Objective To investigate the prevalent condition of endotracheal cuff pressure and risk factors for under inflation. Methods A prospective cohort study was conducted. Patients admitted to the Department of Critical Care Medicine of Fuxing Hospital Affiliated to Capital Medical University,who were intubated with a high-volume low-pressure endotracheal tube,and had undergone mechanical ventilation for at least 48 hours,were enrolled. The endotracheal cuff pressure was determined every 8 hours by a manual manometer connected to the distal edge of the valve cuff at 07:00,15:00,and 23:00. Measurement of the endotracheal cuff pressure was continued until the extubation of endotracheal or tracheostomy tube,or death of the patient. According to the incidence of under inflation of endotracheal cuff,patients were divided into the incidence of under inflation lower than 25%group(lower low cuff pressure group)and higher than 25% group(higher low cuff pressure group). The possible influencing factors were evaluated in the two groups,including body mass index(BMI),size of endotracheal tube,duration of intubation,use of sedative or analgesic,number of leaving from intensive care unit(ICU),the number of turning over the patients, and aspiration of sputum. Logistic regression analysis was used to determine risk factors for under-inflation of the endotracheal cuff. Results During the study period,53 patients were enrolled. There were 812 measurements,and 46.3%of them was abnormal,and 204 times(25.1%)of under inflation of endotracheal cuff were found. There were 24 patients(45.3%)in whom the incidence of under inflation rate was higher than 25%. The average of under inflation was 7(4,10)times. Compared with the group with lower rate of low cuff pressure,a longer time for intubation was found in group with higher rate of low cuff pressure〔hours:162(113,225)vs. 118(97,168),Z=-2.034,P=0.042〕. There were no differences between the two groups in other factors,including size of endotracheal tube,the time from intubation to first measurement of endotracheal cuff pressure,number of leaving from ICU during admission, use of sedative agent or analgesic,and the number of body turning and aspiration(all P>0.05). No risk factor was found resulting from under inflation of the endotracheal cuff by logistic regression analysis. No significant difference was found in the incidence of ventilator associated pneumonia,duration of mechanical ventilation,successful rate of weaning on 28th day,or 28-day mortality after weaning from mechanical ventilation,and ICU mortality between the two groups. However,patients in the group of higher rate of low cuff pressure had a longer ICU stay compared with that in the group of lower rate of low cuff pressure group〔days:13(8,21)vs. 10(6,18),Z=-2.120,P=0.034〕. Conclusions Abnormal endotracheal cuff pressure is common in critically ill patients with intratracheal intubation. Duration of intubation is associated with under inflation of the cuff,and it calls for strengthening monitoring and management.

OBJECTIVE: The purpose of this study is to investigate the effective of alternating Chemo-radiotherapy for locally Advanced Nasopharyngeal Carcinoma. METHOD: Retrospective analysis 106 cases of patients with locally advanced nasopharyngeal carcinoma between November 2005 and March 2007. All patients received cisplatin-based chemotherapy but 15 patients received radiotherapy(RT) alone. Inducing chemotherapy (IC) + RT + adju-vant chemotherapy (AC) regimen in 36 patients, IC+RT regimen was delivered in 25 patients and AC + RT regimen in 30 patients. 61 patients received 1 to 2 cycles of inducing chemotherapy and 66 patients received 3 to 6 cycles of adjuvant chemotherapy after radiotherapy. Chemotherapy started on the first day after the end of the induction chemotherapy, adjuvant chemotherapy begun after radiotherapy for a week. All patients were treated by radiotherapy using 60 Co r-ray, the nasophyarynx primary site was given a total does of 68 -74 Gy. The lymph nodes of the neck was given 60 to 70 Gy. The prophylactic irradiation does of the neck was 48-50 Gy. RESCULT: The median follow up time was 51 months. A total of 58 patients died, the overall survival rate was 45% in whole groups. The 5-year overall survival rates were 33%, 63%, 60% and 50% in RT, IC + RT + AC, IC + RT and RT+AC group, respectively. The 5-year disease-free survival rates were 13%, 56%, 48% and 40% in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. The 5-year relapse-free survival rates were 13%, 53%, 48% and 50% in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. The 5-year metastasis-free survival rates were 6%, 50%, 44% and 47% in RT, IC + RT + AC, IC+ RT and RT + AC group, respectively. There was significant difference in all groups (P < 0.05). The median time to relapses were 22 months, 29 months, 28 months and 25 months in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. The median time to first distant metastasis were 10 months, 19 months, 15 months and 12 months in RT, IC + RT + AC, IC + RT and RT + AC group, respectively. There was no significant difference in all groups (P > 0.05). IC + RT + AC group had heavier acute toxicity effects than other groups, but it did not affect the treatment process, all patients could be tolerated. CONCLUSION This retrospective study has demonstrated that alternating Chemo-radiotherapy and early radiotherapy not only can improve the survival rate for locally Advanced Nasopharyngeal Carcinoma, but also have slight toxicities and side reaction, all patients may tolerated.
Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Carcinoma ; Chemotherapy, Adjuvant ; adverse effects ; Cisplatin ; administration & dosage ; Disease-Free Survival ; Female ; Humans ; Induction Chemotherapy ; adverse effects ; Male ; Nasopharyngeal Carcinoma ; Nasopharyngeal Neoplasms ; drug therapy ; mortality ; pathology ; radiotherapy ; Neoplasm Staging ; Radiotherapy Dosage ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Carcinoma ; Cytological Techniques ; Humans ; Nasopharyngeal Neoplasms ; pathology ; Neoplastic Stem Cells ; cytology ; Oncogenes

Objective To evaluate the efficacy and safety of double-J stents in extracorporeal shock wave lithotripsy for the treatment of middle and upper ureteral calculi, and to explore the reasonable application of double-J stents. Methods 511 patients with middle and up-per ureteral calculi in our hospital were selected as the statistical objects. 161 patients of the catheter group were indwelled double-J stent be-fore extracorporeal lithotripsy while the other 350 patients in the no-catheter group underwent extracorporeal shock wave lithotripsy directly. The satisfaction rate of X-ray display location, gravel effect, and rate of adverse reaction were compared. Results The satisfaction rate of X-ray display location in the catheter group was higher than the no-catheter group (P=0. 025). And the gravel effect of the two groups were of statistical significance (P=0. 041). The incidence of hematuria and lower urinary tract symptoms in the catheter group was significantly high-er than that in the no-catheter group (P<0. 05). The incidence of renal colic in catheter group was lower than that in no-catheter group (P=0. 001). Conclusion Indwelling double-J stents is useful for stones display and localization, and it can improve the stone clearance rate. For ureteral stones whose diameter were less than 1 cm, double-J stents has little influence on the rate of stone clearance, but it can reduce the occurrence of severe renal colic.

Objective To study the effect of glutamine on hypermetabolism reaction and hormone secretion after severe burn injury. Methods Eighty-eight Wistar rats were inflicted with 30% total body surface area full thickness burns and randomly divided into two groups: namely burned control (B) and glutamine treatment(GLN) group. There was isonitrogenous and isocaloric intake in both groups, and rats of GLN and B groups were given glutamine and glycine at 1 0g/kg d, respectively. The following indices including the resting energy expenditure (REE), the levels of plasma cortisol, insulin and glucagon were determined. Results After burn injury, the REE, plasma cortisol,insulin and glucagons levels were significant increased in both groups. Compared with B group, the level of REE decreased and the ratio of insulin/glucagons increased in GLN group. Correlation analyses showed that REE had a negative correlation with insulin/glucagons ratio (r=-0 78,P

Objective To study the clinical features of cardiac arrest patients and the influence factors of effective resuscitation. Methods The clinical data of 76 patients in our hospital who underwent cardiac arrest and resuscitation were analyzed retrospectively. Results The effective resuscitation were observed in forty-seven patients (47/76, 61.8%), 28 patients completely survived(28/76,36.8%), and the total death rate was 63.2%. The successful rate of resuscitation was positive relation to the starting time of resuscitation, the way of cardiac arrest, and the structure and function of heart, but was negative relation to the times of cardioversion. The successful rate of resuscitation had indefinite relation with the patients age and gender. Conclusion The immediate cardioversion was the key factor of successful resuscitation.The successful resuscitation was dependent on the continuous and effective cardio-press. Basical cardio-disease was the major factor affecting prognosis.

Objective: To explore the effects of different nutrition support pathway on enterogenous hypermetabolism after severe burn injury. Methods: Eighty-eight Wistar rats were inflicted with 30% total body surface area full thickness burns and randomly divided into two groups: total parenteral nutrition (TPN) and enteral nutrition(EN) group. The following indices including the resting energy expenditure (REE), the plasma LPS, TNF and IL-1 level were determined. Results: After burn injury, the REE, TNF, LPS and IL-1 were significantly increased in two groups . Comparing with TPN group , the level of REE, TNF, LPS and IL-1 were significantly decreased in EN group (P

0.05).However,metabolic acidosis and hyperchloremia were observed with feeding arginine hydrochloride for 7 days in severe burned rabbits,and no such significant changes were found in arginine acetate group.CONCLUSION:Arginine acetate is safer than arginine hydrochloride in severe burned rabbits.

Objective The effect of fertilizer application on yield and quality of Notopterygium forbesii was studied in order to provide a theoretical basis for high quality and yield planting.Methods With various nitrogenous(N) and phosphorous(P) fertilizer formula,the field tests were carried out to determine the yield,extract content,and essential oil content,from the root of N.forbesill.Results Showed that various proportion of fertilizer had a great affect on yield,extract content,and essential oil content,and the treatment with N2P2 was the highest.The yield in the treatment with N2P2 increased 43.33%,the extract content increased 17.95%,and the essential oil content increased 43.48% as compared with CK.Different rates of fertilizer application had a certain effect on weight and diameter in the root of N.forbesii,and the N2P2 was the best.Each treatment had a significant effect on diameter in the root of N.forbesii in comparision with CK.Conclusion Amount and ratio of N and P fertilizers have a greater influence on the yield and quality,while improper application could reduce the yield and quality.

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