OBJECTIVE To investigate the effects of esketamine for multimodal analgesia on opioid consumption and gastric motility in mechanically ventilated non-surgical intensive care unit （ICU） patients. METHODS Forty cases of mechanically ventilated non-surgical patients in the ICU of our hospital from February 1st， 2023 to July 31st， 2023 were selected and randomly divided into control group and esketamine （S-K） group using grouping method with opaque envelopes， with 20 cases in each group. Control group was given sufentanil， and S-K group was infused with Esketamine hydrochloride injection at a constant rate of 0.2 mg/（kg·h）+ sufentanil. The treatment period length， analgesic compliance rate， sedation level， analgesic and sedative consumption， and gastric motility indexes were compared between the two groups. RESULTS There was no statistically significant difference in the treatment period length， analgesic compliance rate， sedation level， or the consumption of propofol and midazolam between the two groups （P＞0.05）. The consumption of sufentanil in the S-K group was significantly less than control group （P＜ 0.05）. Compared with 1 h after randomization， the antral contraction frequency， antral contraction amplitude and antral motility index of patients in the S-K group were significantly higher at 72 h after randomization and were significantly higher than control group （P＜0.05）. CONCLUSIONS Esketamine may reduce opioid consumption and improve gastric motility in mechanically ventilated non-surgical ICU patients while ensuring a level of analgesic sedation.

The eutR gene deletion mutant of Salmonella enteritidis was successfully constructed by homologous recombination.Through the study of its biochemical characteristics,motility,resist-ance to stress in vitro and survival ability in RAW 264.7 cells,it was found that the biochemical characteristics and motility of the eutR gene deletion mutant of Salmonella enteritidis had no sig-nificant change compared with the wild type of Salmonella enteritidis.The ability of eutR gene de-letion strain of Salmonella enteritidis to resist acid,alkali and oxidation was significantly reduced,while the ability to resist heat was not significantly changed;the survival ability of eutR gene dele-tion strain in RAW 264.7 cells was significantly reduced compared with the wild type.In order to further analyze the effect of eutR gene on the expression of virulence factors of Salmonella enterit-idis,the relative expression levels of invH,ssav,ssrA,xthA,orf245,sodC,lrp,mrr1 and hflk virulence genes of the deletion strain and the wild strain were detected by SYBR Green PCR.It was found that the expression of the virulence factors mentioned above in the eutR gene deletion strain of Salmonella enteritidis was significantly down-regulated compared with that in the wild-type strain.The LD50 of the eutR gene-deleted strain of Salmonella enteritidis was determined by ani-mal experiments,and the results showed that the LD50 of the eutR gene-deleted strain was higher than that of the wild-type strain,indicating that the eutR gene could affect the virulence of Salmonella.This study clarified the effect of eutR gene on the survival ability,some biological characteristics and virulence of Salmonella enteritidis in macrophages,and provided a new gene knockout target for the development of attenuated Salmonella enteritidis genetic engineering vac-cine.

Intra-abdominal infection is the second common infectious disease in intensive care unit and inhospital patients, with the mortality rate of 20%-30%. Advances in medicine have not improved the outcomes of patients with intra-abdominal infection, and the increasing multi-drug resistance organism may lead to a deterioration in the prognosis of patients with intra-abdominal infection. Gut microbiota dysbiosis and abdominal cavity infections show an interdependent and mutually aggravating relationship. Intestinal microecological preparations regulate gut flora and are potential therapeutic measures for intra-abdominal infections. The authors review the changes in gut flora during intra-abdominal infection, the effect of gut flora on the prognosis of intra-abdominal infections and the role of intestinal microecological preparations in intra-abdominal infections.

Objective:To investigate the clinical characteristics and influencing factors of mortality in patients with intra-abdominal candidiasis (IAC).Methods:The retrospective case-control study was conducted. The clinicopathological data of 203 IAC patients who were admitted to 7 medical centers from June 2018 to June 2020 were collected, including 54 cases in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine, 31 cases in Fujian Medical University Union Hospital, 25 cases in Beijing Hospital, 25 cases in the First Affiliated Hospital of Xi'an Jiaotong University, 24 cases in China-Japan Friendship Hospital, 22 cases in General Hospital of Eastern Theater Command of Chinese PLA and 22 cases in Chongqing University Cancer Hospital. There were 130 males and 73 females, aged (64±15)years. Observation indicators: (1) candida infection and treatment of IAC patients; (2) analysis of influencing factors for mortality of IAC patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Univariate and multivariate analyses were performed by Logistic regression model. Results:(1) Candida infection and treatment of IAC patients: 134 cases of candida albicans were cultured in the initial abdominal drainage fluid or intraoperative abdominal specimens of 203 patients, and 49 cases were treated with fluconazole. Of 69 cases infected with non candida albicans, 13 cases were treated with fluconazole. The resistance rate of candida albicans to fluconazole was 5.91%(12/203). Of 203 patients, there were 68 cases with infections shock, 53 cases with renal failure, 84 cases with respiratory failure and 63 cases with multiple organ failure, respectively. There were 148 of 203 patients admitted to intensive care unit for 9 days(range, 3-20 days), and the total hospital stay was 28 days(range, 17-50 days). Of 203 patients, 86 cases were cured and discharged, 50 cases were improved and transferred to local hospitals, 32 cases gave up treatment and discharged automatically, 19 cases died, 16 cases had no follow-up data. The mortality was 25.12%(51/203). (2) Analysis of influencing factors for mortality of IAC patients. Results of univariate analysis showed that acute physiology and chronic health evaluation score, sequential organ failure assessment score, the Cr, bilirubin, albumin, procalcitonin, and PLT on the first day of candida positive culture, of the lowest value in a week and the highest in a week, heart disease, diabetes, infections shock, renal failure, respiratory failure, multiple organ failure, anti-fungal therapy were the related factors for mortality of IAC patients ( t=-2.322, Z=-2.550, -2.262, -4.361, t=2.085, Z=-3.734, -5.226, -2.394, -5.542, t=3.462, Z=-4.957, -5.632, 3.670, -5.805, t=3.966, Z=-3.734, -5.727, χ2=4.071, 4.638, 27.353, 18.818, 13.199, 26.251, 13.388, P<0.05). Multivariate analysis showed that the bilirubin, procalcitonin on the first day of candida positive culture and infections shock were independent risk factors for mortality of IAC patients ( odds ratio=1.021, 1.022, 6.864, 95% confidence interval as 1.010-1.033, 1.001-1.044, 1.858-25.353, P<0.05). Conclusions:The common fungus of IAC was candida albicans, and fluconazole can be used as the initial empirical treatment. The prognosis of patients with abdominal candidiasis is poor. Bilirubin, procalcitonin on the first day of candida positive culture and infections shock are indepen-dent risk factors for mortality of IAC patients.

Objective To explore the expression of Octamers binding transcription factor 4 (Oct4) and its relationship with clinicopathological parameters in the non-small cell lung cancer (NSCLC) tissues .Methods From September 2013 to December 2016 ,100 cases of NSCLC patients with lung cancer (group NSCLC ,n=100) and their corresponding normal paracancerous tissues (the control group ,n=100) were selected as the samples .The expression of Oct4 mRNA and protein in two groups of tissue samples were detected by fluores-cence quantitative PCR ,immunohistochemistry and western blot .The relationship between the level of Oct4 expression and the clinicopathological parameters of the patients was analyzed ,and the prognosis of the Oct4 positive and negative patients in the NSCLC group was compared .Results The expression of Oct4 mRNA in NSCLC group was (3 .21 ± 0 .18) ,protein expression was (0 .74 ± 0 .11) and the positive rate was 74 .00％ , which were significantly higher than those of control group [(1 .47 ± 0 .11) ,(0 .10 ± 0 .03) ,10 .00％ ,P<0 .05] .The positive rate of Oct4 expression in NSCLC patients was not related to sex ,age ,smoking index and tumor size (P>0 .05) ,but related to pathological type ,degree of differentiation ,and TNM staging ,in which the positive rates of Oct4 in patients with adenocarcinoma ,low differentiation and TNM stage Ⅲ stage were significantly higher than those of non adenocarcinoma ,middle-high differentiation degree ,Ⅰ - Ⅱ TNM stage patients (P< 0 .05) .In NSCLC patients ,compared with Oct4 negative patients ,the distant metastasis rate (64 .86％ ) ,pulse tube infiltration rate (47 .30％ ) in Oct4 positive patients were significantly higher ,and the 1 year survival rate (67 .57％ ) decreased (P<0 .05) .Conclusion The expression of Oct4 in NSCLC tissue is closely related to its clinicopathological parameters .Oct4 is highly expressed in adenocarcinoma ,and with thedecrease of differentiation and progression of tumor stages ,the expression increases and affects the prognosis . Oct4 can be used as a specific diagnostic marker of NSCLC .

Translational medicine means that to establish a bridge between fundamental research and clinical medicine through bidirectional translation path in order to promote the translation and application from fundamental research to clinical medicine.The purpose of traditional Chinese medicine (TCM) translational model is to collate and build one multidimensional TCM translational model,rationality carry out the research on TCM translation.Three paths have been confirmed,where are from literature research to clinical verification,from clinical application to clinical verification,and from experiment to clinical verification.In this research,methodology of one path mcntioned above could be established,which is the key technology of translational medicine.Take constipation,insomnia,and post-flu cough as target diseases to investigate the herbal compounds which could be qualified for clinical application based on preliminary work.This research not only provided clinical data to TCM translation,but also established one methodology of TCM translation path--"from experiment to clinical verification".

Objective To discuss the clinical value of Dimethicone power applied under endoscopy in examination of upper gastrointestinal tract. Methods 800 patients who received common endoscopy examination from Nov. 2014 to Nov. 2015 were recruited into the study and randomly divided into two groups: experimental group and control group. Fifteen minutes before the examination, the experimental group took Dimethicone power 5 g and 30 ml pure water. At the same time, the control group took 30 ml pure water only. According to the clarity of the endoscopic field of vision, the examination results were classified into 4 levels (A, B, C, D), and the inspect time of each patient was recorded. Results In experimental group, endoscopic vision was significantly higher than control group ( <0.05), and the inspect time was significantly shorter than control group ( < 0.05). Conclusion Dimethicone power can significantly improve the clarity of the endoscopic field of vision and alleviate the suffering of patients with short-er inspect time, which can be used as an adjuvant before routine endoscopy examination.

BACKGROUND:Microtubule-associated protein-2 is a kind of important regulatory factor in regulating tubulin assembly. As one of the main members of microtubule-associated proteins, microtubule-associated protein-2 plays an important role in the repairing and development of the nervous system function. It has been found that microtubule-associated protein-2 can promote the repair and rebuilding of injured nerves. OBJECTIVE:To summarize the relationship between microtubule-associated protein-2 and nerve injury as wel as the mechanism of action. METHODS:The PubMed database and CNKI database were retrieved by the fist author for the articles related to microtubule-associated protein-2 published from January 1976 to January 2015. The key words were“microtubule-associated protein-2 (MAP-2), nerve injury, progress”in English and Chinese, respectively. In the same field, articles published recently or in authorized journals were preferred. Repetitive or old articles were excluded, and final y 82 articles were included in result analysis. RESULTS AND CONCLUSION:Microtubule-associated protein-2 is involved in nerve repair, and plays a promoting role in neuronal morphology and plasticity. To increase the concentration of microtubule-associated protein-2 contributes to the recovery of neurologic function in the early stage after nerve injury.

Objective To observe the effects of dexmedetomidine for different loading dose on blood pressure of surgery inten-sive care unit(SICU) patients conscious-sedation derivative phase .Methods 60 patients after general anaesthesia were divided into routine dose group(dexmedetomidine 1 .00 μg/kg ,group C) ,middle dose group(dexmedetomidine 0 .75 μg/kg ,group M ) and low dose group(dexmedetomidine 0 .50 μg/kg ,group L) ,and the loading time were reset 10 min .sedative effect was evaluated by Ram-say sedation score .Record the mean arterial blood pressure of everyone before administration ,5 min after ,15 min after ,30 min af-ter ,60 min after .Results All patients achieved good conscious-sedation .Compared with pro-administration ,the mean arterial blood pressure of group C descend significantly .The mean arterial blood pressure of group M and L descend significantly ,and then they were recover over time .60 min after the treatment ,the mean arterial blood pressure in group C was significantly lower than group L and goup M (P<0 .05) .Conclusion Small dose dexmedetomidine can achieved good conscious-sedation for SICU patients .It has less influence on hemodynamics .

BACKGROUND:Nonunion is a common clinical problem of bone fracture. For decades, with the help of
internal/external fixation materials, popularization of microsurgical technique, innovation of bone graft materials, especial y molecular biology techniques, breakthrough progress has been made in the treatment of nonunion. OBJECTIVE:To summarize the research progress of treatment in nonunion and to provide better technology theory and choices of method for the treatment of nonunion in future.
METHODS:The PubMed database and CNKI database were retrieved by the first author for the articles related to reason and treatment method of nonunion published from January 1990 to May 2013. The key words were
“fracture nonunion, treatment, progress”. For the articles in the same field, those published recently or in authorized journals were selected.
RESULTS AND CONCLUSION:The repetitive and old articles were eliminated, and final y 48 articles were selected for further analysis. At present, two methods can be used in the treatment of nonunion, including
nonsurgical method and surgical method, the surgical method is utilized more frequently and more efficiency in clinic. Fracture healing is the complex process involving various aspects, and once the nonunion occurred,
different patients should be treated with different methods, and the combination of various surgical and
nonsurgical methods can be used if necessary to obtain satisfactory effect. But al the treatment methods should pay attention to soft tissue protection.