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 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 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 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 evaluate the effects of interleukin-22(IL-22)on the expression of tazarotene-induced gene 3(TIG3)in HaCaT cells. Methods Cultured HaCaT cells were randomly divided into several groups to be treated with different concentrations (12.5, 25, 50, 100 μg/L)of IL-22 alone, or the combination of 50 μg/L IL-22 with the MAPK-ERK1/2 inhibitor PD98059 or the JAK/STAT inhibitor AG490 for 24 hours. Those HaCaT cells treated with phosphate buffered saline served as the control group. Subsequently, total proteins and mRNAs were extracted from the HaCaT cells. An immunofluorescence assay, Western blot and enzyme-linked immunosorbent assay (ELISA) were performed to determine the protein expression level of TIG3, and real-time fluorescence-based quantitative PCR to quantify the mRNA expression of TIG3 in HaCaT cells. Results The immunofluorescence assay showed that TIG3 protein was mainly expressed in the cytoplasm of HaCaT cells. As Western blot revealed, the protein expression level of TIG3 was 0.743 ± 0.035, 0.678 ± 0.040, 0.582 ± 0.041 and 0.328 ± 0.032 in HaCaT cells treated with IL-22 of 12.5, 25, 50 and 100μg/L, respectively, significantly lower than that in the control group (0.839 ± 0.045, all P<0.05). ELISA also showed a decrease in the protein expression of TIG3 in IL-22-treated HaCaT cells, which was consistent with Western blot results. Further more, the mRNA expression level (2-△△Ct)of TIG3 was significantly weaker in HaCaT cells treated with IL-22 of 12.5, 25, 50 and 100μg/L than in the control group (0.838 ± 0.036, 0.686 ± 0.061, 0.565 ± 0.047 and 0.457 ± 0.033 vs. 1.000, all P< 0.05). The decrease in TIG3 mRNA and protein expressions was significantly attenuated in HaCaT cells treated with the combination of 50 μg/L IL-22 with PD98059 or AG490 compared with those treated with 50 μg/L IL-22 alone. Conclusion IL-22 can dose-dependently inhibit the expression of TIG3 in HaCaT cells, likely through the MAPK-ERK1/2 and JAK2/STAT3 signaling pathways.

Iliac arteriovenous ifstula (AVF) usually manifests in a wide range of symptoms similar to typical deep venous thrombosis (DVT), which often lead to delayed diagnosis or misdiagnosis. We reported a 51-year old woman who was performed lumbar discectomy and showed a progressive abdominal distention, dyspnea, and swollen left leg. She was initially diagnosed as deep vein thrombosis and the ifnal diagnosis was arteriovenous ifstula. hTe ifstula was successfully sealed by an endovascular covered stent. No further recurrence was found atfer a half year’s follow-up. hTis article summarized the experience regarding iliac arteriovenous ifstula misdiagnosed, and discussed the differential diagnosis between arteriovenous ifstula and pulmonary thromboembolism causedby deep vein thrombosis.

Objective To investigate the mechanisms underlying intedeukin-22 (IL-22)-induced expression of heparin-binding epidermal growth factor-like growth factor (HB-EGF) in HaCaT cells.Methods Some HaCaT cells were divided into several inverention groups treated with IL-22 at concentrations of 12.5,25,50,100 μg/L,respectively and a control group treated with phosphate buffer saline (PBS).After 24-hour culture,total proteins were extracted from the HaCaT cells,and Western blot was performed to measure the expression of phosphorylated extracellular signalregulated kinase 1/2 (P-ERK1/2) in the mitogen-activated protein kinase (MAPK)-ERK1/2 pathway,as well as phosphorylated-JAK2 (P-JAK2) and phosphorylated-signal transducer and activator of transcription 3 (P-STAT3) in the JAK2/STAT3 pathway.In a blocking experiment,some HaCaT cells were divided into 4 groups to be treated with PBS,IL-22,PD98059 (an inhibitor of MAPK-ERK1/2) combined with IL-22 (PD98059 group),AG490 (an inhibitor of JAK2/STAT3) combined with IL-22 (AG490 group),respectively.After 24-hour treatment,total proteins and mRNAs were extracted from the HaCaT cells followed by Western blot and real-time quantitative reverse transcription-PCR for the measurement of protein and mRNA expressions of HB-EGF respectively.Statistical analysis was carried out with the software SPSS 16.0 by one-way analysis of variance (ANOVA) for intergroup comparisons and by Bonferroni's test for multiple comparisons.Results After treatment with IL-22 at the above 4 concentrations,the expressions of P-ERK1/2,P-JAK2 and P-STAT3 in HaCaT cells were all increased compared with the control group (all P ＜ 0.05).The protein and mRNA expression levels (expressed as the HB-EGF/β-actin ratio and 2-△△Cr respectively) of HB-EGF were both significantly decreased in the PD98059 group and AG490 group than in the IL-22 group (protein:0.183 ± 0.020 and 0.199 ± 0.011 vs.0.924 ± 0.032,F =37.700,36.400,respectively,both P ＜ 0.05; mRNA:1.034 ± 0.072 and 0.989 ± 0.038 vs.1.844 ± 0.135,F =11.271,13.429,respectively,both P ＜ 0.05).Conclusions IL-22 can activate the MAPK-ERK1/2 and JAK2/STAT3 signaling pathways in HaCaT cells,which may contribute to IL-22-induced expression of HB-EGF in HaCaT cells.

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.