Objective To determine the likelihood of G-protein coupled receptor 56 (GPR56 ) induces axonal development and myelination in the corpus callosum of mouse brain.Methods A total of 64 Gpr56 +/-and Gpr56 -/-mice were selected and randomly divided into two groups:Gpr56 +/-group (n=32)and Gpr56 -/-group (n=32).According to number of days after birth,each group was further divided into 4 subgroups including P7d,P14d,P21d and P28d subgroups.Levels of neurofilament-200 (NF -200)and proteolipid protein (PLP ) of myelin basic protein in corpus callosum were measured with immunohistochemistry staining and Western blot in P7d、P14d、P21d、P28d Gpr56 +/- and Gpr56 -/-mice.Gpr56 +/-and Gpr56 -/-neurons were cultured using P1 d Gpr56 +/-and Gpr56 -/-mouse brain.The lengths of Gpr56 +/- and Gpr56 -/-neuronal axon were measured and compared with Image J software. Axonal myelination in the corpus callosum of mouse brain in each group was observed under electronic microscopy and the axonal diameters between subgroups were compared.Results The levels of NF-200 and PLP in the corpus callosum in P7d、P14d、P21d、P28d Gpr56 -/-mice decreased significantly compared with Gpr56 +/- mice.The length of Gpr56 -/-neuronal axon was shortened compared with Gpr56 +/-neuronal axon.The number of myelinated axons was obviously reduced in the corpus callosum in P28d Gpr56 -/-mice.The diameter of axon in the corpus callosum of P28d Gpr56 +/-mouse is longer than that of P28d Gpr56 -/-mouse. Conclusions GPR56 may be involved in axonal development and myelination in the corpus callosum of mouse brain.

ObjectiveTo investigate whether esmolol could improve clinical outcome and tissue oxygen metabolism by controlling heart rate (HR) in patients with septic shock.Methods A single-center double-blinded randomized controlled trial was conducted. The patients suffering from septic shock received 6-hour early goal directed therapy (EGDT) with pulmonary artery wedge pressure≥ 12 mmHg (1 mmHg = 0.133 kPa) or central venous pressure (CVP)≥ 12 mmHg requiring norepinephrine to maintain mean arterial pressure (MAP)≥ 65 mmHg and HR≥95 bpm admitted to intensive care unit (ICU) of Guangdong General Hospital from September 2013 to September 2014 were enrolled. They were randomly divided into esmolol group and control group by computer-based random number generator. All patients received conventional basic treatment, while those in the esmolol group received in addition persistent esmolol infusion by micro pump with dosage of 0.05 mg·kg-1·min-1 with the dosage adjusted to maintain HR lower than 100 bpm within 24 hours. The patients in control group did not receive drug intervention for HR. The primary end-points consisted of length of stay in ICU and 28-day mortality. The secondary end-points included hemodynamic parameters [HR, MAP, CVP, cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI)] and tissue oxygen metabolism parameters [central venous oxygen saturation (ScvO2), lactate level (Lac)]before and 24, 48, 72 hours after the treatment.Results A total of 48 patients with septic shock were enrolled with 24 patients in esmolol group and 24 in control group.① The primary end-points: compared with control group, the length of stay in the ICU in the esmolol group was significantly shortened (days: 13.75±8.68 vs. 21.70±6.06,t = 3.680, P = 0.001), and 28-day mortality was significantly lowered [25.0% (6/24) vs. 62.5% (15/24),χ2 = 6.857,P = 0.009].② The secondary end-points: there were no significant difference in the hemodynamic and tissue metabolism parameters before treatment between two groups. No significant difference was found between before and after treatment of all above parameters in control group. HR and Lac in the esmolol group were obviously declined, SVI, SVRI, ScvO2 were gradually increased, but no significant difference in MAP, CVP, and CI was found. Compared with the control group, HR in the esomolol group was significantly lowered (bpm: 84.4±3.5 vs. 111.2±7.2,P< 0.01), SVRI and ScvO2 were significantly increased from 24 hours [SVRI (kPa·s·L-1·m-2): 137.9±1.6 vs. 126.9±1.3, ScvO2: 0.652±0.017 vs. 0.620±0.017, bothP< 0.01]; SVI was significantly increased (mL/m2: 39.9±2.2 vs. 36.8±1.7,P< 0.01) and Lac level significantly declined from 48 hours (mmol/L: 2.8±0.3 vs. 3.4±0.3,P< 0.01).Conclusion The results demonstrate that HR controlled by a titrated esmolol infusion given to septic shock patients was associated with an improvement in tissue metabolism, reduction in the length of ICU stay and lowering of 28-day mortality.

Objective To investigate the effects of stress hyperglycemia on prognosis in patients with severe cerebral vascular diseases.Methods A retrospective analysis was conducted.416 patients with severe cerebral vascular diseases confirmed by radiological imaging admitted to intensive care unit (ICU) of Guangdong General Hospital from December 2013 to June 2015 were enrolled.According to the values of randomise blood glucose (RBG) and glycosylated hemoglobin (HbA1c) and diabetes history,the patients were divided into euglycemia group (RBG ＜ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history),diabetes group (RBG ≥ 11.1 mmol/L,HbA1c ≥ 0.065,with diabetes history),and stress hyperglycemia group (RBG ≥ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history).The nosocomial infection rate,the length of ICU stay and 28-day mortality were compared among the three groups.Survival analysis was performed using Kaplan-Meier method,and multivariate Cox proportional hazard model was used to estimate the risk of death.Results Among 416 patients,there were 40 cases with stress hyperglycemia,46 with diabetes and 330 with euglycemia,with the incidence of stress hyperglycemia of 10.81％ (40/370).The nosocomial infection rates in the stress hyperglycemia group and diabetes group were significantly higher than those of the euglycemia group [55.00％ (22/40),52.17％ (24/46) vs.18.79％ (62/330),both P ＜ 0.01],and the length of ICU stay was significantly longer than that of the euglycemia group (days:16.53 ± 6.26,15.79 ± 8.51 vs.9.23 ± 4.29,both P ＜ 0.01).No significant differences in nosocomial intection rate and length of ICU stay were found between stress hyperglycemia group and diabetes group (both P ＞ 0.05).The 28-day mortality rate in stress hyperglycemia group was significantly higher than that of diabetes group and euglycemia group [47.50％ (19/40) vs.26.09％ (12/46),10.30％ (34/330),P ＜ 0.05 and P ＜ 0.01].It was showed by Kaplan-Meier survival analysis that 28-day cumulative survival rate in stress hyperglycemia group was significantly lower than that of euglycemia group and diabetes group (log-rank =6.148,P =0.043).It was showed by Cox death risk analysis that stress hyperglycemia was the risk factor of death in patients with severe cerebral vascular disease [hazard ratio (HR) =1.53,95％ confidence interval (95％CI) =1.04-1.26,P =0.001].Conclusion The patients with stress hyperglycemia may have a higher 28-day mortality and a poorer prognosis compared with those with diabetes and normal blood glucose in severe cerebral vascular diseases.

Objective To evaluate the clinical efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of patients with acute respiratory distress syndrome (ARDS), and to look for the predictors of failure of NPPV. Methods A retrospective observation was conducted. ARDS patients underwent NPPV admitted to emergency intensive care unit (EICU) of Guangdong General Hospital from January 2013 to December 2015 were enrolled. The patients were divided into success group and failure group according to the clinical efficacy. The condition of the patients in the two groups was evaluated, and ARDS classification and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score before treatment were recorded. Etiological composition of ARDS was analyzed. The parameters, including heart rate (HR), respiratory rate (RR), oxygenation index (PaO2/FiO2), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (SaO2), were recorded before and 2 hours after the treatment of NPPV. Multivariate logistic regression analysis was conducted for predicting the independent factors inducing the failure of NPPV treatment of patients with ARDS. Results The date of 137 patients with ARDS were collected, excluding the followed patients, 6 with coma, 18 with hemodynamic instability, 5 with severe hypoxia, and 5 with incomplete date. Finally, a total of 103 patients entered the statistics. There were 69 patients in NPPV success group, and 34 in failure group. Compared with success group, APACHE Ⅱ score in the failure group was higher (21.4±6.2 vs. 19.7±8.9), the ratios of patients with severe ARDS and those induced by pulmonary infection were higher [82.4% (28/34) vs. 5.8% (4/69), 32.4% (11/34) vs. 8.7% (6/69), respectively, both P < 0.05]. HR and RR before NPPV in the failure group were significantly higher than those of success group [HR (bpm): 124±13 vs. 117±12, RR (bpm): 39±5 vs. 33±4], and PaO2/FiO2, PaO2, PaCO2, and SaO2 were significantly lower than those of the success group [PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 104±10 vs. 156±12, PaO2 (mmHg): 53±8 vs. 68±7, PaCO2 (mmHg): 31±5 vs. 37±7, SaO2: 0.83±0.07 vs. 0.91±0.05, all P < 0.05]. It was shown by logistic regression analysis that severe ARDS [odds ratio (OR) = 10.533, 95% confidence interval (95%CI) = 5.847-89.852, P = 0.000], pulmonary infection resulted ARDS (OR = 4.831, 95%CI = 1.688-13.825, P = 0.003) and PaO2/FiO2 < 140 mmHg 2 hours after treatment (OR = 7.049, 95%CI = 1.266-39.236, P = 0.026) were the independent risk factors of NPPV failure for the treatment of patients with ARDS. Conclusions Patients with severe ARDS and pulmonary infection derived ARDS were the risk factors of failure to NPPV in ARDS. Lack of improvement in oxygenation 2 hours after NPPV is the predictor of NPPV failure and change to invasive ventilation.

Objective To evaluate (1,3)-β-D-glucan (BG) assay as an aid for invasive fungal infection (IFI) diagnosis in severe pneumonia patients (diagnosis followed 2007 American Thoracic Society (ATS) and Infectious Disease Society of America (IDSA) severe pneumonia standard).Methods BG antigenemia was measured by BG Assay Box.IFIs was classified according to the blood fungal laboratory reports.Results 558 patients (185 females,373 males,mean age 64.7) were included.41 patients were proven to be fungal infected to be classified in exposure group.BG assay mean value in exposure group and unexposure group were (568.53 ±796.57) pg/mL,(51.4 ±63.27) pg/mL,respectively.Patients in the exposure group had significantly higher BG assay value than patients in the unexposure group (P ＜0.05).For the cutoff 100 pg/mL recommended by manufacturer,the sensitivity,specificity,positive predict value and negative predict value of the BG assay were 92.7％,92.5％,49.4％ and 0.6％,respectively.Conclusion BG assay has positive clinical value in invasive fungal infection diagnosis in severe pneumonia patients.

Objective To explore the advantages and disadvantages of helicopter emergency medical services of South China in the long-distance transport for critical patients.Methods A total of 30 patients who received helicopter emergency medical services by Guangdong Generral Hospital from August 2004 to December 2014 were selected as the observation group,and the other 30 patients with similar conditions who received ground emergency medical services were selected as the control group.To analyses the difference between the two groups in the disease,transport distance,transportation time,costs and compliction by χ2-test,t-test and nonparametric test according types of data.Results There were significantly difference between two groups in transport distances (km) [578.0 (313.0,707.5)vs.214.5 (101.5,313.5),P <0.05],set-up time (min) [95.7 (56.7,133.4)vs.10.7 (6.8,15.7),P <0.05],transportation time (min) [112.3 (64.3,152.4) vs.146.8 (67.8,217.5),P <0.05],costs (yuan/h) [14378.5 (9887.0,16348.5)vs.557.0 (356.5, 787.5),P <0.05]and the distance/total time value [2.8 (1.3,4.8)vs.1.4 (0.8,2.8),P <0.05]. There was no significantly difference in the incidence of complications between two groups (χ2 =0.058,P >0.05).Conclusions Helicopter emergency medical services could shorten the transportation time of critical patients on long distance transportation,and improve the efficiency of first-aid.However,there were many disadvantages that need to be improved in the helicopter emergency medical service of China.

Objective To evaluate the therapeutic effcacy with CT-guided percutaneous radiofrequency ablation(RFA)for the liver tumor.Methods 60 cases of patients with a total of 73 lesions were treated with radio-frequency ablation.The diameter of the lesions was 1.4～7.0cm.with a mean diameter of 4.2cm.The therapeutic efficacy was evaluated with enhanced CT scanning and AFP.Results 45 patients of 60 cases with lesions were full damaged,no blood flow Was found on enhanced CT scans.39 patients with significantly increased blood-AFP before treatment were decreased significantly after treatment,Complications occured in 11 patients,including refractory hiccup (n=2),epidermal scald(n=3),intrahepatic hemorrhage(n=2)and hepatic abscess(n=1).Conclusion The radiofrequency ablation was simple and effective treatment of liver tumor.The effect could be similar to that of surgical resection.

AIM: To investigate the therapeutic effect of chloride channel blocker tamoxifen on hypoxia pulmonary hypertension in rats.METHODS: Sixty male Wistar rats were randomly divided into therapeutic group(H/Q group),hypoxia group(H group),normal control group(C group).Mean pulmonary artery pressure(mPAP),the ratio of the weight of right ventricle to that of left ventricle plus septum[RV(LV+S)],and the ratio of the pulmonary arteriole wall area to that of vascular total area(WA/TA),were measured at 4,7,14,21 days.RESULTS:The mPAP began to increase from 7 days,and reached peak at 21 days in hypoxia group,however it is obviously lower in therapeutic group at same time.The ratio of RV(LV+S) began to increase from 14 days,and reached peak at 21 days in hypoxia group,however it is obviously lower in therapeutic group at same time.The ratio of WA/TA at 21 days in hypoxia group was significantly higher than therapeutic group,respectively(P

Objective To summarize the therapeutic results and experience of the interventional managements for pseudoaneurysms occurred after surgery. Methods Five pseudoaneurysms with different location that occurred after surgery in five patients were treated with different interventional managements. One patient suffered from a ruptured pseudoaneurysm of left common iliac artery, which was treated by obstructing the diseased artery with balloon via the abdominal aorta followed by the replacement of vascular prostheses. One patient had a pseudoaneurysm of right subclavian artery and endovascular covered stent was employed to isolate it. The remaining three patients were affected by pseudoaneurysm of terminal arteries and intraarterial embolization with gelfoam and/or steel coils was camed out. Results Complete closing of the pseudoaneurysm was obtained in all five patients and no therapy-related complications occurred. Conclusion Pseudoaneurysms occurred after surgery can be effectively treated with different interventional managements, it is worth popularizing this technique in clinical practice.

Objective To evaluate the value of NT-proBNP in predicting weaning outcomes of the patients with mechanical ventilation by using the receiver operating characteristic (ROC)curve. Method The data of patients after the weaning of mechanical ventilation and spontaneous breathing trial (SBT) in the intensive care unit,from July 2008 to January 2010, were retrospective reviewed. All patients were divided into the success group and failure group as per the outcomes of weaning. Demographics and the serum NT-proBNP levels measured before weaning were compared between two groups with Student t -test and Chi-square test. The ROC curve was drawn to evaluate the value of serum NT-proBNP in predicting outcomes after weaning. Results A total of 160 patients were eligible for inclusion in the study, and there were 106 cases in success group and 54 cases in failure group.Compared with the failure group, the patients of success group were younger (63.17 ± 17.00 vs. 71.28 ± 12.56,t = 2.063,P =0.024), and no difference in gender (χ2 = 0.06, P ＞ 0.05). The NT-proBNP levels of failure group were significantly higher than those of success group (Lg NT-proBNP 2.80 ± 0.72 vs. 3.75 ± 0.56, t =2.351,P =0.014). The area under cure (AUC) of the ROC cure of NT-proBNPto predict the failure of weaning was 0.855 ±0.036 (95%CI0.784 ～ 0.925) when the cut-off level of NT-proBNP was 3635.5 pg/mL. And, this NT-proBNP level had a followed predictive efficiency in weaning outcome (Youden's index: 0. 60, accuracy:82.5%, sensitivity: 75%, specificity: 84.7%, positive likelihood ratio: 4.90, negative likelihood ratio:0.295,Kappa value: 0.62). Conclusions The levels of NT-proBNP before weaning have predictive value in weaning outcome, and it may be used as one of the screening indicators for weaning.