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Objective:To observe the epidemiology, clinical manifestations, laboratory tests, imaging findings, treatment and prognosis of patients with corona virus disease 2019.Methods:Clinical data of 109 patients with suspected and definite corona virus disease 2019 admitted to the Sixth Hospital of Wuhan from December 24, 2019 to January 28, 2020 were retrospectively analyzed. Statistical analysis was performed by using t test or chi-square test. Results:Among the 109 patients, 54(49.5%) patients had definite contact history. Among the 109 patients, 104(95.4%) presented with fever, 37(33.9%) with headache, 78(71.6%) with general pain, 88(80.7%) with fatigue and poor appetite, 23(21.1%) with diarrhea, 94(86.2%) with coughing, 23(21.1%) with shortness of breath, 57(52.3%) with palpitation, 45(41.3%) with chest distress, 4(3.7%) with chest pain, 40(36.7%) with lung rales. Forty-two cases (38.5%) had leukocyte count <4×10 9/L, 58 cases (53.2%) had lymphocyte count <1.5×10 9/L, 27 cases (24.8%) had hemoglobin <120 g/L, 37 cases (33.9%) had lactic dehydrogenase (LDH) >230 mmol/L, 29 cases (26.6%) had pro-brain natriuretic peptide>300 ng/mL, 87 cases (79.8%) had hypersensitive C reactive protein>10 mg/L, 26 cases (23.9%) had D-dimer>0.5 mg/L, 35 cases (32.1%) had coagulation disorder. On admission, chest computed tomography showed that 27 cases (24.8%) of pneumonia were unilateral, 82 cases (75.2%) were bilateral, and most of them were ground glass. The leukocyte counts, LDH, pro-brain natriuretic peptide and D-dimer of severe/critical cases ((11.33±4.87)×10 9/L, (527.51±260.87) mmol/L, (722.88±189.56) μg/L, (4.24±1.89) mg/L, respectively) were all higher than those of common cases ((4.02±1.49)×10 9/L, (159.75±30.31) mmol/L, (428.22±124.76) μg/L and (0.41±0.22) mg/L, respectively), while the lymphocyte count of severe/critical cases ((0.60±0.17)×10 9/L) was lower than common cases ((1.13±0.43)×10 9/L) ( t=11.36, 11.33, 9.81, 2.81 and 7.77, respectively, all P<0.05). The comprehensive treatment included antiviral drugs, prevention of bacterial infection and supportive treatment, and glucocorticoid and respiratory support treatment were administrated when necessary. Conclusions:The corona virus disease 2019 is characterized by highly infectious, rapid progression, and diverse clinical and imaging features. Early diagnosis and active comprehensive treatment could improve the prognosis and reduce the mortality.
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Pay-for-performance(P4P) is the third stage of payment evolution in the United States. As of 2010, the Centers for Medicare and Medicaid Services launched a series of P4P programs, including hospital value-based purchasing(HVBP) program. This paper introduced the background and eligibility of HVBP in the United States, focusing on the contents and calculation methods of HVBP as references for the reform of payment methods in China.
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Pay-for-performance(P4P) is the third stage of payment evolution in the United States. As of 2010, the Centers for Medicare and Medicaid Services launched a series of P4P programs, including hospital value-based purchasing(HVBP) program. This paper introduced the background and eligibility of HVBP in the United States, focusing on the contents and calculation methods of HVBP as references for the reform of payment methods in China.
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Objective To investigate the effect and mechanism of adenosine monophosphate activated protein kinase(AMPK) activation on insulin resistance and inflammatory factors in rats with chronic intermittent hypoxia.Methods The chronic intermittent hypoxia rat model was established to simulate the obstructive sleep apnea syndrome (OSAS),and the 36 male SD rats were divided into the normal oxygen control group,2-week intermittent hypoxia group and 8-week intermittent hypoxia group.The levels of rat inflammatory medium,serum lipid,adiponectin,leptin and insulin resistance in different hypoxia degrees of rats by the action of AMPK agonist and AMPK inhibitor were observed,and the levels of AMPK and GLUT4 in rat adipose tissue were monitored and statistically analyzed.Results The levels of total cholesterol,triglyceride,TNF-α,IL-6,IL-2,NF-κB and HIF-1 in the intermittent hypoxia rats were significantly higher than those in the control group(P＜0.05);while the levels of adiponectin,leptin and insulin resistance index were significantly lower than those in the control group(P＜0.05).The release of inflammatory factors in rats after using AMPK activator was decreased,the contents of adiponectin and leptin were increased,blood lipid and insulin resistance were improved compared with before,and the expression level of GLUT4 was increased.But after treatment by using AMPK inhibitor,the levels of inflammatory factors,adiponectin and leptin were increased,insulin resistance was more severe,and the expression level of GLUT4 protein was also further decreased.Conclusion AMPK can reduce the release of inflammatory mediators,promotes the release of adiponectin and leptin,increases the level of GLUT4,improves insulin resistance,thus regulates the energy metabolism and inflammatory mediators,which provides a new idea and target for clinical treatment of OSAS related diseases.
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Objective To investigate the effect of noninvasive ventilator therapy on serum C-reactive protein (CRP), endothelin-1 (ET-1) and tumor necrosis factor-α (TNF-α) levels in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and its clinical significance. Methods One hundred cases of moder-ate and severe OSAHS patients were selected by the method of parallel opening. All of the patients were given health education requirement , quitting smoking and wine , low fat diet and exercise to lose weight and other con-ventional treatment. The patients were randomly divided into the treatment group of 42 cases with noninvasive ventilator treatment , 44 cases treated with conventional treatment , to observe the changes of serum CRP , ET-1 and TNF-α levels and PSG parameters after 12 weeks in two groups. Results Apnea hypopnea index (AHI), oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO2), and the average oxygen saturation MSpO2 in OSAHS patients were significantly improved after treatment (P < 0.01), but the degree of improvement in the two groups after treatment was significantly higher than the control group (P < 0.01). Plasma CRP, ET-1 and TNF-α levels in the two groups after treatment were lower than before treatment (P < 0.05 or P < 0.01), but the treatment group was significantly higher than that of the control group ( P < 0 . 05 or P < 0 . 01 ) . Conclusion Noninvasive ventilator therapy in improving the OSAHS monitoring data of patients with PSG can effectively reduce the serum CRP, TNF-α, ET-1 level, reduce the body′s inflammatory reaction.
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This study compared the efficacy and safety of tiotropium bromide inhalation powder (spiriva) and doxofylline oral tablet (doxofylline) in the treatment of chronic obstructive pulmonary disease (COPD). A multi-center, randomized, double-blind, double-dummy, parallel-controlled study involved 127 eligible stable moderate to severe COPD patients treated with inhaled tiotropium dry powder (18 μg/day) or oral doxofylline tablets (0.2 g/time, 2 times a day) for 12 and 24 weeks. Before and after treatment for 12 weeks and 24 weeks, respectively, pulmonary function, 6-min walking distance and dyspnea index were recorded. The results showed that in both tiotropium group and doxofylline groups, after 12-week treatment, FEV(1), FEV(1)/FVC% and 6-min walk distance were significantly higher than those before the medication, while dyspnea index decreased as compared with that before treatment. After 24-week treatment, a slight improvement in the measures was observed as compared with that of 12-weeks treatment, but the difference was not statistically significant. With both 12-week and 24-week treatment, the effect of tiotropium was slightly better than that of doxofylline tablets, with the difference being statistically insignificant. The major adverse events in the tiotropium group and doxofylline group were observed in 9 cases (9.9%) and 12 cases (12.9%), respectively, and no statistically significant difference was found between them. We are led to conclude that both tiotropium at 18 μg a day and doxofylline tablets at 0.2 g/day (two times a day) are effective and safe for the treatment of COPD.
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Objective To study the relationship between the expression of NKG2D ligands and oxidative stress,and to analyze the effect of oxidative stress on the function of NK cells. Methods Tumor cells were cultured and exposed to hydrogen peroxide to develope an oxidative stress model. Then to detect the expression of NKG2D ligands in cells by Real-time PCR and Flow Cytometry. The cytotoxicity of NK cells to tumor cells was detected and compared by CCK-8 kit before and after oxidative stress. Results The expression of NKG2D ligands was induced by oxidative stress,however the NKG2D ligands induced was variable. The up-regulation of NKG2D ligands increased the cytotoxicity of NK cells efficiently,and this effect was blocked by anti-NKG2D antibody. Conclusion The expression of NKG2D ligands can be selectively induced by oxidative stress on tumor cells,and the improvement of the cytotoxicity of NK cells may enhance the immune responses accordingly.
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Objective To evaluate the diagnostic value of endoscopic ultrasonography (EUS) guided fine needle aspiration (FNA) in patients with suspected chronic pancreatitis. Methods Forty seven patients including 28 males and 19 females (mean age 52.3 years, range 47～69 years) were enrolled into study. The diagnosis of chronic pancreatitis or pancreatic malignancy was based on results of BT PABA test, Sudan Ⅲ staining of stool and abdominal CT scanning, the mean course of disease was 6.3 year (range 3 21 year). Pancreatic tissue specimens were harvested by EUS guided FNA and investigated by histopathological study. Results Totally 31 cases (31/47, 69%) were diagnosed as chronic pancreatitis based on histopathological examination of the specimens taken by EUS FNA. Conclusion EUS FNA had the potential clinical value in diagnosis of chronic pancreatitis.