Objective To explore the effects of continuous positive airway pressure (CPAP) on N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in the non‐obese patients with obstructive sleep apnea (OSA) .Methods A total of 41 cases of severe OSA complicating coronary artery disease(CAD) were divided into two groups based on their body mass index (BMI):obese group (BMI>28 kg/m2 ) and non‐obese group (BMI≤28 kg/m2 ) .All the patients were treated by CPAP for 24 weeks .Serum NT‐proBNP lev‐el was detected by adopting the electrochemiluminescence method ,the changes of the serum levels of NT‐proBNP were compared between before and after treatment .Results The NT‐proBNP level after treatment in the non‐obese group was significantly de‐creased ,which was decreased from (141 .8 ± 156 .5)pg/mL before treatment to (106 .7 ± 167 .2)pg/mL ,the difference was statisti‐cally significant (P<0 .05);the NT‐proBNP level after treatment in the obese group showed the increasing trend ,which was in‐creased from (32 .2 ± 24 .5)pg/mL before treatment to (86 .3 ± 174 .4)pg/mL ,the difference was not statistically significant (P>0 .05) .Conclusion CPAP can effectively decrease the NT‐proBNP level in non‐obese patients OSA complicating CAD .

Objective To analyze the clinical observation and incidences of complications of therapeutic post-endoscopic retrograde cholangiopancreatography (ERCP).Methods The clinical information of 1 482 cases of therapeutic ERCP was analyzed retrospectively.Results Among them,468 cases had nasal biliary drainage,532 cases had pancreatic or bile duct stent after endoscopic procedure and the other 482 case hadn't.For the drainage group, there were 396 cases of biliary stone,36 cases of simple dilatation of common bile duct,8 cases of biliary cyst,6 cases of strictured papilla,18 cases of inflammatory stricture of common bile duct,2 cases of sclerosing cholangitis and 2 cases of autoimmune pancreatitis.For the pancreatic or bile duct stent group,there were 483 cases of malignant bili-ary obstruction,13 cases of biliary stone,28 cases of pancreatic duct stone,3 cases of sclerosing cholangitis and 5 cases of inflammatory stricture of common bile duct.And there were 385 cases of biliary stone,36 cases of simple dilatation of common bile duct,38 cases of inflammatory stricture of common bile duct,11 cases of strictured papilla, 9 cases of pancreatic duct stone and 3 cases of biliary cyst for un -drainage group.The incidences of acute pancreati-tis and acute cholangitis (4.4%,2.6%)were higher in un -drainage group than the nasal biliary drainage group (1.5%,0.6%,P <0.05)or the stent group(1.7%,0.8%,P <0.05).The incidences of duodenum or biliary tract perforation and upper gastrointestinal hemorrhage(0.2%,1.2%)were not significantly different compared with the nasal biliary drainage group(0.2%,0.6%,P >0.05)and the stent group(0.4%,0.8%,P >0.05).The incidences of 4 kinds of complications were not significantly different between the nasal biliary drainage group and the stent group.Conclusion Endoscopic nasal biliary drainage or stent can prevent and treat some of therapeutic ERCP com-plications effectively.

Objective To observe the effect of prevention and treatment of gastrointestinal failure and coagu-lation function in severe acute pancreatitis(SAP)with single Rhubarb.Methods 68 caese with SAP were randomly divided into control group(n =34)and treatment group(n =34)by random number table.Both two groups were given routine western medicine,but in the treatment group the patients were additionally administered with single Rhubarb orally or nasal feeding.The time of first defecation,abdominal pain disappeared,bloating disappeared,upper abdomi-nal tenderness disappeared,serum amylase recovery,correction degree of coagulation function and average hospitaliza-tion days of the two groups were compared.Results The time of first defecation in the treatment group was (46.0 ± 18.0)h,which was (73.0 ±23.0)h in the control group,there was significant difference between the two groups(t =2.43,P <0.05).The time of abdominal pain disappeared[(4.3 ±1.2)d],bloating disappeared[(5.2 ±1.6)d], upper abdominal tenderness disappeared[(5.0 ±1.7)d],serum amylase recovery[(6.2 ±1.3)d]of the treatment group were significantly shorter than those of the control group[(5.6 ±1.7)d,(6.7 ±2.3)d,(6.4 ±2.1)d,(8.9 ± 1.6)d](t =2.36,2.17,2.60,2.48,all P <0.05).The average hospitalization days of the treatment group[(24.5 ± 12.3)d]was significantly shorter than the control group[(30.6 ±12.9)d](t =2.65,P <0.05).5 days after treat-ment,in the treatment group,the partially activated thromboplastin time(APTT)[(30.39 ±4.98)s]and prothrombin time(PT)[(12.65 ±1.32)s]were significantly shorter than the control group[(37.25 ±6.27)s,(14.87 ±1.68)s] (t =2.54,2.43,all P <0.05).The platelet count(PLT)and the fibrinogen(FIB)in treatment group were (186.30 ± 59.82)×109 /L and (3.89 ±1.17)g/L repectively,those in control group were (131.80 ±48.57)×109 /L and (5.29 ±1.33)g/L repectively,the differences were statistically significant between the two groups(t =2.16,2.83,all P <0.05).Conclusion The routine western medicine and additionally administered with single Rhubarb can effec-tively prevent and treat gastrointestinal failure,significantly improve coagulation function in SAP.

ObjectiveTo evaluate the effect of aminoguanidine on expression of inducible nitric oxide synthase (iNOS) in neurons in the small intestinal nerve plexus of starved rats.MethodsNinety male SD rats weighing 230-270 g were randomly divided into 3 groups:group normal control (group C,n =10) ; group starvation (group S,n=40) and group starvation + aminoguanidine (group A,n =40).The animals were allowed free access to water but no food during starvation in S and A groups.In group A the animals were given aminoguanidine 150 mg·kg-1 ·d-1 intraperitoneally during starvation.Ten animals were sacrificed at 3,5,7 and 9 d of starvation respectively and intestine specimens were taken for determination of ratio of intestinal transit using dextran blue-2000 as indicator.Then the specimens of intestinal myenteric nerve plexus of ileum were collected and stained by histochemistry with nicotinamide-adenine dinucleotide phosphate-d for determination of iNOS expression.ResultsStarvation significantly reduced the small intestinal transit and increased iNOS expression in neurons in the myenteric nerve plexus of small intestine in proportion to days of starvation in group S compared with group C.Intraperitoneal aminoguanidine significantly attenuated the starvation-induced changes in intestinal transit and iNOS expression.ConclusionAminoguanidine can attenuate the up-regulation of the expression of iNOS in neurons in the myenteric nerve plexus of small intestine induced by starvation and is helpful in promoting the intestinal transit in starved rats.

Objective:To analyze the genetic test results and ultrasonographic markers of 41 fetuses with short femurs and their relationship.Methods:This study retrospectively analyzed 41 fetuses who were diagnosed with short femurs by ultrasound during 19-37 gestational weeks and underwent prenatal genetic examination at the First Affiliated Hospital of Zhengzhou University from January 2018 to June 2019. According to the results of genetic examination, these cases were divided into three groups after excluding three cases of variants of unknown significance: genetically normal group, chromosome variation (including chromosomal aneuploidy and pathogenic or likely pathogenic copy number variations) group, and gene mutation (including pathogenic or likely pathogenic gene mutations) group. According to the head circumference (HC), abdominal circumference (AC) and femur length (FL), Z FL, FL/HC, FL/AC, ΔZ H-F and ΔZ H+A-2F for each fetus were calculated. One-way ANOVA and LSD- t test were used for statistical analysis. Results:(1) Among the 41 fetuses with short femurs, there were 28 in the genetically normal group, five in the chromosome variation group, three with chromosome variations of unknown significance and five in the gene mutation group. (2) In the genetically normal, chromosome variation and gene mutation groups, Z FL values were -2.78±0.77, -4.36±0.69 and -4.69±0.70; FL/HC ratios were 0.178±0.011, 0.170±0.010 and 0.131±0.022; FL/AC ratios were 0.197±0.013, 0.186±0.011 and 0.151±0.017; ΔZ H-F values were 2.49±1.09, 3.53±1.28 and 8.17±1.30; ΔZ H+A-2F values were 4.44±2.00, 6.78±2.20 and 14.28±1.26, respectively. The differences in Z FL values between the genetically normal group and the chromosome variation group as well as the gene mutation group were statistically significant (both P<0.05); so were the differences in FL/HC, FL/AC and ΔZ H-F values between the gene mutation group and the genetically normal group as well as the chromosome variation group (all P<0.05) and in any pairwise comparison of ΔZ H+A-2F among the three groups (all P<0.05). Conclusions:The genetic etiology of fetal short femurs is mainly related to chromosomal variations (including chromosomal aneuploidy and pathogenic or likely pathogenic copy number variations) and gene mutation. In fetuses with chromosome variation and gene mutation, the degree of the femoral development delay relative to the development of HC and AC is worse than that in the normal genetic results group.

Objective To study the effect of mechanical ventilation guided by esophageal pressure on hemodynamics and oxygen metabolism of severe acute pancreatitis (SAP) swine model with intra-abdominal hypertension (IAH) Methods By self-controlled study,SAP model was made by infusing sodium taurocholate (5％) into the pancreatic duct in 6 domestic swine.Mechanical ventilator mode was volumeassist control with tidal volume 10 ml/kg ; FiO2 40％ and PEEP 5 cm H2O (routine ventilation) given to SAP model swine.After 3 h ventilation,pneumo-peritoneum was made with N2 gas to increase the intraabdominal pressure (IAP) to 25 mm Hg in SAP swine.Three more hours later,PEEP was adjusted as the measurement of esophageal pressure (Pes guided ventilation) to such a level that trans-pulmonary pressure stayed above 0 cm H2O during end-expiratory occlusion.During the investigation period,heart rate (HR),cardiac output index (CI),central venous pressure (CVP),mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and ECG monitor,and oxygen partial pressure of artery (PaO2) and carbon dioxide partial pressure of artery (PaCO2) were measured by blood-gas analysis.In addition,systemic oxygen delivery (DO2) and systemic oxygen consumption (VO2) were calculated by using the data of blood-gas analysis of arterial and central venous blood.Results No swine model was subjected to barotrauma.After routine mechanical ventilation,there were significant differences in HR,CI,MAP,CVP,PAWP,Ppeak,Pplat,Pes,pulmonary compliance (Cstat),PaO2,and DO2 between SAP and IAH in swine (all P ＜ 0.05).Compared with routine ventilation,however,PaO2 and Cstat improved significantly with lower CI and increased Pplat after PEEP adjusted according to measurements of esophageal pressure (all P ＜ 0.05).The lactate decreased significantly after esophageal pressure guided ventilation (all P ＜ 0.05).There were no significant changes in PaCO2,HR,MAP,CVP and PAWP in IAH swine after mechanical ventilation with routine parameters (all P ＞ 0.05).Conclusions There were remarkable effects on oxygen metabolism in response to mechanical ventilation guided by esophageal pressure.In case of clinical application of mechanical ventilation,the results of this study are in favor of setting transpulmonary pressure according to measurements of esophageal pressure in SAP patients with IAH in an early stage.

Objective To investigate the modulating effects and explore their mechanism of 9-nitrocamptothecin and its liposomes to induce apoptosis and inhibit cell cycle in HepG2 and L02 cell lines. Methods Cells were incubated with 9-nitrocamptothecin(9NC) or with 9-nitrocamptothecin liposomes for 24 h, 48 h and 72 h, then, the cell viability was measured via MTT assay; cell cycle and apoptosis was evaluated by flow cytometry after stained by PI and Annexin V-PE/7AAD. Additional, Western Blot was used to evaluate the expression of cell cycle and apoptosis related protein. Results Both cells viability were apparently inhibited by the 9-nitrocamptothecin and 9-nitrocamptothecin liposomes, the inhibitory effect showed a time-dependent and dose-dependent manner. Both S and G2/M phases arrest were observed after incubated with drugs. HepG2 cell was completely arrested in S phase when 9NC concentration over than 0. 1 μmol/L after incubation for 24 h, while more than 95% cells arrested in G2/M phase when 9NC concentration is 0. 1 μmol/L after incubation for 72 h. Apoptosis induction effect also showed a time-dependent and dose-dependent manner. Western Blot results showed the expression of Bax and Caspase-3 were upregulated while Cyclin A, Cdk2, Cyclin E and Bcl-2 were downregulated. More importantly, the compounds were more cytotoxic to the cancer cell lines than to the normal liver cell. Conclusions 9-nitrocamptothecin and 9-nitrocamptothecin liposomes can potently inhibit cell growth via regulation of cell cycle and induction of apoptosis, and this effect was preferentially in cancer cell. Inhibitory of 9-nitrocamptothecin liposomes was slightly better than the 9-nitrocamptothecin.

Objective To observe the inhibitory effect and mechanism of 9-nitrocamptothecin liposomes on HepG2 liver carcinoma cells. Methods HepG2 cells were incubated with 9-nitrocampto-thecin(9NC) or with 9-nitrocamptothecin liposomes(9NC-LP) for 24 h, 48 h and 72 h. Cell viability was then measured by the MTT assay. Cell cycle and apoptosis were evaluated by flow cytometry.Western Blot was used to determine the expression of cell cycle and apoptosis related proteins. HepG2tumor-bearing mouse models were then established. The HepG2 tumor-bearing mice were randomly divided into control group, free liposomes group, DMSO group, 9NC low dose group, 9NC high dose group, 9NC-LP low dose group and 9NC-LP high dose group. There were 10 mice in each group.Drugs were administered by tail vein and tumor volume and body weight were observed 28 days after administration. Then animals were sacrificed and the expression of proteins from tumor homogenates was analyzed by Western blotting. Results In vitro, HepG2 cell viability was apparently inhibited by 9NC and 9NC-LP, and the inhibitory effect increased in a time-dependent and dose-dependent manner.Both S and G2/M phase arrests were observed after incubation with drugs. HepG2 cells were completely arrested in S phase with 9NC concentration over than 0.1 μmol/L after incubation for 24 h,while more than 95% of cells arrested in G2/M phase when 9NC concentration was 0.1 μmol/L after incubation for 72 h. In vivo, compared with the control group, the average tumor volume was reduced in both the 9NC and 9NC-LP group (P<0.05) , and the average animal body weight also decreased in both the 9NC and 9NC-LP group (P<0.05). There was no significant difference among the control group, free liposomes group, and DMSO group. The lights inhibition rates of tumor growth in the 9NC-LP(2.5 mg/kg),9NC-LP(1.5 mg/kg),and 9NC(1.5 mg/kg)groups were 87.02%, 51.57%and 35.47%, respectively. In the 9NC-LP(2.5 mg/kg)group, >50% of animals died 14 days after drug administration. Conclusion 9NC and 9NC-LP can inhibit HepG2 cell growth via cell cycle arrest and apoptosis induction. 9NC-LP has a more potent anti-tumor effect and fewer side effects in vivo,which means 9NC-LP is a promising compound for cancer therapy via intravenous administration.

BACKGROUND:Numerous studies have focused on the clinical efficacy of alogeneic bone graft and humeral head replacement for the treatment of proximal humeral fractures, but their comparative studies are rarely reported. OBJECTIVE:To investigate the effect of alogeneic bone grafting in the treatment of proximal humeral fractures in the high risk group. METHODS:Clinical data of 120 cases of proximal humeral fractures aged≥ 60 years were retrospectively analyzed. Sixty of the 120 cases underwent alogeneic bone grafting combined with locking plate fixation as experimental group, and the other 60 cases were subjected to semi-shoulder joint replacement as control group. Al patients were folowed up for 8-24 months. Fracture healing, colodiaphyseal angle, humeral head height and shoulder joint function were observed and measured. RESULTS AND CONCLUSION:During the postoperative 8-24 months, al the fractures were healed by first intention, and there were no rejection reactions, large/smal nodules, humeral head displacement, necrosis, and screw loosening. Loss of the humeral head height at the last folow-up and the active flexion angle of the shoulder at postoperative 12 weeks were significantly higher in the experimental group than the control group (P < 0.05). Scores on forearm, shoulder and hand dysfunction were significantly lower in the experimental group than the control group (P < 0.05). However, no significant difference was observed in the colodiaphyseal angle and SF-36 scores between the two groups. These finding indicate that alogeneic bone grafting can strength the internal fixation of proximal humeral fractures in the high-risk group, and improve patient’s upper limb function.

Objective To systematically assess the diagnostic performance of CTA for lower extremity peripheral arterial disease (PAD) using a Meta analysis method. Methods Studies were located through electronic searching of the PubMed, EBSCO, Springer, Ovid, CNKI, Cochrane library (from the date of establishment of the databases to October 2009 ). Bibliographies of the retrieved articles were also checked. All the studies concerning the diagnosis of PAD using CTA had been searched and reviewed, and the studies with the DSA as the gold standard were adopted as eligible. Subsequently, the characteristics of the included articles were appraised and extracted. Data on accuracy of included studies were extracted for further heterogeneity exploring, statistical pooling and SROC ( summary receiver operating characteristics)analyzing using the Meta Disc 1.4 software. Results Totally 24 studies met the inclusion criteria with a total of 1096 patients. The heterogeneity was found in these studies. The pooled accuracy indicators like sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.95 ( 95% CI:0.94-0.95 ), 0.96 ( 95% CI:0.95-0.96), and 471.13 (95% CI:242. 92-913.71 ), respectively. The area under of SROC curve was 0.9888 and the Q index was 0.9555. Subgroup analysis demonstrated significant difference on diagnostic performance for various CT slices (P ＜ 0.05 ). Conclusion CTA can be regarded as an effective and feasible method for PAD diagnosis and screening, based on the results of this systematic review. However,more rigorous evaluations of CTA in patients with critical limb ischemia are needed.