Objective To explore the factors associated with delayed defecation in long-term ventilated patients in intensivecare unit (ICU) and their potential effect on prognosis.Methods A prospective observational cohort study was conducted. The patients admitted to general ICU of the Affiliated Hospital of Qingdao University from October 1st in 2013 to September 30th in 2015 who underwent mechanical ventilation (MV) for ≥6 days were enrolled, and they were divided into early defecation group (< 6 days) and late defecation group (≥6 days). At admission, clinical nutritional support were given as usual, and gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, admission reasons, MV reasons, the usage of morphine and epinephrine/norepinephrine, the highest positive end-expiratory pressure (PEEP), the lowest oxygenation index (PaO2/FiO2) and the lowest systolic blood pressure were collected. Logistic regression analysis was used to analyze the influencing factors of the first defecation time. ICU mortality, the length of ICU stay, central venous catheter (CVC) indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of ventilator associated pneumonia (VAP) were compared between early defecation group and late defecation group. Logisticorgan dysfunction system (LOD) scores and gastric residual volume per day were recorded at the different time of MV.Results Totally 189 patients were enrolled, 39 patients did not satisfied the inclusion criteria and 13 patients gave up treatment or referrals were excluded. Finally 137 patients were enrolled in the analysis, 83 patients in late defecation group and 54 in early defecation group. There were no significant differences in the baseline characteristics such as gender, age, APACHE Ⅱ score, LOD score at 1 day of MV, admission reasons, MV reasons, disgorging and gastric residual volume per day during the first 5 days of MV, enteral nutrition, lactulose treatment in patients with hepatic encephalopathy during the first 5 days of MV, and blood purification treatment between the two groups (allP > 0.05). Compared with the early defecation group, late defecation group had less patients with loose stools or watery stool at first time [15.7% (13/83) vs. 33.3% (18/54)], more patients using morphine and the usage of epinephrine/norepinephrine more than 24 hours [48.2% (40/83) vs. 40.7% (22/54), 42.2%(35/83) vs. 29.6% (16/54)], higher the maximum PEEP level [cmH2O (1 cmH2O = 0.098 kPa): 7.9±3.7 vs. 6.7±3.5], lower the minimal systolic blood pressure [mmHg (1 mmHg = 0.133 kPa): 74.8±28.1 vs. 88.9±30.2] and more severe of hypoxemia [PaO2/FiO2 < 150 mmHg, 54.2% (5/83) vs. 44.4% (24/53)], all of which had significant differences (allP < 0.05). Factors found statistical significances by single factor analysis were enrolled in the multiple regression analysis, which showed that PaO2/FiO2 < 150 mmHg and systolic blood pressure < 90 mmHg were independently associated with a delay in defecation in patients undergoing long-term MV [PaO2/FiO2 < 150 mmHg: adjusted hazard rate: 1.415, 95% confidence interval (95%CI) = 1.061-1.590,P = 0.026; systolic blood pressure 70-89 mmHg:HR = 1.461, 95%CI = 1.164-1.788, P = 0.002; systolic blood pressure ≤ 69 mmHg: adjusted hazard rate= 1.273, 95%CI = 1.010-1.587,P = 0.034). ICU mortality, the length of ICU stay, CVC indwelling time, duration of MV, ICU acquired bacterial infection rate, and the incidence of VAP at 7 days of MV in late defecation group were significantly higher than those of early defecation group [ICU mortality rate: 15.7% (13/83) vs. 7.4% (4/54), the length of ICU stay (day): 17.0 (14.0, 23.0) vs. 15.0 (13.8, 20.0), CVC indwelling time (days): 12.0 (10.0, 14.0) vs. 10.0 (9.0, 11.3), duration of MV (days): 14.0 (10.0, 20.0) vs. 11.0 (9.8, 15.3), ICU acquired bacterial infections rate: 60.2% (50/83) vs. 14.8% (8/54), the incidence of VAP: 32.5% (27/83) vs. 14.8% (8/54); allP < 0.05]. There was no significant difference in LOD score between both groups. The LOD scores at 4 days and 9 days of MV in late defecation group were significantly higher than those of early defecation group (6.41±4.37 vs. 5.21±3.12, 4.33±2.20 vs. 3.50±2.90, bothP < 0.01).Conclusions PaO2/FiO2 < 150 mmHg and systolic blood pressure < 90 mmHg during the first 5 days of MV were independently associated with a delay in defecation in patients undergoing long-term MV. The results suggest that constipation is associated with adverse outcomes in long-term ventilated patients.

AIM:To investigate the effect of TSM tablet on rat' s atherosclerotic model' s endothelial cell and explore the mechanism of it.METHODS:Fifty Wistar rats were randomly assigned into five groups:control group,model group,Simvastatin group,TSM high group,TSM low group.All groups were fed with high fat diet and vitamin D_3 except for control group to set up atherosclerosis model.After 12 weeks we detected circle endothelial cell,angiotensin Ⅱ and electron microscopy morphology of arteries.RESULTS:Level of circulating enthelia cell(CEC)and Ang Ⅱ in model rats were significantly higher.TSM can reduce level of the CEC and Ang Ⅱ.Model group rat' s artery endothelial cells were severely damaged under electron microscopy;rat's artery endothelial cells in TSM group were basically intact and its internal elastic membrane was unbroken on it thickness was even,without significant lesion.CONCLUSION:TSM by reducing the number of CEC,the level of Ang Ⅱ used for experimental atherosclerotic endothelial cell in rats has the protective effect.

Objective To investigate the effect of rosiglitazone on p38 mitogen-activated protein kinase (p38MAPK) pathway in polycystic kidney cyst-lining epithelial cells. Methods The cyst-lining epithelial cells (PKD cells) from human polycystic kidney were treated with rosiglitazone (10 μmol/L), peroxisome proliferator-activated receptor-γ (PPARγ) inhibitor GW9662 (10 μmol/L), rosiglitazone (10 μmol/L) +GW9662 (10 μmol/L), p38MAPK specific inhibitor SB203580 (10 μmol/L), SB203580 (10 μmol/L)+ rosiglitazone(10 μmol/L) for 2 hours followed by epidermal growth factor (EGF) stimulation. Protein expressions of p38, phuspho-p38 (p-p38) and proliferating cell nuclear antigen (PCNA) were detected by Western blot. p38 mRNA was examined by RT-PCR. Expression of c-fos and c-jun was observed by immunocytochemistry. Results (1) EGF markedly up-regulated the expressions of p38, p-p38, PCNA, c-fos anti c-jun compared with control group (P<0.01). (2) Compared with EGF treated group, rosiglitazone significantly reduced p38 activation and mRNA expression (P<0.01, respectively). Rosiglitazone, rosiglitazone+SB203580 could significantly down-regulated p-p38, PCNA, c-fos and c-jun expression (P<0.01, respectively) with no significant difference between these two groups. (3) GW9662 partially reversed the reduction effect of rosiglitazone. Conclusions Rosiglitazone can inhibit proliferation of autosomal dominant polycystic kidney disease cyst-lining epithelial cells partially through down-regulating p38 activation and reducing c-fos, c-jun and PCNA expression. The above effect of rosiglitazone is in part PPARγ-independcnt.

Objective To evaluate the guiding role of capsule endoscopy (CE) in choosing the access route of double-balloon enteroscopy (DBE) for small bowel diseases. Methods Patients with complete CE and with small bowel diseases confirmed by DBE were enrolled. The lesion location found on CE was represented by the time index, which was the ratio of access time from pylorus to lesion over access time from pylorus to ileocecal valve. Based on our previous retrospective evaluation, oral approach was selected when the index was ≤0. 6, otherwise the anal access would be chosen. Accuracy of time index predicting DBE access rout was evaluated. Results Data of 60 patients undergoing both CE and DBE were evaluated. All lesions detected by CE were confirmed by DBE, with 41 via oral route and 19 via anus. Based on the time index with threshold of 0.6, the accuracy of selecting the insertion route of DBE was 100%. Conclusion DBE is an effective approach to confirm CE results. In patients with complete small bowel investigation by CE, the insertion route for DBE can be reliably indicated with time index based on the CE results.

AIM:To investigate the effect of TSM tablet on rat's atherosclerotic model's endothelial cell and explore the mechanism of it.METHODS:Fifty Wistar rats were randomly assigned into five groups:control group,model group,Simvastatin group,TSM high group,TSM low group.All groups were fed with high fat diet and vitamin D3 except for control group to set up atherosclerosis model.After 12 weeks we detected circle endothelial cell,angiotensinⅡ and electron microscopy morphology of arteries.RESULTS:Level of circulating enthelia cell(CEC) and AngⅡin model rats were significantly higher.TSM can reduce level of the CEC and AngⅡ.Model group rat's artery endothelial cells were severely damaged under electron microscopy;rat's artery endothelial cellsin TSM group were basically intact and its internal elastic membrane was unbroken on it thickness was even,without significant lesion.CONCLUSION:TSM by reducing the number of CEC,the level of AngⅡ used for experimental atherosclerotic endothelial cell in rats has the protective effect.

OBJECTIVE:To investigate the effects of Butylphthalide and sodium chloride injection on neurological function and prognosis of elderly patients with hypertensive intracerebral hemorrhage(HICH)after trepanation and drainage surgery. METH-ODS:During Jan. 2015 to Jun. 2016,80 elderly HICH patients were selected from our hospital and then divided into control group and observation group according to random number table,with 40 cases in each group. Both group received trepanation and drain-age surgery. Control group was given routine treatment. Observation group was given Butylphthalide and sodium chloride injection 100 mL,ivgtt,bid,on the fifth day after surgery,on the basis of control group. Both groups received treatment for 14 d. Clinical efficacies of 2 groups were observed. CSS scores were compared between 2 groups before surgery and 28 d after operation;volume of encephaledema,serum levels of homocysteine(HCY)and substance P(SP)were compared between 2 groups before surgery and 14 d after operation. RESULTS:The total response rate of observation group was 87.5％,which was significantly higher than 67.5％ of control group, with statistical significance (P<0.05). Before surgery, there was no statistical significance in CSS scores,volume of encephaledema or serum levels of HCY and SP between 2 groups(P>0.05). CSS scores 28 d after operation, SP levels 14 d after operation were significanthy increased,volume of encephaledema and serum levels of HCY in 2 groups were significantly decreased,and the observation group was significantly better than the control group,with statistical significance(P<0.05). CONCLUSIONS:Butylphthalide and sodium chloride injection can significantly improve clinical efficacy and hepatic func-tion damage,relieve postoperative encephaledema,reduce serum levels of HCY and increase SP levels in elderly HICH patients af-ter trepanation and drainage surgery.

Objective To evaluate the CT findings of multicentric Castleman disease(CD).Methods The CT findings of thorax and abdomen in a patient with multicentric CD biopsy-proved were retrospectively analyzed, and a literature review was conducted.Results The patient had systemic symptoms, polyclonal hypergammaglobulinemia, extensive lymph node enlargement and mild enhancement, and specific pulmonary infiltration. The lung lesions on thin-section CT were showed poorly-defined centrilobular nodules, ground-glass attenuation, thin-walled cysts, thickening of the bronchovascular bundles, and interlobular septal thickening. The above were highly coincident with that in the literatures.Conclusion Multicentric CD is characterized by the presence of systemic symptoms, extensive lymph node enlargement and mild enhancement, and specific pulmonary lesions when infiltrated. Typical manifestation might suggest multicentric CD.

Objective To define basic medical service items in Shanghai community health centers.Methods Two rounds of Delphi expert consultation were carried out with 36 experts specialized in general practice,general practitioner training,internal practice,public health and health management,then the scope of medical service system was set up based on experts' opinions.Results The newly-defined system consisted of three first-grade items:outpatient medical service,hospital medical service and medical service for home beds and temporary home visits.The first-grade items contained 22 second-grade items and the second-grade items consisted of 26 detailed items,including 17 baseline items,8 optional items and 1 restrained item.In two rounds of Delphi consultation the activity coefficient of experts was all 100％,authority coefficients of experts was 0.825,and harmonious coefficient of the importance of the evaluation was 0.361 and 0.488 (all P ＜ 0.01),respectively.Conclusion The preliminarily developed system of basic medical service items in Shanghai community health service can provide a reference frame for government policy-making.

Objective To survey age of menarehe in Pudong district in Shanghai. Methods Data in this study were derived from 56 924 women at age of 20 -81 years in screening for cervical cancer between January 2007 and July 2008 in Pudong district. The age of menarche were recorded in a questionnaire. To investigate the trends in age at menarehe in different socioeconomic status, the subjects were divided into 12 groups in 5-year birth cohorts. The mean menarche age in each group was analyzed by analysis of variance(ANOVA). The percentage of menarche age at 10- 12 years and more than 18 years was analyzed by χ2 method. Results (1 ) The minimum age of menarcbe recorded is 10 years old, and the maximum is 28 years old, with average age of menarche at 15.7 years. In all groups, the smallest average age of menarcbe is 14. 6 years in 26 - 30 years old age group, while the biggest average age of menarche age is 16. 5 years in ＞ 75 years old group; The difference showed statistical significance (P ＜ 0. 01 ). (2) The percentages for participants with early menarehe age (10 - 12 years old) or late menarehe age (＞ 18-year-old menarche) were 1.82% (1034/56 924 ) and 5.20 % (2959/56 924 ) respectively. However, the maximum percentage for early menarche was recorded in 31 -35 years old group (4. 45% ,197/4431 ), only 0. 84% (10/1191 ) of participants in ＞75 years old group was classified as early menarebe. Meanwhile, the lowest percentage for late menarehe was 0. 38% (17/4431 ) in 31 - 35 years old group, and the highest percentage was 14. 70% (91/619) in ＞ 75 years old group. The changes in the percentages for early menarche or late menarche are significantly associated with age differences (P ＜ 0. 01 ). Conclusion The study suggested that the average of onset age of menarche in Pudong district has declined over the past decades in an age-based way, accompanied with the increase of the percentage for early menarche and the decrease of percentage for late menarehe.

Objective To observe the protein expressions of PI3Kp110, pAkt, pGSK3β of phosphatidylinositol 3-kinase (PI3K) and protein kinase B (Akt) signaling pathway in the whole blood of patients with Kashin-Beck disease and analyze the status of PI3K/Akt signaling pathway. Methods Patients with Kashin-Beck disease ( KBD group ) were from six counties ( Xunyi , Linyou , Yongshou , Qianyang , Changwu and Long County) of Shannxi Province in Kashin-Beck disease areas , and the healthy controls (control group) were matched by age and sex. Venous blood was collected from patients and healthy controls. Trizol method was applied to extract the whole blood protein; protein expression levels of PI3K/Akt signaling pathway in whole blood were detected by Western blotting; the gray values were observed and recorded by the sodium dodecyl sulfate polyacrylamide gel electrophoresis(SDS-PAGE) and GDS-8000 gel imaging analysis system. Differences between the two groups were assessed by Student’s t-test. Results Compared age and sex between KBD group and control group, differences were not statistically significant(t=0.701, P>0.05;χ2=0.400, P>0.05). The protein expression levels of PI3Kp110, pAkt and p-GSK3β in KBD group were higher than that in control group(156.1 ± 92.1 vs. 79.5 ± 21.5, 113.7 ± 15.2 vs. 43.3 ± 10.7 and 105.9 ± 17.5 vs. 37.3 ± 12.0, respectively) and the differences were statistically significant (t=2.563, 6.567, 7.916; all P < 0.05 or < 0.01). Conclusion The PI3Kp110, pAkt and p-GSK3β expressions of signaling pathway proteins in the whole blood of patiens with Kashin-Beck disease are up-regulated significantly and the status of PI3K/Akt signaling pathway is activated.