Objective To observe the clinical effects of early use of neuromuscular blocking agents (NMBA) in patients with severe sepsis and acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.96 patients with severe sepsis and ARDS admitted from July 2012 to September 2013 to intensive care unit (ICU) of Liuzhou People's Hospital in Guangxi Zhuang Autonomous Region were enrolled and divided into severe ARDS group (n=48) and moderate ARDS group (n=48) according to the Berlin definition of ARDS.Then patients in each group were randomly divided into treatment group (n =24) and control group (n=24).All patients with diagnosis in accordance with the 2008 international septic shock and severe sepsis treatment guidelines were provided with comprehensive treatment and mechanical ventilation on the basis of analgesia and sedation.The patients in treatment group were given a loading dose of vecuronium during mechanical ventilation,started with 0.l mg/kg up to 0.05 mg ·kg 1 ·h 1 for continuous intravenous infusion for 24-48 hours.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,sequential organ failure assessment (SOFA),arterial oxygenation index (PaOfFiO2),central venous oxygen saturation (ScvO2),arterial blood lactate (Lac),C-reactive protein (CRP) levels of two groups were compared before treatment and 48 hours after treatment,and 21-day mortality rate was finally compared.Results In moderate or severe ARDS group,there were no statistically significant difference in APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,Lac and CRP before treatment between two groups.APACHE Ⅱ score,SOFA score,PaO2/FiO2,ScvO2,and Lac 48 hours after treatment were significantly improved in severe ARDS group compared with control group [APACHE Ⅱ score:16.58 ± 2.41 vs.19.79 ± 3.52,t=3.679,P=0.010; SOFA score:12.04 ± 2.17 vs.14.75 ±3.26,t=3.385,P=0.010; PaO2/FiO2 (mmHg,1 mmHg=0.133 kPa):159.31 ±22.57 vs.131.81 ± 34.93,t=3.239,P=0.020; ScyO2:0.673 ± 0.068 vs.0.572 ± 0.142,t=3.137,P=0.030; Lac (mmol/L):3.10 ± 1.01 vs.4.39 ± 1.72,t=3.161,P=0.030],while the value of CRP (mg/L) showed no significant difference (180.91 ±37.14 vs.174.66 ± 38.46,t=0.572,P=0.570).21-day mortality in treatment group was significantly lower than that in control group [20.8％ (5/24) vs.50.0％ (12/24),x2=4.463,P=0.035].In moderate ARDS group,each of the above clinical parameters were improved in both groups expect for CRP at 48 hours after treatment,but the indexes showed no statistically significant difference between two groups (all P＞0.05).21-day mortality rate in the treatment group was slightly lower than that in the control group which showed no statistically significant difference [16.7％ (4/24) vs.25.0％(6/24),x2=0.505,P=0.477].Conclusion The early use of NMBA treatment of patients with severe sepsis and severe ARDS cannot only improve the severity but also reduce 21-day mortality.

Objective To explore risk factors for healthcare-associated infection (HAI)in patients undergoing craniocerebral operation,and provide guidance for the prevention of HAI in patients in department of neurosurgery. Methods 200 patients who underwent craniocerebral operation in a department of neurosurgery from November 2013 to November 2014 were surveyed,risk factors for HAI were analyzed.Results Among 200 patients undergo-ing craniocerebral operation,81 patients developed 99 cases of HAI,HAI rate was 40.50%,HAI case rate was 49.50%;the top five HAI sites were lower respiratory tract,urinary tract,intracranial site,bloodstream,and in-testinal tract.Univariate analysis showed that patients’age ≥60,Glasgow Coma Scale (GCS)<15,intraoperative blood loss ≥800 mL,staying in intensive care unit(ICU),indwelling gastric tube,ventricular drainage,using ventilator,tracheotomy,and using H2 receptor antagonists were important risk factors for HAI in patients undergo-ing craniocerebral operation (all P <0.05).Multivariate logistic regression analysis showed that patients’age ≥60, GCS<15,staying in ICU,and using H2 receptor antagonists were independent risk factors for HAI in patients un-dergoing craniocerebral operation.Conclusion Strengthening the surveillance of HAI patients undergoing cranioce-rebral operation and realizing risk factors for HAI are helpful for taking comprehensive prevention measures and re-ducing the incidence of HAI.

Objective By using primary cultured mouse renal tubular epithelial cells (TECs) to develop an in vitro model of simulated ischemia-reperfusion (IR) injury.Methods The outer medulla of C57BL/6J mouse kidney was flushed and primary cultured after digestion in type Ⅰ collagenase,and then immunocytochemical staining was used to verify TECs.Primary cultured TECs were immersed in mineral oil to simulate the ischemic process,and 60 min later the whole culture medium was added to simulate reperfusion process.The cells were collected and RAN was extracted at indicated time points after medium replacement.The expression of TNF-α,IL-1β and IL-6 was detected by using real-time fluorescence quantitative RT-PCR. The culture supernatants were collected at 24 h after medium replacement for detection of the expression of cytokine protein by using ELISA.Results Primary cultured TECs were identified by cobblestone-shaped morphology and then verified by cytokeratin 18 (CK18) staining.In TECs of IR group after medium replacement the mRNA expression of TNF-α,IL-1β and IL-6 was higher than in control group.The expression of TNF-α after medium replacement was increased to a peak level at 0.5 h,about (24.45 ±6.51) times (P＜0.01 ) higher than the control group,and gradually declined thereafter.The mRNA expression of IL-1β after medium replacement kept an increasing tendency,about ( 15.27 ± 4.29) times (P＜0.05) higher than the control group at 6 h,and that of IL-6 after medium replacement was increased to a peak level at 3 h,about ( 11.19 ±4.55) times (P＜0.01) higher than the control group. In the IR group at 24 h after medium replacement,the protein expression of NF-α,IL-1β and IL-6 in the supernatants was significantly higher than in the control group.Conclusion High purity of primary cultured TECs was achieved from the outer medulla of mouse kidney by separation and digestion.The in vitro model of simulated IR in primary cultured mouse renal TECs was successfully created using paraffin oil.

ObjectiveTo investigate the effect and underling mechanism of water-soluble CO-releasing molecules (CORM-3)on the alleviation of allograft rejectionafter mouse kidney transplantation.Methods A mice kidney transplantation model was established using C.FVB-Tg (Itgax-DTR/GFP)57Lan/J or C57BL/6J (H-2Kb) mice as donors,and Balb/c (H-2Kd) mice as recipients.After donor nephrectomy,kidney was preserved in UW solution which contained CORM-3 or iCORM (inactive CO-releasing molecules) for 24 h in 4℃.Recipient survival after removal of both na? ve kidneys,serum creatinine as well as graft histology was observed.In the C.FVB-Tg(ItgaxDTR/GFP) 57Lan/J donors,rDCs were acquired in vitro and selected by magnetic cell sorting (MACS) after graft nephrectomy.The expression of activation markers,CD80 and CD86,on rDC was assessed by using flow cytometry.ResultsThe graft medium survival time was 40.5 days in the iCORM group and 70 days in the CORM-3 group respectively (P＜0.05).CORM-3 preserved the graft function as shown by significantly lower serum creatinine (P＜0.05; or P＜0.01) and alleviated graft pathology injury.Diffuse infiltration of mononuclear cells in the interstitial tissues,moderate tubulitis and partial glomerular sclerosis were found in the iCORM graft kidney,while the CORM-3 graft kidney displayed almost normal histology.Meanwhile,CORM-3 suppressed the expression of CD80 and CD86 in donor-derived rDC.ConclusionCORM-3 can alleviate allograft rejection,prolong the graft survival,and improve kidney function in mouse kidney transplantation,probably via inhibiting rDC activation.

ObjectiveTo investigate the role of aldehyde dehydrogenase 2 (ALDH2) in the protection against tubular epithelial cells (TEC) ischemia/reperfusion (IR)injury induced by pretreatment with ethanol.Methods Mouse primary cultured TECs were pretreated with 50 mM ethanol 3 h before simulation of in vitro IR.Lactate dehydrogenase (LDH) release was assessed to evaluate the protection of ethanol pretreatment on IR injury.Thereafter,TECs were transfected with a negative control siRNA (NC) or an ALDH2-siRNA. The ALDH2 protein levels and ALDH enzymatic activities were assessed 48 h after transfection.Ethanol pretreatment and in vitro IR were performed on those transfected TECs.LDH release was assessed to evaluate the role of ALDH2 in the ethanol pretreatment-induced protection against IR injury.ResultsEthanol pretreatment significantly reduced the LDH release in TECs upon IR insult.As compared with NC group and INTERFERin group,the ALDH2 protein levels were decreased by 82.1％,ALDH enzymatic activities were decreased hy 67.3％,and the protective effect induced by ethanol pretreatment was almost completely abrogated in ALDH2-siRNA group.ConclusionEthanol pretreatment protects TECs against IR injury through ALDH2 dependent pathways.

Objective To analyze the related factors of lymph node metastasis in N2 group of patients with non-small cell lung cancer,and found its meaning for lymph node dissection.Methods A retrospective analysis was made on 110 patients with non-small cell lung cancer from July 2014 to May 2016 in our thoracic surgery department.Potential related factors were collected,single factor analysis and variate analysis were carried out to find the relationship between N2 lymph node metastasis and potential related factors.Results Univariate analysis showed that the longest diameter of the tumor ＞ 2 cm (P =0.016),lymph node imaging (P =0.021),pleural involvement (P =0.002) were related factors of lymph node metastasis in N2 group,and these three factors were independent related factors of lymph node metastasis in N2 group.Conclusions The longest diameter of the tumor,lymph node imaging and pleural involvement are related factors of N2 lymph node metastasis.Systematic lymph node dissection is strongly recommended for patients with three related factors at the same time.

Objective To realize the distribution and characteristics of Mycobacterium leprae (M.leprae) species and its single nucleotide polymorphisms (SNPs) spreading currently in China.Methods A total of 171 cutaneous lesion specimen of leprosy patients from 22 provinces were collected.The 16S rRNA conservative region of Mycobacterium leprae was amplified by nest PCR and the positive products were sequenced directly and aligned by BLAST.The SNPs of M.leprae were genotyped by restricted fragment length polymorphism for the PCR products.Results The 171 specimen were all Mycobacterium leprae since the amplified fragments of DNA samples were 99％ similar to the Br4923 of M.leprae from Brazil.No new species (M.lepromatosis) was found.Among the 85 samples genotyped for SNPs,SNP3,SNP1 and SNP2 accounted for 78.8％ (67/85),20％ (17/85) and 1.2％ (1/85) respectively.There was no sample with SNP4 genotype to be detected.Among the 171 sequencing specimen,130 showed mutation C-T at 251 bp of 16S rRNA.There was no difference for mutant rate of 16S rRNA gene and SNP genotype among the samples with different clinical pathological types.Certain associations between 16S rRNA C251T mutation and SNP genotype were found.Most of the samples with C251T mutations of 16S rRNA sequence were SNP3,only a few were SNP1 but not SNP2.There was significant difference of SNP genotype distribution among the patients from different regions.The distribution rate of SNP3 genotype in the samples from inland region (97.1％,34/35)was significantly higher than that from coastal region (66％,33/50) (x2 =11.96,P ＜ 0.01) . There was significant difference of the gene mutation rate of 16S rRNA sequence among the patients from different regions.The mutation rate of 16S rRNA in the samples from inland region (94.8％,92/97) was significantly higher than that from coastal region (51.4％,38/74) (x2 =43.56,P ＜0.01).Conclusion C251T mutation in 16S rRNA gene sequence of M.leprae may associate with SNP type suggesting that the characteristics of geographical distribution presented in different genotypes of M.leprae.No new species of M.leprae was found in this study.

Objective: To evaluate the prognostic value of three different staging schemes based on positive lymph nodes (pN), metastatic lymph nodes ratio (MLR) and log odds of positive lymph nodes (LODDS) in patients with T3 esophageal cancer. Methods: From 2007 to 2014, clinicopathological characteristics of 905 patients who were pathologically diagnosed as T3 esophageal cancer and underwent radical esophagectomy in Zhejiang Cancer Hospital were retrospectively analyzed. Kaplan-Meier curves and Multivariate Cox proportional hazards models were used to evaluate the independent prognostic factors. The values of three lymph node staging schemes for predicting 5-year survival were analyzed by using receiver operating characteristic (ROC) curves. Results: The 1-, 3- and 5-year overall survival rates of patients with T3 esophageal cancer were 80.9%, 50.0% and 38.4%, respectively. Multivariate analysis showed that MLR stage, LODDS stage and differentiation were independent prognostic survival factors (P<0.05 for all). ROC curves showed that the area under the curve of pN stage, MLR stage, LODDS stage was 0.607, 0.613 and 0.618, respectively. However, the differences were not statistically significant (P>0.05). Conclusions LODDS is an independent prognostic factor for patients with T3 esophageal cancer. The value of LODDS staging system may be superior to pN staging system for evaluating the prognosis of these patients.

Objective:To investigate the unqualified hepatitis C virus (HCV) detection result of blood donors from the served area of blood institutions.Methods:The data related to HCV markers detected of the first and repeat blood donors were collected from the system of practice comparison for the Chinese mainland blood institutions from 2017 to 2021. The anti-HCV reactive rate and the rates of anti-HCV negative but HCV-RNA reaction and all the relationship between rates and the annual, regional and different blood donors were statistically analyzed.Results:During 2017-2021, the number of anti-HCV reactive per 100 000 blood donors decreased from 444.3 to 250.44 in the served area of 22 blood institutions ( χ2=49.677, P<0.05). The number of HCV RNA detected positive per 100 000 anti-HCV negative increased from 0.69 to 2.05 year by year, but there was no statistical significance ( χ2=0.643, P>0.05). The anti-HCV unqualified rate was significantly different among regions ( χ2=3 260.283, P<0.05). The anti-HCV unqualified rate of the first blood donors was significantly higher than that of the repeated blood donors ( F=130.993, P < 0.05). The annual number of HCV RNA detected positive per 100 000 anti-HCV negative blood samples from donors ranged from 0 to 17.28. Conclusions:The anti-HCV unqualified rate of blood donors in the served area of 22 blood institutions decreased year by year. Compared with repeated blood donors, HCV infection should be emphasized in first-time blood donors. The implementation of HCV RNA test can detect out much more HCV infections and reduce the risk of transfusion transmitted infectious HCV.