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 investigate the osteointegration and osteoinduction of nano hydroxyapatite/bioglass ( nHA/BG ) gradient nanofilm on the surface of titanium ( Ti) prepared by hypotherm sintering and plastic deformation. Methods:Hypotherm sintering was used to produce nHA/BG gradient coating followed by soaking in the simulated body fluid. Ti implants with gradient coatings were planted in femoral condyles at one side of 12 New Zealand rabbits and the untreated Ti implants were planted at the other side as the controls. 1, 3 and 6 months after implantation, the animals were sacrificed after X-ray examination and the tissues around the implants from the 3 month group were used for the preparation of hard tissue section and ground section. New bone formation was observed by tetracycline fluorescence staining. Von Gieson staining was used to observe the osteointegration at the interface between bone and im-plant. Results:The gradient coatings were porous and composed of irregular rod-like nano-HA crystals. Animal study showed well es-tablished osteointegration between the gradient coating and more novel bone was found around the implants with gradient coatings. Conclusion:Osteointegration and ostioinduction of Ti implant can be enhanced by nanostructured surface with gradient coatings of nHA/BG.

Hepatocellular carcinoma ( HCC) , as one of the most common malignant neoplasms , has a relatively high morbidity and mortality rate worldwide.MicroRNAs (miRNAs),a type of comparatively conserved endogenous small non-coding RNAs, function as pivotal regulators involved in various biological functions through the post -transcriptional regulation of gene expression .Some miRNA genes are arranged into a intandem model and reside close together on the same chromosome , forming miRNA clusters . These clustered miRNAs are mostly located on polycistronic transcripts and expressed at similar levels.In the human imprinted 14q32 region, 52 miRNA genes are organized as a large cluster which spans about 220 kb of the long arm ( q) .Lines of evidence show that dysregulation of miRNAs in this cluster are involved in the development of HCC .This review summarizes the structural characteristics of 14 q32 miRNA cluster as well as its impact on HCC in initiation and progression .

Objective To discuss the relationship between repetitive variable deceleration with a short interval (RDSI) in labor and neonatal acidosis.Methods One hundred and seventy-seven electronic fetal heart monitoring (EFM) patterns within one hour preceding delivery in term singleton pregnancies were collected in Peking University Third Hospital between February 2011 to October 2013.Continued EFM were recorded before delivery.Analysis was conducted on general information of both mothers and babies,including pregnant complications,duration of labor,cord and placental factors,nature of amniotic fluid,Apgar score and neonatal cord blood gas.RDSI was defined as that over 50％ intervals between two decelerations (the end of the last deceleration to the beginning of the next one) ≤ 60 s which appeared repetitevly in a period of 20 minutes.Independent sample t test,rank sum test,Chi-square test and Fisher's exact test were applied for statistics and receiver operating characteristic curve was obtained from the information of those with RDSI.Results Twenty-four of the 177 women with RDSI were assigned to the study group (24 cases,13.6％) and the rest 153 cases without RDSI to the control group.Background information of women in the two groups was comparable according to the maternal age,gestational weeks at delivery and duration of labor (all P ＞ 0.05).The occurrence of meconium stained amniotic fluid in the study group was higher than that of the control group [16.7％ (4/24) vs 5.2％ (7/153),x2=5.204,P=0.045],while the pH and base excess value of the neonatal blood gas in the study group were lower [7.20 (7.13-7.28) vs 7.29 (7.25-7.33),Z=-4.490;-6.10 (-4.67 to-9.62) mmol/L vs-3.20 (-4.90 to-1.55) mmol/L,Z=-5.044;P ≤ 0.01] resulting a higher rate of neonatal acidosis [50.0％(12/24) vs 7.8％ (12/153),x2=31.456,P ＜ 0.01].No significant difference was found in the incidence of neonatal asphyxia between the two groups.The area under the curve was 0.774 (95％CI:0.579-0.969).Conclusion RDSI in labor might indicate a high risk of neonatal acidosis.

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.

Objective On patients with mechanical ventilation spontaneous breathing trial (SBT) success, out of breath machine smoothly pulled out after endotracheal intubation for active airway moist sequential therapy of clinical new method and new technology. Methods Between January 2013 and May 2014 respiratory endotracheal intubation implementation of mechanical ventilation with intensive medicine successful withdraw machine pulled out of 135 patients with tracheal intubation, they were divided into group A(68 cases) and group B(67 cases) by random digits table method. The patients in group A were treated with buoy type oxygen device, group B with active airway moist heat treatment unit. The breathing rate, PaO2, SpO2, heart rate, Clinical Pulmonary Infection Score(CPIS) were measured after 72 h of pull out endotracheal intubation in two groups. Sputum viscosity was evaluated by Airway Secretions Score before pull out endotracheal intubation and after 24, 48, 72 h of pull out endotracheal intubation in two groups. Results There were no significant differences between two groups in gender, age, clinical diagnosis, mechanical ventilation time, acute physiology and chronic health evaluation systemⅡrating etc (P>0.05). The breathing rate, heart rate and CPIS score respectively (20.94 ± 0.89), (80.79±4.67) times/min and (7.13 ± 2.54) points after 72 h of pull out endotracheal intubation in group B, and (24.12 ± 0.97), (86.32 ± 5.12) times/min and (8.79±3.56) points in group A, and there were significant differences(t=5.113, 7.298, 5.597, all P<0.01). PaO2, SpO2 were (93.24±1.96) mmHg(1 mmHg=0.133 kPa), 0.973 2±0.014 8 in group B, and (87.35±2.32) mmHg, 0.937 8±0.013 2 in group A, and there were significant differences(t=9.279, 4.548, all P<0.01). There was no significant difference in sputum viscosity before pull out endotracheal intubation between two groups (P>0.05). After 24, 48 and 72 h of pull out endotracheal intubation, group B of patients with sputum viscosity was suitable in group A (Z=-2.684,-2.870,-2.771, all P < 0.01). Conclusions Mechanical ventilation in patients with ventilator buoy type oxygen device for the pull out after endotracheal intubation success does not favor the sputum drainage, improve patients with dyspnea and hypoxemia is not obvious. By positive airway plus temperature humidity to sequential therapy is helpful to correct hypoxemia, improve the patients' respiratory function, reduce the breathing difficulties, reduce sputum viscosity, promote the airway drainage unblocked, shortening the time of lung infection.

Objective To analyze the massive explosions and burn at Tianjin Port in 2015 resulted in a mass casualty event,and the entire course of response of a hospital to deal with such major sudden accident in order to find a rational strategy for optimal use of medical resources and reduce the critical mortality.Methods This study was done by a retrospective analysis of data from one trauma center at an academic hospital.Data including outcome,triage,severity and pattern of injuries,patient flow,and medical resources used were obtained by the review of hospital records.Results This disaster caused 165 deaths,8 missing contact,and 797 non-fatal casualties.The Pingjin Hospital admitted 298 casualties,and 29 of them were seriously injured referred to by Tianjin Emergency Medical Center.Excessive triage rate made after transfer to another hospital was 62.07% with 11 of the 29 severely injured patients.Maximum (also the first)surge had 147 injured patients arrived around one hour after incident,the second surge had 31 seriously injured patients occurred around 4 hours after incident.Of them,17 patients needed surgery and 17 patients were admitted to the intensive care unit.Conclusions These data showed that the number of casualties in the first surge was substantially larger than predicted and those casualties had less severe trauma,whereas the number of the injured in the second surge was less but the trauma was more severe.In order to maintain the hospital surge capacity,an effective re-triage and a hospital-wide damage control principle can be used to deal with.

BACKGROUND:The peri-implant bone absorption is closely related to the repair effect. OBJECTIVE:To compare the effects of three kinds of dental implant systems on the peri-implant bone absorption. METHODS:116 patients who underwent the dental implant systems were col ected, including 46 cases with 3I implant system, 40 cases with ITI implant system and 30 cases with BLB implant system. The peri-implant bone absorption, sulcus bleeding index and periodontal probing depth of three groups were detected at 1, 3, 6, 9 and 12 months after implantation, respectively. RESULTS AND CONCLUSION:The peri-implant bone absorption of three groups within 1 year after implantation was in a rise, and the bone absorption of BLB group was significantly higher than that of ITI and 3I groups at 3 and 12 months after implantation (P<0.05). Compared with the natural teeth, the gingival sulcus bleeding index of three groups were al increased at different time points after implantation;the gingival sulcus bleeding index of BLB group was significantly higher than that of natural teeth at 6 months after implantation (P<0.05);the gingival sulcus bleeding index of three groups were significantly higher than that of natural teeth at 9 months after implantation (P<0.05). The periodontal probing depth of three groups showed an ascending trend at 6 months after implantation;the periodontal probing depth of three groups was higher than that of natural teeth at different time points after implantation, which exhibited significant differences at 6 and 9 months after implantation (P<0.05). In conclusion, three kinds of dental implant systems exhibit differet effects on the peri-implant bone absorption, but al achieve excel ent clinical efficacies.

Objective To study the placental vascular distribution of monochorionic (MC) twins with twin-to-twin transfusion syndrome (TTTS) or hirth weight discordance.Methods Twenty-eight MC placentas were injected in Peking University Third Hospital between Feb.2010 and Feb.2011.The vascular distribution type (parallel,crossed,mixed and monoamniotic),the anastomosis of vessels and the placental sharing were recorded.The outcome of pregnancy and the placental characteristics of birth weight discordance (birth weight discordance ≥ 20％) in non-TTTS MC twins were analyzed.Results (1) The outcome of pregnancy:the miscarriage or gestational weeks of 28 MC twins were 20 to 38 weeks (median of 35 weeks).Six cases were TTTS,3 of which received fetoscopic laser occlusion of communicating vessels (FLOC).There were 48 live births,with an average birth weight of (2036 ± 623) g.(2) Type of placental vascular distribution:in the 28 MC placentas,number of parallel,crossed,mixed and monoamniotic type of placental vascular distribution were 4 (14％),14 (50％),6 (21％) and 4 (14％) cases,respectively.No parallel type was found in TTTS.There was no significant difference of vascular anastomosis or unequal placental sharing among the different placental vascular distribution types (P ＞ 0.05).(3) Characteristics of placental vascular distribution in birth weight discordance twins:there were 20 non-TTTS MC twin pregnancies,all of which got live births of both babies.Birth weight discordance equal to or more than 20％ was found in 6 pairs of newborns,while birth weight discordance less than 20％ was found in the rest 14 cases.Ratio of unequal placental sharing was significantly different between the two groups (P ＜ 0.01).There was no significant difference of umbilical cord insertion,placental vascular distribution and anastomosis in the two groups (P ＞0.01).Conclusions Vascular distribution type of MC twins might be related to TTTS.Unequal placental sharing is a risk factor of birth weight discordance in non-TTTS MC twins.

Objective To explore the effect of scenario simulation training to nurses in improving the rescue ability at ICU. Methods A total of 84 nurses were enrolled and divided into12 groups, who received 6 scenarios training developed by researchers. The score of theoretical knowledge, time of practice completion and 7 operating practices were compared before and after training. Results The theoretical knowledge score of the nursing staff before the exercise was 72.21 ± 3.14, and the score was 91.77 ± 4.55 after the exercise, and the difference before and after the exercise was statistically significant (t=2.77, P<0.05). After practice, nursing staff in cardiopulmonary resuscitation (CPR), intestinal spillover, limb fracture, pelvic fractures, burns, bleeding, glass into the seven skills score 96.23 ±4.80, respectively 96.92±4.12, 96.59±3.97, 93.79±3.45, 97.71±4.18, 95.58±4.16, 91.67±3.31, were higher than drills before 85.43± 4.55, 65.44± 4.21, 74.05± 3.25, 66.35± 2.95, 85.31± 4.05, 81.41± 3.11, 69.59± 3.96.There was a significant difference in 7 operational skills between before and after operation (t=4.010-9.780, P<0.01) . After practice,six scenario completion time was (265.45 ± 41.37), (274.90 ± 43.15), (296.52 ± 42.09), (285.44 ± 47.15), (296.42 ± 43.51), (303.50 ± 36.92) s respectively, than drills before (366.29 ± 41.12), (363.54 ± 32.94), (367.78 ± 33.75), (371.29 ± 40.16), (370.57 ± 34.69), (372.98 ± 35.32) s. There was a significant difference in time of finishing 6 scenarios between before and after operation exercises (t =2.190-6.210, P< 0.05). Conclusions Scenario simulation model training can improve the theoretical knowledge, time of practice completion andpractices ability of ICU nursing.