Acute respiratory distress syndrome (ARDS) is a severe respiratory condition that is characterized by rapidly progressive hypoxemia with noncardiogenic pulmonary edema.Despite the improvement of therapeutic methods,the mortality of ARDS is in the range of 40％-50％ all over the world.Some studies have shown that a significant number of patients with ARDS had acute cor pulmonale (ACP),and ACP is independently associated with the mortality of patients with ARDS,which has attracted wide attention in recent years.This paper reviewed recent related studies,summarized the prevalence,pathogenesis and diagnostic approaches of ACP in ARDS,especially echocardiography which was considered as a cornerstone for ACP diagnosis,and elucidated the beneficial effects of right ventricular protective ventilatory strategy and prone-positioning on the pulmonary vasculature and right heart,in order to provide a novel idea for the therapy of ACP in ARDS.

Objective:To construct a recombinant adenoviral vector carrying the specific siRNA of Survivin gene,and to observe its effect on the expression of Survivin gene and on the radiosensitivity of cancer cells in tumor-bearing mice.Methods:The specific siRNA of Survivin gene was designed and synthesized,and a recombinant adenovirus AdEGFP-siRNA was subsequently constructed.SMMC 7721 xenograft models were established with nude mice and were divided into the following 5 groups:siRNA+radiotherapy and siRNA groups(intratumoral injection of AdEGFP-siRNA),siRNA(-)group(injected every other day with AdEGFP-siRNA[-],2?108 pfu/100 ?l per time,total 5 times),pure radiotherapy group and blank control groups(injected with the same volume of normal saline).On day 10,12,14,and 16,the mice in siRNA+radiotherapy and pure radiotherapy groups were given 5 Gy/time radiotherapy.The tumor volumes were measured regularly.The expression of Survivin in tumor tissues was determined immunohistochemically.Results:Adenovirus AdEGFP-siRNA harboring the specific siRNA of Survivin gene and enhanced green fluorescent protein gene(EGFP)was successfully recombined.The growth of SMMC 7721 xenografts in nude mice was inhibited after injecting AdEGFP-siRNA,with the inhibition rate being 56.2%.The inhibition rate in AdEGFP-siRNA therapy + radiotherapy increased to 82.6%.Immunohistochemistry study showed that the specific siRNA markedly silenced the expression of Survivin gene in hepatocarcinoma cells.Conclusion:The specific siRNA can markedly silence Survivin gene and subsequently inhibit the growth of cancer;meanwhile,it can also increase the radiosensitivity of cancer cells so as to improve the treatment effect.

Objective To analyze the risk factors of postoperatively prolonged mechanical ventilation (PMV) after liver transplantation.Method The clinical data of 117 patients who received liver transplantation were retrospectively reviewed.According to the duration of postoperative mechanical ventilation (＜24 h or ≥24 h),the patients were divided into two groups.Commonly-used clinical and lab indexes before,during and after operations were analyzed by using single variance logistic regression analysis,and the screened indexes were analyzed by stepwise multiple variance logistic regression analysis.Result Forty-two patients (35.9％) were diagnosed with PMV after liver transplantation.The intensive care unit stay in the control group was (1.60 ± 1.17) days,shorter than in PMV proup (9.35 ± 10.61days).Sixty indexes were analyzed by univarite logistic regression,and 49 indexes showed statistically significant differences (P ＜ 0.2).Multiple variance logistic regression analysis revealed that the levels of preoperative blood glucose,model for end-stage liver disease score (MELD),the blood loss volume during the operation and the levels of glutamic oxalacetic transaminase within 24 h after the operation showed significant difference.Conclusion Preoperative hyperglycemia,high MELD score,excessive intraoperative blood loss volume and the high level of glutamic oxalacetic transaminase after the operation are independent risk factors of PMV.

The Interleukin-2 gene cDNA was cloned into the Pichia pastoris expression vector pPICZB,which is under the control of the alcohol oxidase promoter AOX1. The linearized recombinant plasmid of BoIL2-pPICZB,digested by Sac I ,was transformed into X-33 strains by electroporation. The multi-copy insert transformants were screened by Zeocin-resistance and induced by 1% methanol. The intracellular expression products were tested by SDS-PAGE analysis and Western blotting. Purified recombinant BoIL2 was gained by metal-chelating affinity chromatographic (MCAC). Assay with murine CTLL-2 cells showed that the recombinant BoIL2 exhibited the biological activity.

Objective To study the effects of electrical stimulation of efferent vagus nerve on the endotoxic shock in rabbits. Method Sixteen Newzealand rabbits were randomly divided into 2 groups, namely group S as the stimulation group and group C as the control group). Rabbits were subjected to bilateral cervical vagotomy and had challenge with intravenous injection of lipopolysaccharide (LPS) (E. COLI O111: B4 , DIFCO, USA) in a dose of 600 μg/kg. The distal end of the left vagus nerve trunk was connected to an electric stimulator with bipolar electrode and controlled by an acquisition system. Stimuli with stable voltage (10 V,5 Hz,5 ms) were applied twice to the nerve for 10 minutes just before and after the administration of LPS in group S. At the time before and after the infusion of LPS 30 min,60 min, 120 min, 180 min,240 min and 300 min respectively, the heart rate(HR)and the mean arterial blood pressure (MABP) in each animal were recorded, and blood samples were taken for measuring serum tumor necrosis factor-αa(TNF-α) and interleukin-10 (IL-10). Results Compared with group C,the electrical stimulation of efferent vagus nerve could significantly attenuated the LPS-induced hypotension and de-creased the contents of TNF-α[(38.12±7.85) pg/mL vs. (55.12±7.89) pg/mL, P <0.01], but increased the contents of IL-10[(55.12±9.37)pg/mL vs. (40.15±5.44) pg/mL, P <0.01]afar LPS challenge. Conclusions The stimulation of the efferent vagus nerve can down-regulate systemic TNF-α, production and attenu-ate the development of shock after LPS challenge.

Objective To evaluate the diagnostic accuracy of Streptocuccus pneumoniae urinary antigen test (SpUAT) in patients with community acquired Streptocuccus pneumoniae pneumoniae (SPP). Methods The clinical studies relating SpUAT diagnostic accuracy for community acquired Streptocuccus pneumoniae infection were searched via computer and manual screening of Chinese databases including China National Knowledge Internet (CNKI), China Biology Medicine disc, China Technical Journal Full-text Database, and Wanfang Database as well as English databases such as PubMed, EBSCO, Elsevier Science, Ovid Technologies, and Springer. Data were extracted according to appropriate inclusion and exclusion criteria and analyzed with Meta-disc 1.4 and Stata 12.0 software. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio as well as diagnostic odds ratio (DOR) were calculated, and summary receiver operating characteristic curve (SROC) was plotted and area under SROC (AUC) was calculated to analyze the diagnostic accuracy of SpUAT for adult community acquired SPP. Results A total of 15 studies enrolling 6 866 patients were included, all of which with a quality assessment of diagnostic accuracy studies (QUADAS) score not lower than 10, indicating a high study quality. Random effect model was applied owing to non-threshold effect associated heterogeneity. It was shown by Meta analysis that compared with routine pathogen diagnosis (hemoculture, sputum smears, sputum culture and trachea and bronchus attractive culture), the pooled sensitivity, pooled specificity, pooled positive likelihood ratio, and pooled negative likelihood ratio was 73% [95% confidence interval (95%CI) = 71%-76%,] 91% (95%CI = 90%-92%), 6.97 (95%CI = 4.13-11.77), and 0.30 (95%CI = 0.26-0.34), respectively, pooled DOR was 24.34 (95%CI = 13.14-45.11), and AUC of SROC was 0.8051±0.0362. It was indicated by heterogeneity test that experiment design (prospective or retrospective), sample sizes (lower than 200 or higher than or equal to 200), reference test (fewer than 3 or more than or equal to 3 test methods), or literature language (Hispanic or non-Hispanic) had no effect on study heterogeneity, indicating certain other unknown factors may be involved. Funnel plot suggested that 15 involved studies uniformly distributed along the two sides of regression line, indicating no publication bias. Conclusions The use of SpUAT for the diagnosis of adult community acquired SPP has a moderate sensitivity and high specificity. Although the overall accuracy of SpUAT diagnosis is relatively high, there is significant heterogeneity among the studies, so more high-quality studies are needed.

Objective To invesigate the value of contrast-enhanced spiral CT scan in diagnosing renal pelvic carcinoma.Methods All 35 cases with renal pelvic carcinoma confirmed by surgical pathology underwent plain and contrast-enhanced (including 4 phases) spiral CT scans before operation.CT data were reviewed retrospectively in comparison with surgical and patholgical results.Results CT findings of renal carcinoma could be classified into 3 types:type Ⅰ,the lesions limited within the renal pelvis in 25 cases;thype Ⅱ,the lesions were out of the renal pelvis and had indefinable margins with the renal parenchyma in 6 cases;type Ⅲ ,only showed the pelvic wall thickened with hydronephrosis in 4 cases.On contrast-enhanced CT scan,inhomogeneous enhancement of the lesions was presented in cortical phase,the intensity of enhancement was not obviously changed in 13 cases in parenchymal and excretion phases,but the lesions were still hypointense in comparison with renal parenchyma,14 cases demonstrated inhomogeneous enhancement of the lesions in delayed phase.Conclusion Contrast-enhanced spiral CT scanning is valuable in diagnosing renal pelvic carcinoma and renal delayed phase should be emphasized.

Objective To observe clinical application value of percutaneous interventional techniques for the treatment of complications of AIDS.Methods Twenty-one AIDS patients with complications were enrolled.CT guided percutaneous needle biopsy and drainage were conducted,and the correct rate of diagnosis,clinical curative effect and complications post-interventional therapy were observed.Results The operations of all patients executed successfully.Fourteen patients underwent 16 times biopsy,11 were correctly diagnosed,the diagnostic accordance rate was 81.25%.Drainage was performed in 6 patients with abscess or cystis,then the lesions completely disappeared in 3,deflated in 2,while the rest one needed continously draining.Partial splenic embolization (50%) was performed in 1 patient,and after operation platelet content increased,while hepatic function decreased temporality.No complicated infection and other severe complications occurred.Conclusion Percutaneous interventional techniques for the treatment of complications of AIDS are safe and feasible.Medical staffs should be careful to exposition of HIV infection.

Objective To explore the prevalence,socio-demographic and clinical characteristics of deficit schizophrenia in Chinese community-dwelling patients with schizophrenia. Methods Five hundred and three community-dwelling patients with schizophrenia were recruited in a cross-sectional study in Yuhua-tai District of Nanjing,and deficit schizophrenia was confirmed by Chinese version of the Schedule for the Deficit Syndrome (SDS). Their socio-demographic and clinical characteristics were collected. All patients' psychopathology was assessed by Positive and Negative Syndrome Scale (PANSS). Results The current prevalence of community-dwelling patients with deficit schizophrenia was 0. 67‰. Deficit schizophrenia had significantly higher hospitalizations((2. 4±1. 3)times,(1. 9±0. 9)times),PANSS negative scores((28. 4± 8. 1),(17. 7±6. 3)),PANSS total score((96. 5±17. 3),(87. 3±18. 1)) than non-deficit schizophrenia(all P<0. 05),while non-deficit schizophrenia had higher currently smoking rate,positive scores,marriage per-centage and age of onset( all P<0. 05) . Further multiple logistic regression analysis indicated that male sex, age of onset,smoking and negative PANSS score were independently associated with deficit schizophrenia. Conclusion The study showed that deficit schizophrenia is very common in Chinese psychiatric outpatients. The results partially support deficit schizophrenia as an independent subtype of schizophrenia.

Despite the great improvements in the techniques and perioperative management of liver transplantation in recent years, there are still several perioperative complications that may lead to the poor prognosis of recipients. Prolonged mechanical ventilation (PMV) is a common complication in the early stage after surgery and may result in a high incidence rate of postoperative complications, prolonged length of stay in the intensive care unit and hospital stay, and an increase in mortality rate. In recent years, many studies have reported PMV after liver transplantation, but no summarization and statistical analysis have been performed and there are still no effective measures to prevent PMV after liver transplantation. This article summarizes the influencing factors and interventions for PMV after liver transplantation, in order to provide valuable information for reducing the duration of mechanical ventilation after liver transplantation and improving the prognosis of liver transplantation recipients.