Ventilator associatcd pneumonia (VAP) is the common complication in patients with machinecal ventilation as well as the main causes due to the increase of fatality rate,length and cost of hospitalization.The diagnostic techniques of VAP and the utilizations of antibiotics have developed,but incidence rate and fatality rate have not descended obviously.So it is important to probe the methods of prevention and cure VAP from the pathogenesis.It is reported recently that the formation of biofilm is one of the important causes of VAP.The review about the relations between VAP and the formation of bacterial biofilm is followed.

The recently published articles about the pathogenesis of osteoarthritis were reviewed.Osteoarthritis(OA)is characterized by cartilage degradation,osteophyte and involvement of the synovium.Mechanics,inflammatory mediators and aging collide studies in developmental,genetic and joint disease models indicate that Wnt/?-catenin signaling is critically involved in these processes.Many different factors contribute to the onset and progression of OA and Wnt/?-catenin signaling plays a vital role in these processes.

Objective To investigate the effects of dexmedetomidine on the activities of glycome-tabolism rate-limiting enzymes in erythrocytes and the plasma levels of glucose and malondialdehyde in pa-tients undergoing radical gastrectomy for cancer.Methods Sixty patients,38 males and 22 females,aged 60-80 years,scheduled for radical gastrectomy for cancer were randomly divided into dexmedetomidine group (group D)and control group (group C),30 cases in each group.The patients in group D were intra-venously infused 0.5 μg/kg dexmedetomidine 10 minutes before operation and perioperatively followed by an infusion at a rate of 0.3 μg·kg-1 ·h-1 until the abdomen were closed.Group C was infused the same a-mount of normal saline.Venous blood samples were collected for the measurement of phosphofructokinase (PFK),glucose-6-phasphate dehydrogenase (G-6PD)and aldose reductase (AR)activities in erythrocytes and the plasma levels of glucose and malondialdehyde (MDA)before induction (T0 ),60 min following the incision (T1 ),60 min (T2 ),day 1 (T3 )and day 2 (T4 )after operation.Results Compared with these at T0 ,the activity of PFK was decreased significantly and the activities of G-6PD and AR were increased markedly at T3 in both groups (P <0.05 or P <0.01),however the activity of the PFK was significantly higher,G-6PD and AR were significantly lower in group D than those in group C (P <0.05).The levels of plasma glucose elevated significantly at T1 (P <0.01),reached high peak values at T3 (P <0.01)and fell at T4 in both groups.The values of plasma glucose in group D were lower than those in group C at T1 ,T2 and T3 (P <0.01).The MDA concentration in both groups increased significantly at T3 (P <0.01),while that of group D was lower than group C (P < 0.05 ).Conclusion Dexmedetomidine could markedly decrease glucose level and alleviate oxidative stress and improve these erythrocyte glucose metabolism changes after radical gastrectomy for cancer in old patients.

Objective To evaluate the surface anesthesia and antibacterial effect of compound lidocaine cream in indwelling urethral catheter in order to seek the optimal indwelling urethral catheter scheme in cardiac surgery.Methods A total of 198 patients undergoing elective cardiac surgery in this hospital from November 2016 to January 2017 were selected and divided into the two groups:the lidocaine cream group(L) and liquid paraffin control group(C).The visual analogue scale (VAS) and catheter-related bladder discomfort(CRBD) were used immediately after tracheal catheter extubation and at 2,4 h after extubation.The number of white blood cells and bacteria in urine were observed on postoperative 1,7 d.The urine culture results were observed on postoperative 7 d.Results The VAS and CRBD scores immediately after extubation in the group L was significantly lower than that in the group C(P＜0.05).The urine WBC count and bacterial count on postoperative 7 d in the group L were significantly lower than those in the group C(P＜0.05),the positive rate of urine culture on postoperative 7 d in the group L was significantly lower than that in the group C,the difference was statistically significant(5.05％ vs.13.13％,P＜0.05).Conclusion Compound lidocaine cream as lubrication indwelling urethral catheter can decrease the incidence rate of urinary tract infection on postoperative 7 d in the patients with cardiac operation,furthermore can prevent the wake agitation caused by indwelling urethral catheter.

Objective:To investigate the predictive value of KAI1 expression in colon cancer tissues for tumor recurrence.Methods:Ninety-two pathological tissue samples were collected from patients undergoing radical operation for colon cancer in Tangshan People's Hospital from August 2010 to November 2011. According to the results of follow-up, the patients were divided into recurrent group (33 cases) and non-recurrent group (59 cases). KAI1 expression in tumor tissues was detected by immunohistochemistry. χ2 test was used to analyze the relationship between KAI1 expression in colon cancer tissues and clinicopathological characteristics of patients with colon cancer. Spearman correlation test was used to analyze the relationship between KAI1 expression in colon cancer tissues and the recurrence time of patients. Cox proportional hazards model was used to analyze the related factors affecting postoperative recurrence of colon cancer. Results:KAI1 expression in tumor tissues in the recurrent group was lower than that in the non-recurrent group [39.39% (13/33) vs. 62.71% (37/59), χ2 = 4.638, P = 0.031]. KAI1 expression was not associated with patients' gender, age and tumor maximum diameter (all P > 0.05), but related to the tumor differentiation and lymphatic metastasis [high and medium differentiation vs. low differentiation: 70.3% (26/37) vs. 43.6% (24/55), χ2 = 6.324, P =0.012; lymph node metastasis vs. non-lymph node metastasis: 43.2% (19/44) vs. 64.6% (31/48), χ2 = 4.238, P = 0.039]. KAI1 expression in tumor tissues was positively correlated with tumor recurrence time ( r = 0.845, P < 0.05). Cox multivariate analysis showed that the low differentiation of the tumor, lymph node metastasis and negative expression of KAI1 in colon cancer tissues were independent risk factors for recurrence of colon cancer after surgery ( HR = 1.736, 95% CI 1.598-5.391, P = 0.019; HR =1.526, 95% CI 1.175-3.029, P = 0.037; HR = 1.799,95% CI 1.756-5.825, P = 0.013). Conclusion:Low KAI1 expression in colon cancer tissues is closely related to colon cancer recurrence, and the detection of KAI1 expression in colon cancer tissues has certain predictive value for tumor recurrence.

Objective To explore the threshold of 4 m-walking speed for predicting falls in patients with stroke and to evaluate its clinical significance. Methods A total of 1 079 cases of stroke patients in Neurology Surgery Department and Neurology Medicine Department of the Second Affiliated Hospital of Wenzhou Medical University from July 2015 to May 2017 were selected as the research subjects by convenience sampling method. Data of physical examination, body composition measurement, blood biochemistry, muscle strength and 4 m-walking speed were collected by questionnaire. According to the results of 4 m-walking speed test, the receiver operating characteristic curve (ROC) of subjects was drawn to determine the critical value of 4 m-walking speed for stroke patients, and the predictive value of the critical value of 4 m-walking speed for the risk of falling was analyzed by logistic regression. Results The incidence of falls was 37.5% in stroke patients. The 4 m-walking speed for male and female with stroke was (0.75±0.02) m/s and (0.82±0.06) m/s respectively. ROC curve showed that, in male patients, the critical value of 4 m-walking speed was 0.84 m/s, the area under curve (AUC) was 0.71 (0.65, 0.75), the sensitivity was 87.5%, and the specificity was 65.9%. In female, the critical value of 4 m-walking speed was 0.79 m/s, the AUC was 0.68 (0.62, 0.73), the sensitivity was 75.3%, and the specificity was 78.6%. Logistic regression analysis showed that after adjusting for age, BMI, smoking, alcohol consumption, exercise and disease history, compared with the elderly population below 4 m-walking speed threshold, the OR values of falls in male and female stroke patients above the 4 m-walking speed threshold were 2.97 (1.94, 4.56) and 2.25 (1.40, 3.60) respectively. Conclusions The incidence of fall is high in stroke patients. The threshold of 4 m-walking speed to predict the fall risk of male and female patients with stroke was 0.84 m/s and 0.79 m/s respectively. The determination of the threshold of 4 m-walking speed can provide reference for the prevention of falls in stroke patients and is worthy of clinical popularization and application.

Objective To study the application of the family centered escort system in neurosurgical intensive care units (NICU). Methods 416 cases of NICU patients from January 2015 to December 2016 were selected, 197 cases of the patients from January to December 2015 serving as the control group subject to a restrictive visit system. 219 cases of patients from January to December 2016 were used as the study group subject to the family centered escort system. The two groups were compared as to the anxiety state and satisfaction of the family members, the job satisfaction of nurses, the duration and cost of the patients in NICU, the ratio of the patients subject to sedation and restraint bands, and the incidences of adverse events of patients during NICU. Results Scores of anxiety state of the family members showed that the control group (52. 76 ± 5. 21) was significantly higher than that of the study group (34. 61 ± 5. 98). The dimensions of " information acquisition" and " access to patients" as found in the satisfaction survey of the family members showed the study group as higher than the control group, a difference of statistical significance between two groups (both P＜0. 01). The dimensions of " state at work" and " interpersonal relationship at work" showed the study group as higher than the control group, a difference of statistical significance between two groups ( P ＜ 0. 05 ) as found in the job satisfaction survey of nurses. The comparison between the two groups in NICU duration and expenses showed no significant statistical difference (P＞0. 05). The ratio of sedation treatment and restraint band usage of control group was significantly higher than that of the study group, a difference of statistical significance (P＜0. 01). The incidence ratio of lower extremity venous thrombosis showed that the control group (13. 7%, 27/197) was higher than that of the study group (6. 8%, 15/219), a difference of statistical significance (P ＜0. 01). There was no significant difference as to the incidences of other adverse events of the two groups ( P ＞ 0. 05 ). Conclusions Compared with the restricted visiting system, the family centered escort system in NICU is beneficial to both the nurses and patients, justifying the humanity of the latter system.

S-adenosyl-l-methionine (SAM) is ubiquitous in living organisms and plays important roles in transmethylation, transsulfuration and transamination in organisms. Due to its important physiological functions, production of SAM has attracted increasing attentions. Currently, researches on SAM production mainly focus on microbial fermentation, which is more cost-effective than that of the chemical synthesis and the enzyme catalysis, thus easier to achieve commercial production. With the rapid growth in SAM demand, interests in improving SAM production by developing SAM hyper-producing microorganisms aroused. The main strategies for improving SAM productivity of microorganisms include conventional breeding and metabolic engineering. This review summarizes the recent research progress in improving microbial SAM productivity to facilitate further improving SAM productivity. The bottlenecks in SAM biosynthesis and the solutions were also addressed.
S-Adenosylmethionine/metabolism* ; Plant Breeding ; Fermentation ; Metabolic Engineering