Objective To observe the effect of penehyclidine hydrochloride (PHCD) combined with mechanical ventilation on inflammatory response in rats with acute respiratory distress syndrome(ARDS)induced by hydrochloric acid(HCl)inhalation. Methods 32 adult healthy male Sprague-Dawley(SD)rats were randomly divided into four groups:sham operation group,ARDS model group,PHCD group(intraperitoneal injection of 0.5 mg/kg PHCD at 30 minutes before HCl instillation)and mechanical ventilation group〔mechanical ventilation was given after PHCD treatment,ventilator settings were as follows:tidal volume(VT)=4 mL/kg,respiratory rate(RR)= 70 beats/min,the time ratio of inspiration to expiration(I:E)=1:2,fraction of inspired oxygen concentration(FiO2)=0.21〕,8 rats in each group. The rat ARDS model was created by HCl(0.1 mol/L,1.2 mL/kg) intratracheal instillation. After mechanical ventilation for 4 hours,the experiment was stopped. Arterial partial pressure of oxygen(PaO2)was measured,and the oxygenation index as well as lung wet/dry weight ratio(W/D)were calculated respectively. The pathological changes in lung tissues were observed under light microscope,and the pathological score was evaluated. The levels of myeloperoxidase(MPO),interlukin-8(IL-8)and nuclear factor-κB (NF-κB)in homogenate of lung tissues were all measured respectively by enzyme linked immunosorbent assay (ELISA). Results In rats of ARDS model group, there were significant infiltration of inflammatory cells, collapse of extensive pulmonary alveoli and hyaline membrane formation in lung tissues,but the edema in pulmonary mesenchymal tissue and congestion of micro vessels were not obvious. Compared with sham operation group,the lung tissue pathological score(9.88±2.03 vs. 1.38±0.92),lung W/D ratio(7.67±0.96 vs. 4.08±0.65)were significantly increased(both P<0.01),while oxygenation index〔mmHg(1 mmHg=0.133 kPa):213±29 vs. 428±28〕was markedly decreased in model group(P<0.01);and the concentrations of MPO(μg/L:34.18±3.99 vs. 20.92±1.40), IL-8(ng/L:864±53 vs. 583±91)and NF-κB(ng/L:1 229±133 vs. 803±130)in homogenate of lung tissues were significantly higher in model group(all P<0.01). The pathological changes in lung tissues including inflammatory cell infiltration,collapse of alveoli and pulmonary edema,etc. were obviously improved when treated by PHCD or mechanical ventilation and the lung pathological score and W/D ratio were significantly decreased compared with those of model group,oxygenation index in these two groups were both significantly increased,meanwhile, the concentrations of MPO,IL-8 and NF-κB were sharply decreased when compared with those of model group (all P<0.05). The degree of improvement in all above indexes were greater in mechanical ventilation group than those in PHCD group(lung injury score:5.63±1.85 vs. 7.63±1.67,lung W/D ratio:5.35±1.05 vs. 6.46±1.17, oxygenation index:325±57 vs. 272±44,MPO:25.80±3.36 vs. 29.88±3.93,IL-8:736±53 vs. 802±53, NF-κB:984±75 vs. 1 109±118,all P<0.05),however they did not reach the levels of the sham operation group (P<0.05 or P<0.01). Conclusion PHCD can inhibit the inflammatory response in ARDS rats induced by HCl inhalation,thus it may protect the lung tissue from injury induced by HCl,and the protective role of PHCD plus menchanical ventilation is superior to that of PHCD only.

Objective To explore the criterion of constitution with Yin-deficiency and provide the evidence for further development of establishing the criterion.Method According to reference documents on TCM,a questionnaire on the criterion of constitution with Yin-deficiency was developed and distributed to 51 experts of TCM in Zhejiang province.Results The mean scores of forty-six items ranged from 2.02 to 2.78 and top sixteen symptoms were dry mouth,dry stools,dry throat,feverish palms and soles,thready pulse,constipation,emaciation,yellowish urine,red tongue,rapid pulse,vertigo,thirst with preference for cold drinks,vexation,dry lips,little coating,thirst with frequent drinking.Modes of 46 items ranged from 1 to 4.Coefficients of weight for diagnosis ranged from 0.018 to 0.024 and variance of coefficients were from 0.540 to 1.572.Conclusion Forty-six items could become the content of the criterion of constitution.

Objective To study the effect of breviscapine injection on cerebral blood perfusion in patients with hypoperfusion/decreased embolic clearance type cerebral infarction.Methods 100 patients with hypoperfusion/decreased embolic clearance type cerebral infarction in our hospital were selected and randomly divided into two groups.Both group were treated with conventional western medicines, and the experimental group was additionally treated with breviscapine injection.The plasma D-dimer (D-D), fibrinogen (Fib), systolic and diastolic blood pressure and recovery of neurological function were compared between the two groups.Results D-D and Fib levels and NIHSS score in the experimental group were significantly lower than those in the control group (P< 0.05), while the systolic blood pressure was significantly higher than that in the control group (P< 0.05).Conclusion Breviscapine injection can reduce the plasma D-D and Fib levels, increase cerebral vascular blood flow and improve the neurological function in patients with hypoperfusion/decreased embolic clearance type cerebral infarction.

Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7％.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95％ CI 5.1-48.1,P ＜ 0.001),septic shock (OR =6.3,95 ％ CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95％ CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9％ vs 59.2％,31.1％ vs 65.8％,44.4％ vs 72.4％ respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.

Objective　To study the relationship between the expression of vascular endothelial growth factor (VEGF) and invasion, metastasis of primary hepatocellular carcinoma (PHCC). Methods　Paraffin-embedded specimens from 30 patients with PHCC undergoing radical resection were studied. Agiogenesis was assessed by the expression of VEGF and microvascular density (MVD) using LSAB immunohistochemical staining. Results　(1) The level of VEGF and MVD in　 PHCC was higher than that in the paratumorous tissue (P<0.05). (2) The level of VEGF expression and MVD in PHCC with tumor metastasis or in nonencapsulated tumors were higher than that in PHCC without metastasis or in well encapsulated tumors (P<0.05). 　(3) There was no significant differance in the expression of VEGF and MVD between large PHCC (diameter >5cm) and small ones (diameter ≤5cm). (4) The expression of VEGF was positively correlated with MVD (P<0.01).　　Conclusions　The expression of VEGF and MVD are highly correlated with invasion and metastasis in PHCC, may serve as a parameter for determining tumor metastasis and prognosis which may suggest a new idea to supervise and treat PHCC.

Objective To evaluate the results of using focus clearance and morselized bone graft to treat a well-fixed socket osteolysis after total hip arthroplasty (THA) during cementless acetabular revisions.Methods From March 2006 to March 2009, 23 patients (23 hips) who had an acetabular revision hip arthroplasty of well-fixed socket for osteolysis were retrospectively reviewed, including 13 males and 10 females with an average age of 46.6 years (range, 39-54), and the mean interval from primary to revision THA was 5.5 years (range, 4.6-7.4). The preoperative Harris hip score was 74. The operative technique included debridement of soft tissues with removal of granulomata and packed tightly with morselized cancellous allograft through ilioinguinal approach, and exchanging the liner and femoral head through the posterior-lateral approach of the hip. Results The mean duration of follow-up after revision was 28 months (range, 8-38). At final follow-up, all hip were functioning well and the average Harris hip score was 93.8. Osteogenesis in bone graft were well-developed in 16 patients. Twelve bone grafts were completely incorporated into surrounding bone through creeping substitution. All acetabular components remain radiographically well-fixed and no loosening and shifting. There were no new osteolytic lesions, ectopic ossification, deep venous thrombosis, hip dislocation or infection during follow-up. Conclusion Our revision strategies included debridement and bone grafting, a revision of femoral heads and polyethylene liner and retention of the cups and femoral stems. The method can reduce the amount of the wear particle from polyethylene. The short-term outcome is excellent.

Objective To discuss the features of MRI and differential diagnosis of cerebral fat embolism syndrome(CFE).Methods The features of MRI of 4 final diagnosis cases of CEF were retrospectively analysed.Results MRI showed that there were spotty and patchy high T_2-weighted signals and some of them were low or equal signals on T_1-weighted.These signals were distributed in bilateral centrum semiovale,corona radiata,thalamus,deep part white matter of brain along the lateral ventricle,the cortex of brain of watershed,collose,brain stem and the hemisphere of cerebellum.The position of these abnormal signals was symmetric in the rough.The figure of the MRI signals in the midbrain liked the reverse Chinese number "eight".Brain swelling was showed in 2 of 4 cases.Conclusion There are some features of the CEF on T_2-weighted of MRI,but the history,the physical signal and the results of laboratory must be considered,and must be differential diagnosed with the diseases liking diffuse axonal injury,etc.

Objective To understand the current status of paediatric medication safety,identify the existing problems on nursing research of paediatric medication safety and supply reference for paediatric medication safety.Methods 268 requested research papers published from 2003 to 2013 were retrieved from CNKI and CBM databases,and were analyzed by quantitative methods.Results Among 268 literatures,60.1％ were experience summaries and discussion.72.0％ didn't use any analyzing methods.64.6％ adopted qualitative analysis.Nine categories of these studies contents were concluded,among these,literatures dealing with medication management and medication safety education for parents came the first,accounting for 31.0％ and 15.3％; while those elaborating about information technology and medication safety education of nurses were the least,accounting for 4.1％ and 3.0％.Conclusions Most of the studies were qualitative comments and experience summaries which lack of rigorous designs and statistical methods.The research contents were scattered and difficult to be used in clinical environment.It is strongly recommended that studies on paediatric medication safety should be enhanced.Furthermore,nursing guideline should be constructed by evidence-based methodology to promote domestic paediatric medication safety.

ObjectiveTo explore the distribution of nanobacteria in prostatic calculus and investigate its role in the formation of prostatic calculus. MethodsThe stones of 40 patients with prostatic calculus was used to isolate and culture the possible bacteria. The genomes of obtained bacteria were extracted, and the 16S rRNA was amplified by PCR followed by sequencing. ResultsThe obtained specific fragment had a 98% resemblance with 16S rRNA of nanobacteria: Score=2 480 bits (1 290), Expect=0.0; Identities=1 387/1 409 (98%), Gaps=4/1 409 (0%); Strand=Plus/Plus. ConclusionNanobacteria is proved existing in the stones of prostatic calculus patients by PCR and sequencing.

Objective　To explore the relationship of pathological types of lung cancer with sex, age, site, and clinical diagnosis. Methods　The data of 1 310 patients with lung cancer diagnosed with fibrobronchoscopy, was retrospectively analyzed. Results　①The preliminary clinical diagnosed lung cancers which were comfirmed by fibrobronchoscopic biopsy later were mainly small cell lung cancer. ②The percentage of squamous carcinoma was significantly greater in male (78.0%) than in female (49.7%), but the percentage of adenocarcinoma was significantly higher in female (38.1%) than in male (13.1%)(P<0.0001). ③Among the patients with lung cancer, 53.7% was from 40 to 59 years old and 40.2% over 60. The average age of male patients (56.9 years old) was significantly greater than that of female (51.1 years old) (P<0.0001). ④ The average age of patients with squamous carcinoma and adenocarcinoma was greater in male than in female, but that with small cell carcinoma and squamous carcinoma was greater in female than in male. ⑤The percentage of male with lung cancer in the left lung (37.3%) was greater than that of female (26.0%), but the female had lung cancer in the right lung (59.7%) while male had (49.3%). The left and right upper lobe was more (45.4%) in male, but the right upper and lower lobe was more(43.3%) in female. Conclusion　①The fibrobronchoscopic examination is very important in the diagnosis of lung cancer. ②The pathological types and sites of lung cancer is different in different sex and age, which provide the exact bases for medical and surgical treatment for lung cancer.