0.05).Conclusions Fluid therapy guided by functional hemodynamic index SVV in elderly patients with severe sepsis under MV is safe and more effective than that guided by CVP.SVV is valuable in prodicting the response to fluid treatment in elderly patients with severe sepsis.

Objective To evaluate the predictive value of brain natriuretic peptide (BNP) on mortality in elderly patient with severe sepsis or septic shock. Method Eighty-three elderly patients meeting with criteria of severe sepsis or septic shock by the American College of Chest Physicians and the Society of Critical Care Medicine (ACCP/SCCM) in 2001, admitted in Intensive Care Unit (ICU) of Zhejiang Hospital during May 2004 to June 2007, were enrolled, and patients with chronic renal failure were excluded. The patients were divided into survivor and non - survivor group according to whether they survived within 28 days staying in ICU, the difference of plasma BNP level,serum C-creative protein (CRP) concentration, APACHE II and SOFA scores on admission day and BNP level on the third day between the two groups were compared; thereafter, the relationship between muhiple variables including age, admission day, BNP, CRP, APACHE 11 and SOFA scores, the 3rd day BNP level and 28-day mortality were analyzed by Logistic regression, and meanwhile the independent predictors for ICU moaality among which were determined. Results BNP levels on both admission day and the 3rd day were significantly higher in nomurvivor group than those in survivor group[ ( 1056.38±676.34) pg/ml vs. (611.59±610.02) pg/ml,p =0.002 and (1448.48+891.11) pg/ml vs. (522.41±575.20) pg/ml, P<0.001, respectively]. By Logistic regression analysis, BNP level on the 3rd day and SOFA score on admission day were independent predictors of ICU mortality, The receiver operating characteristic (ROC) curves indicated that values of areas under the curve of the admission day and the 3rd day BNP levels for 28-days mortality were 0.735 (95% CI,0. 621～0. 848, P <0.001) andO.836 (95% CI, 0.746～0,926,P<0.001), respectively. Conclusions Plasma BNP inereaseds in majority of eldedy patients with severe sepsis or septic shock, which may serve as irdex for prognosis in elderly severe septic paients.

Objective To explore the significance of the plasma procalcitonin (PCT) level for directing antibiotic therapy in elderly patients with ventilator-associated pneumonia (VAP).Methods The 50 elderly patients with VAP were randomly separated into the regular therapy group and the PCT-directed therapy group. The regular therapy group was given regular antibiotic therapy, while the antibiotic therapy was decided according to the plasma level of PCT in the PCT-directed therapy group. The used time and utilization rate of antibiotics, as well as inflammatory indicators including white blood cells, neutrophils, C-reactive protein (CRP) and clinical pulmonary infection score (CPIS) were compared between the two groups. Results After treatment, there were no significant differences in white blood cells, neutrophils and CRP between the PCT-directed therapy group and regular therapy group [(8.9 ± 3.5 ) × 109/L vs. (9.4 ± 3.7) × 109/L, 0.62 ± 0.04 vs.0.60±0.04, (18.7±8.5) mg/Lvs. (21.6±6.0) mg/L, t=0.47, 1.84 and 1.37, allP＞0.05],but the CPIS was markedly lower in PCT-directed therapy group than in regular therapy group [(4.0± 1.4) scores vs. (4.7± 1.0) scores, t= 2. 18, P＜0.05]. The neutrophils, CRP and CPIS were significantly lower after treatment than before in the both groups. The concentration of PCT was decreased after treatment than before [(0.5 ± 0.9) mg/L vs. (1.7 ± 0.7) mg/L]. Meanwhile, the time using antibiotics was longer in regular treatment group than in PCT-directed therapy group [(8.72±1.32) d vs. (5.17±0.72) d, t=11.96, P＜0.01], the utilization rate of antibiotics was higher (95.2 % vs. 55.2 %, χ2 = 12.41, P＜0.01) in regular treatment group. Conclusions Using PCT levels for directing treatment in elderly patients with VAP can achieve better curative effect and reduce the use of antibiotics.

Objective To investigate the role of damaged mitochondria in cardiac cell apoptosis in septic rats and the possible mechanism involved.Methods Seventy-two Sprague-Dawley rats were randomly (random number) divided into negative control group (n =18) and septic group (further divided into three groups as per rats sacrificed 6 h,12 h,and 24 h after endotoxin injection intra-peritoneally,n =18).The hearts of rats were taken.The changes of cardiac morphology were observed under light microscope and scanning electron microscope.Cell apoptosis in situ were examined by using terminal transferase-mediated dUTP nick end-labeling assay and nuclear factor-kappa B (NF-κB) activation in myocardium was detected by using Western blotting to estimate myocardial cell apoptosis.Mitochondrial lipid and protein oxidation were measured to assess oxidative stress,and mitochondrial superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were determined to estimate antioxidant defense.Results Septic induced inflammatory cells infiltration,myocardium degeneration and effusion in a time-dependent manner.A remarkable expansion of capillaries could be observed in the hearts of infected rats at post-challenge of 24 h.Compared with sham-treated rats,the percentage of apoptosis increased in a time-dependent manner in the hearts of infected rats at 6 h,12 h,24 h of post-injection (P ＜0.05).The concentration of NF-κB p65 in the cytosol decreased gradually and increased in the nucleus during sepsis in a time-dependent manner (P ＜0.05),indicating that septic challenge provoked progressive activation of NF-κB.Mitochondrial cristae disappeared in 6 h of challenge,and significant mitochondrial cristae disappearance,vacuolization,and rupture of mitochondria membrane became markedly obvious 12 and 24 h later.Both SOD and GPx activities decreased,while mitochondrial lipid and protein oxidation increased in a time-dependent manner after 6-24 h of challenge (P ＜ 0.05).Conclusions Septic challenge induced myocardial apoptosis and mitochondrial damage.Further,damaged mitochondria might play an important role by means of alteration of defenses against reactive oxygen species in myocardial cell apoptosis during sepsis.

Objective To investigate the clinical values of central venous pressure (CVP) versus stroke volume variation (SVV) in patients with severe sepsis after early goal-directed therapy (EGDT).Methods Totally 30 mechanically ventilated patients with severe sepsis who underwent goal-achieved EGDT were enrolled and randomly divided into CVP group (study group) and SVV group (control group) according to the data detected by pulse contour continuous cardiac output (PiCCO) analysis device.The differences in 28-day survival,3-day APACHE Ⅱ score,time of ICU stay,duration of mechanical ventilation,number that need CRRT,entral venous pressure (CVP),heart end-diastolic volume index (GEDVI),intrathoracic blood volume index (ITBVI),extravascular lung water index (EVLWI),cardiac index (CI),central venous oxygen saturation (ScvO2),lactate clearance rate and APACHE Ⅱ score were compared between the 2 groups.Results The death rate had no difference between the 2 groups(x2=0.240,P=0.624).Among survival patients in the CVP group,the time of ICU stay and duration of mechanical ventilation were shorter in study group than in control group(t=2.166,P=0.041;t=2.104,P=0.046),APACHE Ⅱ score at 3th day was decreased(t=2.20,P =0.038).The values of ITBVI,GEDVI,CI,lactate clearance rate were higher in study group than in control group (t=2.759,2.146,2.199,2.654,3.362,P=0.011,0.043,0.038,0.014,0.003).EVLWI and APACHE Ⅱ score were not different (P＞0.05) between the two groups.Conclusions SVV as a recovery target for fluid resuscitation can reach a better recovery results and improvement of prognosis than CVP goal-achieved EGDT.

Objective To investigate the prognostic value of stroke volume variation (SVV) in patients with severe sepsis after early goal-directed therapy (EGDT). Method Thirty-eight mechanically ventilated patients with severe sepsis underwent EGTD were divided into high SVV (≥10%) group and low SW (< 10%) group according to the data obtained from pulse contour continuous cardiac output (PiCCO) analysis device. The differ-enees in the rate of 28-day survival, length of ICU stay, duration of meehanical ventilation and eomplieation of in-fection between two groups of patients were compared. The rate of 28-day survival of patients was analyzed by using Kaplain-Meier survival analysis, and the relationship between SVV and mortality within 28 days was analyzed by using logistic regression model. Results In comparison with low SVV group, the rate of 28-day survival of high SVV group was signifieantly increased (87.5 % vs. 57.1%, P = 0.032), the length of ICU stay was significantly shortened (27.1±9.2) vs. (41.6±10.0) (P = 0. 004) and duration of mechanical ventilation was significantly more brief (20.4±7.3) vs. (28.5±8.3) (P = 0.038). The rate of cumulative survival of patients in high SVV group was higher than that in low SVV group. In addition, logistie analysis showed SW < 10% increased the risk of 28-day mortality (OR = 3.97; 95% CI 1.63 - 9.21, P = 0. 014). Conclusions The SVV can be served as a prognostic indicator in patients with severe sepsis after EGDT.

Objective:To understand the positive rate of 2019 novel coronavirus (2019-nCoV) specific IgG antibody induced by Coronavirus Disease 2019 (COVID-19) inactivated vaccine in healthy population in Xizang Autonomous Region, and evaluate the immune effect of the vaccine.Methods:Serum samples were collected from COIVD-19 vaccine immunized health population without history of 2019-nCoV infection from six prefecture-level cities in Xizang Autonomous Region. The IgG antibody against 2019-nCoV were tested by chemiluminescence method. Then, the positive rate of IgG antibody was analyzed for different immunization histories and age groups.Results:A total of 22 255 participants were enrolled in this survey. After full-access (two doses of vaccine) and booster immunization, the overall positive rate of specific IgG antibody against 2019-nCoV was 96.38%. The positive rate of IgG antibody in the booster immunized population was 97.12%, which was much higher than the 88.38% in the full-access immunization population, the difference is statistically significant ( χ2=381.11, P<0.001). There was a significant differences in the positive rates of specific IgG antibodies in different age groups ( χ2=138.28, P<0.001). Especially in the younger age groups, including less than 10 years old and the 11-20 years age group, the positive rate of specific IgG antibody were 93.44% and 89.03% respectively, which were lower than those in other age groups. Except for Naqu city and the age group ≤ 10 years old, the differences in antibody positivity rates were statistically significant between different age groups in the same region and between the different regions in the same age group for the two populations with different immunization histories ( P<0.05). Conclusions:The COVID-19 inactivated vaccine showed a good immune effect in the healthy population in Xizang Autonomous Region, and the booster immunization helps to increase the positive rate of specific IgG antibody in healthy population.