Objective To investigate the effects of noisy pressure support ventilation (Noisy PSV) in patients of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure, and to provide basic support for the new weaning mode for AECOPD. Methods A single-center, prospective, randomized, crossover clinical research was conducted. A total of forty-six AECOPD combined with respiratory failure patients who mechanically ventilated more than 24 hours in intensive care unit (ICU) of Tianjin Haihe Hospital from November 2014 to October 2015 were enrolled in this study. When the respiratory failure improved through conventional treatment, patients were mechanically ventilated with conventional PSV and Noisy PSV for two hours respectively in random sequence during spontaneous breathing recovery phase. The pressure support (PS) level was titrated to reach tidal volumes (Vt) about 8 mL/kg in both modes. The level of positive end-expiratory pressure (PEEP) and fraction of inspired oxygen were kept unchanged in both modes. The coefficient of variation of PS during Noisy PSV was set at 30%. Data of gas exchange, hemodynamics, lung functional parameters, breathing patterns and patient-ventilator synchrony were analyzed. Results All of the patients were well tolerated with the two modes, and no adverse reactions were found. The changes of gas exchange, hemodynamics, respiratory mechanics in PSV and Noisy PSV showed a clinical acceptable range. The variability of Vt was significantly increased in Noisy PSV mode than that in conventional PSV mode. While the number of asynchrony events was decreased in Noisy PSV mode than that in conventional PSV mode. Conclusion The Noisy PSV is safe and feasible for patients of AECOPD with respiratory failure, which may be a new weaning mode for AECOPD.

Objective To explore the relationship among vocational selection anxiety, career adaptability and locus of control in practice nurses. Methods Totally 408 practice nurses from five Tertiary A Hospitals in Liaoning Province were assessed with the Career Adaptability Scale, Locus of Control Scale and Vocational Selection Anxiety Questionnaire. All data were analyzed using the software SPSS 22.0 and AMOS 22.0. Results Career adaptability was negatively correlated with vocational selection anxiety (r=-0.44, P<0.01), chance and powerful others (r=-0.21,-0.21,P<0.01). Chance and powerful others were positively correlated with vocation selection anxiety (r=0.45, 0.44,P < 0.01). The career adaptability could negatively predict the vocational selection anxiety directly and indirectly via the mediating role of chance and powerful others. Conclusions Career adaptability and locus of control could influence the vocational selection anxiety. Chance and powerful others played a role of part-mediating variable in the relationship of career adaptability and vocational selection anxiety.

Intestinal microflora is a general term for microbial communities that reside in the human intestine. In recent years, the research on diseases related to intestinal microbiota has developed rapidly. It is found that intestinal microbiota is closely related to digestive tract diseases, metabolic diseases, immune diseases, mental diseases, and lung diseases. Intestinal dysbacteriosis, mucosal barrier damaging and local immune dysfunction may be involved in a variety of disease processes. In addition, respiratory diseases such as asthma and pneumonia seriously affect human health. The intestinal microbiota is crucial in regulating immune response of lung to pathological mechanism of diseases including asthma, pneumonia and pulmonary tuberculosis. Therefore, it may be a new direction for the treatment of lung diseases by understanding intestinal microbiota in lung diseases, and identifying, describing and manipulating immunity network of pulmonary disease.

ObjectiveTo observe whether if intravenous infusion of dexmedetomidine in advance can prevent irritation and cough causing by sufentanil.MethodsNinety patients who performed excision of intracranial tumor were divided into observation group and control group by random digits table with 45 cases each.Patients in observation group were intravenously infused 0.5 μg/kg dexmedetomidine for 10 minutes before induction.Patients in control group were intravenously infused 0.9％ sodium chloride for 10 minutes before induction.All the patients were intravenously infused 0.3 μg/kg sufentanil after taking drugs of load dosage in 3 seconds,and the incidence of irritation and cough in 1 minute was observed.The mean arterial pressure and heart rate were recorded before infusing dexmedetomidine or sodium chloride(T0),at the end of infusing dexmedetomidine or sodium chloride (T1),before intubation (T2),1 minute after intubation (T3).ResultsThe incidence of irritation and cough,moderate-severe irritation and cough in observation group [ 24.4％ ( 11/45 ),11.1％ (5/45) ] were lower than those in control group [ 48.9％ (22/45),22.2％ ( 10/45 ) ]with significant differences(P＜ 0.01 ).The mean arterial pressure in control group at T2 was lower than that in observation group [ (71.2 ± 3.5) mm Hg( 1 mm Hg =0.133 kPa) vs.(84.7 ± 4.1 ) mm Hg] with significant difference (P ＜ 0.05 ).The mean arterial pressure in control group at T3 was higher than that in observation group [(96.7 ± 6.4) mm Hg vs.(83.1 ± 5.2) mm Hg] with significant difference(P＜ 0.05).The heart rate at T1,T2,T3 in observation group was lower than that in control group [ (53.2 ± 4.7 ) beats/min vs.(70.4 ± 6.2 )beats/min,(56.3 ± 3.1 ) beats/min vs. (64.7 ± 3.7) beats/min,(59.1 ± 4.8) beats/min vs. (81.5 ± 6.1 )beats/min],and there were significant differences(P ＜0.05).Conclusions Intravenous infusion of dexmedetomidine (0.5 μg/kg) in advance can effectively prevent irritation and cough causing by sufentanil,and can enhance the stability of circulation during intubation.

Objective To study the clinical and pathological features of rectal carcinoid and factors influencing the prognosis.Methods Data of 33 rectal carcinoid patients were analyzed retrospectively. 29 patients were followed up postoperatively. Primary tumors were classified by size (2*!cm) and muscularis invasion respectively.Results The main symptoms were changes in bowel habits(17/33,52%) and hematochezia (14/33, 42%), or rectal mass (14/33,42%), asymptomatic patients were detected during a survey.Only 4(12%) patients had tumors larger than 2 cm and tumors invading muscularis.The 10 year survival rate was 84% for all patients( n =29), and 94% for those with tumors 2*!cm( n =3) died in 5 years( P = 1 0?10 -9 ) and only one out of the 4 with muscularis invasion lived longer than 5 years( P =1 2?10 -5 ).Conclusions Most rectum carcinoid are at early stage suitable for local excision.

60yr, weighting 50-80kg undergoing general thoracic surgery (lung resection and esophagus cancer resection) were enrolled in this study. Their preoperative hepatic and renal function were normal (blood creatinine

Objective To investigate the therapeutic effects of fluorouracil implants in Stage Ⅲgastric carcinoma patients after radical gastreetomy. Methods The general state of health and cumulative survival of 200 stage Ⅲ gastric carcinoma patients undergone radical gastrectomy from January, 1999 to, December 2002 in the People's Hospital of Zhongshan City were analyzed, in which only 120 patients administrated fluorouracil implants during radical gastreetomy. The therapeutic effects of fluorouracil implants in stage Ⅲ gastric carcinoma patients after radical gastrectomy were observed. Results The differences of weight (P = 0.041), HGB(P =0.024), Plt(P =0.017), CEA(P =0.001), CA19-9(P =0.003) were significant between two groups. The incidence rate of nausea/emesis in group T (28 %) was higher than that in group O(17 %, P = 0.006), and incidence rates of myelosuppression(P =0.81), diarrhea(P =0.72), hepatic function lesion(P =0.97) and renal function lesion(P =0.20) were no significant. The cumulative 5-year survival rate of group T(45 %) was higher than that in group O (15 %, P =0.002). Conclusion Fluorouracil implants can improve the therapeutic effects on gastric carcinoma patients undergone radical gastrectomy.

Objective To study the relationships between cell kinetics, apoptosis and expression, mutation of related genes in breast cancer. Methods Flow cytometry, immunohistochemical SP and PCR SSCP were used respectively to study DNA index(DI), S phase fraction(SPF), proliferation index(PI), apoptosis index(AI), expression of c erbB 2, Bcl 2, p53, PCNA, Ki67, TopoⅡ and mutation of p53 in 54 cases of breast cancer. Results High DI, aneuploidy rate, SPF, PI and AI were coincided with high expression of c erbB 2, p53, PCNA, Ki167 and TopoⅡ. Low DI, SPF, PI and AI were coincided with high expression of Bcl 2. High DI, SPF, PI and AI were coincided with high mutation of p53. High AI was related to a type of p53 mutation——loss of heterozygosity(LOH). Conclusion Abnormal cell kinetics and apoptosis were related with abnormal expression, mutation of related genes in breast cancer. [

Objective To evaluate therapeutic effects of metformin on the expression of serum cytokines,balance of splenic Th17/regulatory T cells (Treg) and expression of splenic AMPK-mTOR in collagen-induced arthritis (CIA) rats,and the mechanism thereof.Methods The rat model of CIA was established by injecting bovine type Ⅱ collagen.Forty rats were randomly divided into five groups:the CIA model group(sterile water by gavage),Met-30 mg/kg group (metformin 30 mg ·kg-1 ·d-1 by gavage),Met100 mg/kg group(metformin 100 mg ·kg-1 ·d-1 by gavage),Met-300 mg/kg group(metformin 300 mg ·kg-1 ·d-1 by gavage) and control group (sterile water by gavage).The hind paw volume was recorded once a week.The serum level of cytokines,tumor necrosis factor (TNF)-α,interleukin (IL)-1β,IL-6,and IL-17,were measured by enzyme linked immunosorbent assay (ELISA) 35 days after the initial immunization.The quantity of Th17 and Treg cells were examined by flow cytometry.The expression of AMPK,p-AMPK,mTOR and p-mTOR were examined by western blotting.One-way analysis of variance was used to evaluate the experimental data.Results The values of hind paw volume were decreased on the 35 d of the initial immunization in the Met100 mg/kg [(2.43±0.37) ml,t=2.97,P＜0.05] and Met-300 mg/kg groups [(2.58±0.21) ml,t=2.96,P＜0.05] than those of CIA model group (2.97±0.23) ml.The serum levels of TNF-α,IL-1β,IL-6 and IL-17 on the 35-d after the initial immunization were significantly lower in the metformin therapeutic groups [Met-300 mg/kg group TNF-α (104±8) pg/ml,t=42.77,P＜0.05;IL-1β (183±24) pg/ml,t=60.457,P＜0.05;IL-6 (19.3±2.8) pg/ml,t=53.62,P＜0.05;IL-17 (64.5±6.7) pg/ml,t=47.92,P＜0.05] than those of the CIA model group [TNF-α (246±8) pg/ml;IL-1β (1 336±40) pg/ml;IL-6 (87.0±5.1) pg/ml;IL-17 (282.3±6.8) pg/ml].The quantity of Th17 and Treg cells were significantly different in the Met-300 mg/kg group than those of the CIA model group 35 d after the initial immunization [Th17(6.57±0.39) vs (9.89±0.53),t=8.74,P＜0.05;Treg (7.60±0.45) vs (3.94±0.61),t =8.37,P＜0.05].The expression of p-AMPK on the 35 d after the initial immunization in the metformin therapeutic groups was significantly higher than in the CIA model group(P＜0.05),and the expression of p-mTOR was significantly lower (P＜0.05).Conclusion Metformin can significantly inhibit the serum levels of TNF-α,IL-1β,IL-6 and IL-17 in CIA model rats,and regulate the balance of Th17/Treg through AMPK-mTOR signaling pathway.

Objective To discuss the effect of daidzein on hepatocellular carcinoma SMMC7721 cell proliferation CD133 expression on tumor stem cell.Methods Hepatocellular carcinoma SMMC7721 cells were cultured,digested and passaged,and divided into six groups with different drug:control group with no daidzein,100 μg/mL daidzein group,200μg/mL daidzein group,300μg/mL daidzein group,400μg/mL daidzein group ,500μg/mL daidzein.The inhibition ratio,hexokinase,alkaline phosphatase and CD133 levels in SMMC7721 cell were detected and compared at 24 h,48 h,72 h among those groups. Results The inhibition ratio was increased by Daidzein dose increasing,and decreased apparently by times extending,especially in 400μg/mL and 500μg/mL daidzeingroups.Compared with control group,the hexokinase and alkaline phosphatase activity and CD133 expression were decreased apparently in groups treated with daidzein(P<0.01).The more the dose,the higher the drop(P<0.01).Conclusion Daidzein can inhibit hepatocellular carcinoma SMMC7721 cell proliferation,and inhibit CD133 expression on tumor stem cell.