Objective To explore the clinical value of clara cell protein 16 (Cc 16) in the early diagnosis of ARDS in critically ill patients.Methods A total of 55 critically ill patients admitted between March 2013 and December 2013 in the Intensive Care Unit were enrolled for study.The inclusion criteria were as follows:sepsis,pneumonia,multiple injuries,patients after emergency or elective operation and non-cardiogenic diseases,whereas the exclusion criteria were cardiogenic pulmonary edema,age ≤ 18 years or≥80 years and disease course prolonged over one week.The level of serum Cc16 was detected with enzyme linked immunosorbent assay (ELISA).In addition,data of other biochemical examinations,the Acute Physiology and Chronic Health Evaluation (APACHE]Ⅱ) score and the relevant medical data were documented.The patients were divided into ARDS groups and non-ARDS groups based on clinical data met Berlin definition.Results The sensitivity and specificity of serum Cc16 for diagnosis of ARDS were 92％ and 80％,respectively with the area under the curve being 0.92,which were better than those of APACHE Ⅱ score,D-dimer,C-reactive protein,N-terminal pro-brain natriuretic peptide and serum albumin detected by the means of receiver operating characteristic curve,and cut off value was 20.62 ng/L.The bivariate analysis showed there was negative correlation between Cc16 and oxagenation index in ARDS patients and the Pearson correlation coefficient of serum Cc16 with oxygenation index was r =-0.342 (P =0.04).The results of one-way analysis of variance showed difference in level of Cc16 between subgroups (F =15.76,P =0.005 17).The level of Ccl6 in severe ARDS group was (64.18 ± 12.95) ng/L which was higher than that in mild ARDS group (35.87 ± 11.28) ng/L (P =0.001 14),and in moderate ARDS group (38.66 ± 20.14) ng/L (P =0.004 9),and in non-ARDS group (16.72 ± 8.74) ng/L (P =0.000 32).There was no statistically significant difference in Cc16 level between mild ARDS group and moderate ARDS group (P =0.682).The level of serum Ccl6 did not correlate with type or days of respiratory ventilation support,28-day survival rate or 120-hour survival rate and days of ICU stay and hospital stay.Conclusions The diagnostic value of serum Cc16 is very high in determining the presence and severity of ARDS in addition to the Berlin criteria in critically ill patients accurately assessing degree of lung injury.

OBJECTIVETo compare therapeutic effects between unilateral decompression technique only and open decompression technique with fusion and internal fixation for the treatment of lumbar spinal stenosis.

METHODSFrom March 2008 to February 2011, 82 patients with lumbar spinal stenosis were treated with operations, and divided into two groups. There were 13 males and 19 females in group A, with a mean age of (56.31±4.31) years old. The patients in group A were treated with unilateral decompression via fenestration technique only, including 23 patients obtaining single level decompression and 9 patients obtaining two levels decompression. In group B, there were 18 males and 32 females, with a mean age of (57.53±4.28) years old. The patients in group B were treated with open decompressive technique with fusion and internal fixation, including 38 patients obtaining single level decompression and 12 patients obtaining two levels decompression. The VAS of back pain and leg pain, ODI were recorded before and after surgery to evaluate low back pain,leg pain and walking tolerance.

RESULTSAll the patients were followed up, and the duration ranged from 10.9 to 43.4 months,with a mean of 32.8 months. There were no differences in age, stenosis level, VAS of back and leg pain and ODI before surgery between two groups. Compared with the corresponding ones in group B, the operation time, blood loss, hospitalization time,recovery time of routine daily life and finacial expenditure of patients were all shorter or less in group A. There was no statistically difference in complications between two groups.

CONCLUSION"Unilateral decompression via fenestration technique" is a less invasive and more effective decompressive technique for degenerative spinal stenosis without posterior elements damage. It has advantages in operation time, blood loss, hospitalization time, recovery to daily life and financial expenditure. When controlling the operative indications strictly, the technique could be an important procedure for surgical treatment of degenerative spinal stenosis, especially in the elderly population.

Adult ; Aged ; Case-Control Studies ; Decompression, Surgical ; methods ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; methods ; Spinal Fusion ; methods ; Spinal Stenosis ; surgery

OBJECTIVETo explore the effect of negative emotions on serum levels of adrenocorticotropic hormone (ACTH) and neuropeptide Y (NYP) in hepatitis B liver cirrhosis (HBLC) patients.

METHODSTotally 617 HBLC patients were assigned to the negative emotion group (415 cases) and the non-negative emotion group (202 cases) judged by negative emotions. Case numbers of various grading Child-Pugh were recorded in the two groups. Their liver functions were compared between the two groups. Serum levels of ACTH and NPY were detected using double antibody sandwich enzyme-linked immunosorbent assay (ELISA) in the two groups.

RESULTSThere was no statistical difference in Child-Pugh grading between the two groups (χ2 = 0.65, P = 0.72). Compared with the non-negative emotional group, serum ACTH levels decreased significantly in the negative emotion group with statistical difference (P < 0.05). There was no statistical difference in serum ACTH levels between the two groups (P > 0.05).

CONCLUSIONThe negative emotion of HBLC patients was not related to the serum ACTH level, but to relatively lower-concentration serum NPY levels.

Adrenocorticotropic Hormone ; blood ; Emotions ; Hepatitis B ; blood ; psychology ; Humans ; Liver Cirrhosis ; blood ; psychology ; Neuropeptide Y ; Serum

OBJECTIVETo investigate the effect of propofol on brain regions at different sedation levels and the association between changes in brain region activity and loss of consciousness using blood oxygen level-dependent functional magnetic resonance imaging (BOLD-fMRI) and bispectral index (BIS) monitoring.

METHODSForty-eight participants were enrolled at Peking Union Medical College Hospital from October 2011 to March 2012 and randomly assigned to a mild or a deep sedation group using computer- generated random numbers. Preliminary tests were performed a week prior to scanning to determine target effect site concentrations based on BIS and concomitant Observer's Assessment of Alertness/Sedation scores while under propofol. Within one week of the preliminary tests where propofol dose-response was established, BOLD-fMRI was conducted to examine brain activation with the subject awake, and with propofol infusion at the sedation level.

RESULTSMild propofol sedation inhibited left inferior parietal lobe activation. Deep sedation inhibited activation of the left insula, left superior temporal gyrus, and right middle temporal gyrus. Compared with mild sedation, deep propofol sedation inhibited activation of the left thalamus, precentral gyrus, anterior cingulate, and right basal nuclei.

CONCLUSIONMild and deep propofol sedation are associated with inhibition of different brain regions, possibly explaining differences in the respective loss of consciousness processes.

Adult ; Brain ; drug effects ; Consciousness Monitors ; Deep Sedation ; Dose-Response Relationship, Drug ; Humans ; Hypnotics and Sedatives ; pharmacology ; Male ; Propofol ; pharmacology

Objective To study the correlation between pulse pressure(PP) and cardiovascular structure and function in aged patients with essential hypertension. Methods Forty-eight aged patients with essential hypertension were enrolled into the study and divided into the following two groups by the mean value of PP: PP

Background Diabetic complication is associated with lipid peroxidation.Aldehyde dehydrogenases (ALDH) catalyze the irreversible oxidation of a variety of biological aldehydes,including lipid-derived aldehydes (LDAs),and thus protect organs and tissues from toxic LDAs.Understanding the activity of ALDH in different ocular tissues in diabetic subjects is very important for prevention and treatment of diabetic ocular complications.Objective This research aimed to investigate the activity and expression of ALDH in different ocular tissues in diabetic rats and to explore the mechanism of ALDH in diabetes-induced eye disease.Methods Twenty-eight healthy SPF male Sprague-Dawley(SD) rats weighted 170-180 g were randomly divided into the normal control group and diabetic group.The diabetic animal model was established by intraperitonial injection of 4％ streptozotocin at 65 mg/kg.Isometric citric acid buffer was injected in the rats of the normal control group.The rats were sacrificed in each group 2 and 4 months after the establishment of the diabetic models,and eyeballs were obtained for the preparation of corneal,lens and retinal homogenates.ALDH activity was detected using a multifunctional microplate reader SpectraMax M5,and ALDH content was measured by ELISA at the wavelength of 450 nm with the SpectraMax M5 ELISA reader.Results The blood glucose level in diabetic rats was significantly elevated at various time points compared with the normal control group(P=0.000),and body weights were evidently lower in the diabetic group than in the normal group (P =0.000).The activities of ALDH (A340) in corneal,lens and retinal tissues in the diabetic group were increased in comparison with the normal control group (F =396.601,P=0.000),and showed an enhancement with the lapsing of time (F =53.139,P =0.000).In addition,the highest level of ALDH was found in the cornea and the lowest level in the lens(F =6973.000,P=0.000).The expression level of ALDH in the corneal,lens and retinal homogenates was significantly higher in the diabetic group compared with the normal control group (F=312.985,P =0.000) and showed a considerable increase over the course (F =19.203,P=0.000).The highest expression level was seen in the cornea and the lowest was in the lens,with a significant difference among these three kinds of tissues (F =3243.000,P =0.000).Conclusions ALDH can protect ocular tissue from the damage of lipid peroxidation.Thess results suggest that ALDH plays a role in preventing diabetes-related ocular complications.

Objective:To investigate the proliferation of rat glomerular mesangial cells (GMC) influenced by different ethanol extracts of Tripterygium wilfordii HooK F.(TWHF).Methods:An HPLC method was used to establish the fingerprints of 5 different ethanol extracts of TWHF,and GMC was chosen to study the effects of different ethanol extracts of TWHF on cell proliferation.After statistical analysis,the spectrum-activity relationship was analyzed by using partial least squares regression(PLSR).Results:The HPLC fingerprints of the 5 different ethanol extracts of TWHF were established,and 32 characteristic peaks were characterized by the HPLC fingerprints.60%,70% and 95% ethanol extracts and glycosides tablets showed dose-effect relationship,and with the increase of dose,the more significant inhibition of cell proliferation was exhibited.The absorbance values of the 60% ethanol extracts at medium and high doses were lower than those of the other extracts at the same dose.The proliferation inhibition rate of GMC was used as the potency index and analyzed by PLSR,and 20 peaks were potency peaks at high dose(40 μg·L-1),17 ones were potency peaks at medium dose(20 μg·L-1) and 15 ones were potency peaks at low dose(10 μg·L-1).Conclusion:Part of the potency peaks has regular dose-effect relationship with the changes of dose.

Objective To compare the procotol of EGDT +Pt (cv-a ) CO2 with EGDT in fluid resuscitation and management after evaluate fluid responsiveness in shock patients by Vigileo and passive leg raising test.Metheds Prospectively collect patients who meet the criteria between 2013.5.1-2013.1 1.30 in our ICU.Randomly (random number)divided into Vigileo group (first evaluate the fluid responsiveness then give EGDT +Pt (cv-a) CO2 ) and CVP group (give EGDT).Compare the hospital mortality and morbility of MODS,the volume given in the first 6 hours and the first 7 days,consume of blood products , the ICU and hospital stay.Results Collected 46 patients,Vigileo group (21 )and CVP group (25 ). There’s no significant difference between groups at baseline.In the first 6 hours the CVP group had received more fluids (3656.281678.57 vs. 2639.141326.59 ) mL, P =0.03;and more blood products (573.00172.57 vs. 190.4770.82)mL,P=0.04,respictivily.Vigileo group significantly short the ICU stay ,(6.384.34 vs. 12.165.77)d,P=0.04.But there’s no significant difference in hospital motality and the morbility of MODS.The ROC of Age ,the accumulative volume of balance in 7 days,APACHEⅡscore in the first day to predict death is 0.84 (0.68-0.99)、0.82 (0.69-0.95)、0.80 (0.66-0.94),all P>0.05,respectively.By 7 days the accumulative volume of balance 3454.51mL as cutoff to predict death with the sensitivity of 0.67,specificity of 0.84.Conclusions 1.Given EGDT +Pt (cv-a) CO2 after evaluate the fluid responsiveness can reduce fluid and blood products given in the first 6 hours,significantly short the ICU stay,without worsen the tissue flow or increase the morbility of MODS;2.Consecutive positive fluid balance is a risk factor about poor prognosis,and also a sensitive indicator to predict death.

This paper points out that the sub-health state is not equal to chronic fatigue syndrome (CFS) on basis of elaborating the concept and category of sub-health. And the present understanding on concepts of fatigue, chronic fatigue and CFS, as well as the diagnosis criteria and differential diagnosis of CFS are discussed systematically.
Chronic Disease ; Diagnosis, Differential ; Fatigue ; diagnosis ; Fatigue Syndrome, Chronic ; diagnosis ; Fibromyalgia ; diagnosis ; Humans ; Terminology as Topic