Critical care medicine-related treatment is an interdisciplinary and multi-professional process,often leading to secondary or concomitant mental disorders in clinical practice.Currently,there is no consensus on the pharmacological treatment of related mental illnesses in China.The Chinese Society of Psychosomatic Medicine collaborated with the Critical Care Medicine expert group to form a consensus writing expert group.After a systematic review of relevant literature,summarizing published domestic and foreign literature,and extensive discussions,the consensus was developed.The consensus elaborates on the principles and processes of the standardized use of psychotropic drugs in critical care medicine,as well as the clinical indications,precautions,and specific drug selection of various psychiatric medications,providing feasible suggestions and guidance for the clinical application of psychiatric medications in the intensive care unit.

Objective To evaluate the clinical effect and safety of transcatheter thrombus-breaking combined with local infusion of reteplase (rPA) in treating severe pulmonary thromboembolism (PTE). Methods During the period from June 2010 to June 2013 at authors’ hospital, transcatheter thrombus-breaking combined with local infusion of reteplase was carried out in 26 patients (17 males and 9 females) with severe pulmonary embolism. The changes of pulmonary circulation and the cardio - pulmonary hemodynamics after the treatment were analyzed. Results The preoperative mean pulmonary artery pressure, arterial blood oxygen partial pressure and the blood pressure were (63.78 ± 6.89) mmHg, (73.23 ± 11.51) mmHg and (87.35 ± 10.92) mmHg respectively, while the postoperative ones were (26.23 ± 10.27) mmHg, (93.48 ± 6.17) mmHg and(127.14 ± 13.15) mmHg respectively, and the differences between preoperative and postoperative ones were statistically significant (P<0.01). All the patients were followed up for 6 - 36 months. Significant stable clinical improvement was obtained in 25 patients, and recurrence was seen in one patient. Conclusion Transcatheter thrombus-breaking combined with local infusion of reteplase can quickly improve the pulmonary circulation and the clinical conditions for patients with severe pulmonary thromboembolism, and it has no obvious complications. This technique carries excellent value in maintaining the stability of hemodynamics.

Objective To investigate the therapeutic effect and safety of high intensity focused ultrasound(HIFU) combined with Gemcitabine in treating unresectable pancreatic carcinoma Methods Forty one patients suffering from unresectable pancreatic carcinoma were randomly divided into two groups.The patients in experimental group(n =21) were provided with HIFU in combination with gemcitabine therapy and those in control group(n =20)received HIFU treatment alone.The effect,clinical benefit rates,changes of tumor marker carbohydrate antigen 19-9(CA19-9)and adverse reactions were compared between these two groups.The median survival time,6-month and 12-month survival rates were calculated by Kaplan-Meier method and Logrank test.Results The median survival time,6-month and 12-month survival rates were 10.22 months,76.2％(16/21) and 42.9％(9/21) in experimental group,and they were 7.43 months,50.0％(10/20) and 15.0％(3/20) respectively in control group.Among them,12-month survival rates was significantly higher in experimental group than that in control group(x2 =4.00,P ＜ 0.05).The clinical benefit rates in experimental group were significantly higher than that in control group[76.2％(16/21) vs 45.0％(9/20),x2 =4.20,P ＜0.05].But there was no significant difference on pain remission rate between the two groups(66.6％ vs45.0％,P ＞ 0.05).There was significant difference on CA19-9 after treated for 2,3,4,5 and 6 months in experimental group than that in control group(t =2.225,2.133,1.743,2.599,2.278,respectively,P ＜ 0.05)Conclusion HIFU in combination with Gemcitabine therapy is better than application of HIFU treatment alone.The former may become of the most effective treatmenffor unresectable pancreatic carcinoma.

objective The roles of TLRs and their signal pathway in gouty arthritis(GA)were explored.Methods TLR2 and TLR4 mRNA was measured using real-time quantitative polymerase chain reaction(RT-PCR)in PBMCs,IL-1β level was detected using ELISA in plasma,and NF-κB p65 protein level in PBMCs was measured using Western blot.Level of TLR2 mRNA,ILR4 mRNA,IL-1β,NF-κB p65protein was compared among acute GA,non-acute GA and healthy controls.Correlation between TLR2mRNA,TLR4 mRNA and serum uric acid,IL-1β level in GA patients was analyzed.One-way ANOVA was used to analyze data between multiple groups and q-test was used for two-two comparison.Spearman's analysis was applied for correlation analysis.Resuits The expression of TLR4 mRNA,NF-KB p65 protein,IL-1β arid serum uric acid level in patients with acute GA [(5.0±1.2), (7.11±0.18), (283±83)pg/ml,[585±123)μmol/L] was significantly increased compared to non-acute GA[(2.3±0.4),(0.63±0.06),(134±29)pg/ml,(493±107)μmol/Lj and healthy controls(1.1±0.6),(0.52±0.12),(97±17)pg/ml,(326±65)μmol/L](P<0.01,respectively).Significant diffefence was also observed between non-acute GA patients and healthy controls(P<0.05,respectively).The level of TLRR4 mRNA was positively correlated with uric acid and IL-1β level in GA patients(rs=0.876,0.779;P<0.05,respectively).Conclusion Innate immunity are activated by membrane-type pattern recognition receptors in primary GA.TLR4-NFκB p65-IL-1β signat transduction may participate in the inflammatory mechanisms of gout.Urate crystals in patients with gout may:be involved in the activation of TLR4 and its signal pathway.

Objective To explore MRI characteristics of virus encephalitis and its relevance with pathlological changes,and to improve understanding MRI features of virus encephalitis.Methods Seventeen cases of virus encephalitis clinically proven were collected and reviewed.The correlation between MRI findigns and pathology were analyzed.MRI examinations included plain scan and FLAIR scan in all 17 patients,among which 13 underwent contrast-enhanced MR scanning.Results The lesions mainly located at the cerebral cortex gray matter and the cerebrum subcortical gray matter nuclei.16 cases appeared as multiple foci,and 1 case was single focus.The foci had definite margins and with no obvious peripheral edema.The lesions were slightly hypo-or iso-intense on T_1WI,slightly intensity on T_2WI and obvious high signal intensity on FLAIR.After enhanced scan,the lesions were no obvious enhancement in 2 cases,enhancement line in the surfaces of the brain in 15 cases,in which the lesions showed patch enhancement in 6 cases and gyrus-like enhancement in 2 cases.Conclusion The pathological changes of viral encephalitis can be reflexed with MR imaging features,which is of important value in the differential diagnosis of virus encephalitis.

Objective To investigate the expression levels of telomeric protein TPP1 and POT1mRNA in the peripheral blood mononuclear cells (PBMCs) of patients with systemic lupus erythematosus (SLE), and the relations between these gene expression levels and disease activity are explored. Methods TPP1 and POT1 genes were measured using real-time polymerase chain reaction (RT-PCR) in PBMCs. The expression levels of TPP1 and POT1 genes in PBMCs were compared between 48 SLE patients and 30 healthy indivi-duals. Results The expression levels of TPP1 and POT1 in the PBMCs of SLE patients significantly decreased compared to healthy individuals (P<0.01). The expression levels of TPP1 and POT1 were much lower in SLE patients with lupus nephritis than those in patients without lupus nephritis (P<0.01), and in LN patients, the levels of TPP1 and POT1 were negatively correlated with proteinuria. The expression levels of POT1 in active SLE patients was lower than that in inactive SLE patients (P<0.05). The expression levels of POT1 was negatively correlated with serum IgG and SLEDAI scores, but positively correlated with complement C3, but no correlation between ESR, CRP, C4,ANA and the expression levels of TPP1, POT1, SLEDAI scores. Conclusion TPP1 and POT1 genes play a key role in the etiology of SLE, and they are involved in the pathogenesis of lupus nephritis. POT1 is helpful in evaluating SLE disease activity and severity.

Objective To investigate the signaling cascades involved in the regulatory effects of reactive oxygen species(ROS)on adiponectin expression in 3T3-L1 adipocytes.Methods 3T3-L1 cells were cultured and differentiated into mature adipocytes.Adiponectin mRNA expression was evaluated by quantitative real-time PCR.The signaling pathways associated with ROS-decreased adiponectin expression were screened by Bioplex phosphoprotein assays and various protein kinase inhibitors.Results As an important ROS,H_2O_2activated several signaling pathways including extracellular signal regulated protein kinase 1/2(ERK1/2),c-Jun N-terminal kinase (JNK),protein kinase B(Akt),p70 S6 kinase(p70 S6K),and Janus kinase/signal transducer and activator of transcription(JAK/STAT).Akt and JAK/STAT inhibitors completely reversed H_2O_2-decreased adiponectin expression(both P<0.01).Conclusions ROS markedly down-regulates adiponeetin expression in 313-L1 adipocytes by activating Akt and JAK/STAT signaling pathways,which may contribute to the development of obesity and its related diseases.

AIM: To prepare Nano-Liposome encapsulated MAGE3/HSP70(NL M3H) and study its character and antitumor immunity in mouse. METHODS: NL M3H was prepared by the thin film-dispersion ultrasonic. The shape and size of NL M3H were detected by electron microscope. The encapsulation rate, drug-carrying capacity, stability and the releasing character were tested by Sephedex-G100 gel filtration. The mouse was immunized by NL M3H, and the antitumor immunity was detected by ELISPOT and LDH release assay. RESULTS: The mean size of NL M3H was lower than 100 nm. The encapsulation rate was 38％.The drug content was 0.038 g/L. NL M3H has good stability after stored in 4℃ for 6 months. The releasing profile showed that 74 percent of proteins was released during the first 24 hours in saline. The results of ELISPOT and LDH release assay showed that NL M3H generated tumor specific cytotoxic T lymphocyte(CTL)to damage tumor cel1. CONCLUSION: NL M3H has novel characters, it can generate specific CTL to kill tumor cell, and can be used as new kind of vaccine agsinst tumor.

Objective To explore the anti-tumor effects of Egr-IFNγ gene therapy combined with 125I-UdR radionuclide therapy in mice bearing H22 hepatocarcinoma and its mechanism. Methods The recombinant plasmid pcDNAEgr-IFNγ mixed with liposome was injected into tumor. 48 h later, 370 kBq 125I-UdR was injected into tumor. The tumor growth rates at different times were observed. After 3 d gene-radionuclide therapy, the concentration of IFNγ in cytoplasm of H22 cells and cytotoxic activities of splenic CTL of the mice in different groups were examined. Results The tumor growth rates of pcDNAEgr-IFNγ +125 I-UdR group were obviously lower than those of control group, 125I-UdR group and pcDNAEgr-1 +125I-UdR group 6-15 d after gene-radionuclide therapy. IFNγ protein was found in cytoplasm of H22 cells in PcDNAEgr-1FNγ+125I-UdR group after 3 d gene-radionuclide therapy. Cytotoxic activity of splenic CTL in pcDNAEgr-IFN7 + 125I-UdR group was significantly higher than that in the other groups (P<0.01). Conclusions The anti-tumor effects in vivo of pcDNAEgr-IFNγ gene therapy combined with 125I-UdR radionuclide therapy are better than those of 125I-UdR therapy.

OBJECTIVETo investigate the expression of anaphylatoxin receptor C5aR (CD88) in synoviocytes from patients with rheumatoid arthritis (RA) and osteoarthritis (OA).

METHODSThe expression of C5aR was assessed in synoviocytes isolated from 27 RA and 12 OA patients using reverse transcription-polymerase chain reactions (RT-PCR), flow cytometry, and immunofluorescence analysis. The effects of C5a on the release of tumor necrosis factor alpha (TNF alpha) from synoviocytes were assayed using enzyme-linked immunosorbent assays (ELISA).

RESULTSC5aR mRNA was detected in 24 of 27 samples from RA patients, and 10 of 12 samples from OA patients. Flow cytometric analysis and immunofluorescence study demonstrated the cell surface expression of C5aR in a significant proportion of synoviocytes from both RA and OA patients, and the level of C5aR expression in synoviocytes was significantly correlated with joint swelling, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in RA patients. Finally, interaction of C5aR with its ligand C5a was shown to enhance lipopolysaccharide (LPS)-induced TNF alpha release from synoviocytes.

CONCLUSIONSThe expression of C5aR in synoviocytes from inflammatory joint diseases and also the induction of TNF alpha release in activated synoviocytes by the interaction of C5a and C5aR suggest that the C5a/C5aR system may play an important role in joint inflammation process.

Adult ; Aged ; Arthritis, Rheumatoid ; metabolism ; Cells, Cultured ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; metabolism ; Receptor, Anaphylatoxin C5a ; analysis ; Synovial Membrane ; chemistry ; cytology