Objective To understand the incidence trend of ventilator -associated pneumonia(VAP)in ICU and to evaluate the effects of the interventions on the incidence of VAP,so as to provide scientific evidences for the prevention of VAP.Methods A study of 149 patients with VAP occurred in the 3 710 patients of ICU before and after intervention during 7 /2010 -12 /2014 in Wujin People's Hospital,Changzhou city was conducted.It was divided into two stages:baseline survey and stem expectations,VAP interventions included:training and education,chlorhexidine oral care and maintain appropriate endotracheal tube cuff pressure,elevated head of bed to up to 30°and improved hand hygiene.Hospital infection control professionals collected the number of patients,basic information,length of hospital stay,days of receiving mechanical ventilation and the VAP incidence data in ICU.And then change of the VAP incidence of the intervention before and after the intervention was compared and evaluation of the effect of combined intervention measures.Results Prospective data from 3 710 patients hospitalized in ICU were collected for an aggregate of 14 831 days,the utilization rate of ventilator was 55.2%.The occurrence of VAP was 149 cases.The average rate of VAP was 18.2 cases per 1 000 ventilator -day.VAP was associated with a crude mortality of 7.56%and with increased ICU LOS of 13.2d.As the results of the interventions,the rate of VAP was decreased from 52.38 /1 000 during 7 /2010 -6 /2011 to 5.71 /1 000 during 1 /2014 -12 /2014.Conclusion The rate of VAP in the inves-tigated ICU has led to a decreased incidence of VAP under the comprehensive interventions.

Objective To summarize perioperative care and effect of surgical treatment of total anomalous pulmonary venous connection (TAPVC) in newborns and babies within 6 months.Methods From September 2001 to May 2013,ninetytwo consecutive patients with TAPVC received surgical correction under cardiopulmonary bypass (CPB) with moderate or deep hypothermia.The anatomic subtype included supracardiac type 48,intracardiac type 36,infracardiac type 6 and mixed type 2.There were 36 newboms.Pathological diagnosis was made by echocardiogram,computerized tomography and operative findings during operation.The option of procedure was determined by findings.Respirator assisted breathing after operation and cardiac function was maintained by a variety of positive inotropic drugs,to prevent the happening of the pulmonary hypertension crisis.Results Severely low cardiac output syndrome occurred in 8 patients and they died within 24 hours after operation.The remaining cases postoperative recover smoothly and receive postoperative follow-up about 1 month to 12 years,3 cases of postoperative pulmonary vein stenosis (PPVS) occurred.Conclusion Total anomalous pulmonary venous connection should be surgical treatment as soon as possible with satisfied effect.The key of perioperative care is maintenance of left heart function,negative balance of liquid,prevention and treatment of pulmonary hypertension.

Objective To study the expression changes of placental insulin-like growth factor Ⅰ and Ⅱ (IGF-Ⅰ and IGF-Ⅰ) between pregnancies following the in vitro fertilization and embryo transfer (IVF-ET) and those conceived spontaneously.Methods The placenta were collected from 49 cases of pregnancies after IVF-ET(case group) and 49 cases of pregnancies who were normal (control group).The expressions of IGF-Ⅰ and IGF-Ⅱ mRNA in placenta were detected by reverse transcription-polymeras chain reaction (RT-PCR).The levels of IGF-Ⅰ and IGF-Ⅱ protein were determined by immunohistochemistry.Results The mRNA levels of the placental IGF-Ⅰ and IGF Ⅱ were 0.30 ±0.13 and 0.28 ±0.04 in the IVF-ET group,and 0.65 ±0.10 and 0.91 ±0.26 in the control group.The protein levels of the placental IGF-Ⅰ and IGF-Ⅱ were 0.26 ±0.04 and 0.29 ± 0.05 in the IVF-ET group,and 0.32 ± 0.07 and 0.34 ± 0.04 in the control group.The mRNA and protein expressions of IGF-Ⅰ and IGF-Ⅱ in human placenta were significantly decreased in IVF-ET group compared to control group (P ＜ 0.05).The incidence rate of low birth weight infant in IVF-ET group was significantly higher than control(P ＞ 0.05).Conclusions Expressions of placental IGF-Ⅰ and IGF-Ⅱ in the IVF-ET group did not affect fetal growth and development.

Objective To study the features of anatomical delamination of the posterior renal fascia in CT images.Methods Clinical datas and CT images of 85 patients with acute pancreatitis were collected,the anatomical delamination features of the adult posterior renal fascia were observed and recorded.Results (1) 23 cases showed anatomical delamination of the left posterior renal fascia, 9 cases showed anatomical delamination of the right posterior renal fascia, and 8 cases showed anatomical delamination of bilateral posterior renal fascia.(2) The features of anatomical delamination of the posterior renal fascia were detected in the whole posterior renal fascia or in the lateral part of the posterior renal fascia.Anatomical delamination was detected in the whole left posterior renal fascia in 6 cases, and was detected in the lateral part of the left posterior renal fascia in 17 cases.Anatomical delamination was detected in the whole right posterior renal fascia in 4 cases and in the lateral part of the right posterior renal fascia in 5 cases.Anatomical delamination of the whole part in the bilateral posterior renal fascia were detected in 4 cases and pure delamination of the lateral part in the both sides were 4 cases.Conclusion CT images can show the anatomical delamination of the posterior renal fascia which has two types.The anatomical delamination of bilateral posterior renal fascia is not always the same.

Objective To investigate the imaging characteristics of rabbit liver VX2 tumor with contrast-enhanced ultrasonography(CEUS) and multidetector spiral CT(MDCT), to explore the criterion of phase timing apllicable to the model.Methods CEUS and MDCT were acquired in thirty-three New Zealand rabbits with hepatic VX2 tumors.The initial time of hepatic arterial phase was verified as the time the hepatic artery beginning to enhance,the initial time of portal phase as the time the VX2 tumor reaching peak enhancement and the initial time of hepatic parenchymal phase as the time the hepatic parenchyma reaching peak enhancement.The enhancing characteristics were observed.The time-intensity curve of VX2 tumor and peripheral parenchyma in CEUS was analysed and compared with the time-desity curve of abdominal aorta, portal vein, hepatic parenchyma and tumor in MDCT.Results The initial time of heptic arterial phase,portal phase and parenchymal phase in CEUS and MDCT was (6.82±1.36)s and (9.43±2.23)s,(11.64±2.03)s and (13.77±2.01)s,(20.24±4.17)s and (22.71± 4.58)s,respectively.The initial time of each phase in CEUS was earlier than that in MDCT (P<0.01).The contrast enhancing characteristics in CEUS and MDCT were consistent as fast wash-in and fast wash-out.Conclusions The status of hemodynamic perfusion in rabbit hepatic VX2 tumor could be well displayed by CEUS and the phase timing criterion concluded in this experimental study could offer fundmental theory basis for relevant imaging evaluation.

Objective To discuss the effects of Liuwei Dihuang Decoction on expressions of TGF-β1 and complement regulatory protein CR1 of the renal on IgA nephropathy rats.Methods Forty SD rats were randomized into normal group, model group, tripterygium glycosides group and Liuwei Dihuang Decoction group after adaptive feeding for one week. Complex method was used to establish IgA nephropathy model. All administration groups were given relevant medicine for gavage for 4 weeks;urine routine, the number of urine erythrocyte and 24 h urine protein were detected;creatinine, urea nitrogen, total serum protein and serum alburin were detected from blood;the renal pathological changes were observed under light microscope by HE and Masson staining;the expressions of TGF-β1 and CR1 were detected by immunohistochemistry.Results Compared with model group,Liuwei Dihuang Decoction could significantly decrease the proteinuria and hematuria levels and renal fibrosis changes of IgA nephropathy model rats, reduce the expression of TGF-β1, and raise the expression of CR1 (P<0.05).Conclusion Liuwei Dihuang Decoction can delay the renal fibrosis in IgA nephropathy rats through reducing the degree of TGF-β1 and promoting the expression of CR1.

Objective To explore the association of HbA1C with microvascular complications,and to evaluate the diagnostic value of HbA1C in diabetes mellitus in high-risk populations of Guangzhou.Methods HbA1C,blood glucose,fundus photography,and microalbuminuria were detected in 208 permanent residents with high-risk factors of diabetes.The receiver operating characteristiC(ROC)curves were used to estimate the area of HbA1C,fasting plasma glucose(FPG),postprandial 2 h plasma glucose(2hPG)under the curve for discriminating microvascular complications.Results There were 14.9% adults suffering from diabetic retinopathy and 12% microalbuminuria in high risk populations of diabetes.The optimal cutoff points of HbA1C,FPG,and 2hPG in detecting retinopathy were 5.8%,7.0 mmol/L,and 10.9 mmol/L respectively.The thresholds for increasing prevalence of microalbuminuria were5.8% for HbA1C,6.4 mmol/L for FPG,and 10.7 mmol/L for 2hPG.Conclusions The prevalence of diabetic microvascular complications increases dramatically at the concentration of HbA1C 5.8%.As a diagnostic value for microvascular complications,there is no significant difference between HbA1C and 2hPG.

Objective: To investigate the perioperative weight loss and its influencing factors in patients with colorectal cancer, and to provide evidence for the development and management of perioperative nutritional support strategies. Methods: Ninety-one patients with colorectal cancer were enrolled and divided into observation group (n=61) with the degree of weight loss less than 5% of preoperative weight and control group (n=30) with the degree of weight loss more than 5% of preoperative weight. Change of body composition and factors of weight loss in patients with colorectal cancer were compared between the two groups by single factor and multivariate analysis. Results: Ninety-one patients with colorectal cancer had the average weight loss of 2.0 kg. Of perioperative changes in body composition, the degree of body fat, muscle mass and protein group decreased statistically (P<0.05). Univariate analysis showed that the age, intraoperative blood loss and postoperative oral nutrition intake compliance were the risk factors for the degree of weight loss in patients with colorectal cancer after the operation. Multivariate logistic regression analysis showed that the intraoperative blood loss was an independent influencing factor for the degree of postoperative weight loss in patients with colorectal cancer (P<0.05). Conclusion Age, intraoperative blood loss and postoperative oral nutritional intake compliance may affect the degree of weight loss during perioperative period. Intraoperative blood loss is an independent risk factor affecting the degree of weight loss during perioperative period. In future clinical research and practice, minimally invasive and accurate surgical treatment should be strengthened, the amount of intraoperative blood loss and surgical trauma should be reduced, and the postoperative oral nutrition intake of patients should be paid attention, especially for elderly patients. Personalized dietary guidance and management for different groups should be conducted, and perioperative nutritional status of patients should be improved.

With the progress of medical technology, the popularization and wide clinical application of advanced monitoring and treatment equipment in intensive care unit (ICU), the survival rate of critically ill patients has been remarkably improved. Increasing attention has been paid to the importance of early activities for the late rehabilitation in patients. Under the safe condition, early activities are an effective strategy to improve the prognosis. At present, early activities have not been widely used in the clinic in China because of various factors. This review addresses the research progress of early activities in critically ill patients in terms of safety, benefits, influential factors and coping strategies. Findings from this review will help nursing staff to better understand early activities in critically ill patients and promote the development of early individualized activities.