Objective To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the degree of bronchial asthma (BA) in adults, and to analyze the potential relationship between the two. Methods A retrospective study was used to collect 90 patients with BA patients who were admitted to Jiangsu Provincial Hospital of Traditional Chinese Medicine from January 2018 to June 2022. All patients received polysomnography (PSG) to calculate the apnea hypopnea index (AHI). Patients were divided into mild OSAS (AHI<15), moderate OSAS (1530) according to AHI value. In addition, BA related indicators of patients were measured, such as forced expiratory volume in the first second (FEV1), FEV1%, FEV1/forced vital capacity (FVC), exhaled nitric oxide (FeNO), total airway resistance (R5), central airway resistance (R20) and peripheral elastic resistance (X5). Analysis of variance was used to compare the differences in BA related indicators in patients with different degrees of OSAS, and Pearson linear correlation analysis was used to analyze the correlation between AHI and the measured values of BA indicators. Results There was 1 case (1.11%) in AHI<15, 41 cases (45.56%) in 1530. There was no difference in gender composition among different AHI groups, but the AHI value of BA patients aged 70 years and above was higher, and the age difference was statistically significant (P<0.05). The results of different AHI groups showed that the patients with moderate to severe OSAS received higher step-up treatment for asthma, most of which were in step 3 and step 4, with a statistically significant difference (2=90.085，P<0.001). The variance analysis results showed that the more severe the OSAS, the lower the ratio of FEV1/FVC (%) (F=2.600, P=0.011), and the higher the FeNO and R5 measurements values (F=-6.454 , F=-3.291, P<0.001). Pearson linear correlation analysis showed that AHI was negatively correlated with FEV1% (r=-0.356, P<0.05) and FEV1/FVC% (r=-0.289, P<0.001), but AHI was positively correlated with R5 (r=0.447, P<0.05). Conclusion BA patients with OSAS have significantly abnormal respiratory function-related indicators, and with the aggravation of OSAS, BA will further deteriorate

To revise GBZ 188 Technical Specification for Occupational Health Surveillance based on national laws, regulations, standards, specifications and legal documents of occupational disease, and combination with the actual situation in China. The main modifications are as follows: the occupational health surveillance for workers exposed to toluene (xylene may implement by reference), bromopropane, methyl iodide, ethylene oxide, chloroacetic acid, indium and its compounds, coal tar, coal tarasphalt, asphalt, β-naphthylamine, dust of metal and its compounds(tin, iron, antimony, barium and its compounds), hard metal dust, erionite dust, low temperature, laser, tick-borne encephalitis virus, Borrelia burgdorferi, and human immunodeficiency virus, for scraper or grind operators, and underground workers using squatting or kneeling position, crawling position, side-lying position, or shoulder position for a long period of time are included. The emergency health screening for workers exposed to arsenic, fluorine and its inorganic compounds, and acrylamide are included. The occupational medical examination (OME) for workers exposed to amino and nitro compounds of benzene, phosgene, monomethylamine, organic fluorine and dimethyl sulfate has been adjusted and made mandatory, with corresponding assessments required upon leaving the job. The special occupational health surveillance for workers exposed to mycobacterium tuberculosis and hepatitis virus is removed. The OME conclusion of reexamination is removed, and standardize recheck/additional inspection requirements. The optional items in OME performed before, during and after leaving post are removed, but the optional items in emergency medical examination are retained. Additional OME items are added. The Guideline for OME Summary Reports is added as informative appendix, and so on. The revised GBZ 188 Technical Specification for Occupational Health Surveillance is more scientific and practical.

Objective:To investigate the clinical effect of lateral rectus abdominis approach combined with presacral decompression for surgical treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.Methods:A retrospective case series study was performed on the clinical data of 9 patients with old Denis type II sacral fractures complicated with upper sacral plexus injury (L 4-S 1) admitted to Zhongnan Hospital of Wuhan University from June 2010 to December 2016. There were 6 males and 3 females, aged (33.1±7.5)years (range, 15-58 years). Embolization of internal iliac artery and preimplantation of abdominal aortic balloon were performed 2 hours before operation under the guidance of digital subtraction angiography (DSA). Surgery was performed using a single lateral rectus abdominis approach combined with presacral decompression. The operation time, intraoperative blood loss and full weight-bearing time were recorded. The visual analogue scale (VAS) and European QOL Five Dimensional health scale (EQ-5D) were compared before and after operation. The Gibbons' impairment scale was used to assess neurological function. X-ray and CT scan were used to observe internal fixation and fracture healing. The complications during and after operation were recorded. Results:The patients were followed up for 24-52 months [(35.2±5.2)months]. The operation time was (2.9±0.6)hours. The intraoperative bleeding was (573±138)ml, and the full weight-bearing time was (11.6±1.2)weeks. X-ray and CT scan showed bone healing in all patients at the latest follow-up. The VAS and EQ-5D scale improved from preoperative (7.8±0.6)points and (0.34±0.07)points to the final follow-up of (0.8±0.3)points and (0.81±0.05)points ( P<0.05). According to Gibbons classification, 8 patients were grade I and 1 patient was grade II one year after operation ( P<0.01). Namely, the radiation pain of lower extremities was significantly improved in all patients, among which 8 patients showed pain disappeared and completely returned to normal and 1 patient showed residual numbness and hypoesthesia of the affected limbs. No major complications (eg, iatrogenic lumbosacral plexus injury, vital blood vessels or pelvic organs injury) occurred during the operation. During the follow-up period, only one patient developed traumatic hip arthritis and underwent total hip arthroplasty 6 months after operation. Fractures of the remaining patients were healed well without complications like infection, pressure ulcer or implant failure. Conclusions:For old Denis type II sacral fractures complicated with upper sacral plexus injury, lateral rectus abdominis approach combined with presacral decompression can fully decompress the upper sacral plexus nerve, relieve pain, and promote functional rehabilitation, with low incidence of complications. It is an alternative surgical method for the treatment of old Denis type II sacral fractures complicated with upper sacral plexus injury.

Objective: To investigate the predictive values of the acute physiology and chronic health evaluation II (APACHE.II) score and disseminated intravascular coagulation (DIC) score on death in patients with heat stroke. Methods: A total of 76 patients with heat stroke who were treated in Emergency Department of Harrison International Peace Hospital from June 2013 to September 2017 were studied. According to the outcome of patients, we distributed the patients to death group and survival group. APACHE.II score and DIC score were calculated according to the clinical data and the test results at admission. Evaluate the correlation between the two indicators associated with death. Results: There were 76 patients, with 23 deaths (30.3%) and 53 survivors (69.7%) . The APACHE-II score and DIC score were 26.26±6.48 and 4.00±1.38 in the death group.significantly higher than 20.74±4.17 and 2.28±1.21 in the survival group, and there were significant difference (P< 0.01) . The APACHE. II score was positively correlated with the DIC score, and the higher the score, the higher the mortality rate.Both indicators are significant for the Logitic regression analysis of death (P<0.01) .The sensitivity and specificity of the APACHE.II score were 65.2% and 81.1% in prediction of mortality, The sensitivity and specificity of DIC score were 65.2% and 84.9% in prediction of mortality. The specificity of the APACHE II score plus DIC score were higher than that of single APACHE. II score or DIC score in prediction of mortality (P<0.05) . Conclusion The APACHE.II score and DIC score are significantly increased in the early stage of the patients with heat stroke, and the APACHE. II score combined with DIC score may improve the value in prediction of mortality with heat stroke.

Objective To investigate the clinical value of Rheum officinale Ball.as a main agent in a tra-ditional Chinese medicine recipe combined with continuous hemoperfusion in patients with acute paraquat poison-ing(APP). Methods A total of 124 patients with APP were divided into three groups:A group(40 cases),B group(42 cases)and C group(42 cases). Before,3 days and 7 days after treatment,PⅢNP,CⅣ,TGF-β1, MDA,SOD and SOFA scores were observed. The correlation between PⅢNP and the concentration of paraquat were analyzed,and the outcomes in 28 days were compared.Results In admission,there were no differences in PⅢNP,CⅣ,TGF-β1,MDA,SOD and SOFA scores among three groups(P>0.05).After treatment for 3 days, MDA and SOFA scores were elevated in three groups compared with these three scores in the three groups at admis-sion. Group A was increased significantly;the activity of SOD were decreased,especially in A group decreased most significantly(P<0.05);After 7 days'treatment,MDA and SOFA scores were lower than those of 3 days af-ter treatment in three groups,especially in C group decreased most significantly(P < 0.05),the activity of SOD were higher than 3 days after treatment,especially in C group increased most significantly(P<0.05);After 3,7 days treatment,PⅢNP,CⅣ,TGF-β1 were increased gradually,C group increased slowly(P<0.05).PⅢNP in patients with APP was positively correlated with the concentration of paraquat(P < 0.05). The mortality rate of three groups were 65.00%,45.24%and 23.81%,there were significant difference among three groups(P<0.05). Conclusions Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe combined with con-tinuous hemoperfusion in patients with APP could decrease PⅢNP,CⅣ,TGF-β1 and MDA. The can enhance the expression of SOD and reduce the mortality rate of patients.

Objective To review the clinical characteristics and current management strategy and to examine the factors to be considered in the selection of treatment options for mitral regurgitation (MR) in elderly inpatients.Methods Elderly patients(≥60years old)who had been diagnosed with moderate to severe MR by transthoracic echocardiography and hospitalized from May 1,2014 to April 30,2015were included in this study (N=680).Patients were grouped according to therapy:the surgery group (n=372) and the medication group (n=308).Data at baseline including medical history and echocardiography were collected for comparison between the two groups and for analysis of factors associated with treatment choice.Results Of the 680 patients with moderate to severe MR,45.3％ were treated with medication.Compared with the surgery group,patients in the medication group were older,with a lower prevalence of primary MR,a higher prevalence of coronary heart disease and higher Euroscore-Ⅱ scores (all P＜0.01).Furthermore,the medication group had a lower prevalence of moderate MR(75/308 or 24.4％ vs.200/372 or 53.8％,P＜ 0.01),a lower left ventricular ejection fraction (47.8 ± 16.1) ％ vs (61.5 ± 9.2)％(P＜0.01),and a larger left ventricular end diastolic diameter(59.2±11.4)mmw (55.8±8.8)mm (P＜ 0.01).Besides,multivariable analysis revealed that regurgitation grade,left ventricular ejection fraction,multiple valve disease,age,and diabetes were correlated with therapy decisions(OR=62.067,1.089,4.791,0.879 and 0.414,respectively,P＜0.01 or P＜0.05).Conclusions Old age,impaired left ventricular ejection fraction,low regurgitation grade,diabetes,and absence of multiple valves are the most salientfactors for which surgery should not be selected.

Objective To investigate the clinical effect of paraquat (PQ) detoxification recipe combined with continuous hemoperfusion (HP) in the treatment of patients with acute paraquat poisoning (APP) and clinical significance of soluble CD14 subtype (sCD14-st, Presepsin). Methods A prospective randomized controlled trial was conducted. 152 patients with moderate APP admitted to Department of Emergency Medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University from July 2013 to June 2017 were enrolled, and they were randomly divided into three groups. The patients in HP group (group A, n = 35) only received 2-hour HP for 3 times, 8 hours each time, those in PQ detoxification recipe combined with HP group (group B, n = 50) received PQ detoxification recipe 1 (once per 2 hours until no PQ component was found in faeces) and 2 (3 times a day for 14 days) beside HP. The others in PQ detoxification recipe combined with persistent HP group (group C, n = 67) received continuous HP until the PQ component in serum was not detected. The parameters of organ function and inflammatory factor, and blood Presepsin and PQ contents were determined before and after treatment. The curative effect and 28-day mortality were recorded. The correlations between serum Presepsin level and PQ content as well as 28-day mortality were analyzed with Pearson correlation analysis. Receiver operating characteristic curve (ROC) was plotted to analyze the predictive value of Presepsin on prognosis. Results The total effective rate of group C was significantly higher than that of groups A and B [70.1% (47/67) vs. 34.3% (12/35), 54.0% (27/50)], and 28-day mortality was significantly lowered [29.8% (20/67) vs. 65.7% (23/35), 46.0% (23/50), both P < 0.05]. There was no significant difference in alanine aminotransferase (ALT), MB isoenzyme of creatine kinase (CK-MB), serum creatinine (SCr), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukins (IL-6 and IL-10) before treatment among the three groups. Five days after treatment, the above parameters in the three groups were increased as compared with those before treatment, but the increase degree in group C was the lowest. At 7 days after treatment, the parameters were decreased, especially in group C. There was no significant difference in serum Presepsin and PQ levels before treatment among the three groups. With the prolongation of treatment time, the Prespsin levels in groups A, B, and C were increased, and peaked at 12 hours (μg/L: 4.28±0.20, 3.87±0.25, 3.53±0.23), then gradually decreased,and the PQ contents were lower than those before treatment from 8 hours (mg/L: 1.76±0.12 vs. 2.12±0.17, 1.57±0.08 vs. 2.24±0.16, 1.25±0.10 vs. 2.14±0.18), with a time dependence pattern, especially in group C (all P < 0.05) . Correlation analysis showed that blood Presepsin level was positively correlated with PQ content and 28-day mortality (r1= 0.917, r2= 0.864, both P = 0.001), suggesting that the higher the PQ content was, the higher the Presepsin level, and the higher the 28-day mortality was. ROC curve analysis showed that the area under ROC curve (AUC) of Presepsin predicting 28-day mortality was 0.863; when the cut-off value was 1.22 μg/L, the sensitivity was 83.3%, the specificity was 81.4%, the positive predictive value was 77.46%, and the negative predictive value was 86.42%. Conclusions Early administration of PQ detoxification recipe combined with continuous HP treatment can effectively reduce Presepsin level, decrease the mortality of patients with moderate APP, improve the prognosis. Presepsin can assess the prognosis of patients with APP.

Objective To observe the impact of ginkgo biloba extract(Ginaton) on nerve functioninpa-tients withdelayed encephalopathy after acute carbon monoxide poisoning(DEACMP). Methods 96 patients with DEACMP treated in our hospital from April 2011 to February 2017 were randomly divided into a control group and a study group. The control group received hyperbaric oxygen ,control of intracranial pressure ,and improvement of brain cell metabolism;while the study group receivedintravenous injection of Ginaton 70 mg(adding into 250 mL of 0.9% sodium chloride) once daily fora 2-week therapeutic course. MRIand EEGwere used forexamination in DEACMP patients within 24 h after onset and 14 days after treatment. Changes in MRI and EEG examination , clinical symptoms ,mini-mental state examination (MMSE) score ,Barthel index (BI),and Montreal cognitive assessment(MoCA)were assessed before and after treatment between the two groups. Results The therapy wasef-fective in 39 patients in the study group,with a total effectiveness rate of 81.25%;and in 29 patients in the control group,with a total effectiveness rate of 60.42%. There was significant difference between the two groups (χ2 =5.042,P = 0.025). Inadmission,there were no differences between the two groups in the abnormal signals of MRI,abnormal rate of EEG,and the scores on MMSE,BI,andMoCA(P>0.05). After a 14-day treatment,the abnormal signals of MRI,abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA score were improved better in the study than in the control group(P < 0.05). The MMSE score was negatively correlated with disease severity in DEACMP patients(r=-0.832,P=0.000). Conclusions Early treatment with Ginaton can effectively improvethe cerebral lesions on MR,the abnormal rate of EEG,andthe scores on MMSE,BI,and MoCA. It has certain clinical efficacy.

Objective To investigate the clinical value of type Ⅲ procollagen peptide (P Ⅲ P) in sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe in patients with acute paraquat poisoning (APP).Methods A total of 104 patients with APP treated in Emergency Department of Harrison International Peace Hospital Affiliated to Hebei Medical University from March 2013 to December 2016 were divied into three groups:A group (n =30,routine therapeutic agents coupled with a single hemoperfusion),B group (n =34,treated by Rheum officinale Ball.as a main agent in a traditional Chinese medicine recipe coupled with a single hemoperfusion),C group (n =40,treated by Rheum officinale Ball.as a predominant agent in a traditional Chinese medicine recipe and sequential continuous hemoperfusion).Before and 3 days and 7 days after treatment,tumor necrosis factor t (TNF-α),interleukin-18 (IL-18),maleic dialdehyde (MDA),superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX) of patients were detected,and the change of sequential organ failure assessment (SOFA) scores were observed.Before and 3 days,7 days,10 days and 14 days after treatment,PⅢP were detected,and the changes of lung CT in three groups were observed before and 7 days,14 days after treatment.Pearson correlation test was used to analyze the correlation between P Ⅲ P in patients with APP and the concentration of paraquat,and the outcomes in 28 days were compared with chi square test.Results At admission,there were no differences in the levels of plasma TNF-α,IL-18,MDA,P Ⅲ P,SOD,GSHPX and SOFA scores among three groups (P ＞ 0.05).At 3 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were elevated in three groups compared with those at admission,especially in group A were increased significantly,whereas the activity of plasma SOD and GSH-PX were decreased in thress groups,especially in group A decreased most significantly (P ＜ 0.05).At 7 days after treatment,the levels of plasma TNF-α,IL-18,MDA and SOFA scores were lower than those at 3 days after treatment in three groups especially those in group C decreased most significantly (P ＜ 0.05),whereas the activities of plasma SOD and GSH-PX were higher than those at 3 days after treatment especially in group C decreased most significantly (P ＜0.05).At 3 days,7 days,10 days,14 days after treatment,the level of P Ⅲ P were increased gradually in three groups,especially in group C increased most slowly with statistically significant difference between the groups (P ＜ 0.05).At admission,there were no statistically significant difference in the features of lung CT among three groups (P ＞ 0.05).At 7 days after treatment,lung CT mainly manifested ground glass lesions in C group.At 14 days after treatment,lung CT mainly manifested small size of the exudative changes and the irregular line of pleura in C group with higher proportion of those changes than that in A,B group,while pulmonary interstitial changes were found in the lung CT of A and B groups with higher proportion of these changes than that in C group,and those A group was higher than those in B group (P ＜ O.05).The level of serum P Ⅲ P in patients with APP was positively correlated with the concentration of paraquat (r =0.310,P =0.001).The mortality rate of three groups were 53.33％,44.12％ and 25.00％,respectively,with significant difference among three groups (P ＜ 0.05).Conclusion The clinically therapeutic effect of sequential treatment with Rheum officinale Ball.as a main agent in a traditional Chinese medicine in patients with APP was distinct.It could decrease the levels of PⅢ P,TNF-α,IL-18 and MDA,enhance the expression of SOD and GSH-PX,reduce pulmonary fibrosis in patients and the mortality rate of patients.The P Ⅲ P is the evaluation index of pulmonary fibrosis and can provide useful clinical value for the treatment of patients with APP.

Nourishing kidney-yin (NKY) granules and warming kidney-yang (WKY) granules represent one of the prescriptions that prescribed in treating primary osteoporosis (POP) in light of tonifying kidney and nourishing essence principle as well as the theory of "treating both the disease and traditional Chinese medicine (TCM) syndrome".Both granules were created through the systematic analysis of clinic prescriptions by Professor Shi Qi.Consequently clinical investigations have well established that NKY granules significant improved bone mineral density (BMD) as well as relieved the kidney-yin deficiency syndromes in POP patients.Meanwhile,WKY granules relieve kidney-yang deficiency syndrome and the quality of life (QOL).What is more,pharmacological study established the application of common cnidium fruit,and fructus ligustri lucidi alleviated bone loss in OVX-induced mice.In addition,investigation with effective components identified that both NKY and WKY granules play systematic pharmacological effects on bone remodeling by regulating the expression of BMP/Smad,Wnt/β-catenin,RANKL/RANK/OPG axis,and Notch.The drug discovery was performed by the lead of traditional Chinese medicine (TCM) theory.It is one successful transformation investigation based on pharmacological effects,clinical intervention,animal model,cell culture and molecular investigation.