Objective To study the efficacy and safety of low-dose azithromycin with tiotropium bromide in the treatment of stable chronic obstructive pulmonary disease.Methods A hundred and ten patients were randomized into three groups:tiotropium bromide group (36 cases,group A),azithromycin with tiotropium bromide group(38 cases,group B)and control group(36 cases,group C).Patients in group A were given tiotropium bromide (18 μg,q,d )in addition to conventional treatment.The patients in group B were given lowdose azithromycin (250 mg,twice a week) in combined with tiotropium bromide.The patients in control group were given the conventional treatment only.The courses of treatment lasted for six months.Results Compared with the control group,the frequency of acute exacerbation in patients treated with azithromycin and tiotropium bromide was reduced remarkably ( 2.1 ± 0.6 and 4.9 ± 0.7,t =18.5061,P ＜ 0.05 ).The severity of clinic symptoms ( Cough 1.3 ± 0.5 vs.2.2 ± 0.6,P ＜ 0.05 ),expectoration ( 1.0 ± 0.2 vs.1.7 ± 0.3,P ＜ 0.05 ),anhelation ( 1.5 ± 0.8 vs.2.1 ± 0.6,t =3.6342,P ＜ 0.001 ) ],life quality ( 29 ± 8 vs.42 ± 11,P ＜ 0.05 ) and six-minutes walking distance( [ 370.00 ± 14.26 ] m vs.[ 290.00 ± 12.85 ] m,P ＜ 0.05 ) of the azithromycin with tiotropium bromide group were improved significantly when compared with control.Compared with the tiotropium bromide group,the frequency of acute exacerbation ( 2.1 ± 0.6 vs.3.2 ± 0.8,P ＜ 0.05 ),the severity of clinic symptoms (Cough 1.3 ±0.5 vs.1.8 ±0.4,P＜0.05),expectoration( 1.0 ±0.2 vs.1.3 ±0.3,P ＜0.05) and anhelation( 1.5 ±0.8 vs.1.9 ± 0.6,P ＜ 0.05 ) ],life quality ( 29 ± 8 vs.36 ± 10,P ＜ 0.05 ) and six-minutes walking distance ( [ 370.00 ± 14.26 ] m vs.[ 330.00 ± 13.76 ] m,P ＜ 0.05 ) were improved over those of tiotropium bromide group.Conclusion The long-term low-dose azithromycin in combinned with tiotropium bromide is good and safe in treating stable COPD.Therefore,it is worth of further clinical evaluation.

Objective To investigate the significance of optimization of bedside Gram staining of sputum smear in the early diagnosis and antimicrobial treatment for ventilator-associated pneumonia(VAP)patients. Methods The data of patients with VAP undergoing mechanical ventilation over 48 hours in the Department of Critical Care Medicine of Tianjin Fourth Central Hospital from June 2009 to June 2014 were analyzed. The patients were divided into two groups according to whether or not bedside Gram staining of sputum smear was used or not. The sputum samples from lower respiratory tract of all VAP patients were collected daily with tracheal catheter. In empirical examination group(from June 2009 to December 2011,n=43),the patients received antibiotics at the time of onset of VAP, selection of antibiotics depended on the information of bacterial epidemiology of the intensive care unit(ICU),and also existence of high risk factors of multi-drug resistant bacteria. In target treatment group(from January 2012 to June 2014,n=43),the patients received antibiotics according to the results of bedside instant sputum smear examination and empirical antibiotic regime. The correlation between the results of sputum smear examination and culture result was analyzed. The levels of body temperature,white blood cell(WBC)count,procalcitonin(PCT)level,and high sensitivity C-reactive protein(hs-CRP)were measured on the 1st day and 3rd day. The length of antibiotics treatment, duration of mechanical ventilation,and the time of ICU stay were recorded for both groups. Results There were 512 qualified sputum specimens for culture,from which 336 pathogens were found,and 358 strains of pathogenic bacteria were found from microscopic examination of 512 qualified sputum smear. The coincidence rate of results of bedside examination of sputum smear and that of sputum culture was 78.32%(401/512). The diagnostic acumen of the former was 85.42%(287/336),specificity was 64.77%(114/176),positive predictive value was 80.17%(287/358),and negative predictive value was 74.03%(114/154). On the 1st day,no statistical differences in infection index between the two groups could be found,but on the 3rd day,the results were significantly improved in both groups. Compared with the empirical treatment group,the body temperature,WBC,PCT and hs-CRP in the target treatment group were significantly lower〔body temperature(℃):36.83±0.69 vs. 37.64±0.71,WBC(×109/L):7.91±2.75 vs. 9.66±3.39,PCT(μg/L):7.14±3.89 vs. 10.14±4.32,hs-CRP(mg/L):12.24±6.28 vs. 15.54±5.94,P<0.05 or P<0.01〕. Compared with the empirical treatment group,the time of antibiotics use(days:6.00±2.55 vs. 9.20±3.46), the duration of mechanical ventilation(days:5.00±1.73 vs. 7.00±1.94),and the length of ICU stay(days:7.43±1.72 vs. 12.57±4.16)were significantly shortened(P<0.05 or P<0.01). Conclusions The results of bedside sputum examination and sputum culture showed a good correlation,and the former is helpful in early diagnosis and treatment of VAP. The result of high quality sputum smear in significant in guiding the first choice of antibiotics,reduce the time of antibiotic use,shorten the duration of mechanical ventilation and the length of ICU stay,and improve the outcome of the patients.

Animals ; Carbon Radioisotopes ; Diabetes Mellitus, Experimental ; genetics ; metabolism ; Diabetes Mellitus, Type 1 ; genetics ; metabolism ; Gene Expression Regulation ; Glucose ; administration & dosage ; metabolism ; Lipid Metabolism ; Liver ; metabolism ; Male ; Mice ; Mice, Inbred C57BL ; Transcriptome

To establish an EDTA complexation extraction pretreatment combining with GFAAS method for the determination of residual aluminium ion in Huoxiang zhengqi pellets without digestive treatment, systematical investigation was made on sample preparation, and EDTA was used for the complexation extraction of residual aluminium ion in samples. The pH, concentration and volume of extraction solution, the temperature and time of microwave extraction, and graphite furnace temperature program were investigated. The results were compared with the microwave digestion. It was showed that, 0.1 g of sample weight was added in 20 mL 0.05 mol x L(-1) EDTA solution (pH 3.5), followed by heating at 150 degrees C for 10 min in the microwave extraction device. The determination of GFAAS was performed at optimized detection wavelength (257.4 nm) as well as graphite furnace temperature program, the detection limits and quantification limits were 2.37 μg x L(-1) and 7.89 μg x L(-1), respectively. The precision (RSD) was less than 2.3%. The average recovery was 96.9% -101%. The present method is easy, rapid and accurate for the determination of residual aluminium ion in Huoxiang zhengqi pellets.
Aluminum ; chemistry ; isolation & purification ; Drug Contamination ; Drugs, Chinese Herbal ; chemistry ; Edetic Acid ; chemistry ; Graphite ; chemistry ; Spectrophotometry, Atomic ; methods ; Temperature

OBJECTIVETo investigate the distributive path and proliferative rule of marrow mesenchymal stem cells (MSCs) in the rat transplanted via caudal vein from male rat to female rats model of chronic aristolochic acid nephropathy (CAAN).

METHODSCells taken from femoral bone marrow of male Wistar rats were made into single cell suspension, cultured, purified and identified as MSCs. MSCs were transplanted via caudal vein into 50 female Wistar CAAN model rats allocated in the test group, they were killed, 10 rats in a batch, at various time points (6 h, 48 h, 10 d, 30 d and 60 d after transplantation). Besides, 10 rats allocated in the control group were killed on the 30th day after received sham-transplantation. Kidney tissue of all rats was taken for detecting cells originated from the donors by fluorescence in situ hybridization test with FAM-labeled sex determining region of Y chromosome (SRY FISH) probe, and their number in SRY was counted using SRY PCR.

RESULTSMSCs were mainly distributed in the glomerular capillaries at the time points of 6 h and 48 h, but the number of MSCs in glomerular capillaries decreased and those in renal mesenchyma increased at the time points from 10 d to 60 d gradually, then tended to a steady state, meanwhile it showed a stable increasing trend in renal tubule. Cell colony of MSCs could be found in mesenchyma with a slowed down increasing between 30 d to 60 d, but the increasing in tubule was still steady.

CONCLUSIONMSCs originated from the donor can enter the kidney of acceptor and distribute from blood capillary to renal mesenchyma and tubule, and they can long time inhabit there and make propagation.

Animals ; Aristolochic Acids ; toxicity ; Bone Marrow Cells ; cytology ; Cell Proliferation ; Female ; Kidney ; pathology ; Kidney Diseases ; chemically induced ; pathology ; Male ; Mesenchymal Stromal Cells ; cytology ; Rats ; Rats, Wistar

BACKGROUNDThe auditory brainstem implants (ABIs) have been used to treat deafness for patients with neurofibromatosis Type 2 and nontumor patients. The lack of an appropriate animal model has limited the study of improving hearing rehabilitation by the device. This study aimed to establish an animal model of ABI in adult rhesus macaque monkey (Macaca mulatta).

METHODSSix adult rhesus macaque monkeys (M. mulatta) were included. Under general anesthesia, a multichannel ABI was implanted into the lateral recess of the fourth ventricle through the modified suboccipital-retrosigmoid (RS) approach. The electrical auditory brainstem response (EABR) waves were tested to ensure the optimal implant site. After the operation, the EABR and computed tomography (CT) were used to test and verify the effectiveness via electrophysiology and anatomy, respectively. The subjects underwent behavioral observation for 6 months, and the postoperative EABR was tested every two weeks from the 1 st month after implant surgery.

RESULTThe implant surgery lasted an average of 5.2 h, and no monkey died or sacrificed. The averaged latencies of peaks I, II and IV were 1.27, 2.34 and 3.98 ms, respectively in the ABR. One-peak EABR wave was elicited in the operation, and one- or two-peak waves were elicited during the postoperative period. The EABR wave latencies appeared to be constant under different stimulus intensities; however, the amplitudes increased as the stimulus increased within a certain scope.

CONCLUSIONSIt is feasible and safe to implant ABIs in rhesus macaque monkeys (M. mulatta) through a modified suboccipital RS approach, and EABR and CT are valid tools for animal model establishment. In addition, this model should be an appropriate animal model for the electrophysiological and behavioral study of rhesus macaque monkey with ABI.

Animals ; Auditory Brain Stem Implants ; Deafness ; surgery ; Evoked Potentials, Auditory, Brain Stem ; physiology ; Female ; Macaca mulatta ; Male

OBJECTIVETo evaluate the efficacy and safety of drug-coated balloon (DCB) angioplasty versus uncoated balloon (UCB) angioplasty in treatment of lower extremity arterial occlusive disease (LEAOD).

METHODSRandomized controlled trial comparing DCB and UCB angioplasty for treatment of LEAOD were searched in online databases. Literature screening and quality assessment was carried out according to the established inclusion criteria and exclusion criteria. Restenosis rate at 6 months after surgery, late lumen loss, target lesion revascularization rate, patency rate, mortality rate, and amputation rate at 1 year after operation were compared between DCB group and UCB group using RevMan 5.3 software.

RESULTSEleven trials involving a total of 1853 patients with 2150 lesions were included, with 1110 patients (1288 lesions) in DCB group and 743 patients (862 lesions ) in UCB group. Meta-analysis showed that the restenosis rate at 6 months after the operation (15.2% vs 39.0%; OR: 0.28; 95%CI: 0.17 to 0.48; P<0.00001), late lumen loss (range -0.05 to 0.56 vs 0.54 to 1.7; WMD: -0.57; 95%CI: -0.93 to -0.21), and target lesion revascularization rate at 1 year after operation (13.0% vs 28.1%; OR: 0.39; 95%CI: 0.23 to 0.64; P=0.0002) were significantly lower in DCB group than in UCB group. The patency rate at 1 year after the operation was significantly higher in DCB group than in UCB group (71.8% vs 52.9%; OR: 2.32; 95%CI: 1.21 to 4.43; P=0.001). The mortality rate (4.8% vs 5.0%; OR: 1.00; 95%CI: 0.62 to 1.63; P=0.99) and amputation rate at 1 year after the operation (3.4% vs 2.9%; OR:1.41; 95%CI: 0.74 to 2.70; P=0.30) did not differ significantly between DCB and UCB group.

CONCLUSIONDCB angioplasty is more effective than UCB angioplasty in endovascular treatment of LEAOD with similar treatment safety.

BACKGROUND:An orthodontist can gain all comprehensive data about the tooth and jaw based on a model measurement.With the development of CAD/CAM,a three-dimensional (3D) digital model shows more accurate information than a traditional model.OBJECTIVE:To explore the characteristics of dental arch and basal bone in permanent dentition Angle Class Ⅱ malocclusion based on 3D digital models.METHODS:Thirty cases of normal occlusionin permanent dentition were selected as control group,and 30 cases of Angel Ⅱ1 and 30 cases of Angel Ⅱ2 malocclusion were enrolled,respectively.Three kinds of 3D digital models were established using a 3shape R700 scanner and measured with Orthoanalyzer 2013.The data of individual normal occlusion and Angel Ⅱ1 and Angel Ⅱ2 data were analyzed statistically with SPSS 19.0 software respectively.Intergroup comparison was analyzed by the least significant difference test method.RESULTS AND CONCLUSION:Maxillary and mandibular dental arch length and maxillary dental arch width of front section (3-3) and middle section (4-4)/maxillary basal bone length and mandibular basal bone width of middle section (4-4):Ⅱ2 ＞ normal occlusion ＞ Ⅱ1 (P ＜ 0.05).Mandibular dental arch front width of section (3-3)/maxillary and mandibular basal bone length:normal occlusion ＞ Ⅱ1＞ Ⅱ2 (P ＜ 0.05).Maxillary dental arch width of behind section (6-6)/maxillary basal bone width of front section (3-3) and middle section (4-4)/mandibular basal bone width of front section (3-3):normal occlusion ＞ Ⅱ2 ＞ Ⅱ1 (P ＜ 0.05).The angle of tooth long axis and plane:there was significant difference in the Angel Ⅱ1,Ⅱ2 and normal occlusion (P ＜ 0.05).Maxillary posterior-teeth area (coronary):Ⅱ1 ＞ Ⅱ2 ＞ normal occlusion (P ＜ 0.05).Mandibular posterior-teeth area (coronary):Ⅱ2 ＞ normal occlusion ＞ Ⅱ1 (P＜ 0.05).The dental arch of Angel Ⅱ1 was narrow and long in shpape,and the dental arch of Angel Ⅱ2 was wide and short in shape.Sagittal discordant existed in the anterior of Angel Ⅱ1,such as lip-side incline of maxilla and mandible.Coronal discordant existed in the median and posteior of Angel Ⅱ1,such as palatine-side incline of the maxillary dental arch,and buccal-side incline of the mandible.Sagittal discordant existed in the anterior of Angel Ⅱ2,e.g.lingual-side incline of the maxilla and mandible.No discordant existed in the posterior section of Angel Ⅱ2.

BACKGROUND: In the past few years, many studies have shown that mesenchymal stem cells play roles in tissue repair and regeneration, which is to a large extent by their paracrine effect. As one of the important paracrine factors, exosomes have become an issue of concern for researchers. OBJECTIVE: To explain the components, sources and biological characteristics of exosomes, to summarize the latest research advances of mesenchymal stem cells derived exosomes in tissue repair and regeneration, and to make prospects of its application in the field of oral medicine. METHODS: A computer-based search of the relevant literature in CNKI and PubMed full-text databases of journals from 1983 to 2017 was performed. The keywords were "exosome, MSC-exosomes, tissue repair and regeneration, oral diseases" in Chinese and English, respectively. Totally 61 eligible articles were included in the result analysis. RESULTS AND CONCLUSION: Exosome is a vesicle secreted by cells and contains different proteins and RNAs. It plays an important role in the intercellular communication, and has the functions of inhibiting apoptosis, stimulating proliferation and regulating immunity. Mesenchymal stem cells derived exosomes play an important role in repairing bone injury, skin injury, nerve injury and liver injury, but its mechanism is yet unclear. The application of exosomes in the field of oral medicine is rarely reported, which is certainly worthy of further research and exploration.

Acute respiratory and circulatory disorders are the most common critical syndromes, the essence of which is damage to the organs/systems of the heart and lungs. These comprise the essential manifestation of disease and injury progression to the severe stage. Its development involves the following components: individual specificity, primary disease strike, dysregulation of the host′s response, and systemic disorders. Admission for acute respiratory and circulatory disorders is a clinical challenge. Based on a previously proposed flow, a critical care ultrasound-based stepwise approach (PIEPEAR) as a standard procedure to manage patients with acute cardiorespiratory compromise and practical experience in recent years, a modified seven-step analysis and treatment process has been developed to help guide clinicians with rational thinking and standardized treatment when faced with acute respiratory and circulatory disorders. The process consists of seven steps: problem-based clinical analysis, intentional information acquisition, evaluation of core disorder based on critical care ultrasound, pathophysiology and host response phenotype identification, etiology diagnosis, act treatment through pathophysiology-host response and etiology, and re-check. The modified seven-step approach is guided by a “modular analysis” style of thinking and visual monitoring. This approach can strengthen the identification of clinical problems and facilitate a three-in-one analysis. It focuses on pathophysiological disorders, body reactions, and primary causes to more accurately understand the condition′s key points, and make treatment more straight forward, to finally achieve the aim of “comprehensive cognition and refined treatment”.