Objective By studying the expressions of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in rats′ cardiac muscle after acute myocardial infarction, we try to find out the relation between the expression of these two factors and the formation of new blood vessels under ischemia. Methods Wistar rats were divided into control group and infarction group (3, 7, 14, 28, 42, 56 d). The expression of VEGF and bFGF in cardiac muscle and endothelial cells is detected by means of immunohisto-chemial staining while the density of newly formed ressels is detected by marking the endothelial cells with antigens associated with factor Ⅷ. Results After ligating the left anterior descending coronary artery of the rats, the expression of VEGF and bFGF increased along with the prolongation of myocardial ischemia and reached the peak on the 7th day. The expression of the 2 factors began to decrease on the 28th day and the most significant decrease happened on the 42th and 56th day. The density of the newly formed capillaries is directly propontimal to the levels of the 2 factors. Less expression of VEGF and bFGF was observed in the control group. Conclusion The up-regulation of VEGF and bFGF expression might play important roles in neovascularization. Dicrectly intramyocardial injection of bFGF and VEGF gene at the time when the expression of bFGF and VEGF began to decrease maybe optimal.

Objective To observe the effects of dexmedetomidine and ketamine on breast lumpectomy in women patients .Meth‐ods Thirty women who underwent breast lumpectomy were randomly allocated into two groups (n=15) .Group A received mid‐azolam 2 .0 mg ,fentanyl 0 .1 mg and ketamine 2 .0 mg/kg ,everyone required supplementary propofol 5 .0 mg?kg -1 ?h-1 .In group B ,dexmedetomidine 0 .5 μg/kg was administered as a loading dose during 10 minutes followed by a continuous infusion of 0 .2μg?kg -1 ?h-1 ,Ketamine 2 .0 mg/kg was administered along with the dexmedetomidine loading dose .The recovery time ,the VAS and Ramsay at the end of the first hour of postoperation were recorded along with side effects .Meanwhile ,hemodynamic parameters , like heart rate(HR) ,mean blood pressure (MAP) and SPO2 were also monitored .Results Compared with group A ,the HR and MAP were significantly lower(P<0 .05) ,and no significant changes in SPO2 were noted (P>0 .05) in group B;there was no sig‐nificant difference in VAS and Ramsay scores among two groups ,the recovery time was shorter in group B(P<0 .05) .However ,the incidence of respiratory arrest and glossocoma were greatly higher in group A(P<0 .05) .Conclusion Dexmedetomidine and ket‐amine can offer an effective sedoanalgesia and lower hemodynamic discrepancy without causing any significant side effect on breast lumpectomy in women patients .

Cyclic diguanylate (c-di-GMP) is a bacterial second messenger of growing recognition involved in the regulation of a number of complex physiological processes. In combinations to the related progress of Xanthomonas oryzae pv. oryzae, the causing agent of bacterial blight of rice in our lab, this review describes (1) the biosynthesis and hydrolysis of c-di-GMP and several mechanisms of regulation of c-di-GMP metabo-lism, (2) the contribution of c-di-GMP to regulating virulence, motility and biofilm formation, processes that affect pathogenesis of many bacteria, and (3) ways in which c-di-GMP may mediate these regulatory effects.

Objective To investigate the relationship between satisfaction of nursing service and nurses' personality and mental state.Methods 368 nurses ,288 patients and 234 dependents involved the investigation.Minnesota Multiphasic Personality Inventory(MMPI)was used to analyze nurses' personality.Symptom Checklist-90(SCL-90),Self-rating Depression Scale(SDS) and Self-rating Anxiety Scale(SAS)were used to analyze nurses' mental states.A self-made questionnaire on satisfaction was used to investigate the satisfaction degree of patients and dependents with nursing service.The data were analyzed by descriptive statistics and multiple regression analysis.Results The average score on satisfaction with the nurses' service was(8.29±0.98)and the average score on satisfaction with nurses' attitude was(8.19±1.21).The satisfaction with nurses' service was negatively correlated with the MMPI factors of manifest anxiety and dependency and positively with dominance of MMPI(both P<0.05).Satisfaction with nurses' attitude was negatively correlated with total score of SAS,dependency of MMPI,compulsion,anxiety,hostility and paranoid ideation of SCL-90(all P<0.05).Satisfaction with the service attitude was positively correlated with social responsibility of MMPI(P<0.05). Conclusion Satisfaction degree of patients and their dependents is related to nurses' personality and mental states.It's helpful to establish good relationship between nurses and patients and improve the clinical nursing service to perfect nurse's personality and relieve psychological stress on nurses.

Objective To summarize and analyze data of solid pseudopapillary tumor of pancreas (SPTP) in China,and investigate its epidemiology,clinical features,diagnosis and treatment.Methods Retrieval of Chinese Medical Current Contents and China Biology Medicine disc by the key words of solid pseudopapillary tumor of the pancreas,papillary cystic tumor of the pancreas,pancreatic papillary epithelial tumor,cystic solid tumor of pancreas and Frantz tumor were performed,and relevant literatures were included.Results A total of 1180 SPTP patients from 117 articles were involved.There were 1054 women and 126 men and the ratio of male to female was 1:8.37.The average age was 29 years old (range 9 ～83 years).Detailed clinical information was available for 1172 cases,and the main clinical manifestations included abdominal discomfort (n=526,44.88％),medical check-up (n=464,39.59％),abdominal mass (n=131,11.18％).Laboratory and imaging tests were non-specific.The tumors size was 1.3～ 30 cm with a mean value of 7.84 cm.Four handreds and seven (36.8％) cases were located in pancreatic head,96 (8.7％)were in pancreas neck and 587 (53.1％) were in the body and tail of pancreas.Eleven handreds and sixteen patients received treatment,and the resection rate was 99.2％ (n =1107).Pathological examination showed that 628(57.0％) cases were benign and 306 (27.8％) were presented as malignant behavior,mainly as infiltrative growth and invasion of the surrounding organs,vessels.Nine handreds and seventy-seven cases were followed up (ranging from 1 month to 13 years),and re-occurrence or metastasis were detected in 42 cases (4.3％) and 24 patients died.Conclusions Solid pseudopapillary tumor of pancreas is a rare pancreatic tumor with low-grade malignant potential,and part of this tumor may present as malignant behavior and it primarily affects young females.No characteristics in clinical manifestations,laboratory and imaging tests are found.Pathological examination can confirm the diagnosis.Surgical resection is the therapy of choice and the prognosis is good.

Objective To evaluate the effectiveness of treating depressive patients with somatic symptoms with combined TCM and western medicine.Methods 69 patients were randomly divided into 2 groups:a combined therapy group (treated with Yangyin-Qinggan decoction and paroxetine) and mono-therapy (treated with paroxetine alone as an active control),The depressive and somatic symptoms were assessed before (0 week),during (2 weeks and 4 weeks) and at the end point (8 weeks) of the treatment.Results ①Both therapies alleviated the depressive symptoms:HAMD assessed among patients receiving combined therapy are listed as:(0 week:19.29±2.38),(2 weeks:17.38 ± 2.37),(4 weeks:15.27 ± 2.15),(8 weeks:13.35 ± 2.09) ;combined therapy started to ease the depressive symptoms after 2 weeks of treatment (2 week compared with 0weeks),similar improvements could also be noticed after 4 weeks of treatment 4 weeks with 2 weeks:P＜0.05)and at the end of this research (after 8 weeks of treatment:8 weeks with 4 weeks:P＜0.05).HAMD for mono-therapy are as:(0 week:18.69±3.03),(2 weeks:16.63±3.09),(4 weeks:15.20±2.95),(8 weeks:14.60±2.72) ; mono-therapy started to alleviate the depressive symptoms also,after 2 weeks of treatment (2 weeks compared with 0 week:P＜0.05),yet only slight improvements could be seen after 4 weeks (4 weeks with 2 weeks:P＞0.05) and 8 weeks of the treatment (8 weeks with 4 weeks:P＞0.05).The combined therapy turned to be more effective in alleviating depressive symptoms at the end point of the treatment (P＜0.05).②In terms of improving the somatic symptoms,the Somatization Symptom Scale (SSS) among patients with combined therapy were as follows:(0 week:48.74±4.07),(2 weeks:46.74±4.16),(4 weeks:43.74±3.77),(8 weeks:41.18 ± 3.50) ; Combined therapy was witnessed to start to ease those symptoms after 2 weeks o f treatment (2week compared with 0 weeks,P＜0.05),similar patterns were found again,after 4 weeks (4 weeks with 2 weeks:P＜0.05) and 8 weeks of the treatment (8 weeks with 4 weeks:P＜0.05).Mono-therapy was found to ease the somatic symptoms in a less-effective way,yet no difference was found between any two SSS after 2 weeks,4weeks or 8 weeks of treatment (P＞0.05,respectively).Combined therapy was better at improving the somatic symptoms (P＜ 0.01).Conclusion Combined therapy proved to be more effective in both relieving depression and somatic symptoms.

Objective To observe the expression of pannexin1(PX1) in the dorsal horn of spinal cord in model ratwith neu-ropathipain afteselective ligation of sciatinerve branche.Method50 male SD ratwere randomly divided into 3 group,inclu-ding the control group(Wgroup ,n= 10) ,sham operation group(sham group ,n= 10) and sciatinerve branch selective injury group(SNI group ,n=30) .30 ratwere killed on postoperative 3 ,5 ,7 ,14 d and the lumbasegmenof the spinal cord wataken fodetecting the expression of PX1 by using Western blo.Othe20 ratwere killed on 7 d afteSNI and the expression of glial fibril-lary acidiprotein(GFAP) in the spinal cord wadetected with immunohistology .Among them ,10 ratin the SNI group were trea-ted with intrathecal intubation before operation and administrated with saline 20 μL ocarbenoxolone(CBX) 20 μL by intrathecal injection on postoperative 7 d fodetermining the expression of GFAP by the immunohistology .ResultThe expression of PX1 in the SNI group waincreased and enhanced with time ,which wasignificantly highethan thain the Wgroup and the sham group (P＜0 .05);the GFAP expression on 7 d in the SNI group waobviously increased compared with the Wgroup and the sham group(P＜0 .05);afteintrathecal injection of CBX ,the expression of GFAP wasignificantly decreased compared with thain the normal saline group(P＜0 .05) .No statistically significandifferencein the expression of PX1 and GFAP were found in the Wgroup and the sham group .Conclusion PX1 may be involved in the activation of astrocyte,prompting thaPX1 playan importanrole in the neuropathipain caused by the peripheral nervel injury .

Objecfive To investigate the change of V-ATPase B subunits on epithelial to mesenchymal transition (EMT)in rat renal tubular epithelial cells (NRK52E) stimulated by transforming growth factor β1 (TGF-β1). Methods NRK52E cells were stimulated by TGF-β1 (10 μg/L)for O h(control),12 h,24 h,48 h,72 h after sefrum-free culture for 24 h.The mRNA and protein expression of E-cadherin,α-SMA,B2 and B1 subunits of V-ATPase were detected by real-time PCR,Western blotting and immunofluorescence. Results After stimulated by TGF-β1 (10 μg/L)for 48 h,the expression of α-SMA was markedly increased(P<0.05),but the expression of E-cadherin was dramatically decreased(P<0.05).Meanwhile,the expressions of V-ATPase subunit B2 was significantly increased (P<0.05).However,the B1 subunit distributed rarely in NRK 52E cells,and did not increase after TGF-β1 stimulation.Double-label immunofluoerscence staining also showed that the V-ATPase B2 subunit was increased in the cytosol.tending to accumulate to the cell membrane after TGF-β1 stimulation. Conclusions The main isoform of V-ATPase distributed in NRK52E cells is B2 subunit.B2 subunit is increased alone with TGF-β1-induced EMT.It may suggest that V-ATPase B2 subunit may play a potential role in TGF-β1-induced tubular EMT and renal fibrosis.

Objective To evaluate the serum trough concentration and the pharmacokinetics/pharmacodynamics (PK/PD)of vancomycin in patients with severe acute pancreatitis (SAP), and analyze the effect of vancomycin continuous infusion for optimizing the characteristics of its PK/PD.Methods The inhospital patients with SAP received vancomycin treatment and admitted to emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to December 2016 were enrolled. Steady-state trough concentrations of vancomycin from patients were collected retrospectively. The SAP patients were divided into augmented renal clearance (ARC) and non-ARC groups, as well as systemic inflammatory response syndrome (SIRS) and non-SIRS groups according to the patients with or without symptom above. Adjustments of increased dosage or 24-hour continuous infusion or increase vancomycin dose were made for patients if the steady-state trough concentrations fell below the target level. Steady state trough concentration for vancomycin intermittent infusion or steady state concentration for vancomycin continuous infusion was determined by the fluorescence polarization immunoassay method. PK parameters of vancomycin were calculated using the Bayesian estimator and the area under the serum drug concentration-time curve (AUCc-t), the minimum inhibitory concentration (MIC) and AUCc-t/MIC was recorded and calculated.Results The steady state trough concentration or steady state concentration from 61 patients with SAP were collected with mean steady state trough concentration of vancomycin of (7.7±4.4) mg/L, which was significantly lower than standard concentration (15 mg/L,P < 0.001). Apparent volume of distribution (Vd) and clearance of vancomycin was (1.06±0.26) L/kg and (8.9±2.8) L/h. The serum steady state trough concentration of vancomycin in ARC group (n = 33) was significantly lower than that in non-ARC group (n = 28; mg/L: 6.7±3.5 vs. 8.2±4.1, P < 0.01), clearance was significantly increased (L/h: 9.8±2.9 vs. 7.7±2.2,P < 0.01). Compared with non-SIRS group (n = 31), the serum steady state trough concentration of vancomycin in SIRS group (n= 30) was significantly lowered (mg/L: 6.1±3.2 vs. 13.0±4.2,P < 0.01), and clearance was significantly increased (L/h: 9.4±2.0 vs. 7.1±2.1,P < 0.05). Compared with the only increasing vancomycin dose group (n = 29), vancomycin continuous infusion for 24 hours (n = 21) could significantly reduce daily dosage (mg/kg: 13.6±3.9 vs. 19.1±3.5,P < 0.01), increase the serum trough concentration (mg/L: 18.1±7.0 vs. 12.6±5.3,P < 0.01), and improve the AUCc-t/MIC.Conclusions The serum trough concentration of vancomycin was significantly reduced in SAP patients with ARC. The more serious of the SIRS is, the lower the vancomycin trough concentration is. Vancomycin 24-hour continuous infusion could optimize the PK/PD parameters, decrease the daily dose, increase the clinical effect, and reduce the bacterial resistance.

Objective To observe the change of the serum trough concentration and its pharmacokinetics of vancomycin in patients with severe acute pancreatitis (SAP), and to analyze the factors influencing vancomycin concentration. Methods A retrospective analysis was conducted. Steady-state trough concentrations of vancomycin from patients (18-80 years old) with SAP concomitantly with G+ infection admitted to Intensive Care Unit (ICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2010 to December 2016 were enrolled. According to the usage time of vancomycin, the patients with SAP were divided into early group (onset within 21 days), middle group (onset between 21-28 days) and late group (onset over 28 days). The gender, age, body weight, clinical diagnosis, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ ) score, renal function, and the pharmacokinetic parameters were recorded. Influencing factors of vancomycin was analyzed by multiple linear regression and stepwise regression. Results Fifty-eight patients were enrolled who contained 134 times trough concentrations of vancomycin. There were 41 patients enrolled and 61 times of trough concentrations in the early group, 24 patients enrolled and 33 times of trough concentrations in the middle group, and 28 patients enrolled and 40 times of trough concentrations in the late group. There was no significant difference in gender, age, body weight, serum creatinine, creatinine clearance (CCr), albumin, APACHE Ⅱ score among the three groups. There was significantly difference in the duration from the onset time to vancomycin administration between early, middle groups and late group (days:15.9±3.2, 23.3±2.2 vs. 35.0±6.7, both P < 0.05). The positive liquid balance in early group was lower than that of late group (mL: 1565.2±3132.1 vs. 3675.1±3411.5, P < 0.01), while it was increased in the middle group as compared with that of late group (mL: 5078.7±3892.4 vs. 3675.1±3411.5, P < 0.05). The average daily dose of vancomycin in the early, middle and late groups were (14.7±5.0), (15.0±2.8), (17.0±4.2) mg/kg, respectively, and there was no significant difference (P > 0.05). Compared with the standard concentration (15 mg/L) of vancomycin, the serum trough concentration of vancomycin was significantly reduced in SAP patients [(7.5±4.3) mg/L, P < 0.01]. Apparent volume of distribution (Vd) was (72.4±15.4) L, and clearance rate (CL) was (9.0±2.8) L/h. According to the Bayesian, the serum trough concentration of vancomycin was significantly reduced in early group and middle group compared with late group (mg/L: 5.0±2.1, 7.3±2.5 vs. 11.5±5.1, both P < 0.01), CL was significantly increased (L/h: 10.5±3.0, 8.1±1.9 vs. 7.4±1.9, both P < 0.05), and Vd was significantly increased in early group compared with late group (L: 73.7±15.5 vs. 71.0±12.6, P < 0.05). It was shown by multiple linear regression analysis that there was strong relationship between serum trough concentration and the serum creatinine, CCr, average daily dose and the starting time of vancomycin treatment (r value were 0.449, -0.318, 0.373, 0.763, respectively, all P < 0.05). Conclusions The serum trough concentration of vancomycin was significantly reduced in SAP patients. And the earlier usage of vancomycin, the lower of the trough concentration is. Therefore, higher dosage regimen was needed to ensure the clinical effect, and reduce the bacterial resistance.