Objective To identify risk factors associated with repeat use of pulmonary surfactant ( PS) in the treatment of respiratory distress syndrome ( RDS ) in the term and near-term neonate. Methods There were 130term and near-term new borns with RDS who were treated with pulmonary surfactant were enrolled. These infants were categorized into two groups: single-dose group (85 cases) and repeat-dose group (45 cases). The differences in basic information were compared between the two groups, and logistic regression analysis was used to identify the risk factors for repeat use of pulmonary surfactant.Results TherepeatutilizationrateofPSwas34.6℅.The incidence of asphyxia,maternal gestational hypertension, X-ray RDS grade 3-4, the age of first dose PS,respiratory support time in the repeat-dose group was significantly higher than in the single-dose group (P<0. 05). PaO2/FiO2 and the cure rate in the repeat-dose group were significantly lower than in single-dose group ( P<0. 05 ) . The incidence of sepsis, pulmonary hemorrhage, shock and patent ductus arteriosus ( PDA) in the repeat-dose group was significantly higher than in the single-dose group ( P<0. 05). Further logistic regression analysis showed that birth asphyxia ( OR=5. 674 , 95℅CI 1. 378 -23. 354 , the age of first dose of PS (OR=1.092, 95℅CI 1.002 -1.191)and PDA(OR =23.499, 95℅CI 2.348 -235.152)were the independent risk factors for repeat use of pulmonary surfactant.Conclusions Birth asphyxia,the age of first dose PS and PDA are the risk factors for repeat use of pulmonary surfactant in the treatment of RDS in the term and near -term neonate.

Objective primary hospitals at the county level in xiaogan City 17 years for the production of scientific papers in qualitative and quantitative statistical analysis,summary of research progress and existing problems in county hospitals,and provides references for research management in local hospitals.Methods Wanfang medicine network included in 1998-2014 year published Xiaogan city 7 county hospital as the object;All biomedical scientific papers published as the first author to statistical analysis.Results 7 County Hospital of xiaogan City 17-year total output articles 1909,General journals 1273articles(66.68％ per cent),Core journal 636 papers (33.31％ per cent).Hanchuan city people's Hospital total the largest number of papers;total 544 articles (28.50％ total),yingcheng hospital quality highest core journal papers and the highest proportion;total 186 (proportion of the total core thesis 29.25 ％),minimum quantity and quality of outputs anlu city people's Hospital,only 15 articles in periodicals of General The core journals and 2 papers (0.89％ of the total number of accounts for the paper,core paper accounted for 0.31％ of the total).On the whole 2006-2009 published papers began to gradually slow growth,The number 2010-2014 entered the stage of rapid growth,but the core papers for slow growth.Conclusions xiaogan city grass-roots scientific articles in recent years in county hospitals are generally presented a trend of rapid growth,but the quality of growth is relatively slow,output quantity and quality distribution imbalances between hospitals.

Objective To investigate the low-dose hyper-radiosensitivity (HRS)/induced radioresistance (IRR) in A549 cells synchronized at G2 phase and the role of ATM kinase in the process.Methods Human lung adenocarcinoma cell line A549 was synchronized at G2 phase by aphidicolin.The ATM-specific activator and inhibitor,chloroquine and KU55933,were used to regulate the activity of ATM.The colony formation assay was used to evaluate cell survival.Flow cytometry was used to determine the cell cycle of radiation-exposed A549 cells synchronized at G2 phase.Immunofluorescence was used to observe the dynamics of γ-H2AX fluorescence and evaluate the efficiency of DNA repair in A549 cells synchronized at G2 phase.Western blot was used to detect the expression of phosphorylated ATM (Ser1981) and ATM.Results A549 cells synchronized at G2 phase had substantially enhanced HRS than non-synchronized cells.The dose-induced transition from HRS to 1RR was in accordance with the dose-response pattern of early G2/M checkpoint.However,with the same threshold dose,the activation of early checkpoint occurred earlier and lasted longer than normal.The activation of ATM kinase inhibited HRS and enhanced DNA repair,while the inhibition of ATM kinase enhanced HRS and hindered DNA repair.Conclusions ATM kinase-mediated early G2+M checkpoint is a molecular switch for HRS in synchronized A549 cells.Low-dose irradiation with G2-phase synchronization and ATM inhibitor can enhance the low-dose radiosensitivity.

ObjectiveToinvestigatetherelationshipbetweenserumcystatinC(CysC)leveland hypertensive intracerebral hemorrhage (HICH). Methods The patients w ith HICH and healthy controls w ere enroled. The demographic and clinical data were colected. Immunoturbidimetric assay was used to detect serum CysC level. Results A total of 94 consecutive patients w ith HICH and 131 healthy controls w ere enroled. The baseline systolic blood pressure ( 168.57 ±28.64 mmHg vs.128.13 ±16.23 mmHg; t=-13.442, P<0.001;1 mmHg=0.133 kPa), diastolic blood pressure ( 95.56 ±14.68 mmHg vs.76.80 ± 8.76 mmHg; t= -11.965, P<0.001 ), fasting plasma glucose ( 6.24 ±1.83 mmol/L vs.5.22 ± 1.13 mmol/L; t= -4.234, P<0.001), and serum CysC level (1.02 ±0.26 mg/L vs.0.91 ±0.13 mg/L, P<0.001) in the HICH group w ere significantly higher than those in the control group. Multivariable logistic regression analysis show ed that baseline systolic blood pressure≥140 mmHg ( odds ratio [ OR] 12.523, 95% confidence interval [CI] 5.353-29.299; P<0.01), diastolic blood pressure ≥90 mmHg (OR 3.968, 95%CI 1.792-8.784; P<0.01 ) and serum CysC level≥1.09 mg/L ( OR 3.279, 95%CI 1.336-8.050; P<0.05) w ere the independent risk factors for HICH. In patients w ith HICH, the CysC serum level (1.13 ±0.26 mg/L) in the bleeding ≥30 ml group w as higher than that in the bleeding <30 ml group (0.99 ±0.25 mg/L; P<0.001) and the control group ( 0.91 ±0.13 mg/L; P<0.001). The serum CysC level in the bleeding volume <30 ml w as higher than that in the control group ( P=0.004). There w ere positive correlations betw een serum CysC and age, creatinine, urea, and uric acid (al P<0.01);there w ere negative correlations betw een serum CysC level and the estimated glomerular filtration rate ( P<0.01). Multivariable linear regression analysis show ed that age, creatinine, urea and uric acid w ere independent associated w ith the serum CysC level ( al P<0.05 ). Conclusions The increased serum CysC level is correlated w ith the amount of bleeding in patients w ith HICH. The increased serum CysC level is an independent risk factor for HICH.

Objective:To explore the influences of neutrophilic granule protein (NGP) on nitric oxide (NO) production in lipopolysaccharide (LPS)-induced macrophages and the regulatory mechanism.Methods:NGP highexpression RAW264.7 cells (NGP/RAW) and negative control empty vector cells (NC/RAW), NGP knockout RAW264.7 cells (NGP KO/RAW) and wild-type cells (WT/RAW) were cultured in vitro. Cells in logarithmic phase were stimulated with 10 mg/L LPS (LPS group) or phosphate buffered saline (PBS group) respectively. The content of NO in the supernatant was detected by Griess method. The mRNA expression of inducible nitric oxide synthase (iNOS) was detected by quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The protein expressions of iNOS and phosphorylated signal transducer and activator of transcription 1 (p-STAT1) were detected by Western blotting.Results:Compared with PBS group, iNOS mRNA and NO expression were significantly increased at different time after LPS stimulation, the mRNA expression of iNOS peaked at 12 hours after LPS stimulation (2 -ΔΔCt: 38.45±1.34 vs. 1.00±0.00 in NC/RAW cells, 56.24±2.41 vs. 1.45±0.30 in NGP/RAW cells, 37.84±1.52 vs. 1.00±0.00 in WT/RAW cells, 5.47±0.62 vs. 0.98±0.40 in NGP KO/RAW cells, all P < 0.05), and the production of NO peaked at 24 hours after LPS stimulation (μmol/L: 24.15±1.26 vs. 0.15±0.04 in NC/RAW cells, 58.80±2.11 vs. 0.18±0.02 in NGP/RAW cells, 25.04±1.80 vs. 0.16±0.02 in WT/RAW cells, 2.42±0.38 vs. 0.12±0.03 in NGP KO/RAW cells, all P < 0.05). After being stimulated by LPS, the expression of iNOS mRNA and NO in NGP/RAW cells were increased significantly compared with NC/RAW cells [iNOS mRNA (2 -ΔΔCt): 8.42±0.59 vs. 4.63±0.37 at 2 hours, 27.16±1.60 vs. 14.25±1.02 at 6 hours, 56.24±2.41 vs. 38.45±1.34 at 12 hours; NO (μmol/L): 4.12±0.25 vs. 2.23±0.17 at 6 hours, 16.50±1.52 vs. 6.35±0.39 at 12 hours, 58.80±2.11 vs. 24.15±1.26 at 24 hours, all P < 0.05]. At the same time, the protein expressions of p-STAT1 and iNOS were also significantly enhanced (p-STAT1/GAPDH: 4.26±1.84 vs. 1.00±0.32 at 0 hours, 20.59±4.97 vs. 0.93±0.21 at 2 hours, 141.99±10.99 vs. 11.17±2.11 at 6 hours; iNOS/GAPDH: 1.27±0.86 vs. 1.00±0.22 at 0 hours, 7.94±1.94 vs. 2.01±0.92 at 2 hours, 24.24±4.88 vs. 3.72±1.11 at 6 hours, all P < 0.05), indicating that NGP might increase the expression of iNOS by promoting the phosphorylation of the signal transducer and activator of transcription 1 (STAT1) pathway, thereby increasing the production of NO. After being stimulated by LPS, the expression of iNOS mRNA and NO in NGP KO/RAW cells were significantly lower than that of WT/RAW cells [iNOS mRNA (2 -ΔΔCt): 2.46±0.31 vs. 4.22±0.18 at 2 hours, 3.61±0.44 vs. 13.02±1.34 at 6 hours, 5.47±0.62 vs. 37.84±1.52 at 12 hours; NO (μmol/L): 1.22±0.19 vs. 2.01±0.12 at 6 hours, 1.60±0.44 vs. 5.15±0.62 at 12 hours, 2.42±0.38 vs. 25.04±1.80 at 24 hours, all P < 0.05]. It showed that iNOS activation was reduced after NGP knockout, which in turn reduced NO production. Conclusion:NGP can positively regulate NO production in activated macrophages by activating the STAT1/iNOS pathway.

Objective To explore how to define the difficulty and time measurement of nursing items in general wards in level three grade A hospital in Beijing, so as to provide evidence for nursing workload measurement. Methods By literature review, we self-designed nursing items scale, and selected 30 nurses conveniently for the each item assessment of workload. After screening nursing items again, 10 nurse clinicians had been chosen for semi-structure interview. Finally, we selected 9 nurse clinicians to take part in the discussion meeting, in order to acquire a suitable difficulty assessment and time measurement of nursing items. Results Our study confirmed 64 nursing items at the end, and all items were suitable for difficulty assessment and time measurement, and included the work items of personal care assistant and field staffs, but never contained some items, which could not measure time, such as grade one nursing. Conclusions The nursing items had some certain development and updating recently in level three grade A hospital in Beijing, and this study acquires 64 nursing items, which are all normal clinical nursing activities and suitable for difficulty assessment and time measurement, can be cornerstone for a reasonable and accurate nursing workload measurement.

Objective To explore the correlation between nurses′ preventive behavior against needle stick injuries and perception of risks, hospital safety climate as well as provide some references for strategy making. Methods In accordance with a multi-stage sampling method, questionnaires were used to collect data from 1 012 nurses in 8 level three class A general hospitals. Results The average scores of nurses′ preventive actions toward needle stick injuries and hospital safety climate were (3. 71 ± 0. 50) and (3. 91 ± 0. 53) respectively. Nurses with high perception of risks accounted for 67. 1%. In addition, the Spearman correlation analysis suggested that nurses′preventive behavior was negatively correlated with perception of risks (r= -0. 093,P<0. 01), while it positively correlated with hospital safety climate (r=0. 463,P<0. 01). Conclusions Clinical nurses should have further regulations for protective behavior against needle injuries. We can take measurements actively to reduce nurses perception of risks and create safety work climate that can be benefits for nurses taking favorable protective behavior and reducing the incidence of needle injuries.

? This paper introduces the connotation and theoretical development of adaptive leadership framework and its current application in different fields, and analyzes the applicability and possibility of introducing the theory into the intervention and management of frailty in the elderly so as to provide a possible path for medical and nursing workers to intervene frailty in the elderly effectively.

This article reviews different screening and assessment tools for frailty in the elderly, including tool makers, assessment contents, scoring methods, results determination and applicability of tools, in order to provide reference for the broad medical staff in screening and evaluating frailty in elderly people.

Objective To investigate the risk factors of acute respiratory distress syndrome (ARDS) occurrence in intensive care unit (ICU) traumatic patients. Methods Clinical data of traumatic patients in ICU of the People's Hospital of Liangping in Chongqing from January 1st, 2012 to June 30th, 2018 were retrospectively analyzed. According to the outcomes, the patients were divided into ARDS group and non-ARDS group. The differences of demographic indexes (gender, age), time of admission, type of injury, atrial fibrillation, trachea cannula, multiple injury, open injury, shock, surgery, blood transfusion, central venous indwelling catheter, infection, and blood routine indexes [white blood cell count (WBC), red blood cell count (RBC), platelet count (PLT), plateletcytocrit (PCT), hematocrit (Hct)], biochemical indexes [total bilirubin (TBil), albumin (Alb), serum creatinine (SCr), blood sodium, blood calcium, blood potassium, blood glucose], arterial blood gas analysis indexes [partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), blood pH], coagulation indicators [activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), fibrinogen (Fib)], injury severity score (ISS), new injury severity score (NISS), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), sequential organ failure assessment (SOFA), Glasgow coma scale (GCS) within 24 hours of admission, and the length of ICU stay between the two groups were analyzed, and the possible influencing factors were screened out. Logistic regression model was used to analyze the risk factors of ARDS in patients with severe trauma, and receiver operating characteristic curve (ROC) was drawn to evaluate its predictive value. Results A total of 303 patients with severe trauma, including 223 males and 80 females, were enrolled. The average age was (52.98±17.03) years old. ARDS occurred in 149 cases (49.17%), including 114 males and 35 females. Compared with the non-ARDS group, the ARDS group had older age, higher rates of traffic injuries, endotracheal intubation and infection, higher blood sugar, PaO2/FiO2, TT, ISS, NISS and SOFA, lower GCS and longer the length of ICU stay. Logistic regression analysis showed that hyperglycemia, PaO2/FiO2anomalies and increased SOFA score were independent risk factors for ARDS in ICU trauma patients [blood glucose > 6.10 mmol/L:odds ratios (OR) = 2.72, 95% confidence interval (95%CI) = 1.20-6.19, P = 0.017; PaO2/FiO2< 400 mmHg (1 mmHg =0.133 kPa): OR = 7.40, 95%CI = 1.59-34.37, P = 0.011; SOFA > 5: OR = 2.92, 95%CI = 1.63-5.21, P < 0.001]. ROC curve analysis showed that blood glucose, SOFA and PaO2/FiO2could predict ARDS in ICU trauma patients, with the area under ROC curve (AUC) were 0.65, 0.70 and 0.75, respectively (all P < 0.01). The predictive value of PaO2/FiO2was better, when the cut-off value was 275 mmHg, the sensitivity was 85.89% and specificity was 70.29%. Conclusion The traumatic patients on admission with hyperglycemia, abnormal PaO2/FiO2and increased SOFA score are more susceptible to ARDS occurrence.