Patients who are diagnosed with acute lung injury/acute respiratory distress syndrome (ALI/ARDS) usually have ventilation-perfusion mismatch, severe decrease in lung capacity, and gas exchange abnormalities. Health care workers have implemented various strategies in an attempt to compensate for these pathological alterations. By rotating patients with ALI/ARDS between the supine and prone position, it is possible to achieve a significant improvement in PaO2/FiO2, decrease shunting and therefore improve oxygenation without use of expensive, invasive and experimental procedures. Prone positioning is a safe and effective way to improve ventilation when conventional strategies fail to initiate a patient response. Because a specific cure for ARDS is not available, the goal is to support the patients with therapies that cause the least amount of injury while the lungs have an opportunity to heal. Based on current data, a trial of prone positioning ventilation should be offered to the patients who have ALI/ARDS in the early course of the disease. Published studies exhibit substantial heterogeneity in clinical results, suggesting that an adequately sized study optimizing the duration of proning ventilation strategy is warranted to enable definitive conclusions to be drawn.
Acute Lung Injury ; physiopathology ; therapy ; Hemodynamics ; Humans ; Practice Guidelines as Topic ; Prone Position ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; physiopathology ; therapy ; Time Factors

Objective To understand the characteristics of competition attitude of nurses at different age groups and to improve the overall competitiveness of the nursing staff.Methods Competitive attitude scale and self-demographic data questionnaire were used to cross-sectional survey 232 in-service female nurses in our hospital born in 70's,80's and 90's and evaluate and analyze the healthy competition and over-competition scores.Results Significant difference of healthy competition was found ( F =4.90,P ＜0.01) among three age groups ( 70's,80's and 90's).Single factors such as education or working experiences didn't show difference of effects on competition attitude( P＞0.05 ).For healthy competition,scores under single factor analysis for 70's,80's and 90's groups were (43.90 ± 8.57 ),( 46.76 ± 6.85 ) and (46.87 ± 8.09 ).The analysis showed significant difference among three groups ( F =3.174,P ＜ 0.05 ) and between 70' s group and 80's or 90's groups (P＜0.05 ).However,no significant difference was found between 80's and 90's groups ( P＞0.05).For the over - competition,scores for 70's,80's and 90's groups were (31.92 ± 6.07 ),( 36.01±5.34) and (36.22 ±6.02) respectively.Similar to healthy competition,significant difference existed between 70's group and 80's or 90's group ( P ＜ 0.01),but didn't exist between 80's and 90's groups ( P＞0.05 ).Conclusions Managers should correctly evaluate the competitive attitude of nursing staff to avoid the excessive competition while giving full play to the characteristics of the healthy competition,adopt different management measures in accordance with characteristics of different age groups,and help improve the overall competitiveness of the nursing staff.

Objective To compare the efficacy of ultrasound-guided fine-needle aspiration(US-FNA)biopsy in diagnosing solid and complex thyroid nodules with different size. Methods One hundred and seventy-five thyroid FNA biopsies were prospectively performed on 168 patients ranging from 4 to 75 years of age. Sixty-three nodules were surgically excised and the others were clinically followed-up. The cytology diagnoses were categorized into four groups: benign, malignant, suspicious and unsatisfactory. Results There was no significant complication in the all 115 solid and 60 complex thyroid lesions and there were 36and 3 malignant nodules respectively in solid and complex thyroid nodules. The nondiagnostic rates of solid and complex nodules were 7％ and 8％. The accuracy of US-FNA in diagnosing complex thyroid nodules was comparatively equal to that of in solid thyroid nodules. In solid thyroid nodules, the sensitivity and accuracy in ≤1 cm group were similar to that of in ＞1 cm group. Conclusions US-FNA was an accurate and reliable method to diagnose thyroid solid and complex lesions.

OBJECTIVEA perspective study was conducted to describe the epidemiologic profile of nosocomial infection in the neonatal intensive care unit (NICU).

METHODSThe newborn infants who were admitted in the NICU for more than 48 hrs were enrolled from February 2006 to January 2007. The clinical data were collected. The rate of nosocomial infection was calculated according to the CDC surveillance system. The risk factors of nosocomial infection were investigated by multivariate regression analysis.

RESULTSA total of 1 159 neonates were recruited. A total of 169 nosocomial infections occurred, with a cumulative rate for nosocomial infection of 14.58%. The incidence of nosocomial infection was 19.52 per 1 000 patient-days. Ninety-two cases of pneumonia, including 38 cases of ventilator-associated pneumonia (VAP), were reported, with a nosocomial infection rate of 7.94%, which was the most common nosocomial infection in the NICU. Among these infants the rate of VAP was 48.8 per 1 000 ventilator days. The major microorganisms isolated from the infected patients were Acinetobacter baumannii, Klebsiella pneumoniae, Coagulase negative staphylococcus, and aeruginosus Bacillus. Birth weight (OR 2.130, 95%CI 1.466-3.094), mechanical ventilation (OR 7.038, 95%CI 3.901-12.698), chest tube drainage (OR 7.004, 95%CI 1.841-26.653) and ibuprofen therapy (OR 2.907, 95% CI 1.303-6.487) were the risk factors for the development of nosocomial infection.

CONCLUSIONSPulmonary infection is the most common nosocomial infection in the NICU, and the Gram-negative bacillus is the main pathogen. Low birth weight, mechanical ventilation, chest tube drainage and ibuprofen therapy are independent risk factors for nosocomial infection in the NICU.

Birth Weight ; Chest Tubes ; adverse effects ; Cross Infection ; epidemiology ; etiology ; Female ; Humans ; Ibuprofen ; adverse effects ; Incidence ; Infant, Newborn ; Intensive Care Units, Neonatal ; Male ; Respiration, Artificial ; adverse effects ; Risk Factors

Animals ; Bone and Bones ; cytology ; metabolism ; pathology ; Collagen ; metabolism ; Durapatite ; metabolism ; Female ; Osteoporosis ; metabolism ; pathology ; Ovariectomy ; adverse effects ; Rats ; Rats, Sprague-Dawley

OBJECTIVETo analyze the relationship between high-performance liquid chromatography (HPLC) fingerprints of the chloroform extract fractions of Peucedanum harrysmithii var. subglabrum (PHS) and its phlegm-reducing effect, in order to establish "active component group for reducing phlegm".

METHODHPLC was adopted to determine and analyze HPLC fingerprints of chloroform extract fractions of PHS. Phenol red expectorant experiment was used to observe the phlegm-reducing effect in mice. Mice were administered intragastrically with chloroform extract fractions for 6 days (1.4 g x kg(-1)), with acute bronchitis syrup as the positive control drug (12 mL x kg(-1)). The phenol red secretion in mice was determined by spectrophotometer. Then the grey relational analysis was used to study the spectrum-effect relationship.

RESULTThe phlegm-reducing effect of the chloroform extract fractions of PHS were resulted from the combined effect of all of its chemical components. Its various characteristic peaks represented different chemical components, and the order of their contributions to the phlegm-reducing effect was (number of peaks) 13 > 12 > 16 > 18 > 19 > 6 > 20 > 14 > 1 > 11 > 15 > 10 > 17 > 2 > 5 > 4 > 7 > 3 > 8 > 9, in No. 1, 3, 4, 10, 13 and 16 characteristic peaks were identified as marmesin, psoralen, xanthotoxin, Pd-Ib, pteryxin and peuformosin.

CONCLUSIONThe chloroform extract fractions of PHS show strongly phlegm-reducing effect. There may be certain relationship between their HPLC fingerprint and phlegm-reducing effect.

Chromatography, High Pressure Liquid ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; Ferns ; chemistry ; Mucus ; drug effects

Objective To understand the characteristics of physiological craving to alcohol related cues of the alcohol abstinents and explore the corresponding nursing strategy. Methods 20 alcohol abstinents were confirmed with ICD-10 diagnosis of alcohol dependence (test group) and 20 normal subjects were selected to match the cases with gender, age and years of schooling (control group). All the subjects were exposed to alcohol-related environmental cues. The multi-channel biofeedback recordings were taken to record the physiological indicators before and after exposure. Alcohol Urge Questionnaire Scale (AUQ) was adopted to assess the extent of craving before and after exposure and analysis craving change characteristics of physical indicators. Results The test group in the alcohol-related environmental cues increased craving after induction (P <0. 01), and systolic and diastolic blood pressure, heart rate and skin power were also increased (P < 0.01), however, skin temperature was lower (P < 0. 05), compared with normal subjects. Conclusions Exposing to alcohol-related cues could increase abstinent alcohol dependents' craving and induce the change of physiological indicators. It was useful to construct corresponding nursing strategy according to characteristics of psychological craving and physiological indicators.

Objective To explore the clinical effect of Bayesian discriminant analysis in predicting the risk of macrosomia. Methods 169 fetal macrosomia and 169 non-macrosomia were enrolled in a 1:1 matched case-control study. Conditional Logistic regression was used to select the discriminant indexes,and the discriminant indexes were put into the Bayesian discriminant model to obtain the Bayesian discriminant function. The discriminant function was the retrospectively examined and externally tested. Results The results of conditional Logistic regression model indicated that mother's height, early pregnancy body mass index (BMI), gestational diabetes, gestational weeks, the height of uterine and abdominal circumference were associated with the birth of fetal macrosomia. The Bayesian discriminant function were established: Fetal macrosomia:y1=-27.802+8.420×Mother＇s height+8.719×early pregnancy BMI+10.485×gestational weeks+3.375×gestational diabetes+2.862×height of uterine and abdominal circumference; Non-macrosomia y2=-17.477+7.161×Mother＇s height+7.217×early pregnancy BMI+7.862×gestational weeks+2.036×gestational diabetes-0.085×height of uterine and abdominal circumference. Wilks′ Lambda λ=0.489, P<0.001, the Bayesian discriminant function was statistically significant. The internal and external conformity rates of the Bayesian discriminant model were all more than 80%. Conclutions The birth of fetal macrosomia is related to many factors. The Bayesian discriminant model in the present study is valuable to discriminate macrosomia and provide an objective reference for more accurate identification of macrosomia in the future.

BACKGROUNDChimerism analysis is an important tool for the surveillance of post-transplant engraftment. It offers the possibility of identifying impending graft rejection and recurrence of underlying malignant or non-malignant disease. Here we investigated the quantitative chimerism kinetics of 21 relapsed leukemia patients after allogeneic hematopoietic stem cell transplantation (HSCT).

METHODSA panel of 29 selected sequence polymorphism (SP) markers was screened by real-time polymerase chain reaction (RT-PCR) to obtain the informative marker for every leukemia patient. Quantitative chimerism analysis of bone marrow (BM) samples of 21 relapsed patients and 20 patients in stable remission was performed longitudinally. The chimerisms of BM and peripheral blood (PB) samples of 14 patients at relapse were compared.

RESULTSTwenty-one patients experienced leukemia relapse at a median of 135 days (range, 30 - 720 days) after transplantation. High recipient chimerism in BM was found in all patients at relapse, and increased recipient chimerism in BM samples was observed in 90% (19/21) of patients before relapse. With 0.5% recipient DNA as the cut-off, median time between the detection of increased recipient chimerism and relapse was 45 days (range, 0 - 120 days), with 76% of patients showing increased recipient chimerism at least 1 month prior to relapse. Median percentage of recipient DNA in 20 stable remission patients was 0.28%, 0.04%, 0.05%, 0.05%, 0.08%, and 0.05% at 1, 2, 3, 6, 9, and 12 months, respectively, after transplantation. This was concordant with other specific fusion transcripts and fluorescent in situ hybridization examination. The recipient chimerisms in BM were significantly higher than those in PB at relapse (P = 0.001).

CONCLUSIONSThis SP-based RT-PCR assay is a reliable method for chimerism analysis. Chimerism kinetics in BM can be used as a marker of impending leukemia relapse, especially when no other specific marker is available. Based on our findings, we recommend examining not only PB samples but also BM samples in HSCT patients.

Adolescent ; Adult ; Child ; Female ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Leukemia ; genetics ; therapy ; Male ; Middle Aged ; Reverse Transcriptase Polymerase Chain Reaction ; Transplantation Chimera ; genetics ; Transplantation, Homologous ; adverse effects ; Young Adult

BACKGROUNDAnalysis of changes in recipient and donor hematopoietic cell origin is extremely useful to monitor the effect of hematopoietic stem cell transplantation (HSCT) and sequential adoptive immunotherapy by donor lymphocyte infusions. We developed a sensitive, reliable and rapid real-time PCR method based on sequence polymorphism systems to quantitatively assess the hematopoietic chimerism after HSCT.

METHODSA panel of 29 selected sequence polymorphism (SP) markers was screened by real-time PCR in 101 HSCT patients with leukemia and other hematological diseases. The chimerism kinetics of bone marrow samples of 8 HSCT patients in remission and relapse situations were followed longitudinally.

RESULTSRecipient genotype discrimination was possible in 97.0% (98 of 101) with a mean number of 2.5 (1-7) informative markers per recipient/donor pair. Using serial dilutions of plasmids containing specific SP markers, the linear correlation (r) of 0.99, the slope between -3.2 and -3.7 and the sensitivity of 0.1% were proved reproducible. By this method, it was possible to very accurately detect autologous signals in the range from 0.1% to 30%. The accuracy of the method in the very important range of autologous signals below 5% was extraordinarily high (standard deviation <1.85%), which might significantly improve detection accuracy of changes in autologous signals early in the post-transplantation course of follow-up. The main advantage of the real-time PCR method over short tandem repeat PCR chimerism assays is the absence of PCR competition and plateau biases, with demonstrated greater sensitivity and linearity. Finally, we prospectively analyzed bone marrow samples of 8 patients who received allografts and presented the chimerism kinetics of remission and relapse situations that illustrated the sensitivity level and the promising clinical application of this method.

CONCLUSIONThis SP-based real-time PCR assay provides a rapid, sensitive, and accurate quantitative assessment of mixed chimerism that can be useful in predicting graft rejection and early relapse.

Adolescent ; Adult ; Child ; Female ; Genotype ; Hematopoietic Stem Cell Transplantation ; Humans ; Male ; Middle Aged ; Polymorphism, Single Nucleotide ; genetics ; Real-Time Polymerase Chain Reaction ; methods ; Reproducibility of Results ; Transplantation Chimera ; genetics ; Young Adult