ICU is the important place of ventilator associated pneumonia, the occurrence of fatality rate in patients with ventilator associated pneumonia is higher. In this paper, the cause of the ventilator associated pneumonia in ICU and nursing research progress are summarized, that enhance their awareness of the importance of nursing care and the use of normative evidence-based nursing in clinical practice thinking and nursing process, explore the nursing methods of more appropriate, to reduce the incidence of ventilator associated pneumonia in ICU is of great help.

ObjectiveTo explore the clinical characteristics of reversible posterior leukoencephalopathy syndrome ( RPLS ),in order to deepen the awareness of the disease.MethodsThe clinical data of 11 patients with RPLS in our hospital were retrospectively analyzed.ResultsIn the 11 cases with RPLS,there were two cases of pregnancy induced hypertension,preeclampsia(38 weeks pregnant),four eases of chronic renal insufficiency,four cases of malignant hypertension,and one case of lung cancer after chemotherapy.The main clinical presentations were headache,abnormality of visual perception,mental and behavioral abnormalities,ataxia,epileptic seizure and so on.The neuroimaging performances were extensive white matter abnormalities of the rear of the bilateral cerebral hemispheres,such as the parietal-occipital temporal lobe lesions,also involving the brain stem,cerebellum,thalamus and other parts.ConclusionThe clinical characteristics and neuroimaging performances of RPLS has certain characteristics,the majority of lesions were reversible,if the early diagnosis and treatment,the prognosis is usually good.

Objective To evaluate the role of MLK3-MKK3/6-p38MAPK signal transduction pathway in lipopolysaccharide (LPS)-induced acute lung injury (ALI) in rats. Methods Seventy-eight healthy adult male SD rats weighing 200-250 g were randomly divided into 4 groups: control group (group C, n = 6), ALI group ( n =24), MLK3 inhibitor K252a group (group MK, n = 24) and p38MAPK specific inhibitor SB203580 group (group MS, n = 24). ALI was induced by iv injection of LPS 5 mg/kg via tail vein, while the equal volume of normal saline was given instead in group C. K252a 75 μg/kg and SB203580 10 mg/kg were injected intravenously via tail vein 30 min before LPS administration in group MK and MS respectively. The rats were killed at 1, 3, 6 and 12 h (T1-4) after LPS administration in group ALI, MK and MS (6 rats at each time point) and immediately after normal saline administration in group C. The lungs were removed for microscopic examination. The left lung was lavaged.The broncho-alveolar lavage fluid (BALF) was collected. The concentration of TNF-α in the BALF was determined by ELISA. W/D lung weight ratio was calculated. The expression of p-MLK3, p-MKK3/6 and p-p38MAPK were determined by Western blot. Results The concentration of TNF-α in the BALF, W/D lung weight ratio, and expression of p-MLK3, p-MKK3/6 and p-p38MAPK were significantly higher in the other three groups than in group C (P ＜ 0.01). The parameters mentioned above were significantly lower in group MK, and the concentration of TNF-α in the BALF, W/D lung weight ratio, and p-p38MAPK expression were significantly lower in group MS than in group ALI (P ＜ 0.05). The microscopic examination showed that LPS-induced ALI was less severe in group MK and MS than in group ALI. Conclusion MLK3-MKK3/6-p38MAPK signal transduction pathway plays an important role in LPS-induced ALI in rats.

ObjectiveTo investigate the effect of dexamethasone on mitogen-activated protein kinase phosphatase-1 (MKP-1) expression in lung tissues in rats with lipopolysaccharide (LPS)-induced acute lung injury (ALI).MethodsFifty-four male SD rats weighing 180-230 g were randomly divided into 3 groups:control group (group C,n =6) ;ALI group ( n =24) and dexamethasone group (group D,n =24).LPS 5 mg/kg was injected via tail vein in groups ALI and D,while the equal volume of normal saline was given in group C.Dexamethasone 6 mg/kg was injected intraperitoneally at 30 min before LPS administration in group D.Eight rats in each group were sacrificed at 1 h after normal saline administration (T1) in group C and at 1,3,and 6 h after LPS administration (T1-3 ) in groups ALI and D.The lung tissues were then removed for determination of the expression of phosphorylated p38 mitogen-activated protein kinase (p-p38MAPK) and MKP-1.The concentrations of albumin and TNF-α in bronchoalveolar lavage fluid (BALF) were detected and histopathological changes were observed at T3 ·Another 32 SD rats weighing 180-230 g were randomly divided into 2 groups ( n =16 each):group ALI1 and group D1.The rats were treated as the method mentioned above and the 48 h survival condition was observed.Results Compared with group C, the concentrations of protein and TNF-α in BALF were significantly increased,p-p38MAKP expression was up-regulated at T1.3,and MKP-1 expression was down-regulated at T2,3 in group ALI,and TNF-α concentration in BALF was significantly increased and the expression of p-p38MAKP and MKP-1 was up-regulated at T1-3 in group D ( P ＜ 0.05).Compared with group ALI,the concentrations of protein and TNF-α in BALF were significantly decreased,p-p38MAKP expression was down-regulated and MKP-1 expression was up-reg-ulated at T1-3 ( P ＜ 0.05 ),and the pathological damage was attenuated in group D.The 48 h survival rate was significantly higher in group D1 than in group ALI1 ( P ＜ 0.05).ConclusionThe mechanism by which dexamethasone attenuates the ALI induced by LPS may be related to up-regulation of MKP-1,inhibition of phosphorylation of p38MAPK and decrease in inflammatory response.

Adolescent ; Adult ; China ; epidemiology ; Humans ; Middle Aged ; Motor Activity ; Rural Population ; Suburban Population ; Urban Population

Objective To identify the use of body mass index (BMI) to predict the areas under curve (AUC) of hypertension,and to find the optimal cutoff of predicting the incidences of hypertension in Chinese adults. Method Using the data from Nationwide Nutrition and Health Survey to find the new cases of four-years hypertension,and to calculate the four-year cumulative incidence (CI) of hypertension,and operate the receiver operating characteristic (ROC),analyze the AUC and calculate the sensitivity and specificity of optimal cutoff. Results Four-year CI of hypertension were 17.2% (20.3% for men and 14.2% for women),the AUC were 0.62 and 0.61 for men and women,respectively. Conclusion The optimal cut off was applicable in monitoring the incidences of hypertension,and more verification should be carried out in the future when applying this cut off.

Objective To investigate the serum levels of 25-hydroxyvitamin D3 (25 (OH)D3) and urine vitamin D binding protein(uVDBP) in patients with diabetic nephropathy (DN),and to determine the relationship between 25 (OH) D3,uVDBP and DN,in order to provide a new method for early diagnosis and treatment of DN.Methods From January 2015 to December 2015,85 DN patients admitted into Weihai Municipal Hospital were selected.According to the ratio of UALB to UCR(UACR),the patients were divided into three groups.Type 2 diabetes had 28 cases of normal albuminuria group,31 cases of microalbuminuria group,and 26 cases of clinical albuminuria group.We also enrolled 25 healthy people who received outpatient service as control group.Serum 25 (OH) D3 levels were measured by chemiluminescence method.Urine VDBP levels were assayed by ELISA.FPG,HbA1 c,UREA,SCr,TC,TG were measured by electrochemiluminescence.Results The results showed that serum 25 (OH)D3 was significantly lower in the normal albuminuria group,microalbuminuria group and clinical proteinuria group than that in the control group (P ＜ 0.05),and there was statistically significant difference among the four groups [(20.04 ± 7.52) ng/mL,(16.54 ± 6.51) ng/mL,(10.77 ± 4.63) ng/mL,(29.65 ± 5.47) ng/mL,F =86.294,P ＜ 0.001].The results showed that uVDBP was significantly higher in the DN group than that in the control group(all P ＜ 0.05),and there was statistically significant difference among the four groups [(8.44 ± 3.20) mg/L,(14.22 ± 3.26) mg/L,(2 1.77 ± 5.87) mg/L,(4.95 ± 1.34) mg/L,F =125.583,P ＜ 0.001].Correlation analysis showed that serum 25 (OH) D3 decreased gradually with the increase of DN and negatively correlated with UACR (r =-0.575,P ＜ 0.01),while uVDBP level was positively correlated with UACR (r =0.436,P =0.015).Conclusion With the progress of DN,serum 25 (OH) D3 levels gradually decreased,indicating that 25 (OH) D3 may play an important role in the pathogenesis of DN;uVDBP may be an early diagnostic method for DN.

Objective To evaluate the efficacy and drug resistance profiles of nucleosides (NA) retreatment in NA experienced chronic hepatitis B (CHB) patients. Methods Totally 104 NA experienced CHB subjects were enrolled in this study.All these subjects had received at least 3 months NA monotherapy and stopped the treatment,and then received NA retreatment for at least one year.The subjects were divided into three groups according to the following criteria:reached the therapy endpoint of China guideline when they stopped NA-naive treatment (group A,n =39); did not reach the therapy endpoint when they stopped NA-naive treatment but hepatitis B virus (HBV) DNA＜1.0× 103 copy/mL (group B,n=33); and with HBV DNA＞1.0× 103 copy/mL (group C,n=32).The efficacy and drug resistance profiles of retreatment were compared among three groups. The effects of baseline alanine aminotransferase (ALT) levels,HBV DNA levels and HBeAg titers on the retreatment efficacies were analyzed. The mutations of HBV P gene were detected by nested polymerase chain reaction (PCR) and direct sequencing.The data were analyzd by Wilcoxon test and x2 test.Results The time to ALT normalization in patients with baseline ALT＜ 1.3 × upper limit normal (ULN) was shorter than that in patients with ALT≥1.3×ULN (2 months vs 4 months; Z=2.281,P=0.023).The time to virological response in patients with baseline HBV DNA＜5 lg copy/mL was shorter than that in patients with HBV DNA≥5 lg copy/mL (1 month vs 2 months; Z=2.054,P =0.040). The time to virological response and ALT normalization in baseline HBeAg negative were both shorter than those in patients with baseline HBeAg positive patents ( 1 month vs 3 months and 2 months vs 4.5 months,respectively; Z=2.580 and 2.304,respectively; both P＜0.05). The subjects in group A achieved virological response and HBeAg seroconversion after retreatment earlier compared to previous NA-naive therapy ([1.61 ± 1.76] months vs [3.48±4.066]months and [3.38 ± 3.34] months vs [9.92-11.22] months,respectively; Z=-2.854 and-1.094,respectively; both P＜0.05).The cumulative HBeAg seroconversion rate in group A was higher compared to those in group B and group C (80.0％ vs 36.8％ and 37.5％,respectively; x2 =4.368 and 5.100,respectively; both P＜0.05).Thirteen patients developed clinical resistance and four of them developed genotypic resistance proved by PCR direct sequencing.Among the patients retreated with the same regimen as previous in the C group,the cumulative resistance rate was highest compared to group A and B (44％ vs 9％ and 0,respectively; x2 =5.019 and 6.588,respectively;both P＜0.05).No resistance was detected in the 14 patients retreated with combined NA treatment without cross resistance.Conclusions For NA experienced CHB patients who fulfill the indication of antiviral therapy,the retreatment should be started as earlier as possible. Retreatment with NA combination without cross resistance can prevent (reduce) the risk of developing drug resistance.

Objective To explore the influence factors on hepatitis B virus (HBV) relapse after nucleos(t)ide analogues (NA) withdrawal in the chronic hepatitis B (CHB) patients who met NA cessation criteria. Methods Eighty-one consecutive CHB patients were treated with NA, 38 with lamivudine (LAM), 25 with adefovir dipivoxil (ADV), 12 with entecavir (ETV), 6 with LAM +ADV. Among recruited patients, 40 were hepatitis B virus e antigen (HBeAg) positive, 41 were HBeAg negative, 67 of them were initial treatment, 14 were retreatment due to resistance to NA at baseline. The treatment was discontinued after meeting China therapeutic end-point criteria. HBV DNA, HBV serological markers, alanine aminotransferase (ALT) were measured respectively at baseline, every month before virological response, every 3 months after virological response, every month within first 6 months and every 2 months over 6 months after drugs withdrawal. Twelve probable influence factors on relapse which were sex, age, HBV family history, baseline HBV DNA,baseline HBeAg status, baseline ALT, virological response time, total duration of treatment, duration of additional treatment, the level of hepatitis B virus surface antigen (HBsAg) at cessation therapy,initial treatment or retreatment, drug category were analyzed with univariate, multivariate Cox regression modle and stratified analysis. The cumulative relapse was calculated by the Kaplan-Meier method. Results A total of 36 patients (44. 4%) relapsed within 1 year. Initial treatment or retreatment, HBV family history, virological response time, the level of HBsAg at cessation therapy were independent risk factors. The relapse rate of retreatment was higher than that of initial treatment (78.6% vs 37. 3% , χ2 = 7. 983, P = 0. 005) , those of patients with HBV family history higher than without family history (64. 5% vs 15.0%, χ2 =12. 096,P = 0.002), those of patients obtained virological response within 3 months lower than after 3 months(34. 0% vs 64. 3% , χ2 =6. 823,P=0. 009) , those of patients with HBsAg≤150 μg/L at cessation therapy lower than >150 μg/L(27. 6% vs 53. 8%, χ2=5. 199,P=0. 023). Conclusions Retreatment, HBV family history, later virological response and higher HBsAg level at cessation therapy are risk factors of relapse after NA withdrawal. Such patients should be treated with prolonged duration after meeting end-point criteria to strengthen the efficacy.

Objective To conduct a prospective phase Ⅱ clinical study to explore the distribution of CYP2D6 gene polymorphism in Chinese population and its relationship with the metabolism of tamoxifen in early-stage hormonal receptor-positive breast cancer. Methods CYP2D6 genotype was tested by Sanger sequencing using the ABI 3500 Genetic Analyzer. Plasma concentrations of tamoxifen and endoxifen were measured using the HPLC-MS/MS(API 2000)assay. We downloaded the data of CYP2D6 allele from the CPIP database. Results In Chi-nese patients,the most common alleles were CYP2D6*1,*2,and *10;the predominant diplotypes were *1/*10 (38.3%)and*10/*10(18.8%). The distribution of metabolic phenotype,plasma concentration of endoxifen,and endoxifen:tamoxifen plasma concentration ratio were inconsistent between the normal metabolic phenotype(EM) and the intermediate phenotype(IM)under different CYP2D6 activity prediction criteria.The differences in the ratios and endoxifen plasma concentrations were statistically significant between the three groups by cluster analysis. Conclusions The CYP2D6 genotype distribution in Chinese population is different from that in the Western popu-lation. There is considerable variation of serum endoxifen concentration in Chinese breast cancer patients possess-ing the phenotype previously known as the intermediate active metabolizers of CYP2D6. Therefore,in the current era of precision medicine,the standard CYP2D6 genotype-phenotype classification system cannot properly stratify the Chinese population with different levels of endoxifen plasma concentration.