Objective To assess three-dimensional color Doppler energy (3D-CDE) in the diagnosis of liver tumors.Methods Vascular pattern of 2D- and 3D-CDE were used to analyze 106 tumors of 96 patients,and their sensitivity and specify were calculated respectively.Three-dimensional volumetric measurement was used to calculate the volume,vessel counts of tumor,as well as the ratio of vessel counts and volume,whereas vascular index (VI) of both benign and malignant lesions were assessed.Results ①Using the vascular pattern of IE as diagnosis standard of liver malignant,the sensitivity and specificity of 2D-CDE and 3D-CDE were 21.33%,100% and 81.33%,100%,respectively) using the vascular pattern of II and Ⅲ,the sensitivity and specificity were 73.33%,67.74% and 100%,45.16%,respectively.②Mean VI was 0.38 counts/cm~3 of malignant tumors and 0.18 counts/cm~3 of 31 benign tumors (P<0.05),The sensitivity and specificity in diagnosing malignant tumors of liver was 78.67% and 87.10%,respectively with VI>0.30 counts/cm~3.Conclusion The vascular pattern of 3D-CDE HI and VI>0.30 counts/cm~3 may be taken as parameters for the diagnosis of malignant liver tumor.

Objective To investigate the incidence and influencing factors of aldosterone escape in patients with non-diabetic nephropathy by RASI-therapy. Methods A total of 104 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB in a mean follow-up period of 12 months. Aldosterone escape was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment, while the influencing factors of aldosterone escape in patients with non-diabetic nephropathy was also analyzed after therapy with RASI . Results In 12 months, the incidence of aldosterone escape was significantly higher than that in 6 months (26.92% vs. 14.42%, P = 0.007). After 12-month treatment, the difference was statistically significant in incidence of aldosterone escape among different stages of CKD (P = 0.027). Compared with 6-month incidence of aldosterone escape in the losartan group, 12-month incidence increased evidently (P = 0.020). The Ald level was positively correlated with urinary protein excretion and the Scr level (r = 0.431, P = 0.003 and r = 0.336, P = 0.009, respectively), and negetively correlated with levels of the eGFR (r = -0.275, P = 0.006). Univariate Logistic regression demonstrated that risk factors of aldosterone escape included pre-treatment values of the urinary protein excretion (OR = 3.671, P = 0.028) and the eGFR (OR = 0.972, P = 0.019). Multivariate Logistic model revealed pre-treatment values of the eGFR was positively associated with aldosterone escape (OR = 0.970, P = 0.012). Conclusion The incidence of the aldosterone escape increases along with the time of treatment. Renal function has correlated with aldosterone escape and pre-treatment value of the eGFR is an independent risk factor of aldosterone escape.

Objective To investigate the effects of electroacupuncture (EA) on the implementation of blind nasojejunal (NJ) tube placement and enteral nutrition (EN) in neurosurgical severe coma patients in intensive care unit (ICU).Methods Seventy-nine neurosurgical severe coma patients admitted to ICU were randomly divided into conventional group (blind NJ tube placement,n =40) and EA group (NJ placement and EA,n =39).EA was performed after NJ tube placement at bilateral acupoints Zusanli (ST36) and Hegu (L14) points using EA treatment instrument.The impelling distance of NJ tube were measured and the success rate of NJ tube placement were calculated.The postoperative complications were observed.Results The difference of NJ tube impelling distances at the 24th,48th,and 72th hours after surgery in EA group were significant longer than that in conventional group (P ＜ 0.05).The success rates of NJ tube placement at the 24th and 72nd hours after surgery in EA group were significantly better than that in conventional group (P ＜ 0.05).Their EN calories qualifiedness rate in 72 hours also increased significantly compared with conventional group and the proportion of patients assisted with parenteral nutrition decreased (P ＜0.05).The postoperative complications including alimentary tract hemorrhage,vomiting,and abdominal distension decreased remarkably in EA group compared with conventional group (P ＜ 0.05).Conclusions EA stimulation at acupoints could promote the gastrointestinal peristalsis of neurosurgical severe coma patients and elevate the success rate of blind NJ tube placement,so it is beneficial for the implementation of early enteral nutrition (EEN).

OBJECTIVE:To investigate the new management model of the hospital pharmacy established by application of vender managed inventory (VMI) model. METHODS:Concerned about the implementation of VMI model,its effects and prob-lems,new management model of hospital pharmacy were described after the hospital cooperated with two suppliers. The hospital is mainly in charge of the management and application of pharmaceutical staff and equipment,drug capital flow,and the selection and optimization of drug use list;focus on the training of pharmaceutical talents;improve drug quality management,pharmaceuti-cal administration,pharmaceutical care and rational drug use. Two suppliers are mainly in charge of drug logistics,and the alloca-tion of servicer,software and hardware(as automatic medicine dispensing machine);share logistic cost of supply chain. Drug in-formation flow was established by both hospital and supplier. RESULTS:After cooperation,pharmaceutical staff,related equip-ment and inventory cost(floating capital decreased by 10 million yuan each month)were decreased,and the efficiency of distribu-tion improved;the error rate of drug dispensing in outpatient pharmacy were decreased (decreasing from 0.39‰ to 0.12‰) after the establishment of automatic pharmacy. The establishment of early warning system for abnormal patients flowrate in pharmacy window shortened the time of getting medicine,and improved service level and satisfactory degree of patients (increasing from 84.91% to 93.62%). CONCLUSIONS:New management model of hospital pharmacy based on VMI model provides reference for public hospital reform and hospital-enterprise cooperation under New Medical Reform.

Aim To observe the cardioprotection of chronic intermittent hypobaric hypoxia (CIHH) against ischemia/reperfusion injury in adult and young rats.Methods Adult and postnatal male Sprague-Dawley rats were divided randomly into four groups:control 28-day group (CON28),control 42-day group (CON42), CIHH 28-day treatment group (CIHH28), and CIHH 42-day treatment group (CIHH42). CIHH animals with maternal rats were put into a hypobaric chamber 2 days before birth to get 28 days and 42 days CIHH mimicking 3000 m altitude (P_B=525 mmHg,P_(O_2)=108.8 mmHg), 5 h daily, respectively.The control animals were kept in the same environment as CIHH rats with free access to water and food except hypoxic exposure. The isolated hearts were perfused in the Langendorff apparatus, undergoing 30 min global ischemia and 60 min reperfusion.Cardiac function was recorded continuously during the whole experiment. Parameters of left ventricular function included left ventricular developing pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), maximal positive (+LVdp/dt) and negative (-LVdp/dt) velocity of left ventricular pressure, coronary flow (CF) and heart rate(HR).Results ① For adult rats, there was no significant difference in the parameters of left ventricular function between CIHH28 and CON28 groups. However, the recovery of cardiac function in CIHH42 rats was much better than that in CON42, including LVDP, LVEDP, ±LVdp/dt and CF (P<0.05). ② For young rats, the basic coronary flow (CF) in CIHH rats was significant higher than that in CON rats, while other parameters of cardiac function didn't change. The recovery of cardiac function in CIHH rats was much better than that in CON rats, including LVDP, LVEDP,±LVdp/dt and CF (P<0.05).Conclusion CIHH confers cardioprotection against ischemia/reperfusion injury in rat cardiomyocytes, which is predominant in CIHH42 group and significantly affected by the age of animals. Cardioprotective effects produce more easily in young rats by CIHH.

Objective To investigate the effects and mechanism of prone ventilation in rats with lipopolysaccharide(LPS)-induced extra pulmonary acute lung injury(ALI). Methods Thirty-two male Sprague-Dawley(SD)rats were randomly divided into four groups:control group,ALI group,supine position group(ALIS group)and prone position group(ALIP group). The ALI animal model was reproduced by intra-peritoneal injection of LPS 6 mg/kg,and 2 mL/kg sterile saline was intra-peritoneally injected in control group. After 24 hours,the ALIS group and ALIP group were mechanically ventilated for 4 hours in supine and prone positions respectively. Arterial partial pressure of oxygen(PaO2),carbon dioxide partial pressure(PaCO2),wet to dry weight ratio of lung(W/D) were observed,and the levels of tumor necrosis factor-α(TNF-α),interleukins(IL-6,IL-10)in bronchoalveolar lavage fluid(BALF)were measured. The degrees of histopathological changes of lung were investigated and assessed under light microscope. Results Compared with control group,PaO2 was significantly lower in ALI,ALIS and ALIP groups〔mmHg(1 mmHg=0.133 kPa):68±7,82±8,93±7 vs. 116±7〕,and the PaCO2 in ALI and ALIS groups was obviously higher(mmHg:53±6,51±5 vs. 43±7,both P<0.05);lung W/D ratio as well as levels of TNF-α, IL-6 and IL-10 in BALF were significantly higher in ALI,ALIS and ALIP groups〔lung W/D ratio:5.11±0.32, 4.71±0.38,4.53±0.45 vs. 4.48±0.15,TNF-α(ng/L):548±82,431±64,347±53 vs. 162±16,IL-6(ng/L):772±119,587±178,490±139 vs. 127±16,IL-10(ng/L):211±43,295±36,352±59 vs. 104±31,all P<0.05〕. Compared with ALI group,PaO2 in ALIS and ALIP groups was significantly higher,and in ALIP group,PaCO2 was lower,lung W/D ratio,TNF-α and IL-6 in BALF were obviously lower,while IL-10 in BALF was obviously higher(all P<0.05). Compared with ALIS group,the changes in ALIP group were more significant(all P<0.05). Compared with ALIS group,under light microscope,it was shown that the hyper-inflated areas were less,normal and collapsed areas were greater on the ventral side,and the collapsed area was less and the normal ventilation area was greater on the dorsal side in ALIP group(all P<0.05). Conclusion In rats with LPS-induced extra pulmonary ALI,the prone ventilation can improve gas exchange,promote uniform distribution of ventilation,decrease pulmonary edema and in the mean time attenuate inflammatory response.

Objective To investigate whether miR?485?3p plays a role in regulation of radiosensitivity of gastric cancer cells by targeting TLR1. Methods Quantitative real?time PCR and Western blot were used to determine the expression of miR?485?3p and TLR1, respectively. The interaction between miR?485?3p and TLR1 was verified by target prediction software ( DIANA, TargetScan, and miRanda) and dual luciferase reporter assay. Gastric cancer MGC803 cells transfected with miR?485?3p mimic or TLR1 siRNA were exposed to irradiation. Apoptosis assay, colony formation assay, and MTT assay were used to evaluate the changes in radiosensitivity of gastric cancer cells. Dual luciferase reporter assay was used to determine the effects of miR?485?3p overexpression and TLR1 silencing on the activity of NF?κB. Western blot was used to study the effects of miR?485?3p overexpression and TLR1 silencing on NF?κB target genes. Results In gastric cancer cells exposed to radiation, the expression of miR?485?3p was downregulated and the expression of TLR1 was upregulated. TLR1 was predicted to be the target of miR?485?3p by target prediction software. Dual luciferase reporter assay further confirmed TLR1 as the direct target of miR?485?3p. miR?485?3p negatively regulated the expression of TLR1. The overexpression of miR?485?3p, as well as TLR1 silencing, increased the apoptosis rate of cells, reduced colony formation and cell proliferation, and enhanced the radiosensitivity of the cells. Both miR?485?3p overexpression and TLR1 silencing reduced the activity of NF?κB and downregulated the expression of multiple NF?κB target genes. Conclusions miR?485?3p enhances the radiosensitivity of gastric cancer cells probably by targeting TLR1 and regulating the NF?κB signaling pathway.

Objective To explore the effects and mechanisms of periostin overexpression on migration and invasion of nasopharyngeal carcinoma ( NPC) cell line.Methods The recombinant plasmids [ pCMV-neo ( +)-periostin ] and control plasmids [pCMV-neo (+)] were transfected into 6-10B cells using lipofectamine 2000TM reagent.The expression of periostin was detected with PCR and Western blotting .Transwell chamber invasion assay was employed to assay the migration and invasion of 6-10B cells before and after transfection .A gelatin zymogram was used to detect the activity of MMP-2 and MMP-9 in cultivated supernatant of 6-10B cells before and after transfection .The expression of integrin-αvβ5 was detected by immunohistochemistry ( IHC) in 6-10Bperiostin cells, 6-10Bvector cells and 6-10B cells as well as normal nasopharyngeal mucosa ( NNM) and NPC and at the same time periostin also was detected by immumohistochemistry in NNM and NPC, and densitometry analysis using image-pro plus 6.0 software, and the correlation between periostin and integrin-αvβ5 on NPC was assayed with statistics .Results Over expression of periostin promoted cell migration and invasion.The expression levels of integrin-αvβ5 in primary NPC and 6-10Bperiostin cells were significantly higher than those in NNM and 6-10Bvector, 6-10B cells.The expression in NPC of integrin-αvβ5 showed positively correlated with the expression of periostin (r=0.682, P<0.01).Conclusion Periostin plays an important role in regulation of cell migration and invasion probably by combining with integrin-αvβ5 to improve the activities of MMPs .

Objective:To systematically evaluate the real experience of caregivers in patients with hematopoietic stem cell transplantation.Methods:The Cochrane Library, PubMed, Scopus, Web of Science, PsycINFO, CBM, CNKI, VIP, and Wan Fang Data were searched for qualitative studies on caregivers' experience of hematopoietic stem cell transplant patients. The time limit for the search was from inception to June 2019. The results were assessed using a pooled integration approach using the Australian JBI Evidence-Based Health Care Center (2016) Quality Evaluation Standards Evaluation.Results:A total of 6 studies were included to refine 27 complete and definitive findings, and similar results were grouped into 8 new categories and integrated into 5 integrated results: the physical and mental experience of the caregiver, dilemmas and needs, caregivers′ coping style, social support in the care process, caregiver adaptation and growth.Conclusion:Medical staff should pay attention to the psychological state and potential needs of this group. In the process of transplantation, the caregiver should be self-regulated and better qualified as a caregiver.

Objective:To explore the application of folding transfer shelf in the transportation of critically ill patients.Methods:Patients transferred from the emergency department to the intensive care unit (ICU) admitted to the First Hospital of Jiaxing from January 1st to December 31st in 2019 were enrolled. The patients were divided into study group and control group by whether or not using the self-developed folding transfer shelf. The incidence of adverse events, the stability rate of vital signs and the transport time were compared between the two group.Results:A total of 437 patients were enrolled in the study, with 222 in the study group (which used the self-developed folding transfer shelf) and 215 in the control group (which used the conventional stretcher). The baseline data such as gender, age, disease status and disease severity were balanced between the two groups. The stability rate of vital signs in the study group was higher than that in the control group (89.19% vs. 82.33%, P < 0.05). The transfer time in the study group was shorter than that in the control group (minutes: 6.39±1.35 vs. 7.61±1.34, P < 0.01). The total incidence of adverse transport events in the study group was lower than that in the control group (2.25% vs. 10.23%, P < 0.01). The incidence of miscarriage of emergent materials and instrument falling in the study group were lower than those in the control group (0% vs. 2.79%, 0% vs. 2.33%, both P < 0.05). Conclusions:The folding transfer shelf could reduce the transport risk of critical ill patients, especially the risk of miscarriage and falling of rescue instrument. The application of folding transfer shelf could regulate the management of transport, keep the vital signs of patients stable during transport, shorten the transport time, and facilitate an efficient and high-quality transport.