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Objective To discuss the clinical effects of different energy densities of enteral nutrition (EN) preparations on mechanical ventilation (MV) patients with acute severe traumatic brain injury (sTBI). Methods Sixty MV patients with acute sTBI admitted to the Department of Critical Care Medicine of Hangzhou Xiaoshan District First People's Hospital from July 2015 to December 2017 were divided into two groups according to different energy densities of nutritional preparations. Thirty patients of the control group were given nasal feeding with standard energy density EN (energy density 3.35 - 4.19 kJ/mL) and 30 patients of the observation group were given nasal feeding with relatively higher energy density (energy density 5.44 - 6.28 kJ/mL). The indexes of nutritional status between the two groups before and after treatment were compared: including prealbumin (PA), albumin (Alb), globulin (Glo), hemoglobin (Hb), 5-day and 1-week heat calorie compliance rates of reaching target calories, MV time and incidence of complications. Results There were no statistically significant differences in nutritional indicators before treatment between the two groups (all P > 0.05). The compliance rates of reaching target calories of the observation group on the 5 and 7 days after treatment were significantly higher than those in the control group [5 days: 66.67% (20/30) vs. 50.00% (15/30), 1 week: 81.33% (25/30) vs. 70.00% (21/30), both P < 0.05], and the MV time was significantly lower than that in the control group (hours: 92.48±12.04 vs. 128.88±16.29, P < 0.05); the levels of PA, Alb, Hb, Glo were significantly higher in the observation group than those in control group on the 21st day after treatment [PA (g/L): 0.28±0.11 vs. 0.15±0.04, Alb (g/L): 36.52±5.79 vs. 29.63±2.74, Hb (g/L): 92.40±9.50 vs. 81.10±8.60, Glo (g/L): 24.42±1.73 vs. 18.19±3.59, all P < 0.05]. Complications: the total incidence of abdominal distension, diarrhea and constipation of the observation group was 36.6% (11/30), while that of the control group was 66.7% (20/30), the difference between the two groups being statistically significant (P < 0.05). Conclusion High energy density enteral nutrition can improve the nutritional status of the organisms of MV patients with acute sTBI, reduce the time of MV and the incidence of complications, thus it is worthy to be widely applied clinically.
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Objective To understand the cognition about healthcare-associated infection(HAI) management among directors in secondary and above hospitals in Shaanxi Province.Methods Questionnaire survey was adopted to investigate hospital directors who participated in The third session of Shaanxi Provincial HAI management training course for hospital directors.Results A total of 181 questionnaires were distributed, 173 (95.58％) were qualified.74.57％ of surveyed hospitals were secondary hospitals, 61.85％ were comprehensive hospitals, 67.05％ of respondents received HAI training in recent 3 years, 81.50％ and 55.49％ of hospital directors thought the main factors influencing the HAI management were health care workers'' awareness on HAI and leaders'' attention respectively.58.96％, 60.12％, and 46.82％ of hospital directors thought the director of HAI management department should have intermediate and above professional title, bachelor degree or above education, and preventive medicine professional requirements respectively.The awareness rate of HAI management-related knowledge was 86.71％, difference in awareness rate of HAI management-related knowledge among respondents of different job, gender, and HAI training in recent 3 years were all significantly different(all P<0.05).Conclusion Hospital directors'' cognition on HAI management affect the development of HAI work, strengthen the training on HAI knowledge among administrators can improve hospital administrators'' awareness on HAI prevention and control.
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Objective:To explore the function of IL-9 and PU.1 on genesis and development of pulmonary fibrosis,and the effect of active vitamin D3[1,25(OH)2VD3] on the expression levels of this two factors during the pathogenesis of fibrosis.Methods: 90 male SD rats were randomly divided into model group,treatment group,control group (n=30).Bleomycin(5 mg/kg) was injected into the trachea of rats to establish the model of pulmonary fibrosis in the model group and treatment group,while the control group was injected with isopyknic sterile saline.The treatment group,the model group and the control group were injected intraperitoneally with active vitamin D3,solvent of vitamin D3 (propylene glycol) and sterile saline on the 2nd day after surgery respectively.All injections were carried out once every other day.10 rats were euthanized at 14th,21st and 28th day in each group in turn.After obtaining lung tissues from experimental rats,the pathological change of lung was compared by hematoxylin-eosin staining.The difference of collagen fiber and hydroxyproline content were compared by the Masson staining and basic-hydrolysis method respectively.The mRNA and protein expression of IL-9 and PU.1 in lung tissue were detected by Real-time PCR and immunohistochemical technology respectively.The expression of IL-9 in serum was detected by ELISA.Results: Fibrosis appeared in lungs of experimental rats treated with bleomycin after 14 days,and more and more aggravated with time.At three time points,the hydroxyproline content in model group and treatment group were significantly higher than that of control group,and the treatment group was significantly lower than the model group.At three time points,the expression of IL-9 and PU.1 in model group and treatment group were risen gradually,and obviously higher than that in control group.On the 14th and 21st day,the expression of two factors in treatment group was significantly lower than model group;on the 28th day,there was no statistically significant difference between treatment group and model group(P>0.05).In model group and treatment group,the expression of two factors on 21st day was significantly higher than that on 14th day;there was no statistically significant difference between the 28th day and the 21st day.Conclusion: IL-9 and PU.1 may play a profibrotic role at early stage of pulmonary fibrosis induced by bleomycin.The active vitamin D3 may lower the expression level of PU.1,and then reduce the secretion of IL-9,thus may play an inhibiting effect on genesis and development of pulmonary fibrosis in rats.
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Bacterial ghosts are bacterial cell envelopes devoid of cytoplasmic contents while maintaining their cellular morphology, which can be used as a new vaccine and delivery vector. In this study, a clinical isolate of avian pathogenic Escherichia coli (APEC) strain DE17 was used to prepare bacterial ghost through three different ways. The results showed that the cleavage efficiency of DE17 bacterial ghost was 99.9% with the lysis plasmid containing the PhiX174 lysis gene E. Scanning electron microscopy showed that transmembrane tunnels were formed in the middle or both ends of the cell envelope of DE17. Furthermore, the DE17 bacterial ghost was prepared with one of cell penetrating peptides (CPPs) named MAP (KLALKLALKALKAALKLA), which will completely inactivate DE17 (OD₆₀₀=0.1) by 10 μmol/L MAP. The cell envelope showed a gully-like structure and obvious transmembrane tunnels were not found through the SEM. However, the DE17 could not be lysed by importing the lysis plasmid (pBV220-MAP), which was used to express MAP. The present study will benefit for research on bacterial ghost preparation methods and provide a reference for biosafety of bacterial ghost vaccines.
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Objective To investigate the current situation of healthcare-associated infection(HAI)management in secondary and above medical institutions in Shaanxi Province,analyze development trend,and put forward sugges-tions for improvement.Methods In May-June,2016,170 secondary and above hospitals in 10 cities were selected for surveying through stratified random sampling method.Survey content included basic situation of hospitals,HAI management,HAI monitoring,and so on.Results Available questionnaires were obtained from 165 hospitals (43 tertiary hospitals,and 122 secondary hospitals).Of 165 hospitals,more than 90% have established HAI manage-ment organizations and regulations,but hospital risk management should be paid more attention,only 63.03% of hospitals perfected the risk management system and 66.06% conducted risk assessment.99.09% of hospitals im-plement training on HAI to all staff regularly and 88.41% conducted effective feedback.In the aspect of staff alloca-tion,88.48% of the hospitals assigned enough professionals for HAI management,but only 34.55% have specific training programme for these personnel.Only 33.94% of hospitals have special funds for HAI control;in the aspect of monitoring on HAI,21.21% of hospital installed and used HAI monitoring software;In the aspect of implemen-tation of monitoring programme,about 90% of hospitals developed monitoring on HAI cases and environmental hy-giene,but only 34.55% and 23.64% of hospitals conducted targeted monitoring on intensive care unit and neonatal intensive care unit respectively.Conclusion Organizational structure of HAI management in Shaanxi Province is perfect,relevant rules and regulations are basically established,basic monitoring projects are universal,but the awareness of risk management needs to be strengthened,professional allocation and professional quality develop-ment are both imbalance,informational monitoring is inadequate.
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Objective Idiopathic pulmonary fibrosis ( IPF) is a chronic inflammatory disease with unknown etiology and is lack of effective therapy. The aim of this study is to explore the function of Ca2+ and PI3K/AKT/mTOR pathway in the pathogenesis of IPF, and the impact of 1,25?( OH) 2 D3 on Ca2+ and PI3K/AKT/mTOR pathway in type Ⅱalveolar epithelial cells of rat with IPF. Methods 150 male SD rats were randomly divided into 2 groups: prevention group ( control groupⅠ, model groupⅠ, medication groupⅠ) and treatment group ( control groupⅡ, model groupⅡ, medication groupⅡ) . The tracheal exposure surgery was operated in control groupⅠ/Ⅱ, and then 200μL sterile physiological saline was administered by intraperitoneal injection of each rats 2 days and 14 days after surgery, separately. Bleomycin(BLM)(5 mg/kg) was in?jected into the trachea of model groupⅠ/Ⅱ, and then vitamin D3 solvent(0.1%ethanol and 99.9%glycol propylene, 1μL/g) was ad?ministered by intraperitoneal injection 2 days and 14 days after surger?y, separately. Bleomycin( BLM) ( 5 mg/kg) was injected into the tra?chea of medication groupⅠ/Ⅱ, and then 1,25?( OH) 2 D3( 2μg/kg) was administered by intraperitoneal injection 2 days and 14 days after surgery, separately. IPF model was built by injecting Bleomycin into the trachea of rats, 1,25?(OH)2D3(2μg/kg) was used to prevent and treat IPF by intraperitoneal injection in medication group. The hydroxyproline content of lung tissue in each group was measured, type Ⅱalveolar epithelial cells were separated from lung tissue and labeled with Fluo?3AM, then concentration of Ca2+ was detected by Laser scanning confocal microscope. The mRNA levels of PI3K, AKT and mTOR in the typeⅡalveolar epithelial cells were tested by RT?PCR. Results Compared with control groupⅠ/Ⅱ at each time point, hydroxyproline content of lung tissue, Ca2+ concentration and expression of PI3K, AKT and mTOR in typeⅡalveolar epithelial cells in model groupⅠ/Ⅱand medication groupⅠ/Ⅱwere sig?nificantly raised( P<0.05 or P<0.01) , but these were significantly reduced in medication groupⅠ/Ⅱcompared with model groupⅠ/Ⅱ( P<0.05 or P<0.01) . Correlation analysis showed that there is significant positive correlation between Ca2+ concentration and mRNA expression levels of PI3K, AKT and mTOR in model groupⅠ/Ⅱ(r=0.5988, r=0.6230, r=0.6603,P<0.01)and medication groupⅠ/Ⅱ( r=0.701 2, r=0.632 3,r=0.740 3,P<0.01) . Conclusion The PI3K/AKT/mTOR pathway plays an important role in devel?opment of IPF. 1,25?( OH) 2 D3 is able to reduce Ca2+concentration in typeⅡalveolar epithelial cells and inhibit the PI3K/AKT/mTOR pathway, and then inhibit the development of IPF.
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OBJECTIVE:To provide reference for clinical application of antibiotics and the management of pathogen. METH-ODS:The clinical isolated bacteria in our hospital from 2011 to 2014 were identified and analyzed,and the amount of antibiotics in our hospital from 2011 to 2014 were analyzed. The operation and result of drug susceptibility test were in accordance with the standard of clinical laboratory standards institute(CLSI),using WHONET software for statistical processing. RESULTS:The main bacteria isolated in our hospital during 2011-2014 were as follows:constituent ratio of Escherichia coli were 14.93%,16.81%, 15.01% and 15.41%,respectively;that of Staphylococcus aureus were 9.84%,11.90%,9.83% and 7.17%,respectively;that of Acinetobacter baumannii were 9.00%, 9.95%, 14.24% and 18.64%, respectively;that of Pseudomonas aeruginosa were 12.36%,12.42%,14.20% and 15.48%,respectively. The main antibiotics used in our hospital during 2011-2014 were as fol-lows:the amount of piperacillin/tazobactam(2.25 g/a)were 4 685,12 610,13 639 and 14 542,respectively;that of cefepime (0.5 g/a)were 8 613,24 738,12 684 and 6 751,respectively;that of aztreonam(0.5 g/a)were 14 124,32 062,3 323 and 4 534,respectively;that of meropenem(0.5 g/a)were 2 291,5 436,6 813 and 5 341,repectively;that of levofloxacin(0.3 g/a) were 12 253,40 893,48 468 and 50 558,respectively. CONCLUSIONS:With the increase of antibiotics,susceptibility rate of main pathogen are gradually decreased;rational use of antibiotics plays an important role in decreasing the drug resistance.
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Bacterial ghost is intact envelope of Gram-negative bacteria, which is produced by the function of the lysis gene E from bacteriophage PhiX174. The expression of the lysis gene E is usually controlled by the thermosensitive lambdapL/pR-cI857 promoter. In this study, we described a mutation (T --> C) at the ninth nucleotide of the OR2 in the lambdapR promoter of the lambdapL/pR-cI857 system by overlap PCR. The bacteriolytic assay showed that the mutation in the lambdapL/pR-cI857 system enhanced the temperature of repressing the expression of gene E up to 37 degrees C. The lysis efficiency of altered lambdapR promoter in Escherichia coli DH5a and avian pathogenic E. coli DE17 was up to 99.9%. The expanded range of temperature will benefit for the production of bacterial ghost.
Subject(s)
Bacteriolysis , Physiology , Bacteriophage lambda , Genetics , Base Sequence , Cell Membrane , Physiology , DNA, Bacterial , Escherichia coli , Genetics , Physiology , Virology , Gene Expression Regulation , Genetics , Molecular Sequence Data , Mutation , Promoter Regions, Genetic , Genetics , Viral Proteins , Genetics , MetabolismABSTRACT
OBJECTIVE: To investigate the clinical curative effect and adverse reaction of oxaliplatin combined with paclitaxel and fluorouracil in the treatment of advanced colorectal cancer.METHODS: 189 cases with advanced colorectal cancer were randomly divided into two groups: Group A(n=94) received oxaliplatin combined with paclitaxel and fluorouracil,and Group B(n=95) to receive oxaliplatin combined with fluorouracil.Both groups were treated with 3 cycles(21 days in every cycle).RESULTS: The total effective rate in Group A was 54.3% versus 40.0% in Group B;and the toxicity in Group A was less severe than in Group B(P
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Objective To study the diagnosis and treatment of blunt pancreatic injury (BPI). Methods A retrospective analysis was made on the clinical data of 58 cases of BPI admitted and treated in our hospital during 23 years. Results The positive diagnosis rate was 51.1%(23/45) for single BUS examination ,but 70.0%(21/30) for two and more BUS examimations. The positive diagnosis rate was 65.0%(26/40) for single CT scanning, but 91.3%(21/23) for two and more CT scannings. Twenty-five cases(25/37,67.6%) with BPI were determined preoperatively, and 12 cases(12/37,32.4%)during (operation).Thirty-seven cases underwent operatiom, included grade I in 10cases、grade II 13cases、grade III 9cases、 grade IV 4cases and gradeV 1case. Twenty-one cases received nonoperative treatment, included 11 grade in I,7 grade II and 3 grade III. In the entire group, 6 cases died(10.4%).The mortality in the operation group was 16.2%(6/37).There were no deaths in the nonoperative group. The main cause of death was multiorgan failure(5/6,83.3%). There were 11(19.0%)cases of pancreatic pseudocyst after treatment in the entire group, included 3(3/37,8.1%) in operation group and 8(8/21,38.1%) in nonoperation group. Conclusions The diagnosis of BPI should combine the clinical findings with repeated BUS and CT scanning. Nonoperative treatment is a good choice for BPI without main pancreatic duct injury. Operative treatment is suitable for serious BPI and those with other intra-abdominal organ jnjury.