Effect of early external diaphragm pacing on patients with mechanical ventilation / 中华急诊医学杂志

Objective:To investigate the effect of early external diaphragm pacing on the diaphragm function and prognosis of patients with mechanical ventilation.Methods:A total of 47 patients receiving invasive mechanical ventilation in the Emergency Intensive Care Unit of Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University) from October 2019 to July 2021 were selected and randomly divided into the treatment group ( n=23) and control group ( n=24). The patients in the control group received routine clinical treatment. On this basis, the treatment group received external diaphragm pacing treatment every day from the third day of mechanical ventilation until weaning, and was followed up to 30 days after discharge. The diaphragm thickness, diaphragm excursion, diaphragm thickening fraction, mechanical ventilation time, number of weaning failures, length of hospital stay and death toll were compared between the two groups. Results:Compared with the control group, the diaphragm thickness [(0.21±0.05) cm vs. (0.16±0.05) cm], diaphragm excursion [(1.38±0.37) cm vs. (1.11±0.48) cm], and diaphragm thickening fraction [26% (19%, 32%) vs. 18.5% (10.25%, 20%)] in the treatment group increased significantly (all P<0.05). The mechanical ventilation time was shorter in the treatment group [10 (7, 15) d vs. 13 (10.25, 19) d], and the difference was statistically significant ( P<0.05). There were no significant differences in the number of weaning failures (7 vs. 9), length of hospital stay [22 (15 , 30) d vs.. 24 (17.25, 34.25) d] and deaths (8 vs. 8) (all P>0.05). Conclusions:Early application of external diaphragm pacing can improve the diaphragm function of patients with mechanical ventilation, delay the decline in diaphragm function, increase diaphragm excursion and diaphragm thickening fraction, and shorten the mechanical ventilation time.

Value of the diaphragm movement index tested by ultrosonography for ventilation weaning / 中华危重病急救医学

Objective To evaluate the diaphragm movement index of mechanical ventilation weaning patients by ultrosonography, and to explore its value for weaning. Methods Forty patients undergoing invasive mechanical ventilation for at least 48 hours admitted to emergency intensive care unit (EICU) of Hunan Provincial People's Hospital from September 2017 to February 2018 were enrolled. Low level pressure support ventilation (PSV) was used for spontaneous breathing test (SBT), and bedside M-mode ultrasonography was used to assess the diaphragm movement index of the patient within 1 hour of SBT, including the excursion of the diaphragm, diaphragmatic-rapid shallow breathing index (D-RSBI). The rapid shallow breathing index (RSBI) was measured by ventilator. The patients who met the clinical weaning criteria were weaned. According to the success or failure of the weaning, the patients were divided into the successful weaning group and the failure weaning group. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of each indicator to the failure of the weaning. Results A total of 40 patients were enrolled in the final analysis, including 28 patients in the successful weaning group and 12 patients in the failure weaning group. The excursion of the diaphragm in the failure weaning group was significantly less than that in the successful weaning group (mm: 9.56±2.13 vs. 13.66±4.10, P < 0.01), and the D-RSBI and RSBI were significantly higher than those in the successful weaning group [D-RSBI (times·min-1·mm-1): 2.06±0.68 vs. 1.44±0.66, RSBI (times·min-1·L-1): 61.70±25.00 vs. 44.91±14.51, both P < 0.05]. The area under the ROC curve (AUC) of diaphragm displacement, D-RSBI, and RSBI was 0.830, 0.851 and 0.711, respectively, and the predicted value of diaphragm excursion and D-RSBI was higher. When the optimal critical value of diaphragmatic excursion was 11.15 mm, the sensitivity of predicting weaning failure was 83.3%, the specificity was 71.4%; when the optimal critical value of D-RSBI was 1.42 times·min-1·mm-1, the sensitivity of predicting the failure of weaning was 91.7%, and the specificity was 82.1%. Conclusion Diaphragm excursion and D-RSBI of the diaphragmatic ultrosonography index could accurately predict the failure of the weaning, which was superior to the traditional RSBI in guiding weaning.

Clinical effect of pulmonary rehabilitation therapy including respiratory exercise and vibration expectoration on patients with pulmonary infection after abdominal surgery / 中华危重病急救医学

Objective To investigate the clinical effect of pulmonary rehabilitation therapy including respiratory exercise and vibration expectoration on patients with pulmonary infection after abdominal surgery.Methods A retrospective case control study was conducted.Seventy-six patients with pulmonary infection after abdominal surgery admitted to the First Affiliated Hospital of Hunan Normal University from September 2015 to September 2016 were enrolled.According to whether accept the pulmonary rehabilitation therapy or not,the patients were divided into two groups.In the control group (n =35),the convemional expectoration method was adopted.The patients in pulmonary rehabilitation group (n =41) received both methods of the control group and pulmonary rehabilitation treatment,including respiratory exercise (effective cough,lip reduction breathing),respiratory exercise device (respiratory exerciser tri-ball),and vibrated expectoration.The 24-hour sputum volume,degree of comfort,inflammatory and pulmonary function parameters,and recovery situation were recorded in the two groups.Results ① There were no significant differences in the parameters of inflammation and pulmonary function before treatment between the two groups.After treatment,the white blood cell (WBC) and C-reactive protein (CRP) in both groups were significantly decreased,and the forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC) were significantly increased.The above changes in pulmonary rehabilitation group were more significant than those of the control group [WBC (× 109/L):11.12 ± 2.88 vs.13.42 ± 2.62 at 3 days,8.22 ± 1.48 vs.9.27 ± 1.92 at 5 days;CRP (mg/L):13.47 ± 4.77vs.16.03±4.94 at 3 days,9.69±1.56 vs.11.77±1.41 at 5 days;FEV1 (L):2.48±0.14 vs.2.29±0.16 at 3 days,FEV1/FVC:0.78±0.04 vs.0.75±0.04 at 3 days;all P ＜ 0.05].② The 24-hour sputum volume within 3 days of pulmonary rehabilitation group were significantly higher than that of the control group (mL:30.51 ± 4.15 vs.18.30 ± 3.64at 1 day,31.08±3.22 vs.20.37±3.20 at 2 days,29.03±2.55 vs.19.03±2.51 at 3 days,all P ＜ 0.01].③ In the pulmonary rehabilitation group,the recovery time of pulmonary infection symptoms (days:5.44 ± 1.45 vs.6.20 ± 1.55),the days of antibiotic use (days:12.61 ± 3.15 vs.15.03 ± 3.78),the time of getting out of the bed (days:4.05 ± 0.74vs.4.51±0.89),and the hospital days (days:19.95±3.90 vs.22.00±4.42) were significantly shorter than those of the control group (all P ＜ 0.05),and the degree of comfort was significantly better than that of the control group (comfort score:2.71 ±0.90 vs.2.14±0.91,P ＜ 0.01).Conclusion The application of pulmonary rehabilitation including respiratory exercise and vibration expectoration in abdominal surgery patients with pulmonary infection can promote recovery,and it has a good clinical and practical application value.

Guiding significance of diaphragm function evaluation in ventilation weaning / 中华危重病急救医学

Diaphragm dysfunction is common in clinical work, which is a frequently important cause of ventilation weaning failure ignored by clinicians. Assessing diaphragmatic function while weaning helps early detection and prevention of weaning failure, so as to improve the clinical outcome of patients on mechanical ventilation (MV). Reviewing studies of diaphragmatic function evaluation in weaning, we can find that assessing diaphragmatic function during weaning can help guide weaning. Weaning predictors including pressure index, electrophysiological index and morphological index, among which bedside ultrasound as a morphological index is widely used in intensive care unit (ICU), which is simple, non-invasive, and easy to operate. It is also accurate in the assessment of diaphragmatic function and guidance on weaning, which is worthy of promotion and application.

Determination method of muscone in rat intestinal perfusate by GC-MS/MS and its intestinal absorption kinetic characteristics in rats / 中国中药杂志

<p><b>OBJECTIVE</b>To establish the method for determining muscone in rat intestinal perfusate by GC-MS/MS and study its intestinal absorption kinetic characteristics in rats.</p><p><b>METHOD</b>The GC-MS/MS method was used to determine the content of muscone in rat intestinal circulation fluid. In situ intestinal circulation perfusion was adopted to study absorption kinetics of muscone in rats.</p><p><b>RESULT</b>Muscone was proved to be well absorbed in each section of small intestine. Its absorption rate constants (Ka) and the absorption rate (A) in the rat intestine showed duodenum > jejunum (P < 0.05) , duodenum > ileum (P < 0.01). Its Ka, A and t1/2 in rat small intestine was 0.990 h(-1) , 43.58% and 0.705h, respectively.</p><p><b>CONCLUSION</b>Muscone was well absorbed in each intestinal section, with duodenum better than jejunum (Ka, T1/2, P < 0.05) significantly better than ileum (Ka, T1/2, P < 0.01; A, P < 0.05). There is no obvious statistical difference between jejunum and ileum.</p>

Theoretical and experimental studies on apparent solubility parameters of multiple components for Chinese materia medica with HPLC fingerprint / 中国中药杂志

<p><b>OBJECTIVE</b>To establish the theories and methods to determine apparent solubility paraneters of multiple components for the Chinese materia medica (CMM) with HPLC fingerprint.</p><p><b>METHOD</b>The mathematical functional expresses to determine the apparent solubility parameters for multiple constituents were established according to total quantum geometrical average retention time (TQGART) for HPLC fingerprint that characterized the entirety tendencies for all-over chromatographic peaks, validated by the aloe-emodin's solubility parameters which had been determined. The HPLC for the aloe-emodin's solubility parameters were carried out with an Alltech Apollo C18 as column, Acetone: Water as mobile phase, gradient elution,flow rate as 1.0 mL x min(-1), the detection wave-length as 430 nm and the temperature as 30 degrees C.</p><p><b>RESULT</b>The mathematical functional model between the TQGART of HPLC chromatographic fingerprint and the total quantum apparent solubility parameters was established and used to determine the aloe-emodin's mixture solubility parameter as 36.12 J(1/2) x cm(-3/2), nearly equal to 35.57, 36.07 J(1/2) x cm(-3/2) calculated by ration of peak area ratios and molecular fraction, respectively.</p><p><b>CONCLUSION</b>The TQGART of HPLC fingerprint can be used to determine simultaneously the apparent or single intrinsic solubility parameters for total quantum or intrinsic solubility parameters for single in multiple constitute systems, by which theoretical and technologic platform to study the compatibility rule and dosage form reform of the single CMM will be established.</p>

Solubility peak and dielectric requirement of Buyang Huanwu docoction / 中国中药杂志

<p><b>OBJECTIVE</b>To study the solubility peak and dielectric requirement of the Buyang Huanwu docoction materials, and provide theoretical and experimental foundation for selecting extraction solvent for extracting traditional Chinese drugs (TCD).</p><p><b>METHOD</b>11 types of solvents were employed as single or complex solvent systems, whose solubility parameter and dielectric constant were from 14.11 to 47.86, dielectric requirement from 1 to 80 respectively, to lixiviate Buyang Huanwu decoction (5 g per samples) in nearly saturate volume as V0 for materials at 25 degrees C. The apparent solubilities of extracts were determined and calculated out according to the section of determination of extract in the appendix of 'Chinese Pharmacopoeia'.</p><p><b>RESULT</b>The saturate solvent V0 for materials powder were 0.21, 0.31, 0.49, 0.36, 0.77, 0.93, 0.86, 0.92, 1.08, 1.00, 1.14 mL x g(-1), respectively. The apparent solubility of Buyang Huanwu docoction for each solvent system were 114.0, 101.3, 73.40, 109.4, 210.7, 295.0, 501.4, 437.0, 355.6, 423.1, 210.6 g x mL(-1), respectively, among which the max apparent solubility, illustrated as solubility peak, was carried out by methanol-water (68: 32) with 47.5 corresponding to the Buyang Huanwu docoction dielectric requirement.</p><p><b>CONCLUSION</b>The apparent solubilities of (TCD) and their formula are controlled by dielectric constant of extraction solvent, and are in accordance with stable dielectric requirement.</p>

Separation and purification of total flavones from Herba Epimedii by macroporous adsorption resin with the help of ultrasonic extraction / 中国中药杂志

<p><b>OBJECTIVE</b>To investigate the optimal separation of the total flavones from Herba Epimedii by macroporous adsorption resin.</p><p><b>METHOD</b>Nine types of macroporous adsorption were evaluated for separating efficiency by measuring the adsorption ratio, eluting ratio of total flavones.</p><p><b>RESULT</b>The D-101 macroporous adsorption resin had the best separating efficiency. After enrichment and purification with it, the product purity of total flavones was up to 63.8%.</p><p><b>CONCLUSION</b>This method is simple, feasible and fit for industry production.</p>

Comparative Study on the Extraction Process for the Preparation of Maxingshigan Pill / 中草药

Influence of extraction process on the quality of Maxingshigan pills was studied. Guided by the amount of ephedrine in the extraction as determined by dual wavelength TL- C-scanning. Four different processes were compared. Result showed that Process C was the best among all.

Application of hydrating swelling kinetic model to Radix et Rhizoma Rhei / 中成药

AIM: To establish a new kinetic model of hydrating swelling and to make experiments of Radix et Rhizoma Rhei (Rhubarb) designed to validate this model. METHODS: The model was set up according to kinetics, residul water analysis was adopted to measure Rhubarb's sakage, and then obtained the fittin curve and kinetic parameters, its goodness of fit was evaluated by analysis of variance. RESULTS: Hydrating swelling model of the vegetable herb had a form of multivariate first order linear differential equation. Rhubarb comformed to three compartment model with ? = 0.3241min -1 , ? = 0.0185min -1 , ?=5.659?10 -3 min -1 , V ∞ T =1.726mL?g -1 , V ∞ 1 =1.008mL?g -1 , V ∞ 2 =0.2814mL?g -1 V ∞ 3 =0.4366mL?g -1 ,K= 0.2186min -1 ,K 12 =0.02426min -1 ,K 21 =0.07422min -1 ,K 13 =6.402?10 -3 min -3 ,K 31 =0.02481min -1 . CONCLUSION: The kinetic model of hydrating swelling has been in accordance with quantitative changes with multivariate first order linear mammary.

Study on Clarifying Process of Zhonglizhikang Granules / 中成药

Objective: To investigate the effects of alcohol, chitosan、 101 juice clarifying agent and ZTC natural clarifying agent on content of active components and the solid compositions in zhonglizhikang decoction. Methods: The solid compositions of different samples were determined by the methods adopted in pharmacopeia, and the chrysophanol content was determined by HPLC. Results: Chitosan has no effect on the content of chrysophanol, and solid compositions decreased by 30.8%. But alcohol、 101 juice clarifying agent and ZTC natural clayifying agent can decrease solid compositions and the content of chrysophanol. Conclusion: Chitosan can decrease solid compositions but has no effect on the content of active components.

Study on Preparation Procedure of Grub Eye Drops / 中成药

Objective: To establish the optimum preparation procedure for Grub Eye Drops. Methods: The amount of extract abtained from extraction solutions, the contents of glutamic acid and glycine, nitrogen content and TLC spots were used to evaluate the extraction procedure for Grub Eye Drops by orthogonal design. Results: The optimum extraction condition was A 3B 2C 1. That is adding ten times amount of water to soaking for 30min, decocting for 1.5h, filtering to obtain filtrate Ⅰ, adding seven times of water into filter residue, decocting for 1h to obtain filtrate Ⅱ, combining filtrate Ⅰ and Ⅱ. Conclusion: The experimental method is suitable for the productive preparation of Grub Eye Drops.