Objective To make a systematic review of pressure ulcers risk factors in critically ill patients. Methods We systematically reviewed all articles related to the pressure ulcers risk factors in critically ill patients. The Cochrane Library, PubMed, EMBASE, Web of Science Core Collection, CNKI, WANFANG and SinoMed were searched to August 2016. Results In total, 13 eligible articles were included. These studies included 18, 184 critically ill patients, six studies were classified as high quality, and seven were classified as moderate quality. Risk factors for the development of pressure ulcers include age, ICU stay, diabetes, mean arterial pressure<60-70 mmHg (1 mmHg=0.133 kPa), mechanical ventilation and mechanical ventilation, drugs, sedation and postural changes. Conclusions There is no single factor that can explain the occurrence of pressure ulcers. So it is in a variety of factors interaction, the occurrence of a significant increase in risk.

Objective To understand the Helicobacter pylori ( Hp) infection eradication rate of standard tri-ple therapy in Guangdong Meizhou and the drug resistance situation for metronidazole ,clarithromycin ,amoxicillin and levofloxacin ,in order to look for the treatment countermeasures in Hp eradication failure .Methods 297 cases of Hp positive patients because of gastrointestinal symptoms to our hospital examined from April 2011 and March 2013,were randomly assigned into three standard triple therapy groups:A ( OCA ) group and B ( OCM ) group and C ( OCL ) group.The Hp eradication rate was analyzed .Patients with primary treatment failure were selected as group D (OBAL),proceed to (PPl+B+A+L)7 d therapy,the Hp eradication rate was analyzed .230 Hp strains were isola-ted and cultured from 297 cases received the first eradication therapy and 87 cases received again eradication therapy . The minimum inhibitory concentration (MIC) of metronidazole,clarithromycin,amoxicillin and levofloxacin were tested by E-test,in order to determine the resistance of these four antibiotics in clinical isolated Hp strains .Results With intention-to-treat(ITT) analysis,the Hp eradication rates of group A (OCA),group B(OCM) and group C(OCL) were 72.0%(72/100),63.0%(63/100) and 72.2%(70/97),respectively.With per-protocol(PP) analysis,the Hp eradication rates of group A (OCA),group B(OCM) and group C(OCL) were 72.7%(72/99),64.3%(63/98),73.7%(70/95),respectively.The eradication rate among three standard triple therapy groups had no obvi-ous difference (ITT:P=0.278,PP:P=0.288,P>0.05).With ITT analysis,the Hp eradication rate in the quadrup-le therapy group D(OBAL) was 92.0%(80/87).With per-protocol(PP) analysis,the Hp eradication rate in the quadruple therapy group D(OBAL) was 97.6%(80/82),which was higher than that of the three standard triple ther-apy groups(ITT:P=0.000,PP:P=0.000).In 230 clinical isolated Hp strains,the resistant rates of levofloxacin,amoxicillin,clarithromycin and metronidazole were 6.08%(14/230),6.52%(15/230),25.65%(59/230), 70.87%(163/230),respectively.Of those 37 strains were mixed resistance,the mixed resistant rate was 16.09%(37/230).The resistant rate of metronidazole was higher than levofloxacin , amoxicillin and clarithromycin ( P =0.000,P<0.01),the resistant rate of clarithromycin was higher than levofloxacin and amoxicillin (P=0.000),no statistically significant difference between amoxicillin and levofloxacin (P=0.848).Conclusion The Hp resistance is similar to the national average in Guangdong Meizhou ,the eradication rate of standard triple therapy is lower than 80%,contain bismuth agent of quadruple therapy is good rescue therapy .

Objective To explore the effect of goal-oriented repetitive training on motor function of upper limb in patients with stroke. Methods From March, 2014 to February, 2016, a total of 60 stroke patients were randomly divided into experiment group (n=30) and con-trol group (n=30). Both groups received routine rehabilitation, while the experiment group received goal-oriented repetitive training in addi-tion, 30 minutes once a day, 5 days a week for 4 weeks. They were assessed with simple Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and modified Barthel index (MBI) before and after training. Results There was no difference in the scores of FMA-UE and MBI between two groups before training (Z<1.153, P>0.05). The scores of FMA-UE and MBI significantly improved in both groups after treat-ment (Z>5.645, P<0.001), in which the scores were higher in the experiment group than in the control group (Z>2.275, P<0.05), as well as the D-value of scores before and after training (t>5.770, P<0.001). Conclusion Goal-oriented repetitive training could promote the recovery of upper limb motor function in patients with stroke.

Objective To analyze the risk factors of in-hospital mortality in patients with intracerebral hemorrhage (ICH) in the intensive care unit.Methods Patients with intracerebral hemorrhage were retrospectively collected from January 2013 to January 2018 in the Department of Intensive Care Unit,Zhongnan Hospital of Wuhan University.Patients were excluded aged less than 18 years,pregnant women,the onset time of more than 7 days,the length of hospital stay of less than 48 hours,lack of renal function outcomes within 24 hours after admission,the glomerular filtration rate (eGFR) of lower than 15 mL/(min.1.73 m2),the history of chronic kidney disease,regular dialysis and renal transplantation,and incomplete data.Clinical data were collected from baseline characteristics,past history,and laboratory examination.The included patients were divided into the in-hospital non-survival group and the survival group.SPSS 20.0 software as used for statistical analysis,the binary Logistic regression analysis was performed to evaluate risk factors of in-hospital mortality with intracerebral hemorrhage,the prognosis was assessed by receiver operating characteristic (ROC) curve and survival curve (Kaplan-Meier).A P＜0.05 was considered statistically significant.Results In this single-center retrospective study,a total of 300 patients were enrolled,including 96 patients in the hospital nonsurvival group and 204 patients in the survival group.The incidence of in-hospital death in patients with intracerebral hemorrhage in ICU was 32％.Multivariate analysis demonstrated that the risk factors of inhospital mortality were lower GCS score (OR=0.629,95％CI:0.523-0.757,P＜0.01),higher APACHE Ⅱ score (OR=1.590,95％CI:1.369-1.847,P＜0.01),elevated leukocytes (OR=1.082,95％CI:1.028-1.139,P=0.002) and the incidence of acute kidney injury (AKI) (OR=6.978,95％CI:3.381-14.405,P＜0.01).The ROC curve demonstrated that the area under curve (AUC) of APACHE Ⅱ score was the largest with a sensitivity and specificity of 73.96％ and 75.98％,respectively,which can better predict the mortality of patients with cerebral hemorrhage.Kaplan-Meier survival curve showed that in-hospital survival rate of non-AKI patients were higher than that of AKI patients (P＜0.01).Conclusions Lower GCS score,higher APACHE Ⅱ score,elevated white blood cells and AKI are risk factors for predicting in-hospital mortality in patients with intracerebral hemorrhage in the ICU.Therefore,early identification and treatment should be adopted in these high-risk populations.

Objective: To evaluate the performance of Vitek MS, an automated mass spectrometry microbial identification system, in identification of clinical filamentous fungi isolates, which provide a new insight into filamentous fungi identification strategy. Methods: Twenty-five isolates of filamentous fungi genetically confirmed by molecular sequencing method were inoculated in different culture conditions to analyze the potential influences of culture conditions on the identification of filamentous fungi with Vitek MS. Further evaluation of the performance of Vitek MS in filamentous fungi identification was carried out with 207 clinical isolates of filamentous fungi and the comparison of the results with those of morphology and sequencing analysis. Results: The performance of Vitek MS in filamentous fungi identification was not significantly influenced by culture conditions. Vitek MS successfully identified 87.9% (182/207) of all tested filamentous fungi. Lacking of reference MS spectra in Vitek database was the main reason that the other isolates could not be identified. Vitek MS was superior to the traditional morphological method in identification of filamentous fungi especially non-Aspergillus molds at species level. Conclusion Vitek MS is an efficient approach for clinical filamentous fungi identification. Continuous enrichment of the species coverage in database will be of great importance for improving the performance of Vitek MS in identification of filamentous fungi.

Objective:To explore the effect of Toll-like receptor 9 (TLR9) signaling pathway activation on the transcriptome in the renal tubular cells.Methods:Mouse primary renal tubular epithelial cells were extracted and cultured. When the degree of cell fusion reached 80%, they were divided into two groups, which were added with 10 μL phosphate buffered saline (PBS, PBS control group) and TLR9 activator cytosine phosphate guanidine oligodeoxynucleotide (CpG-ODN) with a final concentration of 5 μmol/L (CpG-ODN treatment group). The RNA sequencing was performed on the Illumina platform after extraction. DEGseq software was used to analyze the differential expression of genes between the two groups. Goatools and KOBAS online software were used to analyze the differential genes involved signal pathways. Homer software was used to predict transcription factors.Results:Compared with the PBS control group, there were a total of 584 differentially expressed genes in the CpG-ODN treatment group, of which 102 were up-regulated and 482 were down-regulated. The most significantly enriched gene ontology (GO) terms of differentially expressed genes included response to interferon-β, defense response to virus and other inflammatory pathway. The most significantly enriched Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathways included 2'-5'-oligoadenylate synthase activity, regulation of ribonuclease activity, negative regulation of virus life cycle, cellular response to interferon-βand defense response to protozoan. The results of transcription factor prediction showed that interferon regulatory factor 3 (IRF3) was the most significantly enriched transcription factor in the promoter sequence of differential genes; the most significant transcription factor downstream of TLR9 was IRF3, and other predicted transcription factors such as transcription factor 21 (TCF21), zinc finger protein 135 (ZNF135), and PR domain containing 4 (PRDM4) might be new candidates for TLR9 signaling pathway.Conclusion:CpG-ODN activates TLR9 signaling pathway, and primary renal tubular epithelial cells can directly respond to CpG-ODN stimulation and undergo transcriptome changes, which provides a basis for further research on the molecular mechanism of TLR9 pathway in sepsis induced acute kidney injury.

Objective:To investigate the role and diagnostic value of miRNA-205 in chronic kidney disease (CKD) patients with vascular calcification.Methods:It was divided into in vitro cell experiment and retrospective cohort study. In vitro experiments were conducted by using rat thoracic aortic smooth muscle cells. Alizarin red staining and calcium content detection were used to detect the calcification of vascular smooth muscle cells (VSMCs). Alkaline phosphatase (ALP) test kit was used to measure ALP activity. Western blotting was used to detect the protein expression levels of osteogenic transcription factors runt-related transcription factor 2 (Runx2), α smooth muscle actin (α-SMA) and smooth muscle-22α (SM-22α) in VSMCs. qRT-PCR was used to detect miRNA-205 and Runx2 expression levels. The double luciferase reporter gene assay was used to verify the targeted relationship between miRNA-205 and Runx2. The non-dialysis patients with CKD 3-5 stage from June 2020 to January 2021 in the Department of Nephrology of Fourth Hospital, Hebei Medical University were selected. According to coronary artery calcium score (CACs), the patients were divided into non-calcification group (CACs=0), mild-moderate calcification group (0 400). Spearman correlation analysis was used to analyze the correlation between miRNA-205 and Runx2 and vascular calcification. Logistic regression model and receiver operating characteristic (ROC) curve analysis were used to analyze the ability of miRNA-205 to predict the vascular calcification in patients with CKD. Results:(1)Compared with the control group, calcium nodules were more, and the calcium content, ALP activity and Runx2 protein level were higher, and the expression levels of miRNA-205, α-SMA and SM-22α were significantly lower in high phosphorus group (all P<0.05). Overexpression of miRNA-205 significantly reduced the calcification of VSMCs and Runx2 protein level, and increased the protein levels of α-SMA and SM-22α (all P<0.05). miRNA-205-5p reduced the activity of luciferase in the wild-type Runx2-3'-end non-coding region plasmid. (2) Eighty CKD patients were enrolled, with age of (57.50±14.93) years old and 49 males (61.3%). The results of comparison of miRNA-205 and Runx2 expression levels in non-calcification group ( n=26), mild- moderate calcification group ( n=30) and severe calcification group ( n=24) showed that, the higher degree of calcification, the lower miRNA-205 expression level and the higher Runx2 mRNA expression level (all P<0.05). miRNA-205 was negatively correlated with CACs ( r=-0.50, P<0.01) and Runx2 was positively correlated with CACs ( r=0.55, P<0.01). Multivariate logistic regression analysis results suggested that miRNA-205 ( OR=0.451, 95% CI 0.122-0.873) was an independent influencing factor of vascular calcification in CKD patients. The area under the ROC curve of miRNA-205 and miRNA-205 combined with Runx2 for predicting vascular calcification were 0.796 (95% CI 0.697-0.859) and 0.924 (95% CI 0.866-0.982), respectively. Conclusions:miRNA-205 inhibits vascular calcification by targeting Runx2 to negatively regulate osteogenetic phenotype transformation of VSMCs and is expected to be an early diagnostic marker of vascular calcification in CKD patients.

Fibroblast growth factors (FGF) are a group of structurally related polypeptides which constitute an elaborate signaling system with their receptors. Evidence accumulated in the years suggests that the FGF family plays a key role in the repair of central nervous system injury. The main protective mechanisms include activating the expression of PI3K-Akt, peroxisome proliferator-activated receptor (PPARγ) and other signals; inhibiting NF-κB-mediated inflammatory response, oxidative stress and apoptosis; regulating neuronal differentiation and neuronal excitability as well as participating in protection of neurovascular units and nerve function repair. This paper comprehensively summarizes the latest research progress in FGF signaling related to diseases of the central nervous system such as cerebral infarction, cerebral hemorrhage, traumatic brain injury, Alzheimer's disease, Parkinson's disease, epilepsy and depression, aiming to provide scientific basis and reference for the development of innovative FGF drugs for the prevention and treatment of neurological diseases.
Humans ; Fibroblast Growth Factors ; Phosphatidylinositol 3-Kinases/metabolism* ; Central Nervous System/metabolism* ; Signal Transduction/physiology* ; Alzheimer Disease