Objective To determine if the cardiac index (CI) measured by transesophageal echocardiography (TEE) through the mitral valve (MV) agrees with that measured by transesophageal echocardiography through the ascending aorta (AA).Methods Sixteen ASA Ⅱ or Ⅲ patients (NYHA Ⅱ or Ⅲ),aged 18-70 kg,weighing 46-72 kg,undergoing mitral valve replacement under cardiopulmonary bypass (CPB),were studied.Total intravenous anesthesia was used for induction and maintenance of anesthesia.After tracheal intubation,the TEE probe was placed in the esophagus.CI was measured by transesophageal echocardiography through the MV (CIMV)and AA (CIAA) at 15,30 and 60 min after termination of CPB and recorded.All the data were compared by Bland-Altman analysis.Results CIMV values were significantly lower at each time point than CIAA values (P ＜0.01).The results of Bland-Altman comparison:CIMV 1.29-5.52 L· min-1 · m-2,mean was (2.6 ± 0.9)L·min-1·m-2,and CIAA 2.7-8.8 L·min-1·m-2,mean was (4.9± 1.7) L·min-1 ·m-2,bias was-2.3 L·min-1 ·m-2,and limit of agreement was-5.62-1.03 L· min-1 · m-2 resulting in r =-0.577,P ＜ 0.01.Conclusion CI values obtained through the MV agrees well with that measured through the AA using TEE in patients undergoing mitral valve replacement,but CIAA values are significantly higher than CIMV values,there is a large difference between them for clinical use,and both methods for CI measurement cannot replace each other.

Objective To quantitatively analyze the early warning value of laboratory indexes for death risk in children with criti ‐cal hand foot and mouth disease (HFMD) .Methods The univariate and multivariate Logistic regression analysis were conducted to explore the independent risk factors of death in critical HFMD children .Then the area under receiver operating characteristic curve (AUC) was applied to give the comprehensive assessment of the test model ,as well as the early warning capacity and the optimal cut‐off level of laboratory indexes in critical HFMD children .Results The AUC of the Logistic regression model (Y ) established based on white blood cell ,neutrophil ,myoglobin ,creatinine for early predicting the death risk in critical HFMD children patients was 0 .847 (95% CI :0 .783 - 0 .911) ,which indicating that its diagnostic value was superior to single index .Conclusion The diag‐nostic value of the Y model established based on four indexes of white blood cell count ,neutrophile granulocytes count ,myohemo‐globin and creatinine is superior to any single index ,which has the better early warning value for the death risk in children with crit‐ical HFMD .

Objective To evaluate the efficiency and safety of exercise interventions on cancer related fatigue. Methods Cochrane Library, JBI Database of Systematic Reviews, MEDLINE, EMbase, CINAHL, Chinese Journal Full- text Database, Chinese Biomedical Literature Database, and Wanfang Databse were searched from the inception to November 2014 to screen the systematic review and Meta-analysis conforming to the inclusion criteria. Two authors independently appraised their methodological qualities with Overview Quality Assessment Questionnaire (OQAQ), and analyzed the data using descriptive analysis. The primary outcome included the scaling of cancer related fatigue, the secondary outcome included adherence to exercise intervention and the incidence of adverse events. Results Fourteen systematic review/Meta-analysis were identified, twelve of them had a high methodological quality (Scoring 5-7). Six systematic review/Meta-analysis found that aerobic exercise could effectively alleviate cancer related fatigue, especially for breast cancer patients;seven articles showed that exercise could modulate cancer related fatigue of patients under active treatments;seven articles reported the compliance to the exercise intervention, four articles reported adverse events occurring during the intervention, very few of them resulted directly from the exercise intervention. Conclusions Exercise intervention can modulate cancer related fatigue with good safety.

OBJECTIVE:To observe therapeutic efficacy and safety of Shensong yangxin capsules combined with edaravone in the treatment of cerebrovascular disease complicated with cerebrocardiac syndrome(CCS). METHODS:A total of 128 cerebrovas-cular disease patients with CCS were randomly divided into control group (64 cases) and observation group (64 cases). Control group received routine treatment,observation group was additionally given Shensong yangxin capsule 1.6 g orally,3 times a day+Edaravone injection 30 mg added into 0.9% Sodium chloride solution 250 mL intravenously,2 times a day. Treatment courses of 2 groups lasted for 10 d. Clinical efficacies of 2 groups were observed,and MDA,SOD,catecholamine(NE,E,DA)levels,cT-nI,NIHSS scores,correlation of cTnI level with NIHSS score were also observed before and after treatment. The occurrence of ADR was recorded. RESULTS:Total response rate of nervous system and electrocardio gram in observation group were significant-ly higher than control group,with statistical significance (P<0.05). Before treatment,there was no statistical significance in MDA,SOD,NE,E,DA,cTnI levels or NIHSS scores between 2 groups(P>0.05). After treatment,MDA,NE,E,DA,cTnI levels and NIHSS scores of 2 groups were significantly lower than before,and the observation group was significantly lower than the control group;SOD of 2 groups were significantly higher than before,and the observation group was significantly higher than the antrol group,with statistical significance (P<0.05). cTnI level was positively correlated with NIHSS score (r=0.956,P=0.001). There was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on rou-tine treatment,Shensong yangxin capsules combined with edaravone can significantly improve therapeutic efficacy of cerebrovascu-lar disease patients with CCS,and improve the levels of catecholamine,MDA and SOD without increasing the occurrence of ADR.

Objective To OxplorO thO OffOct of N-tOrminal pro-brain natriurOtic pOptidO( NT-proBNP) combinOd with nOutrophil to lymphocytO ratio ( NLR) on short -tOrm prognosis in patiOnts with acutO ST sOgmOnt OlOvation myocardial infarction ( STEMI ) undOrgoing primary pOrcutanOous coronary intOrvOntion ( PCI ). Methods From January 2015 to DOcOmbOr 2016, 243 patiOnts with acutO STEMI who undOrwOnt primary PCI in Harrision IntOrnational POacO Hospital wOrO OnrollOd in thO study. ThO lOvOls of NT-proBNP and NLR wOrO mOasurOd at admission. ThO occurrOncO of major advOrsO cardiac and cOrObrovascular OvOnts(MACCE) was followOd up during 1 yOar aftOr PCI. ROcOivOr opOrating charactOristic( ROC) curvOs wOrO usOd to sOt cut-off valuOs of NT-proBNP and NLR for prOdicting MACCE. All patiOnts wOrO dividOd into 4 groups basOd on thO optimal cut-off point: low NT-proBNP/low NLR group, low NT - proBNP/high NLR group, high NT - proBNP/low NLR group, high NT-proBNP/high NLR group. Various indicators wOrO comparOd among thO four groups. Survival curvOs of thO 4 groups at 12 months wOrO constructOd by Kaplan -MOiOr analysis and comparOd using thO log -rank tOst. ThO prOdictivO valuO of NT-proBNP and NLR alonO or in combination for MACCE aftOr PCI was OvaluatOd by thO Cox proportional hazard modOl. Results ThOrO wOrO statistically significant diffOrOncOs in TC,LDL-C, blood glucosO, glycosylatOd hOmoglobin, FMC to Ballon timO, NT-proBNP, NRL among thO high NT-proBNP/high NLR group and thO othOr thrOO groups(F =40.684,65.429,398.62,41.330,217.218,331.5,393.02,all P <0.05). ROC analysis indicatOd thO optimal cut-off point of NT-proBNP, NLR for prOdicting MACCE wOrO 1 600 ng/L(thO arOa undOr thO ROC curvO 0.779,sOnsitivity 81.4% ,spOcificity 83.5% ) and 6.5(thO arOa undOr thO ROC curvO 0.742, sOnsitivity 78.6% ,spOcificity 80.8% ),rOspOctivOly.ThO patiOnts in thO high NT-proBNP(>1 600ng/L) and high NLR(>6.5) group had significantly highOr risk of cardiovascular dOath(23.5% ),hOart failurO(47.1% ),rOcurrOnt MI(17.6% ),and cOrObral strokO(11.7% ),but no significantly incrOasO in thO risk of non-plan rOpOat rOvascular-ization, stOnt thrombosis.ThO survival ratO in high NT -proBNP and high NLR group(76.5% ) was significantly lowOr than thO othOr thrOO groups(98.1% ,97.9% ,95.0% ,χ2 =20.626,P<0.05).MultivariatO analysis of COX proportional hazards modOl showOd that TC, LDL - C, blood glucosO, glycosylatOd hOmoglobin, thO onsOt timO, NT-proBNP, NRL could bO usOd as thO prognostic factors for cardiac and cOrObrovascular OvOnts. ThO prOdictivO powOr of NT-proBNP combinOd with NLR was highOr than OithOr NT-proBNP or NLR alonO.Conclusion IncrOasOd lOvOls of NT -proBNP and NLR at admission could prOdict cardiovascular dOath, hOart failurO, rOcurrOnt MI and cOrObral strokO in patiOnts with STEMI aftOr primary PCI. ThO prognostic capability of intOrgratOd application of NT-proBNP and NLR is bOttOr than OithOr NT-proBNP or NLR alonO.

Objective To investigate the efficacy and safety of different doses of Rosuvastatin calcium in treating elderly patients with coronary heart disease complicated with hyperlipidemia.Methods A total of 130 patients with coronary heart disease in combination with hyperlipidemia admitted into our hospital from January 2015 to December 2017 were enrolled.They were randomly divided into the control group(with Rosuvastatin calcium 10 mg per day,n=65)and the study group (with Rosuvastatin calcium 20 mg per day,n=65).Clinical efficacy,changes of blood lipid levels and adverse reactions after treatment were compared between the two groups.Results In the study group,25 cases had obvious effects,35 cases had effects and 5 cases had noeffect.In the control group,21 cases with obvious effects,31 cases with effects and 13 cases without effect were found.The total effective rates were 92.3％ in the study group and 80.0％ in control group(x2 =4.127,P =0.042).The blood levels of total cholesterol (TC),triglyceride(TG)and low-density lipoprotein cholesterol (LDL-C) in the study group were decreased in post-vs.pre-treatment,and were lower in treatment group than in control group(all P =0.000).Nausea and vomiting in 1 case,and muscle ache in 1 case were found in the control group.In the study group,2 cases of nausea and vomiting,2 cases of skin rash,1 case of muscle ache,and 2 cases of joint ache were found.The incidences of adverse reactions were 10.8％ and 3.1％ in the study and control group respectively,with no significant difference between the two groups (x2 =2.984,P =0.084).Conclusions The high-dose of Rosuvastatin calcium(20 mg daily)has significant clinical efficacy and improve the blood lipid levels in elderly patients with coronary heart disease complicated with hyperlipidemia,with no significant difference in incidence of adverse reactions between 10 mg daily versus 20 mg daily Rosuvastatin calcium.

AIM: To investigate the role of ribonucleotide reductase M2 (RRM2) in 5-fluorouracil (5-FU) resistance of HCC cells and to develop potential strategies to enhance the sensitivity of HCC cells to 5-FU. METHODS: The expression of RRM2 was examined by Western blot in BEL/5-FU cells and BEL7402 cells. The expression of RRM2 was down-regulated through RNA interference (RNAi) technology and the activity of RRM2 was inhibited by the RRM2 inhibitor 3-AP. The cell proliferation ability was detected by CCK-8 assay and colony formation assay, and the apoptosis was analyzed by Confocal high-content system. RESULTS: The expression level of RRM2 was increased by 2.5-fold in BEL/5-FU cells compared with BEL7402 cells. Compared with control siRNA, the half maximum inhibitory concentration IC

Child ; Chromosomes, Human, Pair 21 ; Core Binding Factor Alpha 2 Subunit ; genetics ; Gene Amplification ; Gene Deletion ; Humans ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; genetics ; Proto-Oncogene Proteins c-ets ; genetics ; Repressor Proteins ; genetics

Objective: To improve the accuracy of diagnosis and to reduce the misdiagnosis rate of nasopharyngeal carcinoma by analyzing the characteristics of such masses. Methods: Clinical data from 55 patients with suspicion of nasopharyngeal carcinoma diagnosed and treated between March 2016 and September 2017 were analyzed. All patients were followed up regularly. Results: With following-up of 12 to 25 months, 6 (10.9%) of 55 cases were identified as nasopharyngeal malignant tumors, including 4 cases of nasopharyngeal carcinoma and 2 cases of lymphoma, and 49 cases (89.1%) were diagnosed with nasopharyngeal benign masses, including 29 (59.2%) cases for nasopharyngeal lymphoid proliferation, 15 (30.6%) for adenoid hypertrophy, 2 (4.1%) for nasopharyngeal cyst, 1 (2.0%) for polyp, 1 for papilloma and 1 for nasopharyngeal pharyngeal cyst. Small nasopharyngeal malignant tumor and masses with benign hyperplasia showed the overlap of images on the enhanced MRI/CT and Fibro-nasopharyngoscopy, but all 6 patients with nasopharyngeal malignant tumors presented with moderately enhanced multiple enlarged lymph nodes. Conclusions Fibro-nasopharyngoscopy and enhanced MRI/CT have some value on evaluation of nasopharyngeal masses, but biopsy is a golden standard for diagnosis. Follow-up is necessary for the patients with negative biopsy and benign nasopharyngeal hyperplasia indicated by fibro-nasopharyngoscopy and enhanced MRI/CT.

COVID-19 is caused by a novel coronavirus-severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which has being spreading around the world, posing a serious threat to human health and lives. Neutralizing antibodies and small molecule inhibitors for virus replication cycle are the main antiviral treatment for novel coronavirus recommended in China. To further promote the rational use of antiviral therapy in clinical practice, the National Center for Infectious Diseases (Beijing Ditan Hospital Capital Medical University and the First Affiliated Hospital, Zhejiang University School of Medicine) invited experts in fields of infectious diseases, respiratory and intensive care to develop an Expert Consensus on Antiviral Therapy of COVID-19 based on the Diagnosis and Treatment Guideline for COVID-19 ( trial version 10) and experiences in the diagnosis and treatment of COVID-19 in China. The consensus is concise, practical and highly operable, hopefully it would improve the understanding of antiviral therapy for clinicians and provide suggestions for standardized medication in treatment of COVID-19.