Objective To investigate the role of the expression of a proliferation-inducing ligand (APRIL) and its receptors in the gastric carcinogenesis. Methods The real-time fluorescence quantitative polymerase chain reaction (RFQ-PCR) was used to detect expression of APRIL and its receptors. Based on the standard curves, the quantitative levels of target genes in tissue samples were determined by using software, and the results were presented as the ratios of mRNA levels of target genes to ?2-microgluobulin(?2M). Results The detection linear range of RFQ-PCR was 101-109 pg/ml and the coefficient of variation values for both intra-experimental and inter-experimental reproducibility ranged 6.52% - 12.02% and 8.76% - 14.16%, respectively.The expression levels of APRIL in the tissue of intestinal metaplasia , dysplasia and gastric cancer were significantly higher than those in normal tissue(P0.05 , respectively). Conclusions The present study indicated that RFQ-PCR had satisfied sensitivity and reproducibility in quantitative measurement of APRIL and its receptors. APRIL may play an important role in the development and progress of gastric cancer and could be established as a target molecule for early diagnosis and anti-cancer therapy. Besides, there maybe some unknown receptors of APRIL expressed on tumor tissue.

Objective To optimize an extracting technology for Fufang Baige capsule. Methods The orthogonal design was used for the inspection of water-extracting process and alcohol-precipitating process. Water volume, extracting time and extracting times were screened as inspection elements for water-extracting process. And liquid concentration, alcohol-precipitating concentration and incubating time were screened as inspection elements for alcohol-precipitating process. The transferring rate of paeoniflorin which is the indicator component in drug-Jun was screened as the inspection indicator for each fraction of extraction process. Results The optimal extraction conditions were as follows:for water- extracting process, that was extracting 2 times with 15-fold water, 2 hours for each time ; For alcohol-precipitating process, that was concentrating liquid to 1.0 g/mL Chinese herbs containing, then adding alcohol untill alcohol concentration ammouted to 70%, and at last putting it static for 18 hours. Conclusion The extracting technology was simple, economical and practical, and was able to increase production efficiency.

Objective To analyze the reasons of the emergency patients forgoing the invasive rescue therapy and to put forward the corresponding strategy.Methods According to whether the patients accepted the invasive rescue therapy or not,2 673 patients in resuscitation room of Peking Union Medical College Hospital were divided into rescue group (group R) and do not rescue group (group DNR).There were 2 147 cases in group R and 526 case in group DNR.The rescue consent form or do not rescue consent form was required to sign by patient self,patient' s family member or relatives.The patient' s basic information,underlying disease,payment of medical expenses,personnel who signed the consent form,treatment and prognosis in both groups were investigated.Results There was no significant gender deference in both groups (x2 =1.86,P =0.173).The mean age of patients in group DNR was much higher than that in group R (69.5 ±-12.5 vs.58.6 ± 19.2 years,F =28.92,P =0.000).The proportion of patients outside Beijing in group DNR was higher than that of group R (51.90％ vs.44.01％,x2 =10.59,P =0.001).The ratios of chronic heart failure,chronic respiratory failure,chronic hepatic encephalopathy,chronic renal failure,malignant tumor in group DNR were significantly higher than that of group R (8.17％ vs.3.03％,8.17％ vs.2.61％,3.80％ vs.1.16％,5.32％ vs.1.44％,11.98％ vs.2.28％,all P=0.000).The proportion of patients without insurance in group DNR was higher than that of group R (52.09％ vs.41.08％,x2 =20.87,P =0.000).Except the ratio of patients self signing the consent form in group DNR was higher than that of group R (3.04％ vs.0.42％,x2 =64.40,P =0.000),there were no significant deference in other people who signed the consent form such as patient's offspring,spouse,parents,siblings and others.Univariate and multivariate logistic regression analyses showed older age,non Beijing patients,chronic underlying diseases,without insurance and patients self signing the consent form were the major risk factors on refusing the invasive rescue therapy.The mortality rate of group DNR was much higher than that of group R (19.39％ vs.7.68％,x2=64.40,P=0.000).Conclusions Most of patients who refused to accept invasive rescue therapy were elderly people or in condition of end stage of chronic disease.The doctors and nurses in emergency department should continue to take care of these patients and make use of noninvasive methods to treat them or relieve their pain.

Objective To establish a fluorescence quantitative-reverse transcription-polymerase chain reaction (FQ-RT-PCR) with two-probe for quantification of HCV RNA loads,and to optimize the experimental conditions to increase sensitivity and specificity.Methods HCV RNA loads in 89 cases with positive anti-HCV and 220 cases with negative anti-HCV were quantified by FQ-RT-PCR with double probe,and the results were compared with another two commercial HCV RNA quantificationkits simultaneously.Results For the 2 groups (89 cases with positive anti-HCV and 220 cases with negative anti-HCV), the positive rate of HCV RNA was 91.0%(81 cases) and was 2.27%(5 cases) respectively by FQ-RT-PCR with two-probe, while it was 82.0% (73 cases)and 0.45% (1 cases)), 79.7%(71 cases))and 1.81%(4 cases) respectively by using the two commercial kits.Conclusion FQ-RT-PCR assay with two-probe may increases the sensitivity and specificity for the detection of HCV RNA loads comparing with commercial kits.

Objective To explore the change in nutritional status of perioperative gastrointestinal cancer patients. Methods The nutritional status of 207 gastrointestinal cancer patients who were to undergo elective radical surgery was evaluated by SGA within 48h of admission and 7 days after operation. The investigation results went through analysis. Results Body weight was significantly decreased 7 days after operation compared with 48h of admission, the prevalence of malnutrition 7 days after operation was higher than 48h of admission; weight loss, change of food intake and decreased functional activity were the related factors of change in nutritional status of perioperative gastrointestinal cancer patients. Conclusions There was a decreased nutritional status among perioperative gastrointestinal cancer patients, and appropriate nutrition intervention program and treatment should be taken to improve clinical outcomes according to the risk factors.

Objective:Based on the clinical indicators of severe community-acquired pneumonia in emergency department, the early warning indicators of critical condition were constructed.Methods:The general information, vital signs before entering ICU, laboratory indexes and the survival rate in 30 days of 118 patients with community-acquired pneumonia were retrospectively collected in the emergency care unit of Peking Union Medical College Hospital from January to December 2018. The indexes of death patients (24 cases) and alive patients (98 cases) underwent comparative analysis, using ROC curve to predict the clinical outcome and reliable parameters of emergency patients with community-acquired pneumonia. The best cutoff value was determined according to Youden index and then undergoing multiple factors Logistic stepwise regression analysis. Then early warning model of critical degree was finally built.Results:Eleven indicators were used to predict the criticality of patients with acute community-acquired pneumonia, including AVPU (alert, voice, pain, unresponsive) score, Glasgow Coma Scale(GCS), heart rate, pulse oxygen saturation (SpO 2), fraction of inspiration O 2, oxygenation index,potential of hydrogen, blood potassium (K +), bilirubin, urea nitrogen, and C reactive protein, the optimal cutoff values were 2 points, 8 points, 91 times per minute, 0.94, 41%, 81.20%, 7.38, 4.0 mmol/L, 10.90 μmol/L, 2.23 mmol/L, and 41.5 mg/L. Multiple Logistic stepwise regression showed that the independent factors for predicting death were GCS score, SpO 2 and urea nitrogen, and the predictive ability of the early-warning model was 83.7%. Conclusions:GCS score, SpO 2 and urea nitrogen are effective early warning indicators for the severity of severe community-acquired pneumonia in emergency department, which are conducive to the rapid and efficient early identification and treatment of critically ill patients. Therefore, they are worthy of promotion and application in clinical practice.

Objective To explore the influencing factors of compression fatigue time and the correlation between fatigue and the quality indexes of chest compression. Methods A convenience sample of 120 medical staff members in Emergency Department of PUMCH were selected and implement single hand chest compression 2 minutes according to the quality requirements of the AHA 2010 guidelines, and the computer automatically recorded the pressing quality data, including pressing frequency, pressing depth, chest wall recoil, and recording the operator fatigue time. Results The rescuer fatigue is associated with gender, body mass index and pressposture(r= -0.233,0.232,0.400;P<0.05); fatiguetimeofthemalewas(110.5±18.2)swhile the female was (81. 9 ± 20. 8)s (P<0. 05);low body mass index pressers as well as overweight tended to feel fatigue earlier than pressers with normal one. Fatigue time of kneeling posture pressing was longer than the standing posture; fatigue time was negatively associated with depressing frequency, and positive with the pressing depth. Conclusions In order to delay the compression fatigue in the chest compression process, the male and kneeling posture should be chosen with the control of pressing frequency;the female and underweight pressers should be early replaced to guarantee the pressing quality.

Objective To investigation the incidence of central venous catheter related bloodstream infection (CRBSI) and the distribution of pathogens in patients in the emergency intensive care unit (EICU),and analyze the risk factors of central venous catheter related bloodstream infection.Methods Clinical materials of the patients with central venous catheters in the emergency intensive care unit in Peking Union Medical College Hospital from April 2015 to March 2016 were collected. The indwelling of central venous catheters and the infection situation were investigated with the self-designed central venous catheter monitoring table. Results From April 2015 to March 2016,108 cases of catheters were indwelled in EICU. The total number of days of central venous catheter indwelling was 688 days. There were 9 cases of CRBSI. The incidence of CRBSI was 13.08‰. There were 66.67% of catheters inspected. The gram-negative bacterium infection was the main pathogen of hospital infection. The main CRBSI risk factors were whether contaminated dressings were changed in time and timely removing unnecessary catheters.Conclusions Long term continuous targeted monitoring, timely understanding of infection related factors,and taking timely appropriate preventive measures can effectively reduce the incidence of catheter related bloodstream infection.

Objective To investigate the construction of outpatient quality care services and the needs of patient for outpatient service,and to explore the relevance of the two projects.Methods A total of 152 cases of outpatient department registered nurse of Beijing Union Hospital and 281 cases of hospitalized patients on May,2017 were selected,and then developed the Content Questionnaire on Quality Nursing Work of Outpatient Nurse and the Questionnaire on Outpatient Needs Status to carry out investigation.Results This kind of hospital patients with college or university in 216 cases(76.9%,216/281),personal monthly income of 5.0-10.0 thousand accounted for 44.8%(126/281);outpatient nurses aged ≥46 in 83 cases(54.6%,83/152),the working time≥20 years in 120 cases(78.9%,120/152),college degree or above in 137 cases(90.1%,137/152),97 nurses(63.8%,97/152)in charge.The clinic nursing work relates to the rate of above 85%for disease treatment and consultation,health education,guidance service,self-service system services,on-site inspection,consulting room environment,and the cost of nurses working hours and the most frequent content for the on-site inspection and diagnosis of diseases,counseling,health education,medical order service.The order of patients' needs from high to low was disease and consultation,health education,guidance service,order service,on-site inspection,self-service system,registration service,waiting environment and consulting room environment.There was no correlation between the patient's needs and the rate of nursing,the length of work,and the frequency of work(P＞0.05).There were significant differences in the demand for health education on each department(F =3.047,P ＜0.05),education level,medical order service and on-site inspections have significant difference on demand(F=3.809,3.409,P＜0.05),family income,sources of patients were not statistically significant in the comparison(P＞0.05).The outpatient quality care services had lower improved demand(≤26%),and the first six item that needed to improve are disease and medical consultation,self-service system,treatment order service,waiting environment,health education,guidance services.Conclusions In view of the characteristics of outpatient medical staff and patients in large general hospitals,we will improve the quality of outpatient service and meet the needs of patient outpatient service,which will help to deepen the medical reform and improve the quality of medical service.

Ventilator-associated pneumonia (VAP) has become one of the most common and severe complications in patients with mechanical ventilation due to its high morbidity and mortality rates, and is an important cause of death in critically ill patients. Pathogenic oropharyngeal colonization mostly accumulates in the subglottic secretion, which is easy to be ignored and difficult to be cleaned. The leakage of subglottic secretion can result in pathogenic oropharyngeal colonization in the lung, and in turn cause VAP. Flushing of the subglottic secretion can effectively prevent VAP. Selection and amount of rinses, flushing frequency and proper cuff pressure maintenance during flushing were reviewed in the current study.