Influence of clinical nutritional support on the effects of mechanical ventilation / 中华危重病急救医学

Objective To study the influence of clinical nutritional support on the effects of mechanical ventilation (MV), and to find the factors affecting the outcome of patients undergoing MV. Methods A case-control study was conducted. The clinical data of 235 patients undergoing MV admitted to intensive care unit (ICU) of Tongde Hospital of Zhejiang Province from January 2015 to June 2017 were retrospectively analyzed. The patients were divided into two groups according to whether weaning successfully within 7 days. The clinical data of patients in the two groups were collected including gender, age, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, underlying disease, nutritional indicators, nutritional support, and complications. The outcome of withdrawal within 7 days was served as a dependent variable, all observed indicators were served as independent variables, and Logistic regression analysis was carried out to screen the influencing factors of the weaning results within 7 days. Results 235 patients undergoing MV were enrolled, 128 patients were successfully withdrawn within 7 days, and 107 were unsuccessfully withdrawn. Compared with the successful weaning group, the patients of weaning failure group were older, and had higher APACHEⅡ score and lower albumin (Alb) and hemoglobin (Hb), more patients with internal medical underlying diseases and receiving parenteral nutrition (PN) and mixed nutrition, and the incidences of secondary infection, vomiting, abdominal distension, abnormal bowel sound, gastric retention, and diarrhea were higher. However, there was no statistical significance in gender between the two groups. The variables of statistical significance in univariate analysis were enrolled in the multifactor analysis model showing that age [odds ratio (OR) = 1.269, 95% confidence interval (95%CI) = 1.119-1.439, P < 0.001], APACHEⅡ score (OR = 1.643, 95%CI = 1.423-1.897, P < 0.001), internal medical underlying diseases (OR = 6.298, 95%CI = 4.012-9.887, P < 0.001), secondary infection (OR = 8.323, 95%CI = 2.568-26.975, P < 0.001), abdominal distension (OR = 3.368, 95%CI = 1.586-7.152, P = 0.002), abnormal bowel sounds (OR = 2.856, 95%CI = 1.215-6.713, P = 0.017), gastric retention (OR = 1.996, 95%CI = 1.183-3.368, P = 0.010), diarrhea (OR = 3.035, 95%CI = 1.337-6.890, P = 0.008) were risk factors for unsuccessful weaning,and compared with PN, enteral nutrition (EN; OR = 0.191, 95%CI = 0.098-0.372, P < 0.001) and mixed nutrition (OR = 0.375, 95%CI = 0.150-0.938, P = 0.037) were protective factors of successful weaning. The gender, Alb and Hb before and after MV, vomiting, gastrointestinal hemorrhage were not associated with weaning outcome within 7 days. Conclusions Elder, high APACHEⅡ score, internal medical underlying diseases, or secondary infection, abdominal distension, abnormal bowel sounds, gastric retention, diarrhea were risk factors of weaning failure within 7 days in patients undergoing MV. Compared with PN, EN and mixed nutrition were protective factors for successful weaning. For patients undergoing MV, EN should be performed early in the case of full recovery, hemodynamic stability, and serious metabolic disorders.

Progress in diagnosis and treatment of bronchiolitis / 中华实用儿科临床杂志

Bronchiolitis is the most common lower respiratory tract disease in infants younger than 2 years of age.Many viruses can cause bronchiolitis,however,respiratory syncytial virus is most common etiology.The pathological characters are acute inflammation,edema,necrosis of epithelial cells and mucus productions increased.Diaguosis of bronchiolitis is based on clinical signs and symptoms and a thorough history and physical exam.The disease severity and risk factors for severe disease need to be assessed.The treatment of bronchiolitis has been largely supportive.Continuous positive airway pressure treatment has been accepted for severe cases.Palivizumab prophylaxis is probable in high risk infants.Hand hygiene,decreasing tobacco smoke and breastfeeding are considered as efficient preventive methods.

Effect of Methimazole and Propylthiouracil on beta-2 globulin and thyroid hormone levels in the treatment of hyperthyroidism / 中国生化药物杂志

Objective To compare the effects of methimazole and propylthiouracil on 2-beta globulin and thyroid hormone level in patients with hyperthyroidism.Methods90 cases of patients with hyperthyroidism were treated in our hospital from May 2013 to May 2015, and randomly divided into control group and observation group, 45 cases in each group, the control group was treated with propylthiouracil, the observation group was treated with methimazole, and the level of thyroid hormone, the blood and urine β2-globulin, the occurrence of adverse reactions were compared between the two groups during before&after treatment.ResultsCompared with before treatment, blood, urine β2-globulin content of two groups were significantly decreased, and the blood, urine beta β2-globulin content of the observation group significantly lower than the control group (P<0.05);compared with before treatment, FT3 and FT4 levels of two groups were significantly decreased during 1,2,3 months after treatment (P<0.05), TSH levels were significantly increased(P<0.05), and the observation group was better than the control group(P<0.05);During treatment, the incidence of adverse reactions in the two groups was no significant difference.ConclusionThere is significantly effect of methimazole in the treatment of hyperthyroidism with methimazole, it can effectively reduce the β2-globulin content, and regulating thyroid hormone levels in the body, it is safe worthy of promotion and application.

Detection of Mig in serum and CXCR3 on lymphocytes of peripheral blood of infants with bronchiolitis / 临床儿科杂志

ObjectiveTo explore the expression of monokine induced by interferon- γ(Mig) in serum and chemokine receptor 3(CXCR3)on lymphocytes of peripheral blood in children with bronchiolitis.MethodsIn this study, 55 patients with bronchiolitis in our hospital were randomly recuited, and were divided into two groups: atopic group and non-atopic group. Of the same age 26 healthy children had been enrolled randomly as control group. The level of CXCR3 expression (CD183) on lymphocytes of peripheral blood was detected by lfow cytometry in all children. The level of Mig in serum was assayed by ELISA.ResultsThe level of CD183 expression on the CD3+CD4+T lymphocytes in atopic group and non-atopic group(16.39±4.13%,14.39±3.74 %)were higher than that of control group(11.17±3.13%,P<0.05),CD183+CD4+/CD4+% in atopic group were higher than that in non-atopic group(P<0.05). The level of CD183 expression on CD3+CD8+T lymphocytes in atopic group and non-atopic group(67.18±10.57 %, 61.44±11.46 %)were higher than that of control group(51.19±5.42 %, P<0.05),CD183+CD8+/CD8+% in atopic group were signiifcantly higher than that in non-atopic group(P<0.05). The level of Mig in serum of children with bronchiolitis in atopic group and non-atopic group(99.67±35.77ng/L, 120.28±32.28ng/L)were signiifcantly higher than that in control group(63.90±15.82 ng/L,P<0.05). The level of Mig in non-atopic group was higher than that in atopic group, there was signiifcant difference(P<0.05).ConclusionsMig and CXCR3 are involved in the pathogenesis of bronchiolitis, and CXCR3 may relate to allergic factors.

Clinical analysis of heterozygous ABCA3 mutations in children / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the association of ATP-binding cassette transporter A3 (ABCA3) gene mutations with severe neonatal respiratory distress syndrome (NRDS) and lung disease in children.</p><p><b>METHOD</b>Thirty-eight children hospitalized with respiratory disorders in Children's Hospital of Chongqing Medical University from January 2010 to December 2011 were screened. Two mutations (E292V, G1221S) in the ABCA3 gene were identified. Interstitial lung disease (ILD) was present in 10 cases, NRDS was found in 23 and congenital pulmonary dysplasia in 5 cases. There were 24 males and 14 females, with an age range of 1 hour to 15 years. Genomic DNA was prepared from blood samples and sequences were analyzed by polymerase chain reaction (PCR). Clinical feature, imaging characteristics and the results of gene detection were retrospectively analyzed.</p><p><b>RESULT</b>Four cases with ABCA3 gene mutations were found; 2 patients (case 2 and case 4) had the heterozygous mutation of ABCA3 E292V. One was a 3-hour-old girl and another was a 52-day-old boy, 2 patients (case 1 and case 4) had the heterozygous mutation of ABCA3 G1221S. One was a 78-day-old boy and another was a girl, 15 years and one month old. The family history was negative for respiratory disease. Three patients (case 1, 2, 4 ) had NRDS and 2 (case 1, 2) of them were premature. One patient (case 3) had normal growth and development. She was diagnosed clinically as interstitial lung disease (ILD) after admission. The clinical outcomes of 4 cases were various. Case 1 had recurrent wheezing and inhaled corticosteroid was needed. Case 2 died because she failed to wean from mechanical ventilator. Case 3 was discharged with improvement but lost to follow-up. Case 4 grows normally.</p><p><b>CONCLUSION</b>Genetic variants within ABCA3 may be the genetic causes or background of a contributor to some unexplained refractory NRDS, and chronic lung disease developed in latter childhood. Identification of ABCA3 genetic variants in NRDS infants is important to offer genetic counseling, as well as early prognosis estimation and intervention in pediatric chronic lung disease.</p>

Role of CREB in LPS-induced injury of RPMVEC / 中国药理学通报

Aim To investigate the role of cAMP re-sponse element binding protein (CREB)in the injury of rat pulmonary microvascular endothelial cell (RPM-VEC)induced by LPS.Methods RPMVECs were i-solated and cultured in vitro,Western-blot was used to assay phosphorylation levels of CREB.Endothelial per-meability was determined by measuring the influx of Evans blue-labeled albumin across endothelial mono-layer.Results LPS increased CREB phosphorylation at Ser 1 3 3 in RPMVEC in a time-dependent manner , peaked at 30 min,but still higher at 120 min compared with basal control group.Pretreatment of cells with PKA inhibitor V5681 nearly suppressed the CREB phosphorylation stimulated in the presence of LPS,and the monolayer permeability of PMVEC was significantly increased. Conclusions LPS rapidly induces the phosphorylation of CREB in RPMVEC,and PKA me-diates the process.During the process of LPS-stimula-ted injury of RPMVEC,phosphorylation of CREB may play a protective role.

The study between temporal bone HRCT and operations in congenital abnormality of external and middle ear / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#We explore the deformity degrees of external ear, mastoid process, tympanic cavity and auditory ossicle by the HRCT features of bilateral and unilateral patients of congenital abnormality of external and middle ear for preoperative analysis and selection for surgical approaches.@*METHOD@#Twenty-nine patients were enrolled in our study, and HRCT were performed on all patients. There were 23 unilateral ears deformity (13 right and 10 left), 6 patients with bilateral ears deformity in the study group. Nineteen patients (19 ears) were treated with operations.@*RESULT@#The deformity degree of auricle was correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. We got data of shortest distance from tympanic cape to atresia board in HRCT, (0.59 +/- 0.13)cm in comparison group, (0.45 +/- 0.19)cm in unilateral deformity group, (0.32 +/- 0.12)cm in bilateral deformity group, and there were significant differences compared the two deformity groups with the comparison group. There were 1 ear with normal auditory ossicle (2.86%), 5 ears with fixation of stapes foot board (14.29%), 3 ears with no auditory ossicle (8.57%); 26 ears with malleus and incus abnormality (74.29%). Abnormality of malleus was always concomitant with that of incus. Degeneration of malleus, the joint amalgamation of malleus and incus were discovered mostly in this research.@*CONCLUSION@#The deformity degree of auricle is correlated with that of external auditory meatus, and mastoid process develops bad aeration extent with bad tympanic cavity development in 35 ears in our research. The shortest distance from tympanic cape to atresia board in HRCT in unilateral ears deformity group are shorten 0.15 cm in that of comparison group. And that of bilateral ears deformity group are shorten 0.25 cm in that of comparison group. The main abnormality of auditory ossicle in our research present in both malleus and incus, and degeneration of malleus and the joint amalgamation of malleus and incus are main types.

Analysis on scores of epidemiologic exam and investigation on applications of course content in practice / 中华医学教育探索杂志

Objective To provide references for epidemiology teaching reform by investigating scores of epidemiological exam and applications of epidemiologic course content in practice.Methods The epidemiological exam scores of students majoring in preventive medicine from 2004 to 2007 grade were statistically analyzed and questionnaire survey was carried out among students of 2006 and 2007 grade.Results The skewness of epidemiological scores from four garades were negative skew,and the kurtosis of 2007 grade was positive,the others were negative;there were statistical differences among the average scores of different grades(F=2.70,P＜0.05);there were statistical differences between 2004 grade and other grades in passing rate(x2=7.94,P＜0.008).Most of the contents applied in survey were prevention and control of infectious deseases(16.0％),prevention and control of chronic diseases(13.9％),surveillance of diseases(11.8％).Conclusions Epidemiology teaching reform should be enhanced and should integrate theory with practice.

Effect of the application of continuous cenous venous hemofiltration on pulmonary vascular permeability in the early stage of septic shock / 中华急诊医学杂志

Objective To investigate the effect of continuous veno-venous hemofiltration (CVVH) on pulmonary vascular permeability in the early stage of septic shock.Methods Fifty-one patients of septic shock admitted in intensive care unit of the First Affiliated Hopsital of Medical College,Zhejiang University between June 2010 and December 2011 were randomized into two groups by simple random method.Routine treatment was carried out to patients in group A,and routine treatment plus CVVH to patients in group B in the first 72 hours.Repeated respiratory mechanic hemodynamic measurements were done at baseline (Tb) before treatment,at 48 hours (T48) and 72 hours (T72) after the treatment.Pulmonary compliance (Cst),platform pressure (Pplat),oxygenation index (PaO2/FiO2),extravascular lung water index (EVLWI) and E-selectin determined at each time point were recorded in two groups.Results (1) Pplat were decreased significantly after treatment in two groups,and the Pplat in group B were all lower than those in group A at T48 and T72 (t =2.215,P ＜ 0.05 ; t =4.266,P ＜ 0.01).Cst were elevated after treatment in two groups,and Cst in group B were all higher than those in group A at T48 and T72 (t =2.516,P ＜0.05 ; t =3.052,P ＜ 0.01).(2) Compared to before treatment,PaO2/FiO2 increased significantly after treatment in two groups,and PaO2/FiO2 in group B were all higher than those in group A at T48 and T72 (t =2.732,P ＜0.01 ; t =3.511,P ＜0.01).(3) EVLWI were decreased significantly after treatment in two groups,and the EVLWI in group B were all lower than those in group A at T48 and T72 (t =2.597,P ＜0.05; t =2.125,P ＜ 0.05).ITBVI,CI,SVRI and MAP did not change over time in two groups compared with those at Tb (all P ＞ 0.05).(4) E-selectin were decreased significantly after treatment in two groups,and the E-selectin in group B were all lower than those in group A at T48 and T72 (t =2.154,P ＜0.05 ; t =3.581,P ＜ 0.01).Conclusion CVVH in early stage of septic shock can improve pulmonary vascular permeability and oxygenation,increase Cst,and decline EVLWI,with neither increased hemodynamics.

Mechanical environment of rotating bioreactor and its effect on cell growth / 生物医学工程学杂志

In this paper is presented an analysis of the mechanical effect of horizontal rotating bioreactor on cell culture. Getting the microgravity of the bioreactor and the shear stress on canine mesenchymal stem cells (cMSCs) with theoretic calculating model and differential equations, we have validated the density,growth rate and modality of cultured cell by scanning electron microscopy. The horizontal rotating bioreactor which we developed could create the mechanic environment of microgravity (K<8.38 X 10(-2))and low shear stress(r<1.62 dyn/cm2) in theory. The results of scanning electron microscopy indicated that the cells' growth-speed, quantity and modality in bioreactor were better than those of cells cultured in static 24-well plate. The mechanical environment of the rotating bioreactor is propitious for keeping better modality and more rapid proliferation of cMSCs. The rotating bioreactor is a novel approach and technique it is superior to static culture.

Clinical Study on Motor-development Tuina Therapy for Infantile Cerebral Palsy / 针灸推拿医学（英文版）

Objective: To quantify the effect of motor-developmental Tuina therapy on 61children with cerebral palsy. Methods: All the children received the motor-developmental Tuina therapy for 20 min each time, 3 to 6 times per week. The gross motor functions of the children were evaluated by GMFM 66. The baseline period evaluations in 15 children and follow-up period evaluations in 26 children were performed. Results: GMFM 66 score significantly increased at the end of treatment period (P<0.001). The GMFM 66 score changes per month in treatment period was significantly greater than those of both baseline period and follow-up period (P<0.001). Conclusion: The effect of motor-developmental Tuina therapy was notable on children with cerebral palsy. Continuous progress of the gross motor functions in these children may be obtained by continuous therapy.

Applications of Gross Motor Function Measure Scale and Peabody Developmental Measure Scale-Gross Motor in the evaluation of children with cerebral palsy / 中国康复理论与实践

@#Objective To compare the advantages of two gross motor measure scales, Peabody Developmental Measure Scale Gross Motor (PDMS-GM) and Gross Motor Function Measure Scale (GMFM), in the evaluation of children with cerebral palsy (CP).Methods The gross motor functions of 29 CP children, 0-3 years old, were evaluated three times using PDMS-GM and GMFM respectively. The improvement percentile each month of PDMS-GM and GMFM were compared by t test.Results There was significant difference between the improvement percentile each month of PDMS-GM and GMFM. Conclusion The GMFM was more sensitive than PDMS-GM in the evaluation of CP children especially in the evaluation of treatment effect.

Establishing animal model of passive transferred myasthenia gravis in C57BL/6 mice aged 4 to 5 weeks by acetylcholine receptor monoclonal antibody / 第三军医大学学报

Objective To establish an animal model of passive transferred myasthenia gravis(PTMG) in C57BL/6 mice aged 4 to 5 weeks with nicotinic acetylcholine receptor monoclonal antibody-mAb35 so as to decide the effective dose of mAb35 required to induce PTMG and to supply animal model for further study of the pathogenesis and immunotherapy of human MG.Methods The C57BL/6 mice aged 4 to 5 weeks in the experimental group were divided into three subgroups(E1,E2,E3),injected intraperitoneally(i.p.) with 0.2 ml of Ringer's buffer solution containing 0.5,1.0 or 1.5 mg/kg capital monoclonal antibody mAb35 of acetylcholine receptor respectively.The control group(N) were injected i.p.with 0.2 ml of Ringer's buffer solution without mAb35.To decide whether the model was successful,the clinical symptoms,ultrastructural changes of the mice as well as pharmacological and electrophysiological evaluation were observed and the serum levels of acetylcholine receptor antibody(AChRAb) were detected.Results All mice in the experimental groups were induced of clinic symptoms of myasthenia.The features in pharmacology,electrophysiology,ultrastructure and increased level of acetylcholine receptor antibody were in accordance with those of MG patients.Conclusion The model of PTMG can be successfully induced in C57BL/6 mice with mAb35 at effective dose of 1.0 mg/kg.The method is convenient and reliable.A fine animal model is established for experimental study of myasthenia gravis in children.