AIM:To explore the protective effect of fasudil hydrochloride against cisplatin (CP)-induced renal tubular epithelial cell apoptosis via Akt activation and PTEN inhibition .METHODS:Healthy male Sprague-Dawley ( SD) rats were randomly divided into control group , CP group and CP+fasudil group .All animals were sacrificed 96 h after in-jection of 0.9%saline or CP .Blood samples and kidney tissues were collected to evaluate levels of blood urea nitrogen (BUN), serum creatinine (sCr) and morphological alteration of the kidneys , respectively.The apoptosis of renal tubular epithelium cells was detected by TUNEL.Protein levels of Rho-associated protein kinase 1 (ROCK1), PTEN and Akt were measured by Western blotting and immunohistochemistry .The protein level of p-Akt was analyzed by Western blotting . RESULTS:Compared with control group , the sCr and BUN levels , the expression of ROCK 1 and PTEN and TUNEL-posi-tive cells were increased , while the level of p-Akt was decreased in CP group and CP +fasudil group .The histological structure of the kidneys observed by PAS staining was developed marked structural damage in CP group (P<0.05).Com-pared with CP group, sCr level, the expression of ROCK1 and PTEN and TUNEL-positive cells were decreased, while the level of p-Akt was increased in CP+fasudil group (P<0.05).Very little structural damage was detected in fasudil-treated groups .CONCLUSION:Fasudil hydrochloride has a protective effect on CP-induced renal tubular epithelial cell apoptosis via Akt activation and PTEN inhibition 1.

Objective To evaluate the effects of intermittent nasogastric feeding on neonatal intensive care unit ( NICU) on very low birth weight infants gastrointestinal complications .Methods Two hundred and fifteen very low birth weight infants were randomly assigned to either observation group ( n=106 ) or the control group ( n=109 ) .Infants in the observation group received intermittent gravity tube feeding .Infants in the control group received continuous drip tube feeding .Weight increase , total parenteral nutrition time , length of stay and complication were assessed .Results Observation group of very low birth weight infants when were turned out of the NICU, weight increased to(1 397.0 ±22.10)g, higher than the control group (1 320.0 ± 18.25)g, was statistically significant difference (t=2.26,P<0.05);total parenteral nutrition time, length of stay in NICU were (4.94 ±0.70),(9.69 ±7.19)d,in observation group, were lower than the control group [(4.74 ±0.74),(11.63 ±4.02)d], differences were statistically significant (t=2.72,4.85,respectively;P<0.01).The incidence of abdominal distention , vomiting, diarrhea, upper gastrointestinal bleeding in observation group were lower than the control group , and had statistical significance (P<0.05).However, the very low birth weight infants had not occurred necrotizing enterocolitis in two groups .Conclusions Intermittent nasal tube feeding can reduce the complications of enteral nutrition , shorten the time of hospitalizationand increased body weight growth rate .

Objective To investigate the application effect of centralized health education among low-income parents in neonatal intensive care unit ( NICU) . Methods A total of 200 cases, who had low income parents and admitted to NICU from December 2012 to June 2013, were randomly divided into observation group (100 cases) and control group (100 cases). The neonatus in the control group underwent conventional health education mode, while neonatus in the observation group received conventional health education model based on a new type of health education on adoption. The awareness of health education, medical compliance and satisfaction of nursing assessed by self-designed health education effect scale, self-realization medical compliance and the satisfaction questionnaire in our hospital for quality of care. Results The satisfaction for quality of care in the experimental group was 97. 0% higher than 84. 0% in the control group (χ2 =9. 83,P<0. 01). The knowledge control of parents after health education in the experimental group was better than that in the control group (P<0. 01). Similarly, the medical compliance of neonatal parents in the experimental group was better than that of control group including treatment (92. 0%), treatment cooperation (95. 0%), payment on time (100. 0%) and visit as required (90.%) (χ2 =20. 37,20. 41,18. 58,14. 59, respectively;P <0. 01). Conclusions The centralized health education can facilitate the knowledge control of low-income parents in NICU, satisfaction of health education and medical compliance, and is worth of clinical promotion.

Objective To explore the application of PDCA cycle on reducing unplanned extubation ( UEX) incidence of invasive arterial blood pressure monitoring in child patients. Methods The PDCA cycle had been used to documented the UEX status of invasive arterial blood pressure monitoring in 2013, analyses the reason of UEX, set improvement goals, formulate measures, organize and implement the strategy, and compared and analyses the improved effect. Results After the introduction of PDCA cycle management approach, the experimental group of arterial indwelling catheter UEX rate (4. 5%) was lower than that of the observation group (15. 45%) (χ2 =6. 62,P <0. 05); for children of experimental group, the length of hospitalization was (22. 98 ± 2. 53) d, which was lower than that of the control group (22. 98 ± 2. 53) d (t=12. 846,P<0. 05), the expenditure of hospitalization of the control group (6 991. 1 ± 237. 1) yuan was higher than that observation group(5849.71±252.80) yuan(t=34.631,P<0.05).Conclusions ThePDCAnursingcanpreventand control the UEX rate of invasive arterial blood pressure monitoring standardize nursing operation, and improve nursing management level.

Objective To explore the application effect of traditional and gravity nasogastric feeding of preterm infants in neonatal intensive care unit ( NICU) .Methods Eighty preterm infants whose gestational age was less than 34 weeks and birth weight was lower than 2 000 g from August 2012 to June 2013 were chosen through the prospective randomized controlled study method and were randomly divided into the control group and the observation group according to the hospitalization number , each with 40 cases.The control group received the traditional nasogastric feeding , and the observation group received the gravity nasogastric feeding . The time of achieving the total parenteral nutrition and hospitalization , the tolerance for feeding and the related complication were compared between two groups .Results The time of achieving the total parenteral nutrition and hospitalization in the observation group were significantly better than those of control group , and the differences were statistically significant (t=4.780, 8.846, respectively;P<0.05).The tolerance for feeding in the observation was higher than that of the control group , and the cases of apnea in the observation group were less than those of the control group , and the differences were statistically significant (χ2 =3.19, 9.69, respectively;P <0.05).No differences were found in the abdominal distension, diarrhea, necrotizing enterocolitis between two groups (χ2 =0.11, 0.21, respectively;P>0.05).Conclusions Gravity nasogastric feeding can increase the tolerance for feeding in the preterm infants , and shorten the time of achieving the total parenteral nutrition and hospitalization in order to lay a good foundation for growth and development of preterm infants.

Objective To discuss the effect of measuring central venous with peripherally inserted central catheter (PICC) in low birth weight infants (LBWIs).Methods Totally 100 LBWIs admitted in the intensive care unit ( ICU) of a tertiary hospital from January to Octomber 2015 were selected and were randomly divided into the PICC group and the central venous catheterization ( CVC) group, with 50 cases in each group. Patients in the PICC group received the main intravenous catheter, while patients in the CVC group received subclavian intravenous catheter. Data were collected for statistical analysis. The difference of central venous pressure and the incidence rate of complications in patients with different measure methods were compared between two groups.Results The central venous pressure of LBWIs in the PICC group was (8.26±2.18) cmH2O, and in the CVC group was (7.85±2.36) cmH2O (t=0.421,P>0.05); the incidence rates of catheter obstruction, phlebitis and puncture point bleeding of the PICC group were lower than that of the CVC group (χ2=5.01,6.93, 4.00;P<0.05).Conclusions PICC catheter measurement won′t affect the measure results of central venous pressure in LBWIs,and can reduce the incidence of complications related with central venous catheter in very low LBWIs, so it can be popularized for use.

Objective:To investigate the prognostic value of proprotein convertase subtilisin/kexin type 9 (PCSK9) and blood lipid indexes in patients with sepsis.Methods:Patients with sepsis or septic shock who were ≥ 18 years old and met the Sepsis-3.0 diagnostic criteria admitted to the department of critical care medicine of Binzhou Medical University Hospital from January to October 2021 were enrolled. Healthy adults at the same period were selected as healthy control group. Baseline characteristics, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) and sequential organ failure assessment (SOFA) score were recorded. Venous blood samples were collected within 24 hours after diagnosis, and serum PCSK9 was determined by enzyme-linked immunosorbent assay (ELISA) at 1, 3 days and 5 days. Meanwhile, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG) and lipoprotein A were detected. The differences of each index between sepsis group (28-day death group and survival group) and healthy control group were compared. Meanwhile, the indexes of patients with different severity and 28-day prognosis in sepsis group were compared. Receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of PCSK9 and blood lipid for the prognosis of sepsis. Multivariate Logistic regression was used to analyze the influencing factors for the prognosis of sepsis, and the Kaplan-Meier survival curve at 28th day was drawn.Results:There were 50 patients in sepsis group (including 19 patients with sepsis, 31 patients with septic shock) and 27 patients in healthy control group. In the sepsis group, 19 patients died and 31 patients survived within 28 days. The serum PCSK9 in the sepsis group was significantly higher than that in the healthy control group [μg/L: 223.09 (198.47, 250.82) vs. 188.00 (165.27, 214.90), P < 0.01], and HDL-C, LDL-C, TC and lipoprotein A were significantly lower than those in the healthy control group [HDL-C (mmol/L): 0.82±0.35 vs. 1.45±0.24, LDL-C (mmol/L): 1.53 (1.14, 2.47) vs. 2.89 (2.55, 3.19), TC (mmol/L): 2.03 (1.39, 2.84) vs. 4.24 (3.90, 4.71), lipoprotein A (g/L): 8.80 (5.66, 17.56) vs. 27.03 (14.79, 27.03), all P < 0.01]. PCSK9 in the sepsis death group was higher than that in the survival group [μg/L: 249.58 (214.90, 315.77) vs. 207.01 (181.50, 244.95), P < 0.01], and the HDL-C, LDL-C and TC were lower than those in the survival group [HDL-C (mmol/L): 0.64±0.35 vs. 0.93±0.30, LDL-C (mmol/L): 1.32±0.64 vs. 2.08±0.94, TC (mmol/L): 1.39 (1.01, 2.23) vs. 2.69 (1.72, 3.81), all P < 0.01]. With the progression of the disease, the PCSK9 in the sepsis death group and the survival group was significantly lower than that within 1 day of diagnosis (all P < 0.05). ROC curve analysis showed that PCSK9 had higher predictive value of 28-day death than HDL-C, LDL-C, TC [area under ROC curve (AUC) and 95% confidence interval (95% CI): 0.748 (0.611-0.885) vs. 0.710 (0.552-0.868), 0.721 (0.575-0.867), 0.702 (0.550-0.854)]. Multivariate Logistic regression analysis showed that PCSK9 was an independent risk factor affecting the 28-day prognosis of sepsis (β value was 1.014, P = 0.020). Kaplan-Meier survival curve analysis showed that when PCSK9 ≥ 208.97 μg/L, with the increase of PCSK9, the 28-day survival rate of sepsis patients decreased significantly. Conclusions:PCSK9, HDL-C, LDL-C and TC can all predict the 28-day prognosis of patients with sepsis. The prognostic value of PCSK9 is the highest. PCSK9 is an independent risk factor affecting the prognosis of sepsis. In the early stage of the disease, PCSK9 may have a good predictive value for the prognosis of sepsis. When PCSK9 ≥ 208.97 μg/L, the 28-day survival rate decreased significantly.

Since the discovery of circulating hepatitis B virus (HBV) RNA in the peripheral blood of patients with chronic hepatitis B in 1996, a growing number of studies have focused on clarifying the biological characteristics and clinical application value of serum HBV RNA. This consensus mainly summarizes the research progress of serum HBV RNA existing profiles, quantitative detection methods, and current clinical applications. In order to better apply this indicator for the clinical management of patients with chronic HBV infection, recommendations on quantitative detection target regions, detection results, and clinical applications are put forward.

BACKGROUNDAnticoagulation treatments are an important aspect of hemodialysis; however, few reports have addressed these treatments. This investigation intends to increase the understanding of the current status and improvements of hemodialysis-related anticoagulation treatments in China.

METHODSIn this study, an epidemiological investigation was conducted that examined 842 patients in 2007 and 1 175 patients in 2012 who underwent hemodialysis anticoagulation treatments in seven blood purification centers in northern Chinese cities.

RESULTSHeparin was the most commonly used anticoagulant, although the percentage of use of low-molecular-weight heparin (LMWH) increased from 26.5% in 2007 to 42.1% in 2012. In 2007, there were no significant differences in anticoagulant selection among either patients with various primary diseases or patients with hemorrhage, thrombosis, thrombocytopenia, or a low hemoglobin level. However, compared with patients with other diseases, significantly lower doses of LMWH were administered to patients with hypertension (55.5 U/kg vs. 67.3 U/kg, P < 0.05) or diabetes (58.5 U/kg vs. 67.3 U/kg, P < 0.05), and patients with hemorrhage received lower doses of heparin than the other patients (61.6 U/kg vs. 71.8 U/kg, P < 0.01). In 2012, patients with diabetic nephropathy (51.5% vs. 36.5%, P < 0.01), hemorrhage (43.4% vs. 31.7%, P < 0.01), or a hemoglobin level below 90 g/L (57.2% vs. 37.1%, P < 0.01) experienced significantly higher doses of LMWH administration; patients with hemorrhage received significantly reduced LMWH dosages (50.4 U/kg vs. 57.8 U/kg, P < 0.05), and patients with thrombosis received significantly higher doses of heparin (73.8 U/kg vs. 62.1 U/kg, P < 0.01) or LMWH (57.8 U/kg vs. 52.6 U/kg, P < 0.05). Antiplatelet drugs were administered to 20.4% of the examined patients in 2007 and 20.7% in 2012. In 2012, patients with hypertension (25.9% vs. 18.5%, P < 0.01) and thrombosis (36.6% vs. 16.1%, P < 0.01) had a higher rate of using antiplatelet drugs than patients with other primary diseases and complications. Patients receiving antiplatelet drugs also received higher doses of heparin than patients without using antiplatelet drugs (74.4 U/kg vs. 65.9 U/kg, P < 0.01). However, the use of the drugs was not correlated with thrombocytopenia. The rate at which coagulation indices were determined increased from 45.7% in 2007 to 64% in 2012.

CONCLUSIONThese findings suggested that hemodialysisrelated anticoagulation treatments in China have gradually become more standardized and individualized.

Adult ; Aged ; Anticoagulants ; therapeutic use ; China ; Cities ; Female ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Middle Aged ; Renal Dialysis ; methods