Objective To observe the application of modified perfusion device pre-flushing method in double plasma molecular adsorption system (DPMAS) treatment and nursing care effect on patients with liver failure. Methods A retrospective analysis was conducted; 56 patients with liver failure who were consistent with the enrolled standard and admitted to the Surgical Intensive Care Unit (SICU) of Beijing Chaoyang Hospital fromJune 2014 to December 2016 were the objects of the study and their clinical data were collected. Ten patients involving the results of 17 case times from June 2014 to April 2015 were selected as the control group by using the traditional method of pre-flushing, and 46 patients involving the results of 68 case times from May 2015 to December 2016 were chosen as the observation group by using the modified perfusion device pre-flushing method. Both groups adopted effective nursing care cooperation: such as closely observe the changes of symptoms and signs of patients during the peri-treatment period, strengthen psychological care, maintain pipeline properly, and carry out the preventive management of anticoagulation and potential complications. The changes of symptoms and signs in the patients of two groups were observed, the DPMAS pre-flushing time and single time effective treatment time of the two groups were compared, before and 3 days after DPMAS treatment, the changes of serum total bilirubin (TBil), total bile acid (TBA) and its clearance rate, the changes of electrolytes, liver and kidney functions, blood routine and blood coagulation function were observed and compared between the two groups to evaluate and analyze the therapeutic effect of DPMAS.Results In the two groups, there were 56 patients involving 85 case times of DPMAS treatment all successfully completed, and the patients' symptoms and signs were improved significantly. The pre-flushing time of the observation group was obviously shorter than that in the control group (minutes: 29.5±13.1 vs. 38.9±14.7), and the single effective treatment time was obviously longer than that in the control group (minutes: 6.7±1.1 vs. 3.4±0.9,P < 0.05). After treatment, the TBil, TBA, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and albumin (ALB) in two groups were decreased significantly compared with those before treatment, the prothrombin time (PT) was markedly prolonged compared with that before treatment (allP < 0.05), and the degrees of improvement in the observation group were more obvious than those of the control group (butP > 0.05), and urea nitrogen (BUN), creatinine (Cr), hemoglobin (Hb), platelet count (PLT), Na+ and K+ had no significant changes compared with those before treatment (allP > 0.05). The TBil clearance rate [(42.5±15.5)% vs. (32.9±13)%] and TBA clearance rate [(27±8.9)% vs. (17.1±5.8)%] in the observation group were significantly higher than those in the control group (allP < 0.05). There were no adverse events such as electrolyte disturbance, errhysis or bleeding found in the two groups during the treatment. In the study, there were 8 case times with self feeling of skin itching, 8 case times of skin rash, 6 case times of nausea and vomiting, 6 case times of chest tightness, 5 case times of blood pressure dropping phenomena and 4 case times of fever symptoms, and after the symptomatic treatments and nursing intervention, all the above symptoms were relieved or disappeared.Conclusion The modified perfusion device pre-flushing method can effectively elevate the pre-flushing effect and therapeutic effect, it is simple, time-saving, can reduce the economic burden of the patients, thus it is worthy to be used widely in clinic, during the therapeutic process, reasonable and effective nursing measures are practiced, that is the key to guarantee the successful treatment of patients.

Objective To detect the expression levels of RAD21(S.Pombe RAD21 homolog)in lung cancer,and assess its clinical significance and potential functions. Methods The expression level of RAD21 in lung cancer was determined by Western blot and immunohistochemistry meth?ods;the RAD21 mRNA expression in lung cancer was analyzed through Oncomine database;the relationship between the RAD21 expression levels and prognosis in patients with lung cancer was studied by Kaplan Meier curve;the RAD21 functions in lung cancer were predicted by using gene set enrichment analysis. Results Compared with adjacent normal tissue,the protein level of RAD21 in lung tissues were upregulated . The data from Oncomine database showed that RAD21 mRNA levels were significantly higher than the normal control groups in multiple lung cancer datasets(P<0.01);in addition,Kaplan?Meier survival curves showed that the RAD21 expression levels was correlated with the survival of patients with lung can?cer(P<0.05);gene set enrichment analysis indicated that RAD21 was mainly enriched in apoptotic signaling pathways and cell cycle regulation gene sets. Conclusion The downregulated RAD21 could be used as a biomarker to assess the prognosis of lung cancer patients. In addition, RAD21 may be involved in the regulation of cell cycle and apoptosis,which affects the development and progression of lung cancer.

Objective To investigate the level of illness uncertainty among family members of patients in surgical intensive care unit (ICU) and analyze its potential influencing factors based on Mishel′s theory. Methods A sample of 260 family members were recruited from the surgical ICU during the period from September 2014 to June 2015. Illness uncertainty was assessed by the Mishel Uncertainty of Illness Scale-Family Member. General variables questionnaire, Social Support Rating Scale, Simplified Coping Style Questionnaire were also examined to explore the influencing factors. Results The score of illness uncertainty was ( 96.75 ± 13.90 ) points in family member of patients in surgical ICU, at a high level. Multiply liner regression showed that social support (P=0.011), positive coping style (P=0.027) and average family income (P=0.033) were significant influencing factors of illness uncertainty. Conclusions The level of illness uncertainty is high among family members of patients in surgical ICU. There is a need for nurses to provide accessible social support and psychological intervention, help them cope with illness uncertainty positively.

Objective To investigate the relationship between the expression of Toll-like receptor 4 (TLR4) on mononuclear cells in peripheral blood and changes of serum vitamin D level in children with bronchiolitis.Methods The children who were diagnosed as bronchiolitis and received treatment in the Second Affiliated Hospital of Harbin Medical University from October 2013 to January 2014 were chosen as the pre-treatment group,and then divided them into moderate group and severe group according to the clinical symptoms,20 cases for each group.Then the cases in pre-treatment group who recovered after treatment were recruited as the after-treatment group,and the children who were healthy and medical examination in the Second Affiliated Hospital of Harbin Medical University in the same period were recruited as the healthy control group.The expressions of TLR4 on CD14 labeled mononuclear cells in the periphera were measured by flow cytometry.The level of 25 (OH) D in serum was detected by enzyme linked immunosorbent assay (ELISA).Results (1) The expression level in children with bronchiolitis of TLR4:the mode-rate group [(18.98 ±2.29)％] and severe group [(30.13 ±2.13)％] increased significantly (P ＜0.05) compared with control group [(1.17 ± 0.57) ％].And the expression level of moderate group [(2.02 ± 0.48) ％] and severe group [(11.43 ± 1.52) ％] decreased significantly after treatment (P ＜0.05).(2) Serum vitamin D level in children with bronchiolitis of the moderate group[(17.16 ± 3.34) μg/L] and severe group [(6.56 ± 2.28) μg/L] were lower than healthy control group [(53.69 ± 20.18) μg/L] before treatment (P ＜ 0.05),especially the severe group [(6.56 ±2.28) μg/L].The level of moderate group [(9.59 ± 2.31) μg/L] and severe group [(4.70 ± 0.67) μg/L] became lower after treatment (P ＜ 0.05).(3) Both severe group (r =-0.491,P ＜ 0.05) before treatment and moderate group (r =-0.436,P ＜ 0.05) after treatment showed negative correlation between TLR4 on mononuclear cells in peripheral blood and serum 25 (OH)D level in children with bronchiolitis.And no correlation was found among healthy control group,moderate group before treatment and severe group after treatment (P ＞ 0.05).Conclusions The conditions of children with bronchiolitis was positively correlated with the expression level of TLR4,and negatively correlated with the vitamin D level.The serum 25 (OH) D decreased steadily during the treatment.The expression of TLR4 in monocytes has a certain correlation with the level of vitamin D in children with bronchiolitis.

Objective To analyze the effects of individualized lifestyle intervention on compliance and metabolic status of patients with type 2 diabetes mellitus (T2DM).Methods Two hundred T2DM patients were selected and randomly divided into experimental and control groups of 100 patients respectively.The experimental group was given individualized lifestyle intervention for 6 months in addition to conventional oral medications.The intervention was to prescribe diet control and exercise therapy according to the patients' individual conditions.The control group was given conventional treatment and verbal lifestyle intervention for 6 months.Comparison was made in patients compliance and various metabolic markers between the two groups.Results The percentage of conduction of diet control and exercise therapy in experimental group was significantly higher than control group ( Diet control:80 vs.52,x2=7.08,P=0.029;Exercise therapy:78 vs.44,x2=11.207,P=0.004).After intervention,the fasting plasma glucose (FPG),2-hour postprandial blood glucose (2hPG),glycated hemoglobin ( HbA1c),body mass index ( BMI),triglyceride ( TG),total cholesterol (TC),low-density lipoprotein ( LDL-C ),and insulin resistance index ( HOMA-IR ) in experimental group decreased significantly,and high-density lipoprotein ( HDL-C ) increased significantly [FPG:( 8.45 ± 1.46 ) mmol/L vs.(6.66 ± 0.67) mmol/L,P=0.000;2hPG:( 12.76 ± 2.25 ) mmol/L vs.(8.22 ± 1.79) mmol/L,P=0.000;HbA1c:(7.68 ± 1.06 ) ％ vs.( 6.48 ± 0.69 ) ％,P=0.000;BMI:( 25.90 ± 1.72 ) kg/m2 vs.( 22.81 ±1.41 ) kg/m2,P=0.016;TG:(2.57 ±0.68) mmol/Lvs.( 1.88 ±0.35) mmol/L,P=0.006;TC:(5.72 ±0.13) mmol/L vs.(5.14 ± 1.38) mmol/L,P=0.043;LDL-C:(3.28 ±0.10)mmol/L vs.(2.81 ±0.57)mmol/L,P=0.009;HOMA-IR:7.58 ± 0.19 vs.4.58 ± 1.98,P=0.000;HDL-C:( 1.29 ± 0.04) mmol/L vs.( 1.62 ± 0.27 ) mmol/L,P=0.003].The levels of FPG,2hPG,HbA1c,BMI,TG,HOMA-IR also decreased in control group after intervention compared with before intervention [FPG:( 8.67 ± 2.71 ) mmol/L vs.( 7.26 ± 1.21 ) mmol/L,P=0.001;2hPG:( 12.82 ± 2.15 ) mmol/L vs.( 10.85 ± 1.98 ) mmol/L,P=0.000,HbA1c:( 7.75 ± 1.08 ) ％ vs.( 7.01 ± 0.87 ) ％,P=0.002;BMI:( 25.82 ± 1.74 ) kg/m2 vs.( 24.23 ± 1.36 ) kg/m2,P=0.024;TG:(2.47 ±0.75) mmol/L vs.(2.13 ± 0.43 ) mmol/L,P=0.018;HoMA-IR:7.88 ± 0.20 vs.6.15 ± 2.01,P=0.042].No significant difference was found on the values of TC,HDL-C and LDL-C before and after intervention in control group (P ＞ 0.05).The effect of intervention of experimental group was more obvious when compared with control group ( FPG:P=0.036;2hPG:P=0.000;HbA1c:P=0.045;BMI:P=0.037;TG:P=0.022;HoMA-IR:P=0.000).Conclusion Individualized lifestyle intervention can improve the compliance of T2DM patients,and was in favor of control metabolic status of T2DM patients to delay the occurrence and development of complications.

Objective To detect the methylation status of p16 gene promoter in CD4~+ T cells of patients with systemic lupus erythematosus(SEE),and its significance in the pathogenesis of SLE.Methods The pl 6 gene promoter methylation in peripheral CD4~+ T cells was detected with the Taqman probe-based realtime PCR(Methylight)technology in 28 patients with SLE and 20 healthy human controls.Results The methylation rate of p16 gene promoter in peripheral CD4~+ T cells was higher in patients with SLE than that in the controls(35.7%VS 10%,x~2=4.11,P<0.05).There was no correlation between SLE disease activity index (SLEDAI)and the normalized index of methylation(NIM)of p16 gene promoter(r_s=-0.29,P>0.05).Conclusion The methylation status of p16 gene promoter is aberrant in CD4~+ T,:ells of SLE patients,suggesting that the hypermethylation of p16 gene plays a certain role in the pathogenesis of SLE.

AIM:To investigate the effects of seipin gene deficiency on renal injury and the possible mecha-nisms in seipin-/-mice.METHODS:Six-month-old male seipin knockout ( seipin-/-) and wild-type ( WT) mice ( n=8) were used to study 24 h urinary albumin excretion ( UAE) , renal functions, pathological changes, and plasma leptin and adiponectin levels.Seipin mRNA expression in different tissues and each part of the kidney was also measured in WT mice.RESULTS:Real-time PCR analysis showed seipin mRNA expression in WT mice was higher in adipose tissue and testicles, and was also found in the kidney, which was mainly in glomeruli.Compared with control group, seipin-/-group showed increased kidney weight/tibia length (P<0.01), 24 h UAE (P<0.01), creatinine clearance (P<0.01), and glomerular and mesangial surface area (P<0.05).Both plasma leptin (P<0.01) and adiponectin (P<0.05) levels were significantly decreased in seipin-/-mice.CONCLUSION:Seipin gene deficiency in mice leads to renal injury prob-ably by decreasing plasma leptin and adiponectin levels due to lack of adipose tissue.

Objective:To examine the expression ofphospholipase A2 receptor (PLA2R) in renal tissues and the level of anti-PLA2R antibody in serum in patients with idiopathic membranous nephropathy (IMN) and secondary membranous nephropathy (SMN),and to evaluate their diagnostic value in IMN.Methods:A total of 73 patients,who were diagnosed between May,2014 and February,2015 in the Department of Nephrology of the Second Xiangya Hospital,Central South University,were divided into three groups:an IMN group (n=48),an SMN group (n=17) and a minimal change disease group (n=8) according to the renal biopsy.PLA2R expression in renal tissues and the level of antiPLA2R antibody in serum were detected by indirect immunofluorescence technique.Results:The positive rate and fluorescence intensity for PLA2R in the renal tissues in the IMN group were higher than those in the SMN group (91.7％ in the IMN group vs 29.4％ in the SMN group,P＜0.05),while the positive rate and serum level for anti-PLA2R antibody in the IMN group were higher than those in the SMN group (85.4％ in the IMN group vs 29.4％ in the SMN group,P＜0.05);the expression of PLA2R in renal tissues and the serum level for anti-PLA2R antibody were not detected in the minimal change disease group,The serum level of anti-PLA2R antibody was positively correlated with 24 h urine protein (r=0.432,P＜0.01) and negatively correlated with serum albumin (r=-0.307,P＜0.05).Conclusion:The expression of PLA2R in renal tissues and the serum level of anti-PLA2R antibody might be potential markers for diagnosis oflMN.

Objective K93T point mutation exists in the quinoid dihydropteridine reductase ( QDPR) of OLEFT rats which catalyzes QDPR into tetrahydrobinopterin(BH4), while dihydrofolate reductase(DHFR) can reduce QDPR to BH4, which implies crosstalk between hydrobiopterin and folate metabolism.By investigating the influence of QDPR expression on DHFR expression of NRK-52E cells, the article aimed to find out the possible underlying mechanism of QDPR gene in diabetic nephropathy ( DN). Methods Western blot was performed to identify the expression level in NRK-52E cell under high glucose ambience and DHFR pro-tein expression of OLETF rats.NRK-52E cells were transfected by the lentivirus to establish no-load overexpression, overexpressed QDPR and knockdown QDPR models.Each group was given 5.4 mmol/L normal sugar medium and 30mmol/L in high glucose ambi-ence for 72 hours'cell cultivation to simulate DN model.Observation was made on the influence of QDPR gene expression levels on DHFR in high glucose ambience. Results The western blot analysis revealed that DHFR protein decreased in NHG group( [0.33 ± 0.16] vs [0.64 ±0.5], P<0.05) and OLETF rats cortex ([0.56 ±0.16] vs [1.03 ±0.12], P<0.01).In high glucose ambi-ence, compared with LV-OCON-HG group, the protein expression of DHFR was significantly decreased in LV-QDPR-HG group ([0.12 ±0.09] vs [0.63 ±0.08], P<0.01).No difference was found in the comparison of DHFR expression levels between LV-SHQDPR-HG and LV-SHCON-HG group. Conclusion DHFR protein expression decreases in NRK-52E cells of high glucose and LOLETF rat model, which suggests that DHFR protein plays an important role in the development of DN.QDPR overexpression leads to the decreased expression of DHFR, which implies that overexpressed QDPR influences the occurrence and process of DN by down-regulating DHFR expression level.

_ Objective_ To study whether quinoid dihydropteridine reductase ( QDPR ) expression level change can affect oxidative stress of NRK-52E renal tubular cells in a high glucose environment. Methods The NRK-52E model of overexpression, knockdown QDPR gene and respective control were constructed by lentivirus. All groups were given 5. 4 mmol/L and 30 mmol/L glucose culture medium respectively to imitate normal and high glucose condition. The level of superoxide anion ( O-2 ) was detected by flow cytometer dihydroethidium method. The protein expression level of superoxide dismutase 1 (SOD1)was tested by Western blot. Results QDPR over-expression can decrease O-2(P<0. 01)and SOD1(P<0. 05)levels in high glucose condition;QDPR knockdown increases O-2(P<0. 01) and does not change SOD1. Conclusion Under high glucose condition, overexpression of QDPR gene decreases NRK-52E cell oxidative stress. Knockdown QDPR gene increases NRK-52E cell oxidative stress. QDPR gene may influence the development of diabetic nephropathy by oxidative stress.