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OBJECTIVE：To establish the quality standard of the Tibetan medicine Ma lus Fructus （known as the fruit of Ese ）， and to provide scientific reference for quality control and utilization of resource. METHODS ：The qualitative analysis of 20 batches of Malus Fructus with different producing areas and different origins was carried out by morphological observation ，microscopic and TLC identification. According to the method stated in 2015 edition of Chinese Pharmacopoeia ，water content ，total ash content and extract content were determined. HPLC method was used to determine the contents of 6 kinds of flavones （chlorogenic acid ， hyperin，isoquercitrin，quercitin，phloridzin，quercetin）in Malus Fructus. RESULTS ：The properties of this medicinal material were obovate ，spheroidal or oval ，its surface was reddish brown to dark red ，with slight shrinkage. Its taste was sweet ，sour and slightly astringent. The microscopic characteristics of the powder were clear ，the stone cells were scattered individually or clustered，and the pulp parenchyma cells contained calcium oxalate cube crystal and cluster crystal. The results of TLC showed that there were fluorescent spots of the same color in the chromatogram of the tested product and the corresponding position of the reference substance （ursolic acid ）. The content ranges of moisture ，total ash and extracts were 9.02％-11.39％，2.29％-3.35％， 37.12％-58.41％ respectively. The linear ranges of chlorogenic acid ，hyperin，isoquercitrin，，quercetin phlorizin and quercetin were 3.12-50，1.25-20，1.25-20，3.12-50，18.7-300，0.5-8 μg/mL（all r were not less than 0.999 7）. RSDs of prescision ，stability and reproducibility tests were all lower than 3.0％（n＝6）. The average recoveries were 97.56％，98.28％，106.14％，103.74％， 98.37％，98.76％；RSDs were 1.57％，1.62％，1.38％，1.99％，2.15％，2.31％（n＝6）. The content ranges of the above six components in 20 baches of samples were 0.001 5％-0.028 8％，0.005 9％-0.022 0％，0.008 7％-0.030 4％，0.019 4％- 0.048 5％，0.068 5％-0.199 8％ and 0.005 1％-0.081 4％. CONCLUSIONS ：Established method is accurate and stable ，and can be used for quality control of Malus Fructus. It is preliminarily Δ 基金项目：四川省科技计划项目（No.2020YFS0495）；“杏林学 proposed that moisture and total ash content should not exceed 者”学科人才科研提升计划（No.CXTD2018016） 12％ and 3.5％，and extract （by dry product ）and phlorizin ＊硕士研究生 。研究方向 ：中药品种 、质量与资源 。E-mail： content should not be less than 40％ and 0.1％ respectively. 1159020313@qq.com # 通信作者：教授。研究方向：中药品种、质量与资源。E-mail：
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Objective@#To investigate the safety, feasibility and operation key points of whole lung lavage in infants with pulmonary alveolar proteinosis.@*Methods@#The clinical manifestations, genetic screening, therapeutic interventions and outcome of an infant with pulmonary alveolar proteinosis complicated with respiratory failure who received whole lung lavage in November 2018 in Shanghai Children′s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine were reported. Websites including PubMed, Springer Link, China National Knowledge Infrastructure (CNKI), Weipu Database, and Wanfang Database were searched using the key words of "whole lung lavage" "pediatric" and "pulmonary alveolar proteinosis" for articles published from their establishments to April 2019. Relevant literature was reviewed.@*Results@#A 3-month-old boy had experienced cough, shortness of breath and cyanosis for 1 week prior to admission to pediatric intensive care unit. Physical examination showed hepatosplenomegaly. Complete blood cell count showed mild anemia (hemoglobin 96 g/L) and normal white blood cells. The patient had normal C-reactive protein and normal blood platelet. Biochemical panel showed hypoalbuminemia (31 g/L), mildly elevated glutamic oxaloacetic transaminase (115 U/L) and blood ammonia (165 μmol/L), extremely elevated lactate dehydrogenase (>6 600 U/L) and hyperferritinemia (>4 500 μg/L). Chest computed tomography (CT) revealed decreased transmittance of both lungs, patchy high density shadow and ground glass opacity. Genetic testing revealed a mutation of c.625+1G>A in SLC7A7. Schiff reaction (PAS staining) in bronchoalveolar lavage fluid was positive. The patient was diagnosed with severe pneumonia, respiratory failure, lysinuria urinary protein intolerance, and pulmonary alveolar proteinosis. The patient received sequential unilateral whole lung lavage in 2 days and was successfully weaned from ventilator. He was discharged home breathing room air. Eleven articles (11 in English and non in Chinese) were reviewed. Twenty-one patients were included. After whole lung lavage, 76% (16/21) of the patients had improvement in respiratory function.@*Conclusions@#Whole lung lavage can effectively improve respiratory failure caused by pulmonary alveolar proteinosis in infant patients. The procedure is feasible and safe.
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Objective To investigate the effect of three-dimensional conformal radiotherapy (3D-CRT)combined with PC chemotherapy (paclitaxel + carboplatin)on non-small cell lung cancer (NSCLC) patients and the serum levels of CA125,tissue inhibitor of metalloproteinase-1 (TIMP-1),serum amyloid A (SAA)and T-lymphocyte subsets. Methods A total of 100 patients with NSCLC treated in Affiliated Hospital of Guangdong Medical University from May 2015 to December 2017 were selected as the study subjects. They were divided into control group and observation group according to random number table method,with 50 cases in each group. The observation group was treated with 3D-CRT combined with PC chemotherapy,while the con-trol group was treated with PC chemotherapy. The two groups were treated for 4 cycles. The therapeutic effect, serum CA125,TIMP-1,SAA,T-lymphocyte subsets and adverse reactions were compared between the two groups. Results Four cases were lost to follow-up both in the two groups. The overall response rate in the observation group (43. 48％,20 / 46)was higher than that in the control group (23. 91％,11 / 46;χ2 = 3. 941, P = 0. 047). The serum levels of CA125,TIMP-1 and SAA of the two groups had no significant difference be-fore treatment,and the levels of these indexes decreased after treatment. The serum levels of CA125,TIMP-1 and SAA in the observation group after treatment were (12. 31 ± 1. 13)U/ ml,(275. 31 ± 13. 69)pg/ ml and (47. 21 ± 7. 21)mg/ L,which were lower than those in the control group [(30. 36 ± 1. 98)U/ ml,(320. 36 ± 17. 23)pg/ ml,(65. 92 ± 8. 36)mg/ L],with significant differences (t = 53. 699,P < 0. 001;t = 13. 884, P < 0. 001;t = 11. 495,P < 0. 001). The levels of CD3 +,CD4 +,CD8 + and CD4 + / CD8 + of the two groups had no significant difference before treatment,and the levels of these indexes decreased after treatment. The levels of CD3 +,CD4 +,CD8 + and CD4 + / CD8 + in the observation group were (35. 27 ± 10. 31 )％, (20. 27 ± 6. 72)％,(15. 89 ± 3. 37)％ and 0. 91 ± 0. 37,which were higher than those in the control group [(30. 77 ± 9. 27)％,(15. 27 ± 5. 73)％,(12. 02 ± 2. 69)％ and 0. 75 ± 0. 39],with significant differences (t = 2. 201,P = 0. 030;t = 3. 840,P < 0. 001;t = 6. 087,P < 0. 001;t = 2. 019,P = 0. 047). There were no significant differences in the adverse reactions such as nausea and vomiting [63. 04％ (29 / 46)vs. 43. 48％(20 / 46);χ2 = 3. 537,P = 0. 060],phlebitis [6. 52％ (3 / 46)vs. 4. 35％ (2 / 46);χ2 = 0. 000,P >0. 999],abnormal liver function [6. 52％ (3 / 46)vs. 2. 17％ (1 / 46);χ2 = 0. 261,P = 0. 609]and myelo-suppression [8. 70％ (4 / 46)vs. 6. 52％ (3 / 46);χ2 = 0. 000,P > 0. 999]between the observation group and the control group. Conclusion For patients with NSCLC,3D-CRT combined with PC chemotherapy can im-prove the overall response rate,decrease the levels of serum CA125,TIMP-1 and SAA,and improve the im-mune function of patients. The therapeutic effect is remarkable and the safety is good. The therapeutic scheme is suitable for the treatment of NSCLC.
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Objective@#To investigate the effect of three-dimensional conformal radiotherapy (3D-CRT) combined with PC chemotherapy (paclitaxel + carboplatin) on non-small cell lung cancer (NSCLC) patients and the serum levels of CA125, tissue inhibitor of metalloproteinase-1 (TIMP-1), serum amyloid A (SAA) and T-lymphocyte subsets.@*Methods@#A total of 100 patients with NSCLC treated in Affiliated Hospital of Guangdong Medical University from May 2015 to December 2017 were selected as the study subjects. They were divided into control group and observation group according to random number table method, with 50 cases in each group. The observation group was treated with 3D-CRT combined with PC chemotherapy, while the control group was treated with PC chemotherapy. The two groups were treated for 4 cycles. The therapeutic effect, serum CA125, TIMP-1, SAA, T-lymphocyte subsets and adverse reactions were compared between the two groups.@*Results@#Four cases were lost to follow-up both in the two groups. The overall response rate in the observation group (43.48%, 20/46) was higher than that in the control group (23.91%, 11/46; χ2=3.941, P=0.047). The serum levels of CA125, TIMP-1 and SAA of the two groups had no significant difference before treatment, and the levels of these indexes decreased after treatment. The serum levels of CA125, TIMP-1 and SAA in the observation group after treatment were (12.31±1.13) U/ml, (275.31±13.69) pg/ml and (47.21±7.21) mg/L, which were lower than those in the control group [(30.36±1.98) U/ml, (320.36±17.23) pg/ml, (65.92±8.36) mg/L], with significant differences (t=53.699, P<0.001; t=13.884, P<0.001; t=11.495, P<0.001). The levels of CD3+ , CD4+ , CD8+ and CD4+ /CD8+ of the two groups had no significant difference before treatment, and the levels of these indexes decreased after treatment. The levels of CD3+ , CD4+ , CD8+ and CD4+ /CD8+ in the observation group were (35.27±10.31)%, (20.27±6.72)%, (15.89±3.37)% and 0.91±0.37, which were higher than those in the control group [(30.77±9.27)%, (15.27±5.73)%, (12.02±2.69)% and 0.75±0.39], with significant differences (t=2.201, P=0.030; t=3.840, P<0.001; t=6.087, P<0.001; t=2.019, P=0.047). There were no significant differences in the adverse reactions such as nausea and vomiting [63.04% (29/46) vs. 43.48% (20/46); χ2=3.537, P=0.060], phlebitis [6.52% (3/46) vs. 4.35% (2/46); χ2=0.000, P>0.999], abnormal liver function [6.52% (3/46) vs. 2.17% (1/46); χ2=0.261, P=0.609] and myelosuppression [8.70% (4/46) vs. 6.52% (3/46); χ2=0.000, P>0.999] between the observation group and the control group.@*Conclusion@#For patients with NSCLC, 3D-CRT combined with PC chemotherapy can improve the overall response rate, decrease the levels of serum CA125, TIMP-1 and SAA, and improve the immune function of patients. The therapeutic effect is remarkable and the safety is good. The therapeutic scheme is suitable for the treatment of NSCLC.
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Objective To evaluate the efficacy and safety of chloral hydrate combined with dexmedetomidine for sedation during echocardiography in pediatric patients with Williams-Beuren syndrome.Methods Eighteen pediatric patients diagnosed with Williams-Beuren syndrome by genetic testing,aged 5-58 months,scheduled for elective echocardiography under sedation,received oral chloral hydrate 50 mg/kg.Vital signs were measured every 5 min,and sedation was assessed using Ramsay sedation score.When Ramsay sedation score＜4 points 20 min later,intranasal dexmedetomidine 1 μg/kg was given as rescue sedative.Medicine used,vital signs,onset time,moderate and deep sedation duration and emergence time were recorded.Results The success rate of sedation with chloral hydrate alone was 38.9％ and with chloral hydrate and dexmedetomidine 61.1％.The onset time,sedation duration and emergence time were (15.7+1.9) min,(75+26) min and (52+25) min,respectively,in pediatric patients received chloral hydrate alone.The onset time,sedation duration and emergence time were (33.2±3.4) min,(83±49) min and (61±46) min,respectively,in pediatric patients received chloral hydrate and dexmedetomidine.The onset time was significantly prolonged in pediatric patients received chloral hydrate and dexmedetomidine than in pediatric patients received chloral hydrate alone (P＜0.05).Heart rate,respiratory rate and SpO2 were stable during sedation in all pediatric patients,and nausea and mild vomiting were found in 3 pediatric patients received chloral hydrate and in 6 pediatric patients received chloral hydrate and dexmedetomidine,and no other adverse reactions were observed.Conclusion Oral chloral hydrate 50 mg/kg combined with intranasal dexmedetomidine 1 μg/kg provides reliable sedative efficacy and exerts less influence on respiratory and circulatory function with higher safety when used for echocardiography in pediatric patients with Williams-Beuren syndrome.
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Objective To observe the correlation between CD4+ CD29+ T cells and metastasis and radiotherapy for patients with pulmonary adenocarcinoma. Method Seventy-one patients with lung adenocarcinoma, 93 patients with lung adenocarcinoma ,76 cases of chronic obstructive pulmonary disease (COPD),63 cases of healthy volunteers were enrolled. Frequencies of blood CD4+ CD29+ T cells and their intracellular necrosis factor alpha(TNF-α)and interleukin 1(IL-1)were compared. Compare TNF-α,IL-1,integrin beta 1 and vascular endothelial growth factor(VEGF)levels in the patients with transferred pulmonary adenocarcinoma or with non-transferred pulmonary adenocarcinoma and their changes with the treatment of radiotherapy. Results the patients with lung adenocarcinoma and non lung adenocarcinoma were significantly higher than that of COPD and health group,and patients with lung adenocarcinoma is significantly higher than patients with non lung adenocarcinoma (P<0.05);Integrin beta 1,VEGF and CD4+CD29+T cells,TNF-αand IL-1 level in patients with lung adeno-carcinoma metastasis were significantly higher than non-transferred group(P < 0.05);After radiotherapy,CD4+CD29+T cells,TNF-αand IL-1 in patients with lung adenocarcinoma were significantly lower than before(P<0.05);CD4+ CD29+ T cells,TNF alpha and IL-1 with integrin beta 1 and VEGF had significantly positive correlations. Conclusion CD4+CD29+T cells and cytokines increase significantly in the blood of patients with lung adenocarci-noma,and are related to the prognosis of metastasis and radiation therapy,which has important clinical significance.
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Objective To evaluate the accuracy of ultrasonographic measurement of the subglottic airway diameter in selecting the cuffed endotracheal tube (ETT) size for the pediatric patients with congenital heart disease.Methods Sixty pediatric patients of both sexes with congenital heart disease,of American Society of Anesthesiologists physical status Ⅱ-Ⅳ,aged 1 month-7 yr,undergoing elective open heart surgery,were included in this study.The subglottic airway diameter was measured by bedside ultrasonography after induction of anesthesia.The outer diameter of the cuffed ETT was determined according to the subglottic airway diameter.The air leak test was performed after intubation to determine whether or not the ETT size selected based on ultrasonography was appropriate.When the difference between the inner diameter of the finally selected ETT and the result calculated by the Motoyama formula was less than 0.2 mm,the ETT size selected based on the Motoyama formula was considered appropriate.The agreement and correlation between the subglottic airway diameter measured by age-based formula and ultrasonography and the outer diameter of the actually selected ETT were analyzed using Bland-Altman plot and Passing-Bablok regression analysis.Results The accurate rate of the ETT selected based on the ultrasonic measurement and Motoyama formula were 80％ and 55％,respectively,and there was significant difference (P＜0.05).Conclusion Ultrasonographic measurement of the subglottic airway diameter produces higher accuracy than the classical Motoyama formula in selecting the cuffed ETT size for the pediatric patients with congenital heart disease.