ObjectiveTo observe the effects of mechanical ventilation with different tidal volumes (VT) on coagulability and fibrinolytic characteristics in rabbits with acute respiratory distress syndrome (ARDS) induced by two-hits with oleic acid (OA) and lipopolysaccharide (LPS).Methods Forty healthy adult male rabbits were randomly divided into five groups (8 rabbits in each group): sham operation group, model group, low VT group (6 mL/kg), rontine VT group (10 mL/kg), high VT group (15 mL/kg). ARDS model was reproduced by sequential injection of 0.1 mL/kg OA and 500μg/kg LPS via auricular vein, and the rabbits in sham operation group received normal saline in same volume. Mechanical ventilation was performed in different VT groups after model reproduction, and the end of the experiment was determined as 6 hours after LPS injection. Blood was collected from the carotid artery at 30 minutes and 360 minutes after LPS injection, with which arterial partial pressure of oxygen (PaO2) was determined, and oxygenation index was calculated. Internal jugular vein blood was collected at 5, 120, 240, and 360 minutes after LPS injection, and activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen (Fib) and antithrombinⅢ(AT-Ⅲ) were determined. The blood was collected at the end of the experiment, and then the rabbits were sacrificed, and serum levels of procollagen typeⅢ (PⅢP), plasminogen activator inhibitor-1 (PAI-1) as well as PⅢP level in lung tissue were determined. The wet/dry weight ratio (W/D) of lung tissues was calculated.Results Compared with sham operation group, oxygenation index at both 30 minutes and 360 minutes were significantly decreased in model group, while W/D ratio was significantly increased. PT and APTT at 5 minutes were significantly shortened followed by a gradual increase. Fib and AT-Ⅲ showed no change at 5 minutes followed by a gradual decrease, while serum PAI-1 and PⅢP as well as PⅢP in lung tissue were significantly increased. There was no significant difference in oxygenation index between all VT groups and model group, with a tendency to increase in low VT group. W/D ratio in low VT group was the lowest (5.09±0.19), and it was significantly lower than that of the model group (6.02±0.27, P< 0.01), while it was the highest in high VT group (6.27±0.32). PT and APTT in all VT groups were gradually prolonged, and Fib and AT-Ⅲ were gradually decreased. PT and APTT in low VT group were significantly shorter than those in model group from 120 minutes on [PT (s): 120 minutes: 8.90±0.28 vs. 11.43±0.28, 240 minutes: 9.18±0.21 vs. 11.99±0.50, 360 minutes: 9.25±0.15 vs. 12.49±0.29; APTT (s): 120 minutes: 69.09±3.91 vs. 76.08±4.21, 240 minutes: 67.53±2.14 vs. 79.71±2.25, 360 minutes: 66.95±1.13 vs. 83.21±4.01, allP< 0.05], Fib (g/L) was significantly elevated (120 minutes: 3.80±0.09 vs. 3.38±0.15, 240 minutes: 3.91±0.05 vs. 2.47±0.16, 360 minutes:4.06±0.13 vs. 2.39±0.16, allP< 0.05), and no significant difference was found in AT-Ⅲ. Serum contents of PAI-1 and PⅢP as well as PⅢP in lung tissue were significantly lowered [serum PAI-1 (ng/L): 1.14±0.26 vs. 1.63±0.91, serum PⅢP (ng/L): 1.62±0.52 vs. 2.91±0.64, lung PⅢP (ng/L): 4.40±0.58 vs. 5.75±0.47, allP< 0.01]. The change tendency of all parameters in routine VT group was lower than that in low VT group, PT at 120 minutes and 360 minutes, APTT at 240 minutes and 360 minutes was significantly shorter than that in model group, and Fib at 120 minutes and 240 minutes were significantly higher than those in model group (allP< 0.05). No significant difference was found in AT-Ⅲ, serum PAI-1 and PⅢP as well as lung PⅢP as compared with model group. PT and APTT at 360 minutes in high VT group were significantly longer than those in model group, Fib at 360 minutes was significantly lower than that in model group, and lung PⅢP was significantly higher than that in model group. Conclusions There are some important changes in coagulability which changes from a hyper state into a hypo coagulate state, while fibrinolysis is inhibited during the pathological process of ARDS produced by two-hit of OA and LPS. Mechanical ventilation with low VT can obviously improve coagulability and fibrinolytic status, while ventilation with routine VT has little effect on coagulability and fibrinolytic status. Mechanical ventilation with high VT, however, will greatly deteriorate the coagulability and fibrinolytic function in ARDS.

Objective To assess the diagnostic value of cytokeratin 18 fragment M30 (CK18-M30) and Fas in patients with nonalcoholic fatty liver disease (NAFLD),especially nonalcoholic steatohepatitis (NASH).Methods Among 58 patients with NAFLD,36 patients with NAFLD received liver biopsy.According to NAFLD activity score (NAS) and liver fibrosis score,patients were divided into NASH group (24 cases) and non-NASH group (12 cases).And at the same period,15 healthy individuals were set as healthy control group.The serum level of CK18 M30 and Fas were measured with enzyme-linked immunosorbant assay (ELISA).Rank sum test was performed to analyze the differences in the level of CK18-M30 and Fas between groups.The diagnostic value of CK18 M30 and Fas were assessed by the receiver operating characteristic (ROC) curves.Results The level of serum CK18-M30 of NAFLD group was significantly higher than that of healthy control group (97.24 U/L (86.06 to 113.12 U/L) vs 78.41 U/L (74.29 to 80.76 U/L),Z=-4.206,P＜0.01)).The level of serum CK18-M30 of NASH group was higher than that of non-NASH group (111.06 U/L (94.30 to 142.68 U/L) vs 89.00 U/L (83.56 to 106.50 U/L),Z=-2.233,P＜0.05)).The area under the ROC curve (AUC) of CK18-M30 in the diagnosis of NASH was 0.73 (0.56,0.90),and the sensitivity and specificity of CK18-M30 in diagnosis of NASH was 79.2％ and 58.3％,respectively.The AUC of Fas in diagnosis of NASH was 0.58 (0.38,0.77),while the sensitivity and specificity of Fas in diagnosis of NASH was 54.2％ and 66.7 ％.The serum level of Fas increased in FAFLD group compared with healthy control group,and in NASH group compared with non-NASH group,however the differences were not signifincant (both P＞ 0.05).Conclusions The level of CK18-M30 has certain value in the diagnosis of NASH.The diagnostic value of Fas in NASH needs more samples in further study.

Composite Resins ; Dental Bonding ; methods ; Dental Restoration, Permanent ; methods

OBJECTIVE To investigate the effect and mechanisms of chrysophanol on the expression of c-fos and c-jun mRNA induced by ammonia chloride(NH4Cl) in mouse astrocytes. METHODS Primary mouse astrocytes were cultured with NH4Cl 5 mmol·L-1+chrysophanol 0.1,1.0 or 10.0 mg·L-1 ,or NH4Cl 5 mmol · L- 1+extracellular regulated kinase1/2(ERK1/2) inhibitor UO126 10 mmol · L- 1 and NH4Cl 5 mmol · L-1+p38 mitogen-activated protein kinase(p38 MAPK)inhibitor SB239063 10 mmol · L-1 for 48 h. The levels of glutathione peroxidase(GSH-Px),superoxide dismutase(SOD),malondaldehyde(MDA), nitric oxide(NO)and nitric oxide synthase(NOS)were detected by UV spectrophotometry. The phos?phorylation levels of ERK1/2 and p38 MAPK were detected by Western blotting. The expression of c-fos and c-jun mRNA was detected by RT-PCR. RESULTS Compared with NH4Cl 5 mmol · L- 1 group, ammonia-induced astrocytes oxidative stress was improved by chrysophanol (1.0 and 10.0 mg · L-1). The content of MDA and NO and the activity of NOS were reduced(P<0.05). The activity GSH-Px and SOD was increased(P<0.05). The phosphorylation level of ERK1/2 and p38 MAPK induced by ammonia was reduced in chrysophanol groups (P<0.05). Ammonia-induced c-fos and c-jun mRNA expression downregulation was reversed by chrysophanol (0.1,1.0 and 10.0 mg · L-1)and UO126 and SB239063(P<0.05). CONCLUSION Chrysophanol may improve the downregulated expresion of c-fos and c-jun mRNA in mouse astrocytes exposed to NH4Cl by anti-oxidative stress by inhibiting the ERK1/2 and p38 MAPK phosphorylation.

Candidiasis, Oral ; diagnosis ; drug therapy ; microbiology ; Humans

Objective In order to reduce neonatal missing and obstetric malpractice,design and application of a new neonatal hand ring was proposed in this paper.Methods Positive stop button,positive stop knot,positive stop cannula,rope,double sandwich tag set were included in the structure of new neonatal hand ring.Results The new neonatal hand ring has been experimentally applied by some departments in Nanjing Maternity and Child Health Care Hospital.The result showed the new neonatal hand ring effectively reduced the incidence of hand ring falling off,arm erythema and beds error.Conclusions Application of the new neonatal hand ring can guarantee the legal rights of newnates,avoid the disputes caused by misunderstanding and increase the automatic management level of hospitals.

Objective To study leprosy epidemic level and its trends in Yancheng during 1949－ 1999. Methods Materials of 8 997 cases detected and leprosy control in Yancheng City were analyzed. Results Prevalence, incidence and detection rates of each county and city showed the trends which first rose then declined. And the district distribution showed a characteristic of“ high in the south and low in the north, more in the west and less in the east” .At the end of 1999,the mean prevalence of late 5 years was 0.5/100 000 with both detection and incidence rates of 0.08/100 000. Conclusion The leprosy endemicity has been controlled through 50 year control. It illustrates that in the futare the leprosy control must strengthen the health education, carry out classified guidance and improve the case－ finding efficacy.

Objective To compare the effects of butorphanol,midazolam and innovar on relieving appendix traction response during appendectomy. Methods Sixty-eight patients who underwent appendectomy were randomly divided into butorphanol group(n=21),midazolam group(n=23) and innovar group(n=24).Butorphanol,midazolam and innovar were intravenously administered to patients during skin incision.The appendix traction response,sedation score,heart rate(HR),mean arterial pressure(MAP) and pulse oxygen saturation(SpO2) were recorded and compared among groups.Results Compared with those before operation,there was no significant changes in HR,MAP and SpO2 during operation.The effective rates of butorphanol,midazolam and innovar in relieving appendix traction response were 95.2%,65.2% and 50.0%,respectively.Butorphanol surpassed midazolam and innovar in sedation and relieving appendix traction response(P

In constructing the system of medical functional teaching and enhancing the quality and ability of students,we adjust the content and method of teaching in practice,and try to find students'problems in study through questionnaire survey and promote teaching reform and disciplines construction.

Objective To investigate the protective effects of etomidate on the cortex and hippocampus against anoxia-reoxygenation (A/R) injury.Methods Male adult SD rats weighing 90-100 g were anesthetized with ether and decapitated. Their brains were immediately removed. Cortical and hippocampal slices were prepared and were randomly divided into 6 groups: group Ⅰ control; groupⅡ A/R; in group Ⅲ - Ⅵ the brain slices were first incubated in the presence of etomidate 3, 6, 15 ?mol?L-1 or etomidate 6 ?mol?L-1 + picrotoxin 50 ?mol?L-1 (GABA receptor antogonist) for 30 min. Then the slices were subjected to 10 min anoxia (95% N2 +5% CO2) followed by 120 min reoxygenation. The absorbance value (A490) of TTC staining (2. 3. 5-triphenyl tetrazolum chloride) and intracellular free Ca2+ ([Ca2+]i) accumulation were determined. Results The A490 in cortical and hippocampal slices were significantly decreased while [Ca2+] i significantly increased in A/R group as compared with control group. Different concentrations of etonlidate attenuated the changes induced by A/R especially 6 ?mol?L-1. The protective effects of etomidate could be antagonized by GABAA antagonist. Conclusion Etomidate can protect the cortex and hippocampus against A/R injury to some extent by acting on GABAA recoptor and decreasing intracellular Ca2+ overloading.