Objective:To investigate the efffects of protease inhibitor on lipopolysaccharide-induced acute lung injury in rats and its possible mechanisms. Methods: Thirty-two male Wister rats, weighting 250-270 g, were divided into four groups randomly. C, normal controls (n=8); A: acute lung injury group (n=8), receiving intravenous endotoxin (lipopolysaccharide O55:B5, LPS 5 mg/kg); V, low-dose group (n=8), U, high-dose intervention group (n=8,receiving Ulinastatin 50 000 U/kg and (100 000) U/kg respectively and LPS 5 mg/kg). The specimens were collected 2 hours later, We observed the following changes: blood gas analysis, the lung wet/dry weight ratio, the pulmonary vascular permeability, histological manifestations, lung tissue myeloperoxidase activity, plasma endothelin-1, lung tissue malonaldehyde and conjugated-diene. Results: Compared with Group C, the lungs of the rats in Group A had significant hyperemia and spotted hemorrhage. The inflammatory granulocyte infiltrating, diffused alveolar septum thickening and spotted hemorrhage were observed in pathological examinations. The lung wet/dry weight ratio and Evans Blue content (per gram) increased significantly in group A[(5.41?(0.06),)(27.64?(2.48) ?g)] compared with group C[(4.95?0.08),(12.99?2.83) ?g], in the intervention groups((U:5.0?)0.05,19.47?2.09;V:4.98?0.06,21.44?3.12)however the difference was not significant between the intervention groups; The plasma endothelin-1 and lung tissue myeloperoxi- △Corresponding author’s e-mail, chenxuyan@medmail.com.cn dase activity increased significantly in group A[(948.23?103.45) u/g,(152.90?8.41) u/g] compared with group C[(729.38?88.64) u/g],[(54.62?15.49) u/g] but intervention groups[U:(633.27?93.27) u/g,(119.40?11.32) u/g;V:(671.87?105.45) u/g,(129.55?9.57) u/g] decreased significantly compared with group A, no significant difference between intervention groups; lung tissue Lipid- peroxide(malonaldehyde,MDA and conjugated-diene,C-diene)increased significantly in group A[MDA:(73.95?4.62) nmol/g;C-diene:(10.96?0.81)nmol/g] compared with group C[MDA:((39.65?)6.21) nmol/g;C-diene:(3.34?0.51) nmol/g],intervention groups [U:MDA:((51.26)?5.56) nmol/g,C-diene:(7.59?0.84) nmol/g;V:MDA:(59.87?4.62) nmol/g,C-diene:((8.79?)0.45) nmol/g] decreased significantly compared with group A. MDA decreased significantly in group U compared with group V. Conclusion: The protease inhibitor, Ulinastatin, may decrease inflammatory reaction and further decrease lung damage induced by LPS in rats, all indicating protection of protease inhibitor against acute lung injury.

Objective To observe the changes of plasma ghrelin in patients with severe sepsis and to explore the correlation of the plasma ghrelin and cytokines with sepsis.Methods Choose the healthy volunteer(n=10)as control group,and measure the plasma ghrelin(by ELISA),TNF-?,IL-1?,PCT(procalcitonin)and CRP at the 1st day,3rd day and 10th day in sepsis group(n=26).Results The plasma ghrelin level in sepsis group increased significantly compared with control group(P

Objective To understand the feeling of mothers of children with osteogenesis imperfecta during the accompany of children's diagnosis and treatment.Methods A total of 20 mothers of children with osteogenesis imperfecta participated the semi-structured interview.The data were analyzed by Colaizzi's method of phenomenology.Results Three themes were acquired including heavy psychological burden,facing multiple pressure and mother's support through analysis,reorganization and extraction of the subjects.Conclusions Mothers of children with osteogenesis imperfecta needed humanistic concern and emotional support.Nursers should adopted personalized care measures to improve their quality of life.

ObjectiveTo investigate the efficiency of autologous transplantation of peripheral blood stem cells for treatment of patients with diabetic lower limb ischemia.MethodsEighteen patients of type 2 diabetes with diabetic lower limb ischemia (30 legs) were treated by autologous transplantation of peripheral blood stem cells.ResultsThe limb pain, cool feeling and numbness feeling improved significantly after PBSC transplantation,the improvement rate were 96.7％, 100.0％ and 95.8％ respectively.Intermittent claudication was also relieved significantly, total remission rate was 76.9％.The ABI and TcPO2 of patients increased significantly at 3 months after transplantation.After the transplantation ABI raised from 0.60 ± 0.11 to 0.71 ±0.12(t =-6.882, P ＜ 0.01) .93.3％ of patients' TcPO2 raised in different degrees.The foot infections were well controlled.Ulcer or toes gangrene got better or healed.No obvious complications or adverse reaction were observed after the transplantation.ConclusionAutologous transplantation of peripheral blood stem cells shows to be a simple, safe and effective method in treating patients with diabetic lower limb ischemia.

Background:The pathogenesis of irritable bowel syndrome(IBS)is not fully known,social psychological factor is the important factor of IBS,especially the relationship with anxiety and depression. Aims:To investigate psychological stress factor,anxiety and depression in IBS patients among soldiers in northeast area. Methods:A total of 11 400 soldiers in northeast area were enrolled by multistage,stratified,cluster random sampling method asking to fulfill a questionnaire on IBS. Zung self-rating anxiety scale(SAS)and Zung self-rating depression scale(SDS)were assessed,and the relationship with anxiety,depression and stress was analyzed. Results:The incidence of IBS was 15. 9% . Prevalences of anxiety and depression in IBS group were significantly higher than those in non-IBS group(22. 9% vs. 9. 6% ,26. 6% vs. 12. 4% ,P< 0. 05). Score of SAS and SDS in IBS group were significantly higher than those in non-IBS group(50. 86 ± 7. 27 vs. 36. 54 ± 6. 97,53. 47 ± 7. 86 vs. 38. 25 ± 9. 83,P < 0. 05). Positive correlation was found between score of SAS and SDS and stress factors such as feeling lonely,depression,intensive training,working pressure,poor relationship with colleagues,solving emergency event or participating in military exercises in IBS group(P < 0. 05). Conclusions:IBS in soldiers is related with stress and psychological factors.

Objective: To evaluate the reliability and validity of the Chinese version of the Questionnaire of Executive Functioning (QEF) among elementary school students aged 7-12 years. Methods: A total of 841 elementary school students from four primary schools in the Pearl River Delta (Guangzhou), eastern Guangdong area (Jieyang), northern Guangdong area (Shaoguan), and western Guangdong area (Maoming) were selected for item analysis by using a stratified whole group sampling method in September 2022. A total of 377 elementary school students from the four elementary schools were selected for testing the structural validity and reliability, and 87 subjects from an elementary school in Guangzhou were selected at 15-day intervals for assessing test retest reliability test. Results: The questionnaire had good discrimination, and the correlation between the items and the total score ranged from 0.22 to 0.46 ( P <0.01). Exploratory factor analysis showed a cumulative variance contribution rate of 56.68%, with item loadings ranging from 0.41 to 0.74. Confirmatory factor analysis showed a good model fit ( χ 2/ df =3.048, CFI=0.988, TLI= 0.980 , RMSEA=0.058, SRMR =0.009). The overall Cronbach s α , split half reliability and test retest reliability of the questionnaire were 0.72 , 0.76, 0.79, respectively. Conclusion The Chinese version of the Questionnaire of Executive Functioning has good reliability and validity, and it is suitable for application to the self assessment of executive function among elementary school students.

Objective To investigate the effect of graded motor imagery ( GMI) therapy combined with rou-tine occupational therapy on the recovery of upper extremity function after stroke. Methods Thirty stroke survivors who met inclusion criteria were randomly assigned to a control group ( n=15) or a GMI group ( n=15) . The control group received routine medication, conventional physical therapy and routine occupational therapy ( one hour a day) , while the GMI group received 30 minutes of routine occupational therapy and 30 minutes of graded motor imagery therapy every day in addition to conventional medication and physical therapy. Before and after four weeks of treat-ment, the patients in both groups were evaluated using the Fugl-Meyer Assessment for the Upper Extremities ( FMA-UE) , the Box and Block Test ( BBT) and Brunnstrom arm and hand staging. Surface electromyography of the biceps brachii and triceps brachii was performed as the affected elbow flexed and stretched in maximum isometric contrac-tions, and the co-contraction ratios ( CRs) were calculated. Results After the treatment, the average FMA-UE score, Brunnstrom arm and hand stage, BBT and CR scores in both groups had improved significantly. The average improvement in the GMI group was significantly greater than in the control group. Conclusions Graded motor im-agery therapy can significantly promote motor recovery of the upper extremities of hemiplegic patients after a stroke.

BACKGROUNDCommunity acquired pneumonia (CAP) is one of the most common infectious disease in emergency department. In 2005 the concept of healthcare associated pneumonia (HCAP) was proposed by the ATS/IDSA guidelines. The clinical features and microbiology of HCAP are different from CAP, however, the initial antimicrobial treatment is still controversial. We aimed to compare the clinical efficacy between HCAP patients treated initially with HCAP guideline-concordant antimicrobial agents and those with CAP guideline-concordant antimicrobial agents.

METHODSWe conducted a retrospective observational study on HCAP patients who were admitted to emergency department between December 2011 and December 2012. Patients were divided into 2 groups according to their different initial antimicrobial treatment. We compared clinical features, distribution of pathogen, severity, days and spending on intravenous antimicrobial, length and charge of hospitalization and clinical outcomes, and meanwhile analyzed the clinical efficacy as well.

RESULTSOf the 125 HCAP patients, 55 patients received CAP guideline-concordant antimicrobial agents and 70 received HCAP agents. The major pathogens were Klebsiella pneumoniae, methicillin-resistant staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Escherichia coli. The 2 groups were similar at baseline, including old age, comorbidities, Pneumonia Severity Index scores, APACHE scores, and length of intravenous antimicrobial use and hospitalization duration, and in-hospital mortality. Overall efficacy rate occurred in 70.0% of HCAP agent patients and 50.9% of CAP agent patients (P = 0.029). Antimicrobial charge and total hospital charge for HCAP agent patients were significantly higher than that for CAP agent patients.

CONCLUSIONSInitial treatment of HCAP patients in emergency department with HCAP guideline-concordant antimicrobial could increase clinical efficacy rate, as well as antimicrobial charge and total hospital charge, but was not associated with shortening the length of stay, or lowering in-hospital mortality.

Aged ; Aged, 80 and over ; Anti-Bacterial Agents ; pharmacology ; Emergency Service, Hospital ; Escherichia coli ; pathogenicity ; Female ; Humans ; Klebsiella pneumoniae ; pathogenicity ; Male ; Methicillin-Resistant Staphylococcus aureus ; pathogenicity ; Pneumonia ; drug therapy ; microbiology ; Pseudomonas aeruginosa ; drug effects ; Retrospective Studies

Bloodstream infection (BSI) is a systemic infectious disease. The incidence and mortality of BSI caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) remain high, which brought severe challenges into clinical anti-infection treatment and enormous economic burdens for the patients. This article reviews the current research progress on risk factors of BSI caused by CRKP, hoping to provide reference for the early diagnosis and treatment of this disease.