BACKGROUND: Medicine treatment of chronic respiratory failure achieved little effect. Interfering chronic respiratory failure of chronic cor pulmonale with noninvasive positive pressure ventilation (NIPPV) may be an effective measure to eliminate symptom and physical sign of patients.OBJECTIVE: To investigate the effect of nocturnal noninvasive positive pressure ventilation (NIPPV) on respiratory muscle function, pulmonary function of chronic respiratory failure patients with stable chronic cor pulmonale at high altitude area (HACCP).DESIGN: A completely randomized grouping design and randomized control trial.SETTING: Center of Respiratory Medicine, the 4th Hospital of Lanzhou Military Area Command of Chinese PLA.PARTICIPANTS: Totally 60 HACCP patients with chronic respiratory failure in stable stage, 38 male and 22 female, were admitted to Department of Respiratory Disease, the 4th hospital of Chinese PLA from October 2002 to November 2004. All cases, after informed consent was obtained,were randomly divided into two groups, including treatment group and control group with 30 cases in each group.METHODS: [1] Treatment group: Fitted with ventilator with pressure support ventilation (PSV) mode or positive end-expiratory pressure (PEEP)mode from 22:00 to next 7:00 every night. Before and after 5 weeks therapeutics, pulmonary function, arterial blood gas, respiratory muscle function and 6-minute walking distance (6MWD) were measured. Control group:Those were either assessed in inpatient objects stabled at least 1 week as control group before discharged and 5 weeks thereafter. [2] 6-minute walking distance (6MWD) test: Patients made their effects to walk 6 minutes in20 meters long corridor, or could not go on because of dyspnea, walking distance was determined. Using electronic diaphragmatic function meter,oral maximal inspiratory pressure (PImax) and maximal expiratory pressure(PEmax) were determined, then maximal transdiaphragmatic pressure (Pdimax) was measured with airway block method. With blood gas analyzer,partial pressure of oxygen in arterial blood (PaO2) and partial pressure of carbon dioxide in arterial blood (PaCO2) were assessed. With electronic spirometre, forced expiratory volume in one second (FEV1) expressed as percentage predicted (FEV1%), FEV1 forced vital capacity (FVC) ratio(FEV1/FVC) were assessed. [3] Differences between the groups in response to rehabilitation were identified using the unpaired Student's t test, while changes within groups were measured using the paired Student's t test.MAIN OUTCOME MEASURES: Respiratory muscular function, pulmonary function, arterial blood gas and 6-minute walking distance in two groups before and after intervention.RESULTS: All 60 chronic respiratory failure patients with stable chronic cor pulmonale were involved in-the analysis of results. Every parameters of blood gas and pulmonale function in two groups were similar before intervention (P ＞ 0.05). After 5-week intervention, PaO2, FEV1%, FEV1/FVC,PImax, PEmax, Pdimax and 6MWD were higher than before in treatment group and those in control group (P ＜ 0.05-0.01). PaCO2 after therapy was lower than before in treatment group and that in control group after treatment (P ＜ 0.01).CONCLUSION: Nocturnal NIPPV can markedly improve the arterial blood gas and pulmonary function, and increase respiratory muscle strength.

Objective To investigate the efficacy of laparoscopic percutaneous common bile duct exploration (LPCBDE) with internal draining tube placement for the treatment of cholelithiasis. Methods The clinical data of 962 patients with choledocholithiasis who were admitted to the No. 451 Hospital of PLA were retrospectively analyzed. A self-made internal draining tube was placed in the common bile duct and duodenum to drain bile internally. The correct position of the internal draining tube was comfirmed by injecting water into and draining water from duodenum. The internal draining tube was pulled out with the help of duodenoscope at 30 days after the operation. Results LPCBDE with internal draining tube placement was successfully performed on 864 patients. Forty-two patients were transferred to open surgery, and 56 patients were transferred to receive LPCBDE with T-tube drainage. The mean operation time was (36 ± 18) minutes (range, 20-72 minutes), and the length of postoperative hospital stay was (6.6 ±2.1)days. Two patients were complicated with retroperitoneal abscess and they were cured by puncture and drainage, 32 patients were complicated with bile leakage and they were cured by conservative treatment. A total of 862 patients were followed up by B ultrasound at 30 days after the operation. The internal draining tube which was confirmed in the common bile duct was extracted with duodenoscope in 603 patients; the internal draining tube which was drawn back in 1 patient was removed with endoscopic sphincterotomy ( EST); the internal draining tube was removed naturally in 258 patients. The follow-up period ranged from 1 to 3 years, 26 patients had recurrent cholelithiasis and they were treated by EST. Conclusions LPCBDE with internal draining tube placement is a safe and minimally invasive method for the treatment of cholelithiasis.

OBJECTIVE:To prepare aspirin phospholipid complex (ASP-PC) and conduct the characterization. METHODS:Using the combination rate of ASP and PC as index,single factor test was used to screen the preparation method of ASP-PC,PC type,solvent type,reaction time,reaction temperature,solvent volume and drug-lipid ratio. The verification test was conducted. UV spectrophotometry,Thermogravimetric analysis,X-ray diffraction and Fourier transform infrared spectroscopy were used for the characterization of ASP-PC. RESULTS:Magnetic stirring-condensing reflux method was adopted,drug-soybean phospholipids ratio was 1:3 (mol/mol),solvent was tetrahydrofuran,reacting for 3 h under 58 ℃. The average combination rate of prepared ASP-PC was 83.52％(RSD=1.16％,n=3). Compared with ASP,physical mixture of ASP and PC,UV spectrum showed that ASP-PC had no new absorption peak. Thermogravimetric analysis,X-ray diffraction and Fourier transform infrared spectroscopy showed the ASP and PC in ASP-PC were interacted;and ASP-PC changed little in quality within 0-300 ℃. CONCLUSIONS:ASP-PC can be successfully prepared,in which,ASP and PC were combined successfully;while there are still trace amounts of ASP in the form of crystals.

Objective To investigate the effects of nicotinamide phosphoribosyl transferase (NAMPT) inhibitor FK866 on polymicrobial sepsis-induced liver injury in mice. Methods Eighty-four healthy male C57BL/6J mice were divided into four groups by random number table method (n = 21): sham group, sepsis-induced liver injury model by cecal ligation and perforation group (CLP group), vehicle+CLP group and FK866+CLP group. FK866 (10 mg/kg) or same volume dimethyl sulfoxide were given intraperitoneally into mice 24, 12 and 0.5 hours prior to CLP in the FK866+CLP group or the vehicle+CLP group, respectively. Fifteen mice in each group were used to observe the 48-hour survival after operation. The remaining 6 mice were sacrificed 20 hours after operation to harvest venous blood and liver tissue samples for index detection. The levels of serum alanine transaminase (ALT) and aspartate aminotransferase (AST) were measured by colorimetry; the levels of serum NAMPT, tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by enzyme linked immunosorbent assay (ELISA); the mRNA expressions of TNF-α and IL-6 were measured by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR); the protein expressions of hepatic NAMPT, cytoplasmic IκBα and nuclear factor-κB (NF-κB) were measured by Western Blot. Results Compared with the sham group, the 48-hour survival in the CLP group was significantly decreased; serum and liver NAMPT protein levels were significantly increased, serum ALT, AST, TNF-α, IL-6 levels and mRNA expressions of TNF-α, IL-6 in liver tissue were significantly increased; the expression of cytoplasmic IκBα protein was significantly decreased, and the expression of nuclear NF-κB protein was significantly increased; which indicated that CLP induced NF-κB activation, inflammation and liver injury. There was no significant difference between the vehicle+CLP group and the CLP group. Compared with the vehicle+CLP group, the 48-hour survival in FK866+CLP group was significantly increased (53.33% vs. 26.67%); serum ALT, AST, TNF-α, IL-6 levels and mRNA expressions of TNF-α, IL-6 in liver tissue were significantly decreased [serum ALT (U/L): 128.94±32.48 vs. 237.24±58.61, serum AST (U/L):289.89±68.74 vs.468±82.17, serum TNF-α (pg/L): 65.17±18.74 vs.127.64±48.18, serum IL-6 (ng/L): 31.78±5.23 vs. 60.87±13.12, liver TNF-α mRNA (2-ΔΔCt): 8.37±4.17 vs. 18.24±6.12, liver IL-6 mRNA (2-ΔΔCt): 18.58±7.12 vs.34.24±6.71], the expression of cytoplasmic IκBα protein was significantly increased (IκBα/GAPDH: 0.23±0.03 vs. 0.12±0.04), while expression of nuclear NF-κB protein was significantly decreased (NF-κB/Lamin B1: 0.25±0.04 vs. 0.42±0.05), with statistically significant differences (all P < 0.05). Conclusion NAMPT inhibitor FK866 protects polymicrobial sepsis-induced liver injury via the inhibition of NF-κB activation and inflammation.

OBJECTIVE:To study the pharmacokinetics behaviors and the bioavailability of aspirin phospholipid complex self-microemulsion in rats in vivo. METHODS:12 SD rats were randomly divided into aspirin suspension group(10 mg/kg)and as-pirin phospholipid complex self-microemulsion group (10 mg/kg),6 in each group. Rats were intragastrically administrated,and blood sample 0.6 mL was taken from jugular vein before administration and after 0.083,0.25,0.5,0.75,1.0,2.0,3.0,4.0,6.0, 8.0,12.0 h of administration. HPLC was used to determine the concentration of salicylic acid in rats'plasma. DAS 2.0 pharmacoki-netic software was adopted to calculate the pharmacokinetic parameters and relative bioavailability. RESULTS:The pharmacokinetic processes of both aspirin suspension and aspirin phospholipid complex self-microemulsion were in line with one-compartment mod-el. The salicylic acid of cmax of rats in aspirin suspension group and aspirin phospholipid complex self-microemulsion group were (1.904 ± 0.208),(6.457 ± 1.091) μg/mL;AUC0-12 h were (12.860 ± 1.327),(47.270 ± 12.860) μg/(h·mL);tmax were (2.167 ± 0.983),(0.917±0.540)h,respectively. Compared with aspirin suspension,salicylic acid of cmax and AUC0-12 h of aspirin phospholip-id complex self-microemulsion in rats in vivo were significantly increased (P<0.01),while tmax was significantly decreased (P<0.05);the relative bioavailability was 367.57%. CONCLUSIONS:Making aspirin into phospholipid complex self-microemulsion can improve the gastrointestinal absorption,with high relative bioavailability.

OBJECTIVE: To detect the expression of RA SAL2 in patients with hepatocellular carcinoma (HCC), and to investigate the association of RASAL2 expression with pathological characteristics and prognosis. METHODS: Immunohistochemical SP method was used to detect the expression of RA SAL2 in 164 samples of HCC tissue and the adjacent tissue. Th e association of RA SAL2 expression with clinical features and prognosis was analyzed. RESULTS: The expression of RASAL2 in adjacent tissue was significantly increased compared to that in HCC tissue (P<0.001). The expression level of RASAL2 was associated with the degree of differentiation, tumor TNM stage and vascular invasion (P<0.001), but not associated with the level of AFP, tumor size, or the number of nodules (P>0.05). The 5 years recurrence-free survival (RFS) in patients with low expression of RASLA2 was significantly reduced compared with that in patients with high expression of RASLA2 (P<0.001). Cox analysis showed that low expression of RASLA2 was the independent factor for recurrence and death in HCC patients after surgery (P<0.001). CONCLUSION Low expression of RRASAL2 is significantly associated with the poor prognosis of HCC, which is an independent factor for HCC prognosis.
Carcinoma, Hepatocellular ; genetics ; metabolism ; Carrier Proteins ; genetics ; metabolism ; Humans ; Liver Neoplasms ; genetics ; metabolism ; Neoplasm Recurrence, Local ; Prognosis

Background:The incidence of gastric cancer is gradually rising in recent years,long non-coding RNA taurine up-regulated gene 1 (TUG1)may have certain effects on the occurrence and progression of gastric cancer. Aims:To study the expression TUG1 in gastric cancer tissue and its effect on prognosis of patients with gastric cancer,and study the correlation between TUG1 and p27,cyclin D1. Methods:Surgically resected gastric cancer tissues and corresponding distal normal tissues of 48 gastric cancer patients from June 2013 to December 2013 at Qingdao Municipal Hospital were collected. qRT-PCR was used to detect the mRNA expression of TUG1,and its relationship with clinicopathological features was analyzed. Protein expressions of p27 and cyclin D1 were determined by Western blotting,and correlation with expression of TUG1 was analyzed. Kaplan-Meier was used to analyze the relationship between expression of TUG1 and prognosis. Results:The mRNA expression of TUG1 in gastric cancer tissues was significantly higher than that in corresponding normal tissues (6. 18 ± 0. 19 vs. 5. 09 ± 0. 16,P < 0. 05),and was not correlated with gender,age,tumor size,but correlated with lymph node metastasis,tumor differentiation and TNM staging (P < 0. 01). The protein expression of p27 was significantly decreased in gastric cancer tissues than in normal tissues (0. 1709 ± 0. 0212 vs. 0. 3087 ± 0. 0252,P < 0. 01),while protein expression of cyclin D1 was significantly increased (0. 3417 ± 0. 0271 vs. 0. 2417 ± 0. 0173,P < 0. 01),and the expression of p27 was negatively correlated with expression of cyclin D1 in gastric cancer tissues (r = - 0. 897,P < 0. 01). The expression of TUG1 was negatively correlated with expression of p27 (r = - 0. 730,P < 0. 01),and was positively correlated with expression of cyclin D1 (r = 0. 809,P < 0. 01)in gastric cancer tissues. The median survival time was shorter in gastric cancer patients with high-expressed TUG1 than in patients with low-expressed TUG1 (P < 0. 05). Conclusions:Long non-coding RNA TUG1 plays a role of cancer gene in the development of gastric cancer through p27 /cyclin D1 pathway. Detection of expression of TUG1 has important significance on the prediction of prognosis of gastric cancer patients.

Objective:To investigate the differences in CT imaging features of head and neck mucoepidermoid carcinomas (MEC) from different origins and different histological grades.Methods:Clinical and CT imaging findings of 53 patients with pathologically proved MEC in the First Affiliated Hospital of Kunming Medical University admitted from January 2009 to May 2019 were retrospectively reviewed. On the basis of origins, all MECs were divided into 2 groups: large salivary gland group (23 cases) and small salivary gland group (30 cases). All MECs were further divided into 3 groups based on histological grades: highly differentiated (19 cases), moderately differentiated (28 cases) and poorly differentiated (6 cases). The CT imaging features of MEC from different origins and different histological grades (including location, number, size, morphology, boundary, density, calcification, cystic cavity, necrosis, bone changes, flat CT scan value, arterial phase CT enhancement value-added, venous phase CT enhancement value-added, enhancement method, adjacent structure invasion, cervical lymph node metastasis and distant metastasis) were analyzed and compared using t test, χ 2 test, Fisher exact probability or rank-sum test. Results:Comparisons of characteristics between different origins: only lesion size, morphology, bone changes, and plain CT values ( P<0.05) was significantly between different origin groups. There was no significant difference of residual image features ( P>0.05). Compared with MECs derived from large salivary glands, the small salivary gland group had larger MEC lesions, irregular shapes and was prone to have bone changes (including expansion and destruction). In addition, the plain scan CT value of MEC from the large salivary glands was slightly lower than that of the small salivary glands MEC (all P<0.05). Comparison of characteristics among different histological grade groups: only cystic cavity was statistically different (χ2=8.045, P=0.015). Compared with poorly differentiated MEC, highly differentiated MEC was more prone to have cysts (χ2=7.707, P=0.012). Conclusion:There are some differences in CT findings of head and neck MEC from different origins. The cystic cavity has reference value for evaluating histological grade.

Objective:To compare surgical methods and clinical efficacy among different types of cesarean scar pregnancy (CSP).Methods:A total of 158 patients with CSP who received treatment in Yuncheng Central Hospital from January 2016 to June 2019 were included in this study. According to Expert Consensus on Diagnosis and Treatment of Cesarean Scar Pregnancy (2016 version), type I CSP was found in 55 patients, type II in 86 patients and type III in 17 patients. These patients were divided into groups A (ultrasound-guided suction curettage), B (uterine artery chemoembolization + ultrasound-guided suction curettage) and C (laparoscopic scar pregnancy lesion resection + scar repair) according to different surgical methods. The amount of intraoperative blood loss, the difference in human chorionic gonadotropin (HCG) level between before and after surgery, the time to postoperative HCG level returning to normal level, menstruation recovery, and re-pregnancy were compared between groups.Results:The amount of intraoperative blood loss in the groups A, B and C was (43.33 ± 72.31) mL, (34.41 ± 17.16) mL, (65.71 ± 70.52) mL, respectively. There was significant difference between groups ( F = 8.51, P = 0.014]. The difference in HCG level between before and after surgery in groups A, B and C was (0.64 ± 0.18), (0.79 ± 0.10), (0.76 ± 0.19), respectively. There was significant difference in the difference in HCG level between groups ( F = 19.21, P < 0.001). There was significant difference in the incidence of postoperative menstrual volume reduction between group B and the other two groups ( χ2 = 6.73, P = 0.003). After surgery, intrauterine pregnancy occurred in 12 patients, including 8 patients in group A (type I CSP in 2 patients, type II CSP in 3 patients, type III CSP in 3 patients), 4 patients in group B (type I CSP in 3 patients, type II CSP in 1 patient). Finally, full-term fetus delivery by cesarean section was performed in 6 patients (4 patients in group A and 2 patients in group B). Conclusion:Uterine artery chemoembolization combined with uterine curettage had less blood loss, during surgery and leads to an obvious decrease in HCG level, but it can result in reduction of menstrual volume. Ultrasound-guided suction curettage is preferred for type I and type II CSP. Balloon compression can be used to stop bleeding if massive bleeding occurs. Laparoscopic scar pregnancy lesion resection plus scar repair is recommended for type III CSP.

Objective:To explore the application of OTD (observation, teaching and discussion) teaching combined with clinical pathway in nursing standardized training in operating room.Methods:A total of 50 nurses who were trained in the Operating Room of The First Affiliated Hospital of Air Force Medical University from August 2017 to June 2020 were selected and divided into control group and study group according to the rotation order, with 25 nurses in each group. Traditional teaching was used in the control group, and OTD teaching combined with clinical pathway was used in the study group. After the rotation training, the teaching effect was evaluated through the assessment of theoretical knowledge and clinical practice comprehensive ability, teaching satisfaction, and the satisfaction scores of participating surgeons and patients. SPSS 22.0 was used for t-test and chi-square test. Results:The results of theoretical assessment, clinical skill assessment and comprehensive ability assessment of operating room of the rotating nurses in the study group were higher than those in the control group, with significant difference ( P < 0.05). The study group was significantly better than the control group in 8 aspects, including learning initiative, stimulating learning interest, problem-solving ability, communication ability, clinical thinking ability, teamwork ability, critical thinking ability and teaching satisfaction ( P<0.05). The satisfaction scores of doctors [(94.06±2.67) vs. (92.17±2.75)] and patients [(94.90±3.22) vs. (91.25±3.10)] in the study group were significantly higher than those in the control group ( P<0.05). Conclusion:OTD teaching combined with clinical pathway can help to improve the theoretical knowledge, clinical practice comprehensive skills and teaching satisfaction of nursing students in operating room, and then improve the teaching quality.