Objective To discuss and summarize nursing measures of elderly patients with severe brain injury after tracheotomy. Methods A retrospective analysis was carried out in 60 elderly patients with severe traumatic brain injury after tracheotomy in our hospital from July, 2009 to August, 2010, all patients were given holistic nursing care, including close observation of patients' condition, controlling the suction time, methods and techniques, strict aseptic technique, to effectively prevent infection. Results In the implementation of the patient-centered holistic care, the results were significant, 49 cases survived the acute phase and finally removed tracheal tube. Only 5 patients had pulmonary infection, accounting for 8.3%. 3 patients died due to brain injury and 5 cases were discharged against advice, 3 patients did not gain extubation due to severe brain stem injury. Conclusions The patients with severe head injury need tracheotomy to maintain airway patency, timely call-back, suction, effective airway humidification, prevention of pulmonary infection, reduction of respiratory tract injury is key to successful treatment. The patientcentered holistic care is worthy of wide clinical application.

Objective To study the reasons and nursing care methods of rehemorrhage in patients with subarachnoid hemorrhage(SAH).Methods The risk factors were compared between the rebleeding in subarachnoid hemonhage patients group and the non-rebleeding group.Results In the rebleeding patients,more patients had the risk factors as being over 60 years-old,hypertension,aneurysm,drinking alcohol,mood swing,defecation and out-of-bed activity,with a significant difference compared with non-rebleeding patients.Conclusions According to the risk factors of subarachnoid hemorrhage,to strengthen the health education to subarachnoid hemorrhage patients is important to the treatment,nursing and rehabilitation of this disease.

Exosomes,a branch of extracellular vesicles,are nano-sized vesicle-like bodies with bilayer lipid membrane structure,which are secreted actively by multiple vesicles formed by intracellular lysosomal particles fusing with cell membrane. Exosomes carry a variety of signal molecules such as proteins,nucleic acids and lipids,which mediate the transmission of information between cells and regulate the surrounding environment. Tumor cells secrete more exosomes than normal cells,and tumor-derived exosomes(TEXs)play an important role in the formation and maintenance of immunosuppressive microenvironment conducive to the survival of tumor cells,which can induce immune surveillance and regulate immune function in vivo and in vitro. This paper reviews the research progress of TEXs on immunosuppression induced by the regulation of various immune cell functions and the immunomodulation of microenvironment.

Mycobacterium tuberculosis ( Mtb) is an extremely successful intracellular bacterial pathogen that engages multiple strategies to escape host immune surveillance,so as to survive within host macrophages for long period. Upon the invasion of pathogenic bacteria,the host ubiquitin system plays a critical role in activating the host innate immune responses and associated signaling pathways such as inflammatory and immune responses, autophagy, phagosome maturation and cell death, etc. On the other hand, recent studies have demonstrated that intracellular pathogenic bacteria such as Mtb can secrete a variety of effector proteins into host cells to hijack or co-opt the ubiquitin system to suppress host immune responses. Those pathogen-host interacting interfaces could provide potential novel targets for the development of anti-tuberculosis drugs.

BACKGROUND:Because of the special and complicated biological characteristics of oocytes, the suitable cyropreservation technology for oocytes faces more various chalenges. However, the uneven survival rate and fertilization, damages of developmental potential of the thawed oocyte stil exist. OBJECTIVE:To introduce the progress in basic and application researches of oocyte cryopreservation technology, and to iluminate the technical defects and thoughts and possible research points to overcome these problems. METHODS: A computer-based search of CNKI and PubMed was performed for articles concerning oocyte cryopreservation from January 2004 to October 2014. The search terms were oocyte, cryopreservation, vitrification in Chinese and English, respectively. The old and repeated articles were excluded. Finaly, 41 articles were included in result analysis. RESULTS AND CONCLUSION:The cryopreservation of oocytes by slow freezing and vitrification has been used in clinic. At the same time, the uneven survival and fertilization rate, damaged developmental potential of the thawed oocyte stil puzzle the clinicians. The key point to breakthrough or improvement of oocyte cryopreservation technology is the systematization of the protocol for oocylte cryopreservation, for example, the choice of cryoprotective agents, the development of carriers for oocytes, and the determination of oocyte stage. Furthermore, other related technologies should also be considered, including thein vitro mature technology of oocytes, cryopreservation and transplantation of ovary tissues.

Objective To explore and provide guidelines for the clinical diagnosis and treatment of primary nephrotic syndrome complicated with acute pancreatitis. Methods The clinical data of 14 children with primary nephrotic syndrome complicated with acute pancreatitis during September 2013 to September 2016 were retrospectively analyzed. Results In 14 children (6 males and 8 females) aged 3 to 15 years. all children presented massive proteinuria, hypoalbuminemia, varying degrees of edema, hyperlipidemia and pain in upper abdomen or left hypochondrium. Seven children had nausea and vomiting, and their amylase in serum and urine fluctuated at 392–802 U/L and 561–3180 U/L, and the lipase level was 339.1±2.52 U/L. After supportive treatment, 13 children were cured from pancreatitis except one who gave up the treatment. Conclusion Due to infection, coagulation disorder, hyperlipidemia and drug application in primary nephrotic syndrome, acute pancreatitis may be induced. Clinician should be alerted to it and early diagnosis and treatment were needed for acute pancreatitis.

Objective To evaluate the efficacy and safety of linezolid in empirical treatment of methicillin-resistant Staphylococcus (MRS) pneumonia. Methods One hundred and thirty-five hospitalized patients with MSR pneumonia receiving linezolid from April 2009 to October 2010 were enrolled in this retrospective cohort study, and all subjects were assigned to two groups: 75 cases with empirical treatment (linezolid 0. 6 g by infusion q12h at admission) , and 60 cases with objective treatment (linezolid after the sputum culture). The severity score, clinical effect and adverse effect were observed, and the therapeutic effects in patients with high risk factors were especially evaluated. SPSS13.0 software was used for statistical analysis. Results The scores were decreased significantly after finishing therapeutic causes for 3 and 7 days in both groups (tempirical =12.29 and 16.53, tobjective =9.36 and 11.49, P<0. 05). There were significant differences in severity scores after 3 and 7 days between empirical and objective treatment groups (t =2. 64 and 3. 08, P < 0. 01). There were significant differences in absorption time, length of ICU and total hospital stay between two groups (t =6. 61 , 4. 39 and 10. 25, P <0. 05). In empirical and objective group, the effective rates were 88.0% (66/75) and 83.3% (50/60) (x2 = 0.60, P > 0.05 ). In the patients with high risk factors, the effective rates of two groups were 86. 8% (33/38) and 63. 6% (14/22) , and the difference was significant (x2 =4.42, P<0.05). The rate of adverse effects were 6.7% (5/75) in empirical group and 5.0% (3/60) in objective group, and the difference was not significant (x2 =0. 17, P > 0. 05). Conclusion Linezolid can be used as empirical treatment for MRS pneumonia with rapid symptoms relieve and high efficacy, especially for patients with high risk.

BACKGROUND:The key of vertebroplasty and percutaneous kyphoplasty to success is whether the puncture needle can accurately reach the vertebral body through pedicle. Therefore, it is important to identify the correct point and direction of needling in the X-ray fluoroscopy. Among many methods published in present reports, the puncture point and the puncture angle are not fixed. Few reports concerned whether the puncture needle perforated pedicle medial wal . OBJECTIVE:To seek safe, effective puncture point and the puncture angle of percutaneous pedicle from the perspective of anatomy and radiography. METHODS:The best entry point during percutaneous vertebroplasty in the X-ray fluoroscopy:dissection was performed on thoracic, lumbar skeletal samples (T 6-L 5 ) to find the position of pedicle axis leading to the rear of the vertebral body, and this position is the best entry point of percutaneous vertebroplasty. It was fixed with mini-screw. The relationship of the best entry point and pedicle developing position in the X-ray fluoroscopy was analyzed to find the best entry point in the X-ray fluoroscopy. The best entry angle during percutaneous vertebroplasty:The average included angle of pedicle axis and vertebral sagittal line was measured using autopsy and CT scanning on adult thoracic and lumbar skeletal samples (T 6-L 5 ). The best entry angle during percutaneous vertebroplasty was found. RESULTS AND CONCLUSION:During percutaneous vertebroplasty, the best entry point in the X-ray fluoroscopy was the left pedicle projection 9 area and right pedicle projection 3 area. The optimal needle angle during percutaneous vertebroplasty:5°-10° in lumbar vertebra L1-L4;20° in L5, not more than 25°;about 5° in thoracic vertebra T6-T12 .

Objective:To investigate the expression and correlation of EHD2 and E-cadherin in hepatocellular carcinoma (HCC). Meth-ods:Western blot and immunohistochemistry were used to detect the expression of EHD2 and E-cadherin in HCC specimens and adja-cent noncancerous tissues. The correlations of EHD2 and E-cadherin with the clinicopathological characteristics and prognosis of pa-tients were further analyzed using Pearsonχ2 test and Kaplan-Meier method. Results:EHD2 expression, along with E-cadherin, was markedly reduced in HCC tissues than in adjacent noncancerous tissues. Moreover, EHD2 and E-cadherin expression were correlated with histological grade, microvascular invasion, and lymph node metastasis (P<0.05). Kaplan-Meier survival analysis showed that HCC patients with decreased EHD2 and E-cadherin expression had shorter overall survival time than those with higher expression. Conclu-sion:The abnormal expression of EHD2 and E-cadherin possibly promote HCC. Detection of EHD2 and E-cadherin may be valuable for diagnosing HCC and evaluating malignancy extent and prognosis.

AIM: To investigate the effect of aminoguanidine (AG) on plasma and renal levels of angiogenesis Ⅱ (AngⅡ), and to identify the relationship of AGEs with AngⅡ in STZ-induced diabetic rats. METHODS: Wistar rats were randomly assigned to three groups. Diabetes was induced, rats were then received AG in treatment group. At the end of 12th week, urine albumin excretion rate (UAER) and calculate creatinine clearance (Ccr) were detected. Periodic acid-Schiff reagent was used to evaluate renal pathology. Plasma and renal AngⅡ were analyzed by radioimmunoassay and immunohistochemistry, respectively. RESULTS: AG treatment significantly prevented the increase in UAER (P<0.01), renal pathology (P<0.01), and level of renal AngⅡ (P<0.01). However, plasma concentration of AngⅡ was higher than that in diabetic rats without AG treatment (P<0.01). CONCLUSION: AG down-regulates renal Ang Ⅱ level, probably by reducing the formation of AGEs, which may be one of the renoprotective factors in diabetic nephropathy. More proofs are needed to identify the result that plasma AngⅡ concentration increases in DMA group.