Objective To investigate the evaluation value of blood lactic acid dynamic monitoring and APACHE Ⅱ score in trhe prognosis of sepsis.Methods The blood lactic acid level,lactic acid clearance rate,shock and MODS occurrence rate and mortality in 76 patients with sepsis in ICU of our hospital from January to October 2015 were statistically analyzed.Various indexes and prognosis were performed the multi-variable Logistic regression analysis.Results The APACHEⅡ scores,shock and MODS occurrence rate and mortality in the lactic acid elevation group were higher than those in the lactic acid normal group,the difference was statistically significant(P<0.05).In grouping according to the lactic acid peak value,the observation indexes had no statistical difference among 3 groups(P>0.05);in grouping according to 6 h lactic acid clearance rate,except APACHEⅡscore,the other observation indexes in the high clearance rate group were significantly lower than those in the low clearance rate group,the difference was statistically significant (P<0.05).The lactic acid level at admission,lactic acid peak value,6 h lactic acid clearance rate and APACHEⅡscore in the survival group were significantly better than those in the death group,the difference was statistically significant(P<0.05).In 3 groups according to APACHEⅡ score,the lactic acid peak value,shock,MODS occurrence rate and mortality rate had statistically significant differences among 3 groups (P<0.05).The lactic acid level at admission,6 h lactic acid clearance rate and APACHEⅡscore were the independent risk factors in the patients with sepsis.Conclusion The lactic acid level at admission,6 h lactic acid clearance rate and APACHEⅡ score were the independent risk factors in the patients with sepsis.

Objective To explore the epidemiological characteristics of acute sporadic hepatitis E.Methods 109 cases of hepatitis E were investigated to collect the information on epidemic history and other health behaviors and the rate was used to describe the data.Results Of 67.3%(109/162) cases of hepatitis E in 2008 of Taizhou,the male to female ratio was 1∶0.31.Among the 109 cases,illiterates and semi-illiterates accounted for 47.7% and the proportion of rural workers was 78.0%.87.2% cases had an average monthly incomes below 1 000 Yuan and 45.9% cases occurred from February to April.47.7% cases had meals in small restaurants,and the rates of unhealthy foods and business travelling were 36.7% and 16.5% within 15 to 75 days before onset of the disease.64.2% cases had poor habits of washing hands before meals.Conclusions The occurring of hepatitis E were reported from February to April in Taizhou and most cases came from rural residents between 30 to 60 with low income and lower educational levels.The top three exposure risk factors were the history of eating outside,unhealthy foods and business travelling.

Objective To study the clinical value of sTREM-1, PCT, CRP in sepsis. Methods A prospective study was conducted and clinical data of related patients from January to October 2015 were collected. Thirty-nine cases of sepsis patients , 15 patients with SIRS and 12 normal controls were detected by ELISA then the prognostic value of sTREM-1, PCT, CRP was determined in sepsis. Results In sepsis and SIRS group, sTREM-1 and PCT level were significantly higher than those in control group (P < 0.05); CRP only in sepsis group and control group was statistically significant (P < 0.05). In sepsis group, sTREM-1,PCT and CRP were significantly higher than those in SIRS group (P < 0.05). The ROC curve analysis indicated that sTREM-1,PCT and CRP for SIRS and non SIRS area under the curve was 0.914,0.887 and 0.831 respectively. Conclusion sTREM-1 is a good indicator for early diagnosis of sepsis, and it has high sensitivity and specificity.

Objective To evaluate the clinical value of color Doppler ultrasound (CDUS) and computed tomography angiography (CTA) in diagnosis of Budd-Chiari syndrome(BCS).Methods The CDUS and CTA data about 33 BCS patients diagnosed by digital subtraction angiography(DSA) and treated by interventional therapy were retrospectively analyzed.All of 33 patients with BCS were examined with CDUS,26 cases of then received CTA.The diagnostic value of BCS between two methods were compared.Results The diagnostic accordance rate of CDUS and CTA for BCS were 90.9％ and 96.2％ respectively,which had no significant statistical difference(P ＞ 0.05).The two methods could not only comprehensively systematically reflect the morphologic changes of liver and spleen,the stenosis and blood flow state of the lesion regions,but also clearly display the intrahepatic/extrahepatic collateral vessels trend in the abdomen.One week after interventional therapy,the CUDS results showed blood vessels pristine and stable hemodynamics.Conclusion CDUS is the preferred imaging in the diagnosis and postoperative re-examination of BCS.While,CTA can provide many important parameters for preoperative assessment and operation way.

BACKGROUND: Quiet a number of researches has reported the morphological changes of global ischemic reperfusion model. However, there are few reports on the ultrastructural changes of cortex in early reperfusion, especially the change of blood brain barrier.OBJECTIVE: To explore the changes of brain cortex neurons, glial cells and blood brain barrier in order to provide reliable evidence for clinical treatment.DESIGN: A randomized and controlled trial.SETTING: Department of Neurosurgery, Departnent of Anesthesia and Electron Microscope Room of Beijing Tiantan Hospital.MATERIALS: The experiment was conducted to 6 Wistar rats in Beijing Neurological Surgery Research Institute of Capital University of Medical Sciences during February 2003 to February 2004. The rats were randomly divided into two groups with one of ischemia-reperfusion group and sham operation group with 3 rats in each group.INTERVENTIONS: To prepare global ischemic reperfusion model of rats. Brain was removed from ischemic group in one hour of reperfusion and from sham operation group one hour after the operation. Electronic microscope technique was used to observe the ultrastructural changes of cortex.MAIN OUTCOME MEASURES: Ultrastructural changes of cortex.RESULTS: The neurons of cortex shrank to certain degree in the early stage of ischemic reperfusion(1 hour) . The glial cells were swollen with dissolved chromosome in nucleus and unclear nuclear membrane. The foot protrusions around blood vessel slightly swelled and separated from basement membrane. Mircro-tubes were partially dissolved.CONCLUSION: In early stage of reperfusion injury, the cortex neurons, glial cells, cellular framework and blood brain barrier already changed which suggested that the protective treatment such as reducing brain edema, protecting blood brain barrier should start as early as possible.

Objective To investigate the effect of ketamine on cAMP response element binding protein pbosphorylation(p-CREB)in hippocampus of neonatal rats.Methods Seventy-five 7-day old SD rats of both sexes were randomly divided into 3 groups(n=25 each):control group(group C)and 2 ketamlne groups(group K1,K2)which received 7 subcutaneous injections of ketamine 10 and 20 mg/kg respectively at 90 min intervals.The animsla were decapitated at 24 h after fwst ketamine injection.The brains were immediately removed and the hippocampi were isolated for detection of neuronal apoptosis by TUNEL.Apoptosis index wag calculated.The expression of p-CREB Wag meagured by immuno-histochemistry and the expression of BDNF mRNA and Bcl-2 mRNA was detected by RT-PCR.Cognitive function Wag agsessed using Morris water maze test at 6 weeks after first ketamine injection.Results The apoptosis index Wag significantly increased while the expression of CREB,BDNF mRNA and Bcl-2 mRNA was down-regulated in group K1 and K2 as compared with group C.The apoptosis index Wag significantly higher and the expression of p-CREB and BDNF mRNA and Bcl-2 mRNA Wag significantly lower in group K2 than in group K1.The latent period of escape was significantly longer in group K2 than in group C and K1.Conclusion Ketamine 20 mg/kg administered in neonatal rats can decrease cognitive function when they grow up by increasing neuronal apoptosis induced by down-regulatlon of the expression of p-CREB,BDNF and Bcl-2.

Objective:To observe the effect of old RBCs transfusion on cognitive function in rats and the improvement effect of mi -nocycline.Methods: Male SD rats at the age of 6 months were randomly divided into 4 groups.The RBCs were obtained from male rats by centrifuging the total blood and stored at 4℃.The rats of fresh RBCs group (group F) were transfused with the RBCs stored for 1 day.The rats of old RBCs group (group O) were transfused with the RBCs stored for 7 days.The rats of treatment group (group T) received 40 mg· kg-1 minocycline with intraperitoneal injection before the transfusion .The rats of the control group ( group C) were transfused with the normal saline .The brain levels of IL-1βand IL-6 were determined with Quantikine ELISA kits in 24 hours after the blood transfusion (n=6).The rats were subjected to Barnes maze tests after 1 week of the blood transfusion (n=10).Results:The brain levels of IL-1βand IL-6 in group O were higher than those in group C and F (P<0.05), which were lower in group T than those in group O(P<0.05).The rats of group O spent longer time finding the target box than those of group C and F in the Barnes maze (P<0.05), and the time was shorter in group T than that in group O (P<0.05).Conclusion: Old RBCs transfusion plays a role in neuro-inflammation and induces cognitive dysfunction in rats , which may be improved by minocycline .

Objective PCT and sTREM-1 combined with APACHE Ⅱ score for assessing diagnosis of sepsis and prognostic value.Methods The clinical data for related patients who had hospitalized between January and October 2015 were collected by prospective study methods.According to China guidelines for treatment of severe sepsis/septic shock (2014).The patients were divided into SIRS group,sepsis group,severe sepsis group,septic shock group,and control group.Results Levels of CRP and sTREM-1 were significantly higher in total sepsis group and subgroups than in SIRS group and control group,with a statistical difference (P ＜ 0.05);but there were no significant differences among he subgroups.Lactic acid level differed statistically between both total sepsis group and its subgroups and both control group and SIRS group,so did level of lactic acid between the other groups and septic shock group (P ＜ 0.05).PCT was significantly higher in total sepsis group and its subgroups than in the control group and SIRS group,so did it in septic shock and severe sepsis group than in sepsis group.PCT level was significantly higher in septic shock than in severe sepsis (P ＜ 0.05).APACHE Ⅱ scores were markedly in total sepsis group and its subgroups than in SIRS group and the control group;and it differed statistically between septic shock group and sepsis group (P ＜ 0.05).According to the ROC curve analysis,the area under the curve was 0.935,0.877,0.816,and 0.856 for PCT,sTREM-1,APACHE Ⅱ,CRP,and lactic acid,respectively.Conclusions Detection of serum PCT and sTREM-1 combined with APACHE Ⅱ score can be used to assess diagnosis of sepsis and prognostic value,which has more benefit to the diagnosis and treatment of sepsis.

Objective To evaluate the effect of lithium chloride (LiCl) pretreatment on isoflurane-induced cognitive dysfunction and inflammatory response in hippocampus in aged rats.Methods Eighty 20-month-old male Sprague-Dawley rats,weighing 350-400 g,were randomly assigned into 4 groups (n =20 each):control group (group C),1.4％ isoflurane group (group I),100 mg/kg LiCI + 1.4％ isoflurane group (group L+ I),and 100 mg/kg LiC1 group (group L).Group I was exposed to 1.4％ isoflurane in 30％ O2-70％ N2 for 6 h,while group C was exposed to 30％ O2-70％ N2 only.LiCl 100 mg/kg was injected intraperitoneally once a day for 3 consecutive days and isoflurane anesthesia was performed on 4th day in group L + I.LiCl 100 mg/kg was injected intraperitoneally once a day for 3 consecutive days and then the rats inhaled 30％ O2-70％ N2 for 6 h on 4th day in group L.Blood samples were taken immediately after the end of anesthesia for blood gas analysis.Hippocampi were isolated 24 h after the end of anesthesia for determination of the expression of glycogen synthase kinase-3β (GSK-3β) and acetyl-NF-κB (Lys310) (by Western blot) and TNF-α,IL-1β and IL-6 mRNA (by RT-PCR).The levels of TNF-α,IL-1β and IL-6 were determined by ELISA and the contents of TNF-α,IL-1β and IL-6 were calculated.The cognitive function was assessed on 2nd day after the end of anesthesia.Results Compared with group C,the expression of GSK-3β and acetyl-NF-κB (Lys310) was significantly up-regulated,the expression of TNF-α,IL-1β and IL-6 mRNA and contents of TNF-α,IL-1β and IL-6 were increased,the escape latency was prolonged,and the time of staying at the original platform quadrant was shortened in group I (P ＜ 0.05).Compared with group I,the expression of GSK-3β and acetyl-NF-κB (Lys310) was significantly down-regulated,the expression of TNF-α,IL-1β and IL-6 mRNA and contents of TNF-α,IL-1β and IL-6 were decreased,the escape latency was shortened,and the time of staying at the original platform quadrant was prolonged in group L + I (P ＜ 0.05).Conclusion LiC1 pretreatment can improve isoflurane-induced cognitive dysfunction and inhibition of inflammatory response in hippocampus is involved in the mechanism in aged rats.

This study examined the effects of clinically relevant concentrations of isoflurane on the amplitude of NMDA receptor current (I(NMDA)) and the expression of cytochrome C in cultured developing rat hippocampal neurons. The hippocampi were dissected from newborn Sprague-Dawley rats. Hippocampal neurons were primarily cultured for 5 days and then treated with different concentrations of isoflurane [(0.25, 0.5, 0.75, 1 minimum alveolar concentration (MAC))]. The peak of I(NMDA) was recorded by means of the whole cell patch clamp technique. The cytochrome C level was detected by Western blotting and quantitative real-time PCR. Our results showed that isoflurane (0.25, 0.5, 0.75 and 1 MAC) potentiated the amplitude of I(NMDA) by (116±8.8)%, (122±11.7)%, (135±14.3)% and (132±14.6)%, respectively, and isoflurane increased the mRNA expression of cytochrome C in a concentration-dependent manner. The cytochrome C mRNA expression reached a maximum after 0.5 MAC isoflurane stimulation for 6 h (P<0.05). It was concluded that isoflurane enhances the expression of cytochrome C in cultured rat hippocampal neurons, which may be mediated by facilitation of NMDA receptor.