Effect of venous-to-arterial carbon dioxide difference to arterial-to-venous oxygen content difference ratio combined with ultrasound on fluid resuscitation in critical patients with septic shock / 中国中西医结合急救杂志

Objective To observe the effect of venous-to-arterial carbon dioxide difference to arterial-to-venous oxygen content difference [(Pv-aCO2)/(Ca-vO2)] ratio combined with critical ultrasound during the phases of fluid resuscitation of critical patients with septic shock. Methods Ninety-two critical patients with septic shock admitted to department of intensive care unit (ICU) of Anji County People's Hospital from July 2016 to December 2017 were enrolled, and they were divided into study group (42 cases) and control group (50 cases) according to random number table method. Two groups of patients were given supportive treatment such as antibiotic therapy, vasoactive drugs to support blood pressure, mechanical ventilation (MV), transfusion and nutritional therapy. The fluid resuscitation in patients of control group was guided through monitoring central venous pressure (CVP) and lactic acid (Lac). Patients in study group were given (Pv-aCO2)/(Ca-vO2) ratio combined with critical ultrasound directed therapy on the basis of the monitoring method of the control group. The differences in heart rate (HR), mean arterial pressure (MAP), CVP, Lac, central venous oxygen saturation (ScvO2), (Pv-aCO2)/(Ca-vO2) ratio, dosage of noradrenalin (NE), fluid intake in 6 hours, sequential organ failure assessment (SOFA) of 24 hours, time of MV, length of ICU stay, 28-day mortality rate, and incidence of pulmonary edema were compared. The correlation between (Pv-aCO2)/(Ca-vO2) ratio and Lac in study group was analyzed by Spearman analysis. Results In two groups, the HR, Lac, and (Pv-aCO2)/(Ca-vO2) ratio were significantly lower after 6 hours of treatment than those at admission, and MAP, CVP and ScvO2 were significantly increased compared with those at admission (all P < 0.05). The Lac and (Pv-aCO2)/(Ca-vO2) ratio in study group were significantly lower than those in control group at 6 hours after fluid resuscitation [Lac (mmol/L): 4.1±2.2 vs. 4.6±2.3, (Pv-aCO2)/(Ca-vO2) ratio:0.7±0.2 vs. 0.8±0.3, both P < 0.05], and MAP, CVP and ScvO2 were higher than those in control group [MAP (mmHg, 1 mmHg = 0.133 kPa): 78.6±10.3 vs. 71.4±11.5, CVP (mmHg): 13.2±5.1 vs. 9.8±4.4, ScvO2: 0.73±0.08 vs. 0.70±0.08, all P < 0.05]. In study group, the dosage of NE, fluid intake in 6 hours, and incidence of pulmonary edema were less than those in control group [dosage of NE (μg·kg-1·min-1): 0.22±0.16 vs. 0.43±0.11, fluid intake in 6 hours (mL): 1 290±518 vs. 1 560±426, incidence of pulmonary edema: 19.05% (8/42) vs. 32.00% (16/50)], 24 hours SOFA declined (9.3±3.2 vs. 12.6±3.8), and time of MV and length of ICU stay were obviously shortened [time of MV (hours):70.48±8.65 vs. 88.35±10.37, length of ICU stay (days): 7.28±2.07 vs. 8.42±1.51, all P < 0.05]. The 28-day mortality in study group had a trend of decrease compared with that in control group [40.5 % (17/42) vs. 44% (22/50)], but there was no statistical significant difference between two groups (P > 0.05). There was a significant positive correlation between the (Pv-aCO2)/(Ca-vO2) ratio and Lac in study group (r = 0.532, P < 0.001). Conclusion (Pv-aCO2)/(Ca-vO2) ratio combined with critical ultrasound can better guide the volume management of critical patients with septic shock, reduce the usage of vasoactive drugs and incidence of pulmonary edema, and decrease the time of MV and length of ICU stay.

Construction of a set of informatics-based assessment indicators for hospital operation and management / 中华医院管理杂志

Objective To establish a set of operational status assessment indicators to meet the needs of informationized hospital management.Methods Assessment indicators were selected and weights were set respectively through literature review,field interview,and questionnaire survey.Six target dimensions were key performance indicators medical business,operational performance,cost control,medical insurance,balance and risk management,and development capability.Thus a set of operational status evaluation indicators was established in IT means,and based on the informationization level of a tertiary A general hospital in Zhejiang province.Results In the principle of public welfare,objectivity,effectiveness and prospectiveness,we analyzed and sorted out relevant data in the current hospital informationization,identifying six quantitative indicators,15 level-1 indicators,and 86 level-2 indicators.Conclusions It is feasible to build a set of assessment indicators for hospital operation and management in view of both technology and methodology.

Impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation: a prospective randomized controlled study / 中华危重病急救医学

Objective To compare the impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation (MV). Methods A prospective randomized controlled study was conducted. Eighty-two patients requiring MV admitted to intensive care unit (ICU) of Anji People's Hospital from January 2015 to March 2017 were enrolled, and they were randomly divided into the permissive underfeeding group (n = 40, non-protein heat was 52.3-62.8 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1) and standard enteral feeding group (n = 42, non-protein heat was 104.6-125.5 kJ·kg-1·d-1, protein was 1.2-1.5 g·kg-1·d-1). Permissive underfeeding group received 50% of their daily energy expenditure via enteral nutrition (EN) and standard enteral feeding group received 100% of their daily energy expenditure via EN in 24-48 hours after admitted to ICU. Nutritional status [pro-albumin (PA), serum albumin (ALB)], inflammation state [procalcitonin (PCT), hypersensitive C-reactive protein (hs-CRP)] were detected before treatment and 7 days after treatment. Duration of MV, length of ICU stay, daily insulin dosage, 28-day mortality, hospital acquired pneumonia (HAP), urinary tract infection, septic shock and other secondary infection, and the nutrition related complications were recorded. Results Compared with before treatment, the levels of serum PA (mg/L) and ALB (g/L) were significantly increased, the levels of PCT (ng/L) and hs-CRP (mg/L) were significantly decreased at 7 days after treatment in both groups [permissive underfeeding group: PA was 127.42±65.83 vs. 80.92±60.14, ALB was 30.16±4.32 vs. 25.36±6.21, PCT was 375.8±227.2 vs. 762.3±314.5, hs-CRP was 32.19±7.53 vs. 120.48±60.24; standard enteral feeding group: PA was 132.56±61.32 vs. 86.78±47.06, ALB was 31.25±4.63 vs. 26.71±5.48, PCT was 412.1±323.4 vs. 821.7±408.6, hs-CRP was 35.86±5.69 vs. 116.38±72.16, all 1 < 0.05], but there was no significant difference in PA, ALB, PCT or hs-CRP at 7 days after treatment between two groups (all 1 > 0.05). There was no significant difference in the duration of MV, length of ICU stay, 28-day mortality or ICU-associated infection between two groups [duration of MV (hours): 162.35±20.37 vs. 153.48±18.65, length of ICU stay (days): 7.52±1.61 vs. 6.34±1.87, 28-day mortality: 17.5% vs. 19.0%, ICU-associated infection: 45.0% vs. 47.6%, all 1 > 0.05]. Compared with standard enteral feeding, insulin demand was significantly decreased (U/d: 13.68±10.36 vs. 26.24±18.53), and gastrointestinal intolerance was less frequent (32.5% vs. 54.8%) in the permissive underfeeding group (both 1 < 0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference between the two groups (χ2= 3.216, 1 = 0.068). Conclusion The curative effect and prognosis of MV severe patients receiving permissive underfeeding are similar to those of standard enteral feeding, but it can reduce the dosage of insulin with better gastrointestinal tolerance.

Design and implementation of inpatient's laboratory report self-printing program used in doctor station / 医疗卫生装备

Objective To explore a new mode for self-printing by a doctor station.Methods A self-printing program was developed with Delphi 6.0,which obtained the information on the hospitalized and discharged patients from oracle database of HIS first,then inquired the examination results and printing identification in SQL database of LIS and printed the laboratory report finally.Results The new mode saved the workload for laboratory report printing and distribution,shortened the time consumed for pasting the report,reduced the ratio for missed and false pasting,avoided the pathogen transmission due to the report and increased the report quality.Conclusion The new mode realizes data sharing and raises working efficiency,and thus is worthy promoting practically.

Design and implementation of inpatient's laboratory report self-printing program used in doctor station / 医疗卫生装备

Objective To explore a new mode for self-printing by a doctor station.Methods A self-printing program was developed with Delphi 6.0,which obtained the information on the hospitalized and discharged patients from oracle database of HIS first,then inquired the examination results and printing identification in SQL database of LIS and printed the laboratory report finally.Results The new mode saved the workload for laboratory report printing and distribution,shortened the time consumed for pasting the report,reduced the ratio for missed and false pasting,avoided the pathogen transmission due to the report and increased the report quality.Conclusion The new mode realizes data sharing and raises working efficiency,and thus is worthy promoting practically.

Research and development of medical record assistant management system / 医疗卫生装备

Objective To establish a basic information database of hospital medical records management and improve the management process.Methods The system was developed with C# programming language,basic information from Oracle 10g databases of HIS and electronic medical record system (EMRS),which stored corresponding information during the process into SQL 2005 database and generated early warning information based on statistical analysis on medical records.Results The system realized standardized filing of medical records,synchronized filing of electronic medical record and the first page of medical record,normalized lending of medical record,auto generation of statistical reports,auto alarming in case of standard-exceeded information and etc,which could be used as a platform for medical record management.Conclusion The system enhances the efficiency and management of medical record section,and thus is worthy promoting practically.

Hepatic Cyp1a2 Expression Reduction during Inflammation Elicited in a Rat Model of Intermittent Hypoxia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intermittent hypoxia (IH) is a key element of obstructive sleep apnea (OSA) that can lead to disorders in the liver. In this study, IH was established in a rat model to examine its effects on the expression of hepatic cytochrome P450 (CYP) and CYP regulators, including nuclear receptors.</p><p><b>METHODS</b>Hematoxylin and eosin staining was conducted to analyze the general pathology of the liver of rats exposed to IH. The messenger RNA (mRNA) expression levels of inflammatory cytokines, CYPs, nuclear factor-κB (NF-κB), and nuclear factors in the liver were measured by quantitative reverse transcription polymerase chain reaction.</p><p><b>RESULTS</b>We found inflammatory infiltrates in the liver of rats exposed to IH. The mRNA expression level of interleukin-1beta was increased in the liver of the IH-exposed rats (0.005 ± 0.001 vs. 0.038 ± 0.008, P = 0.042), whereas the mRNA expression level of Cyp1a2 was downregulated (0.022 ± 0.002 vs. 0.0050 ± 0.0002, P = 0.029). The hepatic level of transcription factor NF-κB was also reduced in the IH group relative to that in the control group, but the difference was not statistically significant and was parallel to the expression of the pregnane X receptor and constitutive androstane receptor. However, the decreased expression of the glucocorticoid receptor upon IH treatment was statistically significant (0.056 ± 0.012 vs. 0.032 ± 0.005, P = 0.035).</p><p><b>CONCLUSIONS</b>These results indicate a decrease in expression of hepatic CYPs and their regulator GR in rats exposed to IH. Therefore, this should be noted for patients on medication, especially those on drugs metabolized via the hepatic system, and close attention should be paid to the liver function of patients with OSA-associated IH.</p>

Neuroprotective effects of electroacupuncture on hypoxic-ischemic encephalopathy in newborn rats are associated with increased expression of GDNF-RET and protein kinase B / 中国结合医学杂志

<p><b>OBJECTIVE</b>To explore the neuroprotective effects of electroacupuncture (EA) on hypoxic-ischemic encephalopathy (HIE) and to further investigate the role of glial cell line-derived neurotrophic factor (GDNF) family receptor member RET (rearranged during transfection) and its key downstream phosphatidylinositol 3 kinase (PI-3K)/protein kinase B (Akt) pathway in the process.</p><p><b>METHODS</b>A total of 220 seven-day-old SD rats (of either sex, from 22 broods) were randomly divided into two groups, one (30 rats) for sham-surgery group and the other (190 rats) for HIE model group. The HIE model was established using the left common carotid artery ligation method in combination with hypoxic treatment. The successfully established rats were randomly divided into five groups, including control model group, EA group, sham-EA group, antagonist group and antagonist plus electroacupuncture group, with 35 rats in each group. Baihui (GV 20), Dazhui (GV 14), Quchi (LI 11) and Yongquan (KI 1) acupoints were chosen for acupuncture. EA was performed at Baihui and Quchi for 10 min once a day for continuous 1, 3, 7 and 21 days, respectively. The rats were then killed after the operation and injured cerebral cortex was taken for the measurement of neurologic damage by hematoxylin-eosin (HE) staining and the degenerative changes of cortical ultrastructure by transmission electron microscopy. RET mRNA level and Akt protein level were detected by real-time reverse-transcription polymerase chain reaction (RT-PCR) and western blot analysis, respectively.</p><p><b>RESULTS</b>EA could ameliorate neurologic damage of the first somatic sensory area (S1Tr) and alleviate the degenerative changes of ultrastructure of cortical neurons in rats subjected to HIE. And the longer acupuncture treatment lasted, the better its therapeutic effect would be. This was accompanied by gradually increased expression of GDNF family receptor RET at the mRNA level and its downstream signaling Akt at the protein level in the ischemic cortex.</p><p><b>CONCLUSION</b>EA has neuroprotective effects on HIE and could be a potential therapeutic strategy for HIE in the neonate. Activation of RET/Akt signaling pathway might be involved in this process.</p>

Primary adenosquamous carcinoma of liver: a clinical study of 2 patients / 中华肝胆外科杂志

Objective To study the diagnosis and treatment of primary adenosquamous carcinoma (ASC) of liver.Methods The clinical and histopathological data of 2 patients with ASC were analyzed retrospectively.The cases were confirmed by surgery and histopathological examination.Results The tumors were located in the left liver in these 2 patients.Both patients presented with abdominal pain and they underwent surgical resection.On gross pathological examination,the tumors were irregular in shape with unclear boundaries.Microscopically,the tumor cells were arranged in a nesting pattern with a tubular structure,which was an adenosquamous carcinoma structure.One patient survived 4 months after surgery and the other patient died of intrahepatic tumour recurrence 7 months after surgery.Conclusions The diagnosis of primary hepatic ASC relied on histopathological examination.Surgical resection was safe and feasible.

Epidemiologic study of primary aldosteronism in northern Jiangsu / 心血管康复医学杂志

Objective:To explore epidemiologic features of primary aldosteronism (PA) in northern Jiangsu and using plasma aldosterone/renin activity ratio (ARR) combined plasma aldosterone level to screen PA patients among pa-tients with hypertension .Methods:A total of 2014 inpatients and outpatients with hypertension were collected from our hospital .Radioimmunoassay was used to measure plasma levels of renin and aldosterone and blood biochemical indexes ,then ARR was calculated .PA was diagnosed when ARR>240 and aldosterone>150 pg/ml .Results:A to-tal of 239 patients (11. 87% ) were complicated with PA among the 2014 patients with hypertension ,and it occupied 23.69% (145/612) among patients with refractory hypertension .Compared with pure hypertension group ,there were significant reductions in renin activity [ (2.18 ± 2.54) ng?ml-1 ?h-1 vs .(0.68 ± 0.49) ng?ml-1 ?h-1 ] and serum potassium level [ (3.96 ± 0.45) mmol/L vs .(3.54 ± 0.45) mmol/L] ,significant rise in aldosterone level [ (132.99 ± 104.25) pg/ml vs .(272.55 ± 154.68) pg/ml] and ARR [ (118.40 ± 109.4) vs .(463.19 ± 251.85)] ,P<0.05 or <0.01 ,and significant reduction in onset age of hypertension [ (49.37 ± 9.31) years vs .(39.69 ± 7.59) years] ,P<0.01. Patients complicated with hypokalemia occupied 33.47% among PA patients ,linear correlation a-nalysis indicated that serum potassium level was correlated with aldosterone level (r= -0.706 , P=0.001) .Conclu-sion:In northern Jiangsu ,PA occupies 11.87% among patients with hypertension and it occupies 23.69% among pa-tients with refractory hypertension .Therefore ,plasma ARR should be regularly detected to screen PA patients in patients with hypertension ,especially those with refractory hypertension .

Hepatic perivascular epithelioid cell tumors-not otherwise specified: a case report / 南方医科大学学报

Neoplasms of perivascular epithelioid cells (PEComas) are characterized by epithelioid to spindle cells with eosinophilic to clear cytoplasm, an intimate relationship with blood vessels, and coexpression of myoid and melanocytic immunohistochemical markers. While most reported hepatic PEComas, such as angiomyolipoma (AML), behave in a benign fashion, emerging PEComas cases without typical characteristics require further clarification. We report a case of primary hepatic perivascular epithelioid cell tumors-not otherwise specified (HPEComas-NOS) with untypical pathological and immunohistochemical features compared to those of the benign hepatic AML cases. HPEComas-NOS may represent a special type of PEComas classified as having "malignant potential" or at "high risk of aggressive behavior", suggesting the need for further clarification of hepatic PEComas and long-term follow-up of patients with HPEComas-NOS.

Role of rennin-angiotensin system in cholinergic agonist carbachol-induced cardiovascular responses in ovine fetus / 生理学报

To investigate the mechanisms underlying the cholinergic agonist carbachol-induced cardiovascular responses, changes of renin-angiotensin system were examined in fetal hormonal systems. In the ovine fetal model under stressless condition, the cardiovascular function was recorded. Blood samples were collected before (during baseline period) and after the intravenous administration of carbachol. Simultaneously, the levels of angiotensin I (Ang I), angiotensin II (Ang II) and vasopressin in the fetal plasma were detected by immunoradiological method. Also, blood gas, plasma osmolality and electrolyte concentrations were analyzed in blood samples. Results showed that in chronically prepared ovine fetus, intravenous infusion of carbachol led to a significant decrease of heart rate (P < 0.05), and a transient decrease followed by an increase of blood pressure (P < 0.05) within 30 min. After the intravenous infusion of carbachol, blood concentrations of Ang I and Ang II in near-term ovine fetus were both significantly increased (P < 0.05); however, blood concentration of vasopressin, values of blood gas, electrolytes and plasma osmolality in near-term ovine fetus were not significantly changed (P > 0.05). Blood levels of Ang I and Ang II in the atropine (M receptor antagonist) + carbachol intravenous administration group was lower than those in the carbachol group without atropine administration (P < 0.05). In conclusion, this study indicates that the near-term changes of cardiovascular system induced by intravenous administration of carbachol in ovine fetus, such as blood pressure and heart rate, are associated with the changes of hormones of circulatory renin-angiotensin system.

Investigation of Ureaplasma urealyticum biovars and their relationship with antimicrobial resistance.

Purpose: To develop Taqman fluorescence quantitative polymerase chain reaction (PCR) method for investigating the characteristics of the distributions of Ureaplasma urealyticum (UU) biovars and to explore the relationship between UU biovars and antimicrobial resistance. Materials and Methods: By the method of culture, Ureaplasma species were detected. Taqman fluorescence quantitative PCR for detecting UU biovars were developed and UU clinical isolates were detected to distinguish biovars. The broth micro-dilution susceptibility testing methods were used to determine UU susceptibility. Results: By Taqman PCR method, UU biovars was successfully detected. Of 126 samples, biovar 1 was found in 73 (57.94%). There was a statistical difference between genital-urinary tract infection group and asymptomatic group (P<0.05). In the region, UU biovar 1 to 9 kinds of agents kept higher susceptibility rates, but biovar 2 maintained higher susceptibility rates only to tetracyclines. Compared with biovar 1, UU biovar 2 resistance rates to 7 kinds of agents were higher (P<0.05). Conclusions: (1) Our new established Taqman PCR method is a useful tool for screening UU biovars. (2) UU biovar 1 predominated in asymptomatic population; whereas in genital-urinary tract infection population UU biovar 2 had a higher proportion. (3) The characteristics of drug resistance were different between UU biovars. Overall, both two biovars remained higher susceptibility rates to tetracyclines. A majority of biovor 1 strains were sensitive to macrolides and quinolones; while only a small number of biovar 2 strains kept sensitive to roxithromycin and quinolones, a large proportion of biovar 2 strains were found in intermediate ranges.

Screening and identification of CD13-binding peptides with phage display peptide library / 南方医科大学学报

<p><b>OBJECTIVE</b>To screen and identify the peptides that specifically bind to CD13 on monocytes.</p><p><b>METHODS</b>The phages capable of specific binding to CD13 were screened in the phage-displayed 12-peptide library. The affinity of the selected phages with CD13 was verified with enzyme-linked immunosorbent assay (ELISA). The sequences of the peptides bound to the phages were deduced according to the phage DNA sequences, and the functional peptides aligned using the BLASTP on the Website NCBI were synthesized. To analyze the biological function of the screened peptides, the location of the peptides bound to THP-1 cells was detected using immunofluorescence assay. The blocking effect of WM15 on the peptide binding to THP-1 cells was assessed by immunofluorescence assay.</p><p><b>RESULTS</b>The phages that specifically bound to CD13 were effectively enriched to approach saturation after 4 rounds of panning. The recovery rate in the fourth round was 30 times that in the first round. Twenty selected phages were verified by ELISA, and the signals of 10 phages were higher than the control. The sequences of the peptides P9 and P7 showed 83% and 100% identity with those of human cytomegalovirus (HCMV) UL38 and UL105, respectively. The peptides bound to the cell membrane of THP-1 cells as shown by immunofluorescence assay. The binding of the peptides P9 and P7 to THP-1 cells was blocked by CD13-specific monoclonal antibody WM15 at different levels.</p><p><b>CONCLUSION</b>Two peptides (P7 and P9) that can specifically bind to CD13 have been screened successfully, and these two peptides show specific binding to CD13 on the membrane of THP-1 cells.</p>

Clinical analysis of bacterial infection in liver transplant recipients / 西安交通大学学报(医学版)

Objective To explore the incidence and risk factors of bacterial infection after othtotopic liver transplantation (OLT). Methods Altogether 56 OLT recipients from January 2005 to October 2007 were included in the study. The incidents and the related variables of the infection were analyzed retrospectively. The related variables were evaluated using multivariate logistic regression model to identify the significant risk factors. Results Bacterial infection was confirmed in 29 recipients (51.8%). Among them, the lung infection was the most common site (53.7%). The Gram-positive cocci were 46.3%, while the Gram-negative bacilli were 53.7%. The risk factors for bacterial infection included duration of the operation and detained respirator using. Conclusion Bacterial infection is a major complication following OLT. Surveillance for the risk factors, enhancement the skill of operation, and improving the recovery of respiratory function is the key to decreasing the incidence of bacterial infection after transplantation.

Mechanism of the protective effect of α_(1A)-AR antagonist on renal ischemic injury in rats with hepatorenal syndrome / 西安交通大学学报(医学版)

Objective To study the mechanism of the protective effect of α_(1A)-AR antagonist Tamsulosin (Tam) on renal ischemic injury in hepatorenal syndrome (HRS) rats. Methods HRS was induced in male Sprague-Dawley (SD) rats by intraperitoneal injection of D-(+)-galactosamine hydrochloride (GalN). Thirty-two HRS rats were divided into 3 groups randomly. Then surgical occlusions of the infrahepatic inferior vena cave (OIVC) were performed; Tam, an α_(1A)-AR antagonist, was administered daily before injection of GalN. During the operation, hemodynamic changes of the kidney and liver were measured by laser Doppler flowmetry (LDF). Serum samples were collected to measure serum levels of liver and renal function. At the same time, renal and liver samples were harvested and stained by HE and immunohistochemistry. Other parts of the sample were fixed with 2.5% glutaral to observe the cellular ultrastructure of renal and vascular endothelium by electron microscope. Results OIVC developed much severe ischemic injury in the kidney and liver of HRS rats. The renal cortex blood perfusion (RCBP) of HRS rats decreased rapidly after OIVC, and did not return to baseline after reflow. Pathological study showed severe injury of the liver and kidney. However, expressions of alpha-1 AR on renal artery and kidney were reduced in those rats that had received Tam before OIVC. Histological examination of the kidney also showed few abnormalities. Conclusion Marked increases of contractive response of renal artery of HRS rats induced by up-regulation of α_1-AR may be associated with a high risk of progression to acute renal failure in HRS rats after ischemia. Tamsulosin has a protective effect on renal ischemic injury through reducing α_(1A)-AR overexpression in HRS rats.

Diagnosis and treatment of cytomegalovirus pneumonitis following liver transplantation / 西安交通大学学报(医学版)

Objective To study the diagnosis and treatment of cytomegalovirus (CMV) infection after liver transplantation. Methods The clinical data of 111 patients who received liver transplantation from November 2000 to December 2007 in our hospital were analyzed retrospectively. The recipients were diagnosed as having CMV infection by the predisposing factors, clinical symptoms and detection of CMV-PP65 and CMV-IgM in peripheral blood specimens in combination with chest X-ray. The treatment of CMV infection was administration of Ganciclovir. Results Five recipients were diagnosed as having CMV infection, with the incidence of 4.5%. Two were diagnosed as having CMV pneumonitis, with the incidence of 1.8% (40% of the recipients having CMV infection). Two were both improved. Three were diagnosed as having CMV active infection. Two of them were cured and one was improved. Conclusion The detection of CMV-PP65 is necessary for early diagnosis and guiding treatment of CMV infection. Ganciclovir can exert significant therapeutic effects on CMV infection.

Preliminary analyses for influence of mutant PrPs with different number of octapeptide / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>The present study was conducted to understand the effects of PrP in different octapeptide repeats on proliferation of HeLa cells.</p><p><b>METHODS AND RESULTS</b>Mutant PrPs with octapeptide repeat insertion were transiently expressed in HeLa cells and their results of MTT assay showed stronger cytotoxic effect on the proliferation of cells than wild-type PrP. Annexin V/PI assay also demonstrated that the expression of mutant PrPs was much easier to induce apoptosis than wild-type in HeLa cells. The percentage of both early and late stage apoptosis in mutant groups were significantly higher than that of wild type.</p><p><b>CONCLUSION</b>These data suggest that the expression of mutant PrPs associated with familial CJD is much easier to induce apoptosis in cultured cells than expression of wild type PrP.</p>

Molecular-biological identification of pathogens which caused an outbreak of viral encephalitis in Jinan area / 中华实验和临床病毒学杂志

<p><b>OBJECTIVE</b>To investigate the etiology of the outbreak of viral encephalitis in Jinan area in 2003.</p><p><b>METHODS</b>Virus-specific nucleic acid fragments were amplified by random PCR and RT-PCR using specific primers to enterovirus. After sequencing, the gene sequence was handled by the program BLAST for homologous analysis and the software Clustal W 1.82 for multiple sequence alignment to identify the etiology and its genotype.</p><p><b>RESULTS</b>Five strains were isolated from clinical specimens. A gene fragment for one strain was acquired using random PCR, which was highly homologous to enterovirus. Then, the 5' non-translated region and partial VP1 region were amplified and sequenced. The five isolated strains were all identified as Coxsackievirus B5, and what was more, they were most homologous to the strain isolated during the outbreak of aseptic meningitis and encephalitis in Zhejiang province from 2002 to 2004.</p><p><b>CONCLUSION</b>Coxsackievirus B5 is closely associated with the outbreak of viral encephalitis in Jinan area in 2003. It is an important etiology but other viruses may also played a role which remains to be clarified.</p>

Investigation of ulinastatin on protection of organ functions in patients with severe disease / 中国中西医结合急救杂志

Objective To study the mechanism and protection of ulinastatin on organ functions in patients with severe disease.Methods Sixty patients in the intensive care unit(ICU)from October 2005 to July 2007 were randomly divided into a control group and an ulinastatin treatment group(each 30 cases).The patients in the control group received the conventional therapy,and the cases in the other treatment group accepted ulinastatin and conventional therapy.According to the disease situations,ulinastatin was administered 200-400 kU once,2-4 times a day,sequentially for 5-7 days.On the day of admission and 3, 5,and 7 days after admission in ICU respectively,blood samples were obtained for measuring alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr),blood urea nitrogen(BUN), activated partial thromboplastin time(APTT),fibrinogen(FIB)and oxygenation index(PaO_2/FiO_2); whether breathing machine or hematodialysis was used and the end results were recorded.Results The rate of usage of breathing machine(23.3%),the incidences of hepatosis(3.3%)and renal dysfunction(10.0%) and fatality(3.3%)in ulinastatin treatment group were obviously lower than those of the control group (63.3%,23.3%,46.7%,10.0%,P0.05).Only one patient received bematodialysis in control group.Conclusion Ulinastatin can protect liver,renal and lung functions markedly and lower the incidence of multiple organ dysfunction syndrome and mortality in patients with severe disease.