Objective To determine a combination of biomarkers that assure the diagnosis of sepsis and severe sepsis in patients in emergency department (ED).Methods A total of 652 patients with systemic inflammatory response syndrome (SIRS) were enrolled for this prospective study in the ED of Beijing Chaoyang Hospital of the Capital Medical University between March 2010 and March 2013.Eight biomarkers were determined,including levels of procalcitonin (PCT),interleukin-6 (IL-6),D-dimer,C-reactive protein (CRP),brain natriuretic peptide (BNP),white blood cell count (WBC),percentage of immature neutrophil,and platelet count (PLT).Patients were divided into the sepsis group (452 cases) and non-sepsis group (200 cases) according to the diagnostic criteria of sepsis.Then all these patients were stratified into severe sepsis group (190 cases,including septic shock) and non-severe sepsis group (462 cases) according to the diagnosis of severe sepsis.Logistic regression was performed to identify the independent factors for the diagnosis of sepsis and severe sepsis,and the optimal combination of biomarkers was established.Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic ability of the combination and the biomarkers.Results PCT,IL-6 and D-dimer were independent factors for diagnosis of sepsis and severe sepsis.The area under the ROC curve (AUC) of the combination of three biomarkers was 0.866 for diagnosis of sepsis,and it was higher than the AUC of PCT (0.803),IL-6 (0.770) and D-dimer (0.737) alone,and this new combination showed better sensitivity,specificity,positive predictive (PPV),and negative predictive (NPV) values than that when the three biomarkers was used individually (the results of combination were 81.2％,8 1.0％,90.6％,56.5％ ; that of PCT were 75.2％,80.0％,89.5％,58.8％; that ofIL-6 were 81.0％,61.0％,82.4％,58.7％; and that of D-dimer were 79.9％,59.0％,81.5％,56.5％,respectively).The AUC of the combination was 0.815 for the diagnosis of severe sepsis and was better than the three biomarkers used alone,which was 0.758 for PCT,0.740 for IL-6,and 0.704 for D-dimer respectively.Moreover,the sensitivity,specificity,PPV and NPV of the combination were higher than that of the three biomarkers used singularly (the results of combination were 81.6％,73.6％,56.0％,90.6％; that of PCT were 79.5％,65.0％,48.2％,88.5％; that of IL-6 were 65.8％,70.6％,47.9％,83.4％; and that of D-dimer were 60.5％,73.2％,48.1％,81.8％,respectively).Conclusion The combination of PCT,IL-6 and D-dimer enhances the diagnostic ability for sepsis and severe sepsis.

ObjectiveTo assess the sepsis score used for detecting the mortality of patients with sepsis in emergency department, and to compare with APACHE Ⅱ score, simplified acute physiology Ⅱ score ( SAPS Ⅱ ) and modified early warning score (MEWS) in terms of 28-day mortality of patients. Methods A total of 613 patients with sepsis were enrolled from the emergency department for a prospective study from September 2009 to September 2010. The sepsis score, APACHE Ⅱ score, SAPS Ⅱ score and MEWS score all were recorded and compared. The patients with sepsis were followed up for 28 days. Based on the sepsis score, patients with sepsis were stratified into 5 mortality risk groups, namely very low risk group (0～4 points), low risk group (5 ～7 paints), moderate risk group (8 ～ 12 points), high risk group ( 13 ～ 15points) and very high risk group (more than 15 points). The actual mortality rates were compared among all 5 groups by using Chi square test. Then, comparison between survivors and non-survivors carried out with logistic regression analysis to determine the independent risk factors of mortality.Receiver operating characteristic curve (ROC curve) was used to compare the sepsis score with APACHE Ⅱ score, SAPS Ⅱscore and MEWS in respect of the prognosis validity. ResultsTen patients were out of the follow-up and the data of 603 patients followed up were completely documented. The actual mortality rates of 5 risk groups were 0％, 7.7％, 18.5％, 46. 7％ and 63％, respectively. There were significant differences in age and four scoring systems between survivors ( n = 440) and non-survivors ( n = 163 ) ( P ＜ 0. 01 ). Sepsis score,APACHE Ⅱ score, SAPS Ⅱ and MEWS all were valid and eligible for detecting the risk of mortality in patients with sepsis. The ROC areas under the curve (AUC) of these 4 scoring systems were 0. 767, 0. 743,0. 741 and 0. 636, respectively. ConclusionsThe sepsis score can be used to stratify patients with sepsis according to mortality risk with better sensitivity to predict 28-day mortality. It is rational for evaluation in prediction of patients with sepsis in Emergency Department.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Genital Diseases, Male ; therapy ; Humans ; Male ; Middle Aged

Objective To use high and low condition to get contrast radiography of nasal bone photograph to raise the image quality. Methods 75 cases with nasal bone injury were adopted as the subjects. Results In 75 cases of nasal bone wound,93% could meet the demand. Conclusion Nasal bone side position photography in high and low codition can rasie the image quality and meet the clinical diagnosis demand in maxium degraee.

BACKGROUND: Compared with the bone marrow mesenchymal stem cells, umbilical cord blood mesenchymal stem cells (UCB-MSCs) is an ideal source of tissue engineered seed cells, but the culture success rate is low.OBJECTIVE: To explore establish a stable reliable method to isolate and culture UCB-MSCs by optimizing medium choice,centrifugation speed and time, incubation density, choice of growth factor, first time of medium change.DESIGN, TIME AND SETTING: The cytological in vitro study was performed at the Department of Blood Transfusion, Bethune International Peace Hospital of Chinese PLA from January to October 2008.MATERIALS: A total of 20 samples of neonatal UCB by full-term uterine-incision delivery were supplied by Stem Cell Center,Bethune International Peace Hospital of Chinese PLA. Parturient and their family member signed the informed consent.METHODS: Under sterile conditions, UCB-MSCs were isolated by combination of density gradient centrifugation (1 500 r/min, totally 15 minutes) and different adherent time method. UCB-MSCs were incubated in DMEM/F12 medium, supplemented with 10% human UCB serum, 5 μg/L granulocyte-macrophage colony-stimulating factor (GM-CSF), 15 pg/L interleukin-3. MSCs at 1 ×1010/L were incubated in plastic flask coated with human UCB serum at 37℃ and 5% CO2 saturated humidity. The medium was changed following 3 days of culture. Non-adhered cells were removed. Subsequently, the medium was changed once every other 24 hours. When 80% confluence, UCB-MSCs were digested by the mixture of pancreatin-athylenediamine tetraacatic acid.MAIN OUTCOME MEASURES: Morphological changes of UCB-MSCs were observed by inverted phase contrast microscopy. Cell immunophenotypes were determined by flow cytometry.RESULTS: A small quantity of adherent round cells were determined after 24 hours, and adherent cells became more at 48 hours,with a few monopole spindle cells. Cell colonies were detected at day 7. Fibroblast-like cells arranged parallelly, presented whirlpool-shape and unclear boundary, with 80% 80% confluence 2-3 weeks following culture. At the second passage, these calls adhered at hour 12, and reached 80% 90% confluence at day 10. Flow cytometry showed that these calls were positive for CD29 and CD44, but negative for hematopoietic lineage marker CD34.CONCLUSION: MSCs can be successfully isolated from human UCB by using this modified method in vitro, with short culture cycle and high cell purification. Adherent cells have the same immunophenotype as bone marrow mesenchymal stem cells.

Objective To study the therapeutic effect of pulse-activating injection on acute poisoning by pa-raquat(PQ). Methods 50 Sprague-Dawley (SD) rats were randomly divided into five experimental groups: blank group, negative control group, positive control group, low-dose pulse-activating injection group (LDG), and high-dose pulse-activating injection group(HDG) (n = 10 for each group). Blank group were injected with normal suline,30 ml/kg,and other groups were established as acute paraquat poisoning models. Macroscopic and histopathological ex-aminations were performed and biological indexes were measured for the lung specimens. The indexes included lung wet weight/dry weight,the rats of neutrophils and protein content in the pulmonary alveolar lavage fluid. In the mean time, the level of malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) both in plasma and bronchoalveolar lavage flui(BALF) were detected. Results Compared with that in negative control group,lung congestion and lung edema of LDG group were mitigated; and the MDA level decreased from (5.04± 0.50) nmol/ml,(1. 19±0.18) nmol/ml to (4.04±0.21) nmol/ml,(0.79±0.04) nmol/ml both in plasma and BALF;the SOD activities were increased from (123.30±20. 39) U/ml, (26.43±2.22) U/ml to (277.09± 11.66) U/ml,(37.10± 2.49) U/ml as well; the GSH-Px activities were increased from (1796.63 ±81. 12) U/ml, (598.24 ± 62.50) U/ml to (2151.54 ± 148.32) U/ml, ( 1788.44 ± 175.11 ) U/ml as well ( P < 0. 01 ). Conclusions Administration of pulse-activating injection could improve the lipid peroxidation damage caused by a-cute poisoning of PQ.

Objective To study the changes of hemodynamic parameters and electrolytes observed within 72 hours of hypothermic therapy in porcine model of cardiac ventricular fibrillation after cardiopulmonary resuscitation (CPR ) in order to provide clinical basis for safe application of mild hypothermia.Methods After typical ventricular fibrillation (VF)for 8 minutes,the survival animals were randomly (random number)divided into two groups,namely normothermia group and hypothermia group. Upon restoration of spontaneous circulation (ROSC ),swine of the hypothermic group was treated by endovascular cooling device at a rate of 1 ℃/h until 33 ℃ and it was maintained for 12 h,then rewarming was initiated passively at a rate of 0.5 ℃/h until 38 ℃.The neurologic deficit scores (NDS)of swine were used to evaluate neurological function at 24 h and 72 h after recovery.Serum levels of potassium and sodium were measured at 0.5 h,6 h,12 h,24 h and 72 h after recovery.Results ROSC (restoration of spontaneous circulation)rate was 84.2%.The hypothermia group had higher survival rates at 24 h (75%) and 72 h (62.5%)compared to the normothermia group (37.5% and 25%,respectively),(P<0.01 ). There were no significant differences in hemodynamic variables (HR,MAP,CO,PAWP and CVP)between the two groups (P<0.05 ),Serum potassium of the hypothermia group was lower obviously at 24 h after recovery (3.41 ±0.11)(P<0.01),and there were no significant differences in serum sodium at all the intervals,and there were no significant differences in underlying trend of electrolytes changes over time (P>0.05).The mean NDSs at 24 h and 72 h after recovery was 112.5 (98.75 -126.25)and 61 (50-75), respectively,in the hypothermic group,and 230 (225 -235)and 207.5 (165 -250),respectively,in the normothermia group (P <0.01 ).Conclusions Hypothermia has little influence on serum levels of potassium and sodium,and mild hypothermia following resuscitation improves neurological function in the porcine models of cardiac fibrillation.

Objective:To study the healing effect of Chitin dressing on second-degree scalds in mice and rabbits respectively.Methods:The model of the second-degree scald was established in mice and rabbits respectively by vapour and hot water;the healing time was observed and the tissue specimens were obtained from the scalds for pathologic analysis.Results:Compared with the contrast group,the healing time in chitin dressing treated group was shorter(P

Objective To observe the effects of fluvastatin on proliferation and apoptosis of HL-60 cells,and to offer the theoretical evidence for tumor treatment.Methods HL-60 cells were divided into:fluvastatin groups(0.5,5.0,10.0 and 20.0 ?mol?L-1),HL-60 control group,positive control group(treated with 10.0 ?mol?L-1ATRA).The live cell number was counted for cell proliferation assay.The growth inhibitory rate of HL-60 cells was detected using CCK-8 kit.The cell cycle distribution and apoptotic rate were measured using flow cytometry assay.Results Compared with control group,after HL-60 cells were treated with 0.5,5.0,10.0 and 20.0 ?mol?L-1of fluvastatin for 1-4 d,the number of live cells decreased in different level(P

Objective To understand the drug resistance and changes of Pseudomonas aeruginosa in Tianjin Medical University Eye Hospita and to explore the relationship between the drug resistance and the dosage of antimicrobial agents, so as to provide the basis for clinical rational drug use.MethodsUsage of antibiotics in our hospital during 2012 to 2016 were analyzed retrospectively, and the drug resistance of pseudomonas aeruginosa were calculated respectively.SPSS 22.0 software was used to analyze the drug resistance and the frequency of use of antimicrobial agents (DDDs).ResultsResistance rate of pseudomonas aeruginosa to aztreonam, ceftazidime and meropenem were decreased gradually.Resistance rate of pseudomonas aeruginosa to gentamicin increased gradually.The resistance of pseudomonas aeruginosa to piperacillin, imipenem, cefepime, evil ciprofloxacin, piperacillin/tazobactam tazobactam and cefempidone/sulbactam is in a state of fluctuation.Piperacillin DDDs were significantly negatively correlated with gentamicin resistance.There was a significant positive correlation between imipenem DDDs and gentamicin resistance and there was a significant negative correlation between imipenem DDDs and drug resistance rates of piperacillin, imipenem, ceftazidime, meropenem, levofloxacin and cefoperazone/sulbactam.There was a significant positive correlation between aztreonam DDDs and ceftazidime, meropenem, ciprofloxacin and cefoperazone/sulbactam, There was a significant negative correlation between cephalosporin DDDs and gentamicin resistance rates.There was a significant positive correlation between the DDDs of piperacillin/tazobactam and the resistance rate of piperacillin/tazobactam;the resistance rates of cefoperazone/sulbactam DDDs to aztreonam and meropenem were Significant negative correlation.ConclusionDrug resistance of pseudomonas aeruginosa and the dosage of clinical antibacterial drug is closely related, suggesting that clinicians should use antibiotics for clinical rationally, in order to reduce the number of drug resistance of pseudomonas aeruginosa.