Objective To investigate the timing and value of noninvasive ventilation (NIV) as a weaning tool immediately after early extubation in patients with acute respiratory distress syndrome (ARDS).Methods A prospective randomized controlled trial was conducted.The ARDS patients with surgical diseases admitted to Department of Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University were enrolled.The patients were randomly divided into sequential group and control group.All patients underwent endotracheal intubation and were mechanically ventilated.Every 12 hours during the first 3 days,the lung recruitment maneuver was performed during pressure control ventilation (PCV).After lung recruitment,all patients were ventilated with synchronized intermittent mandatory ventilation (SIMV) + pressure support ventilation (PSV) + positive end-expiratory pressure (PEEP) or assistant/control ventilation (A/C).The objects in sequential group who met the following criteria including those with oxygen index (PaO2/FiO2) reaching 200-250 mmHg (1 mmHg=0.133 kPa) under PEEP of 8 cmH2O (1 cmH2O =0.098 kPa),and pressure support of 12 cmH2O,and most acute infiltrating lesions having resolved on chest imaging,received noninvasive ventilation (NIV) immediately after extubation,and patients in control group continued to have invasive mechanical ventilation via intubation or tracheostomy with an endotracheal tube.The baseline data in both groups and the number of re-intubation in the sequential group were recorded.The duration of invasive mechanical ventilation and total duration of mechanical ventilation,ICU length of stay,the incidence of ventilator-associated pneumonia (VAP),and mortality rate were compared between the two groups.Results 53 consecutive adult patients were enrolled,including 26 in sequential group and 27 cases in control group.The period of endotracheal intubation was 7.0 (6.8,9.5) days,and 7.7％ (2/26) patients underwent re-intubation in sequential group.There were significant difference in respiratory and circulatory indicators before extubation spontaneous breathing trial (SBT) ≤10 minutes in sequential group,indicating that the patients were still in the early stage of extubation sequential NIV.There was no significant difference in indices reflecting respiratory function and circulation between the two groups,except that respiratory rate at 1 hour was slightly increased in sequential group as compared with that of control group,indicating that sequential NIV could maintain invasive ventilation function.There was significant difference in duration of invasive mechanical ventilation [days:7.0 (6.8,9.5) vs.21.0 (17.0,25.0),Z=-6.048,P=0.000],duration of total mechanical ventilation (days:18.0 ± 4.1 vs.22.0 ± 7.3,t=-2.805,P=0.008),and length of ICU stay (days:21.0 ± 4.1 vs.28.0 ± 8.1,t=-4.012,P=0.000) between sequential group and control group,but there was no significant differences in the incidence of VAP [15.4％ (4/26) vs.29.6 (8/27),x2=1.535,P=0.215] and mortality rate [7.7％ (2/26) vs.18.5％ (5/27),P=0.420].Conclusion When PaO2/FiO2 reached 200-250 mmHg under the condition of low ventilation,sequential NIV facilitates the early discontinuation of mechanical ventilation in ARDS patients with surgical diseases,with shortening of duration of invasive mechanical ventilation,total mechanical ventilation,and the length of ICU stay.

ObjectiveTo investigate the efficacy of invasive-noninvasive sequential mechanical ventilation (MV) in senile patients with severe community-acquired pneumonia (CAP).Methods A prospective study was conducted. The patients with severe CAP aged≥ 75 years admitted to Department of Respiratory Intensive Care Unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from November 2012 to July 2014, with refusal to have tracheostomy, were enrolled. All patients meeting the diagnostic criteria of CAP and severe CAP were first admitted into the Department of Emergency, and they were found to need MV without absolute contraindication for noninvasive ventilation (NIV) in RICU. The patients were mechanically ventilated via endotracheal intubation (ETI), and they were randomly divided into invasive-noninvasive sequential MV group (sequential MV group) and conventional MV group. NIV was initiated immediately when patients matched the conditions for early extubation in the sequential MV group. Oxygen therapy (5 L/min) via a Venturi mask was provided when the indications of conventional extubation were met. The baseline data and clinical characteristics were recorded, the risk factors of death were analyzed by logistic regression analysis, and 60-day survival rate was analyzed by Kaplan-Meier curve. Results Ninety-one senile patients with severe CAP were enrolled, among them 28 patients died within 60 days, with a mortality rate of 30.77%. No significant difference in 60-day mortality was found between sequential MV group (n = 44) and conventional MV group [n = 47, 25.0% (11/44) vs. 36.2% (17/47),χ2 = 1.331,P = 0.249]. In the sequential MV group, the incidence of ventilator-associated pneumonia (VAP) was significantly decreased [27.3%(12/44) vs. 55.3% (26/47),χ2 = 7.350,P = 0.007], and the rate of ETI≥2 times was increased [59.1% (26/44) vs. 29.8% (14/47),χ2 = 5.095,P = 0.024] as compared with conventional MV group. Compared with survival group, the patients in non-survival group showed a higher incidence of cerebrovascular disease (60.7% vs. 25.4%,P = 0.002), higher acute physiology and chronic health evaluationⅡ (APACHEⅡ) score (26.46±2.59 vs. 24.41±2.47,P = 0.001), British Thoracic Society confusion, uremia, respiratory rate, blood pressure,≥75 years (CURB-75 score, 4.00±0.47 vs. 3.68±0.53,P = 0.013), a longer total duration of MV (days: 21.18±10.02 vs. 14.56±7.62,P = 0.002), and a higher ratio of ETI≥ 2 times (53.6% vs. 33.3%,P< 0.001). It was revealed by multivariate logistic regression analysis that ETI≥ 2 times and comorbidity of cerebrovascular infarction were independent predictors of a worse outcome in the senile patients [odds ratio (OR) = 9.677, 95% confidence interval (95%CI) = 3.075 - 30.457,P< 0.001;OR = 5.386, 95%CI = 1.781 - 6.284,P = 0.003]. It was showed by Kaplan-Meir survival analysis that ETI times and concurrent cerebrovascular infarction imparted significant effects on the 60-day survival rate (χ2 = 40.805,P= 0.000;χ2 = 4.425, P = 0.035).ConclusionInvasive-noninvasive sequential MV may not improve the outcome of senile patients with severe CAP, and ETI≥ 2 times and concurrent cerebrovascular disorders drastically lowered the survival rate.

Clinical pathway (CP), as a standardized approach and clinical management process for disease diagnosing and treating, is being widely used with more relevant publications reported gradually. But different forms of CP reports may prevent the evaluation and spreading of CP. The authors recommend guidelines for evidence-based Chinese medicine CP report, including 18 items which form 5 big sections, by precise item selection and rigorous expert consensus. All these items can embody the principles of Chinese medicine and comply with the requirements of the clinical practice of Chinese medicine. All above are based on synthesizing the published literature systematically and analyzing the current status in this field, also according to the characteristics of Chinese medicine and methodology requirement of evidence-based medicine.

Objective:To investigate the association between the C1GALT1 rs1008898,the DEFA rs2738081 polymorphisms and susceptibility to IgA nephropathy in Chinese Han and Hui population in area of Gansu Province and explore molecular markers to predict IgA nephropathy Methods: In this study,there were 146 patients with IgAN and 180 normal controls in Han people and 83 patients with IgAN and 100 normal controls in Hui people.Two SNPs as rs1008898 and rs2738081 were analyzed with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and polymerase chain reaction-gene sequencing technology.The genotype and allele frequency of rs1008898 and rs2738081 were compared between patients with IgAN and normal controls.Results: Rs1008898 GG genotypes and G allele were over represented in IgAN patients compared with controls.Distribution of rs1008898 polymorphism in patients with IgAN and normal controls showed no difference in Hui people.Neither Han nor Hui population,rs2738081 polymorphism had difference between IgAN patients and normal controls.Conclusion: The G allele of rs1008898 probably has correlation with the genetic susceptibility of IgAN in Gansu Han people.

Objective To investigate the predictive value of clinical and radiographic features in fungal pathogen identification in immunocompromised patients with pulmonary invasive fungal infection (IFI).Methods All consecutive immunocompromised adult patients with pulmonary IFI in respiratory intensive care unit (ICU)in the First Affiliated Hospital of Xinjiang Medical University were recruited during a 2 year period.All patients met the 2008 European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC /MSG) criteria were studied for proved or probable IFI responding to antifungal agents.The data of demographic,clinical and radiographic features,as well as serological test results of the patients were collected.Differences in the clinical and radiographic features of pulmonary IFIs caused by yeasts and molds were compared by χ2 test.A logistic regression model was used to perform discriminant analysis,and the effect of discrimination was assessed for accuracy.Results The study included 143 patients with a probable diagnosis of IFI who had the following risk factors:diabetes mellitus (43.4%),chronic lung disease (32.2%),broad-spectrum antibiotics administration (≥14 days;35.7%),malignancy (23.1%),corticosteroid therapy (≥14 days;23.1%),chronic renal failure and renal replacement therapy (16.1%),and immunological disease (10.5%).Frequent broad-spectrum antibiotics administration was associated with yeast infection (P <0.05 ),while mold infection was associated with chronic lung disease (P <0.05 ) .Yeast was more often isolated from patients with concurrent bacterial infection and on mechanical ventilation (P <0.05 ) . Thoracic high-resolution computed tomography (HRCT)showed the following images:bronchial pneumonia/pulmonary consolidation (53.1%),massive shadowing (29.4%),small nodules (24.5%),large nodules (18.9%),pleural effusion (18.9%),halo sign (14%),and cavity (9.8%).Imaging showed that mold was more common than yeast in patients with pleural and pericardial effusions (P <0.05).Logistic regression modeling showed that broad-spectrum antibiotics administration,prolonged mechanical ventilation,and pleural and pericardial effusions were statistically significant in fungal identification (P <0.05 ),with a predictive accuracy of 77.6%.Conclusions For immunocompromised patients with pulmonary IFI,most of the risk factors ,the main clinical and chest HRCT features did not help to predict the type of fungal pathogen,and yeast but not cryptococcus may be accompanied or colonized.

BACKGROUND:Mason II type and III type radial head fractures with massive bone are mainly treated by open reduction and metal fixation, but metal implants have to be removed in the second operation, which increased patients’ travail and financial burden. Absorbable screw/rod also can be used to treat radial head fractures, and has its special advantages due to the low price and no second operation. OBJECTIVE:To compare the clinical therapeutic effects of absorbable rod and Herbert screw for the treatment of Mason II or III type radial head fractures. METHODS:A total of 80 patients with Mason II and III type radial head fractures were equal y assigned to experimental and control groups. They received open reduction and internal fixation. The experimental group was treated with absorbable rod and the control group received Herbert screw. RESULTS AND CONCLUSION:A total of 79 patients were fol owed up for averagely 34 months. No significant difference in average operative time, fracture healing time, Broberg and Morrey elbow scores and incidence of complications was detected between the experimental and control groups (P>0.05). However, treatment costs were lower in the experimental group than in the control group (P<0.05). Results indicated that the therapeutic effects between absorbable rod and Herbert screw for Mason II or III type radial head fractures were similar. However, absorbable rod for radial head fractures can avoid the second operation for removal of the implant. Therefore, we recommend absorbable rod in the choice of internal fixation materials.

BACKGROUND:At present, the methods of treating unstable comminuted radial head fractures contain open reduction and internal fixation and metal prosthesis replacement. There were success cases treated by the two methods, but some shortcomings simultaneously existed.
OBJECTIVE:To compare the clinical therapeutic effects of replacement of the radial head with metal prosthesis with open reduction and internal fixation for the treatment of unstable comminuted radial head fractures.
METHODS:A prospective randomized control ed analysis was performed in 45 cases of unstable comminuted radial head fractures. These cases received open reduction and internal fixation and metal prosthesis replacement. This study compared the Broberg and Morrey elbow joint function score and the incidence of complications after fixation, and performed statistical analysis.
RESULTS AND CONCLUSION:The subjects were fol owed up for 1-5 years, averagely 2.8 years. According to Broberg and Morrey scores, the average score was 90.1 and the incidence of complications was 13.6%in the prosthesis replacement group. The average score was 76.8 and the incidence of complications was 47.9%in the open reduction. Significant differences were visible between the two groups (P<0.01). Compared with the open reduction group, prosthesis replacement for unstable comminuted radial head fractures obtained better joint function and lower incidence of complications.

Objective To investigate and analysis the actuality and demands of scientific researchers in state clinical research facility of TCM, in order to provide evidences for policy making. Methods All the trainees taken part in the meeting for the training of clinical research method were assigned to answer the self-designed questionnaire. Results Of all these people, 47.58 percent people had senior professional title, 84.14 percent people had doctorate or master degree, 57.24 percent people had participated in project research at provincial or ministerial level as key personnel, 35.17 percent people had participated in a key disease research as directors, 65.52 percent people had taken methodology training of clinical research,30.34% of who trained by evidence-based medicine. The majority of these people had clear understanding in methodology of clinical research, who believed that evidence-based medicine and system evaluation are the most difficult subjects to understand and practice, hoping to learn more about the knowledge on statistics. Conclusion Clinical researchers of state clinical research facility of TCM had sound basis for scientific research, but relatively lacking of key disease research and systematic knowledge of scientific methodology, which needed to be enhanced.

The social and behavioral research in promoting human health and the impact on human social relations and structures has been confirmed .With the development of social and behavioral science , the importance of ethics review for the research is also increased .Despite its uniqueness , the basic principles of ethics in social and behavioral research are consistent with other biomedical studies .This paper introduces ethics review points of social and behavioral research from the research design , risk and benefits , informed consent , deception and debriefing , expedited review , exemption of ethics review, privacy and confidentiality .This paper also introduces the relevant experiences from Europe and America giving references for the domestic professionals .

Objective: To investigate the effect of comorbid cardiovascular diseases on the perioperative period of colorectal cancer pa-tients aged over 80 years. Methods: Clinicopathological data of 313 elderly patients aged over 80 years who underwent radical surgery for colorectal cancer at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, from January 2007 to December 2018 were retrospectively collected and analyzed. Propensity score matching was used for 1 : 1 matching of 10 covari-ates. Finally, 128 patients with comorbid cardiovascular diseases were matched with 128 patients without comorbid cardiovascular dis-eases. Perioperative indicators and postoperative complications were compared between the two groups. Result: Both groups were balanced in terms of baseline variables (all P>0.05). In terms of postoperative complications, there was no statistical difference be-tween the two groups [37.5% (48/128) vs . 30.5% (39/128), P=0.235]. According to the Clavien-Dindo classification of postoperative complications, the incidence of postoperative Clavien-DindoⅣcomplications in the comorbid cardiovascular disease group was signifi-cantly higher than that in the non-cardiovascular disease group [7.0% (9/128) vs . 1.6% (2/128), P=0.031]. In terms of local surgical complications, the incidence of postoperative anastomotic leakage in patients with cardiovascular diseases was significantly higher than that in patients without cardiovascular diseases [7.8% (10/128) vs . 2.3% (3/128), P=0.046]. In terms of other local surgical compli-cations, there was no statistical difference between the two groups (all P>0.05). In terms of non-surgical local complications, the inci-dence of postoperative blood circulatory system complications in patients with cardiovascular diseases was significantly higher than that in patients without cardiovascular diseases [10.2% (13/128) vs . 3.1% (4/128), P=0.024]. There was no significant difference in the incidence of other non-surgical local complications between the two groups (all P>0.05). Conclusions: Comorbid cardiovascular diseas-es did not increase the risk of colorectal cancer surgery in patients aged over 80 years. However, it should be noted that the incidence of postoperative blood circulatory system complications and anastomotic leakage is significantly increased in elderly patients with car-diovascular diseases. For such patients, adequate preoperative evaluation, close postoperative monitoring, and the application of pro-tective stoma are key to ensure that elderly patients with colorectal cancer can successfully survive the perioperative period.