Objective To evaluate the effect of the early goal-directed therapy (EGDT) on mortality in patients with septic shock, and to analyze the risk factors of mortality.Methods A retrospective controlled study was conducted.Complete clinical data of patients with septic shock admitted to emergency intensive care unit (EICU) of Sichuan Provincial People's Hospital from May 1994 to December 2014 were recorded and analyzed.According to the International Guidelines for Management of Severe Sepsis and Septic Shock (SSC) with the time of promulgation as dividing point, the patients were divided into two groups as before and after the publication of the guideline, i.e.early group (from May 1994 to April 2004) and late group (from May 2004 to December 2014).The patients of the late group were subdivided into 6-hour and 24-hour reaching standard groups and non-reaching standard group according to the time of reaching standard of EGDT.All patients were divided into death group and survival group according to the 28-day survival.The patients in early group were not treated according to EGDT guidance, so only age, the case history of chronic disease, the main site of infection, organ dysfunction, vital signs, urine output, the amount of fluid for resuscitation, blood routine, blood gas analysis, time for starting antibiotics treatment, the use of vasoactive drugs and hormone, etc.were recorded.The central venous pressure (CVP), central venous oxygen saturation (ScvO2), blood lactate (Lac), and the monitor of other parameters of patients in late group were consummated late.The relationship of EGDT compliance standard time and tissue perfusion index recovery time between the two groups of patients was observed.The risk factor for mortality was analyzed by multiple factors logistic regression.Results ① 134 patients were included,and the overall 28-day mortality was 49.25％.② The 6-hour EGDT compliance rate of early group was 0 (0/58),and it was 28.95％ (22/76) in late group (x2 =20.087, P =0.000).Compared with the early group, the 6-hour urine volume in the late group was significantly increased (mL·h-1·kg-1: 1.72± 1.04 vs.0.89±0.24, t =11.950, P =0.001),6-hour mean arterial pressure (MAP, mmHg, 1 mmHg =0.133 kPa) was elevated (64.24±3.90 vs.56.21 ±5.95, t =6.444, P =0.012), the use of antibiotics within 1 hour was increased (76.32％ vs.48.28％, x2 =11.250, P =0.001), the use of vasocative drugs (21.05％ vs.89.66％, x 2 =61.942, P =0.000) and hormone (8.57％ vs.34.48％, x 2 =14.871,P =0.000) were lowered, and the 28-day mortality rate was lowered significantly [34.21％ (26/76) vs.68.96％ (40/58),x2 =15.897, P =0.000].The difference was not statistically significant in the total recovery of liquid volume between late group and early group (mL: 1 856.31±805.81 vs.1 903.1 ± 897.11, t =0.101, P =0.752).③ In all patients, it was shown by single factor analysis that the age, infection sites, altered mental status at admission, white blood cell (WBC) before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour, and incidence of acute renal injury (AKI) or acute lung injury/acute respiratory distress syndrome (ALI/ARDS) within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).In the late group, it was shown by single factor analysis that the age, the case history of chronic disease, infection sites, WBC, pH value, Lac, and ScvO2 before treatment, 6-hour urine output after treatment, the number of organ with failure, the use of antibiotics within 1 hour,and incidence of AKI or ALI/ARDS within 24 hours were risk factors of 28-day death (P ＜ 0.05 or P ＜ 0.01).It was shown by the logistic regression analysis that aging [odds ratio (OR) =4.81, P =0.02], failure of 2 organs (OR =28.63,P =0.00) or ≥ 3 organs (OR =62.69, P =0.00) were the independent risk factors for mortality in patients with septic shock.④ The 76 patients of late group were subdivided into three groups, namely 6-hour reaching standard of EGDT group (n =22), 24-hour reaching standard of EGDT group (n =28), and non-reaching standard of EGDT group (n =28).Compared with those before treatment, the Lac after therapy was decreased obviously both in 6-hour EGDT group and 24-hour EGDT group, and the CVP, MAP, and ScvO2 were increased significantly.The Lac in 6-hour EGDT group was lowered more significantly as compared with that in 24-hour EGDT group (mmol/L: 1.64 ± 0.40 vs.3.01 ± 1.13, P ＜ 0.01),while MAP and ScvO2 were increased significantly [MAP (mmHg): 81.82 ± 8.01 vs.69.01 ± 9.63;ScvO2:0.718 ± 0.034 vs.0.658 ±0.036, P ＜ 0.05 and P ＜ 0.01].The urine output in both reaching standard of EGDT groups was more than 0.5 mL·h-1·kg-1, without statistically different significance.The 28-day mortality rate of 24-hour EGDT group was 14.29％, and it was 0 in 6-hour EGDT group.Conclusions Mortality was as high as 68.96％ during 10 years when the period before the use of 2004 SSC, and the mortality rate was lowered to 34.21％ during 10 years during which the early fluid resuscitation treatment was based on EGDT.Aging and failure of more than 2 organs were independent risk factors for mortality in patients with septic shock.Compared with reaching the standard of EGDT within 24 hours,reaching the standard of EGDT within 6 hours can rapidly reverse hypoxic-ischemic tissue, thereby improving the prognosis of the patient with lowering of mortality rate.

Non-invasive coronary artery angiography is one of the hotspots of imaging.This article reviewed the status and the relevant advancement of the cardiac EBCT, DSCT, MSCT and MR imaging.

Tumor-derived heat shock protein-peptide complex 96 (HSPPC-96) containing tumor antigenic peptides can elicit po-tent tumor-specific and protective immunity. Autologous HSPPC-96 vaccine has been shown to effectively prolong recurrence-free sur-vival and increase the overall survival of many tumors, thereby suggesting extensive future applications. However, as an autologous tu-mor-derived individual vaccine, the development of HSPPC-96 vaccine is challenged by the lack of an adequate autologous tumor, lim-ited efficacy for advanced-stage cancer, etc. This paper summarized the progress, future perspectives, and challenges in the clinical de-velopment of HSPPC-96 vaccine immunotherapy.

Breast cancer is one of reproduction-endocrine related tumors, so the risk factors including environmental and genetic factors which can disrupt anabolism and function of estradiol may increase the risk of breast cancer. Persistent environmental endocrine disruptor chemical (EDCs) can disrupt anabolism and function of endogenous hormone and the degree of disruption may depend on genetic polymorphism. EDCs and metabolic enzyme genetic polymorphism were discussed in this paper. To study the risk factors of breast cancer, both of the environmental factors and the genetic factors should be included.

Objective To discuss the effects of high-fluoride intake and iodine-deficiency on thyroid glands of pregnant mice and their offspring. Methods 200 mg/ L sodium fluoride solution was supplied ad.lib. for the adult female Kunming mice before pregnancy and during pregnancy with iodine-sufficiency and iodine-deficiency. The morphological changes and functions of thyroid glands and the body weights of the pregnant mice and their offspring were observed and measured. Results Under the condition of iodine-sufficiency, significantly higher levels of blood T4 in pregnant mice exposed to high-dose fluoride and their offspring were observed compared with those of control group. Significantly heavier body weights were found in 18 d-pregnant mice and 7 d-old offspring compared with those of control group (P

Objective To establish culture method for Phyllanthus urinaria. Methods To study the possible effective factors of culture condition by comparing with different explants,sucrose,plant growth substance,and its ratio. Results The inductivity of stem was the highest about 55.56%,but callus of leaves could not be induced.6-BA was the most important factor on callus induction,followed by 2,4-D NAA and sucrose. Conclusion The optimal medium to induce and subculture is MS+2,4-D 0.5 mg/L+6-BA 1.0 mg/L+NAA 0.1 mg/L+sucrose 10 g/L.

A protein was isolated by DEAE-cellulose Chromatography and ultracentrifuge from the fruits of Momordica charantid L., and identified by chemical and polyacrylamide gel electrophoresis methods. The molecular weight was 34 000; isoelectric point pH 8.4,N-end amino acid was leucine.It was composed of 17 kinds of amino acids. The protein has been shown to have antifertility action in male rats.

ObjectiveTo study the diagnostic value of serum type IV collagen(IV-C) in hepatic fibrosis. MethodsSerum IV-C levels were detected by using radioimmunoassay(RIA) and were compared with serum type Ⅲ procollagen(PCⅢ ) levels in normal controls(NC) and patients with chronic liver diseases. ResultsSerum IV-C and PCⅢ levels in patients with chronic liver diseases were all much higher than those in NC(P < 0.01, totally). Serum IV-C level in severe chronic hepa titis(CH) group was significantly higher than those in mild and median CH groups (P<0.01 total ly), and that in active liver cirrhosis(LC) group was significantly higher than that in static LC group (P＜0.05). There were significant positive correlation between serum IV-C level and serum PcⅢ level both in CH group and in LC group ( in CH γ=0.7023, in LC γ=0. 5878, P＜0. 001).Conclusion Serum IV-C level could reflect the activity of hepatic fibrogenesis.

A total of 17 hip joint lesion patients (24 hips) combined with ankylosing spondylitis and severe osteoporosis from March 1996 to March 2003.They.received autologous impaction bone graft and cementless total hip replacement.They were 20-52 years old,averagely 35 years.Harris score and X-ray method were used to evaluate clinical outcomes.A total of 17 patients (24 hips) were followed up for 36-120 months,averagely 87 months.Harris score increased from averagely 34 points (preoperation) to averagely 86.4 points (postoperation),resulting in an excellent and good rate of 87.5%.Radiograph showed that femoral prosthesis was closely fixed to proximal segment of the femur,without prosthetic infection or dislocation.One hip suffered from 5-mm prosthetic subsidence within 1 year following replacement,and no further subsidence following over 5-year follow up.The prosthesis showed good contact to sclerotin,without loose.It is suggested that bone mass has great effects on cementtess prosthetic replacement.Autologous impaction bone graft for bone remodeling provides a good method for total hip replacement in patients combined with ankylosing spondylitis and severe osteoporosis.The clinical outcome is satisfactory.

Tumor markers for early diagnosis of cancer is an important auxiliary mean,which for early tumor detection,monitoring and for judging curative effect of treatment regimens play important role.Clinical method for early diagnosis on ovarian cancer is the detection of serum CA125,however,its precision and specificity for early diagnosis are not enough.It has been found that in the development period of the patients with ovarian cancer,SMRP and CA125 is co-expression.This article reviews the value of serum mesothelin on diagnosis of epithelial ovarian cancer to provide reference on early diagnosis and treatment.