This paper introduces the airway care of a patient with motor neuron disease treated with mechanical ventilation for eight years. The airway care for the patient focused on individualized suctioning,measures to prevent atelectasis such as lung hyperinflation,adjustments of ventilator parameters,regular weaning exercise,as well as measures to prevent ventilator-associated pneumonia such as prevention of aspiration,strict disinfection and isolation,wound care of tracheotomy. The ventilator-associated pneumonia was effectively prevented. Effective nursing care for patients with long-term mechanical ventilation can prevent atelectasis and ventilator-associated pneumonia.

Objective:To study the analgesic effect of dezocine combined with sufentanil in hip arthroplasty. Methods:Totally 60 patients with hip arthroplasty were randomly divided into the observation group and the control group. The 30 patients in the observation group were treated with dezocine combined with sufentanil, and those in the control group were treated with sufentanil. The analgesic efficacy and adverse reactions in the two groups were investigated and analyzed. Results:The visual analog scale ( VAS) in the obser-vation group in 3h, 6h, 12h, 24h and 48h after the surgery was significantly lower than that in the control group (P<0. 05). MMSE score in the observation group in 1h, 3h and 5h after the surgery was higher than that in the control group (P<0. 05). The total effec-tive rate of the observation group was 100. 00%, which was much higher than that of the control group (70. 00%, P<0. 05). There was significant difference in the adverse reactions between the two groups(P<0. 05). Conclusion:The efficacy of dezocine combined with sufentanil used in hip arthroplasty is significant with lower incidence of adverse reactions, which is worthy of popularized applica-tion in clinical practice.

Objective To study the value of RDW in severity evaluation and prognostic assessment of COPD. Methods Retrospective study was carried out on 115 COPD patients and 50 healthy controls. Blood routine, CRP, IL-6 data were collected on admission aiming at analyzing RDW difference in patients and controls, severity, severity grading and evaluation of prognosis. Results The level of CRP, RDW, IL-6 and WBC in patients were higher than that of healthy controls(P < 0.05). Mild and moderate groups have no significant difference from each other in terms of RDW, CRP and IL-6 conparison, but the difference between any other two groups were significant. There were significant positive correlation between RDW and CRP, IL-6, and negative correlations between the post-bronchodilator FEV1% and RDW. The mortality rate for patients with higher RDW level was higher than those with normal RDW. Conclusion Elevated RDW levels on admission are associated with severity of patients with COPD. RDW may be a prognostic marker for COPD.

Objective Analyzing NNT epidemiological characteristics and the influeutial factors in Guangdong province from 2001 to 2005 in order to formulate the strategies for elimination NNT.Methods To make descriptive study on the data collected from NNT surveillance system. Results 2832 cases were concentrated in the Pearl River Delta and the west of Guangdong.About 72.04% NNT cases occurred in the migrant children.Through analyzing the data of the year of 2004 and 2005,73.81% of migrant NNT cases occurred in the Pearl River Delta.The cases happened in the Pearl River Delta accounted for 90.18% of whole cases.Most of local cases occurred in the west of Guangdong,which accounted for 39.04% of local cases.The cases occurred all around the year.A seasonal peak of NNT was found from June to August.Most of the onset of disease were during 2～10 days after birth.There were a higher ratio of reported male cases to the female.The ratio was 2.08∶1.Most of the NNT cases were happened to the infants who delivered at home and most of the midmives who were responsible for delivery lacked of training.99.75% mothers did not kown or administe the tetanus toxoid vaccine. Conclusion The elimination of neonatal tetanus is a difficult task in Guangdong province.Publicity to the mass should be strenghtened.The cooperation between sectors should be conducted for NNT eliminodion.

Objective; To express and purify HCA518 protein and prepare its monoclonal antibody ( McAb). Methods: The HCA518 protein was expressed with gene recombinant technique in prokaryotic system and purified with nickel chelate nitrilotriacetic acid(Ni-NTA) affinity chromatography column. Hybridoma cell lines that secreted anti-HCA518 McAb were established by cells fusion and screened by enzyme linked immunosorbent assay( ELISA). The specificity of anti-HCA518 McAb wa3 identified by Western blot assay. The HCA518 protein in tumor cells was stained by immunoflourescence assay. Results: Rcombinant HCA518 protein was expressed with a purity of 98%. Two hybridoma cell lines was selected and anti-HCA518 McAb was purified from mice ascites. The titers of anti HCA518 McAb in ascites were 1?10-4 and 5?10-4 respectively. The antibody belonged to IgG2b subtype and IgM. Anti-HCA518 McAb specifically reacted with recombinant HCA518 protein and tumor cells'nuclear protein (P100). The HCA518 protein was mainly located in cell nucleus. Conclusion: Stable hybridoma cell lines that secreted anti-HCA518 McAb have been established and anti HCA518 McAb was prepared with high specificity. It has important significance for detecting HCA518 protein in tumor tissues and determining malignant proliferation status of tumor cells and predicting its prognosis.

Objective:To observe the clinical effects of dexmedetomidine(DDM)under monitored anesthesia care(MAC)in oral and maxillofacial patients undergoing percutaneous dilatational tracheostomy(PDT).Methods:38 patients with oral and maxillofa-cial tumor undergoing PDT before surgery were randomly assigned into 2 groups(n =19).Patients in group D received a single-dose DDMof 0.5 μg/kg infused for 10 min;those in group Mreceived 2 mg of midazolam and 1 μg/kg of fentanil.Then all patients were given local anesthesia followed by PDT.MAP,HR and SpO2 were monitored before (T0 )and after drug administration (T1 ),at T2 (skin incision)and T3 (insert dilation catheter).Ramsay scorce,bucking,respiration depression and adverse cardiovascular reaction were recorded.All patients were followed up 24 h postoperatively for the observation of adverse recall of PDT.Results:Compared with T0 ,at T1 ,T2 MAP and HR in group D were lower,but MAP and HR at T3 in group Mwere higher(P <0.05).At T1 ,T2 and T3 ,MAP and HR in group D were significantly lower than those in group M(P <0.05).During operation,the incidence of bucking and respiration depression in group D was lower than that in group M(P <0.05).Conclusion:During PDT operation under MAC,a single-dose dexmedetomidine is effective in stablizing hemodynamics,reducing bucking and respiration depression.

Objective To explore the condition and method of primary cultures of atrial myoeytes in sukling guinea pig .Methods The atrial myoeytes of sukling guinea pig with 1‐2 d old were taken and digested once by 0 .06% trypsin ,then repeatedly digested by 0 .08% type Ⅱ collagenase for four times .And the cells after former twice ,latter twice and former and latter four times of diges‐tion were adopted for conducting respective culture .The influence of three kinds of culture method on atrial myocytes production , survival rate ,pulsating rate and purification rate were observed .Results Three kinds of culture method all obtained the considera‐ble number of atrial myocytes and a higher survival rate ,pulsation rate and purification rate ,particularly the cell culture method af‐ter latter twice digestion .Conclusion Once digestion by 0 .06% trypsin and 0 .08% type Ⅱ collagenase for four times can isolate a great quantity and good condition of atrial myocytes .

Objective To investigate the structural response of diaphragm and soleus of the rat after mechanical ventilation (MV), and to explore the specific mechanism of the dysfunction of both muscles.Methods Sixteen male Sprague-Dawley (SD) rats were randomly divided into control group and MV group, with 8 rats in each group. Rats in MV group were treated with controlled ventilation and maintained anesthesia, and those in control group were only anesthetized without MV and maintained anesthesia. The diaphragm and soleus were harvested after MV for 18 hours, and the morphology changes were observed with light microscope. The cross section of muscle fiber was observed by immunofluorescence technique analysis, and the cross-sectional area of muscle fiber was calculated. The ultra structural changes in muscle fibers were observed under transmission electron microscope.Results ① Observed under light microscope, the cross section of the diaphragm and soleus muscle in the control group was regular, the nucleus was normal and the cytoplasm was homogeneous. The fibers in the diaphragm-biopsy specimens from MV subjects were smaller than those from control subjects, whereas these signs were not found in soleus. But fiber atrophy in MV specimens was not accompanied by an inflammatory-cell infiltrate. ② Under the fluorescence microscope, the control group had a smaller cross-section of the slow-twitch muscle in diaphragm, while the fast-twitch muscle fibers werelarger. As compared with diaphragm-biopsy specimens from control, specimens from MV subjects showed decreased cross-sectional areas of slow-twitch and fast-twitch fibers, respectively (μm2: 1069.00±155.24 vs. 1297.12±331.15, 2279.66±442.31 vs. 3031.80±596.11, bothP < 0.05). The disproportionate decrease in fast-twitch fibers cross-sectional areas [(70.42±3.61)% vs. (75.63±2.48)%] resulted inan increase in the percentage of total area occupied by the slow-twitch fibers [(29.58±3.61)% vs. (24.35±2.48)%, bothP < 0.01]. There were no significant differences in cross-sectional areas of slow-twitch and fast-twitch fibers in soleus between control group and MV group (μm2: 3193.80±559.36 vs. 3008.84±559.22, 3392.86±514.56 vs. 3594.35±651.67, bothP > 0.05). ③ In the control group, the muscle fibers of the diaphragm and soleus were arranged orderly, the boundary of the light and dark bands and the Z-line were clear, and there was no autophagy in the visual field. The outer membrane of the mitochondria was complete, and the cristae were in the shape of clapboard. The signs of misalignment of myofibrils, disruption of Z-line and vacuolar mitochondria were found in diaphragm from MV group, whereas these signs were not found in soleus. Diaphragm from MV group exhibited an increase in autophagic vesicles visualized by transmission electron microscopy as compared with control group.Conclusions Controlled MV for 18 hours resulted in diaphragmatic inactivity and promoted muscle injury and atrophy, while autophagy and mitochondrial dysfunction were enhanced. Soleus immobilization for 18 hours was not associated with muscle atrophy. These facts suggest that the signaling associated with diaphragm atrophy during MV may involve different mechanisms compared with other models of muscle atrophy. Diaphragm appeared to be more susceptible to MV.

OBJECTIVE To investigate the clinical distribution and drug resistance of clinical Pseudomonas aerugilosa isolates,and offer reasonable experimental data for clinical therapy.METHODS P.aerugilosa was identified by ATB Expression system,and its drug resistance was determined by Kirby-bauer and ATB Expression method.RESULTS The main departments in which frequently P.aerugilosa infection accurred were Intensive Care Unit(41.2%) and Respiration Departments(19.3%).The common site of P.aerugilosa infection was respiratory tract(68.2%).The sensitive rate of P.aerugilosa to polymyxin E and cefoperazone/sulbactam was the highest(95.1% and 91.4%),while to meropenem and imipenem was 77.5% and 70.6%.The highest resistant rate of P.aerugilosa to trimethoprim/sulfamethoxazole,ampicillin/sulbactam was 97.1% and 95.1%.The resistunce to ciprofloxacin,ticarcillin and piperacillin,were 64.9%,63.3% and 56.3%.CONCLUSIONS P.aeruginosa is major pathoge in our hospital.It is important to select antibiotics correctly according to the results of susceptibility tests.

ObjectiveTo investigate the role of lymphocyte apoptosis and endoplasmic reticulum stress (ERS) on the development of sepsis and their association with the prognosis of sepsis patients.Methods A prospective cohort study was conducted. Seventy septic patients admitted to intensive care unit (ICU) of Shanghai East Hospital of Tongji University were enrolled. Blood samples were collected on days 1, 3 and 7 to measure percentage of circulating apoptotic lymphocyte with flow cytometry analysis. The relative expressions of endoplasmic reticulum specific glucose regulated protein 78 (GRP78) mRNA and transcription factor CHOP mRNA were measured by real-time reverse transcription-polymerase chain reaction (RT-PCR). The correlation between CHOP mRNA expression and percentage of circulating apoptotic lymphocyte was analyzed by Spearman relative analysis. The patients were divided into death (n = 23) and survival subgroups (n = 47). Twenty healthy volunteers during the same period were selected as the healthy control group.Results① Rate of lymphocyte apoptosis: compared with healthy control group [(2.86±0.66)%], septic patients, either survival or death subgroup, exhibited higher rate of lymphocyte apoptosis on days 1, 3 and 7 [survival subgroup: (12.44±4.43)%, (8.57±3.38)%, (6.78±3.35)%; death subgroup: (14.42±2.01)%, (11.32±2.53)%, (8.87±3.62)%, allP< 0.01], and it was obvious on day 1, and the phenomenon became less marked gradually. The rate of circulating apoptotic lymphocytes did not differ between the death and survival subgroups on day 1, but there was a significant difference in the rate on day 3 and day 7 (bothP< 0.05).② The expression of CHOP mRNA (2-ΔΔCt):compared with that in healthy controls [(2.56±1.09)×10-3], CHOP mRNA expression was increased on days 1, 3 and 7 in septic patients [survival subgroup: (5.83±1.96)×10-3, (4.24±1.60)×10-3, (4.15±1.64)×10-3, death subgroup:(37.20±20.70)×10-3, (18.80±13.90)×10-3, (9.28±7.78)×10-3, allP< 0.01], and it was more obvious in the death subgroup, as it was increased by 6.38, 4.43, and 2.24 folds (P values was 0.000, 0.000, and 0.001), but it decreased rapidly in death subgroup.③ The expression of GRP78 mRNA (2-ΔΔCt): compared with healthy controls [(3.31±2.04 )×10-3], the expression of GRP78 mRNA in both survival and death subgroups increased in septic patients on day 1 [(5.83±2.00)×10-3, (11.30±6.48)×10-3, bothP< 0.01], and they decreased subsequently. The expression of GRP78 mRNA in the survival subgroup declined to the levels of the healthy control group on day 3 and day 7 [3 days: (3.99±1.60)×10-3, 7 days: (3.30±1.35)×10-3, bothP> 0.05], and GRP78 mRNA expression in the death subgroup was gradually lowered, but it was still higher than that in the healthy control group [3 days: (7.27± 3.64)×10-3, 7 days: (5.23±1.94)×10-3, bothP< 0.01].④ Spearman relative analysis showed that the expression of CHOP mRNA was positively correlated with the rate of lymphocyte apoptosis (r = 0.414,P = 0.000 ).Conclusion The increase in the rate of lymphocyte apoptosis and activation of ERS play an important role in the development of sepsis, and it is associated with worse outcome in the septic patients.