Humans ; Liver Cirrhosis, Biliary ; diagnosis ; etiology ; therapy

Objective To assess the efficacy of laryngeal mask airway Supreme (LMA Supreme) used in patients undergoing laparoscopic surgery. Methods One hundred and twenty ASA I or Ⅱ patients of both sexes aged 35-60 yr weighing 48-85 kg undergoing elective laparoscopic surgery were randomized to 2 groups ( n = 60 each): LMA Supreme group (group S) and tracheal intubation group (group T). Mallampati test was performed before operation in both groups. The patients were classified as I - Ⅲ . In group S the LMA Supreme was inserted after induction of anesthesia with sufentanil 0.2 fig/kg, propofol 2-3 mg/kg and vecuronium 0.1 mg/kg. A gastric tube was inserted through the drain tube of the LMA Supreme. In group T the patients were intubated under direct laryngoscopy. The success rate, LMA placement/intubation time, success rate of gastric tube placement, airway seal pressure, SpO2, PETCO2 , peak airway pressure and complications (hypoxemia, nausea and vomiting, choking hoarseness, sore throat and regurgitation of gastric contents) were recorded. The duration of surgery, anesthesia time, extubation time and emergence time were also recorded. Results There was no significant difference in the success rate between the two groups. The placement and removal time and recovery time were significantly shorter in group S than in group T. The airway seal pressure was (25 ±4) cm H2O in group S. SpO2, PETCO2 and peak pressure were within normal range in both groups. The incidence of postoperative hypoxemia, choking and sore throat were significantly lower in group S than in group T. Conclusion LMA Supreme can provide adequate ventilation during operation with less complications and can be used effectively for laparoscopic surgery.

Purpose　To study the anti-inflammatory,anti-allergy and immunosuppressive effect of polyglycosides of tripterygium wilfordii Hook (TⅡ).　Methods　Animal model of acute and subacute inflammation,adjuvant arthritis,type Ⅳ and Ⅲ allergic reaction were used.Serum haemolysin level,lymphocyte proliferation and T-cell subsets in spleen were tested.　Results　TⅡ 60,120 mg/kg and pre(prednisone)10 mg/kg had marked inhibitory effect on carrageenine induced swelling,tampon induced granulation and on the prevention of adjuvant arthritis.The delayed type hypersensitivity reaction(type Ⅳ) and arthus reaction (type Ⅲ) was distinctly suppressed.It had a suppressive action on serum haemolysin and lymphocyte proliferation with and without concanavatin A which was dose dependent.In the T-cell subsets:TⅡ 60 mg/kg decreased TS and TⅡ 120 mg/kg inhibited both TS and TH,preacted mainly on TH and rendered the decreased ratio of TH/TS.　Conclusions　TⅡ has suppressive effect on inflammation,allergic reaction and immune function.

Alzheimer disease (AD) is a fatal neurodegenerative disorder,and the most common cause of dementia in the elderly.Accumulated evidences in AD research suggest that alterations in the microRNA (miRNA) network could contribute to risk for the disease.As the second discovered miRNA,Let-7 has an important effect on cell proliferation,differentiation,apoptosis,immune response,tumorigenesis,metastasis,and so on.We review in this article the role of Let-7 family in the pathogenesis of AD to provide a strong basis for future research aimed at understanding the potential contribution of miRNAs to AD pathophysiology.

Academic ethics is closely related to the construction of the world class disciplines,the academic ethics of university mentors and their graduate students are especially important to the development of disciplines and Universities.This article was based on a survey which used two-way evaluation conducted at Peking University Health Science Center,investigated the cognition,current status,misconduct and possible causes,as well as related trainings of academic ethics between mentors and mentees,furthermore,this article also analyzed the application of mentor-mentee two-way evaluation in the academic ethics trainings for post graduate students.

Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation (MLGP) to treat macular edema.Methods Consecutive 89 patients (109 eyes)diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving- 0.8 (0.19±0.13);the intraocular pressure(IOP)ranged from 7 mm Hg to 21 mm Hg(1 mm Hg=0.133 kPa)and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations,the central macular thickness was (570±182) μm;the average light sensitivity was (5.07±3.94) dB and the fixation percentage was 70.67% within 4 ° area around the macular fovea.All the patients received IVTA treatment,39 patients (48 eyes)further received MLGP 1 month later (IVTA-MLGP group).The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group.Best corrected visual acuity (BCVA),lOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months,the BCVA in IVTA-MLGP and IVTA group was (0.41±0.20),(0.24±0.19) respectively (P<0.05);the central macular thickness was (309±187) and (487±206) μm respectively(P<0.05);the mean light sensitivity of 4° central macular was (8.24±4.64)and(6.30±3.22) dB respectively (P<0.05);the fixation percentage was (87.01±19.70)% and (78.85±20.41) % respectively (P<0.05).During the follow-up recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTA-MLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema.

OBJECTIVE:To provide a reference for innovative drugs to enter the health insurance directory smoothly and pro-mote the rapid development of pharmaceutical industry in China. METHODS:Based on related policy study of foreign and domes-tic innovative drugs entering the health insurance directory,the policy barriers of innovative drugs entering the health insurance di-rectory were analyzed and the countermeasures were put forward. RESULTS & CONCLUSIONS:In China,the foundation of drug selection was not objective enough;the review results were so vulnerable to subjective views because of the experts selection mech-anism;the health insurance directory deletion mechanism was deficient;the waiting time for innovative drugs entering the health in-surance directory was too long;innovative drugs negotiation mechanism was imperfect,etc. It is recommended that forcibly requir-ing pharmaceutical companies should provid the related data about pharmacoeconomic evaluation;the independence and pluralism of the expert group should be enhanced;drugs in the health insurance directory should be secondarily evaluated regularly;the inno-vative drugs should be given the green channel;innovative drug price negotiation rules should be unified to promote drug informa-tion sharing.

Objective:To investigate the feasibility of rectus muscle insertion measurement with anterior segment optical coherence tomography (AS-OCT) after corrective surgery of concomitant exotropia.Methods:A cross-sectional study was performed.Twenty-five eyes of 25 patients with concomitant exotropia were included in Shenyang Aier Eye Hospital from March 2018 to February 2019, and all patients received concomitant exotropic corrective surgery.The distance of limbus to rectus muscle insertion was measured before operation, at the beginning and at the end of operation with a caliper and at postoperative 2 weeks, 1 month, 3 months and 6 months with AS-OCT, respectively.Degree of strabismus was examined by the alternate prism cover test at 33 cm.The research followed the Declaration of Helsinki and the protocol was approved by a Medical Ethics Committee of Shenyang Aier Eye Hospital (No.2017KJB005). Written informed consent was obtained from the patients/custodians prior to any medical examination and treatment.Results:A total of 44 rectus muscles of 25 eyes with concomitant exotropia were measured, including 25 lateral rectus muscles and 19 medial rectus muscles.The detection rate of the muscle insertion by AS-OCT was low at 2 weeks and 1 month after surgery.The mean distance of limbus to lateral rectus muscle insertions was (12.30±1.40), (11.72±1.45) and (11.84±1.27)mm at the end of operation and postoperative 3 and 6 months, respectively, showing a significant difference among them (F=4.085, P=0.023), and the distance measured at the end of operation was significantly larger than that at postoperative 3 months (P=0.018). The mean distance of limbus tomedial rectus muscle insertion was (5.12±0.42), (5.56±0.61) and (5.28±0.57)mm at the end of operation, postoperative 3 and 6 months, respectively, and there was no significant difference among the three time points (F=3.912, P=0.055). The degree of strabismus of the patients at various time points after surgery were significantly reduced in comparison with that before surgery (all at P<0.05).Conclusions:AS-OCT can track the position of extraocular muscle insertions after concomitant exotropic corrective surgery.

Objective To investigate the value of peripheral blood for the prognosis of patients withbloodstream infection. Methods A retrospective analysis of patients with bloodstream infection was conducted inthe intensive care unit (ICU) of Mianyang Central Hospital of Sichuan from January 2012 to October 2016. Accordingto the 28-day survival, the patients were divided into survival group and death group. The white blood cell (WBC),neutrophils count (NEU), lymphocyte count (LYM), neutrophil/lymphocyte ratio (NLR), monocyte count (MO), eosinophilcount (EO), basophil count (BA), hemoglobin (Hb), platelet count (PLT) and procalcitonin (PCT) in peripheral bloodwere recorded when patients were diagnosed with blood infection. Receiver operating characteristic curve (ROC),Kaplan-Meier survival analysis and Cox regression were used to evaluate the value of these risk factors for predictingthe outcome. Results 305 patients were enrolled. 182 patients survived while 123 patients died during the 28-dayperiod. ① There was no significant difference in gender, age and comorbidities between the two groups. There was nosignificant difference in infection rate between the two groups except for fungal infection rate. The fungal infection ratein the death group was significantly higher than that in the survival group (9.8% vs. 3.3%, P = 0.019). ② The LYM,MO, EO and PLT in the death group were significantly lower than those in the survival group [LYM (×109/L):0.58 (0.29, 0.93) vs. 0.76 (0.44, 1.23), MO (×109/L): 0.47 (0.19, 0.80) vs. 0.58 (0.30, 0.94), EO (×109/L):0.00 (0.00, 0.01) vs. 0.03 (0.01, 0.09), PLT (×1012/L): 89 (47, 148) vs. 126 (82, 186), all P < 0.05]. The NLR in the death group was significantly higher than that in the survival group [17.09 (7.60, 33.51) vs. 12.86 (6.51, 24.85), P < 0.05]. There was no significant difference in the WBC, NEU, BA, Hb and PCT between the two groups. ③ It was shown by ROC curve analysis that the maximum area under the ROC curve (AUC) of EO was 0.755. When the best cut-off value was 0.015×109/L as a predictor of death in 28 days, the sensitivity was 80.3%, and specificity was 64.7%. ④ It was shown by survival analysis that the 28-day survival rate in the patients with EO < 0.015×109/L was significantly lower than that of patients with EO > 0.015×109/L [38.3% (62/162) vs. 83.9% (120/143), χ 2 = 56.999, P = 0.000]. ⑤ It was shown by Cox regression that EO was the independent factor for 28-day survival (β = 1.466, χ 2 = 39.535, P = 0.000). Risk of death was 4.331 times greater in patients with EO < 0.015×109/L than in those with EO > 0.015×109/L [hazard ratio (HR) = 4.331, 95% confidence interval (95%CI) = 2.743-6.840]. Conclusions Compared to other parameters in peripheral blood, EO has the best correlation with the prognosis of bloodstream infection. EO is the independent prognostic predictor for 28-day survival.

OBJECTIVE:To establish a method for simultaneous determination of the contents of geniposide and liquiritin in Xinshenning tablets. METHODS:HPLC was performed on the column of Inertsil ODS-3 with mobile phase of acetonitrile-water (gradient elution) at flow rate of 1.0 ml/min,the column temperature was 25 ℃,detection wavelength was 238 nm and the vol-ume was 10 μl. RESULTS:The mass concentration range was 16.3-407.9 μg/ml for geniposide(r=0.999 9) and 7.4-185.9 μg/ml for liquiritin(r=0.999 9);RSDs of precision,stability and reproducibility tests were no more than 1.63%;average recoveries were 99.05%(RSD=1.28%,n=9)and 98.00%(RSD=1.84%,n=9),respectively. CONCLUSIONS:The established method is accu-rate,sensitive and simple,and can be used for the contents determination of geniposide and liquiritin in Xinshenning tablets.