Objective To observe influence of auxiliary treatment of bronchoscopy alveolar lavage on respira-tory mechanics index and infection control effect in patients with severe ventilator associated pneumonia(VAP). Methods 84 cases of severe VAP patients were randomly divided into the observation group (n =42 cases)and con-trol group (n =42 cases),control group was given antibiotics and conventional sputum suction lavage treatment,the observation group was given bronchoscopy alveolar lavage and antibiotics.Clinical pulmonary infection score (CPIS) and serum calcitonin level (PTC)were recorded in the two groups before and after treatment.Respiratory mechanics indexes such as the dynamic compliance (Cdyn),the airway peak pressure (PIP),work of breathing (WOB)and airway resistance (Raw)were measured in the two groups before and after bronchoscopy alveolar lavage,and the clin-ical efficacy of two groups were compared.Results CPIS of the observation group (6.37 ±1.31),(5.42 ±1.13), (3.52 ±0.53)was significantly lower than that of the control group (7.72 ±1.56),(7.14 ±1.33),(5.13 ± 0.94)(t =4.295,6.387,5.821,all P <0.05 )after 3,5,7d treatment.PTC of the observation group ((4.71 ± 0.85)μg/L,(2.65 ±0.61 )μg/L,(0.62 ±0.23)μg/L)were significantly lower than those of the control group (5.10 ±0.92)μg/L,(3.96 ±0.72)μg/L,(1.31 ±0.43)μg/L(t =4.295,6.387,5.821,all P <0.05)after 3,5, 7d treatment.Cdyn of the observation group after 1 and 4h bronchoscopy alveolar lavage (35.39 ±6.39),(35.59 ±5.83)were high those of the control group (26.82 ±4.63),(25.64 ±4.28)(t =7.038,-10.462,all P <0.05);WOB (10.08 ±0.45),(8.10 ±0.38),PIP(21.28 ±2.76),(15.29 ±1.67)and Raw (10.08 ±0.45),(8.10 ± 0.38)in the observation group after 1and 4h bronchoscopy alveolar lavage were lower those in the control group WOB (0.63 ±0.17),(0.49 ±0.12),Raw(13.49 ±0.50),(11.42 ±0.42),PIP(27.38 ±3.10),(23.44 ±2.60)(1h:t =9.681,3.937,32.853,all P <0.05;4h:t =12.231,6.064,6.313,all P <0.05).Total effective rate of the obser-vation group was obviously higher than that of the control group after treatment (93.3% vs.77.8%,chi -square =5.486,P <0.05).Conclusion Auxiliary treatment of bronchoscopy alveolar lavage has clinical curative effect in patients with severe VAP,the method can effectively decreased PTC level of VAP patients,to acquire lung infection control,and improve the respiratory mechanics parameters.

Objective To study antidepressant effects of Epimedium brevicornum extracts.Methods(Behavioral) despair models of male mice,tails suspension test(TST),and forced swimming test(FST) were used to evaluate the effects of E.brevicornum extracts on behavioral,monoamine oxidas(MAOA) and monoamine oxidase B(MAO-B) activities in brain and liver tissue,and MDA level in liver tissue of mouse.Reserpine antagonistic model was also used to investigate possible antidepressant mechanisms of E.brevicornum extracts.Results The extracts of E.brevicornum(25,50, 100,and 200 mg/kg) significantly reduced the duration of murine immobility in TST and FST,inhibited MAO-A and MAO-B activities in brain and liver of mice,and reversed the elevated liver MDA level in mice in TST.There was no significant amelioration in the decreases of body temperature in mice of Reserpine antagonistic model.Conclusion(E.brevicornum) extracts possesses the definite antidepressant properties.

Objective To investigate changes in the intraocular pressure(IOP) and anterior chamber angle in patients with chronic renal failure before and after hemodialysis. Methods Fifty?eight patients(116 eyes) with chronic renal failure were measured with Goldmann applanation tonometer and anterior segment optical coherence tomograph. The patients were divided into three groups based on gonioscopy results:the narrow angle group(22 eyes),the Iris neovascular group(3 eyes)and the open angle group(91 eyes). IOP was measured by Goldmann applanation tonometer in patients in the three groups before and after hemodialysis. Anterior chamber angle opening distance (AOD) was detected by anterior segment optical coherence tomograph before and after hemodialysis. The blood urea nitrogen,creatinine,albumin were also determined before and after hemodialysis. All changes in the parameters were analyzed with a paired t test. Results The IOP in narrow angle eyes and in neovascular eyes increased significantly after hemodialysis ,while the IOP in open angle eyes showed no significant changes. The AOD decreased significantly after hemodialysis. The blood urea nitrogen and creatinine decreased significantly in 58 patients,while albumin increased after hemodialysis. Conclusion The IOP in narrow angle eyes and in neovascular eyes increased after hemodialysis ,correlating with the resistance increase of aqueous outflow pathway and the change of plasma osmotic pressure. As a result ,it is recommended that the condition of eye of patients with chronic renal failure should be checked ,and patients should receive appropriate controlling measure or treatment before hemodialysis.

AIM: To investigate the expression of the nephrin in podocyte of the diabetic nephropathy(DN) rats and the mechanism of irbesartan-induced renal protection.METHODS: The DN model was established by a single injection of streptozotocin(STZ),and DN rats were randomly divided into 2 groups: model group and irbesartan treatment group.In addition,the normal rats served as a normal control group. All the rats were received daily gavage respectively for 8 weeks. The urinary protein quality in 24 hours,body weight(BW),kidney weight (KW),KW/BW,glucemia,urea nitrogen,creatinine,total cholesterol, triacylglycerol were detected with correlative methods and the pathological changes of kidney were also detected with optic microscope and transmission electron microscope.The expression of nephrin in podocyte were detected by immunohistochemistry. RESULTS: In DN rats, irbesartan reduced the urinary protein quality in 24 hours (P

Objective To explore the characteristics and efficacy of manual treatment for postpartum hypogalactia.Methods To retrieve the CNKI from 2007 to 2017 on the massage and manual treatment for postpartum hypogalactia,and analyze its syndrome differentiation,acupoint selection,manipulation rules,treatment frequency,treatment courses and clinical efficacy.Results Among the 83 articles included,the massage therapy for postpartum hypogalactia were based on the diseases and syndromes,and the selection of acupoints was diverse and combined with local and distance such as Danzhong (CV 17),Rugen (ST 18),Shaoze (SI 1),Zusanli (ST 36),Pishu (BL 20).The therapy were rich in techniques which often use acupoint stimulation and manipulation.Conclusions Tuina therapy for postpartum hypogalactia is widely used with safety and reliablility.But the operational procedures and efficacy standards need to be further standardized.

OBJECTIVETo evaluate and compare the value of dynamic multiple pelvic angiography and pelvic four-contrast defecography in the diagnosis of functional defecation disorder.

METHODSFrom September 2014 to July 2015, a prospective controlled trial was carried out in Chengdu Anorectal Hospital. A total of 32 patients met the inclusion criteria of functional defecation disorder simultaneously underwent pelvic four-contrast defecography and dynamic multiple pelvic angiography. The diagnostic results of these two methods were compared.

RESULTSThe absolute values of anorectal angle and level of perineum, peritoneum and bladder from rest to defecation were (29.6±13.6)°, (26.2±14.2) mm, (55.5±25.6) mm and (28.9±16.5) mm in dynamic multiple pelvic angiography, and (24.6±5.8)° (18.7±10.6) mm, (34.5±18.4) mm and (19.2±11.8) mm in pelvic four-contrast defecography respectively, whose differences were statistically significant (P = 0.026, 0.022, 0.000, 0.011 respectively). The diagnostic rate of pelvic peritoneal hernia was 93.8%(30/32) and 68.8%(22/32) in dynamic multiple pelvic angiography and pelvic four-contrast defecography respectively with significant difference(P=0.011).

CONCLUSIONDynamic multiple pelvic angiography has significant advantage in the diagnosis of pelvic peritoneal hernia, and can provide a more objective basis for the diagnosis of functional defecation disorder.

Angiography ; methods ; Constipation ; diagnosis ; Defecation ; Defecography ; methods ; Humans ; Pelvis ; Perineum ; Prospective Studies

Objective:To explore the surgical method and clinical effect of forearm arterialized venous flap in repair of soft tissue defects of fingers.Methods:A total of 13 cases of finger soft tissue defects with exposure of deep tissue were repaired with forearm arterialized venous flap from January, 2013 to October, 2019. The flap was designed in the forearm, and 2 parallel superficial veins were selected, the diameter of vein was similar to that at recipient site. The long axis of the flap was the same as that of the vein, and the width of the flap was divided into 3 equal parts by the 2 superficial veins. The free flap was cut longitudinally in the middle between 2 vessels under microscope, and a width of about 2 mm of the subcutaneous tissue was removed to the subdermal vascular network. The communicating branch between 2 vessels was ligated, and the subcutaneous tissue between 2 vessels was cut completely. The flap was not inverted, and the cut area was 3.5 cm× 2.5 cm-7.0 cm×4.0 cm. The proximal ends of the 2 vessels in the flap were anastomosed with the arteries and veins of the recipient area.Results:Thirteen flaps survived, and 9 patient entered follow-up for an average of 11(3-23) months. The flaps were soft and had no effect on the joint movement, slightly bloated. The TPD of flaps was 9 - 18 mm, with an average of 13 mm.Conclusion:Forearm arterialized venous flap has the advantages of high survival rate, satisfactory function, finger pulp-type change, superficial location, easy harvest and no sacrifice of main artery. It is an ideal method for repairing finger soft tissue defects.

OBJECTIVETo investigate whether transplantation of autologous peripheral blood CD34+ stem cells is a viable approach for treating patients with advanced cirrhosis,which is currently hindered by a shortage in liver donors.

METHODSA total of 100 patients with advanced cirrhosis and who had failed to respond to conservative therapy were recruited for transplantation of autologous peripheral blood CD34+ stem cells.The success of transplantation was investigated 6-and 12-months later by measuring markers of liver biosynthesis function (coagulation,albumin level,indocyanine green clearance,Child-Pugh score) and assessing pathological changes (Knodell score) and morphologic changes in the liver tissue.Complications were also recorded during follow-up.

RESULTSThe 1-year cumulative survival rate was 100%. Fifty-two patients with massive ascites showed gradual reduction and disappearance of the ascites.Four patients experienced upper gastrointestinal bleeding and three patients developed with hepatic encephalopathy (I-II degree) at 3 months post-transplantation.All patients showed significantly improved liver biosynthesis function,liver elasticity and Knodell score after transplantation (P less than 0.05).

CONCLUSIONAutologous peripheral blood CD34+ stem cell transplantation is a safe and effective treatment for advanced cirrhosis,and has high cost-benefit since it improves liver function,liver histology,and quality of life.

Ascites ; Humans ; Liver Cirrhosis ; therapy ; Quality of Life ; Stem Cell Transplantation ; Transplantation, Autologous ; Treatment Outcome

AMP-activated protein kinase (AMPK), known as a sensor and a master of cellular energy balance, integrates various regulatory signals including anabolic and catabolic metabolic processes. Accompanying the application of genetic methods and a plethora of AMPK agonists, rapid progress has identified AMPK as an attractive therapeutic target for several human diseases, such as cancer, type 2 diabetes, atherosclerosis, myocardial ischemia/reperfusion injury and neurodegenerative disease. The role of AMPK in metabolic and energetic modulation both at the intracellular and whole body levels has been reviewed elsewhere. In the present review, we summarize and update the paradoxical role of AMPK implicated in the diseases mentioned above and put forward the challenge encountered. Thus it will be expected to provide important clues for exploring rational methods of intervention in human diseases.

Objective:To evaluate the effect of Xuebijing injection on the improvement of pneumonia severity index (PSI) and prognosis in patients with severe coronavirus disease 2019 (COVID-19).Methods:A multicenter prospective cohort study was designed. Adult patients with COVID-19 admitted to the intensive care unit (ICU) of 28 designated COVID-19 hospitals in 15 provinces and cities of China from January to March 2020 were enrolled. All patients were treated according to the standard treatment plan of COVID-19 issued by the National Health Commission of the People's Republic of China. They were divided into Xuebijing group and standard treatment group according to whether they received Xuebijing injection or not. In the standard treatment group, routine medical care measures such as antiviral, respiratory support, circulatory support and symptomatic treatment were taken. In the Xuebijing group, on the basis of standard treatment, Xuebijing was used within 12 hours of admission to the ICU, 100 mL each time, twice daily. The minimum duration of Xuebijing administration was 1 day. The improvement rate of PSI risk rating on the 8th day and clinical outcome on the 28th day were recorded.Results:A total of 276 COVID-19 patients were screened continuously, and the data of 144 severe patients who met PSI risk rating Ⅲ-Ⅴ were analyzed. Seventy-two cases were involved each in standard treatment group and Xuebijing group. The average age of the standard treatment group and Xuebijing group were (65.7±7.9) years old and (63.5±10.9) years old, and male accounted for 75.0% (54/72) and 70.8% (51/72), respectively. There were no significant differences in general conditions, comorbidities, PSI risk rating and score, sequential organ failure assessment (SOFA) score, oxygenation index (PaO 2/FiO 2), respiratory support mode and other baseline indicators between the two groups. Compared with the standard treatment group, the improvement rate of PSI risk rating in Xuebijing group on the 8th day after admission was significantly improved [56.9% (41/72) vs. 20.8% (15/72), between-group difference and 95% confidence interval (95% CI) was 36.1% (21.3% to 50.9%), P < 0.01], PSI score, SOFA score and PaO 2/FiO 2 were significantly improved [PSI score: 83.7±34.8 vs. 108.2±25.6, between-group difference (95% CI) was -24.5 (-34.9 to -14.1); SOFA score: 2.0 (1.0, 4.0) vs. 7.0 (4.0, 10.0), between-group difference (95% CI) was -3.5 (-5.0 to -2.0); PaO 2/FiO 2 (mmHg, 1 mmHg = 0.133 kPa): 289.4±111.6 vs. 188.5±98.1, between-group difference (95% CI) was 100.9 (65.3 to 136.5); all P < 0.01]. The 28-day discharge rate of Xuebijing group was 44.5% higher than that of standard treatment group [66.7% (48/72) vs. 22.2% (16/72), P < 0.01], and the 28-day survival rate was 9.8% [91.7% (66/72) vs. 81.9% (59/72), P < 0.01]. There was no significant difference in the combination of antiviral drugs, antibiotics, anticoagulants and vasopressor drugs between the two groups. There was no significant difference in the incidence of adverse events between the Xuebijing group and standard treatment group [41.7% (30/72) vs. 43.1% (31/72), P > 0.05], and no serious adverse events and adverse reactions of Xuebijing were reported. Conclusion:Standard treatment combined with Xuebijing injection can significantly improve the PSI risk score and clinical prognosis of patients with severe COVID-19 without increasing drug safety risk.