OBJECTIVE:To observe therapeutic efficacy and safety of Albumin tannate and barm powder in the treatment of infantile acute diarrhea. METHODS:81 cases of infantile acute diarrhea were selected and randomly divided into treatment(41 cas-es)and control group(40 cases). Both groups received routine treatment;treatment group was additionally given Albumin tannate and barm powder orally;control group was additionally given Montmorillonite powder. Clinical efficacy,the taste of drugs and ADR were observed in 2 groups after treatment. RESULTS:There was no statistical significance in total effective rate(97.56%)of treatment group and that (100%) of control group (P>0.05). After treatment,defecation times and urine volume score of treat-ment group were higher than those of control group,with statistical significance(P<0.05). The taste score of Albumin tannate and barm powder(2.93±0.35)in treatment group was significantly higher than(1.25±0.44)in control group,with statistical signifi-cance(P<0.05). No obvious ADR was found in 2 groups. CONCLUSIONS:Albumin tannate and barm powder and Montmorillon-ite powder have good clinical efficacy and safety in the treatment of infantile acute diarrhea. Albumin tannate and barm powder is better than Montmorillonite powder in improving children’s appetite and relieving abdominal pain. Albumin tannate and barm pow-der tastes better when taking,gain a better adherence in the children patients.

Objective To investigate the effect of different additional filtration thickness of DSA on image quality and radiation dose with cerebral angiography. Methods Prospective collected 90 patients with DSA examination of the whole cerebral artery, patients were divided into A, B and C group according to the time of the examination, each group included 30 cases. Patients underwent conventional DSA, the additional filtration of group A, B and C were (1.0 mmAl+0.1 mmCu), (1.0 mmAl+0.4 mmCu) and (1.0 mmAl+0.9 mmCu), respectively. Dose area product (DAP), air kerma (AK), tube current and tube voltage of anteroposterior and lateral radiography of the whole brain were recorded, and scored the image quality. Eye lens organ dose values were obtained by using simulation phantom and LiF dosemeter under A, B and C groups with three different additional filtrations for cerebral angiography. The image quality scores and the radiation dosewere analyzed by one-way ANOVA tests or Kruskal-Wallis tests. Results The image quality comprehensive score of three groups showed significant difference (F=40.07,P<0. 01), which were (3.8±0.4), (3.6 ± 0.5) and (3.0 ± 0.6), respectively. The DAP and AK value of anteroposterior and lateral radiography of three groups also showed significant difference (P<0.05), B and C group were lower than the A group. Left and right eye lens organ dose were decreased along with the increase of the additional filtration thickness, and the difference between the 3 groups also had significant difference (P<0.01). Conclusion Both the image quality and radiation dose can acquire when conducted the whole brain DSA with 1.0 mmAl+0.4 mmCu additional filtration.

Objective To investigate the diagnostic criteria for HBV-related acute-on-chronic pre-liver failure (pre-ACLF) which can effectively predict the risk of liver failure.Methods A total of 1279 patients with severe icteric chronic hepatitis B (CHB) and/or severe acute exacerbation of CHB were enrolled.The influence of serum levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),and total bilirubin (TBil),international normalized ratio (INR) of prothrombin time,sex,and age on the incidence rate of acute-on-chronic liver failure (ACLF) was analyzed,the diagnostic criteria for pre-ACLF and predictive model for ACLF were developed.The chi-square test was used for comparison of categorical variables,and the independent samples t-test was used for continuous data;multivariate logistic regression analysis was performed to evaluate the risk of liver failure.Results The baseline serum levels ofALT,AST,and TBil,and INR were independent risk factors for liver failure (P ＜ 0.05).The diagnostic criteria for pre-ACLF were as follows:(1) INR ≥ 1.30;(2) AST ≥ 10×upper limit of normal (ULN) and obvious jaundice (TBil ≥ 51.3 μmol/L),or TBil ≥ 342.0 μmol/L.These criteria had a positive predictive value of 45.9％,a negative predictive value of 89.8％,a sensitivity of 69.1％,and a specificity of 76.9％.The predictive model for the risk of ACLF was PY =1=eX/(1+ex) (PY represented positive results of logistic regression analysis),X =-10.245+0.026×AST(ULN)-0.025×AST(ULN)+0.046×TBil(mg/d1) + 4.642×INR+0.049×age(years).The patients with higher PY values tended to have a higher incidence rate of ACLE The incidence rate of ACLF was 75.3％ in patients with PY ≥ 0.60,more than 50％ in patients with a PY value of 0.40-0.59,and 1.8％ in patients with PY ＜ 0.10 (P ＜ 0.01).Conclusion The diagnostic criteria for pre-ACLF and predictive model can effectively evaluate the risk of HBV-related ACLF.

Objective:To explore the effects of rhubarb enema combined with intra-abdominal pressure (IAP) monitoring in enteral nutrition (EN) therapy among critical patients.Methods:From August 2017 to August 2018, this study selected 68 EN patients of ICU at a Class Ⅲ Grade A hospital in Hangzhou as subjects by convenience sampling. All of patients were randomly divided into experimental group and control group, 34 cases in each group. Control group carried out the EN treatment guided by IAP monitoring. On the basis, experimental group combined the rhubarb enema for 5 days. This study compared the score of Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, IAP, incidence of feeding intolerance (FI) and feeding volume reaching the standard of patients between two groups.Results:After intervention, the score of APACHE Ⅱ of patients in experimental group was lower than that in control group with no statistical difference ( P>0.05) . The IAP of patients in experimental group was lower than that in control group with a statistical difference ( P<0.01) . The time of feeding volume reaching the standard of patients in experimental group was shorter than that in control group with a statistical difference ( P<0.01) . The incidence of FI of experimental group was lower than that in control group with a statistical difference ( P<0.05) . Conclusions:Rhubarb enema combined with IAP monitoring can reduce the IAP of critical patients, shorten the time of feeding volume reaching the standard and reduce the incidence of FI.

Objective:To investigate whether anisodamine can regulate the ratio of helper T helper cells/regulatory T cells (Th17/Treg) and its protective effect on animals after resuscitation.Methods:Twenty-four Beijing white minipigs were randomly divided into sham operation group (Sham group), resuscitation and normal saline group (SA group), and resuscitation and anisodamine hydrobromide group (AH group), with 8 pigs in each group. In SA group and AH group, ventricular fibrillation was induced by continuous stimulation with intraventricular electrodes for 8 minutes and then resuscitated to establish ischemia/reperfusion (I/R) model. In SA group, after cardiopulmonary resuscitation (CPR), only normal saline was intravenously infused, while in AH group, normal saline and anisodamine hydrobromide were given intravenously at the same time point. Hemodynamic indexes, arterial blood gas analysis indexes, interleukins (IL-17, IL-10) levels in venous blood and IL-17/IL-10 ratio were recorded at 6 different time points: baseline, immediately after return of spontaneous circulation (ROSC), 1 hour, 2 hours, 4 hours and 6 hours after ROSC. The animals were sacrificed at 6 hours after ROSC, and intestinal lymphatic tissues were taken to observe pathological changes under light microscope. At the same time, the levels of IL-17 and IL-10 in intestinal lymphatic tissue were measured (the ratio of IL-17/IL-10 represents the ratio of Th17/Treg cytokines) to evaluate the immune status of the resuscitated animals. The bacterial translocations of different groups were evaluated by culturing intestinal lymphoid tissue.Results:With the extension of ROSC time, the levels of IL-17 in venous blood and the IL-17/IL-10 ratio in pig blood samples continued to decrease, while the levels of IL-10 continued to increase. From 2 hours after ROSC, the IL-17/IL-10 ratio in AH group was significantly higher than that in SA group continued until at 6 hours after ROSC (0.79±0.05 vs. 0.49±0.08, P < 0.05). Light microscopy showed that the number and size of lymph nodules in the cortex of intestinal lymphatic tissue were less in AH group, compared with SA group. Compared with Sham group, the levels of IL-17 and IL-17/IL-10 ratio also decreased in intestinal lymphatic tissue at 6 hours after ROSC [IL-17 (ng/L): 155.23±0.92, 178.76±7.25 vs. 209.21±19.82, IL-17/IL-10 ratio: 1.43±0.13, 1.92±0.18 vs. 3.30±0.31, all P < 0.05], and IL-10 increased significantly (ng/L: 109.85±11.60, 93.55±81.83 vs. 63.45±0.62, all P < 0.05); IL-17/IL-10 ratio in AH group was significantly higher than that in SA group (1.92±0.18 vs. 1.43±0.13, P < 0.05). Tissue culture indicated the intestinal bacterial translocation after resuscitation, suggesting that the animals had immunosuppression and the increased risk of intestinal secondary infection after resuscitation. Compared with SA group, the risk of bacterial translocation was lower than that in AH group [62.5% (5/8) vs. 87.5% (7/8), P < 0.05]. Conclusions:Anisodamine plays an immunomodulatory role by affecting the balance of Th17/Treg cytokines in resuscitated animals, so as to reduce the risk of intestinal secondary infection and has an organ protective effect.

Objective:To evaluate the diagnostic efficacy and practicality of the Jaundice color card (JCard) as a screening tool for neonatal jaundice.Methods:Following the standards for reporting of diagnostic accuracy studies (STARD) statement, a multicenter prospective study was conducted in 9 hospitals in China from October 2019 to September 2021. A total of 845 newborns who were admitted to the hospital or outpatient department for liver function testing due to their own diseases. The inclusion criteria were a gestational age of ≥35 weeks, a birth weight of ≥2 000 g, and an age of ≤28 days. The neonate′s parents used the JCard to measure jaundice at the neonate′s cheek. Within 2 hours of the JCard measurement, transcutaneous bilirubin (TcB) was measured with a JH20-1B device and total serum bilirubin (TSB) was detected. The Pearson′s correlation analysis, Bland-Altman plots and the receiver operating characteristic (ROC) curve were used for statistic analysis.Results:Out of the 854 newborns, 445 were male and 409 were female; 46 were born at 35-36 weeks of gestational age and 808 were born at ≥37 weeks of gestational age. Additionally, 432 cases were aged 0-3 days, 236 cases were aged 4-7 days, and 186 cases were aged 8-28 days. The TSB level was (227.4±89.6) μmol/L, with a range of 23.7-717.0 μmol/L. The JCard level was (221.4±77.0) μmol/L and the TcB level was (252.5±76.0) μmol/L. Both the JCard and TcB values showed good correlation ( r=0.77 and 0.80, respectively) and agreements (96.0% (820/854) and 95.2% (813/854) of samples fell within the 95% limits of agreement, respectively) with TSB. The JCard value of 12 had a sensitivity of 0.93 and specificity of 0.75 for identifying a TSB ≥205.2?μmol/L, and a sensitivity of 1.00 and specificity of 0.35 for identifying a TSB ≥342.0?μmol/L. The TcB value of 205.2?μmol/L had a sensitivity of 0.97 and specificity of 0.60 for identifying TSB levels of 205.2 μmol/L, and a sensitivity of 1.00 and specificity of 0.26 for identifying TSB levels of 342.0 μmol/L. The areas under the ROC curve (AUC) of JCard for identifying TSB levels of 153.9, 205.2, 256.5, and 342.0 μmol/L were 0.96, 0.92, 0.83, and 0.83, respectively. The AUC of TcB were 0.94, 0.91, 0.86, and 0.87, respectively. There were both no significant differences between the AUC of JCard and TcB in identifying TSB levels of 153.9 and 205.2 μmol/L (both P>0.05). However, the AUC of JCard were both lower than those of TcB in identifying TSB levels of 256.5 and 342.0 μmol/L (both P<0.05). Conclusions:JCard can be used to classify different levels of bilirubin, but its diagnostic efficacy decreases with increasing bilirubin levels. When TSB level are ≤205.2 μmol/L, its diagnostic efficacy is equivalent to that of the JH20-1B. To prevent the misdiagnosis of severe jaundice, it is recommended that parents use a low JCard score, such as 12, to identify severe hyperbilirubinemia (TSB ≥342.0 μmol/L).