Objective To investigate the efficacy and safety of percutaneous patent ductus arteriosus (PDA) closure via femoral vein solely under transesophageal echocardiography guidance.Methods From May 2014 to May 2015,28 patients(13 boys,15 girls) were selected in Dalian Children's Hospital Affiliated to Dalian Medical University with PDA closure via the femoral vein under transesophageal echocardiography guidance,with mean age (3.5 ± 2.6)years and mean body weight (16.0 ± 6.5) kg.The mean diameter of PDA was (7.1 ± 3.9) mm.Patients were all treated by percutaneous PDA closure solely by transesophageal echocardiography via the femoral vein.The effect of the procedures was evaluated by echocardiography.The transthoracic echocardiography,chest X-ray film,cardiogram at 1 month,3 months and 6 months after procedure were followed up.Results Twenty-seven cases were successfully treated with percutaneous PDA closure via the femoral vein solely under transesophageal echocardiography guidance,while 1 patient was closed by surgical closure with on-pump beating-heart because PDA occluder strayed into the left pulmonary artery on 1-month follow-up.The procedural time was (48.5 ±8.7) min.The mean diameter of PDA occluder was (8.2 ± 4.1) mm.Twenty-seven patients survived without peripheral vascular injury or complications such as residual shunt,arrhythmia and cardiac perforation.One patient was transformed to surgical closure.Hospitalization time was (2.5 ± 0.5) days.At one month follow-up,no complications such as residual shunt or pericardial effusion occurred.Conclusion Transesophageal echocardiography guided percutaneous PDA closure via the femoral vein approach is safe and effective without the damage from radiation and contrast agents,and aviods the use of femoral artery puncture.

Objective To explore the application value of quantitative analysis of tissue diffusion by ultrasound elastography in evaluating the evolution of achilles tendinopathy and indirectly reflecting the feature of tendon biomechanics.Methods Rabbits underwent 0.1 ml (group M) or 0.3 ml (group S)collagenase or 0.2 ml saline (group C) injection.The percentage of area displaying blue (％AREA) in the area of interest was measured by the diffusion quantitative technique of ultrasound elastography at baseline and 1,3,7 and 14 days after model.The achilles tendon was obtained for pathological examination to observe the changes of collagen fibers and tested to measure the maximum tensile load by the universal testing machine.Results (1) The ％AREAs in group M and S at 1,3,7 and 14 days after model were smaller than those in group C (P ＜0.05),and reached its lowest value at 3 days after model.％ AREA in groupSwas significant lower than that in group M at 3 or 7 days after model (P ＜0.05).(2) The maximum tensile loads in group M at 1,3 and 7 days after model were smaller than those in group C (P ＜0.05),but there was no significant difference between group M and C at 14 days after model (P ＞0.05).The maximum tensile load in group S was significant lower than those in group M and C after model (P ＜0.05),and arrived its lowest point at 3 days after model.(3) The ％AREA was positively associated with the maximum tensile load of achilles tendon (r =0.87,P ＜0.001).Conclusions Ultrasound elastography can dynamically monitor the evolution of achilles tendinopathy and reflect the biomechanical state of achilles tendon.

OBJECTIVETo observe the effects of Shuxuening Injection (SI) on the levels of serum matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase (TIMP-1) in acute exacerbated chronic obstructive pulmonary disease (COPD) patients.

METHODSSeventy-nine patients with acute exacerbated COPD were randomly assigned to the treatment group (39 cases) and the control group (40 cases). Routine therapies for COPD were given to patients in the control group, while 15 mL SI was given to those in the treatment group by intravenous dripping, twice daily for total 14 days. The forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were detected by Spirometer. The FEV1/FVC (%) and the FEV1% were calculated. The levels of serum MMP-9 and TIMP-1 were detected using ELISA before and after treatment, and compared with 20 healthy subjects as the control.

RESULTSThe FEV1, FVC, FEV1/FVC (%), and FEV1% were significantly improved after treatment in the treatment group when compared with before treatment and with the control group (P < 0.05, P < 0.01). When compared with before treatment and with the control group, the levels of serum MMP-9, TIMP-1, and the ratio of MMP-9/TIMP-1 decreased more significantly in the treatment group after treatment (P < 0.01). Correlation analyses showed that obvious negative correlation existed between the levels of serum MMP-9 and TIMP-1 and FEV1/FVC (%) (r = -0.677, -0.629, P < 0.01). Obvious negative correlation existed between the levels of serum MMP-9 and TIMP-1 and FEV1% (r = -0.562, -0.661, P < 0.01). Furthermore, obvious negative correlation also existed between the ratio of MMP-9/ TIMP-1 and FEV1%, as well as FEV1/FVC (%) (r = -0.732, -0.891, P < 0.01).

CONCLUSIONSSI could improve the pulmonary ventilation function of acute exacerbated COPD patients. One of its mechanisms might be correlated with lowering the serum levels of MMP-9 and TIMP-1, and correcting the imbalance of MMP-9/TIMP-1.

Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Female ; Humans ; Male ; Matrix Metalloproteinase 9 ; blood ; Middle Aged ; Phytotherapy ; Pulmonary Disease, Chronic Obstructive ; blood ; drug therapy ; Tissue Inhibitor of Metalloproteinase-1 ; blood

OBJECTIVEThe effects of different nitrogen forms on the growth and photosynthetic characteristics of Prunella vulgaris were observed.

METHODWater culture experiments were carried out to observe the effects of NH4+: NO3- ratios(100:0, 75: 25, 50:50, 25:75, 0:100 in mmol x L(-1)) on the growth and photosynthetic characteristics of P. vulgaris.

RESULTThe leaf area, fresh biomass and P(n) of these cultivars increased with the increasing of NH4(+) -N: NO3(-) -N ratios, and they were found to be the highest in 25: 75 NH4(+) -N: NO3)-) -N. However, they decreased with the increasing NH4(+) -N: NO3(-) -N ratio further. P. vulgaris had a minimum leaf area, biomass, chlorophyll content and P(n) in pure ammonium group. The biggest chlorophyll and carotenoid contents were found in the ratios of NH4(+) -N to NO3(-) -N of 50: 50.

CONCLUSIONThe results indicated that properly increasing nitrate proportion could promote the growth and photosynthesis of P. vulgaris.

Biomass ; Chlorophyll ; Nitrogen ; chemistry ; metabolism ; pharmacology ; Photosynthesis ; drug effects ; Plant Leaves ; drug effects ; Prunella ; growth & development ; metabolism ; Quaternary Ammonium Compounds ; chemistry ; metabolism

OBJECTIVE: To explore an available and sensitive method to detect cervical lymph node micrometastasis in patients with laryngeal squamous cell carcinoma. METHOD: The primary tumors and 182 neck lymph nodes from Twenty cases with supraglottic cancer dissection were examined with immunohistochemical (IHC) staining using cytokeratin 19 (CK19), and haematoxylin and eosin (HgE) staining. The frequency of lymph node metastasis and the clinical relevance, and the relationship between overall survival time and lymph node metastases by Log Rank test were analyzed. RESULT: The expression of CK19 was 23. 6% of lymph nodes and all of the primary tumors. In Hg-E staining, 16.5% of lymph nodes were positive. There was highly significant difference between them. There were 88.4% lymph nodes, 9.3% lymph nodes and 2.3% lymph node corresponding to the II, III and IV levels by IHC. Lymph node metastases were detected on the II (86.7%) and III levels (13.3%) with H&E. The highest rate of positive lymph nodes was on the II level of the neck. There was highly significant difference between overall survival time and lymph node metastasis in CK19 analysis. CONCLUSION The expression of CK19 may be served as an available method to evaluate occult micrometastases in laryngeal squamous cell carcinoma. High frequency of CK19 was associated with a decreased probability of survival time.
Aged ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; Female ; Glottis ; pathology ; Humans ; Keratin-19 ; analysis ; Laryngeal Neoplasms ; diagnosis ; pathology ; Lymph Nodes ; pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Staining and Labeling

Objective:To understand the views of various relevant personnel on the standardized training mode of resident doctors after the implementation of Beijing′s medical education synergy policy, so as to provide references for further improvement of China′s medical education synergy policy.Methods:From January to May 2019, a semi-structured interview method was used to investigate the resident training students, clinical teachers(professional postgraduate tutors and resident training trainees′ guiding doctors)as well as resident training managers in 35 resident training bases in Beijing. The original data of the interviews were sorted out, coded and analyzed by taking root theory and main frame method descriptive analysis.Results:A total of 687 valid interview results were received, of which 71.86% of the resident training managers thought that the mode was more reasonable and the advantages outweighed the disadvantages; 38.07% of the resident training students and 45.45% of the graduate supervisors mentioned that the mode effectively shortened the training time of clinical talents; however, 31.98% of the resident training students and 22.92% of the resident training students′ guiding physicians mentioned it was difficult to balance courses, scientific research and clinical work under this mode, 61.62% of graduate supervisors pointed out that the students were lack of time and energy to engage in scientific research.Conclusions:The training mode of the integration of the standardized training of resident doctors and the postgraduate training of master′s degree in clinical medicine, given its necessity and institutional advantages, is found with room of improvement in its mode setting, arrangement of scientific research courses and clinical rotation, supervision and assessment of the process.

OBJECTIVE: To determine whether central venous-to-arterial carbon dioxide tension difference (Pcv-aCO(2)) could still be used as a goal of fluid resuscitation in septic patients who already had ScvO2 greater than 70% after early resuscitation. METHODS: A prospective observational study was performed on 56 septic patients admitted to the Intensive Care Unit (ICU) in a single University Hospital, who already had ScvO2 greater than 70% after early resuscitation. They were divided into two groups, based on whether the patients' initial Pcv-aCO2 was less than 6 mmHg (low gap group) or greater than or equal to 6 mmHg (high gap group). The following data were collected at 0, 12, and 24 hours (T(0), T(12), T(24)) after study inclusion: hemodynamic indices [mean blood pressure (MAP), heart rate (HR), cardiac output (CO), central venous pressure (CVP)], perfusion-related indexes [ScvO(2), Pcv-aCO2, serum lactate (Lac), Lac clearance rate], organ function- related indices [oxygenation index (PaO2/FiO(2)), serum creatinine (SCr), creatine kinase (CK-MB)], APACHE II score, SOFA score, and 24 hours amounts of fluid infusion. RESULTS: Twenty patients (42.9%) with initial Pcv-aCO(2) ≥ 6 mmHg were included in the high gap group and another thirty-two patients were included in the low gap group. At T12 and T24, ScvO(2) and CO were significantly higher, and Lac and SCr were significantly lower in low gap patients than high gap patients (P<0.05). At T(12) and T(24), Lac clearance rate was significantly higher (P<0.05), and 24-hours amounts of fluid infusion was significantly less [(3449.47 ± 695.41) mL vs (4070.66 ± 757.43) mL, P= 0.002] for the low gap group than for the high gap group, as well as the descrease of SOFA score at T(24) (P<0.05). There was no significant difference of APACHE II score between the 2 groups (P<0.05). CO and Pcv-aCO(2) values were inversely correlated (P< 0.05). CONCLUSION Septic patients targeting only ScvO(2) may still have inappropriate tissue perfusion, especially when Pcv-aCO2 ≥6 mmHg, which indicates insufficient resuscitation. When ScvO(2) > 70% has achieved after early resuscitation, Pcv-aCO2 can still be used as a goal of fluid resuscitation in septic patients .
Adult ; Blood Gas Analysis ; Carbon Dioxide ; blood ; Central Venous Pressure ; Female ; Fluid Therapy ; Hemodynamics ; Humans ; Male ; Middle Aged ; Prospective Studies ; Sepsis ; blood ; physiopathology ; therapy ; Severity of Illness Index ; Vena Cava, Superior

Objective To observe and evaluate the predictive value of electroencephalogram (EEG) abnormalities of the EEG monitoring of patients with brain dysfunction in the intensive care unit (ICU).Methods Total of 58 cases with brain dysfunction under EEG were collected from the ICU of the XiangYa Hospital,Central South University from January 2014 to December 2015.EEG was performed to monitor those patients and data was collected,analyzed and classified according to both Synek and Young EEG scales to evaluate its predictive value.The statistical analysis was performed with SPSS 23.0 software (MAC,USA) and statistical significant was considered as P ＜0.05.Numerical values were given as means ± SD and t-test was performed to compare data of different groups.Kaplan-Meier survival estimator was used to draw the survival curve,and the survival analysis was postulated by COX regression analysis.Results Data from 58 patients were collected and classified according to both Synek and Young EEG scales,positive waveforms as periodic discharge or delta-predominant background were found among 50 patients,electrographic seizures were found in 7 patients,patients with EEG abnormality possessed a high level of SI00β and showed statistical differences.The 28-day mortahty was independently associated with Acute Physiology and Chronic Health Evaluation (APACHE]] score) (OR:1.08;95％ CI [1.03 to 1.14])、Synek Grade ＞2 (OR:0.17;95％ CI [0.03 to 0.80])、electrographic seizures (OR:23.70;95％ CI [2.02 to 277.73]) and slow rhythm (OR:8.54;95％ CI [1.72 to 42.32]).Conclusions The 28-day mortality of patients under EEG with brain dysfunction was independently associated with Synek Grade ＞ 2,electrographic seizures and slow EEG rhythm.

Objective:To investigate the detection rate of motoric cognitive risk(MCR)syndrome and explore the possible risk factors at different age groups.Methods:A total of 561 patients from geriatric outpatient clinic of Hubei Provincial Hospital of Traditional Chinese Medicine from November 2018 to December 2019 were divided into two age groups under 70 years old(n=241)and 70 years old and above(n=320). The general information, Pittsburgh Sleep Quality Index, Geriatric Depression Scale-15(GDS-15), 4-meter walking test, Mini-Mental State Examination and Morse Fall Scale were collected.Patients with MCR were screened out according to the MCR diagnostic criteria.Logistic multiple regression analysis was used to analyze the associated risk factors.Results:7 cases(7/241, 2.9%)met the MCR diagnostic criteria in age<70 years group, and 34 cases(34/320, 10.7%)in age ≥ 70 years group.The proportion of hearing impairment complaints and GDS-15 scores of MCR patients were higher than those of the non-MCR group in age<70 years group, and the Morse Fall Scale of MCR patients was higher than that of the non-MCR group in age ≥70 years old group( P<0.05). After adjusting for associated confounding factors, multiple logistic regression analysis showed that hearing impairment complaints( OR=26.394, P<0.05)and GDS-15( OR=1.385, P<0.05)were independent risk factors for MCR in age<70 years group.And female( OR=0.445, P<0.05)was a protective factor for MCR in age ≥70 years old group. Conclusions:Motoric cognitive risk syndrome has different risk factors in different age groups, which may indicate that the causes and predictive significance of MCR in these two different age groups are different.