0.05).But,the count of lymphocyte in treatment group was higher than that in control group(P

Objective To determine the cleaning and the shortest disinfectant time for gastroscope Methods 1? g/ml HBsAg and 3? 108/ml bacteria of Aureus Staphylococci(ATCC 6538),Escherichia coli(ATTC 8099),Bacterium earuginosum(ATCC 27853)were artificially spreaded on the body of gastroscope ,biopsy hole and biopsy clamp.The gastroscope was routinely cleaned and disinfected.HBsAg and pathogens in the samples,which collected before and after cleaning the gastroscope and 3min,5min,10min after disinfection,were tested by using ELISA and bacteria culture,respectively.Results Pathogen and HBsAg can be detected before cleaning the gastroscope.Pathogen can also be detected,but HBsAg disappears after cleaning.Both HBsAg and pathogen was negative 3 min after gastroscope was immersed in glutaraldehyde.Conclusion The tests for pathogens and HBsAg can be negative after gastroscope was cleaned and immersed in 2％ glutaraldehyde for 3 min.

Objective To investigate the reliability of extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) in assessing the severity of acute respiratory distress syndrome (ARDS) in critically ill patients.Methods Forty-six patients with ARDS,who were admitted in our emergency intensive care unit,aged 18-72 yr,weighing 46-72 kg,of Acute Physiology and Chronic Health Evaluation Ⅱ score 11-25,were divided into 3 groups:PaO2/FiO2 ≤ 100 mmHg severe group (n =16);100 mmHg ＜PaO2/FiO2 ≤ 200 mmHg moderate group (n =14);200 mmHg ＜PaO2/FiO2 ≤ 300 mmHg mild group (n=16).Before treatment,and at 24 and 72 h after diagnosis of ARDS,PVPI,EVLWI,cardiac index (CI),and intrathoracic blood volume index (ITBVI) were measured,and blood gas analysis was performed.PaO2/FiO2 was calculated.The 28 day fatality after admission to hospital was recorded.Person correlation of PVPI and EVLWI with PaO2/FiO2,ITBVI and CI was analyzed.Results The PVPI,EVLWI and fatality rate were significantly higher at each time point in moderate group and severe group than in mild group,and in severe group than in moderate group (P＜0.05).The correlation coefficient between PVPI and PaO2/FiO2 was 0.778,and between EVLWI and PaO2/FiO2 was-0.437 (P＜0.05).There was no correlation between CI and ITBVI (P＞0.05).The correlation coefficient between EVLWI and PaO2/FiO2 was-0.448,and between EVLWI and ITBVI was 0.347 (P＜0.05).There was no significant difference between the correlation coefficient between PVPI and PaO2/FiO2 and the correlation coefficient between EVLWI and PaO2/FiO2 (P＜0.05).Conclusion PVPI and EVLWI both can assess the severity of ARDS in critically ill patients,showing a consistent reliability.

A total of 178 patients with the time of mechanical ventilation beyond 48 hours in the second affiliated hospital of Wenzhou medical college from January 2010 to December 2013 were enrolled in this study,and there were fifty-six patients with ventilator-associated tracheobronchitis (VAT).The associated factors included age,sex,blood pressure,blood glucose,BMI,the time of mechanical ventilation,tracheal intubation methods,raise head to 30-45°,proton pump inhibitors (PPI),prophylactic antibiotic treatment,glasgow coma scale (GCS),acute physiology and chronic health evaluation (APECHE) Ⅱ score.The related factors of VAT were evaluated by using univariate logistical regression analysis,and the statistical significant variables were analyzed by using multivariate logistical regression analysis.By using univariate logistical regression analysis age,blood glucose,the time of mechanical ventilation,raise head to 30-45°,prophylactic antibiotic treatment,GCS and APECHE Ⅱ score were the important factors of VAT (P ＜ 0.05),but sex,blood pressure,BMI,tracheal intubation methods and PPI were insignificant related to VAT(P ＞ 0.05).By using multivariate logistical regression analysis the time of mechanical ventilation (OR =4.072,95％ CI 2.036-8.146),GCS[2.198(1.155-4.184)],age[2.128 (1.119-4.046)],APECHE Ⅱ score [2.109 (1.084-4.104)] and raise head to 30-45 ° [0.488 (0.243-0.979)] were associated independently with the VAT.The time of mechanical ventilation,GCS,age over 60 years,APECHE Ⅱ score and raise head to 30-45°were the independent factors associated with VAT.

Objective To investigate the protective effects of sulforaphen (SFN) on focal cerebral ischemia/reperfusion injuy (IRI) in rats in order to explore the mechanisms.Methods Twenty-four male SD rats were randomly (random number) divided into Sham-operated group (A group,n =8),IRI group (B group,n =12),sulforaphen group (C group,n =8).SD rats were made to be transient focal cerebral IRI models.SFN 5 mg/kg was injected intraperitoneally to rats 15 minutes after IRI in C group,and rats of group A and group B received equal volume PBS instead.Infarct volume was measured by TTC staining and morphologic changes were observed with HE staining.Neuronal cell apoptosis index was detected by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) assay.Rats were sacrificed at 24 h after IRI.The protein levels of NF-κB p65 and iNOS were detected by using western bloting and the mRNA expressions of NF-κB p65 and iNOS were detected by using RT-PCR.Results Compared with the group B,infarct volume was significantly smaller in group C,the number of neuronal cell apoptosis in brain tissue were decreased significantly in group C [(96.34 ±3.72) vs.(124.65 ±3.85),P ＜ 0.01],the levels of NF-κB and iNOS in brain tissue of rats were decreased in the SFN group (P ＜ 0.01).SFN reduced neuronal cell apoptosis,injury,and infarct volume [(0.26 ± 0.018) vs.(0.43 ±0.031),P ＜0.01].The mRNA expression and protein level of NF-κBp65 were decreased in the group C.And the mRNA expression and protein level of induced nitric oxide synthase (iNOS) in IRI affected brain tissue were decreased in the group C [(0.67 ± 0.042) vs.(0.56 ± 0.032),P ＜ 0.01].Conclusions SFN might decrease the neuronal cell apoptosis caused by ischemia/repeffusion injury,and this protective effect is mediated by decreasing the level of NF-κB and iNOS.

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Objective To assay the protective effect of endothelial progenitor cells (EPCs) on acute lung injury (ALI) in rabbits.Methods Forty male New Zealand rabbits were divided into EPCs low-dose group,EPCs mid-dose group,EPCs high-dose group,ALI group,and control group according to the random number table,with 8 rabbits per group.Emulsified oleic acid was used to induce ALl.Instead,saline emulsion was injected to rabbits in control group.PBS containing 1 × 105,1 × 106,and 1 ×107 EPCs were respectively administered to rabbits in EPCs low-dose,mid-dose,and high-dose groups; on the contrary,blank PBS was injected to rabbits in ALI and control groups.Lung weight to dry ratio (W/D) and pulmonary permeability index (PPI) were detected before and after operation; protein expressions of TNF-α and IL-1 βby western blot,and mRNA expression of NF-κB by RT-PCR.Results PPI and W/D value lowered in EPCs low-dose group (15.0 ± 1.1,5.04 ± 0.11),mid-dose group (13.8 ± 0.7,4.80 ± 0.13),and high-dose group (13.7 ± 0.7,4.87 ± 0.08) when compared to 17.1 ± 1.5 and 5.21 ±0.05 in ALI group (P ＜0.05).EPCs low-dose,mid-dose,and high-dose groups showed decreased levels in NF-κB (0.75 ± 0.04,0.41 ± 0.05,0.42 ± 0.03),TNF-α (0.364 ± 0.020,0.312 ±0.015,0.310 ±0.013),and IL-1β (0.230 ±0.017,0.206 ±0.010,0.210 ±0.018) compared to ALI group (0.87 ±0.11,0.387 ±0.018,0.262 ±0.019,P ＜0.05).Moreover,all indicators were lowered significantly in EPCs mid-dose and high-dose groups when compared to EPCs low-dose (P ＜0.05),but the two groups themselves revealed no statistical difference.Conclusion EPCs protect ALI via improving pulmonary edema,pulmonary permeability,and inflammatory response in a dose-dependent correlation with EPCs,but ceiling effect is observed as well.

Objective: To compare the effects on glucose tolerance and insulin sensitivity between equal isocaloric consumption moderate intensity continuous exercise and high-intensity intermittent exercise in healthy male adolescents, and to provide a reference for a reasonable exercise intervention program to maintain and improve the health level of adolescents. Methods: The 13 subjects from middle schools in Nantong were divided into control group, moderate intensity continuous exercise group (MICE) and high-intensity intermittent exercise group HIIE. The oral glucose tolerance tests were carried out on 13 healthy subjects in all conditions. Meanwhile, the insulin sensitivity index (ISI), total area under the curve (tAUC) and incremental area under the curve (iAUC) of glucose as well as insulin were calculated. Results: The tAUC of plasma glucose of MICE and HIIE group decreased by 5.99% (ES=-0.75) and 9.32% (ES=-0.86)(P<0.05) compared to C group, respectively. The tAUC of plasma glucose in HIIE group decreased by 3.54% (ES=-0.30, P<0.01) compared to MICE group. The tAUC of plasma insulin in MICE and HIIE group was attenuated 4.49% (ES=-0.64, P<0.01) and 6.79% (ES=-0.80, P<0.01) compared to C group, respectively. The tAUC of plasma glucose in HIIE group decreased by 2.42% (ES=-0.30，P<0.01) compared to MICE group. The iAUC of plasma glucose in MICE and HIIE group decreased by 25.52% (ES=-0.57, P<0.01) and 35.82% (ES=-0.73, P<0.01) compared to C group, respectively. The iAUC of plasma glucose in HIIE group decreased by 13.83% (ES=-0.16, P<0.05) compared to MICE group. The iAUC of plasma insulin in MICE and HIIE group descended by 7.14% (ES=-0.67, P<0.01) and 10.18%(ES=-0.75, P<0.01) compared to C group, respectively. The iAUC of plasma insulin in HIIE group decreased by 3.27% (ES=0.21, P<0.05) compared to MICE group. The ISI of MICE and HIIE group increased by 1.65% (ES=0.15, P>0.05) and 4.72% (ES=0.25, P<0.01) compared to C group, respectively. There was no significantly difference in ISI between MICE and HIIE group. Conclusion The intervention effects on the level of glucose, insulin and insulin sensitivity of high intensity intermittent exercise is better than moderate intensity continuous exercise among adolescents.

Objective To investigate the constitution and drug resistance status of the major pathogens in mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),so as to provide evidences for clinical treatment.Methods From patients with AECOPD undergoing mechanical ventilation in EICU or ICU of the Second Affiliated Hospital of Wenzhou Medical University from January 2016 to December 2017,various specimens were collected for identification and drug susceptibility testing of pathogens;the clinical data and test results were analyzed.Results A total of 104 patients were included in the study.Total of 163 strains of pathogens were isolated from the specimens,of which gram-negative pathogens were the most common,accounting for 74.8％ of any pathogens.Drug resistance analysis showed that gram-negative pathogens were severely resistant to third generation cephalosporins,and were more sensitive to Sulperazon and carbapenems;gram-positive cocci were more sensitive to vancomycin and linezolid.Fungi were more sensitive to amphotericin B and 5-fluorocytosine.Most of the pathogens were multi-resistant.Conclusions In selecting antibiotics for the treatment of critical patients with AECOPD,emphasis should be placed on bacterial culture and drug susceptibility testing,so as to reduce irrational drug use and the emergence of drug-resistant strains or superinfection.

Objective To evaluate the efficacy of pulse indicator continuous cardiac output (PiC-CO) monitoring in guiding volume therapy in patients with sepsis complicated with acute kidney injury. Methods Eighty-five patients with sepsis complicated with acute kidney injury were divided into PiCCO group (n= 37) and routine group (n = 48) according to whether PiCCO monitoring was used to guide vol-ume therapy. The hemodynamic parameters at 6 and 24 h after volume therapy, fluid volume, consumption of vasoactive drugs, renal function, fatality in intensive care unit and 28-day fatality were recorded. Re-sults Compared with routine group, the volume of fluid for resuscitation at 24 h after volume therapy, and central venous pressure were significantly decreased (P<0. 05), the time of continuous renal replace-ment therapy was shortened, the urine volume was increased, the blood creatinine level was decreased, and the fatality rate in intensive care unit and 28-day fatality rate were decreased in group PiCCO (P<0. 05). Conclusion For the patients with sepsis complicated with acute kidney injury, PiCCO monitoring can reasonably guide volume therapy and is helpful in improving the prognosis.