OBJECTIVE:To observe therapeutic efficacy and safety of cefoperazone sodium and sulbactam sodium combined with Shenmai injection in the treatment of elderly stroke associated pneumonia(SAP). METHODS:A total of 84 SAP patients in Dazhou Municipal Central Hospital during Mar. 2016-Mar. 2017 were divided into control group(42 cases)and observation group (42 cases)according to random number table. Based on routine treatment,control group was additionally given Cefoperazone sodium and sulbactam sodium for injection 3 g added into 5% Glucose injection 100 mL,intravenously,twice a day;suitable antibiotics were selected according to the results of pathogenic examination and drug sensitivity test. Observation group was additionally given Shenmai injection 100 mL added into 5% Glucose injection 250 mL intravenously,once a day,on the basis of control group. Both groups were treated for consecutive 2 weeks. Clinical efficacies of 2 groups were observed,and the levels of T-lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)and inflammatory markers(TNF-α,hs-CRP,PCT),length of hospital stay before and after treatment. The ADR was recorded. RESULTS:The total response rate(95.24%)and marked response rate (47.62%)of observation group were significantly higher than those of control group(83.33%,23.81%);length of hospital stay in observation group [(15.24±3.53)d] was significantly shorter than control group [(18.43±4.21)d],with statistical significance (P<0.05).After treatment,the levels of CD4+and CD4+/CD8+in 2 groups were significantly higher than before treatment,and the observation group was significantly higher than the control group;the levels of CD8 +,TNF-α,hs-CRP and PCT in 2 groups were significantly lower than before treatment;the observation group was significantly lower than the control group,with statistical significance(P<0.05);there was no statistical significance in the incidence of ADR between 2 groups(P>0.05). CONCLUSIONS:Based on routine treatment,cefoperazone sodium and sulbactam sodium combined with Shenmai injection treat SAP significantly,can effectively improve immune function, reduce inflammation level and shorten the length of hospital stay without increasing the occurrence of ADR.

Objective To evaluate the safety and drug adherence of tocilizumab(TCZ)in patients with moderate to severe rheumatoid arthritis(RA)in routine clinical practice. Methods This 24 week single center observational study recruited patients with moderate to severe RA. Therapy adherence rate was calculated by actual dosing/expected dosing×100%. Efficacy end points included physician global assessment of disease activity(PGA),patient global assessment of disease activity(PtGA),28-joint disease activity score(DAS28)and so on. Safety was evaluated by recorded adverse events (AEs). Results Sixty patients were enrolled with a mean (SD) treatment adherence of (67±27)%. PGA, PtGA, pain assessment (VAS), TJC and SJC all decreased during this study. At the 12th week, 25%(6/24) and 29%(7/24) of the patients achieved DAS28 remission and EULAR good response,respectively.Eighteen AEs were recorded,of which only 2 were severe AEs(SAEs)and neither was related to TCZ. Conclusion TCZ is a highly safe treatment for decreasing disease activity in patients with moderate to severe RA in China.However,drug adherence still need to be improved.

Objective To analyze the clinical effect of two different drainage methods after video-assisted thoracoscopic(VATS) lobectomy,and to explore the safety,reliability and practicability of clinical application of thoracic drainage tube in Department of Thoracic Surgery.Methods 1 120 cases who underwent VATS lobectomy were selected.According to different drainage methods,they were divided into two groups.560 cases in the observation group received 16-18 silicone elastic drainage,560 patients in the control group received 28-30 traditional silicone chest tube drainage.After drainage,drainage time,residual pleural fluid volume,pain score,catheter site infection rate,the incidence of pneumothorax after extubation,postoperative incidence rate of pulmonary atelectasis were compared between the two groups.Results The postoperative pleural flow of the observation group was (816 ±176) mL,which was less than (1 580 ± 204) mL of the control group,the difference was statistically significant (P =0.006).The drainage days [(5.01 ± 0.57) d],the pleural fluid volume [(2.1 ± 0.6) cm],the catheter site infection rate (0.017％),extubation pneumothorax rate (0.017％),incidence rate of postoperative atelectasis (0.16％) in the observation group were lower than those in the control group [(8.45 ± 1.24) d,(4.3 ± 0.9) cm,0.031％,0.053 ％,0.031％],the differences were statistically significant (all P ＜ 0.05).The NRS pain score between the two groups had statistically significant difference (x2 =16.24,P ＜ 0.001).Conclusion Curative effect of thin tubedrainage after VATS lung resection is safe and reliable,and can reduce the patients' postoperative pain discomfort caused by drainage tube and related complications,it is worthy of clinical popularization and application.

AIM:Increasing evidence indicates that inflammation contributes to the initiation and perpetuation of atrial fibrillation ( AF) .Al-though tumor necrosis factor ( TNF)-αlevels are increased in patients with AF , the role of TNF-αin the pathogenesis of AF remains unclear.Recent research has revealed that T-type Ca2+currents ( ICa,T ) play an important role in the pathogenesis of AF .METH-ODS:In this study , we used the whole-cell voltage-clamp technique and biochemical assays to explore the role of TNF-αin the regula-tion of ICa,T in atrial myocytes.RESULTS:We found that compared with sinus rhythm (SR) controls, T-type calcium channel (TCC) subunit mRNA levels were decreased , while TNF-αexpression levels were increased , in human atrial tissue from patients with AF .In murine atrial myocyte HL-1 cells, after cultured for 24 h, 12.5, 25 and 50 μg/L TNF-αsignificantly reduced the protein expression levels of the TCC α1G subunit in a concentration-dependent manner .The peak current was reduced by the application of 12.5 or 25μg/L TNF-αin a concentration-dependent manner [from ( -15.08 ±1.11) pA/pF in controls to ( -11.89 ±0.83) pA/pF and (-8.54 ±1.55) pA/pF in 12.5 and 25 μg/L TNF-αgroups, respectively].TNF-αapplication also inhibited voltage-dependent inactivation of ICa,T shifted the inactivation curve to the left .CONCLUSION:These results suggest that TNF-αis involved in the path-ogenesis of AF, probably via decreasing ICa,T function in atrium-derived myocytes through impaired channel function and down -regula-tion of channel protein expression .This pathway thus represents a potential pathogenic mechanism in AF .

Objective To assess the filtration efficiency of two N95 filtering-facepiece respirators(FFRs)for the decomposition products of sulfur hexafluoride (SF6).Methods Two types of N95 FFRs (the particulate and the acid-proof respirators) were selected in this study.The decomposition products of SF6,including particles,hydrogen fluoride (HF) and sulfur dioxide (SO2),were measured under experimental condition by using TSI PortaCount Plus,fluorine ion-selective electrodes and spectrophotometer separately.The filtration efficiency was then calculated and compared.Results Both two models of N95 respirators had lowest filtration efficiency larger than 95％ for particles under airflow ranged from 10 to 95 L/min.When exposed to different concentrations of HF (low:0.00～ 1.99 mg/m3,middle:2.00～3.99 mg/m3,high:＞4 mg/m3),the acid-proof N95respirator was more effective than the particulate respirator (P＜0.05) with a filtration efficiency of 98.83％,99.08％,and 99.03％ versus 48.44％,45.71％,and 47.31％.For four SO2 concentration ranges (0.00～2.49 mg/m3,2.50～4.99 mg/m3,5.00-9.99 mg/m3,and ＞10.00 mg/m3),the acid-proof respirator showed a high filtration efficiency within exposure to 1.5 hours:95.73％,98.67％,98.14％,and 97.78％,respectively,when exposure duration extended to 4 hours,the filtration efficiency of the acid-proof respirator decreased to 91.97％,82.28％,70.12％,and 58.56％,respectively.Conclusion Both the particulate and the acid-proof N95 FFRs met national standards on the particulate filtration efficiency.The acid-proof N95 respirator demonstrates to be more effective in filtering HF and SO2 than the particulate respirator.The filtration efficiency could decrease to an unsafe condition under longer exposure duration,timely replacement of respirator is recommended at the workplace.

Objective To assess the filtration efficiency of two N95 filtering-facepiece respirators(FFRs)for the decomposition products of sulfur hexafluoride (SF6).Methods Two types of N95 FFRs (the particulate and the acid-proof respirators) were selected in this study.The decomposition products of SF6,including particles,hydrogen fluoride (HF) and sulfur dioxide (SO2),were measured under experimental condition by using TSI PortaCount Plus,fluorine ion-selective electrodes and spectrophotometer separately.The filtration efficiency was then calculated and compared.Results Both two models of N95 respirators had lowest filtration efficiency larger than 95％ for particles under airflow ranged from 10 to 95 L/min.When exposed to different concentrations of HF (low:0.00～ 1.99 mg/m3,middle:2.00～3.99 mg/m3,high:＞4 mg/m3),the acid-proof N95respirator was more effective than the particulate respirator (P＜0.05) with a filtration efficiency of 98.83％,99.08％,and 99.03％ versus 48.44％,45.71％,and 47.31％.For four SO2 concentration ranges (0.00～2.49 mg/m3,2.50～4.99 mg/m3,5.00-9.99 mg/m3,and ＞10.00 mg/m3),the acid-proof respirator showed a high filtration efficiency within exposure to 1.5 hours:95.73％,98.67％,98.14％,and 97.78％,respectively,when exposure duration extended to 4 hours,the filtration efficiency of the acid-proof respirator decreased to 91.97％,82.28％,70.12％,and 58.56％,respectively.Conclusion Both the particulate and the acid-proof N95 FFRs met national standards on the particulate filtration efficiency.The acid-proof N95 respirator demonstrates to be more effective in filtering HF and SO2 than the particulate respirator.The filtration efficiency could decrease to an unsafe condition under longer exposure duration,timely replacement of respirator is recommended at the workplace.

AIM:To investigate whether the association of connexin 43 ( Cx43 ) and L-type calcium channel involved in the pathogenesis of atrial fibrillation ( AF) .METHODS:The biochemical assays and whole-cell patch-clamp technique were used to study the expression of Cx43 in human atrial tissue.The co-localization of Cx43 and L-type calcium channel, and the regulation of L-type calcium current in atrial myocytes were investigated.RESULTS:The expression of Cx43 at mRNA and protein levels was decreased in human atrial tissues of AF patients.In cultured atrium-derived myocytes ( HL-1 cells) , knockdown of Cx43 significantly inhibited the mRNA expression of L-type calcium channelα1c subunit, as well as L-type calcium current.Co-localization of Cx43 with L-type calcium channel α1c subunit in mouse atrial myocytes was observed.CONCLUSION:The decrease in Cx43 is involved in the pathogenesis of AF, probably through reducing the L-type calcium current in atrial myoctyes by co-localization with L-type calcium channel, thus representing the potential pathogenesis in atrial fibrillation.

ObjectiveTo examine the clinical features of fractures and related risk factors in patients with rheumatoid arthritis(RA) in China.MethodsSix hundred and eighty-one RA patients were randomly selected from department of rheumatology of 18 hospitals of China.Data were obtained from the questionnaire,including age,sex,disease duration,the involvement of joints,treatment regimen,features of fractures etc.The possible risk factors of fracture in patients with RA were analyzed with a multi-variate Logistic regression analysis.Results① In 681 RA patients of the survey,48 patients had 54 fractures,and the incidence of fractures was about 8％.② Fractures occurred at various sites.Foot/ankle,femur,spine and wrist were the mostfrequent sites.③ The Logistic regression analysis showed that several factors increased the risk of fracture in RA patients,including long disease duration (OR:1.245,95％CI:0.987-1.570,P=0.065),male gender(OR:0.433,95％CI:0.199-0.942,P=0.035),more deformed joints(OR:1.042,95％CI:1.006-1.079,P=0.023),family history of RA (OR:2.201,95％CI:0.984-4.923,P=0.055),and high scores of SF-36(OR:1.017,95％CI:1.002-1.033,P=0.028).④ According to the degree of correlation from strong to weak,the risk factors of fracture were disease duration,SF-36,sex,number of deformed joints and family history of rheumatoid arthritis.ConclusionThe incidence of fracture is high in patients with rheumatoid arthritis.Several factors could increase the risk of fractures in RA patients,including long disease duration,male gender,more deformed joints,and family history of RA.In order to prevent the occurrence of fractures,cautions should be taken to prevent the development of fractures and treat the disease aggressively to suppress the disease activity of RA.

ObjectiveTo study the effect and safety of flurbiprofen cataplasm on osteoarthritis pain in Chinese patients.MethodsOne hundred and eighty-three patients were divided into flurbiprofen cataplasm group,indometacin cataplasm group and Qizheng-xiaotong plaster group randomly.The score of pain,stiffness and physical function were analyzed with WOMAC scale and adverse reactions were also assessed.KruskalWallis H test,Nemenyi test and CMH tese were used.ResultsAfter treatment,the VAS value of the three groups decreased significantly and the VAS difference value of the flurbiprofen cataplasm group changed the most significantly(the changes of VAS value in flat walking,up and down stairs,nighttime,rest and weightbearing were 31±21,35±20,24±19,20±18 and 37±20 respectively).Meanwhile,the value of stiffness and physical function decreased significantly.In terms of safety,flurbiprofen cataplasm group and the indome-tacin cataplasm group were better than Qizheng-xiaotong plaster group.But in sense of constriction,the flurbiprofen cataplasm group was better than the indometacin eataplasm group.ConclusionFlurbiprofen Cataplasm,with its favorable analgesic effect,is suitable for general clinical use.It can reduce stiffness,improvephysical function,and has good safety profile.

Objective To describe the distribution of medication costs of rheumatoid arthritis patients, and to analyze the factors that may affect the costs. Methods Data were obtained from a 12-month retrospective investigation of patients with rheumatoid arthritis (RA) across China. Department of Rheuma-tology of 18 hospitals were randomly selected. The data about their social conditions, clinical conditions, medications associated with RA such as disease-modifying antirheumatic drugs (DMARDs), non -steroidal anti -inflammtory drugs (NSAIDs), steroids, biologic agents were collected, and the costs of drugs were calculated. A non-parameter test and multivariate logistic regression analysis were performed. Results Six hundred and forty six patients were enrolled into the study, 435 completed data were chosen for analysis. The results demonstrated that the average costs per patient for medications in the past year was 8018 . The total medication costs were further subdivided into the following parts: DMARDs, (represented 20% of the total costs), biologic drugs (49%), NSAIDs (4%), herbal drugs (22%), steroids (1%). Data analysis showed that patients with higher education and higher incomes, with medical insurance,better health function status and outpatients paid more on DMARDs. Extra-articular manifestations increased the odds of the high-cost group (OR: 2.180, 95%CI: 1.335～3.558, P=0.002), while poor health function status increased the probability of paying high costs (OR: 1.373, 95%CI: 1.012～1.863, P=0.041). Conclusion High medication costs in RA do exist in RA patients. The costs of medication is associated with health function status and the presence of extra-articular manifestations.