Objective:To compare the dynamic changes of transcutaneous partial pressure of carbon dioxide (PtCO 2) and treatment effect of non-invasive intermittent nebulization and non-invasive simultaneous nebulization in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods:This was a randomized parallel controlled trial study. A total of 70 patients with acute exacerbation of COPD in Changzhou First People′s Hospital from October 2021 to September 2022 were selected by convenience sampling method, and divided into control group and experimental group by randomized digits table method with 35 cases in each group. The control group was given non-invasive intermittent oxygen-driven nebulization, and the experimental group was given non-invasive simultaneous oxygen-driven nebulization. The PtCO 2 values at 0, 5, 10, 15 min (the end point of atomization) of the 2 groups were observed, the daily arterial blood gas analysis indexes (mainly including PaCO 2, PaO 2 and pH) were recorded, and the clinical pulmonary infection score and the self-assessment score of COPD patients were recorded before treatment, on the 4th and 7th day of treatment. Results:Finally, 33 patients were included in both the control group and the experimental group. There were 25 males and 8 females in the control group, aged (75.33 ± 8.24) years old. There were 25 males and 8 females in the experimental group, aged (72.39 ± 8.56) years old. The PtCO 2 values at 0, 5, 10, 15 min in the control group were (63.83 ± 12.47), (64.40 ± 12.57), (65.42 ± 13.77), (66.62 ± 14.59) mmHg (1 mmHg=0.133 kPa). There were statistically significant differences in PtCO 2 at all time points ( F=8.05, P<0.01). Further pairwise comparison by Sidak method showed that there were statistically significant differences in PtCO 2 at 15 min compared with 0, 5, 10 min (all P<0.05). The PtCO 2 values at 0, 5, 10, 15 min in the experimental group were (67.62 ± 11.89), (67.15 ± 12.12), (67.82 ± 12.22), (68.15 ± 12.09) mmHg. There was no statistically significant difference in PtCO 2 at all time points ( F=2.00, P>0.05). The PaCO 2 and pH value of the two groups were improved with the treatment time, the control group had a statistically significant difference on the 4th day of treatment compared with before treatment ( P<0.05), while the experimental group on the second day of treatment compared with before treatment ( P<0.05). Conclusions:Both kinds of nebulization have achieved good therapeutic effects, but non-invasive simultaneous nebulization can better maintain the stability of PtCO 2 in the process of nebulization with higher safety, and can improve the arterial blood gas index PaCO 2 and pH value of patients earlier, which is a more suitable nebulization method for the combination of non-invasive ventilation and nebulization, especially for patients with hypercapnia.

Objective: To investigate the effect of Guangdong Shenqu (GSQ) on intestinal flora structure in mice with food stagnation through 16S rDNA sequencing. Methods: Mice were randomly assigned to control, model, GSQ low-dose (GSQL), GSQ medium-dose (GSQM), GSQ high-dose (GSQH), and lacidophilin tablets (LAB) groups, with each group containing 10 mice. A food stagnation and internal heat mouse model was established through intragastric administration of a mixture of beeswax and olive oil (1:15). The control group was administered normal saline, and the model group was administered beeswax and olive oil to maintain a state. The GSQL (2 g/kg), GSQM (4 g/kg), GSQH (8 g/kg), and LAB groups (0.625 g/kg) were administered corresponding drugs for 5 d. After administration, 16S rDNA sequencing was performed to assess gut microbiota in mouse fecal samples. Results: The model group exhibited significant intestinal flora changes. Following GSQ administration, the abundance and diversity index of the intestinal flora increased significantly, the number of bacterial species was regulated, and α and β diversity were improved. GSQ administration increased the abundance of probiotics, including Clostridia, Lachnospirales, and Lactobacillus, whereas the abundance of conditional pathogenic bacteria, such as Allobaculum, Erysipelotrichaceae, and Bacteroides decreased. Functional prediction analysis indicated that the pathogenesis of food stagnation and GSQ intervention were primarily associated with carbohydrate, lipid, and amino acid metabolism, among other metabolic pathways. Conclusion The digestive mechanism of GSQ may be attributed to its role in restoring diversity and abundance within the intestinal flora, thereby improving the composition and structure of the intestinal flora in mice and subsequently influencing the regulation of metabolic pathways.

Objective:To evaluate the value of time-of-flight (TOF) combined with point spread function (PSF) reconstruction for the improvement of brain PET images and lesion localization in patients with temporal lobe epilepsy (TLE).Methods:A retrospective collection of brain 18F-FDG PET imaging data of 52 hospitalized patients with TLE (30 males, 22 females, age: (26.7±7.1) years) and 26 healthy volunteers (14 males, 12 females, age: ( 31.7±6.8) years) from Xuanwu Hospital between 2017 and 2019 was conducted. Images were reconstructed and divided into 4 groups based on different algorithms: ordered subset expectation maximization (OSEM), OSEM+ TOF, OSEM+ PSF, and OSEM+ TOF+ PSF. The image quality, clarity, noise, and the clarity of lesion display of all subjects were visually analyzed using a four-point scale. The signal-to-noise ratio (SNR), contrast, and asymmetry index (AI) of the lesions were calculated. Differences in visual scores, SNR, contrast, and AI among the 4 groups were analyzed using one-way analysis of variance. The ROC curve was used to analyze the efficiency of PET images in localization of epileptogenic foci. Results:The visual score of OSEM+ TOF+ PSF group was the highest (4.0±0.0) among healthy volunteers; compared with OSEM group, OSEM+ TOF+ PSF group showed lower SNR (decreased by 46.6%; the lower the SNR value, the better the image quality) and contrast (increased by 29.8%). Visual assessment of PET images of patients with TLE showed that the scores of OSEM+ TOF+ PSF group , OSEM+ PSF group , OSEM+ TOF group and OSEM group were decreased in order (4.0±0.0 vs 3.4±0.5 vs 2.3±0.4 vs 1.0±0.0; F=884.0, P<0.001); SNRs of those 4 groups were increased in order ((5.2±2.4)% vs (6.2±2.4)% vs (7.9±2.6)% vs (8.9±3.5)%; F=18.82, P<0.001). The contrast and AI of the lesions in 4 groups were as follows: OSEM+ TOF+ PSF (contrast: 0.81±0.03; AI: 0.28±0.05) > OSEM+ TOF (0.74±0.05; 0.23±0.06) > OSEM+ PSF (0.72±0.06; 0.22±0.07) > OSEM (0.64±0.05; 0.19±0.06) ( F values: 107.10, 19.94, both P<0.001). MRI found unilateral hippocampal sclerosis in 32 patients, and the rest 20 patients with TLE were MRI-negative. ROC curve analysis showed that visual analysis and SUV ratio (SUVR) of lesion/contralateral ROI based on OSEM+ TOF+ PSF PET image could localize epileptogenic foci efficiently, with AUC of 0.874 in MRI-positive patients, and AUC of 0.932 in MRI-negative patients. Conclusions:The application of TOF and PSF significantly improves the quality of PET images. The combined use of both techniques yields the best results and aids in the localization of epileptogenic foci in patients with TLE.

Objective:To explore the pathogenesis of flunarizine-induced parkinsonism from gut-brain axis perspective.Methods:Thirty male C57BL/6 mice were randomly divided into control group and flunarizine group ( n=15). Mice in the control group were given 0.1 mL 50% polyethylene glycol 400+50% saline by gavage once/d for 2 weeks, while mice in the flunarizine group were given 6 mg/mL flunarizine+50% polyethylene glycol 400+50% saline by gavage at a daily dose of 30 mg/kg for 2 weeks. Body mass was recorded 1, 3, 5, 7, 10 and 14 d after drug administration, and motor function was assessed by rotarod test 14 d after drug administration; 16s RNA sequencing was performed in the feces to observe the intestinal flora; intestinal transit function was detected by Evans blue by gavage; and then, the mice were sacrificed and homogenate or frozen sections (brain and intestinal tissues) were prepared; dopamine-ergic neuron expression was detected by Western blotting; RT-qPCR was applied to detect the expressions of inflammatory factors in the substantia nigra, and immunofluorescent staining was used to detect the expressions of ZO-1 and Claudin-5 in the intestinal epithelial tissues. Results:Compared with the control group, the flunarizine group had lower body mass ratio 1, 3, 5, 7, 10 and 14 d after drug administration (ratio to body mass before drug administration). Compared with the control group, the flunarizine group had significantly shortened residence time in rod rotating and lower rotational speed when falling ( P<0.05). Compared with the control group, the flunarizine group had decreased tyrosine hydroxylase protein in the substantia nigra without significant difference ( P>0.05). Compared with the control group, the flunarizine group had significantly increased interleukin-6 and tumor necrosis factor-α in the substantia nigra (1.00±0.00 vs. 2.79±0.83; 1.00±0.00 vs. 3.39±1.37), significantly lower intestinal Evans blue propulsion rate (80.67%±4.51% vs. 50.67%±6.03%), and statistically decreased ZO-1 and Claudin-5 expressions in the colonic epithelial tissues (27.01±1.41 vs. 16.32±2.83; 37.00±2.80 vs. 24.52±2.12, P<0.05). Totally, 576 microorganisms were noted in both control group and flunarizine group, 744 in the control group alone, and 634 in the flunarizine group alone. The intestinal flora β diversity indices in the 2 groups were significantly different based on weighted Unifrac-principle coordinates analysis (PCoA, PCoA1: 39.88%; PCoA2: 30.69%). Compared with the control group, the microbial colony structure of mice in flunarizine group was dominated by phylum thick-walled bacteria and phylum warty microbacteria, and by families Muribaculaceae, Lachnospiraceae and Akkermansiaceae. Compared with the control group, the flunarizine group had significantly decreased relative abundance of Ackermannia spp. and Lactobacillus spp. in the intestinal flora ( P<0.05). Conclusion:Flunarizine may contribute to the pathogenesis of DIP by causing structural disturbances in the intestinal flora and inducing neuroinflammation based on the gut-brain axis.

Objective:To understand the status of frailty in postoperative gastric cancer patients and to explore its influence on symptom groups during the initial oral chemotherapy. Provide theoretical guidance for symptom management of cancer patients.Methods:A total of 133 postoperative gastric cancer patients who received initial oral chemotherapy were selected as subjects by cross section survey from Octomber 2021 to Octomber 2022 in Department of Oncology, First People′s Hospital of Changzhou by couvenient sampling method. Baseline data of patients before chemotherapy were investigated by general data questionnaire and Frailty Phenotype. Symptoms on the 2nd and 14th day of chemotherapy were investigated by M. D. Anderson Symptom Inventory-Gastrointestinal Cancer Module.Results:The incidence of frailty in postoperative gastric cancer patients was 48.9% (65/133). On the 2nd day of chemotherapy, there were four symptom clusters, namely emotional symptom cluster, gastrointestinal symptom cluster, disease related symptom cluster and neurological symptom cluster, and the cumulative variance contribution rate was 61.20%. On the 14th day of chemotherapy, there were five symptom clusters after gastric cancer specific symptom cluster appeared. and the cumulative variance contribution rate was 63.90%. On the 2nd day of chemotherapy, frailty had statistical significance on emotional symptom cluster, gastrointestinal symptom cluster andneurological symptom cluster ( t = 3.52, 2.66, 5.48, all P<0.05), which explained 7.2%, 4.1% and 15.1% of symptom group severity, respectively. On the 14th day of chemotherapy, frailty still had statistical significance on emotional symptom cluster, gastrointestinal symptom cluster and neurological symptom cluster ( t = 3.41, 5.47, 4.06, all P<0.05), which explained 7.1%, 13.2% and 9.6% of symptom group severity, respectively. Conclusions:The incidence of frailty in patients with postoperative gastric cancer was at a relatively high level. The emotional symptom cluster, gastrointestinal symptom cluster, and neurological system related symptom cluster in patients with frailty were more serious at different time points.

Objective:To investigate the current status of activation in patients with spinal cord injury and analyze its influencing factors.Methods:Using the convenient sampling method, a total of 127 patients from Department of Spinal Surgery in the Third Affiliated Hospital of Soochow University from October 2020 to August 2021 were selected as the research objects. The patients were investigated by General Data Questionnaire, Patient Activation Measure (PAM) , General Self-Efficacy Scale (GSES) , Connor-Davidson Resilience Scale (CD-RISC) , Social Support Rating Scale (SSRS) and Hospital Anxiety and Depression Scale (HADS) . Multiple linear hierarchical regression analysis was used to investigate the influencing factors of activation in patients with spinal cord injury.Results:A total of 127 questionnaires were sent out, and 122 were effectively received, with the effective recovery of 96.1%. The score of activation in patients with spinal cord injury was (54.71±7.23) . Regression analysis showed that injury site, mental resilience and social support were the main influencing factors of activation ( P<0.05) , and the global regression model explained 50.0% of the variation in activation in patients with spinal cord injury. Conclusions:Patients with spinal cord injury generally have moderate levels of activation during hospitalization. The activation of patients with spinal cord injury is a positive psychosocial resource, and rehabilitation nurses should pay more attention to it, and improve the mental resilience and social support of patients, so as to further enhance the activation of patients.

Lingguizhugan Decoction (LGZG) has been investigated in basic studies, with satisfactory effects on insulin resistance in non-alcoholic fatty liver disease (NAFLD). This translational approach aimed to explore the effect and underlying mechanism of LGZG in clinical setting. A randomized, double-blinded, placebo-controlled trial was performed. A total of 243 eligible participants with NAFLD were equally allocated to receive LGZG (two groups: standard dose and low dose) or placebo for 12 weeks on the basis of lifestyle modifications. The primary efficacy variable was homeostasis model assessment of insulin resistance (HOMA-IR). Analyses were performed in two populations in accordance with body mass index (BMI; overweight/obese, BMI ⩾ 24 kg/m²; lean, BMI < 24 kg/m²). For overweight/obese participants, low-dose LGZG significantly decreased their HOMA-IR level compared with placebo (-0.19 (1.47) versus 0.08 (1.99), P = 0.038). For lean subjects, neither dose of LGZG showed a superior effect compared with placebo. Methylated DNA immunoprecipitation sequencing and real-time qPCR found that the DNA N6-methyladenine modification levels of protein phosphatase 1 regulatory subunit 3A (PPP1R3A) and autophagy related 3 (ATG3) significantly increased after LGZG intervention in overweight/obese population. Low-dose LGZG effectively improved insulin resistance in overweight/obese subjects with NAFLD. The underlying mechanism may be related to the regulation of DNA N6-methyladenine modification of PPP1R3A and ATG3. Lean subjects may not be a targeted population for LGZG.
Humans ; Non-alcoholic Fatty Liver Disease/drug therapy* ; Overweight/drug therapy* ; Insulin Resistance ; Obesity/drug therapy* ; China ; DNA/therapeutic use*

Objective To investigate the expressions of octamer-binding transcription factor 4 (Oct4) and phosphorylated-protein kinase B (p-Akt) proteins in colorectal cancer and their clinical significances, in order to explore the roles of Oct4 and p-Akt in the staging and grading of colorectal cancer. Methods Immunohistochemical technique was used to examine the expression of Oct4 and p-Akt proteins in 78 cases of colorectal cancer in Wuxi Second Hospital of Traditional Chinese Medicine and Wuxi First People's Hospital from January 2011 to December 2016. Relationship between expressions of Oct4 and p-Akt proteins and clinicopathological parameters were analyzed. Results The positive rate of Oct4 in tumors was 74.36 % (58/78), which was obviously higher than that in normal tissues [35.90 % (20/78), χ2= 23.32, P < 0.01]; and the positive rate of p-Akt in tumors was 67.95 % (53/78), which was obviously higher than that in normal tissues[28.21 %(25/78),χ2=24.68,P <0.01].The double positive and negative expression rate of these two proteins accounted for 80.8 %(63/78), with a linear positive correlation (r= 0.455, P < 0.000 1). In 78 cases of colorectal cancer, the expression of Oct4 protein was correlated with histological grade, lymph node metastasis, and Duke staging (all P < 0.05), and the expression of p-Akt protein was correlated with histological grade and lymph node metastasis (both P < 0.05). The multivariate logistic regression analysis showed that the expression of Oct4 protein was related to histological grade and Duke staging(both P<0.05),and the expression of p-Akt protein was only related to lymph node metastasis (P<0.05). Conclusion The combined detection of Oct4 protein and p-Akt protein has reliable and important clinical significance for judging the histological grade,lymph node metastasis and Duke staging of colorectal cancer.

OBJECTIVETo assess the association of CYP2C19 gene polymorphisms with the incidence of ischemic stroke among patients receiving clopidogrel therapy following coronary stenting for coronary artery disease.

METHODSClinical data of patients receiving clopidogrel therapy after coronary stenting were retrospectively studied. For a case-control study, 137 patients with acute cerebral infarction and 122 non-stroke patients were selected. Based on the variants of the CYP2C19 gene detected by a DNA microarray assay, the patients were further divided into the wild-type group(CYP2C19*1/*1) and mutant group(defined by the presence of at least one loss-of-function allele, including CYP2C19*1/*2, CYP2C19*1/*3, CYP2C19*2/*2, CYP2C19*2/*3 and CYP2C19*3/*3). The incidences of ischemic stroke in the two groups were compared through a chi-square analysis. The influence of CYP2C19 gene polymorphisms and clopidogrel therapy on the incidence of ischemic stroke was analyzed through multivariable logistic regression.

RESULTSA total of 259 patients were enrolled. The case and control groups showed no difference in terms of gender and age. There were 123 cases (47.5%) in the CYP2C19 wild-type group and 136 cases (52.5%) in the mutant group. The incidence of ischemic stroke of mutant group was significantly higher than that of wild-type group (59.9% vs. 44.3%, X2=6.398, P=0.042). Multivariate analysis revealed that loss-of-function polymorphisms of the CYP2C19 gene carried a 1.13 times greater risk for ischemic stroke compared to wild-type genotype (OR=2.13, 95%CI: 1.23-3.71).

CONCLUSIONThe efficacy of clopidogrel for the prevention of ischemic stroke in post-coronary stent patients may be reduced by the insufficiency of the CYP2C19 gene. The dosage of clopidogrel therapy should be adjusted based on its polymorphisms.

Brain Ischemia ; prevention & control ; Cytochrome P-450 CYP2C19 ; genetics ; Genotype ; Humans ; Percutaneous Coronary Intervention ; adverse effects ; Platelet Aggregation Inhibitors ; therapeutic use ; Polymorphism, Genetic ; Stents ; adverse effects ; Stroke ; prevention & control ; Ticlopidine ; analogs & derivatives ; therapeutic use

Objective To prospectively investigate the radiation dose and image quality of pediatric chest CT using Sn100 kV on a third-generation dual-source CT (DSCT)in comparison to standard 100 kV chest CT. Methods From December 12,2015 to June 30,2016,45 consecutive pediatric patients referred for non-contrast chest CT scan in Peking Union Medical College Hospital were prospectively enrolled as study group. They were examined at 100 kV with a dedicated tin filter on a third-generation DSCT. These patients were retrospectively matched with 45 patients who were examined on a second-generation DSCT at 100 kV without tin filter. The radiation dose as well as the lung and mediastinal window image quality(IQ)of the two groups were compared and analyzed statistically. IQ was evaluated using a five-point scale (1=unevaluable,5=excellent). Differences of radiation dose and noise between the two groups were determined with variance analysis and t test,IQ with Mann-Whitney U test,and the consistency of diagnosis with Kappa test. Results The average CT dose index volume of the study group was (0.24±0.11)mGy,which was decreased by 92% compared with the control group [(3.10+1.18)mGy] (t=16.287,P=0.000). Mean dose-length product and mean effective dose for study group were significantly lower than those of control group [(7.13±4.72)mGy·cm vs. (84.78±46.78)mGy·cm,t=11.077,P=0.000;(0.11±0.06)mSv vs.(1.23±0.61)mSv,t=12.334,P=0.000]. There was no significant difference between the two groups in terms of image noise (t=-0.003,P=0.397)and contrast to noise ratio (t=0.545,P=0.488). There was no significant difference between the two groups in lung window IQ (doctor 1:U=796.000,P=0.055;doctor 2:U=889.500,P=0.277),while significant difference was seen concerning of the mediastinal window IQ (doctor 1:U=305.000,P=0.000;doctor 2:U=276.500,P=0.000). Referring to the lung window,the median IQ for the study group and control group was 4 (3-5)and 4 (3-5),respectively. All imaging findings had acceptable IQ. The breath motion artifacts (χ=13.846,P=0.001)and heart beat artifacts (χ=53.519,P=0.000)of the study group were significantly lower than those of the control group. Conclusion Compared with standard 100 kV chest CT,the use of tin-filtered Sn100 kV on a third-generation DSCT provided 92% dose reduction in pediatric chest CT examinations while maintaining diagnostically acceptable lung window images.
Artifacts ; Child ; Feasibility Studies ; Humans ; Lung ; diagnostic imaging ; Radiation Dosage ; Radiographic Image Interpretation, Computer-Assisted ; Retrospective Studies ; Thorax ; diagnostic imaging ; Tomography, X-Ray Computed ; methods