Objective To investigate the development of ICUs and critical care medicine at secondary and above hospitals in Inner Mongolia.Methods Questionnaire survey of ICUs at secondary and tertiary hospitals in Inner Mongolia Autonomous Region from October 2010 to June 2011.Results There are 76 ICUs at 26 hospitals,including 24 general ICUs and 52 special ICUs; tertiary hospitals average 2.47±0.63 special ICUs,while secondary hospital average 2.23±1.12 special ICUs; 35％ of the ICUs are subject to close-off management; general ICUs at tertiary hospitals account for 1.21％ ± 0.35 ％ of total beds of the hospital,and for 1.98％ ± 0.63％ of secondary hospitals.Regarding the ratio of physicians to ICUs beds,it is 0.75±0.15 at tertiary hospitals,and 0.62± 0.231 at secondary hospitals.As to the ratio of nurses to beds,it is 1.58 ± 0.72 at tertiary hospitals,and 1.36 ± 0.27 at secondary hospitals.Conclusion This survey showed that ICUs in Inner Mongolia Autonomous Region are acceptable in numbers,but are found with problems in insufficient beds,poor staff deployment,obsolete medical equipments and weak technical forces.Therefore,critical care medicine and ICU development should be enhanced during the second round of hospital accreditation in China.

AIM:To observe the change of nitric oxide(NO)and hydrogen sulfide(H_2S)in blood and lung homogenate of hypoxic pulmonary hypertension(HPH)rat model,and to discuss the meaning of inhalation sodium nitrite and these factors in the treatment of HPH. METHODS:Fifty healthy male Wistar rats were assigned randomly into 5 groups(10 rats each):normoxia control group(NC),normoxia sodium nitrite group(NNI),hypoxic control group(HC),hypoxic normal saline group(HNS)and hypoxic sodium nitrite group(HNI). The mean pulmonary arterial pressure(mPAP),weight of right ventricle,weight of left ventricle plus septum,and the ratio of the weight of right ventricle to that of left ventricle plus septum(right ventricle hypertrophy index,RVHI)were also determined. The serum level of NO and plasma level of H_2S were measured,and at the same time the levels of NO in the lung homogenate were detected. The structures in pulmonary arteries were examined using optical microscope. RESULTS:After model established,compared to that in the normoxia groups,the body weight decreased significantly in hypoxia groups(P<0.05),although no difference of body weight in five groups before producing model was observed. Compared to that in normoxia groups,the levels of mPAP and RVHI increased significantly in hypoxia groups,and compared to that in hypoxia control groups and hypoxia normal saline group,mPAP and RVHI levels decreased significantly in hypoxia sodium nitrite group(P<0.05). Compared to that in normoxia groups,the serum level of NO decreased significantly in hypoxia groups(P<0.05). NO level in lung homogenate decreased significantly in hypoxia control group and hypoxia normal saline group as compared to that in normoxia groups(P<0.05),and no obvious difference between hypoxic sodium nitrite group and normoxia groups was found. The plasma level of H_2S was decreased significantly in hypoxia groups(P<0.05)as compared to that in normoxia groups. H_2S level increased significantly in hypoxia sodium nitrite group as compared to that in hypoxia control groups and hypoxia normal saline group(P<0.05). Observation under optical microscope,the lumen structure of lung in normoxia control group was normal. No significant change in normoxia sodium nitrite group was found. The proliferation of smooth muscle cells(SMCs),the collagen fiber deposition in the vessel wall and every caliber thickening was observed in hypoxic control group. The same changes were also observed in hypoxic normal saline group. The thickened caliber was relieved significantly in hypoxic nitrite group. CONCLUSION:Pulmonary hypertension and right ventricle reconstitution can be relieved by inhalation of sodium nitrite,and can be regulated by the level of NO and H_2S in rats. Above all,inhalation of sodium nitrite may degrade HPH directly or by affecting the externalization and synthesizing of gas signaling molecule indirectly.

Objective To evaluate the treatment effect of later course accelerated hyperfractionated radiotherapy with chemotherapy for stage Ⅲ and ⅣA nasopharyngeal carcinoma. Methods 116 patients with stage Ⅲand Ⅳ s nasopharyngeat carcinoma were randomly divided into three groups: the conventional fractionation radiotherapy(CFR, 38 cases), the concurrent radiochemotherapy group(CCRT, 39 cases) and the later course accelerated hyperfractionated radiotherapy combined with chemotherapy group (LCAF+CT, 39cases). CFR group was treated with 60Co γ rays and X rays. When the patients had received the dose of 36～38 Gy through composite faciocervical fields, changed into preauricular fields, the total dose was 70 ～75 Gy.And the total dose of cervical metastasis lymph nodes were 70～80 Gy. CCRT group was treated with DDP and 5-Fu. LCAF+CT group was treated with accelerated hyperfractionated radiotherapy. When the dose of composite faciocervical fields had reached 36～38 Gy, changed the fields and treated with accelerated hyperfractionated radiotherapy, 1.3 Gy/fraction, twice daily. The total dose was 69.8～75 Gy. And the chemotherapy drugs was similar to CCRT group. Results The positive response rate among LCAF+CT, CCRT and CFR groups were 94.9 %, 89.7 %, 76.3 % respectively. The complete response rate in the nasopharyn of LCAF+CT group was higher than CFR group(P ＜0.05). The local control rates of one, two and three year of three groups were 100 %, 97.4 %, 89.5 %, 94.9 %, 84.6 %, 68.4 % and 89.7 %, 74.4 %, 57.9 %respectively; and the survival rates of one, two and three year of three groups were 100 %, 92.3 %, 84.2 %;89.7 %, 84.6 %, 71.0 % and 79.5%, 76.9 %, 57.9 % respectively. There were obvious difference between LCAF+CT and CCRT groups in local control rate and survival rate. But there were no difference between LCAF+CT group and CCRTgroup, and also between CCRT group and CFR group. Conclusion The later course accelerated hyperfraetionated radiotherapy combined with chemotherapy can promote disappearance of primary lesion and improve the local control rate and survival rate of patients with stage Ⅲand ⅣA nasopharyngeal carcinoma.

Aim To investigate whether ulinastatin has a beneficial effect on lipopolysaccharide( LPS) induced acute respiratory distress syndrome ( ARDS ) in rats, and to explore the possible underlying mechanisms. Methods Fifty-six Wistar rats were randomly as-signed into control group, model group( LPS 6,12,24 h groups), ulinastatin group(UTI 6,12,24 h groups), with 8 in each group. ARDS rat model was reproduced by intraperitoneal injection of LPS ( 10 mg · kg-1 ) , The rats in UTI groups were injected ulinastatin (20 000 u·kg-1), The rats in the control group re-ceived an equal volume of normal saline at the same time, rats in each group were sacrificed at 6,12,24 hours after LPS challenge. Plasma and lung tissue sam-ples were collected, Histopathological evaluation, lung wet/dry (W/D) ratio, Tumor necrosis factor-a(TNF-α) , Interleukin-18 ( IL-18 ) , surfactant protein A ( SPA) , malondialdehyde ( MDA ) , nitric oxide ( NO ) and superoxide dismutase( SOD) were analyzed. Immu-nohistochemical method was performed to detect the protein expression of p38MAPK and ERK. Western blot method was used to detect lung phosphorylated p38 MAPK ( p-p38 MAPK ) and pERK protein expres-sion changes. Result In the control groups, lung tis-sue showed a normal structure and clear pulmonary al-veoli under a light microscope. In the model group, ARDS characters such as extensive thickening of the alveolar wall, significant infiltration of inflammatory cells, demolished structure of pulmonary alveoli, and hemorrhage were found. In the all UTI treatment groups, these pathological changes in lung were markedly alleviated compared with those of LPS-in-duced ARDS group. Compared with control groups, lung W/D ratio, tumor necrosis factor-a ( TNF-α) , in-terleukin-18 ( IL-18 ) and surfactant protein A ( SPA ) in plasma ,and lung MDA,NO levels in lung homogenates in the LPS group were increased significantly, while the lung SOD levels in the LPS group were decreased. Compared with the LPS group, lung W/D ratio, TNF-aIL-18 and ( SPAin plasma , and lung MDA levels in lung homogenates in the UTI groups were decreased significantly, while the lung SOD levels in the UTI groups were increased. Immunohistochemistry showed that positive expressions of p38 MAPK and ERK in cy-toplasm and nucleus in the ulinastatin treatment groups were significantly lower than those in the model group. Western blot showed that compared with the control group, the p-p38MAPK and pERK protein expression in LPS group were significantly increased, and the uli-nastatin could inhibit the protein expressions compared with model group. Conclusion Ulinastatin can signifi-cantly ameliorate the lung injury induced by LPS in rats via the intervention of p38 MAPK and ERK signa-ling pathway and reducing inflammation and antioxidant effect.

OBJECTIVE: To purify hVEGF_(121)/EGFP fusion protein using transfected BMSCs as culture media, in addition, to detect the function of hVEGF_(121)/EGFP fusion protein in vitro.METHODS: The pEGFP-N_2-hVEGF_(121) recombinant plasmid, which was constructed in the preliminary work of our study group,was used to extract the plasmid DNA. BMSCs were transfected with pEGFP-N2-hVEGF_(121) by positive ionic liposome transfection method. Under a fluorescent microscopy, the expression of hVEGF_(121)/EGFP fusion protein was detected. The hVEGF_(121)/EGFP fusion protein was purified with Am icon ultrafiltration centrifuge tube and the expression of fusion protein was detected by Western-Blotting method.RESULTS: The BMSCs, which transfected with pEGFP-N2-hVEGF_(121), was observed under the fluorescent microscope. Western blotting confirmed that pEGFP-N_2-hVEGF_(121) fusion protein expressed in the culture media of transfected BMCS. MTT results showed the number of human umbilical vein endothelial cells in the fusion protein team was significantly greater than that in the control group (P < 0.05), and Miles test confirmed that pEGFP-N_2-hVEGF_(121) fusion protein increased the permeability of the blood vessel wall.CONCLUSION: ①This study successfully confirmed the pEGFP-N_2-hVEGF_(121) recombinant plasmid, which carrying VEGF_(121)/EGFP fusion protein, can be expressed in BMSCs.②The VEGF_(121)/EGFP fusion protein have the function of wild-type VEGF in vitro.

Oxaliplatin-loaded nanostuctured lipid carriers (OP-NLC) were prepared by ultrasonic emulsification method. And its optimal prescription was selected by orthogonal design. The laser light scattering technique, zeta potential analyzer, TEM, DSC, XRD and HPLC were employed to study the physicochemical parameters of OP-NLC, which displayed in terms of particle size, zeta potential, crystalline, drug loading and encapsulation efficiency. The results showed that OP-NLC had an average diameter of (111 +/- 20) nm, zeta potential of (-27.4 +/- 13.1) mV, encapsulation efficiency of (77.4 +/- 2.5) % and drug content of (0.8 +/- 1.5) mg mL(-1). TEM, DSC and XRD indicated that OP-NLC was spherical and the drug was dispersed as nanoparticles by means of non-crystalline. The in vitro release test showed that the drug could be sustained-released from NLC in buffer solution (pH 4.5) after a burst release in initial phase.

Objective To discuss the feasibility and accuracy of dual-source CT ( DSCT) in the evaluation of aortic stenosis ( AS) with transthoracic echocardiography ( TTE) as reference.Methods A total of 53 patients who underwent both DSCT and TTE were prospectively evaluated.All of them were assessed by TTE for aortic stenosis.Maximum aortic valve area ( AVA) in systolic phase was measured with DSCT , and was compared to that index obtained from the continuity equation on TTE.The severity of AS was graded as mild , moderate , or severe according to the AVA.Linear regression analysis and Bland-Altman plots were used to compare the AVA measured by using CT and TTE.Agreement on semi-quantitative grades of AS severity between the two methods was tested by using Kappa statistics.Results The mean AVA using DSCT was (1.45 ±0.35 ) cm2 compared to the mean AVA of ( 1.33 ±0.36 ) cm2 using TTE, with a significant correlation between them (r=0.92,P<0.01).Bland-Altman analysis demonstrated good inter-modality consistency between DSCT and TTE.However , DSCT demonstrated a slight overestimation of the AVA compared to TTE.As identified by TTE, there were 53 patients with AS, 13 with mild AS, 21 with moderate AS , and 19 with severe AS.In 3 patients DSCT showed no AS , TTE detected mild AS.In 6 cases, TTE had graded the stenosis as moderate , but the stenosis degree was graded as mild using DSCT.Kappa analysis showed a good agreement between the two methods on semi -quantitative grades of aortic stenosis severity (Kappa=0.75,P<0.01).Conclusion AVA measurements using DSCT is feasible and reasonably accurate for those patients with moderate to severe aortic stenosis.

Objective:To develop and validate a clinical prediction model for the risk of malignant ventricular arrhythmia in patients with acute myocardial infarction (AMI) during hospitalization, and evaluate the effect of the prediction model.Methods:A retrospective study was conducted. A total of 2 649 patients with AMI admitted to cardiology department of Changzhou No.2 People's Hospital of Nanjing Medical University from December 2012 to August 2020 were enrolled. The clinical characteristics including gender, age, medical history, discharge diagnosis, vital signs during hospitalization, electrocardiogram characteristics at admission, laboratory examination indexes, interventional treatment, drug usage, malignant ventricular arrhythmias [mainly included sustained ventricular tachycardia (VT), ventricular flutter or ventricular fibrillation (VF)], and death were recorded. All patients were divided into two groups according to whether VT/VF occurred during their hospitalization. Independent risk factors for VT/VF during hospitalization were evaluated by multivariate Logistic regression analysis, and a clinical prediction model was constructed. The receiver operating characteristic curve (ROC curve) was plotted, and the area under ROC curve (AUC) was calculated to evaluate the accuracy of the prediction model.Results:A total of 2 649 eligible patients with AMI were enrolled, of whom 134 (5.06%) developed VT/VF during hospitalization. The in-hospital mortality rate in VT/VF group was significantly higher than that in non-VT/VF group (38.1% vs. 1.7%, P < 0.01). Compared with the non-VT/VF group, the patients in the VT/VF group with lower systolic blood pressure [SBP (mmHg, 1 mmHg = 0.133 kPa): 125.9±28.2 vs. 132.0±24.2], higher random blood glucose (mmol/L: 8.6±4.8 vs. 7.4±3.7), worse cardiac function [Killip heart function grade ≥ 3: 36.6% vs. 10.7%, left ventricular ejection fraction (LVEF) < 0.50: 56.7% vs. 33.6%, frequent premature ventricular contractions: 12.7% vs. 1.2%] and more hypokalemia (46.3% vs. 17.3%), with significant differences (all P < 0.05). Multivariate Logistic regression analysis showed that Killip classification of cardiac function ≥ 3 [odds ratio ( OR) = 3.540, 95% confidence interval (95% CI) was 2.336-5.363], random blood glucose > 11.1 mmol/L ( OR = 1.841, 95% CI was 1.171-2.893), LVEF < 0.50 ( OR = 0.546, 95% CI was 0.374-0.797), frequent premature ventricular contractions ( OR = 12.361, 95% CI was 6.077-25.144), potassium < 3.5 mmol/L ( OR = 4.268, 95% CI was 2.910-6.259), SBP < 90 mmHg ( OR = 0.299, 95% CI was 0.150-0.597) and creatinine (Cr) > 100 μmol/L ( OR = 2.498, 95% CI was 1.170-5.334) were independent risk factors for VT/VF in patients with AMI (all P < 0.05). The clinical prediction model of VT/VF risk was constructed based on the variables selected by multivariate regression analysis. The ROC curve analysis showed that the AUC of the model in predicting VT/VF was 0.779 (95% CI was 0.735-0.823, P < 0.001); the optimal cut-off value of the model was 17, the sensitivity was 76.1%, the specificity was 67.3%. Conclusions:The incidence of VT/VF during hospitalization of AMI patients significantly increases the risk of in-hospital death. The independent risk factors of VT/VF are Killip grade ≥ 3, random blood glucose > 11.1 mmol/L, LVEF < 0.50, frequent ventricular premature beats, potassium < 3.5 mmol/L, SBP < 90 mmHg and Cr > 100 μmol/L. The newly constructed clinical prediction model has certain predictive value for the occurrence risk of VT/VF.

Objective To understand the occurrence situation of negative life events in the past year among college students with suicidal ideation and to explore the correlation between negative life events and suicidal ideation. Methods The stratified and cluster sampling method was applied to conduct the questionnaire survey on 12 114 students from 11 universities in Chongqing City. The questionnaire of general demographic information was used to learn sociodemographic characteristics;the perspective on personal life questionnaire was applied to evaluate the suicidal ideation within recent 1 month and the self-designed life event scale was used to investigate the occurrence of negative life events in the past 1 year. Results The report rate of suicidal ideation within 1 month was 9.6%, the occurrence rate of short term suicidal ideation was increased with experiencing more negative life events. The x2 test showed that there was statistically significant difference in the proportion of suicidal ideation occurrence between college students experiencing 1 negative life event and those without experiencing the negative life event (x2 = 37.72,P<0.01) ;besides, the occurrence proportion of recent suicidal ideation had statistical difference between the college students with experiencing two or more negative life events and those without experiencing negative life event (x2 = 65.46,P<0.01). The multivariate Logistic regression analysis showed that the conflict with other family members (OR=0. 295,95%CI 0. 017-0. 571),abuse (OR=7. 295, 95%CI 6. 049-9. 701) were independentrisk factor for the recent suicidal ideation in college students. Conclusion Experiencing more negative life events, conflicting with other family members and abused by others have a correlation with the appearance of short term suicidal ideation in college students.

Objective To explore the prevalence and epidemic characteristics of overweight, obesity, and central obesity in Shanghai Pudong New Area. Methods Multi-stage stratified random sampling method was conducted in Pudong New Area in 2013. Residents over 15 years old were randomly selected from 13 communities and participated in the cross-sectional study. A structured questionnaire was used to collect the information and physical examination, biochemical assays were also conducted. SPSS 20. 0 was used to analyze the results. Results The averagebodymassindexofparticipantswas(25.04±3.79)kg/m2andtheaveragewaistcircumferencewas(82.44± 9. 51) cm. The prevalences of overweight, obesity, and central obesity were 41. 67%, 17. 70%, and 31. 32%respectively. Standardized prevalences of overweight, obesity, and central obesity were 34. 39%, 16. 96%, and 25. 66% respectively, according to 2010 national age composition of population. Statistically significant sex differences were found among the prevalence of overweight, obesity, and central obesity groups(all P<0. 05). The prevalence of central obesity in female was raised by increasing age. Residents with hypertension, hyperglycemia, dyslipidemia, and metabolic disorders had higher prevalences in overweight, obesity, and central obesity ( all P<0. 05). Conclusion The prevalences of overweight, obesity, and central obesity among the residents in Shanghai Pudong New Area were relatively high. Relevant risk factors should be explored to promote health education that may enhance people′s awareness of weight management.