Research progress of Shegan Mahuang Decoction and predictive analysis on its Q-markers / 中国中药杂志

Shegan Mahuang Decoction has been used in clinical practice for thousands of years, and is a classical formula for treating asthma and other respiratory diseases, with the effects of ventilating lung, dispersing cold, and relieving cough and asthma. This paper summarized the history, clinical application and mechanism of Shegan Mahuang Decoction, and predicted its quality markers(Q-markers) based on the "five principles" of Q-markers. The results suggested that irisflorentin, tectoridin, tectorigenin, irigenin, ephedrine, pseudoephedrine, asarinin, methyleugenol, shionone, epifriedelanol, tussilagone, 6-gingerol, trigonelline, cavidine, schizandrin, and schizandrin B could be used as Q-markers of Shegan Mahuang Decoction, which provided a basis for the quality control and subsequent research and development of Shegan Mahuang Decoction.

Improvement effect of Shegan Mahuang Decoction on rats with cold-induced asthma based on TRPV1/NRF-1/mtTFA pathway / 中国中药杂志

This study investigated the therapeutic effect of Shegan Mahuang Decoction(SGMHD) on cold-induced asthma in rats and explored its underlying mechanism. Seventy-two healthy male SD rats of specific pathogen free(SPF) grade were randomly divided into a blank group, a model group, a positive control group(dexamethasone, 0.4 mg·kg~(-1)), and low-, medium-, and high-dose SGMHD groups(3.2, 6.4, and 12.8 g·kg~(-1)). The blank group received saline, while the other groups were sensitized by intraperitoneal injection of ovalbumin(OVA) solution. Subsequently, the rats were placed in a cold chamber adjustable to 0-2 ℃, and OVA solution was ultrasonically nebulized to induce cold-induced asthma in rats. After three weeks of treatment, the general behaviors of rats were observed. Hematoxylin-eosin(HE) staining was used to evaluate pathological changes in lung tissues, periodic acid-Schiff(PAS) staining assessed mucin changes, and Masson staining was performed to examine collagen deposition. Enzyme-linked immunosorbent assay(ELISA) was used to measure the levels of the inflammatory factors interleukin-4(IL-4) and vascular endothelial growth factor(VEGF) in serum and bronchoalveolar lavage fluid(BALF). Real-time quantitative polymerase chain reaction(RT-PCR) was employed to assess the mRNA expression levels of transient receptor potential vanilloid subfamily member 1(TRPV1), nuclear respiratory factor 1(NRF-1), and mitochondrial transcription factor A(mtTFA) in lung tissues. Western blot was used to measure the protein expression levels of TRPV1, NRF-1, and mtTFA in lung tissues. Compared with the blank group, the model group exhibited signs of rapid respiration, increased frequency of defecation with looser stools, and disheveled and dull fur. Pathological results showed significant infiltration of inflammatory cells in lung tissues, narrowing of bronchial lumens, increased mucin secretion, and enhanced collagen deposition in the model group. Additionally, the levels of IL-4 and VEGF in serum and BALF were significantly elevated, and the mRNA and protein expression levels of TRPV1, NRF-1, and mtTFA in lung tissues were significantly increased. Compared with the model group, SGMHD improved the behaviors of rats, alleviated pathological changes in lung tissues, mucin production, and collagen deposition, significantly decreased the levels of IL-4 and VEGF in serum and BALF, and reduced the mRNA expression levels of TRPV1, NRF-1, and mtTFA in lung tissues, with the medium-dose SGMHD group showing the most significant effect. Moreover, the protein expression levels of TRPV1, NRF-1, and mtTFA in lung tissues were also reduced, with the medium-dose SGMHD group exhibiting the most significant effect. In conclusion, this study demonstrates that SGMHD can alleviate airway inflammation and inhibit airway remodeling in cold-induced asthma rats. These effects may be associated with the modulation of the TRPV1/NRF-1/mtTFA signaling pathway.

Mechanism of Combination of Pungent Dispersing Bitter Evacuant in Treatment of Asthma Based on Theory of Five Flavor Compatibility / 中国实验方剂学杂志

Bronchial asthma， a chronic inflammatory airway disease， belongs to the category of wheezing disease in the system of traditional Chinese medicine （TCM）. The wheezing symptom of this disease is mainly caused by the imbalance of lung Qi. According to the theory of five flavor compatibility， the Chinese medicinal materials with five different flavors （pungent， bitter， sour， sweet， and salty） can be combined to produce new functions. The pungent medicinal materials have dispersing effect and the bitter medicinal materials have discharging effect， which are important components in the theory of five flavor compatibility. Pungent herbs and bitter herbs can relieve the adverse lung Qi， occupying an important position in the current medication for the treatment of asthma. However， there is still a lack of in-depth analysis of the TCM theory and mechanism of the compatibility of pungent herbs and bitter herbs in the treatment of asthma. The molecular mechanisms of action of pungent herbs and bitter herbs are closely related to transient receptor potential （TRP） channels and bitter taste receptors （TAS2Rs）， respectively. Ca2+ signaling has been recognized in the process of asthma and is involved in the development of multiple symptoms of asthma. The TRP channels and TAS2Rs located on the cell membrane have been proved to directly regulate the intracellular Ca2+ signal and play a role in the treatment of asthma. Therefore， the dispersing effect of pungent herbs and the discharging effect of bitter herbs may be realized through the Ca2+ signaling pathway mediated by TRPs/TAS2Rs. We summarized the theoretical understanding and modern studies of pungent herbs dispersing lung Qi and bitter herbs discharging lung Qi， aiming to explain the internal relationship and mechanism of the compatibility of pungent herbs and bitter herbs in the treatment of asthma from the perspective of TCM theory and modern medicine. The compatibility of pungent herbs and bitter herbs based on the theory of five flavor compatibility for the treatment of asthma has a solid theoretical basis of TCM， and its mechanism can be verified by modern research. Therefore， it may be a main research direction in the treatment of asthma by Chinese medicinal herbs in the future.

Therapeutic Observation of Continuous Subcutaneous Insulin Infusion at Acupoint for Type 2 Diabetes / 上海针灸杂志

Objective To observe the difference between continuous subcutaneous insulin infusion (CSII) at acupoint and CSII at non-acupoint in treating type 2 diabetes, for providing a novel option in selecting the insulin injection site. Method Sixty-six subjects with type 2 diabetes were randomized into a treatment group of 32 cases and a control group of 34 cases. The treatment group was intervened by CSII at acupoint, while the control group was intervened by CSII at non-acupoint. The body mass index (BMI), fasting plasma glucose (FPG), 2 h-postprandial plasma glucose (P2hPG), bedtime blood sugar, glycated hemoglobin (HbA1c), consumption of insulin, and the score of diabetes symptom grading and quantification of the two groups were compared. Result The blood sugar level, insulin consumption, HbA1c level and symptom score declined significantly after treatment in both groups (P<0.05);the BMI and initial dosage of insulin in the treatment group dropped significantly after treatment in the treatment group (P<0.05); after treatment, the BMI, FPG level, initial dosage of insulin and symptom score in the treatment group were markedly lower than those in the control group (P<0.05); there were no significant differences between the treatment group and the control group in the P2 hBG level, bedtime glucose sugar level, HbA1c level, pre-prandial insulin dose and total effective rate (P>0.05). Conclusion CSII at acupoint and at non-acupoint both can effectively improve the disease condition of type 2 diabetes. The treatment group is superior to the control group in controlling BMI and FPG, reducing the initial level of insulin, and improving the symptoms, and the treatment group presents a higher total effective rate with the increase of treatment duration compared with the control group. It is indicated that insulin infusion at abdominal acupoint has a certain advantage in the treatment of type 2 diabetes.

Mindfulness Meditation for Primary Headache Pain: A Meta-Analysis / 中华医学杂志(英文版)

<p><b>Background</b>Several studies have reported that mindfulness meditation has a potential effect in controlling headaches, such as migraine and tension-type headache; however, its role remains controversial. This review assessed the evidence regarding the effects of mindfulness meditation for primary headache pain.</p><p><b>Methods</b>Only English databases (PubMed, Cochrane Central Register of Controlled Trials [the Cochrane Library], PsycINFO, Psychology and behavioral science collection, PsyArticles, Web of Science, and Scopus) were searched from their inception to November 2016 with the keywords ("meditation" or "mindfulness" or "vipassana" or "dzogchen" or "zen" or "integrative body-mind training" or "IBMT" or "mindfulness-based stress reduction" or "MBSR" or "mindfulness-based cognitive therapy" or "MBCT" and "Headache" or "Head pain" or "Cephalodynia" or "Cephalalgia" or "Hemicrania" or "Migraine"). Titles, abstracts, and full-text articles were screened against study inclusion criteria: controlled trials of structured meditation programs for adult patients with primary headache pain. The quality of studies included in the meta-analysis was assessed with the Yates Quality Rating Scale. The meta-analysis was conducted with Revman 5.3.</p><p><b>Results</b>Ten randomized controlled trials and one controlled clinical trial with a combined study population of 315 patients were included in the study. When compared to control group data, mindfulness meditation induced significant improvement in pain intensity (standardized mean difference, -0.89; 95% confidence interval, -1.63 to -0.15; P = 0.02) and headache frequency (-0.67; -1.24 to -0.10; P = 0.02). In a subgroup analysis of different meditation forms, mindfulness-based stress reduction displayed a significant positive influence on pain intensity (P < 0.000). Moreover, 8-week intervention had a significant positive effect (P < 0.000).</p><p><b>Conclusions</b>Mindfulness meditation may reduce pain intensity and is a promising treatment option for patients. Clinicians may consider mindfulness meditation as a viable complementary and alternative medical option for primary headache.</p>

Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning: A Prospective Randomized Controlled Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is an unmet need for a reliable method of airway management for patients in the lateral position. This prospective randomized controlled two-center study was designed to evaluate the feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery.</p><p><b>METHODS</b>Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April 1, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group (Group S, n = 38) and the lateral position group (Group L, n = 34). Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student's t-test, Mann-Whitney U-test, or Chi-square test.</p><p><b>RESULTS</b>The median total time to tracheal intubation was significantly longer in Group S (140.0 [135.8, 150.0] s) compared to Group L (33.0 [24.0, 38.8] s) (P < 0.01). The first-attempt intubation success rate was significantly higher in Group L (97%) compared to Group S (16%). Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L (P = 0.02).</p><p><b>CONCLUSION</b>Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position.</p><p><b>TRIAL REGISTRATION</b>Chinese Clinical Trial Register, ChiCTR-IIR-16007814; http://www.chictr.org.cn/showproj.aspx?proj=13183.</p>

An Appreciation for the Rabbit Ladderlike Modeling of Radiation-induced Lung Injury with High-energy X-Ray / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>To evaluate the utility of rabbit ladderlike model of radiation-induced lung injury (RILI) for the future investigation of computed tomography perfusion.</p><p><b>METHODS</b>A total of 72 New Zealand rabbits were randomly divided into two groups: 36 rabbits in the test group were administered 25 Gy of single fractionated radiation to the whole lung of unilateral lung; 36 rabbits in the control group were sham-radiated. All rabbits were subsequently sacrificed at 1, 6, 12, 24, 48, 72 h, and 1, 2, 4, 8,1 6, 24 weeks after radiation, and then six specimens were extracted from the upper, middle and lower fields of the bilateral lungs. The pathological changes in these specimens were observed with light and electron microscopy; the expression of tumor necrosis factor-α (TNF-a) and transforming growth factor-β₁ (TGF-β₁) in local lung tissue was detected by immunohistochemistry.</p><p><b>RESULTS</b>(1) Radiation-induced lung injury occurred in all rabbits in the test group. (2) Expression of TNF-a and TGF-β₁ at 1 h and 48 h after radiation, demonstrated a statistically significant difference between the test and control groups (each P < 0.05). (3) Evaluation by light microscopy demonstrated statistically significant differences between the two groups in the following parameters (each P < 0.05): thickness of alveolar wall, density of pulmonary interstitium area (1 h after radiation), number of fibroblasts and fibrocytes in interstitium (24 h after radiation). The test group metrics also correlated well with the time of postradiation. (4) Evaluation by electron microscopy demonstrated statistically significant differences in the relative amounts of collagen fibers at various time points postradiation in the test group (P < 0.005), with no significant differences in the control group (P > 0.05). At greater than 48 h postradiation the relative amount of collagen fibers in the test groups significantly differ from the control groups (each P < 0.05), correlating well with the time postradiation (r = 0.99318).</p><p><b>CONCLUSIONS</b>A consistent and reliable rabbit model of RILI can be generated in gradient using 25 Gy of high-energy X-ray, which can simulate the development and evolution of RILI.</p>

Inhibitory effect of suramin on inflammatory response in pulmonary tissue and peripheral blood in LPS-induced septic mice / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To investigate the effect of suramin on inflammatory response in pulmonary tissue and peripheral blood in septic mice.</p><p><b>METHODS</b>Twenty-four male C57BL/6 mice were randomly divided into two groups, and suramin(5 mg/kg) or normal saline was intravenously injected 30 min before LPS(5 mg/kg)infusion, respectively. The contents of TNF-α and IL-6 in pulmonary tissue and peripheral blood were detected by ELISA. Suramin or saline-pretreated human mononuclear THP-1 cells were treated with 100 ng/mL LPS in vitro. The expression of TNF-α and IL-6 mRNA and the activity of NF-κB were analyzed by quantitative PCR and Western blotting at different time points after LPS treatment, respectively.</p><p><b>RESULTS</b>Compared with the saline group, the TNF-α and IL-6 levels in pulmonary tissue and peripheral blood were significantly reduced in suramin group at 24 h after LPS treatment(all P<0.01); while there was no significant difference at 72 h between two groups(all P>0.05). The expression of TNF-α, IL-6 mRNA and the activity of NF-κB was decreased in suramin group at different time points after LPS treatment.</p><p><b>CONCLUSION</b>Suramin can protect LPS-induced acute lung injury through down-regulation of systemic and pulmonary pro-inflammatory factors, which may be associated with the inhibition of NF-κB activity.</p>

MRI Features of Spinal Epidural Angiolipomas

OBJECTIVE: To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. MATERIALS AND METHODS: Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. RESULTS: Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. CONCLUSION: Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

Comparison of the effectiveness of dexmedetomidine versus propofol target-controlled infusion for sedation during coblation-assisted upper airway procedure / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Sedation for the coblation-assisted upper airway procedure has lacked easy modulation between appropriate pain control and airway protection. This study aimed to compare the effectiveness of dexmedetomidine versus target controlled propofol infusion in providing sedation during a coblation-assisted upper airway procedure.</p><p><b>METHODS</b>In a prospective, randomized trial, 60 adult patients with obstructive sleep apnea syndrome due to undergoing a coblation-assisted upper airway procedure were enrolled and randomly allocated to receive dexmedetomidine, 1.0 µg/kg over 10 minutes and maintain dosage 0.7 µg×kg(-1)×h(-1) (n=30) or propofol target controlled infusion (n=30). Satisfaction with the analgesia and tolerance of the procedure by the patient, as assessed by a visual analogue scale, were evaluated as primary outcomes. Cardiopulmonary parameters and some side effects were monitored and recorded.</p><p><b>RESULTS</b>Both groups of 30 patients had comparable demographics and initial parameters. Patients in the propofol group reported more pain (P<0.05), tolerated the procedure less well (P<0.05), and were less satisfied with the different stages of procedure (P<0.05 or P<0.01). Changes in mean arterial pressure and heart rate were more dramatic in the propofol group (P<0.05). The dexmedetomidine group experienced fewer airway events and less respiratory depression than did the propofol group.</p><p><b>CONCLUSION</b>Dexmedetomidine in conjunction with local anesthesia offered better analgesia and conscious sedation for a coblation-assisted upper airway procedure as well as less airway obstruction, apnea and greater haemodynamic stability.</p>

Practical value of intravenous urography combined with add-on CT in diagnosing ureteral abnormalities / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intravenous urography (IVU) combined with add-on CT (IVU-CT) can help to provide more diagnostic information for determining the localization and nature of ureteral abnormalities with less irradiation dose. This study aimed to determine the value of IVU-CT for diagnosis of ureteral diseases, where IVU is insufficient to determine the diagnosis.</p><p><b>METHODS</b>Two hundred and eighty patients underwent IVU for suspected ureteral disorders, which identified a definite diagnosis in 184 cases and was insufficient for definite diagnosis in 96 cases designated as indeterminate diagnosis. Subsequently 90 patients (six patients declined CT) with indeterminate diagnosis consented to undergo immediate or delayed helical CT scan. The CT data were transferred to the workstation for post-processing, and the cost and mean effective dose for each imaging method were calculated and compared indirectly.</p><p><b>RESULTS</b>Of the 90 indeterminate diagnosis cases, diagnosis was determined in 86 cases by IVU-CT with a diagnostic accordance rate of 95.6%, while 184/280 (65.7%) had diagnosis determined by IVU alone. There was a significant difference between IVU and IVU-CT in the determination of the diagnosis of ureteral diseases (c(2) = 36.4, P < 0.05). The cost of IVU equals to 1/8 - 1/9 of that for CT urography (CTU), and the cost of IVU-CT is as much as 1/3 of CTU. CTU results in the highest mean effective dose, approximately nine times that for IVU and three times that for IVU-CT.</p><p><b>CONCLUSION</b>IVU-CT provides valuable information for the localization and diagnosis of ureteral abnormalities and may be considered as an efficient, cost-effective and low-dose diagnostic technique in this setting.</p>

[Effect of temperature on the partition coefficient of isoflurane and sevoflurane in perflurocarbon emulsion (Oxygent(TM))].

OBJECTIVE: To investigate the effect of temperature on the partition coefficient of isoflurane and sevoflurane in perflurocarbonate emulsion (Oxygent(TM)). METHODS: The partition coefficients of isoflurane and sevoflurane in perflurocarbonate emulsion (Oxygent(TM)) were measured at different temperatures (4, 22, 27, 32 and 37 degrees celsius;) using syringe-flask double headspace equilibration technique with gas chromatography, and the relationship between the partition coefficients and the temperature was analyzed. RESULTS: At 4, 22, 27, 32 and 37 degrees celsius;, the partition coefficients of isoflurane in Oxygent(TM) were 85.30∓5.60, 40.48∓1.09, 37.14∓3.64, 27.38∓2.28 and 24.66∓1.03, and those of sevoflurane were 91.54∓5.40, 42.50∓0.91, 37.21∓2.76, 25.43∓1.03 and 28.05∓1.74, respectively. The partition coefficients of sevoflurane at 4, 22 and 37 degrees celsius; were significantly higher than those of isoflurane (P<0.05). The regression equations between the partition coefficient and temperature for isoflurane and sevoflurane were Y=-1.893X+89.20 (R(2)=0.942) and Y=-2.075X+95.58 (R(2)=0.951), respectively. An inverse linear relationship was found between temperature and the partition coefficient. CONCLUSION: Within a specified range of temperatures, the partition coefficients isoflurane and sevoflurane decrease as the temperature increases. Sevoflurane shows a high solubility in Oxygent(TM) as compared to isoflurane.

Value of detecting in-stent restenosis by dual source coronary computed tomography coronary angiography / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the value of dual source computed tomography coronary angiography (DSCT-CA) on detecting in-stent restenosis (> 50% luminal narrowing) in symptomatic patients referred for quantitative coronary angiography (QAC).</p><p><b>METHODS</b>Fifty five patients (43 males) with chest pain after coronary stent implantation within 6 - 12 months were evaluated by DSCT-CA and QAC. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DSCT-CA were calculated using coronary angiography as gold standard.</p><p><b>RESULTS</b>Eighty nine stents were implanted. In-stent restenosis was evidenced in 28 stents (31.5%) by QAC. The sensitivity, specificity PPV and NPV of DSCT-CA for the diagnosis of in-stent restenosis was 89%, 87%, 76% and 95%, respectively. Diagnostic efficiency was not affected by heart rate and the sensitivity was 0.94 vs. 0.82, the specificity 0.88 vs. 0.90, the PPV 0.76 vs. 0.75 and the NPV 0.97 vs. 0.93 (all P > 0.05) between patients with heart rate < 70 beats/min and patients with heart rate ≥ 70 beats/min. The sensitivity (84% vs. 100%), specificity (81% vs. 96%), PPV (70% vs. 90%) and NPV (91% vs. 100%) were similar between overlapping or bifurcations stents and single stents. The specificity (100% vs. 80% vs. 66%) and PPV (100% vs. 95% vs. 53%) were significantly higher in the groups with stents ≥ 3.50 mm, stents 3.00 mm than in stents ≤ 2.75 mm (both P < 0.05).</p><p><b>CONCLUSION</b>Diagnostic efficiency of in-stent restenosis with DSCT-CA in the large diameter stent is better than in the small diameter stent and the diagnosis efficacy is not affected by heart rate and stent distribution.</p>

[Comparison of single intubating dose and continuous infusion of rocuronium in prolonged gynecologic laparoscopic surgery].

OBJECTIVE: To compare the cardiorespiratory factors and surgical conditions during total intravenous anesthesia for prolonged laparoscopic pelvic surgery with or without supplemental muscle relaxants. METHODS: Forty female ASA I or II patients undergoing laparoscopic pelvic surgeries were randomized into two groups A and B, both with standardized anesthesia via a intravenous bolus injection of rocuronium (0.6 mg/kg). The patients in group B received continuous rocuronium infusion upon observation of one TOF twitch response with the T1 value maintained within 0-10% and rocuronium withdrawal at 20 to 30 min before the completion of the surgery. The patients in group A received no supplemental muscle relaxants. The cardiorespiratory parameters were measured during the operation. The respiratory system compliance (Ceff rs) was calculated as the quotient of the tidal volume (VT) and peak inspiratory pressure (PIP), and the operative conditions were graded by the operating gynecologist. RESULTS: The cardiorespiratory parameters significant increased and Ceff rs decreased after pneumoperitoneum, but no significant differences were found between the two groups. The surgical conditions were also comparable between the two groups, but the duration of intubation and the operating time were significantly shorter in the group A. CONCLUSION: Pneumoperitoneum severely affects the cardiorespiratory parameters during laparoscopy, which can not be lessened by neuromuscular block agents. A single intubating dose of rocuronium can suffice the requirement of prolonged gynecologic laparoscopic surgery.

Research advances of inflammasome and its role in sepsis / 浙江大学学报·医学版

Inflammasomes are high-molecular-weight, multiprotein complexes in cells, which are assembled after cytoplasmic nucleotide-binding oligomerization domain like receptors (NLRs) sense pathogens and danger signals. The inflammasome can activate caspase-1, and later makes the pro-IL-1β, proIL-18 precursor mature by cleavaging, thereby mediates the innate immunity. Dysregulation of inflammasomes plays an important role in the development of sepsis and other immune inflammatory diseases, thus inflammasome may be a new target for prevention and treatment of sepsis.

[Epidural butorphanol analgesia in elderly patients undergoing hip replacement].

OBJECTIVE: To evaluate the efficacy and safety of continuous epidural analgesia (CEA) with butorphanol in elderly patients undergoing hip replacement. METHODS: Sixty patients scheduled for selective hip replacement were randomized into group B (n=30) to receive patient-controlled epidural analgesia (PCEA) with butorphanol and group M (n=30) to receive PCEA with morphine. Their pain distribution at 5 time points, postoperative global score and the adverse effects in 48 h were observed. RESULTS: The pain distribution at the 5 time points or the global score for postoperative PCEA in 48 h showed no statistically significant difference between the two groups (P<0.05). Analgesia with butorphanol caused less adverse effects (respiratory depression, nausea and vomiting, itching and abdominal distension) than that with morphine (P<0.05). CONCLUSION: CEA with butorphanol is safe and effective for the treatment of postoperative pain in elderly patients and causes less adverse effects than morphine.

Epidemiological study of severe sepsis in a newborn intensive care unit / 中华外科杂志

<p><b>OBJECTIVES</b>To determine the incidence and outcome of severe sepsis in Newborn Intensive Care Unit (NICU) and to characterize their demographics and infection pattern.</p><p><b>METHODS</b>Characteristics of 243 newborns admitted to NICU from June 1st, 2006 to May 31st, 2007 were retrospectively analyzed.</p><p><b>RESULTS</b>Analysis of data derived from 243 newborns admitted to NICU over an 1-year period with 48 (19.8%) cases diagnosed as severe sepsis, and 70.8% of them were males. The median age of severe sepsis patients was 2 (1-6 ) days. In 56.3% of the patients bacteria were isolated, and E. coli was the predominant microbe. PRISM score and mortality rate were higher in those with severe sepsis, while their Apgar score was lower than other cases. The overall hospital mortality of severe sepsis was 45.8%. Risk factors for hospital mortality included higher PRISM score, severe organ dysfunction, circulatory system dysfunction, and hematological or central nervous system dysfunction.</p><p><b>CONCLUSIONS</b>This study shows that severe sepsis is a common, frequently fatal morbid condition in critical ill newborns in NICU, showing similar disease pattern with other investigations. Further multiple-center investigations are helpful to prevent, control and salvage critically ill children suffering from severe sepsis.</p>

Comparison of three different organ failure assessment score systems in predicting outcome of severe sepsis / 中华外科杂志

<p><b>OBJECTIVE</b>To compare multiple organ dysfunction score (MODS), the sequential organ failure assessment (SOFA) and the logistic organ dysfunction score (LODS) in predicting hospital mortality in severe sepsis.</p><p><b>METHODS</b>Four hundred and three patients admitted to the ICU from December 2004 to November 2007 with a diagnosis of severe sepsis were enrolled in this study. Their MODS, SOFA, LODS and Acute Physiology and Chronic Health Evaluation (APACHE) II at admission and the highest score during hospitalization were respectively recorded and collected in regard to mortality. The discrimination of three multiple organ dysfunction score systems were assessed by the areas under the receiver operating characteristic curves (AUC).</p><p><b>RESULTS</b>The AUC of admission scores was 0.811 for LODS, 0.787 for SOFA, 0.725 for MODS, and 0.770 for APACHE II in predicting hospital mortality. All maximum scores had better power of discrimination than the admission scores (P < 0.01). The power of discrimination of LODS and SOFA were better than the MODS, either the admission or the highest, respectively (P < 0.01). However, no significant difference was observed between the LODS and the SOFA regarding mortality prediction (P > 0.05). The AUC value for the APACHE II score was much lower compared to LODS (P < 0.01). However, there was no difference in AUC value among APACHE II, SOFA and MODS (P > 0.05).</p><p><b>CONCLUSION</b>LODS, SOFA and MODS show a good discrimination power, while maximum LODS is of the highest discrimination power to predict the outcome of patient with severe sepsis.</p>

Survey of attitudes and behaviors of healthcare professionals on delirium in ICU / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU).</p><p><b>METHODS</b>One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University.</p><p><b>RESULTS</b>A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P less than 0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium.</p><p><b>CONCLUSIONS</b>Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.</p>

Importance of recognizing and managing delirium in intensive care unit / 中华创伤杂志(英文版)

Delirium is an acute and fluctuating change in mental status, with inattention and altered levels of consciousness. It is a common comorbidity in intensive care units (ICU), resulting in delayed withdrawal of mechanical ventilation, prolonged length of stay in ICU, increased ICU mortality and impaired long-term cognitive function of the survivors. Narcotic or psychoactive medication is one of the major risk factors that contribute to ICU delirium. Surveys conducted in several countries indicated that delirium in ICU was inadequately monitored, underdiagnosed and lacked standardized treatment. In order to improve the prevention and treatment of ICU delirium, it is imperative that the ICU professionals should enrich their knowledge about this comorbidity, familiarize themselves with its screening and management, as well as standardize the administration of narcotic and psychoactive medications.