Development of mortality prediction model for critically ill patients based on multidimensional and dynamic clinical characteristics / 中华危重病急救医学

OBJECTIVE@#To develop a mortality prediction model for critically ill patients based on multidimensional and dynamic clinical data collected by the hospital information system (HIS) using random forest algorithm, and to compare the prediction efficiency of the model with acute physiology and chronic health evaluation II (APACHE II) model.@*METHODS@#The clinical data of 10 925 critically ill patients aged over 14 years old admitted to the Third Xiangya Hospital of Central South University from January 2014 to June 2020 were extracted from the HIS system, and APACHE II scores of the critically ill patients were extracted. Expected mortality of patients was calculated according to the death risk calculation formula of APACHE II scoring system. A total of 689 samples with APACHE II score records were used as the test set, and the other 10 236 samples were used to establish the random forest model, of which 10% (n = 1 024) were randomly selected as the validation set and 90% (n = 9 212) were selected as the training set. According to the time series of 3 days before the end of critical illness, the clinical characteristics of patients such as general information, vital signs data, biochemical test results and intravenous drug doses were selected to develope a random forest model for predicting the mortality of critically ill patients. Using the APACHE II model as a reference, receiver operator characteristic curve (ROC curve) was drawn, and the discrimination performance of the model was evaluated through the area under the ROC curve (AUROC). According to the precision and recall, Precision-Recall curve (PR curve) was drawn, and the calibration performance of the model was evaluated through the area under the PR curve (AUPRC). Calibration curve was drawn, and the consistency between the predicted event occurrence probability of the model and the actual occurrence probability was evaluated through the calibration index Brier score.@*RESULTS@#Among the 10 925 patients, there were 7 797 males (71.4%) and 3 128 females (28.6%). The average age was (58.9±16.3) years old. The median length of hospital stay was 12 (7, 20) days. Most patients (n = 8 538, 78.2%) were admitted to intensive care unit (ICU), and the median length of ICU stay was 66 (13, 151) hours. The hospitalized mortality was 19.0% (2 077/10 925). Compared with the survival group (n = 8 848), the patients in the death group (n = 2 077) were older (years old: 60.1±16.5 vs. 58.5±16.4, P < 0.01), the ratio of ICU admission was higher [82.8% (1 719/2 077) vs. 77.1% (6 819/8 848), P < 0.01], and the proportion of patients with hypertension, diabetes and stroke history was also higher [44.7% (928/2 077) vs. 36.3% (3 212/8 848), 20.0% (415/2 077) vs. 16.9% (1 495/8 848), 15.5% (322/2 077) vs. 10.0% (885/8 848), all P < 0.01]. In the test set data, the prediction value of random forest model for the risk of death during hospitalization of critically ill patients was greater than that of APACHE II model, which showed by that the AUROC and AUPRC of random forest model were higher than those of APACHE II model [AUROC: 0.856 (95% confidence interval was 0.812-0.896) vs. 0.783 (95% confidence interval was 0.737-0.826), AUPRC: 0.650 (95% confidence interval was 0.604-0.762) vs. 0.524 (95% confidence interval was 0.439-0.609)], and Brier score was lower than that of APACHE II model [0.104 (95% confidence interval was 0.085-0.113) vs. 0.124 (95% confidence interval was 0.107-0.141)].@*CONCLUSIONS@#The random forest model based on multidimensional dynamic characteristics has great application value in predicting hospital mortality risk for critically ill patients, and it is superior to the traditional APACHE II scoring system.

The upregulated intestinal folate transporters direct the uptake of ligand-modified nanoparticles for enhanced oral insulin delivery

Transporters are traditionally considered to transport small molecules rather than large-sized nanoparticles due to their small pores. In this study, we demonstrate that the upregulated intestinal transporter (PCFT), which reaches a maximum of 12.3-fold expression in the intestinal epithelial cells of diabetic rats, mediates the uptake of the folic acid-grafted nanoparticles (FNP). Specifically, the upregulated PCFT could exert its function to mediate the endocytosis of FNP and efficiently stimulate the traverse of FNP across enterocytes by the lysosome-evading pathway, Golgi-targeting pathway and basolateral exocytosis, featuring a high oral insulin bioavailability of 14.4% in the diabetic rats. Conversely, in cells with relatively low PCFT expression, the positive surface charge contributes to the cellular uptake of FNP, and FNP are mainly degraded in the lysosomes. Overall, we emphasize that the upregulated intestinal transporters could direct the uptake of ligand-modified nanoparticles by mediating the endocytosis and intracellular trafficking of ligand-modified nanoparticles via the transporter-mediated pathway. This study may also theoretically provide insightful guidelines for the rational design of transporter-targeted nanoparticles to achieve efficient drug delivery in diverse diseases.

Pharmaceutical strategies to extend pulmonary exposure of inhaled medicines

Pulmonary administration route has been extensively exploited for the treatment of local lung diseases such as asthma, chronic obstructive pulmonary diseases and respiratory infections, and systemic diseases such as diabetes. Most inhaled medicines could be cleared rapidly from the lungs and their therapeutic effects are transit. The inhaled medicines with extended pulmonary exposure may not only improve the patient compliance by reducing the frequency of drug administration, but also enhance the clinical benefits to the patients with improved therapeutic outcomes. This article systematically reviews the physical and chemical strategies to extend the pulmonary exposure of the inhaled medicines. It starts with an introduction of various physiological and pathophysiological barriers for designing inhaled medicines with extended lung exposure, which is followed by recent advances in various strategies to overcome these barriers. Finally, the applications of the inhaled medicines with extended lung exposure for the treatment of various diseases and the safety concerns associated to various strategies to extend the pulmonary exposure of the inhaled medicines are summarized.

Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area / 中华危重病急救医学

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

Experience of treating severe cases of 2019 novel coronavirus pneumonia in Changde area / 中华危重病急救医学

Since the cluster of the 2019 novel coronavirus (2019-nCoV) pneumonia, a large number of patients gathered, the mortality of critical patients has remained high and the treatment was unclear. In this outbreak, Hunan Changde region immediately set up a hospital and intensive care unit. The patients relieved through respiratory support, hemodynamics management, nutritional support, the application of antiviral drugs, analgesic and sedation. The treatment experience in severe cases of 2019-nCov pneumonia patients were summarized as follows: in terms of respiratory support, we needed to pay attention to the advantages of high-flow nasal cannula oxygen therapy (HFNC) and the intervention of mechanical ventilation, pay attention to the ventilator parameters, and adopt prone position timely. In the aspects of fluid resuscitation and volume management, we should pay attention to the characteristics of severe patients' volume status, perform early evaluation, and clinicians should focused on hemodynamic management beside the bed. In the aspect of nutritional support and evaluation and maintenance of intestinal function, early enteral nutrition should be adopted in time. However, the trade-off between the risk of intestinal function and nutritional support in patients with mechanical ventilation and the antiviral benefits of Kaletra needed to be reevaluated, the optimized way of analgesia and sedation was adopted, at the same time, the usage and side effects of antiviral drugs should be paid attention to. We should grasp the opportunity of transportation for severe patients. It is suggested that some warning scores should be used to facilitate early recognition of patients with severe infection and then they should be earlier transferred to the designated hospital for intensive care.

Expression level of glial fibrillary acidic protein and its clinical significance in patients with sepsis-associated encephalopathy / 中南大学学报(医学版)

To determine expression levels of glial fibrillary acidic protein in patients of sepsis-associated encephalopathy (SAE) and its clinical significance.
 Methods: Patients, admitted to intensive care units and diagnosed as sepsis, were recruited to our study from October 2016 to August 2018 in the Third Xiangya Hospital, Central South University. SAE is defined as a brain dysfunction secondary to sepsis and without evidence of a primary central nervous system infection or encephalopathy due to other reasons. The SAE group and non-SAE group were classed by Confusion Assessment Method for the ICU (CAM-ICU) score. We measured the levels of serum GFAP, S100β and neuron-specific enolase (NSE) within 24 hours after diagnosis of sepsis, and compared the patients' general clinical data, ICU stay time, 28-day and 180-day mortality.
 Results: Among 152 enrolled patients, 58 and 94 were assigned to the SAE group and the non-SAE group, respectively. There were a significantly higher Sequential Organ Failure Assessment (SOFA) scores, 28-day mortality rate, as well as 180-day mortality rate in the SAE group (all P<0.001). The levels of GFAP, NSE and S100β in the SAE group were significantly higher than those in the non-SAE group (all P<0.001). The diagnostic values of GFAP was 0.67 μg/L, with sensitivity at 75.9% and specificity at 77.7%. Area under the receiver operating characteristic curve (AUROC) of GFAP, NSE and S100β were 0.803, 0.795 and 0.750, respectively. Pearson analysis showed that serum GFAP level was positively correlated with Acute Physiology and Chronic Health Evaluation II (APACHE II) score, but it was negatively correlated with Glasgow Coma Scale (GCS) score, 28-day survival rate and 180-day survival rate.
 Conclusion: The level of serum GFAP is significantly increased in SAE, which shows certain correlation with incidence, severity and prognosis of the disease.

Inhibition of lipopolysaccharide-induced inflammation in RAW264.7 macrophages by sinomenine through regulating heme oxygenase-1 expression and autophagy / 中南大学学报(医学版)

To investigate the effect of sinomenine on lipopolysaccharide (LPS)-induced inflammation in RAW264.7 macrophages and the underlying mechanisms.
 Methods: The mouse RAW264.7 macrophages were treated with sinomenine and/or LPS with or without heme oxygenase-1 (HO-1) inhibitor Znpp. Real-time PCR, ELISA, immunofluenscence, and Western blot were used to detect the mRNA expression of TNF-α and IL-6, the release of TNF-α and IL-6, the protein expression of HO-1 and autophagy, respectively.
 Results: Compared with the control group, the mRNA expression and release of inflammatory cytokines TNF-α and IL-6 were increased, the green fluorescence of autophagy-related protein LC3 was accumulated and the protein expression of HO-1 was increased in RAW264.7 cells after LPS treatment (P<0.05). Compared with the LPS group, sinomenine treatment could reduce the mRNA expression and release of TNF-α and IL-6, accompanied by increasess in green fluorescence aggregation of LC3 and HO-1 production (P<0.05). HO-1 inhibitor Znpp could weaken the ability of sinomenine through suppressing TNF-α and IL-6 expression and decreasing the aggregation of LC3 green fluorescence (P<0.05).
 Conclusion: Sinomenine could alleviate LPS-induced inflammation in RAW264.7 macrophages, which might be related to HO-1 mediated autophagy. This study provides an experimental and theoretical basis for the clinical application of sinomenine in prevention and treatment of inflammation.

Role of autophagy in ameliorating sepsis-induced acute lung injury by allicinin in mice / 中南大学学报(医学版)

Objective:To investigate roles of autophagy in ameliorating sepsis-induced acute lung injury by allicinin in mice.Methods:A total of 152 male Balb/c mice (8-week old) were randomly divided into a sham group,a septic model group,an allicin treatment group,and an autophagy inhibition group.Septic mouse model was established by cecal ligation and puncture (CLP).Mice in the allicin treatment group were given allicin (30 mg/kg,intra-peritoneal injection) at 6 and 12 h,while those in the autophagy inhibition group were given autophagy inhibitor 3-MA (15 mg/kg,intra-peritoneal injection) at half an hour after allicin administration.Mice in the model and sham group were administered with the same amount of saline.Twenty mice in each group were randomly chosen to observe the 7 d survival rate.The other 12 mice were killed at 24 h,and the bronchoalveolar lavage fluid (BALF) (n=6) and lung tissues (n=6) were collected.ELISA was used to detect the tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in the BALF.Hematoxylin-eosin staining was preformed to show the morphological changes in the lung tissues.Malondialdehyde (MDA) content and the activity of superoxide dismutase (SOD) in the lung tissues were examined.The expression of LC3B and Beclin-1 was determined by immunohistochemical analysis.Results:Compared with the sham group,the 7 d survival rate and lung SOD activity were decreased in the CLP group (P<0.05);the lung morphological damage score,the levels of TNF-α and IL-6 in the BALF,MDA content in the lung,and expression of LC3B and Beclin-1 were increased greatly in the CLP group (P<0.05).Compared with the CLP group,the 7 d survival rate,lung SOD activity and the expressions of LC3B and Beclin-1 were increased significantly in the allicin treatment group (P<0.05);the lung morphological damage scores,the levels of TNF-α and IL-6 in the BALF and MDA content in the lung were decreased obviously in the allicin treatment group (P<0.05).Compared with the allicin treatment group,the 7 d survival rate,lung SOD activity,and the expressions of LC3B and Beclin-1 were decreased in the 3-MA group (P<0.05);the lung morphological damage scores,the levels of TNF-α and IL-6 in the BALF,and MDA content in the lung were increased significantly in the 3-MA group (P<0.05).Conclusion:Allicin may ameliorate sepsis-induced acute lung injury in mice by enhancing the level of autophagy.

Role of local citrate anticoagulation in continuous blood purification to patients at high risk of bleeding in ICU / 中南大学学报(医学版)

To evaluate the safety and efficiency of citrate anticoagulant-based continuous blood purification in patients at high risk of bleeding. 
 Methods: One hundred and fifty-two patients at high risk of bleeding were divided into local citrate group (group A, n=68) and heparin group (group B, n=84). Clotting function, change of pH, ionized sodium, bicarbonate ion, ionized calcium, activated clotting time (ACT) and complications were monitored before and during treatment. 
 Results: Compared to the group A, the incidence of clotting in filter and chamber, the degree of bleeding or fresh bleeding were significantly reduced in the group B (P0.05). The pH value, the levels of ionized sodium, bicarbonate ion and ionized calcium during the treatment were maintained in normal range in both group A and group B.
 Conclusion: Local citrate-based continuous blood purification can achieve effective anticoagulation and decrease the incidence of bleeding. It is an ideal choice for patients at high risk of bleeding.

Effect of age on the pharmacokinetics of polymorphic nimodipine in rats after oral administration

The previous investigation has proved that their existed pharmacokinetic difference between the different crystal forms of the polymorphic drugs after oral administration. However, no systemic investigations have been made on the change of this pharmacokinetic difference, resulted either from the physiological or from the pathological factors. In this paper, we used polymorphic nimodipine (Nim) as a model drug and investigated the effect of age difference (2- and 9-month old) on the pharmacokinetics after oral delivery in rats. As the results shown, for L-form of Nim (L-Nim), the AUCin 2-month-old rats was 343.68±47.15 ng·h/mL, which is 23.36% higher than that in 9-month-old rats. For H-form of Nim (H-Nim), the AUCin 2-month-old rats was 140.91±19.47 ng·h/mL, which is 54.64% higher than that in 9-month-old rats. The AUCratio between H-Nim and L-Nim was 2.44 in 2-month-old rats and 3.06 in 9-month-old rats. Since age difference could result in unparallelled change of the absorption and bioavailability of the polymorphic drugs, the results in this experiment are of value for further investigation of crystal form selection in clinical trials and rational clinical application of the polymorphic drugs.

Protective effect of Allicin on intestinal mucosal barrier of septic rats / 中华急诊医学杂志

Objective To investigate the protective effect of allicin on intestinal mucosal barrier of septic rats so as to explore the possible mechanism.Methods Twenty-four male SD rats were randomly (random number) divided into sham,septic model and allicin treatment group.Septic model was established by cecal ligation and puncture (CLP) in rats.Rats in the treatment group were administered with allicin (30 mg/kg,ip)at 6 h and 12 h after modeling,while those in the model and sham groups were treated with equal amount of saline instead.Rats were sacrificed at 24 h and the serum D-lactic acid,diamine oxidase (DAO) and fluorescence isothiocyanate-dextran (FITC-Dextran,FD-40) were determined to evaluate the intestinal mucosal barrier function.The levels of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6),malondialdehyde (MDA),and the activity of superoxide dismutase (SOD) in intestinal tissue were measured.Histopathological changes of intestinal mucosa injury were assessed by Hematoxylin-eosin staining.Results Compared with the sham group,levels of serum D-lactic acid,DAO and FD-40 increased significantly in the CLP group (D-lactic acid:599.4±101.1 vs.149.2±20.63 nmoL/mL,t=11.84,P＜0.01;DAO:302.1 ±64.5 vs.76.57±14.76 ng/mL,t=9.433,P＜0.01;FD-40:6664.0±1437.0vs.1446.0±205.0 ng/mL,t =9.704,P ＜0.01);intestinal morphology damage occurred in the CLP group;intestinal levels of TNF-α,IL-6 and MDA increased greatly (TNF-αt:186.35 ±20.43 vs.58.76 ±8.94 pg/mL,t=17.23,P＜0.01;IL-6:763.25±85.23vs.125.36±14.37 pg/mL,t=22.54,P＜0.01;MDA:29.36±3.27vs.7.24±0.85 nmol/mg prot,t=16.61,P＜0.01),while SOD activity reduced (35.75±6.53 vs.73.26 ±8.35 U/rmg prot,t =10.57,P ＜0.01) in the CLP group.Allicin treatment greatly inhibited the increase of D-lactic acid,DAO and FD-40 levels in rat plasma caused by CLP (D-lactic acid:330.1 ±81.77 vs.599.4±101.1 nmol/mL,t=7.086,P＜0.01;DAO:171.8±49.70vs.302.1±64.56ng/mL,t=5.45,P＜0.01;FD-40:3349.0±1167.0 vs.6664.0±1437.0 ng/mL,t=6.165,P＜0.01);intestinal morphology damage was improved in the allicin treatment group;allicin treatment greatly inhibited the intestinal levels of TNF-o,IL-6 and MDA and preserved the intestinal SOD activity compared with the CLP group (TNF-α:95.37 ±12.68 vs.186.35 ±20.43 pg/mL,t =12.29,P＜0.01;IL-6:354.27±46.27vs.763.25±85.23pg/mL,t=14.45,P＜0.01;MDA:16.27±3.14vs.29.36±3.27 nmol/mgprot,t=9.831,P＜0.01;SOD:55.35 ±6.23vs.35.75±6.53 U/mgprot,t=5.522,P ＜0.01).Conclusions Allicin could inhibit local inflammation and oxidative stress in the intestine and exerts protective effect on intestinal mucosal barrier of septic rats.

Relationship between the ischemic ST-T changes in ECG and the coronary artery diseases / 中南大学学报(医学版)

OBJECTIVE@#To analyze the relationship between the ischemic ST-T changes in electrocardiogram (ECG) and the coronary artery diseases based on the perspective of diagnostics.
@*METHODS@#A total of 341 patients, who underwent coronary angiography in Department of Cardiology of Xiangya Hospital, Central South University from June 2013 to April 2014, were enrolled for this study. The internationally recognized diagnostic criteria for ischemic ST-T changes in ECG and the Judkins diagnostic criteria for coronary angiography were applied, respectively. The sensitivity and specificity of ECG were analyzed.
@*RESULTS@#There were more ischemic ST-T changes in women than that in men (P0.05). For ischemic diagnostic tests by ECG ST-T, the total sensitivity and specificity was 83.6% and 54.4%, respectively. The sensitivity and specificity was 82.3% and 68.0% or 85.0% and 28.2% in the male or female group, respectively. 
@*CONCLUSION@#Ischemic ST-T changes in ECG possess important value in the diagnosis of the coronary artery diseases. The sensitivity of ECG in the diagnosis of myocardial ischemia in women was higher than that in men, whereas the specificity of ECG in the diagnosis of myocardial ischemia in men was higher than that in women.

Measurement of serum lipopolysaccharide binding protein for diagnosis and prognosis prediction in septic patients / 中国病理生理杂志

AIM:To investigate the role of lipopolysaccharide binding protein (LBP) for diagnosis and prog-nosis prediction in the septic patients.METHODS:A total number of 80 ICU patients were enrolled.The patients were divided into systemic inflammatory response syndrome ( SIRS) group and sepsis group, the patients in sepsis group were di-vided into non-survivor sub-group and survivor sub-group.We collected the serum samples and analyzed acute physiology and chronic health evaluation ( APACHE) II score on the first day of the patients hospitalized in ICU.In addition, we also selected 10 healthy volunteers and collected their serum samples.The serum concentrations of LBP, C-reactive protein ( CRP) and procalcitonin ( PCT) were measured by ELISA.ROC analysis of LBP, CRP, PCT and APACHE II score was conducted to discriminate among critically ill patients with sepsis and predict the prognosis of the patients with sepsis.RE-SULTS:The levels of the 4 indicators in the septic patients were higher than those in the patients of SIRS (P<0.05).In addition, serum LBP and APACHE II score in the non-survivor sub-group were higher than those in the survivor sub-group (P<0.05), whereas no difference of the PCT and CRP levels between survivors and non-survivors with sepsis was ob-served.LBP levels greater than 26.84 mg/L had 97.1% sensitivity and 95.9% specificity to discriminate between SIRS and sepsis.LBP levels greater than 54.16 mg/L had 85.2%sensitivity and 80.0%specificity for prognosis of unfavorable outcome.CONCLUSION:LBP level was more accurately correlated with diagnosis or prognosis prediction than CRP or PCT in patients with sepsis.

New treatment for sepsis:stem cell therapy / 中南大学学报(医学版)

Sepsis is the systemic inlfammatory response to infection and a major cause of mortality in critical patients. The severe disorder of immune system is the common pathophysiological changes in septic patients. Mesenchymal stem cells (MSCs) have shown great immunoloregulation properties in recent studies. It can increase the level of IL-10, an anti-inflammatory cytokine, promote the secretion of prostaglandin E2 (PGE2), indolamine 2,3-dioxygenase (IDO), and regulate the proliferation, differentiation and function of the immune cells such as mononuclear macrophage, t-lymphocytes, natural killer cells and so on. MSCs may provide new ideas for the treatment of sepsis.

The effects of Xuebijing on heat shock protein 70 in rats with severe acute pancreatitis / 中华急诊医学杂志

Objective To study Xuebijing(XBJ,a Chinese herbal preparation)on heat shock protein 70(HSP 70)in rats with severe acute pancreatitis(SAP).Methods Sixty healthy male SD rats were randomly(random number)and equally divided into sham operation group(A),SAP group(B),SAP with low-dose XBJ(4 ml/kg)intervention group(C)and high-dose XBJ(8 ml/ kg)intervention group(D).The SAP model was made by retrograde infusion of 5 ％ sodium taurocholate into the bilepancreatic duct.The rats in group C and group D were treated with 4 ml/kg XBJ and 8 ml/kg XBJ injected intraperitoneally and the treatment repeated once 12 hours later.Rats were sacrificed separately 6 h,12 h and 24 hours after modeling with/without XBJ and the blood samples were collected.Serum HSP 70 and cytokines TNF-α,IL-1β,IL-6 levels were measured by using enzyme-linked immunosorbent assay (ELISA); and correlation between serum HSP 70 and cytokines was analyzed.Results Levels of serum HSP 70 and TNF-o,IL-1β,IL-6 did not change significantly in rats of group A.Compared with group B,levels of serum HSP 70 and TNF-α,IL-1 β,IL-6 in all blood samples were lower significantly in groups C and D,and levels of those biomarkers decreased much more in group D than those did in group C.Thelevels of serum HSP 70 were positively correlated with cytokines TNF-α,IL-1β and IL-6(P ＜ 0.05).Conclusions Levels of serum HSP 70 in rats with SAP increased significantly.XBJ could reduce serum HSP 70 level in rats with SAP,and this may be the mechanism of the anti-inflammatory effects of XBJ.

Clinical Analysis on Combining with Early Short Time Venous-venous Hemofiltration in Severe Acute Pancreatitis with Acute Lung Injury / 医学研究杂志

Objective To explore the therapeutic effects of early short time venous-venous hemofiltration(SVVH) on severe acute pancreatitis(SAP) with acute lung injury(ALI).Methods Twenty-there patients with SAP and ALI were treated by routine project,and among them twelve patients accepted SVVH therapy.During the therapy,life sign、PaO2/FiO2 and APACHEII score were registered.Results Compared with control group,the clinical representation and organ function of SVVH group meliorated. PaO2/FiO2 were raised, APACHEII score and death risk were declined.Conclusions The early short time venous-venous hemofiltration(SVVH) on severe acute pancreatitis(SAP) with acute lung injury(ALI) could improve clinical symptom ,protect the organ dysfunction and decline the death risk.

Preparation of enteric microsphere of oleanolic acid dihemiphthalate sodium by salting-out action using spherical crystallization technique / 药学学报

Aim Enteric microspheres were prepared to prevent the interaction of drug with gastric acid and to improve its bioavailability. Methods The enteric microspheres with a matrix structure were successfully produced using a spherical crystallization technique. Hydroxypropyl methylcellulose phthalate ( HP-55 ), an enteric material, was coprecipitated with the drug by salting-out effect during the preparation process. A mixture of water and ethanol was chosen as a good solvent and dichloromethane was used as a the first time to prepare microspheres by making the water-soluble drug and water-insoluble excipient coprecipitated. In vivo test demonstrated that the drug absorption from the enteric oleanolic acid dihemiphthalate sodium (OADHPS) microspheres was significantly prolonged compared to that with OADHPS powder after a lag-time. Furthermore, the drug bioavailability was 181.6% greater than that with the OADHPS powder. Conclusion The microspheres of water soluble drug could be prepared by using water phase replacing organic phase as poor solvent which decrease the quantity of organic solvent and benefit the environment prevention.

OBSERVATIONS ON THE APPLIED ANATOMY OF THE SPLENIC ARTERY / 解剖学报

The splenic arteries of 110 Chinese cadavers and 65 dogs were observed with methods nf gross dissection, angiography (suspension of red lead oxide (Pb_3O_4) as the contrasr meduim) and corrosive cast (Polychloroethylene). The ramifications of the splenic artery and their relation to the splenic lobes and segments were studied. The results were outlined as follows:1. There are three patterns of splenic artery ramifications in human: Type Ⅰ, biramification(89%); Type Ⅱ, triramification(8%); and Type Ⅲ, polyramification(3%).2. In type Ⅰ, most of the splenic arteries divide into a superior and an inferior splenic lodar arteries. Most of the superior splenic lobar arteries subdivide into the superior and mid-superior segmental arteries and the inferior splenic lobar artery subdivides into the mid-inferior and inferior segmental arteries.3. All of the splenic arteries of the dogs we studied may divide into two splenic lobar arteries and each lobar artery further divides into two segmental arteries without exception.4. Between the lobar or segmental arteries there are zones poorly vascularized.5. Based on the anatomic observations we had performed experimental partial splenectomies on 15 dogs. All of the dogs survived the operation and their wound made on the spleen healed up very well.