OBJECTIVE: To summarize and analyze the characteristics of delayed hemolytic transfusion reaction in children, in order to provide a scientific basis for clinical prevention, and ensure the safety of children's blood transfusion. METHODS: The basic situation, clinical symptoms and signs, diagnosis time and disappearance time of alloantibody of delayed hemolytic transfusion reaction in children were retrospectively analyzed. The serological test, routine blood test, biochemical detection and urine analysis results were compared pre- and post-transfusion. RESULTS: Among 15 164 children with repeated blood transfusion, 23 cases occurred delayed hemolytic transfusion reactions, with an incidence rate of 0.15%, and mainly children with thalassemia and acute leukemia. 39.13% of delayed hemolytic reactions occurred in children with more than 20 times of blood transfusions. Anemia was the main clinical symptom in 86.96% of children. 4.35% of children had hypotension and dyspnea. Serological test results showed that the positive rate of direct antiglobulin test was 91.30%, and that of erythrocyte homologous antibody test was 100%. Erythrocyte alloantibodies were common in Rh and Kidd blood group systems, accounting for 73.91% and 13.04%, respectively. Laboratory test results showed that hemoglobin, reticulocyte, spherocyte, total bilirubin, indirect bilirubin, lactate dehydrogenase, serum ferritin and urine color were significantly different after transfusion compared with those before transfusion (all P <0.05). The average diagnosis time of delayed hemolytic transfusion reactions was 18.56 days, and the average disappearance time of erythrocyte alloantibodies was 118.43 days. CONCLUSION The incidence of delayed hemolytic transfusion reaction is high in children with repeated blood transfusion, and the disappearance time of erythrocyte homologous antibody is long. Blood matched ABO, Rh and Kidd blood group antigens should be transfused prophylactically. Once diagnosed, erythrocyte alloantibody corresponding to antigen-negative blood should be used throughout the whole process.
Humans ; Child ; Retrospective Studies ; Child, Preschool ; Transfusion Reaction ; Male ; Female ; Infant ; Adolescent ; Isoantibodies/blood* ; Blood Transfusion

OBJECTIVE: To evaluate the efficacy and safety of Shexiang Tongxin Dropping Pill (STDP) in treating stable angina patients with phlegm-heat and blood-stasis syndrome by exercise duration and metabolic equivalents. METHODS: This multicenter, randomized, double-blind, placebo-controlled clinical trial enrolled stable angina patients with phlegm-heat and blood-stasis syndrome from 22 hospitals. They were randomized 1:1 to STDP (35 mg/pill, 6 pills per day) or placebo for 56 days. The primary outcome was the exercise duration and metabolic equivalents (METs) assessed by the standard Bruce exercise treadmill test after 56 days of treatment. The secondary outcomes included the total angina symptom score, Chinese medicine (CM) symptom scores, Seattle Angina Questionnaire (SAQ) scores, changes in ST-T on electrocardiogram and adverse events (AEs). RESULTS: This trial enrolled 309 patients, including 155 and 154 in the STDP and placebo groups, respectively. STDP significantly prolonged exercise duration with an increase of 51.0 s, compared to a decrease of 12.0 s with placebo (change rate: -11.1% vs. 3.2%, P<0.01). The increase in METs was significantly greater in the STDP group than in the placebo group (change: -0.4 vs. 0.0, change rate: -5.0% vs. 0.0%, P<0.01). The improvement of total angina symptom scores (25.0% vs. 0.0%), CM symptom scores (38.7% vs. 11.8%), reduction of nitroglycerin consumption (100.0% vs. 11.3%), and all domains of SAQ, were significantly greater with STDP than placebo (all P<0.01). The changes in Q-T intervals at 28 and 56 days from baseline were similar between the two groups (both P>0.05). Twenty-five participants (16.3%) with STDP and 16 (10.5%) with placebo experienced AEs (P=0.131), with no serious AEs observed. CONCLUSION STDP could improve exercise tolerance in patients with stable angina and phlegm-heat and blood stasis syndrome, with a favorable safety profile. (Registration No. ChiCTR-IPR-15006020).
Humans ; Double-Blind Method ; Drugs, Chinese Herbal/adverse effects* ; Male ; Female ; Middle Aged ; Angina, Stable/physiopathology* ; Aged ; Syndrome ; Treatment Outcome ; Placebos ; Tablets

Research on the molecular mechanisms controlling circadian rhythm in Western medicine is comparable to the study of a day-night rhythm in Chinese medicine (CM), as also focus on the same life phenomenon. By comparing the two, this paper elaborates on the differences between them in their respective issues of consciousness, ways of thinking, research methods and research results. Relatively speaking, Nobel Prize research has a stronger sense of the problems and concerns about the essence of "what", while CM focuses on "how a thing functions". The former mainly adopts experimental and mathematical methods, while the latter primarily depends on observation and understanding. The natural philosophy and natural science eventually lead to the results and the inevitable, quantitative and qualitative differences. Research on the life rhythm in CM should be proposed, scientific problems should be fully grasped, and research should be carried out with the aid of multidisciplinary new knowledge and new achievements through cross-disciplinary studies. On the basis of clinical epidemiological research and experimental research, a systematic review should be made of the human physiology of CM and the pathological rhythm model to explore the regulatory mechanism of time rhythm and create a new theory of time medicine.

OBJECTIVE: To evaluate the safety and efficacy of endoscopic treatment for ureterovesical junction (UVJ) stenosis in patients with kidney transplantation. METHODS: A retrospective study was conducted among the patients with kidney transplantation diagnosed as UVJ stenosis from 2012 March to 2018 July in Urology and Lithotripsy Center, Peking University People's Hospital. Only the patients who received endoscopic treatment were included, with staged or same-session nephrostomy followed by a retrograde ureteroscopy to evaluate the ureteral stenosis. Incisions with laser, mono- or bipolar energy, or balloon dilation were used to manage the stenosis depending on different situations. Demographic characteristics and clinical data were gathered and analyzed, including age, gender, preoperative serum creatinine, hemoglobin, operation time, success rate, postoperative serum creatinine, hemoglobin, postoperative complications rate, and long-term stenosis recurrence rate. RESULTS: In this study, 13 patients were included (9 males and 4 females). All the UVJ stenoses were diagnosed with preoperative ultrasound, CT scan, MRI, or urethrography. The mean age was 45 years (range 34-57 years). The mean preoperative serum creatinine was 243 μmol/L. Four patients developed UVJ stenosis 1 month after kidney transplantation, while the rest developed long-term stenosis. Fifteen operations were performed in all, of which 14 cases were successful while one failed. The first 8 cases received first-stage nephrostomy and second-stage endoscopic management of the stenosis, while the last 7 cases received the same session surgery. The mean operation time was 95.4 min vs. 68.9 min, and the immediate success rate was 87.5% vs. 100.0% in the first 8 cases and last 7 cases, respectively. The mean decrease of postoperative hemoglobin was 0.6 g/L and mean postoperative serum creatinine was 105 μmol/L. No postoperative fever, severe hematuria, and urine leak were observed. The mean postoperative hospital stay was 2.8 days. Three patients were able to remove ureteral stents and no recurrence was found with a follow-up time of 9, 17, and 82 months. The long-term stenosis recurrence rate was 76.9% (10/13). CONCLUSION Endoscopic approach for the treatment of UVJ stenosis in patients with kidney transplantation was safe and efficient in our study cohort. However, long term stenosis recurrence rate was high and needed to be paid attention to.
Adult ; Female ; Humans ; Kidney Transplantation/adverse effects* ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Ureteral Obstruction/etiology* ; Ureteroscopy

Objective: To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in thoracoscopic dissection or combined segmentectomy. Methods: The clinical data of 30 patients with isolated or multiple pulmonary nodules from September 2017 to August 2019 were retrospectively analyzed. All cases were treated with 3D-CTBA to locate the nodules accurately before operations, in order to explicit the courses of bronchi and vessels, and to observe the variations. The target bronchi, arteries and veins were resected accurately during the operations, and the intersegmental plane was determined by expansion-collapse method. Results: 13 patients underwent segmentectomy and 17 patients underwent combined segmentectomy. The diameter of the nodule was (11.56±3.79)mm; the depth of the nodule (the shortest distance from the visceral pleura) was (13.88±3.96)mm; the operation time was (134.94±18.68)min, and the intraoperative bleeding volume was (94.38±37.94)ml. No cancer metastasis was found by rapid pathological examination of lymph nodes during operations. No conversion to thoracotomy. The indwelling time of thoracic tube was (3.69±1.30)days, and the hospitalization days after operations was (4.81±1.47)days. No serious complications or death during the perioperative period. Conclusions Preoperative 3D-CTBA has advantages in pulmonary segmentectomy, which is a safe and effective method for accurate segmentectomy.

Objective To investigate the biological characteristics of the praziquantel-resistant isolate of Schistosoma japoni-cum in mice,so as to explore the pathogenicity to definitive hosts and transmission intensity of the praziquantel-resistant isolate of S. japonicum. Methods Mice were infected with the cercariae released from two praziquantel-resistant isolates and two pra-ziquantel-susceptible isolates of S. japonicum. The mouse-Oncomelania hupensis snail-mouse cycle was established and main- tained in the laboratory. The prepatent period of parasite eggs,egg production,egg distribution in mice,parasite susceptibility to mice and egg size were investigated in each parasite isolate. Results The prepatent period of parasite eggs,egg counts in mouse feces,adult worms recovered from each mouse,egg counts in mouse tissues,egg counts in the mouse liver,and egg counts in intestine tissues were 36.1 d and 36.8 d ( t=0.907, P=0.372 ) , 14.6 / 100 mg and 21.2 / 100 mg (t=2.946, P=0.007),20.5 and 25.1 worms per mouse(t=2.128, P=0.042),31303 and 38594 per paired adult worm(t=2.185, P=0.04),14810 and 19715 per paired adult worm(t=2.934, P=0.007),and 16493 and 18879 per paired adult worm(t=1.044, P=0.309)in the mice infected with Jiangsu praziquantel-susceptible and-resistant isolates of S. japonicum, respectively,and there were no significant differences between Jiangsu praziquantel-susceptible and-resistant isolates of S. ja-ponicum in the length of paired adult worms(t=0.328, P=0.744),female adult worms(t=0.386, P=0.701)or male adult worms(t=0.332, P=0.741). The prepatent period of parasite eggs,egg counts in mouse feces,adult worms recovered from each mouse,egg counts in mouse tissues,egg counts in the mouse liver,and egg counts in intestine tissues were 35.5 d and 35.6 d(t=0.169, P=0.867),13.3/100 mg and 18.9/100 mg(t=3.622, P=0.001),17.6 and 25.1 worms per mouse(t=3.153, P=0.004),30932 and 53903 per paired adult worm(t=3.865, P=0.001),12307 and 26363 per paired adult worm (t=4.388, P<0.01),and 18625 and 27541 per paired adult worm(t=2.679, P=0.012)in the mice infected with Hunan praziquantel-susceptible and-resistant isolates of S. japonicum,respectively,and there were no significant differences between Hunan praziquantel - susceptible and - resistant isolates of S. japonicum in the length of paired adult worms (t=0.853, P=0.397),female adult worms(t=0.573, P=0.569)or male adult worms(t=0.742, P=0.461). Conclusions The praziquantel-resistant isolate of S. japonicum has a higher parasite egg production and more eggs deposited in the mouse liver than drug-susceptible isolate,suggesting that the praziquantel-resistant isolate of S. japonicum exhibits a greater pathogenicity to definitive hosts. In addition,more parasite eggs are detected in the feces of mice infected with the praziquantel-resistant isolate of S. japonicum relative to the drug-susceptible isolate,indicating that the praziquantel-resistant isolate of S. japonicum exhibits a greater transmissibility than the drug-susceptible isolate.

Objective To investigate the difference of biological characteristics between the praziquantel-resistant and-sus-ceptible isolates of Schistosoma japonicum in intermediate host Oncomelania hupensis snails. Methods Mice were infected with cercariae of praziquantel-resistant and-susceptible isolates of S. japonicum,and the parasite eggs were collected 37 days post-in-fection to hatch miracidium. Then,the snails were infected with the miracidium of each parasite isolate. The snail infection,sur-vival rate of infected snails,prepatent period of cercariae,and the total number of cercariae shed from each infected snail were observed and compared between the praziquantel-resistant and-susceptible isolates of S. japonicum. Results If each snail was exposed to a single miracidium,there were significant differences between the praziquantel-resistant and-susceptible Jiangsu isolates in the snail infection(8.99％vs. 19.74％;χ2=3.948,P=0.047)and the number of cercaria released from a single snail (1460.2 vs. 1039.3;t=2.507,P=0.02),and there were significant differences between the praziquantel-susceptible and-re-sistant Hunan isolates in the snail infection(10.00％vs. 21.52％;χ2=3.980,P=0.046)and the number of cercaria released from a single snail(1319.4 vs. 1003.5;t=2.566,P=0.017). However,there were no significant differences between the pra-ziquantel-resistant and-susceptible isolates of S. japonicum in the prepatent period of cercariae and the survival rate of infected snails(P>0.05). Conclusion The praziquantel-resistant isolate of S. japonicum has a higher susceptibility to O. hupensis but less cercaria released from each infected snail than the susceptible isolate.

BACKGROUND: The present study aimed to determine the short-term and long-term outcomes of critically ill patients with acute respiratory insufficiency who had received sedation or no sedation. METHODS: The data of 91 patients who had received mechanical ventilation in the first 24 hours between November 2008 and October 2009 were retrospectively analyzed. These patients were divided into two groups: a sedation group (n=28) and a non-sedation group (n=63). The patients were also grouped in two groups: deep sedation group and daily interruption and /or light sedation group. RESULTS: Overall, the 91 patients who had received ventilation ≥48 hours were analyzed. Multivariate analysis demonstrated two independent risk factors for in-hospital death: sequential organ failure assessment score (P=0.019, RR 1.355, 95％CI 1.051–1.747, B=0.304, SE=0.130, Wald=50483) and sedation (P=0.041, RR 5.015, 95％CI 1.072–23.459, B=1.612, SE=0.787, Wald=4.195). Compared with the patients who had received no sedation, those who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and hospital, and an increased in-hospital mortality rate. The Kaplan-Meier method showed that patients who had received sedation had a lower 60-month survival rate than those who had received no sedation (76.7％ vs. 88.9％, Log-rank test=3.630, P=0.057). Compared with the patients who had received deep sedation, those who had received daily interruption or light sedation showed a decreased in-hospital mortality rate (57.1％ vs. 9.5％, P=0.008). The 60-month survival of the patients who had received deep sedation was significantly lower than that of those who had daily interruption or light sedation (38.1％vs. 90.5％, Log-rank test=6.783, P=0.009). CONCLUSIONS: Sedation was associated with in-hospital death. The patients who had received sedation had a longer duration of ventilation, a longer stay in intensive care unit and in hospital, and an increased in-hospital mortality rate compared with the patients who did not receive sedation. Compared with daily interruption or light sedation, deep sedation increased the in-hospital mortality and decreased the 60-month survival for patients who had received sedation.

Stellate ganglion blockade (SGB) protects patients from focal cerebral ischemic injury, and transection of the cervical sympathetic trunk (TCST) in a rat model can mimic SGB in humans. The purpose of this study was to investigate the mechanisms underlying the neuroprotective effects of TCST on neuronal damage in the hippocampus in a rat model of middle cerebral artery occlusion (MCAO) in an attempt to elucidate the neuroprotective effects of SGB. The modified method of Zea Longa was used to establish the permanent MCAO model. Male Wistar rats were randomly divided into three groups: sham-operated group, MCAO group, and TCST group. The animals in TCST group were sacrificed 48 h after TCST which was performed after the establishment of the MCAO model. Proteins were extracted from the ipsilateral hippocampus and analyzed by two-dimensional difference gel electrophoresis (2D-DIGE) and peptide mass fingerprinting (PMF). The levels of N-ethylmaleimide-sensitive factor (NSF) were measured as well. The results showed that 11 types of proteins were identified by 2D-DIGE. The expressions of eight proteins were changed both in the sham-operated and TCST groups, and the expressions of the other three proteins were changed in all three groups. Moreover, the expression of NSF was higher in the TCST group than in the MCAO group but lower in the MCAO group than in sham-operated group. The ratio of NSF expression between the MCAO group and shamoperated group was -1.37 (P<0.05), whereas that between the TCST group and MCAO group was 1.35 (P<0.05). Our results imply that TCST increases the expression of NSF in the hippocampus of adult rats with focal cerebral ischemia, which may contribute to the protection of the injured brain. Our study provides a theoretical basis for the therapeutic application of SGB to patients with permanent cerebral ischemia.
Animals ; Brain Injuries ; genetics ; metabolism ; pathology ; Brain Ischemia ; genetics ; metabolism ; pathology ; Gene Expression Regulation ; Hippocampus ; metabolism ; pathology ; Male ; N-Ethylmaleimide-Sensitive Proteins ; biosynthesis ; genetics ; Rats ; Rats, Wistar ; Stellate Ganglion ; metabolism ; pathology ; Transfection

OBJECTIVETo investigate Chinese medical features of acquired immunodeficiency syndrome (AIDS) patients with pulmonary infection.

METHODSUsing cluster analysis method, Chinese medical syndromes of 196 AIDS patients with pulmonary infection were analyzed. The distribution features of each syndrome type were analyzed according to the severity and CD4+ numerical analysis.

RESULTSBasic Chinese medical syndrome types could be summed up as three kinds: exterior invasion of wind heat and phlegm heat obstructing Fei syndrome (61 cases, 31.1%), Fei-Pi deficiency and Fei stagnation of phlegm syndrome (64 cases, 32.7%), Fei-Shen deficiency and yin deficiency induced inner heat syndrome (71 cases, 36.2%). There was statistical difference in the severity degree and the distribution of CD4 among the three syndrome types (P < 0.05).

CONCLUSIONSAIDS patients with pulmonary infection involve Fei, Shen, and Pi. The pathogenic factors were related to "wind", "heat", "phlegm", and "xu". The Chinese medical syndrome distribution was closely correlated with patients' immunity.

Acquired Immunodeficiency Syndrome ; complications ; diagnosis ; epidemiology ; Adolescent ; Adult ; Aged ; Cluster Analysis ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Respiratory Tract Infections ; diagnosis ; epidemiology ; etiology ; Yang Deficiency ; diagnosis ; Yin Deficiency ; diagnosis ; Young Adult