Objective To investigate the effect of C-erbB-2 shRNA on chemosensitivity of mouse lung adenocarcinoma cells and its mechanism,and to find new therapy method for non-small cell lung cancer,especial lung adenocarcinoma.Methods The mouse lung adenocarcinoma Lewis cells were cultured regularly and divided into non-transfected group, pGPU6/RFP/Neo-shNC group and pGPU6/RFP/Neo-erbB-2 group. The plasmids were synthesized and transfected into Lewis cells in each group by Lipofectamine 2000.The expression levels of C-erbB-2 mRNA and protein in the cells in various groups were tested by RT-PCR and Western blotting method, respectively. The Lewis cells were divided into non- transfected group, pGPU6/RFP/Neo-shNC group, carboplatin group, pGPU6/RFP/Neo-erbB-2 group, pGPU6/RFP/Neo-shNC+carboplatin group and pGPU6/RFP/Neo-erbB-2+ carboplatin group. The apoptotic rates of the cells in each group were detected by flow cytometry;the expression levels of Bcl-2 and Bax proteins in each group were determined by Western blotting method.Results The expression levels of C-erbB-2 mRNA and protein in pGPU6/RFP/Neo-erbB-2 group were lower than those in non-transfected group and pGPU6/RFP/Neo-shNC.The apoptotic rate of the cells in pGPU6/RFP/Neo-erbB-2+carboplatin group was the highest in all of the groups (P<0.01);compared with the others, the expression of Bax protein in pGPU6/RFP/Neo-erbB-2+carboplatin group was increased, while the expression level of Bcl-2 protein was decreased.Conclusion C-erbB-2 shRNA can increase the Lewis cells’sensitivity to carboplatin.The mechanism may be that it can enhance the Lewis cells’apoptosis induced by carboplatin through increasing the expression of Bax protein and decreasing the expression of Bcl-2 protein.

Objective To implement and evaluate evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia.Methods This study is a prospective before and after comparison study.Collected 200 acute stroke patients with dysphagia and divided them into test group (trained medical staffs) and control group(untrained medical staffs) equally according to the time order.Two groups of 100 patients were surveyed using a checklist before and after implementation of 10 guidelines about nutrition support.Before the implementation of guidelines,the staffs were enforced training,and summarized regularly.Compliances with guidelines by doctors and nurses were compared,and outcomes of patients were assessed.Results Compared with the control group,the correct implementation of the project significantly improved in the experimental group on nutritional risk screening (92.0％,64.0％; x2 =22.840),nutritional supplements selection (80.0％,48.0％; x2 =22.220),nutrition infusion methods (90％,18％ ; x2 =1.040) and nutrition infusion adjustment (abdominal distension/adjusted:21/10,6/4;x2 =9.634,constipation/adjusted:41/40,57/53 ; x2 =5.122,all P ＜ 0.05).The mortality rate,poor prognosis and length of stay in department of neurology intensive care unit and in hospital were not significant different between the experimental group and the control group.The incidence of hospital-acquired pneumonia was significantly lower in the experimental group (44.3％) than that in the control group (67.5％,x2 =7.281,P =0.007),but other patient outcomes were unaffected significantly.Conclusion Implementation of evidence-based guidelines for enteral nutrition support in acute stroke patients with dysphagia is associated with improvements in clinical quality and selected patient outcomes.

Objective The causes of unsuccessful nasointestinal tube placement in 9 patients with severe brain injury and gastric retention were analyzed and corrected. Methods The 9 cases of unsuccessful nasointestinal tube placement were analyzed from the aspects of disease, sedative drug use, mechanical ventilation, weakened bowel sounds and so on. Blind intubation was used to correct the defect, and the depth and time consumed of blind intubation and ultrasonic catheterization were compared. Results All 9 patients had gastric emptying disorders, decreased gastrointestinal peristalsis, and increased gastric residue, which affected the entrance of the catheter to the pylorus. Among them, 5 patients were given 3 or more sedative drugs in the state of drug sedation, and 2 patients had gastric emptying disorder due to the location of the disease damage. Therefore, ultrasound-guided nasointestinal tube placement was unsuccessful. Finally the 9 patients are successful to be inserted nasointestinal tubes by the blind placement plus air injection method. The average time of blind intubation was (28.89±13.80) min, which was lower than that of ultrasonic catheterization (84.44±20.07) min, and the difference was statistically significant (t=6.842, P＜ 0.01). Conclusions The failure of ultrasound-guided nasointestinal tube placement in patients with severe brain injury and gastric retention is related to the severity of the patient, the use of sedatives, mechanical ventilation, gastric retention and other causes of gastrointestinal peristalsis weakened or disappeared. Clinical nurses are required to give accurate assessment. Patients with severe brain injury and massive gastric retention are advised to use the blind placement plus air injection method for nasointestinal tube placement. In the case of ultrasound-guided nasointestinal tube placement, gastric motility drugs need to be used in advance.

Objective To study the correlation of quantitative electroencephalography (qEEG) parameters with outcomes of adults who sustained coma after cardio-pulmonary resuscitation.Methods The clinical data of coma patients after cardio-pulmonary resuscitation,admitted to our hospital from March 2008 to August 2014 were retrospectively analyzed.Glasgow coma scale (GCS) was performed.EEG was registered and recorded at least once within 7 d of coma after cardio-pulmonary resuscitation:electrodes were placed according to the international 10-20 system,using a 16-channel lay out.The qEEG parameters defined as burst suppression ratio (BSR),brain symmetry index (BSI),[delta+theta]/[alpha+beta] ratio (DTABR) were analyzed at the same time.Follow-up was performed 3 months after onset and the outcomes of these patients were assessed by Glasgow outcome scale (GOS).The correlations of GOS scores with qEEG parameters were analyzed.Results Sixty patients with GCS scores-＜ 8 after cardio-pulmonary resuscitation were included.BSR1 and BSR2 were negatively correlated with GOS scores 3 months after onset (r=-0.723,P=0.000;r=-0.651,P=0.000);DTABR was positively correlated with GOS scores 3 months after onset (r=0.270,P=0.037).BSI and DTABR were not correlated with GCS scores.BSR1 and BSR2 were negatively correlated with GCS scores (r=-0.562,P=0.000;r=-0.429,P=0.001).Conclusion The qEEG parameters are correlated with outcomes after cardio-pulmonary resuscitation.

Objective: To observe the effects of probiotics on gut microecology, immune function, and inflammatory index in patients with critical cerebral infarction. Methods: A total of 70 patients with critical cerebral infarction treated in our hospital from January 2015 to January 2019 were retrospectively studied.They were randomly divided into a control group(n=35)receiving routine treatment and an observation group(n=35)receiving routine treatment added to capules containing live Bifidobacterium, Lactobacillus, and Enterococcus for 4 weeks.The changes of gut microflora, immune function and inflammatory index were compared between the two groups. Results: The number of Bifidobacterium, Lactobacillus, and Enterococcus colonies were significantly increased and the colony count of yeast was decreased in the observation group after treatment versus pre-treatment(P<0.05). There were no significant differences between pre-versus post-treatment in the colony count in the control group(P>0.05). The level of CD4⁺ and CD4⁺/CD8⁺ ratio were significantly higher in observation group than in the control group(P<0.05), and the level of CD8⁺ was lower in observation than in the control group(P<0.05)after treatment.The levels of hemoglobin(Hb), total protein(TP), albumin(Alb), interleukin(IL)-6 and tumor necrosis factor(TNF)were decreased in the two groups, but the decrement of the levelsof IL-6 and TNF was more marked in the observation group than in the control group(P<0.05), However, the levels of Hb, TP, A1b in the observation group were lower tan those in te control group(all P<0.05). Conclusions Probiotics can significantly improve the intestinal flora and immune function, release the deterioration of nutritional status, and inhibit the inflammatory response in patients with critical cerebral infarction, which is worthy of clinical promotion.

BACKGROUNDThe brain death confirmation tests occupy a different position in each country's diagnostic criteria (or guideline); the choices of tests are also different. China brain death criteria include clinical judgment and confirmation tests. This study aimed to confirm the preferred confirmatory test and complementary confirmatory tests.

METHODSWe did a clinical brain death determination on deep coma patients, and then divided them into brain death group and non-brain death group. According to the Chinese standards for determining brain death, both the groups accepted confirmatory tests including electroencephalograph (EEG), somatosensory evoked potentials (SEP), and transcranial Doppler (TCD). The sensitivity, specificity, false positive rate, and false negative rate were calculated to evaluate the accuracy of the confirmatory tests.

RESULTSAmong the 131 cases of patients, 103 patients met the clinical criteria of brain death. Respiratory arrest provocation test was performed on 44 cases and 32 cases (73%) successfully completed and confirmed that they have no spontaneous breathing. Of the three confirmation tests, EEG had the highest completion rate (98%) and good sensitivity (83%) and specificity (97%); TCD had followed completion rate (54%) and not good sensitivity (73%) and specificity (75%); SEP had the lowest completion rate (49%), good sensitivity (100%), and not good specificity (78%). After the combination of SEP or TCD with EEG, the specificity can increase to 100%.

CONCLUSIONSThe completion rate of respiratory arrest provocation test remains a problem in the clinical diagnosis of brain death. If the test cannot be completed, whether to increase a confirmatory test is debatable. SEP had an ideal sensitivity, and the specificity will reach 100% after combining with TCD or EEG. When a confirmed test was uncertain, we suggest increasing another confirmatory test.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Death ; diagnosis ; physiopathology ; Evoked Potentials, Somatosensory ; physiology ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography, Doppler, Transcranial ; Young Adult