Objective:To observe the effects of 12.5% carbohydrate (CHO) solution and medium chain triglycerides (MCT) solutions at various concentrations on gastric emptying, in order to determine the optimal MCT-CHO combination for enhanced recovery after surgery.Methods:This study was a prospective study. Ten healthy volunteers were selected to ingest 400 ml of the following 5 solutions every day: water, 12.5% CHO, 1% MCT, 2% MCT and 4% MCT. According to the above results, the optimal concentration of MCT solution was 2% MCT, showing comparable gastric emptying rate compared with 12.5% CHO solution. On this basis, combinations of MCT and CHO solutions were determined to be 30 energy % (EN%) MCT+70 EN% CHO and 20 EN% MCT+80 EN% CHO according to the energy distribution ratio. Then the volunteers were given 400 ml of the following 4 solutions every day: 12.5% CHO, 2% MCT, 30 EN% MCT+70 EN% CHO (equivalent to 2% MCT+8% CHO), and 20 EN% MCT+80 EN% CHO (equivalent to 4.4% MCT+10% CHO). Gastric emptying during fasting (T m) and immediately (T 1), 30 min (T 2), 60 min (T 3), 90 min (T 4) and 120 min after ingestion (T 5) were observed by antral ultrasonography. The degree of thirst, hunger, and anxiety was assessed by Visual Analogue Scale, and the taste was rated. Results:The gastric emptying rate in descending order was 20%EN MCT+80%EN CHO group>30%EN MCT+70%EN CHO group≈2％MCT group≈12.5%CHO group. There was no significant difference in gastric emptying rate between 30 EN% MCT+70 EN% CHO group and 12.5% CHO group ( P>0.05). The scores of thirst, hunger and anxiety in 30 EN% MCT+70 EN% CHO group at T 1 to T 5 were significantly lower than those at T m ( P<0.05). 30 EN% MCT+70 EN% CHO group showed the highest taste score. Conclusion:30 EN% MCT+70 EN% CHO solution has similar gastric emptying rate compared with 12.5% CHO solution. It can relieve thirst, hunger, anxiety and other subjective feelings caused by fasting, with tastes better than 12.5% CHO solution.

Objective:To observe the effects of 12.5% carbohydrate (CHO) solution and medium chain triglycerides (MCT) solutions at various concentrations on gastric emptying, in order to determine the optimal MCT-CHO combination for enhanced recovery after surgery.Methods:This study was a prospective study. Ten healthy volunteers were selected to ingest 400 ml of the following 5 solutions every day: water, 12.5% CHO, 1% MCT, 2% MCT and 4% MCT. According to the above results, the optimal concentration of MCT solution was 2% MCT, showing comparable gastric emptying rate compared with 12.5% CHO solution. On this basis, combinations of MCT and CHO solutions were determined to be 30 energy % (EN%) MCT+70 EN% CHO and 20 EN% MCT+80 EN% CHO according to the energy distribution ratio. Then the volunteers were given 400 ml of the following 4 solutions every day: 12.5% CHO, 2% MCT, 30 EN% MCT+70 EN% CHO (equivalent to 2% MCT+8% CHO), and 20 EN% MCT+80 EN% CHO (equivalent to 4.4% MCT+10% CHO). Gastric emptying during fasting (T m) and immediately (T 1), 30 min (T 2), 60 min (T 3), 90 min (T 4) and 120 min after ingestion (T 5) were observed by antral ultrasonography. The degree of thirst, hunger, and anxiety was assessed by Visual Analogue Scale, and the taste was rated. Results:The gastric emptying rate in descending order was 20%EN MCT+80%EN CHO group>30%EN MCT+70%EN CHO group≈2％MCT group≈12.5%CHO group. There was no significant difference in gastric emptying rate between 30 EN% MCT+70 EN% CHO group and 12.5% CHO group ( P>0.05). The scores of thirst, hunger and anxiety in 30 EN% MCT+70 EN% CHO group at T 1 to T 5 were significantly lower than those at T m ( P<0.05). 30 EN% MCT+70 EN% CHO group showed the highest taste score. Conclusion:30 EN% MCT+70 EN% CHO solution has similar gastric emptying rate compared with 12.5% CHO solution. It can relieve thirst, hunger, anxiety and other subjective feelings caused by fasting, with tastes better than 12.5% CHO solution.

Objective:To compare and analyze the clinical features of patients with severe coronavirus disease 2019 (sCOVID-19) and severe community acquired pneumonia (sCAP) who meet the diagnostic criteria for severe pneumonia of the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS).Methods:A retrospective comparative analysis of the clinical records of 116 patients with sCOVID-19 admitted to the department of critical care medicine of Wuhan Third Hospital from January 1, 2020 to March 31, 2020 and 135 patients with sCAP admitted to the department of critical care medicine of Shanghai First People's Hospital from January 1, 2010 to December 31, 2017 was conducted. The basic information, diagnosis and comorbidities, laboratory data, etiology and imaging results, treatment, prognosis and outcome of the patients were collected. The differences in clinical data between sCOVID-19 and sCAP patients were compared, and the risk factors of death were analyzed.Results:The 28-day mortality of sCOVID-19 and sCAP patients were 50.9% (59/116) and 37.0% (50/135), respectively. The proportion of arterial partial pressure of oxygen/fraction of inspired oxygen (PaO 2/FiO 2)≤250 mmHg (1 mmHg ≈ 0.133 kPa) in sCOVID-19 patients was significantly higher than that of sCAP [62.1% (72/116) vs. 34.8% (47/135), P < 0.01]. The possible reason was that the proportion of multiple lung lobe infiltration in sCOVID-19 was significantly higher than that caused by sCAP [94.0% (109/116) vs. 40.0% (54/135), P < 0.01], but the proportion of sCOVID-19 patients requiring mechanical ventilation was significantly lower than that of sCAP [45.7% (53/116) vs. 60.0% (81/135), P < 0.05]. Further analysis of clinical indicators related to patient death found that for sCOVID-19 patients PaO 2/FiO 2, white blood cell count (WBC), neutrophils (NEU), neutrophil percentage (NEU%), neutrophil/lymphocyte ratio (NLR), total bilirubin (TBil), blood urea nitrogen (BUN), albumin (ALB), Ca 2+, prothrombin time (PT), D-dimer, C-reactive protein (CRP) and other indicators were significantly different between the death group and the survival group, in addition, the proportion of receiving mechanical ventilation, gamma globulin, steroid hormones and fluid resuscitation in death group were higher than survival group. Logistic regression analysis showed that the need for mechanical ventilation, NLR > 10, TBil > 10 μmol/L, lactate dehydrogenase (LDH) > 250 U/L were risk factors for death at 28 days. For sCAP patients, there were significant differences in age, BUN, ALB, blood glucose (GLU), Ca 2+ and D-dimer between the death group and the survival group, but there was no significant difference in treatment. Logistic regression analysis showed that BUN > 7.14 mmol/L and ALB < 30 g/L were risk factors for 28-day death of sCAP patients. Conclusions:The sCOVID-19 patients in this cohort have worse oxygen condition and symptoms than sCAP patients, which may be due to the high proportion of lesions involving the lungs. The indicators of the difference between the death group and the survival group were similar in sCOVID-19 and sCAP patients. It is suggested that the two diseases have similar effects on renal function, nutritional status and coagulation function. But there were still differences in risk factors affecting survival. It may be that sCOVID-19 has a greater impact on lung oxygenation function, inflammatory cascade response, and liver function, while sCAP has a greater impact on renal function and nutritional status.

Objective:To evaluate the effect of thymosin alpha 1 on the prognosis of patients with coronavirus disease 2019 (COVID-19).Methods:A retrospective cohort study was performed to collect clinical data of 95 patients treated by Shanghai Aid Medical Team in Wuhan Third Hospital during January 31, 2020 and March 4, 2020, who were confirmed COVID-19. They were divided into two groups according to whether they were treated with thymosin alpha 1 after admission. The 28-day mortality (primary outcome), and 28-ventilator-free-day, lymphocyte count (LYM) level, C-reactive protein (CRP) level (secondary outcomes) were compared between two groups. Survival analysis was performed using the Kaplan-Meier curve. The effect of thymosin alpha 1 on 28-day survival was evaluated with Cox regression model.Results:Among the 95 patients, there were 31 cases in thymosin group and 64 cases in non-thymosin group; 29 patients died 28 days after admission, including 11 cases (35.5%) in thymosin group and 18 cases (28.1%) in non-thymosin group. Kaplan-Meier survival curve showed that thymosin alpha 1 could improve the 28-day survival of patients with COVID-19, but the univariate Cox model analysis showed that the difference was not statistically significant [hazard ratio ( HR) = 0.48, 95% confidence interval (95% CI) was 0.20-1.14, P = 0.098]; multivariate Cox model analysis showed that thymosin alpha 1 was the factor to improve the 28-day mortality ( HR = 0.15, 95% CI was 0.04-0.55, P = 0.004), old age ( HR = 1.10, 95% CI was 1.05-1.15, P < 0.001), accompanied by chronic renal dysfunction ( HR = 42.35, 95% CI was 2.77-648.64, P = 0.007), decrease of LYM at admission ( HR = 0.15, 95% CI was 0.04-0.60, P = 0.007) and the use of methylprednisolone ( HR = 4.59, 95% CI was 1.26-16.67, P = 0.021) were also risk factors for the increase of 28-day mortality. The use of immunoglobulin and antiviral drugs abidol and ganciclovir did not affect the 28-day mortality. After adjustment for age, gender, LYM and other factors, weighted multivariate Cox analysis model showed thymosin alpha 1 could significantly improve the 28-day survival of COVID-19 patients ( HR = 0.45, 95% CI was 0.25-0.84, P = 0.012). In terms of secondary outcomes, no statistical difference (all P > 0.05) was found between two groups in days without ventilator at 28 days after admission (days: 17.97±13.56 vs. 20.09±12.67) and the increase of LYM at 7 days after admission [×10 9/L: -0.07 (-0.23, 0.43) vs. 0.12 (-0.54, 0.41)]. But the decrease of CRP at 7 days after admission in thymosin alpha group was significantly greater than that in non-thymosin group [mg/L: 39.99 (8.44, 82.22) vs. 0.53 (-7.78, 22.93), P < 0.05]. Conclusion:Thymosin alpha 1 may improve 28-day mortality and inflammation state in COVID-19 patients.

Vaccines have made great contributions to the prevention of infectious diseases, but vaccine hesitancy is widespread in the world. The reasons for vaccine hesitancy are complex, but the main reasons are the lack of public awareness of vaccine-preventable diseases and the lack of confidence in vaccine effectiveness and safety. In the context of the continuous spread of the coronavirus disease 2019 (COVID-19) epidemic, boosting public confidence and ensuring the orderly development of the vaccination work of COVID-19 vaccines and conventional vaccines are necessary to curb the resurgence of the COVID-19 epidemic and prevent the outbreak of various infectious diseases in China. Under the current situation, the main measures to deal with vaccine hesitancy are to play the role of health care institutions, improve public health literacy, normalize the public opinion orientation of the media platform, strengthen the supervision of vaccine clinical research and production, and do a good job in surveillance and compensation for adverse events following immunization.

Vaccines have made great contributions to the prevention of infectious diseases, but vaccine hesitancy is widespread in the world. The reasons for vaccine hesitancy are complex, but the main reasons are the lack of public awareness of vaccine-preventable diseases and the lack of confidence in vaccine effectiveness and safety. In the context of the continuous spread of the coronavirus disease 2019 (COVID-19) epidemic, boosting public confidence and ensuring the orderly development of the vaccination work of COVID-19 vaccines and conventional vaccines are necessary to curb the resurgence of the COVID-19 epidemic and prevent the outbreak of various infectious diseases in China. Under the current situation, the main measures to deal with vaccine hesitancy are to play the role of health care institutions, improve public health literacy, normalize the public opinion orientation of the media platform, strengthen the supervision of vaccine clinical research and production, and do a good job in surveillance and compensation for adverse events following immunization.

Objective:To explore the effect of KCa3.1 activating NLRP3 inflammasome in paraquat PQ treated-alveolar epithelial cells.Methods:The A549 cells were cultured in vitro and divided into the control group, TRAM-34 (specific inhibitor of KCa3.1) group, PQ group and PQ+TRAM-34 group. The expression of KCa3.1 was detected by immunofluorescence in A549 cells. Western blot was used to detect the level of the proteins related with the NLRP3 infammasome and NEK7 protein. And the level of cell potassium was detected by cell potassium concentration kit.Results:The level of KCa3.1 was significantly increased in A549 cells after PQ treatment by immunofluorescence. The expressions of NLRP3 infammasome-related proteins (NLRP3, ASC and Caspase-1) and NEK7 protein were increased after PQ treatment, and the expressions of NLRP3 infammasome-related proteins and NEK7 protein were decreased after inhibition of KCa3.1, and the difference was statistically significant [NLRP3/β-actin (control group vs TRAM-34 group vs PQ group vs PQ+TRAM-34 group): [ (0.02±0.00) vs (0.03±0.00) vs (0.74±0.00) vs (0.32±0.01) , ASC/β-actin (control group vs TRAM-34 group vs PQ group vs PQ+TRAM-34 group): [ (0.12±0.01) vs (0.11±0.03) vs (0.46±0.02) vs (0.17±0.03) ];Caspase-1/ β-actin (control group vs TRAM-34 group vs PQ group vs PQ+TRAM-34 group): [ (0.05±0.00) vs (0.04±0.00) vs (0.34±0.03) vs (0.15±0.01) ]; NEK7/ β-actin (control group vs PQ group vs PQ+TRAM-34 group);[ (0.38±0.03) vs (0.83±0.02) vs (0.51±0.01) , P<0.01]. The potassium level was decreased after PQ treatment and the degree could be declined by the KCa3.1 inhibitor by colorimetric detection with statistically significant difference (control group vs PQ group vs PQ+TRAM-34 group:[ (1.00±0.00) vs (0.60±0.05) vs (0.86±0.02) , P<0.01]. Conclusions:The KCa3.1 could promote the outflow of intracellular potassium and up-regulate the expression of NEK7, thereby activate the NLRP3 inflammatory in PQ-induced pulmonary fibrosis.

Objective To explore the regional reference intervals of biomarkers in umbilical blood for diagnosis of early onset bacterial infection in the healthy term newborns .Methods The umbilical blood samples were collected from 1 476 term newborns in our hospital during January 2012 to October 2013 ,of which 1 191 were healthy infants and enrolled in this study .Then the levels of high sensitive c‐reaction protein(hs‐CRP) ,procalcitonin(PCT) ,interleukin(IL)‐6 ,IL‐8 ,platelet(PLT) as well as white blood cell (WBC) were detected in the umbilical blood .These values were analyzed by SAS 9 .0 ,data were described through upper or lower limits or upper limits respectively .Differences among different subgroups were judged through analysis of Kruskal‐Wallis t test or Mann‐Whitney test respectively .Results The upper limits for hs‐CRP was 3 .1 mg/L ,for PCT was 0 .18 ng/mL ,while the refer‐ence interval for IL‐6 was 56 .6(11 .9-133 .2)ng/L ,and IL 8 was 976 .0(111 .7-2 507 .1)ng/L ,PLT was 242 .0(120 .0-339 .0)× 109/L and for WBC was 12 .9(7 .6-19 .3 )× 10 9/L ,and the value of PLT varied from vaginal delivery group to caesarean section group(230 vs .254 ,Z= 4 .301 ,P< 0 .05);no significant differences were found in these biomarkers among different gestational week specific groups (P>0 .05) .Otherwise ,compared with the regional reference intervals ,CRP and PCT in early onset neonatal sepsis group increased(P<0 .05) ,no significant difference was found for IL‐6 ,IL‐8 ,WBC and PLT (P>0 .05) .Conclusion The reference intervals of biomarkers in umbilical blood for diagnosis of early onset bacterial infection were established which may make great contribution for early diagnosis of bacterial infection for the newborns .

Objective To discuss the relationship of drip velocity of nitrate on blood pressure while treating coronary disease,in order to provide appropriate drip velocity for clinical treatment.Methods 155 patients with coronary disease using nitrate to lower blood pressure were selected.They were divided into the nitro glycerin group(85 cases) and the isosorbide mononitrate group( 70 cases) according to difference of medication.The velocity of drugs was adjusted on basis of blood pressure changes.The blood pressure changes at different drip velocities were observed and compared.Results The systolic pressure and the diastolic pressure between two groups showed no difference at 20 drops/min,but the results were the opposite at 30 drops/min.The systolic pressure and the diastolic pressure in the nitro glycerin group showed evident changes at different drip velocities,but in the isosorbide mononitrate group,these changes were not so significant.9 patients in the nitro glycerin group had headache during treatment,no headache occurred in the isosorbide mononitrate group.Conclusions Intravenous use of nitrate at a velocity of 20 drops/min is relative secure.The risk of hypotension will increase if the medication speed increases.lsosorbide mononitrate has little influence on blood pressure.

ObjectiveTo explore the influences of Penehyclidine Hydrochloride on [ Ca2 + ] i and the expression of cysteine-containing aspartate-specific proteases-3 (Caspase-3) in neural cells of neonatal rats after hypoxic-ischemic injury within 12 h.MethodsSeven-day-old Sprage-Dowley rats ( n =128) were randomly assigned into four groups:Sham group ( sham operation group,n =32),hypoxic-ischemic encephalopathy (HIE) group ( HIE models,n =32 ),N group ( HIE models treated with Nimodipine,n =32 ),and P group (HIE models treated with Penehyclidine Hydrocloride,n =32).Brain tissues were collected at different time points (2 h,4 h,6 h,and 12 h) after modeling.We utilized fluorescent microscope to detect the expression of Caspase-3 via making frozen slices of rat brain tissue,while [ Ca2+ ]iof neural cells in live brain slices of rats was measured by laser scanning confocal microscope.ResultsCompared with Sham group,both [ Ca2 + ] i and the expression of Caspase-3 of neural cells increased significantly ( P ＜ 0.01 ) in brain cortex in HIE group.[ Ca2 + ] i and Caspase-3 activity increased gradually with time since 2 h after making HIE models and reached a peak at the time points of 12 h ( P ＜0.05).In N group and P group,both of [ Ca2+ ]i and Caspase-3 decreased compared with HIE group (P ＜0.01 ),however,there was no significant difference between N group and P group ( P ＞ 0.05 ).In addition,[ Ca2 + ] i and Caspase-3 activity had no significant difference between 6 h and 12 h (P ＞ 0.05 ).ConclusionPenehyclidine Hydrocloride can protect the brain tissue from hypoxic-ischemic injury via relief of calcium overload and inhibition of Caspase-3 activity.