Objective To explore the effect of early goal-directed therapy (EGDT) according to pulse indicated continuous cardiac output (PiCCO) on septic shock patients.Methods Eighty-two septic shock patients in Subei People's Hospital of Jiangsu Province from January 2009 to December 2012 were enrolled and randomly divided into two groups using a random number table,standard surviving sepsis bundle group (n=40) and modified surviving sepsis bundles group (n =42).The patients received the standard EGDT bundles in standard surviving sepsis bundle group.PiCCO catheter was placed in modified surviving sepsis bundles group.Fluid resuscitation was guided by intrathoracic blood volume index (ITBVI) with the aim of 850-1 000 mL/m2.Dobutamine was used to improve the heart function according to left ventricular contractile index (dPmax) and stroke volume index (SVI).The mean arterial blood pressure (MAP) was maintained 65 mmHg (1 mmHg=0.133 kPa) or above with norepinephrine.Extra-vascular lung water was monitored for the titration of liquid and diuretics.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA) score,the number of patients needed vasopressor,serum procalcitonin (PCT),lactic acid and lactate extraction ratio,the amount of fluid resuscitation,duration of mechanical ventilation,duration of intensive care unit (ICU) stay,hospital mortality were recorded in both groups.Results After treatment,the APACHE Ⅱ score,SOFA score and the number of patients needed vasopressor were gradually reduced in both groups,and those in modified surviving sepsis bundle group were significantly lower than those of standard sepsis bundle group at 72 hours (APACHE Ⅱ score:13.1 ± 6.5 vs.20.9 ± 7.5,SOFA score:8.8 ± 4.3 vs.14.6 ± 4.9,the number of patients needed vasopressor:8 vs.17,all P＜0.05).Arterial blood lactate clearance rate was gradually increased after treatment in both groups.Lactate clearance rate in modified surviving sepsis bundle group was significantly higher than that of standard surviving sepsis bundle group [6 hours:(18.2 ± 8.3)％ vs.(10.8 ± 7.5)％,t=-6.036,P=0.001 ; 12 hours:(22.6 ± 7.3)％ vs.(12.4 ± 8.1)％,t=-4.536,P=0.001 ; 24 hours:(27.8 ± 5.6)％ vs.(16.4 ± 9.5)％,t=-5.882,P=0.000].The amount of fluid resuscitation within 6 hours in modified surviving sepsis bundle group increased significantly compared with standard surviving sepsis bundle group (mL:3 608 ± 715 vs.2 809 ± 795,t=-3.865,P=0.033).The amount of fluid resuscitation within 24,48 and 72 hours in modified surviving sepsis bundle group was significantly less than that of standard modified surviving sepsis bundle group with the nadir at 72 hours (mL:918 ± 351 vs.1 805 ± 420,t=5.907,P=0.037).Duration of mechanical ventilation (hours:98.4 ± 20.3 vs.143.3 ± 29.6,t=9.766,P=0.001) and ICU stay (days:7.1 ± 3.1 vs.9.5 ± 2.5,t=2.993,P=0.004) were significantly reduced in modified surviving sepsis bundle group compared with standard surviving sepsis bundle group.The hospital mortality in modified surviving sepsis bundle group was slightly lower than that in standard surviving sepsis bundle group [16.7％(7/42)比 17.5％(7/40),x2=0.010,P=0.920].Conclusions Modified surviving sepsis bundle treatment according PiCCO can reduce the severity of disease in patients with septic shock,can make more accurately guide fluid resuscitation,and can reduce lung water and duration of mechanical ventilation and ICU stay.It has great clinical significance.

Objective:To investigate the relationship between TGF-? 1mRNA and acute rejection of small intestinal allografts in rats.Methods:Rats were divided into two groups.Group Ⅰ:Wistar→SD Small intestinal transplantation,Group Ⅱ:Wistar→SD Small intestinal transplantation+CsA.The pathologic changes of allografts at 3 rdday,5 thday,7 thday after operation investigated and the transcription of IL-2,IFN- ?,and TGF-? 1mRNA was detected by semi-quantity RT-PCR.Results:Pathologic change:There was acute rejection at 3 rdday,and became severe at 7 thday in group Ⅰ,and there was only slight rejection at 7 thday in groupⅡ.TIFN-?、IL-2mRNA obviously increased after operation in groupⅠ.But they increased only a little in group Ⅱ.It had statistical significance between the two groups(P

Objective To investigate the expression of 5-LOX in pancreatic cancer tissue and the relationship between 5-LOX expression and expression of VEGF.Methods The expression of 5-LOXmRNA,(VEGFmRNA) in 35 pancreatic cancer fresh tissue samples were detected by semi-quantitive reverse(transcriptase)-polymerase chain reaction method.Results Expression of 5-LOXmRNA,VEGFmRNA in(pancreatic) cancer tissue were 74.3%,60% respectively,and the expression was correlated to the with(clinical) stages of the tumor;also expression of VEGFmRNA was correlated to the differentiation of the tumor.Expression of 5-LOXmRNA and VEGFmRNA were synergetic in pancreatic cancer(P

Protozoans,the natural host of the facultative intracellular pathogen Legionella species,play an important role in survival,proliferation,virulence and stress resistance of Legionella species. By repeating transformation and selection,a spontaneous mutant of plasmid over expressing green fluorescent protein was obtained. This mutant replicates and is maintained stably in Legionella cells. The colonies of L. pneumophila harbouring the mutated plasmid were intense green in colour even under the daylight. After feeding BF1 strain of Tetrahymena thermophila with transformed L. pneumophila,the intracellular dynamic of changing of bacterial shape,bacterial proliferation and lysis of the host cell due to the bacterial proliferation were observed clearly under fluorescent microscopy. Thus,the present paper provides a simple and intuitionistic strategy for investigating the ecological and cellular relationship between L. pneumophila and its host.

Objective To investigate clinical feature,diagnosis and prognosis of eosinophilic gastroenteritis(EG),and to analyze the causes of misdiagnosis.Methods Eleven children diagnosed as EG were studied.Their history,clinical manifestations,laboratory tests and endoscopies and treatment,follow-up data were analyzed.The data were analyzed by SPSS 10.0 software.Results 1.The children with EG usually had abdominal pain(5 cases),diarrhea(7 cases),hemafecia(5 cases) and sometimes with fever(2 cases).2.EG and allergy in children was closely related with disease(54.55%).3.Peripheral blood eosinophil(EOS) count increased significantly,and declined when symptoms eased(18.18%).4.Endoscopic manifestations were not specific,the mucosa could see sheet erosion,shallow ulcers,congestive spots or bleeding spots,mainly in antrum,duodenum,terminal ileum,ileocecal junction.The biopsy showed that a large number of EOS infiltration.5.Imaging were not specific,CT or gastrointestinal barium meal examination did not show special often(90.91%).When muscular wall was affected(9.09%),imaging presentations of EG could be partly obstructive.6.Glucocorticoid therapy could relieve symptoms and EOS.Symptoms probably recured by good prognosis.7.EG was a self-limiting allergic diseases,although the attack may be repeated.After long-term follow-up,most had good prognosis and without malignant.Conclusions Clinical and endoscopic presentations of EG are not specific,therefore the presence of EOS in gastrointestinal mucosa strongly indicate the diagnosis.It was easy to misdiagnosis.Biopsy pathology and cli-nical characteristics are the key to diagnosis.

Objective To find out some possible risk factors of death postcardiac surgery undergoing cardiopulmonary bypass.Method Totally 36 patients,who underwent postcardiotomy undergoing cardiopulmonary bypass in Subei Hospital of Jiangsu Provience from March 2005 to June 2006,were retrospectively analyzed.The criteria for the selection of patients were as follow:(1)patients underwent on-pump cardiopulmonary bypass;(2)patients with heart function in Ⅰ-Ⅲ degree; (3)all patients didn't have organ dysfunction before operation;(4)patients died within 28 days postcardiotomy.Therefore,6 patients who died were admitted as death group,the other 30 patients were admitted as control group.The analysis included: (1)preoperative factors,including gender,age,diagnosis preoperative,NYHA grade,APACHEⅡscore,left ventricular end-diastolic diameter.(2)operative factors:operation time,block aorta time. (3)postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary arteria wedged pressure(PAWP),cardiac output index(CI),arterial blood lactic acid,partial pressure of oxygen(PaO2),mixed venous oxygen saturation(SvO2),oxygen delivery index(DO2I),oxygen comsume index(VO2I),oxygen extraction ratio (O2ext).Comparisons between two group was made with SPSSl0.0 for windows.Firstly,the data were analyzed with process of single variable analysis and Some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the IDGISTIC regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The single variable analysis showed that the parameters of APACHE Ⅱ score,left ventricular end-diastolic diameter,block aorta time,mechanical ventilation time,arterial blood lactic acid,SvO2 had significant difference betwen groups(P＜0.05).The LOGISTIC regression showed that left ventricular end-diastolic diameter and arterial blood lactic acid ale the two independent risk factors of death(P＜0.05).Conclusions Arterial lactatemia and left ventricular end-diastolic diameter can be used to predict the prognosis of postcardiotomy undergoing cardiopulmonary bypass.

Objective To evaluate the compliance of sepsis bundles and its impact on the mortality rate in patients with sepsis shock.Methods Fifty-eight adult patients with sepsis shock admitted in the intensive care units from January to December 2007 were enrolled in the study,and the compliance with the 6-h bundle was analyzed.Age,gender,sites of infection,acute physiology and chronic health evaluation II (APACHE II)score,duration of mechanical ventilation,ICU stay and the mortality rate were compared between patients completed 6-h bundles and those not completed 6-h bundles.Results Compliance with the 6-h bundle was obtained in 22 out of 58 patients(37.9%).Patients receiving bundle care had shorter duration of mechanical ventilation and shorter length of ICU stay than non-bundle patients(t=-2.225 and -3.702,P=0.037 and 0.001,respectively),and the mortality rate in 6-h bundle patients was also lower (X2=10.236,P=0.000).Conclusion The application of 6-h bundle care can reduce the mortality rate of the patients with sepsis shock.and the compliance should be improved.

Objective To explore the correlations of extravascular lung water index (ELWI),oxygenation index and intrathoracic blood volume index (ITBI) in patients with acute exacerbation chronicobstructive pulmonary disease (AECOPD) and examine the significance of ELWI in fluid management.Methods A total of 63 hospitalized AECOPD patients with respiratory failure were recruited from our hospital from October 2010 to April 2013.Pulse indicator continuous cardiac output (PiCCO) technology was employed to monitor ITBI and ELWI.We compared the relationship of ELWI,ITBI and oxygenation index.And simple correlation analysis was used for statistical processing.Results Significant negative correlation existed in ELWI and oxygenation index (r =-0.741,P ＜ 0.01).ELWI 14 ml/kg was defined as a cutoff value for subgroup analysis.A negative correlation existed between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but there was no significant difference (r =-0.524,P =0.080) ; in the subgroup with ELWI ≥ 14 ml/kg,there was significant negative correlation (r =-0.952,P ＜ 0.01).No significant correlation existed between ELWI and ITBI (r =0.477,P =0.072).ITBI 1 000 ml/m2 was defined as a cutoff value for subgroup analysis.No significant difference existed in the subgroup with ITBI ＜ 1 000 ml/m2 (r =0.332,P =0.117).However,significant positive correlation existed in the subgroup with ITBI≥ 1 000 ml/m2 (r =0.677,P ＜ 0.01).Conclusion Excessive extravascular lung water is an important factor for acute exacerbation of COPD leading to respiratory failure.

Background and purpose:Diffusion-weighted imaging (DWI) is a non-invasive technique of breast magnetic resonance imaging (MRI). DWI is an alternative to dynamic contrast-enhanced (DCE) MRI for differentiating malignant from benign lesions in breast screening or not. This study aimed to evaluate the potential role of DWI in differentiating malignant breast lesions from benign lesions.Methods:Seventy-four patients underwent digital mammography, DCE and DWI (49 patients’b-value of 0, 400, 600 and 800 s/mm2). The detectability, sensitivity and speciifcity of DWI and DCE were compared. Absolute apparent diffusion coefifcient (ADC) was compared with standardized ADC for quantitative analysis.Results:Sixty-four of 74 patients had positive pathologic findings (38 malignant, 26 benign). All of the malignant lesions were detected on DWI and DCE. The sensitivity of DWI was 83.33%, 90.00% and 93.33%, and the specificity was 85.91%, 76.19% and 72.72%, forb-value of 400, 600 and 800 s/mm2, respectively. The sensitivity and speciifcity of DCE were 86.61% and 90.48%. There was no signiifcant difference between absolute and standardized ADC in detecting breast cancer (P>0.05).Conclusion:DWI is an important complemented technique to DCE-MRI for differentiating malignant from benign lesions in breast MRI.

Objective To evaluate the role ofpleth variability index (PVI) by passive leg raising (PLR) test in volume responsiveness and volume status prediction in patients with septic shock.Methods A prospective randomized controlled trial (RCT) was conducted.Eighty-seven patients suffering from septic shock undergoing mechanical ventilation in Department of Critical Care Medicine of Subei People's Hospital from June 2012 to September 2014 were enrolled.The hemodynamic changes before and after PLR were monitored by pulse indicated continuous cardiac output (PiCCO) and PVI monitoring.Responsive group:positive fluid response was defined as an increase in cardiac index (CI) ≥ 10％ after PLR.Unresponsive group:negative fluid response was defined as an increase in CI ＜ 10％ after PLR.The hemodynamic parameters,including heart rate (HR),mean arterial pressure (MAP),central venous pressure (CVP),stroke volume variation (SVV),CI and PVI,and the changes in cardiac parameters (△ HR,△ MAP,△ CVP,△ SVV,△ CI,and △ PVI) before and after PLR were determined.The relations between hemodynamic parameters and their changes with △ CI were analyzed by the Pearson analysis.The role of the parameters for volume responsiveness prediction was evaluated by receiver operating characteristic (ROC) curves.Results 145 PLRs in 87 patients with septic shock were conducted,with 67 in responsive group and 78 in unresponsive group.There were no statistically significant differences in HR,MAP,CVP and CI before PLR between the responsive and unresponsive groups.SVV and PVI in responsive group were significantly higher than those in the unresponsive group [SVV:(16.9± 3.1)％ vs.(8.4±2.2) ％,t =9.078,P =0.031; PVI:(20.6±4.3)％ vs.(11.1 ±3.2)％,t =19.189,P =0.022].There were no statistically significant differences in HR,MAP,CVP,SVV,and PVI after PLR between the responsive group and unresponsive group.CI in the responsive group was significantly higher than that in the unresponsive group (mL·s-1·m-2:78.3±6.7 vs.60.0±8.3,t =2.902,P =0.025).There were no statistically significant differences in △HR,△MAP,△ CVP between responsive group and unresponsive group.△ SVV,△ CI and △ PVI in responsive group were significantly higher than those in the unresponsive group [△ SVV:(4.6 ± 1.5)％ vs.(1.8 ± 0.9)％,t =11.187,P =0.022;△ CI (mL·s-1·m-2):18.3 ± 1.7 vs.1.7 ± 0.5,t =3.696,P =0.014; △ PVI:(6.4 ± 1.1)％ vs.(1.3 ± 0.2)％,t =19.563,P =0.013].No significant correlation between HR,MAP or CVP before PLR and △ CI was found.SVV (r =0.850,P =0.015) and PVI (r =0.867,P =0.001) before PLR were correlated with △ CI.It was shown by ROC curve that the area under ROC curve (AUC) for SVV fluid responsiveness prediction was 0.948,and cut-off of SVV was 12.4％,the sensitivity was 85.4％,and specificity was 86.6％.The AUC for PVI fluid responsiveness prediction was 0.957,and cut-off was 14.8％,the sensitivity was 87.5％,and specificity was 84.8％.It was higher than other hemodynamic parameters (HR,MAP,CVP).Conclusions PVI and SVV can better predict fluid responsiveness in mechanically ventilating patients with septic shock after PLR.PVI as a new continuous,noninvasive and functional hemodynamic parameter has the same accuracy as SVV.