Objective To study the expression of serum interleukin (IL )-6 and IL-10 in sepsis patients ,and their correlations with immune function .Methods A total of 56 patients with sepsis were divided into three groups ,including 18 patients in sepsis group ,21 patients in severe sepsis group ,17 patients in septic shock group .All the patients were also divided into survivor and death group according to whether they survived within 2 weeks .Other 30 healthy persons were selected in the control group .Serum IL-6 and IL-10 ,CD4+ /CD8+ were detected and compared .Results Serum IL-6 and IL-10 levels in the three sepsis groups were significantly higher than those in control group ,and with the severity aggravating ,these indicators increased .The level of serum IL-6 in sepsis patients was significantly reduced at the 3rd day ,while there was no difference on the serum IL-10 in severe sepsis group and septic shock group compared with that at admission(P>0 .05) .Compared with survivor group ,serum IL-6 and IL-10 levels on both admission and the 3rd in death groups increased significantly (P<0 .05) .CD4+ ,CD8+ ,CD4+ /CD8+ were negative related with serum IL-6 and IL-10 in both severe sepsis and septic shock group (P<0 .05) .Conclusion The expression of IL-6 and IL-10 in patients with sepsis are over-expressive ,and closely related with disease activity and immune function .

Objective To survey the factors associated with deep venous thrombosis after artificial liver treatment in patients with liver failure. Methods A retrospective survey was used in our hospital from January 2014 to December 2016 consecutive liver failure patients by artificial liver treatment, collected patient data, including general demographic information, medical history. Results Medical history data were collected from 189 compliance cases, including deep venous thrombosis group (11 cases),no deep venous thrombosis group(178 cases),and 5.82%(11/189)of deep vein thrombosis.There were significant differences in age(χ2=7.17, P=0.027), catheterization(χ2=4.99, P=0.025), number of successful venipuncture(χ2=10.856, P=0.004),artificial liver frequency(χ2=67.481, P<0.01), activity status(χ2=9.607, P=0.022), D-dimer(t=12.318, P<0.01), infection(χ2=17.231, P=0.001)and other factors in thrombosis group and thrombus group(P<0.05).Logistic regression showed that age(OR=1.643, P=0.01),activity status(OR=1.643,P=0.01),number of successful venipuncture(OR=6.049,P<0.01),D-dimer(OR=2.532, P=0.005)and infection(OR=2.463, P=0.008)were independent risk factors for thrombosis. Conclusions Deep vein thrombosis after artificial liver injury in liver failure is not uncommon, and the prevention of deep vein thrombosis after artificial liver surgery is strengthened, especially for elderly, absolute bed, venous puncture injury patients, elevated D-dimer and infected patients.

Objective To evaluate the clinical efficacy of percutaneous piercing cortical bone at fracture ends and local injection of autologous concentrated bone marrow aspirate (cBMA) and platelet rich plasma (PRP) in the treatment of delayed fracture union.Methods A retrospective study was performed on the clinical data of 34 patients with delayed fracture union who had been treated at Department of Orthopaedics,Luoyang Zhenggu Hospital of Henan Province from April 2014 to February 2017.They were 26 males 8 females,aged from 18 to 63 years (average,36.7 years).There were 15 femoral,11 tibial,5 humerus and 3 ulnar fractures.According to the Weber-Crech classification,14 cases belonged to the type of rich blood supply-active end hypertrophy and 20 to the type of poor blood supply and malnutrition.There were 28 closed and 6 open fractures.Of this cohort,21 cases had their primary fixation,7 had revision once,4 had revision twice,and 2 had revision more than thrice;19 cases had intramedullary fixation,12 had plate fixation and 3 had external fixation.Autologous iliac bone grafting was performed previously in 19 cases.Kirschner wire was used under fluoroscopy to pierce percutaneously the cortical bone at fracture ends;bone marrow blood and peripheral venous blood were collected to prepare autologous cBMA and PRP which were to be injected locally at the fracture ends after mixture.At the last follow-up,the patients were evaluated by visual analogue scale (VAS),SF-36 health survey summary scores and modified Radiographic Union Score for Tibia (RUST).Results The patients were followed up for 12 to 42 months (average,21.5 months).Thirty-one patients healed after surgery,yielding a healing rate of 91.2％.The healing time averaged 5.3 months (from 4 to 10 months).No patient reported such complications as infection or neurovascular injury.At the last follow-up,the VAS scores of the 34 patients were 1.3 ± 0.6 points,significantly lower than the preoperative 5.4 ± 3.6 points (P ＜ 0.05);the postoperative SF-36 scores 74.8 ± 16.5 points,significantly increased than the preoperative 44.8 ± 15.6 scores (P ＜ 0.05);the RUST scores 3.3 ± 0.4 points,significantly higher than the preoperative 1.6 ± 0.8 points (P ＜ 0.05).Conclusions Minimally invasive percutaneous piercing of K-wire on the cortical bone at the fracture ends may result in fluid leakage and restart bone healing process.At the same time,local injection of autologous cBMA and PRP may increase the number and concentration of local bone marrow mesenchymal stem cells and growth factors,promoting fracture healing.

Objective To explore the correlation of the timing of enteral nutrition (EN) and the prognosis of the patients with septic shock.Methods From December 2016 to August 2017,fifty-five patients with septic shock who received treatment in the ICU of Tongji University School of Medicine were selected in the study and randomly divided into two groups,28 cases in the early enteral nutrition (EEN) group and 27 cases in the delayed enteral nutrition (DEN) group.All the patients was treated with EN before and after 48 h at admission respectively.After 1 week of treatment,the nutrition indicators,clinical efficacy,complications and prognosis of the two groups were compared.Results The levels of ALB,PA and HB in EEN group after treatment were significantly increased,compared with those before treatment,and were superior to those in DEN group ((38.4±4.5) g/L vs.(34.6±3.8) g/L,(207.8±41.4) mg/Lvs.(180.6±47.6) mg/L,(119.2 ±18.3) g/Lvs.(110.7±14.2) g/L;t =3.39,2.26,1.99,P＜0.05).Compared with DEN group,the length of ICU stay,CRRT time,mechanical ventilation time of EEN group were significantly shortened ((6.4± 1.7) d vs.(9.8±2.4)d,(4.7±1.2) d vs.(7.9±2.5)d,(3.6±1.2)d vs.(6.4±1.8) d;t=6.16,6.32,7.09,P＜0.05).After treatment,the SOFA score,APACHE Ⅱ score and qSOFA score were significantly improved in both groups,and the improvement in EEN group was significantly better than that in DEN group((3.8±0.9)points vs.(5.1 ± 1.2) points,(12.2 ± 2.4) points vs.(15.1 ± 3.7) points,(87.4 ± 14.7) points vs.(77.4 ± 13.2) points),(t=4.53,3.46,4.31,P＜0.05).Conclusion The implementation of EEN in patients with septic shock can improve the nutritional status of the patients,alleviate the severity of the disease,reduce the incidence of complications and improve the prognosis.