Objective　To explore the method of chemical synth esis of L-alanyl-L-glutamine dipeptide. Methods　 L-alanyl-L -glutamine dipeptide was prepared by condensation and ammoniation reaction of L -glutamine and 2-D-chloropropionyl chloride. The physico-chemical properties of this dipeptide were identified with melting point determination, amino acid analysis, elements analysis and MS and its purity was determined with HPLC. Results　This dipeptide was confirmed good in quality by physico-chem ical determination. Conclusion　Dipeptide synthetized by this me thod is simple, convenient and with good guality.

AIM: To study the inhibitory effect of IGF binding protein-4(IGFBP-4),especially in corporation with heparin on the pathopoiesis of insulin-like growth factor-1(IGF-1) in alveolitis and fibrosis.METHODS: The diploid human embryonic lung(HEL) fibroblasts were incubated respectively with control,100 ?g/L IGF-1,100 ?g/L IGF-1+100 ?g/L IGFBP-4,100 ?g/L IGF-1+200 ?g/L IGFBP-4,100 ?g/L IGF-1+100 ?g/L IGFBP-4+100 ?g/L heparin,100 ?g/L IGF-1 + 100 ?g/L IGFBP-4+200 ?g/L heparin,100 ?g/L IGF-1+100 ?g/L heparin,100 ?g/L IGF-1+200 ?g/L heparin for 24 h.Then the content of glucose transporter-4(GLUT-4),hexokinase-2(HK-2),collagen-4 and elastin were detected,respectively.RESULTS: Compared with control group,HK-2,GLUT-4,elastin and collagen-4 expressed in IGF-1 group were increased obviously.The expression in the group of IGFBP-4 plus IGF-1 was more than that in IGF-1 group.However,all expression was depressed strikingly when heparin was added.CONCLUSION:(1) IGF-1 apparently stimulates HK-2,GLUT-4,elastin and collagen-IV secretions from lung fibroblasts.(2) The intact IGFBP-4 associated with heparin can inhibit the pathopoiesis of IGF-1.

OBJECTIVE: To investigate the efficacy and related factors of nasal surgery combined with upper air way radiofrequency ablation(RFA) for treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) with chronic nasal blockage. METHOD: One hundred and three mild or moderate OSAHS patients with chronic nasal blockage were recruited, all cases had nasal surgery and upper airway RFA. All patients were evaluated by body mass index (BMI), Epworth sleep scale (ESS), snoring scale, and nocturnal polysomnography (PSG). Eighty-nine patients were reevaluated at least 6 months after surgery with the preoperative methods. RESULT: After operation, the apnea and hypopnea index (AHI) decreased from (18.67 +/- 9.48)/h to (9.22 +/- 7.18)/h; the lowest artery oxygen saturation (LSaO2) increased from (0.83 +/- 0.08) to (0.92 +/- 0.06); the Epworth sleep scale(ESS) decreased from (8.74 +/- 5.67) to (5.12 +/- 3.74); the snoring scale decreased from (7.16 +/- 2.85) to (3.56 +/- 2.26), the percentage of time with oxyhemoglobin saturation below 0.90 (CT90) decreased from (18.64 +/- 12.98) to (10.73 +/- 8.29). All of the differences were obvious (P<0.01). Success was defined as a postoperative apnea-hypopnea in dex < 10 events per hour and at least 50% less than the preoperative value. The surgical success rate was 75.3% (67/89). No major perioperative complications occurred. CONCLUSION Our findings suggest that nasal surgery combined with upper airway RFA can improve snoring and disease-specific quality of life in patients with anatomic na sal obstruction with mild or moderate OSAHS.
Adult ; Catheter Ablation ; Female ; Humans ; Male ; Middle Aged ; Nasal Septum ; surgery ; Nasal Surgical Procedures ; Sleep Apnea, Obstructive ; surgery ; Snoring ; surgery ; Turbinates ; surgery

Self-made molecule imprinting polymer-solid phase extraction column was used in extracting nerve agent degradation products in rice. The extraction was then examined by capillary electrophoresis. The method was simple, reliable and sensitive. The calibration curve showed a good linearity for the nerve agent degradation products in rice was in the concentration range of 0.2～5.0　μg/g and the detection limits were 0.05μg/g. The RSD of the method was less than 6.2%.

Objective To evaluate the therapeutic effect of catheter-directed thrombolysis (CDT) for the treatment of acute deep venous thrombosis (DVT) of the lower extremity.Methods Clinical data of 195 patients of acute DVT treated by CDT and adjunctive angioplasty and stenting from August 2010 to February 2014 were analyzed retrospectively.CDT by antegrade puncture of popliteal vein,CDT by great saphenous vein and CDT by retrograde puncture of contralateral femoral vein were used in these cases.Venous recanalization was graded by a thrombus score based on pre-and post-treatment venography.Results Technique success rate,clinical success rate,in popliteal vein group,great saphenous vein group and contralateral femoral vein group were 94.6％,72.2％ and 90.3％,97.3％,83.3％,and 90.0％.Patent rate of deep venous,patent rate of stenting and mild post-thrombotic syndrome (PTS) rate were 88.6％,66.7％ and 75.0％,83.3％,57.1％ and 88.9％,8.3％,26.7％ and 20.8％.Conclusion CDT by antegrade puncture of popliteal vein group combined with adjunctive angioplasty and stenting is safe and effective with higher clinical success rate and better long term results than other approaches for the treatment of DVT patients.

Objective: To investigate the clinical practicability and prognostic value of Helsinki CT score in patients with traumatic brain injury (TBI). Methods: A retrospective case series study was conducted to analyze the clinical data of 124 TBI patients admitted to First Affiliated Hospital of Xinjiang Medical University from September 2016 to October 2018. There were 91 males and 33 females, aged 14-84 years, with an average age of 49 years. Glasgow coma score (GCS) at admission ranged from 3-8 points in 45 patients, 9-12 points in 42 patients, and 13-15 points in 37 patients. According to Glasgow outcome scale (GOS) at 6 months after injury, 26 patients were classified into the poor prognosis group with GOS of 1-3 points and 98 patients were in the good prognosis group with GOS of 4-5 points. The prognosis-related risk factors were analyzed, and the role of Helsinki CT score to predict the adverse prognosis and mortality of TBI patients in the two groups was investigated. The sensitivity and specificity of Helsinki CT Score for 6-month poor prognosis were evaluated by receiver operation characteristic (ROC) curve and area under the curve (AUC). Results: Univariate analysis suggested that there were significant differences in terms of subdural hematoma, intracranial hematoma, extradural hematoma, hematoma volume >25 cm^3, intraventricular hemorrhage and suprasellar cistern pressure between the poor prognosis group and good prognosis group (P<0.05). Multivariate logistic regression analysis showed that the mortality and bad prognosis were related to the hemorrhage of ventricles, the pressure of suprasellar cistern and the disappearance of suprasellar cistern in the poor prognosis group and the good prognosis group (P<0.05), while intracranial hematoma and hematoma volume showed no association with mortality and poor prognosis (P>0.05). The Helsinki CT score could independently predict the adverse prognosis and mortality of TBI patients at 6 months (multivariate logistic regression: OR_death=1.21, OR_{adverse prognosis}=1.14). Helsinki CT score had a better predictive ability of 6-month mortality (AUC=0.85) than that of 6-month adverse prognosis (AUC=0.76), and had a predictive value for 6-month mortality and adverse prognosis. Conclusions Subdural hematoma, extradural hematoma, intraventricular hemorrhage and suprasellar cistern state (compression or disappearance) are the risk factors for the poor prognosis of TBI patients. Intraventricular hemorrhage and suprasellar cistern state are the main risk factors for predicting the mortality of 6 months. Helsinki CT score can independently predict the adverse prognosis and mortality of TBI patients at 6 months, and has relatively better value in predicting the mortality.

The following trends emerged in international critical care practice in 2019: increasing analysis to phenotypes of sepsis and acute respiratory distress syndrome (ARDS), increasing evidences of early initiating of vasopressors and antibiotics for septic shock, also including the early furosemide stress test for critically ill patients with acute kidney injury (AKI). In addition, there are many significantly important trials with positive results: high dose vitamin C for septic shock, weaning strategy with pressure support ventilation (PSV) mode, tranexamic acid for patients with acute traumatic brain injury, and new monoclonal antibody for Ebola virus disease. And there are also negatives trials as following: individual mechanical ventilation, maximal recruitment open lung ventilation or early neuromuscular blockade for moderate-to-severe ARDS, N95 respirators preventing influenza, flexible family visit program against delirium or early sedation with dexmedetomidine to mechanically ventilated patients, intensive care unit (ICU) diary or nurse-led preventive psychological intervention against posttraumatic stress disorder (PTSD) in patients with mechanical ventilation, recombinant human soluble thrombomodulin (rhsTM) in patients with sepsis-associated coagulopathy, and so on. Further investigations should be focus on the phenotype analysis, by which individualized management fitting for specific pathophysiologic and immune characters for each patient could be clarified.

In 2018,a bunch of considerable positive progresses have been presented,including a revised "hour-1 bundle" introduced by international guideline for management of sepsis and septic shock,trans-pulmonary pressure monitoring via esophageal manometry in acute respiratory distress syndrome (ARDS) models,successful trials for new antibiotics,angiotensin Ⅱ in patients with vasodilatory shock and renal replacement therapy,advanced airway management in out-of-hospital cardiac arrest (OHCA) patients as well cellular immunotherapy for septic shock.But some of investigational trials did not yield expected results.For example,extracorporeal membrane oxygenation (ECMO) therapy for ARDS patients,the strategy of sequencing weaning with early extubation to noninvasive ventilation,prevention of delirium with haloperidol,surrogate decision supported by interprofessional intensive care unit (ICU)team and prophylaxis for gastrointestinal stress ulceration with pantoprazole in ICU.And more importantly,it has been obvious that the voices and evidences gathered by the opponents against guidelines development,compulsory polices of implementing bundled strategy,market position of hydroxyethyl-starch solutions (HES) and the usage of steroid in septic shock have been largely strengthen,highlighting a more divided and controversial situation.

OBJECTIVE: To investigate the efficacy and related factors of Z-palatoplasty for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: Thirty-two severe OSAHS patients with Friedman II and III oropharyngeal airway had Z-palatoplasty. Twenty-three patients with modified Mallampti Index (MMI) III-IV had coblation tongue channeling (CTC) simultaneously. The patients were followed up for one year post operatively. RESULT: After operation, the apnea and hypopnea index (AHI) decreased from (54.74 +/- 20.38)/h to (22.72 +/- 18.36)/h; the lowest artery oxygen saturation (LSaO2 ) increased from (0.74 +/- 0.08) to (0.85 +/- 0.14); the Epworth sleep scale (ESS) decreased from (12.24 +/- 5.78) to (5.35 +/- 3.62); the percentage of time with oxyhemoglobin saturation below 0.90 (CT90) decreased from (31.48 +/- 20.15) to (15.73 +/- 12.29). All of the differences were statistically significant (P < 0.01). According to related criterion of chinese journal of otorhinolaryngology head and neck surgery in 2009, accumulative excellence rate was 71.9% and accumulative valid rate 84.4%. Six patients had temporary velopharyngeal insufficiency and returned to normal after 3 months. CONCLUSION Z-palatoplasty is an effective and safe surgical approach for OSAHS patients with Friedman II/III.
Adult ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Palate ; surgery ; Pharynx ; surgery ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome ; Uvula ; surgery

Objective To explore the effect of security,self-acceptance,self-concept,intemet addiction,anxiety,depression on the suicidal ideation of internet addiction patients.Methods The safety,self-acceptance,self-concept,internet addiction,anxiety and depression of 220 internet addiction patients were assessed using the corresponding scale tools.Suicidal ideation was used as the dependent variable,and each influencing factor was used as the independent variable.Correlation analysis,multiple stepwise regression analysis and path analysis were utilized to analyze the predisposing factors.Results The suicidal ideation (12.65 ±5.72) was positively correlated with internet addiction assessment (73.35± 15.83),depression self-evaluation (56.33± 13.75) and anxiety self-assessment (48.93± 17.20) (r=0.250,0.636,0.531,P＜ 0.01),while negatively correlated with security (50.26± 12.33),self-acceptance (38.29±7.15),and self-concept (56.47± 17.92) (r=-0.390,-0.297,-0.298,P＜ 0.01).Sequentially depression (β =0.571,P＜ 0.01),anxiety (β =0.173,P=0.003) were entered into the multiple regression equation.Path analysis based on the structural equation model showed that suicidal ideation had a direct effect with depression and anxiety,with effect values of 0.583 and 0.176.There were indirect effects of self-concept,self-acceptance,sense of security,and internet addiction assessment.The effect values were-0.137,-0.117,-0.281,and 0.034.The total effect of suicidal ideation and self-concept,self-acceptance,sense of security,internet addiction,depression self-assessment,and anxiety self-assessment were-0.137,-0.117,-0.281,0.034,0.583 and 0.176 respectively.Conclusions The influence of security,self-acceptance,and self-concept on suicidal ideation is produced through the mediating effects of depression and anxiety,and it has a negative predictive effect.There is no direct causal relationship between internet addiction and suicidal ideation.