BACKGROUNDWith the widespread use of ventilators in treating critically ill patients, the morbidity of ventilator-induced lung injury (VILI) is increasing accordingly. VILI is characterized by a considerable increase in microvascular leakiness and activation of inflammatory processes. In this study we investigated the effects of inflammatory mediators in VILI rat serum on endothelial cytoskeleton and monolayer cellular permeability, as well as the therapeutic effect of ulinastatin, to explore the pathogenesis and the relationship between biotrauma and lung oedema induced by VILI.

METHODSThirty healthy male Sprague-Dawley rats were randomly divided into three groups: group A (normal tidal volume ventilation), group B (high tidal volume ventilation) and group C (high tidal volume ventilation plus ulinastatin). The serum of each rat after ventilation was added to endothelial cell line ECV-304 medium for two hours to observe the effects of serum and/or ulinastatin on endothelial fibrous actin and permeability.

RESULTSCompared to rats ventilated with normal tidal volume, serum of rats ventilated with high tidal volume caused a striking reorganization of actin cytoskeleton with a weakening of fluorescent intensity at the peripheral filament bands and formation of the long and thick stress fibres in the centre resulting in endothelial contraction and higher permeability. Prior treatment with ulinastatin lessened the above changes significantly. The changes of permeability coefficient of endothelial permeability after group A, B or C rats serum stimulation were (6.95 +/- 1.66)%, (27.50 +/- 7.77)% and (17.71 +/- 4.66)% respectively with statistically significant differences (P < 0.05) among the three groups.

CONCLUSIONSThe proinflammatory mediators in the serum of the rats given high tidal volume ventilation increases endothelial permeability by reorganizing actin cytoskeleton, and pretreatment with ulinastatin lessens the permeability by inhibiting of proinflammatory mediators.

Actins ; analysis ; metabolism ; Animals ; Anti-Inflammatory Agents ; therapeutic use ; Cell Membrane Permeability ; drug effects ; Cells, Cultured ; Endothelial Cells ; drug effects ; metabolism ; physiology ; Glycoproteins ; therapeutic use ; Humans ; Lung ; drug effects ; metabolism ; Lung Diseases ; etiology ; physiopathology ; prevention & control ; Lung Injury ; Male ; Microscopy, Fluorescence ; methods ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Respiration, Artificial ; adverse effects ; Tidal Volume ; drug effects ; Ventilators, Mechanical ; adverse effects

Objective: To explore the association between breastfeeding and the type of obesity in children and adolescents, and to provide a theoretical basis for the identification and intervention of influential factors of different types of childhood obesity. Methods: Using stratified cluster sampling method, 93 primary and secondary schools in 7 provinces and cities in China were selected for physical examination and questionnaire surveys. Totally, 30 437 primary and middle school students aged 7-17, with completed information, were selected. A multivariable Logistic regression model was used to analyze the association between breastfeeding and different types of obesity. Results: The breastfeeding rate of students was 69.8%. The rates of general obesity, simple abdominal obesity, and combined obesity in the breastfeeding group were 7.1%, 3.9%, and 18.7%, the non-breastfeeding group were 7.0%, 4.7%, and 19.5%. The differences were statistically significant(χ2=14.04,P<0.01). Univariate analysis found that breastfeeding significantly reduced the risk of simple abdominal obesity in children and adolescents(OR=0.81,95%CI=0.72-0.92,P<0.01) with normal(BMI non-overweight and obesity and waist Conclusion Breastfeeding is a protective factor for children with simple abdominal obesity and combined obesity, and the rate of breastfeeding in China should be further improved.

Objective To investigate the frequency of CD4~+CD25~+FoxP3~+regulatory T cells (Treg)and the expression of the functional protein,FoxP3,in patients with active tuberculosis and the relationship between Treg and the pathogenesis of tuberculosis.Methods Forty-five patients with active tuberculosis(including 25 cases of pulmonary tuberculosis and 20 tuberculous lymphadenitis), 20 healthy controls,20 recovered tuberculosis patients and 6 patients with reactive hyperplasia in cer- vical lymph node were enrolled.The frequency of CD4~+ CD25~+ FoxP3~+ Treg in the peripheral blood was measured by flow cytometry.FoxP3 mRNA expression was determined by real-time reverse transcriptase-polymerase chain reaction(RT-PCR)and the expression of FoxP3 protein in lymphoid tissues was measured by immunohistochemistry.Results The frequency of natural Treg in the peripheral blood from the patients with active tuberculosis was 2.91%?0.23%,which was signifi- cantly higher than that of healthy control group(1.22%?0.18%)and recovered tuberculosis patients(1.50%?0.17%,P

OBJECTIVETo investigate the diagnostic methods and reasonable treatment of Peutz-Jeghers syndrome (PJS).

METHODSClinical data of six patients with PJS were reviewed.

RESULTSRepeated abdominal pain, intussusception and intestinal polyp with bleeding were main manifestations. Four patients father,three patients grandfather and one patients mother were diagnosed with PJS. Three patients had family history of cancer. Case 4 and case 5 underwent laparotomy for many times because of intussusceptions caused by polyps or recurrent abdominal pain. Case 1 and case 4 had polyps synchronous with adenoma, and case 2 had polyp with gastric cancer. Main treatment included polyp resection and partial small intestinal and colon resection.

CONCLUSIONSPatients with PJS have family history of cancer and a high incidence of polyp recurrence of small intestine. Surgical intervention is the first choice regimen. Surveillance should be emphasized on gastrointestinal tract and other potential malignant organs in PJS patients.

Adolescent ; Adult ; Female ; Humans ; Intestine, Small ; surgery ; Male ; Pedigree ; Peutz-Jeghers Syndrome ; diagnosis ; genetics ; surgery

OBJECTIVETo investigate the effects of inflammatory mediators in the serum of rats with ventilator-induced lung injury (VILI) on endothelial cellular cytoskeleton and monolayer cellular permeability and explore the molecular mechanism of VILI-induced lung edema.

METHODSThirty healthy male SD rats were divided into 3 groups, namely group A with normal tidal volume ventilation, group B with high tidal volume ventilation and group C with high tidal volume ventilation plus ulinastatin treatment. The serum was collected from each rat after ventilation and added into endothelial cell line ECV-304 culture medium, and 2 h later the changes of F-actin and cell permeability were observed.

RESULTSCompared to sera from rats with normal tidal volume ventilation, the sera of rats with high tidal volume ventilation caused obvious reorganization of actin cytoskeleton with weakened fluorescent intensity at the peripheral filament bands and formation of long and thick stress fibers in the center, which resulted in endothelial contraction and increased cell permeability. Pretreatment with ulinastatin could lessen these changes significantly. The percentage in change of permeability coefficient (Ppa%) after stimulation with the sera of rats in groups A, B and C was (6.95+/-1.66)%, (27.50+/-7.77)%, and (17.71+/-4.66)%, respectively, showing statistically significant differences (P<0.05).

CONCLUSIONThe pro-inflammatory mediators in the serum of rats with high tidal volume ventilation increases endothelial cell permeability by reorganizing actin cytoskeleton, and pretreatment with ulinastatin can lessen the hyperpermeability by inhibiting multiple pro-inflammatory mediators.

Actins ; metabolism ; Animals ; Cell Line ; Endothelial Cells ; drug effects ; metabolism ; Glycoproteins ; pharmacology ; Humans ; Inflammation Mediators ; antagonists & inhibitors ; metabolism ; Male ; Permeability ; drug effects ; Rats ; Rats, Sprague-Dawley ; Ventilator-Induced Lung Injury ; blood ; metabolism ; pathology

BACKGROUND: Pulmonary stretch reflex plays an important role in regulation of respiratory movement. This study aimed to evaluate the effect of pulmonary stretch reflex on lung injury in rabbits with acute respiratory distress syndrome (ARDS). METHODS: ARDS rabbits were given intratracheal infusion of hydrochloric acid and ventilated with neurally adjusted ventilatory assistance (NAVA) with a tidal volume (VT) of 6 mL/kg and the electrical activity of diaphragm (EAdi)-determined positive end expiratory pressure. After isolation of the bilateral vagusnerve trunk, the rabbits were randomized into two groups: sham operation (SHAM) group (n=5) and bilateral vagotomy (VAG) group (n=5). Gas exchange and respiratory mechanics were detected at baseline, after lung injury and 1, 2, and 3 hours after ventilation respectively. Pulmonary permeability index, pathological changes and inflammatory response were also measured. RESULTS: Compared with the SHAM group, PaO2/FiO2 in the VAG group decreased significantly 2 and 3 hours after ventilation (P<0.05). There was no significant difference in PaCO2 between the SHAM and VAG groups (P>0.05), and the VAG group had a high VT, peak pressure (Ppeak), and mean pressure (Pm) compared with the SHAM group 1, 2, 3 hours after ventilation (P<0.05). Compared to the SHAM group, dead space fraction (VD/VT) and respiratory system elastance (Ers) in the VAG group increased (P<0.05) and static pulmonary compliance (Cst) decreased markedly (P<0.05) after ventilation for 3 hours. Lung wet/dry weight ratio (W/D) (8.4±1.2 vs. 6.6±1.0), lung injury score (6.3±1.8 vs. 3.8±1.3), tumor necrosis factor-α (TNF-α) (779±372 pg/mL vs. 355±130 pg/mL) and interleukin-8 (IL-8) (169±21 pg/mL vs. 118±17 pg/mL) increased significantly in the VAG group compared with the SHAM group (P<0.05). CONCLUSION: Lung injury is aggravated after bilateral vagotomy, demonstrating that pulmonary stretch reflex may have protective effect on the lung.

Animals ; Borrelia burgdorferi ; genetics ; China ; DNA, Bacterial ; genetics ; isolation & purification ; Rodentia ; microbiology ; Sequence Analysis, DNA

;Objective To investigate the influence of pharmacist inter-vention on patients′knowledge of anticoagulation therapy with warfarin . Methods Two hundred sixteen patients who were admitted to cardiovas-cular wards and were prescribed anticoagulation therapy with warfarin from October 2013 to August 2014 were included in the study .According to the ward they stayed , patients were divided into control group ( Cardiology ward No1.) and intervention group ( Cardiology ward No 2.) . In the control group , physicians and nurses introduced anticoagulation knowledge for the patients as usual , while intervention group received medication education and guidance on warfarin use by pharmacists .All patients of two groups filled out an assessment questionnaire about warfa-rin anticoagulation at discharge ( outpoint =13 ) .If any answer to the questions was wrong , pharmacists would educate them again .The score of the questionnaire were compared between the two groups . Results The intervention group enrolled 112 patients while the control group enrolled 104 patients. Scores of assessment questionnaire at discharge of the intervention group and the control group were (10.50 ±2.24) vs (8.08 ±2.61) respectively,with statistical difference ( P <0.05 ) .Conclusion Knowledge of warfarin therapy was much better in patients who received pharmacist intervention than patients who received usual care . Integrated management model with pharmacist interventions can improve patients′cognition in anticoagulation therapy with warfarin .

Objective: To analyze the association between short term PM 2.5 exposure and high blood pressure in adolescents and its modification effect of overweight and obesity, and to provide a reference for the refined management of students physical health and the scientific prevention and controlling of air pollution. Methods: A total of 148 956 junior high school students and senior high school students who passed the annual physical examination data of middle school students in Beijing from 2017 to 2018 were selected; The inverse distance weighted interpolation method was used to get the meteorological elements and air quality of the research area; Linear mixed effect model was used to estimate the cumulative lag effect of short term PM 2.5 exposure on systolic and diastolic blood pressure within 7 days, and analyze the modification effect of overweight and obesity on the association between short term PM 2.5 exposure and high blood pressure in adolescents. Results: From September 1, 2017 to June 30, 2018, the average concentration of PM 2.5 was (56.53±45.85)μg/m 3; The detection rate of overweight and obesity was 34.22%, and the detection rate of high blood pressure was 8.03%. The cumulative lag effect of PM 2.5 on systolic blood pressure in overweight and obesity group was the largest at lag07, that is, the daily average concentration of PM 2.5 increased by 10 μg/m 3 was significantly correlated with higher systolic blood pressure ( OR =1.05,95% CI =1.03-1.07); the cumulative lag effect of PM 2.5 on systolic blood pressure in non overweight and obese group was the largest at lag05, that is, the daily average concentration of PM 2.5 increased by 10 μg/m 3 was significantly correlated with higher systolic blood pressure ( OR =1.04,95% CI =1.02-1.06). Short term exposure to PM 2.5 did not affect the high diastolic blood pressure in adolescents. Overweight and obese adolescents were more susceptible to high blood pressure caused by short term PM 2.5 exposure within 3 days of cumulative lag (lag01-lag03). Conclusion The short term exposure of PM 2.5 has a significant positive correlation with adolescent blood pressure, and shows a lag effect. Overweight and obese adolescents have higher blood pressure after PM 2.5 short term exposure.

The national health industry standard (WS/T 610-2018), 'the reference of screening for elevated blood pressure among children and adolescents aged 7-to 18-years-old’, plays a significant role in the standardization of the blood pressure evaluation, the early detection of high blood pressure, and the early intervention of hypertension and other chronic non-communicable diseases among Chinese children and adolescents. This standard gives screening thresholds for blood pressure assessment of children and adolescents in different genders, ages, and heights. Given the complexity of applying this standard, it is error-prone and less efficient to evaluate blood pressure one by one or program this procedure. Therefore, this study provides a SPSS package based on the standard for researchers to download and use, combined with specific cases to guide the use of this package to evaluate the blood pressure of children and adolescents step by step, which could empower researchers to accurately and efficiently conduct blood pressure screening for children and adolescents in China.