BACKGROUND: Glomerular mesangial cell (GMC) is the chief target cell of diabetic nephrosis. A series of functional alternations on mesangial cell (MC) in high glucose condition results in constant development of the disease. Intervention of Chinese herb is very significant in retarding the progression of diabetic nephrosis.OBJECTIVE: To probe into GMC proliferation in high glucose condition and the effects of serum with tangshen tang contained on it.DESIGN: Controlled experiment was designed.SETTING: Laboratory Room of Second Affiliated Hospital to Zhejiang College of Traditional Chinese Medicine.MATERIALS: MCs of SD rats were taken as experimental objects collected from Internal Department of Kidney of Shanghai First People's Hospital in August 2003.Totally 45 SD rats of clean grade were employed from Experimental Animal Center of Zhejiang College of Chinese Medicine, of either sex,weighted with (180±20)g in October 2003 and they were prepared as the animals with herb-contained serum. Tangshen tang [composed of dahuang (Rhubarb), taoren (Semen Persicae), chong (insects), huangqi (Radix Astragali seu Hedysari), digupi (Cortex Lycii Radicis), huanglian (Rhizoma Coptidis),etc.] was concentrated as 3 g/mL after decoction and infiltration at ratio.METHODS: SD rats were randomized as normal group, tangshen tang group and captopril group, 15 rats in each. The serums with tangshen tang and captopril of different doses were applied in MCs. In normal group,gastric perfusion of equal volume of distilled water was applied everyday.Trypan blue staining and MTT method were used respectively to assay the effects on MC toxicity and proliferation after medication.MAIN OUTCOME MEASURES: Activity of GMC in rats after stimulation of medical-contained serums and cellproliferation.liferation was inhibited (P ＜ 0.05 , vs blank group) in constant high-glucose condition and the inhibited proliferation due to high glucose was reversed to various extents after the intervention of tangshentang and captoter the intervention of medical-contained serums on GMCs in rats in every group (cell activity was up to over 94% and P ＞ 0.05, vs blank group).CONCLUSION: High glucose inhibits MC proliferation and tangshentang stimulates MC proliferation.

ObjectiveThis study explored the change of IL-18,and IFN-γ and their role in the pathogenesis of primary Sj(o)gren's syndrome (pSS) by determining the expression of IL-18,IFN-γ in labial glands and blood of patients with pSS.MethodsThe levels of IL-18,IFN-γ in labial glands of patients with pSS were determined by immunohistochemical method.The level of serum IL-18 was determined with enzyme linked immunosorbent assay ELISA.The level of γ globulin was measured by the cellulose acetate membrane method.SPSS 17.0 statistical software was used for data analysis.The t test,Fisher's exact probability test and index correlation analysis were performed with linear correlation analysis.Spearman's test was used to examine the association between the expression of IL-18 and IFN.ResultsThe positive rate of IL-18 and IFN-γ in patients with pSS was much higher than normal control group(P＜0.05).And the IL-18 and IFN-γ levels were positively correlated withpatients with pSS (P＜0.05).The level of serum IL-18 in patients with pSS was (216±85) pg/ml,which was much higher than normal control group(39±8) pg/ml.The IL-18 level and γ globulin(23.2±2.6)％ was positively correlated in patients with pSS (r=0.538,P＜0.05).ConclusionThe expression of IL-18 and IFN-γ in labial glands of patients with pSS are much higher in patients with pSS than those of the normal controls.Theresults have shown that IL-18 and IFN-γ may be involved inthe pathogenesis of pSS.

Objective To observe the pathogens and drug-resistance of ventilator-associated pneumonia (VAP) patients in emergency intensive care unit (EICU) for rational antibiotic therapy and the prevention of VAP. Method The sputum culture results and drug-resistance of pathogens of VAP patients in EICU from 2007 to 2009 were collected. Results One hundred and two mechanical ventilation patients were selected. VAP was occurred in 70 patients (68.6%). One hundred and fifty-seven pathogens had been examined,including 92 Gram-negative bacilli (58.6%),35 Gram-positive cocci (22.3%) and 30 fungus (19.1%). Pseudomonas aeruginosa and meticillin-resistant-staphylococcus aureus was 22 strains (14.0%)respectively, stenotrop homonas maltophilia was 21 strains (13.4%) and acinetobacter baumanii was 17 strains (10.8%). Fifty-nine patients (84.3%) had suffered from multiple pathogen infection, with 31 cases having 2 pathogens and 28 cases having 3 pathogens. Conclusions Pseudomonas aeruginosaa,methicillinresistant staphylococcus, stenotrophomonas maltophilia and acinetobacter baumanii are main pathogens of VAP in EICU patients,and candida albicans is still the main pathogens in fungal infection. The rate of multiple pathogen infection is very high, and the problem of drug-resistance is very severe.

This paper summarizes the experience of team training mode in nursing safety management.①Train key members,using case exercises of simulated teaching method and cross-departmental、cross-disciplinary;②The key members of nursing is responsible for the training of the medical staff,and as an observer in the department, observe the practical application of the team training mode;③Build team structure and master four important skills (communication,leadership,monitoring and mutual assistance);④Apply team training mode to nursing safety man-agement. After practice of one year,compare the incidence of safety changes of the observers and nursing adverse events before and after the training. In nursing staff cognition,the changes of team composition with leadership,vigi-lance,cooperation and effective communication,it is statistically significant for the team collaboration,security atmo-sphere,management perception,stress perception,and job satisfaction in the safety attitude scale(P<0.05),fell by 31.3％in the incidence of nursing adverse events. It is believed that the team training mode can improve the knowledge, attitude and execution of the nurses,reduce the occurrence of nursing adverse events,and ensure the patient's safety.

Objective To investigate the effect of head extension angle to glottis exposure by using three-dimensional CT reconstruction sagittal plane images of upper airway.Methods There were 80 patients,aged 7-78 years old,who had been scanned by helical CT in the head and neck.Reconstructed images were obtained by AW4.4 workstation and the following parameter was measured:angle α(A0 group),the angle created by the upper central incisor and root of epiglottis(angular vertex) and midpoint of glottis.Reconstructed images were printed according to the actual size of human body in a ratio of 1∶ 1,then the images were cut off from the upper central incisor to root of epiglottis by a section of arcs.Increasing the degree of angle α by clockwise to hypothetically increase the angle of head extension.The glottis was exposed by using a paper-made laryngoscope(Macintosh) model,and the success rate of glottis exposure was recorded when the degree of angle α was respectively increased 10°(A10 group),20°(A20 group),and 30°(A30 group).Results Compared with A0 group,the success rate of glottis exposure increased significantly in A10 group,A20 group and A30 group.The success rate of glottis exposure in A20 group and A30 group was significantly higher than A10 group.Compared with A20 group,the success rate of glottis exposure obviously increased in A30 group.Conclusion Based on CT reconstruction images of upper airway,we can analog study the effect of head extension angle to glottis exposure.

OBJECTIVE To summarize the characteristics of central vertigo and subclavian steal syndrome(SSS)and analyze the relationship between them.METHODS A retrospective review of 87 cases of patients diagnosed with SSS based on the evidence of clinical symptoms and results of transcranial doppler(TCD),cervical doppler ultrasound(CDUS),head and cervical magnetic resonance angiography(MRA),or cerebral digital subtract angiography(DSA)was present for analyzing the clinical presentation between the central vertigo and the subclavian steal syndrome.RESULTS There were more male than female in the 87 cases;8.05% of patients were under the age of 50,37.93% from 50 to 65,and 54.02% over 65,showing the incidence of SSS increases with the age.In 64.37% of patients,vertigo was the only symptom;in 29.89% of patients,vertigo presented as an accompanying symptom;and in 5.75% of patients,there was no significant vertigo.Of all these patients,65.52% had left SSS,32.18% had right SSS,2.30% had bilateral SSS;there were more left side lesions than right side.CONCLUSION SSS is no longer a rare disease as investigation tools keep developing.Its incidence increases with age.As vertigo may be its only clinical presentation,SSS could be misdiagnosed very easyly.To avoid misdiagnosising,it is very important to screen for SSS in patients with vertigo for the diagnosis early.

Objective To study the efficacy of Ciwujia injection combined with electric acupuncture in the treatment of arteria vetaebralis vertigo.Methods 66 cases with arteria vertebralis vertigo were randomly recruited into a control group with 30 cases and a treatment group with 36 cases.The treatment group was administered with Ciwujia injection and electric acupuncture for 10 days,and the control group was administered with flunarizine and Danshen injection for 10 days.Resuits After 10 days'therapy,thetotal effective rate and the cure ratewas 91.7%and 30.6%in the treatment group,and the total effective rate and the cure rate was 63.3%and 16.7%in the control group.There was statistical diflerence between the two groups(P＜0.05).Conclusion The therapy of Ciwujia injection and electric acupuncture has good effect in treating arteria vertebralis vertigo.

Objective To investigate the therapeutic effects of Yangxin Ningshen capsule in the treatment of insomnia. Methods 78 patients were randomly recurited into a control group (36 cases) and a treatment group (42 cases). The treatment group was administered with 1.6g to 2.0g Yangxin Ningshen capsule, three times daily, for 28 days. The control group was administered with Valium and Orgzanol tablets for 28 days. After 4 weeks therapy, the clinical effect was evaluated. Results The total effective rate and cure rate was 92.85% and 47.62% respectively in the treatment group. The total of effective rate and cure rate was 83.33% and 30.56% respectively in the control group, There was statistical difference between the two groups (P<0.05) .Conclusion The therapy of Yangxin Ningshen capsule has good effects in treating insomnia.

OBJECTIVE To study the rational use of antibiotics in a comprehensive general hospital.METHODS The clinical data of 583 cases used the five kinds of most frequently antibiotics during Nov 20-26,2006 in a comprehensive general hospital were collected and analyzed.RESULTS The total five kinds of most frequently antibiotics used in this hospital were the third generation of cephalosporins,cefoperazone/tazobactam(Kaisi),flomoxef(Fuomaning),cefoperazone/tazobactam(Kaishute),cefpiramide(Xibaiao) and cefoperazone/tazobactam(Xianbita).The daily frequency of these antibiotics was rational to the drug metabolic dynamics characteristics.Some patients received the long time therapy of antibiotic,the longest one was 22 days.The frequency of over-doses in these patients was 19.9%.CONCLUSIONS Antibiotics use is apparently rational in this hospital and the training and education for drug use should be enhanced in the future.

In order to evaluate the value of angiographic diagnosis and interventional therapy in the patients with massive hemobilia, 10 patients with massive hemobilia were analyzed retrospectively from Sep. 1990 to Sep. 1999. All of them underwent emergency celiac and selective right or left hepatic artery angiography. The patients were diagnosed rapidly and treated successfully by embolization of the hepatic artery branch proximal to t he bleeding point, and hemorrhage was stopped immediately. Two out of 10 patients were embolized two times for bleeding again. All patients were alive and followed up for 3 months to 5 years. As a safe, reliable and mininally invasion method, selective hepatic artery angiography and embolization was proved to be an important diagnostic and therapeutic means for massive hemobilia, which had obvious advantages of minimally invasive reatment in unstable patient over surgery and should be the first choice for such patients.