Many methods have been established in developing artificial airway since the first time that tracheotomy was developed by Egyptians and Indians 3000 years ago.Artificial airway is currently widely applied in critical care medicine,and plays an important role in the rescue of critically ill patients.It aims to improve ventilation and correct anoxia,to disencumber airway obstruction,to clean away airway secretions effectively and protect airway from risk of aspiration.This paper discussed about the nursing of tracheotomy and phlegm sucking,phlegm sucking related problems such as hypoxia,trachea hemorrhage and atelectasis,and ways to clean away secretions on air pocket.The risks of ventilator associated pneumonia,airway humidification and the physical and psychological needs were also discussed.

Objective: To compare the efficacy and adverse reactions between gemcitabine + cisplatin regimen and fluorouracil + cisplatin regimen in the treatment of advanced nasopharyngeal carcinoma (NPC). Methods: The Cochrane Library,. MEDLINE, EMbase, CBM and CNKI were searched for related articles published before 2009. Manual searching and additional searching were also performed. The quality of each included studies was evaluated by 2 independent oncologists and analyses of homogeneous property of the studies were done by RevMan 5.0 software. Results: Four studies were enrolled in our study, including 283 patients with NPC. Meta-analyses showed that the 1-year- and 3-year-survival rates of gemcitabine + cisplatin regimen were similar to those of fluorouracil+cisplatin regimen (Z = 0.89, P = 0.37), (Z = 0.70, P = 0.09), but gemcitabine+ cisplatin regimen had significantly higher remission rate (Z = 2. 34, P = 0.02) and slighter myelosuppression and gastrointestinal reactions (Z = 2.47, P = 0.01), (Z = 3. 20, P = 0.001), (Z = 2.19, P = 0.03). Conclusion: Gemcitabine +cisplatin regimen has equivalent efficacy and slighter adverse effects compared with fluorouracil + cisplatin regimen in treatment of advanced nasopharyngeal carcinoma.

Abstract:Chronic hepatitis C (CHC) is a global health problem, which is prevalent all over the world. China is a low epidemic area. Hepatitis C virus (HCV) is mainly transmitted through blood, and nowadays, intravenous drug addicts are the key population for the prevention and treatment of hepatitis C. HCV has multiple genotypes and gene subtypes, and the distribution of these genotypes and gene subtypes varies significantly among the regions of the world. Nowadays, the treatment of hepatitis C has entered the era of direct-acting antiviral agents, which have high efficacy and safety in the general population. However, when special populations use direct-acting antiviral agents to treatment hepatitis C, we don't know how its efficacy and safety will be. The special populations include children, adolescents, drug users, HCV/HBV co-infected patients, HCV/HIV co-infected patients, and patients who have comorbidity of HCV and chronic kidney disease. This review will discuss the efficacy and safety of using direct-acting antiviral agents to treat hepatitis C in these special populations.

Objective To investigate the application value of virtual touch tissue quantification (VTQ) technique in staging of chronic kidney disease (CKD). Methods VTQ examination was performed on a random sample of 96 CKD patients at different clinical stages and 45 healthy volunteers (control group). Shear wave velocity (SWV) of renal parenchyma was measured and compared. Correlation between SWV and clinical stage and glomeru-lar filtration rate (GFR) of CKD patients was analyzed. Results The SWV value of renal parenchyma decreased gradually, along with the progression of CKD disease and impairment of renal function. There was no significant difference(P>0.05)between the control group and the CKD1 group ( P=0.061), the CKD2 group and the CKD3 group (P = 0.238), and the CKD4 group and the CKD5 group (P = 0.624). The difference of SWV between the remaining groups was statistically significant(P < 0.05). SWV of renal parenchyma was negatively correlated with CKD stage (r =-0.65, P < 0.001), which means the higher the stage of CKD was associated with the lower the SWV. SWV was positively correlated with GFR (r = 0.73, P < 0.001), which means the lower the GFR was related to the lower the SWV. Conclusion VTQ technique can noninvasively reflect the changes of renal parenchyma elas-ticity and evaluate the impairment of renal function in CKD patients. It can provide a new quantitative evaluation index for the clinical staging of CKD.

Objective To evaluate the effect of epigallocatechin gallate on radiation-induced lung injury in rats and to discuss the related mechanism. Methods Rat models of radiation-induced lung injury were produced by 6 MV X ray radiation, and then the animals were divided into model control group and low-, medium- and high-dose (200, 100, 50 mg/ [kg • d]) epigallocatechin gallate groups. The pulmonary histopathological changes and collagen disposition were observed by H-E staining and Van Gieson (VG) staining, and the scores of alveolitis and pulmonary fibrosis were calculated. The expression of tumor necrosis factor-α (TNFα) and transforming growth factor β ( TGFβ ) in lung tissues was examined by immunohistochemical (IHC) staining. The activity of superoxide dismutase (SOD) was examined by xanthine oxidase method. Results Apparent alveolitis and pulmonary fibrosis were observed in model rats at 40 d after radiation, and the scores of the alveolitis and pulmonary fibrosis were signficantly lower in medium- and high-dose epigallocatechin gallate groups than in the model control group (P<0. 01), and there was no difference between the low-dose epigallocatechin gallate group and the model control group. Pulmonary TNFα and TGFβ expression was significantly lower in the medium- andhigh-dose epigallocatechin gallate groups than in the model control group and low-dose epigallocatechin gallate groups at 10 d, 20 d, and 40 d after radiation (P<0. 01 or P<0.05), while SOD activity in the former two groups were significantly higher compared with those in the model control group and low-dose epigallocatechin gallate groups ( P < 0. 05). Conclusion Medium- and high-dose.

Objective:To explore the effect of fortified human milk feeding on growth and complica-tions of infants with extremely and very low birth weight (ELBW/VLBW)during hospital stay by a pro-spective,random and controlled study.Methods:In the study,1 22 ELBW/VLBW infants were enrolled and divided into two groups.The infants fed with human breast milk,combined with human milk fortifi-cation (HMF)during hospital stay were named HMF group (n=62),and those fed exclusively with pre-mature formula were named premature formula feeding group (PF group,n=60 ).The data of the in-fants’growth (the velocity of increase on the weight,length,head circumference and upper arm circum-ference),the time of rebounding to birth weight,the time of needing intravenous nutrition,the time of hospitalizing,the proportion of extrauterine growth retardation (EUGR)during hospital stay,the level of hemoglobin,bone metabolism and incidence of complications were compared between the two groups. Results:Among the 1 22 infants included,(1 )the length increment in HMF group was higher than PF group [(0.89 ±0.23)cm/week vs.(0.79 ±0.34)cm/week,P=0.04];there were no significant differences in the weight gain,head circumference increment and upper arm circumference increment (P>0.05);(2)the age of rebounding to birth weight [(1 0.1 3 ±4.03)d vs.(8.03 ±3.28)d,P=0.002]and the duration of intravenous nutrition [(1 6.77 ±6.63)d vs.(1 4.23 ±4.1 5)d,P=0.01 ] in HMF group were longer than that in PF group,there were no significant differences between the two groups in the hospital stay and age achieved feeding;(3 )there were no significant differences between the two groups in the incidence rate of EUGR during hospital stay (P>0.05);(4)the level of calcium at birth in HMF group was lower than that in PF group [(2.1 9 ±0.22)mmol/L vs.(2.32 ±0.27) mmol/L,P=0.005 ],and the level of alkaline phosphatase (AKP)in HMF group at discharge was higher than in PF group [(363.98 ±1 22.49)mmol/L vs.(299.73 ±1 1 7.39)mmol/L,P=0.004];(5)the incidence of the feeding intolerance (6.5% vs.1 8.3%,P=0.04)and sepsis (4.8% vs. 1 6.7%,P=0.03)in HMF group were less than in PF group,there were no significant differences be-tween the two groups on the morbidity of necrotizing enterocditis,retinopathy of prematurity (ROP),and bronchopulmonary dysplasia (BPD)(P>0.05).Conclusion:HMF for premature infants may ensure the same growth pattern as those fed by premature formula,promote the calcium absorption,decrease the inci-dence of sepsis and feeding intolerance,and does not increase the incidence of necrotizing enterocolitis.

Objective To investigate the value of urine L-type fatty acid-binding protein (uL-FABP) and uric neutrophil gelatinase-associated lipocalin (uNGAL), and predict the value of poor outcomes (injury progression,dialysis,or death within 7 days ) in critically ill patients with early acute kidney injury (AKI) at time of nephropathy consultation. Methods One hundred and twenty-five patients with evidence of the AKIN criteria stage1 AKI were enrolled in this study. At time of nephropathy consultation , urinary samples were collected. The levels of uL-FABP and uNGAL were measured. Each marker was assessed for its predictive value using an area under the receiver operator characteristic curves (ROC-AUC) to predict AKI prognosis. Results Twenty-eight patients developed poor outcome. It was 0.81 in ROC-AUC in uL-FABP , in,which it could be improved to 0.83 when combined with APACHEⅡscore (0.75 in ROC-AUC). The ROC-AUC of uNGAL was 0.66, in which it could not impove its predictive power significantly when combined with APACHEⅡscore. Conclusion Among critically ill patients with early AKI , uL-FABP provided an independent and prognostic power when combined with APACHEⅡscore and the level of uL-FABP at time of nephropathy consultation helps to predict clinical outcome in critically ill patients with early AKI.

Objective To evaluate the effect of human milk fortification on short‐term growth of premature infants in NICU and its clinical safety .Methods According to different formulas ,the premature infants were divided into preterm formula group ,human milk group and human milk fortification group (HMF group) .Its growth rate ,blood biochemistry ,adverse event rate and so on were compared .Results There were 147 cases meeting requirements .the weight growth velocity of preterm formula group ,human milk group and HMF group were (19 .44 ± 5 .14) ,(14 .53 ± 5 .86) ,(17 .09 ± 5 .81) g · kg -1 · d-1 respectively with statistical sig‐nificance (P<0 .01);the growth velocity of head circumference of preterm formula group (0 .72 ± 0 .34)cm/w and HMF group (0 .71 ± 0 .29) cm/w were significantly higher than that of human milk group (0 .51 ± 0 .34)cm/w (P<0 .01);the time of regaining or overtopping birth weight of preterm formula group (8 .55 ± 3 .20)d and HMF group (9 .43 ± 4 .53)d was significantly shorter than that of human milk group (10 .93 ± 3 .02)d(P<0 .01);the EUGR occurrence rate of head circumference of preterm formula group and HMF group were significantly lower than that of human milk group(P<0 .01) .The feeding intolerance rate of preterm formula group (15 .52% ) was significantly higher than that of human milk group (2 .13% ) (P<0 .05);there were no significant difference in incidence rate of infection event in each group(P>0 .05) .Conclusion Human milk fortification can control the inci‐dence rate of infection event and feeding intolerance to increase growth velocity of weight and head circumference of premature in‐fants during hospital stay .

ObjectiveTo determine the source of IL-6 in detached retina and the change of IL-6 level in detached and reattached retina.MethodsRetinas of SD rat were examined after subretinal injection of 1.4% Healon GV at different period of time, and the level of IL-6 in detached and reattached retina were detected by radio-immune histochemistry method. Wax-embeded sections were labeled with IL-6 antibody to determine the location of IL-6.ResultsDetached retina with normal vitreous and inner limiting membrane could only induce the subretinal fibrosis. This kind of fibrosis reached to its peak at 10th day and then remolded with time. Retinal pigment epithelial (RPE) cell, Muller cell, endothelial cell, glial cell were labled with IL-6, and the level of IL-6 in neuro-retina reached to its peak at 3rd-4th day and then downed to normal within a few days. The level of IL-6 in reattached retina was lower than in detached retina. The expression of IL-6 in RPE of detached area was stronger than in attached area.ConclusionIL-6 takes active part in wound healing process induced by the separation of RPE and neuro-retina. Reattachment can lower the expression of IL-6 in retina.

ObjectiveTo investigate the expression of integrin β1 during retinal detachment and reattachment of rabbits.Methods24 rabbits were used to make retinal detachment and reattachment model by using hyaluronidase and micropipette. The expression of integrin β1 were observed with hybridization in situ.ResultsThe expression of integrin β1 in reattached retina was lower than that in detached retina.ConclusionRetinal reattachment may inhibit the development of proliferative vireoretinopathy.