Objective To study the protective effect of removing inflammatory cytokines by hemoperfusion (HP)on acute kidney injury (AKI) in patients with sepsis. Method A total of 40 patients with sepsis and AKI were randomly divided into two croups: HP treatment group (n = 22) and control group (n = 18). Hemoperfusion carried out in patients of Hp group with HA330 filter once a day for 3 days and the procedure of each hemoperfusion was completed in 2 hours. The patients of control group were treated with routine treatment. Further, the hemodynamics, plasma IL-6, IL-10, C-reactive protein (CRP), serum creatinine (Scr), blood BUN and urine NAG, γ-GTP,α1-MG of patients in both groups were detected before treatment and 3 d,7 d and 14 days after treatment. Results Compared to control group, the levels of plasma interleukins-6, IL-10 and C-reactive protein were significantly lower (P ＜ 0.05), along with increase in urine output, lower levels of blood BUN and Scr, reduction in urine NAG,γ-GT and α1-MG (P ＜ 0.05). In addition, the patients at Ⅰ or Ⅱ stage of AKI treated with hemoperfusion had significantly lower level of Scr in 14 days and lower mortality in intensive care unit in comparison with control group (P ＜ 0.05). Conclusions Hemoperfusion employed in the earlier stage of AKI with the HA type filter may have protective effect on acute kidney injury by the removal of inflammatory cytokines in the setting of sepsis.

Objective To explore the protective effect of proliferator activated receptor-γ (PPAR-γ)activator pioglitazone on the expression of inflammatory cytokines in cultured cortical neurons after ischemia-reperfusion injury and its mechanism. Method The ischemie-reperfusion model was established by deprivating both glucose an oxygen in medium and then gave them back. Medium or that with pioglitazone was added at the beginning of reperfusion. The MTT values of neurons were determined in control or treatment groups, ANOVA was used to detect the expression of PPAR-γ. The expression of tumor necrosis factors-α(TNF-α) and interleukin-lβ(IL-lβ) were detected by Western Blotting. Results Compared to control group, the markedly reduction of MTT values and enhanced expression of PPAR-γ, TNF-a and IL-1β was observed in the ischemia-reperfusion neurons (P < 0.05). After they were treated by pioglitazone, the reduction of MTT values and enhanced expression of TNF-a and IL-1β were prominently reversed by the further activation of PPAR-γ ( P < 0.05). Conclusions Treatment of PPAR-γ activator pioglitazone has protective effect on neurons after ischemia-reperfusion injury. Its mechanism may be associated with the inhibition of inflammation after injury.

In the middle of the 20th century, the United States first proposed the medical humanities theory to campus and offered a variety of medical humanities curriculum, hoping that medical students would have a better understanding of diseases, pain, show themselves more compassion, and foster their communication skills. In recent years, the medical humanities education played a positive role in developing and improving medical students’ comprehensive ability as well as their diagnosis and treatment technology. Currently, American pays more attention to establish a unified and objective standard to evaluate the effect of medical humanities curriculum. Meanwhile, many experts give some suggestions to the medical humanities education.

Objective To explore the effect of mild hypothermia on inflammation status,lung function protection and clinical prognosis in patients with acute respiratory distress syndrome (ARDS).Methods All of 56 patients with ARDS were randomly divided into two groups: trial group (29 patients,treatment with mild hypothermia) and control group (27 patients, treatment with common practice). The following parameters including tumor necrosis factor (TNF)-α,interleukin (IL)-6 and C reactive protein (CRP), oxygenation index, SOFA evaluation and injury of lungs evaluation were detemined before treatment and at the 3rd, 7th day after treatment, and survival rates and adverse reaction in 28 days also were observed.Results After treatment, the levels of TNF-α ,IL-6 and CRP were decreased significantly, and oxygenation index, the scores of SOFA evaluation and injury of lungs evaluation were improved significantly in trial group than those in control group (P<0.05 ). The survival rate in trial group was higher than that in control group after treatment of 28 days [65.5%(19/29) vs 51.9%(14/27)]. The courses of mechanical ventilation and staying in ICU in trial group were shorter than those in control group [(11.9±3.6)d vs (17.0±5.1)d,(14.1±4.2)d vs (21.5±7.7)d](P<0.05). Conclusion Mild hypothermia can effectively attenuate inflammation disorder, improve damaged lung function and prognosis in patients with ARDS.

Objective To study the effect of continuous blood purification on inflammation and nutritional status in patients with sepsis, and to study relationship between inflammatory, malnutrition and illness. Method Forty-eight patients with severe sepsis were randomly divided into two groups: continuous renal replacement treat-ment (CRRT) group (n=27) and control group (n=21). The flowing biomarkers including albumin, preallbu-min, transfenin, insulin-like growth factor-1 (IGF-1), tumor necrosis factor (TNF-α) and C reactive protein (CRP) were determined before,and 1 week and 2 weeks after treatment. Results Compared with control group, levels of albumin, prealbumin and IGF-1 in treatment group increased significantly at 14 days after CRRT (P<0.05), and levels d CRP and TNF-α decreased significantly (P<0.05), resulted in increase in survival rate, shortened me-chanical ventilation time and decreased SOFA scores (P<0.05). The IGF-1 and prealbumin had a negative cor-relations with CRP and TNF-a in both groups (P<0.05). The survivors in both groups had significantly higher levels of IGF-1,prealbumin and TNF-α than the deads before trearment(P<0.05). Conclusions Continuous blood purification can effectively attenuate inflammation and improve nutritional status in patients with severe sep-sis.Maybe IGF-1 and prealbumin act as prognostic markers more sensitive in severe sepsis.

ObjectiveTo evaluate the effect of xuebijing injection on inflammatory response and cellular immune function in patients with severe sepsis.MethodsSixty-two patients with severe sepsis from September 2008 to August 2009 were divided into treatment group(30 patients) and control group (32patients) by random digits table.All the patients received sepsis-bundle therapy and patients in treatment group added xuebijing injection therapy with 100 ml,twice a day,for 7 days.The levels of serum tumor necrosis factor-alpha(TNF-α ),interleukin(IL)-6,IL-10 and C-reactive protein (CRP),peripheral blood T lymphocyte CD4+、CD8+ 、CD4+/CD8+,the expression of human leucocyte antigen (HLA)-DR on CD14+peripheral blood mononuclear cell (PBMC) were detected before and aftertreatment.ResultsThere was no significant difference in the levels of serum TNF-o,IL-6,IL-10,CRP,peripheral blood Tlymphocyte CD4+、CD8+、CD4+/CD8+ and the expression of HLA-DR on CD14+ PBMC before treatment between two groups(P ＞ 0.05).After treatment,compared with those in control group,the levels of serum TNF- α,IL-6,IL-10 and CRP in treatment group were significantly decreased [ ( 64.4 ± 13.5) ng/L vs.(96.1 ± 22.1 ) ng/L,( 153.8 ± 23.8 ) ng/L vs.(180.1 ± 21.7) ng/L,(73.8 ± 13.8) ng/L vs.(101.1 ± 11.7) ng/L,(53.7 ± 18.8) mg/L vs.(91.3 ± 32.8)mg/L,P ＜0.05],while peripheral blood T lymphocyte CD4+/CD8+ and the expression of HLA-DR on CD14+PBMC were significantly increased [ 0.311 ± 0.021 vs.0.424 ± 0.035,0.201 ± 0.017 vs.0.238 ± 0.038,1.78 ±0.21 vs.1.56 ±0.18,(38.4 ± 11.5)％ vs.(18.1 ± 12.1)％,P＜0.05].ConclusionXuebijing injection can reduce the inflammatory response and ameliorate immune disorder in patients with severe sepsis.

Objective To observe the correlation between the changes of neural cell apoptosis arid caspase-3 gene expression in brain tissues following acute severe traumatic injury to brain(TIB).Method A total of 120 adult Spraque-Dawley rats were divided into a control group(n=8)，TIB group(n=56)and TIB with administration of caspase-3 inhibitor group(n=56).TIB models of rats were made with Feeney's method.The z-DEVDfmk(5 μg)，caspase-3 inhibitor，was administered by intracerebral infusion，and the rats were sacrificed 1，6，24，48 hours and 3，7，14 days postinjury(n=8 for each interval).The specimens of the injured cerebral cortex，suhcerticai white matter，hippocampus，dentate gyrus and contrahteral corresponding brain tissues were taken for detecting apoptesis of neural cells by the terminal deoxynucleotidyl transferase mediated DUTP nick end labeling (TUNEL)methods and flow cytomeay.Caspase-3 mRNA and protein expression were detected by using RT-PCR，immunohistochemistry and western blot analysis.The caspase-3 activity was detected by using caspase-3 fluorescent assay kit.Student t-test and Spearman correlation analysis were used to analyze the data with SPSS version 10.1 software package.Results Apoptesis indexes(AI)and the apoptesis percentage(AP)of neural cells in the injured brain regions increased quickly after injury，and reached its peak 24 to 48 hours later，then decreased slowly,but it remained at higher level above that of normal till 14 days later(P＜0.01).The levels of caspase-3 mRNA,eastme-3 protein and caspase-3 activity were increased significantly post injury，and reached its peak at 24 to 48 hours，then it gradually decreased.Compared with control group，the levels ofoptical density of caspase-3 proteins in the injured hippocampus and subcortical white matter at 24 and 48 hours post injury increased 1484% and 1690%，caspase-3 mRNA expressiom increased 1043%and 1180%，and the degreas of caspase-3 activity increased 148% and 183%，respectively.The expression of caspase-3 proenzyme and its P17 subarrit increased.After trealment with caspase-3 inhibitor z-DEVD-fmk，the levels of caspase-3 mRNA，protein expression and caspase-3 activity were significantly decreased.and AI and AP were significantly decreased as well.The correlation between caspase-3 mRNA and level of neural apoptesis was positive(r=0.821，P＜0.01)，and it was likewise between caspase-3 protein and level of neural apoptosis(r=0.638.P＜0.01).Interestingly enough，a positive correlation was found between caspase-3 mRNA and easpase-3 proteins(r=0.945，P＜0.01).Conclusions The activation of caspase-3 leads to apoptosis of neural cells after acute TIB.The expression of caspase-3 are consistent with apoptosis of neural cells following TIB.The regulation of caspase-3 induced by TIB occurs at a ceriain critical link before transduction.Caspase-3 inhibitor can efficiently inhibit apoptosis of neural cells following TIB.

Objective To study the relationship between homocysteine (Hcy)and carotid atherosclerosis in patients with cer-ebral infarction.Methods During January and November 2013,281 patients with cerebral infarction from Affiliated Hospital of Yan’an University were provided the blood samples as cerebral infarction group,140 healthy volunteers served as control group.Serum Hcy was detected by enzymatic cycle assay.According to the results of carotid artery ultrasonography,cerebral infarction group was divided into five groups:artery normal group,intimal thickening group,soft plaque group,mixed plaque group and hard plaque group.The statistically significance was analyzed by SPSS 19.0.Results The serum Hcy level of cer-ebral infarction group was 19.78 ± 5.21 μmol/L,significantly higher than the control group 10.24 ± 3.33 μmol/L (P <0.001).The serum Hcy levels of control group,artery normal group,intimal thickening group,soft plaque group,mixed plaque group and hard plaque group were 10.24±3.33,15.20±2.99,17.03±1.85,25.44±4.24,19.65±4.74 and 18.31 ±3.67 μmol/L respectively.The differences between groups were statistically significant in addition to intimal thickening group and hard plaque group (P =1.106).The positive rates were 16.4%,53.7%,87.1%,95.7%,83.1% and 77.3% re-spectively,the groups which in cerebral infarction group compared with control group,the differences were statistically sig-nificant (P <0.001).Conclusion Hcy played an important role in the occurrence and development of cerebral infarction. Lower serum Hcy concentration,may be an effective way to prevent carotid atherosclerosis and cerebral infarction.

Objective To observe the incidence of critical illness-related corticosteroid insufficiency (CIRCI) after severe traumatic brain injury (sTBI) and investigate the relationship between CIRCI and prognosis.Methods This prospective cohort study enrolled 89 sTBI patients (68 males and 21 females;at age range of 15-80 years) hospitalized within 24 hours after sTBI from June 2014 to December 2015.The Glasgow coma scale (GCS) was ≤8 points.The causes of injury included extensive contusion of brain (44 cases),subdural hematoma (21 cases),epidural hematoma (11 cases),primary brain stem injury (8 cases) and diffuse axonal injury (5 cases).Adrenocorticotropic hormone (ACTH) stimulation tests were done within 36 hours after sTBI to identify CIRCI patients.The patients were divided into CIRCI group (50 cases) and non-CIRCI group (39 cases).Moreover,the patients were categorized into survival group (62 cases) and death group (27 cases) based on survival status.The GCS score,mechanical ventilation time,cerebral hernia,survival time and mortality within 28 days were observed in two groups.Results The incidence of CIRCI in sTBI patients was as high as 56％ (50/89).Compared with the non-CIRCI group,the CIRCI group had lower GCS [(5.3 ± 1.7) points vs.(6.1 ± 1.4) points,P ＜ 0.05],and sTBI patients with CIRCI were mechanically ventilated for a longer period of time [(9.9 ± 2.8) days vs.(7.5 ± 1.6) days,P ＜ 0.05].In comparison with non-CIRCI patients,the incidence of brain herniation in sTBI patients with CIRCI was higher (58％ vs.21％,P ＜0.01).The total fatality rate within 28 days was 30％ (27/89).The survival time of CIRCI group was significantly shorter than that of non-CIRCI group (P ＜ 0.05).The fatality rate in the CIRCI group was significantly higher than that of the non-CIRCI group [40％ (20/50) vs.18％ (7/39),P ＜0.05].The incidence of CIRCI in death group was significantly higher than that of the survival group [74％ (20/27) vs.48％ (30/62),P ＜ 0.05].Conclusions The incidence of CIRCI in STBI patients is high.The sTBI patients with CIRCI has significantly higher incidence of brain hernia,longer mechanical ventilation time,higher 28-day mortality and shorter survival time compared with non-CIRCI patients.

Objective To study the clinical significance of the injury and functional change of hypothalamic-pituitary-adrenal (HPA) axis after acute severe traumatic brain injury (TBI) in the rats.Methods A total of 60 adult healthy male Spraque-Dawley rats were randomly (random number) divided into 3 groups (n =20 in each group):sham operation group,model group and treatment group.The TBI models of rats were established by Feeney' s method.A low dose of dexamethasone (0.6 mg/kg) was injected into the abdominal cavity 20 minutes,24 hours and 48 hours after injury in treatment group,while rats of sham operation group and model group received equal volume of normal saline instead.All the rats were injected 1 μg adrenocorticotropic hormone (ACTH) into the abdominal cavity.The related parameters were detected at four time points,3 hours,12 hours,24 hours and 72 hours after cerebral contusion.The plasma corticosterone (CORT) and ACTH levels were measured by chemiluminescence.The hypothalamic,pituitary and adrenal of the rats were taken out for observing interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) expression detecting by immunohistochemical techniques at 72nd hour after TBI.One-way ANOVA and SNK-q test were used to analyze the results with SPSS 17.0 software package.Results The levels of ACTH and CORT on 3rd hour of model group raised remarkably compared with that of sham operation group,then they reduced gradually.The levels of CORT were lower than that of sham operation group at every time points after ACTH stimulation test (P ＜0.05 or P ＜0.01).The levels of CORT at all time points of treatment group were changed remarkably compared with that of model group.However,the ACTH levels of treatment group on 24 h increased slightly than that of model group.And the tendency of them was similar to model group (P ＜ 0.05 or P ＜ 0.01).The number of the hypothalamus and pituitary cells which express IL-6 and TNF-α in model group was more significantly increased when compared with that in sham operation group (P ＜ 0.01),while the number of this kind of cell in treatment group was significantly decreased than that in model group (P ＜ 0.01).The number of the adrenal cortex cells which express IL-6 in treatment group was more significantly decreased when compared with that in model group (P＜ 0.01),while the number of this kind of cell in model group was significantly increased than that in sham operation group (P ＜ 0.01).However,there was no significant difference of the TNF-α between all the groups (P ＞ 0.05).Conclusions Functional change of adrenal occurs early in the severe acute traumatic brain injury rats,and the response of adrenal to ACTH decreased as time goes by.Low-dose,short-course dexamethasone can delay the pathological changes,reduce the inflammatory response of HPA axis and increase the sensitivity of adrenal response to ACTH.