Objective:To observe the application effect of respiratory stepwise management in patients with septic shock combined with acute lung injury (ALI).Methods:100 patients with septic shock combined with ALI were selected as the research objects in Haikou Hospital Affiliated to Xiangya Medical College of Central South University from January 2018 to June 2020. Fifty patients were given endotracheal intubation or invasive ventilation on the basis of conventional treatment (conventional treatment group). According to the respiratory situation and blood gas, 50 patients were given systematic respiratory support step-by-step treatment according to the principle of simple to complex, and appropriate and scientific respiratory support was given according to the sequence from unarmed to mechanical (respiratory stepwise management group). The differences of cardiac index (CI), central venous pressure (CVP), mean arterial pressure (MAP), extravascular lung water index (EVLWI), arterial partial pressure of carbon dioxide (PaCO 2), arterial partial pressure of oxygen (PaO 2), oxygenation index (PaO 2/FiO 2) before and after treatment were compared between the two groups, the therapeutic effects of the two groups were evaluated, and the resuscitation effect, postoperative complications rate, tracheotomy rate, utilization rate of invasive ventilator of the two groups were recorded. Results:After treatment, CI, CVP, EVLWI, PaO 2, PaO 2/FiO 2 levels of the two groups were significantly higher than before treatment, MAP and PaCO 2 levels were significantly lower than before treatment; MAP and PaCO 2 levels after treatment of the respiratory stepwise management group were significantly lower than those of the conventional treatment group [MAP (mmHg, 1 mmHg = 0.133 kPa): 68.2±7.0 vs. 74.4±6.8, PaCO 2 (mmHg): 37.82±4.05 vs. 41.76±4.59], the levels of EVLWI, PaO 2 and PaO 2/FiO 2 in the respiratory stepwise management group were significantly higher than those in the conventional treatment group [EVLWI (mL/kg): 15.34±3.03 vs. 13.64±3.32, PaO 2 (mmHg): 84.44±4.83 vs. 79.03±5.54, PaO 2/FiO 2 (mmHg): 452.42±51.32 vs. 431.73±50.03, all P < 0.05]. There was no significant difference in CI or CVP after treatment between respiratory stepwise management group and conventional treatment group [CI (mL·s -1·m -2): 70.01±21.67 vs. 66.68±18.34, CVP (mmHg): 11.1±3.2 vs. 12.3±3.2, both P > 0.05]. Compared with the conventional treatment group, the average recovery time of the respiratory stepwise management group was earlier (hours: 2.04±0.54 vs. 4.29±0.20, P < 0.05), the stable breathing time was shorter (hours: 3.07±0.22 vs. 5.36±0.35, P < 0.05), the total effective rate and the success rate of recovery were significantly improved [86.0% (43/50) vs. 60.0% (30/50), 94.0% (47/50) vs. 74.0% (37/50), both P < 0.05], the incidence of ventilator associated pneumonia (VAP) and airway complications were significantly reduced [14.0% (7/50) vs. 32.0% (16/50), 12.0% (6/50) vs. 40.0% (20/50), both P < 0.05], and the tracheotomy rate and the utilization rate of invasive ventilator were significantly reduced [8.0% (4/50) vs. 28.0% (14/50), 30.0% (15/50) vs. 60.0% (30/50), both P < 0.05]. Conclusion:Respiratory stepwise management can effectively improve the resuscitation effect of septic shock patients with ALI, improve cardiopulmonary function, blood gas index and the treatment efficiency, effectively reduce the incidence of iatrogenic trauma and complications.

Objective To analyze the related records of acupuncture and moxibustion in the treatment of urticaria in ancient medical books,and to select valuable data as a reference for clinical optimization of acupuncture and moxibustion treatment.Methods With the keywords of "Yin Zhen" and "Feng Sao Yin Zhen",the ancient medical records of acupuncture and moxibustion were retrieved from Encyclopaedia of Traditional Chinese Medicine (5th edition) as the research object,to build database including books,publish year,records,number of selected acupoints,acupuncture and moxibustion methods,acupuncture points,and analyze according to the frequency.Results The earliest records were from the Jin Dynasty (A.D.266-420) "A-B classic of acupuncture and moxibustion",the most documented book was the Ming Dynasty Pu Ji Fang (22);63.64％ of the records did not describe the urticaria syndrome classification,while 36.35％ only briefly described the cold and heat.There were 117 single point prescription,4 pair points prescription,11 multi-point prescription.The commonly used interventions were acupuncture combined with moxibustion (41),moxibustion (31) and needling (22).Commonly used acupoints were Quchi (43),Hegu (18),Jianyu (17).The acupoints were mainly from Hand Yangming large intestine meridian (84),as the specific points of five (105) and from upper limb (120).Conclusions Chinese acupuncture treatment of urticaria has a long history.Prescription was usually single prescription,and the lack of the principle of syndrome differentiation,acupoints from the Hand Yangming large intestine meridian were Quchi,Hegu,etc.as the main points.Ancient medical acupuncture treatment program might be suitable for acute urticaria and grassroots units.

Through the analysis of Shenyang Medical College student's scientific research from 2007 to 2016, college student's scientific research has played an important role in promoting the cultivation of innovative talents, it has been an effective way that students understand the process of scientific research, cultivate scientific research ability, and that scientific research promotes teaching in university. College student's research should enhance the scientific and feasibility of the project selection, cultivate students the spirit of independent scientific research.

Objective:To evaluate the efficacy of apatinib combined with 131I therapy for progressive metastatic differentiated thyroid cancer (pmDTC). Methods:Seven patients (1 male, 6 females, age: 58(51, 66) years) with pmDTC in Nanjing First Hospital between November 2017 and February 2022 were enrolled. Patients received oral apatinib 500 mg once daily. The effect of apatinib on differentiated thyroid cancer were evaluated by using 18F-FDG PET/CT or CT at 3(2, 4) months after the treatment. Then in the state of continuous administration of apatinib, 131I therapy was initiated. 18F-FDG PET/CT or CT was performed at 3 months after apatinib combined with 131I therapy to evaluate the response. Both thyroglobulin (Tg) and Tg antibody levels were monitored every 4 to 8 weeks after the treatment. Wilcoxon signed-rank test was used for data analysis. Results:Five patients achieved partial response after 3(2, 4) months of apatinib treatment and two patients had progressive disease. The disease control rate and objective response rate were both 5/7. Five patients achieved partial response and two patients were in stable disease after apatinib combined with 131I therapy for 2(1, 2) times, with disease control rate and objective response rate of 7/7 and 5/7, respectively. The Tg level declined from 8 644(2 504, 16 300) μg/L (baseline) to 143(7, 3 574) μg/L( z=-2.37, P=0.018) after apatinib combined with 131I therapy. In addition, one patient had a significant increase in 131I uptake in the tumor lesions after long-term treatment with apatinib. Conclusions:Apatinib has obvious anti-tumor effects and high objective response rate is observed after apatinib treatment in patients with pmDTC. The anti-tumor effects are more prominent after combined with 131I therapy. Long-term treatment with apatinib may alter the tumor microenvironment to induce differentiation and increase iodine uptake in tumor lesions, which need to be further studied.

Objective:To analyze the horizontal scientific research projects from 2015 to 2019 by the provincial Centers for Disease Control and Prevention (CDC) in China, and to compare the regional differences, in order to provide the suggestion on the scientific management of CDC.Methods:The horizontal scientific research projects from 2015 to 2019 were retrospectively analyzed by questionnaire survey. Multiple linear regression models were adopted to examine the trend, and variance analyses were used to test the differences in horizontal scientific research projects among the Eastern, Central, and Western regions.Results:From 2015 to 2019, provincial CDC have received RMB 124.3 million of horizontal scientific research project funds totally, of which 51.9% were funded by enterprises, and 86.9% were undertaken by provincial CDC themselves. There were no statistical significance in the change of research project funds obtained by provincial CDC ( F=0.46, P = 0.764) during this period.The number of horizontal scientific research projects undertook or participated by provincial CDC in the Eastern region were more than that of the Central and Western region ( F = 5.85, P = 0.004; F = 5.03, P = 0.008). Conclusions:The horizontal scientific research projects obtained by the provincial CDC remained stable in recent years while distribution was unbalanced in the region areas. It is suggested to innovate the management mode of scientific research projects with strengthening the trans-agency, trans-department and trans-regional cooperation.

OBJECTIVE：To study the effect s of Bifidobacterium combined with L-carnitine on intestinal flora of dysbacteriosis diarrhea model rats. METHODS ：Totally 30 SD rats were randomly divided into blank control group ，model group ，probiotics group（Bifidobacterium triple viable enteric coated capsules 70 mg/mL），L-carnitine group （L-carnitine injection 50 mg/mL）and L-carnitine+probiotics group （L-carnitine injection 50 mg/mL+Bifidobacterium triple viable enteric coated capsules 70 mg/mL）. Except for blank control group ，the rats in other groups were given 50 mg/mL clindamycin phosphate intragastrically （2 mL/rat， once a day ，for 4 consecutive days ）to establish the model of dysbacteriosis diarrhea. On the 5th day of the experiment ，the rats in administration groups were given corresponding drugs intragastrically ，blank control group and model group were given equal volume of normal saline intragastrically ；with the dosage volume of 1 mL/rat，once a day ，for consecutive 7 days. The general situation of rats in each group was observed during the experiment. The feces of normal control group and model group at the end of the modeling and the feces of the rats in administration group after the last administration were collected for genomic DNA extraction，polymerase chain reaction amplification ，library construction and high-throughput sequencing. After processing ，the effective data were analyzed by operational taxonomic unitsclustering and species annotation ，as well as Alpha and Beta diversity of compared with blank control group ，grade 1 feces and grade 2feces were found in model group. The diversity and richness of intestinal flora ，the ratio of Firmicutes/Bacteroidetes and zhongjuanwang7@163.com the abundance of probiotics such as Lactobacillus， Bifidobacterium and Ackermann were significantly decreased （P＜0.05），while the abundance of pathogenic bacteria such as Enterococcus was significantly increased （P＜0.05）. At the end of the recovery period ，compared with model group ，the activity，fecal morphology and color of rats in probiotics group ，L-carnitine group and L-carnitine+probiotics group returned to normal，and the diversity and richness of intestinal flora had no significant difference （P＞0.05）. However ，the abundance of Lactobacillus in intestinal tract was increased to a certain extent ，and the abundance of Ackermann in intestinal tract of rats in L-carnitine+probiotics group was significantly increased （P＜0.05）. CONCLUSIONS ：Although Bifidobacterium combined with L-carnitine have no significant effect on improving the diversity and richness of intestinal flora in dysbacteriosis diarrhea model rats，it could increase the abundance of probiotics to a certain extent.