Objective:To observe the efficacy of external diaphragm pacing (EDP) combined with recombinant human growth hormone (rhGH) in the treatment of severe chronic obstructive pulmonary disease (CDOP).Methods:By the prospective study method, 80 patients with severe COPD were admitted to the Xianju People′s Hospital(Zhejiang Southeast Campus of Zhejiang Provincial People′s Hospital)/Xianju Hospital Affiliated to Hangzhou Medical College from April 2021 to April 2023 were divided into the combined group and the conventional group by the random number table method, with 40 cases in each group. All of them received anti-infection, nutritional support, and other conventional treatment. In addition, the combined group was given EDP+rhGH treatment, and they were intervened for 20 d. The diaphragm function, nutrition, pulmonary function, and serum levels of interleukin (IL-6), IL-23, type Ⅱ alveolar cell surface antigen (KL-6) changes before and after treatment and prognosis were compared between the two groups.Results:After treatment, the diaphragm function index diaphragm maximum expiratory pressure (MIP), diaphragm thickness (DTei), and diaphragm mobility (DE) in the combined group were higher than those in the conventional group: (45.36 ± 7.04) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (42.28 ± 6.43) cmH 2O, (0.32 ± 0.12) cm vs. (0.27 ± 0.06) cm, (3.40 ± 1.02) cm vs. (1.85 ± 0.64) cm, there were statistical differences ( P<0.05). After treatment, the nutritional status indexes of serum albumin (ALB), transferrin (Tf), and total protein (TP) in the combined group were higher than those in the conventional group: (34.62 ± 5.13) g/L vs. (31.75 ± 4.93) g/L, (2.21 ± 0.46) g/L vs. (2.00 ± 0.42) g/L, (63.80 ± 8.25) g/L vs. (60.24 ± 6.97) g/L, there were statistical differences ( P<0.05). After treatment, the percentage of forced expiratory volume in the first second (FEV 1) to the expected value (FEV 1%) and the ratio of FEV 1 to forced vital capacity (FEV 1/FVC) in the combined group were higher than those in the conventional group: (60.17 ± 6.30)% vs. (57.25 ± 6.24)%, (61.30 ± 7.04)% vs. (57.12 ± 7.25)%, there were statistical differences ( P<0.05). After treatment, the levels of IL-6, IL-23, and KL-6 in the combined group were lower than those in the conventional group: (23.13 ± 4.26) ng/L vs. (26.60 ± 4.75) ng/L, (20.84 ± 6.16) μg/L vs. (25.00 ± 5.89) μg/L, (375.10 ± 45.18) kU/L vs. (400.25 ± 46.27) kU/L, there were statistical differences ( P<0.05). The mechanical ventilation time and intensive care unit stay time in the combined group were shorter than those in the conventional group: (150.46 ± 10.24) h vs. (189.67 ± 15.43) h, (7.00 ± 2.03) d vs. (9.84 ± 2.72) d, there were statistical differences ( P<0.05). The rate of extubation within 1 week in the combined group was higher than that in the conventional group, and the 28-day mortality was lower than that in the conventional group: 90.00%(36/40) vs. 72.50%(29/40), 5.00%(2/40) vs. 22.50%(9/40), there were statistical differences ( χ2 = 4.02, 5.16, P<0.05). Conclusions:In the patients with severe COPD, EDP combined with rhGH can significantly improve the diaphragm function, nutritional status, and lung function, decrease serum IL-6, IL-23, and KL-6 levels, shorten the mechanical ventilation time, and reduce the 28-day mortality.

Objective To assess the accuracy and consistency of point-of-care testing(POCT)technology in detecting D-dimer(DDI),Procalcitonin(PCT),and N-terminal pro B-type natriuretic peptide(NT-proBNP)in whole blood samples,as well as to validate its feasibility for rapid clinical diagnosis.Methods From July 8 to August 22,2022,a total of 104 paired DDI whole blood and plasma samples,496 paired PCT whole blood and serum samples,and 77 paired NT-proBNP whole blood and serum samples were collected.The consistency and accuracy of test results between whole blood and plasma/serum samples were assessed using the Mann-Whitney U test,regression analysis,relative sensitivity,relative specificity,Youden's index,and Kappa value.Results The test results of DDI,PCT,and NT-proBNP in whole blood and plasma/serum samples demonstrated excellent consistency,with correlation coefficients of r2=0.951 2,r2=0.942 8,and r2=0.991 6,respectively,and all P-values exceeding 0.05.At the medical decision levels,for DDI(0.55 μg/mL),the relative sensitivity,rela-tive specificity,Youden index,and Kappa value were 94.3%,94.1%,0.88,and 0.87,respectively.For PCT(0.5 ng/mL and 2.0 ng/mL),the relative sensitivities were 97.4%and 89.0%,the relative specificities were 95.8%and 98.3%,the Youden indices were 0.93 and 0.87,and the Kappa values were 0.93 and 0.89,respectively.For NT-proBNP(125 pg/mL),the relative sensitivity was 94.1%,the relative specificity was 100%,the Youden index was 0.94,and the Kappa value was 0.87.These findings confirm the high accuracy of whole blood sample testing and the strong concordance between the two methods.Conclusions This study confirmed the efficacy of POCT technology for detecting DDI,PCT,and NT-proBNP in whole blood samples.The results showed a high level of consistency compared to traditional plasma/serum methods,thereby reinforcing the clinical applicability of POCT for rapid diagnosis.

Objective To assess the accuracy and consistency of point-of-care testing(POCT)technology in detecting D-dimer(DDI),Procalcitonin(PCT),and N-terminal pro B-type natriuretic peptide(NT-proBNP)in whole blood samples,as well as to validate its feasibility for rapid clinical diagnosis.Methods From July 8 to August 22,2022,a total of 104 paired DDI whole blood and plasma samples,496 paired PCT whole blood and serum samples,and 77 paired NT-proBNP whole blood and serum samples were collected.The consistency and accuracy of test results between whole blood and plasma/serum samples were assessed using the Mann-Whitney U test,regression analysis,relative sensitivity,relative specificity,Youden's index,and Kappa value.Results The test results of DDI,PCT,and NT-proBNP in whole blood and plasma/serum samples demonstrated excellent consistency,with correlation coefficients of r2=0.951 2,r2=0.942 8,and r2=0.991 6,respectively,and all P-values exceeding 0.05.At the medical decision levels,for DDI(0.55 μg/mL),the relative sensitivity,rela-tive specificity,Youden index,and Kappa value were 94.3%,94.1%,0.88,and 0.87,respectively.For PCT(0.5 ng/mL and 2.0 ng/mL),the relative sensitivities were 97.4%and 89.0%,the relative specificities were 95.8%and 98.3%,the Youden indices were 0.93 and 0.87,and the Kappa values were 0.93 and 0.89,respectively.For NT-proBNP(125 pg/mL),the relative sensitivity was 94.1%,the relative specificity was 100%,the Youden index was 0.94,and the Kappa value was 0.87.These findings confirm the high accuracy of whole blood sample testing and the strong concordance between the two methods.Conclusions This study confirmed the efficacy of POCT technology for detecting DDI,PCT,and NT-proBNP in whole blood samples.The results showed a high level of consistency compared to traditional plasma/serum methods,thereby reinforcing the clinical applicability of POCT for rapid diagnosis.

Objective:To observe the efficacy of external diaphragm pacing (EDP) combined with recombinant human growth hormone (rhGH) in the treatment of severe chronic obstructive pulmonary disease (CDOP).Methods:By the prospective study method, 80 patients with severe COPD were admitted to the Xianju People′s Hospital(Zhejiang Southeast Campus of Zhejiang Provincial People′s Hospital)/Xianju Hospital Affiliated to Hangzhou Medical College from April 2021 to April 2023 were divided into the combined group and the conventional group by the random number table method, with 40 cases in each group. All of them received anti-infection, nutritional support, and other conventional treatment. In addition, the combined group was given EDP+rhGH treatment, and they were intervened for 20 d. The diaphragm function, nutrition, pulmonary function, and serum levels of interleukin (IL-6), IL-23, type Ⅱ alveolar cell surface antigen (KL-6) changes before and after treatment and prognosis were compared between the two groups.Results:After treatment, the diaphragm function index diaphragm maximum expiratory pressure (MIP), diaphragm thickness (DTei), and diaphragm mobility (DE) in the combined group were higher than those in the conventional group: (45.36 ± 7.04) cmH 2O (1 cmH 2O = 0.098 kPa) vs. (42.28 ± 6.43) cmH 2O, (0.32 ± 0.12) cm vs. (0.27 ± 0.06) cm, (3.40 ± 1.02) cm vs. (1.85 ± 0.64) cm, there were statistical differences ( P<0.05). After treatment, the nutritional status indexes of serum albumin (ALB), transferrin (Tf), and total protein (TP) in the combined group were higher than those in the conventional group: (34.62 ± 5.13) g/L vs. (31.75 ± 4.93) g/L, (2.21 ± 0.46) g/L vs. (2.00 ± 0.42) g/L, (63.80 ± 8.25) g/L vs. (60.24 ± 6.97) g/L, there were statistical differences ( P<0.05). After treatment, the percentage of forced expiratory volume in the first second (FEV 1) to the expected value (FEV 1%) and the ratio of FEV 1 to forced vital capacity (FEV 1/FVC) in the combined group were higher than those in the conventional group: (60.17 ± 6.30)% vs. (57.25 ± 6.24)%, (61.30 ± 7.04)% vs. (57.12 ± 7.25)%, there were statistical differences ( P<0.05). After treatment, the levels of IL-6, IL-23, and KL-6 in the combined group were lower than those in the conventional group: (23.13 ± 4.26) ng/L vs. (26.60 ± 4.75) ng/L, (20.84 ± 6.16) μg/L vs. (25.00 ± 5.89) μg/L, (375.10 ± 45.18) kU/L vs. (400.25 ± 46.27) kU/L, there were statistical differences ( P<0.05). The mechanical ventilation time and intensive care unit stay time in the combined group were shorter than those in the conventional group: (150.46 ± 10.24) h vs. (189.67 ± 15.43) h, (7.00 ± 2.03) d vs. (9.84 ± 2.72) d, there were statistical differences ( P<0.05). The rate of extubation within 1 week in the combined group was higher than that in the conventional group, and the 28-day mortality was lower than that in the conventional group: 90.00%(36/40) vs. 72.50%(29/40), 5.00%(2/40) vs. 22.50%(9/40), there were statistical differences ( χ2 = 4.02, 5.16, P<0.05). Conclusions:In the patients with severe COPD, EDP combined with rhGH can significantly improve the diaphragm function, nutritional status, and lung function, decrease serum IL-6, IL-23, and KL-6 levels, shorten the mechanical ventilation time, and reduce the 28-day mortality.

Persistent Müllerian duct syndrome(PMDS) is a rare disorder that arises from a lack of active anti-Müllerian hormone(AMH) or type Ⅱ AMH receptor(AMHR2) deficiency in males with a normal 46, XY chromosome karyotype.It presents that the external genitalia appears normally while the Müllerian duct structure(uterus, fallopian tubes, upper vagina) persists in the body.Common pathogenic factors are mutations in the AMH and AMHR2 genes, inherited in an autosomal recessive manner.This study reported two families with PMDS.The first patient was diagnosed with PMDS due to cryptorchidism in May 2019.Gene sequencing analysis revealed a new missense mutation(c.579G>T; p.W193C) and a splicing mutation(c.622-3C>A; splicing) in the AMHR2 gene.His father had the missense mutation(c.579G>T; p.W193C), and his mother had the splicing mutation(c.622-3C>A; splicing).The second patient was diagnosed with PMDS due to bilateral cryptorchidism, transverse testis ectopia in the right testicle in March 2023.Undegraded Müllerian tube derivatives were found between the two testicles, and serum AMH levels were very high(565.00 μg/L).Gene sequencing analysis reported that the AMHR2 gene had a new deletion mutation(c.835_837del; p.Leu279del).Both his father and mother had a deletion mutation(c.835_837del; p.Leu279del).This study reports two new AMHR2 gene mutations that expand the mutation sites of this rare disease.It is recommended to consider PMDS in the differential diagnosis of cryptorchidism, undergo surgery as early as possible, and treat Müllerian duct derivatives based on individual anatomical characteristics.

Objective:To investigate the early clinical characteristics of elderly patients with severe burns and the risk factors on prognosis.Methods:This study was a retrospective case series study. Clinical data of 124 elderly patients with severe burns who met the inclusion criteria and were admitted to the 12 hospitals from January 2015 to December 2020 were collected, including 4 patients from the Fourth People's Hospital of Dalian, 5 patients from Fujian Medical University Union Hospital, 22 patients from Guangzhou Red Cross Hospital of Jinan University, 5 patients from Heilongjiang Provincial Hospital, 27 patients from the First Affiliated Hospital of Naval Medical University, 9 patients from the First Affiliated Hospital of Nanchang University, 10 patients from Affiliated Hospital of Nantong University, 9 patients from Tongren Hospital of Wuhan University & Wuhan Third Hospital, 12 patients from the 924 th Hospital of PLA, 6 patients from Zhangjiagang First People's Hospital, 4 patients from Taizhou Hospital of Zhejiang Province, and 11 patients from Zhengzhou First People's Hospital. The patients' overall clinical characteristics, such as gender, age, body mass index, total burn area, full-thickness burn area, inhalation injury, causative factors, whether combined with underlying medical diseases, and admission time after injury were recorded. According to the survival outcome within 28 days after injury, the patients were divided into survival group (89 cases) and death group (35 cases). The following data of patients were compared between the two groups, including the basic data and injuries (the same as the overall clinical characteristics ahead); the coagulation indexes within the first 24 hours of injury such as prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time, D-dimer, fibrinogen degradation product (FDP), international normalized ratio (INR), and fibrinogen; the blood routine indexes within the first 24 hours of injury such as white blood cell count, platelet count, neutrophil-to-lymphocyte ratio, monocyte count, red blood cell count, hemoglobin, and hematocrit; the organ function indexes within the first 24 hours of injury such as direct bilirubin, total bilirubin, urea, serum creatinine, aspartate aminotransferase, alanine aminotransferase, total protein, albumin, globulin, blood glucose, triglyceride, total cholesterol, alkaline phosphatase, creatine kinase, electrolyte indexes (potassium, sodium, chlorine, calcium, magnesium, and phosphorus in blood), uric acid, myoglobin, and brain natriuretic peptide; the infection and blood gas indexes within the first 24 hours of injury such as procalcitonin, C-reactive protein, pH value, oxygenation index, base excess, and lactate; treatment such as whether conducted with mechanical ventilation, whether conducted with continuous renal replacement therapy, whether conducted with anticoagulation therapy, whether applied with vasoactive drugs, and fluid resuscitation. The analysis was conducted to screen the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns. Results:Among 124 patients, there were 82 males and 42 females, aged 60-97 years, with body mass index of 23.44 (21.09, 25.95) kg/m 2, total burn area of 54.00% (42.00%, 75.00%) total body surface area (TBSA), and full-thickness burn area of 25.00% (10.00%, 40.00%) TBSA. The patients were mainly combined with moderate to severe inhalation injury and caused by flame burns. There were 43 cases with underlying medical diseases. The majority of patients were admitted to the hospital within 8 hours after injury. There were statistically significant differences between patients in the 2 groups in terms of age, total burn area, full-thickness burn area, and inhalation injury, and PT, APTT, D-dimer, FDP, INR, white blood cell count, platelet count, urea, serum creatinine, blood glucose, blood sodium, uric acid, myoglobin, and urine volume within the first 24 hours of injury (with Z values of 2.37, 5.49, 5.26, 5.97, 2.18, 1.95, 2.68, 2.68, 2.51, 2.82, 2.14, 3.40, 5.31, 3.41, 2.35, 3.81, 2.16, and -3.82, respectively, P<0.05); there were statistically significant differences between two groups of patients in whether conducted with mechanical ventilation and whether applied with vasoactive drugs (with χ2 values of 9.44 and 28.50, respectively, P<0.05). Age, total burn area, full-thickness burn area, serum creatinine within the first 24 hours of injury, and APTT within the first 24 hours of injury were the independent risk factors for the mortality within 28 days after injury in elderly patients with severe burns (with odds ratios of 1.17, 1.10, 1.10, 1.09, and 1.27, 95% confidence intervals of 1.03-1.40, 1.04-1.21, 1.05-1.19, 1.05-1.17, and 1.07-1.69, respectively, P<0.05). Conclusions:The elderly patients with severe burns had the injuries mainly from flame burns, often accompanied by moderate to severe inhalation injury and enhanced inflammatory response, elevated blood glucose levels, activated fibrinolysis, and impaired organ function in the early stage, which are associated with their prognosis. Age, total burn area, full-thickness burn area, and serum creatinine and APTT within the first 24 hours of injury are the independent risk factors for death within 28 days after injury in this population.

Objective:To explore the clinical characteristics and treatment regimens of adrenal incidentaloma (AI) in children.Methods:Clinical data of 38 children with AI treated in the Department of Urology, Children′s Hospital of Nanjing Medical University from December 2016 to October 2021 were retrospectively analyzed.A total of 38 children were divided into neonatal group and non-neonatal group according to their age at first diagnosis.The neonatal group had 7 males and 9 females patients, of whom 7 cases were detected with AI during prenatal examinations, 9 cases were diagnosed postnatally.Four children in neonatal group had AI in the left adrenal gland and 12 cases in the right, with the maximum diameter of tumor (MDT) ranging from 16-48 mm.In the non-neonatal group, there were 14 males and 8 females patients aged 7 months and 1 day to 12 years and 1 month, and the MDT was 29-131 mm.Paired t test was used to compare the age and MDT of benign and malignant tumors. Results:In the neonatal group, 3 patients were surgically treated, with 2 cases and 1 case of neuroblastoma and teratoma confirmed by postoperative histology, respectively.The remaining 13 patients in the neonatal group were followed up for 1-31 months, with 8 cases and 5 cases of complete remission and significantly decreased tumor volume, respectively.In the non-neonatal group, there were 3, 9 and 10 patients received open biopsy, laparoscopic adrenalectomy, and open adrenalectomy, respectively.Of these 22 surgically treated cases, 8 cases had a benign lesion, including ganglioneuroma ( n=4), adrenocortical adenoma ( n=1), adrenal cyst ( n=1), teratoma ( n=1), and pheochromocytoma ( n=1); while 14 cases had a malignant lesion, including neuroblastoma ( n=8), ganglioneuroblastoma ( n=5), and adrenocortical carcinoma ( n=1). The mean age of patients with malignant tumors was significantly younger than those with benign tumors[(38.94±35.44) months vs.(95.89±41.43) months, t=3.63, P=0.001]. The mean MDT in malignant tumors was significantly longer than that of benign tumors[(64.43±25.20) mm vs.(41.44±15.66) mm, t=2.45, P=0.023]. Conclusions:AI in children has a high risk of malignancy.Therefore, more detailed examinations are needed to detect tumor markers and endocrinological parameters, and imaging tests such as non-contrast and CT examination should be performed as early as possible.AI in children is predominantly neuroblastic tumors.For non-neonatal patients, surgery should be performed as early as possible.For AI found in the neonatal period and prenatal examination, expectant management is feasible if the tumor is relatively small and limited to the adrenal gland without distant metastases.

Objective: To study the therapeutic effect of laparoscopic ureteral end-to-side anastomosis at pelvic level for duplicate ureteral malformation. Methods: Clinical data of 10 children with unilateral ureteral duplication, who received laparoscopic ureteral end-to-side anastomosis at pelvic level at Department of Urology, Affiliated Children′s Hospital of Nanjing Medical University from September 2016 to November 2017 were reviewed.There were 6 boys and 4 girls with an average age of 13.9 months(1 month and 21 days to 3 years and 9 months). Ultrasonography, intravenous pyelography and magnetic resonance urography were performed before surgery.There were 6 cases of duplication with hydronephrosis in the upper moiety. The rest 4 cases were complicated with ureteroceles.Presentations included urinary dripping and symptoms caused by urinary tract infections.Urine test, ultrasonography, intravenous pyelography were performed during the 3-16 months follow-ups for all the patients after surgery. Results: The laparoscopic ureteral end-to-side anastomosis was performed successfully in all patients at the pelvic level, the average ope-rating time was 98 minutes (60-125 minutes) and mean hospital stay was 7.3 days(7-8 days). All the presentations disappeared after surgery.All the patients were followed up for 3 to 6 months with relieved hydronephrosis.Postoperative examination of intravenous pyelography in 10 cases showed that there was no anastomotic obstruction. Conclusions The laparoscopic ureteral end-to-side anastomosis can be used for duplicate ureter, and it is a safe and effective method for the treatment of ureteral duplication.

Objective To analyze the prognostic factors of adrenal tumor in children under 12 years of age. Methods A total of 90 children with 97 adrenal tumors admitted from June 2006 to August 2017 were selected in Children's Hospital of Nanjing Medical University.The age distribution,tumor type,biochemistry and tumor indicators, treatment,stage classification and prognosis were analyzed.Results There were 46 males and 44 females in 90 cases. Ages ranged from 4 days to 11 years and 1 month,with an average of (38.1 ± 31.3)months.The main clinical mani-festations were abdominal mass,fever and abdominal pain.Eighty cases (82.5%)underwent surgery,while 17 cases (17. 5%)did not.Open resection was performed in 48 cases,open partial resection in 11 cases,laparoscopic surgery in 10 cases,and just biopsy in 11 cases.The pathological examination showed 43 cases with neuroblastoma,13 cases with ganglioneuroblastoma,8 cases with ganglioneuroma,5 cases with adrenocortical carcinoma,3 cases with teratoma,1 case with pheochromocytoma,1 case with malignant rhabdoid tumor.Statistical analysis revealed that neuron－specific eno-lase(NSE)value of neuroblastoma and lactate dehydrogenase(LDH)value of cortical cancer increased significantly. The age was correlated with tumor stage,and patients had older age on stage Ⅳ.Complete resection in surgery was correlated with the stage of the tumor,as tumor in lower tumor stage seemed easier to be completely removed.Fifty－three cases (58.9%)were followed up for 2 months up to 11 years and 4 months.Forty－four cases survived and 9 ca-ses died.Higher tumor stage predicated worse prognosis.Conclusions Adrenal gland tumors need early diagnosis and active treatment.Earlier onset of age,complete surgical resection with patients have better prognosis.Complete resection of the disease was a key factor in the prognosis.

Excavating and characterizing the dosage forms characteristics of classic Chinese medicine preparations is the basis for the innovation of modern preparations of Chinese medicine. Through the combing statistics of the National Natural Science Foundation of China (NSFC) on the establishment of traditional Chinese medicine preparations, the research literature on Chinese medicine preparations at home and abroad, and the registration of new Chinese medicines in the past ten years, this paper finds that the research projects of classic Chinese medicines have been greatly reduced. The market share of traditional Chinese medicine classics has shrunk year by year. The modern preparation produced in the "preparation of traditional Chinese medicine by western medicine technology" mode dominates the market. However, because of its "degraded" effect, it is less competitive. Therefore, with the wave of classic dosage forms research promoted by national policies, accelerating the study of classical Chinese medicine preparations will not only promote the development of pharmaceutical discipline of traditional Chinese medicine, enhance the classic medical culture literacy, but also promote the protection and inheritance of classic medicine.