Objective:To investigate the effects of extracorporeal carbon dioxide removal (ECCO 2R) combined with continuous renal replacement therapy (CRRT) on respiratory efficiency and diaphragm function in patients with acute respiratory distress syndrome (ARDS) received mechanical ventilation. Methods:A prospective randomized controlled study was conducted. Sixty patients with mild to moderate ARDS admitted to the department of respiratory and critical care medicine of Henan Provincial People's Hospital from January 2019 to January 2021 were enrolled, and they were divided into observation group and control group according to the random number table method, with 30 cases in each group. All patients received antibiotics, anti-inflammatory, and mechanical ventilation therapy. On this basis, the observation group received ECCO 2R and CRRT, while the control group received bedside CRRT. Baseline data including gender, age, etiology, acute physiology and chronic health evaluationⅡ(APACHEⅡ), etc., were recorded. Arterial blood gas analysis [including arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2), and oxygenation index (PaO 2/FiO 2)] was performed at 12 hours and 24 hours during the treatment, and respiratory mechanics parameters [including tidal volume, respiratory rate, maximum expiratory pressure (MEP), and maximum inspiratory pressure (MIP)] were recorded, and rapid shallow breathing index (RSBI) was calculated. The levels of glutathione peroxidase (GSH-Px), malondialdehyde (MDA), and superoxide dismutase (SOD) in serum were detected by enzyme-linked immunosorbent assay (ELISA). Diaphragm thickness and diaphragm activity were measured by ultrasonography at 24 hours during the treatment. Results:There were no significantly differences in age, gender, etiology, and APACHEⅡ score between the two groups, indicating that the baseline data of the two groups were balanced and comparable. Compared with the 12 hours after treatment, the PaO 2 and PaO 2/FiO 2 in the observation group significantly increased, PaCO 2 significantly decreased, RSBI significantly decreased, MEP and MIP significantly increased, and serum GSH-Px and MDA significantly decreased, while SOD significantly increased at 24 hours during the treatment. In the control group, only PaCO 2 significantly decreased. Compared with the control group, the PaCO 2 significantly decreased in the observation group at 12 hours and 24 hours [mmHg (1 mmHg≈0.133 kPa): 55.05±7.57 vs. 59.49±6.95, 52.77±7.88 vs. 58.25±6.92, both P < 0.05], but no significantly differences in PaO 2 and PaO 2/FiO 2. Compared with the control group, the observation group showed significant decreases in RSBI at 12 hours and 24 hours (times·min -1·L -1: 85.92±8.83 vs. 90.38±3.78, 75.73±3.86 vs. 90.05±3.66, both P < 0.05), significant increases in MEP and MIP [MEP (mmH 2O, 1 mmH 2O≈0.01 kPa): 86.64±5.99 vs. 83.88±4.18, 93.70±5.59 vs. 85.04±3.73; MIP (mmH 2O): 44.19±6.66 vs. 41.17±3.13, 57.52±5.28 vs. 42.34±5.39, all P < 0.05], and significant decreases in serum GSH-Px and MDA [GSH-Px (mg/L): 78.52±8.72 vs. 82.10±3.37, 57.11±4.67 vs. 81.17±5.13; MDA (μmol/L): 7.84±1.97 vs. 8.71±0.83, 3.67±0.78 vs. 8.41±1.09, all P < 0.05], as well as a significant increase in SOD (U/L: 681.85±49.24 vs. 659.40±26.47, 782.32±40.56 vs. 676.65±51.97, both P < 0.05). Compared with the control group, the observation group showed significant increases in diaphragm thickness and diaphragm activity at 24 hours of treatment [diaphragm thickness (cm): 1.93±0.28 vs. 1.40±0.24, diaphragmatic thickening fraction: (0.22±0.04)% vs. (0.19±0.02)%, quiet breathing diaphragm displacement (cm): 1.42±0.13 vs. 1.36±0.06, deep breathing diaphragm displacement (cm): 5.11±0.75 vs. 2.64±0.59, all P < 0.05]. Conclusion:ECCO 2R combined with CRRT can reduce work of breathing and oxidative stress levels in ARDS patients receiving non-invasive ventilation, and protect diaphragm function.

Femoral head fracture combined with posterior hip dislocation is a serious traumatic condition. Conservative treatment has a long time of bed rest, and may cause muscle apraxia atrophy, hypostatic pneumonia, deep vein thrombosis of the lower limbs, or pulmonary embolism, which has poor clinical efficacy. Therefore, surgical treatment is the first choice for femoral head fracture combined with posterior hip dislocation. The direct anterior approach of the hip can better expose Pipkin type I and type II femoral head fractures without the need to dislocate the hip completely. However, the disadvantage is that it destroys the structural integrity of the anterior hip joint, which increases the risk of femoral head necrosis and heterotopic ossification to a certain extent. The medial approach can also be chosen for Pipkin type I and II fractures, but it is important to avoid damaging the integrity of the fascial layer, some small vascular branches can be ligated, and injury to the medial rotary femoral artery should be avoided. The lateral approach is considered to be an effective treatment for Pipkin type III fractures, but there is limited exposure of the posterior acetabular injury and a risk of injury to the superior gluteal vessels and nerves, which may be secondary to adductor weakness postoperatively. The posterior approach is the main surgical approach for type IV Pipkin fracture. The classic posterior lateral approaches mainly include the Kocher - Langenbeck approach and the Ganz surgical dislocation approach. The Kocher - Langenbeck approach does not destroy the abductors and is particularly suitable for patients with posterior hip dislocation and difficult to reposition. Ganz surgical approach protects the blood supply of the medial femoral circumcator artery, so the incidence of femoral head necrosis is low. It can achieve all-round visualization of the femoral head and acetabulum, comprehensively evaluate the lesions of the femoral head and acetabulum, and find the occult injuries missed in imaging examinations..

Objective:To explore the efficacy and safety of transurethral anatomical vapor incision technique of prostate (VIT) with six-step method high power side-emitting greenlight laser in the treatment of benign prostatic hyperplasia (BPH).Methods:A retrospective analysis of 82 patients with BPH who used high power side-out green laser in the treatment from October 2018 to June 2020 in Gongli Hospital of Naval Medical University was performed. Among them, 40 patients were treated with six-step method VIT, and 42 patients were treated with photoselective vaporization of prostate (PVP). The two groups of patients were compared in age [(71.1±8.7)years vs.(72.1±7.0)years], prostate volume [75 (68.25, 89.00) ml vs. 73 (63.25, 85.00) ml], and peak urinary flow rate (Q max) [6.20 (5.20, 8.20) ) ml/s vs. 5.9 (4.75, 7.50) ml/s], post-void residual volume (PVR) [74.00 (42.50, 103.75) ml vs. 67.00 (58.00, 84.50) ml], international prostate symptom score (IPSS) [(21.2±5.2) vs. ( 21.0±3.9)], quality of life score (QOL) [5 (4, 6) vs. 5 (4, 6) ], prostate specific antigen (PSA) [6.20 (4.12, 8.43) ng/ml vs. 5.40 (3.88, 7.13) ng/ml ]. In general, there was no statistical difference ( P>0.05). The VIT group adopts the six-step method of marking, removing film, grooving, excision, trimming and crushing. In the PVP group, the prostate tissue was uniformly vaporized layer by layer from the inside to the outside. Perioperative indexes and complications were compared between the two groups. The Q max, IPSS, QOL, PVR and PSA between the two groups before and 3 months after surgery were compared. Results:All patients in the VIT group and PVP group successfully completed the surgery, and there was no case of transfer to TURP or open surgery. The average operation time was [60.00(50.00, 73.75)min vs. 70.00(50.00, 73.75)min] ( P<0.05). There was no significant difference in the amount of postoperative hemoglobin decline[15.00(10.00, 17.75)g/L vs. 16.00(14.00, 19.25)g/L], average bladder irrigation time[1(1, 1)d vs. 1(1, 1)d], indwelling catheterization time[3(3, 3)]d vs. 3(3, 3)d] and hospitalization time in patients after operation[4(3, 4)d vs. 4(4, 4)d] ( P>0.05). All patients had no blood transfusion, second bleeding, readmission, TURS, urethral stricture and urinary incontinence.There were 2 cases (5.0%) of postoperative urinary tract infection in the VIT group and 9 cases (21.4%) of postoperative urinary tract infection in the PVP group ( P<0.05), and they were cured after anti-inflammatory treatment. Three months after operation, Q max, IPSS, QOL, PVR and PSA in the two groups were significantly improved compared with preoperatively. Among them, the differences of IPSS [(5.7±2.5) points vs. (7.5±2.8) points] and PSA [2.65(2.10, 3.90)ng/ml vs. 4.00(2.45, 4.45)ng/ml] in the VIT group and PVP group after operation were statistically significant ( P<0.05). Conclusions:Applying the six-step method high power side-emitting greenlight laser transurethral anatomical VIT to treat BPH, there is less intraoperative and postoperative bleeding, short operation time, significant decrease in PSA, and fewer complications. It is a safe and effective minimally invasive technology for the treatment of BPH.

Purpose: Reduced quality of life after cystectomy has made bladder preservation a popular research topic for muscle-invasive bladder cancer (MIBC). Previous research has indicated significant tumor downstaging after neoadjuvant chemotherapy (NAC). However, maximal transurethral resection of bladder tumor (TURBT) was performed before NAC to define the pathology, impacting the real evaluation of NAC. This research aimed to assess real NAC efficacy without interference from TURBT and apply combined modality therapies guided by NAC efficacy. Materials and Methods: Patients with cT2-4aN0M0 MIBC were confirmed by cystoscopic biopsy and imaging. NAC efficacy was assessed by imaging, urine cytology, and cystoscopy with multidisciplinary team discussion. Definite responders (≤ T1) underwent TURBT plus concurrent chemoradiotherapy. Incomplete responders underwent radical cystectomy or partial cystectomy if feasible. The primary endpoint was the bladder preservation rate. Results: Fifty-nine patients were enrolled, and the median age was 63 years. Patients with cT3-4 accounted for 75%. The median number of NAC cycles was three. Definite responders were 52.5%. The complete response (CR) was 10.2%, and 59.3% of patients received bladder-sparing treatments. With a median follow-up of 44.6 months, the 3-year overall survival (OS) was 72.8%. Three-year OS and relapse-free survival were 88.4% and 60.0% in the bladder-sparing group but only 74.3% and 37.5% in the cystectomy group. The evaluations of preserved bladder function were satisfactory. Conclusion After stratifying MIBC patients by NAC efficacy, definite responders achieved a satisfactory bladder-sparing rate, prognosis, and bladder function. The CR rate reflected the real NAC efficacy for MIBC. This therapy is worth verifying through multicenter research.

Objective: The purpose of this study is to investigate the expression change of cell cycle-related molecules in platal tissue of fetal mice with cleft palate, induced by 2, 3, 7, 8-Tetrachlorodibenzo-p-dioxin (TCDD), and to explore the mechanism of cell cycle-related molecules in cleft palate. Methods: In vivo, 48 pregnant mice were randomly divided into TCDD treatment group and control group with Random number table, 24 mice in each group. On the embryonic day 10.5 (E10.5), pregnant mice were orally administrated with TCDD 28 μg/kg (containing 5 μg/ml TCDD of corn oil) in TCDD treatment group. The same volume of corn oil was given to the mice in control group. The pregnant mice in each group were sacrificed on E13.5, E14.5 and E15.5, to collect the fetal palates for analysis. Fetal palates were used to extract total RNA and total protein, so as to detect the expression levels of cell cycle-related molecules, using RT-PCR and western blotting respectively. In vitro, human kidney embryo 293t (HEK293t) cells were treated with different concentrations of TCDD (0.01, 0.1, 0.5 and 1 nmol/L), and cells proliferation activity was detected using MTT assay. Statistical analysis was performed with IBM SPSS 24.0. Kolmogorov-Smimov test was used for normal distribution check, and the distribution was normal. Independent t-test was carried out among two groups. P<0.05 was considered statistically significant. Results: At E13.5, E14.5 and E15.5, the expression level of interferon regulatory factor 6 (Irf6) protein were higher in the control group (1.26 ± 0.13, 1.67 ± 0.14 and 1.42 ± 0.15, respectively) compared to that in the TCDD group (0.81 ± 0.08, 1.04± 0.02 and 0.86 ± 0.12, respectively), on each time point (t value were 2.836, 3.662 and 2.867, respectively; P values were 0.0471, 0.0146 and 0.0241, respectively). The expression level of cyclin-dependent kinase inhibitor 1A (P21) protein on E13.5 and E14.5 of the control group (2.26 ± 0.21, 1.99 ± 0.21)were higher than that in the TCDD group on each time point(1.43 ± 0.12、0.93 ± 0.22), (t value were 3.398 and 3.378; P value were 0.8726 and 0.0273). The expression level of cyclin D1 in the control group (1.00±0.02, 0.94±0.03 and 1.11±0.09, respectively)were higher than that of the TCDD group (0.28±0.01, 0.33±0.06 and 0.88±0.01, respectively) on each time point (t value are were 22.53, 22.35 and 14.27, respectively, P value <0.001, <0.001 and<0.001, respectively). The expression of cyclin E1, cyclin A2, cyclin B1, CDK6, CDK2 and CDK1 in TCDD groups were higher than that of the controls (P<0.05). However, there was no significant difference of cyclin B1 on E13.5 and Cdk2 on E15.5. As treatment with TCDD (0.1 nmol/L) at 1, 2 and 3 days (0.70 ± 0.05, 1.05 ± 0.03 and 1.39 ± 0.04, respectively), the proliferation of HEK293t cells increased compared with the control group (0.49 ± 0.04, 0.98 ± 0.03 and 1.55 ± 0.02, respectively). The differences were statistically significant (t value were 2.829, 1.395 and 2.692, respectively; P value were 0.0198, 0.1320 and 0.0247, respectively). Conclusions TCDD down-regulates Irf6 and P21, and interferes with the normal expression of cell cycle-associated molecules, which in turn interferes with medial edge epithelia (MEE) cells cycle arrest and proliferation. These indicate that the disorder of spatiotemporal expression of cell cycle-related molecules during palatal development may be involved with the mechanism of TCDD-induced cleft palate..

Objective To improve the accuracy of preoperative diagnosis of renal vein tumor thrombus in renal cell carcinoma (RCC),the clinical characteristics of RCC with misdiagnosis of renal vein tumor thrombus (RVTT) were analyzed.Methods Clinical data of 128 patients with RCC accompanied with RVTT from January 2000 to September 2015 were studied retrospectively.According to whether RVTT failed to be detected preoperatively,all patients were divided into 39 cases of misdiagnosis group and 89 cases of no misdiagnosis group.Forty cases of RCC with pathologically confirmed no RVTT were selected as no tumor thrombus group from January 2015 to June 2015.Misdiagnosis group included 29 males and 10 females,with age of (61.4 ± 11.1) years old,body mass index of (26.74 ±3.12) kg/m2,KPS ＜80 in 2 cases,paraneoplastic syndrome and Mayo grade 0 in 1 case.No misdiagnosis group consisted of 74 males and 15 females,with age of (60.2 ± 9.7) years old,body mass index of (25.12 ± 1.93) kg/m2,KPS ＜ 80 in 5 cases,paraneoplastic syndrome and Mayo grade 0 in 7 cases.No tumor thrombus group comprised of 31 males and 9 females,with age of (59.5 ± 10.7) years old,body mass index of (24.48 ± 2.56) kg/m2,KPS ＜ 80 in 3 cases,and paraneoplastic syndrome in 3 cases.There was no significant difference in general clinical data between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group (P ＞ 0.05).The tumor location,tumor diameter and imaging data were compared between misdiagnosis group and no misdiagnosis group,and misdiagnosis group and no tumor thrombus group.Results There was no significant difference in term of tumor locating in the middle pole [56.4％ (22/39) vs.38.2％ (34/89)],tumor with collateral vessels [33.3％ (13/39) vs.31.5％ (28/89)] and renal vein contrast agents filling defect [42.9％ (9/21) vs.61.8％ (21/34)] between misdiagnosis group and no misdiagnosis group (P ＞ 0.05).The proportion of renal tumor locating in the middle pole,tumor with collateral vessels and renal vein contrast agents filling defect in misdiagnosis group was significantly higher than that of no tumor thrombus group [30.0％ (12/40),P =0.018;10.0％ (4/40),P =0.012;16.7％ (4/24),P =0.002].Conclusions RVTT is vulnerable of misdianosis in RCC.It should be alert to the possibility of complicating tumor thrombus in the presence of renal tumor locating in the middle pole,renal tumor with collateral vessels and renal vein contrast agents filling defect.The clinical understanding of these features should be improved.

Objective To investigate the biodistribution of 18F-Alfatide II in patients with breast diseases and to compare its uptake with 18F-fluorodeoxyglucose(FDG)uptake.Methods A total of 44 female patients(age:(50.7±8.0)years)with clinically suspected breast cancer from December 2015 to May 2017 were prospectively enrolled and underwent 18 F-Alfatide II and 18F-FDG PET/CT prior to treatment.By drawing regions of interest in normal organs and breast lesions,differences between 18F-Alfatide II uptake and l8F-FDG uptake were evaluated in all patients.Paired t test,two-sample t test and Wilcoxon rank sum test were used for data analysis.Results There were 53 breast lesions confirmed by histopathology in 44 patients.Among them,42 lesions were malignant and the others were benign.The uptake of 18F-Alfatide II was very low in the brain,vocal cords,lungs,blood pool and muscle.But the renal cortex and bladder had high 18F-Alfatide II accumulation.Different levels of 18F-Alfatide II uptake were found in other normal organs including normal breast tissue.There were differences(t values:2.04-41.65,all P<0.05)between 18F-Alfatide II and 18F-FDG maximum standardized uptake value(SUVmax)and mean standardized uptake value(SUVmean)in many normal organs except for the choroid plexus,salivary glands,liver,colon and normal breast tissue.The uptake of 18F-Alfatide II was significantly lower than 18F-FDG in breast cancer lesions(SUVmax:3.77±1.78 vs 7.37±4.48,SUVmean:2.25±0.98 vs 4.54±2,82;t values:4.89,4.82,both P< 0.05),but it was still higher in benign breast lesions(SUVmax:2.37±1.62,SUVmean:1.50±0.92;t val-ues:2.35,2.29,both P<0.05).Also,target/non-target(T/NT)of 18F-Alfatide II in breast cancer lesions was higher than that in benign breast lesions(5.32±3.08 vs 2.60±2.37;t = 2.72,P<0.05).Condusion The biodistribution of 18F-Alfatide II in patients is favorable and 18F-Alfatide II can be clinically used for breast cancer imaging.

Objective To analyze the correlation of serum levels of galectin-3(Gal-3), N-terminal pro brain natriuretic peptide(NT-proBNP),brain natriuretic peptide(BNP)and C reactive protein(CRP)with prognosis of patients with decompensated acute attack of chronic heart failure (DAACHF),and to evaluate its significance in predicting mortality during 30-day hospitalization. Methods 103 DAACHF patients admitted in Peking University First Hospital and Capital Medical University-affiliated Beijing Anzhen Hospital Department of Cardiology from July 2012 to June 2015 were divided into death group(n=53,died of DAACHF)and survival group(n=50)matched for age, gender,cardiac function during 30-day hospitalization.Serum levels of Gal-3,NT-proBNP,BNP,CRP and the Minnesota Living with Heart Failure Questionnaire(MLHFQ)were retrospectively collected and compared on the first hospital day and 3 days,7 days,14 days after treatment.After 7 days of treatment,the serum levels of four markers were correlated with MLHFQ.The areas under the receiver operating characteristic(ROC)curve were used for estimating efficiencies of serum levels of four markers in predicting DAACHF patients' mortality during 30-day hospitalization. Results With prolonged treatment,the scores of Gal-3,NT-proBNP,BNP,CRP and MLHFQ were gradually increased in the group of death,and gradually decreased in survival group.The scores of Gal-3,NT-proBNP,BNP,CRP and MLHFQ were higher in the death group than in control group(P<0.05)at the day of hospital admission and at 3 days,7 days and 14 days after treatment(P<0.05).On 7 days after treatment,Gal-3,NT-proBNP, BNP,and CRP were positively correlated with MLHFQ score(r=0.748,0.730,0.6872,all P<0.01),and the areas under ROC curves predicting performance for mortality during 30-day hospitalization were 0.943, 0.907,0.876,0.867,0.913 for Gal-3,NT-proBNP,BNP,CRP and MLHFQ score,respectively,all P<0.01). Conclusions Serum levels of Gal-3,NT-proBNP,BNP and CRP were positively correlated with adverse prognosis for DAACHF patients,and they may be predictors of mortality during 30-day hospitalization with sequence effect of Gal-3>NT-proBNP>BNP>CRP.And their joint monitoring is better in predicting the prognosis of patients with heart failure.

BACKGROUND:The infection after spinal internal fixation was its serious complications. A number of studies have shown that erythrocyte sedimentation rate and C-reactive protein are of great importance in judging infections. OBJECTIVE:To analyze the trend of change of erythrocyte sedimentation rate and C-reactive protein for patients without infection after the cervical fixation. METHODS:Total y 56 patients, who underwent cervical fixation from October 2013 to July 2014, were retrospectively analyzed, and then divided into anterior cervical group (n=29) and posterior cervical group (n=27). Patients in the anterior cervical group underwent anterior cervical decompression bone graft internal fixation. Patients in the posterior cervical group underwent posterior cervical unilateral open door decompression internal fixation. The peripheral blood was col ected before fixation and at the early morning of the 1, 3, 6, 9 days after fixation. Erythrocyte sedimentation rate and C-reactive protein values were determined. The fol ow-up of patients was more than one year. Signs of infection did not appear. RESULTS AND CONCLUSION:(1) General rule:After the cervical fixation, the erythrocyte sedimentation rate was increased significantly and reached a peak on postoperative day 6. The peak level gradual y decreased but has not returned to normal at the 9 postoperative days. The C-reactive protein increased significantly on the first postoperative day and reached a peak on postoperative day 3. The peak level rapidly decreased but has not returned to normal at the 9 postoperative days. The level of erythrocyte sedimentation rate of patients in the posterior cervical group was significantly higher than that in the anterior cervical group at 3, 6 and 9 days after internal fixation (P<0.05). There was no significant difference in the C-reactive protein between these two groups (P>0.05). (2) These results demonstrate that C-reactive protein is an important indicator of monitoring the inflammatory response of patients after cervical internal fixation, which was conductive to the judgment of early infection after internal fixation. The abnormal inflammatory indices of erythrocyte sedimentation rate and C-reactive protein do not suggest a presence of blade infection after internal fixation. C-reactive protein can reach the peak at 3 days after fixation. It is recommended to check blood at 2 and 3 days. If there is no apparent rebound, then the possibility of infection is smal . It may indicate the presence of infection if the inflammatory indices increased again or decreased slowly after the decrease.

AIDS-Related Opportunistic Infections ; diagnosis ; Humans ; Oral Medicine ; Sarcoma, Kaposi ; diagnosis