ObjectiveTo analyze the influencing factors and explore the countermeasures of patients with complication of lower respiratory tract infection after tracheotomy in intensive care unit (ICU).Methods The clinical data of 382 patients with tracheotomy admitted to ICU of Hangzhou Third People's Hospital from March 2015 to March 2016 were retrospectively analyzed, including 153 patients with complicated lower respiratory tract infection as the infected group, and 229 cases without the infection as the no-infected group. The gender, age, emphysema, respiratory failure, time of admission to ICU, the kinds of antimicrobial agents used, time length of applying antimicrobial agents, aerosol inhalation, airway opening time, invasive operation, surgical opportunity and so on were analyzed in the two groups by univariate analysis. In order to screen out the independent risk factors for patients with complication of lower respiratory tract infection after tracheotomy in ICU, the multiple logistic regression analysis was used on the statistically significant risk factors found by using univariate analysis.Results There were statistically significant differences in age, emphysema, primary disease, respiratory failure, time of admission to ICU, the kinds of antimicrobial agents used,time length of using antimicrobial agents, aerosol inhalation, airway opening time, invasive operation and the time of mechanical ventilation between infected group and non-infected group (allP < 0.05). The single factor analysis showed that age [odds ratio (OR) = 5.868, 95% confidence interval (95%CI) = 2.790-10.342,P = 0.000), cerebral hemorrhage (OR = 3.920, 95%CI = 2.250-6.540,P = 0.034), cerebral infarction (OR = 1.048, 95%CI = 1.005-1.092,P = 0.027), emphysema (OR = 5.995, 95%CI = 2.851-8.374,P = 0.001), respiratory failure (OR = 5.022, 95%CI = 2.107-10.244, P = 0.009), time of admission to ICU (OR = 4.968,95%CI = 2.461-8.236,P = 0.003), airway opening time (OR = 4.149, 95%CI = 1.298-9.027,P = 0.019), the kinds of antimicrobial agents used (OR = 4.364, 95%CI = 1.166-9.339,P =0.029), time length of using antimicrobial agents (OR = 3.944, 95%CI = 1.546-7.622,P = 0.027), aerosol inhalation (OR = 2.052, 95%CI = 1.150-5.042,P = 0.014), invasive operation (OR = 3.467, 95%CI = 2.869-8.956,P = 0.000), surgical opportunity (OR = 0.366, 95%CI = 0.175-0.763,P = 0.037), the time of mechanical ventilation (OR = 0.981, 95%CI = 0.966-0.996,P = 0.041)were risk factors for patients with lower respiratory tract infection after tracheotomy in ICU. The multivariate logistic regression analysis showed that the risk factor sequence of influencing degree from high to low on occurrence of lower respiratory tract infection in patients after tracheotomy in ICU was as follows: time of admission to ICU (OR = 5.697, 95%CI = 2.891-8.739,P = 0.001), respiratory failure (OR = 5.543, 95%CI = 2.347-9.882, P = 0.012), emphysema (OR = 5.388, 95%CI = 2.671-7.963,P = 0.002), invasive operation (OR = 4.987, 95%CI =3.644-9.876,P = 0.014), time of using antimicrobial agents (OR = 4.823, 95%CI = 1.369-8.542,P = 4.823), the kinds of antimicrobial agents used (OR = 4.514, 95%CI = 1.369-8.542,P = 0.022), age (OR = 4.395, 95%CI = 2.194-8.786, P = 0.013), airway opening time (OR = 3.287, 95%CI = 2.542-9.677,P = 0.036) and aerosol inhalation (OR = 2.141, 95%CI = 1.242-5.211,P = 0.045).Conclusions The time of admission to ICU, invasive operation, emphysema and so on are the main risk factors of patients with complication of lower respiratory tract infection after tracheotomy in ICU, thus, corresponding measures should be directed to the risk factors and formulated to strengthen the prevention in order to control the occurrence of lower respiratory tract infections after tracheotomy in ICU.

Objective To determine whether Nutritional Risk Screening 2002 (NRS2002) of admission independently predicts outcome of non-invasive positive pressure ventilation (NIPPV) in chronic obstructive pulmonary disease (COPD) patients during hypercapnic respiratory failure.Methods Patients with COPD presenting with hypercapnic respiratory failure at Sichuan University Hospital between December 2010 and May 2012 and receiving NIPPV were studied prospectively.NRS2002 was measured before NIV administration.233 patients met the inclusion criteria,with NIPPV failed in 71 cases and succeed in 162 cases.The patients were followed up till they were discharged.Results After multivariate Logistic regression,the items such as baseline PaCO2,NRS2002 score could predicted 76.4％ of the failure outcome.The area under the curve was 0.767.The positive predictive value was 35.23％.The negative predictive value was 84.21％.Conclusions We can predict the risk failure of NIPPV in patients with COPD and hypercapnic respiratory failure with NRS2002 score and baseline PaCO2,and adjust the treatment project according to the evaluation result.NRS2002 supply non-invasive and portable method for predicting the failure of NIPPV.

Objective The diolistic assay has been modified to make it simpler and more efficient in labeling neurons and glia. Methods CNS neurons and glial cells were labeled with DiI diolistic assay in fixed tissue and living brain slices of C57/B6J mice. Results The method allowed the visualization of the fine structure of neurons and glia including synaptic structures such as dendritic spines. Conclusion With the method, the labeling efficacy of cell's fine structure is improved, making it preferable for the analysis of dendritic spine. In addition, the ability to label the living neuron and glia will extend its application vastly.

BACKGROUND:Owing to containing large amounts of growth factors, platelet-rich plasma has been widely used in bone regeneration, wound healing, and so on, while few studies have been reported on cartilage tissue engineering. OBJECTIVE:To explore the effects of platelet-rich plasma on the proliferation and differentiation of chondrocytes, and the feasibility of constructing tissue-engineered cartilage by the combination of chondrocytes and platelet-rich plasma. METHODS:We detected the concentrations of transforming growth factor-β, insulin-like growth factor-1, platelet-derived growth factor and epidermal growth factor BB in the whole blood, platelet-rich plasma, and activated platelet-rich plasma. The rabbit articular chondrocytes were cultured in 10%, 15%, 20%, 30%platelet-rich plasma for 7 days, then the cellproliferation was tested by cellcounting kit-8, and cartilage-related genes (col agen type II, Aggrecan, Sox-9) were determined using QT-PCR. The chondrocytes/platelet-rich plasma composite was implanted subcutaneously into the rabbits, and the samples were harvested after 6 weeks of transplantation for histological examination. RESULTS AND CONCLUSION:The levels of different growth factors in the platelet-rich plasma were higher than those in the whole blood (P<0.05), but lower than those in the activated platelet-rich plasma (P<0.05). Platelet-rich plasma at different concentrations promoted the proliferation of chondrocytes. When the concentration of platelet-rich plasma was no more than 20%, the proliferation of chondrocytes showed a concentration-dependent manner. The 20%platelet-rich plasma showed the best effects to promote the expression of col agen type II (P<0.05), while the 15%platelet-rich plasma could maximize the expression of Sox-9 and Aggrecan (P<0.05). After transplantation of chondrocytes/platelet-rich plasma composite, cartilage-like tissue formed with cartilage lacuna-like structures, and rich extracellular matrix was found, which indicates platelet-rich plasma can be used as an injective scaffold in cartilage tissue engineering.

Objective To explore the effects of continuous renal replacement thempy ( CRRT) on efficacy in severe acute pancreatitis ( SAP) patients based on different time .Methods A total of 38 SAP patients were divided into two groups randomly:early group(CRRT within 48h) for 21 patients and late group(CRRT after 48h)for 17 pa-tients.the APACHE II score,the length of stay ICU and the mortality of 28d were compared between the two groups . Results The APACHE Ⅱscore was significantly higher in late group than that in early group in day 1 and 2 ( t=2.231,2.304,both P<0.05);there is no significant differences between late group than that early group in APACHEⅡscore before treatment(P>0.05);the hospitalizing days and mortality were significantly higher in late group than that in early group(t=2.156,χ2 =4.293,both P<0.05);there was no significant differences between late group and early group in gender,age,APACHEⅡscore(all P>0.05).Conclusion Early CRRT can decrease both the hospi-talizing days and mortality in SAP patients .CRRT may provide more clinical benefits in the early phase (within 48h) of SAP.

Objective To investigate efficiency and distribution of gene delivery to the injured tendons by microinjeetion and tissue reactions caused by different vectors. Methods By using a mi-croinjection technique, 10μl of pCMV-EGFP, pCAGGS-EGFP, AAV2-EGFP and Ad5-EGFP harboring enhanced green fluorescence protein (EGFP) gene were respectively injected to two sites of the proximal stump of 48 transected digital flexor tendons in 18 chickens. At days 3, 7, 14 and 21, the tendons wereharvested for observing distribution and expression of EGFP under a fluorescence microscope by using fro-zen tissue sections. The tendon sections were also stained with hematoxylin and eosin to examine inflam-mation caused by these vectors. The other 24 normal flexor tendons were served as controls. ResultsCompared with normal tendon tissues, the EGFP expression was observed in tendons at days 3, 7, 14 and21 after injection. The EGFP expression was observed at day 3 and reached peak at day 7 for all vectors.The EGFP expression was decreased at day 14 but seldom seen at day 21. EGFP was distributed evenly inthe injected tendon segment adjacent to the cut level. The EGFP expression in the tendons injected withAAV2-EGFP and Ad5-EGFP was higher than that with pCMV-EGFP and pCAGGS-EGFP injection, withinsignificant statistical difference upon the EGFP expression between AAV2-EGFP and Ads-EGFP vec-tors. Tissue reactions of the tendons caused by the liposome-plasmid vector ( including pCMV-EGFP and pCAGGS-EGFP) were the most prominent among all vectors. Infiltration of inflammatory cells, chiefly lymphocytes and neutrophilic granulocytes, were found. The tendons injected with AAV2 vectors presen-ted gentle inflammatory reactions. Conclusions Mieroinjection to two sites of each tendon stump deliv-ers the transgene to the entire tendon segment adjacent to the cut. Gene delivery by the AAV2 and Ad5 vectors has the highest cfficiency among four vectors tested, when expression level peaks at day 7 after in-jection and AAV2 vector causes the slightest tissue reactions in the tendons, indicating that the AAV2 vector is a promising gene delivery vector and microinjection is practical for tendon gene therapy.

ABSTRACT:Objective To investigate the effects of Xiefei Lishui recipe on left ventricle remodeling in rats with heart failure.Methods Heart failure rat model was induced by intraperitoneal injections of doxorubicin. Rats were randomly divided into sham operation group (sham group),model group,traditional Chinese medicine group (TCM group),captopril group,and digoxin group.Distilled water,TCM [22 g/(kg · d)],captopril [19 mg/(kg·d)],and digoxin [32μg/(kg·d)]were administered by gastrogavage in rats in different groups for 35 days,respectively.Indices of ventricle remodeling and cardiac function,plasma levels of B-type natriuretic peptide (BNP),rennin (REN),angiotensin Ⅱ(AngⅡ)and aldosterone (ALD)were measured.Cardiomyocyte apoptosis index and collagen volume fraction (CVF)were analyzed.We also assayed myocardial mRNA expressions of MMP-2/9 and TIMP-1/2,and their tissue inhibiting factors TIMP-1 and TIMP-2.Results Compared with those in sham group,in model group cardiac function was significantly decreased,which could be significantly increased by TCM or captopril or digoxin,indices of cardiac remodeling were significantly increased,which could be significantly decreased by TCM or captopril (P<0.01 or P<0.05).Plasma levels of BNP,REN,AngⅡ and ALD,cardiomyocyte apoptosis index and CVF in model group were significantly increased,could be significantly decreased by TCM or captopril (P<0.01 or P<0.05).Myocardial mRNA expressions of MMP-2,MMP-9,TIMP-1 and TIMP-2 in model group were significantly upregulated compared with those in sham group, which could be significantly downregulated by TCM (P<0.01 or P<0.05).Conclusion Xiefei Lishui recipe can attenuate left ventricle remodeling and improve cardiac function in rats with heart failure, which may be related to downregulating myocardial mRNA expressions of MMP-2 ,MMP-9 ,TIMP-1 and TIMP-2 in the left ventricle as well as inhibiting cardiomyocyte apoptosis and myocardial fibrosis.

Objective To investigate the clinical effect of posterior pedicle screw fixation combined with anterior decompression and fusion for the treatment of thoracolumbar burst fractures.Methods The clinical data of 53 patients underwent posterior pedicle screw fixation and anterior decompression and fusion were retrospectively analyzed.The vertebral height,Cobb angle,vertebral tube volume,the Frankel gradient and Fugl -Meyer score were recorded and compared before and after treatment.Results 49 patients were followed up.At the last time of follow -up,the vertebral height,Cobb angle,vertebral tube volume all significantly improved (t =24.047,P <0.001;t =21.815,P <0.001;t =31.699,P <0.001).The Frankel gradient before treatment was:A 6 cases,B 18 cases,C 15 cases,D 10 cases,E 4 cases.After treatment,it came to 3 cases,8 cases,11 cases,17 cases,10 cases,respectively.There was significant difference before and after treatment (Z =2.997,P =0.003).There was significant difference in Fugl -Meyer score before and after treatment[(74.65 ±8.42)points,(90.26 ±9.17)points,respectively,P <0.001 ].Conclusion There is excellent effect on posterior pedicle screw fixation followed by anterior decompression and fusion for the treatment of thoracolumbar burst fractures.It is good for the recovery of motion and spinal function.

Objective To explore the effects of continuous renal replacement therapy (CRRT) on the changes of the respiration and blood circulation as well as peripheral blood cytokines levels in patients with severe acute pancreatitis(SAP) complicated with acute respiratory distress syndrome.Methods 48 SAP patients complicated with acute respiratory distress syndrome were divided into control group and CRRT treatment group according to the parallel control design principle.The control group was treated with routine way,and the CRRT treatment group was treated with CRRT on the basis of routine way.The clinical data and the levels of IL-6,IL-1β,TNF-α were compared between the two groups.Results The levels of IL-6,TNF-α were significantly lower in the CRRT treatment group than those in the control group in 12h [(147.72 ± 22.06) ng/L vs.(132.27 ± 18.03) ng/L,t =2.315,P＜0.05;(236.08 ±41.29) ng/L vs.(208.79±39.25)ng/L,t =2.406,P ＜0.05].The levels of IL-6,IL-1β,TNF-α were significantly lower in the CRRT treatment group than those in the control group in 24h [(136.57 ± 30.74) ng/L vs.(109.98 ± 35.83) ng/L,t =2.184,P ＜ 0.05;(35.76 ± 8.57) ng/L vs.(28.96 ±3,95) ng/L,t =2.237,P ＜0.05;(219.81 ±36.06) ng/L vs.(173.48 ±48.19) ng/L,t =2.206,P ＜0.05].The level of PaO2/FiO2 was significantly higher in the CRRT treatment group than that in the control group in 24h[(139.89 ±35,61) vs.(173.12 ±21.84),t =2.913,P ＜0.01].The levels of Ppeak,IL-1β were significantly lower in the CRRT treatment group than those in the control group in 48h [(28.96 ± 4.14) cmH2 O vs.(24.73 ± 8.52) cmH2 O,t =2.518,P ＜0.05;(29.87 ±5.12) ng/L vs.(23.57 ±3.91) ng/L,t =2.427,P ＜0.05].The levels of IL-6,TNF-αwere significantly lower in the CRRT treatment group than those in the control group in 48h [(117.60 ± 23.46) ng/L vs.(88.56 ± 13.02) ng/L,t =3.062,P ＜ 0.01;(205.25 ± 46.14) ng/L vs.(141.63 ± 33.80) ng/L,t =3.174,P ＜0.01].The level of PaO2/FiO2 was significantly higher in the CRRT treatment group than that in the control group in 48h [(148.07 ± 25.64) vs.(193.23 ± 29.60),t =2.983,P ＜ 0.01].There were no significant differences between the control group and CRRT treatment group in PaO2/FiO2,Ppeak,IL-6,IL-1β,TNF-α before treatment [(103.68±29.65) vs.(107.07 ±25.13),t =0.359,P ＞0.05;(34.62 ±7.36)cmH2O vs.(35.18 ±4.04)cmH2O,t =0.416,P ＞0.05;(152.61 ±31.53)ng/L vs (150.74 ±30.26) ng/L,t =0.668,P ＞0.05;(40.06 ±5.15) ng/L vs.(38.09 ±10.13) ng/L,t =0.819,P ＞0.05;(226.85 ±37.62) ng/L vs.(225.47 ±39.02) ng/L,t =0,702,P＞0.05].Conclusion CRRT can effectively reduce the plasma levels of IL-6,IL-1β,TNF-α in SAP patients complicated with acute respiratory distress syndrome,it has therapeutic effect on the respiration through changing the cytokines of SAP patients complicated with acute respiratory distress syndrome.

Transient ischemic attack (TIA) is a high-risk signal of acute ischemic cerebrovascular diseases, indicates a significant increase in the risk of ischemic stroke, especially within 7 days.Risk assessment and stratification are important in patients with TIA.A variety of simple prediction scales were developed based on the risk factors for stroke in patients with TIA, such as the California scale, ABCD scale, and ABCD2 scale.Among them, the ABCD scale score is used most commonly, but as its application becomes more and more common, the defects of this scale are also increasingly apparent.In recent years, some derived scales of ABCD score were introduced in order to improve the sensitivity and specificity of prediction.This article reviews the evolution, contents, characteristics, and predictive value of the ABCD score and its derived scales in the prediction of stroke risk in patients with TIA.