP has guiding significance. Currently the modes of blood purification have limited value and cannot cure all SAP patients.

Objective To observe the effects of Niupo Zhibao pellet, a compound traditional Chinese herbal medicine,on helper T cell(Th cell)expression in rats with endotoxin-induced rapid pulmonary fibrosis (RPF). Methods Two hundred and twenty-four Wistar rats were randomly divided into four groups:normal control,model,dexamethasone(DXM)and Niupo Zhibao pellet(NW)groups(each n=56). By using endotoxin three-hit regimen,the RPF model was established. Three days before and 7 days after the establishment of models in NW group,they were administered with the pellet by intragastric feeding,50 mg/100 g of distilled water twice a day,a total of 10 days medication. Rats in DXM group received DXM intraperitoneal injection,3.0 mg/kg once a day for consecutive 7 days. Rats in normal control group were administered with the same volume of distilled water by intragastric administration. On 1,3,7,9,14,21,28 days after the administration,blood and bronchoalveolar lavage fluid(BALF)specimens were collected. The contents of γ-interferon(IFN-γ)and interleukin-4(IL-4) in the serum and BALF were investigated by enzyme-linked immunosorbent assays(ELISA). The lung tissue was stained by hematoxylin-eosin(HE)and Van Gieson respectively. Morphological changes in lung tissue were observed under light microscope. Results HE staining showed that the pulmonary interstitial tissues of rats in model group were thickened,there was a large amount of inflammatory exudates,and micro thrombi were seem in alveolar space. The pulmonary interstitial tissues in rats of DXM group were thickened too,but the inflammatory exudate in alveolar space was much less. Compared to rats in DXM group,the rats in NW group had slightly more inflammatory exudate and their pulmonary interstitial tissues were basically normal. Van Gieson staining showed that the expression of collagen fiber in model group was obvious,that of DXM group less than the former one but not significant,while that in the NW group was reduced markedly. ELISA assays demonstrated that the levels of IFN-γin BALF and serum in model group were increased significantly,those in DXM group were lowered to the minimum on the 7th day,raised to the levels before treatment on the 14th day,and gradually declined on the 21st day. In the NW group,the IFN-γwas consistently at a high level,and then gradually declined at a slow rate. After 7 days of drug administration,the IFN-γ levels in BALF and serum at various time points in NW group were obviously higher than those in model and DXM groups〔BALF(ng/L):140.47±4.22 vs. 149.23±8.35,90.67±6.65;serum(ng/L):140.47±4.15 vs. 100.43±11.05,99.35±7.85,P<0.05 or P<0.01〕. The levels of IL-4 in BALF and serum in each group increased significantly,reached to their maximum on the 7th day,and then gradually decreased. After the drug administration for 28 days,those levels in NW group were obviously lower than those in model and DXM group〔BALF(ng/L):6.60±1.05 vs. 7.20±1.25,8.55±1.05,serum(ng/L):6.75±1.05 vs. 7.21±1.25,8.25±1.15,P<0.05 or P<0.01〕. Conclusion Niupo Zhibao pellet can suppress inflammation,ameliorate injury of lungs and inhibit lung fibrosis by promoting IFN-γsecretion,restraining IL-4 secretion and adjusting the imbalance of Th cells.

Objective To investigate the anti-fibrosis mechanism from effects of difference in iron load levels on activation and apoptosis of hepatic stellate cells(HSCs). Methods According to the difference in iron load levels in HSCs,HSC-T6 cells were divided into four groups:blank control,iron deposition model,50μmol/L desferrioxamine and 25 μmol/L desferrioxamine groups. Quantitative polymerase chain reaction(PCR)was applied for the detection of collagen type Ⅰ and transforming growth factor-β1(TGF-β1)mRNA expressions of HSC-T6 cells. Immunohistochemical assay was used for the detection of α-smooth muscle actin(α-SMA)expression. The method of terminal deoxynucleotidyl transferase(TdT)-mediated dUTP nick end labeling(TUNEL)was used for the examination of apoptosis of HSC-T6 cells. Under electron microscope,the ultrastructures of HSC-T6 cells were observed. Results Compared with the blank control group,despite the TGF-β1 mRNA expression in iron deposition model group was increased,no statistical significant difference was seen(1.594±0.168 vs. 1.477±0.126, P>0.05),whereas collagen type I mRNA expression was significantly enhanced(1.354±0.076 vs. 1.197±0.104, P<0.01). Both 50μmol/L and 25μmol/L desferrioxamine could down-regulate collagen type I and TGF-β1 mRNA expressions,and the action of 50μmol/L desferrioxamine was superior to that of 25μmol/L desferrioxamine(collagen typeⅠmRNA:0.391±0.076 vs. 0.688±0.060,TGF-β1 mRNA:0.421±0.068 vs. 0.714±0.090,both P<0.01). Iron deposition could induce HSCs to expressα-SMA in great amount,while apoptosis could be seen scarcely in iron deposited HSCs. By desferrioxamine therapy,α-SMA expression of HSCs was decreased significantly,but some of the cells underwent apoptosis. Conclusion Different iron load levels inside HSCs can induce activation or apoptosis of the cells,showing that iron plays an important role in regulating the process of HSCs activation and apoptosis and revealing that desferrioxamine possesses the potential action for treatment of liver fibrosis.

Objective To approach the clinical effect of cefoperazone sulbactam associated with tigecycline for treatment of patients with severe pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in intensive care unit(ICU). Methods Retrospectively,the treatments of 88 patients with sepsis and pulmonary infection caused by pan drug-resistant Acinetobacter baumannii admitted in ICU from January,2011 to June,2013 were analyzed,among them antibiotics were used for 82 patients,and the rest 6 patients did not use antibiotics because of family refusal or abandonment of therapy. The patients having used antibiotics were divided into three groups:A group(27 patients)received cefoperazone sulbactam,B group(30 patients)received cefoperazone sulbactam associated with amikacin,and C group(25 patients)received cefoperazone sulbactam associated with tigecycline, antimicrobial treatment being for 7-15 days. The venous blood was collected to determine the changes in white blood cell count(WBC),C-reactive protein(CRP)and procalcitonin(PCT)before and after therapy. The rate of bacteriological efficiency,successful weaning of mechanical instrument,28-day mortality rate and clinical efficacy were observed after therapy in three groups. Results Before therapy,the comparisons of levels of WBC,CRP and PCT among three groups were of no statistically significant difference(all P>0.05),and they were decreased obviously after therapy in three groups among which they were decreased most significantly in C group〔WBC(×109/L):17.01±5.35 vs. 20.40±6.54,18.28±6.41;CRP(mg/L):64.6±8.4 vs. 68.3±12.7,70.0±13.4;PCT(μg/L):20.84±7.26 vs. 36.14±10.12,52.66±13.47,P<0.05〕. The rates of bacteriological efficiency and successful weaning in C group were increased more significantly than those in either A or B groups after therapy(bacteriological efficiency:76.00%vs. 44.44%,46.67%,χ2=9.750,P=0.006;rate of successful weaning:72.00%vs. 40.74%, 43.33%,χ2=12.083,P=0.009),and 28-day mortality rate in C group was much lower than those in A and B groups (24.00% vs. 48.15%,36.67%,χ2=11.510,P=0.030). The total clinical efficiency in C group was much higher than those in A and B groups(76.00%vs. 44.44%,46.67%,both P<0.05). Conclusion Cefoperazone sulbactam associated with tigecycline has significant clinical therapeutic effect in patients with pulmonary infection caused by pan drug-resistant Acinetobacter baumannii in ICU,as it can decrease inflammatory reaction,increase the rates of successful weaning and survival.