Adenine phosphoribosyltransferase deficiency after kidney transplantation: a case report and literature review / 器官移植

Objective To summarize the diagnosis and treatment experience of adenine phosphoribosyltransferase deficiency after kidney transplantation. Methods Clinical data of 1 patient with adenine phosphoribosyltransferase deficiency after kidney transplantation were retrospectively analyzed. Clinical characteristics, diagnosis, treatment and prognosis of adenine phosphoribosyltransferase deficiency were summarized by literature review. Results Renal biopsy showed that salt crystallization was found in most renal tubule lumen and positive results were observed under polarized light microscopy. After allopurinol, hemodialysis and anti-crystallization treatment, the graft function was gradually recovered. After postoperative 1-year follow-up, the patient's renal function was properly recovered. Conclusions Adenine phosphoribosyltransferase deficiency after kidney transplantation may lead to delayed graft function or graft dysfunction. Early detection, diagnosis and treatment may delay disease progression and improve renal function.

The Expression and Significance of Serum Protein ROCK2 in Patients with Chronic Graft-Versus-Host Disease / 中国实验血液学杂志

OBJECTIVE@#To investigate the expression and clinical significance of serum protein ROCK2 in patients with chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).@*METHODS@#The patients were divided into cGVHD group and control group (without cGVHD). The expression levels of serum protein ROCK2 were detected by ELISA in patients with or without cGVHD after allo-HSCT.@*RESULTS@#The expression level of ROCK2 in serum of cGVHD patients was significantly higher than those in control group, moreover, the expression level of ROCK2 in severe cGVHD group was significant higher than that in moderate and mild cGVHD group (P<0.001). The expression level of ROCK2 was significantly decreased in the serum of cGVHD patients after treatment（P＜0.01）; the expression level of ROCK2 was significantly higher in the serum of cGVHD patients with lung as the target organ（P＜0.01）. The median survival time of patients with severe cGVHD were significantly shorter than that of patients with mild and moderate cGVHD（P＜0.05）.@*CONCLUSION@#ROCK2 shows certain reference value in the evaluation of severity and prognosis of cGVHD, and may be a new target for the treatment of cGVHD.

Effects of cisapride on digestive symptoms and gastrointestinal hormones in elderly peritoneal dialysis patients / 中华老年医学杂志

Objective:To study the effects of cisapride on digestive symptoms and gastrointestinal hormones in elderly peritoneal dialysis patients.Methods:Forty-two elderly patients with renal failure undergoing peritoneal dialysis in our hospital from July 2017 to December 2017 were randomly selected as the study group.Meanwhile, 20 healthy elderly people in the corresponding time period were selected as the control group.Control group received continuous ambulatory peritoneal dialysis(CAPD)and other conventional basic therapy, and study group received cisapride as add-on therapy to treatment for control group.Serum levels of somatostatin(SS), motilin(MOT)and vasoactive intestinal peptide(VIP)were compared between the two groups.Gastrointestinal symptoms, serum levels of gastrointestinal hormones and biochemical indexes were compared before and after treatment in the study group.Results:The score of acid reflux, nausea, abdominal distension, belching and constipation were lower in the study group after treatment than before treatment( t=4.42, 4.32, 6.80, 6.29 and 6.76, all P=0.00). Before treatment, levels of MOT, SS and VIP were higher in the study group than in the control group[(636.65±32.02)pmol/L vs.(228.47±28.74)pmol/L, (64.02±16.32)mg/L vs.(42.38±6.42)mg/L, (118.64±17.68)ng/L vs.(58.62±11.63)ng/L, t=48.44, 7.47 and 15.93, all P=0.00]. The level of MOT was lower after than before treatment[(385.36±19.64)pmol/L vs.(636.65±32.02)pmol/L, t=43.36, P=0.00], and the levels of SS and VIP had no significant difference before versus after treatment( t=-0.11 and -0.42, P=0.91 and 0.68). After treatment, the level of MOT was still higher in the study group than in the control group[(385.36 ±19.64)pmol/L vs.(228.47 ±28.74)pmol/L, t=22.08, P=0.00]. There was no significant difference in blood urea nitrogen(BUN), creatinine, haemoglobin and kt/v levels between before and after treatment( P>0.05). The level of albumin(ALB)was higher after than before treatment[(38.60±1.89)g/L vs.(37.71±1.96)g/L, t=2.12, P=0.04]. Conclusions:Gastrointestinal symptoms are common in elderly patients with peritoneal dialysis, and the accumulation of gastrointestinal hormones is obvious, which leads to gastrointestinal dysfunction.The conventional treatment in combination with cisapride can improve gastrointestinal symptoms and reduce serum MOT level in these patients.

The design and implementation of power control circuit of ultrasonic scalpel based on DSP / 中国医学装备

Objective:To independently develop a power control system of ultrasonic scalpel so as to reduce the energy consumption and maintain the normal temperature of ultrasonic scalpel.Methods:In this paper, the model of equivalent circuit of ultrasonic transducer nearby syntony was built up, and the hardware control system of ultrasonic scalpel based on digital signal processing (DSP) was designed.Results:Through testing the circuit and work performance of power control system, the series of parameters such as effective value and so on which were produced by this system could adjust frequency of power source in time and attain anticipative functional indicator, and it took the ultrasonic scalpel to work in syntonic situation.Conclusion:The tested indicators of power control system of ultrasonic scalpel based on the kernel design of DSP can attain anticipative requirement, and can take this system to work in syntonic situation.

Postoperative acute urinary retention in anorectal diseases treated with acupuncture combined with grain-moxibustion: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the efficacy differences between acupuncture combined with grain-moxibustion and acupuncture on acute urinary retention after epidural anaesthesia for anorectal diseases.@*METHODS@#A total of 60 patients were randomized into an acupuncture combined with grain-moxibustion group and an acupuncture group, 31 cases in each one. In the acupuncture group, acupuncture was applied at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6), Shuidao (ST 28), Pangguangshu (BL 28), Sanyinjiao (SP 6) and Yinlingquan (SP 9). In the acupuncture combined with grain-moxibustion group, grain-moxibustion was given at Zhongji (CV 3), Guanyuan (CV 4), Qihai (CV 6) and Shuidao (ST 28) on the basis of acupuncture. Those who failed to urinate 60 min after the first treatment received the second treatment. 30 min after the second treatment, the lower abdominal symptom scores before and after treatment as well as the bladder residual urine volume after the first urination after treatment were compared between the two groups. In addition, the clinical efficacy and security were evaluated.@*RESULTS@#Compared before treatment, the symptom scores after treatment were reduced in the two groups (<0.05), and the score in the acupuncture combined with grain-moxibustion group was lower than that in the acupuncture group after treatment (<0.05). The bladder residual urine volume in the acupuncture combined with grain-moxibustion group was (26.71±17.01) mL, which was lower than (35.32±20.76) mL in the acupuncture group (<0.05). The total effective rate was 93.5% (29/31) in the acupuncture combined with grain-moxibustion group, which was superior to 71.0% (22/31) in the acupuncture group (<0.05).@*CONCLUSION@#The efficacy of acupuncture combined with grain-moxibustion is superior to simple acupuncture on acute urinary retention after epidural anaesthesia for anorectal diseases, which is safe and reliable.

Effects of cisapride on symptoms of digestive and gastrointestinal hormones in chronic renal failure patients / 中华肾脏病杂志

Objective To study the effects of cisapride on symptoms of digestive and gastrointestinal hormones in chronic renal failure patients.Methods There were 46 cases of chronic renal failure patients in this paper,all patients were given routine treatment of the underlying disease and were randomly divided into two groups.23 patients were additionally treated with cisapride as research group,and the others as control group.The gastrointestinal symptoms,serum somatostatin (SS),motilin (MOT) and vasoactive intestinal peptide (VIP) and other gastrointestinal hormones and renal function in two groups of patients were compared before and after treatment.Results The score of acid reflux,nausea,vomiting,abdominal distension,belching and other symptoms of hard feces and other gastrointestinal after treatment were significantly lower than that before treatment in research group and after treatment in control group (all P ＜ 0.05).There was no significant change between before and after treatment in SS and VIP of two group (all P ＞ 0.05),and MOT in control group (P ＞0.05),but the MOT in research group was decreased significantly(P ＜ 0.05).There was no significant difference in Scr,Ccr and BUN between the control and research group after treatment (all P ＞ 0.05).Conclusion Conventional treatment combined with cisapride can improve the effect of gastrointestinal symptoms in patients with chronic renal failure,while reducing serum motilin level.

Correlation Research on Photodegradation Products of Cobamamide / 中国药师

Objective:To research the correlation between the cobamamide photodegradation products in the visible light area at different wavelengths and the photodegradation rate intensity. Methods:The 40-minute illumination experiment was conducted for co-bamamide reference solution respectively at the wavelength of 400 nm,450 nm,500 nm,550 nm,600 nm,650 nm and 700 nm under the illumination of 50 Lx,100 Lx,200 Lx,300 Lx,400 Lx and 500 Lx,respectively. An HPLC method was used to detect the cobam-amide content after the irradiation, the contents and proportions of hydroxocobalamin and adenosine (two photodegradation products) were calculated and the two photodegradation products were confirmed by mass spectrum. Results:The main photodegradation products of cobamamide (impurity 1,adenosine and hydroxocobalamin) had the similar photodegradation tendency. Within the scope of 50 Lx-200 Lx,the illumination intensity affected the concentration ratio of hydroxocobalamin and adenosine obviously. Within the scope of 200 Lx-500 Lx,the illumination intensity showed smaller effect. Under the different wavelengths and photodegradation rate intensity, the content of hydroxocobalamin was higher than that of adenosine under the same experimental condition.Conclusion:This paper re-searched the cobamamide photodegradation products in the optimum dark condition. The method is accurate and reliable,which can be used for the control of photodegradation related substances of cobamamide.

Investigation on microbial contamination of infant formula powder during production process / 中国食品卫生杂志

Objective The aim of this study was to investigate the microbial contamination situation in infant formula powder during the processes of production.Methods A total of 880 samples were collected from Gansu Province,which included raw materials,manufacturing facilities,personnel swabs and final infant formula powder.The detection method conducted in this study were complied with the standard of the SN/T 0738-1997 and GB 4789,and the microbial species detected in this study included Enterobacteriaceae,Enterobacter sakazakii,and Bacillus cereus.Results The detection rate of Enterobacteriaceae was 28.41％ (250/880),the detection rates of Enterobacter sakazakii and Bacillus cereus were 0.46％ (4/872) and 16.94％ (31/183) respectively.The prevalence of Enterobacteriaceae (40.00％,40/100) was the highest in raw materials.Four Enterobacter sakazakii strains were isolated from the pretreatment workshop,equipment and environment surface.The prevalence of Bacillus cereus was 22.73％ (10/44) in final product.Conclusion The microbial contamination was existent widely in infant formula powder and the production procession.Rigid laws and managements should be conducted to reduce the microbial contamination in raw materials,production processes and the environment,which might improve the quality of infant formula powder.

Curative effectiveness of human chorionic gonadotropin treatment on hypospadias with micropenis / 中华实用儿科临床杂志

Objective To evaluate the curative effectiveness and safety of human chorionic gonadotropin(HCG) treatment on children with microphallic hypospadias.Methods A total of 48 consecutive children with microphalic hypospadias were enrolled in the study,and the children were randomized into the experiment group(HCG treatment) and the control group with the research randomizer.The patients in experiment group were treated with HCG prior to surgery,and the control group did not received any hormone therapy preoperatively.All children in the experiment group and the control group underwent hypospadias repair by using transverse preputial island flap (Duckett technique) urethroplasty.Penile length,diameter of glans penis,bone age,serum testosterone level,and secondary effects were recorded before and after therapy in the experiment group.Postoperative complications were assessed with respect to fistulas,urethral strictures,diverticula,meatal stenosis,and glanular dehiscence in both groups.Results (1)Mean penile length and diameter of the experiment group increased significantly by (1.08±0.47) cm (t=-5.196,P<0.05) and (0.31±0.06) cm and there was a significant difference between before and after treatment (t=-5.080,P<0.05).(2)Urethrocutaneous fistulas were observed in 8 patients in the control group compared to 2 patients in the experiment group with a statistically significant difference (χ2=4.547,P<0.05).There was a significant difference between the overall reoperation rates of control group (9 patients) and the experiment group (3 patients,χ2=4.000,P<0.05).The penile tissue of the patients in the experiment group was soft and able to be easily separated and released during the operation and the flap had more blood supply.Conclusions Pretreatment with HCG therapy prior to hypospadias repair is beneficial to children with microphallic hypospadias.Significant penile growth was seen in the children treated with HCG and there was no obvious side effect.Moreover,pretreatment with HCG is beneficial to decrease the complications and reoperation rates of hypospadias repair which proves to be effective and safe.

Study on Lung Injury of Rats Caused by PM2.5 and Intervention Effect of Platycodonis Radix Total Saponins / 中国中医药信息杂志

Objective To observe the lung injury of rats caused by PM2.5 and the intervention effect of Platycodonis Radix total saponins (PGS); To discuss the repair mechanism of PGS for lung injury caused by PM2.5. Methods The model of lung injury caused by PM2.5 was induced by tracheal instillation. The rats were randomly divided into blank group, model group and PGS high-, medium- and low-dose groups, with 10 rats in each group. After medication for 14 d, BALF and left lung and right lung tissue of rats were collected. HE staining was used to observe the pathological changes of lung tissue. The contents of TNF-α, IL-6, IL-10 and IL-13 in BALF were detected by ELISA. RT-PCR was used to detect the expression of TGF-β mRNA in lung tissues. The expression of TGF-β protein in lung tissue was detected by Western blot. Results Compared with model group, TNF-α and IL-6 decreased significantly while IL-10 and IL-13 increased significantly in BALF in high- and medium-dose group of PGS. Degree of pulmonary interstitial edema and fibroplasia alleviated in PGS groups. Expressions of TGF-βmRNA and protein in lung tissue was reduced in PGS groups. Conclusion PGS can alleviate inflammatory injury caused by PM2.5 via regulating the balance of cytokine and down-regulating the expression of TGF-β and inhibiting the development of fibrosis, which results in the protection and repair on the lung injury of rats caused by PM2.5.

Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.

The value of adenosine deaminase, interferon-gamma, and interferon-gamma induced protein of 10KD in the diagnosis of tuberculous pleuritis / 解放军医学杂志

Objective To explore the value of adenosine deaminase (ADA) activity, interferon-gamma (IFN-γ) and IFN-γ induced protein of 10kD (IP-10) levels in pleural effusion for the diagnosis of tuberculous pleuritis. Methods ADA activity, IFN-γ and IP-10 levels in pleural effusion were determined in sixty-three patients with tuberculous pleuritis and 50 patients with malignant pleural effusion. Results The mean levels of ADA, IFN-γ and IP-10 in the tuberculous pleural effusion were significantly higher than those in malignant pleural effusion (P<0.01). When 45U/L was regarded as cut off value for ADA, the sensitivity, specificity and diagnostic odds ratio in the diagnosis of tuberculous pleurisy were 71.4%, 94.0% and 39.17 respectively. When 138.5pg/ml was regarded as cut off value for IFN-γ in tuberculous pleural effusion, the sensitivity, specificity and diagnostic odds ratio were 93.7%, 82.0% and 67.19 respectively. When 9.21μg/ml was regarded as cut off value for IP-10 in tuberculous pleural effusion, the sensitivity, specificity and diagnostic odds ratio were 85.7%, 90.0% and 54.00 respectively. The combined determination of the three markers for the diagnosis of tuberculous pleurisy had a sensitivity of 95.2%, specificity of 96.0% and diagnostic odds ratio of 72.16. Conclusion The accuracy of diagnosis for tuberculous pleurisy can be improved by combined determination of ADA, IFN-γ and IP-10.

The subsidiary effect of Wenyang Yiqi method on patients with severe traumatic brain injury under mild hypothermia therapy / 中国中西医结合急救杂志

Objective To observe the neural protective subsidiary effect of Wenyang Yiqi method on patients with severe traumatic brain injury under mild hypothermia therapy.Methods A prospective study was conducted in which 53 patients with severe traumatic brain injury treated by mild hypothermia were randomly divided into control group (26 cases) and observation group (27 cases). All the patients in the two groups received conventional western treatment combined with mild hypothermia therapy. In the observation group, additionally was given the representative drug of Wenyang Yiqi method, Shenfu injection 100 mL mixed into 5% glucose 500 mL intravenous drip once a day. At the end of mild hypothermia, the Shenfu injection was stopped. After treatment, the changes of intracranial pressure (ICP) on 1 (the day the treatment began), 2, 3, 4, 5, 6 and 7 days and the indexes levels, including S-100B, lactate dehydrogenase (LDH) and creatinkinase (CK) in the cranial spinal fluid (CSF) before treatment and 2, 4, 6 days after treament (CSF) were observed. The Glasgow coma score (GCS) before treament and 3, 5, 7, 14, 28 days after treament, and Glasgow outcome scale (GOS) on 28 days and 3 months after treatment were recorded, and the incidences of complications were calculated at the end of therapy.Results After treatment with the prolongation of therapeutic time, the levels of ICP were gradually increased in two groups and reached the peak values on the 4th day, then beganto fall, and on the 5th day it was significantly lower in observation group than that in control group [ICP (mmHg, 1 mmHg = 0.133 kPa): 16.11±1.23 vs. 18.73±1.42], persisting the same situation to the 7th day (14.17±0.80 vs. 16.94±1.00,P 0.05); after treatment, the GCS score of the two groups was progressively improved, and on the 14th day the score in the observation group began significantly higher than that in the control group (11.74±1.24 vs. 9.41±2.11,P 0.05), but the score in the observation group was significantly higher than that in the control group after treatment for 3 months (4.11±0.38 vs. 3.72±0.41, P < 0.05). The incidences of complications in the observation group were significantly lower than those in the control group [respiratory failure: 25.9% (7/27) vs. 50.0% (13/26), shock: 18.5% (5/27) vs. 53.8% (14/26), acute pulmonary edema: 14.8% (4/27) vs. 30.8% (8/26), stress ulcer: 22.2% (6/27) vs. 57.7% (15/26), hypoproteinemia: 40.7% (11/27) vs. 73.1% (19/26), allP < 0.05].Conclusion Wenyang Yiqi method has the subsidiary neural protective effect on patients with severe traumatic brain injury treated by mild hypothermia, and can improve their outcome.

Effect of oral and intravenous Prednisolone on infants with biliary atresia after hepatoportoenterostomy / 中华实用儿科临床杂志

Objective To compare oral with intravenous Prednisolone after hepatoportoenterostomy in improving biliary drainage and survival with the native liver.Methods Forty-nine cases of biliary atresia were conducted from January to December in 2012.Participants were randomized to receive oral Prednisolone (group A) or intravenous Prednisolone (group B) on the fifth day of posthepatoportoenterostomy (the other treatments were same,including intravenous injection of Cefoperazone for 2 weeks, choleretic treatment, etc.).The initial dose was 4 mg/(kg · d), and it was reduced by half per 3 days, until 1 mg/(kg · d).Then Prednisolone was administered orally with 1 mg/(kg · d)for 3 months.The primary end points were the total bilirubin level(TBIL) and the percentage of cholangitis in 6 months of posthepatoportoenterostomy.Secondary outcome was survival with native liver in 24 months after hepatoportoenterostomy.Results The ages of group A and group B were(98 ±33) d and(105 ±36) d,TBIL of them were (158.36 ± 55.22) μmol/L and (160.11 ±43.12) μmol/L,and there were no statistical differences between the 2 groups before surgery (t =-0.663,-0.123, all P ＞ 0.05).In the first 2 months after operation, the mean TBIL value of group A was higher than that of group B (in the first month after surgery ,the TBIL quartiles P25 ,P50 ,P75 of group A were 105 μmol/L, 152 μmol/L, 236 μmol/L, and the quartiles of group B were 40 μmol/L, 74 μmol/L, 99 μmol/L.In the second month after surgery,the TBIL quartiles of group A were 67 μmol/L, 103 μmol/L, 144 μmol/L,and the quartiles of group B were 39 μmol/L,64 μmol/L, 196 μmol/L) (all P ＜ 0.05).The morbidity of cholangitis which occurred in group A(56.0％ ,60.0％) was higher than that in group B (25.0％, 29.2％) (x2 =4.871,4.705, all P ＜ 0.05).However,from the 3rd to 6th months,there was no statistical difference between group A and group B(all P ＞ 0.05).Transplant-free survival was 44.0％ in group A and 47.7％ in group B 24 months after operation, and there was no statistical difference(x2 =1.007 ,P ＞ 0.05).Conclusions Therapy of intravenous Prednisolone following portoenterostomy may be more beneficial in bile drainage than oral method,but it's of no use to improve survival.

The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study / 대한중환자의학회지

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

The Adequacy of a Conventional Mechanical Ventilator as a Ventilation Method during Cardiopulmonary Resuscitation: A Manikin Study / 대한구급학회지

BACKGROUND: We conducted this study to verify whether a mechanical ventilator is adequate for cardiopulmonary resuscitation (CPR). METHODS: A self-inflating bag resuscitator and a mechanical ventilator were used to test two experimental models: Model 1 (CPR manikin without chest compression) and Model 2 (CPR manikin with chest compression). Model 2 was divided into three subgroups according to ventilator pressure limits (P(limit)). The self-inflating bag resuscitator was set with a ventilation rate of 10 breaths/min with the volume-marked bag-valve procedure. The mode of the mechanical ventilator was set as follows: volume-controlled mandatory ventilation of tidal volume (Vt) 600 mL, an inspiration time of 1.2 seconds, a constant flow pattern, a ventilation rate of 10 breaths/minute, a positive end expiratory pressure of 3 cmH2O and a maximum trigger limit. Peak airway pressure (P(peak)) and Vt were measured by a flow analyzer. Ventilation adequacy was determined at a Vt range of 400-600 mL with a P(peak) of < or = 50 cmH2O. RESULTS: In Model 1, Vt and P(peak) were in the appropriate range in the ventilation equipments. In Model 2, for the self-inflating bag resuscitator, the adequate Vt and P(peak) levels were 17%, and the P(peak) adequacy was 20% and the Vt was 65%. For the mechanical ventilator, the adequate Vt and P(peak) levels were 85%; the P(peak) adequacy was 85%; and the Vt adequacy was 100% at 60 cmH2O of P(limit). CONCLUSIONS: In a manikin model, a mechanical ventilator was superior to self-inflating bag resuscitator for maintaining adequate ventilation during chest compression.

Current option of clinical research in biliary atresia treated with Kasai procedure / 中华实用儿科临床杂志

Biliary atresia (BA) is characterized of progressive inflammation and obstruction with fibrosis in biliary system and presents symptoms with obstructive jaundice in neonatal period,if its treatment is not ineffectively may lead to progressive liver fibrosis,end-stage liver failure and die within 2 years.Kasai procedure is the major method in BA treatment,but not all cases have postoperative jaundice clearance and survive with native liver,it is need to optimize the choice of surgical time and methods,postoperative protocol with medicine,prevention and treatment of complications for improving the postoperative therapeutic effect.In this paper,the current option of clinical research and statue in Kasai procedure were summarized.

Antihypertensive use of 969 hypertension patients in Guiyang and impact factors analysis / 中华医院管理杂志

Objective By means of analyzing the antihypertensive use of hypertension patients of Guiyang in 2013 and impact factors for basic drug use,to evaluate the impacts of the essential medicines list in place in Guiyang to hypertension patients in communities in Guiyang.Methods 969 hypertension patients were surveyed with structured questionnaire of stratified random sampling at 6 community health centers in Guiyang city.Results Hypertension patients in communities averaged 1.4 types of antihypertensive,and the essential medicines used accounted for 39.8％of all the antihypertensive.The distribution differences of the ratio of essential medicines use are significant interms of age,gender,and household annual income.Use ratio of non-essential medicines of the 55～64 age group and 65～74 age group are 3.48 times and 0.47 times over that of the 75 and above age group.For hypertension patients of low income and medium income,their probable use of non-essential medicines is 2.05 and 2.87 times that of high income households.Conclusion As the use ratio of hypertension patients in Guiyang is relatively low,and the factors for it are age and household income,focused intervention is recommended for the 65～74 age group and low-income households,for the purpose of high use ratio of essential medicines of such people.

Value of CYP2C19 genotype predicted by thromboelastography in guiding clopidogrel treatment following percutaneous coronary intervention / 第二军医大学学报

Objective To investigate the role of thromboelastography (TEG) in predicting cytochrome P450 2C19 (CYP2C19) genotype and its value in guiding clopidogrel treatment following percutaneous coronary intervention (PCI). Methods From January 2012 to August 2012, 70 patients with coronary artery disease undergoing PCI were enrolled and treated with aspirin and clopidogrel. They were divided into clopidogrel resistance (CR) group and clopidogrel sensitive (CS) group according to adenosine diphosphate (ADP)-induced platelet aggregation inhibition rate. Genotyping of CYP2C19 in the 70 patients was classified as: extensive metabolizers (* 1/ * 1), intermediate metabolizers (* 1/* 2, * 1/* 3) and poor metabolizers(* 2/ * 2, * 2/ * 3, * 3/ * 3). The clinical data, biochemical parameters, and CYP2C19 genotypes were compared between two groups. The independent risk factors of CR were analyzed by multiple logistic regression analysis. A receiver operating characteristic (ROC) curve was used to evaluate the efficacy of ADP-induced platelet aggregation inhibition rate in predicting the genotype of CYP2C19. Results High-density lipoprotein and genotypes of CYP2C19 were significantly different between the CR group (n = 31) and CS group (n=39)(P<0. 05). Stepwise forward multiple logistic regression analysis found that CYP2C19 poor metabolizers and lower HDL level were independent risk factors for CR (P<0. 05). The results of ROC curve demonstrated a satisfactory predictive value for ADP-induced platelet aggregation inhibition rate, with the area under the curve (AUC) being 0. 847 (95 % CI: 0. 729-0. 965,P=0. 003). When the ADP-induced platelet aggregation inhibition rate was at the optimal cut-off value (39. 45%), the sensitivity, specificity, positive predictive value and negative predictive value in diagnosing the poor metabolizers.

The Relation between Neurologic Prognosis and Optic Nerve Sheath Diameter Measured in Initial Brain Computed Tomography of Cardiac Arrest and Hanging Patients / 대한구급학회지

BACKGROUND: Early prediction of neurologic outcome is important to patients treated with therapeutic hypothermia after hypoxic brain injury. Hypoxic brain injury patients may have poor neurologic prognosis due to increased intracranial pressure. Increased intracranial pressure can be detected by optic nerve sheath diameter (ONSD) measurement in computed tomography (CT) or ultrasound. In this study, we evaluate the relation between neurologic prognosis and optic nerve sheath diameter measured in brain CT of hypoxic brain injury patients. METHODS: We analyzed the patient clinical data by retrospective chart review. We measured the ONSD in initial brain CT. We also measured and calculated the gray white matter ratio (GWR) in CT scan. We split the patients into two groups based on neurologic outcome, and clinical data, ONSD, and GWR were compared in the two groups. RESULTS: Twenty-four patients were included in this study (age: 52.6 +/- 18.3, 18 males). The mean ONSD of the poor neurologic outcome group was larger than that of the good neurologic outcome group (6.07 mm vs. 5.39 mm, p = 0.003). The GWR of the good neurologic outcome group was larger than that of the poor outcome group (1.09 vs. 1.28, p = 0.000). ONSD was a good predictor of neurologic outcome (area under curve: 0.848), and an ONSD cut off > or = 5.575 mm had a sensitivity of 86.7% and a specificity of 77.8%. CONCLUSIONS: ONSD measured on the initial brain CT scan can predict the neurologic prognosis in cardiac arrest and hanging patients treated with therapeutic hypothermia.