OBJECTIVE:To evaluate efficacy and safety of caspofungin for non-effect/intolerant to fluconazole in patients with invasive fungal infetion(IFI) in intensive care unit(ICU).METHODS:A retrospective analysis was conducted in 14 IFI patients in ICU who was without effect/intolerant to gluconazole.They were treated with caspofungin in a dose of 70 mg in the first day,and then in a dose 50 mg?d-1 for 3～28 d.RESUITS:Of total 14 cases,2 cases had been diagnosed including 1 case of candidemia albicans and 1 case of pulmonary candidosis glabrata;5 probable cases including 2 cases of pulmonary aspergillus species,2 cases of pulmonary candidosis albicans and 1 cases of pulmonary candidosis parapsilosis;In 7 suspected cases pathogen fungus were not found out.One patient died of respiratory failure at third day of treatment.Clinical efficacy of death case cannot be evaluated.Of total evaluable 13 cases,2 were cured(2/13,15.4%),4 markedly effective cases(4/13,30.8%),2 improved cases(2/13,15.4%) and 5 ineffective cases(5/13,38.5%),the overall effective rate was 46.2%.Caspofungin can be tolerated by all patients during therapy without drug related adverse reaction.CONCLUSION:Caspofungin is certain of efficacy and safety for non-effect/intolerant to fluconazole in IFI patients in ICU,and is the first choice for IFI patients in ICU.

OBJECTIVE:To evaluate the availability and equipment of antidiabetic drugs in public hospitals from Shaanxi prov-ince. METHODS:Using a standardized methodology developed by WHO and Health Action International,the availability and equipping rate of the most common oral antidiabitic drugs were investigated and evaluated in public hospitals of Shaanxi province. RESULTS:The availability and equipping rate of tertiary hospitals and secondary hospitals were all higher than those of community health service centers. Among generic drugs,the availability of metformin was the highest (94.4%),and those of glibenclamide and repaglinide were the lowest(5.6%). Among original drugs,the availability of acarbose was the highest(68.1%). The equip-ping rate of original drugs was higher than that of generic drugs. The equipping rate of generic drugs(25.0%)was higher than that of original drugs(12.5%)in community health service center,but the equipping rates of generic drugs and original drugs were in low level. CONCLUSIONS:General hospitals (especially tertiary hospitals) have high equipping rate of original antidiabetic drugs,the community health services have low availability and equipping rate. Comprehensive measures should be taken to im-prove the availability of drugs in primary medical institutions and ensure drug use of chronic disease patients in primary hospitals.

OBJECTIVETo discuss the synergistic mechanism of compatible use of two medicinal herbs, Zingiber offiicinale and Aconitum cainichaeli, by determining single decoction of Z. offiicinale and four gingerols (6-gingerol, 8-gingerol, 6-shogaol, 10-gingerol) contained in compound decoction of Z. offiicinale and A. cainichaeli of different compatibility ratio using HPLC.

METHODKromasil-C18 column (4.6 mm x 250 mm, 5 microm) was adopted. The mobile phase was acetonitrile (B) and 0.1% aqueous acetic acid (A) for gradient elution (0-30 min, 40%-90% B; 30-35 min, 90%-40% B). The flow rate was 1.0 mL x min(-1). The detection wavelength was set at 275 nm. The column temperature was 30 degrees C.

RESULTThe four gingerols were in baseline separation, with a good linearity (r > 0.999), an average recovery of 100.9% -103.5% and RSD < 3.0%. Compared with the single decoction of Z. offiicinale, the content of gingerols in the compound decoction of Z. offiicinale and A. cainichaeli was on the rise and in direct proportion with the increase in the volume of A. cainichaeli.

CONCLUSIONThe synergistic mechanism of the compatibility of Z. offiicinale and A. cainichaeli can be proved with the increased release of gingerols from Z. offiicinale.

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.

Objective:To analyze the incidence, biochemical and molecular characteristics, and gene mutation spectrum of neonatal methylmalonic acidemia (MMA) in Shaanxi province.Methods:This study involved 146 152 newborns undergoing neonatal screening for methylmalonic acidemia by tandem mass spectrometry in Northwest Women's and Children's Hospital from January 2014 and December 2019. Clinical manifestations and follow-up data of newborns diagnosed with MMA and their acylcarnitine profiles and gene mutations were analyzed. According to whether they had elevated homocysteine or not, these patients were divided into two groups, the complicated group and the isolated MMA group. The control neonates were those excluded from having methylmalonic acid by re-examination. Kruskal-Wallis and Mann-Whitney U test was conducted for statistical analysis. Results:(1) Twenty-one cases of MMA were confirmed with an incidence of 1/6 960, including 11 cases (52.4%) of isolated MMA (isolated MMA group) and 10 (47.6%) complicated by elevated homocysteine (complicated group). Eight patients in the isolated group had symptoms within one month after birth, mainly feeding difficulties, vomiting, drowsiness, poor response and infection, and five died. Patients in the complicated group were all diagnosed before developing typical clinical symptoms, and no developmental abnormalities were reported during follow-up. (2) Blood propionyl carnitine and its ratios to acetylcarnitine and free carnitine in the isolated MMA and complicated groups were higher than those in the control group [ M (min-max), 9.26 (3.70-37.78) μmol/L and 7.27 μmol/L (3.58-13.62 μmol/L) vs 4.51 μmol/L (1.48-8.69 μmol/L), H=23.239; 1.12 (0.32-2.43) and 0.74 (0.36-1.90) vs 0.25 (0.09-0.45), H=47.061; 0.94 (0.12-1.92) and 0.56 (0.18-1.03) vs 0.17 (0.06-0.38), H=36.868; all P<0.001]. The blood methionine level in the complicated group was significantly lower than that in the isolated MMA group [7.64 μmol/L (3.40-19.25 μmol/L) vs 24.22 μmol/L (10.73-56.55 μmol/L), U=3.000, P<0.001]. (3) All 21 patients carried complex heterozygous mutations or homozygous mutations in pathogenic genes, including 15 distinct MMUT mutations and 13 distinct MMACHC mutations. In the isolated MMA group, the most common mutation was c.323G>A (p.Arg108His) in the MMUT gene with a positive rate of 13.6%, and an unreported mutation, c.1676+11A>G, with unidentified clinical significance, was also found. The most common mutations in the complicated group were c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in the MMACHC gene, and the positive rates were both 20.0%. Moreover, two unreported variants, c.430-2A>C and c.648_650delAGA (p.216_217delSEinsS), were detected and suspected to be pathogenic. Conclusions:MMA is not uncommon in Shaanxi province. Children with isolated MMA tend to be more severe clinically. The identification of hotspot mutations, including c.609G>A (p.Trp203Ter) and c.567dupT (p.Ile190fs) in MMACHC gene and c.323G>A (p.Arg108His) in MMUT gene, provides a foundation for further genetic screening, counseling, and prenatal diagnosis, and is conducive to reduce the mortality and disability rate of neonatal MMA.

OBJECTIVETo study the variation regularity of chemical constituents contained in Euphorbia ebracteolata after vinegar processing.

METHODThe colorimetric method was adopted for determining the variation of total lactone content in toxic constituents contained in E. ebracteolata decoction, with Kedde as the coloring reagent. The HPLC method was used for detecting the content variation of jolkinolide B and jolkinolide C, both were active constituents contained in E. ebracteolata decoction, before and after roasting with vinegar, in which Kromasil-ODS column (4.6 mm x 250 mm, 5 microm) was adopted, with the detection wavelength of 290 nm, column temperature at 25 degrees C , gradient elution with acetonitrile and water and the flow rate of 1.0 mL x min(-1).

RESULTAfter roasting with vinegar, the total lactone content in E. ebracteolata was reduced from 0.60 to 0.45 mg x g(-1) , with active constituents, jolkinolide B and jolkinolide C, increased to varying degrees. The established chromatographic fingerprint contained risk information and could reflect the overall variation regularity of chemical constituents after roasting with vinegar.

CONCLUSIONThe chemical constituents of E. ebracteolata show significantly changes, especially a reduced toxicity, after roasting with vinegar. The increase in its efficacy may be related to the variation of these constituents.

Recently clinical MR contrast media consists mainly of gadolinium based small molecule complexes,such as Gd-dTPA,Gd dOTA,etc,but small molecule complexes are defective in the relaxation and early diagnosis.With the development of nanotechnology,molecular nanoprobes not only have the advantages of small particle size,good biocompatibility,enhanced penetration and retention (EPR) effect and long half-life,but also their relaxation rates are higher than that of common gadolinium contrast media.The application of current MR molecular probe,such as liposomes,dendrimers,mesoporous silica,polymer micelles,carbon nanotubes,nano-gold and paramagnetic nanoparticles were mainly introduced in this paper.

Objective To explore the effect of neostigmine in treatment of severe acute pancreatitis (SAP) combined with intra-abdominal hypertension (IAH).Methods 42 patients diagnosed as SAP combined with IAH and meeting standard were collected from Aug.2012 to Jul.2016 in our hospital.They were randomly divided into two groups:observation group and the control group.General information of the two groups was comparable.Patients of the control group received conventional treatment methods such as fasting,gastrointestinal decompression,nutritional support,antispasmodic,analgesia,intravenous infusion of omeprazole and octreotide.Patients of the observation group received intramuscular injection of neostigmine methylsulfate on the basis of the control group for seven days.The intra-abdominal pressure,recovery time of bowel sounds,the first exhaust and defecation time,remission time of abdominal distention,modified Marshall score,APACHE-Ⅱ score,SIRS score,total hospitalization time and total hospitalization expenses,MODS rate,operation rate and mortality of the two groups were recorded during the treatment.Results The intra-abdominal pressure of the observation group was (14.25±1.03) mmHg,(13.52 ±1.23) mmHg,(12.73±1.14)mmHg respectively,lower than that of the control group (15.14± 1.12) mmHg,(14.60± 1.11) mmHg,(13.84±1.08) mmHg at the 3rd,4th,and 5th day after treat ment (P＜0.05).For the observation group,the recovery time of bowel sounds was (7.24±1.35) d,the first exhaust and defecation time was (11.33±1.51) d,(8.36±1.63) d,remission time of abdominal distention was (13.62±2.26) d,lower than those of the control group ((9.56±1.17)d,(13.42±1.26)d,(10.45±1.54)d,(16.75±3.05)d) (P＜0.05).The recovery time of bowel sounds,the first exhaust and defecation time,remission time of abdominal distention of the observation group were lower than those of the control group (P＜0.05).The modified Marshall score,APACHE-]Ⅱ score,SIRS score of the two groups had no significant difference (P＞0.05).The total hospitalizationtime and total hospitalization expenses of the two groups had no significant difference (P＞0.05).MODS rate,operation rate and mortality of the two groups had no significant difference (P＞0.05).Conclusions Neostigmine can significantly reduce intra-abdominal pressure of patients suffering from SAP combined with IAH,improve the symptoms of paralytic ileus,promoting exhaust and defecation.However,it has limited effects on prognosis of patients suffering from SAP combined with IAH.

Objective To study the serum levels of oxidative stress markers in the new type 2 diabetes mellitus (T2DM) patients with nonalcoholic fatty liver disease (NAFLD),and the effect of o-lipoic acid (A-LA) on oxidative stress markers.Methods From August 2016 to August 2017,80 new T2DM patients complicated with NAFLD (T2DM + NAFLD group) and 80 new T2DM patients without NAFLD (T2DM group) admitted to Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University were selected.The serum levels of Fasting blood glucose (FPG),body mass index (BMI),triglyceride (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C),low density lipoprotein cholesterol (LDL-C),insulin resistance index (HOMA-IR),serum superoxide dismutase (SOD),serum malondialdehyde (MDA),glutathione peroxidase (GSH-PX) were detected and compared between the two groups.And then,the T2DM patients with NAFLD were treated by A-LA for two weeks.The SOD,MDA,GSH-PX levels were compared before and after treatment.Results The FPG,BMI,TG,HOMA-IR of the T2DM + NAFLD group were (10.71 ± 3.63) mmol/L,(27.08 ± 3.87) kg/m2,(3.40 ± 1.85) mmol/L,(5.40 ± 2.98),respectively,which were significantly higher than those of the T2DM group[(9.50 ± 3.78)mmol/L,(23.58 ± 2.75) kg/m2,(1.79 ± 1.44) mmol/L,(2.41 ± 1.18)] (t =2.022,6.603,2.829,4.157,all P ＜ 0.05).The age and levels of HbA1c,TC,HDL-C,LDL-C between the two groups had no statistically significant differences (all P ＞ 0.05).The level of MDA in the T2DM + NAFLD group was (5.11 ± 0.25) μmol/L,which was significantly higher than (4.56 ±0.28) μmol/L in the T2DM group(t =2.106,P ＜0.05).The levels of SOD,GSH-PX,SOD/MDA in the T2DM + NAFLD group were (77.42 ± 10.31) U/mL,(69.62 ± 9.24) U,(15.39 ± 2.23),respectively,which were significantly lower than those in the T2DM group [(93.26 ± 11.21) U/mL,(87.54 ± 9.58) U,(20.33 ± 2.93)] (t =2.455,2.653,3.148,all P ＜ 0.05).After treatment with A-LA,the MDA level of the T2DM + NAFLD group was (4.81 ±0.26) μmol/L,which was significantly lower than that before treatment[(5.11 ±0.25) μmol/L,t=2.117,P ＜0.05],the levels of SOD,GSH-PX,SOD/MDA of the T2DM + NAFLD group were (87.15 ± 10.88) U/mL,(78.73 ± 9.57) U,(18.05 ± 2.51),respectively,which were significantly higher than those before treatment (t =2.117,2.207,2.228,3.148,all P ＜ 0.05).Conclusion A-LA might prove usefully in the treatment of patients with T2DM and NAFLD by change the oxidative stress.

Objective:The study aimed to study the efficacy and safety of combined dual therapy using anti-programmed death (PD)-1 and tyrosine kinase inhibitor (TKI) with combined triple therapy using anti-PD-1, TKI and locoregional intervention triple therapy in patients with postoperative refractory recurrent liver cancer.Methods:Patients with postoperative refractory recurrent liver cancer who had undergone either anti-PD-1 and TKI dual therapy or anti-PD-1, TKI and locoregional intervention triple therapy between July 2016 and March 2019 at the First Medical Center, Chinese PLA General Hospital were retrospectively studied. Tumor responses were assessed by the modified response evaluation criteria in solid tumors and overall survival and progression free survival were compared. Adverse events were evaluated according to the National Cancer Institute Common Terminology Criteria for Adverse Events.Results:Of 63 patients who were included in this study, there were 25 patients in the dual therapy group (16 males and 9 females, aged 54.3±8.8 years) and 38 patients in the triple therapy group (31 males and 7 females, aged 55.5±8.4 years). The 1-year survival rate of the triple therapy group was significantly higher than the dual therapy group (94.5%vs 54.9%) ( P<0.01). The disease control rate was 64.0% (16/25) in the dual therapy group and 84.2% (32/38) in the triple therapy group, and the difference was not significant ( P>0.05). The incidence of treatment-related adverse events in the triple therapy group and the dual therapy group were 78.9% (30/38) and 80% (20/25), respectively. There was no treatment-related death in the 2 groups. Conclusions:Anti-PD-1 and TKI dual therapy and anti-PD-1, TKI and locoregional intervention triple therapy were effective and tolerable treatments for postoperative refractory recurrent liver cancer. The latter treatment had a significantly better clinical benefit on survival outcomes.