Objective To investigate the effects of goal-oriented scheme for continuous mild sedation on patients with mechanical ventilation.Methods A total of 78 patients undergoing mechanical ventilation were enrolled via simple random number sampling method from January,2013 to December,2015,and divided into the experimental group(n=38)and the control group(n=40).The experimental group received goal-oriented scheme for continuous mild sedation designed by our department,and the control group received routine sedation protocol.Total sedative dosage,duration of mechanical ventilation,length of ICU stay,fatality rate in ICU,ventilator-associated pneumonia,pneumothorax,accidental extubation,tracheotomy were recorded.Results Duration of mechanical ventilation,length of ICU stay and total sedative dosage,incidence of ventilator-associated pneumonia and rate of tracheotomy in the experimental group were significantly lower than those in the control group and the differences were statistically significant(P＜0.05).There were no significant differences in accidental extubation,reintubation and barotrauma between two groups (P＞0.05).Conclusion Goal-oriented scheme for continuous mild sedation can reduce total sedative dosage,length of ICU stay,duration of mechanical ventilation,rates of ventilator-associated pneumonia and tracheotomy.It is safer and more effective which can improve the prognosis of mechanically ventilated patients.

To express feruloyl esterase A from Aspergillus oryzae in Pichia pastoris expression system and study its hydrolysis function, explore the conditions and effects of purification for ferulic acid extracts by macroporos resin. Using the total RNA from A. oryzae CICC 40186 as the template, we amplified coding sequence AorfaeA encoding a mature feruloyl esterase A (AorFaeA) by RT-PCR technique. Then, the coding sequence AorfaeA was successfully expressed in Pichia pastoris GS115 mediated by an expression plasmid pPIC9K. The purified recombinant AorFaeA (reAorFaeA) showed one single band on SDS-PAGE with an apparent molecular weight of 39.0 kDa. The maximum activity of reAorFaeA to methyl ferulate, measured by high-performance liquid chromatography (HPLC), was 58.35 U/mg. Then, reAorFaeA was used to release ferulic acid from de-starched wheat bran in the presence of xylanase. The purification tests for ferulic acid from the enzymatic hydrolysate were carried out with preselected macroporous resins. The results showed that macroporous resin HPD-300 had much higher adsorption and desorption capacities. Ferulic acid could be quantitatively recovered by 50% of the eluent concentration at a flow speed of 1 mL/min. Under the purification condition, the recovery ratio of ferulic acid was 92%, and the content of ferulic acid was increased from 0.13% in the raw material to 10.55%. This work exploits the breakdown of ferulic acid by recombinant enzymeand provids a good strategy to its "green production".
Aspergillus oryzae ; enzymology ; Carboxylic Ester Hydrolases ; biosynthesis ; genetics ; Cloning, Molecular ; Coumaric Acids ; chemistry ; Electrophoresis, Polyacrylamide Gel ; Hydrolysis ; Molecular Weight ; Pichia ; genetics ; metabolism

Objective To explore the short-term clinical outcomes of ankle arthrodesis for the treatment of posttraumatic ankle arthritis.Methods Retrospectively study the data of 47 patients with posttraumatic ankle arthritis who were followed up after receiving ankle arthrodesis from January 2008 to May 2012.There were 28 males and 19 females,with an average age of 44 years (range,14-72 years).All of them wereclassified into stage-3 arthritis according to Morrey-Wiedeman,among whom 31 had obvious foot varus deformity or equines deformity,and 16 were almost normal in appearance.The ankle joint function of patients were assessed by Kofoed,American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score,Maryland foot score systems and visual analog scale (VAS) preoperatively and at the last follow-up.Results The patients were followed up from 5 to 52 months (average,25 months).All the ankles got fused at the last follow-up,with one receiving removal of internal fixation and debride because of infection.Forty-three patients were satisfied with or without reservations; the others thought it so.The satisfaction rate was 91.5％(43/47).The Kofoed,AOFAS,Maryland foot scores and VAS were significantly improved from 48.11 ±5.00,53.38±5.52,49.74±5.71,7.89±0.87 to 80.96±6.07,82.21±4.26,88.94±5.14,2.28±1.10 respectively at the last follow-up.The normotopia X-ray of ankle joint showed that there were 22 cases in which the ankle got fused at neutral position,19 cases in which the eversion was less than 5°,3 cases in which the eversion was between 5° to 10°,2 cases in which the varus was less than 5°,and 1 case in which the varus was between 5° to 10°.Lateral X-ray showed that there were 32 cases in which the ankle got fused in dorsiflexion neutral position,12 cases plantar flexion 5°,and 3 cases plantar flexion 5° to 10°.Conclusion Ankle arthrodesis is still the preferable surgical treatnent option in patients with end-stage ankle arthritis,which shows high reliability and effectively in correcting deformity,pain relieving and function improvement.

Objective To investigate the expression of serum B factor in the peripheral blood of patients with systemic lupus erythematosus (SLE),and explore its role in the pathogenesis.Methods Seventy eight patients with SLE in our hospital and 46 healthy persons were eligible to participate in this study.Rate nphelometyr was used to test serum B factor for 78 patients with SLE and 46 healthy controls.According to systemic lupus erythematosus disease activity index (SLEDAI),participants were divided into steady SLE group (SLEDAI ＜ 5) and active SLE group (SLEDAI ≥5),which was further divided into mild,moderate,and serious subgroups.The differences in serum B factor between SLE patients and healthy controls,including SLE patients with different severity,were all compared.Then we analyzed the differences in serum B factor and other laboratory and clinical indexes between active and steady SLE patients.The correction of serum B factor and other laboratory and clinical indexes were also analyzed.Results Compared to healthy controls,patients with SLE had significantly lower value of serum B factor [(27.13 ± 8.98) mg/dl vs (36.73 ± 5.47) mg/dl,t =7.4,P ＜ 0.01].Compared to steady SLE group,SLE active group had significantly lower level of serum factor B,C3 and C4,and also had significant higher level of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) (all P ＜ 0.05).Moreover,There were significant differences in the lower level of serum B factor between subgroups.Correlation analysis showed that the level of serum B factor was negatively associated with the levels of CRP and SLEDAI scores,whereas serum B factor was positively associated with the levels of C3 and C4 (all P ＜ 0.05).Conclusions Serum B factor is related to SLE.Serum B factor might be involved in the pathogenesis of SLE.Detection of serum B factor is helpful for diagnosis and evaluation of SLE disease activity.

Objective To evaluate the associations of human leukocyte antigen(HLA)-DQ gene with autoimmune polyglandular syndrome(APS),type 1 diabetic mellitus(T1DM) and autoimmune thyroid disease(AITD).Methods Fifteen cases of APS,29 cases of T1DM and 40 cases of AITD were selected as research subjects,while 27 healthy children were selected as controls.The DQA1 and DQB1 alleles were determined by polymerase chain reaction(PCR) and sequence-based typing method.The difference of their frequency in children and adolescents was analyzed.Results Compared with controls,APS and T1DM patients had increased frequency of subjects with DQA1*0301,0501(all P

Objective To discuss early and standard treatment of open calcaneal fractures so as to lower incidence of amputation and osteomyelitis. Methods From October 2005 to October 2006,16 cases of 17 open calcaneal fractures were treated in our department.There were 12 males(13 fractures)and 4 females at a mean age of 31 years.All cases were treated with the sanle early treatment protocol,including emergent debridement,and lavaging with normal saline,H2O2 and iodide solutions.All cases were immobilized with plaster or multiple K-wires according to systemic condition and fracture type.With detumescence of the soft tissues.open reduction and internal fixation was done via lateral incision.The patients were followed up for mean six months and the incidence rate of complications evaluated bv American Orthopaedic Foot and Ankle Society(AOFAS)scale. Resuits No amputation was found.but there was one case with osteomyelitis.one with superficial infection and one with deep infection.Delayed skin union was found in one case and plantar skin necrosis in one. Conclusion Early and standard treatment of open calcaneal fractures can minimize the infection,prevent osteomyelitis and provide sound soft tissue for secondary surgical management.

Objective:To explore the effect of fortified human milk feeding on growth and complica-tions of infants with extremely and very low birth weight (ELBW/VLBW)during hospital stay by a pro-spective,random and controlled study.Methods:In the study,1 22 ELBW/VLBW infants were enrolled and divided into two groups.The infants fed with human breast milk,combined with human milk fortifi-cation (HMF)during hospital stay were named HMF group (n=62),and those fed exclusively with pre-mature formula were named premature formula feeding group (PF group,n=60 ).The data of the in-fants’growth (the velocity of increase on the weight,length,head circumference and upper arm circum-ference),the time of rebounding to birth weight,the time of needing intravenous nutrition,the time of hospitalizing,the proportion of extrauterine growth retardation (EUGR)during hospital stay,the level of hemoglobin,bone metabolism and incidence of complications were compared between the two groups. Results:Among the 1 22 infants included,(1 )the length increment in HMF group was higher than PF group [(0.89 ±0.23)cm/week vs.(0.79 ±0.34)cm/week,P=0.04];there were no significant differences in the weight gain,head circumference increment and upper arm circumference increment (P>0.05);(2)the age of rebounding to birth weight [(1 0.1 3 ±4.03)d vs.(8.03 ±3.28)d,P=0.002]and the duration of intravenous nutrition [(1 6.77 ±6.63)d vs.(1 4.23 ±4.1 5)d,P=0.01 ] in HMF group were longer than that in PF group,there were no significant differences between the two groups in the hospital stay and age achieved feeding;(3 )there were no significant differences between the two groups in the incidence rate of EUGR during hospital stay (P>0.05);(4)the level of calcium at birth in HMF group was lower than that in PF group [(2.1 9 ±0.22)mmol/L vs.(2.32 ±0.27) mmol/L,P=0.005 ],and the level of alkaline phosphatase (AKP)in HMF group at discharge was higher than in PF group [(363.98 ±1 22.49)mmol/L vs.(299.73 ±1 1 7.39)mmol/L,P=0.004];(5)the incidence of the feeding intolerance (6.5% vs.1 8.3%,P=0.04)and sepsis (4.8% vs. 1 6.7%,P=0.03)in HMF group were less than in PF group,there were no significant differences be-tween the two groups on the morbidity of necrotizing enterocditis,retinopathy of prematurity (ROP),and bronchopulmonary dysplasia (BPD)(P>0.05).Conclusion:HMF for premature infants may ensure the same growth pattern as those fed by premature formula,promote the calcium absorption,decrease the inci-dence of sepsis and feeding intolerance,and does not increase the incidence of necrotizing enterocolitis.

Objective To investigate optimal extraction process of Piper puberulum ( Benth.) Maxim.and qualitative analyze the chemical component of the extracts.Methods Method of solvent heating reflux was used for extraction.On the basis of single factor experiment, L9 (34 ) orthogonal experiment was designed with the variants of extraction frequency, time, material-liquid ratio, and immersion time.Extraction rate as index, extraction processes were optimized to achieve best extraction.The extracts, including total extract, water elution, and ethanol elution, were physiochemically analysed to achieve an initial qualitative result.Results The optimal extraction process was: extractions 3 times for 2 hours, with an 1︰30 material -liquid ratio and 2 hours of immersion, Initial qualitative analyzed the total extracts containing amino acids, polypeptides, proteins, alkaloids, steroids or triterpenes, flavones, saponins, polysaccharides, reducing sugars or glucosides, cumarins, terpene lactones, phenols, and tannins.The water elution containing: amino acids, polypeptides, proteins, saponins, polysaccharides, reducing sugars or glucosides, cumarins, and terpene lactones.The ethanol elution containing: amino acids, polypeptides, proteins, alkaloids, steroids or triterpenes, flavones, polysaccharides, reducing sugars or glucosides, phenols, and tanins.Conclusion The experiments show that optimal extraction process can achieve high extraction yield, stable and practical.

Launching social work program in Cleft Lip and Palate department, volunteers can help provide supportive services for patients, to enhance our service level, and to benefit patients suffering and health care quality in hospital. Also this program helps develop volunteers′ skills by doing face to face practice and getting feedback from patients directly and consistently. Most importantly, patients will receive excellent services, which assist to Improve the reputation of the hospital. This article introduces how volunteers perform supportive services and also provides a specific way that volunteers, participate in Cleft Lip and Palate department

Objective To evaluate the effect of human milk fortification on short‐term growth of premature infants in NICU and its clinical safety .Methods According to different formulas ,the premature infants were divided into preterm formula group ,human milk group and human milk fortification group (HMF group) .Its growth rate ,blood biochemistry ,adverse event rate and so on were compared .Results There were 147 cases meeting requirements .the weight growth velocity of preterm formula group ,human milk group and HMF group were (19 .44 ± 5 .14) ,(14 .53 ± 5 .86) ,(17 .09 ± 5 .81) g · kg -1 · d-1 respectively with statistical sig‐nificance (P<0 .01);the growth velocity of head circumference of preterm formula group (0 .72 ± 0 .34)cm/w and HMF group (0 .71 ± 0 .29) cm/w were significantly higher than that of human milk group (0 .51 ± 0 .34)cm/w (P<0 .01);the time of regaining or overtopping birth weight of preterm formula group (8 .55 ± 3 .20)d and HMF group (9 .43 ± 4 .53)d was significantly shorter than that of human milk group (10 .93 ± 3 .02)d(P<0 .01);the EUGR occurrence rate of head circumference of preterm formula group and HMF group were significantly lower than that of human milk group(P<0 .01) .The feeding intolerance rate of preterm formula group (15 .52% ) was significantly higher than that of human milk group (2 .13% ) (P<0 .05);there were no significant difference in incidence rate of infection event in each group(P>0 .05) .Conclusion Human milk fortification can control the inci‐dence rate of infection event and feeding intolerance to increase growth velocity of weight and head circumference of premature in‐fants during hospital stay .