Objective:To investigate the clinical efficacy and safety of non-invasive bilevel positive airway pressure (BiPAP) ventilator combined with oxygen atomization in the treatment of chronic obstructive pulmonary disease (COPD) complicated with type Ⅱ respiratory failure.Methods:A total of 80 patients with COPD complicated with type Ⅱ respiratory failure admitted to Haiyan County People′s Hospital from June 2019 to July 2021 were selected, and they were divided into the observation group and the control group by the random number table method, with 40 cases in each group. Patients in both groups received conventional treatment, while patients in the control group were connected with BiPAP non-invasive ventilator and received non-invasive mechanical ventilation in S/T mode; the observation group was given aerosol inhalation drugs during ventilation, and both groups were treated for 7 d. Blood gas indicators and vital signs were collected before treatment and 7 d after treatment. Clinical symptoms were investigated by COPD patient Caring Assessment Tool (CAT) and Dyspnea Scale (DECAF). Serum levels of interleukin (IL)-10, tumor necrosis factor (TNF-α) and CD 4+/CD 8+ were determined, and treatment outcomes and adverse reactions were compared between the two groups. Results:After treatment, the partial pressure of oxygen (PaO 2) and the oxygen saturation (SaO 2) in the observation group were higher than those in the control group: (73.41 ± 5.26) mmHg(1 mmHg = 0.133 kPa) vs. (65.11 ± 4.33) mmHg, 0.921 ± 0.052 vs. 0.884 ± 0.039; the arterial partial pressure of carbon dioxide (PaCO 2), heart rate (HR), respiratory rate (RR) were lower than those in the control group: (45.20 ± 5.33) mmHg vs. (50.52 ± 5.96) mmHg, (90.12 ± 8.56) times/min vs. (98.52 ± 9.63) times/min, (17.41 ± 2.26) times/min vs. (22.10 ± 3.05) times/min, there were statistical differences ( P<0.05). After treatment, CAT scores and DECAF scores in the observation group were lower than those in the control group: (8.45 ± 1.63) scores vs. (12.77 ± 2.36) scores, (0.89 ± 0.15) scores vs. (1.15 ± 0.19) scores, there were statistical differences ( P<0.05). After treatment, the levels of IL-10 and CD 4+/CD 8+ in the observation group were higher than those in the control group: (15.28 ± 3.12) ng/L vs. (13.41 ± 2.96) ng/L, 1.71 ± 0.38 vs. 1.54 ± 0.30; while the level of TNF-α was lower than that in the control group: (215.27 ± 33.96) ng/L vs. (251.11 ± 50.95) ng/L, there were statistical differences ( P<0.05). The hospitalization time in the observation group was shorter than that in the control group: (13.52 ± 3.96) d vs. (15.22 ± 2.74) d, there was statistical difference ( P<0.05). The rates of tracheal intubation and the incidence of adverse reactions between the two groups had no significant differences ( P>0.05). Conclusions:Non-invasive BiPAP ventilator combined with oxygen atomization can improve blood gas index, vital signs and clinical symptoms of COPD patients complicated with type Ⅱ respiratory failure and reduce inflammatory response.

Objective:To evaluate the interaction between remimazolam and propofol for sedation during hysteroscopy.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients, aged 20-45 yr, with body mass index of 18-28 kg/m 2, scheduled for elective hysteroscopy, were included. The test was conducted in two steps. Up-and-down sequential allocation was used to determine the median effective dose (ED 50) of remimazolam (group A) and propofol (group B). The ED 50 obtained in A and B groups were then used as the standard to determine the combination regimen in group C (0.25×ED 50 of remimazolam+ 0.75×ED 50 of propofol as the initial dose), in group D (0.5×ED 50 of remimazolam+ 0.5×ED 50 of propofol as the initial dose), and in group E (0.75×ED 50 of remimazolam+ 0.25×ED 50 of propofol as the initial dose). Up-and-down sequential allocation was used to determine the ED 50 of propofol when propofol and remimazolam were combined in C, D and E groups. The interaction between the sedative effects of two drugs was analyzed using the isobolographic analysis method, and the interaction coefficient and synergistic dose ratio of two drugs were calculated. Results:The ED 50 of remimazolam was 0.180 mg/kg in group A, and the ED 50 of propofol was 1.167 mg/kg in group B. The results of isobolographic analysis showed that remimazolam and propofol had a synergistic effect. When remimazolam 0.045, 0.090 and 0.135 mg/kg were combined with propofol 0.546, 0.288 and 0.160 mg/kg, the interaction coefficients were 1.393, 1.339 and 1.127 respectively. The synergistic dosage ratio of remimazolam and propofol was 1.0∶(3.2 to 12.0). Conclusions:Remimazolam and propofol have a synergistic effect on sedation when used for hysteroscopy, and the dose ratio is 1.0∶(3.2-12.0).

Objective:To investigate the efficacy of sintilimab combined with paclitaxel and docetaxel in the treatment of advanced non-small cell lung cancer (NSCLC).Methods:Prospective cohort study was performed. A total of 90 patients with advanced NSCLC receiving second-line treatment in Baotou Cancer Hospital from October 2019 to October 2022 were prospectively selected. All patients were divided into the study group (sintilimab combined with paclitaxel and docetaxel as second-line treatment, 45 cases) and the control group (paclitaxel or docetaxel alone, 45 cases) according to random number table method. The short-term efficacy, serum cytokine levels, quality of life and T-cell subsets of the two groups were compared. The survival of patients within 6 months was followed up. Kaplan-Meier method was used to analyze the overall survival (OS) of both groups, and log-rank test was used to make comparison among groups.Results:There were 25 males (55.56%) in the study group with the age of (63±5) years and 28 males (62.22%) in the control group with the age of (65±6) years. There were no statistically significant differences in the gender, age, Eastern Cooperative Oncology Group scores, the body mass (all P>0.05). The total effective rate was 88.89% (40/45) in the study group and 71.11% (32/45) in the control group, and the difference was statistically significant ( χ2 = 4.44, P = 0.035). The levels of serum vascular endothelial growth factor (VEGF) and carbohydrate antigen 125 (CA125) of both groups after treatment were lower than those before treatment (all P<0.001); the levels of VEGF and CA125 in the study group after treatment were lower than those in the control group [VEGF: (223±15) pg/ml vs. (289±15) pg/ml, t=20.82, P<0.001;CA125: (23±6) ng/ml vs. (75±4) ng/ml, t=51.28, P<0.001].Quality of life scale score, Karnofsky score of both groups after treatment were higher than those before treatment (all P<0.05); quality of life scale score and Karnofsky score in the study group after treatment were higher than those in the control group [quality of life scale score: (63±6) scores vs. (51±5) scores, t=10.29, P<0.001; Karnofsky score: (80.5±5.7) scores vs.(78.8±3.7) scores, t=1.70, P=0.041]. T-cell subsets indicators of both groups after treatment were higher than those before treatment (all P<0.001). T-cell subsets indicators in the study group after treatment were higher than those in the control group [CD3 + cell proportion: (68±5)% vs. (65±5)%, t=2.52, P = 0.014; CD4 + cell proportion:(42.5±1.7)% vs. (36.5±3.7)%, t=9.91, P<0.001;CD4 +/CD8 +: 1.78±0.54 vs. 1.46±0.27, t=3.56, P<0.001]. There was no significant difference in the incidence of adverse reactions between the two groups [11.11% (5/45) vs. 15.55% (7/45), χ2=0.39, P=0.534]. The follow-up time was 6 months. The OS in the study group was better than that in the control group ( χ2=3.86, P = 0.044). Conclusions:Sintilimab combined with taxoid chemotherapy drugs is effective in the second-line treatment of advanced NSCLC, and it improves immune function and shows a favorable safety.

Objective:To evaluate the influence of age factors on dose-effect relationship of oxycodone inhibiting responses to tracheal intubation during induction of general anesthesia in pediatric patients.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ pediatric patients of both sexes, aged 6 months-6 yr, with body mass index of 12-22 kg/m 2, scheduled for elective surgery under general anesthesia with tracheal intubation, were divided into 3 groups: infant group (group I, 6-12 months), young children group (group Y, >1-3 yr) and preschooler group (group P, >3-6 yr). Oxycodone was slowly injected intravenously, 2 min later etomidate 0.3 mg/kg and cisatracurium 0.15 mg/kg were intravenously injected, and 3 min later endotracheal intubation was carried out with a visual laryngoscope in all the children. Mean arterial pressure(MAP) and heart rate (HR) immediately before intubation and peak MAP and HR within 3 min after intubation were recorded. The modified Dixon′s sequential method was used. The initial dose of oxycodone was 0.3 mg/kg in each group. If the response to tracheal intubation was positive, the dose of oxycodone was increased by 0.02 mg/kg in the next child; if the response to tracheal intubation was negative, the dose of oxycodone was decreased by 0.02 mg/kg in the next child. Positive response to tracheal intubation was defined as increase in MAP and/or HR and increase in the peak value exceeding 20% of the pre-intubation level within 3 min after tracheal intubation. The aforementioned process was repeated until 7 negative and positive reactions crossed, and then the test was stopped. The median effective dose (ED 50) and 95% confidence interval of oxycodone were calculated by Probit method. Results:The ED 50 (95% confidence interval) of oxycodone inhibiting responses to the tracheal intubation were 0.280 (0.247-0.301) mg/kg, 0.321 (0.304-0.342) mg/kg and 0.354 (0.342-0.368) mg/kg in I, Y and P groups, respectively. The ED 50 of oxycodone inhibiting responses to the tracheal intubation was gradually increased during induction of general anesthesia with increasing age ( P<0.05). Conclusions:For children aged 6 months to 6 yr, the potency of oxycodone in inhibiting responses to the tracheal intubation during general anesthesia induction gradually decreases with increasing age.

AIM:To investigate the effect of a disintegrin and metalloproteinase(ADAM)domain-like decy-sin 1(ADAMDEC1)knockdown on the proliferation,migration and invasion of pancreatic carcinoma cells.METHODS:Expression levels of ADAMDEC1 in pancreatic carcinoma tissues were analyzed using the GEPIA and UALCAN online da-tabases.Western blot analysis was employed to detect the protein expression levels of ADAMDEC1 in pancreatic carcino-ma cell lines(MIA PaCa-2 and PANC-1)and pancreatic ductal cell line(hTERT-HPNE).The effects of ADAMDEC1 knockdown on cell proliferation,migration and invasion were evaluated using CCK-8,colony formation,wound-healing and Transwell assays.Additionally,Western blot analysis was used to detect the effects of ADAMDEC1 knockdown on the expression levels of migration and invasion markers,as well as Wnt/β-catenin signaling pathway-related proteins in pancre-atic carcinoma cells.Furthermore,a recovery experiment was conducted to assess the role of Wnt/β-catenin signaling path-way agonist CHIR-99021 in ADAMDEC1 knockdown-induced inhibition of pancreatic carcinoma cell growth and migra-tion.RESULTS:(1)ADAMDEC1 was highly expressed in pancreatic carcinoma cells.(2)Knockdown of ADAMDEC1 led to a significant reduction in the proliferation,migration and invasion of pancreatic carcinoma cells.(3)Knockdown of ADAMDEC1 resulted in increased E-cadherin protein expression and decreased levels of matrix metalloproteinase 9,N-cadherin and vimentin proteins,alongside a reduction in the expression of Wnt/β-catenin signaling pathway-related pro-teins.(4)Co-treatment of pancreatic carcinoma cells with CHIR-99021 and ADAMDEC1 small interfering RNA reversed the inhibitory effects of ADAMDEC1 knockdown on cell proliferation,migration,and invasion.CONCLUSION:ADAMDEC1 is highly expressed in pancreatic carcinoma.Targeted silencing of ADAMDEC1 has the potential to inhibit the prolifera-tion,migration and invasion of pancreatic carcinoma cells by regulating the Wnt/β-catenin signaling pathway.

AIM:To investigate the impact and regulatory mechanisms of zinc finger protein 36-like protein 1(ZFP36L1)on pancreatic carcinoma cell growth.METHODS:The ZFP36L1 expression in pancreatic carcinoma and its correlation with patient prognosis were analyzed using online databases UALCAN and GEPIA.Western blot was utilized to detect ZFP36L1 protein expression in pancreatic ductal cells(HPNE)and three different pancreatic carcinoma cell lines.CCK-8 and cell colony formation assays were performed to evaluate the effects of ZFP36L1 on pancreatic cancer cell prolif-eration.Wound healing and Transwell assays were used to assess the impact of ZFP36L1 expression changes on pancreatic carcinoma cell migration and invasion.Flow cytometry experiments were used to analyze the effect of ZFP36L1 on the pan-creatic carcinoma cell cycle process.Bioinformatics analysis was conducted to predict potential ZFP36L1 interacting pro-teins.Co-immunoprecipitation experiments were carried out to confirm the interaction between ZFP36L1 and mitogen-acti-vated protein kinase 14(MAPK14).Rescue experiments were performed to assess the function of MAPK14 in ZFP36L1-regulated pancreatic carcinoma cell growth.RESULTS:(1)ZFP36L1 is highly expressed in pancreatic carcinoma and is positively correlated with poor prognosis in pancreatic carcinoma patients.Compared to HPNE,ZFP36L1 is highly ex-pressed in MIA PaCa-2 and ASPC-1 cells,but relatively low in PANC-1 cells.(2)ZFP36L1 overexpression significantly increased the cell viability,colony formation,migration,and invasion abilities of PANC-1 and MIA PaCa-2 cells,while siRNA interference of ZFP36L1 led to opposite results.(3)ZFP36L1 promotes the entry of pancreatic carcinoma cells into the S phase of the cell cycle.(4)ZFP36L1 interacts with MAPK14 to regulate pancreatic cancer cell growth.MAPK14 overexpression reversed the cell viability and migration abilities of pancreatic carcinoma cells overexpressing ZFP36L1.Furthermore,it also decreased the cell viability and migration abilities of pancreatic carcinoma cells with ZFP36L1 inter-ference.CONCLUSION:ZFP36L1 is a potential oncogene in pancreatic carcinoma growth and may regulate pancreatic carcinoma cell growth through cell cycle modulation and interaction with MAPK14.

Nucleotide excision repair was a complex biochemical process that involved in the repair of many kinds of DNA damage. Previous study suggested that xeroderma pigmentosum group C (XPC) gene played an important role in the process of DNA damage repair. This study aimed to explore the influence of XPC gene polymorphism on the prognosis of patients with colorectal cancer (CRC) who were treated with capecitabine-related adjuvant chemotherapy. METHODS: A total of 158 patients with CRC who received surgical resection and capecitabine-based adjuvant chemotherapy were included in this study consecutively. Baseline clinical characteristics of patients were collected and analyzed. Additionally, peripheral blood specimens of the patients were collected for polymorphism analysis of XPC gene and mRNA expression of XPC, respectively. The association analysis between XPC polymorphism and prognosis and mRNA expression was performed. Cox regression analysis was used for multivariate adjustment. RESULTS: Prognostic data in the 158 patients with CRC who received capecitabine-based adjuvant chemotherapy was collected retrospectively. The median follow-up duration of the patients was 5.0 years (range: 0.25-7.5 years). The median DFS and OS of the 158 patients with CRC was 4.5 years and 5.7 years, respectively. XPC polymorphism analysis suggested that rs2228001 was of clinical significance. The prevalence of rs2228001 polymorphism among CRC patients was: TT genotype 86 cases (54.4%), TG genotype 60 cases (38.0%) and GG genotype 12 cases (7.6%), resulting in a minor allele frequency of 0.27, which was in accordance with Hardy-Weinberg equilibrium (P=0.733). TG and GG genotypes were merged in the subsequent analysis. The prognostic results exhibited that the median DFS of patients with TT genotype and TG / GG genotype was 4.5 and 5.7 years, respectively (c

Objective:To compare the efficacy of different drugs in reducing incidence of emergence agitation after tonsillectomy and adenoidectomy in the pediatric patients.Methods:Cochrane Library, PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Databases were searched from inception to July 2023 for the randomized controlled trials involving interventions to reduce the incidence of emergence agitation after tonsillectomy and adenoidectomy in pediatric patients. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. STATA 17.0 software was used to conduct a network meta-analysis according to the frequency-ology framework.Results:Twenty randomized controlled trials were finally included, involving 1 687 patients. Compared with placebo, 10 interventions could reduce the incidence of emergence agitation in pediatric patients after tonsillectomy and adenoidectomy, and the order of probability was as follows: dexmedetomidine ( OR and 95% confidence interval [ CI] 0.13 [0.09-0.20]), ketamine ( OR and 95% CI 0.15 [0.08-0.26]), clonidine ( OR and 95% CI 0.15 [0.05-0.50]), tramadol ( OR and 95% CI 0.16 [0.04-0.61]), remazolam ( OR and 95% CI 0.17 [0.06-0.47]), afentanil ( OR and 95% CI 0.22 [0.08-0.62]), remifentanil ( OR and 95% CI 0.24 [0.12-0.48]), desocine ( OR and 95% CI 0.29 [0.12-0.69]), fentanyl ( OR and 95% CI 0.31 [0.19-0.52]) and propofol ( OR and 95% CI 0.46 [0.24-0.86]). Four interventions cloud reduce the usage rate of postoperative rescue drugs, and the probability was ranked as follows: dexmedetomidine ( OR and 95% CI 0.19 [0.11-0.32]), tramadol ( OR and 95% CI 0.20 [0.10-0.42]), ketamine ( OR and 95% CI 0.49 [0.28-0.86]) and fentanyl ( OR and 95% CI 0.49 [0.32-0.77]). One intervention cloud reduce the incidence of postoperative nausea and vomiting: dexmedetomidine ( OR and 95% CI 0.54 [0.31-0.94]). Conclusions:Dexmedetomidine provides the best effect in reducing the incidence of emergence agitation after pediatric tonsillectomy and adenoidectomy.

The clinical application of immune checkpoint inhibitors (ICIs) has significantly improved the prognosis of hepatocellular carcinoma (HCC) patients. With the widespread applica-tion of ICIs in HCC, the management of immune-related adverse events (irAE) gained more and more attention. However, the complicated disease characteristics and various combination therapies in HCC throw out challenges to irAE management. Therefore, the editorial board of the 'Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors (2021 edition)' organizes multidisciplinary experts to discuss and formulate this consensus. The consensus focuses on issues related to HCC irAE manage-ment, and puts forward suggestions, in order to improve standardized and safety clinical medication, so as to maximize the benefits of immunotherapy for patients.

Objective:To explore the diagnostic value of the combined detection of galactomannan (Gm) in bronchoalveolar lavage fluid (BALF) and IgG of aspergillus fumigatus in blood for pulmonary aspergillosis.Methods:Seventy-four patients with pulmonary aspergillosis admitted to Haiyan People′s Hospital from February 2017 to September 2019 were divided into chronic pulmonary aspergillosis group (35 cases) and invasive pulmonary aspergillosis group (39 cases). The BALF of ttwo groups were collected, the Gm level of BALF was tested, and the IgG level of blood aspergillus fumigatus was detected by using the aspergillus IgG enzyme-linked immunosorbent assay (ELISA) kit, and the positive prediction rate, negative prediction rate, diagnostic sensitivity, specificity and accuracy of the two methods was compared.Results:The Gm I value of BALF and the IgG level of blood in invasive pulmonary aspergillosis group were lower than those in chronic pulmonary aspergillosis group: 0.65 ± 0.09 vs. 0.98 ± 0.12, (118.95 ± 12.31) kAU/L vs. (147.63 ± 15.32) kAU/L, and there were significant differences ( P<0.05). The positive predictive rate and negative predictive rate in combined detection of detection of GMI and IgG in BALF and blood were significantly higher than those in the single detection of GMI and IgG in BLAF and blood: 92.50%(37/40) vs. 61.90%(26/42) and 61.54%(24/39), 88.24%(30/34) vs. 53.13%(17/32) and 51.43%(18/35), and there were significant differences ( P<0.05). There was a certain correlation between the severity of pulmonary aspergillosis and the Gm I value of BALF and the IgG level of blood aspergillus fumigatus. The sensitivity and accuracy of the diagnosis in combined detection of Gm I and IgG in BALF and blood were higher than those in the single detection of Gm I and IgG in BALF and blood: 92.86%(39/42) vs. 65.00%(26/40) and 67.57%(25/37), 83.78%(62/74) vs. 75.68%(56/74) and 75.68%(56/74), the diagnostic specificity was lower than that of the single detection of GM I and IgG in BALF and blood: 71.88%(23/32) vs. 88.24%(30/34) and 83.78%(31/37), and there were significant differences ( P<0.05). Conclusions:There is a certain correlation between Gm in BALF and aspergillus fumigatus IgG in blood and the symptoms of pulmonary aspergillosis. The combined detection of Gm in BALF and aspergillus fumigatus IgG in blood is of great significance for the clinical diagnosis and treatment of pulmonary aspergillosis.