Objective To investigate the changes in circulatory and pulmonary monary angiotensinⅡin rats with acite lung injury(ALI)and explore the role of angiotensinⅡin ALI.Method Thirty S-D rats were randomly divided into control group(n=6)and ALI group(n=24).The ALI group was further divided into four subgroups of observation at various intervals,3,6,9 and 12 hours after administration of lipopolysaccharide (LPS)into the femoral vein(each n=6).The indices rate,blood gas analysis,wet weight/dry weight(W/D)ratio of lung lobes,and pathological changes were successively observed at 3,6,9,and 12 hours after injury.The content of angiotensinⅡin lung tissue and blood plasma were detected at above set intervals by radioimmunoassay.Data of these assays were analyzed by one-factor analysis of variance.Results Compare with the control group,pH and PaO2 of arterial blood in ALI group decreased significantly(P＜0.05)at all intervals and PaCO2 of arterial blood in ALI group decreased significanfly(P＜0.05).at all intervals and PaCO2 of arterial blood and lung W/D weight ratio increased significantly(P＜0.05),and scores of lung histopathology denoted the lung injuried(P＜0.01).After injury of lung,angiotensin Ⅱ content increased markedly in lung homogenate and blood plasma (P＜0.05).Angiotensin Ⅱ content in blood plasma reached peak value at 9 hours,and content of angiotensin Ⅱ in lung homogenates kept on increasing at allintervals of observation.Conclusions A large amount of angiotensin Ⅱ releases into lung tissue and blood plasma during ALI,suggesting systemic and pulmonary rennin-angiotensin systems are activated.

Objective To evaluate the effects of positive end-expiratory pressure (PEEP) targeting optimal oxygenation on local gas distribution and inflammation in dogs with acute respiratory distress syndrome (ARDS). Methods ARDS was induced by saline alveoli-lavage and oleic acid intravenous. The animals were mechanical ventilated 4 h at optimal PEEP titrated by oxygenation. Computed tomography (CT) scans were performed before and after induction of ARDS and at the end the study. NF-κB was measured by electrophoretic mobility shift assay (EMSA), IL-6 and IL-10 were assessed by ELISA.Myeloperoxidase (MPO) and malondialdehyde (MDA) were measured. Pathological changes were examined under optical microscope. Results (1) Compared to baseline, total lung volumes decreased and nonaerated areas increased significantly after the induction of ARDS in both groups (P ＜ 0.05 ). Compared with ARDS models, PEEP titrated to achieve optimal oxygenation resulted in greater lung recruitment but was accompanied with hyperinflation, hyperinflation occurred in non-dependent lung. Compared with oleic acidinjured ARDS, the changing of hyperinflated lung areas was increased markedly in saline lavage-injured ARDS (P＜0.05). (2) Compared with right lung ventral lower lobe, lung injury score was lower in right lung upper lobe. Histological injury in right lung dorsal lower lobe was severer than that in right lung upper lobe and right lung ventral lower lobe. NF-κB activation of right lung dorsal lower lobe was markedly higher than right lung upper lobe (P ＜ 0.05 ). MPO and MDA were much higher with right lung dorsal lower lobe than right lung upper lobe and right lung ventral lower lobe ( P ＜ 0.05 ). Compared with right lung upper lobe and right lung ventral lower lobe, IL-6 and IL-10 increased markedly in right lung dorsal lower lobe ( P ＜ 0.05 ). Conclusions Alveolar hyperinflation and aggravated lung injury in non-dependent region were occurred at PEEP targeting optimal oxygenation. Hyperinflation was more common in saline lavage-injured ARDS.

Objective To investigate the relationship between the resistance of the Klebsiella pneumoni-ae and the Klebsiella pneumoniae plasmid pNDM-LJ carrying blaNDM-1 by high-throughput DNA sequencing. Methods High-throughput DNA sequencing was carried out by the Illumina Miseq platform , and sequencing data were assembled by Edena software. Contigs were annotated by the RAST server and analyzed by the BLAST server. Results The plasmid pNDM-LJ was 54-kb in size with a GC content of 49%. The plasmid encoded 52 putative functional genes and belonged to the IncX3 group in incompatible classifications. Analysis of the plasmid sequence revealed high similarity with other IncX3 plasmids. The blaNDM-1 gene was located in a complicated gene environment possibly constructed by several transposition events. The 5′ and 3′ ends of the blaNDM-1 gene were adjacent to the ISAba125 and IS 26 respectively , forming a 10.8-kb transposon-like structure. Conclusion The plasmid pNDM-LJ carried the blaNDM-1 gene being resistant to carbapenems and played a possibly impor-tant role in transmission of blaNDM-1 in China.

The writing of vocational college thesis is the maln way to test whether the students are able to analyze and solve practical problems with the professional knowledge and skills they've learnt, as well as improve the capability of production and practice. This paper analyzes the present situation of the thesis written by higher vocational college students majoring in pharmaceutical sci-ences, and figures out the four kinds of evaluation standards about graduation thesis for students in various pharmaceutical fields with different problems. The four kinds of evaluation standards includes key point analysis on Standard Operation Procedure (SOP), planning strategy for pharmaceutical mar-keting, investigation of rational use of drugs in hospitals and subject research. The author puts forward the solving method for the problem, and formulate the evaluation requirements.

ObjectiveTo assess the efficacy of subglottic secretion drainage for preventing ventilatorassociated pneumonia.MethodsData of relevant randomized controlled trials (RCT) from January 1991 to June 2010 were collected,and data were split into two groups,namely draining group and non-draining group.Meta analysis of ventilator-associated pneumonia was carried out for finding the incidence and mortality in patients with mechanical ventilation using the methods recommended by the Cochrane Collaboration.ResultsSeven RCTs met the inclusion criteria and 1647 patients were enrolled.Subglottic secretion drainage reduced the incidence of ventilator-associated pneumonia ( OR =0.45,95％ confidence interval [CI]:0.32 - 0.63 ),primarily by reducing early-onset pneumonia.But the mortalities of ventilator associated pneumonia were not significantly different between the two groups ( OR =1.03,95％ confi dence interval [CI]:0.75 - 1.41 ).ConclusionsSubglottic secretion drainage appeared effective in preventing ventilator associated pneumonia among patients expected to require ＞48 hours of mechanical ventilation,but the mortality was unchanged.

Occupational Health Services ; methods ; organization & administration

[Objective] To investigate the effect of Suiqing Pill (SP), a Chinese prescription with the actions of activating blood and removing blood-stasis, on growth and metastasis of tumor. [Methods] Sixty C57BL/6 mice were randomized to three groups: group A (model control), group B (low-dose SP) and group C (high-dose SP). H22 hepatocarcinomatous metastasis models were established by subcutaneous injection of H22 hepatocarcinoma cells into the right lower limb. The inhibitory rate of tumor weight, incidence of metastatic carcinoma of lung, metastasis of lymph node, survival time and life-span prolongation rate were observed. [Results] The weight of tumor was reduced and the inhibitory rate of tumor weight was 36.83% in group B (P

Objective To observe the effect of early goal directed therapy (EGDT) on tissue perfusion,microcirculation and tissue oxygenation in patients with septic shock.Methods A prospective observational study was carried out in 20 patients with early septic shock admitted to ICU within 24 hours after onset.Patients with one of following conditions,including stroke,brain injury,other types of shock,severe heart failure,acute myocardium infarction,ages below 18,pregnancy,terminal stage of disease,cardiac arrest,extensive bums,mouth bleeding,oromandiblular dyetonia (difficult to open the mouth),and the time elapsed over 24 hours after onset of septic shock,were excluded.The eligible patients were treated with the standard procedure of EGDT.The partial pressure of transcutaneous oxygen and carbon dioxide (PtcO2,PtcCO2) was monitored and hemodynamic data were recorded.Sidestream dark field imaging device was applied to detect the sublingual microcirculation.Hemodynamics,tissue oxygen,and sublingual microcirculation were compared before treatment and after EGDT.When the variables met the normal distribution,t test was applied.Otherwise,Wilcoxon test was used.Correlation between variables was analyzed with Pearson Correlation Analysis.Results Of 20 patients,19 met all 4 elements in criteria of EGDT after treatment and were eligible for study.PtcO2 and PtcCO2 were monitored in 19 patients.Sublingual microcirculation was obtained in four of them.(1) After the criteria of EGDT were entirely met,PtcO2 increased from (62.7 ± 24.0) mm Hg to (78.0 ± 30.9) mm Hg (P ＜ 0.05) ; tissue oxygenation index (PtcO2/FiO2) was (110.7 ± 60.4) mm Hg before treatment and (141.6 ± 78.2) mm Hg after EGDT (P ＜ 0.05).PtcCO2 and PaCO2 gap (difference between PtcCO2 and PaCO2) decreased significantly after EGDT (P ＜ 0.05).(2) Both proportion of small vessels with perfusion (PVP) and microcirculatory flow index of small vessels (MFI) showed a trend of increase after EGDT,but there were no significant differences between pre-and post-EGDT (P was 0.051 and 0.074 respectively).(3) PtcO2,PtcO2/FiO2,and PtcCO2 were not linearly related to central venous saturation,lactate,oxygen delivery,and oxygen consumption (All P ＞ 0.05).Conclusions Peripheral perfusion improved after EGDT in patients with septic shock but those hemodynamic variables might not exactly reflect the authenticity of global perfusion.

BACKGROUND: This study aimed to observe the effect of early goal directed therapy (EGDT) on tissue perfusion, microcirculation and tissue oxygenation in patients with septic shock. METHODS: Patients with early septic shock (<24 hours) who had been admitted to the ICU of Zhongda Hospital Affiliated to Southeast University from September 2009 through May 2011 were enrolled (research time: 12 months), and they didn't meet the criteria of EGDT. Patients who had one of the following were excluded: stroke, brain injury, other types of shock, severe heart failure, acute myocardial infarction, age below 18 years, pregnancy, end-stage disease, cardiac arrest, extensive burns, oral bleeding, difficulty in opening the mouth, and the onset of septic shock beyond 24 hours. Patients treated with the standard protocol of EGDT were included. Transcutaneous pressure of oxygen and carbon dioxide (PtcO2, PtcCO2) were monitored and hemodynamic measurements were obtained. Side-stream dark field (SDF) imaging device was applied to obtain sublingual microcirculation. Hemodynamics, tissue oxygen, and sublingual microcirculation were compared before and after EGDT. If the variable meets the normal distribution, Student's t test was applied. Otherwise, Wilcoxon's rank-sum test was used. Correlation between variables was analyzed with Pearson's product-moment correlation coefficient method. RESULTS: Twenty patients were involved, but one patient wasn't analyzed because he didn't meet the EGDT criteria. PtcO2 and PtcCO2 were monitored in 19 patients, of whom sublingual microcirculation was obtained. After EGDT, PtcO2 increased from 62.7±24.0 mmHg to 78.0±30.9 mmHg (P<0.05) and tissue oxygenation index (PtcO2/FiO2) was 110.7±60.4 mmHg before EGDT and 141.6±78.2 mmHg after EGDT (P<0.05). The difference between PtcCO2 and PCO2 decreased significantly after EGDT (P<0.05). The density of perfused small vessels (PPV) and microcirculatory flow index of small vessels (MFI) tended to increase, but there were no significant differences between them (P>0.05). PtcO2, PtcO2/FiO2, and PtcCO2 were not linearly related to central venous saturation, lactate, oxygen delivery, and oxygen consumption (P>0.05). CONCLUSION: Peripheral perfusion was improved after EGDT in patients with septic shock, and it was not exactly reflected by the index of systemic perfusion.

Objective To understand the changes of cardiac systolic and diastolic function in human immunodeficiency virus (HIV)-infected patients without evidence of cardiac disease in China.Methods Forty-two HIV-infected patients who were followed up in the Department of Infectious Diseases at Peking Union Medical College Hospital without cardiac involvement were recruited.All the HIV-infected patients had received highly active antiroviral therapy (HAART) for more than 12 months with viral suppression.And 30 age and sex matched healthy subjects without cardiac disease manifestations were enrolled as controls.Every group members underwent transthoracic echocardiography evaluation.The indexes of cardiac systolic and diastolic function between HIV-infected patients and healthy controls were compared.Results Diastolic abnormality occurred in 20 cases in HIV-infected group and 6 cases in control group, with statistically significant difference (χ2=5.79, P=0.007).The E wave deceleration time (EDT) in HIV-infected patients were significantly decreased than healthy controls ([161.87±21.64] ms vs.[190.34±37.22], t=-3.20, P=0.002).There were no significant differences of E/A ratio ([1.16±0.35] vs.[1.19±0.26]), E/Ea ratio ([5.43±1.99] vs.[5.78±0.91]), isovolumic relaxation time (IVRT), ([93.18±20.34] ms vs.[93.57±18.55]ms), Ea ([10.18±2.80] cm/s vs.[11.45±2.75] cm/s) between HIV-infected patients and controls (t=1.13,1.53,0.67 and 0.29, respectively, all P>0.05).Among cardiac systolic function markers, left ventricular ejection fractions in HIV-infected patients and control group were (66.7±6.4)% and (68.7±4.2)%, respectively.And left ventricular shortening rates were (37.08±4.79)% and (38.17±3.96)%, respectively.Both showed no significant difference between the two groups (t=-1.51 and-1.00, respectively, both P>0.05).Conclusions Compared with control group, subclinical cardiac diastolic dysfunction is more frequently observed in HIV-infected patients.However, there are no significant differences of cardiac systolic function markers between HIV-infected patients and controls.