Objective To approach the evaluative effect of respiratory variation of superior vena cava peak flow velocity measured using transthoracic echocardiography (TTE) on fluid responsiveness in patients with mechanical ventilation.Methods A prospective cohort study was conducted.All mechanical ventilated critically ill patients whose fluid therapy was planned due to hypovolemia in Department of Critical Care Medicine of Beijing Tongren Hospital of Capital Medical University from April 2011 to April 2013 were enrolled.Volume expansion was performed with 500 mL Linger solution within 30 minutes.Patients were classified as responders if pulse pressure variation (PPV) increased ≥ 13％ before volume expansion.The respiratory variation in superior vena cava peak velocity was calculated as the difference between maximum and minimum values of velocity in peak A,peak S and peak D over a single respiratory circle,and their variations (ΔA,ΔS,ΔD) were also calculated.The receiver operating characteristic curve (ROC curve) was plotted to assess the evaluative effect of respiratory variation of superior vena cava peak velocity on fluid responsiveness.Results Twenty-seven patients were enrolled in this study.Volume expansion increased PPV ≥ 13％ happened in 14 patients (responders).The velocity of superior vena cava in peak A,peak S,peak D was significantly increased after volume expansion compared with that before volume expansion in responders [peak A (cm/s):34.6 ± 2.2 vs.31.3 ±2.1,t=-2.493,P=0.027; peak S (cm/s):39.1 ± 1.3 vs.35.3 ±2.1,t=-2.564,P=0.024; peak D (cm/s):28.1 ± 1.2 vs.23.3 ± 1.4,t=-4.995,P=0.000],but there was no significant difference in ΔA,ΔS and ΔD between before and after volume expansion.The ΔA,ΔS and ΔD were positively correlated with PPV (r＝0.040,P=0.854; r=0.350,P=0.074; r=0.749,P=0.000).The area under ROC curve (AUC) of peak S was 0.36 [95％ confidence interval (95％CI):0.11-0.52],but the AUC of ΔS was 0.68 (95％CI 0.47-0.89),the AUC of peak D was 0.41 (95％CI 0.19-0.63),but the AUC of ΔD was 0.95 (95％CI 0.86-1.00),so the aberration rate of superior vena cava in respiration was better than the flow rate in superior vena cava.When the cut-off value of ΔS was 20.7％ for predicting fluid responsiveness,the sensitivity was 78.6％ and the specificity was 61.5％.When the cut-off value of ΔD was 12.7％ for predicting fluid responsiveness,the sensitivity was 92.0％ and the specificity was 92.3％.Conclusion Respiratory variations in superior vena cava peak velocity measured by TTE could assess fluid responsiveness in patients with mechanical ventilation.

AIM To optimize the preparation of two inclusion compounds of erinacine A and to evaluate their stabilities.METHODS With feed ratio,milling time and milling speed as influencing factors,inclusion rate and yield as evaluation indices,the preparation was optimized by orthogonal test.The obtained inclusion compounds were characterized by infrared spectrophotometry and TLC,whose stabilities at high temperature (60 ℃),strong light (3 000 1x) and high humidity [(90 ±5)％] were investigated.RESULTS The optimal β-cyclodextrin inclusion conditions were determined to be 5 ∶ 1 for feed ratio,60 min for milling time,and 300 r/min for milling speed,the inclusion rate and yield were 20.66％ and 88.21％,respectively.The optimal hydroxypropyl-β-cyclodextrin inclusion conditions were determined to be 25 ∶ 1 for feed ratio,90 min for milling time,and 400 r/min for milling speed,the inclusion rate and yield were 69.25％ and 96.31％,respectively.The inclusion of Hericium erinaceus 80％ ethanol extract was physical process without composition change.At high temperature and strong light,two inclusion compounds' appearance showed no obvious change with little loss of erinacine A,which was just the contrary at high humidity.The inclusion effect of hydroxypropyl-β-cyclodextrin inclusion compound was better than that of β-cyclodextrin inclusion compound.CONCLUSION Both β-cyclodextrin and hydroxypropyl-β-cyclodextrin inclusion compounds of erinacine A exhibit good heat stability and light stability,but deliquescence can easily happen to them.

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Fertility ; Hematologic Diseases/therapy* ; Hematologic Neoplasms/therapy* ; Hematopoietic Stem Cell Transplantation ; Humans

Objective To explore the status, characteristics and factors in relation to occupational stress for medical staffs in tertiary general hospitals. Methods A total of 2460 medical staff were sampled in five tertiary general hospitals in Beijing, with their occupational stress levels evaluated with the Occupational Stress Inventory. Results The top ten stressors as found ranked as heavy duty, high risk exposure, high workload, low wages, setbacks in the health care management system, insufficient staffing, excessively frequent inspections and examinations, strained doctor-patient relationship, price inflation, frequent overtime, and pressure from continuous learning. Occupational stress is seen as moderate and above by 95.2% of the surveyed. Differences in age, gender, marital status, professional title, education, work experience, as well as those of different organizations, departments, professions, and duty were found to be statistically significant in regard of professional stress. Conclusions Stress management should be in place targeting demographic and stress characteristics. Effective measures are recommended to alleviate the pressure on medical staff, in order to maintain their physical and mental health, hence improving their work efficiency and organizational cohesion.

Objective     To investigate the safety and feasibility of day surgery for patients with palmar hyperhidrosis based on the principles of enhanced recovery after surgery (ERAS). Methods     We retrospectively reviewed the medical records of consecutive patients who underwent endoscopic thoracic sympathicotomy (ETS) in the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to December 2021. Patients were divided into a day surgery group and a conventional group according to their perioperative management methods. The patients in the day surgery group underwent an optimized perioperative procedure under the guidance of ERAS, and were ventilated with a laryngeal or face mask during the operation. The patients in the conventional group completed the preoperative examination, operation and postoperative observation according to the conventional procedures, and were intubated with a single-lumen endotracheal tube. The demographic characteristics, operation time, hospital stay, postoperative complications, and hospitalization cost were compared between the two groups. Results     Finally 172 patients were collected, including 90 males and 82 females, with an average age of 25.97±7.43 years. There were 86 patients in each group. All patients ceased suffering from palmar sweating after surgery. No patient experienced massive bleeding or conversion to thoracotomy. There was no statistical difference in operation time between the two groups (P=0.534). Patients in the day surgery group were discharged within 24 hours. The average hospital stay in the conventional group was 2.09±0.41 days. Incidence of postoperative respiratory complications, and the hospitalization cost of the day surgery group were significantly lower than those of the conventional group (P<0.001). The satisfaction rate in both groups was greater than 95%. Conclusion     Day surgery for patients with palmar hyperhidrosis based on the principles of ERAS is safe and feasible, which can reduce postoperative complications, shorten the length of hospital stay and save the cost of hospitalization.

Objective: To establish a scoring system for predicting the risk of side branch occlusion(SBO) in coronary bifurcation intervention based on visual estimation of quantitative coronary angiography (QCA). Methods: RESOLVE scoring system was developed from QCA. A total of 1545 patients with 1601 bifurcation lesions by RESOLVE study were enrolled. Based on RESOLVE scoring system, visual estimation was conducted to compare the consistency. According to SBO occurrence after main branch stent implantation, our research was divided into 2 groups: SBO group, which was defined by coronary angiography confirmed TIMI grade decreasing, n=114 patients with 118 lesions and Non-SBO group, n=1431 patients with 1483 lesions. Using RESOLVE scoring method as reference,V-RESOLVE scoring system was established, the discrimination, goodness-of-fit and V-RESOLVE score for the incidence of SBO were assessed;the diagnostic value for predicting the risk of SBO in coronary bifurcation intervention was compared between 2 scoring systems. Results: The consistency between visual and QCA was from fair to moderate (weighted Kappa=0.22-0.44). Compared with Non-SBO group, SBO group had the higher degrees of pre-operative bifurcation stenosis and side branch stenosis before main branch stent implantation; larger bifurcation angle and vessel diameters in main/side branches, all P<0.01. The area of V-RESOLVE under ROC curve was 0.76(95%CI 0.71-0.81) which was similar to the area of RESOLVE under ROC curve:0.77 (95% CI 0.72-0.81), P=0.74, Hosmer-Lemeshow P=0.17. The patients were categorized into 2 conditions by V-RESOLVE: high risk (V-RESOLVE score≥12)and non-high risk (V-RESOLVE score<12), the incidence of SBO was higher in high risk patients (16.7% vs 4.3%), P<0.01. The incidences of SBO were similar in non-high risk patients by V-RESOLVE and RESOLVE (4.3% vs 3.4%), P=0.22 and in high risk patients (16.7% vs 18.0%), P=0.60. Conclusion: V-RESOLVE scoring system may predict the risk of SBO in patients with coronary bifurcation intervention.

There have been many clinical trials conducted to evaluate novel systemic regimens for unresectable pancreatic cancer. However, most of the trial results were negative, and gemcitabine monotherapy has remained the standard systemic treatment for years. A number of molecular targeted agents, including those against epidermal growth factor receptor and vascular endothelial growth factor receptors, have also been tested. In recent years, there have been some breakthroughs in the deadlock: three regimens, namely gemcitabine-erlotinib, FOLFIRINOX, and gemcitabine-nab-paclitaxel, have been shown to prolong the overall survival of patients when compared with gemcitabine monotherapy. In addition, emerging data suggested that the membrane protein human equilibrative nucleotide transporter 1 is a potential biomarker with which to predict the efficacy of gemcitabine. Here we review the literature on the development of systemic agents for pancreatic cancer, discuss the current choices of treatment, and provide future directions on the development of novel agents.
Adenocarcinoma ; drug therapy ; Albumins ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Camptothecin ; analogs & derivatives ; Deoxycytidine ; analogs & derivatives ; Equilibrative Nucleoside Transporter 1 ; Erlotinib Hydrochloride ; Fluorouracil ; Humans ; Leucovorin ; Organoplatinum Compounds ; Paclitaxel ; Pancreatic Neoplasms ; drug therapy ; Quinazolines ; Receptor, Epidermal Growth Factor ; Receptors, Vascular Endothelial Growth Factor

OBJECTIVETo observe the effect of volatile oil of Schizonepetae Herba (VOSH), and its essential components-menthone and pulegone against anti-influenza virus A/PR/8/34 (H1N1) in vivo and in vitro, as well as the signaling mechanism of its toll-like receptor/interferon (TLR/IFN).

METHODThe lung-adapted PR-8 virus model was prepared in mice. They were administered with preventive and therapeutic drugs, and the hemagglutination titer of model animals was determined to evaluate in vivo effect against H1N1. ELISA test was conducted to observe the effect on IFN-alpha, IFN-beta, IL-2, IL-6 and TNF-alpha in serum, as well as IFN-beta secretion in H1N1 infected MDCK supernatant. Real-time RT-PCR was employed to observe the expression levels of IRAK4 and TLR3 mRNA.

RESULTThe in vivo experiment shows that the hemagglutination titer was significantly decreased when the mice were treated with VOSH (0.266 mg x kg(-1)), menthone(0.5 mg x kg(-1)) and pulegone (0.19 mg x kg(-1)) in therapeutic way; VOSH (0.226 mg x kg(-1)) had a significant effect on increasing serum levels of IFN-alpha, IL-2; Methone (0.5 mg x kg(-1)) had a significant effect on increasing serum levels of IFN-beta; Methone (0.5 mg x kg(-1)) and pulegone (0.19 mg x kg(-1)) had a significant effect on decreasing serum levels of IL-6; VOSH (0.452, 0.226 mg x kg(-1)) and pulegone (0.19 mg x kg(-1)) had a significant effect on decreasing serum levels TNF-alpha. The in vitro experiment showed that the expression levels of IRAK4 mRNA and IFN-beta were significantly increased in VOHS (0.1 g x L(-1)) and pulegone (0.1 g x L(-1)) groups; and the menthone (0.25 g x L(-1)) group showed a significant rise in the expression levels of IRAK4 mRNA, but a notable decline in TLR3 mRNA.

CONCLUSIONThe administration with VOSH, methone and pulegone in therapeutic way can significantly decrease the hemagglutination titer, which demonstrates the anti-virus effect of the administration in therapeutic way, but no notable efficacy of the administration in preventive way. The in vivo anti-virus mechanism is related to regulation of IFN-alpha, IFN-beta and IL-2.

Animals ; Drugs, Chinese Herbal ; pharmacology ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; drug effects ; physiology ; Influenza, Human ; drug therapy ; genetics ; immunology ; virology ; Interferon-alpha ; genetics ; immunology ; Interleukin-1 Receptor-Associated Kinases ; Interleukin-2 ; genetics ; immunology ; Interleukin-6 ; genetics ; immunology ; Lamiaceae ; chemistry ; Male ; Mice ; Oils, Volatile ; pharmacology ; Tumor Necrosis Factor-alpha ; genetics ; immunology