ObjectiveTo investigate clinical effect of eradication of helicobacter pylori in patients with idiopathic thrombocytopenic purpura(ITP). Methods145 cases with HP-positive ITP paitients were divided into two groups( platelet counts results ＜ 50 × 109/L and platelet counts results ＞ 50 × 109/L). 95 cases with platelet counts ＜50 × 109/L were divided into two groups and treated with prednisone and Hp eradication(48 cases) or with prednisone without Hp eradication(47 cases). 95 cases with platelet counts ＞ 50 × 109/L were divided into two groups and treated with Hp eradication 25 cases)or follow-up without any treatment(25 cases). ResultsThe total effective rate in group treated with prednisone and Hp eradication was significantly higher than that in group with prednisone without Hp eradication( 92％ vd 75％, x2 ＝ 5.01 ,P ＜ 0.05 ). The recurrence rate in two year in group treated with prednisone and Hp eradication was significantly lower than that in group with prednisone without Hp eradication( 19％ vs 49％,x2 ＝ 9. 69, P ＜ 0. 01 ). HP eradicatiaon single can improve platelet counts in HP-positive ITP paitients.ConclusionThe detection and eradication of H pylori infection should be considered in patients with ITP. H. pylori eradication could be used for initial treatment in HP-positive ITP paitients.

Objective To investigate the effect of dexmedetomidine versus sevoflurane to perioperative myocardial ischemia in coronary heart disease patients undergoing noncardiac surgery.Methods A total of 135 patients (90 males,45 females,aged 45-82 years,ASA grade Ⅱ or Ⅲ) with coronary heart disease,undergoing endoscopic thoracic and abdominal surgery,were divided into control group (group C),dexmedetomidine group (group D) and sevoflurane group (group S) by random number table.Anesthesia induction and maintenance were adopted by etomidate 0.2 mg/kg,propofol 0.5 mg/kg,atracuronium sulfonate 0.2-0.3 mg/kg and fentanyl 5.0-6.0 μg/kg.Dexmedetomidine was given the continuous injection from 10 min before the start of the operation to the end in group D.Equal volume of saline was given in group C.Sevoflurane was inhaled from the induction of anesthesia 30 min before the end of surgery.ST segment changes of electrocardiogram were recorded for diagnosis of myocardial ischemia during the operation and postoperative 72 hours.Results The incidence of myocardial ischemia in group C,group D and group S were 26.7% (12 cases),6.7% (3 cases),8.9% (4 cases) during the operation and 13.3% (6 cases),8.9% (4 cases) and 8.9% (4 cases) postoperative 72 hours.Conclusion Dexmedetomidine and sevoflurane can improve the balance of blood oxygen supply and demand to reduce cardiovascular complications of non-cardiac surgery in patients with coronary heart disease.

Objective:To investigate the effect of activin A and nerve growth factor ( NGF) NGF on stimulating neurite outgrowth of dorsal root ganglia(DRG)of the embryonic chicken.Methods:In this study,we observed that activin A and NGF together induced neurite outgrowth of DRG and kept survival of DRG neurons by the primary cultured DRGs from embryonic day 8 ( E8 ) chicken.calcitonin gene-related peptide(CGRP)CGRP mRNA expressions were analyzed by RT-PCR.Results: The DRG treated with activin A +NGF had obvious neurite outgrowth ,compared with only NGF group on day 3,and the number of living DRG neurons also increased.Activin A +NGF up-regulated the mRNA expressions of CGRP in DRG.Conclusion:The Data demonstrated that activin A with NGF can synergistically stimulate DRG neurite outgrowth and maintain the DRG neurons survival , suggesting that it is more effective that NGF and activin A together treat the associated disease of nerve system.

Objective To explore the characteristics of intestinal Microbiota in T2DM patients by two molecular fingerprint technologies,and investigate the correlation of intestinal microbiota and T2DM,and evaluate the application value of two fin-gerprint technologies.Methods Fecal samples of 8 healthy groups and 7 diabetes patients were collected.Then the total DNA of gut microbiota was extracted.Through the analysis of products by two molecular fingerprints of ERIC-PCR and DGGE-PCR,ecological characteristics of diversity and similarity of gut microbiota were obtained in healthy groups and dia-betes patients.Results Compared to healthy groups,the number of bands and Shannon-Wiener index of gut microbiota in di-abetes patients was decreased but no statistical significance.The similarity in patients group was declining(P <0.05),and the construction of gut microbiota was inclined to differ.Two fingerprint technologies of ERIC and DGGE could directly re-flect the diversity of gut microbiota and were the modern molecular biological techniques without depending on cultivation. ERIC was simple and convenient,had a better reflection of microbial diversity,but gel band cutting and regarded asa proper approach with higher diffraction efficiency and excellent repetition to studysequencing couldn’t be performed since there were more influencing factors on the experiment.DGGE could better reflect the ecological characteristics such as microbial diversity and similarity,and selecting bands,gel band cutting and sequencing could be done.Conclusion The composition and construction of gut microbiota in diabetes patients were changed,which suggests the occurrence of the disease had the correlation with gut microbiota.ERIC and DGGE is regarded as a proper approach with higher diffraction efficiency and ex-cellent repetition to study intestinal microbiota,but also gel band cutting,sequencing,bacteria identification can be performed by DGGE,both can be used in combination.

Objective:To evaluate the effect of lung recruitment maneuvers combined with individualized positive end-expiratory pressure(PEEP) on the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.Methods:One hundred and forty-three elderly patients, aged ≥65 yr, with body mass index of 18.5-30.0 kg/m 2, scheduled for elective laparoscopic surgery, were assigned to either individualized PEEP combined with recruitment maneuvers (group Ⅱ) or fixed PEEP (group Ⅰ) using a random number table method. PEEP was maintained at 6 cmH 2O starting from the beginning of procedure until the end of the procedure in group I. Individualized PEEP titration was performed after induction of anesthesia in group Ⅱ. The primary outcome measure was the 12-zone lung ultrasound score at 15 min after tracheal extubation. Other outcome measures were the occurrence of postoperative pulmonary complications within 7 days after surgery, Quality of Recovery-15 scale score on 3rd day after surgery, rate of unplanned admission to intensive care units, length of hospital stay, incidence of intraoperative hypoxemia, usage rate of intraoperative vasoactive drugs, and incidence of postoperative hypotension. Results:Compared with group Ⅰ, the lung ultrasound score, driving pressure and postoperative pulmonary complications were significantly decreased, the dynamic lung compliance was increased ( P<0.05 or 0.01), and no significant changes were found in the other parameters in group Ⅱ ( P>0.05). Conclusions:Individualized PEEP combined with recruitment maneuvers can reduce the degree of postoperative atelectasis in elderly patients undergoing laparoscopic surgery.

Dandy-Walker syndrome is one of the posterior fossa malformations, which is easily confused with arachnoid cyst or cerebellar dysplasia in clinical practice, leading to misdiagnosis. Dandy-Walker syndrome is easy to be combined with hydrocephalus, resulting in increased intracranial pressure, increased head circumference, growth retardation, spastic hemiplegia and other manifestations, and can also be accompanied by other nervous system malformations. On February 27, 2021, a child with Dandy-Walker syndrome with growth retardation as the primary manifestation was admitted to Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine. After multiple surgical treatment, the child's hydrocephalus was significantly improved. Through the analysis of the clinical data of the child's operation and the treatment of complications, it is helpful to improve the clinicians' understanding of the surgical treatment of the disease.

Objective To investigate the therapeutic effect of ambroxol hydrochloride combined with Xuebijing injection for treatment of elderly patients with severe pneumonia. Methods A total of 60 patients with severe pneumonia admitted to the Third Affiliated Hospital of Soochow University from January 2015 to December 2016 were enrolled, and they were divided into an observation group and a control group by random number table method, 30 cases in each group. Both groups were given routine treatment of antibiotics, nutritional support, oxygen aspiration, spasmolysis and phlegm reduction therapies. etc. On the basic conventional treatment, the patients of the control group were treated with 300 mg ambroxol hydrochloride added into 100 mL normal saline for intravenous (IV) drip, twice a day; on the basis of treatment of control group, the patients in the observation group additionally were treated with 50 mL Xuebijing injection added into 100 mL normal saline for IV drip, twice a day. After treatment for 14 days, the curative effect was observed. Before and after treatment, the changes of immune function, inflammatory factors, respiratory mechanics, blood gas indexes and clinical efficacy were observed in the two groups. Results Compared with those before treatment, levels of the CD3+, CD4+ and CD4+/CD8+, arterial oxygen satuation (SaO2), arterial partial pressure of oxygen (PaO2) and oxygenation index (PaO2/FiO2) in the two groups after treatment were significantly increased, while CD8+, interleukin-6 (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), airway platform pressure (Pplat), peak inspiratory pressure (PIP), mean airway pressure (mPaw) and airway resistance (Raw) and arterial partial pressure of carbon dioxide (PaCO2) were decreased significantly after treatment in the two groups (all P < 0.05), the levels of immune indexes CD3+, CD4+, CD4+/CD8+, SaO2, PaO2 and PaO2/FiO2 after treatment in the observation group were significantly higher than those in the control group [CD3+: 0.69±0.05 vs. 0.60±0.04, CD4+: 0.40±0.04 vs. 0.35±0.03, CD4+/CD8+: 1.84±1.10 vs. 1.41±0.79, SaO2: 0.96±0.04 vs. 0.91±0.05, PaO2 (mmHg, 1 mmHg =0.133 kPa): 97.71±10.03 vs. 74.68±8.14, PaO2/FiO2 (mmHg): 361.87±20.01 vs. 258.95±17.54, all P < 0.05], meanwhile the CD8+, IL-6, CRP, TNF-α, Pplat, PIP, mPaw, Raw and PaCO2 were significantly lower than those of the control group [CD8+: 0.23±0.03 vs. 0.30±0.05, IL-6 (pg/L): 97.48±8.14 vs. 144.51±12.67, CRP (mg/L): 31.26±4.85 vs. 68.97±7.02, TNF-α (mg/L): 16.07±1.80 vs. 21.85±2.64, Pplat (cmH2O, 1 cmH2O = 0.098 kPa): 12.23±1.57 vs. 15.97±1.91, PIP (cmH2O): 23.26±3.07 vs. 28.09±3.10, mPaw (cmH2O): 8.54±0.54 vs. 9.39±1.30, Raw (cmH2O·L-1·s-1): 6.74±1.12 vs. 9.29±1.55, PaCO2 (mmHg): 36.44±4.13 vs. 47.07±5.35, all P < 0.05]. After treatment, the effective rate of the observation group was significantly higher than that of the control group [90.00% (27/30) vs. 63.33% (19/30), P < 0.05]. Conclusions Using ambroxol hydrochloride combined with Xuebijing injection for treatment of elderly patients with severe pneumonia can promote their immune function, reduce the inflammatory factors, improve respiratory mechanics and blood gas index levels, thus the combined therapy can elevate the clinical therapeutic effect for treatment of senile severe pneumonia.

Objective:To evaluate the relationship between preoperative frailty and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic lobectomy.Methods:The elderly patients with non-small cell lung cancer who underwent thoracoscopic lobectomy in the Affiliated Hospital of Jiangnan University were collected.The general data, frailty status, parameters of blood and operation-related parameters were recorded.The patients were divided into PPC group and non-PPC group according to whether PPCs occurred during hospitalization, and the differences between the parameters were compared.Logistic regression analysis was used to analyze the independent risk factors for PPCs.Stratification analysis and interaction test were used to further analyze the relationship between frailty and PPCs.Results:A total of 298 elderly patients with non-small cell lung cancer undergoing thoracoscopic lobectomy were included in this study, and the incidence of PPCs was 22.8%.Compared with non-PPC group, the albumin and FEV 1/FVC were decreased, and age, blood creatinine, ratio of diabetes mellitus, ratio of chronic obstructive pulmonary disease (COPD) and rate of preoperative frailty were significantly increased in PPC group ( P<0.05). The results of logistic regression analysis showed that COPD and preoperative frailty were independent risk factors for PPCs.After adjusting all the risk variables, the frail patients had a 171% increased risk of PPCs compared with non-frail patients ( OR value=2.71, 95%CI: 1.18-4.73, P<0.05). The results of subgroup analysis showed that body mass index and operation time had effect modification on the association between frailty and PPCs (interaction P<0.05). Conclusion:COPD and preoperative frailty are independent risk factors for PPCs in elderly patients undergoing thoracoscopic lobectomy, and the frail patients with obesity or long operation time are at higher risk of PPCs.

Objective:To evaluate the relationship between preoperative malnutrition and postoperative pulmonary complications (PPCs) in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.Methods:The elderly patients who underwent elective thoracoscopic and laparoscopic radical esophagectomy in the Affiliated Hospital of Jiangnan University were enrolled.The general clinical data and nutritional status, Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) score, tumor pathological stage and operation-related variables based on the Gobal Leader Initiative on Malnutrition criteria were recorded.The patients were divided into 2 groups according to whether PPCs occurred during hospitalization, and the differences between the variables were compared.Logistic regression analysis was used to identify the risk factors for PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy.The accuracy of the ARISCAT score and ARISCAT score combined with malnutrition in predicting the occurrence of PPCs was evaluated by receiver operating characteristic curve.Results:A total of 256 elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy were included, and the incidence of PPCs was 23.8%.There were no significant differences between patients with and without PPCs in FEV 1/FVC, age, American Society of Anesthesiologists physical status, chronic obstructive pulmonary disease ratio, malnutrition ratio and ratio of patients with high ARISCAT score ( P<0.05). The results of logistic regression analysis showed that increasing age, chronic obstructive pulmonary disease, malnutrition and high ARISCAT score were independent risk factors for PPCs.The area under the receiver operating characteristic curve of ARISCAT score and malnutrition combined with ARISCAT score in predicting the occurrence of PPCs was 0.722 and 0.777, respectively, and the difference was statistically significant ( P<0.05). Conclusions:Preoperative malnutrition is an independent risk factor for the occurrence of PPCs in elderly patients undergoing thoracoscopic and laparoscopic radical esophagectomy, which is helpful in improving the accuracy of ARISCAT score in predicting the occurrence of PPCs.

Objective:To explore the clinical significance of thrombelastography (TEG) and conventional coagulation tests (CCTs) in the diagnosis of trauma-induced coagulopathy(TIC) and the risk factors for TIC.Methods:Traumatic patients hospitalized in PICU at Shengjing Hospital of China Medical University from December 1, 2017 to January 31, 2019 were divided into three groups according to injury severity score(ISS): non-severe group(≤16 points), severe group (17-25 points) and extremely severe group(>25 points). All patients received 2.5 mL of venous blood at admission/after 6 h, 12 h, 24 h, and 48 h injury to detect TEG and CCTs.The prevalence, time of onset, recovery time of coagulation function and risk factors for TIC were summarized.Results:A total of 64 cases were collected, including 18 non-critical cases, 28 critical cases and 18 extremely critical cases.TEG and CCTs were used to diagnose TIC in nine cases(14.1%)and four cases(6.3%), respectively.TIC could be diagnosed by TEG at 6 hours after trauma, and 12 hours for CCTs.TEG was used to diagnose four cases of hypercoagulability.Univariate analysis showed that female, blood transfusion, transfusion, shock, multiple organ dysfunction syndrome, mechanical ventilation, hypothermia, low age, low glasgow coma scale (GCS) and high ISS were all risk factors for TIC.Logistics regression analysis found that children with high-risk factors such as girl, hypothermia, shock and mechanical ventilation were 4.333, 17.889, 10.208, and 4.479 times more likely to develop TIC than those without high-risk factors.For every 1 score increase in the ISS score, the risk of TIC increased by 1.147.As the age increased by 1 year, GCS increased by 1 point, and the risk of TIC decreased by 0.765 and 0.817, respectively, which were protective factors for TIC.Conclusion:TEG and CCTs are consistent in the diagnosis of TIC, but TEG is more sensitive at an earlier stage and can detect hypercoagulability.Female, shock, hypothermia, low age, high ISS, and low GCS are risk factors for TIC.