Although acute respiratory distress syndrome (ARDS) has been the focus of extensive basic science and clinical research over the past 40 years,its pathogenesis is not clear.The therapies for ARDS have been not consensus.In addition to the lung-protective ventilatory strategies,effective pharmacologic therapy for ARDS remains extremely limited and still continue to explore and study.This paper reviews the cunent pharmacotherapies to treat ARDS,including neuromuscular blockers,corticosteroids,neutrophil elastase inhibitor,antioxidants,granulocyte macrophage-colony stimulating factor,β2 adrenergic receptor agonists,pulmonary vasodilators.

Hyper glycemia and hypoglycemia are associated with poor outcome of critically ill patients.No consistent evidence shows that intensive insulin strategy improves health outcomes in hospitalized patients.Because of its potentially harmful and life-threatening consequences,hypoglycemia represents the main limit to the development of a tight blood glucose control strategy in critical illness.Hypoglycemia-related neurological signs may be masked.The occurrence of hypoglycemia in critical illness,especially severe hypoglycemia,is associated with a poor prognosis.So it is necessary to closely detect glycemic variability and control the blood glucose in proper level.

Streptomyces phage ?C31 integrase is a site-specific recombinase and introduce foreign gene to unidirectional recombination.Because of its integration mediated by ?C31 integrase without any cofactors and especially directed integration,it possesses high efficiency and stable expression of foreign gene.These advantages make it an attractive tool for genetic engineering.It has been widely used to transgene integration in mammalians and provides an opportunity to overcome the bottlenecks in the generation of transgenetic animals,such as random integration,low integral rate,low level of expression and so on.The ?C31 integrase will have a wide application in the near future.

Objective To study the activation of macrophage and upregulation of CD40 in neutropenic and nonneutropenic lipopolysaccharide (LPS)-induced acute lung injury (ALI).Methods Forty mice were randomly divided into four groups (neutropenic septic group,neutropenic control group,non neutropenic septic group and normal control group).The pathologic changes of mice lungs were observed after hematoxylin and eosin staining.CD40 expression was determined by flow cytometry.Cytokine tumor necrosis factor-α levels from bronchoalveolar lavage fluid (BALF) and serum were measured by ELISA.Results The average weight and peripheral blood white cell counts were increased significantly in the neutropenic group as compared to the non neutropenic group before the rats were sacrificed [(181.13 ± 16.94) g vs (168.56 ±5.03) g,(9.54 ± 1.25) × 109/L vs (2.56 ± 1.12) × 109/L,P ＜0.05,respectively].The cell counts in BALF were higher in neutropenic septic and non neutropenic septic groups compared to the normal control group [(3.33 ±0.26) × 106/L,(3.23 ± 0.06) × 106/L,(1.68 ± 0.23) × 106/L,P ＜ 0.05].The concentration of tumor necrosis factor-α from serum were increased significantly in neutropenic septic and non neutropenic septic groups as compared to the normal control group [(2 337.08 ± 1 148.85) pg/ml,(2 274.01 ± 1 569.37) pg/ml,(96.20 ± 93.69) pg/ml,P ＜ 0.05].The CD40 molecular expressions were higher in neutropenic septic and non neutropenic septic groups compared to the normal control group [(42.06 ± 11.90) ％,(46.38 ±7.42) ％,(21.62 ± 4.86) ％,P ＜ 0.01].Conclusion Upregulation of CD40 molecule induces the inflammatory cytokines releasing,then leads to ALI.Therefore both the inflammatory cytokines and CD40 play vital role in the pathogenesis of ALI.

OBJECTIVETo study the expression difference in MicroRNA-21 (miRNA-21) levels of the plasma between the patients with coronary heart disease and the subjects without coronary artery lesions, and its clinical significance.

METHODSPlasma was obtained from the patients with coronary heart disease(trial group,56 cases) and the subjects without coronary artery lesions(control group, 10 cases), patients with coronary disease were divided into angina(AP, 39 cases) and acute myocardial infarction(AMI, 17 cases)subgroup, the contents of miRNA-21 were detected using qRT-PCR method, and the differential expression of miRNA-21 in each group was analyzed. The levels of creatine kinase isoenzyme (CK-MB), high sensitive troponin I(cTnI), B type natriuretic peptide urea (BNP), Gensini, left ventricular ejection fraction (LVEF), integral value of coronary left ventricular end diastole diameter (LV) and homocysteine (HCY) were determined and the correlation between miRNA-21 and these clinical indexes was analyzed.

RESULTSCompared with control group, there was a significant difference in expression of miRNA-21 in patients with angina and AMI (P < 0.05), and miRNA-21 expression in AMI group was much higher than that in AP group. There was statistical significance in CK, CK-MB, cTnI, Genisis integral comparison between AMI group and control group (P < 0.05). The correlation analysis showed that there was a positive correlation between expression of CK, CK-MB, cTnI and the level of circulating miRNA-21 in patients with acute myocardial infarction. And there was a negative correlation between BNP, Gensini integral, LVEF value of coronary artery, LV and circulating miRNA-21.

CONCLUSIONmiRNA-21 was significantly elevated in acute myocardial infarction subgroup than the control group. The level of miRNA-21 associates with the degree of coronary artery stenosis, and might be a potential marker for the diagnosis of acute myocardial infarction. miRNA-21 may play an important role in protecting myocardium from ischemia/reperfusion injury.

Acute Disease ; Biomarkers ; blood ; Coronary Disease ; blood ; Creatine Kinase, MB Form ; metabolism ; Humans ; MicroRNAs ; blood ; Myocardial Infarction ; blood ; Natriuretic Peptide, Brain ; metabolism ; Troponin I ; metabolism

Child ; Female ; Hematemesis ; complications ; Humans ; Tracheoesophageal Fistula ; complications ; congenital

Objective To understand the status of depression and compare with the same age group of Chinese norms of CES-D in urban areas and analyze its potential influencing factors among male nursing undergraduates.Methods In this cross-sectional study,the CES-D and self-made questionnaire were administrated to 102 male nursing undergraduates from two schools of nursing through two-stage random sampling.Results The prevalence of depression was 14.0％,and the score of nursing undergraduates was (11.00±6.37) points,which had no significant difference from the scores of the same age group of Chinese norms in urban areas.Univariate analysis showed that coming from countryside,worse interpersonal relationship,worse career prospect,getting no attention from parents had some significant association with depression.Multivariate analysis showed that worse career prospect and getting no attention from parents associated with lower CES-D scores.Condusions For male nursing undergraduates,efforts should be given from the aspects of families and career prospects to improve their psychological health condition,and reserve qualified resources for nursing profession.

Objective To observe the curative effects of the combined therapy of Folic acid,Vitamin(Vit) B6 and Vit B12 in youth stroke associated with hyperhomocysteinemia.Methods 150 youth stroke patients with hyperhomocysteinemia were randomly devided into low dose Folic acid,Vit B6 and Vit B12 treatment group(low dose group);high dose Folic acid,Vit B6 and Vit B12 treatment group(high dose group) and control group,50 cases in each group.Low dose group was taken by the treatments of Folic acid 2.5 mg/d,Vit B6 10 mg/d,Vit B12 0.5 mg/d;high dose group was taken by the treatments of Folic acid 5 mg/d,Vit B6 30 mg/d,Vit B12 1.5 mg/d;control group was not taken by the treatments of Folic acid,Vit B6 and Vit B12.The plasma homocysteine(Hcy)concentration was detected before and after treatment.The level of plasma Hcy 0.05).No obvious side effect was found in the three groups.Conclusions It is effective in the combined therapy of Folic acid,Vit B6 and Vit B12 in youth stroke associated with hyperhomocysteinemia.The effectiv rates are same by the low dose and high dose drug.The therapy is free from side effect.

After half a century of development,liver transplantation has become an important means to solve the problem of end-stage liver diseases and has greatly improved the prognosis of the patients.This article reviewed and summarized the post-operation intensive care management and treatment of complication in children with liver transplantation.