Obgective To analyze the demographic data,non-specific items,pathogens and antibiotic sensitivity between the children with early-onset and late-onset sepsis,in order to guide the diagnosis and treatment of neonatal sepsis.Methods Three hundred and fifty-two cases with positive blood culture were retrospectively recruited and divided into an early-onset group and a late-onset sepsis group according to the onset of sepsis.Results Of 352 cases,144 cases (40.91％) were the early-onset children while 208 cases (59.09％) were the late-onset children,and in the late-onset group,108 cases occurred due to nosocomial infection.Most neonates of the early-onset term were term infants [107/144 cases (74.31％)],while the preterm infants [77/208 cases (37.02％)] and low birth weight infants[70/208 cases(33.65％)] accounted for the majority of the late-onset group.The asphyxia,perinatal intrauterine distress,meconium-staining amniotic fluid and premature rupture of fetal membranes ≥ 18 h occurred more frequently in the early-onset group [21/144 cases (14.58％),14/144 cases (9.72％),26/144 cases (18.06％),31/144 cases (21.53％)],respectively,while those in the late-onset group were [17/208 cases (8.17％),9/208 cases(4.33％),13/208 cases(6.25％),17/208 cases(8.17％)],respectively,there were significant differences (x2 =4.622,3.886,5.950,13.345,all P ＜ 0.05) between 2 groups.In the early-onset group abnormal temperature[72/208 cases(34.62％)vs 30/144 cases(20.83％)],vomiting or abdominal distention[109/208 cases (52.40％) vs 35/144 cases (24.31％)],lethargy [79/208 cases (37.98％) vs 38/144 cases (26.39 ％)] and umbilicalitis or skin pustule [33/208 cases (15.87 ％) vs 11 / 1 44 cases (7.64 ％)] occurred more frequently in late-onset group,and there were significant differences (x2 =7.853,8.763,5.153,5.265,all P ＜ 0.05).Besides,more cases in the late-onset group had elevated immature neutrophil vs total neutrophil count ratio [27/184 cases (14.67％)] and C-reactive protein value [76/206 cases (36.89％)],compared with those in early-onset group [9/133 cases (6.77％),38/143 cases(26.57％)],and there were significant differences (x2 =4.794,4.087,allP ＜ 0.05).Compared with early-onset group,patients in the late-onset group were more likely to suffer from suppurative meningitis [17.79％ (37/208 cases) vs 8.33％ (12/144 cases);x2 =6.348,P ＜ 0.05].In terms of pathogens,the main pathogens in the early-onset group were gram negative bacteria[39.58％ (57/144 cases),including detection of Klebisella pneumoniae in 21 cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64％ (47/144 cases)].In late-onset group,the main pathogens were gram positive bacteria [58.65％ (122/208 cases)],including detection of coagulase negative staphylococcus in 90 cases(43.27％) and E.coli [17.79％ (37/208 cases)].There was no significant difference in prognosis between 2 groups(x2 =1.187,P =0.552).Conclusions Early-onset sepsis and late onset sepsis differ in the clinical manifestation and laboratory findings.Distinguishing neonatal early-onset and late onset septicemia is of clinical significance in choosing appropriate antibiotics.

Objective To explore the change of copeptin in plasma and its significance in patients with intracerebral hemorrhage combined with stress ulcer.Methods Eighty patients with intracerebral hemorrhage were collected.Forty-nine patients of pure intracerebral hemorrhage and 31 patients of intracerebral hemorrhage combined with stress ulcer were included.Thirty healthy people were taken as controls.The level of copeptin in plasma was measured and compared in all subjects.Results The level of copeptin in plasma in patients with pure intracerebral hemorrhage and intracerebral hemorrhage combined with stress ulcer was significantly higher than that in controls:(303.684 ± 68.691),(527.034 ± 74.111) ng/L vs.(121.460 ± 53.364) ng/L,and the level of copeptin in plasma in patients with intracerebral hemorrhage combined with stress ulcer was significantly higher than that in patients with pure intracerebral hemorrhage.The differences were statistically significant (P ＜ 0.05).Conclusion The level of copeptin in plasma in patients with pure intracerebral hemorrhage increases significantly,and it is much higher in patients with intracerebral hemorrhage combined with stress ulcer.

Objective To investigate the efficacy of ventilation with selective lobar collapse for thoracic surgery in elderly patients with chronic obstructive pulmonary disease (COPD).Methods Thirty ASA Ⅱ or Ⅲ patients with COPD,aged 65-80 yr,with a body mass index of 16-28 kg/m2,undergoing radical resection of esophagus cancer,were randomly divided into 2 groups (n=15 each):one-lung ventilation (OLV) group and ventilation with selective lobar collapse group (group SLC).In group OLV,OLV was performed,while in group SLC,the balloon of the blocker was placed at 0.5 cm below the opening of the upper lobe bronchus and the lower lobe was collapsed when chest was open.The patients were mechanically ventilated (VT =7-8 ml/kg,RR =14-16 bpm,I∶E=1∶1.5-2.0,FiO2 =100％).Peak pressure (Ppeak),plateau pressure (Pplat),airway resistance (Raw),and dynamic lung compliance (Cd) were measured at 10 min of two-lung ventilation in supine position (T0),at 5,45 and 90 min of OLV or selective lobar collapse (T1-3) and at 10 min of two-lung ventilation in lateral position after the end of operation (T4).Arterial blood samples were obtained at To,T3 and T4 for blood gas analysis.Oxygenation index (OI),alveolar-arterial oxygen gradiant (P(A-a)O2),and respiratory index (RI) were calculated.Results Ppeak,Pplat and Raw were significantly lower at T2-4,while Cd was significantly greater at T1-4,OI was significantly higher at T3,4,and P(A-a)O2 and RI were significantly lower at T3,4 in group SLC than in group OLV.Conclusion The thoracic operation can be completed safely using ventilation with selective lobar collapse and OLV,however,ventilation with selective lobar collapse can improve oxygenation and provides better ventilatory efficacy than OLV in elderly patients with COPD.

Objective To investigate the status of depression with anxiety symptoms, and analyze the influencing factors of anxiety symptoms from demographic data and social psychological factors. Methods Hamilton depression rat?ing scale (HAMD), Hamilton anxiety rating scale (HAMA), Eysenck personality questionnaire (EPQ), life event scale (LES), trait coping style questionnaire (TCSQ) and social support scale (SSS) were used to evaluate 729 patients with de?pression. According to HAMA scores, patients were divided into non anxiety symptoms group (HAMA<7) and anxiety symptoms group (HAMA>14). Social psychological factors were compared between two groups, and the influencing fac?tors of anxiety symptoms were analyzed. Results The incidence of anxiety symptoms in depression was 58.85% (429/729), and 119 cases (16.32%) were certainly without anxiety symptoms. Compared with the group without anxiety symp?toms, the anxiety symptoms group had higher scores on neuroticism, psychoticism, negative life events and negative cop?ing style (P<0.001), but lower scores on introversion and extroversion (P=0.010). Degree of depression (OR=9.255, 95%CI:4.726~18.127), neuroticism (OR=1.595, 95%CI:1.197~2.125), negative life events (OR=1.009, 95%CI:1.001~1.017) and negative coping style (OR=1.046, 95%CI:1.013~1.080) were the risk factors of anxiety symptoms (P<0.05). Conclu?sion The incidence of anxiety symptoms in patients with depression is high. Patients with higher degree of depression and typical neurotic personality experiencing more negative life events and those with tendency to adopt negative coping style are more susceptible to anxiety symptoms.

Objective To investigate the effect of remote ischemic preconditioning (RIPC) combined with dexmedetomidine on lung injury during perioperative period and postoperative pulmonary complications in elderly patients with thoracotomy and pulmonary dysfunction.Methods Sixty ASA Ⅱ or Ⅲ patients aged 65-76 years [mean (70.4±6.3) years],weighing 50-75 kg,with moderate and severe pulmonary dysfunction,who were scheduled for elective radical operation for esophageal cancer,were randomly divided into 3 groups (n=20,each) by using a random number table:the control group (group C),RIPC group (group OR) and RIPC plus dexmedetomidine group (group ORD).At 10 min after endotracheal intubation,group ORD was induced by three cycles of 5 min of lower extremity ischemia followed by 5 min of reperfusion,at the same time a loading dose of dexmedetomidine 0.5 μig / kg was infused iv over 15 min,and then was infused at a rate of 0.5 μg · kg-1 · h-1 until the end of operation.Group OR was induced by three cycles of 5 min of lower extremity ischemia followed by 5min of reperfusion without dexmedetomidine.Group C received only the equal volume of normal saline.Blood samples were obtained from radial artery immediately before anesthesia induction (T0),before one lung ventilation (T1),at 1 h after one lung ventilation (T2),the end of surgery (T3) and 24 h after operation (T4).Blood gas analysis was done at T1,T2,and T3.Plasma superoxide dismutase (SOD) activity and concentration of malonyldialdehyde (MDA),matrix metallo-proteinase-9 (MMP-9),interleukin-6(IL-6) and white blood cell (WBC) and neutrophil granulocyte (PMN) counts were measured at T0,T2,T3 and T4.The complications including pulmonary infection and atelectasis were recorded at 1,3 and 7 days after operation.Results At T2-3,PaO2 was higher in groups of OR and ORD than in group C Group ORD had higher PaO2 than did group OR [(265±15) mmHg,(305±23) mmHg vs.(231±17) mmHg,(273±21)mmHg,(312±24) mmHg vs.(242±18) mmHg,F=34.791 and 31.813,P＜0.01].At T2-3,RI was lower in groups of OR and ORD than in group C,and group ORD had lower RI than did group OR [(1.48±0.16),(1.14 ±0.14) vs.(1.86±0.18);(1.35±0.13),(0.96±0.09) vs.(1.73±0.15),F=119.260 and 164.855,P＜0.01].At T3-4,SOD activity was higher in group OR and ORD than in group C,and group ORD had higher SOD activity than did group OR [(83.6 ± 7.8) U/mg prot,(97.6± 9.5) U/mgprot vs.(70.5±7.4) U/mgprot;(73.5 ± 6.3) U/mgprot,(87.7 ± 8.9) U/mgprot vs.(61.6 ± 5.4) U/ mgprot,F=94.540 and 90.839,P＜0.01].At T3-4.plasma concentration of MDA,MMP-9,WBC and PMN counts were lower in group OR and ORD than in group C,and the above indices were lower in group ORD than in group OR [(7.5 ± 1.4) nmol/mgprot,(5.8 ± 1.0) nmol/mgprot vs.(9.5 ±1.5) nmol/mgprot;(8.2± 1.5) nmol/mgprot,(6.5 ± 1.0) nmol/mgprot vs.(10.1 ±1.6) nmol/mgprot;(205±23) μg/L,(173±21) μg/L vs.(237±26) μg/L,(179±16) μg/L,(158±12) μg/L vs.(203± 20) μg/L;(8.0±0.5) ×109/L,(7.2±0.6) × 109/L vs.(9.2±0.8)×109/L;(9.4±0.7) ×109/L,(8.2±0.6)×109/Lvs.(11.2±0.8) ×109/L;(7.4±0.7) ×109/L,(6.5±0.5) ×109/Lvs.(8.3 ±0.8) ×109/L,(7.8±0.8) ×109/L,(6.7±0.6) ×109/L vs.(9.2±0.9) ×109/L,F=98.872,52.723;198.307,47.622,20.319,36.935,18.197,35.036,respectively,all P＜0.01].At T2-4,IL-6 level was lower in groups of OR and ORD than in group C,and group ORD had lower IL-6 level than did group OR [(105±14) ng/L,(86±12) ng/L vs.(127±18) ng/L;(125±19) ng/L,(101±16) ng/ L vs.(156±22) ng/L;(110±16) ng/L,(89±12) ng/L vs.(132±20) ng/L,F=85.449,139.848,124.129,respectively,P＜0.01].The incidences of postoperative pulmonary infection and atelectasis were lower in group OR and ORD than group C,and group ORD had lower incidences of postoperative pulmonary infection and atelectasis than did group OR (x2 =6.303 and 14.545,P ＜ 0.05).Conclusions RIPC combined with dexmedetomidine can improve pulmonary function in elderly patients with thoracotomy and pulmonary dysfunction,may relieve the inflammatory reaction and oxidation reaction during perioperative period and finally help to improve the prognosis of patients.

Objective To investigate the effects of microRNA-196a(miR-196a) inhibitory sequences transfection on HOXB8 expression in PANC1 cells.Methods PANC1 cells were divided into control group,miR-196a inhibitory sequences group and siRNA control group.Liposomal transfection method was applied to transfect miR 196a inhibitory sequences and siRNA control into PANC1 cells.RT-PCR and Western blot were used to detect the expressions of miR-196a and HOXB8 mRNA and protein.Results After miR-196a inhibitory sequences transfection,when compared with that of siRNA control group,the expression of miR-196a was significantly decreased (0.05 ± 0.054 vs.0.839 ± 0.025,t =3.12,P ＜0.05) ; and the expression of HOXB8 mRNA was significantly increased by 1.57 folds (2.20 ± 0.07 vs.1.29 ± 0.10,t =3.86,P ＜ 0.05),the expression of HOXB8 protein was also obviously increased (0.90 ± 0.03 vs.0.40 ± 0.10,t =3.11,P ＜ 0.05).Conclusions MicroRNA-196a down-regulates the expression of HOXB8.

Objective To explore the characteristics of cognitive impairment and its influence factors in first-epi?sode depression patients with sleep disorder. Methods Three hundred and eighteen patients with first-episode depres?sion and two hundreds and forty-three healthy controls were recruited. The patients were divided into two group accord?ing to the sleeping situation: 202 patients with sleep disorder and 116 patients without. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to evaluated the cognitive function of all subjects, including immediate memory, visual span, speech function, attention and delayed memory. The 17 item Hamilton Depression Scale (HAMD-17) was used to evaluate patients’symptoms. Results The scores of immediate memory, visual span, speech function, delayed memory and the whole scale in the depression patients with sleep disorder were significantly lower than the patients without sleep disorder and the controls (P<0.05). Compared with the controls, the patients without sleep disor?der had lower scores of immediate memory, language function, delayed memory and the whole scale (P<0.05). Multiple linear regression showed that in the depression patients with sleep disorder, the RBANS score was related with the cogni?tive factors in HAMD (β=6.29, P=0.04);immediate memory was related with age (β=-0.24, P=0.04);visual span was re?lated with sleeping factor in HAMD (β=2.33, P=0.01);speech function was related with marriage (β=-5.74, P=0.01) and sleeping factor in HAMD (β=-1.20, P=0.03). In the depression patients with sleep disorder, speech function of RBANS was related with age (β=-0.32, P=0.04);attention was related with retardation factor in HAMD (β=2.52, P=0.01). Con?clusion The first-episode depression patients with sleep disorders have cognitive function damage in many aspects. The depressive symptoms (sleep changes, cognitive disorders, retardation and so on), age and marital status may be the influ?encing factors on cognitive impairment in first-episode depression patients with sleep disorder.

Objective To construct a nucleic acid vaccine expressing H.pylori HpaA and inter- leukin-2 gene and to identify the immunogenicity of the vaccine proteins in vitro and protection in vivo. Methods The H paA gene fragment was amplified by polymerase chain reaction(PCR) from the genomic DNA of the standard H.pylori strain 17874.Mouse interlukin(IL)-2 gene was amplified from pClneo- IL-2.The HpaA and IL-2 were cloned into pUCmT vector.After DNA sequences of the amplified HpaA gene and IL-2 were confirmed,both were cloned into the eukaryotic expression vector pIRES through a serial of enzyme digestion and ligation reactions.The recombinant plasmids were screened by PCR and restriction enzyme digestion.Then,recombinant pIRES-HpsA-IL-2 was transfected to COS-7 cells using Lipofectamine~(TM)2000.The immunogenicity of HpaA and IL-2 protein was detected by SDS- PAGE and Western blot.The recombinant plasmids were transformed to LB5000 and then to final host SL7207.The recombinant strains were passaged repeatedly.The mice were challenged with H.pylori after 4 weeks of inoculation of nucleic acid vaccine.H.pylori infection was detected by rapid urease test.Results The amplified HpaA gene fragment and IL-2 were confirmed by sequence analysis.The eukaryotic expression vector plRES and the pIRES-HpaA-IL-2 construction were confirmed by PCR and restriction digestion.The expressions of HpaA(30 000) and IL-2(14 000)protein by pIRES-HpaA-IL- 2 were detected by Western blot.The in vivo study showed that 75.0% and 58.4% of mice vaccinated by HpaA-IL-2 and HpaA,respectively,were protected anaigst H.pylory infection,which was signifi- cant different in comparison with PBS control (P

Objective To explore the effect of TNF-α in intracellular Ca~(2+)-overload associated myocardial injury. Methods Thirty Wistar rats were randomly divided into three groups:control group,Ca~(2+)+-paradox group,and pentoxifylline treatment group. The intracellular Ca~(2+)-overload rat model was established by pre-filling the rats with Langendorff for 20 minutes,isolated rat hearts subjected to Ca~(2+)-depletion for 5 minutes and Ca~(2+)-repletion for 30 minites(Ca~(2+)-paradox). Changes in hemodynamics indexes were monitored continuously. TNF-α in cardiac tissues was tested by ELISA method,and nuclear factor-κB(NF-κB)in cardiac tissues was detected with Western blot. Results Dramatic depression in left ventricle contraction function was found in the Ca~(2+)-paradox hearts:significant decrease in left ventricular diastolic pressure(LVDP),markedly elevated left ventricular end diastolic pressure(LVEDP),decreased dP/dt ratio,increased TNF-α content,decreased cytosolic/homogenate NF-κB ratio. All these changes in Ca~(2+)-paradox group were significantly attenuated upon the treatment with 100 μmol/L pentoxifylline. Conclusions Activation of NF-κB and increased production of TNF-α may play important roles in cardiac injury associated with intracellular Ca~(2+)-overload.

Objective To compare the efficacy and safety of E1B gene-deleted adenovirus (H101)and ethanol in treating advanced pancreatic carcinomas by intratumoral injection combined with intravenous gemcitabine.Methods We constructed an orthotopic nude mouse model of pancreatic carcinoma through cancer cell injection into pancreas.A total of 54 nude mice were randomly allocated to 6 groups to accept H101,ethanol or saline (control) intratumoral injection,combined with or without intravenous gemcitabiein.The animals were sacrificed 4 weeks after the treatment and the pancreatic tumors were collected to determine the size,existence of metastasis,distribution of virus by indirect immunofluorescence and apoptosis in tumor by TUNEL and electron microscope.Results All mice completed the scheduled treatment,while 3 died in 48 hours after ethanol injection resulting in a mortality of 16.7％ (3/18).On the contrary,no mice died in the adenovirus injcction group.The average tumor size in group of H101 intratumoral injection combined with intravenous gemcitabie was significant smaller than that in group of saline injection with or without systemic gemcitabie (P =0.008,0.040,respectively).Similar differences were observed between ethanol intratumoral injection and control groups (P =0.012,0.041).Meanwhile,the H101 was absent in all the other organs except the pancreas,which meant that the selectivity of the H101 was tremcndous.The virus combine gemcitabie group had higher apoptosis rate in tumor (83.2 ± 35.7) ％,determined by TUNEL.Conclusion E1B gene-deleted adenovirus intratumral injection in combination with intravenous gemcitabine treating pancreatic carcinomas is efficient and safe,in spite of its lower effectiveness than ethanol.