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.

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 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.

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 evaluate the relationship between the cytokine levels in the serum and cerebrospinal fluid and the brain injury in preterm infants. Methods From August of 2012 to August of 2013,51 preterm infants were included and 46 infants were survived. All of them were born at the Maternal and Child Hospital of Hubei Pro-vince,with GA≤32 weeks and high risk factors of intrauterine infection and suffering from early onset sepsis. Ac-cording to the screening findings of cerebral ultrasound and/or MRI,the infants were divided into normal group(n=28) and abnormal groups(n=18) with intracranial hemorrhage or white matter damage. The levels of interleukin(IL)-6,IL-1β and tumor necrosis factor-α( TNF-α) in the serum within 12 hours after birth and in cerebrospinal fluid within 72 hours after birth were investigated. The differences in cytokines between two groups were compared with t-test and Chi-square test,and high risk factors of brain injury were analyzed by Logistic regression models. Results The ab-normal group had higher incidence of clinical maternal chorioamnionitis[44. 44%(8/18 cases) vs 14. 29%(4/28 ca-ses),χ2=5.168,P=0.038] and higher white blood cell count[(11.51±9.03)×109/L vs(6.95±5.64)×109/L,t=-2. 107,P=0. 041]. In the abnormal group,the levels of serum IL-6 [(44. 83±16. 31) ng/L],and IL-6,IL-1βand TNF-αin cerebrospinal fluid [(51. 85±15. 65) ng/L,(11. 95±2. 58) ng/L and(193. 11±67. 25) ng/L] were higher than those in the normal group[(36.83±8.76) ng/L,(42.56±12.89) ng/L,(10.26±2.91) ng/L and(160.56± 29. 02) ng/L,respectively] with the statistical difference(t=-2. 687,-2. 250,0. 269,-2. 243,P=0. 010,0. 029,0. 044, 0. 030). Maternal chorioamnionitis,higher serum TNF-αand cerebrospinal fluid IL-6 were high risk factors for brain in-jury(P=0. 014,0. 031,0. 047). Conclusion Increased systemic and cerebrospinal fluid cytokine levels are possibly re-lated to the preterm brain injury when intrauterine infection occurred.

Objective To investigate the current staffing of nurses and need of hospital nursing human resources in China.Methods Data were collected from 181 secondary and tertiary hospitals and 9774 nurses in mainland China by questionnaires.Results The average doctor-nurse ratio was 1 ∶ 1.39 in tertiary hospitals and 1 ∶ 1.31 in secondary hospitals.The doctor-nurse ratios in 164 hospitals (97.6％) and the proportion of nurses in health care staff in 105 hospitals (61.8％) had not reached the standard set by the Ministry of Health of China.62.3％ nurses held secondary diploma for their initial nursing education.The constituent ratio of nurses held secondary diploma decreased,while the ratio of nurses held advanced diploma and bachelor degree increased in the last 5 years from 2003 to 2007.Sixty percent of newly employed nurses were contract nurses in 2003.The proportion increased to 78％ in 2007,and in some regions it accounted for more than 90％ of new nurses.The needs and constituent ratio of nurses with.secondary diploma and advanced diploma would decrease while nurses with bachelor degree and master degree would increase in the next 5 years (from 2009 to 2013).Conclusions The nursing shortage is still severe in China,and nursing staff mainly held secondary diploma for their initial nursing education.Most of new nurses were employed as conwact nurses.The need of hospitals for nurses has increased,especially for nurses with higher educational level such as bachelor degree and master degree,while the need for secondary diploma hold ers have decreased.The need for advanced diploma holders has increased in the last 5 years and would decrease in the next 5 years,but they would still be the majority of employed nurses.The authors suggested that the staffing of nursing manpower,the work environments and career development of contract nurses should be improved,and the initial nursing education should be upgraded to meet the needs of hospitals.

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.

OBJECTIVETo explore the influence of relapse and survival by chronic graft versus host disease (cGVHD) in patients with acute myeloid leukemia (AML) after allogeneic hematopoietics stem cell transplantation (allo-HSCT).

METHODSFifty-five AML patients received allo-HSCT were retrospectively reviewed. Relapse rate and overall survival (OS) were analyzed according to cGVHD.

RESULTScGVHD significantly decreased the relapse rate of AML patients after transplantation within 2 years when compared with those without cGVHD (8.7% vs 38.6%, P=0.019), however, cGVHD had no effect on the long-term relapse rate (22.8% vs 5.9%, P=0.217). cGVHD had no effect on OS within 2 years (78.3% vs 61.0%, P=0.155) but could decrease the rate of long-term survival (63.7% vs 100%,P=0.01). cGVHD also could reduce the rate of relapse (8.3% vs 46.2%, P=0.044) and enhanced the rate of survival (83.3% vs 47.2%, P=0.045) in patients with high risk AML after allo-HSCT in 2 years, while it had no effect on the relapse rate and OS in patients with low and intermediated risk AML in early and late phase. Moreover, compared with the rate of relapse(38.6%) in patients without cGVHD, the rate of relapse were lower in patients with limited cGVHD and intensive cGVHD (27.3% and 31.3%, respectively) but the long-term survival was significantly lower (53.3%, P=0.001) in those patients with intensive cGVHD after all-HSCT.

CONCLUSIONThe benefit effect of cGVHD mainly took place within 2 years after allo-HSCT in AML patients especially in those with high risk, while in late phase after allo-HSCT, cGVHD especially intensive cGVHD had an effect on reducing long-term survival.

Objective: To investigate the potential effects of cytochrome P450 1A1 (CYP1A1) in regulating macrophages polarize to M2 type and explore the molecular mechanism. Methods: All trials were completely randomized. ① Experiment 1: 6-8 weeks old healthy male C57BL/6J mice were collected, and primary peritoneal cells were extracted, then the cells were divided into phosphate buffered saline (PBS) group and interleukin-4 (IL-4) group. The cells in the IL-4 group were stimulated with 10 mg/L IL-4 (M2 macrophage inducer); and those in the PBS group were given with an equal amount of PBS. The mRNA expressions of intracellular M2 type polarized marker molecules including arginase-1 (Arg-1) and chitinase 3 like protein 1 (YM1) at 2, 4, 6 hours after IL-4 challenge were determined by quantitative reverse transcription-polymerase chain reaction (RT-qPCR). The phosphorylation of tyrosine protein kinase 1/signaling transcriptional and transduced activator 6 (JAK1/STAT6) signaling pathway and protein expressions of CYP1A1 and Arg-1 at 6, 12, 24 hours after IL-4 challenge were determined by Western Blot. ② Experiment 2: RAW264.7 cells with high expression CYP1A1 (CYP1A1/RAW) and their negative control cells (NC/RAW) were cultured in vitro. The cells in logarithmic growth phase were collected, and then they were divided into PBS control group and IL-4 group. The treatment method was the same as experiment 1. The phosphorylations of intracellular JAK1/STAT6 and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) pathways in different cells at 1 hour and 2 hours after IL-4 challenge were determined by Western Blot. The mRNA and protein expressions of Arg-1 in different cells at 2 hours and 4 hours after IL-4 challenge were determined by RT-qPCR and Western Blot, respectively. Results: ① Experiment 1: after IL-4 challenge for 2 hours, the mRNA expressions of Arg-1 and YM1 in the primary peritoneal macrophages of mice were significantly increased as compared with the PBS control group [Arg-1 mRNA (2^-ΔΔCt): 1.75±0.82 vs. 1.00±0.21; YM1 mRNA (2^-ΔΔCt): 2.58±0.53 vs. 1.00±0.20, both P < 0.05] which indicated that IL-4 induced macrophage to M2 type polarization successfully. Meanwhile, the mRNA expression of CYP1A1 in polarized mouse peritoneal primary macrophages was also elevated as compared with the PBS control group, and peaked at 4 hours [CYP1A1 mRNA (2^-ΔΔCt): 2.25±0.69 vs. 1.00±0.17, P < 0.01]. The results indicated that CYP1A1 expression was enhanced when macrophages polarized to M2 type. Compared with the PBS control group, the bands of phosphorylated JAK1 (p-JAK1), phosphorylated STAT6 (p-STAT6), Arg-1 and CYP1A1 were enhanced in primary peritoneal macrophages of mice in the IL-4 group, and reached the peak value at 12 hours then gradually decreased. This result indicated that the phosphorylation of JAK1/STAT6 pathway was enhanced in M2 macrophages with high expression of CYP1A1, and the pathway was activated. ② Experiment 2: after IL-4 challenge for 2 hours, the expression of Arg-1 mRNA in CYP1A1/RAW cells was significantly higher than that in NC/RAW cells (2^-ΔΔCt: 3.02±0.60 vs. 1.47±0.43, P < 0.05), and the protein band signal was also stronger, and both peaked at 4 hours. This indicated that CYP1A1 could promote the polarization of macrophages to M2. After IL-4 challenge for 2 hours, the expression of p-JAK1 and p-JAK3 protein bands in both cells were significantly enhanced as compared with the PBS control group, but the enhancement of p-STAT6 band in CYP1A1/RAW cells was stronger than that of NC/RAW cells, indicating that CYP1A1 promoted macrophage polarization by promoting phosphorylation of the JAK1/STAT6 pathway. In the meantime, the protein band of Akt, a downstream protein of the PI3K/Akt pathway, in CYP1A1/RAW cells was significantly lower than that of NC/RAW cells, indicating that CYP1A1 did not promote macrophage polarization through this pathway. Conclusions CYP1A1 promotes the polarization of macrophage to M2 type. The mechanism is related to promoting the phosphorylation of JAK1/STAT6 pathway.