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1.
Article in Chinese | WPRIM | ID: wpr-879265

ABSTRACT

The high frequency oscillatory ventilation (HFOV) is characterized with low tidal volume and low mean airway pressure, and can well support the breathing of the patients with respiratory diseases. Since the HFOV was proposed, it has been widely concerned by medical and scientific researchers. About the HFOV, this paper discussed its current research status and prospected its future development in technologies. The research status of ventilation model, mechanisms and ventilation mode were introduced in detail. In the next years, the technologies in developing HFOV will be focused on: to develop the branched high-order nonlinear or volume-depended resistance-inertance-compliance (RIC) ventilation model, to fully understand the mechanisms of HFOV and to achieve the noninvasive HFOV. The development in technologies of HFOV will be beneficial to the patients with respiratory diseases who failed with conventional mechanical ventilation as one of considerable ventilation methods.


Subject(s)
High-Frequency Ventilation , Humans , Lung , Respiration, Artificial , Respiratory Distress Syndrome, Newborn , Tidal Volume
2.
Journal of Clinical Hepatology ; (12): 1164-1168., 2021.
Article | WPRIM | ID: wpr-876664

ABSTRACT

ObjectiveTo investigate the clinical and prognostic features of hypertriglyceridemic pancreatitis (HTGP) during pregnancy. MethodsA total of 77 patients with acute pancreatitis in pregnancy who were admitted to The Affiliated Hospital of Southwest Medical University from January 2013 to June 2020 were enrolled as subjects, and according to the presence or absence of HTGP, they were divided into HTGP group with 38 patients and non-HTGP group with 39 patients. The two groups were compared in terms of the clinical features including age, pregnancy, laboratory markers, complication, and prognostic indices. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups, and the Mann-Whitney U test was used for comparison of ranked data between two groups. According to the trimester of pregnancy, the patients were divided into early pregnancy group with 4 patients, middle pregnancy group with 14 patients, and late pregnancy with 59 patients, and blood lipid levels were compared between groups; the Kruskal-Wallis H test was used for comparison between two groups or within each group. ResultsCompared with the non-HTGP group, the HTGP group had significantly higher mean age (t=-3.000, P=0.004) and proportion of patients with diabetes (χ2=8.867, P=0.003). Compared with the non-HTGP group, the HTGP group had a significantly higher proportion of patients with disease onset in the third trimester (P<0.001) and a significantly lower serum level of sodium (Z=-6.328, P<0.001). Compared with the non-HTGP group, the HTGP group had significantly higher incidence rates of acute peripancreatic fluid collection (76.3% vs 33.3%, χ2=14.342, P<0.001) and systemic inflammatory response syndrome (81.6% vs 410%, χ2=13.310, P<0.001). There were significant differences between the two groups in the length of hospital stay, the rate of admission to the intensive care unit, and hospital costs (Z=-2.077, χ2=11.537, Z=-3.525, all P<0.05). The levels of total cholesterol and triglyceride in the third trimester were significantly higher than those in middle pregnancy (both P<0.05). ConclusionCompared with the non-HTGP group, the HTGP group has a higher proportion of patients with disease onset in the third trimester of pregnancy, a higher risk of complications, a longer length of hospital stay, and higher hospital costs.

3.
Article in Chinese | WPRIM | ID: wpr-869842

ABSTRACT

Objective:To evaluate the value of controlled low central venous pressure (CLCVP) in laparoscopic hepatectomy within an enhanced recovery after surgery (ERAS) programme.Methods:Sixty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, of liver function Child-Pugh grade A, with New York Heart Association classⅠor Ⅱ, scheduled for elective laparoscopic hepatectomy with an expected surgery time 3-5 h, were divided into 2 groups ( n=30 each) using a random number table method: CLCVP-ERAS group (group CE) and routine ERAS group (group E). In group CE, the central venous pressure was maintained less than 5 cmH 2O through using restricted fluid replacement, adjusting the position, giving the vasodilator and etc.In group E, the central venous pressure was maintained at 5-12 cmH 2O.Arterial blood samples were then collected before operation and at 1 and 4 days after operation for determination of parameters of hepatic and renal functions.The volume of fluid infused before and after liver resection, total volume of intraoperative fluid infused, blood loss, blood transfusion, duration of surgery, postoperative time to first flatus, off-bed time, length of hospitalization and total cost of hospitalization were recorded. Results:Compared with group E, the volume of fluid infused before liver resection, total volume of intraoperative fluid infused, blood loss, and blood transfusion were significantly decreased, the volume of fluid infused after liver resection was increased, the duration of surgery, time to first flatus after operation, off-bed time and length of hospitalization were shortened, and the total cost of hospitalization was reduced ( P<0.05), and no significant change was found in the parameters of hepatic and renal functions in group CE ( P>0.05). Conclusion:CLCVP is helpful for the rapid recovery of patients without obvious adverse reactions when used for laparoscopic hepatectomy within an ERAS programme.

4.
Article in Chinese | WPRIM | ID: wpr-774193

ABSTRACT

Traditionally, adequate tidal volume is considered to be a necessary condition to support respiratory patient breathing. But the high frequency ventilation (HFV) with a small tidal volume can still support the respiratory patient breathing well. In order to further explore the mechanisms of HFV, the pendelluft ventilation between left and right lungs was proposed in this paper. And a test platform by using two fresh sheep lungs was developed for investigating the pendelluft ventilation between the left and right lungs. Furthermore, considering the viscous resistance ( ), inertance ( ) and lung compliance ( ) in the lung, a second-order lung ventilation model was designed to inspect and evaluate the pendelluft ventilation between left lung and right lungs. On referring to both results of experiments in practice and simulation in MATLAB Simulink, between the left and right lungs, the phase difference in their airflow happens during HFV at some frequencies. And the pendelluft ventilation between the left and right lungs is resulted by the phase difference, even if the total airflow entering a whole lung is 0. Under HFV, the pendelluft ventilation between left and right lungs will benefit the lungs being more adequately ventilated, and will be improve the utilization rate of oxygen in the lungs.


Subject(s)
Animals , High-Frequency Ventilation , Humans , Lung , Physiology , Pulmonary Gas Exchange , Respiration, Artificial , Sheep , Tidal Volume
5.
Chinese Journal of Geriatrics ; (12): 836-839, 2019.
Article in Chinese | WPRIM | ID: wpr-755424

ABSTRACT

Objective To investigate clinical significance of procalcitonin (PCT)in the early diagnosis of acute left heart failure complicated with pulmonary infection in the elderly.Methods A total of 113 patients with acute left heart failure or acute left heart failure complicated with pulmonary infection who were admitted into our emergency department from August 2012 to February 2018 were retrospectively analyzed.Data of serum concentration of PCT were collected on the first and third days after admission.The diagnostic values of serum PCT and C-reaction protein(CRP)were evaluated based on the patient's diagnostic data.ROC curves were plotted for PCT,and its cut-off value was calculated.Results Serum levels of PCT on the first and third days after admission were higher in pulmonary infection group than in left heart failure group[(2.45±0.42) μg/L vs.(0.54±0.03) μg/L,(1.25±0.17) μg/L vs.(0.43±0.03) μg/L,t =34.27 and 35.78,P=0.000 and 0.000].The diagnostic specificity,positive predictive value,and negative predictive value of PCT were better than those of CRP(x2 =4.97,4.76 and 4.17,P =0.030,0.030 and 0.040).There was no significant difference in the diagnostic sensitivity between PCT and CRP (x2 =3.05,P =0.080).The best diagnostic cut-off value of PCT was 0.597 μg/L in which the sensitivity of diagnosis of heart failure complicated with pneumonia was 91.07% and the specificity was 90.77%.Conclusions Serum PCT test can assist the early diagnosis of acute left heart failure complicated with pulmonary infection in elderly patients with high sensitivity and specificity.The best diagnostic cut-off value of PCT is 0.597 μg/L.Based on serum PCT test,early rational use of antibiotics for controlling acute left heart failure complicated with pulmonary infection in elderly patients is worthy of generalization.

6.
Article in Chinese | WPRIM | ID: wpr-755103

ABSTRACT

Objective To evaluate the effect of down-regulating SALL4 on the radiosensitivity of leukemia cells,aiming to provide new ideas for improving radiosensitivity of leukemia patients.Methods Human acute myeloid leukemia cell line HL-60 infected with shRNA SALL4 and shRNA control lentivirus was classified into the Lv-shSALL4 group and Lv-shNC group.The levels of SALL4 mRNA and protein in cells were detected by RT-PCR and Western blot.The infected cells treated with 8 Gy dose irradiation were assigned into the Lv-shSALL4 + radiation and Lv-shNC+radiation groups.The cell apoptosis was detected by flow cytometry.The levels of cleaved Caspase-3,cleaved Caspase-9 and Bax proteins in cells were determined by Western blot.The cells in the Lv-shSALL4 and Lv-shNC groups were exposed to 0,2,4,6 and 8 Gy irradiation.The radiosensitivity ratio was determined by cell clone test.Results The level of SALL4 in the Lv-shSALL4 group was significantly lower than that in the Lv-shNC group (P<0.05).The cell apoptosis rate was significantly increased,the levels of cleaved Caspase-3,cleaved Caspase-9 and Bax proteins were remarkably up-regulated in cells compared with those in the Lv-shNC group (all P< 0.05).The cell proliferation ability in the Lv-shSALL4 + radiation was significantly reduced,the cell apoptosis rate was considerably increased,the levels of cleaved Caspase-3,cleaved Caspase-9 and Bax proteins were significantly up-regulated compared with those in the Lv-shSALL4 and Lv-shNC+ radiation groups (all P<0.05).The cell radiosensitization ratio in the Lv-shSALL4 group was 1.323.Conclusion Down-regulating SALL4 can increase the radiosensitivity of leukemic cells,inhibit the cell proliferation and induce the apoptosis of leukemic cells.

7.
Article in Chinese | WPRIM | ID: wpr-799996

ABSTRACT

Post-payment for patients can minimize their errands and improve their medical experience. Since February 2019, Hangzhou Municipal Health Commission began to try the " post-payment" service. This mode is integrated into the municipal credit system, and the patients can obtain the corresponding credit line according to their credit rating. Within such line, the patient can pay only once for all their medical services received per visit. The mode covers all Hangzhou residents with credit rating and has served nearly 20 million outpatient and emergency patients with expedient services. Thanks to the reform, the number of payment for patients to see a doctor reduced from an average of 2 to 3 times to only 1 time. It is proved that the credit system can realize payment after medical service and it is controllable.

8.
Article in Chinese | WPRIM | ID: wpr-797689

ABSTRACT

Objective@#To evaluate the effect of down-regulating SALL4 on the radiosensitivity of leukemia cells, aiming to provide new ideas for improving radiosensitivity of leukemia patients.@*Methods@#Human acute myeloid leukemia cell line HL-60 infected with shRNA SALL4 and shRNA control lentivirus was classified into the Lv-shSALL4 group and Lv-shNC group. The levels of SALL4 mRNA and protein in cells were detected by RT-PCR and Western blot. The infected cells treated with 8 Gy dose irradiation were assigned into the Lv-shSALL4+ radiation and Lv-shNC+ radiation groups. The cell apoptosis was detected by flow cytometry. The levels of cleaved Caspase-3, cleaved Caspase-9 and Bax proteins in cells were determined by Western blot. The cells in the Lv-shSALL4 and Lv-shNC groups were exposed to 0, 2, 4, 6 and 8 Gy irradiation. The radiosensitivity ratio was determined by cell clone test.@*Results@#The level of SALL4 in the Lv-shSALL4 group was significantly lower than that in the Lv-shNC group (P<0.05). The cell apoptosis rate was significantly increased, the levels of cleaved Caspase-3, cleaved Caspase-9 and Bax proteins were remarkably up-regulated in cells compared with those in the Lv-shNC group (all P<0.05). The cell proliferation ability in the Lv-shSALL4+ radiation was significantly reduced, the cell apoptosis rate was considerably increased, the levels of cleaved Caspase-3, cleaved Caspase-9 and Bax proteins were significantly up-regulated compared with those in the Lv-shSALL4 and Lv-shNC+ radiation groups (all P<0.05). The cell radiosensitization ratio in the Lv-shSALL4 group was 1.323.@*Conclusion@#Down-regulating SALL4 can increase the radiosensitivity of leukemic cells, inhibit the cell proliferation and induce the apoptosis of leukemic cells.

9.
Article in Chinese | WPRIM | ID: wpr-700249

ABSTRACT

Objective To observe the benefits and safety of different maintenance doses of azithromycin for long-term treatment in adult patients with non-cystic fibrosis (CF) bronchiectasis. Methods One hundred and thirty-two indigenous outpatients (>18 years old) with stable non-CF bronchiectasis were enrolled. All patients were randomly assigned to a control group and two treatment groups. Patients in the azithromycin fixed-dose treatment group received oral azithromycin (250 mg daily) and ambroxol hydrochloride (30 mg, 3 times/d). Azithromycin progressively decreased dosage treatment group received oral azithromycin (250 mg daily for 8 weeks-250 mg 3 times/week for 8 weeks-250 mg 2 times/week for 10 weeks) and ambroxol hydrochloride (30 mg, 3 times/d). Subjects in control group only received ambroxol hydrochloride therapy. The course of treatment lasted for 26 weeks. Spirometry, exacerbations, sputum microbiology, quality of life, dyspnea scores and adverse effects were monitored after treatment for 26 weeks. Results One hundred and twenty-nine evaluable subjects completed the study. After treatment, the level of percentage of estimated value forced expiratory volume in 1 second (FEV1% Pred) in azithromycin fixed-dose treatment group and azithromycin progressively decreased dosage treatment group was significantly higher than that before treatment: (83.01 ± 5.79)% vs. (79.39 ± 3.53)%, (84.97 ± 5.10)% vs. (80.94 ± 3.46)%, P<0.05. Forced expiratory flow between 25% and 75% of vital capacity (FEF25%- 75%) was also increased in two groups: (54.87 ± 5.72) % vs. (51.86 ± 8.16)%, (55.65 ± 3.39)% vs. (53.46 ± 5.75)% , there was significant difference (P<0.05). But the levels of above parameters between two groups after treatment had no significant differences (P >0.05). The parameters of FEV1% Pred, forced expiratory volume in 1 second (FEV1)/forced ventilatory capacity (FVC) and FEF25%-75%were lower compared to those before treatment in the control group (P <0.05). However, the scores of LRTI-VAS and FACED in control group after treatment were decreased slightly: (20.55 ± 1.76) scores vs. (21.34 ± 1.86) scores, P<0.05; (4.16 ± 0.75) scores vs. (4.36 ± 0.72) scores, P > 0.05. Seven episodes of acute exacerbation was occured during 26 weeks, 2 cases exited. The others did not interrupt azithromycin treatment during acute exacerbation. Drug-related adverse reactions were mild. Conclusions For adult stable patients with non-CF bronchiectasis, the clinical symptoms and airflow limitation are improved after long-term treatment of low-dose azithromycin. Similar effects on FACED score and LRTI-VAS score are observed in patients with progressively decreased dosage of azithomycin.

10.
Protein & Cell ; (12): 909-929, 2018.
Article in English | WPRIM | ID: wpr-758007

ABSTRACT

70%-80% of our sensory input comes from vision. Light hit the retina at the back of our eyes and the visual information is relayed into the dorsal lateral geniculate nuclei (dLGN) and primary visual cortex (V1) thereafter, constituting the image-forming visual circuit. Molecular cues are one of the key factors to guide the wiring and refinement of the image-forming visual circuit during pre- and post-embryonic stages. Distinct molecular cues are involved in different developmental stages and nucleus, suggesting diverse guidance mechanisms. In this review, we summarize molecular guidance cues throughout the image-forming visual circuit, including chiasm determination, eye-specific segregation and refinement in the dLGN, and at last the reciprocal connections between the dLGN and V1.


Subject(s)
Animals , Geniculate Bodies , Metabolism , Humans , Visual Cortex , Metabolism , Visual Pathways , Metabolism
11.
Chinese Journal of Rheumatology ; (12): 165-170, 2018.
Article in Chinese | WPRIM | ID: wpr-707842

ABSTRACT

Objective To explore the risk factors of urinary stone formation in primary gout patients by urinary chemical,serum and urinary biochemical features analysis.Methods All the patients diagnosed as primary gout at Peking University First Hospital from 2009 to 2015 were included in the study.All patients were diagnosed with or without urolithiasis by ultrasound or computed tomography.Their clinical features,baseline urinary metabolic panels and stone composition were analyzed and compared between the two group of patients.Moreover,the risk factors of uric acid stone formation were determined by comparing different composition of stone formation group.Analysis of variance,t-test,chi-square test,spearman's test and logistic regression were used for statistical analysis.Results One hundred and forty-four male gout patients were enrolled in the study among these patients,48 were with urolithiasis and 96 patients were without urolithiasis.Most (136,94.4%) patients were under excretion of uric acid.Among 48 gout patients with uric acid urolithiasis,30 (62.5%) patients who had pure uric acid stones,and 18 (37.5%) had stones composed of mixed uric acid and oxalic acid.Compared with mixed stone group,the mean age was significantly lower in pure uric acid stone group [(46±13) years vs (60±15) years,t=4.1,P<0.05];and disease duration was shorter [(42±11)months vs (71±22) months,t=-0.2,P<0.01].The 24-hour urinary uric acid were significantly higher in the uric acid stone group [(5 205±3 524) μmol/d vs (2 132±1 326) μmol/d,t=3.6,P<0.05].Also,the mean of both Ccr and Cua were higher [(119±61) ml/min vs (75±39) ml/min,t=3.6,P<0.05;(6.3±3.6) ml/min vs (3.2±2.0)ml/min,t=l.4,P<0.05].Urinary pH was negatively correlated with uric acid stone in primary gouty patients (r=-0.212,P<0.01);The total excretion of urinary uric acid was positively correlated with uric acid stones formation (r=0.633,P<0.05).High urinary uric acid excretion and Ccr were independent risk factors for uric acid stone formation in primary gout patients.Conclusion Urine pH is negatively correlated with uric acid stone formation.Urinary analysis of 24-hour uric acid and Ccr are risk factors for pure uric acid urolithiasis in primary gout patients.

13.
Chinese Journal of Pathophysiology ; (12): 1153-1162,1236, 2017.
Article in Chinese | WPRIM | ID: wpr-616503

ABSTRACT

AIM: To investigate the role of transcription factor hairy and enhancer of split 1 (Hes1) in the malignant transformation of human bronchial epithelial cell line BEP2D induced by tobacco.METHODS: The BEP2D cells were chronically exposed to cigarette smoke condensate (CSC) at 1 cigarette per L until the 70th generation.The phenotype of malignant transformation of the cells induced by CSC was detected by soft agar clony formation assay.RT-PCR and Western blot were used to determined the expression of Hes1 at mRNA and protein levels in each generation of the cells.The proliferation and apoptosis of the BEP2D cells exposed to CSC were analyzed with the methods of MTT assay, flow cytometry and cell colony formation assay after treatment with Notch pathway bloker DAPT or liposome transfection with Hes1-siRNA.The expression of Hes1 in the peripheral small airway tissues of the smoking rats was evaluated by immunohistochemical staining.The expression of Hes1 in non-small-cell lung cancer and normal airway tissues was also detected by the methods of immunohistochemistry and RT-PCR.RESULTS: The BEP2D cells in the 70th generation had a malignant transformation phenotype.The expression of Hes1 in the BEP2D cells exposed to CSC for different time showed an increa-sing trend.DAPT and liposome transfection with Hes1-siRNA down-regulated the expression of Hes1, inhibited the cell proliferation and induced cell apoptosis.The expression of Hes1 in the airway mucosa of the rats exposed to cigarette smoke for 1 month and 6 months was significantly higher than that in control group.Cigarette smoking induced the expression of Hes1 in lung cancer and normal airway tissues.CONCLUSION: Hes1 may be involved in smoking-induced lung cancer by promoting the imbalance between apoptosis and proliferation.

14.
Article in Chinese | WPRIM | ID: wpr-514941

ABSTRACT

BACKGROUND: Previous studies have shown that HLA-identical sibling allogeneic peripheral blood hematopoietic stemcelltransplantation (allo-HSCT) provides higher disease-free and overall survival rates for patients with intermediatecytogenetic risk acute myeloid leukemia (AML) in complete remission (CR). But prognosis factors have not been fullydefined.OBJECTIVE: To evaluate the outcome of patients with intermediate cytogenetic risk AML undergoing HLA-matchedallo-HSCT in CR, and to analyze the prognostic factors.METHODS: Fifty cases of intermediate cytogenetic risk AML in CR receiving HLA-matched allo-HSCT from January2009 to January 2015 were retrospectively analyzed. Primary outcome measures of the study included overall survival(OS), relapse rate and non-relapse mortality.RESULTS AND CONCLUSION: The 4-year OS of the study population reached to 64%, and the relapse rate and NRMreached to 18% and 20% respectively. Incidence of acute graft-versus-host disease was 26%. Different prognosis wasobserved between female donor/male recipient (FDMR) combination transplant and control (4-year OS: 50% vs. 71.9%,P=0.041), between patients requiring more than one course of induction chemotherapy to achieve CR and control(4-year OS: 40% vs. 70%, P=0.038), between older age (≥ 40 years) and control (4-year OS: 44.4% vs. 68.3%,P=0.056). The 4-year OS for matched sibling donor and matched unrelated donor was 63.2% and 66.7% (P=0.427),respectively. Further analysis revealed significantly high non-relapse mortality in FDMR combination transplant (P=0.024)and older age (≥ 40 years; P=0.043). Multivariate analysis revealed three negative prognostic factors: FDMRcombination (P=0.031, RR=1.38, 95% CI: 1.03-1.95), requiring more than one course of induction chemotherapy toachieve CR (P=0.016, RR=1.46, 95% CI: 1.10-1.98) and older age (≥ 40 years; P=0.024, RR=1.63, 95% CI: 1.32-2.12).To conclude, HLA-matched allo-HSCT is a choice for the intermediate cytogenetic risk AML case in CR. FDMRcombination, requiring more than one course of induction chemotherapy to achieve CR and older age (≥ 40 years) areconfirmed as risk factors of poor prognosis for HLA-matched allo-HSCT patients with intermediate cytogenetic risk AMLin CR. To these cases, the donor-recipient sex combination is more important than the donor type in donor selection.

15.
Article in Chinese | WPRIM | ID: wpr-508486

ABSTRACT

Objective To observe the characteristics of respiratory airflow in healthy adults and stable chronic obstructive pulmonary disease (COPD) patients by analysis of analyzing tidal breathing flow-volume curves (TBFV). Methods Fifteen stable moderate COPD patients (COPD group) and 15 healthy cases without smoking(healthy control group)were enrolled into the study. No bronchodilators were used in patients of COPD group 8 h before test. Pulmonary function test and TBFV in seated position were measured, and the pressure of oral cavity was monitored concomitantly. Results The levels of percentage of vital capacity (VC%), percentage of forced expiratory volume in the first second (FEV 1)/forced vital capacity (FVC) and percentage of maximum mid-expiratory flow (MMEF%) in COPD group were significantly lower than those in healthy control group (P0.05). The levels of tidal expiratory flow at 50%of the remaining tidal volume/PTEF (TEF50/PTEF) and tidal expiratory flow at 25%of the remaining tidal volume/PTEF (TEF25/PTEF) in healthy control group were significantly higher than those in COPD group:0.54 ± 0.13 vs. 0.40 ± 0.12, 0.28 ± 0.13 vs. 0.20 ± 0.06, P<0.01 or<0.05. No differences were found in peak inspiratory pressure (PI max) and peak expiratory pressure (PE max) between two groups. Conclusions The degree of airflow limitation and the effect of bronchodilator in critical patients could be evaluated by analysis of TBFV parameters. The measurement of TBFV is simple and don′t need special technique. It is worth of promoting.

16.
Article in Chinese | WPRIM | ID: wpr-607102

ABSTRACT

Objective To investigate the application of radial endobronchial ultrasound (R-EBUS)-guided bronchoscopy in the diagnosis of peripheral pulmonary lesions (PPLs),assess its safety and diagnostic value,and explore the influencing factors.Methods Clinical data of 140 patients who underwent R-EBUS transbronchial biopsy (TBB) and brush biopsy in our department of respiratory endoscopy from January 2015 to March 2017 were collected and retrospectively analyzed in the study.Eighty-three cases were diagnosed as PPLs.The detection rate,ability to locate the peripheral lesions,and influencing factors of EBUS were analyzed.The incidence rate of complications was observed to assess its safety.Results Of the 83 PPLs patients,they were 55 males and 28 females,and at a mean age of 59.81 ± 11.85 years.The total success rate of EBUS-guided bronchoscopic diagnosis was 59.04% (49/83),and the diagnostic rate was 50.94% (27/53) for malignant lesions,and 73.33% (22/30) for benign diseases.The rate of EBUS-TBB (56.92%,37/65) was significantly higher than that of brush biopsy (30.12%,25/83,Chi square =10.76,P =0.001).EBUS-guided diagnostic methods had an accuracy of 60.00% (45/75),while the EBUS-guided bronchoscopy had a rate of 50.0% (4/8),but no significant difference was seen between the 2 methods (Chi square =0.03,P =0.87).The sizes of the lesions ranged from 10.0 to 52.4 mm,and the diagnostic yield for PPLs ≤20 mm in diameter (36.84%,7/19) was lower than that for those >20 mm (65.62%,42/64,Chi square =5.02,P =0.003).There was no significant difference (Chi square =10.05,P =0.07)in the diagnostic yield for different sites,with that of right upper lobe of 46.15% (12/26),right middle lobe 100.00% (8/8),right lower lobe 53.85% (7/13),left upper lobe 37.50% (3/8),left lingula lobe 63.64% (7/11),left lower lobe 70.59% (12/17).But the detection rate was obviously lower in the upper lobe (22/45,48.89%) than the middle/lower lobe (27/38,71.05%,Chi square =5.02,P =0.003).Of all the 83 patients,74 ones (89.16%) were successfully identified using radial probe EBUS,but the lesions were not found in 9 patients.When the radial probe position was within the target lesion,the diagnostic yield was 81.58% (31/38),notably higher than that when the probe was positioned adjacent to the lesion (50.00%,18/36,Chi square =8.24,P =0.004).Mild bleeding was observed when performing biopsy under bronchoscope,and no pneumothorax,or other serious complications were observed.Conclusion Radial EBUS is a safe and feasible nethod to accurately identify PPLs and improve its diagnostic rate.EBUS-guided bronchoscopy has higher positive detection rate for PPLs,and is cost saving.The relationship of the probe and the site of lesion is the main factor influencing the diagnostic rate.

17.
Chinese Journal of Hematology ; (12): 523-527, 2017.
Article in Chinese | WPRIM | ID: wpr-808918

ABSTRACT

Objective@#To explore the efficacies of regimens of three-drug induction therapy (ATRA+ATO+anthracyclines) versus two-drug induction therapy (ATRA+ATO) in patients with acute promyelocytic leukemia (APL).@*Methods@#Of 184 patients diagnosed with APL from January 2009 to March 2016, 58 patients underwent three-drug induction therapy, while the rest were treated with two-drug induction therapy. Three-drug induction therapy was of ATRA (20 mg·m-2·d-1, d1-28) + ATO (0.16 mg·kg-1·d-1, d1-28) + Idarubicin (8 mg·m-2·d-1, d3-5) /daunorubicin (40 mg·m-2·d-1, d3-5) , while two-drug induction therapy ATRA+ATO with the same doses and methods as above. Of 184 cases, 69 cases accompanied with WBC counts>10×109/L, 115 cases with WBC counts≤10×109/L at onset.@*Results@#①Short-term efficacy: After one cycle induction therapy, the rates of hematologic remission, genetic remission, molecular remission and induced differentiation syndrome (DS) in three-drug regimen group were 98.3%, 87.9%, 72.4% and 0 respectively, while those in two-drug regimen group were 87.3%, 65.9%, 51.6% and 12.7% respectively. In patients with WBC >10×109/L, DS rate and early mortality in three-drug regimen group were lower than in two-drug regimen group (0 vs 15.6%, 4.2% vs 15.6%, respectively). In patients with WBC≤10×109/L, DS rate in three-drug regimen group was also lower than in two-drug regimen group (0 vs 12.3%) , but there were no statistical differences in terms of relapse and early mortality. ② Long-term efficacy: The relapse rate, overall survival (OS) and disease free survival (DFS) in three-drug regimen group were 0, 98.5%, 96.6% respectively, while those in two-drug regimen group were 8.6%, 86.5% and 84.1% respectively; the advantages of three-drug over two-drug regimen, especially in cases of WBC >10×109/L were observed. ③ Side effects: the incidences of gastrointestinal reaction, liver dysfunction, myocardial damage and headache in three-drug regimen group hardly increased.@*Conclusion@#The efficacies of three-drug induction therapy were superior to two-drug one.

18.
Chinese Journal of Hematology ; (12): 210-215, 2017.
Article in Chinese | WPRIM | ID: wpr-808400

ABSTRACT

Objective@#To investigate the prognostic value of dynamic monitoring of RUNX1-RUNX1T1 transcript in pediatric patients with t (8;21) acute myeloid leukemia (AML) .@*Methods@#The clinical features and RUNX1-RUNX1T1 transcript levels of 55 pediatric t (8;21) AML patients, newly diagnosed from Jan. 2010 to Apr. 2016, were analyzed retrospectively. The relationship between the minimal residual disease (MRD) and prognosis was analysed by dynamic monitoring of RUNX1-RUNX1T1 transcript levels using real-time quantitative PCR (RQ-PCR) technology.@*Results@#The RUNX1-RUNX1T1 transcript levels in bone marrow cells at diagnosis was not related to relapse. After one course of induction therapy, patients with a more than 2 Log reduction of RUNX1-RUNX1T1 transcript levels (>2 Log) had lower 5 years cumulative incidence of relapse (CIR) [ (24.3±8.4) % vs (52.6±9.7) %, χ2=9.046, P=0.003], relapse-free survival (RFS) [ (71.6±12.7) % vs (48.1±13.2) %, χ2=5.814, P=0.016], and better overall survival (OS) [ (76.9±12.5) % vs (48.9±14.7) %, χ2=6.346, P=0.012], compared to patients with a less than 2 Log reduction (a<2 Log) . Multivariate Cox survival analysis suggested that a>2 Log reduction in RUNX1-RUNX1T1 transcript levels after a course of induction therapy was an independent prognostic factor for RFS (HR=0.263, 95%CI 0.081-0.851, P=0.026) and OS (HR=0.214, 95% CI 0.057-0.808, P=0.023) . During consolidation therapy and follow-up period, molecular relapse of 16 cases and hematologic relapse of 13 cases were identified by continuous dynamic monitoring of RUNX1-RUNX1T1 transcript levels, with a median interval of 4.0 (1.5-5.8) months from the molecular relapse to hematologic relapse. 2 cases of molecular relapse who received timely allogeneic hematopoietic stem cell transplantation did not experience hematologic relapse.@*Conclusion@#Dynamic monitoring RUNX1-RUNX1T1 transcript levels by RQ-PCR technique can subdivide patients into relatively low and high risk group, early screen patients at high risk of relapse and provide a scientific basis for precision stratification and risk-adapted therapy for pediatric t (8;21) AML children.

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Article in Chinese | WPRIM | ID: wpr-493542

ABSTRACT

Objective To observe the benefits and safety of low-dose azithromycin maintenance treatment on pulmonary function and quality of life in patients with bronchiectasis. Methods Thirty-seven adult bronchiectasis patients accompanied with chronic purulent respiratory tract symptoms were selected, and all the patients were given azithromycin 250 mg oral, once/d for 12 months. The respiratory symptoms, pulmonary function and quality of life before treatment and 16, 52 weeks after treatment were observed. Results Among 37 patients with bronchiectasis, 3 cases were lost, 1 case was in the follow-up of the 16th week, and 2 cases exited because of acute exacerbation. There were no statistical differences in body mass index (BMI) and inspiratory capacity percentage of estimated value (IC%Pred) before treatment, 16 and 52 weeks after treatment (P>0.05). The C-reactive protein (CRP), forced expiratory volume in 1 second (FEV1)/ forced ventilatory capacity (FVC), forced expiratory flow between 25% and 75% of vital capacity percentage of estimated value (FEF25-75%Pred), modified British medical research council dyspnea scale (mMRC) score 16 and 52 weeks after treatment were significantly better than those before treatment:(15.33 ± 4.00) and (9.21 ± 3.04) mg/L vs. (25.59 ± 9.82) mg/L, (75.94 ± 5.59)%and (75.52 ± 7.06)% vs. (72.14 ± 5.62)%, (60.22 ± 10.90)% and (63.73 ± 6.54)% vs. (55.44 ± 9.16)%, (1.75 ± 0.69) and (1.41 ± 0.56) scores vs. (2.19 ± 0.74) scores;the low respiratory tract infection visual analog scale (LRTI- VAS) score, FEV1 percentage of estimated value (FEV1% Pred) and chronic obstructive pulmonary disease assessment test (CAT) score 52 weeks after treatment were significantly better than those before treatment: (17.74 ± 3.76) scores vs. (21.57 ± 4.47) scores, (70.31 ± 4.07)% vs. (66.95 ± 5.48)%and (18.06 ± 3.32) scores vs. (21.54 ± 4.89) scores, and there were statistical differences (P<0.05). In the course of treatment, 5 cases might be associated with the drug adverse reactions, but the symptoms were mild. No patients exited because of adverse reaction. Five patients had 7 episodes of acute exacerbation, among whom 2 cases exited and the other 3 cases did not interrupt azithromycin treatment during acute exacerbation. Conclusions For adult patients with bronchiectasis, the long-term treatment of low-dose azithromycin (250 mg/d) can improve the respiratory symptoms and quality of life, and reduce the airflow limitation of peripheral airway.

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Article in Chinese | WPRIM | ID: wpr-488124

ABSTRACT

Objective To compare the inspiratory cycling-off synchronization with expiratory trigger sensitivity (ETS) setting during noninvasive pressure support ventilation (PSV) under the different conditions of respiratory mechanics. Methods Bi-level pressure ventilator was connected to a lung model (Hans Rudolph Series1101 simulator). And its mechanics was set to normal, obstructive and restrictive ventilation dysfunction. Tests were performed with pressure support levels of 10 (in normal condition, 1 cmH2O = 0.098 kPa) and 15 cmH2O, 5 cmH2O positive end-expiratory pressure (PEEP). The data including cycling delay time (Td), tidal volume (TV) and airflow were collected in the presence of air leaks (24-28 L/min). Results Significant performance on airflow was observed in various respiratory mechanics conditions. The peak inspiratory flow (PIF) and peak expiratory flow (PEF) were different, and the tidal volume, PEF and inspiratory time were increased after decreasing the ETS level. Premature cycling occurred frequently in normal and restrictive model. Delay cycling was found only when the ETS setting was at the lowest level (about 5% of PIF), at which Td were (15.20 ± 0.43) ms and (105.00 ± 15.82) ms. In obstructive model, PIF and PEF were significantly decreased, and delay cycling was always present. Td were increased after the ETS setting was changed from the most sensitive level to moderate level:(51.30 ± 12.63) ms vs. (162.40 ± 15.59) ms, as cycling-off criteria were reduced from (34.52 ± 3.36)% to (16.04 ± 2.58)% of PIF, and there were statistical differences (P<0.05). Severe delay cycling was found when the ETS level was at the lowest level. Conclusions There are significant differences in performances and cycling-off synchrony in various respiratory mechanics models during PSV. For Curative Flexo ST30 bi-level pressure ventilator, its flow cycling-off criteria range is about 5%-35%of PIF. The higher ETS level might be beneficial to improve patient-ventilator synchrony in patients with obstructive airway diseases, which could result in premature cycling in patients with restrictive disease.

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