Factors affecting nasal drug delivery and design strategies for intranasal drug delivery / 浙江大学学报·医学版

Intranasal drug delivery system is a non-invasive drug delivery route with the advantages of no first-pass effect, rapid effect and brain targeting. It is a feasible alternative to drug delivery via injection, and a potential drug delivery route for the central nervous system. However, the nasal physiological environment is complex, and the nasal delivery system requires "integration of medicine and device". Its delivery efficiency is affected by many factors such as the features and formulations of drug, delivery devices and nasal cavity physiology. Some strategies have been designed to improve the solubility, stability, membrane permeability and nasal retention time of drugs. These include the use of prodrugs, adding enzyme inhibitors and absorption enhancers to preparations, and new drug carriers, which can eventually improve the efficiency of intranasal drug delivery. This article reviews recent publications and describes the above mentioned aspects and design strategies for nasal intranasal drug delivery systems to provide insights for the development of intranasal drug delivery systems.

Pre-hospitalization process reengineering based on the failure mode and effect analysis combined with process analysis method / 中华医院管理杂志

The pre-hospitalization service is an important initiative for medical institutions to implement the national reform of the medical security system. In 2018, Zhejiang province proposed the " most run once reform", requiring the establishment of an admission preparation center to carry out pre-hospitalization services. In June 2021, a certain maternal and child health hospital conducted a process reengineering for the pre admission process of the admission preparation center by applying the combined process analysis and failure mode and effects analysis, high-risk points of the hospitalization process were screened, the job value and job functions of each sector were sorted out, and the sector for improvement sector was evaluated, to launch an independent information system, establish a one click automatic import of pre hospital medical orders function, and remove on-site billing physicians from various specialties for improvement measures. The steps of the process had been optimized, inlcuding issuing pre hospital medical orders, waiting for pre-hospitalization, pre-hospitalization, and so on. The completeness rate of pre hospital medical orders, average waiting days before hospitalization, and patient satisfaction scores of pre hospitalization centers had changed from 91%, 2.99 days, and 93.46 points before process reengineering to 92%, 2.44 days, and 95.80 points after reengineering, respectively. This practice had achieved dual improvements in pre admission service quality and efficiency, so as to provide a reference for China′s medical institutions to carry out safe and efficient pre admission services.

Qualitative study on post-traumatic experience of inpatients with simple maxillofacial trauma / 中国实用护理杂志

Objective:To investigate the post-traumatic experience of inpatients with simple maxillofacial trauma, and to provide a theoretical basis for the construction of post-traumatic intervention programs.Methods:A qualitative approach was used to conduct semi-structured interviews with 17 inpatients with simple maxillofacial trauma in Affiliated Hospital of Nantong University from January to April, 2020, and Colaizzi phenomenological analysis was used to analyze the interview data.Results:The post-traumatic experience of inpatients with simple maxillofacial trauma mainly included five themes: acute impairment of maxillofacial function, change of comfort, disorder of self-image, transformation from negative psychological experience to positive psychological experience, and lack of coping resources.Conclusions:Medical staff should pay attention to the functional recovery, body image and psychological intervention of inpatients with simple maxillofacial trauma, provide more professional support, and promote the physical and mental recovery of patients.

Clinical efficacy of atezolizumab plus bevacizumab for first-line treatment of unresectable hepatocellular carcinoma / 中华消化外科杂志

Advanced hepatocellular carcinoma (HCC) has limited treatment options and poor prognosis. Only two tyrosine kinase inhibitors have been approved as single agents for first-line treatment over the last decade. In 2020, atezolizumab combined with bevacizumab was appro-ved for first-line treatment of advanced HCC. As the first brand-new therapy to surpass sorafenib, atezolizumab combined with bevacizumab showed good safety and life quality in patients. The authors introduced the diagnosis and treatment of a China Liver Cancer Staging Ⅲb HCC patient receiving atezolizumab combined with bevacizumab, in order to provide references for patient management.

Fructosan form Paenibacillus kribbensis PS04 enhance disease resistance against Rhizoctonia solani and tobacco mosaic virus

BACKGROUND: Rice sheath blight (caused by Rhizoctonia solani) and tobacco mosaic virus are very important plant diseases, causing a huge loss in global crop production. Paenibacillus kribbensis PS04 is a broad-spectrum biocontrol agent, used for controlling these diseases. Previously, extracellular polysaccharides (EPS) from P. kribbensis PS04 had been purified and their structure was inferred to be fructosan. This study aimed to evaluate the effects of exogenous EPS treatment on plant­pathogen interactions. RESULTS: Plant defense genes such as phenylalanine ammonia-lyase, catalase, chitinase, allene oxide synthase, and PR1a proteins were significantly induced by exogenous EPS treatment. Moreover, subsequent challenge of EPSpretreated plants with the pathogens (R. solani or tobacco mosaic virus) resulted in higher expression of defenseassociated genes. Increased activities of defense-associated enzymes, total phenols, and flavonoids were also observed in EPS pretreated plants. The contents of malondialdehyde in plants, which act as indicator of lipid peroxidation, were reduced by EPS treatment. CONCLUSIONS: This study comprehensively showed that EPS produced from P. kribbensis PS04 enhances disease resistance in plants by the activation of defense-associated genes as well as through the enhancement of activities of defense-related enzymes.

Efficacy analysis of T lymphocyte polyclonal antibody in renal transplantation from donor kidney of organ donation after citizen's death / 器官移植

Objective To compare the clinical efficacy of different T lymphocyte polyclonal antibodies in renal transplantation from donor kidney of organ donation after citizen's death. Methods Clinical data of 691 donors and recipients undergoing renal transplantation from donor kidney of organ donation after citizen's death were retrospectively analyzed. According to different T lymphocyte polyclonal antibodies used for induction, all recipients were divided into the rabbit anti human T lymphocyte immunoglobulin (rALG) group (n=414) and rabbit anti human thymocyte immunoglobulin (rATG) group (n=277). The recovery of renal graft function in recipients of the two groups were collected, including the incidence of delayed graft function (DGF) and acute rejection (AR), and the changes of serum creatinine level after renal transplantation. The 1-year survival rate of the recipients and renal grafts was collected. The incidence of adverse effects within 1 year after operation was calculated. According to the DGF risk score of donors, all recipients were divided into 5 groups. The use proportion of rALG and rATG in the recipients of each group was calculated. Results The incidence of DGF in the recipients of rALG and rATG groups was 14.5% (60/414) and 11.9% (33/277), respectively. The duration of DGF in the recipients of rALG and rATG groups was (7±4) d and (12±7) d respectively, with no statistically significant difference between two groups (P > 0.05). The incidence of AR in the rALG group was 7.5% (31/414), significantly higher than 4.0% (11/277) in the rATG group (P < 0.05). The serum creatinine levels of recipients within 6 months after renal transplantation tended to gradually decline in both groups. In renal transplantation for donor kidney with a DGF risk score of 0-15, the use proportion of rALG was significantly higher than that of rATG. However, the use proportion of rATG was significantly higher than that of rALG in renal transplantation for donor kidney with a DGF risk score over 16 (P < 0.05). The 1-year survival rates of the recipients and renal grafts in the rALG and rATG groups were 99.8% and 99.6%, 98.1% and 98.2%, respectively. There was no significant difference between two groups (both P > 0.05). The incidence of acute pulmonary edema and leukopenia in the recipients of rATG group was significantly higher than that in the rALG group (both P < 0.05). Conclusions Both rALG and rATG can effectively reduce the incidence of DGF and AR and achieve good clinical efficacy after renal transplantation from donor kidney of organ donation after citizen's death. The incidence of leukopenia and acute pulmonary edema induced by rATG is higher than that by rALG in the renal transplant recipients.

Application of hypothermic machine perfusion in the renal transplantation from deceased donor with high-risk delayed graft function / 器官移植

Objective To evaluate the clinical effect of hypothermic machine perfusion (HMP) in the storage of renal grafts from deceased donor (DD) with high-risk delayed graft function (DGF). Methods Clinical data of 52 donors with high-risk DGF were collected in this prospective randomized controlled study. Two renal grafts from each donor were randomly divided into the HMP group (n=52) and static cold storage (SCS) group (n=52). In the HMP group, the renal grafts were stored by LifePort under HMP, whereas the renal grafts in the SCS group were preserved in University of Wisconsin solution (UW solution). The incidence of DGF and primary nonfunction (PNF) after renal transplantation was statistically compared between two groups. The recovery of renal graft function, the survival rates of the recipients and renal grafts within postoperative 1 year were observed in two groups. Results The incidence of DGF in the HMP group was 4%(2/52), significantly lower than 17% (9/52) in the SCS group (P < 0.05). No PNF was reported in the HMP group and 1 case of PND was noted in the SCS group, the difference was not statistically significant (P > 0.05). The recovery time of graft function of the recipients in the HMP and SCS groups were (7.2±0.6) d and (7.7±1.0) d with no statistical significance (P > 0.05). In the HMP group, the urine volume of the recipients on the day of operation, postoperative 1 and2 d was significantly larger than that in the SCS group (all P < 0.05). In the HMP group, the levels of serum creatinine at each time point after operation were significantly lower than those in the SCS group (all P < 0.05). The 1-year survival rates of the recipient and kidney were 98.1%, 92.3% and 100%, 96.2% in the HMP and SCS groups with no statistical significance (all P > 0.05). Conclusions HMP can significantly reduce the incidence of DGF after renal transplantation from DD with high-risk DGF and promote the early recovery of graft function.

Clinical value of asymmetric skin folds for screening of developmental dysplasia of the hip in infant / 中华实用儿科临床杂志

Objective@#To investigate the clinical significance of asymmetric skin folds in the diagnosis of developmental dysplasia of the hip (DDH) in infant.@*Methods@#The clinical data of 3 266 infants aged up to 6 months who were evaluated because of suspicious findings for DDH, hospitalized at Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University between January 2012 and April 2019 were reviewed retrospectively, including 1 185 boys and 2 081 girls, with a mean age of 2.8 months (ranging from 1 d to 6 months). The referred reasons included regular screening for DDH without suspicious findings [379 cases(11.6%)], clunk of the hip[59 cases(1.8%)], limb-length discrepancy[188 cases (5.8%)], limitation of hip motion or asymmetrical range of motion[58 cases(1.8%)], asymmetric skin folds[2 107 cases(64.5%)], and combined conditions of musculoskeletal disorder[475 cases(14.5%)]. The Graf′s ultrasound method was used to define the hip conditions.A type Ⅰ or Ⅱa hip was graded as normal, and a type Ⅱb or more serious was graded as DDH.The percentages of DDH for various reasons were compared.@*Results@#Among 3 266 patients (6 532 hips), a total of 194 infants(230 hips)were diagnosed as DDH, and the total diagnostic rate was 5.94%, including 31 males and 163 females; there were 109 cases involving in the left, 49 cases in the right, and 36 cases in the bilateral.The DDH diagnosed rate for regular screening was 8.71%(33/379 cases), 6.78%(4/59 cases) for clunk of the hip, 10.34%(6/58 cases) for limitation of hip motion, 14.36%(27/188 cases)for limb-length discrepancy, 4.79%(101/2 107 cases) for asymmetric skin folds, 4.84%(23/475 cases) for combined conditions of musculoskeletal disorder, and the DDH diagnosed rate for asymmetric skin folds was the lowest(χ2=37.14, P<0.05).@*Conclusions@#Although asymmetric skin folds is the most common reason for DDH screening in infant up to 6 months, its clinical significance is limited, asymmetric skin folds should not be considered as an independent indication for DDH screening.

Reducing treatment strategy for bronchial asthma based on fractional exhaled nitric oxide level and symptom control / 中华全科医师杂志

Objective To evaluate the application of fractional exhaled nitric oxide (FeNO) in the reducing treatment of bronchial asthma.Methods From October 2015 to September 2016,60 asthmatic patients with FeNO＞25 ppb were randomized into FeNO group and control group with 30 cases in each group.Patients in both groups were treated with combined inhaled corticosteroids and long-acting beta 2 agonist (ICS/LABA) starting with low doses;the dosage was adjusted according to the symptom control alone in control group,while in FeNO group the dosage was adjusted according to the symptom control and FeNO level.After 1 year-follow up,the Asthma Control Test (ACT) scores,Asthma Life Questionnaire (mini AQLQ)scores,pulmonary function,FeNO levels,blood eosinophil counts,total IgE,hierarchical control level,cumulative corticosteroid use and cumulative months of leukotriene receptor antagonists (LTRA) use were compared before and after treatment within group,and between two groups.Stratified analysis was carried out in the patients complicated with allergic rhinitis.Results After treatment,ACT scores,mini AQLQ scores and FEV1/pred (％) were significantly higher than those before treatmentin both groups (t=10.755,10.189,8.632 and 13.311,8.102,12.456,respectively,all P＜0.05),while the FeNO,EOS and total IgE levels were significantly lower than those before treatment (t=8.005,3.313,3.924 and 8.967,3.885,3.270,respectively,all P＜0.05),and the numbers of patients with good control were significantly increased (Z=-5.035 and-4.976 respectively,P＜0.05).Compared with control group,FeNO level was lower,mini AQLQ scores of symptom scores and emotional scores were higher and the average numbers of asthma attacks per patient per year were less after treatment in FeNO group (t=2.912,4.214,4.589,U=2.154,all P＜0.05).However,there was no significant difference in cumulative corticosteroid use and cumulative months of LTRA use between two groups (U=564.000 t=1.921 and 0.165,respectively,P＞0.05).For patients complicated with allergic rhinitis,the numbers of acute asthma attack were increased and the cumulative dosage of systemic corticosteroid use was higher in control group than those in FeNO group (both P＜0.05).Conclusion The reducing treatment strategy based on FeNO level and symptom control is of clinical value for patients with bronchial asthma,especially for those complicated with allergic rhinitis.

Application of new perioperative functional exercise combined with rehabilitation guidance in the treatment of developmental hip dislocation in children / 中国基层医药

Objective To explore and analyze the clinical application of perioperative functional exercise combined with rehabilitation guidance in the treatment of pediatric developmental hip dislocation.Methods From December 2015 to December 2017,40 children with developmental dislocation of the hip treated in Shengjing Hospital Affiliated to China Medical University were selected in the research.The patients were randomly divided into control group and observation group,with 20 cases in each group.The control group was given conventional perioperative rehabilitation guidance,the observation group was given new perioperative functional exercise combined with rehabilitation guidance.The limb function and mental status changes before and after the intervention were compared between the two groups.Results After intervention,the scores of FMA and Barthel were all increased in the two groups compared with those before intervention,and the improvements of the observation group wese more significant than those of the control group (all P ＜ 0.05).After intervention,the self-rating anxiety scale (SAS),self-rating depression scale (SDS),Hamilton depression scale(HAMD) and other negative emotions scores in the observation group were significantly lower than those in the control group (all P ＜ 0.05).Conclusion New perioperative functional exercise combined with rehabilitation guidance can effectively improve the limb function of children with developmental dislocation of the hip joint,at the same time improve the patients' mental state,and has positive significance to enhance the curative effect.

Therapeutic effects of p38 mitogen-activated protein kinases inhibitor SB203580 on airway inflammation in a mouse model of asthma / 中华微生物学和免疫学杂志

Objective@#To investigate the effects of p38 mitogen-activated protein kinases (p38 MAPK) inhibitor (SB203580) on airway inflammation in a mouse model of asthma.@*Methods@#Forty-eight female BALB/c mice were randomly divided into four groups (n=12): control group, asthma group, dexamethasone group (2 mg/kg) and SB203580 group (5 mg/kg). Within 24 hours after the last ovalbumin (OVA) challenge, airway responsiveness was measured by lung resistance (RL) and dynamic compliance (Cdyn). Bronchoalveolar lavage fluid (BALF) was collected for counting total cells, eosinophils, lymphocytes, neutrophils and macrophages. IgE and OVA-specific IgE in serum and IL-4, IL-5, IL-13 and IFN-γ in BALF were detected by ELISA. Lung tissues were stained with hematoxylin and eosin (HE) and alcian blue-periodic acid-Schiff (AB-PAS) to observe histopathological changes. Expression of p38 MAPK and phosphorylated p38 (p-p38) MAPK was detected by immunohistochemical staining and Western blot, respectively.@*Results@#(1) The mice in the asthma group showed typical symptoms of acute asthma after inhaling aerosolized OVA, while the symptoms were alleviated in those treated with dexamethasone or SB203580. (2) When challenged with the methacholine at the doses of 0.050 mg/kg, 0.100 mg/kg and 0.200 mg/kg, asthmatic mice treated with dexamethasone or SB203580 showed significantly decreased RL and increased Cdyn as compared with those in the asthma group (all P<0.05). (3) The concentrations of total IgE and OVA-specific IgE in serum in both dexamethasone and SB203580 groups were lower than those in the asthma group (all P<0.05). (4) Compared with the asthma group, the numbers of the total cells, eosinophil, lymphocytes and neutrophils in BALF were decreased in dexamethasone and SB203580 groups (all P<0.05). (5) Compared with the asthma group, the dexamethasone and SB203580 groups showed lower levels of IL-4, IL-5 and IL-13, but higher levels of IFN-γ in BALF (all P<0.05). (6) Dexamethasone or SB203580 significantly decreased the hyperemia and edema in airway mucosa, reduced the infiltration of inflammatory cells in the peribronchial areas and alleviated the tracheal epithelium goblet cell metaplasia in asthmatic mice. (7) Treatment with dexamethasone or SB203580 inhibited OVA-induced phosphorylation of p38 MAPK in asthmatic mice as revealed by immunohistochemical staining (both P<0.05). No significant difference in the expression of p38 MAPK was observed among the four groups (all P>0.05). (8) Expression of p-p38 MAPK at protein level in both dexamethasone and SB203580 groups was lower than that in asthma group (both P<0.05).@*Conclusion@#SB203580 regulated the Th1/Th2 balance through inhibiting the activation of p38 MAPK signaling pathway to alleviate OVA-induced airway inflammation.

Long-term follow-up cohort of hepatitis B in China : current status and perspectives / 临床肝胆病杂志

Hepatitis B virus (HBV) infection is a global public health issue,especially in the Asian-Pacific region.At present,entecavir,tenofovir,and pegylated interferon are the first-line antiviral drugs recommended by related guidelines for the prevention and treatment of hepatitis B;however,different national/regional policies,economic level,coverage of health insurance,and medical level have caused the difference in antiviral regimens.Therefore,we have established a long-term follow-up cohort of hepatitis B to evaluate the efficacy of different treatment regimens,in order to improve the cure rate of hepatitis B and reduce the incidence rates of liver cirrhosis,liver cancer,and end-stage liver disease.Real-world data from cohort study help to understand the differences between guidelines and clinical practice,provide a reference for HBV guidelines,and balance clinical effect and cost-effectiveness.

Effect of sedation with regional anesthesia with dexmedetomidine on postoperative cognitive function in elderly patients with diabetes mellitus / 中华麻醉学杂志

Objective To evaluate the effect of sedation with regional anesthesia with dexmedeto-midine on postoperative cognitive function in elderly patients with diabetes mellitus. Methods A total of 180 elderly patients of either sex with diabetes foot, aged 65-80 yr, weighing 45-90 kg, of American So-ciety of Anesthesiologists physical status ⅡorⅢ, with preoperative Mini-Mental State Examination score>24, undergoing elective débridement, were divided into 2 groups(n=90 each)using a random number table: sedation with dexmedetomidine group(group D)and routine sedation control group(group C). Lumbar plexus block and sciatic nerve block were performed, after the reliable efficacy was achieved, dexmedetomidine was intravenously infused in a dose of 0.5 μg∕kg for 10 min followed by an infusion of 0.5 μg·kg-1·h-1until the end of surgery. Midazolam 0.02-0.04 mg∕kg was intravenously injected and mid-azolam 1 mg was injected intermittently during operation in group C. Ramsay sedation scores were main-tained between 2 and 4. At 30 min before surgery(T1), 1 h after the beginning of surgery(T2), at the end of surgery(T3), 6 h after the end of surgery(T4), and 24 h after the end of surgery(T5), venous blood samples were collected for determination of the level of blood glucose and plasma cortisol(Cor)con-centrations. Mini-Mental State Examination scores were assessed at 1 day before surgery and 1 and 3 days after surgery, and the occurrence of postoperative cognitive dysfunction was recorded in a short time period after operation. Results Compared with the baseline at T1, the level of blood glucose at T2-5and plasma Cor concentrations at T3,4were significantly increased in group C, and plasma Cor concentrations were sig-nificantly increased at T3,4(P<0.05), and no significant change was found in the level of blood glucose at T2-5in group D(P>0.05). Compared with group C, the level of blood glucose at T3-5and plasma Cor con-centrations at T3,4were significantly decreased, Mini-Mental State Examination scores were increased at 1 and 3 days after operation, and the incidence of postoperative cognitive dysfunction in a short time period after operation was decreased in group D(P<0.05). Conclusion Sedation with regional anesthesia with dexmedetomidine can improve postoperative cognitive function in elderly patients with diabetes mellitus.

Relationship between amount of literacy and behavior problems in primary pupils / 中国心理卫生杂志

Objective:To know the amount of literacy and scores of behavior problems of the grade 2-5 pupils in the primary school,and explore the correlation between them.Methods:A total of 673 pupils from grade 2 to 5 in primary school of Nanhai distric,Foshan City were enrolled.Their amount of literacy was assessed with the Primary School Literacy Assessment Scale,and their teachers were assessed with the Conners Teacher Rating Scale.Results:The amount of literacy in different grades,genders and parents' education levels were significantly different among the primary school students (P ＜0.05),girls's scores were higher than boys's [(2312 ±719) vs.(2184 ±734),P ＜ 0.05],students whose parents of high education level were higher than those of low education level (P ＜ 0.05).Scores of hyperactivity,inattentive-passive behaviors and conduct problems in different grades and genders were significantly different.Scores of Grade 2 pupils were higher than others,and boys's scores were higher than girls' s (P ＜ 0.05).Three factors of CTRS,including conduct problems (r =-0.31),hyperactivity (r =-0.43) and inattentive-passive behaviors (r =-0.36) and hyperactivity index(r =-0.38) had significantly negative correlation with the amount of literacy (P ＜ 0.001).Regression analysis showed that hyperactivity (β =-22.27,P ＜ 0.01) and conduct problems (β =-17.69,P ＜ 0.01) could significantly explain the amount of literacy (R2 =0.81).Conclusion:It suggests that hyperactivity and conduct problems are moderately associated with the amount of literacy in primary pupils.

New considerations in antiviral therapy for special populations with chronic hepatitis B / 临床肝胆病杂志

Increasing attentions have been paid to the antiviral therapy for special populations with chronic hepatitis B (CHB), including patients co-infected with HIV, HDV, or HCV, children and adolescents, pregnant women, patients with chronic kidney diseases, and patients who require chemotherapy or immunosuppressive therapy. The indications for antiviral therapy, drug selection and adjustment, and treatment course in special populations with CHB have become the hot topics of clinical research. In recent years, all guidelines for the prevention and treatment of CHB have provided a summary of key considerations in the standardized management of these populations. However, the strength of recommendations for antiviral therapy in these populations is not high. In order to obtain a strong medical evidence for antiviral therapy in these populations, we should standardize clinical management processes and carry out high-quality cohort studies based on the previous research.

Effect of Health Education and Psychological Nursing Intervention on the Patients with Postpartum Depression / 昆明医科大学学报

Objective To explore the clinical effect of health education and psychological nursing intervention on the prognosis of patients with postpartum depression. Methods Ninety cases of postpartum depression in our hospital from March 2012 to March 2014, were randomly divided into the control group and the observation group, 45 cases in each group. The patients in the control group were given routine nursing, the patients in the observation group received health education and psychological intervention on the basis of the control group. The anxiety and depression scores change, medication adherence and quality of life in the two groups were observed and compared. Results The scores of SDS and SAS in the observation group were significantly lower than those in the control group (P<0.05) . The medication adherence and quality of life score 3 months and 6 months after discharge in the observation group were significantly higher than those of control group (P<0.05) . Conclusion Health education and psychological intervention has positive effect on the prognosis of postpartum depression patients, and can effectively improve the patient's medication compliance and quality of life, it's one of the effective measures for the prevention and treatment of postpartum depression.

Common bacteria and change in antimicrobial resistance in the intensive care unit of a hospital from 2009 to 2013 / 中国感染控制杂志

Objective To investigate the common bacteria and change in antimicrobial resistance in an intensive care unit (ICU)in the past 5 years,and provide evidence for rational use of antimicrobial agents.Methods Bacteria isolated from ICU patients in a tertiary first-class hospital from 2009 to 2013 were collected,identified,and per-formed antimicrobial susceptibility testing.Results A total of 1 196 bacteria isolates were isolated in 2009-2013, the top five species were Acinetobacter baumannii (A.baumannii,29.60%),Pseudomonas aeruginosa (P . aeruginosa,14.38%),Staphylococcus aureus (S .aureus ,12.21 %),Escherichia coli (E.coli,12.21 %),and Klebsiella pneumoniae (K .pneumoniae ,11 .37%).Resistance rates of S .aureus to oxacillin,gentamycin, clindamycim,ciprofloxacin,and rifampicin showed a decreasing tendency from 2009 to 2013(all P 80% in 2009-2011 and 10.53% in 2013,A.baumannii had high resistance rates to most antimicrobial agents(resistance rates were >80%)during 5 years.Resistance rates of K .pneumoniae and E. coli to piperacillin/tazobactam,cefazolin,cefepime,amikacin,and aztreonam had a decreased tendency in 2009 -2013(all P <0.05).Conclusion The common bacteria causing infection in the ICU of this hospital showed a down-ward trend,which may be related to the introduction of national policies and management of hospital,continuous management of antimicrobial agents is suggested,antimicrobial agents should be used rationally to prevent the in-crease of bacterial resistance.

Diagnostic value of mult-detector CT for papillary renal cell carcinoma and chromophobe renal cell carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To explore the significance of multi-detector CT (MDCT) in differential diagnosis of papillary renal cell carcinoma and chromophobe renal cell carcinoma.</p><p><b>METHODS</b>Clinical data of forty-one cases of renal cancers confirmed pathologically were collected, including 21 cases of papillary renal cell carcinoma (PRCC) (14 type I, 7 type II) and 20 cases of chromophobe renal cell carcinoma (ChRCC). Their morphological and MDCT characteristics were retrospectively analyzed. Receiver operator characteristic curve (ROC) was used to analyze the value of MDCT in differential diagnosis of PRCC and ChRCC. Two senior radiologists analyzed the morphological and the dynamic enhancement characteristics of the images. The attenuation of the lesions and the adjacent renal parenchyma were measured. The morphological indexes were compared with chi-square test and the quantitative indexes were compared with independent sample T-test. Receiver operator characteristic curve (ROC) was used to analyze the sensitivity, specificity and accuracy of diagnosis of PRCC and ChRCC.</p><p><b>RESULTS</b>Angioid enhancement and filled enhancement were more common in ChRCC than in PRCC, while delayed enhancement was more often seen in PRCC than in ChRCC. Calcification was more common in type I than type II PRCC. The enhancement value (ΔCT value) in corticomedullary phase was (29.08 ± 20.12) Hu for PRCC, significantly lower than the (48.29 ± 26.70) Hu for ChRCC (t = -2.611, P = 0.013). The ΔCT value of type I PRCC in corticomedullary phase was (26.36 ± 18.16) Hu, showing a significant difference from that of ChRCC (t = -2.666, P = 0.012). The lesion to kidney ratio (LKR) in corticomedullary phase was 0.44 ± 0.19 for PRCC and 0.58 ± 0.15 for ChRCC, with a significant difference between them (t = -2.587, P = 0.014). The LKR of type I PRCC in corticomedullary phase was 0.39 ± 0.15, showing a significant difference from that of ChRCC (t = -3.628, P = 0.001). The difference value (D-value) of the attenuation of lesion between corticomedullary and nephrographic phases was (-3.69 ± 8.90) Hu for PRCC and (8.39 ± 21.98) Hu for ChRCC, with a significant difference between them (t = -2.285, P = 0.031). The D-value of type I PRCC was (-4.55 ± 9.82) Hu, showing a significant difference from that of ChRCC (t = -2.323, P = 0.028). There was no significant difference between the ΔCT, LKR and D-value of the type II PRCC and ChRCC (P > 0.05 for all). The area under the curve (AUC) for ΔCT value, LKR value in corticomedullary phase, and D-value were 0.718, 0.751 and 0.668, respectively, and there were no significant differences among them (z values were 0.896, 0.683 and 0.559, respectively, and P values were 0.370, 0.495 and 0.576, respectively). Using 49.350 Hu as the cutoff value for ΔCT value in corticomedullary phase, resulted in a sensitivity, specificity and accuracy of 50.0%, 90.5% and 70.7%, respectively. Corresponding values were 65.0%, 81.0% and 73.2%, when using a cutoff value of 0.532 for LKR in corticomedullary phase, and were 60.0%, 76.2% and 68.3%, when using a D-value of 0.400 Hu.</p><p><b>CONCLUSIONS</b>The ΔCT value, LKR value in corticomedullary phase, and the D-value are all useful indexes for the differentiation of PRCC and ChRCC.</p>

Phosphorylation of PTEN increase in pathological right ventricular hypertrophy in rats with chronic hypoxia induced pulmonary hypertension / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Phosphatase and tensin homologue on chromosome ten (PTEN) acts as a convergent nodal signalling point for cardiomyocyte hypertrophy, growth and survival. However, the role of PTEN in cardiac conditions such as right ventricular hypertrophy caused by chronic hypoxic pulmonary, hypertension remains unclear. This study preliminarily discussed the role of PTEN in the cardiac response to increased pulmonary vascular resistance using the hypoxia-induced PH rats.</p><p><b>METHODS</b>Male Sprague Dawley rats were exposed to 10% oxygen for 1, 3, 7, 14 or 21 days to induce hypertension and right ventricular hypertrophy. Right ventricular systolic pressure was measured via catheterization. Hypertrophy index was calculated as the ratio of right ventricular mass to left ventricle plus septum mass. Tissue morphology and fibrosis were measured using hematoxylin, eosin and picrosirius red staining. The expression and phosphorylation levels of PTEN in ventricles were determined by real time PCR and Western blotting.</p><p><b>RESULTS</b>Hypoxic exposure of rats resulted in pathological hypertrophy, interstitial fibrosis and remodelling of the right ventricle. The phosphorylation of PTEN increased significantly in the hypertrophic right ventricle compared to the normoxic control group. There were no changes in protein expression in either ventricle.</p><p><b>CONCLUSION</b>Hypoxia induced pulmonary hypertension developed pathological right ventricular hypertrophy and remodelling probably related to an increased phosphorylation of PTEN.</p>

Effect of different withdrawal time of dexmedetomidine on the quality of general anesthesia recovery / 中国医师杂志

Objective To explore effect of different withdrawal time of dexmedetomidine (DEX) on the quality of general anesthesia recovery.Methods Eighty patients of ASA Ⅰ or Ⅱ undergoing lymph surgery were randomly assigned to four groups (n =20).Groups D1,D2 and D3 received DEX 0.5 μg/kg as bolus before induction,continued with 0.5 μg/(kg · h) by infusion until one hour,30 min before the end of operation and the end of operation,respectively.Group C received equal volume of normal saline.Mean artery pressure (MAP),heart rate (HR) and pulse oxygen saturation (SpO2) were observed during and after operation.Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time,observer's assessment of alertness/sedation score (OAA/S),restlessness score (RS),and visual analogue scales (VAS) were observed after operation.Results For MAP and HR in Groups D2 and D3,there were no statistically significant difference during extubation compared to those at preoperation,but at the same time point,they were lower than those in group C (P ＜ 0.05).For groups C and D1,MAP and HR at extubation and 5 min after extubation were higher than those at preoperation (P ＜0.05).Spontaneous respiration recovery time,eyes open time,extubation time,orientation recovery time in group D3 were significantly longer than those in Group C (P ＜ 0.05),while there were no statistically significantly difference between groups D1,D2,and group C.OAA/S in group D3 was significantly lower than that in group C (P ＜ 0.05) at extubation.Incidence of restlessness,VAS,and cases given analgesic 2 hours after operation in groups D2 and D3 were significantly lower than those in groups C and D1.Compared to those in group C,dosages of propofol and remifentanil in groups D2 and D3 were significantly lower.Conclusions Dexmedetomidine administered of 0.5 μg/kg before induction,continued with infusion of 0.5 μg/(kg · h) until 30 min before the end of operation,may improve emergence,without influencing the awakening time of patients,and prolong the duration time of analgesia which comfort the patients.