Analysis on prevalence and epidemic risk of animal plague in different ecological plague foci in Inner Mongolia Autonomous Region / 中华预防医学杂志

The risk of plague epidemics and relapse of various types of plague foci persists in Inner Mongolia Autonomous Region. For Marmota sibirica plague foci, the animal plague has not been found but antibody has been detected positive. Nowadays, Marmota sibirica has been increasing in population and distribution in China. In bordering countries Mongolia and Russia, the animal plague has been continuously prevalent. For Spermophilus dauricus plague foci, the animal plague has been taken place now and then. Compared to the above foci, the animal plague is most prevalent in Meriones unguiculatus plague foci and frequently spread to humans. Due to higher strain virulence and historical disaster in Marmota sibirica plague foci and Spermophilus dauricus plague foci, plague prevention and control should be strengthened on these foci. In addition to routine surveillance, epidemic dynamics need to be further monitored in these two foci, in order to prevent their relapse and spread to humans.

Interpretation for diagnosis of Yersiniosis / 中华流行病学杂志

Yersiniosis is one of the "other infectious diarrhea" of the notifiable infectious diseases and also an important food-borne disease. However, it lacked the basis or standard for diagnosis. The Chinese Preventive Medicine Association coordinated experienced researchers from National Institute for Communicable Disease Control and Prevention, China CDC and other institutes to produce the group standard entitled "Diagnosis of Yersiniosis" (T/CPMA 005-2019). Based on the principle of "legality, scientificity, advancement, and feasibility" , the standard gives a clear definition for Yerisiniosis, stipulates diagnosis basis, principles and main differential diagnosis and provides two informative appendixes for epidemiological and clinical characteristics and a normative appendix for laboratory detection. The standard provides accurate basis and methods of Yersiniosis diagnosis for hospitals and CDCs at all levels in China. It will solve the problems that Yersiniosis cannot be clearly diagnosed for clinical cases and in the outbreaks.

Clinical study on the early predictive value of renal resistive index in acute kidney injury associated with severe acute pancreatitis / 中华危重病急救医学

To investigate the value of renal resistive index (RRI) in early predictor and discriminator of severe acute pancreatitis (SAP)-related acute kidney injury (AKI). Methods A retrospective observational study was conducted. SAP patients complicated with AKI (within 1 week of onset) and admitted to intensive care unit (ICU) of Ruijin Hospital Shanghai Jiaotong University School of Medicine from January 2016 to June 2019 were enrolled. The RRI within 24 hours admission was measured. Clinical data such as acute physiology and chronic health evaluation Ⅱ(APACHEⅡ), heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), intra-abdominal pressure (IAP), arterial blood lactate (Lac), oxygenation index (PaO2/FiO2), base excess (BE), serum creatinine (SCr), urine output, norepinephrine (NE) and RRI were collected. Within 24 hours and 7 days after ICU admission, patients were grouped according to AKI classification criteria of Kidney Disease: Improving Global Outcomes (KDIGO), and the differences of relevant parameters were statistically analyzed. Influence factors of AKI grading were screened by Logistic regression analysis. Pearson correlation analysis was used to analyze the correlation between RRI and other parameters. The predictive value of RRI for AKI classification was analyzed by receiver operating characteristic (ROC) curve. Results A total 57 patients were included, with an average age of (54.6±13.5) years old, and APACHEⅡscore of 21.8±5.6. Within 24 hours, the number of patients suffered from stage 1-3 AKI were 19 (33.3%), 18 (31.6%) and 20 (35.1%), respectively. On day 7, the number of patients suffered from stage 0-3 AKI were 21 (36.9%), 8 (14.0%), 9 (15.8%) and 19 (33.3%), respectively. The higher APACHEⅡ score, CVP, IAP, Lac, NE dosage and RRI were found in the group with higher AKI grades, especially in the group with stage 3 AKI on day 7. RRI of patients with stage 3 AKI was significantly higher than that of patients with stage 1 and 2 AKI within 24 hours (0.74±0.04 vs. 0.65±0.05, 0.68±0.05, both P < 0.05). Similarly, RRI of patients with stage 2 and 3 AKI were significantly higher than that of patients with stage 0 and 1 AKI on day 7 (0.70±0.04, 0.74±0.04 vs. 0.65±0.05, 0.66±0.05, all P < 0.05). Multivariate Logistic regression analysis showed that RRI was an independent factor of AKI classification [odds ratio (OR) = 3.15, 95% confidence interval (95%CI) = 1.09-9.04, P < 0.05], and IAP and CVP also had significant impacts on AKI grading [OR value was 2.11 (95%CI = 1.16-4.22), 3.78 (95%CI = 1.21-12.90), both P < 0.05]. ROC curve analysis showed that the area under curve (AUC) of RRI for predicting AKI ≥2 stage was 0.87 (P < 0.05); the cut-off ﹥ 0.71, sensitivity was 71% and specificity was 83%. The correlation analysis showed that RRI was positively correlated to a certain extent with IAP and lactic acid (r1 = 0.49, r2 = 0.39, both P < 0.05). Conclusion High RRI on ICU admission was a significant predictor for development of severe AKI during the first week, and RRI can help predict the tendency of AKI in SAP.

Etiology of bacterial diarrhea in large cities, mid-sized/small cities and rural areas of China / 中华流行病学杂志

Objective To understand the etiological characteristics of bacterial diarrhea in different areas,including large cities,mid-sized/small cities and rural area,in China.Methods A cross-sectional surveillance was conducted in 17 provinces of China from 2010 to 2014.The acute diarrhea outpatients were selected from clinics or hospitals in large cities,mid-sized/small cities,including rural-urban fringe zones,and rural areas.The demographical and clinical characteristics of the patients were collected by using questionnaire,and stool samples were taken from them for laboratory detection of 17 kinds of bacteria.The differences in pathogen positive rates (PPR) and pathogen spectrum across the cases from three-type areas were compared.The different infection risk in different cases were analyzed with unconditional logistic regression model.Results In our study,we enrolled 9 253 cases from large cities,5 138 cases from rural areas and 13 683 cases from midsized/small cites.The pathogen with largest differences in infection rate across the three-type areas was Shigella (S.)flexneri (rural area:5.81％,mid-sized/small city:2.78％,large city:0.46％),followed by Aeromonas (A.) hydrophila (rural area:2.14％,mid-sized/small city:0.96％,large city:0.48％).Compared with cases in large cities,the cases in mid-sized/small cities and rural areas had higher infection risks for S.flexneri (mid-sized/small city:OR =6.481,95％CI:4.666-9.002,rural area:OR =11.304,95％ CI:8.018-15.938) and A.hydrophila (mid-sized/small city:OR=1.992,95％ CI:1.401-2.832,rural area:OR=4.083,95％ CI:2.833-5.884).The constituent ratio of diarrheagenic Escherichia coli and Salmonella increased with the urbanization development,while the ratios of Shigella and A.hydrophila had an opposite trend.S.sonnei (60.00％) was the predominant serogroup of Shigella in urban infections,while S.flexneri (77.37％) was the predominant serogroup in rural infections.Conclusion The differences in pathogen spectrum of bacterial diarrhea were obvious across large cities,mid-sized/small cities and rural areas in China,especially the differences in the infection rates of S.flexneri and A.hydrophila.

The effect of AmpD on the expression of AmpC β-lactamase and the regulation mechanisms of β-N-acetylglucosaminidase in Yersinia enterocolitica / 中华预防医学杂志

Objective@#In this study, we analyze the regulation mechanisms of the expression of ampD in AmpC β-lactamase and the regulation mechanism of β-N-acetylglucosaminidase (NagZ) in Yersinia enterocolitica.@*Methods@#We construct the mutation strains of Yersinia enterocolitica AmpD (AmpD1-3) gene (ampD1-3), Low-Molecular-Mass Penicillin-Binding Proteins (LMM PBPs) gene (pbp4, pbp5a, pbp5b, pbp7), NagZ gene (nagZ), and ampR gene by deleting and complementing genes, and induce them by cefoxitin. We determined the activity of AmpC β-lactamase activity (U) of mutant strains (basal level and induce level) by using cephalothiophene hydrolysis method, the promoter activity of AmpC β-lactamase ((relative light unit (RLU)) was detected by the luxCDABEreporter system, and the activity of β-N-acetylglucosaminidase (nmol/L) was determined by by using 4-nitrophenyl N-acetyl-β-D-glucosaminide as the chromogenic substrate.@*Results@#AmpD1 (Basal level: (3.29±1.58) U; Induced level: (4.08±1.75) U) was the most potent one. The YEΔ5b, YEΔ4Δ5b, YEΔ5aΔ5b and YEΔ5bΔ7 of ampC promoter activity increase significantly, whichYEΔ4Δ5b is the highest one (Basal level: (106 903.16±61 910.61) RLU; Induced level: (205 427.45±45 352.17) RLU). The YEΔ4Δ5bΔ7 of ampC promoter activity is the highest among triple mutant strain (Basal level: (304 108.04±99 274.53) RLU; Induced level: (531 440.21±68 891.02) RLU). Quadruple deletion strain YEΔ4Δ5aΔ5bΔ7 have the highest ampC promoter activity (Basal level: (1 013 810.99±260 955.96) RLU; Induced level: (1 230 214.59±205 526.79) RLU). After the deletion of nagZ gene, there is no significant change in β-lactamase activity of YEΔD1D2D3ΔZ, while β-lactamase activity of YEΔ4Δ5aΔ5bΔ7ΔZ shows a significant decrease (Basal level: (0.30±0.20) U; Induced level: (0.29±0.21) U), which basically drops to the wild strain level.@*Conclusion@#This is the first report of ampC multi-step upregulation mechanism driven by three AmpD homologues in Yersinia enterocolitica. The AmpC regulation mode with the function of single PBP4, PBP5a or PBP7 is relatively low, which work in coordination with PBP5b. Yersinia enterocolitica have both NagZ-depend and NagZ-independent mechanisms for β-lactamase expression.

Etiology of bacterial diarrhea in large cities, mid-sized/small cities and rural areas of China / 中华流行病学杂志

Objective To understand the etiological characteristics of bacterial diarrhea in different areas,including large cities,mid-sized/small cities and rural area,in China.Methods A cross-sectional surveillance was conducted in 17 provinces of China from 2010 to 2014.The acute diarrhea outpatients were selected from clinics or hospitals in large cities,mid-sized/small cities,including rural-urban fringe zones,and rural areas.The demographical and clinical characteristics of the patients were collected by using questionnaire,and stool samples were taken from them for laboratory detection of 17 kinds of bacteria.The differences in pathogen positive rates (PPR) and pathogen spectrum across the cases from three-type areas were compared.The different infection risk in different cases were analyzed with unconditional logistic regression model.Results In our study,we enrolled 9 253 cases from large cities,5 138 cases from rural areas and 13 683 cases from midsized/small cites.The pathogen with largest differences in infection rate across the three-type areas was Shigella (S.)flexneri (rural area:5.81％,mid-sized/small city:2.78％,large city:0.46％),followed by Aeromonas (A.) hydrophila (rural area:2.14％,mid-sized/small city:0.96％,large city:0.48％).Compared with cases in large cities,the cases in mid-sized/small cities and rural areas had higher infection risks for S.flexneri (mid-sized/small city:OR =6.481,95％CI:4.666-9.002,rural area:OR =11.304,95％ CI:8.018-15.938) and A.hydrophila (mid-sized/small city:OR=1.992,95％ CI:1.401-2.832,rural area:OR=4.083,95％ CI:2.833-5.884).The constituent ratio of diarrheagenic Escherichia coli and Salmonella increased with the urbanization development,while the ratios of Shigella and A.hydrophila had an opposite trend.S.sonnei (60.00％) was the predominant serogroup of Shigella in urban infections,while S.flexneri (77.37％) was the predominant serogroup in rural infections.Conclusion The differences in pathogen spectrum of bacterial diarrhea were obvious across large cities,mid-sized/small cities and rural areas in China,especially the differences in the infection rates of S.flexneri and A.hydrophila.

Implantation of a triamcinolone acetonide drug delivery system into the suprachoroidal space for the prevention of traumatic anterior proliferative vitreoretinopathy / 中华实验眼科杂志

BackgroundAnterior proliferative vitreoretinopathy (aPVR)is a tissue injury and repair progress,and treatment of aPVR is very important in clinic.Chitosan drug delivery system is becoming a hot spot for its large lading dose and long acting duration.ObjectiveThe present study was to investigate the curative effect of a triamcinolone acetonide (TA) drug delivery system after implantation into the suprachoroidal space to treat traumatic aPVR.MethodsaPVR models were created in the left eyes of 65 healthy pigment rabbits by performinga 5 mm penetrating incision 2.5 mm posterior to limbum at 10:30-11:30.The animals were randomly divided into 4groups.Blank chitosan was implanted into the suprachoroidal space as the blank control group.Chitosan with 1 mg TA was implanted in the TA + chitosa group.The TA solution ( containing 1 mg TA) was intravitreally injected in the TA injection group.Fifteen models were used as the traumatic control group.Another 15 left eyes of normal pigment rabbits were used as the normal control group.The thickness of the ciliary tissue was measured using a ultrasound biomicroscope(UBM) 3,5 and 8 weeks after operation.The animals were sacrificed by excessive anesthesia and eyeballswereobtainedforhistopathologicalandultrastructuralexaminations.ResultsHistopathological examination showed the edema of the ciliary tissue and inflammatory cells infiltration in the blank control group,TA injection group and model control group,but mild response was seen in the TA + chitosa group.Severe damage in the ciliary tissue and subcellular organelle was found in the blank and model control groups,but mild damage was detected in the TA + chitosa group under the transmission electron microscope.UBM examination revealed that obvious abnormalities were visible in the ciliary and iris tissue in the blank control group,TA injection group and traumatic control group,but a mild abnormality was seen in the TA + chitosa group.Significant differences in ciliary thickness were exhibited among the 5 groups 2,5 and 8 weeks after operation (F =212.938,515.323,447.919,P＜0.01 ).Compared with the normal control group,ciliary thickness significantly increased in the blank control group and normal control group at various time points (all P＜0.05 ),but that in the TA + chitosa group was significantly lower than the normal control group at various time points ( two weeks:0.484±0.075 vs.0.327 ±0.094 ; five weeks:0.422 ±0.089vs.0.327±0.094 ;eight weeks:0.418±0.085 vs.0.327±0.094) (all P＞0.05). ConclusionsThe chitosan drug delivery system with TA suppresses the excessive proliferation of injured ocular tissue after implantation into the suprachoroidal space,which prevents the formation and development of aPVR.

Prevention effect of 5-fluorouracil natural delayed-release microballoons on proliferative vitreoretinopathy / 中华实验眼科杂志

Background Proliferative vitreoretinopathy(PVR) is a tissue repair prevention and treatment of PVR in clinic.Natural delayed release microballoons are therefore becoming a hot spot for its easy manipulation,large lading dose and long acting duration.Objective This study was to evaluate the effect of 5-fluorouracil natural delayed release microballoons on the prevention of PVR.Methods The lymphocytes were collected from clean pigment rabbit to prepare the 8×107/ml cell suspension with complete culture fluid.PVR models were established in 45 healthy pigment rabbits by intravitreal injection of lymphocyte suspension.The animals were randomly divided into 3 groups and 15 rabbits for each.0.1ml normal saline,10g/L or 20g/L 5-fluorouracil natural delayed release microballoons were injected into vitreous cavity respectively.PVR was graded on Fastenberg's method under the slit lamp in 1,2,4,8 weeks.The animals were sacrificed and retinas were obtained for the histopathological and ultrastructural examination in the eighth week after administration of drug.Results The numbers of eyes with different grades of PVR were significantly different among 3 groups in 1 week,2,4,8 weeks(P＜0.05).The eye numbers with PVR was significant less in 20g/L Fu group than those of 10g/L Fu group and normal saline group(P＜0.05).There was statistical difference in PVR ranking among these 3 groups in 8 weeks after injection of drug(H=46.795,P＜0.05).The morphology and ultrastructure of retinas under the light microscope and transmission electron microscope were near normal in all of the three groups.Conclusion Implantation of 5-fluorouracil natural delayed release microballoons into vitreous cavity is effective and safe in preventing PVR in experimental model,and the therapeutic effect of microballoons with 20g/L 5-Fu is better.

Investigation of distribution of bacteria and fungi in severe acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the spectrum of bacteria and fungi in different sites in severe acute pancreatitis (SAP).</p><p><b>METHODS</b>The prospective study was performed in 205 patients with SAP treated from January 2000 to December 2008. The Infection rate of bacteria and fungi was observed prospectively in pancreatic necrosis and(or) pus form abdomen, body fluids and deep vein catheter in SAP. Body fluids and pancreatic necrosis were cultured twice a week. Central venous catheter was cultured when it had been placed for two weeks. Blood was cultured for bacteria and fungi when body temperature was more than 39 degrees C. Constituent ratio of bacteria and fungi was observed in different sites and in all sites within 28 days after onset of SAP.</p><p><b>RESULTS</b>There were 937 pathogens, among which infection rates of gram-negative bacteria was higher than gram-positive bacteria and fungi (P < 0.05), the infection rates of gam-positive bacteria and fungi were similar. Infection rates of gram-negative bacteria in pancreatic necrosis (55.2%), bile (55.4%), blood (68.1%) and central venous catheter (44.4%) were increased significantly (P < 0.05) compared with gram-positive bacteria and (30.2%, 33.9%, 23.4%, 38.9%) and fungi (14.6%, 10.7%, 8.5%, 16.7%); however, infection rate of fungi (59.6%) was increased significantly (P < 0.05) compared with gram-negative bacteria (24.0%) and gram-positive bacteria (16.3%) in urine; infection rate of gram-negative bacteria (53.2%) was significantly higher (P < 0.05) than that of fungi (27.1%) and gram-positive bacteria (19.7%) in sputum. Infection rate of non-zymogenic bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii and Stenotrophomonas maltophilia) in gram-negative bacteria in pancreatic necrosis, bile, blood, central venous catheter and sputum was significantly higher than that of zymogenic bacteria (Klebsiella pneumoniae, Escherichia coli and Enterobacter cloacae) (P < 0.01); infection rate of zymogenic bacteria (Klebsiella pneumoniae, Escherichia coli) was higher significantly (P < 0.01) than that of non-zymogenic bacteria (Pseudomonas aeruginosa, Acinetobacter baumannii). Infection rate of staphylococcus aureus, Staphylococcus epidermidis and Staphylococcus haemolyticus was significantly higher (P < 0.05) than that of Enterococcus faecalis and Enterococcus faecium in pancreatic necrosis and sputum;but infection rate of Enterococcus faecium in bile and urine was significantly higher than other gram-positive bacteria (P < 0.05). There was not difference among gram-positive bacteria;however, infection rate of Staphylococcus epidermidis in central venous catheter was increased significantly (P < 0.05). Infection rate of candida mycoderma in pancreatic necrosis, bile, urine and sputum was significantly higher than that of tricho bacteria (P < 0.05). The peak of infection rate of microbes in body fluid was within 2 to 3 weeks.</p><p><b>CONCLUSIONS</b>Constituent ratio in gram-negative, gram-positive bacteria and fungi as well as their species in different sites is diverse. The peak of infection rate of microbes is 2 to 3 weeks after onset of the disease.</p>

Influencing factors of the early enteral nutrition in patients of severe acute pancreatitis / 国际外科学杂志

Objective Analyse the influencing factors of early enteral nutrition support in patients of severe acute pancreatitis( SAP). Methods From April 2006 to August 2008, a total of 57 patients with SAP were analyzed in two aspects:the APACHE II scores, Ranson scores, Balthazar CT scores, and some frequent complications (shock, MODS, ACS, severe sepsis, paralytic ileus, etc.) were compared in two groups of A(≤5 d) and B( >5 d) according to the initial time of enteral nutrition:Hie initial timing of entend nutrition,the above scores and complications were also compared in two groups of nasojejunal feedingtube and jejunostomy feeding tube. Results The APACHE H scores, Ranson scores, Balthazar CT scores and the incidence of shock, MODS and ACS in group A were significant higher than those in group B; The APACHE II scores, Ranson scores and Balthazar CT scores in group of nasojejunal feeding tube were significant lower than those in group of jejunostomy feeding tube, and the initial time of enteral nutritionin nasojejunal feeding tube was significantly earlier. Conclusions Early enteral nutrition support in SAP is influenced by multiple factors, especially of pathogenetic severity, severe complications and feeding pathways.Homeostasis and intestines functions recover are the sign of enteral nutrition initiation, and to carry out enteral nutrition in ≤5 d after admission is feasible.The APACHE II scores may be helpful to guide the time of EN start.

Strategy of treatment with high-volume hemofiltration on severe acute pancreatitis and fulminant acute pancreatitis / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate strategy of treatment of hemofiltration on severe acute pancreatitis (SAP) and fulminant acute pancreatitis (FAP).</p><p><b>METHODS</b>One hundred and thirty patients with SAP and eighty-one patients with FAP treated with hemofiltration (HF) were prospectively observed from March 1997 to December 2008. Indications for HF, variables (time interval for hemofiltration), mode, therapeutic dosage, blood rate, heparin dosage and components of hemofiltration, therapeutic efficacy (time of disapearance of abdominal pain, intra-abdominal pressure and survival rate) and complications (incidence of bleeding and blood infection).</p><p><b>RESULTS</b>All patients underwent high volume hemofiltration (HVHF) or hemodialysis-filtration (HDF) within 72 hours after onset of the disease. Dose of SAP and FAP was (53 +/- 6) mlxkg(-1)xh(-1) and (59 +/- 10) mlxkg(-1)xh(-1) (P < 0.05), respectively. Rate of short veno-venous hemofiltration in SAP (76.9%) was higher than that of FAP (38.3%) (P < 0.05); however, rate of continuous veno-venous hemofiltration (23.1%) was lower than that of FAP (37.0%) (P < 0.05). Rate of HDF was much higher in FAP than that of SAP. Low molecular weight heparin and heparin were both available to anticoagualte;but dosage required in patients with FAP was much higher than that of SAP (P < 0.05). Time intervals for amelioration of abdominal pain in SAP and FAP were (9 +/- 6) h and (15 +/- 10) h, respectively. Itra-abdominal pressure was decreased significantly at the end of hemofiltration compared to prior to hemofiltration in SAP and FAP (P < 0.05). Level of serum triglyceride decreased abruptly after adsorption (P < 0.05). Rate of operation within 28 days in SAP (73.8%) was lower than FAP (87.7%). The in-hospital survival rates in SAP and FAP were 88.5% and 67.9%, respectively. Amount of platelet decreased in patients with blood flow rate less than 240 ml/min was higher than that of more than 240 ml/min (P < 0.05). And incidence of blood stream infection and bleeding increased significantly (P < 0.05).</p><p><b>CONCLUSIONS</b>HVHF and HDF used in SAP and FAP patients underwent conservative treatment within 72 hours, respectively, can increase survival rate significantly.</p>

Fluid therapy for severe acute pancreatitis in acute response stage / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Fluid therapy for severe acute pancreatitis (SAP) should not only resolve deficiency of blood volume, but also prevent fluid sequestration in acute response stage. Up to date, there has not a strategy for fluid therapy dedicated to SAP. So, this study was aimed to investigate the effects of fluid therapy treatment on prognosis of SAP.</p><p><b>METHODS</b>Seventy-six patients were admitted prospectively according to the criteria within 72 hours of SAP onset. They were randomly assigned to a rapid fluid expansion group (Group I, n = 36) and a controlled fluid expansion group (Group II, n = 40). Hemodynamic disorders were either quickly (fluid infusion rate was 10 - 15 ml x kg(-1) x h(-1), Group I) or gradually improved (fluid infusion rate was 5 - 10 ml x kg(-1) x h(-1), Group II) through controlling the rate of fluid infusion. Parameters of fluid expansion, blood lactate concentration were obtained when meeting the criteria for fluid expansion. And APACHE II scores were obtained serially for 72 hours. Rate of mechanical ventilation, incidence of abdominal compartment syndrome (ACS), sepsis, and survival rate were obtained.</p><p><b>RESULTS</b>The two groups had statistically different (P < 0.05) time intervals to meet fluid expansion criteria (Group I, 13.5 +/- 6.6 hours; Group II, (24.0 +/- 5.4) hours). Blood lactate concentrations were both remarkably lower as compared to the level upon admission (P < 0.05) and reached the normal level in both groups upon treatment. It was only at day 1 that hematocrit was significantly lower in Group I (35.6% +/- 6.8%) than in Group II (38.5% +/- 5.4%) (P < 0.01). Amount of crystalloid and colloid in group I ((4028 +/- 1980) ml and (1336 +/- 816) ml) on admission day was more than those of group II ((2472 +/- 1871) ml and (970 +/- 633) ml). No significant difference was found in the total amount of fluids within four days of admission between the two groups (P > 0.05). Total amount of fluid sequestration within 4 days was higher in Group I ((5378 +/- 2751) ml) than in Group II ((4215 +/- 1998) ml, P < 0.05). APACHE II scores were higher in Group I on days 1, 2, and 3 (P < 0.05). Rate of mechanical ventilation was higher in group I (94.4%) than in group II (65%, P < 0.05). The incidences of abdominal compartment syndrome (ACS) and sepsis were significantly lower in Group II (P < 0.05). Survival rate was remarkably lower in Group I (69.4%) than in Group II (90%, P < 0.05).</p><p><b>CONCLUSIONS</b>Controlled fluid resuscitation offers better prognosis in patients with severe volume deficit within 72 hours of SAP onset.</p>

Application of nano-sized TiO2 photocatalysis to air purification and sterilization / 中华预防医学杂志

<p><b>OBJECTIVE</b>To develop and evaluate the efficiency of air purification and sterilization instrument based on nano-sized TiO(2) photocatalytic technique.</p><p><b>METHODS</b>The nano-sized TiO(2) photocatalytic air purification and sterilization instrument was designed and a sample had been prepared. The sterilization efficiencies for E.coli and Klebsiella by the nano-sized TiO(2) photocatalytic instrument and ultraviolet (UV) were measured in closed labs. The on-site efficiency of the instrument was evaluated, too.</p><p><b>RESULTS</b>The nano-sized TiO(2) photocatalytic air purification and sterilization instrument was composed of five units: rough filter, nano-sized TiO(2) photocatalytic unit, activated carbon fiber filter, negative ion generator, and programmed control unit. The E.coli killing rates by the nano-sized TiO(2) photocatalytic instrument were 76.0%, 81.8%, 77.5%, and 80.7% at 30, 60, 90, and 120 minutes, respectively. There was no significant difference between the E.coli killing rates of the instrument and UV (P > 0.05), except the 120 minutes timepoint. The Klebsiella killing rates by the instrument were 78.4%, 79.5%, 67.3%, and 58.5% at 30, 60, 90, and 120 minutes, respectively. The Klebsiella killing efficiencies of the instrument at 30 and 60 minutes were better than that of UV (P < 0.01). There was no significant difference between the Klebsiella killing efficiencies of the instrument and UV (P > 0.05).</p><p><b>CONCLUSION</b>The air sterilization efficiency of the nano-sized TiO(2) photocatalytic instrument should be equivalent or better as compared with the UV. This instrument might be used for the air purification and sterilization of the public locations.</p>

Strategy of controlling fluid resuscitation for severe acute pancreatitis in acute phase / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the strategy of controlling fluid resuscitation for severe acute pancreatitis (SAP) in acute phase.</p><p><b>METHODS</b>From March 2001 to January 2006, 83 patients meeting for experimental criteria were included in this clinical trial. They were divided into early fluid expansion group (Group I, within 24 h after admission, 21 patients), middle fluid expansion group (Group II, within 25 - 48 h, 35 patients) and late fluid expansion group (Group III, within 49 - 72 h, 27 patients). Parameters of treatment of fluid therapy within 4 d after admission were observed. Serum lactic level was measured on admission and on meeting for criteria of fluid expansion. APACHEII scores, operation rate within 2 weeks, rate of mechanical ventilation, rate of ACS and survival rate were observed.</p><p><b>RESULTS</b>Time interval for meeting fluid expansion criteria in Group I, Group II, Group III was (13 +/- 6) h, (38 +/- 5) h and (61 +/- 8) h, respectively. And there was statistical significance among them (P < 0.05). HCT (%) in Group I (33 +/- 6)% was lower than that of Group II (40 +/- 6)% and Group III (42 +/- 11)% significantly (P < 0.01) at the first day after admission; and there was no statistical significance between Group II and Group III. The amount of crystal and colloid infused in Group I (4014 +/- 2887) ml and (1220 +/- 705) ml at the day of admission was more than those of Group II (2366 +/- 1959) ml and (821 +/- 600) ml and Group III (2615 +/- 1574) ml and (701 +/- 585) ml (P < 0.01); but there was not different between Group II and Group III (P > 0.05). The ratio of colloid and crystal in Group III at the day of admission was lower than those of Group I and Group II (P < 0.05). The total amount of fluid infused was not different among 3 groups for the 4 d (P > 0.05). And infusion rate at the day of admission in Group I was more rapid than those of Group II and Group III (P < 0.05); and there was no difference between Group II and Group III (P > 0.05). The total amount of fluid sequestration in Group II for the 4 d was lower than those of Group I and Group III (P < 0.05); and there was no statistical significance between Group I and Group III (P > 0.05). At the first to the third day after admission APACHEII scores in Group I were higher than those of Group II and Group III (P < 0.05); and at the second and third day, APACHEII scores in Group III were higher than those of Group II (P < 0.05). Rate of mechanical ventilation in Group I (85.7%) was higher than those of Group II (37.1%) and group III (63.0%) (P < 0.05); and rate of ACS was most lowest in Group II (37.1%) (P < 0.05). Survival rate in Group I (38.1%) was lower than those of Group II (85.7%) and Group III (66.7%) (P < 0.05); and Group III was lower than that of Group II (P = 0.075).</p><p><b>CONCLUSIONS</b>Within 72 h after onset of the disease, survival rate is improved significantly through controlling fluid resuscitation and prevention of body fluid sequestration.</p>

Therapeutic experience of fulminant acute pancreatitis in acute response stage / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate therapeutic strategy of fulminant acute pancreatitis (FAP) in acute response stage.</p><p><b>METHODS</b>Sixty-four patients were divided into Death group (27 patients) and Survival group (37 patients). The time course of shock and recovery of enteral function, parameters of fluid resuscitation, PaO(2)/FiO(2) and AaDO(2) at 24 hours prior to mechanical ventilation, rate of continuous venovenous hemofiltration (CVVH) and abdominal compartment syndrome (ACS), severity of the disease in the acute response stage were investigated. And the effect of surgical manner and time on the prognosis was also analyzed.</p><p><b>RESULTS</b>Compared with Survival group, the time course of shock and recovery of enteral function in Death group were prolonged significantly (P < 0.05). Between the groups, there was no difference in the amount of crystal fluid infused from admission to 72 hours after, but the amount of colloid fluid infused and ratio of amount of colloid and crystal fluid in Survival group were higher (P < 0.05). The amount of fluid retention in third space from admission to 72 hours after in Death group was higher than that of Survival group significantly (P < 0.05). The fluid infusing rate in Survival group in the first day of admission was faster than Death group (P < 0.05). PaO(2)/FiO(2) and AaDO(2) in 24 hours prior to mechanical ventilation in Death group were negatively changed significantly. Within 72 hours after the onset of the disease, the rate of CVVH in Survival group was higher than Death group. Incidence rate of ACS and the APACHEII scores within 72 hours after admission in Death group were higher than in Survival group. The cure rate of the patients operated in the day 7 to day 14 after admission was higher than that of patients operated prior and post this period. Time for the first operation in operated patients was earlier than patients received minimally invasive drainage (MID) and its cure rate was lower than that of MID Group.</p><p><b>CONCLUSIONS</b>It is the key point to shorten the time course of ischemia, to control persistent systemic inflammatory response syndrome (SIRS) and to adopt reasonable surgical intervention in acute response stage for FAP.</p>

The effects of earlier resuscitation on following therapeutic response in sepsis with hypoperfusion / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effects of early sufficient resuscitation on important organs function and their therapeutic response in sepsis with hypoperfusion.</p><p><b>METHODS</b>From January 2004 to December 2005, 34 sepsis patients with hypoperfusion in surgical and respiratory intensive care units were resuscitated sufficiently for the management of severe sepsis and septic shock. According to the time of resuscitation end points, these patients were divided to early resuscitation group (E group, 15 patients) and later group (L group, 19 patients). The important organs function and their therapeutic response followed resuscitation were investigated and compared in the tow groups.</p><p><b>RESULTS</b>After earlier sufficient resuscitation, the incidence of repeated resuscitation was 73.7% in L group and 20.0% in E group (P < 0.01); the incidence of steroids replacement, coagulation dysfunction and multiple organ dysfunction syndrome (MODS) were 63.2%, 73.7% and 68.4% respectively in L group and significantly higher than those in E group (P < 0.05). Seven days after resuscitation, the level of serum creatinine in E group was lower than that in L group (P < 0.05). In the day 1 and 7 after resuscitation, heart rate in E group was lower than that in L group (P < 0.05). Seven days post resuscitation, PaO(2) and PaO(2)/FiO(2) were higher in E group than in L group (P < 0.05). The mortality was 42.1% in L group and 13.3% in E group (P < 0.05).</p><p><b>CONCLUSIONS</b>Early sufficient resuscitation in sepsis patients with hypoperfusion could significantly enhance the effects of following treatment, relieve inflammation and coagulation reaction and thereby reduce the mortality.</p>