Objective To screen the influencing factors related to prolonged mechanical ventilation (PMV). Methods Series of parameters of 154 elderly patients with pneumonia or COPD exacerbation were collected before using ventilator, after weaning of ventilator or at the 21st day of ventilating, respectively. Results By single factor analysis, PMV related to not only age, lying on bed, white blood cell, neutrophil, P (A-a)O 2, BUN, Cr, upper digestive tract bleeding, heart rate(HR), and blood pressure(BP) before using ventilator, but also related to heart function and consciousness after ventilator weaning or ventilating for 21 days. By multiple factor analysis, age, P (A-a) O 2 , heart function when ventilating for 21 days were related to PMV. Age≥82.0, P (A-a)O 2 ≥95.0 mm Hg, heart function≥grade 3 were high risk factors of PMV. Furthermore, it was found that the accuracy rate for meeting with those three parameters among 8 elderly patients with PMV was 87.5%. Conclusions Age, P (A-a)O 2 and heart function when ventilating for 21 days might be the independent factors of PMV.

Objective The effects of dexamethasone on cell signal transaction system ERK and PI3-K were studied in acute lung injury (ALI) rat in order to provide a theoretical basis for clinical treatment. Methods 36 healthy male SD rats were randomly divided into 3 groups, 12 rats for each group: injured group, dexamethasone treated group and control group. 0.25ml/kg oleic acid was injected via caudal venous into each animal in the former two groups to form ALI models. Then, for dexamethasone treated group, each animal received 1.0mg/kg of dexamethasone 15 min after oleic acid injection; the same amount of saline was given to the animals in injured group, and the animals in control group were injected the same amount of saline at the last two times. All animals were killed by common carotid artery bleeding 2 hours after the last injection. The indexes of PaO2, wet/dry weight of left lung, pulmonary permeability and lung pathology were investigated. The expression of PI3-K, ERK and P-ERK were determined by Western blot and immunohistochemical method. Results PaO2 declined in the animals of injured group, while left lung wet/dry ratio and pulmonary permeability increased obviously, and pulmonary edema and transparent film were observed in injured lung pathology. Compared to injured group, those indexes were improved in dexamethasone treated group. PI3-K, ERK and P-ERK were highly expressed in bronchus epithelial cells, alveolar epithelial cells, pulmonary vessel endothelial cells and macrophage cells of the animals in injured group, the expression of PI3-K, ERK and P-ERK were reduced in dexamethasone group, but the expression in the both groups were still higher than that in control group. Conclusions The higher expression of PI3-K and ERK were involved in the regulation of earlier period of ALI, and dexamethasone may improve ALI by repressing the high expression of PI3-K and ERK.

Objective To study the expression of phosphoinositide 3 kinase (PI3-K) and its relationship with lung cell apoptosis in rats with acute lung injury induced by oleic acid. Methods 60 healthy male SD rats were divided into 5 groups randomly, with 12 rats for each group. 0.25ml/kg oleic was injected into the tail vein in 4 oleic groups in which the rats were respectively sacrificed after 1h, 2h, 4h, 6h and 24h by exsanguination. In the control group 0.25ml/kg of saline was injected intravenously and sacrificed 2h later. Arterial blood gas, left lung wet/dry ratio, lung index, protein content of BALF, and pulmonary permeability index (PPI) were determined. Fas-L expression of lung tissue was determined by immunohistochemical method and protein expression of PI3-K was determined by Western blot and immunohistochemical method. Results PaO_2 was lowered, and left lung wet/dry ratio, lung index, and protein content of BALF and PPI were increased obviously after oleic acid injection. Fas-L and PI3-K in bronchus epithelial cells, alveolar epithelial cells, pulmonary vessel endothelial cells and macrophage cells were highly expressed in the lung of ALI rats, and peak value of PI3-K appeared earlier than Fas-L. Conclusion Fas-L related apoptosis of bronchial epithelial cells, alveolar epithelial cells, pulmonary vessel endothelial cells and macrophage cells participated in the pathogenesis of earlier period of ALI through PI3-K transduction pathway.

Child ; Evidence-Based Medicine ; Humans ; Nephrotic Syndrome ; diagnosis ; etiology ; therapy ; Practice Guidelines as Topic ; Recurrence

Impotence is one of the more common and serious symptom type of male sexual disturbance.It demonstrates by domestic sampling investigation that about more than 10% of male adult have impotence,and the incidence of impotence goes higher with the growing of age.Warming and invigorating kidney-yang has been the main therapy method for treating impotence.Through years of clinic practices,the treatment for impotence from liver has achieved satisfied effects.

OBJECTIVE To discuss cause and nursing of hospital infection in infectious disease ward.METHODS Hospital infection in infectious disease ward of a general hospital was analyzed retrospectively.RESULTS The hospital infection rate was 6.18%;the main site of infection was respiratory tract(48.84%);November is the highest month of infection rate.The infection rate was seen higher among liver disease patients.CONCLUSIONS The hard ware must be enhanced to reform and the sickroom arrangement be regularized.It is important for hospitals to strengthen infection control.The main treatment to control hospital infection is applying aseptic operation strictly.

Objective:To evaluate the role of esophagogastric junction contractile index (EGJ-CI) in distinguishing patients with refractory gastroesophageal reflux disease (RGERD) from functional heartburn (FH).Methods:From March 2014 to January 2018, 82 patients with proton pump inhibitor (PPI) refractory heartburn and/or regurgitation, who visited the Outpatient Department of Gastroenterology at The First Affiliated Hospital with Nanjing Medical University were enrolled, among them 50 patients with RGERD (RGERD group) and 32 patients with FH (FH group). EGJ-CI of RGERD group and FH group were compared. The sensitivity and specificity of EGJ-CI to distinguish RGERD from FH patients. The correlation between EGJ-CI and high resolution esophageal manometry parameters, baseline impedance level and 24 h impedance-pH monitoring parameters were analyzed. Mann-Whitney U test, receiver operator characteristic curve analysis and Spearman correlation analysis were used for statistical analysis. Results:The EGJ-CI of RGERD group was lower than that of FH group (25.8 mmHg·cm (14.1 mmHg·cm, 35.9 mmHg·cm)(1 mmHg=0.133 kPa) vs. 39.2 mmHg·cm (23.0 mmHg·cm, 60.8 mmHg·cm)), and the difference was statistically significant ( Z=-2.833, P=0.005). When the cut-off value of EGJ-CI was 35.8 mmHg·cm, the sensitivity and specificity to distinguish RGERD from FH were 76.0% and 62.5%, respectively; area under the curve was 0.69 (95% CI 0.57 to 0.81). EGJ-CI was positively correlated with lower sphincter resting pressure, integrated relaxation pressure, distal contractile integral, distal esophageal pressure, and mean nocturnal baseline impedance ( r=0.812, 0.631, 0.451, 0.490 and 0.401, all P<0.01). EGJ-CI was negatively correlated with DeMeester score, acid exposure time, total reflux episodes, acid reflux episodes, long reflux episodes and longest reflux time ( r=-0.363, -0.372, -0.346, -0.318, -0.300 and -0.291, all P<0.01). Conclusions:EGJ-CI can help to distinguish patients with FH from RGERD.

Objective To investigate the effect of Suanzaoren Decoction on hippocampus, cortex BDNF and TrKB gene expression in depression model rats. Methods Depression rat models were established by social-isolated raise and chronic stress stimulation. Suanzaoren decoction was administrated to the models. RT-PCR was adopted to detect the expression of mRNA BDNF and TrKB genes. Results The mRNA expression of BDNF and TrKB in cortex of Suanzaoren decoction high dose group、medium dose group and clomipramine group(0.213±0.094, 0.639±0.023, 1.032±0.015, 1.089±0.014, 1.580±0.012, 1.860±0.019)were all higher than the model group(0.032±0.008, 0.001±0.000), showing a significant difference among four groups (P<0.01), and the mRNA expression of BDNF and TrKB in hippocampus of Suanzaoren decoction high dose group, medium dose group and clomipramine group(0.213±0.094, 0.639±0.023, 1.032±0.015, 1.089±0.014, 1.580± 0.012, 1.860±0.019)were higher than the model group (0.021±0.015, 0.125±0.013), there was a significant difference between four groups(P<0.01). Compared with the model group, the mRNA expression of low-dose group of Suanzaoren decoction in both cortex and hippocampus of BDNF and TrKB was not significantly different to the model group(P>0.05). Conclusion Suanzaoren decoction can increase the expression of BDNF and TrKB gene, promote neuronal proliferation, and resist depression.

Objective: Clone, express and purify human recombinant calreticulin (CRT). Methods: Human CRT cDNA was amplified from total RNA of human lung cancer cell line A549 cells by RT-PCR. Then, PCR product was subcloned into prokaryotic expression vector pET-15b. After sequencing, this recombinant plasmid was transformed into E.coli. Rossetta. Recombinant CRT was expressed in host cells by IPTG induction. Resulted protein was purified by Ni-NTA resin under denature condition and dialyzed to recover its native structure. SDS-PAGE and Western blot method were used to identify the expression and purification of reconbinant CRT. Results: Human CRT cDNA was cloned from total RNA of A549 cells. CRT prokaryotic expression vector pET-15b-crt was constructed. Reconbinant CRT was induced to express in E.coli and purified by Ni-NTA affinity chromatograph. Conclusion: A method for prokaryotic expression and purification of human recombinant CRT was successfully established. This method laid a foundation for the subsequent CRT research.

Objective: To evaluate the safety and efficacy of intratumoral injection of polylactic-co-glycolic acid (PLGA) microspheres containing cobra venom cytotoxin in nude mice with transplanted human hepatoma. Methods: Cytotoxic activity of cytotoxin from cobra venom was determined by using methyl thiazolyl tetrazolium method in vitro. Microspheres containing cobra venom cytotoxin were prepared with a double emulsion-solvent evaporation method. Forty BALB/c nude mice were inoculated subcutaneously in right flank with hepatoma BEL-7404 cells. Thirty-two mice whose tumor size reached about 1.0 cm in diameter, were randomly assigned into normal saline group, blank microsphers group, cytotoxin group and cytotoxin-PLGA group. Nude mice were intratumorally injected with normal saline, blank microspheres, cytotoxin or cytotoxin-PLGA microspheres respectively. Internal echo characteristics and blood flow of tumors were observed by high-frequency ultrasound every week after treatment. Twenty-six days after treatment, the tumors were removed to calculate the inhibition rate of tumor growth. The tumor, heart, liver and kidney tissues were obtained for histopathological examination. Results: The cytotoxin separated and purified from crude cobra venom caused intense cytotoxic effects to the BEL-7404 cells in vitro. The diameter of PLGA microspheres containing cobra venom cytotoxin was about (34.45+/-9.85)mum. Encapsulation rate was up to (78.13+/-8.92)%, and cumulative amount of cobra venom cytotoxin released from the PLGA microspheres in vitro during 30 days was up to 84.3%. After intratumoral injection, tumor volumes and weights in the cytotoxin-PLGA group were lower than those in the normal saline group, with a tumor growth inhibition rate of 52.36%. Observed under a light microscope, most tumor tissues were necrotic. No obvious morphological change could be seen on the liver, kidney and heart tissues. Conclusion: The above findings indicate that intratumoral injection of cytotoxin-PLGA microspheres has strong antitumor effect and can obviously lessen systemic toxicity, which may provide an effective and feasible method for hepatocellular carcinoma treatment.