Altitude Sickness ; diagnosis ; Humans ; Occupational Diseases ; diagnosis ; Reference Standards

Objective To explore the method and performance of using multiple indices to diagnose sepsis and to predict the prognosis of severe ill patients.Methods Critically ill patients at first admission to intensive care unit (ICU) of Changzheng Hospital, Second Military Medical University, from January 2014 to September 2015 were enrolled if the following conditions were satisfied: ① patients were 18-75 years old;② the length of ICU stay was more than 24 hours; ③ All records of the patients were available. Data of the patients was collected by searching the electronic medical record system. Logistic regression model was formulated to create the new combined predictive indicator and the receiver operating characteristic (ROC) curve for the new predictive indicator was built. The area under the ROC curve (AUC) for both the new indicator and original ones were compared. The optimal cut-off point was obtained where the Youden index reached the maximum value. Diagnostic parameters such as sensitivity, specificity and predictive accuracy were also calculated for comparison. Finally, individual values were substituted into the equation to test the performance in predicting clinical outcomes.Results A total of 362 patients (218 males and 144 females) were enrolled in our study and 66 patients died. The average age was (48.3±19.3) years old. ① For the predictive model only containing categorical covariants [including procalcitonin (PCT), lipopolysaccharide (LPS), infection, white blood cells count (WBC) and fever], increased PCT, increased WBC and fever were demonstrated to be independent risk factors for sepsis in the logistic equation. The AUC for the new combined predictive indicator was higher than that of any other indictor, including PCT, LPS, infection, WBC and fever (0.930 vs. 0.661, 0.503, 0.570, 0.837, 0.800). The optimal cut-off value for the new combined predictive indicator was 0.518. Using the new indicator to diagnose sepsis, the sensitivity, specificity and diagnostic accuracy rate were 78.00%, 93.36% and 87.47%, respectively. One patient was randomly selected, and the clinical data was substituted into the probability equation for prediction. The calculated value was 0.015, which was less than the cut-off value (0.518), indicating that the prognosis was non-sepsis at an accuracy of 87.47%. ② For the predictive model only containing continuous covariants, the logistic model which combined acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score to predict in-hospital death events, both APACHE Ⅱ score and SOFA score were independent risk factors for death. The AUC for the new predictive indicator was higher than that of APACHE Ⅱ score and SOFA score (0.834 vs. 0.812, 0.813). The optimal cut-off value for the new combined predictive indicator in predicting in-hospital death events was 0.236, and the corresponding sensitivity, specificity and diagnostic accuracy for the combined predictive indicator were 73.12%, 76.51% and 75.70%, respectively. One patient was randomly selected, and the APACHE Ⅱscore and SOFA score was substituted into the probability equation for prediction. The calculated value was 0.570, which was higher than the cut-off value (0.236), indicating that the death prognosis at an accuracy of 75.70%.Conclusion The combined predictive indicator, which is formulated by logistic regression models, is superior toany single indicator in predicting sepsis or in-hospital death events.

Anxiety Disorders ; etiology ; therapy ; Breast Neoplasms ; complications ; therapy ; Humans ; Medicine, Chinese Traditional ; Qi

Objective To investigate relationships between the expression of cNOS mRNA and invasion and metastasis and prognosis in primary gastric carcinomas. Methods In situ hybridization was used to determine the expression of cNOS mRNA in 119 gastric cancer and 82 follow-up data were analyzed to obtain survival figures. Results In gastric carcinoma specimens,the expression of cNOS mRNA can be observed in the tumor cells,endothelial cells and mononuclear phagocytes;the poorer the carcinoma differentiation,the higher the positive rate of cNOS mRNA in tumor cells and endothelial cells;the expression of cNOS mRNA in tumor cells and endothelial cells reveals a significant positive correlation to the depth of invasion,lymph node metastasis and TNM stage;the patient with positive expression of cNOS mRNA in endothelial cells has a poor prognosis;the expression of cNOS mRNA in mononuclear phagocytes is not related to histopathologic type,the depth of invasion,lymph node metastasis and TNM stage.Conclusion In gastric carcinoma,the expression of cNOS mRNA in tumor cells and endothelial cells might be realted to potential of invasion,metastasis,and the patient with cNOS mRNA positive expression in endothelial cells would have a poor prognosis.

Aim The kinetics of nicotinic acetylcholine receptor (N-AChR) was stadied. MethodsThe saturation experiments of Torpedo electric organ N-AChR were taken with125I-?-BuTX. The results were calculated by Scatfit program. Experiments were thenperformed to study the kinetics of dissociation of ?-BuTX and nicotine from N-AChR,respectively. When their binding reached saturation, an excess of 1000 times ?-BuTX ornicotine was added. The saturation binding properties of the N-AChR extracted fromleg muscles of the 13th day chick embroys and optic lobes of the 20th day chick em-broys were studied. The results were calculated by Scatfit program. The othe experi-ments were taken to observe the competition between mcotine and 125I-?-BuTX forbinding with Torpedo, optic lobe and skeletal muscle of the chick N-AChRs. ResultsThe saturation experiments of Torpedo electric organ N-AChR resulted in a Scatchardplot of hyperbola which responded to the model of two kinds of receptor with on eli-gand.The difference of and B max between high affinity binding site and low affnitybineing site was significant. The dissaciation experiment showed that the fast dissocia-tion rate of tow ligands was 500 times more than that of the slow dissociation rate. Thisresult suggested that there may be two subtype N-AChRs.The saturation bindingproperties of N-AChR of leg muscles and optic lobe of the chick embroys revealed aScatchard plot of two kinds of N-AChR indicating a single type of site. The bindingaffinity of receptor of optic lobe was 100 times more than that of muscles. In competi-tion for Torpedo receptor by nicotine and 125I-?-BuTX, the values of IC50 were different:which suggested that two kinds of receptor sites were existent. In competition ofNicotine and 125I-?-BuTX for optic lobe and skeletal muscles of the chick N-AChR, thevalue IC50 of skeletal muscles N-AChR was 7. 7 times higher than that of optic lobe. Itindicated that two kinds of N-AChR subtype existed in the optic lobe and in theskeletal muscles of chick respectively. Conclusion N-AChR of Torpedo electric organcontains two kinds of subtype receptors. N-AChR of optic lobe of chick embroys is onesubtype receptor, and N-AChR of skeletal muscles of chick embroy is another subtypereceptor.

Objective To investigate the relationships between the expression of VEGF,its receptor KDR/flk-1,cNOS mRNA and angiogenesis,cell proliferation,metastasis in human hepatocellular carcinoma(HCC). Methods Immunohistochemical analysis using antibodies against VEGF and its kinase insert domain receptor (KDR) was carried out.cNOS mRNA expression in HCC,liver cirrhosis and normal liver tissue was observed by in situ hybridization.CD34 immunostaining was used to measure the microvascular density(MVD)and proliferative index was evaluated by Ki-67 immunostaining. Results The expressions of VEGF and KDR of HCC were significantly related to MVD,proliferation and metastasis of HCC(P

ObjectiveTo study central venous oxygen saturation (ScyO2) in controlled hemorrhagic shock rabbits resuscitation process as a transfusion trigger and traditional transfusion trigger of comparison.MethodsSelection New Zealand pure line of rabbit 32 only,simple randonly divided into 4 groups,groups A and B for the observation group,groups C and D as control group,groups of eight only.A,B,C,D four groups respectively by ScvO2 ≤70％,ScvO2 ≤75％,hemoglobin (Hb)≥8g/dl,blood loss for the whole blood volume≥30％ as transfusion trigger.From right femoral artery bloodletting 10 minute inside,made the MAP to about (40 ± 5 )mmHg,and maintained the blood pressure 60 minutes,established controlled hemorrhagic shock rabbits of animal model.And then started to resuscitate,with colloid and crystalloid infusion according to the proportion 1∶2,infusion rate of about 10 ～ 15ml/( kg · h),according to the blood pressure and heart rate,and proper adjustment according to the different requirements of each group conducted a blood transfusion.Monitoring based value,shock,shock treatment 30 minutes,60 minutes,120 minutes,180 minutes all time points,and various indexes of blood loss,blood transfusions,crystalloid and colloid fluid volume and so on.ResultsIn shock treatment observation group A late blood pressure,pH,BE,HCO3-,O2ER etc compared with the other three groups had obvious statistical differences ( P ＜ 0.05 ),group B with C and D two groups at the same time points each monitoring were no significant differences ( P ＞0.05 ).The volume of transfusion group C was most,compared with the other three groups were significant difference ( P ＜ 0.05 ),group D of blood transfusions than A,B two groups (P ＜ 0.05 ),groups A and B infused colloid fluid,crystal fluid volume than groups C and D ( P ＜ 0.05 ),each group blood lossed without significant difference.ConclusionScvO2 for controlled hemorrhagic shock rabbit resuscitation monitoring can guide controlled hemorrhagic shock rabbit of blood transfusions,according to ScvO2 ≤75％ transfusion with traditional according to Hb or blood loss transfusion trigger comparison,can achieve the same resuscitation effect,and can more accurately and individualized guide transfusion,reduce unnecessary blood transfusions,save resources.

Objective To observe the changes of the blood pressure after intracerebral hemorrhage (ICH) in spontaneously hypertensive rats (SHRs) as well as the expressions of α2A-adrenergic receptor (AR) in center (brain tissue) and peripheral (renal tissue) α1A-AR and to investigate the correlation between α1A-AR/α2A-AR and blood pressure regulation in acute hypertensive ICH. Methads A total of 30 six-month-old male SHRs were randomly divided into a sham-operation group and ICH (day 1,3, 7 and 14) groups (n =6 in each group). Blood pressure was measured by the tail-cuff method. Collagenase Ⅳ was injected into caudate-puta-men nucleus to induce a model of ICH. The expressions of α1A-AR and α2A-AR were detected by using immunohistochemistry and reverse-transcription polymerase chain reaction. Results One day after ICH, the blood pressure was 195.4 ± 8.39 mm Hg, and it was significantly higher than 177.8 ± 8.69 mm Hg (P = 0. 000) before ICH and 184. 1 ± 3.76 mm Hg in the sham-operation group (P=0. 002). At day 3 it was 185.3 ±9.22 mm Hg, and it was lower than that at day 1. It was 177.7 ±5.62 mm Hg and 176.7 ±6. 06 mm Hg at day7 and 14 respectively, which almost returned to the normal level before ICH. The α1A-AR mRNA and protein in renal tissue at day 1 after ICH were 0. 91 ±0. 013 and 0. 944 ±0. 142%, respectively, They were higher than 0. 89 ±0. 018 and0. 779 ±0. 103% in the sham-operation group, and they reached the peak (0. 93 ±0.015, P =0.008; 1.526 ± 0.296%, P =0.010) at day 3. The α2A-AR mRNA and protein in brain tissue were 0. 93 ±0. 020 and 2.64 ±0. 293% at day 3 after ICH, and they were significantly higher than 0. 86 ±0. 019 (P =0. 001) and 1. 070 ±0. 155% (P = 0. 020), and0.87 ±0. 029 (P =0. 000) at day 1 after ICH and 1. 629 ±0. 488% (P =0. 023) in the sham-operation group. The changes of blood pressure in the ICH day 1 to day 7 grottos in SHRs and correlation coefficient of α2A-AR mRNA absorbance in brain tissue r was - 0. 509 (P = 0.031), and the correlation coefficient of α2A-AR protein-expression volume fraction in brain tissue r was - 0. 473 (P = 0. 047). Conelusions Regulation of blood pressure during acute ICH may have certain correlation with the up-expressions of α2A-AR in brain tissue and α1A-AR in renal tissue.

Adult ; Female ; Humans ; Male ; Medical Staff ; Middle Aged ; Occupational Exposure ; Phosgene ; poisoning ; Poisoning ; etiology ; Young Adult

Objective To obtain the lung adenocarcinoma initiating cells from the A 549 cell line based on paclitaxel treatment combination with serum-free cultivation and to validate spared cells can represent tumor initiating cells (TICs) .Methods After dis-sociated by trypsogen ,about 106 /mL cells were suspended in serum-free medium supplemented with 0 .4% bovine serum albumin (BSA) ,insulin ,basic fibroblast growth factor (bFGF) ,human recombinant epidermal growth factor (EGF) and obtained spheroid cells .At the second passage ,paclitaxel was added at a concentration of 100 nmol/L for 48 h and then replaced with completely fresh medium once or twice per week until new spheroids emerged .Results The subpopulation of cells that survived serum-free cultiva-tion and paclitaxel treatment could highly express the cluster of differentiation 133/cluster of differentiation (CD133/CD326) mo-lecular markers and have features of stemness including differentiation ,high expression of cancer stem cells (CSCs)-associated genes and stronger capability of tumorigenesis .Conclusion The survived subpopulation that highly express the CD 133/CD326 molecu-lar markers presenting the characteristics of stemness in vitro and in vivo ,and could be used in future researches of biological functions .