Objective To study the incidence of ventilator-associated pneumonia(VAP)and antimicrobial resistance of pathogens in an intensive care unit(ICU).Methods The occurrence of VAP in hospitalized patients with mechan-ical ventilation>48 hours between January 2011 and December 2012 were investigated,species and antimicrobial re-sistance of pathogens causing early onset-VAP (E-VAP,mechanical ventilation≤4 d)and late-onset VAP(L-VAP, mechanical ventilation>4 d)were compared.Results A total of 1 76 patients were investigated,incidence of VAP was 44.32% (78 cases);With the prolongation of mechical ventilation,incidence of VAP increased gradually (χ2=52.561,P<0.001).The incidence of L-VAP was significantly higher than E-VAP (58.33% [70/120]vs 14.29%[8/56])(χ2= 30.02,P<0.001).A total of 178 pathogens were isolated,gram-negative bacteria,gram-positive bac-teria and fungi were 104(58.43% ),46(25.84% ),and 28(15.73% )isolates respectively;97(54.49% )multidrug-resistance/pandrug resistance organisms (MDRO)were isolated. MDRO isolation rate in L-VAP patients was high-er than E-VAP patients([58.86% ,n= 93]vs [20.00% ,n= 4]),resistance rate of major pathogens causing L-VAP was significantly higher than E-VAP patients(allP<0.05).Fungi infection only occurred in L-VAP patients,the total antimicrobial resistance rate was 12.14% .Conclusion The prolongation of mechanical ventilation can increase the incidence of VAP,and resistance rate of pathogen in L-VAP is high.

Objective To investigate the role of the predictive prognostic value of BRCA1 screened by whole genome expression profiling in ductal carcinoma in situ.Methods Collected 4 cases of breast ductal carcinoma and 4 cases of breast invasive ductal carcinoma fresh samples from January 2014 to June 2014,and the difference of BRCA1 expression on whole genone expression profiling was analyzed by microarray comparative genomic hybridization.The expression of BRCA1 was detected by immunohistochemistry in 70 cases of ductal carcinoma in situ of the breast,and the prognosis of intraductal carcinoma was evaluated.Results BRCA1 gene differentially expressed in invasive ductal carcinoma and ductal carcinoma in situ by screening.The positive rate of BRCA1 protein in breast ductal carcinoma in 14.3％ (10/70),its expression had no significant relationship with age (P =0.959),menopause (P =0.959),tumor size (P =0.627),axillary lymph node status (P =1.000),HR status (P =0.958),HER-2 status (P =1.000),P53 expression (P =0.460).ductal carcinoma with micro-infiltration ratio in BRCA1 negative group was higher than BRCA1-positive group (P =0.043).The median follow-up of 47 months,Disease-free survival rate of all was 97.1％.Disease-free survival of BRCA1 negative group and BRCA1-positive group had no significant difference (96.7％ vs 100％,P =0.569),over all survival of BRCA1 negative and positive groups was 100％.Conclusions BRCA1 expression may not predict the prognosis of intraductal carcinoma,but ductal carcinoma in situ with microinvasion group ratio in BRCA1 negative was higher than ductal carcinoma in situ group,BRCA1 may take affect within ductal carcinoma infiltration process work.

Objective Resarech on the value of body mass index (BMI) predicting efficacy of neoadjuvant chemotherapy and prognostic in breast cancer.Methods Clinical data of 99 patients who received neoadjuvant chemotherapy Ⅱ B-Ⅲ C stage breast cancer patients was collected between January 2007 and December 2013 in Women and Children Hospital of Guangdong Province.Anaslysing the relation of BMI and efficacy of neoadjuvant chemotherapy and prognosis.Results In the study, Clinaical complete ressiom was 12.1％ (12/99), partal ressiom was 68.7％ (68/99), stable disease or disease progression was 19.2％ (19/99), respone rate was 80.8％ (80/99), pathlogic complete ression was 9.1％ (9/99).BMI was significantly associated with response rate(P =0.039), but not with pathlogic complete ression (P =0.454).Univariate and multivariate analysis showed that BMI was not significantly associated with disease free survival and overall survival(P ＞ 0.05).Conclusions BMI was significantly associated with response rate, overweight or obese patients would prodict poorly efficacy of neoadjuvant chemotherapy.The relationg of BMI and prognosis of breast cancer who accepted neoadjuvant chemotherapy is not clear, for further study.

Anxiety is a strong behavioral and psychological reaction with fear components, while depression is a mental disorder dominated by high or low mood, both of which are accompanied by cognitive and behavioral changes, and are common comorbidities in patients with heart disease. Cardiac surgery is one of the important factors which trigger specific emotional and physiological reactions of patients. Persistent or initial depression and anxiety after surgery will not only increase surgical complications, short- or long-term mortality and medical costs, but also seriously affect patients' social function and quality of life. With the transformation of bio-psycho-social medical model, it is necessary to evaluate the perioperative psychological state and biological risk of patients undergoing cardiac surgery. This article reviews the characteristics, related mechanisms and therapeutic interventions of anxiety and depression in patients undergoing cardiac surgery.

OBJECTIVETo establish HPLC characteristic fingerprints of the saponins in Pulsatilla medicinal plants, and provide the basis for authentication and classification of Pulsatilla species.

METHODThe HPLC profiles were determined at 35 degrees C on a Symmetry C18 column (4.6 mm x 250 mm,5 microm) eluted with water (A) and acetonitrile (B) as mobile phases in a linear gradient elution with the flowrate of 0.5 mL x min(-1). The elution program was as follows: 0-8 min, 90% A to 77% A, 8-25 min, changed to 71% A, 25-40 min, to 60% A, 40-50 min, to 50% A, 50-75 min, to 10% A, 75-80 min, to 0% A. The detection wavelength was set at 210 nm.

RESULTThe different species of Pulsatilla showed different HPLC fingerprints, but with 10 common peaks. A cluster analysis of 14 accessions indicated that they were divided into four groups: all accessions from P. koreana were classified into group I, P. ambigua in group II, P. dahurica and P. turczaninovii in group III, and P. chinensis in group IV, respectively. The significant differences between P. koreana and P. dahurica, and between P. turczaninovii and P. ambigua were observed.

CONCLUSIONThe results obtained were in agreement with the traditional taxonomic study. The method was rapid and precise, not only can be used to classify and authenticate Pulsatilla species, but also provides important references for HPLC fingerprints and quality control of Pulsatilla medicinal plants.

Chromatography, High Pressure Liquid ; methods ; Cluster Analysis ; Plants, Medicinal ; chemistry ; classification ; Pulsatilla ; chemistry ; classification ; Quality Control

Objective:To explore the relationship between growth arrest-specific protein 6 (Gas6) and acute myocardial infarction (AMI).Methods:Patients were included from Renmin Hospital of Wuhan University between January to June 2018. A total of 103 patients with angina pectoris aged 60.20±9.35 were included as angina pectoris group. A total of 102 patients with myocardial infarction aged 58.85±9.80 were included as AMI group. A total of 130 healthy individuals aged 63.14±10.40 were included as healthy control. Spearman analysis was performed to investigate the correlations between Gas6 and risk factors of (coronary heart disease, CHD). Logistic regression was performed to investigate the risk factor of myocardial infarction. ROC (receiver operating characteristic) curve was used to analyze the diagnostic performance of Gas6 to AMI.Results:The levels of Gas6 in angina pectoris group [13.77 (10.57-17.03) ng/ ml, t=2.444, P=0.025] and AMI group[16.22 (12.70-20.09) ng/ml, t=4.965, P<0.001] was higher than control group [10.92 (8.90-14.92) ng/ml]. The levels of Gas6 in angina pectoris group was lower than AMI group ( t=3.854, P<0.001). In the sensitivity analysis excluding hypertension and diabetes, the serum Gas6 level in AMI group ( n=37) [15.05 (11.08-16.20) mg/L] was higher than that in control group [10.93 (8.91-14.93)mg/L, t=3.479, P=0.001] and angina group ( n=42) [12.85 (9.10-16.20) mg/L, t=2.639, P=0.019]. CRP (C-reactive protein), WBC (white blood cell count), Glu (fasting glucose) and Cr (creatinine) were positively correlated with Gas6, r=0.194, 0.176, 0.180 and 0.120, P value=0.010, 0.012, 0.010 and 0.002, respectively. Logistic regression showed that Gas6 was a independent factor of myocardial infarction [ OR and 95 %CI were 1.080 (1.012-1.152), P=0.020]. AUC and 95 %CI of ROC curve was 0.648 (0.572-0.723). Conclusion:The levels of Gas6 may be positively associated with myocardial infarction risk.

The liver is a highly proliferative organ. As the liver injured, the hepatocytes can quickly enter the cell cycle to restore the volume and function of liver. Liver regeneration involves complex processes that depend on the interaction of many different cell types. As limited by the average cell change level in tissues, traditional sequencing methods can only acquire the average genetic information reflecting dominant cell subpopulations, but ignore the secondary cell subpopu-lations, which leads to the loss of cellular heterogeneity information. Single-cell sequencing tech-nology can analyze the biological behavior of single cell, which helps to better understand the distri-bution, interaction and cell heterogeneity of different cells during liver regeneration. The authors review the application of single cell sequencing technology in liver regeneration.

OBJECTIVETo study lung protection by perfusion with hypothermic protective solution to the pulmonary artery during total correction of tetralogy of Fallot (TOF).

METHODSSixty-four consecutive children with TOF were randomly divided into control group (n = 30) and lung protective group (n = 34). The way of lung protection in the lung protective group was to perfuse with hypothermic protective solution to the pulmonary artery. Patients in the control group were subjected to routine approach. Patients' hemodynamics and lung functions were monitored. Plasma malondialdehyde (MDA), TNF-alpha and IL-6, IL-8 in tracheal suction were measured. Lung biopsy specimens were obtained after operations to study histological changes.

RESULTSThe oxygen index was higher in the lung protect group than in the control group at 6 h, 12 h and 24 h after operation (t = 2.400, P < 0.05; t = 3.898, P < 0.01; t = 3.339, P < 0.01, respectively). The time for ICU and mechanical ventilation was significantly less in the lung protective group than in the control group (t = -2.652, P < 0.05; t = -2.081, P < 0.05). The level of MDA was lower in the lung protective group than in the control group at 0 h and 6 h after operations (t = -4.255, P < 0.01; t = -2.372, P < 0.05 respectively). The level of TNF-alpha was lower in the lung protective group than in the control group at 0 h, 6 h and 24 h after operation (t = 3.112, P < 0.01; t = 3.072, P < 0.01; t = 2.306, P < 0.05, respectively). The levels of IL-6, IL-8 in tracheal suction were lower in the lung protective group (t = -2.419, P < 0.05; t = -2.613, P < 0.01). Tissue examination showed intraalveolar edema, capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no change in the lung protective group.

CONCLUSIONPerfusion with hypothermic protective solution to the pulmonary artery in CPB could reduce lung injury during the total correction of TOF.

Cardiopulmonary Bypass ; adverse effects ; methods ; Child ; Child, Preschool ; Cold Temperature ; Female ; Humans ; Infant ; Lung Diseases ; prevention & control ; Male ; Perfusion ; Postoperative Complications ; prevention & control ; Pulmonary Artery ; Tetralogy of Fallot ; surgery

Objective:To investigate the risk factors of hypoalbuminemia (HA) in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) after endovascular mechanical thromboectomy (EMT) and impact on outcomes.Methods:Patients first diagnosed with anterior circulation LVO-AIS and underwent emergency EMT at the Department of Acute Stroke, the Affiliated Hospital of Jining Medical University from June 1, 2020 to April 31, 2023 were retrospectively included. According to the first follow-up serum albumin examination after procedure (6-8 d), the patients were divided into HA group (<35 g/L) and non-HA group (≥35 g/L). According to the modified Rankin Scale score at 90 d after EMT, the patients were divided into a good outcome group (0-2) and a poor outcome group (3-6). Univariate and multivariate logistic analysis was used to determine independent risk factors for HA after EMT and their impact on outcomes. Results:A total of 144 patients were enrolled, including 107 males (74.30%) with a median age of 64 years (interquartile range, 56-71 years). There were 50 patients (34.72%) in the HA group and 94 (65.28%) in the non-HA group; 60 (41.67%) in the good outcome group, and 84 (58.33%) in the poor outcome group. Multivariate logistic regression analysis showed that age (odds ratio [ OR] 1.061, 95% confidence interval [ CI] 1.014-1.111; P=0.011) and pulmonary infection ( OR 5.136, 95% CI 1.917-13.760; P=0.001) were independent risk factors for HA; HA ( OR 4.345, 95% CI 1.367-13.814; P=0.013), pneumonia ( OR 5.113, 95% CI 1.217-12.528; P=0.026), and onset to reperfusion time ( OR 5.473, 95% CI 1.090-16.05; P=0.038) were independent risk factors for poor outcomes. Conclusions:Age and pulmonary infection are independent risk factors for HA in LVO-ASI patients after EMT, and HA is the independent risk factor for poor outcomes of the patients.

Compared with conventional cardiopulmonary resuscitation (CCPR), extracorporeal cardiopulmonary resuscitation (ECPR) can improve the survival rate of patients with cardiac arrest, and reduce the risk of reperfusion injury. However, it is still difficult to avoid the risk of secondary brain damage. Low temperature management has good neuroprotective potential for ECPR patients, which minimizes brain damage. However, unlike CCPR, ECPR has no clear prognostic indicator. The relationship between ECPR combined with hypothermia management-related treatment measure and neurological prognosis is not clear. This article reviews the effect of ECPR combined with different therapeutic hypothermia on brain protection and provides a reference for the prevention and treatment of neurological injury in patients with ECPR.
Humans ; Brain ; Cardiopulmonary Resuscitation ; Brain Injuries ; Hypothermia, Induced ; Heart Arrest