Objective To observe the changes of plasminogen activator inhibitor-1(PAI-1)mRNA expression in experimental lung iniury and to evaluate the effect of inhaled nitric oxide(NO)on PAI-1 mRNA expression.Methods In this study,acute lung injury rat model was established by lipopolysaccharide(LPS)-induced endotoxemia followed by a second LPS attack via intratracheal injection.Eighty-nine SD male rats aged 4～5 week were randomly assigned to three groups:saline control(C-A)group,LPS-A group attacked by LPS,LPS-NO group treated by nitric oxide.Realtime PCR was used to study the expression of PAI-1 mRNA in the lung.Histopathological lung injury score was evaluated.Results In LPS group,the histopathological lung injury score values were significantly higher than that of C-A group at 2 h[(3.10±0.38)vs(1.12±0.84)](P＜0.05)and the score values after 2 h were higher than that of LPS group at 2 h(P＜0.05).PAI-1 mRNA in lung increased gradually in LPS groups at 2 h,4 h,8 h,16 h,24 h(P＜0.05)and decreased at 48 h(P＞0.05).The PAI-1 mRNA decreased in LPS-NO groups at 4h(P＜0.05).Conclusion The study above demonstrates that PAI-1 mRNA expression is early elevated in rats with endotoxin-induced acute lung injury.Decreased PAI-1 mRNA expression is associated with the efficacy of inhaled nitric oxide.

[Abts ract] Ven tilato r-associated pneumonia ( VAP) is one fo the most common nosocomila infec-tions of mechanically ventilated children in PICU.VAP not only contributes to prolong ed hospital and PICU lengt h of stay,but asl o icn reaseds medical cost,mortality and mo rbility in critiac lly ill children.It′s an urgent task to prevent VA P in pediatrici ntensive care medicine.The aimo f the articel was to intor duce the epidemi-ology,risk factors,prevention strategya nd practice in children.The article reviewed guidelines of strategies to prevent VAP in pediatric patients.

At present,the satisfaction of free medical care of undergraduate is declining,and the doctor-patient relationship is becoming tense.By investigating and interviewing the three representative universities in Beijing,we conclude three reasons including the supplier of medical service,the receiver and doctor-patient communication.By adhering to the medical treatment concept of"Patient-Oriented",the paper puts forword serveral measures including incresing input and improving system and so on to achieve the harmonious development of doctor-patient relationship of undergraduate.

Objective To explore the effects of inhaled nitric oxide(NO) on expression of plasminogen activator inhibitor-1 (PAI-1) mRNA and protein in the early-stage of experimental acute lung injury (ALI) in a rat model.And to investigate the relationship between endogenous NO system including inducible nitric oxide synthase (iNOS)and intrapulmonary NO production and expressions of PAI-1 in ALI.Methods In the study,endotoxemia followed by the second attack due to intratracheal injection of lipopolysaccharide (LPS) in rats caused ALI.Male SD rats aged 4-5 weeks (clean conventional rats,180-200 g) were randomly assigned to 2 groups:saline control (C) group,LPS-treated (LPS) group,and the 2 groups were randomly allocated to subgroups exposed to air (A) or 20 × 10-6 NO.They were sacrificed for 24 h.Expressions of PAI-1 mRNA of the lung tissue were evaluated by real-time polymerise chain reaction; PAI-1 proteins were determined by immunohistochemistry.NO production in the lung tissues and pulmonary iNOS activity were measured.Meanwhile,histopathological lung injury scores were evaluated and modified martius acid fuchsin brilliant blue(MSB) stains was performed to evaluate fibrin of the lung tissues.Results At 24 h time point with intervention of iNO,PAI-1 mRNA and protein levels in LPS-NO subgroup were decreased compared with those in LPS-A subgroup (4.94 ± 0.52 vs 5.56 ± 0.27 ; 1.31 ± 0.40 vs 1.69 ± 0.16,all P ＜ 0.05).Meanwhile,iNOS activity and NO productions in LPS-NO subgroup were lower than those of LPS-A subgroup [(0.84 ± 0.36) U/mg prot vs (2.30 ± 0.25) U/mg prot ; (1.90 ± 0.84) μmol/g prot vs (3.38 ± 0.73) μmol/g prot,all P ＜ 0.05].iNOS activity had significant correlation with expression of PAI-1 mRNA and protein in lung tissue (r =0.481,P =0.005 ; r =0.667,P =0.000) ; NO production had significant correlation with expression of PAI-1 mRNA and protein in lung tissue(r =0.532,P =0.002; r =0.784,P =0.000).At 24 h time point,the histopathologic lung injury scores in LPS-NO subgroup were decreased in contrast to LPS-A subgroup (4.28 ±0.94 vs 6.12 ± 1.51,P ＜ 0.05).Fibrin deposition evaluated by modified MSB stains in LPS subgroups was found in alveolar space,lumen of blood vessel and mesenchymal ;LPS subgroup with NO appeared a decreasing trend in contrast to LPS subgroup with air.Conclusions Inhaled nitric oxide of 20 × 10 6 can suppress elevated expression of PAI-1 in ALI induced by endotoxin.This inhaled NO can improve the imba-lance of plasminogen activation system and alleviate lung injury.Meanwhile,inhaled NO down-regulates intrapulmonary iNOS activity as well as endogenous NO productions in rats with 2 hits of LPS induced ALI.These changes also have a close correlation with down-regulation of PAI-1 mRNA and protein.Thus,regulation of endogenous NO system on the expression of PAI-1 will be the future direction of new therapies for ALI.

OBJECTIVE To investigate the reasonable use of antibacterial in department of orthopedics.METHODS The patients in our department were registered according to the inventory of antibacterial use made by the hospital infection monitoring network of Medical Administration Bureau,Ministry of Health of the People′s Republic of China,the(operative) incision was classified according to Clinical Surgery.The data of reasonable use of antibacterial were(obtained) after evaluation and(analysis).RESULTS Of the 257 patients in our study,79.37% of them were used antibacterial,20.62% were not used antibacterial,24.50% were used antibacterial for therapy,75.49% were used antibacterial for infection(prevention);95.09% were used systematically;74.50% were reasonable(usage,) 25.49% were unreasonable usage;of the 204 patients who were used antibacterial,only 34 patients were tested by drug sensitivity trial,and the others were used by experience.CONCLUSIONS In order to use antibacterial reasonably,we suggest two points,one is that the medicine management department should workout a feasible antibacterial use institution and mass(evaluation) criterion,take mass examination regurally,and connect the bonus to the examination result;the other is that we should enhance the management of antibacterial market,avoid the improper competition,rise the morality view of the doctor,and suggest them to use antibacterial reasonably(according) to the scientific theory.

Objective To investigate platelet counts and acute obstructive suppurative cholangitis correlation analysis and possible influential factors.Methods Data of 117 patients from October 2012 to October 2015 treated in our hospital,of whom 57 with acute obstructive suppurative cholangitis and 60 with common acute cholangitis were analyzed retrospectively to explore whether there was a correlation between thrombocytopenia (100 × 109/L) and AOSC,then experimental and control groups were established according to thrombocytopenia in the AOSC patients.The patient's age,sex,previous biliary surgery,white blood cells(WBC) count after admission within 6h,the percentage of neutrophils (NEU％),calcitonin (PCT) were retrospectively analyzed to further explore the influence factors of thrombocytopenia in AOSC patients.Results By comparison with the common acute cholangitis group,thrombocytopenia in AOSC group had obvious difference (P =0.01).In experimental group,NEU％,PCT had statistical difference compared with those in control group (P ＜ 0.05),and the patient's age,sex,previous biliary surgery,white blood cells(WBC) after admission within 6h count had no statistical significance.The logistic multivariate regression analysis showed that,NEU％,PCT were the independent predictors.Conclusion Correlated with AOSC,thrombocytopenia can be valued as indicators of the severity of acute cholangitis.In AOSC patients,NEU％,PCT were independent predictors of thrombocytopenia.

OBJECTIVETo compare the efficacy difference among acupuncture smoothing-liver and regulating-spleen method, regulating Governor Vessel method and oral administration of western medicine for menopausal insomnia.

METHODSOne hundred and fifty-six cases of menopausal insomnia were randomized into a smoothing-liver and regulating-spleen group (group A), a regulating Governor Vessel group (group B) and a medication group (group C), 52 cases in each one. Acupuncture at Zhongwan (CV 12), Daheng (SP 15), Sanyinjiao (SP 6) and Taichong (LR 3), etc. was applied in the group A; acupuncture at Baihui (GV 20), Fengfu (GV 16), Shenting (GV 24) and Yintang (GV 29), etc. was used in the group B; oral administration of estazolam tablets (1 mg each-day) was adapted in the group C, all once a day for totally 30 days. The each item score and total score in Pittsburgh sleep quality index (PSQI) were evaluated before and after treatment in each group, also the efficacy in each group was assessed.

RESULTSAfter the treatment, the sleeping rate in the group A and B was significantly higher than that in the group C (both P < 0.05); the total effective rate in the Group A and B was also significantly higher than that in the group C [86.5% (45/52) and 82.7% (43/52) vs 63.5% (33/52), both P < 0.05; the total cured rate in the group A was significantly higher than those in the group B and C [48.1% (25/52) vs 23.1% (12/52) and 25.0% (13/52), both P < 0.05]. Each item score and total score of PSQI were all improved after treatment in the group A and B (P < 0.01, P < 0.05), while only sleeping time, sleeping efficiency and total score were improved in the group C (all P < 0.05). The sleeping quality, sleeping time, sleeping difficulty and daytime dysfunction in the group A were all lower than those in the group C (all P < 0.05). The sleeping quality, sleeping time and daytime dysfunction in the goup B were all lower than those in the group C (all P < 0.05). The total score in the group A was significantly lower than that in the group B and C (both P < 05).

CONCLUSIONAcupuncture has better effect for menopausal insomnia than estazolam. Between the two acupuncture methods, the acupuncture method of smoothing-liver and regulating-spleen has a better effect.

Acupuncture Therapy ; Female ; Humans ; Liver ; physiopathology ; Menopause ; physiology ; Meridians ; Middle Aged ; Sleep Initiation and Maintenance Disorders ; physiopathology ; therapy ; Spleen ; physiopathology

ObjectiveTo discuss the relationship between patella location and chondromalacia patella,explore its mechanism and clinical significance.Methods Knee joint MRI was performed in 1052 patients (506 men and 546 female).Among them,there were 299 patients( 100 men and 199 female)with chondromalacia patella.They were divide into the group of 1-19,the group of 20-39,the group of 40-59 years old and the group of older than 60 years to compute the positive rate respectively.Insall-Salvati method was used to measure the length of chondromalacia ligaments(L) and the length of chondromalacia path(P).The relationship between patella location and chondromalacia was tested by using t test and x2 test.ResultsThe total positive rate of chondromalacia patella was 28.4％ (299/1052).In female it was 36.4％ (199/546) and in men was 19.8％ (100/506).The group of 1-19 years old had 16 patients ( 16.8％,16/95).The group of 20-39 years old had 71 patients( 17.9％,71/396).The group of 40-59 years old had 116 patients ( 33.2％,116/349 ).The group of older than 60 years had 96 patients (45.3％,96/212).The positive rate of chondromalacia patella increased with age.The L/P value of normal group and chondromalacia patella group were 1.15 ±0.15 and 1.24 ±0.17 respectively.The L/P value of normal group of men and women were 1.13 ± 0.15 and 1.17 ± 0.14 respectively.The L/P value of chondromalacia patella group of men and women were 1.20 ±0.17 and 1.26 ±0.16 respectively.The InsallSalvati index of age groups showed significant differences.The L/P value of pathological changes group and normal group of 1-19 years old were 1.38 ± 0.25 and 1.24 ± 0.16 respectively.The L/P value of pathological changes group and normal group of 20-39 years old were 1.24 ± 0.17 and 1.15 ± 0.16 respectively.The L/P value of pathological changes group and normal group of 40-59 years old were 1.24 ±0.16 and 1.12 ±0.12 respectively.The L/p value of pathological changes group and normal group of older than 60 years were 1.21 ±0.16 and 1.12 ±0.12 respectively.All of them had significant differences (P ＜ 0.01 ).ConclusionsThe positive rate of chondromalacia patella for female is higher than that for men,which also increases with age.High patella location is relevant to chondromalacia patella.

Objective To investigate the changes of serum adiponectin (APN) levels in patients with essential hypertension (EH) and the correlation with carotid artery intima-media thickness (IMT).Methods Sixty patients with EH(EH group) and 30 healthy people (control group) were studied,the EH patients were divided into 3 subgroups with 20 cases each according to the standard of China guideline for hypertension prevention and control (2005).The serum APN level was detected by double antibody sandwich ABC enzyme-linked immunosorbent assay,the blood lipids levels [total cholesterol (TC),triglyeride (TG),low density lipoprotein-cholesterol (LDL-C) and highdensity lipoprotein-cholesterol (HDL-C)]were detected by automatic biochemical analyzer,and the carotid artery IMT was detected by color Doppler ultrasonography.Results The serum APN levels and carotid artery IMT in EH group and 1,2,3 subgroup were significant differences compared with those in control group [(3.94 ± 1.28),(5.25 ± 1.69),(4.01 ±1.27),(2.56 ± 0.87) mg/L vs.(7.63 ± 2.50) mg/L; (1.30 ± 0.42),(0.94 ± 0.30),(1.32 ± 0.44),(1.65 ±0.51)mm vs.(0.69 ± 0.22) mm,P ＜ 0.05].The comparison between two subgroups,along with elevated blood pressure levels,APN levels gradually decreased,and carotid artery IMT gradually increased (P ＜0.05).The serum TC,TG,LDL-C and HDL-C levels in EH group and 1,2,3 subgroup were significant differences compared with those in control group [TC:(6.53 ± 2.09),(5.14 ± 1.66),(6.59 ± 2.20),(7.86 ±2.42) mmol/L vs.(4.17 ± 1.32) mmool/L;TG:(2.15 ± 0.69),(1.72 ± 0.55),(2.07 ± 0.69),(2.65 ± 0.82)mmol/L vs.(1.38 ±0.44) mmol/L;LDL-C:(3.78 ± 1.21),(3.12 ± 1.01),(3.74 ± 1.25),(4.48 ± 1.38)mmol/L vs.(2.46 ±0.78) mmol/L;HDL-C:(0.96 ±0.31),(1.39 ±0.45),(0.85 ±0.28),(0.64 ±0.20)mmol/L vs.(1.69 ± 0.54) mmol/L,P ＜ 0.05].The comparison between two subgroups,along with elevated blood pressure levels,TC,TG and LDL-C levels gradually increased,and HDL-C gradually decreased (P ＜0.05).There was negative correlation between the serum APN level and carotid artery IMT (r =-0.435,P＜0.01),and there was correlation between the serum APN level and blood lipids levels (TC,TG,LDL-C and HDL-C) (P ＜ 0.01).Conclusions The APN plays an important role in the occurrence and development of EH,it is closely related to the carotid artery IMT thickening and lipid metabolism disorders.Increasing the lipid-lowering drugs may improve the efficacy of antihypertensive therapy in patients with resistant EH.