Hospital-acquired pneumonia(HAP)is one of common causes of hospital-associated infections.Because of the higher prevalence and mortality in elderly patients,HAP has been becoming the challenge for the clinicians.HAP is highly associated with host status,pathogen(particularly the occurrence of multidrug resistant pathogens),and the extensive use of antibiotics.The diagnostics should include clinical and bacteriologic strategies.The initial therapy with antibiotics should consider whether HAP was early-onset or late-onset and cover the potential pathogens.The quantitative or semiquantitative cultures of the samples from low respiratory tracts are used to direct the target and step down therapy.The prevention of HAP in the elderly patients is a priority.

Based on the description of styles and characteristics of fume hoods in modern laboratories, this paper analyzes the control strategies in fume hoods and ventilation systems and discusses the control and application of VAV as well as its advantages on safety, energy conservation and comfort.

Objective To investigate the alterations of pulmonary dead space,pulmonary shunt fraction (Qs/Qt) and gas exchange after thromboembolism of lungs in swines and to evaluate the mechanism in respect of pathophysiology and implication.Methods Swine model of pulmonary thromboembolism was made by injection of thrombus into pulmonary artery.Eight swine were used for study of physiologic dead space (VDphy),alveoli dead space (VDalv),airway dead space (VDaw),Qs/Qt,pulmonary arterial pressure (PAP),oxygen partial pressure in arterial blood (PaO2 ),carbon dioxide partial pressure in arterial blood (PaCO2 ),alveolar-arterial O2 gradient (PA-aDO2) determined 30 min before thromboembolism and 0 min,30 min,60 min,120 min after thromboembolism.Results The results showed that VDphy,VDalv,Qs/Qt,PAP,PA-aDO2 increased markedly after thromboembolism in comparison with pre-thromboembolism (P ＜ 0.01 ),while PaO2 declined significantly (P ＜ 0.01 ),and the differences in VDaw and PaCO2 were not significant ( P ＞ 0.05 ).SNK test showed that VDphy and VDalv declined to be smaller at 60 min,120 min than those at 30 min,and PAP declined to be lower at 30 min,60 min,120 min than that at 0 min.Other variables did not change at different intervals after thromboembolism.Hemodynamics did not change significantly after embolization.Conclusions After pulmonary thromboembolism,a various of changes in pathophysiology happened such as increase in dead space,Qs/Qt and PA-aDO2 and decrease in PaO2,but PaCO2 did not change.

Objective To assess diagnostic value of Wells and Geneva seales in patients with suspected pulmonary embolism(PE).Methods Clinical data of 958 consecutive cases of suspected PE admitted to Shanghai Pulmonary Hospital form January 1,1995 to January 1,2009,were analyzed retrospectively,and all patients were assessed with Wells and Geneva scales,respectively for likelihood of PE,as compared to those diagnosed by lung imaging Results Three hundred and forty-seven patients with PE were diagnosed with lung imaging as gold standard,sensitivity,specificity,and positive and negative predictive values for Wells scale and Geneva scale in diagnosis for PE were 82.4%,58.1%,52.8%and 85.3%.and 88.8%,55.3%,53.1%and 89.7%,respectively,with positive and negative likelihood ratios.Youden index and crude agreement of 1.97,0.30,0.41 and 0.21,and 1.99,0.20,0.44 and 0.25.respectively.Area under the receiver operating characteristic(ROC) curve of Geneva scale(0.79)was significantly more than that of Wells scale(0.73)(Z=2.25,P＜0.05).As compared to Wells scale,sensitivity and specificity for Geneva scale in diagnosis for PE was significantly higher(χ2=7.12 and 6.84,respectively,P＜0.05).Conclusions Although there is a considerable gap in accuracy between clinical scales and lung imaging in diagnosis for PE.both Wells and Geneva scales can be used in clinical screening for PE to save unnecessary cost.however,Geneva scale is more practical and accurate than Wells scale,worthwhile to be popularized clinically.

0.05).Conclusion Retropubic DVC control before laparoscopic radical prostatectomy is beneficial for both the surgical procedure and postoperative recovery of physiological functions,owing to minimal blood loss,clear surgical field,and less injury to the urinary continence system.

Objective: To study the effects of the total flavonoids of tartary buckwheat germ (TFTBG) on serum lipid and antioxidation in hypercholesterolemic rats. Method: According to body weight,60 Wistar rats were divided randomly into 6 groups: normal control group (NC), high-fat control group (HFC), Jiaogulan positive control group (JPC, Gynostemma pantaphyllum total glucoside tablet 0.032g/kg bw),TFTBG 1.0,0.5and TFTBG 0.2 g/kg bw (HD,MD,LD) group. Except NC group, all other groups were fed high-fat diet for hyperlipidemia model. NC group and HFC group were given distilled water 10 ml/kg bw. Water and TFTBG were given by gavage once a day for 6 w respectively. Serum TG, TC HDL-C, LDL-C, apoA1, apoB, SOD, GSH-Px and MDA were determined. Results: Compared with HFC group, serum TG ,TC were lowered significantly(P

Objective: To analyse the composition and content of the fatty acid and unsaponifiable matters in both tartary buckwheat seed oil and buckwheat seed oil. Methods: Fatty acids were obtained by the methods of KOH-EtOH(95%) saponification and treatment of inorganic acid. They were analyzed and determined by gas chromatography and GC/MS chromatography respectively. Results: 4-5 kinds of fatty acid were determined in both oils, and the content of unsaturated fatty acids in tatary buckwheat oil was 83.2% ( oleic acid 47.1%, linoleic acid 36.1%), buckwheat oil was 81.8% ( oleic acid 35.8% , linoleic acid 40.2% and linolenic acid 5.8%). The content of unsaponifiable matters in tartary buckwheat seed oil was 6.56%(?-sitosterol 54.37%), and in buckwheat seed oil was 21.90%(?-sitosterol 57.29%,?-tocopherol 1.41%). Conclusion: Both buckwheat oils were functional vegetable oils.

To retrospectively analyze the clinical data of 48 patients with allergic bronchopulmonary aspergillosis (ABPA) at Shanghai Pulmonary Hospital.There were 23 males and 25 females with a mean age of (36 ± 15) years.Their clinical manifestations included wheeze,cough,sputum production,sputum plugs,fever,hemoptysis,weight loss,chest pain,weakness and night sweats.They had a high peripheral blood eosinophilia,a higher serum total IgE,a higher level of aspergillosis fumigatus-specific IgE and positive immediate skin-prick test to aspergillus fumigatus.Aspergillus species were detected in sputum samples of 26 patients.Chest computed tomography (CT) was performed in 48 patients.There were patchy infiltrations (n =45),transient infiltrations (n =40),central bronchiectasis (n =35) and mucoid impaction (n =18).Obstructive ventilation dysfunction was confirmed by lung function test.

Objective To investigate the mutual effect between G protein-coupled receptors(GPCR)including C5a receptor(C5aR),C5a like receptor 2(C5L2)and chemotaxis inhibitory protein(CHIPs)secreted by Staphylococcus aureus.Methods The purified CHIPs was incubated with HEK 293T cells overexpressing C5aR,C5L2 and C-X-C chemokine receptor type 3(CXCR3).Binding signal was detected by Western blot.Results HEK 293T cells overexpressing C5aR can efficiently bind to CHIPs.No apparent relation between CHIPs and C5L2 or CXCR3 was identified.Conclusion C5aR but not C5L2 is a membrane receptor for binding CHIPs,suggesting a difference between C5aR and C5L2 in association with binding CHIPs.

Objective To study the value of Geneva score assessment combined with simplified rapid plasma D-dimer assay(SRPDDA)for early diagnosis of pulmonary embolism(PE).Methods Clinical data of 658 suspected cases of PE hospitalized at Shanghai Pulmonary Hospital during January 1,1995 to November 30,2007 were retrospectively analyzed.The patients were divided into three categories based on their Geneva score assessment,highly suspected with equal to or greater than 9 scores,intermediately suspected with 5-8 scores and mildly suspected with equal to or less than 4 scores,respectively.Clinical diagnosis for PE of the patients was made based on their probability Geneva score developed by Wicki,SRPDDA,and both Geneva score assessment and SRPDDA,respectively,and compared with results of lung imaging.Results Finally,PE diagnosis was established in 267 cases.Sensitivity for Geneva score and SRPDDA to diagnose PE was 88.4%and 90.3%,with negative predictive value(NPV)of 88.9%and 90.2%and Youden Index(YI)of 51.7%and 51.4%,respectively.And,sensitivity of both Geneva score assessment combined with SRPDDA wag 97.8%,with NPV and YI of 97.3%and 53.8%,respectively,with a likelihood ratio(LR)for both positive test results of 2.62 and a LB for both negative test results of 0.04,respectively.Conclusions As a routine and non-invasive diagnostic test,Geneva score assessment,as well as SRPDDA,play a screening role in early diagnosis for PE,which can help to save unnecessary cost of imping,and complement each other so to improve accuracy of diagnosis and reduce misdiagnosis.