Objective To investigate the effects of low-dose of hydrocortisone on circulating thymus-dependent lymphocyte (T lymphocyte) apoptosis in patients with septic shock. Method fifty-seven patients with septic shock admitted into ICU from January 2006 to January 2009 were prospectively randomized (random number) to treatment group and control group. Another 20 healthy volunteers and 18 patients with sepsis alone were included as external control groups.The patients of treatment group and control group were treated with low-dose of hydrocortisone and placebo,respectively. Samples of peripheral blood were taken from healthy volunteers and patients 0 hr,24 hrs,48 hrs,72 hrs and 168 hrs after onset of the disease to determine the circulating T lymphocyte apoptosis by using the assays of Annexin V and flow cytometry. Least significant difference t -test was used for multiple comparisons. Results The percentage of Annexin V-positive CD4+ T lymphocytes in the primary stage was (11.01 +4.52)% in septic shock patients, (4.41 + 1.45)% in healthy volunteers, and (7.87 + 3. 82)% in patients with sepsis alone. And in the initial setting, the percentage of Annexin V-positive CD4+ T lymphocytes in the septic shock patients was higher than that in healthy volunteers ( P < 0.05) and in patients with sepsis alone ( P < 0.05). The percentage of Annexin V-positive CD8 + T lymphocytes at the beginning was (11.33+19.62)% in septic shock patients, (9.62+8.32)% in healthy volunteers, and (13.09+ 15.84)% in patients with sepsis alone (P > 0.05 between three groups). The percentages of Annexin V-positive CD4+ T lymphocytes in control group after 24 his, 48 hrs and 72 hrs were(13.51+6.85)%, (19.39 + 6.63)% and (15.33+ 6.21)%, respectively. And the percentages of Annexin V-positive CD4+ T lymphocytes in treatment patients after 24 hrs, 48 hrs and 72 hrs were (17.4 + 7.21)%, (22.61 + 5.64)%, and (25.73 + 6.91)%, respectively. The percentage of Annexin V-positive CD4+ T lymphocytes in septic shock patients was higher than that in control groups ( P < 0.05). The percentages of Annexin V-positive CD8+ T lymphocytes in control group after 24 hrs, 48 hrs and 72 hrs were (11.49+ 11.73)%, (12.74+ 10.39)% and (13.28+ 16.6)%, respectively, and in the treatment group, those were (9.49 + 8.9)%, (15.32+18.17)% and (13.68+16.84)%, respectively (P >0.05 between two groups). In the meantime, the percentages of Annexin V-positive CDS'1' T lymphocytes in control group and in treatment group were (12.72+ 19.69)% and (13.88 + 13.28)%, respectively (P >0.05). Conclusions Low-dose of hydrocortisone could induce CD4+ T lymphocyte apoptosis and has no effects on CD8+ T lymphocyte apoptosis when it is used to treat septic shock.

Objective To compare the different characteristics of adaptive support ventilation (ASV) and synchronized intermittent mandatory ventilation-pressure support ventilation (SIMV-PSV) mode in weaning patients after general anesthesia.Methods One hundred and twenty-eight patients received general anesthesia,ending in odd and even numbers by hospital number divided into ASV group (single number,62 cases) and SIMV-PSV group (double number,66 cases).The propofol dosage,duration of mechanical ventilation,duration of intubation,ventilator alarms,ventilator settings manipulations and each stage of the blood gas analysis,hemodynamic,respiratory mechanics were recorded.Results One hundred and twenty-eight patients completed the extubation.The propofol dosage,duration of mechanical ventilation,duration of intubation in ASV group were significantly shorter than those in SIMV-PSV group [(1.13 ± 0.33)mg/kg vs.(1.28 ±0.49) mg/kg,(169.8±36.5) min vs.(201.9 ±37.3) min,(197.2 ±38.9) min vs.(239.5 ± 42.3) min,P ＜ 0.05].There was no statistically significant difference in various stages of heart rate,mean arterial pressure,central venous pressure,pH,arterial carbon dioxide partial pressure,oxygenation index between two groups (P ＞0.05).In the first and second stages,tidal volume in ASV group was significantly higher than that in SIMV-PSV group [(543.6 ± 72.3) ml vs.(489.5 ± 68.7) ml,(513.9 ± 65.7)ml vs.(462.8 ± 61.7) ml,P＜ 0.05],respiratory rate in ASV group was significantly lower than that in SIMV-PSV group [(13.2 ± 3.6) times/min vs.(17.2 ±4.1) times/min,(15.1 ± 3.1) times/min vs.(16.8 ± 3.7)times/min,P ＜ 0.05].In the first stage,the mean airway pressure and peak airway pressure in ASV group were significantly lower than those in SIMV-PSV group [(8.2 ± 1.7) cm H2O (1 cm H2O =0.098 kPa) vs.(12.3 ± 3.1) cm H2O,(16.2 ± 2.9) cm H2O vs.(21.2 ± 4.3) cm H2O,P ＜ 0.05].The pulmonary dynamic compliance in ASV group was better than that in SIMV-PSV group [(64.8 ± 12.3) ml/cm H2O vs.(52.6 ±13.5) ml/cm H2O,P ＜ 0.05].The ventilator alarms,ventilator settings manipulations in ASV group were significantly shorter than those in SIMV-PSV group [(2.3 ± 1.6) times vs.(5.1 ± 1.9) times,(0.8 ± 0.5) times vs.(1.6 ± 0.8) times,P ＜ 0.05].Conclusion ASV weaning mode is safe and effective,which could accelerate the extubation and simplify the manipulation.

Objective To investigate the effect of extracellular histones (EH) on intestinal mucosal barrier function in mice and the correlation of EH with the pathogenesis of sepsis.Methods Twenty male C57BL/6 mice were assigned into experiment group (n =10) and control group (n =10) according to the random number table.Same dose (50 mg/kg) of EH and saline were administered through the caudal vein of mice in experiment and control groups respectively.Blood and intestinal samples in each group were collected 3 h after the administration.Morphology of intestinal mucosal tissue was detected by light scope and transmission electron microscope.Expressions of tight junction related proteins (ZO-1,Occludin and Claudin-1) were detected by western blot.Plasma levels of diamine oxidase (DAO) and intestinal fatty acid binding protein (I-FABP) were determined by ELISA method.Plasma level of endotoxin (ET) was determined by limulus test.Results Under transmission electron microscope,experiment group showed disorganized microvilli of intestinal epithelial cells with partially twisted,broken and lost,unclear tight junctions,and widened cellular space.Under light scope,experiment group showed substantial inflammatory cell infiltration in the intestinal wall,disorganized intestinal villi,edema and hemorrhage of mucosa and submucosa,and edematous goblet cells.Experimental versus control group showed significant reduction in levels of Claudin-1 (0.587 7 ±0.060 6 vs.0.677 2 ±0.038 3),Occludin (0.1277±0.0857vs.0.4306±0.0869) and ZO-1 (0.393 3±0.080 8 vs.0.812 8± 0.096 3) (P ＜ 0.05).Experimental versus control group showed significantly up-regulated plasma levels of DAO [(1.61 ±0.20) U/ml vs.(0.69 ± 0.15) U/ml],I-FABP [(548.5 ± 36.8) EU/ml vs.(178.8±26.9) EU/ml] andET [(0.182±0.076) EU/mlvs.(0.091 ±0.029) EU/ml](P＜0.05).Conclusion EH can obviously impair the integrity of intestinal mucosal barrier in mice and hence induce endotoxin translocation.

Objective To evaluate the effect of blind bedside non-spiral nasointestinal tubes in critically ill patients.Methods Patients requiring bedside nasointenstinal tubes in intensive care unit of Nanjing First Hospital from February 2017 to February 2018 were enrolled in this study.The placement of nasointenstinal tubes was conducted according to the reference procedure of our department,recording operation times,operation duration,position of the tube's tip,expense and complications.Results A total of 53 patients received the bedside non-spiral nasointenstinal tubes which were conducted for 64 times.51 patients (51/53,94.4％) were successful in tube placement,45 case-times (45/64,70.3％) were successful at the first attempt,and 50 case-times (50/64,78.1％) were successful at the second attempt in accumulation.The mean time of our procedure was (13.80±6.90) minutes,the mean insertion length was (99.55±8.35) cm,and the mean expense was (244.82±45.68) Yuan.No severe complications were observed.Conclusion Blind bedside placement of non-spiral nasointestinal tubes has high success rate and many advantages as short operation time,low expense and less complications,which is a good choice for early establishment of enteral feeding pathway and early supplement of enteral nutrition in critically ill patients.