Objective To evaluate the effects and safety of closed tracheal suction system(CTSS)versus open tracheal suction system (OTSS) for mechanically ventilated patients.Methods All randomized controlled trials (RCTs) comparing CTSS with OTSS for mechanically ventilated patients home and abroad were identified via manual and computer retrieval.All related data were extracted.Meta analysis was conducted using the statistical software RevMan 5.1 on the basis of strict quality evaluation with the methods recommended by the Cochrane Collaboration.Results Fifty-one related papers were found and 12 RCTs involving 1205 patients in CTSS group and 1179 patients in OTSS group were included.The results of meta analysis showed that CTSS was associated with a significant reduction in the duration of mechanical ventilation (WMD =-0.73,95％ CI-1.07--0.40,P＜0.0001),but the incidence of ventilator associated pneumonia and microbial colonization,mortality and length of ICU stay exhibited no difference between the two groups (P ＞ 0.05).However,compared with OTSS,CTSS reduced the incidence of arrhythmia (RR =0.23,95％ CI 0.07-0.74,P =0.01) and minimized the disturbance to heart rate (WMD =-1.97,95％ CI-3.03--0.91,P =0.0003),mean arterial pressure (WMD =-2.01,95％ CI-3.02--1.01,P ＜ 0.0001) and oxygen saturation (SpO2) (WMD =-1.00,95％ CI-1.14--0.86,P ＜ 0.000 01).Conclusions Compared with OTSS,CTSS could reduce disturbance to respiratory and circulatory system by sputum suction and shorten the duration of mechanical ventilation.However,CTSS has no advantage in prevention of ventilator associated pneumonia or microbial colonization,nor does it shorten the length of ICU stay or improve the outcome of mechanically ventilated patients.

Objective:To prepare the monoclonal antibody(mAb) against human B7 1 and analyse its biological characteristics.Methods:The B lymphocytes hybridization technique was applied by using XG7 B7 cell,a multiple myeloma(MM) cell line transfected with human B7 1 gene,as immunogen;the specificity and the antigen binding activity of mAbs were identified by flow cytometry and Western blot analysis;its biological effects on human PBTC and human B lymphoma cell line were examined by 3H TdR incroporation and annexin V satining.Results:Four mouse anti human B7 1(B7 1) hybridoma(1F11,3H8,6H2,7B10) were obtained.They secrete continuosly and steadily specific anti human B7 1(B7 1) mAb and their subclasses belong to IgG1 and IgM respectively;three of four mAbs could inhibit the proliferation of response cells(the human peripheral blood T lymphocytes),stimulated by costimulatory molecule B7 1.Furthermore,it was found that these mAbs induced the apoptosis of human B lymphoma cell line,Raji,which express naturally human B7 1 molecule,by using annexin V staining analysis after 24 hours of mAb treatment.Conclusion:Sucessefully obtained four mouse anti human B7 1 functional monoclonal antibodies,which have a potential value in anti allogenetic graft rejection and in the therapeutic approach of B lymphoma.

Objective To systematically review the efficacy of dexmedetomidine or midazolam for sedation in critically ill patients. Methods We searched the PubMed, EMBaes, Cochrane Library, Wanfang Database,CNKI and VIP for all randomized controlled trials (RCTs) about the efficacy of dexmedetomidine versus midazolam for sedation in severe cases. The quality of the studies was evaluated by the method recommended by Cochrane Collaboration. Meta-analysis was conducted using the Cochrane Collaboration's RevMan 5.0 software. Results Six RCTs involving 613 patients were included in our Meta-analysis. The results of Meta-analysis showed that the length of ICU stay was significantly shorter in group dexmedetomidine than in group midazolam. There were no significant differences in the duration of mechanical ventilation, incidences of bradycardia, hypotension and delirium and mortality rate between the two groups. Conclusion Dexmedetomidin can shorten the length of ICU stay and is beneficial for the outcome in critically ill patients.

Objective To investigate the clinical value of bile reinfusion combined with enteral nutrition before R0 resection of hilar cholangiocarcinoma.Methods The clinical data of 46 patients with hilar cholangiocarcinoma who underwent R0 resection at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2010 to January 2014 were analyzed retrospectively.The clinical data of 21 patients (the experimental group) who received bile reinfusion by preoperative percutaneous transhepatic cholangiography and drainage (PTCD) combined with enteral nutrition with nasojejunal tube were compared with 25 patients (the control group) who received neither PTCD nor enteral nutrition.The differences in the clinical indicators between the 2 groups were analyzed.Results In the experimental group,the levels of ALT,AKP,TBil and DBil decreased significantly after PTCD as compared with the original levels (t =4.433,4.547,5.648,4.681,P ＜ 0.05).The operation time and blood loss in the experimental group was reduced significantly when compared with the control group (t =-2.810,-2.047,P ＜ 0.05).The volume of postoperative albumin transfusion and the postoperative hospitalization in the experimental group was significantly reduced when compared with the control group (t =-3.083,t =-3.083,P ＜ 0.05).Conclusion Bile reinfusion combined with enteral nutrition facilitated the recovery of preoperative hepatic function in patients who underwent R0 resection of hilar cholangiocarcinoma,thus improving the safety of surgery and facilitated postoperative rehabilitation.

10.3969/j.issn.1000-3606.2013.06.020

Objective To investigate the feasibility of the simultaneous measurement of right ventricular pressure-volume loops by cardiac catheterization and 2D electrocardiogram. Methods Patients referred for pulmonary hypertension underwent right heart catheterization in our hospital between June 1st, 2015 and June 1st, 2017 are to be enrolled in this study. The right ventricular volume was measured simultaneously by catheter and electrocardiogram. The pressure-volume loops were constructed by the parameters of the pressure and volume in the same cardiac cycle. Results The study completed in four cases and their pressure-volume loops were drawn. The obtained images were irregular and there was no relationship among them. As a result, the construction was a failure. Conclusions The construction of the right ventricular pressure-volume loops of pulmonary hypertension patients by simultaneous catheterization and 2D electrocardiogram is difficult to overcome the technology defects.

To establish and manage of multicentral collection bio-sample banks of malignant tumors from digestive system, the paper designed a multicentral management system, established the standard operation procedures (SOPs) and leaded ten hospitals nationwide to collect tumor samples. The biobank has been established for half a year, and has collected 695 samples from patients with digestive system malignant tumor. The clinical data is full and complete, labeled in a unified way and classified to be managed. The clinical and molecular biology researches were based on the biobank, and obtained achievements. The biobank provides a research platform for malignant tumor of digestive system from different regions and of different types.
Biological Specimen Banks ; organization & administration ; Digestive System ; pathology ; Humans ; Neoplasms ; Specimen Handling

This article tried to discuss that spleen deficiency is the key mechanism of hepatitis B virus associated glomerulonephritis from TCM and Western medicine viewpoint. From the view of pathophysiology, energy metabolic disorder caused by mitochondrial injury and its series of damages are similar to symptoms caused by spleen deficiency appeared as yin fire and organs dystrophy, so mitochondrial injure belongs to spleen deficiency. And mitochondrial damage can further aggravate the virus replication of hepatitis B virus associated glomerulonephritis, causing damage to the kidney. Therefore, from the view of Western medicine, it can be known that spleen deficiency determines whether the liver function damage in the process of hepatitis B virus associated glomerulonephritis and lower energizer transformation. In terms of TCM, spleen deficiency plays an important role in all stages of the disease, and determines the outcome and prognosis of the disease. Therefore, this article proposed that the spleen deficiency is the mechanism of hepatitis B virus associated glomerulonephritis, which can provide references for clinic.

LI Dong-yuan discussed the pathogenesis and treatment of "atrophic debility of bones" in his writings. This article explained and summarized the pathogenesis of atrophic debility of bones in LI's works. LI held that the pathogenesis of atrophic debility of bones is divided into damp-heat, overabundant yin leading to yang hyperactivity, and overabundant yin leading to insufficient yang. Combined with clinical observation, this article considered that the LI's atrophic debility of bones is similar to renal osteopathy in terms of disease name, clinical manifestation and pathogenesis. Therefore it put forward to the treatment of renal osteodystrophy from LI's theory. The methods of treatment were invigorating splenic yang and dehumidify, moistening dryness and tonifying kidney, replenishing qi, purging yin fire, raising yang and lifting prolapsed zang-fu organs, and expeling wind and removing dampness.

Objective To investigate the feasibility of ~1H-MR spectroscopy(~1H-MRS)imaging to quantitatively detect fatty liver.Methods Twenty patients with fatty liver and 11 healthy volunteers underwent plain CT scan,conventional MR imaging and ~1H-MRS analysis.The blood lipid and liver function were tested on the same day as the MR examination.~1H-MRS sequence measured the peaks of H_2O and lipid,and the areas under the peaks.The relative contents of the lipid compound were calculated,and compared with the results of CT scan and liver function tests.Results The CT values of the normal group and the fatty liver group were(59?9)HU and(24?11)HU respectively.On ~1H-MRS a protruding high H_2O peak and a flat low lipid peak were observed in the normal group,while the protruding high H_2O peak and a high lipid peak appeared in the fatty liver group.The values of lipid peak in the normal group and the fatty liver group were(0.05?0.01)?10~5,(0.70?0.24)?10~5 respectively(t=4.32,P0.05),the areas under the lipid peak were(1.36?0.73)?10~9、(2.35?1.15)?10~9 respectively(t=5.21,P0.05).Conclusion ~1 H-MRS imaging is feasible to quantitatively detect liver fat and is a non-invasive method for detecting early fatty liver.