To observe the change of serum cholinesterase (S-ChE) levels in patients with severe pneumonia and its correlativity with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and multiple organ dysfunction syndrome (MODS) score.

A total of 86 patients with severe pneumonia were enrolled in this study as the severe pneumonia group, and divided into the survival group (46 cases) and death group (40 cases). And 100 patients with common pneumonia (common pneumonia group) and 124 people with health examination normal (control group) were served as control. The S-ChE levels were collected and APACHE Ⅱ score and MODS score were calculated after the patients were hospitalized in ICU within 24 hours. The Pearson correlation was used to analyze the association between S-ChE level and APACHE Ⅱ score as well as MODS score.

The S-ChE levels in the severe pneumonia group, common pneumonia group and control group were (3 679 ± 1 433) U/L, (5 142 ± 1 884) U/L, (8 469 ± 1 377) U/L, respectively, and the S-ChE levels in the severe pneumonia group were much lower than those in the common pneumonia group and control group (all P<0.05). Meanwhile, the S-ChE levels in the death group [(2 748 ± 826) U/L vs. (4 489 ± 1 360) U/L, t=7.041, P<0.001] were much lower, whereas the APACHEⅡscores (26 ± 5 vs. 16 ± 5, t=8.540, P<0.001) and MODS scores (8.15 ± 2.49 vs. 4.35 ± 2.01, t=7.832, P<0.001) were higher than those in the survival group. The Pearson correlation showed that the S-ChE levels were negative related with APACHE Ⅱscore (r=-0.437, P<0.05) and MODS score (r=-0.337, P<0.05).

The S-ChE levels in patients with severe pneumonia decrease remarkedly, which can reflect the severity of severe pneumonia and have negative correlation with APACHE Ⅱscore or MODS score.

To investigate the predictive value of plasma copeptin for acute traumatic progressive hemorrhagic brain injury (PHI).

A total of 112 craniocerebral trauma patients from January 2012 to January 2015 were enrolled as the trauma group, and 112 healthy people served as the control group at the same time. The levels of plasma copeptin, glial fibrillary acidic protein (GFAP), myelin basic protein (MBP), neuron specific enolase (NSE), S100B, ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), phosphorylated axonal neurofilament subunit H (pNF-H) and tau were detected and compared between the two groups. And the correlation between all above indices and Glasgow coma scale (GCS) scores were analyzed by Pearson correlation. The ROC was used to analyze the predictive value of these biomarkers and GCS scores for PHI.

The plasma copeptin [(355 ± 124) pmol/L vs. (86 ± 30) pmol/L], GFAP [(0.14 ± 0.05) pmol/L vs. (0.05 ± 0.03) pmol/L], MBP [(0.61 ± 0.22) μmol/L vs. (0.23 ± 0.17) μmol/L], NSE [(0.11 ± 0.04) nmol/L vs. (0.05 ± 0.03) nmol/L], S100B [(15.5 ± 6.9) pmol/L vs. (2.6 ± 0.9) pmol/L], UCH-L1 [(66 ± 28) pmol/L vs. (10 ± 3) pmol/L], pNF-H [(2.52 ± 0.71) pmol/L vs. (0.14 ± 0.11) pmol/L] and tau [(4.4 ± 1.6) pmol/L vs. (0.4 ± 0.3) pmol/L] concentrations in the trauma group were much higher than those in the control group (t=22.308, 19.418, 18.531, 16.928, 20.221, 21.063, 39.625, 27.025; all P<0.001). Pearson correlation showed that GCS scores were all negative related with plasma copeptin, GFAP, MBP, NSE, S100B, UCH-L1, pNF-H and tau concentrations (r=-0.519, -0.478, -0.455, -0.422, -0.431, -0.408, -0.423, -0.421, all P<0.001). The ROC presented that GCS scores, plasma copeptin, GFAP, MBP, NSE, S100B, UCH-L1, pNF-H and tau concentrations all had significant predictive value for PHI (all P<0.05), and the area under curve (AUC) of GFAP (Z=2.693, P=0.007), MBP (Z=2.551, P=0.011), NSE (Z=2.397, P=0.017), S100B (Z=2.446, P=0.014), UCH-L1 (Z=2.558, P=0.011), pNF-H (Z=3.050, P=0.002) and tau concentrations (Z=2.597, P=0.009) were markedly lower than AUC of GCS scores. However, there were no significant differences between the AUC of GCS scores and plasma copeptin (Z=1.388, P=0.165).

Plasma copeptin concentrations show high clinical value in predicting PHI.

To evaluate the clinical application of warfarin individualized anticoagulation based on CYP2C9 and VKORC1 genotypes in patients with acute pulmonary thromboembolism.

Seventy-two patients with acute pulmonary thromboembolism in the General Hospital of Tianjin Medical University from July 2014 to June 2015 were enrolled. The CYP2C9 and VKORC1 genetic polymorphisms were detected by PCR and gene chip technology. The patients were randomly divided into study group (n=34) and control group (n=38). The patients in the study group were given warfarin dose according to the International Warfarin Pharmaeogenetics Consortium (IWPC) at the first 3 days, and the patients in the control group received the dose of 3 mg/d at the first 3 days. Then all the patients adjusted the warfarin dose according to the international normalized ratio (INR) and routine clinical practice. The INR were measured routinely at 1, 4, 6, 8, 14, 21, 28, 42, 56, 84 d, and warfarin dose were recorded everyday.

The CYP2C9 and VKORC1 genetic polymorphisms in the two groups showed no significant differences (χ²=0.941, P=0.919). Compared with the control group, the first time to INR target range [(8.8 ± 3.6) d vs. (10.7 ± 2.9) d; t=2.481, P=0.016] and time-to-stable dose [(14.3 ± 6.1) d vs. (19.2 ± 6.5) d; t=3.252, P=0.002] were much shorter, number of stable dosage at 2 weeks (19/34 vs. 12/38, χ²=4.323, P=0.038) were much higher in the study group. Meanwhile, the INR in the two groups were changed over time (F=42.016, P<0.001), and the INR at 4, 6, 8, 10, 12, 14, 19, 21, 28 d in the study group also showed statistical significance (all P<0.05).

The warfarin individualized anticoagulation based on CYP2C9 and VKORC1 genotypes can shorten the adjustment time to reach INR target range and warfarin stable dose, and have a guiding role at the early stage of anticoagulation.

To investigate the effect of ulinastatin on the apoptosis of regulatory T cells (Tregs) and cytokine secretion in septic mice.

A total of 60 male mice were randomized into the sham group, model group and ulinastatin group, 20 mice in each group. The model of sepsis was reproduced by cecal ligation and perforation, the mice in the sham group received celiotomy without ligation and puncture, and the mice in the ulinastatin group were given 100 000 U/kg ulinastatin by tail intravenous injection at 30 min after operation. The apoptosis rates of regulatory T cells were detected by flow cytometry, and the level of interleukin-2 (IL-2), IL-4 and interferon γ were determined by enzyme-linked immunosorbant assay.

The apoptosis rates of Tregs in the sham group, model group and ulinastatin group showed significant differences [(20.1 ± 1.0)%, (10.9 ± 0.8)%, (13.7 ± 0.8)%, F = 10.236, P = 0.030], and the apoptosis rates of Tregs in the ulinastatin group were much lower than those in the sham group, and much higher than those in the model group (all P < 0.05). Meanwhile, the levels of IL-2 [(352 ± 76), (172 ± 59), (249 ± 64) ng/L] and interferon γ [(177 ± 25), (56 ± 14),(109 ± 18) ng/L] in the model group and ulinastatin group decreased obviously as compared with the sham group, and it decreased most in the model group (all P < 0.05). The levels of IL-4 in the model group and ulinastatin group were much higher than those in the sham group, and were highest in the model group [(46 ± 15), (328 ± 81), (242 ± 62) ng/L, all P < 0.05].

Ulinastatin may induce the apoptosis of Tregs, improve the levels of IL-2 and interferon γ, and reduce the levels of IL-4.

To evaluate the value of the technique of spleen subpedicle severance for laparoscopic splenectomy in traumatic splenic rupture (TSR) patients.

Totally 17 TSR patients in the Department of Hepatobiliary and Pancreatic Surgery in Hangzhou First People's Hospital were collected. Based on CT diagnosis before operation and laparoscopic exploration during operation, the levels of spleen injury of TSR patients were determined, following by the standard classification of spleen injury which was released in the sixth national conference on spleen surgery in 2000. The total splenectomy or partial splenectomy were operated during surgery based on the levels of spleen injury, the intraoperative observation and postoperative recovery were recorded.

There were 3 cases of levelⅠspleen injury, 5 cases of level Ⅱ, 7 cases of level Ⅲ, and 2 cases of level Ⅳ in total 17 TSR cases. The mean operation time was (78 ± 12) min, the mean volume of autologous blood transfusion during operation was (750 ± 23) ml, and the mean volume of bleeding was (220 ± 45) ml. All TSR patients recovered anus exhaust and diet in 3 d after surgery, the mean hospital stay was (11.7 ± 2.1) d, and no associated long-term complication was found in post-operation follow-up.

The technique of spleen subpedicle severance for laparoscopic splenectomy in TSR patients is safe and effective.

To evaluate the effect of fluid management under the guidance of pulse indicator continuous cardiac (PICCO) on patients with severe acute pancreatitis (SAP) and acute respiratory distress syndrome (ARDS).

A total of 57 patients with SAP and ARDS were enrolled in the study, and were divided into the treatment group (29 cases) and control group (28 cases). The patients in the control group were only treated by routine fluid infusion, while patients in the treatment group were treated by PICCO guided fluid infusion. The ARDS's incidence, the percentage of patients using vasoactive drugs, the intubation rate, the duration of invasive mechanical ventilation, the amount of fluid resuscitation within 0~<6 h, 6~<24 h, 24~<48 h, 48~72 h respectively, and the mortality rate were all recorded and compared between the two groups.

The severe ARDS's incidence[17.24% (5/29) vs. 42.85% (12/28), χ²=4.47, P=0.045] and intubation rate [6.90% (2/29) vs. 28.57% (8/28), χ²=4.63, P=0.041] were much lower, while the duration of invasive mechanical ventilation [(5.8 ± 2.7) d vs. (9.1 ± 3.7) d, t=4.01, P<0.001] was significantly shorter in the treatment group than those in the control group. But there was no statistical differences in the percentage of patients using vasoactive drugs (4/29 vs. 7/28, χ²=1.15, P=0.330) and mortality rate [10.34% (3/29) vs. 17.86% (5/28), χ²=0.47, P=0.670] between the two groups. The amount of fluid resuscitation within 6 hours in the treatment group increased significantly when compared with the control group (P<0.05), the levels of fluid resuscitation during 6~<24 h, 24~<48 h and 48~72 h in the treatment group were remarkably less than that in the control group (all P<0.05).

PICCO can guide the fluid resuscitation of patients with SAP and ARDS in the early stage, and avoid lung injury induced by blind rehydration.

To observe the oxidative stress and lipid peroxidation damage in lung of rats with acute paraquat (PQ) poisoning, and investigate the intervention effect of curcumin on it.

Totally 120 adult male Sprague-Dauley rats in the study were divided into the control, PQ-poisoned and curcumin-intervened groups (40 rats in each group). Rats in the PQ-poisoned group were intraperitoneally (i.p.) administered with PQ (15 mg/kg). Curcumin 200 mg/kg was injected i.p. at 15 min before administered with PQ (15 mg/kg, i.p.) in rats of the curcumin-intervened group. The same (15 mg/kg, i.p.) in rats of the curcumin-intervened group. The same volume of saline were injected i.p. in rats of the control group. Eight rats from each group were sacrificed at 3 h, 6 h, 24 h, 3 d, and 7 d after poisoning, respectively. The expression of TGF-β₁ mRNA in lungs of rats were measured with fluorescence real-time quantitative PCR. The levels of malondialdehyde (MDA), myeloperoxidase (MPO), and superoxide dismutase (SOD) in lung of rats were measured with thiobarbituric acid colorimetric, spectrophotometer colorimetry and xanthine oxidase method, respectively. Pathological changes in lung were observed by light microscope.

Compared with the control group, TGF-β1 mRNA expression in lung of rats increased significantly at 6 h, 24 h, 3 d, and 7 d after PQ poisoning (F = 136.93, 32.28, 52.01, 30.94; all P < 0.05), the levels of MDA (F = 132.896, 64.988, 30.622, 30.192) and MPO(F = 34.738, 202.578, 122.019, 119.626) increased obviously (all P < 0.05), but the SOD level decreased remarkably in the PQ-poisoned group and curcumin-intervened group (F = 34.738, 202.578, 122.019, 119.626; all P < 0.05). When compared with the PQ-poisoned group, the levels of TGF-β1 mRNA expression, MPO and MDA in lung of rats in the curcumin-intervened group decreased significantly and the level of SOD in the curcumin-intervened group increased statistically at 6 h, 24 h, 3 d, and 7 d after PQ poisoning (all P < 0.05).

The initiation of oxidative stress and lipid peroxidation of cell membrane may be one of the mechanisms of acute lung injury in rats with PQ poisoning. The curcumin may reduce the lung injury in rats by inhibiting it.

To evaluate the application value of bedside fiberoptic bronchoscopy (BFB) on airway management in intensive care unit (ICU) patients.

The clinical data of 956 ICU patients who underwent BFB from January 2008 to December 2015 in the Central Hospital of Lishui City were enrolled in this study. The route of BFB entrance, destination, therapeutic effect, sputum culture and complication were summarized and recorded.

Totally 956 cases of critically ill patients were treated with BFB of 1 321 times, and 929 cases were treated by artificial airway, 25 cases by nasal endoscope, and 2 cases by endoscopy. Operating purpose was given priority to the secretion clearance and atelectasis treatment in 95.08% patients (909/956). Eight hundred and fifty-two patients (89.12%) with pulmonary infection were given antibiotics combined with 1 126 times of BFB to remove secretions, and the symptoms, signs and laboratory indicators were all improved postoperatively. Fifty-seven atelectasis patients underwent BFB under direct vision with lung lavage of 142 times, and the lung recruitment rate was 91.23% (52/57). At the same time, the culture positive of sputum specimens rate was 66.13%(289/437). The main complications were hypoxia, arrhythmia, trachea hemorrhage after operation, and there was no serious adverse reaction.

The application of BFB on airway management in critically ill patients has better diagnosis and treatment value, and is worth to be popularized.