Objective:To investigate the clinical efficacy of different doses of budesonide/formoterol in the treatment of an acute exacerbation of chronic obstructive pulmonary disease in patients.Methods:A total of 200 inpatients with an acute exacerbation of chronic obstructive pulmonary disease graded C/D by global initiative for chronic obstructive lung disease (GOLD) staging system who received treatment in Jiuquan City People's Hospital, China from January to December in 2019 were included in this study. They were randomly divided into a control group and a treatment group ( n = 100/group). Based on anti-infection and expectorant treatment, the treatment group was given inhalation therapy (higher dose budesonide/formoterol, 320 μg/9 μg), while the control group was identically given inhalation therapy (lower dose budesonide/formoterol, 160 μg/4.5 μg), with a total course of 9 days in each group. Before treatment and at 5 and 9 days of treatment, procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP), fractional exhaled nitric oxide (FeNO), percentage of eosinophils (EO%), partial pressure of oxygen (PaO 2), lactic acid, interleulin-6 (IL-6), forced expiratory volume in 1 second (FEV 1), the ratio of FEV 1/ forced vital capacity (FVC) were monitored in each group. COPD assessment test (CAT) score, modified Medical Research Council (mMRC) dyspnea score, 6-minute walking test (6MWT), and symptom improvement were determined in each group. Results:Before treatment, there were no significant differences in PCT and PaO 2 between the control and treatment groups (both P > 0.05). There were significant differences in PCT, PaO 2, FeNO, hs-CRP, E0 (%), IL-6, FEV 1, FEV 1/FVC, 6MWT, mMRC, cough, expectoration, shortness of breath and CAT score measured at 5 days of treatment between the treatment and control groups ( t = 2.416, 3.289, 3.982, 4.871, 3.332, 4.098, 5.253, 6.214, 3.843, 7.268, 5.387, 7.392, 5.398, 6.349, all P < 0.05). There were significant differences in PCT, PaO 2, FeNO, hs-CRP, E0 (%), IL-6, FEV 1/FVC, FEV 1, 6MWT, mMRC, cough, expectoration, shortness of breath and CAT score measured at 9 days of treatment between the treatment and control groups ( t = 2.508, 4.032, 2.948, 3.527, 3.118, 5.251, 5.325, 6.338, 2.907, 6.289, 3.246, 2.084, 2.151, 2.527, all P < 0.05). At 5 days of treatment, lactic acid level in the observation group was significantly lower than that in the control group ( t = 4.341, P < 0.05). At 9 days of treatment, there was no significant difference in lactic acid level between the control and observation groups ( t = 1.173, P > 0.05). There was no significant difference in the incidence of adverse reactions between the control and treatment groups [4%(4/100) vs. 5%(5/100), P > 0.05]. Conclusion:Inhalation of high doses of budesonide/formoterol can greatly improve pulmonary function, 6MWT performance, decrease mMRC and CAT scores, alleviate cough, expectoration, shortness of breath, and decrease serum levels of FeNO, hs-CRP, E0(%), IL-6 and other inflammatory factors. Inhalation of higher doses of budesonide/formoterol exhibits better efficacy in the treatment of an acute exacerbation of chronic obstructive pulmonary disease in patients than inhalation of lower doses of budesonide/formoterol.

Objective To study the change in sodium channel current(ⅠNa)in the developement of the left ventricular hypertrophy in spontaneously hypertensive rat(SHR).Methods ⅠNa and membrane capacitance(MC)were measured in myocytes of 10,24 and 34-week SHR by the whole-cell patch-clamp technique.Systolic blood pressure(SBP)and left ventricular mass index(LVMI)were detemined.10-week old Wistar rats served as controls.Results LVMI and MC of SHR were significantly higher than those of Wistar rat(P0.05),however the density of ⅠNain 34-week SHR were higher than those of Wistar rat(-18.3?1.9)vs(-15.3?2.0)pA/pF,P

Objective To evaluate the effects of penehyclidine hydrochloride on synthesis and release of high mobility group protein box 1 (HMGB1) in macrophages induced by lipopolysaccharide (LPS) in mice.Methods RAW264.7 cells obtained from mice were seeded in the culture dishes.After being cultured for 24 h,the cells were randomly divided into 5 groups (n =6 each) using a random number table.The cells were incubated routinely in group C.The cells were incubated in the presence of LPS 500 ng/ml (group LPS),LPS 500 ng/ml + penehyclidine hydrochloride 0.5 μg/ml (group P1),LPS 500 ng/ml + penehyclidine hydrochloride 2 μg/ml (group P2),or LPS 500 ng/ml + penehyclidine hydrochloride 5 μg/ml (group P3).All the cells were incubated for 24 h.The cells and supernatant were collected.The proliferation of the cells was measured by CCK-8 assay,HMGB1 mRNA expression in the cells was detected by RT-PCR,NF-κBp65 protein expression in the cells was detected by Western blot and the concentration of HMGB1 in the supernatant was detected by ELISA.Results Compared with group C,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly upregulated,and the concentration of HMGB1 in the supernatant was increased in LPS,P1,P2 and P3 groups (P ＜ 0.05).Compared with group LPS,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly down-regulated,and the concentration of HMGB1 in the supernatant was decreased in P2 and P3 groups (P ＜ 0.05).Compared with group P1,the expression of HMGB1 mRNA and NF-κBp65 protein in the cells was significantly down-regulated,and the concentration of HMGB1 in the supernatant was decreased in P2 and P3 groups (P ＜ 0.05).There was no significant difference in the indicators mentioned above between group P2 and group P3 (P ＞ 0.05).There was no significant difference in the proliferation of the cells among the 5 groups (P ＞ 0.05).Conclusion Penehyclidine hydrochloride can reduce the synthesis and release of HMGB1 in macrophages induced by LPS through inhibiting NF-κB activation in mice.

Objective To observe the surgical results of modified percutaneous endoscopic interlaminar decompression(PEID) and traditional PEID in the treatment of degenerative lumbar spinal stenosis (DLSS),and to explore the optimizations scheme of PEID for DLSS.Methods 60 patients (36 males and 24 females) were brought into the research for DLSS.According to the different operation ways,the patients were randomly divided into the modified PEID group(observation group) and traditional PEID group (control group) according to the digital table method,30 cases in each group.The surgical outcome,indicators included the change in spinal canal,visual analogue scale (VAS) score and Oswestry disability index (ODI) at pre-operation,postoperative 3 d,postoperative 3 months and postoperative 6 months,operation time,headache and painful stiff nape incidence in the operation,postoperative complications were compared between the two groups.Results The VAS scores (postoperative 3 days,postoperative 3 months and postoperative 6 months) of the observation group were (4.37 ± 1.20) points,(2.59 ± 1.30) points,(1.29 ± 1.21)points respectively,which of the control group were (4.45 ± 1.22)points,(2.67 ± 1.36)points,(1.17 ± 1.10)points respectively,which were significantly better than (7.93 ± 1.56)points of the observation group and (8.22 ± 1.70) points of the control group before operation,the differences were statistically significant (F =1 254.387,512.762,all P ＜ 0.05).The ODI scores (postoperative 3 days,postoperative 3 months and postoperative 6 months) of the observation group were (48.64 ± 19.59) points,(27.66 ± 10.22) points,(10.69 ± 8.87) points respectively,which of the control group were (47.22 ± 20.96) points,(25.17 ± 11.93) points,(10.16 ± 7.89) points respectively,which were significantly better than (75.20 ± 23.20) points of the observation group and (70.35 ± 28.66) points of the control group before operation,the differences were statistically significant(F =1 254.387,512.762,all P ＜ 0.05).The VAS and ODI scores (pre-operation,postoperative 3 days,postoperative 3 months andpostoperative 6 months) of the observation group and control group had no statistically significant differences (VAS:t =2.088,2.124,3.021,3.173;ODI:t =2.366,1.079,1.694,1.573,all P ＞ 0.05).The incidence of neck pain and operation time of the observation group were 20.69％,(63 ± 7) min,which were significantly lower than 87.50％ and (157 ± 8)rin of the control group,the differences were statistically significant(t =3.601,2.167,all P ＜ 0.05).The central sagittal diameter of the spinal canal and the central transverse diameter of the spinal canal between the observation group and the control group had no statistically significant differences (x2 =4.260,t =3.694,all P ＞ 0.05).Conclusion Modified PEID has advantages in surgical efficiency,operation time and headache and painful stiff nape incidence compared with traditional PEID,so it can be chosen for DLSS.

Objective To learn 2009~2014 Shaanxi Province sentinel surveillance six classes of HIV infection focus groups, and estimates of HIV-1 new infection.Methods Used enzyme-linked immunosorbent assay (ELISA)and Western blot (WB)experiments for the 2009~2014 HIV sentinel surveillance Shaanxi Province Category 6 focus groups conducted a total of 77 778 HIV antibody screening and confirmatory testing estimates of HIV-1 new infection.Results 2009~2014 men who had sex with men and people with HIV infection rate were 3.75%,8.77%,3.50%,5.00%,6.20% and 5.75%,and a slow upward trend;HIV-1 new infection were 5.04%,8.96%,5.01%,5.95%,4.68% and 6.39%,the overall downward trend. Young students,drug addicts,sex workers,pregnant women,and male STD clinic attenders five people with HIV infection and HIV-1 new infection were emerging to remain low.But male STD clinic attenders of HIV infection and HIV-1 new in-fection was emerging slowly rising trend.Conclusion Shaanxi MSM HIV infection and HIV-1 new infection were high,but HIV-1 new infection had decreased slowly.Emerging trend should continue to increase the population of the intervention ef-forts.The infection rate in other monitoring population was relatively low but a few people on the rise,the need to take the necessary coping methods.

China ; Data Systems ; Humans ; Radiology ; Retrospective Studies ; Thyroid Neoplasms/diagnostic imaging* ; Thyroid Nodule ; Ultrasonography/methods* ; United States

Objective To investigate the effectiveness of predicting the incidence of supine hy-potension syndrome (SHS)after spinal anesthesia measured by ultrasonic measurement of the varia-tion of brachial artery peak velocity in different positions of parturient.Methods Parturient scheduled for elective cesarean section,ASA physical status Ⅰ or Ⅱ,were divided into SHS group and no-SHS group (SBP in the upper extremity decreased by > 30 mm Hg or decreased to < 80 mm Hg)after spinal anesthesia.HR,SBP,DBP of supine position and left lateral position before anesthesia were re-corded,and brachial artery peak velocity were measured by Ultrasonic.The differences of the above indexs before and after the transformation position were calculated.The receiver operating characteris-tic curve (ROC)was plotted by indexs of which P values were less than 0.05,to evaluate the predic-tive effect of each index on SHS after spinal anesthesia.Results Among the 196 patients,89 cases (45.4%)developed SHS after spinal anesthesia.SBP,DBP,peak velocity of brachial artery (Vpmin) and brachial artery peak velocity variation (ΔVp)were different before and after the transformation position (P<0.05).The difference in SHS group was significantly higher than no-SHS group.The areas under ROC curve (AUC)of ΔSBP,ΔDBP,ΔVpmin,ΔΔVp were 0.711 (95%CI 0.575-0.846), 0.573 (95%CI 0.419-0.727),0.948 (95% CI 0.895-0.987),0.864 (95% CI 0.770-0.958),and the cut-off values were 17.5 mm Hg,7.6 mm Hg,17.8 cm/s,and 13.1%.Conclusion The differ-ence of brachial artery peak velocity measured by ultrasonic in different positions of parturient can ef-fectively predict the occurrence of SHS,in which ΔVpmin≥ 17.8 cm/s has better predictive effect.

Objective To evaluate the efficacy of acupuncture combined with tropisetron in treating nausea and vomiting induced by carboprost tromethamine in cesarean section. Methods Sixty-six patients aged 22-40 yr who received carboprost tromethamine and developed nausea and vomiting during cesarean section under lumbar anesthesia, were randomly divided into 3 groups(n=22 each): acupuncture group (group A), tropisetron group(group T)and acupuncture+ tropisetron group(group AT). In group A, 09% normal saline 2 ml was intravenously injected immediately, acupuncture was given at Renzhong, Neiguan and Hegu acupoints with lifting thrusting twirling the acupuncture needle for 10 min. In group T, tropisetron 10 mg was intravenously injected immediately, the needle was placed on Renzhong, Neiguan and Hegu skin surface. In group AT, tropisetron 10 mg was intravenously injected immediately, acupunc-ture was given at Renzhong, Neiguan and Hegu acupoints with lifting thrusting twirling the acupuncture nee-dle for 10 min. The nausea and vomiting score was assessed before anesthesia induction(T0), when nause-a or vomiting occurred(T1)and at 1, 3, 5 and 15 min after acupuncture or administration(T1-5). The degree of patient′s satisfaction with therapeutic effect was recorded. Results Compared with group A, the nausea and vomiting scores were significantly decreased at T4, and the patient's satisfaction score was in-creased in group AT(P<005). Compared with group T, the nausea and vomiting scores were significantly decreased at T2-4and the patient's satisfaction score was increased in group AT(P <005). Conclusion Acupuncture combined with ondansetron can quickly and effectively relieve the nausea and vomiting induced by carboprost tromethamine during cesarean section.

Objective:To evaluate the improved efficacy of transversus abdominal plane (TAP)-rectus sheath (RS) block combined with general anesthesia in the patients undergoing laparoscopic pancreaticoduodenectomy.Methods:Fifty-six American Society of Anesthesiologists physical status Ⅰ-Ⅲ patients of both sexes, aged 45-64 yr, with body mass index of 18-25 kg/m 2, scheduled for elective laparoscopic pancreaticoduodenectomy, were divided into 2 groups ( n=28 each) using a random number table method: general anesthesia group (group G) and TAP-RS block plus general anesthesia group (group TRG). In group TRG, after induction of general anesthesia, bilateral TAP-RS block was performed with 0.375% ropivacaine mixed with 0.5 μg/kg dexmedetomidine under ultrasound guidance, 20 ml was injected into the plane of bilateral transverse abdominis, and 10 ml was injected into the posterior sheath of the bilateral rectus abdominis, and the tube was placed on the plane of the transverse abdominis, and 5 ml/h was continuously pumped after operation.In both groups, anesthesia was induced with IV midazolam, sufentanil, etomiddate and cisatracurium besylate and maintained using combined intravenous-inhalational anesthesia, and patient-controlled intravenous analgesia (PCIA) was performed after operation.Pulmonary function indexes were measured before induction of anesthesia (T 0) and at 6, 12 and 24 h after removal of the tracheal tube (T 1-3). Blood gas analysis was performed at T 0, T 2 and T 3.The occurrence of high/low blood pressure, tachycardia/bradycardia, consumption of opioids, PACU stay time, pressing times of PCIA within 24 h after surgery, rescue analgesia, time of passing the first flatus, the first postoperative off-bed time, length of postoperative hospital stay, and 48 h quality of recovery-40 (QoR-40) were recorded.The occurrence of adverse reactions and nerve block-related complications were recorded within 48 h after operation. Results:Conversion to laparotomy during operation was found in 4 patients, changing the scope of resection in 2 patients, and a total of 50 patients were enrolled in this study.Compared with group G, the pressing times of PCIA was significantly reduced, the requirement for postoperative rescue analgesia was decreased, the intraoperative consumption of sufentanil and remifentanil was reduced, the incidence of intraoperative hypertension and tachycardia was decreased, the FEV1, FVC and PEFR were increased at T 2, 3, the 48 h QoR-40 score was increased, the time of passing the first flatus, the first postoperative off-bed time, and length of postoperative hospital stay were shortened, the incidence of nausea, agitation, somnolence, and hypoxemia was decreased ( P<0.05), and no significant change was found in the indicators of blood gas analysis at each time point in group TRG ( P>0.05). Nerve block-related complications were not found in group TRG. Conclusion:Compared with general anesthesia alone, TAP-RS block combined with general anesthesia is helpful in carrying out anesthetic model of low-consumption opioids and improving the quality of early postoperative recovery when used in the patients undergoing laparoscopic pancreaticoduodenectomy.

Objective To investigate the incidence of food intolerance in patients with inflammatory bowel disease (IBD) and to analyze the differential diagnostic value of intolerant food in Crohn 's disease (CD) and ulcerative colitis (UC) and its effects on the diseases.Methods From January 2017 to June 2018, at Department of Gastroenterology and Hepatology , Jinling Hospital, Medical School of Nanjing University /General Hospital of Eastern Theater Command , PLA, a total of 252 IBD (154 CD and 98 UC) patients were enrolled. In the same period 46 non-IBD patients were recruited.Allergic diseases were excluded.The food-specific IgG antibodies were detected by enzyme linked immunosorbent assay (ELISA) in all enrolled patients.The chi-square test, Kruskal-Wallis test and Spearman correlation analysis were performed for statistical analysis . Regression analysis was used to screen the risk factors .Results The total positive rates of serum IgG antibody of corn, rice, soybean, tomato and wheat in CD patients were 60.4％ (93 /154), 57.8％ (89 /154), 42.9％(66 /154), 68.2％ (105 /154) and 19.5％ (30 /154),respectively, which were higher than those in patients with UC (7.1％, 7 /98; 5.1％, 5 /98; 5.1％,5 /98; 16.3％, 16 /98 and 3.1％, 3 /98, respectively) and those of non-IBD patients (2.2％,1 /46; 2.2％,1/46; 0,0 /46; 0,0 /46 and 0,0/46, respectively), and the differences were statistically significant (χ2 =70.940,71.092,42.185,64.517,14.187;48.190,44.270, 29.424,66.029,10.542; all P <0.01).The total number of positive food related IgG antibodies had strong ability to discriminate CD, UC from non-IBD, the value of area under the curve (AUC) was 0.815 (95％confidence interval (CI) 0.762 to 0.869, P <0.01)and 0.824(95％CI 0.767 to 0.880,P <0.01).There was no correlation between the total number of IgG positive food and age in CD patients (P >0.05) and there was a negative correlation between the total number of IgG positive food and age in UC patients (rs =-0.376, P <0.01).The median number of total IgG positive food of patients with lesions involving the terminal ileum (L1) and ileocolon (L3) was two and four, respectively, and the difference was statistically significant (the statistic was 11.717,P =0.002).The median number of total IgG positive food of UC patients with rectal lesions (E1) and extensive colon lesions (E3) was zero and one, respectively, and the difference was statistically significant (the statistic was 7.191,P =0.022).In addition, positive IgG shrimp and soybean were risk factors of CD patients combined with extra-intestinal manifestations and low body mass index (odd ratio (OR) =24.558, 95％CI 2.243 to 268.936; OR =2.253, 95％ CI 1.048 to 4.841; both P <0.05, respectively ). Conclusions CD patients are more susceptible to food intolerance .The number of intolerant foods have differential diagnostic value in CD, UC and non-IBD.The larger the lesion of IBD patients, the more common the food intolerance.IgG antibody positive food positive, may affect extra-intestinal manifestations and nutritional status of CD patients .