Myasthenia gravis is an autoimmune disorder resulting from the production of antibodies against acetylcholine receptors leading to the destruction of the postsynaptic membrane at the neuromuscular junction.Myasthenic crisis is defined as any myasthenia gravis exacerbation necessitating mechanical ventila-tion or post-operation extubation delayed beyond 24 hours because of respiratory weakness.Most patients presenting with myasthenic crisis have an identifiable risk factor.The diagnosis of myasthenic crisis should be suspected in all patients with respiratory failure,particularly those with unclear etiology.Acute management of myasthenic crisis includes ventilatory therapy,removal of the offending trigger and immunomodulatory treat-ments.The latter includes plasma exchange or intravenous immunoglobulin,and high dose corticosteroids therapy.

Acute kidney injury(AKI) is defined as functional and structural disorder or signs of renal damage including any defect from blood and urine test,or tissue imaging that is less than 3 months.The current treatment for AKI includes therapeutic agents and renal replacement therapy (RRT).The goal of RRT is to remove endogenous and exogenous toxins,inflammatory mediator,pathogenic factor,and to maintain fluid,electrolyte,and acid-base balance until renal function returns.The principal methods of RRT include intermittent hemodialysis,continuous renal replacement therapy,peritoneal dialysis,plasmaphresis exchange and hemoperfusion.In this article,we discussed the timing,choice of therapeutic mode,indication and common technical issues of RRT in pediatric AKI.

Objective To observe the clinical effect of card other tromethamine for postpartum hemorrhage. Methods 80 cases with postpartum hemorrhage were randomly divided into the observation group and control group, 40 cases in each group.The control group was given oxytocin treatment.While the observation group was given oxyto-cin and card other tromethamine treatment.The clinical curative effect,bleeding time after treatment,postpartum 2h haemorrhage amount and adverse reaction,etc.were observed and compared.Results The total effective rate of the observation group was 95.0%,which was significantly higher than 75.0% of the control group,the difference was sta-tistically significant(χ2 =15.68,P <0.05).The haemorrhage amount of postpartum 2h of the observation group was (273.7 ±10.5)mL,which was significantly lower than (547.1 ±16.4)mL of the control group,the difference was statistically significant(t =88.79,P <0.05).The bleeding time of the observation group was (14.8 ±3.4)min,which was significantly shorter than (34.9 ±8.4)min of the control group,the difference was statistically significant (t =14.02,P <0.05).The incidence rate of adverse reactions of the observation group was 7.5%,that of the control group was 5.0%,there was no statistically significant difference between the two groups(χ2 =0.53,P >0.05 ). Conclusion Card other tromethamine in the treatment of postpartum hemorrhage has good clinical curative effect and high safety.

BACKGROUND: Promoting immunological function of patients with chronic obstructive pulmonary disease (COPD) can control development of COPD.OBJECTIVE: To investigate the effect of bufei yishen granule on pulmonary ventilation function and immunological function of COPD patients and compare with placebo.DESIGN: A randomized grouping comparison and placebo controlled study.SETTING: Respiration Department of the First Affiliated Hospital of Henan Traditional Chinese Medical.PARTICIPANTS: A total of 62 COPD patients selected from Department of Respiration of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine from January 1999 to October 2004,were randomly divided into two groups :Observation group and control group with 31 in each group.METHODS: Patients in observation group were treated with bufei yishen granule consisting of ginseng, mongolian milkvetch root, largehead atractylodes rhizome, divaricate saposhnikovia root, dwarf lilyturf tuber, Chinese magnoliavine fruit, malytea scurfpea fruit, medicinal evodia fruit, Chinese cster pillar fungus, Chinese eaglewood wood, scorpion, almond, thunberg fritillary bulb, szechwan lovge rhizome, etc., produced by Pharmaceutic Department of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. Each granule of 1 g contained an equivalent of 5.78 g raw drugs. Three times a day with 10 g for each; and patients in control group were treated with placebo consisting of hawthorn fruit and malt. The dosage and medication were the same as those in observation group. Both therapies were respectively administered in a treatment course of two months. Before and after the therapy course,the followed indexes were measured.① Assay of immunological function: The levels of IgG, IgA and IgM from blood serum were detected with simple agar diffusion.② Assay of Ag level in nucleolus organizer region (Ag-NORs): The ratios non-histone staining acidity non-histone vs core area (IS%) was calculated by staining the activating lymphocytes of the blood by silver staining technique with microscope image analysis technique. ③ Assay of pulmonary function: The pulmonary function was measured by Sensor Medics Ros System in all of the people with the levels of forced expiratory volume in first second (FEV1.0), mean maximu expiratory flow (MMEF), peak expiratory flow (PEF), once after and before treatment. The examination was repeated three times in order to obtain the peak number. The difference of the three examinations was within ±5%.MAIN OUTCOME MEASURES: Comparison of T lympholeukocyte subpopulation and pulmonary ventilation function in the patients before and after 1 course.RFSULTS: Data of totally 62 patients was entered the final analysis without any loss.① Comparison of pulmonary ventilation function of patients in the two groups before and after 1 course: FEV1.0, MMEF, PEF,and ratio of FEV1.0 and forced vital capacity (FEV1%) in observation group were significant higher than those before treatment (t=2.12-3.41,P ＜ 0.05-0.01), thoseindexes in observation group were higher than those in control group (t=2.54-3.17, P ＜ 0.05-0.01). ② Changes of T lymphocyte subgroups of patients in the two groups before and after 1 course:The levels of CD3+, CD4+, CD4+/CD8+ in observation group after 1 course were high.er than those before treatment (t=2.71-13.20, P ＜ 0.01), but the level of CD8+ was decreased as compared with that before treatment (t =8.63, P ＜ 0.01). The levels of CD3+, CD4+, CD4+/CD8+ in observation group were higher than those in control group (t=2.85-11.84, P ＜ 0.01), but the level of CD8+ was decreased as compared with that in control group (t =5.83, P ＜ 0.01).CONCLUSION: The bufei yishen granule can obviously improve the pulmonary ventilation function and immunological function of COPD patients,and its intervention is superior to that of placebo.

A simple and rapid method was established for the determination of the content of L-malic acid in fermentation liquor. This procedure includes six steps: (1) Use a microi- njector to inject the fermentation liquor quantitively on the filter paper, then use the chromatography solution (n-butanol: formic acid: water=8:1.5:1) for paper chromatography. (2) Atomize the display reagent (10ml 0.02?10~(-2) bromocresol green: 0.2ml 10?10~(-2) sodium hydroxide) on the chromatography paper. (3) Scissor off L-malic acid spots from the paper and put in into 5 ml distilled water for three hours. (4) In 1ml eluent, add 6 ml 96?10~(-2) sulphuric acid and 0.1ml 1.0?10~(-2) ?-naphthol.(5) Heat the reaction system in 100℃ water for sixty minutes. (6) After cooling determine the optical density at the wavelength 476 am in the colorimeter.

This study was aimed to analyze correlation between traditional Chinese medicine (TCM) syndromes and symptoms of acute exacerbation chronic obstructive pulmonary disease (AECOPD) based on complex network in order to provide a scientific basis for TCM syndrome amendments of diagnostic criteria, and explore relevant technologies to promote its application. By way of the current Clinical Research Information Sharing System, data and data pro-cessing were carried out (EHR 3000 between August 2011 and January 2013) into the database by ETL software. The MISCR (correlation between common symptoms and common syndromes) from both common symptoms and com-mon syndromes of AECOPD was analyzed with existing diagnosis standards of AECOPD. The comparative analysis on TCM syndromes such as heat phlegm obstructing the lung, lung and kidney qi deficiency, phlegm turbid obstructing the lung and their correspondent existing diagnosis standards of AECOPD showed that the common TCM syndromes in the clinic are the mixture of deficiency and excess syndromes. However, some individual symptom is contradicted to its correspondent syndrome. It was concluded that based on the Clinical Research Information Sharing System, the research on correlation analysis between syndromes and symptoms of AECOPD can provide strong evidence and methodology for the validation and revision of TCM diagnostic criteria.

OBJECTIVETo investigate the effects of Naoxinduotai capsule on the markers of prothrombotic state as plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor (vWF) and alpha-granular membrane protein (CD62p) in essential hypertension patients of yang hyperactivity and blood stagnation.

METHODThe 62 essential hypertension patients of yang hyperactivity and blood stagnation were divided into Naoxinduotai capsule + perindopril group (treatment group, 30 subjects) and Perindopril group (control group, 32 subjects). Clinical symptoms, blood pressure and the blood plasma PAI-1, vWF, CD62p of the patients were observed. The blood plasma PAI-1, vWF and CD62p were measured by enzyme-linked immunosorbant assay (ELISA).

RESULTAfter 8 weeks treatment, in treatment group the clinical symptoms became better, and there was a significant difference with control group (P < 0.05). Blood pressure was significantly degraded, but there was not a significant difference with control group. The blood plasma PAI-1, vWF, CD62p level was degraded ,and there were significant differences with control group in all the three makers (P < 0.05).

CONCLUSIONNaoxinduotai capsule can treat the essential hypertension patients of Yang hyperactivity and blood stagnation, and it has conspicuous advantages in improving the clinical symptoms and the makers of prothrombotic state.

Aged ; Biomarkers ; blood ; Blood Pressure ; drug effects ; Capsules ; Female ; Humans ; Hypertension ; blood ; drug therapy ; physiopathology ; Male ; P-Selectin ; blood ; Plasminogen Activator Inhibitor 1 ; blood ; Platelet Membrane Glycoproteins ; metabolism ; Thrombosis ; blood ; Treatment Outcome

Objective To investigate the variations in the pol region of HIV-1 strain in treatment failed patients in Yunnan province's Dehong prefecture and Kunming. Methods Blood samples were collected from 139 patients who experienced treatment failure ( HAART treatment ＞ 1 years and HIV-1 RNA Viral load ＞ 1 000 copies/ml). HIV-1 RNA was extracted from plasma, and nested-PCR was performed for amplification of PR and RT genes on the HIV-1 pol region. The PCR products were then sequenced and submitted to Stanford HIV Drug Resistance Database for comparison. The evolution tree was built up with MEGA 4. 1 system, combined with patients' demographics. Results The most prevalent mutation in Kunming patients were T215F/N/Y/I, M41L/M, and T69G/N/I/S/A/D, the mutation rates were 39%(24/62), 27% (17/62) and 27% (17/62) , respectively, which were higher than the corresponding mutations in the Dehong prefecture [16% ( 11/69), 13% (9/69) and 9% (6/69)]. The rate differences were statistically significant ( x2 = 8.646, 4.242 and 7. 909, all P ＜ 0.05 ). The most common HIV-1 pol region subtype in the Dehong patients were CRF01_AE subtype (32%, 22/69), followed by C subtype (25% ,17/69), and B subtype ( 19%, 13/69). Major subtypes in Kunming patients were 08_BC (60%,37/62 ), CRF01_AE subtype(21% , 13/62 ) and 07_BC ( 15% ,9/62). Conclusions Partial differences of the point mutations of the HIV-1 strain pol region and frequency of their occurrences exist among Dehong and Kunming patients, HIV-1 strains in Dehong prefecture for the NNRTIs mutations at the T215 Y/N/T, M41L and T69G/N/I/S/A/D are significantly higher than those in Kunming. Six isoforms are found respectively:CRF01_AE, B, C, BC, 08_BC and 07_BC from the epidemic strains of HIV-1 pol region subtype in Dehong and Kunming areas.

Objective To evaluate the synergistic effect of everolimus on cisplatin-mediated cytotoxicity against human cutaneous squamous cell carcinoma COLO-16 cells.Methods Cultured COLO-16 cells were divided into several groups to be treated with everolimus at different concentrations of 50,100 and 200 nmol/L or 25 μmol/L cisplatin for 12 and 24 hours.Acridine orange (AO)-labeled autophagic vesicles combined with lysomal enzyme inhibitors (E64d and pepstatin) were used to detect the levels of autophagy and autophagic flow.Western blot analysis was performed to track the conversion of the autophagosome marker microtubule-associated protein 1 light chain-3 (LC3)-Ⅰ to LC3-Ⅱ,as well as to detect cleavage levels of Caspase 3 and poly-ADP-ribose polymerase (PARP).Lactate dehydrogenase (LDH) assay was conducted to detect cell death,and Annexin V-EGFP staining to evaluate cell apoptosis.Results The LC3-Ⅱ / LC3-Ⅰ ratios (LC3-Ⅰ conversion to LC3-Ⅱ) after 12-and 24-hour treatment did not differ among the 50-,100-and 200-nmol/L everolimus groups (12 hours:3.52 ± 0.21 vs.4.03 ± 0.39 vs.5.05 ± 0.22,P ＞ 0.05;24 hours:3.38 ± 0.26 vs.3.29 ± 0.06 vs.6.57 ± 0.16,P ＞ 0.05),but were significantly higher in the three everolimus groups than in the control group receiving no treatment (12 hours:2.07 ± 0.05,P ＜ 0.05;24 hours:2.61 ± 0.16,P ＜ 0.05).After 12-hour treatment,no significant differences were observed in the ratio of LC3-Ⅱ to β-actin between the 50-nmol/L everolimus + E64d + pepstatin group (1.26 ± 0.40),100-nmol/L everolimus ± E64d + pepstatin group (1.16 ± 0.34),200-nmol/L everolimus + E64d + pepstatin group (1.21 ± 0.39) and E64d + pepstatin group (1.19 ± 0.27,P ＞ 0.05).Moreover,there was no significant difference in the percentages of autophagic vesicle-positive cells between the 100-nmol/L everolimus + E64d + pepstatin group and E64d + pepstatin group (2.06％ ± 0.61％ vs.1.68％ ± 0.62％,P ＞ 0.05).After 24-hour treatment,the everolimus + cisplatin group showed significantly increased rate of cell death compared with the cisplatin alone group (42.58％ ± 0.93％ vs.18.20％ ± 1.46％).However,no significant differences were observed in the cleavage levels of Caspase 3 and PARP,the number of annexin V-labelled cells and ratio of LC3-Ⅱ to β-actin between the everolimus + cisplatin group and the cisplatin-alone group (P ＞ 0.05).Conclusion Everolimus has a synergistic effect on the cisplatin-mediated COLO-16 cell death,and this effect does not depend on cell apoptosis or autophagy.

Objective:To apply the best evidence for the prevention of radial artery occlusion after transradial coronary angiography or intervention to clinical practice and evaluate its effect.Methods:This was a quasi-experimental study. Based on the evidence continuous quality improvement model, evidence-based practice method was used to obtain the best evidence, formulated review indicators, analyzed the obstacles in the practice process and took action strategies. The 88 patients who underwent transradial coronary angiography or intervention in the Cardiology Department of Qilu Hospital of Shandong University (Qingdao) from June 1 to 30, 2020 were selected as the baseline review group by convenience sampling. The 94 patients who underwent this treatment from September 1 to 30, 2020 were selected as the evidence application group. The baseline review group used the original perioperative management plan, and the evidence application group used the perioperative management plan based on the best evidence. The implementation rate of each review indicator, the incidence of radial artery occlusion, the degree of compression pain, and the comfort level of patients were compared between the two groups.Results:The implementation rates of review indicators 1, 2, 3, 5, 6, 7, 8 in the evidence application group were 100.0% (94/94), 100.0% (94/94), 11.7(11/94), 88.3% (83/94), 100.0% (94/94), 100.0%(94/94), 85.1%(80/94), respectively, which were higher than those in the baseline review group(all 0), except for the review indicator 4, the differences were statistically significant ( χ2 values were 9.00-178.02, all P<0.05). The incidence of radial artery occlusion and the incidence of pain Numerical Rating Scale>3 points in the evidence application group were 2.1% (2/94) and 3.2% (3/94), respectively, which were lower than 14.8% (13/88) and 23.9% (21/88) in the baseline review group; the comfort level of patients in the evidence application group was 96.8% (91/94), which was higher than 63.6% (56/88) in the baseline review group. The differences were statistically significant ( χ2 = 8.01, 15.21, 30.10, all P<0.05). Conclusions:The best evidence for the prevention of radial artery occlusion after transradial coronary angiography or intervention can be applied to clinical practice, which can standardize the behavior of medical staff, reduce the incidence of postoperative radial artery occlusion, reduce the degree of compression pain, and improve the comfort of patients.