The role of oxygen free radicals in multiple system organ failure (MSOF) was studied in rats produced by reticuloendothelial system blockade in addition to hemorrhagic shock. In MSOF animals blood reduced glutathione (GSH) elevated to 4.17?0.38 mg/g Hb at day 2, compared with baseline 2.67?0.09. Plasma glutathione peroxidase declined to 1.22?0.27 U/ml?min at day 1, and gradually increased at day 2 and day 3, but still lower than baseline 3.08?0.20. Blood superoxide dismutase (SOD) level was 182.6?27.1 at day 1, lower than baseline 249.5?72.4 ?g/g Hb. Plasma malondialdehyde (MDA) increased twice the normal level of 6.54?31 nmol/ml. Correlation analysis showed that lung index, plasma GPT and creatinine negatively correlated with the level of lung and liver homogenate SOD and kidney homogenate GSH, respectively.Results indicate that there are significant changes in the levels of blood and tissue antioxidants and lipid peroxides during MSOF. Organ failure appears to be correlated with the decrease in tissue antioxidation capacity.

Complement activation induces polymorphonucleal neutrophilic leukocyte (PMN) aggregation in circulation causing microvascular occlusion. The activated PMNs release lysosome enzymes which damage the tissue. It might take an important part in shock and multiple organ failure. We pre-treated rat PMNs with sinomeuine, which was extracted and purified from the stem of Sinomeuium acufum Rehd et Wils. It was found to inhibit the morphological changes and lysosome enzymes release in PMNs activated with zymosanactivated plasma. With administration of sinomeuine PMNs remained a spherical shape, no apparent ruffling or cytoplasmic projection and less aggregation. Elastase and Nacetyl-?-D-glucosaminidase content in PMNs supernatant increased less.

Complement-induced polymorphonuclearcytes (PMN) aggregate in microvasculature of vital organs, produce microemboli, and block microcirculation blood flow. Activated PMN release oxygen free radicals, prostaglandins and proteases, in turn, damage endothelial and parenchyma cells. This is an important factor in pathogenesis of multiple system organ failure. We have found that Sinomeuine and Sodium Ferulate prevented PMN aggregation induced by activated complement. Adding the drugs into PMN suspension treated with cytochalasin B, the zymosan activated plasma, PMN aggregation was prevented. The changes of light transmission were smaller than those of control without drugs recorded with platelet aggregometer. The 50% of PMN aggregation inhibition with Sinomeuine was 0.76mg/ml (1.gmmol/L), and 0.82mg/ml (3.8mmol/L) with Sodium Ferulate.

Objective To explore the effect of personalized intervention on drug compliance in patients with multidrug-resistant pulmonary tuberculosis. Methods A total of 80 patients with multidrug-resistant pulmonary tuberculosis were selected from March 22, 2016 to March 22, 2017, and randomized groups were randomly divided into the observation group and the control group,40 cases in each groups . The observation group and the control group Intervention and routine care. Results Observation group of patients satisfaction score (97.92±1.24), compliance score (95.42±3.14), the incidence of adverse events (5.00%), reasonable nutrition rate (100.00%), prescribed medication rate (100.00%), don't do STH without authorization (100.00%), rate of quitting cigarettes, alcohol and drug withdrawal rate (95.00%), and regularly review rate (95.00%), the psychological function (97.53±1.22) and body function (96.18 ± 1.42) points (95.31±2.41), material life, social function (94.82± 3.42mm) were better than control group (P<0.05).Conclusion Individualized intervention in multidrug-resistant tuberculosis patients can improve drug compliance.

Objective To investigate the association between nonalcoholic fatty liver disease (NAFLD) and metabolism or carotid intima-media thickness (CIMT) in Type 2 diabetic(T2DM). Methods According to the liver B-ultrasonography, a total of 321 T2DM patients were divided into two groups, with or without NAFLD. Metabolic indexes such as BMI, BP, blood glucose, blood lipid, uric acid ( UA ), insulin, C-peptipe,insulin resistance index(HOMA-IR) between the two groups were compared, and the relationships between alanine aminotransferase (ALT) and the above indexes were analyzed. Furthermore,the CIMT of the two groups were compared, and the relationships between NAFLD, ALT and CIMT were investigated by correlation and regression analysis. Results Compared with the group without NAFLD, the patients with NAFLD had higher level of BMI, triglyceride ( TG ), UA, fasting blood glucose ( FBG ), fasting insulin ( FIns ), fasting C peptide (FCP) ,HOMA-IR,and lower level of high density lipoprotein ( HDL-C ) significantly; BMI ( OR = 1.25, P ＜0. 001 ), TG ( OR = 1.74, P = 0. 008 ) and HOMA-IR ( OR = 2. 33, P = 0.010) were independent risk factors of NAFLD while H DL-C was independent protective factor; ALT was positively correlated with BMI (r = 0. 255, P ＜0. 001 ) ,TG(r =0. 156,P ＜0. 018) ,UA(r =0. 239,P ＜0. 001 ) ,FIns(r =0. 213,P =0. 001) ,FCP(r =0. 199,P ＜0. 003), HOMA-IR ( r = 0. 247, P ＜ 0. 001 ) and negatively correlated with HDL-C ( r = - 0. 199, P =0. 002) ,and BMI (β =0. 456,P =0. 048) ,UA (β =0. 021 ,P =0. 025) and HOMA-IR(β =3.634 ,P =0. 004)were independent associated facrors. The difference of CIMT between the two groups didn't reach statistical significance, while mutiple regression analysis revealed that ALT was independently associated with CIMT(β =0. 002,P = 0. 013). Conclusion T2DM patients with NAFLD show more serious disorder of metabolism and insulin resistance. ALT is an independent risk factor of CIMT in T2DM patients.

AIM: To determine the evolutionary pattern of parenchymal cell apoptosis in multiple organs early after intestinal ischemia-reperfusion(I/R) and its induction mechanisms and the role of apoptosis in triggering SIRS/MODS. METHODS: An I/R model was reproduced by clipping and releasing the superior mesenteric artery in rats and mice. Flow cytometry, electron microscope, DNA agarose gel electrophoresis, TUNEL method, fluorescent and Gomori's silver-HE staining were used to detect apoptosis. Distribution features of apoptotic parenchymal cells in multiple organs were observed. Immunohistochemical staining of HSP 70 and Bcl-2 were performd to study the induction mechanisms of apoptosis.RESULTS and CONCLUSION: 1. Damage of the liver, lung, gut and kidney was appeared in early phase of I/R. The percentages of apoptosis in parenchyma organs increased progressively. The percentages of cell necrosis increased with the prolonged I/R duration. 2. Percentages of apoptosis were much higher near the central veins of liver lobules, in the outer medulla of the kidney, and the antimescenteric border of intestinal mucosal epithelium because of ischemia. 3. The expression of HSP 70 increased and Bcl-2 reduced in the areas mentioned above because of hypoperfusion. 4. Apoptosis of I/R hepatocytes, splenocytes and thymocytes was obviously increased after Kupffer cell blockage with GdCl3, showing the functional state of Kupffer cells may play an important role in SIRS/MODS.

BACKGROUND:Perioperative treatment of emergency liver transplantation for acute hepatic failure is extremely different from common liver transplantation, due to complex conditions, high risk, several complications, and high mortality. OBJECTIVE:To summarize the experience of emergency liver transplantation for acute hepatic failure during the perioperative period, and to increase the success rate in treatment of acute hepatic failure. METHODS:A retrospective analysis was undertaken on the clinical data of 38 cases undergone emergency liver transplantation for acute hepatic failure. There were 21 male and 17 female, who aged 15-69 years. Among them, 23 cases had hepatitis B virus (including 2 cases with hepatitis B and C virus), 7 cases had Wilsons disease, 3 cases had mushroom poisoning, 2 cases had unknown liver damage, 1 case had Tripterygium wilfordi poisoning, 1 case had decompensation after partial liver resection due to trauma, and 1 case had liver transplantation from corpse. RESULTS AND CONCLUSION:The survival time of the involve patients was 13-1 740 days, and the median survival time was 634 days. Perioperative survival rate was 76%, 1-year survival rate was 63%, and 2-year survival rate was 58%. During the perioperation nine cases died of brain edema and intracranial hypertension, renal failure, severe pulmonary infection, multiple organ failure, coagulation disorders (intracranial hemorrhage, upper digestive tract hemorrhage), acute respiratory distress syndrome and primary graft non-function. At present, emergency liver transplantation is stil the most effective way for acute liver failure. Hemorrhage, infection and rejection are the leading causes of the death. Each perioperative treatment is of great significance for the success of liver transplantation and long-term survival.

Objective To investigate drug resistance and clinical efficacy of second-line anti-tuberculosis drugs in patients with multidrug-resistant pulmonary tuberculosis.Methods A total of 183 multi-drug resistant pulmonary tuberculosis (MDR-PTB) patients received standard anti-tuberculosis treatment in Zhejiang Provincial Center for Diagnosis and Treatment of Tuberculosis during March 2011 and March 2013.Patients were divided into four groups according to the results of first-line anti-tuberculosis drugs susceptibility test:group A (n =30) resistant to isoniazid (H) and rifamipicin (R) ; group B (n =28) resistant to HR and ethambutol (E) ; group C (n =53) resistant to HR and streptomycin (S) ; groups D (n =72) resistant to HRES.Drug susceptibility tests of second-line drugs kanamycin (Km),protionamide (Pto),paraaminosalicylic acid (PAS) and levofloxacin (Lfx) were performed.Negative conversion rates of mycobacterium tuberculosis in sputum culture were also observed and compared among different groups with x2 test.Results Among 183 MDR-PTB patients,49 cases (26.8％) were resistant to Lfx,which was significantly higher than that of Km (8.7％,n =16),Pto (13.1％,n =24) and PAS (6.6％,n=12) (x2 =37.983,P＜0.05).The resistant rate to Lfx in group D was 45.8％ (33/72),which was higher than that in group A (2/30,6.7％),group B (6/28,21.4％) and group C (8/53,15.1％) (x2 =14.413,5.047 and 13.087,P ＜0.05).The occurrence of pre-extensively drug resistance (Pre-XDR) in group D was 34.7％ (25/72),which was higher than that in group A (3/30,10.0％) and group C (9/53,17.0％) (x2 =6.499 and 4.852,P ＜ 0.05).Among 157 MDR-PTB patients who received standard anti-tuberculosis treatment for one year,the negative conversion rate of mycobacterium tuberculosis in sputum culture was 87.3％ (137/157).The negative conversion rate in group D was lower than that in other groups,but the difference was not of statistical significance (x2 =1.899,P ＞ 0.05).Conclusions The efficacies of second-line anti-tuberculosis drugs vary among MDR-TB patients resistant to different firstline anti-tuberculosis drugs.The sensitivity tests results of the first-line drugs may serve as reference for MDR chemotherapy regimen in lack of test results of second-line drugs.

Objective To explore the difference in pain threshold between related acupoints and the specificity of acupoints in cholecystitis patients.Method Actual measurement was made in 80cases, a normal group of 30 cases (volunteers without psychological and physiological diseases) and a patient group of 50 cases (volunteers with cholecystitis). The probe of an algometer was perpendicularly placed on the selected acupoint, the pressure point was pushed and pressing was stopped immediately after the subject felt pain. The pain thresholds displayed by the measured acupoints were recorded. The pain thresholds of the selected acupoints were compared between the normal and patient groups and thedifferences were analyzed to explore the specificity of acupoints.Result A comparison of the pain thresholds of the Back-Shu points of the Bladder Meridian of Foot-Taiyang between the patient and normal groups showed that there were no significant differences in the thresholds of the left Back-Shu points Geshu (BL17), Ganshu (BL18), Danshu (BL19), Pishu (BL20), Weishu (BL21) and Dachangshu (BL25) of the bladder meridian between the two groups (P>0.05) and there were significant differences in the thresholds of the right Back-Shu points Geshu, Ganshu, Danshu, Pishu, Weishu and Dachangshu of the bladder meridian between the two groups (P<0.01). The pain threshold was significantly lower in thepatient group than in the normal group. A comparison of the pain thresholds of the main points of the Liver Meridian of Foot-Jueyin, the Gallbladder Meridian of Foot-Shaoyang and the stomach meridian between thepatient and normal groups showed that there were significant differences in the thresholds of the right points Liangmen (ST21), Riyue (GB24) and Qimen (LR14) of the liver, gallbladder and stomach meridians (P<0.01) and no significant difference in the threshold of the right point Taichong (LR3) between the two groups (P>0.05). The pain thresholdwas significantly lower in thepatient group than in the normal group. There were no significant differences in thethresholds of the left points Liangmen, Riyue, Qimen and Taichong of the Liver Meridian of Foot-Jueyin, the Gallbladder Meridian of Foot-Shaoyang and the stomach meridian between the patient and normal groups (P>0.05).Conclusion The pain sensitivity of ipsilaterali related acupoints increase and the relative specificity of acupoints exist in cholecystitis patients.

Objective:To compare and study coronary artery lesions characteristics of patients with non -ST -seg‐ment elevation acute myocardial infarction (NSTEMI) .Methods :A total of 66 patients diagnosed as acute NSTEMI were enrolled as NSTEMI group ,meanwhile 74 patients with unstable angina pectoris (UAP) were regarded as UAP group and 76 patients with acute ST -segment elevation myocardial infarction (STEMI ) were regarded as STEMI group .All patients received coronary angiography (CAG) and optical coherence tomography (OCT) examination . Coronary artery lesions characteristics were compared among three groups .Results:Pairwise comparison showed , that occlusion lesion (33.3% ) and serious stenosis (70% ~94% ) lesion (34.8% ) in NSTEMI group were signifi‐cantly more than those of UAP group (14.9% ,8.1% ) respectively;the occlusion lesion and serious stenosis lesion of STEMI group were no significant difference compared with those of STEMI group , P>0.05 all;type C lesion 43.9% of NSTEMI group was significantly more than that of UAP group (27.0% ) and of STEMI group (31.6% ) respectively ( P<0.05 all);vulnerable plaque of NSTEMI group (56.1% ) was significantly more than that of UAP group (23.0% ,P<0.01) ,but was no significant difference compared with STEMI group (56.6% ,P> 0.05). Conclusion :Serious stenosis lesion ,type C lesion and vulnerable plaque of NSTEMI group are significantly more than those of UAP group ;in NSTEMI group , type C lesion is significantly more than ,and occlusion lesion occlusion le‐sion significantly less than that of STEMI group .