To summarize the nursing experience of 5 patients with severe ARDS complicated with hypercapnia who underwent extracorporeal carbon dioxide removal(ECCO2R).Key points of nursing care included:establishing a rapid emergency response nursing team for ECCO2R;PETCO2 real-time monitoring to grasp the timing of the machine;ensuring continuity of treatment and improving the removal efficiency;respiratory-related monitoring;prevention of complications of blood coagulation and hypothermia;and weaning from extracorporeal carbon dioxide removal.After careful treatment and care,all the 5 patients were successfully removed from ECCO2R treatment.

Objective:To document the clinical efficacy of supplementing intra-articular injection of sodium hyaluronate with Baduanjin exercise in the treatment of knee osteoarthritis (KOA).Methods:Forty patients with KOA were randomly divided into an observation group and a control group, each of 20. Both groups received health education and intra-articular injection of sodium hyaluronate once a week for 5 consecutive weeks. The observation group additionally underwent Baduanjin exercise 3 times a week for the 5 weeks. Before and after the treatment, knee joint function, pain and surface integrated electromyography (iEMG) values of the affected quadriceps were assessed using the Western Ontario and McMaster University (WOMAC) Osteoarthritis Index Scale, and a visual analogue scale (VAS).Results:After the treatment the average VAS and WOMAC scores of both groups had decreased significantly, while the average iEMG value of the quadriceps on the affected side had increased significantly. The average VAS and WOMAC scores of the observation group were significantly lower than the control group′s averages after the treatment, while the average iEMG value of the quadriceps on the affected side was significantly higher.Conclusion:Combining Baduanjin exercise with sodium hyaluronate joint injection in the treatment of KOA has a synergistic effect which can better relieve knee pain, improve knee functioning, and delay the progression of KOA. The combined treatment is worthy of clinical promotion and application.

OBJECTIVETo compare the effects of "paraplegic triple needling" and conventional needling on psychological and daily living ability of patients with spinal cord injury.

METHODSA total of 50 patients with spinal cord injury were randomized into an observation group and a control group, 25 cases in each one. Rehabilitation training was applied in the two groups. In the observation group, on the basis of rehabilitation training, "paraplegic triple needling" was added, namely, puncturing the governor vessel (GV) and back- points respectively in the upper and lower segments of the injury plane and locating the key muscle movement points of the lower extremities by the peripheral nerve electrical stimulation device. Electroacupuncture (EA) was given at the points up and down the two sections of the GV points, back- points, the key muscle movement points. In the control group, conventional needling was applied at the points of GV, back- points, Huantiao (GB 30), Zusanli (ST 36), Xuanzhong (GB 39) and Yanglingquan (GB 34). The treatment was given once a day, the treatment for a month as one course and a total of 2 course were required. In addition, 25 health checkers were selected at the physical examination center of General Hospital of Chengdu Military Region as a normal control group. The content of peripheral serum 5-hydroxy tryptamine (5-HT) was tested before treatment, 1 course and 2 courses of treatment, The modified Barthel index (MBI) was used to observe the daily living activities, the Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were used to evaluate the psychological status.

RESULTSIn the two groups, the content of serum 5-HT was lower than that in the normal control group before treatment (both <0.05). After one course of treatment, the MBI score and content of serum 5-HT were all increase in the two groups; the HAMA score and HAMD score were all reduced (all <0.05); the results in the observation were better than those in the control group (all <0.05). After 2 courses of treatment, the MBI score and content of serum 5-HT were all increased in the two groups, and the HAMA score and HAMD score were all reduced (all <0.05), but the difference was not significant statistically between the two groups (all >0.05). Pearson correlation analysis showed that the content of serum 5-HT in patients with spinal cord injury was negatively correlated with disease course, HAMA and HAMD score (all <0.05), and positively correlated with MBI score (<0.05).

CONCLUSIONThere are differences in the content of serum 5-HT between the normal person and the patients with pinal cord injury. The content of serum 5-HT can early predict the depression and anxiety in patients with spinal cord injury. Compared with the conventional needling, "paraplegic triple needling" can improve depression and anxiety in the early stage and improve the daily living ability of patients with spinal cord injury.

Objective To establish the pyrogen removing effect of activated carbon in the technics of traditional Chinese medicine (TCM) injections. Methods The content of bacterial endotoxin concentration was detected by kinetic turdimetric assay to evaluate the effect of removing pyrogen before and after using activated carbon in concentrated solution of TCM injection. Results The activated carbon adsorption rate of Shuanghuanglian concentrated solution≥70%and the activated carbon adsorption rate of Danshen concentrated solution>95%. Conclusion Pyrogen manufacturing process is scientific and rational by adding activated carbon adsorption in powder injection of TCM. The bacterial endotoxin of large doses can't be removed fully by activated carbon adsorption.

To make sure the role of flagellin as mucosal adjuvants and the protective effect of streptococcus pneumonia infection when combined with DnaJ protein.Methods:Recombinant plasmid pET-28 ( a)/flagella was transferred to E.coli BL21(DE3).Over-expression of flagella was induced by IPTG and purification for animal study.All the C57BL/6 mice were randomly divided into three groups ,then respectively intranasally given the mixture of flagellin and DnaJ protein ( experimental group ) , DnaJ protein( control group 1 ) and the mixture of GST and DnaJ protein ( control group 2 ).The serum IgG and its subtype , cytokines secreted by mice spleen cells were detected by ELISA.At last all the C57BL/6 mice were intranasally immunized with Streptococcus pneumoniaD39.The protective effect by survival times were evaluated.Results: The mice of experimental group could secrete high level of serum IgG and cytokines IFN-γ,IL-4 and IL-17A.What more,the survival rate of mice in experimental group was 60%,a significant statistical difference with the control group.Conclusion:The flagellin as an adjuvant can reinforce the immune response of DnaJ protein and have better protection of resistance D 39 infection.We suggest that flagellin can be used as protein vaccine adjuvants.

Objective The article described the design and building of a virtual reality technology-based rehabilitation system for patients with cognitive deficits, including overall idea, design and structure of the system, the key technology, such as formal description of the training data, man-machine interactive control, controlling simulation of the training process and virtual environment module development to achieve system implementation. The system is suitable for our country and military. It will create a new way for the cognitive rehabilitation and help to promote the application of virtual reality technology in rehabilitation

The evaluation system of PBL teaching was constructed to develop PBL teaching in combination with the characteristics of medical courses. It covered students evaluation system, teacher's evaluation, and teaching pattern system in all aspects of teaching. The present study was carried out through repeated verification in many clinical medicine curriculum and many grades of students, and standardized assessment model, a more mature evaluation system, has been fully applied. All the indices of the evaluation system were comprehensive in contents, scientific, objective, manipulated easily and with good results, which is worth promoting the application of PBL teaching in the future.

It has been a major topic for the reform on higher medical education and teaching to cultivate medical students' professional information literacy so asto make them equipped with the information competence required for disease control or medical research.In this thesis,the concept of professional information literacy for medical students was introduced,and by analyzing the relationship of information literacy education and medical education modes,countermeasures and methods of cultivating medical students' professional information literacy by combining the reform on medical education and teaching were put forward.

Objective To lay the foundation for further exploration on parasitifer's defence reaction to pneumolysin through constructing ply gene-deletion strain of Streptococcus pneumoniae and researching on its virulence change. Methods A linker fragment with erm gene in middle and homologous upstream and downstream fragment of ply gene at both sides was prepared by long flanking homology-polymerase chain reaction(LFH-PCR). The linker fragment was transformed into Streptococcus pneumoniae. ply-deficient strain was then screened out from blood plate which contains erythromycin and identified by PCR. ply-deficient strain growth in vitro was observed and virulence change was observed through infecting mouse model. Results PCR results showed that ply gene was replaced completely by erm gene. The ply deficient strain was successfully constructed. The growth of single strain culture medium showed that ply genetic defect made no influence on bacterial's external growth. While in the mice nasal cavity infecting experiment, deficient strain enter into blood after 6 h from infecting which obviously slower than that did wild-type(2 h). And the number of bacteria at each point was much smaller than that of wild-type(P ＜0. 01 ). The mice peritonaeum infecting experiment showed that median lethal time of wild-type was 3 d, while that of deficient strain was 18 d(P＜0. 01). Conclusion It is a good way to completely substitute ply gene using LFH-PCR. ply deletion made no influence on baterial's growth in vitro, but it resulting in reduction of bacterial virulence in vivo.

This paper was designed to investigate the effect of laminar shear stress on matrix metalloproteinase -9 (MMP-9) expression in rat bone marrow-derived mesenchymal stem cells (MSCs), and the possible signal transduction mechanism involved. Rat bone marrow MSCs were isolated and cultured, then, exposed to laminar shear stress at indicated strengths such as low (5dyne/cm2), medium (15 dyne/cm2) and high (30 dyne/cm2) via parallel plate flow chamber. RT-PCR was used to analyze the expression of MMP-9. The signaling inhibitors such as Wortmannin (PI3K specific inhabitor), SB202190 (p38MAPK specific inhabitor), and PD98059 (ERK1/2 specific inhabitor) were used to investigate the possible mechanical signal transduction pathway. The results showed: (1) The expression of MMP-9 was weak in static state, however, MMP-9 expression increased when MSCs were exposed to 15 dyne/cm2 shear stress for 2 hours, and MMP-9 expression increased with the extension of stimulating time, and it reached the peak at 24 h; (2) MSCs were stimulated by shear stress for 2 hours at different strengths (5 dyne/cm2, 15 dyne/cm2, 30 dyne/cm2), and under all these conditions, the expression of MMP-9 increased, and reached the peak at 15 dyne/cm2; (3) After MSCs were pretreated by three kinds of signal pathway inhibitors, the expression of MMP-9 did not change obviously in Wortmannin group and PD98059 group, but it was significantly inhibited in SB202190 group. This study demonstrated that shear stress could induce the expression of MMP-9 in rat bone marrow-derived mesenchymal stem cells; the amount of MMP-9 expression was closely related to stimulating time and the strengths of shear stress; and p38MAPK signal pathway played a critical role during the process.
Animals ; Bone Marrow Cells ; cytology ; metabolism ; Cells, Cultured ; Matrix Metalloproteinase 9 ; genetics ; metabolism ; Mesenchymal Stromal Cells ; cytology ; metabolism ; Rats ; Signal Transduction ; Stress, Mechanical