Objective To evaluate systematically the effect of ventilator circuit changes on incidence of ventilator-associated pneumonia(VAP).Methods Literatures about the effect of ventilator circuit changes on occurrence of VAP were searched from PubMed,Cochrane Library,CNKI,VIP,and Wanfang database,incidence of VAP in pa-tients who received circuit changes at different intervals was compared,odds ratio (OR)and 95%CI were as effect index of the study,RevMan 5.2 software was used for data analysis.Results A total of 12 literatures were included,including 18003 patients using ventilators.According to the interval of ventilator circuit changes,patients were divided into 1-day group (n=191),2-day group(n=8932),3-day group(n=228),and 7-day group(n=8652).Meta analysis showed that circuit changed every 7 days had a lower risk of VAP than that changed once ev-ery day (OR,3.72[95%CI,1.50,9.23]),there was no significant difference in risk of VAP between 7-day group and 2-day group (OR,1.17[95%CI,1.00,1.37])as well as 7-day group and 3-day group(OR,0.77 [95%CI, 0.49,1 .23]).Conclusion Patients who received circuit changes every 7 days have a lower risk of developing VAP than those who received circuit changes once per day,so change the ventilator circuit in patients with mechanical ventilation every 7 days is more reasonable.

Objective:To investigate the efficacy of methotrexate combined with mifepristone in the treatment of ectopic pregnancy and its effect on serum human chorionic gonadotropin (β-HCG) and cancer antigen 125 (CA125) levels and endometrial thickness.Methods:Eighty-two patients with ectopic pregnancy who received treatment in Ningbo Yinzhou No. 2 Hospital, China from August 2017 to August 2019 were included in this study. They were randomly assigned to receive treatment with methotrexate (control group, n = 41) or methotrexate combined with mifepristone (observation group, n = 41). Clinical efficacy was evaluated, and adverse reactions and clinical recovery indexes were observed in each group. Before and after treatment, serum biochemical indexes, endometrial thickness and mass diameter were compared between the observation and control groups. Results:Clinical efficacy in the observation group was significantly higher than that in the control group [95.12% (39/41) vs. 75.61% (31/41), χ2 = 6.248, P < 0.05]. The incidence of adverse reaction in the observation group was significantly lower than that in the control group [4.88% (2/41) vs. 19.51% (8/41), χ2 = 4.100, P < 0.05]. After treatment, serum β-HCG, CA125, progesterone and vascular endothelial growth factor levels in the control and observation groups were (1 106.26 ± 122.36) U/L and (902.65 ± 61.32) U/L, (32.26 ± 6.86) kU/L and (28.26 ± 5.26) kU/L, (15.33 ± 3.01) nmol/L and (10.33 ± 1.92) nmol/L, (85.36 ± 16.41) ng/L and (65.33 ± 12.22) ng/L, respectively, which were significantly lower than those before treatment ( t = 56.964 and 82.206, 12.380 and 17.642, 9.976 and 19.471, 7.490 and 12.912, all P < 0.05). After treatment, serum β-HCG, CA125, progesterone and vascular endothelial growth factor levels in the observation group were significantly lower than those in the control group ( t = 10.624, 3.304, 8.967, 6.991, all P < 0.05). After treatment, endometrial thickness and mass diameter in the control and observation groups were (8.23 ± 1.81) mm and (6.25 ± 1.25) mm, (2.21 ± 0.52) cm and (1.52 ± 0.35) cm respectively, which were significantly lower than those before treatment ( t = 3.555 and 15.118, 11.631 and 24.167, both P < 0.05). After treatment, endometrial thickness and mass diameter in the observation group were significantly less or smaller than those in the control group ( t = 6.248 and 7.861, both P < 0.05). After treatment, symptom disappearance time, serum β-HCG recovery time, urine β-HCG negative time, pelvic mass disappearance time and hospital stay in the control and observation groups were (7.26 ± 1.92) d and (4.23 ± 0.85) d, (16.25 ± 3.82) d and (12.33 ± 2.21) d, (15.36 ± 3.26) d and (10.66 ± 2.12) d, (24.12 ± 4.12) d and (18.66 ± 3.61) d, (29.58 ± 5.68) d and (23.52 ± 4.36) d, respectively. After treatment, symptom disappearance time, serum β-HCG recovery time, urine β-HCG negative time, pelvic mass disappearance time and hospital stay in the observation group were significantly shorter than those in the control group, respectively ( t = 10.305, 6.343, 8.631, 7.118, 6.044, all P < 0.05). Conclusion:Methotrexate combined with mifepristone is highly effective in the treatment of ectopic pregnancy because it can reduce adverse reactions, decrease serum β-HCG, CA125, progesterone and vascular endothelial growth factor levels, promote the recovery of serum β-HCG to normal level, reduce endometrial thickness, and promote adnexal mass disappearance, which are conducive to the early recovery of patients, with good clinical safety.

Objective To observe the effects of low frequency electrostimulation(LFES)on sleep disorder of patients after acute cerebral infarction(ACI)as evaluated by using polysomnography,and on the recovery of neurological deficits. Methods Seventy cases of acute cerebral infarction were randomly divided into two groups,a treatment group and a control group.Both groups were treated with routine drugs, and the treatment group was also treated with LFES in addition.The changes of neurological deficits(ND) scores and such parameters of polysomnography as sleep latency(SL),total sleep time (TST),sleep efficiency(SE%),sleep maintenance(SMT),rapid eye movement sleep(REM),REM latency(RL),REM time(RT),REM activity(RA),REM density(RD).stage 1 sleep(S1),stage 2 sleep(S2)and deep sleep (S3+4) were observed.Results It was shown that,after treatment,both groups got significant improvement in terms of the ND scores and all the polysomnography parameters except RA,S1 and S2,(P<0.01),and the treatment group improved to a significantly greater extend when compared with the control group (P<0.01).Conclusion It is concluded that LFES could promote recovery of neural function and sleep disorder of ACI patients.

Objective:To investigate the efficiency and pharmacoeconomics of pegylated recombinant human granulocyte colony-stimulating factor (PEG-rhG-CSF) for mobilization of peripheral blood stem cells (PBSCM) in patients with multiple myeloma (MM).Methods:The data of 91 patients with newly treated MM who were hospitalized in the First Hospital of Jilin University and Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College from January 2015 to October 2017 were retrospectively analyzed. According to the patient's wishes, a high-dose chemotherapy combined with subcutaneous injection of PEG-rhG-CSF or recombinant human granulocyte colony-stimulating factor (rhG-CSF) was used for stem cell mobilization in 42 and 49 patients, respectively. The number of mononuclear cells (MNC) and CD34 + cells collected after mobilization, the maximum absolute neutrophil count (mANC), the cost of mobilization, and the engraftment time of white blood cells and platelets after transplantation were compared between the two groups. Results:The median number of MNC collected after mobilization in the PEG-rhG-CSF group and rhG-CSF group were 5.86×10 8/kg [(1.08-24.54)×10 8/kg] and 6.61×10 8/kg [(0.83-33.80)×10 8/kg], and the difference was not statistically significant ( U = 883.00, P = 0.245); while the median number of CD34 + cells collected after mobilization in the PEG-rhG-CSF group was higher than that in the rhG-CSF group [5.56×10 6/kg (0.94-19.90)×10 6/kg and 4.82×10 6/kg (1.12-14.61)×10 6/kg], and the difference was statistically significant ( U = 732.00, P = 0.038). The median number of mANC during mobilization in the PEG-rhG-CSF group was lower than that in the rhG-CSF group [20.50×10 9/L (7.26-61.30)×10 9/L and 32.08×10 9/L (6.92-69.99)×10 9/L], and the difference was statistically significant ( U = 490.00, P = 0.001). After autologous stem cell transplantation (ASCT), the time-to-recovery of white blood cell count (WBC) to 1.0×10 9/L in the PEG-rhG-CSF group was shorter than that in the rhG-CSF group [(11.59±1.98) d vs. (12.93±2.83) d], and the difference was statistically significant ( t = -2.395, P = 0.019), and the time-to-recovery of platelet count (Plt) to 20.0×10 9/L in the PEG-rhG-CSF group was also shorter than that in the rhG-CSF group [(12.86±2.62) d vs. (14.80±5.47) d], but the difference was not statistically significant ( t = -1.749, P = 0.085). The total mobilization cost of the PEG-rhG-CSF group was not statistically different from that of the rhG-CSF group [(21 405.47±7 365.98) yuan vs. (22 976.83±10 264.34) yuan, t = -0.721, P = 0.474]. Conclusions:PEG-rhG-CSF combined with high-dose chemotherapy is an effective option for PBSCM in MM patients, and its mobilization cost is equivalent to rhG-CSF. Therefore, PEG-rhG-CSF may be a better choice for PBSCM in MM patients.

Objective: To investigate the clinical features, diagnosis, occurrence sequence and clonal origin of chronic lymphocytic leukemia complicated with multiple myeloma. Methods: The diagnosis and treatment of one patient with multiple myeloma and chronic lymphocytic leukemia who was admitted to the First Hospital of Jilin University in May 2018 was retrospectively analyzed, and the related literatures were reviewed. Results: This patient began with lumbosacral pain, and he was diagnosed as chronic lymphocytic leukemia complicated with multiple myeloma after bone marrow aspiration, flow cytometry, and blood and urine immunofixation electrophoresis. It is recommended that Rd (lenalidomide + dexamethasone) or MPV (melphalan + prednisone + bortezomib) regimen, but the patient did not receive chemotherapy and died of infectious diarrhea 1 month later. Conclusions The occurrence of multiple myeloma and chronic lymphoblastic leukemia may originate from the same clone or different new clone. It is very rare that multiple myeloma and chronic lymphoblastic leukemia can co-occur. Therapeutic options tend to be more aggressive multiple myeloma-based regimen.