Objective To summarize the clinical experience of extracorporeal membrane oxygenation (ECMO) treatment for adult acute respiratory distress syndrome (ARDS) caused by lung infections,so as to explore the clinical efficacy and application value of ECMO.Methods The patients with 7 ARDS who were responded poorly to mechanical ventilation in Zhongshan Affiliated Hospital of Sun Yat-sen University from January 2003 to January 2015 were collected.All patients were divided into a study group (7 cases) treated by ECMO and a control group (7 cases) treated by traditional methods.The percutaneous incision on femoral vein-internal jugular vein (V-V) was selected to carry out ECMO intubation,and the V-V ECMO model was used for auxiliary bypass of flow.The comparisons between the two groups for the results of hemodynamics,blood-gas analysis and oxygen metabolism were performed to evaluate synthetically the adjuvant effects of ECMO.Results Seven ARDS patients caused by lung infections were treated by ECMO,including 4 cases with bacterial pneumonia,2 cases with H7N9 and 1 case with H1N1.Thc duration of ECMO was (21.00 ± 10.06) days;2 cases were weaned from ECMO successfully,and 1 case recovered and discharged.Seven cases with ARDS caused by severe lung bacterial infections in control group were all not recovered on discharge.After treatment,the heart rate (HR),pulmonary arterial wedge pressure (PCWP),venous partial pressure of oxygen (PvO2),arterial blood lactic acid (Lac) in study group were significantly lower than those in the control group [HR (bpm)was 100± 12 vs.120± 19,PCWP (mmHg,1 mmHg =0.133 kPa) was 8.8 ± 2.6 vs.11.6± 3.8,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,Lac (mmol/L) was 2.1 ± 0.8 vs.5.2 ± 0.6,all P ＜ 0.05],the mean arterial pressure (MAP),cardiac output index (CI),arterial and venous blood pH values,arterial partial pressure of oxygen (PaO2),arterial partial pressure carbon dioxide (PaCO2),arterial oxygen saturation (SaO2),oxygen delivery (DO2),oxygen consumption (VO2),oxygen extraction (ERO2) were obviously higher in study group than those control group [MAP (mmHg) was 83.6 ± 8.2 vs.72.2 ± 94,CI (mL· s-1 · m-2) was 93.35 ± 3.33 vs.81.68 ± 8.33,pH of arterial blood was 7.4 ± 0.1 vs.7.1 ± 0.3,PaO2 (mmHg):98.5 ± 20.4 vs.49.3 ± 12.6,PaCO2 (mmHg):38.9 ± 16.2 vs.26.1 ± 17.4,SaO2:0.95 ± 0.02 vs.0.58 ± 0.04,pit of venous blood was 7.1 ± 0.2 vs.6.4 ± 0.3,PvCO2 (mmHg) was 40.8 ± 13.1 vs.48.9 ± 16.2,SvO2 was 0.75 ± 0.07 vs.0.49 ± 0.08,DO2 (mL· min-1 · m-2) was 651 ± 36 vs.400 ± 81,VO2 (mL· min-1 · m-2) was 245.0 ± 11.2 vs.103.0 ± 14.8,ERO2 was (35.6± 3.9)％ vs.(21.3± 5.2)％,all P ＜ 0.05].Conclusions ECMO can improve hypoxemia.So it can improve the metabolism and maintain hemodynamic stability,in the mean time the patients may gain more time for diagnosis and treatment of their primary lung diseases.The key points of a successful ECMO are suitable selection of patients and forceful prevention of complications.

Objective To explore the association between serum FGF23 and Klotho protein,and bone mineral density in maintenance hemodialysis (MHD) patients.Methods A total of 125 MHD patients admitted in the Hospital between January 2015 and November 2015 was enrolled.Their bone mineral densities of femur neck and lumbar spine were studied by dual-energy X-ray absorptiometry.These patients were divided into three groups as normal,osteopenic and osteoporotic,according to World Health Organization criteria based on bone mineral density T scores.Levels of serum FGF23,Klotho protein and 1,25(OH)2VitD3 were measured by ELISA.The parameters including calcium,phosphorus,and parathyroid hormone were assessed.Results The incidences of osteopenia and osteoporosis at the femur neck and lumbar spine in MHD patients were 82.40％ and 56.00％ respectively.No significant difference was found in the levels of serum FGF23 among normal,osteopenic and osteoporotic groups on the basis of femur neck and lumbar spine bone mineral density (P ＞ 0.05).No correlation was found between FGF23 and bone mineral density.There however were significant differences in the levels of serum Klotho protein among three groups on the basis of femoral neck bone mineral density (P ＜ 0.05).And the levels of Klotho protein in the osteoporotic group [(387.172±54.137) ng/L] were significantly decreased than those in normal group [(429.883±41.776)ng/L] and osteopenic group [(410.598±61.056) ng/L] (P ＜ 0.05).There were also significant differences in the levels of serum Klotho protein among three groups in terms of lumbar spine bone mineral density (P ＜ 0.05),while the levels of Klotho protein in the osteopenic group [(387.263 ± 53.255) ng/L] were significantly decreased than those in normal group [(417.108±56.179) ng/L] (P＜ 0.05).A positive correlation was found between Klotho protein and bone mineral densities of femur neck and lumbar spine.Multiple linear regression analysis showed that one of the main factors influencing the degree of bone mineral density in MHD patients was Klotho protein.Conclusions CKD-MBD with low BMD is common and widespread in hemodialysis patients.FGF23 has no direct effect on bone mineral density in MHD patients;while Klotho protein is correlated with the severity of bone mineral density.High-level Klotho protein may reduce the severity of CKD-MBD with low BMD in MHD patients.

Objective To investigate the factors correlated to coronary artery calcification (CAC) in maintenance hemodialysis (MHD) patients.Methods This study included 132 patients(54 females,78 males),aged 26-94 years,who were on hemodialysis for 10-204 months(median dialysis duration 51.00 months).The parameters including calcium,phosphorus,parathyroid hormone,total cholesterol,low density lipoprotein,triglycerides,C-reactive protein (CRP),klotho,and so on were assessed.Quantification of CAC was determined by multi-slice spiral computed tomography (MSCT),known as the coronary artery calcification score (CACs).Results Ninety-two patients (69.70％) had CAC,with CACs ranging from 0 to 13 450.20.More than 30％ patients experienced one even a variety of cardiovascular and cerebrovascular diseases.A positive correlation was observed between the degree of CAC and the incidence of cardiovascular and cerebrovascular diseases.Whereas a positive correlation existed between CACs and age (r=0.347,P=0.000),duration of hemodialysis (r=0.245,P=0.005),systolic blood pressure (r=0.184,P=0.034),diabetes history (r=0.211,P=0.015),phosphorus (r=0.262,P=0.002),calcium-phosphorus product (r=0.247,P=0.004);and a negative correlation between CACs and klotho level (r=-0.294,P=0.001).Multivariate logistic regression analysis showed that the main factor influencing the degree of CAC in MHD patients was age.Conclusions CAC is common and widespread in hemodialysis patients,who are often accompanied by cardiovascular and cerebrovascular diseases.The prevalence rate of cardiovascular and cerebrovascular diseases increases with the aggravation of CAC degree.Age,duration of hemodialysis,systolic blood pressure,diabetes history,disturbance of calcium and phosphorus metabolism and klotho are correlated with the severity of CAC.Age is an independent risk factor of CAC degree.

Objective To investigate the epidemiological features of infection among hemodialysis patients. Methods A total of 55 hemodialysis hospitalized patients diagnosed with infection were enrolled in this retrospective study from April 2010 to Augest 2013. Clinical date from 55 patients, were collected and analyzed with SPSS software. Results The 55 hemodialysis patients in 60 cases time got infected during the study, and the infection rate was 28.57%. Age, diabetes, hemoglobin were risk factors for infection. Pathogenic analysis showed 51.67% of infection was caused by gram-positive bacteria, 36.67% of infection was caused by gram-negative bacteria. The infection sites included vascu-lar access infection (43.33%) and lung infecton (48.33%). Drug sensitive tests showed that drug resistant rate of gram-positive bacteria to penicillin, ceftazidime, levofloxacin, streptomycin was high. There was no significance in the sea-sonal distribution of infection. Conclusion Infection rate is high in hemodialysis patients. Vascular access infection and lung infection are dominant infection sites.Drug resistance rate is high in infectious hemodialysis patients.

ObjectiveTo observe the occurrence and related factors of pulmonary hypertension (PH) in maintenance hemodialysis (MHD) patients.MethodsOne hundred MHD patients were divided into PH group(41 cases) and non-PH group(59 cases) according to the pulmonary artery pressure measured by cardiac ultrasound.The age,systolic blood pressure (SBP),diastolic blood pressure(DBP),vascular access way (arteriovenous fistula,central venous catheter ),dialysis adequacy index (KT/V) and albumin (ALB),hemoglobin (Hb),calcium (Ca),phosphorus (P),parathyroid hormone (PTH) was compared between two groups,and related factors were analyzed by Logistic regression analysis.Results Pulmonary artery systolic pressure (PASP) of PH group and non-PH group was (46.72 ±9.26) mm Hg (1mm Hg =0.133 kPa) and (32.06 ±6.14) mm Hg,and the difference between two groups was significant (P＜ 0.01 ).The arteriovenous fistula rate accounts for 95.1％ (39/41)in PH group,and Hb was (78.27 ±4.53) g/L,PTH was (863.16 ± 146.91 ) ng/L,right ventricular cross diameter was(32.43 ±4.32) mm,right atrial cross diameter was (38.67 ± 7.13 ) mm,right atrial length diameter was (57.23 ± 7.26) mm and left ventricular ejection fraction (LVEF) was (56.38 ± 11.43 )％,while 79.7％ (47/59),(82.67 ± 5.32 ) g/L,(725.68 ± 137.14) ng/L,(21.64 ± 3.65 ) mm,(34.17 ± 6.28) mm,(46.18 ± 6.20) mm,(64.37 ± 6.83)％ in non-PH group,the differences were statisticaly significant between two groups(P ＜0.05 or ＜0.01).Multivariate Logistic regression analysis showed that serum PTH,Hb,rightatrial cross diameter,LVEF,vascular access way were related factors of PH.ConclusionThe serum PTH,Hb,right atrial cross diameter,LVEF,vascular access way are related factors of PH,and the PH may be early prevented and treated by correcting these related factors.

Objective To examine the correlation of serum neutrophil gelatinase-associated lipocalin (NGAL) with dialysis adequacy,microinflammatory state and iron metabolism,and to assess the value of NGAL in identifying the dialysis adequacy in maintenance hemodialysis (MHD) patients.Methods A total of 150 MHD patients and 50 healthy control people were enrolled in the study.Clinical data were collected and serum NGAL,CRP,transferrin saturation,serum ferritin were measured.MHD patients were divided into adequacy group and non-adequacy group according to spKt/V value.Serum NGAL between two groups was compared and correlation of NGAL with spKt/V,inflammatory factors,and other clinical indexes was examined by Pearson,multivariate regression Logistic model and area under curve (AUC) of ROC.MHD patients were followed up for 3 months.Similar correlation analysis was carried out before and after follow up between two groups.Results Serum NGAL of MHD patients was higher compared to healthy people [(445.45±50.34) μg/L vs (50.02 ±6.45) μg/L].Among 150 MHD patients,95 were classified into adequacy group,while 55 into non-adequacy group according to spKt/V value.Serum NGAL was significantly higher in adequacy group as compared to non-adequacy group [(589.14±56.34) μg/L vs (360.13±46.23) μg/L,P＜0.05].Serum NGAL was positively correlated to spKt/V,CRP,TSAT [r=0.652,0.825,0.785,all P＜0.05],but not to serum ferritin.Serum NGAL was also correlated to spKt/V,CRP,TSAT by multivariate regression Logistic model.AUC showed that NGAL level could reflex the condition of dialysis adequacy.During the follow up,all adequacy patients remained the same adequacy status.Thirty-eight out of 55 non-adequacy patients were qualified for complete adequacy after intervention.The serum NGAL before and after intervention was (368.14±56.21) μg/L and (360.56±46.23) μg/L respectively without significant difference.Conclusions Serum NGAL is obviously higher in MHD patients with dialysis adequacy compared to those without dialysis adequacy.Serum NGAL is positively correlated to spKt/V,CRP,TSAT.NGAL can reflex the condition of dialysis adequate in MHD patients.

Objective To investigate DNA methylation markers in the whole blood of patients with systemic lupus erythematosus(SLE),in hope to facilitate the evaluation of SLE severity.Methods Whole blood samples were obtained from 58 patients with SLE(including 14 cases of severe SLE,25 moderate SLE,19 inactive SLE)and 50 healthy controls.Bisulphite sequencing was performed to determine the methylation status of interleukin-2 common receptor gamma chain(IL-2RG)promoter region,and real-time reverse transcriptionPCR to quantify the expression level of IL-2RG mRNA,in these subjects.Results The methylation level of IL2RG promoter region was 0.217 ± 0.140,0.325 ± 0.230,0.342 ± 0.085 and 0.175 ± 0.036 in the patients withsevere,moderate and inactive SLE and healthy controls,respectively.A significant increase was observed in the methylation level of IL-2RG promoter region in the patients with inactive SLE compared with the patients with severe SLE and healthy controls(both P ＜ 0.01),and in the patients with SLE compared with the healthy controls(0.263 ± 0.047 vs.0.175 ± 0.036,P ＜ 0.05).The expression level of IL-2RG mRNA was significantly lower in the patients with SLE than in the healthy controls(2.550 ± 0.823 vs.4.293 ± 1.283,P ＜ 0.05).A negative correlation was observed between the expression level of IL-2RG mRNA and methylation level of IL2RG promoter region in 20 patients with SLE(r =-0.44,P ＜ 0.05).Conclusion The methylation status of IL2RG promoter region is statistically higher in patients with SLE than in healthy controls,and significantly different between patients with active SLE and those with stable SLE.

The national standards of biofuels specify the technique specification and analytical methods. A water content certified reference material based on the water saturated octanol was developed in order to satisfy the needs of the instrument calibration and the methods validation, assure the accuracy and consistency of results in water content measurements of biofuels. Three analytical methods based on different theories were employed to certify the water content of the reference material, including Karl Fischer coulometric titration, Karl Fischer volumetric titration and quantitative nuclear magnetic resonance. The consistency of coulometric and volumetric titration was achieved through the improvement of methods. The accuracy of the certified result was improved by the introduction of the new method of quantitative nuclear magnetic resonance. Finally, the certified value of reference material is 4.76% with an expanded uncertainty of 0.09%.
Biofuels ; standards ; Magnetic Resonance Spectroscopy ; methods ; Octanols ; chemistry ; Reference Values ; Water ; analysis

Objective To evaluate the effect of extracorporeal membrane oxygenation(ECMO) for critical acute respiratory distress syndrome(ARDS).Methods Twenty-two patients with critical ARDS were treated with ECMO after failure of conventional ventilation therapy.The PaO_2,PaCO_2,DO_2,VO_2 and hemodynamic parameters were retrospectively analysed.Result PaO_2,DO_2,VO_2 was improved significantly after ECMO.Sixteen patients survived.Conclusion Whenever other treatments fail to improve PaO_2 on critical ARDS patients,ECMO should be considered.

OBJECTIVE:To study the hemostatic effect of reptilase on abdominal operations in perioperative period.METH-ODS:The study was conducted in 66 patients.They were randomly divided into 2 groups:reptilase group(n=35) and control group(n=31).In reptilase group,the reptilase was given in pre-operative,post-operative and intraoperative period and in control group,other commonly-used hemostants were given in the same way as in reptilase group.The amount of bleeding,the content of D-D in venous blood,the quantity of postoperative bloody drainage were compared between 2 groups.RESULTS:The amount of intraoperative bleeding,postoperative contents of D-D in venous blood and the quantity of bloody drainage in reptilase and control group were(312.1?30.3)ml,(521.5?29.2)ml(P