Objective To investigate the clinical effect and nursing methods of bilevel positive air-way pressure(BiPAP)ventilation in patients with neurogenic pulmonary edema(NPE).Methods Totally 11 NPE patients from January 2004 to December 2007 were enrolled.Ventilation support adopted specific invasive BiPAP mode of Puritan-Bennett840.Aiway pressure release ventilation(APRV)tactics was ap- plied in this mode.The blood oxygen saturation rote(SpO2),acidity-alkalinity(pH),arterial oxygen pres-sure(PaO2),arterial carbon dioxide pressure(PaCO2)were analyzed and compared between synchronized intemittent mandatory ventilation(SIMV)mede2 h and 24 h after BiPAP ventilation.Results Among,arterial blood gas analysis of 11 patients,SpO2 and PaO2 were obviously ameliorated after BiPAP ventilation compared with SIMV ventilation.No side-effect occurred.Conclusions The application of invasive Bi- PAP ventilation support in NPE patients proved to be a fast and effective method.

In the Jinsong district of Beijing,345 patients with dyslipidemia were selected for study.Health management was implemented for one year,during which time,monitoring,analysis,and evaluation of the health of individuals and groups was conducted; health advice and guidance were given with regard to health risk factors.After the one-year intervention,the average daily dietary intake of salt,oil,and meat was reduced by 2,4,and 18 g,respectively,and the average daily intake of vegetables increased by 45 g.The average levels of body mass index,systolic blood pressure,diastolic blood pressure,total cholesterol,triglycerides,and low-density lipoprotein cholesterol were reduced by 0.47 kg/m2,3.0 mm Hg ( 1 mm Hg =0.133 kPa),1.6 mm Hg,0.76 mmol/L,0.83 mmol/L,and 0.42 mmol/L,respectively,while the average level of high-density lipoprotein cholesterol increased by 0.05 mmol/L.All the differences were significant.

Objective To observe the efficacy and untoward reactions of FOLFOX4 regimen and XELOX regimen in the treatment of patients with advanced colorectal cancer.Methods Fifty four advanced colorectal cancer patients were randomly divided into two groups.Group A (FOLFOX4):28 patients were treated with oxaliplatin 85 mg/m2 on day 1,LV 200 mg/m2 as a 2h infusion followed by bolus 5 -FU 400 mg/m2 and a 24h infusion of 5 -Fu 600 mg/m2 ,repeated for consecutive days every 2 weeks.One cycle was 14 days and efficacy was evaluated after 4 cycles.Group B(XELOX):26 patients were treated with oxaliplation 130mg/m2 on day 1,capecitabine 1 000 mg/m2 orally daily for 14 days.One cycle was 21 or 28 days and efficacy was evaluated after 2 cycles.Efficacy of the two groups was evaluated at 2 cycles.Results All 54 patients were available for evaluating objective response.In A group,the overall response rate was 46.4%,and the overall response rate was 42.3% in B group.The overall response rate of A group was slightly higher than B group,but there was no statistically significant difference(χ2 =0.093,P =0.791 ).Adverse reactions:thrombocytopenia incidence rate and the peripheral nerve toxicity had no significant differences between the two groups(χ2 =0.552,0.108,P =0.550,0.787).The incidence rates of nausea, vomit,diarrhea and leucocytopenia in B group were lower than those in A group(χ2 =9.495,4.862,6.273,P =0.003,0.033,0.108).The incidence rate of hand -foot syndrome was higher in B group than in A group(χ2 =13.389,P =0.000),but the severity was less(grade Ⅰ ~Ⅱ).Conclusion The response rate in the treatment of advanced colorectal cancer was similar between XELOX and FOLFOX4 regiments,but XELOX regiment has the advantages of more convenience,better safety.Thus,XELOX regiment is worth recommending as a first -line therapy for the treatment of patients with advanced colorectal cancer.

Objective To observe the clinical effects of pemetrexed alone or pemetrexed combined with platinum in the treatment of advanced non -squamous non -small cell lung cancer who failed first line therapy. Methods 34 patients with advanced NSCLC who had failed to previous chemotherapy and all of these patients had been confirmed with pathology or cytology.Pemetrexed monotherapy group included 14 cases and pemetrexed plus platinum group included 20 cases.21 days as one cycle.All patients who received 2 or more cycles could be evaluated. Results No complete response (CR)occurred.There were 3 cases of partial response (PR),15 cases of stable disease(SD)and 16 cases of progressive disease(PD)in the 34 patients.The disease control rate was 52.9%(18 /34).The median progressive free survival was 2.7 months.The major toxic reaction included leucopenia,anemia and gastrointestinal response.Conclusion Pemetrexed or pemetrexed combined with platinum can prolong the survival time of some patients of non -squamous non -small cell lung cancer who failed first line therapy.The toxic effects can be tolerated.

Objective:To investigate the expression of MMP-1 and PTEN protein in basal cell papilloma (BCP), as well as their correlation with skin photoaging. Methods:Immunohistochemistry technique via Elivison method was employed to measure the expres-sion of MMP-1 and PTEN protein in lesions from 50 cases of BCP on exposed areas, 50 cases on non-exposed areas, and 30 normal controls. We compared the differences among the three groups and analyzed the result. A total of 90 BCP cases on exposed areas were randomly divided into three groups. Titanium dioxide cream and placebo were respectively applied in the trial groups twice daily for 12 weeks, whereas the control group was non-administered. After 12 weeks, the MMP-1 in the lesions of the three groups was measured and compared. Results:The expression scores of MMP-1 on exposed areas were significantly higher than those in the control group (P<0.01). No significant difference was found between non-exposed areas and the control group (P>0.05). The expression scores of PTEN protein on exposed areas and on non-exposed areas were significantly lower than that in control group (P<0.01). The expression scores of MMP-1 in the group that used titanium dioxide were evidently lower than those in control group after 12 weeks (P<0.05). Conclu-sion:MMP-1 is overexpressed in BCP on exposed areas. PTEN protein is underexpressed in BCP of exposed areas and non-exposed ar-eas. Skin photoaging is a possible cause of BCP on exposed areas.

Objective To investigate the diagnosis and treatment of anticoagulation complication,heparin-induced thrombocytopenia (HIT),induced by low-molecular-weight heparin (LMWH) after joint replacement.Methods Retrospectively analyzed the clinical manifestations,treatment and prognosis of 4 patients after total knee arthroplasty (TKA) suffered from HIT induced by LMWH.Results The morbidity rate of HIT induced by LMWH was 0.3％(4/1376).Platelets were found less than 70 × 109/L after 4-9 d,minimum to 16 × 109/L.Different level of cardiorespiratory distress and lower extremity deep venous thrombosis all appeared.Once diagnosed,patients were immediately stopped using LMWH and replaced with argatroban,fondaparinux or rivaroxaban and warfarin.Deep vein thrombosis gradually disappeared and cured in 3 patients after treatment.One patient suffered cerebral hemorrhage and multiple pulmonary embolism,received craniotomy hematoma removal and decompressive craniectomy.But the patient didn't wake up after 1-month treatment,became a vegetative one.Conclusions HIT is rare but dangerous,which can result in deep vein thrombosis,pulmonary embolism,cerebral hemorrhage and other serious consequences.Early diagnosis and timely treatment can reduce the rate of disability and mortality.

Objective:To investigate the effects of TLR/STAT pathway in the proliferation of mesangial cell induced by HMGB1.Methods:Human mesangial cells were inoculated in the dose of 1?104 ml-1.After 24 h,cells were cultured with standard medium as control group or with medium supplement with 10 ?g/L human recombinant protein HMGB1 as trial group in vitro.Then the cells were collected in 6,12 and 24 h respectively,as well as control group cells.Immunocytochemical staining was adopted to examine the expressions of PCNA proteins on mesangial cells in different groups.Immunocytochemical staining and FCM were performed to detect the changes of TLR2 protein expression.STAT1 and STAT3 mRNA were examined by RT-PCR technique.Results:Immunocytochemical staining indicated that the mesangial cells could multiply after they were induced by human recombinant protein HMGB1.Immunocytochemical staining showed that the level of TLR2 protein in trial groups were higher than those in control groups.FCM indicated that HMGB1 could significantly up-regulate the expression of TLR2 protein time-dependently.The STAT1 and STAT3 mRNA in HMGB1 groups were higher than those in control groups.The expression of TLR2 protein was positively correlated with those of STAT1 and STAT mRNA respectively.The positive rate of PCNA was remarkably correlated with the expression of STAT1 and STAT3 mRNA.Conclusion:HMGB1 could activate STAT1/STAT3 through combining with its cell-surface receptor TLR2,which may play an important role in promoting the proliferation of mesangial cells and then damaging the renal of lupus nephritis.

10.3969/j.issn.1000-3606.2013.06.005

Objective:To investigate the expression and mechanism of NF-κB signal pathway in murine lupus nephritis.Methods:The BXSB mice as well as C57BL/6 of 16 weeks were used.Transmission electron microscope and PAS were used to detect the pathological change of renal tissue.RT-PCR and ELISA were used to detect the expression of HMGB1 mRNA and protein.The expression of HMGB1,p- NF-κB,RAGE,IκB and PCNA protein was detected by immunohistochemical stain,FCM and Western blot.Results:The level of BUN in serum and Micro-albumin in urine of BXSB mice was higher than that in C57BL/6 mice.The expression of HMGB1 mRNA and HMGB1 protein level in peripheral blood increased significantly in BXSB group.Compared with those in control group,electron microscopy and PAS revealed the thickness of glomerular basement membrane(GBM),fusion of foot processes partly of epithelial dell and subepithelial electron-dense deposits in the renal tissue of BXSBA mice.Compared with that of control group,expression of PCNA was higher in glomeruli of BXSB mouse.HMGB1 protein over-expression localized in cytoplasm and extracellular milieu,especially in proliferative glomeruli in BXSB group,while the HMGB1 protein primarily confined to the nuclear of tubule in control group.In BXSB group,the expression of p-NF-κB and RAGE increased,while the expression of IκB decreased.There were positive correlation between the expression of HMGB1,RAGE and p-NF-κB protein (r=0.833,0.621,0.848,P＜0.01),while the expression of p-NF-κB protein negatively correlated with that of IκB.Conclusion:HMGB1 could activate NF-κB through combining with its receptor-RAGE,induce the form of proliferative glomerulonephritis by promoting the proliferation of inherent cell of glomeruli,which may play an important role in the murine lupus nephritis.

Objective To investigate the relationship between the effect of high mobility group protein box 1 (HMGBI) on the renal injure of systemic lupus erythematosus (SLE) and the expression of Toll-like receptor 4(TLR4). Methods The level of HMGB1, MMP-2 and TIMP-2 in serum from 16 pa-tients with SLE, 18 patients with lupus nephritis(LN) and 12 healthy people were measured by ELISA. The fresh peripheral blood mononuelear cell (PBMC) were isolated and the total RNA was extracted. Then the mRNA expression of HMGB1 was amplified by RT-PCR. Flow cytometry analysis was performed to study cell surface markers and the expression of TLR4. Results RT-PCR and ELISA results showed that the expres-sions of mRNA and level of HMGB1 protein in serum were higher in patients with LN than those in SLE and healthy people. The expression of TLR4 in CD14+ monecytes of patients with LN was higher than that with SLE and healthy people, while there were no significance in CD3+ T cells among LN, SLE and healthy peo-ple. The expressions of MMP-2 and TIMP-2 in serum of LN was lower than that in SLE and healthy people, at the same time the ratio of MMP-2/TIMP-2 decreased in LN group. HMGB1 mRNA and CD14+/TLR4+ was negatively correlated with the ratio of MMP-2/TIMP-2, and the level of HMGB1 in serum was positively correlated with proteinuria, while negatively correlated with the ratio of MMP-2/TIMP-2 in LN. Conclusion HMGB1 is one of the important cytokine in the pathogenesis of lupus nephritis. HMGBI might play a role in proteinuria of lupus nephritis in part via TLR4 pathway to activate monocytes and decrease the expression of MMP-2/TIMP-2.