Fluid overload is frequently found in patients with intravenous fluid resuscitation,and recent studies showed the potential risks of fluid overload for organ failure and mortality.To avoid volume overload and its associated complications,strategies to identify fluid responsiveness are necessary.Apart from the amount of fluid utilized for resuscitation,the type of fluid used also impacts patient outcome.In recent years,there has also been an increasing focus on comparing various resuscitation fluids with respect to both benefits and risks.In this article,through analyzing the impact of fluid overload on patient outcome,we describe the differences in static and dynamic estimates of fluid responsiveness,and review the current literature regarding choice of intravenous fluids for resuscitation in critically ill patients to help clinicians to make appropriative decision on intravenous fluids prescription and to optimize patient outcome.

Sepsis is a serious problem among the elderly population as its incidence and mortality rates dramatically increase with advanced age. More importantly, the elderly has increased vulnerability to developing sepsis due to diminished physiologic reserve, presence of comorbidities, immunosenescence and frequent instrumentation. Those who survive severe sepsis are more likely to have irreversible organ damage, cognitive impairments, and diminished overall function. Additionally, elderly patients with sepsis often present with atypical symptoms which further complicates and potentially delays diagnosis. Although sepsis is a serious life-threatening disease, recognition of this problem is very low compared to other age-associated diseases. Therefore, the purpose of this review is to analyze the challenges facing this cohort and how to optimize their management.

The contents of coumarins in the sulfur fumigated Angelicae Dahuricae Radix (Baizhi, ADR) were reduced significantly. To achieve the quality control of ADR, the qualitative identification of sulfur fumigated ADR and quantitative model of imperatorin content should be established. The near-infrared (NIR) spectrograms of non-sulfur and sulfur fumigated ADR were collected by NIR diffuse reflectance spectroscopy technology and pretreated by the method of first derivative derivation and vector normalization. The Ward's Algorithm method was used for the cluster analysis. The non-sulfur and sulfur fumigated ADR can be quickly identified in the range of 8,806. 0-3 811.0 cm(-1) based on the cluster analysis. The NIR quantitative model of imperatorin was established by the contents of imperatorin determined by HPLC in combination with partial least squares regression analysis. According to the calibration model established in this study, correlation coefficients (R2), the root-mean-square error of cross-validation (RMSECV), and the root-mean-square error of prediction (RMSEP) for imperatorin were 0.982 8, 0.006 8, 0.011 8, respectively. The quantitative model of imperatorin can be applied to determine the content of imperatorin in ADR accurately.
Angelica ; chemistry ; classification ; China ; Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; Quality Control ; Spectroscopy, Near-Infrared ; methods ; Sulfur ; chemistry

OBJECTIVETo observe the effect of Qinwen Baidu Decoction (QBD) in treating snake bite induced dissseminated intravascular coagulation (DIC).

METHODSForty-six patients were randomly divided into the control group (n = 16) and the treated group (n = 30). They were all treated with the conventional therapy, including application of anti-snake venom serum and supplement of blood agglutination factors. For the treated group, QBD was administered additionally. The efficacy of treatment, chief indexes for DIC (platelet, fibrinogen and prothrombin time) and their recovery time, etc. were observed.

RESULTSThe total effective rate of the treated group was 93.33%, which was higher than that of the control group (56.35%), and the recovery time of chief DIC indexes in the treated group was significantly shorter than that in the control group respectively (P < 0.01).

CONCLUSIONQBD shows obvious effects of shortening therapeutic course and enhancing efficacy in treating snake bite induced DIC.

Adolescent ; Adult ; Combined Modality Therapy ; Disseminated Intravascular Coagulation ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Immune Sera ; Male ; Middle Aged ; Phytotherapy ; Single-Blind Method ; Snake Bites ; complications ; drug therapy ; Snake Venoms ; immunology

OBJECTIVETo study the chemical constituents of unsaponifiable matter from the seed oil of Trichosanthes hupehensis.

METHODThe fatty oil from the seeds of T. hupehensis was extracted with petroleum ether. The saponification was carried out with potassium hydroxide. The unsaponifiable matter was isolated and purified by silica gel column chromatography. Their structures were elucidated by means of MS, IR, UV, and 1H-NMR.

RESULTKarounidiol, isokarounidiol, 5-dehydrokarounidiol, 7-oxodihydrokarounidiol, stigmast-7-en-3beta-ol, stigmast-7, 22-dien-3beta-ol, 10alpha-Cucurbitadienol, beta-sitosterol, stigmast-7, 22-dien-3beta-O-beta-D-glucoside were elucidated.

CONCLUSIONAll of these compounds were found in this plant for the first time.

Oleanolic Acid ; analogs & derivatives ; chemistry ; isolation & purification ; Plant Oils ; chemistry ; isolation & purification ; Plants, Medicinal ; chemistry ; Seeds ; chemistry ; Sitosterols ; chemistry ; isolation & purification ; Trichosanthes ; chemistry ; Triterpenes ; chemistry ; isolation & purification

OBJECTIVETo analysis the changes of two chemical constituents, namely 2, 3-dihydro-3, 5- dihydroxy-6-methyl-4H-pyran-4-one (DDMP) and 5-hydryoxymethyl-furfural (5-HMF) produced in Radix Polygoni Multiflori after processing, with processing time, and to determine the contents of 5-HMF in samples of Radix Polygoni Multiflori and Radix Polygoni Multiflori preparata.

METHODAn HPLC method was applied with a Zobax SB-C18 (3.9 mm x 150 mm, 5 microm) column by a elution using methanol-water (10: 90) as the mobile phase. The detection was set at UV 280 nm.

RESULTThe contents of DDMP were increasing with the processing time until 24 hour, followed by a decrease until 60 hour process. The contents of 5-HMF were increasing gradually throughout the 60 hour steaming process. The contents of 5-HMF in 11 samples of Radix Polygoni Multiflori preparata were from 0.013% to 0.101%, and only one in 4 samples of Radix Polygoni Multiflori containing trace amount of 5-HMF.

CONCLUSIONThe chemical components in Radix Polygoni Multiflori were changed during the processing procedures. Therefore, the processing of Radix Polygoni Multiflori should be controlled and standardized.

Chromatography, High Pressure Liquid ; methods ; Drugs, Chinese Herbal ; chemistry ; Polygonaceae ; chemistry ; Reproducibility of Results

OBJECTIVETo study the chemical constituents contained in the seeds of Cucumis sativus.

METHODThe fatty oil was extracted by heating and refluxing with petroleum ether. Potassium hydroxide-methanol solution was used for saponification. An unsaponifiable matter was extracted by EtOAc and separated with various chromatographic methods. Its structure was identified on the basis of their physicochemical properties and spectral data. The fatty acid fraction was methyl-esterified and determined by GC. The composition and relative content of fatty acid were determined with normalization method of peak area.

RESULT24-ethylcholesta-7, 22, 25-trienol (1), 24-ethylcholesta-7, 25-dienol (2) ,avenasterol (3), spinasterol (4), karounidiol (5) and isokarounidiol (6) were separated and identified from the unsaponifiable matter. Myristic acid (7, 0.12%), palmitic acid (8, 12.04%), palmitoleic acid (9, 0.09%), heptadecanoic acid (10, 0.06%), stearic acid (11, 5.64%), oleic acid (12, 6.95%), linoleic acid (13, 74.40%), arachidic acid (14, 0.19%), and alpha-linolenic acid (15, 0.51%) were identified from the fatty acids part.

CONCLUSIONCompounds 5, 6, 9, 10, 14,and 15 were first reported in C. sativus.

Cucumis sativus ; chemistry ; Fatty Acids ; analysis ; Plant Oils ; analysis ; Seeds ; chemistry

OBJECTIVETo compare the effect between mini-traumatic bone-grafting and non-bone-grafting in percutaneous K-wire fixation for treating the calcaneal fractures.

METHODSFrom 2002 to 2006, 112 patients with the type II (Paley type) fractures of calcaneus were studied. There were 56 cases in bone-grafting group involving 36 males and 20 famales,aged from 21 to 65, averaged (42.0 +/- 2.3) years; 11 cases were in type II a and 45 were in type II b; the course was from 3 to 14 days, averaged (6.0 +/- 1.2) days. And there were 56 cases in non-bone-grafting group involving 38 males and 18 famales,aged from 22 to 67, averaged (43.0 +/- 2.5)years; 13 cases were in type II a and 43 were in type II b; the course was from 2 to 15 days, averaged (5.0-2.1) days. All the cases were treated by closed reduction and percutaneous K-wire fixation, and bone-grafting group(56 cases) were treated by mini-traumatic bone-grafting, but the other group (56 cases) were not. The collapsing rate and fineness rate were compared.

RESULTSAll the cases were followed up from 5 to 52 months. There were no collapsing cases in the bone-grafting group after operation, but 3 cases occurrenced re-collapsing in the non-bone-grafting group. According to the Zhang Tie-liang's evaluation criterion, in the bone-grafting group,the results were excellent in 43 cases, good in 12, fair in 1, the fineness rate was 98.2%. In the non-bone-grafting group,the results were excellent in 37 cases, good in 16, fair in 2, poor in 1, the fineness rate was 94.7%.

CONCLUSIONTreatment of the type II fracture of calcaneus with closed reduction, percutaneous K-wire fixation and mini-traumatic bone-grafting can prevent the posterior talar articular surface of caltaneus from collapsing again after operation, enhance the union of fracture, elevate the curative effect, thus it should be taken with the standard therapeutic regimen.

Adult ; Aged ; Bone Transplantation ; methods ; Bone Wires ; Calcaneus ; injuries ; surgery ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Transplantation, Autologous ; Treatment Outcome ; Young Adult

Adult ; Basilar Artery ; abnormalities ; Carotid Artery, Internal ; abnormalities ; Carotid-Cavernous Sinus Fistula ; surgery ; Embolization, Therapeutic ; Humans ; Male

OBJECTIVETo offer both the accurate three-dimensional anatomical information and algorithmic morphology of perforators in the lower leg for perforator flaps design.

METHODSThe cadaver was injected with a modified lead oxide-gelatin mixture. Radiography was first performed and the images were analyzed using the software Photoshop and Scion Image. Then spiral CT scan was also performed and 3-dimensional images were reconstructed with MIMICS 10.01 software.

RESULTSThere are (27 +/- 4) perforators whose outer diameter > or = 0.5 mm ( average, 0.8 +/- 0.2 mm). The average pedicle length within the superficial fascia is (37.3 +/- 18.6) mm. The average supplied area of each perforator is (49.5 +/- 25.5) cm2. The three-dimensional model displayed accurate morphology structure and three-dimensional distribution of the perforator-to- perforator and perforator-to-source artery.

CONCLUSIONSThe 3D reconstruction model can clearly show the geometric, local details and three-dimensional distribution. It is a considerable method for the study of morphological characteristics of the individual perforators in human calf and preoperative planning of the perforator flap.

Arteries ; Cadaver ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Leg ; blood supply ; Perforator Flap ; blood supply ; Surgical Flaps