Objective To evaluate the effects of conventional mechanical ventilation (CMV) and mechanical ventilation with ideal PEEP and permissive hypercapnia (PHY + PEEPi) on expression of ?-defensin-2 (HBD-2) gene and protein in ventilator-associated pneumonia (VAP). Methods Forty-eight male SD rats weighing 280-320 g were randomly divided into 2 groups: (1) CMV group (VT = 12 ml? kg-1 , RR = 70bpm, FiO2 = 1.0) (n = 24) and (2) PHY + PEEPi group (VT =6 ml?kg-1 , RR = 90bpm, PEEP = 0.2 kPa, FiO2 = 1,0) (n = 24) . The animals were anesthetized with intraperitoneal 20% urethane 1 ml?100 g-1 , tracheotomized and mechanically ventilated. After being ventilated for 24 h P. aeruginosa (3 ? 108 CFU/ml) 0.2 ml was introduced into trachea to induce pulmonary infection. Three animals were sacrificed at following intervals: before and 1.5 h, 3h,6h,12h,3d and 5 d after introduction of P. aeruginosa. Lung tissaes were obtained from middle and lower lobes of left lung for microscopic examination and determination of expression of mRNA of HBD-2 by RT-PCR and HBD-2 protein level by Western blot analysis. Right lung was lavaged and broncho-alveolar lavage fluid (BALF) was collected for bacteriological examination. Results There were significantly more severe pathological changes in the lung in CMV group as compared with PHY + PEEPi group. In CMV group the levels of up-regulation of HBD-2 mRNA and protein expression were significantly lower after 3h than those in PHY + PEEPi group. The positive rate of blood and BALF bacterial culture was also higher in CMV group. The survival rate of PHY + PEEPi group was 76% , significantly higher than that of CMV group (40% ) ( P

AIM: To validate the alternations of flow velocity patterns in the infarct-related artery (IRA) during no-reflow phenomenon in a canine model of acute myocardial ischemia and reperfusion by transthoracic Doppler echocardiography (TTDE) combined with myocardial contrast echocardiography (MCE) by means of administration of Albunex. METHODS: Nineteen dogs first underwent 60 min myocardial ischemia and then followed by 60 min,120 min and 180 min reperfusion ( n = 6, 6 and 7, respectively). The perfusion defect area determined by MCE at 60 min myocardial ischemia was regarded as risk area (RAMCE). The perfusion defect area defined by MCE after reperfusion was considered as no-reflow area (NRAMCE). The ratio between NRAMCE and RAMCE ≥ 25 %was regarded as the development of no-reflow phenomenon and the ratio of NRAMCE to RAMCE＜25% was considered as the myocardial reflow. The coronary flow velocity parameters in IRA were determined through TTDE. RESULTS: Two dogs died during experiment and the remaining seventeen dogs completed throughout the procedure.There were seven dogs in reflow group and ten dogs in noreflow group. No significant difference was present in reflow group between at baseline and at 60 min reperfusion in systolic peak velocity (PVs), systolic velocity time integral (VT Is), corrected systolic flow duration (cFDs),diastolic peak velocity (PVd), diastolic velocity time integral (VT Id), corrected diastolic flow duration (cFDd),diastolic deceleration rate (DDR), corrected diastolic deceleration duration (cDDD) (P＞0.05), however, a significant difference was found in no-reflow group between at baseline and at 60 min reperfusion in PVs,VTIs, cFDs, PVd, VTId and cFDd (P＜0.05). The most marked alterations during diastolic phase were the increase of DDR and reduction of cDDD. CONCLUSION: The impaired microvasculature may profoundly affect the coronary flow velocity pattern in the IRA. The increase in microvascular resistance and decrease in coronary perfused pressure can contribute to the changes.Transthoracic Doppler echocardiography combined with MCE has the capability of noninvasive assessment of coronary flow velocity pattern in the IRA during no-reflow phenomenon.

Objective To explore the value of CD+4T lymphocyte count in laboratory diagnosis of AIDS complicated with pulmonary tuberculosis.Methods Forty-three patients with acute tuberculosis were selected as the subjects.Among them,14 patients had typical tuberculosis(X-ray or chest CT),29 cases were atypical tuberculosis(X-ray or chest CT).43 patients were examined by CD+4T lymphocyte count,sputum smear tuberculosis acid-fast bacilli test and T-SPOT.TB(interferon-γ release test),and the results of various methods were compared.Results The The number of CD+4T lymphocytes in patients with typical pulmonary tuberculosis was (151.26±59.47)/μL,and that in atypical pulmonary tuberculosis was (69.11±19.65)/μL,the difference was statistically significant(t=5.124,P<0.05);and with the reduction of CD+4T lymphocytes,AIDS patients showed more atypical pulmonary tuberculosis.The positive detection rates of CD+4T lymphocyte count,T-SPOT.TB and sputum smear were 86.05%,16.28% and 51.16% respectively.The positive rate of combined detection of three methods(90.70%) was significantly higher,the differences were statistically significant(x2=5.123,6.023,7.125,all P<0.05).Conclusion CD+4T lymphocyte count is of great value in the laboratory diagnosis of AIDS complicated with tuberculosis,and it is worthy to be widely carried out in clinical practice.

Objective To evaluate the value of the 7-joint ultrasound score (US7) in treatment of rheumatoid arthritis (RA) with Chinese and western medicine.Methods A total of 160 RA patients were divided into 2 groups based on different methods of treatment,including Yi Shen Qing Luo (YSQL) group and western medicine group.The patients were examined by grey scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) with US7 at baseline and after 3 and 6 months later.There were 7 related joints and 5 single factors for scoring in US7 system.The joints included the wrist joints,the second/third metacarpophalangeal joints (MCP Ⅱ/Ⅲ),the second/third proximal interphalangeal joints (PIP Ⅱ / Ⅲ) and the second/fifth metatarsophalangeal joints (MTP Ⅱ/Ⅴ).And the factors included synovitis of GSUS,synovitis of PDUS,myotenositis/tenosynovitis of GSUS,myotenositis/tenosynovitis of PDUS and bone erosion (ES).Meanwhile,the laboratory index included C-reactive protein (C-RP) and erythrocyte sedimentation rate (ESR) were examined.And the clinical indexes as disease activity score in 28 joints (DAS28) were evaluated.Results The statistical differences of synovitis of GSUS,synovitis of PDUS,myotenositis/tenosynovitis of GSUS and myotenositis/tenosynovitis of PDUS scores in US7 system were found in both 2 groups at baseline,3 months and 6 months after treatment (all P＜0.01).There was no statistical difference of ES before and after treatment in all cases (P＞0.05).The factors of US7 were positively correlated with DAS28,C-RP and ESR in different extent.Condusion US7 is a viable tool for examining patients with RA.

Objective To explore the effects of Tongfu Huayu Daotan Decoction (通化阏导痰汤)on the serum concentration of S-100β protein, neuron-specific enolase(NSE) and Prognosis in patients with severe craniocerebral injury.Methods Sixty patients with severe craniocerebral injury were randomly divided into a a'eatment group and a control group.The treated group was treated with Tongfu Huayu Daotan Decoction plus conventional treatments including dehydration,antibiotics, organ functional support, nerve nutrition, prevention of complication, etc.; the control group was treated with conventional treatments alone. The concentration of serum S-100β protein and neuron-specific enolase(NSE) in plasma at admission and at24, 36, 72huors, and 5, 7 days after treatment were determined respectively; the Glasgow outcome scale (GOS)and neurological deficits scoring at 2weeks and 4weeks after hospitalization were compared to observe the efficacy of the patients. Results The concentration of serum S-100β protein and neuron-specific enolase (NSE) in plasma at previous treatment and at 24, 36 hours after the treatment had no statistical difference in the two groups(P＞0.05 ), The concentration of serum S-100β protein and neuron-specific enolase (NSE) in plasma at 72huors, 5 and 7 days after the treatment in the Tongfu Huayu Daotan Decoction group were lower than those in the control group, the differences being significant (P＜0.01). The Glasgow outcome scale (GOS) and neurological deficits scoring at 2weeks and 4weeks after the treatment in the Tongfu Huayu Daotan Decoction group were significantly nigher than those in the control group, the differences being significant (P＜0.01) .Conclusion Tongfu Huayu Daotan Decoction can alleviate the plasma concentrations of S-100β protein and neuron-specific enolase (NSE) in patients with severe craniocerebral injury and markedly improve the clinical therapeutic effects. Combined Tongfu Huayu Daotan Decoction and western medicine can significantly reduce mortality and improve the Glasgow outcome scale (GOS), neurological deficits scoring and therapeutic effect.

Objective To evaluate clinical application value of polymerase chain reaction (PCR) detection for bacteria in peritoneal dialysis associated peritonitis (PDAP).Methods Peritoneal dialysis fluid specimens were collected from January 2014 to December 2014 in The First Affiliated Hospital of Anhui Medical University.Conventional bacterial culture and PCR detection were used respectively.According to the bacterial 16S rRNA gene, universal primers were devised and designed, based on reference, the specific primers of 17 kinds of experimental bacteria.Real-time fluorescent PCR (Real-time PCR, qPCR) amplification was implemented.The establishment of standard strain DNA extract was used as positive control;sterile double distilled water was used as negative control.Results (1) The traditional bacterial culture results showed that positive proportion was 26/40 in specimen of 40 cases, gram-positive strains accounting for 18/26.Main species were epidermis staphylococcus (5/26), hemolysis staphylococcus (4/26), escherichia coli (4/26), and streptococcus viridans (3/26).(2) The PCR detection results showed that total positive rate was 33/40 in 40 patients specimens, among which 2 cases of positive samples ended up with no specific strains being detected;the main bacteria strains in PCR were not different from ordinary culture results.(3) With bacterial culture as the gold standard, the detection sensitivity of PCR technology for PDAP pathogenic bacteria was 96.15％ and specificity was 42.86％;the detection positive rate was significantly higher than ordinary culture method.(4) PCR technology for detecting pathogenic bacteria could produce results within 4-6 hours, while reported positive results in the traditional bacterial culture would take (77.88±15.53) hours, which was significantly longer than PCR.Conclusion Compared with traditional bacteria culture method, PCR method is more sensitive, simple, and quick.Bacteria detection using PCR technique is of clinic applied value in PDRP.

Objective To investigate the effects of crude extracted proteins from lesions of condyloma acuminata on immunophenotypes of dendritic cells.Methods Plastic-adherent mononuclear cells(MNCs)were isolated from umbilical cord blood or peripheral blood and cultured in media containing cytokines(GM-CSF,IL-4and LPS).The morphology and phenotypes of these cells were analyzed by flow cytometry and microscopy in12day's culture.Cells on the fourth day were incubated with crude extracts from lesions of condyloma acuminata,foreskin proteins,and PBS,respectively,followed by phenotypic analysis after9-12days' culture.Results Expression of antigens CD1a,CD80,CD86,MHC-I,MHC-II,CD14,CD54was detected after12days' cul-ture.It was shown that MNCs could be induced to differentiate to mature dendritic cells in our culture system.After incubation with crude extracts from lesions of condyloma acuminata for another9-12days,expression of CD86and HLA-DR was increased on dendritic cells.Conclusions Compared to foreskin and PBS pulsed dendritic cells,expression of CD86and HLA-DR is upregulated on dentritic cells after pulsing with condyloma acuminata lesion proteins.The data suggest that crude extracts from lesions of condyloma acuminata might enhance antigen-pre-senting capacity of dendritic cells and strengthen activation of T lymphocytes.

AIM: To understand the effect of the RB1 gene mutation on the function of pRB (the protein product of the RB1 gene) in the patients with retinoblastoma (RB). METHODS: The genomic DNA from retinoblastoma patients was extracted. After amplification, the promoter and all 27 exons were screened by SSCP-heteroduplex method. The mutation was cloned and identified by sequencing. The effect of the mutation product on the function of pRB was analyzed. RESULTS: One missense mutations of the exon 4 of the RB1 gene was identified in the genomic DNA from RB patients. This mutation was outside the large pocket of the pRB. No mutation of the RB1 gene was found in the genome DNA of the patient's parents. This is the fourth report that there was a genome mutation located outside the large pocket of pRB in the RB patients. CONCLUSION: The amino-terminus of the pRB may be essential for growth suppression.

Objective To observe the efficacy of a rotating magnetic field and granisetron hydrochloride in preventing nausea and vomiting caused by a eisplatin regimen, and any side effects. Methods Sixty-eight patients receiving cisplatin regimen chemotherapy were randomly assigned to two groups: a magnetic treatment group and a drug treatment group. The patients in the two groups were exposed to a rotating magnetic field or received granisetron hydrochloride, respectively. The effects of the treatments were observed. Results Both treatments could effectively prevent and treat the vomiting caused by chemotherapy. The rate of response to the rotating magnetic field was 88.2% and to the drug 91.2%. However, tardive vomiting was significantly better controlled in the rotating magnetic field group. The incidence of side effects in the magnetic field group was 20.6% , and in the drug treatment group it was 45.6%. Conclusion The efficacy of a rotating magnetic field and granisetron in treating acute vomiting were simi- lar. The rotating magnetic field was more effective in preventing tardive vomiting and had fewer side effects. Magnetic therapy should be more generally applied in clinical practice.

Taking Suxi Healthcare Center in Yiwu City, Zhejiang province as an example, the paper analyzed the present mission and organizational characteristics of township healthcare centers in China, especially their dual functionality of community public health and primary medicare. Based on such analysis, it designed a matrix-based model for organizational structure and job performance management for such heslthcare centers. The features are as follows. 1) The two dimensions of the matrix structure refer to the departments for medical treatment and the multi-village doctors team in the community, respectively and jointly offering primary medicare and public health services; 2) Jobs are designed based on the organizational structure and functionality. Every job carries out dual Junctions as described and managed by the job description and target responsibility certificate; 3) The job responsibility certificate is a breakdown of the balanced scorecard of the healthcare center, as divided between the departments for medical treatment and the multi-village doctors team; 4) The balanced scorecard of the township healthcare center is designed based on its strategic mission and developing plan. The entire organizational design and management of the center are built on the strategic orientation and logical programmed research.