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.

OBJECTIVETo study clinical effects of inversive LISS (less invasive stabilization system, LISS) plate combined with steel wire for the treatment of Seinsheimer type V subtrochanteric femoral fractures.

METHODSFrom January 2009 to Janurary 2012, 11 patients with Seinsheimer type V subtrochanteric femoral fractures were treated with inversive LISS plate combined with steel wire, including 8 males and 3 females, ranging in age from 35 to 61 years old (averaged, 51 years old). Causes of injury: 8 patients caused by accident and 3 patients caused by falling down. According to X-ray examination, all the patients were type V subtrochanteric femoral fractures and were treated with LISS plate combined with steel wire. Merle d'Aubigne scores were used to evaluate therapeutic effects on hip.

RESULTSThe mean period of follow-up was 16 months (ranged, 12 to 28 months). All the patients obtained bone union for average 3.8 months (ranged from 3 to 4.3 months). There were no complications such as deep infection,deep vein thrombosis, pulmonary embolism and bone nonunion. According to Merle d'Aubigne scores, 7 patients got an excellent result and 4 good.

CONCLUSIONInversive LISS plate combined with steel wire for the treatment of Seinsheimer type V subtrochanteric femoral fractures is satisfactory, Which can provide stable fixation for fracture end and provide an ideal internal fixation method for treatment of this kind of fractures in the future.

Adult ; Bone Plates ; Bone Wires ; Female ; Fracture Fixation, Internal ; methods ; Hip Fractures ; surgery ; Humans ; Male ; Middle Aged

Ahigh-resolutionmethodforhumanleukocyteantigen-B(HLA-B)genotypingwasestablished based on the optimized polymerase chain reaction, cloning and sequencing technology. The exon2 and exon3 of HLA-B gene were amplified with primers based on the HLA-B gene sequence. These produced heterozygous alleles were effectively cloned into plasmid DNA based on the principle of plasmid incompatibility, and were followed by bacterial culture. Then Sanger sequencing was carried out and after analyzing the result by software ClustalX2 and IMTG/HLA database comparison, the HLA-B genotype of the samples was achieved. Seven clinical samples were detected, and the results were consistent with those of PCR-SBT genotyping method. The method was cost-effective, high-resolution and it did not require technical software. The use of universal primers simplified the cumbersome design and optimization process of specific primers.

Objective To explore molecular mechanisms underlying the in vitro counteracting effect of curcumin on malignant melanoma.Methods Cultured A375 and C8161 human melanoma cells were cultivated in vitro,and randomly divided into several test groups and a control group to be treated with different concentrations of curcumin and dimethyl sulfoxide respectively for different durations.Then,methyl thiazolyl tetrazolium (MTT) assay,Transwell assay,flow cytometry and Western blot were performed to evaluate the effect of curcumin on the proliferation,invasion and cell cycle of,as well as expressions of AKT/mTOR signaling pathway-related proteins in A375 and C8161 cells respectively.Statistical analysis was carried out by using t test.Results MTT assay showed that the treatment with curcumin of 5-35 mg/L for 24-96 hours significantly inhibited the proliferation of both A375 and C8161 cells compared with that with dimethyl sulfoxide (all P ＜ 0.001),and the inhibitory effect was in a dose-dependent manner within the range of 5-15 mg/L for A375 cells and within the range of 5-10 mg/L for C8161 cells,and in a time-dependent manner from 0 to 48 hours for both cells.After treatment for 24 hours,the 50％ inhibitory concentration (IC50) of curcumin against A375 cells and C 8161 cells was 10 mg/L and 5 mg/L respectively.Transwell assay demonstrated that the invasion of A375 and C8161 cells was significantly suppressed by 72-hour treatment with curcumin at 10 mg/L and 5 mg/L respectively (both P ＜ 0.001).Flow cytometry showed that the cell cycle of A375 and C8161 cells was arrested at G2/M phase after 24-hour treatment with curcumin at 10 mg/L and 5 mg/L respectively,with significant differences in the proportion of A375 cells and C8161 cells in G2/M phase between the test group and control group (A375 cells:35.00％ ± 3.54％ vs.120.80％ ± 7.46％,P＜ 0.001;C8161 cells:19.33％ ± 4.04％ vs.85.00％ ± 9.53％,P ＜ 0.001).Western blot revealed that the expressions of AKT/mTOR signaling pathway-related proteins were decreased in A375 and C8161 cells after 24-hour treatment with 10 mg/L and 5 mg/L curcumin respectively.Conclusion Curcumin can inhibit the proliferation and invasion of A375 and C8161 cells,likely by blocking cell cycle and inhibiting activation of the AKT/mTOR signaling pathway.

Surgical nutrition therapy is a novel course for undergraduates who are major in food hygiene and nutrition.In this study,the purpose,content,model and specific teaching approaches of the course were discussed,and the essentials of clinical practice for surgical nutrition therapy were pointed out.We hope that our experience would be helpful for the development of the course.

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 the efficacy and security of splenic artery ligation for severe hypersplenism during liver transplantation.Method Thirty-two liver transplant patients with preoperative hypersplenism were selected,including 17 cases (ligation group) treated by splenic artery ligation during liver transplantation,and rest 15 patients as non-ligation group.The fluctuation of white blood cells,platelets and volume of spleen were compared between these two groups.At the same time,splenic infarction,postoperative infection,recurrent gastrointestinal bleeding,splenic artery steal syndrome and other complications were observed in these two groups.Result All recipients were followed up for over 6 months.One recipient in ligation group died of multiple organ dysfunction caused by delayed recovery of liver donor with the survival rate being 94.1％ (16/17).The survival rate in non-ligation group was 93.3 ％ (14/15) (one recipient died of respiratory failure caused by pulmonary infection).There was no statistically significant difference in survival rate between these two groups (P＞0.05).Splenic necrosis wasn't detected in the ligation group.The splenic volume in ligation group was significantly less than that in non-ligation group (P＜0.01).The products of splenic maximum length and wide diameter shrunk 33.17-± 8.26 cm2 and 22.47 ± 7.25 cm2 in ligation group and non-ligation group,respectively.The platelet counts of ligation group were significantly greater than those of non-ligation group in all the observation points within 6 postoperative months (P＜0.01).The white blood cell counts of ligation group were greater than those of non-ligation group at the first week postoperatively (P＜0.01),whereas,there was no statistically significant difference between these two groups from then on (P＞0.05).The infection incidence of ligation group was lower than that of non-ligation group within 6 postoperative months (P ＜0.05).Statistically significant differences in recurrent gastrointestinal bleeding and splenic artery steal syndrome weren't found between these two groups (P＞0.05).Conclusion Splenic artery ligation in liver transplantation is safe and effective.It can rapidly increase the counts of platelet and white blood cell in the earlier postoperative time,which is beneficial to patient's recovery.Besides,it adds no correlative complication.

Objective:This study was conducted to evaluate and discuss the curative effect and toxicity of gemcitabine, navel-bine, and therarubicin (GNT) regimen for patients with refractory or relapsed T-cell lymphoma (TCL). Methods:A total of 69 patients with refractory or relapsed TCL treated with GNT were enrolled. The treatment protocol was set as follows:800 mg/m2 gemcitabine ad-ministered at 1 and 8 d;25 mg/m2 navelbine administered at 1 d;and 20 mg/m2 therarubicin administered at 1 d. This protocol was re-peated every three weeks. The median cycle was 4 (range:2 to 6). Results:The overall response rate was 65.2%and the achieved com-plete remission was 29.0%. Hematology toxicities were the main adverse reactions observed in all of the patients. The incidence rates of grades 1 and 2 toxicity in leukopenia or neutropenia, anemia, and thrombocytopenia were 50.7%, 33.3%, and 26.1%, respectively. Grades 3 and 4 treatment-associated toxicities were detected in 23.1%of the responding patients. One-, three-, and five-year estimated overall survival (OS) of the whole cohort were 71.7%, 47.3%, and 32.4%, respectively. The median OS was 36 months. Conclusion:GNT was effective and suitable for patients with refractory or relapsed TCL.

Pyrosequencing is one of the important genetic polymorphism detection methods currently, but the complicated pretreatment procedure limits its application in clinical test. To simplify the whole process of pyrosequencing, on the basis of the linear_after_the_exponential_polymerase chain reaction ( LATE_PCR) , we improved the primer design method of LATE_PCR, increased the length and the concentration of the excess primer, applied direct amplification technology with whole blood, and established a whole blood_imLATE_PCR method based on common rTaq polymerase and “HpH Buffer” ( High pH buffer ) . The amplification system was optimized, and the influences of blood anticoagulant and the amount of whole blood template were investigated. The single stranded template for the pyrosequencing was obtained by PCR amplification using a single tube in one_step process, and the alcohol dehydrogenase gene polymorphisms of 24 clinical blood samples were then detected successfully. The results could be used to guide clinical individualized medication. The genotypes of ADH1B locus of 24 samples were 6 cases of AA homozygote, 14 cases of AG heterozygote, and 4 cases of GG homozygote. The genotypes of ADH1C were 20 cases of GG homozygote, 4 cases of AG heterozygote, and no cases of AA homozygote.

A method for the real-time polymerase chain reaction ( PCR ) coupled with high specific invader assay to detect single nucleotide polymorphism ( SNP) was established. To reduce the background signal, the amount of flap endonuclease 1 ( FEN1 enzyme ) and wild-type detection probe was optimized. Under the optimum conditions including 0. 05 μmo/L invasive oligonucleotide probe, 0. 125 μmol/L wild-type detection probe, 0. 5 μmol/L mutation detection probe, 0. 25 μmol/L each fluorescence resonance energy transfer (FRET) probe and 1. 5 U FEN1, the background signal of wild-type sample and mutation sample was dramatically decreased and the background interference to the detecting results was thus eliminated. A total of 21 cases of aldehyde dehydrogenase-2*2 ( ALDH2*2 ) , 19 cases of cytochrome p450 2 C19*2 ( CYP2 C19*2 ) and 19 cases of CYP2C19*3 were analyzed with the established method, and the genotypes of ALDH2*2 were 10 cases of GG homozygote, 8 cases of GA heterozygote and 3 cases of AA homozygote; the genotypes of CYP2C19*2 were 9 cases of GG homozygote, 8 cases of GA heterozygote and 2 cases of AA homozygote;and the genotypes of CYP2C19*3 were 18 cases of GG homozygote and 1 case of GA heterozygote. These results were consistent with those by pyrosequencing. The established method was specific, simple, short time-consuming and low cost, and could be used for the detection of SNP genotyping with non-polluting in single closed tube.