Objective To investigate the effect of continuous blood purification ( CBP) on the level of blood lactic acid and 6 h lactic clearance in the patients with severe sepsis. Methods 48 patients with severe sepsis were cho-sen in ICU, and they were randomly divided into two groups: control group ( n=20 ) and CBP group ( n=28 ) . Their arterial blood lactic acid level was tested on admission and was retested 6, 24, 48 and 72 h after treatment. The patients’6 h blood lactic clearance rate and the corresponding APACHEIIscore were calculated. The level of arterial blood lactic acid and the score of APACHE IIwere compared at different time. 6 h blood lactic clearance, the period of stay in ICU and the 28-days mortality were compared too. Results The level of lactic acid and the score of APACHE II after 24 h were lower in CBP group, and the period of stay in ICU was shorter in CBP group than that in control group at different time ( P<0.05 ) . 6 h blood lactic clearance was higher than that in control group (P<0.05). Moreover, the 28-days mortality had no significant difference in CBP group. Conclusion The CBP plays an important role in clearing the blood lactic acid and it can reduce the severity of the sepsis as well as shorten the period of stay in ICU.

Sixty-six rabbits were divided into 2 groups, the control group and the experimental group. The latter was subdivided into 10 groups according to the time of observation after burn injury including 2nd-hour group to 30th-day group. Each group consisted of 6 animals. Specimens from the trachea and the lungs were examined with optical microscopy, scanning electron microscopy and transmission electron microscopy.No obvious lesion was seen in the specimens from the control. In the experimental group, various pathological changes began to appear from the 6th hour after injury. In the trachea and bronchi, congestion of varying degrees, edema, leucocytic infiltration, lodging, adhesion, breaking or separation of cilia, and increase of goblet cells and Clara cells in number weie found. In. the lungs, interstitial edema of varying degrees, accumulation and infiltration of neutro-phils in capillaries, pulmonary interstitium and alveolar spaces, decrease in num ber of type II pneumocytes and their lamellar bodies, vacuolization of lamellar bodies, and phagocytosis of lamellar bodies by macrophages were seen. Most prominent changes were shown on the 3rd day postburn, and they began to alleviate on the 7th day. The number of type II pneumocytes and their lamellar bodies gradually increased number. Some lesions still existed on the 30th day postburn but no significant fibrosis could be found. The occurrence and development of the main lesions and their significance were discussed.

Objective To further explore the effects of acupuncture and Fuyuan Mixture(FM) on learning and memory. Methods One hundred and twenty_nine NIH male mice were allocated to six groups:Group A (normal control group),Group B(model group),Group C(treated with acupuncture),Group D(treated with FM),Group E(FM and acupuncture),and Group F(treated with nimodipine). Model mice with acquired memory disorder were induced by scopolamine.Baihui,Dazhui,Shenting and Zusanli were chosen as the acupoints.FM is composed of Cornu Cervi Pantotrichum,Radix Ginseng,Rhizoma Polygonati,Fructus Lycii,Fructus Alpiniae Oxyphyllae,Radix Salviae Miltiorrhizae,etc..The methods of platform jumping and finding food in complex maze were used to observe their learning and memory. Results Compared with Group B,incubation period was prolonged,electric shock time shortened and errors reduced at 20 min and 24h after modeling in Group C and Group E,and time for finding food in complex maze was shortened in Group C and Group D(P

Objective To investigate the impact of early initiation of continuous renal replacement therapy (CRRT) based on Kidney Disease: Improving Global Outcomes (KDIGO) classification on the prognosis of critically ill patients with acute kidney injury (AKI). Methods A retrospective analysis of clinical data of patients diagnosed as AKI in Department of Critical Care Medicine of Zhejiang Provincial People's Hospital from January 2011 to January 2015 was conducted. All patients included should be 18 years old or older, having stayed in intensive care unit (ICU) for more than 48 hours, and received CRRT. All subjects were divided into three groups according to their renal function before CRRT according to the KDIGO-AKI guideline: AKI-stage 1 group, AKI-stage 2 group and AKI-stage 3 group. The general condition, original disease, severity of disease, duration of mechanical ventilation, the length of ICU or hospital stay, 28-day survival rate and in-hospital mortality rate were compared among these three groups. Additionally, risk factors for the 28-day survival rate and hospital mortality of critically ill patients with AKI were screened by logistic regression analysis. Results A total of 258 critically ill patients with AKI were enrolled, with 64 cases in AKI-stage 1 group, 62 cases in AKI-stage 2 group, and 132 cases in AKI-stage 3 group. 116 patients survived with 28-day survival rate of 44.96%. 154 patients died with hospital mortality 59.69%. The precipitating factors of AKI in all three groups (stage 1, stage 2, and stage 3) were similar, with sepsis, heart failure and poisoning (drugs or poison) being the main triggers for AKI, accounting for 35.66%, 19.38% and 13.18%, respectively. There were significant differences in the rate of vasoactive agent usage (31.25%, 41.94%, 50.00%, χ2 = 6.241, P = 0.044), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (20.87±7.37, 17.19±7.02, 22.58±7.95, F = 5.292, P = 0.006) and sequential organ failure assessment (SOFA) score (8.41±3.46, 6.22±2.43, 9.58±3.71, F = 10.328, P = 0.000), while there was no significant difference in gender, age, primary disease, time from ICU admission to the beginning of CRRT, mean arterial pressure (MAP), lactate level or 24-hour lactate clearance rate (LCR), mechanical ventilation time, the length of ICU or hospital stay, 28-day survival rate or hospital mortality among these three groups (all P > 0.05). According to the logistic regression analysis, time from ICU admission to start of CRRT and lactate level were the independent risk factors for 28-day survival rate or hospital mortality of critically ill patients with AKI [odds ratio (OR) for 28-day survival rate was 0.850 and 0.774, 95% confidence interval (95%CI) was 0.752-0.960 and 0.638-0.940, P value was 0.009 and 0.010, respectively; OR for hospital mortality was 0.884 and 0.756, 95%CI was 0.781-1.000 and 0.610-0.939, P value was 0.049 and 0.011, respectively]. Conclusion Early initiation of CRRT based on KDIGO-AKI classification could not improve the prognosis of critically ill patients with AKI, the optimal timing of RRT for such patients remains to be further explored.

Objective To discuss the classification and treatment of the degloving hand.Methods All 68 degloving hand treated between January, 2005 and December, 2014 in our department were reviewed.The cases were divided into three types according to the extent of the injury.Type Ⅰ the degloving tissue had enough blood supply which was debrided and stitched.Type Ⅱ the degloving tissue had less or no blood supply which was revascularized with replantation or vein anastomosis, some degloving palm or dorsum resurfaced the wound by the degloving skin graft.Type Ⅲ the degloving tissue had no blood supply or severely damaged,the tissue defect should be resurfaced with other tissue reconstruction.Type Ⅱ and Ⅲ were further divided into subtype A, B and C depending on the degloving scope and location, each subtype has its own surgical procedure.Results The total survival rate was 83.8％.The survival rate decreased with the increasing extent of the injury and the increasing degloving scope.Conclusion Classification of the hand degloving injuries depending on the extent of the injury, the degloving scope and location is useful for the assessment of injury and the selection of proper operation procedures.

Objective To summarize the surgery effect of removal of tuberculum sellae meningiomas by anterior interhemispheric approach.Methods The data of 18 cases of removal of tuberculum sellae meningiomas by anterior interhemispheric approach were analyzed retrospectively.Results Simpson grade Ⅰ resection was achieved in 5 cases;grade Ⅱ in 10 cases and grade Ⅲ in 3 cases.15 patients were followed up for 6 months to 7 years,3.1 years on average.6 patients recovered normal ability in work and life,6 patients' symptom was improved after sugery,3 patients' postoperative visual acuity remained unchanged,2 patients got the result of medium disability and 1 patient died.Conclusion Large tuberculum sellae meningiomas that grows anteriorly and superiorly can be well exposed through anterior interhemispheric approach,the amount of page pull is reduced,so the satisfactory sugical effect can be achieved.

Purpose To investigate the difference of imaging features of tree-in-bud (TIB) sign at CT between stage Ⅰ central lung cancer and bronchial disseminated pulmonary tuberculosis in order to reduce the misdiagnosis rate of central lung cancer.Materials and Methods 32 patients of stage Ⅰ central type lung cancer confirmed pathologically or clinically (lung cancer group) and 47 patients of bronchial disseminated pulmonary tuberculosis confirmed pathologically or clinically (tuberculosis group) underwent chest CT scanning and were found with TIB sign.The imaging data of all the cases were analyzed retrospectively in terms of distribution range,accompanying CT findings of TIB sign,and abnormalities of segmental and (or) larger bronchus proximal to it.Results TIB sign was mainly focal (unilobar) in lung cancer group (96.88％),while it was mainly diffuse (more than one pulmonary lobe) in tuberculosis group (80.85％).The difference was significant (P＜0.01).Accompanying CT findings:① Obstructive bronchial mucoid impaction distal to the TIB was more common in lung cancer group than in tuberculosis group (100％ vs 6.38％,P＜0.01).② Consolidation and/or ground-glass opacities were found both in lung cancer group (34.38％) and in tuberculosis group (48.94％).The difference was not significant (P＞0.05).③ Cavity was less common in lung cancer group than in tuberculosis group (0 vs 38.30％,P＜0.01).④ Nodules with diameter larger than 5 mm were much fewer in lung cancer group than in tuberculosis group (0 vs 76.60％,P＜0.01).TIB sign was found in 33 lobes in lung cancer group,and the abnormity was found in all these lobes (100％);while in tuberculosis group,TIB sign was found in 144 lobes and the abnormity was found in 56 lobes (38.89％).Conclusion TIB sign shows differences between stage Ⅰ central lung cancer and bronchial disseminated pulmonary tuberculosis.The TIB signs such as focal distribution,accompanied by bronchial mucoid impaction and abnormality of segmental or (and) larger bronchus may predict the high possibility of central lung cancer.

Objective To investigate the clinical efficacy and safety of hybrid artificial kidney in the treatment of patients with uremia.Methods 30 maintenance hemodialysis patients who were altered to be treated by hybrid artificial kidney(treatment group)were compared with 29 patients who were treated by hemodialysis only(control group).The amelioration of clinical symptom,remove of urea nitrogen(BUN),creatinine(Cr).Middle Molecular Substance(MMS)and variation of blood regular test were observed.Results BUN,Cr,haemoglobin level,leucocyte count and blood platelets count improved between after and before treatment(P ＜0.05),but there was no significant difference between the two groups(P ＞ 0.05).Clearance rate ofMMS(25.6%)and improvement of clinical symptoms in treatment group were better than those of control group(5.9%)and difference was statistically significant(P ＜0.05,P＜0.01).There was no serious adverse events in two groups.Conclusion Hybrid artificial kidney could remove molecular substances better and markedly improv clinical symptoms.It can make up for the shortcomings of conventional hemodialysis.

Objective To explore the clinical significance of treating severe patients with frontal lobe and temple lobe with enlarging pterion approach operation. Methods All the severe patients with frontal lobe and temple lobe injury were divided into two groups at random. One group adopted the standard large trauma craniotomy, the other group adopted enlarging pterion approach operation. Under the same conditions, score of GCS, patients ages in two groups were analyzed. And we compare their operation results. Results Compared the standard large trauma cranioto-my,the good recover rates rise 9.2% (P < 0.05) and the death rate reduce 10.2% (P < 0.05) by using the enlarging pterion approach operation. Conclusion The enlarging pterion approach operation could improve existing quality and decrease mortality and disabled rate in patients with severe brain injury in frontal lobe and temple lobe.

Objective To evaluate serum C-reactive protein (CRP) level and its correlation with malnutri-tion,anemia. Methods Thirty-eight elderly and 42 young maintenance hemodialysis patients were studied. Blood samples were collected at the day on hemodialysis for the determination of red blood cell(RBC), hemoglobin(Hgb), hematocrit (Hct), transferrin (TF), serum albumin (Alb), serum creatinine (SCr), blood urea nitrogen (BUN) and CRP; and triceps skinfold (TSF), arm circumference (AC), arm muscle circumference (AMC) were measured. Results The levels of TSF、AC、AMC、RBC、Hgb、Hct、TF、BUN、SCr、Alb in elderly maintenance hemodialysis pa-tients were lower than those of young patients; but serum CRP was higher( P < 0.05 or P < 0.01), The serum-CRP is negatively correlated with hemoglobin(Hgh), hematocrit (Hct) and serum albumin(P <0.01, P <0.01, P <0.05) in elderly maintenance hemodialysis patients. Conclusion Serum CRP is the sensitive index which reflecting early malnutrition and micro-inflammation.