Objective To investigate the effect of Qingyi Decoction enema on the toll-like recep-tor(TLR)4/nuclear factor(NF)-κB signaling pathway in patients with acute pancreatitis(AP).Methods A total of 100 patients with mild AP were selected as the study objects,and randomly di-vided into control group(n=50)and observation group(n=50).The control group received con-ventional western medicine therapy combined with ulinastatin,while the observation group was treated with Qingyi Decoction retention enema on the basis of control group.Clinical efficacy,symptom re-lief,traditional Chinese medicine syndrome scores,pancreatic function indicators,inflammatory mark-ers as well as TLR4 mRNA and NF-κB mRNA expression levels were compared between the two groups.Results The clinical effective rate in the observation group was 92.00％which was significantly higher than 76.00％in the control group(P＜0.05).The observation group had significantly shorter times for abdominal distension pain relief,first bowel movement,recovery of bowel sounds and normalization of amylase(AMS)levels compared to the control group(P＜0.05).After 10 days of treatment,both groups showed significantly lower scores for abdominal pain,tenderness,fullness,dryness,nausea,vomiting and short red urine syndrome compared to before treatment,with the observation group showing significantly lower scores than the control group(P＜0.05).After 10 days of treat-ment,serum AMS and lipase(LPS)levels were significantly lower in both groups compared to be-fore treatment,with the observation group showing significantly lower levels than the control group(P＜0.05).After 10 days of treatment,serum tumor necrosis factor(TNF)-α,triggering receptor expressed on myeloid cells(TREM)-1,microtubule-associated protein 1 light chain 3(MAP1-LC3)and intercellular adhesion molecule(ICAM)-1 levels were significantly lower in both groups com-pared to before treatment,with the observation group showing significantly lower levels than the con-trol group(P＜0.05).After 10 days of treatment,TLR4 mRNA and NF-κB mRNA expression lev-els were significantly lower in both groups compared to before treatment,with the observation group showing significantly lower levels than the control group(P＜0.05).Conclusion Qingyi Decoc-tion can effectively improve the clinical symptoms of AP patients such as abdominal pain andabdomi-nal distension,inhibit inflammatory response,and promote the recovery of pancreatic function,which may be related to the inhibition of TLR4/NF-κB signaling pathway.

Ojective To determine the risk factors and the clinical distribution of multiple drug resistant bacteria in stroke- associated pneumonia (SAP) patients with multiple drug-resistant bacterial infections from in-tensive care unit, providing guidance for clinical treatment of SAP. Methods A retrospective study was de-signed to analyze the clinical data of the SAP patients from January 2012 to December 2015. Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections , and investigated the distribu-tion and drug resistance of MDR. Results There were 183 SAP patients, of which 131patients (71.6%) had MDR infection. There are 193 MDR strains in the 131 patients , the first 5 MDR strains were Acinetobacter bau-mannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli. MDR in-fection is highly associated with sever unconsciousness , time of stay in ICU longer than 7 days , ventilator time longer than 7 days and late-onset pneumonia and the difference was significant (P < 0.05). Conclusion SAP patients with MDR bacterial infections are in association with the following risk factors: sever unconsciousness , time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia. The rate of MDR bacterial infections was high , and these MDR strains were widely different degrees of resistance to many antibiotics.

Objective To observe the effects of Ulinastatin on pulmonary vascular endothelium permeability and respiratory function in patients with extrapulmonary acute respiratory distress syndrome(ARDS exp). Methods The data of 39 patients with ARDS exp were retrospectively analyzed.According to whether treated with Ulinastatin or not, all patients were divided into Ulinastatin group(n = 21)and control group(n = 18); The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index(PVPI) and respiratory function were measured before and after the treatment. Results The mortality rate of Ulinastatin group was lower than that of control group (28.6% vs 38.9%). The time of decreasing EVLWI, PVPI and improving PaO2/FiO and respiratory function in Ulinastatin group was shorter than that of control group, and the effect was superior. Conclusion Ulinastatin could reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with extrapulmonary acute respiratory distress.

OBJECTIVETo assess the effects of continuous blood purification (CBP) on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome (ARDSexp).

METHODSThe data of 31 patients with ARDSexp admitted in our department were retrospectively analyzed.Sixteen of the patients received CBP, and the other 15 patients did not (control group). The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and respiratory function were measured before and after CPB.

RESULTSThe mortality rate was significantly lower in CBP group than in the control group (12.5% vs 33.3%, P<0.05). The patients in CPB group showed markedly earlier and significantly greater improvements in EVLWI, PVPI, PaO2/FiO, and respiratory function than the control patients (P<0.05).

CONCLUSIONCBP can reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with ARDSexp.

Capillary Permeability ; Extravascular Lung Water ; Hemofiltration ; Humans ; Lung ; Monitoring, Physiologic ; Respiration ; Respiratory Distress Syndrome, Adult ; Retrospective Studies

Objective To assess the effects of continuous blood purification (CBP) on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome (ARDSexp). Methods The data of 31 patients with ARDSexp admitted in our department were retrospectively analyzed.Sixteen of the patients received CBP, and the other 15 patients did not (control group). The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and respiratory function were measured before and after CPB. Results The mortality rate was significantly lower in CBP group than in the control group (12.5% vs 33.3%, P<0.05). The patients in CPB group showed markedly earlier and significantly greater improvements in EVLWI, PVPI, PaO2/FiO, and respiratory function than the control patients (P<0.05). Conclusion CBP can reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with ARDSexp.

Objective To assess the effects of continuous blood purification (CBP) on extravascular lung water and respiratory function in patients with extrapulmonary acute respiratory distress syndrome (ARDSexp). Methods The data of 31 patients with ARDSexp admitted in our department were retrospectively analyzed.Sixteen of the patients received CBP, and the other 15 patients did not (control group). The level of extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI), and respiratory function were measured before and after CPB. Results The mortality rate was significantly lower in CBP group than in the control group (12.5% vs 33.3%, P<0.05). The patients in CPB group showed markedly earlier and significantly greater improvements in EVLWI, PVPI, PaO2/FiO, and respiratory function than the control patients (P<0.05). Conclusion CBP can reduce EVLWI and PVPI, improve pulmonary compliance and oxygenation, and reduce mortality rate in patients with ARDSexp.

Objective To investigate the effects of microRNA-29a (miR-29a) on lipopolysaccharide (LPS)-induced apoptosis in human monocytes THP-1 cells in order to understand the molecular mechanisms.Methods Human monocytes THP-1 cell line were exposed to LPS after transfected with miR-29a inhibitors (100 nmol/L) or just transfected with miR-29a mimic (100 nmol/L) by lipofectamine RNAiMAX.Flow cytometry (FCM) was used to detect the cell apoptosis.Real-time RT-PCR was employed to measure expressive levels of the gene Bcl-2 and Mcl-1.The luciferase assay was performed in HEK293T cells,which were co-transfected with plasmid DNA and miRNA by using Lipofectamine 2000.Statistical analysis carried out by using SPSS 13.0 software for One-way ANOVA and Student' s t test.Results Transfection with miR-29a mimics for 48 h increased apoptosis rate and significantly reduced the expressions of Bcl-2 and Mcl-1 in THP-1 cells in comparsion with the control group.The apoptosis rate also raised in THP-1 cell stimulated by LPS for 24 h followed by LPS stimulation for 24 h,the apoptosis rate was decreased in comparison with the LPS group.In addition,our luciferase assay data showed that HEK293T cells cotransfected with miR-29a mimics and Bcl-2 3 ' UTR-Wt or Mcl-1 3' UTR-Wt plasmid significantly reduced the luciferase activity compared with the control group.Conclusions The miR-29a may regulate apoptosis by targeting the genes Bcl-2 and Mcl-1,and miR-29a may play a pivotal role in the process of apoptosis in immune cells.

Objective To comparie the effects of pre-dilution with post-dilution continuous renal replacement therapy (CRRT) for patients with MODS. Method Thirty-two MODS patients admitted to ICU (Intensive Care Unit ) were randomized and treated with different modes of CRRT. The results of creatinine clearance, acid-base equilibrium, haemodynamic variables before and post therapy were recorded.The maximal pre-filter pressure, the duration of filter unworn out and mortality of patients treated with different modes of CRRT were also recorded. Results Seventeen patients were treated with pre-dilution mode of CRRT and 15 patients treated with post-dilution mode of CRRT. After 24 hours of pre- and postdilution modes of CRRT, the net increase in Ccr (namely the rate of replacement creatinine clearance) were (15.6±4.6) vs. (22.7 ±4. 1) mL/min respectively (P＜0.01); after 48-hour, they were (14.9±3.3)vs. ( 18. 9 ±2. 3) mL/min (p ＜0. 05) . Both dilution modes could improve the blood PH、 HCO3- and BE( P ＜ 0. 05 ) without significant differences between two groups after CRRT therapy ( P ＞ 0. 05 ) . The MAP of patients treated with pre-dilution modes of CRRT therapy for 24 hours and the MAP of patients before therapy were 69. 2 ± 4. 6 and 56. 7 + 9. 1 mmHg respectively ( P ＜ 0. 05 ), and dosage of dopamine used in patients before CRRT therapy and that after CRRT for 24 hours were ( 11.20 +3.45 ) vs (6. 12 +3.41 ) μg ·kg-1 min -1(P＜0.05).The maximal pre-filter pressures of pre-and post-dilution modes were (82.23+9.11) cm H2O, (110.56 +28. 14) cmH2O respectively (P＜0.05), and the durations of lasting effect of filter used in two modes of CRRT were ( 39 + 28. 12 ) vs. ( 25 + 14. 45 ) h respectively ( P ＜0. 05) . Both dilution modes could improve APACHE Scores. There were no significant differences in APACHE Scores and mortalities between two groups after CRRT therapy. Conclusions Post-dilution mode of CRRT has higher filtration rate, but have higher maximal pre-filter pressure and shorter longevity of filter.Pre-dilution mode of CRRT has better effect on improving hemodynamics, reducing usage of vasopressor.Both modes of CRRT can correct acid base equilibrium disorder rapidly. There are no differences in the results of blood gas analysis improved、 APACHE scores and mortality between the two groups.

Objective To analyze the pathogeny of acute respiration failure after kidney transplantation on early period and discuss the clinical value of mechanical ventilation.Methods A total of 16 cases of acute respiration failure after kidney transplantation on early period were studied retrospectively.Results The main causes were acute pulmonary edema caused by heart failure and serious pneumonia; patients were divided into two groups according to pathogeny: heart failure group (n=8) and non-heart failure group (n=8). It was found that the patients in heart failure group were older, preoperative blood pressure higher, dialysis duration longer, acute respiratory failure occurred earlier and mechanical ventilation time shorter than in non-heart failure group. The mechanical ventilation could raise oxygen pressure in artery blood and correct hypoxemia quickly. The mechanical ventilation could keep oxygen pressure in artery blood on the ideal level.Conclusion The pathogeny of acute respiration failure after kidney transplantation on early period included acute pulmonary edema caused by heart function failure and serious pneumonia; the mechanical ventilation was important to treat patient with acute respiration failure after kidney transplantation on early period because it could ensure oxygen pressure in artery blood in order to win time to cure heart failure and serious pneumonia. Also, the mechanical ventilation could improve prognosis of the patients.