OBJECTIVE: To explore the preventive effect of transcutaneous phrenic nerve stimulation on ventilator-induced diaphragmatic dysfunction (VIDD) in patients requiring invasive mechanical ventilation. METHODS: A randomized controlled trial was conducted. The patients requiring invasive mechanical ventilation admitted to the intensive care unit (ICU) of Jiaxing First Hospital from November 2022 to December 2023 were enrolled. Participants were randomized into the control group and the observation group using a random number table. The control group was given ICU standardized nursing intervention, including turning over and slapping the back, raising the head of the bed, sputum aspiration on demand, aerosol inhalation, oral care, and monitoring of airbag pressure and gastric retention, the observation group was given additional transcutaneous phrenic nerve stimulation intervention on the basis of ICU standardized nursing intervention. The stimulation intensity was set to 10 U, the pulse frequency was set to 40 Hz, and the stimulation frequency was set to 12 times/min. Transcutaneous phrenic nerve stimulation was administered once a day for 30 minutes each time, for a total of 5 days. Diaphragm thickening fraction (DTF) and arterial blood gas parameters on days 1, 3, and 5 of intervention were compared between the two groups. After 5 days of intervention, other parameters including the incidence of VIDD, duration of mechanical ventilation, and length of ICU stay were compared. RESULTS: A total of 120 patients requiring invasive mechanical ventilation were enrolled, with 16 dropouts (dropout rate was 13.33%). Ultimately, 51 patients in the control group and 53 patients in the observation group were analyzed. Baseline characteristics, including gender, age, body mass index (BMI), acute physiology and chronic health evaluation II (APACHE II) score, albumin (Alb), hemoglobin (Hb), and disease type, showed no significant differences between the two groups. DTF in both groups gradually increased over duration of intervention [DTF on days 1, 3, and 5 in the control group was (20.83±2.33)%, (21.92±1.27)%, and (23.93±2.33)%, respectively, and that in the observation group was (20.89±1.96)%, (22.56±1.64)%, and (25.34±2.38)%, respectively], with more significant changes in DTF in the observation group, showing time effects (F_time = 105.975, P < 0.001), intervention effects (F_intervention = 7.378, P = 0.008), and interaction effects (F_interaction = 3.322, P = 0.038). Arterial blood gas parameters did not differ significantly before intervention between the groups, but after 5 days of intervention, arterial partial pressure of oxygen (PaO₂) in the observation group was significantly higher than that in the control group [mmHg (1 mmHg≈0.133 kPa): 100.72±15.75 vs. 93.62±15.54, P < 0.05], and arterial partial pressure of carbon dioxide (PaCO₂) was significantly lower than that in the control group (mmHg: 36.53±3.10 vs. 37.69±2.02, P < 0.05). At 5 days of intervention, the incidence of VIDD in the observation group was significantly lower than that in the control group [15.09% (8/53) vs. 37.25% (19/51), P < 0.05], and both duration of mechanical ventilation and length of ICU stay were significantly shorter than those in the control group [duration of mechanical ventilation (days): 7.93±2.06 vs. 8.77±1.76, length of ICU stay (days): 9.64±2.35 vs. 11.01±2.01, both P < 0.05]. CONCLUSIONS Transcutaneous phrenic nerve stimulation can improve diaphragmatic and respiratory function in patients receiving invasive mechanical ventilation, reduce the incidence of VIDD, and shorten the duration of mechanical ventilation and length of ICU stay.
Humans ; Transcutaneous Electric Nerve Stimulation ; Respiration, Artificial/adverse effects* ; Diaphragm/physiopathology* ; Phrenic Nerve ; Intensive Care Units ; Male ; Female ; Middle Aged

Objective To design a medical banking system to realize self register,self settlement,self printing and etc so as to enhance the efficiency.Methods The system was composed of a outpatient self-service sub-system,a hospitalization self-service sub-system,an appointment register sub-system by network bank,a cellphone App for self service,a comprehensive supervision and management platform for self-service system and self-service terminals,which had the functions such as hospital outpatient service,hospitalization self service and background supervision and management.Results Fulfilled the requirements of the patient on self register and settlement,and decreased the workloads of medical staffs.Conclusion The satisfaction over hospital service is enhanced greatly,and the system is of great value for practical application.

Objective To investigate the antitumor activity of the procaspase-3 activator SM-1 in BGC-823 cells in vivo and in vitro and the mechanisms.Methods The inhibitory effects of SM-1 on proliferation of BGC-823 cells were evaluated using MTT method, the cell apoptosis rate was detected by flow cytometry, and the expression of caspase-3 protein and procaspase-3 mRNA was detected by Western blotting and RT-PCR, respectively.SM-1 Antitumor activity was evaluated using the xenograft of BGC-823 cells in nude mice.Results SM-1 effectively inhibited the proliferation in vitro and in-duced apoptosis of BGC-823 cells in a dose-dependent manner.After treatment with SM-1 for 48 h, the protein expression levels of caspase-3 and mRNA expression levels of procaspase-3 were increased.SM-1 significantly inhibited growth of BGC-823 xenograft tumor at the 300 mg/kg dose and the inhibition rate was 56.3%(P<0.05).Conclusion SM-1 can significantly inhibit the tumor growth of BGC-823 cells in vivo and in vitro.The mechanism is possibly related to the activation of procaspase-3 and induced apoptosis of tumor cells.

Objective To investigate the clinical characteristics and prevalent features of an influenza erupting prevalence.Methods All of 653 patients with an erupting influenza were enrolled in the study from May 29,2003 to July 3,2003. The data included clinic manifestations and etiology. The retrospective study was used to evaluate the clinical and prevalent features. Results All patients consisted of 392 boys and 261 girls aged 5~17 years(mean 11.5 years),who were all students in middle school or primary school. Most of the patients had no typical symptoms including chill(2.45%),headache(30.00%),tiredness(10.87%)and the aching in whole body(4.44%),whereas fever,faucial inflammation and lymphatic follicular hyperplasia of the faucial posterior wall were the most common among these patients,accounting for 100%,60.03%,64.78% respectively. There were 98 patients whose peripheral leukocyte amounts were increased,most happening on the 6 ~7 th day from the onset(75.51%)following the fever on the 5~6 th day(80.6%). Detection of serum double virus-antigen indicated that influenza virus antibody increased more than 4-fold,as well as parainfluenza virus and adenovirus. Even in minority patients,there were several kinds of virus antibody raised 4-fold at the same time. We applied antivirus allopathy associated with the Chinese traditional medicine such as injection of shuanghuanglian or yuxingcao,plus the effectual antibiotics when necessary . All of the patients were cured and no sequelae. Conclusion Sometimes the influenza is prevalent only in some special crowds and has no typical symptoms such as chill,headache,tiredness and the aching in whole body.The antibiotics should be used in time after the synthetic treatment has no effect,when the patient has the onset for more than 5 days and has the fever for more than 4 days.