Objective:To investigate the clinical application of optimized preoxygenation with nasal high flow humidification oxygen therapy before tracheal intubation in critically ill patients.Methods:The100 critically ill patients who needed emergency tracheal intubation in ZhejiangYiwu Central Hospital from June 2018 to June 2019 were selected as the research objects. According to the random number table method, they were randomly divided into observation group (50 cases) and control group (50 cases). The vital signs were continuously monitored in both groups. After the supine position was taken, the airway was opened by traditional methods to remove oral and respiratory secretions. The patients in the control group were given pressure oxygen by balloon mask, while the patients in the observation group were given pre-oxygenation by nasal high flow humidification oxygen therapy. The time required to achieve the goal of pre-oxygenation, blood gas analysis, SpO 2 changes and abdominal distension before and after pre-oxygenation and after intubation were compared between the two groups. Results:In observation group, time required to reach the target preoxygenation was faster than control group: (4.34 ± 0.56) min vs. (7.62 ± 1.43) min ( P<0.05). In the observation group, PaO 2 preoxygenation and immediately after intubation were higher than those in control group: (67.25 ± 2.34) mmHg (1 mmHg=0.133 kPa) vs. (61.87 ± 2.65) mmHg, (62.46 ± 3.51) mmHg vs. (56.32 ± 3.98) mmHg; while those after PaCO 2 preoxygenation and immediately after intubationwere lower than those in control group: (38.78 ± 2.68) mmHg vs. (43.12 ± 2.95) mmHg, (42.57 ± 2.65) mmHg vs. (49.46 ± 3.43) mmHg, the differences were statistically significant ( P<0.05). In observation group, SpO 2 preoxygenation and immediately after intubation were higher than those control group: 0.97 ± 0.03 vs. 0.92 ± 0.03, 0.92 ± 0.03 vs. 0.88 ± 0.05, the differences were statistically significant ( P<0.05). In observation group, the incidence of abdominal distension was lower than that in control group: 4.00%(2/50) vs. 24.00% (12/50), the difference was statistically significant ( P<0.05). Conclusions:Optimized preoxygenation with nasal high flow humidification oxygen therapy has a good effect before tracheal intubation in critically ill patients. It can improve the blood oxygen level and reduce complications.

Objective To study the related factors and how they influence the formation of collateral circulation in patients with severe coronary arteries stenosis. Methods A total of 111 consecutive patients were catagorized into 3 groups according to their grading of collateral connections which were: CC0 (n=27), CC1 (n=45) and CC2 (n=39) respectively. Serum lipid levels were measured including total cholesterol, triglycerides, high density lipoprotein cholesterol and low density lipoprotein. All patients received UCG examination within one week after admission. Results (1)Serum lipid levels: the total cholestoral level in the CC2 group (4.23?0.71 mmol/) was lower than those of the CC0 group (4.81?0.88 mmol/L, P0.05) and the CC2 group (1.40?0.24 mmol/L, P

OBJECTIVE:To observe the clinical efficacy and safety of flunarizine combined with salvianolate in the treatment of acute migraine. METHODS:A total of 72 patients with acute migraine were randomly divided into control group(36 cases)and observation group (36 cases). Based on routine treatment,control group was given Flunarizine hydrochloride capsules orally,10 mg for 65 year-old and below once a day,5 mg for more than 65 year-old once a day. Observation group was additionally given Flunarizine hydrochloride for injection 200 mg intravenously,once a day,on the basis of control group. Both groups were treated contineously till cured or for 2 weeks. Clinical efficacy,onset time,recovery time,VAS score,frequency and duration of head-ache attack,ADR were observed in 2 groups. RESULTS:In the course of treatment,the two groups did not terminate and fall off, and all of them completed the treatment. The total response rate(97.22%)of observation group was significantly higher than that (86.11%)of control group;onset time and recovery time of observation group were both shorter than those of control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in VAS score,frequency or duration of headache attack between 2 groups (P>0.05). After treatment,VAS score,frequency and duration of headache attack in 2 groups were all significantly lower than before,and the observation group was significantly lower than the control group,with statistical significance (P<0.05). There was no statistical significance in the incidence of ADR between 2 groups (P>0.05). CONCLU-SIONS:Based on routine treatment,flunarizine hydrochloride capsules combined with Salvianolate injection show significant effica-cy for acute migraine with good safety.

Objective To analyze the current clinic application of severe acne treatment, and to provide evidences to improve its treatment. Methods Using sampling survey, a total of 3 012 severe acne patients who visited the dermato-logical department of 35 hospitals over the country for the first time were selected for this study. Each patient filled a ques-tionnaire about their acknowledgement, history of medical intervention and drug therapy of severe acne. Results Among all 3 012 patients with severe acne, 76.6%believed acne is a kind of skin disease, but only 35.2%of the patients went to see doctors at early stage of disease, while others choose interventions such as self-extrudation , topical medication or skin care products, herbal tea/folk recipes, beauty salons and application of coverture cosmetics. Among all severe acne patients, 2 388 cases (79.3%)had taken oral medications, which included 1 161(48.6%) patients who took anti-biotics. 394 cases (33.9%) took roxithromycine and 173 cases(14.9%) took other kinds of anti-biotics. 55.5%of all these patients who took oral medication less than 4 weeks in duration. 2 081 cases (69.1%) applied external drugs, in which includes 90 cases (4.3%) of using glucocorticoid, and 437 cases (21.0%) of using other kinds of external products. The adverse effects of topical treat-ments were commonly observed, such as erythema (512 cases, 24.6%), desquamation (683 cases, 32.8%), scab (73 cases, 3.5%) and hypersensitive (281 cases, 13.5%). Conclusion Severe acne is a disease need systematic treatment. but only mi-nority of the patients went to see doctors at early stage of disease. The current problems in treatment of severe acne include lack of target in choosing drugs, not long enough treatment course, and adverse effects of cutaneous administration.Early , safe and targeted medical attention with sufficient treatment course is encouraged.

Sepsis is a frequent condition with high mortality,and its early diagnosis in the pediatrics department is one of the keys to improve survival. C-reactive protein and procalcitonin have been used as bio-markers in the diagnosis of sepsis,but they have limited susceptibility and specificity,and can be elevated in non inflammatory condition. Presepsin is the free fragment of a glycoprotein expressed on monocytes/macro-phages. Preliminiary reports suggest that levels of presepsin are significantly higher in septic patients com-pared to healthy individuals, and presepsin is useful for evaluating the severity of sepsis.

Objective To explore the application value of fetal echocardiography for the diagnosis and prognosis assessment of anomalous pulmonary venous connection (APVC),by comparing the results of prenatal diagnosis of APVC by ultrasound and follow-up.Methods Eighty-one APVC fetuses diagnosed by fetal echocardiography were followed up regularly.These results were compared with postnatal ultrasound diagnosis,operation and anatomy.The main points of methodology and differential diagnosis were summarized.Results Eighty-one APVC fetuses included 68 cases of total APVC(31 cases of supracardiac type,15 cases of intracardiac type,22 cases of infracardiac type),13 cases of Partial APVC(2 cases of supracardiac type,10 cases of intracardiac type,1 case of infracardiac type);12 cases of isolated APVC,69 cases of complex APVC(combined with other cardiovascular abnormalities);6 cases were born(4 infants of isolated APVC survived after operation,2 infants of complex APVC died),2 cases were ongoing pregnancy,71 cases were aborted (30 cases were dissected),2 cases were lost to follow-up.Conclusions Fetal echocardiography has important application value in diagnosis and prognosis assessment of APVC and the ones with other cardiovascular abnormalities.

Objective To investigate the effect of chemotherapy regimen of rituxmab combined with CHOP (R-CHOP) on the survival of patients with diffuse large B cell lymphoma (DLBCL). Methods One hundred and fifty-six cases of DLBCL diagnosed according to the WHO 2008 classification were collected from the haematopathological laboratory, the department of pathology, and Beijing University Health Science Center. Standard two-step method of immunohistochemical staining with Envision was used to assess the expression of CD10, MUM-1, bcl-6, and bcl-2. The different classification models were made according to the immuaohistochemical staining results. Hans algorithm classifies the patients into two subgroups originating from germinal center B cell-like cell (GCB) and non-germinal center B cell-like cell (non-GCB), and Muris model were classfied the DLBCL patients into the good-survival groupl and the poor-survival group2. Thirty patients with treatment of R-CHOP were set as study group and the other 126 patients without Retuxmab were defied as control group. The data were analyzed with X2 test, log-linear model and Life Table survival analysis by the SAS 8.2 statistical package. Results The 3-year survival rate of the study group was 78.3 %, but was 53.4 % in the control group. The over-all survival of the study group was obviously better than the control group with the significant difference (P <0.05). Hans algorithm showed no implication of survival for any group. The survival of different groups in Muris model has no difference in study group but was obvious in control group. The expression of bcl-2 protein has no association with survival in study group but acted as a worse implication of survival in control group. Conclusion R-CHOP chemotherapy regimen could improve the remission rate and over-all survival of DLBCL. Rituxmab could weaken the effect of bcl-2 expression in the prognosis, and the implication of survival by Muris model has diminished.

Objective To investigate the role of PPAR-γ in the gene expression of T-bet/GATA-3 in Jurkat T cells,and to explore the mechanisms underling this sensitizing effect of the change of TH cell subpopulation group.Methods Jurkat T cells were stimulated with PPAR-γ agonist pioglitazone.TH cell related cytokine IFN-γ and IL-10 was detected by ELISA,and the expression of transcription factors(T-bet and GATA-3)mRNA was detected by RT-PCR.To prove the PPAR-γ-dependent effect.the PPAR-γ-specific antagonist GW9662 was used.Results Stimulated with agonist PPAR-γpioglitazone.the concentration of IFN-γ and IL-10 and the expression of transcription factor T-bet and GATA-3 mRNA were both significantlY decreased in Jurkat T cells obviously,and these actions were dependent on the time and the concentrations of pioglitazone.Added with antagonist GW9662 at the same time,such inhibitory actions of IFN-γ and T-bet expression were recovered.but not IL-10 and GATA-3.Conclusion Pioglitazone can inhibite T cells proliferation and their secretion of cytokines.Pioglitazone can inhibit TH1 cells from secreting cytokines,and it is a PPAR-γ-dependent effect related to T-bet.The inhibition on TH2 is not a PPAR-γ-dependent effect and it is GATA-3 related.

Objective To determine alkylglycerol (AKG) contents and variation in breast-milk of lactating women. Methods Five cases of healthy lactating women with term delivery were selected from June 2011 to June 2012. Breast-milk samples were collected at 1, 2, 3, 4, 8, 12, 16, 20 and 24 weeks postpartum. Breast milk samples were extracted, saponificated and derivatized. AKGs composition in breast-milk was quantitatively analyzed by GC chromatography. Results Mean 16C:0 AKG content in breast-milk decreased from(17.31 ± 3.59)× 10-3g/L to(11.14 ± 1.83)× 10-3g/L. Mean 18C:0 AKG content de-creased from(14.95±6.00)×10-3g/L to(9.68±2.51)×10-3g/L. Mean 18C:1 AKG content fluctuated between(4.64±0.91)×10-3g/L and(3.95±0.68)×10-3g/L. Conclusions 16C:0, 18C:0 and 18C:1 AKG contents exist in Chinese breast-milk through determina-tion by GC chromatography, and the concentrations vary among different stages of lactation.

Objective To investigate the expressions of Nanog and Oct4 (stem cell transcription factors) in endometriosis and adenomyosis, and to explore their potential functions in the development of endometriosis and adenomyosis. Methods The expressions of Nanog and Oct4 in the ectopic and eutopic endometrium of 50 patients with endometriosis and/or adenomyosis (ectopic endometrium group and eutopic endometrium group), and 21 patients free from endometriosis and adenomyosis (control group) were detected by immunohistochemical SABC methods. Statistical analysis was conducted for the correlation between the expressions of Nanog and Oct4 based on patients′ clinical pathological parameters. Results Nanog and Oct4 protein expressions in ectopic endometrium group were higher than that in control group (P<0.01);the expressions of Nanog and Oct4 in eutopic endometrium group and control group showed no significance (P > 0.05); there was positive correlation between the expressions of Nanog and Oct4 in ectopic endometrium group (r = 0.590, P < 0.01). Conclusion Nanog and Oct4 present high expression in eutopic and ectopic endometrium , which may play a important role in the development of endometriosis and adenomyosis.