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Objective To observe the clinical sedativelefficacy of Tianwang-Buxin Dan treating chronic obstructive pulmonary disease patients undergoing mechanical ventilation.Methods 97 patients with chronic obstructive pulmonary disease undergoing mechanical ventilation were randomly recruited into a treatment group (47 cases) and a control group (50 cases).The control group was treated with midazolam and fentanyl,and the treatment group were treated by Tianwang-Buxin Dan on the basis of the control group.The amount of medazolam and fentanyl,duration of MV,and incidence of side-effects such as hypotension,bradycardia,delirium,nausea,etc were observed in both groups.Results The expected sedative and analgesia scores were obtained in patients of both groups.Compared with the control group,the patients in the treatment group were easier to be aroused and be kept in sedation and analgesia state,besides the dose of midazolam (μg/kg·h-1) (9.51 ±5.87 vs 20.01 ±6.24,P＜0.01)and fentanyl (μg/kg·h-1) was significantly fewer (0.22 ±0.13 vs 0.32±0.12,P＜0.05),duration of MV (days) was shorter(7.13±6.25 vs 12.85±9.13,P＜0.01),duration of disable sedatives for extubating (hours)was shorter (4.35 ± 2.57 vs 8.79±4.02,P＜0.01),the rates of hypotensionand brdycarcardia were significantly lower,the rates of delirium and nausea were clearly lower(both P＜0.05)in the treatment group.Conclusion Sedative effect of Tianwang-Buxin Dan is satisfactory for patients with chronic obstructive pulmonary disease undergoing mechanical ventilation,with the property of easier arousal,lower hypotension rates,lower brdycarcardia rates,lower delirium rates nausea rates,and fewer dosage of midazolam (by 50％) and fentanyl (by 30％) administration.

Objective To identify the imaging features of pancreatic acinar cell carcinomas.Methods Eleven patients of pancreatic acinar cell carcinomas proven surgically and pathologically were included.We retrospectively evaluated the CT and MR findings including the location, size, shape, margin, necrosis , calcification, hemorrhage, enhancement degree, enhancement pattern, invasion to other organs, perilesional lymph nodes, metastasis, recurrence.Results The tumors were distributed in the head(n=4), body and tail(n=4),tail(n=3) of pancreas.The median tumor size was 97 mm(27 to 180 mm).Nine cases presented with a well-defined enhancing capsule.Tumor vessels could be seen in 9 cases.Seven cases were hypovascular while the other 4 were hypervascular.Different extents of necrosis could be seen in all masses as a swirling or cleft low density in the enhanced tumors, with an median of 10％ (2％ to 25％).The hypovascular masses more frequently demonstrated a lobulated tumor, heterogeneous enhancement pattern, with a larger necrotic component and were more common invasion to other organs.Conclusions Pancreatic acinar ccll carcinoma typically presents as a sizable pancreatic mass with a well-defined enhancing capsule.

Objective To observe the influence of Xiaoshuan enteric-coated Capsule (XSECC) on neuronal damage in cortex of cerebral hypo-perfusion rats. Methods Rats were divided into a sham group (12), a model group (17), a XSECC large dose group (15), a medium dose group (15) and a low dose group (15) by a random number table. The cerebral hypo-perfusion model was produced by permanent bilateral common carotid artery ligation (2VO). The mixed suspension of XSECC was given orally to rats in the XSECC large dose group (420 mg/kg), the medium dose group (140 mg/kg) and the low dose group (47 mg/kg) once each day for 40 days from the beginning of two hour after ischemia. The expressions of NeuN and Caspase-3 were observed by immunofluorescence staining at 40 days after ischemia. The content of GSH-PX,SOD and MDA were measured by biochemical assay. Results Compared to the model group, the expressions of NeuN (8 716.86 ± 2 539.93, 9 549.31 ± 1 663.26 vs. 7 297.05 ± 1 932.49) were significantly increased in the XSECC large dose group and the medium dose group (P<0.05 or P<0.01);The content of GSH-PX (7.37 ± 1.08 U/mg, 7.77 ± 3.26 U/mg vs. 3.67 ± 2.52 U/mg) was increased in the XSECC large dose group and the medium dose group(P<0.05); The expressions of Caspase-3 (11.65 ± 2.68, 14.05 ± 4.55, 12.60 ± 4.56 vs. 16.80 ± 5.41) were obviously decreased in the XSECC large dose group, the medium dose group and the low dose group, compared with the model group (P<0.05 or P<0.01);The content of MDA (1.44 ± 0.40 nmol/mg, 1.96 ± 1.13 nmol/mg, 2.12 ± 1.19 nmol/mg vs. 3.19 ± 0.98 nmol/mg )was decreased in the XSECC large dose group, the medium dose group and the low dose group when compared with the model group (P<0.05 or P<0.01);The content of SOD (555.61 ± 92.45 U/mg, 607.90 ± 228.45 U/mg, 515.98 ± 184.01 U/mg vs. 348.12 ± 108.84 U/mg) was increased in the XSECC large dose group, the medium dose group and the low dose group when compared with the model group (P<0.05 or P<0.01). Conclusion XSECC could protect injured neurons, which is related to the improvement of free radical metabolism.

OBJECTIVE To study the effect of different concentrations of 17-AAG and EGCG monotherapy or in combination on the induced apoptosis in human nasopharyngeal carcinoma, and to explore new molecular targets for the treatment of nasopharyngeal carcinoma. METHODS MTT colorimetric method and fluorescent staining were used to detect the change of CNE proliferation inhibition rate and cell morphology. And furthermore, the expression level of Bcl-2, Bax, Caspase-3 were detected by RT-PCR. RESULTS 1. 17-AAG or EGCG alone had inhibitory effect on the human nasopharyngeal carcinoma CNE cells at 24 h, 48h and 72 h, and it was related with time and dose(P<0.01). The inhibition effect of combination of 17-AAG and EGCG was significantly increased,which was time and dose dependent(P<0.01). 2. RT-PCR was used to detect the mRNA expression level of Bcl-2, Bax and caspase-3. The level of Caspase-3 and Bax mRNA expression after treated by 17-AAG and EGCG was significantly higher, and the level of bcl-2 mRNA expression was lower than that after treated by 17-AAG or EGCG alone. CONCLUSION Our investigation implied that 17-AAG and EGCG in combination can effectively inhibit the proliferation of human nasopharyngeal carcinoma CNE cells. The involved mechanisms may be associated with the upregulation of Bax and Caspase-3 expression.

Objective To investigate the influence of Wenxin granule combined with trimetazidine on inflam-matory factors and cardiac function in patients with chronic heart failure(CHF).Methods From January 2015 to November 2016,100 patients with CHF in Tengnan Hospital of Zaozhuang Mining Industry Group were chosen,and were divided into control group and research group.The control group was treated with trimetazidine,the research group was treated with Wenxin granule on the basis of the control group.After treatment for 6 months,the clinical effects,cardiac function,inflammatory factors and adverse reactions between the two groups were compared.Results The total effective rate of the research group was higher than that of the control group,the difference was statistically significant (90.00% vs.72.00%,χ2＝5.263,P＜0.05).Before treatment,the cardiac function between the two groups had no statistically significant differences(t＝0.062,0.185,0.511,all P＞0.05).After treatment,the LVEF of the research group was higher than that of the control group,the LEVSD and LVEDd of the research group were lower than those of the control group,the differences were statistically significant (t＝12.754,7.936,7.367,all P＜0.05).Before treat-ment,the inflammatory factors between the two groups had no statistically significant differences(t＝0.145,0.156,all P＞0.05).After treatment,the levels of IL－6 and TNF－αof the research group were lower than those of the control group,the differences were statistically significant (t ＝6.366,10.473,all P ＜0.05 ).During the treatment,all patients had no adverse drug reactions such as vomiting,dizziness,irritability,nausea and so on.There was no signifi-cant change in liver and kidney function and hematuria.Conclusion Wenxin granule combined with trimetazidine can furtherly improve the inflammatory reactions and cardiac function of patients with CHF,it is conducive to the improvement of clinical efficacy.

Objective: To summarize the clinical features and genetic analysis results of 10 children with Dent disease. Methods: The clinical data and gene test results of 10 boys aged from 8 months to 12 years with Dent disease diagnosed in Children's Hospital of Nanjing Medical University from January 2014 to July 2017 were analyzed retrospectively. Results: All patients had insidious onset, 5 cases were found to have proteinuria on routine urine examination after hospitalization duo to other diseases, 4 cases were admitted to hospital because increased foams in the urine, and 1 case was found to have proteinuria on health checkup. All cases presented with low molecular weight proteinuria, urine protein electrophoresis showed that the proportion of low molecular weight protein was greater than 50%, 7 cases had nephrotic-range proteinuria, but none had hypoproteinemia. Six cases had hypercalciuria, 3 cases had nephrocalcinosis, 1 case had nephrolithiasis, 2 cases had glomerular microscopic hematuria, in 1 case urine glucose wa weakly positive but blood glucose was normal. All patients had normal renal function, normal serum calcium, no hypophosphoremia and none had rickets. Genetic analysis results showed that 7 patients with variants in the CLCN5 gene, including 2 nonsense variants (p.R637X, p.Y143X), 3 missense variants (p.A540D, p.G135E, p.G703V), 1 deletion variant (exons 9, 10, 11, 12, 13, 1 missing), and 1 frameshift variant (p.T260Tfs*10). Three cases had missense variants of OCRL gene (p.I274T, p.I371T, p.F399S). Except for p.R637X and p.I274T, the other 8 cases had newly discovered variants. Five patients underwent a renal biopsy, the biopsy revealed focal global glomerulosclerosis in 3 patients, mild mesangial proliferative glomerulonephritis in 1 patient and renal minimal change in 1 patient. Mild focal tubular atrophy and interstitial fibrosis were noted in three cases. Mild segmental foot process effacement was noted under electron microscope in all five cases. Conclusions All the children with Dent disease had insidious onset, low molecular weight proteinuria is the main clinical manifestation, most cases presented with nephrotic-range proteinuria, but there was no hypoalbuminemia, some cases were not associated with hypercalciuria. The pathogenic genes in most cases were CLCN5 and a few were OCRL. The types of genetic variation include missense variant, nonsense variant, deletion variant and frameshift variant. Although Dent disease is a renal tubular disease, renal biopsy suggests that most cases are associated with glomerular lesions.

Objective:To investigate the effect of acupoint application combined with modified electroconvulsive therapy (MECT) on life control in patients with bipolar disorder.Methods:A total of 98 patients with bipolar disorder who received treatment in The Third People's Hospital of Huzhou from January to December 2022 were included in this study. They were randomly divided into a control group and an observation group ( n = 49 per group). The control group received acupoint application, while the observation group received acupoint application combined with MECT. All patients were treated for 2 weeks. Before and after treatment, Personal Mastery Scale (PMS), Self-Perceived Burden Scale (SPBS), Perceived Social Support Scale (PSSS), and Bipolar Disorder Self-rating Questionnaire (BSQ) scores were compared between the two groups. The severity of the disease and clinical efficacy were assessed in each group. Results:Before treatment, there were no significant differences in PMS, SPBS, and PSSS scores between the two groups (all P > 0.05). After treatment, PMS scores in the observation and control groups were (31.2 ± 4.5) points and (27.8 ± 4.1) points, respectively, and PSSS scores in the two groups were (66.6 ± 12.3) points and (63.2 ± 10.1) points, respectively. After treatment, PMS and PSSS scores in the observation and control groups were significantly increased compared with those measured before treatment in the corresponding groups [observation group: PMS score (15.6 ± 3.3) points, PSSS score (32.1 ± 6.2) points, control group: PMS score (15.2 ± 3.1) points, PSSS score (34.7 ± 6.6) points, t = 20.50, 16.23, 17.53, 16.54, all P < 0.05]. After treatment, SPBS scores in the observation and control groups [(16.2 ± 3.4) points, (17.7 ± 3.6) points] were significantly decreased compared with those measured before treatment in the corresponding groups [observation group: (30.9 ± 5.8) points, control group: (28.1 ± 5.5) points, t = 15.31, 11.07, both P < 0.05]. After treatment, PMS score in the observation group was significantly higher than that in the control group ( t = 4.45, P < 0.05). Before treatment, there was no significant difference in BSQ score between the two groups ( P > 0.05). After treatment, BSQ scores in the observation and control groups [(14.6 ± 6.5) points, (20.1 ± 7.5) points] were significantly decreased compared with those measured before treatment in the corresponding groups [observation group: (39.5 ± 10.2) points, control group: (36.4 ± 9.5) points, t = 12.32, 21.20, both P < 0.05]. After treatment, BSQ score in the observation group was significantly lower than that in the control group ( t = 5.60, P < 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( χ2 = 4.90, P < 0.05). The Spearman test showed a significant negative correlation between PMS and BSQ scores ( r = -0.689, P < 0.05). Conclusion:Acupoint application combined with MECT therapy can improve life control in patients with bipolar disorder and increase clinical efficacy .

Objective:To investigate the clinical manifestations, pathological characteristics, treatment and prognosis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) in 13 children.Methods:The clinical and pathological data of 13 cases of AAV in children′s Hospital of Nanjing Medical University from June 2000 to December 2021 were retrospectively analyzed.Results:Among the 13 cases, 12 cases were diagnosed with microscopic polyangiitis (MPA) and 1 case was granulomatosis with polyangiitis (GPA), including 10 females and 3 males. The onset age ranged from 3 years and 11 months to 13 years and 10 months. The most frequently involved organ was the kidney (12 cases, 92.3%), followed by respiratory system (7 cases, 53.8%), skin (5 cases, 38.5%), digestive system (4 cases, 30.8%), nervous system (4 cases, 30.8%) and cardiovascular system (3 cases, 23.1%). There were 10 cases with orthotic anemia, 7 cases with positive antinuclear antibody, and 3 cases with mildly decreased complement C3. Among the 12 children with renal impairment, 9 cases were accompanied by abnormal renal function at the beginning of the disease. Renal biopsy was classified according to the Berden as follows: sclerotic in 5 cases, crescentic 3 cases, focal in 2 cases and mixed in 2 cases. All children were treated with glucocorticoid combined with immunosuppressant. During the follow-up time from 8 months to 128 months, 4 cases acquired complete remission, 8 cases achieved partial remission and 1 case recurred after complete remission, and 7 cases progressed to chronic kidney disease stage 5. Three children with complete remission underwent repeated renal biopsy, including 2 cases of mixed type and 1 case of crescent type initially, and all changed to focal type.Conclusions:AAV in children occurs mainly in school-age female, and most of AAV in children is MPA. The clinical manifestations are various. Most of them have renal damage and anemia, and lung damage is also common. Patients with skin purpura onset may be misdiagnosed as Henoch-Schonlein purpura, and AAV with ANA positive or complement reduction should exclude systemic lupus erythematosus. Once the renal function is abnormal in AAV, especially estimated glomerular filtration rate<60 ml·min -1·(1.73 m 2) -1 and the pathological classification is sclerotic type or crescent type, it is difficult to reverse even after active treatment. Early diagnosis and treatment are very important for AAV.

Objective:To analyze the clinical and pathological features of adolescent- onset primary nephrotic syndrome (PNS) in children (10 years≤age≤18 years), so as to explore the renal biopsy indications in adolescent-onset PNS.Methods:It was a single-center retrospective observational study. The clinical and pathological data of adolescent-onset PNS (age≥10 years) who underwent renal biopsy in Children's Hospital Affiliated to Nanjing Medical University from December 2004 to June 2022 were analyzed retrospectively.Results:A total of 110 children were included in the study, including 76 males (69.1%) and 34 females (30.9%), with the onset age ranging from 10 years to 14 years and 9 months. Forty-nine cases (44.5%) were accompanied by hematuria, including 14 cases (12.7%) of gross hematuria and 35 cases (31.8%) of microscopic hematuria. Twenty-five cases (22.7%) had hypertension, 19 cases (17.3%) had renal insufficiency, and 4 cases (3.6%) had low complement C3 at the onset. Fifty-two cases (47.3%) were steroid sensitive nephrotic syndrome and 58 cases (52.7%) were steroid resistant nephrotic syndrome. Biopsy results showed that minimal change disease(MCD) was the most common histopathological subtype (47.3%, 52 case), followed by focal segmental glomerulosclerosis (FSGS) in 22 cases (20.0%), IgA nephropathy (IgAN) in 17 cases (15.5%), membranous nephropathy (MN) in 7 cases (6.4%), mesangial proliferative glomerulonephritis in 5 cases (4.5%), IgM nephropathy in 4 cases (3.6%), membranous proliferative glomerulonephritis in 2 cases (1.8%), and C1q nephropathy in 1 case (0.9%). Among 44 children with simple type nephrotic syndrome, the pathological type was mainly MCD (77.3%), and 66 children with nephritic type nephrotic syndrome were mostly non-MCD (72.7%), such as IgAN, FSGS, MN, etc. If there are two or more clinical manifestations of persistent hematuria, hypertension, renal insufficiency or low C3 levels, the proportion of non-MCD would further increase to 92.0%(23/25). The pathological type of patient with gross hematuria or low C3-emia was non-MCD. The frequency of hematuria (69.0% vs. 17.3%, χ2=29.619, P<0.001), hypertension (31.0% vs. 13.5%, χ2=4.821, P=0.028) and renal insufficiency (24.1% vs. 9.6%, χ2=4.047, P=0.044) in non-MCD group was significantly higher than those in MCD group. Conclusions:If the clinical manifestation of PNS in adolescent over 10 years old is simple type nephrotic syndrome, the histopathological lesion is mostly MCD, and most of them are steroid sensitive. It is recommended to give hormone treatment first, and then perform renal biopsy if steroid resistance occurs; If the clinical manifestation is nephritic type nephrotic syndrome, the histopathological lesion is mostly non-MCD, especially those with gross hematuria or low C3-emia, or those have two or more clinical manifestations of persistent hematuria, hypertension, renal insufficiency and hypocomplement C3-emia, a kidney biopsy should be performed at onset.