Objective To investigate the value of cluster cate forpatients with ventilator-associated pneumo-nia (VAP) in the intensive care unit. Method Three hundred fifty-four consecutive patients with mechanical ven-tilation support in the Emergency Intensive Care Unit of Nanjing First Hospital from January 2006 to September 2007 were included in this study. The cluster care included elevating patient's head and chest to at least 30 de-grecs to the horizontal level, intensiving frequency of oral-pharyngeal nursing with thorough suction, washing hands, changing ventialtor tube at shorter regular interval, closely observing temperature, sputmn, WBC count, pu-turn, white blood cell count, chest X-ray examination and respiratory tract bacterial culture etc. Another 398 me-chanical ventilated patients with conventional care in the Hospital from January 2004 to November 2005 were taken as control. The t -test and X2 -test were used for analysis. Results The morbidity of VAP was significantly de-creased after cluster care(16.6 % vs. 24.6% P<0.01), the length of intensive care unit stay (LOS) was shorter in patients with cluster care than those in patients of control [(10.75±5.86) d vs. (14.26±9.40) d, P <0.05]. Conclusions Pneumonia associated with mechanical ventilation can be effectively reduced by the cluster care.

OBJECTIVETo compare the effective differences between deep needling and shallow needling at three acupoints around ear for subjective tinnitus.

METHODSFifty patients with subjective tinnitus were randomized divided into a deep needling group and a shallow needling group, 25 cases in each group. Twenty-two patients in the deep needling group and 20 patients in the shallow needling group were brought into statistic in the end. In the two groups, the three acupoints around ear and distal acupoints were both selected. The acupoints of the affected side such as Yifeng (TE 17), Tinghui (GB 2), Ermen (TE 21), Zhigou (TE 6), Zhongzhu (TE 3) and Hegu (LI 4) were adopted. Yifeng (TE 17), Tinghui (GB 2) and Ermen (TE 21) were acupunctured 30-38 mm in the deep needling group and 15-20 mm in the shallow needling group. The other acupoints were conventionally acupunctured in the two groups. The needles were retained for 30 min,once a day and five times a week for all patients. The treatment was continuously for 4 weeks in the two groups. Tinnitus handicap inventory (THI) scores, tinnitus grades and visual analogue scale (VAS) for tinnitus sound levels were observed before and after treatment, and the effects of the two groups were compared.

RESULTSThe total effective rate in the deep needling group was 59.1% (13/22), and it was better than 20.0% (4/20) in the shallow needling group (P < 0.05). In the deep needling, group, the THI score, tinnitus grade and the VAS score were improved than those before treatment (all P < 0.05). In the shallow needling group, the three above indices before and after treatment were not different in statistical significance (all P > 0.05). After treatment, all the three indices in the deep needling group were superior to those in the shallow needling group (all P < 0.05).

CONCLUSIONAcupuncture at the three acupoints around ear deeply could apparently improve tinnitus, and reduce tinnitus sound levels for subjective tinnitus. The effect is better than that by shallow needling at the three acupoints.

Acupuncture Points ; Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Ear ; physiopathology ; Female ; Hearing ; Humans ; Male ; Middle Aged ; Tinnitus ; physiopathology ; therapy ; Treatment Outcome ; Young Adult

Objective To evaluate the efficacy and safety of dexmedetomidine aiding spinal -epidural anes-thesia for sedation.Methods Ninety ASAI -II female patients scheduled for elective spinal -epidural anesthesia were randomly divided into 3 groups(30 cases for each group)according to the digital table method.An epidural catheter was inseted at L2 -3 after satisfactory anesthesia,sedative drugs was intravenous.Group A received midazolam 0.05μg/kg initial loading dose for 10min and maintaining with 0.5μg·kg -1 ·h -1 .Group B received midazolam 0.06μg/kg for 5min and maintaining with 0.5mg·kg -1 ·h -1 .Group C received first intravenous injection of propo-fol 0.5 mg/kg,injection time 60s,maintaining with 0.3 -1.2mg·kg -1 ·h -1 .The infusion rate was adjusted to increase or decrease in order to maintain the desired level of sedation(Ramsay score of 3)during operation.The seda-tion efficacy and adverse reactions of three groups were compared.Results The onset time[(11.2 ±2.8)min]in group A was longer than that of group B[(6.4 ±2.4)min],group C[(5.0 ±2.1)min](t =7.12,9.70,all P <0.05).The offset time of group A,B[(12.3 ±2.4)min,(13.8 ±2.5 )min]were longer then those of group C [(7.4 ±2.3)min](t =8.36,7.95,all P <0.05).But 5 and 6 patients in the group B and C occurred hypoxia,and there were 8 and 9 patients developed partial airway obstruction due to relaxation of jaw muscle.At the time 30min, 60min and the end of surgery,the HR of the group A decreased deeply than the other two groups(t =5.02,4.92, 4.90,3.95,5.71,4.09,all P <0.05),10,5,6 patients were given atropine for increasing the HR in the group A,B and C respectively.Conclusion Dexmedetomidine is more safe and effective for the sedation of spinal -epidural an-esthesia,compared with midazolam and propofol,but with lower HR and longer onset time.

AIM: To analyze the effects of two kinds of anti-vascular endothelial growth factor (VEGF) drugs, conbercept and ranibizumab, on proliferative diabetic retinopathy (PDR) patients as pre-treatment for pars plana vitrectomy (PPV).METHODS: From June 2016 to December 2016, 62 patients (64 eyes) aged 41-59 years old diagnosed with PDR with nonclearing vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) requiring PPV were enrolled in our study.Patients were treated with intravitreal injection of anti-VEGF drugs 0.50mg (0.05mL) 3d before PPV.Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed where there were no significant complications after the injection of anti-VEGF drugs.The operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy and silicone oil, and postoperative complications were recorded and analyzed.We compared and analyzed the visual acuity and macular thickness before and 1mo after the surgery with the preoperative data.RESULTS: Both conbercept and ranibizumab could improve the postoperative visual acuity and reduce the postoperative macular thickness of PPV.There was no significant difference between the impacts of two kinds of anti-VEGF drug pre-treatment on operation time, intraoperative bleeding, iatrogenic retinal breaks, the use of endodiathermy, silicone oil filling and postoperative vitreous secondary hemorrhage.CONCLUSION: The effects of conbercept and ranibizumab pre-treatment were similar.PPV combined with anti-VEGF pre-treatment could improve postoperative visual acuity and macular edema.The choice of conbercept or ranibizumab should be made flexibly according to the actual situation of patients.

Objective To investigate the effects and mechanism of microRNA150 (miRNA150) on proliferation, invasion and metastasis of gastric cancer.Methods From January 2015 to June 2016, 45 surgical specimens were collected.The expression of miRNA150 and Ras-interacting protein 1(RASIP1) at miRNA level in gastric cancer tissues and paracancerous tissues were quantified by quantitative real-time fluorescent reverse transcriptase-polymerase chain reaction (qRT-PCR).The correlation between miRNA150 and the biological features of gastric cancer as well as RASIP1 expression was analyzed.Gastric cancer cell line SGC-7901 was cultured and transfected with pcDNA3.1-miRNA150 expression plasmids.The effect of miRNA150 over-expression on the proliferation of SGC-7901 cells was determined by 3-(4,5-dimethyl-2-thiazolyl)-2,5-dipheayl 2-H-tetrazolium bromide (MTT) assay.And the effect of miRNA150 over-expression on the invasion and metastasis of SGC-7901 cells was detected by Transwell assay.The potential target gene of miRNA150 was analyzed by bioinformatics software and dual-luciferase reporter assay system.The effect of miRNA150 over-expression on RASIP1 expression in SGC-7901 cells was tested by qRT-PCR and Western blotting.Analysis of variance and t test were used to compare normal distribution data.And the Mann-Whitney rank sum test was used to compare skewed distribution data.Spearman assay was used for correlation analysis.Results The median level of miRNA150 in gastric cancer tissue was higher than that of paracancerous tissues (3.85, 0.26 to 7.92 vs 1.98, 0.19 to 5.66), and the difference was statistically significant (U=466.22,P<0.05).The median level of RASIP1 mRNA in gastric cancer tissue (1.65, 0.13 to 3.59) was lower than that of paracancerous tissues (2.96, 0.59 to 6.08), and the difference was statistically significant (U=522.31,P<0.05).The results of correlation analysis indicated that RASIP1 expression level was negatively correlated with miRNA150 expression (r=-0.589, P=0.008).The RASIP1 expression at mRNA level was negatively correlated with miRNA150 expression (r=-0.614, P=0.004).The dual-luciferase reporter assay showed RASIP1 was the target gene of miRNA150.The miRNA150 expression level was related with tumor size, TNM staging and lymph node metastasis(χ2=5.81, 6.00 and 10.04,all P<0.05).The results of MTT assay showed that after SGC-7901 cells cultured for 24 hours, the A value of pcDNA3.1-miRNA150 plasmid transfected cells was higher than that of the untransfected SGC-7901 cells (0.51±0.04 vs 0.79±0.03), and the difference was statistically significant (t=4.745, P<0.05).The results of Transwell assay indicated that there were more invasive and metastatic cells in pcDNA3.1-miRNA150 plasmid transfected cells.The results of qRT-PCR showed that the relative levels of RASIP1 mRNA in control group, pcDNA3.1-miRNA150 plasmid transfected cells and pcDNA3.1 empty plasmid transfected cells were 1.00±0.02, 0.51±0.03 and 1.08±0.03, respectively.The RASIP1 mRNA level in pcDNA3.1-miRNA150 plasmid transfected cells was lower than untransfected and pcDNA3.1 empty plasmid transfected cells, and the differences were statistically significant (t=3.940, 4.120, both P<0.05).miRNA150 could negtively regulate the RASIP1 protein expression and promote the proliferation and invasion of gastric cacer cells.Conclusions Over-expression of miRNA150 induced invasion and metastasis of gastric cancer by down-regulating RASIP1 expression.miRNA150 may be a novel biomarker for the diagnosis and treatment of tumor metastasis.

Objective To discuss the intraoperative and postoperative effects of conbercept combined with pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR) patients.Methods From January 2016 to December 2016,123 PDR patients (149 eyes) aged 41-65 years old with nonclearing vitreous hemorrhage (VH) and/or tractional retinal detachment (TRD) were enrolled in this study.According to whether preoperative intravitreal injection conbercept,the patients were divided into two groups:Conbercept group (64 cases,78 eyes),Control group (59 cases,71 eyes).Conbercept group was treated with intravitreal injection of Conbercept 0.50 mg (0.05 mL) at 3 days before PPV.Then the standard 23G minimally invasive sclera three-channel vitrectomy was performed if no significant complications after the injection of conbercept.The operation time,intraoperative bleeding,iatrogenic retinal hole,use of endodiathermy and silicone oil,and postoperative complications were recorded and analyzed.The visual acuity and macuiar thickness were compared before and 1 month after the surgery.Results Two groups had no difference on age,sex,HbA1 C,duration,VH ≥ three degree(56/78,45/71),TRD.Conbercept pretreatment could significantly reduce the bleeding during PPV (43/78,49/71),the probability of iatrogeuic retinal holes (11/78,21/71),reduce intraocular electrocoagulation using (57/78,62/71) and silicone oil (43/78,51/71),and then shorten the operation time (58.63 ± 21.66)s and (72.69 ± 22.48)s,and it could significantly improve the postoperative visual acuity (0.23 ± 0.15,0.16 ± 0.11) and macular edema thickness (260.95 ± 27.44) μm and (330.81 ± 36.62)μm,while reduce the incidence of second bleeding (3/78,10/71).Conclusion Conbercept pre-treatment combined with PPV for PDR is a positive and effective treatment,which has good clinical application significance.

[Objective]To evaluate the outcomes of treating thoracolumbar burst fractures in young adults with posterior short-segment pedicle screw fixation without fusion by analyzing the clinical and radiographic parameters.[Method]Fifty-four patients with thoracolumbar burst fractures from June 2002 to April 2006 were investigated retrospectively.Thirty-one patients were male and 23 were female.The mean age was 31 years.All patients underwent open reduction and posterior short-segment pedicle screw fixation without bone graft fusion,and had their implants removed at 12 to 20 months post-operatively.Pain status was evaluated using the visual analog scale(VAS).Changes in the anterior vertebral height ratio,Cobb′s angle,and vertebral wedge angle were measured preoperatively,postoperatively,before implant removal,and at 2 years after implant removal.[Result]Thirty-two patients were available to follow-up,with an average period of 43 months(range,36-56 months).A good correction was gained and pain was released significantly after surgery.The loss of correction was statistically significant and there were 4 patients suffering from screw broken before the instrumentation removal,however.A progressive kyphotic deformity (Cobb′s angle increased while vertebral wedge angle unchanged) was caused by the collapse of the intervertebral disc space while the reduced vertebral height was stable after the implant removal.No significant correlation was found between the final kyphosis and pain scale.[Conclusion]Short-segment pedicle screw fixation without fusion can provide good reduction and sustained corrective height if adequat indication of thoracolumbar burst fractures has been choosen.Earlier implant removal can regain local segmental motion.

Objective To evaluate two different histopathological classification systems (Fletcher and Miettinen) for the risk in cases of gastrointestinal stromal tumors (GIST). Methods One hundred and sixty-five GIST cases with complete clinicopathologic and follow-up data were evaluated for their biologic potential by the histopathological classification systems of Fletcher, and among those, 164 cases GIST were evaluated by the histopathological classification systems of Miettinen. The implication of two classification systems were compared by survival analysis. Results Evaluated by Fletcher histopathological classification system, 59 cases (35. 8%) were graded as high risk, 49 cases (29. 7%) as intermediate risk, 43 cases (26. 1%) as low risk and 14 cases (8. 5%) were very-low risk. Evaluated by Miettinen's system, 68 cases (41.5%) were as high risk, 23 cases (14. 0%) were intermedatie risk, 60 cases (36. 6%) were low risk and 13 cases (7. 9%) were very-low risk. Evaluated by both two systems, the survival time and disease-free survival time of high risk GIST were lower than those of very-low, low and intermediate risk GIST(P <0. 05), the survival time and disease-free survival time of intermediate risk GIST were lower than those of low risk GIST(P<0. 05). According to Fletcher's system, in the high risk GIST, the disease-free survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P = 0. 022), and in the intermediate risk GIST, the survival time of small intestinal, colonic and rectal GIST was lower than that of gastric GIST(P =0. 032). According to Miettinen's system, in the risk subgroup of GIST, the survival time and disease-free survival time of gastric, small intestinal, colonic and rectal GIST has no statistical difference(P > 0. 05). Conclusions Fletcher histopathological classification system is simple and easy to use, while Miettinen's system for evaluating biological potential by anatomic site is more accurate and predictive in the selection of high risk patients for target adjuvant treatment.

Objective To investigate the relationship between tumor subclassifieation and the clinicopathologic features and prognosis of patients with gastrointestinal diffuse large B-cell lymphoma (DLBCL). Method From June 2000 to June 2007, 63 gastrointestinal DLBCL cases were enrolled. Immunohistochemical staining was performed to detect CDIO, Bcl-6 and MUM1 expression. Tumors were subclassified according to CDIO, Bcl-6 and MUM1 expression. Results CD10 expression was positive in 13 cases. Bcl-6 expression was positive in 53 cases. MUM1 expression was positive in 52 cases. According to the expression of CD10, Bcl-6 and MUM1, 17 cases(27%) were of germinal center B cell-like (GCB) DLBCL and 46 cases (73%) were of non-GCB. There was a significant difference in local lymph node metastasis between GCB group and non-GCB group, but there was no significant difference in terms of tumor size and infiltrate depth between the two subgroups. The survival time of patients in GCB group(76 months) was significantly longer than that of non-GCB group (28 months). Among cases receiving postoperative chemotherapy (CHOP), the survival of GCB group (76 months) was longer than non-GCB group (24 months). All 4 GCB cases and 4 non-GCB cases under R-CHOP chemotherapy are alive (22 ～ 47 months). Conclusion Gastrointestinal DLBCL subclassification is closely correlated with local lymph node metastasis, and this in combination with the expression of CD10 could be used to predict the prognosis of patients with gastrointestinal DLBCL.

Objective To design a slide support nursing bed for the patient after cross leg flap transplant operation.Methods The bed was designed based on the principle of four-link-type mechanism slide,which was composed of a bed body,slide support,sliding rails,locking bolt,connector bar for sliding rails,extension arm,leg support and etc.Accurate localization of leg support was executed by zero setting,readjustment and etc.Results The bed could be adjusted up and down,back and forth or at different angles so as the compression on the cross leg flap was avoided to enhance the comfort of the patient after cross leg flap transplant operation.Conclusion The bed gains advantages in convenience,safety,effect and etc,and is worthy promoting clinically for the patient after cross leg flap transplant operation.