ObjectiveTo investigate the effect of different degrees of pressure of sustained inflation (SI) in patients with acute respiratory distress syndrome (ARDS) after lung recruitment as the result of different negative pressure for sputum aspiration.Methods A prospective single-blind randomized controlled trial was conducted. The factorial analysis of variance was adopted. 150 patients with ARDS admitted to the emergency intensive care unit (ICU) of Chongqing Three Gorges Central Hospital from January 2012 to December 2014 were enrolled, and they were randomly divided into S1, S2, S3 group, with 50 patients in each group, suction pressure varying from 150, 175, to 200 mmHg (1 mmHg = 0.133 kPa) was respectively used in each group. Then the patients of each group were randomly subdivided into five subgroups of P0, P1, P2, P3, P4, with 10 patients in each group, and 0, 30, 35, 40, and 45 cmH2O (1 cmH2O = 0.098 kPa) were used for control pulmonary inflation pressure, respectively. The respiratory mechanics and the hemodynamic parameters were recorded, and they were compared before and after the sputum aspiration as well as lung recruitment with sustained inflation.Results The lung recruitment volume (mL: 87.56±28.47 vs. 109.38±34.63, t = 3.573,P = 0.001) and lung static compliance [Cst ( mL/cmH2O): 27.69±13.25 vs. 35.87±17.47,t = 2.814,P = 0.004] after sputum aspiration in the 150 patients were significantly lower than those before the sputum aspiration, and peak airway pressure [PIP (cmH2O): 24.16±8.28 vs. 18.63±6.67,t = 2.957,P = 0.005], airway plateau pressure [Pplat (cmH2O): 21.28±9.14 vs. 17.47±7.26,t = 2.089,P = 0.032], and mean airway pressure [Pm (cmH2O): 13.26±4.65 vs. 10.41±3.54,t = 3.271,P = 0.001] were significantly higher than those before the treatment. There were no significant differences in the lung recruitment volume, Cst, PIP, Pplat and Pm between groups with different negative pressure for sputum aspiration (F value was 0.809, 0.986, 1.121, 0.910, 1.043, andP value was 0.452, 0.381, 0.335, 0.410, 0.361), but statistical significance was found among different groups of different lung recruitment pressures (F value was 3.581, 5.028, 3.064, 3.036, 4.050, andP value was 0.013, 0.002, 0.026, 0.027, 0.007). There was no interaction between the two factors. After pairwise comparison, under the same negative pressure for sputum aspiration, lung recruitment volume and Cst in different lung recruitment pressures subgroups (P1, P2, P3, P4) were significantly higher than those of P0 subgroup, and PIP, Pplat, and Pm were significantly lower than those of P0 subgroup. There was no significant difference among P1, P2, P3 and P4 groups. There were no significant differences in mean arterial pressure (MAP) and pulmonary arterial pressure (PAP) among different groups with negative pressures for sputum aspiration and different lung recruitment pressures (negative pressure for sputum aspiration:F = 0.586,P = 0.561,F= 1.373,P = 0.264; lung recruitment pressure:F = 1.313,P = 0.280,F= 1.621,P = 0.186), there was no interaction between the two factors (F = 0.936,P = 0.497,F = 1.391,P = 0.227). The difference of heart rate (HR) in different negative pressure for sputum aspiration groups was not significant (F = 1.144,P = 0.328), and there were significant differences in different lung recruitment pressure groups (F = 3.297,P = 0.019), there was no interaction between the two factors (F = 1.277, P = 0.280). After pairwise comparison, under the same negative pressure for sputum aspiration, HR in P3 and P4 subgroups was significantly higher than that in P0, P1, and P2 subgroups (allP< 0.05).Conclusion 30 cmH2O and 35 cmH2O were the suitable pressure for SI in ARDS patients, and they were not affected by different negative pressure for sputum aspiration.

Objective: To explore the relationship between plasma level of N terminal pro brain natriuretic peptide (NT-proBNP) and severity of coronary artery lesion in patients with coronary heart disease (CHD). Methods: A total of 206 patients suspected CHD, who admitted from Jan 2010 to Jun 2012 in our department and underwent coronary angiography (CAG), were divided into single vessel coronary disease group (n=54), double-vessel coronary disease group (n=52), multi-vessel coronary disease group (n=67) and normal group (n=33), according to CAG examination; and divided into acute myocardial infarction (AMI) group (n=45), unstable angina pectoris (UAP) group (n=91), stable angina pectoris (SAP) group (n=43) and normal group (n=27) according to clinic symptom. All patients received measurement for NT-proBNP, creatine kinase-isoenzyme (CK-MB) and cardiac troponin I (cTnI). Stenotic severity of coronary artery lesion was evaluated using Gensini score method. Data of all groups were analyzed statistically. Results: Compared with SAP group and normal group, there was significant increase in plasma level of NT-proBNP [(2.28±0.22) vs. (2.18±0.69) vs. (2.94±0.24) vs. (2.74±0.15), P<0.01 or P<0.05] in AMI group and UAP group. Compared with normal group, there was significant increase in plasma level of NT-proBNP [ (2.07±0.43) vs. (2.44±0.38) vs. (2.69±0.34) vs. (2.98±0.28), P<0.05] in single, double and multi-vessel coronary disease groups. Plasma level of NT-proBNP was positively correlated with Gensini score (r=0.51, 0.67, 0.73 respectively in single, double and multi-vessel coronary disease group, P<0.05 all). Conclusion: NT-proBNP concentration can be regard as an index predicting severity of coronary artery lesion.

Objective To understand the microbiological pollution of drinking water dispensers and find out the effective disinfection method for dispensers. Methods The counts of bacteria, fungi and yeast in water samples collected from the water stored in liners of 52 drinking water dispensers were determined. The total counts of bacteria in water samples of 8 water dispensers were determined before and after disinfection by 1/10 YOUJIE disinfectant for 2 min. Results The medians and over standard rates were 440 cfu/ml and 96.15% for the total count of bacteria, 0 and 30.77% for fungi and yeast in the water samples before disinfection respectively. After 2_min disinfection by 1/10 YOUJIE disinfectant, 5 of 8 drinking water dispensers showed bactericidal rates of 100% and other 3 water dispensers showed bactericidal rates of 99.56%, 99.77% and 99.78% respectively. Bacillus was found in some unkilled bacteria. Conclusion Microbiological pollution in water stored in liners of drinking water dispensers was high, which could be effectively eliminated and disinfected by 1/10 YOUJIE disinfectant for 2 min.

BACKGROUND: It is a new tendency to treat central nervous system injury or tumor therapy using the combination of seed cells and gene therapy.OBJECTIVE: To observe the dose-relationship between transfection and expression of rabbit bone marrow mesenchymal stem cell (BMSCs) with adenovirus vector carrying green fluorescent protein (Ad-GFP), and to study its effects on cell biological properties, in addition, to explore the feasibility of using Ad-GFP vector to construct gene modified BMSCs.DESIGN, TIME AND SETTING: A randomized grouping, contrast observation. The experiment was performed at the Southern Medical University between August 2008 and March 2009.MATERIALS: New Zealand white rabbits, irrespective of genders, weighing 2.0-3.0 kg, were selected.METHODS: BMSCs were separated and cultured in vitro, and then the cell immunophenotypes were detected by flow cytometry.The adenovirus was obtained by packaging 293 cells and was used to transfect BMSCs with various liters (1 ×-10~3-1×10~(10) PFU/mL).Cytometry was used to analyze the transfection efficiency.MAIN OUTCOME MEASURES: Cell morphological changes were detected under an invert microscope. The cell proliferation was detected by CCK8 kits. BMSCs transfected with Ad-GFP were induced differentiating into neuron-like cells by adding of β-mercaptoethanol.RESULTS: The surface markers of 3-6-generation BMSCs were negative to CD34 and CD45, but positive for CD29 and CD44.When the virus titers were 1 ×10~7 PFU/mL, the transfection rate was 55%, which were 85% when the virus titers were 1 ×10~9 and1×10~(10) PFU/mL. However, cell pathology phenomenon occurred when the virus titer was 1 ×10~(10) PFU/mL. The fluorescence was strongest expressed at day 7, and it still can be seen at day 28. The BMSCs trasfected with Ad-GFP could differentiate into neuron-like cells under induction of p-mercaptoethanol, with positive neuron-specific enolase.CONCLUSION: Ad-GFP with suitable titers can infect BMSCs effectively with little influence on the biology property or differentiation function. BMSCs can serve as seeds cell in gene therapy field when utilizing ad-GFP vector system.

Objective To study the expression of EI-1 in myocardium during cerebral ischemia and reper-fusion, and to investigate the mechanism of cerebral cardiac syndrome. Method Two hundred and eight SD rats weighting 220～250 gram, were divided into three groups: sham control group (n=48), cerebral ischemia group (n=80), cerebral ischemia/reperfusion group (n=80). The area of cerebral ischemia, and the concentration of sennn ET-1 and CK-MB, and the content of myocardial ET-1 were determined in 0,6, 12,24,48,72 h after cerebral ischemia and reperfusion, and were analyzed by t-test or F-test. Results Cerebral necrosis area was ob-served at 6 h after cerebral ischemia in cerebral ischemia group, and peaked at 12 h (P>0.05). The concentra-tion of CK-MB increased gradually after cerebral ischmia, peaked at 12 h (P<0.05), and then gradually de-creased. The serum concentration of ET-1 peaked at 6 h and then gradually decreased. The content of ET-1 in my-ocardium began to increase at 6 h after cerebral ischemia, and peaked at 12 h (P<0.05). In cerebral ischemia/reperfusion group, all of cerebral necrosis size, CK-MB concentration and myocardial ET-1 concent paelced at 12 h and then gradually decreased (P<0.05). Change of ET-1 concentration in blood was similar to that in cerebral ischemia group. Compared with cerebral ischemia group, the size of cerebral necrosis reduced obviously at 24 h,48 h,72 h in cerebral ischemia/reperfusion group (P<0.05). The concentration of CK-MB in cerebral ischemia/ reperfusion group was higher than that in cerebral isehemia group (P<0.05). The peak time of myocardial ET-1 was shatened in cerebral ischemia/reperfusion group. The change of serum ET-1 was not different between two groups. Conclusions Large area of cerebral ischemia, might cause myocardial injury. ET-1 is involved in the course of myocardial injury following cerebral ischemia. Though cerebral reperfusion can protect brain,but it make myocardial injury more serious,and ET-1 might participate in this course.

BACKGROUND:Many scholars have developed a variety of dynamic elastic spine fixator. After biomechanical research, animal experiments and clinical application found that no one elastic spine fixator was general y recognized clinical y. OBJECTIVE:To compare the stress difference between“X”-shaped spine dynamic fixation and traditional pedicle screw fixation. METHODS:Three-dimensional finite element models of“X”-shaped spine dynamic fixation and traditional pedicle screw fixation were established according to adult spine imaging data. Mechanical differences in vertical compression, flexion, extension, lateral bending and rotation were compared between the two groups. RESULTS AND CONCLUSION:The stress at vertical compression was lower than that at flexion, extension, lateral bending and rotation in both groups. The stress at“X”-shaped spine dynamic fixation mainly focused on“X”-shaped connecting rod, but the stress of traditional pedicle screw fixation mainly focused on conjunction of screw-rod. Moreover, the stress of the screw of“X”-shaped spine dynamic fixation was significantly less than that of traditional pedicle screw fixation (P<0.001). These results suggest that“X”-shaped spine dynamic fixation system can share stress of screws and reduce the postoperative stress concentration compared with traditional pedicle screw fixation.

Objective: To analyze influence of fluvastatin on carotid intima-media thickness (IMT) and pulse pressure (PP) in patients with essential hypertension (EH). Methods: A total of 62 EH patients were enrolled and randomly divided into fluvastatin group (n=32, received fluvastatin therapy based on routine antihypertensive therapy) and routine treatment group (n=30, received routine antihypertensive therapy). Course of treatment was one year for all patients. Levels of blood lipids, PP and carotid IMT were compared between two groups before, six and 12 months after treatment. Results: Compared with before treatment, there were significant decrease in levels of all blood lipids, PP [(66.9±7.3) mmHg vs. (53.1±6.2) mmHg] and IMT [(0.97±0.42) mm vs. (0.76±0.29) mm] in fluvastatin group after treatment six and 12 months, and significantly improved more than those of routine treatment group, P<0.05 all. The levels of above-mentioned indexes were no significant improvement in routine treatment group before and after treatment（P>0.05）. Conclusion: Fluvastatin can improve carotid intima-media thickness and pulse pressure in patients with hypertension and is worth extending in clinic.

Objective To investigate the curative effect of using new irrigation pump in acute hematogenous osteomyelitis.Methods Forty patients with acute hematogenous osteomyelitis were divided into the control group and observation group,20 cases in each group.The control group adopted the conventional lavage for drainage,while the observation group used self-made irrigation pump.Then the clinical curative effect and cure time were compared between the two groups.Results The total effective rate in the observation group was 100.00 ％,which was significantly higher than 80.00 ％ in the control group(P＜0.05),and the difference was statistically significant(P＜0.05).The cure time in the observation group was(10.13 ± 8.03)d,which was significantly shorter than (18.14-±5.43)in the control group,and the difference was statistically significant(P＜0.05).Conclusion The curative effect of new type irrigation pump in acute hematogenous osteomyelitis is more acurate than that of conventional lavage for vacuum darianage.

Objective:To analyze the understanding of "informed consent" in clinical treatment of medical staff in institutions with different nature , understand the current situation of informed consent in clinical treatment and further analyze its progress and deficiency .Methods:Using a self-developed questionnaire , a survey was conduc-ted among 326 medical staff in institutions with different nature in Shanghai .Results:In aspect of informing , the choices of medical staff in specific content of clinical treatment and informed objects differed significantly ( P<0 .05 ) .In aspect of voluntary , the medical staff ' s choices on whether patients or their families could refuse doc-tor's treatment differed significantly (P<0.05).In aspect of decision -making capacity, the medical staff's choices in assessment experience , methods, the necessity of assessment and how to assess differed significantly ( P<0.05).Conclusion:At present, the differences of understanding of medical staff from institutions with different nature towards informed consent were more significant .Although medical staff ' s awareness and understanding of informed consent has increased , but the specific operation mode and process need further training and improve-ment.

ObjectiveTo determine the prevalence of avian influenza viruses in the external environment of poultry in Anqing City， Anhui Province， and provide scientific evidence for prevention and control of animal-derived influenza in humans. MethodsA total of 28 farmers’ markets/farms in 10 counties （cities， districts） of Anqing City， Anhui Province， were selected as surveillance sites by simple random sampling strategy. Poultry faeces and other related samples were collected for 6 consecutive weeks. Real-time fluorescence quantitative PCR was used to examine the nucleic acids of influenza A virus. Subtypes H5， H7， and H9 of avian influenza virus were further tested in the positive samples. ResultsA total of 426 specimens were collected， among which 113 tested positive with a positive rate of 26.53%. Among the positive specimens， 104 were determined to be subtype H9， accounting for 92.04%. It did not significantly differ in the positive rate between the main and non-main urban areas （χ²<0.01， P>0.05） or among the specimens collected in different weeks （χ²=7.57， P>0.05）. However， it significantly differed in the positive rate among the specimens collected in the third week and other weeks （χ²=6.89， P<0.05）. Furthermore， among the different sampling sites， farms had the highest positive rate of 46.67%. Among the specimens from different sources， the surface-coated specimens from poultry cages had the highest positive rate of 34.78%. ConclusionAvian influenza viruses are prevalent in the external environment of poultry in Anqing City. It warrants strengthening the surveillance and risk assessment to reduce the virus transmission in the external environment and risk of human infection with animal-derived influenza.