Objective To investigate the influence of inspired oxygen fraction (FiO2) on the ratio of PaO2/FiO2(P/F) during the implementation of lung protective ventilation strategy in patients with acute respiratory distress syndrome(ARDS) in order to unravel its clinical significance. Method This was a prospective study of 16 selected patients with ARDS treated with mechanical ventilation ( MV ) to get ratio of P/F in range of 100 to 200 by PEEP≥5 cmH2O and high inspired oxygen. After lung recruitment maneuvers by BiPAP with high pressure (PH) of 40 cmH2O for40 s, the MV was maintained the basic requirement for stabilizing the patients for 30 minutes. A series of FiO2 were set at fractions of 0.5,0.6,0.7,0.8,0.9 and 1in random sequence, and the changes of respiratory mechanics, blood gas and hemodynamics under the different concentrations of FiO2 were analyzed by using SPSS version 13.0 software. Results ( 1 ) The ratio of P/F increased as FiO2 increased, and it's significant as FiO2 increased to 0.7 or above. As the fractions of FiO2 were set at 0.5 and 1. O, the ratios of P/F changed in 24.70% ± 23.36% respectively. ( 2 ) Of them,6 patients ( 37.5% ) treated with FiO2 set at 0.5 had the ratio of P/F ＜ 200, and the fraction of FiO2 was increased to 1.0, the P/F ＞ 200. (3) FiO2 and Qs/Qt were negatively correlated ( r = - 0.390, P = O. 027 ),the higher inspired oxygen fraction, the lower shunt. When the fractions of FiO2 were set at 0.5 and 1.0 ,there was a positive correlation between △Qs/Qt and △P/F( r = 0.82, P = 0.005 ). Conclusions The inspired oxygen fraction affects the ratio of P/F, which may be resulted from shunt and it may influence the diagnosis of ARDS.

Objective To study the clinical significance of plasma ET ,NO ,CGRP and EGF detection after acupuncture at Zusanli pointinpatientswithchronicatrophicgastritis.Methods 36casesofpatientswithchronicatrophicgastritiswereenrolledinthe study ,whose plasma ET ,CGRP ,EGF were measured by using radio immunoassay and NO by using biochemical methods .Results After acupuncture administrated in patients with chronic atrophic gastritis ,whose plasma ET ,EGF significantly decreased ,while CGRP ,NO increased(P<0 .05) .The levels of the 4 test items were significantly different between acupuncture for 7 d and 1 d(P<0 .05) .Conclusion Acupuncture at zusanli point could lead to the regulation of the plasma ET ,CGRP ,NO and EGF ,which has time‐dose effect .

OBJECTIVE To investigate spectrum distribution of pathogens in patients with artificial airway and analyze their associated factors.METHODS The clinical data of 27 patients with tracheal intubation or tracheotomy from Mar 2005 to Mar 2006 were analyzed retrospectively.RESULTS Twenty seven patients were diagnosed as pneumonia.A total of 384 isolates of pathogens were collected from 258 sputum culture.The most were Gram-negative bacilli(293 isolates),and then were Gram-positive cocci and fungi.The four most pathogens were Pseudomonas aeruginosa,Stenotrophomonas maltophilia,meticillin-resistant Staphylococcus aureus(MRSA) and Acinetobacter baumannii.More multiple drug resistant(MDR) pathogens were detected in patients two weeks after intubation or tracheotomy than that after one week,and it was the same with sensitive rates to antibiotics of G-bacilli.CONCLUSIONS Patients with artificial airways have a higher morbidity of MDR pathogens and longer retention time of artificial airway can increase infection of MDR pathogens of lower respiratory tract.

Objectives: To evaluate the effects of glutamine on the nutritional metabolism and permeability of intestinal mucosa in MODS patients.Methods: The randomized and controlled study was designed.Twenty MODS patients were randomly divided into control group and treatment group.The concentration of serum albumin,transferrin and blood sugar,L(lactulose) and M(mannitol) ratio in urine,nitrogen balance,the related complication were compared and obserwed.Results: In treatment group,the concentration of serum albumin,prealbumin and transferrin were higher than that of control group on the same time and showed significant difference(P

Objective To investigate the impacts of valsartan on cell apoptosis induced by angiotensin Ⅱ in vascular smooth muscle cells,and discuss whether the mechanism is relevant to AMP-Activated Protein Kinases.Methods Vascular smooth muscle cells (A7r5) were designated to 5 groups:①control (DMSO) group,②Angiotensin Ⅱ (Ang]Ⅱ) 100 μmo]/L group,③Angiotensin lⅡ 100 μmol/ L + valsartan 10 μmol/L group,④Angiotensin Ⅱ 100 μmol/L + valsartan 10 μmol/L + compound C 1 μmol/L group,⑤ Angiotensin Ⅱ 100 μmol/L + 5-Aminoimidazole-4earboxamide-ribo-nucle-oside (AICAR) 100 μmol/L group,after 24h incubation,the intracellular activity of Caspase 3 was measured by spectrophotometry,the cell apoptosis were enumerated by low cytometry,the intracellular AMP-Activated Protein Kinases (AMPK) phosphorylation and total expression quantity were examined by western blot,the intracellular reactive oxygen species (ROS) was measured by fluorescent probe DCFH-DA,the intracellular activity of total superoxide dismutase (SOD) was measured by WST-1 method,the intracellular activity of Malondialdehyde (MDA) was measured by TBA method.Two groups were compared by using Student t test.Differences among multiple groups were evaluated by ANOVA.Results Compared with control group,the cell apoptosis of Angiotensin Ⅱ group was increased [(45.46 ± 15.40)％ vs.(1.88 ± 3.28)％,P =0.002],the synthesis of ROS was increased [(9.24 ±0.46) vs.(1.00 ±0.00),P＜0.01],theactivity of Caspase 3 was increased [(35.03 ± 3.54) vs.(13.33 ± 1.79),P ＜ 0.01],the activity of MDA was increased [(4.32 ±0.73) vs.(2.05 ±0.18),P＜0.01)],the phosphorylation of AMPK was decreased,the activity of SOD was decreased [(90.29 ± 14.73) vs.(136.02 ± 18.82),P =0.001];compared with Angiotensin Ⅱ group,the cell apoptosis of Angiotensin Ⅱ + valsartan group and Angiotensin Ⅱ + AICAR group were decreased [(24.91 ±8.46)％ vs.(45.46±15.40)％,P=0.031];[(27.90 ±4.39)％ vs.(45.46 ± 15.40)％,P =0.038],the synthesis of ROS was decreased [(2.37 ±0.05) vs.(9.24±0.46),P＜0.01];[(2.79±0.31) vs.(9.24±0.46),P＜0.01],the activity of Caspase3wasdecreased [(18.08±2.69) vs.(35.03±3.54),P＜0.01];[(27.83±3.56) vs.(35.03 ± 3.54),P =0.002],the activity of MDA were decreased [(3.25 ± 0.55) vs.(4.32 ± 0.73),P=0.017];[(3.46±0.60) vs.(4.32±0.73),P=0.047],the phosphorylationofAMPKwas increased,the activity of SOD was increased [(140.71 ±20.27) vs.(90.29 ± 14.73),P ＜0.01];[(116.73 ± 17.96) vs.(90.29 ± 14.73),P =0.029];compared with Angiotensin Ⅱ + valsarntan group,the cell apoptosis of Angiotensin Ⅱ + valsartan + compound C group was increased [(43.84 ± 12.00) ％ vs.(24.91 ± 8.46)％,P =0.043],the synthesis of ROS was increased [(4.64 ± 0.15) vs.(2.37 ± 0.05),P ＜ 0.01],the activity of Caspase 3 was increased [(25.64 ± 3.52) vs.(18.08 ± 2.69),P=0.011],the activity of MDA was increased [(5.12 ±0.92) vs.(3.25 ±0.55),P＜ 0.01],the phosphorylation of AMPK was decreased,the activity of SOD was decreased [(99.48 ± 16.59) vs.(90.29 ± 14.73),P =0.002)].Conclusions Valsartan could inhibit angiotensin Ⅱ-induced vascular smooth muscle cell apoptosis via activating AMPK,suppressing the synthesis of ROS and the activity of MDA,elevating the activity of SOD.

Acupressure ; Child ; Child, Preschool ; Combined Modality Therapy ; Female ; Humans ; Male ; Moxibustion ; Nocturnal Enuresis ; therapy

Objective To observe the expression of triggering receptor-1 on myeloid cells (TREM-1) of mice with acute lung injury (ALI) in oder to find out its regularity and significance in inflammatory response of or-ganisms. Method Thirty BALB/C mice were randomly(random number) divided into normal control group (n =6) and ALl group (n = 24). The models of ALI were made with intraperitonal injection of lipopolysaccharide (LPS) in dose of 10 mg/kg. Specimens from peripheral blood and lung tissue were collected 6 h, 12 h, 24 h and 48 h after LPS injected. The fluorescent real-time quantitative reverse transcriptiun-polymerase chain (RT-PCR) was used to detect TREM-1 mRNA, and ELISA was employed for detection of TREM-1 protein and TNF-α protein, and HE staining was made doe the pathological Smith lung score under light microscope. Analysis of variance was used for comparison of TREM-1 mRNA, TNF-α and Smith lung injury score between two groups. Spearman corre-lation analysis was made to find out the relationship among these three variables. Results The expressions of TREM-1 mRNA in lung tissue of ALI mice 6 h, 12 h, 24 h, and 48 hours after injection of LPS were 6.61±0.08,34.71±0.83, 61.85±14.05 and 56.46±8.89, respectively which were higher than that in control group (1.00±0.00, P = 0.017, 0.009, 0.002 and 0.003, respectively). The expressions of TREM-1 mRNA in blood were 14.01±3.24, 47.07±0.98, 8.18±0.43 and 8.06±0.05, respectively which were higher than that in normal control group (1.00±0.00, P = 0.010, 0.004, 0.011 and 0.011, respectively). The expression of TREM-1 rnRNA in tissue began to increase 6 hours after modeling and reached its peak 24 hours later, and expres-sion of TREM-1 mRNA in blood reached its peak after 12 hours. The levels of TREM-1 protein in lung tissue of ALl mice 6 h,12 h,24 h and 48 hours after LPS injected were 997.8±114.62, 1579.70±45.92, 1123.9±108.2 and 429.8±89.96 pg/mL, respectively which were higher than that of mice in control group (279.22±4.62 pg/mL, P = 0.024, 0.007, 0.011 and 0.04, respectively). The level of TREM- 1 protein reached the peak 12 hours after LPS injected, but it had no significant correlation with the expression of TREM-1 mRNA (P =0.14). The levels of TNF-α protein in lung tissue of ALI mice 6 h, 12 h, 24 h and 48 hours after LPS injection were 313.16±39.50, 491.91±96.65, 388.48±29.84 and 282.5±52.76 pg/mL, respectively which were sig-nificantly higher than that of mice in control group (256.6±28.31 pg,/mL, P = 0.037, 0.019, 0.032 and 0.043, respectively). The TNF-α concentration was positively correlated with TREM-1 levels in lung tissue and with Smith pathological score (r = 0.795, P = 0.001: r = 0.499, P = 0.034), but not with the expression of TREM-1 mRNA (P = 0.176). Conclusions The expression of TREM-1 mRNA in lung tissue of mice with ALI is elevated, and the expression of TREM-1 mRNA is related to the level of TNF-α and the severity of the ALI in in-flammatory responses in lung. The expressions of TREM- 1 gene are not consistent with the levels of TREM- 1 pro-tein, suggesting another new functional proteins involved in immune regulation.

Objective To investigate whether pulse pressure variation (△PP) reflect the effects of PEEP and fluid resuscitation (FR) on hemodynamic effects.Methods Twenty critical patients with acute lung injury was ventilated with volume control (VT =8 mL/kg,Ti/Te = 1: 2) ,and PaCO2 was kept at 35 to 45 mm Hg.PEEP was setted as 5 cm H2O and 15 cm H2O in randomized order.Hemodynamic parameters including cardiac index, pulse pressure, central venous pressure, etc.were monitered by PiCCO system.Measurements were performed after the application of 5 cm H2O PEEP (PEEPs group)and 15 cm H2O PEEP (PEEP15 group) respectively.When the PEEP-induced decrease in cardiac index (CI) was > 10%, measurements were also performed after fluid resuscitation.Results Compared with PEEPs group, CI was decreased significantly in PEEP15 group(P < 0.05), and APP was increased significantly (P < 0.05).In 14 patients whose PEEP-induced decrease in CI was > 10%, fluid resuscitation increased CI from (3.01±0.57)L · min-1· m-1to (3.62±0.68)L · min-1 · m-2(P<0.01),and decreased △PP from (17±3)% to (10±2) % (P < 0.01).PEEP15-induced decrease in CI was correlated negatively with APP on PEEP5 (r =-0.91,P < 0.01) and with the PEEP15-induced increase in △PP (r =-0.79, P < 0.01).FR-induced changes in CI correlated with APP before FR (r = 0.96, P < 0.01) and with the FR-induced decrease in APP (r =-0.95, P < 0.01).Conclusions In ventilated patients with ALI, △PP may be a simple and useful parameter in predicting and assessing the hemodynamic effects of PEEP and FR.

Purpose:We present the imaging and pathological features of pPNET tumor in six patients,to add to the knowledge of this tumor. Methods:Retrospective analysis of six pPNETs integrated with data of radiography and pathology. Results:The CT appearance of the tumor arising in soft tissue showed a large,ill-defined,non-calcified mass and heterogeneous appearance with hypodense cystic areas. The tumors demonstrated heterogeneous contrast enhancement. The pPNET arising in bone demonstrated extensive lytic lesion with large soft tissue mass,no newly-born bone and demonstrated heterogeneous contrast enhancement. MRI in SE sequences on T 1 W demonstrated homogeneous intensity for muscle and showed enhancement pattern of multiple internal septa and envelope. On T 2 W image,the tumors were heterogeneous with hyperintense signal. Conclusions:The study of clinic and radiology on pPENT does not show specificity. CT and MRI findings on pPENT can provide more information of it's internal structure,involved area,adjacent vascular and nervous structures. CT and MRI can also be useful in detection of recurrent and metastatic disease and very useful in preoperative staging,and in the planning of the surgical appproach.

Haloacetic acids are the main disinfection by-products in chlorinated drinking water,which are known or suspected to carcinogenic. Many countries have promulgated haloacetic acids as the routine monitoring item for drinking water safety. In order to better control the formation of haloacetic acids in chlorinated drinking water,many techniques and analysis methods were exploited. This review summarized the development of techniques and analysis methods and the comparative analysis was conducted in technique cost,method detection limit,sensitivity,resistance to disturb and sample pretreatment. The electrospray mass spectrometry is the best choice,but the instrument and operation cost is much higher,so the standard method based on the gas chromatography will still be the popular method for drinking water quality analysis.