Objective To evaluate the efficacy of low-dose levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome(ESS). Methods One hundred and twenty inpatients with severe pulmonary tuberculosis and ESS were randomly divided into treatment group and control group by gender, age, disease duration and severity. Both groups were given anti- tuberculosis, antiinfection treatment and nutritional support for 2 weeks; patients in treatment group were given low-dose levothyroxine sodium additionally. Thyroid function, clinical improvements, increase of albumin, reduction of acid-fast bacilli, improvements on images and the mortality rates were compared between the groups.Results After 2 weeks of treatment, symptoms including fever, cough and night sweats were improved in both groups. Marked improvements were observed in 19 patients(31.7%)of treatment group and 8 patients (13.3%)of control group(χ2 = 5. 73, P ＜ 0.05). Clearance rate of acid-fast bacilli in treatment group was 25.0%(15/60), but that in the control was only 6.7%(4/60)(χ2 = 7. 50, P ＜ 0.01). Serum albumin in the treatment group was increased to(34.2 ±0.4)g/L after the treatment, and that in the control group was(29.1 ±0.6)g/L(t =2.42, P＜0.05). T3 and FT3 were significantly increased in both groups, but more significant difference was observed in the treatment group(t = 59. 42 and 50. 66, P ＜ 0. 01). No empty closed after treatment in both groups, but the effective rate in treatment group was significantly higher than that in the control group(93.3% vs. 76.7%, χ2 =6. 54, P＜0.05). Two patients in control group died(2/60, 3. 3%), while no death was reported in treatment group. Conclusions Low-dose levothyroxine sodium treatment is effective for ESS in patients with severe pulmonary tuberculosis.Improvement on low T3 syndrome may be an important indicator for the overall improvement or recovery.

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To evaluate the value of serum human epididymis protein 4(HE4),cancer embryonic antigen(CEA), carbohydrate antigen(CA125,CA19-9,CA153),alpha fetoprotein(AFP) and β-human chorionic gonadotrophin (β-HCG) in ovarian cancer early diagnosis.Methods:Abbott Architect i2000SR was used to detect the levels of preoperative serum tumor markers (n=7) in ovarian cancer group,benign ovarian tumor group and the normal control (each n=60).Results:The levels of serum HE4,CA125, CA199,CEA,CA153,AFP and β-HCG in ovarian cancer group were markedly higher than the benign ovarian tumor group and the control group.There was statistically significant difference ( P<0.05 ).The diagnosis of ovarian cancer tumor markers were high specificity,but sensitivity was not high except HE4 (76.67%) and CA125 (68.33%).With Youden Index,the area under curve of ROC,the HE4 was demonstrated higher specificity ,sensitivity and accuracy.There was also medium diagnostic value of CA 125 ,CA199 and CEA for ovarian cancer.The sensitivity of ovarian cancer diagnosis is raised by combined assay with serum tumor marker ,but the specificity would be reduced accordingly.HE4, CA125, CA199 and CEA combined detection is considered the best.Conclusion:CA153,AFP and β-HCG have lowered diagnosis for ovarian cancer.HE4, CA125, CA199 and CEA combined detection could significantly improve specificity ,sensitivity and accuracy in the early diagnosis of ovarian cancer.

Ninety eight patients with chronic hepatitis B (CHB) admitted to Department of Infectious Diseases, Yongkang First People′s Hospital from January 2017 to June 2018 were randomly divided into two groups. On the basis of entecavir+dicyclool treatment, patients in control group (48 cases) received health education and weekly telephone follow-up from the nurses, while patients in intervention group (50 cases) received health guidance from doctors and psychological counseling and communication from the nurses. All patients were followed up for 8 weeks. The illness perception, negative emotions, quality of life, and medication compliance were evaluated with the Revised Illness Perception Questionnaire (IPQ-R), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), SF-36 and Morisky Medication Adherence Scale (MMAS-8) in two groups, respectively. The results showed that, after 8 weeks, the disease identity, serious consequences, treatment control and disease correlation; SAS and SDS scores; physiological function, emotional function, energy and social function were significantly improved in control group( t=2.30, 3.45, 2.35, 2.23, 5.04, 6.03, 2.03, 2.79, 2.02, 2.34, all P<0.05). All dimension of illness perception; SAS and SDS scores; physiological function, physiological function, emotional function, energy, mental health, social function and general health were also improved significantly in intervention group ( t=4.06, 5.44, 6.91, 8.53, 5.65, 8.77, 7.25, 6.06; 12.71, 11.91, 2.27, 2.60, 4.48, 2.82, 3.65, 3.461, 2.82,all P<0.05). And the personal control, disease correlation and emotional expression; SAS and SDS scores; emotional function and mental health in intervention group were better than those in control group ( t=1.49, 2.74, 2.60, 5.02, 5.18, 5.56, 13.72, all P<0.05). In addition, the medication compliance of patients in both groups was significant improved ( Z=5.56, 13.72, all P<0.01), and the improvement was more marked in the intervention group ( Z=3.22, P<0.01). The study indicates that the comprehensive psychotherapy can more significantly improve the degree of illness perception, negative emotions, quality of life and medication compliance in patients with chronic hepatitis B.

Obesity has become one of the most serious issues threatening the health of humankind, and we conducted this study to examine whether and how celastrol protects against obesity.

Nutritional support is an indispensable part in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19). Critically ill COVID-19 patients are often in a state of high inflammation, high stress, high catabolism, and their energy consumption increases significantly. All critically ill patients with COVID-19 should be screened for nutritional risk with NRS-2002 or Nutric tool in the early stage. If there is a risk of malnutrition, subjective global assessment (SGA) or Global Leadership Initiative on Malnutrition (GLIM) are further used for malnutrition assessment. After assessment, the daily energy, protein, electrolyte and liquid quantity needed by the patients should be determined according to the actual condition. Then, according to the degree of gastrointestinal function impairment in patients, the oral nutrition supplement, enteral nutrition, parenteral nutrition or their combination are selected for nutritional support. For patients with normal gastrointestinal function who require prone position ventilation or receive extracorporeal membrane oxygenation (ECMO) treatment, enteral nutrition is recommended as the first choice. In addition, in the process of nutrition implementation, it is necessary to closely monitor the adverse reactions such as abdominal distention, diarrhea, regurgitation, phlebitis and liver function damage, timely adjust the nutrition program to ensure the smooth implementation of nutritional support. Based on the metabolic characteristics of critically ill patients with COVID-19, this paper makes a summary and suggestion on the following perspectives such as nutritional risk screening and assessment, target amount of nutritional treatment, nutritional intervention and treatment, nutritional support of special populations, and common adverse reactions in nutritional support treatment, so as to provide reference for individualized nutritional support therapy of critically ill patients with COVID-19.
Betacoronavirus ; Coronavirus Infections ; Critical Illness ; Humans ; Nutritional Support ; Pandemics ; Pneumonia, Viral

Objective To investigate the effects of Tianxiang capsule on Neurotransmitters and Hormone Level of rats with motion sickness. Methods Male SD rats were randomly divided into six groups, including blank control group, model control group, positive drug control group, low-dose, mid-dose and high-dose Tianxiang capsule groups with the method of random digital table, and every group had 10 mice. Except the normal group, the rats in the other groups were intragastrically pre-administered for 1 hour, and the low, medium and high doses of Tianxiang capsule were 0.91, 1.82, 3.64 g/kg, the positive drug control group was given scopolamine 1 mg/kg, and then the rat motion sickness model was induced by a rotary stimulation device. After the modeling, the feces, urine, standing hair, trembling were immediately observed and recorded, and the halo response index of the rats was calculated. The blood from the heart puncture was taken and the vestibular nucleus were put on the ice. Then, the content of histamine (HIS) in the vestibular nucleus and plasma was detected by ELISA. The expression of plasma cortisol (Cort) and arginine vasopressin (AVP) were measured by radioimmunoassay. Results Compared with the model control group, the motion sickness index of rats with low, medium and high doses of Tianxiang capsule (6.56 ± 2.16, 6.10 ± 1.35, 4.46 ± 2.50 vs. 8.90 ± 2.61) significantly decreased (P<0.05 or P<0.01). The HIS content in the vestibular nucleus (12.70 ± 3.86 μg/L, 11.45 ± 1.57 μg/L, 10.02 ± 1.30 μg/L vs. 17.50 ± 4.82 μg/L) significantly decreased (P<0.05 or P<0.01). The plasma content of HIS (4.24 ± 1.75 μg/L vs. 7.69 ± 3.06 μg/L), Cort (286.90 ± 8.72 ng/ml vs. 329.26 ± 29.04 ng/ml) and AVP (16.54 ± 2.48 pg/ml vs. 22.35 ± 3.08 pg/ml) in the high doses of Tianxiang capsule significantly decreased (P<0.05 or P<0.01). Conclusions The Tianxiang capsule could effectively reduce the motion sickness index of rats with motion sicknes, which might be related to the down-regulation of HIS in Vestibule Nucleus and HIS, Cort and AVP in plasma.

Objective:To investigate the application value of dual-energy CT in the differential diagnosis of lung metastases and benign nodules in breast cancer.Methods:The data of 96 patients with pathology-confirmed breast cancer at the Fifth Affiliated Hospital of Wenzhou Medical University from March 2017 to June 2021 were analyzed retrospectively. All patients received dual-energy chest CT scans within 2 weeks before surgery. All 96 patients were female, aged 31-84 (56±12) years. A total of 207 pulmonary nodules from 96 patients were classified into 81 lung metastases and 126 benign nodules according to pathological findings. Conventional CT features [longest diameter, boundary, location and CT value difference between arterial and venous phases (ΔCT) of nodules] and dual-energy CT parameters [standardized iodine concentration (NIC), slope of energy spectrum (λ HU) and normalized effective atomic number (nZ eff) in arterial and venous phases] were analyzed and measured. The χ 2 test, independent samples t test and Kruskal-Wallis rank-sum test were used to analyze the differences of conventional CT features and dual-energy CT parameters between lung metastases and benign nodules. First, the least shrinkage and selection operator (LASSO) regression method was used to screen conventional CT features and dual-energy CT parameters, and then logistic regression analysis was performed to screen out independent risk factors for lung metastases. Receiver operating characteristic (ROC) curves were used to evaluate the efficacy of CT parameters alone and logistic model in differentiating lung metastases from benign lung nodules. Results:There were statistically significant differences between lung metastases and benign nodules in longest diameter, ?CT, NIC, λ HU and nZ eff in arterial and venous phases (all P<0.05). LASSO regression and binary logistic regression analysis showed that the venous phase λ HU (OR=59.413, 95%CI 14.233-248.002, P<0.001) and the venous phase nZ eff (OR=4.508, 95%CI 2.787-7.290, P<0.001) were independent risk factors for predicting lung metastases. Among them, the venous phase λ HU had the highest diagnostic efficiency, with an area under curve (AUC) of 0.794 and an accuracy of 74.88%. The AUC of the logistic model constructed by combining the venous phase λ HU and the venous phase nZ eff could reach 0.958, and the accuracy was improved to 92.27%, which was significantly higher than the efficacy of the two alone ( Z=6.02, 9.54, all P<0.001). Conclusion:Dual-energy CT has great application value in the identification of lung metastases and benign nodules in patients with breast cancer, especially when combined with venous phase λ HU and venous phase nZ eff, the diagnostic efficiency is further improved.