Objective To explore the clinical application of adaptive support ventilation (ASV) in elderly patients with acute respiratory failure.Methods A total of 46 mechanically ventilated patients aged over 65 years with acute respiratory failure admitted from January 2013 to June 2015 were enrolled.Comparison between the ASV mode and synchronized intermittent mandatory ventilation (SIMV) mode was carried out in respects of the impacts of both modes on respiratory mechanics, hemodynamics, oxygen availability and comfort rate.Results Difference between ASV and SIMV in respiratory rate was [(20.84 ±4.04) vs.(24.50 ±4.60) cycles/min, t =4.04, P ＜0.05], in inspiratory resistance was [(13.24 ±4.76) vs.(16.54±5.25) cmH2O/ (L·s), t=3.16, P＜0.05], in mean airway pressure was [(13.58±2.58) vs.(16.63 ±1.57) mmHg, t =6.84, P＜0.05], in peak airway pressure was [(25.96 ± 3.69) vs.(27.87 ± 2.45) mmHg, t =2.92, P ＜ 0.05], and tidal volume was [(378.41 ± 85.61) vs.(341.52 ± 86.84) mL, t =2.05, P ＜ 0.05], and comfort rate of patients was increased in ASV mode.There were no statistically significant differences in arterial oxygen partial pressure, carbon dioxide partial pressure, lactate, heart rate, mean arterial pressure and central venous pressure between the two modes (PP ＞ 0.05).Conclusions Compared with the synchronized intermittent mandatory ventilation mode, the adaptive support ventilation mode can improve the respiratory mechanics and can increase the comfort rate in the elderly patients with mechanical ventilation.

Objective To explore the relationship between children obesity and adiponectin(ADPN),leptin(LP),and high-sensitive C-reactive protein(hsCRP).Methods Seventy-one obese volunteers as obesity group and 30 normal volunteers who matched obese volunteers in age and sex as control group were selected from 13 702 children and adolescents of 2 to 18 years old in Xiangtan city by sampling survey.The body mass index(BMI),ADPN,LP,hsCRP,fasting blood-glucose(FBG),and fasting pure insulin(INS) were checked respectively.The homeostasis model assessment for insulin resistance(HOMA-IR) and the quantitative insulin-sensitivity check index(QUICKI) were calculated.The difference between the two groups was compared and the relationship of all indexes was analyzed.Results The values of ADPN and QUICKI in obesity group were significantly lower than those of control group(P

Objective To investigate feasibility and validity of endovascular aortic repair (EVAR) of traumatic thoracic aortic injuries (TTAI).Methods A retrospective analysis was conducted on data of 13 patients with TTAI.Pathological changes were evaluated by spinal CT angiography (CTA) preoperatively and re-evaluated by digital subtraction angiography (DSA) in EVAR.CTA was performed again to confirm therapeutic effects at postoperative 3,6,12 months and annually thereafter.Results All patients had successful EVAR.Complete or partial cover of left subclavian artery was observed in four patients.Endoleak in angiography shortly after stent delivery was noticed in three patients.However,endoleak disappeared in one patient after short stent placement for twice; endoleak was evidently decreased in one patient after balloon dilation.Follow-up was performed for another patient with slight endoleak.A total of 12 patients were followed up,which showed no complications,such as endoleak,ischemia of left upper extremity,paralysis or stent-graft migration.Conclusion EVR is safe and effective in treatment of TTAI.

Batifiban, a synthetic cyclic peptide, is a potent platelet glycoprotein GPIIb/IIIa antagonist which may be useful in the treatment and prevention of acute coronary syndromes. The pharmacokinetics and pharmacodymanic (inhibition of platelet aggregation) effects, and tolerability of batifiban were investigated in healthy subjects following single bolus injection with doses of 55, 110, or 220 microg/kg, or multiple doses of an bolus followed intravenous infusion for 24 h (180 microg/kg plus 2.0 microg/min.kg, and 220 microg/kg plus 2.5 microg/min.kg) in this phase I clinical trial. Plasma levels of batifiban and areas under the curve were found to be proportional to doses. Batifiban was rapidly eliminated with a half-life of approximately 2.5 h. Significant differences were noted for plasma levels of batifiban and areas under the curve between males and females. No significant differences in the terminal half-life were found between males and females. Batifiban reversibly inhibited ex vivo platelet aggregation in a dose- and concentration-dependent manner, consistent with its mechanism as a GPIIb/IIIa antagonist. Single and multiple intravenous doses of batifiban were found to be safe and well tolerated in healthy subjects. These results support a bolus injection plus intravenous infusion regimen of batifiban for the treatment and prevention of acute coronary syndromes.
Injections, Intravenous ; Peptides, Cyclic/*pharmacokinetics ; Peptides, Cyclic/*pharmacology ; Platelet Aggregation Inhibitors/adverse effects ; Platelet Aggregation Inhibitors/*pharmacokinetics ; Platelet Aggregation Inhibitors/*pharmacology ; Platelet Glycoprotein GPIIb-IIIa Complex/*antagonists & inhibitors ; Young Adult

Aged ; Case-Control Studies ; Cerebral Infarction ; blood ; genetics ; Female ; Fibrinogen ; genetics ; metabolism ; Haplotypes ; Humans ; Male ; Middle Aged ; Polymorphism, Genetic

Objective To investigate the expression of nucleotide-binding oligomerization domain protein 2 (NOD2)in serum of patients with hepatocellular carcinoma (HCC),and to analyse the roles of NOD2 in HCC development and its clinical diagnostic value.Methods This study including 66 patients with HCC in the hospi-tal from March 1,2013 to December 31,2014 and 61 healthy controls.Serum NOD2 levels were determined by enzyme-linked immunosorbent assay (ELISA).Analysis of significance was performed with rank sum test using SPSS statistical 16.0 software.Results Serum levels of NOD2 in HCC patients were 171 pg/ml,significantly higher than that of healthy controls(95 pg/ml,Z =-5.00,P =0.00),and the serum NOD2 levels were correla-ted with clinical stage of HCC (H=56.26,P =0.00).Compared with the serum NOD2 levels in stageⅠ,Ⅱpatients (106 pg/ml)and healthy controls (95 pg/ml),the serum NOD2 level in stage Ⅲ and Ⅳ (220 pg/ml) were significantly increased (χ2 =31.24,P =0.00;χ2 =47.23,P =0.00),but the expression of NOD2 in stageⅠandⅡwere nearly equal to that of the healthy controls (χ2 =0.36,P =0.83).The ROC analysis revealed that the best diagnostic cutoff-point of serum NOD2 levels for predicting the Ⅲ and Ⅳ stages of HCC was 148.78 pg/ml,meanwhile corresponding sensitivity was 89.1% and specificity was 77.0%.Additionally,corre-lation analysis demonstrated that there was no significant correlation between NOD2 and alpha-fetal protein (r =0.44,P =0.14).Survival curves obtained that the survival time of HCC patients with NOD2 serum concentrations≥ 200 pg/ml was significantly less than that <200 pg/ml (χ2 =15.32,P <0.05).Conclusion NOD2 is highly expressed in the serum of HCC patients,especially in advanced patients,which is possibly involved in the development of HCC and has the potential to become an effective marker used for HCC diagnosis.

Objective To report 11 cases with the tissue defects of their upper or lower limbs repaired with the anastomsed medial sural artery perforator flaps.Methods The free medial sural artery perforator flaps,with length of 8 cm to 15 cm and width of 6 cm to 14 cm were used for tissue defect reconstruction of the distal upper or lower limbs in 11 cases,including 6 females and 5 males.The flap was harvested from the ho- mo-lateral calf,confined between the posterior-medial edge of the tibia and the middle line of the calf and a- bove the distal half part of the medial sural muscle,with a same axis of this muscle.Results Ten cases survived very well,which was relatively thin,and the donor site can be acceptable.One case resulted in a complete flap necrotized and covered with a split skin graft.No obvious motor function defect was observed of the donor leg.Conclusion The anastomsed medial sural artery perforator flap is alternative donor flap for the upper or lower limb tissue defect repair,especially for the defect in the hand or foot.

Objective To observe the serum B-type natriuretic peptide(BNP)changes in patients with acute coronary syndrome during percutaneous coronary intervention(PCI).Method The serum BNP level was determined and the heart function was assessed in 236 consecutive patients with acute coronary syndrome(ACS) admitted to CCU and in 54 normal normal suvjects as control from January 2005 to December 2006 in Tongji Hospital.The ACS patients were further divided into various subgroups according to the involved arteries and performance of PCI.Serum BNP,hypersensitive c respose protein(HsCRP)level,amd heart comstitution and function were analyzed.Results The serum BNP and HsCRP level were significantly increased in patients with ACS [(332.06?483.17)ng/L and(31.06?52.15)mg/L]more than those in normal subjects [(81.44?195.55)ng/L and(11.15?20.78)mg/L,respectively,P

Objective: To analyze the clinical data of children with pertussis and explore the necessity of respiratory virus detection in the combined diagnosis so as to improve the clinician′s understanding and standardize the diagnosis and treatment of pertussis in children. Method: Clinical data and laboratory examination of 195 suspected pertussis children between Jan. 2015 and Dec. 2016 in Children′s Hospital Affiliated to Capital Institute of Pediatric were analyzed retrospectively. Result: The nasopharyngeal secretions were collected from 195 suspected pertussis children, PCR was employed to detect the nucleic acid of Bordetella pertussis. Meanwhile, 172 of 195 cases were screened for antigens of 7 common respiratory viruses by direct immunofluorescence (DIF) (respiratory syncytial virus(RSV), adenovirus(ADV), influenza virus A and B, parainfluenza viruses type Ⅰ-Ⅲ). (1) Eighty cases were positive in pertussis nucleic acid detection (positive rate was 41.0%), 47 males and 33 females, age ranged from one month to ten years, all of them had paroxysmal cough (100.0%), 50 cases with spasmodic cough (62.5%), 9 cases with vomiting after cough(11.2%), 22 cases with cyanosis after cough(27.5%), 13 cases with roaring after cough(16.2%), 4 cases with dyspnea(5.0%), 18 cases were diagnosed as pneumonia by chest radiography(22.5%) and 1 case was diagnosed as pertussis encephalopathy(1.2%); (2) 172 cases of respiratory virus DIF detection were completed and 69 of them were positive(positive rate was 40.1%), including 32 cases positive for RSV(18.6%), 29 cases for PIVⅢ(16.8%); (3) In 80 confirmed pertussis children, 66 cases of respiratory virus DIF detection were completed and 9 were positive(9/66, 13.6%), including 7 cases positive for PIVⅢ. The clinical manifestations were cyanosis after cough(6 cases), dyspnea(2 cases) and pneumonia were diagnosed by chest radiography in 3 cases, the clinical symptoms of these children were more prominent than children with general pertussis; (4) Patients were divided into three groups according to the pathogens: 57 cases in single pertussis group, 32 cases in RSV infection group, 22 cases in single PIVⅢ infection group.The cases of spasmodic cough in Pertussis group was 35 (61.4%), RSV infection group was 7(21.9%), single PIVⅢ infection group was 8(36.4%), compared with the other two groups, the incidence of spasmodic cough were higher in Pertussis group (χ² =12.850, 4.013, P<0.05). The cases of roaring in Pertussis group was 11 (19.3%), RSV infection group was 1(3.1%), single PIVⅢ infection group was 0, and the incidence were higher in Pertussis group (χ²=4.596, 4.932, P<0.05). The cases of dyspnea in Pertussis group was 2 (3.5%), RSV infection group was 11(34.4%), single PIVⅢ infection group was 0, and the incidence was higher in RSV infection group (χ²=15.654, 9.487, P<0.01). Conclusion Pertussis is common in children, especially in unvaccinated or incompletely vaccinated infants. The typical clinical manifestation is paroxysmal spasmodic cough; complicated with PIVⅢ infection is a risk factor for sever pertussis. Early detecting of Bordetella by PCR is helpful for the diagnosis of pertussis, RSV and PIVⅢ are the main pathogen for Pertussis-like syndrome. The detection of respiratory virus is helpful for differential diagnosis and medication guidance.

Objective:To study the application of scenario interaction combined with phased goal teaching method in nursing teaching of cardiovascular medicine.Methods:A total of 55 nursing students who interned in our department before the implementation of scenario interaction combined phased goal teaching method (from September 2017 to February 2019) were randomly selected into control group, and 55 nursing students who had internship in our department after the implementation of the nursing teaching model (from March 2019 to September 2020) were randomly selected as study group. One week before the students leaving the department, the comprehensive ability (theoretical assessment and practical assessment), thinking ability (Critical thinking disposition inventory-Chinese version, CTDI-CV), work satisfaction (Minnesota satisfaction questionnaire, MSQ) and psychological states (Maslach burnout inventory, MBI) were compared between the two groups of intern nursing students. SPSS 19.0 was used for chi-square test and t test. Results:One week before the students leaving the department, the scores of theoretical assessment, practical assessment, CTDI-CV scale, MSQ scale and personal achievement of MBI scale of intern nursing students in study group were higher than those in control group ( P<0.05). The scores of emotional exhaustion and depersonalization tendency of MBI scale in study group were lower than those in control group ( P<0.05). Conclusion:Scenario interaction combined with phased goal teaching method is beneficial to improve the comprehensive ability and job satisfaction, and strengthen the thinking ability and psychological states of intern nursing students.