0.05).②Gabexate mesilate significantly reduced the frequency of contraction (P0.05).③High dose gabexate mesilate could markedly reduce the motility index ( P

Objective To evaluate the value of plasma soluble urokinase plasminogen activator receptor (suPAR) and serum pmcalcitonin (PCT) to investigate their assessment of disease severity and prognosis in patients with sepsis.Methods The levels of plasma suPAR and serum PCT were monitored in 77 patients with sepsis.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were recorded.According to the disease severity and their prognosis,the value of plasma suPAR,serum PCT,APACHE Ⅱ and SOFA score on predict the disease severity and prognosis of septic patients were compared.Results The levels of plasma suPAR in septic patients [(7.9 ±6.5) ng/mL] were lower than severe sepsis patients [(8.4 ±4.5) ng/mL] and septic shock patients [(13.9 ± 8.0) ng/mL],allP ＜ 0.05.The levels of serum PCT in septic patients (6.3 ± 3.5) ng/mLwere lower than severe sepsis patients [(23.7 ± 3.9) ng/mL] and septic shock patients [(25.7 ±4.3) ng/mL],allP ＜0.05.But there was no significant difference in the levels of serum PCT between the severe sepsis group and the septic shock group.Receiver operator characteristic curve (ROC)of the level of plasma suPAR could distinguish survivors from non-survivors in septic patients,maximal area under curve (AUC) of plasma suPAR was 0.803.The best cut-off value of plasma suPAR to distinguish survivors from non-survivors was 9.905 ng/mL.And the AUC of serum PCT was 0.61 (P ＞ 0.05) ; the AUCofAPACHEⅡ score was 0.832 (P＜0.05); the AUC of SOFA score was 0.767 (P＜0.05).Conclusion Monitoring of the levels of plasma suPAR and the APACHE Ⅱ score can help to assess the severity and the prognosis of sepsis in the early stage.

Objective To investigate the Toll like receptor-4 (TLR4) expression on pancreatic islet beta-cell of septic rat and its effects on glucose regulation.Methods SD male septic rats were made with LPS intra-abdominal injection in a dose of 5 mg/kg body weight and it repeated once 3 h later.Rats were randomly (random number) divided into four groups randomly (n =5 in each):normal control group,LPS group,LPS antibody group and PLS with LPS antibody group.The expression and protein level of TLR4 were measured by RT-PCR,Western-blot and immunochemistry analysis respectively.IVGTT (intra-venous glucose tolerant test) was used to measure the glucose and insulin levels 6 hours after LPS administration and as well as in control group,and then their AUC were calculated.Results The TLR4 protein and mRNA expressed on pancreatic islet beta-cell of normal rat were significantly up-regulated 6 hours after LPS administration,while its up-regulation could be inhibited when LPS antibody was used in advance (P ＜ 0.01).Rat blood glucose levels were higher at 10,30,60 and 120 min in LPS group and insulin levels were lower at 30,60,120 min compared with normal control (P ＜ 0.01).LPS antibody improved the insulin secretion and then blood glucose level distinctly decreased during 30-120 min period after LPS challenge proved by IVGTT test.Conclusions TLR4 expression up-regulated on pancreatic islet beta-cell of septic rat and LPS-TLR4 system might be a mechanism of stress hyperglycemia genesis.

Objective: To compare the early and mid-term postoperative changes of left ventricular structure and function beteen mitral repair and replacement in patients with mitral regurgitation. Methods: 100 patients with degenerative mitral regurgitation underwent mitral valve replacement and mitral repair from January 2008 to January 2018 were retrospectively studyed. Of them, 46 patients underwent mitral repair and(repair group) 54 patients underwent mitral valve replacement(replacement group). The results of color Doppler echocardiography before, one week after, 12 months after and 24-36 months after operation were collected. Left atrial diameter(LAD), left ventricular end diastolic diameter(LVEDD) and left ventricular end systolic diameter(LVESD) were selected to evaluate left ventricular structure, fraction shortening(FS)、left ventricular stroke volume( SV )and left ventricular ejection fraction(LVEF) to evaluate left ventricular function. The data were analyzed by SPSS 22.0. Results: In left ventricular structural parameters, LAD, LVEDD and LVESD in mitral repair group and replacement group were significantly improved compared with those before operation(P<0.05). There was no significant difference in LAD, LVEDD and LVESD between the two groups at 12 months after operation(P>0.05). There were significant differences in LAD(42.26 mm vs 47.15 mm), LVEDD(52.97 mm vs 60.18 mm) and LVESD(31.34 mm vs 34.82 mm) between the two groups at 24-36 months of follow-up(P<0.05). Among the left ventricular function indicators, the early and mid-term SV of the two groups were significantly improved compared with that of the preoperative group(P<0.05). LVEF(0.64 vs 0.59、0.64 vs 0.58)was significantly improved in the 12 and 24-36 months after the operation, and FS(36.18% vs 31.47%) was significantly different in the 24-36 months after the operation(P<0.05). Conclusion Mitral repair has high technical requirements and long operation time, but it has obvious advantages over mitral valve replacement in maintaining left ventricular structure and function in the middle and late period after operation.