The high mortality of paraquat (PQ) poisonings is mainly due to the lack of effective treatments. Most toxicologists recommend rapid initiation of charcoal haemoperfusion (CHP) to lower plasma PQ levels and to limit pulmonary and other organs uptake of PQ. Although there are considerable evidences of CHP efficacy in the reversion of the fatal outcome resulting from PQ poisonings, the usefulness of this therapy has been the subject of significant controversy with several evidences published in the literature showing a lack of clinical benefit in numerous cases. Considering that the blood concentration at a given time is directly related to clinical outcome, the rebound in plasma paraquat concentration after haemoperfusion may be partly relate to the poor clinical benefit, but may indicate the necessity for prolonged haemoperfusion. Continuous rather than intermittent haemoperfusion has been advocated for treatment of paraquat poisoning. However, 24h daily conventional pump driven haemoperfusion is usually impossible to carry out due to bleeding complications. Plasmapheresis is also a blood purification process. Unselective therapeutic plasma exchange is the first technology used for therapeutic apheresis (TA). However, limited efficacy by restricted plasma volume that can be exchanged in a single session is one of the severe limitations. To further increase the clearance of target molecules, plasma perfusion (PP) techniques was developed. modification of the conventional plasma perfusion in patients with paraquat poisoning has been reported and plasma levels of paraquat were reduced effectively.

Objective To explore the application value of uric indicant monitoring on patients with impaired glucose tolerance. Methods 9 6 health examination people were selected who with glucose tolerance impairment diagnosis standard population in Jan to Feb 2015 in LaiZhou,There were no significant differences in age and sex composition between the two groups in 48 cases of experimental group and 48 cases in control group.There were no other diseases,and no drugs were taken to con-trol blood glucose.IGT patients in the experimental group using uric indican monitoring to establish personal diet guide, while the control group used normal health education guidance,the two groups respectively before experiment and at the end of detecting urinary indican,fasting blood glucose,2h glucose tolerance levels,and were compared.Results According to the findings of the two groups follow up and the experimental data collected during one year,at the end of the experiment the IGT patients in the experimental group levels of urinary indicant was (50.7±6.2 mg/L vs 78.5±7.9 mg/L),fasting blood glucose was (6.34±0.11 mmol/L vs 6.91±0.29 mmol/L),2h glucose tolerance was (7.81 ± 0.52 mmol/L vs 9.57 ± 1.13 mmol/L)which was lower than the control group.There was significant difference between two groups (t=2.0,2.6, 3.06,P<0.05).Compared with IGT in the experimental group at the end of the experiment,the level of uric indican was (50.7±6.2 mg/L vs 78.3±8.1 mg/L),fasting glucose was (6.34±0.11 mmol/L vs 6.78±0.19 mmol/L),2h glucose tol-erance was (7.81±0.52 mmol/L vs 9.33±0.93 mmol/L)was lower than before the start of the level (t=2.01,2.28, 2.83,P<0.05),and the difference was statistically significant.In terms of the outcome of the various stages of diabetes, IGT patients in the experimental group was significantly better than the control group (χ2=10.85,P<0.05),the difference was statistically significant.Conclusion Through the determination of uric indican to guide the glucose tolerance decrease in patients with a reasonable diet,is conducive to glucose tolerance in the patients with impaired on blood glucose control,can effectively reduce the glucose tolerance decrease (IGT)conversion to diabetes mellitus (DM),change to a positive direction.

Patients with advanced lung cancer should be given proper hospice care .Doctors should not only practice protective medicine on the foundation of laws and regulations , informing the patients about their conditions tactfully , but also try their best to provide the patients with optimal therapeutic strategies , taking the patient's physi-cal tolerance, economy, etc.into account and achieving the goal of humanized and individualized therapy .Mean-while, the construction of professional medical -nursing institution is in urgent need .Only providing general nurs-ing in multiple aspects of illness , mental health , social functions , can we relieve the pain both physically and men-tally, and improve the patient's quality of their terminal times .

Objective To study the differences in levels of plasma cytokine profiles including interleukin-6 (IL-6),interleukin-10 (IL-10),tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) between healthy controls and people with smoking and alcohol drinking behaviors at different ages,and to investigate the correlation of plasma cytokine profiles with age,smoking and alcohol drinking behaviors.Methods The concentrations of IL-6,IL-10,TNF-alpha and CRP in 350 healthy volunteers,60 cigarette smokers and 65 people with smoking and alcohol drinking behaviors were detected by ELISA.All subjects were grouped by age,gender,smoking and alcohol drinking behavior.The differences in the levels of plasma cytokine profiles among groups were analyzed by statistics software SPSS18.0.Results The concentrations of IL-6 and CRP in 25-39years,40-49 years,50-59 years and over 60 years groups were (1.1±0.7) ng/L,(1.5±0.1) ng/L,(1.7±0.2) ng/L,(2.1±0.1) ng/L and (3.1±1.0) mg/L,(4.4±±0.6) mg/L,(6.2±1.7) mg/L,(8.0±0.8) mg/L,respectively.The concentrations of IL-6 and CRP were significantly increased with age (F=1.60,7.50,P=0.012,0.043),while the concentrations of IL-10 and TNF-alpha were not correlated with age (F=4.20,4.80,P=0.178,0.421).There were no significant differences in the concentrations of IL-6,IL-10,TNF alpha and CRP between males and females (P＞0.05).The plasma CRP level was higher in smoking group than in control group [(6.8±0.6) mg/L vs.(3.1± 0.4) mg/L] and was highest in smoking-alcohol group [(9.5±0.5) mg/L vs.(6.8±0.6) mg/L,(3.1±0.4) mg/L,F=8.40,P=0.046].Compared with the control group,IL-6 level was increased and IL-10 level was decreased in smoking group and smoking-alcohol group.There were no significant differences in levels of IL-6,IL-10 and TNF-a among the three groups (F=2.90,4.30,4.80,P=0.089,0.672,1.231).Conclusions The plasma levels of IL-6 and CRP are significantly increased with age,but the plasma levels of IL-10 and TNF-a have no correlations with age.The plasma levels of IL-6,IL-10,TNF-a and CRP are not affected by gender.CRP level is significantly influenced by smoking and alcohol drinking behaviors,which should be taken into consideration to establish the reference values.

Objective To investigate whether there is a correlation between the esophageal length of the adult Chinese people and their height, sitting height, sex or age. Methods The length from the upper end of esophagus to the dentate line of the cardia was measured by watching esophageal cavity with endoscope. A total of 613 cases (378 males and 235 females) were studied. Results ① The average length of esophagus was (24.8?2.1)cm for male and (22.8?1.9)cm for female. The difference between male and female was statistically significant (P

Objective To investigate the clinical outcome and placental characteristics of spontaneous twin anemia-polycythemia sequence (sTAPS). Methods Twelve cases with sTAPS delivered in Peking University Third Hospital from May 2013 to August 2016. The data of ultrasound characteristics, gestational age at delivery, and 1 minute Apgar score were analyzed,retrospectively. Placental superficial vascular anastomoses, placental territory discordance and the ratio of umbilical cords insertion distance to the longest placental diameter were also analyzed. Results (1) Only 1 case of sTAPS was diagnosed prenatally, the others were diagnosed postnatally because the fetal middle cerebral artery(MCA) doppler was not measured regularly. Five cases were complicated with selective intrauterine growth restriction (sIUGR). The median gestational age at delivery was 32.8 weeks(31-37 weeks). The pregnancies were terminated because 3 cases were sIUGR typeⅠ, 1 case was sIUGR type Ⅱ, 1 case was sIUGR type Ⅲ, 2 cases were fetal distress, 2 cases were severe pre-eclampsia, 2 cases were premature rupture of membrane, 1 case was fetal hydrops with abnormal doppler waveforms of ductus venouses. (2) When 5 sIUGR cases were excluded, there was no difference between the twins in birth weight [1797 g(940-2620 g),1648 g(980-2500 g);P=0.688]. The hemoglobin (Hb) level in all donor was significantly lower than recipient(P=0.000)and the inter-twin Hb difference was 147.6 g/L (84.0-216.0 g/L). While the reticulocyte percentage in donor was significantly higher than recipient (P=0.013) and reticulocyte percentage ratio was 3.60 (1.04-7.50). Five donor newborns had neonatal asphyxia, including 1 severe asphyxia, while no asphyxia happened in the recipient twins. (3) Arterio-arterial (A-A) anastomoses, veno-venous (V-V) anastomoses, arterio-venous (A-V) anastomoses were found in 3, 1 and 11 placentas, respectively. The total number of anastomoses was 2 (1-5) and the total diameter was 1.1 mm (0.4-2.1 mm), including 0 (0-1) A-A anastomoses with 0.2 mm (0.0-0.9 mm) in diameter and 2 (0-5) A-V anastomoses with 0.7 mm (0.0-2.1 mm) in diameter. The placental territory discordance was 0.17 (0.02-0.40) and the ratio of umbilical cords insertion to the longest placental diameter was 0.82 (0.34-0.99). Conclusions The pathogenesis of sTAPS might result from slow and chronic blood transfusion from donor to recipient through a few minuscule vascular anastomoses in the placenta. In all monochorionic twins, especially sIUGR cases, MCA doppler should be monitored closely in the second and third trimester, in order to diagnose and manage sTAPS in time.

We investigated the correlation between toxin gene exoS,exoU and fluoroquinolone resistance in lower respiratory tract infection with P.aeruginosa so as to provide guidance for reasonable treatment of clinical infections.We collected P.aeruginosa of sputum samples in hospitalized patients from October 2015 to March 2016.The antimicrobial susceptibility was tested by liquid dilution method.The exoS and exoU genes were detected by PCR technique.Results showed that forty-six P.aeruginosa strains were identified from sputum.The exoS and exoU gene positive rate were 86.96 ％ (40/46) and 69.57 ％ (32/ 46) respectively,and the highest proportion of genotype was exoS+/exoU+ (60.87％,28/46).Among them,36.96％ (17/ 46) were multiple drug-resistant bacteria(MDR).Fluoroquinolone non-sensitive (FQ-NS) strain were 78.95％ (15/19) for MDR and 89.47 ％ (17/19) exoU gene were positive,which was significantly higher than the fluoroquinolone sensitive strains (FQ-S).Compared with the FQ-S strain,FQ-NS strains were serious drug resistance.The drug resistant rate of eefepime and aztreonam were more than 70％,and then meropenem and imipenem were more than 50％.The drugs of lower resistance rate in FQ-NS strain had polymyxin B(10.53％,2/19),amikacin(10.53％,2/19),ceftazidime (15.79％,3/19) and gentamicin (21.05％,4/19).P.aeruginosa of lower respiratory infection carried toxin genes exoS and exoU were higher,the main genetpy was exoS+/exoU+.FQ-NS strains were higher drug resistance rate and a higher proportion of exoU+ strains than FQ-S strains.We should strengthen virulence genes test and drug resistance monitoring in clinical practice.

Objective To investigate whether the long non-coding RNA (lncRNA) metastasis associated lung adenocarcinoma transcript 1 (MALAT1) can act as a competitive endogenous RNA (ceRNA) to promote the migration of hepatocellular carcinoma (HCC) cells.Methods Transient transfection of small interfering RNA (siRNA) against MALAT1 was used to knockdown MALAT1 in HepG2 cells.Transwell assays were employed to assess the migration capabilities of HepG2 cells upon MALAT1 knockdown.RNA pull-down assays were performed to validate the direct binding between MALAT1 and miR-126*.Quantitative reverse transcription PCR (qRT-PCR) and Western blotting assays were used to detect the mRNA and protein levels of the miR-126* target genes.The dysregulation and prognostic significance of MALAT1 and miR-126* were analyzed in the public dataset of The Cancer Genome Atlas (TCGA).Results Compared with the control group, MALAT1 knockdown significantly inhibited the migration of HCC cells.MALAT1, with three miR-126* response elements, directly sponged miR-126* in a sequence-specific manner.The mRNA and protein levels of CXCL12, which was the miR-126* target gene, were significantly down-regulated upon MALAT1 knockdown.The TCGA database showed that MALAT1 was significantly up-regulated in HCC and high expression levels of MALAT1 were significantly associated with poor disease-free survival, whereas an opposite pattern of miR-126* was observed.Conclusion This study suggests that MALAT1 directly sponges miR-126* and upregulates the expression of CXCL12, which in turn promotes the migration of HCC cells.

Objective To evaluate the efficacy of fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) in treatment of twin-twin transfusion syndrome (TTTS) and to investigate the incidence of TTTS complicated with selective intrauterine growth restriction (sIUGR) for better understanding the effects of sIUGR as a complication of TTTS on pregnancy outcomes. Methods A retrospective study was performed on 116 gravidas who were diagnosed with TTTS of Quintero stage Ⅰ - Ⅳ in Peking University Third Hospital from September 2008 to September 2014. Among them, 44 cases received FLOC therapy. The incidences of sIUGR in each Quintero stage of TTTS were analyzed. Pregnancy outcomes of those 44 cases treated with FLOC were observed and the differences among four stage groups were analyzed. Chi-square or Fisher exact test was performed for statistical analysis. Results (1) The survival rates of both twins from stage Ⅰ to Ⅳ groups were 4/7, 10/14, 5/19 and 3/4, respectively, with statistically significant difference (χ2=7.840, P=0.038), but that in stage Ⅲ group was lower than in stage Ⅱ group without significant difference (P'=0.008). Differences in the total fetal survival rate among the four groups were statistically significant [8/14, 75% (21/28), 32% (12/38) and 6/8, χ2=14.016, P=0.002]. The total fetal survival rate in stage Ⅲ group was significantly lower than that in stageⅡ group (P'<0.008). In patients with stage Ⅲ TTTS, those complicated with sIUGR, after receiving FLOC therapy, showed a lower total fetal survival rate than those without sIUGR [21% (6/28) vs 6/10, P<0.05]. (2) Among the 116 TTTS patients, there were 63 cases (54%) with sIUGR complication. Patients with sIUGR complication in TTTS stages Ⅰ to Ⅳ groups accounted for 40% (14/35), 48% (11/23), 78% (28/36) and 46% (10/22), respectively, and the differences were significant (χ2=11.963,P=0.007). The incidence of sIUGR in stage Ⅲ group was greater than that in stage Ⅰ group (χ2=10.482, P'=0.002), and those in both stage Ⅲ and Ⅱ groups were higher than in stage Ⅰgroup without significant difference. Conclusions TTTS patients in stage Ⅲ have lower survival rate of both twins and total fetal survival rates after FLOC therapy, which may be related to a higher incidence of concurrent sIUGR.

Central venous catheters (CVCs) are now widely used in critical care for critical care, fluid resuscitation, drug infusion, parenteral nutrition, hemodynamic monitoring, chemotherapy, and continuous blood purification treatment. Although the application of CVCs can facilitate clinical medical care work, the proportion of patients with various catheter complications will exceed 15%, and the incidence of catheter blockage is about 25%. At present, adequate flushing and effective sealing are considered to be important means to reduce and prevent catheter blockage. This article reviews the prevention of central venous catheter occlusion with different sealing fluids, in order to provide reference for clinical nurses to prevent central venous catheter occlusion.