Based on the practice of large tertiary hospitals in clinical pathway (CP) entrance management, we implemented a fine CP management model with standardized clinical diagnosis and treatment, and encouraged the department to continuously optimize the path form, expand CP coverage and improve the entry rate in a flexible path. Combining PDCA cycles with CP management, it can promote the realization of management goals and achieve continuous improvement, while providing operable (repeatable) methods to the practice of hospital CP management.
Objective To observe the effects of hydrogen peroxide on the expression of transforming growth factorβ1(TGF-β1) and Smad3 protein in A549 cells. Methods A549 cells were cultured with different concentrations of hydrogen peroxide. MTT assay was used to determine the cell growth and survival rates. The level of TGF-β1 and p-Smad3 protein were detected by western blotting. Results It was observed that hydrogen peroxide significantly inhibit proliferation of A549 cells. When the concentration of hydrogen peroxide was 1.0 mmol/L, the inhibition ratio reaches 46.34%, and the level of TGF-β1 and p-Smad3 protein were increased in a time-dependence manner and reached a peak after 24 h, then decreased a little but also remained at high level. Conclusions In the early oxidative damage, A549 cells express high level of TGF-β1 and p-Smad3 protein. It may be relevant to tissue repair and remodeling after lung injury.
ObjectiveTo investigate the effects of smoking on Th17/Treg T cell subsets and cytokines expression in patients with chronic obstructive pulmonary disease (COPD) in stable stage. MethodsFrom February 2012 to June 2013, sixty outpatients with stable COPD (20 cases of non-smokers, 40 cases of smokers) and 15 normal volunteers were recruited in the study in the Traditional Chinese Medicine Hospital affiliated to Xinjiang Medical University. Th17/Treg level in peripheral blood was detected by flow cytometry method. Cytometric bead array system was used to detect TGF-β, IL-10, IL-17A, IFN-γand other inflammatory factors in serum. ResultsThe patients' age, duration of disease, lung function, disease severity, and other related data were comparable between the smoking COPD group and the non-smoking COPD group (P > 0.05). Th17/Treg level was increased in the smoking COPD group compared with the normal group (P < 0.05), and showed an increasing trend from the normal group to the non-smoking COPD group and the smoking COPD group. The level of IL-2 in the smoking and non-smoking COPD groups was lower than that in the normal group. Compared with the normal group, the level of TNF-αwas significantly decreased in the smoking and non-smoking COPD groups(P < 0.05). ConclusionsSystemic inflammatory response continuously exists in patients with COPD even in the stable phase. Smoking can partly enhance the inflammatory reaction in COPD. The Th17/Treg T cell subsets associated cytokine regulation has gradually tended to a balance in the stable phase, and inflammatory factors related recovery speed is not consistent, suggesting that smoking may play a certain role in the recovery of balance.
ObjectiveTo evaluate the effectiveness and safety of nebulized amikacin for the treatment of ventilator-associated pneumonia (VAP) caused by gram-negative bacilli. MethodsFrom January 2010 to December 2013,a total of 120 patients with VAP due to gram-negative bacilli were randomised to a nebulized group (60 patients) and a control group (60 patients) in Shanghai Fifth People's Hospital. On the basis of similar routine treatment and systemic antibiotics based on the physicians' decision according to guidelines,the patients received 400 mg nebulized amikacin diluted in 5 mL normal saline in the nebulized group or 5 mL normal saline in the control group twice daily for 7 days. The rate of clinical cure and bacterial eradication,mortality,weaning rate and adverse events were recorded. ResultsAt the end of nebulized treatment,the rate of clinical cure in the nebulized group was significantly higher than that in the control group (75.0% vs. 53.3%,P=0.013). So was the rate of bacterial eradication (75.0% vs. 44.4%,P=0.008). But the crude mortality and weaning rate were similar between two groups (P>0.05). The adverse events in two groups were similar too (P>0.05). When followed-up to the 28th day,the weaning rate in the nebulized group was significantly higher than that in the control group (71.7% vs. 51.7%,P=0.024),but the crude mortality was not different (P>0.05). ConclusionNebulized amikacin as an adjunctive therapy for the treatment of VAP,which do not demonstrate obviously adverse events,can help improve rate of clinical cure and bacterial eradication and long-term weaning rate,but can not reduce patients' crude mortality.