Hemodynamics is monitoring a series of physiological and pathological parameter changes such as blood flow,the chamber pressure of the heart,pressure or resistance of cardiovascular and cardiopulmonary system.Traditional hemodynamic monitoring in septic shock manily includes central venous pressure,cardiac index,blood lactate and pH.In recent years,expanded non-invasive or invasive monitoring technologies include central venous or mixed venous oxygen saturation,continuous ultrasound associated with underlying cardiac output monitoring and pulse indicator continuous cardiac output.Macro-hemodynamic,metabolic and microcirculatory parameters constitute a new hemodynamics network.In order to properly assess the patient's blood volume and circulation function and to overcome the limitations of a single parameter,it is need to emphasize analysis and integration of the various parameters.

DNA polymerase γis the only known DNA polymerase in human mitochondria,and is essential for mitochondrial DNA replication and repair.DNA polymerase γ is encoded by POLG gene.POLG-related disorders resulted from mutations of POLG gene comprise a continuum of overlapping phenotypes including Alpers Huttenlocher syndrome and other five subtypes, with high prevalence rate at patients with intractable seizure.Genetic testing for POLG mutations in patients with intractable epilepsies is very important for clinical diagnostics, genetic counseling, and treatment decisions because of the increased risk for VPA-induced liver failure in patients with POLG mutations.

BACKGROUND: Pyramidal cells in hippocampal CA1 region are neurons most susceptible to ischemia-hypoxia damage. Their membrane potential is shown as hyperpolarization of cell membrane during early hypoxia. With the progress of hypoxia time, cell membrane has slow and rapid hyperpolarization, which causes irreversible damage to neurons.OBJECTIVE: To investigate the effects of the blocker of N-methyl-D-aspartate receptor MK801 on the electrophysiological changes of CA1 neurons during hypoxia in isolated hippocampal slices of rats with intracellular recording technique.DESIGN: Observational and controlled study.SETTING: The 97th Hospital of the Chinese PLA, Provincial Key Anesthesiology Laboratory of Xuzhou Medical College; Center of Health Science, State University of New York.MATERIALS: The experiment was conducted from September 2002 to March 2003 in the State University of New York. Five adult male SD rats were anesthetized with 0.02 volume of isoflurane after 3 minutes' pre-oxygenation with oxygen.METHODS: The hippocampal slices from the rats were randomly divided into simple anoxia group (n=10) and MK801 group (n=10). The slices in simple anoxia group were only subjected to 10-minute hypoxia with the artificial cerebrospinal fluid (ACSF), and the slices in MK801 group were treated with 100 μmol/L MK801 for 10 minutes before and during 10 minutes of hypoxia. The neuronal membrane potential before hypoxia, the rate of slow depolarization, the amplitude of and time to rapid depolarization were recorded with intracellular recording technique described in the literature. Meanwhile, the neuronal response to the intracellular current injection and Schaffer collateral stimulation were observed respectively at the end of 60 minutes' re-oxygenation.gion of hippocampal slices: It was significantly higher in simple anoxia group than in MK801 group [(0.20±0.05) mV/s, (0.08±0.03) mV/s, P ＜ 0.05].hippocampal slices: It was significantly higher in MK801 group than in of rapid depolarization of pyramidal cells in CA1 region of hippocampal slices: It was significantly lower in MK801 group than in simple anoxia sponse to stimuli was recovered in 9 out of 10 neurons.CONCLUSION: MK801 blocker of N-methyl-D-aspartate receptor can decrease the rate of slow depolarization of neurons induced by hypoxia, postpone the onset of rapid depolarization of neurons, and decrease the amplitude of rapid depolarization of neurons. This suggests that the blocker of N-methyl-D-aspartate receptor can relieve the hypoxic damage to neurons and promote the functional recovery of neurons.

Objective To investigate the association of immunological indicators with the severity and prognosis of pediatric patients with severe sepsis.Methods We enrolled 82 pediatric patients with severe sepsis admitted to pediatric intensive care unit (PICU) at Shanghai Children′s Hospital between March 2013 and February 2017 as septic group.Fifteen healthy children served as control group.The blood samples were collected within 24 hours after admission and on day 7 after treatment.The levels of immunoglobulin (IgG,IgM and IgA) were analyzed by automatic special protein analyzer,and the proportion of T-lymphocyte subgroup (CD3+,CD4+,CD8+ and CD19+) and natural killer (NK) cells (CD16+ and CD56+) in peripheral blood were detected by flow-cytometry.Results The levels of IgG,IgM and IgA had no statistical differences between septic group and control group(P>0.05).Interestingly,the proportion of NK cells in pediatric patients with severe sepsis was significantly lower compared to the control group,and the number of NK cells was significantly increased after 7 days treatment compared with that within 24 hours after admission[(3.7±1.9)% vs.(11.5±1.9)%,P<0.05].In addition,the proportions of T-lymphocyte subgroups including CD3+,CD4+ and CD8+ were significantly decreased in patients of septic group compared with control group[(62.8±8.5)% vs.(70.9±2.3)%,(33.3±7.0)% vs.(39.8±1.8)% and(22.6±2.8)% vs.(34.8±15.6)%,respectively,all P<0.05].Moreover,the proportions of NK cells,CD3+ and CD4+ T lymphocytes subsets in peripheral blood of patients with severe sepsis were positively associated with pediatric critical illness score(P<0.05),and negatively associated with pediatric risk of mortality score Ⅲ and the number of dysfunction organs(all P<0.05).Furthermore,the proportions of NK cells and CD3+ and CD4+ T lymphocytes in peripheral blood of non-survivor with severe sepsis were significantly lower than those in the survivor[(1.5±0.5)% vs.(4.7±1.4)%,(55.1±5.0)% vs.(66.4±7.4)%,(29.7±5.2)% vs.(35.0±7.2),P< 0.05].Conclusion The proportion of NK cells and CD3+ and CD4+ T lymphocytes subsets in peripheral blood decreases in pediatric patients with severe sepsis,which is associated with severity and prognosis of severe sepsis.

Objective To evalute Qiliqiangxin capsule for improving cardiac function and identifiy Qiliqiangxin capsule for directing cytoprotective effects against apoptosis of cardiomyocytes. Methods Sprague Dawley (SD) rats were tested as subjects and the model rats were built by anterior descending coronary deligation, then the survival rats were devided into 6 groups randomly:sham-operated group(sham,n=8),fed with normal saline of same volume instead;control group(control,n=7),fed with normal saline of same volume instead;Qiliqiangxin great dosage group(great,n=9),Qiliqiangxin 1.2g/(kg?d) treatment;Qiliqiangxin medium dosage group(medium,n=9),Qiliqiangxin 0.6g/(kg?d) treatment;Qiliqiangxin small dosage group(small,n=8 rats),Qiliqiangxin 0.3g/(kg?d) treatment;the captopril group(captopril,n=9),captopril 25mg/(kg?d) treatment.24 hours later,rats in sham operated group and model group were given normal saline,rats in treating group were given Qiliqiangxin,rats in the contrasting group were given captopril.After being treated for 4 weeks, all rats′ heart function was measruated by right flank arteria carotis communis arterial cannula.The left ventricle mass index was calculated and the expression of protein caspase-3 was tested by immunohistochemical method and Westernblot. Results Compared with control group, Qiliqiangxin capsule could reduce effectively BW,HMI,LVMI,increase LVEDP and LVSP,+dp/dtmax and -dp/dtmax.Immunohistochemical analysis and Westernblot analysis showed that adminstration of Qiliqiangxin significantly inhibited caspase-3 expressions in myocardial cells in a dose-dependent manner.Conclusion Qiliqiangxin significantly improved the CHF rat′s cardiac function and reduced the left ventricle mass index and heart mass index 4 weeks after being treated with relative high dose Qiliqiangxin. It might be partially attributed to the suppression of caspase-3 expressions.

Objective To discuss the incidence,clinical characteristics of sepsis-associated liver injure in pediatric patients and risk factors that may affect the prognosis.Methods A retrospective analysis was made on the data of patients with sepsis-associated liver injure that had been hospitalized in Shanghai Children′s Hospital from January 2011 to December 2015.The cases were divided into the survival group and the death group.Logistic regression analysis was made to screen out risk factors of patients with sepsis-associated liver injure that influence the prognosis.Results The incidence of sepsis associated liver dysfunction was 9.7%(120/1242),the mortality rate was 35.8%(43/120).The most common focus of infection was respiratory tract infection(50.0%),followed by abdominal cavity infection(33.3%) and central nervous system infection(6.7%).The pathogenic microorganisms were mainly gram-negative bacilli(51.3%),followed by virus(26.5%) and gram-positive bacterium(17.7%).The main manifestations of the liver injure were elevated glutamic-pyruvic transaminase(117 cases,97.5%),prolonged prothrombin time(PT)(93 cases,77.5%),hypoproteinemia(83 cases,69.2%) and hyperbilirubinemia(70 cases,58.3%).The total bilirubin(TBIL),PT,activated partial thromboplastin time and total bile acid of the death group were higher than thoes of the survival group.Logistic regression analysis indicated that elevated TBIL(OR=2.937,95%CI 1.179-7.315,P=0.021) was the independent risk factor for death.The area under receiver operating characteristic curve for TBIL(cut off was 64.5μmol/L)was 0.736 with sensitivity 57.7% and specificity 84.8%.Conclusion The incidence rate of sepsis-associated liver injure among pediatric patient is high.Gram-negative bacilli are the main pathogenic microorganisms.This disease is manifested as the elevated glutamic-pyruvic transaminase,hypoproteinemia,prolonged PT and hyperbilirubinemia.Hyperbilirubinemia is the independent risk factor that influences the prognosis.

0.05). However, egg production (0.37?0.22 egg/hen? day) and feed efficiency(0.21 ?0.11 egg kg/feed kg) in group 4(FSD) increased 54.2% and 61.5% respectively. The results from this study showed that egg cholesterol significantly decreased when laying hens were fed fiber-sequestrant.

Objective To investigate the effect of vasoactive intestinal peptide (VIP) and methylprednisolone (MP) on Toll-like receptor (TLR)2/4 mRNA expression in endotoxin (lipopolysaccharide,LPS) induced shock.Methods Ninety Sprague-Dawley rats were randomly divided into LPS group (n =20),LPS + VIP group (n =20),LPS + MP group (n =20),LPS + VIP + MP group (n =20) and control group (n =10).LPS group injected intravenously LPS (E Coli O55B5) 10 mg/kg.LPS + VIP group,LPS + MP group and LPS + VIP + MP group were injected intravenously VIP 5 nmol/kg,MP 3 mg/kg and VIP 5 nmoL/kg + MP 3 mg/kg after LPS 10 mg/kg injection.The control group injected normal saline intravenously instead of LPS.The rats were sacrificed at 6 h and 24 h after injection and the intestine samples were collected.Pathological changes of the intestine were observed by microscopy.RT-PCR was used to detect the intestinal TLR2 mRNA and TLR4 mRNA expressions.Results Intestinal mucosa showed edema or necrotic change with structure of the microvilli disappeared after LPS injection.The inestinal lesions in VIP,MP and VIP + MP groups were milder than LPS group.At 6 h after LPS injection,TLR2 mRNA and TLR4 mRNA expressions were significantly up-regulated in LPS group,LPS + VIP group,LPS + MP group and LPS + VIP + MP group (TLR2 mRNA:1.14 ±0.38,1.17 ±0.42,1.16 ±0.41,0.92 ± 0.29;TLR4 mRNA 1.21 ±0.18,1.04 ± 0.38,1.11 ± 0.34,1.01 ± 0.20) compared with the control group (0.32 ± 0.20,0.24 ± 0.17) (P ＜ 0.01).But there was no significant difference between LPS group,LPS + VIP group,LPS + MP group and LPS + VIP + MP group (P ＞ 0.05).At 24 h after LPS injection,TLR2 mRNA and TLR4 mRNA expressions in LPS + VIP group,LPS + MP group and LPS + VIP + MP group (TLR2 mRNA:0.63 ± 0.12,0.59 ± 0.13,0.52 ±0.19;TLR4 mRNA 0.67 ±0.09,0.64 ±0.09,0.51 ±0.13) were significantly lower than LPS group (1.04 ± 0.38,0.82 ±0.18) (P ＜0.01) (P ＜0.05).Conclusion VIP and/or MP can mitigate intestinal injury induced by LPS shock.The gastrointestinal protection of VIP and glucocorticoids were related to downregulation signaling TLR2 mRNA and TLR4 mRNA expression.But VIP/MP and VIP + MP have no significant effect on expression of intestinal TLR2/4 mRNA until 24 h after LPS shock.

Objective To observe the changes of HNP1-3 and NE content in serum quantitatively during perioperation of cardiac surgery under cardiopulmonary bypass(CPB),and to explore the role of changes of HNP1-3 and NE content in early diagnosis of system inflammatory response syndromes(SIRS)after cardiopulmonary bypass.Methods The contents of HNP1-3 and NE in serum during perioperation of 21 cardiac surgeries under cardiopulmonary bypass were measured quantitatively using ELISA method,and the contents of CK,CK-MB and C-RP in serum were measured at the same time points as that of HNP1-3 and NE.Results The contents of HNP1-3 and NE in serum were 54.55?26.45 ng/ml and 41.09?9.93 ng/ml respectively before CPB,and they were 435.45?500.13 ng/ml and 250.91?97.21 ng/ml respectively 0.5 h after CPB which were significantly higher than that before CPB(P