Objective:To explore the feasibility of bedside ultrasound in monitoring gastric residual volume and predicting feeding intolerance during enteral nutrition in critically ill patients in intensive care unit.Methods:The data of critically ill patients admitted to emergency intensive care unit of the Second Affiliated Hospital of Zhejiang University School of Medicine from April 2018 to September 2018 were retrospectively analyzed. The following patients were finally included in this study: (1) abdominal computed tomography during the stay of emergency intensive care unit was performed due to the requirement of disease evaluation and management; (2) bedside ultrasound was performed to measure the gastric antrum cross-sectional area at 30 min prior to or after abdominal computed tomography. The outline of stomach wall in the imaging of abdominal computed tomography was traced with the help of VOLUME-Work Flow medical imaging software to calculate the value of gastric residual volume. The relationship between gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions and gastric residual volume was evaluated by Pearson correlation analysis. The difference of gastric antrum cross-sectional area between those critically ill patients with or without feeding intolerance was compared by independent-sample t test. The predictive value of gastric antrum cross-sectional area under different body positions on feeding intolerance during enteral nutrition was analyzed by ROC curve. Results:Totally, forty-two patients were enrolled and analyzed in this study, in which the mean age was (53±13) y, mean body mass index was (21.5±2.8) kg/m 2 and mean acute physiology and chronic health evaluation was 17.0±6.9. The value of gastric residual volume was (314.5±126.6) mL, and the values of gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions were (7.11±4.13) cm 2, (4.22±2.66) cm 2, (8.36±4.58) cm 2, respectively. The correlation analysis indicated that gastric residual volume was positively associated with gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions ( r=0.543, 0.604 and 0.618, respectively; all P<0.001). During enteral nutrition, 15 patients experienced feeding intolerance while 27 patients hadn’t feeding intolerance, in which the gastric antrum cross-sectional areas under semi-sitting, horizontal and right-lateral positions were significantly increased in those patients with feeding intolerance than those patients without feeding intolerance [semi-sitting: (8.53±4.07) cm 2vs (4.60±2.76) cm 2; horizontal position: (5.15±2.75) cm 2vs (2.61±1.32) cm 2; right-lateral position: (10.32±4.06) cm 2vs (4.95±3.20) cm 2, all P<0.005] . ROC curve analysis showed that the area under ROC curves of gastric antrum cross-sectional area under semi-sitting, horizontal and right-lateral positions for predicting feeding intolerance during enteral nutrition were 0.815, 0.833 and 0.849, respectively; when its values≥3.917 cm 2, 3.395 cm 2 and 4.402 cm 2 were used as the cut-off points, the sensitivities were 92.0%, 69.6% and 92.3%, and the corresponding specificities were 69.2%, 92.3% and 71.4%, respectively. Conclusions:Bedside gastric ultrasound could accurately evaluate the status of gastric residual volume in critically ill patients, and effectively predict their occurrence of feeding intolerance during enteral nutrition.

Objective To investigate the value of early lactate levels in predicting the progressionof acute kidney injury (AKI) in patients with extremely severe burns.Methods A retrospective casecontrol study was conducted to analyze 30 severe burn patients with early AKI who met the AKIhierarchical diagnostic criteria JP3 (RIFLE) and occurred within 72 hours after injury in the aluminiumdust explosion accident in Kunshan City,Jiangsu Province on August 2,2014.There were 20 males and10 females,aged 20-50 years [(37.1 ± 7.4) years].The total area of burn was 75％-100％ of total bodysurface area (TBSA) [(95.5 ± 4.3) ％ TBSA].Acute Physiological and Chronic Health Evaluation Ⅱ(APACHE Ⅱ) score ranged from 7 to 20 points [(13.0 ± 2.7)points].According to the progression ofrenal injury within one week after injury,the patients were divided into aggravation group and non-aggravation group,with 15 patients in each group.Laboratory examinations upon admission such as whiteblood cell (WBC),platelet,and plasma albumin,medical treatments during the first week after burninjury and 30-day mortality were compared between the two groups.The blood lactic acid,urea nitrogen,creatinine concentration and crinetime kinase in 72 hours after injury were compared between the twogroups.The receiver operative characteristic (ROC) curve of early blood lactic acid,blood urea nitrogen,creatinine concentration and crinetime kinase in patients with early AKI after injury was drawn to evaluateits predictive effect on early AKI aggravation in patients with severe burn.Results The plasma albuminconcentration of patients in the aggravation group was higher than that in the non-aggravation group onadmission to ICU (P ＜ 0.05).There were no significant differences in concentrations of WBC andplatelet upon admission and application of nephrotoxic antibiotics during the first week after burn injurybetween the two groups (P ＞ 0.05).In the aggravation group,the blood lactate concentration at 24 and48 hours after injury did not change significantly compared with the first detection after injury (P ＞0.05),but the concentration at 72 hours after injury was significantly lower than the first detection (P ＜0.05).In the non-aggravation group,the blood lactate concentrations at 24 hours,48 hours,72 hoursafter injury were not significantly different compared with the first detection (P ＞ 0.05).The first bloodlactate concentration in the aggravation group was significantly higher than that in the non-aggravationgroup (P ＜ 0.05),but there were no significant differences in the concentrations between the early AKIaggravation group and the non-aggravation group at 24 hours,48 hours and 72 hours after injury (P ＞0.05).The blood urea nitrogen concentration of patients in the early AKI aggravation group was higherthan that in non-aggravation group on admission (P ＜ 0.05),and no differences were observed in serumncreatine and creatine kinase concentrations between these two groups (P ＞ 0.05).The serumn creatineand creatine kinase concentrations of patients in the aggravation group were higher than those in non-aggravation group 24,48,and 72 hours after burn injury (P ＜0.05),and no difference was observed increatine kinase concentration between these two groups (P ＞ 0.05).The total area under ROC curve offirst blood lactic acid,blood urea nitrogen,creatinine and crinetine kinase in early AKI patients were0.872 (95％CI0.703-1.000,P＜0.05),0.722 (95％CI0.477-0.967,P＞0.05),0.411 (95％CI0.143-0.679,P＞0.05) and 0.656 (95％CI0.400-0.911,P＞0.05).The optimum threshold for thefirst blood lactate concentration after injury was 3.5 mmol/L.The sensitivity and specificity for predictingearly AKI exacerbation were 100％ and 72.7％,respectively.The 30-day mortality rate in the aggravationgroup was significantly higher than that in the non-aggravation group (P ＜ 0.05).Conclusion The firstblood lactate concentration in patients with severe burn is an early predictor of AKI aggravation,and itsearly predictive value is better than that of routine indicators such as serum creatinine blood urea nitrogenand crinetine kinase.

OBJECTIVETo explore the repair effects of acupuncture for promoting the governor vessel and tranquilizing the mind (acupuncture technique) on cerebral white matter injury of premature infants.

METHODSA total of 56 cases of cerebral whiter matter injury of premature infants, the fetal age less than 35 weeks were selected and randomized into an observation group (27 cases) and a control group (29 cases). The routine basic rehabilitation therapy was used in the two groups. Additionally, in the observation group, the acupuncture technique was added, once a day and the treatment for 15 days was as 1 course. Totally, 3 courses of treatment were required. Before and after treatment, the cranial magnetic resonance imaging (MRI) and the diffusion tensor imaging (DTI) were adopted to observe the location and severity of cerebral white matter injury. The Gesell developmental scale was used to assess the nerve motor development.

RESULTSAfter treatment, the difference was not significant statistically in the severity of cerebral white matter injury in the infants between the two groups (>0.05). The FA value of cerebral white matter in the interesting zone was increased as compared with that before treatment in the infants of the two groups (both<0.05). The result in the observation group was higher than that in the control groups (<0.05). After treatment, DQ value of each function zone in Gesell scale was all increased as compared with that before treatment in the two groups (all<0.05). After treatment, the DQ values of gross motor, fine motor and social adaptability in the observation group were higher than those in the control group (all<0.05). After treatment, the difference was not significant in DQ value of individual-social and speech behaviors between the two groups (both>0.05).

CONCLUSIONAcupuncture technique for promoting the governor vessel and tranquilizing the mind promotes the repair of the function in the premature infants with cerebral white matter injury and further benefits the promotion of the intelligence.

Influenza A virus is an enveloped virus of the Orthomyxoviridae family. Acute fever, generalized pain, fatigue and respiratory symptoms are the typical symptoms after influenza A virus infection. Influenza A virus triggers the activation of signaling pathways that are dependent on host pattern recognition receptors (PRRs) including toll-like receptors (TLRs), retinoic acid-inducible gene I receptors (RLRs) and NLRs. Then these signaling pathways activate downstream transcript factors that induce expression of various interferons and cytokines (IL-1, IL-18). This review will elaborate the mechanisms of these PRRs.

Objective: To investigate the association between single nucleotide polymorphisms (SNP) in cytokine IL6, IL10 genes and the susceptibility to primary hepatic carcinoma(PHC) of Shunde district in Guangdong Province. Methods: Patients from two hospitals in Shunde District of Foshan City were selected from October 2010 to October 2012. Case group inclusion criteria includedprimary liver cancer; local residents of Shunde or living in Shunde for more than 10 years. The control group inclusion criteria included: patients visited ENT, general surgery and physical examination department in the same hospital during the same period; Local residents or living in Shunde for 10 years and above. The control group was matched 1∶1 by gender, and age (±3 years old) with case group. A total of 306 subjects were collected. Questionnaires were used to investigate the information including demographic characteristics, PHC status survey and so on. The venous blood was collected from each subject to extract DNA, and to detect label SNP site and genotype. Hardy-Weinberg equilibrium was detected in the control group by the goodness-of-fit χ² test. Multivariate conditional logistic regression was used to estimate the relationship between IL6 (rs1800796), IL10 (rs1800871, rs1800872)genes polymorphisms and susceptibility to PHC. Results: There were 264 males and 42 females both in the case group and the control group, with an average age of (55.84±11.49) and (55.83±11.67) years old respectively (t=0.011, P=0.992). The frequencies of IL6 (rs1800796), IL10 (rs1800871) and IL10 (rs1800872) genotypes in the control group were in accordance with the Hardy-Weinberg equilibrium, which indicated the population was representative (all P values>0.05). Conditional logistic regression analysis showed that compared with the AA genotype and AA+AC genotype of IL10(rs1800872), CC genotype increased the risk of PHC by 2.02 times (OR=3.02, 95%CI:1.21-7.56)and 1.89 times (OR=2.89, 95%CI:1.19-7.04)respectively after the smoking history, eating fish history, drinking history, chronic hepatitis B infection, and family history of liver cancer adjusted. No statistical association was found between SNP in cytokine IL6 (rs1800796) and the susceptibility to PHC (P>0.05). Conclusion The results indicated that people who carried CC genotype in rs1800872 of IL10 gene have an increasing risk of PHC.

BACKGROUND:Stem cel s with wide variety of sources have the potential of differentiation and self-renewal. In additional, autologous stem cel s can avoid immune rejection after transplantation, and thus it has become one of the most promising alternative strategies for tissue/organ transplantation. However, due to the adverse environments at injured sites, such as oxidative stress and inflammation, current stem cel transplantation efficacy is relatively low. OBJECTIVE:To review the effects of oxidative stress on stem cel s and on their transplantation efficiency as wel as relevant mechanisms. METHODS:PubMed database was searched by the first author for relevant articles about stem cel s published from 1990 to 2015. The keywords were“stem cel transplantation, stem cel , oxidative stress, molecular mechanism”. After eliminating literatures which had poor authority or similar content, 97 articles were involved in result analysis. RESULTS AND CONCLUSION:Different types of stem cel s have different basal endogenous antioxidant stress levels. Oxidative stress through multiple molecular pathways causes cel aging, apoptosis and cancer, which also can result in apoptosis of cancer cel s. Stem cel s can adjust endogenous antioxidant levels through multiple paths. To improve the endogenous antioxidant stress level using a variety of methods can increase stem cel transplantation efficiency and prevent stem cel cancerization due to oxidative stress, which makes the clinical application of stem cel transplantation therapy safer and more popular.

Aged ; Benzylisoquinolines ; therapeutic use ; Bronchoalveolar Lavage ; Female ; Humans ; Male ; Middle Aged ; Oxidative Stress ; Phytotherapy ; Pneumoconiosis ; metabolism ; therapy ; Quality of Life ; Treatment Outcome

Objective To study the medication rule of traditional Chinese medicine treatment of urinary stone disease data mining. Methods Clinical study literature in China Journal Full-text Database 1985-2012 on Chinese medicine prescription of urinary stone disease were retrieved, database was established and analyzed by SPSS12.0 statistical software. Results There were 209 literatures meeting the inclusion criteria of Chinese medicine for urinary lithiasis, including 209 oral administration compound, 234 kinds of traditional Chinese medicine, 1843 times of frequency. The traditional Chinese medicine mainly for diuresis and diffusing dampness, restoring vital energy, blood-activating and removing stasis, regulating qi, clearing heat, promoting digestion and purgation, counted for 86.43%;with flavour of sweet, bitter, spicy, fresh, counted for 86.67%;nature of cold, plain, warm, counted for 93.08%;meridian tropism of liver, bladder, spleen, stomach, kidney, lung, heart, counted for 83.67%. Conclusion Trditional Chinese medicine of diuresis and diffusing dampness, restoring vital energy, blood-activating and removing stasis, regulating qi, clearing heat were commonly used. The core single medicine are Lysimachiae Herba, Glycyrrhizae Radix, Talcum, Lygodii Spora, Plantaginis Semen, Pyrrosiae Folium, Cyathulae Radix, Malvae Fructus, Galli Gigerii Endothelium Corneum, Akebiae caulis, etc.

Objective To evaluate the sufentanil-sparing effect of ketorolac tromethamine for postoperative analgesia in the elderly patients.Methods Sixty ASA Ⅱ or Ⅲ patients,aged ≥ 65 yr,with a body mass index of 18-24 kg/m2,undergoing elective gynecological operations,were randomly divided into 2 groups(n =30 each):sufentanil group(group S)and ketorolac tromethamine plus sufentanil group(group T).Both groups received combined intravenous-inhalational anesthesia and patient-controlled intravenous analgesia(PCIA)after operation.PCIA solution contained ketorolac tromethamine 180 mg and sufentanil 100 μg in 100 ml of normal saline in group T.After a loading dose of ketorolac tromethamine 30 mg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 rain lockout interval and background infusion at a rate of 1.5 ml/h in group T.PCIA solution contained sufentanil 100 μg in 100 ml of normal saline in group S.After a loading dose of sufentanil 5 μg was injected intravenously at 15 min before the end of operation,the PCA pump was set up with a 1.6 ml bolus dose,a 20 min lockout interval and background infusion at a rate of 1.5 ml/h in group S.The effective analgesia(postoperative VAS scores at rest and during activity ＜ 3)was maintained within 48 h after operation.The amount of sufentanil consumed within 48 h after operation and adverse effects were recorded.Results Compared with group S,the amount of sufentanil consumed within 48 h after operation was significantly reduced,and the incidence of nausea and vomiting,urinary retention and pruritus was significantly decreased in group T(P ＜ 0.05).Conclusion Ketorolac tromethamine used with PCIA with sufenlanil has a significant sufentanil-sparing effecl for posloperative analgesia and improves the safety of analgesia in the elderly patients.

Objective To study the effects of soybean isoflavone(SI) on lipid peroxidation and liver ultrastructure in ovariectomized rats. Methods Seventy female Sprague-Dawley(SD) rats were randomly divided into 7 groups according to the levels of total cholesterol(TC) in serum: hyper-lipoid group,estrogen group,low-dose SI group,middle-dose SI group,high-dose SI group,sham group and normal control group.After bilateral ovaries were extirpated except sham and normal control groups for a week,the estrogen,different doses of SI or deionized water were fed with intragastric administration for 12 weeks.The rat body weight was weighted once per week and blood samples were collected at the time of ovariectomization,the 4th and 8th weeks after administeration at the time of being killed.The serum TC,triglyceride(TG),high or low density lipoprotein-cholesterol(HDL-C,LDL-C),lipoprotein(a) and antioxygen enzyme were assayed. Results LDL-C levels in SI intervention groups were significantly lower than that in hyper-lipoid groups but higher than that in normal control group;the levels of lipoprotein(a) were changed;there was almost no effect on HDL-C in serum.SI could retain integrity and ultrastructure of hepatocyte;there was similar structure in high dose SI group and normal control group.An obvious damage was detected in hyper-lipoid group.Conclusion SI can improve lipoprotein(a) and lipid peroxidation in ovariectomized rats.A continuous intervention with high-SI can reduce LDL-C to normal lever and retain integrity and ultrastructure of hepatocyte.