Diagnostic yield of bronchoscopic rapid on-site evaluation in severe invasive bronchopulmonary aspergillosis / 中华危重病急救医学

OBJECTIVE@#To explore the diagnostic yield of bronchoscopic rapid on-site evaluation (B-ROSE) in patients with severe invasive bronchopulmonary aspergillosis (IBPA) and provide evidence for starting antifungal treatment before microbiological results were available.@*METHODS@#A prospective cohort study was conducted to select patients with severe pneumonia suspected of IBPA admitted to the respiratory intensive care unit (RICU) in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2022, and those who were primarily infected with other pathogens (such as bacteria, Mycobacterium tuberculosis) at admission were excluded. Whether the antifungal treatment was initiated or not on the basis of the bedside B-ROSE, the B-ROSE was administered as soon as possible within 24 hours after admission to RICU. The current international definition of invasive aspergillosis was used as the gold diagnostic standard, the diagnostic accordance rate, the sensitivity and specificity of B-ROSE were calculated respectively, and the receiver operator characteristic curve (ROC curve) was also plotted, to evaluate the predictive value in diagnosing IBPA.@*RESULTS@#A total of 176 patients with severe pneumonia suspected of IBPA were included in the study. According to international diagnostic standards, there were 81 cases of IBPA and 95 cases of non-IBPA. According to the early diagnosis of B-ROSE, there were 89 cases of IBPA and 87 cases of non-IBPA. The diagnostic accordance rate of B-ROSE was 84.09% (148/176), the area under the ROC curve for B-ROSE in diagnosing severe IBPA was 0.844, the 95% confidence interval (95%CI) was 0.782-0.905, the sensitivity was 87.65%, the specificity was 81.05%, the positive predictive value was 79.78%, the negative predictive value was 88.51%, the rate of underdiagnosis was 12.35% (10/81), and the rate of misdiagnosis was 18.95% (18/95). Compared with the true negative group, the proportion of long-term (≥ 14 days) use of glucocorticoid [70.0% (7/10) vs. 9.1% (7/77), P < 0.01] and the proportion of cases with diabetes [40.0% (4/10) vs. 10.4% (8/77), P < 0.05] were significantly higher in the false negative group (underdiagnosis group). However, B-ROSE of both groups showed mucosal bleeding, congestion and edema [100.0% (10/10) vs. 94.8% (73/77), P > 0.05], indicating that acute mucosal inflammation was non-characteristic. Compared with the true positive group, the proportion of long-term (≥ 14 days) use of glucocorticoid in the false positive group (misdiagnosis group) was significantly reduced [33.3% (6/18) vs. 60.6% (43/71), P < 0.05]. The B-ROSE results showed the proportion of cases with mucosal white spots, black plaques and pseudomembrane was significantly reduced [16.7% (3/18) vs. 52.1% (37/71), P < 0.01] in the misdiagnosed group, which suggest that cases of long-term use of glucocorticoid and cases with B-ROSE showing mucosal white spots, black plaques and pseudomembrane were less likely to be misdiagnosed. The main diseases that were easily misdiagnosed as IBPA included pulmonary tuberculosis (38.9%, 7/18), inflammatory lung adenocarcinoma (27.8%, 5/18) and pulmonary vasculitis (16.7%, 3/18).@*CONCLUSIONS@#Before obtaining microbiological evidence, B-ROSE can assist in decision-making of early anti-aspergillus treatment for severe IBPA. This method is prompt, simple, and has high accuracy and reliability. If B-ROSE lacks characteristic manifestations, especially for severe pneumonia in patients with long-term use of glucocorticoid or diabetes, attention should be paid to the underdiagnosis of IBPA. Diseases such as lung tuberculosis, inflammatory lung adenocarcinoma and lung vasculitis should be vigilant against misdiagnosis as IBPA.

Preliminary experience of Bacillus Calmette-Guerin in the treatment of bladder cancer secondary to kidney transplantation / 中华泌尿外科杂志

Objective:To summarize the experience of Bacillus Calmette-Guerin(BCG) in the treatment of bladder cancer secondary to renal transplantation.Methods:The clinical data of 5 patients who underwent BCG bladder irrigation after secondary bladder cancer after kidney transplantation in Tianjin First Central Hospital from January 2015 to December 2019 were analyzed. There were 1 male and 4 female cases. During the period of immunosuppression after transplantation, 1 case developed secondary high-level non-muscular invasive bladder cancer (NMIBC), 3 cases developed secondary low-grade NMIBC, and 1 case developed secondary glandular cystitis (4 cases). The mean age of the 5 patients with secondary bladder cancer was 59.7±4.0 years. Case one with high level NMIBC was treated with transurethral resection of bladder tumor (TURBT) and postoperative irrigation of epirubicin. Case 3 and 5 with low-level NMIBC accepted regular postoperative irrigation of gemcitabine. No irrigative therapy was performed in case 2. Bladder cancer recurred in case 1, 2, 3 and 5 after 20.1±9.7 months. TURBT was observed in all the 4 patients, among which 3 were of high grade NMIBC and 1 was of low grade NMIBC. Four patients were irrigated with BCG 2 weeks after operation. Postoperative pathology indicated low-level NMIBC in case 4, and BCG was irrigated 2 weeks after the operation. During perfusion therapy, immunosuppressive agents were continued.Results:During BCG perfusion, 4 of the 5 cases showed BCG related local inflammation, among which 2 cases presented symptoms of bladder irritation, 1 case presented hematuria, and 1 case presented hematuria with low fever. Patients with frequent urination, pain in urine, hematuria and other symptoms improved after drinking plenty of water, taking bed rest and taking levofloxacin (0.5g/ day ×7 days). Patients with low fever were treated with antipyretic treatment. No antituberculous agents were used prophylactically during BCG perfusion. There were no symptoms of tuberculosis infection or sepsis. The function of transplantated kidney was normal and no tendency of rejection. The 5 patients were followed up for 7-24 months, 1 patient was lost to follow-up after 7 months of BCG bladder perfusion, and no tumor recurrence or metastasis was found in 5 patients during the follow-up.Conclusions:The use of immunosuppressive agents does not reduce the biological activity of BCG, and BCG does not increase the risk of systemic toxicity or affect the function of transplanted kidneys in immunocompromised patients. BCG is a treatment option for bladder cancer secondary to renal transplantation.

Clinical analysis of 5 children with lung abscess related to adenovirus / 中华实用儿科临床杂志

Objective:To analyze the clinical characteristics of lung abscess related to adenovirus (ADV).Methods:The data of 5 cases suffering from pulmonary abscess by ADV in Guangzhou Women and Children′s Medical Center from January to December 2019 were collected, including general information, clinical characteristics, examination and follow up visits.Results:The age of the patients ranged from 4 months to 12 months and the mean age was 8.6 months.All of them had fever and the degree was more than 39 ℃.What′s more, they had the history of cough and sputum.Somebody had dyspnea and pleural effusion.The imaging examinations of 5 cases strongly suggested that the interstitial and parenchymal lung disease subsequently appeared different sized cystic shadow, liquid flat cystic shadow, thickened wall empty tissue image, while some cases displayed the pleural effusion.The ADV-PCR or ADV-IgM were positive in the children, while the C-reactive protein, white blood cells and neutrophile were higher than the normal, but some were not.All the platelet count and lactate dehydrogenase were higher than the normal.Three children experienced the surgical treatment and their pathologic result revealed lung abscess.All the children were cured after the treatment, with good prognosis.Conclusions:Lung abscess related to ADV was rare in children and its system was not clear.If children who suffered from ADV were not cured after the treatment for a long time, the CT scan can differentiate whether it was combined with the complication of lung abscess or not.Early therapy for these patients could obtain satisfactory prognosis.

Study on Spectrum-effect Relationship of Anti-hepatoma Effect of C Ⅱ-3 Extract from Periplaneta americana / 中国药房

OBJECTIVE：To study the spectrum-ef fect relationship of anti-hepatoma effect of C Ⅱ-3 extract from Periplaneta americana，and to preliminarily clarify the anti-hepatoma active components of it. METHODS ：Based on UHPLC fingerprints of 10 batches of C Ⅱ-3 samples，with the help of UHPL C-Q-TOF/MS，the compounds corresponding to each chromatographic peak were identified qualitatively by standard substances and related literatures. Using the IC 50 value of each batch of C Ⅱ-3 sample against human hepatoma cells HepG 2 as anti-hepatoma activity index ，the spectrum-effect relationship of fingerprint and anti-hepatoma effect was established and analyzed by the combination of grey relational analysis （GRA）and orthogonal partial least squares（OPLS）. RESULTS ：There were 25 common peaks in UHPLC fingerprints of 10 batches of C Ⅱ-3 samples，and 10 chemical compounds were identified ，which were cyclo- （Tyr-Pro）（peak 24），cyclo-（Gly-Phe）（peak 15），hypoxanthine（peak 3）， adenine（peak 7），phenylalanine（peak 10），inosine（peak 11），N-acetyldopamine（peak 16），cyclo-（Pro-Ala）（peak 13），2-hydroxy propionyl（peak 22），cyclo-（Pro-Ser）（peak 6）. The IC 50 of 10 batches of C Ⅱ-3 samples to HepG 2 cells was 70.550-200.303 μg/mL. Among 25 common peaks ，the order of GRA correlation （r）of anti-hepatoma activity was peak 20＞23＞24＞15，all of r values were greater than 0.7；the order of variable importance projection （VIP）of OPLS analysis was peak 23＞18＞15＞24＞7＞14＞6＞ 2＞20，all of VIP values were greater than 1. The standard regression coefficients of peak 7，15，20，23，24 were all greater than 0；while the standard regression coefficients of peak 2，6，14，18 were all less than 0. Conjoint analysis shows that the order of anti-hepatoma activity was peak 20＞23＞24＞15. CONCLUSIONS：unknown chemical ingredients （peak 20， ），cyclo-（Tyr-Pro）（peak 24）and cyclo- （Gly-Phe）（peak 15） in C Ⅱ-3 may be main anti-hepatoma active components.

BK virus infection and urothelial carcinoma after renal transplantation / 中华器官移植杂志

Objective To explore the potential role of BK virus (BKV) in urothelial carcinoma after renal transplantation .Methods From May 2013 to March 2017 , We collected 26 cases of urothelial carcinoma after renal transplantation (study group) and 30 cases of urothelial carcinoma of non-immunosuppressed patients (control group) .Tumor tissues were stained with SV40 T antigen by immunohistochemical assay .Urinary and peripheral blood samples were assayed for BKV-DNA levels by real-time fluorescent quantitative polymerase chain reaction (PCR) .Results There were 7 positive cases of SV40 T-Ag in study group and only 1 weakly positive case in control group .The positive rate of BKV-DNA was 38 .5％ in urinary samples in study group (10 /26 ) and it was significantly higher than that in control group by 10％ (3/30)(P< 0 .05) .And the positive rate of blood BKV-DNA was not different between two groups ( P > 0 .05 ) .Conclusions There is a relatively high prevalence of BKV infection in urothelial carcinoma after renal transplantation .And a ,high level of BKV infection may play a role in urothelial carcinoma after renal transplantation .

Predictive factors for failure of non-invasive positive pressure ventilation in immunosuppressed patients with acute respiratory failure / 中华危重病急救医学

Objective To evaluate the predictive factors for failure of non-invasive positive pressure ventilation (NIPPV) in immunosuppressed patients with acute respiratory failure (ARF). Methods The clinical data of 118 immuno-deficient patients treated with NIPPV in the respiratory and intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2012 to August 2017 were retrospectively analyzed. The patients were divided into a non-endotracheal intubation (ETI) group (n = 62) and ETI group (n = 56) according to whether ETI was performed during the hospitalization period or not. Each observed indicator was analyzed by univariate analysis, and factors leading to failure of NIPPV were further analyzed by Logistic regression. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of risk factors for failure of NIPPV in immunosuppressed patients with ARF. Results The non-intubation rate for NIPPV in immunosuppressed patients was 50.8% (60/118). Compared with the non-ETI group, the body temperature, pH value in the ETI group were significantly increased, the partial pressure of arterial carbon dioxide (PaCO2) was significantly decreased, the ratio of oxygenation index (PaO2/FiO2) < 100 mmHg (1 mmHg = 0.133 kPa), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score ≥ 20, and the number of cases requiring catecholamine were significantly increased, the mortality was significantly increased. Multivariate Logistic regression analysis showed that the APACHE Ⅱ score ≥ 20 [odds ratio (OR) = 15.274, 95% confidence internal (95%CI) = 2.175-107.252, χ2= 7.516, 1 = 0.006], PaO2/FiO2< 100 mmHg (OR = 0.075, 95%CI = 0.014-0.408, χ2= 8.968, 1 = 0.003), and need for catecholamine (OR = 35.736, 95%CI = 6.974-183.124, χ2= 18.400, 1 < 0.001) were independent risk factors for failure of NIPPV. ROC curve analysis showed that the APACHE Ⅱ score ≥ 20 and PaO2/FiO2< 100 mmHg could predict failure of NIPPV, the area under ROC curve (AUC) of the APACHE Ⅱ score ≥ 20 was 0.787, the sensitivity was 83.93%, the specificity was 69.35%, the positive predict value (PPV) was 71.21%, the negative predict value (NPV) was 82.69%, the positive likelihood ratio (PLR) was 2.74, the negative likelihood ratio (NLR) was 0.23, and Youden index was 0.53; the AUC of PaO2/FiO2< 100 mmHg was 0.757, the sensitivity was 80.65%, the specificity was 66.07%, the PPV was 68.18%, the NPV was 78.85%, the PLR was 2.38, the NLR was 0.29, and Youden index was 0.47. Conclusions 50.8% of immunocompromised and ARF patients treated with NIPPV did not require ETI, which is independent of the etiology of ARF. APACHE Ⅱ score ≥ 20, PaO2/FiO2<100 mmHg, and the need for catecholamine are predictive factors for failure of NIPPV in immunocompromised patients.

A preliminary study on the expression of human leucocyte antigen G in urothelial carcinoma after renal transplantation / 中华泌尿外科杂志

Objective To investigate the expression of human leucocyte antigen G (HLA-G) in urothelial carcinoma after renal transplantation,and to analyse the relationship between HLA-G expression and the various clinical and pathological parameters.Methods 29 patients with urothelium carcinoma after renal transplantation for the first time from January 2005 to June 2016 were selected as the experimental group,the age range was 32-70 years,with an average of (55.5 ± 8.1) years.29 non-transplanted patients with urothelial carcinoma as the control group 1,the age range was 36-74 years,with an average of (57.9 ± 8.2) years.15 cases of normal urinary tract epithelial were from cystoscopy biopsy as the control group 2.Immunohistochemical method was used to detect the difference of HLA-G expression between the three groups.The clinical and pathological data of patients with urothelial carcinoma after renal transplantation were analyzed.Results The expression rate of HLA-G was 79.3％ (23/32) in patients with urothelial carcinoma after renal transplantation,37.9％ (11/32) in non-transplanted group and 0 (0/15) in normal urinary tract epithelium group.The expression rate of HLA-G in non-transplanted group was significantly higher than that in normal urinary tract epithelium group (P ＜ 0.05).The expression rate of HLA-G in patients with urothelial carcinoma after renal transplantation was significantly higher than that in nontransplanted group and normal urinary tract epithelium group (P ＜ 0.05).Conclusions HLA-G is associated with the occurrence of urothelial carcinoma after renal transplantation.It may provide a new idea for the prevention and treatment of urinary tract epithelium after renal transplantation.

Expression of Notch4 in renal cell carcinoma and its relationship with the microvascular density / 实用医学杂志

Objective To investigate the expression of Notch4 protein and to analyze its correlation with the clinical parameters and the microvessel dentisty in renal cell carcinoma. Methods The expression of Notch4 was examined in 60 cases of renal cell carcinoma and the para-carcinoma tissue by SP immunohistochemical stain-ing ,and CD34 detection was used for counting microvessel density. Statistical analysis was performed to reveal the correlation with clinicopathological parameters ,microvessel density and prognosis. Results The positive rate of Notch4 protein expression was 75%(45/60)in para-carcinoma tissue,and was 43.3%(26/60)in renal cell car-cinoma,with significant difference on tumor grade and Lymph node metastasis(P<0.05). The microvessel densi-ty in Notch4 positive tissues was significant lower than that in the negative samples(P<0.05). The survival time of patients with Notch4 positive expression was significantly longer than that of patients with Notch4 negative expres-sion(P<0.05). Conclusion Notch4 protein plays an important role in the development of renal cell carcinoma. Notch4 expression might both attenuate the malignant biological characteristics and suppress the angiogenesis dur-ing tumor development.

The predictive value of clinical and radiographic features in fungal pathogen identification in immunocompromised patients with pulmonary invasive fungal infection / 中华急诊医学杂志

Objective To investigate the predictive value of clinical and radiographic features in fungal pathogen identification in immunocompromised patients with pulmonary invasive fungal infection (IFI).Methods All consecutive immunocompromised adult patients with pulmonary IFI in respiratory intensive care unit (ICU)in the First Affiliated Hospital of Xinjiang Medical University were recruited during a 2 year period.All patients met the 2008 European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC /MSG) criteria were studied for proved or probable IFI responding to antifungal agents.The data of demographic,clinical and radiographic features,as well as serological test results of the patients were collected.Differences in the clinical and radiographic features of pulmonary IFIs caused by yeasts and molds were compared by χ2 test.A logistic regression model was used to perform discriminant analysis,and the effect of discrimination was assessed for accuracy.Results The study included 143 patients with a probable diagnosis of IFI who had the following risk factors:diabetes mellitus (43.4%),chronic lung disease (32.2%),broad-spectrum antibiotics administration (≥14 days;35.7%),malignancy (23.1%),corticosteroid therapy (≥14 days;23.1%),chronic renal failure and renal replacement therapy (16.1%),and immunological disease (10.5%).Frequent broad-spectrum antibiotics administration was associated with yeast infection (P <0.05 ),while mold infection was associated with chronic lung disease (P <0.05 ) .Yeast was more often isolated from patients with concurrent bacterial infection and on mechanical ventilation (P <0.05 ) . Thoracic high-resolution computed tomography (HRCT)showed the following images:bronchial pneumonia/pulmonary consolidation (53.1%),massive shadowing (29.4%),small nodules (24.5%),large nodules (18.9%),pleural effusion (18.9%),halo sign (14%),and cavity (9.8%).Imaging showed that mold was more common than yeast in patients with pleural and pericardial effusions (P <0.05).Logistic regression modeling showed that broad-spectrum antibiotics administration,prolonged mechanical ventilation,and pleural and pericardial effusions were statistically significant in fungal identification (P <0.05 ),with a predictive accuracy of 77.6%.Conclusions For immunocompromised patients with pulmonary IFI,most of the risk factors ,the main clinical and chest HRCT features did not help to predict the type of fungal pathogen,and yeast but not cryptococcus may be accompanied or colonized.

An investigation of the efficacy of invasive-noninvasive sequential mechanical ventilation in senile patients with severe community-acquired pneumonia / 中华危重病急救医学

ObjectiveTo investigate the efficacy of invasive-noninvasive sequential mechanical ventilation (MV) in senile patients with severe community-acquired pneumonia (CAP).Methods A prospective study was conducted. The patients with severe CAP aged≥ 75 years admitted to Department of Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from November 2012 to July 2014, with refusal to have tracheostomy, were enrolled. All patients meeting the diagnostic criteria of CAP and severe CAP were first admitted into the Department of Emergency, and they were found to need MV without absolute contraindication for noninvasive ventilation (NIV) in RICU. The patients were mechanically ventilated via endotracheal intubation (ETI), and they were randomly divided into invasive-noninvasive sequential MV group (sequential MV group) and conventional MV group. NIV was initiated immediately when patients matched the conditions for early extubation in the sequential MV group. Oxygen therapy (5 L/min) via a Venturi mask was provided when the indications of conventional extubation were met. The baseline data and clinical characteristics were recorded, the risk factors of death were analyzed by logistic regression analysis, and 60-day survival rate was analyzed by Kaplan-Meier curve. Results Ninety-one senile patients with severe CAP were enrolled, among them 28 patients died within 60 days, with a mortality rate of 30.77%. No significant difference in 60-day mortality was found between sequential MV group (n = 44) and conventional MV group [n = 47, 25.0% (11/44) vs. 36.2% (17/47),χ2 = 1.331,P = 0.249]. In the sequential MV group, the incidence of ventilator-associated pneumonia (VAP) was significantly decreased [27.3%(12/44) vs. 55.3% (26/47),χ2 = 7.350,P = 0.007], and the rate of ETI≥2 times was increased [59.1% (26/44) vs. 29.8% (14/47),χ2 = 5.095,P = 0.024] as compared with conventional MV group. Compared with survival group, the patients in non-survival group showed a higher incidence of cerebrovascular disease (60.7% vs. 25.4%,P = 0.002), higher acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (26.46±2.59 vs. 24.41±2.47,P = 0.001), British Thoracic Society confusion, uremia, respiratory rate, blood pressure,≥75 years (CURB-75 score, 4.00±0.47 vs. 3.68±0.53,P = 0.013), a longer total duration of MV (days: 21.18±10.02 vs. 14.56±7.62,P = 0.002), and a higher ratio of ETI≥ 2 times (53.6% vs. 33.3%,P< 0.001). It was revealed by multivariate logistic regression analysis that ETI≥ 2 times and comorbidity of cerebrovascular infarction were independent predictors of a worse outcome in the senile patients [odds ratio (OR) = 9.677, 95% confidence interval (95%CI) = 3.075 - 30.457,P< 0.001;OR = 5.386, 95%CI = 1.781 - 6.284,P = 0.003]. It was showed by Kaplan-Meir survival analysis that ETI times and concurrent cerebrovascular infarction imparted significant effects on the 60-day survival rate (χ2 = 40.805,P= 0.000;χ2 = 4.425, P = 0.035).ConclusionInvasive-noninvasive sequential MV may not improve the outcome of senile patients with severe CAP, and ETI≥ 2 times and concurrent cerebrovascular disorders drastically lowered the survival rate.

Research advances in the correlation between DEK protein and oncogenesis / 中国肿瘤临床

DEK protein is an abundant chromatin protein in metazoans with highly conserved nuclear factor. This protein is a unique member of its family and is preferentially expressed in actively proliferating and malignant cells. Recently, much attention has been paid to the role of DEK protein in the development of various cancers, which was originally discovered in a subset of acute my-elogenous leukemia. Oncogene DEK is overexpressed in several malignancies including hepatocellular carcinoma, glioblastoma, retino-blastoma, bladder cancer, malignant melanoma, and cervical cancer. Oncogene DEK is a chromatin remodeling protein that supports cancer cell proliferation and invasion. In this review, we summarized research advancements in the correlation between DEK protein and oncogenesis.

Quality Evaluation of Radix Zanmthoxyli Avicennae from Different Habitats / 中国药师

Objective:To establish the methods for the quality evaluation and hesperidin content determination of Radix Zanm-thoxyli Avicennae. Methods: The moisture, ash and extract content was respectively detected according to the methods described in Chinese Pharmacopoeia 2010 edition, and the content of hesperidin was detected by HPLC. Results: The moisture contents of Radix Zanmthoxyli Avicennae from seven different areas were between 7. 27% and 9. 65%; the total ash contents were between 5. 28% and 7. 90%;the acid-insoluble ash content were between 0. 39% and 0. 86%;the water-soluble extract contents were within the range of 5. 95%-10. 72% by infusion and 8. 16%-12. 67% by hot dipping;the alcohol extract contents were within 5. 88%-10. 97% by infu-sion and 2. 38%-3. 83% by hot dipping. The content of hesperidin was 0. 40%-2. 68%. Conclusion:The established methods can be used to evaluate the quality of Radix Zanmthoxyli Avicennae.

Study of timing of invasive and noninvasive sequential ventilation in patients with acute respiratory distress syndrome / 中华危重病急救医学

Objective To investigate the timing and value of noninvasive ventilation (NIV) as a weaning tool immediately after early extubation in patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted.The ARDS patients with surgical diseases admitted to Department of Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University were enrolled.The patients were randomly divided into sequential group and control group.All patients underwent endotracheal intubation and were mechanically ventilated.Every 12 hours during the first 3 days,the lung recruitment maneuver was performed during pressure control ventilation (PCV).After lung recruitment,all patients were ventilated with synchronized intermittent mandatory ventilation (SIMV) + pressure support ventilation (PSV) + positive end-expiratory pressure (PEEP) or assistant/control ventilation (A/C).The objects in sequential group who met the following criteria including those with oxygen index (PaO2/FiO2) reaching 200-250 mmHg (1 mmHg=0.133 kPa) under PEEP of 8 cmH2O (1 cmH2O =0.098 kPa),and pressure support of 12 cmH2O,and most acute infiltrating lesions having resolved on chest imaging,received noninvasive ventilation (NIV) immediately after extubation,and patients in control group continued to have invasive mechanical ventilation via intubation or tracheostomy with an endotracheal tube.The baseline data in both groups and the number of re-intubation in the sequential group were recorded.The duration of invasive mechanical ventilation and total duration of mechanical ventilation,ICU length of stay,the incidence of ventilator-associated pneumonia (VAP),and mortality rate were compared between the two groups.Results 53 consecutive adult patients were enrolled,including 26 in sequential group and 27 cases in control group.The period of endotracheal intubation was 7.0 (6.8,9.5) days,and 7.7％ (2/26) patients underwent re-intubation in sequential group.There were significant difference in respiratory and circulatory indicators before extubation spontaneous breathing trial (SBT) ≤10 minutes in sequential group,indicating that the patients were still in the early stage of extubation sequential NIV.There was no significant difference in indices reflecting respiratory function and circulation between the two groups,except that respiratory rate at 1 hour was slightly increased in sequential group as compared with that of control group,indicating that sequential NIV could maintain invasive ventilation function.There was significant difference in duration of invasive mechanical ventilation [days:7.0 (6.8,9.5) vs.21.0 (17.0,25.0),Z=-6.048,P=0.000],duration of total mechanical ventilation (days:18.0 ± 4.1 vs.22.0 ± 7.3,t=-2.805,P=0.008),and length of ICU stay (days:21.0 ± 4.1 vs.28.0 ± 8.1,t=-4.012,P=0.000) between sequential group and control group,but there was no significant differences in the incidence of VAP [15.4％ (4/26) vs.29.6 (8/27),x2=1.535,P=0.215] and mortality rate [7.7％ (2/26) vs.18.5％ (5/27),P=0.420].Conclusion When PaO2/FiO2 reached 200-250 mmHg under the condition of low ventilation,sequential NIV facilitates the early discontinuation of mechanical ventilation in ARDS patients with surgical diseases,with shortening of duration of invasive mechanical ventilation,total mechanical ventilation,and the length of ICU stay.

Effect of combined low dose Gemcitabine and Oxaliplatin in the treatment of advanced or metastatic urothelial carcinoma / 中华泌尿外科杂志

Objective To evaluate the therapeutic effect and toxicities of low dose Gemcitabine combined with Oxaliplatin in the treatment of advanced or metastatic uroedthelial carcinoma.Methods A total of 42 patients pathologically confirmed advanced or metastatic urothelial carcinoma (23 bladder cancer cases,11 ureteral carcinoma cases,and 8 renal pelvic carcinoma cases) were reviewed.Karnofsky score for each patient before treatment was more than 60.Combined treatment with Gemcitabine and Oxaliplatin regimen was as follows:Gemcitabine 700 mg/m2,iv infusion at day 1,8 and day 15,Oxaliplatin 100 mg/m2,iv infusion at day 2.The regimen was administered for more than 2 cycles (every 4 weeks) and the response rate was evaluated.The regimen was used in palliative chemotherapy and adjuvant chemotherapy,respectively.Results According to WHO evaluation criteria on therapeutic effectiveness,7 patients (16.7％) had complete response,13 patients (30.9％) had partial response,14 cases (33.3％) remained stable status,and 8 cases (19.1％) had progression.The overall response rate was 47.6％.The main side effects included thrombocytopenia,leucopenia,nausea,vomiting and alopecia,which were mild to moderate and disappeared when the chemotherapy was ceased.No chemotherapy related death occurred.Conclusions Combined treatment with low dose Gemcitabine and Oxaliplatin is effective for advanced or metastatic urothelial carcinoma,with mild and tolerable toxicities.

Recent research progress in treatment of liver fibrosis by using natural drugs and natural products / 中国中药杂志

The recent research progress of the utilization of natural drugs for the treatment of liver fibrosis in China and other countries was reviewed. Forty reported remedies were summarized and classified into 3 categories, that is, the single herbal drugs (rhizome, leaf, fruit, bark, peel, flower, whole plants, and oil), traditional Chinese medicine prescriptions and animal drugs. The future directions of the R&D of new natural drugs against liver fibrosis were discussed and some suggestions were provided.

Investigation on medicinal plant resources of Swertia in Yunnan province / 中国中药杂志

<p><b>OBJECTIVE</b>To explore the species and distribution of medicinal plants Swertia in Yunnan province, and provide scientific basis for sustainable utilization.</p><p><b>METHOD</b>Field investigation was carried out, specimens were collected, and literature and data were consulted.</p><p><b>RESULT</b>There were 35 species and 2 varieties (including 1 newly recorded species), most of them were used as medicinal plants, and an identification index was established.</p><p><b>CONCLUSION</b>The results provide reliable foundation for comprehensive utilization and in-depth study of Swertia in Yunnan province.</p>

Arbuscular mycorrhizae in Paris polyphylla var. yunnanensis / 中国中药杂志

<p><b>OBJECTIVE</b>To study the infection situation of arbuscular mycorrhizal fungi, as well as the mycorrhizal structures of Paris polyphylla var. yunnanensis, and the main types and quantities of AMF spores in rhizosphere soil.</p><p><b>METHOD</b>The arbuscular mycorrhizal of P. polyphylla var. yunnanensis were detected by Phillips and Hayman staining. At the same time, some AMF spores were accessed by Gendemann's Wet-screening method and identified by their morphological characteristics.</p><p><b>RESULT</b>Arbuscular mycorrhizal fungi could infect the roots of P. polyphylla var. yunnanensis and formed arbuscular mycorrhizal. Infection rate was from 35.3% to 98.6%, indicating that infection strength was strong. From 10 soil samples collected in Yunnan, 11 Acaulospor species, 7 Glomus species, 3 Gigaspora species and 3 Scutellospora species were isolated and identified, including Acaulospora appendicola, A. brieticulata, A. excavata, A. foveata, A. lacunosa, A. laevis, A. koskei, A. myriocarpa, A. polonica, A. rehmii, A. scrobiculata, Glomus albidum, G. ambisporum, G. deserticola, G. fragarioides, G. luteum, G. microaggregatum, G. multiforum, Gigaspora albida, G. margarita, G. ramisporophora, Scutellospora calospora, S. pellucida and S. gilmorei. Among them, Acaulospora brieticulata was advantage species.</p><p><b>CONCLUSION</b>AMF may be a potent biological resource which can stimulate the growth of P. polyphylla var. yunnanensis.</p>

Inhibitory effect of Periplaneta Americana extract on 3LL lung cancer in mice / 中国肺癌杂志

<p><b>BACKGROUND</b>It has been known that Kangfuxin, a drug derived from Periplaneta Americana, can induce cell apoptosis of many cancer cell lines in vitro. The aim of this study is to investigate the inhibitory effect and mechanism of Periplaneta Americana extract (PAE) on 3LL lung cancer in mice.</p><p><b>METHODS</b>The C57BL/6J mice transplanted with 3LL lung cancer were divided into normal saline (NS), PAE high dose (PAE-H) and PAE low dose (PAE-L) groups. The body weight changes and inhibitory rate of tumor growth in each group were observed. In addition, the cell cycle, apoptosis index (AI) and the expression of apoptosis associated genes were analysed by flow cytometry (FCM).</p><p><b>RESULTS</b>The body weights were decreased in PAE-L and PAE-H treated group compared with NS group and the inhibitive rate of tumor growth was 41.24% and 81.08% respectively. FCM assay indicated that PAE could induce apoptosis of lung cancer cell, and the apoptosis rate was concentration-dependent. At the same time, the number of S and G2/M phase cells was decreased, most of the cells were arrested in G1/G1 phase. The result of TUNEL showed that there were apoptosis and necrosis associated with upregulated expression of Fas, FasR and p53 genes, and downregulated expression of Bcl-2.</p><p><b>CONCLUSIONS</b>PAE may inhibit the growth of 3LL lung cancer in mice and induce apoptosis of 3LL lung cancer cells. It might be related to its effects on the regulation of apoptotic gene expression.</p>

Study on Chemical Constituents of Essential Oil from Acorus calamus from Two Different Habitats / 中国药房

OBJECTIVE: To analyze the chemical constituents of essential oil of Acorus calamus from different habitats in order to provide scientific basis of exploitation of A.calamus.METHODS: The essential oil was extracted from A.calamus by steam distillation.The chemical constituents were analyzed by GC-MS.The relative contents of chemical constituents were calculated using normalization method.RESULTS: 39 kinds of chemical components were identified in A.calamus from Yunnan province,accounting for 80.51% of total amount of essential oil.37 kinds of chemical components were identified in A.calamus from Sichuan province,accounting for 81.96% of total amount of essential oil.There were 31 kinds of same chemical constituents in A.calamus from Yunnan province and Sichuan province.The content of ?-asarone was highest in A.calamus from Yunnan province (13.46%) and that of ?-asarone was highest in A.calamus from Sichuan province (10.01%).CONCLUSION:The study can provide scientific basis for the further development of A.calamus.

Detection of major allergen parvalbumin in fish / 中国免疫学杂志

Objective:To develop an indirect enzyme-linked immunosorbent assay (ELISA) for semi-quantification of major allergen parvalbumin in fish.Methods:The soluble proteins were prepared from both white and dark muscles of seven species of freshwater fish and five species of marine fish.Tricine-SDS-PAGE and Western blot were performed to examine the protein patterns of fish muscle extracts.Natural parvalbumin being used to make calibration curve was purified from silver carp (Hypophthalmichthy molitrix) by ammonium sulphate fractionation,followed by ion exchange and gel filtration chromatography.The molecular mass of purified protein was estimated by Tricine-SDS-PAGE and identified by Western blot with anti-frog parvalbumin monoclonal antibody PARV-19.ELISA using PARV-19 was carried out to evaluate parvalbumin contents in white and dark muscles.Results:Tricine-SDS-PAGE revealed species-specific differences in proteins of heated extracts.Western blot confirmed that the major bands were showed in Tricine-SDS-PAGE with the molecular masses of 10-14 kD corresponded to parvalbumins recognized by PARV-19 and various numbers of isoforms of parvalbumin existed in different species of fish.There might be some differences in the parvalbumin contents and the epitope region was recognized by PARV-19 based on the differences in relative intensities of protein immunodetection.The ELISA showed that the contents of parvalbumin were 4 to 33 folds higher in the white muscle than in the dark muscle and varied greatly in different species of fish.Conclusion:These results validate that the dark muscle might be less allergenic than the white muscle due to the lower content of parvalbumins,and it is suggested that the commercial anti-parvalbumin antibody PARV-19 can be used to detect parvalbumins from the commercially important species of fish tested in this study and the method we develope succeeds to detect the major allergen in various species of fish.