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【Objective:】 To explore the ethical dilemmas faced by the critical care physicians in the process of practicing the right to informed consent in a region of Beijing. 【Methods:】 14 doctors in the critical care unit from 5 medical institutions in a certain region of Beijing were interviewed in depth face-to-face by qualitative research method. The data obtained were analyzed through coding, classification, and extraction of subjects. 【Results:】 The lack of trust in doctor-patient communication leads to the instrumentalization of the right to know. When the decision of family members is inconsistent with the patient’s right to life and health, doctors are faced with the dilemma of choice and its impact. 【Conclusions:】 Faced with such ethical dilemmas, it is suggested to rebuild doctor-patient trust through multiple measures, and make appropriate restrictions on the agent-executing of the right of informed consent.
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OBJECTIVE To analyze the changes of volatile co mponents in Olibanum and its processed products ，and to determine the contents of 4 components as octyl acetate. METHODS The volatile oil of Olibanum ，fried Olibanum and Olibanum stir-baked with vinegar were extracted. The components of volatile components were identified by GC-MS. The structure identification and data analysis of the chemical components with similarity ≥80％ were performed by using Xcalibur 4.0 software and NIST 2.0 mass spectrum database. The peak area normalization method was used to calculate the relative content of each component. GC method was adopted to simultaneously determine and compare the contents of limonene ，octyl acetate ，linalool and n-octanol in volatile components of Olibanum and its processed products. RESULTS Thirteen components were identified from volatile components of Olibanum ，fried Olibanum and Olibanum stir-baked with vinegar ，mainly including alcohols ，olefins and esters；among them ，relative contents of octyl acetate in Olibanum ，fried Olibanum and Olibanum stir-baked with vinegar were higher，which were 23.86％ ，37.80％ and 53.86％ respectively. The linear ranges of limonene ，octyl acetate ，linalool and n-octanol were 0.006 6-0.066 4，0.179 2 -1.792 0，0.003 7-0.037 0 and 0.032 8-0.328 0（r＞0.999 5）respectively；RSDs of precision，repeatability and stability （24 h）tests were all less than 2％；average recoveries were 98.56％，100.02％，99.13％ and 98.66％，respectively（RSD≤2.16，n＝6）. Average contents of 4 components in Olibanum were 0.15％，16.27％，0.36％ and 2.26％，while those of fried Olibanum were 0.85％，17.58％，0.66％ and 3.47％，respectively；those of Olibanum stir-baked with vinegar were 0.50％，19.75％，0.58％ and 3.34％，respectively. Compared with Olibanum ，average contents of octyl acetate ， linalool，n-octanol and limonene in volatile components of fried Olibanum and Olibanum stir-baked with vinegar were increased significantly（P＜0.05 or P＜0.01）. Compared with fried Olibanum ，average contents of limonene ，linalool and n-octanol were decreased significantly ，while those of octyl acetate were increased significantly （P＜0.05 or P＜0.01）. CONCLUSIONS After fried and stir-baked with vinegar ，the volatile components in Olibanum are similar ，but the relative contents are different ，and the contents of octyl acetate and other components are increased.
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Objective:To investigate the relationship between high mobility group protein box-1 (HMGB1) level in peripheral blood and no-reflow in patients with acute myocardial infarction after interventional therapy.Methods:120 patients with acute myocardial infarction patients who received interventional treatment in Liuzhou People's Hospital, China between October 2019 and October 2020 were included in this study. They were divided into normal blood flow group ( n = 78) and no-reflow group ( n = 42) according to the situation of coronary reflow after interventional treatment. The clinical data and laboratory test results were compared between the two groups. The level of HMGB1 in peripheral blood was detected using enzyme-linked immunosorbent assay and compared between the two groups. The diagnostic value of HMGB1 in no reflow was analyzed by the receiver operating characteristic (ROC) curve. Results:There were no significant differences in age, gender, history of hypertension, history of smoking, history of coronary heart disease, and peak value of creatine kinase MB between no reflow and normal flow groups (all P > 0.05). The number of patients developing diabetes mellitus, the proportion of patients developing lesions of multiple vessels, C-reactive protein level and brain natriuretic peptide level in no-reflow group were significantly higher than those in the normal blood flow group (all P < 0.05). Enzyme-linked immunosorbent assay results revealed that there was significant difference in HMGB1 level between no reflow and normal flow groups [(5.2 ± 0.85) mg/L vs.(3.2 ± 0.9) mg/L, t = -2.38, P = 0.02). The ROC curve was used to compare the diagnostic values of HMGB1, brain natriuretic peptide and C-reactive protein for no reflow. The results showed that the area under the ROC curve values of HMGB1, brain natriuretic peptide and C-reactive protein were 0.746 (0.661-0.830), 0.605 (0.504-0.705) and 0.688 (0.595-0.781), respectively. The area under the ROC curve value of HMGB1 was the highest. Conclusion:The level of HMGB1 is obviously increased in patients with acute myocardial infarction presenting with no reflow, which has a high diagnostic value for no reflow.
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OBJECTIVE：To establish the f ingerprint of Qinlian runfei decoction，determine the contents of 11 components， and conduct cluster analysis and orthogonal partial least squares discriminant analysis （OPLS-DA）. METHODS ：HPLC method was used. The determination was performed on ZORBAX Eclipse Plus C 18 column with mobile phase consisted of acetonitrile- 0.05％ phosphoric acid solution （gradient elution ）at the flow rate of 1.0 mL/min. The detection wavelength was set at 260 nm， and column temperature was 30 ℃. The sample size was 10 μL. Using wogonoside as reference，HPLC fingerprints of 10 batches of Qinlian runfei decoction were drawn and the similarity evaluation was conducted with Similarity Evaluation System of TCM Chromatographic Fingerprint （2012 edition），the common peaks were also confirmed ；the contents of 11 components in Qinlian runfei decoction were determined by the same method. SPSS 21.0 software was used for clus ter analysis ，and SIMCA 14.0 software was used for OPLS-DA to screen marker components affecting quality. RESULTS ：There were 21 common peaks in 10 batches of Qinlian runfei decoction ，and the similarity with control fingerprint was greater than 0.98. A total of 11 common peaks were identified ， which were rutin ， forsythiaside A ， forsythiaside B ， iris， irigenin， baicalin， forsythiaside， wogonoside， baicalein， irisflorentin and wogonin. The line ar ranges of 11 components were 9.960 0-49.800 0，1.974 0-9.870 0，0.672 0-3.360 0，0.960 0-4.800 0，0.549 0- 2.745 0，5.040 0-25.200 0，1.374 0-6.870 0，0.615 0-3.075 0，0.759 9-3.795 0，0.162 0-0.810 0，0.042 0-0.210 0 μg（all r＞ 0.999）； RSDs of precision ， stability （48 h） and repeatability tests were less than 2％ ； the average recoveries were 95.81％-100.29％ with RSDs of 0.43％-1.73％（n＝6）；the contents were 8.924 4-12.820 8，0.352 2-0.868 7，0.435 6-0.711 2， 0.389 8-1.309 0，0.335 8-0.530 1，1.680 5-4.542 3，0.701 8-1.584 2，2.240 2-5.442 5，2.351 0-5.558 9，0.106 0-0.182 2，0.076 8- 0.128 9 mg/g，respectively. The results of cluster analysis showed that when class spacing was 10，it could be divided into two groups，S1-S3 and S 4-S10；when the class spacing was 5，the second class could be divided into two categories ，S6，S7，S9 were clustered into one category ，and S 4，S5，S8，S10 were clustered into one category. The results of OPLS-DA analysis showed that S6，S7 and S 9 were at the top of the figure ，S4，S5，S8 and S 10 were at the lower left side of the figure ，and S 1-S3 were at the lower right side of the figure ，which was consistent with the cluster analysis results ；VIP values of baicalin ，iris，forsythiaside A ， baicalein and wogonoside were all greater than 1. CONCLUSIONS ：Established fingerprint and content determination methods have high precision and good stability. Combined with multivariate statistical analysis ，it can be used for the quality control of Qinlian runfei decoction. Five components as baicalin are the marker components affecting the quality of Qinlian runfei decoction.
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【Objective】 To retrospectively analyze the epidemiological characteristics and regularity of HIV among voluntary blood donors in our hospital, so as to provide help for the formulation of effective coping strategies for voluntary blood donation, reduce the incidence of blood transmitted diseases, and improve blood safety. 【Methods】 HIV infection and population characteristics of voluntary blood donors in our hospital from January 2010 to December 2019 were statistically analyzed. 【Results】 A total of 330 000 blood donations occurred during 2010 to 2019, and 1 024 HIV-infected blood donors were screened out, with a positive rate of 0.31%. The detection rate was the highest in 2016, with 158 cases infected(158/35 889, 0.44%), followed by 151 in 2015(151/37 586, 0.40%), and 42 in 2010(42/20 824, 0.20%). The difference was statistically significant (χ2=88.754, P<0.001). Among the 1 024 HIV-infected patients, 876 were males and 148 females, with a gender ratio close to 6∶1. The majority were aged between 18~35 years old, accounting for 86.13%. 【Conclusion】 The HIV infection rate among voluntary blood donors had been increasing year by year in recent years. Major blood centers should strengthen the health information before blood donation, carry out HIV screening strictly, select blood donors appropriately, establish a stable blood donation team, so as to reduce the discarding rate of blood.
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Objective:To investigate the characteristics of pregnancy with pre-excitation syndrome and its influence on pregnancy outcomes.Methods:A retrospective analysis was made on the clinical data of 62 cases of pregnancy complicated with pre-excitation syndrome in Beijing Anzhen Hospital from Jan. 2008 to Dec. 2008. According to whether there was a supraventricular tachycardia (SVT) in pregnancy, they were divided into two groups. There were 16 pregnant women in the SVT seizure group during pregnancy, and 46 pregnant women in no SVT seizure group, with a multi-disciplinary comprehensive diagnosis and treatment model. SPSS software was used to analyze the data and compare the gestational age, age and weight of the newborn, and then compare the pregnancy outcomes.Results:(1) The total number of deliveries in Beijing Anzhen Hospital during the study period was 21 786, and the patients with pregnancy combined with pre-excitation syndrome account for 0.28% (62/21 786). (2) Totally 44 patients (71%, 44/62) were diagnosed with pre-excitation syndrome before pregnancy, and 18 patients (29%, 18/62) were diagnosed for the first-time during pregnancy. Among patients diagnosed with pre-excitation syndrome before pregnancy, 16 patients (36%, 16/44) had seizures before pregnancy, 28 patients (64%, 28/44) had asymptomatic before pregnancy, and 4 of asymptomatic patients had SVT during pregnancy. (3) Of the 16 pregnant women in the SVT seizure group during pregnancy, 2 patients (2/16) had SVT episodes in the first trimester, 5 patients (5/16) had SVT episodes in the second trimester, 9 patients (9/16) had SVT episodes in the third trimester. In the SVT seizure group, 8 patients (8/16) had SVT episodes before pregnancy, and 8 patients (8/16) had no SVT episodes before pregnancy. There were 46 patients in the SVT seizure-free group during pregnancy, including 9 patients with SVT attacks before pregnancy and 37 patients without SVT before pregnancy. (4) Compared with the pregnant women in the SVT seizure group, the age, weight gained during pregnancy, delivery gestation week, newborn weight, and the time of the first and second labors were not statistically different between the two groups of pregnant women (all P>0.05). However, the total duration of labor in the SVT seizure group during pregnancy was shorter and pre-pregnancy weight was lower (all P<0.05). The rate of cesarean section in pregnant women with SVT attack was 12/16, and the rate of cesarean section in pregnant women without SVT was 50% (23/46; P=0.051). No pregnant woman had an arrhythmia during delivery. Conclusions:SVT episode in patients during pregnancy most occurs in the third trimester. Patients who are asymptomatic before pregnancy may also have SVT during pregnancy. Pre-excitation syndrome patients with SVT attacks during pregnancy increase adverse pregnancy outcomes. Multidisciplinary comprehensive management could effectively control pregnant women with pre-excitation syndrome, effectively reduce the occurrence of serious arrhythmia risk events during pregnancy, so that most patients could get good pregnancy outcomes.
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Objective To determine interleukin (IL)-23 and IL-17 level in latent autoimmune diabetes in adult (LADA) patients,and to explore the relationship of IL-23,IL-17and β-cell function in these patients.Methods Forty LADA patients from 2011 to 2016 in our hospital were selected as LADA group,and forty participants were as normal control group.Clinical and biochemical data was collected and the level of the IL-23 and IL-17 was measured with the enzyme linked immunosorbent assay (ELISA).The differences in interleukin levels among the two groups were compared.Pearson correlation analysis was used for investigating the relationship between the dependent of statistical significant interleukins and the independent data in the LADA patients,all closely related variables then were included in a stepwise multiple linear regression analysis.Results The levels of serum IL-23,IL-17 and IL-23/IL-17 were significantly higher in LADA group than those in control groups [3.54 (2.88 ～ 5.24) μg/L vs 1.98 (1.62 ～ 2.18) μg/L,P ＜0.05],[22.42 (17.71 ～ 26.07) ng/L vs 17.97 (17.15 ～ 20.70) ng/L,P ＜ 0.05],(175.79 ± 38.67 vs 105.22 ± 19.08,P ＜0.01).IL-23 and IL-17 in the LADA group were negatively correlated with fasting C peptide (FCP) (r =-0.42,r =-0.48,P ＜ 0.05),and the ratio of IL-23/IL-17 was positively correlated with fasting plasma glucose (FPG) (r =0.44,P =0.00).Stepwise multiple liner regression analysis showed that serum IL-23 and IL-17 level were independently associated with the FCP in LADA group.Conclusions IL-23 and IL-17 were possibly important proinflammatory factor in LADA patients,and can provide the new immunodiagnosis markers for LADA.
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Objective:To analyze the clinical value of different MRI sequences in the diagnosis of elbow trauma in children.Methods:From March 2015 to March 2019, 78 children with elbow joint injury were studied.All patients were examined by X-ray and MRI, including 3D-DESS, TSETIWI, T1-TIRM and FS-PDWI.The differences between the two methods were analyzed.Results:A total of 62 cases of epiphyseal fracture were confirmed by MRI.According to the distribution of Salter Harris fracture: 23 cases of type Ⅱ (37.10%)>17 cases of type Ⅲ (27.42%)>12 cases of type Ⅳ (19.35%)>10 cases of type Ⅰ (16.13%)>0 case of type Ⅴ (0.00%), the difference was statistically significant (χ 2=6.126, P=0.025). Among 78 children of elbow joint injury, 73 cases had bone marrow edema, of which 62 cases were within 1 cm from epiphyseal plate, 11 cases were outside 1 cm from epiphyseal plate, 5 cases were without bone marrow edema, and there was a correlation between bone marrow edema and epiphyseal fracture ( r=0.174, P=0.006). Type Ⅰ-Ⅳ epiphysis injury of elbow joint in children could be accompanied with articular cartilage injury, and 3D-DESS had good effect on articular cartilage injury. Conclusion:Different sequences of MRI have high accuracy in the diagnosis of elbow joint injury in children, which is of great significance in reducing misdiagnosis and missed diagnosis rate of epiphyseal fracture, bone marrow edema and articular cartilage injury in children.
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OBJECTIVE@#To predict and verify the target gene of miR-200c-3p and evaluate the inhibitory effect of miR-200c-3p on the proliferation of nephroblastoma cells.@*METHODS@#The putative target genes of miR-200c-3p were predicted by bioinformatics approach. Nephroblastoma cell models with miR-200c-3p overexpression or knockdown were established in SK-NEP-1 and G401 cells with corresponding control groups. The expressions of CCNE2 in SK-NEP-1 and G401 cells in different groups were detected by RT-PCR and Western blotting. A luciferase reporter assay was used to determine the targeting relationship between miR-200c-3p and CCNE2. The effects of miR-200c-3p overexpression or knockdown on cell proliferation was detected by cell counting kit-8 (CCK-8) assay and soft agarose assay.@*RESULTS@#CCNE2 was one of the target genes of miR-200c-3p as predicted by bioinformatics methods. Transfection of the two nephroblastoma cell lines with miR-200c-3p mimic resulted in significantly lowered CCNE2 mRNA and protein expressions ( < 0.05). The results of dual-luciferase assay confirmed that miR-200c-3p bound to the 3'UTR of CCNE2. CCK-8 assay and soft agarose assay demonstrated that overexpression of miR-200c-3p significantly inhibited the proliferation of the nephroblastoma cells ( < 0.01), and knocking down miR-200c-3p in the cells produced the opposite effects.@*CONCLUSIONS@#miR-200c-3p overexpression inhibits the proliferation of nephroblastoma cells by down-regulating its target gene CCNE2.
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Objective@#To determine interleukin (IL)-23 and IL-17 level in latent autoimmune diabetes in adult (LADA) patients, and to explore the relationship of IL-23, IL-17and β-cell function in these patients.@*Methods@#Forty LADA patients from 2011 to 2016 in our hospital were selected as LADA group, and forty participants were as normal control group. Clinical and biochemical data was collected and the level of the IL-23 and IL-17 was measured with the enzyme linked immunosorbent assay (ELISA). The differences in interleukin levels among the two groups were compared. Pearson correlation analysis was used for investigating the relationship between the dependent of statistical significant interleukins and the independent data in the LADA patients, all closely related variables then were included in a stepwise multiple linear regression analysis.@*Results@#The levels of serum IL-23 , IL-17 and IL-23/IL-17 were significantly higher in LADA group than those in control groups [3.54(2.88~5.24)μg/L vs 1.98(1.62~2.18)μg/L, P<0.05], [22.42(17.71~26.07)ng/L vs 17.97(17.15~20.70)ng/L, P<0.05], (175.79±38.67 vs 105.22±19.08, P<0.01). IL-23 and IL-17 in the LADA group were negatively correlated with fasting C peptide (FCP) (r=-0.42, r=-0.48, P<0.05), and the ratio of IL-23/IL-17 was positively correlated with fasting plasma glucose (FPG) (r=0.44, P=0.00). Stepwise multiple liner regression analysis showed that serum IL-23 and IL-17 level were independently associated with the FCP in LADA group.@*Conclusions@#IL-23 and IL-17 were possibly important proinflammatory factor in LADA patients, and can provide the new immunodiagnosis markers for LADA.
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Objective: To explore the ethical justification of reducing sedation in ICU based on the need of medical treatment but the increase of patient's discomfort and the solution of this ethical conflict. Methods: Quali-tative research was used to conduct the in - depth interview among 15 senior medical staffs. We analyzed the ob-tained information, refined the research contents and formed the research report. Results: In ethics, it was a chal-lenge to achieve a satisfactory balance between the guarantee of the patient's comfortable experience and medical demand for reducing sedation. Conclusions: When making a sedation therapy program, the clinicians should pay more attention to the patient's own comfortable experience, that is, try to minimize the discomfort of patients in the pursuit of the most satisfactory treatment outcome.
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Objective: To study the dose-effect relationship of Yuning ointment and its decomposed recipes in the treatment of oleic acid induced acne in mice. Methods: Oleic acid was administrated to the back (2 cm ×2 cm) of the mice (once a day) for 21 days to induce acne. At d22, the gradient dosage of Anemone flaccida crude drug (1. 06-1 060. 23 mg?kg-1?d-1,k=3. 16), Yuning oint-ment without Anemone flaccida crude drug (4. 73-1 767. 75 mg?kg-1?d-1, k=3. 16) and Yuning ointment (2. 84-2 827. 28 mg?kg-1?d-1, k=3. 16) was respectively administrated to the back of mice for 14 days. The pathological changes of skin were observed by hematoxylin-eosin (HE) staining. The diameter of sebaceous glands and the ratio of follicular keratinization area were morphomet-rically analyzed. The serum levels of IL-1, IL-6 and TNF-α were detected by ELISA assay. The median effective dosages (ED50) of A-nemone flaccida in the three prescriptions were regressed by Prism 5. 01 software to determine the prescription dose-effect. Results: All the therapy groups were with significantly relieved pathological changes of sebaceous glands hypertrophy and follicular keratinization, and decreased serum levels of IL-1, IL-6 and TNF-α in a dose-dependent manner. The dose-response curves showed an "S" shape. A-mong the three therapy groups, the effect of Yuning ointment was the best. The ED50of Yuning ointment regressed by Anemone flaccida dose was 0. 28-fold for improving sebaceous glands hypertrophy, 0. 14-fold for inhibiting follicular keratinization, and 0. 15-, 0. 49-and 0. 24-fold for decreasing serum levels of IL-1, IL-6 and TNF-α. . Regressed by Yuning ointment without Anemone flaccida, the ED50of Yuning ointment was lower than Yuning ointment without Anemone flaccid in terms of improving pathological changes and inhibiting the secretion of cytokines. Conclusion: Yuning ointment can prevent and treat acne through regulating immune function. And the prescrip-tion compatibility can enhance the effects of Anemone flaccida.
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Objective:To investigate the dose-effect relationship of Xianfu ointment and its decomposed recipes the 1-chloro-2,4-dini-trochlorobenzene(DNCB) induced chronic eczema in mice, and confirm the median effective dose (ED50) of each formula and the synergetic effect by compatibility. Methods:DNCB was used to induce chronic eczema in C57 mice. The mice were treated with gradient dosages of the Xianfu ointment (11.71-11 662.50 mg?kg-1?d-1,k = 0.316), Anemone flaccid (0.53-530.12 mg?kg-1?d-1,k = 0.316), Xianfu ointment without Anemone flaccid (11.18-11 132.40 mg?kg-1?d-1,k =0.316),respectively. The pathological features were observed after hematoxylin-eosin staining. The volume ratio of epidermides and the number of lymphocyte infiltrated in dermis were analyzed with morphometry. The serum levels of IL-2,IFN-γ,IL-4,and IL-13 were detected by ELISA assay. The ED50was calculated by non-linear regression with various slope using Prism-5.0 software.Results:The effects of Xianfu ointment and its decomposed recipes on chronic eczema showed a dose-dependent tendency. The dose-response curves showed"S"shape. The efficacy of Xianfu ointment on chronic eczema was the most significant among the three formulas, which was demonstrated by decreased epidemical thicknes (ED50= 377.90 mg?kg-1?d-1), reduced infiltrated lymphocyte number(ED50= 153.20 mg?kg-1?d-1), increased serum IL-2(ED50=608.90 mg?kg-1?d-1) and IFN-γ (ED50= 205.50 mg?kg-1?d-1) levels, and decreased serum IL-4(ED50= 198.70 mg?kg-1?d-1) and IL-13 levels (ED50= 117.60 mg?kg-1?d-1). And the dose-effect curves of Anemone flaccid and Xianfu ointment without Anemone flaccid groups were both right shift when compared with that of Xianfu ointment. Conclusion:Xianfu ointment and its decomposed recipes can effectively treat chronic eczema. Anemone flaccid has obvious compatibility synergy in the whole formula. The effects of Xianfu ointment is most significant.
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Objective To analyze the effects of Hual qi huang granules on children with mycoplasma pneumoniae pneumonia.Methods A randomized,multicenter parallel controlled clinical trial was carried out.A total of 3 000 cases of hospitalized children with mycoplasma pneumoniae pneumonia were selected.All of them were given treatment for mycoplasma pneumoniae pneumonia with macrolide antibiotics and symptomatic treatment.They were randomly divided into 2 groups:research group and control group.The children of research group were give oral Huai qi huang granules for three months.According to the classification of pneumonia,these two groups were divided into:lobar pneumonia research group,lobar pneumonia control group,lobular pneumonia research group,lobular pneumonia control group.The hospitalization duration of fever,length of hospital stay,the absorption area of lung inflammation and pneumonia severity sores were observed.The frequency of upper respiratory infections,bronchitis,pneumonia were observed in 3 months after discharge.Results 2 378 cases were investigated.The hospitalization duration of fever,length of hospital stay of research group were significantly shorter than that of in control group (P ＜ 0.001).The children with lobar pneumonia,2 weeks after treatment,the absorption of consolidation of the lobar pneumonia research group is significantly better than lobar pneumonia control group (P ＜0.001).After two weeks treatment,the pneumonia scores of lobar pneumonia research group is lower than lobar pneumonia control group (P ＜ 0.05).Followup of 3 months after hospital discharge,frequency of upper respiratory infection and bronchitis of research group,were significantly lower than that of control.In addition,appetite increased significantly in research group than control (P ＜ 0.001).There are 21 cases with drug associated adverse reactions (mild diarrhea),including 12 cases of research group,9 cases of control group,and there was no statistical significance (P ＞0.05).Conclusion Standard treatment combined with oral Huai qi huang granules in the treatment of mycoplasma pneumoniae pneumonia,can significantly shorten hospitalization duration of fever,length of hospital stay and reduce the severity score of pneumonia.Three months oral Huai qi huang granules can significant reduce the frequency of respiratory infections and bronchitis,also can increase patients appetite,and be safe.
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Objective The purpose of this study was to detect serum 25-hydroxyvitamin D [25-(OH) VitD] levels in children with atopic dermatitis (AD) and to explore its association with food allergy (FA).Methods Sixty cases of infant patients with AD have been collected.The morning fasting venous blood were obtained to check the 25-(OH)VitD level in serum.Moreover,IgE in 6 kinds of common food was also tested.Multiple regression analysis was used to analyze the relation between 25-(OH)VitD level in serum and FA.The potential risks and confounding factors were adjusted.Results Among the 60 AD children,67.4％ of them had FA,and the majority of them had milk allergy (86.84％),no wheat allergy was found.There was a positive correlation between 25-(OH) VitD levels and age (r=0.46,P＜ 0.01),but no statistical correlation with total IgE levels (P＞0.05).25-(OH)VitD deficiency may significantly increase the risk of suffering from FA (OR=11.20,95％CI:1.35-73.66,P=0.023).Conclusion The decrease of the 25-(OH)VitD level in infant patients with AD is associated with FA.What's more,25-(OH)VitD deficiency may be a risk factor for increasing FA.
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Objective To evaluate the efficacy and safety of short-term deep sedation strategy in patients with spontaneous intracerebral hemorrhage (ICH) after surgery. Methods A perspective, randomized, parallel-group study was conducted. Adult patients with spontaneous ICH and undergoing craniotomy admitted to Daxing Teaching Hospital of Capital Medical University from December 2015 to November 2016 were enrolled. The patients who received surgery were randomly divided into a short-term deep sedation and a slight and middle sedation group. Sufentanil was used as an analgesic drug in all patients and midazolam was used as a sedative after the operation. The patients in the slight and middle sedation group received midazolam 0.05-0.10 mg/kg with a goal of mild sedation [Richmond agitation and sedation scale (RASS) score of -2-1]. The patients in the short-term deep sedation group received midazolam 0.1-0.2 mg/kg with a goal of deep sedation (RASS score of -4 to -3) and a duration of no more than 12 hours. Postoperative sedation, blood pressure changes, laboratory indexes, residual hematoma and clinical outcomes were recorded in two groups. Results During the study, a total of 183 patients with spontaneous ICH were collected, excluding who was older than 65 years, with shock, and with preoperative Glasgow coma score (GCS) of 3. 106 patients were enrolled in this study, and 53 patients were assigned to the short-term deep sedation group and slight and middle sedation group, respectively. In the slight and middle sedation group, 4 patients received reoperation because of repeated hemorrhage and no patient operated repeatedly in the short-term deep sedation group, and there was a significant difference between the two groups (χ2= 4.000, P = 0.045). The number of patients undergoing tracheotomy in the short-term deep sedation group was significantly lower than that in the slight and middle sedation group (9 cases vs. 21 cases,P < 0.05). RASS score within 12 hours after operation of the patients in the short-term deep sedation group was lower than that in slight and middle sedation group [-4 (-4, -2) vs. -2 (-3, -1) at 4 hours, -4 (-4, -2) vs. -1 (-2, 0) at 8 hours,-3 (-4, -2) vs. 0 (-2, 1) at 12 hours, all P < 0.01], sudden restlessness was significantly reduced [times: 1 (0, 1) vs. 3 (2, 3), P < 0.01], and postoperative sedation duration was significantly prolonged [hours: 14.0 (8.3, 20.8) vs. 8.9 (3.4, 15.3), P < 0.05]. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) within 12 hours after operation in the short-term deep sedation group were significantly lower than those of the slight and middle sedation group [SBP (mmHg, 1 mmHg = 0.133 kPa): 136.8±30.5 vs. 149.1±33.5, DBP (mmHg): 85.0 (70.8, 102.3) vs. 89.0 (69.2, 116.7), both P < 0.05]. There were no significant differences in the arterial blood gas, routine blood test or coagulation function between the two groups at 24 hours after operation. The volume of residual hematoma at 2, 7 and 14 days after operation in the short-term deep sedation group was significantly decreased as compared with slight and middle sedation group (mL: 16.4±15.6 vs. 38.2±22.2 at 2 days, 9.6±8.7 vs. 20.6±18.6 at 7 days, 1.2±1.0 vs. 4.4±3.6 at 14 days, all P < 0.05), number of deaths in 3 months were significantly less (5 cases vs. 13 cases), and the patients with favorable prognosis were increased significantly (39 cases vs. 12 cases, both P < 0.05). Conclusion The study results showed that short-term deep sedation strategy after surgery can reduce the incidence of adverse events and improve the prognosis of patients with spontaneous ICH, so it is safe and effective.
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Based on the problems of the medical software laboratory such as heavy workload of software superposition management and maintenance,low resource utilization rate,difficulty in sharing,the paper takes Shanghai University of Medicine & Health Sciences as an example to introduce the construction of cloud desktop medical software laboratory based on the cloud computing technology,and analyze the using experience.This laboratory helps save costs,simplify deploymem,reduce the intensity of management work,so as to better serve for teaching.
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Objective To investigate ablation characteristics of PVC/VT originating from left ventricle anterior papillary muscles.Methods This study included 10 patients of PVC/VT originating from left ventricle anterior papillary muscles from January 2015 to June 2016 in Beijing Anzhen Hospital.Electrophysiological mapping and radiofrequency ablation were completed using three-dimensional anatomical mapping system combined with three-dimensional intracardiac ultrasound technology.ECG and abaltion target diagram characteristics as well as the special anatomy were explored.Results All the 10 patients were successfully ablated and followed up for 12 months.One patient had recurrence within 12 months and no complications were recorded.The target sites localized at the tip (n =1),middle portion(n =4)or the base (n =5) of the LV-APM.Among 7 patients,the target sites were located at the anterior septal papillary muscle and in 3 patients were located in the free papillary muscle.9 patients were successfully ablated via anterograde trans-septal catheterization after the failure of retrograde approach.Premature QRS wave time were 152.80 ± 11.72 ms and 6 patients presented sharp potential at the targets during PVC/VT.Conclusions PVC/VT originating from left ventricle anterior papillary muscles have similar ECG and diagram characteristics that is different from which originating from left anterior fascicle.It is recommended to get the target via transseptalpuncure approach.Ablation target could be clearly positioned by three-dimensional intracardiac ultrasound technology.
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Objective Cryoballoon ablation of pulmonary vein (PV) ostia often induces a vagal response.This prospective study was designed to assess the effectiveness of prophylactic intravenous administration of atropine on hemodynamic impairment induced by cryoballoon ablation in patients with atrial fibrillation.Methods Twenty-five patients with paroxysmal atrial fibrillation undergoing cryoballoon ablation were prospectively enrolled and assigned to either the trial group on the control group.First twelve patients (the trial group) were administered 1 mg of atropine before deflation of the cryoballoon,while the following 13 patients (the control group) were given atropine only after the onset of the hemodynamic variation (decrease in heart rate and/or blood pressure).Treatment was considered effective when the hemodynamic variations were restored.Results In the trial group,three patients with transient hypotension did not require further supportive care throughout the procedures and one patient with hypotension required supportive management.In the control group,hypotension,bradycardia and mixed bradycardia with hypotension requiring supportive care occurred in six,three,and three patients,respectively.Overall,the rate of marked vagal responses was significantly lower when prophylactic atropine was administrated (4/12 vs.12/13 patients,P ＜ 0.01).Conclusions Atropine is effective in the prevention of all types of vasovagal responses induced by cryoballoon ablation in patients with atrial fibrillation.
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The Economists Intelligence Unit pointed out that the global ranking of Chinese people's death quality index falls behind and once again causes people's attention and discussion of death and related legal issues.Palliative Care can make people go to death as far as possible with dignity,ready and calm.So it is gradually being concerned,and the importance of legislation related to it is also becoming increasing.Palliative Care has emerged in our country,but because of the lack of legislative regulation,relatives of patients and medical staff are at risk being accounted for legal liability.Through the analysis of the legitimacy and feasibility of palliative care,this paper put forward some suggestions of relevant legislation and current corresponding countermeasures;it should clarify the legal validity of living will signed by patients,strengthen the supervision in the implementation process and exempt responsibility of relevant personal.