Research and application of Raman spectroscopy in the diagnosis and therapy of brain glioma / 中华核医学与分子影像杂志

Brain glioma invariably relapses since the tumor is difficult to remove completely. Accurate identification of tumor subtypes and tracing of tumor boundaries intraoperatively are the key clinical issues. Raman spectroscopy has a good application prospect in the intraoperative diagnosis of brain glioma due to its advantages of nondestructive, label-free, histology imaging and high specificity. In this article, the research and application of Raman spectroscopy in the in vitro diagnosis and intraoperative navigation-related diagnosis and treatment of brain glioma are reviewed.

Application of organic fluorescent probe-assisted near infrared fluorescence imaging in cervical cancer diagnosis / 生物工程学报

Fluorescence imaging has been widely used in the fields of biomedicine and clinical diagnosis. Compared with traditional fluorescence imaging in the visible spectral region (400-760 nm), near-infrared (NIR, 700-1 700 nm) fluorescence imaging is more helpful to improve the signal-to-noise ratio and the sensitivity of imaging. Highly-sensitive fluorescent probes are required for high-quality fluorescence imaging, and the rapid development of nanotechnology has led to the emergence of organic dyes with excellent fluorescent properties. Among them, organic fluorescent probes with the advantages of high safety, good biocompatibility, and high optical stability, are more favorable than inorganic fluorescent probes. Therefore, NIR fluorescence imaging assisted with organic fluorescent probes can provide more structural and dynamic information of biological samples to the researchers, which becomes a hot spot in the interdisciplinary research field of optics, chemistry and biomedicine. This review summarizes the application of NIR organic fluorescent probes in cervical cancer imaging. Several typical organic fluorescent probes (such as indocyanine green, heptamethine cyanine dye, rhodamine and polymer fluorescent nanoparticles) assisted NIR fluorescence imaging and their applications in cervical cancer diagnosis were introduced, and the future development and application of these techniques were discussed.

Predictive value of carotid ultrasound in combination with passive leg raising on fluid responsiveness in critically ill patients / 中华危重病急救医学

Objective:To investigate the value of monitor carotid velocity time integral (VTI) and corrected flow time (FTc) by bedside ultrasound before and after passive leg raising (PLR) in predicting fluid responsiveness in critically ill patients.Methods:A prospective observational study was conducted. Fifty patients with critical illness admitted to the First People's Hospital of Fuyang Hangzhou from January 2020 to March 2021 were enrolled. The clinical data including the gender, age, body mass index (BMI), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, and the duration of mechanical ventilation were recorded. The changes of carotid VTI and FTc were measured by bedside ultrasound, and the values of heart rate, mean arterial pressure (MAP), central venous pressure (CVP), stroke volume index (SVI), and intrathoracic blood volume index (ITBVI) were measured by pulse indicated continuous cardiac output (PiCCO) monitor before and after PLR in all patients. According to the changes of SVI before and after PLR, the patients were divided into fluid responsiveness positive group with the change rate of SVI≥15% and fluid responsiveness negative group with the change rate of SVI < 15%. The differences in the values of VTI, FTc, CVP, and ITBVI obtained before and after PLR (ΔVTI, ΔFTc, ΔCVP and ΔITBVI) were calculated and then compared between the two groups. The predictive values of these indicators on fluid responsiveness in critically ill patients were analyzed by receiver operator characteristic curve (ROC curve), and their relationship with the difference in SVI (ΔSVI) obtained before and after PLR was evaluated by Pearson correlation analysis.Results:Fifty patients were all enrolled in this study, in which 27 patients were fluid response and 23 patients were fluid nonresponse. Basic clinical data were not different between the two groups. The values of ΔVTI, ΔFTc, ΔCVP, and ΔITBVI in fluid response were all significantly higher than those in fluid nonresponse [ΔVTI (cm): 2.07±1.16 vs. 0.67±0.86, ΔFTc (ms): 4.00±6.10 vs. 0.01±2.26, ΔCVP (cmH 2O, 1 cmH 2O = 0.098 kPa): 1.67±1.14 vs. 1.00±1.17, ΔITBVI (mL/m 2): 98±69 vs. 48±70, all P < 0.05]. ROC curve analysis showed that ΔVTI, ΔFTc, ΔCVP and ΔITBVI were all positive for predicting fluid responsiveness, their area under ROC curve (AUC) and 95% confidence interval (95% CI) were 0.870 (0.769-0.972), 0.694 (0.547-0.841), 0.684 (0.535-0.832) and 0.709 (0.564-0.855), respectively. When using ΔVTI 0.92 cm, ΔFTc 1.45 ms, ΔCVP 1.50 cmH 2O and ΔITBVI 44.50 mL/m 2 as the threshold values, the sensitivities were 96.3%, 63.0%, 44.4% and 81.5%, and the specificities were 65.2%, 78.3%, 82.6% and 56.5%, respectively, in which the predictive value of ΔVTI was the largest. Pearson correlation analysis indicated that ΔVTI, ΔFTc, ΔCVP, and ΔITBVI were positively associated with ΔSVI ( r values were 0.971, 0.334, 0.440, 0.650, P values were 0.000, 0.018, 0.001, 0.000, respectively). Conclusion:Carotid ΔVTI and ΔFTc monitored by bedside ultrasound before and after PLR could be as effective as conventional indicators in predicting fluid responsiveness in critically ill patients, and the predictive value of ΔVTI was better than others.

Evaluation of the effect of serratus anterior combined with transversus abdominis plane block in the radical operation of esophageal cancer guided by ultrasound / 中国医师进修杂志

Objective:To evaluate the effect of general anesthesia combined with ultrasound-guided serratus anterior plane block and transversus abdominis plane block of the lower costal margin in minimally invasive radical resection of esophageal cancer.Methods:Forty patients who underwent thoracolaparoscopic minimally invasive radical esophageal cancer radical resection in the Yuying Children′s Hospital, the Second Affiliated Hospital of Wenzhou Medical University from April to June 2020 were selected. According to the random number table, they were divided into nerve block group and control group, with 20 cases in each group. The general anesthesia was the same in the two groups. The nerve block group was blocked at the serratus anterior plane and the bilateral transversus abdominis plane after the induction of general anesthesia. The intraoperative dosages of propofol, remifentanil, and sufentanil were compared between the two groups. The postoperative extubation time, the time of stay in the postanesthesia care unit (PACU), and the postoperative hospital stay were compared between the two groups. The visual analogue scale (VAS) scores under static and coughing conditions 30 min, 2 h, 4 h, 12 h and 24 h after surgery, and the 24 h postoperative intravenous patient-controlled intravenous analgesia (PCIA) drug dosage and the occurrence of nausea and vomiting were compared between the two groups.Results:The intraoperative dosages of propofol, remifentanil and sufentanil in the nerve block group were lower than those in the control group: (1 262.6 ± 163.8) mg vs. (1 388.3 ± 213.2) mg, (3 834.3 ± 477.3) mg vs. (4 175.2 ± 503.4) mg, (56.3 ± 8.2) mg vs. (66.1 ± 5.3) mg, and the differences were statistically significant ( P<0.05). The postoperative extubation time, PACU stay time and postoperative hospital stay in the nerve block group were significantly shorter than those in the control group: (28.6 ± 12.1) h vs. (42.1 ± 13.7) h, (66.8 ± 21.4) h vs. (89.3 ± 35.4) h, (10.4 ± 2.0) d vs. (14.5 ± 7.0) d, and the differences were statistically significant ( P<0.05). The VAS scores of patients in the nerve block group were lower than those in the control group under static and coughing conditions at 30 min and 2, 4, 12, 24 h after the operation, and the differences were statistically significant ( P<0.05). The ratio of total PCIA compressions/effective compressions within 48 h after the operation of the nerve block group and the total amount of analgesic pump drug infusion at 24 and 48 h after the operation were lower than those in the control group: 1.21 ± 0.19 vs. 1.42 ± 0.20, (39.3 ± 3.2) ml vs. (106.5 ± 7.4) ml, (138.5 ± 9.5) ml vs. (211.9 ± 13.7) ml, and the differences were statistically significant ( P<0.05). The incidence of postoperative nausea and vomiting in the nerve block group were lower than those in the control group: 25.0% (5/20) vs. 65.0% (13/20), 10.0% (2/20) vs. 45.0% (9/20), and the differences were statistically significant ( P<0.05). Conclusions:General anesthesia combined with ultrasound-guided serratus anterior plane block and transversus abdominis plane block can reduce the amount of anesthetics and opioid analgesics in minimally invasive radical resection of esophageal cancer, improve the patient′s recovery quality, enhance the operation post-analgesic effect, and accelerate the patient′s recovery.

The network investigation on knowledge, attitude and practice about Novel coronavirus pneumonia of the residents in Anhui Province / 中华预防医学杂志

Objective@#To analyze the current situation of the knowledge, attitudes and practice about Novelcoronavirus pneumonia (NCP) of the residents in Anhui Province. @*Methods@#Anonymous network sampling survey was carried out with an electronic questionnaire that designed by the questionnaire star, and a total of 4016 subjects from Anhui province were investigated. The content of the survey includes that the basic information of subjects,the residents’ knowledge, attitudes and practice about NCP, as well as their satisfaction with the prevention and control measures adopted by the government and health authorities and the suggestions on future prevention. The questionnaire doesn’t involve any privacy information, and all questions were mandatory to ensure the response rate.@*Results@#The M (P25, P75) age the 4016 subjects was 21 (19, 24), and the ranging from 7 to 80 years old. The number of males was1431(35.6%). Social networking tools such as WeChat and QQ were the main sources of epidemic information for residents (97.8%, 3 929 respondents). Residents have a high awareness rate of the main symptoms, transmission routes, using of masks, hand washing and treatment information of NCP, while a low awareness rate of the atypical symptoms. 92.6% of the subjects (n=3 720) think that the outbreak was scary. In terms of psychological behavior scores, the results showed that female (9.38±4.81), the urban (9.37±5.02) and the medical workers (10.79±5.19) had a poorer mental health than the male (8.45±5.00) , the rural (8.71±4.75) and the non-medical workers (the students: 8.85±4.83; public institude workers: 9.02±5.08; others: 8.97±5.39) (P < 0.05). 71.9% of the residents (n=2 887)were satisfied with the local epidemic control measures. The residents took various of the measures to prevent and control the epidemic. The ratio of residents that could achieve "no gathering and less going out" , "wear masks when going out" and "do not go to crowded and closed places" was up to 97.4% (n=3 913), 93.6% (n=3758) and 91.5% (n=3 673) respectively.@*Conclusion@#The residents in Anhui province have a good KAP about NCP, yet it is necessary to strengthen the community publicity, the mental health maintenance of residents and students’ health education.

The network investigation on knowledge, attitude and practice about Novel coronavirus pneumonia of the residents in Anhui Province / 中华预防医学杂志

Objective@#To analyze the current situation of the knowledge, attitudes and practice about Novelcoronavirus pneumonia (NCP) of the residents in Anhui Province.@*Methods@#Anonymous network sampling survey was carried out with an electronic questionnaire that designed by the questionnaire star, and a total of 4016 subjects from Anhui province were investigated. The content of the survey includes that the basic information of subjects,the residents’ knowledge, attitudes and practice about NCP, as well as their satisfaction with the prevention and control measures adopted by the government and health authorities and the suggestions on future prevention. The questionnaire doesn’t involve any privacy information, and all questions were mandatory to ensure the response rate.@*Results@#The M (P25, P75) age the 4016 subjects was 21 (19, 24), and the ranging from 7 to 80 years old. The number of males was1431(35.6%). Social networking tools such as WeChat and QQ were the main sources of epidemic information for residents (97.8%, 3 929 respondents). Residents have a high awareness rate of the main symptoms, transmission routes, using of masks, hand washing and treatment information of NCP, while a low awareness rate of the atypical symptoms. 92.6% of the subjects (n=3 720) think that the outbreak was scary. In terms of psychological behavior scores, the results showed that female (9.38±4.81), the urban (9.37±5.02) and the medical workers (10.79±5.19) had a poorer mental health than the male (8.45±5.00) , the rural (8.71±4.75) and the non-medical workers (the students: 8.85±4.83; public institude workers: 9.02±5.08; others: 8.97±5.39) (P < 0.05). 71.9% of the residents (n=2 887)were satisfied with the local epidemic control measures. The residents took various of the measures to prevent and control the epidemic. The ratio of residents that could achieve "no gathering and less going out" , "wear masks when going out" and "do not go to crowded and closed places" was up to 97.4% (n=3 913), 93.6% (n=3758) and 91.5% (n=3 673) respectively.@*Conclusion@#The residents in Anhui province have a good KAP about NCP, yet it is necessary to strengthen the community publicity, the mental health maintenance of residents and students’ health education.

A multicenter study on nutritional risk and nutritional therapy strategy in patients with chronic obstructive pulmonary disease undergoing mechanical ventilation / 中国中西医结合急救杂志

Objective To investigate the relationship between nutritional risk status and implementation of nutrition therapy in mechanical ventilated (MV) chronic obstructive pulmonary disease (COPD) patients, so as to provide evidence for individualized nutrition therapy. Methods A prospective multicenter observational study was conducted. MV COPD patients admitted to Department of Intensive Care Units (ICU) of 10 County Hospitals in Zhejiang Province from January 2015 to January 2016 were enrolled, and according to nutrition risk screening 2002 (NRS2002) score, they were divided into nutritional high risk group (NRS2002 3-5) and nutritional extremely high risk group (NRS2002 6-7). Nutrition therapy situation and hospital mortality were compared between the two groups; multivariate Cox regression analysis was used to analyze the risk factors affecting the prognosis of patients with COPD under mechanical ventilation. Kaplan-Meier curve was used to analyze the prognosis at 30 days; receiver operating characteristic (ROC) curve was used to test the robustness of multivariable regression analysis. Results ① One hundred and six COPD patients with MV were analyzed; among them, 90 patients were in the nutritional high risk group, and 16 were in the nutritional extremely high risk group. There were no significant differences in age, gender and body mass index (BMI) between the two groups (all P > 0.05); the acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, NRS2002 score in patients of nutrition risk extremely high group were obviously higher than that in patients with nutrition high risk group (APACHEⅡ: 24.9±6.1 vs. 20.3±5.8, NRS2002 score: 6.3±0.5 vs. 4.2±0.8, both P < 0.05). ② Patients in both groups received early enteral nutrition (EN) therapy, the proportion of patients in nutritional extremely high risk group received early EN was lower than that of patients in the nutritional high risk group [12.5% (2/16) vs. 17.7% (16/90)], along with the prolongation of hospital stay, the proportions of patients beginning to receive the EN were gradually increased in the nutrition extremely high risk group and high risk group, after 2 days the EN increased significantly, and reached the highest value on day 6 after entering ICU [100.0% (16/16), 98.9% (89/90), respectively]; within 3 days after admission into ICU, the proportion of EN in nutrition extremely high risk group was obviously lower than that in nutrition high risk group, and from day 4, there was no statistical significant difference in proportion of EN between the two groups (all P > 0.05). The time to start parenteral nutrition (PN) treatment was relatively early admission to the ICU on day 1 and the proportion of this therapy was high in the two groups [56.2% (9/16), 27.7% (25/90), respectively], the PN proportion did not decrease with the length of hospitalization and the increase of EN. The proportion of patients in the nutrition extremely high risk group who started PN treatment was higher, which reached 56.2% admission to the ICU on day 1.③ With extension of hospital stay, the calories of EN were gradually increased in the nutritional high risk group, the highest calories in nutritional high risk groups was 4 318 (3 912, 4 812) kJ/d at day 7; while the highest calories in nutritional extremely high risk groups was 3 602 (2 167, 4 615) kJ/d at day 6 and a slight decreased at day 7; the difference of calories within the first week between the two groups had no significance (all P > 0.05). The calorific value of PN therapy remained at a constant level during hospitalization within 7 days, and after admission into ICU for 4-5 days, the target range of calories was achieved. ④ Kaplan-Meier survival curve analysis showed that the mortality at 30 days in the extremely high risk group was significantly higher than that in the high risk group [62.5% (10/16) vs. 11.1% (10/90), χ2 = 15.4, P < 0.01]. ⑤ Multiple cox-regression analysis showed that NRS2002 scoring was the independent risk factor affecting the mortality of patients in hospital [odds ratio (OR) = 2.08, 95% confidence interval (95%CI) = 1.39-3.12, P = 0.005]. ⑥ ROC curve analysis: according to ROC curve analysis of the effectiveness of multi-factor regression model, area under ROC curve (AUC) was 0.79, sensitivity was 70.00%, specificity was 74.42%, positive likelihood ratio was 2.74, negative likelihood ratio was 0.40, 95% confidence interval (95%CI) was 0.702-0.864, P = 0.001, and it showed that the regression model had a good prediction effect. Conclusions MV COPD patients have significant nutritional risk and all receive early EN therapy. The proportion of beginning to use PN treatment in patients with nutritional extremely high risk is relatively high. Initial nutritional status is the independent risk factor of poor prognosis in MV patients with COPD.

Effectiveness of glucosamine chondroitin sulfate calcium tablets for knee osteoarthritis / 中华创伤骨科杂志

Objective To study the effectiveness,side effects and safety of glucosamine chondroitin sulfate calcium (Keylid(R)) tablets for osteoarthritis of the knee.Methods To review the clinical data of 103 cases of primary knee osteoarthritis who had been treated between March 2013 and February 2014.The intervention group included 53 cases (23 males and 30 females with an age of 71.0 ± 9.1 years) who received Keylid(R) tablets (2 tablets twice per day) accompanied with exercise therapy for 24 weeks;the control group included 50 cases (22 males and 28 females with an age of 69.8 ± 8.8 years) who received placebo (2 tablets twice per day) accompanied with exercise therapy for 24 weeks.No NSAIDs,calcium or other articular dietary supplements were taken by the 2 groups during the study period.T-test was used to analyse the results.Results After treatment,the range of knee motion for the intervention group (123.27° ± 10.22°) was significantly larger than that for the control group (116.34° ± 8.76°),and the average pain visual analogue score after 40 m walking for the former (2.92 ± 0.36) significantly lower than that for the latter (3.30 ± 0.22) (P ＜ 0.05).There were no significant differences between the 2 groups in Western Ontario and McMaster Universities Arthritis Index,time for 40 m walking or circumference of the knee (P ＞ 0.05).No side effects were observed in either group during the study period.Conclusion Keylid(R) tablets complemented with exercise therapy may reduce pain and improve knee function with no adverse events in the patients with knee osteoarthritis.

Analysis of the difference between indirect calorimetry and predicted energy estimation in patients with chronic obstructive pulmonary disease / 中华危重病急救医学

Objective To analyze the difference between indirect calorimetry (IC) and predicted energy estimation in patients with chronic obstructive pulmonary disease (COPD), and its possible factors affecting the difference, to provide reasonable energy supply basis for COPD patients. Methods A prospective cohort study was conducted. Twenty-six patients with COPD undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Hangzhou City Fuyang District First People's Hospital in Zhejiang Province from January to December in 2016 were enrolled. The energy values of patients were calculated by IC and predicted energy estimation, respectively. According to the degree of IC values deviating from the predicted energy estimation, the patients were divided into energy approaching group (IC values deviating from the empirical energy estimation ≤15%) and energy deviation group (IC values deviating from the empirical energy estimation > 15%). Bland-Altman diagram was drawn, and the consistency of the energy target values assessing by two methods was analyzed. The factors influencing the energy value deviation of the two measuring methods were screened by the multivariate Logistic regression and linear regression analysis. Results Twenty-six patients were enrolled in the final analysis. The energy target value of IC was significantly higher than that of predicted energy estimation (kJ: 7 079.3±1 213.4 vs. 6 527.0±949.8), and the difference between two values was statistically significant (P < 0.01). Bland-Altman heterogeneity analysis showed that the overall consistency of the energy values between the predicted energy estimation and IC was quite good. There were 14 patients in energy approaching group, and 12 in energy deviation group. There was no significant difference in gender, age, body mass index (BMI), type of COPD, or acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score between the two groups. In energy deviation group, the IC value of patients was significantly higher than predicted energy estimation (kJ: 7 711.1±1 125.5 vs. 6 556.3±907.9, P < 0.01). However, in energy approaching group, there was no significant difference between the energy values of IC and predicted energy estimation (kJ: 6 539.6±1 037.6 vs. 6 501.9±1 016.7, P > 0.05). Multivariate Logistic regression analysis showed that APACHEⅡ score was an independent risk factor inducing the deviation of energy evaluation between IC and predicted energy estimation [odds ratio (OR) = 1.403, 95% confidence interval (95%CI) =1.019-1.932, P = 0.038]. Multivariate linear regression analysis showed that the APACHEⅡ score increased by 1, and the energy deviation increased by 2.0 kJ (β = 0.476, 95%CI = 0.004-0.956, P = 0.047). Conclusions For patients with COPD, there was a good correlation between predicted energy estimation and the resting energy expenditure measured by IC. APACHE Ⅱ score was an independent risk factor inducing the deviation of energy evaluation between IC and predicted energy estimation. It is suggested that the target value of energy should be determined by IC for patients with high APACHE Ⅱ score.

Effect of dexmedetomidine hydrochloride on hemodynamics,immune function and inflammatory factors in patients gynecological laparoscopic operation / 中国基层医药

Objective To investigate the effect of dexmedetomidine hydrochloride on hemodynamics,immune function and inflammatory factors in patients with gynecological laparoscopic operation.Methods According to the random comparison table,86 elderly patients with gynecological laparoscopic operation were divided into observation group(43cases) and control group(43cases).The observation group received conventional general anesthesia,and intravenously pumped with dexmedetomidine hydrochloride.The the control group received conventional general anesthesia,and intravenously pumped with normal saline.The changes of hemodynamics,immune function and inflammatory factors were observed and compared in different periods in the two groups.Results Compared with before induction,the level of HR increased significantly at intubation(t=-3.257,-5.019,all P0.05),the level of MAP increased significantly at intubation in control group(t=-2.122,P0.05);Compared with before induction,the levels of CRP and IL-6 increased significantly at after operation and 24 h after operation in the two groups(CRP:t=-9.974,-16.872;IL-6:t=-7.284,-11.449,all P0.05),the levels of CD+3,CD+4,CD+4/CD+8 and NK decreased significantly after operation in the control group(t=11.514,10.317,9.180,6.815,all P<0.05),there were statistically significant differences after operation in the two groups(t=10.232,10.298,7.728,4.900,all P<0.05),and the level of NK decreased significantly at 24h after operation in the control group(t=4.362,P<0.05).Conclusion Dexmedetomidine hydrochloride can keep hemodynamics stability,reduce immune function damage and inflammation.

Accelerating the professional clinical research team building in the process of transforming towards research-oriented hospitals / 上海交通大学学报（医学版）

Building a professional clinical research team inside hospitals is in favor improving their research abilities,accelerating the clinical discipline construction,improving their comprehensive influence.Also it fits the objective of general hospital development under gate-keeping system.Now in domestic,the percentage of professional research staff in large hospitals accounts was much less than the international level.The main reasons included the misunderstanding of constructing the research-oriented hospitals,insufficient human resources enrollment,less attractive environment to the highlevel researchers and the absence of relevant degree training programs.To enhance the construction of research-oriented hospitals,it's of key importance to build the professional research team in hospitals.Besides,the hospital has to update management conception,broaden the channels of talent cultivation,grasp the development of the subject accurately and interact with the basic medicine and public health subject,increase the financial investment and perfect the relevant management regulations.

Correlation analysis of bacterial resistance and antibiotic consumtion in our hospital / 中国生化药物杂志

Objective To investigate the drug resistance of bacteria clinically isolated from Yuyao people's hospital and its relationship with antibiotic consumption, in order to provide basis for rational use of antibiotics in clinic.MethodsA total of 3178 strains of bacteria were detected in our hospital from the third quarter of 2015 to the second quarter of 2016.The drug resistance of bacteria, the consumption of antibacterial agents in each quarter, and their relationships were analyzed.ResultsThe major isolated bacteria was gram-negative bacteria, among which constituent ratio of Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa ranked the top 4.Gram-negative bacteria's resistance rates of several antibiotics were positively correlated with the utility rate of quinolones, and also had a different degree of positive correlation with the use of beta lactamase/inhibitor, aminoglycosides and carbapenems.Staphylococcus were the mainly gram positive bacteria, whose resistance rates to penicillin, ciprofloxacin, levofloxacin and erythromycin were positively correlated with the usage of the same type of antibiotics.ConclusionBacterial resistance rates are closely associated with the consumption of antimicrobials.Selecting antibacterial agents reasonably according to the results of drug susceptibility test is important to control the drug resistance of bacterial.

The situation about cognitive performance of critical care staffs in nutrition therapy for mechanical ventilated COPD patients in county hospitals / 中华急诊医学杂志

Objective To investigate the situation about cognitive performance of critical care staffs in nutrition therapy for mechanical ventilated chronic obstructive pulmonary disease (COPD) patients in county hospitals.Methods A chart of questionnaire about nutrition therapy was formulated according to the current guidelines.Critical care staffs from 12 hospitals of county-level of Hang Zhou city were enrolled.The role of staffs in management of nutritional therapy for patients was observed to assess their cognitive performance and influence factors were analyzed according logistic analysis.Results A total of 137 staffs were enrolled.Almost all of the staffs thought that nutrition therapy for ventilated COPD patients was very important.About 90％ of the staffs never heard about the use of NRS2002 (nutritional risk screening 2002)to evaluation COPD patients but the rate of using it was higher among senior staffs (OR =1.08,95％ CI:1.01-1.16,P =0.04).Most of staffs assess the nutritional status of patients according to biomarkers and other methods.However,doctors might assess nutritional status more often according to their experience.The majority of staffs did choose enteral nutrition for patients especially seen in doctors and senior staffs (OR =3.10 and1.13,95％ CI:1.27-7.55 and 1.03-1.23,both P =0.01).For those without malnutrition,senior staffs did not choose parenteral nutrition (OR =0.14,95％ CI:0.04-0.57,P =0.01).Besides,senior staffs did not continue the enteral nutrition in patients with unstable haemodynamics (OR =1.10,95％ CI:1.03-1.16,P =0.002).Most of staffs considered that the head piece of bed was raised up to 30-45 degree and gastric residual volume monitoring was very important.However,compared with nurses,the cognitive performance of doctors was poorer (OR =0.39,95％ CI:0.18-0.83,P =0.01).Most of staffs thought that the nutrition therapy implementation checklist was necessary but it was used in only 20％ institutions.The understanding and demand for nutritional knowledge was more urgent among doctors than nurses (OR =3.13 and 5.33,95％ CI:1.45-6.75 and 1.13-25.02,P =0.004 and 0.03).Conclusions Nutrition therapy was important for ventilated COPD patients,but the staffs were not very familiar with nutritional knowledge.The cognitive performance of medical staffs was influenced by their profession and experience of practice.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy with spinal cord lesion: A case report and literature review

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy(CADASIL)is a common hereditary disease caused by NOTCH3 gene. The major clinical manifestations includerecurrent small-vessel ischaemic events, migraine, dementia and mood disturbance. Herein, wereport a 32-years-old male presented with right leg weakness and persistent migraine. We carried outneurological exams, genetic testing, blood and cerebrospinal fluid analysis (CSF) as well as magneticresonance imaging (MRI) for the brain and spinal cord. There were no anti-aquaporin-4 antibodiesand oligoclonal bands in the CSF and blood investigations were within the normal range. MRI scansrevealed multiple hyperintense regions in the brain and longitudinally hyperintense signal in spinal cord.Further, we identified a c.383G>A(p.Cys128Tyr) mutation in NOTCH3 gene. Therefore, the patientwas diagnosed with CADASIL concurrent with spinal cord lesion. The patient’s condition slightlyimproved after two weeks treatment with daily dosage of 0.5 g citicoline and 75 mg clopidogrel.

Hereditary spastic paraplegia with SPG30 mutation: A report from North East China

Hereditary spastic paraplegia is a heterogeneous group of genetic neurodegenerative disorders of the nervous system. It is classified into four subtypes based on the mode of inheritance; and among them, most autosomal recessive hereditary spastic paraplegia cases are due to type SPG11 and SPG15 gene mutations. Autosomal recessive hereditary spastic paraplegia cases with SPG30 gene mutation have never been reported in China. Herein, we present our experience with a case of hereditary spastic paraplegia with SPG30 gene mutation in our hospital from North East China. In this patient we detected a missense mutation of c.499 C>T (p.Arg167Cys) in gene KIF1A, a causative gene of type SPG30.

Analysis on clinical effect of breviscapine in patients with septic shock complicating acute renal injury / 重庆医学

Objective To investigate the effects of breviscapine on the expression of urine Kim‐1 and NGAL in the patients with septic shock complicating renal injury .Methods A total of 66 cases patients with septic shock complicating acute kidney inju‐ry(AKI) in our hospital from May 2013 to May 2015 were selected and randomly divided into the intervention group and control group according to the random number table ,33 cases in each group .All cases were given the standardized therapy of septic shock . On this basis the intervention group was given the intravenous drip of breviscapine .The clinical curative effects were compared be‐tween the two groups .Results The level of Kim‐1 and NAGL were risen after 1 d of treatment ,but began to gradually drop on 3 d of treatment ,the levels of Kim‐1 and NAGL on 3 ,5 ,7 ,9 d had statistical differences between the two groups (P<0 .05);in the in‐tervention group ,5 cases died ,while 6 cases in the control group died .The ICU stay time ,cases number needing dialysis ,dialysis times and dialysis curative time in the control group were more than those in the intervention group ,the differences were statistical‐ly significant(P< 0 .05) .Conclusion Breviscapine could reduce the expression of Kim‐1 and NGAL in the patients with septic shock complicating AKI and promote the recovery of renal function .

Determination of the Genotoxicity Impurity in Mesylate Nafamostat Raw Materia by GC-MS / 中国药房

OBJECTIVE:To establish a method for determination the genotoxicity impurities (methyl methanesulfonate,ethyl methanesulfonate and isopropyl methanesulfonate) in mesylate nafamostat raw materia. METHODS:GC-MS was conducted,and the genotoxicity impurities were extracted by dichloromethane. The column was DB-5 capillary column by programmed tempera-ture,the inlet temperature was 240 ℃,column flow was 3.0 ml/min,purge flow was 6.0 ml/min,sample mode splitless injection, carrier gas was high purity helium,detector is a mass spectrometer detector,ion source temperature was 230 ℃,the interface tem-perature was 230 ℃,the delay time of solvent was 2.5 min,ionization mode was electron impact,detector voltage was respect to the tuning results,scanning(detection)method was selective ion monitoring,electron energy was 70 eV,and the injection volume was 1.0μl. RESULTS:The separation degree of 3 impurities were greater than 2.0;the linear range of 3 impurities were 0.10-20μg/ml (r≥0.999 5);RSDs of precision,stability and reproducibility tests were lower than 2%;recoveries were 97.7%-104.8%(RSD=2.8%, n=9),102.5%-110.7%(RSD=2.6%,n=9)and 103.0%-107.6%(RSD=1.6%,n=9). CONCLUSIONS:The method is simple, accurate,sensitive and rapid,and can be used for the genotoxicity impurities in mesylate nafamostat raw materia.

Identifying the injury in demyelinating cervical spinal cord disease: A diffusion tensor imaging and tractography study

Background & Objectives: Multiple sclerosis (MS), neuromyelitis optica (NMO) and acute transverse myelitis (ATM) are common diseases in neurology; however their corresponding cervical spinal cord involvements are still ambiguous. The purpose of this study was to demonstrate the utility of diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in identifying the injury in cervical spinal cord. Methods: Nine patients and nine healthy volunteers were enrolled in this study. Conventional sequences and DTI scan were performed on each participant. Results: The average fractional anisotrophy (FA) values of the cervical cord in patients with acute cerebral type MS, acute or stationary cerebrospinal type MS, acute NMO, or acute ATM were all significantly decreased relative to the control group (p <0.05). As to the cerebrospinal type MS, the changes in acute-stage patients were more apparent (p <0.05). The average FA value of the cervical cord in acute NMO was decreased more extensively, involving the normal-appearing spinal cord (p <0.05). In patients with MS or NMO, The lesions showed significantly hypointense on FA images and directionally encoded color (DEC) images, nevertheless the pathological areas on DTI images were no significantly different from those on routine sequences. On DTT, the fiber tracts in the lesion-involved regions were all sparser than that in control regions, nevertheless interruption or impairment of fiber tracts could only be noted in NMO patients. Bilateral differences of average FA values in the cervical cord was noted in one case with ATM and another case with MS (p <0.05), and the decrease of FA values was significant in the main side of clinical presentations. Conclusion: DTI and DTT may be a sensitive measure for early cervical injury in MS, NMO and ATM

rare case of pituitrin-induced delayed encephalopathy

A 26-year-old girl was admitted to the Neurological Department of The First Teaching Hospital of Jilin University with complaints of rapidly deteriorating speech clumsiness for 18 days

Five Days before her attack she had undergone intramuscular pituitrin therapy on account of recurrent haemoptysis. Cranial MRI revealed multiple abnormal signals in bilateral hemisphere and symmetric abnormal signal in bilateral caudate nucleus and putamen

Serum electrolyte analysis revealed mild hyponatremia

The abnormal signals in bilateral hemisphere almost disappeared after 7 days of cerebral circulation ameliorating and serum electrolyte turbulence correcting therapy, whereas the symmetric abnormal signals in bilateral caudate nucleus and putamen still existed. A diagnosis of delayed encephalopathy was made and we presume the encephalopathy was associated with pituitrin therapy

Clinical analysis of 48 cases of kidney transplantation from cardiac death donors / 中南大学学报(医学版)

OBJECTIVE@#To evaluate the recovery of patients with end-stage renal disease (ESRD) receiving kidney transplant from cardiac death donors, and to assess graft survival in China from this type of donor.@*METHODS@#A total of 48 cases of patients with ESRD have received the kidneys from cardiac death donors in our hospital between February 2010 and March 2012. We retrospectively analyzed data on the preoperative and postoperative serum creatinine concentrations, on the survival of recipients and allografts with a view to investigating prognoses after this type of kidney transplant.@*RESULTS@#Primary non-function (PNF) did not occur in any of the 48 recipients. Delayed graft function (DGF) occurred in 18 of 48 (37.5%) of kidneys from cardiac death donors, but the occurrence of DGF did not adversely influence patient's survival (P=0.098) or graft survival (P=0.447). Seven of 48 (14.6%) recipients lost their graft. Over a median follow-up period of 8 months (range 0.5-23 months), 39 of 41(95.1%) recipients' graft function had fully recovered. The actuarial graft and patient's survival rates at 1, 3, 6 and 12 months after transplantation were 95.7%, 93.0%, 90.0%, 87.5%, and 100%, 94.9%, 90%, 87.5%, respectively.@*CONCLUSION@#As the legislation of donation after brain death (DBD) has not been ratified in China, the use of kidneys from cardiac death donors might be an effective way to increase the number of kidneys available for transplantation here. Our experience indicates good short- and mid-term outcomes with transplants from cardiac death donors.