OBJECTIVE:To establish the quality standard of Jiawei guiqi tablets.METHODS:Angelicae sinensis and Radix Astragali in the tablets were identified qualitatively by TLC;the content of ferulic acid was determined by HPLC. RESULTS:The TLC spots were distinctive and free from interference of negative control.The linear range of the ferulic acid was 0.135 6～1.356 0 ?g(r=0.999 6) and the average recovery rate was 99.20%(RSD=0.97%,n=6).CONCLUSION:The established standard is suitable for the quality control of Jiawei guiqi tablets.

Objective To investigate the effects of exogenous pulmonary surfactant(PS)on the inflammatory response in rats with ventilator-induced lung injury(VILI).Methods Twenty-eight adult male Wistar rats weighing 310-388 g were randomly divided into 4 groups(n =7 each):normal control group(group C),group VILI,group PS and air control group(group A).VILI was produced by high-pressure ventilation(HPV)with peak inspiratory pressure(PIP)40 cm H2 O,respiratory rate(RR)20 hpm and without positive end-expiratory pressure(PEEP)for 20 min.The rats were sacrificed by exsanguination immediately after anesthesia and after VILI in groups C and VILI,respectively.In groups PS and A,PS 100 mg/kg(50 mg/ml)and the equal volume of air were injected into the trachea via the airway after the tracheal edema fluid was removed respectively,and the rats were mechanically ventilated(Vr 10 ml/kg,RR 45 bpm and PEEP 7.5 cmH2O)for 120 min and then sacrificed by exsanguination.The blood samples were taken from femoral artery for determination of the plasma levels of IL-6,IL-10,MIP-2 and TNF-α by ELISA.The tracheal edema fluid was collected to determine the protein concentration by Bradford method.The lungs were removed for microscopic examination and the number of neutrophils was counted under microscope.Results There was no significant difference in the plasma levels of TNF-α among the four groups(P ＞ 0.05).Compared to group C,the plasma levels of MIP-2,IL-10 and IL-6 were significantly increased and the number of neutrophils was significantly enlarged in group VILI(P ＜ 0.05).The number of neutrophils was significantly smaller in group PS than in group A(P ＜ 0.05).There was no significant difference in the plasma levels of MIP-2,IL-10 and IL-6 between groups PS and A(P ＞ 0.05).The inflammatory damage in lung tissues was observed obviously in groups VILI,A and PS.Conclusion When exogenous PS is used to treat the rats with VILI,PS reduces neutrophil recruitment,but can not inhibit the release of inflammatory cytokines.

Objective To observe the expression of thioredoxin (Trx) and thioredoxin-interacting protein (Txnip) in the kidney of type 2 diabetic rats induced by streptozotocin and the effect of probucol treatment on thioredoxin system. Methods Thirty male SD rats were divided into control group( C, n = 10), diabetes group ( D, n =10), and probucol treated diabetic group ( P, n = 10). After eight weeks of probucol treatment, the expressions of Trx and Txnip in the kidney of three groups were measured by RT-PCR, Western blot, and immunohistochemistry. Body weight,24 h microalbuminuria( ALB), fasting plasma glucose( FPG), fasting insulin( HNS), blood urea nitrogen (BUN), creatinine (Cr), malondialdehyde ( MDA ), superoxide dismutase ( SOD ), and catalase (CAT) were determined. Results Compared with group C, Trx was markedly decreased in group P (0. 162 ±0. 008 vs 0. 239 ±0. 006, P＜0.05 ), while Txnip was significantly increased (0. 159±0.003 vs 0. 091 ±0.016, P＜0.05 ). Trx in group P was increased as compared with group D (0. 162 ±0. 008 vs 0. 108 ± 0. 013, P ＜ 0. 05 ), while Txnip was lowered (0. 159±0.003 vs 0. 236±0.009 ,P＜0.05 ). FPG, 24 h ALB, BUN, Cr,and MDA levels in group D were markedly increased as compared with group C (P＜0. 05), while the activity of SOD, CAT, and FINS levels were decreased apparently (P＜0.05). The above markers except for FPG in group P were ameliorated (P＜0. 05 ).Conclusions Probucol attenuated oxidative stress by means of partially restoring Trx function and reducing Txnip expression, and thus played a major role in renoprotection of type 2 diabetic nephropathy.

Objective To analyze CT characteristics of metastatic liver leiomyosarcoma(MLL),and to improve the diagnostic accuracy of MLL.Methods CT manifestations and clinical characteristics of 5 patients with pathological-proved MLL were retrospectively analyzed.Plain and contrast-enhanced triphase(including arterial,portal phase in all cases and delayed phase in a part of cases) scans were performed.Results On plain scan,all lesions were hypo-dense."Bull-eye-sign" was found in two cases on contrast-enhanced scan,which is the typical metastatic feature.During arterial phase,the smaller lesions showed marked peripheral enhancement and central necrosis.The larger MLL presented as solid-cystic lesions,the parenchyma of tumor was rich in blood supply.Some cases presented mild hypo-dense or iso-dense comparing with the parenchyma of the liver on delayed phase.One case was misdiagnosed as hepatic hemangioma or focal nodular hyperplasia(FNH).Metastases were found out of the liver.Tumor thrombus of portal vein was not found in all of the cases.Conclusion MLL should be considered in the patients with history of extra-hepatic leiomyosarcoma,no marker expressions,no history of hepatitis,no tumor thrombus of portal vein and the special CT findings.

Objective To investigate the blood-saving effect of tranexamic acid in off-pump coronary artery bypass (OPCAB). Methods Two hundred and sixty ASA Ⅰ- Ⅲ and NYHA Ⅰ- Ⅲ patients of both sexes,aged 18-64 yr, with body mass index 16-22 kg/m2 , undergoing OPCAB, were randomly divided into 2 groups (n = 130 each): control group (group C) and tranexamic acid group (group T) . Anesthesia was induced with iv injection of midazolam 0.1 mg/kg, fentanyl 5-10μg/kg and pipecuronium 0.1 mg/kg. The patients were tracheal intubated and mechanically ventilated. PEr CO2 was maintained at 35-45 mm Hg. A bolus of tranexamic acid 1 g was infused intravenously within 30 min after indution followed by continuous infusion at 400 mg/h until the end of operation in group T. While equal volume of normal saline was given in control group. Anesthesia was maintained with inhalation of isoflurane and intermittent iv injection of fentanyl and pipecuronium. Venous blood samples were taken before induction, at the end of operation and at 24 h after operation for determination of Hb, platelet count (P1t), prothrombin time (PT) and international normalized ratio (INR). The volume of chest tube drainage was collected and recorded at 6 and 24 h after operation. The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was also recorded. Results There was no significant difference in Hb, Plt, PTand INR at each time point between the two groups ( P ＞ 0.05). The requirement for transfusion of allogeneic red blood cells and fresh frozen plasma was significantly reduced in group T as compared with group C ( P ＜ 0.05 or 0.01 ). No deaths and complications occurred during hospital stay in the two groups. Conclusion Tranexamic acid exerts the blood-saving effect in OPCAB.

Objective To investigate the predictive value of quick sequential organ failure assessment (qSOFA) score on the prognosis of adult patients with infection in intensive care unit (ICU). Methods A retrospective analysis was conducted on the clinical data of the infected patients in the ICU of the 401st Hospital of the People's Liberation Army from August 1st, 2000 to December 31st, 2017. The clinical data included patients' gender, age, basic diseases, etc.; the worst values of vital signs and laboratory test results within 24 hours of admission were recorded, the scores of the qSOFA, sequential organ failure assessment (SOFA), acute physiology and chronic health evaluationⅡ(APACHEⅡ) were calculated separately; the outcome of ICU was recorded. The predictive values of three scoring systems were evaluated by receiver operating characteristic curve (ROC). Results Excluding patients with incomplete clinical data, cancer and immunosuppressive patients, a total number of 1 059 patients were enrolled in this study, with 679 males and 380 females, the average age was 72.57±16.06, the ICU mortality was 35.32% (374/1 059). The ROC curve analysis showed that the areas under ROC curve (AUC) of APACHE Ⅱ, SOFA, qSOFA scores to predict the prognosis of infected patients were 0.713, 0.744 and 0.662, respectively. Although the AUC of qSOFA in predicting prognosis was significantly lower than that of other two scoring systems (both P < 0.05), but it still had some predictive ability. According to the Youden index, the best cut-off point for qSOFA was 2 to evaluate the prognosis of the infection, and the sensitivity was 71.65%, the specificity was 53.87%, the positive likelihood ratio was 1.55, the negative likelihood ratio was 0.53, the positive predictive value was 0.426, the negative predictive value was 0.799, and the accuracy was 59.62%. The mortality of the infected patients was increased with qSOFA score, and the mortality difference among patients with different qSOFA scores was statistically significant (χ2= 84.605, P = 0.000). The patients were divided into two groups according to the cut-off value of qSOFA, and the mortality in qSOFA score ≥2 group was higher than that in qSOFA score < 2 group [odds ratio (OR) = 2.767, 95% confidence interval (95%CI) = 2.116-3.617, P = 0.000]. Conclusions qSOFA, SOFA and APACHE Ⅱscores have the capability of predicting the outcome for the infected patients. qSOFA score is expected to be a quick and simple tool to judge the prognosis of ICU infection patients because of its advantages of quick acquisition.

Objective: To explore correlation between chest CT score and oxygenation index in patients with acute hydrogen sulphide poisoning, whether CT score can be applied to assess acute lung injury after acute hydrogen sulfide poisoning and provide basis and reference. Methods: The clinic and a series of CT datas of 32 acute hydrogen sulphide poisoning cases were retrospectively analysed and compared, According to GBZ31-2002 (the diagnostic standard of occupational H₂S acute poisoning) , these patients were divided into 2 grouds including moderate groud and severe groud; The CT score were improved, referenceing the scoring criteria of the chest X-ray; The difference of the CT score and the oxygenation index were analyzed between moderate and severe group in the acute phase and the disperse phase; The correlation between CT score and oxygenation index were analyzed. Results: The CT score in moderate poisoning group were lower than severe group (2.26±1.37 vs 10.44±2.55, 1.34±0.65 vs 4.55±2.45, all P<0.05) in the acute phase and the dissipation phase.The oxygen index of the 19 cases in the acute phase were 307.55±28.29, and the oxygen index of the 8 cases in the dissipation phase was 435.75±37.00; The oxygen index of the 9 cases in the acute phase and the dissipation phase were respectively 193.17±36.41, 347.67±44.49. The oxygen partial pressure and oxygenation index in severe group were significantly lower than those in moderate group (all P<0.01) in the acute phase and the dissipation phase. Pearman correlation analysis showed that the CT score were negatively correlated to the oxygen index in the acute phase and the dissipation phase, respectively (r=-0.97、-0.75, all P<0.01) . Conclusions The CT score of lung injury and oxygenation index is negatively correlated. The CT score can be used to evaluate the degree of lung injury, and can be used in the evaluation of acute lung injury after acute hydrogen sulfide poisoning.

Objective:To explore the relationship between metabolic score for insulin resistance (METS-IR) and chronic kidney disease (CKD) and albuminuria in the Chinese population.Methods:This cross-sectional study was conducted from January to December 2018 among residents aged 20 to 70 years in ten regions of eight provinces in China; all residents had lived in their region for more than 5 years. Various parameters were measured, included fasting blood glucose, 2-hour postprandial blood glucose, glycosylated hemoglobin (HbA 1c), blood lipids, renal function, urinary albumin/creatinine ratio (UACR), etc. Data of 5 060 subjects meeting the criteria were included in the study. CKD was defined as estimated glomerular filtration rate (eGFR)<60 ml·min -1·1.73 m -2 or UACR≥30 mg/g. Albuminuria was defined as UACR≥30 mg/g. METS-IR was calculated and categorized into quartiles: Q1, METS-IR≤32.19; Q2, METS-IR 32.20-37.10; Q3, METS-IR 37.11-42.58; and Q4, METS-IR>42.58. The correlation between METS-IR and CKD and albuminuria was analyzed by binary logistic regression, and subgroup analyses were performed. Results:There were 1 266, 1 266, 1 265, and 1 263 participants included in Q1-Q4 groups, respectively. With the increase of METS-IR quartile, various parameters increased, including age, fasting blood glucose, HbA 1c, triglycerides, serum uric acid, waist circumference, body mass index, and systolic and diastolic blood pressure, and the proportion of males also increased (all P<0.05). The proportion of patients with CKD and albuminuria increased significantly with the increase in interquartile range (Q) of METS-IR (all P<0.05). Logistic regression analysis showed that for every 1-unit increment of METS-IR, the risk of CKD and albuminuria were both increased by 2% [for both: odds ratio ( OR)=1.02, 95% confidence interval ( CI) 1.01-1.03]. Compared with the lowest METS-IR group (Q1), the ORs for CKD and albuminuria in the highest METS-IR group (Q4) were 1.57 (95% CI 1.17-2.10) and 1.46 (95% CI 1.09-1.96), respectively. In the subgroup analyses, increased METS-IR was significantly associated with CKD and albuminuria among women (CKD: OR=1.62, 95% CI 1.14-2.31; albuminuria: OR=1.53, 95% CI 1.07-2.18), individuals with HbA 1c<7% ( OR=1.64, 95% CI 1.21-2.23; OR=1.55, 95% CI 1.14-2.11), individuals with eGFR≥90 ml·min -1·1.73 m -2 ( OR=1.78, 95% CI 1.27-2.49; OR=1.80, 95% CI 1.28-2.53), and the Chinese Han population ( OR=1.56, 95% CI 1.13-2.17; OR=1.41, 95% CI 1.01-1.96). Conclusions:METS-IR is significantly associated with CKD and albuminuria in a Chinese population. Furthermore, the higher the METS-IR, the higher the risk of CKD and albuminuria.

OBJECTIVETo investigate the epidemiological characteristics of respiratory syncytial virus (RSV) subtypes and genotypes in southern Zhejiang province, and to determine whether RSV genotypes are correlated with the disease severity of lower respiratory tract infection (LRTI).

METHODNasopharyngeal secretions (NPS) from children under 5 years of age who were hospitalized with LRTI during 5 consecutive seasons from July 1, 2009 to June 30, 2014 were collected. RSV antigen was determined using direct immunofluorescence (DIF). Two hundred strains of RSV were randomly selected from each epidemic season. RNA was extracted and identified as subtype A or B by using reverse transcription-polymerase chain reaction (RT-PCR), and randomly selected strains of the full length attachment (G) genes of both subtype A and subtype B were amplified by PCR and sequencing. Clinical data were collected, and the disease severity between different genotypes were compared simultaneously.

RESULTOf the total 1 000 randomly selected RSV positive samples, 462 (46.2%) and 538 (53.8%) samples were identified as subtype A and B, respectively. It was found that subtype B predominated in the 2009-2010 and 2012-2014 epidemic seasons and subtype A in 2010-2012 epidemic seasons. A total of 112 strains of complete sequences of G genes were obtained, including four subtype A genotypes NA1, NA4, GA2 and ON1, and six subtype B genotypes BA8-10, BA-C, CB1, and GB2. Phylogenetic analysis revealed that 39/52 (75.0%) subtype A strains were classified as NA1 genotype, followed by ON1 genotype (10/52,19.2%) and 44/60 (73.3%) subtype B strains were classified as BA9 genotype, followed by BA8 genotype (6/60,10.0%). BA9 was the predominant genotype among subtype B except 2010-2011 epidemic season, while NA1 was the predominant genotype among subtype A except 2013-2014 epidemic season. Only ON1 and BA9 genotypes were checked out during 2013-2014 epidemic season. There was statistically significant difference in the average severity score of illness in 39 cases infected with NA1 genotype (4.154) and 44 cases of BA9 genotype (3.341) (U=642.500, P<0.05). Furthermore, in the rate of oxygen uptake, the percentage of those infected with NA1 genotype (33.3%) was higher than those infected with BA9 genotype (13.6%) (χ2=4.544, P<0.05). However, there were no significant difference in the age, clinical symptoms, the percentage of intensive care unit admission, length of hospitalization and the outcome of the disease between NA1 and BA9 infection.

CONCLUSIONThe shift of predominant RSV subtype from 2009 to 2014 were B-A-A-B-B in the southern areas of Zhejiang province. Multiple genotypes co-circulated during five RSV epidemic seasons. NA1 and BA9 genotypes were the predominant genotypes of subtype A and B, respectively. Compared with infection with BA9 genotype, NA1 genotype infection was associated with more severe disease and proportion of patients needed oxygen therapy was higher.

Child, Preschool ; China ; epidemiology ; Genotype ; Hospitalization ; Humans ; Infant ; Nasopharynx ; Phylogeny ; Polymerase Chain Reaction ; Respiratory Syncytial Virus Infections ; epidemiology ; Respiratory Syncytial Virus, Human ; genetics ; Respiratory Tract Infections ; epidemiology ; Seasons

Objective To understand the regional epidemiology and antibiotic resistance pattern of diarrheagenic E .coli infection in children ,and to clarify the pathogenic association between diarrheagenic E .coli infection and childhood diarrhea .Methods Totally 680 diarrheal children in the outpatient setting and 680 non-diarrheal control children were enrolled prospectively .The stool samples were collected and the potential enteric pathogens were detected .Minimal inhibitory concentration (MIC) method was used to determine the antimicrobial susceptibility for diarrheagenic E .coli isolates .Results The isolation rates of diarrheagenic E .coli in diarrhea group and control group were 15 .6％ and 13 .1％ ,respecitvely ,and diarrheagenic E .coli was the most commonly detected enteric bacteria .Multivariate logistic regression analysis adjusted for age suggested no clinical association between diarrhea and infection with enteropathogenic E .coli (EPEC) (aOR=1 .2 ,95％ CI:0 .8-1 .8) ,enteroadhesive E .coli (EAEC) (aOR=1 .1 ,95％ CI:0 .7 -1 .6) and enterotoxigenic E .coli (ETEC) (aOR= 1 .8 ,95％ CI:0 .5 -6 .2) . Among 199 diarrheagenic E .coli strains ,the rates of resistance to ampicillin ,tetracycline ,trimethoprim-sulfamethoxazole ,azithromycin ,and ceftriaxone were 63 .8％ ,55 .8％ ,48 .2％ ,34 .2％ and 26 .6％ , respectively ,while the rates of resistance to ciprofloxacin , amoxicillin-clavulanate and cefoxitin were 4 .5％ ,1 .5％ and 0 .5％ ,respectively .Conclusions Diarrheagenic E .coli is the most common enteric bacteria detected in the stool samples from children with and without diarrhea in this study . The pathogenic role of infections with EPEC ,EAEC and ETEC in childhood diarrhea is not determined .EHEC and EIEC are rarely detected and further studies are needed to clarify the pathogenic association between infection with EHEC ,EIEC and childhood diarrhea .