Objective To summarize the effect of bronchoscopy for sputum suction on aspiration pneumonia in elderly patients. Methods 45 elderly patients with aspiration pneumonia treated with bronchoscopy for early sputum suction on the basis of comprehensive treatment were assigned into group A ,and another 44 elderly patients with the same disease receiving the only comprehensive treatment as the control group (group B). After treatment,the two groups were compared in terms of temperature,WBC,arterial blood partial pressure of oxygen and lung shadow resolution. The key links in the operative manipulation were summarized. Results In group A, the temperature and WBC both resumed to the normal level, the time for increased arterial partial pressure of oxygen (PaO2) in group A was significantly shorter than in group B and lung shadow resolution significantly more evident than in group B (P < 0.01). In group A, the sputum suction was completed and there were no cases of death and serious complications. Conclusions Early bronchoscopy for sputum suction in the treatment of aspiration pneumonia in elderly people is effective. Skilled operation and accurate grasping of the key points of the suction process make sure that this technology can be more applicable in clinical practice.

Objective To investigate and analyze the cause of the illness, types and conditions combined with dysfunction of important organs and death of severe heatstroke patients in military hospitals in southern China. Methods 117 cases of heatstroke patients from Jan 1988 to Mar 2005 admitted to 8 military hospitals were retrospectively analyzed. Results 94.02% of the cases occurred during military drill; 10% of patients complained of slight discomfort before or during the drill; the incidence of thermoplegia, heat cramp and heat exhaustion were 43.26%, 42.55% and 13.86%, respectively, in severe heatstroke, and the respective death rate was 9.76%, 5% and 23%. The incidence of severe heatstroke combined with liver dysfunction was 31.9%, with central nervous impairment was 14.9%, and with MOF was 21.3%. All patients survived when no organ dysfunction occurred; the death rate in those with single organ dysfunction was 3.6%, while it was 35% in MOF patients. Conclusion An attempt to set up a predicting index of heatstroke might be beneficial for scientifically supervising the military drill for the servicemen. Reduction of the core temperature is the“the first critical point”in the treatment. Other “critical point” in the treatment may also be emphasized for those with MOF. The present therapeutic system for heat stroke as executed in the military needs to be perfected.

In order to identify problems in the use of antibiotics and propose corresponding countermeasures, a statistical analysis was made into 6 000 prescriptions and medical records detailing the use of antibiotics by outpatients and inpatients randomly selected from the years 2002～2003. It was found that the irrational use of antibiotics was prevalent. It is pointed out that high attention ought to be paid to the issue and countermeasures be adopted, including strengthening physician training in the "three basics", implementing various rules and regulations, adhering to the standards and guides for the use of antibiotics, dynamically tracing the use of antibiotics by means of the computer, and providing timely analysis and feedback of information on the use of antibiotics.

BACKGROUND:Bone marrow mesenchymal stem cells (BMSCs) can differentiate into renal paranchymal cells including renal intercapillary cells.BMSCs can repair kidney structure and function after damage.OBJECTIVE:To investigate renal histology and function changes following BMSC transplantation in a rat model of radiation-inducad damage.DESIGN,TIME AND SETTING:The cytological in vitro study was performed at the Laboratory of the Department of Hematology,Zhujiang Hospital from January to October 2009.MATERIALS:A total of 35 clean male Sprague Dawley rats were selected.Of them,20 were used to prepare BMSCs.The remaining was randomly assigned to a normal control,model and cell transplantation groups,with 5 in each group.METHODS:Rat BMSCs were incubated by the whole bone marrow method.When 90% cells were confluent,BMSCs were digested in trypsin for subculture.In the model and cell transplantation groups,rats were used to establish radiation-induced models,and then underwent X-ray general irradiation,at a dose of 500 cGy/min,100 cm from the target,6 Gy each,once per week,for consecutively 3 weeks.24 hours following irradiation,BMSCs of 3 passage were collected at logarithmic phase.In the cell transplantation group,1 mL cell suspension was infused into the rat caudal vein,containing 3×10~6 cells,totally three times.In the normal control and model groups,rat caudal vein received an equal volume of saline.MAIN OUTCOME MEASURES:The following parameters were measured:results of hematoxylin-eosin staining;serum and kidney malondialdehyde (MDA) content and superoxide dismutase (SOD) activity;serum creatinine and urea nitrogen levels.RESULTS:Kidney histopathology demonstrated thin renal cortex,increased number of mesenchyme,uneven renal corpuscle,and disordered structure of renal glomerulus,narrow renal glomerular vessel,partial disappeared capsular space,and degeneration and sclerosis of some glomerulus in the model group.In the cell transplantation group,renal cortex became thick,with clear structure;interstitial hyperemia and edema was significantly relieved;many complete renal corpuscles were observed;partial renal glomerulus presented degeneration and sclerosis;significant capsular space could be seen.Oxygen free radical examination results showed that compared with the model group,SOD activity was significantly higher (P ＜ 0.05),MDA levels were significantly lower (P ＜0.05) in the cell transplantation group.Renal function examination results demonstrated that compared with the model group,serum creatinine and urea nitrogen levels were significantly reduced in the cell transplantation group (P ＜ 0.05).CONCLUSION:BMSC transplantation can effectively treat renal radiation injury and improve renal function.

Objective To evaluate the methods for the prevention of internal jugular vein malposition of peripherally inserted central catheter (PICC) in patient with limited neck motion.Methods 210 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were divided into observation group (n =106) and control group (n =104) with a random number table.Ultrasound probe compression on the internal jugular vein was used in the observation group,while finger compression was used in the control group.The 2 groups were compared in terms of incidence of internal jugular vein malposition,accuracy of PICC tip position in X-ray,and incidence of complications.Results Incidence of PICC malposition was significantly lower in the observation group than the control group [3 (2.8％) vs.36 (34.6％),P =0.000].The accuracy of PICC tip position in both groups was 100％.No complication was observed in the observation group,while the rate of complication in the control group was 4.8％,with a statistically significant difference (P =0.022).Conclusion The ultrasound probe compression method can significantly lower the incidence of internal jugular vein malposition of PICC and is safer than the finger compression method.

Objective:To explore the correlation among cardiac troponin I (cTnI),cardiac troponin T (cTnT),crea-tine kinase isoenzyme (CK-MB)levels and range of myocardial infarction in aged patients with acute myocardial in-farction (AMI).Methods:Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed.Correlation among levels of cTnI,cTnT,CK-MB and range of myocardial infarction were analyzed before and one week after treatment.Results:Compared with before treatment,there were significant reductions in levels of cTnI [(4.63±0.21)μg/L vs.(0.15±0.03)μg/L],cTnT [(0.71±0.05)μg/L vs.(0.17±0.01)μg/L],CK-MB [(40.21±2.13)U/L vs.(23.32±2.11)U/L]and myo-cardial infarction area [(35.25±4.65)mm2 vs.(23.17±3.76)mm2 ]after treatment,P <0.01 all;Pearson cor-relation analysis indicated that cTnI,cTnT and CK-MB were all positively correlated with myocardial infarction area (r =0.99,0.98,0.95,P <0.01 all).Conclusion:Cardiac troponin I,T and creatine kinase isoenzyme are closely related to myocardial infarction range.Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.

Terminology of persistent inflammation immunosuppression and catabolism syndrome (PICS) is developed based on the concept of multiple organ failure (MOF), which reflect that the preponderance is gradually reversed from pro-inflammation to anti-inflammation, and eventually the state of simultaneously persistent inflammation and severe immunosuppression appeared. Although the improvement of rescue technology and management increase the early survival rates of patient with critical illnesses, the long-term outcomes of most patients are not optimistic. The patients with PICS are difficult to treat or prevent, and are likely to indolent death and have a rising incidence, which is an important challenge to the intensive care unit (ICU). The paper review the understanding of PICS, summarize the specific changes of immune system in PICS, and explore the immunological markers for early recognition of PICS and judgment of immune state in order to provide new thinking for prevention and control of PICS.

AIM: To observe the effects of dexamethasone and interleukin-10 (IL-10) on the release of proinflammatory cytokines, tumor necrosis factor-?(TNF-?), IL-6 and activation of transcriptional factors, nuclear factor-?B(NF-?B), activator protein-1 (AP-1) and cAMP response element binding protein (CREB) in cultrued human peripheral blood mononuclear cells (hPBMC). METHODS: The hPBMC were divided into control group, lipopolysaccharide (LPS) stimulated group, dexamethasone and IL-10 treated group. The contents of TNF-? and IL-6 in supernatant were mensured by ELISA. The activity of NF-?B, AP-1 and CREB of nuclear abstract were analyzed by electrophoretic morbility shift assay (EMSA). RESULTS: The content of TNF-? was significantly increased 1 hour after LPS stimulation, and it was significantly inhibition by dexamethasone and IL-10. The contents of IL-6 and IL-10 were significantly increased after LPS stimulation for 12 hours. The production of IL-6 was still inhibited by dexamethasone and IL-10, but the production of IL-10 was not affected by dexamethasone. The activities of NF-?B, AP-1 and CREB were significantly increased 1 hour after LPS stimulation. Dexamethasone and IL-10 significantly ihibited their activities, but the effects of dexamethasone was stronger than that of IL-10. CONCLUSIONS: LPS induces the release of several pro and anti- inflammatory cytokines and induces the activation of several transcriptional factors in hPBMC. Dexamethasone and IL-10 can inhibite the production of proinflammatory cytokines TNF-?, IL-6 and the activation of NF-?B, AP-1 and CREB. Dexamthasone has more significant inhibitory effect on AP-1 and CREB than IL-10.

Objective: To explore the correlation among cardiac troponin I (cTnI), cardiac troponin T (cTnT), creatine kinase isoenzyme (CK-MB) levels and range of myocardial infarction in aged patients with acute myocardial infarction (AMI). Methods: Clinical data of 80 aged AMI patients hospitalized in our internal medicine department from Sep 2012 to Sep 2013 were retrospectively analyzed. Correlation among levels of cTnI, cTnT, CK-MB and range of myocardial infarction were analyzed before and one week after treatment. Results: Compared with before treatment, there were significant reductions in levels of cTnI [(4.63±0.21) μg/L vs. (0.15±0.03) μg/L], cTnT[(0.71±0.05) μg/L vs. (0.17±0.01) μg/L], CK-MB [(40.21±2.13) U/L vs. (23.32±2.11) U/L] and myocardial infarction area [(35.25±4.65) mm2 vs. (23.17±3.76)mm2] after treatment, P<0.01 all; Pearson correlation analysis indicated that cTnI, cTnT and CK-MB were all positively correlated with myocardial infarction area (r=0.99, 0.98, 0.95, P<0.01 all). Conclusions: Cardiac troponin I, T and creatine kinase isoenzyme are closely related to myocardial infarction range. Combination of these three indexes can be used as important basis for judging myocardial infarction range in patients with myocardial infarction.

Apoptosis of neutrophils controls the duration and the intensity of an inflammatory response and therefore the extent of neutrophil- mediated tissue damage, disturbance of neutrophil apoptosis has been associated with many diseases, underlying mechanism is not elucidated. C5a is a complement fragment that has multifunctional properties, which induces neutrophil chemoattraction, an oxidative burst, enhancement of phagocytosis, release of granule enzymes, and suppress neutrophil apoptosis. Several studies have reported calpain is involved in both neutrophil functions and apoptosis and it might play a more specific role in the regulation of neutrophil apoptosis. Diffenrent isoform of calpains is activted by diffenrent stimuli through different transduction pathway. It was reported previously that calpain is required for neutrophil migration and chemotaxis induced by C5a. In addition, autophagy is a ubiquitous physiological process that occurs in all eukaryotic cells and is considered to be a survival mechanism. Atg5 promotes autophagy and is indispensable to autophagosome formation. Upon calpain activation, Atg5 is cleaved and the resulting 24 ku Atg5 mediates apoptosis while losting the property of autophagy. Therefore, Atg5 represents a molecular switch between autophagy and apoptosis. The interaction among the C5a, calpain and Atg5 was introduced and new direction for further research was provided.