Objective:To determine the risk factors of extubation failure and its effect on the prognosis of patients who had successfully passed a spontaneous breathing trial (SBT).Methods:The clinical data of patients with mechanical ventilation more than 24 hours who passed SBT admitted to department of intensive care unit (ICU) of First Hospital of Qinhuangdao from November 2018 to November 2019 were retrospectively analyzed. According to the outcome of weaning within 48 hours after weaning, patients were divided into weaning success group and weaning failure group. The baseline data, the presence of basic cardiopulmonary diseases, B-type natriuretic peptide (BNP), fluid balance, albumin and hemoglobin within 24 hours before weaning, the time of mechanical ventilation before weaning, rapid shallow breathing index (RSBI) during SBT, oxygenation index, cough peak flow at the end of SBT, and prognostic indicators were collected. The outcome of weaning was taken as the dependent variable, and the observation factors were taken as the independent variable for univariate analysis. The factors with statistical significance in univariate analysis were analyzed by binary Logistic regression to determine the influencing factors of weaning failure.Results:Of the 204 patients, 167 (81.9%) were successfully weaned, and 37 (18.1%) failed. Compared with the weaning success group, the total duration of mechanical ventilation and the length of ICU stay in the weaning failure group were significantly longer [days: 13.0 (7.5, 23.5) vs. 5.0 (3.0, 8.0), 17.0 (12.5, 31.0) vs. 10.0 (6.0, 15.0), both P < 0.01], and the tracheotomy rate and mortality were significantly higher (32.4% vs. 0%, 51.4% vs. 0%, both P < 0.01). Univariate analysis showed that there were significant differences in age, proportion of patients with cardiopulmonary diseases, BNP and cough peak flow between weaning failure group and weaning success group [age (years old): 70.65±15.78 vs. 62.69±15.82, cardiopulmonary diseases: 62.2% vs. 24.6%, BNP (ng/L): 416.87 (32.70, 1 225.80) vs. 45.36 (10.00, 273.60), cough peak flow (L/min): 59.89±9.06 vs. 83.84±16.52, all P < 0.01]. However, there were no significant differences in gender, acute physiology and chronic health evaluationⅡ (APACHEⅡ) at admission, mechanical ventilation time before weaning, albumin, hemoglobin, oxygenation index, RSBI and fluid balance 24 hours before weaning between weaning failure group and weaning success group [male: 51.4% vs. 68.3%, APACHEⅡ: 16.70±6.65 vs. 15.67±6.28, mechanical ventilation time before weaning (days): 6.0 (2.5, 11.0) vs. 5.0 (3.0, 8.0), albumin (g/L): 27.78±4.15 vs. 27.76±4.46, hemoglobin (g/L): 102.43±15.80 vs. 100.61±17.19, oxygenation index (mmHg, 1 mmHg = 0.133 kPa): 359.33±79.83 vs. 365.75±78.23, RSBI (times·L -1·min -1): 50.73±24.97 vs. 46.76±15.53, positive fluid balance: 70.3% vs. 69.5%, all P > 0.05]. The results of binary Logistic regression analysis showed that age ≥ 75 years old [odds ratio ( OR) = 3.099, 95% confidence interval (95% CI) was 1.003-9.574, P = 0.049], presence of cardiopulmonary diseases ( OR = 3.599, 95% CI was 1.126-11.498, P = 0.031), BNP within 24 hours before weaning ( OR = 1.002, 95% CI was 1.000-1.003, P = 0.005) were the risk factors of extubation failure, while cough peak flow at the end of SBT was the protective factor ( OR = 0.869, 95% CI was 0.823-0.917, P = 0.000). Conclusions:For patients who had successfully passed SBT, age ≥ 75 years old, the presence of cardiopulmonary diseases and an increased level of BNP within 24 hours were the risk factors of extubation failure. In addition, the higher the cough peak flow at the end of SBT, the lower the risk of weaning failure will be.

Background: Epidemiological evidence revealed that stress is the causative factor of dyspeptic symptoms. It has been documented that duodenal inflammation is one of the key mechanisms of dyspepsia, and macrophage is crucial for inflammation. Aims: To determine whether patients with functional dyspepsia (FD) comorbid psychological stress have duodenal inflammation. Furthermore, to identify whether macrophage is involved in the mechanisms of stress-related duodenal inflammation by using water avoidance stress (WAS)animal model. Methods: Duodenal inflammation was observed and compared between FD patients with psychological factors and asymptomatic healthy controls. WAS mouse model with 1 h stress daily for 10 days was used to evaluate the duodenal inflammation at different time points to describe its dynamic changes. The role of macrophage in the development of duodenal inflammation was determined in an interventional study, in which the resident macrophages were depleted by clodronate liposomes. In both clinical and animal studies, the severity of duodenal inflammation was assessed by HE staining and immunocyte counts, the macrophage infiltration was detected by immunohistochemistry, and the expression of inflammatory cytokines was detected by real-time PCR. Results: FD patients with psychological factors developed severe duodenal inflammation in comparison with the healthy controls (immunocytes/HPF: 138.91±7.13 vs. 81.44±23.60, P<0.000 1). At the same time, the expressions of proinflammatory cytokines (IL-1β, TNF-α, and IL-17A) were increased, while the expressions of anti-inflammatory cytokines (IL-10 and TGF-β) were decreased (all P<0.05). In WAS mouse model, a dynamic change in duodenal inflammation which peaked on day 5 was observed, and the changes of macrophage infiltrating in the duodenal tissue were consistent with the duodenal inflammation. Clodronate liposomes pretreatment could effectively deplete macrophages, protected the WAS mouse model against duodenal inflammation (immunocytes/HPF: 75.10±4.08 vs. 202.43±5.18, P<0.001), with a marked reduction of the expressions of proinflammatory cytokines (IL-1β, TNF-α, and IL-8), and a marked elevation of the expression of anti-inflammatory cytokine IL-10 (all P<0.05). Conclusions: Psychological stress may lead to dyspeptic symptoms via macrophage-mediated duodenal inflammation.

Objective To explore the clinical value of perfusion index (PI) in treatment of full-term infants with shock.Methods Totally 52 full-term neonates were selected and divided into mild shock group (n =16),moderate shock group (n =28) and severe shock group (n =8) according to neonatal shock score,and PI value was detected at the time points of visiting doctor,24 h and 48 h after treatment.Meanwhile,48 normal full-term newborns in the same period were selected as control group,and the PI value was measured at birth,postnatal 24 h and 48 h.The PI value and prognosis was analyzed.Results The PI values at birth,postnatal 24 h and 48 h in neonatal shock group were significantly lower than those in control group (P ＜ 0.05).With the increase of the severity of the disease,the PI value of neonates with shock decreased significantly,and there were no significant difference among the four groups after anti-shock treatment (P ＞ 0.05).Conclusion The PI value of full-term neonates with shock significantly decrease.

Objective To explore the clinical value of perfusion index (PI) in treatment of full-term infants with shock.Methods Totally 52 full-term neonates were selected and divided into mild shock group (n =16),moderate shock group (n =28) and severe shock group (n =8) according to neonatal shock score,and PI value was detected at the time points of visiting doctor,24 h and 48 h after treatment.Meanwhile,48 normal full-term newborns in the same period were selected as control group,and the PI value was measured at birth,postnatal 24 h and 48 h.The PI value and prognosis was analyzed.Results The PI values at birth,postnatal 24 h and 48 h in neonatal shock group were significantly lower than those in control group (P ＜ 0.05).With the increase of the severity of the disease,the PI value of neonates with shock decreased significantly,and there were no significant difference among the four groups after anti-shock treatment (P ＞ 0.05).Conclusion The PI value of full-term neonates with shock significantly decrease.

Objective To observe the peripapillary choroidal thicknesses (pCT) and subfoveal choroidal thicknesses (SFCT) of nonarteritic anterior ischemic optic neuropathy (NAION). Methods Forty-four Chinese patients with unilateral NAION were recruited and compared with 60 eyes of 60 normal age and refractive-error matched control subjects. pCT and SFCT were measured by enhanced depth imaging optical coherence tomography. Choroidal thicknesses of eyes with NAION and unaffected fellow eyes were compared with normal controls. Choroidal thicknesses of NAION eyes with or without optic disc edema were also compared. The correlation between choroidal thickness and retinal nerve fiber layer (RNFL) thickness, logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA), and the mean deviation (MD) of Humphrey static perimetry in NAION eyes were analyzed. Results The pCT at the nasal, nasal inferior and temporal inferior quadrants in NAION eyes with optic disc edema were significantly thicker than that of normal subjects (t=3.152, 3.166, 2.808; P<0.05). There was no significant difference in the choroidal thicknesses between the unaffected fellow eyes of NAION patients and normal eyes of healthy controls; or between the NAION eyes with resolved optic disc edema and normal eyes (P>0.05). No significant correlation between choroidal thickness (r=-0.220, -0.140, 0.110), SFCT (r=0.096, -0.148, -0.131) and logMAR BCVA, perimetry MD and RNFL was found in eyes affected by NAION (P>0.05). Conclusions The peripapillary choroidal thicknesses increase in some quadrants in NAION eyes with optic disc edema. However, the choroidal thickness of NAION eyes is the same in age and refractive error-matched normal subjects.

Serum pepsinogen(PG)is an effective marker for evaluating gastric mucosa function and can be used as a supplement for screening and early diagnosis of gastric cancer. Recently,serum PG has become a hot spot of study in portal hypertensive gastropathy and functional dyspepsia. Serum PG detection is a noninvasive,simple and low cost investigation method with marked clinical value. This article reviewed the value of serum PG detection in warning gastric cancer and evaluating gastric mucosa function.

Objective:To evaluate the effect of nutritional status on postoperative outcomes for patients with gastric cancer. Methods:Data of 353 gastric cancer patients at Xinjiang Medical University Affiliated Tumor Hospital between January 2013 and October 2014 were collected prospectively. Preoperative nutritional status was evaluated using Nutrition Risk Screening 2002 (NRS 2002). Postoperative complication rates were compared among different preoperative nutritional status. Results:On the basis of NRS 2002, the morbidities of patients with and without malnutrition risk were 47.0%(77/164) and 31.2%(59/189), respectively (P=0.002). Among the patients with an NRS score of at least 3, the complication rate was significantly lower in the group with preoperative nutrition than in the group of patients without preoperative nutrition support (P=0.013). NRS 2002 was a significant predictor of postoperative complications (P=0.039, OR=1.634, 95%CI:1.025-2.606) on the basis of multivariable logistic regression analysis. Conclusion:As a nutritional evaluation tool, NRS 2002 may predict postoperative complications for gastric cancer patients.

Objective To analyze the incidence factors between accompanies and mwses in pediatric transfusion clinic, and find out the countermeasures. Methods 75 conflicts occurred between August 2004 to August 2008 were analyzed and made a contrast. Results The elements for the conflict were as follows: nurses, accompanies and patients. Conclusions The nurses should improve the emergency cop-ing abilities, communication skills, technical skills, supporting psychological nursing for the patients and the accompanies. All these are effective measures to avoid conflicts.

Objective T To investigate the effect of sirolimus (SRL) on the differentiation,development,and maturation of mice bone marrow-derived dendritic cells (DC),and the synergic effects of them in prolonging survival time of skin allograft.Methods (1) DC of C57BL/6 mice were derived from bone marrow cells upon culture with SRL. The expression of CD11c,CD86 and major histocompatibility complex (MHCⅡ) molecules was assessed with or without lipopolysaccharide (LPS) stimulation by flow cytometry; (2) The capacity of DC administrated by SRL to stimulate allogeneic T lymphocyte proliferation was examined by mixed lymphocyte culture (MLR); (3) A skin transplantation model was established with the recipients BALB/c mice and the donor C57BL/6 mice. Recipients were divided into control group (there was no administration before skin transplantation),immature DC group (injection of donor C57BL/6 mice immature dendritic cells 2?10 6 via tail vein before skin transplantation),SRL group (receiving oral SRL 3 mg/kg every day for 7 days before skin transplantation),combined group (receiving an injection of donor C57BL/6 mice immature DC via tail vein and of oral SRL before skin transplantation),and isogeneic group (in which the donors and recipients were both BALB/c mice and there was no administration before skin transplantation). Survival time and histological changes of skin allograft were observed in different groups.Results (1) CD11c expression on the DC in the presence of SRL was slightly decreased,but CD86 and MHCⅡ molecules significantly decreased,and SRL treatment could resist the stimulation of LPS; (2) MLR revealed that DC administrated by SRL could inhibit allogeneic T lymphocyte proliferation; (3) SRL treatment in combination with donor immature DC before transplantation could alleviate inflammation and prolong survival time of skin allograft in mice.Conclusions SRL does not alter differentiation but inhibit the maturation of DC. Sirolimus can cooperate with immature DC to prolong survival time of skin allograft in mice.

AIM: To investigate the effects of Astragalus polysacharin(APS) on human fibroblast and human umbilical vein endothelia cell (HUVEC) proliferation, as well as its acts on adhesion between white cells and HUVECs. METHODS: Human fibroblasts from distal and proximal skin away the ulcer were cultured as normal fibroblasts(NF) and wounded fibroblasts(WF). MTT assay was used for detecting cell proliferation, Rose Bengal staining and fluorescence immunohistology assay were used for examining the adhesion of human polymorpho-nuclear cell(PMN) and TPH-1 to HUVECs. RESULTS: 2 44-156 mg/L APS promoted WF proliferation, and 2 44-39 mg/L APS also promoted NF proliferation, but it did not show any proliferating effect on HUVECs. APS inhibited the adhesion of PMN or TPH-1 to HUVECs induced by tumor necrosis factor(TNF). At 25-100 mg/L, it also inhibited both VCAM-1 and ICAM-1 expression in HUVECs induced by TNF. Treatment with APS for 12 h also inhibited CD44 expression in HUVECs. CONCLUSION: APS shows mitogenic activity on both human normal and wounded fibroblasts. It also exerts anti-inflammation effects by inhibiting adhesion molecule expression and adhesion of white cells to HUVECs. [