Objective To evaluate the efficacy and safety of dienogest in the conservative treatment of adenomyosis(AM).Methods The relevant randomized controlled trials were searched by computer from domestic and foreign electronic bibliographic databases to August 2023.Risk of bias tool was used to evaluate the literature quality,and RevMan 5.4 software was used for analysis.Results A total of 654 patients with AM were included in 9 randomized controlled trials.338 patients received dienogest for 3 to 6 months.Meta-analysis results showed that the total effective rate of dienogest in the treatment of adenomyosis(OR=6.70,95％CI:1.84-24.42,P=0.004)and serum carbohydrate antigen 125(CA125)reduction(MD=-6.89,95％CI:-12.84-0.93,P=0.02),uterine volume(MD=-26.49,95％CI:-37.86-15.12,P<0.00001),quality of life questionnaire score(MD=6.12,95％CI:4.76-7.47,P<0.00001),the difference was statistically significant.Pain improvement(MD=-0.14,95％CI:-2.19-1.92,P=0.90),endometrial thickness(MD=-0.54,95％CI:-3.66-2.59,P=0.74),the difference was not statistically significant.The overall incidence of adverse reactions(OR=0.51,95％CI:0.12-2.18,P=0.37)and the incidence of irregular vaginal bleeding(OR=1.98,95％CI:0.25-15.59,P=0.52),the difference was not statistically significant.Conclusion Dienogest improves overall response rates,reduces uterine volume in certain degree,relieves subjective symptoms,and improves quality of life in patients with adenomyosis.

OBJE CTIVE To establish a method for quality evaluation of Xin ’an capsule by combining fingerprint ， multi-component quantitative analysis and chemical pattern recognition analysis. METHODS High performance liquid chromatography（HPLC）combined with Similarity Evaluation System of TCM Chromatogram Fingerprint （2012 edition）were used to establish the fingerprints of 24 batches of Xin ’an capsules and evaluate the similarity. The common peaks were determined. The contents of glucosylvitexin ，rhamnosylvitexin，vitexin，hyperoside and isoquercetin in Xin ’an capsules were determined by the same HPLC method. Taking the common peak area of fingerprint as the variable ，MetaboAnalyst 5.0 tool was used to draw the cluster analysis （CA）heat map. SIMCA 14.1 software was used to perform principle component analysis （PCA）and partial least squares-discriminant analysis （PLS-DA）. RESULTS Twelve common peaks were identified with the similarity greater than 0.97. Six common peaks were identified as chlorogenic acid ，glucosylvitexin，rhamnosylvitexin，vitexin，hyperoside and isoquercetin.The linear range of glucosylvitexin ，rhamnosylvitexin，vitexin， hyperoside and isoquercetin were 2.36-151.35，9.15-585.20， 1.20-76.50， 0.68-43.20， 0.44-27.90 µg/mL（all r＞0.999）.RSDs of precision ，repeatability and stability （24 h）tests were 163.com all less than 2.00％ . The average recoveries were 95.80％（RSD＝0.96％ ，n＝6），102.10％ （RSD＝0.93％ ，n＝6）， 103.26％（RSD＝1.28％，n＝6），103.89％（RSD＝0.73％，n＝6） and 102.09％（RSD＝1.79％，n＝6），respectively. The contents of the five components were 0.988 8-1.559 1，4.336 6-11.220 1， 0.065 1-0.830 5，0.043 8-0.692 5 and 0.023 2-0.427 2 mg/grain，respectively. The results of CA and PCA showed that 24 batches of samples could be divided into three categories ，i.e. S 1-S15，S16-S18 and S 19-S24. PLS-DA showed that variable importance in projection values of the corresponding component of peak 6 and glucosylvitexin （peak 7），rhamnosylvitexin（peak 8），hyperoside （peak 10） and isoquercetin （peak 11） were greater than 1. CONCLUSIONS The established HPLC fingerprint and multi-component quantitative method are simple and feasible. Combined with chemical pattern recognition analysis ，it can be used for the quality control of Xin ’an capsules. Glucosylvitexin ，rhamnosylvitexin and other components may be differentital markers affecting the quality of each batch of samples.

Objective:To investigate the influencing factors of the survival in infants with congenital diaphragmatic hernia (CDH) and to develop a prediction model for CDH.Methods:Clinical data of 252 infants with a prenatal diagnosis of CDH in Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2010 to December 2018 were retrospectively analyzed. Adverse outcomes were defined as neonatal death on discharge. Chi-square and t test were used for univariate analysis of 16 perinatal and five postnatal risk factors. Regression analysis was used to determine the independent predictors of survival. The receiver operating characteristics (ROC) curves of the risk factors for predicting the survival of CDH were drawn. A prediction model based on the combination of risk factors for predicting adverse outcomes of CDH was established using the cut-off value. ROC curves of the model were drawn and the area under curve (AUC), sensitivity, and specificity were calculated. Results:Out of the 252 patients, 173(68.7%) survived on discharge. Univariate analysis showed that lung-to-head ratio (LHR), polyhydramnios, right diaphragmatic hernia, liver herniation, intrathoracic stomach, premature birth, low birth weight, 5 min Apgar score <7, and amniotic fluid index (AFI) were significantly associated with the survival of CDH. Regression analysis showed that polyhydramnios ( OR=11.19,95% CI:2.83-45.33), liver herniation ( OR=2.81,95% CI:1.32-11.92), intrathoracic stomach ( OR=5.02, 95% CI:1.29-17.13), low birth weight ( OR=8.58,95% CI:1.59-45.01) and AFI ( OR=3.68, 95% CI:1.37-14.72) were independent risk factors for survival at discharge in children with CDH, while LHR ( OR=0.36, 95% CI:0.01-0.69) were protective factors. The predictive cut-off values of LHR, polyhydramnios, liver herniation, intrathoracic stomach, low birth weight, and AFI were 1.6, 1.0, 1.0, 1.0, 1.0, and 232.5 mm, respectively. The model based on the combination of the above indicators for predicting CDH adverse outcomes was shown with an AUC value of 0.904, predictive sensitivity of 0.747, and specificity of 0.896. Conclusions:In this study, LHR, liver herniation, intrathoracic stomach, polyhydramnios, low birth weight, and AFI are independent risk factors for CDH survival. The combination of prenatal and postnatal indicators is noted for a higher accuracy for predicting CDH survival.

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Objective To explore the application effect and nursing methods of pulse indicator continuous cardiac output (PICCO) monitoring technology in large area burn patients. Methods A total of 82 cases of large area burn patients in the hospital from January 2014 to June 2017 were chosen and divided into experimental group (41 cases) and control group (41 cases) by random digits table method. Two groups of patients were treated with the same method, the control group using routine monitoring method to guide liquid resuscitation, the experimental group based on the use of PICCO monitoring technology to guide fluid resuscitation. Hemodynamic indexes, fluid resuscitation time, ICU days, complication rate and mortality rate of the two groups were compared and analyzed. Results After fluid resuscitation, the acute physiology and chronic health system II (APACHE II) score, heart rate (HR), mean arterial pressure (MAP) and central venous pressure (CVP) of the observation group were (18.4 ± 4.2) marks, (98.7±8.5) once/min, (88.5±9.6) mmHg (1 mmHg=0.133 kPa), (10.3±2.5) mmHg.The APACHE II score, HR, MAP and CVP of the control group were (22.7±5.4) marks, (112.5±9.6) once/min, (81.2±10.5) mmHg, (7.9±2.2) mmHg. There were significant differences between the two groups (t=3.285-6.891, all P <0.05). The cardiac index (CI),cardiac output(CO), global end-diastolic volume index (GEDVI), intrathoracic blood volume index(ITBVI), extravascular pulmonary water index(EVLWI) of the observation group after fluid resuscitation were (4.21±0.46) L·min-1·m-2, (4.87±0.52) L/min, (734.51±95.83) ml/m2, (725.91 ± 88.42) ml/m2, (6.26 ± 1.21) ml/kg, respectively. The difference was statistically significant compared to those before fluid resuscitation (t=10.454-21.143, all P <0.05).Resuscitation time and ICU days in the observation group were (3.1±1.2), (31.4±5.8) d. Resuscitation time and ICU days in the control group were (3.9 ± 1.5), (37.8 ± 6.5) d. There were significant differences between the two groups (t=2.667, 4.704, P<0.05). Conclusions PICCO monitoring plays an important role in the early fluid resuscitation in the treatment of large area burn patients, and strengthening the nursing work is beneficial to the targeted treatment and rehabilitation of the patients.

Objective To analyze the related risk factors affecting the prognosis of elderly patients with severe community acquired pneumonia (SCAP). Methods A retrospective study method was conducted; the elderly (≥ 75 years old) patients with SCAP treated in the First Affiliated Hospital of Hainan Medical College from January 2015 to January 2019 were enrolled. The general data of patients were collected, including sex, age, oxygenation index (PaO2/FiO2), involved organs, presence or absence of following diseases or treatment: damage in multiple lung lobes, septic shock, basic diseases (cardiovascular disease, chronic lung disease, diabetes, hypertension, and cerebrovascular disease), invasive mechanical ventilation, ventilator-associated pneumonia (VAP), misinhalation event, hyponatremia, respiratory acidosis, hypoproteinemia, intubation times, total mechanical ventilation time, etc. According to the prognosis, the patients were divided into a death group and a survival group. The general data were compared between the two groups with different prognoses. Single factor analysis was carried out by selecting variables. The indicators with statistical significant differences in the results of univariate analysis were introduced into the multivariate Logistic regression analysis to analyze the related risk factors affecting the prognosis of elderly patients with SCAP. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive values of risk factors in the patients with SCAP. Results A total of 112 patients were included, 33 died, and the mortality rate was 29.46%. Univariate analysis showed that the following factors were higher in the death group than those in the survival group: organ involvement >2 [69.70% (23/33) vs. 35.44% (28/79)], lung lobe damage ≥ 3 [75.76% (25/33) vs. 51.90% (41/79)], invasive mechanical ventilation [72.73% (24/33) vs. 32.91% (26/79)], diabetes [30.30% (10/33) vs. 12.66% (10/79)], intubation times ≥2 [57.58% (19/33) vs. 48.10% (38/79)], hypoproteinemia [75.76% (25/33) vs. 41.77% (33/79)], hyponatremia [72.73% (24/33) vs. 48.10% (38/79)], respiratory acidosis [66.67% (22/33) vs. 44.30 %(35/79)] and total mechanical ventilation time ≥ 15 days [69.70% (23/33) vs. 40.51 (32/79)]; the factors in the death group lower than those in the survival group were: septic shock [3.03% (1/33) vs. 17.72% (14/79)], chronic lung disease [6.06% (2/33) vs. 25.32% (20/79)] and PaO2/FiO2 [mmHg (1 mmHg = 0.133 kPa): 102.89±14.78 vs. 109.56±14.08],the differences were statistically significant (all P < 0.05); there were no significant differences in gender, age, cardiovascular disease, hypertension, VAP, misinhalation events and cerebrovascular disease between the two groups (all P > 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus [odds ratio (OR) = 1.074, 95% confidence interval (95%CI) = 1.017-1.287, P =0.045], septic shock (OR = 2.765, 95%CI = 1.083-3.411, P = 0.047), hyponatremia (OR = 1.792, 95%CI = 1.128-1.417, P = 0.006), hypoalbuminemia (OR = 2.187, 95%CI = 1.872-5.462, P = 0.046), invasive mechanical ventilation (OR = 5.870, 95%CI = 2.324-23.796, P = 0.001), respiratory acid poisoning (OR = 2.934, 95%CI = 2.454-7.275, P = 0.043), time of mechanical ventilation (OR= 1.986, 95%CI = 2.467-3.483, P = 0.034), number of intubation (OR = 6.760, 95%CI = 2.116-24.696, P = 0.001), PaO2/FiO2 (OR = 1.981, 95%CI = 1.006-1.417, P = 0.007), organ involvement > 2 (OR = 2.924, 95%CI = 2.534-6.285, P = 0.048), chronic lung disease (OR = 2.887, 95%CI = 1.487-3.483, P = 0.039), and lung lobe damage≥3 (OR = 2.754, 95%CI = 1.131-1.798, P = 0.045) were independent risk factors affecting the prognosis of elderly patients with SCAP. ROC analysis showed that hyponatremia, hypoalbuminemia, invasive mechanical ventilation, total mechanical ventilation time, PaO2/FiO2, organ involvement > 2, damage of lung lobes ≥ 3, had predictive values for the prognosis of SCAP [the areas under ROC curve (AUC) were 0.377, 0.267, 0.301, 0.646, 0.650, 0.329, and 0.381, respectively, all P < 0.05]. Conclusions Underlying disease, invasive mechanical ventilation, respiratory acidosis, total mechanical ventilation time, PaO2/FiO2, intubation times ≥ 2, chronic lung disease and lung damage≥ 3 lobes are the independent risk factors for the prognosis of elderly patients with severe community acquired pneumonia. Clinical treatment should focus on the above aspects to minimize the mortality of patients.

Objective To analyze the present situation of glucose metabolism and the characteristics of blood glucose fluctuation in in-hospital type l diabetic patients (T1DM). Methods One hundred and forty-three hospitalized cases of T1DM patients from November 2012 to November 2016 were retrospectively analyzed.The percentage of adult-onset T1DM patients was 76.22%(109/143)and none adult-onset was 23.78%(34/143). The following data were collected: general information, the indexes of glucose metabolism and islet function.Seventy-two-hour continuous glucose monitoring(CGM) was carried on 40 patients as a subgroup.Results The average age was(40.29 ± 16.79)years.The onset age of diabetes was(33.57 ± 17.18)years.The disease duration was 4.0(1.0,10.0)years.The body mass index(BMI)was(20.68 ± 2.95)kg/m2.The fasting blood glucose(FBG)was(12.02 ± 5.40)mmol/L.The HbA1c was(9.80 ± 2.65)%.The fasting C-peptide was 0.08(0.01,0.38)nmol/L.The 2-hour postprandial C-peptide (C-P 2 h) was 0.12(0.01, 0.70) nmol/L. The anti-glutamic acid decarboxylase antibody was 12.08(8.16,20.56)μg/L.The islet-cell antibody was 4.85(2.66,12.07)μg/L.By using multivariate linear regression analysis, HbA1c were negatively related to the duration and BMI of T1DM. CGM: the mean blood glucose was (10.34 ± 2.97) mmol/L. The standard deviation of blood glucose was (2.89 ± 1.07) mmol/L. The mean amplitude glycemic excursions was (7.10 ± 3.09) mmol/L. The incidence of hypoglycemia was 10.00% (≤ 2.8 mmol/L) and 32.50% (≤ 3.9 mmol/L). Conclusions Adult-onset T1DM patients account for more than two-thirds. In-hospital T1DM patients have poor control of blood glucose, and they show the clinical characteristics of high blood glucose fluctuation and more hypoglycemia.

Objective To study the anti-inflammatory,antitussive,and analgesia effects of Jinhua qingre capsules.Methods The anti-inflammatory effect was assessed by the methods include xylene-induced mouse auricular swelling and histamine-induced pigment oozing from skin vessel in rats;The antitussive and analgesic effect were assessed by ammonia water induced cough model and acetic acid-induced twisting method.Results In anti-inflammation experiment,the high dose (12 g·kg-1) and moderate (6 g·kg-1) groups of Jinhua qingre capsules showed significant inhibitory effect on auricular swelling and significant difference compared with control group (P ＜ 0.01,P ＜ 0.05.);the high dose (10 g· kg-1) and moderate dose (5 g·kg-1) groups of Jinhua Qingre capsules play a marked inhibitory role in the increase in mouse peritoneal capillary permeability (P ＜ 0.01,P ＜ 0.05).In antitussive experiment,high dose (12 g· kg-1) and moderate dose (6 g· kg-1) groups had significant inhibitory effect on cough caused by ammonia water (P ＜ 0.01,P ＜ 0.05) compared with control group.In analgesic experiment,the high dose (12 g·kg-1),moderate dose (6 g·kg-1),and low dose (3 g·kg-1) groups effectively reduced the writhing frequency of mice (P ＜ 0.01,P ＜ 0.05).Conclusion Jinhua qingre capsules have potential effects on anti-inflammatory,antitussive,and analgesic.

Objeetive To analyze the clinical efficacy of liver transplantation (OLT) for patients with hepatopulmonary syndrome (HPS).Methods From 2008 to 2013,420 adult patients underwent liver transplantation in our hospital.There were 91 patients with,and 329 patients without,HPS.The 5-year survival and mortality rates after OLT for the two groups were retrospectively analyzed.Results There were no significant differences between patients without and with HPS in age,primary disease,Child-Pugh score,MELD score,cold ischemia time and warm ischemia time.However,the differences on serum albumin [(29.6 ± 1.2) g/L vs.(26.4 ± 1.6) g/L] and blood oxygen pressure [(61.0 ±9.0) mmHg (1 mmHg =0.133 kPa) vs.(87.0 ± 6.0) mmHg] were significantly different (P ＜ 0.05).The 1-year cure rate was 65.9％ (60/91) in 91 patients with HPS after liver transplantation.The 1,3,5-year cumulative survival rates for patients without HPS were 97.3％,90.9％ and 80.3％,respectively,and the main causes of death were primary graft dysfunction,recurrent cardiovascular events and primary disease recurrence or tumors.The 1,3,5-year cumulative survival rates for patients with HPS were 65.9％,59.3％ and 56.0％,and the main causes of death were multiple-organ failure,pulmonary infection and cerebrovascular events.Kaplan-Meier survival curve analysis showed that the survival of patients with HPS was significantly lower than that of patients without HPS (P ＜ 0.05).Conclusions Liver transplantation is the most effective treatment for patients with HPS,but the short-term mortality rate is relatively high.We still need to learn more about HPS to improve the survival rate of patients with HPS after liver transplantation.

Objective To evaluate the efficacy and safety of sirolimus and tacrolimus after renal transplantation.Method PubMed,Web of knowledge,Medline and the Cochrane controlled trials register,Chinese Biomedicaldatabase,and Vip database were searched with the terms and Boolean operators as (kidney transplantation OR renal transplantation) AND (sirolimus OR rapamycin OR rapamune) AND (tacrolimus OR FK506 OR prograf).Results retrieved were updated on November,2015.Data were extracted for patient and graft mortality,acute rejection (AR),wound complications,infection,GFR,withdrawl.Professional meta analysis software RevMan 5.3 was employed.Result Altogether,1810 patients from 10 randomized controlled trials (RCTs) were included.Patients in the sirolimus group showed a decreased rate of graft mortality and infection (RR =0.63,95％ CI,0.45-0.89,P=0.009;RR=4.42,95％ CI,1.73-11.31,P=0.002).Patients in the sirolimus group showed an increased rate of AR,wound complications,GFR,withdrawl (SMD=-0.52,95％ CI,-0.73-0.31,P＜0.000 01;RR=0.54,95％ CI,0.40-0.73,P＜0.000 1;RR=0.17,95％ CI,0.11-0.25,P＜0.000 01;RR =0.44,95％ CI,0.37-0.51,P＜0.000 01).The patient mortality was insignificantly different between two groups.Conclusion This meta-analysis concluded that sirolimus showed advantage over tacrolimus about safety when used early after renal transplantation.The options of immunosuppressive regimens after kidney transplantation should be based on the specific condition.To obtain more reliable and accurate clinical data,the RCTs with more rational design,higher methodological quality,larger sample size,including domestic patients,longer follow-up are still needed.