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.

ICU treatment experience is the major source of patients′psychological stress as well as their relatives. Because of physical strain, sedation, invasive therapies, patients with critically ill usually tend to have some delusion, nightmare and memory loss, which cause several psychological disorder such as anxiety, fear and depression. The intensive care diary plays an important role in fill in memory gap , distinguish between delusion and reality ,make sense of illness experience, it is helpful to protect patients and their relatives from psychological disorders. Ever-growing scholars apply the intensive care diary to patients′post-ICU psychological rehabilitation. This review aim to introduce the concept, content, benefit as well as application status, provide some reference of the use in our country.

Objective To investigate the diagnostic value of breast MRI in patients presenting with microcalcifications on mammography.Methods Eight four patients were retrospectively analyzed,who had mammographically detected BI-RADS (breast imaging reporting and data system) 3 to 5 microcalcifications and underwent breast MRI before surgical biopsy.All mammography and MR images were reviewed with BI-RADS.With histopathological diagnosis as golden standard,the sensitivity,specificity and accuracy of the two methods were calculated and compared with x2 test or Fisher exact test.The diagnostic efficacy of the two methods was compared with ROC curve.Results Pathologic examination revealed 91 lesions in 84 patients including 49 benign lesions and 42 malignant lesions.For 21 lesions of category 3 microcalcifications,the specificity of mammography and MR was 100.0％ (21/21) and 95.2％ (20/21),which had no significant difference (P=1.000).For 51 lesious of category 4,sensitivity,specificity and accuracy of mammography were 100.0％(23/23),0 and 45.1％(23/51).The corresponding values for MR were 91.3％(21/23),82.1％ (23/28) and 86.3％ (44/51).The difference for specificity and accuracy between the two methods was statistical significant(x2 value was 30.030 and 19.182,respectively,with P＜0.01),but not for sensitivity(x2=0.523,P=0.470).Nineteen lesions of category 5 were all correctly diagnosed on mammography and MRI.For all the 91 lesions,the sensitivity,specificity and accuracy of mammography were 100.0％(42/42),42.9％(21/49) and 69.2％(63/91),respectively.The corresponding values for MRI were 95.2 ％(40/42),87.8％(43/49) and 91.2％(83/91).There was significant difference for specificity and accuracy between the two methods (x2 value was 21.798 and 13.851,respectively,with P＜0.05),but not for sensitivity (x2=0.512,P=0.474).The areas under ROC curve for mammography and MR were 0.844,0.945(P＜0.01),for the estimation of the benign and the malignent.Conclusions Compared with mammography,breast MRI significantly improved the diagnosis of category 4 microcalcifications with increased specificity and accuracy.But for microcalcifications of category 3 and 5,MR didn't improve the diagnostic effect.

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 determine the sun protection factor (SPF) and protection factor of ultraviolet A (PFA) of a self-made sunscreen cream.[Methods] The sample of a self-made sunscreen cream and a commercial sunscreen cream were painted to an artificial skin (3M film) at a dose of 2 μl/cm2,and a tester was used to evaluate their photoprotective effect.A total of 48 albinism guinea pigs were classified into 8 groups to remain unprotected or be protected by the self-made or commercial sunscreen cream.A solar ultraviolet light simulator (SUV-1000) was used to simulate the ultraviolet rays in sunlight to irradiate the guinea pigs,and the photoprotecfive effect of these sunscreen creams was determined.[Results] The in vitro evaluation revealed that the SPF value of the self-made sun-screen cream and commercial cream was 32.26 ± 2.42 and 30.87 ± 2.57respectively (n =5,t =0.94,P ＞ 0.05),and the PFA value was 24.28 ± 2.44 and 17.53 ± 2.28 respectively (n =5,t =4.52,P＜ 0.01 ).As the in vivo experiment showed,the SPF value of the self-made sun-screen cream and commercial cream was 30.39 ± 6.65 and 28.79 ± 7.36,respectively (n =12,t =0.38,P＞ 0.05),and the PFA value was ＞ 8.91 and ＞ 8.93 respectively.[Conclusion] The photoprotective effect of the self-made sunscreen cream is similar to that of the commercial cream.

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.

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 To analyze the relocation stress and its influencing factors of the families of patients transferred from ICU.Methods Totally 101 ICU patients' families were recruited by convenience sampling approach from three hospitals between October and December,2016.General information questionnaire and the relocation stress scale for the families of patients transferred from ICU were used to collect data.Results The relocation stress score was 55.49±6.30.The average score of the total items was 3.25±0.55.Multiple regression analysis showed that education level of family members,family members' gender,age of patients and the time of patients staying in ICU were main factors affecting the relocation stress of the families of patients transferred from ICU(P＜0.05).Conclusion The families of patients transferred from ICU have a certain intensity of relocation stress.Family members with low education level,being female,younger age of patients and long duration of staying in ICU have relatively high relocation stress.

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.