Unplanned extubation (UEX) is defined as premature removal of the indwelling catheter tube by a patient (deliberate unplanned extubations) or by staff during nursing and medical care (accidental extubations). UEX, either deliberate or accidental, can cause severe damage of patients, with the increasing of hospital costs and medical disputes. Identifying high-risk patients is the key point of reducing UEX. This review conclude risk assessment tools reported for UEX.

Objective To evaluate the therapeutic effect of silver ion dressings combined with hydro gel in treatment of diabetic foot by using Meta-analysis.Methods The Cochrane Library,EMbase and domestic main databases were searched,the quality of included studies which screened by certain standards was evaluated.The Review Manager 5.0 software was taken for analysis.Results Totally 11 studies were included,containing 765 patients with diabetic foot.The Meta-analysis showed that there were significant differences between two groups in treatment efficiency,granulation tissue growth time and basic healing time.But the epithelial formation time showed no significant difference between two groups.Conclusions Silver ion dressings combined with hydro gel in treatment of diabetic foot was effective.However,the quality and quantity of most studies included in this review are low,studies of higher quality and quantity are needed to confirm the results in the future.

Objective To discuss the function and advantages of ultrasound technology in various factors in the diagnosis of vertebral artery stenosis lesions.Methods The objective data of ultrasonography were selected in 60 patients (120 vertebral arteries) with paroxysmal,reversible vertigo and headache as the chief complaint,the internal relations were summarized and analyzed.Results In the subjects of study,the vertebral artery stenosis for 38.2％,vertebral artery course tortuosity changer accounted for 33.3％,congenital abnormal development accounted for 9.8％,mixed cause 18.6％,dominant etiology was vertebral artery sclerosis and vertebral artery tortuosity change.Conclusion Ultrasound technology has important value of clinical application in the reasons diagnosis of vertebral artery stenosis disease,it can help extend clinical diagnosis.

Objective To investigate the role and significance of miRNA-21 in the pathogenesis and development of inflammatory bowel disease (IBD).Methods The expressions of microRNA-21 (miRNA-21) in colonic mucosa and peripheral blood CD4+T cells were analyzed by fluorescence quantitative polymerase chain reaction (PCR) in 26 patients with active Crohn's disease (CD), 23 patients with active ulcerative colitis (UC) and 19 healthy controls.The relative expression amount of miRNA-21 in colonic mucosal and peripheral blood CD4+ T cells in 11 patients with CD was compared before and after infliximab (IFX) treatment, and its correlation with tumor necrosis factor (TNF)-α was analyzed.t-test was performed for comparison between groups.The correlation between miRNA-21 expression in peripheral blood CD4+ T cells and serum TNF-α was analyzed by Spearman correlation analysis.Results The expression of miRNA-21 in colonic mucosa of CD patients and UC patients was 4.720 ± 0.397 and 4.993±-0.415, respectively, which were both higher than that of healthy control group (1.101±-0.284),and the differences were statistically significant (t =7.657 and 8.356, both P＜0.01).The expression of miRNA-21 in peripheral blood CD4+ T cells of CD patients and UC patients was 3.254 ± 0.323 and 3.450±0.311, which were both higher than that of healthy control group (0.891 ±0.220), and the differences were statistically significant (t=6.007 and 7.098, both P＜0.01).After 12 weeks of IFX treatment, simple endoscopic score for Crohn's disease (SES-CD) of CD patients was 8.019 ± 0.349,which was lower than that before treatment (21.502 ± 1.185), and the difference was statistically significant (t=10.910, P＜0.01).The serum TNF-α level was 61.570±6.252, which was lower than that before treatment (173.500 ± 12.670), and the difference was statistically significant (t=7.926, P＜0.01).The results of correlation analysis indicated that serum TNF-α level was positively correlated with miRNA-21 expression in peripheral blood CD4+ T cells (r =0.780 4, P ＜ 0.01).Conclusions The increasing of miRNA-21 expression in IBD was closely correlated with the serum TNF-α level and severity of inflammation.miRNA-21 might be a new target for IBD treatment.

ObjectiveToobserve the regulating effect of acupuncture at Fengchi (GB20) and extraordinary points on tumor necrosis factor (TNF)-aand endothelin (ET) in hypertension.MethodTotally 150 patients with hypertension were randomized into two groups at a ratio of 1:1.In the control group, 75 subjects were intervened by acupuncture at bilateral Fengchi; in the treatment group, 75 subjects were intervened by acupuncture at bilateral Fengchi plus extraordinary points. The needles were manipulated once every 10 min duringthe 30-min session. The treatment was given once per day, 2 weeks as a treatment course. ResultDuring the intervention, the TNF-aand ET contents were decreased significantly in the treatment group (P<0.05); the TNF-aand ET contents were also decreased in the control group but without statistical significance (P>0.05). After 1 treatment course, the TNF-aand ET contents were decreased significantly in the treatment group (P<0.05); the TNF-aand ET contents were insignificantly decreased in the control group (P>0.05); there was a significant difference in comparing the TNF-aand ET contents between the two groups (P<0.05). There were also significant differences in comparing the TNF-aand ET contents inhypertension of various degrees between the two groups (P<0.01). The results showed that the TNF-aand ET contents in patients intervened by acupuncture at Fengchiand extraordinary points were lower than that in those intervened by acupuncture at Fengchialone, i.e. combination of Fengchi and extraordinary points produces a significant effect on regulating TNF-aand ET contents.Conclusion Acupuncture at Fengchi and extraordinary points can produce a more significant effect than acupuncture at Fengchi alone on regulating TNF-aand ET in patients with hypertension.

Objective To evaluate the role of using non-invasive ventilation with bi-level positive airway pressure (BiPAP) in order to reduce the need of re-intubation in pediatric patients with respiratory failure after cardiac surgery. Method From January 2007 to December 2007, 25 patients aged from three months to 11 years with median 2.3 years operated on for cardiac surgery with respiratory insufficiency after extubation and re-intubation indicated were enrolled in this study. They were put on non-invasive nasal (mask) BiPAP ventilation before re-intubation. The arterial blood gas, A-aDO2 and PaO2/FiO2 were measured. In addition, clinical data including heart rate, respiratory rate, and the product of heart rate and systolic pressure were recorded before and after BiPAP. The software SPSSD 13.0 was used to process by ANOVA test for statistical analysis. Meanwhile, the outcome of these patients was analyzed. Results Twenty-five patients with 30 episodes of respiratory insufficiency were treated with BiPAP ventilation with median duration of 1.96 days ranged from 0.03 to 12 days. Of these respiratory failure episodes, 25 ones (83.3%) could be controlled by BiPAP and the needs of re-intubation were avoided. Five episodes of respiratory failure in 4 patients could not be quelled and the endo-tracheal tubes were inserted in these patients. All patients were saved with a median of mechanical ventilation duration of 3.4 days and ICU stay of 10.6 days. No major complications were observed. The heart rate, respiratory rate and the rate-pressure product were decreased significantly one hour after BiPAP (P < 0.05 all). Meanwhile, patients showed rapid improvement of oxygenation. The pH, SpO>2 and PaO2/FiO2 were increased significantly and A-aDO2 was decreased significantly (P < 0.05 all). The PaCO2, was decreased significantly four hours after BiPAP (P < 0.05). Conclusions Non-invasive nasal mask BiPAP can be used safely and effectively in children after cardiac surgery to improve oxygenation/ventilation, decreasing the work of breathing. It may be particularly useful in patients with high risk of re-intubation.

Objective To evaluate the therapeutic effect of intravenously use of ambroxol in treatment of mechanical ventilator patients.Methods Meta-analysis was used.The Cochrane Library,PubMed,Elsevier (ScienceDirect),OVID series medical databases and domestic main databases were searched,the quality of included studies was evaluated by certain standards.The Review Manager 5.0 software was used for analysis.Results 14 studies were included,1 184 mechanical ventilation patients were involved.The Meta-analysis showed that there were significant differences between two groups in blood gas analysis,airway resistance and pressure and lung compliance.However,there were no differences between two groups in expectorant effect and VAP incidence.Conclusions Intravenously use of ambroxol in treatment of mechanical ventilator patients was effective.A large multi-center sample of high-quality clinical studies is needed to confirm the results.

AIM: To observe the effects of puerarin on blood lipid and expression of aorta laminin B_1 mRNA in streptozotocin-induced diabetic rats. METHODS: Diabetic nephropathy rats were induced by intraperitoneal injection of STZ, and the experimental rats were divided into normal control group, model group, and puerarin group. During and after the treatment for 12 weeks, the general state, blood suger(BS), triglyceride(TC), cholesterol, low density lipoprotein(LDL-C), high density lipoprotein(HDL-C), glycosylated hemoglobin(HbA1c) and glycosylated low density lipoprotein(G-LDL) were detected. Aorta alteration of tissue morphology was observed by H.E staining, and the expressions of laminin B1 mRNA were determined by in situ hybridization analysis. RESULTS: Diabetes mellitus and aorta lesion occurred in the two model groups. Puerarin could improve the general state, decrease the level of triglyceride(P

Objective To systematically evaluate the efficacy of high-flow nasal cannulae oxygen (HFNC) in patients with respiratory failure.Methods Computerized PubMed, Embase, Web of Science, the Cochrane Library, CNKI, CBM, VIP, Wanfang Database up to March 31st, 2017, all published available randomized controlled trials (RCTs) or cohort studies about HFNC therapy for patients with respiratory failure were searched. The control group was treated with face mask oxygen therapy (FM) or non-invasive positive pressure ventilation (NIPPV), while the experimental group was treated with HFNC. The main outcomemeasurements included endotracheal intubation rate, patient comfort, and the secondary outcome was in-hospital mortality. The quality of the literature was completed by two professionally trained evidence-based medical students, and meta-analysis was performed on quality-compliant literature. Funnel plot was used to analyze the publication bias.Results A total of 17 articles were enrolled including 15 RCTs and 2 cohort studies. There were 3909 patients enrolled, 1907 patients in HFNC group, and 2002 in control group (1068 patients with FM, and 934 with NIPPV). Meta-analysis showed that HFNC had a significant advantage over FM in reducing the tracheal intubation rate of patients with respiratory failure [odds ratio (OR) = 0.51, 95% confidence interval (95%CI) = 0.29-0.89,P = 0.02], but there was no significant difference as compared with that of NIPPV (OR = 0.80, 95%CI = 0.54-1.17,P = 0.25). It was shown by pooled analysis of two subgroups that compared with FM/NIPPV, HFNC had a significant advantage in reducing tracheal intubation rate in patients with respiratory failure (pooledOR = 0.66, 95%CI = 0.47-0.94, P = 0.02). Compared with FM, patients with respiratory failure were more likely to receive HFNC for comfort [standardized mean difference (SMD) = -0.41, 95%CI = -0.56 to -0.26,P < 0.00001]. There was no significant difference in hospital mortality between HFNC and FM (OR = 0.82, 95%CI = 0.55-1.24,P = 0.35) or NIPPV (OR = 0.66, 95%CI = 0.37-1.17, P = 0.16). The results of pooled analysis of two subgroups were still unchanged (pooledOR = 0.75, 95%CI = 0.54-1.05, P = 0.09). It was shown by the funnel analysis that there was a bias in the study of tracheal intubation rate in the literature, while the bias of patient comfort and hospital mortality was low.Conclusions Compared with FM, HFNC could reduce the rate of tracheal intubation in patients with respiratory failure, but no difference was found as compared with NIPPV. Compared with FM, HFNC made patients more comfortable, and it was easier to be accepted and tolerated. However, there was no difference in hospital mortality among FM, NIPPV, and HFNC.

ObjectiveTo analyze the clinical manifestation of hemolytic disease of the newborn (HDN) due to anti-M and Rhesus system.MethodsClinical information was collected and analyzed for three cases with HDN due to anti-M and 64 with Rhesus hemolytic disease, who were admitted to Department of Neonatology, Beijing Children's Hospital Affiliated to Capital Medical University from February 2011 to January 2015, as well as another 28 cases of HDN due to anti-M with complete information retrieved from literature in Wanfang and China National Knowledge lnfrastructure (CNKI) Database from 1992 to 2014.Chi-square test was performed for statistical analysis.ResultsTwo out of the 64 Rh hemolytic babies gave up therapy due to kernicterus and another two out of the 31 MN hemolytic babies, obtained from literature, died 24 h after birth because of anemia or edema, while the rest survived. Although more babies were the first child of the family in HDN due to anti-M than those of Rh hemolytic disease [26%(8/31) vs 9%(6/64),χ2=4.487, P=0.034], but lower incidence of jaundice [81%(25/31) vs 98%(63/64),χ2=9.686,P=0.002], less proportion of presentation of jaundice within 24 h after birth [29% (9/31) vs 64%(41/64),χ2=10.279,P=0.001] and lower positive rate of direct antiglobulin test [39%(12/31) vs 100%(64/64), Fisher exact test,P=0.000] were shown in HDN due to anti-M. No significant difference was found in the incidences of hyperbilirubinemia [58%(18/31) vs 66%(42/64),χ2=0.513], severe hyperbilirubinemia [23%(7/31) vs 36%(23/64),χ2=1.724], anemia [81%(25/31) vs 89%(57/64),χ2=1.253] and severe anemia [29%(9/31) vs 34%(22/64),χ2=0.271] between HDN due to anti-M and Rh hemolytic babies (allP>0.05).ConclusionsHDN due to anti-M and Rhesus hemolytic disease can cause severe pathological jaundice and/or anemia in newborns. Indirect antiglobulin test should be offered when direct antiglobulin test is negative which is helpful in the diagnosis of HDN due to anti-M.