Diaphragm is the principal respiratory muscle.Diaphragm dysfunction resulting from mechanical ventilation,chronic cardiopulmonary disease,medicine,cardio-thoracic surgery,septic shock and chronic malnutrition predisposes to weaning failure from mechanical ventilation and prolongs intensive care unit (ICU) stay.Traditionally,the method of assessment of diaphragm structure and function was invasive,lacking specific,and was difficult to be used bedside.A number of recent studies have been suggested that ultrasonographic evaluation has been proposed as an accurate,safe and noninvasive method of quantification of diaphragm structure and function.This article reviews the related researches of technique and the clinical applications of ultrasonography in the evaluation of diaphragmatic structure and function,which may possibly result in timely identification of patients with diaphragm dysfunction and improve the assessment of recovery from diaphragm weakness.

AIM:To investigate whether hypoxic preconditioning(HPC)protects cardiomyoblast H9c2 cells against oxidative injury,and to discuss whether calreticulin(CRT)contribute to this protection through p38 MAPK signaling pathway.METHODS:Cardiomyoblast H9c2 cells were randomly divided into eight groups as follows:hydrogen peroxide stress(H2O2);brief hypoxic exposure of 20 min to simulate hypoxic preconditioning(HPC);20 min of hypoxic exposure followed by 24 h of normoxic reoxygenation before hydrogen peroxide stress(HPC+H2O2),SB203580(the specific inhibitors of p38 MAPK)+HPC+H2O2,antisense oligonucleotides transfection of calreticulin(AS),AS+H2O2,AS+HPC+H2O2 and control.Morphological studies,estimation of lactate dehydrogenase(LDH)leakage and flow cytometry were employed to assess the cell apoptosis and necrosis.RT-PCR and Western blotting analysis was used to detect calreticulin expression and phosphorylation of p38 MAPK.RESULTS:The results obtained are as follows:(1)HPC relieved cell injury caused by H2O2.Compared with those in H2O2 group,apoptosis rate and LDH leakage in culture medium in HPC + H2O2 group decreased 13.4% and 44.0%,respectively(P

ObjectiveTo investigate p38 MAPK protein expression in human breast tumors and the regulation of preoperative chemotherapy. MethodsWe assessed p38 MAPK protein in 50 cases of breast cancer and adjacent normal tissue and that of breast benign tumors in 14 cases by Western blot. 15 cancer patients received preoperative CAF or TA protocol. Results The p38 protein level in tumors was significantly greater than that in the normal tissues, while there was not significant difference between benign tumors and corresponding normal tissue. p38 protein T/N ratio was higher in patients with lymph node metastasis than patients without( P

Objective To evaluate the value of ultrasound-guided channel establishment in minimally invasive percutaneous nephrolithotomy(MPCNL).MethodsBetween May 2006 and December 2007,85 patients received MPCNL in our hospital.Puncture points were selected and then channels were established under the guidance of ultrasonography according to the distributions of calculi during MPCNL.ResultsUnder the guidance of ultrasonography the puncture was completed at one session in all of our 85 cases.No massive hemorrhage or other severe complications occurred.In the cases,57 cases were cured after the first operation,and 27 cases received a second surgery.One of the cases was diagnosed as having calcification of the renal papillae without kidney calculi during the operation.Residual calculi(

The antitumor activities of artemisinin and its derivatives has become a hot topic in recent years.Artemisinin and its derivatives have been reported to exert antitumor effects mainly by blocking the cell cycle, promoting tumor cell apoptosis, inhibiting angiogenesis and so on.Also, their influence on signaling pathways has attracted considerable interest of many scholars.Currently, in order to discover some compounds with better therapeutic potentials, many studies dedicated to the synthesis and development of new artemisinin derivatives.In addition, the effects of artemisinin and its derivatives on multi-drug resistantace in tumor cells also become a trend of the future research.In this paper, we review the research advances in the antitumor activities of artemisinin and its derivatives during the past five years to provide a reference for future study .

Objective To investigate the structural response of diaphragm and soleus of the rat after mechanical ventilation (MV), and to explore the specific mechanism of the dysfunction of both muscles.Methods Sixteen male Sprague-Dawley (SD) rats were randomly divided into control group and MV group, with 8 rats in each group. Rats in MV group were treated with controlled ventilation and maintained anesthesia, and those in control group were only anesthetized without MV and maintained anesthesia. The diaphragm and soleus were harvested after MV for 18 hours, and the morphology changes were observed with light microscope. The cross section of muscle fiber was observed by immunofluorescence technique analysis, and the cross-sectional area of muscle fiber was calculated. The ultra structural changes in muscle fibers were observed under transmission electron microscope.Results ① Observed under light microscope, the cross section of the diaphragm and soleus muscle in the control group was regular, the nucleus was normal and the cytoplasm was homogeneous. The fibers in the diaphragm-biopsy specimens from MV subjects were smaller than those from control subjects, whereas these signs were not found in soleus. But fiber atrophy in MV specimens was not accompanied by an inflammatory-cell infiltrate. ② Under the fluorescence microscope, the control group had a smaller cross-section of the slow-twitch muscle in diaphragm, while the fast-twitch muscle fibers werelarger. As compared with diaphragm-biopsy specimens from control, specimens from MV subjects showed decreased cross-sectional areas of slow-twitch and fast-twitch fibers, respectively (μm2: 1069.00±155.24 vs. 1297.12±331.15, 2279.66±442.31 vs. 3031.80±596.11, bothP < 0.05). The disproportionate decrease in fast-twitch fibers cross-sectional areas [(70.42±3.61)% vs. (75.63±2.48)%] resulted inan increase in the percentage of total area occupied by the slow-twitch fibers [(29.58±3.61)% vs. (24.35±2.48)%, bothP < 0.01]. There were no significant differences in cross-sectional areas of slow-twitch and fast-twitch fibers in soleus between control group and MV group (μm2: 3193.80±559.36 vs. 3008.84±559.22, 3392.86±514.56 vs. 3594.35±651.67, bothP > 0.05). ③ In the control group, the muscle fibers of the diaphragm and soleus were arranged orderly, the boundary of the light and dark bands and the Z-line were clear, and there was no autophagy in the visual field. The outer membrane of the mitochondria was complete, and the cristae were in the shape of clapboard. The signs of misalignment of myofibrils, disruption of Z-line and vacuolar mitochondria were found in diaphragm from MV group, whereas these signs were not found in soleus. Diaphragm from MV group exhibited an increase in autophagic vesicles visualized by transmission electron microscopy as compared with control group.Conclusions Controlled MV for 18 hours resulted in diaphragmatic inactivity and promoted muscle injury and atrophy, while autophagy and mitochondrial dysfunction were enhanced. Soleus immobilization for 18 hours was not associated with muscle atrophy. These facts suggest that the signaling associated with diaphragm atrophy during MV may involve different mechanisms compared with other models of muscle atrophy. Diaphragm appeared to be more susceptible to MV.

Objective Three-dimensional(3D) automated ultrasonic volume measurement is becoming favorable in clinical application and turns to be an important direction .The article was to evaluate the consistency of two-dimensional (2D) and three-di-mensional ultrasonography in the diameter measurement of single follicle . Methods 438 single folliculars were respectively meas-ured by the same sonographer in 2D and 3D ultrasonic measurement.2D diameter, 3D mean diameter and 3D virtual ball diameter of every single follicle were recorded , and Bland-Altman method were used to evaluate the consistency of the results by these two meth-ods. Results In the consistency analysis on the diameter measurement of single follicle by 2D and 3D mean diameter measurment methods, d equaled -1.06 mm, and 95% LoA range covered the range of -4.82 mm to 2.70 mm.95% CI of 95% LoA range,-5.21 mm to 3.08 mm, was beyond the settings of clinical acceptable error limit range , -3.56 mm to 1.44 mm, showing poor consis-tency.Likewise, in the research of the consistency in the measurement of 2D diameter and 3D virtual ball diameter in the diameter measurement of single follicle , d equaled -0.07 mm , and 95%LoA range covered the range of -3.11 mm to 2.98 mm.95%CI of 95%LoA range, -3.43 mm to 3.29 mm, was beyond the settings of clinical acceptable error limit range , -2.57 mm to 2.43 mm, showing poor consistency . Conclusion 2D and 3D ultrasound measurements in the diameter measurement of single follicle are not consistent.However, considering the objectivity and accuracy of the results , 3D ultrasonography still has an advantage over 2D ultra-sonography , which can provide more acurate aid for assisted reproductive technology .

Objective To evaluate the application value of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance (TEB) in elderly non-cardiac surgery patients after general anaesthesia.Methods Fifty-six elderly non-cardiac surgery patients after general anaesthesia were divided into control group and TEB group with 28 patients in each group by random digits table. All patients received standardized care including central venous pressure (VAP). Besides these monitoring, hemodynamic monitoring by TEB was used to evaluate the hemodynamic state of patients in TEB group. Diuretics, inotropic agents, vasoactive drugs or intravenous fluid therapy were used according to monitoring guidance. The heart rate (HR), mean arterial pressure (MAP), VAP, urine output (UO) were recorded in different time. The length of mechanical ventilation and ICU stay were also recorded. The difference in HR, MAP, VAP, UO, the length of mechanical ventilation and ICU stay between two groups were analyzed. Results The differences between two groups had no significance in HR, MAP, VAP, UO at the same time (P ＞ 0.05 ). The length of mechanical ventilation of TEB group [ (19.5±15.9)h] was shorter as compared to that of control group [ (25.5 ± 16.5) h ], but the difference was not significant (P =0.173). The ICU stay of TEB group [(2.8 ± 1.0) d ] was shorter as compared to that of control group[(3.6±1.6)d] and the difference was significant (P=0.032). Conclusion Non-invasive hemodynamic monitoring by TEB can monitor the changes of hemodynamics and direct treatment in elderly non-cardiac surgery patients after general anaesthesia.

OBJECTIVE:To observe clinical efficacy and safety of salmeterol fluticasone combined with tiotropium bromide in the treatment of COPD via different inhalation devices.METHODS:Eighty COPD patients were selected from our hospital during Jan.2014 to Jan.2015,and then divided into trial group and control group according to random number table,with 40 cases in each group.Both groups were given Salmeterol fluticasone inhalant 500 μg,bid+Tiotropium bromide inhalant 18 μg,qd.Control group was given medicine via inhalation device coming with medicine,while trial group was given medicine via gas compression type ultrasonic spray inhalator.Both groups were treated for 1 year.Blood concentration of medicine 0.5 h after medication,mMRC score and COPD acsessment test (CAT) score 3,6,9 months after treatment,the times of acute exacerbation during treatment,FEV1％ before and af ter treatment were all observed in 2 groups.The occurrence of ADR was recorded.RESULTS:Four cases withdrew from trial group and 1 case from control group.After medication,there was no statistical significance in blood concentration of fluticasone,salmeterol and tiotropium bromide between 2 groups (P＞0.05).0.5 h after medication,mMRC score of trial group was slightly lower than that of control group,without statistical significance (P＞0.05);CAT score of it was significantly lower than that of control group,with statistical significance (P＜0.05).The times of acute exacerbation in trial group during treatment was significantly less than control group,with statistical significance (P＜0.05).The decrease of FEV1％ in trial group was slightly lower than control group,without statistical significance (P＞0.05).The incidence of ADR in trial group was significantly lower than control group,with statistical significance (P＜0.05).CONCLUSIONS:For COPD patients,salmeterol fluticasone combined with tiotropium bromide via gas compression type ultrasonic spray inhalator is better than inhalation device coming with medicine in clinical efficacy and safety.

Objective:To compare the expression and biological activity of glucosyl transferases (GTFs)of Streptococcus mutans (S.mutans)under normal outside environment between high temperature requirment serine proteinase A(HtrA)-deficient strains and high virulent strains isolated from children with high cario-susceptibility.Methods:The HtrA-deficient strains and high virulent strains of S.mutans were obtained by preliminary study.The strains were reanimated and incubated in BHI medium to exponential phase at tenth hour.The expression of gtfB,gtfC and gtfD were detected by real-time RT-PCR.The biological activity of the GTFs were detected by entong sulfuric acid method and Western Blot.Results:The expression of gtfs and GTFs in the HtrA-deficient strains was higher than those of high virulent strains,but the biological activity of the GTFs was lower.Conclusion:The HtrA gene plays an important regulatory role in the process of the GTFs expression of S.mutans isolated from children with high cario-susceptibility.