Objective To unravel the relationship between artefiM blood lactate (ABL) level and is1et β-cell secretion constituents in stress hyperglycemia(SHG)setting of critical illness,and analyze the effect of inadequate tissue perfusion on islet β-cell function.Method According to ABL level,68 critically ill patients with SHG were divided into three groups,namely,group A(ABL≤1.5 mmol/L),group B (ABL 1.6～4.4 mmol/L)and group C(ABL≥4.5 mmol/L).Another 25 healthy volunteers served as insulin (IRI) were measured.The homeostasis model assessment for secretion index of islet beta-cell (HOMA-β)was calculated.The relationship among the above B-c3eH secretion constituents were analyzed.Results The TI level of group C was significantly lower than that of group A(P<0.01).The PI levels of group B and C were significantly higher than those of group A and control group(P<0.05).The C-P level of group C was significantly higher that of group A and control group(P<0.05).The HOMA-β of group C was significant lower than that of group A and B and control group(P<0.05).The ABL had positive correlation with PI and C-P(r=O.322,P=O.015;r=0.513,P=0.000),and the ABL had negative correlation with TI and HOMA-β(r=-0.353,P=0.007;r=-0.294,P=0.002).Conclusions The worse tissue perfusion was in SHG of critical illness,the higher PI and C-P were,the lower TI was, Inadequate tissue perfusion setting could lead to islet beta-cell paracrisis and deceleration.

Objective To explore the method of comfort nursing in patients with nasogastric feeding and observe the influence on enhancement of patients satisfaction degree. Methods Case control study Was used in 162 conscious patients with nasogastric feeding.80 patients from January 2005 to January 2006 were selected as control group and given routine nursing.82 patients from February 2006 to May 2007 were named as the test group and received confort nursing.The satisfaction degree of patients, injury of nasal mucosa, shedding rate of the gastric tube and aspiration rate were investigated with self-designed discomfort questionnaires. Results The satisfaction degree in the test group Was 63.41％,which was higher than that of the control(40.00％,P＜0.01).The rate of nasal mucosa injury, shedding of the gastric tube and aspiration rate were lower in the test group(1.22％,2.44％,1.22％)than those in the control group(8.75％,10.00％,7.50％,P＜0.05).Conclusion The application of comfort nursing in patients with nasogastric feeding contributed to the enhancement of satisfaction degree of patients and nursing quality.

Objective To explore the clinical effect of application of mechanical insufflation-exsufflation (MI-E) for airway mucus clearance in patients with artificial airway.Methods 72 patients were divided into the observation group (36 cases) and the control group (36 cases)according to admission order by random number table.All subjects were given with individual treatment and nursing,while the control group was given with the application of rock sputum ejection machine twice per day,the observation group was given with application of both cough assist and rock sputum ejection machine for sputum excretion.The clinical effect of airway mucus clearance after 5 days' treatment was compared between two groups.Results Compared with the control group,oxygenation index after 5 days' treatment in the observation group increased [(48.16±9.57) kPa vs.(37.99±14.67) kPa,t=-3.48,P＜0.01],clinical pulmonary infection score [(3.39±0.77) scores vs.(5.33±1.47) scores] and procalcitonin level [0.10 (0.07,0.27) μg/L vs.0.43 (0.12,0.79) μg/L] were lower (t=-7.02,Z=-3.28,P＜0.01),the mean sputum amount was bigger [(3.64±0.43) ml vs.(2.31 ±0.44) ml] (t=-4.84,P＜0.01),and the mean interval of suction was longer [(97.81 ±7.28) min vs.(82.00±8.88) min](t=-3.08,P＜0.05).Conclusions MI-E can clear the airway secretion effectively so as to improve oxygenation and the inflammatory markers.And MI-E is a simple,noninvasive and safe technique.

Objective To observe the infiltration situation of Langerhans cells(LC)in laryngeal squamous cell carcinoma tissue and to investigate its clinical significance.Methods Seventy-two cases of laryngeal squamous cell carcinoma were selected and the tumor tissue in all cases was operatively resected.The immunohistochemical SP method was adopted to detect the infiltration situation of LC in laryngeal squamous cell carcinoma tissue.Then the relationship between the LC infiltration degree with tumor stage,relapse,metastasis and prognosis was analyzed.Results Among 72 cases of laryngeal squamous cell carcinoma,27 cases(37.5％)were LC infiltration degree of +,37 cases(37.5％)were ++ and 18 cases(25.0％)were +++.The LC infiltration degree in laryngeal carcinoma tissue was correlated with the cervical lymph node metastasis,recurrence,disease free survival,3-year survival and 5-year survival(P＜0.05),and had no correlation with the age,classification,TNM stage and postoperative radiotherapy(P>0.05).Conclusion LC infiltration can be seen in the tumor tissue of the patients with laryngeal squamous cell carcinoma.The LC infiltration degree is higher,indicating that the prognosis would be better.

[ABSTRACT]OBJECTIVETo evaluate the clinical value of ultrasound guided fine-needle aspiration (US-FNA) in the diagnosis of thyroid nodules with different size.METHODSThe clinical data of 122 thyroid nodules of 109 cases referred to FNAC for diagnosis were retrospectively reviewed. The final operating histological results of 122 nodules were considered gold standard. RESULTSNon-diagnostic FNAC results occurred in 17 nodules (13.9%). FNAC achieved a sensitivity of 78.6%, a specificity of 93.9%, a positive predictive value of 93.6%, a negative predictive value of 78.3%, and a total accuracy of 85.7%. There was no significant difference between the diameter of the nodule≤1 cm group and>1 cm group, except negative predictive value. The non-diagnostic results rate was no significant difference between groups of different nodule size, benign or malignant nodules, and different operators. CONCLUSIONFNAC is a sensitive, specific and accurate method for differential diagnosis of thyroid nodules.

Objective To explore the effect of dietary fat acids on incretin and islet function in healthy adults .Methods Before each test, healthy subjects received a 1-week pre-experiment eucaloric diet .Fifteen subjects consumed two meals containing different fat acids , including high saturated fat acid ( HSF) and high monounsaturated fat acid ( HMF) .On two separate occasions,they underwent a minimum of 1-week washout between meals .At 0,30,60,120,180 and 240 min following meal intake, the plasma concentrations of gastric inhibitory polypeptide (GIP), glucagon-like peptide-1(GLP-1) and serum concentrations of glucose, insulin, triglycerides ( TG) and free fatty acid ( FFA) were measured.Results Postprandial glucose did not increase significantly following HSF and HMF meals (P>0.05).Compared with HMF meal, significant increase in AUCins240min,AUCTG240min and AUCFFA240minwas observed following HSF meal (P<0.05).Compared with HMF meal,a significant decrease in AUCGIP30min, AUCGIP240min, AUCGLP-1 30min and AUCGLP-1 240min was found following HSF meal (P<0.05).No significant difference was observed inΔI30/ΔG30 following HSF and HMF meals (P>0.05). AUCI/AUCG was significantly lower following HMF meal as compared with HSF meal (P<0.05).Conclusion This study demonstrates that the function of GIP ,GLP-1 andβcell is affected by the dietary fat acids in healthy adults .The HMF meal may stimulate GIP and GLP-1 secretion to a greater extent than HSF meal .

Objective To evaluate the systolic function of left ventricle in myocardial infarction(MI)patients with ventricular aneurysm and the changing law of blood flow in ventricle with regional abnormality of wall movement by vector flow mapping (VFM).Methods Tirty-one MI patients with ventricular aneurysm and 35 healthy participants were enrolled in this study.The characteristic of vector and streamline,and the changing of the velocity gradient in left ventricular outflow tract (LVOT), and the average flow quantity through aneurysm neck were detected in the isovolumic contraction period, the rapid ejection period and the slow ejection period by VFM.Results The distinction between aneurysm and control group was mainly the persistance of vortex in aneurysm.The size of vortex in aneurysm was highly correlated with that measured by 2-D ultrasound(P ＜0.01).The percentage of vortex duration to cardiac cycle in patients group was significantly greater than that in control group(P ＜0.01).In the early systolic contraction the velocity gradient in LVOT in patients with ventricular aneurysm was smaller than that of control group(P ＜0.05).The average flow through aneurysm neck was notablely decreased compared with control group(P ＜0.01).Conclusions VFM can reveal the hemodynamics of left ventricle with aneurysm directly as well as quantitively measure the regional velocity and flow quantity.VFM can evaluate the systolic function of left ventricle exactly.

Objective To explore the clinical characteristics and treatment in elderly patients with gastric bezoars. Methods Totally 49 patients with gastric bezoars were retrospectively analyzed,and among them,36 patients were aged 65-77 years, 48 cases underwent sequential therapy,1 elderly patient underwent surgical operation. Results There were differences in etiology, medical histories, clinical manifestations and therapeutic efficacy between elderly and non elderly patients with gastric bezoars.There were 42％ (15/36) of elderly patients eating glutinous rice cakes,4 cases with gastric surgery histories,6 cases with diabetes in elderly patients,but in non eldcrly patients only 8％ (1/13) of patients eating glutinous rice cake,and there were no cases with surgery histories and diabetes. Gastric bezoars in 48 cases were cleared away by sequential therapy. 1 elderly patient developed intestinal obstruction after surgical operation and died of infectious shock. Conclusions There are some different characteristics between elderly and nonelderly patients with gastric bezoars.Sequential therapy is safe and effective for elderly patients with gastric bezoars.

Objective To discuss the clinical efficacy of Mepilex surgical dressing in prevention of pressure sore. Methods 46 patients with high risk factors and Norton grading lower than 10 point were divided into the experimental group and the control group with 23 patients in each group. The control group was given reduction of local pressure, protection of the skin, nutritional support and other conventional measures to prevent pressure sore. Besides conventional nursing measures, the experimental group was given Mepilex to cover the bone eminence place, replaced every 7～10 days. The occurrence and development of the pressure sore was observed on the second, fourth, sixth and eighth week after admission. Results The occurrence rate of the experimental group on the sixth week was 4.55%, and the control group was 26.09%,the difference had statistical significance. The cure rate of the two groups showed no difference on the eighth week. Conclusions Application of Mepilex to treat patients with high risk of pressure sore has good effect.

Objective To investigate the cell-type-specific enhancer (CTSE) in HPV16 and its variation in cervical carcinoma. Methods CTSEs were detected by polymerase chain reaction (PCR) in 58 cervical carcinoma from Shaanxi province; in addition variation of CTSEs was analyzed through single-strand conformation polymorphisms (SSCP). Results HPV16 CTSEs were detectable in 34 of 58 (57%) specimens and mutant rate was 41%(14/34) and the main mutations of chosen randomly variant CTSE (CTSEv) happened at YY1 binding sites in addition to glucocoticoid response elements (GRE). Conclusion CTSE in some specimens of Shaanxi province was obviously different from that in HPV16 wild type and variant CTSE might affect the transcriptional regulation of LCR on viral P97, which regulates over-expression of viral oncogenes in cervical carcinoma.