Arterial partial pressure of carbon dioxide combined with Wells score helps predict acute pulmonary embolism / 中华急诊医学杂志

Objective:To explore the clinical value of arterial partial pressure of carbon dioxide (PaCO 2) combined with Wells score in predicting acute pulmonary embolism (PE). Methods:Patients with suspected acute PE admitted to Emergency Department of Beijing Chaoyang Hospital, Capital Medical University from January 1, 2016 to August 31, 2021 were screened. Patients with positive computed tomography pulmonary angiography (CTPA) results were classified as the PE group, and those with negative CTPA results were classified as the non-PE group. Demographic characteristics, symptoms, vital signs, underlying diseases, risk factors for venous thrombosis, arterial blood gas analysis and Wells scores were statistically analyzed and compared between the two groups, and the clinical efficacy of PaCO 2 combined with Wells score in predicting acute PE was evaluated. Results:A total of 1 869 patients with suspected acute PE were screened, and 1 492 patients were finally selected. There were 537 cases in the PE group and 955 cases in the non-PE group. The frequency of chest pain, dyspnea, unilateral lower limb edema, history of PE or deep venous thrombosis, history of surgery or immobilization within 3 months, history of fracture within 3 months, active malignant tumor, elevated Wells score and reduced PaCO 2 in the PE group was significantly higher than that in the non-PE group (all P< 0.05). The area under receiver operating characteristic (ROC) curve (AUC) of Wells score was 0.784 (95% CI: 0.758-0.810), and the sensitivity and specificity of predicting acute pulmonary embolism were 61.64% and 88.48%, respectively. The AUC of reduced PaCO 2 was 0.679 (95% CI: 0.651-0.707), and the sensitivity and specificity of predicting acute pulmonary embolism were 79.89% and 55.92%, respectively. The AUC of reduced PaCO 2 combined with Wells score was 0.837 (95% CI: 0.816-0.858), and the sensitivity and specificity of predicting acute pulmonary embolism were 74.12% and 77.07%, respectively. The AUC of reduced PaCO 2 combined with Wells score was significantly greater than the AUC of Wells score ( P<0.001) and the AUC of reduced PaCO 2 ( P<0.001). Conclusions:The efficacy of PaCO 2 reduction combined with Wells score in predicting acute PE was superior to that of either of them alone. This was a beneficial supplement to the screening of patients with acute PE, and would also help reduce the abuse of CTPA in the emergency department.

Application and evaluation of formative assessment combined with scenario simulation teaching in Emergency Nursing practical course / 中华医学教育探索杂志

Objective:To evaluate the teaching effect of Emergency Nursing practice course using scenario simulation teaching combined with formative assessment. Methods:The subjects were selected from vocational nursing students of Batch 2015 (control group, n=49) and Batch 2016 (intervention group, n=40). The control group adopted the scenario simulation teaching method, and the intervention group added formative assessment on the basis of simulation teaching. The end-of-term theoretical scores of Emergency Nursing and the scores of students' general self-efficacy scale were used as evaluation tools. SPSS 22.0 statistical software was used for data processing and analysis. Results:The scores of the intervention group (85.20±8.05) were higher than those of the control group (79.73±8.46), with statistical significance ( P<0.05). The scores of self-efficacy in both groups were improved, while the scores of the control group after the course (2.68±0.42) were higher than those before the course (2.61±0.47), but there was no statistical significance. The scores of the intervention group after the course (2.78±0.43) were higher than those before the course (2.62±0.43), with statistical significance. Conclusion:The application of scenario simulation teaching combined with formative assessment in the practical course of Emergency Nursing can be helpful to improve students' self-efficacy and comprehensive ability of first aid.

The predictive value of red blood cell count, fibrinogen combined with platelet count for risk stratification of acute pulmonary embolism / 中华急诊医学杂志

Objective:To explore the predictive value of red blood cell count (RBC), fibrinogen (FBG) combined with platelet count (PLT)for risk stratification of acute pulmonary embolism (PE).Methods:Patients admitted to Beijing Chaoyang Hospital from January 2013 to October 2019 and diagnosed with acute PE were retrospectively collected. According to the risk stratification criteria for PE, the patients were divided into the high/medium risk group and low risk group. The demographic characteristics, previous medical history, parameters of RBC and PLT, and FBG of the two groups were compared.Results:Totally 696 patients were selected in the study, of them, 193 patients were in the high/medium risk group and 503 in the low risk group. RBC and hematocrit (HCT) in the high/medium risk group were significantly higher than those in the low risk group, but FBG and PLT in the high/medium risk group were significantly lower than those in the low risk group (all P<0.05). There was no significant difference in age, gender, previous medical history, hemoglobin (HGB), HCT, mean corpuscular volume (MCV), mean corpuscular hemogloin (MCHC), red blood cell distribution width (RDW), platelet distribution width (PDW), mean platelet volume (MPV), and platelet large cell rate (P-LCR) between the two groups. Logistic regression analysis showed that RBC, PLT and FBG were independent influencing factors for risk stratification of acute PE. RBC was positively correlated with risk stratification, while PLT and FBG were negatively correlated. The area under the ROC curve (AUC) of RBC, PLT and FBG were 0.552 (95% CI: 0.514-0.589), 0.591 (95% CI: 0.554-0.628), and 0.565 (95% CI: 0.527-0.602), with the cut-off value of 4.57 ×10 12/L,182 ×10 9/L and 322.8 mg/dL, respectively. Conclusions:RBC, FBG combined with PLT have clinical predictive value for risk stratification of acute PE.

Leucine-rich repeat kinase 2 inhibitor as Parkinson′s disease novel therapeutics:research advances / 国际药学研究杂志

Parkinson′s disease(PD)is a common disease caused by multiple factors and characterized by pathological degen?eration in the dopaminergic neural system. Based on its pathogenic factors,PD can be divided into several subtypes,so it is essential to develop therapeutic agents based on the main pathogenic factor of each subtype of PD. Recently it is confirmed that the mutation of leucine-rich repeat kinase 2(LRRK2)gene leads to increased activity of the LRRK2 notably,and then causes neurodegeneration. Thus developing LRRK2 inhibitors to modulate the kinase activity will be a novel therapy for the PD subtype which is caused by LRRK2 gene mutation. LRRK2,either a kinase or a GTPase,has two drug binding sites. Therefore,two types of LRRK2 inhibitors are being studied,one is the kinase inhibitor and the other is GTPase inhibitor. This paper summarizes the recent progress in the dis?covery and development of LRRK2 inhibitors.

The predictive value of Wells score combined with D-dimer in the diagnosis of acute pulmonary embolism / 中华急诊医学杂志

Objective To evaluate the predictive value of Wells score combined with D-dimer in the diagnosis of acute pulmonary embolism.Methods A total of 540 patients with suspected pulmonary embolism admitted from 2008 to 2011 were enrolled for study.The diagnosis of pulmonary embolism (PE) was confirmed by using computed tomography pulmonary angiography (CTPA).These patients were divided into two groups:PE group and non-PE group.Comparative analysis was carried out in demographics,underlying diseases,chief complaints,physical signs,venous thrombosis risk factors,laboratory findings and Wells scores between the two groups.Results Of 502 patients selected into this study,there were 246 in PE group and 256 in Non-PE group.The incidence rates of history of recent surgery or bed-ridden,recent fracture of pelvis or lower limb,symptoms of hemoptysis,transient disturbance of consciousness,signs of unilateral lower limb swelling,hypoxia and hypocapnia of arterial blood gas analysis,elevated levels of D dimer,high Wells score in PE group were significantly higher than those in non-PE group (P ＜ 0.05).And there were no statistical difference in other variables found between the two groups.The areas under the ROC curve of Wells score,D-dimer and the combination of the two were 0.775 (95％ CI:0.719-0.831),0.802 (95 ％ CI:0.751-0.853) and 0.899 (95 ％ CI:0.834-0.964),respectively.And the area under the ROC curve of the combination of the two was greater than that of separated application (P ＜ 0.05).When the cut-off value of Wells score was 5 and D-dimer was 1 724 μg/L,the weighted maximum sensitivity and specificity were reached,and these cut-off values were higher than above determined values,the reliability of the diagnosis of PE was obviously increased,and those were lower than these cut-off values,the reliability of excluding PE was also increased.Conclusions Wells score combined with D-dimer showed a higher value in predicting acute pulmonary embolismthan than their separated application.

The use of Charlson weighted index to evaluate the time of observation in emergency internal observation room / 中华急诊医学杂志

Objective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities (WIC).Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out.The patients were divided into two groups according to the length of observation time:Group A (time of observation ≥72 h,n =1908) and Group B (time of observation ＜ 72 h,n =928).The data of the length of observation time were recorded,and the WIC and the APACHE Ⅱ score were calculated.Logistic regression analysis was used to determine the independent predictors for 72-hour observation.Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation.Results Of 2836 patients,1176 (41.5％) suffered from respiratory disease,709 (25.0％) had cardiovascular and cerebrovascular diseases,423 (14.9％) were contracted digestive system disease,251 (8.8％) had renal and endocrinology system diseases and 277 (9.8％) had diseases arisen from physicochemical factor and miscellaneous causes.Compared with patients in Group B,the average age,the number of elderly patients residing in apartment exclusively for elderly,the WIC and the APACHE Ⅱ score were higher in patients in Group A.The one-variable and multi-variable Logistic regression analyses showed that age,the WIC score,the APACHE Ⅱ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room.The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score,0.788 for APACHE Ⅱ score and 0.853 for their combination.Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.

Determination of Pharmacokinetics Differences of Ammuxetine Isomers in Rat Plasma Using On-Line Solid Phase Extraction with Liquid Chrommatography-Tandem Mass Spectrometry / 分析化学

An on-line solid phase extraction ( SPE ) coupled with HPLC-MS/MS method was developed to determine S-ammuxetine and R-ammuxetine in rat plasma. The sample preparation consisted of the following steps:A protein precipitation extraction used methanol and acetonitrile ( 50:50 , V/V ); an on-line SPE treatment to remove most matrixes in plasma;an enrichment and separation step used a C18 analytical column. S-and R-ammuxetine were determined by tandem mass spectrometry. The SPE column was a Retain PEP Javelin (10 mm × 2. 1 mm × 5 μm), while the chromatographic separation was achieved using a ZORBAX SB-C18 (50 mm × 2. 1 mm × 3. 5 μm) analytical column with an isocratic mobile phase composed of acetonitrile-water-formic acid (40:60:0. 1, V/V/V, 0. 3 mL/min). The selected reaction monitoring mode of the positive ion was performed and the precursor to the product ion transitions of m/z 292 . 1/154 . 0 and m/z 260. 4/116. 2 were used to measure S-ammuxetine, R-ammuxetine and internal standard (propranolol). The method was linear over a concentration range from 0 . 2 to 1000 μg/L with the correlation coefficients of 0 . 9903 and 0 . 9951 . The average intra-day precision values were 1 . 2% -12 . 0% for S-ammuxetine and 0. 4%-11. 2% for R-ammuxetine, respectively. The average recoveries were 94. 2%-101. 6% for S-ammuxetine and 94. 3% -109. 4% for R-ammuxetine. Compared to the literature, the sensitivity of this method increased dramatically. The present method has been successfully applied to the preclinical rat research of ammuxetine isomers following intragastric administration.

Determination of contents and related substances of demethyl levophencynonate hydrochloride tablets by HPLC / 军事医学

Objective To establish a simple, feasible and precise quality control method for the determination of contents and related substances of demethyl levophencynonate hydrochloride (L-LPC)tablets.Methods The mobile phase consisted of methanol,acetonitrile and sodium acetate buffer solution(pH 5.0),at a ratio of 4∶3∶3,at a flow rate 1.0 ml/min and a detection wavelength of 220 nm.Samples were injected 100 μl and determined at room temperature.Results The calibration curves showed good linearity (R2 =1) within the test range of 0.1-50μg/ml.The recovery of the method was about (100.15 ±0.73)%, and the stability of working solutions was acceptable in 8 h (RSD=0.36%).Conclusion The results indicated that the developed method can be readily used as a quality control method.

A new charging scheme in an emergency department observation unit under Beijing's basic medical insurance / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The new medical insurance policy (JRSYF(2010) No.255) was released by the Beijing Municipal Government and became effective on January 1, 2011. Medical expenses incurred during a stay in an emergency department (ED) observation unit can be reimbursed as a hospital admission. The aim of this study was to evaluate the impact of a new charging scheme during stays in ED observation unit under Beijing's Basic Medical Insurance.</p><p><b>METHODS</b>Data for those patients who had stayed in ED observation unit in 2010 (before the implementation of a new charging scheme) and 2012 (after the implementation of this policy) were retrospectively analyzed in terms of length of stay, patients who were observed (PO), and median medical costs.</p><p><b>RESULTS</b>After the implementation of a new charging scheme, compared with the year of 2010, in year of 2012, there were statistically significant longer lengths of stay at the observation unit (6 (4-9) vs. 5 (4-7) days; P < 0.001), more PO (2 257 vs. 1 783; P < 0.001), and more median medical costs (RMB 6 026 vs. 3 650 Yuan; P < 0.01). The proportion of elderly patients (≥ 60 years of age) in 2012 was larger than that in 2010 (70.22% vs. 63.71%; P < 0.01). It was performed on those patients who were admitted after the implementation of a new charging scheme. Compared with patients who were not admitted had stayed in ED observation units, the patients who were admitted had stayed in ED observation units that had a higher proportion for >15 days (36.22% vs. 5.61%; P < 0.01); they had higher median medical costs RMB (9 186 vs. 5 668 Yuan; P < 0.001) and they were more elderly (≥ 60 years of age) (86.10% vs. 66.39%; P < 0.01).</p><p><b>CONCLUSIONS</b>The new charging scheme under Beijing's Basic Medical Insurance allows patients to get access to inpatient admission more easily. It lowers patients' financial burden in ED observation unit. Since more people stay at ED observation unit, it increases ED payments by the insurance system. However, it slows the turnover rate of ED observation unit and causes overcrowding in ED. Hence, the advantages and disadvantages of the new policy are obvious.</p>

Study of pulmonary artery monitoring for intracranial and cervical artery angiography with dual energy CT / 中华放射学杂志

Objective To explore the application value of pulmonary artery monitoring program for intracranial and cervical artery angiography with dual-energy CT.Methods Sixty patients performed intracranial and cervical artery angiography with dual-energy CT were divided into two groups according to the random number table.Group A (optimization group,30 patients):the monitoring points were located in the main pulmonary artery,with threshold 150 HU,trigger delay time 8-9 s,pitch 0.9,and the iohexol (350 mg I/ml) 60-65 ml.Group B (conventional group,30 patients):the monitoring points were located in aortic arch,with threshold 100 HU,trigger delay time 5 s,and the iohexol (350 mg I/ml)60-70 ml.Patients with the body weight less than 75 kg were injected with the flow rate of 4.0 ml/s,and those weight greater than 75 kg or with body mass index (BMI) greater than 27 kg/m2 were 4.5 ml/s,following 40 ml saline solution with the same flow rate respectively.All images were transferred to Siemens Syngo workstation for further processing and analysis.The attenuation values were measured on axial images in the common carotid artery,internal and external carotid artery,vertebral and basilar artery,the horizontal segment of the middle cerebral artery,the subclavian vein of injection side,the proximal,middle and distal segment of jugular vein,the straight sinus and the superior sagittal sinus.Two experienced observers blinded independently evaluated the image quality of CTA,the impact of contrast material residues artifacts of subclavian vein of injected side and the affect of venous return factors on arterial image display.Images of volume rendering technique(VR),the maximum intensity projection (MIP),and curved planar reformation (CPR) were reconstructed using dual energy bone removal and Inspace and 3D software.The mean intraluminal attenuation of contrast material (HU),the volume of contrast material and the mean image quality scores were compared with t test between the two groups.Chi-square test was used to compare of image contrast agents residual artifacts,the absence segments of the root of the neck artery,and the degree of the jugular vein return in two groups.Results The mean CT values were 372-414 HU for each segment of artery showing no significant differences between two groups (P ＞ 0.05).In group A,the CT values of the jugular vein in proximal,middle,distal segment of the two sides were (95 ± 36),(95 ± 36),(131 ±58),(133 ± 57),(174 ± 68),and (180 ± 66) HU respectively.In group B,CT values were (135 ± 58),(137 ±59),(170 ±58),(181 ±58),(218 ±62),and (224 ±68) HU.The CT value of jugular venous in group A was significantly lower than that in group B (t =-3.30--2.54,P ＜ 0.05).Case numbers of contrast agent residual artifacts of injection side subclavian vein and the absence segments of root of the neck artery at the beginning in group A (5,11) were less than that in group B (12,24) (x2 =4.02,5.65,P ＜0.05).The degree of the jugular vein return in group A were lesser severely than that in group B (x2 =6.79,6.37,P ＜0.05).Below the level of carotid artery bifurcation:slight 5 patients,severe 1 patient in group A vs.slight 15 patients,severe 9 patients in group B.Above the level of carotid artery bifurcation:slight 9 patients,severe 6 patients in group A vs.slight 12 patients,severe 17 patients in group B.Image quality scores of group A (3.84 ± 0.40) was higher than that of group B (3.64 ± 0.63) (t =4.26,P ＜0.05).Conclusions Pulmonary Artery Monitoring combines with 60-65 ml contrast material optimization scheme for intracranial and cervical artery angiography with dual energy CT can significantly reduce the degree of jugular venous return and contrast material residues artifacts of subclavian vein of injected side.This technique is helpful to improve the work efficiency and image quality.

Transpulmonary thermodilution for evaluating respiratory function in swine after severe acute dichlorvos poisoning / 中华急诊医学杂志

Objective In order to extrapolate the respiratory dysfunction of patients in early stage of acute organophosphorus pesticide poisoning (AOPP),transpulmonary thermodilution technique was used in swine models of severe acute dichlorvos poisoning (SADP) to evaluate respiratory function.Methods Twenty healthy female swine were randomly divided into dichlorvos ( n =7 ),atropine ( n =7 ) and control (n =6) groups.In the dichlorvos group,the swine were administered with 80％ emulsified dichlorvos (100mg/kg) via the gastric tube toinduce SADP.In the atropine group,swinewere administered with dichlorvos,and 0.5h later,atropine was injected to obtain and maintain atropinization.The swine of control group were administered with saline solution instead.Arterial and venous blood samples were collected 0,0.5,1,2,4 and 6 hours after modeling for blood gas analysis and detecting acetylcholinesterase levels.Both extravascular lung water index (EVLWI) and pulmonary vascular permeability index ( PVPI ) were measured by using PiCCO (pulse indicator continuous cardiac output ). At the termination of the experiment,the animals were sacrificed and the lung wet/dry weight ratio was determined and histopathological changes of lung tissue were also observed under microscope.Results In the dichlorvos group,EVLWI and PVPI were substantially increased from 0.5 h to 6 h after modeling but PaO2/FiO2 decreased from 0-6 h after modeling.In the atropine group,EVLWI and PVPI increased initially,but then they decreased 1 h afterwards and PaO2/FiO2 was also gradually decreased from 0-1 h.In both dichlorvos group and atropine group,the EVLWI was negatively correlated with PO2/FiO2 and positively correlated with PVPI.Compared with the control group,the lung wet/dry weight ratio increased markedly in the dichlorvos group and mildly increased in the atropine group.Meanwhile,the histopathological changes of lung tissue were obvious in the dichlorvos group and mild in the atropine group.Conclusions SADP swine experienced substantial changes in respiratory function. EVLWI was a reliable and valuable indicator for evaluating respiratory function in the early stage of AOPP.

The roles of catecholamine in cardiac injury after severe acute dichlorvos poisoning / 中华急诊医学杂志

ObjectiveTo study the role of catecholamine in genesis of myocardium injury after organophosphorus poisoning (OP) in order to elucidate the underlying mechanisms of OP-induced cardiotoxicity.Methods Of 92 patients with severe acute dichlorvos poisoning,41 were consecutively enrolled for study and followed up for three months. The levels of serum creatine kinase isoenzyme myocardium (CK-MB),cardiac troponin Ⅰ (cTnI),acetylcholinesterase (AChE),acetylcholine (Ach),epinephrine and norepinephrine were assayed on the 1st,3rd and 5th days after admission and on the day of discharge.Electrocardiography was recorded every day after admission.ResultsOf them,37 (90.2％ )patients survived and four ( 9.8％ ) patients died during treatment.Sinus tachycardia was found in 37 (90.2％ ) patients and ST-T changes in 33 (80.4％ ) patients.CK-MB and cTnI levels peaked 3 days after admission,and then decreased to normal levels.Serum Ach,epinephrine and norepinephrine peaked on the 1st day after admission and then decreased.ConclusionsSevere acute dichlorvos poisoning is associated with myocardial dysfunction likely caused by increase in catecholamine levels.

The application of dual-source CT coronary angiography in low tube voltage setting and the influence of heart rate on image quality and radiation doses / 中华放射医学与防护杂志

Objective To evaluate the application value of dual-source CT coronary angiography in low tube voltage setting and the influence of heart rate on image quality and radiation doses.Methods 323 patients suspected of coronary artery disease received retrospective ECG-gating coronary angiography with dual-source CT scanner,who were divided into low tube voltage group (100 kVp,n =201) and conventional voltage group (120 kVp,E group,n =122).No beta-blockers were taken before CT scan.All patients in low tube voltage group were divided into four groups according to the heart rate (HR):group A,HR≤59 beats per minute (bpm),n =50; group B,60≤HR ＜69 bpm,n =64; group C,70≤HR ＜91bpm,n =62;group D,HR ≥ 91 bpm,n =25.All images were transferred to a workstation for further processing.The best R-R interval reconstruction images of all groups were evaluated.The value of pitch,CT volume dosage index(CTDIvol),dose length product(DLP) and effective dose(E)were recorded.The pitch,the score of imaging quality of coronary artery segments and the radiation dose were compared with One-Way ANOVA.The influence of heart rate on image quality and radiation doses of coronary artery was analyzed.Results The value of pitch in groups A-D was 0.24 ± 0.03,0.29 ± 0.04,0.33 ± 0.05,0.38 ± 0.06,respectively,with statistical difference (F =62.57,P ＜ 0.05).The value of CTDIvol in groups A-E was (21.59±7.97),(20.24±6.03),(18.23±7.55),(18.14 ±5.75),(38.62±16.21)mGy,respectively,with statistical difference (F =85.16,P ＜ 0.05).The value of E in group A-E was (5.31 ±2.18),(4.85 ±1.70),(4.49 ± 1.86),(4.37 ±1.50),(8.75 ± 4.07) mSv,respectively,with statistical difference(F =44.83,P ＜ 0.05).The image score was (4.65 ±0.46),(4.55 ± 0.53),(4.55 ±0.53),(4.47 ±0.72),(4.66 ± 0.44) (F =1.89,P ＞ 0.05).Conclusions No beta-blockers was taken before CT scan,and a high quality image could be acquired by using dual-source CT coronary angiography in low tube voltage setting(100 kVp).When the auto ECG-gating is selected,medium and low HR have little influences on radiation dose,while the radiation dose could be decreased significantly at higher HR,but the possibility to obtain the high quality image decreased.

Dual-source CT coronary angiography in patients with medium and low heart rate: imaging quality and radiation doses at a low tube voltage / 中华放射学杂志

Objective To evaluate the imaging quality and radiation doses of dual-source computed tomography (DSCT) coronary angiography at a low tube voltage in patients with medium and low heart rate.Methods Eighty-five patients[heart rate (HR) ＜ 91 beats per minute (bpm); body mass index (BMI) 17. 51-30. 00 kg/m2]suspected of coronary artery disease received retrospectively ECG-gating coronary angiography with dual-source CT scanner (Somatom Definition, Siemens) at a tube voltage of 100 kVp. For all patients, no beta-blocker was used before CT scan. According to the HR, the patients were divided into three groups: Group A, HR ≤ 59 bpm, n = 27; Group B, HR 60-69 bpm, n = 29; Group C,HR ≥70 bpm, n = 29. All images were transferred to a workstation for postprocessing. The best R-R interval reconstruction images of all groups were evaluated. The value of pitch, CT volume dosage index (CTDIvol), dose length product (DLP)and effective dose (ED)were recorded. The pitch, the score of imaging quality of coronary artery segments and the radiation dose were compared with one-way ANOVA. The influence of HR on image quality and radiation doses of coronary artery was analyzed. Results The value of pitch in Group A, Group B and Group C was 0. 241 ± 0. 025, 0. 286 ± 0. 034 and 0. 335 ± 0. 036,respectively. The mean score of imaging quality of coronary artery segments in Group A, Group B and Group C was 4. 78 ± 0. 26, 4. 66 ± 0. 56 and 4. 70 ± 0. 46, respectively. The value of CTDIvol in Group A,Group B and Group C was (18.06 ±5. 16), (19. 62 ±7. 15) and (17. 50 ±7. 13) mGy, respectively. The value of ED in group A, Group B and Group C was (4.23 ± 1.76), (4.59 ± 1.75) and (4.12 ±1.39) mSv, respectively. There was statistical difference in value of pitch among the three groups (F =60. 00, P= 0. 00). There were no statistical difference in score of imaging quality, CTDIvol and value of ED among the three groups (F = 0. 53, P = 0. 59; F = 0. 83, P = 0. 44 ; F = 0. 86, P = 0. 43). Conclusion Medium and low HR have little influences on image quality of dual-source CT coronary angiography at a low tube voltage. When the auto ECG-gating is selected, there is little influence on radiation dosage as well.

Design, synthesis and antidepressive activity of duloxetine derivatives / 药学学报

In this paper, duloxetine was chosen as the lead compound. The pharmacophores with 5-HT(1A) antagonism activity were used to replace the naphthyl of duloxetine. A series of duloxetine derivatives had been designed and synthesized and whose structures were confirmed with elemental analysis, MS and H NMR. All synthesized compounds were tested by tail suspension test and forced swimming test in vivo. The test results revealed that most of the compounds have shown better activity than duloxetine at the same dosage. Some of them are worth to be studied further.

Traumatic diaphragmatic rupture: the diagnostic value of multiplanar reformation in multi-slice spiral CT examination / 中华放射学杂志

Objective To investigate the diagnostic value of multiplanar reformation (MPR)reconstruction for the detection of traumatic diaphragmatic rupture (TDR) in multi-slice CT examination.Methods Thirty six cases with thoracoabdominal trauma, including 21 cases with and 15 cases without TDR confirmed by surgery, received multi-slice CT examination. They were enrolled in this study. Three experienced radiologists retrospectively analyzed the axial and MPR images. The diagnostic criteria for TDR included abnormally elevated hemidiaphragm, diaphragmatic discontinuity, the "collar sign" or "dependent viscera "sign. Referenced to surgical results, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of axial and MPR images in detection of TDR were calculated. The McNemar was used to investigate the differences between axial and MPR images in the detection of diaphragmatic discontinuity and "collar sign", and the differences between axial and MPR images of these two signs in TDR diagnosis. Results The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of axial images in detection of TDR were 71% ( 15/21 ), 80% ( 12/15 ), 83% ( 15/18 ),67% ( 12/18 ) and 75% ( 27/36 ), respectively; of MPR images, they were 86% ( 18/21 ), 93%(14/15), 95% ( 18/19 ), 82% ( 14/17 ) and 89% ( 32/36), respectively. By axial images, twelve diaphragmatic defects or interrupts were identified in nine cases, and "collar sign" was identified in six cases. By MPR, 20 diaphragmatic defects or interrupts were identified in 15 cases ( P = 0.125 ), and "collar sign" was identified in 14 cases (P =0.021 ). The sensitivity and specificity of diaphragmatic defects or interrupts for TDR diagnosis in axial images were 43% (9/21) and 80% ( 12/15 ), respectively;in MPRimages, they were71% (15/21) (P=0.125)and93% (14/15) (P=0.500), respectively.The sensitivity and specificity of "collar sign" for TDR diagnosis in axial images were 29% (6/21) and 100% ( 15/15), respectively; in MPR images, they were 67% ( 14/21 ) (P =0. 021 ) and 100% (15/15)( P = 1.000), respectively. Conclusions MSCT presented good sensitivity, specificity and accuracy for the diagnosis of TDR. MPR images were useful supplements for axial images in TDR diagnosis which improved the diagnosis.

Effectiveness of thymosin alpha-1 on patients with severe community-acquired pneumonia / 中华全科医师杂志

To investigate the effectiveness of thymosin a1 on patients with severe community-acquired pneumonia (SCAP). Methods Thirty-five patients with SCAP were randomly divided into two groups, group A with regular treatment as control and group B with both thymosin a1 and regular treatment. Venous blood specimens were collected from them before treatment (baseline) and seven days after treatment for laboratory testing, including serum concentrations of c-reactive protein (CRP) and albumen (ALB), serum activities of aspartate aminotransferase (AST) and aniline aminotransferase ( ALT), and percentage of T-lymphocyte subsets CD3+ , CD+ and CD8+ by indirect immunofluorescence. Meanwhile, their symptoms, signs and chest X-ray were observed. Length of mechanical ventilation and stay at emergency intensive care units (EICU) of the patients were recorded. Results Percentages of CD3+ and CD4+ , and ratio of CD+ to CD8 + increased significantly and percentage of CD8+ reduced significantly in group B seven days after treatment, as compared to those before treatment [ (46.3 ± 5.3) % vs. (29.9 ± 2.1 ) %, (44.5 ± 5.2) % vs. (28. 7 ± 2. 8 ) %, and 1.8 ± 0. 4 vs. 0. 9 ± 0. 1, respectively, P < 0.05, and (24.6 ± 2.9) % vs. (31.4 ± 3.7) %, P < 0. 05 ]. But, no significant improvements in those indicators were found in group A after treatment. There were significant differences in percentages of CD3+ , CID4+ and CD8 + , and ratio of CD4+ to CD8+ between group B and group A after trestmenL Serum concentration of ClIP reduced in both groups after treatment, as compared to that before treatment, but reduced more significantly in group B than that in group A. Serum concentration of ALB increased slightly in both groups after treatment, more in group B than that in group A, as compared to that before treatment. However, no significant difference in occurrence of ventilator-associated pneumonia ( VAP ) was found between the two groups (44.4% vs. 17.7%, P > 0.05 ) . Length of mechanical ventilation and stay at EICU were significantly shorter in group B than those in group A [ ( 8.4 ± 2.7 ) d vs. ( 5.1 ± 1.6 ) d, P < 0.05 ; and ( 16.1±2.9) d vs. ( 11.7 ± 2. 3 ) d, P < 0.01 ], and overall cure rates improved significantly in group B than that in group A (76.5% vs. 44.4%, P < 0.05 ), but no difference in case-fatality ratio was found between the two groups (33.3% vs. 23.5%, P >0.05).Conclusions Immune status of patients with SCAP could be improved by thymosin a1, with a shorter length of mechanical ventilation and stay at EICU, to promote their recovery.

Effects of Shengmai drink(生脉饮) on nitric oxide and inducible nitric oxide synthase in rats with acute lung injury induced by lipopolysaccharide / 中国中西医结合急救杂志

Objective: To investigate the effects of Shengmai drink(生脉饮) on nitric oxide(NO) and inducible nitric oxide synthase(iNOS) in rats with acute lung injury(ALI) induced by lipopolysaccharide(LPS).Methods: The male Wistar rats were randomly divided into four groups: control group,ALI group,Shengmai drink group and dexamethasone group.LPS was injected into the sublingual vein of rats to prepare ALI models.Macroscopic and histopathological examinations were performed and biological indexes including lung wet weight/dry weight,the ratio of neutrophils and protein content in the bronchoalveolar lavage fluid((BALF),) pulmonary vascular permeability and pulmonary alveolar permeability index were detected.(Meanwhile),the activities of serum NO and lung tissue homogenate iNOS were measured.Results: Lung histopathological examination showed the injury and cellular infiltration in the pulmonary stroma and alveoli were more prominent in the ALI group than that in the control group.Lung wet weight/dry weight,the(ratio) of neutrophils and protein content in BALF,pulmonary alveolar(permeability) index,pulmonary vascular(permeability) were significantly increased,NO and iNOS were also markedly elevated in the ALI group((P