Obiective To develop an integration profile for hospital clinical system and medical image information system, and discuss relative problems on regional medical image sharing based on the Cross-Enterprise Document Sharing Integration Profile (XDS). Methods As medical image constitutes important information of the patient health record, it is logical to extend the XDS integration profile to include images. The new integration profile for sharing images and image reports between multiple enterprises and the XDS for Imaging(XDS-I) was used. Results The XDS-I profile can be used in medical image sharing system in multiple enterprises. Conclusion The IHE XDS-I can give references for medical imaging regional sharing.

Objective To develop an integration profile for hospital clinical system and medical image information system, and discuss relative problems on regional medical image sharing based on the Cross -Enterprise Document Sharing Integration Profile (XDS). Methods As medical image constitutes important information of the patient health record, it is logical to extend the XDS integration profile to include images. The new integration profile for sharing images and image reports between multiple enterprises and the XDS for Imaging(XDS-I) was used. Results The XDS-I profile can be used in medical image sharing system in multiple enterprises. Conclusion The IHE XDS-I can give references for medical imaging regional sharing.

Objective To explore independent risk factors of ventilator associated pneumonia (VAP) on severe craniocerebral injury patients, and propose nursing intervention measures to reduce occurrence of VAP. Methods A retrospective analysis was conducted on 73 severe craniocerebral injury patients with VAP postoperatively from January 2013 to June 2015, and 80 severe craniocerebral injury patients underwent mechanical ventilation without VAP postoperatively at the same time were selected as the control group. Through literature review, questionnaire was designed to collect potential impact factors of VAP in both two groups, the single factor analysis and Logistic regression analysis were applied to explore the VAP independent risk factors, and nursing intervention countermeasures were proposed to improve VAP clinical prevention. Results VAP incidence rate of severe craniocerebral injury patients postoperatively was 23.0%(73/317) , from which 81 strains were detected, the first three strains of strain spectrum were Klebsiella pneumonia (21.0% ), Bauman Acinetobacter (17.3% ) and pseudomonas aeruginosa bacteria (14.8% ). Single factor analysis showed there were significant differences on composition of two groups in age, preoperative Glasgow Coma Scale (GCS) score, operation times, artificial airway type, postoperative mechanical ventilation time, daily airway humidification frequency, daily sputum suction frequency compound injury, daily oral care times (χ2=1.809-11.936, P < 0.01 or 0.05). Logistic regression models showed duration of mechanical ventilation (OR≥7d=3.013; OR≥14d=3.695), secondary surgery (OR =3.111) , preoperative GCS score (OR =2.989), daily airway humidification frequence (OR =2.280), age (OR=2.237) had remarkable influence on occurrence of postoperative VAP (P<0.01 or 0.05). Conclusions The incidence rate of VAP in severe craniocerebral injury patients is higher, age, mechanical ventilation duration, preoperative GCS score, airway humidification degree, second surgery are the independent risk factors of VAP.

Objective To observe the clinical efficacy of infrared thermal therapy against pseudomonas ae-ruginosa infection on deep partial-thickness burn wound. Methods Forty-three patients in our hospital with main-ly deep partial-thickness burn wound from January 2015 to October 2016 were randomly enrolled to the treatment group(TG,treated with sulfadiazine silver + infrared thermal therapy)and the control group(CG,treated with sulfadiazine silver only). Scores of wound exudation,positive rate of pseudomonas aeruginosa on wound,wound healing rate,wound healing time and overall evaluation of wound healing on the day of 0,3,7,14,21,28 after treatment were conventionally recorded. Adverse effects in TG and CG were also observed. Results (1)Age,sex and burn surface area of patients were found no statistically significant difference between the two groups(P>0.05). (2)On the day of 3,7 and 14,wound exudation score of TG was significantly lower than that of CG(P<0.05);On the day of0,21 and 28,wound exudation score of the two groups were almost same.(3)Positive rate of pseudomonas aeruginosa between the two groups on the day of 7,14 and 21,TG was significantly lower than CG(P < 0.05). (4)Wound healing rate of TG on the day of 7,14 and 21 was higher than CG,which was statistically significant difference in the 2 groups(P<0.05);Wound healing time of TG patients[(21.1 ± 6.5)day]was significantly shorter than that of CG patients[(26.2 ± 6.5)day](P<0.05).(5)Overall evaluation of wound healing of TG was better than that of CG on the day 14 and 21(P<0.05). Conclusions Infrared thermal therapy could reduce the secretion of deep partial-thickness burn wound and effectively control pseudomonas aeruginosa infection. Furthermore,infrared thermal therapy finally improved wound healing rate and shortenedwound healing time of burn wound.

Objective To observe the effect of glucocorticoid on osteoblast-like cell apoptosis and the cell cycle. Methods Osteoblast-like cells OS-732 at the density of 1?105/mL were cultured in vitro with dexamethasone (DMX) at the concentrations of 10-7,10-8 and 10-9 mmol/L. The apoptosis of OS-732 was detected by flow cytometry after the culturing for 24 and 48 hours,and then DNA content was detected and the cell cycle was analysed. Results At the time point of the 24th hour,DNA content at G2/M phase of OS-732 cell cycle was increased obviously in DMX1(10-7 mmol/L)group (P

Objective:To investigate the specific interference of OX40 gene expression induced by RNAi technique in 293T cell lines transfected with rat OX40 gene.Methods:293T cells were transfected with recombined plasmid pEGFP-N1-GFP/OX40,and the positive cell clones were selected by fluorescence protein observation and RT-PCR.One specific dicer siRNA targeted to OX40 mRNA was designed and synthesized,which shared no homology with exons of known human gene.Quantitative real-time PCR was performed to measure the inhibitory rate of target gene expression by comparing OX40 mRNA concentrations before and after siRNA transfection.Results:10 nmol/L siRNA-OX40 elicited the highest level of gene silence in 293T cells which was transfected with siRNA after 48 h (68.3?8.7)%);The time of maximal inhibitory effect was at 48-72 h [(61.7?8.4)%,(39.6?5.6)%].Conclusion:The exogenous OX40 expression can be significantly inhibited by treatment with specific siRNA in a dose and time -dependent manner in 293T cells,which may provide a useful profile for further investigation of inhibition of OX40 protein,and a promising control approach for preventing immune reaction.

Objective To explore the application ways of IHE XDS technology in electronic medical record (EMR) system and develop application system of clinical EMR integration. Methods The clinical EMR integration plan was worked out based on IHE XDS technical framework. Results A EMR solution based on IHE XDS was presented. It was consisted of the components of the clinical Data Entry, XDS Registry, clinical document Repository, EMR application server and the i-node accessing server. The system was tested and the result indicated that the system was effective and scalable. Conclusion IHE XDS profile can be not only used to realize the sharing of EMR documents across multiple hospital, but also support the collection clinical data within a hospital clinical system integration.

Chlorzoxazone ; blood ; Chromatography, High Pressure Liquid ; methods ; Cytochrome P-450 CYP2E1 ; blood ; Humans

Objective To studythe efficacy of levosimendan in treating refractory heart failure complicating severe renal in sufficiency.Methods Sixty-seven cases of refractory heart failure complicating severe renal insufficiency in the internal medicine department of our hospital were randomly divided into the levosimendan treatment group(L group,n=33)and dopamine treatment group(D group,n=34).The changes of N-terminal pro-B-type natriuretic peptide(NT-pro-BNP),left ventricular ejection fraction (LVEF)and glomerular filtration rate(GFR)before treatment and on 1,3,7,30 d after treatment were compared between the two groups and analyzed.Results Before the treatment,there were no statistically significant differences in the baseline indicators between the two groups(P＞0.05).The group L:the NT-pro-BNP level on 1,3,7 d after treatment was decreased significantly(P＜ 0.05),LVEF on 3,7 d was significantly increased compared with th baseline(P＜0.05)and GFR on 1,3,7,30 d was significantly increased compared with the baseline(P＜0.05).The group D:the NT-pro-BNP level on 7 d of treatment was significantly decreased(P＜0.05),LVEF on 7 d of treatment was significantly increased compared with the baseline(P＜0.05),and no statistically significant changes were observed in GFR on 1,3,7,30 d(P＞0.05).After treatment,NT-pro-BNP,LVEF and GFR significant level values in the group L were better than those in the group D.Conclusion Levosimendan is superior to dopamine in improving heart and renal function for the patients with refractory heart failure complicating severe renal insufficiency.

Objective To assess the value of end-tidal carbon dioxide partial pressure (PETCO2) combined passive leg raising (PLR) test on volume responsiveness assessment in shocked patients post cardiac operation.Methods A prospective,self-controlled,and observational study was conducted.The shocked patients post cardiac operation undergoing complete mechanical ventilation admitted to Department of Critical Care Medicine of First Affiliated Hospital of College of Medicine,Zhejiang University from June 2014 to October 2015 were enrolled.PETCO2 and hemodynamic parameters including stroke volume variation (SVV),cardiac index (CI),mean arterial pressure (MAP) monitored by a pulse indicator continuous cardiac output (PiCCO) were determined before and after PLR and volume expansion (VE).Volume responsiveness was defined as an increase in CI (△ CI) of 15％ or greater after VE,namely response group (△ CI ≥ 15％) and non-response group (△ CI ＜ 15％).The value of PLR-induced PETCO2 change (△PETCO2 PLH) to predict volume responsiveness was evaluated by receiver operating.characteristic curves (ROC).Results Among the 41 patients enrolled,21 had volume responsiveness (response group),and 20 had no responsiveness (non-response group).After PLR,the changes in CI and PETCO2 were both significantly increased in the response group compared with non-response group [△ CI:(13.5 ± 4.6)％ vs.(3.6± 3.5)％,△ PETCO2:(7.4 ± 3.4)％ vs.(2.8 ± 2.5)％,both P ＜ 0.05].△ PETCO2 PLR and baseline SVV were positively correlated with PLR-induced CI change (△ CI PLR) (r1 =0.50,r2 =0.38,both P ＜ 0.05).VE-induced PETCO2 change (△ PETCO2 VE),baseline SVV and △ CI PLR were positively correlated with VE-induced CI (△ CI VE) (r1 =0.58,r2 =0.56 and r3 =0.84,all P ＜ 0.01).The area under ROC curve (AUC) of △ PETCO2 PLR was 0.875±0.054 [95％ confidence interval (95％CI) =0.769-0.981,P ＜ 0.05].△ PETCO2 PLR ≥ 5.8％ predicted volume responsiveness with sensitivity of 76.2％ and specificity of 90.0％.AUC of △CI PLR was 0.933±0.036 (95％CI =0.862-1.000,P ＜ 0.05).△CI PLR ≥ 10.4％ predicted volume responsiveness with sensitivity of 81.0％ and specificity of 90.0％.AUC of baseline SVV was 0.831 ±0.066 (95％CI =0.702-0.960,P ＜ 0.05).Baseline SVV ≥ 12.5％ predicted volume responsiveness with sensitivity of 85.7％ and specificity of 75.0％.Conclusion The change in PETCO2 induced by PLR is a convenient,reliable and non-invasive indicator to predict volume responsiveness in shocked patients post cardiac operation with mechanical ventilation.