Objective To study the curative effect of traditional chinese medicine combined with noninvasive ventilation on respiratory failure in patients with acute exacerbation of chronic obstructive pulmonary disease.MethodsThe patients were divided into experimental group (n=37) and control group (n=37).The experimental group was treated with traditional chinese medicine combined with noninvasive ventilation.The control group was treated with noninvasive ventilation method.The heart rate, blood gas analysis index, ventilation index and complication were compared between the two groups before and after treatment.ResultsAfter treatment, the levels of PaO2 in the two groups were not significantly different.The heart rate and PaCO2 of the experimental group were significantly lower than those of the control group, while the pH value and SaO2 were significantly higher than those in the control group (P< 0.05), and the total incidence of complications was 21.62%, which was significantly lower than that of the control group (64.86%, P<0.05).The time of infection control window, the highest PEEP and the time of mechanical ventilation were significantly shorter than those of the control group (P< 0.05).ConclusionThe treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(COPD) combined with noninvasive ventilation therapy can significantly improve the heart rate and blood gas analysis indexes, and optimize the noninvasive ventilation efficiency, control lung infection as soon as possible, shorten the time of noninvasive ventilation and reduce the side effects that noninvasive ventilation brought about.

Deflazacort (DFZ, a prodrug) is well absorbed and rapidly metabolized into the active metabolite 21-hydroxydeflazacort (21-OH DFZ) after oral administration. The aim of this study is to evaluate the pharmacokinetic properties of 21-OH DFZ in healthy Chinese volunteers after a single and multiple oral administration of DFZ tablets under fed condition. Twelve volunteers (six males and six females) were administered a single dose of 6 mg or 12 mg or 24 mg of DFZ in three different periods separately, according to the 3 x 3 Latin square design. Between each administration period there was a washout period of one week. The multiple-dose study of 12 mg dose DFZ per day for 7 consecutive days was started after a 1 w washout period when the single-dose study completed. The pharmacokinetic parameters of 21-OH DFZ after the single oral administration of 6 mg, 12 mg and 24 mg DFZ tablets were as follows: (37.7 +/- 11.6), (61.5 +/- 17.7) and (123 +/- 23) ng x mL(-1) for C(max); (1.90 +/- 0.32), (1.96 +/- 0.27) and (2.13 +/- 0.34) h for t1/2; (96.6 +/- 25.9), (190 +/- 44) and (422 +/- 107) ng x h x mL(-1) for AUC(0-14 h), respectively. After the multiple dose administration, the mean plasma concentration at steady-state C(av) was (7.00 +/- 1.66) ng x mL(-1) and the degree of plasma concentration fluctuation DF was 7.7 +/- 1.2. The results showed that the pharmacokinetic characteristics of 21-OH DFZ in healthy Chinese volunteers were linear over the dose range of 6 to 24 mg. No significant gender differences were found in the pharmacokinetics of 21-OH DFZ in healthy Chinese volunteers. After the multiple dose administration of 12 mg DFZ for 7 d, no accumulation of 21-OH DFZ in healthy Chinese volunteers was observed.

Objective To predict the target genes and function of has-miR-26b,has-miR-1972,has-miR4485,has-miR-4498,and has-miR-4743 by bioinformatics analysis,and provide the theoretical basis for the further research.Methods The targets of the five microRNAs were predicted by Target Scan,miRBD,and DIANA-microT-CDS,and the result were analyzed by gene ontology and pathway analysis using FunNet.Results 734 predicted targets were obtained by finding the intersected genes of Target Scan,miRBD,and DIANA-microT-CDS.GO analysis showed that biological processes regulated by the differentially expressed microRNAs included diverse terms,among which some terms (e.g.,central nervous system development,neuron differentiation,axonogenesis,synaptic transmission,learning,and memory,etc.) had direct relationship with the central nervous system and brain functions.The pathway analysis showed that a significant enrichment in several pathways related to neuronal brain function,such as axon guidance,glutamatergic synapse,Wnt signaling pathway,mTOR signaling pathway,VEGF signaling pathway,etc.Among the five microRNAs,has-miR-26b,has-miR-1972,has-miR-4498 might have more important regulatory functions.Conclusion Bioinformatic analysis indicates that has-miR-26b,has-miR-1972,has-miR-4485,has-miR-4498,and has-miR-4743 are closely related to the mechanism and pathogenesis of major depressive disorder.

Objective To investigate the clinical features and magnetic resonance imaging (MRI)findings of patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy.Methods Three patients with Hirayama disease simply presenting proximal upper extremity muscular atrophy received cervical spine MRI on neutral and flexion position. The relationship between MRI findings and their clinical symptoms were analyzed. The outcomes were compared with those of 43 patients who were diagnosed as Hirayama disease with muscular atrophy at the hand and forearm. Results 1) Clinical features:three patients were young men. The disease was characterized by unilateral weakness and atrophy of the proximal upper limbs, such as pectoralis major muscle, deltoid muscle, and biceps brachii muscle. Electromyogram (EMG) showed bilateral upper extremities neurogenic damage. 2) Cervical spine MRI findings:cervical spine kyphosis without spinal cord compression was found on neutral position. On flexion position,anterior shifting of C3-C5 cervical cord and the posterior wall of dural sac were found; C4-C5 cervical cord was compressed by vertebral body or intervertebral disc or dural sac. Engorged posterior internal vertebral venous plexus were observed in epidural space. In the 43 patients who were diagnosed Hirayama disease with muscular atrophy at the hand and forearm, similar MRI findings were found, while cervical cords compression were at C6-C7 level. Conclusion Hirayama disease could present as proximal upper extremity muscular atrophy and weakness, such as pectoralis major muscle, deltoid muscle, and biceps brachii muscle.Neglecting of this will result in diagnostic errors or missed diagnosis. Flexion position MRI is an important base of early diagnosis of Hirayama disease.

Objective To investigate the efficiency of 16S rRNA Real-time reverse transcription PCR technique in the diagnosis of periprosthetic joint infection,and compare its sensitivity and specificity with conventional culture.Methods There were 43 revision cases from July 2013 to December 2015.Synovial fluid collected by puncture preoperatively,tissues from five different parts around the prosthesis collected intra-operatively were cultured by blood plate and BacT/Alert FN respectively.The 16S rRNA in interface membrane was detected by real-time reverse transcription PCR as a marker to diagnose PJI.At the same time,the synovial fluid was routinely bacterial cultured.We compared the sensitivity and specificity of two methods.Results There are 22 THAs and 21 TKAs respectively in 43 cases,23 cases diagnosed prosthetic joint infection and 20 cases diagnosed non prosthetic joint infection.The sensitivity of 16S rRNA Real-time reverse transcription PCR is higher than the conventional bacterial culture (78.2％ vs.47.8％).There was no difference in the specificity and PPV and NPV.For PCR in prosthetic joint infection group,Staphylococcus epidermidis in 5 cases,Staphylococcus aureus in 3 cases,streptococcus in 4 cases,E.coli in 2 cases,Staphylococcus lugdunensis,Pseudomonas aeruginosa,Staphylococcus haemolyticus and Mycoplasma in 1 case respectively.For culture in prosthetic joint infection group,Staphylococcus epidermidis in 5 cases,Staphylococcus aureus in 2 cases,Staphylococcus lugdunensis,Pseudomonas aeruginosa,Staphylococcus haemolyticus and E.coli in 1 case respectively.For non prosthetic joint infection group,PCR and culture are all negative.Conclusion The sensitivity of 16S rRNA Real-time reverse transcription PCR is higher than the conventional bacterial culture.

Objective To investigate the expression of MPZL1 in gastric cancer tissues, its relation with the prognosis, and its effects on proliferation and colony formation of gastric cancer. Methods GEPIA and UALCAN databases were used to analyze the expression of MPZL1 in various malignant tumors. The KM Plotter database and UALCAN database were used to analyze the effect of MPZL1 on the overall survival of gastric cancer patients. The expression of MPZL1 protein and the changes of apoptosis-related proteins in gastric cancer cells were detected by Western blot, and the effects of MPZL1 expression on cell proliferation and colony formation were detected by CCK-8 and colony formation assay, respectively. Results MPZL1 was found to be highly expressed in various malignant tumors by GEPIA database. The results of UALCAN and KM Plotter databases analysis showed that MPZL1 was highly expressed in gastric cancer tissues, and might be correlated with the overall survival of gastric cancer patients. The results of CCK-8 and colony formation assay showed that the overexpression of MPZL1 promoted the proliferation and colony formation ability of gastric cancer cells (P < 0.05). Western blot results showed that compared with control group, the expression levels of pro-apoptotic proteins Bad and Caspase-7 in the overexpression group were significantly lower while those in knockdown group were higher. Conclusion MPZL is highly expressed in gastric cancer tissues and promotes the proliferation and colony formation of gastric cancer cells, which may be related to the inhibition of apoptosis.

Objective To investigate the variation characteristics of adenovirus type 55 (HAdV-B55) gene on plateaus.Methods Throat swabs were collected from HAdV-B55 infected patients and used for virus isolation in HEp-2 cells.The whole-genome sequence was obtained by PCR and sequencing.HAdV-B55 gene sequence was blast with the previously reported virus.Results HAdV-B55 strains were isolated from throat swabs, which were named LS89/Tibet/2016.The whole-genome sequence was obtained and submitted to GenBank with the accession number of KY002683.No large fragment gene recombination was found between this HAdV-B55 strain and previous strains, and the sequence similarity with QS-DLL strain was 99.9%.Conclusion This study provides more information for the evolution patterns of adenovirus 55 and will contribute to the prevention and control of HAdV-B55 infection in the future.

Objective　To evaluate the effect of anterior cervical fusion or non-fusion surgery for the treatment of Hirayama disease.Methods　The patients with Hirayama disease who underwent anterior cervical surgery in our hospital from July 2008 to December 2015 were retrospectively enrolled in this study.These cases were divided into two groups:fusion group(11 cases)and non-fusion group(12 cases).In fusion group,there were 9 males and 2 females,with an average age of 17.92±0.61 years(range,15-29).In the non-fusion group,there were 10 males and 1 female,with an average age of 19.18±1.14 years(range,15-23).Muscle strength,muscular atrophy,and the Michigan score for hand function were compared between the two groups preoperatively and postoperatively.The indexes such as arc cervical physiological curvature index,the maximum flexion angle,the maximal range of motion(ROM),flexion ROM of adjacent segments of lower(cervical vertebra were measured from the X-ray of the two groups,and the cross-sectional area of spinal cord was measured and compared on neutral position MRI.Results　There were no significant differences between the two groups in grip strength,preoperative hand function Michigan score,cervical physiological(curvature index,the maximum flexion angle,the maximal ROM,flexion ROM of adjacent segments of lower cervical vertebra,and cross-sectional area of spinal cord on neutral position MRI(P>0.05).Patients in fusion group were followed up for 38-103 months with an average of 59.73±5.57 months,while patients in non-fusion group were followed up for 40-95 months with an aver-age of 56.25±4.57 months.Clinical outcomes:At the last follow-up,the finger tremor and cold paralysis were alleviated in all patients,but the symptoms in fusion group and non-fusion group were not completely disappeared in 2 and 3 cases,respectively.The grip strength of fusion group(preoperative 17.14±6.09,postoperative 17.47±5.64)and the non-fusion group(preoperative 17.75±5.49,postoperative 17.40±4.58)were not significantly improved compared with preoperative(P>0.05).The Michigan score for hand function of fusion group(preoperative 10.27±0.41,postoperative 6.64±0.24)and the non-fusion group(preoperative 9.25±0.35,postoperative 6.83±0.24)were significantly improved compared with preoperative(P<0.05).There was no significant difference in postoperative Michigan score between the two groups(P>0.05).Radiological outcomes:The cervical physiological curvature index and cross-sectional area of the spinal cord of the two groups increased after operation,while the maximum flexion angle,the maximal ROM decreased.There was no significant difference in these indexes between the two groups postoperatively(P>0.05).The spinal cord had no compression on flexion MRI.The cross-sectional area of C4-C7 spinal cord in Neutral MRI were significantly increased at C6 and C7 levels in both groups.There was no significant difference in the cross-sectional area of C4-C7 spinal cord between the two groups postoperatively(P>0.05).Two cases of internal fixation loosening occurred in non-fusion group 3 years after the operation,while there were no cases of loosening in the fusion group.Conclusion　Anterior cervical fusion or nonfusion surgery can limit excessive cervical kyphosis in patients with Hirayama disease,reduce atrophy of compressed cervical spinal cord,and alleviate the disease progress of muscular atrophy of the distal upper limb.It can be selected as a treatment method for Hirayama disease.However,there is a risk of internal fixation loosening in non-fusion cases,and also a risk of adjacent segment degeneration in fusion cases.The appropriate cases should be selected carefully for surgery.

Objective To evaluate the effectiveness of free anterolateral thigh flaps for the reconstruction of lower extremities vast soft tissue defect caused by Gustilo Ⅲ open fracture. Methods From June,2013 to December, 2016,pedicled vascular anterolateral thigh flaps with end-to-side vascular anastomosis were adopted to repair 10 cas-es of lower legs caused by Gustilo Ⅲ open fracture and soft tissue defects. Among those cases,6 cases combined with anterior tibial arteries injury and 4 cases with posterior tibial arteries injury. The receiving arteries were anastomosed with flaps arteries in end-to-side method and the receiving veins were anastomosed in end-to-end method. All pa-tients were regular follow-up, and follow-up contents included flap appearance, color, limb ischemia. Results All the flaps survived in10 cases. Venous crisis was happened in one case,and flap survived after the exploration. Two cases delayed healing because of wound infection.All the 10 cases were followed up for 3-24 months,with an average of 10 months.The skin flaps of 10 cases were thin and well fitted,with good appearance and soft texture. The color of the flaps were similar to that of the recipient areas.The appearance and function of the affected limbs were satisfacto-ry. Conclusion Free anterolateral thigh flap with end-to-side vascular anastomosis is an ideal method to repair the vast soft tissue defects caused by Gustilo Ⅲ open fracture.

OBJECTIVETo retrospectively explore the effectiveness of surgical intervention model for repairing the tuberculosis wound with sinus tract.

METHODSForty-three patients with tuberculosis wound with sinus tract who met the inclusion criteria were admitted to the 309th Hospital of PLA from January 2010 to October 2015. These patients were divided into test group (n=38) and control group (n=5) according to the different treatment and patient's consent. Patients in test group were treated as follows. Firstly, antituberculosis drugs were taken orally for at least 3 weeks, and the wounds were accurately assessed using magnetic resonance imaging combined with 3-dimensional reconstruction software. Then sinus tract and its surrounding devitalized tissue were completely excised, and vacuum sealing drainage (VSD) treatment with negative pressure value of -26.6 kPa was performed for 1 to 2 weeks (dressing change was performed per 7 days). Lastly, the wounds were covered through direct suture or grafting skin or flap. Patients in control group were firstly given antituberculosis drugs orally for at least 3 weeks, and then they were treated with routine dressing change in outpatient service every 3 days. After the former therapy, patients in both groups were given antituberculosis drugs by oral administration for at least 6 months and were followed up for 6 to 36 months. Detection of Bacillus tuberculosis, Acid-fast bacilli, and tuberculosis granuloma, wound healing time, and relapse of tuberculosis wound in patients of both groups were recorded. The rates of single sinus tract, two sinus tracts, and more than or equal to 3 sinus tracts of patients in test group were recorded. Data were processed with Fisher's exact test and Wilcoxon rank-sum test.

RESULTSBacillus tuberculosis was respectively detected in wounds of 5 patients in test group and 2 patients in control group. Acid-fast bacilli were positively expressed in wounds of 8 patients in test group and 3 patients in control group. A typical tuberculosis granuloma phenomenon was observed in the wounds of 27 patients in test group and 4 patients in control group. These differences in above-mentioned 3 indexes between two groups were not statistically significant (with P values respectively 0.238 4, 0.154 4, 1.000 0). The median of wound healing time of patients in test group was 19.6 d, which was significantly shorter than that in control group (94.4 d, χ(2)=12.986 0, P=0.000 3). There were 2 and 1 patients with recurrent tuberculosis wound in test group and control group respectively, without statistically significant difference (P=0.363 0). Among patients in test group, the rate of single sinus tract was 23.7%(9/38), the rate of two sinus tracts was 28.9%(11/38), and the rate of more than or equal to 3 sinus tracts was 47.4% (18/38).

CONCLUSIONSRepairing the tuberculosis wound with sinus tract in surgical intervention model of antituberculosis therapy+ accurate wound assessment+ debridement+ VSD treatment+ surgical repair is beneficial to making the optimal operation plan under the premise of knowing location of sinus tract, which can reduce surgical risk.

Debridement ; Humans ; Magnetic Resonance Imaging ; Negative-Pressure Wound Therapy ; Paranasal Sinuses ; pathology ; surgery ; Retrospective Studies ; Skin Transplantation ; Surgical Flaps ; Treatment Outcome ; Tuberculosis ; drug therapy ; surgery ; Wound Healing