Objective　To Investigate the pathogenesis of chronic idiopathic urticaria.Methods　Basophil histamine release assay was utilized.Result　15 of 32 cases(46.9%)had increased serum histamine releasing activities. This implied that anti-FcεR1 and anti-IgE autoantibodies existed in the sera of some patients with chronic idiopathic urticaria.Conclusion　It suggested that autoimmunity might take part in the occurrence of some patients with chronic idiopathic urticaria.

Objective To investigate the role of recombinant human growth hormone (rhGH) in the treatment of patients with multiple organ dysfunction syndrome (MODS). Methods Thirty eight patients with MODS routinely treated with antibiotics and nutrition support were divided into two groups: the rhGH group and control group. The rhGH group was treated by subcutaneous injection of 5 U rhGH for two weeks. Results On the 7th day of treatment, the score of APACHE Ⅱ in the rhGH group was much higher than the control group, the levels of ALT, AST, BUN and Cre did not change much compared with the control group. The level of albumin in the rhGH group increased ( P

Objective To investigate the bacterial spectrum and drug resistance of gram-negative bacteria infection in intensive care unit(ICU).Methods A retrospective analysis was conducted on flora isolates from Jan 2003 to Dec 2003 to investigate the bacterial spectrum,bacterial resistance and clinical characteristics.Results The leading causative microorganisms isolated were Acinetobacter spp (22.1%),Pseudomonas aeruginosa(20.1%),and E.coli (16.9%). Gram-negative bacteria exhibited the lowest resistance rates to imipenem/cilastati and Amikacin in all antibiotics currently used.However Pseudomonas aeruginosa had the highest resistance rate to imipenem/cilastatin in all the gram-negative bacteria (12.1%).The respiratory tract was the most common compromised site in ICU.Conclusions The causative bacteria in infection in ICU have a higher resistance to antibiotics currently used including cephalosporins of third-generation.It is critical to adopt specific antibiotics based on bacteriology and susceptibility to prevent the development of drug resistance.

Objective To observe the clinical effect of Zhang point in subclavian vein puncture. Methods One hundred patients underwent deep vein catheterization were selected, ASA grade of Ⅱ- Ⅲ. The patients were divided into 2 groups according to puncture method with 50 cases each, the patients in group A used traditional puncturing method, and the patients in group B used Zhang point puncture method. The total success rate, success rate of the first trial and incidence of complication were recorded. All the patients received the bedside chest X-ray examination to observe the location of central venous catheter after surgery. Results The total success rate and success rate of the first trial in group B were significantly higher than those in group A:100%(50/50) vs. 88%(44/50) and 96%(48/50) vs. 76%(38/50), the incidence of complication was significantly lower than that in group A: 4% (2/50) vs. 20%(10/50), there were statistical differences (P<0.05). Conclusions Using of Zhang point is very simple in subclavian vein puncture catheterization, with a higher success rate and a less complication rate.

Objective To explore the prognostic value of serum C-reactive protein/albumin (CRP/ALB) ratio in the adult patients with sepsis.Methods A retrospective study was conducted.Clinical data were collected from septic patients who were at least 18 years old and whose intensive care unit (ICU) lengths of stay were at least 3 days,and who were admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University in Henan Province from September 2013 to September 2015.These patients were divided into survival group and death group according to 28-day outcome.The serum CRP,ALB,and CRP/ALB ratio levels at the start of treatment (0 hour),24 hours and 72 hours after treatment in ICU were analyzed.And the receiver-operating characteristic (ROC) curve was plotted to assess the value of CRP,ALB and CRP/ALB ratio at different time points for predicting the outcome.Results Sixty-nine patients with sepsis were selected,among whom 28 cases were in the death group and the mortality was 40.6％.The characteristic of the baseline data in the two groups was balanced.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score at the first 24 hours of ICU admission in the death group were significantly higher than those in the survival group (APACHE Ⅱ score:25.18 ± 3.18 vs.17.88±3.20,SOFA score:11.71± 1.78 vs.9.17 ± 2.38,both P ＜ 0.05).And the ICU length of stay in the death group was significantly longer than that in the survival group [days:9.0 (2.5) vs.8.0 (3.0),P ＜ 0.05].The ALB level increased gradually as the treatment was extended in both groups while the levels of CRP and CRP/ALB declined gradually.The ALB levels at 0,24,72 hours after treatment in the death group were significantly lower,and the CRP and CRP/ALB levels were significantly higher than those in survival group [ALB (g/L):23.40 (4.20) vs.25.20 (8.20) at 0 hour,24.18±4.33 vs.28.54±4.88 at 24 hours,25.50±4.88 vs.34.88±7.23 at 72 hours;CRP (mg/L):179.32±34.04 vs.159.55±36.82 at 0 hour,160.08±22.91 vs.146.23±30.31 at 24 hours,159.36±25.81vs.142.53±36.30 at 72 hours;CRP/ALB:7.52±1.32 vs.6.04±1.46 at 0 hour,6.77±1.42 vs.5.23±1.24 at 24 hours,6.40± 1.34 vs.4.19± 1.21 at 72 hours;all P ＜ 0.05].ROC curves analysis showed that the area under ROC curves (AUC) of CRP/ALB at all time points were larger than those of CRP and ALB,with higher sensitivity and specificity;the AUC of ARP/ALB at 0,24,72 hours were 0.767,0.807,0.895,respectively;the cut-off values were 6.96,5.44,4.91,the sensitivity were 71.4％,85.7％ and 89.3％,and the specificity were 73.2％,63.4％ and 82.9％,respectively.Conclusions High serum CRP,CRP/ALB and low ALB in adult patients with sepsis indicate a poor prognosis,while the prognostic value of CRP/ALB is obviously better than the single value of CRP or ALB.CRP/ALB at 72 hours may be one of the best indicators for the assessment of clinical therapy and prognosis of patients with sepsis.

Objective To evaluate prognostic value of pentraxin3 (PTX3) content combining with extravascular lung water index (EVLWI) in patients with sepsis.Methods A retrospective analysis of complete clinical data of septic patients admitted to Department of Critical Care Medicine of the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2014 was conducted.These patients were divided into two groups,survival group and death group,according to the outcome on the 28th day.Pulse index continuous cardiac output (PiCCO) was used to record the levels of EVLWI on the 1st,2nd and 3rd day of intensive care unit (ICU) admission.The plasma level of PTX3 was measured simultaneously by enzyme-linked immunosorbent assay (ELISA).At the same time,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) were calculated.Correlation analysis between plasma PTX3 and EVLWI values was performed,receiver operating characteristic curve (ROC) was drawn,and the prognostic value of each parameter was assessed finally.Results A total of 74 septic patients were enrolled,with 41 cases in the survival group and 33 cases in the non-survival group.Blood lactate,APACHE Ⅱ,SOFA scores in the non-survival group were significantly higher than those of the survival group at ICU admission,and the length of ICU stay was significantly shorter than that of the survival group,while differences of the other clinical characteristics between two groups were not statistically significant.The plasma PTX3 level gradually declined with time in both groups,and plasma PTX3 at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [PTX3 (μg/L) at 1 day:46.3± 10.5 vs.19.4±6.5,t =-13.486,P =0.000; 2 days:34.8± 10.7 vs.17.7±8.4,t =-8.284,P =0.000; 3 days:23.9± 11.2 vs.15.6 ± 7.9,t =-5.036,P =0.000].EVLWI gradually declined in survival group,but increased in death group.EVLWI at 1,2,3 days after ICU admission in non-survival group were significantly higher than those in survival group [EVLWI (mL/kg) at 1 day:12.12 ± 4.31 vs.10.02 ± 2.87,t =-2.502,P =0.023; 2 days:13.67 ± 4.95 vs.9.08 ± 2.89,t =-5.188,P =0.000; 3 days:14.51±5.06 vs.8.09±2.50,t =-7.126,P =0.000].PTX3 at 1,2,3 days after ICU admission showed a significant positive correlation with EVLWI (r1 =0.747,r2 =0.719,r3 =0.705,all P =0.000).ROC curve analysis showed that the area under the ROC (AUC) of PTX3 at 1 day was 0.845 ± 0.045,at the cut-off point of 23.0 μg/L,PTX3 showed a sensitivity of 84.8％,a specificity of 74.1％,a negative predictive value of 85.81％,and a positive predictive value of 72.42％.AUC of EVLWI at 3 days was 0.838 ± 0.048,at the cut-off point of 10.5 mL/kg,EVLWI showed a sensitivity of 83.9％,a specificity of 82.9％,a negative predictive value of 86.45％,and a positive predictive value of 79.79％.Their sensitivities and specificities were found to be better than APACHE Ⅱ,SOFA score.AUC of PTX3 combined with EVLWI at 1 day was 0.886 ± 0.038.On the 1st day after ICU admission,with combination of the two indicators,cut-off point was found to be 0.312,a sensitivity of 86.8％,a specificity of 85.4％,a negative predictive value of 88.93％,and a positive predictive value of 82.72％.On the 3rd day after ICU admission,AUC of PTX3 combined with EVLWI was 0.856 ± 0.046,and showed a cut-off of 0.471 for the prognosis of sepsis,a sensitivity of 85.8％,a specificity of 85.4％,a negative predictive value of 87.97％,and a positive predictive value of 82.50％.Compared with other single index,a combination of above mentioned two indexes showed a better sensitivity and specificity.Conclusions PTX3 can serve as a novel prognostic indicator at early stage in septic patients.Combined with EVLWI,it shows important value in predicting prognosis of septic patients,and it also provides guidance in treatment of high-risk patients.

Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The early mortality of patients with sepsis-induced myocardial dysfunction (SMD) is higher than those with normal cardiac function, and the long-term prognosis is worse. Therefore, early detection of SMD and timely intervention can reduce mortality and improve prognosis. This review focused on the progress in evaluation and treatment of SMD, with a view to provide some ideas for the diagnosis and treatment of SMD.
Cardiomyopathies/therapy* ; Humans ; Sepsis/complications*

ObjectiveTo study the protective effects of terlipressin on the renal function of recipients afterlivertransplantation.MethodsAmong 35casesreceivingorthotopicliver transplantation (OLT),16 cases were given terlipressin (group T):continuous infusion of terlipressin (1mg) into the vein immediately after the operation,twice every day for 3-4 days;19 cases were given dopamine and procaine (group D):continuous infusion of dopamine (40 mg) and procaine (0.5 g) into the vein immediately after the operation,twice every day for 3-5 days.In both two groups,the serum creatinine and urea nitrogen levels were normal before the operation. Serum creatinine,urea nitrogen,serum β2 microglobulin and urine amount were determined.ResultsSerum creatinine,urea nitrogen,serum β2 microglobulin and urine amount were increased significantly at 5th day after operation in both two groups (P＜0.05).As compared with group D,urea nitrogen and serum β2 microglobulin were decreased,while the urine amount increased significantly at 5th day after operation in group D (P＜0.05).Three cases (18.8％) in group T,and10 cases (52.6％ ) in group D developed RFALT at 5th day after operation (P＜0.05).ConclusionTerlipressin can protect the renal function of recipients after liver transplantation,and it can more effectively provide good recovery conditions for the recipients who develop RFALT after liver transplantation.

ObjectiveTo detect glucose-6-phosphate isomerase (GPI) in knee joint synovial fluid of active rheumatoid arthritis (RA) and explore the correlation between GPI and anti-cyclic citrulline peptide antibody (anti-CCP).MethodsGPI and anti-CCP in the synovial fluid were measured by enzyme linked immunosorbent assay(ELISA) from 22 patients with active RA and 37 patients with active osteoarthritis (OA).Student's t-test was used for intergroup comparison and Spearman's analysis was used for correlation analysis.ResultsThe level of GPI and anti-CCP in the synovial of active RA [ (9.6±8.4) μg/ml,( 14.61 ±18.64) U/ml] was significantly higher than that of active OA[ (0.9±1.8) μg/ml,(1.42±0.09) U/ml)].There was positive correlation between GPI and anti-CCP (r=0.447,P=0.037).ConclusionHigh expression of GPI is shown in active RA synovial fluid.It is suggested that GPI as an antigen that may participate in chronic synovitis,bone destruction and joint malformation.Both GPI and anti-CCP may be the laboratory markers for the diagnosis of RA.