Hospital-acquired pneumonia (HAP) is a very common complication in patients with neurological diseases.Its incidence and mortality are very high and result in a prolonged hospital stay and an increase in hospitalization costs.Therefore,how to effectively prevent HAP has become the focus of attention by neurologists.There are many risk factors for HAP,such as advanced age,conscious disorders,dysphagia,body position,oropharyngeal colonization,mechanical ventilation,enteral nutrition,and stress ulcer prevention drugs,etc.Clearing the risk factors for HAP and taking appropriate measures to strengthen protection may reduce the occurrence of HAP and improve the prognosis of patients.

Objective To explore the effects of human menopausal gonadotropopin(HMG) supplementation on the outcome of women underwent in vitro fertilization-embryo transfer(IVF-ET) .Methods The data of 406 IVF-ET cycles in Reproductive Medi-cine Center of the 105th Hospital of PLA were analyzed retrospectively .All cases underwent long down regulation protocol with gonadotropin releasing hormone agonist(GnRH-a) in the mid-luteal phase and controlled ovarian stimulation(COS) was carried out with follicle stimulation hormone(r-FSH) on the days 3 -5 of the menstrual cycle .Then 75 -150 U HMG was administrated in group A(257 cycles) when a dominant follicle reached a diameter of 14 mm ,while the remaining cases(149 cycles) underwent HCG still with r-FSH were served as group B .Based on the LH levels on the day of HMG administration ,the cases in group A were sub-divided into :group A1(99 cycles) ,LH<1 U/L ;group A2(96 cycles) ,1 U/L≤LH≤2 U/L ,and group A3(62 cycles) ,LH>2 U/L .Clinical outcomes of all groups were analyzed and compared .Results The durations and doses of gonadotropin(Gn) ,the rates of fertilization and pregnancy were higher and the abortion rate was lower in group A than that in group B (P<0 .05) .There were no significant difference in serum LH concentrations on the days of HMG and HCG administration ,oocytes retrieved ,the rates of cleavage and embryo implantation between group A and group B(P>0 .05) .There was significant difference in serum LH levels on the day of HMG supplementation among group A1 ,A2 and A3(P<0 .05) and the doses of HMG supplemented reduced gradually from group A1 to group A3(P<0 .05) .The duration of Gn was significantly lower and the fertilization rate was significantly higher in group A3 compared with group A1 and A2(P<0 .05) .The pregnancy rate in group A2 and A3 was higher than that in group A1 ,which showed significant difference between group A2 and A1(P<0 .05) .Meanwhile ,there were no significant difference in doses of r-FSH ,serum LH concentrations on the day of HCG administration ,oocytes retrieved ,the rates of cleavage ,implantation and abortion among the three groups(P>0 .05) .Conclusion HMG supplementation in the middle and late follicle phases in stand-ard long down-regulation protocol during IVF could obtain higher pregnancy rate and lower abortion rate ,especially when their ser-um LH level was between 1 U/L and 2 U/L without obvious increase of LH .

Objective To evaluate the clinical efficacy ofZi Wu Liu Zhu Na Jia needling (acupuncture based on midnight-noon ebb-flow theory) in treating spastic hemiplegia after cerebral stroke by using surface electromyography (sEMG).Method Fifty-two patients with spastic hemiplegia due to cerebral stroke were randomized into a treatment group and a control group, 26 cases each. The two groups were both intervened by conventional rehabilitation training. In addition, the treatment group was givenZi Wu Liu Zhu Na Jia needling and the control group was given ordinary acupuncture. The two groups were treated once a day, 15 sessions as a course. The ambulation ability, muscle tension, neurological deficit score (NDS), Fugl-Meyer Assessment Scale (FMA), and Berg Balance Scale (BBS) were evaluated before the intervention and after 2 treatment courses, and the sEMG signals were also collected and analyzed.Result The Holden's Functional Ambulation Classification (FAC) and Modified Ashworth Scale scores were significantly changed in the two groups after the intervention (P<0.01). After the intervention, the FAC and MAS scores in the treatment group were significantly different from those in the control group (P<0.05). The NDS, FMA and BBS scores were significantly changed in the two groups after the treatment (P<0.05). The NDS, FMA and BBS scores in the treatment group were significantly different from those in the control group after the treatment (P<0.05). Of the sEMG signals, H/M max in the treatment group was significantly different from that in the control group after the intervention (P<0.01).Zi Wu Liu Zhu Na Jia needling with rehabilitation training can significantly mitigate the muscle tension and promote the activities of daily living in patients with spastic hemiplegia after cerebral stroke.

[Objective]To investigate the prognostic value of 18F-FDG PET/CT with different metabolic parameters in newly diagnosed limited-disease(LD)small cell lung cancer(SCLC).[Methods]Retrospective analysis was carried out in the patients between June 2005 to December 2016 in our hospital confirmed of LD SCLC by pathology or cytology and comprehensive imaging. Fifty-four patients were recruited. Record the general characteristics of patients,pre-treatment KPS score,smoking status,weight loss,serum LDH,NSE,OS,PFS. All lesions(primary lesions + metastases)were sketched out within one VOI,and the SUVmax, SUVmean and SUVpeak in the VOI were automatically measured and recorded. The automatic measurement was performed by the fixed threshold method. The thresholds of tumor of MTV and TLG were 40% and 50% of SUVmax. The TLG and MTV were identified as TLG40%,TLG50%,MTV40% and MTV50% respectively. Kaplan-Meier method was used for survival analysis. All the prognostic factors were analyzed by Cox model.[Result]The median SUVmax was 13.92(2.61~43.28),the median of SUVmean was 8.31(1.71~26.85) and the median of SUVpeak was 10.51(1.49 ~ 27.48). The median of TLG40% was 340.22(16.58 ~ 2827.26),the median of TLG50%was 215.645(1.70 ~ 2270.36),the median of MTV40% was 36.71(1.15 ~ 259.47 cm3),the median of MTV50% was 19.65(0.93 ~1900.00)cm3. Univariate and multivariate analysis of metabolic index and prognosis showed that TLG50% was the prognostic factor of OS(P = 0.013),but not of PFS(P > 0.05). The SUVmax,SUVmean and SUVpeak were not the prognostic factors of OS and PFS(P >0.05).[Conclusion]The volume metabolic parameters TLG50%was the independent prognostic factor of the overall survival time of the LD SCLC. The volume metabolic parameters (TLG and MTV) of 18F-FDG PET/CT were related to the prognosis of SCLC ,which could provide the basis for individual chemotherapy.

Objective To evaluate the role of Toll-like receptor 4 (TLR4) in mechanical ventilationinduced increase in pulmonary capillary permeability in diabetic mice.Methods Two types of mice,aged 8-10 weeks,weighing 20-25 g,were used in this study:free wild type mice (C3H/HeN) and TLR4 gene mutation type (C3H/HeJ).Diabetes was induced by intraperitoneal streptozotocin 150 mg/kg (in citric acid buffer solution 0.1 mol/L) and confirmed by blood glucose level ＞ 16 mmol/L.Each type of diabetic mice was randomly divided into 2 groups (n =14 each):group diabetes + sham operation (group DS) and group diabetes + mechanical ventilation (group DM).The animals were anesthetized with intraperitoneal ketamine,midazolam and atropine.Tracheal intubation was performed and the animals kept spontaneous breathing in group DS.The animals were mechanically ventilated (FiO2 50％,RR 70 bpm,VT 15 ml/kg,PEEP 2 cmH2O) for 4 h in group DM.Arterial blood samples were obtained at 4 h of ventilation for blood gas analysis,PaO2 and PaCO2 were recorded,and NO concentration in the serum was measured.Then the animals were sacrificed and the lungs were removed for determination of W/D lung weight ratio (W/D ratio),content of evans blue (EB),and expression of caveolin-1,endothelial nitric oxide synthase (eNOS) and phosphor-eNOS (p-eNOS) (by Western blot).The ratio of p-eNOS/eNOS was calculated.Results Compared with group DS,PaO2,PaCO2 and p-eNOS/eNOS ratio were significantly decreased,and W/D ratio,EB content and caveolin-1 expression were increased in group DM (P ＜ 0.05).Compared with C3H/HeN mice,W/D ratio,caveolin-1 expression and EB content were significantly decreased,peNOS/eNOS ratio and serum NO concentrations were increased (P ＜ 0.05),and no significant changes in PaO2 and PaCO2 were found in C3H/HeJ mice in group DM (P ＞ 0.05).Conclusion TLR4 increases the pulmonary capillary permeability after mechanical ventilation in diabetic mice through effectively combining with caveolin-1 and reducing NO bioavailability.

AIM:To investigate the effect of puerarin on acute high glucose-induced attenuation of ACh relaxation in isolated rat aortic rings, and to elucidate its underlying mechanism. METHODS: The thoracic aortic rings with endothelium of male Sprague-Dawley rats were mounted on a bath system. Isometric relaxation of aortic rings was measured. RESULTS: ① After incubation with high concentration of glucose (44 mmol/L), the vascular relaxation responses to ACh decreased. ② After coincubation with puerarin (10-10-10-8 mol/L) and high glucose, the high glucose-induced attenuation of ACh relaxation responses of artery was partly inhibited in a dose-dependent manner. ③ After incubation with puerarin for 2 h, the HO-1 activity of thoracic aorta increased. ZnPPIX (an inhibitor of heme oxygenase-1) abrogated the protective effect of puerarin. CONCLUSION: Puerarin prevents the acute high glucose-induced attenuation of endothelium-dependent relaxation in aortic rings. The mechanism might be involved in the activation of heme oxygenase-1.

AIM:To investigate the effect of high glucose on the expression of an endoplasmic reticulum stress marker glucose-regulated protein 78(GRP78),and explore its underlying mechanism.METHODS:(1) Human umbilical vein endothelial cells(HUVECs) were exposed to normal glucose(5.5 mmol/L) and high glucose(30 mmol/L) for 24 h,36 h or 48 h.Cell viability was determined by MTT method.Cell apoptosis was detected by flow cytometry analysis.The expression of proteins was evaluated by Western blotting analysis.RESULTS:After treated with high glucose for 24-48 h,the expression of GRP78 increased early but decreased at 48 h of incubation,while cyclooxygenase-2(COX-2) expression increased in a time-dependent manner.COX-2 selective inhibitor nimesulide inhibited high glucose induced changes of GRP78 expression and also inhibited high glucose induced cell apoptosis.CONCLUSION:Prolonged high glucose exposure changes the expression of GRP78 in a COX-2 dependent manner in HUVECs.

AIM: To explore the protective effect of curcumin on high glucose-induced decrease in contraction of isolated rat aortic rings, and to elucidate its underlying mechanism. METHODS: The thoracic aortic rings with endothelium of male Sprague-Dawley rats were mounted on a bath system. Isometric contractions of aortic rings were measured. HO activity was also evaluated. RESULTS: (1)Four hours after incubated with 44 mmol/L of glucose (high glucose),the vascular contraction responses to phenylephrine (PE) decreased compared to control group (containing 11 mmol/L of glucose). (2)Coincubation with curcumin (3×10~(-11)-3×10~(-10) mol/L) and high glucose,the high glucose-induced decrease in contraction responses to PE of arteries was partly inhibited. (3)Four hours after incubation with curcumin,the HO activity in thoracic aorta increased. ZnPP,an inhibitor of HO-1,completely abrogated the protection effect of curcumin. (4)Methylene blue,an inhibitor of guanylate cyclase (GC),partly abolished the protective effect of curcumin. CONCLUSION: Curcumin prevents the high glucose-induced decrease in contraction responses to PE in intact aortic rings. The mechanism might be mainly involved in the activation of HO-1 and GC.

Objective: To explore the relationship between eHealth literacy and illness behavior of vocational college students in Jinan city,and to provide reference for improving health education in vocational colleges. Methods: In December 2019, 1 157 college students from 4 vocational colleges in Jinan city were selected to conduct eHealth literacy and illness behavior survey. Results: The score of eHealth literacy was(29.92±8.36),and the score of illness behavior was(52.82±18.04). Illness behavior score of male students was lower than female students,urban students was higher than the rural students,only children lower than the non-only children,those who did not serve as student leaders were lower than those who were served,those with paternal education lower than high school were lower than those with paternal education higher than high school,and those differences were statistically significant (t=-10.82,2.29,-3.85,-3.99,-4.89,P<0.05). The score of eHealth literacy of male students was lower than that of female students,that of urban students was higher than that of rural students,that of only children was lower than that of non-only children,that of student cadres was higher than those who do not,and the differences were statistically significant (t=-3.16,2.87,-3.32,-2.91,P<0.05). The total score and dimensions of eHealth literacy were significantly positively correlated with total score and dimensions of illness behavior (r=0.09-0.27,P<0.01),and eHealth literacy significantly positively predicted illness behavior (β=0.15,P<0.01). Conclusion eHealth literacy is an important factor affecting the illness beahvior of college students in vocational colleges, more attention should be paid to the cultivation of eHealth literacy of vocational college students to improve their illness behavior.

Eighty-two newly-diagnosed type 2 diabetic patients with poor glycemic control were treated by mitiglinide calcium for 16 weeks.Plasma fibroblast growth factor-21 ( FGF-21 ) level were evaluated.The relationship of plasma FGF-21 levels with body mass index,body fat,waist-to-hip ratio,lipid,blood glucose,HbA1c,and free fatty-acid were analyzed.Plasma FGF-21 was decreased significantly by treatment with mitiglinide calcium in type 2 diabetic patients,and it may play a role in the pathogenesis of type 2 diabetes mellitus.