ObjectiveTo evaluate whether AN69 ST membrane would prolong filter lifetime in continuous renal replacement therapy (CRRT) without anticoagulation in patients with high risk of bleeding.Methods A single-center, prospective, randomized, double-blind control trial with crossover design was conducted. From March 1st to December 31st in 2013, patients who were admitted to Department of Critical Care Medicine of the Fourth Hospital of Hebei Medical University meeting CRRT treatment indications, but could not receive systemic anticoagulation because of high risk of bleeding were studied. The selected patients were randomly divided into two groups according to a random number table, and four filters consisting of two AN69 ST100 membrane filters (A) and two traditional AN69 M100 membrane filters (B) were used for them. GroupⅠ with the filter order of A-B-A-B, and groupⅡ with the order of B-A-B-A. The clinical data of patients was recorded in detail, and conventional AN69 ST and AN69 membrane filter lifetime, their influence on coagulability, and the incidence of bleeding complications were compared.Results Seventeen patients were enrolled, with 10 in groupⅠ, and 7 in groupⅡ. The basic medical characteristics including gender, age, acute physiology and chronic health evaluationⅡ (APAECHⅡ) score, sequential organ failure score (SOFA), Acute Renal Injury Network (AKIN) stage, activated partial thromboplastin time (APTT), prothrombin time (PT), international normalized ratio (INR), platelet count (PLT), and use of mechanical ventilation were not significantly different between two groups. But the use of vasoactive drug was more frequent in groupⅡcompared with that of groupⅠ[100.0% (7/7) vs. 30.0% (3/10),χ2 = 8.330,P = 0.010]. AN69 ST filter lifetime (n =34) was (15.92±2.10) hours, there was no statistically significant difference compared with that of AN69 membrane (t = 0.088,P = 0.942), filter lifetime of which (n = 34) was (16.12±1.38) hours. It was also found by Kaplan-Meier survival analysis that there was no significant difference between the two membrane filter lifetime (χ2=1.589,P =0.208). Logistic regression analysis showed that the life of the first filter was not correlated with coagulation indicators, including APTT, PT, INR, and PLT [APTT: odds ratio (OR) = 0.977, 95% confidence interval (95%CI) = 0.892-1.071, P = 0.623; PT:OR = 1.001, 95%CI = 0.901-1.109,P = 0.988; INR:OR = 1.078, 95%CI = 0.348-3.340,P = 0.896;PLT:OR = 0.996, 95%CI = 0.974-1.019,P = 0.735]. The application rate of vasoactive drugs, which was different between two groups for basic medical indications showed no effect on filter life time (OR = 2.541, 95%CI = 0.239-26.955,P = 0.439). Reasons of clotting in filters were also analyzed, and it was found that blood coagulation in the filter ranked the top (88.2%), and the other reasons were catheter-related problems, death, and unscheduled transport. No difference in blood coagulation function was found in both groups after treatment for 12 hours, and there was no bleeding complication.ConclusionDuring the CRRT without systemic anticoagulant, both surface-treatment with polyethyleneimine AN69 and AN69 ST membrane cannot prolong filter lifetime.

Objective To explore gene polymorphism of the C/T genotype of rs 16 944 in the promoter of IL-1β gene in male population living in the coastal area of Shandong,and thus to investigate the relationship between the gene polymorphism of IL-1β and gout.Methods A total of 276 gout patients and 268 healthy controls were enrolled.The possible association between the polymorphism of IL-1β-511 C/T and gout in Chinese was investigated and gcnotype frequencies and allelic frequencies were calculated by polymerase chain reaction (PCR) restriction fragment length polymorphism (RFLP) method.Hardy-Weinberg was used to verify the representativeness of the sample.Comparisons between the groups were performed with x2 test and t-test.Results There was no statistically difference in IL-1β-511 C/T genotype frequencies between gout patients and controls(x2=3.251,P=0.197,df=2).The allele frequencies of C and T in gout cases were not different from those in the controls (x2=2.941,P=0.086,OR=1.232,95％CI:0.971-1.563).Moreover,no association between IL-1β-511C/T genotypes and risk factors for gout were observed in gout cases by x2 test.Conclusion Results of the present study suggest that the C/T genotype of rs 16944 in the promoter of IL-1β gene is not associated with gout in male population living in the coastal area of Shandong.

Objectives To evaluate the count of endothelial progenitor cells (EPCs) in peripheral blood (PB) and bone marrow (BM) of acute leukemia (AL) patients and explore its clinical significance.Methods EPCs were detected by flow cytometry procedures in 43 AL patients and in 10 benign hematologic patients as control group.Results The absolute counts of EPCs in AL patients before the treatment [(119.46± 72.23)/μl in BM and (13.69±8.26)/pl in PB] were significantly higher than those in control group [(23.21 ± 12.59)/pl in BM and (1.86±1.18)/μl in PB] (P ＜ 0.01).The absolute counts of EPCs were significandy higher in BM than those in BP in AL patients before the treatment (P ＜ 0.001).After the treatment, the absolute counts of EPCs in no remission (NR) group [(110.02±67.28)/μl in BM and (10.04±9.51)/μ1 in PB] were significantly higher than those in control group (P ＜ 0.05), while the counts of EPCs in complete remission (CR) group were no significant difference compared with those in control group (P ＞ 0.05).After the treatment ,the absolute counts of EPCs both in BM and in BP of CR group [(26.32±17.44)/μl and (2.54±2.12)/μl, respectively] were significantly lower than those before treatment [(113.18±69.22)/μl and (14.45±10.76)/μl, respectively] (P ＜ 0.05), however those of NR group were no significant difference than before (P ＞ 0.05).The absolute counts of EPCs whether in PB or in BM were no significant difference between acute myeloid leukemia (AML) and acute lymphoid leukemia (ALL) (P ＞ 0.05).The absolute counts of EPCs in PB of AL had a positive correlation with β2-MG and LDH (P ＜ 0.05).Conclusions EPC levels are significantly increased in BM and BP of AL patients and may correlate with disease status, response to treatment and prognosis.

Objective To investigate the effect of morphine combined with noninvasive positive pressure ventilation in the treatment of patients with acute left heart failure .Methods 80 patients with acute left heart failure were enrolled ,and they were randomly divided into two groups according to the digital table method ,40 cases in each group.The patients in the control group were treated with noninvasive positive pressure mechanical ventilation .The patients in the observation group were treated with morphine sedation on the basis of the treatment of the control gorup.The vital signs test indicators,disease-related parameters,clinical events,cognitive function and quality of life were compared between the the two groups .Results The systolic blood pressure,heart rate,respiratory rate,PaCO2 and myocardial oxygen consumption in the observation group were significantly lower than those in the control group at 30min after treatment,PaO2 and pH in the observation group were significantly higher than those in the control group , the APACHEⅡ,BNP,Hs-cTnl and CK levels in the observation group at 24 h after treatment were significantly lower than those in the control group,the differences were statistically significant (t =8.349,13.127,7.413,17.072, 15.334,2.631,3.088,12.371,8.061,4.784,18.931,6.568,9.464,all P<0.01).The rate of tracheal intubation of the observation group was significantly lower than that of the control group (0.0％vs.20.0％),the rate of withdrawal of the observation group was significantly higher than that of the control group (85.0％ vs.50.0％),the differences were statistically significant (χ2 =6.806,11.168,all P<0.01).The MLHFQ score of the observation group 3 months after treatment was significantly lower than that in the control group [( 24.69 ±5.38)points vs.( 38.24 ± 8.03)points],the difference was statistically significant (t=8.866,P<0.01).There was no statistically significant difference in MoCA score after treatment between the two groups [(24.80 ±2.93)points vs.(25.07 ±2.33)points, t=0.456,P>0.05].Conclusion Morphine has significant influence on the effect of noninvasive positive pressure mechanical ventilation in patients with acute left heart failure .

Objective:To explore the application of "upgraded single-entry colonoscope training method" in the primary endoscopic training of refresher doctors.Methods:A total of 71 refresher doctors who participated in the primary single endoscopy training in the Endoscopy Center of the Affiliated Hospital of Qingdao University from January 2017 to December 2019 were randomized to two groups: upgraded single-entry endoscopy training group ( n=36) and traditional single-entry endoscopy training group ( n=35). In the first week of training, all the participants learned the basic theory of single-entry enteroscopy insertion. From week 2 to week 11, each doctors of the two groups finally completed 80 to 100 cases of single-entry endoscopy. The upgraded single-entry colonoscopy training group was divided into two stages: "rectum-proximal sigmoid colon" and "descending colon-ileocecal part" with the boundary of descending-sigmoid colon as the dividing point, which was different from the traditional group. At the 12th week, each doctors were assessed by 20 cases of single-entry colonoscopy operation. the success rate of ileocecum insertion, the time to pass through sigmoid colon, the rate of loop formation and the average operation time of successful ileocecum insertion were compared between the two groups. SPSS 26.0 was used for t test or chi-square test. Results:Compared with the traditional single-entry endoscopy training group, the upgraded single-entry endoscopy training group achieved better results in the successful rate of ileocecal insertion (66.8% vs. 59.0%, P=0.005), the time to pass sigmoid colon [(6.05±3.32) min vs. (7.15±3.12) min, P<0.001], the loop rate (35.13% vs. 40.71%, P=0.035), the average operation time of successfully inserting the ileocecal part [(9.01±2.12) min vs. (10.25±3.12) min, P<0.001] and the discomfort response score [(5.19±1.41) vs. (6.70±2.15), P<0.001], with statistical significance between the groups. Conclusion:"Upgraded single-entry endoscopy training method" emphasizes no loop through sigmoid colon, which is more helpful for refresher doctors to master the operation skills of single-entry colonoscopy, shorten the teaching time, and reduce the discomfort of patients, and is suitable for popularization in the teaching.