Objective To study the variation and prognostic value of serum heparin-binding protein (HBP),a potent inducer of vascular leakage in septic shock.Methods A total of 82 sepsis patients admitted to central ICU from August 2011 to July 2012 were enrolled in the prospective study.Eighty-two sepsis patients were divided into septic shock group (group A,n =39) and sepsis without shock group (group B,n =43).At the same time,another 30 shock patients without sepsis were enrolled as group C and 35 patients without sepsis and shock were enrolled as group D.Blood samples obtained within 24 hours after enrollment,and the concentrations of HBP were measured by ELISA and lactate by electrode method.Comparisons of HBP,lactate and APACHE Ⅱ score between groups were carried out by Studers't test,and the early prognostic value in septic shock and mortality was studied by receiver operating characteristic (ROC) curve.Results Patients in group A (t =3.862,P＜0.001) and group B(t =5.193,P＜ 0.001) both had higher HBP level than patients in group D.HBP level in group A patients was also higher than that of group B (t =3.270,P =0.002).Septic shock patients (group A) had higher HBP than patients of group C (t =3.029,P =0.004).The area under curve (AUC) of HBP predicting septic shock patients was 0.834,with sensitivity 0.795,specificity 0.795.The AUC of HBP predicting 28-day mortality of all enrolled patients was was 0.680,and the AUC of predicting 28-day mortality of sepsis patients was 0.784.Conclusions HBP levels were increased in septic patients,especially in septic shock patients.HBP is a better predictor than traditional predictors like lactate and APACHE Ⅱ score for predicting septic shock.HBP is a good and specific evaluation marker for predicting septic shock and the mortality of sepsis patients.The measurement of HBP during the early stage of disease presents valuable information about diagnosis and treatment.

Diaphragm is the principal respiratory muscle.Diaphragm dysfunction resulting from mechanical ventilation,chronic cardiopulmonary disease,medicine,cardio-thoracic surgery,septic shock and chronic malnutrition predisposes to weaning failure from mechanical ventilation and prolongs intensive care unit (ICU) stay.Traditionally,the method of assessment of diaphragm structure and function was invasive,lacking specific,and was difficult to be used bedside.A number of recent studies have been suggested that ultrasonographic evaluation has been proposed as an accurate,safe and noninvasive method of quantification of diaphragm structure and function.This article reviews the related researches of technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic structure and function,which may possibly result in timely identification of patients with diaphragm dysfunction and improve the assessment of recovery from diaphragm weakness.

Objective To study the changes of arterial blood lactate(ABL) and serum enzymes activities and thier correlation.Method Lactate dehydrogenase(LDH),alkaline phosphatase(AKP) and creatine kinase(CK) in serum were determined in sixty-four critical patients in the intensive care unit(ICU) at admission immediately,following 24h,48h and 72h,respectively.The patients was divided into three groups:favorable,survival and death groups.Results Before treatment,ABL level was(3.9?2.5,2.9?1.3 and 3.8?2.3)mmol/L in favorable,survival and death groups respectively.Although ABL in favorable and survival groups were decreased gradually to normal level during 24～72h,the death group showed that the decline was very slowly it still persistent elevated in 72h.There was significanct difference between the death group and the favorable and survival groups(P

Objective To investigate the effects of botulinum toxin type A on the proliferation,apoptosis and ERK/MAPK signaling pathway of human hypertrophic scar fibroblasts in vitro.Methods Fibroblasts were isolated from human hypertrophic scar and cultured by tissue explant method.The cells were divided into control and botulinum toxin type A groups.The botulinum toxin group A was cultured in DMEM medium containing 0.4U/L botulinum toxin type A.The control group was cultured with DMEM alone.Cell proliferation was measured by CCK8 kit at days 1,3,5 and 7 and compared within groups.Apoptosis of fibroblasts was detected by flow cytometry which treated with botulinum toxin and control group.Western blot was used to detect the relative expression of collagen Ⅰ,p-ERK1/2 and total ERK protein in fibroblasts of control,botulinum toxin type A and U0126 groups.Results Botulinum toxin type A could significantly inhibit the proliferation of fibroblasts,the number of cells was only 68.9％ in the control group at 7th days.The apoptotic rate of botulinum toxin type A was 35.9％,which was significantly higher than that of the control group.ERK 1/2 protein expression in the three groups was not significantly different (P ＞ 0.05),while p-ERK 1/2 expression in the control group was still significantly higher,but the p-EKR 1/2 in botulinum toxin type A and U0126 group was significantly inhibited.Collagen Ⅰ was highly expressed in the control group,which was significantly higher than that in the botulinum toxin type A and U0126 groups (P ＜ 0.05).Conclusion Botulinum toxin type A can inhibit the ERK/MAPK signaling pathway and increased fibroblasts apoptosis,decreased proliferation activity and collagen Ⅰ secretion.

Abnormal savda munziq could be used as an effective drug for treatment of hypertrophic scar.

Objective To investigate reconstructive repair methods of a large scalp defect with the granulation tissue wounds and skull exposure caused by the trauma.Methods Skin and soft tissue expansion technique was used to repair eight patients with a large scalp defect with the granulation tissue wounds and skull exposure caused by the trauma.The skin and soft tissue expanders were embedded under normal epicranial aponeurosis after the formation of fresh granulation tissue wound.Strict aseptic technique as well as water injection was done in the expansion process and moderate expansion to maintain rich blood circulation in the expansive parts.Results 12 skin and soft tissue expanders were implanted in 8 patients and the scalp wounds were completely repaired.No infection was detected after surgery and injection expansion process.Conclusions The skin and soft tissue expansion can be used to reconstruct post-traumatic scalp defect with granulation tissue wound and skull exposure.

Objective To measure intrapulmonary tumor motion due to breathing and analyze the impact factors and characteristics of the respiratory movement of large lung tumors.Methods CT sean was conducted in 30 patients with pulmonary cancer,in the calm inspiratory breath-holding and calm breath after breath-holding state.The tumor GTV in the two phases was recorded.The motion range in the left-right and antero-postefior directions in the GTV center level during the respiratory cyele was measured.The motion range of uppermost and lowermost layer of the tumor from top to bottom was also recorded.The clinical variables and anatomical factors assoeiated with the degree of motion were analyzed.Results The position of large lung tumor was relatively fixed,and the motion range was 3-5 mm,but 2 patients movement was found more than 5 mm.The two tumors were located in the lower part and the rear of the chest with low adhesion coefficient and smaller vertical direction of movement.95 ％ of motion range of the intrapulmonary tumors were under 3.8 mm in the vertical direction,under 5.8 mm in the front-rear direction,and under 1.1 mm in the left-right direction.Conclusion The movement of lung tumors caused by respiratory are influenced by tumor location,volume,and other factors such as the degree of adhesion,but the motion ranges are lower.The motion of lower rear tumors mainly occur in the vertical direction with the maximum range.

Objective To study the role of heparin-binding protein (HBP) in sepsis-associated acute respiratory distress syndrome (ARDS),and to evaluate the prognostic value of HBP in ARDS.Method Sixty seven sepsis patients were enrolled in the prospective study.According to whether present ARDS,patients were divided into two groups:ARDS group and non-ARDS group.Blood samples were obtained within 2 hours after patients were diagnosed with sepsis.We measured the level of interleukin-6,interleukin8 and HBP by ELISA,counted the number of polymorphonuclear neutrophils (PMN),and calculated Acute Physiology and Chronic Health Evaluation Ⅱ score.We compared interleukin-6,interleukin-8,PMN and HBP between two groups by Student's t test.Correlation analysis was studied between HBP and other indicators by Spearman rank correlation coefficient.We also studied the early prognostic value on sepsisassociated ARDS by establishing receiver operating characteristic (ROC) curve.Results Interleukin-6 (t=4.25,P＜0.01),interleukin-8 (t=10.10,P＜0.01),PMN (t=3.47,P=0.0009) and HBP (t =0.0225,P =2.336,all showed significant difference between ARDS group and non-ARDS group.Interleukin-6 (r=0.535,P=0.002),interleukin-8 (r=0.419,P=0.017) and PMN (r=0.419,P =0.017) all had positive correlation with HBP.The area under curve (AUC) of HBP predicting ARDS was 0.796.Conclusions HBP level elevated in sepsis-associated ARDS patients and were correlated with interleuki-6,interleuki-8 and PMN.HBP show a high value on predicting emergence of sepsis-associated ARDS.HBP may play an important role in sepsis-associated ARDS pathological process.From this study we can conclude one of possible ARDS pathogenesis:inflammatory mediators,such as interleuki-6,interleuki8,activate PMN.Subseqoently PMN releases HBP.Then HBP resolts in vascolar leakage,which is one of the basic ARDS pathology.

OBJECTIVETo investigate the clinical effect of steroids on reducing postoperative edema in rhinoplasty.

METHODSCochrane, Medline data, Pubmed date, were searched and updated on October 2013. Randomized controlled trials(RCTS) studies were included to assess the efficacy of steroids on decreasing postoperative edema after rhinoplasty. The methodological quality of the included studies was evaluated, and date analyses were performed using the Cochrane Collaboration's software RevMan 5.2.

RESULTSA total of 4 RCTS involved 172 patients with rhinoplasty, including 87 patients in the experimental group( steroid) and 85 paitents in control group (placebo). Meta analysis results showed the edema in experimental group was significantly less than that in the control group on postoperative day 1 and 3 (P < 0.01), while the difference was not significant on postoperative day 7 (P = 0.19).

CONCLUSIONSPerioperative application of steroid in rhinoplasty can significantly reduce periorbital edema in the first postoperative day. The edema can completely be relieved after application of steroid for 3 days. It is a safe and effective way to reduce the postoperative edema.

Objective To investigate the morphological characteristics and proliferation ability of diabetes mellitus-derived adipose-derived stem cells (ADSCs) by comparing with normal-derived ADSCs.Methods The ADSCs could be achieved from diabetes mellitus' adipose tissue by the similar method of normal ADSCs isolation and culture,and then the differnce was compared between the two groups about their morphologies under microscope,and the proliferation ability of two groups was determined by CCK-8.Results ADSCs in patients with diabetes were obvious hypertrophy and irregular in morphology.A values of ADSCs in diabetes and non-diabetes were 0.210+0.002 and 0.390+0.006 in 1st day;0.250+0.015 and 0.443+0.023 in 2nd day;0.368+0.014 and 0.726+0.033 in 3rd day;0.368+0.014 and 0.726+0.033 in 4th day;1.767+0.072 and 3.153+0.067 in 5th day and 1.810+0.072and 3.170+0.021 in 6th day,respectively.The difference was statstically significant at the beginning from 4th day (P＜0.05).Conclusions There is obvious difference of the microscopic morphology between the diabetes mellitus-derived ADSCs and normal-derived ADSCs.The proliferation ability of the diabetes mellitus-derived ADSCs is lower than normal-derived ADSCs.These difference could be closely related to ulcerous non-healing wounds in patients with diabetes mellitus.