Acute lung injury/acute respiratory distress syndrome (ALI/ARDS) refers to acute progressive respiratory failure with stubborn hypoxemia induced by different predisposing factors except cardiogenic causes. The definition of ALI/ARDS have been renewed and standardized in recent years, thus there is a new understanding in the pathogenesis of ALI/ARDS. The new diagnostic criteria and the combining therapeutic measures of ALI/ARDS have been proposed. With the progress in research pertaining to ALI/ARDS and the new insight into the pathogenesis of intractable systemic inflammation, new therapeutic measures directing at controlling and regulating inflammatory responses may be expected to achieve a breakthrough in the treatment of ALI/ARDS.

Objective To investigate the clinical efficacy of gastrectomy and simple repair in the treatment of acute gastric perforation.Methods 132 patients with acute gastric perforation were randomly divided into the control group and observation group by random number table,66 cases in each group.The control group received gastrectomy,the observation group was given simple repair treatment.The clinical efficacy,clinical indicators and ulcer recurrence Visick grading of patients in two groups were observed.Results The total effective rate of the observation group (87.9％) was significantly higher than that in the control group(71.3％) (x2 =5.634,P ＜ 0.05).The operative time,bed time,gastrointestinal function recovery time and hospitalization time in the observation group were (38.76 ± 6.23) min,(4.26 ± 1.67) d,(28.68 ± 4.74) h,(11.52 ± 2.32) d,those in the control group were (72.13 ± 10.78) min,(10.01 ± 2.21) d,(45.61 ± 5.69) h,(25.65 ± 3.95) d,there were statistically significant differences between the two groups(t =21.773,25.058,18.572,16.863,all P ＜ 0.01).The relapse rate in the observation group (4.6％) was significantly lower than that in the control group (15.2 ％) (x2 =4.181,P ＜ 0.05).Conclusion The simple repair in the treatment of acute gastric perforation has significant effect,it can effectively reduce the value of clinical parameters and the recurrence rate of patients,which has important clinical application value.

Objective To observe the influence of different dosage of mannitol on hemodynamics after hypertensive intracerebral hemorrhage ( HIH ). Methods Sixty cases with HIH were divided into three groups by random digits table with 20 cases each. Performing routine treatment, also 20% mannitol 250 ml was used 3-4 times/d for 14-21 d in group A,20% mannitol 125 ml was used 2-3 times/d for 3-14 d in group B,and mannitol was not used in group C. The mean blood flow velocity(Vm) and pulsatility index (PI)in bleeding side of the middle cerebral artery (M1) were measured by TCD, and monitoring patient's kidney function. Results After treatment 1 d , Vm comparative differences among three groups were no statistically significant (P ＞ 0.05 ), and after treatment 10 d and 3 weeks, the Vm in group A [(45.01 ± 5.13 ), (59.41 ±7.24) cm/s] and group B [(44.61 ± 5.04), (58.94 ±7.12) cm/s] were significantly higher than those in group C [(42.42 ±4.26), (55.06 ±7.16) cm/s] (P ＜0.05), but the differences were no statistically significant between group A and group B (P ＞0.05). With the extension of treatment time, PI recovery gradually, but compared PI,after treatment 1 d, 10 d and 3 weeks,there were no statistical differences among three groups (P ＞ 0.05 ). After treatment 3 weeks, kidney function abnormal ratio in group A [35.0%(7/20)] was significantly higher than that in group B [20.0% (4/20)] and group C [15.0% (3/20)] (P＜0.05). Conclusion Using small dosage of mannitol,not only increase HIH cerebral blood flow velocity,improve brain blood perfusion,reduce cerebral ischemic injury,but also reduce kidney damage,safety is higher.

The results of analysing 179 patients with pulmonary heart disease (PHD) show an acid-base disorder just before death.Acid-base disorder,chronic respiratory acidosis is the most commoa Triple acid-base disorder,chronic respiratory acidosis plus metabolic acidosis and chronic respiratory acidosis plus metabolic alkalosis are in succession.Chronic respiratory alkalosis ( CRA),CRA plus metabolic alkalosis and metabolic acidosis are seldom.The major cause of death in patients with PHD is supper gastrointestinal hemorrhage,the next is acid-base disorder,especially triple acid-base disorders.

Acute lung injury(ALI) and acute respiratory distress syndrome(ARDS) are commonly encountered serious diseases.The pathogenesis of ALI and ARDS remains unclear at present.The mortality rate of ALI and ARDS remains high due to the Absence of sensitive method for early diagnosis and specific and effective therapy.The present paper will focus on the latest developments of diagnosis and treatment for ALI and ARDS.Diagnosis:Althongh theoretically it is possible to look for the diagnostic markers and target of injury by painstaking study of its pathogenesis,but as yet an ideal pathognomonic marker with due sensitivity and specificity remains unavailable.Diffuse alveolar injury is a major pathological feature and may act as a reliable parameter for the diagnosis of ALI and ARDS.However,it is difficult to obtain the lung tissues from living patients with ALI/ARDS,and dynamic monitoring of arterial blood gas,combined with clinical symptoms,is still the main criterion for early diagnosis of API and ARDS in clinical setting.Therapy:The use of corticosteroids to subdue rampant inflammatory reaction had not given a promising result in clinical study,so it is not recommended for routine use,however short-term corticosteroids may be considered for allergy-or aspiration-induced ALI in early stage.With the treatment of primary diseases as the main strategy,the main therapeutic measures for ALI/ARDS should be integrated treatment of multiple targets and correction of hypoxia.Mechanical ventilation is the main substitutive therapy for correction of hypoxia.Protective ventilation with adequate tidal volume and positive end-expiratory pressure(PEEP) are recommended.Briefly,management of primary disease,correct use of mechanical ventilation,nutritional support and specific treatment for pathological changes and clinical manifestation are important for ALI and ARDS patients.Hereafter,emphasis should be placed on seeking the methods for early diagnosis and effective therapies for diffuse alveolar injury and massive inflammation.

AIM: To explore the changes of L-selectin expression on peripheral blood polymorphonuclear leukocytes (PMNs) and their significance in rats with acute lung injury (ALI). METHODS: ALI model in rat was established by intravonous injection of E. coli endotoxin (ET). The expression of L-selectin on peripheral blood PMNs was measured by immunofluorescence and flow cytometry.RESULTS: The contribution of L-selectin fluorescence signal was on the surface of PMNs membrane. The expression of L-selectin on poeripheral blood PMN was significantly lower at 5 min after injection of ET and the lowest during 15 min to 30 min, then gradually increased, but the expression of L-selectin on PMN was lower at 60 min after injection of ET than that of control animal.CONCLUSION: In physiological state, L-selectin were expressed on the surface of PMN membrane. The protein expression of L-selectin on PMNs reduced rapidly after injection of ET and the lowest at 15 min, then gradually increased. L-selectin may play a role in the development of ALI.

When a series of omics technologies such as genomics, epigenomics and proteomics are proposed, the concept of metabolomics occurs. Metabolomics is a top-down system biology approach, which analyzes endogenous metabolites by using high throughput, high resolution and high sensitivity based on metabolic analysis platform. By identifying characteristic biomarkers and analyzing the biomarkers of metabolic pathway, it will provide a new way for the diagnosis and treatment of diseases. Therefore, it is more and more widely used in bronchial asthma, chronic obstructive pulmonary disease, pulmonary cystic fibrosis, acute respiratory distress syndrome, pulmonary tuberculosis, lung cancer and other respiratory diseases. In this paper, the application of metabolome analysis in respiratory disease of recent years has been briefly reviewed.

Objective To investigate the influence of the chronic mountain sickness (chronic mountain sickness, CMS) on Cerebrovascular reactivity (CVR) and regulators of cerebrovascular responses. Methods Twenty-six CMS pa?tients and 23 healthy control group using transcranial Doppler ultrasound (Transcranial Doppler Ultrasoiund, TCD) as?sessment of CVR, enzyme-linked immunosorbent assay were applied to measure the serum levels of the endothelin (endo?thelin 1 , ET-1) and its receptor (endothelin receptor B, ETBR), endothelial nitric oxide synthase (endothelial nitric oxide synthase, eNOS) in CMS patients and healthy control. Results CVR (3.84 ± 3.01) was significantly lower in CMS patients than in the healthy control CVR (6.39 ± 6.87) (P <0.05); the serum concentration of ETBR in CMS patients was higher than in control [(386.07±281.57)μg/μL vs.(312.30±238.07)μg/μL] (P<0.05). Conclusions The cerebral circulation re?serve in CMS patients is significantly lower compared with healthy people. The regulation of vascular capacity by serum ET-1 and eNOS is similar between CMS patients and healthy control. The hypoxic vasodilatation in CMS patients is close?ly associated with cerebrovascular high expression of ETBR. This study may provide a scientific basis for the prevention and treatment of cerebral infarction in the patients with chronic mountain sicknes.

Objective To construct human eukaryotic expression system expressing T cell surface molecule CD40L and identify the expression product in SCCL cell line h446. Methods The expression vector pcDNA3.1-CD40L was constructed by recombinant DNA technology, then transfected into h446 cell line of SCCL by lipidosome methods, and the expressed membrane protein was identified by flow cytometry. Results The pcDNA3.1(+)-CD40L was constructed successfully and the coding region was inserted into the vector correctly. The membrane protein was observed by flow cytometry on transfected h446 cell line of SCCL. Conclusion Human CD40L was expressed successfully in eukaryotic system, which is very important in the anti-tumor vaccination study with a recombinant human CD40L in clinic.

Background and purpose:Extraovarian peritoneal serous papillary carcinoma(EPSPC) originats from peritoneum with rare incidence, sometimes may affect the surface of ovary and have multi-focal lesions, whose standard therapy have not been established. In this study, we preliminarily reviewed the clinical characteristics, treatment and prognosis of EPSPC in 11 cases. Methods:The clinical characteristics of 11 cases with EPSPC were first retrospectively analyzed. All the patients underwent cytoreduction surgery followed by chemotherapy. Finally, short-term and long-term effi cacy, time to progression (TTP) and overall survival were evaluated by RECIST, respectively. Results:Abdominal pain, distention and ascites were the most common presenting symptoms, but tumors could be palpable in only 18.2% of the patients. The positive rate of ascites, abdomen B ultrasound,MRI scan and ascending CA125 level in the plasma and ascites was 100%,45.5%,100%,72.7%,81.2%,respectively. The successful rate of cytoreduction surgery was 45.5% for the EPSPC. After chemotherapy, the cases of complete remission, partial remission, stable disease and progression disease were 1(11.1%,1/9),3(33.3%,3/9),2(22.2%,2/9) and 3(33.3%,4/9), respectively. TTP was 5-14 months for all the patients and the median TTP was 8.6 months. The 1,2,3-year overall survival was 72.7%,18.2%,0%, respectively and the median overall survival was 14.6 months. Conclusions: Ascite, abdomen MRI scan and CA125 level are the most meaningful factor to diagnose EPSPC. EPSPC is a carcinoma of poor prognostic with non-specific clinical characteristics, low successful rate of cytoreduction surgery and is chemotherapy-resistent.