Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)versus non-invasive positive pressure ventilation(NPPV)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied by mild to moderate hypercapnia.Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021,to October 2023,with 49 in the NPPV group and 43 in the HFNC group.The two groups were compared in terms of 28-day intubation rate,90-day mortality,and arterial blood gases.Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group(28.57％vs.11.63％,P<0.05),but no significant differences in the 90-day mortality rate(36.73％vs.23.26％,P>0.05).The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group(Log-Rank test:χ2=4.257,P=0.039),but no significant difference in 90-day mortality rate(Log-Rank test:χ2=2.596,P=0.107).A Cox proportional hazards model,which incorporated APACHE Ⅱ score and baseline PaCO2,demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69％as compared to the NPPV group(HR=0.31,95％CI:0.10～0.93,P=0.037),but the risk of 90-day mortality did not show a significant decrease(HR=0.61,95％CI:0.27～1.37,P=0.232).PaCO2 in both groups decreased gradually and pH increased simultaneously.PaCO2,pH,and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups(P>0.05).Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia,HFNC reduces intubation rates compared to NPPV,without increasing mortality,and shows similar improvements in arterial blood gas indicators,making it a suitable respiratory support option.

Objective To evaluate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC)versus non-invasive positive pressure ventilation(NPPV)in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)accompanied by mild to moderate hypercapnia.Methods The study included 92 AECOPD patients with hypercapnia treated at the second medical center of Chinese PLA General Hospital from August 2021,to October 2023,with 49 in the NPPV group and 43 in the HFNC group.The two groups were compared in terms of 28-day intubation rate,90-day mortality,and arterial blood gases.Results The NPPV group showed a significantly higher 28-day intubation rate compared to the HFNC group(28.57％vs.11.63％,P<0.05),but no significant differences in the 90-day mortality rate(36.73％vs.23.26％,P>0.05).The Kaplan-Meier curve indicated that the HFNC group had a significantly lower 28-day intubation rate compared to the NPPV group(Log-Rank test:χ2=4.257,P=0.039),but no significant difference in 90-day mortality rate(Log-Rank test:χ2=2.596,P=0.107).A Cox proportional hazards model,which incorporated APACHE Ⅱ score and baseline PaCO2,demonstrated that the risk of 28-day intubation in the HFNC group was reduced by 69％as compared to the NPPV group(HR=0.31,95％CI:0.10～0.93,P=0.037),but the risk of 90-day mortality did not show a significant decrease(HR=0.61,95％CI:0.27～1.37,P=0.232).PaCO2 in both groups decreased gradually and pH increased simultaneously.PaCO2,pH,and PaO2 at 2h and 48h against the baseline values did not differ significantly between the two groups(P>0.05).Conclusion In elderly AECOPD patients with mild-to-moderate hypercapnia,HFNC reduces intubation rates compared to NPPV,without increasing mortality,and shows similar improvements in arterial blood gas indicators,making it a suitable respiratory support option.

Objective To evaluate the relationship between perioperative myocardial injury(PMI)and serum N/OFQ levels in elderly patients with coronary heart disease.Methods Totally 120 elderly patients who underwent hip fracture surgery under general anesthesia from January 2022 to May 2023 were included,including 60 patients with coronary heart disease(CHD group)and 60 patients without coronary heart disease(control group).The venous blood of patients was collected 10 minutes before anesthesia induction(T0),12 hours after surgery(T1)and 24 hours after surgery(T2)to detect the content of N/OFQ and high-sensitivity myocardial troponin I(hs-cTnI)in serum.Record perioperative adverse cardiovascular events(PACE)and the use of vasoactive drugs during surgery.Results Compared with the control group,the N/OFQ and hs cTnI levels at T0 and T1 in the CHD group were significantly increased(P<0.05).There was a positive correlation between N/OFQ and hs-cTnI levels at T1 and T2 in CHD and control group(P<0.05).The use of PACE and intraoperative vasoactive drugs in the CHD group was higher than that in the control group(P<0.05).Conclusion There is a correlation between the increased N/OFQ content and PMI in elderly patients with coronary heart disease after surgery,which may become an early predictive indicator of PMI.

Objective To explore the characteristics of blood vitamins A, B2, B6, B12, D, E, K1, K2 and folic acid and their correlation with severity in patients with metabolic-related fatty liver disease (MAFLD). Methods　From September to December 2022, a total of 473 cases of residents were recruited through community MAFLD screening activities and their health information was obtained through questionnaire survey and physical examination. The severity of hepatic steatosis was determined with FibroScan, and vitamin concentrations were determined with liquid chromatography-tandem mass spectrometry. Two independent samples' t-tests were used to assess the differences between the two groups, and univariate chi-square tests and multivariate logistic regression analysis were used to explore the related factors of MAFLD. Results　Of the 473 inhabitants, 195 (41.23%, 195/473) met the diagnostic criteria for MAFLD, including mild 43 (22.05%, 43/195) cases of fatty liver, 88 (45.13%, 88/195) cases of moderate fatty liver, and 64 (32.82%, 64/195) cases of severe fatty liver. Using healthy residents collected during the same period as controls, the overall mean of vitamins A, E, K1, and K2 in the MAFLD group was higher than that of the healthy group, with a statistical difference (P<0.05). Furthermore, the concentrations of vitamins A, E, K1 and K2 increased with the severity of fatty liver [R=0.149, P=0.004; R=0.245, P<0.001; R=0.110, P=0.032; R=0.129，P=0.012]. There were statistically significant differences (P<0.05) in the blood levels of vitamin A and E between patients with moderate or severe fatty liver and the healthy population. The blood vitamins K1 and K2 in severe fatty liver patients were also different from those of healthy people (P<0.05). However, there was no significance between folic acid, vitamin D, B2, B6, B12, and MAFLD (P>0.05). Through univariate chi-square analysis and multivariate logistic regression analysis, it was found that male [Wald=5.789, P=0.034，OR=1.598(1.037-2.463)] and vitamin E≥8.13 μg/mL[Wald=14.632，P<0.001，OR=2.378(1.522-3.674)] were risk factors for moderate and severe MAFLD. Conclusions The concentrations of vitamin A, E, and K in the blood are increased in patients with MAFLD compared to the healthy population, and they are positively correlated with the severity of MAFLD. ale gender and high levels of vitamin E may be related to moderate to severe MAFLD.

Objective:To analyse the skin clinical characteristics of adverse reactions to cosmetic products.Methods:A total of 132 patients suffered with the skin adverse reactions of cosmetics were collected in the Department of Dermatology in the First Affiliated Hospital of Xinxiang Medical University from January 2021 to December 2021. There were 5 males and 127 females, aged 2-66 (34.0±13.1) years. and the personal information, medical records, clinical characteristics and the cosmetic information as well as laboratory results were collected.Results:The major types of adverse reactions to cosmetic products were contact dermatitis (86.4%). Head was the most commonly affected site, The most common symptoms were pruritus and burning sensation (83.9%), and sores, dryness, tightness of the skin, and the common skin lesions included erythema and papula (92.9%). Suspected cosmetics were mostly skin care products (45 cases) and freckle removing products (30 cases). Only 7 patients accepted patch tests, 1 case had negative results and others were all tested positive.Conclusions:Adverse drug reactions affect young and middle-aged women mostly. Contact dermatitis is the most common adeverse reaction to cosmetic products and the patch test is still the most effective method in helping diagnosing contact dermatitis to cosmetic products.

Abstract: Objective　To investigate the antimicrobial activity of omadacycline (OMC) against clinical Streptococcus agalactiae (GBS) isolates, as well as its relationship with biofilm formation, resistance genes and virulence genes. Methods　A total of 136 strains of Streptococcus agalactiae isolated from Shenzhen Nanshan People's Hospital between 2015 to 2020. The minimum inhibitory concentration (MIC) of OMC against Streptococcus agalactiae was determined by broth microdilution. Crystal violet staining was used to detect the biofilm formation ability of GBS. Resistance genes (tetM, tetO, tetK, ermB, OptrA) and virulence genes (cpsⅢ, bca, fbsA, cpsA, scpB) were investigated by polymerase chain reaction (PCR). Results　Among the 136 clinical isolates of GBS, 20 strains (14.7%) were resistant to OMC, 64 (47.1%) were intermediate, and 52 (38.2%) were sensitive. Fifty-seven strains (41.9%) were biofilm-positive, 20 of which (35.1%) were sensitive to OMC. Seventy-nine strains (58.1%) were biofilm-negative, 32 of which (40.5%) were susceptible to OMC. There was a statistically significant difference in the sensitivity rates between the two groups of strains (χ2=63.062, P<0.001), but there was no significant difference in the sensitivity of OMC among the biofilm-positive strains (Fisher's exact test, P=0.824). The resistance rates of tetM, tetO, ermB and OptrA positive strains were higher than those of negative strains, while tetK was opposite. The presence of tetM (Z=0.815, P=0.415), tetO (Z=0.151, P=0.88), tetK (Z=0.567, P=0.571), ermB (Z=1.198, P=0.231) resistance genes in Streptococcus agalactiae had no significant impact on the sensitivity of OMC. However, the presence of the OptrA resistance gene showed a statistically significant effect on the sensitivity of OMC (Z=2.913, P=0.004). The virulence factors cpsⅢ, bca, fbsA, cpsA and scpB were all detected at a rate higher than 50%. The presence of the virulence genes cpsⅢ (Z=0.222, P=0.824), bca (Z=0.141, P=0.888), fbsA (Z=0.813, P=0.416), and cpsA (Z=1.615, P=0.106) in Streptococcus agalactiae had no significant impact on the sensitivity of OMC. However, there was a significant inter-group difference in the scpB virulence gene (Z=2.844, P=0.004), but the rank mean values and resistance rates of scpB-positive strains were lower than those of the negative strains. Conclusions　The formation of biofilm in Streptococcus agalactiae reduces its sensitivity to OMC, but there was no significant difference in the sensitivity to OMC among the biofilm-positive strains. The presence of resistance genes tetM, tetO, tetK, ermB, and virulence genes cpsⅢ, bca, fbsA, cpsA, scpB in Streptococcus agalactiae is not associated with OMC resistance, but the presence of the resistance gene OptrA is correlated with OMC resistance..

Background: Autoimmune pancreatitis (AIP) is a chronic pancreatitis associated with immune factors. IgG4-related sclerosing cholangitis (IgG4-SC) is a common extrapancreatic manifestation of AIP, however, its optimal treatment still needs to be clarified. Aims: To summarize the experience in the clinical diagnosis and treatment of AIP, especially IgG4-SC. Methods: Twenty-five patients with AIP admitted from the First Affiliated Hospital of Nanchang University between January 2015 and May 2021 were recruited, and a retrospective analysis was conducted on the clinical symptoms, laboratory and imaging findings, pathological results, as well as the treatment regimens and clinical outcomes. Results: All the patients were diagnosed as type 1 AIP (84.0% male, mean age 63.5 years). Obstructive jaundice (56.0%) and epigastric pain (44.0%) were the main clinical symptoms. The main imaging findings were diffuse enlargement of the pancreas, capsule-like rim, and distal biliary stricture associated with intra- and extra-hepatic duct dilation. The serum IgG4 elevated significantly. In 14 patients with IgG4-SC, the total bilirubin was between 1-2 upper limit of normal (ULN) in 3 cases, between 2-5 ULN in 3 cases, and > 5×ULN in 8 cases. Fifteen (83.3%) patients obtained pathological diagnosis by endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA). Six IgG4-SC patients were treated with steroids alone, and 6 received biliary stenting with or without steroids, no differences in liver function tests were existed between the two groups prior to treatment (all P> 0.05). Liver function tests in most of these patients were normalized after treatment. Conclusions: AIP is a rare disease in clinical practice, and is more frequently seen in elderly male patients. Biliary involvement (IgG4-SC) is common and often presents initially as obstructive jaundice, which can be effectively managed with steroids alone, without the need for biliary stenting.

OBJECTIVETo explore the effect of body mass index (BMI) on postoperative short-term prognosis and survival rate of gastric cancer patients.

METHODSClinical and follow-up date of 153 gastric cancer cases undergoing radical operation in our hospital from January to June 2010 were retrospectively analyzed. According to BMI, patients were divided into low group (BMI<18.5, 23 cases), normal group (18.5≤BMI<25.0, 95 cases) and high group (BMI≥25.0, 35 cases). Clinicopathological features and outcomes were compared the among three groups.

RESULTSAmong three groups, the differences in operation time, intraoperative blood loss, number of lymph node retrieved, postoperative hospital stay, lymph node metastasis rate, tumor staging and postoperative complication morbidity were not statistically significant (all P>0.05). Preoperative hemoglobin in the low group was significantly lower as compared to normal and high groups [(106.1±13.8) g/L vs. 113.5±5.2) g/L and (123.5±8.7) g/L, F=3.265, P=0.041], and so was the preoperative albumin [(38.7±2.5) g/L vs. (41.3±0.8) g/L and (43.5±1.4) g/L, F=8.516, P=0.000]. The ratio of gastric cardiac cancer in the low group was significantly lower as compared to the normal and high groups[34.8%(8/23) vs. 68.4%(65/95) and 62.9%(22/35), χ(2)=8.913, P=0.012]. Five-year survival rate of the low, normal and high groups were 43.5%, 50.5% and 65.7% respectively(P=0.189). Subgroup analysis showed that the 5-year survival rate of patients with gastric cardiac cancer in the low group was significantly lower as compared to those in the high group (25.0% vs. 84.6%, P=0.004).

CONCLUSIONSBMI dose not generally play a role in short-term outcomes and long-term survival of the gastric cancer patients. Nutritional improvement and body weight maintenance may be beneficial to low BMI patients, especially those with gastric cardiac cancer.

Blood Loss, Surgical ; Body Mass Index ; Gastrectomy ; Humans ; Length of Stay ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Stomach Neoplasms ; surgery ; Survival Rate ; Treatment Outcome

OBJECTIVE:To investigate synergistic effect of carbapenems combined with fosfomycin(FOS)on carbapenems-re-sistant Pseudomonas aeruginosa isolates from urinary tract infections in vitro. METHODS:The minimum inhibitory concentration was detected using agar double dilution method. The fractional inhibitory concentration index was determined by checkerboard meth-od. The effect of carbapenems combined with FOS on biofilm of P. aeruginosa isolates was determined using 96 crystal violet stain-ing. RESULTS:12 strains of carbapenem-resistant P. aeruginosa isolates were highly sensitive to FOS and amikacin,and were com-pletely resistant to imipenem and meropenem. The combination of imipenem with FOS could induce a synergistic effect on 4 strains (33.3%);meropenem combined with FOS could induce a synergistic effect on 5 strains(41.7%);no antagonistic effect of carbap-enems combined with FOS appeared. FOS combined with carbapenems could inhibit the biofilm of carbapenems-resistant P. aerugi-nosa(P<0.05 or P<0.01). CONCLUSIONS:The combination of carbapenems with FOS possesses in vitro synergistic antibacteri-al effect on part of carbapenems-resistant P. aeruginosa isolates,the mechanism of which may be associated with inhibiting the bio-film.

This paper is to report the study of the pharmacokinetics of a fusion protein TAT-haFGF(14-154) for human acidic fibroblast growth factor and transcriptional activator protein in rat plasma, and the investigation of their penetration across blood-brain barrier in mice and rats, in order to provide a basis for clinical development and treatment of Alzheimer's disease. Enzyme-linked immunosorbent assay (ELISA) was used to determine concentration of TAT-haFGF(14-154) in rat plasma and in mouse brain homogenate; and immunohistochemistry was used to analyze the distribution in brain. The concentration-time curve fitted two-compartment open model which was linear kinetics elimination after a single intravenous injection of TAT-haFGF(14-154) in rat at the dose of 300 microg x kg(-1). The half life time was 0.049 +/- 0.03 h for distribution phase and 0.55 +/- 0.05 h for elimination phase, and the weight was 1/C2. The result showed that TAT-haFGF(14-154) could be detected in the brain by ELISA and immunohistochemistry, the elimination of TAT-haFGF(14-154) in rat was swift, and TAT-haFGF(14-154) could penetrate across the blood-brain barrier, distribute in pallium and hippocampus and locate in the nucleus.