To investigate the efficacy and safety of aromatase inhibitors (AI) combined with recombinant human growth hormone (r-hGH) in improving the final height (FH) of boys in late puberty.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Turning to critical illness is a common stage of various diseases and injuries before death. Patients usually have complex health conditions, while the treatment process involves a wide range of content, along with high requirements for doctor′s professionalism and multi-specialty teamwork, as well as a great demand for time-sensitive treatments. However, this is not matched with critical care professionals and the current state of medical care in China. Telemedicine, which shortens the distance of medical professionals and the gap of disease diagnosis and treatments in various regions through electronic information, can effectively solve the current problem. Therefore, there is an urgent need to develop a standardized, high-quality visualization telemedicine round system .Therefore, experts have been organized to search domestic and foreign literature on telemedicine round for critically ill patients and to form this consensus based on clinical experiences so as to further improve the level of critical care treatments in regions.

Objective To explore the prognostic value of serum interleukin-36(IL-36)family cyto-kines in patients with Guillain-Barre syndrome(GBS).Methods A retrospective trial was conduc-ted on 176 GBS patients admitted to our hospital from December 2020 to January 2023.According to their Hughes score at 6 months'follow-up,they were divided into good prognosis group(n=92)and poor prognosis group(n=84).Their general data were collected,and the levels of IL-36 family cytokines,such as IL-36α,IL-36β,IL-36γ and IL-36Ra were detected.Multivariate logistic regression analysis was employed to identify the influencing factors for poor prognosis of GBS patients,and ROC curve was plotted to analyze the predictive values of related factors.Results There were significant differences in age,injury types by electromyography(EMG),length of hospital stay and respiratory assisted ventilation between the two groups(P＜0.05,P＜0.01).The levels of IL-36α,IL-36β and IL-36γ were obviously higher while that of IL-36Ra was notably low-er in the poor prognosis group than the good prognosis group(P＜0.01).Multivariate logistic regression analysis showed that age,respiratory assisted ventilation,EMG injury types(myelin sheath and axon are damaged),and serum IL-36γ and IL-36Ra levels were independent influen-cing factors for poor prognosis of GBS patients(P＜0.05,P＜0.01).ROC curve analysis indicated that the AUC value of IL-36γ,IL-36Ra and their combination was 0.674(95％CI:0.599-0.742),0.862(95％CI:0.80 3-0.910)and 0.888(95％CI:0.832-0.931),respectively.Calibration positive curve analysis showed that the combined model of IL-36γ and IL-36Ra levels presented good con-sistency with the actual risk in predicting the risk of poor prognosis in GBS patients.Conclusion Age,respiratory assisted ventilation,EMG injury types(myelin sheath and axon are damaged),and IL-36γ and IL-36Ra levels are independently risk factors for poor prognosis of GBS patients.The combination of IL-36γ and IL-36Ra levels has a good predictive value for poor prognosis of GBS patients,and can be used as an effective indicator for the prediction.

Critical ultrasonography(CUS) is different from the traditional diagnostic ultrasound,the examiner and interpreter of the image are critical care medicine physicians.The core content of CUS is to evaluate the pathophysiological changes of organs and systems and etiology changes.With the idea of critical care medicine as the soul,it can integrate the above information and clinical information,bedside real-time diagnosis and titration treatment,and evaluate the therapeutic effect so as to improve the outcome.CUS is a traditional technique which is applied as a new application method.The consensus of experts on critical ultrasonography in China released in 2016 put forward consensus suggestions on the concept,implementation and application of CUS.It should be further emphasized that the accurate and objective assessment and implementation of CUS requires the standardization of ultrasound image acquisition and the need to establish a CUS procedure.At the same time,the standardized training for CUS accepted by critical care medicine physicians requires the application of technical specifications,and the establishment of technical specifications is the basis for the quality control and continuous improvement of CUS.Chinese Critical Ultrasound Study Group and Critical Hemodynamic Therapy Collabration Group,based on the rich experience of clinical practice in critical care and research,combined with the essence of CUS,to learn the traditional ultrasonic essence,established the clinical application technical specifications of CUS,including in five parts:basic view and relevant indicators to obtain in CUS;basic norms for viscera organ assessment and special assessment;standardized processes and systematic inspection programs;examples of CUS applications;CUS training and the application of qualification certification.The establishment of applied technology standard is helpful for standardized training and clinical correct implementation.It is helpful for clinical evaluation and correct guidance treatment,and is also helpful for quality control and continuous improvement of CUS application.

Objective:To optimize the extraction technology and evaluate antioxidant activity of total flavonoids from Hedyotis dif-fusa. Methods:The content of kaempferol was detected by an HPLC method,and spectrophotometry was used to detect the content of total flavonoids. Results: The optimum extraction conditions were investigated by orthogonal design with the extraction quantities of kaempferol and total flavonoids as the evaluation indices. The antioxidant activities of the extracts were detected based on the clearance of hydroxyl radical and DPPH·model. The optimum extraction conditions were as follows:10-fold amount of 80% methanol and with ultrasonic extraction for 15 min. The clearance rate of 1ml methanol extract for scavenging DPPH· and ·OH was 73.89% and 91.27%,respectively.Conclusion:The optimum technology is stable and feasible for the extraction of Hedyotis diffuse. The extract shows good in vitro antioxidant properties, which provides powerful reference for the future development of relevant antioxidant prod-ucts.

Objective To evaluate the detection competence of HbA2 and HbF in Guangxi medical laboratories.Methods The external quality assessment(EQA) of HbA2 and HbF was conducted twice a year and five samples was detected each time during 2012 to 2016.The laboratories participated in EQA completed the samples' detection and submitted the detection results at specified time according to the requirements of EQA.The distribution of each detection system,the qualification rate of each laboratory,the variation degrees of each detection system and each detection method,and the variations of results for different levels of quality control(QC) materials during 5 years were analyzed based on the returned results.Results The application of high performance liquid chromatography (HPLC) and capillary electrophoresis(CE) increased year by year and their usage rates in 2016 reached up to 46.1％ (82/178) and 18.0％ (32/178),respectively.The qualification rates of HbA2 and HbF increased from 51.5％ (34/66) and 60.6％ (40/66) in 2012 to 93.3％ (166/178) and 92.1％ (164/178) in 2016,respectively.The average coefficient of variation(CV) of each detection system decreased year by year.There were good CVs for the results of high,medium and low levels of HbA2 QC materials detected by the Bio-Rad Variant Ⅱ and Sebia CAPILLARYS 2 systems,and they were less than 6.0％.HPLC and CE could quantitatively detect the HbA2 and HbF levels,and their total detection competence was superior to that of agarose gel electrophoresis.Conclusion EQA can assess the abihty of one laboratory detecting HbA2 and HbF,and quantitatively analyze the levels of HbA2 and HbF,which may provide the quality assurance and data support for the screening and prevention of thalassemia.

Objective To determine the effect of unfractionated heparin (UFH) on lipopolysaccharide (LPS)-induced expression of chemokines and nuclear factor-κB (NF-κB) signaling pathway. Methods Human pulmonary microvascular endothelial cells (HPMECs) were cultured in vitro, and the cells between passages 3 and 5 were used in the experiments. The cells were divided into control group, LPS challenge group, 1 kU/L or 10 kU/L UFH+LPS group, and NF-κB inhibitor N-tosyl-L-lysyl chloromethyl-ketone (TLCK) group (TLCK+LPS group). HPMECs in LPS challenge group were treated with 10 mg/L LPS. UFH pretreatment with different dosages groups were treated with 1 kU/L or 10 kU/L UFH 15 minutes before LPS challenge. Cells in the TLCK+LPS group were treated with 10 μmol/L of TLCK 30 minutes before the addition of LPS, and HPMECs in control group were treated with an equal volume of phosphate-buffered saline (PBS) instead. The cells were harvested 1 hour after LPS challenge, and the nuclear translocation of NF-κB was determined by immunofluorescence assay to detect the effect of UFH on NF-κB activation. The levels of interleukin-8 (IL-8) and monocyte chemoattractant protein-1 (MCP-1) in cell culture supernatants were determined by enzyme linked immunosorbent assay (ELISA) 3 hours and 6 hours after LPS challenge to detect the effect of UFH on LPS induced expression of chemokines and its mechanism of effect on NF-κB signaling pathway in HPMECs. Results ① In the control group, NF-κB was mostly located in the cytosol as shown by immunofluorescence. Treatment of HPMECs with LPS significantly increased the translocation of NF-κB from the cytosol to nucleus. UFH suppressed LPS-induced NF-κB activation both in 1 kU/L and 10 kU/L dosages, and 10 kU/L UFH gave even better results. ② Compared with control group, the levels of IL-8 and MCP-1 in the supernatants in LPS challenge group were significantly increased at 3 hours and 6 hours after LPS challenge [IL-8 (ng/L): 387.1±26.4 vs. 23.8±8.1 at 3 hours, 645.5±69.6 vs. 125.7±18.7 at 6 hours; MCP-1 (ng/L): 3 654.9±467.9 vs. 721.6±61.3 at 3 hours, 8 178.5±792.6 vs. 1 324.7±148.7 at 6 hours, all P < 0.05]. Compared with that of LPS challenge group, in 1 kU/L and 10 kU/L UFH pretreatment groups, the levels of IL-8 and MCP-1 were significantly decreased [IL-8 (ng/L): 315.3±24.8, 275.8±31.1 vs. 387.1±26.4 at 3 hours, 557.8±43.3, 496.9±38.7 vs. 645.5±69.6 at 6 hours; MCP-1 (ng/L): 2 924.1±267.9, 2 668.3±522.6 vs. 3 654.9±467.9 at 3 hours, 7 121.7±557.2, 6 563.9±576.4 vs. 8 178.5±792.6 at 6 hours, all P < 0.05]. The results indicated that 10 kU/L UFH yielded better results. However, inhibition study using the known NF-κB inhibitor TLCK could decrease LPS-induced increase in IL-8 and MCP-1 levels [IL-8 (ng/L): 162.4±21.3 vs. 387.1±26.4 at 3 hours, 274.1±22.6 vs. 645.5±69.6 at 6 hours; MCP-1 (ng/L): 1 478.2±138.5 vs. 3 654.9±467.9 at 3 hours; 3 667.6±259.4 vs. 8 178.5±792.6 at 6 hours, all P < 0.05]. Conclusions The levels of IL-8 and MCP-1 were increased obviously in LPS treated HPMECs. UFH might suppress LPS-activated NF-κB signaling pathway, contributing to the inhibitory effects of chemokines in HPMECs.

Objective To investigate the protective effect of butylphthalide for focal cerebral ischemiareperfusion injury and its possible mechanism.Methods A total of 60 healthy and clean adult Sprague-Dawley rats were randomly divided into sham operation,saline control,low-dose butylphthalide and high-dose butylphthalide groups (n =15 in each group).A focal cerebral ischemia-reperfusion model was induced by the suture method.At the beginning of reperfusion,100 rng/kg and 400 mg/kg butylphthalide injection were injected intraperitoneally in the rats of the low-dose butylphthalide and high-dose butylphthalide groups; 0.5 ml/kg saline was injected intraperitoneally in rats of the sham operation and saline control groups.All the rats were sacrificed after 24 h of ischemia-reperfusion.Results The degree of neurological deficit in the low-dose butylphthalide (t =1.488,P =0.000) and high-dose butylphthalide (t =2.362,P =0.000) groups were significantly improved compared to the saline control group,in which the high-dose butylphthalide group was improved more significantly than the low-dose butylphthalide group (t =-0.873,P =0.000).The infarct volume in the low-dose butylphthalide (t =18.589,P =0.000) and high-dose butylphthalide (t =36.963,P =0.000) groups were reduced significantly compared to the saline control group,in which the infarct volume of the high-dose butylphthalide group was reduce more significantly than that of the low-dose butylphthalide group (t =-18.374,P =0.000).HE staining showed that neurons were sparse,there were a large number of degeneration and necrosis,cell space became larger,and the intercellular substances showed vacuolar changes.In the butylphthalide group,the neuronal degeneration and necrosis reduced significantly,the survival of nerve cells increased,and the improvement of the high-dose butylphthalide group was more remarkable.SOD activity of the low-dose and high-dose butylphthalide groups were increased significantly compared to the sham operation and saline control groups (all P ＜0.05),in which the SOD activity in the high-dose butylphthalide group was significantly higher than that in the low-mall dose butylphthalide group (t =80.199,P =0.000); The MDA levels in the low-dose and high-dose butylphthalide groups were decreased significantly compared to the sham operation and saline control groups (all P ＜ 0.05),in which the MDA level in the high-dose butylphthalide group was significantly lower than that in the low-dose butylphthalide group (t =-1.308,P=0.000).Conclusions The protective effect of butylphthalide on ischemia-reperfusion injury may be associated with the increased antioxidant activity.