Objective To analyze and discuss the negative effects of atomization inhalation in mechanical ventilation patients in intensive care unit. Methods A retrospective study of all the mechanical ventilation patients in the general ICU of our hospital was carried out from Aprilto December 2015. The risk of multidrug-resistant organisms(MDROs)colonizationin the lower respiratory tract and ventilation associated pneumonia(VAP)in mechanical ventilation patients were analyzed. Results A total of 922 patients were monitored, 160 of whom had atomization inhalation, 92 for MDROs colonizationin the lower respiratory tract and 18 for VAP. The rates ofatomization inhalation in patients with and without MDROs colonizationin the lower respiratory tract were 30.4%(28/92)and 15.9%(132/830)with statistical difference (χ2=12.193, P=0.000). And those in patients with and without VAP were 50.0%(9/18) and 16.7%(151/904), with statistical difference (χ2=11.420, P=0.000). Atomization inhalation was the independent risk factor both of MDROs colonizationin the lower respiratory tract(OR=1.917, 95%CI1.163-3.159, P=0.011) and VAP(OR=4.613, 95%CI 1.773-12.002, P=0.000) in mechanical ventilation patients. Conclusions Atomization inhalation may increase the risk of MDROs colonizationin the lower respiratory tract and VAP in mechanical ventilation patients. Thus unnecessary and too frequent operations of atomization inhalation should be decreased.

Objective Exploration of TSH, FT3, FT4 changes in critical condition prior to death.Methods 84 patients that were anti-tumor therapy acceptable and not associated with the treatment of thyroid disease in patients with terminal tumors. Age from 24 to 85-year-old, male 56, female 28. The use of SELDI technology (surface-enhanced laser description / ionization time-of-flight mass spectrometry protein chip technology) checks to M/Z for the 11 100 + H～11 900 + H peak of the cluster, divided into the positive group for critically ill patients with early warning protein (LGT) and the negative group for it. All patients were given TSH, FT3, FT4 inspection. The results were statistically analyzed. Results TSH, FT3, FT4 in the LGT positive group was significantly lower than in the negative LGT group. There was no correlation between TSH,FT3 and FT4 in the LGT positive group;In the negative LGT group FT3 and FT4 had a positive correlation,and FT3 and TSH no relevance. Conclusion Thyroid function is normal in the stage of cancer patients stable condition. Possible pituitary-hypothyroidism may occur as the disease advances to the end or before death.This may be an important factor causing the acceleration to the death of the patients. However, the cause and effect between this phenomenon and the early warning of protein fingerprint group(LGT) is still not clear. In critical condition checking thyroid function and render supplementary amount of thyroid hormone in accordance with the checking results may be beneficial.

Objective: To investigate the effects of folic acid (FA), vitamin B6 (VB6) and B12 (VB12) on plasma homocysteine (Hcy) and antioxidative activities in focal cerebral ischemia rats. Method: Rats were randomly divided into four groups including sham operation (Sham), middle cerebral artery occlusion model (MCAO), MCAO+FA and MCAO+FA +VB6+VB12(MCAO+CV). MCAO model was induced by operation. Plasma Hcy, serum and brain SOD and GSH-Px activities and MDA content in rats were measured before and 28 d after supplementation and 24 h after ischemia or only after ischemia. Results: Plasma Hcy in MCAO+FA and MCAO+CV group were significantly lower than those in Sham and MCAO groups after supplementation and ischemia, and the MCAO+CV group lower than MCAO+FA group. Serum and brain SOD and GSH-Px activities were significantly higher, and MDA contents lower in MCAO+FA and MCAO+CV groups than those in MCAO group. Conclusion: Supplementing FA, VB6 and VB12 can reduce plasma Hcy, improve antioxidative abilities and decrease the injury by oxidative stress following cerebral ischemia.

Objective To study the potential role of tumor necrosis factor-α (TNF-α) induction in the development of mucosal barrier dysfunction in rats caused by acute intestinal ischemia-reperfusion injury, and to examine whether pretreatment with monoclonal antibody against TNF-α (TNF-α MoAb) would affect the release of D(-)-lactate after local gut ischemia followed by reperfusion. Methods Anesthetized Sprague-Dawley rats underwent superior mesenteric artery occlusion for 75 min followed by reperfusion for 6 hr. The rats were treated intravenously with either TNF-α MoAb (20 mg/kg) or albumin (20 mg/kg) 30 min prior to the onset of ischemia. Plasma D(-)-lactate levels were measured in both the portal and systemic blood by an enzymatic spectrophotometric assay. Intestinal TNF-αmRNA expression as well as protein levels were also measured at various intervals. In addition, a postmortem examination was performed together with a macropathological evaluation based on a four-grade scoring system.Results Intestinal ischemia resulted in a significant elevation in D(-)-lactate levels in the portal vein blood in both the control and treatment groups ( P ＜0.05). However, animals pretreated with TNF-α MoAb at 6 hr after reperfusion showed significant attenuation of an increase in both portal and systemic D(-)-lactate levels when compared with those only receiving albumin (P ＜ 0.05). In the control animals, a remarkable rise in intestinal TNF-α level was measured at 0.5 hr after clamp release ( P ＜ 0.01); however, prophylactic treatment with TNF-α MoAb completely annulled the increase of local TNF-α levels seen in the control animals. Similarly, after anti-TNF-α MoAb administration, intestinal TNF-α mRNA expression was markedly inhibited, which showed significant differences when compared with the control group at 0.5 hr, 2 hr and 6 hr after the release of occlusion ( P ＜ 0.05-0.01 ). In addition, the pathological examination showed marked intestinal lesions that formed during ischemia, which were much worse upon reperfusion,particularly at the 6 hr time point. These acute injuries were obviously attenuated in animals receiving TNF-α MoAb.Conclusions It appeared that acute intestinal ischemia was associated with failure of the mucosal barrier, resulting in increased plasma D(-)-lactate levels in both portal and systemic blood. These results suggest that TNF-α appears to be involved in the development of local damage associated with intestinal ischemic injury. Moreover, prophylactic treatment with TNF-α MoAb exerts preventive effects on ischemia/ reperfusion-induced circulating D (-)-lactate elevation and gut injury. ( J Geriatr Cardiol 2004;1(2):119-124. )

Objective To investigate the predictive value of the 40 Hz auditory steady state response (40-Hz ASSR) in the short-term prognosis of patients with brainstem stroke.Methods The 40-Hz ASSR and brainstem auditory evoked potentials (BAEP) examinations were recorded and graded from 36 patients with brainstem stroke admitted in the Neurological Intensive Care Unit (NICU). Tue end point of short-term prognostic evaluation was at the time of leaving the NICU. Tue patients with brainstem stroke were divided into the survival group (n =21) and the death group (including brain death,n = 15). The correlation between the grade of the 40-Hz ASSR or BAEP and the short-term prognosis was analyzed. Results The grade of the 40-Hz ASSR (r=0.571,P =0.000) or BAEP (r =0.441,P =0.001 ) was significantly correlated with the short-term prognosis in patients with brainstem stroke. The sensitivity,specificity and accuracy of the 40-Hz ASSR were 60.00％,100％ and 83.33％,respectively,and those for BAEP were 66. 67％,71.43％ and 69. 44％,respectively. Conclusions Tue 40-Hz ASSR has a certain short-term prognostic value in patients with brainstem stroke. The higher the grade of 40-Hz ASSR is,the more serious the illness,and the worse the prognosis.

Objective To explore the predictive value of early electroenphalography (EEG) for a malignant course in patients with large middle cerebral artery infarction (LMCAI).Methods Thirty-seven patients (20 patients with a malignant and 17 with a benign course) with stroke of >50% of the middle cerebral artery territory in early CT/MRI scan were included;Glasgow-Pittsberg Coma Scale (24 ±1 vs. 30 ±4, P =0. 003) and National Institutes of Health Stroke Scale (23 ±3 vs. 16 ±4, P =0.000) in the group with a malign course were higher than those in the group with a benign course. Early EEG was recorded within 24 h after ischemic stroke. The correlation between the change characteristics of EEG and a malignant course in patients with LMCAI was analyzed. Results The contralateral occipital background frequencies < 8 Hz (17/20 vs. 3/20, P =0.000), β frequency within the focus ≤20 Hz (19/26 vs. 7/26, P= 0-001), EEG non-reaction to stimuli (11/12 vs. 1/12, P= 0.002),slowing affecting the whole hemisphere in the lesion (17/24 vs. 7/24, P = 0. 008) and focal slowing contralateral to the lesion (16/19 vs. 3/19, P =0. 000) were significantly related with a malignant course. Whereas the contralateral occipital background frequencies ≥8 Hz (14/17 vs. 3/17, P =0. 000),β frequency >20 Hz within the focus (10/11 vs. 1/11, P =0. 001) were related with a benign course. Conclusions Early EEG has a certain predictive value for a malignant course in patients with LMCAI, and it may be used as one of the bedside monitoring approaches of LMCAI.

Objective To explore the clinical results of the arthroscopic acromioplasty in the rotator cuff repair.Methods Sixty-five patients (42 males and 23 females) to receive suture bridge repair under the arthroscopy between May 2012 and May 2014 were selected and randomly divided into an experimental group and a control group.The experimental group was given suture bridge repair with acromioplasty,while the control group underwent the suture bridge repair without acromioplasty.The time of operation was recorded.The range of motion (ROM) of the shoulder,the UCLA shoulder scoring system (ULCA) score,American orthopedic surgeon scoring system (ASES) score,the visual analogue scale (VAS) score and Constant score were observed 3 and 12 months after the operation.Results There were no significant differences in age,sex and the affected side between the two groups.Significant differences were found between the two groups in the duration of the operation (t=-18.5,P＜0.05).There were no significant differences in the ROM and the ULCA,ASES,VAS and constant scores of the shoulder 3 and 12 months after the operation.Conclusion No significant differences were found in the ROM and the shoulder function scoring between giving acromioplasty under the arthroscopy or not.However,the operation time of undergoing acromioplasty under the arthroscopy was longer.

Objective To investigate the protective effect of mild hypothermia on cerebral ischemia-reperfusion injury in rats and the effect of mild hypothermia on the expression of inhibitor of differentiation 2 (Id2) protein.Methods A total of 72 adult male rats were randomly divided into a sham operation group,a normothermia group,and a mild hypothermia group.A model of middle cerebral artery occlusion was induced by a suture method.The mild hypothermia group was treated with low temperature (anal temperature 33±1 ℃,tympanic membrane temperature 31±1 ℃).Modified Neurological Severity Score (mNSS) was used to evaluate neurological deficits,triphenyltetrazolium chloride staining was used to detect infarct volume,and Western blot was used to detect the Id2 expression in the ischemic cortex at ischemia-reperfusion 6,12,24,and 72 h,respectively.ResultsThe mNSS scores in the mild hypothermia group were significantly lower than those in the normothermia group,the infarct volumes were significantly smaller than those in the normothermia group at ischemia-reperfusion 6,12,24,and 72 h (all P<0.001).Western blot analysis showed that the Id2 expressions in the ischemic cortex in the mild hypothermia group were significantly lower than those in the normothermia group at ischemia-reperfusion 6,12,24,and 72 h (all P<0.05).Conclusion s Mild hypothermia can decrease neurological deficits and reduce infarct volume after cerebral ischemia-reperfusion,its mechanism may be associated with the down-regulation of the Id2 expression.

Objective To compare arthroscopic double-pulley knotless suture bridge with conven tional arthroscopic suture bridge in repair of rotator cuff tear.Methods From May 2013 to May 2015,70patients with rotator cuff tear were repaired at our department.They were 38 males and 32 females,with a mean age of 53.7 years.They were randomized into 2 equal groups to receive repair either using arthroscopic double-pulley knotless suture bridge (the experimental group) or using conventional arthroscopic suture bridge (the control group).The 2 groups were compared postoperatively in terms of VAS (visual analogue scale),Constant,ASES (American Shoulder and Elbow Surgeons) and UCLA (University of California at Los Angeles) scores,shoulder range of motion,and rotator cuff retear.Results The 2 groups were compatible with no significant differences in gender,age,laterality,tear type,or preoperative function or range of motion of the shoulder joint (P ＞ 0.05).At 12 months postoperatively,the VAS,Constant,ASES and UCLA scores and shoulder range of motion in the experimental group were respectively 1.1 ± 1.3,86.0 ±8.9,13.3 ± 0.8,32.0 ± 2.9,156.8° ± 15.0° and 55.9° ± 5.8°,significantly improved than the preoperative values (P ＜0.05).At 12 months postoperatively,the VAS,Constant,ASES and UCLA scores and shoulder range of motion in the control group were respectively 1.3 ± 1.3,86.6 ±4.2,13.1 ± 1.0,31.1 ±2.6,153.3°±10.0° and 55.7° ± 5.1 °,significantly improved than the preoperative values (P ＜ 0.05).At 12 months postoperatively,there were no significant differences between the 2 groups in VAS,Constant,ASES or UCLA scores or shoulder range of motion (P ＞ O.05).No case of rotator cuff retear occurred in the experimental group while 5 cases were observed in the control group,showing a significant difference (0 versus 14.3％) (P ＜ 0.05).Conclusions Compared with conventional arthroscopic suture bridge,arthroscopic double-pulley knotless suture bridge presents no significant differences in range of motion or function of the shoulder joint in repair of rotator cuff tear.However,the latter may lead to a lower incidence of rotator cuff retear and,additionally,is less skillfully demanding.

Objective To establish a method for preparing orthotropic transplantable hepatocellular carcinoma in mice. Methods According to the liver detailed anatomical structure of the mouse, 50 μl mouse ascites containing 1 ×106 and 5 ×105 mouse hematoma H22 cells was input to liver in 12 Kunming mice through percutaneous intraperitoneal injection by syringe, respectively, to establish orthotopic transplantable hepatocellular carcinoma model. The growth status of mice was observed, and the pathological changes of liver and tumor metastasis tissues were detected. The tumor formation and metastasis were analyzed. Results The tumor formation rate was 100% (12/12) by direct injection of mouse hematoma H22 cells in 2 groups. The inoculated mice started to appear ascites at the 6th day, and all mice produced ascites at the 10th day. The survival time was (16.17 ±3.07) d and (18.08 ±3.34) d in 1 ×106 group and 5 ×105 group, respectively. Some mice emerged tumor metastasis in kidney, intestine, spleen and mesenteric lymph nodes. Conclusion The method of direct injection could establish orthotropic transplantable hepatocellular carcinoma model in mice, which can be used for antitumor drug research.