This paper introduces the airway care of a patient with motor neuron disease treated with mechanical ventilation for eight years. The airway care for the patient focused on individualized suctioning,measures to prevent atelectasis such as lung hyperinflation,adjustments of ventilator parameters,regular weaning exercise,as well as measures to prevent ventilator-associated pneumonia such as prevention of aspiration,strict disinfection and isolation,wound care of tracheotomy. The ventilator-associated pneumonia was effectively prevented. Effective nursing care for patients with long-term mechanical ventilation can prevent atelectasis and ventilator-associated pneumonia.

As the actual clinical reflecting of transform Chinese medicine special curative effect, Chinese medicine preparation not only satisfies the need of hospital clinic, scientific research and teaching, but also plays an important role in deepening medical and health system reform, improving people's health level and contributing to the economic growth. However, some problems about administration and approval (tending to western medicine), contraction of the scale, lack of synchronization for clinic and scientific research, and the imbalance of regional development make Chinese medicine preparation move forwards slowly in contradiction. It has not only reduced the effectiveness of the Chinese medicine preparation in hospital clinic, but also brought bad effect on modernized development of Chinese medicine preparation. Research shows that main influencing factors of status quo of Chinese medicine preparation in medical institution include imperfect laws and regulations, high cost than income, and shortage of talents in preparation research. The analysis indicated that the necessary measures to break the contradiction, improve clinical effect of Chinese medicine, and promote the modernization development of Chinese drugs preparation were as follows: government and related departments should strengthen the supporting force in policy by adjusting the examination and approval policy, speeding up dispensing use, reforming pricing system, including into medicare reimbursement, integrating advantage resources and so on; medical institution should actively carry out research and development of traditional Chinese Medicine through drawing the traditional and modern essence, reserving professional talents, and developing characteristic preparation; companies cooperate with hospitals for complementary advantages, which can rapidly transform Chinese medicine preparation into clinical practice.
Chemistry, Pharmaceutical ; economics ; methods ; trends ; China ; Drug Discovery ; economics ; trends ; Drugs, Chinese Herbal ; chemistry ; economics ; pharmacology ; Humans ; Medicine, Chinese Traditional ; economics ; trends

Objective To investigate the clinical manifestations of coexistent rheumatoid arthritis(RA)and systemic lupus erythematosus(SLE)(Rhupus syndrome).Methods Clinical data from a patient with Rhupus syndrome were analyzed combined with literature review.Results The patient was a middle-aged female,who presented with features of RA and developed features of SLE 7 years later.Renal involvement in common cases is rare but presented in our patient with severe renal dysfunction.The patient showed part remission with glucocorticosteroids and cyclophosphamide therapy.Conclusion Rhupus syndrome is a rare condition sharing features of RA and SLE.These patients present with features of one disease but later on develop features of another.Glucocorticosteroids and immune suppressors are effective.Appreciation of these patients with rhupus is important since their therapy and outcome differ from those having RA or SLE alone.

Objective To observe the effect of intermedin (IMD) preconditioning on cyclin D1, cyclin E and CDKs expression, and explore its role in.promoting kidney tissue regeneration after renal ischemiareperfusion injury. Methods One hundred and forty-four healthy male Wistar rats were randomly divided into four groups: sham operation (S) group, ischemia-reperfusion injury (IR) group, empty plasmid (EP) group and IMD group. In the IR group, after the right kidney was excised, the aorta abdominalis and left renal artery were bluntly dissected in EP and IMD group, empty plasmid and IMD plasmid were transfected into the left kidney using ultrasound-micro-bubble (SonoVue) mediated system, respectively. One week later, renal IRI model was made by clasping the left renal artery for 45 min. After 1, 2, 3, 4, 7 and 14 day of reperfusion, the kidney in each group was collected to detect the expression of cyclin D1, cyclin E, CDK4 and CDK2 by western blot analysis or enzyme-linked immunosorbent assay (ELISA). Results Compared with S group, the expression of cyclin D1, cyclin E, CDK4 and CDK2 was significantly up-regulated in day 1, 2,3, 4, 7 and 14 in IR group. And the above index increased gradually after reperfusion, and reached the peak at day 7 (F=54.92, 69.60, 61.28, 77.38, P＜0.05). While in IMD group, these indexes reached the peak at day 1, then progressively declined, and could not be detected at day 14 (compared with the IR group, F=54.92, 69.60, 61.28, 77.38, P＜0.05). Conclusion IMD preconditioning can up-regulate the expression of cyclin D1, cyclin E, CDK2 and CDK4 in the early phase of renal ischemia-reperfusion injury that may accelerate repair of renal tissue, at least by part, by enhancinge cell proliferation.

Objective To investigate the effect of intermedin (IMD) on tubular cells apoptosis induced by renal ischemia/reperfusion (I/R) injury and its associated mechanism.Methods A total of twenty-four male Wistar rats were randomly divided into four groups (control group, I/R group, empty plasmid group and IMD group). One week after the removal of right kidney, ultrasound plasmid was used to transfect empty or IMD plasmid into the left kidney. Renal I/R model was made by clasping the left renal artery for 45 minutes. Tubular cell apoptosis was determined by TUNEL. Expression of Bax, Bcl-2, Fas was detected by semi-quantitative RT-PCR.Activity of caspase-8 and caspase-9 was evaluated with commercially available kits respectively.Protein level of caspase-3 was measured by Western blotting analysis. Results Compared with control group, apoptosis of tubular epithelial cells, expression of Bax and Fas, activities of caspase-8 and caspase-9, as well as protein level of caspase-3 were all significantly increased in I/R group (all P＜0.05). IMD pre-treatment significantly inhibited all these effects (all P＜0.05). There were no differences of above parameters between empty plasmid group and I/R group. Conclusion IMD pre-treatment protects against renal I/R injury by inhibion of tubular epithelial cell apoptosis.

Objective To characterize the internal structures of fluconazole-loaded cubic phase gels and establish a method for determination of fluconazole.Methods Glycerol monooleate( GMO) was used as the liquid crystal material to prepare the fluconazole loaded cubic phase gels.Polarizing light microscopy ( PLM ) and small-angle X-ray scattering ( SAXS) were used to confirm their internal structures and establish an HPLC method for determination of their content. Results Cubic phase gels were the dark field under PLM,SAXS showed that the blank cubic phase gels had two single peaks:q1(0.832 09 nm-1 ) and q2 (1.017 nm-1 ) while the fluconazole-loaded cubic phase gels had two single peaks:q1(0.818 88 nm-1)and q2(0.950 95 nm-1).Under the selected HPLC, the linearity within the range of 20-500 μg/ml was good.Conclusion PLM and SAXS are reliable for characterization of cubic phase gels.The HPLC method can be used in quality control and evaluation of this enema.

Objective To explore the lymphcyte subsets distribution in cerebrospinal fluid in patients with HIV infection ,and to investigate the clinical significance of the lymphocyte subsets in cerebrospinal fluid in HIV central nervous system complication . Methods 34 patients with HIV infection ,including 20 patients without nervous system symptoms (simple HIV group) and 14 pa‐tients with nervous system symptoms (neurological HIV group) ,and 15 cases of healthy people (control group) were selected . Flow cytometry was used to detect lymphocyte subsets ,and immunoturbidimetry was used to detect the level of IgG in cerebrospinal fluid .Results The percentage of CD8+ T cells was higher and percentage of CD4+ T cells was lower in the simple HIV group and neurological HIV group than those in the healthy control ,with statistically significant differences (P<0 .01) .The level of IgG in pa‐tients with HIV infection was higher than that in the healthy control group (P<0 .01) .While no significant difference were found in the percentage of B cells and NK cells among the there group (P>0 .05) .There were also no significant differece between the sim‐ple HIV group and neurological HIV group in the ratio of each lymphcyte subset in cerebrospinal fluid (P>0 .05) .Conclusion The immune disorder in cerebrospinal fluid in patients with HIV infection may appear in the early time before the nervous system com‐plication .The changing trends of lymphocyte subsets are consistent with the peripheral blood ,which demonstrate that the T lym‐phocyte subsets may be correlated with the nervous system symptoms of HIV .

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ObjectiveTo explore the effect of intermedin pretreatment on repair and regeneration process of renal ischemia reperfusion (IR) injury.Methods Male Wistar rats were randomly divided into four groups: sham group,IR group,empty plasmid group and IMD group.One week after removing the right kidney,eukaryotic expression vector encoding rat IMD gene was transfected into the left kidney using an ultrasound-microbubble-mediated system,and transfection effect was detected by Western blotting and RT-PCR.After successful transfection,renal IR injury model was induced by clamping left renal arteries for 45 minutes followed by reperfusion.BUN and Scr were tested.Renal pathology was observed by PAS and HE staining.The proliferation of tubular epithelial cells was detected by SABC immunohistochemical method.Results (1)The expression of IMD protein and mRNA in IMD group was significantly up-regulated compared to empty plasmid group(P＜0.05),reaching the peak at day 7,and the difference was not significant with that at day 4.(2)Compared with sham group,BUN and Scr were obviously increased at day 1and 2 in IR group(P＜0.05).However,compared with IR group,BUN and Scr in IMD group decreased obviously(P＜0.05).Differences between IR group and empty plasmid group were not significant(P＞0.05).(3)Kidney tubules in IR group,IMD group and empty plasmid group were injuryed,but the injury in IMD group was less serious compared with that in IR group and empty plasmid group.The injury in three groups was the most severe at day 2 after reperfusion.(4)The number of PCNA positive cells evidently increased at day 7 in IR group and empty plasmid group,but the number of PCNA positive cell evidently increased at day 3 in IMD group.Compared with IR group 1 to 4 days after perfusion,PCNA positive cells in IMD group increased obviously (P＜0.05).Compared with IR group day 7,PCNA expression in IMD group 7 d was obviously decreased(P＜ 0.05).Conclusion IMD pretreatment can induce tubular epithelial cells proliferative and accelerate the repair and regeneration progress in IR injury kidneys.

Objective To investigate the effect of adrenomedullin on rat renal tubular epithelial cell line (NRK-52E) apoptosis induced by hypoxia-reoxygenation (HR) injury and its mechanism.Methods NRK-52E cells were cultured and randomly allotted to the following 4 groups:control group,HR group,empty plasmid + HR group,ADM + HR group.NRK-52E cells were transfected with pcDNA3.1-myc-his B empty vector or pcDNA3.1-ADM by transfection complex comprising optimal proportion of plasmid and Fugene HD reagents.Cells were counted by trypanblau and cell survival rate was computed.The concentration of lactate dehydrogenase (LDH) was detected by spectrophotometric method to evaluate cell vitality.The apoptotic rate of NRK-52E cells was measured by flow cytometry.The transfer efficiency was detected by immunocytochemistry.The mRNA expressions of ADM,Bax,Bcl-2 and Fas were determined by Semi-quantitative RT-PCR,and active caspase-3,8,9 protein expression were examined by Western blotting.Results Compared with control group,the expression of ADM significantly increased in HR group (P ＜ 0.05).The expression of ADM significantly increased in ADM + HR group than that in empty plasmid + HR group.Compared with control group,in HR group,the living cell counts and cell survival rate significantly decreased; the LDH concentration in media,apoptotic rate and the levels of Bax,Bcl-2,Bax/Bcl-2,Fas,active Caspase -3,8,9 significantly increased (all P ＜ 0.05).Compared with HR group,in ADM + HR group,the living cell counts and cell survival rate significantly increased; the LDH concentration in media,the cell apoptotic rate and the levels of Bax,Bax/Bcl-2,Fas,active Caspase-3,8,9 significantly decreased,while Bcl-2 was promoted (all P ＜ 0.05).The above indexes had no differences between empty plasmid + HR group and HR group (all P ＞ 0.05).Conclusion The increased expression of ADM can inhibit NRK-52E apoptosis induced by HR,and the mechanism might be achieved by inhibiting mitochondrial and death receptor-mediated apoptotic pathways.