BACKGROUNDWeaning difficulties occur in 31% of total intubated patients, and result in prolonged weaning duration. A computer-driven automated weaning system can perform a spontaneous breathing trial (SBT) automatically and display a message when the trial is successfully passed. Such a system might have a beneficial effect on difficult-to-wean patients. The aim of this study was to examine whether the computer-driven automated weaning system can accelerate discontinuation of mechanical ventilation and improve outcomes in difficult-to-wean patients.

METHODSThis randomized controlled study included 39 difficult-to-wean patients who failed their first spontaneous breathing trial. Before initiating weaning, eligible patients were randomly allocated to wean by computer-driven automated weaning system (CDW group, n = 19) or a physician-controlled local protocol (PW group, n = 20). Weaning duration, defined as the time from inclusion until first extubation, was the primary endpoint. Secondary endpoints were total duration of mechanical ventilation, the length of intensive care unit (ICU) stay, the number of reintubations, the mortality rate in the ICU, the number of noninvasive ventilations, the number of complications in the ICU, and the number of ventilator-associated pneumonia cases.

RESULTSThe weaning duration was reduced with the computer-driven weaning as compared with the usual protocol (median 29.0 hours vs. 45.5 hours, P = 0.044). Total duration of mechanical ventilation and duration of the ICU stay did not differ between the CDW and PW groups. There was no difference in the number of reintubations between the CDW and PW groups (3 and 4 patients, P = 0.732). The study groups showed comparable numbers of tracheostomy, self-extubations, ventilator-associated pneumonia, and non-invasive ventilation. Mortality in the ICU was similar in the CDW and the PW groups (21.1% vs. 20.0%, P = 0.935).

CONCLUSIONThe computer-driven automated weaning system can reduce weaning duration in difficult-to-wean patients as compared with a physician-controlled weaning protocol.

Aged ; Female ; Humans ; Intensive Care Units ; Male ; Middle Aged ; Respiration, Artificial ; methods ; Ventilator Weaning ; methods

In this paper,a hypertension management system based on mobile intelligent computation is built,intorduces its overall architecture and function realization.The user side can implement collection and monitoring of body signs,behavior monitoring,hypertension riskassessment and emergence help,etc.In addition,the doctor side can assist the doctor in diagnosis service.With the help of this system,the user can know his/her physical status and make self-adjustment in time,and the doctor can quickly track the progressof the patient and provide health guidance.As a result,the personalized hypertension management for both the doctor and the patient can be achieved.

OBJECTIVEUtilizing the hypoxia inducible factor 1/hypoxia reaction element (HIF-1/ HRE) gene regulation system to construct antisense vascular endothelial growth factor (VEGF165) cDNA eukaryotic expression vector promoted by HRE, and investigate its targeted inhibiting VEGF expression of osteosarcoma cells in hypoxia environment.

METHODSEukaryotic expression plasmid with HRE promoter was constructed containing luciferase reporter gene and antisense VEGF165 cDNA by using PCR and recombinant DNA techniques. The recombinant vectors were transfected into osteosarcoma cells with lipofectin method. Hypoxia-inducible reporter gene expression was determined by liquid scintillation analyzer and the expression of VEGF protein was detected by ELISA method.

RESULTSThe eukaryotic expression plasmid containing antisense VEGF165 and luciferase promoted by HRE was constructed successfully. After being transferred into MG63 cells, luciferase expression was increased 3.5 x 10(2) times and VEGF protein expression decreased 45% under hypoxia condition.

CONCLUSIONAntisense VEGF165 cDNA expression, efficiently realized by HRE promoter under hypoxia condition, provides an experimental basis for targeted antiangiogenesis of tumors.

Bone Neoplasms ; metabolism ; pathology ; Cell Hypoxia ; Cell Line, Tumor ; Genetic Vectors ; Humans ; Hypoxia-Inducible Factor 1 ; genetics ; Luciferases ; genetics ; metabolism ; Oligodeoxyribonucleotides, Antisense ; Osteosarcoma ; metabolism ; pathology ; Plasmids ; Promoter Regions, Genetic ; Recombinant Proteins ; genetics ; metabolism ; Transfection ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

OBJECTIVETo investigate the effect of VEGF expression in osteosarcoma cell line and the target killing effect of HSV1-TK/GCV system on transfected osteosarcoma cells under hypoxia conditions.

METHODSEukaryotic expression plasmid with HRE promoter was constructed to express the antisense VEGF165 cDNA and Hygromycin phospho-transferase-thymidine kinase (HyTK) fusion gene. The recombinant vectors were then transfected into osteosarcoma cell line MG63 with lipofectin mediated gene transfer methods. PCR and RT-PCR were used to confirm the presence and expression of TK gene. The sensitivity of transfected cells to GCV and "bystander effect (BSE)" of HSV1-TK/GCV system under normoxia or hypoxia conditions were measured by MTT assay and mixed co-culture experiment. The expression of VEGF protein was detected by ELISA under hypoxia condition. Cell cycle phase distribution was determined by flow cytometry. In addition, electromicroscopy was used to document ultrastructural alterations.

RESULTSThe eukaryotic expression vector pBI-HRE-AsVEGF165 -HyTK was constructed successfully. The transfected cell line MG63TV was established and confirmed by PCR and RT-PCR of the presence of transgene and its mRNA expression. GCV was toxic to transfected cells in a concentration-dependent manner. The sensitivity to GCV toxicity was 100 times higher under hypoxia condition than that under normoxic condition. The mixed culture experiments showed that the "bystander effect" was enhanced significantly under hypoxia condition. VEGF expression of transgene cells under hypoxia condition decreased 50% compared to that of normal condition. Under hypoxia and GCV, DNA synthesis of MG63TV cells was inhibited along with an increase of cells at G0 approximately G1 phase, apoptosis and necrosis.

CONCLUSIONSAntisense VEGF expression driven by HRE promoter in combination with hypoxia can provide a target inhibition of VEGF expression in human osteosarcoma cells, with an enhanced selective killing effect and BSE of the HSV-TK/GCV system. The double-gene co-expression system in study provides experimental basis for therapy against osteosarcoma by a synchronous antiangiogenic and suicide gene approach.

Apoptosis ; Bone Neoplasms ; metabolism ; pathology ; Bystander Effect ; Cell Hypoxia ; Cell Line, Tumor ; Cell Proliferation ; DNA, Neoplasm ; biosynthesis ; Ganciclovir ; pharmacology ; Genetic Vectors ; Humans ; Hypoxia-Inducible Factor 1 ; genetics ; Oligodeoxyribonucleotides, Antisense ; Osteosarcoma ; metabolism ; pathology ; Phosphotransferases (Alcohol Group Acceptor) ; genetics ; Plasmids ; Promoter Regions, Genetic ; RNA, Messenger ; metabolism ; Recombinant Proteins ; genetics ; metabolism ; Thymidine Kinase ; biosynthesis ; genetics ; Transfection ; Vascular Endothelial Growth Factor A ; genetics ; metabolism

OBJECTIVETo clarify the effect of aluminum exposure on the cognitive function in electrolytic workers and the prevalence of mild cognitive impairment (MCI) among them by prevalence survey, and to investigate its influential factors.

METHODSSixty-six retired workers from the electrolysis workshop of an electrolytic aluminum plant were selected as an aluminum exposure group, while 70 retired workers from a flour mill in the same region were selected as a control group. MCI patients were screened out by Mini-Mental State Examination (MMSE); the blood aluminum level was measured by inductively coupled plasma-mass spectrometry; multivariate statistical analysis was used to investigate the influential factors for MMSE scores and the correlation between blood aluminum level and MCI prevalence.

RESULTSThe aluminum exposure group showed a significantly higher blood aluminum level than the control group (25.18 ± 2.65 µg/L vs 9.97 ± 2.83 µg/L, P < 0.01). The total MMSE score of the aluminum exposure group (26.13 ± 2.57) was significantly lower than that of the control group (27.89 ± 1.91) (P < 0.05), particularly the scores on time and place orientation, short-term memory, calculation ability, and language skill (P < 0.05). The detection rate of MCI was significantly higher in the aluminum exposure group (18.2%) than in the control group (5.7%) (P < 0.01). The main influential factors for MMSE scores were gender, age, education level, and blood aluminum level. The logistic regression analysis indicated that the MCI prevalence was significantly correlated with blood aluminum level in the study population (OR = 1.168, P < 0.01).

CONCLUSIONLong-term exposure to aluminum can cause cognitive disorders in electrolytic workers and may be one of the risk factors for MCI. Advanced age, male, low education level, and high blood aluminum level may be high-risk factors for cognitive impairment.

Aged ; Aluminum ; adverse effects ; Case-Control Studies ; Cognition ; drug effects ; Cognition Disorders ; chemically induced ; epidemiology ; Electrolysis ; Female ; Humans ; Male ; Middle Aged ; Neuropsychological Tests ; Occupational Exposure

OBJECTIVETo evaluate the safety and efficacy of umbilical cord-derived mesenchymal stem cells (MSCs) infusion in patients with steroid-resistant severe acute graft-versus-host disease (aGVHD).

METHODSA total of 19 patients with steroid-resistant severe aGVHD received MSCs infusion treatment. The treatment response, transplantation-related mortality, events associated with infusion and relapse rate were analyzed.

RESULTSTwo patients with grade II, 5 patients with grade III and 12 patients with grade IV aGVHD received a total of 58 infusions of MSCs. The mean total dose of MSCs was 2.13 (range 0.60 - 7.20)×10(6) cells per kg bodyweight. Seven patients received one infusion, 2 patients received two infusions, and 10 patients received three or more infusions. Eleven patients had a complete response and 4 had a partial response and 4 had no response. No patients had side-effects during or immediately after infusions, and no MSCs related tumorigenesis was detected to date. Eleven patients survived and 8 died, 4 for aGVHD, 1 for infection and 2 for aGVHD with concomitant infection and 1 for underlying leukemia relapse. The cell viability of freshly prepared MSCs is 93% (92% - 95%) by trypan blue staining. The cell viability of programmatically frozen and thawed MSCs is 72% (70% - 74%).

CONCLUSIONInfusion of umbilical cord-derived MSCs expanded in vitro is an effective therapy for patients with steroid-resistant severe aGVHD without negative impact on relapse. Freshly prepared MSCs are superior to frozen and thawed cells in terms of cell viability.

Adolescent ; Adult ; Cord Blood Stem Cell Transplantation ; Female ; Graft vs Host Disease ; etiology ; surgery ; Humans ; Male ; Mesenchymal Stem Cell Transplantation ; Mesenchymal Stromal Cells ; Middle Aged ; Steroids ; pharmacology ; Survival Rate ; Umbilical Cord ; cytology ; Young Adult

Objective To explore the development and implementation of International Classification of Functioning, Disability and Health (ICF) (International Chinese Version) in China. Methods A total of 332 research papers in ICF had been selected from CNKI from 2001 to 2017 and analyzed using Citespace III. The time, authors and institutions distributions had been explored. Results There was a sus-tainable increase of ICF publications in Chinese from 2001. The core authors of ICF are QIU Zhuo-ying and his research team. Chinese Journal of Rehabilitation Theory and Practice has published most researches in ICF in China. ICF Chinese version has been widely imple-mented in the areas of disability statistics at population level, clinical and services, management and service information, and social policy. With the guidance and coordination of WHO Family of International Classifications Collaborating Center (WHO-FIC CC) and cooperation with WHO-FIC CCs Germany, Australia, and Italy, and cooperation with WHO CC Rehabilitation in China, remarkable achievements has been made in the fields of ICF research and implementation. Conclusion It is a promising new research area to research and implement ICF in China. New ideologies and tools has been developed and significant influences have been made from ICF research and implementation in the fields of health care, rehabilitation, education, social security and employment, social services, disability studies, and informatics.

Objectives:The purpose of this study was to evaluate the prognostic value of the Thrombolysis In Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores for in-hospital mortality in Chinese ST-segment elevation myocardial infarction (STEMI) patients. Methods:Present data are obtained from the prospective, multicenter Chinese AMI (CAMI) registry, 107 hospitals from 31 provinces, municipalities or autonomous districts in China took part in this study. From January 2013 to September 2014, 17886 consecutive ST-segment elevation myocardial infarction patients admitted to these 107 hospitals were enrolled. For each patient, TIMI and GRACE risk scores were calculated using specific variables collected at admission. Their prognostic value on the primary endpoint (in-hospital mortality) was evaluated. Results:Mean age of this patient cohort was (61.9±12.4)years, 76.5% (n=13685) patients were males. The in-hospital mortality was 6.4%(n=1 153)and the median length of hospital stay was 10.0 days. The incidence of cardiac arrest at admission were 4.3% (n=764). Coronary reperfusion therapy including fibrinolytic therapy(n=1782), primary percutaneous coronary intervention (n=7763) and emergent coronary artery bypass grafting (n=10) were applied to 9555 (53.4%) patients and the median of time to reperfusion was 300.0 minutes. The predictive accuracy of TIMI and GRACE for in-hospital mortality was similar:TIMI risk score (AUC) [area under the curve:0.7956; 95% confidence interval (95%CI:0.7822~0.8090)] and GRACE risk score (AUC:0.8096; 95%CI:0.7963~0.8230). Conclusions:The TIMI and GRACE risk score demonstrate similar predictive accuracy for in-hospital mortality and there are some disadvantages in risk stratification by these two risk scores for Chinese STEMI patients.

Objective:To investigate the health-related sedentary behavior (SB) characteristics of adolescents aged twelve to 17. Methods:From May to July, 2020, 300 adolescents were sampled and tested SB, break of sedentary time (BST), light physical activity (LPA) using wGT3X-BT accelerometer and Adolescent Sedentary Behavior Questionnaire. Results:The objective measurement showed that the daily sedentary time was high (80.28% on weekdays and 81.38% on weekends). The proportion of sedentary time was high in girls than in boys both on weekdays and weekends (F > 5.322, P < 0.05). There were significant differences in the proportion of SB (weekdays/weekends), the frequency of BST (weekdays/weekends), and the proportion of LPA (weekdays/weekends) among different grades (F > 11.355, P < 0.001). The subjective measurement showed that the sedentary time more than eight hours were 86.67% and 63.67% of children and adolescents on weekdays and weekends, respectively. The educational SB, social SB and video SB were the main types for children and adolescents. The educational SB time increased, and the social SB and video SB time decreased with grades. Traffic SB and cultural SB accounted for a small proportion of the total sedentary time. There were significant differences in social SB (weekdays), cultural SB (weekends), video SB (weekdays/weekends), educational SB (weekdays/weekends) and traffic SB (weekdays/weekends) among different grades (F > 2.934, P < 0.05). Conclusion:The sedentary time is high among children and adolescents, in which educational SB accounts the most, and varies with grade.

Objective To explore the functional status and influencing factors of physical fitness of children with intellectual and developmental disabilities enrolled in special education, and to establish framework of physical fitness for analysis of physical fitness and exercise intervention using International Classification of Functioning, Disability and Health (ICF). Methods Based on the ICF apporach, we analyzed the functional status and physical fitness characteristics and influencing factors of students in special education schools, and developed a function-based physical fitness intervention program for children with intellectual and developmental disabilities with reference to the requirements of WHO Guidelines on Physical Activity and Sedentary Behavior (2020). Results A systematic analysis of the overall functional status of children with intellectual and developmental disabilities based on ICF, especially intellectual functions, activities and environmental factors related to intellectual disability, was conducted and discussed in the context of related motor functions and physical fitness. A physical activity program was developed based on the ICF and with reference to WHO Guidelines on Physical Activity and Sedentary Behavior (Children and Adolescents), and related adaptive support strategies were proposed. Conclusion The overall functional status of children with intellectual and developmental disabilities has been analyzed in body functioning (both intellectual and motor), activity and participation, and environmental factors. Based on WHO Guidelines on Physical Activity and Sedentary Behavior and the ICF framework, a physical activity program for physical fitness with adaptive and supportive teaching and training methods, has been developed for children with intellectual and developmental disabilities.