Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on the peripheral blood levels of high mobility group box chromosomal protein 1 (HMGB-1) in patients with systemic inflammatory response syndrome (SIRS) or sepsis.Methods Thirty patients with SIRS or sepsis in Intensive Care Unit of our hospital were scheduled for treatment of CVVH.The replacement liquid was put in by the pattern of pre-dilution of 40％ and post-dilution of 60％.The flow-rate was 3 L/h.The blood flow-rate was from 200 to 300 ml/min.5 ml blood from right radial artery was got at the time points of preCVVH,CVVH 2 h,6 h,8 h and post-CVVH 12 h and the serum was stored at the temperature of-20 ℃ after high speed centrifugation,and 2 ml filter liquor was reserved at the time point of CVVH 6 h.The concentration of serum and filter liquor HMGB-1 was measured by ELISA,but that of TNF-α and IL-6 were measured by radioimmunity.Results 30 patients adept CVVH therapy within 24 h to the hospital,and their therapy time was 2 ～ 5(2.4 ± 1.5) d.Among them,17 cases survived and 13 cases died with a fatality rate of 43.3％.Serum concentration of HMGB-1 decreased from the baseline in patients,although this decrease was not statistically significant[(11.88 ± 6.06) ng/ml,(11.97 ± 5.66) ng/ml,(11.94 ± 5.94) ng/ml,(11.73 ± 5.19) ng/ml vs (13.87 ± 4.68) ng/ml,P ＞ 0.05],Serum concentration of both TNF-αand IL-6 after therapy significantly decreased compared to the baseline in patients [TNF-α: (0.28 ± 0.15)ng/ml,(0.30 ± 0.14) ng/ml,(0.29 ± 0.19) ng/ml,(0.33 ± 0.19) ng/ml vs (0.41 ± 0.12) ng/ml,IL-6:(408.20 ±92.18)pg/ml,(250.51 ± 107.34)pg/ml,(276.00 ± 126.20) pg/ml,(315.16 ± 130.97) pg/ml vs (513.35 ± 125.95) pg/ml,P ＜ 0.05].Conclusions CVVH could decrease the concentration of HMGB-1 in peripheral blood,which would be one of the mechanisms of action for CVVH on sepsis.

Objective To evaluate the correlation between the level of CD4+CD25+regulatory T cells in periphend blood and disease severity in patients with sepsis.Methods Thirty-six septic patients and 5healthy controls were enrolled.Septic patients were divided into sepsis group(n=10),severe sepsis group (n=15)and septic shock group(n=11).The lymphocyte was seperated from peripheral blood and marked by PE-CD4 and FTTC-CD25 monoclonal antibody,the level of CD4+CD25+ regulatory T cells was detected by flow cytometry,and the clinical data of APACHE Ⅱ scores of septic patients was considered in 24 hours.The correlation between level of CD4+CD25+ regulatory T cells in peripheral blood and APACHE Ⅱ scores in septic patients was analyzed.Results Compared with the healthy controls [(5.48±0.98)%],the level of CD4+ CD25+ regulatory T cells in sepsis group(10.31±2.32)%,severe sepsis group(14.27 43.33)%,septic shock group(15.32±3.98)% had a significant increase(P＜0.05 or＜0.01).The log value of regulatory T cells in each group correlated positively with the APACHE Ⅱ scores(r=0.829,P=0.032;r=0.868,P=0.021;r=0.913,P=0.009),and the total coefficient of correlation was 0.903(P=0.013).Conclusion The level of CD4+CD25+ regulatory T cells in peripheral blood in septic patients has an abnormal increase,and their levels are related with the severity of disease.

Objective To evaluate the effect of electroacupuncture (EA) pretreatment on NODlike receptor pyrin domain-containing 3 (NLRP3) in neurons during cerebral ischemia-reperfusion (I/R) in rats.Methods Fifty-four adult male Sprage-Dawley rats,aged 7 weeks,weighing 250-280 g,were randomly divided into 3 groups (n =18 each) using a random number table:sham operation group (group S),group I/R,and EA pretreatment group (group E).Cerebral I/R was induced by occlusion of the right middle cerebral artery for 90 min using a nylon thread inserted into the internal carotid artery and advanced intracranially to block the blood flow,followed by reperfusion.In group E,the acupoint Baihui was stimulated with an electric stimulator (sparse-dense wave,frequency 2 Hz/15 Hz,intensity ≤ 1 mA) for 30 min once a day for 5 consecutive days,and the model of cerebral I/R was established at 24 h after the last stimulation.At 72 h of reperfusion,neurological function was assessed and scored.The rats were then sacrificed,and their brains were removed for determination of cerebral infarct volume (using TTC staining),expression of NLRP3,caspase-1 and interleukin-1beta (IL-1β) in brain tissues (by Western blot),and expression of NLRP3 protein in neurons (by immunofluorescence histochemistry).The percentage of cerebral infarct volume was calculated.Results Compared with group S,the percentage of cerebral infarct volume and neurological scores were significantly decreased,and the expression of NLRP3,caspase-1 and IL-1β in brain tissues was significantly up-regulated in group I/R (P＜0.05).Compared with group I/R,the percentage of cerebral infarct volume and neurological scores were significantly increased,and the expression of NLRP3,caspase-1 and IL-1β in brain tissues was significantly down-regulated ingroup E (P＜0.05).Conclusion The mechanism by which EA pretreatment reduces inflammatory responses during cerebral I/R injury may be related to down-regulation of NLRP3 expression in neurons in rats.

Objective To compare the outcomes of percutaneous Kirschner wire assisted reduction with minimally invasive plate osteosynthesis and open reduction with locking plate in treatment of Robinson type 2B midshaft clavicular fractures.Methods A retrospective case control study was conducted to analyze the clinical data of 96 patients with Robinson type 2B midshaft clavicular fracture from June 2009 to October 2016.There were 70 males and 26 females with an average age of 34.5 years.The patients were divided into two groups according to the different surgical methods:49 patients were treated with percutaneous Kirschner wire assisted reduction and minimally invasive locking plate osteosynthesis (minimally invasive group);47 patients were treated with open reduction with locking plate internal fixation (open plating group).According to the Robinson fracture typing,there were 28 patients with type 2B1 and 21 with type 2B2 in the minimally invasive group;there were 23 patients with type 2B1 and 24 with type 2B2 in open plating group.The length of incision,operation time,visual analog scale (VAS) 2 days after surgery,length of hospital stay,time of fracture healing,Constant score results of postoperative 6 months,1 year,and at the last follow-up,feedbacks on incision and functional satisfaction,and complications were compared between the two groups.Results The average follow-up was (19.6 ± 5.5)months in minimally invasive group and (20.3 ± 6.2)months in open plating group.The incision lengths of the minimally invasive group and the open plating group were (4.8 ±0.7)cm and (8.3 ± 1.6) cm,respectively.The minimally invasive group had significantly longer operation time [(75.5 ±21.6)minutes] compared with open plating group [(60.2 ± 19.1)minutes] (P ＜0.0l).In the minimally invasive group and open plating group,the VAS 2 days after surgery was (2.9 ± 1.5) points and (3.9 ± 1.7) points;the hospitalization time was (7.1 ± 2.6) days and (9.5 ± 2.9) days;the fracture healing time was (11.7 ± 2.2) weeks and (13.4 ± 2.9) weeks;patients' satisfaction with the appearance of the incision was 84％ and 60％,respectively.There were no significant differences in the Constant score and functional satisfaction between the two groups at postoperative 6 months,l year,and the last follow-up (P ＞ 0.05).The incidence of postoperative incisional hypertrophic scar was 8％ and 30％,and the incidence of local skin numbness or sensory loss was 10％ and 32％ in minimally invasive group and open plating group,respectively (P ＜ 0.0l).No significant differences in nonunion,internal fixation failure,incision infection,subcutaneous prominent plate or revision rate were found between the two groups (P ＞ 0.05).Conclusion Percutaneous Kirschner wire assisted reduction with minimally invasive locking plate and open reduction with locking plate internal fixation can both achieve good clinical outcomes in the treatment of Robinson 2B midshaft clavicular fracture;but the former shows more advantages in terms of incision length,incision appearance,operation time,pain 2 days after surgery,fracture healing time,and local skin sensory disturbances.

Neuroendocrine neoplasm (NEN) is a type of heterogeneous tumor that originates from peptidergic neurons and neuroendocrine cells. The presence of over-expressed somatostatin receptors (SSTR) on the surface of NEN tumor cells has led to the administration of radiolabeled somatostatin analogs (SSA) in combination with over-expressed SSTR, which is called peptide receptor radionuclide therapy (PRRT). The 1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacceticacid- D-Phe1-Tyr3-Thr8-octreotide (DOTATATE)-based α/β radionuclide therapy is one of the representative therapeutic methods of PRRT. This article reviews the progress of research on α/β radionuclide therapy based on DOTATATE and its related combination therapy, drug toxicity and safety, as well as expectation for modalities with clinical value for NEN treatment.

Objective: : EID3 (EP300-interacting inhibitor of differentiation) was identified as a novel member of EID family and plays a pivotal role in colorectal cancer development. However, its role in glioma remained elusive. In current study, we identified EID3 as a novel oncogenic molecule in human glioma and is critical for glioma cell survival, proliferation and invasion. Methods: : A total of five patients with glioma were recruited in present study and fresh glioma samples were removed from patients. Four weeks old male non-obese diabetic severe combined immune deficiency (NOD/SCID) mice were used as transplant recipient models. The subcutaneous tumor size was calculated and recorded every week with vernier caliper. EID3 and AMP-activated protein kinase α1 (AMPKα1) expression levels were confirmed by real-time polymerase chain reaction and Western blot assays. Colony formation assays were performed to evaluate cell proliferation. Methyl thiazolyl tetrazolium (MTT) assays were performed for cell viability assessment. Trypan blue staining approach was applied for cell death assessment. Cell Apoptosis DNA ELISA Detection Kit was used for apoptosis assessment. Results: : EID3 was preferentially expressed in glioma tissues/cells, while undetectable in astrocytes, neuronal cells, or normal brain tissues. EID3 knocking down significantly hindered glioma cell proliferation and invasion, as well as induced reduction of cell viability, apoptosis and cell death. EID3 knocking down also greatly inhibited tumor growth in SCID mice. Knocking down of AMPKα1 could effectively rescue glioma cells from apoptosis and cell death caused by EID3 absence, indicating that AMPKα1 acted as a key downstream regulator of EID3 and mediated suppression effects caused by EID3 knocking down inhibition. These findings were confirmed in glioma cells generated patient-derived xenograft models. AMPKα1 protein levels were affected by MG132 treatment in glioma, which suggested EID3 might down regulate AMPKα1 through protein degradation. Conclusion : Collectively, our study demonstrated that EID3 promoted glioma cell proliferation and survival by inhibiting AMPKα1 expression. Targeting EID3 might represent a promising strategy for treating glioma.

Objective To understand the current status of research on lung cancer immunotherapy to provide a reference for further investigation and future topic selection in this field. Methods CiteSpace visualization analysis software was used to analyze 400 Chinese studies in CNKI and 5 001 English studies in the Web of Science database from 2005 to 2021, with "lung cancer" and "immunotherapy" as keywords. Keyword co-occurrence analysis was performed on 17 English studies of "Lung Cancer" "Immunotherapy" and "Single cell sequencing" in the Web of Science database. Results "Non-small cell lung cancer" "immunosuppressants" "PD-L1" "dendritic cells" and "cytokine-induced killer cells" are current research hotspots in lung cancer immunotherapy. Monoclonal antibody drugs including nivolumab, pembrolizumab, atezolizumab, and durvalumab are hotspot drugs. Immunotherapy combined with chemotherapy as well as PD-L1 expression have become the focus of continuous research. The majority of studies on lung cancer immunotherapy are conducted in the United States, followed by China. Conclusion Lung cancer immunotherapy has gradually become a research hot spot in China. In the future, in-depth research is needed to provide cutting-edge directions for lung cancer immunotherapy.

Objective To investigate the characteristics of lung ultrasound images in critical care postoperative patients using BLUE-plus protocol . Methods Two hundred and twenty-two patients who were performed lung ultrasound measurements according to the BLUE-plus protocol within 24 hours admitted to the Department of critical care were included in this study . Data was collected and retrospectively analyzed to compare the proportion of different lung ultrasound signs at different speculate regions ,and to compare the lung ultrasound characteristics of patients undergo different surgeries . Results Excluding A lines ,the most common abnormal lung ultrasound signs at the diaphragmatic points were B7 lines (13 .06％ ) ,and the most common abnormal lung ultrasound signs at the posterior blue points were C signs (28 .60％ ) . The rate of C signs was significantly higher in post spinal cord surgery patients than those in other groups ( P =0 .032) . The rate of B3 lines was significantly higher at bilateral PLAPS points in oxygenation index 100-200 group compared with that in oxygenation index>300 group ( P =0 .011) . The rate of C signs was significantly higher at the left posterior blue point in oxygenation index 200-300 group , and at bilateral posterior blue point in oxygenation index 100-200 and <100 groups compared with those in oxygenation index >300 group ( P =0 .011 , P <0 .001 and P =0 .002) . The rate of pleural effusion was significantly higher at the right posterior blue point in oxygenation index 200 -300 group ,and at bilateral posterior blue point in oxygenation index 100 -200 group compared with those in oxygenation index >300 group ( P = 0 .001 , P < 0 .001 ) . Conclusions Screen with the BLUE-plus protocol can help to find abnormal signs including B3 lines ,B7 lines ,C signs and pleural effusion ,therefore instructs individualized treatment for postoperative patients . Pulmonary edema ,lung consolidation and pleural effusion are three main reasons responsible for hypoxemia in postoperative patients . Intensivists should avoid fluid overload , strengthen airway management ,postural therapy and encourage early mobility in postoperative patients .

Objective To analyze the dynamic changes and the influencing factors of T lymphocyte subsets in recipients with stable graft status within 1 year after lung transplantation. Methods Clinical data of 41 recipients with stable graft status after allogeneic lung transplantation were analyzed. The absolute value and ratio of T lymphocyte subsets in peripheral blood from recipients were measured by flow cytometry before operation, 2 weeks and each month (within 1 year) after operation, respectively. The effects of age, gender, body mass index (BMI), surgical method, incidence of primary graft dysfunction (PGD) after operation, and primary disease upon the absolute values of T lymphocytes were evaluated. Results Within 1 year after lung transplantation, the absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes and CD4⁺/CD8⁺ ratio were changed over time (all P < 0.001). Compared with preoperative values, there was no statistical significance in the absolute values of CD3⁺ and CD3⁺CD4⁺T lymphocytes at 12 months after operation (P=0.659, 0.109), whereas the absolute value of CD3⁺CD8⁺T lymphocytes was increased (P=0.02) and the CD4⁺/CD8⁺ ratio was decreased (P < 0.001). Age, gender, BMI, surgical method and incidence of PGD after operation exerted no significant effect on the dynamic changes of absolute values of CD3⁺CD4⁺ and CD3⁺CD8⁺T lymphocytes (all P > 0.05). Primary disease before lung transplantation exerted no effect on the changes of CD3⁺CD4⁺T lymphocytes, whereas the postoperative absolute value of CD3⁺CD8⁺T lymphocytes was higher in recipients with infectious lung diseases (P < 0.05). Conclusions The absolute values of CD3⁺, CD3⁺CD4⁺, CD3⁺CD8⁺T lymphocytes in recipients with stable graft status after lung transplantation are relatively low in the early stage after lung transplantation, then gradually restore, and stabilize at 6 months after operation. Dynamic changes are not associated with age, gender, BMI, surgical method and incidence of PGD after operation of recipients.

Objective To analyze the risk factors and clinical prognosis of acute kidney injury (AKI) early after lung transplantation. Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed, and they were divided into the AKI group (n=104) and non-AKI group (n=51) according to the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline. The incidence of AKI early after lung transplantation was summarized. The main indexes of recipients were collected. The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis. The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated. Results The incidence of AKI early after lung transplantation was 67.1%(104/155), including 47 recipients with stage 1 AKI, 34 recipients with stage2 AKI and 23 recipients with stage 3 AKI, respectively. Sixteen recipients required continuous renal replacement therapy (CRRT) early after lung transplantation. Preoperative complication with diabetes mellitus, preoperative complication with pulmonary hypertension, intraoperative mean arterial pressure (MAP) < 60 mmHg, intraoperative massive blood transfusion, and treatment with excessive therapeutic concentration of tacrolimus (Tac) within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation. Up to the end of follow-up, 66 recipients (42.6%) died, including 50 recipients in the AKI group and 16 recipients in the non-AKI group. The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group (40% vs. 66%, P < 0.05). With the increase of AKI severity, the cumulative survival rate of lung transplant recipients was decreased. Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis. Preoperative complication with diabetes mellitus and pulmonary hypertension, intraoperative MAP < 60 mmHg and massive blood transfusion, and treatment with excessive therapeutic concentration of Tac within postoperative 1 week are the independent risk factors for the occurrence of AKI early after lung transplantation.