Objective To investigate the clinical role of central venous pressure(CVP) to evaluate fluid responsiveness in septic shock patients. Methods 66 septic shock patients were studied, every patient was administered a volume challenge, before and after it, CVP, intrathoracic blood volume index (ITBVI),global end-diastolic volume index(GEDVI), cardiac index(CI), stroke volume index(SVI) were measured by PiCCO method. All the obtained values were analyzed by statistics method. Results Initial CVP in responders is significantly different from that in nonresponders; △ITBVI, △GEDVI, △CI, △SVI, △HR (△:changes) before and after volume challenge in responders were significantly different from those in nonresponders; the significance of △ITBVI, AGEDVI to predict volume responsiveness was strong indicated by high values of areas under the receiver operating characteristic curves (0.674 and 0.700, respectively).If patients were regrouped by CVP≤11 mm Hg(1 mm Hg=0.133 kPa) and CVP > 11 mm Hg, initial ITBVI and GEDVI in responders were not significantly different from that in nonresponders; △ITBVI,△GEDVI, △CI, △SVI before and after volume challenge in responders were significantly different from those in nom'esponders. Conclusion In septic shock patients, CVP play a guidance role to predict and evaluate volume responsiveness and when CVP was > 11 nun Hg, a positive response will be less likely. Initial volumetric parameters(intrathoracic blood volume and global end-diastolic volume) play a questionable role in predicting and evaluating volume responsiveness, changes before and after volume challenge maybe helpful.

Objectlve To research and analyze the hemod)rnamic status of refractory septic shock associated cardiac dysfunction.Methods 70 refractory septic shock patients were studied.In the duration of pulmonary artery catheter(PAC)-directed hemodynamic optimization,the patients were divided into a cardiac dysfunction group and a control group.Hemodynamic parameters,arterial blood lactate concentration and APACHE II scores were obtained instantly after the placement of a PAC,then lactate clearance in 24 hours was surveyed and calculated.Subsequently the two groups of patients were regrouped by nonsurvivor and survivors respectively.All the obtained values were analyzed with statistic methods.Results 37% of the refractory septic shock patients was complicated with cardiac dysfunction.The age of the patients complicated with cardiac dysfunction was significantly higher than that of the patients of the control group.Central venous pressure(CVP),pulmonary artery obstruction pressure(PAOP),pulmonary artery pressure (PAP),systemic vascular resistance index(SVRI),pulmonary vascular resistance index(PVRI)and oxygen extraction ratio(O2ext)in the cardiac dysfunction group were significantly different from those in the control group.Cardiac output(CO),cardiac index(CI),oxygen delivery index(DO2I)and mixed venous oxygensaturation(S-v O2)were significantly lower than those of the patients in the control group.S -v O2 had a strong correlation witIl CI.If the patients were regrouped by nonsurvivors and survivors.in the patients complicated with cardiac dysfunction APACHE II scores were significantly higher in the nonsurvivors than survivors:the lactate clearance in 24 hours(median-25%)of the nonsurvivors was significantly lower than that of nonresponders(median 22%),P＜0.05.Conclusion (1)In refractory septic shock patients,cardiac dysfunction maybe the main reason leading to bad outcome.(2)Higher CVP and PAOP and lower S -v O2 indicate the onset of cardiac dysfunction.(3)The patients with significantly high initial arterial blood lactate level and the low lactate clearance in 24 hours had bad outcome.

OBJECTIVETo observe the effect of β₃adrenoceptors (β₃-AR) activation on rat thoracic aorta smooth muscle contractility and the possible related mechanism.

METHODSThe endothelium removed thoracic aorta was pre-contracted with 30 mmol/L KCl physiological saline solution (PSS). Then the tension of the thoracic aorta was recorded in presence of BRL37344 (BRL) to determine the action of β₃-AR. The tension of the thoracic aorta was also recorded in the presence of Propranolol (PRA), SR59230A (SR), L-NNA, H-89 and Iberiotoxin (IBTX) respectively to reveal the underling mechanism of β₃-AR activation on rat vascular smooth muscle. Immunohistochemistry was adopted to confirm the existence and the distribution of β₃-AR in rat thoracic aorta.

RESULTSThe results showed that: (1) The thoracic aorta was relaxed by β₃-AR activation, with a relaxation percentage of (10.59 ± 0.79). (2) β₃-AR was expressed in both endothelial and smooth muscle layer in thoracic aorta sections of rats. (3) PRA did not block the effect of BRL on the thoracic aorta. The relaxation actions of BRL could be antagonized by pre-incubating the thoracic aorta with SR. (4) L-NNA (a NOS inhibitor) and H-89 (a PKA inhibitor) reversed the relaxation effect of BRL on vascular smooth muscle. (5) The effect of BRL was decreased after application of Ibriotoxin (IBTX), a large conductance calcium dependent potassium channel blocker.

CONCLUSIONThe results confirmed that activation of β₃-AR led to relaxation of thoracic aorta smooth muscle. The relaxation action of β₃-AR on smooth muscle of rat thoracic aorta was related to activation of NOS and PKA signaling pathway. Large conductance Ca²⁺-K⁺ channels were involved in the relaxation action of β₃-AR activation on rat thoracic aorta smooth muscle.

Animals ; Aorta, Thoracic ; physiology ; In Vitro Techniques ; Isoquinolines ; Large-Conductance Calcium-Activated Potassium Channels ; physiology ; Muscle Contraction ; Muscle Relaxation ; Muscle, Smooth, Vascular ; physiology ; Nitroarginine ; Peptides ; Propanolamines ; Propranolol ; Rats ; Receptors, Adrenergic, beta-3 ; physiology ; Signal Transduction ; Sulfonamides

Objective To observe and evaluate acute toxicities in a series of human immunodeficiency virus (HIV)-positive cancer patients receiving radiation therapy.Methods The study retrospectively reviewed the acute radiation reaction of radiation therapy of 14 HIV seropositive patients diagnosed with carcinoma between Feb 2008 and Dec 2013 at the Yunnan Tumor Hospital during the radiotherapy period and 1 month following treatment.Acute adverse effects were classified according to the site of radiation therapy and analyzed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0.Results Seven patients experienced interruptions or delays in treatment,and 2 stopped treatment entirely.The most common acute adverse effects were skin reactions and mucous membrane reactions,including dermatitis,stomatitis or diarrhea.Eight patients had grade 3 acute adverse effects,including 6 patients with grade 3 skin reactions and 2 patients with grade 3 mucosa reactions.Conclusions Radiotherapy is an effective treatment for HIV positive patients with tumors,however it frequently induced severe acute radiation responses.

Objective To analyze the epidemiological characteristics of Mycobacterium tuberculosis by enterbaeterial repetitive intergenic consensus-polymerase chain reaction(ERIC-PCR)DNA fingerprint. Methods Mycobacterium tuberculosis positive sputum samples between September 2003 to May 2006 were collected and cultured.Chromosomal DNA were extracted and ERIC-PCR DNA fingerprinting was analyzed by software,such as RAPD PHYLIP and Treeview.Results A total of 42 different fingerprints were detected.Phylogenetic analysis showed that they could be classified into three clusters,the clustering rate was 72.6%.The characteristics of ERIC-PCR fingerprint patterns were related to age,drug resistance,and type of resistance.Conclusions ERIC-PCR DNA fingerprinting technique used in this study is good for epidemiological studies with its strong discrimination,simplicity and rapidness.A high level of recent transmission is found in our city.

Objective To analyze the relationship between body weight index (BMI) during the different pregnant weeks and the birth weight of newborns. Methods One hundred pregnant women and newborns were selected. BMI in every month during the pregnancy period, birth weight and height were observed and recorded. Then the relationship between BMI of pregnant women and birth weight of newborns was analyzed using Peas,son correlation coefficient. Results The correlation between BMI of pregnancy from the fifth month to the ninth month and the birth weight of newborns had significantly statistical meaning, especially the correlation between BMI of the fifth, the sixth and the eighth months and the birth weight of newborns were more obvious, each showing a positive correlation. Conclusions The higher the BMI of pregnant women, the higher the birth weight of newborns. Therefore the pertinent diet guidance should be given to the pregnant women in the middle to late stages of pregnancy according to the pregnant women's BMI, in order to reduce the incidence of enormous infants and premature infants.

Objective To investigate primipara' s fatigue status during pregnancy and the major related factors, provide basis for relevant intervention measures. Methods A total of 150 primiparas from a top-notched hospital in Beijing were investigated by using General Fatigue Self-assessment Scale (FSAS) ,Self-Efficacy Scale (GSES), Trait Coping Style Questionnaire (TCSQ) and Pregnancy Pressure Scale (PPS). Results Primipara's fatigue status was at a mild level, and could be relieved by sleep or rest; Age, gestational age and weight gain during pregnancy had different degrees of relevance with the score of FSAS( P <0. 05 ) ; Primipara' s fatigue was negatively relate to the general self-efficacy ( P <0. 05 ) ; Primipara' s fatigue was positively relate to positive coping,pregnancy pressure(P <0. 05 ). Conclusions The health education and pregnancy counseling for the primipara should be strengthened. And we should pay attention to primipara with fast weight gain, old gestational age and pregnancy complications. Further more, primipara should be encouraged to adopt positive coping, cultivate self-efficacy and reduce pregnancy stress by using early period intervention, which could help to reduce fatigue during pregnancy.

Objective： The current study was designed to investigate the expression of p73 gene in lung cancer tissue. Methods： The authors detected quantitatively p73 gene expression in 40 specimens of lung cancer and matched paracancer tissue by RT PCR and analyzed the alteration of p73 by PCR and SSCP. Results： ① Using RT PCR, 24 specimens of lung cancer were determined to be overexpression of p73, 9 of which were moderately differentiated, 15 of which were poor differentiated; 9 of which were Stage Ⅰ-Ⅱ , 15 of which were Stage Ⅲ-Ⅳ . No specimen of paracancer tissue was screened out to be overexpression of p73. There was significantly different expression rates between lung cancer and paracancer tissue (P< 0.01). ② Allele specific analysis showed that expression of G/C： A/T appeared in 10 of 12 heterozygous lung cancer specimens and expression of G/C in 27 specimens. ③ No mutation was detected by SSCP. Conclusion： The expression of p73 gene may be related to differentiation level of lung cancer but not related to clinical stage.

Objective To study experimentally the mechanism of Guasha therapy in curing diseases. Methods All Wistar rats (n=40) were randomly divided into the normal group, group with 0.5 hour after Guasha (0.5 h group), group with 6 hours after Guasha (6 h group) and group with 12 hours after Guasha (12 h group). The arterial blood samples were collected and given blood routine examination. The levels of bilirubin, superoxide dismutase (SOD), interlukin- 1 (IL-1) and IL-6 were detected respectively . Results In the 6 h group the WBC count decreased significantly and the level of the total bilirubin increased significantly (P<0.05) compared with those in the normal group. The level of SOD decreased significantly in the 12 h group compared with that in the normal group (P<0.05).[WTHZ] Conclusion The Guasha therapy can inhibit the inflammatory reaction of WBC and raise the level of the total bilirubin , which may be its one of the mechanisms for abating of fever and curing diseases.

Objective To study the current situation of emergency nurses' structural empowerment,competency,job satisfaction,and their correlative factors.Methods Literature review, interview and questionnaire were used to establish the emergency nurses' structural empowerment and competency model.300emergency nurses were structurally empowered,and their quality of care and job satisfaction was compared before and after.Results The quality of care and job satisfaction after structural empowerment was (98.45 ±1.36) and (98.19 ± 2.63 ),both of which were higher than that before structural empowerment (95.33 ±2.47) and (93.81 ± 4.54),and the differences were statistically significant (t =-4.468,16.136,respectively; P ＜ 0.05).After structural empowerment,there was great improvement in emergency nurses' selfevaluation,as well as their ability of critical thinking,receiving information,communication and health education,while there was little improvement in their ability of social support,logical reasoning and innovation.Conclusions Establishing structural empowerment and competency model for emergency nurses helps them position themselves and promote their development,as well as provides reference to select and train professional nurses for hospitals.