OBJECTIVE:To assess the impact of albumin (Alb) administration on the prognosis of patients with acute kidney injury (AKI). METHODS:Clinical data of AKI patients in the intensive care unit (ICU) were retrospectively analyzed from the American Medical Information Mart of Intensive Care-IV (MIMIC-IV), including demographic data, acute physiology score (APS), comorbidities, vital signs, laboratory indicators, treatment status, ICU length of stay, and outcome indicators. The main outcome measure is ICU mortality. AKI patients were divided into Alb infusion group and Alb non infusion group based on whether they received Alb treatment. Multiple imputation was used to process missing data and eliminate variables that missing more than 30%. To ensure the stability of the results, propensity score matching (PSM) and inverse probability weighting (IPW) were used to correct the results. Using Kaplan-Meier survival curve and Cox proportional hazards regression model to evaluate the effect of Alb infusion on ICU survival rate in AKI patients. Perform subgroup analysis based on patient age, gender, and comorbidities to evaluate the prognostic effects of Alb on different patient subgroups. RESULTS:A total of 6 390 AKI patients were included, including 1 721 in the Alb infusion group and 4 669 in the Alb non infusion group. After adjusting for key covariates in the Cox regression model, compared with the Alb non infusion group, patients in the Alb infusion group were significantly younger in age, with APS III score, proportion of vasoactive drugs and continuous renal replacement therapy (CRRT) use, sepsis proportion, heart rate, respiratory frequency, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine (Cr), lactic acid (Lac), and arterial partial pressure of carbon dioxide (PaCO2) levels significantly higher. The proportion of hypertension, myocardial infarction, and congestive heart failure, as well as blood pressure, urine output, platelet count (PLT), and Alb levels were significantly lower. The results of univariate and multivariate Cox regression analysis on the raw data showed that the risk of death in the Alb infusion group was significantly lower than that in the Alb non infusion group [hazard ratio (HR) = 0.69, 95% confidence interval (95%CI) was 0.60-0.80, all P < 0.05]. The results after propensity score matching (PSM) and inverse probability weighting (IPW) processing are consistent with the original data trend (both P < 0.05). The Kaplan-Meier survival curve showed that the cumulative survival rate during ICU stay in the Alb infusion group was significantly higher than that in the Alb non infusion group (24.48% vs. 12.17%, Log-Rank test: χ2 = 74.26, P < 0.05). Subgroup analysis shows that Alb infusion has a more significant survival benefit for AKI patients who use vasoactive drugs, have concurrent sepsis, and do not have liver disease. CONCLUSION:Albumin infusion can decrease the ICU mortality of AKI patients.

Acute pulmonary embolism (APE) is a life-threatening complication that is primarily caused by the migration of deep vein thrombosis to the lungs. However, current drug treatments have limited efficacy and can lead to lung ischemia-reperfusion injury (LIRI) after thrombolysis. Inhaled nitric oxide has shown potential for APE therapy, but its clinical feasibility is still uncertain. In this study, nitric oxide (NO) was directly encapsulated by nanobubbles to form NO-loaded nanobubbles (NanoNO) as a potential treatment for APE and subsequent LIRI. NanoNO, with a size of 219.27 +/- 2.42 nm and a polydispersity index of 0.17, could encapsulate up to 1.1 mM NO. In the LIRI cell model, NanoNO increased NO concentration and superoxide dismutase (SOD) enzyme activities while reducing reactive oxygen species (ROS) and malondialdehyde (MDA) levels (2.80-fold), leading to decreased cell apoptosis. In a rabbit model of APE, NanoNO was compared to sodium nitroprusside (SNP, a positive control) for thrombolysis efficacy by using blood gas analysis, pulmonary angiography, echocardiography, and hematoxylin-eosin staining. The results demonstrated that NanoNO was more effective than SNP in thrombolysis, as evidenced by its better ability to remove blood clots, normalize pulmonary arteries, and relieve right ventricular (RV) dilatation. In the LIRI rabbit model, NanoNO decreased serum MDA, tumor necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6) while increasing serum SOD. Collectively, these findings highlight the potential of NanoNO as a promising therapeutic approach for the treatment of APE and the mitigation of LIRI.

Background: Management guidelines for acute lung injury (ALI) are extremely limited. Xuebijing, a traditional Chinese medicine, exerts therapeutic effects in patients with ALI; however, supportive evidence is currently insufficient. Material and methods: A systematic literature search of seven electronic databases for randomised controlled trials assessing the efficacy of Xuebijing injections in patients with ALI, published from inception to March 31, 2024, was performed. The Risk of Bias assessment tool recommended by The Cochrane Collaboration was used for quality evaluation. Review Manager version 5.3 (R Foundation for Statistical Computing, Vienna, Austria) was used for analysis. Dichotomous variables are expressed as relative risk (RR) and continuous variables as standardised mean difference (SMD). Heterogeneity was assessed using the I2 statistic and a funnel plot was used to visually assess publication bias. Results: Sixteen studies comprising 1327 patients were included. Xuebijing injection improved oxygenation index (SMD 1.08 [95 % confidence interval (CI) 0.79-1.38]), reduced the incidence of acute respiratory distress syndrome (RR 0.56 [95 % CI 0.42-0.74) and all-cause mortality (RR 0.48 [95 % CI 0.34-0.67]), and decreased serum tumor necrosis factor-alpha (SMD -1.33 [95 % CI -1.50 to -1.17]) and interleukin-6 levels (SMD -1.35 [95 % CI -1.52 to -1.17]). The funnel plot indicated no publication bias. Conclusion: Xuebijing injection may be an effective treatment for ALI. However, this needs to be further confirmed in well-designed, large-sample, randomised controlled trials.

Objective To examine the therapeutic effect of Fangji Fuling Decoction (FFD) on sepsis through network pharmacological analysis combined with in vitro and in vivo experiments. Methods A sepsis mouse model was constructed through intraperitoneal injection of 20 mg/kg lipopolysaccharide (LPS). RAW264.7 cells were stimulated by 250 ng/mL LPS to establish an in vitro cell model. Network pharmacology analysis identified the key molecular pathway associated with FFD in sepsis. Through ectopic expression and depletion experiments, the effect of FFD on multiple organ damage in septic mice, as well as on cell proliferation and apoptosis in relation to the mitogen-activated protein kinase 14/Forkhead Box O 3A (MAPK14/FOXO3A) signaling pathway, was analyzed. Results FFD reduced organ damage and inflammation in LPS-induced septic mice and suppressed LPS-induced macrophage apoptosis and inflammation in vitro ( P <0.05). Network pharmacology analysis showed that FFD could regulate the MAPK14/FOXO signaling pathway during sepsis. As confirmed by in vitro cell experiments, FFD inhibited the MAPK14 signaling pathway or FOXO3A expression to relieve LPS-induced macrophage apoptosis and inflammation ( P <0.05). Furthermore, FFD inhibited the MAPK14/FOXO3A signaling pathway to inhibit LPS-induced macrophage apoptosis in the lung tissue of septic mice ( P <0.05). Conclusion FFD could ameliorate the LPS-induced inflammatory response in septic mice by inhibiting the MAPK14/FOXO3A signaling pathway.

OBJECTIVE:Several trials had compared the efficacy and safety between non-vitamin K antagonist oral anticoagulants and warfarin for acute venous thromboembolism, but the results were incomplete. This updated review comprehensively assessed the efficacy and safety of non-vitamin K antagonist oral anticoagulants for venous thromboembolism.DESIGN:Meta-analysis of randomised control trials. Six databases were searched from January 2000 to December 2018.SETTING:Adult patients had got non-vitamin K antagonist oral anticoagulants or warfarin for venous thromboembolism.PARTICIPANTS:Randomised control trials that compared the efficacy and safety between non-vitamin K antagonist oral anticoagulants and warfarin.MAIN OUTCOME MEASURES:The efficacy and safety of non-vitamin K antagonist oral anticoagulants .RESULTS:Seven studies involving 29,879 cases were included, among which 14,943 cases were assigned to non-vitamin K antagonist oral anticoagulants group and 14,936 cases to warfarin group. Meta-analysis showed that compared with warfarin, recurrent venous thromboembolism (odds ratio 0.94 [95% confidence interval 0.81 to 1.11]), death related to venous thromboembolism or fatal pulmonary embolism (odds ratio 1.00 [95% confidence interval 0.63 to 1.60]), symptomatic deep-vein thrombosis (odds ratio 0.88 [95% confidence interval 0.72 to 1.09]), symptomatic nonfatal pulmonary embolism (odds ratio 1.03 [(95% confidence interval 0.82 to 1.30]) and all deaths (odds ratio 0.92 [95% confidence interval 0.76 to 1.12]) are similar in non-vitamin K antagonist oral anticoagulants group, but major bleeding event (odds ratio 0.61 [95% confidence interval 0.50 to 0.75]) and clinically relevant non-major bleeding event (odds ratio [95% confidence interval 0.53 to 0.85]) are less in non-vitamin K antagonist oral anticoagulants group. .CONCLUSIONS:For the treatment of venous thromboembolism, non-vitamin K antagonist oral anticoagulants is as effective as warfarin, and has a better safety profile than warfarin.

Abstract Background: Acute respiratory distress syndrome (ARDS) is caused by an inflammatory injury to the lung. Dysregulated inflammation is the cardinal feature of ARDS. Methylprednisolone is an option for treating ARDS. However, the benefits and adverse effects of methylprednisolone have not been well assessed in patients with ARDS. This study aimed to evaluate the efficacy and safety of methylprednisolone against ARDS. Material and methods: The electronic database of Embase, PubMed, the Cochrane Library, CNKI, and Wanfang were searched, and randomized controlled trials (RCTs) reporting the efficacy and safety of methylprednisolone for ARDS were included. Revman 5.3 and Stata 15.0 were used to conduct the analysis. The fixed-effects model was used to calculate summary odds ratios (ORs) and 95% confidence interval (CIs). Results: Ten RCTs studies involving 692 patients with ARDS. The summary results demonstrated that, compared with placebo, methylprednisolone had a statistically significant effect on mortality (OR = 0.64; 95% CI: 0.43–0.95, I 2 = 42%); the time of mechanical ventilation (MD) = –2.70, 95% CI: –3.31 to –2.10; I 2 = 0%) in patients with ARDS, but it was not associated with increased rates of adverse events (OR = 0.80; 95% CI: 0.34–1.86; I 2 = 58%). Conclusions: This systematic review and meta-analysis demonstrated that Methylprednisolone is safe against ARDS. It may reduce mortality and shorten the time of mechanical ventilation. However, well-designed and large-sample studies were required to fully characterize the efficacy and safety of methylprednisolone against ARDS.

目的:探讨前列腺癌放射性粒子植入术后膀胱癌患者接受腹腔镜根治性膀胱切除的可行性、安全性及临床疗效.方法:回顾性分析2015年6月就诊于北京中医药大学东直门医院1例前列腺癌放射性粒子植入术后发生肌层浸润性膀胱癌患者的临床资料.该患者接受腹腔镜根治性膀胱全切+回肠膀胱术.通过查阅相关文献,分析放射粒子植入对膀胱癌发生和演进、根治膀胱全切手术操作及尿流改道选择等影响.结果:术中发现前列腺与周围组织粘连严重,通过逆行与顺行相结合的方式进行根治性膀胱切除,并采取回肠输出道作为尿流改道方式,未出现直肠损伤、尿漏、肠梗阻等早期并发症.随访5年6个月,无肿瘤复发、无输尿管回肠吻合口狭窄等远期并发症.结论:腹腔镜根治性膀胱切除术+回肠输出道可以作为前列腺癌粒子植入术后肌层浸润性膀胱癌患者安全、有效的手术方式之一.

目的:探讨腹腔镜膀胱外黏膜下隧道法输尿管膀胱再植术联合腰大肌悬吊术治疗末段输尿管缺损的适应证、手术要点及术后疗效.方法:回顾性分析2012年1月－2019年3月行腹腔镜输尿管膀胱再植术联合腰大肌悬吊术的22例末段输尿管病变患者的临床资料,男10例,女12例,年龄21～55岁,平均(40.6±7.2)岁.其中内镜激光碎石术后狭窄7例;妇产科术后输尿管狭窄6例;输尿管子宫内膜异位症3例;原发性狭窄6例.术前影像学结果提示输尿管缺损长度4～8 cm,平均(5.0±1.6)cm;输尿管扩张直径0.7～2.5 cm,平均(1.3±0.7)cm;肾盂分离1.5～4.1 cm,平均(2.6±0.8)cm.术中均先充分游离末段病变输尿管及膀胱,离断输尿管后将膀胱悬吊于腰大肌或腰小肌肌腱;将病变段输尿管裁剪后,采用膀胱外黏膜下隧道法行输尿管膀胱的再植术.结果:22例手术均在腹腔镜下成功完成,手术时间130～230 min,平均(168±30.2)min;出血量15～120 mL,平均(60±30.2)mL;引流管留置时间4～8 d,平均(6±0.5)d;尿管留置时间7 d;术后住院8～11 d,平均(9±1.2)d;术中留置双J管均于术后2～3个月拔除.随访5～80个月,平均(48.4±25.3)个月,患者均无尿瘘、吻合口瘘及吻合口狭窄;行B超、静脉肾盂造影、膀胱造影检查提示肾积水均明显减轻或消失,其中轻度肾积水8例,无明显肾积水14例,轻度膀胱输尿管反流1例.结论:腹腔镜膀胱外黏膜下隧道法联合腰大肌悬吊输尿管膀胱再植术治疗中等长度的末段输尿管缺损安全有效,损伤小,术后恢复快.腰大肌悬吊术能有效解决输尿管缺损较长的问题,使输尿管膀胱达到无张力吻合,黏膜下隧道法抗反流成功率高,降低了术后患者尿液反流导致逆行感染及慢性肾功能损害的发生率.

目的 观察杨氏萆薢分清饮加减方联合超声药物透入治疗中老年女性尿频的疗效.方法 选取北京中医药大学东直门医院泌尿外科2017年3月至2018年3月门诊以尿频为主诉的中老年女性下尿路症状(LUTS)患者60例,按就诊顺序随机数字表法分治疗组(29例)与对照组(28例),治疗组采用中药口服联合超声药物透入治疗,对照组单纯采用西药M受体阻滞剂治疗,疗程4周.患者填写问卷,包括排尿日记、膀胱过度活动症评分(OABSS)问卷表和生活质量(QoL)指数,评价中药联合穴位贴敷治疗治疗中老年女性尿频的有效性和安全性,随访观察其症状缓解及生活质量改善情况.结果 两组中医有效率差异有显著性(P<0.05);两组OABSS症状评分、QoL指数和中医证候评分在治疗前后组内比较,差异有显著性(P<0.05);两组治疗后组间比较,QoL指数和中医证候评分治疗组优于对照组,差异有显著性(P<0.05).结论采用中药配合超声药物透入外治女性下尿路症状安全有效.

MicroRNA-191 (miR-191) has been identified as being upregulated in several types of cancers, and plays the role of oncogene. The expression of miR-191 has been found to be upregulated in prostate cancer tissues as well as cell lines. In this study, we analyzed the correlation of miR-191 expression with clinicopathologic factors and prognosis in prostate cancer. Prostate cancer tissue samples and adjacent normal prostate tissue samples were collected from 146 patients who underwent laparoscopic radical prostatectomy between April 2013 and March 2018. Student two-tailed t-test was used for comparisons of 2 independent groups. The relationships between miR-191 expression and different clinicopathological characteristics were evaluated using the Chi-squared test. Kaplan-Meier survival plots and log-rank tests were used to assess the differences in overall survival of the different subgroups of prostate cancer patients. miR-191 expression was significantly higher in prostate cancer tissues compared with normal adjacent prostate tissues (P<.001). miR-191 expression was observed to be significantly correlated with Gleason score (P<.001), pelvic lymph node metastasis (P=.006), bone metastases (P<.001), and T stage (P=.005). Kaplan-Meier analysis showed that patients with higher levels of miR-191 had significantly poorer survival than those with lower expression of this miRNA in prostate cancer patients (log rank test, P=.011). Multivariate analysis revealed that miR-191 expression (hazard ratio [HR]=2.311, 95% confidence interval, [CI]: 1.666-9.006; P=.027) was independently associated with the overall survival of prostate cancer patients. Our results demonstrated that miR-191 might serve as an independent prognostic indicator for prostate cancer patients.

Objective:To compare the effect of extracorporeal shock wave lithotripsy (SWL),ureteroscopic lithotripsy (URL)and flexible ureteroscopic lithotripsy (FURL)in the treatment of single larger than 1 cm in di-ameter calculus in upper ureter.Methods:From May 2016 to December 2017,124 cases of single larger than 1 cm in diameter calculus in upper ureter were treated in our hospital,including 22 cases given SWL,59 cases URL 59 and 43 cases FURL.The indexes of success rate of ureteral calculi,the incidence of complications,non-anticipated emergency readmission rate and treatment costs were compared.Results:The success rate of SWL was 27.3%, which was significantly lower than URL and FURL.The incidence of complications in SWL was significantly higher than that in URL and FURL (P<0.05 for both).The URL was better than SWL in terms of success rate,complication rate, unexpected emergency readmission rate and other indicators.There was no significant difference in the incidence of com-plications between URL and FURL (P>0.05).FURL had a maximum one-time success rate of 95.3%,with the lowest non-anticipated readmission rate and statistical significance (P< 0.05),while the treatment cost of FURL was signifi-cantly greater than that of SWL and URL (P<0.05).Conclusions:In comprehensive consideration for single larger than 1 cm in diameter calculus in upper ureter,FURL is the preferred treatment.Combined with the use of the interceptor, URL is also a kind of optimal method,while SWL should be carefully chosen.

OBJECTIVE:To investigate the value of bedside lung ultrasound B-line score in the diagnosis of acute heart failure (AHF).METHODS:A retrospectively analysis was conducted. The adult patients presenting with acute dyspnea in intensive care unit (ICU) of Affiliated Hospital of Nanjing University of Traditional Chinese Medicine from January 2016 to June 2017 were enrolled. An 8-zone lung ultrasound was performed and plasma B-type natriuretic peptide (BNP) level was tested in all patients. AHF was determined as the final diagnosis by two experienced ICU doctors according to the diagnostic criteria of AHF. Patients were divided into two groups: AHF group and non-AHF group. The levels of BNP and B-line score were compared between the two groups, and the diagnostic value of BNP and B-line score in AHF was evaluated.RESULTS:Fifty-six patients were included in this study, with 32 of men and 24 of women, and with an average age of 77.3±8.8. Thirty-six patients were diagnosed as AHF. The level of BNP and lung ultrasound B-line score in AHF group were higher than those in non-AHF group [BNP (ng/L): 1 640.4±1 078.4 vs. 236.9±124.9, B line score: 12.8±5.3 vs. 5.4±1.8, both P < 0.01]. There was a strong correlation between elevated BNP levels and an increased B-lines score (R2 = 0.712, P = 0.000). The receiver operating characteristic curve (ROC) showed that when the cut-off of lung ultrasound B-line score was 8.5, AHF could be discriminated from dyspnea caused by other diseases (sensitivity was 77.8%, specificity was 95%, positive likelihood ratio was 15.56, negative likelihood ratio was 0.23). The area under the ROC curve (AUC) of lung ultrasound B-line score was 0.917 [95% confidence interval (95%CI) = 0.847-0.987, P = 0.000], slightly lower than that of plasma BNP [0.979 (95%CI = 0.951-1.008)].CONCLUSIONS:Lung ultrasound B-line score was highly specific, but moderately sensitive for identifying patients with AHF.

Objective:To explore the method and clinical value of transurethral plasmakinetic enucleation of prostate combined with partitioned resection using Nesbit technique in treating benigh prostatic hyperplasia (BPH) with huge volume.Methods:From May 2015 to February 2017,a total of 36 cases of BPH with huge volume grea-ter than 100mL were treated with transurethral plasmakinetic enucleation of prostate combined with partitioned re-section using Nesbit technique at our institution and the clinical data were collected and analyzed.Results:All op-erations were successfully carried out.Operative time was (105.6±23.2)min.Estimated blood loss was (120.3± 42.9)mL.There were no cases with transfusion,transurethral resection syndrome (TURS)or ureteral injury. Mean catheterization time was (3.5±1.2)days and hospital stay was (9.5±2.3)days.Patients had significant im-proved IPSS score,QOL score and Qmax one month after surgey (P <0.05).Four patients,suffering from mild incontinence after catheter removal,were all recovered three months later.Conclusions:Transurethral plasmaki-netic enucleation of prostate combined with partitioned resection using Nesbit technique was a safe and efficient&nbsp;surgical method in treating BPH with huge volume.

Background and aim: Iron oxide nanoparticles (IONPs) can protect hearts from ischemia reperfusion (I/R) injuries. Long noncoding RNAs (LncRNAs) have been believed to play important roles in regulation of many biological processes. The aim of our study was to investigate the lncRNA profile in I/R injury rat model following IONPs ferumoxytol administration. Methods: Models of I/R were induced by 30 min of ischemia followed by 24 hours of reperfusion in male Sprague-Dawley rats. The rats were randomized into three groups: sham group, I/R group, and ferumoxytol group. The profiles of lncRNAs and mRNAs were confirmed using Illumina RNA-Seq technology combining quantitative real-time PCR analysis. Results: Ferumoxytol leads to a significant reduction in the area of myocardial infarction. Iron deposition was observed around ischemic myocardial tissue by Prussian blue staining. Sequencing revealed the existence of a total of 19754 lncRNAs distributed in all chromosomes of the experimented rats. In ferumoxytol intra-myocardial injected heart, 433 lncRNAs were up-regulated, whereas 287 lncRNAs were down-regulated when compared with I/R injured hearts (fold-change >2.0). In I/R injury hearts, 419 lncRNAs were up-regulated, whereas 393 lncRNAs were down-regulated when compared with sham heart (fold-change >2.0). Top 10 lncRNAs were selected for RT-qPCR validation. Based on cis-acting target genes prediction and mRNA-sequencing results, NONRNOT219022-Reg3b is likely to be the key lncRNA-mRNA pair. Conclusion: We identified a set of lncRNAs aberrantly expressed in myocardial I/R injury rats with ferumoxytol, shedding lights for further research of the mechanism of feurmoxytol in myocardial protection and proposing a potential therapeutic target for I/R injuries.

Heatstroke usually occurs in summer during heat waves, and few cases occur in winter. We report the case of a 26-year-old man who went through multiple organ dysfunction after sauna in January, and finally was diagnosed as heatstroke.

Objective: This study aims to describe the technique and feasibility of laparoscopic submucosal tunneling ureteroneocystostomy in combination with psoas hitch to restore urinary tract continuity in patients showing medium-length distal ureteral defects. Materials and Methods: From January 2012 to April 2016, a total of 13 patients (4 males and 9 females) with a mean age of 37 years were performed with the laparoscopic operation of ureteral submucosal tunneling reimplantation combined with psoas hitch. The mean defective length was 5.5 cm (range 4-8 cm). The etiologies included ureteral strictures secondary to endoscopic laser lithotripsy in 2 patients, previous gynecological surgeries in 4, infiltrative ureteral endometriosis in 3, as well as ureteral strictures without obvious causes in the remaining 4. Results: The operations were successfully performed in all patients. The mean operating time was 179 min (range 150-230 min). The mean estimated blood loss was 32 mL (range 15-80 mL). The mean drainage time was 5.8 days (range 4-8 days). No major complications occurred during the perioperative period. The mean follow-up time was 25 months. All patients experienced symptomatic relief and showed good urine drainage. Conclusion: Extravesical submucosal tunneling ureteroneocystostomy combined with psoas hitch under laparoscopy is a feasible and effective option for medium-length distal ureteral defects in selected patients.

Background: The Surviving Sepsis Campaign has recommended early goal-directed therapy (EGDT) as an essential strategy to decrease mortality among patients with severe sepsis and septic shock. However, three latest multicenter trials failed to show its benefit in the patients with severe sepsis and septic shock. This article was to evaluate the effect of EGDT on the mortality of patients with severe sepsis and septic shock.Methods: Relevant studies from PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials were identified from January 1, 2001 to June 13, 2015. With both randomized controlled trials (RCTs) and non-RCTs selected, a meta-analysis on the effects of EGDT on all identified trials was performed. The primary outcome was the inhospital mortality. In subgroup, RCTs and non-RCTs were analyzed, respectively.Results: A total of five RCTs and 10 non-RCTs involving 3285 patients in EGDT group and 3233 patients in the control group were identified. Pooled analyses of all studies showed significant difference in the inhospital mortality between the EGDT group and the control group (risk ratio [RR], 0.84; 95% confidence interval [CI], 0.74-0.94; P = 0.003) with substantial heterogeneity (chi(2) = 24.93, P = 0.04, I-2 = 44%). In subgroup analysis, there were no significant difference in inhospital mortality between the EGDT group and the control group (RR, 0.95; 95% CI, 0.83-1.10; P = 0.51) with no significant difference in heterogeneity (chi(2) = 6.62, P = 0.16, I-2 = 40%) in RCTs. In non-RCTs, EGDT significantly reduced inhospital mortality (RR, 0.75; 95% CI, 0.65-0.88; P = 0.0003) with no significant difference in heterogeneity (chi(2) = 11.96, P = 0.22, I-2 = 25%).Conclusions: This meta-analysis suggests that EGDT can significantly reduce the mortality among patients with severe sepsis and septic shock. (C) 2015 Elsevier Inc. All rights reserved.

16 rabbits received tracheotomy in order to observe the antibacterial effect and biosafety of a novel nano-silver/polyurethane coated endotracheal tube in them. The rabbits in the experimental group were investigated by inserting the novel antibacterial endotracheal tube while the control group was investigated by insertion of an ordinary medical endotracheal tube. The colony count from bronchoalveolar lavage fluid (BLF) and formation of biofilm on the tube walls were observed in both groups 72 h after intubation, and the tracheal mucosa that was in contact with the external tube surface was observed as well. We evaluated the bio-safety using the nano-silver lyophilized powder in the ICR mice and calculated its maximum tolerated dose (MTD). The results showed that the colony counts from the BLF and thickness of biofilm were significantly different between two groups (P < 0.001). The tracheal mucosa in contact with the external tube surface showed no significant change in both groups. No obvious abnormal behavior or death was found in all the mice after administration of the nano-silver lyophilized powder. The general and pathological changes in major organs showed no significant differences in both groups. The MTD was 3,592 times, just as clinical human adult daily dose after conversion, meaning that the novel antibacterial nano-silver/polyurethane coated endotracheal tube could markedly inhibit the bacterial generation and biofilm formation in the respiratory tract and tube wall in rabbits, respectively.