Objective To explore the roles of bacterial infection in the pathogenesis and progression of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Methods The clinical data of 604 patients with ALI or ARDS hospitalized from April 1991 to March 2001 were analyzed. Results (1) The cause of direct lung injury was predominantly ascribed to lung infection, whereas indirect lung injury was due to sepsis. (2) The gram positive cocci (50.76%) and gram negative bacilli (40.15%) in the isolated pathogenic bacteria from patients were approximately similar. Furthermore, Staphylococcus aureus and Pseudomonas aeruginosa were the first and second pathogenic bacteria, respectively. (3) The incidences of ALI and ARDS in infected patients significantly increased with the grade elevation of systemic inflammatory response syndrome (SIRS) ( P

Objective:To investigate the effect of NEMO binding domain peptide (NBDP) on lung inflammation and apoptosis in mice with acute respiratory distress syndrome (ARDS) and its mechanism.Methods:Thirty-six male BALB/c mice were divided into normal saline (NS) control group, ARDS model group, NBDP negative control group and 6, 12 and 18 μg NBDP pretreatment group by random number table method, with 6 mice in each group. ARDS mouse model was reproduced by aerosol inhalation lipopolysaccharide (LPS) 50 μL. An equivalent among of NS was inhaled in NS control group. The mice in NBDP negative control group were inhaled the materials similar to the non-functional NBDP 30 minutes before the aerosol inhalation LPS; 6, 12 and 18 μg of NBDP 50 μL were respectively inhaled in NBDP pretreatment groups. After inhalation of LPS for 6 hours, mice were sacrificed to get lung tissue and observe the degree of pathological injury and edema. Western blotting was used to detect the phosphorylation of nuclear factor-κB (NF-κB) pathway related proteins [NF-κB inhibitor (IκB) kinaseα/β(IKKα/β), IκBα and NF-κB p65; p-IKKα/β, p-IκBα, p-p65] and the expression of caspase-3 in lung tissue. The bronchoalveolar lavage fluid (BALF) was collected and the levels of inflammatory markers such as myeloperoxidase (MPO), interleukins (IL-1β, IL-8), and tumor necrosis factor-α (TNF-α) were detected by enzyme linked immunosorbent assay (ELISA).Results:ARDS model group had severe edema and hemorrhage, alveolar structure destruction, pulmonary hemorrhage and hyaline membrane formation etc. under light microscope, consistent with the pathological characteristics of ARDS lung tissue, suggesting that the ARDS model was successfully reproduced. ELISA showed that MPO, IL-1β, IL-8 and TNF-α levels of BALF in ARDS model group were obviously higher than those in NS control group. There were no significant differences in the above inflammatory indicators between NBDP negative control group and ARDS model group. The levels of MPO, IL-1β, IL-8 and TNF-α in NBDP pretreatment groups were significantly lower than those in ARDS model group in a dose-dependent manner, especially in 18 μg NBDP, the differences were statistically significant as compared with ARDS model group [MPO (ng/L): 393.32±19.35 vs. 985.87±101.50, IL-1β (ng/L): 43.05±5.11 vs. 97.68±10.88, IL-8 (ng/L): 84.64±2.32 vs. 204.00±17.37, TNF-α (ng/L): 229.13±17.03 vs. 546.73±62.72, all P < 0.05]. Western blotting showed that p-IKKα/β, p-IκBα, p-p65 and caspase-3 protein expressions in ARDS model group were significantly higher than those in NS control group. There was no significant difference in above NF-κB pathway and apoptosis-related protein expression between the NBDP negative control group and ARDS model group. The p-IKKα/β, p-IκBα, p-p65 and caspase-3 protein expression in NBDP pretreatment groups were significantly lower than those in ARDS model group in a dose-dependent manner, especially in 18 μg NBDP, the differences were statistically significant as compared with ARDS model group [p-IKKα/β protein (p-IKKα/β/β-actin): 0.15±0.02 vs. 0.42±0.04, p-IκBα protein (p-IκBα/β-actin): 0.10±0.01 vs. 0.93±0.30, p-p65 protein (p-p65/β-actin): 0.22±0.05 vs. 1.37±0.21, all P < 0.05]. Conclusion:NBDP can inhibit inflammatory response and apoptosis in ARDS lung tissue in a dose-dependent manner, and its mechanism is associated with interference NF-κB signaling pathway transduction.

AIM:To investigate the expression of extracellular matrix metalloproteinase inducer(EMMPRIN)and hepatocyte growth factor(HGF)in non-small-cell lung carcinoma(NSCLC)and their relationship with lymphoid metastasis and prognosis.METHODS:Expression of EMMPRIN and HGF in 77 cases of patients with NSCLC was detected immunohistochemically.The relationship of expression of EMMPRIN and HGF with tumor size,smoking,histological type,differentiation,lymphoid metastasis,clinical stage,and prognosis was analyzed.RESULTS:The expressive rates of EMMPRIN and HGF were 68% and 44%,respectively.The expressions of EMMPRIN and HGF were associated positively with lymphoid metastasis(r=0.371 and 0.339,P0.05).The expression of EMMPRIN was associated with the expression of HGF in NSCLC.CONCLUSION:The expression of EMMPRIN and HGF is associated with lymphoid metastasis and prognosis in NSCLC.Overexpression of EMMPRIN and HGF implies infavourable prognosis in NSCLC.

Objective To compare the influence of sevoflurane inhalation sedation and propofol intravenous sedation on duration of endotracheal intubation as well as the length of intensive care unit (ICU) stay and total length of hospital stay in postoperative critical patients.Methods Six databases including CNKI,Wanfang data,PubMed,Embase,Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) about the influence of sevoflurane inhalation sedation or propofol intravenous sedation on the sedation time,the duration of endotracheal intubation,the length of ICU stay,the total length of hospital stay and the adverse effects rate in postoperative critical patients from the time of database establishment to July 2018.At the same time,the reference materials of included literature were retrieved manually.All literatures were screened by three independent reviewers,and the data extraction and quality evaluation of the included studies were conducted.Meta-analysis was used for RCT that met the quality standards.Results A total of 7 RCT studies were enrolled involving 537 patients who were all transferred into ICU after surgery with trachea cannula.Among the patients,272 received sevoflurane sedation while the other 265 received propofol sedation.All the included studies were well designed and of high quality.The results of Meta-analysis showed that compared with propofol sedation,sevoflurane sedation could significantly shorten the duration of endotracheal intubation [standardized mean difference (SMD) =-0.60,95％ confidence interval (95％CI) =-0.88 to-0.31,P ＜ 0.000 1]and the total length of hospital stay (SMD =-0.36,95％CI =-0.61 to-0.12,P =0.003),and lower the cardiac troponin T (cTnT) within 12-24 hours after ICU admission (SMD =-0.61,95％CI =-0.85 to-0.36,P ＜ 0.000 01).There was no significant difference in the sedation time (SMD =-0.07,95％CI =-0.29 to 0.15,P =0.52),the length of ICU stay (SMD =-0.19,95％CI =-0.39 to 0.01,P =0.06),the incidence of nausea and vomiting [odds ratio (OR) =1.19,95％CI =0.61 to 2.32,P =0.61] or incidence of delirium (OR =0.80,95％CI =0.34 to 1.90,P =0.62) between sevoflurane group and propofol group.Conclusions Sevoflurane inhalation sedation may lead to shorter duration of endotracheal intubation and total length of hospital stay,and had better protection for myocardium as compared with propofol intravenous sedation.The above conclusions needed further study to confirm,due to the lack of literature enrolled in this Meta-analysis.

Objective? To?systematically?analyze?the?effect?of?haemoperfusion?(HP)?combined?with?continuous?veno-veno?haemofiltration?(CVVH)?in?the?treatment?of?the?patients?with?paraquat?poisoning?(PQP).? Methods? Words?of?paraquat,?poisoning,?continuous?venous?hemofiltration,?hemoperfusion,?hemodiafiltration?in?Chinese?and?paraquat,?poisoning,?intoxication,?haemofiltration,?continuous?venovenous?haemofiltration,?haemoperfusion?in?English?were?chosen?as?keywords,?the?Chinese?and?English?literatures?about?acute?PQP?treated?with?HP?combined?with?CVVH?published?in?Wanfang?database,?CNKI,?CBM,?VIP?database,?PubMed,?Embase,?Cochrane?Library?were?searched?by?computer,?and?the?retrieval?time?was?from?the?establishment?of?the?database?to?July?2018.?The?experimental?group?was?treated?with?HP?combined?with?CVVH,?while?the?control?group?was?treated?with?HP?alone.?Besides,?the?outcome?indicators?included?mortality,?survival?time?of?dead?patients?(the?patient's?time?from?exposure?to?poison?to?death),?serum?creatinine?(SCr),?alanine?aminotransferase?(ALT),?arterial?partial?pressure?of?oxygen?(PaO2),?and?incidence?of?circulatory?and?respiratory?failure.?The?literature?data?were?extracted?by?two?researchers?independently,?the?quality?of?the?literature?was?evaluated? according?to?the?modified?Jadad?score?table?or?Newcastle-Ottawa?scale?(NOS),?and?the?Meta-analysis?was?carried?out?by?RevMan?5.3?software;?and?the?stability?of?the?results?of?Meta-analysis?was?tested?by?sensitivity?analysis.?Further,?the?publication?bias?was?analyzed?through?drawing?a?funnel?diagram.? Results? Finally,?20?articles?were?included,?with?18?in??Chinese?and?2?in?English.?Among?them,?6?were?randomized?controlled?trial?(RCT)?and?14?were?case-control?studies.?Furthermore,?a?total?of?2?870?patients?were?involved,?with?1?558?in?the?control?group?and?1?312?in?the?experimental?group.?Meta-analysis?showed?that?the?mortality?rate?of?patients?in?the?experimental?group?was?significantly?lower?than?that?in?the?control?group?[odds?ratio?(OR)?=?0.55,?95%?confidence?interval?(95%CI)?=?0.42?to?0.73,?P

Purpose Lymph-vascular invasion (LVI) is a risk factor for the prognosis of colorectal cancer, and it is of great value to evaluate the status of lymphatic vessels before treatment. This study aims to predict colorectal cancer LVI preoperatively based on radiomics. Materials and Methods Radiomics features were extracted from preoperative CT images of colorectal cancer retrospectively collected and radiomics labels were constructed. The predictive efficacy of radiomics labels were assessed and internally verified. Joint predictive factors were established by combining clinical factors with independent predictive efficacy and radiomics labels, and their predictive efficacy was evaluated. Results Radiomics labels consisted of 58 radiomics features were correlated with LVI status (P<0.0001)with the former showing good discrimination ability[C-index 0.719,95% CI:0.715-0.723]and classification ability(sensitivity 0.726, specificity 0.628) with internal validation (C-index 0.720). Joint predictive factors containing radiomics labels and carcino-embryonic antigen further enhanced the predictability of radiomics labels (C-index 0.751, sensitivity 0.788, specificity 0.667). Conclusion The radiomics labels built in this study can provide individualized prediction of LVI status of patients with colorectal cancer before surgery. Joint predictive factors in combination with clinical risk factors further improved predictive efficacy.

Objective To evaluate the relationship between hypophosphatemia and prognosis in critically ill patients. Methods Some hypophosphatemia-associated prospective or retrospective clinical cohort studies were searched through CNKI, Wanfang Data, PubMed, Embase, Cochrane library, and Google Scholar English database respectively, with the guidance of these key words such as hypophosphatemia, intensive care, prognosis and fatality rate. The articles were concerned about the correlation between hypophosphatemia and the prognosis of patients in intensive care unit (ICU). The literatures collected were restricted from the creation of data base to April 2017. The mean value of < 0.8 mmol/L in serum phosphorus concentrations of the patients within the first 2 days of ICU admission would be treated as the diagnostic criteria of hypophosphatemia. Literature qualities were assessed by Newcastle-Ottawa scale (NOS). Meta-analysis was carried out by RevMan 5.3, and the sensitivity analysis was performed to test the stability of the meta-analysis. The existence of bias was analyzed by using the funnel graph analysis. Results Ten articles were ultimately included in the analysis, including 9 in Chinese and 1 in English, all of which were high qualities. 1 555 patients were involved in these clinical studies, of whom 606 patients had hypophosphatemia and other 949 were normal phosphatemia. Meta analysis results showed that patients with hypophosphatemia had higher acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score as compared with that of normal phosphatemia group [standardized mean difference (SMD) = 0.64, 95% confidence interval (95%CI) = 0.24-1.04, P = 0.002]. Subgroup analysis showed that APACHE Ⅱ score increased in mild, moderate and severe hyperphosphatemia subgroups, and there were significant differences between any two subgroups (all P < 0.01). Longer duration of mechanical ventilation (SMD = 0.50, 95%CI =0.23-0.78, P = 0.000 3) and the length of ICU stay (SMD = 0.36, 95%CI = 0.06-0.67, P = 0.02), and even higher ICU mortality [odds ratio (OR) = 2.99, 95%CI = 2.09-4.27, P < 0.000 01] were seen in patients with hypophosphatemia as compared with normal phosphatemia patients. However, serum creatinine (SCr) levels (SMD = -0.19, 95%CI =-2.76-2.39, P = 0.89) and serum albumin (Alb) level (SMD = -0.63, 95%CI = -1.54-0.27, P = 0.17) were all similar between hypophosphatemic group and normal phosphatemia group. Sensitivity analysis excluded the effect of heterogeneity on statistical results. The funnel graphics were basically symmetrical, which indicated that the included literatures were distributed well, and the publication bias was small. Conclusions Occurrence of hypophosphatemia in ICU patients is associated with severity of illness, prolonged duration of MV and length of ICU stay, and higher mortalities. Levels of serum phosphorus may have certain clinical values for assessing prognosis of ICU patients.

This paper aimed at discussing the characteristics of blood glucose changes of type 2 diabetes according to the flow rule of Qi and Blood as well as the Hurst index of dynamic blood glucose collected by CGMS. A total of 156 T2DM patients were selected from the Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine. After continuous monitoring of dynamic blood glucose for 3 consecutive days (72 hours) with CGMS, the first complete 24 hour dynamic glucose, which start at 3 to 5 am(corresponding to Lung) and end at 1 to 3 am next morning(corresponding to Liver), are used for calculating each two-hours?? Hurst index. The measurement data was set at each two-hours, and multiple groups of related sample tests (Friedman) non- parametric test methods were used for comparison between groups. The statistical significance level was set to P ＜ 0.05. The results showed that the Hurst indices of each two-hour are all greater than 0.5. The three highest Hurst indices were: Stomach Hurst (0.960) ＞ Heart Hurst (0.946) ＞ Spleen Hurst (0.945), and the three lowest Hurst indices were: Lung Hurst (0.886) ＜ Liver Hurst (0.893) ＜ Large intestine Hurst (0.905). The standard deviation of the large intestine Hurst was the largest, reaching 0.088, and the standard deviation of the gastric Hurst was the smallest, 0.058. The distribution image of the Hurst index of individual patients at each twohours was similar to that obtained by the whole sample, but the specific time to a certain two-hours had fluctuations. The number of pairs with statistical difference between each two groups in two-hours is 29, accounting for 44％ of the total number of pairs. The organs and meridians that have more differences with other two-hours are successively stomach, lung, liver, kidney, spleen and heart. The differences of the blood glucose changes at different times in patients with type 2 diabetes can be indicated by the dynamic blood glucose Hurst indices, which are calculated according to the rule of Qi and blood flow.

Objective:To explore the effectiveness and complications of non-incision removal of tunneled cuffed catheter (TCC).Methods:The clinical characteristics, surgical plans and complications of patients with TCC removal in the Renal Division of Peking University First Hospital from January 1, 2015 to December 31, 2020 were collected and analyzed retrospectively. The patients were divided into non-incision removal group and traditional incision removal group. The clinical characteristics, procedure success rate, procedural duration and complications were compared between the two groups.Results:A total of 349 patients were included in this study, for whom 368 catheter removal procedures were performed, including 286 procedures in the non-incision removal group, 75 procedures in the traditional incision removal group, and 7 procedures without records of surgical plans. There was no significant difference in age, sex, basic kidney diseases and catheter remaining time and location between the two groups (all P>0.05). Two procedures in the non-incision removal group and 1 procedure in the traditional incision removal group failed respectively, and there was no significant difference in the procedure success rate between the two groups (99.3% vs 98.7%, χ2=0.290, P=0.590). The procedural duration in the non-incision removal group was lower than that in the traditional incision removal group [(5.36±1.70) min vs (17.55±3.28) min, t=44.198, P<0.001]. Among the patients who needed TCC exchange, there was no significant difference in the selection of new catheter position between the two groups ( P=0.330). In terms of complications, there were 2 procedures of local hematoma in the non-incision removal group and 1 procedure of infection in the traditional incision removal group, and there was no severe complication in both groups. Conclusions:There was no significant difference in the procedural success rate and complications between non-incision removal group and traditional incision removal group, and non-incision procedure may be superior in reducing the procedure duration and harm less to the patients. Non-incision procedure is a safe and effective method to remove TCC.

Objective To compare the lung protection roles of intraperitoneal pre-injection with penehyclidine for two kinds of rat models with pulmonary and extrapulmonary acute respiratory distress syndrome (ARDSp and ARDSexp). Methods Forty healthy adult Sprague-Dawley (SD) rats were randomly divided into five groups (each n = 8): the rats in sham group received only tracheotomy; the ARDS rat models were reproduced by intratracheal inhalation of 0.1 mol/L hydrochloric acid (HCl) 2 mL/kg to simulate ARDSexp (HCl group) and 0.15 mL/kg oleic acid (OA) intravenous injection to simulate ARDSp (OA group) after tracheotomy; and the rats in two intervention groups were intraperitoneal injected with penehyclidine 0.5 mg/kg. All rats were received mechanical ventilation immediately after model reproduction. Carotid arterial blood was collected 4 hours after model reproduction for determining the arterial partial pressure of oxygen (PaO2), and oxygenation index (PaO2/FiO2) was calculated. Carotid venous blood and lung tissues were harvested, and the levels of myeloperoxidase (MPO), interleukin-8 (IL-8) and nuclear factor-κB (NF-κB) in serum and lung tissue were determined by enzyme linked immunosorbent assay (ELISA). Pulmonary pathology was observed under optical microscope, and pathological score of Smith was calculated. Results Under optical microscope, a large number of inflammatory cells infiltration in lung tissue, obvious alveolar collapse, fibrous exudation in alveolar and alveolar hyaline were found in HCl group. In OA group, however, microvascular congestion and interstitial pulmonary edema were the main pathological changes, with alveolar structure being kept relatively intact. Compared with sham group, pathological score of Smith in HCl and OA groups were increased, oxygenation was lowered, and inflammatory factors levels in serum and lung tissue were increased with levels in lung tissue being higher than those in serum, without significant difference between the two models. When pretreated with penehyclidine, however, pathological injury induced by HCl or OA was alleviated, and pathological score of Smith was also decreased as compared with that of corresponding model groups (5.48±1.76 vs. 9.69±2.02, 3.97±2.14 vs. 8.71±2.18, both P < 0.05), PaO2/FiO2was raised significantly [mmHg (1 mmHg = 0.133 kPa): 323±55 vs. 211±27, 307±56 vs. 207±31, both P < 0.05], the inflammatory factors levels in serum and lung tissue were obviously decreased [MPO (μg/L): 11.91±1.55 vs. 14.82±1.25, 12.75±1.16 vs. 16.97±2.06 in serum, 25.80±3.36 vs. 35.18±4.01, 24.23±1.24 vs. 33.94±1.43 in lung tissue; IL-8 (ng/L): 358±30 vs. 459±25, 377±38 vs. 427±34 in serum, 736±53 vs. 866±51, 701±53 vs. 809±39 in lung tissue; NF-κB (ng/L):483±68 vs. 632±73, 514±83 vs. 685±78 in serum, 984±75 vs. 1 217±123, 944±90 vs. 1 163±105 in lung tissue;all P < 0.05]. But all parameters above were similar between the two pretreatment groups (all P > 0.05). Conclusions Inflammatory cell infiltration and alveolar collapse mainly happened in HCl induced ARDSp, while pulmonary interstitial edema and hemorrhage was mostly seen in ARDSexp rats induced by OA intravenous injection. There was no significant difference in oxygenation and inflammatory response between the two models of rats. Pre-intraperitoneal injection of penehyclidine equally improved oxygenation state, inhibited lung inflammation response, and reduced lung injury in the two kinds of ARDS, but there was no difference in protective role between two models pretreated with penehyclidine.