Objective:To investigate the effect of deescalation noninvasive positive pressure ventilation in the removal of endotracheal intubation in patients with Stanford type A aortic dissection (AAD) complicated with obesity.Methods:A total of 80 obese patients with AAD from March 2018 to January 2020 in the First Affiliated Hospital of Xi′an Jiaotong University were divided into experimental group and control group with 40 cases in each group by random number table method. The control group received traditional oxygen treatment with mask, while the experimental group received de-escalation noninvasive positive pressure ventilation. The blood gas index, respiratory rate and respiratory comfort score was recorded at different times before and after intervention, make a comparison with the two groups in the incidence of hypoxemia, secondary intubation and other complications.Results:Finally, 36 cases were included in the experimental group and 38 cases in the control group. After 2, 8, 24, 48, 72 h of extubation, the oxygenation index, PaO 2, SaO 2 were higher and PaCO 2, respiratory rate were lower in the experimental group compared to the control group, the differences were statistically significant ( t values were 2.02-9.00, all P<0.05). At 72 h after extubation, the pH value of the experimental group was 7.43 ± 0.08, which was higher than 7.38 ± 0.09 of the control group, and the difference was statistically significant ( t=2.44, P<0.05). At 24, 48, 72 h after extubation, the throat pain scores and oral nasal dryness symptom and sore throat symptom scores were (3.11 ± 1.53), (2.25 ± 0.57), (0.94 ± 0.14) points and (4.33 ± 1.08), (3.33 ± 0.68), (2.81 ± 0.43) points in the experimental group, lower than in the control group (5.24 ± 1.96), (3.58 ± 0.73), (2.18 ± 0.91) points and (6.00 ± 1.92), (5.39 ± 1.13), (4.79 ± 0.54) points, the differences were statistically significant ( t values were 3.46-5.21, all P<0.05). The incidence of hypoxemia, secondary intubation and intolerance were 2.8% (1/36), 2.8% (1/36) and 0 in the experimental group, lower than in the control group 26.3% (10/38), 21.1% (8/38) and 10.5% (4/38), the differences were statistically significant ( χ2=8.09, 5.78, 4.01, all P<0.05). Conclusions:De-escalation noninvasive positive pressure ventilation for obese patients with AAD can effectively improve oxygenation, reduce the incidence of hypoxemia and secondary intubation, and alleviate respiratory symptoms.

Development of thoracolumbar vertebra (TLV) and rib primordium (RP) is a common evolutionary feature across vertebrates, although whole-organism analysis of the expression dynamics of TLV- and RP-related genes has been lacking. Here, we investigated the single-cell transcriptome landscape of thoracic vertebra (TV), lumbar vertebra (LV), and RP cells from a pig embryo at 27 days post-fertilization (dpf) and identified six cell types with distinct gene expression signatures. In-depth dissection of the gene expression dynamics and RNA velocity revealed a coupled process of osteogenesis and angiogenesis during TLV and RP development. Further analysis of cell type-specific and strand-specific expression uncovered the extremely high level of HOXA10 3'-UTR sequence specific to osteoblasts of LV cells, which may function as anti-HOXA10-antisense by counteracting the HOXA10-antisense effect to determine TLV transition. Thus, this work provides a valuable resource for understanding embryonic osteogenesis and angiogenesis underlying vertebrate TLV and RP development at the cell type-specific resolution, which serves as a comprehensive view on the transcriptional profile of animal embryo development.

Plasticity in the glutamatergic synapses on striatal medium spiny neurons (MSNs) is not only essential for behavioral adaptation but also extremely vulnerable to drugs of abuse. Modulation on these synapses by even a single exposure to an addictive drug may interfere with the plasticity required by behavioral learning and thus produce impairment. In the present work, we found that the negative reinforcement learning, escaping mild foot-shocks by correct nose-poking, was impaired by a single in vivo exposure to 20 mg/kg cocaine 24 h before the learning in mice. Either a single exposure to cocaine or reinforcement learning potentiates the glutamatergic synapses on MSNs expressing the striatal dopamine 1 (D1) receptor (D1-MSNs). However, 24 h after the cocaine exposure, the potentiation required for reinforcement learning was disrupted. Specific manipulation of the activity of striatal D1-MSNs in D1-cre mice demonstrated that activation of these MSNs impaired reinforcement learning in normal D1-cre mice, but inhibition of these neurons reversed the reinforcement learning impairment induced by cocaine. The results suggest that cocaine potentiates the activity of direct pathway neurons in the dorsomedial striatum and this potentiation might disrupt the potentiation produced during and required for reinforcement learning.

Objective To investigate the diagnostic accuracy of malignant tumor of 18F-fluorodeoxyglucose positron emission tomography/computed tomograprhy (18F-FDG PET/CT) imaging in the patients of elevated serum carbohydrate antigen 19-9 (CA19-9) and its correlation with maximum standardized uptake value (SUVmax) and serum CA19-9 level.Methods Whole-body 18F-FDG PET/CT scan was performed in 149 patients with elevated serum CA19-9 level without the history of malignancy.Blood sample was drawn in each case for CA19-9 assay two weeks or less before the performing PET/CT.Final diagnoses were confirmed by operation/biopsy pathological results and clinical follow-ups.Results Among the 149 patients,64 cases were finally diagnosed as malignancies and 85 cases of non-malignancy diseases.The true positive of the diagnoses by 18F-FDG PET/CT was 60 cases,the false positive 13 cases,the true negative 72 cases,the false negative 4 cases.The accuracy of diagnosis of malignant tumor with elevated serum CA19-9 was 43.0％,while elevated serum CA19-9 combined with 18F-FDG PET/CT imaging was 88.6％,with statistically significant difference (x2 =59.882,P ＜ 0.05).The serum CA19-9 was divided into 4 groups according to the different levels of 37-100 U/ml,100-500 U/ml,500-1000 U/ml and ＞ 1 000 U/ml.The diagnostic accuracy of each group of PET/CT was 94.5％,84.9％,81.3％ and 88.0％,respectively.There was no statistically significant difference between each group (x2 =3.503,P ＞ 0.05).The area under the curve (AUC) of the serum CA19-9 for the diagnosis of malignant tumor (ROC) was 0.726,and the sensitivity and specificity of the diagnostic boundary value of 152.75 U/ml were 70.3％ and 68.2％,respectively.The AUC of SUVmax in diagnosis of malignant tumor was 0.742,the best cutoff value was 6.95,and the sensitivity and specificity were 73.3％,69.2％ respectively.Conclusions 18 F-FDG PET/CT is useful for detecting malignant tumors combined with serum tumor marker CA19-9.The patients with elevated serum CA19-9 are necessary to do PET/CT imaging,especially serum CA19-9 ＞ 152.75 U/ml.And it should be considered malignant tumor when SUVmax ＞ 6.95.

Purpose To explore the value of spectral coronary CT angiography (CCTA) in reducing radiation dose and contrast dose using individualized optimal monochromatic imaging.Materials and Methods Sixty patients with suspected coronary disease were recruited in the study,who were randomly divided into two groups:group A (n=30) using conventional CT protocol with 350 mgI/ml contrast agent;group B (n=30) using low dose spectral CT imaging mode with 300 mgI/ml contrast agent.The images of group A were reconstructed with conventional process,and the images of group B were reconstructed with Optimal CNR to obtain the optimal monochromatic energy images.The images of both groups were transferred to an Advanced Workstation for analysis.Double-blinded method was carried out to qualify the images.CT values of coronary artery segments,as well as standard deviations (SD),the signal-to-noise ratio (SNR),contrast-to-noise ratio (CNR) of aortic sinus were measured.Radiation doses and iodine intake were compared between the two groups.The optimal keV distribution in group B was analyzed.Results There was no significant difference for the subjective scoring of image quality,CT value of each coronary artery segment,SD,SNR,and CNR values between the two groups (P＞0.05).The effective radiation dose and total iodine load in group B were less than that in group A (P＜0.05).The optimal energy distribution for group B was 60-75 keV,average at (66.50+3.91) keV.Conclusion Compared with the conventional CT protocol,spectral CT imaging at optimal energy levels combined with iterative reconstruction can effectively reduce the radiation dose and iodine load,and obtain better images than usual protocol.

Objective To explore the cost-effectiveness and clinical effect of three platinum based chemotherapy regiments for advanced non small cell lung cancer (NSCLC).Methods 100 patients who were diagnosed as NSCLC,were randomly divided into four groups.The group Ⅰ received NP which was given NVB and DDP.The group Ⅱreceived GP which was given GEM and DDP.The group Ⅲ received TP which was given taxotere and DDP.The clinical effect,adverse reaction and cost effectiveness of the three groups were assessed.Results The clinical effective rates of the three groups were 31.43%,36.36%,37.50% from Ⅰ to Ⅲ group.The adverse events of the group Ⅰ and group Ⅱ were more than those of the group Ⅲ.In the adverse effects of treatment,the major cytotoxicity was digestive reaction and leukopenia in the two groups,but they were tolerable.The ratios of cost effectiveness in the four groups were 550.22yuan,556.48yuan,583.23yuan from Ⅰ to Ⅲ group.Conclusion The NP group is the best one in total cost.

Objective To explore the application of low dose of radiation combined with low concentration of contrast medium in the energy spectrum CT of the coronary artery angiography.Methods 60 patients with suspected diagnosis of coronary heart disease were randomly divided into A,B two groups,30 cases in each group.Group A with 350 mg I/mL contrast agent,undergoing conventional CT scanning;Group B using 300 mg I/mL contrast agent,the gems energy spectrum CT scanning with low-dose.Two groups both adopted forward-looking heart switch control scanning mode.After scanning,group A reconstructed conventional images of 40% ASiR sequence,group B rebuilded axial surface images of single energy 65 keV and 40% ASiR sequence,all the reconstruction images were introduced to AW4.6 workstations used for analysis.Double-blind subjective rating was done by two experienced doctors to measure CT values and SD of aortic sinus (AS),left main (LMA),the left anterior descending branch proximal (LAD-p),left circumflex branch proximal (LCX-p), right coronary artery proximal (RCA-p)and pericardial fat,AS the noise (SD),to calculate the signal-to-noise ratio (SNR)and contrast to noise ratio (CNR),to calculate the effective doses of radiation(ED)by recording CTDI and DLP,and to record iodine intake.By using two independent samples t test to compare two groups of patients’the effective radiation doses,iodine intake,the average CT value,SD,SNR and CNR.Results The subjective image quality score differences and coronary measuring section CT values between the two groups had no statistical significance.In the aspects of effective radiation dose,group B reduced about 29% compared to group A,the difference was statistically significant.Iodine intake in group B decreased about 16% than in group A.Conclusion In coronary artery CT imaging, spectral scanning with low dose of radiation and reconstruction images with single energy can effectively reduce the radiation dose and iodine intake,at the same time it can obtain the approximate image quality like conventional scanning.

OBJECTIVE:To provide reference for the application of position number in the pharmacy drug management. METHODS:Three-dimensional coding method was used for coding the position number. The mentioned method was combined with hospital information management system (HIS) for the out of storage,deployment and inventory. Memory field assumptions method was used to compare the size of field memorized by pharmacist in inpatient pharmacy before and after management of posi-tion number. Sampling controlled trial was conducted to compare the drugs deployment time and walking distance of pharmacists in inpatient pharmacy and drug storehouse before and after coding management of position number. RESULTS:After management of coding management in inpatient pharmacy,the memory required field was decreased from 1 028 to 25,deployment time of pharma-cists was decreased from(36.57±0.82)min to(24.20±0.33)min,and the walking distance was decreased from(79.17±0.29)m to(38.59±0.56)m. After management of coding management in drug storehouse,deployment time of pharmacists was decreased from(61.86±0.44)min to(47.18±0.63)min,and the walking distance was decreased from(129.53±0.58)m to(68.97±0.32) m. CONCLUSIONS:The drug coding management of position number can improve the deployment efficiency and reduce the brain and physical quantity of pharmacists.

PurposeTo explore the feasibility of personalized energy spectrum scanning in upper abdomen CT by comparing the image quality and radiation dose of optimizing choice spectrum scanning protocol with conventional 120 kVp scan.Material and Methods Sixty patients undergoing abdominal CT scan with and without contrast enhancement were prospectively collected and randomly assigned into two groups. Group A (30 patients) underwent conventional 120 kVp scan and spectral enhancement scanning; group B (30 patients) underwent spectrum scan and 120 kVp enhancement scanning. Spectral scanning protocol was based on individual choice with conventional 120 kVp NI10-5 mm average mAs scan for every patient. The CT dose index of volume (CTDIvol) and effective dose (ED) during non-contrast phase and portal venous phase were recorded. The CT value, standard deviation (SD), signal noise ratio (SNR) and contrast noise ratio (CNR) were measured in the liver parenchyma, spleen parenchyma and portal venous trunk.Results The CTDIvol and ED of spectrum scanning were less than 120 kVp scan but there was no statistical difference (P>0.05). The SD of group B GSI imaging was less than group A 120 kVp (P<0.05), while the SNR was greater than group A. The SD of group A GSI portal venous phase in the liver, spleen and portal vein was less than group B 120 kVp (P<0.05).ConclusionThe optimized energy spectrum scanning protocol can reduce radiation dose with quality of single energy image from the energy spectrum equal to or better than the conventional 120 kVp scanning protocol. Personalized energy spectrum scan protocol provides multi-parameter diagnosis and multi-application platform and can be used routinely in the upper abdomen scan.

Objective To study the regulation of aquaporin-1(AQP-1)changes in the heart of septic rats, compare the correlations of the AQP-1 with myocardial cytokines tumor necrosis factor-α(TNF-α),interleukin-6 (IL-6),and myocardial tissue water content,and to investigate the dexmedetomidine protective effect on myocardia in septic rats and its possible mechanism. Methods According to the random number table methods,90 male Sprague-Dawley(SD)rats were divided into sham operation group,sepsis model group and dexmedetomidine group, 30 rats in each group. The rat sepsis model was established by cecal ligation and puncture(CLP). In the sham operation group,the animal abdomen was only opened and closed without CLP. Half hour before operation in dexmedetomidine group,dexmedetomidine 1μg/kg(2μg/mL)was injected into the vein,while in the model and sham groups,saline 5 mL/kg was subcutaneously injected into the rat after the operation. At 2,12,24,48,72 hours after operation,6 rats were sacrificed and their hearts removed at one time point in a group. Enzyme linked immunosorbent assay(ELISA)was used to detect the content of AQP-1 and the levels of the TNF-α,IL-6 in the myocardial tissue homogenate at all time points,the myocardial tissue water content was detected by dry wet weight,and the correlations between AQP-1 and TNF-α,IL-6 and between AQP-1 and myocardial tissue water content were compared. Results From 2 hours after operation,the levels of the AQP-1,TNF-αand IL-6 in model group were significantly higher than those in the sham operation group;with prolongation of time,the level of AQP-1 and myocardial tissue water content were decreased, but the levels of TNF-α and IL-6 were persistently increased. From 2 hours after operation in dexmedetomidine group,all the above indexes except myocardial tissue water content at 72 hours after operation were significantly lower than those in the model group〔AQP-1(ng/g):9.29±0.15 vs. 9.73±0.26,TNF-α(pg/g):109.47±8.41 vs. 128.13±7.36,IL-6(pg/g):232.95±20.56 vs. 279.71±22.24,myocardial tissue water content:(74.82±6.37)%vs.(75.62±6.39)%,all P<0.05〕,but still higher than those of the sham operation group. The correlation analyses for the septic group showed that the change of AQP-1 was positively correlated to the myocardial water content in early stage(r=0.418,P=0.001)and later stage(r=0.235,P=0.022),and the changes of the AQP-1 in early stage (at post-operative 2 hours)were positively correlated to the concentration changes of the cytokines TNF-α(r=0.235,P=0.021)and IL-6(r=0.345,P=0.003),but in the later stage(at post-operative 72 hours)were negatively correlated with the changes of TNF-α(r=-0.408,P=0.037)and IL-6(r=-0.276,P=0.002). Conclusions In the early stage of septic rats,there is obvious myocardial injury,resulting in the over expression of AQP-1 and the occurrence of myocardial edema,dexmedetomidine can play a role in myocardial protection in such rats and its mechanism is possibly related to the reduction of the expression of AQP-1 and the levels of inflammatory cytokines, and in turn the alleviation of myocardial cell edema.