Nowadays there are still a lot of controversies about indications methods and timing for tracheotomy in the patients who need long-term mechanical ventilation.Some recent studies have shown that early tracheostomy can increase patient comfort compliance and may reduce the use of sedatives,decrease ventilator associated pneumonia occurrence,reduce duration of mechanical ventilation and ICU stay.Presently we consider that the early tracheostomy may benefit patients needing long-term mechanical ventilation,and percutaneous dilational tracheostomy is a better way of tracheotomy,however we need to correctly grasp the indications.

0.05). Blood lactate levels in surviving group gradually went down to the normal, while it consistently deteriorated in fatal group.ConclusionsSeptic shock patients had defective oxygen consumption. Patients with higher initial DO 2 had a good outcome. Contineous elevation in blood lactate levels predicts a poor prognosis.

Epigenetic modification includes DNA methylation, histone modification, non-coding RNA, etc., and is crucial in determining gene expression. A growing number of recent studies have shown that epigenetic regulation may play a central role in the pathogenesis of sepsis. Due to its explicit mechanism and relatively mature technic, DNA methylation has received extensive attention in sepsis-related researches. By examining recent studies on septic DNA methylation mechanism, this review elucidates the key role in sepsis occurrence and progression that DNA methylation plays from etiology, immunology and other aspects, as well as its application potential in the diagnosis, prognosis and treatment of sepsis before pointing out the direction for further research.

[Objective]To study the transfection and expression of green fluorescent protein gene in rat chondrocytes by constructing a combination lentiviral vector containing green fluorescent protein gene.[Method]293T cells were co-transfected with the vector plasmids pLentiLox 3.7,the packaging plasmids pRSV-REV,pMDL g/p RRE and the envelope plasmids VSV-G to produce lentiviral vector particles.Rat chondrocytes were isolated,cultured and infected by the lentiviral vector particles.The expression of reporter gene GFP was observed under fluorescent microscope.[Result]At 96 hours after transfection,a strong expression of GFP could be found in 293T cells.The viral titer was 3.0?103ifu/?l.GFP expression was observed in about 80% of the rat chondrocytes.[Conclusion]A combination lentiviral vector containing green fluorescent protein gene was successfully established and it could infect rat chondrocytes efficiently,which will provide a basis for gene modification of chondrocytes through RNA interference.

Objective To discuss the clinical significance of percutaneous cervical diskectomy (PCD) in the management of radicular type cervical spondylosis. Methods A retrospective analysis was carried out on clinical records of 106 radicular type cervical spondylosis cases treated by PCD from July 1993 to June 2002. Results Follow-up observations for 6 months～8 years(mean 3.6 years) in 91 cases showed the outcomes were excellent in 36 cases, good in 40, and unchanged in 15, the rate of excellent-or-good results being 83.5%. Conclusions PCD has an excellent therapeutic effect for nerve-root symptoms resulted from cervical disc herniation, such as numbness and pain of the upper extremities or shoulders.

Objective Based the previous studies, the present study was performed to investigate the antagonistic effects of different doses of Astragaloside IV on the immune function of Treg mediated by HMGB1 in vitro and its potential mechanism.Methods CD4+CD25-T cells isolated from the spleens of male BABL/c mice by magnetic beads were seeded on 48-well cell culture plates and were randomly divided into four groups as follows(12 holes per group). Normal control group: CD4+CD25-T cells were cultured merely. Treg group: Tregs(100μl) and CD4+CD25-T cells were co-cultured in ratio of 1:10. HMGB1+Treg group: Tregs(100μl) stimulated by HMGB1(1μg/ml) for 72 h and CD4+CD25-T cells were co-cultured in ratio of 1∶10. HMGB1+AST IV+Treg group: Tregs(100μl) stimulated by HMGB1(1μg/ml) and AST IV(100μg/ml)for 72 h were co-cultured with CD4+CD25-T cells in ratio of 1:10. CD4+CD25-T cells and supernatants were again collected on post-culture 72 hour. The proliferation of CD4+CD25- T cells was analyzed by MTT test, the activity of NFAT and the contents of cytokines of IL-2 released into supernatants were also determined by means of ELISA. Results When CD4+CD25-T cells were co-cultured with Tregs, the cell proliferation(0.166±0.039) and the levels of NFAT(0.156±0.035) and IL-2(2.38±0.58) in supernatant were markedly decreased as compared with those in the control group(P<0.01). However, the contrary results were found when CD4+CD25-T cells were co-cultured with Treg stimulated by HMGB1. Compared with those in the(HMGB1+Treg) group, the contrary results were showed with a dose-dependent in the(HMGB1+ASTⅣ+Treg) group.Conclusion ASTⅣcan rivalry the effects of HMGB1 on immune function of Treg in vitro, this result indicate that ASTⅣhas the therapeutic action on inflammation promoted by HMGB1.

Objective To summarize the nursing experience of treatment of percutaneous and transhepatic portal venous autologous bone marrow stem cell transplantation for chronic hepatic failure.Methods 19 patients who were definitely diagnosed as chronic liver failure received pertinent nursing in different perioperative period of transhepatic portal venous autologous bone marrow stem cell transplantation.Results All of the 19 patients went through perioperative period safely without any adverse reactions or complications.Conclusions In the process of treatment of autologous bone marrow stem cell transplantation for chronic hepatic failure,sufficient preoperative preparation,good communication and close cooperation among doctors,nurses and patients during operation,careful nursing and rehabilitation instruction after operation,are important assurances for autologous bone marrow stem cell transplantation to run smoothly.

Objective To explore the efficacy of sequential or combined amphotericin B (AmB) and fluconazole (FCZ) therapy on a 5 flucytosine based regimen in non-acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis.Methods A tatal of 117 cases of non-AIDS-related cryptococcal meningitis treated with 5-flurocytosine-based regimens were retrospectively divided into five groups:AmBgroup (n=38),FCZ group (n=25),FCZ and AmB sequential group (n=18),AmB and FCZ sequential group (n=15),AmB and FCZ combination group (n=21).The number in cerebrospinal fluid (CSF) of the five groups were compared.Statistical analyses included t test,oneway analysis of variance,K-independent samples test and chi-square test.Results Intracranial pressure of AmB group,FCZ group,FCZ and AmB sequential group,AmB and FCZ sequential group,AmBandFCZ combination group were (208.6±75.1),(191.5±94.5),(185.0±76.3),(201.9±69.7) and (223.1±89.3) mm H2O (1 mm H2O=0.0098 kPa),respectively,and the differences were not statistically significant (F=0.611,P =0.656).Median cryptococcus counts in CSF of the five groups were 0,10,0,3 and 0/mL,respectively,with no statistical significance (x2 =7.638,P-0.090).CSF protein levels of the five groups were 0.55,0.69,0.67,0.53 and 0.96 g/L,respectively,with no significant differences among groups (F=7.063,P=0.133).The cure rates of the five groups were 55.3％ (21/38),32.0％ (8/25),9/18,6/15 and 47.6％ (10/21),respectively;progression rates or mortality of the five groups were 28.9％ (11/38),44.4％ (11/25),5/18,4/15and 23.8％ (5/21),respectively; and the differences among cure rates (x2 =3.638,P=0.457) and progression rates or mortality (x2-2.785,P =0.604) were not statistically significant.Conclusion FCZ or AmB alone,sequential or combined therapy were all effective in the treatment of cryptococcal meningitis.

OBJECTIVE To summarize the clinical characteristics,diagnositic and therapeutic strategies of severe cytomegaloviral (CMV) pneumonia after kidney transplantation. METHODS To analyze retrospectively pertinent clinical information of 6 cases of severe cytomegaloviral pneumonia after kidney transplantation, including developing process of disease, clinical manifestation of pre-and post-hospitalization ,various assistant examination,therapeutic procedures and prognosis. RESULTS 6 cases had similar characters of episode as follows:CMV pneumonia occurred after 1～3 months after kidney transplantation. Major clinical symptoms included fever, coughing,few sputum without obvious manifestation of breathholding.Peripheral white blood cell was normal or less than normal range, serum CMVpp65 was finally positive during hospital stay. Radiological image of the lung presented inflammatory infiltration and obvious interstitial lesion after 7～10 days of fever, which went worse rapidly. Renal function descended with deterioration of pulmonary infection. All of patients had been treated with multiple antibiotics,glucocorticoid and mechanical ventilation, Etiological diagnosis of the 3th～6th cases were earlier than 1th～2th cases , the 3th～6th cases who finally survived were treated with longer and higher doses of antivirus and glucocorticoid, than 1th～2th cases who died of refractory hypoxemia and acute renal failure during hospital stay. CONCLUSIONS Severe cytomegaloviral pneumonia had similar clinical characteristics of episode. early diagnosis of etiology,continuous application of antivirus and glucocorticoid were crucial for Severe cytomegaloviral pneumonia after kidney transplantation.

Objective To discuss the clinical value of the treatment of intercondylar fractures of the distal femur using open reduction and internal fi xation. Methods From July 1995 to December 2001, a total of 32 intercondylar fra ctures of the distal femur were treated with open reduction and internal fixatio n with a plate, 95? blade plate, a dynamic condylar screw (DCS) or a condyla r buttress plate. There were 13 cases of type-C1, 10 type-C2 and 9 type-C3 ac cording to the AO/ASIF standard. The outcomes of internal fixation were evaluate d according to preoperative and postoperative radiographs and postoperative func tions of the knee. Results 27 patients were followed-up from 8 months to 8 year s. The results were excellent in 14 cases, good in 9, poor in 4 according to San ders standard. Conclusion Open reduction and internal fixation is an ideal ch oice for intercondylar fractures of the distal femur.