Clinicians monitor the gastric residual volume(GRV) of critical ill patients to minimize or prevent side effect of EN.Nevertheless,recommendations about the threshold GRV in critically ill patients treated with EN are not uniform.Many recent clinical studies had demonstrated that increasing the limit of GRV was associated with the increase in the diet volume ratio of ICU patients receiving EN,and it was not associated with adverse effects in gastrointestinal complications.This review summarizes the influence factors of GRV monitoring to evaluate the feasibility and necessity of increasing the threshold of GRV.

BACKGROUND: In the field of intervertebral disc tissue engineering, seed cells primarily consist of nucleus pulposus cells (NPCs) and mesenchymal stem cells (MSCs). NPCs have been known to have several shortcomings: limited source, inconvenient collection, poor proliferative capacity, and difficult in vitro culture.OBJECTIVE: To investigate the proliferation of MSCs after co-culture with NPCs in alginate beads-simulated three-dimensional environment.DESIGN, TIME AND SETTING: A cell observation was performed at the Laboratory of Orthopedics, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between December 2007 and October 2008.MATERIALS: Six healthy New Zealand rabbits of 4 months old were provided by the Laboratory Animal Center, Tongji Medical College of Huazhong University of Science and Technology and were used for the present study.METHODS: Rabbit MSCs were isolated and purified using density gradient centrifugation and adherence methods. Rabbit NPCs were isolated and purified using collagenase Ⅱ digestion and adherence methods. Following liposome-mediated green fluorescent protein tranfection and G418 screening, MSCs of passage 3 were cultured either alone (control group) or with NPCs at a ratio of 1:1 (co-culture group) in alginate beads. After 14 days of culture, alginate beads were dissolved and MSCs were collected by flow cytometry sorting.MAIN OUTCOME MEASURES: The expression of collagen Ⅱ and aggrecan in MSCs was detected by RT-PCR and Western blot techniques.RESULTS: mRNA and protein expression of collagen Ⅱ and aggrecan was observed in the co-culture group, but not in the control group, after 14 days of culture.CONCLUSION: MSC differentiation towards nucleus pulposus-like cells can be induced by co-culture with NPCs in a three-dimensional environment.

Objective To observe the preventive and therapeutic effects of L-carnitine on the metabolic disorder and cardiac remodeling in alcoholic cardiomyopathy. Methods Experimental animals were divided into three groups: alcohol-fed group(A), an alcohol/L-carnitine fed group(B) and a control group(C). Free fatty acid(FFA) and earnitine were detected in the blood serum at different time. mRNA and protein expressions of peroxisome proliferator-activated receptors (PPARα and PPARγ), retinoic acid receptor retinoid X receptor alpha (RXRα), earnitine palmitoyl transferase isoform and medium-chain acyl-CoA dehydrogenase (MCAD) were observed with RT-PCR and Western blotting methods. Results (1) When group A and B were compared with group C, FFA was increased and carnitine was decreased;mRNA and protein expressions of PPARα, RXRα, CPT-Ⅰ and MCAD were decreased with the development of alcoholic cardiomyopathy (ACM), being more significantly in group A than group B (P < 0.05). (2) mRNA and protein expressions of PPARγ had no statistical significance between these three groups at the end of 2 and 4 months(P>0.05), but after 6 months, they were increased in group B and decreased in group A (A vs. C,P<0.01;B vs. C,P<0.05). Conclusion Metabolic disorder and cardiac remodeling occur in the development process of ACM; they are partly prevented by L-carnitine through downregulating mRNA and protein expressions of PPARct, RXRα, CPT-Ⅰ, MCAD and PPARγ.

Sixty four patients undergoing endoscopic sinus surgery were randomly divided into two groups.In nimesulide group (n=32) patients were given nimesulide capsule 100 mg after surgery and 32 patients in control group were given 100 mg vitamin C as placebo.The visual analogue scale (VAS) was used to evaluate the degree of pain during withdrawing nasal packing.The VAS value of the nimesulide group was 2.8±1.1 3 h after surgery and 2.7±1.2 during with drawing nasal packing,that of control group was 6.7±0.6 and 8.3±0.6,respectively (both P<0.01).The results revealed that nimesulide had a siguificant analgesic effect in endoscopic sinus surgery.

Objective To study the prognostic factors of primary duodenal papilla carcinoma.Methods The clinical data of 73 patients with primary duodenal papilla carcinoma who were admitted to the Dongnan Hospital of Xiamen University from June 1995 to June 2005 were retrospectively analyzed.Ten factors including gender,age,jaundice,tumor size,course of disease,total bilirubin,tumor differentiation,lymphatic metastasis,type of surgery and degree of resection were analyzed by Log-rank test.Prognostic factors with significant difference were further analyzed by the Cox regression model.The survival curve was drawn by using the Kaplan-Meier method.Results The median survival time of the patients was 34 months.Age,jaundice,tumor size,course of disease,total bilirubin,tumor differentiation,lymphatic metastasis,type of surgery and degree of resection were correlated with the prognosis (x2 =18.315,4.562,7.989,10.660,11.138,7.995,5.423,114.464,83.383,P＜0.05),while no significant difference was found between gender and prognosis ( x2 =1.720,P ＞ 0.05 ).Multivariate analysis demonstrated that tumor differentiation,type of surgery and degree of resection were the factors influencing the prognosis of patients with duodenal papilla carcinoma (RR =2.039,2.178,5.798,P＜0.05).Conclusions Tumor differentiation,type of surgery and degree of resection are the dependent factors influencing the prognosis of patients with duodenal papilla carcinoma.The standard type of surgery and degree of resection are important for the prognosis of patients.

Objective To investigate the efficacy of intracoronary tirofiban during percutaneous coronary intervention(PCI)for patients with acute myocardial infarction(AMI).Methods Seventy-six consecutive AMI patients,treated with primary coronary angioplasty in 12 hours were enrolled.They were randomly divided into two groups:tirofiban group(39 cases)and control group(37 cases).Tirofiban group was treated with intracoronary timfiban during PCI and after the operation for 48 hours.Both of them were given heparin in PCI and aspirin,clopidogrel before PCI.At the end of PCI procedure,angiographic features such as TIMI flow grade and TIMI myocardial perfusion grade(TMPG)were analyzed.The difference of two groups in complication and major adverse cardiac events(MACE) was investigated.Results The myocardial reperfusion of tirofiban group was better than that of control group[TIMI grade 3 flow 94.9%(37/39) vs 78.4%(29/37),P<0.05;TMPG 3 grade 89.7%(35/39)vs 67.6%(25/37),P<0.05].There was no significant difference between two groups in bleeding complication.The occurrence of MACE in tirofiban group was less than that in control group[7.7%(3/39)vs 18.9%(7/37),P<0.05].Conclusion Intracoronary tirofiban dunng primary PCI in patients with AMI can improve coronary flow and myocardial perfusion,and has no more bleeding and less MACE occurrence.

OBJECTIVE: To provide reference for the research and development of current hospital pharmaceutical preparation.METHODS: The development strategy and research & development thinking were put forward on the basis of current state laws and regulations as well as the newest trend in pharmaceutical researching field.RESULTS: Firstly,the development strategy should be planned elaborately such as building moderate-scale manufacturing laboratory,introducing advanced instrument and equipment,cultivating high quality talented group,establishing highly efficient running mechanism,formulating valid incentive policy and implementing scientific standardized management.Furthermore,research and development thinking should be scientific and feasible to adopt new pharmaceutical technology to research new pharmaceutical dosage form and develop new compound preparation,distinctive preparation and Chinese traditional medicine preparation based on the clinic requirement.CONCLUSIONS: Hospital pharmaceutical preparation can go out of the predicament and realize sustainable development so long as formulating active correct development strategy and stick to scientific feasible research thinking.

To study the effect of antioxidants R-(+)-lipoic acid (R-LA) on cells growth,proliferation and related mechanisms in human HepG2 cells lines.MTT was used to measure cells growth and proliferation.Reactive oxygen species (ROS) kit was used to analyze ROS level.Cell apoptosis and cell morphological changes were observed by flow cytometry and Hoechst 33258 test.Protein expression levels of apoptosis,autophagy and related pathway were analyzed through Western blot,including Bax,Bcl-2,caspase 3,PARP,ATG5,ATG7,LC3,Beclin1,mTOR,P70S6K,P38,P53,ERK and Akt etc.Results showed that cell growth and proliferation were inhibited in a dose-and time-dependent manner after being treated by lipoic acid.R-LA could increase ROS production,pro-apoptosis proteins Bax levels,activated caspase family and PARP.Meanwhile,R-LA could up-regulate the levels of autophagy-related proteins including ATG5,ATG7,Beclin1 and LC3,and down-regulate phosphomTOR and P70S6K levels.Signal pathway results showed that R-LA could up-regulate phospho-P38 and phospho-JNK levels,and decrease phospho-Akt and phospho-ERK.When adding 3-methyladenine,autophagy was inhibited.Thus,R-LA might activate autophagy and induce apoptosis by P38/AMPK-JNK,PI3K/AKT and Ras/ Raf/MEK/ERK pathways.

In recent years, the number of ICU survivor is ever-growing with the increase of cure rate. The survivors′ outcome has aroused more and more attentions from medical personnel. ICU survivors tend to experience lasting physical, psychological and cognitive injuries, the post-traumatic stress disorder is one kind of significant psychological injury associated with patients′ critical experience. This review aims to summarize relevant literatures, introduces the prevalence, risk factors, complications, and interventions of ICU survivors′ post-traumatic stress disorder symptom, in order to prevent ICU survivors from post-ICU psychological injury and improve their long-term outcome.

Objective It is to observe the clinical effect of Wenxinkeli combined with metoprolol on frequent ventricular premature beat (FVEB).Methods234 patients with FVEB were randomly divided into the study group and control group.117 patients in the control group were treated with metoprolol combined with placebo, and 117 patients in the stduy group were treated with Wenxinkeli combined with metoprolol.4 weeks were a course of treatment.After four weeks, the heart rate variability, QT interval dispersion and 24h average heart rate of two groups were observed, and the clinical effect were evaluated.ResultsAfter 4 weeks of treatment, 5 cases in the study group and 7 cases in the control group were excluded.The efficiency of control group and study group were 89.29% and 79.09% (P<0.05), respectively.After treatment, the SDNN、SDANN、RMSSD and PNN50 of two groups were significantly higher than those before treatment(P<0.05), and the increase value of the study group was higher than that of the control group(P<0.05).After treatment, the QTd and QTcd of two groups were decreased than those before treatment(P<0.05), and the decreased value of the study group was higher than that of the control group(P<0.05).There was no significant change in the heart rate of the two groups before and after treatment.ConclusionWenxinkeli combined with metoprolol in the treatment of FVEB can prolong HRV, reduce QTd, improve the treatment effect, has no significant effect on the heart rate.