Acute respiratory distress syndrome (ARDS) is a common diseases in critical ill patients, which is an acute-onset hypoxic condition with radiographic bilateral lung infiltration. And it can be divided into two phases in pathophysiology: an acute exudative phase combining diffuse alveolar damage and lung edema followed by a later fibro proliferative phase. The early prediction and risk assessment of patients with ARDS is still very poor in the clinical. In recent years, researchers gradually focus their research on exploration of biomarkers of ARDS. The article mainly aims to sum up the development of biomarkers exploration.

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.

Objective To investigate the sonographic characteristic of hepatic lymphoma. Methods Fifteen patients with pathological proven hepatic lymphomas (4 primary and 11 secondary hepatic lymphomas) were included in this retrospective study. All the 15 patients underwent conventional B-mode ultrasound examinations. Two patients (one with primary lymphoma and another with secondary lymphoma) underwent contrast enhanced ultrasonography (CEUS). Results In the conventional ultrasonography, hepatic masses were detected in 9 patients (4 primary and 5 secondary lymphomas). No hepatic mass was detected in the remaining 6 patients with pathological proven secondary lymphomas. For the 4 patients with detectable primary masses, 2 had a single mass and 2 had multiple masses. All primary hepatic lymphomas were hypoechoic. For the 5 patients with detectable secondary masses, 2 had a single mass and 3 had multiple masses. The hypoechoic lymphomas were found in 3 patients, while hyperechoic and isoechoic lymphomas were found in the other 2 patients. In the 4 patients with primary hepatic lymphomas, 3 had hepatomegaly, while none of the 4 patients had splenomegaly. In the 5 patients with detectable secondary masses, hepatomegaly was found in 3 patients in whom 2 had splenomegaly and 1 had a plate-shaped hypoechoic region within spleen. For the 6 patients without detectable secondary masses, splenomegaly was found in all 6 patients and hepatomegaly was found in 4 patients. In the spleen of one patient, a plate-shaped hypoechoic region was detected in the B-mode ultrasonography. In the CEUS, the primary lymphoma presented a thick ring region with slight enhancement peripheral to the mass during the hepatic artery phase;while the secondary lymphoma presented the uneven enhancement pattern with a small plate-shaped region unenhanced in its center during the hepatic artery phase. Conclusions In ultrasonography, the patients with hepatic lymphomas commonly present a single or multiple hypoechoic well-deifned hepatic masses, poor blood lfow and uneven enhancement peripheral to the mass during the hepatic artery phase of CEUS. Other sonographic characteristic include hepatomegaly and splenomegaly. No mass is detected in ultrasonography can not exclude the diagnosis of hepatic lymphoma.

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.

Assessment of liver function reserve has important clinical significance,which can be used to decide the safe range of liver resection,to identify the potential liver injury early,to evaluate the treatment effect and to predict the prognosis of middle/end-stage liver diseases.There are a number of methods to assess liver function reserve.The indocyanine green (ICG) elimination test is the most commonly used and widely acknowledged approach for this assessment.With the development of functional imaging,evaluation of liver function reserve can be non-or minimalinvasive,more convenient and accurate.The application of imaging in assessment of liver function reserve and the relationship with ICG elimination test were reviewed in this article.

Objective To analyze the changes of portal venous velocity (PVV) ratio (PVVR) in different degrees of portal vein stenosis (PVS) following 70％ partial hepatectomy (PH) in rats.Methods According to different surgical methods,102 SD rats were randomly subjected into sham operation rats group (n=6),non PVS group,mild,moderate and severe PVS group (each group n=24).Models of 70％ PH without PV ligation were established in non-PVS group,while in PVS groups were produced with partially ligating PV in different degrees following 70％ PH.PVV was measured 1,3,7 and 14 days after operation,and PVVR was calculated in PVS groups.Combined with mitotic index (MI) 3 days after operation and liver regeneration degree (LRD) 7 days after operation,the changes of PVVR in different groups were analyzed.Results MI of non-PVS and moderate PVS groups were significantly higher than that of mild PVS group (both P＜0.05),while of severe PVS group was significantly lower than that of moderate PVS group (P＜0.05).LRD of severe PVS group was significantly lower than that of non PVS and moderate PVS groups (both P＜0.05).In non-PVS group,PVV decelerated to the lowest 3 days after operation,and recovered 7 and 14 days.In PVS groups,PVVR decelerated to the lowest 7 days after operation,and recovered until 14 days.PVVR of severe PVS group was significantly higher than that of mild and moderate PVS groups 1 and 3 days after operation (all P＜0.05),while there was no statistical differences among PVS groups 7 and 14 days after operation (all P＞0.05).Conclusion Ultrasound can well demonstrate blood flow changes of PVS following 70％ PH in rats.Changes of PVVR may relate to pathological changes in hepatocytes,the nuclear division and the volume of regenerated liver in rats.

Out-of-hospital cardiac arrest (OHCA) with high mortality and disable rate is a public health problem of common concern all over the world. In order to improve the survival rate of OHCA, developed countries such as Europe and the United States have established regional and even national OHCA registration database for continuous monitoring and quality improvement of OHCA, identifying the weaknesses in each link of the survival chain, and evaluating effective measures to enhance the survival rate. At present, China still lacks of registration database that can comprehensively collect the information of OHCA and effectively reflect the treatment status and research direction of OHCA. In order to shorten the huge gap of OHCA survival rate between China and developed countries such as Europe and the United States, we should learn from the experience of foreign registration databases and establish OHCA registration database suitable for China's national conditions, so as to promote the improvement of OHCA survival rate in China. This paper presents several major OHCA registry databases of the internationally recognized, such as cardiac arrest registry to enhance survival (CARES), resuscitation outcomes consortium (ROC), European registry of cardiac arrest (EuReCa), Pan-Asian resuscitation outcomes registry (PAROS), and Australian resuscitation outcome consortium (Aus-ROC), aims to provide a reference for promoting the construction of the cardiac arrest registration database in China.

Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are leading causes of death and disability in the world population. Cardio-cerebral infarction (CCI) is a rare clinical syndrome of AMI combined with AIS, which refers to the critical symptoms of simultaneous acute focal neurological deficits and precordial pain or electrocardiogram changes. The incidence of CCI ranges from 0.09% to 1.6%, but patients have a critical condition, poor prognosis, and high mortality and disability rates. Due to the complexity of the condition, diverse etiology, and limited evidence and mechanistic research, the management of patients with CCI is challenging. This article summarizes the pathogenesis related to CCI, the effectiveness of drug treatment, indications for endovascular treatment, and the selection of surgical sequence, with the aim of shortening thrombolysis/endovascular treatment time and improving outcomes of patients.

Objective To assess the sweat secretion of Yin-deficient ovariectomized rats and investigate the changes in biochemical indexes.Methods Eighteen SD female rats were randomly divided into a sham operation group,model group,and positive control group of six rats each.The rats in the sham operation group underwent a sham operation,and those in the model group and positive control group underwent bilateral ovariectomy.L-Thyroxine(92 mg/kg)was given once a day for 7 consecutive days starting on the 7th postoperative day to establish a Yin-deficient ovariectomized model.The rats in the positive control group were orally administered Qinggu San Tang(7.3 g/kg)once a day,while those in the sham operation group and model group were orally administered an equal amount of distilled water once a day for a total of 14 days.Sweat secretion from the plantar region of the foot was measured using the Wada-Takagaki reagent coloring method.At the end of the experiment,blood was taken from the abdominal aorta and the tissue of the paw pads was separated.The serum levels cyclic adenosine monophosphate(cAMP),cyclic guanosine monophosphate(cGMP),luteinizing hormone(LH),gonadotropin-releasing hormone(GnRH),and estradiol(E2)were measured by enzyme-linked immunosorbent assay.Western Blot was used to determine the expression levels of M3 R,β2 AR,and aquaporin-5(AQP5)in the paw pad.Results The three main findings of this study were as follows.(1)Compared with the rats in the sham operation group,those in the model group were more irritable and aggressive,and their body weights decreased while their average temperature and sweat secretion significantly increased.(2)Serum cAMP level and cAMP/cGMP ratio increased,the LH and GnRH levels significantly increased,and the E2 level decreased.(3)M3 R expression was down-regulated and β2 AR and AQP5 expression was up-regulated in the paw pads of the rats.After 2 weeks of positive control treatment,the serum cAMP level and cAMP/cGMP ratio significantly decreased and the LH and GnRH levels decreased;however,no statistically significant difference was observed in the serum E2 level.The expression levels of M3 R were increased-regulated in paw pads of the rats,and reduced expression of β2 AR and AQP5.Conclusions Sweat secretion significantly increased in this"combined disease and evidence"model of perimenopausal syndrome kidney yin deficiency established by desiccation combined with thyroxine.The underlying mechanism may be related to the changes in cGMP,cAMP,and key proteins M3 R,β2 AR,and AQP5 in sweat glands that regulate sweat secretion.

Acute kidney injury (AKI) is a common complication in patients with sepsis, with poor prognosis and high mortality. The pathogenesis of sepsis-induced acute kidney injury (SAKI) is closely related to renal hemodynamic abnormalities, inflammatory injury and adaptive mechanism. It is insufficient for previous criteria based on urine output and creatinine to the early diagnosis of SAKI. The emergence of new biomarkers may make up for deficiencies in early diagnosis. And significant progress has also been made in the treatment of SAKI. The aim of this article was to review the researches on pathophysiology, early diagnosis and treatment of SAKI and provides some help for clinical staff to understand SAKI.
Acute Kidney Injury ; Biomarkers ; Creatinine ; Humans ; Kidney ; Sepsis