Objective To evaluate the effect of selective oral decontamination (SOD)on reducing incidence of ventilator-associated pneumonia (VAP).Methods Sixty patients hospitalized in an intensive care unit (ICU)for >72 hours and with mechanical ventilation for >48 hours from January to June 2102 were selected for study,patients were ran-domly divided into trial group(n =30)and control group(n=30).All patients received cefotaxime intravenous drip for 4 days,then trial group received oropharyngeal application of tobramycin during the whole process of mechanical ventila-tion,control group topically received saline solution,the incidence and onset time of VAP ,duration of mechanical ventila-tion,length of stay in ICU,and mortality of two groups were compared.Sputum in the trachea was taken periodically for bacterial culture.Results The incidence of VAP in trial group was lower than control group (30.00% vs 63.33%);the onset time of VAP was later than control group ([9.37±6.62]d vs [5.17 ±4.72]d);Overall duration of me-chanical ventilation was less than control group ([7.63 ±6.91 ]d vs [12.26 ±9.36]d);length of stay in ICU was shorter than control group([13.56±7.22]d vs [16.79±11 .16]d)(all P <0.05).There were no significant differ-ence in mortality between two groups(P >0.05).Conclusion SOD is effective for preventing and treating VAP,it can reduce the incidence of VAP,delay onset time of VAP,shorten mechanical ventilation,and reduce length of stay in ICU.

Objective To compare the effect of pressure regulated biphasic positive airway pressure ventilation(BiPAP) and airway pressure release ventilation(APRV) on cardiopulmonary function of pigs with or without acute lung injury. Methods after anaesthesia, 18 healthy pigs were given BiPAP or APRV ventilation through tracheotomy. Inspiration pressure and expiration pressure in BiPAP equal to APRV. Inspiration time and expiration time is 1.5/2.5s in BiPAP and 4.0/2.0s, 4.5/1.5s, 5.0/1.0s, 5.5/0.5s in APRV respectively. Respiration dynamics, hemodynamics, blood gases and oxygen metabolize scales were measured during two mechanical ventilatory modalities pigs acquired from Swam-gans catheter in internal jugular vein and from catheter in femoral artery. Then oleic-induced acute lung injury model was made, modalities pigs were distributed to BiPAP group (n=9) and APRV group (n=8) randomly. Forenamed scales were repeat measured. Results BiPAP has not difference with APRV on respiration dynamics, hemodynamics, blood gases and oxygen metabolize during normal condition, BiPAP has higher cardiac output (CO) and lower oxygen extraction ratio (O2ER) compare with APRV in ALI pigs. If expiration time is short to 0.5s in APRV, it would represent intrinsic peak end-expiratory (PEEPi), heart rate (HR), mean pulmonary arterial pressure (MPAP) and systemic vascular resistance (SVR) increased and CO decreased. Conclusion Both BiPAP and APRV are beneficial in ALI, but BiPAP has fewer side-effect compared with APRV in early ALI.

Objective To observe the regularity of expression changes in CD80 in peripheral blood, lung and splenic dendritic cells (DCs) in mice with acute lung injury (ALI) induced by lipopolysaccharide (LPS) and its correlation with lung inflammation. Methods Twelve C57BL/6 mice were randomly divided into two groups, namely control group and ALI group, with 6 mice in each group. LPS (2 mg/kg) was intra-tracheal instilled in mice to reproduce ALI model, while the control mice received intra-tracheal administration of phosphate buffer saline (PBS) instead. The mice were sacrificed 6 hours after model reproduction, lung tissues were collected, and lung coefficient was calculated (lung wet weight/body weight ×100%). The pathological changes were examined under optical microscope after hematoxylin and eosin (HE) straining, the severity of lung injury was evaluated by the Smith score. Interleukin-6 (IL-6) level was determined by enzyme-linked immunosorbent assay (ELISA). After single-cell suspensions were isolated from the lung and spleen, the level of CD80 on DC in peripheral blood, lung and spleen was assessed by flow cytometry (FCM). The correlation between CD80 positive DC number and the severity of lung injury was analyzed by Spearman correlation method. Results Compared with control group, LPS-induced ALI resulted in a significant increase in lung coefficient [(0.67±0.04)% vs. (0.52±0.02)%, P < 0.05], and the levels of IL-6 were significantly enhanced (pg/mg: 2 712±475 vs. 335±168, P < 0.05). Histologically, widespread alveolar wall thickening caused by congested, severe hemorrhage in the interstitium and alveolus, and marked and diffuse interstitial infiltration with inflammatory cells were observed in ALI group. In contrast, no histological alteration was observed in the control group. In addition, the lung injury scores were markedly higher in ALI group than those in the control group (5.10±0.24 vs. 0.60±0.12, P < 0.05). It was shown by FCM analysis that there was a gradual but significant increase trend of CD80 positive dendritic cells number in blood, lung, and spleen in both control mice and ALI mice. However, no significant differences in the number of peripheral blood CD80 positive DCs were found between control group and ALI group [(3.3±1.5)% vs. (5.1±2.1)%, P > 0.05]. In contrast, there were a low but significantly higher percentage of CD80 positive DCs in the lung and spleen in ALI group than that in control group [Lung: (9.6±2.5)% vs. (3.6±1.2)%, spleen: (25.2±4.7)% vs. (9.0±3.6)%, both P < 0.05]. It was shown by the Spearman correlation analyses that respiratory CD80 positive DCs number was significantly positively correlated with IL-6 level in the lung (r = 0.761, P = 0.042) and the Smith score (r = 0.752, P = 0.047). Conclusions There is a significantly higher percentage of CD80 positive DCs in the lung and spleen in ALI mice, and a significantly positively correlation between respiratory CD80 positive DCs number and IL-6 level in the lung or the Smith score, which suggests elevated expression of CD80 on dendritic cells seems to play an important role in the pathogenesis of acute lung injury.

Objective: To investigate the effects of early enteral nutrition (EEN) in the treatment of patients with severe burns. Methods: Medical records of 52 patients with severe burns hospitalized in the three affiliations of authors from August to September in 2014 were retrospectively analyzed and divided into EEN group (n=28) and non-early enteral nutrition (NEEN) group (n=24) according to the initiation time of enteral nutrition. On the basis of routine treatment, enteral nutrition was given to patients in group EEN within post injury day (POD) 3, while enteral nutrition was given to patients in group NEEN after POD 3. The following items were compared between patients of the two groups, such as the ratio of enteral nutrition intake to total energy intake, the ratio of parenteral nutrition intake to total energy intake, the ratio of total energy intake to energy target on POD 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28, the levels of prealbumin, serum creatinine, blood urea nitrogen, total bilirubin, direct bilirubin, and Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score on POD 1, 3, 7, 14, and 28, the first operation time, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage, and low blood sugar within POD 28. Data were processed with χ²test, ttest, Wilcoxon rank sum test, and Bonferroni correction. Results: (1) The ratio of parenteral nutrition intake to total energy intake of patients in group EEN on POD 1 was obviously lower than that in group NEEN (Z=2.078, P<0.05). The ratio of enteral nutrition intake to total energy intake and the ratio of total energy intake to energy target of patients in group EEN on POD 2 and 3 were obviously higher than those in group NEEN (Z=5.766, 6.404, t=4.907, 6.378, P<0.01). The ratio of total energy intake to energy target of patients in group EEN was obviously lower than that in group NEEN on POD 4, 5, 6, and 7 (t=4.635, 2.547, 3.751, 5.373, P<0.05 or P<0.01). On POD 2, 4, 5, 14, 21, and 28, the ratio of enteral nutrition intake to total energy intake of patients in group EEN was obviously higher than the ratio of parenteral nutrition intake to total energy intake within the same group (Z=5.326, 2.046, 2.129, 4.118, 3.174, 3.963, P<0.05 or P<0.01). In group NEEN, the ratio of enteral nutrition to total energy intake of patients on POD 1, 2, and 3 was obviously lower than the ratio of parenteral nutrition intake to total energy intake within the same group (Z=2.591, 2.591, 3.293, P<0.05 or P<0.01), while the ratio of enteral nutrition to total energy intake of patients on POD 14, 21, 28 was obviously higher than the ratio of parenteral nutrition intake to total energy intake within the same group (Z=2.529, 3.173, 3.133, P<0.05 or P<0.01). (2) The prealbumin levels of patients in the two groups were close on POD 1, 3, 7, and 14 (t=1.983, 0.093, 0.832, 1.475, P>0.05). On POD 28, the prealbumin level of patients in group EEN was obviously higher than that in group NEEN (t=3.163, P<0.05). The levels of serum creatinine, blood urea nitrogen, total bilirubin, and direct bilirubin of patients in the two groups at all time points post injury were close (Z=1.340, 0.547, 0.245, 0.387, 0.009, 1.170, 0.340, 1.491, 0.274, 1.953, 0.527, 0.789, 0.474, 1.156, 0.482, 0.268, 0.190, 0.116, 1.194, 0.431, P>0.05). (3) The APACHE Ⅱ scores of patients in group EEN were (22.5±3.1) and (15.6±3.8) points respectively on POD 1 and 3, which were close to (23.6±3.0) and (17.6±4.2) points of patients in group NEEN (t=1.352, 1.733, P>0.05). The APACHE Ⅱ scores of patients in group EEN on POD 7, 14, and 28 were (13.6±3.6), (13.8±4.1), and (15.5±4.1) points, respectively, which were obviously lower than (18.5±3.9), (19.5±4.2) and (20.8±3.8) points of patients in group NEEN (t=4.677, 4.843, 4.792, P<0.05). (4) Within POD 28, the time of the first operation, the number of operations, and the frequencies of abdominal distension, diarrhea, vomiting, aspiration, catheter blockage and hypoglycemia were similar between patients of the two groups (t=0.684, 0.782, Z=0.161, 1.751, 0.525, 0.764, 0.190, 0.199, P>0.05). Conclusions EEN in the treatment of patients with severe burns potentially increases the energy intake at early stage and improves APACHE Ⅱ score and prealbumin level on POD 28, without increasing frequencies of adverse reactions.

Objective To investigate the causes of bile duct dilatation. Methods Clinical data of 1 430 patients with bile duct dilatation who were admitted to People's Hospital of Hainan Province between January 2000 and December 2014 were retrospectively analyzed. Among them, 876 were males and 554 were females, aged 13-85 years old with a median age of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. The causes and severity of bile duct dilatation were observed. The relationship between the degree of secondary bile duct dilatation and serum total bilirubin (TB) level was analyzed by Kruskal-Wallis rank-sum test. Results Congenital cystic dilatation of common bile duct accounted for 6.3% (90/1 430). And secondary bile duct dilatation accounted for 93.7%(1 340/1 430), including 28.4% (380/1 340) of mild dilatation, 35.8% (479/1 340) of moderate, 25.4%(341/1 340) of severe and 10.4%(140/1 340) of extremely severe. Common causes of secondary bile duct dilatation were common bile duct stone, pancreatic head carcinoma, periampullary carcinoma, extrahepatic cholangiocarcinoma and chronic pancreatitis, in the order. The degree of secondary bile duct dilatation induced by common bile duct stone, pancreatic head carcinoma, periampullary carcinoma and chronic pancreatitis was correlated with the serum TB level (H=29.401, 9.483, 9.722, 11.907; P<0.05). Conclusions Bile duct dilatation is mainly secondary. The common causes are common bile duct stone, pancreatic head carcinoma, periampullary carcinoma, extrahepatic cholangiocarcinoma and chronic pancreatitis, in the order. The degree of secondary bile duct dilatation induced by common bile duct stone, pancreatic head carcinoma, periampullary carcinoma and chronic pancreatitis is correlated with serum TB level.

OBJECTIVE: To assess the association of polymorphisms of receptor of advanced glycation end products (RAGE) gene, monocyte to high-density lipoprotein cholesterol ratio (MHR) and variability of heart rate among patients with coronary heart disease (CHD). METHODS: 120 patients with CHD and 120 healthy individuals were respectively selected as the observation group and the control group. Allelic and genotypic differences of -429T>C, 1704G>T, 82G>S, MHR ratio and heart rate variability between the two groups and patients with different severity were analyzed. The correlation between their genotypes and MHR ratio and heart rate variability was analyzed. RESULTS: The 82G>S polymorphism of the RAGE gene and the allelic difference between the two groups and patients with different severity were statistically significant (P< 0.05). Compared with the control group and patients with mild to moderate phenotype, monocyte, total cholesterol, triglyceride, low density lipoprotein, MHR, low frequency in the observation group and patients with severe symptoms were significantly higher, while their high density lipoprotein, standard deviation of NN intervals (SDNN), standard deviation average of NN intervals (SDANN), root mean square successive differences, percentage of differences exceeding 50ms between adjacent normal number of intervals (PMN50), high frequency (HF) were significantly lower. The gene frequencies of G-Gly-T, T-Gly-T, G-Ser-T and G-Gly-C were correlated with SDNN, SDANN, rMSSD, PMN50, HF and MHR, but negatively correlated with low frequency. CONCLUSION Polymorphisms of the RAGE gene in patients with coronary heart disease are associated with the MHR ratio and heart rate variability, which can be used as markers for the diagnosis and efficacy evaluation.
Antigens, Neoplasm ; Coronary Disease/genetics* ; Gene Frequency ; Glycation End Products, Advanced ; Heart Rate ; Humans ; Mitogen-Activated Protein Kinases ; Polymorphism, Genetic

Objective To investigate the causes of peripheral cytopenia in patients with posthepatitic cirrhosis and portal hypertensive splenomegaly.Methods The clinical data of 183 patients with hepatitic cirrhosis and portal hypertensive splenomegaly complicated by peripheral cytopenia who were operated in our hospital in the past 17 years were retrospectively studied.Results All these patients underwent splenectomy.Before operation,all these patients had one or more types of peripheral cytopenia (cumulative cytopenia:390 patient-times).After splenectomy,blood counts in 79.2％ returned to normal;in 15.9％ increased but failed to reach normal levels;and in 4.9％ became lower than before operation.5 patients died soon after operation.Conclusion Hypersplenism is the main cause for the peripheral cytopenia most cirrhotic portal hypertension patients.Splenectormy is an effective method to treat hypersplenism.

Immune disorders are common in critically ill patients. Catecholamines play a crucial role in theimmune regulation and modulation. Immune cells can synthesize catecholamines and express adrenergic receptors. Catecholamine has a wide-ranging regulatory effect on innate immunity such as neutrophils, monocyte macrophages, dendritic cells, natural killer cells, and lymphocyte-mediated acquired immunity. Catecholamines exert different immunomodulatory effects by binding to α receptors, β receptors, and dopamine receptor subtypes on immune cells. In-depth study of the effect and mechanism of catecholamine on immune function in critically ill patients will provide new ideas for the prevention and treatment of immune dysfunction in critical illness.
Catecholamines ; Critical Illness ; Humans ; Killer Cells, Natural ; Neutrophils

Objective:To investigate the CT features and surgical treatment of mixed epithelial and stromal tumor of the kidney (MESTK).Methods:From April 2015 to August 2018, 13 patients with MESTK confirmed by pathology at the First Affiliated Hospital, College of Medicine, Zhejiang University, were enrolled in this study and their clinical data were analyzed retrospectively. These patients included 3 males and 10 females, with age ranging from 22 to 80 years old and the median age of 37 years old. Two patients complained of lumbar discomfort with urinary urgency and another 2 patients presented with hematuria. Nine patients were asymptomatic and their renal lesions were detected by abdominal ultrasonography for physical examination or other reasons. There were 2 cases had a history of polycystic kidney disease, 1 patient took contraceptive for 2 years, and 3 cases took antihypertensive agents for 5-10 years. The other patients denied any administration of hormone or other medicine for long time. The urine routine test was normal for these patients except for 2 patients did not take this test before operation. The creatinine value ranged from 45 to 486 μmol/L, with the median value of 67 μmol/L. The scope of glomerular filtration rate (GFR) was 6.98 to 132.28 ml/min, with the median value of 109.28 ml/min. The preoperative computer tomography (CT) showed single neoplasm in 11 patients and no obvious neoplasm was found in 2 patients who had polycystic kidney disease. Moreover, these lesions presented cystic neoplasm for 8 cases, cystic-solid neoplasm for 2 cases and solid neoplasm for 3 cases. Long diameter was measured about 2.5 to 7.5 cm, with the median of 5 cm, and calcification was found in 4 cases. These tumors manifested mild to moderate enhancement and delayed-enhancement for tumor parenchyma and intracapsular septum. The CT attenuation value was from 20 to 55 Hounsfield unit (HU). Base on the R. E.N.A.L. score system, these renal lesions got 4 to 10 points, with the median value of 7 points. Before operation, just 1 case was diagnosed as angiomyolipoma and 2 cases were diagnosed as polycystic kidney disease. No definitive diagnosis was made for the other 10 cases by CT imaging. In addition, the tumor staging based on preoperative imaging was made at T1a for 8 cases and T1b for 3 cases. Among these cases, 2 patients with polycystic kidney disease underwent open radical nephrectomy due to recurrent hematuria and uremia. One patient underwent laparoscopic radical nephrectomy due to perirenal fat adhesion. Partial nephrectomy was performed in remaining 10 patients by open surgery for 6 patients, robotic surgery for 3 patients and laparoscopic surgery for 1 patient. These renal tumors and 0.5-1.0 cm surrounding normal renal parenchyma were removed during operation.Results:In this study, 8 patients had blood loss of 30 to 100 ml during open operation, and 5 patients had blood loss of 20 to 100 ml during laparoscopic or robotic surgery. The warm ischemic time during partial nephrectomy was around 17 to 40 min, with the median value of 20 min. All of 13 cases were diagnosed as MESTK by postoperative pathology and the surgical margin was negative. There were no serious complications or special treatment after operation. The follow-up time ranged from 12 to 41 months, with the median time of 21 months. Obvious signs of tumor recurrence or metastasis were not detected in 13 cases during follow-up.Conclusions:CT images of MESTK mostly presented cystic or cystic-solid lesions, and solid lesions were relatively rare. This disease always showed mild to moderate enhancement and delayed enhancement of septal or tumor parenchyma. If there is coarse calcification in the lesions, it is more likely to be diagnosed as MESTK. Partial nephrectomy is preferred and radical nephrectomy should be considered when perirenal fat adhesion is suggested by the preoperative CT images.

Immune disorders are common in critically ill patients. Catecholamines play a crucial role in theimmune regulation and modulation. Immune cells can synthesize catecholamines and express adrenergic receptors. Catecholamine has a wide-ranging regulatory effect on innate immunity such as neutrophils, monocyte macrophages, dendritic cells, natural killer cells, and lymphocyte-mediated acquired immunity. Catecholamines exert different immunomodulatory effects by binding to α receptors, β receptors, and dopamine receptor subtypes on immune cells. In-depth study of the effect and mechanism of catecholamine on immune function in critically ill patients will provide new ideas for the prevention and treatment of immune dysfunction in critical illness.