time of infusion. Data analysis indicated that A1B3C2 was the best combination of the 3 factors according to the degree of lung injury. Conclusion Adequate amount of HES 200/0.5 infused during compensated stage of hypovolemic shock produces best result.

Objective To access the changes in blood gases and electrolytes during anaphylactic shock induced by Echinococcus granulosus (EG) in sheep.Methods Fifteen healthy sheep of either sex weighing 31.2 ? 3.5 kg were repeatedly infected with EG for six months. The infected sheep were anesthetized with intramuscular thiopental 20mg?kg-1 and ketamine 15 mg?kg-1. The animals were breathing spontaneously and placed on the left side. ECG (lead Ⅱ) was monitored. Swan-Ganz catheter was placed via right internal jugular vein for hemodynamic monitoring. Anaphylactic shock was induced with antigen prepared from fluid in EG capsules. Blood samples were taken from right internal carotid artery before shock (T0) and 3.5 min (T1 ), 8 min (T2), 15 min (T3), 30 min (T4) and 60 min (T5 ) after shock was induced for determination of blood Na+ , K+ , Hct, Hb, pH, PaO2 , PaGO2 and HCO3-. Shock was confirmed by hypotension (MAP decreased by 30%), tachypnea, dyspnea, agitation and pupil dilation. Results Three sheep did not develop shock and two sheep died of severe shock within 10 min after iv antigen challenge. Blood K+ significantly increased at T1 and T2 after antigen challenge and then gradually returned to baseline value at T5 . PaO2 decreased, PaGO2 increased and pH deceased after challenge. Hct and Hb also increased significantly after challenge. Conclusion There are significant changes in blood gas and electrolytes indicated by hyperkalemia, acidosis and hypoxemia during anaphylactic shock induced by EG.

Objective To evaluate the effects of curcumin on the activity of NR2B and NR1 in the spinal dorsal horn in a rat model of diabetic neuropathic pain (DNP).Methods Diabetes mellitus was induced by high-sucrose and high-fat diet and intraperitoneal streptozotocin 35 mg/kg,then confirmed by fasting blood glucose level ≥ 16.7 mmol/L 3 days later in male Sprague-Dawley rats.DNP was confirmed by the mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) measured on day 14 after streptozotocin administration ＜ 80％ of the baseline value.The rats were then randomly divided into 3 groups (n =27 each) using a random number table:DNP,DNP+ curcumin group (group DCur)and DNP + solvent control group (group DSC).Curcumin 100 mg· kg-1 · d-1 and corn oil 4 ml· kg-1 · d-1 were injected intraperitoneally for 14 consecutive days starting from 14 days after administration of streptozotocin in DCur and DSC groups,respectively.Another 27 normal male Sprague-Dawley rats served as control group (group C) and were fed with normal forage.At 3,7 and 14 days after curcumin injection,MWT and TWL were measured and the lumbar segments (L4-6) of the spinal cord were removed.The expression of pTyr1472-NR2B and pSer896-NR1 in the spinal dorsal horn was determined by immunohistochemistry and Western blot.Results Compared with group C,MWT was significantly decreased,TWL was shortened,and the expression of pTyr1472-NR2B was up-regulated at each time point in group DNP.Compared with group DNP,MWT was significantly increased,and TWL was prolonged at 7 days after curcumin injection,and the expression of pTyr1472-NR2B was down-regulated at 3 days after curcumin injection in group DCur.There was no significant difference in each parameter between DNP and DSC groups,and in the expression of pSer896-NR1 between the four groups.Conclusion The mechanism by which curcumin mitigates neuropathic pain in type 2 diabetic rats may be related to inhibition of up-regulation of pTyr1472-NR2B expression,while unrelated to pSer896-NR1 expression in the spinal dorsal horn.

This paper retrospectively analyzed nursing care of 20 critically ill patients with human infections of avian influenza A(H7N9) virus treated by oxygen therapy.According to the severity of hypoxia in patients admitted to the hospital,individualized oxygen therapy strategy was selected,such as humidified high flow nasal cannula or mechanical ventilation.Oxygen therapy strategy was adjusted in a timely manner according to patients' condition,such as prone position ventilation and extracorporeal membrane oxygenation.As a resuh,15 cases were transferred to the general ward when the virus associated test was negative,and 5 cases died.

AIM:To determine the role of Kv1 2, Kv1 5, Kv2 1 in the hypoxia pulmonary vasoconstriction (HPV). METHODS: Male Wistar rats were divided into two groups: normoxic group and hypoxic group. The single smooth muscle cell was obtained from pulmonary artery of Wistar rats with acute enzymatic digestion method. The conventional whole-cell patch clamp technique was used to record the resting membrane potential (Em) and the potassium currents of voltage-gated potassium channel (IKv) in rat pulmonary arterial smooth muscle cells (PASMC). Intracellular application of Kv1 2/Kv1 5/Kv2 1 antibodies (1∶125) was conducted through the whole-cell patch clamp system. RESULTS: ① Em of PASMC was depolarized after 24 h hypoxia compared with that of control cells [from (-51 8?0 8) mV to (-47 2? 0 7) mV, P

OBJECTIVEProtein induced by vitamin K absence or antagonist II (PIVKA II), also called des-gamma carboxy prothrombin (DCP), is a sensitive marker for the diagnosis of hepatocellular carcinoma (HCC), in Japan and the United States since the sensitive kits were available (1998). PIVKA II is not used in clinical diagnosis in China so far. The aim of this study was to assess the diagnostic value of PIVKA II in Chinese patients with HCC.

METHODSSerum PIVKA II and alpha-fetoprotein (AFP) levels were determined in 60 patients with HCC and 30 patients with cirrhosis not carrying HCC.

RESULTSThe mean serum concentration of PIVKA II in HCC patients (784.3 +/- 1364.1 mean +/- s) was higher than that in cirrhosis patients (16.1 +/- 31.7); this difference was highly significant (P < 0.0001). When the cutoff level of 40 mAU/ml was used as the level of discriminating HCC from cirrhosis, 51.7% of patients (31/60) with HCC had PIVKA II values above this level (sensitivity). Only 4 patients with cirrhosis had such high PIVKA II levels. Thus, the specificity of this test was 86.7% (26/30). Total accuracy was 62.2% [(31 + 26)/(60 + 30)]. Seven of 19 small HCCs (36.84%) had PIVKA II values above the cutoff level. Concentrations of AFP above 20 ng/ml were observed in 34 of 60 patients with HCC (56.7%) and in 11 patients with cirrhosis (36.7%). Eleven of 26 patients with HCC (46.2%) without increased AFP had concentrations of PIVKA II greater than 40 mAU/ml. No significant correlation was found between serum levels of AFP and PIVKA II that were measured in 60 HCC patients (rs = 0.101, P = 0.247). Combining the information from PIVKA II and AFP showed an increase of approximately 21.6% over AFP and 26.7% over PIVKA II alone. For small HCC patients, combining the information from PIVKA II and AFP showed an increase of approximately 15.8% over AFP alone and 21.1% over PIVKA II alone.

CONCLUSIONPIVKA II is a useful early diagnostic marker for HCC and may be more sensitive when combined with AFP in Chinese patients.

Adult ; Aged ; Aged, 80 and over ; Biomarkers ; Biomarkers, Tumor ; blood ; Carcinoma, Hepatocellular ; blood ; diagnosis ; pathology ; Female ; Humans ; Liver Cirrhosis ; blood ; Liver Neoplasms ; blood ; diagnosis ; pathology ; Male ; Middle Aged ; Protein Precursors ; blood ; Prothrombin ; alpha-Fetoproteins ; analysis

Objective To analyze the risk factors associated with acute type A aortic dissection,and to establish an effective predictive scoring model for early clinical intervention.Methods A retrospective review of 200 patients diagnosed as acute type A aortic dissection in the Department of Emergency,Guangdong Provincial People's Hospital between April 1,2012 and March 31,2017 was conducted as a modeling group.There were 160 males and 40 females with age of (53.30 ±13.19) years.According to the criteria of dissection rupture within 72 h after CTA examination,patients were divided into a rupture group (100 cases) and an unruptured group (100 cases).A prediction model of rupture risk was established based on the multivariate Logistic regression analysis of the risk factors of acute A-type aortic dissection in the early stage.After the establishment of the model,a prospective review of 80 patients diagnosed as acute type A aortic dissection in our hospital between April 1,2017 and May 31,2018 was conducted as a validation group.There were 57 males and 23 females with age of (54.00 ±13.68) years.In the validation group,there were 53 patients with rupture and 27 patients without rupture.Furthermore,this model was verified in the validation group.The scores were divided into low-risk rupture and high-risk rupture according to the best cut-off value of the receiver operating model curve of the modeling group.Results Logistic regression analysis showed that 10 factors were finally established the rupture risk prediction score model.The factors were as following:age ＞63 years (2 points),women (2 points),ventilator assisted ventilation (3 points),AST ＞80 U/L (2 points),no distortion of the inner membrane (2 points),diameter of the aortic sinus ＞41 mm (1 point),maximum diameter of the ascending aorta ＞48 mm (1 point),ratio of false lumen area to true lumen area ＞2.12 (2 points),Lac ＞1.9 mmol/ L (3 points),and WBC ＞14.2×109/L (1 point).The results of validation showed that the scoring model had a high predictive value (AUC =0.928,95％ CI:0.872-0.984,P ＜ 0.001) and goodness of fit (Hosmer-Lemeshow x2 =8.331,P =0.402).Moreover,the scoring model was further divided into low-risk (0-6 points) and high-risk (7-19 points),with sensitivity of 83.0％ and specificity of 86.0％.Conclusions The predictive model of dissection risk in the acute type A aortic dissection constructed within 72 h after CTA is helpful for the evaluation of the disease and early intervention,and has certain clinical application value.

Objective:To investigate the protective effect of nicotinamide phosphoribosyltransferase (NAMPT) on abdominal aortic aneurysm by delaying the senescence of aortic vascular smooth muscle cells (VSMC).Methods:The primary VSMC cells from normal and patients with abdominal aortic aneurysm were cultured by tissue adherence method. Cells were divided into normal human-derived VSMC group (Ctrl-VSMC group), abdominal aortic aneurysm patient-derived VSMC group (AAA-VSMC group), and angiotensinⅡ(AngⅡ) in vitro abdominal aortic aneurysm model group (AngⅡ-VSMC group, 100 nmol/L AngⅡ treated normal human-derived VSMC for 48 hours), AngⅡ+P7C3 group and AAA+P7C3 group after NAMPT agonist P7C3 intervention (adding 5 μmol/L P7C3 on the basis of AngⅡ-VSMC group and AAA-VSMC group, respectively). Immunofluorescence staining was used to identify VSMC; cell proliferation-associated antigen Ki67 staining was used to detect cell proliferation; senescence associated β-galactosidase (SA-β-gal) staining was used to detect cell senescence in each group; Western blotting was used to detect the protein expression levels of senescence-related proteins p21, p16 and NAMPT in each group. Results:Compared with the Ctrl-VSMC group, the positive rate of SA-β-gal staining and the expression levels of senescence-related proteins p21 and p16 in the AAA-VSMC group and AngⅡ-VSMC group were significantly increased [SA-β-gal staining positive rate: (74.1±4.4)%, (68.6±5.5)% vs. (36.8±10.3)%, p21/GAPDH: 0.61±0.07, 0.51±0.03 vs. 0.31±0.03, p16/GAPDH: 0.77±0.03, 0.72±0.06 vs. 0.33±0.26, all P < 0.01]. However, the expression of NAMPT was significantly decreased (NAMPT/GAPDH: 0.88±0.07, 0.79±0.14 vs. 1.29±0.02, both P < 0.01). Compared with the AngⅡ-VSMC group, the positive rate of SA-β-gal staining and the expressions levels of senescence-related proteins p21 and p16 in the AngⅡ+P7C3 group were significantly lower [SA-β-gal staining positive rate: (49.1±3.2)% vs. (68.6±5.5)%, p21/GAPDH: 0.35±0.06 vs. 0.51±0.03, p16/GAPDH: 0.47±0.08 vs. 0.72±0.06, all P < 0.05], while the expression of NAMPT was significantly increased (NAMPT/GAPDH: 1.15±0.06 vs. 0.79±0.14, P < 0.01). Compared with the AAA-VSMC group, the positive rate of SA-β-gal staining and the expression levels of senescence-related proteins p21 and p16 in the AAA+P7C3 group were significantly lower [SA-β-gal staining positive rate: (54.1±6.0)% vs. (74.1±4.4)%, p21/GAPDH: 0.38±0.02 vs. 0.61±0.07, p16/GAPDH: 0.50±0.13 vs. 0.77±0.03, all P < 0.05], but the expression of NAMPT was significantly increased (NAMPT/GAPDH: 1.25±0.28 vs. 0.88±0.07, P < 0.01). Conclusion:NAMPT agonist P7C3 can delay the senescence of VSMC and play a protective role in abdominal aortic aneurysm.

Objective:To investigate the clinical manifestations, treatments and prognosis of subacute arsenic poisoning.Methods:In January 2020, a retrospective analysis was carried out on 11 patients hospitalized with subacute arsenic poisoning caused by arsenic contaminated drinking water. We observed manifestations, treatments and prognosis.Results:The main clinical presentations of subacute arsenic poisoningin were gastroenteritis in early phase, some of them had other organ damage, such as skin, blood, liver, kidney, cardiovascular and so on. The later phase was mainly peripheral nervous system damage. The treatment was mainly to chelate arsenic, protect target organs and treat toxic peripheral neuropathy. Most were significantly recoveried, but the recovery of severe toxic peripheral neuropathy was tardy.Conclusion:Acute gastroenteritis is the mainly early manifestation of subacute arsenic poisoning caused by digestive tract, and toxic peripheral neuropathy in the later phase. The prognosis is good, but the recovery of severe toxic peripheral neuropathy is tardy.

Objective:To investigate the clinical manifestations, treatments and prognosis of subacute arsenic poisoning.Methods:In January 2020, a retrospective analysis was carried out on 11 patients hospitalized with subacute arsenic poisoning caused by arsenic contaminated drinking water. We observed manifestations, treatments and prognosis.Results:The main clinical presentations of subacute arsenic poisoningin were gastroenteritis in early phase, some of them had other organ damage, such as skin, blood, liver, kidney, cardiovascular and so on. The later phase was mainly peripheral nervous system damage. The treatment was mainly to chelate arsenic, protect target organs and treat toxic peripheral neuropathy. Most were significantly recoveried, but the recovery of severe toxic peripheral neuropathy was tardy.Conclusion:Acute gastroenteritis is the mainly early manifestation of subacute arsenic poisoning caused by digestive tract, and toxic peripheral neuropathy in the later phase. The prognosis is good, but the recovery of severe toxic peripheral neuropathy is tardy.