Objective To investigate the effects of macmphage migration inhibitory factor (MIF) on glucocorticoid (GC) re]ease and glucocorticoid recer (GR) in mts.Methods Test Ⅰ Thirty-two male SD rats weighing 250-300 g were randomly divided into 4 groups(n=8 each):control group(C),low dose recombinant MIF (rMIF) group (rMIF-L),middle dose rMIF group (rMIF-M) and high dose rMIF group (rMIF-H).The animals received l ml normal saline via the right femoral vein in group C.The animals received rMIF50.100 and 200 ng in l ml normal saline though right femoral vein in group rMIF-L,rMIF-M or rMIF-H respectively.Blood samples were taken from left femoral artery immediately before inection(T0,baseline),and at 5 min,3 h,6 h.12 h and 24 h after injection of rMIF(T1-5) for determination of serum concentration of corticosterone.Test Ⅱ Primary cultured neonate rat(2-3 days)myocardial ceils were randomly divided into 3 groups(n=24 each):group C,group rMIF-L and group rMIF-M.The ceUs in group C,rMIF-L and rMIF-M wefe incubated with DMEM.rMIF 50 ng+DMEM and rMIF 100 ng+DMEM for 3 h respectively.The expression of GR and HsPg0 wag determined by Western blot.ResuBs Test Ⅰ The serum concentration of corticosterone was signifieemily higher in the other 3 groups than in group C at T1-5(P<0.05).The sertlm concentration of corticostemne was significantly increased at T1-5 in group rMIF-L,rMIF-M and rMIF-H compared with the baseline values(P<0.05).Test Ⅱ HSP90 expresion was significantly lower in the other two groups than in group C(P<0.05).Them was rio signifieanf difference in HSP90 expression between group rMIF-L and group rMIF-M(P>0.05).There was no significant difference in GR expression among the 3 groups ( P > 0.05). Conclusion MIF druing sepsis can weaken GR function through down-regulating HSP9O expression, resulting in CC resistance.

Objective To evaluate the sentinel lymph node biopsy (SLNB) in clinical lymph node negative oral squamous cell carcinoma. Methods Sentinel lymph node biopsy (SLNB) by using methylene blue staining were employed to 20 patients with clinical cervical lymph node negative in oral squamous cell carcinoma. Results SLNB was successful identified in 14 of 20(70%). A 100%(6/6) accuracy of SLNB to predict cervical lymph node status was reached. Conclusion SLNB could accurately predict the cervical status of clinical negative node and decrease the extent of surgery and postoperative complication

Objective To evaluate the clinic efficacy of sufentanil and remifentanil by target- controlled infusion (TCI) combined with propofol in patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).Methods Sixty patients,ASA Ⅰ ～ Ⅱ,undergoing elective EBUS-TBNA were randomly divided into group S ( sufentanil group),group R (remifentanil group) and group SR (sufentanil + remifentanil group),each group were twenty patients.The anesthesia of all groups is propofol intravenous anesthesia with 2％ lidocaine topical anesthesia,to controll BIS between 50 and 60 during surgery.Heart rate(HR),mean arterial pressure(MAP) pulse oxygen saturation( SpO2 ) and respiratory rate (RR) were recorded and compared 5mins after entering room(T0),30mins after the beginning of surgery(T1 ) and after surgery(T3).Arterial blood gas and the times of cough during surgery were also recorded and compared in all groups.The use of propofol and lidocaine,the wake-up time,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were also obtained.Results ( 1 ) RR decreased distinctly in group R and PaCO2 increased distinctly in group S and group R compared with that of group SR (P ＜0.05) during surgery.(2)The times of cough and the wake-up time lessened distinctly in group R and group SR compared with that of group S ( P ＜0.05 ).(3) The use of propofol and lidocaine,satisfaction with anesthesia and adverse reactions in 6 hrs after surgery were similar in all groups ( P ＞ 0.05 ).Conclusion Sufentanil compounded remifentanil by TCI combined with propofol is a safe and feasible anesthesia option for EBUS-TBNA,which provides better efficacy,high satisfaction and less side effects compared with using alone of sufentanil and remifentanil respectively.

Objective To analyse the difference between stage Ⅰ pure bronchioloalveolar carcinoma (BAC) and stage Ⅰ adenocarcinoma of the lung among operative cases.Methods We use the Lobectomy Cases Registration and Statistics System database (2006-2011) to compare the epidemiology,clinical presentation,image characteristics,surgical outcomes,recurrence and overall survival between BAC and adenocarcinoma groups.All the patients received lobectomy procedure in the department of thoracic surgery of Peking University People' s Hospital.Results Excluding those cases with both BAC and adenocarcinoma aspects,337 patients were enrolled.Thirty-nine patients were stage Ⅰ pure BAC and 298 patients were stage Ⅰadenocarcinoma.BAC has its proper clinical spectrum,occurring more frequently in women (69.2％ vs.52.0％,P =0.042)and in younger patients (57.4 vs.61.8,P =0.014).BAC also seems to be less dependent on tobacco exposure (12.8％ vs.29.9％,P =0.026).The percentage of ground-glass opacity (GGO) in CT scan of BAC patients was much more than that registered in adenocarcinoma patients (35.9％ vs.9.7％,P ＜0.001).And the tumor size of BAC group was smaller than that of the adenocarcinoma group (1.4 cm vs.2.3 cm,P ＜0.001).The operation method,time,blood loss and complications were similar between the two groups.Kaplan-Meier survival curves showed that both 3-year disease-free survival (DFS) and overall survival (OS) were significantly higher in patients affected by BAC (100％ vs.76.1％,P =0.030 and 100％ vs.86.1％,P =0.041).Conclusion BAC presents specificity in its epidemical,clinical,radiological and evolutionary aspects.Stage Ⅰ pure BAC patients have better prognosis following video-assisted thoracoscopic lobectomy and system lymph node dissection than the similar stage adenocarcinoma patients.

To achieve higher level expression of Interferon α2b (IFN-α2b) in methylotrophic yeast (Pichia pastoris), a cDNA fragment coding for the mature IFN-α2b was designed and synthesized based on the synonymous codon bias of P. pastoris and optimized G+C content. The synthetic IFN-α2b was inserted into the secreted expression vector pPICZαA, and then integrated into P. pastoris GS115 genome by electroporation. Multi-copy integrants in the Mut+ recombinant P. pastoris strain were screened by high concentrations of Zeocin. 120 hours culturing allowed expression of the IFN-α2b transformant up to 810 mg/L as detected by SDS-PAGE and quantitative methods. In addition, Western blot analysis showed that the recombinant proteins had immunogenicity. The significant antiviral activity of the recombinant IFN-α2b protein was verified by WISH/ VSV system, which was 3.3×105 IU/mL.

Objective To evaluate the analgesic efficacy of thoracic paravertebral block (PVB) in patients after lobectomy performed via video-assisted thoracoscope (VAT) .Methods Fifty ASA Ⅰ or Ⅱ patients of both sexes aged 20-76 yr weighing 45-90 kg undergoing elective lobectomy via VAT were randomly divided into 2 groups (n = 25 each): patient-controlled intravenous analgesia (PCIA) group and thoracic PVB group. PVB was performed according to the method described by Jamieson et al and Richardson et al. Paravertebral catheter was placed at T7-8 after induction of anesthesia and tracheal intubation. A loading dose of 0.5% ropivacaine 20 ml was administered via PVB catheter at 30 min before the end of operation. PVB was then controlled by the patients with 0.2% ropivacaine (bolus dose 8.0 ml, lockout interval 30 min). In PCIA group a loading dose of sufentanil 0.1 μg/kg was given iv at 30 mln before the end of operation. Sufentanil 1.0 μg/ml was used. PCIA included a bolus of 2 ml with a 15 min lockout interval and background infusion 2 ml/h. Numeric rating scale (NRS) (0=no pain, 10 = most severe pain) was used to assess the intensity of pain. NRS score, MAP, HR and SpO2 were recorded before operation (T0 ,baseline), 30 min after withdrawal of chest tube (Ti) and at 24, 48 and 72 h after operation (T2, T3, T4). Forced vital capacity (FVC) and forced expiratory volume first second (FEV1.0) were measured and FVC/FEV1.0 ratio was calculated after chest tube was withdrawn. Blood cortisone and glucose concentrations were determined at To, T1 and T4. Requirement for rescue analgesics and side effects were recorded. Results There was no significant difference in MAP, HR, SpO2 and NRS at rest between the 2 groups.NRS at coughing and blood cortisone and glucose concentrations were significantly lower and the postoperative FEV1.0 was significantly higher in PVB group than in PCIA group. The requirement for rescue analgesics and side effects were comparable between the 2 groups. Conclusion Thoracic PVB can provide better postoperative analgesia with little side effects.

Objective To evaluate the effects and side effects of three different recruitment maneuvers (RM) in acute respiratory distress syndrome (ARDS) caused by extrapulmonary disease.Methods Forty-four patients of extrapulmonary ARDS, according to crossover design methods, were undergone three RM in different periods, including sustained inflation (SI), increase progressively positive end expiratory pressure (IP), pressure control ventilation (PCV). Heart rate (HR), mean arterial blood pressure (MAP), central venous pressure (CVP), oxygenation index, lung compliance were recorded before and after RM, and were analyzed for statistical analysis. Results Oxygenation index and lung compliance were increased obviously in a short time after RM, improvement of IP method were better more obviously than the other two methods [1 h oxygenation index after RM:227 ± 42 vs 190 ± 19,186 ± 21; lung compliance:(59.4±12.5 ) ml/cm H2O(1 cm H2O = 0.098 kPa) vs (50.1 ± 9.3 ), (49.7 ± 10.6) ml/cm H2O;P＜ 0.05], 2h after RM,there were no statistical difference among the three methods (P＞0.05). After RM,HR and CVPwere increased, MAP was decreased in a short time, changes of SI method were smaller than the other two inethods [10 min HR after RM: (94.0±10.3 ) beats/min vs (116.0 ± 14.8 ), ( 107.0 ± 5.7 ) beats/min; CVP:(13.7±3.1 )cm H2O vs ( 18.4 ± 6.7 ), ( 15.4 ± 2.7 )cm H2O; MAP: ( 87.0 ± 12.1 ) mm Hg( 1 mm Hg = 0.133 kPa) vs (73.0 ± 4.8), (81.0 ± 6.6) mm Hg;P＜ 0.05), 20 min after RM, there were no statistical difference among the three methods (P＞ 0.05). Conclusion When extrapulmonary ARDS undergo RM ,IP method is the most effective on increasing oxygenation index and lung compliance, SI method has the smallest side effect on hemodynamics.

Objective To research the clinical significance of acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients.Method Fifty-nine sepsis patients were divided into two groups:lactic acid Ringer solution and hetastarch (group A,27 cases)and acetated Ringer solution and suecinylated gelatin (group B,32 cases),compared the fluid resuscitation and other parameter.Results There were no significant difference in the central venous pressure,mean arterial pressure and the dose of noradrenaline (P ＞ 0.05).The activated partial thrombeplastin time in group A was longer than that in group B[(58±10),(74±13)s vs(48±7),(54 ±11) s in 6,24 hours],fibrinogen concentration was lower than that in group B [(3.3 ±0.8),(1.6±0.3)g/L vs (4.2±1.1),(2.1±0.2)g/L in 6,24 hours] (P＜0.05).Serum lactic acid,creatinine,calcium concentration in group A [(6.9±0.8)retool/L,(289 ~ 27)μ mol/L,(2.1 ±0.3)mmol/L]were higher than those in group B [(3.2 ±1.1)mmol/L, (193 ±42)μmol/L, (1.7±0.2)mmol/L](P＜0.05),there was no difference in APACHE Ⅲ scores on the third day between two groups (P＞0.05).Conclusions Acetated Ringer solution and succinylated gelatin in the fluid resuscitation of sepsis patients has the same effect,but fewer impacts on serum coagulation,serum lactic acid and renal function than lactic acid Ringer solution and hetastareh.They may be more suitable for fluid resuscitation of sepsis patients,but hypecalcemia is easy to happen,and there is no significant evidences proving the prognosis.

OBJECTIVETo investigate the correlation between the pathogeneses of diarrhea-pre- dominant irritable bowel syndrome (D-IBS) complicated functional dyspepsia (FD) patients of Gan-stagnation Pi-deficiency Syndrome (GSPDS) and symptoms, psychological states, and gastrointestinal hormones.

METHODSA total of 111 patients with confirmed D-IBS complicated FD of GSPDS were recruited as the treated group by using Rome III standard and Chinese medical syndrome standard. And 30 healthy volunteers were recruited as the control group. The general condition, scoring for digestive symptoms, and the distribution of GSPDS subtype of all subjects were recorded by a questionnaire, and assessed by Symptom Checklist (SCL-90; a software for psychological test developed by Beijing Huicheng Adult Cor- poration). Meanwhile, plasma levels of 5-hydroxytryptamine (5-HT), somatostatin (SS), vasoactive intestinal peptide (VIP), endothelin (ET), interleukin 10 (IL-10), and interleukin 12 (IL-12) were measured in all subjects.

RESULTS(1) The subtype of D-IBS complicated FD of GSPDS was dominant in Pi-qi deficiency type (51/111,45.9%),Pi yang deficiency type (34/111,30.6%), and GSPDS. There was no statistical difference in the scoring of digestive symptoms among the 3 subtypes (P >0.05). (2) Compared with the control group, the anxiety factor score and the total score significantly increased in all three subtypes of D-IBS complicated FD of GSPDS, and the depression score of Pi yang deficiency type and Gan-depression type also significantly increased (P <0.05, P <0.01); the depression score of Gan-depression type was significantly higher than that of the Pi-qi deficiency type (P <0.01). Plasma 5-HT levels were obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities, and VIP and IL-10 levels were significantly lower than those in the control group (P <0.05). Plasma VIP levels were also obviously lower in D-IBS complicated FD patients of GSPDS accompanied with anxiety or depression than in those with no obvious psychological abnormalities (P <0.01), and SS levels were significantly lower than those in the control group (P <0.05). There was no statistical difference in plasma ET or IL-12 levels in each patient group, when compared with the control group (P >0.05). (3) Compared with the.control group, plasma 5-HT levels significantly increased, plasma VIP and IL-10 levels significantly decreased in ach subtype of D-IBS complicated FD patients of GSPDS (P <0.05, P <0.01), and no significant change of SS, ET, or IL-12 occurred (P >0.05). Besides, plasma 5-HT levels were significantly higher in Gan-depression type than in Pi yang deficiency type, VIP levels were lower in Gan-depression type than in Pi-qi deficiency type (all P <0.05).

CONCLUSIONSGan stagnation and Pi deficiency were dominant in D-IBS complicated FD patients of GSPDS. Psychological abnormalities, increased plasma 5-HT levels, and decreased plasma VIP levels were closely correlated with Gan stagnation subtype, which provided some reference for looking for objective indicators of Chinese medical syndromes in treating D-IBS complicated FD patients of GSPDS.

Adult ; Case-Control Studies ; Diarrhea ; etiology ; Dyspepsia ; blood ; complications ; psychology ; Gastrointestinal Hormones ; blood ; Humans ; Irritable Bowel Syndrome ; blood ; complications ; psychology ; Psychological Tests ; Qi ; Serotonin ; Surveys and Questionnaires ; Yang Deficiency

Objective To reduce the rate of unscheduled nasogastric extubation for the patients in neurology department.Methods A nursing care team was set up for a thematic activity to reduce the rate of nasogastric tube unscheduled extubation.The team analysed the situations of 164 patients with nasogastric intubation in the neurology department,specifying the problems,deciding their aims and working out the strategies.Result The rate of unscheduled nasogastric extubation decreased from 19.63％ to 2.12％ and the rate of nursing omission decreased from 9.93％ to 2.59％ (P＜0.05).Conclusion The improvement activity of nursing projects can effectively reduce the rate of unscheduled nasogastric extubation and improve the quality of nursing care.