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Objective To evaluate the effect of clinical pharmacists participating in the treatment of hospitalized patients with diabetic foot by antibiotics management index and health economics index. Methods 40 hospitalized patients with diabetic foot of Wagner Grade 4 in the Endocrine Department of Air Force Medical Center from April to September 2017 were selected as control group, and 40 hospitalized patients with diabetic foot of Wagner Grade 4 in the Endocrine Department from April to September 2019 were selected as interventional group. No clinical pharmacists were involved in drug treatment of patients in the control group, while the clinical pharmacists in the interventional group participated in drug treatment, and implemented antimicrobial stewardship, medication reconciliation, pharmaceutical care and medication education. Antibiotics management indexes (use intensity of antibiotics, use rate of special class antibiotics) and health economics indexes (medicine expenses, hospitalization expenses) of the two groups were compared. Results The efficacy of the two groups was similar. The use intensity of antibiotics and use rate of special class antibiotics of the interventional group in which clinical pharmacists participated were significantly lower than the control group (P<0.01), so were the medicine expenses and hospitalization expenses (P<0.01). Conclusion Clinical pharmacists participating in the treatment of hospitalized patients with diabetic foot could reduce antibiotics administration index and health economics index, promote rational medicine use and save medical expenses.
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Objective:To investigate the clinical and mycological characteristics, treatment and prognosis of invasive candidiasis(IC)in the elderly.Methods:This retrospective study included aged patients(≥65 years)admitted to the Peking University First Hospital between January, 2010 and December, 2019, who were diagnosed with IC based on positive culture results.The infecting strains were re-identified and their antifungal drug resistance was tested.The clinical and mycological characteristics, treatment and prognosis information of the elderly patients were collected and compared with those of non-elderly adults.Results:A total of 99 aged patients were included, with a median age of 78(70-83)years and a male-to-female ratio of 2.1∶1.0.The elderly accounted for 62.7%(99/158)of the adult IC patients.Compared with their younger counterparts, elderly patients were more likely to need medium-to long-term hospitalization and intensive care unit(ICU)stay, and to show concurrent heart failure, respiratory failure or renal failure, to require mechanical ventilation, and to show deep-seated bacterial infections and multifocal Candida colonization, especially for those with previous fluconazole exposure( P<0.05). Bloodstream was the most common Candida transmission route(71/99, 71.7%)and Candida albicans was the most prevalent species(47/99, 47.5%). Antifungal resistance was highest for fluconazole(17/117, 14.5%)and voriconazole(15/117, 12.8%). No significant difference was found between elderly patients and non-elderly patients in terms of infected sites, Candida species, and antifungal resistance( P>0.05). A total of 86 patients(86.9%)received systemic antifungal treatment and fluconazole was the most commonly used drug(35/86, 40.7%). The thirty-day all-cause mortality in aged IC patients was 32.6%(29/89), significantly higher than in younger patients( P=0.022). Logistic regression analysis revealed that advanced age( OR=1.12, 95% CI: 1.06-1.20, P<0.001), renal failure( OR=4.81; 95% CI: 1.65-14.03; P=0.004), and a high Candida score( OR=1.81, 95% CI: 1.06-3.11, P=0.031)significantly increased the risk of death. Conclusions:Elderly patients were the main affected population of IC, and the mortality of IC steadily increases with age.Treatment for aged IC patients should be proactive and cautious.
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In order to avoid the intra- and post-operative risks caused by massive blood loss, there are various clinical methods for evaluating the blood supply of the tumor and the distribution of blood vessels around the tumor before surgery, such as dynamic enhanced CT, dynamic enhanced magnetic resonance imaging, digital subtraction angiography, etc. And there are a variety of pre- and intra-operative methods to reduce tumor bleeding, such as transarterial vertebral tumor embolization, percutaneous or transpedicular injection of Onyx/NBCA, antifibrinolytic drugs, controlled deliberate hypotension, etc. This article reviews on spinal tumor blood supply assessment and the methods to reduce the amount of surgical bleeding.
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Objective@#To evaluate the effect of dexmedetomidine on renal fibrosis in a mouse model of renal ischemia-reperfusion (I/R) and the role of serine-threonine kinase (Akt).@*Methods@#Sixty male C57BL/6 mice, aged 8 weeks, weighing 20-25 g, were divided into 5 groups (n=12 each) using a random number table method: sham operation group (S group), renal I/R group (I/R group), renal I/R plus dexmedetomidine group (I/R + D group), renal I/R plus dexmedetomidine plus Akt agonist SC79 group (I/R + D + SC group), and renal I/R plus dexmedetomidine plus normal saline group (I/R+ D+ NS group). Renal I/R injury model was established by clamping the bilateral renal pedicle for 30 min followed by reperfusion.Dexmedetomidine was intraperitoneally injected at 30 min before surgery in I/R+ D, I/R+ D+ SC and I/R+ D+ NS groups.SC79 was intraperitoneally injected as a bolus of 0.04 mg/kg at 1 min of reperfusion, followed by an intraperitoneal injection of the same dose every 24 h until day 7.The serum blood urea nitrogen (BUN) and Scr concentrations were detected at 24 h of reperfusion.Renal tissues were taken, and the damage to the renal tubules was scored.Renal tissues were removed at 14 days of reperfusion to detect the degree of renal fibrosis and expression of collagen 1 (COL1), fibronectin (FN), and α-smooth actin (α-SMA) (by immunofluorescence and Western blot). The expression of phosphorylated Akt (p-Akt) in renal tissues was determined by Western blot at 24 h and 14 day of reperfusion.@*Results@#Compared with group S, the serum BUN and Scr concentrations, renal tubule damage score and degree of renal fibrosis were significantly increased, and the expression of COL1, FN, α-SMA and p-Akt was up-regulated in group I/R (P<0.05). Compared with I/R group, the serum BUN and Scr concentrations, renal tubular damage score and degree of renal fibrosis were significantly decreased, and the expression of COL1, FN, α-SMA and p-Akt was down-regulated in I/R+ D and I/R+ D+ NS groups (P<0.05). Compared with I/R+ D group, the serum BUN and Scr concentrations, renal tubule damage score and degree of renal fibrosis were significantly increased , and the expression of COL1, FN, α-SMA and p-Akt was up-regulated in I/R+ D+ SC group (P<0.05).@*Conclusion@#Dexmedetomidine can reduce the degree of renal fibrosis in a mouse model of renal I/R and the mechanism is related to inhibiting activation of Akt.
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Objective To evaluate the effect of dexmedetomidine on renal fibrosis in a mouse model of renal ischemia-reperfusion (I/R) and the role of serine-threonine kinase (Akt).Methods Sixty male C57BL/6 mice,aged 8 weeks,weighing 20-25 g,were divided into 5 groups (n=12 each) using a random number table method:sham operation group (S group),renal I/R group (I/R group),renal I/R plus dexmedetomidine group (I/R + D group),renal I/R plus dexmedetomidine plus Akt agonist SC79 group (I/R + D + SC group),and renal I/R plus dexmedetomidine plus normal saline group (I/R+D+NS group).Renal I/R injury model was established by clamping the bilateral renal pedicle for 30 min followed by reperfusion.Dexmedetomidine was intraperitoneally injected at 30 rmin before surgery in I/R+D,I/R+D+SC and I/R+D+NS groups.SC79 was intraperitoneally injected as a bolus of 0.04 mg/kg at 1 min of reperfusion,followed by an intraperitoneal injection of the same dose every 24 h until day 7.The serum blood urea nitrogen (BUN) and Scr concentrations were detected at 24 h of reperfusion.Renal tissues were taken,and the damage to the renal tubules was scored.Renal tissues were removed at 14 days of reperfusion to detect the degree of renal fibrosis and expression of collagen 1 (COL1),fibronectin (FN),and α-smooth actin (α-SMA) (by immunofluorescence and Western blot).The expression of phosphorylated Akt (p-Akt) in renal tissues was determined by Western blot at 24 h and 14 day of reperfusion.Results Compared with group S,the serum BUN and Scr concentrations,renal tubule damage score and degree of renal fibrosis were significantly increased,and the expression of COL1,FN,α-SMA and p-Akt was up-regulated in group I/R (P＜0.05).Compared with I/R group,the serum BUN and Scr concentrations,renal tubular damage score and degree of renal fibrosis were significantly decreased,and the expression of COL1,FN,α-SMA and pAkt was down-regulated in I/R+D and I/R+D+NS groups (P＜0.05).Compared with I/R+D group,the serum BUN and Scr concentrations,renal tubule damage score and degree of renal fibrosis were significantly increased,and the expression of COL1,FN,α-SMA and p-Akt was up-regulated in I/R+D+SC group (P＜0.05).Conclusion Dexmedetomidine can reduce the degree of renal fibrosis in a mouse model of renal I/R and the mechanism is related to inhibiting activation of Akt.
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Objective To investigate the role of enteral nutrition (EN) support in the treatment of patients with chronic heart failure. Methods Ninety patients with chronic heart failure (conform to the New York Heart Association (NYHA) cardiac function class Ⅲ-Ⅳ) admitted to Intensive Care Unit (ICU), Cardiology Care Unit (CCU) and Emergency ICU (EICU) of Taizhou First People's Hospital from January 2015 to September 2017 were enrolled, and according to different nutritional methods, they were divided into a control group (rational autonomous diet group) and an observation group (Ruineng enteral nutritional emulsion for EN group), each group 45 cases. Based on the calculation (Harris-Benedict) of individual total energy consumption the control group had a reasonable autonomous diet and Ruineng EN emulsion for EN group. The chang of various nutrition indexes [including body mass index (BMI), serum total protein (TP), albumin (Alb), hemoglobin (Hb), vitamin B12, folic acid, serum iron], inflammatory factors [tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6)], and the level of cardiac function index (LVEF) before and after treatment were observed. Results ① Before treatment, vitamin B12 in the observation group was significantly higher than that in the control group (ng/L: 153.3±54.6 vs. 113.4±80.2, P < 0.05), there were no statistical significant differences in other indicators between the two groups (all P > 0.05). ② After treatment, compared with those before treatment, the nutritional indicators and LVEF of both groups were higher, and inflammatory factors were lower, there were statistical significant differences in the other indicators before and after treatment except Hb and IL-6 in the control group and serum iron in the observation group [the control group: BMI (kg/m2) was 20.9±1.8 vs. 19.9±1.2, TP (g/L) was 66.0±2.4 vs. 63.7±1.6, Alb (g/L) was 34.4±3.5 vs. 31.1±2.3, vitamin B12 (ng/L) was 149.5±79.2 vs. 113.4±80.2, folic acid (nmol/L) was 10.0±1.7 vs. 4.6±3.2, serum iron (μmol/L) was 16.5±13.7 vs. 10.4±7.5, TNF-α (ng/L) was 23.8±10.0 vs. 28.3±8.6, LVEF was 0.35±0.14 vs 0.32±0.04; observation group: BMI (kg/m2) was 21.5±1.4 vs. 20.2±1.4, TP (g/L) was 66.5±2.8 vs. 64.3±2.2, Alb (g/L) was 35.8±3.1 vs. 33.3±1.9, Hb (g/L) was 121.4±13.8 vs. 112.9±12.0, vitamin B12 (ng/L) was 201.1±98.6 vs. 153.3±54.6, folic acid (nmol/L) was 15.7±14.4 vs. 8.8±2.8, TNF-α (ng/L) was 20.5±6.3 vs. 25.8±3.0, IL-6 (ng/L) was 209.4±6.5 vs. 220.9±16.9, LVEF was 0.38±0.07 vs. 0.33±0.02, all P < 0.05]. ③ Before and after treatment, the changes of BMI, Hb, vitamin B12, folic acid and IL-6 in the observation group were more significant than those in the control group [BMI (kg/m2): 1.4±0.9 vs. 1.1±0.3, Hb (g/L): 8.6±1.2 vs. 2.7±0.9, vitamin B12 (ng/L): 47.1±1.0 vs. 36.2±0.9, folic acid (nmol/L): 6.8±1.8 vs. 5.5±1.8, IL-6 (ng/L):-10.8±2.3 vs. -1.6±1.0, all P < 0.05]. After treatment, the degree of increase of serum iron in the control group was more significant than that in the observation group (μmol/L: 6.2±0.8 vs. 1.4±0.9, P <0.05), there were no significant differences in the degrees of improvement in TP, Alb and TNF-α between the two groups (all P > 0.05). ④ The difference value of each indicator before and after treatment of the two groups of patients with cardiac grade Ⅲ was more significant than that in the patients with cardiac grade Ⅳ, among the indicators in the control group, Hb, serum iron and IL-6 showed statistical significant differences [Hb (g/L): 3.05±0.42 vs. 2.47±0.84, serum iron (μmol/L): 6.81±0.91 vs. 5.95±1.82, IL-6 (ng/L): -3.87±0.45 vs. -0.53±0.28, all P < 0.05], while in the observation group of patients with cardiac grade Ⅲ and Ⅳ, Alb, Hb, serum iron, IL-6 appeared statistical significant differences [Alb (g/L): 3.41±0.38 vs. 2.27±0.91, Hb (g/L): 9.83±1.44 vs. 8.10±0.98, serum iron (μmol/L): 2.23±0.34 vs. 1.04±0.88, IL-6 (ng/L):-14.11±0.42 vs. -9.45±1.01, all P < 0.05]. Conclusion In the treatment of patients with chronic cardiac failure, simultaneously EN support is given energetically, that can improve the nutrition status of organism, reduce inflammatory reaction and enhance cardiac function; the therapeutic effect of Ruineng EN support is remarkably better than that of the autonomous diet support.
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Objective To explore composited multiple mediating effects of intolerance of uncertain-ty,generalized anxiety symptoms and obsessive-compulsive symptoms between neuroticism and insomnia. Methods In this study,405 university students were evaluated using several questionnaires,including Ath-ens Insomnia Scale,Intolerance of Uncertainty Scale,the Penn State Worry Questionnaire and Obsessive-com-pulsive. Inventory-Revised and Eysenck Personality Questionnaire-Revised Short Scale for Chinese. Results The scores of Athens Insomnia Scale(4. 07±2. 57),Intolerance of Uncertainty Scale(72. 33±14. 42),The Penn State Worry Questionnaire(40. 57±10. 35),Compulsive Activity Checklist-Revised(1. 60±1. 45) and Eysenck Personality Questionnaire-Revised Short Scal(4. 86±3. 22) were positively correlated with each other(r=0. 18~0. 64,P<0. 01). Model fit indices in SEM were χ2/df=2. 15,P>0. 05;CFI=0. 99;GFI=0. 99;NFI=0. 99;NNFI(TLI)=0. 97;RMSEA=0. 05. The results indicated that neuroticism directly af-fected insomnia ( effect size 0. 125), neuroticism affects insomnia through generalized anxiety symptoms (effect size 0. 082) and obsessive-compulsive symptoms( effect size 0. 053) respectively. Thus,generalized anxiety symptoms and obsessive-compulsive symptoms were parallel mediators. Neuroticism affects general-ized anxiety symptoms through intolerance of uncertainty, and then affected the insomnia ( effect size 0. 022). And neuroticism affected obsessive-compulsive symptoms through intolerance of uncertainty, and then affected the insomnia ( effect size 0. 014). Conclusion The neuroticism personality of university students can influence insomnia through the multiple mediation model of intolerance of uncertainty,general-ized anxiety symptoms and obsessive-compulsive symptoms.
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Objective To observe the intervention effect of immune-enhancing enteral nutrition (EN) emulsion on immune function of critically ill patients with mechanical ventilation (MV). Methods One hundred and twenty critically ill patients with MV admitted to the Department of Emergency Intensive Care Unit (EICU) of Taizhou First People's Hospital from July 2015 to June 2017 were enrolled, and they were divided into immune-enhancing EN group and standard EN group by random numbers generated by a computer. Ultimately, 76 cases were enrolled in the study, among them, 36 cases were in the immune-enhancing nutrition group and 40 cases were in the standard nutrition group. The differences of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), the sequential organ function evaluation (SOFA) score on 1, 3, 7 days and immunity indexes (secretory immuno-globulins IgA, IgG, IgM), lymphocyte subpopulation (CD4 and CD8), duration of MV and the length of ICU stay on the 1, 7 days after EN were compared. Results Comparisons between the immune-enhancing EN group and standard EN group showed: APACHE Ⅱ score had no statistically significant difference between the two groups at each time point, SOFA score on 7 days after EN treatment was significantly decreased in the immune-enhancing EN group (2.56±1.38 vs. 3.68±2.96, P < 0.05); IgA, IgG, IgM were obviously higher in the immune-enhancing EN group than those in standard EN group on 7 days after treatment [IgA (mg/L): 2 967.6±635.6 vs. 2 525.0±592.7, IgG (mg/L): 14 982.5±2 899.7 vs. 12 996.4±2 875.9, IgM (mg/L): 1 206.8±233.3 vs. 1 093.2±165.1, all P < 0.05], CD4 (0.45±0.06 vs 0.37± 0.10) and CD8 (0.20±0.03 vs. 0.18±0.04) were significantly higher than those in standard EN group (both P < 0.05). The MV time (hours): 122.33±63.91 vs. 155.69±77.06) and ICU stay time (hours): 197.57±70.60 vs. 239.61±84.83) of the immuno-enhancing EN group were markedly shorter than those of the standard EN group (both P < 0.05). Conclusion Compared with standard EN, the immune-enhancing EN emulsion can improve the immune function of critically ill patients with MV, and shorten the duration of MV support and the length of ICU stay.
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Objective To investigate the imaging characteristics of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy.Methods The retrospective and descriptive study was conducted.The clinical data of 12 patients with nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy who were admitted to the First People's Hospital of Wenling (11 patients) and Taizhou Hospital of Zhejiang Province (1 patient) between January 2010 and December 2016 were collected.Patients received plain and enhanced scans of computed tomography (CT).Patients stopped warfarin therapy,received intramuscular injection of vitamin K1 and fresh-frozen plasma transfusion.Observation indicators:(1) primary signs of CT:① small bowel wall thickening;② increased density of small bowel wall;(2) secondary signs of CT:intestine lumen stenosis,intestinal pneumatosis,perienteric changes and other concomitant signs;(3) treatment situations.Measurement data with normal distribution were represented as (x)±s.Measurement data with skewed distribution were described as M (range).Results Twelve patients received total abdomen plain scans of CT,and 7 received total abdomen enhanced scans of CT.(1) Primary signs of CT:① Small bowel wall thickening.CT of 12 patients showed solitary,homogeneously symmetric,consecutive and diffuse thickening of small bowel wall,including ileal involvement in 7 patients and jejunum involvement in 5 patients.Ascending part of duodenum of 3 patients involved the 2nd and 3rd groups small bowel.The average length of involved small bowel was 30.7 cm (range,11.0-58.0 cm).There was no multifocal thickening or colonic involvement.Of 12 patients,10 and 2 showed moderate thickening (thickness was 1.0-2.0 cm) and severe thickening (thickness ＞ 2.0 cm),and the thickest small bowel wall was 2.5 cm.② Increased density of small bowel wall.Twelve patients showed varying degrees of increased density of small bowel wall,with an average value of 49.7 HU (range,36.0-63.4 HU).Of 12 patients,homogeneously increased whole layer density of small bowel wall were detected in 4 patients,higher submucous layer density of small bowel compared with serosal layer density in 4 patients,and all of the above characteristics in 4 patients.Enhanced scans of CT in 7 patients showed enhancement in small bowel mucosal layer and serosal layer,no obvious enhancement in the submucous layer of small bowel wall,clear layers,and a target sign when small bowel lumen was perpendicular to scan slice,including 5 patients with obvious enhancement in small bowel mucosal layer,spring-like change,and clear imaging in portal vein phase.(2) Secondary signs of CT:① Intestine lumen stenosis:12 patients had varying degrees of intestine lumen stenosis.Five patients were complicated with small bowel obstruction,showing a gas-liquid level.② Intestinal pneumatosis:2 of 12 patients showed patchy and mottled gas shadow.③ Perienteric changes and other concomitant signs:12 patients showed obviously increased fat density in surrounding area of involved small bowel and corresponding mesenteric area,and indistinct outside small bowel,including 8 with lots of lath-like high density shadow in surrounding area of small bowel and mesenteric area.The varying degrees of hemoperitoneum were seen in 12 patients.(3) Treatment situations:of 12 patients,9 underwent correct treatments,8 of them were improved,and 1 of them with persistently severe abdominal pain underwent urgent explorative laparotomy,showing hemorrhage and necrosis,and then underwent surgery;3 didn't undergo correct treatment,without improved or severe symptoms.Conclusion Patients undergoing anticoagulant therapy show acute abdominal pain with abnormal coagulation function,small bowel wall thickening and increased density by CT scans,hemoperitoneum complicated with intestine lumen stenosis,small bowel obstruction and hematocele in surrounding area of small bowel and mesenteric area,these are highly indicative of nontraumatic spontaneous intramural hematoma of small bowel secondary to warfarin therapy.
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Objective To evaluate the satisfaction and current situation of advanced health assessment course for postgraduates. So that it can provide the evidence for the development of teaching reform. Methods Facilitating the convenient sampling of 69 nursing master′s degree authorized schools in China. And a further survey using self-designed questionnaires was conducted in the teacher who in charge of this course and 73 postgraduates in 17 schools offering Advanced Health Assessment. The data were analyzed using reliability, validity, frequency and percentage. Results There were 45 schools responded effectively, of which only 17 schools set up this course. There were no uniform norms of the teaching materials, hours and credits. 73 postgraduates were satisfied with the teaching methods, training practical abilities, meeting academic development needs, practicality, and commonality of the advanced health assessment course. However, 54.8％ of the students said the course is too difficult to handle. Conclusion All the schools should pay more attention to Advanced Health Assessment Course and improve the professional level of postgraduates.
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Objective@#To explore correlation between chest CT score and oxygenation index in patients with acute hydrogen sulphide poisoning, whether CT score can be applied to assess acute lung injury after acute hydrogen sulfide poisoning and provide basis and reference.@*Methods@#The clinic and a series of CT datas of 32 acute hydrogen sulphide poisoning cases were retrospectively analysed and compared, According to GBZ31-2002 (the diagnostic standard of occupational H2S acute poisoning) , these patients were divided into 2 grouds including moderate groud and severe groud; The CT score were improved, referenceing the scoring criteria of the chest X-ray; The difference of the CT score and the oxygenation index were analyzed between moderate and severe group in the acute phase and the disperse phase; The correlation between CT score and oxygenation index were analyzed.@*Results@#The CT score in moderate poisoning group were lower than severe group (2.26±1.37 vs 10.44±2.55, 1.34±0.65 vs 4.55±2.45, all P<0.05) in the acute phase and the dissipation phase.The oxygen index of the 19 cases in the acute phase were 307.55±28.29, and the oxygen index of the 8 cases in the dissipation phase was 435.75±37.00; The oxygen index of the 9 cases in the acute phase and the dissipation phase were respectively 193.17±36.41, 347.67±44.49. The oxygen partial pressure and oxygenation index in severe group were significantly lower than those in moderate group (all P<0.01) in the acute phase and the dissipation phase. Pearman correlation analysis showed that the CT score were negatively correlated to the oxygen index in the acute phase and the dissipation phase, respectively (r=-0.97、-0.75, all P<0.01) .@*Conclusions@#The CT score of lung injury and oxygenation index is negatively correlated. The CT score can be used to evaluate the degree of lung injury, and can be used in the evaluation of acute lung injury after acute hydrogen sulfide poisoning.
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Objective@#To investigate the dynamic change of paraquant-induced kidney injury in rats and the protective effect of edaravone.@*Methods@#Eighty SD rats were randomly divided into 4 groups: the normal control group, paraquat poisoning group, edaravone treatment group and edaravone control group. The normal control group of 8 rats were given 1 ml of 0.9% sodium chloride through the abdominal cavity, and the same amount of fluid into the abdominal cavity after 30 minutes. The paraquat poisoning group of 24 rats were given 1 ml of paraquat solution (20 mg/kg) through the abdominal cavity to build poisoning models, and the same amount of 0.9% sodium chloride was injected into the abdominal cavity after 30 minutes. The edaravone treatment group of 24 rats were given edaravone (5 mg/kg) through the abdominal cavity after 30 minutes when the poisoning models were set up. The edaravone control group of 24 rats were given 1 ml of 0.9% sodium chloride through the abdominal cavity, and edaravone (5 mg/kg) was injected into the abdominal cavity after 30 minutes. In addition to the normal control group, the other groups processed 1 times a day to mantain 7 d. On 1, 3, 7, 21 d several rats in each group were excuted and the kidney tissue and serum samples were collected, then each pathological changes of the kidney were observed with light microscopy. Serum creatinine, KIM-1, NGAL were measured by ELISA, the expression of HSP70 protein in kidney were observed with immunohistochemical staining.@*Results@#The pathological examination reveald that the damage of kidney tissue in the paraquat group was the most serious on 3 d, and the damage was consistently alleviated in edaravone treatment group at the same time, renal fibrosisn was unseen in each group until 21 d. Compared with normal control group, there was no statistically significant in edaravone control group (P>0.05) . The KIM-1 in blood and kidney in paraquat poisoning group were markedly increased in 1 d (P<0.05) . The NGAL in blood and creatinine were markedly increased in d7 (P<0.05) . The NGAL in kidney increased over time, but had no statistically difference with the control group (P>0.05) .Compared with paraquat poisoning group, the serum creatinine, KIM-1 in blood and kidney, the KIM-1 in kidney had decreased significantly in edaravone treatment group (P<0.05) . The NGAL in kidney has no statistically significant compared with the poisoning group (P>0.05) . HSP70 expression of kidney tissue in edaravone treatment group had significantly increased in d3 compared with the paraquat poisoning group (P<0.05) .@*Conclusion@#Edaravone can prompt a significant rise of HSP70 in kidney tissue, reduce KIM-1 and NGAL levels, and play a protective role in kidney injury of acute paraquat poisoning.
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Objective To investigate whether exosome-derived microRNA of nasopharyngeal carcinoma suppresses apoptosis of tumor associated macrophage (TAM).Methods Target microRNAs and genes were determined by bioinformatics methods.Isolated exosomes were used to detect miR-20a expression by qRT-PCR.Furthermore,apoptosis index and proteins involved in apoptotic pathways were detected after miR-20a mimic and inhibitor transfection into macrophages.Results miR-20a expression was upregulated in isolated exosomes.miR-20a target gene was BCL2L11.MiR-20a overexpression could inhibit apoptosis of macrophages,meanwhile,apoptotic pathways related proteins Bim,caspase-9 and caspase-3 were significantly suppressed by miR-20a mimic(P＜0.05).Condusion miR-20a can suppress activation of Bim-caspase-9-casepase-3 and resulting in apoptotic inhibition of macrophages.
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Objective To explore symptom clusters and changes with time goes among inpatients of lung cancer to provide the basis for clinical nursing staff on symptom management. Methods Using the Chinese version of the M.D. Anderson Symptom Inventory (MDASI-C) and the revised lung cancer module on 217 cases of inpatients with lung cancer, and the follow-up after 1 month, 3 months by telephone. Results The result of principal component analysis of three times:there are same symptom clusters on three times evaluation, fatigue-related symptom cluster, lung cancer specific symptom cluster, chemotherapy-related symptom cluster and psychological symptom cluster. The first and third time assessment also contains respiratory symptom cluster. Over time some kinds of symptom clusters company with the disease trajectories. Fatigue-related symptom cluster is the major cluster and correlate to psychological and other symptom clusters. Conclusions Clinical workers should perfect the symptom management of patients all the time according to severity and changes of symptom clusters to benefit patients with lung cancer.
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Objective To detect genetic polymorphism of Toll like receptor 2 (TLR2) R753Q and Toll like receptor 4 (TLR4) D299G and T399I ,and to analyze its role and mechanism in the occurrence and development of colorectal carcinoma .Meth‐ods Totally 256 cases of patients with colorectal carcinoma and 256 cases of healthy control individuals were collected .The geno‐types of TLR2 R753Q ,TLR4 D299G and TLR4 T399I were detected by using PCR‐RFLP method .The levels of IL‐1α,IL‐8 ,MIP‐1αand MCP‐1 protein were detected by using ELISA .Results It is shown that TLR4 T399I was associated with the risk of color‐ectal cancer .The frequency of CT combined TT genotype of T399I in case group and control group was 31 .2% and 18 .7% ,respec‐tively .The frequency of T allele in case group and control group was 18 .2% and 10 .2% ,respectively ,and difference was statistical‐ly significant(P<0 .05) .Individuals with T allele of T399I showed a 2 .534‐fold increase in colorectal cancer risk compared with the T399I C allele(95% CI:1 .462-2 .734 ,P<0 .01) .There were significant differences in the expression levels of IL‐1αand MCP‐1 in colorectal carcinoma tissues of different genotypes .The expression level of IL‐1α in patients with CT combined TT genotype of T399I and those with CC genotype was (36 .97 ± 21 .43) and (22 .27 ± 17 .89)pg/mg respectively ,and the expression level of MCP‐1 was (24 .57 ± 17 .74) and (12 .91 ± 9 .78)pg/mg respectively .Conclusion T399I TLR4 is associated with the occurrence and de‐velopment of colorectal carcinoma ,and the risk of colorectal carcinoma in individuals with T genotype is significantly increased ,in which monitoring the expression of IL‐1 and MCP‐1 in colorectal carcinoma tissues might be the mechanism .
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Objective To promote the development of oncologic nursing by establishing the accreditation standards for oncologic nursing professional training base.Methods In the early stage Delphi method was used to make a consultation with 21 experts for the construction of accreditation standards for oncologic nursing professional training base.Then the weights of each level was determined by using Analytic Hierarchy Process (AHP).Results Five first-level indicators were established,including oncologic nursing,clinical practice teaching staff,training management,the basic conditions of the department and the basic conditions of the hospital,their weights were 0.385 5,0.248 4,0.160 0,0.121 3 and 0.084 9.Conclusions The accreditation standards for oncologic nursing professional training base is constructed by AHP.It can make the accreditation standards more scientific and reliable to provide a quantitative basis for the review.
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OBJECTIVE:To establish a method for the contents determination of tetrahydropalmatine and rosmarinic acid in Xiaoheling capsule. METHODS:HPLC was performed on the column of Phenomenex C18 with mobile phase A of 0.1% phosphoric acid(adjusted pH to 6.0 with triethylamine)-methanol(45:55,V/V) and (adjusted pH to 6.0 with triethylamine) B of 0.1% phos-phoric acid-methanol(55:45,V/V)(gradient elution)at flow rate of 0.8 ml/min,detection wavelength was 282 nm(0-25 min)and 330 nm(25.01-60 min)and volume size was 10 μl. RESULTS:The linear range was 1.502-75.10 μg/ml for tetrahydropalmatine and 6.03-301.6 μg/ml for rosmarinic acid(r=0.999 8);RSDs of precision,reproducibility and stability tests were ≤1.36%;recoveries were 97.11-99.87%(RSD=0.95%,n=9)and 98.47-101.99%(RSD=1.08%,n=9),respectively. CONCLUSIONS:The method is simple,accurate and reliable,and can be used for contents determination of tetrahydropalmatine and rosmarinic acid in Xiaoheling capsule.
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The anaerobic granular sludge from an Internal Circulation (IC) reactor of a paper mill wastewater treatment plant were seeded in an Anammox upflow anaerobic sludge blanket reactor. After 185 days operation, the reactor was finally started up by increasing the influent ammonium and nitrite concentrations to 224 mg/L and 255 mg/L, respectively, with volumetric nitrogen removal rate increasing to 3.76 kg/(m3·d). The physicochemical characteristics of the cultivated Anammox granules were observed by scanning electron microscope, transmission electron microscope and Fourier Transform infrared spectroscopy (FTIR). Results suggested that during the start-up course, the granular sludge initially disintegrated and then re-aggregated. FTIR spectra results revealed that the Anammox granular sludge contained abundant functional groups, indicating that it may also possess good adsorption properties. The ecological structure of the granular sludge, analyzed by the metagenomic sequencing methods, suggested that the relative abundance of the dominant bacterial community in the seeding sludge, i.e., Proteobacteria, Firmicutes, Bacteroidetes, significantly reduced, while Planctomycetes which contains anaerobic ammonium oxidation bacteria remarkably increased from 1.59% to 23.24% in the Anammox granules.
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Ammonia , Chemistry , Bacteria , Bioreactors , Nitrogen , Chemistry , Sewage , Microbiology , Waste Disposal, Fluid , Methods , Wastewater , ChemistryABSTRACT
Objective To compare the effects of different general anesthesia protocols on perioperative cellular immune function in patients undergoing laparoscopic surgery for colorectal cancer.Methods Ninety ASA Ⅰ or Ⅱ colorectal cancer patients,aged 40-64 yr,weighing 50-85 kg,undergoing laparoscopic surgery were randomly divided into 3 groups (n =30 each):group total intravenous anesthesia (group Ⅰ) ; group inhalational anesthesia(group Ⅱ) and group combined intravenous-inhalational anesthesia (group Ⅲ).Anesthesia was induced with iv midazolam,sufentanil,TCI of propofol and remifentanil and vecuronium in groups Ⅰ and Ⅲ.In group Ⅰ anesthesia was maintained with TCI of propofol and remifentanil and intermittent iv boluses of vecuronium,while in group Ⅲ with inhalation of sevoflurane and intermittent iv boluses of vecuronium.In group Ⅱ anesthesia was induced and maintained with inhalation of sevoflurane and intermittent iv boluses of vecuronium.Narcotrend index was used to monitor depth of anesthesia and maintained at 37-64 during operation.Venous blood samples were taken for determination of the levels of T lymphocyte subsets (CD3+,CD4+,CD8+,CD4+/CD8 +) and natural killer cells at 30 min before induction of anesthesia (T0),2 h after skin incision (T1),at the end of operation (T2) and 24 h after operation (T3).Results The levels of CD3 +,CD4 +,CD4+/CD8+ and natural killer cells were significantly decreased at T2 in group Ⅱ,while the levels of natural killer cells were decreased at T2 in group Ⅲ as compared with the baseline at T0,and were significantly lower than those in group Ⅰ.The levels of CD3+ and CD4+ were significantly lower at T2 in group Ⅱ than in group Ⅲ.Conclusion Intravenous anesthesia with midazolam,propofol,sufentanil,remifentanil and vecuronium has less inhibitory effect on perioperative cellular immune function than inhalational anesthesia and combined intravenous-inhalational anesthesia in patients undergoing laparoscopic surgery for colorectal cancer.
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Objective In order to construct the standards of review for oncology nursing professional training base by aggregating the requirement of the professional training base in multiple regions in China.Methods Delphi expert consultation method by self-designed questionnaire were conducted among 21 nursing educators in medical university,nursing administrators,oncology clinicians,oncology clinical nurse specialists in hospitals.Results The Cr,Cronbach's α was 0.825,0.980.A standards of review for oncology nursing professional training base included 5 first-level indicators,19 second-level indicators and 76 third-level indicators after three rounds of consultation.Conclusions The 100-item for standards of the review is reliable and valid,which can provide objective and quantitative standards for evaluation,assessment and access of oncology nursing professional training base.