Objective:To evaluate the efficacy and safety of micronised fenofibrate on lipid and uric acid metabolism in patients with hyperlipidemia.Methods: A total of 116 patients with hypertriglyceridemia and hyperuricemia received 200 mg micronised fenofibrate for 4 weeks.Physical and laboratory investigations of lipid profiles,serum uric acid,and 24 h urine uric acid,for adverse effects were assessed.Results:(1) Serum triglyceride(TG) was significantly reduced by 51%,whilst high density lipoprotein cholesterol(HDL-C) increased 24% after 4-week fenofibrate treatment.Moreover,serum total cholesterol(TC) and low density lipoprotein cholesterol(LDL-C) were reduced by 10% and 12%,respectively.(2) Serum uric acid levels were significantly reduced by 28.3% [from(462.8?73.5) ?mol/L to(320.1?83.0) ?mol/L] after fenofibrate treatment,independent of baseline uric acid le-vels.There was no difference in serum uric acid changes between male gender and female gender(29.8% and 25.1%,respectively).(3) Urine uric acid levels were increased by 36.0% [from(2 874.2?503.4) ?mol/L to(3 604.2?769.7) ?mol/L].The urine uric acid changes were 41.1% in male gender group and 33.4% in female gender group.The uric acid clearance/creatinin clearance ratio was increased in all cases after treatment.Conclusion: Micronised fenofibrate treatment could significantly improve lipid and uric acid metabolism in patients with hypertriglyceridemia and hyperuricemia,and is ge-nerally safe and well tolerated.The anti-hyperuricemic effect of fenofibrate is a result of increasing the urinary excertion of uric acid,independent of baseline level and gender.

Objective To study the effects of esmolol on fluid responsiveness and hemodynamic parameters in patients with septic shock.Methods A prospective self-control study was conducted.Fifteen septic shock patients undergoing mechanical ventilation admitted to Department of Critical Care Medicine of Yijishan Hospital from January 2015 to August 2015 were enrolled.All patients enrolled in this study were given the treatment based on American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus 2012.Esmolol was intravenously injected at a beginning rate of 6 mg·kg-1·h-1, and then the dose was adjusted to reduce heart rate by 10％ from baseline.The changes in hemodynamic and systemic oxygen metabolism indexes were monitored by pulse indicator continuous cardiac output (PiCCO) before and 2 hours after the esmolol administration, and the fluid responsiveness was evaluated by stroke volume variation (SVV).SVV ≥ 10％ was considered to be a positive fluid responsiveness.Results In 15 patients, 9 were male and 6 female, with an age of 65 ± 16.Among them 10 patients suffered from pulmonary infection, and 5 patients with abdominal infection.Acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ±9;sequential organ failure score (SOFA) was 8 ±4.28-day mortality was 40.0％.SVV was significantly decreased after esmolol infusion as compared with baseline [(14 ± 5)％ vs.(17 ±7)％, t =2.400, P =0.031].Heart rate [HR (bpm): 100±4 vs.112±8, t =8.161, P =0.000], cardiac output [CO (L/min):6.13 ± 1.45 vs.7.88 ± 1.82, t =4.046, P =0.001], cardiac index [CI (mL·s-1·m-2): 51.51 ± 11.00 vs.66.18 ± 11.48, t =4.131, P =0.001], stroke volume index [SVI (mL/m2): 31.0 ± 6.4 vs.35.4 ± 6.5, t =2.577, P =0.020], the maximum rate of left ventricular pressure rise [dp/dt max (mmHg/s): 927±231 vs.1 194±294, t =3.775, P =0.002], global ejection fraction (GEF: 0.21 ±0.05 vs.0.24±0.06, t =3.091, P =0.008), cardiac function index (CFI: 5.03 ± 1.37 vs.6.59 ± 1.92, t =4.769, P =0.000) showed significant decrease during esmolol infusion.On the other hand, central venous pressure [CVP (mmHg, 1 mmHg =0.133 kPa): 9±3 vs.8±3, t =-3.617, P =0.003], diastolic blood pressure (DBP, mmHg: 69± 15 vs.66± 13, t =-2.656, P =0.019), systemic vascular resistance index (SVRI, kPa·s·L-1·m-2:206.8±69.8 vs.206.8±69.8, t =-3.255, P =0.006) were significantly increased during esmolol infusion.No significant difference was found in systolic blood pressure [SBP (mmHg): 120 ± 25 vs.123 ± 18, t =0.678, P =0.509],mean arterial pressure [MAP (mmHg): 86 ± 18 vs.85 ± 14, t =-0.693, P =0.500], global end diastolic volume index [GEDVI (mL/m2): 614 ± 84 vs.618 ± 64, t =0.218, P =0.830], extravascular lung water index [EVLWI (mL/kg):5.99±1.50 vs.5.73±1.14, t =-1.329, P =0.205], central venous oxygen saturation (ScvO2: 0.711±0.035 vs.0.704 ± 0.048, t =-0.298, P =0.773), arterial blood lactate [Lac (mmol/L): 3.1± 0.3 vs.3.0 ± 0.4, t =-0.997, P =0.345],and difference of central venous-arterial carbon dioxide partial pressure [Pcv-aCO2 (mmHg): 4.1 ± 0.9 vs.4.7 ± 0.5,t =1.445, P =0.182] as compared with those before esmolol treatment.Conclusion Heart rate control with esmolol infusion may reduce fluid responsiveness, cardiac function, heart rate and cardiac output without adverse effect on systemic perfusion in septic shock patients.

Objective To evaluate the effect of cell-penetrating peptide (protein transduction domain 4,PTD4) mediated copper-zinc superoxide dismutase (Cu/Zn SOD) on hypoxia/reoxygenation injury (HRI) in rat myocardial cells.Methods Rat myocardial cell H9C2 HRI model was prepared by using the anaerobic incubator (85% N2,10% H2,5% CO2).The HRI group (without adding any treating factor in HRI cell culture fluid),HRI+Cu/Zn SOD group (adding 10 μmol/L Cu/Zn SOD) and HRI+PTD4-Cu/Zn SOD group (10 μmol/L PTD4-Cu/Zn SOD) were set up.In addition,normally cultured myocardial cells served as the normal control group.After incubating for 30 min,the ultra microstructure of mitochondria was observed under transmission electron microscope.The mitochondrial membrane potential was detected by JC-1 kit.The myocardial cell apoptosis was detected by TdT mediated dUTP nick end labeling TUNEL technique.Results The mitochondria injury degree after 30 min incubation in the PTD4-Cu/Zn SOD group was significantly improved compared with the HRI group.Compared with the normal control group,the mitochondrial membrane potential in the HRI group was significantly decreased,while the mitochondrial membrane potential in the PTD4-Cu/Zn SOD group was lower than that in the normal control group,but compared with the HRI group,which was obviously recovered.The cardiomyocyte apoptosis in the HRI+PTD4-Cu/Zn SOD group was (10.20±2.77)%,which was significantly decreased compared with (28.40±2.41)% in the HRI group,the difference was statistically significant (P<0.05).Conclusion PTD4 mediated Cu/Zn SOD can attenuate HRI in rat myocardial cells.

Objective: To investigate the current situation and influencing factors of knowledge, attitude and practice (KAP) of fall prevention among the elderly in Huzhou City, Zhejiang Province, so as to provide the evidence for the development of fall intervention for the elderly. Methods: The permanent residents aged 60 years and over in Huzhou City were selected using multi-stratified cluster sampling method from March to April 2023. Demographic information, activity of daily living (ADL), fall risk, and KAP of fall prevention was collected using questionnaire surveys. Factors affecting KAP of fall prevention were identified using a multivariable logistic regression model. Results: Totally 2 160 questionnaires were allocated, and 2 104 valid questionnaires were recovered, with an effective recovery rate of 97.41%. There were 1 063 males (50.52%) and 1 041 females (49.48%), and 861 residents aged 60 to <70 years (40.92%). The awareness of fall prevention knowledge was 84.13%, the percentage of attitude towards fall prevention was 85.88%, and the percentage of practice of fall prevention was 14.59%. Multivariable logistic regression analysis showed that age, educational level, exercise duration and fall risk were associated with the awareness of fall prevention knowledge; age, educational level, marital status, exercise duration, ADL and fall risk were associated with the attitude towards fall prevention; gender, age, educational level, marital status, exercise duration, chronic diseases, ADL and fall risk were associated with the practice of fall prevention (all P<0.05). The desired access to fall prevention knowledge was mainly dominated by medical personnel, accounting for 75.51% (589/780). Conclusions The practice towards fall prevention among the elderly is relatively low in Huzhou City. The KAP of fall prevention is related to age, educational level, exercise duration and fall risk.

Objective To investigate the factors influencing basic rehabilitation service needs of people with disability at Zhabei District in Shanghai .Methods Primary rehabilitation demands and services of 10 311 disabled persons in Zhabei District were surveyed.Results The screening rate of persons with disability having primary rehabilitation demands was 83.5%. And the gender, age, type of disability, disability level, education, employment might be the factors affecting the primary rehabilitation demands of people with disability.Conclusion The primary rehabilitation service demands vary in deferent types of people with disability. The various services based on the extensive rehabilitation services should be provided to deferent categories of people with disability.

Objective To understand the status of special rehabilitation service demands of people with disability at Zhabei District in Shanghai and to provide the basis for the policy development.Methods Screen rate (SR) was used to indicate the level of demand of rehabilitation service, the data were analyzed with SPSS 13.0 statistical software.Results There were 4 349 persons with disability who demanded the special rehabilitation service; the SR of “on-site rehabilitation service” demands was the highest among the whole persons with disability; the SR of “personalized allotment of supplies and appliances” demands of the intellectual disability and mental disability was lower than the other types; the SR of special rehabilitation service demands of the female, the elderly, the low cultural level, the unemployed and the people with severe disability were relatively higher.Conclusion The form of “on-site rehabilitation services” needs to improve based on the demand of the disabilities; “personalized supplies and appliances” for the intellectual disability and mental disability needs to further develop; the rehabilitation services targeted to the female, the elderly, the low cultural level, the unemployed and the people with severe disability need to improve.

Objective To provide the advice on how to optimize the allocation of resources and make other policy through the analysis factors affecting rehabilitation services needs of people with disability at Zhabei district in Shanghai.Methods The factors affecting rehabilitation services needs such as types of disability, disability levels, education, employment, marital status, age and sex were analyzed with Logistic analysis.Results The factors affecting primary rehabilitation services were types of disability, education, employment situation, marital status and sex. And people with disability had the characters of female, hearing disability, retired returned to more primary rehabilitation services, with OR values being 1.219, 1.544 and 1.533 respectively compared with itself controls. And the high educational disable people' will, returning to primary rehabilitation services, was weaker compared with low educational disable people. The factors affecting special rehabilitation services were types of disability and employment situation. And people with disability had the characters of hearing disability, unemployment returned to more special rehabilitation services, with OR values being 2.380 and 1.310 respectively compared with itself controls.Conclusion The rehabilitation needs are different among different groups people with disability, so the factors affecting rehabilitation services needs such as types of disability, education, employment situation, marital status and sex should be taken into consideration while activating primary rehabilitation services, while the types of disability and employment situation should be taken into more consideration while activating special rehabilitation services.

Objective To investigate the potential role of soluble triggering receptor expressed on ayeloid cells-1(sTREM-1) expression in serum,endotracheal aspiration (ETA),bronchoalveolar lavage fluid (BALF) and exhaled breath condensate (EBC) as early biomarkers for the diagnosis of ventilator-associated pneumonia (VAP) in patients with acute ischemic stroke.Methods One hundred and thirty-two patients with clinically suspected VAP were prospectively included in this multicenter study.The levels of sTREM-1 in serum,ETA,BALF and EBC were analyzed for diagnostic evaluation at the time of VAP clinically suspected.The bacterial count over 104/CFU as a gold standard for VAP,and the receiver operating characteristic curves were used to identify the ideal cutoff values.Results VAP was confirmed in 76 patients (57.58％).In VAP patients (VAP group) and non-VAP patients (non-VAP group),the level of sTREM-1 in BALF was 32.35 (30.08-41.72) and 18.92(11.89-31.72) ng/L,and the level of sTREM-1 in EBC was 1.57 (1.02-2.61) and 0.41(0.19-1.61)ng/L respectively.The level of sTREM-1 in BALF and in EBC in VAP group was significantly higher than that in non-VAP group (P ＜0.05).The optimum cutoff value for sTREM-1 in BALF according to the maximum Youden index was 23.61 ng/L.This cutoff value had 85.5％ sensitivity and 73.1％ specificity,with 0.813 area under the curve.sTREM-1 in BALF had excellent correlation with that in EBC (R2 =0.78,P ＜ 0.05).Conclusions The results of this prospective study suggest that sTREM-1 levels in BALF and EBC have better roles in facilitating the diagnosis of VAP and thus may be practically recommended to guide the administration of antibiotics when VAP is suspected.

AIM:Toinvestigatetheeffectofnicotinicacidamide(NAA)ontheinfusiondamageofhuman umbilical cord mesenchymal stem cells ( hUC-MSCs) under the condition of instant blood-mediated inflammatory reaction ( IBMIR) .METHODS:Normal peripheral blood without anticoagulant at volume of 2.7 mL was mixed with 0.3 mL phys-iological saline (as blank group), CFSE labeled hUC-MSCs (1 ×106 cells in 0.3 mL as MSC group) and CFSE labeled hUC-MSCs (1 ×106 cells in 0.3 mL) preprocessed with NAA at concentration of 10 mmol/L for 24 h ( as MSC+NAA group) , respectively.The mixture was immediately injected into the improved Chandler Loop model, placed in 37℃water bath, and then started the peristaltic pump at the speed of 20 mL/min for 1 h.The number of CFSE labeled hUC-MSCs, platelets, white blood cells were counted and the concentration of complement C3a was measured before and after cycling, respectively.RESULTS: After 1 h circulation, the platelet dissipation rate were ( 29.96 ±10.88 )% in blank group, (77.76 ±19.29)% in MSC group all and (50.13 ±18.10)% in MSC +NAA group; and the leukocyte counts were (37.82 ±13.81)%in blank group, (64.57 ±17.08)% in MSC group and (41.52 ±17.26)% in MSC+NAA group. Compared with blank group, the differences of the dissipation rates in MSC group and MSC+NAA group all had statistical significance.The hUC-MSCs relative survival rate in MSC+NAA group was higher than that in MSC group.C3a concentra-tions in blank group, MSC group and MSC+NAA group were (206.27 ±58.10), (230.47 ±39.61) and (208.37 ± 40.66) μg/L, respectively.CONCLUSION:Co-circulating the mixture of hUC-MSCs with normal peripheral blood with-out anticoagulant in the improved Chandler Loop for 1 h depletes a large number of hUC-MSCs and blood components, and increases C3a, suggesting that this model can induce IBMIR.NAA has a protective effect on the hUC-MSCs in the infusion damage by inhibiting IBMIR, reducing the wastage of the blood components and enhancing the survival rate of the hUC-MSCs.

Objective To investigate the respiratory burst function of neutrophils in very low birth weight infants (VLBWI).Methods Twenty two VLBWI was divided into two groups:neonatal respiratory distress syndrome (NRDS) and non NRDS (11 in each).The respiratory burst function of neutrophils in the peripheral blood of VLBWI within 48 hours after birth was determined using the flow cytometrydihydrorhodamine 1,2,3 method before and after the chemical stimulation of phorbol-12-myrismte 14 acetate (PMA),and the gp91Phox was also measured in resting neutrophils by flow cytometry.Twenty healthy term neonates served as controls.Mann-Whitney U test was used for statistical analysis.Results Before the stimulation of PMA,the percentage of activated neutrophils of VLBWI [(49.10±20.19) ％] producing a respiratory burst was higher than that of term neonates [(18.73 ±6.81) ％] (Z--4.911,P=0.000),however,after the stimulation of PMA,the percentage of activated neutrophils of VLBWI [(96.58 ± 3.44) ％] was lower than that of term neonates [(99.20±0.62) ％] (Z--3.186,P=0.001),and the stimulation index (SI) of VLBWI (171.40 ± 103.35) was lower than that of term neonates (306.30 ± 138.47),with significant difference (Z=-3.413,P=0.001).The geometric mean of gp91Phox in VLBWI (21.66± 19.87) was higher compared with term neonates (19.60±8.03),however,the difference was not significant (P=0.350).The percentage of neutrophils that expressed gp91Phox [(56.11 ± 29.40) ％] was lower in VLBWI than that in term neonates [(80.14± 14.87) ％],with significant difference (Z=-2.374,P=0.018).Before the stimulation of PMA,the percentage of activated neutrophils of VLBWI with NRDS (63.40± 16.45) ％] was higher than that of VLBWI without NRDS [(34.80± 11.65) ％],with significant difference (Z=-3.382,P=0.001),the SI of VLBWI with NRDS (129.46 ± 75.36) was significantly lower than that of VLBWI without NRDS (213.35 ± 113.49) (Z=-2.331,P=0.020).Conclusions Neutrophils producing a respiratory burst in both VLBWI and term neonates are active without stimulation of PMA,while the phenomenon is more obvious in VLBWI.Neutrophils in VLBWI and term infants can be activated by the stimulation of PMA,and express gp91Phox.The activation and gp91Phox expression of neutrophils in VLBWI with NRDS tend to be lower than those in VLBWI without NRDS.