In order to observe the pattern of energy expenditure in trauma patients,the REE, substrate oxygenization and nitrogen balance were measured in1 8severely injured patients. REE in posttrauma day1 was1 882? 2 45 kcal/d,1 .1 9of HBBEE,reduced gradually to normal range on posttrauma day 1 0 .REE in single trauma patients decreased more rapidly than that in multiple trauma patients.REE in patients with APACHE ≥ 1 2 was higher than that in patients with APACHE

Objective To evaluate the hemorrheological changes after tourniquet deflation.Methods Twenty rabbits were subjected to lower extremity tourniquet inflation for 3 h. Venous blood samples were taken before tourniquet inflation and 2min after tourniquet deflation for measurement of hemorrheological parameters: low-shear viscosity and high-shear viscosity of whole blood; plasma high-shear viscosity , hematocrit; fibrinogen; aggreability,deformability and stiffness of erythrocyte; and blood sedimentation K value. The levels of parameters before tourniquet inflation served as baseline values. The gastrocnemius muscle samples were taken before tourniquet inflation and 5 min after torrniquet deflaion for observation of ultrastructure of small blood vessel.Results Compared with the baseline values, the levels of low- and high- shear viscosities of whole blood, plasma viscosity, fibrinogen, blood sedimentation K value, and aggreability and stiffness of erythrocyte increased significantly (P

Objective To explore the clinical significances of leukocyte (WBC ) ,C‐reactive protein (CRP ) and procalcitonin (PCT) in early diagnosis of bacterial bloodstream infections (BSI) ,in order to provide references for early diagnosis of BSI . Methods The detection results of WBC ,PCT and CRP from 48 cases of patients with positive blood culture(positive blood culture group) and 50 cases of patients with negative blood culture(negative blood culture group) were retrospectively analysed .Then com‐pared the detection results between the two groups ,and between patients with gram‐positive bacteria infection and those with gram‐negative bacteria infection in the positive blood culture group .The diagnostic performance of WBC ,PCT and CRP were determined by drawing the receiver operator characteristic(ROC) curves ,and areas under ROC curves(ACUs) were calculated .The perform‐ance of the three indicators in predicting BSI were evaluated by using the binary logistic regression analysis .Results The levels of PCT and CRP in positive blood culture group was significantly higher than those in negative blood culture group ,had statistically significant differences(P<0 .05) ,while no statistically significant difference was found in WBC count between the two groups(P>0 .05) .In the positive blood culture group ,statistically significant difference was only found in PCT level between patients with gram‐positive bacteria infection and patients with gram‐negative bacteria infection(P<0 .05) .The AUCs of WBC ,PCT and CRP were 0 .579 ,0 .746 and 0 .624 ,respectively .The result of the binary logistic regression analysis showed that only PCT made a unique statistically significant contribution to the model(P=0 .013) for predictive diagnosis of BSI .And the positive predictive rate of joint detection of these three indicators was 71 .4% .Conclusion WBC ,PCT and CRP could be indicators for early diagnosis of BSI ,while PCT and CRP might have much more important significance ,moreover ,PCT could distinguish between gram‐positive bacterial in‐fection and gram‐negative bacteria infection .

Objective To observe the expression of connective tissue growth factor (CTGF) in pancreas, and discuss its significance. Methods The pancreatic fibrosis model was induced by high fat diets. The rats were sacrificed 16 weeks later, and the pancreatic tissue was harvested for routine pathologic examinations. Pancreatic collagen fibrosis I was determined by HE and Sirius red staining;α-SMA and CTGF expression were detected by immunohistochemistry. Results After pancreatic fibrosis, pancreatic lobules and acinar atrophy was observed, lobules gap was widened, interstitial fibrous tissue was significantly proliferated, the synthesis of pancreatic collagen fibrosis I was significantly increased when compared with normal pancreas ( 1500.2 + 255.8 vs. 57.4 ± 23.2, P ＜ 0. 01 ), the expression of α-SMA was significantly increased when compared with normal pancreas( 1500.2 + 255.8 vs. 57.4 + 23.2, P ＜ 0. 01 ), and the expression of CTGF was significantly increased when compared with normal pancreas (2950.5 ± 431.9 vs. 382.2 + 190.8, P ＜0.01 ), and there were abundant activated PSCs. Conclusions CTGF participated in the regulation of pancreatic fibrosis development; the function of CTGF was closely related to PSCs activation.

ObjectiveTo explore the sensitivity of cancer stem cells to chemotherapy in human pancreatic carcinoma.MethodsPANC-1 ceils were cultured in an incubator filled with 5％ CO2 at a temperature of 37℃,and were labeled with Hoechst 33342.The SP analysis and sorting were performed using a FACSVantage SE.RT-PCR was performed to detect the expression of human CD133 ABCG2 and Notch1.SP and non-SP cells from the PANC-1 cell line were treated with 5-fluorouracil (5-FU; 1,10,or 100 μg/ml) or gemcitabine (10,100,or 1000μg/ml),and the cell viability was determined using the MTT assay.The sensitivity of sorted tumor cells to chemotherapeutics was determined in NOD/SCID mice model.ResultsSP cells were found to have higher drug-resistance both in vivo and in vitro and higher levels of mRNA expression for CD133,ABCG2 and Notch1,when compared to non-SP ceils.The xenografted tumors derived from injected SP cells and treated with gemcitabine had more CD133± cells than the untreated group.ConclusionsThe SP of PANC-1 pancreatic carcinoma cells are enriched with highly gemcitabine-resistant CSCs and determine the carcinogenesis of the PANC-1 pancreatic carcinoma cells.

Objective To study the relationship of levels of circulating endothelial microparticles (EMP62E, EMP31) and high-sensitivity C-reactive protein (hs-CRP) with severity of chronic left heart failure in elderly patients. Methods According to New York Heart Association (NYHA) class and left ventricular ejection fraction (LVEF), the healthy subjects and the patients were divided into five groups: control group [LVEF: (63.97±4.65)%], classⅠ group [LVEF: (42.67±2.06)%], classⅡ group [LVEF: (34.26±3.17)%], class Ⅲ group [LVEF: (29.05±1.07)%] and class Ⅳ group[ LVEF:(25.17±1.42)%] . The levels of circulating EMP62E, EMP31 and hs-CRP of the patients and healthy subjects were measured by flow cytometry and nephelometry immunoassay, respectively. Results There were significantly differences in EMP62E, EMP31 and hs-CRP between class Ⅳ group and classⅠ group P＜0.01) EMP62E [(1092.7 ± 102.8) counts/μl vs. (291.0±21.9) counts/μl], EMP31 [(1596.1±46.3) counts/μl vs. (477.8±40.3) counts/μl] and hs-CRP [(14.74±0.07) mg/L vs. (4.86 ± 0.09) mg/L]. The levels of circulating EMP62E, EMP31 and hs-CRP were gradually elevated significantly along with the increased severity of chronic left heart failure in elderly. Conclusions The upregulation of circulating EMP31, EMP62E and hs-CRP may contribute to the development of chronic heart failure in elderly.

Objective To observe the effect of changes in CD34+ cell level on various degrees of chronic heart failure (CHF) in the elderly. Methods The enrolled patients were divided into four CHF groups according to the New York Heare Association(NYHA) functional class: NYHA class I (n=23), Ⅱ (n=27), Ⅲ (n = 20) and IV group (n= 16) , and there were 41 healthy controls over the same period. The levels of peripheral blood CD34+ cells were measured, and the tumor necrosis factor-α (TNF-α). its soluble receptors (sTNFR-1 and sTNFR-2) and vascular endothelial growth factor (VEGF) were also measured. Results The levels of CD34+ cells were elevated in the early CHF and depressed in the advanced CHF in elderly patients. The levels of CD34+ cells were (0. 6± 0.2) 109/L in control group, (2.4±0. 4) 109/L in NYHA class I group, (1.9±0.2)×109/L in NYHA class Ⅱ group, (1.3±0.1)×109/L in NYHA class Ⅲ group and (0.5±0.2)×109/L in NYHA class Ⅳ group, respectively (all P<0.01).And TNF-α, sTNFR-1, sTNFR-2 and VEGF were increased in severe chronic left ventricular failure CNYHA class IV vs. I group:TNF-α: (61.4± 15.7) ng/L vs. (28.4±10.8)ng/L; sTNFR-1: (2820.9±1282.8)ng/L vs. (690.8±62.7) ng/L; sTNFR-2: (4113.1±1102.2) ng/L vs. (740.8± 112.3)ng/L; VEGF: (996.3±487.1)ng/L vs. (423. 3±147. 9)ng/L, all P<0. 013. Conclusions The changes of CD34+ cell level may predict various degrees of chronic heart failure in elderly patients.

Objective To observe the effects of penehydidine hydrochloride (PHC) on t acute lung injury ( ALI) . To investigate into the expression of TLR4 on peripheral monocytes, kinetics of inflammatory and anti- inflammatory mediators. To explore the mechanism of TLR4 in ALI. Method A total of 45 patients with ALI were randomly divided into PHC treatment group(experimental group, n =21) and routine treatment group (control group, n = 24) . Patients of both groups were given with the routine treatment,and patients in experimental group were given with PHC in addition (1 mg,im,ql2h) . Therapeutic effects, average length of hospital stay, ICU stay,PaO_2 and PaO_2/FiO_2 > as well as the expression of TLR4 and some cytokines were observed for 48 hours. Results Patients of both groups got better gradually after treatment. The PaO_2 and PaO_2/FiO_2 of patients of both groups progressively increased. At 6 hours, 12 hours, 24 hours and 48 hours after treatment, the PaO_2 and PaO_2/FiO_2significantly increased than 0 hour ( P < 0.05). The improvement in experimental group was obviously better than that in control group at 6 hours, 24 hours and 48 hours after treatment (P < 0.05). There were no differences in average length of hospital stay between the two groups. The ICU stay was significantly shorter in the experimental group ( P < 0.01) . The expressions of TLR4 were higher in patients of both groups than in healthy ones (P <0.01) . TLR4 decreased significantly at 24 hours and 48 hours, while it was lower in experimental group than that in the control group (P < 0.05). The higher level of TLR4in the early stage implied worse prognosis. Most of them deteriorated to ARDS stage. At 24 hours, the incidence of ARDS in experimental group was 23.8 % , and 29.17% in control group. Two patients in control group didn' t become ARDS till 48 hours. Serum IL-1, IL-8 and TNF-α level reduced atr 24 hours in both groups. The reduction of IL-8 and TNF-α in experimental group was more obvious than in control group ( P < 0.05). IL-13 increased gradually from 0 hour to 24 hours, then descended a little at 48 hours. There was no difference in IL-13 some difference between the two groups ( P > 0.05) . Conclusions PHC can improve the arterial oxygen pressure, down-regulate TLR4, restrain inflammatory factors in its signal transduction downstream. This inhibitory action is not accomplished by increase in anti-inflammatory factors,but by down-regulating TLR4. PHC can prevent the development of ALI, and can be considered to act as an effective medicine for the treatment of ALI. TLR4 plays an important role in ALT process, and it is suggested that TLR4 can be used as a prognostic factor.

Objective To evaluate the effect of tripterine on hydrochloric acid-induced acute lung injury(ALI)in mice.Methods Eighteen pathogen-free healthy adult male ICR mice,aged 7-9 weeks,weighing 25-30 g,were divided into 3 groups(n=6 each)using a random number table:control group(group C),hydrochloric acid-induced ALI group(group ALI)and tripterine group(group T).ALI was induced by a single intratracheal instillation of hydrochloric acid 2 ml/kg(pH 1.5)via a 24-gauge angiocatheter inserted into the trachea in pentobarbital sodium-anesthetized mice.Tripterine 3 mg/kg was injected intraperitoneally once a day for 3 consecutive days,and then the model was established in group T.The mice were sacrificed at 6 h after instillation,and lung specimens were obtained for microscopic examination and for determination of the levels of tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),macrophage migration inhibitory factor(MIF)and myeloperoxidase(MPO)in lung tissues.Results Compared with group C,the levels of TNF-α,IL-6,MIF and MPO were significantly increased at 6 h after instillation in ALI and T groups(P<0.01).Compared with group ALI,the levels of TNF-α,IL-6,MIF and MPO were significantly decreased at 6 h after instillation in group T(P<0.01).The pathological changes of lung tissues were significantly attenuated in group T compared with group ALI.Conclusion Tripterine can attenuate hydrochloric acid-induced ALI in mice.

Objective To investigate the drug resistant mechanism and homology of three strains of carbapenem-resistant Klebsiella pneumoniae (K.pneumoniae) isolated from different sites of one patient.Methods Three strains of carbapenem-resistant K.pneumoniae were isolated from femoral vein catheter tip,wound secretions and sputum of a patient with severe burns,respectively.Their carbapenemase,metallo-β-lactamase (MBL) and drug resistance genes were detected by modified Hodge test,double-disk synergy test and combination disk diffusion and PCR,respectively,and homology and biological typing were analyzed by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) assay and multilocus sequence typing (MLST) technology,respectively.Results The carbapenemase and MBL of three strains of carbapenem-resistant K.pneumoniae were negative and positive,respectively.The blaNDM-1 gene was identified from the three strains,but other drug resistance genes such as blanC,blaGES,blaIMP,blaSPM,blaVIM,blaGIM and blaOXA-48 were not detected.ERIC-PCR showed that three isolates belonged to the same genotype,and MLST showed that they were type ST17.Conclusion Carring blaNDM-1 gene is the main cause leading to the drug resistance of three strains of carbapenem-resistant K.pneumoniae,and they belong to the same genotype.