Objective To investigate N-terminal pro-B-type natriuretic peptide (NT-proBNP) cutoff value for the mortality in different age groups in critically ill patients.Methods A retrospective study was conducted.295 patients admitted to the intensive care unit (ICU) of 401st Hospital of PLA from January 2011 to October 2012 were divided into two groups according to age [group with age＜65 years old (n=105) and group with age≥ 65 years old (n =190)].The concentrations of serum NT-proBNP,hematocrit (HCT),procalcitonin (PCT),C-reactive protein (CRP),serum creatinine (SCr),estimated glomerular filtration rate (eGFR),acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and probability of survival (PS) were recorded within 24 hours.The primary outcome was ICU mortality.Receiver operator characteristic curve (ROC curve) was used to evaluate the value of NT-proBNP for predicting the mortality.Results ① There were no significant differences in the length of stay in ICU,mechanical ventilation rate,the mortality,the incidence of cardiovascular disease,digestive disease,neurologic disease,and the number of patients having received operation,HCT,PCT and CRP between the two groups (all P＞0.05).The percentage of the male,the APACHE Ⅱ score,the percentage of respiratory disease,and NT-proBNP in group with age ≥ 65 years old were higher than those of the group with age ＜ 65 years old [the percentage of the male:51.6％ vs.33.0％,x2=9.093,P=0.003; APACHE Ⅱ score:22.94 ±8.10 vs.19.44 ±8.51,Z=-3.259,P=0.001; the percentage of respiratory disease:29.47％ vs.17.14％,x2=5.472,P=0.024; NT-proBNP(ng/L):5 859.00(2 050.75,23 802.75) vs.2 882.00 (275.15,6 236.00),Z=-5.514,P=0.000]; PS,the percentage of patients having multiple injuries and other diseases and eGFR in group with age ≥65 years old were lower than those of the group with age ＜65 years old [PS:59.0 (31.5,79.0)％ vs.70.0 (40.0,84.0),Z=-3.431,P=0.001; the percentage of multiple injuries:0.53％ vs.17.14％,x2=30.987,P=0.000; the percentage of other disease:5.79％ vs.13.33％,x2=4.962,P=0.030; eGFR (ml·min-1· 1.73 m-2):81.07 (45.77,131.80) vs.95.54 (33.64,165.55),Z=-2.214,P=0.027].② The area under the ROC curve (AUC) [95％ confidence interval (95％ CI)] of NT-proBNP in patients with age＜65 years old was significantly higher than that of group with age≥65 years old and the entire group [0.825(0.738-0.892) vs.0.664 (0.592-0.731) and 0.725 (0.670-0.775),Z1 =-2.835,P1 =0.005; Z2=-1.995,P2=0.046].③ The sensitivity (76.]0％ vs.64.10％),specificity (82.35％ vs.67.12％),positive predictive value (90.0％ vs.75.8％),and negative predictive value (62.2％ vs.53.8％) with cutoff value of NT-proBNP (2 882 ng/L) in group with age ＜65 years old were significantly higher than those with NT-proBNP cutoff value (6 062 ng/L) in group with age ≥ 65 years old.Conclusion NT-proBNP cutoff value in different age groups for the prediction of mortahty in the critically ill patients maybe more objective and accurate.

Adolescent ; Child ; Child, Preschool ; China ; epidemiology ; Female ; Hepatitis B ; epidemiology ; immunology ; prevention & control ; Humans ; Infant ; Infant, Newborn ; Male

Objective To study the efficacy of T-piece resuscitator on the very preterm infants in the delivery room.Method Very preterm infants (gestational age 28 ～ 31 weeks) who needed positive pressure ventilation during delivery room resuscitation were included in the study between January 2010 and December 2015.Enrolled infants were randomly assigned to self-inflating bag group and T-piece group.Tracheal intubation ratio,duration of mechanical ventilation,continuous positive airway pressure (CPAP),supplementary oxygen through a nasal cannula and total oxygen requirement were compared between groups.The percentages of pneumothorax,sepsis,necrotizing enterocolitis (NEC),bronchopulmonary dysplasia (BPD),retinopathy of prematurity (ROP),intracranial hemorrhage and patent ductus arteriosus (PDA) between groups were also compared.Data were analyzed using independent sample t test and chi-square test.Result A total of 51 preterm infants were enrolled in this study,with 25 infants in the self-inflating bag group and 26 in the T-piece group.There was no statistically significant difference in the gender,gestational age,birth weight,Apgar scores,delivery mode and antenatal glucocorticoids between the two groups (P ＞ 0.05).The ratio of intubation in T-piece group was significantly lower than that in self-inflating bag group (15.4％ vs.44.0％,P ＜ 0.05).Further more,duration of mechanical ventilation and total oxygen requirement in the T-piece group were significantly shorter than those in the self-inflating bag group [(4.2±2.8) dvs.(10.1 ±4.3) d,(36.2±14.7) dvs.(47.2±19.2) d,P＜0.05].However,the duration of nasal CPAP and supplementary oxygen through a nasal cannula,the rate of pneumothorax,sepsis,NEC,BPD,ROP,intracranial hemorrhage and PDA did not differ significantly between groups (P ＞ 0.05).Conclusion Compared with the self-inflating bag group,the use of the T-piece in delivery room decrease the rate of tracheal intubation and the duration of mechanical ventilation and total oxygen requirement.

Objective To explore the effects of quality improvement in delivery room resuscitation on very/extremely low birth-weight infants (VLBWI/ELBWI). Methods A retrospective analysis was performed to analyze the clinical data of VLBWI/ELBWI who were admitted to the Neonatal Intensive Care Unit (NICU) of Nanjing Maternity Hospital Affiliated to Nanjing Medical University from January to December 2015 (pre-improvement group, n=176) and of those who were admitted from January to December 2016 after the implementation of quality improvement program on delivery room resuscitation (post-improvement group, n=199). Several parameters were monitored, including resuscitation modalities [continuous positive airway pressure (CPAP) , peak inspiratory pressure (PIP)+positive end expiratory pressure (PEEP) with T-piece resuscitator and intubation rate in delivery room], neonatal body temperature and pH on NICU admission, respiratory outcomes, morbidity from intraventricular hemorrhage, necrotizing enterocolitis, retinopathy ofprematurity and hospitalization. Chi-square (or Fisher's exact test), t or rank Sum test was used for statistical analysis. Results There was no significant difference in gestational age, birth weight, gender proportion, delivery mode and Apgar scores between the two groups (all P>0.05). After implementing the quality improvement program, there was an increased overall usage of CPAP [85.9% (171/199) vs 66.3% (112/176), χ2=19.881, P<0.01] and PIP+PEEP with T-piece resuscitator [33.8% (67/199) vs 10.8% (12/176), χ2=19.819, P<0.01], but a decreased usage of balloon catheter ventilation [6.0% (12/199) vs 39.3% (44/176), χ2=53.682, P<0.01]. No significant change in intubation rate was observed(P>0.05). The average admission temperature increased after launching the quality improvement program [M (P25-P75), 36.2 (35.8-36.5) vs 35.6 (35.4-35.7)℃ , Z= - 9.681, P<0.01]. The morbidities of pulmonary hemorrhage within one week after birth [1.5% (3/199) vs 5.1% (9/176),χ2=3.921] and grade Ⅲ / Ⅳ intraventricular hemorrhage [1.1% (2/199) vs 11.9% (21/176), χ2=33.885] decreased along with the improvement in delivery room resuscitation (both P<0.05). The duration of invasive ventilation decreased as well [3 (1-6) vs 4 (2-9) d, Z= - 2.286, P<0.05]. Conclusions Quality improvement in delivery room resuscitation measures standardizes the management of delivery room resuscitation and improves the clinical outcomes of VLBWI/ELBWI.

Objective To investigate the effect of fatty acid synthase (FASN)on apoptosis in pancreatic cancer cell PANC-1 and the possible molecular mechanism.Methods Annexin V/FITC and flow cytometry were performed to detect the expression of FASN in pancreatic cancer PANC-1 after C75 treatment and the change of apoptosis in pancreatic cancer cell PANC-1 treated with C75.Quantity reverse transcriptase polymerase chain reaction (RT-PCR)and Western blot were used to measure the protein and RNA expressions of Caspase-3,bcl-2 and FASN.Results Inhibited by C75,the activity of FASN in pancreatic cancer cell PANC-1 was significantly decreased.Meanwhile,PANC-1 showed an increased apoptosis level in a dose-dependent manner (P < 0.05 ). Furthermore,after C75 inhibited FASN in pancreatic cancer cells,the protein and RNA expressions of Caspase-3 significantly increased (P <0.05)whereas the level of Bcl-2 reduced (P <0.05).Conclusion FASN is involved in the process of apoptosis in PANC-1 via Bcl-2 and Caspase-3.Therefore,FASN will provide a new target for the treatment of pancreatic cancer and generate better treatment efficacy.

Gene Expression Profiling ; Humans ; Killer Cells, Natural ; pathology ; Lymphoma, T-Cell ; genetics ; metabolism ; pathology ; Nose Neoplasms ; genetics ; metabolism ; pathology ; Oligonucleotide Array Sequence Analysis ; Protein Tyrosine Phosphatase, Non-Receptor Type 6 ; biosynthesis ; genetics ; RNA, Messenger ; biosynthesis ; genetics

This paper summarizes the concept of telemedicine, the application of telemedicine in home-based palliative care for cancer patients, and the impact of telemedicine on cancer patients receiving home-based palliative care. This paper also provides suggestions for the application of telemedicine in home-based palliative care, aiming to provide a reference for the application of telemedicine in home-based palliative care for cancer patients in China.

Objective:To evaluate the clinical efficacy of Bupi Qingfei decoction in the treatment of bronchiectasis colonized by Pseudomonas aeruginosa （PA） （lung-spleen Qi deficiency syndrome and phlegm heat accumulating in lung syndrome）. Method:A total of 72 bronchiectasis patients colonized with PA （ lung-spleen Qi deficiency syndrome and phlegm heat accumulating in lung syndrome ） were randomly divided into the observation group （36 cases， two cases were lost to follow-up and three dropped out） and control group （36 cases， three cases were lost to follow-up and four dropped out）. There were 31 cases in the observation group and 29 cases in the control group completing the trial. Patients in the observation group were treated with Bupi Qingfei decoction orally，once in the morning and again in the evening， one bag every other day， and simulated azithromycin tablet at the dose of 0.5 g，once every other day， while those in the control group with azithromycin tablet at 0.5 g，once every other day， and simulated Bupi Qingfei decoction， once in the morning and again in the evening， one bag every other day. Patients in both groups received health education and postural expectoration. The treatment lasted for 24 weeks，followed by a 24-week follow-up. The frequency of acute exacerbation，quality of life （St. George's Respiratory Questionnaire） score，traditional Chinese medicine （TCM） syndrome score，lung function ［forced expiratory volume in one second percentage of predicted（FEV₁%pred） and FEV₁/forced vital capacity（FVC）］， and serum immunoglobulin （Ig）A，IgE，IgG，and IgM levels of the two groups were evaluated after treatment. Result:The frequencies of acute exacerbation after 24 weeks of treatment and during the 24-week follow-up in the observation group were lower than those in the control group （P<0.05）. The total quality of life （St. George's Respiratory Questionnaire） score and symptom scores in the observation group after 24 weeks of treatment were significantly decreased as compared with those before treatment （P<0.05）. There was no significant improvement in the quality of life in the control group either after 24 weeks of treatment or during the 24-week follow-up. The effective rate against TCM syndrome in the observation group was 64.52%（20/31） after 12 weeks of treatment，which was obviously higher than 31.03%（9/29） in the control group （χ²=6.726，P<0.05）. After 24 weeks of treatment，the effective rate in the observation group was 83.87%， slightly higher than 68.97% in the control group. After 12 and 24 weeks of treatment，the scores of cough，expectoration，fatigue，anorexia，spontaneous sweating，abdominal distension， and loose stool in the observation group were better than those in the control group （P<0.05）. There were no significant changes in lung function and serum immunoglobulin classes in the two groups. Conclusion:Bupi Qingfei decoction is effective in reducing the frequency of acute exacerbation， alleviating the symptoms， and improving the quality of life of bronchiectasis patients colonized by PA （lung-spleen Qi deficiency syndrome and phlegm heat accumulating in lung syndrome）.

Objective To explore scientific research ability of clinical teaching teachers of nursing undergraduate. Methods 221 clinical nursing teachers who involved in clinical teaching in 3 three-grade A teaching hospital were investigated by the questionnaires which included general information, research participation, paper writing and the knowledge about nursing research. Results The teachers' awareness about scientific research in these hospitals was worse. Participated was 51. 1%, presided was 6.8%, published was 51.6%. There were statistically significant differences in educational background, title, properties of affiliated hospital. Conclusions It's necessary to further strengthen the teaching quality of the whole clinical team, and to train them with research knowledge to increase their scientific research ability.

OBJECTIVETo study the imageology change of the intervertebral foramen degenerative intervertebral disc in different degrees and explore its clinical significance.

METHODSThe imageology data (MRI and CT) of 37 patients with degenerative disc disease of L4,5 (male 23, female 14, age from 28 to 62 years with an average of 41.6 years)were investigated. The patients were divided into three groups depending on the mean signal intensity rate of degenerative disc and cerebrospinal fluid:light degenerative group (group A) of 11 cases, intermediate degenerative group (group B) of 13 cases, and severe degenerative group (group C) of 13 cases. The extreme altitude, maximum width and areas of the intervertebral foramen were measured from the CT 1.25 mm scan reconstitution. The changes of the intervertebral foramen were analyzed.

RESULTS(1) 1. The extreme altitude and areas of the intervertebral foramen gradually diminished among the light degenerative group, intermediate degenerative group and severe degenerative group, there was no significant deviation between intermediate degenerative group and the light degenerative group (P > 0.05), there was statistical significance between severe degenerative group and intermediate degenerative group (P < 0.05), there was statistical significance between severe degenerative group and light degenerative group (P < 0.01). (2) There was no statistical significance of the maximum width of intervertebral foramen among three groups (P > 0.05).

CONCLUSIONThe extreme altitude and areas of the intervertebral foramen gradually diminished when the disc are differently degenerative. But there was not significant correlation to width of the intervertebral foramen; the dimin height and area of intervertebral foramen should result in root compression.

Adult ; Female ; Humans ; Intervertebral Disc ; chemistry ; diagnostic imaging ; Intervertebral Disc Degeneration ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed