Investigation and analysis of late reporting and under-reporting of occupational diseases from 2018 to 2020 in China / 中华劳动卫生职业病杂志

Objective: To understand the late reporting and the under-reporting of occupational disease from 2018 to 2020 in China and analyze the causes, so as to provide scientific evidence for improving the quality of occupational disease reports in China, timely acquiring the incidence of occupational disease, and assessing the occupational hazards. Methods: From May to December 2021, A total of 320 occupational disease diagnostic institutions were selected for investigation. The original documents of occupational disease diagnosis cases from 2018 to 2020 were compared with the online reported cases, and late reported and under-reported cases of occupational disease were analyzed. Results: A total of 32207 diagnosed cases from 2018 to 2020 were investigated, including 28934 confirmed cases and 3273 cases without occupational disease. The overall late reported rate and under-reported rate of confirmed cases were 20.2% and 2.1%, respectively. There were significant differences in the rate of late reporting and under-reporting of occupational diseases in different regions and different types of diagnostic institutions (P<0.001). The southwest region had the highest rates of late reporting and under-reporting, 61.6% and 7.9% respectively. The late reported rate of all kinds of occupational diseases was about 15.0%, and the under-reported rate was from 1.5.0% to 5.0%. Conclusion: At present, the phenomenon of late reporting and under-reporting occupational diseases is still obvious. It is necessary to strengthen the inspection of occupational disease reporting, improve the quality of occupational disease reporting, and provide scientific basis for the formulation of occupational disease prevention and control policies.

Aesthetic reconstruction of distal segment of finger with modified second toe nail flap without sacrifice a toe / 中华显微外科杂志

Objective:To explore the method and effect of aesthetic reconstruction of distal segment of finger with modified second toe nail flap while retains the full length of the second toe.Methods:From April 2018 to June 2020, 16 patients with degloving injury of distal segment of fingers were treated. The patients were 11 males and 5 females aged 18 to 45 years in an average of 29 years. All injuries were degloving injury of the distal segment of finger, including 5 index fingers, 7 middle fingers, 3 ring fingers and 1 little finger. The time from injury to operation was 0.5-3.0 hours, with an average of 1.5 hours. The second toe nail flap was used for the reconstruction. After the dorsal flap of the second toe was rotated to the plantar side of the foot, the donor site defect was repaired by a skin graft. The regular follow up reviews were carried out.Results:All 16 flaps survived except 1 flap had necrosis and underwent toe amputation of the distal segment of the second toe. All patients entered follow-up for 4-12 months, with an average of 5.7 months. The blood supply of all flaps was good. After the flaps having atrophied, they were equivalent to the diameter of the body of normal fingers with the TPD at 6.5(4-10) mm; All patients returned to work. According to the Evaluation Standard of Upper Limb Function of Chinese Hand Surgery Society, 13 cases were graded as excellent, 2 were good and 1 was fair.Conclusion:The techniques of modified second toe toenail flap in aesthetic reconstruction of the distal segment of a finger can effectively restore the length and aesthetic appearance of the affected finger, without sacrificing the donor toe. Clinical application of it should be promoted.

Clinical Observation on Wagner 2-3 Diabetic Foot Ulcer Treated by TCM External Treatment Scheme for Euriching Pus for Tissue Growth / 中国实验方剂学杂志

ObjectiveTo observe the clinical efficacy and safety of traditional Chinese medicine （TCM） external therapeutic protocol of enriching pus for tissue growth （EPTG） in the treatment of Wagner 2-3 diabetic foot ulcer. MethodThe randomized controlled trial （RCT） design was adopted. Patients receiving basic treatment were divided into the EPTG group and the control group （debridement and change of nano-silver medical antibacterial dressing）. Ulcer healing rate， ulcer area， ulcer depth， TCM symptom score， visual analogue scale（VAS）， transcutaneous partial pressure of oxygen， wound blood flow， inflammatory factors ［C-reactive protein （CRP）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α）］， growth factors ［vascular endothelial growth factor （VEGF）， transforming growth factor-β1 （TGF-β1）， and fibroblast growth factor-β （FGF-β）］， adverse events， and outcome events of the two groups before and after treatment were observed. ResultCompared with the conditions before treatment， the ulcer healing rate， ulcer area， ulcer depth， TCM symptom score， VAS score， transcutaneous partial pressure of oxygen， wound blood flow， CRP， IL-6， TNF-α， VEGF， TGF-β1， and FGF-β were significantly improved （P<0.01）. In terms of the improvement in the ulcer healing rate， ulcer area， ulcer depth， VAS score， transcutaneous partial pressure of oxygen， wound blood flow， CRP， IL-6， TNF-α， VEGF， TGF-β1， and FGF-β， the EPTG group was superior to the control group （P<0.01）. There were no statistically significant differences in adverse events and outcome events between the two groups. ConclusionThe TCM external therapeutic protocol of EPTG is safe and effective in the treatment of Wagner 2-3 diabetic foot ulcer. It can greatly reduce the area and depth of diabetic foot ulcer， improve the ulcer healing rate and TCM symptom score， relieve the pain of patients， and improve the microcirculatory blood supply in the local ulcer. Its mechanism of action may be related to the reduction of the local inflammatory response of the wound and the improvement of the proliferation of fibroblasts and vascular endothelial cells.

A novel cyclic peptide targeting LAG-3 for cancer immunotherapy by activating antigen-specific CD8 T cell responses

PD-1 and CTLA-4 antibodies offer great hope for cancer immunotherapy. However, many patients are incapable of responding to PD-1 and CTLA-4 blockade and show low response rates due to insufficient immune activation. The combination of checkpoint blockers has been proposed to increase the response rates. Besides, antibody drugs have disadvantages such as inclined to cause immune-related adverse events and infiltration problems. In this study, we developed a cyclic peptide C25 by using Ph.D.-C7C phage display technology targeting LAG-3. As a result, C25 showed a relative high affinity with human LAG-3 protein and could effectively interfere the binding between LAG-3 and HLA-DR (MHC-II). Additionally, C25 could significantly stimulate CD8 T cell activation in human PBMCs. The results also demonstrated that C25 could inhibit tumor growth of CT26, B16 and B16-OVA bearing mice, and the infiltration of CD8 T cells was significantly increased while FOXP3 Tregs significantly decreased in the tumor site. Furthermore, the secretion of IFN- by CD8 T cells in spleen, draining lymph nodes and especially in the tumors was promoted. Simultaneously, we exploited T cells depletion models to study the anti-tumor mechanisms for C25 peptide, and the results combined with MTT assay confirmed that C25 exerted anti-tumor effects CD8 T cells but not direct killing. In conclusion, cyclic peptide C25 provides a rationale for targeting the immune checkpoint, by blockade of LAG-3/HLA-DR interaction in order to enhance anti-tumor immunity, and C25 may provide an alternative for cancer immunotherapy besides antibody drugs.

Repair of finger pulp defect with free second toe pulp flap anastomosed with palmar vein / 中华显微外科杂志

Objective:To explore a surgical procedure of reconstruction finger pulp defect with free toes plantar flap with vascular anastomosis of toe-finger artery and plantar-palmar vein of finger.Methods:From April, 2018 to November, 2019, 15 patients with finger pulp defect were repaired by transplantation of the second toe pulp. In the procedure, the plantar vein of the toe and palmar vein of the finger were anastomosed. The artery and nerve of the toe and finger were anastomosed. The flap size was 0.8 cm×0.5 cm-1.0 cm×1.2 cm. The donor site was primary closed without deformity and other complication.Results:All flaps survived without vascular crisis. The mean followed-up period was 5.7 (range 3-9) months. The flaps had good blood flow, soft texture and good elasticity. Three months after surgery, touch sensation was partly recovered in some patients, and while pain was partly recovered in some patients 4-6 months after surgery. There was no deformity and other complication in the donor site. The donor sites of the foot had good appearance and normal walking function.Conclusion:The free toe plantar flap anastomosed with palmar vein can repair the digital pulp defect without dissecting the dorsal vein of digital (toe), and the donor sites can be primary sutured without deformity and other complications. The surgery operation is simple with satisfactory clinical effect.

Application of 3D printed head film fixation technology in radiotherapy for head tumors / 中华放射肿瘤学杂志

Objective:To customize the individualized 3D printed head film for patients with head tumors undergoing radiotherapy, and to evaluate the physical properties of the material and the precision of this technology compared with the thermoplastic head film.Methods:The 3D printed head film and thermoplastic head film were placed on the solid water surface, and the depth and surface dose were measured at 5 cm by ionization chamber and film, respectively. Thirty patients with head tumors receiving radiotherapy were randomly divided into the control and experimental groups. The patients were fixed with thermoplastic head film and 3D printed head film. The translational and rotational errors in the x, y and z direction were obtained by CBCT.Results:The radiation attenuation rate of two materials at the depth of 5 cm was less than 1%. The dose of thermoplastic head film in the surface position was increased by 27%, and increased by 18% in the 3D printed head film. In two groups, 116 sets of setup errors were collected. The average translational setup errors in the control and experimental groups were 1.29 mm and 1.16 mm, 1.42 mm and 1.24 mm, 1.38 mm and 1.16 mm, respectively, and the average rotational setup errors were 1.29°and 1.08°, 1.02°and 0.96°, 1.01°and 1.00°, respectively. The translational setup errors in the y and z direction and rotational setup errors in the x direction significantly differed between the control and experimental groups (all P<0.05), but no statistical significance was found in the other direction (all P>0.05). Conclusion:The 3D printed head film fixation meets the precise setup requirements of modern radiotherapy, which deserves further application in clinical trials.

Establishment and the effectiveness analysis of a comprehensive management system for preventing and curing venous thromboembolism within hospital / 中华医院管理杂志

Venous thromboembolism(VTE)is an important etiology for unexpected deaths and perioperative deaths of inpatients. Early diagnose and early prevention are main measures to reduce the incidence and mortality of VTE. Herein, we have established a comprehensive management system of VTE prevention, treatment and research. On one hand, we implemented the in-hospital VTE prevention management and improved the implementation status of VTE prevention and treatment. As a result, the number of diagnosed VTE cases and related medical disputes decreased by years. On the other hand, we have built up the VTE monitoring platform, providing useful statistical data for the clinical use of anticoagulants and further reducing the incidence of VTE. The VTE monitoring platform also revealed some significant differences of the VTE incidence between the medical patients and the surgical patients, which could provide reference for further revision of VTE guidelines.

Establishment and the effectiveness analysis of a comprehensive management system for preventing and curing venous thromboembolism within hospital / 中华医院管理杂志

Venous thromboembolism ( VTE) is an important etiology for unexpected deaths and perioperative deaths of inpatients. Early diagnose and early prevention are main measures to reduce the incidence and mortality of VTE. Herein, we have established a comprehensive management system of VTE prevention, treatment and research. On one hand, we implemented the in-hospital VTE prevention management and improved the implementation status of VTE prevention and treatment. As a result, the number of diagnosed VTE cases and related medical disputes decreased by years. On the other hand, we have built up the VTE monitoring platform, providing useful statistical data for the clinical use of anticoagulants and further reducing the incidence of VTE. The VTE monitoring platform also revealed some significant differences of the VTE incidence between the medical patients and the surgical patients, which could provide reference for further revision of VTE guidelines.

Curative effect and safety of posterior laminectomy surgery in the treatment of intraspinal schwannoma / 中国基层医药

Objective To investigate the curative effect and safety of posterior laminectomy in the treatment of intraspinal schwannoma .Methods 67 cases with intraspinal schwannoma were treated with posterior laminectomy surgery.The surgical conditions of 67 patients,such as surgery time,intraoperative blood loss and postoperative complications and tumor recurrence were observed and measured .The patients were followed up for 6 months,the preoperative and postoperative muscle strength , cervical spinal cord function improved were compared . Results 67 patients were successfully completed , the average operation time was ( 2.75 ±0.60 ) h, the mean intraoperative blood loss was(489.36 ±115.28)mL.There were postoperative 2 cases of exercise dysfunction after anesthesia awake , to be targeted after treatment symptoms were relieved;cerebrospinal fluid leakage in 4 cases, symptoms improved to be pillow supine , drainage and local pressure bandaged after treatment .All patients were followed up for 6 months,without recurrence of tumor .Compared with preoperation ,the postoperative muscle strength of 67 patients was significantly improved ,and restored to the level IV(61.19％) or level V(38.81％),the difference was statistically significant(Z=7.370,P<0.05).Compared with preoperation,the postoperative cervical spinal cord function score of 67 patients was higher [ ( 11 .72 ±0 .85 ) points ] , the difference was statistically significant ( t =29.341,P <0.05).Conclusion Posterior laminectomy surgery in the treatment of intraspinal schwannoma can significantly improve the patients'spinal cord function , effectively promote muscle recovery , the effect is more significant ,with high safety .

Analysis on the relationship between Occupational Stress Factors and Psychological Stress Reaction among Petrochemical Workers / 中华劳动卫生职业病杂志

Objective@#Analyze the detection rates of occupational contraindication and suspected occupational disease from the employee exposure to noise and describe the distribution characteristics.@*Methods@#According to the Technical Specifications for Occupational Health Surveillance (GBZ 188-2014) 、Diagnosis of Occupational Noise-induced Deafness (GBZ 49-2014) and Guideline of Identification of Contraindication to Job Placement (GBZ/T 260-2014) , calculate and analyze the occupational contraindication and suspected occupational disease detection rates of 149 271 workers from January 1st to December 31st in 2015 who were exposed to noise. Analyze the detection rates distribution characteristics between different gender, age, seniority, industry and enterprise scale.@*Results@#The detection rates of occupational contraindication is 2.08%. The suspected occupational disease detection rates of absences workers (2.13%) is higher than during (2.03%) . The occupational contraindication detection rates of< age 20 (2.64%) , 41~50 years old (2.48%) and<1 working years (5.35%) , are higher than others. The detection rates of suspected occupational disease increases with the growth of ages and working years. The occupational contraindication detection rates of scientific research and technology services industry (10.46%) is the highest. The suspected occupational disease detection rates of transportation warehousing and postal services (5.88%) is the highest. The occupational contraindication detection rates of medium-sized enterprise (2.27%) is the highest, meanwhile, the microenterprise’s (1.60%) is the lowest. The suspected occupational disease detection rates of large-scale enterprise (3.21%) is the highest, meanwhile, the microenterprise’s (1.33%) is the lowest.@*Conclusion@#Enterprise should insist on regular occupational health examination, strengthen screening of occupational contraindication in new workers, especially pre-job workers and detect the occupational disease patients early. Focus on non-traditional noise industries above mentioned, improve intensity of noise hazards prevention and control. The detection rates of occupational contraindication and suspected occupational disease can be used as a reference standard for the quality control of occupational examination and report of medical institutions.

Desmoplastic trichoepithelioma complicated by sebaceous hyperplasia: a case report / 中华皮肤科杂志

A 67-year-old male patient presented with a plaque on the top of the head for more than 1 year.Physical examination showed an annular pale red plaque sized about 1.5 cm × 1 cm on the top of the head.It had a depressed center and papule-like elevated faint yellow boundaries,and there was no hair on the surface of the lesion.Histopathologic examination revealed milder epidermal hyperplasia,a small area of epidermal depression,confluence and hyperplasia of multiple sebaceous glands in the dermis,many keratinous cysts and funicular basophilic epithelial cells surrounded by hyperplastic collagen fibers in the superficial dermis.Immunohistochemical study showed positive staining for CD34 (hair mesenchymal cells),epithelial membrane antigen (EMA),cytokeratin 20 (CK20),but negative staining for bcl-2,P53,CD56 and collagen Ⅳ,with the proliferation index Ki-67 of 2％-5％.Based on the pathological results,the patient was diagnosed with desmoplastic trichoepithelioma complicated by sebaceous hyperplasia.

Evaluation of effects of detailed target management on patients with diabetic ketoacidosis complicated with acute pancreatitis / 中国中西医结合急救杂志

Objective To explore the clinical role and value of detailed target management on patients with diabetic ketoacidosis (DKA) complicated with acute pancreatitis (AP).Methods The clinical data of patients with DKA complicated with AP admitted to the Department of Emergency of Linyi City People's Hospital from January 2013 toDecember 2016 were retrospectively analyzed. The patients managed by detailed target management (from January 2015 to December 2016) were served as the observation group (detailed target management group), and those managed by routine management (from January 2013 to December 2014) were set as the control group (traditional management group). The gender, age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, Ranson score, underlying disease, blood glucose, glycemic excursion [including: standard deviation of blood glucose (SDBG) level, the largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursion (MAGE), and absolute means of daily difference (MODD) in blood glucose], remission time of DKA, the incidence of MODS and mortality were compared between two groups.Results There were no significant differences in sex, age, APACHE Ⅱ score, Ranson score, blood glucose and the distribution of underlying disease between the two groups (allP > 0.05). Compared with the traditional management group, the level of blood glucose in the detailed target management group was decreased steadily, blood glucose excursions of within-day and day-to-day were significantly reduced on the 2nd and 3rd day (the 2nd day: SDBG was 3.01±1.38 vs. 4.27±1.89, LAGE was 4.14±1.52 vs. 5.62±2.54, MAGE was 0.61±0.35 vs. 1.01±0.57, the 3rd day: SDBG was 2.94±0.91 vs. 3.83±1.29, LAGE was 3.81±1.05 vs. 5.02±2.13, MAGE was 0.58±0.32 vs. 0.96±0.52), MODD: 0.82±0.81 vs. 1.59±1.12, allP < 0.05]. Remission time of DKA and the staying time at emergency department after the implementation of the detailed target management was significantly reduced [remission time of DKA (days): 1.73±0.88 vs. 2.57±1.09, the staying time at emergency department (days): 6.13±0.99 vs. 7.29±1.38, bothP < 0.05], and no hypoglycemic events occurred. There was no significant difference in the incidence of MODS and mortality between the two groups (bothP > 0.05).Conclusions Detailed target management can help the salvage and treatment of patients with diabetic ketoacidosis complicated with acute pancreatitis, control the blood glucose steadily, and significantly shorten the remission time of DKA and the stay time at emergency department.

Expression of long non-coding RNA SNHG8 in Epstein-Barr virus-related gastric cancer and clinical outcome / 中华病理学杂志

Objective@#To investigate the expression of long non-coding RNA (lncRNA) SNHG8 in EB virus related gastric cancer and their correlation prognosis.@*Methods@#The expression of SNHG8 in 93 gastric cancers and 93 cancer-free controls, matched by age and sex, were determined by real-time PCR. EB virus expression was detected by EBER in situ hybridization.@*Results@#Forty-one gastric cancers were EB virus associated. For all gastric cancers, SNHG8 expression was 14 times higher (P=0.001) than that in non-cancer controls; in the EB virus related gastric cancers, SNHG8 expression was increased 25 times (P<0.05) over EB virus negative gastric cancers. SNHG8 expression level was also significantly associated with TNM staging (P<0.05).@*Conclusions@#SNHG8 may act as a proto-oncogene, participating in gastric carcinogenesis.EB virus infection of gastric mucosa may promote SNHG8 expression.

AngioJet mechanical thrombectomy plus thrombolysis for the treatment of acute deep venous thrombosis of the lower extremity / 中华普通外科杂志

Objective To summary the experience of AngioJet mechanical thrombectomy for the treatment of acute deep venous thrombosis (DVT) of lower extremity.Methods Clinical data of 28 patients suffering from acute DVT of lower extremities treated by AngioJet mechanical thrombectomy were analyzed retrospectively from October 2013 to February 2015.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Follow-up was performed by Doppler ultrasound and clinical evaluation.Results Twelve patients were planted temporary vena cava filters.The average length of hospitalization was (3.9 ± 1.1) days.The average operation time was (1.2 ± 0.4) hours.The dosage of urokinase was (320 ± 120) × 104 U and heparin was (46 ± 10)mg during surgery.The average reduction of hemoglobin was (7.5 ± 2.6) g/L.Two patients (Grade Ⅰ thrombolysis) were converted to catheter-directed thrombolysis (CDT).There were 10 (35.7％) cases achieving grade Ⅱ and 16 (57.1％) cases achieving grade Ⅲ,respectively.Technique success rate were 92.9％.Minor bleeding events occurred in 2 patients.Nine (32.1％) patients had stents implanted.One year follow-up found patent deep venous in 26 (92.9％) patients and stent patency rate was 88.9％ (1/9).Two (7.1％) cases developed mild postthrombotic syndrome (PTS).Conclusion AngioJet is a safe and effective tool to treat acute DVT accelerating thrombolytic therapy,and reducing bleeding complications.

Relationship between dust mass concentration and fiber number concentration of refractory ceramic fibers / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To explore the quantitative relationship between the dust mass concentration and fiber number concentration of refractory ceramic fibres.</p><p><b>METHODS</b>A typical refractory ceramic fiber plant was selected as the study site. Fifty-three paired samples of total dust mass concentration and fiber number concentration were collected using the long-time fixed site mode. The total dust mass concentration was measured according to the GBZ/T 192.1-2007 (Measurement of dust in the air of workplace, part 1: Total dust concentration). Membrane filter method/phase-contrast optical microscopy was used to determine the fiber number concentration. Univariate analysis was used to describe the distribution of the two concentrations and their ratio. Spearman rank correlation, as well as linear regression, logarithmic curve, polynomial, power function, and exponential curve model, were used to explore the relationship between the two concentrations. Results The range of the total dust mass concentration (x) was 0.45-13.82 mg/m3. The range of the fiber number concentration (y) was 0.01-1.04 f/ml. The range of the ratio (x/y) was 4-158. All of the three parameters did not follow normal distribution (P<0.000 1). The two concentrations showed a positive correlation (r,=0.705 22, P< 0.000 1). All the coefficients of determination (R2) of linear regression, logarithmic curve, polynomial, power function, and exponential curve model were relatively low. The trinomial curve model had the highest R2 (0.6848) and the fitted equation was y=-0.001, 1x+0.010 4x2+0.101 4x-0.055 1.</p><p><b>CONCLUSION</b>There is a positive correlation between the total dust mass concentration and fiber number concentration of refractory ceramic fibers. However, there is no fixed regression relationship between the two concentrations, and neither is a definite coefficient which can be used to convert each other. The two concentrations cannot be replaced by each other.</p>

Effects of neurally adjusted ventilatory assist on inflammatory reaction and weaning in patients with AECOPD / 中华急诊医学杂志

Objective To observe the correlation between neutrally adjusted ventilatory assist (NAVA) mode and improvement of inflammation and oxidative stress in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and as well as to investigate the effects of NAVA mode versus pressure support ventilation (PSV) mode on improving the success rate of weaning advantages.Methods A total of 40 patients with AECOPD-Ⅲ supported by mechanical ventilation treatment admitted from November 2012 to January 2014 into intensive care unit (ICU) were enrolled for prospective study.The patients were randomly divided into PSV mode (n =20) and NAVA mode (n =20) according to gender,age,APACHE Ⅱ score,medical history,PaCO2 of five factors and adopting the principle of minimum distribution of the imbalance index.The comparisons of the successful rate of weaning,48 h re-intubation rate and length of ICU stay were made between two groups.The level of C-reactive protein (CRP),serum amyloid A (SAA),human cartilage glycoprotein 39 (YKL-40) in serum were measured by enzyme-linked immunosorbent assay (ELSIA) on the 1st day,3rd day,5th day and 7th day after initiation of mechanical ventilation,and results of these laboratory tests in patients were compared with those in healthy subjects of control group.And simultaneously,the broncho-alveolar lavage fluid (BALF) was collected with Gibot method by employment of optic fiber bronchoscope on the given days for detection of YKL-40,and levels of YKL-40 were compared between NAVA mode and PSV mode.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test or repeated measures analysis of variance,and P ＜ 0.05 was considered to be significant.Results (1) There were no significant differences in leukocyte count and neutrophils percentage between NAVA mode and PSV mode (P ＞ 0.05).The magnitudes of decrease in concentrations of blood CRP and SAA in NAVA mode were significantly greater than those in PSV mode (P ＜ 0.01),but there was no significant difference in blood YKL-40 between NAVA mode and PSV mode (P ＞ 0.05).The magnitude of reduction in concentration of BALF YKL-40 in NAVA mode was significantly greater than that in PSV mode (P ＜0.01).(2) There was on significant difference in rate of final weaning between NAVA mode and PSV mode,but the rate of direct weaning was higher in NAVA mode than that in PSV mode (P =0.046),and the 48 h re-intubation rate was lower in NAVA mode than that in PSV mode (P =0.032).The length of ICU stay was shorter in NAVA mode than that in PSV mode (P =0.031).The peak of EAdi (electric activated diaphragma trigger) in 8 patients failing in direct weaning before first attempt was significantly higher than that in other patients with successful weaning patients (P =0.002).Conclusions NAVA mode can attenuate inflammation and oxidative stress in patients with AECOPD,and ultimately improve the rate of direct weaning and shorten the length of ICU stay.Further research is necessary to confirm the capability of NAVA mode for improving the ultimate rate of weaning in AECOPD patients.

The impact of relevant factors in mechanical ventilation on intra-abdominal pressure in patients with ALI/ARDS / 中华急诊医学杂志

Objective To investigate the impact of relevant factors in mechanical ventilation on intraabdominal pressure in patients with ALI/ARDS by continuous monitoring of intra-abdominal pressure.Methods A total of 116 ALI/ARDS patients treated with mechanical ventilation in ICU were enrolled in this study.Intra-abdominal pressure (IAP) was recorded continuously.Meanwhile ventilator parameters, arterial blood gas analysis, hemodynamic variables, and as well as the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid (BALF) were determined and recorded.The detection of risk factors for intra-abdomen hypertension (IAH) were carried out using multivariate stepwise logistic regression.ROC curve analysis used to estimate the diagnostic performance of these parameters for IAH.Results The oxygenation index (PaO2/FiO2) in patients with IAH after 2 hours' mechanical ventilation was significantly lower than that in patients with normal intra-abdomen pressure (IAP) (P ＜ 0.01);PEEP and RR in mechanical ventilation were higher in IAH group (P ＜ 0.01 or P =0.001);Mean artery pressure (MAP), ejection time percent (ET), stroke volume (SV), cardiac index (CI) were lower in IAH group than those in normal IAP group (P ＜ 0.01);the levels of IL-4, IL-8 and TNF-α in blood and bronchial alveolar lavage fluid were higher in IAH group than those in normal IAP group (P ＜ 0.01);IAH patients have a higher mortality on 28 d (Log rank test, P =0.023).Poor oxygenation index (PaO2/ FiO2) after 2 hours' ventilation, high PEEP setting, low MAP, ET, SV, CI and elevated IL-4 in the BALF were resulted in increasing risk of IAH for ARDS patients under mechanical ventilation support.Conclusions The monitoring of intra-abdominal pressure should be emphasized for ALI/ARDS patients when mechanical ventilation was employed.PaO2/FiO2, SV and IL-4 in BALF might be the independent risk factors of IAH.

Development of SCI-covered papers list database in Dalian Medical University / 中华医学图书情报杂志

After the contents and characteristics of SCI-covered papers list database in Dalian Medical University were described, it was pointed out that databases in academic library should provide more contents and links for the users to browse information and to use related resources by making full use of network technology. Technology and manpower should be well prepared and librarians should be qualified with patience and painstaking if an excellent SCI-covered papers list database is to be developed.

The clinical effect of traditional Chinese medicine dialectical therapy for treatment of gastrointestinal dysfunction in patients with acute lung injury/acute respiratory distress syndrome undergoing mechanical ventilation / 中国中西医结合急救杂志

Objective To explore the clinical effect of traditional Chinese medicine (TCM) dialectical therapy for treatment of gastrointestinal dysfunction in patients with acute lung injury / acute respiratory distress syndrome(ALI/ARDS)undergoing mechanical ventilation. Methods A prospective,randomized controlled trial was conducted. Ninety-six ALI/ARDS patients admitted in intensive care unit(ICU)and treated with mechanical ventilation in Tianjin First Central Hospital were chosen and randomly divided into traditional Chinese medicine(TCM) group and conventional therapy group using a random number table,48 patients in each group. Conventional therapy alone was used in conventional therapy group,and TCM therapy of primarily using Dachengqi decoction combined with conventional therapy was applied in TCM group〔Dachengqi decoction was composed of mongolian milkvetch root 15 g, pilose asiabell toot 15 g,Chinese angelica 10 g,officinal magnolia bark 10 g,tangerine peel 10 g,immature tangerine fruit 10 g,peach seed 10 g,white peony root 12 g,red peony root 12 g,immature bitter orange 6 g,mongolian dandelion herb 30 g,radish seed(stir-fried)30 g,foxtail millet sprout 20 g,barley sprout 20 g,glauber salt 9 g (with water),rhubarb 10 g(added in water at last)〕,one dose orally taken daily for 28 days. The intra-abdominal pressure(IAP),gastrointestinal diseases in TCM symptom score and the incidence of gastrointestinal dysfunction were compared between the two groups before treatment and on the 3rd,6th and 8th day after treatment. Results There were no statistical significant differences in IAP and TCM symptom scores between the two groups before treatment (both P>0.05),but after treatment with the prolongation of therapeutic time the IAP and TCM symptom scores were decreased gradually compared with those before treatment,having reached the valley value on the 18th day and the changes in TCM group were more remarkable〔IAP(mmHg,1 mmHg=0.133 kPa):0.91±0.69 vs. 2.08±0.92, TCM symptom score:48.33±10.41 vs. 88.33±20.21,both P<0.05〕. In the TCM group,the incidences of the untoward symptoms and signs of gastrointestinal dysfunction such as bleeding of stress ulcer,toxic intestinal paralysis, abdominal distension,diarrhea and so on were lower than those in conventional therapy group〔stress ulcer bleeding:16.7%(8/48)vs. 39.6%(19/48),toxic intestinal paralysis:16.7%(8/48)vs. 43.8%(21/48),abdominal distension:10.4%(5/48)vs. 37.5%(18/48),diarrhea:6.3%(3/48)vs. 33.3%(16/48),all P<0.05〕. Conclusion Addition of TCM Dachengqi decoction on conventional treatment can effectively lower the incidence of gastrointestinal dysfunction in treatment of patients with ALI/ARDS undergoing mechanical ventilation.

Culturing bone marrow mesenchymal stem cells from Sprague-Dawley rats using whole bone marrow adherence method / 中国组织工程研究

BACKGROUND:Tissue and cellimplantation entails high-quality seed cells. In order to satisfy this requirement, it is crucial to produce adequate wel-conditioned, high-purity and strong proliferation ability bone marrow-derived mesenchymal stem cells. OBJECTIVE:To establish a simple, rapid and effective in vitro isolation and culture method of bone marrow-derived mesenchymal stem cells, and to define the biological features of bone marrow mesenchymal stem cells. METHODS:Rat bone marrow mesenchymal stem cells were isolated from the bilateral tibial and femoral bones by the method of whole bone marrow, then purified and passaged by attachment method. The morphology and features of bone marrow mesenchymal stem cells were observed, the growth curve was drawn and the cellsurface antigen was detected by flow cytometry. The bone marrow mesenchymal stem cells were induced to differentiate along the osteogenic, chondrogenic and adipogenic lineages. RESULTS AND CONCLUSION:Bone marrow mesenchymal stem cells isolated by the whole bone marrow adherence method grew vigorously and were highly purified. The cultured cells were spindle-shaped. The growth curve was S-shaped and the population doubling time was 29 hours. The cells stil maintained a strong proliferative capacity after they were passaged for 10 generations. The surface markers such as CD44, CD29, CD90 were positive, while CD45, CD34, CD11b were negative. At the third passage, bone marrow mesenchymal stem cells were induced to differentiate along the osteogenic, chondrogenic and adipogenic lineages, respectively. Fol owing induction, Alizarin red staining, alkaline phosphatase staining, von-kossa mineralized nodules staining, toluidine blue staining, and oil red O staining were al positive. This shows that the whole bone marrow adherence method is a simple and reliable method for the in vitro isolation, culture and proliferation of bone marrow mesenchymal stem cells. Moreover, they have multi-lineage differentiation capacity under different inducers. The third passage bone marrow mesenchymal stem cells have the highest biological activity and can act as the ideal seed cells for subsequent experiments.