Objective:To understand the effect of a new tracheal tube fixation device in the "double fixation" of oral tracheal intubation for critically ill patients in adult emergency department.Methods:A retrospective analysis of patients with oral tracheal intubation admitted to our EICU from January 2016 to June 2017 was performed using traditional tape and inch band fixation as a control group; the experience of treatment from July 2017 to December 2018 for patients with oral tracheal intubation, the new double-fixation method of tracheal tube fixation device was used as the observation group. The degree of displacement, oral cleanliness, facial skin allergies and injuries, and comfort of the two groups of patients was compared.Results:The rate of tracheal displacement in the experimental group was mildly 11.2% (11/98), moderately 5.1% (5/98), and the control group was mildly 24.2% (15/62), moderately 14.5% (9/62) and severe 6.5% (4/62). The incidence of facial skin allergy and skin damage was 6.1% (6/98), 0, and the control group was 24.2% (15/62), 11.3% (7/62), the difference was statistically significant ( Z value was -4.021, χ2 value was 24.48, P<0.05). The comfort score of the test group was (1.05±1.01) points, which was significantly higher than (2.10±1.71) points of the control group ( t value was 4.920, P<0.01). Conclusions:The new type of tracheal tube fixation device "dual fixation" for critically ill patients with mechanical ventilation through oral endotracheal intubation is visually beautiful, and has good firmness and comfort. It can effectively reduce the occurrence of adverse events and has good application value.

Background and purpose:Perioperative hypothermia will affect the prognosis of cancer patients. Amino acid infusion can increase the core temperature by endogenous thermogenesis. And the forced-air warming system has gained high acceptance as a measure for rewarming. This study aimed to find out whether amino acid infusion was effective to treat postoperative hypothermia and how well the treatment effect was when compared with the forced-air warming system.Methods:Fifty-seven ASAⅠ orⅡ patients aged 18-60 years undergoing elective esophageal or gastric cancer operation under epidural-general anesthesia and whose core temperature were below 36℃. When admitted to the recovery room wererandomly divided into 3 groups (n=19): GroupⅠ received intravenous infusion of mixed amino acid at a rate of 2 mL·kg-1·h-1 (A); GroupⅡ received a forced-air system (B); groupⅢreceived no therapy (C). Rectal temperature and thermal comfort were recorded per 5 min during the ifrst 1 h and oral temperature and thermal comfort were recorded at the 2, 6 and 24 h. ABG was recorded when patients were admitted to the recovery room and at the ifrst hour.Results:At the ifrst hour, the rectal temperature and thermal comfort of groups A and B were higher when compared with group C (P<0.05), and there was no difference between groups A and B (P>0.05). At the second and sixthhour, the temperature and thermal comfort of group A were higher when compared with group B and C (P<0.05), and there was no difference between groups B and C (P>0.05). At the 24th hour, there were no statistically signiifcant differences in the temperature and thermal comfort among the three groups (P>0.05).
Conclusion:The rewarming effect of infusion of mixed amino acid is better than that of the forced-air warming system. It is the more effective and convenient method to rewarm the postoperative hypothermia.

Background and purpose:Previous researches have shown that intravenous amino acid infusion during general anaesthesia prevents the decreases in core temperature. This study aimed to investigate the effect of amino acid infusion on postoperative liver and renal function in elderly patients undergoing gastrointestinal surgery. Methods:Forty ASAⅠ orⅡ patients (33 males, 7 females) aged 65-75 years undergoing elective gastrointestinal can-cer operation under epidural block combined with general anesthesia were randomly divided into 2 groups (n=20 each). GroupⅠ received intravenous infusion of mixed amino acids at a rate of 2 mL·(kg·h) -1 from induction of anesthesia to the end of operation (AA group); GroupⅡ received infusion of equal volume of normal saline (NS group). Snuff temperature was monitored for induction of anesthesia immediately, after 90 min and at closed abdomen. Renal and hepatic function was performed regularly before operation and on the 1st and 7th postoperative day.Results:The naso-pharyngeal temperatures at 90 min after the beginning of surgery and the time when the peritoneum was closed in AA group were signiifcantly higher than those in NS group (P<0.05). Hepatic and renal function indices were within the normal range in the AA and NS groups. There were signiifcant increases in TBIL, DBIL, ALT, and AST (P<0.05) after operation, whereas TP, ALB, BUN, Scr and UA decreased signiifcantly (P<0.05). There were no signiifcant differences in hepatic and renal function indices between the AA and NS groups (P>0.05).Conclusion:Intraoperative amino acid infusion has no signiifcant effects on the renal or hepatic function in elderly patients undergoing gastrointestinal surgery.

Objective To investigate the correlations of P2Y1 and ITGB3 single nucleotide polymorphisms (SNP) with aspirin resistance (AR) in patients with large atherosclerotic stroke (LAA) in a Chinese Han population.Methods Patients with first-ever LAA from Anhui stroke registration system were enrolled.Thrombus elasticity diagram was used to detect the platelet function.TaqMan technology was used to detect the P2Y1 and ITGB3 genotypes.Results A total of 206 patients with LAA were enrolled.Thirty-one patients (15.0％) had AR and 175 (85.0％) were aspirin sensitive (AS).The frequency of P2Y1 rs701265 G allele in the AR group was significantly higher than that in the AS group (43.5％ vs.26.9％;x2 =7.074,P=0.008).The frequency of P2Y1 rs701265 AA genotype in the AR group was significantly lower than that in the AS group (32.3％ vs.53.7％;x2 =4.850,P=0.028).There were no significant significances in the frequencies of P2Y1 rs1065776 and ITGB3 rs5918 alleles and genotypes between the AR group and the AS group.Multivariate logistic regression analysis showed that P2Y1 rs701265 G allele was an independent risk factor for AR in patients with LAA (odds ratio 2.186,95％ confidence interval 1.190-4.016;P=0.012).Conclusion The P2Y1 rs701265 polymorphism is associated with AR in Chinese Han patients with LAA,while the P2Y1 rs1065776 and ITGB3 rs5918 polymorphisms are not.

In acute lung injury, two subsets of lung macrophages exist in the alveoli: tissue-resident alveolar macrophages (AMs) and monocyte-derived alveolar macrophages (MDMs).However, it is unclear whether these 2 subsets of macrophages have different functions and characteristics during the recovery phase. RNA-sequencing of AMs and MDMs from the recovery period of LPS-induced lung injury mice revealed their differences in proliferation, cell death, phagocytosis, inflammation and tissue repair. Using flow cytometry, we found that AMs showed a higher ability to proliferate, whereas MDMs expressed a larger amount of cell death. We also compared the ability of phagocytosing apoptotic cells and activating adaptive immunity and found that AMs have a stronger ability to phagocytose, while MDMs are the cells that activate lymphocytes during the resolving phase. By testing surface markers, we found that MDMs were more prone to the M1 phenotype, but expressed a higher level of pro-repairing genes. Finally, analysis of a publicly available set of single-cell RNA-sequencing data on bronchoalveolar lavage cells from patients with SARS-CoV-2 infection validated the double-sided role of MDMs. Blockade of inflammatory MDM recruitment using CCR2 −/− mice effectively attenuates lung injury. Therefore, AMs and MDMs exhibited large differences during recovery. AMs are long-lived M2-like tissue-resident macrophages that have a strong ability to proliferate and phagocytose. MDMs are a paradoxical group of macrophages that promote the repair of tissue damage despite being strongly pro-inflammatory early in infection, and they may undergo cell death as inflammation fades. Preventing the massive recruitment of inflammatory MDMs or promoting their transition to pro-repairing phenotype may be a new direction for the treatment of acute lung injury.

【Objective】 To explore the causes of hypothermia in patients undergoing transurethral thulium laser prostatectomy. 【Methods】 A total of 170 patients who underwent transurethral thulium laser prostatectomy in our hospital during Sep.2020 and May 2021 were prospectively enrolled in the study. The patients were divided into normal body temperature group (n=143) and hypothermia group (n=27), based on whether perioperative hypothermia happened. The clinical data were analyzed to evaluate the risk factors of hypothermia. 【Results】 Univariate analysis showed that there were statistical differences in anesthesia time, operation time, prostate size and total amount of perfusion fluid between the two groups (P<0.05). Logistic analysis showed that the size of prostate was the independent risk factor of perioperative hypothermia (P<0.05). Patients were further divided according to prostate size. For patients with prostate < 80 g, the size of prostate was the independent risk factor of perioperative hypothermia (P<0.05), while for patients with prostate ≥ 80 g, the amount of perfusion fluid was the independent risk factor (P<0.05). 【Conclusion】 Perioperative hypothermia in patients undergoing transurethral thulium laser prostatectomy is related to the anesthesia time, operation time, prostate size and total amount of perfusion fluid. It is necessary to evaluate the risk factors before operation and take effective thermal insulation measures.

OBJECTIVE： To investigate the potential pharmacological mechanism of the seed of Draba nemorosa， and to provide reference for further development， utilization and clinical application. METHODS： Effective components and related target proteins of D. nemorosa were screened and identified by using TCMSP and STRING database. Cytoscape 3.7.0 software was used to construct a visual network of effective components and target proteins for the seed of D. nemorosa， and the network topology analysis was performed. The targeting protein-protein interaction （PPI） network was constructed and analyzed by STRING database and Cytoscape 3.7.0 software. KEGG pathway enrichment of target proteins was analyzed by DAVID bioinformatics resource database. RESULTS： A total of 9 effective components were screened from the seed of D. nemorosa， including quercetin， kaempferol， β-sitosterol， etc. Totally 174 target proteins were obtained， mainly including PTGS2， NCOA2， PGR， etc. Among them， JUN and MAPK1 were core proteins in PPI network. KEGG enrichment pathway included PI3K/Akt signaling pathway， TNF-α signaling pathway， HIF-1 signaling pathway， Toll-like receptor signaling pathway and thyroid hormone signal pathway， etc. CONCLUSIONS： Effective components from the seed of D. nemorosa such as quercetin， kaempferol and β-sitosterol may act on PTGS2， JUN and MAPK1 target proteins through PI3K-Akt signaling pathway and TNF-α signaling pathway， thus exert the effects of purging lung， relieving asthma， promoting edema and reducing edema.

ObjectiveTo investigate the mechanism of action of Xiayuxue decoction in inhibiting nonalcoholic fatty liver disease （NAFLD） induced by high-fat diet in mice by regulating nucleotide binding oligomerization domain like receptor containing pyrin domain protein 6 （NLRP6）. MethodsA total of 15 male C57BL/6 mice were randomly divided into low-fat diet （LFD） group， high-fat diet （HFD） group， and Xiayuxue decoction-HFD group （XYXD group）， with 5 mice in each group. Liver function parameters （alanine aminotransferase ［ALT］ and aspartate aminotransferase ［AST］） and blood lipid metabolic indicators （triglycerides ［TG］ and total cholesterol ［TC］） were measured； HE staining and oil red O staining were performed for liver tissue to observe histomorpholoty and lipid droplet deposition； quantitative real-time PCR was used to measure the expression levels of inflammatory factors （tumor necrosis factor-α ［TNF-α］， interleukin-1β ［IL-1β］， interleukin-18 ［IL-18］， and NLRP6） in liver tissue； Western blot was used to measure the protein expression levels of NLRP6， nuclear factor-kappa B （NF-κB）， and NF-κB p65； immunohistochemistry was used to measure the expression of NLRP6 and CD68. Mouse Raw264.7 cells were treated with palmitic acid （PA）， lipopolysaccharide， and serum containing Xiayuxue decoction to observe inflammation. A one-way analysis of variance was used for comparison of continuous data between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsCompared with the LFD group， the HFD group had significant increases in the serum levels of ALT， AST， TC， and TG （all P<0.05）. Liver histopathological examination showed that the HFD group had marked hepatic steatosis and a signficant increase in NAS score （P<0.05）， and quantitative real-time PCR showed significant increases in the inflammatory factors such as IL1β and IL-18 and a significant reduction in the expression of NLRP6 （all P<0.05）. Immunohistochemistry showed that the expression of NLRP6 showed a similar trend as that of the macrophage marker CD68. Western blot showed that after the downregulation of NLRP6 expression， there was a significant increase in phosphorylated NF-κB p65 （P<0.05）. Compared with the HFD group， Xiayuxue decoction effectively improved liver inflammation， upregulated the expression of NLRP6， and downregulated phosphorylated NF-κB p65 in HFD mice （all P<0.05）. After Raw264.7 cells were treated with PA， NLRP6 was downregulated to promote the progression of inflammation （P<0.05）， and treatment with Xiayuxue decoction could upregulate NLRP6 and inhibit inflammation NF-κB （P<0.05）. ConclusionXiayuxue decoction can effectively improve hepatic steatosis and liver inflammation in a mouse model of NAFLD， possibly by regulating NLRP6/NF-κB to alleviate macrophage activation.