Follow-up testing of viral nucleic acid in discharged patients with moderate type of COVID-19 / 浙江大学学报·医学版

OBJECTIVE@#To investigate the clinical outcome of patients with moderate type of coronavirus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.@*METHODS@#Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantined in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the quarantined period, the symptoms and signs were documented, and sputum or nasal swab and feces samples were collected to test SARS-CoV-2 nucleic acid by RT-PCR method.@*RESULTS@#There was no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-CoV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.@*CONCLUSIONS@#There is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.

Follow-up testing of viral nucleic acid in discharged patients with moderate type of 2019 coronavirus disease (COVID-19) / 浙江大学学报·医学版

OBJECTIVE@#To investigate the clinical outcome of patients with moderate type of corona virus disease 2019 (COVID-19) after discharge by retesting viral nucleic acid.@*METHODS@#Seven patients with moderate COVID-19 met the discharge criteria enacted by National Health Commission were quarantine in hospital for 7 days, then continuously quarantined at home for 4 weeks after discharged. During the three weeks of quarantined period, the symptoms and signs were documented; and sputum or nasal swab and feces samples were collected to test SARS-COV-2 nucleic acid by RT-PCR method.@*RESULTS@#There were no symptoms and signs during the quarantine period in all 7 patients. However, respiratory swabs from 3 patients were confirmed positive of SARS-COV-2 nucleic acid at 5 to 7 days after they met the discharge criteria.@*CONCLUSIONS@#The study indicates that there is a relatively high incidence of positive viral nucleic acid in patients met the discharge criteria, and it is suggested that patients met the current discharge criteria should be quarantined in hospital for another 7 days and the follow-up viral testing is necessary.

Effects of general anesthesia maintenance without muscle relaxants for double-balloon enteroscopy:a randomized controlled trial / 中华消化内镜杂志

Objective To evaluate the feasibility and safety of maintaining general anesthesia without neuromuscular blockade in oral double-balloon enteroscopy. Methods Totally 120 patients undergoing oral double-balloon enteroscopy under general anesthesia were randomly assigned into two groups:the observation group and the control group. The observation group was not given muscle relaxants for anesthesia maintenance,while the control group was given muscle relaxants punctually. Observation indexes were monitored,including the mean arterial pressure (MAP),heart rate (HR),peak airway pressure (Ppeak)and end-tidal CO2 partial pressure (PETCO2 )before anesthesia (T0),immediately after intubation (T1),at the time of endoscopy placement (T2),at the end of endoscopy withdrawal (T3),and at the time of waking-up (T4). The cases of spontaneous breathing recovery before the end of endoscopy,postoperative recovery time,extubation time,length of PACU stay,postoperative adverse reactions and satisfactory rates were recorded. Results Twelve cases were removed by the exclusion criteria,and the remaining 108 cases completed the study,including 56 cases in the observation group and 52 cases in the control group. The one-time success rate of induction was both 100％ in the two groups. There were no significant differences in MAP,HR,Ppeak,and PETCO2 between the two groups at each observation point (all P>0. 05),and the same is true for within group comparison with T0 (all P>0. 05). The recovery rate of spontaneous respiration in the observation group was significantly higher than that in the control group [100％ (56/ 56)VS 42％(22/ 52),χ2 = 44. 73,P = 0. 000]. The awaken time,extubation time and length of PACU stay were 6±2 min,10±3 min,and 11± 4 min,respectively,in the observation group,compared with 15± 5 min (t= -12. 64,P= 0. 000),17±5 min (t = -8. 90,P = 0. 000),and 17±7 min (t = -5. 73,P = 0. 000)in the control group. None of the patients required assisted ventilation. Hypoxemia occurred in 2 cases and nausea in 3 cases in the control group,while only nausea occurred in 1 patient in the observation group. The overall incidence of adverse reactions was not statisticaly different between the two groups (P > 0. 05). Anesthesia satisfaction rate of two groups was 100％. Conclusion It is feasible and safe to perform oral double-balloon enteroscopy without muscle relaxants during maintaining under general anesthesia,with quick recovery of spontaneous breathing and awakening,early extubation and less cost.

Effects of general anesthesia maintenance without muscle relaxants for double-balloon enteroscopy: a randomized controlled trial / 中华消化内镜杂志

Objective@#To evaluate the feasibility and safety of maintaining general anesthesia without neuromuscular blockade in oral double-balloon enteroscopy.@*Methods@#Totally 120 patients undergoing oral double-balloon enteroscopy under general anesthesia were randomly assigned into two groups: the observation group and the control group. The observation group was not given muscle relaxants for anesthesia maintenance, while the control group was given muscle relaxants punctually. Observation indexes were monitored, including the mean arterial pressure (MAP), heart rate (HR), peak airway pressure (Ppeak) and end-tidal CO2 partial pressure (PETCO2) before anesthesia (T0), immediately after intubation (T1), at the time of endoscopy placement (T2), at the end of endoscopy withdrawal (T3), and at the time of waking-up (T4). The cases of spontaneous breathing recovery before the end of endoscopy, postoperative recovery time, extubation time, length of PACU stay, postoperative adverse reactions and satisfactory rates were recorded.@*Results@#Twelve cases were removed by the exclusion criteria, and the remaining 108 cases completed the study, including 56 cases in the observation group and 52 cases in the control group. The one-time success rate of induction was both 100% in the two groups. There were no significant differences in MAP, HR, Ppeak, and PETCO2 between the two groups at each observation point (all P>0.05), and the same is true for within group comparison with T0 (all P>0.05). The recovery rate of spontaneous respiration in the observation group was significantly higher than that in the control group [100% (56/56) VS 42% (22/52), χ2=44.73, P=0.000]. The awaken time, extubation time and length of PACU stay were 6±2 min, 10±3 min, and 11±4 min, respectively, in the observation group, compared with 15±5 min (t=-12.64, P=0.000), 17±5 min (t=-8.90, P=0.000), and 17±7 min (t=-5.73, P=0.000) in the control group. None of the patients required assisted ventilation. Hypoxemia occurred in 2 cases and nausea in 3 cases in the control group, while only nausea occurred in 1 patient in the observation group. The overall incidence of adverse reactions was not statisticaly different between the two groups (P>0.05). Anesthesia satisfaction rate of two groups was 100%.@*Conclusion@#It is feasible and safe to perform oral double-balloon enteroscopy without muscle relaxants during maintaining under general anesthesia, with quick recovery of spontaneous breathing and awakening, early extubation and less cost.

A simulation study on the features of the angle and bent length of lightwand for intubation in patients with ankylosing spondylitis / 中国医师进修杂志

Objective To investigate the effects of angle and length of lightwand in patients with ankylosing spondylitis (AS) using three-dimensional reconstruction based on computed tomography.Methods The head and neck helical computed tomography data of 53 patients with AS(AS group)and 60 common patients without cervical spine deformity (control group) were retrospectively analyzed.Reconstructed images, obtained by three-dimensional computed tomography reconstruction technique, were printed out by the ratio of 1:1.The endotracheal tube was used to simulate tracheal intubation in patient's computed tomography images.The length of tracheal tube from midpoint of glottis to upper central incisor(L),bend angle of tracheal tube(α),distance between the upper central incisor and root of epiglottis (D1) and distance between the root of epiglottis and midpoint of glottis (D2) were recorded.Results The α and D1in AS group were significantly bigger than those in control group:(89.57 ± 15.22)°vs.(67.65 ± 13.32)°and(8.11 ± 0.69)cm vs.(7.39 ± 0.58)cm,and there were statistical differences(P<0.05).There were no statistical differences in L and D2between 2 group(P>0.05).The α, L, D1and D2in male AS patients were significantly bigger than those in female AS patients:(90.78 ± 14.51)° vs.(81.57 ± 15.01)°, (12.84 ± 0.88)cm vs.(11.56 ± 1.17)cm, (8.18 ± 0.59)cm vs.(7.69 ± 0.64)cm and(3.22 ± 0.38)cm vs.(2.30 ± 0.29)cm,and there were statistical differences(P<0.05).Conclusions Compared with that of common patients, the bent angle on lightwand with AS patients is increased,which also can be affected by patients'gender.

Indirect Assessment of Daily Physical Activity Using Walking Indicators / 中国运动医学杂志

Objective To analyze the feasibility of using walking indicators to estimate other physical activity data,so as to provide evidences for the application of using walking monitoring tools to comprehensively assess the daily physical activity level.Methods Eighty participants were assessed 7 kinds of physical activities through wearing Cosmed K4b2 portable indirect calorimetry system and Actigraph GT3X accelerometer simultaneously.The indirect calorimetry was used as the criterion for measuring energy expenditure to develop individual equations using the vector magnitude (VM) as the independent variable.Then all participants were randomly divided into an experimental group(n=60) and a validation group (n=20).Omron HJ-113 pedometer and GT3X were then simultaneously worn to monitor their daily physical activities,with the wearing time of 3～4 days for the experimental group and 7 days for the validation group.Physical activity data were calculated using the individual equations.The correlation between walking indicators and the other physical activity data was analyzed in the experimental group,and the indicators of high correlation and application value were selected to develop equations to predict physical activity indicators.Then the data of the validation group were used to validate these equations.Results The correlation coefficients between daily steps and the moderate-to-vigorous physical activity(MVPA) time,MVPA volume,MVPA10 time and MVPA10 volume were 0.723,0.730,0.681 and 0.677 respectively(P＜0.01 for all).The correlation coefficient of the daily aerobic walking time to MVPA10 time and MVPA10 volume were 0.752 and 0.759 respectively(P＜0.01 for both).Six equations were developed based on these correlations(r2=0.55～0.63),and paired t test showed that there were no significant differences between the physical activity data predicted using these equations and the data measured by GT3X(P＞0.05).Moreover,Bland-Altman plot showed there was little predicted error for the 6 equations.Conclusion Walking indicators can indirectly reflect the overall physical activity level,and the equations developed in this study can be used to monitor the physical activity of larger samples.

A simulation study on the effects of the bent length and angle of lightwand: based on the upper airway on computed tomography images / 中国医师进修杂志

Objective To investigate the effects of angle and length of lightwand in three-dimensional reconstruction images of the upper airway based on computed tomography.Methods A total of 245 patients,aged 18-86 years,were scanned by helical computed tomography in the head and neck.Reconstructed images,obtained by Aw4.4 Workstation,were printed out by the ratio of 1 ∶ 1.The tracheal tube was used to investigate the anatomic structure of the upper airway.The length L and angle α of the tracheal tube were recorded.And two distances (D1,D2) and one angle (β) were recorded:D1,the distance between the upper central incisor and root of epiglottis;D2,the distance between the root of epiglottis and midpoint of glottis;angle β,the angle of line D1 and D2.Results The oα value in male patients was significant higher than that in female patients:(70.02 ± 15.49)° vs.(55.84 ± 14.70)°.The β value in male patients was significant higher than that in female patients:(129.74 ± 14.82)° vs.(120.40 ± 14.19)°.The L value in male patients was significant higher than that in female patients:(12.80 ± 0.85) cm vs.(11.50 ± 0.65) cm.The D1 and D2value in male patients were significant higher than those in female patients:(7.53 ± 0.66) cm vs.(6.76 ± 0.53) cm,(3.13 ± 0.52) cm vs.(2.45 ± 0.32) cm.There were significant differences (P ＜ 0.05).The 245 patients were classified to 2 groups by using the function of hierarchical cluster analysis in the statistical software.The α value in group 2 was significant higher than that in group 1:(75.45 ± 9.53)° vs.(48.17 ± 9.29)°.The 3 value in group 2 was significant higher than that in group 1:(136.27 ± 9.86)° vs.(112.31 ± 8.64)°.The age in group 2 was significant higher than that in group 1:(53.92 ± 19.64) years vs.(36.93 ± 17.21) years.Correlation analysis showed that in 245 patients,angle α was positively correlated to angle β and age (P ＜ 0.05),and angle β was positively correlated to age (P ＜ 0.05).Conclusions The bent length and angle on lightwand can be affected by both the patients' gender and ages.

Application of modified laryngeal mask airway combining fiberoptic bronchoscopy intubation in difficult airways / 临床麻醉学杂志

Objective To observe the clinical effect of modified laryngeal mask airway combining fiberoptic bronchoscope intubation in difficult airways.Methods Forty patients,21 males and 1 9 females,aged 30-55 years,ASA physical status Ⅰ or Ⅱ,scheduled for elective general anes-thesia surgery after failure to direct laryngoscope two attempts were randomly divided into two groups,20 cases in each group.Patients in group LMA-FOB underwent intubation with modified la-ryngeal mask airway combining fiberoptic bronchoscope,and patients in group FOB underwent intu-bation with fiberoptic bronchoscope.The fiberoptic bronchoscope score,the intubation time and the rate of successful intubation at first attempt were recorded.All the patients were followed up postop-eratively for adverse effects.Results The fiberoptic bronchoscope scores (Ⅰ/Ⅱ/Ⅲ/Ⅳ:1 5/4/1/0 vs. 8/4/5/3,P <0.05)and the rate of once successful intubation (90% vs.60%,P <0.05)was signifi-cantly higher,and the intubation time [(75 ± 20)s vs.(105 ± 25 )s,P < 0.05 ]was significantly shorter in group LMA-FOB than that in group FOB.In group LMA-FOB,one patient had blood stain in the LMA and one patient felt slight sore throat.There were no significant adverse effects in the two groups.Conclusion Modified Laryngeal mask airway combining fiberoptic bronchoscope intubation in difficult airways was effective to improve the grade of the view of the larynn and the success rate of intubation and shorten the intubation time.No significant adverse effect postoperatively was reported. It is relatively safe,effective and promising in patients with difficult airway.

Risk prediction of colorectal cancer with common genetic variants and conventional non-genetic factors in a Chinese Han population / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the association between multiple genetic loci identified by genome-wide association studies (GWASs) and colorectal cancer (CRC) risk, and whether these genetic factors, along with traditional risk factors, could contribute to the colorectal cancer risk prediction in a Chinese Han population.</p><p><b>METHODS</b>A case-control study (1 066 CRC cases and 3 880 controls) was initially conducted to assess the association between 21 recently discovered single-nucleotide polymorphisms (SNPs) and CRC risk. Genetic risk score (GRS) and weighted genetic risk score (wGRS) were calculated to evaluate the joint effects of selected loci. Multiple models combining genetic and non-genetic factors were established and receiver operating characteristic curve analysis was used to compare the discriminatory power of different predictive models.</p><p><b>RESULTS</b>There were 7 SNPs significantly associated with CRC susceptibility. As the GRS or wGRS increased, the risk of CRC also increased (trend P=0.002 6 for GRS, trend P<0.000 1 for wGRS). The ORs for highest versus lowest quartile of GRS and wGRS were 1.33 (95% CI: 1.12-1.58, P=0.001 0) and 1.76 (95% CI: 1.45-2.14, P<0.000 1) , respectively. The model incorporating wGRS and traditional risk factors, including sex, age, smoking and drinking, was the best one to predict CRC risk in this population, with an area under curve of 0.593 (95% CI: 0.573-0.613).</p><p><b>CONCLUSION</b>Multiple genetic loci identified by GWASs jointly influenced the CRC risk. The combination of genetic factors and conventional non-genetic factors improved the performance of risk predictive model for colorectal cancer.</p>

Role of spinal dopamine D2 receptors in a rat model of neuropathic pain / 中华麻醉学杂志

Objective To evaluate the role of spinal dopamine D2 receptors in a rat model of neuropathic pain.Methods Thirty healthy male Sprague-Dawley rats,aged 6-8 weeks,weighing 180-200 g,wcre randomly divided into 5 groups (n =6 each) using a random number table:control group (group C),sham operation group (group S),neuropathic pain group (group NP),normal saline group (group N) and dopamine D2 receptor agonist quinpirole group (group Q).Neuropathic pain was produced by chronic constriction injury of the sciatic nerve (CCI) in rats anesthetized with intraperitoneal 2％ pentobarbital sodium 40 mg/kg.At 7 days after CCI,normal saline 10 μl was injected intrathecally over 30 s in group N,and quinpirole 10 μg (in 10 μl of normal saline) was injected intrathecally over 30 s in group Q.At 1 day before CCI,3 and 7 days aher CCI,and 30 min and 1,2,4,8 and 16 h after administration,mechanical paw withdrawal threshold (MWT) and thermal paw withdrawal latency (TWL) were measured.Results There was no significant difference in MWT and TWL at each time point between group C and group S.MWT was significantly lower,and TWL was shorter at T1-8 in NP,N and Q groups than in C and S groups.Compared with group N,no significant change was found in MWT and TWL at each time point in N group,and MWT was significantly increased,and TWL was prolonged at T4-6 in group Q.Conclusion Inhibited function of spinal dopamine D2 receptors is involved in the maintenance of neuropathic pain in rats.

Analysis of the efficacy of repairing unilateral incomplete cleft lip with the straight line and the auxiliary incision of lip skin in 120 children / 中国基层医药

Objective To explore the effect of the straight line and the auxiliary incision of lip skin on repairing unilateral incomplete cleft lip.Methods 120 cases of unilateral incomplete cleft lip repaired with the straight line method and reconstruction of the orbicularis oris muscle with the auxiliary incision of lip skin.Results 2 cases of cleft relapse by tumble.The wound of 115 children were healed one stage.3 children were healed two stage.All children didn't present vermilion deficiency.The upper lip presented natural labial groove between affected and unaffected side.Both sides of nostrils were symmetry and scars were not ovbious.Conclusion This new method was simple and effective in repairing unilateral incomplete cleft lip.

Deletion of phoQ gene decreases the resistance of Pseudomonas aeruginosa to aminoglycoside antibiot-ics / 中华微生物学和免疫学杂志

Objective To analyze the sequences of two component signaling system PhoP/PhoQ encoding genes of Pseudomonas aeruginosa strains sensitive or resistant to aminoglycoside antibiotics and to determine the correlation between the PhoQ/PhoP and the resistance. Methods The segments of entire pimQ and phoP genes of P. aeruginosa were obtained by PCR and then sequenced after T-A cloning. Two prokaryotic expression systems of phoQ and phoP genes were constructed and the target recombinant expres-sion products rPhoQ and rPhoP were extracted by Ni-NTA chromatography. Rabbits were intracutaneoualy immunized with rPhoQ and rPhoP to obtain antisera and double immunodiffusion test was used to detect the titers of antisera. The phoQ genes of aminloglycoside antibiotics-resistant P. aeruginosa strains were knocked out by using Red recombination system, and phoQ mutants were identified by PCR plus sequencing and Western blot assay. Tube dilution method was applied to determine MIC values of wild and mutant strains of P. aeruginosa to four different aminoglycoside antibiotics. Results In comparison with the corresponding sequences in GenBank, the similarities of nueleotide and putative amino acid sequences of the cloned phop and phoQ genes were 98.7%-99.6% and 98.7%-100% , and 98.4%-99.8% and 99.1%-100%, respec-tively. Both rPhoQ and rPhoP were successfully expressed using pET-42a and E. coil BL21 DE3 system, and their rabbit antisera with 1 : 4 and 1 : 8 double immunodiffusion titers were also obtained. The deletion of phoQ genes and absence of the products in the two phoQ mutants were confirmed by PCR, sequencing and West-ern blot assay. MIC values of the four different aminoglycoside antibiotics to the two mutants were 1/512-1/2048 as those of their wild strains. Conclusion PboQ/PhoP is a sequence conserved two component sig-naling system of P. aeruginosa, and this system mediates resistance of the microbe to aminoglycoside antibiotics.

Determination of Serum Tryptophan and Kynurenine in Pregnant Women / 浙江中医药大学学报

[Objective] To establish a method for determination of serum tryptophan and kynurenine in pregnant women.[Method] RP-HPLC was applied to analysis.C18 column was used.The mobile phase was composed of methanol-0.001M KH2PO4(PH=4)(12∶88).The UV detection wave length was 245nm.[Results] The linear response ranged from 2.56～307.06?mol?L-1 for tryptophan, r=0.9999.The linear response ranged from 0.12～5.05?mol?L-1 for kynurenine, r=0.9997.The mean concentrations of serum tryptophan and kynurenine were 49.73?7.48?mol?L-1 and 0.74?0.33?mol?L-1 respectively in 30 pregnant women.[Conclusion] The method is sensitive and suitable for the determination.

The analysis of clinical factors affecting the therapeutic efficacy of traumatic optic neuropathy / 中华眼底病杂志

objective To evaluate the therapeutic efficacy of surgical and nonsurgical treatment and the clinical factors affecting the efficacy in traumatic optic neuropathy. Methods To analyse retrospectively the efficacy of recovery of visual acuity in 40 cases of traumatic optic neuropathy after treatment with transnasal endoscopic sphenoethmoidal optic canal decompression (28 cases) and drug therapy (12 cases). Results No significant difference existed between the therapeutic efficacy of surgery and that of drug therapy in patients with the visual acuity of LP～0.02. In surgery group,the therapeutic efficacy of the patients with visual acuity of LP～0.02 was better than that of the patients with no LP.The therapeutic efficacy of patients with duration shorter than seven days before sutgery is better than that of patients with duration longer than seven days. Conclusions The patients with serious traumatic comperssive optic neuropathy should not be treated with decompressive surgery and should not delay to at most seven days after injury.With or without the visual acuity of light perception of the affected eye surgery is usually an important factor affecting the therapeutic efficacy.

Methodological study of preparing iris pigment epithelial cells for autologous transplantation in rabbits / 中华眼底病杂志

Objective To explore a better method in obtaining iris pigment epithelium (IPE) specimen for autologous transplantation in rabbits. Methods IPE was obtained from 20 black rabbits with method A, i.e., surgical peripheral iridectomy at 12:00 position obtaining a triangle iris tissue with the hemline of 4-5 mm in left eyes,and method B,i.e., surgical peripheral iridectomy at 11:00 and 1:00 positions obtaining two triangle iris tissues with the hemlines of 2-2.5 mm in right eyes . The IPE cells were isolated precisely with enzyme microdissection-enzyme isolation method, cultured in vitro, observed with light and electronic microscope, and identified with immunocytochemical staining. Results The success rate of cells culture were 65% for method A and 95% for method B. After 3-4 generations of culturing,the amount of IPE cells was enough for transplantation, and most of the functions of primary clutured IPE cells were kept still. Viability of IPE cells was 85%-93%. Conclusion The success rate of cells culture for method B is higher than that for method A. The third generation of cultured cells is available for autologous transplantation.