Objective To evaluate the risk clinic factors of severe community-acquired pneumonia in older adults,and to provide examples for its clinic application.Methods Sixty-four case patients who were admitted for a diagnosis of severe community-acquired pneumonia in older adults in Beijing Haidian Hospital from January 2013 to July 2015 were selected as observation group.One hundred cases patients also admitted for a diagnosis of community-acquired pneumonia were selected as control group.Within 24 h of admission,the clinical data were collected,medical history were collected,and the serum biochemistry,coagulation index fibrin degradation product,D-dimer and inflammatory factor procalcitonin were detected.The data were analyzed by univariate analysis,and logistic regression analysis was used to analyze the variables with significant difference in single factor analysis.Results Single factor analysis showed that the percentage of severe pneumonia with central nervous system disorders,severe pneumonia with aspiration,severe pneumonia with two or more comorbidities,aspiration and severe pneumonia with bedridden patient in observation group were obviously higher than the control group,the difference between two groups have remarkable statistical significance((82.21％ (53/64) vs.32％(32/100),60.93％(39/64) vs.1％(1/100),(84.37％,54/64) vs.54％(54/100),90.62％(58/ 64) vs.28％ (28/100),59.37％ (38/64) vs.11％ (11/100);P＜0.01 or P＜0.05).The mortality of observation group was higher than the control group,the difference between two groups have remarkable statistical significance(56.62％ (36/64)] vs.3％ (3/100),P=0.001).Albumin of severe pneumonia was obviously lower than the control group,the difference between two groups have remarkable statistical significance ((27.79 ±8.53) g/L vs.(33.66±9.63) g/L,P=0.011).Fibrin degradation product of severe pneumonia was obviously lower than the control group,the difference between two groups have remarkable statistical significance ((i0.98 ± ± 1.32) ng/L vs.(3.61±0.98) ng/L,P=0.002).D-dimer of severe pneumonia was obviously higher than the control group,the difference between two groups have remarkable statistical significance ((2.68± 0.56) mg/L vs.(0.42±0.12) mg/L,P=0.001).Procalcitonin of severe pneumonia was obviously higher than the control group,the difference between two groups have remarkable statistical significance ((1.63±0.32) ng/L vs.(0.13 ± ±0.21) ng/L,P =0.015).The result of multiple factors logistic regression analysis showed the aspiration,hypoproteinemia,D-dimer were severe community-acquired pneumonia in older adults's independent risks (OR =1.782,1.208,1.356,P＜0.05).Conclusion Aspiration,hypoproteinemia,D-dimer are the factors of risking suffering severe community-acquired pneumonia in older adults.D-dimer could be the detection index of severe community-acquired pneumonia in older adults.

BACKGROUND:The blood loss and the need of blood transfusion after bilateral total knee arthroplasty are very high. Therefore, the use of medicine such as tranexamic acid in total knee arthroplasty is overheated in recent years. Tranexamic acid has been proved to be able to decrease the blood loss after total knee arthroplasty, while the study of its use in bilateral total knee arthroplasty is seldom. OBJECTIVE:To observe the effect and safety of tranexamic acid on perioperative blood loss and the change of hemoglobin in patients undergoing bilateral total knee arthroplasty. METHODS: We selected 69 patients who received bilateral total knee arthroplasty and divided them into two different groups randomly. The patients in the experimental group were given 1 g of tranexamie acid dissolved in 100 mL of 5% glucose solution through intravenous infusion. Those in control group were only given 5% glucose solution 100 mL. Total blood loss, intraoperative blood loss, the hidden blood loss, amount of postoperative drainage, the ratio of blood transfusion, hemoglobin, D-dimer, prothrombin time and activated partial thromboplastin time were studied and compared between the two groups. We also observed the incidence of thrombotic events between the two groups. RESULTS AND CONCLUSION:The blood loss of the experimental group was significantly lower compared to the control group (t=2.194-2.908,P < 0.05). The blood transfusion rate of experimental group was significantly lower compared to the control group (χ2=5.219,P=0.022). The hemoglobin of the experimental group was significantly higher than that of the control group at 3 and 5 days after replacement (t=-3.481, 2.319,P < 0.05). No significant difference in prothrombin time and activated partial thromboplastin time was detectable between the two groups before and after replacement (P > 0.05). Thrombotic events were not visible in both groups. Venous ultrasonography in the lower extremity did not reveal deep venous thrombosis. Above results suggest that tranexamic acid can significantly reduce intraoperative blood loss in patients undergoing bilateral total knee arthroplasty, decreases the requirement of blood transfusion and the dynamic change of hemoglobin, and does not increase the risk of thrombosis.

Objective To explore the expressions and significance of brain natriuretic peptide (BNP),hypersensitive C-reactive protein (hs-CRP),human fibrinogen (Fib),D-Dimer and blood gas analysis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pulmonary hypertension (PH).Methods Totally 135 patients with AECOPD were divided into single AECOPD group (n =75) and AECOPD + PH group (n =60).The value of pulmonary systolic pressure (PASP) was measured by echocardiography.Serum BNP,hs-CRP,D-Dimer,Fib levels and arterial blood gas analysis indexes such as p(CO2) and p(O2) were compared between two groups.Results The levels of hs-CRP,BNP,D-Dimer and p(CO2) in AECOPD + PH group were significantly higher than those in AECOPD group (P ＜ 0.05),while p (O2) in AECOPD + PH group was significantly lower than that in AECOPD group.Multiple linear regression analysis showed that the levels of hs-CRP,Fib,BNP,D-Dimer and p (CO2) were positively correlated with pulmonary artery pressure (P ＜ O.05),and p (02) was negatively correlated with PASP (P ＜ 0.05).Conclusion The hs-CRP,Fib,BNP,and D-Dimer participate in the formation of AECOPD complicated with pulmonary hypertension,and systemic inflammation plays an important role in the pathogenesis of AECOPD complicated with pulmonary hypertension.

Objective To explore the expressions and significance of brain natriuretic peptide (BNP),hypersensitive C-reactive protein (hs-CRP),human fibrinogen (Fib),D-Dimer and blood gas analysis in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pulmonary hypertension (PH).Methods Totally 135 patients with AECOPD were divided into single AECOPD group (n =75) and AECOPD + PH group (n =60).The value of pulmonary systolic pressure (PASP) was measured by echocardiography.Serum BNP,hs-CRP,D-Dimer,Fib levels and arterial blood gas analysis indexes such as p(CO2) and p(O2) were compared between two groups.Results The levels of hs-CRP,BNP,D-Dimer and p(CO2) in AECOPD + PH group were significantly higher than those in AECOPD group (P ＜ 0.05),while p (O2) in AECOPD + PH group was significantly lower than that in AECOPD group.Multiple linear regression analysis showed that the levels of hs-CRP,Fib,BNP,D-Dimer and p (CO2) were positively correlated with pulmonary artery pressure (P ＜ O.05),and p (02) was negatively correlated with PASP (P ＜ 0.05).Conclusion The hs-CRP,Fib,BNP,and D-Dimer participate in the formation of AECOPD complicated with pulmonary hypertension,and systemic inflammation plays an important role in the pathogenesis of AECOPD complicated with pulmonary hypertension.

Objective:To investigate the protective function and mechanism of β-hydroxybutyrate (β-HOB) on cisplatin (CP)-induced nephrotoxicity.Methods:C57BL/6 male mice aged 10 weeks were randomly divided into the following three groups: control group (no special treatment), β- HOB+CP group (mice received intraperitoneal injection of 20 mmol/kg β-HOB for 10 days), CP group (received intraperitoneal injection of normal saline for 10 days). CP group and β-HOB+CP group were given once cisplatin (20 mg/kg) intraperitoneal injection on the 8th day in the experiment. On the 10th day, all the mice were sacrificed. Renal pathology was evaluated by HE staining; blood samples were collected for blood urea nitrogen (BUN) and serum creatinine (Scr) measurement; immunohistochemistry staining was performed to detect the protein level of Caspase3, Cleaved-caspase3, mitogen-activated protein kinase (MAPK) and nuclear factor-κB (NF-κB) in renal tissues; Western blotting was used to detect the relative expression levels of p-MAPK/MAPK and p-NF-κB/NF-κB. In vitro experiment, HK-2 cells were set into three groups: control group, CP group, β-HOB+CP group, and β-HOB+CP+Sappanone A (Sap, MAPK-p38 activator) group. The expression levels of p-MAPK, p-NF-κB, Caspase3 and Cleaved-caspase3 were tested by cell immunofluorescence. The cell apoptosis and mitochondrial membrane potential (MMP) were examined by flow cytometry. DNA damage was detected by TUNEL staining. Results:In vivo experiments, the renal pathological injury score, BUN and Scr in CP group were significantly higher than those in control group (all P<0.05), while renal pathological injury score, BUN and Scr in β-HOB+CP group were lower than those in CP group (all P<0.05). The protein expression levels of p-MAPK, p-NF-κB, Caspase3 and Cleaved-caspase3 in CP group were higher than those in control group, while these indexes in β-HOB+CP group were lower than those in CP group (all P<0.05). In vitro experiments, compared with CP group, the MMP was higher in β-HOB+CP group; the ratio of cell apoptosis, the expression of Caspase3, Cleaved-caspase3, p-MAPK and p-NF-κB, and the number of TUNEL staining positive cells were significantly lower (all P<0.05). Compared with β-HOB+CP group, the MMP in β-HOB+CP+Sap group was lower; the ratio of cell apoptosis, the expression of Caspase3 and Cleaved-caspase3, and the number of TUNEL staining positive cells were significantly higher (all P<0.05). Conclusions:β-HOB can alleviate the acute renal injury induced by cisplatin, which may be related to the reduction of apoptosis and inhibition of MAPK/NF-κB pathway.

Present study aimed to investigate the eff ect of curcumin-pretreatment on intestinal I/R injury and on intestinal mucosa barrier. Thirty Wistar rats were randomly divided into: sham, I/R, and curcumin groups (n=10). Animals in curcumin group were pretreated with curcumin by gastric gavage (200 mg/kg) for 2 days before I/R. Small intestine tissues were prepared for Haematoxylin & Eosin (H&E) staining. Serum diamine oxidase (DAO) and tumor necrosis factor (TNF)-alpha levels were measured. Expression of intestinal TNF-alpha and tight junction protein (ZO-1) proteins was detected by Western blot and/or immunohistochemistry. Serum DAO level and serum and intestinal TNF-alpha leves were signifi cantly increased after I/R, and the values were markedly reduced by curcumin pretreatment although still higher than that of sham group (p<0.05 or p<0.001). H&E staining showed the significant injury to intestinal mucosa following I/R, and curcumin pretreatment signifi cantly improved the histological structure of intestinal mucosa. I/R insult also induced significantly down-regulated expression of ZO-1, and the eff ect was dramatically attenuated by curcumin-pretreatment. Curcumin may protect the intestine from I/R injury through restoration of the epithelial structure, promotion of the recovery of intestinal permeability, as well as enhancement of ZO-1 protein expression, and this eff ect may be partly attributed to the TNF-alpha related pathway.
Amine Oxidase (Copper-Containing) ; Animals ; Blotting, Western ; Curcumin* ; Eosine Yellowish-(YS) ; Immunohistochemistry ; Intestinal Mucosa ; Intestine, Small ; Intestines ; Permeability ; Rats, Wistar ; Reperfusion Injury* ; Tight Junctions* ; Tumor Necrosis Factor-alpha* ; Zonula Occludens-1 Protein*

Objective To analyze the interventional effect of high-flow nasal cannula oxygen(HFNC)therapy in patients with stable chronic obstructive pulmonary disease(COPD)combined with hypercapnia.Methods A total of 45 patients with stable COPD complicating with hypercapnia who require long-term oxygen therapy were selected as study subjects.They were divided into three groups based on different respiratory support modes:long-term home oxygen therapy(LTOT)group,non-invasive ventilation(NIV)group,and HFNC group,with 15 patients in each group.The general condition,blood gas index,lung function index,respiratory status,quality of life,and walking test results of the three groups were compared after discharge.Results During the follow-up period,the number of admission and acute exacerbation in the HFNC group and NIV group was lower than that in the LTOT group(P＜0.05).At 6 and 12 months after discharge,the arterial partial pressure of car-bon dioxide[pa(CO2)]in the three groups was lower than before discharge,while the arterial partial pressure of oxygen[pa(O2)],pulse oxygen saturation(SpO2),forced vital capacity(FVC),and forced expiratory volume in one second(FEV1)were higher than before discharge.Moreover,the changes in the above indicators in the HFNC group were greater than those in the NIV group and LTOT group(P＜0.05).At 1-,3-,6-,and 12-month after discharge,the scores of dyspnea scale of the modified Medical Research Council(mMRC)and the St.George's Respiratory Questionnaire(SGRQ)in the three groups gradually decreased,and the 6-minute walking distance(6MWD)grad-ually increased.Additionally,the changesin the above indicators in the HFNC group were greater than those in the NIV group and LTOT group(P＜0.05).Conclusion HFNC can effectively alleviate dyspnea symptoms,improve lung function,promote the recovery of blood gas indicators,enhance quality of life and exercise tolerance,and reduce re-hospitalization rates in patients with stable COPD combined with hypercapnia.

Objective: To understand the oral health status and associated factors of preschool children with disabilities in Bengbu City, so as to provide evidence for preventing dental caries in children with disabilities. Methods: From September 2021 to March 2022, a total of 405 preschool children with disabilities from two rehabilitation institutions in Bengbu were randomly selected for oral health examination, questionnaire survey and physical examination. The caries prevalence rate among disabled children was analyzed. After grouping based on childrens BMI, the correlation between body mass index (BMI) and dental caries among children was explored. Multivariate binary Logistic regression analysis was employed to investigate the factors associated with dental caries occurrence in children. Results: The prevalence of dental caries in preschool children with disabilities was 74.07%, with rates of 71.01% for boys and 77.27% for girls. There was a significant difference in caries prevalence between boys and girls aged 5（66.67%，88.24%） (χ2=7.53, P<0.05). There were significant differences in the dmft index among different BMI groups (underweight: 240, normal weight: 606, overweight:30,obese:60,H=35.66,P<0.05). BMI was negatively correlated with dmft（r=-0.50，P＜0.01）. Frequent tooth brushing (2-3 times daily), the use of fluoride toothpaste, limited intake of sugary foods (< 2 times/d) in the past six months, and exclusively breastfeeding within first six months were negatively correlated with the occurrence of dental caries in disabled children (OR=0.09，0.41，0.24, P＜0.05). Sleep forward to eat，parental education level of junior high school or lower, and parental education of vocational school or high school were positively correlated with dental caries (OR=3.18，5.95，3.99，66.95，7.75，P＜0.05). Conclusions The caries prevalence rate of disabled children in Bengbu City is high and is influenced by multiple factors. It is time to strengthen the oral health training for parents and teachers in educational institutions, pay attention to childrens oral health care, and help disabled children improve their quality of life.

Objective To analyze the interventional effect of high-flow nasal cannula oxygen(HFNC)therapy in patients with stable chronic obstructive pulmonary disease(COPD)combined with hypercapnia.Methods A total of 45 patients with stable COPD complicating with hypercapnia who require long-term oxygen therapy were selected as study subjects.They were divided into three groups based on different respiratory support modes:long-term home oxygen therapy(LTOT)group,non-invasive ventilation(NIV)group,and HFNC group,with 15 patients in each group.The general condition,blood gas index,lung function index,respiratory status,quality of life,and walking test results of the three groups were compared after discharge.Results During the follow-up period,the number of admission and acute exacerbation in the HFNC group and NIV group was lower than that in the LTOT group(P＜0.05).At 6 and 12 months after discharge,the arterial partial pressure of car-bon dioxide[pa(CO2)]in the three groups was lower than before discharge,while the arterial partial pressure of oxygen[pa(O2)],pulse oxygen saturation(SpO2),forced vital capacity(FVC),and forced expiratory volume in one second(FEV1)were higher than before discharge.Moreover,the changes in the above indicators in the HFNC group were greater than those in the NIV group and LTOT group(P＜0.05).At 1-,3-,6-,and 12-month after discharge,the scores of dyspnea scale of the modified Medical Research Council(mMRC)and the St.George's Respiratory Questionnaire(SGRQ)in the three groups gradually decreased,and the 6-minute walking distance(6MWD)grad-ually increased.Additionally,the changesin the above indicators in the HFNC group were greater than those in the NIV group and LTOT group(P＜0.05).Conclusion HFNC can effectively alleviate dyspnea symptoms,improve lung function,promote the recovery of blood gas indicators,enhance quality of life and exercise tolerance,and reduce re-hospitalization rates in patients with stable COPD combined with hypercapnia.