Objective To observe the short-term and long-term effect of mask bi-level positive airway pressure (BiPAP) combined with recombinant human brain natriuretic peptide (rhBNP) on acute heart failure.Methods One hundred cases of acute heart failure patients were divided into BiPAP combined with rhBNP group (51 cases) and conventional treatment group (49 cases) by random digits table.Conventional treatment group was given routine drug for heart failure treatment,and BiPAP combined with rhBNP group on the basis of routine treatment,was given BiPAP combined therapy with rhBNP.Arterial blood oxygen partial pressure (PaO2),arterial blood oxygen saturation (SaO2),and the change of clinical symptoms were recorded before and 30 min,2 h after treatment.All patients were followed up for 3 months,and cardiovascular events,related parameters of echocardiography and 6 min walking distance test were compared between two groups.Results Clinical symptoms (respiratory frequency and heart rate) and blood gas analysis index (PaO2,SaO2) were significantly improved after treatment in two groups,and BiPAP combined with rhBNP group improved more significantly.There was significant difference (P ＜ 0.05).After 3 months' follow-up,the incidence of cardiovascular events in BiPAP combined with rhBNP group was lower than that in conventional treatment group [17.6％ (9/51) vs.38.8％ (19/49),P ＜ 0.05].The left ventricular end-diastolic diameter (LVEDd),left ventricular ejection fraction (LVEF) in BiPAP combined with rhBNP group was better than that in conventional treatment group [(55.0 ± 6.1) mm vs.(63.3 ± 6.5) mm,(52.5 ±7.2)％ vs.(44.7 ± 6.8)％] (P ＜ 0.05).The 6 min walking distance test in BiPAP combined with rhBNP group was higher than that in conventional treatment group [(325.6 ± 36.4) m vs.(210.2 ± 34.1) m] (P ＜0.05).Conclusion BiPAP combined with rhBNP in short-term treatment of acute heart failure is effective and safe,and can improve the long-term prognosis of patients.

OBJECTIVE: To evaluate the effectiveness of glucocorticoid in the management of olfaction in patients with chronic rhinosinusitis accompanied with nasal polyposis. METHOD: The published studies of the effectiveness of glucocorticoid in the management of chronic rhinosinusitis with nasal polyposis were searched in the Medline, Cochrane, EMBASE, Springer and CNKI databases(from the date of establishment of the databases to December 2014). The trails selection based on inclusion criteria and the quality of the included studies was assessed and meta-analysis was performed with RevMan 5. 3 software. RESULT: A total of 5 trials involving 325 patients were included. The Meta-analysis showed that oral glucocorticoid showed more significant improvement in subjective olfaction scores compared to placebo [SMD = -2.22, 95% CI (-3.94 - -0. 49), P < 0.05], oral glucocorticoid also showed significant improvement in objective olfaction scores compared to placebo [SMD = 0.65, 95% CI (0.28-1.01), P < 0.05]. But subsequent use of nasal glucocorticoid had no impact on subjective and objective olfaction scores [SMD = -2.15, 95% CI (-5.67-1.38), P > 0.05], [SMD = 0.28, 95% CI (-0.08-0.64) P > 0.05]. CONCLUSION According to current evidence, oral glucocorticoid can significantly improve subjective and objective olfaction among patients with CRSwNP, but nasal glucocorticoid cannot improve subjective or objective olfaction dysfunction.
Chronic Disease ; Clinical Trials as Topic ; Glucocorticoids ; therapeutic use ; Humans ; Nasal Polyps ; complications ; drug therapy ; Sinusitis ; complications ; drug therapy ; Smell ; drug effects

Objective To construct a colon cancer chemotherapy-resistant cell line COLO,and study its characteristics and its relationship with tumor stem cells.Methods We constructed two 5-fluorouraci (5-FU)-resistant colon cancer cell line COLO/5-FU-1 and COLO/5-FU-2, which were resistant to 0.1 0 μmol/ml and 0.20 μmol/ml 5-FU respectively through gradiently increased drug concentration.The cha-racteristics of 5-FU-resistant cell lines were compared with parental colon cancer cell line COLO related to proli-feration,colony forming ability,migration and invasion,sphere forming ability,expression of stemness genes and cross drug-resistance.Results In the cell viability assay,4 days after regular training,the absorbancy of colon cancer 5-FU-resistant cell lines COLO/5-FU-2,COLO/5-FU-1 and parental colon cancer cell line COLO were 0.61 ±0.1 3,0.54 ±0.07 and 0.41 ±0.09 respectively,with significant difference (F =63.43,P =0.033).With the increased concentration of 5-FU,5-FU-resistant cell lines presented increasing clonality. The cloning efficiency of COLO/5-FU-2,COLO/5-FU-1 and parental colon cancer cell line COLO were (87.6 ±1 2.7)%,(65.3 ±9.7)% and (38.5 ±7.6)% respectively,with significant difference (F =33.64, P =0.01 7).In each high power field of vision,the cell numbers of migration through the basement membrane of COLO/5-FU-2,COLO/5-FU-1 and parental colon cancer cell line COLO were 482 ±39,434 ±45 and 373 ±38 respectively;and the cell numbers of invasion through the basement membrane were 1 74 ±42,1 1 2 ± 31 and 87 ±29 respectively,with significant differences (F =1 09.61 ,P =0.009;F =67.31 ,P =0.032). Compared with parental colon cancer cell line COLO,5-FU-resistant cell lines had higher expression of stem-ness genes (F =47.31 ,P =0.042).5-FU-resistant cell lines were cross-resistant to other chemotherapeutic drugs such as mitoxantrone.For example,after incubation for 96 hours,inhibition rate of mitoxantrone to parent colon cancer cell line COLO was higher significantly than COLO/5-FU-1 and COLO/5-FU-2 (0.749 ± 0.042,0.423 ±0.024,0.342 ±0.01 8),with significant difference (F =1 2.61 ,P =0.028).The micro-sphere forming rates of COLO/5-FU-2,COLO/5-FU-1 and parental colon cancer cell line COLO were (8.90 ± 0.97)%,(6.20 ±0.75)% and (3.90 ±0.32)% respectively,with significant difference (F =1 64.32,P =0.006).Conclusion Colon cancer drug-resistant cell line COLO possess tumor stem cell-like characteristics, which are enriched in cancer stem cells.

To investigate the assessment values of procalcitonin (PCT), lactic acid (LAC), sequential organ failure assessment (SOFA) score and acute physiology and chronic health evaluationⅡ (APACHEⅡ) score in patients with sepsis. Methods 140 patients with suspicious bacterial infection admitted to emergency department of Beijing Chaoyang Hospital of the Capital Medical University from August 2017 to June 2018 were enrolled. They were divided into three groups according to diagnostic criteria of Sepsis-3: non-sepsis group (n = 58), sepsis group (n = 66) and septic shock group (n = 16). The PCT, LAC, SOFA score, APACHEⅡscore, 28-day prognosis, and positive detection rate of PCT and LAC were compared among three groups. Independent predictors of 28-day mortality were analyzed by Logistic regression; predictive values of PCT, LAC, SOFA score and APACHEⅡscore for 28-day mortality in sepsis patients were analyzed by receiver operating characteristic (ROC) curve. Results PCT, LAC, SOFA score, APACHEⅡscore at admission, and 28-day mortality in sepsis group and septic shock group were significantly higher than those in non-sepsis group, and PCT, LAC, APACHEⅡ score, and 28-day mortality in sepsis shock group were further higher than those in sepsis group [PCT (μg/L): 38.1±12.6 vs. 4.6±2.3, LAC (mmol/L):3.3±2.1 vs. 2.4±2.1, APACHEⅡ score: 14.9±2.4 vs. 9.5±4.3, 28-day mortality: 75.0% vs. 24.2%, all P < 0.05]. The positive detection rate of PCT and LAC in sepsis group and septic shock group were higher than those in non-sepsis group (positive detection rate of PCT: 56.1%, 81.3% vs. 32.8%; positive detection rate of LAC: 42.4%, 62.5% vs. 13.7%; all P < 0.01). Logistic regression analysis showed that PCT, LAC, SOFA score and APACHEⅡ score were independent predictors of 28-day mortality [PCT: odds ratio (OR) = 0.933, 95% confidence interval (95%CI) = 0.878-0.991; LAC:OR = 0.539, 95%CI = 0.347-0.838; SOFA score: OR = 0.291, 95%CI = 0.514-0.741; APACHEⅡ score: OR = 0.808, 95%CI = 0.669-0.976; all P < 0.05]. ROC curve analysis showed that the area under ROC curve (AUC) of PCT, LAC, SOFA score and APACHEⅡ score predicting 28-day mortality was 0.76, 0.86, 0.81 and 0.87, respectively. The assessment values of APACHEⅡscore and LAC were higher than PCT in predicting 28-day mortality (Z1 = 2.56, Z2 = 2.45, both P < 0.01), and the performance of SOFA score was similar to PCT. Conclusions PCT, LAC, SOFA score and APACHEⅡscore were reliable indexes to evaluate disease severity for patients diagnosed with infection. The assessment values of APACHEⅡscore and LAC in 28-day mortality were superior to SOFA score and PCT.

Objective:To compare the image quality and the diagnostic efficiency for breast malignant lesions using simultaneous multi-slice single shot echo planar imaging (SMS+SS-EPI) and readout segment of long variable echo trains (RESOLVE) for breast diffusion-weighted imaging (DWI).Methods:This study was a cross-sectional study. Clinical and imaging data of 102 patients with breast lesion from March 2021 to February 2023 in the First Hospital Affiliated to Ningbo University were prospectively analyzed. All patients underwent routine breast MRI scans and cross-sectional RESOLVE and SMS+SS EPI sequence DWI, and the image quality of 2 types sequences of DWI was evaluated. The subjective evaluation was based on a 5-point scale, including geometric distortion, artifact blurring, fat suppression, overall image quality, and lesion conspicuity of the breast. The objective evaluation included signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) value of the lesion. Wilcoxon signed rank sum test was used to compare the subjective and objective parameters between the two sequences. Finally, the receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the effectiveness of ADC values for diagnosing breast malignant lesions based on two sequence images.Results:All 102 female patients had single lesions, aged from 25 to 68 years and 60 lesions were malignant and 42 were benign. The acquisition time for SMS+SS-EPI sequence imaging was 1 min 50 s, and the acquisition time for RESOLVE sequence imaging was 3 min 43 s.The subjective scores from both SMS+SS-EPI and RESOLVE sequence were over than 3 points. The geometric distortion, artifact blurring, and overall image quality scores of RESOLVE sequence images were higher than those of SMS+SS-EPI (all P<0.001). The overall lesion conspicuity score, malignant lesion conspicuity score, and benign lesion conspicuity score of DWI and ADC images combined with SMS+SS-EPI sequence were higher than those of the RESOLVE sequence (all P<0.05). There were no statistically difference in SNR, CNR, overall ADC value, malignant ADC value, and benign ADC value between SMS+SS-EPI and RESOLVE sequence DWI images of breast lesions (all P>0.05). The AUC of RESOLVE sequence ADC value in diagnosis of breast cancer was 0.973, the sensitivity was 0.929, and the specificity was 0.915; The AUC of SMS+SSC-EPI sequence ADC value in diagnosis of breast cancer was 0.956, the sensitivity was 0.977, and the specificity was 0.850. Conclusions:In breast DWI, the subjective score of SMS+SS EPI image quality can basically meet the diagnostic requirements and the conspicuity of lesions is better than that of the RESOLVE sequence. Both have good diagnostic efficacy for malignant breast lesions.

Objective To investigate the level of vascular endothelial growth factor (VEGF), homocysteine (HCY), fibronectin (Fn) and apolipoprotein E (ApoE) in the serum and cerebrospinal fluid patients with stroke to inquire into patients′endothelial function damage.Methods We chose standard stroke patients in Brain Hospital of Hu′nan Province from August 2015 to August 2016, divided into ischemic stroke (IS) group (52 cases) and hemorrhagic stroke (HS) group (33 cases), and chose patients with the cerebrospinal fluid for diagnosis and treatment and ruled out infections, the nervous system and cardiovascular system diseases as control group (20 cases).The serum VEGF, HCY, Fn, and ApoE levels of the patients on the 1 th, 5 th and14 th day after admission were monitored and compared with those in cerebrospinal fluid expression, NIHSS and Barthel were also performed for assessment of severity and prognosis of HS.Results The serum levels of VEGF, HCY and ApoE in HS group were higher than those in IS group, and the Fn level was lower than that in IS group and control group.At the same time, the Fn levels gradually increased on the 5 th and 14 th day after admission (P＜0.05), close to the control group.Cerebrospinal fluid of VEGF, HCY, Fn, and ApoE levels in HS group were higher than those in the control group, while Fn level was lower, and these indexes were lower in cerebrospinal fluid than those in the serum, and the differences were statistically significant (P＜0.05).In correlation analysis, HCY level of cerebrospinal fluid was positively correlated with ApoE in HS patients (r=0.645, P=0.001), HCY and ApoE levels in HS patients were positively correlated with patients′NIHSS score (r=0.547, P=0.006;r=0.720, P＜0.001), and negatively correlated with Barthel index score (r=-0.703, P＜0.001, r=-0.765, P＜0.001, respectively).Conclusion There were vascular endothelial injury and neuroprotective function decreased in brain tissue of stroke patients.The level of Fn was related to the patient′s prognosis, which was conducive to the differentiation of IS and HS.The cerebrospinal fluid levels of HCY and ApoE can be used to evaluate the prognosis of HS patients.

Objective:To establish a clinical diagnostic scoring system for septic cardiomyopathy (SCM) and evaluate its diagnostic efficacy.Methods:A prospective cohort study was performed. Patients with sepsis and septic shock admitted to the department of emergency of China Rehabilitation Research Center were enrolled from January 2019 to December 2020. The baseline information, medical history, heart rate (HR), mean arterial pressure (MAP), body temperature and respiratory rate (RR) on admission were recorded. Laboratory indexes such as white blood cell count (WBC), hypersensitivity C-reactive protein (hs-CRP), N-terminal pro-brain natriuretic peptide (NT-proBNP), and blood lactic acid (Lac) were measured. Transthoracic echocardiography was conducted within 24 hours and on the 7th after admission. Sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluationⅡ(APACHEⅡ), and nutritional risk screening 2002 scale (NRS2002) were also assessed. The patients were divided into two groups according to whether SCM occurred or not. The risk factors of SCM were screened by univariate and multivariate Logistic regression. The cut-off value of continuous index was determined by receiver operator characteristic curve (ROC curve) and discretized concerning clinical data. The regression coefficient β was used to establish the corresponding score, and the clinical diagnostic score system of SCM was established. The diagnostic value of the model was evaluated by ROC curve.Results:In total, 147 patients were enrolled in the study and the incidence of SCM was 28.6% (42/147). Univariate Logistic regression analysis showed the risk factors of SCM included: ① continuous indicators: age, NT-proBNP, RR, MAP, Lac, NRS2002, SOFA, APACHEⅡ; ② discrete indicators: shock, use of vasoactive drugs, history of coronary heart disease, acute kidney injury (AKI). Multivariate Logistic regression analysis after discretization of above continuous index showed that age≥87 years old, NT-proBNP≥3 000 ng/L, RR≥30 times/min, Lac≥3 mmol/L and SOFA≥10 points were independent risk factors for SCM [age ≥87 years: odds ratio ( OR) = 3.491, 95% confidence interval (95% CI) was 1.371-8.893, P = 0.009; NT-proBNP≥3 000 ng/L: OR = 2.708, 95% CI was 1.093-6.711, P = 0.031; RR≥30 times/min: OR = 3.404, 95% CI was 1.356-8.541, P = 0.009; Lac≥3 mmol/L: OR = 3.572, 95% CI was 1.460-8.739, P = 0.005; SOFA≥10 points: OR = 8.693, 95% CI was 2.541-29.742, P = 0.001]. The clinical diagnostic score system of SCM was established successfully, which was composed of age≥87 years old (1 point), NT-proBNP ≥ 3 000 ng/L(1 point), RR≥30 times/min (1 point), Lac≥3.0 mmol/L (1 point), SOFA≥10 points (2 points), and the total score was 6 points. ROC curve analysis showed the cut-off value of the scoring system for diagnosing SCM was 3 points, the area under ROC curve (AUC) was 0.833, 95% CI was 0.755-0.910, P < 0.001, with the sensitivity of 71.4%, and specificity of 86.7%. Conclusion:The clinical diagnostic scoring system has good diagnostic efficacy for SCM and contributes to early identification of SCM for clinicians.

Objective:To investigate the relationship between antibacterial treatment scheme and prognosis, and to analyze the mortality risk factors of bloodstream infection with carbapenem-resistant Klebsiella pneumoniae(CRKP).Methods:A retrospective case-control study was conducted. The CRKP isolated from clinical venous blood samples in the First Medical Center, Chinese PLA General Hospital between January 1, 2013 and December 31, 2018(not included from January 1, 2016 to December 31, 2017) was collected. According to relevant standards, a total of 50 patients with bloodstream infection with CRKP were included. The patients were divided into death (19 cases) or survival (31 cases) group according to their hospitalization outcomes, and clinical data and antibacterial treatment scheme after infection were collected. The clinical features of the two groups and the correlation between different antibacterial treatment regimens and prognosis were compared. Logistics regression model was used to analyze the risk factors for death in CRKP-infected patients.Results:The all-cause mortality rate of patients with CRKP bloodstream infection during hospitalization was 38%(19/50). The age ((66.89±18.13) vs. (55.06±14.39) years old, t=2.555, P=0.014), charlson's comorbidity index ((6.11±2.87) vs. (3.19±1.97), t=4.256, P<0.001) of the death group was higher than that of the survival group. The proportion of patients with chronic obstructive pulmonary disease (42.1%(8/19) vs. 3.2%(1/31), χ2=9.574, P=0.002), Charlson's comorbidity index ≥5 (68.4%(13/19) vs. 22.6%(7/31), χ2=10.314, P=0.001), septic shock (36.8%(7/19) vs. 6.5%(2/31), χ2=5.456, P=0.020), source of lung infection (36.8%(7/19) vs. 9.7%(3/31), χ2=3.868, P=0.049) was higher in death group than those in survival group. Kaplan-meier survival curve showed that the 30-day mortality of appropriate targeted treatment was lower than that of inappropriate targeted treatment ( χ2=8.138, P=0.004). Multivariate analysis showed that septic shock ( OR=56.363, 95% CI: 4.309-737.273, P=0.002) and charlson's comorbidity index ≥5 ( OR=18.605,95% CI: 1.813-190.896, P=0.014) were independent risk factors for mortality in patients with bloodstream CRKP infection. Conclusion:Appropriate targeted therapy can reduce 30-day mortality in patients with CRKP bloodstream infection. In order to reduce the risk of mortality, we should prevent the occurrence of septic shock and strengthen the diagnosis and treatment of patients with Chalson's comorbidity index ≥5.

Objective:To explore the association of Vitamin D (Vit D) nutritional status and prognosis in elderly patients in emergency care settings.Methods:The clinical data of 317 elderly patients admitted in the Emergency Care Unit and Emergency Observation Ward of Beijing Bo'Ai hospital from January 2021 to September 2021 were collected continuously. Blood routine, biochemical indicators, serum interleukin-6 (IL-6), thyroid-stimulating hornone (TSH), cortisol (COR) and 25-hydroxyvitamin D [25(OH)D] levels were detected within 24 hours after enrollment. Patients were divided into severe vitamin D deficiency group and non-severe vitamin D deficiency group according to the level of serum 25(OH)D. Patients were followed up for the treatment with machinery ventilation during hospitalization and 28-day all-cause mortality. Multivariable logistic regression model was used to analyze the association between the Vit D nutritional status and machinery ventilation. In order to evaluate the predictive ability of serum 25(OH)D for the requirement of machinery ventilation, the receiver operating characteristic (ROC) curve was applied and the area under the ROC curve (95% confidence interval) [AUC (95% CI)] was calculated. Cox proportional hazards regression model was used to analyze the association between Vit D nutritional status and 28-day all-cause mortality. Results:Serum 25(OH) level in the machinery ventilation group was significantly lower than that in the non-mechanical ventilation group ( Z = 5.150, P < 0.001). Multivariable logistic regression analysis showed that severe Vit D deficiency ( OR = 7.223, 95% CI: 1.546-33.742, P = 0.012) was independently associated with machinery ventilation. The AUC (95% CI) of serum 25(OH)D for predicting machinery ventilation was 0.825 (0.770-0.871) ( P < 0.001), the predictive cut-off point was 11.0 μg/L, and the Youden index was 0.580, yielding a sensitivity of 0.903 and a specificity of 0.677. Cox regression analysis showed that severe Vit D deficiency ( HR = 2.403, 95% CI: 1.133-5.096, P = 0.022) was an independent predictor of 28-day all-cause mortality in elderly emergency patients. Conclusions:Serum 25(OH)D can be used as an independent predictor of short-term prognosis in elderly emergency patients.

Objective:To establish a 14-day prognosis model for emergency patients with acute ischemic cerebral stroke and evaluate its predictive efficacy.Methods:A prospective cohort study was conducted. Patients with acute ischemic stroke admitted to the emergency department of Beijing Bo’ai Hospital within 72 hours of onset from October 2018 to December 2020 were enrolled. Univariate and multivariate logistic regression analysis were used to screen the risk factors of poor prognosis. The ROC curve was drawn to determine the cut-off value of continuous variables and discretise data with reference to clinical practice. The corresponding scores were set up according to the β regression coefficient of each variable, and the clinical scale prediction model of short-term prognosis of acute cerebral infarction was established. Patients with ischemic stroke in the hospital from January to December 2021 were selected as the internal validation, to verify the constructed predictive model.Results:A total of 321 patients were included in the study, including 223 in the training set and 98 in the internal validation set. Multivariate logistic regression analysis showed that age, hypersensitive C-reactive protein, prealbumin (PA), infarct volume, Frailty Screening Questionnaire (FSQ) and National Institute of Health Stroke Scale (NIHSS) were independent risk factors for poor short-term prognosis of acute cerebral infarction. The total score of the clinical prediction scoring system for short-term prognosis of acute cerebral infarction in the emergency department was 15 points, including age ≥74 years (1 point), PA ≤373 mg/L (2 points), large artery atherosclerosis (1 point), cardiogenic embolism (2 points), infarct volume ≥ 2.18 cm 3 (2 points), FSQ ≥3 points (1 point), NIHSS ≥4 points (6 points); The area under the ROC curve (AUC) of the scoring system for predicting short-term poor prognosis of acute cerebral infarction was 0.927 (95% CI: 0.894-0.960). The optimal cut-off value was ≥5 points, and the sensitivity and specificity were 0.770 and 0.976, respectively. In the internal validation set, the scoring system had similar predictive value for poor outcomes (AUC=0.892, 95% CI:0.827-0.957). Conclusion:The scoring system for short-term prognosis prediction of acute ischemic cerebral infarction has good diagnostic efficacy, and could guide clinicians to judge the prognosis of emergency patients in the early stage.