Objective To understand the incidence trend of ventilator -associated pneumonia(VAP)in ICU and to evaluate the effects of the interventions on the incidence of VAP,so as to provide scientific evidences for the prevention of VAP.Methods A study of 149 patients with VAP occurred in the 3 710 patients of ICU before and after intervention during 7 /2010 -12 /2014 in Wujin People's Hospital,Changzhou city was conducted.It was divided into two stages:baseline survey and stem expectations,VAP interventions included:training and education,chlorhexidine oral care and maintain appropriate endotracheal tube cuff pressure,elevated head of bed to up to 30°and improved hand hygiene.Hospital infection control professionals collected the number of patients,basic information,length of hospital stay,days of receiving mechanical ventilation and the VAP incidence data in ICU.And then change of the VAP incidence of the intervention before and after the intervention was compared and evaluation of the effect of combined intervention measures.Results Prospective data from 3 710 patients hospitalized in ICU were collected for an aggregate of 14 831 days,the utilization rate of ventilator was 55.2%.The occurrence of VAP was 149 cases.The average rate of VAP was 18.2 cases per 1 000 ventilator -day.VAP was associated with a crude mortality of 7.56%and with increased ICU LOS of 13.2d.As the results of the interventions,the rate of VAP was decreased from 52.38 /1 000 during 7 /2010 -6 /2011 to 5.71 /1 000 during 1 /2014 -12 /2014.Conclusion The rate of VAP in the inves-tigated ICU has led to a decreased incidence of VAP under the comprehensive interventions.

6cm,the recrudescenc rates when factors were male,mild or moderate malignant,stage of Dukes C,distance from tumor to anus 4～6cm were significantly higher(?2=4.53,P

Objective:To evaluate effect of telephone follow-up combined with written instruction on compliance and Helicobacterpylori (H.pylori) eradication in patients with H.pylori infection.Methods:A total of 160 H.pylori positive patients were randomly divided into an experimental group and a control group (n=80 in each group).Ml the patients got the guide instruction named the guidance of clinical medication for H.pylori infection patients before the treatment.The patients in the experimental group were added individualized follow-up with telephone.The compliance,eradication ofH.pylori,adverse events,and satisfaction were compared between the 2 groups.Results:The eradication rate of H.pylori in the perprotocol analysis for the experimental group and control group were 64.4％ (47/73) and 56.5％(35/62),respectively (P=0.380),while in the intention-to-treat analysis,the rates were 58.8％ (47/80) and 43.8％ (35/80,P=0.082),respectively.The compliance rate in the experimental group was significantly higher than that in the control group (91.3％ vs 77.5％,P＜0.05).There was significant difference in patients' satisfaction in good ones (75.3％ vs 51.6％) and poor ones (5.5％ vs 21.0％) between the 2 groups (P＜0.05).There were 11 patients in the experimental group and 36 patients in the control group,who appeared adverse reactions such as nausea,bad breath,abdominal distention,poor appetite,and defecation habit change during the process of eradicating H.pylori,but the occurrence rate in the experimental group was obviously lower than that in the control group (15.1％ vs 58.1％,P＜0.05).Conclusion:The telephone follow-up cannot increase the H.pylori eradication rate,but it can improve compliance and satisfaction for the patients and relieve adverse effects.

Objective To investigate the effects of ketamine on the expression of NMDA receptor-1(NRⅠ)in a rat model of focal cerebral ischemia and the possible mechanism of the neuroprotection.Methods Forty healthy male SD rats weighing 250-290g were randomly divided into 2 group(n=20 each):groupⅠketamine and groupⅡpentobarbital.The aminals were anesthetized with intraperitoneal ketamine 60 mg?kg~(-1) in groupⅠor pentobarbital 40 mg?kg~(-1) in groupⅡ.Focal cerebral ischemia was produced by permanent middle cerebral artery occludion(MCAO).The animals were killed at 24 h and 72 h of MCAO and their brains removed for determination of infarct size,the number of living neurons in the penumbra and the expression of NRⅠprotein(immuno- histochemistry).Results The infarct size was significantly smaller;the number of living neurons in penumbra significantly larger and NRⅠexpression significantly down-regulated in ketamine group than in pentobarbital group.Conclusion Ketamine can protect the brain against ischemia through downregulation of NMDA receptor-1.

BACKGROUND: Osteoblasts derived from bone marrow stromal stem cells are the main force of the cells In bone marrow cavity.In the artificial joint replacement cases, their life situation is closely related to conductive pressure of prosthesis.OBJECTIVE: To observe the continuous pressure on the proliferation of rabbit's bone marrow stromal stem cells, and to reveal the biomechanism of continuous pressure causing loosening and sinking of prosthesis and its activity after replacement.DESIGN, TIME AND SE'I-I'ING: A randomized study based on cytology was performed at the Institute of Othorpaedics, the Fourth Military Medical University of Chinese PLA from February 2004 to October 2007.MATERIALS: One New Zealand rabbit aging 1 month and weighing 0.5 kg was used to extract the bone marrow stromal calls.METHODS: The third-passaged bone marrow stromal stem cells were inoculated in seven 24-well culture plates at the density of 1 × 104 cells/well. After 14 hours, cells were adherent completely and cultured in DMEM culture media containing 10% fetal bovine serum. Thereafter, the four culture plates were randomly divided into 4 experimental groups, including control group without any pressure, and continuous pressure (20, 60, and 100 kPa) groups. The continuous pressure was performed for 3 hours every day.MAIN OUTCOME MEASURES: Absorbance was detected at day 1, 3, 5, and 7 after culture using MTT assay.RESULTS: Absorbance of the three pressure groups after 3, 5 and 7 days was significantly lower than the control group (P < 0.01). There was no significant difference in absorbance between 20 kPa continuous pressure group and 60 kPa continuous pressure group on the third day (P >0.05); but the absorbance was significantly higher than 100 kPa continuous pressure group (P < 0.05). On the fifth day, there was significant difference in absorbance between paired continuous pressure groups (P < 0.05),i.e., the higher the continuous pressure was, the lower the absorbance was. On the seventh day, the absorbance of the 100 kPa continuous pressure group was significantly lower than 20 kPa continuous pressure group (P < 0.05).CONCLUSION: Patients with eady post-joint replacement had better not stand on the ground; otherwise, a continuous stress will be caused so as to induce the restrain of bone marrow stromal stem calls in the bone marrow cavity, which is not helpful for bone healing and easily causes subsidence and loosening of prosthesis.

Objective To evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR) and hemoglobinto-white blood cell ratio (HWR) prior to treatment in prognosis of non-operative esophageal squamous cell carcinoma (ESCC) patients.Methods From October 2009 to November 2014,a total of 362 non-operative ESCC patients were enrolled in this prospective study.x2 test was used to analyze the relationship between NLR,HWR and general clinical features;Univariate and multivariate Cox regression analysis was performed to evaluate the association between variables and prognosis of non-operative ESCC patients.Results The optimal cutoff level of 1.23 for NLR and 24.92 for HWR were identified by X-title software.x2 test indicated NLR was significantly associated with gender,tumor length,T stage,TNM stage and fasting blood glucose level.Moreover,univariate and multivariate analyses showed that high NLR and high HWR were all associated with a poor prognosis in non-operative ESCC.However,when patients were specifically stratified by treatment modus,subset analysis showed that NLR was only predictive of prognosis in the concurrent chemoradiotherapy group (HR =4.080,95％ CI:1.074-15.497,P =0.039),whereas the influence of HWR on prognosis was just existed in the sequential chemoradiotherapy group (HR =2.625,95％ CI:1.311-5.254,P =0.006).Conclusions In this investigation,we found that high NLR and high HWR were associated with poor prognosis in non-operative ESCC.

BACKGROUND:Studies have shown that sacral nerve-root stimulation based on anodes block technique can effectively reconstruct the bladder voiding function of the rabbits with spinal cord injury. But the corresponding technology of stimulating electrode has not been reported so far.
OBJECTIVE:To design and develop the stimulating electrodes matching with both rabbit sacral nerve roots and anodal blocking technique, to observe the ultrastructure and morphological change of rabbit sacral nerve roots which implanted in electrode stimulation for a long-term and to assess the safety of stimulating electrodes.
METHODS:Thirty New Zealand rabbits were included, 10 rabbits were randomly selected from them and sacrificed after anesthesia, and then cut the anterior roots of bilateral S 2 and S 3 immediately;after measuring the diameter under the light microscope, the sleeve type stimulation electrode matched with the diameter was made. The remaining 20 rabbits were randomly divided into control group and implantation group, with 10 rabbits in each group. In the implantation group, the stimulating electrodes were implanted into the forepart of S 2 and S 3 nerve roots after anesthesia, and then sacrificed after fed for half a year for col ecting the samples. Then ultrastructure change of sacral nerve roots with the implantation was observed.
RESULTS AND CONCLUSION:Structure of nerve cel s of sacral nerve roots remained in good condition under a light microscope after long-term implantation of the stimulating electrodes. No obvious degeneration of axons, no inflammatory infiltration and glial scar formation were observed. In the implantation group, myelins arranged closely without demyelination phenomenon, and there was no atrophy of neuronal nuclear, no nuclear sag, no increased nuclear decompression and heterochromatin in neurons under the light microscope. Immunohistochemical analysis showed, compared with the control group, there were no significant differences in the expressions of glial fibril ary acidic protein, Bax, Bcl-2 and Caspase-3 proteins of nerve roots in the implantation group. The stimulation electrode of rabbit sacral nerve root is developed successful y, that is, the implantation is simple and safe as it can be used for long-term implantation without histopathological changes and apoptosis.

In this cross-sectional survey,2 682 traffic policemen in Tianjin were enrolled,and they were tested with Occupational Stress Inventory-Revised (OSI-R) and Symptom Checklist 90 (SCL-90).Body mass index,blood pressure,fasting blood glucose,triglycerides,and high-density lipoprotein-cholesterol ( HDL-C ) were also determined at the same time. Correlation analysis showed that body mass index was positively correlated with somatization ( r =0.039,P =0.045 ),hostility ( r =0.046,P =0.01 8 ),and psychoticism ( r =0.041,P =0.036).Systolic blood pressure was positively correlated to somatization (r =0.056,P =0.004 ),obsessive-compulsiveness ( r =0.044,P =0.023 ),interpersonal sensitivity ( r =0.041,P =0.034 ),depression ( r =0.039,P =0.043),anxiety ( r =0.055,P =0.004 ),and psychoticism ( r =0.051,P =0.009 ).Diastolic blood pressure was positively correlated to somatization ( r =0.047,P =0.015 ),interpersonal sensitivity ( r =0.042,P =0.030 ),anxiety ( r =0.050,P =0.010 ),and psychoticism ( r =0.047,P =0.014 ).Fasting blood glucose was positively correlated to somatization ( r=0.042,P=0.028 ).Multiple regression analysis showed that occupational stress factors were role boundary,physical environment,responsibility,recreation,role ambiguity,role overload,and cognitive coping.Among these factors,role ambiguity and cognitive coping reduced occupational stress while others increased the stress.The results of the unconditional logistical regression analysis showed that there is an independent association of metabolic syndrome with somatization,role insufficiency,and physical strain for the task and body tension ( P＜0.01).

ObjectiveTo investigate the expression and clinical significance of heat shock transcription factor 1 (HSF1) protein in human hepatocellular carcinoma (HCC) tissues,and deduce the probable molecular mechanism of HSF1 in the development and advancement of HCC.MethodsSixty-seven samples of HCC tissue and 21 samples of normal liver tissue were obtained from March 2006 to March 2007 at the Xijing Hospital.The expressions of HSF1 protein and heat shock protein 70 (HSP70) were detected by using immunohistochemistry.The probable molecular mechanism of HSF1 in the development and advancement of HCC was deduced according to the relationship between the expressions of HSF1 protein and HSP70.Positive rates of HSF1 protein in different tissues and the relationship between HSF1 protein expression in the HCC tissues and clinical pathological factors were analyzed by the chi-square test and by calculating Fisher exact probability,respectively.The correlation between the expressions of HSF1 protein and HSP70 in the HCC tissue was analyzed by the Spearman correlation coefficient.The survival curve was drawn by the Kaplan-Meier method,and the survival rate was analyzed by the Log-rank test.ResultsThe positive rates of HSF1 protein expression was 69％ (46/67) in the HCC tissue,which was significantly higher than 29％ (6/21) in the normal liver tissue ( x2 =10.628,P ＜ 0.05 ),The positive rates of HSP70 expression in the HCC tissue was 57％ (38/67),which was significantly higher than 24％ (5/21) in the normal liver tissue ( x2 =6.929,P ＜ 0.05 ).The expression of HSF1 protein in the HCC tissue was positively correlated with that of HSP70 (r=0.319,P ＜0.05).The high expression of HSF1 protein was correlated with the integrity of capsule of HCC,tumor differentiation and TNM stage (x2 =5.935,9.762,5.159,11.267,P＜0.05 ),while the high expression of HSF1 protein was not correlated with the gender,age,levels of hepatitis B surface antigen and alpha fetoprotein,and portal vein tumor thrombus ( x2 =0.822,0.172,2.059,P ＞0.05 ).The survival time was (21.4 ± 1.9 )months for patients with positive HSF1 protein expression and (29.8 ± 2.7 ) months for patients with negative HSF1 protein expression.There was a significant difference in the survival time between patients with positive and negative HSF1 protein expression ( x2 =4.276,P ＜ 0.05 ).Conclusions HSF1 is correlated with the development,advancement,invasion,metastasis and malignant prognosis of HCC.HSF1 takes effects by regulating the expression of HSP70,and it has a good perspective of clinical application for the diagnosis and treatment of HCC.

Objective To compare the cuffed renal vein technique and the classical techniques in kidney transplantation.Method The classical techniques of mouse renal transplantation required clamping both vena cava and aorta simultaneously and carried out suture anastomoses of the renal artery and vein in a heterotopic position.In our laboratory,we have successfully developed mouse orthotopic kidney transplantation for the first time,using a rapid cuffed renal vein technique for vessel anastomosis,wherein the donor's renal vein was inserted through an intravenous catheter,folded back and tied.During grafting,the cuffed renal vein was directly inserted into the recipient's renal vein without the need for clamping vena cava and suturing renal vein.Result This technique allowed for the exact transplantation of the kidney into the original position,compared to the classical technique,and had significantly shortened the clamping time due to a quicker and more precise anastomosis of renal vein as described.The renal vein anastomoses time was dramatically shortened in cuffed renal vein technique (4 min) as compared with the classical technique (9 min,P＜0.001).This also allowed for a quicker recovery of the lower extremity activity,reduction in myoglobinuria with resultant kidney graft survival of 88.9％.Conclusion The cuffed renal vein technique simplifies microvascular anastomoses and affords important additional benefits.