SJAMP and HLAMP are glucose-containing acidic mucopolysacc-harides isolated from sea cucumbers, Stichopus Japonicus and Holot-huria Lecospilota respectively. Their effects on the interaction of thrombin with endothelial cells were studied. Human vascular endothelial cells isolated from umbilical veins treated with 0.1% collagenasc were cultured with MEM medium. The contents of von Willebrand factor (vWF) and 6-keto-PGFla, stable hydrolysis product of PGI,, in the culture medium were measured with ELISA and immunoradioassay technique. The addition of thrombin to confluent monolayer endothelial cells resulted in a significant increase in the release of vWF and 6 ~ keto-PGFla in the culture medium. When heparin,SJAMP or HLAMP was added, no significant amount of vWF or 6~keto-PGFla could be detected in the medium .Whereas preincubation of thrombin with heparin, SJAMP or HLAMP respectively inhibited the thrombin-induced vWF and 6-keto-PGF 10 release and this effect was well correlated with the dose of heparin, SJAMP or HLAMP, indicating that SJAMP, HLAMP as well as heparin had inhibitory effect on the interaction of thrombin with endothelial cells

Objective To raise diagnostic rate of protruded lesion of gastrointestinal mucosa and to judge the precise differentiation to the depth of malignant lesion.Methods 12 cases of gastrointestinal diseases were examined by MPS combined with endoscopic examination.Results To the patients suffering protruded lesion of gastrointestinal mucosa with negative biopsy,the MPS provided a sound basis for diagnosis;To the cases of malignant lesion,findings of MPS with regard to the depth were in total concordance with that of surgical biopsy.Conclusion MPS is significanfly superior to conventional endoscopy with pathological biopsy in the differentation of protruded lesion of gastrointestinal mucosa.But in the case of malignant lesion,only the depth of infiltration of gastrointestinal wall can be correctly assessed by MPS.The value is limited in showing whole Picture for larger focus and in the identification of around lymphnodes and whether or no distal metastases in the near organs.

Objective To compare the difference in quercetin against oxidative stress response in mouse and in NIH-3T3 cells before and after H2O2 treatment,to explore the underlying mechanism for the quercetin antioxidant.Methods The cultured NIH-3T3 cells were randomly divided into 4 groups: quercetin(Q) pre-protective group(Qb) firstly treated with quercetin for 24 h followed by incubation with H2O2 for 30 min;post-protective group(Qa) treated with H2O2 for 30 min followed by incubation with quercetin for 24 h;H2O2 group(H2O2) after exposure to H2O2 for 30 min,incubated with DMEM medium and the control group(C) only cultured with DMEM medium.The survival rate and apoptotic rate were detected respectively with MTT and TUNEL in NIH-3T3 cell sus-pension samples.The expression of cyclin D1,PTEN,NF-?B,HSP-70,BCl-2,BAX and caspase-3 were examined with immunocytochemistry and immunoblotting.Besides,20 Wistar rats were divided into control group and experimental group,the latter was given with quercetin in the doze of 0.13 mmol/kg.The levels of T-AOC,SOD,GSH-Px,GSH,MDA,NOS and NO2-/NO3-were detected both in the cleaved NIH-3T3 cells and in the plasma from both experimental and control animals prior to and post-1 h,2 h and after 24 h.Results When the Qb group was compared with H2O2 or Qa group,the survival rate was higher and the apoptotic rate was lower.When the H2O2 group was compared with C group,the expression of cyclin D1、PTEN or BCl-2 was down-regulated;while that of BAX、HSP-70、NF-?B or caspase-3 was up-regulated;the level of T-AOC,SOD,GSH-Px or GSH was decreased;that of NOS、NO2-/NO3-or MDA enhanced in the cleft NIH-3T3 cells.When the plasma level of the anti-oxidative enzyme system prior to-compared with post-1h and 2h-treatment with Q,the level of T-AOC,SOD,GSH-Px and GSH,especially the former two,were higher;MDA,lower;NOS or NO2-/NO3-promoted.However,the above parameters basically became normal 24 h after treatment with Q.Conclusion Quercetin down-regulates the promoted expression of HSP70,NOS,NO2-/NO3-and NF-?B etc.in H2O2-treatment NIH-3T3 cells.Qb could reverse the H2O2 damage effects more markedly.Moreover,the quercetin exerts anti-oxidant protective effect through modulating the anti-oxidative enzyme system both in vivo and in vitro.However,based on the cell heterogeneity in none-or pre/post-H2O2-treatment state,a difference in quercetin antioxidant response is noted.

Objective To evaluate the value of transpulmonary pressure (Ptp) guided optimal positive end-expiratory pressure (PEEP) selection in patients with early acute respiratory distress syndrome (ARDS).Methods A prospective randomized self-control study was conducted.ARDS patients in the early stage (onset ≤3 days) undergoing intubation and mechanical ventilation admitted to intensive care unit (ICU) of Jiangsu Provincial Subei People's Hospital from December 2013 to December 2015 were enrolled.The PEEP level was regulated to 30 cmH2O (1 cmH2O =0.098 kPa) after recruitment maneuver,and then it was gradually decreased to 0 with lowering by 3 cmH2O every 5 minutes.The optimal PEEP was titrated by Ptp,lowest dead space fraction (VD/VT),highest static lung compliance (Cst),and optimal oxygenation,respectively.Parameters of respiratory mechanics and gas exchange were observed.Results Totally 28 patients with ARDS (including 17 male and 11 female) were included with the average age of (45 ± 12) years old,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score was 21 ± 9,oxygenation index (PaO2/FiO2) was (165 ± 76) mmHg (1 mmHg =0.133 kPa).① During decremental PEEP titration,Ptp was gradually decreased,and expiratory Ptp (Ptp-e) was more than zero [(1.3±0.3) cmH2O] when PEEP was (9.6 ± 2.3) cmH2O.Cst was initially improved until reaching a peak,and then deteriorated.Cst was highest [(50 ± 8) mL/cmH2O] when PEEP was (11.5 ± 2.4) cmH2O.PaO2/FiO2 reached the maximum [(312 ± 99) mmHg] at PEEP level of (18.0 ± 2.5) cmH2O.Compared with Ptp-e 3.00-5.99 cmH2O,PaO2/FiO2 was significantly decreased when Ptp-e became negative (all P ＜ 0.05).VD/VT was lowest (0.52 ±0.05) when PEEP was (10.1 ± 2.2) cmH2O.When compared with ventilation [inspiratory Ptp (Ptp-i) 0-2.99 cmH2O],it was significantly higher during high (Ptp-i ≥ 15 cmH2O,all P ＜ 0.05).② There were no statistically significant differences in the levels of optimal PEEP,Ptp-i and Ptp-e among Ptp,lowest VD/VT and highest Cst methods (all P ＞ 0.05),but they were significantly less than optimal oxygenation method (all P ＜ 0.05).Compared with baseline and the method of optimal oxygenation,Cst in other three PEEP titration methods including Ptp,lowest VD/VT and highest Cst was improved obviously (mL/cmH2O:46± 7,47±9,50± 8 vs.30± 8,35 ± 10,all P ＜ 0.05).PaO2/FiO2 (mmHg) in the method of Ptp and lowest VD/VT were higher than the baseline (252 ± 86,258 ± 72 vs.165 ± 76,both P ＜ 0.05),but significantly lower than that of optimal oxygenation method (312 ± 99,both P ＜ 0.05),and did not significantly differ from that of highest Cst (268± 85,both P ＞ 0.05).Compared with baseline and the method of optimal oxygenation,VD/Vr improved significantly in ventilated patients on PEEP targeting with Ptp and lowest VD/VT (0.53±0.05,0.52±0.05 vs.0.59±0.05,0.58±0.04,all P ＜ 0.05).Conclusion Titration the optimal PEEP level with the method of Ptp could promote collapse alveolar recruitment,improve oxygenation and lung compliance,decrease dead space ventilation,and will not cause alveolar excessive inflation in patients who undergoing mechanical ventilation with early ARDS.

Objective To explore the prognostic value of arterial blood lactate (Lac) levels and lactate clearance rate (LCR) in the patients with septic shock.Methods A retrospective study was conducted.Clinical data of 94 septic patients admitted in the Department of Critical Care Medicine in Subei People's Hospital from January 2011 to June 2014 were analyzed.The arterial blood Lac levels at the moment of diagnosis of septic shock (incipient value,0 hour) and early-stage after treatment (3,6 and 24 hours) were reviewed,and individual LCR was calculated at 3,6,24 hours for each patient.According to the outcome in intensive care unit (ICU),patients were divided into survival group (n =48) and death group (n =46).The Lac and LCR at different time points in two groups were analyzed,and the relationships between them and outcome were analyzed.The receiver-operating characteristic (ROC) curve was plotted to assess the value of Lac and LCR at different time points for predicting the outcome.Results Lac level after treatment in survival group was significantly lower than incipient value,but there was no obvious change in death group.Compared with death group,early Lac levels (mmol/L) in survival group were significantly reduced (0 hour:3.80 ± 2.14 vs.5.75±3.21,3 hours:2.05± 1.04 vs.5.03±2.53,6 hours:1.80±0.77 vs.4.40±2.02,24 hours:1.35±0.43 vs.4.90 ± 2.72,P ＜ 0.05 or P ＜ 0.01),the LCR was significantly increased [3 hours:50.00 (72.35)％ vs.13.51 (20.67)％,6 hours:41.43 (58.42)％ vs.22.00 (22.31)％,24 hours:58.73 (29.94)％ vs.18.92 (47.28)％,P ＜ 0.05 or P ＜ 0.01].The Lac levels at all time points were positively correlated with the outcome,and 6-hour and 24-hour LCR were negatively correlated with the outcome.According to the incipient Lac level,patients were divided into low Lac group (Lac ＜ 2 mmol/L),mild Lac group (Lac 2-3 mmol/L) and high Lac group (Lac ≥ 4 mmol/L).The mortality in low Lac group,mild Lac group,high Lac group was gradually increased [23.07％ (6/26),50.00％ (8/16),61.54％ (32/52),x2=10.270,P =0.006].ROC curves demonstrated that the area under ROC curve (AUC) of 24-hour Lac was the largest,0.944,and it was more sensitive and specific in the prognosis evaluation (100％ and 78.3％,respectively).According to the cut-off value of 24-hour Lac as 2.35 mmol/L,patients were divided into high Lac and low Lac groups,and mortality rate in high Lac group was significantly higher than that in low Lac group [100.0％ (36/36) vs.17.24％ (10/58),x2=30.441,P =0.000].The AUC of 24-hour LCR was the largest,0.865,and it was more sensitive and specific for the prognosis evaluation (83.3％ and 91.3％,respectively).According to the cut-off value of 24-hour LCR as 36.8％,patients were divided into high LCR group and low LCR group,and mortality rate in low LCR group was significantly higher than that in high LCR group [84.00％ (42/50) vs.9.09％ (4/44),x2=26.278,P =0.000].Conclusion Early high Lac in patients with septic shock prompts a poor prognosis,and 24-hour Lac levels and LCR are indicators of assessment of clinical therapeutic effect and prognosis of patients with septic shock.

Objective To identity factors influencing willingness to participate in shoulder and neck rehabilitative exercise in laryngeal cancer patients after neck dissection surgery, and to provide reference for subject recruitment in research of similar kind. Methods Between December 2014 to December 2015, when study was conducted to subjects participating in shoulder and neck rehabilitative exercise in laryngeal cancer patients after neck dissection surgery, demographic and disease-related data of patients in two groups (those who were willing /unwilling to participate in the study) were retrospectively analyzed. Binary Logistic regression analysis was used to identify predictive factors influencing willingness to participate in shoulder and neck rehabilitative exercise in laryngeal cancer patients after neck dissection surgery. Results It was revealed by single factor analysis that differences of the following variables between the two groups were statistically significant: age (t=-3.12, P=0.001), whether living in solitude (χ2=4.55, P=0.030), whether currently employed (χ2=9.92, P=0.002), whether with other chronic diseases (χ2=7.91, P=0.004), and whether with radiotherapy after surgery (χ2=4.95, P=0.030); no statistical differences were found regarding tumor location, staging, or neck dissection method (P>0.05). Binary Logistic regression analysis indicated that age (OR=0.71, P=0.001), living alone (OR=0.76, P=0.005) and postoperative radiotherapy (OR=0.88, P=0.001) were predictors of patients' participation in shoulder and neck rehabilitation exercise. Conclusions Certain demographic factors may play a role in the patients' decision on whether or not to participate in shoulder and neck rehabilitation exercise. Senior patients and patients who live alone showa bigger tendency of refusing to attend the exercises. Also, postoperative radiotherapy reduces the patients' willingness in participating in shoulder and neck rehabilitation exercise.

The naissance of evidence-based medicine raises profound changes of medical practice mode all over the world. Evidence-based nursing follows the same methodology and principle with evidence-based medicine. This paper discussed how the evidence-based practice assisted development of nursing subject from three aspects including decision-making, thinking and culture. In decision-making, we should be based on the best research evidence, professional judgment and benefits of patients. In thinking, we should make clinical problems structured and scientific. In culture, we should evaluate evidences with critical eyes and establish transformative, enlightened, inclusive organization culture.

Swallowing function rehabilitation has great significance in improving life quality of patients partial laryngectomy. This paper summarized the main causes, methods of subjective and objective assessment as well as its advantages and disadvantages of patients with dysphagia after partial laryngectomy to set up measurement standard so as to provide a basis for rehabilitation nursing of impaired swallowing.

Objective The purpose of this study was to acquire a deeper understanding for the short-term psychological experience after discharge for male patients after laryngectomy. Methods Phenomenological method and in-depth interviews were used. Eleven patients were recruited. The data were analyzed by Giorgi′s phenomenological procedures. Results After analyzing the data, five main themes were extracted: rejecting tracheal tube, desiring to speak early, sense of uncertainty about the future, emerging various negative emotions, heavy pressure caused by disease treatment, facing reality and living in the moment. Conclusions Patients with laryngectomy discharged in short term faced major problems, so clinical staff should give timely support and care to help them return to society in a better condition.

Objective To develop audio-visual materials and confirm their effect in patients with nasopharyngeal carcinoma receiving radiotherapy. Methods Audio-visual development were produced based on relevant literature, professional demonstration, and digital video. A total of 84 patients with nasopharyngeal carcinoma were selected from Jinhua Hospital of Zhejiang University and divided into control group (n=42) and intervention group (n=42) according to admission time. The patients of control group received usual one-to-one healthcare education. The patients of intervention group received audio-visual materials systematically for imitation excise with professional guidance. The compliance of rehabilitation exercise and patients′ satisfaction on nursing service were compared between two groups. Results The scores of compliance in the intervention group at 1 month after discharge and at 3 months after discharge ware higher than those of the control group (P<0. 05). There was significant difference between the intervention group and the control group in patients′satisfaction (P<0. 01). Conclusions Self-made audio-visual materials are intuitionistic, iconic, straightaway, imitable, receivable, and they can improve patients′ compliance on rehabilitation exercise and satisfaction on nursing service effectively.