Objective To study the effects of HVHF on cytokines in elderly patients with septic shock and MODS. Methods 22 elderly patients with septic shock and MODS were included in this prospective and interventional study. Before HVHF and 1,3,6,9,12,18 and 24 hour after HVHF, blood sample and ultrafiltration fluid were collected for cytokines analysis(radioimmunoassay). Results All patients finished HVHF. No severe side effects were observed,and the APACHEⅡ and MODS scores were decreased during HVHF(P

Objective To survey small dense low-density lipoprotein cholesterol(sdLDL-C)distribution among different popula-tions,and analyze its relationship with lipid component.Methods 986 cases of people who underwent medical examination in the hospital were recruited in the study.There were 654 people with normal concentrations of serum blood lipids(normal blood lipids group),according to sex and age they were divided into groups.The people whose serum lipids concentrations increased above the normal range were divided into TG increasing group,LDL-C increasing group and joint increasing group according to the type of lip-ids componet increased.Serum sdLDL-C,LDL-C,TG,TC,HDL-C,ApoAⅠ and ApoB were determind in the people mentioned a-bove,and the correlation between sdLDL-C and TG,TC,HDL-C,ApoAⅠ,ApoB concentrations were analyzed.Results SdLDL-C began to decline after the age of 70,the difference was statistically significant(P <0.05 );the ensemble average of the males was higher than that of females,the difference was statistically significant(P <0.05).The serum sdLDL-C cocentrations of all the serum lipis increasing groups were significantly higher than those of normal blood lipids group,the difference was statistically significant (P <0.05 ).SdLDL-C concentrations were positively correlated with TC,TG,ApoB(r =0.254,0.589,0.302),and was negative correlated with HDL-C and ApoA Ⅰ (r = - 0.421,- 0.275,- 0.311 ).Conclusion There was a positive correlation between sdLDL-C and TC,TG,ApoB,and sdLDL-C was negatively correlated with HDL-C,ApoAⅠ,which can accurately reflect the overall status of lipid metabolism.

Objective:To establish an HPLC method for the simultaneous determination of 18α-glycyrrhizic acid and 18β-glycyr-rhizic acid in diammonium glycyrrhizinate .Methods:A Diamonsil C18 column (200 mm ×4.6 mm, 5 μm) was used with the mobile phase of water (water-60%perchloric acid solution:48∶0.5, adjusting pH to 8.0 with ammonium hydroxide)-methanol (48∶52). The detection wavelength was set at 248 nm and the flow rate was 1.0 ml· min-1 .The column temperature was 30℃and the injection volume was 20 μl.Results:18α-Glycyrrhizic acid and 18β-glycyrrhizic acid were well separated .They had a good linear relationship within the range of 0.005 0-1.000 0 mg· ml-1(r=0.999 7 and 0.999 3).The average recovery was 99.7%and 99.1%, and RSD was 0.9%and 0.4%, respectively (n=9).Conclusion:The method is accurate, simple and reproducible, which can be used for the simultaneous determination of the two constituents in diammonium glycyrrhizinate .

0.05) between two groups.After EGDT,the level of cTnI in EGDT group was obviously dowered on the 7th day (0.16?0.22?g/L) and 14th day (0.09?0.13?g/L) compared with those in control group (0.39?0.43,0.29?0.29?g/L,P

Objective To report a pedigree with late-onset Pompe' s disease complicated with cerebral vascular diseases as to summarize their clinical,pathological and molecular genetic characteristics.Methods We investigated the clinical and pathological data of the two affected siblings with late-onset Pompe' s disease complicated with cerebral vascular diseases.All the 5 members of this pedigree accepted the GAA gene analysis.ResultsBoth affected siblings had progressive pelvic girdle muscle weakness from young adult age,and recently developed vertigo and ataxia.Brain imaging of them revealed multiple cerebral hemorrhage,infarction and diffuse ischemic white matter lesions.The brother had multiple aneurysms and stenoses of cerebral arteries revealed by brain CTA.However,his sister was only found to have multi-beaded stenoses of cerebral arteries.The muscle pathology of the brother showed typical vacuolar degeneration and glycogen storage in muscle fibers. The GAA enzyme activity of 2 siblings were dramatically lower than normal.A heterozygous 19 bp-deletion (c.1388-c.1406,exon 9) were found in GAA gene in the 2 siblings and their healthy mother. Conclusions Cerebrovascular involvement should be a special phenotype of Pompe' s disease.A novel heterozygous mutation c.1388del19 in GAA gene was found in this pedigree,but the relationship between the mutation and the rare clinical phenotype needs further study.

Objective To investigate the mitral annular three dimensional configuration changes after application of two dimensional mitral annuloplasty.Methods Includes criteria:serious mitral prolapse without other cardiac disorders,with age ranged from 18 to 60 years old.Three dimensional echocardiography was performed before the surgery in the operation room.The mitral annular three dimensional configuration,the mitral prolapse and regurgitation grades were examined.And same procedure was done after the mitral repair.All the measure results were expressed as x ± s and the statistical analysis was performed using SPSS 19.0 software.Results Totally 42 cases were enrolled,including 28 posterior prolapse and 14 anterior prolapse cases.All the mitral repair got satisfied none or mild regurgitation.The mitral annulus moved consistently as saddle shape during the whole cardiac cycle,the lowest annulus part was at the commissure and the highest part was at the anterior and posterior annulus centers.During the systolic phase the non-planer angel between anterior and posterior annuls was bigger than in diastolic phase.The annulus circumference,transverse,longitudinal diameters decreased compared with before the surgery.Preoperative mitral transverse diameter and longitudinal diameter values are almost the equal size,indicating the mitral annulus was in nearly round shape.However the longitudinal/transverse ratio reached 0.88 after surgery which implied the annulus configuration recovery after annuloplasty.After the mitral annuloplasty the annular height decreased from (8.4 ± 0.6) mm to (3.2 ±0.1) mm while the annular height/transverse diameter ratio decreased from 0.24 to 0.15,which may be affected by the application of the two dimensional rigid artificial annulus.Non-planar angle between the anterior and posterior mitral annuls increased from(136 ± 13)degrees to(145 ± 14) degrees after mitral repair.Conclusion The mitral annulus configuration may have planarization changes due 1o the apply of two dimentional artificial annulus.

Objective To investigate the expression of inflammatory cytokines in patients with severe sepsis by using an antibody chip.Methods Twelve patients with severe sepsis and other 10 patients whose age and gender were matehed were enrolled in this study.Proteins from patients were labeled with biotin.The biotin-labeled proteins reaeted with antibody chips,on which there were antibodies of 40 major inflammatory cytokines.The target proteins were conjugated with streptomycin antibody labeled by horseradish peroxidase(HRP),and signals were imaged by laser scanner.Results In comparison with control group,the serum levels of inflammatory eytokines ineluding pro-and anti-inflammatory cytokines,ehemokines and certain eytokines receptors were notably increased,while expression of anti-inflammatory interleukin(IL)-2,-4,-13,-15 was remarkably decreased in sepsis group.Conclusions Excess inflammatory response and imbalance of pro-and anti-inflammatory eytokines were presented in the eourse of severe sepsis.

Objective To explore the significance of the plasma procalcitonin (PCT) level for directing antibiotic therapy in elderly patients with ventilator-associated pneumonia (VAP).Methods The 50 elderly patients with VAP were randomly separated into the regular therapy group and the PCT-directed therapy group. The regular therapy group was given regular antibiotic therapy, while the antibiotic therapy was decided according to the plasma level of PCT in the PCT-directed therapy group. The used time and utilization rate of antibiotics, as well as inflammatory indicators including white blood cells, neutrophils, C-reactive protein (CRP) and clinical pulmonary infection score (CPIS) were compared between the two groups. Results After treatment, there were no significant differences in white blood cells, neutrophils and CRP between the PCT-directed therapy group and regular therapy group [(8.9 ± 3.5 ) × 109/L vs. (9.4 ± 3.7) × 109/L, 0.62 ± 0.04 vs.0.60±0.04, (18.7±8.5) mg/Lvs. (21.6±6.0) mg/L, t=0.47, 1.84 and 1.37, allP＞0.05],but the CPIS was markedly lower in PCT-directed therapy group than in regular therapy group [(4.0± 1.4) scores vs. (4.7± 1.0) scores, t= 2. 18, P＜0.05]. The neutrophils, CRP and CPIS were significantly lower after treatment than before in the both groups. The concentration of PCT was decreased after treatment than before [(0.5 ± 0.9) mg/L vs. (1.7 ± 0.7) mg/L]. Meanwhile, the time using antibiotics was longer in regular treatment group than in PCT-directed therapy group [(8.72±1.32) d vs. (5.17±0.72) d, t=11.96, P＜0.01], the utilization rate of antibiotics was higher (95.2 % vs. 55.2 %, χ2 = 12.41, P＜0.01) in regular treatment group. Conclusions Using PCT levels for directing treatment in elderly patients with VAP can achieve better curative effect and reduce the use of antibiotics.

Objective To evaluate the predictive value of brain natriuretic peptide (BNP) on mortality in elderly patient with severe sepsis or septic shock. Method Eighty-three elderly patients meeting with criteria of severe sepsis or septic shock by the American College of Chest Physicians and the Society of Critical Care Medicine (ACCP/SCCM) in 2001, admitted in Intensive Care Unit (ICU) of Zhejiang Hospital during May 2004 to June 2007, were enrolled, and patients with chronic renal failure were excluded. The patients were divided into survivor and non - survivor group according to whether they survived within 28 days staying in ICU, the difference of plasma BNP level,serum C-creative protein (CRP) concentration, APACHE II and SOFA scores on admission day and BNP level on the third day between the two groups were compared; thereafter, the relationship between muhiple variables including age, admission day, BNP, CRP, APACHE 11 and SOFA scores, the 3rd day BNP level and 28-day mortality were analyzed by Logistic regression, and meanwhile the independent predictors for ICU moaality among which were determined. Results BNP levels on both admission day and the 3rd day were significantly higher in nomurvivor group than those in survivor group[ ( 1056.38±676.34) pg/ml vs. (611.59±610.02) pg/ml,p =0.002 and (1448.48+891.11) pg/ml vs. (522.41±575.20) pg/ml, P<0.001, respectively]. By Logistic regression analysis, BNP level on the 3rd day and SOFA score on admission day were independent predictors of ICU mortality, The receiver operating characteristic (ROC) curves indicated that values of areas under the curve of the admission day and the 3rd day BNP levels for 28-days mortality were 0.735 (95% CI,0. 621～0. 848, P <0.001) andO.836 (95% CI, 0.746～0,926,P<0.001), respectively. Conclusions Plasma BNP inereaseds in majority of eldedy patients with severe sepsis or septic shock, which may serve as irdex for prognosis in elderly severe septic paients.

Objective To explore the clinical characteristics of treatment?resistant depression ( TRD) and of its relevance with thyroid hormones. Methods 43 patients with TRD and 48 patients with non?TRD were as?sessed with 17?item Hamilton depression scale ( HAMD?17) and Hamilton anxiety scale ( HAMA) . The serum lev?el of thyroid?stimulating hormone ( TSH) ,total triodothgronine ( TT3) ,total thyroxine ( TT4) ,free triodothgronine ( FT3) and free thyroxine ( FT4) were determined by radioimmunoassay. χ2 test and t test were used for statistic a?nalysis. The quantitative relation of FT3 level with TRD was analyzed and the value of FT3 level in TRD diagnosis was evaluated by ROC curve.Results Compared with non?TRD patients,the TRD patients showed a younger dis?ease onset age ((16.98±2.25)years vs (23.50±3.38)years) and a longer disease course ((10.14±6.47)years vs (5.48±4.15)years) for total disease course;(60.35±23.64)months vs (5.00±3.40)months for current disease course),and had shorter education years ((8.53±1.72)years vs (11.04±2.07)years) and higher HAMD total scores (19.09±1.59 vs 15.69±2.38) and behavior retarding factor scores (8.72±0.98 vs 4.98±1.63). In addition, the FT3 level of TRD patients was lower than that of non?TRD patients ((3.92±0.15)pmol/L vs (4.16±0.20) pmol/L).All the above differences between two groups were statistically significant (P<0.05). The logistic regres?sion analysis showed that the risk of suffering TRD increased by 1. 006?fold when FT3 level reduced 0. 1 pmol/L (OR=2.006,95%CI=(1.501,2.681). The area under ROC curve was 0.821 (P<0.001) with its 95% confidence interval of (0.734,0.907). Conclusion Compared with non?TRD patients,TRD patients have a longer disease course,a younger disease onset age, a lower education level, higher HAMD total scores, more severe retardation symptoms,and a lower FT3 level. The serum FT3 level has a high reference value in diagnosis of TRD.