Objective To investigate clinical value of gelsoin level for evaluating severity and prognosis in patients with critical illness. Methods Forty-eight patients with critical illness admitted to the Emergency Intensive Care Unit of Beijing Hospital during February to December 2008 were enrolled in this study, with 23 survivors and 25 deaths. Serum level of gelsolin was measured for 31 of them at least twice during their hospital stay, and for other 17 only once at their admission. They all were evaluated with acute physiology and chronic health evaluation Ⅱ ( APACHE Ⅱ ) scores within 24 hours after admission. In addition, serum level of gelsolin was measured for another 307 healthy adults as controls. Results Initial level of gelsolin was significantly lower in 48 patients at critically ill than that in controls [(24 ± 11) mg/L vs. (192 ±39) mg/L, P < 0. 01]. There was significant difference in initial level of gelsolin between surviving group (23 cases) and death group (25 cases) [(28 ± 10) mg/L vs. (21 ±12) mg/L, P = 0. 033]. Fatality of patients at critically ill increased as their level of gelsolin at 22 mg/L or less, with a predicting accuracy of 74. 19% , as well as decreasing trend of their gelsolin levels in continuously minitoring, with a predicting accuracy of 70. 97%. Predicting accuracy of APACHE Ⅱ scores of 30 or more was 67.74%. However, predicting accuracy would reach 93.55% as final level of gelsolin and its decreasing trend combined with APACHE Ⅱ scores in prognostic assessment for critically ill patients. Conclusions Severity of patients at critically ill can be predicted by their gelsolin level, especially in continuously monitoring, which is an indicator better than APACHE Ⅱ scores. Combination of gelsolin level with APACHE Ⅱ scores shows a more accurate prognostic assessment for critically ill patients.

Objective To evaluate the value of gelsolin for the prognosis of patients with severe sepsis.Methods 50 patients in the emergency intensive care unit of Beijing hospital from January 2015 to July 2015,were determined white blood cell count (WBC),C-reactive protein (CRP),procalcitonin (PCT),gelsolin at admission,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were estimated within 24 hours.According to the 28 days of survival outcome,50 patients were divided into two groups:survival group and death group.The significant difference of these factors was compared.Binary logistic regression analysis was applied for screening independent risk factors for the prediction of death.The receiver operating characteristic (ROC) curve was applied for the evaluation and comparison about prognosis ability.Results 31 patients were in the survival group,19 patients in the death group.The gelsolin [(21.43±10.54) vs.(13.31±8.54),P=0.007] andAPACHE Ⅱ score [(19.2±6.86) vs.(24.6 ± 8.9),P =0.021] in two groups had significance difference.Binary logistic regression analysis indicated that the gelsolin and APACHE Ⅱ score were independent risk factors of predicting death.The area under of ROC curve (AUC) of the gelsolin was 0.745 (95％ CI:0.599-0.851,P =0.004) and the APACHE Ⅱ score was 0.699 (95％ CI:0.537-0.862,P =0.019).Both prognosis ability were equivalent.To combine the tow factors,the accuracy of predition was 90％ and has better complementarity.Conclusions the gelsolin could assess the severity of patients with severe sepsis and predict the prognosis more accurately.

0.05).The elevated scales of anxiety,depression,indignation,indignation in,indignation-out,intellect,self restrain in LCG had significant difference from CG on measuring of TCBQ,but the scales of optimistic and social support in the latter were obviously higher than the former(t=1.996～2.235,all P

Objective To investigate the clinical outcome of tibiotalocalcaneal arthrodesis plus retrograde intramedullary nail in treatment of severe posttraumatic tibiotalar and talocalcaneal arthritis.Methods A total of 17 cases of severe posttraumatic tibiotalar and subtalar arthritis were treated with tibiotalocalcaneal arthrodesis plus retrograde intramedullary nail between June 2003 and June 2006.Patients were evaluated by a standardized follow-up examination using ankle-hindfoot scale of the American Orthopedic Foot & Ankle Society(OFAS)score. Results Of all,14 cases were followed up postoperatively,with a mean follow-up period of 14.6 months(6-23 months).Bony fusion was achieved in 12 cases (86%)after an average of 11.6 weeks(8-19 weeks)but a delayed union in 2 after 17-19 weeks.Two cases(12%)complained heel pain at the nail entry point at initial stage of operation.The average anklehindfoot score improved from 47 points(43-55 points)preoperatively to 75 points(69-86 points)postoperatively. Conclusion Tibiotalocalcancal arthrodesis plus retrograde intramedullary nailing is proved to be effective in treating severe posttraumatic tibiotalar and talocalcaneal arthritis by marked relief from pain and improvement of life quality.

OBJECTIVE: To realize the application of nasal obstruction symptom evaluation (NOSE) and Epworth sleep score (ESS) before and after nasal cavity ventilation expansion techniques. METHOD: Forty-two OSAHS patients with nasal obstructive symptoms were diagnosed by clinical symptoms and polysomnography. Nasal cavity ventilation expansion technique was performed. Before and after the surgery, the NOSE and ESS were used to compare the difference. Postoperative data were obtained at least 3 months later. RESULT: Compared the data before and after operation, the NOSE and ESS were significantly decreased respectively (P<0. 05), there is no significant difference between 3 groups (P>0. 05). CONCLUSION The result suggest that OSAHS patients taking nasal cavity ventilation expansion operations showed improvement in severity of nasal obstructive symptoms and daily sleepy.
Humans ; Nasal Cavity ; surgery ; Nasal Obstruction ; physiopathology ; surgery ; Nasal Surgical Procedures ; Paranasal Sinuses ; Polysomnography ; Sleep ; Sleep Apnea, Obstructive ; physiopathology ; surgery ; Surveys and Questionnaires ; Symptom Assessment ; methods

Objective To investigate the effect of reinfusion of drained bile and pancreatic juice on the outcome of pancreaticoduodenectomy (PD).Methods The clinical data of 51 patients who received PD at the Affiliated Hospital of Binzhou Medical College from June 2005 to March 2009 were retrospectively analyzed.Nineteen patients received external drainage of bile and pancreatic juice ( ED group) and the other 32 patients received external drainage and intraintestinal administration of autologous bile and pancreatic juice (ID group).The daily volume of output of bile and pancreatic juice,intraoperative condition,tolerance of enteral nutrition,liver function and nutritional parameters of the 2 groups were detected.All data were analyzed by using chi-square test,Fisher exact test,independent t test,Mann-Whitney U test and one-way analysis of variance.Results The pulmonary infection rate of ID group was 3％ (1/32) after operation,which was significantly lower than 26％ (5/19) of the ED group (P ＜ 0.05).The output of pancreatic juice in the ID group was significantly lower than that in the ED group since postoperative day 4 ( t =7.143,9.244,8.808,7.915,6.461,14.097,15.038,P ＜ 0.05 ).There was no significant difference in the daily output of bile between the 2 groups.The incidence of diarrhea in the ID group was 9％ (3/32) after nutritional support,which was significantly lower than 37％ (7/19) of ED group (P＜0.05).The duration of achieving targeted enteral feeding in the ID was 3 days,which was significantly shorter than 4 days of the ED group ( U =145.000,P ＜ 0.05 ).The levels of total bilirubin ( TBil),direct bilirubin (DBil) and indirect bilirubin (IBil) were (261 ± 108 ),( 132 + 55 ) and ( 129 + 55 ) μmol/L in the ID group,and (239 ±92),( 12A ±46) and ( 116 ±46) μmol/L in the ED group before operation.The levels of TBil,DBil and IBil were (39 ± 19),(20 ± 10) and ( 19 +9) μmol/L in the ID group,and (55 ±22),(29 ± 12) and (26 ±11 ) μmol/L in the ED group at 12 days after nutritional support.There were significant differences in the decrease of TBil,DBil and IBil between the 2 groups ( t =7.324,8.437,5.827,P ＜ 0.05 ).The levels of serum prealbumin,retinol binding protein and transferrin were (0.261 ± 0.021 ) g/L,(34.3 ± 2.8 ) mg/L,(3.08 + 0.26 ) g/L in the ID group,and (0.263 ±0.021)g/L,(33.8 +3.5)mg/L and (3.10 +0.27)g/L in the ED group before operation.The levels of serum prealbumin,retinol binding protein and transferrin decreased significantly after operation,and then got increased 3 days after nutritional support.The levels of serum albumin,retinol binding protein and transferrin were (0.238 ±0.025)g/L,(30.7 ±2.0)mg/L,(2.78 ±0.19)g/L in the ID group,and (0.222 +0.025)g/L,(29.3 ±2.1)mg/L and (2.63 +0.21)g/L in the ED group at 12 days after nutritional support.The levels of serum albumin,retinol binding protein and transferrin in the ID group were significantly higher than those in the ED group (t=4.615,6.097,4.913,P＜0.05).Conclusion Reinfusion of external drained bile and pancreatic juice after PD could enhance the tolerance of patients in early enteral nutrition,reduce incidence of pneumonia,promote decrease of serum bilirubin and improve the nutritional status.

ObjectiveTo observe the effects of parenteral nutrition (PN) containing ω-3 polyunsaturated fatty acids (ω-3PUFAs) on postoperative systemic inflammatory response syndrome (SIRS) in patients with obstructive jaundice. MethodsTotally 40 patients with obstructive jaundice who underwent hepatobiliary surgery in the Affiliated Hospital of Binzhou Medical College from June 2008 to October 2009 were enrolled in this study and randomly divided into the conventional PN group and PUFAs group with 20 cases in each group. The conventional PN group was provided with medium-chain/long-chain triglycerides lipid emulsion, while the PUFAs group was provided with medium-chain/long-chain triglycerides lipid emulsion supplemented with ω-3PUFAs. The two groups received PN support with equal nitrogen content and calories for 9 days. The non-protein caloric value given was 117.15 kJ/(kg · d) with 0.2 g/(kg · d) of nitrogen. Interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-c) in serum were measured on the day before operation and on the postoperative day 1,3, 5, 7, and 9. Meanwhile, the incidences of SIRS and multiple organ dysfunction syndrome (MODS) were analyzed. ResultsThe levels of IL-6, CRP, and TNF-α on the postoperative day 3, 5, 7, and 9 were significantly lower in the PUFAs group than those in the conventional PN group ( all P ＜ 0.05). The duration of SIRS in the PUFAs group [(3.85 ±2.36) days] was significantly shorter than that in the conventional PN group [(5.31 ±1.47 ) days, P =0.0230]. The incidence of MODS was significantly lower in the PUFAs group ( 10％ ) than that in the conventional PN group (25％, P =0.0076). Conclusionsω-3PUFAs-supplemented PN improves the functions of liver and pancreas and alleviates acute inflammatory response in patients with obstructive jaundice.

Objective To explore the possible role and mechanism of the Kupffer cells (KCs) in liver allo-geneic transplantation at the early stage. Methods In vitro cell contact coculture system was established. Culture supernatants were collected respectively on the 1st, 2nd, 4th, 6th d after cocul-ture and the KCs and PBMCs were harvested on the 6th day after culture. The expression of HLA-G on the membrane of the KCs and PBMCs was detected with immunochemistry. Nitrate reduction test was used to determine the concentration of nitric oxide. IFN-γ, IL-10, TGF-β1 cytokine levels in the supernatants were also measured with ELISA. The proliferation of lymphocytes was evaluated with MTT. Results six days later, no HLA-G molecules were detected on the membrane of the KCs and PBMCs. In the experimental group containing KCs, the levels of NO, IL-10 and TGF-β1 was signifi-cantly increased(P<0. 05), while the levels of IFN-γ was relatively lower(P<0. 05) as compared to the experimental group without KCs. No IL-10 and IFN-γ were detected in the control group, and on-ly few NO and TGF-β1 was found in the control group with KCs. MTT test showed that the value of optical density was lower in the experimental group with KCs than that in any other group(P<0. 05).Conclusion No HLA-G is expressed on the membrane of KCs and PBMCs after contact coculture.KCs may participate in regulating production of NO and Th2/Th3-like cytokines and suppressing the proliferation of lymphocytes, through which KCs probably take part in inducing immunotolerance of liver transplantation in early stage.

OBJECTIVE To observe the effects of Dexamethasone on the expression of cyclic nucleotide-gated channels (CNG channels) mRNA of olfactory receptor neurons (ORNs) by real-time quantitative reverse transcription-polymerase chain reaction(RT-PCR). METHODS Forty Wistar rats were randomly divided into four groups: 24-hours Dexamethasone treated group and its control group; 2-weeks Dexamethasone treated group and its control group. Dexamethasone was injected i.p. (1 mg/kg for 24-hours group, 0.2 mg/d for 2-weeks group). Control group rats were injected with the same volume of normal saline. Real-time quantitative RT-PCR was performed to evaluate mRNA production of CNGA2 subunits. RESULTS In Dexamethasone-injected rats, the up-regulation of CNGA2 mRNA was observed in 2-weeks group(P

Although new immunosuppressive agents have greatly improved the post-transplantation survival, their adverse effects remain a major challenge. Appropriate assessment and monitoring the immune status in post-transplantation patients is therefore essential. This article summarizes the monitoring indicators and reviews recent advances in this field.
Humans ; Immunosuppressive Agents ; adverse effects ; therapeutic use ; Monitoring, Immunologic ; Organ Transplantation ; Postoperative Care