Objective To compare the effects of dexmedetomidine on the respiration and circulation with midazolam in mechanically ventilated patients.Methods A total of 62 patients supported with mechanical ventilation in medical intensive care unit were randomly (random number) divided into two groups:midazolam group ( group A,n =38 ) and dexmedetomidine group ( B group,n =24).The patients in group A were intravenously administered with midazolam in bolus dose of 0.05 mg/kg given over 30 - 60 s,and then maintained with 0.05 -0.15 mg/(kg ·h) by venous pump.The patients in group B were intravenously administered dexmedetomidine in bolus dose of 1.0 μg/kg given in more than 10 min,and then maintained with 0.2 - 0.7 μg/( kg · h) by venous pump.When the patients' sedation degree were required to reach Ⅲ - Ⅳ Ramsay Grade,the heart rate,mean arterial pressure,respiratory rate and SpO2 before sedation were compared with those 10 min,30 min and 2 hours after sedation between two groups.Results Respiratory rate or heart rate after sedation significantly decreased compared with those of presedation ( P ＜ 0.05 ).Blood pressure after sedation did not decrease significantly compared with that of presedation in Dexmedetomidine group.In midazolam group,blood pressure was (83.11 ± 12.95 ) mm Hg before sedation,and there was a significant decrease to (74.13 + 12.50) mm Hg in 10 min after sedation (P ＜ 0.05 ),while there were no significant difference between ( 80.53 + 12.93 ) mm Hg 30 min after sedaton and (82.47 ± 12. 15 ) mm Hg 2 hours after sedation.Conclusions There is no difference in effects on respiration of mechanically ventilated patients between dexmedetomidine and midazolam,and the effect of dexmedetomidine on circulation was less than that of midazolam.

Objective To observe different effects of cyclic and continuous nutrition infusion on serum nutritional indicators, peripheral white blood cell counts (WBC), arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and acute physiology and chronic health evaluation Ⅲ (APACHE Ⅲ ) score in patients with mechanical ventilated respiratory failure (MVRF).Methods A cross-over and self-controlled trial was conducted in 48 patients with MVRF treated in a medical intensive care unit during December 2006 to June 2009, and continuous nutrition (group A) and cyclic nutrition (group B) were infused respectively for patients of the two groups.Serum levels of albumin (ALB), pre-albumin (PA), transferrin (TR), PaO2, PaCO2, WBC and APACHE Ⅲ score were measured for the patients with 24-hour continuous nutrition (group A) and 16-hour cyclic nutrition (group B)infusion.Effects of the two nutritional therapies were compared.Results After nutrition infusion, serum levels of ALB, PA and TR were (34±3)g/L, (196±28)mg/L and (2.1±0.3 ) g/L in group A, and (35 ±4) g/L, (198 ±25) mg/L and (2.0 ±0.4) g/L in group B, respectively; and PaO2 and PaCO2levels were (92 ± 12) mm Hg ( 1 mm Hg =0.133 kPa) and (42 ± 10) mm Hg in group A, and (91 ±9)mm Hg and (42 ± 10) mm Hg in group B, respectively.WBC and APACHE Ⅲ score were ( 11.8 ± 1.7) ×109/L and 38 ±7 in group A, and ( 12.6 ± 1.2) × 109/L and 40 ±6 in group B, respectively.Significant difference in serum levels of PA and TR was found between the two groups (PPA =0.019 and PTR =0.013),while there was no significant difference in other indictors between the two groups.Conclusions 24-hour continuous nutrition infusion for patients with MVRF can obviously improve their serum levels of PA and TR,but has no effect on serum level of ALB, PaO2, WBC and APACHE Ⅲ score in critical ill patients, as compared to those with 16-hour cyclic nutrition infusion.

Objective:To investigate the protective effects of Ghrelin on LPS-induced apoptosis of human alveolar epithelial A549 cells,along with the possible molecular mechanisms.Methods: CCK-8 assay was used to examine the cell viability of A549 treated by LPS.Apoptosis of A549 cells was measured by TUNEL.NO(Nitric oxide)production was detected by NO-specific fluorescent probe 3-Amino,4-aminomethyl-2′,7′-difluoresceindiacetate(DAF-FM DA).Western blot was also performed to examine the expressions of iNOS(inducible nitric oxide synthase),AKT,ERK,p-AKT,p-ERK and apoptotic proteins,such as Bcl-2,Bax,and cleaved caspase-3.Results: LPS exposure impaired cell viability and increased apoptosis of A549 cells significantly in concentration-and time-dependent manners accompanied with increased Bax and cleaved caspase-3 production,coupled with decreased Bcl-2 levels.Meanwhile,LPS promoted iNOS expression and the production of NO.Ghrelin pretreatment ameliorated LPS-caused alterations in the ratio of Bax/Bcl-2 and cleaved caspase-3 expression.TUNEL analysis showed that Ghrelin could decrease the apoptosis induced by LPS in A549(P<0.05).Simultaneously,LPS remarkably decreased the expression of p-AKT and p-ERK in A549 cells,which was abrogated by Ghrelin pretreatment.However,Ghrelin had no significant effect on NO production induced by LPS.Conclusion: Ghrelin reduces LPS-induced apoptosis of human alveolar epithelial cells partly through activating the AKT and ERK pathway,but the level of iNOS derived NO could not be reduced.

Objective To determine the diagnostic and assessment value of soluble urokinase plasminogen activator receptor (suPAR) level in septic patients.Methods Totally 82 septic patients in the Department of Intensive Care Unit of The First Affiliated Hospital,Sun Yat-Sen University were prospectively analyzed from June 2013 to March 2014.Another 29 patients with systemic inflammatory response syndrome (SIRS) and 15 healthy subjects served as controls.Septic patients were divided into sepsis group (n =27),severe sepsis group (n =27) and septic shock group (n =28) according to the severity,and there was no significant difference in age and sex among these groups.Measurement of plasma suPAR,serum procalcitonin (PCT) and C-reactive protein (CRP) levels,and calculation of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were performed.Comparison of group differences for continuous variables was done by oneway ANOVA or nonparametric Kruskal-Wallis test.Spearman rank correlation analysis was applied to establish the relation between variables.Receiver operating characteristics (ROC) curve was created and area under curve (AUC) was calculated to determine the diagnostic value of these variables in sepsis.Results The levels of plasma suPAR in SIRS group,sepsis group,severe sepsis group,septic shock group,and healthy control group were (8.22±0.61),(11.45±1.12),(12.99±1.28),(15.75± 1.23) and (4.65 ±0.30) ng/mL,respectively.Plasma suPAR levels in SIRS group and sepsis group were higher than that in healthy control group (P ＜ 0.01),and elevated plasma suPAR was accompanied by increased severity of sepsis (P ＜ 0.05).PCT levels of sepsis group (17.66 ± 8.42) ng/mL,severe sepsis group (9.67 ±3.56) ng/mL and septic shock group (29.19 ± 10.78) ng/mL were greater than that in SIRS group (1.10 ± 0.78) ng/mL,P ＜ 0.01.CRP levels elevated in all groups,but there were no significant differences among them.When suPAR and CRP were applied to distinguishing sepsis from SIRS,the AUC values from suPAR and combination of suPAR and PCT were 0.817 (P ＜ 0.01,95 ％ CI:0.714-0.921) and 0.927 (P＜0.01,95％ CI:0.870-0.985),respectively.Using9.52 ng/mL suPAR as the best cut-off to distinguish sepsis from SIRS,there were 71.93％ sensitivity and 95.46％ specificity.The levels of plasma suPAR positively correlated with PCT levels (r =0.326),APACHE Ⅱ score (r =0.492) and SOFA score (r =0.386),P ＜ 0.01.Conclusions Plasma suPAR levels significantly elevated in septic patients and correlated with the severity of sepsis.Sepsis and SIRS may be discerned by plasma suPAR levels.Joint use of suPAR and PCT could greatly increase the specificity of diagnosis of sepsis.

Objective To explore the relationship among clinicians' work pressure,perceived social support and compassion fatigue,and to provide a new prospective for the localization studying of intervention and treatment to compassion fatigue.Methods Data of scale for occupational stressors on clinician,perceived social support scale and professional quality of life scale were collected from a sample of 533 clinicians and analyzed with structural equation modeling to study the relationship among clinicians' work pressure,perceived social support and compassion fatigue.Results (1)Work pressure(2.40±0.45),burnout (2.14±0.54) and secondary traumatic stress(1.93±0.60) scores of the clinicians with high perceived social support were significantly lower than that of the clinicians with low perceived social support (2.78±3.67,2.73± 0.59,2.32±0.71;t=7.68,-9.44,8.77,5.07;P＜0.01).Compassion satisfaction scores (4.15±0.63) of the clinicians with high perceived social support were significantly higher than that of the clinicians with low perceived social support (3.40±0.71,t =-9.44,P＜0.01).(2) According to relevant results,work pressure was significantly negative correlation with both perceived social support (r=-0.34,P＜0.01) and compassion satisfaction (r=-0.44,P＜0.01),and significantly positive correlation with both burnout (r=0.69,P＜0.01) and secondary traumatic stress(r=0.53,P＜0.01);while perceived social support was significantly positive correlation with compassion satisfaction (r=0.42,P＜0.01),and significantly negative correlation with burnout (r=-0.40,P＜0.01) and secondary traumatic stress(r=-0.26,P＜0.01).(3) According to the results of structural equation modeling,perceived social support played a partly mediating role in the effect of work pressure toward compassion satisfaction and fatigue with the intermediary effect of 55.4％ and 12.5％.Conclusion Perceived social support plays a mediation role between work pressure and compassion fatigue for clinicians,and better social support of the clinician is beneficial to clinicians mental health level.

OBJECTIVETo study the correlation of polymorphisms of CYP1A1 MSPI and glutathiones S-transferase (GST-M1) independently and in combination with the risk of lung cancer.

METHODSA case control study which included 91 cases of lung cancer and 138 controls collected from the First Affiliated Hospital of Sun Yat-sen University of Medical Sciences, Guangzhou Tumor Hospital and The Red Cross Hospital of Guangzhou or conmunity area. All subjects were investigated with a uniform questionnaire. Blood samples were collected from all cases and controls for detecting CYP1A1 MSPI and GST-M1 polymorphisms which were analyzed by PCR and RFLP.

RESULTSIt showed that there was no significant difference in frequencies of this genotypes of CYP1A1 MSPI between the two groups. The frequency of GST-M1 null (0/0) genotype was higher in the case group than in the control group, with an OR of 1.38 (95% CI 0.81 - 2.38), but there was no statistical significance. However, combination of several genotypes was strongly associated with lung cancer. There was a synergistic interaction between the m2m2 genotype of CYP1A1 MSPI and GST-M1 (0/0) genotype, with an OR of 2.47 (95% CI 1.03 - 5.90).

CONCLUSIONThe combination of two genetic polymorphisms significantly increases the risk of lung cancer.

Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Cytochrome P-450 CYP1A1 ; genetics ; Female ; Genotype ; Glutathione Transferase ; genetics ; Humans ; Lung Neoplasms ; etiology ; genetics ; Male ; Middle Aged ; Polymorphism, Genetic ; Risk ; Smoking ; adverse effects

OBJECTIVETo establish the scale of the norm of occupational stress on the professionals and put it into practice.

METHODST scores were linear transformations of raw scores, derived to have a mean of 50 and a standard deviation of 10. The scale standard of the norm was formulated in line with the principle of normal distribution.

RESULTS(1) For the occupational role questionnaire (ORQ) and personal strain questionnaire (PSQ) scales, high scores suggested significant levels of occupational stress and psychological strain, respectively. T scores >/= 70 indicated a strong probability of maladaptive stress, debilitating strain, or both. T scores in 60 approximately 69 suggested mild levels of maladaptive stress and strain, and in 40 approximately 59 were within one standard deviation of the mean and should be interpreted as being within normal range. T scores < 40 indicated a relative absence of occupational stress or psychological strain. For the personal resources questionnaire (PRQ) scales, high scores indicated highly developed coping resources. T scores < 30 indicated a significant lack of coping resources. T scores in 30 approximately 39 suggested mild deficits in coping skills, and in 40 approximately 59 indicated average coping resources, where as higher scores (i.e., >/= 60) indicated increasingly strong coping resources. (2) This study provided raw score to T-score conversion tables for each OSI-R scale for the total normative sample as well as for gender, and several occupational groups, including professional engineer, professional health care, economic business, financial business, law, education and news. OSI-R profile forms for total normative samples, gender and occupation were also offered according to the conversion tables.

CONCLUSIONThe norm of occupational stress can be used as screening tool, organizational/occupational assessment, guide to occupational choice and intervention measures.

China ; Female ; Humans ; Male ; Occupations ; Reference Values ; Stress, Psychological ; psychology ; Surveys and Questionnaires ; standards ; utilization

OBJECTIVETo establish the norm of occupational stress on the professionals in Chengdu and Chongqing area.

METHODSAccording to the "Occupation Sorting Canon in the People's Republic of China", the professionals of the above-mentioned area were sorted out and randomly stratified. The normative data were derived from a sample of 2 064 participants. The modified Occupation Stress Inventory Revised Edition (OSI-R) was used to test the targets' occupational stress level (including stressors, strain and coping resources).

RESULTS(1) In these professionals, the sex ratio was about 1:1, average age (36.4 +/- 9.4) years, average length of service (15.9 +/- 10.0) years, 63.07% people were college educated and over 80% married. (2) Descriptive statistics for OSI-R scale scores for the total normative sample, for gender samples and for occupational group samples were modulated. (3) The gender norm showed that there were heavier role overload and stronger occupational strains in males than those in females (P < 0.01). The score of personal resources in the males was not different from that in females (P > 0.05). (4) In terms of different occupations, the scores of occupational role and personal strain among various groups indicated significant differences (P < 0.01). The score of personal resources did not manifest difference (P > 0.05). (5) The major factors influencing OSI-R were sex, occupation and length of service.

CONCLUSIONThe norm established can basically represent the occupational stress on professionals in Chengdu and Chongqing area.

Adult ; China ; Female ; Humans ; Male ; Middle Aged ; Occupations ; Research Personnel ; psychology ; Stress, Psychological ; Surveys and Questionnaires

OBJECTIVETo retrospective analyze the short- and long-term therapeutic effect of TCM treatment based on syndrome differentiation on bradyarrhythmia.

METHODSData of 116 patients with bradyarrhythmia treated by TCM based on syndrome differentiation from 1995 to 2005 were collected. The changes of clinical symptoms and their outcomes as well as the 24h-dynamic cardiogram were evaluated. And a 1-5 years follow-up study was conducted to survey the heart rhythm, heart rate, drugs applied and artificial cardiac pacemaker (ACP) installation in the patients.

RESULTSAfter 3 months' treatment, the total effective rate was 91.4%. During the 1-5 years of follow-up, except 6 patients received ACP installation, all the others were alive in stable condition, and no obvious side effect was found.

CONCLUSIONTCM treatment based on syndrome differentiation has reliable and stable therapeutic effects on bradyarrhythmia.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bradycardia ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Retrospective Studies

Objective It has traditionally been difficult to isolate and culture mouse bone marrow mesenchymal stem cells (BMSC),which has low success rate.And thus restricts the development of related research to some extent.We aimed to optimize the whole bone marrow adherent method for isolation and culture of mouse bone marrow mesenchymal stem cells and search for an effective method of inducing BMSCs to differentiate into alveolar epithelial cells.Methods Bone marrow contents harvested from the tibia and femur of C57BL/6 mice were cultured based on the whole bone marrow adherent method.The timing and split ratios of passage were determined according to the size and number of cell colonies.After 6 passages,cells were counted to detect cell proliferation ability,surface markers were examined by flow cytometry and Small Airway Epithelial Cell Medium (SAEpiCM) was used to induce the differentiation of BMSCs.Results With the increase of passages and the purity of BMSCs,the proliferation of cells at passages 6 tended to be stable.Flow cytometry showed that they were strongly positive for bone marrow mesenchymal stem cell surface markers CD29 and Sca-1 (99.1％,88.5％),but almost negative for the surface marker of hematopoietic stem cells CD117 (0.008 2％).BMSCs cultured in SA-EpiCM showed an epithelium-like morphological change and expressed surfactant associated protein C,a specific marker of alveolar epithelial cells.Conclusion It is effective to isolate and culture mouse bone marrow mesenchymal stem cells by adjusting the timing and split ratios of passage according to the size and number of the clonal cell colonies,which possessed the potential to differentiate into alveolar epithelial cells.