Objective To investigate the clinical value of heart-type fatty acid-binding protein ( H-FABP) and N terminal probrain natriuretic peptide (NT-proBNP) in sepsis patients with myocardium injury. Methods 118 sepsis patients were included as survivor group (68 cases) and death group (50 cases) according to their prognosis outcome. 50 healthy people were selected as control group. Creatase, H-FABP, NT-proBNP, APACHEⅡscore and 28 day morbidity of control group and sepsis patients were assessed at 1 h, 6 h after admission by physical examination . Results At 1 h after admission , APACHEⅡscore , H-FABP and NT-proBNP level in sepsis patients were significantly higher than control group (P < 0.05); APACHEⅡscore, H-FABP, NT-proBNP and cTnI level at 6 h after admission were higher than that at 1 h (P < 0.05); APACHEⅡscore, H-FABP and NT-proBNP level in death group were higher than survivor group at 1, 6 h after admission (P < 0.05), cTnI level at 6 h after admission was higher in death group (P < 0.05). Futhermore, H-FABP, NT-proBNP and cTnI at 6 h after admission were positively correlated with each other (both P < 0.05). At 6 h after admission , H-FABP showed a better predictive value of 28-day mortality than NT-proBNP and APACHEⅡscore (P < 0.05). Conclusion H-FABP and NT-proBNP may suggest important significance in early diagnosis and prognosis prediction of sepsis patients with myocardium injury.

Objective To explore the clinicalpathological characteristics of Lynch syndrome associated ovarian cancer.Methods Totally 260 cases ovarian cancer patients were admitted to Tianjin Medical University General Hospital during Jan.2004 and Jan.2011,among which 10 patients( LS group) belonged to Lynch syndrome associated ovarian cancer according to Amsterdam Ⅱ criteria.One hundred ovarian cancer patients without any family cancer history were enrolled randomizely as control group (sporadic group).Results Lynch syndrome associated ovarian cancer accounted for 3.8％ ( 10/260),the incidence rate of ovarian cancer for female family members of Lynch syndrome was 8.7％ ( 10/115 ).Mean age at time of diagnosis in LS group was (46 ±7) years,significantly earlier than that in sporadic group [ (56 ±11 ) years,P ＜ 0.05 ].There was no statistical difference between two groups in histological type or International Federation of Gynecology and Obstetrics ( FIGO ) stage ( P ＞ 0.05 ).Most of the tissue differentiation in LS group were well or moderate differentiated,there was statistical difference between the two groups(9/10 vs.55％,P ＜0.05).The 3-year and 5-year survival rate in LS group were 87.5％ and 52.5％respectively,compared with 55.4％and 22.7％ in sporadic group(all P＜0.05).Conclusion Compared with sporadic ovarian cancer,Lynch syndrome associated ovarian cancer is more likely present as the clinicalpathological characteristics of early age of onset,serous adenocarcinoma,lower grade and better prognosis.

AIM To investigate the effects of Shuxuening Injection (Ginkgo biloba extract) combined with ganglioside on cerebral oxygen utilization coefficient (O2UCc) and lactate clearance rate (LCR) in patients with acute severe carbon monoxide poisoning (ASCOP).METHODS Two hundred and sixty-two patients with ASCOP treated in emergency department of Harrison International Peace Hospital Affiliated to Hebei Medical University from Mar 2011 to Mar 2016 were randomly divided into control group,Shuxuening Injection group,ganglioside group and Shuxuening Injection combined with ganglioside (combined medication) group.The changes were detected in oxygen saturations of carotid blood and jugular blood,arterial blood lactic acid,O2UCc and LCR in all patients before and 6,24 hours,3 days after the treatment.The clinical symptoms,and the mortality and morbidity of delayed encephalopathy after acute carbon monoxide poisoning after two weeks were observed.RESULTS Total effective rate of the combined medication group was higher than that of the other groups.O2 Ucc at 6,24 hours after the treatment in the combined medication group were significantly lower than those in the other groups,so did the mortality and morbidity of delayed encephalopathy after acute carbon monoxide poisoning,but LCR was significantly higher than that in the other groups.All the differences had statistical significances.CONCLUSION The efficacy of combined medication of Shuxuening Injection and ganglioside in ASCOP patients is better than that of applying single administration separately.

AIM To investigate the effects of safflower yellow on myocardial injury in patients with severe sepsis.METHODS Using prospective research methods,ninety-two patients with severe sepsis treated in our hospital from Jan.2013 to Mar.2016 were divided equally into two groups:control group (routine treatment) and observation group (routine treatment + safflower yellow).In addition,6 and 72 hours after the treatment,heart-type fatty acid binding protein (H-FABP),creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) of patients were detected,and the changes of left ventricular ejection fraction (LVEF) and sequential organ failure assessment (SOFA) scores were observed;length of ICU stay,cumulative incidence of major adverse cardiac events (MACE) and 28-day survival also were recorded at the same time.RESULTS In admission,there were no differences in the levels of H-FABP,CK,CK-MB and LVEF,SOFA scores between the two groups.After 6 hours treatment,the levels of H-FABP,CK,CK-MB and SOFA score in the observation group were lower than those in the control group;the two groups had higher levels of H-FABP,CK and CK-MB than those before the treatment,SOFA score was lower than that before the treatment;After 72 hours treatment,H-FABP,CK,CK-MB and SOFA score were lower than those after 6 hours treatment;SOFA score in the observation group was lower than that in the control group;there were no differences in H-FABP,CK and CK-MB between the two groups.The observation group had a lower cumulative incidence of MACE than the control group.There was no statistical difference in LVEF and length of ICU stay after the treatment between the two groups.The observation group had a higher 28-day survival than the control group,the difference was statistically significant (76.08％,35/46 vs 54.35％,25/46;x2 =4.529,P =0.033).The level of serum H-FABP in severe sepsis patients was negatively correlated with LVEF (r =-0.270,P =0.009).CONCLUSION Therapeutic effects of safflower yellow on myocardial injury in patients with severe sepsis is superior to routine treatment with the improvement of the prognosis of patients to a certain extent.

Objective To investigate the changes and significance of cerebral oxygen utilization coefficients (O2UCc) in patients with acute carbon monoxide poisoning (ACOP) after treatment with Danshen Chuanxiongqin injection combined with ganglioside.Methods A prospective study was conducted.Two hundreds and six patients with ACOP admitted to the Department of Emergency in Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to January 2016 were enrolled,and they were divided into Danshen Chuanxiongqin group,ganglioside group and Danshen Chuanxiongqin injection combined with ganglioside group (combined treatment group) by random number table.The changes in oxygen saturation of internal carotid artery blood (SaO2) and oxygen saturation of internal jugular vein blood (SjO2) were detected by blood gas analysis for all the patients before and 6 hours,1 day,3 days after treatment,and then according to the rate of oxygen utilization formula [O2UCc=S(a-j)O2/SaO2],O2UCc wascalculated.Before and after treatment,the changes of O2UCc in three groups were compared;after treatment for 14 days,the improvement of clinical symptoms,the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and the 28-day mortality were observed.Results The total therapeutic effective rate of combined treatment group was significantly higher than that in either Danshen Chuanxiongqin injection group or ganglioside group [91.67％ (66/72) vs.77.27％ (51/66),77.94％ (53/68),both P ＜ 0.05].Before treatment,there were no differences in levels of O2UCc among three groups (P ＞ 0.05);after treatment for 6 hours and 1 day,the level of O2UCc in combined treatment group was obviously lower than either that of Danshen Chuanxiongqin injection group or of ganglioside group [6 hours:(38.13±7.95)％ vs.(42.96±7.58)％,(42.30±9.87)％,1 day:(28.42±5.41)％ vs.(33.27±7.53)％,(32.64 ± 6.76)％,all P ＜ 0.05],and the levels of O2UCc at 6 hours and 1 day after treatment had no statistical significant differences between those in Danshen Chuanxiongqin injection group and ganglioside group (P ＞ 0.05);after treatment for 3 days,the percentages of O2UCc levels were very close in Danshen Chuanxiongqin injection group,ganglioside group and combined treatment group [(23.87 ± 6.06)％,(22.38±6.09)％,(23.68 ±4.34)％,respectively,all P ＞ 0.05];The incidence of DEACMP and the 28-day mortality after treatment in combined treatment group were lower than those in Danshen Chuanxiongqin injection group or ganglioside group [the incidence of DEACMP:2.78％ (2/72) vs.12.12％ (8/66),14.71％ (10/68),the 28-day mortality:2.78％ (2/72) vs.13.64％ (9/66),16.18％ (11/68),both P ＜ 0.05];while the incidence of DEACMP and the 28-day mortality after treatment had no statistical significant differences between Danshen Chuanxiongqin injection group and ganglioside group (all P ＞ 0.05).No adverse reactions occurred in the three groups.Conclusion The treatment of Danshen Chuanxiongqin injection combined with ganglioside in treatment of ACOP patients can effectively reduce the O2UCc,decrease the occurrence of DEACMP and 28-day mortality,thus it may improve the prognosis,and the clinical curative effect is distinct.

Objective:To explore the arsenic trioxide (As 2O 3)-induced apoptosis of human neuroblastoma cells (SH-SY5Y cells) and the protection mechanisms of folic acid (FA) and vitamin B 12 (VB 12). Methods:SH-SY5Y cells were cultured in vitro and divided into six groups by group design: control group (normal cultured), arsenic exposed group (10.00 μmol/L As 2O 3), FA intervention group (0.30 mmol/L FA + 10.00 μmol/L As 2O 3), VB 12 intervention group (0.06 mmol/L VB 12 + 10.00 μmol/L As 2O 3), combined intervention group (0.30 mmol/L FA + 0.06 mmol/L VB 12 + 10.00 μmol/L As 2O 3) and reagent control group (0.30 mmol/L FA + 0.06 mmol/L VB 12). Cells in each group were cultured for 24 h ( n = 3). Flow cytometry was used to determine the apoptosis rate of cells in each group. Transmission electron microscopy was used to observe the ultrastructural changes of the cells. The expression levels of mRNA and protein of apoptosis-related indicator B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated X (Bax) were detected by fluorescence quantitative PCR and Western blotting. The activity of cysteinyl aspartate specific proteinase (Caspase) 3 was detected by luminescent assay. The above indicators were statistically analyzed. Results:There was statistically significant difference in the apoptosis rate among different groups ( F = 213.036, P < 0.05). The apoptosis rate in arsenic exposed group [(44.43 ± 3.54)%] was higher than that in control, FA intervention, VB 12 intervention, and combined intervention groups [(1.80 ± 0.06)%, (14.37 ± 0.13)%, (19.10 ± 1.56)%, (17.11 ± 2.34)%, P < 0.05]. Under transmission electron microscope, the apoptotic bodies, mitochondria swelling and degeneration, chromatin agglutination were observed in SH-SY5Y cells exposed to arsenic. The morphological and organelle changes of SH-SY5Y cells were significantly improved after respective and combined intervention of FA and VB 12. The expression levels of Bcl-2, Bax mRNA and protein were significantly different among different groups ( F = 5.178, 7.169, 6.142, 9.194, P < 0.05). The expression level of Bcl-2 protein in arsenic exposed group was lower than that in control group ( P < 0.05), and the expression levels of Bax mRNA and protein were higher than those in control group ( P < 0.05). The expression levels of Bcl-2 mRNA and protein in FA intervention group and combined intervention group were higher than those in arsenic exposed group ( P < 0.05), and Bcl-2 mRNA expression level in VB 12 intervention group was higher than that in arsenic exposed group ( P < 0.05). The expression levels of Bax mRNA and protein in FA intervention, VB 12 intervention and combined intervention groups were lower than those in arsenic exposed group ( P < 0.05). There were statistically significant differences in Caspase 3 activity among different groups ( F = 84.604, P < 0.05). Caspase 3 activity in arsenic exposed group was significantly higher than those in control, FA intervention, VB 12 intervention, and combined intervention groups ( P < 0.05). Conclusions:Arsenic exposure can lead to apoptosis and ultrastructural changes of SH-SY5Y cells. FA and VB 12 may effectively inhibit apoptosis through regulating Bcl-2/Bax pathway and decrease Caspase 3 activity, thus playing a protective role on nerve cells.

ObjectiveTo observe the effects of extract of Ginkgo biloba, Ginaton, on cerebral oxygen utilization coefficients (O2UCc) and lactate clearance rate (LCR) in patients with delayed encephalopathy after acute carbon monoxide poisoning (DEACMP).Methods The 196 patients with DEACMP admitted to Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2011 to March 2016 were enrolled, and they were randomly divided into a control group and an observation group, 98 cases in each groups. The control group received routine treatments such as hyperbaric oxygen, measures to prevent and treat cerebral edema, and promote brain cell metabolism, etc routine therapies: while in the observation group, besides the above routine treatments, additionally intravenous drip of Ginaton 70 mg (with 0.9% sodium chloride injection 250 mL added), once a day, for consecutive 2 weeks to complete one therapeutic course. At ambient air, before treatment and 6, 24 and 72 hours after treatment, the O2UCc and LCR and the changes of mini-mental state examination (MMSE) score, clinical efficacy and hospital mortality were observed and compared between two groups. Pearson correlation test was used to analyze the correlations between O2UCc, LCR and MMSE score.Results On the day of admission before treatment, there were no differences in O2UCc, lactate and MMSE score between the two groups (allP > 0.05). At 6 hours, 24 hours after treatment, the levels of O2UCc in observation group were obviously lower than those in control group [6 hours: (40.64±9.50)% vs. (45.78±7.94)%, P = 0.000; 24 hours: (30.51±6.76)% vs. (33.34±8.19)%,P = 0.009], while the levels of LCR were significantly higher than those in control group [6 hours: (14.93±2.27)% vs. (11.45±1.88)%,P = 0.000; 24 hours: (19.86±3.42)% vs. (13.73±2.35)%,P = 0.009]. There were no statistical significant differences in O2UCc and LCR at 72 hours after treatment between the two groups (P > 0.05). The MMSE scores at 6, 24 and 72 hours after treatment in observation group were higher than those in control group (6 hours: 15.52±3.61 vs. 11.60±2.49, 24 hours: 20.05±5.79 vs. 14.85±5.71,72 hours: 23.87±5.96 vs. 18.07±6.97, allP < 0.05). The total effective rate in observation group was significantly higher [77.55% (76/98) vs. 61.22% (60/98),P < 0.05], and the mortality [3.06% (3/98) vs. 10.20% (10/98),P < 0.05] was obviously lower than their own counterparts in control group. The correlation analysis showed that at different time points, the levels of O2UCc were negatively correlated to the corresponding MMSE scores (r6 h = -0.153,r24 h = -0.158, P6 h = 0.032,P24 h = 0.027), and there were positive correlations between the levels of LCR and MMSE scores (r6 h = 0.473, r24 h = 0.242,P6 h = 0.000,P24 h = 0.001) in patients with DEACMP.Conclusions The treatment of Ginaton in patients with DEACMP can effectively elevate the LCR and MMSE score, reduce O2UCc, decrease mortality and improve the prognosis, thus the clinical curative effect is distinct.

Objective To investigate the relationship between soluble CD14-st (Presepsin)and assessment,prognosis in patients with acute paraquat poisoning (APP).Methods A total of 82 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2013 to January 2016 were divied into three groups:mild poisoning group (n =20),moderate poisoning group (n =36)and severe poisoning group (n =26).According to the outcomes,patients were divided into survivor group (n =28)and non-survivor group (n =54).Another 50 healthy subjects were selected as control group.In control group,samples of 3 mL venous blood from 50 healthy subjects were collected for laboratory examination.Samoles of 10 mL venous blood from all patients were collected before and 72 hours,7 days after treatment to detect presepsin,C reactive protein (CRP), tumor necrosis factor α(TNF-α),interleukin-6 (IL-6)and interleukin-10 (IL-10).Before and 72 hours, 7 days after treatment,the change of Acute physiology and chronic health evaluation (APACHE)Ⅱscore and the outcomes in 28 days were observed.The variance analysis of repeated measures was used for comparison among multiple groups,and the t test was used to compare changes of detected biomarkers between two groups,and the outcomes in 28 days between two groups were compared with chi square test. Pearson correlation test was used to analyze the correlation between Presepsin in patients with APP and the survival rate.Results APACHE Ⅱ scores and the serum level of prespsin,CRP,TNF-α,IL-6 at admission and 72 hours,7 days after treatment in three poisoning groups were significantly increased compared with control group,IL-10 were decreased compared with control group (P <0.05 ),and there were significant differences in those biomarkers between moderate group and mild group,and between severe group and mild group,moderate group (P <0.05).At admission,72 h,7 d after admission,APACHEⅡscore and the serum levels of presepsin,CRP,TNF-α,IL-6 in non-survivor group were higher than those in survivor group,and IL-10 in non-survivor was lower than that in survivor group (P <0.05).The mortality rates of these 3 groups were 25.00%,69.44% and 92.31%,demonstrating significant differences among three groups (P <0.05).The AUCs were 0.862 and 0.731 for presepsin and APACHEⅡscore respectively at admission.The predictive capability of presepsin for 28-day mortality was superior over that of APACHEⅡscore (P <0.05).The level of serum presepsin in patients with APP was negatively correlated with the survival rate (r =-0.285,P =0.009).Conclusions The detection of prespsin has important clinical value in the severity assessment and prognosis in patients with APP.It is an important guidance for early therapeutic strategy.

Objective To observe the impact of ginkgo biloba extract(Ginaton) on nerve functioninpa-tients withdelayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods 96 patients with DEACMP treated in our hospital from April 2011 to February 2017 were randomly divided into a control group and a study group. The control group received hyperbaric oxygen ,control of intracranial pressure ,and improvement of brain cell metabolism;while the study group receivedintravenous injection of Ginaton 70 mg(adding into 250 mL of 0.9% sodium chloride) once daily fora 2-week therapeutic course. MRIand EEGwere used forexamination in DEACMP patients within 24 h after onset and 14 days after treatment. Changes in MRI and EEG examination , clinical symptoms ,mini-mental state examination (MMSE) score ,Barthel index (BI),and Montreal cognitive assessment(MoCA)were assessed before and after treatment between the two groups. Results The therapy wasef-fective in 39 patients in the study group,with a total effectiveness rate of 81.25%;and in 29 patients in the control group,with a total effectiveness rate of 60.42%. There was significant difference between the two groups (χ2 =5.042,P = 0.025). Inadmission,there were no differences between the two groups in the abnormal signals of MRI,abnormal rate of EEG,and the scores on MMSE,BI,andMoCA(P>0.05). After a 14-day treatment,the abnormal signals of MRI,abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA score were improved better in the study than in the control group(P < 0.05). The MMSE score was negatively correlated with disease severity in DEACMP patients(r=-0.832,P=0.000). Conclusions Early treatment with Ginaton can effectively improvethe cerebral lesions on MR,the abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA. It has certain clinical efficacy.

Objective To study the early diagnostic value of high-sensitivity cardiac troponin Ⅰ(hs-cTnI) and soluble growth stimulating gene 2 protein (soluble suppression of tumorigenicity 2,sST2) in myocardial injury of acute organophosphorus pesticide poisoning (AOPP).Methods Totally 168 AOPP patients hospitalized from March 2014 to October 2018 were divided into the mild group (n=45),moderate group (n=55) and severe group (n=68).Another 30 healthy persons were served as the control group.The levels of cTnI,hs-cTnI,N-terminal B-type natriuretic peptide(NT-proBNP) and sST2 were detected at 4 h and 12 h after admission.SPSS 21.0 was used for statistical analysis.The measurement data were expressed by mean±standard deviation,two groups were compared by LSD-t test,and the multigroup comparison was made by single factor analysis of variance (ANOVA).The correlation analysis by Spearman correlation test (P＜0.05).Results At 1 h after admission,the hs-cTnI of AOPP patients with different degrees of poisoning was higher than that of control group,and that of severe group was higher than that of mild to moderate group.Comparison between groups was statistically significant (P＜0.05).However,there was no significant difference in the cTnI level (P＞0.05).At 4 h and 12 h after admission,the levels of cTnI and hs-cTnI increased with the increase of poisoning degree and the extension of time,and their level at 12 h after admission were significantly higher than those at 4 h after admission,with statistically significant difference between the two groups (P＜0.05).At 1 h after admission,the level of sST2 in the poisoned patients was higher than that in the control group,and the level in the severe group was higher than that in the mild to moderate groups.At 4 h and 12 h after admission,the level of sST2 was increased significantly,especially in the severe group.The level of sST2 at 12 h after admission was significantly higher than that at 4 h after admission (P＜0.05).The concentration of NT-proBNP was in normal range 1 h after admission,increased gradually at 12 h after admission,and the level of NT-proBNP in the severe group was significantly higher than that in the other groups (P＜0.05),and comparison between the groups was significantly different (P＜0.05).The correlation analysis showed that there was a positive correlation between hs-TnI and sST2 in AOPP patients (r=0.776,P＜0.01).hs-TnI and sST2 was positively correlated with the severity of AOPP (r=0.958,P＜0.01;r=0.844,P＜0.01).That is,the more severe the patient,the higher the concentration of hs-TnI and sST2,and the more serious myocardial injury.Conclusions Early detection ofhs-cTnI and sST2 levels in AOPP patients can identify early myocardial damage and objectively evaluate the extent of myocardial damage.