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 detect the serum level of interleukin (IL)-1 1, lymphocyte subsets and NK cells in patients with idiopathic thrombocytopenic purpura (ITP), and explore the related factors in the pathogenesis of ITP. Methods The serum level of IL-11, lymphocyte subsets and NK cells were detected by double antibody sandwich enzyme linked immunosorbent assay (ELISA) and flow cytometry in 50 ITP patients (ITP group) and 30 controls (control group). Results The platelet in ITP group [ (30.21 ± 19.40) ×109/L] was lower than that in control group [ (207.21 ± 31.55 ) × 109/L] obviously (P ＜ 0.05 ); the serum level of IL-11 in ITP group [(255.72 ± 163.43) ng/L] was significantly higher than that in control group [ (40.60 ± 5.57 ) ng/L ] (P ＜ 0.05 ). The correlation analysis indicated that the blood serum levels of IL- 11 had negative relationship with the platelet (r = -0.557 ,P ＜ 0.05). The percentage of CD3+ and CD4+ T lymphocyte percentage, CD4+/CD8+ in ITP group were lower and the percentage of CD8+ T lymphocyte was higher than those in control group obviously (P ＜ 0.05 ). The percentage of CD3- CD(16+56) +NK cell in ITP group was lower than that in control group (P ＜ 0.05). Conclusion IL-11, lymphocyte subgroup and NK cell change correlate with ITP morbidity closely, and the IL-11 level and the platelet possibly have the negative feedback control action.

Objective To investigate the components of mesenteric lymph of the rats with severe intraperitoneal infection,and inquire into the effect of intestinal lymphatic pathway in severe intraperitoneal infection.Methods Twenty-four male Wistar rats were randomly divided into two groups according to random number table method,namely model group and sham group with 12 rats in each group.The rat model of severe intraperitoneal infection was reproduced by injecting artificial gastric juice and E.coli intraperitoneally.Mesenteric lymph in both groups was collected 4 hours after the reproduction of the model,and white blood cells were counted and classified.The levels of endotoxin,alkaline phosphatase (AKP),lactate dehydrogenase (LDH),creatine kinase (CK),glutamine transferase (GST),protein and cytokines of mesenteric lymph were determined.Results Compared with the sham group,there was an increase in the neutrophil ratio in mesenteric lymph (0.167 ± 0.004 vs.0.610 ± 0.006,t=33.520,P＜0.001),however the percentage of both macrophages (0.009 ± 0.001 vs.0.020 ± 0.004,t=-6.677,P＜0.001) and lymphocytes (0.824 ± 0.005 vs.0.921 ± 0.004,t=-31.471,P＜0.001) was decreased in model group.Compared with sham group,the levels ofendotoxin (kEU/L:0.346 ±0.022 vs.0.186 ±0.001,t=18.103,P＜0.001),AKP [U (king unit):13.97 ± 5.55 vs.3.76 ± 0.18,t=4.503,P=0.006],LDH (U/L:2 827.45 ± 1 940.32 vs.712.68 ± 14.09,t=2.670,P=0.044),CK (kU/L:2.19 ± 1.21 vs.0.70 ± 0.01,t=3.035,P=0.029),GST (kU/L:12.33 ± 6.53 vs.1.36 ± 0.39,t=4.105,P=0.009) were all significantly elevated.The concentration of protein (g/L:4.40 ± 0.48 vs.2.84 ± 0.16,t=6.882,P=0.001),tumor necrosis factor-α [TNF-α (ng/L):499.39 ±76.36 vs.180.90 ± 70.98,t=7.483,P＜0.001],interleukin-6 [IL-6 (μg/L):13.74 ± 0.78 vs.-0.07 ± 0.07,t=52.972,P＜0.001],intercellular adhesion molecule-1 [ICAM-1 (ng/L):2 754.19 ±221.48 vs.1 362.85 ±393.43,t=6.891,P＜0.001] and monocyte chemo-attractant protein-1 [MCP-1 (μg/L):28.23 ± 1.77 vs.24.87 ± 1.15,t=3.561,P=0.007] and high mobility group protein-1 [HMGB-1 (ng/L):1 392.78 ± 572.42 vs.564.17 ± 21.32,t=3.543,P=0.016] in mesenteric lymph in model group were significantly higher than those in sham group.Conclusion Intestinal lymphatic pathway maybe the early pathway for the production of remote organ injury caused by severe intraperitoneal infection.

Objective To observe the effects of Qingfei Chengqi decoction on lung tissue cell apoptosis and its associated protein,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)of lung tissues in rats with severe intra-peritoneal infection(SII). Methods Thirty male Wistar rats were randomly divided into three groups:sham operation group,model group and traditional Chinese medicine(TCM)group(each n=10). Simulating clinical pathophysiological process of digestive tract perforation,the rat model of SII was reproduced by injecting E. coli intraperitoneally. The TCM group was treated by gavage with Qingfei Chengqi decoction one day in advance of the study,3 times per day,once 2 mL. The same amount of nutrient broth which contained 10%barium sulfate(BaSO4) to replace the bacteria solution was injected into the sham operation group. Six hours after model establishment,all rats were killed and lung tissues were harvested for pathohistological evaluation and for the determination of apoptosis rate with TdT-mediated dUTP nick-end labeling(TUNEL)method,of Bax,Bcl-2 protein expression with Western Blot method,and of the level of TNF-α,IL-6 with enzyme-linked immunosorbent assay(ELISA)method,and the pathological changes of lung tissues were observed under the light and electron microscopes. Results Compared with sham operation group,the apoptosis rate〔(12.7±5.4)%vs. 0〕,the expression of Bax protein〔absorbance(A)value:8 416.89±875.16 vs. 6 654.09±1 130.18〕,the level of TNF-α(ng/L:3 132.56±457.96 vs. 1 948.55±269.32), the level of IL-6(ng/L:75.14±1.63 vs. 31.17±0.81)of lung tissues were significantly increased(all P<0.05), meanwhile Bcl-2 protein expression decreased observably(A value:7 490.59±200.34 vs. 12 289.02±535.93,P<0.05)in model group induced by SII. After treatment with TCM,apoptosis rate〔(7.9±0.3)%〕,the expression of Bax protein(A value:7 619.50±999.30),the level of TNF-α(ng/L:3 114.34±454.32)and IL-6(ng/L:52.46±0.96) of lung tissues were decreased and Bcl-2 protein expression(A value:11 155.07±1 018.87)increased(all P<0.05) compared with model group. General observation:the color of lung tissues was uniform in sham operation group;the lung tissues of model group swelled obviously,and parts of lung tissues had patches of ecchymosis and hemorrhage. The light microscope showed:the pulmonary vessels,the alveolar interstitium,alveolar epithelium and lobular interstitium of sham operation group were all normal,while in the model group,the pulmonary interstitium was edematous and hemorrhagic,and in the alveolar cavities there was infiltration of inflammatory cells. Under the electron microscope, the lung tissue type Ⅱ alveolar epithelial cells of model group were increased,and they had morphological changes in various degrees,such as cell shrinkage and change becoming round,and cell nucleus presenting irregular in shape. After treatment with TCM,the above pathological changes were all alleviated compared with those in the model group. Conclusions Qingfei Chengqi decoction can ameliorate the SII leading to acute lung injury,and reduce the cell apoptosis rate of lung tissues in SII rats. Its mechanism may be related to the intervention of above TCM which can lower the levels of inflammatory media and elevate the protein expression of Bcl-2.

Objective To demonstrate the clinical results of the patients with failed cemented femoral component due to aseptic loosening with extensive porous-coated femoral implants. Methods Be-tween 1998 and 2003, twenty hips (20 patients) with a failed cemented femoral component were revised us-ing extensive porous-coated femoral components and allograft. There were 12 males and 8 females. The mean age of the patients at the time of revision was 64 years (41-77 years). All of the revised femoral com-ponents were cemented stems,with first-generation cement technique in 18 hips and second-generation ce-ment technique in 2 hips. The indications for hip arthroplasty included osteonecrosis of the femoral head in 14 hips and femoral neck fracture in 6 hips. The interval from primary hip arthroplasty to revision surgery ranged from 5 to 17 years, with an average of 11.5 years. There were 4 re-revisions in this group. Based on Paprosky classification for bone deficiency, 3 hips were of type I, 6 of type II and 11 of type IIIA. The com-ponents implanted included AML (DePuy) in 5 cases , Solution (DePuy)in 7, full-coated (Zimmer)in 6 and Perfecta Extend Stems (Wright Med) in 2. The postoperative stability was evaluated according to the Engh criteria. The patients were followed for an average of 40 months (18-60). Results At the latest fol-low-up, the mean Harris score was improved from 40 to 85 points postoperatively. The bony ingrowths were found in 17 hips and the fibrosis stability in 3 on postoperative radiographic evaluation. There were no re-revisions in this group. The bone remodeling was observed in all osteolytic zones. Conclusion In the pres-ence of bone loss in the proximal metaphyseal region of the femur, the extensive porous-coated femoral com-ponents may provide a bypass for the deficient proximal bone. It may further obtain initial optimizing pros-thesis-bone fitting and an axial anti-rotational stability in the relatively normal diaphyseal region of the fe-mur to allow the reliable biological fixation with bony ingrowths.

Objective To analysis the outcome of gastroscopy and B ultrasonography in patients of post hepatitis cirrhosis with portal hypertension, and to evaluate the degree of cirrhosis in clinic and affording suggestions in preventing complication. Methods One hundred and ninety two cirrhosis patients with portal hypertension were divided into three groups : mild, moderate and severe group based on the extent of esophageal varicosis. By estimating the diameter of portal vein, thickness of spleen and width of splenic vein in three groups to investigate their correlation with the extent of cardio-esophageal varicosis. Results The incidences of gastric varices in these three groups have prominent difference,The severer the degree of esophageal varices , the higher the incidence of gastric varices. According to the different degree of esophageal varices, the diameter of portal vein,thickness of spleen,diameter of splenic vein are differed. There is linear relation between thickness of spleen and diameter of splenic vein. Conclusion Diameter of portal and splenic vein, thickness of spleen,can provide valuable suggestion in predicting the presence of portal hypertension,but further confirmation is based on the result of gastroendoscopy.

Objective To evaluate the efficacy and safety of tacrolimus (TAC) for treatment of Henoch-SchSnlein purpura nephritis in children.Methods Forty children with Henoch-SchSnlein purpura nephritis (pathological grade Ⅲ-Ⅵ) in Children's Hospital Affiliated to Soochow University from January 2013 to June 2016 were selected and divided into TAC group (n =19) and cyclophosphamide (CTX) group (n =21).The children in TAC group were given TAC orally;the children in CTX group were given CTX pulse therapy intravenously.The 24 h urine protein,urine red blood cell count,serum albumin,serum creatinine and blood urea nitrogen of children before treatment and after 6 months treatment were observed and compared between the two groups.The treatment effects and adverse reactions of patients were observed and compared between the two groups.Results There was no statistic difference in the 24 h urine protein,urine red blood cells count,serum albumin,blood creatinine and blood urea nitrogen levels of children between the two groups before treatment (P ＞ 0.05).The 24 h urinary protein and urine red blood cells count of children after 6 months of treatment in the two groups were significantly lower than those before treatment (P ＜ 0.05);there was no statistic difference in the serum albumin,serum creatinine and blood urea nitrogen levels of children in the two groups before treatment and after 6 months of treatment (P ＞ 0.05).Mter 6 months of treatment,the 24 h urine protein and urine red blood cells count of children in TAC group were significantly lower than those in the CTX group (P ＜ 0.05);there was no statistic difference in the serum albumin,serum creatinine and blood urea nitrogen levels of children between the two groups (P ＞ 0.05).After 6 months treatment,the effective rate of children in the TAC group was significantly higher than that in the CTX group (x2 =4.607,P ＜ 0.05).The incidence of adverse reactions of children in the TAC group was significantly lower than that in the CTX group (x2 =4.043,P ＜ 0.05).Conclusion TAC is effective in treatment of Henoch-Sch(o)nlein purpura nephritis in children.It is easy to take,and has less adverse reactions.

365 low birth weight infants have been born inour Obstetric Department in the past two years. Aretrospective investigation of their morthers' con-ditions during pregnancy and delivery which had aneffect on their babies weight was done. The resultsshowed that incidence of low birth weight infantswas 7. 99% and mortality rate was 15. 07%. The care.X~2 test indicated that hypertention syndrome ofpregnancy and anemia which the mothers sufferedfrom were the main diseases which affected birthweight of infants. The analysis of multiple stepwiseregression showed that the most dangerous factorswere peasant mothers, premature and neonate ab-normity. So we must strengthen perinatal healthcare.

Objective To understand the efficacy of meibomian gland compression by themselves and outpatient meibomian gland dredge treatment with dry eye young patients of meibomian gland dysfunction.Methods Selected 48 young patients with dry eye of meibomian gland dysfunction,patients were divided into two groups according to the wishes,28 patients were given method guidance of meibomian gland compression by themselves (compression group),every 10 minutes,three times a day,4 weeks after the referral.Other 20 cases meibomian gland dredge by a doctor at the eye clinic performed under anesthesia (dredge group),2 weeks,4 weeks after the referral and then dredge,3 times.All patients were given to health education,all patients before treatment and after treatment for 4 weeks underwent Schirmer Ⅰ test (S Ⅰ t),tear film breakup time (BUT),corneal fluorescein staining (CFL) examination and compared.Results The level of BUT,S Ⅰ t,CFL before treatment in two groups had no significant difference (P ＞ 0.05).After treatment for 4 weeks,eye symptom had improved in two groups.The level of BUT,CFL before and after treatment for 4 weeks in two groups had significant difference (P ＜ 0.05).But the level of S Ⅰ t,BUT,CFL after treatment for 4 weeks between two groups had no significant difference (P ＞ 0.05).Conclusion Dry eye young patients of meibomian gland dysfunction if they can correctly perform meibomian gland compression by themselves can also be reached effectively alleviate dry eye and ocular discomfort symptom improvement purposes.

Objective To learn the influence on the outcome of the pregnant by measuring the type Ⅲ antibody of Group B Streptococcus(GBS). Methods During December 31, 1997 to December 31, 2000, 28 pregnant women whose GBS screening were positive were selected as study group while 46 negative as control group. Vaginal swab cultures were conducted in 74 pregnant women at different gestational periods(before 20 gestational weeks, 20~28 weeks and after 34 weeks). After birth maternal and cord blood samples were collected immediately for the test of GBS IgG antibody with ELISA method. Results 28 of 74 women(37.8%)were GBS culture positive in the antenatal screening. The obstetrical complications such as gestational diabetes millitus, impaired glucose tolerance test, fetal growth retardation, premature rupture of membrane, threatened premature labor and asphyxia of newborn have no significant difference between the GBS carrier group and non-carrier group. The result was same for the newborns. The antibody(IgG)of GBS value of the 74 pairs of maternal and cord blood samples showed that the values of IgG in maternal blood samples and cord blood samples were (3.1?2.2) mg/L and (2.3?1.8) mg/L, respectively,r=0.86,P