Objective To explore the correlation between the levels of nitrite/nitrate(NO2/NO3) in exhaled breath condensate (EBC) and pulmonary infection in mechanically ventilated patients.Methods The clinical data from ventilated patients in critical care units of Peking University People' s Hospital from November 2006 to August 2007 were collected and analyzed.The patients' clinical pulmonary index score (CPIS) were calculated.EBC of those patients were collected via endotracheal tube or tracheostomy cannula, and the concentrations of NO2/NO3 were assayed.The level of NO2/NO3 in different CPIS patients in 24 hours' ventilation,weaning proportion in 3 days and mortality in different NO2/NO3 level patients were compared.The correlation of the CPIS and level of NO2/NO3 were explored between survival and non-survival patients.Results A total of 76 patients were enroled.The NO2/NO3 levels in patients of CPIS≤3 ,CPIS 3-6 and CPIS >6 in 24 hours of ventilation were (23.31±5.79), (28.72±9.10) and (35.42±12.10) μmoL/L respectively, with significantly differences between each other (P < 0.01).The lower the patients' concentration of NO2/NO3 was, the earlier the weaning and the lower the mortality were.The NO2/NO3 levels on 4th and 7th day were detected in 24 survival patients and 23 non-survival patients.The difference of NO2/ NO3 levels between the survival patients and non-survival patients became significant on 7th day [(29.32±9.52) μmol/L vs.(37.22±12.03) μmol/L, P < 0.01].Linear correlation analysis showed that the NO2/ NO3 level was positively correlated with CPIS (r = 0.76, P < 0.01).Condusions The NO2/NO3 level of EBC in ventilated patients is positively correlated to the severity of pulmonary infection, thus may be used as a new predictor for weaning and prognosis.

The pathogenesis of cancer-related sarcopenia is complicated,involving all aspects of tumor and the body's metabolism,mainly related to accelerated proteolysis and insufficient protein synthesis.Cancerrelated sarcopenia can predict antineoplastic-induced dose-limiting toxicities,increase complications,and reduce survival rate.The interventions of cancer-related sarcopenia includes nutrition,exercise,hormone therapy and other interventions.A single treatment can not reverse clinical outcome.Various interventions are still in the investigation stage,in which more evidence-based studies are needed.

Objective To observe the efficacy of invasive ventilation (Ⅳ) in treatment of acute pulmonary edema (APE), and to explore the factors associated with prognosis. Method From March 2005 to December 2007, 23 APE patients, who were hospitalized in the EICU of People' s Hospital of Peking University and the con-ventional treatment and noninvasive ventilation were not effective, were treated by Ⅳ (PEEP 5～18 cmH2O). Blood pressure, heart rate, respiratory rate, and arterial blood gas values were recorded accurately before and after ventilation and compared with each other. Regression analysis was used to analyze the factors associated with prog-nosis. Resets Three hours after Ⅳ, the blood pressure, heart rate, respiratory rate, arterial blood gas were sig-nificanfly improved (P <0.01). Among the 23 patients, 11 survived, and the other 12 patients died. Nine pa-tients died of MOF. Among 16 patients with cardiac function Ⅲ-Ⅳ, 10 died. Among 15 patients with acute my-ocardial infarction, 9 died. Among 11 patients with renal insufficiency, 9 died. The multivariate logistic regression analysis showed that the reduced left ventricular ejection fraction, the lower mean arterial pressure, and the in-creased creatinine were the independent predictor of prognosis. Conclusions Invasive ventilation is an effective method of treating patients with acute pulmonary edema. Proper ventilation may improve the cardiac function and clinical symptoms, but it's not the fundamental measure for increasing cure rate. 1he renal insufficiency and heart failure are the independent predictor of prognosis.

Objective To explore the clinical value of high-frequency color Doppler ultrasound in the diagnosis of isolated calf muscle vein thrombosis (ICMVT). Methods Sonographic features of 175 patients with isolated calf muscular venous thrombosis were analyzed retrospectively and outcome of anticoagulant therapy in 1, 3, and 6 months was followed up. Diagnosis was established with high-frequency color Doppler ultrasound examination. Results One hundred and seventy-ifve patients presenting with 190 calf muscle vein thrombosis were included. One hundred and iffty-eight cases with 173 calf muscle vein thrombosis were diagnosed by high-frequency color Doppler ultrasound, 7 cases of misdiagnosis, missed diagnosis in 10 cases. The accuracy rate was 91.1%(173/190). Seven cases were misdiagnosed with 1 euroifbromatosis, 1 mixed hemangioma, 5 gastrocnemius hematoma. After diagnosis of ICMVT, all patients prescribed thrombolysis and anticoagulation therapy. High-frequency color Doppler ultrasound for 1, 3, 6 months after treatments revealed partial or complete recanalization without calf deep vein thrombosis. Typical sonographic features included:calf muscle venous lumen dilation, tortuous anechoic lumen or hypoechoic iflling, with tubular or branched shape in the longitudinal view and oval or round shape in the transversal view. Conclusion High-frequency color Doppler ultrasound is an accurate and reliable method in the diagnosis of the isolated calf muscular venous thrombosis.

Objective To study the ventricular-arterial coupling in the patients with type 2 diabetes mellitus (DM) by ultrasound.Methods Eighty patients with DM were divided into 2 groups:normal left ventricular ejection fraction (EF) group (DMN,EF≥50 ％,n =40) and abnormal EF group (DMA,EF＜50％,n =40).At the same time,42 healthy volunteers were selected as a control group.The left ventricular (LV) relative wall thickness (RWT),mass index (LVMI),stroke volume (SV),stroke works (SW),ratepressure product (RPP),systemic vascular resistance index (SVRI),LV end-systolic elastance (Ees),arterial elastance index (Ea) and ventricular vascular index (VVI) were measured and calculated.Longitudinal strain (LS) of myocardial segment including base(LSBA),papillary muscle (LSPM) and apex (LSAP) were analyzed by two-dimensional speckle tracking imaging.Results (1) Compared with the control,the RWT and LVMI were all increased (P ＜0.01),but the LSBA,LSPM and LSAP were decreased (P ＜ 0.01) in the DMN and DMA groups (P ＜0.01).In DMA group,the RWT,LSBA,LSPM and LSAP were decreased (P ＜0.01).Compared with the DMN group,the LSBA,LSPM and LSAP were decreased in DMN group (P ＜0.01).(2) Compared with the control,the Ea,VVI,RPP and SVRI were increased,but the Ees was decreased (P ＜0.05)in DMA group (P ＜0.01).In the DMN,RPP was increased compared with the control group (P ＜0.01).Compared with the DMN group,the Ea,VVI,RPP and SVRI were increased,but Ees was decreased in the DMA (P ＜0.05).(3)The LSBA,LSPM and LSAP were all positively correlated with VVI(P ＜0.01).Multiple regression analysis showed that the LSAP,RWT,LVMI and SW were independent predictor of VVI (b' =-0.613,-0.290,0.290 and-0.205,P ＜ 0.05).Conclusions The ventricular-arterial coupling is normal in the DMN group,but is abnormal in DNA group.LSAP is independent predictors for ventricular-arterial coupling.

Objective To explore effect of application of quality control circle (QCC)on improving the correct rate of hand hygiene (HH)among health care workers (HCWs)in intensive care unit(ICU).Methods QCC activity group was set up,the activity theme was established,correct rate of HH among HCWs in March 2014 (pre-inter-vention group)was monitored,the causes of incorrect HH behavior were analyzed,goals were set;from May 2014, QCC activities were initiated,correct rate of HH between before performing QCC activities and September 2014 (post-intervention group)was compared.Results 834 and 900 times of HH among HCWs were investigated before and after performing QCC activities,the number of correct HH before and after QCC activities were 360 and 714 re-spectively,correct rate of HH after implementing QCC was higher than before QCC activities (79.33% vs 43.17%,χ2 =240.19,P <0.05).The correct rate of HH among HCWs of this ICU and HCWs engaging in ad-vanced studies in this ICU after implementing QCC activities were both higher than before QCC activities (χ2 =264.44,6.36,respectively,both P <0.05).The main incorrect HH before and after QCC was non-implementation of HH indication.Conclusion Application of QCC activities for the management of HH among HCWs can effec-tively improve the correct rate of HH among HCWs in ICU.

Objective:To investigate the expression of TLR4 mRNA?TLR2 mRNA in the peripheral blood mononuclear cells (PBMC) from the patients with Gram positive and Gram negative infections.Methods:TLR4 and TLR2 mRNA were detected in the patients with Gram negative infections ( n =20) and the patients with Gram positive infections ( n =15) and the normal persons as control ( n =24) with the method of Taqman Real-time PCR.Results:TLR4 mRNA expression in the patients with Gram negative infections were significantly higher than Gram positive infections patients and the normals ( P 0.05).Conclusion:The results showed that the increased expression levels of TLR4 mRNA in PBMC from the Gram negative infectious patients are associated with Gram negative infections and the detection of TLR4 mRNA expression may be a method of diagnosis for Gram negative infections in the early stage.

Objectives To analyze the deployment of medical equipment and its impacts on medical services of hospitals.Methods Existing data collection,a survey of public hospitals and a chart review of acute myocardial infarction(AMI)inpatients were used to collect related data.Gini coefficients,Chi-square and multivariate model were used to analyze deployment of medical equipment and its impacts on medical services.Results The number of CTs and that of CTs per million population in Pudong new area were higher than those of MRIs and DSAs,and the distribution of CTs among districts in Shanghai was relatively equal(Gini coefficient was 0.20).But lack of DSAs in some public general hospitals had affected the AMI inpatient care.Conclusions Public hospitals and governments in China should keep at a balance the demand of medical services,deployment level of medical equipment,and financial affordability for the society,governments and hospitals.

A discussion of the connotation and key issues of the new normal in the healthcare sector,with an introduction to the new normal.The furthering reform is unveiling roadblocks in the healthcare system.For example,human resources available can hardly support development of the sector, and revenue growth of tertiary hospitals in the cities will decline,while county hospitals will be further challenged by debt crisis.In the meantime of steady elevation of medical capabilities in both urban and rural areas,the gap between the two will be maintained for a while.The authors predict that the sector will be faced with restructuring essential medicine system,grading diagnosis and treatment practice,rising risks for health insurance,and growing market shares of commercial health insurance and private capital, as well as fiercer competitions to challenge public hospitals.

Cationic lipid nanoparticles possessing favorable biocompatibility and controllable particle size has at-tracted increasing attention in the field of non-viral vectors for delivering nucleic acids in vitro and in vivo.1,2-Dilinoleyloxy-3-dimethylaminopropane(DLinDMA)and its derivatives,one of the most important cationic lipid materials,have been widely studied as the mainly composition of cationic lipid nanoparticels.This paper summa-rized the structure,characteristics and clinical application of DLinDMA nanoparticles.