Objective To discuss the clinical characteristics of elderly patients with acute pulmonary embolism in common circumstance of primary hospital in order to improve the quality of diagnosis and treatment of such patients.Methods Retrospective analysis was made on case records of acute pulmonary embolism patients older than 60 years.Results Among 41 cases of acute pulmonary embolism,21 cases (51.2％) have co-exiting lower extremity deep vein thrombosis (DVT).The risk factors of pulmonary embolism include:hypertension (23 cases,51.2％) ;malignant tumor (12 cases,21.3％) ;operation with time of anesthesia longer than 30 minutes (11 cases,26.8％) ;immobilization (11 cases,26.8％) ;diabetes mellitus (10 cases,24.4％) ;hyperlipidemia (9 cases,22.0％) ;obesity (8 cases,19.5％) ; prolonged atrial fibrillation (6 cases,16.6％).The major symptoms include:dyspnea (36 cases,87.8％) ; cough (11 cases,26.8％) ; chest pain (8 cases,19.5％) ; syncope (6 cases,14.6％) ; palpitation (5 cases,12.2％) ; hemoptysis (5 cases,12.2％) ; agitation (2 cases,4.9％).Common signs include:cyanosis (38 cases,92.7 ％) ; tachypnea (34 cases,82.9％) ; tachycardia (34 cases,82.9 ％) ; asymmetrical swelling of lower extremities (13 cases,31.7 ％) ; hypotension (7 cases,17.1％).Common finding of the patient's blood gas analysis is hypoxemia (39 cases,95.1％) and hypocapnemia (20 cases,48.8％).Common findings of chest X-ray are infiltration of the lungs and small amounts of pleural effusion.15 (36.6％) patients with DVT have both risk factors and typical clinical symptoms.Common findings of EKG were sinus tachycardia.Definite diagnosis of pulmonary embolism was made by CTPA (computed tomography pulmonary angiography) in 22 cases(53.7％).37 (90.2％) patients with PE (pulmonary thrombo-embolism) underwent anticoagulant therapy,4 (9.8％) patients underwent anticoagulant plus thrombolysis.The motility of this group was 19.5％.Conclusion The most common risk factors of elderly PE patients are chronic illness (most commonly COPD,hypertension,hyperlipidemia),malignant tumor,operation and immobilization.No clinical sign and laboratory test have high specificity.CTPA is the main way to make definite diagnosis.Anticoagulant is the primary therapy in elderly patients with PE,which is safe and efficacious.Thrombolysis of large area PE in elderly patients with risk factors of bleeding should be cautious.Excessive thrombolysis should be avoided.

Objective To observe the effect and the influence on PCT,CRP in the treatment of patients with acute exacerbation pulmonary disease by Budesonide and ipratropium bromide.Methods 80 patients with acute exacerbation pulmonary disease were randomly divided into 40 cases of the control group and 40 cases of the observa-tion group,the two groups were given routine treatment,the control group then had been given ipratropium bromide for 7d,and the observation group had been given Budesonide and ipratropium bromide for 7d,the blood gas indicators (PaO2 ,PCO2 ),pulmonary function (FEV1 ,PEF,FEV1 /FVC),dyspnoea and exercise tolerance score,serum PCT levels,serum CRP levels and clinical efficacy were compared,Adverse reactions were recorded.Results (1 )the PaO2 ,FEV1 ,PEF,FEV1 /FVC of the observation group and the control group after treatment were (70.7 ±2.3)mmHg and (62.5 ±3.0)mmHg,(2.15 ±0.63)L and (1.76 ±0.56)L,(3.49 ±0.82)L/s and (3.06 ±0.75)L/s, (68.52 ±6.53)% and (60.14 ±6.03)%,These indicators were significantly higher than those before treatment,all P <0.05,the PCO2 ,PCT,CRP were (51.4 ±1.7)mmHg and (56.6 ±2.3)mmHg,(1.75 ±1.20)μg/L and (2.58 ± 1.17)μg/L,(10.25 ±6.77)mg/L and (19.07 ±5.75)mg/L,These indicators were significantly lower than those before treatment,all P <0.05,the PaO2 ,FEV1 ,PEF,FEV1 /FVC of the observation group were significantly higher than those of the control group,the PCO2 ,PCT,CRP were significantly lower than those of the control group,all P <0.05;(2)The dyspnoea and exercise tolerance score of the observation group and the control group after treatment was significantly lower than those before treatment,the dyspnoea and exercise tolerance score of the observation group was significantly lower than those of the control group;(3)The clinical total effective rate of the observation group was 90%,which was higher than 65% of the control group(χ2 =7.312,P <0.05).Conclusion The method containing Budesonide and ipratropium bromide Inhalation has exact effect,and can effectively improve respiratory function, which is an effective treatment of choice for acute exacerbation of COPD.

Objective To study the effect and mechanism of Shenshaoruangan Decoction on liver fibrosis in rats.Methods Seventy-two male Wistar rats were selected and normally fed for 1 week.Then they divided into the control group(n=12) and model constructing group(n=60).The model constructing group was subcutaneously and intraperitoneally injected by 40％ CCl4 olive oil for constructing fibrosis rat model.After successfully constructing model,which was divided into the model group(equivalent normal saline gavage),positive control group(colchicines 0.154 mg · kg-1 · d-1),low-dose group(2 mL per 100 g body mass,containing Shenshaoruangan Decoction crude drug 0.23 g/mL),medium-dose group(2 mL per 100 g body mass,containing Shenshaoruangan Decoction crude drug 0.46 g/mL) and high-dose group(100 g/2 mL,containing Shenshaoruangan Decoction crude drug 0.69 g/mL),12 cases in each group.The differences of related indicators rat hepatic fibrosis after 8-weeks treatment were observed.Results The control group was the stage 0 standard,the liver fibrosis degree in the positive control group was significantly better than that in the model group(P＜0.05);the liver fibrosis degree in the low-dose group,medium-dose group and high-dose group was gradually alleviated;the liver fibrosis degree in the high-dose group was significantly slighter than that in the model group and-dose group(P＜0.05).The detection values of PC-Ⅲ,LN,Ⅳ-C and HA in the model group were significantly higher than those in the control group(P＜0.05),and the detection values of PC-Ⅲ,LN,Ⅳ-C and HA in the positive control group,lowdose group,medium-dose group and high-dose group were significantly lower than those in the model group(P＜0.05).Serum SOD detection value of the model group was significantly lower than that in the control group(P＜0.05),the serum MDA level in the model group was significantly higher than that in the control group(P＜0.05);serum SOD level in the positive control group,low dose group,medium-dose group and high-dose group was significantly higher than that in the model group(P＜0.05),while serum MDA level in those group was significantly lower than that in the model group(P＜0.05).Conclusion Shenshaoruangan Decoction can effectively alleviate the liver fibrosis degree,and its mechanism is to reduce the levels of liver fibrosis indicators,inhibit the prodmotion of peroxides and alleviate the damage of free radicals on liver cells.

Objective: To observe the effect of vitamin A and iron supplementation on iron status during pregnancy. Methods: 167 pregnant women aged 21～33 years in the second trimester were recruited and randomly allocated to four groups: placebo; vitamin A (1.1 mg/d); iron(60 mg elemental iron); vitamin A and iron, for 10 weeks. Results:The incidences of vitamin A deficiency, anemia and iron depletion were 0.6%,7.8% and 6.2% in the second trimester respectively. Serum VA level was not changed in three supplemented groups but decreased in placebo group. Hemoglobin in all groups before and after supplementation was in normal range, with no significant differences. The improvement in serum ferritin, free erythrocyte proporphyrin and transferrin saturation was better in the group supplemented with VA+Fe than VA or Fe alone. Conclusion: The simultaneous supplementation of vitamin A and iron is better in improvement of iron status than supplementation of vitamin A or iron alone during pregnancy. Improvement of iron status by simultaneous supplementation of pregnant women with vitamin A and iron was better than supplementation with iron or vitamin A alone.

Objective To approch the characteristic of diagnosis and treatment of optic nerve injury in double wall optic canal.Methods Six patients,with double wall optic canal found by CT,were treated by drug,operation and visual rehabilitation training.The results of CT,vision-evoked potential and visual recovery were analysed.Results In 6 patients,4 were holo-double wall optic canal and 2 were mero-double wall optic canal,4 were found having bone fracture.All the 6 cases were effective to treatment including 3 patients whose vision was over 0.1.Conclusion In double wall optic canal,the degree of optic nerve injury is slight,visual recovery is better by drug,operation and visual rehabilitation training.

Objective:To evaluate the prognostic value of pretreatment systemic immune-inflammation index (SII) and lactate dehydrogenase (LDH) in non-metastatic nasopharyngeal carcinoma (NPC).Methods:We retrospectively collected the data of 839 patients with non-metastatic NPC from National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Sun Yat-sen University Cancer Center between January 2007 and October 2015. All patients received intensity modulated radiation based treatment. Optimal cutoff value of SII and LDH were determined by X-title software. The association between SII, LDH and clinical prognosis of non-metastatic NPC patients were analyzed. Kaplan-Meier method was used for survival analysis, and Log rank test was used for comparison of survival rates between groups. Propensity score matching (PSM) analysis was carried out to minimize the effects of confounding factors. The risk stratification model of prognosis by combining N stage, SII and LDH was constructed to compare the prognosis of patients in high risk group, middle risk group and low risk group, and the receiver operating characteristic (ROC) curve analysis was used to evaluate its prognostic value.Results:The optimal cutoff value of SII is 447.2×10 9/L for predicting the 5-year overall survival (OS) of NPC patients, and the best cutoff value of LDH is 198.9 U/L. The proportion of patients with stage T3-4 and stage III-IVB in high SII group was higher than that in low SII group ( P<0.001). Multivariate Cox regression analysis showed that N stage, SII and LDH were independent factors of OS, progression-free survival (PFS) and distant metastasis-free survival (DMFS) of NPC patients (N stage, HR=1.705, 95% CI: 1.247-2.332; HR=1.755, 95% CI: 1.342-2.295; HR=2.161, 95% CI: 1.515-3.082. SII, HR=1.525, 95% CI: 1.097-2.119; HR=1.518, 95% CI: 1.150-2.004; HR=1.837, 95% CI: 1.272-2.653. LDH, HR=2.041, 95% CI: 1.403-2.968; HR=1.725, 95% CI: 1.233-2.414; HR=2.492, 95% CI: 1.690-3.672, respectively). After PSM, SII was still an independent prognostic factor of OS, PFS and DMFS in NPC patients ( HR=1.52, 95% CI: 1.09-2.12; HR=1.52, 95% CI: 1.15-2.00; HR=1.82, 95% CI: 1.26-2.63, respectively). Combined with N 2-3 stage, SII (>447.2×10 9/L), and LDH (>198.9 U/L), patients were divided into high-(3 risk factors), intermediate- (2 risk factors) and low-risk (0-1 risk factors) groups. The 5-year OS rates of patients in low-, intermediate- and high-risk groups were 86.1%, 79.8% and 41.2% respectively, the 5-year PFS rates were 80.7%, 70.2% and 33.9% respectively, and the 5-year DMFS rates were 88.9%, 79.2% and 47.5% respectively. There were significant differences in OS, PFS and DMFS among these three groups ( P<0.001). Distant metastasis was the main failure pattern in low-, intermediate- and high-risk groups, and the highest rate of distant metastasis was 83.3% (15/31) in high-risk group. ROC curve of the risk stratification model for predicting 5-year OS of NPC patients is 0.610, which is higher than TNM stage (0.609), SII (0.574) and LDH (0.558). Conclusions:Pretreatment SII and LDH are significantly correlated with the prognosis of patients with non-metastatic NPC. The combination of SII, LDH and N stage can stratify the prognostic risk of NPC patients. The risk stratification model can enhance the accuracy of prognosis.

Objective:To evaluate the prognostic value of pretreatment systemic immune-inflammation index (SII) and lactate dehydrogenase (LDH) in non-metastatic nasopharyngeal carcinoma (NPC).Methods:We retrospectively collected the data of 839 patients with non-metastatic NPC from National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Sun Yat-sen University Cancer Center between January 2007 and October 2015. All patients received intensity modulated radiation based treatment. Optimal cutoff value of SII and LDH were determined by X-title software. The association between SII, LDH and clinical prognosis of non-metastatic NPC patients were analyzed. Kaplan-Meier method was used for survival analysis, and Log rank test was used for comparison of survival rates between groups. Propensity score matching (PSM) analysis was carried out to minimize the effects of confounding factors. The risk stratification model of prognosis by combining N stage, SII and LDH was constructed to compare the prognosis of patients in high risk group, middle risk group and low risk group, and the receiver operating characteristic (ROC) curve analysis was used to evaluate its prognostic value.Results:The optimal cutoff value of SII is 447.2×10 9/L for predicting the 5-year overall survival (OS) of NPC patients, and the best cutoff value of LDH is 198.9 U/L. The proportion of patients with stage T3-4 and stage III-IVB in high SII group was higher than that in low SII group ( P<0.001). Multivariate Cox regression analysis showed that N stage, SII and LDH were independent factors of OS, progression-free survival (PFS) and distant metastasis-free survival (DMFS) of NPC patients (N stage, HR=1.705, 95% CI: 1.247-2.332; HR=1.755, 95% CI: 1.342-2.295; HR=2.161, 95% CI: 1.515-3.082. SII, HR=1.525, 95% CI: 1.097-2.119; HR=1.518, 95% CI: 1.150-2.004; HR=1.837, 95% CI: 1.272-2.653. LDH, HR=2.041, 95% CI: 1.403-2.968; HR=1.725, 95% CI: 1.233-2.414; HR=2.492, 95% CI: 1.690-3.672, respectively). After PSM, SII was still an independent prognostic factor of OS, PFS and DMFS in NPC patients ( HR=1.52, 95% CI: 1.09-2.12; HR=1.52, 95% CI: 1.15-2.00; HR=1.82, 95% CI: 1.26-2.63, respectively). Combined with N 2-3 stage, SII (>447.2×10 9/L), and LDH (>198.9 U/L), patients were divided into high-(3 risk factors), intermediate- (2 risk factors) and low-risk (0-1 risk factors) groups. The 5-year OS rates of patients in low-, intermediate- and high-risk groups were 86.1%, 79.8% and 41.2% respectively, the 5-year PFS rates were 80.7%, 70.2% and 33.9% respectively, and the 5-year DMFS rates were 88.9%, 79.2% and 47.5% respectively. There were significant differences in OS, PFS and DMFS among these three groups ( P<0.001). Distant metastasis was the main failure pattern in low-, intermediate- and high-risk groups, and the highest rate of distant metastasis was 83.3% (15/31) in high-risk group. ROC curve of the risk stratification model for predicting 5-year OS of NPC patients is 0.610, which is higher than TNM stage (0.609), SII (0.574) and LDH (0.558). Conclusions:Pretreatment SII and LDH are significantly correlated with the prognosis of patients with non-metastatic NPC. The combination of SII, LDH and N stage can stratify the prognostic risk of NPC patients. The risk stratification model can enhance the accuracy of prognosis.

Background Nitrogen dioxide (NO₂), a crucial component of traffic pollutants, has been shown in studies to exert toxic effects on the nervous system. However, there is a limited body of research examining the relationship between NO₂ exposure and neurological disorders in children. Objective To explore the impact of short-term NO₂ exposure on the outpatient visits due to pediatric neurological diseases in Shijiazhuang. Methods From 2013 to 2021, we collected outpatient data related to neurological diseases at the Children's Hospital in Shijiazhuang, Hebei Province. We also collected air pollution data and meteorological data of the same city. The air pollution data included daily average concentrations of inhalable particles (PM₁₀), fine particulate matter (PM_2.5), sulfur dioxide (SO₂), NO₂, carbon monoxide (CO), and daily maximum 8-hour average concentration of ozone (O₃). The meteorological data comprised daily average atmospheric pressure, temperature, relative humidity, wind speed, and sunshine duration. Employing a time-stratified case-crossover design, we used conditional logistic regression models to analyze the association between NO₂ and pediatric outpatient visits for neurological diseases. Stratification analyses were conducted based on gender (male, female) and age groups (0-6 years, 7-14 years). Results The study included a total of 154348 valid pediatric outpatient visits for neurological diseases. The daily average concentration of NO₂ was 49.3 μg·m⁻³ for the study period. The results from the single-pollutant model indicated that NO₂ increased the risk of pediatric neurological outpatient visits, with the highest association observed at lag0. Specifically, for every 10 μg·m⁻³ increase in atmospheric NO₂ exposure, there was a 1.40% increase (95%CI: 1.05%, 1.74%) in pediatric neurological outpatient visits. The stratification analyses revealed that increased atmospheric NO₂ exposure was associated with an elevated risk of neurological outpatient visits for girls (ER=1.54, 95%CI: 1.01, 2.08) and children aged 7-14 years (ER=2.35, 95%CI: 1.68, 3.02). Even after introducing PM_2.5 (ER=1.96, 95%CI: 1.49, 2.43), SO₂ (ER=2.09, 95%CI: 1.62, 2.55), and O₃ (ER=1.40, 95%CI: 1.06, 1.74) to the models, the impact of NO₂ exposure on pediatric neurological outpatient visits remained statistically significant. The results of the multi-pollutant model also indicated a significant association (ER=2.53, 95%CI: 1.97, 3.08). Conclusion The effect of short-term exposure to atmospheric NO₂ on the outpatient visits of children with neurological diseases in Shijiazhuang is acute and independent, especially for children aged 7-14.

Chang-Kang-Fang (CKF) formula, a Traditional Chinese Medicine (TCM) prescription, has been widely used for the treatment of irritable bowel syndrome (IBS). However, its potential material basis and underlying mechanism remain elusive. Therefore, this study employed an integrated approach that combined ultra-performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF-MS) with network pharmacology to systematically characterize the phytochemical components and metabolites of CKF, as well as elucidating its underlying mechanism. Through this comprehensive analysis, a total of 150 components were identified or tentatively characterized within the CKF formula. Notably, six N-acetyldopamine oligomers from CicadaePeriostracum and eight resin glycosides from Cuscutae Semen were characterized in this formula for the first time. Meanwhile, 149 xenobiotics (58 prototypes and 91 metabolites) were detected in plasma, urine, feces, brain, and intestinal contents, and the in vivo metabolic pathways of resin glycosides were elaborated for the first time. Furthermore, network pharmacology and molecular docking analyses revealed that alkaloids, flavonoids, chromones, monoterpenes, N-acetyldopamine dimers, p-hydroxycinnamic acid, and Cus-3/isomer might be responsible for the beneficial effects of CKF in treating IBS, and CASP8, MARK14, PIK3C, PIK3R1, TLR4, and TNF may be its potential targets. These discoveries offer a comprehensive understanding of the potential material basis and clarify the underlying mechanism of the CKF formula in treating IBS, facilitating the broader application of CKF in the field of medicine.
Humans ; Tandem Mass Spectrometry/methods* ; Irritable Bowel Syndrome/drug therapy* ; Molecular Docking Simulation ; Drugs, Chinese Herbal/chemistry* ; Glycosides ; Chromatography, High Pressure Liquid/methods*