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Objective:To compare the effects of citrate and heparin anticoagulation on coagulation function and efficacy in children with septic shock undergoing continuous blood purification (CBP), and to provide guidance for CBP anticoagulation in children with septic shock.Methods:A case control study was conducted. Thirty-seven children with septic shock admitted to the pediatric intensive care unit (PICU) of the First Affiliated Hospital of Gannan Medical University from July 2019 to September 2022 were enrolled as the research subjects. The patients were divided into citrate local anticoagulation group and heparin systemic anticoagulation group according to different anticoagulation methods. The baseline data, the level of coagulation indicators [prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib), D-dimer] before treatment and 1 day after weaning from CBP, serum inflammatory mediators [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), hypersensitivity C-reactive protein (hs-CRP), procalcitonin (PCT)], bleeding complications during CBP and 7-day mortality were collected.Results:A total of 37 cases were enrolled finally, including 17 cases with citric acid local anticoagulation and 20 cases with heparin systemic anticoagulation. There was no statistically significant difference in general data such as gender, age, and body weight of children between the two groups. There were no statistically significant differences in baseline levels of coagulation indicators and inflammatory mediators before treatment of children between the two groups. One day after weaning from CBP, both groups showed varying degrees of improvement in coagulation indicators compared with those before treatment. Compared with before treatment, the PT of the heparin systemic anticoagulation group was significantly shortened after 1 day of weaning (s: 11.82±2.05 vs. 13.64±2.54), APTT and TT were significantly prolonged [APTT (s): 51.54±12.69 vs. 35.53±10.79, TT (s): 21.95±4.74 vs. 19.30±3.33], D-dimer level was significantly reduced (mg/L: 1.92±1.58 vs. 4.94±3.94), with statistically significant differences (all P < 0.05). While in the citrate local anticoagulation group, only APTT was significantly prolonged after treatment compared with that before treatment (s: 49.28±10.32 vs. 34.34±10.32, P < 0.05). There were no statistically significant differences in other coagulation indicators compared with before treatment. Compared with the citric acid local anticoagulation group, the PT of the heparin systemic anticoagulation group was significantly shortened after treatment (s: 11.82±2.05 vs. 13.61±3.05, P < 0.05), and the D-dimer level was significantly reduced (mg/L: 1.92±1.58 vs. 3.77±2.38, P < 0.01). The levels of inflammatory mediators in both groups were significantly reduced 1 day after CBP weaning compared with those before treatment [citric acid local anticoagulation group: hs-CRP (mg/L) was 12.53±5.44 vs. 22.65±7.27, PCT (μg/L) was 1.86±1.20 vs. 3.30±2.34, IL-6 (ng/L) was 148.48±34.83 vs. 202.32±48.62, TNF-α (ng/L) was 21.38±7.71 vs. 55.14±15.07; heparin systemic anticoagulation group: hs-CRP (mg/L) was 11.82±4.93 vs. 21.62±8.35, PCT (μg/L) was 1.90±1.08 vs. 3.18±1.97, IL-6 (ng/L) was 143.81±33.41 vs. 194.02±46.89, TNF-α (ng/L) was 22.44±8.17 vs. 56.17±16.92, all P < 0.05]. However, there was no statistically significant difference between the two groups (all P > 0.05). There was no statistically significant difference in bleeding complication during CBP and 7-day mortality in children between the citrate local anticoagulation group and the heparin systemic anticoagulation group (5.9% vs. 30.0%, 17.6% vs. 20.0%, both P > 0.05). Conclusions:Heparin for systemic anticoagulation and regional citrate anticoagulation can significantly reduce the levels of IL-6, TNF-α, hs-CRP and PCT in children with septic shock, and relieve inflammatory storm. Compared with citric acid local anticoagulation, heparin systemic anticoagulation can shorten the PT and reduce the level of D-dimer in children with septic shock, which may benefit in the prevention and treatment of disseminated intravascular coagulation (DIC).
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Objective:To systematically evaluate the effect of hydrocortisone combined with vitamin C and vitamin B1 on the efficacy of patients with sepsis or septic shock.Methods:Databases including CNKI, Sino Med, VIP, Wanfang, PubMed, the Cochrane Library, and Embase were searched from inception to January 2021 for the randomized controlled trial (RCT) about hydrocortisone combined with vitamin C and vitamin B1 to treat sepsis or septic shock. The experimental group was given intravenous injection of hydrocortisone, vitamin B1 and vitamin C based on conventional treatment; the control group was given conventional treatment or placebo/hydrocortisone/hydrocortisone+vitamin B1 based on conventional treatment. Outcome indicators included sequential organ failure assessment (SOFA), mortality, the duration of vasoactive drugs, new acute kidney injury (AKI) patients, length of stay in intensive care unit (ICU) and in hospital. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. RevMan 5.3 software was then used to perform Meta-analysis. Funnel plot was used to test publication bias.Results:A total of 6 articles involving 816 patients were included, with 411 patients in the experimental group and 405 patients in the control group. The Meta-analysis results showed that the duration of vasoactive drugs in the experimental group was significantly shorter than that in the control group [mean difference ( MD) = -24.02, 95% confidence interval (95% CI) was -32.36 to -15.68, P < 0.000 01]. However, there were no significant differences in SOFA, mortality, new AKI patients, the length of ICU stay and hospital stay between the two groups [SOFA: MD = -0.14, 95% CI was -1.15 to 0.87, P = 0.79; mortality: relative risk ( RR) = 0.99, 95% CI was 0.81 to 1.21, P = 0.92; new AKI patients: RR = 1.10, 95% CI was 0.42 to 2.87, P = 0.84; length of ICU stay: MD = 1.33, 95% CI was -2.22 to 4.89, P = 0.46; length of hospital stay: MD = 1.02, 95% CI was -0.66 to 2.69, P = 0.23]. The funnel plot showed that most of the points were symmetrical and showed an inverted funnel shape, suggesting that the publication bias among the studies was small. There was no significant publication bias on this Meta-analysis. Conclusions:Hydrocortisone combined with vitamin C and vitamin B1 can shorten the duration of vasoactive drugs in patients with sepsis or septic shock, but it cannot effectively reduce the SOFA score, mortality, new AKI patients, length of stay in ICU and in hospital. Limited by the number and quality of the included studies, further large-scale, multi-center, blinded, RCT are still needed for verification.
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OBJECTIVE:To observe the efficacy and safety of insulin in the treatment of gestational diabetes in different gesta-tional age. METHODS:The data of 121 women with gestational diabetes were retrospectively analyzed,and divided into observa-tion group (63 cases) and control group (58 cases) based on first use of insulin in different gestational age. All patients received dirt control [(calorie control in 30-35 kJ/(kg·d),55% carbohydrates,25% fat and 20% protein)];based on it,Biosynthetic hu-man insulin injection was injected before meals and at bedtime by 4∶2∶3∶1 with 4-6 units before pregnant 30 weeks according to the FPG and postprandial 2 h blood glucose(2 h PG)levels in observation group,the blood glucose of women with gestational dia-betes was monitored to prevent the occurrence of complications such as hypoglycemia. Control group received Biosynthetic human insulin injection(the same dosage with control group)when no less than 30 weeks. The treatment course for both groups was 15 d. FPG and 2 h PG levels when first diagnosed and delivery,pregnancy outcomes and neonatal conditions in 2 groups were observed, and the incidence of adverse reactions was recorded. RESULTS:When first diagnosed,there were no significant differences in FPG and 2 h PG levels in 2 groups(P>0.50). When delivery,FPG and 2 h PG levels in 2 groups were significantly lower than first di-agnosed,and observation group was lower than control group,the differences were statistically significant (P0.05). There were no obvious adverse reactions during treatment. CONCLUSIONS:Based on diet control,insulin in the treatment of gestational diabetes before pregnant 30 weeks can effectively control blood glucose level and improve pregnancy outcomes,with good safety.
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BACKGROUND:There is a certain association between stem cels, microenvironment and methods for promoting blood circulation and removing stasis. OBJECTIVE:To propose a perspective of“kidney properties”of promoting blood circulation and removing stasis by elaborating the correlation and interactions of stem cels and microenvironment with methods for promoting blood circulation and removing stasis. METHODS:A computer-based search of Chinese Journal Ful-text Database, Wanfang and PubMed was performed for articles published form 2009 to 2015 addressing improving stem cel proliferation and differentiation by promoting blood circulation and removing stasis as wel as microenvironments. The keywords were “bone mesenchymal stem cels, transformation, differentiation, blood-activation and stasis-resolved method, microenvironment” in Chinese and English, respectively. Finaly, 32 literatures were reviewed. RESULTS AND CONCLUSION:Stem cels homing to the damaged tissue trigger an“environment-dependent differentiation”,that is, stem cels candifferentiate into myocardial cels, vascular endothelial cels and other injured tissues and cels under local special microenvironments. Microenvironment as an assembly for integrating dynamic, microscopic changes as wel as development of a variety of indices is of great importance for stem cel survival, proliferation and differentiation. Recipes for promoting blood circulation and removing stasis are involvedto regulate multi-steps and multi-targets during stem cel homing. Theoreticaly, this review attempts to investigate correlation among stem cels, microenvironment and methods for promoting blood circulation and removing stasis in association with previous preclinical and clinical findings. Here, we further refine the view of “kidney properties” of promoting blood circulation and removing stasis and clarify that stem cels as the material basis of “kidney properties”of promoting blood circulation and removing stasis is the main executor for promoting blood circulation and removing stasis. This paper is of a certain value for fuly revealing the scientific connotation of the theory of promoting blood circulation and removing stasis.
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OBJECTIVE:To investigate the effects of Maiqi jiangtang pill combined with insulin on related indicators in mater-nal gestational diabetes. METHODS:135 GDM women were randomly divided into control group (69 cases) and observation group(66 cases). Control group was given diet controlling and exercise therapy,Novolin R insulin biosynthesis and protamine syn-thetic human insulin were injected before meals and bedtime from 4-6 units with the ratio of 4∶2∶3∶1,and decided whether to ad-just the insulin dose based on the blood glucose monitoring results(increase or decrease 2-4 units each times);observation group was additionally given 6 g Maiqi jiangtang pill,4 times a day. The treatment course for both groups was 15 d. Fasting plasma glu-cose(FPG),2 h postprandial glucose(2 h PG),glycated hemoglobin(HbA1c),body mass index(BMI),maternal pregnancy out-comes(preeclampsia,preterm labor,puerperal infection,postpartum hemorrhage,neonatal asphyxia,low-weight children and noc-turnal hypoglycemia)and incidence of adverse reactions in 2 groups were observed. RESULTS:FPG,2 h PG,HbA1c,BMI,pre-eclampsia,preterm labor,low-weight children,neonatal asphyxia and nocturnal hypoglycemia in observation group were signifi-cantly lower than control group,the differences were statistically significant(P0.05). And there were obvious adverse reactions between 2 groups during treatment. CONCLUSIONS:Maiqi jiangtang pill combined with insulin can effectively reduce the blood glucose of GDM women,with good safety.
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OBJECTIVE:To observe the clinical efficacy and safety of Fuyankang combined with azithromycin in the treat-ment of pelvic inflammatory disease. METHODS:90 patients with pelvic inflammatory disease were selected and randomly divided into observation group and control group,with 45 cases in each group. Control group was given Lactose acid azithromycin for injec-tion 500 mg,ivgtt,qd,and then Azithromycin capsule 250 mg,po,qd;observation group was additionally given Fuyankang Tab-let 1.56 g,tid,on the basis of control group. A treatment course of 2 groups lasted for 7 d,and both received 3 courses of treat-ment. Clinical efficacies of 2 groups were observed as well as the level of CRP,IL-2 and life quality score before and after treat-ment,and the occurrence of ADR was compared between 2 groups. RESULTS:Total effective rate of observation group was 97.78%,which was significantly higher than that of control group (86.67%),with statistical significance (P<0.05). The level of CRP,IL-2 and life quality score of 2 groups were improved significantly after treatment,and the observation group was more better than the control group,with statistical significance (P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Fuyankang combined with Azithromycin is effective for pelvic inflammatory disease,and can improve the quali-ty of life,reduce inflammation cytokines infiltration and the generation of inflammatory medium with good safety.
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OBJECTIVE:To observe the efficacy and safety of Guizhi fuling capsule combined with leuprolide acetate in the treatment of endometriosis (EMS) after laparoscopicsurgery. METHODS:87 EMS patients were randomly divided into control group(44 cases)and observation group(43 cases). Control group received EMS resection under laparoscope,3.75 mg Leuprolide acetate for injection was given in the first day of postoperative first menstruation by intramuscular injection,once a day. Observa-tion group additionally received 0.93 g Guizhi fuling capsule,3 times a day. The treatment course for both groups was 6 months. Clinical efficacy,estradiol(E2),follicle stimulating hormone(FSH),luteinizing hormone(LH)and prolactin(PRL)levels before and after treatment,recurrence after 6 months and the incidence of adverse reactions in 2 groups were observed. RESULTS:The to-tal effective rate in observation group was significantly higher than control group,recurrence rate was significantly lower than con-trol group,the differences were statistically significant (P0.05);after treatment,E2,FSH,LH and PRL in 2 groups were significantly lower than be-fore,and E2,FSH and LH in observation group were lower than control group,the differences were statistically significant (P0.05). And there was no significant difference in the inci-dence of adverse reactions in 2 groups (P>0.05). CONCLUSIONS:After laparoscope resection,Guizhi fuling capsule combined with leuprolide acetate can effectively improve efficacy,reduce sex hormone level and recurrence rate,and do not increase the inci-dence of adverse reactions in the treatment of EMS.
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BACKGROUND:New ideas for regenerative treatment of cardiovascular disease are as fol ows:to understand the changes in al kinds of stem cel s differentiating into cardiomyocytes, to determine the physiological role of differentiated stem cel s in cardiac functional activities, to stimulate the proliferative potential of various stem cel s under certain conditions that can directly differentiate into functional cardiomyocytes, thereby replenishing deficient cardiomyocytes and effectively inhibiting excessive proliferation of fibroblasts. OBJECTIVE:To investigate the effects of panax notoginseng saponins, salidroside and astragalus effective components on the homing, proliferation and differentiation of endogenous CD105-positive bone marrow mesenchymal stem cel s of myocardial infarction rats. METHODS:Acute myocardial infarction rats were randomly divided into activating blood circulation group, tonifying qi group, activating blood circulation+tonifying qi group (combined group), model group. Normal rats served as control group. The former three groups were oral y given 80 g/L Xuesaitong soft capsules (panax notoginseng saponins as the main component), 0.5 g/mL astragalus particles and 70 g/L Nuodikang capsules (salidroside as the main component), respectively, at a dose of 1 mL/100 g, once a day, total y for 28 days. The control and model groups were given the same volume of normal saline. Expressions of CD105, CD117, vimentin, cardiac troponin T (cTnT), zinc finger transcription factor 4 (GATA-4) and Ki-67 were detected using immunohistochemical method at 1, 3, 7, 14, 28 days of drug administration. RESULTS AND CONCLUSION:(1) Compared with the control group, the expressions of CD105, CD117, cTnT, GATA-4 and Ki-67 were higher in the model group, which were increased at 1-7 days, peaked at 7 days, and then decreased. Compared with the model group, the expressions of CD105, CD117, cTnT, GATA-4 and Ki-67 were significantly higher in the activating blood circulation group, tonifying qi group and combined group, especial y in the activating blood circulating group, at different time of drug administration (P<0.05). In each group, the staining results of Ki-67 were not exactly paral el to those of CD105, CD117, cTnT and GATA-4, but their rising tendency was substantial y the same. (2) Compared with the control group, the vimentin expression in the model group was higher, which showed an increasing tend at 1-3 days, peaked at 3 days and then declined. Compared with the model group, the vimentin expression was significantly lower in the activating blood circulation group, tonifying qi group and combined group, especial y in the activating blood circulating group, at different time of drug administration (P<0.05). It suggested that the activating blood circulation group had a remarkable antifibrotic role. These findings indicate that panax notoginseng saponins, salidroside and astragalus effective components al can promote the proliferation and differentiation of bone marrow mesenchymal stem cel s to delay myocardial remodeling, but the recipe for promoting blood circulation has the most obvious outcomes.
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<p><b>OBJECTIVE</b>Frictions of Lock-loose brackets with ligated main wings or all six wings were measured as they slid along archwires in dry and artificial saliva environments. The Lock-loose brackets were then compared with traditional brackets and self-ligating brackets.</p><p><b>METHODS</b>The surface states of the stainless steel archwires were observed with atomic force microscopy before and after mechanical traction. The Lock-loose brackets, traditional brackets, and self-ligating brackets used in this study were composed of 0.406 4 and 0.457 2 mm stainless steel round archwires and 0.457 2 mm x 0.634 9 mm and 0.482 6 mm x 0.634 9 mm stainless steel rectangular archwires. Two different ligating methods were applied to the Lock-loose brackets, i.e., main wings ligated and all six wings ligated. Frictions were measured by using an electronic universal testing machine.</p><p><b>RESULTS</b>No significant differences were found between the roughness of different archwires before and after mechanical traction in different brackets (P > 0.05). When the main wings of the Lock-loose brackets were ligated, the frictions of the four different stainless steel archwires were close to zero, and the difference with frictions of traditional brackets was significant (P < 0.05). When using 0.457 2 mm x 0.634 9 mm rectangular archwires, maximum friction (P < 0.05; significantly different from those of other brackets) was reached when all six wings of the Lock-loose brackets were ligated. Frictions in the dry state were higher than those in the wet state (P < 0.05).</p><p><b>CONCLUSION</b>The Lock-loose brackets can adjust the friction efficiently with different ligating methods, thus solving the problem of low friction and strengthening anchorage.</p>
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Humans , Friction , Materials Testing , Microscopy, Atomic Force , Orthodontic Appliance Design , Orthodontic Brackets , Orthodontic Wires , Stainless Steel , Surface PropertiesABSTRACT
This paper selects Jiashan, Zhejiang, the high incidence area of colorectal cancer in China, as research site and adopts case control as research method to study relative hazards of colorectal cancer, especially the relation between dietary factor and colorectal cancer. It makes a further understanding of the possible cause of high incidence of colorectal cancer in Jiashan in order to provide a scientific basis for the prevention of colorectal cancer
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<p><b>OBJECTIVE</b>To evaluate the anti-hepatoma effect of Calmodulin antagonist 0 - 4-ethoxyl-butyl-Berbamine (EBB), one of the berbamine derivatives.</p><p><b>METHODS</b>Monotetrazolium (MTT) method was used to analyze the effect of EBB on the proliferation and growth inhibition effect. Of a hepatoma cell line in vitro. A mouse hepatoma model was induced by injection of hepatoma cells (H22) in the abdominal cavity. The effect of EBB on survival at different concentrations as well as in combination with 5-FU were investigated in vivo. Flow cytometry analysis, dot blot hybridization, western blot, immunochemistry, enzyme-linked lectin assay (ELISA), trifluoperazine (TFP) and electron microscopic observation were used to study the effect of EBB on cell cycle process, P53 mRNA and protein levels, calmodulin content and ultrastractural changes of hepatoma cells.</p><p><b>RESULTS</b>EBB exerts a very strong inhibitory effect on human hepatoma cell line 7402 and mouse hepatoma cell line H22 in vitro. The IC(50) value of EBB for the two cell lines are 3.312 microg/ml and 1.167 microg/ml, respectively. The sensitivity of H22 cells to 5-FU can be markedly enhanced: The IC(50) dosage of 5-Fu can be decreased from 0.75 microg/ml down to 0.15 microg/ml, when jointly administered with nontoxic dosages of EBB (IC(10)). In vivo, EBB can prolong the lifespan of mice with ascites H22 to more than three months. 64% of mice survived, while all animals in the control group died by the 18th day. When EBB (5 mg x kg(-1) x d(-1)) is jointly used with 5-FU (25 mg x ml(-1) x d(-1)), 73% of mice with ascites H22 survived, much higher than 27% in the 5-FU treated group. EBB can enhance the anti-hepatoma ability of 5-Fu treatment. EBB mechanism against hepatoma: P53 expression in the EBB treated group is substantially higher than that in the control group. EBB increased the translation of P53. As a calmodulin antagonist, EBB decreases amount of the CaM in hepatoma cells and blocked the hepatoma cell proliferation cycle at the G(2)M phase. Before the G(0)/G(1) phase, a diploid peak and apoptic cells in the treated groups were observed.</p><p><b>CONCLUSIONS</b>The CaM antagonist, EBB, has a strong anti-hepatoma effect and enhances the effect of 5-FU, induces hepatoma cell to apoptosis, promotes the P53 protein expression and decreases the amount of CaM in the cytoplasm. All these results demonstrate that EBB is a new and potentially useful drug against hepatoma and should be researched further.</p>
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Animals , Mice , Alkaloids , Pharmacology , Antimetabolites, Antineoplastic , Pharmacology , Benzylisoquinolines , Calmodulin , Metabolism , Carcinoma, Hepatocellular , Drug Therapy , Metabolism , Pathology , Cell Division , Cell Survival , Chromatography, Thin Layer , Dose-Response Relationship, Drug , Drug Synergism , Fluorouracil , Pharmacology , Inhibitory Concentration 50 , Liver Neoplasms, Experimental , Drug Therapy , Metabolism , Pathology , Neoplasm Transplantation , RNA, Messenger , Genetics , Metabolism , Tumor Cells, Cultured , Tumor Suppressor Protein p53 , Genetics , MetabolismABSTRACT
Confronted with the complex and volatile situation of the medical market, hospitals must formulate long-term development strategies, enhance their core competitiveness, and secure or maintain an undefeatable position amidst competition. The paper discusses the strategic management of large hospitals from five dimensions: improving hospital leaders' strategic-thinking and decision-making skills, continuously implementing brand marketing strategies, adopting the ideas and methods of strategic cost management, constructing information-based hospitals, and creating vigorous and dynamic hospital culture. It argues that only by strengthening strategic management can the sustainable and concerted development of hospitals be promoted.
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The hospital the authom work with, the first one to undergo the second-cycle nation-wide hospital evaluation, was assessed by a third party and the hospital evaluation experts. The two cycles of hospital evaluation were entirely different in historical background, priorities and procedures. The evaluation standards for the second cycle, which were on a par with internafional ones, set the right track of development for medical institutions, emphasizing quality, security, service and performance and highlighting the delivery of quality patient care. The gains from the second-cycle hospital evaluation can be summarized as follows: more highly emphasized continuous improvement of service quality, enhanced awareness of people-oriented management, reinforced medical quality and medical security control, heightened hospital infection control, greater capability of responding to emergencies, and strengthened for-malation of hospital rules and regulations. In the end five suggestions are put forward with regard to the second-cycle hospital evaluation.
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Aim To investigate the potential suppressing effect of calmodulin antagonist EBB on metastasis-associated properties of human metastatic ovarian clear cell adenocarcinoma cell ES-2.Methods MTT assay was used to assess the growth inhibition of EBB on ES-2 cells.The invasive capacity and motility potential were determined by Transwell chamber assay and Wound assay.[Ca2+]i was observed under the laser scanning confocal microscopy.Results EBB inhibited the proliferation of ES-2 cells in vitro.The IC50 on ES-2 cells was(13.67?1.56)?mol?L-1.The invasive ability and motility potential of ES-2 cells were decreased after exposure to 3,7 and 14 ?mol?L-1 EBB respectively(P