Treatment plan of mycobacterium abscessus infection after autologous fat injection / 中华医学美学美容杂志

Objective:To explore an effective treatment method for mycobacterial infection of multiple abscesses in the face and breast after autologous fat injection.Methods:Six patients with non-tuberculous mycobacterial infection after autologous fat injection in the face and chest were treated from June to September in 2018. All patients underwent preoperative ultrasound localization. The small incision was opened for debridement and the necrotic granular tissues were completely scraped. Vacuum aspiration therapy in the sinus was used to promote wound growth, in line with the standard anti-tuberculosis drug treatment.Results:All six patients in this group were being followed up for 10-14 months. The average follow-up time was 12 months. All the infected patients were recovered, and the appearance of the infected site was satisfied by the patients.Conclusions:Small incision debridement with vacuum aspiration therapy combined with a variety of anti-tuberculosis drugs can effectively treat non-tuberculous mycobacterial infection after autologous fat injection, and achieve good results.

Clinical value of neutrophil/lymphocyte ratio in early prediction of the incidence of organ dysfunction and 28-day mortality in patients with sepsis / 中华危重病急救医学

Objective:To evaluate the clinical value of neutrophil/lymphocyte ratio (NLR) in early prediction of the incidence of sepsis-induced organ dysfunction and 28-day mortality.Methods:A retrospective study was conducted in 815 adult patients with sepsis admitted to the department of critical care medicine of the First Affiliated Hospital of China Medical University from January 2017 to December 2019. The clinical data including age, gender and complication were collected, and the peripheral blood routine indexes at 24, 48 and 72 hours after the diagnosis of sepsis were collected, and the NLR was calculated. The primary endpoint of the study was the incidences of sepsis related acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC) and acute liver failure (ALF); the secondary endpoint was the 28-day in-hospital mortality in septic patients with organ dysfunction. Univariate and multivariate Logistic regression were used to analyze the risk factors of organ dysfunction and 28-day mortality in patients with sepsis, the receiver operating characteristic curve (ROC curve) was drawn and the area under the ROC curve (AUC) was calculated to evaluate the predictive value of NLR for organ dysfunction and 28-day mortality in patients with sepsis.Results:A total of 714 patients with sepsis were enrolled for final statistical analysis. There was no significant difference in NLR at 24, 48 and 72 hours in patients with or without organ dysfunction (such as AKI, ARDS, DIC and ALF). Logistic regression analysis showed that there was no significant difference in NLR at 24 hours with 28-day in-hospital mortality [odds ratio ( OR) = 1.006, 95% confidence interval (95% CI) was 0.994-1.019, P = 0.323]. However, NLR at 48 hours and 72 hours had a significant difference with 28-day mortality (48 hours: OR = 1.026, 95% CI was 1.013-1.040, P = 0.000; 72 hours: OR = 1.021, 95% CI was 1.005-1.037, P = 0.010), which suggested that NLR at 48 hours and 72 hours after diagnosis were independent risks factor for 28-day mortality in patients with sepsis. ROC curve showed that the AUC of NLR at 48 hours was 0.598, 95% CI was 0.540-0.658, P = 0.02; when the cut-off value was 10.1, the sensitivity and specificity for predicting 28-day mortality was 75.2% and 58.0%, respectively; the AUC of NLR at 72 hours was 0.595, 95% CI was 0.536-0.655, P = 0.03; when the cut-off value was 9.24, the sensitivity and specificity for predicting 28-day mortality was 75.3% and 59.9%, respectively. Conclusions:NLR cannot predict the occurrence of AKI, ARDS, DIC and ALF in sepsis in early stage. NLR has a certain clinical value in predicting 28-day mortality in patients with sepsis, but its predictive efficiency is low.

A reevaluation of diagnostic efficacy of International Society of Thrombosis and Haemostasis and Japanese Association for Acute Medicine criteria for the diagnosis of sepsis disseminated intravascular coagulation / 中华内科杂志

Objective To reevaluate the diagnostic efficacy of International Society of Thrombosis and Haemostasis (ISTH) and Japanese Association for Acute Medicine (JAAM) criteria for sepsis disseminated intravascular coagulation (DIC).Methods A total of 769 patients diagnosed as sepsis were enrolled in our study.Blood samples were collected within the first hour in ICU and the index of coagulation was detected.The correlation between the conventional coagulation index and the acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores was analyzed.The sensitivity and specificity of diagnostic efficacy were analyzed by receiver operating characteristic (ROC) curve.Results In the 769 cases,95 cases (12.35％) conformed to the standard of ISTH and 271 cases (35.24％) were in accordance with the standard of JAAM.Prolonged prothrombin time (PT) was seen in 726 cases (94.41％).Activated partial thromboplastin time (APTF) was prolonged in 434 cases (56.44％).Plasma fibrinogen (Fib) was decreased in 94 cases (12.22％) and increased in 365 cases (47.46％).Platelet (PLT) count decreased in 158 cases (20.55％).D-dimer was elevated in 759 cases (98.70％).Fibrin degradation product (FDP) was increased in 724 cases (94.15％).PT,APTT,D-dimer,FDP,PLT were correlated with APACHE Ⅱ (r value were 0.259,0.348,0.319,0.289,-0.275,all P values＜0.05)and SOFA score(r values were 0.409,0.445,0.407,0.411,-0.526,respectively,all P values＜0.05).The areas under the curve (AUCs) in the ISTH standard from high to low were accordingly PT (0.813),FDP (0.792),PLT (0.746),Fib (0.563).The AUCs from high to low were FDP (0.844),PLT (0.716),and PT (0.660),respectively in the JAAM standard.Under the criteria of ISTH,the diagnostic sensitivities of PT,PLT,Fib and FDP were 92.63％,67.37％,9.47％,98.95％,respectively,and specificities as 53.56％,86.05％,99.26％ and 33.38％％ respectively.As to the JAAM criteria,the diagnostic sensitivities of PT,PLT,and FDP were 74.54％,52.77％,91.51％ and specificities as 51.61％,84.94％,40.76％ respectively.Conclusions According to the ISTH and JAAM diagnostic criteria,the diagnostic efficacy of PT and PLT is relatively high,which is associated with the severity of DIC.D-dimer and FDP have the high sensitivity but the specificity is poor.The diagnostic specificity of Fib is good,yet with low sensitivity and poor overall efficacy.

Rho-kinase Inhibitor Ameliorates Lipopolysaccharide-induced Kidney Injury by Inhibiting Toll-like Receptor 4 and Nuclear Factor-κB Signaling Pathway / 中国医科大学学报

Objective To explore whether Rho kinase inhibitor protects endotoxemia mice from kidney injury,and to investigate the mechanism underlying this effect. Methods Adult male C57BL/6 mice were randomly divided into three groups (n = 8 for each group): control,lipopolysaccharide (LPS),and LPS+ Y-27632 (Rho kinase inhibitor). For induction of acute kidney injury,mice were administered 30 mg/kg LPS intraperitoneally. Y-27632 (10 mg/kg body weight) was injected intraperitoneally 18 h and 1 h before injection of LPS,and an equal volume of sterile saline was administered at the corresponding time point in each group. The mice were killed 8 h after LPS administration. Blood samples and kidney tissues were taken and preserved for subsequent analysis. Results Pretreatment with Y-27632 significantly attenuated LPS-induced kidney injury;pretreatment with Y-27632 markedly reduced renal expression of inflammatory cytokines (TNF-α and IL-1β) in endotoxemia mouse,and also significantly inhibited LPS-induced caspase-3 expression in the kidney; and Y-27632 pretreatment dramatically reduced TLR4 protein expression and NF-κBp65 phosphorylation in kidney tissues of endotoxemia mouse. Conclusion Rho kinase inhibitor may inhibit TLR4 and NF-κB signaling pathway to reduce the inflammatory response in the kidneys of endotoxemia mice and alleviate acute renal injury induced by LPS.

Flexor muscle disconnection combined with myocutaneous flap for pressure ulcer in patients of ankylosing posture / 中华创伤杂志

Objective To investigate the efficacy of flexor muscle disconnection combined with myocutaneous flap in the treatment of pressure ulcer in patients of ankylosing posture.Methods A retrospective case series study was conducted to analyze 15 patients with pressure ulcer at different body parts due to ankylosing posture after paraplegia admitted to the First Affiliated Hospital of Jinan University from January 2012 to July 2017.There were 10 males and five females,aged 40-78 years,with an average age of 68 years.The pressure ulcer ranged from 3 cm× 3 cm to 15 cm × 11 cm.The pressure ulcers were distributed at sacrococcygeal region in eight patients,macro-rotator in four,and ischial nodules in three.According to the size and position of pressure ulcer,different musculocutaneous flaps were selected,and high selective decompression of hip flexion and knee flexion was performed to ensure the tension free suture of the wound.After the operation,the negative pressure closed drainage (VSD) was given to maintain a proper posture for wound healing.The stitches were removed after the wound healed.The wound healing,pressure ulcer recurrence,flap texture,flap color,and donor site were observed,and patient satisfaction were also surveyed.Results All patients were followed up for 12-36 months,average 24 months.The pressure ulcer was healed in 12 patients after the first repair operation.In two nonunion cases,the unrelieved knee flexion and knee muscles led to high muscular tension and stiff joint,causing strong resistance during limb movement and strong flexor reflex.Two patients were healed after twice operation.In one patient,the incision was torn by the excessive flexion tension due to improper body position caused by the passive movement of the limb after operation,and the wound was healed after twice operation.All muscle flaps covered the wound and survived well,and the wounds were completely closed and healed with good shape,texture as well as elastic recovery.After the suture was removed18 days after surgery,the patients were discharged satisfactorily.The patients received conventional pressure ulcer care,and no new pressure ulcer was reported during the follow-up.The flap donor site was healed well after autologous skin repair.Conclusion For pressure ulcer in patients of ankylosing posture,flexor muscle disconnection combined with myocutaneous flap has notable effects in reducing tension and can accelerate wound healing and improve healing rate.

Effects of temperature on the bioactivity of fat graft and adipose-derived stem cells situated in fat graft / 中华医学美学美容杂志

Objective To observe the impacts of different storage temperatures on the activities of adipose tissues and the extraction and proliferation of adipose-derived stem cells (ADSCs) situated in harvested fat.Methods Adipose tissues obtained by liposuctions in healthy females were kept in different temperature;all groups of adipose tissues were studied in context of the histomorphology and activity of GAPD as well as the extraction efficiency and proliferation of ADSCs.Results Adipose tissues cryopreserved at 4 ℃ within 24 hours could retain their activities effectively,but their activities would decrease rapidly if they preserved at room temperature.The efficiency of adipose tissues extracting stem cells and their proliferations were affected by storage temperatures and times.If adipose tissues were preserved at room temperature for over 1 hour,the extraction efficiency and proliferation of their ADSCs would be lower significantly.Conclusions Adipose tissues cryopreserved at 4 ℃ can effectively ensure their activities and their extraction efficiency and proliferation of ADSCs.It is important to preserve adipose tissues at low temperature after harvesting fat graft.

Effect of heparin pretreatment on the level of neutrophil extracellular traps of serum and lung tissue in septic mice / 中华危重病急救医学

Objective To investigate the influence of heparin pretreatment on serum and lung tissue level of neutrophil extracellular traps (NETs) in septic mice model and its molecular mechanism.Methods Ninety male C57BL/6J mice were randomly divided into control group (n = 30), lipopolysaccharides (LPS) group (n = 30, 30 mg/kg LPS in 100μL normal saline was intraperitoneally injected) and LPS+heparin group (n = 30, 8 U of heparin in 20μL normal saline was subcutaneously injected 30 minutes before the injection of LPS). Six hours later of LPS injection, blood was collected and lung tissue was harvested. Enzyme linked immunosorbent assay (ELISA) was used to assess the concentration of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and histones 2AX (H2AX), neutrophil elastase (NE), which reflected NETs concentration. PicoGreen fluorescent dyes was used to detect serum circulating free DNA (cf-DNA/NETs) concentration. The protein expression levels of H2AX and NE in lung tissue were examined by Western Blot.Results The serum concentrations of TNF-α, IL-6, H2AX, NE, cf-DNA/NETs, and the protein expression levels of H2AX and NE in lung tissue of septic mice were significantly higher than those of control group [TNF-α (ng/L): 133.0±14.1 vs. 2.7±1.0, IL-6 (ng/L): 3911.2±189.2 vs. 298.9±52.5, H2AX (ng/L): 545.5±40.0 vs. 21.9±8.3, NE (μg/L): 6.48±0.12 vs. 0.47±0.15, cf-DNA/NETs (μg/L): 846.3±137.5 vs. 152.7±36.4, H2AX protein (gray value): 1.14±0.09 vs. 0.68±0.04, NE protein (gray value): 0.56±0.03 vs. 0.32±0.04, allP 0.05).Conclusion Heparin pretreatment could significantly decrease the level of NETs in serum and lung tissue, and can be the potential mechanism of its organ protection in sepsis.

Heparin reduces endothelial cell damage induced by neutrophil extracellular traps / 中华危重病急救医学

Objective Clarify the effect of neutrophil extracellular traps (NETs) on endothelial cell injury, and investigate whether the heparin can exert a protective effect on endothelial cells by reducing the endothelial cell injury induced by NETs.Methods Neutrophils (PMN) were obtained from healthy human peripheral blood by Percoll-Histopaque density gradient centrifugation, and was stimulated with phorbol ester (PMA) to induce NETs. The qualitative and quantitative analysis of NETs was detected by immunofluorescence staining combined with fluorescence detector. The NETs were used to induce human umbilical vein endothelial cells (HUVEC)in vitro. Recombinant DNA hydrolytic enzymes (rhDNase) and heparin intervention were added respectively. The activity of HUVEC was measured by methyl thiazolyl tetrazolium (MTT) method after 6 hours.Results PMA can stimulate PMN to produce NETs. Immunofluorescence staining showed the formation of reticular formation around the PMN. The concentration of cell-free DNA in the supernatant of PMN stimulated by PMA was significant increased compared with the control group through the detection of PicoGreen fluorescent labeling instrument (2 hours: 119.62±14.83 vs. 24.27±0.67, 4 hours: 146.67±21.24 vs. 28.35±2.98, bothP < 0.05). Application of NETs to stimulate the HUVEC, cell damage was dose dependent and inhibition rate increased gradually. The endothelial cell inhibition induced by NETs can be antagonized after adding rhDNase [10μg/L NETs: (8.65±0.51)% vs. (10.99±0.35)%, 20μg/L NETs:(14.85±0.43)% vs. (16.85±0.49)%, 30μg/L NETs: (26.06±3.51)% vs. (27.54±0.62)%, allP < 0.05]. Heparin with different concentrations were added into the experimental group (0.01, 0.1, 1, 10 kU/L). We found that the endothelial cell inhibition rate decreased compared with control group [10μg/L NETs: (8.96±0.70)%, (5.32±1.36)%, (0.70±0.30)%, (0.75±0.20)% vs. (10.99±0.35)%; 20μg/L NETs: (15.57±0.62)%, (13.28±0.65)%, (6.91±0.15)%, (5.86±0.17)% vs. (16.85±0.49)%; 30μg/L NETs: (30.49±0.74)%, (29.41±1.41)%, (23.45±0.75)%, (21.72±1.52)% vs. (27.54±0.62)%, allP < 0.05].Conclusions NETs can induce endothelial cell injury, and the injury degree was increased with the concentration of NETs. Heparin can reduce endothelial cell injury induced by NETs, which may be a potential mechanism for the protective effect of heparin on sepsis.

Plasma level of neutrophil extracellular traps in septic patients and its clinical significance: a prospective observational study / 中华危重病急救医学

Objective To investigate the changes of neutrophil extracellular traps (NETs) level in plasma of sepsis patients and judge its clinical value for early diagnosing of sepsis.Methods A prospective observational study was conducted. The patients after surgery aged > 18 years and expected to stay in the ICU > 24 hours admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from November 2014 to February 2015 were enrolled. According to the criteria of sepsis diagnosis in 1991, patients were divided into non-sepsis group and sepsis group. The healthy people who taken a physical examination were enrolled in the healthy control group. 3 mL peripheral venous blood was collected at 1 hour after admission to ICU. A fasting blood was collected in the healthy control group in the morning. The plasma free DNA (cf-DNA/NETs) was determined by using the fluorescence microplate reader, white blood cell (WBC), neutrophil ratio (NEU), procalcitonin (PCT), C-reactiveprotein (CRP) in peripheral blood of the patients were detected, and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) scores were calculated. The correlation between plasma NETs and the risk factors in sepsis patients was analyzed by Spearman correlation analysis. The value of cf-DNA/NETs and WBC level in the diagnosis of sepsis was analyzed by using the receiver operating characteristic curve (ROC).Results Twenty-three sepsis patients, 20 non-sepsis patients, and 22 healthy persons were enrolled. There were no differences in baseline variables including gender and age among three groups, which indicated baseline data equalization. The plasma concentration of cf-DNA/NETs in sepsis group was significantly higher than that in non-sepsis group and healthy control group (μg/L: 453.44±185.37 vs. 188.35±29.66, 203.83±43.25, bothP 0.05). WBC, NEU, PCT, CRP, APACHE Ⅱ and SOFA score in sepsis group were significantly higher than those of non-sepsis group [WBC (×109/L): 9.52±5.51 vs. 5.97±2.28, NEU: 0.787±0.110 vs. 0.655±0.067, PCT (mg/L): 7.14 (3.60, 13.29) vs. 6.07 (3.57, 7.91), CRP (mg/L): 64.44±13.14 vs. 27.00±19.47, APACHE Ⅱ: 10.25±4.92 vs. 6.00±1.22, SOFA: 6.0±5.1 vs. 5.0±1.2, allP 0.05). The area under the ROC curve (AUC) of plasma cf-DNA/NETs for the diagnosis of sepsis was 0.981. When the cut-off valueof plasma cf-DNA/NETs was > 257.96μg/L, the sensitivity was 91.3%, specialty was 95.2%, and Youden index was 0.865. AUC of WBC in the diagnosis of sepsis was 0.663. When the cut-off value of WBC was > 6.0×109/L, the sensitivity was 78.3% and specificity was 25.0%.Conclusion The plasma cf-DNA/NETs levels increased significantly in sepsis patients. In the diagnosis of sepsis, plasma NETs levels had better advantages over WBC. NETs can be used as a biomarker for early diagnosis of sepsis.

Neutrophil extracellular traps and coagulation dysfunction in sepsis / 中华危重病急救医学

Neutrophil extracellular traps (NETs) are net-like structure composed of DNA and nuclear proteins, which are produced by activated neutrophils under the circumstances of a variety of pathogens or drugs. As part of defensive mechanism, NETs have been proved to restrict the spread of pathogens and release of antimicrobial molecules. NETs can not only strengthen the adhesion between neutrophils and platelets, promote platelet mediated procoagulant reaction, but also lead to endothelial cell damage and coagulopathy in sepsis. In addition, NETs also plays an important role in pathophysiological processes of venous thrombosis. Therefore, NETs may become the biomarkers of evaluating coagulation dysfunction and potential therapy target in sepsis.

Expression of specific marker molecules of long-term cultured human dermal papilla cells in vitro / 中华医学美学美容杂志

Objective To investigate the expression of specific marker molecules in hair-inducing activity of long-term cultured human dermal papilla cells (HDPCs) in vitro.Methods After dissected and cultured the HDPCs in vitro,the cells of passages 1 to 8 were used for experiments.The growth appearances of HDPCs in different passages were observed under inverted microscope.To detect the expression of specific marker molecules of long-term cultured HDPCs,the alkaline phosphatase (ALP) activity of the HDPCs was examined,and the specific genes ALP and insulin-like growth factor-1 (IGF-1) expression levels of HDPCs were determined by real-time quantitative PCR.Results After long-term cultured in vitro,the ALP and IGF-1 expression levels of HDPCs gradually decreased in different passages,as well as the display of the aggregated and cartouche growth.The ALP and IGF-1 expression levels of HDPCs in passage 1 was the highest,they were almost about 6.8-fold and 3.5-fold higher than the HDPCs in passage 8.The ALP staining of the HDPCs in passage 1 and passage 2 were evident,but the cells' ALP staining gradually became much weaker than the cells in the previous passages after the long-term cultured in vitro.Conclusions The expression levels of specific marker molecules ALP and IGF-1 of the HDPCs decrease gradually after long-term cultured in vitro,and the higher passage HDPCs lost the special aggregated and cartouche growth appearance,and hence lead to the loss of hair-inducing activity of HDPCs.

The role of DDAH2/NOS/NO in lung endothelial cell damages in streptozotocin induced diabetic rats with sepsis / 中华急诊医学杂志

Objective To investigate the pulmonary microvascular responsiveness of diabetic animals to sepsis and the potential mechanism of NO system.Methods Sixty-four Wistar rats of clean grade were randomly (random number) divided into 4 groups,namely normal control group (group A,n =16),diabetes group (group B,n =16),sepsis group (group C,n =16),diabetes and sepsis group (group D,n =16).Diabetic mellitus model was made in rats with injection of streptozotocin,STZ (65 mg/kg).Successful model was defined as the blood glucose value≥ 16.67 mmol/L 48 hours after injection of STZ.All animals were fed 4 weeks before initiation of next experiment.The sepsis model was established by intravenous injection of LPS (10 mg/kg) in rats.RT-PCR was used to determine the mRNA expression of Tie-2 in rats'blood.The ratio of dry/wet of lung tissue and the extravasation of Evans blue dye into the lung were detected.Quantitation of NO in lung tissue and serum was measured by using Griess method.RT-PCR was also used for determination of iNOS,eNOS,DDAH2 mRNA expressions in lung tissue.Data were analyzed with ANONA and LSD method for comparison between groups,and P ＜ 0.05 was considered statistically significant.Results Compared with septic group.,the diabetic rats with sepsis group demonstrated higher expression of Tie-2 mRNA in blood (19.72 ± 0.70) vs.(3.99 ± 0.92),P =0.00,lower ratio of dry/wet in lung tissue (0.19 ±0.01) vs.(0.22 ±0.01),P =0.000,higher permeability of Evans blue dye into lung tissue (3.76 ± 0.77) vs.(1.74 ± 0.24),P =0.000.Serum NO level was lower in group D than that in group C (123.13 ±4.24) vs.(188.30 ±5.18),P =0.000,however,NO levels in lung tissue of both group D and group C were higher than that in control group (53.62 ± 6.70),(23.63± 3.92) vs.(10.37 ± 1.29),P =0.00,and NO level in group D was higher in 2 times than that in group C (P =0.00).However,there were no differences in eNOS expression among groups A,B and C,but the difference in eNOS expression was present between group D with lower expression and group A,that lower in group D (0.07 ±0.02) vs.(0.38 ±0.05),P=0.017.Compared with group C,the expression of iNOS was higher in group D (80.23 ±2.49),(32.48±5.37) vs.(1.74±0.23),P=0.00),and the expression of DDAH2 was lower in group D (0.49 ±0.13),(7.26 ±0.50) vs.(11.96 ±0.55).Conclusions Diabetic rats with sepsis enhanced endothelial cell damages.Diabetes deteriorates the regulatory activity of NO system,suggesting the potential mechanism of the worsened damages of EC in diabetic sepsis host.

Evaluation of clinical effects on low-dose heparin therapy for sepsis / 中华内科杂志

Objective To investigate the therapeutic effects of low-dose heparin on sepsis. Methods Seventy-nine sepsis patients were randomly divided into tow groups: beparin treatment group (n=37) and routine treatment group(n =42). The 7-day and 28-day mortality, the days in ICU and the length of stay, the changes of oxygenation index, the days of mechanical ventilation and the rates of disseminated intravascular coagulation (DIC), acute renal failure (ARF), acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome(MODS) were observed. The levels of APTT, PT and platelet (PLT) count were determined before and after treatment in two groups. Results The rates of DIC, ARF and MODS in beparin group decreased significantly after therapy: rate of BIC, 15.4% vs 38. 7% (P=0.03) ; rate of ARF, 25.0% vs51.9% (P=0.04); rate of MODS, 26.3% vs50.0% (P=0.04). In heparin group, the 28-day mortality was statistically reduced (15.4% vs 32.4%, P = 0. 03). The differences between beparin group and routine group were not statistically significant in the 7-day mortality (7. 7% vs 12. 9% ,P =0. 08) ,the days in ICU(Z =0. 281 ,P =0. 779,rank sum test) ,the length of stay (Z = 0. 562, P = 0. 574, rank sum test), the oxygenation index (P = 0. 82), the days of mechanical ventilation [(126.07±166.21)h vs (179.27±221.7)h,P=0.28] and the rate of ARDS (44.0% vs 46.2% ,P= 0. 88). The differences in APTT, PT and PLT were not significant between the two groups. Conclusion Low-dose beparin can decrease the mortality rate of sepsis and improve the prognosis of patients. It is a safe promising therapy in sepsis patients without severe side effects.

Effect of itraconazole injection for patients with invasive fungal infections / 中国实用内科杂志

Objective To evaluate the efficacy and safety of itraconazole injection in treatmeat of invasive fungal infections.Methods The clinical trial was conducted in 16 patients(17 times)with invasive fungal infection from August 2003 to August 2005,including 1 case confirmed,11 cases(12 times)suspected and 4 cases for empiric treatment.They were treated with iv itraconazole injection in a dose of 200 mg twice daily in the first and the second day,from the third day to 14th day they were given iv itraconazole injection in a dose of 200 mg once daily,and then treated with capsule in a dose of 200 mg twice daily for another 28 days.Two cases were treated with iv itraconazole injection in a dose of 200 mg twice daily for 9 days and 14 days;1 case in a dose of 200 mg once daily for 21 days.Results 62 strains were isolated from 16 patients with invasive fungal infection,including 40 strains in urine cultivate,and 21 strains of tropic candida were primacy.In confirmed and suspected patients,the cure rate was 6/13,the effective rate was 11/13 and the eradication rate was 6/13.The incidence of adverse reaction was 3/24.Conclusion Itraconazole injection is effective and safe in treatment of severe invasive fungal infections,especially in severe ill,old patients for long time use.