Objectives To explore ventilation induced cytokine production and the role of oxidant stress in lung stretch. Methods Both in vitro and in vivo models of ventilator-induced lung injury (VILI) were used. Alveolar epithelial cells were stretched in vitro to mimic the lung injury in VILI. Rats were ventilated at large tidal volume to produce ventilator-induced lung injury in vivo. A total of 23 inflammatory cytokines were screened with micro gene array in stretched alveolar epithelial cells. Cytokines found to have up-regulated in cells were measured in serum and lung tissue of rats exposed to large tidal volume ventilation. For investigating the intracellular pathway of cytokine up-regulation in VILI, exogenous TNF-? or H_ 2O_ 2 was added to culture media of alveolar epithelial cells. Cytokines were then measured. To explore the role of oxidant stress in VILI, N-acetylcysteine (NAC), as an anti-oxidant, was used in vitro and in vivo. Results We found that transforming growth factor-?_1 (TGF-?_1 and transforming growth factor-?_2 (TGF-?_2) were up-regulated in stretched alveolar epithelial cells and also in serum of rats with large tidal volume ventilation. Tumor necrosis factor-? (TNF-?) had no effects on TGF-? production in alveolar epithelial cells. Exogenous H_ 2O_ 2, as an oxidant, increased TGF-? production in alveolar epithelial cells. NAC, an anti-oxidant, decreased stretch induced TGF-? production, along with a down-regulation of oxidant injury. NAC also blocked the up-regulation of TGF-? in in vivo model of VILI. Conclusion TGF-?_1 and TGF-?_2 were up-regulated in VILI. Oxidant injury mediated up-regulation of TGF-? in VILI. NAC, which attenuated oxidant injury and blocked TGF-? up-regulation in VILI, could be a future therapeutic strategy in VILI.

Objectives To explore ventilation induced cytokine production and the role of oxidant stress in lung stretch. Methods Both in vitro and in vivo models of ventilator-induced lung injury (VILI) were used. Alveolar epithelial cells were stretched in vitro to mimic the lung injury in VILI. Rats were ventilated at large tidal volume to produce ventilator-induced lung injury in vivo. A total of 23 inflammatory cytokines were screened with micro gene array in stretched alveolar epithelial cells. Cytokines found to have up-regulated in cells were measured in serum and lung tissue of rats exposed to large tidal volume ventilation. For investigating the intracellular pathway of cytokine up-regulation in VILI, exogenous TNF-α or H2O2 was added to culture media of alveolar epithelial cells. Cytokines were then measured. To explore the role of oxidant stress in VILI, N-acetylcysteine (NAC), as an anti-oxidant, was used in vitro and in vivo. Results We found that transforming growth factor-β1 (TGF-β1 and transforming growth factor-β2 (TGF β2) were up-regulated in stretched alveolar epithelial cells and also in serum of rats with large tidal volume ventilation. Tumor necrosis factor-α (TNF-α) had no effects on TGF-β production in alveolar epithelial cells. Exogenous H2O2, as an oxidant, increased TGF-β production in alveolar epithelial cells. NAC, an anti-oxidant, decreased stretch induced TGF-β production, along with a down-regulation of oxidant injury. NAC also blocked the up-regulation of TGF-β in in vivo model of VILI. Conclusion TGF-β1 and TGF-β2 were up-regulated in VILI. Oxidant injury mediated up-regulation of TGF-β in VILI. NAC, which attenuated oxidant injury and blocked TGF-β up-regulation in VILI, could be a future therapeutic strategy in VILI.

Objective To analyze the epidemiological and clinical characteristics of 5 patients with importing yellow fever ,and to explore the preventive and control strategies of infection in hospital .Methods The epidemiological and clinical characteristics of 5 cases of importing yellow fever in Infectious Disease Hospital of Fujian Medical University from March 18th to April 6th in 2016 were retrospectively reviewed and analyzed .Results Five patients were all from Angola Luanda .One of them was vaccinated before going aboard ,and the others were vaccinated 1—10 days before disease onset in Angola .All of them were bitten by mosquitoes ,and their onset date ranged from March 11th to March 27th ,before returned to Fujian .The main clinical symptoms were fever ,chilly ,shivering ,fatigue ,arthrodynia ,headache ,and liver and kidney injury .At manifestations ,two patients had positive nuclear acid of yellow fever virus in serum samples and 3 patients were positive in urine samples .All of these patients were negative for dengue virus and Zika virus testing ,meanwhile no plasmodium was found in blood smears .All patients were cured and discharged . Conclusions There is risk of yellow fever transmission in Fujian Province . Prevention and control of the disease should be focus on improving the ability of finding and coping with the importing cases .Vaccination and hygiene knowledge propagation should be given for those who are going to epidemic country/area .Emergency monitoring and control of mosquitoes are necessary .

ObjectiveTo assess the value of passive leg raising (PLR) test in predicting fluid responsiveness in patients with sepsis-induced cardiac dysfunction.Methods A prospective observational cohort study was conducted. Thirty-eight patients under mechanical ventilation suffering from sepsis-induced cardiac dysfunction admitted to Department of Surgical Intensive Care Unit of First Affiliated Hospital of Sun Yat-Sen University from September 2013 to July 2014 were enrolled. The patients were studied in four phases: before PLR (semi-recumbent position with the trunk in 45°), PLR (the lower limbs were raised to a 45° angle while the trunk was in a supine position), before volume expansion (VE, return to the semi-recumbent position), and VE with infusing of 250 mL 5% albumin within 30 minutes. Hemodynamic parameters were recorded in every phase. The patients were classified into two groups according to their response to VE: responders (at least a 15% increase in stroke volume,ΔSVVE≥15%), and non-responders. The correlations among all changes in hemodynamic parameters were analyzed by linear correlation analysis, and the receiver operating characteristic curve (ROC) was plotted to assess the value of hemodynamic parameters before and after PLR in predicting fluid responsiveness.Results Of 38 patients, 25 patients were responders, and 13 non-responders. There was no significant difference in the baseline and hemodynamic parameters at semi-recumbent position between the two groups. The changes in SV and cardiac output (CO) after PLR (ΔSVPLR andΔCOPLR) were significantly higher in responders than those of non-responders [ΔSVPLR: (14.7±5.7)%vs. (6.4±5.3)%,t = 4.304,P = 0.000;ΔCOPLR: (11.2±7.5)% vs. (3.4±2.3)%,t = 3.454,P = 0.001], but there was no significant difference in the changes in systolic blood pressure, mean arterial pressure, pulse pressure, and heart rate after PLR (ΔSBPPLR,ΔMAPPLR,ΔPPPLR andΔHRPLR) between two groups.ΔSVVE in responders was significantly higher than that of the non-responders [(20.8±5.5) % vs. (5.0±3.7) %,t = 8.347,P = 0.000]. It was shown by correlation analysis thatΔSVPLR was positively correlated withΔSVVE (r = 0.593,P = 0.000),ΔCOPLR was positively correlated withΔSVVE (r = 0.494,P = 0.002). The area under ROC curve (AUC) ofΔSVPLR≥8.1% for predicting fluid responsiveness was 0.860±0.062 (P = 0.000), with sensitivity of 92.0% and specificity of 70.0%; the AUC ofΔCOPLR≥5.6% for predicting fluid responsiveness was 0.840±0.070 (P = 0.000), with sensitivity of 84.0%and specificity of 76.9%; the AUC ofΔMAPPLR≥6.9% for predicting fluid responsiveness was 0.662±0.089, with sensitivity of 68.0% and specificity of 76.9%; the AUC ofΔSBPPLR≥6.4% for predicting fluid responsiveness was 0.628±0.098, with sensitivity of 76.0% and specificity of 61.5%; the AUC ofΔPPPLR≥6.2% for predicting fluid responsiveness was 0.502±0.094, with sensitivity of 56.0% and specificity of 53.8%; the AUC ofΔHRPLR≥-1.7%for predicting fluid responsiveness was 0.457±0.100, with sensitivity of 56.0% and specificity of 46.2%.Conclusion In patients with sepsis-induced cardiac dysfunction, changes in SV and CO induced by PLR are accurate indices for predicting fluid responsiveness, but the changes in HR, MAP, SBP and PP cannot predict the fluid responsiveness.

Objective To observe the effect of Bifico particles combined with Qiuxieling granule in the treatment of infantile rotavirus enteritis. Methods Children with infantile rotavirus enteritis in our hospital, with 74 patients in the control group and the observation group each. Patients in control group were taken montmorillonite and patients in observation group were taken Bifico particles combined with Qiuxieling granule, the course of treatment was 3 successive days,then the therapeutic effects in the two groups were evaluated after 5 days. Results Clinical symptoms,the fecal bifidobacterium and stool fecal lactose before therapy were compared, there were no significant difference between the two groups (P>0.05). After therapy, the vomiting times and the frequency of diarrhea in the observation group were significantly less than the control group (P<0.01). The fecal bifidobacterium in the observation group was significantly more than the control group (u=8.49,P<0.01). The stool fecal lactose in the observation group was significantly more than the control group (χ2=15.39,P<0.01). Conclusion It has a definite therapeutic effect of Bifico particles combined with Qiuxieling granule in treatment of infant with rotavirus enteritis,and it deserves popularization and application.

Objective To analyze the epidemiological and clinical characteristics of 403 local cases with dengue fever , and to provide guidance for dengue fever's prevention , diagnosis and treatment . Methods The epidemical data ,clinical characteristics ,laboratory results ,therapy and outcomes of 403 cases with dengue fever treated in Mengchao Hepatobiliary Hospital of Fujian Medical University ,Fuzhou from July to November 2016 were collected and analyzed retrospectively .Results Among the 403 cases , 56 cases (13 .89％ ) were younger than 20 years old ,160 cases (39 .71％ ) were 21 to 50 years old ,and 187 cases (46 .40％ ) were over 50 years old .The peak incidence period of dengue fever was from August to October ,accounting for 94 .29％ of the cases .The clinical classification was dominated by typical dengue fever (98 .01％ ) .Most of the cases had sudden onset .The main clinical symptoms included fever in 391 cases (97 .02％ ) , body aches in 355 cases (88 .09％ ) , and rash in 156 cases (38 .71％ ) . All patients were tested for serology and etiology of dengue virus at the early stage of disease .Among them , the positive rate of NS1 antigen was 95 .04％ ;the positive rate of IgM antibody was 13 .90％ ,and the positive rate of IgG antibody was 8 .19％ . Thrombocytopenia was founded in 332 cases (82 .38％ ) .Neutrophil count decreased in 293 cases (72 .70％ ) , w hite blood cell count decreased in 274 cases (67 .99％ ) .Aspartate aminotransferase increased in 256 cases (63 .52％ ) and alanine aminotransferase increased in 146 cases (36 .23％ ) .Creatine kinase elevated in 130 cases (32 .26％ ) and prothrombin time was prolonged in 40 cases (9 .93％ ) .A total of 289 cases (82 .75％ ) had bilateral lesions in both lungs and 25 cases (6 .20％ ) had pleural effusions . Color doppler ultrasound found 46 cases (11 .41％ ) of hepatomegaly ,84 cases (20 .84％ ) of splenomegaly ,8 cases (1 .99％ ) of a small amount of ascites . Conclusions Most of the 403 cases of dengue fever show typical clinical manifestations .Dengue fever mainly affects the blood system ,liver ,heart ,lung ,kidney ,skeletal muscle system ,and immune system . Clinicians should carefully observe the condition ,master the warning signs of severe dengue fever ,and achieve early identification and timely treatment of severe cases ,thereby reducing the mortality rate .

BACKGROUNDEndostar™ (rh-endostatin, YH-16) is a new recombinant human endostatin developed by Medgenn Bioengineering Co. Ltd., Yantai, Shandong, P.R.China. Pre-clinical study indicated that YH-16 could inhibit tumor endothelial cell proliferation, angiogenesis and tumor growth. Phase I and phase II studies revealed that YH-16 was effective as single agent with good tolerance in clinical use.The current study was to compare the response rate , median ti me to progression (TTP) ,clinical benefit andsafety in patients with advanced non-small cell lung cancer ( NSCLC) , who were treated with YH-16 plus vi-norelbine and cisplatin (NP) or placebo plus NP.

METHODSFour hundred and ninety-three histologically or cy-tologically confirmed stage IIIB and IV NSCLC patients , withlife expectancy > 3 months and ECOG perform-ance status 0-2 , were enrolledin a randomized ,double-blind ,placebo-controlled , multicenter trial ,either trialgroup : NP plus YH-16 (vinorelbine 25 mg/m² on day 1 and day 5 ,cisplatin 30mg/m² on days 2 to 4 , YH-167.5mg/m² on days 1 to 14) or control group : NP plus placebo (vinorelbine 25 mg/m² on day 1 and day 5 ,cis-platin 30 mg/m² on days 2 to 4 ,0.9% sodium-chloride 3 .75 ml on days 1 to 14) every 3 weeks for 2-6 cycles .The trial endpoints included response rate ,clinical benefit rate ,time to progression,quality of life and safety .

RESULTSOf 486 assessable patients , overall response rate was 35.4% in trial group and 19.5% in controlgroup (P=0 .0003) . The median TTP was 6 .3 months and 3 .6 months for trial group and control group respectively (P < 0 .001) . The clinical benefit rate was 73 .3 %in trial group and 64.0% in control group (P=0 .035) .In untreated patients of trial group and control group ,the response rate was 40 .0% and 23.9%(P=0 .003) ,the clinical benefit rate was 76 .5 % and 65 .0 % (P=0 .023) ,the median TTP was 6 .6 and 3 .7months (P=0 .0000) ,respectively .In pretreated patients of trial group and control group ,the response ratewas 23.9% and 8.5%(P=0 .034) ,the clinical benefit rate was 65.2% and 61.7%(P=0 .68) ,the median TTP was 5 .7 and 3 .2 months (P=0 .0002) ,respectively . The relief rate of clinical symptoms in trial groupwas higher than that of those in control group ,but no significance existed (P > 0 .05) . The score of quality oflife in trial group was significantly higher than that in control group (P=0 .0155) after treatment . There were no significant differences in incidence of hematologic and non-hematologic toxicity , moderate and severe sideeffects betweentrial group and control group .

CONCLUSIONSThe addition of YH-16 to NP regimen results in significantly and clinically meaningful improvement in response rate , median time to tumor progression,and clinical benefit rate compared with NP alone in advanced NSCLC patients . YH-16 in combination with chemotherapy shows a synergic activity and a favorable toxic profile in advanced cancer patients .

ObjectiveTo investigate the distribution of traditional Chinese medicine （TCM） syndrome types and influencing factors of protein-energy wasting （PEW） in chronic kidney disease （CKD） undergoing maintenance hemodialysis （MHD）. MethodsAccording to diagnostic criteria， 164 patients with MHD were divided into PEW group and non-PEW group. The clinical data of all patients were collected， including general information such as gender， age， height and weight， disease characteristics such as course， cormobidity， and haemodialysis duration， laboratory indicators such as blood routine， liver function， renal function， electrolyte， blood lipid， grip strength， and the four examinations. Logistic regression analysis was used to find the influencing factors of PEW by taking the clinical indicators with significant differences between the two groups （P＜0.05） as the independent variables， diagnosis of PEW as the dependent variable， and normal values as the reference. ResultsOut of 164 patients with MHD， there were 96 （58.5%） cases in PEW group and 68 cases （41.5%） in non-PEW group. Compared to the non-PEW group，PEW group had increased age， ratios of bedrest， deep vein preservation， edema， and low grip strength， percentages of comorbidities type 2 diabetes， cardiovascular and cerebrovascular diseases，infections and anemia， and levels of alanine aminotransferase and permine amin aminotransferase， as well as decreased body mass index， self-care ratio，internal arteriovenous fistula， red blood cell count， hemoglobin， serum total protein， serum albumin levels （P＜0.05）. The PEW group had significantly higher frequency of poor appetite and digestion， abdominal distension， fear of cold and preference of warmth， weak breathing and fatigue， poor appetite， oliguria， nausea and vomiting than non-PEW group （P＜0.05）. The incidence of both yin and yang deficiency syndrome and damp-turbidity syndrome were significantly higher in the PEW group than the non-PEW group， while that of liver-kidney yin deficiency syndrome and stirring of wind syndrome were lower （P＜0.05）. Logistic regression analysis showed that low BMI （＜22 kg/m²）， inability to take care of oneself， low grip strength，low serum albumin （＜38 g/L）， infection， older age， fear of cold and cold limbs，and poor appetite were the risk factors of PEW in patients undergoing MHD （P＜0.05）. ConclusionThe root syndrome of MHD-PEW patients is both yin and yang deficiency， concurrent with damp-turbidity syndrome. Low BMI， low serum albumin， infection and older age may be the influencing factors of PEW in patients undergoing MHD.

BACKGROUNDMany studies have shown that continuous renal replacement therapy (CRRT) could clean lactate and treat the hyper-lactatemia. On the contrary, some other studies found that filter lactate clearance only accounted for a very small part of total lactate clearance and the hemofilter's contribution to the overall lactate clearance was negligible. The objective of this study was to evaluate the effects of various doses of continuous veno-venous hemofiltration (CVVH) on plasma lactate elimination in critically ill patients.

METHODSPatients were divided into three groups according to their incipient plasma lactate concentration. Group A: lactate ≤ 2 mmol/L, group B: lactate 2-5 mmol/L, group C: lactate ≥ 5 mmol/L. Three different doses (20 ml × kg(-1)× h(-1), 35 ml × kg(-1)× h(-1) and 45 ml × kg(-1)× h(-1)) of CVVH were applied to critically ill patients who experiencing CVVH. The concentrations of plasma lactate in pre-(A), post-dialyzer (V) sites and ultrafiltrate were measured after each dosage of CVVH was carried out for 30 minutes. Rate of lactate clearance by the filter (RLC) and filter lactate clearance (FLC) and Lactate-Sieving Coefficient (LSC) were calculated under different circumstances, including different doses of CVVH and different incipient lactate levels.

RESULTSFifteen patients were enrolled and 104 blood samples were drawn and lactate concentrations were measured in this study. RLC was found increased ((9.36 ± 9.73) mmol/h, (13.92 ± 12.56) mmol/h and (16.52 ± 12.71) mmol/h, P < 0.05 respectively) with the dose of CVVH increased. RLC was also increased ((3.46 ± 1.46), (10.38 ± 5.50) and (24.53 ± 14.69) mmol/h, P < 0.05 respectively) with the incipient lactate increased. FLC was increased ((1.95 ± 0.63), (2.95 ± 0.74) and (3.45 ± 0.54) L/h, P < 0.05 respectively) with the dose of CVVH increased. There was no significant difference of LSC in different doses of CVVH and different incipient lactate levels.

CONCLUSIONSPlasma lactate can be eliminated by CVVH and different doses of CVVH affect the rate of lactate clearance in critically ill patients.

Adult ; Aged ; Aged, 80 and over ; Critical Illness ; Female ; Hemofiltration ; Humans ; Lactic Acid ; blood ; Male ; Middle Aged