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Gastric residual volume (GRV) has been widely used in clinical practice for a long time as an essential indicator of gastrointestinal motility and enteral nutrition tolerance. Recent studies have questioned the rationality of monitoring GRV routinely in critically ill patients. A "one size fits all" principle is not an optimal solution in the clinical practice of enteral nutrition in critically ill patients because of the huge heterogeneity of the intensive care unit (ICU) population. Each method of monitoring GRV has advantages and disadvantages. With the widespread clinical application of harmless monitoring technologies such as ultrasound, the gastric suctioning method maybe used less and less. The management of enteral nutrition focuses on identifying the factors and triggers of gastric retention, attempting to solve them from the perspective of prevention and elimination of high-risk factors for aspiration and analysis of pathophysiological mechanisms, eliminating all negative hindering factors, and actively promoting the concept of "creating conditions for enteral nutrition". As a critical nutrition management team, it is necessary to pay attention to the continuous improvement of enteral nutrition management culture and rationally use diversified management strategies, which may be more important than monitoring GRV.
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Objective:To evaluate the effect of electroacupuncture (EA) on Golgi apparatus stress in the rats with endotoxin-induced acute lung injury (ALI).Methods:Twenty clean-grade male Sprague-Dawley rats, aged 2 months, weighing 160-185 g, were divided into 4 groups ( n=5 each) according to a random number table method: control group (C group), endotoxin group (LPS group), EA plus endotoxin group (EA+ LPS group), and sham EA plus endotoxin group (SEA+ LPS group).The model of endotoxin-induced ALI was developed by intravenous injection of lipopolysaccharide (LPS) 5 mg/kg in anesthetized animals.Bilateral Zusanli (ST36) and Neiguan (PC6) acupoints were stimulated with an electric stimulator for 30 min once a day at 1-4 days before and during model preparation in group EA+ LPS.In group SEA+ LPS, acupuncture needles were inserted to the surface of ST36 and PC6 acupoints with no current stimulation, and the other parameters were the same as those previously described in group EA+ LPS.Blood samples were collected from the abdominal aorta at 6 h after development of the model for measurement of concentrations of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in serum by enzyme-linked immunosorbent assay.The animals were sacrificed and lungs were removed for microscopic examination of the pathological changes of lung tissues (with a light microscope) and morphological changes of Golgi apparatus (with a transmission electron microscope) and for determination of wet to dry lung weight (W/D) ratio, cell apoptosis index (by TUNEL), activity of superoxide dismutase (SOD) (by WST-1 method), content of malondialdehyde (MDA) (by TBA method), and expression of Golgi matrix protein 130 (GM130), Golgin-84 and Golgi phosphoprotein 3 (GOLPH3) protein and mRNA in lung tissues (by Western blot or real-time polymerase chain reaction). Results:Compared with group C, the lung injury score, W/D ratio, cell apoptosis index, serum IL-6 and TNF-α concentrations and MDA content were significantly increased, SOD activity was decreased, the expression of GM130 and Golgin-84 protein and mRNA was down-regulated, the expression of GOLPH3 protein and mRNA was up-regulated ( P<0.05), and Golgi apparatus was swollen and vacuolated in the other three groups.Compared with group LPS, lung injury score, W/D ratio, cell apoptosis index, serum IL-6 and TNF-α concentrations and MDA content were significantly decreased, SOD activity was increased, the expression of GM130 and Golgin-84 protein and mRNA was up-regulated, the expression of GOLPH3 protein and mRNA was down-regulated ( P<0.05), and swelling and vacuolization of Golgi apparatus were reduced in group EA+ LPS, and no significant change was found in the parameters mentioned above in group SEA+ LPS ( P>0.05). Conclusions:The mechanism by which EA reduces endotoxin-induced ALI may be related to inhibition of Golgi apparatus stress in lung tissues of rats.
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Background:MicroRNA-9 (miR-9)is involved in the modulation of a variety of physiological process such as organ development and self-renewal and multipotential differentiation of cells. Moreover,its aberrant expression is closely associated with several types of malignant tumors. Aims:To investigate the effect of miR-9 on biological behavior of human gastric cancer cells. Methods:Expression of miR-9 in normal human gastric epithelial cell line GES-1 and human gastric cancer cell line BGC-823 and SGC-7901 was detected by real-time PCR. Then the two gastric cancer cell lines were transiently transfected with miR-9 mimic,miR-9 inhibitor and empty vector,respectively;the efficiency of transfection was assessed by real-time PCR. CCK-8 assay,Transwell assay and wound healing assay were used to examine the cell proliferation and migration capacities. Results:The expression level of miR-9 was significantly higher in gastric cancer cells than in normal gastric epithelial cells (P＜0. 05). Compared with cells transfected with empty vector,overexpression of miR-9 occurred in cells transfected with miR-9 mimic and effectively promoted the proliferation and migration of BGC-823 and SGC-7901 cells (P ＜ 0. 05 ). Conversely,transfection with miR-9 inhibitor significantly suppressed the proliferation and migration of gastric cancer cells (P＜0. 05). Conclusions:Up-regulating miR-9 expression promotes the proliferation and migration of gastric cancer cells,which indicates that miR-9 overexpression may be associated with progression of gastric cancer.
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Objective To detect the expression of tumor necrosis factor-α-induced protein-8 like-3 (TIPE3) in colonic mucosa of patients with colon cancer,and to analyze the correlation between its abnormal expression and clinicopathological features of patients with colon cancer.Methods The expression of TIPE3 mRNA in 58 cases of colon cancer and tumor adjacent tissues was detected by realtime polymerase chain reaction (RT-PCR).The expression of TIPE3 at protein level in 83 cases of colon cancer and tumor-adjacent tissues was determined by SP immunohistochemistry.Nonparametric rank-sum test and chi-square test were performed for statistical analysis.Results The relative expression of TIPE3 mRNA in the colon cancer tissues was 0.719 (0.104 to 0.887),which was lower than that of tumor-adjacent tissues (4.770,1.732 to 6.800),and the difference was statistically significant (Z=-6.345,P＜0.05).There was no statistically significant difference in the expression of TIPE3 mRNA in colon cancer tissues between different gender,age and TNM stage (all P＞0.05).The expression of TIPE3 mRNA in group of patients with lymph node metastasis (0.113,0.061 to 0.375) was lower than group of patients without lymph node metastasis (0.489,0.327 to 0.956;Z=3.815,P＜0.01).The expression of TIPE3 mRNA of patients survived less than five years after operation (0.104,0.049 to 0.220) was lower than that of patients survived over five years (0.482,0.266 to 0.908;Z=-3.653,P＜0.01).The expression of TIPE3 mRNA of patients with recurrence after operation (0.188,0.091 to 0.493) was lower than that of patients without recurrence (0.409,0.233 to 1.010;Z=-2.431,P=0.015).The recurrence rate of TIPE3 mRNA high expression group in five years after operation was lower than that of TIPE3 mRNA low expression group (23.1％,6/26 vs 56.2％,18/32);and the difference was statistically significant (x2 =6.508,P＜0.05).The expression of TIPE3 at protein level of colon cancer tissues (44.6 ％,37/83) was lower than that of tumor-adjacent tissues (68.7 ％,57/83;x2 =8.004,P＜0.05).The expression of TIPE3 at protein level was not correlated with age and gender (both P＞0.05).The positive expression rate of patients at stage Ⅱ was higher than that of patients at stage Ⅲ (60.5％,23/38 vs 29.7％,1/37);and the difference was statistically significant (x2 =7.174,P＜ 0.05).The positive expression rate of TIPE3 in group of patients with lymph node metastasis was lower than that of groups of patients without lymph node metastasis (28.2％,11/39 vs 59.1％,26/44),and the difference was statistically significant (x2=7.983,P =0.005).Conclusions The expression of TIPE3 in colon cancer tissues is lower than that in tumor-adjacent tissues.Furthermore,it is correlated with lymph node metastasis,recurrence rate and survival rate.TIPE3 may be involved in the genesis,development,invasion and metastasis of colon cancer.
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Objective To explore the predictive value of early changes in platelet counts in the prognosis of severe pneumonia in aged patients.Methods This retrospective study included elderly patients with severe pneumonia,who were ≥65 years old and whose length of ICU stay ≥72 hours,admitted to the intensive care unit(ICU)of NO.2 People's Hospital of Changzhou from January 2014 to January 2017.They were divided into a survival group and a death group according to the 28-day outcome.General information and serum platelet levels at 0,24,36,and 72 hours after admission were collected.Receiver operating characteristic curve (ROC)was plotted according to platelet counts,changes in platelet counts and rates of change in platelet counts to evaluate their predictive value for 28-day prognosis.Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between different groups of patients,who were further divided according to platelet counts at 0 and 72 hours after admission to ICU,changes in platelet counts and rates of change in platelet counts at 72 hours after admission.Results (1)One hundred elderly patients with severe pneumonia were enrolled,among whom 41 cases were in the death group,thus with a mortality of 41.0％.The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),sequential organ failure assessment (SOFA),C-reactive protein (CRP),and procalcitonin(PCT)in the death group were significantly higher than those in the survival group.2)Serum platelet levels showed a downward trend in both the death group and the survival group.The level of serum platelets at 72 hours after admission to ICU in the death group was significantly lower than that in the survival group(80.00 × 109/L vs.171.00 × 109/L,Z=5.786,P＜0.05);changes in platelet counts and rates of change in platelet counts in the death group were significantly higher than those in the survival group,especially at 72 hours after admission to ICU(/△PLT72:-79.00 × 109/L vs.-38.00 × 109/L,Z =4.938,P ＜0.05;△PLT 72％:43.6％ vs.-17.7％,Z=6.816,P＜0.05).(3)ROC curve analysis showed that platelet levels,changes in platelet counts,and rates of change in platelet counts could predict 28-day mortality in aged patients with severe pneumonia.The largest area under ROC curve was 0.902 when plotted with the rate of platelet counts at 72 hours after admission to ICU.Using the cut-off value of-36.14％ in the rate of change at 72 hours after admission to evaluate the predictive value in 28 day mortality,the sensitivity and specificity were 89.8％ and 75.6％,respectively.(4)Kaplan-Meier survival analysis showed that the 28 day survival rate was significantly higher and the length of survival was significantly greater when platelet counts at 0 and 72 hours after admission to ICU were higher than the cut-off value,and this also occurred in changes in platelet count and rates of change at 72 hours after admission to ICU.Conclusions Continuous decline in serum p[atelet levels indicates poor prognosis.When combined with platelet counts,changes in platelet counts and rates of change in platelet counts at 72 hours after admission to ICU,it may play an important role in assessing the prognosis of aged patients with severe pneumonia.
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Objective To explore the predictive value of dynamic serum phosphorus levels in the evaluation of prognosis in patients with sepsis. Methods A retrospective study was conducted. The septic patients admitted to intensive care unit (ICU) of the Second People's Hospital of Changzhou from January 2016 to June 2017 were enrolled, who were ≥18 years old and whose length of ICU stay > 72 hours. These patients were divided into survival group and death group according to 28-day outcome. The general information, the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score within 24 hours of ICU admission, the serum phosphorus at 1, 3, 5, 7 days after admission were collected. Receiver operating characteristic curve (ROC) was plotted according to the dynamic serum phosphorus levels and APACHE Ⅱ score for evaluating the predictive value of 28-day prognosis. Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between two groups of patients, who were divided according to the corresponding time of the serum phosphorus cut-off value. Results ① Eighty-five patients with sepsis were enrolled, among whom 25 cases were in the death group and the mortality was 29.4%. APACHE Ⅱ score in the death group was significantly higher than that in the survival group (22.28±3.98 vs. 16.05±5.44, P < 0.01), the rate of using vasoactive drugs was significantly higher than that in the survival group [64.0% (16/25) vs. 31.7% (19/60), P < 0.01], but there was no significant difference in the length of invasive mechanical ventilation and ICU stay between two groups.② The level of serum phosphorus was increased in survival group along with time of the treatment, and the death group showed a downward trend. The levels of serum phosphorus at 3, 5, 7 days after admission to ICU in death group were significantly lower than those in survival group (mmol/L: 0.90±0.24 vs. 1.05±0.19 at 3 days, 0.96±0.16 vs. 1.11±0.17 at 5 days, 0.83±0.19 vs. 1.21±0.14 at 7 days, all P < 0.01).③ROC curve analysis showed that APACHE Ⅱ score and serum phosphorus level on the 7th day could significantly predict 28-day mortality in patients with sepsis, and the areas under ROC curve (AUC) of them were 0.813 and 0.945 respectively (both P < 0.01). The AUC of serum phosphorus level on the 3rd day and 5th day were 0.692 and 0.745 respectively (both P < 0.01). Based on serum phosphorus cut-off value 1.01 mmol/L on the 7th day to evaluate the predictive value of 28-day mortality, the sensitivity was 91.7%, the specificity was 84.0%, the positive and negative likelihood ratios were 5.73 and 0.10 respectively. ④ Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher and the length of survival was significantly longer if the serum phosphorus were higher than the cut-off value at different time points of ICU admission. The 28-day survival rate was significantly higher and the length of survival was significantly longer in the patients with serum phosphorus > 1.01 mmol/L than those serum phosphorus ≤ 1.01 mmol/L on the 7th day [28-day survival rate: 93.2% (55/59) vs. 22.7% (5/22), χ2= 49.697, P = 0.000; survival period (days): 27.1±3.6 vs. 19.8±7.8, t = 4.768, P =0.000]. Conclusion The continuous decline of serum phosphorus indicates poor prognosis, and the serum phosphorus level on the 7th day is one of the most important indicator to evaluate the prognosis of patients with sepsis.
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Exosomes are vesicular bodies secreted by living cells containing proteins and RNA, and play an important role in the process of physiology and pathology.Pancreatic cancer is one of the common gastrointestinal tumor with high morbidity and mortality.As a hotspot in oncology, exosomes have potential values in the research of development, diagnosis and treatment of pancreatic cancer.This article reviewed the role of exosomes in pancreatic cancer.
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Objective To analyze and evaluate the precision ,accuracy and linearity of the chemiluminescence method for detec‐ting plasma BNP .Methods According to the experimental schemes of CLSI EP15‐A2 ,EP6‐A files and other relevant documents , the precision ,accuracy and linearity of the Siemens Centaur XP chemiluminescence instrument for detecting BNP ,and the detection results were compared with the performance declared by manufacturer or the quality target formulated by laboratory .Results The imprecision of BNP detected by the chemiluminescence method was less than 1/3 TEa regulated by the Clinical Laboratory Center of Ministry of Health (allowable total error);the variation coefficient index (CVR) of internal quality control data was less than ± 2;the relative bias of the results of external quality control blind samples with the target values were less than Tea regulated by the Ministry of Health ;the linear evaluation results showed that BNP was once linearity in the range of 5 .3‐4696 .7 pg/mL .Conclusion The precision ,accuracy and linearity of the Siemens Centaur XP chemiluminescence instrument for detecting BNP can accord withthe quality objectives requirements and meet the clinical needs .
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Objective:To construct and screen the high efficiency interference plasmid of TFAIP8-shRNA-pSIREN-RetroQ.Methods:Selected and synthesized three Target Sequence of TNFAIP8 shRNA1,TNFAIP8 shRNA2,TNFAIP8 shRNA3,and construct the TNFAIP8 interference plasmid.Transfection TNFAIP8-shRNA-pSIREN-RetroQ interference plasmid to A549 cells.Filter out the highest interference efficiency plasmid by detecting the mRNA and protein levels using RT-PCR and Western blot methods.Results:We successfully design and built three TNFAIP8-shRNA-pSIREN-RetroQ interference plasmids,and screen out the highest efficiency interference plasmid.Conclusion: Three interference plasmids targeting the TNFAIP8 gene have been constructed successfully and provide a useful tool for studying the function of TNFAIP8.
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ObjectiveTo observe whether if intravenous infusion of dexmedetomidine in advance can prevent irritation and cough causing by sufentanil.MethodsNinety patients who performed excision of intracranial tumor were divided into observation group and control group by random digits table with 45 cases each.Patients in observation group were intravenously infused 0.5 μg/kg dexmedetomidine for 10 minutes before induction.Patients in control group were intravenously infused 0.9％ sodium chloride for 10 minutes before induction.All the patients were intravenously infused 0.3 μg/kg sufentanil after taking drugs of load dosage in 3 seconds,and the incidence of irritation and cough in 1 minute was observed.The mean arterial pressure and heart rate were recorded before infusing dexmedetomidine or sodium chloride(T0),at the end of infusing dexmedetomidine or sodium chloride (T1),before intubation (T2),1 minute after intubation (T3).ResultsThe incidence of irritation and cough,moderate-severe irritation and cough in observation group [ 24.4％ ( 11/45 ),11.1％ (5/45) ] were lower than those in control group [ 48.9％ (22/45),22.2％ ( 10/45 ) ]with significant differences(P＜ 0.01 ).The mean arterial pressure in control group at T2 was lower than that in observation group [ (71.2 ± 3.5) mm Hg( 1 mm Hg =0.133 kPa) vs.(84.7 ± 4.1 ) mm Hg] with significant difference (P ＜ 0.05 ).The mean arterial pressure in control group at T3 was higher than that in observation group [(96.7 ± 6.4) mm Hg vs.(83.1 ± 5.2) mm Hg] with significant difference(P＜ 0.05).The heart rate at T1,T2,T3 in observation group was lower than that in control group [ (53.2 ± 4.7 ) beats/min vs.(70.4 ± 6.2 )beats/min,(56.3 ± 3.1 ) beats/min vs. (64.7 ± 3.7) beats/min,(59.1 ± 4.8) beats/min vs. (81.5 ± 6.1 )beats/min],and there were significant differences(P ＜0.05).Conclusions Intravenous infusion of dexmedetomidine (0.5 μg/kg) in advance can effectively prevent irritation and cough causing by sufentanil,and can enhance the stability of circulation during intubation.
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Abstract A new microfluidic system with four different microchambers （a circle and three equilateral concave polygons） was designed and fabricated using poly（dimethylsiloxane） （PDMS） and the soft lithography method. Using this microfluidic device at six flow rates （5, 10, 20, 30, 40, and 50 μL/h）, the effects of microenvironmental geometry and aqueous flow on bacterial adhesion behaviors were investigated. Escherichia coli HB101 pGLO, which could produce a green fluorescent protein induced by L-arabinose, was utilized as the model bacteria. The results demonstrated that bacterial adhesion was significantly related to culture time, microenvironment geometry, and aqueous flow rates. Adhered bacterial density increased with the culture time. Initially, the adhesion occurred at the microchamber sides, and then the entire chamber was gradually covered with increased culture time. Adhesion densities in the side zones were larger than those in the center zones because of the lower shearing force in the side zone. Also, the adhesion densities in the complex chambers were larger than those in the simple chambers. At low flow rates, the orientation of adhered bacteria was random and disorderly. At high flow rates, bacterial orientation became close to the streamline and oriented toward the flow direction; All these results implied that bacterial adhesion tended to occur in complicated aqueous flow areas.The present study provided an on-chip flow system for physiological behavior of biological cells, as well as provided a strategic cue for the prevention of bacterial infection and biofilm formation.
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A new microfluidic system with four different microchambers (a circle and three equilateral concave polygons) was designed and fabricated using poly(dimethylsiloxane) (PDMS) and the soft lithography method.Using this microfluidic device at six flow rates (5,10,20,30,40,and 50 μL/h),the effects of microenvironmental geometry and aqueous flow on bacterial adhesion behaviors were investigated.Escherichia coli HB101 pGLO,which could produce a green fluorescent protein induced by L-arabinose,was utilized as the model bacteria.The results demonstrated that bacterial adhesion was significantly related to culture time,microenvironment geometry,and aqueous flow rates.Adhered bacterial density increased with the culture time.Initially,the adhesion occurred at the microchamber sides,and then the entire chamber was gradually covered with increased culture time.Adhesion densities in the side zones were larger than those in the center zones because of the lower shearing force in the side zone.Also,the adhesion densities in the complex chambers were larger than those in the simple chambers.At low flow rates,the orientation of adhered bacteria was random and disorderly.At high flow rates,bacterial orientation became close to the streamline and oriented toward the flow direction.All these results implied that bacterial adhesion tended to occur in complicated aqueous flow areas.The present study provided an on-chip flow system for physiological behavior of biological cells,as well as provided a strategic cue for the prevention of bacterial infection and biofilm formation.
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Objective To evaluate the effects of hyperbaric oxygen (HBO) combined with drug therapy on patients with delayed encephalopathy caused by carbon monoxide poisoning ( COP). Methods Twenty to forty sessions of HBO therapy were used to treat 34 COP patients. Assessment relied on 99mTc-ethyl cysteinate dimer (~(99m)Tc-ECD) single photon emission computed tomography (SPECT) imaging of cerebral perfusion before and after treatment. Results After HBO therapy, cerebral perfusion in the COP patients improved significantly. There was a significant difference of the SPECT images before and after treatment. Conclusions SPECT imaging of cerebral perfusion can play an important role in the diagnosis of delayed encephalopathy caused by carbon monoxide poisoning, and it can be used for the therapeutic surveillance of HBO treatment.