Objective　To explore the significance of dynamic determination of arterial blood gas for early diagnosis, treatment and prognosis of patients with acute respiratory stress syndrome(ARDS). Methods　The results of 655 times arterial blood gas assayed in 113 patients with ARDS were analysed retrospectively.Results　(1)Types of acid-basic disturbance:The simple acid-base disturbances were 44 cases,in which respiratory alkalosis were 20 cases, respiratory acidosis 11 cases, metabolic acidosis 10 cases, metabolic alkalosis 3 cases. Complex acid-base disturbances were 53 cases,in which respiratory alkalosis with metabolic acidosis were12 cases, respiratory alkalosis with metabolic alkalosis 14 cases, respiratory acidosis with metabolic acidosis 21 cases, respiratory alkalosis with metabolic alkalosis 6 cases. Triple acid-base disturbances (TABD) were 16 cases, in which the type of respiratory alkalosis were 11 cases, the type of respiratory acidosis 5 cases. the types of acid-base disturbances in cured patients mainly were respiratory alkalosis (17 cases) and respiratory alkalosis with metabolic alkalosis (12 cases). The types of acid-base disturbances in dead patients were mainly respiratory acidosis with metabolic acidosis (19 cases),TABD (14 cases) and respiratory acidosis (9 cases).(2)The oxygenation indexes(PaO2/FiO2) of all 113 patients were less than 26.7kPa.(3)The cured rate in 113cases was 53/113(46.0%)and the mortality was 61/113(54.0%).Conclusion　Dynamic determination of arterial blood gas and calculation of index of oxygenation were of important clinical value in diagnosis and treatment of ARDS.

[Summary] Sodium glucose cotransporter 2 (SGLT2) inhibitors have been developed as a new antidiabetic agent .The antihyperglycemic effect of SGLT 2 inhibitors is independent of insulin secretion and insulin action .SGLT2 inhibitors improve IS and islet βcell function with the possible mechanisms of reducing glucotoxicity ,weight loss and increasing GLP‐1 response .

Objective To investigate the relationships of nuclear factor кB (NF-кB) activation with protein kinase B (Akt) and glycogen synthase kinase 3β (GSK-3β) during amyloid-β (Aβ) (25-35) -induced apoptosis in pheochromocytoma cells (PC12 cells) of rats. Methods Apoptosis in PC12 cells was induced by A(25-35). The activities of Akt, GSK-3β and NF-кB were analyzed in this process. The Akt and GSK-3β pathways were blocked by their specific inhibitors, respectively, and the relationships of Akt and, GSK-3β with NF-кB during Aβ(25-35)-induced apoptosis in PC12 cells were determined. Results Aβ(25-35) induced apoptosis was in a dose-dependent manner. With 0, 5, 10, 20 μmol/L and 40 μmol/L Aβ(25-35) treaing for 48 h, the apoptosis rates of PC12 cells were (3. 01 ± 0.03)%, (3.08 ±0.03)%, (25.32 ± 0.76)%, ( 42.88 ± 0.60 )% and ( 60.85 ± 2.39 )% , respectively. Compared to control, both Akt and GSK-3β were suppressed during apoptosis, at meantime NF-кB was activated. The inhibited Akt activity by wortmannin leaded to decreased NF-кB activatity and increased GSK-3β activatity. Suppression of GSK-3β with its specific inhibitor LiCl caused the decreased activation of NF-кB too, but it had no significant influence on Akt activity. Conclusions These results suggest that both Akt and GSK-3β are upstream regulators of NF-кB. They co-regulate the activation of NF-кB during Aβ(25-35)-induced apoptosis in PC12 cells. This study contributes to the theoretical base for the pathogenesis of Alzheimer disease (AD) , and provides a new idea to AD prevention and therapy.

Objective To establish core competence evaluation index system of orthopaedic specialized nurse .Methods Alto‐gether 35 experts from Class Ⅲ Grade Ⅰ hospital in Chongqing ,Beijing ,Jiangshu were consulted by a three‐round delphi survey ,and finally established the core competence evaluation index system of orthopaedic and the weight of each index .Results The core com‐petence evaluation indexes of orthopaedic specialized nurse included 4 first class indexes ,14 second class indexes and 72 third class indexes .The expert authority coefficient was 0 .833 ,the familiar coefficient was 0 .794 ,the determination coefficient was 0 .872 ,The coordination coefficient of primary and secondary and third indicators were 0 .390 ,0 .324 ,0 .308 ,respectively ,and there were statis‐tically significant differences (P< 0 .05) .Conclusion The expert opinions for the core competence evaluation indexes are consist‐ent ,the results are objective and scientific .It can provide quantitative standards for training ,examining and evaluation of orthopaedic specialized nurse .

Objective To evaluate the prevalence of macrosomia in Beijing in 2013 and identify its risk factors. Methods Retrospective six months analysis of 14 188 full-term singleton pregnant women from 15 hospitals with different levels in Beijing in 2013. Each participant′s demographic data and medical information were collected individually by questionnaires. Multiple logistic regression analysis was used to examine the associations between variables and the risk of macrosomia. Results (1)The total prevalence of macrosomia was 7.069%(1 003/14 188) in Beijing in 2013. (2)The prevalence varied between the 15 hospitals, the lowest was 5.36%(89/1 659), while the highest reached 8.80%(46/523). Furthermore, the incidence of macrosomia was 1.284 times (95%CI: 1.114-1.480, P=0.001) higher in the second graded hospitals than that in the tertiary hospitals. (3) Multiple logistic regression analyses showed that risk factors for macrosomia were maternal height≥160 cm (adjusted OR=1.875, 95%CI: 1.559-2.256), pre-pregnant body mass index (p-BMI) ≥24.0 kg/m2 (24.0-27.9 kg/m2:adjusted OR=1.696, 95%CI: 1.426-2.018; p-BMI≥28.0 kg/m2:adjusted OR=2.393, 95%CI: 1.831-3.127), gestational weight gain (GWG)≥15.9 kg (adjusted OR=2.462, 95%CI: 2.125-2.853), gravidity>1 (adjusted OR=1.408, 95%CI: 1.224-1.620), gestational weeks≥40 (adjusted OR=2.007, 95%CI:1.745-2.308) and gestational diabetes mellitus (adjusted OR=1.522, 95%CI:1.298-1.784). GWG≥15.9 kg, p-BMI≥28.0 kg/m2 and gestational weeks≥40 were three risk factors that had the strongest associations with macrosomia (all P<0.01). Conclusions The prevalence of macrosomia in hospitals with different levels is obvious different. Gestational weeks, p-BMI and GWG are three main controllable risk factors for macrosomia, thus should receive more attentions.

Objective:To explore the clinical effect of intravenous immunoglobulin combined with conventional therapy in the treatment of severe pneumonia in infants and children.Methods:Selected the January 2015 to April 2016 in our hospital for treatment of 88 cases of children with severe pneumonia were retrospectively analyzed,which 47 cases by routine treatment plus intravenous immunoglobulin protein (treatment group),41 cases of children only take routine therapy (control group),with a course of 2 weeks.Results:The symptoms of fever,dyspnea,cough,wheezing,pulmonary rales were improved faster in the treatment group than the control group (P＜0.05);after 2 weeks of treatment,IgG levels were significantly higher in the treatment group than the control group(P＜0.05);after 2 weeks of treatment,the serum IL-6 and TNF-α levels were significantly lower in the treatment group than the control group(P＜ 0.05);after 1 week of treatment,57.45％ of patients was cured in the treatment groups while only 34.15％ patients in the control group (P＜0.05).Conclusion:Intravenous immunoglobulin combined with conventional therapy in the treatment of infants with severe pneumonia can significantly improve the theraputic effect and enhance blood immunoglobulin levels.

Objective To evaluate the anxiety and depression problems in children parents with leukemia, as well as the problems' influence to the psychosocial characteristics of leukemia children.Methods Twenty long-term survivors of childhood leukemia (group A), thirty children newly diagnosed as leukemia (group B) and fifty age-matched healthy controls (group C) completed the questionnaires allowing assessment of symptoms associated with anxiety, depression and self-concept. At the same time, the anxiety and depression in the parents of children with leukemia were also measured using SAS and SDS. Results The anxiety and depression scores of the parents in study group (48.56±9.23, 51.86±9.53) were much higher than that in normal population (37.23±12.59, 41.88±10.57) (P = 0.000, 0.000, respectively), the positive rate of anxiety and depression symptoms among group B was significantly higher than that among group A (60.0 % vs 25.0 %, 46.7 % vs 20.0 %; P <0.05, respectively). There was a significant positive relation between the depression and anxiety scores in the parents of children with leukemia(r =0.947, P =0.0000). Group A scored significantly higher on subscales of somatization/panic (6.11 ±4.36), generalized anxiety (5.72±4.56),social phobia (7.67±4.19) and the total scale (25.8±13.98) than group C (the score was 3.68±3.39, 2.54±2.99,4.24±2.88 and 15.9±10.52, respectively) (P<0.05, respectively), group B scored significantly higher on subscales of social phobia (6.03 ±2.16) than group C (4.24±2.88) (P =0.016). There was a significantly positive relation between the depression score in children with leukemia and the anxiety (r = 0.309, P = 0.029) & depression(r = 0.342, P = 0.015) scores in their parents. Group A scored significantly higher on the total score of self-concept(60.8±6.25) as well as the subscales of happiness(7.95±1.32) than group G (64.48±7.89 vs 8.64±1.19) (P =0.039, 0.026, respectively); and group B scored significantly higher on subscales of behavior (12.47±1.25), intelligence(10.80±2.12), physical appearance and attributes (8.40±2.66), anxiety (9.93±1.29) and the total scale (59.83±5.87) than group C (14.00±2.17, 12.60±2.96, 9.64±2.30, 11.38+2.18, 64.48±7.89) (P <0.05, respectively). There was a significantly positive relation between the score of gregarization subscale in leukemic children and the anxiety score in their parents (r = 0.337, P = 0.017). Conclusion The findings of our studies have suggested that the parents of children with leukemia are at risk for psychological difficulties, and which have a great influence on the psychological health of their children.

The paper is to report the establishment of a method for quickly evaluating compatibility of Chinese medicines injections. Isothermal titration calorimetry (ITC) was used to evaluate compatibility of Yiqifumai (YQFM) and vitamin C injection (Vc)/5% glucose injection (5% GS). The diversification of Gibbs free energy (deltaG), enthalpy (deltaH) and entropy (deltaS) were used to decide reaction types of colliquefaction procedures of different injections. The reactive profiles were used to determine signs and quantity of heat. And high performance liquid chromatography (HPLC) was used as a supportive method for ITC. Then, feasible binding sites were analyzed based on the information of spatial structures of major compositions. During the colliquefaction procedure of YQFM and Vc, [deltaH] > T[deltaS], so, the reaction is enthalpy-driving. And the reactive profile showed that a big deal of heat was given out during the procedure. Obviously, chemical reactions happened and the major compositions changed. On the other side, the reaction of YQFM mixed with 5% GS was entropy-driving, because [deltaH] < T[deltaS]. The reactive profile showed there was a little heat gave out. So, non-chemical reactions happened, and the major compositions did not change. The conformity existed between the results of ITC and HPLC. ITC could be used to evaluate the compatibility of Chinese medicines injections because of the advantages of ITC, such as real time, fast, sensitive and having more parameters.

Objective To determine the effectiveness of systolic blood pressure gradient between the right arm and the right leg(SBPG) tests in the diagnosis of neonatal aorta anomaly(AoA).Methods The SBPG of infants suspected of having critical congenital heart diseases were collected prospectively,who were admitted to Guangdong General Hospital from January 2013 to December 2015.The results of SBPG test were compared with those of echocardiography or cardiac computed tomography (golden standard).The rates of true positive,true negative,false positive,false negative were calculated under cutoff values of 5 mmHg(1 mmHg =0.133 kPa),10 mmHg,15 mmHg and 20 mmHg,respectively.Receiver operating characteristic (ROC) curves was used to compare tests of different cutoff and the areas under the ROC curve were also calculated.Results Among 664 enrolled infants,67 cases were confirmed by golden standard test.The systolic blood pressure in the right arm,the legs and SBPG in AoA group and non-AoA group were (88.0±20.4) mmHgvs.(73.4±9.3) mmHg (P＜0.01),(66.1 ±10.1) mmHg vs.(69.0 ±9.7) mmHg(P＞0.05) and (22.6±17.8) mmHgvs.(2.3 ±4.8) mmHg(P ＜0.01),respectively.In these patients,31 cases(46.3％),31 cases(46.3％),27 cases(40.3％) and 21 cases(31.3％) were diagnosed of AoA,and 36 cases(53.7％),36 cases (53.7％),40 cases(59.7％),and 46 cases (68.7％) were missed by SBPG tests of 5 mmHg,10 mmHg,15 mmHg and 20 mmHg,respectively (P ＜ 0.01).The rates of true negative among those groups were 94.1％,99.5％,99.7％ and 100.0％,and the areas under ROC curve were 0.656,0.722,0.695 and 0.657,respectively (P ＜ 0.01).Conclusions Almost half of AoA infants could be screened out by SBPG test.The cutoff of 10 mmHg could probably be used to screen potential AoA infants,with higher true positive rate and lower false positive rate.

Objective To observe the effects of Weipixiao on the ultrastructure of gastric mucosa capillaries in rats with precancerous lesions of gastric cancer ( PLGC). Methods The rats were randomized into six groups, including normal group, model group, Vatacoenayme Tablets group ( 0.2 g·kg-1·d-1) , and high-, middle-, and low- dose Weipixiao groups ( 15, 7.5, and 3.75 g·kg-1·d-1 respectively) . The rats received spontaneous intake of N-methyl-N’-nitro-nitrosoguanidine ( MNNG, 200 μg/mL) solution combined with irregular diet and intragastric administration of purgative herbs Xiao Chengqi Decoction ( 2 mL, containing 1 g/mL crude drug) for 18 weeks to induce spleen-deficiency PLGC. The pathological changes in gastric mucosa and the ultrastructure of gastric mucosa capillaries were observed under the transmission electron microscope. Results The model has been established successfully. Transmission electron microscopy results in the model group showed as severely swollen endothelial cells of gastric mucosa capillaries, severely-narrowing or even blocked vascular lumens, rough and discontinuous basement membrane, and swollen, degenerated or even absent pericytes. And the ultrastructure of gastric mucosa capillaries in high-, middle-, and low- dose Weipixiao groups were improved to some degrees, the effect of low-dose Weipixiao group being the best. Conclusion The improvement of the mucosal microcirculation of spleen-deficiency PLGC rats may be one of the pathohistological mechanisms of Weipixiao for spleen-deficiency PLGC.