Objective To evaluate the effect of de-escalation therapy of antimicrobial agents on the treatment of ventilator assoeiated pneumnonia(VAP).Methods 40 VAP patients were evaluated.17 cases were treated by de-escalation therapy of antimicrobial agents,the rest were treated by routine therapy.Results The achievement ratio of machine removing was superiorer to that of routine therapy(P1 week) received de-escalation therapy of antimicrobial agents whose average duration of ventilation was shorter than that treated by routine therapy(P

In recent years the incidence of acute kidney injury (AKI) has increased, with a high mortality rate and poor prognosis.The key of improving the prognosis of AKI is early diagnosis and intervention.Due to the lack of biomarkers of early diagnosis in AKI, the effective early treatment is generally delayed.Traditional diagnosis biomarkers such as serum creatinine and blood urea are delayed and affected by various factors.Recently, some new potential early diagnostic biomarkers have been found.MicroRNA(hereinafter referred to as the miRNA) is a kind of endogenous non-coding small RNA, and studies have shown that it is related to the development of AKI.

Objective To explore the effects of resistance exercise on intradialytic blood pressure variability and the lowest blood pres-sure. Methods From September, 2015 to March, 2016, 80 patients with intradialytic hypotension frequently during maintenance hemodialy-sis were included, and divided into control group (n=40) and intervention group (n=40) by drawing lots. Both groups accepted routine nurs-ing, while the intervention group accepted resistance exercise during hemodialysis. The coefficient of variation (CV) of blood pressure and the lowest blood pressure were compared twelve weeks later. Results The CV of systolic blood pressure was less in the intervention group than in the control group (t=-4.356, P<0.001), while the lowest blood pressure, both systolic and diastolic, were more (t>4.122, P<0.001). Conclusion Resistance exercise may reduce the intradialytic systolic blood pressure variability and increase the lowest blood pressure in pa-tients with frequent intradialytic hypotension.

Warfarin is widely used as one of the coumarins anticoagulation drugs in the clinical.Every physician has been disturbed by its narrow therapic index and bleeding complications.It is a difficult thing for the doctor to use it rationally.However,recently,with the rapid development of molecule biology,some research find that gene polymorphism of pharmacodynamics and pharmacokinetics cause the individual variability in drug response.In this review,we focus on the latest development in pharmacogenomics of warfarin at home and abroad in order to give some suggestions for the individual use of warfarin.

Functional experiment plays an important role in basic theory and clinical practice. For training high-quality medical talents in medical colleges,many improvements have been made in the functional experiment teaching and certain effects have been obtained. But a comprehensive evalu-ation system was still needed. Clinical medical students of 2010 grade were taken as the appraisal objects. Assessment content,methods and standards were designed according to the basic requirements of functional experiment. Students were evaluated by ordinary performance,test papers and experiment competition. Practice showed that the system was of significant importance in improving the experi-mental teaching quality and developing students' practical ability and comprehensive quality.

Objective To investigate the effects of orexin-A on learning and memory of pentyleneterazol (PTZ)-kindled epileptic rats.Methods Adult Wistar rats were randomly divided into control group(normal saline,NS)and PTZ group.The PTZ-kindled rats were randomly divided into,orexin-A group and NS group administrated by intracerebroventricular(i.c.v.)injection of 10μl orexin-A(1.4 nmol/μl)or 10μl NS.Using Morris water msze experiment,the ability of learning and memory was measured in all rats.Results Eighty percent of rats in PIZ group were kindled successfully after intraperitoneal injection of 35mg/kg PTZ every day for 30 days.Compared to control group,the escape latency in the PTZ-kindled rats was significantly increased in place navigation test(PNT)(F=200.956,P<0.01),whereas a remarkable reduction of time spent in the target quadrant and number of pool circlings in 120 seconds Was observed during probe trials.Following injection of orexin-A,the latency of escape platform was significantly declined in both PTZ-kindled((39.73±2.03)8,(33.76±2.96)s)and NS rats,increased the number of crossing the platform(10.83±1.80)vs(4.67±3.34).In addition,the treatment with orexin-A markedly increased swim velocity and number of pool circlings in beth groups(P<0.01),particularly to the PTZ-kindled rats.Conclusion Spatial learning and memory in the PIZ-kindled rats can be improved by treatment with orexin-A.

ObjectiveTo explore the role and mechanism of NGAL in the process of hypoxia/ reoxygenation (H/R) injury in human renal tubular epithelial cell (HK-2).MethodsThe H/R model of HK-2 cells was established in vitro (oxygen concentration ＜ 0.1％ ).The expressions of NGAL in the cells of H/R group and control group were determined by WB and real-time RT-PCR.The cell models were treated with 50,100,200,400 and 1 000 ng/ml of recombinant NGAL respectively.Cell proliferation and apoptosis of the treated groups and control group were detected by the MTT assay and Annexin V-FITC/PI staining to determine the appropriate NGAL concentration.The cell cycle distributions in the H/R group,NGAL treated H/R group and control group were detected by flow cytometry,and the expressions of bax/bcl-2 and caspase-3 were measured by real-time RT-PCR.The experiments were triplicated to obtain the mean values.Results The protein expression of NGAL/actin in H/R group (5.875 ±0.081 ) was higher than that of the control group ( 1.513 ±0.032),the differences between the two groups had statistic significance (t =96.89,P ＜0.05). While the gene expressions of NGAL/actin in HL/R groups (12.32 ± 1.27 ) and control group ( 1.00 ±0.00) had statistical significance of difference ( t =15.40,P ＜ 0.05 ).In MTT assay,the absorption values of the H/R group and control group were 0.97 ± 0.03 and 0.56 ± 0.04,the differences had statistic significance( t =18.680,P ＜ 0.05 ).And the absorption value of cells treated with different concentrations of NGAL (50,100,200,400,1 000 ng/ml) were 0.56±0.04,0.53 ±0.03,0.56 ±0.04,0.53 ± 0.03,0.54 ± 0.02,respectively.There were no significant differences between the H/R group and NGAL treated groups ( F =0.978,P ＞ 0.05 ),but the differences of absorption values in the control group and other groups had statistical significance ( F =105.20,P ＜ 0.05 ).The ratios of early apoptotic cells ( Annexin V positive,PI negative) in the control group and the H/R group were ( 1.0 ±0.2) ％ and ( 27.6 ± 1.4 ) ％ respectively with a statistical significance of difference ( t =33.590,P ＜0.05 ).After the treatment of NGAL ( 50,100 ng/ml),the ratios were ( 27.8 ± 1.1 ) ％ and ( 26.4 ±1.3 ) ％ and there were no significant differences compared to the H/R group ( t =0.250,P ＞ 0.05 ).When the H/R model was treated with 200 ng/ml of NGAL,the ratio of early apoptotic cells dropped to ( 19.4 ± 0.6) ％,leading to a statistical significance of difference ( t =10.350,P ＜ 0.05 ).However,in the H/R model treated with high concentration of NGAL (400,1 000 ng/ml),the ratios were ( 19.3 ± 1.1 )％ and ( 18.9 ±0.5 ) ％,which had no significant differences compared to the cells treated with 200 ng/ml of NGAL (t =0.130,0.630; P ＞0.05).Thus the study chose 200 ng/ml as the appropriate treating concentration of NGAL.In the control group,H/R group and 200 ng/ml,NGAL treated HR group,PI values were (30.2 ±0.4)％,(22.1 ± 2.7 )％ and (23.2 ± 3.7 )％ respectively.There were no significant differences between the H/R group and NGAL treated group (t =0.510,P ＞0.05),but there was still statistical significance in difference among the control group and the treated groups ( F =8.28,P ＜ 0.05 ).The ratio of bax/bcl-2 and the expression of caspase-3 detected by real-time RT-PCR were 1.00 ± 0.00,1.00 ± 0.00 in the control group,5.83 ±0.33,8.13 ±0.20 in the H/R group and 2.52 ±0.07,1.89 ±0.02 in the NGAL treated H/R group.The bax/bcl-2 ( F =485.30,P ＜ 0.05 ) and caspase-3 ( F =3456.78,P ＜ 0.05 ) did have statistical significances of difference among the three groups.ConclusionsNGAL acts as a protective factor against hypoxia-reoxygenation injury by regulating pro-apoptotic genes.It provides a new idea and evidences for the treatment of AKI caused by ischemia-reperfusion injury.

Objective To observe the effects of Bushen Huoxue Decoction on clinical symptom, vertigo degree and cognitive function for elderly patients with chronic cerebral circulation insufficiency (CCCI); To explore its possible mechanism. Methods Totally 70 cases were randomly divided into observation group and control group according to the random digits table method, with 35 cases in each group. The two groups were given Western medicine consisting of blood pressure control, glucose control and blood lipid control. Based on this, the control group was given Flunarizine Hydrochloride capsules, 5 mg once a day orally before sleeping. The observation group was given Bushen Huoxue Decoction, one dose a day and taken twice a day. The treatment lasted for 30 days. The TCM symptom score, Chinese version of dizziness handicap inventory (DHI) and Montreal cognitive assessment (MoCA) score were observed. The mean blood flow velocity (Vm) of basilar artery (BA), bilateral vertebral artery (VA), bilateral middle cerebral artery (MCA) and the content of plasma acid phospholipid (AP) were detected, and the clinical efficacy was evaluated. Results The total effective rate of the observation group was 94.3％ (33/35), which was significantly higher than that of 82.9％ (29/35) in the control group, with statistical significance (P<0.05); after treatment, the TCM symptom score, DHI score, and the content of plasma AP were significantly lower than those of pre-treatment in the same group (P<0.05); the MoCA score and the Vm of VA, LBA, RBA, LMCA, RMCV were significantly higher than those of pre-treatment in the same group (P<0.05); the TCM symptom score, DHI score, MoCA score, the Vm of LVA, LMCA, RMCA and the content of plasma AP in the observation group were improved better than those in the control group, with statistical significance (P<0.05). Conclusion Bushen Huoxue Decoction has an obvious therapeutic effects for elderly patients with CCCI, which can improve clinical symptom, vertigo degree and cognitive level, which possible mechanism is related to increasing the cerebral blood flow velocity and reducing the content of plasma AP.

This study was aimed to optimize optimum preparation process of 5,7,3',4'-O-tetramethylquercetin (TMQ). With 5,7,3',4'-O-tetramethylrutin as raw material, TMQ was prepared by acidic aqueous solution method. The preparation process of TMQ was optimized by single factor test and orthogonal test. The results showed that the optimum technology conditions were ethanol concentration at 0, temperature at 80℃, hydrochloric acid concentration at 0.50%, and the hydrolysis time for 1.0 h. It was concluded that the optimum preparation process had the charac-teristics of high yield, simple process, stable and feasible.

Objective To explore the clinical characteristics of Chronic obstructive pulmonary diseases(COPD)(≥65 years old,acute episode)with active pulmonary tuberculosis.Methods62 of COPD(≥65 years old,acute episode)with active pulmonary tuberculosis from 2002 to 2007 in hospital were reviewed and analyzed.ResultsThe attack rate of active pulmonary tuberculosis is 7.3% in COPD(≥65 years old,acute episode).By Clinical analysis showed clinical manifestation and chest X-ray or CT were not typical,but positive morbility of acid-fast bacilli sputum smear and bronchoalveolar lavage fluid was higher.ConclusionThe result suggests that COPD(≥65 years old,acute episode)patients are high-risk group of active pulmonary tuberculosis and need to be diagnosed early as soon as possible.