ObjectiveTo investigate the influence of the midazolam sedation based on remifentanil analgesia on the occurrence of delirium in critically ill patients in intensive care unit (ICU).Methods A single-center prospective randomized controlled trial was conducted. 140 consecutive critically ill patients admitted to ICU of Peking University People's Hospital, undergoing mechanical ventilation longer than 24 hours, with the need of sedation, from February 2014 to January 2015 were enrolled. They were randomly divided into two groups by computer generated random numbers table, eachn = 70. The patients in observation group received midazolam 1μg·kg-1·min-1 for sedation, and 1 mg/mL remifentanil for analgesia with 0.05 mg/kg intravenous bolus, then continuous infusion of 0.02-0.10 mg·kg-1·h-1. The patients in control group received midazolam for sedation only. The data were recorded as follows: the main indices for observation included the occurrence of delirium and its duration; the second item for observation was consumption of drug for sedation, followed by the mean arterial pressure (MAP) before and after sedation, the time of wake-up, duration of mechanical ventilation, the length of ICU stay, and 28-day fatality rate. The 28-day survival was analyzed by Kaplan-Meier survival curve.Results The dosage of remifentanil used in observation group was (98.6±24.9) mg/d, the dosage of midazolam was significantly lower than that of the control group (mg/d: 160.6±33.3 vs. 178.9±43.4, t = 2.829,P = 0.005), the incidence of delirium was obviously lower than that of the control group [22.9% (16/70) vs. 57.1% (40/70),χ2 = 15.700,P< 0.001], and the time of delirium was slightly shorter than that of the control group (hours: 162.9±78.0 vs. 194.8±117.3,t = 0.947,P = 0.348). Among the patients with delirium, the dosage of dexmedetomidine used in observation group was significantly less than that of the control group (mg/d: 0.54±0.11 vs. 0.64±0.14,t = 2.112,P = 0.041). The MAP before sedation was similar as the MAP after sedation in both groups, and there was no significant difference between observation group and control group [mmHg (1 mmHg = 0.133 kPa), before treatment: 84.7±16.2 vs. 89.5±37.7, after treatment: 82.3±10.7 vs. 80.8±13.9, bothP> 0.05]. There was no significant difference in the time of waking-up between observation group and control group (hours: 2.3±0.9 vs. 2.4±0.8,t = 0.487,P = 0.627). The duration of mechanical ventilation (hours: 143.4±138.3 vs. 163.9±158.9, t = 0.812,P = 0.418), the length of ICU stay (days: 8.8±7.7 vs. 10.0±7.8,t = 0.917,P = 0.361) and 28-day fatality rate [11.4% (8/70) vs. 20.0% (14/70),χ2 = 1.941,P = 0.245] in observation group were slightly lower than those of the control group without significant difference. Kaplan-Meier survival curve showed that the cumulative 28-day survival rate in observation group was slightly higher than that of control group (χ2 = 1.647,P = 0.199). ConclusionAnalgesia based on sedation may reduce the occurrence of delirium and its severity, furthermore, even if delirium occurs, it may be less severe.

Breast Neoplasms ; etiology ; Female ; Humans ; Integrins ; physiology

Aim To investigate the effect of microRNA-155(miR-155)on sorafenib resistance in hepatocellular carcinoma(HCC).Methods Lentivirus mediated miR-155 inhibition was transfected into SMMC-7721 cells,while lentivirus mediated miR-155 overexpression was transfected into HepG2 cells.The level of miR-155 was evaluated by qPCR.Cell viability and apoptosis were analyzed by cell counting kit-8(CCK-8)assay and flow cytometry,respectively.The protein expression of activated caspase-3 was measured by Western blot.Results Compared to control group,the expression of miR-155 was significantly downregulated in miR-155 inhibition lentivirus infected SMMC-7721 cells(P<0.01),sorafenib treatment markedly suppressed cell viability(P<0.05)and increased cell apoptosis(P<0.01),as well as enhanced the expression of activated caspase-3(P<0.01).However,HepG2 cells were infected by miR-155 overexpression lentivirus which deserved completely opposite results.Conclusion miR-155 may participate in sorafenib resistance in HCC and provide a promising molecular target for the treatment of HCC.

Objective Nanoparticles are widely investigated and applied in clinical diagnosis and treatment as drug carrier,and their transmembrane process is related to their biological effects.The aim of this study was to investigate the interaction of fluorescein-labeled PLGA nanoparticles and HL60 cells via fluorescence tracking.Methods The transmembrane process of nanoparticles was quantitatively analyzed by laser scanning confocal microscopy.Results The analyzing results showed that the interaction of fluorescein-labeled PLGA nanoparticles and HL60 cells was strongly temperature-dependent.The receptor-mediated endocytosis mechanism played an important role in the transmembrane process for cellular uptake of nanopaticles.Conclusions This study provides a theoretical basis for design and application of nano-medicines.

Cerebral microbleeds (CMBs) are a key biomarker of cerebral small vessel disease on magnetic resonance imaging,They have potential clinical relevance to future stroke risk.Therefore,the detection of CMBs has important clinical significance for various cerebrovascular disease phenotypes.This article briefly summarizes the detection method of CMBs,mainly investigating the clinical significance of CMBs in general population and in patients with ischemic stroke,cerebral hemorrhage,vascular cognitive impairment,cerebral amyloid angiopathy,and leukoaraiosis.

Objective To investigate the clinical efficacy of percutaneous kyphoplasty(PKP) in treatment of elderly osteoporotic vertebral compression fractures(OVCF).Methods 122 elderly OVCF patients from Oct.2009 to Oct.2013 in Lihuili Hospital of Ningbo Medical Center were selected,and were randomly divided into group A,and group B.There were 61 cases in each group.Group A received percutaneous kyphoplasty(PKP),and group B were treated with percutaneous vertebroplasty(PVP).The two groups were observed in terms of pain,activity,vertebral compression rate and Cobb angles after treatment.The two groups were followed up at least for 3 months.The postoperative side effects were recorded and analyzed.Results After the treatment,the two groups significantly improved in VAS score and activity(P ＜ 0.05),but no significant difference was found between the two groups (P ＞ 0.05).After the treatment,vertebral compression rate and Cobb angle got better than before in the two groups,but group A recovered more obviously than group B,and the difference had statistical significance (P ＜ 0.05).The postoperative recurrence rate was 18.03 ％ (11/61) in the observation group and 9.84 ％ (6/61) in the control group,and the difference had statistical significance (P ＜ 0.05).Conclusion PKP and PVP can significantly relieve pain,but PKP had better effect than PVP in vertebral body and spinal kyphosis improvement,which is worth of clinical application.

RAGE (receptor for advanced glycation end products) is a multiligand receptor on the cell surface.Ligand-RAGE inter-actions activate several signal transduction pathways that propa-gate cellular oxidative stress and inflammatory response.RAGE expressed on the CD4 + T cells has been identified as a central transduction receptor which affects the activation,proliferation, migration and differentiation of the cells.In addition,blockade of RAGE suppressed the development of multiple immune-related
disorders mediated by CD4 + T cells.These studies highlight the importance of RAGE and its ligands for CD4 + T cells.This arti-cle briefly reviews the role of RAGE and its ligands on the prolif-eration,migration and differentiation of CD4 + T cells and sum-marizes the related research progress.

Objective To explore the effects of clinical psychological intervention on anxiety and depression in hemodialysis patients .Methods Hemodialysis patients were randomly divided into two groups:psychological inter-vention group and control group ,25 patients in each group .In intervention group ,besides routine clinical treatment and nursing measures ,we analyzed the clinical information of the patients ,consulted the relevant documents ,combined the evidence and clinical experience ,and finally conducted the psychological intervention .Self-Rating Anxiety Scale and Self-Rating Depression Scale of these patients were analyzed .Results Before the intervention , the SAS and SDS scores of intervention group and control group were (57.3 ±1.5) versus (56.9 ±1.6) and (55.3 ±2.3) versus (56.1 ±3.5),respectively.The t values were 0.912(P>0.05) and 0.955(P>0.05),respectively.After interven-tion,the score before and after the trial between these two groups were significantly different (P<0.05).The SAS and SDS scores of intervention group and control group were (16.4 ±0.9) versus (10.1 ±1.3) and (14.3 ±2.1) ver-sus (9.7 ±1.5),respectively.Conclusion Clinical psychological intervention can effectively relieve anxiety and depression in hemodialysis patients .

A total of 218 patients on chemotherapeutic regimens containing oxaliplatin were randomly divided into experimental (n =120) and control (n =98) groups.The experimental group received an intravenous infusion of lipoic acid plus sodium potassium magnesium calcium and glucose injection.The control group had only normal saline.Overall incidence of neurotoxicity and toxicity grade of peripheral nerve were observed after 4,8 and 12 cycles.Those with neurotoxic symptoms were followed up for 1 year.No significantly statistical difference existed in the incidence of peripheral neurotoxicity after 4,8 cycles (P ＞0.05).After 12 cycles,31 patients in the experimental group had an onset of neurotoxicity of grade3 (n=8,6.7％) &grade4 (n=0) versus21 cases of grade3 (n=21,21.4％) and grade4 (n=5,5.1％) in the control group.Statistically significant differences existed between grades 3 and 4 neurotoxicity (P ＜0.05).After 1 year of follow-up,the incidence of grade 1 of neurotoxicity was 2.5％ (n =3) in the experimental group versus 23.7％ (n =9) in the control group.And the inter-group difference was statistically significant (P ＜ 0.05).Lipoic acid plus sodium potassium magnesium,calcium and glucose injection can effectively prevent the occurrences of acute and chronic peripheral neurotoxicity associated with oxaliplatin.

Objective To evaluate the clinical value of 3.0T magnetic resonance imaging (MRI) diffusion weighted imaging (DWI) on evaluation effect of neoadjuvant chemotherapy in advanced gastric cancer. Methods 3.0 T MRI DWI examination was performed in 42 cases of advanced gastric cancer diagnosed by gastroscopy and pathology, including 32 patients were examined with DWI both before and after chemotherapy. Lymph nodes of gastric cancer lesions and display ability of stomach were measured, and the area of the apparent diffusion coefficient (ADC) values in normal stomach and tumors were compared. ADC values were compared in the same patients before and after neoadjuvant chemotherapy and analyzed along with postoperative pathological examinations. Results In a total of 40 patients who received 74 DWI examinations, ADC values in tumor and lymph nodes were significantly higher than those in normal tissue. The ADC value in tumors was (1.348 ±0.278) ×10-3 mm2/s, and in 12 cases of stomach lymph node enlargement was (1.329±0.188) ×10-3 mm2/s. However, the average ADC value of normal stomach was (2.081± 0.189) ×10-3 mm2/s with significantly lower DWI than that of the former (P< 0.001). After chemotherapy, the ADC value in tumors was increased, which was (1.572 ±0.261) ×10-3 mm2/s (P< 0.001). After neoadjuvant chemotherapy, 16 patients received gastric cancer radical prostatectomy, and postoperative pathological TRG ratings of tumor were decreased with different extent. Tumor cell density (TCD) before treatment with an average of 4.45 ×10-5 / px2, which was downgraduated to 2.48 ×10-5 / px2 after chemotherapy and surgery. Negatively correlation between TCD values and ADC values were observed. Conclusion MRI DWI examination can effectively detect advanced stomach cancer and the associated lymph node enlargement. Comparison of tumor morphology and ADC values in advanced gastric cancer before and after neoadjuvant chemotherapy has clinical value in prognosis.