Hyper glycemia and hypoglycemia are associated with poor outcome of critically ill patients.No consistent evidence shows that intensive insulin strategy improves health outcomes in hospitalized patients.Because of its potentially harmful and life-threatening consequences,hypoglycemia represents the main limit to the development of a tight blood glucose control strategy in critical illness.Hypoglycemia-related neurological signs may be masked.The occurrence of hypoglycemia in critical illness,especially severe hypoglycemia,is associated with a poor prognosis.So it is necessary to closely detect glycemic variability and control the blood glucose in proper level.

Although acute respiratory distress syndrome (ARDS) has been the focus of extensive basic science and clinical research over the past 40 years,its pathogenesis is not clear.The therapies for ARDS have been not consensus.In addition to the lung-protective ventilatory strategies,effective pharmacologic therapy for ARDS remains extremely limited and still continue to explore and study.This paper reviews the cunent pharmacotherapies to treat ARDS,including neuromuscular blockers,corticosteroids,neutrophil elastase inhibitor,antioxidants,granulocyte macrophage-colony stimulating factor,β2 adrenergic receptor agonists,pulmonary vasodilators.

Objective To study the activation of macrophage and upregulation of CD40 in neutropenic and nonneutropenic lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Forty mice were randomly divided into four groups (neutropenic septic group,neutropenic control group,non neutropenic septic group and normal control group).The pathologic changes of mice lungs were observed after hematoxylin and eosin staining.CD40 expression was determined by flow cytometry.Cytokine tumor necrosis factor-α levels from bronchoalveolar lavage fluid (BALF) and serum were measured by ELISA.Results The average weight and peripheral blood white cell counts were increased significantly in the neutropenic group as compared to the non neutropenic group before the rats were sacrificed [(181.13 ± 16.94) g vs (168.56 ±5.03) g,(9.54 ± 1.25) × 109/L vs (2.56 ± 1.12) × 109/L,P ＜0.05,respectively].The cell counts in BALF were higher in neutropenic septic and non neutropenic septic groups compared to the normal control group [(3.33 ±0.26) × 106/L,(3.23 ± 0.06) × 106/L,(1.68 ± 0.23) × 106/L,P ＜ 0.05].The concentration of tumor necrosis factor-α from serum were increased significantly in neutropenic septic and non neutropenic septic groups as compared to the normal control group [(2 337.08 ± 1 148.85) pg/ml,(2 274.01 ± 1 569.37) pg/ml,(96.20 ± 93.69) pg/ml,P ＜ 0.05].The CD40 molecular expressions were higher in neutropenic septic and non neutropenic septic groups compared to the normal control group [(42.06 ± 11.90) ％,(46.38 ±7.42) ％,(21.62 ± 4.86) ％,P ＜ 0.01].Conclusion Upregulation of CD40 molecule induces the inflammatory cytokines releasing,then leads to ALI.Therefore both the inflammatory cytokines and CD40 play vital role in the pathogenesis of ALI.

Streptomyces phage ?C31 integrase is a site-specific recombinase and introduce foreign gene to unidirectional recombination.Because of its integration mediated by ?C31 integrase without any cofactors and especially directed integration,it possesses high efficiency and stable expression of foreign gene.These advantages make it an attractive tool for genetic engineering.It has been widely used to transgene integration in mammalians and provides an opportunity to overcome the bottlenecks in the generation of transgenetic animals,such as random integration,low integral rate,low level of expression and so on.The ?C31 integrase will have a wide application in the near future.

Aorta, Thoracic ; abnormalities ; Humans ; Infant ; Magnetic Resonance Angiography ; Male ; Pulmonary Artery ; abnormalities ; Recurrence ; Respiratory Insufficiency ; etiology ; Respiratory Sounds ; etiology ; Subclavian Artery ; abnormalities ; Vascular Diseases ; complications ; congenital ; diagnosis ; pathology ; physiopathology

OBJECTIVETo study the expression difference in MicroRNA-21 (miRNA-21) levels of the plasma between the patients with coronary heart disease and the subjects without coronary artery lesions, and its clinical significance.

METHODSPlasma was obtained from the patients with coronary heart disease(trial group,56 cases) and the subjects without coronary artery lesions(control group, 10 cases), patients with coronary disease were divided into angina(AP, 39 cases) and acute myocardial infarction(AMI, 17 cases)subgroup, the contents of miRNA-21 were detected using qRT-PCR method, and the differential expression of miRNA-21 in each group was analyzed. The levels of creatine kinase isoenzyme (CK-MB), high sensitive troponin I(cTnI), B type natriuretic peptide urea (BNP), Gensini, left ventricular ejection fraction (LVEF), integral value of coronary left ventricular end diastole diameter (LV) and homocysteine (HCY) were determined and the correlation between miRNA-21 and these clinical indexes was analyzed.

RESULTSCompared with control group, there was a significant difference in expression of miRNA-21 in patients with angina and AMI (P < 0.05), and miRNA-21 expression in AMI group was much higher than that in AP group. There was statistical significance in CK, CK-MB, cTnI, Genisis integral comparison between AMI group and control group (P < 0.05). The correlation analysis showed that there was a positive correlation between expression of CK, CK-MB, cTnI and the level of circulating miRNA-21 in patients with acute myocardial infarction. And there was a negative correlation between BNP, Gensini integral, LVEF value of coronary artery, LV and circulating miRNA-21.

CONCLUSIONmiRNA-21 was significantly elevated in acute myocardial infarction subgroup than the control group. The level of miRNA-21 associates with the degree of coronary artery stenosis, and might be a potential marker for the diagnosis of acute myocardial infarction. miRNA-21 may play an important role in protecting myocardium from ischemia/reperfusion injury.

Acute Disease ; Biomarkers ; blood ; Coronary Disease ; blood ; Creatine Kinase, MB Form ; metabolism ; Humans ; MicroRNAs ; blood ; Myocardial Infarction ; blood ; Natriuretic Peptide, Brain ; metabolism ; Troponin I ; metabolism

Child ; Female ; Hematemesis ; complications ; Humans ; Tracheoesophageal Fistula ; complications ; congenital

Objective To explore the total treatment effect,layered diagnostic treatment effect,the relationship between effect and site of infection and common side effects of commonly used antifungal agents such as itraconazole,Voriconazole,caspofungin and amphotericin B liposome in invasive fungal infection with hematologic malignancies.Methods The clinical data of 117 cases of patients with hematologic malignancies combining with invasive fungal infection hospitalized in our department from Jan,2005 to Aug,2008 were retrospectively analyzed.Results The total effect rates of itraconazole,Voriconazole,caspofungin and amphotericin B liposome were 69.0%(40/58),77.4%(24/31),64.7%(11/17)and 63.6%(7/11)respectivley(P=0.726).In patients with pulmonary infection,the effect rates of the agents were 63.0%(17/27),85.7%(12/14),50.0%(4/8)and 62.5%(5/8)respectively(P=0.283),which itraconazole group was higher than that of the other agents.The effect rates of the 4 groups have similar rates in patients with liver and spleen candidiasis,fungemia and infections with unknown origin.The rates of 6 weeks survival were 86.2%,87.1%,70.6% and 72.7% respectively.The common side effects of itraconazole and Voriconazole were mainly gastrointestinal reaction and mild hypokalemia.There were few patients showed gastrointestinal reaction(12.1%) and hypokalemia(20.7%)in the former.Some individual showed visual abnormity(9.7%)and external vertebral body symptoms(6.4%).caspofungin showed mild toxic and side effects,which was only gastrointestinal reaction(15.4%),while they were common in amphotericin B liposome group,which were Chill and fever(81.8%),hypokalemia(100%),gastrointestinal reaction(18.2%)and liver damage(9.1%).Conclusion The total effect,layered diagnostic effect and 6 weeks survival rates were similar in itraconazole,Voriconazole,caspofungin and amphotericin B liposome in patients with hematologic malignancies combining with invasive fungal infection.

It is very important to develop nasal sprays with higher bioavailability and better targeting capability by making further use of advanced technology and new methods according to its characteristics. Intensive research has been searched on nasal sprays quality control methods which have been developed in the last few years. This review discusses the critical quality attributes of nasal sprays and the research progress of the quality control methods. Clarifies the characters examine of the nasal spray (pH, osmolality, particle size distribution and viscosity), content and related substances, packaging materials compatibility studies, spray pattern and droplet distribution methods of quality control.