Adult ; Aminolevulinic Acid ; urine ; China ; Female ; Humans ; Male ; Middle Aged

OBJECTIVE:To explore the effects of the early use of heparin on the prognosis related indicators of patients with acute respiratory distress syndrome(ARDS). METHODS:Data of 86 ARDS patients were retrospectively analyzed and divided in-to observation group(45 cases)and control group(41 cases)by whether the early use of heparin. Control group received invasive mechanical ventilation,using end-expiratory pressure(PEEP)ventilation method,enteral nutrition support,nasogastric enteral nu-trition suspension 35-40 kcal/(kg·d);patients with combined infection were given Sodium ceftizoxime for injection 2 g,adding in-to 0.9% Sodium chloride injection 100 mL by intravenously infused,twice a day. Observation group was additionally given Hepa-rin sodium injection 6250 units by continuous intravenously pumped. They were treated for 14 d. The cumulative incidence of dis-seminated intravascular coagulation(DIC),and D-dimer,platelet count(PLT)before treatment and after 3,7,14 d of treatment, IL-6,IL-8,IL-10,TNF-α levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RE-SULTS:The cumulative incidence of DIC in observation group was significantly lower than control group,with statistical signifi-cance(P<0.05). Before treatment,there were no significant differences in the D-dimer,PLT,IL-6,IL-8,IL-10,TNF-α levels, with no statistical significance (P>0.05). After treatment,D-dimer,IL-6,IL-8 and TNF-α levels in 2 groups were significantly higher than before,while observation group was significantly lower than control group;PLT in 2 groups was significantly lower than before,while observaton group was higher than control group,with statistical significance (P<0.05). There was no signifi-cant difference in the IL-10 level in 2 groups before and after treatment (P>0.05). And there were no obvious adverse reactions during treatment. CONCLUSIONS:Based on conventional treatment,early use of heparin can significantly decrease the DIC rick for ARDS patients,which can improve coagulation disorders,reduce inflammatory response,and dose not increase the incidence of adverse reactions.

OBJECTIVE:To prepare Lipoic acid orally disintegrating tablets,and to evaluate its quality. METHODS:Lipoic acid orally disintegrating tablets were prepared with direct compression after wet granulation. With disintegration time and dissolu-tion as index,the constituents of disintegrating agent,filler and lubricant were screened by single factor test combined with orthogo-nal test. The tablet weight,hardness,disintegration time,accumulative rate and percentage content were investigated. RESULTS:The optimal formulation was MCC 167.58 mg,L-HPC 23.94 mg,PVPP 47.88 mg,mannitol 60 mg,lipoic acid 300 mg and mag-nesium stearate 0.6 mg. The parameters of prepared disintegrating tablets was as follows as (0.59 ± 0.05) g in weight,(20.32 ± 0.16)kg in solidity and(23.5±0.4)s in disintegration time,101.49% in 3 min accumulative dissolution rate,96.34% of labeled content. CONCLUSIONS:Lipoic acid orally disintegrating tablets are prepared successfully and controllable in quality.

OBJECTIVE:To observe the efficacy and safety of amikacin different administrations in the treatment of ventila-tor-associated pneumonia. METHODS:Data of 109 patients with ventilator-associated pneumonia were divided into observation group (58 cases) and control group (51 cases) based on different administrations. All patients received 3.0 g Ceftriaxone sodium for injection,adding into 100 ml 0.9% Sodium chloride injection,intravenously,once every 12 h. Based on it,control group re-ceived 7.5 mg/kg Amikacin sulfate injection,once a day. Observation group received 7.5 mg/kg Amikacin sulfate injection,adding into 20 ml 0.45% Sodium chloride injection,aerosol inhalation,twice a day. The treatment course for both groups was 7 d. Clini-cal pulmonary infection score (CPIS),alanine aminotransferase (ALT),serum creatinine (Cr),oxygenation index (PaO2/FiO2), IL-10,IL-6,C-reactive protein(CRP),tumor necrosis factor(TNF)-α,cumulative mortality after 3 months of treatment and the incidence of adverse reactions before and after treatment in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the CPIS score,ALT,Cr,PaO2/FiO2,IL-10,IL-6,CRP and TNF-α levels in 2 groups(P>0.05). After treatment,CPIS score,TNF-α,IL-6 and CRP levels in 2 groups were significantly lower than before,observation group was low-er than control group,the difference was statistically significant(P<0.05),and there was no significant difference in IL-10 before and after treatment in 2 groups(P>0.05). PaO2/FiO2 in observation group and ALT,Cr and PaO2/FiO2 in control group were signif-icantly higher than before,PaO2/FiO2 in observation group was higher than control group,ALT and Cr were significantly lower than control group,the differences were statistically significant(P<0.05). The cumulative mortality after 3 months of treatment in observation group was significantly lower than control group,the difference was statistically significant(P<0.05). And there were no severe adverse reactions during treatment. CONCLUSIONS:The efficacy of amikacin by aerosol inhalation is superior to by in-travenous infusion in the treatment of ventilator-associated pneumonia,it can effectively reduce inflammatory cytokine levels and mortality rate,do not increase the incidence of adverse reactions.

OBJECTIVE:To prepare zolmitriptan-diclofenac microemulsion,and conduct quality evaluation and in vitro trans-dermal study. METHODS:Using solubility and microemulsion area in pseudo-ternary phase diagram as indexes,the types of oil phase and mixed emulsifier ratio of zolmitriptan-diclofenac microemulsion were screened;the microemulsion quality was inspected using particle size,Zeta potential,appearance and stability. HPLC was used to measure the contents of zolmitriptan and diclofenac. Transdermal diffusion test instrument was used,2 g microemulsion was smeared in cuticle of extracouporeal rats'skin,and cumula-tive transdermal rate in 24 h was determined. RESULTS:The microemulsion formulation was as follow as 10% oil phase(octanoic acid triglyceride),25% mixture emulgator [polysorbate 80-brij 97 (1:1)],8.3% propylene glycol and 25 mg zolmitriptan,1.25 mg diclofenac,and water adding to 100 mL. The average particle size of prepared microemulsion was(28.2±2.5)nm,Zeta poten-tial was(-3.25±0.33)mV,the appearance was rounding;the microemulsion showed no stratification or flocculation at room tem-perature after placed for 1 month. Contents of zolmitriptan and diclofenac were 0.248 mg/mL,12.46 mg/mL(n=3);24 h cumula-tive transdermal rates were 80%,75%. CONCLUSIONS:Zolmitriptan-diclofenac microemulsion is prepared,and its in vitro trans-dermal ability is good.

OBJECTIVE:To explore the effects of xingnaojing combined with naloxone on related indexes of patients with he-patic encephalopathy. METHODS:In retrospective analysis,76 patients with hepatic encephalopathy were divided into control group(40 cases)and observation group(36 cases)according to drug use. Based on routine treatment,control group was additional-ly given Naloxone injection 1 mg added into 10% Glucose solution 100 mL intravenously twice a day. Observation group was addi-tionally given Xingnaojing injection 20 mL added into 0.9% Sodium chloride injection 250 mL intravenously once a day on the ba-sis of control group. Treatment courses of 2 groups lasted for 2 weeks. HDS score,MMSE score,the levels of blood ammonia,β-endorphin,CRP,IL-6 and TNF-α,the occurrence of ADR were observed in 2 groups before and after treatment. RESULTS:Af-ter treatment,HDS score and MMSE score of 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of blood ammonia,β-endorphin,IL-6,CRP and TNF-α in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statis-tical significance(P<0.05). There was no statistical significance in the level of IL-10 between 2 groups before and after treatment (P>0.05). There was no statistical significantly in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,Xingnaojing combined with naloxone can significantly improve cognitive function for patients with hepatic en-cephalopathy and reduce peripheral blood neurotoxin and inflammatory factor,moreover,do not increase the incidence of ADR.

A new ion chromatography was developed for the determination of clodronate disodium and its related substances. A suppressed conductivity detection was used. The analytical column was an IonPac AS11-HC anion-exchange column. The column temperature was maintained at 30 ℃. The potassium hydroxide solution was used as the eluent at a flow rate of 1.2 mL/min. For the determination of content and related substances,an isocratic elution program and a gradient elution program were performed, respectively.A good linear relationship was observed in the concentration range of clodronate disodium of 0.0568-0.1895 g/L(r=0.9999). The average recoveries of the injection and the capsules were 100.1%(RSD=0.7%) and 98.9%(RSD=0.6%),respectively. The limit of detection was 0.3 ng. The related substances gained a completely chromatography separation with the principal peak. The present method is accurate, sensitive and simple, which provides a new reliable analytical method for the quality control of clodronate disodium and its preparations.

Through focusing on widely concerned maternal death incident in Peking University Third Hospital,something can be discovered:for the upper hand in doctor-patient conflicts,they start to have a scramble for discourse power based on information dissemination of social media.On one hand,the evolution of social media builds a bridge for interactions and connections between doctors and patients.It contributes to rebuilding professional authority for doctors and increasing objectivity of information dissemination,On the other hand,information dissemination leads the new scramble for discourse power.It causes some problems:self-reflection decline of doctora,truth diiution about incident and even some moral and ethical risks both patients and doctors.Media tactics of doctors are Proposed to regulate and improve the scramble for discourse power in the social media context from two big aspects,namely establishing matrix platform and reducing propagation loss about social media.

Pyroptosis is a newly discovered form of programmed cell death, which has a close relationship with infectious diseases and spontaneous inflammatory disease and autoimmune disease.Gasdermin-D is the effector of pyroptosis.Inflammatory caspases cleave Gasdermin-D, break the structural autoinhibition and active the pore-forming activity of Gasdermin-D.Gasdermin-D-N domain is the active form of Gasdermin-D.Oligomerized Gasdermin-D-N domain forms membrane pores.Both pyroptosis and necroptosis can form pores.In this article, the progress of the research on pyroptosis, the involvement of Gasdermin-D in the molecular mechanism of pyroptosis, the distinguishment of pyroptosis from necroptosis and pyroptosis-related diseases are reviewed.

Objective:To investigate the effect of levosimendan on myocardial injury in patients with sepsis.Methods:Eighty-two patients with sepsis complicated by myocardial injury who received treatment in Yinzhou Second Hospital from June 2015 to September 2017 were included in this study. They were randomly assigned to receive either dobutamine treatment (control group, n = 41) or levosimendan treatment (study group, n = 41) based on conventional basic treatment. Before and after treatment, serum levels of heart-type fatty acid-binding protein (H-FABP), cardiac troponin I (cTnI), N-terminal pro brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LEVF), Acute Physiology, Age, and Chronic Health Evaluation II (APACHE II) score, intensive care unit (ICU) stay, and 28-day mortality were compared between the control and study groups. Results:Before treatment, there were no significant differences in serum levels of H-FABP, cTnI, and NT-proBNP as well as LVEF and APACHE II score between the control and study groups (all P > 0.05). At 6 hours after treatment, serum levels of H-FABP, cTnI, and NT-proBNP in the control and study groups [(26.22 ± 7.22) μg/L vs. (39.93 ± 9.85) μg/L, (25.97 ± 6.93) μg/L vs. (34.86 ± 8.55) μg/L, (0.004 ± 0.002) μg/L vs. (1.580 ± 0.360) μg/L, (0.003 ± 0.003) μg/L vs. (0.760 ± 0.210) μg/L, (1 561.73 ± 633.70) ng/L vs. (2 570.06 ± 747.95) ng/L, (1 602.28 ± 681.45) ng/L vs. (2 225.53 ± 585.14) ng/L] were significantly increased compared with before treatment ( t = 7.188, 5.172, 28.031, 23.079, 6.586, 4.443, all P < 0.05). After treatment, serum levels of H-FABP, cTnI, and NT-proBNP in the study group were significantly lower than those in the control group ( t = 2.489, 12.598, 2.323, all P < 0.05). In each group, serum level of H-FABP at 72 hours after treatment was significantly lower than that at 6 hours after treatment [(39.93 ± 9.85) μg/L vs. (6.28 ± 1.07) μg/L, (34.86 ± 8.55) μg/L vs. (5.82 ± 1.88) μg/L], serum levels of cTnI and NT-proBNP at 72 hours after treatment were significantly increased compared with those at 6 hours after treatment [(1.58 ± 0.36) μg/L vs. (2.72 ± 0.55) μg/L, (0.76 ± 0.21) μg/L vs. (1.78 ± 0.49) μg/L, (2 570.06 ± 747.95 ) ng/L vs. (3 623.27 ± 1 105.28) ng/L, (2 225.53 ± 585.14) ng/L vs. (3 128.08 ± 1 098.07) ng/L, t = 11.105, 12.251, 5.053, 4.645, all P < 0.05). At 72 hours after treatment, serum levels of cTnI and NT-proBNP levels in the control group were significantly higher than those in the study group ( t = 8.171, 2.035, both P < 0.05). At 72 hours after treatment, there was no significant difference in serum H-FABP level between the control and study groups ( P > 0.05). At 72 hours after treatment, APACHE II score in each group was significantly decreased and LVEF in each group was significantly increased compared with before treatment ( t = 7.718, 11.380, 9.049, 9.501, all P < 0.05). The change in APACHE II score at 72 hours after treatment relative to before treatment in the study group was more obvious than that in the control group ( t = 2.583, P < 0.05). At 72 hours after treatment, there were no significant differences in LVEF, ICU stay and 28-day mortality between the control and study groups (all P > 0.05). Conclusion:Levosimendan can reduce the serum levels of H-FABP, cTnI and NT-proBNP as well as APACHE II score in patients with sepsis, increase serum level of LVEF, and alleviate myocardial injury.