Sepsis and septic shock are common critical diseases in the ICU, which have a high mortality and seriously affect the patients'' quality of life.The pathogenesis of sepsis is very complicated and involves the changes in the functions of multiple systems and organs.Recently, the investigation into the potential mechanisms underlying the development of sepsis is becoming a hotspot all over the world.The author presents an overview on the advances in the studies of the pathogenesis of sepsis, relating to the imbalance of inflammatory response, immune dysfunction, abnormal blood coagulation, nerve-endocrine-immunity network, mitochondrial function damage, endoplasmic reticulum stress, autophagy, and genetic polymorphism, in order to provide some theoretical evidence for the prevention and treatment of sepsis in clinical practice.

Objective To provide methodological references for laboratories to carry out newborn screening for disorders of amino acid metabolism,we compared the difference and distribution of ten amino acids including alanine (Ala),arginine (Arg),citrulline (Cit),glycine (Gly),leucine (Leu),methionine (Met),ornithine (Orn),phenylalanine (Phe),tyrosine (Tyr),and valine (Val) from newborn dried blood spots specimen using derivatization or non-derivatization as sample preparation methods.Method It is a comparative research study.A total of 4135 newborn screening dried blood spot samples for inborn errors of metabolism were collected from January to June,2012.All specimens came from neonatal screening center of shanghai children's hospital.Samples were prepared by two different techniques,the corresponding kits and the procedures were used as follows:(1) Simultaneous detection of 100 dried blood spot specimens using two methods respectively to compare the paired difference of each amino acid.(2) 2000 cases of normal newborn specimens were detected respectively to obtain the normal distribution of ten neonatal amino acids.(3) 35 specimens from patients previously diagnosed positively as inborn errors of metabolism were simultaneously detected with 7 amino acids to verify the consistency of two techniques in clinical judgment.Results The amino acid levels of normal newborns analyzed by one-sample.kolmogorovSmirnov test (Z value ranged from 1.997 to 6.229) showed a skewed distribution (P ＜ 0.01).Except for Leu and Tyr,non-derivatization techniqueshowed a lower concentration than derivatization technique,and the CVs of nine amino acids were ＜ 10％ except for Met (the CV of Met was 47.8％),and the average CV is 7.8％.Except for Met,Phe and Tyr,the levels of other 7 amino acids measured by two techniques showed no significant difference (P ＞ 0.05).According to 0.5th to 99.5th percentiles,the normal reference range for derivatization method were greater than on-derivatization method,and the average value was 25.3％.After clinic judgment,the results of the abnormal indicators of children with true metabolism disorders showed no statistically significant between two methods (P ＞ 0.05),the detection rate was 100％.Conclusions There was a slight difference between derivatization and the non-derivatization techniques in detecting multiple amino acids.The results of the abnormal indicators of amino acid metabolism disordersshow no statically significant difference between the two methods,and no difference in clinical judgment.Both methods can be used in detecting amino acid metabolism disorders in newborn screening.

OBJECTIVE:To study the efficacy of Urokinase vs.Low Molecular Weight Heparin in the treatment of acute pulmonary thromboembolism.METHODS:A total of 35 patients with acute pulmonary thromboembolism who had no past history of heart and lung diseases were enrolled and randomly assigned to two groups following ultrasonography and pulmonary ventilation/perfusion scanning:15 were given thrombolysis therapy with urokinase,and 20 given anticoagulation therapy with low molecular weight heparin.Symptoms,arterial blood gas analysis,electrocardiogram,echocardiogram were compared in two groups before and after treatment.RESULTS:The patients receiving thrombolysis therapy had better improvement in symptoms,arterial blood gas index,echocardiogram and the pulmonary ventilation/perfusion scanning than in those receiving anticoagulation therapy(P

Objective To detect the change and clinical significance of homocysteine (Hcy),hypersensitivity C response protein (hs-CRP) and hypersensitivity troponin I (hs-TnI) in patients with acute myocardial infarction (AMI).Methods Ninety-six cases of AMI were selected as the research group and 60 cases of coronary heart disease without AMI were enrolled in the control group.Blood samples were collected to measure the contents of serum Hcy,hs-CRP and hs-TnI.ROC curve was drawn and Logistic regression model was established to analyze the role of each index alone and combined detection in the diagnosis of AMI.Results The levels of Hcy,hs-CRP and hs-TnI in the research group were significantly higher than those in the control group (Hcy: (29.29±7.65) mol/L vs.(17.23±4.68) mol/L;hs-CRP: (15.47±5.01) mg/L vs.(9.21±3.15) mg/L;hs-TnI: (40.88±9.18) ng/mL vs.(7.34±2.12) ng/mL,t=2.78,8.66,34.36,P<0.05).The area under the ROC curve of Hcy,hs-CRP,hs-TnI were 0.802 (95%CI(0.729~0.874)),0.71(95%CI(0.62~0.792)),0.929 (95%CI(0.891~0.967)),respectively.The area under the combine detection curve was 0.971 (95%CI,0.950~0.992).The sensitivity of Hcy,hs-CRP and hs-TnI in the diagnosis of AMI were 79%,57%,87%,respectively,the specificity of the three groups were 72%,70%,90%,the sensitivity and specificity of combined detection were 96% and 88%.Conclusion Combined detection of Hcy,hs-CRP and hs-TnI plays a better role in the diagnosis of AMI than that of Hcy,hs-CRP,hs-TnI alone and has a high specificity and sensitivity in the diagnosis of AMI.

Objective To summarize our preliminary experience of selective fetieide with bipolar coagulation in complicated monochorionie twins(MCT),and discuss the clinical application of feticide in discordant MCT.Methods Three MCT with one twin anomaly.in which 2 had severe twin-twin transfusion syndrome(TTTS),stage Ⅳ ,and 1 had acardiac twin,were identified in the second trimester of pregnancy.To terminate the abnormal twin and isolate the co-twin's circulation completely.selective feticide was performed by umbilical cord occlusion with bipolar coagulation under guidance of ultrasound and fetoscopy.After each invasive procedure,serial monitoring was performed,including procedural complications,Doppler of fetal middle cerebral artery and umbilical artery.Pregnancies were followed up every 2 weeks for fetal growth until delivery.After birth the placentas and the terminated fetuses were examined.Result Cord occlusion was successfully accomplished in all 3 targeted fetuses,at 21,22 and 24 weeks of gestation respectively.One case with TTTS was complicated with rupture of the membrane in the terminated fetus at the 7th day after the procedure.and a healthy baby was born at 32 weeks.The other case with TTTS delivered a boy by cesarean section at 38 weeks.The third case with TRAP is at 35 weeks of gestations and under regular follow-up.Monochorionicity was confirmed by placental examination after delivery.and the effects of bipolar coagulation were observed at the,cord of terminated fetuses.Conclusions Umbilical cord occlusion witll bipolar coagulation is an effective procedure for selective feticide in MCT with one twin anomaly.The outcome of normal fetus can be favorable.

Objective To evaluate the predictive value of admission blood glucose level for the mortality within 30-day and major adverse cardiac events(MACE) rate in patients with ST-segment elevation acute myocardial infarction (STEMI). Methods An observational analysis of 7446 Chinese STEMI patients from a global randomized controlled trials of cases recruited within 12 hours of symptom onset was carried out. According to the levels of admission glucose (hyperglycemia was defined as admission glucose>10 mmol/L) and known diagnosis of diabetes mellitus (DM) ,these patients were divided into four groups, Ⅰ :no DM and normal glucose group (control group) ; Ⅱ : DM but normal glucose group; Ⅲ : no DM and hyperglycemia group; and Ⅳ: DM and hyperglycemia group. Results Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (group Ⅲ 17. 1% vs group I 8.6%, group Ⅳ 18.6% vs group Ⅰ 8. 6%, P<0.001) and also an increased incidence of MACE (group Ⅲ36. 3% vs group Ⅰ 21.6%, group Ⅳ 38. 8% vs group Ⅰ 21.6%, P<0.001). However, DM without admission hyperglycemia did not increase the 30-day mortality (group Ⅱ 11.6% vs group Ⅰ 8. 6%, P = 0.096). Multivariate logistic regression analysis showed that compared with group Ⅰ patients, group Ⅲ and group Ⅳ had a risk of death of 1.51 fold(OR 1.51,95% CI 1.22-1.87,P<0.001) and 1.83 fold(OR 1.83,95% CI 1.40-2. 39, P<0.001) respectively; hyperglycemia was an independent predictor of 30-day mortality and an increase of 1 mmol/L in glucose level was associated with a 5% increase of mortality risk (OR 1.05,95% CI 1.04-1.07,P<0.001), but DM without hyperglycemia was not so (OR 1.11,95% CI 0. 87-1.42, P =0. 412). Conclusions The rates of 30-day mortality and cardiovascular events are significantly higher in STEMI patients with acute hyperglycemia than in patients without. Hyperglycemia on admission is an independent risk factor for the short-term outcome of STEMI, but diabetes mellitus without hyperglycemia isv not associated with the short-term mortality.

Objective:To explore influence of nursing intervention according to comprehensive geriatric assessment (CGA)on quality of life (QOL)in aged patients With coronary heart disease (CHD).Methods:A total of 96 aged CHD inpatients admitted in department of cardiology from Mar 2012 to Mar 2013 Were enrolled.According to num-ber table method,they Were randomly divided into routine nursing group (n=48,received specific nursing of cardi-ology department)and CGA group (n=48,received nursing intervention according to CGA based on routine nurs-ing).Chinese questionnaire of quality of life in patients With cardiovascular disease (CQQC)Was used to score and compare each dimension of QOL betWeen tWo groups at admission and on 6-month after discharge.Results:Com-pared With routine nursing group after intervention,there Were significant increase in scores of physical strength [(7.35±4.12)scores vs.(10.86±5.06)scores],patient's condition [(4.57±0.85)scores vs. (8.75±4.54) scores],medical condition [(4.72±0.82)scores vs.(5.90±0.40)scores],general living [(3.85±1.45)scores vs. (5.22±1.95)scores],social psychological conditions [(3.67±1.52)scores vs.(8.41±3.22)scores],Working sta-tus [(0.70±0.64)scores vs.(0.97±0.66)scores]and total score of CQQC [(24.86±4.43)scores vs.(40.11± 9.05)scores]in CGA group,P<0.01 or<0.05.Conclusion:Nursing intervention according to comprehensive geri-atric assessment can improve quality of life in aged patients With coronary heart disease.

To analyze the relationship between obesity with related measurable indicators and insulin resistance among the residents over 50-year-old in Wuxi area.The questionnaire survey,physical examination,and relevant biochemical measurements as well as gender,age,height,body w eight,waist circumference,and hip circumference were obtained.The prevalence of obesity was 11.95％ of which 57.24％ were with central obesity,and the prevalence in male was higher than that in female(P＜0.05).With inereasing body mass index (BMI) and waist circumference(WC),the prevalence of insulin resistance increased gradually (P ＜ 0.05).Meanwhile,With the increasing HOMA-IR,the prevalence of obesity and central obesity also gradually increased (P＜0.05).BMI,WC,and waist-to-hip ratio can effectively predict insulin resistance.The cut-off point of waist circumference was 87.5 cm for male,and 84 cm for female.At the same level of body mass index,metabolic measurements in central obesity group were higher than those of non-central obesity group with the same body mass index,especially in normal weight group.The related metabolic measurements of metabolic obesity but normal weight group were mostly higher than metabolically healthy but obese group,and there were statistically significant differences in fasting blood glucose,fasting insulin,HOMA-IR and HOMA-β.Obesity,especially central obesity,is closely related to insulin resistance among residents over 50-year-old in Wuxi area.Meanwhile,waist circumference may effectively predict insulin resistance and may serve as a parameter in the occurrence of metabolic syndrome and cardiovascular diseases.

Objective To study neuroendocrine change and clinical value of percutaneous thrombectomy system(GuardWire PlusTM)in treatment of patients with ST-elevation acute myocardial infarction(STEMI). Methods 72 patients with STEMI underwent percutaneous coronary intervention(PCI)were divided into A group(38 patients)with direct stent placement after thrombectomy and B group(34 patients) with primary PCI. The plasma levels of ET, PRA, ALD, AngⅡ, NE, E were measured on the day of operation and the first, second, third and fifth days after PCI. Left ventricular ejection fraction(LVEF) was measured by echocardiography at one week and three months after PCI. Results The stents were successfully implanted in two groups. All the neuroendocrine factors have no difference between the two groups before operation. The first and second day after PCI, the levels of ET, PRA, ALD, AngⅡand E were significantly lower in A gronp than those in B group(P 0.05). Conclusions Deteriorated neuroendocrine changes are significantly improved with thrombectomy, providing potential benefits on heart function.

BACKGROUND:Poly(butylene succinate) (PBS) and polypropylenecarbonate (PPC) are new medical materials developed in recent years, characterized as good biocompatibility, biodegradability and the low price. OBJECTIVE:To prepare the PBS/PPC biofilm by electrostatic spinning method and evaluate its physical and chemical properties, degradation performance and effect on cel proliferationin vitro. METHODS:The PBS/PPC biofilm was prepared using electrostatic spinning method: 0.9 g PBS and 0.9 g PPC were dissolved in 10 mL of trichloromethane at room temperature and stirred magneticaly until they were fulydissolved. Then, the spinning solution was added into a spinning tube with a distance of about 15 cm and at a voltage of 18 kV. The surface morphology was observed by scanning electron microscopy. The intensity, contact angle and water absorption, pH value and weight loss in the process ofin vitro degradation were measured. MG63 cels were co-cultured with the biofilm for 7 days and cel proliferation was detected by cel counting kit-8. RESULTS AND CONCLUSION: The PBS/PPC biofilm showed a porous structure with interconnected pores. The fiber diameter was about 0.88 μm, the average aperture was about 5.68 μm, the porosity was 78.3%, the fracture intensity was 2.31 MPa, the elongation rate at break was 23.48%, the average value of contact angle was 87°, and the water absorption rate was 68.54%. During the biofilm degradation, the pH value decreased gradualy andreduced to 6.76 at 12 weeks; meanwhile, the biofilm degraded equaly and gradualy, and the weight loss rate was 6.04% at the end of the 12th week. The results of cel counting kit-8 showed that the PBS/PPC biofilm could promote cel proliferation. Overal, the PBS/PPC biofilm has good physical and chemical properties, good space-making feature, wettability and degradability, which can provide sufficient time for bone tissue regeneration.