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.

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 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.

Humans ; Root Canal Therapy ; Tooth Apex ; Tooth Root ; injuries

Objective: To observe the effect of bisoprolol on cardiac function in heart failure (HF) rats and to explore the mechanism. Methods: The experimental rats were divided into 6 groups: Control group, with normal healthy rats, Sham group, the rats received intraperitoneal injection of normal saline; chronic heart failure (CHF) model was successfully established in 40 rats and divided into 4 groups: CHF group, CHF+bisoprolol (Bis) group, CHF+captopril (Cap) group and CHF+Bis and Cap group.n=10 in each group. The cardiac function was observed among different groups; plasma BNP level was measured by ELISA, myocardial miR-25-3p expression was examined by RT-PCR, protein expressions of SERCA2a and phospholamban (PLB) were detected by Western blot analysis and SERCA2a activity was determined by inorganic phosphorus method. Results: Compared with Control group, CHF group showed decreased cardiac output (CO), left ventricular fractional shortening (LVFS), left ventricular ejection fraction (LVEF), reduced expression of cardiac SERCA2a, PLB, the ratio of SERCA2a/PLB and SERCA2a activity; while increased plasma BNP and miR-25-3p expression, allP<0.01. Compared with CHF group, CHF+Bis, CHF+Cap and CHF+Bis and Cap groups had increased CO, LVFS, LVEF, elevated expression of cardiac SERCA2a, PLB, the ratio of SERCA2a/PLB and SERCA2a activity; while decreased plasma BNP and miR-25-3p expression, allP<0.05.Conclusion: Bisoprolol could improve cardiac function in HF rats, which might be related to down regulating myocardial miR-25-3p expression, up regulating myocardial protein expressions of SERCA2a, PLB and enhancing SERCA2a activity.

Objective To investigate the effects of bisoprolol on myocardial SERCA2a activity in rats with heart fail-ure.Methods Male SD rats were randomly divided into normal control group (control group), sham operation group ( sham group ) , model group , bisoprolol group ( Bis group ) , captopril group ( Cap group ) and bisoprolol plus captopril group[(Bis+Cap)group], heart failure rat model was induced by intraperitoneal injections of doxorubicin .Distilled water, bisoprolol, captopril or bisoprolol plus captopril were administrated by gastrogavage for 35 days, respectively. Indices of cardiac function and plasma levels of B-type natriuretic peptide ( BNP) were measured , myocardial expres-sion of miR-25-3p was detected by Stem-loop RT-qPCR, myocardial levels of SERCA2a and phospholamban (PLB) were detected by Western blot , myocardial SERCA2a activity was determined by the inorganic phosphorus method . Results Cardiac function in model group decreased significantly while plasma levels of BNP were significantly higher than those of control group ( P<0.01 ) .Myocardial expression of miR-25-3p in model group was significantly higher while myocardial levels of SERCA 2a and PLB,SERCA2a activity were significantly lower than those of con-trol group(P<0.01).Cardiac function in Bis group , Cap group and Bis +Cap group improved significantly while plasma levels of BNP were significantly lower than those of model group ( P<0.01 ) .Myocardial expression of miR-25-3p in Bis group, Cap group and Bis +Cap group were significantly lower while myocardial levels of SERCA2a and PLB were significantly higher than those in model group (P<0.01).The SERCA2a/PLB ratio and SERCA2a activity in Bis group and Bis +Cap group were significantly higher than those of model group ( P<0.05 ) .Conclu-sions Bisoprolol therapy improves cardiac function in rats with heart failure , which may be related to inhibition of myocardial miR-25-3p, increasing myocardial SERCA2a and PLB levels, enhancing SERCA2a activity.

Objective To explore the effect of Xinkang Tablets on myocardial apoptosis index,collagen volume fraction and sarcoplasmic reticulum Ca2+-ATPase activity of rats with adriamycin-induced heart failure.Methods The chronic heart failure (CHF) SD rat model was established by intraperitoneal injection of doxorubicin.After successful modeling,the rats with CHF were randomly divided into 5 groups,namely model group,western medicine group,and low-,middle-and high-dose of Chinese medicine groups,10 rats in each group.The rats in the above groups were given intragastric administration of distilled water,22.5 μg/kg of Digoxin mixed suspension,9,18,36 g/kg of XinkangTablets,respectively,in the volume of 10 mL/kg of distilled water dilution,once a day,for 5 continuous weeks.Another the same batch of 10 SD rats were randomly allocated to the sham operation group,and were treated with intragastric administration of the same volume of distilled water.And then the apoptotic rate of myocardial cells was measured by TUNEL method,the collagen volume fraction (CVF) was measured after Masson staining,and the sarcoplasmic reticulum Ca2+-ATPase activity was determined by inorganic phosphate assay.Results Compared with the sham operation group,the apoptotic rate of myocardial cells and CVF in the model group were increased(P ＜ 0.01),indicating that the myocardial remodeling occurred in rats with CHF.Compared with the model Group,the apoptotic rate of western medicine group and three Chinese medicine groups was significantly decreased(P ＜ 0.01),suggesting that Digoxin and Xinkang Tablets can relieve apoptosis to certain extent.The CVF in Digoxin group and middle-and high-dose of Chinese medicine groups were lower than those in the model Group (P＜ 0.05 or P＜ 0.01),indicating that Digoxin and Xinkang Tablets can delay the myocardial fibrosis.Last but not least,the SERCA2a activities in the middle-and high-dose of Chinese medicine groups were higher than those in the model group (P ＜ 0.05 or P ＜ 0.01),suggesting that Xinkang Tablets may relieve myocardial remodeling and improve cardiac function through the regulation of SERCA2a activity.Conclusion Xinkang Tablets decrease the apoptotic rate and myocardial cell volume fraction probably through the regulation of SERCA2a activity,which may play a role in counteracting apoptosis and myocardial fibrosis,and ultimately delay the remodeling of the myocardium.

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.

The problems about scientific research design,data disposal and paper writing of medical scientific research are described in the article.