Objective To evaluate the effect of a new type of fixation tape for tracheal catheter in intensive care patients.Methods A purposive sampling study was conducted. Ninety patients experienced oral tracheal intubation for mechanical ventilation, and admitted to respiratory intensive care unit (ICU) of the Second Affiliated Hospital of Nantong University from November 2015 to February 2017 were enrolled. All the patients were randomly (random number) divided into the control group and the observation group with 45 patients in each group. The patients in control group was treated with the traditional medical adhesive tape and fixation belt to fix endotracheal tube, while the patients in observation group was treated with a new type of tracheal catheter fixation tape. The fixation effect, skin complication rate, patient's comfort level, nursing workload and satisfaction were evaluated in both groups.Results There were 6 patients with mild displacement, 2 patients with moderate displacement and 1 patient with severe displacement in the control group, while there was no catheter displacement or detachment occurred in the observation group, and the difference between the two groups was statistically significant (χ2 = 2.944,P = 0.003). In the control group, there were 39 patients with facial skin redness,6 patients with facial skin damage, 36 patients with neck skin redness, and 2 patients with neck skin damage. In the observation group, there were no facial skin complications and only 2 patients with neck skin redness, and the skin complication rate was significantly higher than that of the control group (facial skin:Z = 9.173,P = 0.000; neck skin:Z = 7.549,P = 0.000). Compared with the control group, the patients' comfort levels were significantly elevated in the observation group (the intolerance patients: 9 vs. 24, the extreme discomfort patients: 4 vs. 8,Z = 3.695,P = 0.000). The total changing times of the fixation belt and operating time for each change in the observation group were significantly decreased as compared with those of control group [changing times of the fixation belt (times): 1.89±0.77 vs. 3.86±1.18, operating time for each change (minutes): 10.31±1.47 vs. 15.78±1.89, bothP < 0.01]. Nursing satisfaction in the observation group was significantly higher than that of the control group (100% vs. 33.3%,P < 0.01).Conclusions The new fixation tape for tracheal catheter could significantly reduce the catheter displacement and detachment rate, and decreasethe incidence of facial skin injury. It is easy to learn and worth to generalize clinically.

Objective To investigate the effects of small RNA interference targeting mammalian target of rapamycin (mTOR) expression on paraquat-induced pulmonary fibrosis in rats.Methods Human embryonic kidney cells HEK-293 were culturedin vitro. The mTOR small interfering RNA (mTOR-siRNA) expression plasmid transfection lentivirus was constructed, and non-specific sequence plasmid with no homology to mTOR gene was set as the control. Seventy-two healthy male Sprague-Dawley (SD) rats were randomly divided into normal saline (NS) control group, paraquatmodel group, mTOR unrelated sequence group, and mTOR-siRNA group, with 18 rats in each group. Paraquat poisoning animal model was reproduced by intraperitoneally injecting 20% paraquat solution 15 mg/kg, while the NS control group was intraperitoneally injected the same volumes of NS. Rats in the mTOR unrelated sequence group and mTOR-siRNA group were injected 1×109 TU/mL lentivirus solution 50μL into the airway, respectively, while in the NS control group and paraquat model group were injected the same volumes of NS. At 7, 14 and 28 days after treatment, 6 rats in each group were sacrificed respectively for lung tissue, the pathological changes and fibrosis of lung tissues were observed under light microscope. The levels of hydroxyproline (HYP) in lung tissues were determined by alkaline hydrolysis. The mRNA and protein expressions of mTOR in lung tissues were determined by reverse transcription-polymerase chain reaction (RT-PCR) and Western Blot.Results Under light microscope, there was no obvious pathological changes in the lung tissues in the NS control group, while in the paraquat model group and mTOR unrelated sequence group, lung tissue in rats were damaged, there were a lot of inflammatory cell infiltration, a large number of matrix collagen and fibrous tissues hyperplasia, and gradually increased with time, and it was consistent with paraquat-induced lung tissue fibrosis process. The pathological and fibrotic changes in lung tissue of mTOR-siRNA group were obviously reduced after silencing mTOR gene. The levels of HYP and the expression levels of mTOR mRNA and mTOR protein of lung tissues in the paraquat model group and mTOR unrelated sequence group were continuously increased in time-dependent manner, and they were significantly higher than those in the NS control group at all of the time points, but no significant difference was found between mTOR unrelated sequence group and paraquat model group. In mTOR-siRNA group, silencing mTOR gene could inhibit paraquat poisoning induced HYP increase in lung tissue, and the expressions increase in mTOR mRNAand mTOR protein, the values were close to the levels of NS control group, and the significant difference was found as compared with paraquat model group at 7 days or 14 days, and the change was maintained to 28 days [7 days: HYP (μg/mg) was 1.13±0.06 vs. 1.25±0.07; 14 days: HYP (μg/mg) was 1.19±0.09 vs. 1.29±0.12, mTOR mRNA (2-ΔΔCt) was 0.99±0.11 vs. 1.94±0.12, mTOR protein (gray value) was 0.39±0.08 vs. 0.75±0.09; 28 days: HYP (μg/mg) was 1.28±0.06 vs. 1.40±0.05, mTOR mRNA (2-ΔΔCt) was 1.15±0.13 vs. 2.85±0.15, mTOR protein (gray value) was 0.45±0.10 vs. 0.86±0.12, allP < 0.05].Conclusion Lentivirus-mediated mTOR-siRNA could effectively inhibit the expressions of mTOR in lung tissues of paraquat-poisoned rats, and reduce the damage and fibrosis of lung tissues caused by paraquat.

Objective To investigate the role of phosphorylated Moesin (p-Moesin) in the injury of pulmonary microvascular endothelial cells (PMVECs) of rats induced by tumor necrosis factor-α (TNF-α), and to approach the impact of Rac1 signal pathway on Moesin phosphorylation.Methods PMVECs of rats were culturedin vitroand passed on to the third generation, and the TNF-α time-effect experiment, dose-effect experiment and Rac1 signaling pathway intervention experiment were performed respectively. ① Time-effect experiment: PMVECs were stimulated with 10μg/L TNF-α for 0, 15, 30 minutes and 1, 3, 6, 12 hours, and the protein expressions of Moesin and p-Moesin were determined by Western Blot. ② Dose-effect experiment: PMVECs were stimulated with 0, 0.1, 1, 10μg/L TNF-α for 6 hours, and the protein expressions of Moesin and p-Moesin were determined by Western Blot. ③ Rac1 signaling pathway intervention experiment: PMVECs were divided into two parts, which were pretreated with 3 mL Rac1 specific inhibitor NSC23766 (200μmol/L) for 0.5 hour or Rac1 specific agonist O-Me-cAMP (200μmol/L) for 1 hour, respectively, and then incubated with 10μg/L TNF-α for 6 hours. The PMVECs without treatment were served as blank control group, andthose were treated with only O-Me-cAMP, NSC23766 or TNF-α were served as corresponding groups. The protein expressions of Moesin and p-Moesin were determined by Western Blot.Results ① Time-effect experiment results: the expression of Moesin showed no change among all time points after 10μg/L TNF-α stimulated PMVECs. But the expression of p-Moesin was sharply up-regulated at 15 minutes after TNF-α stimulation as compared with 0 minute (p-Moesin/Moesin: 4.399±0.523 vs. 1.000±0.195), peaked at 30 minutes (6.069±0.557), and then gradually decreased after 1 hour (5.005±0.544, 4.599±0.478, 1.742±0.288, 1.503±0.352 at 1, 3, 6, 12 hours, respectively) with significant difference among all time points (F = 15.397,P = 0.002). ② Dose-effect experiment results: no significant change in expression of Moesin was found among all doses of TNF-α incubated with PMVECs for 6 hours. But the expression of p-Moesin was significantly up-regulated after TNF-α stimulation with 0.1μg/L as compared with0μg/L (p-Moesin/Moesin: 2.194±0.430 vs. 1.000±0.273), which showed an upward trend with dose increase in TNF-α (3.201±0.688 and 4.413±0.296 with 1μg/L and 10μg/L TNF-α, respectively) with significant difference among all doses (F = 92.513,P < 0.001). ③ Rac1 signaling pathway intervention experiment results: there was no significant difference in Moesin expression among all the groups. Compared with blank control group, Rac1 specific agonist O-Me-cAMP or Rac1 specific inhibitor NSC23766 alone could not change the expression of p-Moesin, while TNF-α could induce p-Moesin expression. Compared with TNF-α group, the expression of p-Moesin induced by TNF-α was up-regulated by NSC23766 (p-Moesin/Moesin: 2.612±0.355 vs. 1.911±0.297,P < 0.05), and it was attenuated by O-Me-cAMP (p-Moesin/Moesin: 1.928±0.331 vs. 3.030±0.353,P < 0.05).Conclusion The phosphorylation of Moesin is involved in the damage of TNF-α-induced PMVECs in rats, and PMVECs damage could be alleviated by modulating Moesin phosphorylation in the Rac1 signaling pathway.

Objective To evaluate the serum trough concentration and the pharmacokinetics/pharmacodynamics (PK/PD)of vancomycin in patients with severe acute pancreatitis (SAP), and analyze the effect of vancomycin continuous infusion for optimizing the characteristics of its PK/PD.Methods The inhospital patients with SAP received vancomycin treatment and admitted to emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to December 2016 were enrolled. Steady-state trough concentrations of vancomycin from patients were collected retrospectively. The SAP patients were divided into augmented renal clearance (ARC) and non-ARC groups, as well as systemic inflammatory response syndrome (SIRS) and non-SIRS groups according to the patients with or without symptom above. Adjustments of increased dosage or 24-hour continuous infusion or increase vancomycin dose were made for patients if the steady-state trough concentrations fell below the target level. Steady state trough concentration for vancomycin intermittent infusion or steady state concentration for vancomycin continuous infusion was determined by the fluorescence polarization immunoassay method. PK parameters of vancomycin were calculated using the Bayesian estimator and the area under the serum drug concentration-time curve (AUCc-t), the minimum inhibitory concentration (MIC) and AUCc-t/MIC was recorded and calculated.Results The steady state trough concentration or steady state concentration from 61 patients with SAP were collected with mean steady state trough concentration of vancomycin of (7.7±4.4) mg/L, which was significantly lower than standard concentration (15 mg/L,P < 0.001). Apparent volume of distribution (Vd) and clearance of vancomycin was (1.06±0.26) L/kg and (8.9±2.8) L/h. The serum steady state trough concentration of vancomycin in ARC group (n = 33) was significantly lower than that in non-ARC group (n = 28; mg/L: 6.7±3.5 vs. 8.2±4.1, P < 0.01), clearance was significantly increased (L/h: 9.8±2.9 vs. 7.7±2.2,P < 0.01). Compared with non-SIRS group (n = 31), the serum steady state trough concentration of vancomycin in SIRS group (n= 30) was significantly lowered (mg/L: 6.1±3.2 vs. 13.0±4.2,P < 0.01), and clearance was significantly increased (L/h: 9.4±2.0 vs. 7.1±2.1,P < 0.05). Compared with the only increasing vancomycin dose group (n = 29), vancomycin continuous infusion for 24 hours (n = 21) could significantly reduce daily dosage (mg/kg: 13.6±3.9 vs. 19.1±3.5,P < 0.01), increase the serum trough concentration (mg/L: 18.1±7.0 vs. 12.6±5.3,P < 0.01), and improve the AUCc-t/MIC.Conclusions The serum trough concentration of vancomycin was significantly reduced in SAP patients with ARC. The more serious of the SIRS is, the lower the vancomycin trough concentration is. Vancomycin 24-hour continuous infusion could optimize the PK/PD parameters, decrease the daily dose, increase the clinical effect, and reduce the bacterial resistance.

Objective To analyze the changes and characteristics of respiratory tract bacteria in Hebei 3A Hospital, and to provide new rationale for clinical diagnosis and treatment.Methods A single-center retrospective analysis was conducted. 7497 patients with respiratory tract infection admitted to Hebei Chest Hospital from January 2013 to December 2016 were enrolled. Deep sputum was collected, and the bacterial cultures and susceptibility analysis was conducted in sputum and upper respiratory secretions were collected by fiberoptic bronchoscopy.Results A total of 7497 patients with respiratory tract infection were enrolled in the study, and 11909 strains of 13 kinds of dominant pathogens were isolated. The dominant pathogens for respiratory tract infection wereMonilia albican (23.7%),Klebsiella pneumoniae (12.9%),Pseudomonas aeruginosa (11.6%),Escherichia coli (9.5%),Candida glabrata (9.1%),Acinetobacter baumanii (7.9%),Aspergillus (6.7%),Stenotrophomonas maltophilia (4.5%), coagulase negativeStaphylococcus(3.7%) and some species ofPseudomonas (3.7%),Staphylococcus aureus (3.0%),Aerobacter cloacae (1.9%), andCandida tropicalis (1.8%). A total of 6198 strains of 7 kinds of Gram negative (G-) bacilli infection dominant pathogens accounts for 52.0% of all infections,Klebsiella pneumonia (24.8%),Pseudomonas aeruginosa (22.3%),Escherichia coli (18.2%) andAcinetobacter baumanii (15.3%) were the main pathogens, and increased year by year. Susceptibility analysis showed that the preferred antibiotics for G- bacteria were carbapenems, followed by risperidone, sulbactam, cefepime, amikacin, and the third generation of cephalosporins. A total of 798 strains of 2 kinds of Gram positive (G+) bacilli infection dominant pathogens accounted for 6.7% of all infections, were coagulase negativeStaphylococcus(54.8%) and Staphylococcus aureus (45.2%), each had changed little by year. Susceptibility analysis showed that G+ bacteria were sensitive to glycopeptides, followed by cefoxitin, cotrimoxazole, the tetracyclines, quinolones, azithromycin, erythromycin and so on. The advantages of 4 species of fungi were 4913 strains, accounted for all of the 41.3% strains, with 57.5% of Candida albicans, and the trend was increasing year by year. Susceptibility analysis results showed that the antifungal susceptibility of dominant fungi were higher.Conclusions G- bacilli is still the main source of infection, and showed an upward trend year by year. Fungal infection rate cannot be ignored, and we must pay attention to fungal infection incentives. We should strengthen the rational use of antibiotics.

Mechanical ventilation is regarded as an effective means of replacing artificial ventilation during cardiopulmonary resuscitation (CPR), and has been widely used in the treatment of cardiac arrest (CA) patients. However, there are still some controversial issues remaining to be settled, such as the assessmentof the effectiveness of mechanical ventilation, the selection of the optimal oxygen concentration (FiO2), tidal volume (VT), respiratory frequency, and mode of ventilation during the CPR process. The pros and cons of positive pressure ventilation are also inconclusive. We reviewed and summarized the related research in recent years, and recommended that the intermittent positive pressure ventilation (IPPV) of volume controlled with small VT (6-7 mL/kg), low ventilation rates (10 times/min), and pure oxygen could be applied during the mechanical ventilation of CPR. The best mechanical ventilation strategy still needs further experimental researches to discover and explore.

Infectious diseases are resulted from the invasion of an organism's body tissues by multiple disease-causing agents. It has been demonstrated that the occurrence and development of infectious diseases are closely associated with the functional status of immune system. Cytokines play significant roles in modulating the host immune response to the clearance of pathogenic microorganisms and maintaining immune homeostasis. Interleukin-35 (IL-35), as a newly identified member of IL-12 family, exerts suppressive effect on immune response by means of a specific pattern. With the progress of research in recent years, IL-35 might serve as an essential contributor in the immunopathogensis of vast infectious diseases, including hepatitis B, sepsis, tuberculosis and parasite infection, which simultaneously appear to be closely related to the severity, progression as well as prognosis of the illness. Apparently, IL-35 is regarded as a potent and promising anti-inflammatory cytokine in clinical application; its potential value may shed light on the therapeutic strategies for infectious diseases. Herein, we mainly review the potential role and its mechanism of IL-35 in the pathogenesis of infectious diseases.

Pulmonary embolism (PE) refers to the endogenous or exogenous emboli blocking pulmonary trunk or branches, causing clinical and pathophysiological syndrome of pulmonary circulation disorder, the incidence rate is high. Sometimes PE patients were lack of specific symptoms and signs, or without any symptoms, which often result in misdiagnosis, un-timely diagnosis, and the delay of treatment. A PE case with syncope, vomiting and shock, which was proved to be pulmonary artery trunk and branch wide embolism later, was presented so as to improve the understanding of the disease.

Objective To use evidence-based nursing on patients with artificial airway to the practice of stomach tube, and to evaluate the self made guidance for difficult gastric tube placement in patients with artificial airway.Methods Forty patients with artificial airway and were difficult to put the tube, and admitted to Department of Critical Care Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from April to December in 2016 were enrolled as observation group. Through the evidence-based nursing strategy, the related literatures at home and abroad were collected to search clinical evidence and formulate and implement the nursing program, the gastric tube was inserted into the stomach tube under the direct vision of the laryngoscope. Thirty-six patients of difficult gastric tube placement with artificial airway straightly under the direct vision of the laryngoscope from August 2015 to March 2016 were retrospectively analyzed as the control group. The success rate of first catheterization, indwelling time, throat edema and bleeding of pharyngeal mucosa were compared between the two groups.Results All patients were enrolled in the final analysis. In the control group, 28 patients were successfully placed once, while 8 failed. Only 1 patient in observation group failed to catheterize, and successful placed after symptomatic treatment, the one-time success rate of catheter was significantly higher than that of control group (97.5% vs. 77.8%), and catheter time was significantly shortened (minutes: 4.8±1.2 vs. 5.1±1.0), the difference was statistically significant (bothP < 0.05). There were 2 patients with laryngeal edema in the control group and 4 patients of pharyngeal mucosal hemorrhage. In the observation group, there was no laryngealedema and laryngeal edema occurred in the patients with laryngoscopy, and only 1 patient had a hemorrhage of pharyngeal mucosa.Conclusion Using self made guiding device can effectively insert the difficult gastric tube in patients with artificial airway, and increase the one-time success rate of intubation, shorten the catheter time, and have a trend in reduce complication as compared with traditional gastric tube placement.

Objective To investigate the correlation between acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) scores and delirium probability of senile severe pneumonia patients undergoing invasive mechanical ventilation (MV).Methods A retrospective study was conducted. Eighty-nine senile severe pneumonia patients undergoing invasive MV admitted to intensive care unit (ICU) of Hunan Provincial People's Hospital from January 2015 to March 2017 were enrolled. APACHE Ⅱ scores were collected 24 hours before invasive MV. Consciousness assessment method-ICU (CAM-ICU) was used to diagnose delirium, and the patients were divided into delirium group and non-delirium group. The first delirium occurrence time, duration of MV and the length of ICU stay were recorded. The patients were divided into ≤15, 16-20, 21-25, 26-30, 31-35, 36-40 groups according to APACHEⅡ score, and the incidence of delirium in all groups were observed. The linear regression and Pearson correlation were used to analyze the correlation between APACHE Ⅱ scores and delirium probability. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive effect of APACHEⅡ score on delirium.Results Eighty-nine patients were enrolled in the final analysis, of which 35 had delirium, and 54 had no delirium, with delirium incidence of 39.33%, and the first delirium occurrence time of (1.85±1.30) days. The duration of MV and the length of ICU stay of delirium group were significantly higher than those of non-delirium group [duration of MV (days): 9.43±4.77 vs. 6.08±3.30, length of ICU stay (days): 14.60±6.59 vs. 9.69±4.61, bothP < 0.01]. The APACHE Ⅱ score in delirium group was significantly higher than that in non-delirium group (29.89±5.45 vs. 21.48±4.76,P < 0.01). With the increase in APACHE Ⅱ scores, the delirium incidence was gradually increased. Correlation analysis showed that there was a negative correlation between APACHE Ⅱ scores and first delirium occurrence time (r = -0.411,P = 0.014), and a significant linear positive correlation between APACHE Ⅱ scores and delirium incidence in all patients was found (r = 0.982, P = 0.000), which indicated the higher APACHE Ⅱ scores, the higher delirium incidences and the earlier first delirium occurrence time was. ROC curve analysis showed that the area under ROC curve (AUC) of APACHE Ⅱ scores on predicting delirium occurrence was 0.877, when the cut-off value of APACHE Ⅱ score was over 27, the sensitivity was 92.59%, the specificity was 71.43%, the positive predictive value was 83.33%, and the negative predictive value was 86.21%.Conclusions With the increase in APACHE Ⅱ score, the incidence of delirium was increased gradually in senile severe pneumonia patients receiving invasive MV. APACHE Ⅱ score played an important clinical value in evaluating the delirium probability of these patients