Objective:To explore whether the optic nerve sheath diameter (ONSD) within 24 hours of intensive care unit (ICU) admission is the predictor of 28-day delirium or coma and death in etiologically diverse critically ill patients.Methods:A prospective, observational study was conducted. The critically ill patients admitted to the emergency ICU of Cangzhou Central Hospital from January 2021 to October 2022 were enrolled. Bedside ultrasound monitoring ONSD was performed within 24 hours of ICU admission. The consciousness status was assessed daily during ICU hospitalization. Coma was defined as Glasgow coma scale (GCS) score < 8 or Richmond agitation-sedation scale (RASS) score -4 or -5. Delirium was defined as responsiveness to verbal stimulation and with a positive confusion assessment method-intensive care unit (CAM-ICU). A positive result of CAM-ICU was defined as acute change or fluctuating course of mental status+inattention+altered level of consciousness or disorganized thinking. X-tile software analysis was used to visualize the best cut-off value for creating divisions in predicting 28-day coma or delirium and death, and then Kaplan-Meier curves were plotted. ONSD≥the optimal cut-off value from X-tile analysis was defined as ONSD broadening. ONSD broadening and related indicators were enrolled, and multivariate Cox regression analysis was used to analyze the risk factors of 28-day coma or delirium and 28-day death in etiologically diverse critically ill patients.Results:A total of 321 critically ill patients were enrolled. Of them, 49 had primary brain injury, 54 had hypoxic ischemic brain injury (HIBI) after cardiac arrest, 70 had acute heart failure, 73 had sepsis, and 75 had other causes. Coma affected 184 patients (57.3%), and delirium affected 173 patients (53.9%). At 28 days of follow-up, 100 patients died, 16 patients remained comatose and 20 patients remained delirious. In all patients, as the GCS score decreased upon admission to the ICU, there was a gradually increasing trend in ONSD [GCS score 15 group: 5.20 (4.93, 5.43) mm, GCS score 10-14 group: 5.30 (4.90, 5.65) mm, GCS score 6-9 group: 5.40 (5.10, 5.80) mm, GCS score < 6 group: 5.70 (5.20, 5.96) mm, P < 0.05]. X-tile software analysis showed that in all patients and five etiological subgroups, ONSD broadening was a predictor for 28-day coma or delirium, and the optimal cut-off value was obtained (5.60 mm for all patients, 4.90 mm for primary brain injury, 5.75 mm for HIBI after cardiac arrest, 5.40 mm for acute heart failure, 5.90 mm for sepsis, and 5.75 mm for other causes). The Kaplan-Meier curves were plotted according to the optimal cut-off values, and the results showed that the higher the ONSD, the higher the incidence and duration of coma or delirium within 28 days in above patient population. X-tile software analysis showed that in all patients, and HIBI after cardiac arrest, sepsis and other causes patients, ONSD was a predictor for 28-day death, and the optimal cut-off value was obtained (6.20 mm for all patients, 5.85 mm for HIBI after cardiac arrest, 5.35 mm for sepsis, and 6.10 mm for other causes). The Kaplan-Meier curves were plotted according to the optimal cut-off values, and the results showed that the higher the ONSD, the higher the 28-day survival rate and the shorter survival duration in above patient population. Multivariate Cox regression analysis showed that ONSD broadening was an independent risk factor for 28-day coma or delirium in all patients [hazard ratio ( HR) = 1.513, 95% confidence interval (95% CI) was 1.093-2.095, P = 0.013] and patients with primary brain injury ( HR = 5.739, 95% CI was 2.112-15.590, P = 0.001). However, ONSD broadening was not independently associated with 28-day death in all patients or in the five etiological subgroups. Conclusions:ONSD within 24 hours of ICU admission is an independent risk factor for 28-day coma or delirium in etiologically diverse critically ill patients. It serves as a predictor for 28-day coma or delirium in 5 subgroups of etiology including primary brain injury, HIBI after cardiac arrest, acute heart failure, sepsis, and other causes, but not for 28-day death.

Objective:To evaluate the prognostic accuracy of the sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria in predicting the mortality in patients with infection or suspected infection by using network Meta-analysis.Methods:Five databases including Wanfang Data, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), PubMed, Web of Science were searched from February 23, 2016 to September 5, 2020 to identify the relevant literatures comparing the prognostic accuracy of two or more scores for mortality in patients with infection or suspected infection. The literatures screening, data extraction and the quality assessment of the included studies were all conducted independently by two reviewers. Stata 14.0 software was used to test the heterogeneity between the original studies of pairwise comparison of each of the three scoring systems. Ring inconsistency test was used to judge the consistency between direct comparison and indirect comparison. Then network Meta-analysis was performed and the results were ranked. The predictive ability of the three scoring systems was evaluated by surface under cumulative ranking curve (SUCRA). A "comparison-correction" funnel plot was drawn to assess whether there was publication bias in the included studies.Results:A total of 38 studies were enrolled, the overall quality was high. Network meta-analysis showed that SOFA had a great prognostic performance in predicting mortality for patients with infection or suspected infection, which was followed by qSOFA [mean difference ( MD) = 0.07, 95% confidence interval (95% CI) was 0.05-0.09] and SIRS scores ( MD = 0.16, 95% CI was 0.14-0.18), and the qSOFA score was better than SIRS score ( MD = 0.09, 95% CI was 0.07-0.11). In the order of predicting the death risk of patients with infection or suspected infection, SOFA score had higher predictive value, followed by qSOFA score, and SIRS score was the lowest, with SUCRA values of 1.0, 0.5 and 0, respectively. Funnel plot showed that all the studies were distributed on both sides of the midline, but the distribution was not symmetrical, suggesting that there was a high possibility of publication bias and small sample effect. Conclusions:SOFA score had the best prognostic performance in predicting mortality of patients with infection or suspected infection as compared with qSOFA score and SIRS score. However, the funnel plot showed that included literatures may exist small sample effects or publication bias. So the final results should be validated by more prospective studies with multicenters and large samples.

Objective: To retrospectively analyze the efficacy and prognostic factors of postoperative intensity modulated radiotherapy for grade Ⅱ gliomas. Methods: Retrospective analysis was conducted on patients with postoperative grade Ⅱ glioma in our hospital from Jan. 2010 to Dec. 2018. The primary endpoint was progression-free survival, and the secondary endpoint was overall survival. Correlative analyses of prognosis by age, gender, initial resection status, the maximum diameter of the lesions, bi-hemisphere, astrocytoma, chemoradiation, adjuvant chemotherapy were conducted. Results: A total of 109 cases with grade Ⅱ glioma were enrolled. The follow-up rate was 91.75%, including 10 cases dead and 27 relapsed. There were 24 cases (88.9%) of in-field failure, and 3 cases (11.1%) of out-field failure. 14 cases of recurrence occurred in 81 cases of total resection group, accounting for 17.3%, and 13 in 28 cases of subtotal resection group, accounting for 46.4%. The recurrence rate in the subtotal resection group was significantly higher than that in the total resection group (χ ²=9.484, P<0.05). The 1-, 2-, 3-, 4- and 5-year progression-free survival rates were 92.5%, 86.0%, 80.6%, 77.5% and 66.8%, respectively. The 2-, 3-, 4- and 5-year overall survival rates were 97.2%, 90.8%, 87.7% and 84.5%, respectively. Multivariate analysis showed that patients with subtotal resection(HR=3.608, P<0.05) and bi-hemisphere(HR=3.183, P<0.05)were significantly correlated with the progression free survival. Conclusions Postoperative intensity modulated radiotherapy for grade Ⅱ gliomas can achieve a better PFS. Recurrence in the radiation field is the main failure mode. Initial resection status and bi-hemisphere of tumor are important influential factors for PFS of grade Ⅱ gliomas patients.

Aim To investigate the axonal regeneration effect of salidroside in MCAO rats and its potential mechanism.Methods Thirty-six healthy adult male Sprague-Dawley rats were randomly divided into three groups: sham, MCAO, MCAO+Sal groups.The rats were subjected to focal cerebral ischemia/reperfusion with suture-occluded method.Neurological deficit testing was performed with Zea Longa scale.The protein expression of p-Akt(Ser473), Akt, p-GSK-3β(Ser9), GSK-3β, p-CRMP-2(Thr514) and CRMP-2 in side cerebral ischemic tissues were determined using Western blot analysis.NF200 immunofluorescence staining was used to evaluate axonal regeneration.Results Compared with MCAO group,salidroside significantly improved the neurological deficit,up-regulated the protein expression of NF200,p-Akt and p-GSK-3β,and inhibited the protein expression of p-CRMP-2.Conclusions Salidroside improves neurological function recovery after focal cerebral/ischemic injury in rats,which may be associated with the up-regulation of phosphorylated Akt and GSK-3β and inhibition of phosphorylated CRMP-2,thereby promoting axonal regeneration.

Objective: To understand the viral etiology of a clustered case of human infection outbreak in the middle school of Huai’an city. Methods: Nasopharyngeal swab samples from patients were collected and rapidly detected by Real-time RT-PCR and the target virus isolated in cells. Furthermore, HA1 segments of target virus were amplified by RT-PCR and sequenced. The genetic and phylogenetic analysis based on HA1 genes was computed. Results: Influenza A(H1N1)pdm09 viral nucleic acid in 11 nasopharyngeal swab samples from patients in the outbreak were positive. Compared to the vaccine strains A/California/07/2009, the Huai’an isolates, nucleotide identity was 97.7%-98.1%, and amino acid identity was 96.6%-97.4%. Phylogenetic analysis of HA1 segment sequences indicated that the Huai’an strains from the outbreak were related closely to the viruses isolated in the year of 2014. Sequence analysis indicated that the Huai’an isolates had no amino acid substitution in the receptor binding sites and glycosylation sites, while in the Ca1 of antigenic determinant of HA1 the Huai’an isolates had an amino acid substitution of S for T at 220. Conclusions The pathogen of the clustered case of human infection was Influenza A(H1N1)pdm09 virus. Though the Huai’an isolates had one animo acid substitution in the Ca1 of antigenic determinant, the antigenicity characteristic remained unchanged.

Objective To establish a novel method by integrating immunomagnetic bead enrich-ment with immunochromatography for the detection of influenza A virus. Methods The immunomagnetic beads were prepared by using EDC/NHS method and then coupled with monoclonal antibodies against influ-enza A virus. A direct immunomagnetic beads-based immunochromatography for the detection of influenza A virus was developed by using double-antibody sandwich method and immunochromatography, which was fur-ther combined with immunomagnetic separation to establish the novel integrated method of immunomagnectic bead enrichment and immunochromatography. Clinical throat swab samples collected from patients with influ-enza A virus infection and healthy subjects were analyzed by the novel method and the results were compared with those by using the conventional colloidal gold immunochromatography to evaluate the specificity, sensi-tivity and positive coincidence rate of this established method. Results The direct immunomagnetic beads-based immunochromatography and the colloidal gold immunochromatography showed no significant differences in specificity and sensitivity and could be used to identify influenza A virus-positive samples with cycle threshold ( Ct) values less than or equal to 22 obtained by real-time PCR assay. The integrated method could identify positive samples with Ct values less than or equal to 28, indicating that the novel method was more sensitive. Conclusion The novel method by integrating immunomagnetic bead enrichment with immunochroma-tography was successfully established and suitable for the rapid and on-site detection of influenza A virus.

Objective To observe the impact of modified Liangge powder (MLP) on platelet activation markers and the release of proinflammatory cytokine in mice by stimulation of lipopolysaccharide (LPS). Methods 112 male mice were randomly divided into control group, model group and MLP low, middle and high dose treatment groups. The sepsis model was reproduced by injection of LPS 10 mg/kg into a mouse tail vein. In the control group, normal saline 10 mg/kg was injected into the tail vein of mouse. The MLP low, middle, and high dose groups received 0.94, 1.89, 2.84 g/mL MLP 0.02 mL/g by gavage respectively for 3 days, while the control group and model group received equal amount of normal saline by gavage for 3 days. After modeling for 24 hours and 72 hours, 8 mice in each of the three different dose MLP groups and model group were killed and their blood was taken. In the control group, after modeling for 24 hours, 8 mice were killed and their blood was taken. Platelet (PLT) was counted by blood cell analyzer, plasma interleukin-10 (IL-10), high mobility group protein B1 (HMGB1) and platelet factor 4 (PF4) were detected by enzyme-linked immunosorbent assay (ELISA). In each group after modeling for 72 hours, another 8 mice were taken, and laser scanning confocal microscopy was used to measure the platelet cytosolic Ca2+ concentration. Results Compared with the control group, the level of PLT at 24 hours(×109/L: 347.70±115.10 vs. 1 013.10±136.60) was decreased, and the levels of IL-10 (μg/L: 356.86±34.72 vs. 39.50±23.45), HMGB1 (mg/L: 16.24±4.49 vs. 10.75±1.91), PF4 (μg/L: 5.43±0.61 vs. 1.33±0.40) and Ca2+ (nmoL/L: 8.60±0.52 vs. 1.05±0.33) were elevated in model group. Compared with the model group, the levels of PLT in the MLP high, middle and low dose groups were all significantly elevated; the increase in PLT in middle dose group after modeling for 72 hours was the most remarkable (×109/L:952.13±104.02 vs. 771.50±129.30, P < 0.05); the levels of IL-10, HMGB1, PF4, Ca2+ in MLP low, middle, high dose groups were significantly decreased. The most obvious degree of decrease in level of the following indexes were as follows:IL-10 in MLP high dose group at 72 hours after modeling (μg/L:110.17±29.12 vs. 441.50±30.72), HMGB1 in MLP high dose group after modeling for 24 hours (mg/L: 10.33±3.52 vs. 16.24±4.49), PF4 in MLP middle dose group after modeling for 24 hours (μg/L:2.08±0.92 vs. 5.43±0.61) and Ca2+ in MLP high dose group (nmoL/L:2.97±0.96 vs. 8.60±0.52, all P<0.05). Conclusion MLP may possibly down-regulate the inflammatory cytokines release induced by LPS to inhibit the activation of platelet Ca2+, in turn prevent the activation of platelet and improve thrombocytopenia caused by LPS.

Objective To investigate the modulatory effect of different dosage of sufentanil on I GABA in rat dorsal root ganglion neurons. Methods The rat root ganglion neurons were enzymatically dissociated. The whole-cell patch clamp techniquewas applied to record the effect of 0.02 , 0.1, 0.5, 2.5 μmol/L sufentanil and 0.5 mol/L sufentanil + 1 nmol/L Naloxone, a non-specific ityopioid receptor antagonist on IGABA. Results 0.02, 0.1, 0.5, 2.5 μmol/L sufentanil potentiated IGABA to (108.7 ± 6.7)%,(122.0 ± 2.3)%, (146.7 ± 7.9)% and (130.1 ± 5.6)%, respectively (n = 10; *P < 0.05, **P < 0.01). The potentiation role of 0.1,0.5, 2.5 μmol/L sufentanil on IGABA lasted 10 to 20 min The potentiation could be blocked by Naloxone (n = 7; *P < 0.05, **P < 0.01). Conclusion Sufentanil activates μ opioid receptor and potentiates the action of GABAA receptor, and the potentiation could be blocked by Naloxone. The enhancement of currents by sufentanil may increase GABA A receptor-mediated presynaptic inhibition at the spinal cord level.

Objective To observe the effect of Compoud Qingqin Liquids on renal function of rat model of uric acid nephropathy, and to discuss its protection of renal function. Methods The rat model was induced by gavaging adenine and feeding yeast. SD rats were randomly divided into control group, model group, positive group, and high-, medium-, low-dose groups of Chinese medicine. Blank control group and model group were daily gavaged with distilled water, positive control group was daily gavaged with allopurinol by 9.33 mg/kg, and high-, medium-, low-dose group of Chinese medicine was daily gavaged with Compound Qinggin Liguids by 3.77, 1.89, 0.09 g/(kg·d) respectively for 6 weeks. General condition of rats were observed, renal pathological changes were observed with light and electron microscope. Urine protein concentration, blood uric acid, blood urea nitrogen, creatinine and kidney weight index were respectively tested before and after treatment. Results There were no significant differences in eating, drinking and body weight between before and after modeling. Compoud Qingqin Liquids can obviously decrease the concentration of urine protein, blood uric acid, serum creatinine, blood urea nitrogen, and kidney weight index (P<0.05) of rats with uric acid nephropathy. Renal tubular epithelial cells atrophy and renal interstitial fibrosis of high-dose group of Chinese medicine were not evident. Conclusion Compoud Qingqin Liquids can protect the rats renal function against uric acid renal injury.

Objective To evaluate the efficacy of continuous lumbar plexus block (CLPB) combined with a bolus dose added at night for postoperative analgesia in patients undergoing hip arthroplasty.Methods Sixty ASA Ⅰ or Ⅱ patients of both sexes,aged 51-75 yr,weighing 47-77 kg,with body height 150-180 cm,scheduled for hip arthroplasty,were randomized to receive either CLPB (group CLPB) or patient-controlled intravenous analgesia (PCIA) (PCIA group) for postoperative analgesia (n =30 each).Spinal anesthesia was performed at L3,4 interspace.Postoperative analgesia was performed at 30 min before the end of surgery.PCIA solution contained morphine 100 mg in 100 ml of normal saline.The PCA pump was set up with a 2 mg bolus dose and a 5 min lockout interval.CLPB solution contained 0.125 ％ ropivacaine hydrochloride 200 ml.CLPB pump was set up to deliver a 4 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h after a loading dose of 0.125％ ropivacaine 30 ml.In addition the patients received 0.25％ ropivacaine 30 ml at 8 o' clock every night after surgery in group CLPB.VAS scores at rest and during activity were recorded at 6,12,18,24,30,36,42 and 48h after operation.The side effect such as nausea and vomiting,pruritus and urinary retention were recorded within 48 h after operation.The patient' s satisfaction was assessed.The maximal hip flexion and abduction ranges of motion were recorded at 12,24,36 and 48 h after operation.The times of sleep interruption resulted from pain during nighttime were also recorded.Results Compared with group PCIA,the VAS scores during activity,severity of nausea and vomiting,pruritus and urinary retention,and times of sleep interruption resulted from pain during nighttime were significantly decreased,and the overall satisfaction score and maximal hip flexion and abduction ranges of motion were increased in group CLPB (P ＜ 0.05).Conclusion CLPB combined with a bolus dose added at night can provide better efficacy for postoperative analgesia in patients undergoing hip arthroplasty than PCIA,with fewer complications.