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15 June 2018, Volume 46 Issue 6 Previous Issue    Next Issue

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The present and future of intensive medicine QIN Ying-zhi 2018, 46 (6):  561-563.  doi: 10.11958/20180562 Abstract ( 2065 )   PDF (349KB) ( 3740 )   In the past thirty years, intensive medicine has made great development, and it has been playing an active role in hospital medical practice and other emergencies. Intensive medicine has become an indispensable part in rescuing critically ill patients and protecting people’s life and health. It has been proved that intensive medicine is capable to adapt to change and to lead the development of the discipline. These changes have greatly improved the prognosis of patients. This article is mainly focused on the four aspects to explore the research status and future development of intensive medicine,including the early recognition of sepsis, acute kidney injury (AKI) and renal replacement therapy (RRT), respiratory failure and mechanical ventilation, hemodynamic monitoring and volume resuscitation. It can be predicted that the future trend of intensive medicine is to foster collaboration between clinical and basic researches, and to make full use of big data and artificial intelligence. Related Articles | Metrics

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intensive care units| informatics| critical care medicine|big data WANG Chun-ting, LUAN Qing-hao 2018, 46 (6):  564-567.  doi: 10.11958/20180876 Abstract ( 804 )   PDF (342KB) ( 3614 )   Critical care medicine is a study about the characteristics and regularity of any injury or disease leading to the development of the body to death, and which is also a study about treatment of severe patients on the basis of these characteristics and regularity. Informatization, as a noun, refers to the historical process of making full use of information technology, developing and utilizing information resources, promoting information and knowledge sharing, improving the quality of economic growth, and promoting the economic and social development transformation. On the other hand, as an adjective, it means the new form or state of an object or domain as a result of its intensive application of information technology. The combination of critical care medicine and informatization can be divided into three stages: (1) critical care medicine, informatization, (2) critical care medicine and informatization, and (3) information based critical care medicine.The development of informatization is to serve mankind, also to serve critical care medicine. At the same time, the improvement of critical care medicine affirms the meaning of informatization, which promotes the development of informatizatiion. From computer to internet, to internet of things, to big data and artificial intelligence, the combination of critical care medicine and informatization is constantly opening up a new chapter. Related Articles | Metrics

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Reaching the standard does not mean achieving the aim –the most important role of analgesia and sedation in organs AN You-zhong 2018, 46 (6):  567-570.  doi: 10.11958/20180560 Abstract ( 1121 )   PDF (374KB) ( 3922 )   The aim of analgesia and sedation treatment is to protect the morphology and functional reserve of organs. On the basis of circulatory perfusion and oxygenation, which can meet the minimum requirement of body and organ metabolism in the whole body, the organs can be rest and function harmoniously, so as to save and protect the organ’s reserve function to the maximum extent, so that the critically ill patients can maintain good living quality as much as possible after the rehabilitation. It will be very important for the sustainable development of critical care medicine. In the process of achieving the purpose of analgesic and sedative therapy, it is necessary to set up different analgesic sedative targets according to the patient’s condition, basic state and organ function. It is not suitable to simply and mechanically emphasize "deep sedation" or "light sedation". Analgesic and sedative treatment is a double-edged sword. No monitoring, no analgesia and sedation. To give the optimal analgesia and sedation therapy, it requires continuous monitoring and evaluation of whether the treatment is in order to achieve analgesic and sedative targets and to reach the purpose of protecting organ function. However, the monitoring and evaluation should not only be limited to the understanding of pain and consciousness and cognition, but also the dynamic changes in the basic vital signs of patients. By means of monitoring and evaluation, we can achieve the goal of keeping all organs of the body alive, preserving function as much as possible, reducing chronic and critical illness and improving the quality of life in patients. Related Articles | Metrics

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Focus on the hotspots of CRRT HU Zhen-jie, LIU Li-xia 2018, 46 (6):  571-576.  doi: 10.11958/20180415 Abstract ( 760 )   PDF (400KB) ( 4149 )   With the progress of technology and the development of severe kidney medicine, continuous renal replacement therapy (CRRT) has been extended to kidney support and has been widely used for aiming to rapidly correct fatal complications of several life-threatening renal impairment (AKI). However, there are many controversies and problems,including the timing of initiating CRRT, the dosage of treatment and the choice of filter membrane material for different kinds of critically ill patients. The controversy and study of 60 years have not come to a unanimous conclusion, which reflects the critically clinical complexity. There is no "unchangeable (one size fits all)" treatment model, but rather a "patientcentered, individualized, precision CRRT" treatment. This article was to explore these three hotspots in order to provide more evidences for clinicians to perform rationalized, personalized and precise CRRT, and to make more patients benefit from CRRT. Related Articles | Metrics

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Enlightenment and thinking of 2016 guidelines on sepsis MA Xiao-chun, ZHAO Dong-mei 2018, 46 (6):  576-580.  doi: 10.11958/20180569 Abstract ( 674 )   PDF (390KB) ( 3868 )   In 2017, the American Society of Critical Care Medicine (SCCM) and European Society Intensive Care Medicine (ESICM) issued the latest guidelines for sepsis in 2016. The guide updated the guidelines of 2012 and proposed more precise, accurate and effective diagnosis and treatment program. This article elaborated the new enlightenment and thinking of the guide in order to improve the understanding and clinical practice of the sepsis guidelines for the intensive medical doctors. Related Articles | Metrics

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The role of PI3K/AKT in acute kidney injury induced by abdominal sepsis in rats YANG Rui, XU Hua, WANG Bing, WANG Yong-qiang 2018, 46 (6):  581-584.  doi: 10.11958/20180398 Abstract ( 824 )   PDF (384KB) ( 3809 )   Objective To investigate the role of PI3K/AKT in acute kidney injury (AKI) induced by abdominal sepsis in rat model. Methods The cecal ligation and puncture (CLP) was used to establish rat model of abdominal sepsis. The serum levels of creatinine (Cr) and urea nitrogen (BUN) were detected by automatic biochemical analyzer at different time points (24, 48 and 72 h) after operation. The expressions of PI3K/AKT mRNA were detected by real-time PCR. Western blot assay was used to verify the expression levels of NLRP3, ASC and Caspase-1. The serum levels of TNF-α, IL-1β and IL-18 were detected by enzyme-linked immunosorbent assay. Results The serum levels of Cr and BUN were increased significantly in CLP group compared with those of control group (P＜0.05). The expression levels of PI3K/AKT in kidney were significantly increased in rats with abdominal sepsis (P＜0.01). And the released NLRP3 inflammasome, which was activated by PI3K / AKT, was significantly increased (P＜0.01). Meanwhile, compared with the sham-operated group, the serum levels of IL-1β, TNF - α and IL-18 were increased significantly (P＜0.01). Conclusion PI3K / AKT signaling pathway plays an important role in acute kidney injury induced by abdominal sepsis, which activates the NLRP3 inflammasome, increases the release of inflammatory cytokine and aggravates the sepsis condition. Related Articles | Metrics

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Comparative study on sepsis models induced by Escherichia coli subtypes ZHANG Jing-jing, KONG Xian-bin, HUO Jing-rui, WANG Lei, LIU Ying, YANG Xiao-hui, TIAN Yi, HOU Zhen-jiang, CHEN Feng, CHEN Xu-yi, SUN Shi-zhong, XIA Tian-guang, SUN Zhong-lei, HUANG Meng-qiang, LIU Ying-fu 2018, 46 (6):  585-589.  doi: 10.11958/20180370 Abstract ( 914 )   PDF (753KB) ( 3966 )   Objective To investigate the degrees of injury severity of sepsis models made by different kinds of Escherichia coli. Methods The 152 mice were randomly divided into control group, DH5α group, 44102 group, and 25922 group, with 38 rats in each group. DH5α group, 44102 group and 25922 group were intraperitoneally injected with 300 μL of Escherichia coli DH5α, 44102 and 25922 at the concentration of 1.0 × 109 CFU/kg to prepare sepsis models of different kinds of Escherichia coli. Control group was injected intraperitoneally with the same amount of normal saline. (1) After 8 h,four mice were taken from each group for peripheral blood bacterial culture . (2) After 12 h, ten mice in each group were used for measuring serum levels of TNF-α and IL-6 by enzyme-linked immunosorbent assay (ELISA). (3) Western blot assay was used to determine the serum levels of high-mobility group protein (HMGB1) in four mice of each group. (4) Ten mice in each group were used to measure serum levels of alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine (CR) and blood urea nitrogen (BUN) by automatic biochemical analyzer. (5) After liver, lung and kidney tissues were fixed with formaldehyde, hematoxylin-eosin (HE) staining was performed (n=10 for each group). Results In DH5α group, 44102 group and 25922 group, bacteria, inflammatory cytokines TNF- α, IL-6 and HMGB1 protein, liver and kidney indicators ALT, AST, CR and BUN showed a sequential increasing trend (P＜0.01). The severe degrees of alveolar structure damage,hepatic cell infiltration and renal glomerular atrophy were DH5α group, 44102 group and 25922 group in turn. There were no obvious damages of lung, liver or kidney tissues in control group. Conclusion Escherichia coli 25922 induces severe sepsis injury and can be used to study the animal models of the initial inflammatory phase of sepsis. Escherichia coli 44102 induces moderate damage of sepsis and can be used in animal models that do not require definitive sepsis staging experiments. Escherichia coli DH5α induces less damage of sepsis and can be used to explore immunosuppressive therapy of the animal model of sepsis. Related Articles | Metrics

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Clinical study of different sedative methods in critically ill patients after heart surgery MENG Dong-mei, QI Yu-juan, MU Yu, LI Jian, LI Pei-jun 2018, 46 (6):  590-594.  doi: 10.11958/20180500 Abstract ( 879 )   PDF (371KB) ( 3724 )   Objective To study the effect of light sedation and traditional sedation (moderate sedation with daily sedation interruption) on hemodynamic indexes and prognosis in critically ill patients after cardiac surgery. Methods A total of 134 patients who were ventilated delay after heart surgery in our hospital from January to June 2017 were enrolled in this study. The patients were randomly divided into light sedation group (RASS score -1-1, n=65) and traditional sedation group (RASS score - 3--2, n=69). All patients received sufentanil for postoperative analgesia. The light sedation group received propofol and / or dexmedetomidine as sedative drugs after operation, and the conventional sedation group used midazolam for postoperative sedation. The hemodynamic indexes, the first time of weaning off the ventilator, the duration of mechanical ventilation and ICU stay were compared between the two groups. Patients with low cardiac output syndrome after surgery were analyzed in subgroups. Results (1) There were no significant differences in heart function, operative complications and other indicators between the two groups after surgery (all P＞0.05). The low cardiac output syndrome was found in 12 patients in the light sedation group and 10 cases in the traditional sedation group. (2) Hemodynamic monitoring results displayed that the sedation/central venous oxygen saturation (SvO2/ScvO2) and cardiac index (CI) were higher after sedation than before sedation in both groups (all P＜0.05), but there was no significant difference between the two groups (all P＞0.05). Subgroup analysis showed that the SvO2/ScvO2 index was higher in patients with low cardiac output syndrome in the traditional sedative group than that in the light sedation group (P＜0.05). There was no difference in the SvO2/ScvO2 index in patients with non-low cardiac output syndrome between two groups. (3) Compared with the traditional sedationgroup, the first off-line time, the total mechanical ventilation after surgery and the ICU stay time were significantly shortened, and the incidence of postoperative delirium was decreased in the light sedation group (all P＜0.05). Subgroup analysis showed that in patients with non-low cardiac output syndrome, the first off-line time, total postoperative mechanical ventilation time and total ICU stay were significantly shorter in the light sedation group than those in the traditional sedation group (all P＜0.05). There was no significant difference in patients with low cardiac output syndrome between the two groups (P＞0.05). Conclusion Patients with non-low cardiac output syndrome after cardiac surgery benefit significantly from the superficial sedative strategy, and the postoperative mechanical ventilation time and ICU residence time are reduced. The moderate sedation may contribute to the early cardiac function recovery in patients with low cardiac output syndrome Related Articles | Metrics

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A case of refractory hemophagocytic syndrome combined with multiple organ failure - ICU rescue experience WANG Yi-jun, ZHANG Zhen, LI Cai-feng, ZHANG Ying, GAO Ying, WANG Zhao, WANG Zhi-qiang 2018, 46 (6):  595-599.  doi: 10.11958/20180269 Abstract ( 1338 )   PDF (1023KB) ( 4112 )   Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is a lifethreatening condition of severe hyperinflammation caused by the uncontrolled proliferation of activated lymphocytes and histiocytic secreting high amounts of inflammatory cytokines. This article describes a case of refractory hemophagocytic syndrome combined with multiple organ failure. Through the review of medical history and treatment process, analysis of rescue occasion and details, and the practice on the concept of salvage therapy, our purpose is to discuss the strategy and experience that we have gained from rescuing severe refractory hemophagocytic syndrome in ICU. The key to the success rescue of this case is that we not only have carried out timely and effective early stage of initial treatment and salvage treatment, but also have had real-time monitoring and timely and effective treatment in ICU. Based on the effective infection control and comprehensive organ support, the phased treatment results of patients with HPS can be significantly improved,which provides possibility for HPS patients’survival. Related Articles | Metrics

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The progress of long-term outcomes in survivors of acute respiratory distress syndrome WANG Zhi-yong, XU Lei 2018, 46 (6):  600-605.  doi: 10.11958/20180424 Abstract ( 924 )   PDF (370KB) ( 3968 )   Along with the development of critical care medicine and the advances in respiratory support，the short-term mortality of acute respiratory distress syndrome (ARDS) has significantly decreased, and many patients have survived. Then the long-term outcomes of survivors of ARDS is getting more and more attention. ARDS survivors can have complete recovery of pulmonary function, but they might continue to present sequelae including physical impairment (muscle weakness and limited activities), cognitive impairment and psychologic problem (anxiety, depression, post-traumatic stress disorder) over five years, called as post intensive care syndrome, resulting in a decline in quality of life and increasing the burden of family and medical resource consumption. For ARDS patients, some factors have a significant impact on the longterm outcomes of survivors, including pre-ARDS health status (such as comorbidity, obesity, functional independence,mental health status), lifestyle (such as smoking) and the relevant variables during their stay in ICU (such as delirium, corticosteroids, opioids, acquired muscle weakness, hypoxemia). Identifying the modifiable risk factors for long-term outcomes of ARDS patients, and taking timely intervention measures have important significance for decline of post-ARDS dysfunction. It is unclear whether interventions in ICU or post-ICU can effectively improve long-term outcomes in ARDS survivors, and further investigation and validation are required. Related Articles | Metrics

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The research status of pathogenesis of sepsis related thrombocytopenia XU Hua, WANG Bing, WANG Yong-qiang 2018, 46 (6):  606-609.  doi: 10.11958/20180453 Abstract ( 1096 )   PDF (347KB) ( 3674 )   Sepsis is a lethal organ dysfunction caused by infection induced reaction maladjustment. Thrombocytopenia is not only a common complication of sepsis, but also closely related to the patient's prognosis. In the clinical treatment, it is important to identify the etiology and pathogenesis of thrombocytopenia associated with sepsis and choose appropriate methods to correct thrombocytopenia in time to improve the prognosis of patients. This article gives an introduction to the research status of the etiology, pathophysiological mechanism and molecular mechanism of sepsis-related thrombocytopenia. Related Articles | Metrics

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Identify the molecular target of nasopharyngeal carcinoma by bioinformatics analysis LIU Yu-zhi, MEN Jian-long, LI Yang 2018, 46 (6):  610-614.  doi: 10.11958/20171427 Abstract ( 965 )   PDF (429KB) ( 3412 )   Objective To study the pathogenesis of nasopharyngeal carcinoma and identify potential biomarkers or therapeutic targets. Methods Microarray data (GSE12452 and GSE13597) were downloaded from Gene Expression Omnibus. Processing of original microarray data and screening of differentially expressed genes were performed through bioinformatics analysis. Then, GO and KEGG pathway enrichment analysis was performed for these genes using DAVID database. Real time-PCR and Western blot assay were used to detect the expression levels of the identified genes. Results A total of 260 overlap DEGs were obtained including 16 GO entries and 4 signal pathways. Eighteen potential therapeutic targets that relative to cell cycle were identified by gene enrichment analysis. Expression levels of 12 selected genes were confirmed by real-time PCR. Finally, 4 selected genes were confirmed by Western blot assay. Conclusion By bioinformatics analysis of two sets of microarray data and molecular biology research, four genes were found including CDC6，CDK1，MCM2 and CCNB1, which might be potential key genes that can be developed for therapy targets of NPC in the future Related Articles | Metrics

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Preparation of thymopentin supramolecular hydrogel and its application in immunomodulatory REN Chun-hua, GAO Yang, CHU Li-ping, LIU Jian-feng 2018, 46 (6):  615-619.  doi: 10.11958/20180349 Abstract ( 908 )   PDF (1212KB) ( 3835 )   Objective To prepare a thymopentin-contained supramolecular hydrogel, and characterize its micromorphology and mechanical property, and further investigate its effects on the cellular uptake and the immunomodulatory performance in vitro. Methods The self-assembling peptide containing thymopentin was prepared by solid phase synthesis method and identified using LC-MS after being purified by high performance liquid chromatography (HPLC). Supramolecular hydrogel was prepared through a heating-cooling process, and its micromorphology and mechanical property were characterized using transmission electron microscopy (TEM) and rheology. The cellular uptake efficiencies of free thymopentin and thymopentin nanofibers were observed by inverted fluorescence microscope after FITC-labeling. The abilities of free thymopentin and thymopentin nanofibers to stimulate RAW 264.7 cells to secrete tumor necrosis factor (TNF-α) were studied by enzyme-linked immunosorbent assay (ELISA). Results A macroscopic visible supramolecular hydrogel was obtained by a heating-cooling process, composing with long cross-linked nanofibers and possessing good ductility of mechanics. Compared with free thymopentin, thymopentin nanofibers showed much more enhanced cellular uptake, and better immunomodulation property as stimulating the RAW 264.7 cells to produce much higher concentration of TNF-α in vitro. Conclusion After rational structural modification, the cellular uptake and immunomodulatory activity of thymopentin, which formed nanomedicine, were significantly enhanced. This study can provide new methods and guidance for improving the therapeutic effect of thymopentin in clinical application. Related Articles | Metrics

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The effects of mechanical loading on high-fat induced obesity and non-alcoholic fatty liver disease TAN Nian, LI Xin-le, ZHAI Li-dong, LIU Da-quan, ZHANG Ping 2018, 46 (6):  620-624.  doi: 10.11958/20180091 Abstract ( 988 )   PDF (756KB) ( 3804 )   Objective To investigate the therapeutic effect of mechanical loading on obesity and non-alcoholic fatty liver disease. Methods Thirty 6-week-old female C57BL/6 mice (body weight 18 g) were randomly assigned into three groups: normal control group (NC group, n=10), high-fat diet group (HF group, n=10) and high-fat diet with mechanical loading treatment group (HF+L group, n=10). All mice except for NC group were fed with high-fat diet for 12 weeks. After 6 weeks of high-fat diet, mice of HF+L group received 6-week mechanical loading. The whole body composition was analyzed to detect the total body fat content. The mesenteric fat, perirenal fat, inguinal fat, periuterine fat and the liver were collected and weighed. A portion of the liver sample was isolated for histological analysis (Oil red O staining and HE staining) to observe pathologic changes, while the other was used for Western blot assay to detect the expression of eIF2α, p-eIF2α and ATF4, which were the marker proteins of endoplasmic reticulum stress. Results Compared with the NC group, high-fat diet resulted in a significant increase in body weight and body fat (P＜0.05). After mechanical loading treatment, the body weight and body fat were significantly decreased in the HF+L group compared with those of HF group (P＜0.05). Hepatic histological analysis showed that high-fat diet induced hepatic steatosis, which was effectively alleviated by mechanical loading treatment (P＜0.05). Western blot analysis indicated that high-fat diet led to higher expression levels of p-eIF2α and ATF4 in liver, and mechanical loading was effective in inhibiting the increased expressions of p-eIF2α and ATF4.Conclusion Mechanical loading can effectively alleviate obesity and non-alcoholic fatty liver disease caused by high-fat diet, and its effects may be associated with endoplasmic reticulum stress in liver Related Articles | Metrics

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Juncus inhibits osteoclast formation induced by RANKL WANG Peng, GUO Di, CHEN Li-hua, ZHANG Li-wei, CHEN Hai-xiao 2018, 46 (6):  624-628.  doi: 10.11958/20180184 Abstract ( 825 )   PDF (3688KB) ( 4187 )   Objective To observe the effect of Juncus effuses on osteoclasts differentiation from bone marrow macrophages (BMMs) induced by receptor activator for nuclear factor - κ B ligand (RANKL), and its mechanism thereof. Methods BMMs were isolated from whole bone marrow of 8-week-old C57/BL6 mice, and CCK-8 was used to detect the effect of Juncus on BMMs cell proliferation. Tartrate resistant acid phosphatase (TRAP) staining was used to show that 50 μg/L RANKL and 30 μg/L macrophage colony stimulating factor (M-CSF) stimulated the BMMs differentiation into osteoclasts, but the process was inhibited by Juncus (0, 6.25, 12.5 and 25 μmol / L). RT-PCR was used to detect the expressions of osteoclast-specific genes including calcitonin receptor (CTR), vacuolated H+ triphosphate transporter -d2 (V-ATPase-d2) and - a3 (V-ATPase-a3), activated T nuclear factor 1 (NFATC1) and C-FOS. Results There was no inhibition in the proliferation of BMMs cells treated with Juncus less than 12.5 mol/L detected by CCK-8. The 50 μg/L RANKL can induce BMMs differentiated into positive multinuclear giant cells detected by TRAP staining, but Juncus significantly inhibited osteoclast formation with a concentration dependence. The results of RT-PCR experiment showed that Juncus inhibited the expression of specific genes in osteoclast differentiation in concentration-dependent manner. Conclusion Juncus can inhibit osteoclast formation in concentration-dependent manner, resulting from the inhibitory effect on osteoclast specific gene expression. Related Articles | Metrics

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Study on ecologic microorganisms in lesions of acute guttate psoriasis induced by upper respiratory tract infection ZHANG Bao-lan, WANG Xiao-meng, CHANG Gui-zhen, ZHANG Li-tao 2018, 46 (6):  629-634.  doi: 10.11958/20180442 Abstract ( 876 )   PDF (1110KB) ( 3584 )   Objective To investigate the characteristics of lesions of acute guttate psoriasis induced by upper respiratory tract infection, and to compare the difference in the different species between patients and healthy controls.Methods A total of 11 cases of acute guttate psoriasis induced by upper respiratory tract infection and 11 cases of healthy control without skin lesions of any dermatosis were included in this study. The 16SrDNA sequencing technology was used for analyzing data. The aseptic cotton swabs were used for sampling. DNA extraction and quality inspection were then performed. PCR amplification, library construction, microbial gene extraction, purification and recovery process were also performed. Then the gene samples were sent to be sequenced and to annotate the species. Finally, the data were analyzed by α and β diversity analysis to find the differences in microbial species and the diversity of microbial community. LEfSe analysis was used to find the species with significant difference, and the results were verified by the rank test. Results There was no significant difference in α diversity analysis between the two groups. There was a trend of difference in β diversity analysis between the two groups. However, LEfSe analysis (LED Score was 4) and rank test (P＜0.05) found that acinetobacter was a statistically significant different species and played a major role in the lesions of acute guttate psoriasis.Conclusion The skin lesions of microbiota is developing from one steady state to another one in the primary or recurrent acute guttate psoriasis patients with the history of upper respiratory infection. The different species of acinetobacter may play a key role in this change. However there is no significant difference in the overall microbial community between two groups. Related Articles | Metrics

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Analysis of influencing factors of lymph node metastasis in patients with central and peripheral types of squamous cell lung cancer LI Miao, WANG Chang-li 2018, 46 (6):  635-639.  doi: 10.11958/20171211 Abstract ( 1175 )   PDF (366KB) ( 3707 )   Objective To analyze the factors related to the metastasis of lung squamous cell carcinoma in patients with central and peripheral types of lung squamous carcinoma, and provide evidence-based basis for preoperative preparation,intraoperative lymph node treatment choice and postoperative treatment. Methods Clinical data of 142 patients with lung squamous carcinoma who performed operation in Tianjin Medical University Cancer Institute and Hospital from January 2014 to December 2015 were retrospectively analyzed. There were 83 cases of central lung squamous cell carcinoma and 59 cases of peripheral lung squamous carcinoma in these 142 patients. Single factor and multiple factor Logistic regression analysis were used to analyze the clinical data in patients with different type groups, including gender, age, smoking history and smoking index, preoperative CYFRA21-1 level, preoperative predictive lymph nodes metastasis, tumor diameter, tumor type (keratotic and non-keratotic), pleura invasion, tumor embolism and postoperative lymph node metastasis. Results There were 47 cases with lymph node metastasis in 147 patients, including 31 cases of central type metastasis, and 16 cases of peripheral type metastasis. Single factor analysis showed that gender, smoking history, smoking index, preoperative lymph node metastasis assessment, tumor diameter, and non-keratotic type were related to the metastasis of central type of lung squamous cell carcinoma. Pleural invasion and non-keratotic type were associated with peripheral type of pulmonary squamous cell carcinoma. Multivariate Logistic regression analysis showed that more smoking, large tumor diameter and nonkeratotic type were independent risk factors for lymph node metastasis of central type of lung squamous cell carcinoma. The non-keratotic type was an independent risk factor for lymph node metastasis of peripheral pulmonary squamous carcinoma.Conclusion Non-keratotic type of squamous cell carcinoma is related to lymph node metastasis especially N1 lymph node metastasis. It is suggested that such patients should be actively treated and colsely followed up after the operation. Patients with more smoking may be more likely to have N2 lymph node metastasis. Related Articles | Metrics

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Correlation of serum uric acid levels and carotid lesions in H type hypertension patients with type 2 diabetes mellitus YANG Hong, LIU Xuan, LIU Wen, YUE Song 2018, 46 (6):  639-643.  doi: 10.11958/20180158 Abstract ( 712 )   PDF (402KB) ( 4246 )   Objective To analyze changes of serum uric acid (SUA) and carotid lesions in H type hypertension patients with type 2 diabetes mellitus (T2DM) and explore the risk factors of H type hypertension with T2DM. Methods A total of 119 patients diagnosed as H-type hypertension and admitted to our hospital from November 2016 to December 2017 were included in this study. Patients were divided into two groups according to whether they were combined with T2DM: 64 cases in simple H type hypertension group (simple group) and 55 cases in H type hypertension combined with T2DM group(combined group). Fifty healthy people in healthy physical examination at the same period were enrolled in this study as the control group. Questionnaires (age, gender, hypertensive history, cerebrovascular history, smoking history and drinking history) were collected in patients. The blood biochemical indicators including homocysteine (Hcy), SUA, fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were detected. The color Doppler ultrasonography was used to measure carotid intimamedia thickness (cIMT). The carotid plaque scores were also measured. The risk factors of H type hypertension with T2DM were analyzed by multivariate Logistic regression. Results Values of SUA, cIMT incrassation ratio, carotid plaque score,carotid plaque detection rate, cerebrovascular history, smoking history and drinking history in simple group was higher than control group and lower than combined group (P＜0.05). Data of hypertension and Hcy were increased in simple group and combined group (P＜0.05). The serum level of FPG was significantly higher in combined group than that of control group and simple group (P＜0.05). There were no significant differences in hypertensive history, blood pressure and Hcy between simple group and combined group. There were no significant differences in TC, TG, HDL-C and LDL-C between three groups. Multivariate Logistic regression analysis showed that the elevated SUA (OR=1.015, 95%CI: 1.008-1.023), cIMT incrassation (OR=13.754, 95%CI: 2.556-74.016) and smoking history (OR=5.229, 95%CI: 2.872-9.775) were risk factors for H type hypertension with T2DM. Conclusion For patients with hypertension and T2DM, Hcy, SUA and cIMT should be routinely tested, which can take corresponding intervention at early stage to prevent atherosclerosis and control the occurrence of cardiovascular and cerebrovascular diseases effectively. Related Articles | Metrics

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Clinical analysis of minimally invasive surgery in the treatment of hypertensive lobar cerebral hemorrhage LI Qian-feng, DUAN Fa-liang, WU Jing-lei, CHEN Xiao-bin, HUANG Cong-gang, LUO Ming 2018, 46 (6):  644-647.  doi: 10.11958/20171387 Abstract ( 808 )   PDF (1277KB) ( 4192 )   Objective To explore the clinical value and effect of neuronavigation-assisted neuroendoscopy for hypertensive lobar cerebral hemorrhage. Methods Clinical data of 35 cases treated with the neuroendoscopy(neuroendoscopy group) and 32 cases treated with the neuronavigation-assisted microscope (microscope group) were retrospectively analyzed. Data of the operative time, intraoperative blood loss and the clearance rate of hematoma, the postoperative complications (stress gastric ulcer, pulmonary infection, urinary tract infection and intracranial infection), the hospital stay, postoperative ability of daily life (ADL) in 6 months and fatality rates were observed and compared. Results The operative time and intraoperative blood loss were less in the neuroendoscopy group than those in the microscopy group,and the clearance rate of hematoma was higher in neuroendoscopy group than that in the microscopy group (P＜0.01). There was no significant difference in postoperative complications between the two groups (P＞0.05). The hospital stay was less in the neuroendoscopy group than that of the microscope group (P＜0.01). On the basis of ADL grading method, the prognosis of the endoscopy group was better than that of the craniotomy group (P＜0.05). There was no significant difference in the fatality rate between the neuroendoscopy group and the microscopy group (P＞0.05). Conclusion The neuronavigation assisted neuroendoscopy is a safe and effective surgical method for hypertensive lobar cerebral hemorrhage, and which can improve the prognosis of patients with hypertensive intracerebral hemorrhage. Related Articles | Metrics

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The study on cytokines of bronchoalveolar lavage fluid in children with mycoplasma pneumoniae pneumonia GUO Wei, ZHANG Tong-qiang, XU Yong-sheng, LIU Fu-jun 2018, 46 (6):  648-651.  doi: 10.11958/20180116 Abstract ( 852 )   PDF (353KB) ( 4008 )   Objective To study the cytokine levels of TNF-α, IFN-γ, IL-2, IL-4, IL-6 and IL-10 in bronchoalveolar lavage fluid (BALF) in children with mycoplasma pneumoniae pneumonia (MPP). Methods Clinical data of 90 patients with MPP (MPP group), who were admitted to Tianjin Children’s Hospital from January to December 2017, were collected in this study. The 90 cases were divided into group A1 (< 7 days), group A2 (7-14 d) and group A3 (15-30 d) according to the course of disease on admission, with 30 cases in each group. Children who were without MPP and needed bronchoscopy examination or treatment at the same time were used as the control group (B group). The expression levels of cytokines (TNF-α, IFN-γ, IL-2, IL-4, IL-6 and IL-10) were detected by enzyme-linked immunoassay (ELISA). Results The serum and BALF levels of TNF-α, IFN-γ, IL-2, IL-4, IL-6 and IL-10 increased significantly in A group compared with those in B group (P < 0.05). The highest levels of cytokines (TNF-α, IFN-γ and IL-2) were found in Group A1. The highest levels of cytokines (IL-4 and IL-6) were found in Group A2. Conclusion The levels of TNF-α, IFN-γ and IL-2 are increased significantly in the disease course of < 7 days. In the disease course of 7 to 14 days, the IL-4 and IL-6 are elevated significantly. Our data suggest that these cytokines may be involved in the pathogenesis of MPP. Related Articles | Metrics

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The upper gastrointestinal hemorrhage as the initial symptom in gastric diffuse large B-cell lymphoma combined with liver cirrhosis: a case report XU Bai-guo, LIU Lei, LI Jun, YIN Wei-li, WANG Fei, YANG Yan-kai 2018, 46 (6):  651-653.  doi: 10.11958/20180020 Abstract ( 917 )   PDF (1155KB) ( 3806 )   Diffuse large B-cell lymphoma (DLBCL) is the most prevalent type of diffuse B-cell lymphoma in nonhodgkin lymphoma (NHL). The progressive enlarging lymphonodus is the most common clinical manifestation of this disease. DLBCL often appears heterogeneous presentations. It is easy to be misdiagnosed. Here, we reviewed a case of DLBCL with liver cirrhosis, in which the initial symptom was upper gastrointestinal hemorrhage, and the endoscopic examination showing gastric ulcer. We hope to improve the understanding and diagnosis and treatment levels of DLBCL by analyzing this case. Related Articles | Metrics

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Case report and literature review of neonatal hemolysis induced by anti-E and anti-Ec combined with anti-Fyb SHI Wu-juan, MU Yu, SONG Li, ZHANG Fang, MA Qing-rong, WANG Dan 2018, 46 (6):  654-656.  doi: 10.11958/20171327 Abstract ( 747 )   PDF (359KB) ( 3768 )   Hemolytic diseases of newborn (HDN) can cause miscarriage, premature birth, fetal edema, fetal intrauterine anemia and even fetal death in early pregnancy. Neonatus with HDN can have jaundice,anemia,hepatosplenomegaly, edema and nuclear jaundice sequelae. This article reviewed the diagnosis and treatment of two patients with HDN caused by anti -E and anti-Ec combined with anti-Fyb, and reviewed the relevant literature on the epidemilogy, the diagnosis and treatment of HDN in order to improve the understanding of the disease. Related Articles | Metrics

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Research progress of STIM1 in tumor development and clinical application HU Jin-meng, WANG Jian 2018, 46 (6):  657-660.  doi: 10.11958/20180135 Abstract ( 583 )   PDF (499KB) ( 3565 )   Studies have shown that stromal interaction molecule 1(STIM1) is closely related to the development of tumors, and which is involved in the regulation of apoptosis, proliferation, migration and invasion in many human cancers.Blocking or knockdown of STIM1 can significantly inhibit the proliferation and migration of cancer cells. Elucidation of the regulatory mechanism of STIM1 in cancer cells will be helpful for the identification of new therapeutic targets. This paper reviews the mechanism of STIM1 molecule in different tumors and its clinical application. Related Articles | Metrics

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The progress in surgical procedure for early stage of non-small cell lung cancer SUN Bing-sheng, LI Chen-guang, SU Yan-jun 2018, 46 (6):  661-665.  doi: 10.11958/20171530 Abstract ( 880 )   PDF (360KB) ( 3771 )   Surgical treatment is important for the treatment of non-small cell lung cancer (NSCLC). In recent years, video-assisted thoracic surgery (VATS) and Robotic VATS (RVATS) have been widely used in the therapies for patients of early stage NSCLC and traditional thoracotomy is becoming less and less. Many patients with ground-glass note (GGN) can be cured by VATS and Robotic procedures, and which promotes the development of minimally invasive surgery. However,the treatment of GGN is controversial. This article makes a summary of the selection in single VATS, RVATS and lung segments for surgical procedures in NSCLC. Related Articles | Metrics

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The role of sex hormones on ion channels of drug-induced long QT syndromes WANG Cui-hua, JIA Xin-le, LIU Yan-gong, ZHENG Ming-qi 2018, 46 (6):  665-669.  doi: 10.11958/20171441 Abstract ( 708 )   PDF (377KB) ( 3945 )   Female gender is an independent risk factor for the development of torsade de pointes (TdP) arrhythmias not only in congenital long QT syndromes（LQTs）but also in acquired long QT syndromes. Clinical evidences imply that sex steroid hormones appear to play important roles in gender differences by affecting the cardiac repolarization process of action potential. This review summarizes the effects of sex hormones on cardiac ion channel currents and the effects of gender differences on drug-induced long QT syndromes, and reveals the mechanism of sex hormone induced arrhythmia by computer simulation Related Articles | Metrics

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Clinical research progress of Kawasaki disease shock syndrome KAN Xuan, WU De-jing, LIU Ge-li 2018, 46 (6):  670-672.  doi: 10.11958/20180053 Abstract ( 1176 )   PDF (348KB) ( 3800 )   Kawasaki disease shock syndrome (KDSS) is a serious manifestation of Kawasaki disease. It is a clinical symptom of hypoperfusion, which occurs hemodynamic instability on the basis of the diagnosis of Kawasaki disease. KDSS can occur in the early stage of Kawasaki disease, and can be easily missed and misdiagnosed. Now, the clinical features,pathogenesis and treatment of KDSS are reviewed, in order to improve the ability of clinical pediatricians to identify the disease early and reduce the occurrence of life-threatening complications. Related Articles | Metrics