ObjectiveTo compare the outcomes of 3 modes of weaning,e.g.SmartCare (a computerdriven knowledge-based system),spontaneous breathing trials (SBBT) and empirical methods,used in patients with chronic obstructive pulmonary diseases (COPD) weaned off mechanical ventilation.MethodsSixty-eight COPD patients were enrolled and randomly (random number) assigned to receive SmartCare (SC group,n =24),SBT (SBT group,n=24) or empirical methods (EM group,n =20).The following data were recorded including beginning of weaning:time consumed for weaning,duration of mechanical ventilation,length of ICU stay,success rate of weaning,survival rate during hospitalization and the complications of mechanical ventilation.The patients were considered as successfully weaned when they were able to tolerate at least 48 consecutive hours of spontaneous breathing.ResultsTime required for weaning and total time for mechanical ventilation in SC group were greatly shorter than those in EM group (P =0.002,0.002),but there were no differences between SC group and SBT group (P =0.540,0.573).Though the length of ICU stay (7.5 d) in SBT group was notably shorter than that in EM group (82.5 d) (P=0.015),there was no difference between SBT group and SC group (8.0 d).Weaning success rate was greater in the SC group (88.3％) than that in EM group (50.0％),but there was no difference between SBT group (66.7％ ) and SC group.No significant differences in survival rate during hospitalization,rate of re-intubation,self-extubation and need for noninvasive ventilation were found among three groups.ConclusionsCompared to empirical methods for weaning,SmartCare could greatly increase the success rate of weaning,but it was not superior to SBT.

Objective To evaluate the effect of continuous aspiration of subglottic secretions (CASS) on the prevention of ventilator-associated pneumonia (VAP) in mechanically ventilated patients. Methods Patients ventilated mechanically at the ICU from October, 2004 to April,2006 were randomly divided into 2 groups: one group received CASS and the other did not (NASS group). CASS was performed immediately after admission for patients in the CASS group. The diagnosis d VAP was made based on clinical presentations, and the evaluation of YAP was done using simplified version of the clinical pulmonary infection score (CPIS). The general status of the patients, days of ventilated treatment, the volume of daily aspirated aubglottic secretions, the morbidity and timing of VAP, days of stay in ICU and mortality within 28 days of hospitalization were recorded. Results One hundred and one patients were included in the study. There were 48 patients in the CASS group who were treated with mechanical ventilation more than 48 hours,and 43 patients in the NASS group. There was no significant difference in the general status of the patients and days of ventilation between 2 groups with the averaged score of APACHE Ⅱ being 20.8± 6.1. The average of CPIS was of 5.6±1.0 when VAP was diagnosed. The mean volume of aspirated subglottic secretions within the first 24 hours in the CASS group (n=48) was (27.2±21.2)ml. The morbidity of VAP in the CASS and the NASS groups was 25.0% and 46. 5% respectively (P=0.032), and the length of time before the onset of VAP in these 2 groups was (7.3±4.2) days and (5.1±3.0) days respectively (P=0.100). There was a significant increase in the percentage of gram-positive cocci from the lower respiratory tracts in the NASS group compared with that in the CASS group (P=0.004). In the CASS group, the volume of the first daily aspirated subglottic secretions in patients with VAP was significantly less than that in patients without VAP(P =0.006). The morbidity of VAP in patients with failed early aspiration (the volume of first daily aspirated secretions≤20 ml) was significantly higher than that in patients in whom the aspiration was effective (P<0.01). The length of mechanical ventilation in patients with VAP was significantly longer than that in patients without VAP(P=0.000). The in-hospital mortality in patients with VAP was significantly higher than that in patients without VAP(P=0.009), and the mortality in 28 days after admission in patients with VAP was significantly higher than that in patients without VAP(P=0.035).Conclusion Effective continuous aspiration of subglottic secretions could significantly reduce the morbidity of early-onset VAP.

Aim To investigate the regulatory effects of baicalin on apoptosis induced by virus H1 N1 in hu-man pulmonary carcinoma cell A549 . Methods The chips were used to screen the RNA samples in virus-in-fected A549 cells. Differentially expressed genes were selected in the pathway of apoptosis. The mRNA ex-pressions of caspase-3 and -8 were verified by Real-Time PCR. Results With the DNA microarray, the functions of differentially expressed genes involved in apoptosis biological pathways were analyzed by Kyoto Encyclopedia of Genes and Genomes ( KEGG ) Path-way databases. caspase-3, -7, -8, -10, TRAIL, MYD88 , IL1 A and IL1 B were up-regulated in virus-in-fected group. Oseltamivir could down-regulate gene ex-pressions of caspase-3 ,-4 and-8 . High-dose of baica-lin could down-regulate gene expressions of caspase-3 ,-4,-6 and -8. Except gene expressions of above, low-dose of baicalin could also down-regulate gene expres-sions of IL1RAP and Cn. Real-Time PCR experiments showed that baicalin could significantly decrease mR-NA expression of caspase-3 , -4 , -6 , -8 , IL1 RAP and Cn ( P < 0. 01 ) , compared with the virus-infected group. The results also figured that the interference ef-ficacy of low-dose baicalin was better than that of high-doses. As expected, real-time PCR data were in good agreement with the microarray assay. Conclusions Baicalin can be detected in their suppression effect of caspase-3,-4,-6, and -8 mRNA expression, so it re-sists against the apoptosis to fight against influenza vi-rus in vitro.

Objective To investigate the current situation of medical students' individual career management and its educational status.Methods Self-made questionnaire was used to investigate the present situation of individual career management and education of medical students in a medical college in November 2016.SPSS 20.0 was used for analyzing descriptive statistical analysis,t test and rank test in questionnaire data.From April to May 2017,30 students were randomly selected for interviews to explore the current situation of medical students' individual career management.Result 900 questionnaires were issued and 816 valid questionnaires were collected,and the recovery rate was 90.67％.Whether medical students accept the relevant education had significant difference in their career management ability (P＜ 0.05),30.15％ of the students who received the relevant education (246) had a higher total score of their own career management than those who had not received,which was reflected in social work environment cognition level,participation in extracurricular activities,consideration of graduation and stage goals setting.It is learned from the interview that most medical students lack clear self-awareness and professional goals are vague,and they fail to form a good personal career management atmosphere.Conclusion Individual career management education promotes the cognitive level of social work environment of medical students and then develops their self-awareness.At the same time,it urges medical students to participate in extracurricular activities,to consider the whereabouts after graduation,to set phased goals,and to carry out targeted self-improvement.The comprehensive development of self-cognition and self-improvement finally make the medical students' individual career management ability continuously improved.

Objective Triple-negative breast cancer(TNBC)poses a significant challenge for treatment efficacy.CD8+T cells,which are pivotal immune cells,can be effectively analyzed for differential gene expression across diverse cell populations owing to rapid advancements in sequencing technology.By leveraging these genes,our objective was to develop a prognostic model that accurately predicts the prognosis of patients with TNBC and their responsiveness to immunotherapy. Methods Sample information and clinical data of TNBC were sourced from The Cancer Genome Atlas and METABRIC databases.In the initial stage,we identified 67 differentially expressed genes associated with immune response in CD8+T cells.Subsequently,we narrowed our focus to three key genes,namely CXCL13,GBP2,and GZMB,which were used to construct a prognostic model.The accuracy of the model was assessed using the validation set data and receiver operating characteristic(ROC)curves.Furthermore,we employed various methods,including Kyoto Encyclopedia of Genes and Genomes(KEGG)pathway,immune infiltration,and correlation analyses with CD274(PD-L1)to explore the model's predictive efficacy in immunotherapeutic responses.Additionally,we investigated the potential underlying biological pathways that contribute to divergent treatment responses. Results We successfully developed a model capable of predicting the prognosis of patients with TNBC.The areas under the curve(AUC)values for the 1-,3-,and 5-year survival predictions were 0.618,0.652,and 0.826,respectively.Employing this risk model,we stratified the samples into high-and low-risk groups.Through KEGG enrichment analysis,we observed that the high-risk group predominantly exhibited enrichment in metabolism-related pathways such as drug and chlorophyll metabolism,whereas the low-risk group demonstrated significant enrichment in cytokine pathways.Furthermore,immune landscape analysis revealed noteworthy variations between(PD-L1)expression and risk scores, Conclusion Our study demonstrates the potential of CXCL13,GBP2,and GZMB as prognostic indicators of clinical outcomes and immunotherapy responses in patients with TNBC.These findings provide valuable insights and novel avenues for developing immunotherapeutic approaches targeting TNBC.

Objective To compare the trigger delay and work of trigger between neurally adjusted ventilatory assist (NAVA) and pressure support ventilation (PSV) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients with intrinsic positive end-expiratory pressure (PEEP) during mechanical ventilation. Methods AECOPD patients with intrinsic PEEP (PEEPi) greater than or equal to 3 cmH2O (1 cmH2O=0.098 kPa) were enrolled during invasive mechanical ventilation. Subjects were ventilated with low, medium and high pressure under either NAVA or PSV mode. Servo Tracker software continuously recorded the waveform of ventilator and respiratory mechanics indexes (including respiratory frequency, inspiratory tidal volume (Vti), minute ventilation volume (VE), peak airway pressure (PIP), inspiratory time), and calculated trigger and expiratory conversion delay time, work of trigger and total work of breath. Results A total of 14 AECOPD patients were enrolled with the average PEEPi (4.3±1.3) cmH2O. PSV inspiratory trigger delay time was positively correlated with PEEPi (r=0.913, P<0.05). Compared with PSV, NAVA significantly decreased trigger delay time in low, medium and high pressure level groups [(48±17) ms vs. (167±86) ms, (63±65) ms vs. (247±240) ms, (63±49) ms vs. (342±192) ms,respectively all P<0.05]. Similar results were shown as to work of trigger [(0.92±0.36) μV?s vs. (1.22±0.70) μV?s, (1.08±0.51) μV?s vs. (1.62 ± 1.25) μV?s, (1.20 ± 0.96) μV?s vs. (2.29 ± 1.02) μV?s, all P<0.05]. Trigger delay time increased according to the increase of pressure level in PSV mode.Conclusion The presence of PEEPi in AECOPD patients leads to obvious trigger delay under PSV mode, which is positively correlated with PEEPi level. NAVA significantly reduces trigger delay time and work of trigger compared with PSV mode.

Cervical cancer is the second most common female reproductive system tumor in developing countries and ranks second among female cancer deaths worldwide. In recent years, with the continuous optimization and popularization of cervical cancer screening and preventive measures, the overall incidence rate of cervical cancer has decreased. But the incidence rate of cervical cancer in China is younger and differentiated. It continues to threaten the fertility, reproduction, mental health and life safety of women in China. In view of the current difficulties, precision medicine initiative (PMI) has opened a new chapter in the individualized prevention and treatment of cancer. Chinese medical workers need to learn from the beneficial results of international research organizations on early screening and prevention of cervical cancer, and explore the appropriate early screening and prevention strategies for cervical cancer in China.

Objective:To explore the influence of patient participation-based dietary intervention on nutritional status for patients with severe burn.Methods:From September 2017 to January 2019, 60 severe burn patients hospitalized in the department of burn and plastic surgery of Qingdao Municipal Hospital were recruited and divided into the experimental group ( n=30) and the control group ( n=30) according to the random number table method. The control group received a regular diet. While the experimental group received a patient participation-based dietary intervention(PPDI), The wound healing time and the value of nutritional status index, such as height, body mass index(BMI), serum albumin, serum prealbumin, in the two groups on admission, at 2 weeks after intervention, 4 weeks after intervention were compared. The nutritional knowledge questionnaire of burn patients and "3-day diet diary" were used for investigation. Results:The score of nutritional knowledge showed no significant difference between the two groups before intervention. After intervention, the score of nutritional knowledge in the experimental group was 21.40±2.42, significantly higher than that in the control group (19.00±2.26) ( t value was 3.975, P<0.01). For time effect and between-group effect, there were significant difference in serum albumin between two groups ( F values were 9.232, 4.651, P<0.05); the time effect and between-group effect of serum prealbumin were statistically significant ( F values were 11.592, 6.228, P < 0.05). The wound healing time in the experimental group was significantly lower than that in the control group ( t value was -3.801, P<0.01). Conclusions:Patient participation-based dietary intervention can effectively enhanced the level of nutritional knowledge, improved nutritional status, shortened wound healing time among patients with severe burn.

Objective To investigate the influence of occupational aluminum exposure on cogmtive function and its relationship with tri-methyl histone H3 lysine residues 4 points (H3K4me3) and brain-derived neurotrophic factor (BDNF) levels.Methods By cluster random sampling method,a total of 235 cases of male workers selected from a Shanxi aluminum factory were recruited in the study in September 2015.Used the occupational epidemiological investigation questionnaire,which included Mini-Mental State Examination (MMSE),Clock Drawing Test (CDT),Digit Span Test (DST,including forward test DSFT and backward test DSBT),Fuild Object Memory Evaluation (FOME) and Verbal Fluency Test (VFT),to collect workers' basic information and assess their cognitive function score.Detected the concentration of aluminum in plasma by graphite furnace atomic absorption spectrometry.Workers were divided into three groups by the 25 percentile and 75 percentile of the aluminum content,such as low,middle and high aluminum concentration groups.The concentrations of H3K4me3 in lymphocyte and BDNF in plasma were determined by enzyme-linked immunosorbent assay.Results The levels of aluminum in plasma was 134.36 (100.14,178.96) μg/L.The scores of MMSE,DSFT,DSBT,DST of high aluminum concentration group were lower than low aluminum group (27.98±1.25 vs 28.83±1.54,9.19±2.00 vs 10.64±2.87,6.08±1.63 vs 7.19±3.07,15.27±3.11 vs 17.81±4.72,all P＜0.05),the scores of CDT,FOME,VFT among three groups had no statistical significance (all P＞0.05).The expression levels of H3K4me3 and BDNF of high aluminum concentration group were lower than the low group [(18.45±9.81) ng/μg Pro vs (23.76±9.89) ng/μg Pro,(26.07±10.18) ng/ml vs (31.66±9.24) ng/ml,all P＜0.05].Multiple correlation analysis showed that aluminum concentration were negatively correlated to H3K4me3,BDNF,MMSE,DSFT,DST,respectively (rs =-0.307、-0.214、-0.252、-0.197,-0.181,all P＜0.01).Conclusion Exposure to occupational aluminum for a long time may change cognitive function,which go along with the decreasing of H3K4me3 level in lymphocyte and BDNF protein expression in plasma.

Objective To investigate the influence of occupational aluminum exposure on cogmtive function and its relationship with tri-methyl histone H3 lysine residues 4 points (H3K4me3) and brain-derived neurotrophic factor (BDNF) levels.Methods By cluster random sampling method,a total of 235 cases of male workers selected from a Shanxi aluminum factory were recruited in the study in September 2015.Used the occupational epidemiological investigation questionnaire,which included Mini-Mental State Examination (MMSE),Clock Drawing Test (CDT),Digit Span Test (DST,including forward test DSFT and backward test DSBT),Fuild Object Memory Evaluation (FOME) and Verbal Fluency Test (VFT),to collect workers' basic information and assess their cognitive function score.Detected the concentration of aluminum in plasma by graphite furnace atomic absorption spectrometry.Workers were divided into three groups by the 25 percentile and 75 percentile of the aluminum content,such as low,middle and high aluminum concentration groups.The concentrations of H3K4me3 in lymphocyte and BDNF in plasma were determined by enzyme-linked immunosorbent assay.Results The levels of aluminum in plasma was 134.36 (100.14,178.96) μg/L.The scores of MMSE,DSFT,DSBT,DST of high aluminum concentration group were lower than low aluminum group (27.98±1.25 vs 28.83±1.54,9.19±2.00 vs 10.64±2.87,6.08±1.63 vs 7.19±3.07,15.27±3.11 vs 17.81±4.72,all P＜0.05),the scores of CDT,FOME,VFT among three groups had no statistical significance (all P＞0.05).The expression levels of H3K4me3 and BDNF of high aluminum concentration group were lower than the low group [(18.45±9.81) ng/μg Pro vs (23.76±9.89) ng/μg Pro,(26.07±10.18) ng/ml vs (31.66±9.24) ng/ml,all P＜0.05].Multiple correlation analysis showed that aluminum concentration were negatively correlated to H3K4me3,BDNF,MMSE,DSFT,DST,respectively (rs =-0.307、-0.214、-0.252、-0.197,-0.181,all P＜0.01).Conclusion Exposure to occupational aluminum for a long time may change cognitive function,which go along with the decreasing of H3K4me3 level in lymphocyte and BDNF protein expression in plasma.