Research progression on safety verification of diving decompression procedures / 中国职业医学

@#A diving decompression procedure is a specific rule that divers should follow when they ascend and get out of water. It comes from the decompression theory and algorithm and is designed for the prevention of decompression sickness. With the ， ， development of diving technology and diving medicine the decompression procedures are constantly innovated and the new ， decompression procedure can be used in diving practice after safety verification. In principle the safety verification of ， decompression procedures should be conducted on animal experiments before human experiments and the risks of ， decompression sickness and oxygen toxicity should be systematically assessed. However the assessment methods used in ， ， ， different studies differ greatly thus it is urgent to establish a standard and universal verification system. Traditionally the risk ， ， assessment of decompression sickness and oxygen toxicity is mainly carried out by observing the incidence detecting bubbles ， theoretical calculation and lung functional test. Furthermore biochemical indicators are increasingly becoming important ， ， supplements. Due to the special underwater environment the diving operation is prone to accidents. Therefore in addition to ， verifying the safety of the new decompression procedure exploring its safety decompression limit is of great significance for the formulation of emergency decompression procedures in emergency situations. The specific approach is to shorten the decompression time and assess the safety until the critical time for detecting bubbles without the occurrence of decompression ， ， sickness is found. Future studies should continue to optimize safety assessment methods explore sensitive biochemical markers ， clarify species associations and improve verification efficiency and reliability of results.

Doppler grading for decompression bubbles / 中国职业医学

Ultrasonic bubble detection has been widely used in predicting the risk of decompression sickness and evaluating the efficiency and safety of decompression procedures. Currently, the widely used SPENCER scale is conducted by using Doppler ultrasound to monitor the bubble signal in the precordial region of subjects. KM grading system is a computerized system based on Doppler ultrasound. The grading score can be converted into SPENCER bubble grading scale score and the bubble grading is precise and suitable for the motion status. On the basis of the above two methods, the KISMAN integrated severity score, extended SPENCER bubble grading and simplified Doppler bubble grading system were established. They not only coordinated analysis of Doppler ultrasound bubble detection results with other risk factors of decompression disease, but also convenient to use computer for processing detection results. With the in-depth application of Fourier technique and empirical mode decomposition in Doppler audio bubble signal detection, methods such as three-parameter fuzzy analysis and energy operator method are playing an important role in automatic bubble analysis. Optimization of detection technology and improvement of sensitivity and accuracy of automatic analysis are important development directions in the field of decompression bubble Doppler grating technology.

Ultrasound-Guided Transmuscular Quadratus Lumbar Block Reduces Opioid Consumption after Laparoscopic Partial Nephrectomy / 中国医学科学杂志(英文版)

Objectives Transmuscular quadratus lumborum block (TQLB) may provide postoperative analgesia in patients undergoing intraperitoneal surgeries. The purpose of this study was to examine the potential efficacy of TQLB among patients undergoing retroperitoneal procedures, such as the laparoscopic partial nephrectomy (LPN). Methods This prospective, randomized, controlled study was conducted from August 2017 to November 2018 at Peking Union Medical College Hospital (Beijing, China). Patients who were scheduled for a LPN, aged 18-70 years old with an ASA physical status score of I - II were randomly assigned to receive either TQLB with 0.6 ml/kg of 0.5% ropivacaine plus general anesthesia (TQLB group) or general anesthesia alone (control group). Patient-controlled intravenous analgesia with morphine was initiated immediately upon surgery completion. The primary outcome was the cumulative consumption of morphine within 8 h after surgery. The secondary outcome included postoperative consumptions of morphine at other time points, pain score at rest and during activity, postoperative nausea and vomitting (PONV), and recovery related parameters. Results Totally 30 patients per group were recruited in the study. The 8 h consumption of morphine was lower in the TQLB group than in the control group (median, 0.023 mg/kg

Different level of fasting blood glucose and cardiovascular risk factors clustering among population of Jiangsu Province / 中华疾病控制杂志

Objective To analyze the clustering of major cardiovascular risk factors among population with different level of fasting blood glucose (FBG) in Jiangsu provincial communities. Methods A population-based screening project was conducted during 2015-2017, with 83 522 residents aged 35-75 years from 6 areas included in the study. Prevalence and the clustering of four cardiovascular risk factors (hypertension, obesity, dyslipidemia and smoking) were analyzed. Binary Logistic regression analysis was performed to explore the relationship between FBG and cardiovascular risk factor clustering. Results The prevalence of diabetes was 18.9% among adults aged 35-75 years in Jiangsu province, and 41.4% of them were aware of their disease. Among undiagnosed population, the odd ratios (OR) of cardiovascular risk factors clustering in impaired fasting glucose (IFG) and hyperglycemia group was 1.29 (OR=1.29，95% CI:1.24-1.36，P<0.001) and 1.99 (OR=1.99，95% CI:1.89-2.08，P<0.001), compared with normal FBG group. The control rate of FBG was 15.5% among diagnosed cases. There was no difference in the risk clustering between diabetes patient with and without control of FBG. Conclusions Hyperglycemia and IFG increase the risk of cardiovascular risk factor clustering. Comprehensive interventions should be served as an important role to keep blood glucose at a normal level in high-risk population.

Clinical Effect of Modified Huangqi Guizhi Wuwu Tang on Patient with Lower-extremity Arterial Disease / 中国实验方剂学杂志

Objective:To observe the clinical effect of modified Huangqi Guizhi Wuwu Tang on patient with lower-extremity arterial disease (LEAD) with deficiency of Qi and Yin and blood stasis syndrome, and study the antioxidant mechanism. Method:One hundred and twenty-eight patients were randomly divided into control group (64 cases) and observation group (64 cases) by random number table. Patients in control group was treated for controlling blood sugar, blood pressure and blood fat, and got probucol in the morning and evening, 0.5 g/time, 2 times/days, aspirin enteric-coated tablets for 3 months, 100 mg·d-1, and alprostadil injection diluted with 10 mL normal saline for 15 days, 10 μg·d-1, 1 time/day. A course of the treatment in control group was 15 days, and there were 4 courses. In addition to the therapy of control group, patients in observation group were additionally given modified Huangqi Guizhi Wuwu Tang, 1 dose/day, for 3 months. Before and after treatment, ankle brachial index (ABI) and toe branch index (TBI) were detected, and internal diameter of dorsal artery of foot, peak velocity and blood flow were detected by color Doppler ultrasound. Main symptoms and sign were scored. And levels of interleukin-1 (IL-1), Homocysteine (Hcy), tumor necrosis factor-α (TNF-α), high sensitive C reactive protein (hs-CRP), cystatin C (CysC), malondialdehyde (MDA), superoxide dismutase (SOD) and oxidized low density lipoprotein (OX-LDL) were detected. Result:According to the rank test, clinical effect in observation group was better than that in control group (PPα, hs-CRP, Cys-C and Ox-LDL were lower than those in control group (PConclusion:Modified Huangqi Guizhi Wuwu Tang can relieve symptoms and signs, lower limb vascular function and hemodynamic, with certain anti-inflammatory effect and oxidative stress. It can also reduce vascular endothelial cell injury, and relieve and postpone the progress of LEAD

Analysis on Safety of Polysorbate 80 as a Solubilizing Excipient in Traditional Chinese Medicine Injections / 中国实验方剂学杂志

There are safety problems in traditional Chinese medicine(TCM) injections. Most of the adverse reactions of TCM injections are very similar to those of hypersensitivity reactions. The hypersensitivity reaction of macromolecular substances in TCM injections has also been confirmed by experiments. Polysorbate 80 (trade name of tween-80) is a solubilizing excipient commonly used in TCM injections. Polysorbate 80 contains macromolecular impurities and the material basic research is not clear enough, and its quality problems need to be solved urgently. Based on this, the authors concluded that the macromolecular impurities in polysorbate 80 were the important material basis for the safety of TCM injections contained polysorbate 80. In this paper, the research progress of application of polysorbate 80 as a solubilizing excipient in TCM injections was reviewed and analyzed, so as to provide ideas for improving the safety of TCM injections contained polysorbate 80 and to promote the healthy development of TCM injections.

Effect of Threshold Inspiratory Muscle Training on Respiratory Muscle Function: A Meta-analysis / 中国康复理论与实践

Objective:To evaluate the effect of threshold inspiratory muscle training (TIMT) on respiratory muscle strength and clinical outcomes for machinery ventilates patients. Methods:The Cochrane Library, PubMed, Embase, Web of Science, CBM, Wanfang Database, CNKI and VIP were searched for the randomized controlled trials (RCT) about the effect of TIMT on respiratory muscle strength and clinical outcomes from establishment to July 1st, 2018. Two researchers strictly evaluated literature quality and extracted information, and then a Meta-analysis was carried out. Results:A total of 14 literatures were included with 650 patients, 323 cases in the experimental group and 327 cases in the control group. Compared with the control group, the massive inspiratory pressure (MIP) increased (MD = -6.65, 95%CI -8.27~-5.03, P < 0.001), the respiratory muscle strength increased (MD = -5.04, 95%CI -7.68~-2.04, P = 0.0002), the weaning time reduced (MD = -1.01, 95%CI -1.65~-0.37, P = 0.002), the mechanical ventilation time shortened (MD= -2.24, 95%CI -4.33~-0.15, P = 0.04), as well as the intensive care unit (ICU) length of stay (MD= -3.41, 95%CI -6.06~-0.76, P= 0.01). There was no significant difference in maximum expiratory pressure (MEP) (MD= 1.22, 95%CI -6.55~9.00, P = 0.76), the rate of reintubation/tracheotomy (RR = 0.99, 95%CI 0.56~1.73, P = 0.96) and mortality (RR= 1.05, 95%CI 0.53~2.06, P = 0.89) between two groups. Conclusion:TIMP could improve MIP and respiratory muscle strength of patients with mechanical ventilation, shorten the weaning time, the mechanical ventilation time and the ICU length of stay, and then reduce the incidence of weaning failure.

Upgrading No.1 Military Medical Project database from Oracle 8.17 to Oracle 11g / 医疗卫生装备

Objective To upgrade No.1 Military Medical Project database from Oracle 8.17 to Oracle 11g so as to solve the problems of server overloading and client terminal failing to connect to the server due to excessive concurrent databases. Methods Exp/Imp and Toad tools of the database were used to generate and modify the upgrade statements as well as to import and export database data,so that the inter-platform and-version database upgrade could be carried out.Results The database was upgraded and the system's operation speed was enhanced greatly.Conclusion The upgrade scheme has easy operation,short time consumed,zero data loss and high reliability,and thus is worthy promoting in medium-and small-scale hospitals.

Finite element analysis for self-made femoral head brace device in the treatment of early femoral head necrosis / 中国组织工程研究

BACKGROUND: Core decompression for early adult ischemic necrosis of femoral head gets the identity of most scholars, but the postoperative femoral head easily experiences collapse. How to prevent collapse is still a problem to be solved currently. OBJECTIVE: To perform biomechanical analysis of femoral head ischemic necrosis by using the finite element method and to provide biomechanical basis for the treatment of early adult femoral head necrosis. METHODS: One fresh femur specimen died of accidental death in youth and young adults was obtained, and no deformity or fracture was found. X-ray confirmed that it did not have tumor or osteoporosis. Spiral CT was used to scan normal femoral head and neck, pulp core decompression of femoral head and neck, brace device placement and bone-graft of femoral head and neck for acquiring image data from the proximal to distal vertical longitudinal axis. Scanning data were input in the Mimics software. Finite element method was utilized for biomechanical analysis of femoral head and neck of three models. RESULTS AND CONCLUSION: (1) The stress dispersal and downward conduction of normal femoral head was concentrated in the shaft of the femur and the tensile stress was concentrated in the rotor socket. (2) After pulp core decompression, the stress concentration, displacement and strain increased in the weight-bearing area of femoral head. (3) The stress of the internal bracing was similar to that of normal femoral head. (4) The stress of weight bearing area of femoral head is concentrated, and the strain is increased, so that weight bearing area is easy to collapse after pulp core decompression. The more stress distribution, more bearing load and less strain of implant and bone graft model, are conformed to the normal mechanical properties of the normal femoral head and neck.

Current development of fluorescent probes for cellular reactive oxygen species / 军事医学

Reactive oxygen species(ROS)plays an important role in physiological and pathological processes in cells. Different effects can be produced depending on the type and subcellular localization of ROS.Therefore,various fluorescent probes have been developed to quantify and localize ROS specifically.However,due to technical limitations,these probes have defects in specificity and stability.In this paper, we review existing cellular and mitochondrial ROS probes, and summarize their characteristics.

Application of asymmetric physiologically inert gas kinetics in diving decompression calculation / 军事医学

Objective To explore the application of asymmetric kinetics of physiological inert gases in diving decompression algorithm.Methods Considering that the actual desaturation in the human body was slower than the saturation process,the kinetic equations of different saturation and desaturation rate of inert gases were constructed with piecewise functions on the basis of the original single exponential kinetic equation.The results were compared other adjustment methods.Results With the application of asymmetric kinetics, the time at each decompression stop was prolonged for an approximately equal proportion, remained unchanged at some deeper and shorter stops.Conclusion Asymmetric kinetics can more closely simulate the gas movement in the body to effectively control the conservativeness of decompression,and adapt to different decompression requirements by adjusting the half-saturation time ratio.

Implementation of literature case study in clinical epidemiology teaching reformation for medical students of the eight-year medical education program / 基础医学与临床

In order to improve the teaching quality of clinical epidemiology for medical students engaged in eight-year curriculum of Peking Union Medical College, and foster the practice of evidence-based medicine and clinical research in Peking Union Medical College Hospital (PUMCH), the Clinical Epidemiology Unit of PUMCH(PUMCH-CEU) utilized successful experience from institutions abroad and conducted a teaching reform. In addition to theory teaching, PUMCH-CEU incorporated literature case study and assignments into the course, so as to improve students' understanding about the design, measurement, and evaluation of clinical research. The execution of a well-designed reformation plan has led to a great success of this course, as well as fruitful achievements.

Unusual Isolated Sellar Spindle Cell Carcinoma:Report of One Case / 中国医学科学院学报

Sellar malignant tumors are uncommon and usually reported as metastatic diseases from breast or lung cancers. Spindle cell carcinoma (SCC) is a rare malignancy and has been found in breast,oral cavity,lungs,kidneys,and hepatobiliary pancreatic system but not in sellar region. We report here the first case of isolated sellar SCC with aggressive features in Peking Union Medical College Hospital. This patient was referred to our hospital on September 9,2015 and discharged on October 16,2015. We described the clinical manifestations,imaging findings,and pathological features of this rare disease.

Preliminary Application of WCX Magnetic Bead-Based Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry in Analyzing the Urine of Renal Clear Cell Carcinoma / 中国医学科学杂志(英文版)

Objective To evaluate the application of weak cation exchange (WCX) magnetic bead-based Matrix-Assisted Laser Desorption Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) in detecting differentially expressed proteins in the urine of renal clear cell carcinoma (RCCC) and its value in the early diagnosis of RCCC.Methods Eleven newly diagnosed patients (10 males and 1 female, aged 46-78, mean 63 years) of renal clear cell carcinoma by biopsy and 10 healthy volunteers (all males, aged 25-32, mean 29.7 years) were enrolled in this study. Urine samples of the RCCC patients and healthy controls were collected in the morning. Weak cation exchange (WCX) bead-based MALDI-TOF MS technique was applied in detecting differential protein peaks in the urine of RCCC. ClinProTools2.2 software was utilized to determine the characteristic proteins in the urine of RCCC patients for the predictive model of RCCC. Results The technique identified 160 protein peaks in the urine that were different between RCCC patients and health controls; and among them, there was one peak (molecular weight of 2221.71 Da) with statistical significance (P=0.0304). With genetic algorithms and the support vector machine, we screened out 13 characteristic protein peaks for the predictive model. Conclusions The application of WCX magnetic bead-based MALDI-TOF MS in detecting differentially expressed proteins in urine may have potential value for the early diagnosis of RCCC.

Fabrication of Isoniazid/Rifampicin/Poly L-lactic Acid Donut-shaped Implants via Three Dimensional Printing Technique / 中国医学科学院学报

Objective To investigate the possibility of manufacturing dual-drug loaded isoniazid/rifampicin/poly L-lactic acid (PLLA) implant with donut-shaped structure via three-dimensional (3D) printing technique and study the drug release characteristic and biocompatibility of the implant in vitro.Methods PLLA was crushed into particles with diameters around 75-100 μm.Isoniazid and rifampicin bulk drugs were dissolved into the organic dissolvent respectively to be the binding liquid.The 3D printing machine fabricated the donut-shaped implant via binding the PLLA powder layer by layer.Dynamic socking method was used to study the in vitro release characteristics,and cell culture experiment was used to test the cytocompatibility of the implant.Results PLLA slow-release implants were made by using the PLLA powder as matrix and isoniazid/rifampicin organic solvent as binding liquid through 3D printing.The drugs in the implants distributed in nest under electron microscope.The concentrations of both drugs were still higher than the lowest effective bacteriostasis concentration after release for 32 days.Cytotoxicity and direct contact tests indicated that the implants had rare cytotoxicity and favorable biocompatibility. Conclusion The donut-shaped implants can be successfully fabricated using the 3D printing method,which offers a new method for the manufacturing of topical slow-release anti-tuberculosis drugs.

Changes in Hydrogen Sulfide in Rats with Hepatic Cirrhosis in Different Stages / 华中科技大学学报（医学）（英德文版）

This study aimed to observe changes in the hydrogen sulfide (H2S) system in the blood and liver tissue of rats with hepatic cirrhosis at different stages by studying the effect of H2S on the course of hyperdynamic circulation in rats with hepatic cirrhosis.H2S concentration in the blood from the portal vein and inferior vena cava of hepatic cirrhosis rat model induced with carbon tetrachloride was detected on the 15th,30th,and 52nd day.The expression of cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) protein,and CBS and CSE mRNA in the liver was detected by immunohistochemistry and reverse transcriptase polymerase chain reaction (RT-PCR),respectively.The results indicated that H2S concentration in the blood from the portal vein and inferior vena cava of rats with hepatic cirrhosis was significantly lower than that in the control group.H2S was gradually decreased with the development of the disease and significantly lower in the blood from portal vein than in the blood of inferior vena cava at the mid-stage and the late stage groups.The expression levels of CBS and CSE protein,and CBS and CSE mRNA in the livers with hepatic cirrhosis at different stages were all higher than those in the control group,and the expression gradually increased with the development of the disease.The expression of CBS was lower than CSE in the same stages.The results indicated that the CSE mRNA was expressed predominantly in the cirrhosis groups as compared with CBS rnRNA.Among experimental rats,the H2S system has an important effect on the occurrence and development of hyperdynamic circulation in rats with hepatic cirrhosis.This finding adds to the literature by demonstrating that H2S protects vascular remodelling in the liver,and that CSE is indispensable in this process.

Establishment of near-infrared on-line monitoring model and determination of endpoint in frying process of Hordei Fructus Germinatus / 中国中药杂志

Hordei Fructus Germinatus has been always used by "stir-frying" as a traditional medicine and the endpoint judgment of "fragrant" and "yellow" has been the focus and difficulty in frying process research. In this study, a quantitative calibration model between index components and NIRS was established in order to rapidly detect the contents of reducing sugar, total amino acids, total flavonoids, A420 and moisture; besides, an endpoint judgment method of frying process was put forward based on the "component change rate". Near-infrared spectra of samples with different frying time were collected, and a quantitative analysis model based on near-infrared spectroscopy was established to optimize the parameters such as spectral pretreatment and modeling band. HCA and PLS-DA were used to study the relationship between component and "stir-frying", and the endpoint of frying process was determined. The established calibration model had a good performance that the correlation coefficients between the predicted results and the actual measured values were both more than 0.9, with predicted relative deviations less than 10%. Hordei Fructus Germinatus with different frying time was divided into 4 categories by HCA analysis. PLS-DA analysis showed that total reducing sugar had a significant contribution to distinguishing the Hordei Fructus Germinatus of different frying time. When the change rate of total reducing sugar was 80%, it could judge that the endpoint of frying had been obtained. Results showed that NIRS could not only quickly and accurately determine the contents of reducing sugar, total amino acid, total flavonoid, A420 and moisture in Hordei Fructus Germinatus samples of different frying time, but also judge the endpoint of frying in the process. This study provided a new method for the evaluation and endpoint judgment of "stir-frying" process in research of traditional Chinese medicine.

Therapy progress of spinal cord compression by metastatic spinal tumor / 中国骨伤

Metastatic epidural compression of the spinal cord is a significant source of morbidity in patients with systemic cancer. With improvment of oncotheray, survival period in the patients is improving and metastatic cord compression is en- countered increasingly often. Surgical management performed for early circumferential decompression for the spinal cord com- pression with spine instability, and spine reconstruction performed. Patients with radiosensitive tumours without spine instabili- ty, radiotherapy is an effective therapy. Spinal stereotactic radiosurgery and minimally invasive techniques, such as vertebro- plasty and kyphoplasty, percutaneous pedicle screw fixation, radiofrequency ablation are promising options for treatment of cer- tain selected patients with spinal metastases.

Dynamic change rules of active ingredients and inactive ingredients from Fructus Hordei Germinatus with frying process / 中国中药杂志

It is not scientific to explain that fried Fructus Hordei Germinatus is more effective than row Fructus Hordei Germinatus in resolving food stagnation from the aspects of amylase, tricine and other "active ingredients". In the present experiment, the contents of active ingredients including quercetin, tricine, kaempferol, catechin, ferulic acid and inactive ingredients including 5-hydroxymethyl furfural, acrylamide in frying process were determined by HPLC. The dynamic change rules of active ingredient and inactive ingredients in the frying process were investigated by HCA, PCA and PLS-DA analysis. The results showed that the Fructus Hordei Germinatus samples with different frying temperatures were classified into 4 groups by HCA and PCA analysis. PLS-DA analysis showed that frying temperature mainly impacted the contents of inactive ingredients including 5-hydroxymethyl furfural and acrylamide, with less effects on the contents of active ingredients. Simultaneously, with the increase of time in frying process, the content of 5-hydroxymethyl furfural was significantly increased from 2 min and became stable at 16 min, while the content of acrylamide was increased continuously from 18 min. Based on the variation of the contents of various ingredients, samples at different frying time were classified into 5 groups. The results showed that the content changes of "inactive ingredients" were closely related to the duration and degree of frying process, and the dynamic change rules of "inactive ingredients" can provide scientific basis for evaluating the frying process and elucidating the efficacy mechanism of Fructus Hordei Germinatus.

Advances in Glycemic Characteristics, Complications, and Treatment for Patients Undergoing Total Pancreatectomy / 中国医学科学院学报

Total pancreatectomy has been mainly used to treat malignant diseases of the pancreas, di-ffuse ductal involvement, and severe chronic pancreatitis. Patients may develop pancreatic diabetes after the surgery, in whom the glucose levels fluctuate widely and are hard to control, which increases the incidence of recurrent hypoglycemia. Postoperative complications are closely associated with the glucose levels. Thus, tighter glycemic management is essential for increasing the survival of these patients. Few cases have been discribed in China. In this article, we reviewed the blood glucose features, peri- and post-operative complications, and clinical treatment for patients undergoing total pancreatectomy.