Comparison of neoadjuvant treatment and surgery first for resectable or borderline resectable pancreatic carcinoma: A systematic review and network meta-analysis of randomized controlled trials.

BACKGROUND: Current treatment recommendations for resectable or borderline pancreatic carcinoma support upfront surgery and adjuvant therapy. However, neoadjuvant therapy (NT) seems to increase prognosis of pancreatic carcinoma and come to everyone's attention gradually. Randomized controlled trials offering comparison with the NT are lacking and optimal neoadjuvant treatment regimen still remains uncertain. This study aims to compare both treatment strategies for resectable or borderline resectable pancreatic cancer. METHODS: The PRISMA checklist was used as a guide to systematically review relevant peer-reviewed literature reporting primary data analysis. We searched PubMed, Medline, EMBASE, Cochrane Datebase and related reviews for randomized controlled trials comparing neoadjuvant therapy with surgery first for resectable or borderline resectable pancreatic carcinoma. We estimated relative hazard ratios (HRs) for median overall survival and ratios risks (RRs) for microscopically complete (R0) resection among different neoadjuvant regimens and major complications. We assessed the effects of neoadjuvant therapy on R0 resection rate and median overall survival with Bayesian analysis. RESULTS: Thirteen eligible articles were included. Eight studies performed comparison neoadjuvant therapy with surgery first, and R0 resection rate was recorded in seven studies. Compared with surgery first, neoadjuvant therapy did increase the R0 resection rate (RR = 1.53, I2 = 0%, P< 0.00001), there was a certain possibility that gemcitabine + cisplatin (Gem+Cis) + Radiotherapy was the most favorable in terms of the fact that there was no significant difference concerning the results from the individual studies. In direct comparison, four studies were included and estimated that Neoadjuvant therapy improved mOS compared with upfront surgery (HR 0.68, 95% CI 0.58-0.92; P = 0.012; I2 = 15%), after Bayesian analysis it seemed that regimen with Cisplatin/ Epirubicin then Gemcitabine/ Capecitabine (PEXG) was most likely the best with a relatively small sample size. The rate of major surgical complications was available for six studies and ranged from 11% to 56% with neoadjuvant therapy and 11% to 45% with surgery first. There was no significant difference between neoadjuvant therapy and surgery first, also with a high heterogeneity (RR = 0.96, 95%CI = 0.65-1.43; P = 0.85; I2 = 46%). CONCLUSION: In conclusion neoadjuvant therapy might offer benefit over up-front surgery. Neoadjuvant therapy increased the R0 resection rate with gemcitabine + cisplatin + Radiotherapy that was the most favorable and improved mOS with Cisplatin/ Epirubicin then Gemcitabine/ Capecitabine (PEXG) that was most likely the best.

The Diagnostic Value of a Nomogram Based on Clinical Imaging and MRIBased Radiomic Features in Triple-Negative Breast Cancer.

OBJECTIVE: This study aimed to determine the utility of a radiomic nomogram combined with clinical imaging and radiomic features based on MRI for the diagnosis of triple-negative breast cancer. METHODS: Multi-parametric MRI images of 136 breast cancer patients were retrospectively analyzed, 95 cases were stratified into the training cohort, and 41 cases were selected for the test group. According to the pathological molecular typing, the patients were divided into 23 cases of triple-negative breast cancer and 113 cases of non-triple-negative breast cancer. ITK software was used to manually delineate the lesion volume region of interest (VOI), and the Pyradiomics package was used to extract radiomic features for screening and model building. The platform was then used to analyze the clinical and imaging risk factors of breast cancer to build a characteristic model separately. Finally, a radiomic nomogram was constructed by integrating the radiomic and independent clinical image features. The diagnostic performance of the model was assessed using ROC curves. RESULTS: Univariate and multivariate analyses showed that the menstrual cycle, glandular density, and skin thickening were risk factors for clinical imaging characteristics of triple-negative breast cancer. The Area Under the Curve (AUC) was 0.839 and 0.826 for univariate and multivariate analysis, respectively. After screening, 11 radiomic features participated in the calculation of the radiomic score, and its AUC in the test set was 0.803. Combining it further with clinical models, the AUC improved to 0.899. CONCLUSION: The radiomic nomogram developed in this study has great value in the diagnosis of triple-negative breast cancer.

Investigation on an outbreak of bacillary dysentery due to infection of Shigella sonnei in a town of Guangxi Province.

Objective: To provide a scientific basis for identifying the causes of an outbreak and providing preventive and control measures to prevent the recurrence of similar outbreaks. Study design: A case-control study. Methods: We defined a suspected case as residents living in the affected town presented with inexplicable diarrhea (≥3 times/24 h) and at least with fever (above 37.5) or abdominal pain or vomiting from June 20 to July 14, 2016. The confirmed case was Shigella sonnei isolated from feces or rectal swabs of the suspected case. Cases were identified by reviewing medical records in different medical facilities in the affected town and interviewing physicians and cases using a questionnaire. The local water supply was checked on site. An age-matched case-control study was conducted. Epi-Info 7.0 software was used for data analysis. Results: 133 cases aged from 1 to 77 were identified with 102 suspected and 31 confirmed. The attack rate was 0.7% (133/18131). The majority of clinical manifestations were diarrhea (100%), fever (83.5%) and abdominal pain (40.6%). Among 64 case-control pairs, 64.1% cases and 18.8% of controls drank non-boiled water (OR = 7.7, 95% CI 3.5-17.0) within 15 days before their onset. 42.2% cases and 10.1% controls had the illness in family members (OR = 6.5, 95% CI 2.5-16.3). 18 samples of Shigella sonnei were isolated from 50% (4/8) faces, 40% (13/33) rectal swabs and 14% (1/7) tap water. 8 were strain-typed by PFGE and showed 100% homology in the typing pattern. No disinfection was routinely implemented for water supply, 1household latrine was found to discharge directly into the river which is used as the local water source. Conclusion: This outbreak was caused by contaminated drinking water supply with household exposure helped facilitate further transmission. Water sources should be kept clear of defecation discharge and disinfected before supply, un-boiled water drinking habits need to be addressed through health promotion.

Is early laparoscopic cholecystectomy after clearance of common bile duct stones by endoscopic retrograde cholangiopancreatography superior?: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: With medical advancement, common bile duct stones were treated by endoscopic retrograde cholangiopancreatography (ERCP), considered the standard treatment. However, ERCP might induce complications including pancreatitis and cholecystitis that could affect a subsequent laparoscopic cholecystectomy (LC), leading to conversion to open cholecystectomy perioperative complications. It is not yet known whether or not the time interval between ERCP and LC plays a role in increasing conversion rate and complications. Bides, in the traditional sense, after ERCP, for avoiding edema performing LC was several weeks later. Even no one study could definite whether early laparoscopic cholecystectomy after ERCP affected the prognosis or not clearly. OBJECTIVE: Comparing some different surgical timings of LC after ERCP. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, Cochrane Library, Embase, PubMed, etc. All the included studies should meet the demands of this meta-analysis. In all interest outcomes below, we took full advantage of RevMan5 and WinBUGS to assess; the main measure was odds ratio (OR) with 95% confidence. Moreover, considering the inconsistency of the specific time points in different studies, we set a subgroup to analyze the timing of LC after ERCP. For this part, Bayesian network meta-analysis was done with WinBUGS. RESULT: In the pool of conversion rate, the result suggested that the early LC group was equal compared with late LC (OR = 0.68, I2 = 0%, P = .23). Besides, regarding morbidity, there was no significant difference between the 2 groups (OR = 0.74, I2 = 0%, P = .26). However, early LC, especially for laparoscopic-endoscopic rendezvous that belonged to performing LC within 24 hours could reduce the post-ERCP pancreatitis (OR = 0.16, I2 = 29%, P = .0003). Considering early LC included a wide time and was not precise enough, we set a subgroup by Bayesian network, and the result suggested that performing LC during 24 to 72 hours was the lowest conversion rate (rank 1: 0%). CONCLUSION: In the present study, LC within 24 to 72 hours conferred advantages in terms of the conversion rate, with no recurrence of acute cholecystitis episodes.

Identification of novel saltiness-enhancing peptides from yeast extract and their mechanism of action for transmembrane channel-like 4 (TMC4) protein through experimental and integrated computational modeling.

Excessive consumption of sodium salt is one of the important inducers of cardiovascular and cerebrovascular diseases. The reduction of physical labor and attention to health make research on low-sodium salt imminent. Ultrafiltration, gel filtration, preparative high-performance liquid chromatography, and liquid chromatography with tandem mass spectrometry were employed for further purification and identification of the salty enhancing peptides in yeast extracts. Moreover, human transmembrane channel-like 4 (TMC4) was constructed and evaluated by computer-based methods, and salt-enhancing peptides were identified based on its allosteric sites. PN, NSE, NE and SPE were further determined to be salty enhancing peptides through sensory evaluation, and their taste mechanism was investigated. The results presented here suggest that silicon screening focused on TMC4 allosteric sites and sensory evaluation experiments can greatly increase the discoverability and identifiability of salty enhancer peptides, and this strategy is the first to be applied to the development of salty enhancer peptides.

Characterization of odor-active compounds in moso bamboo (Phyllostachys pubescens Mazel) leaf via gas chromatography-ion mobility spectrometry, one- and two-dimensional gas chromatography-olfactory-mass spectrometry, and electronic nose.

The leaf of moso bamboo (Phyllostachys pubescens Mazel) is rich in odorant compounds, which is important natural materials for the production of flavor. It also contains phenolic acids, amino acids and peptides, which is a potential source of natural bioactive compounds. The study of odor-active compounds in bamboo leaves can provide a basis for the discovery of natural flavor. The leaf, stem, and powder of moso bamboo were analyzed by gas chromatography-ion mobility spectrometry (GC-IMS). Main odor-active compounds in moso bamboo leaf were analyzed and characterized by (1) a gas chromatography olfactory mass spectrometry (GC-O-MS), (2) two-dimensional gas chromatography olfactory mass spectrometry (GC × GC-O-MS) and (3) electronic nose (E-nose). Based on aroma extract dilution analysis (AEDA), 13 key odor-active compounds with high flavor dilution (FD) factor (≥27), including 3-methyl-1-butanol, (E)-2-hexenal, ethyl hexanoate, (Z)-4-heptenenal, 6-methyl-5-hepten-2-one, octanal, ethyl (Z)-3-hexenoate, 1-hexanol, (Z)-3-hexen-1-ol, (E, E)-2,4-heptadienal, (Z)-2-hexen-1-ol, 1-octen-3-ol and benzaldehyde, were further analyzed. The compounds detected by the above four methods were (E)-2-hexenal, 6-methyl-5-hepten-2-one, octanal, (E, E)-2,4-heptadienal, 1-octen-3-ol and benzaldehyde, and all of which were the main and potential odorants of moso bamboo leaf.

Comparison of short-term rehabilitation and long-term prognosis between laparoscopy and traditional laparotomy for colon cancer / 中国医师进修杂志

Objective:To compare the short-term recovery and long-term prognosis of patients with colorectal cancer by laparoscopy and traditional open surgery.Methods:The clinical data of 86 patients with colon cancer treated by the Changshu NO.1 People′s Hospital from April 2017 to April 2019 were retrospectively analyzed. According to different surgical methods, they were divided into observation group (laparoscopic radical resection of colon cancer, 41 cases) and the control group (traditional laparotomy underwent radical resection of colon cancer, 45 cases). The surgical indicators, short-term recovery, complications, serum anti-inflammatory and pro-inflammatory factor levels, and 3-year tumor-free survival rate between two groups were compared.Results:Compared with the control group, the observation group had less intraoperative blood loss and shorter hospital stay: (120.32 ± 32.43) ml vs. (178.43 ± 39.98) ml, (9.65 ± 2.17) d vs. (12.35) ± 2.68) d; the time to get out of bed for the first time, the time of anal exhaust and the time of eating semiliquid in the observation group were earlier: (2.10 ± 0.23) d vs. (3.03 ± 0.54) d, (3.45 ± 1.02) d vs. (4.29 ± 1.03) d, (4.54 ± 1.09) d vs. (5.30 ± 1.05) d, the differences were statistically significant ( P<0.05). The incidence of complications in the observation group was lower than that in the control group: 12.20% (5/41) vs. 31.11% (14/45), the difference was statistically significant ( χ2 = 4.695, P<0.05). Serum interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels in the observation group were lower than those in the control group: (23.12 ± 6.09) μg/L vs. (31.05 ± 5.3) μg/L, (57.87 ± 10.6) μg/L vs. (62.43 ± 6.8) μg/L; serum IL-4 and transforming growth factor (TGF)-β levels were higher than those in the control group: (155.03 ± 14.53) ng/L vs. (127.87 ± 12.09) ng/L, (26.32 ± 3.09) ng/L vs. (20.87 ± 3.87) ng/L, the differences were statistically significant ( P<0.05). There was no significant difference in the tumor-free survival rate between the two groups at 3-year after operation ( P>0.05). Conclusions:Laparoscopic treatment of colon cancer has the advantages of less trauma, fewer complications, and mild postoperative inflammatory reaction, and has a long-term prognosis comparable to traditional laparotomy.

Comparison of clomiphene and letrozole for superovulation in patients with unexplained infertility undergoing intrauterine insemination: A systematic review and meta-analysis.

BACKGROUND: With the medical advancement some studies put forward that letrozole (LE), a specific aromatase inhibitor with the function of reducing oestrogen synthesis, has recently been applied as a potentially better alternative compared with clomiphene citrate (CC), owing to that it has a superior efficacy as compared with CC in patients of unexplained infertility undergoing intrauterine insemination (IUI). However, there is no one study can clear and definite whether LE can replace the CC as first line drug. OBJECTIVE: Our objective is to compare the LE with CC in the induction of ovulation in patients with unexplained infertility IUI. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, The Cochrane Library, Embase, PubMed, etc. All the include studies should meet our demand of this meta-analysis: RESULT:: Based on the current meta-analysis, we rigorously consider that LE has a likelihood to improve dominant follicles (MD= -0.56, I= 100%, P= .04; MD= -0.39, I= 73%, P = .0003, respectively) and reduces the miscarriage rate (RR= 0.61, I= 0%, P = .03). There is no significant differences between the 2 groups in The total rate of pregnancy, pregnancy rate per cycle, multiple pregnancy and endometrial thickness. (RR= 1.06, I= 11%, P = .38; RR= 1.09, I= 7%, P = .32; RR= 0.79, I= 0%, P = .46; respectively) CONCLUSION:: Combined with the results of current systematic review and meta-analysis through subgroup analysis and sensitivity analysis, we can be cautious: in general, compared with CC, LE is an effective treatment in the IUI cycle, has a likelihood to improve dominant follicles and reduces the miscarriage rate.

Identification of Key Off-Flavor Compounds in Thermally Treated Watermelon Juice via Gas Chromatography-Olfactometry-Mass Spectrometry, Aroma Recombination, and Omission Experiments.

Thermally treated watermelon juice (TW) presents a strong unpleasant smell, resulting in poor consumer acceptance. It is necessary to identify the key off-flavor compounds in TW. Solid-phase microextraction (SPME) and solvent-assisted flavor evaporation (SAFE) coupled with gas chromatography-olfactometry-mass spectrometry (GC-O-MS) were applied to the extraction and analysis of the volatile compounds in TW. Five aroma-active compounds and seven off-flavor compounds were quantitatively analyzed by the standard curve method. Based on the flavor dilution factor (FD), odor attribute, odor activity value (OAV) of volatile compounds, and partial least-squares regression (PLSR) analysis, seven key off-flavor compounds were preliminarily identified as follows: (E)-2-heptenal, decanal, octanol, diisopropyl disulfide, hexanol, (E)-2-decenal, and (E)-2-octenol. Aroma recombination proved that these off-flavor compounds above had a negative impact on the overall flavor in TW. Omission experiments were taken to confirm them further. Finally, octanol, diisopropyl disulfide, and (E)-2-decenal were identified as the most potent off-flavor compounds in TW.

Effects of different culture systems on the culture of prepuberal buffalo (Bubalus bubalis) spermatogonial stem cell-like cells in vitro

Currently, the systems for culturing buffalo spermatogonial stem cells (SSCs) in vitro are varied, and their effects are still inconclusive. In this study, we compared the effects of culture systems with undefined (foetal bovine serum) and defined (KnockOut Serum Replacement) materials on the in vitro culture of buffalo SSC-like cells. Significantly more DDX4- and UCHL1-positive cells (cultured for 2 days at passage 2) were observed in the defined materials culture system than in the undefined materials system (p < 0.01), and these cells were maintained for a longer period than those in the culture system with undefined materials (10 days vs. 6 days). Furthermore, NANOS2 (p < 0.05), DDX4 (p < 0.01) and UCHL1 (p < 0.05) were expressed at significantly higher levels in the culture system with defined materials than in that with undefined materials. Induction with retinoic acid was used to verify that the cultured cells maintained SSC characteristics, revealing an SCP3⁺ subset in the cells cultured in the defined materials system. The expression levels of Stra8 (p < 0.05) and Rec8 (p < 0.01) were significantly increased, and the expression levels of ZBTB16 (p < 0.01) and DDX4 (p < 0.05) were significantly decreased. These findings provided a clearer research platform for exploring the mechanism of buffalo SSCs in vitro.

Effects of different culture systems on the culture of prepuberal buffalo (Bubalus bubalis) spermatogonial stem cell-like cells in vitro

Effects of different culture systems on the culture of prepuberal buffalo (Bubalus bubalis) spermatogonial stem cell-like cells in vitro

Currently, the systems for culturing buffalo spermatogonial stem cells (SSCs) in vitro are varied, and their effects are still inconclusive. In this study, we compared the effects of culture systems with undefined (foetal bovine serum) and defined (KnockOut Serum Replacement) materials on the in vitro culture of buffalo SSC-like cells. Significantly more DDX4- and UCHL1-positive cells (cultured for 2 days at passage 2) were observed in the defined materials culture system than in the undefined materials system (p < 0.01), and these cells were maintained for a longer period than those in the culture system with undefined materials (10 days vs. 6 days). Furthermore, NANOS2 (p < 0.05), DDX4 (p < 0.01) and UCHL1 (p < 0.05) were expressed at significantly higher levels in the culture system with defined materials than in that with undefined materials. Induction with retinoic acid was used to verify that the cultured cells maintained SSC characteristics, revealing an SCP3⁺ subset in the cells cultured in the defined materials system. The expression levels of Stra8 (p < 0.05) and Rec8 (p < 0.01) were significantly increased, and the expression levels of ZBTB16 (p < 0.01) and DDX4 (p < 0.05) were significantly decreased. These findings provided a clearer research platform for exploring the mechanism of buffalo SSCs in vitro.

The predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB in prognosis of patients with acute paraquat poisoning / 中华急诊医学杂志

Objective To investigate the predictive value of extra pulmonary multiple factors including creatine kinase-isoenzyme MB (CK-MB) for the prognosis of patients with acute paraquat poisoning.Methods A retrospectively analysis were conducted on 641 patients who were treated at the First Affiliated Hospital of Zhengzhou University due to oral paraquat poisoning from October 2002 to April 2017.The observation end point was that the patients died from paraquat poisoning within 3 months after admission or were still alive within 3 months after paraquat poisoning.The patients' data were retrieved,including general information,the dose of poison,urinary paraquat concentration,arterial blood gas analysis,alanine transaminase (ALT),total bilirubin (TBIL),uric acid (UA),aspartate transaminase (AST),creatine kinase (CK),CK-MB,B type natriuretic peptide (BNP),lactic dehydrogenase (LDH),high sensitivity troponin T (hsTnT),C-reaction protein (CRP) and procaicitonin (PCT).According to the patient's prognosis within 3 months,the patients were divided into a survival group and a non-survival group.The above indicators were compared between the two groups and the diagnostic value of CK-MB for acute paraquat poisoning was analyzed according to the receiver operating characteristics (ROC) curve.Collect the last arterial blood gas analysis,and laboratory test results were analyzed by binary logistic regression analysis to determine the risk factors for death in patients with acute paraquat poisoning.Results Among the 641 patients with acute paraquat poisoning,315 (49.1％) patients survived and 326 (50.9％) died.Compared with the survival group,patients in the non-survival groupthere were older,had a shorter hospital stay,and had a higher oral paraquat dose and urinary paraquat concentration;Lac,TBIL,UA,AST,CK,CK-MB,BNP,LDH,CRP and PCT were higher,while blood gas analysis index were lower in the non-survival group (P＜0.05).Binary logistic regression analysis showed that the dose of paraquat,CK-MB and AST were closely related to the prognosis of patients with acute paraquat poisoning.The optimal cut-off value of ingestion dose,the first urinary paraquat concentration on admission and CK-MB in predicting the prognosis of patients with acute paraquat poisoning were 7 g (AUC=0.918,sensitivity 80.6％,specificity 87.5％,Yoden index 0.681,P＜0.01),5.16 μg/mL (AUC=0.879,sensitivity 93.8％,specificity 70.1％,Yoden index 0.639,P＜0.01),and 18.2 U/L (AUC=0.846,sensitivity 83.9％,specificity 71.9％,Yoden index 0.558,P＜0.01),respectively.Binary logistic regression analysis of the last biochemical indicators of paraquat poisoning showed that the dose of poison,the last CK-MB,the last SCr,urinary paraquat concentration,and the last blood Na+ were closely related to the prognosis of patients with acute paraquat poisoning.Among them,the last CK-MB＞18.05 U/L often indicated poor prognosis (AUC=0.808,sensitivity 79.7％,specificity 65.8％,Yoden index 0.455,P＜0.01).Conclusions In the treatment of patients with acute paraquat poisoning,there are significant differences in extra pulmonary factors such as heart,liver,kidney,electrolytes and inflammatory markers in patients with different prognosis,so the monitoring and follow-up should be improved,in addition to focusing on the presence and treatment of pulmonary fibrosis.In particular,CK-MB is an independent risk factor for the prognosis of acute paraquat poisoning.In the late stage of poisoning,CK-MB,SCr,and blood Na+ have a strong predictive value for the prognosis of the patients,and we should pay attention to the regular follow-up of the above mentioned laboratory items.

Non-invasive ventilation with helmet in patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease / 中华危重病急救医学

Objective:To investigate the effect and tolerance of non-invasive ventilation (NIV) with helmet in patients with respiratory failure caused by acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and the effect on improving blood gas, alleviating dyspnea and the occurrence of complications.Methods:Patients with AECOPD and respiratory failure admitted to emergency intensive care unit (EICU) and respiratory intensive care unit (RICU) of the First Affiliated Hospital of Zhengzhou University from January 1st, 2018 to May 31st, 2019 were enrolled. After obtaining the informed consent of the patients or their authorized family members, the patients were divided into two groups: the helmet group and the facial mask group by random number table. NIV was carried out by using helmet or facial mask, respectively. During the course of NIV (immediately, 1 hour, 4 hours and at the end of NIV), the tolerance score, blood gas analysis, heart rate (HR), respiratory rate (RR) of patients were monitored, and the incidence of tracheal intubation, in-hospital mortality and complications were observed. Kaplan-Meier survival curve was plotted to analyze the 30-day cumulative survival of the two groups.Results:A total of 82 patients with AECOPD and respiratory failure were included during the study period. After excluding patients with the oxygenation index (PaO 2/FiO 2) > 200 mmHg (1 mmHg = 0.133 kPa), with tracheal intubation or invasive ventilation, suffering from acute myocardial infarction, severe trauma within 2 weeks, excessive secretion, sputum discharge disorder or refusal to participate in the study, 26 patients were finally enrolled in the analysis, randomly assigned to the helmet group and the facial mask group, with 13 patients in each group. The PaO 2/FiO 2 after NIV of patients in both groups was increased significantly as compared with that immediately after NIV, without significant difference between the two groups, but the increase in PaO 2/FiO 2 at the end of NIV compared with immediately after NIV in the helmet group was significantly higher than that in the facial mask group (mmHg: 75.1±73.2 vs. 7.7±86.0, P < 0.05). RR at each time point after NIV in the two groups was lower than that immediately after NIV, especially in the helmet group. There were significant differences between the helmet group and facial mask group at 1 hour, 4 hours, and the end of NIV (times/min: 17.5±4.1 vs. 23.1±6.3 at 1 hour, 16.2±2.5 vs. 20.0±5.5 at 4 hours, 15.5±2.5 vs. 21.2±5.9 at the end of NIV, all P < 0.05). The NIV tolerance score of the helmet group at 4 hours and the end was significantly higher than that of the facial mask group (4 hours: 3.9±0.3 vs. 3.3±0.9, at the end of NIV: 3.8±0.6 vs. 2.9±0.9, both P < 0.05). There was no significant difference in the improvement of pH value, arterial partial pressure of carbon dioxide (PaCO 2), or HR between helmet group and facial mask group. The total number of complications (cases: 3 vs. 8) and the nasal skin lesions (cases: 0 vs. 4) in the helmet group were significantly less than those in the facial mask group (both P < 0.05). Only 2 patients in the helmet group received endotracheal intubation, and 1 of them died; 5 patients in the facial mask group received endotracheal intubation, and 3 of them died; there was no significant difference between the two groups (both P > 0.05). The Kaplan-Meier survival curve analysis showed that the cumulative survival rate of 30 days in the helmet group was lower than that in the facial mask group, but the difference was not statistically significant (Log-Rank test: χ 2 = 1.278, P = 0.258). Conclusion:NIV with helmet has better comfort for patients with AECOPD combined with respiratory failure, and better effect on improving oxygenation and relieving dyspnea, and its effect on carbon dioxide emissions is not inferior to that of traditional mask NIV.

Effects of epinephrine for out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials.

AIM: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.

Characterization and Discrimination of Chinese Marinated Pork Hocks by Volatile Compound Profiling Using Solid Phase Microextraction Gas Chromatography-Mass Spectrometry/Olfactometry, Electronic Nose and Chemometrics.

The primary aim of this study was to investigate volatile constituents for the differentiation of Chinese marinated pork hocks from four local brands, Dahongmen (DHM), Daoxiangcun (DXC), Henghuitong (HHT) and Tianfuhao (TFH). To this end the volatile constituents were evaluated by gas chromatography-mass spectrometry/olfactometry (GC-MS/O), electronic nose (E-nose) and chemometrics. A total of 62 volatile compounds were identified and quantified in all pork hocks, and 24 of them were considered as odour-active compounds because their odour activity values (OAVs) were greater than 1. Hexanal (OAV at 3.6⁻20.3), octanal (OAV at 30.3⁻47.5), nonanal (OAV at 68.6⁻166.3), 1,8-cineole (OAV at 36.4⁻133.3), anethole (OAV at 5.9⁻28.3) and 2-pentylfuran (OAV at 3.5⁻29.7) were the key odour-active compounds contributing to the integral flavour of the marinated pork hocks. According to principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) of GC-MS/O and E-nose data, the results showed that the marinated pork hocks were clearly separated into three groups: DHM, HHT, and DXC-TFH. Nine odour-active compounds, heptanal, nonanal, 3-carene, d-limonene, ß-phellandrene, p-cymene, eugenol, 2-ethylfuran and 2-pentylfuran, were determined to represent potential flavour markers for the discrimination of marinated pork hocks. This study indicated the feasibility of using GC-MS/O coupled with the E-nose method for the differentiation of the volatile profile in different brands of marinated pork hocks.

Study of dynamic characteristics of scale-free spiking neural networks based on synaptic plasticity / 生物医学工程学杂志

Biological neural networks have dual properties of small-world attributes and scale-free attributes. Most of the current researches on neural networks are based on small-world networks or scale-free networks with lower clustering coefficient, however, the real brain network is a scale-free network with small-world attributes. In this paper, a scale-free spiking neural network with high clustering coefficient and small-world attribute was constructed. The dynamic evolution process was analyzed from three aspects: synaptic regulation process, firing characteristics and complex network characteristics. The experimental results show that, as time goes by, the synaptic strength gradually decreases and tends to be stable. As a result, the connection strength of the network decreases and tends to be stable; the firing rate of neurons gradually decreases and tends to be stable, and the synchronization becomes worse; the local information transmission efficiency is stable, the global information transmission efficiency is reduced and tends to be stable, and the small-world attributes are relatively stable. The dynamic characteristics vary with time and interact with each other. The regulation of synapses is based on the firing time of neurons, and the regulation of synapses will affect the firing of neurons and complex characteristics of networks. In this paper, a scale-free spiking neural network was constructed, which has biological authenticity. It lays a foundation for the research of artificial neural network and its engineering application.

Application of extracorporeal membrane oxygenation technique in patients with acute respiratory failure caused by ammonia poisoning / 中华危重病急救医学

Acute severe ammonia inhalation can seriously affect oxygenation and ventilation function of patients, and even cause acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) technology is increasingly used in treating patients with ARDS caused by infection, cardiogenic shock, trauma, and drowning with achieved certain effects, but its usage for ARDS caused by ammonia is rarely reported. On July 7, 2018, a case of ARDS caused by ammonia inhalation was admitted to the emergency ICU of the First Affiliated Hospital of Zhengzhou University. After admission, the patient was treated with ECMO immediately on the basis of anti-infection, anti-oxidation, suctioning and nebulization treatments. After 8 days, he was weaned from ECMO and transferred to a general ward for continued rehabilitation. After 23 days, his condition improved and was discharged without complaining of any discomfort during the follow-up till March 2019. The successful experience was summarized in order to provide reference for the treatment of such patients in the future.

Application of plant medicine containing spermine in pingyangmycin fermentation / 中草药

Objective: Screening a plant medicine containing spermidine to promote the fermentation of pingyangmycin (PYM). Methods: Based on the screening method of carbon and nitrogen sources in biological fermentation, the plant medicine with the best promotion effect on PYM was screened out by HPLC method in Lycium ruthenicum, Lycium barbarum, Lycium barbarum bud, Carthamus tinctorius, and Coicis Semen. And the best adding time, amount and frequency were also screened out. Results: The results showed that Lycium barbarum bud had the best effect on PYM fermentation, and the initial adding time was 24 h, the adding interval was 24 h, and the adding frequency was three times. The shaking bottle fermentation level was 21.3 μg/mL when the addition amount was 7 g/L/per batch, and the 25 L tank fermentation level was 37.5 μg/mL when the addition amount was 18 g/L/per batch, which increased by 23.8% and 118.0%, respectively. Compared with the addition of spermidine, the yield was increased by 45.3%. Conclusion: Most plant drugs containing spermidine can promote the fermentation of pingyangmycin, and the selection of Lycium barbarum bud as raw materials for pingyangmycin fermentation meets the production requirements in terms of cost, yield and environmental protection.

Application of extracorporeal membrane oxygenation technique in patients with acute respiratory failure caused by ammonia poisoning / 中华危重病急救医学

Acute severe ammonia inhalation can seriously affect oxygenation and ventilation function of patients, and even cause acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) technology is increasingly used in treating patients with ARDS caused by infection, cardiogenic shock, trauma, and drowning with achieved certain effects, but its usage for ARDS caused by ammonia is rarely reported. On July 7, 2018, a case of ARDS caused by ammonia inhalation was admitted to the emergency ICU of the First Affiliated Hospital of Zhengzhou University. After admission, the patient was treated with ECMO immediately on the basis of anti-infection, anti-oxidation, suctioning and nebulization treatments. After 8 days, he was weaned from ECMO and transferred to a general ward for continued rehabilitation. After 23 days, his condition improved and was discharged without complaining of any discomfort during the follow-up till March 2019. The successful experience was summarized in order to provide reference for the treatment of such patients in the future.