Objective To compare the influences of different routes of nutrition on the outcome and respiratory muscle strength of elderly patients in respiratory intensive care unit (RICU). Methods Totally 147 elderly patients in RICU were equally randomized into combined nutrition group ( combinination of parenteral nutrition and enteral nutrition), total enteral nutrition (EN) group, and total parenteral nutrition (PN) group. The changes of energy metabolism, respiratory muscle strength, and short-term outcome were observed or determined.Results Plasma albumin (ALB), hemoglobin (Hb), creatinine (Cr) levels, and nitrogen balance significantly increased in all group 7 days later ( all P ＜ 0. 01 ), while blood urea nitrogen (BUN) significantly decreased ( P ＜0.01 ). The increase of ALB, Hb, Cr levels, and nitrogen balance were significantly more remarkable than that in EN group and PN group (P＜0.05 or P＜0.01). The decrease of BUN level in the combined nutrition group was significantly more remarkable than that in EN group ( P ＜ 0. 05 ). After nutritional support, the maximum inspiratory pressure in the combined nutrition group (P =0. 021 ) and EN group (P = 0. 011 ) became significantly higher, and occlusion pressure at 0.1 second inspiration level in the combined nutrition group became significantly lower ( P =0. 025). The incidences of infectious and non-infectious complications in PN group were significantly higher than those in EN group (P = 0. 002 and 0. 017, respectively) and combined nutrition group ( P = 0. 005 and 0. 004, respectively). Gastric retention was more common in EN group than that in PN group ( P = 0. 035). The weaning time,length of RICU stay, length of hospital stay and 20-day-mortality were significantly decreased in the combined nutrition group than those in the other two groups ( all P ＜ 0. 05 ). Conclusion The effectiveness of the combined application of PN and EN is superior to PN or EN alone in improving nutritional status and respiratory muscle strength as well as in improving the short-term outcome in elderly patients in RICU..

Dental Bonding ; Dental Implant-Abutment Design ; Humans ; Matrix Metalloproteinases

The metabolic properties of cancer cells diverge significantly from those of normal cells. Energy production in cancer cells is abnormally dependent on aerobic glycolysis. In addition,cancer cells have other metabolic characteristics,such as increasing fatty acid synthesis and glutamine metabolism. Emerging evidences show that many key enzymes in dysregulated Warburg-like glucose metabolism,fatty acid synthesis and glutaminolysis are linked to drug resistance in cancer treatment. For example, lactate dehydrogenase A contributes to paclitaxel/trastuzuma resistance in breast cancer, fatty acid synthase is linked to docetaxel/trastuzumab/adriamycin resistance in breast cancer, and glutaminolysis is linked to cisplatin resistance in gastric cancer. Therefore,targeting cellular metabolism may improve the response to cancer therapeutics,and the combination of chemotherapeutic drugs with cellular metabolism inhibitors may overcome drug resistance in cancer therapy. This review discussed the relationship between dysregulated cellular metabolism and chemotherapy resistance, and the way in which targeting of metabolic enzymes can help overcome the resistance to cancer therapy or enhance the efficacy of common therapeutic agents.

Objective To compare the clinical efficacy of intramedullary pin versus plate fixation for displaced mid-shaft clavicle fractures.Methods The databases,PubMed,CENTAL and CBM,were searched according to the standards of the Cochrane Collaboration for all the randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing intramedullary pin with plate fixation for treatment of displaced mid-shaft clavicle fractures.In addition,hand search was also conducted in relevant journals.Time limit for search was from the beginning till December 2013.Trial quality was assessed using the modified Jadad scale and effective data were pooled for Meta analysis with software RevMan5.2.7,including wound infection,hospital stay,wound size,intraoperative blood loss,operation duration,implant irritation,implant problems,delayed union,malunion,nonunion,total complications and Constant scoring.Results Three RCTs and 7 CCTs with 697 patients were included in our study.The modified Jadad scoring showed fine quality of the 10 trials.Intramedullary fixation was significantly superior to plate fixation in wound size,intraoperative blood loss,operation duration,hospital stay,wound infection,and symptomatic hardware (P ＜ 0.05),but led to a significantly higher rate of implant problems (P ＜ 0.05).However,no significant differences were identified in total complication rate,delayed union,nonunion,malunion or Constant score (P ＞ 0.05).Conclusions The superiority of intramedullary fixation for displaced mid-shaft clavicle fracture lies in its advantages of minimally invasion,such as limited incision,less intraoperative bleeding,shorter operation time and hospital stay,less wound infection and implant irritation.Ahhough intramedullary fixation may lead to a higher rate of implant problems,it shows no significant differences from plate fixation in bone healing and functional recovery.

Objective To investigate the action mechanism of blood-stage treatment that affects psoriasis vulgaris using observation of the Th17/Treg expression.Methods A total of 32 patients ( blood heat group,n =17 ; blood stasis group,n =15) and 15 healthy people ( control group,n =15 ) were observed.The frequencies of Th17 and Treg in peripheral blood were detected by flow cytometric analysis in patients before and after treated by heat-clearing and blood-cooling decoction,qi-enriching and blood-activating decoction.Results The ratio of Th17/Treg in peripheral blood [ blood heat group (4.21 ± 0.52 )％ ;blood stasis group( 3.32 ± 0.43 )％ ] was significantly increased in patients compared with controls [ ( 1.79 ±0.18)％ ] ( P ＜0.01 ).After herbal treatment,the ratio of Th17/Treg expression in the blood heat group [ ( 2.41 ± 0.22 ) ％ ] and in blood stasis group [ ( 2.02 ± 0.12 ) ％ ] was significantly decreased ( P ＜ 0.05 ),respectively.Conclusions Blood-stage treatment works well on Th17/Treg expression in patients with psoriasis vulgaris.

Objective To explore the job burnout and its related factors among nurses.Methods 486 clinical nurses from a three grade second level general hospital were investigated by Moreno-Jimenez nursing burnout scale (NBS) and using SPSS17.0 software and ANOVA method to analyse the data.Results NBS results showed the score of job burnout in 486 objects was (164.92 ± 25.60).Significant differences of job burnout levels were showed among ages,marital status,professional titles,working periods,working relationship,work load,income,and housework periods (P ＜ 0.05).Conclusion Job burnout is a general phenomenon in these investigated nurses and its level is above average.Administrators should pay more attention to these related factors which can easily cause job burnout and take positive feasibility assistant strategies.

Objective To evaluate the performance of the target controlled infusion(TCI) system with midazolam during combined spinal and epidural anesthesia. Methods Twenty female patients scheduled for selective lower abdominal or pelvic surgery under combined spinal and epidural anesthesia were enrolled in this study. They use combined spinal and epidural anesthesia with target controlled infusion of midazolam sedation. Midazolam plasma concentration was set at 100ng/ml. Blood pressure,heart rate, pulse oxygen saturation were monitored during anesthesia and operation. We use BIS as a pharmacodynamic value of midazolam sedation. Blood samples were taken from radial arterial for analysis of plasma midazolam concentration during infusion. Midazolam plasma concentration were tested by high performance liquid chromatography. Results MDPE of target controlled infusion with midazolam with Burher parameters was 38.7%, MDAPE was 38.7%,and wobble is 24.9% in Chinese female patients. Conclusions Burher parameters of midazolam target controlled infusion system should be correct, then can be used for our country female patients conscious sedation accurately.

Objective: To summarize and analyze the early outcomes and clinical experience in 1198 patients undergone off-pump coronary artery bypass (OPCAB). Methods: This multi-center report covers 15 different institutes in China from October 1996 to May 2002. The ratio of OPCAB to conventional coronary artery bypass grafting (cCABG) was 85.2%. The mean age was (61.6?9.0) years. 77.3% patients were male and 22.7% were female. There were 34.6% patients with myocardial infarction, 58.2% with unstable angina pectoris, 18.7% with left main lesion, 76.9% with triple-vessel disease, 1.5% was redo surgery, and 9.9% emergent or urgent surgery. The mean left ventricular ejection fraction was 0.56?0.17. Results: The number of distal anastomosis was 3.1?0.9. IMA was used in 65.6% patients and radial artery was used in 18.0%. 13.5% OPCAB was combined with TMLR. IABP was used in 5.2% patients. The hospital mortality was 1.2%. The morbidity included 0.4% peri-operative myocardial infarction, 0.3% heart failure, 1.2% fatal arrhythmia, 2.0% pulmonary complications, 1.2% neurotic disorder, 0.7% renal dysfunction, 1.0% reopen for bleeding, and 0.6% delayed wound healing. Conclusion: OPCAB surgery is a safe and feasible procedure with good early results. Its late outcomes need further follow-up. OPCAB requires certain special skills and methods in practice so a specific training course should be designed.

17-allylamino-17-demethoxygeldanamycin (17-AAG) is a heat shock protein 90 ( HSP90) inhibitor. It is capable of target-inhibiting tumor-derived HSP90, leading to the depletion of on-cogenic client proteins which play key roles in several signal transduction pathways. Then cell growth and differetiation are inhibited. 17-AAG results in cytostasis and apoptosis. A lot of trials have indicated that 17-AAG is a selective target drug for cancer therapy. It can efficiently inhibit multiple signal transduction pathways involved in tumor cell proliferation and survival. Clinical phaseⅠand phaseⅡtrials have shown that 17-AAG has good pharmacokinetic-pharmacodynamic profile. Moreover, it can combine with radiation and the traditional chemotherapeutics and increase the therapeutic efficacy.

OBJECTIVE To investigate the clinical practicability of inducible clindamycin resistance and to evaluate the clinical value of cefoxitin disk diffusion method in detecting the mecA gene of meticillin-resistant Staphylococcus(MRS). METHODS Resistant phenotypes were classified with erythromycin and clindamycin discs using the D test method and the cefoxitin disk diffusion method in detecting mecA gene of the staphylococcus. RESULTS Of all 390 Staphylococcus strains,218 strains(55.9 %) were resistant to erythromycin and clindamycin(cMLS).Seventy strains(17.9 %) which were resistant to erythromycin but susceptible to clindamycin showed the positive D test results(iMLS),79 strains(20.3 %) resistant to erythromycin but susceptible to clindamycin showed the negative D test results(MS).From 390 strains of clinical isolated staphylococcus,which using the cefoxitin disk diffusion method,272 strains were MRS. CONCLUSIONS Using the D test method to investigate the inducible resistance to erythromycin and clindamycin in the Staphylococcus strains,which could help the doctors choose correctly the antibiotics such as macrolides and clindamycin.At the same time,cefoxitin disk diffusion method can be used reliably by the clinical laboratory in detecting and conforming MRS.