Objective To evaluate the value of plasma soluble urokinase?type plasminogen activator receptor (suPAR)and D?dimer for assessing disease severity and prognosis in patients with traumatic brain injury(TBI). Methods A serial of 112 patients with traumatic brain injury admired to our hospital were divided into mild TBI (GCS score 13~15),moderate TBI(GCS score 9~12)and severe TBI(GCS score 3~8). The levels of plasma suPAR and D?dimer were monitored within 24 h after patient admission. Results The levels of suPAR and D?di?mer in TBI group were obviously higher than those in the control group(15.86±7.33 vs 2.79 ± 0.69,P<0.01;3.50 ± 2.78 vs 24 ± 0.15,P<0.01). The levels of suPAR and D?dimer in the severe TBI group were also obviously high?er than those in the moderate TBI group(P<0.05). Plasma suPAR levels and GCS score had significant negative correlation(r =- 0.854,P < 0.01). D?dimer levels and GCS score showed a negative correlation(r =- 0.738, P < 0.01). Plasma suPAR and D ? dimer was positively correlated(r = 0.753,P < 0.01). The area under the curve of D?dimer(AUC)was larger,0.854,95%CI 0.763~0.945;the AUC of suPAR was 0.801,95%CI 0.698~0.903. Conclusion Higher levels of suPAR and D?dimer in TBI patients is not only relevant to the injury sever?ity ,but also closely to the prognosis.

Objective To investigate the changes of immune state and the impact on immunological rejection elicited by abdominal cavity bacterial infection after DA-Lewis rat liver transplantation.Methods Orthotopic liver transplant model was established by modified Kamada two-cuff technique.The animals were divided randomly into Group 1,isotonic Na chloride injected into abdominal cavity 3 days after operation;Group 2,mixed Bacillus coli liquid injected instead of saline;Group 3,immunosuppressive drug CsA administered routinely after operation(3 mg?kg-1?d-1).All the animals were sacrificed 7 days after infection.The blood and graft samples were collected for cell-subpopulation,mixed lymphocyte culture,IL-4,IFN-? mRNA detection and histological evaluation.Results Seven days after infection,the lympholeukocyte population,CD4/CD8(G1=1.753?0.181,G2=1.384?0.073,G3=0.997?0.025)and lympholeukocyte function(SI:G1=67.59?3.40,G2=37.14?0.90,G3=15.87?0.51)declined in Group 2 as compared with other groups and cellular differentiation drifted to Th2.There was significant difference between Group 2 and Group 1 or 3.Conclusion Abdominal cavity bacterial infection after rat liver transplantation will promote the differentiation of T cells into Th2,down-regulate CD4/CD8 ratio and immune function of lymphocytes and accordingly alleviate partly the acute rejection following liver transplantation.

Objective To establish a rat model of peritoneal bacterial infection after liver transplantation.Methods To construct a dark Agouti rat-to-Lewis(DA-to-LEW) rat model of liver transplantation.Peritoneal bacterial infection in the rats was induced by intraperitoneal injection of bacterial suspension.The liver function,blood gas,blood cell count and other indicators of the rat models were detected.Results There was a high mortality rate in rats with bacterial injection at day 5 after liver transplantation,therefore unfavorable for the following study.It waft better to inject the bacteria in an amount of 5×10~5 cfu/mL at day 3 after liver transplantation.The cumulative 7-day survival rate of those rats after infection reached up to 37.5%.The infection became increasingly severe,the general conditions were worsening,the rectal temperature was rising,the WBC count was increased,the pH was decreased,liver dysfunction was progressively increased,and metabolic acidosis occurred in the rats.Liver parenchymal damage was more pronounced than that of bile ductal injuries,and the rats died one after another at about 5 days after infection.Pathological examination of multiple organs showed that the main cause of death of the rats was liver damage,without accompanying lung and kidney damages.Conclusion The results of this study suggest that it is a successful method to establish a rat model of peritoneal bacterial infection after liver transplantation,and this model can be used in related experimental researches.

Objective To evaluate the effects of modified early goal directed therapy (EGDT )on the prognosis of patients with septic shock .Methods Clinical data of 116 patients with septic shock admitted to ICU during January 2011 to March 2013 were retrospectively analyzed .Patients were divided into modified early goal‐directed therapy group (n=57) and traditional early goal‐di‐rected therapy group (n=59) according to different methods of treatment ,the patients′28‐day survival rates of these 2 groups were compared .Modified early goal‐directed therapy are divided into survival group (n=46) and non‐survival group (n=11) according to 28‐day prognosis .Acute physiology and chronic health evaluation Ⅱ (APACHEⅡ ) score ,sequential organ failure assessment (SOFA) ,multiple organ dysfunction syndrome (MODS) score and other relevant indicators of survival group and non‐survival group were compared .Results The 28‐day survival rate in modified early goal‐directed therapy group had increased approximately 18 .9% higher than that of the traditional early goal‐directed therapy group(P< 0 .05) .The APACH Ⅱ score ,SOFA score and MODS score in non‐survivors were significantly higher than those of survivors in modified EGDT group ,which were[(29 .36 ± 1 .57)d vs .(24 .30 ± 3 .27)d] ,[(13 .45 ± 0 .52)d vs .(12 .78 ± 1 .33)d] ,[(9 .00 ± 0 .00)d vs .(4 .04 ± 1 .94)d]separately .And vaso‐pressors time and mechanical ventilation time was significantly longer in non‐survivors than survivors(P<0 .05) .Conclusion Mod‐ified early goal directed therapy could improve 28‐day survival rate ,and it show s beneficial effects on outcome of critical patients w ith septic shock .

Objective To explore the effects of simvastatin on the protein expressions of urokinase-typeplasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1). Methods Male Sprague–Dawley rats were divided into saline group , LPS group and LPS plus simvastatin group , and were then pretreated with simvastatin (1 mg/kg) for 30 minutes before addition of LPS (8 mg/kg). Changes in left ventricular pressure were recorded. Ninety minutes after LPS injection, whole blood was collected from the inferior vena cava, and neutrophils were separated. The neutrophils were then lysed to detect levels of uPA and PAI-1. Results Left ventricular systolic pressure (LVSP: mmHg), maximal differential of left ventricular pressure (+dp/dtmax:mmHg/s), and heart rate (beats/min) were markedly decreased at different time points after administration of LPS, and maximal differential of left ventricular pressure increased in the rats receiving LPS as compared with those receiving saline, although the differences between the control and LPS groups were not statistically significant. LPS caused a great decline in uPA content and an elevation in PAI-1 content in neutrophils, but simvastatin diminished the impact of LPS on neutrophils. Conclusion Simvastatin plays a role in protection of cardiac function in rats with LPS-induced septic shock , and controls expressions of uPA and PAI-1 in neutrophils.

Objective To investigate the osteogenie and adipogenic difference of bone marrowdeftved mesenchymal stem cells(MSCs)between patients with aplastic anemia(AA)and healthy volunteers and to explore the role of MSCs adipo-differentiation in the pathogenetic mechanism of AA.Methods MSCs were isolated from bone marrow of patients with AA and healthy donors and expanded in vitro.MSCs derived from the AA patients and healthy volunteers were compared with respect to morphology,in vitro proliteration capacity,phenotype,differentiation ability and gene expression during differentiation.Results The MSCs clones in the AA patients were(19.30±4.77)/(5×105 MNCs)7 days after culture,being significantly lower than those in the healthy volunteers,which was(47.72±3.46)/(5×105 MSCs)(P＜0.05).Compared with those the healthy donors,MSCs from the AA patients had similar proliferative capacity in the first 8 passages and then decreased in the following passages.MSCs from different sources had the same Dhenotype.MSCs from the AA patients could differentiate more easily into adipocytes but less easily and slower into osteoblasts than those from the healthy volunteers.Conclusion The increased adipogenic capacity and decreased osteogenic capacity of MSCs in AA patients may contribute to the development and progress of AA.

Objective To evaluate the efficacy and safety of linezolid in the treatment of severe lung infections caused by methicillin-resistant Staphylococcus aureus (MRSA).Methods Fifteen patients admitted to ICU due to severe lung infection caused by MRSA received linezolid treatment. WBC, lactic acid (LAC), IL-1β, IL-6, and TNF-α levels were measured before and after treatment. Results Clinical efficacy rate was 73.3%. The level of WBC, LAC and inflammatory cytokines decreased significantly after linezolid treatment (P<0.01).Conclusions Linezolid shows good efficacy in the treatment of severe lung infections caused by MRSA.

Objective To test plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-α,and observe the relationships between uPA,uPAR and D-dimer,IL-6,TNF-αin patients with SIRS.Methods A prospective,clinical case-control study was adopted.Cases were collected from our hospital in January 2008 to January 2010,and all were ＞ 55 years of age.Venous blood samples were collected via routine venipuncture.Eighty-five patients were divided into two groups according to diagnostic criteria of SIRS:SIRS group collected from Intensive Care Unit ( n =50) and non SIRS group collected from medical ward ( n =35).The control group comprised 30 unrelated healthy blood donors who visited the General Health Checkup Division at our hospital.Patients with (1) pregnant women; (2) cancer; (3) died after admitted into ICU in 7 days; (4) after cardiopulmonary resuscitation ; ( 5 ) with previous blood system diseases; (6) patients with SIRS before admitted into ICU were excluded from the study.uPA,uPAR,D-D,IL-6 and TNF-α in blood were detected by commercial enzyme-linked immunosorbent assay (ELISA) kits.The data was analyzed using SPSS version17.0.Data accorded with normal distribution of measurement was expressed as mean ± standard,and analyzed by independent-samples t test; non-normal distribution of measurement data,expressed by median,was analyzed with Mann-Whitney test.Relationships between plasma levels of uPA,uPAR and D-dimer,IL-6 TNF-α were analyzed using Spearman rank correlation test.To compare with blood level of uPA,uPAR,IL-6 and TNF-α in SIRS patients in the application of diagnostic value of MODS,we constructed the receiver operating characteristic curve ( ROC curve) for blood levels of uPA,uPAR,IL-6 and TNF-α in 24 h.Results The plasma levels of uPA,uPAR,D-dimer,IL-6 and TNF-αin patients of SIRS were obviously higher compared with non-SIRS and normal controls ( all P ＜ 0.01 ).Correlation analysis showed that there was positive correlation between uPAR level and IL-6 level (r =0.395,P =0.004) ; there was positive correlation between uPAR level and TNF-αlevel ( r =0.606,P ＜0.01 ).There was no correlation between uPAR levd and D-dimer level ( r =- 0.069,P =0.632).There was no correlation between uPA level and D-dimer,IL-6 or TNF-α ( all p ＞ 0.05).There ROC curve were made based on the abilities of uPAR,D-dimer,IL-6 and TNF-αlevels in 24 hours to diagnose MODS,and the ROC areas under the curves were 0.76,0.58,0.86,0.83 respectively.Conclusions These results demonstrate that uPA and uPAR play a major contributory role in patients with SIRS in the process of coagulation disorders,but the mechanism in SIRS is not the same.uPAR may play a central rolein the development of SIRS to MODS.

Simvastatin is a hypolipidemic drug that inhibits hydroxymethylglutaryl coenzyme A (HMGCoA) reductase to control elevated cholesterol,or hypercholesterolemia.Previous studies have shown that simvastatin may attenuate inflammation in ischemia-reperfusion injury and sepsis.Herein,we hypothesized that simvastatin may prevent rats from lipopolysaccharide (LPS)-induced septic shock.In our study,rats were divided into a saline group,an LPS group and an LPS plus simvastatin group.Male Sprague-Dawley (SD) rats were pretreated with simvastatin (1 mg/kg) for 30 min before the addition of LPS (8 mg/kg),with variations in left ventricular pressure recorded throughout.Ninety min after LPS injection,whole blood was collected from the inferior vena cava,and neutrophils were separated from the whole blood using separating medium.The neutrophils were then lysed for Western blotting to detect the levels of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1).In addition,mesentery microcirculations of inlet diameter,outlet diameter and blood flow rate were measured in all three groups.The results indicated that simvastatin significantly promoted heart systolic function and increased the level ofuPA while simultaneously inhibited the expression of PAI-1 as compared with LPS group.Moreover,simvastatin reversed the LPS-induced inhibition of mesentery microcirculation.Taken together,it was suggested that simvastatin can effectively protect the rats from LPS-induced septic shock.

Objective To explore the changes in cardiac index and oxygenation index in sepsis piglets after nitric oxide (NO) gas inhalation. Methods A piglet model of sepsis was induced by intravenous infusion of Gram-negative bacterial endotoxin (LPS), then the piglets were randomly divided into two groups. NO group (n=8) was administered with inhaled nitric oxide of 80ppm via volume control (VC) mechanical ventilation for one hour, while the control group (n = 4) received mechanical ventilation with VC and was observed for one hour to assess the stability of the model. The parameters of oxygenation and hemodynamics were measured by PICCO and arterial blood gas analysis every fifteen minutes for one hour. Results Injection of endotoxin induced a stable pig model of sepsis. PH, HCO3-, arterial oxygen pressure (PaO2), mean arterial pressure (MAP) and cardiac index in this model were significantly lower the baseline values (P < 0.01). Arterial oxygen pressure and cardiac index were significantly higher in N0 group than in the control group (P<0.01). Heart rate (HR), central venous pressure (CVP), global end-diastolic volume index (GEDI) and intrathoracic blood volume index (ITBI) did not significantly differ between NO group and the control group. Conclusions Inhalation of nitric oxide gas can significantly improve oxygenation and cardiac function in piglets with sepsis.