Exploring the nexus between energy consumption, income inequality and poverty, economic growth, and carbon dioxide emission: evidence from two step system generalized method of moments.

The concern of environmental degradation, poverty, and income inequality remains a priority in achieving sustainable development goals. Countries are trying to reduce income inequality, alleviate poverty, and reduce environmental degradation which needs special attention. Consequently, this study explores the effect of income inequality, poverty, and energy consumption on carbon dioxide emission in the Belt and Road Initiative countries from 1996 to 2018. By employing the generalized method of moments, the findings show that income inequality, poverty, and energy consumption significantly increase carbon dioxide emission and lead to environmental degradation, while access to electricity significantly raises environmental quality. Economic growth positively affects carbon dioxide emission; however, the environmental Kuznets curve is valid. Income inequality exerts a moderating effect on carbon dioxide emission via per capita economic growth that reduces environmental degradation in the Belt and Road Initiative countries. The results of this study give important policy implications for the Belt and Road Initiative countries.

The nexus between natural resources, renewable energy consumption, economic growth, and carbon dioxide emission in BRI countries.

This study investigates the nexus between natural resources, renewable energy consumption, economic growth, and carbon emission in 35 belt and road initiative (BRI) countries from 1985 to 2019. By employing OLS, fixed effect, generalized method of moments, and seemingly unrelated regression models, the results show that carbon dioxide and renewable energy are the driver factors of economic growth while natural resources reduce economic growth. The effect of economic growth and natural resources on carbon dioxide is positive; however, renewable energy consumption significantly reduces carbon emission. Economic growth rise renewable energy consumption while carbon dioxide and natural resources reduce it. The findings of this study have considerable policy implications for the belt and road countries that how natural resources and income inequality influence the interlinkage of renewable energy consumption, economic growth, and carbon dioxide emission.

The effect of political stability, carbon dioxide emission and economic growth on income inequality: evidence from developing, high income and Belt Road initiative countries.

The reduction of income inequality and environmental frailty are important factors which can help achieve sustainable development. In this context, it is important to investigate the nexus between income inequality and carbon dioxide emission by considering the role of political stability. This paper examines the effect of political stability, economic growth, financial development, and carbon dioxide on income inequality in developing countries, high-income countries, and the Belt Road initiative (BRI) countries from 2002 to 2019. By employing a two-step generalized method of moments and panel quantile regression, the findings show that carbon dioxide emission, financial development, and political stability rise income inequality while economic growth significantly reduces income inequality in developing countries. In the case of high-income countries, political stability and carbon dioxide negatively affect income inequality while financial development rise income inequality. In the case of BRI countries, political stability, economic growth, and carbon dioxide emission significantly reduce income inequality. Our findings have considerable policy implications regarding reducing income inequality in the sample countries.

Protective mechanism of Tangshenbao on kidney of diabetic nephropathy rats / 国际中医中药杂志

Objective:To investigate the protective effect and possible mechanism of Tangshenbao on renal damage in diabetic nephropathy (DN) rats.Methods:Totally 36 SPF male SD rats were randomly divided into normal group ( n=6) and model group ( n=30). The DN rat model was prepared by single high-dose intraperitoneal injection of STZ. According to the random number table method, the rats were divided into model group, irbesartan group and Tangshenbao low-, medium- and high-dosage groups, with 6 rats in each group. Drug intervention lasted for 8 weeks. The general condition and body weight of rats in each group were recorded. The blood glucose, kidney index, 24 h urine protein (24 h UTP), SCr and BUN levels were detected. The pathological morphology of renal tissue was observed by PAS staining and transmission electron microscopy. The mRNA and protein expressions of Ets-1, TGF-β1, Smad2 and Smad3 in renal tissue were detected by real-time fluorescence quantitative PCR and Western blot. Results:Compared with model group, the body weight of Tangshenbao low, medium and high dose groups and irbesartan group significantly increased ( P<0.01). The kidney index decreased ( P<0.05 or P<0.01). The contents of 24 hUTP, BUN and SCr significantly decreased ( P<0.05 or P<0.01). Glomerular volume was significantly reduced ( P<0.05 or P<0.01), the mRNA expressions of Ets-1 (1.59 ± 0.06, 1.47 ± 0.04, 1.31 ± 0.03, 1.39 ± 0.03 vs. 1.64 ± 0.04), TGF-β1 (1.65 ± 0.05, 1.59 ± 0.03, 1.38 ± 0.05, 1.49 ± 0.04 vs. 1.77 ± 0.08), Smad2 (1.48 ± 0.05,1.39 ± 0.05, 1.22 ± 0.03, 1.31 ± 0.04 vs. 1.54 ± 0.05), Smad3 (1.57 ± 0.04, 1.48 ± 0.03, 1.28 ± 0.03, 1.39 ± 0.02 vs. 1.64 ± 0.05) in renal tissue of rats significantly decreased ( P<0.05 or P<0.01), the protein expressions of Ets-1 (1.33 ± 0.32, 1.16 ± 0.38, 0.77 ± 0.06, 0.84 ± 0.06 vs. 1.97 ± 0.43), TGF-β1 ( 1.35 ± 0.14, 1.24 ± 0.22, 0.94 ± 0.13, 1.07 ± 0.06 vs. 1.63 ± 0.20), Smad2 (1.24 ± 0.26, 1.14 ± 0.31, 0.77 ± 0.28, 0.85 ± 0.19 vs. 1.72 ± 0.34) and Smad3 (1.29 ± 0.14, 1.19 ± 0.21, 0.85 ± 0.39, 0.90 ± 0.37 vs. 1.76 ± 0.21) decreased ( P<0.05 or P<0.01). Conclusion:Tangshenbao can improve renal damage in DN rats, and its mechanism may be related to the inhibition of Ets-1 expression and TGF-β1/Smads signaling pathway.

The role of financial development and institutional quality in environmental sustainability: panel data evidence from the BRI countries.

The belt and road countries are mostly emerging and developing countries and heading to attain economic prosperity; however, this development process leads to ecological footprint. The factors of ecological footprint need to be identified and sound level of quality institutions might be helpful to overcome the issue of environmental degradation. Utilizing data from 1985 to 2019 of the belt and road initiative (BRI) countries, this study explores the effect of institutional quality indicators and financial development on carbon dioxide emission by including energy consumption and economic growth to the model. By using OLS, fixed effect, and two-step generalized method of moments, the results indicate that financial development, economic growth, and energy consumption increase carbon dioxide emission and degrade environmental quality. Three out of six institutional quality indicators that include government effectiveness, voice and accountability, and corruption control effect carbon dioxide emission positively, while the other three that include rule of law, regulatory quality, and political stability significantly rise environmental quality. The interaction terms of voice and accountability, government effectiveness, and political stability with financial development also give negative coefficients and reduce emission; however, the interaction of control of corruption with financial development is positive and the interaction of rule of law and regulatory quality with carbon dioxide is insignificant. The findings have considerable policy implication for the sample countries on each individual institutional quality indicator and financial institutions in rising environmental sustainability.

Examining the effect of information and communication technology, innovations, and renewable energy consumption on CO2 emission: evidence from BRICS countries.

The increasing use of information and communication technology (ICT) in this digital era and its interlinkage with other economic and environmental factors have gotten considerable attention from researchers. ICT tools are considered very important in economic activities such as international trade, the financial sector, and foreign direct investment. ICT is also interlinked with innovation and energy consumption. However, ICT with these activities influences ecological footprint, especially in emerging economies such as BRICS (Brazil, Russia, India, China, and South Africa) countries. Therefore, this topic has got considerable attention from researchers and policy makers on the impact of ICT and economic growth activities on environmental quality. Consequently, this study investigates the impact of information and communication technology, renewable energy consumption and innovation on carbon dioxide emission in BRICS countries from 1990 to 2019 using cointegration, generalized least square, and panel corrected standard errors models. The findings show that two ICT indicators, mobile cellular subscription and fixed broadband subscription, negatively affect carbon emission along with economic growth and financial development. Innovation and renewable energy consumption also significantly reduce emission in presence of ICT indicators, while trade openness and fixed telephone subscriptions increase it. In the case of the ICT index model, all variables are positively associated with carbon emission except renewable energy consumption, however, the square and interaction term of all indicators significantly reduce carbon emission and evidence the environmental Kuznets curve hypothesis except trade openness. ICT growth should be considered in the energy sector, innovation, and financial development to enhance environmental quality. The findings of the study have considerable policy implications for the sample countries.

The role of institutional quality in FDI inflows and carbon emission reduction: evidence from the global developing and belt road initiative countries.

Achieving economic growth is the primary concern mostly of every country to enhance living standard; however, an increase in economic activities may have environmental consequences. Foreign direct investment is also considered a driver of economic growth while it affects the quality of environment. The role of institutions can be useful to enhance foreign direct investment (FDI) inflow which can in turn increase economic growth and safeguard environmental quality. Based on the ongoing debate, this study attempts whether the quality of institutions plays any role in FDI inflow and in enhancement of environmental quality. For this purpose, this study examines the role of institutional quality in FDI inflows and carbon emission reduction in the global panel, 107 world developing, and 39 Belt and Road Initiative countries for the period of 2002-2019. By using both static and dynamic panel models, the results indicate that governance indicators are important for FDI inflows, but this impact varies in different panels. Overall, institutional quality has a significant and positive impact on foreign direct investment inflow, while energy use reduces it in all panels. Economic growth positively associated with carbon emission, while the square of GDP evidences the environmental Kuznets curve. FDI and trade increase global and developing countries' emissions, while reducing emission in Belt and Road countries. Institutional quality along individual indicators, political stability, rule of law, and regulatory quality are found to be poor governance indicators in all panels, while voice and accountability and control of corruption are weak indicators in Belt and Road countries; however, the interaction term proves that the quality of institutions is regulated by financial development and FDI in carbon emission reduction in all panels. This study has considerable policy significance for countries to carry out strong policy reforms to increase green FDI and improve environmental quality.

The impact of information and communication technology, financial development, and energy consumption on carbon dioxide emission: evidence from the Belt and Road countries.

In today's digital era of globalization, information and communication technology (ICT) has been considered important that contributes to various sectors of an economy and increases economic growth; however, an increase in ICT may influence environmental quality which needs attention. For this purpose, this study examines the effect of ICT, energy consumption, economic growth, and financial development on carbon emission in the Belt and Road countries from 2000 to 2019 using OLS, fixed effect, dynamic system generalized method of moments (GMM), and generalized least square (GLS) models. The results indicate that ICT, financial development, energy consumption, and economic growth increase carbon dioxide emission, while renewable energy use and international trade reduce it. Foreign direct investment exerts both positive and negative effects on carbon emission across different models with different proxies of financial development. In the individual indicators model, only FBS seems to reduce carbon emission, while other indicators are positively associated with CO2 emission. The findings have considerable policy suggestions for the Belt and Road countries in the improvement of ICT sector, innovations, and enhancing financial institutions which can enhance environmental quality.

The effect of income inequality and energy consumption on environmental degradation: the role of institutions and financial development in 180 countries of the world.

This study investigates the effect of income inequality and institutional quality on carbon emission in 180 countries of the world from 2002 to 2019. The study employed OLS, fixed effect, and system generalized method of moments (SGMM), and the results show that income inequality, institutional quality, financial development, and economic growth have a direct significant and positive effect on carbon emission while trade openness and renewable energy significantly reduce carbon emission. VOA, ROL from the legal system, and GOV from the political system negatively affect carbon emission while the interaction term between GDP and GINI is found negative for carbon emission while the interaction of FD and GINI, INST and GINI, FD, and GDP are positively linked with carbon emission. The EKC hypothesis has been evidenced in the analysis with all INST indices. Our findings have considerable policy implications for the sample countries regarding the income inequality and institutions' development toward environmental quality enrichment.

Institutional quality, financial development and the influence of environmental factors on carbon emissions: evidence from a global perspective.

This study explores the moderating role of institutional quality on carbon emissions using data from a global panel regarding renewable energy consumption, foreign direct investment, economic growth and financial development between 2002 and 2019. Using the two-step system generalized method of moments, the results illustrate that in the panel data, renewable energy usage and foreign direct investment inflow enhance environmental quality, while financial development and economic growth lower it. The results show that many countries' quality institutions cannot yet adequately mitigate the harmful impact of each environmental factor and protect the environment; however, the institutional quality interaction term confirms the significant moderating effect of all explanatory variables on environmental quality in the panel data. The findings also confirm the existence of the environmental Kuznets curve and demonstrate the pollution halo hypothesis. The findings in this paper may be useful for policymakers when enacting stricter environmental regulations.

Application of metagenomic next-generation sequencing in patients with Herpes simplex pneumonia mixed infection / 中国医师杂志

Objective:To explore the application value of next-generation sequencing (mNGS) technology in patients with Herpes simplex pneumonia mixed infection.Methods:The clinical data of pneumonia patients who underwent alveolar lavage fluid mNGS technology and traditional pathogen detection in the Affiliated Hospital of Yangzhou University from June 2018 to January 2021 were retrospectively collected.Results:A total of 41 patients with mNGS Herpes simplex type 1 (HSV-1) test (4 HSV-1 carriers, 37 HSV-1 infections) were enrolled in this study, including 22 males and 19 females. The age ranged from 46 to 83 years old, with a median age of 67 years. The higher proportion of pathogens in 25 cases of HSV-1 co-infection detected by mNGS were Pneumocystis jiroveci (6 cases, 24.0%), Acinetobacter baumannii (4 cases, 16.0%), and Klebsiella pneumoniae (4 cases, 16.0%), and Aspergillus fumigatus (3 cases, 12.0%). The difference in the Simpson's diversity index in the HSV-1carrier group, HSV-1 single infection group and HSV-1 mixed infection group was statistically significant ( P<0.05). Compared with 12 cases of HSV-1 single infection, the time for body temperature to return to normal for 25 cases of HSV-1 mixed infection was [(5.16±2.04)days vs (3.75±1.29)days], and course of antibiotic treatment was longer [(10.60±2.18)d vs (8.92±1.98)d]. Conclusions:The mNGS technology has obvious advantages in identifying HSV-1 mixed infections, which is beneficial to physicians to treat them accurately.

Development of a mouse model of stellate ganglion block and subsequent effects on cerebral cortical blood flow / 中华麻醉学杂志

Objective:To develop a model of stellate ganglion block (SGB) in mice and investigate the effect of SGB on cerebral cortical blood flow.Methods:Thirty clean-grade healthy male C57BL/6 mice, aged 8-9 weeks, weighing 23-27 g, were divided into 5 groups ( n=6 each) using a random number table method: control group (group C), left SGB group (group L), left normal saline group (group SL), right SGB group (group R) and right normal saline group (group SR). Group C received no intervention.SGB was performed with 0.25% ropivacaine 0.08 ml via percutaneous posterior approach in L and R groups, while the equal volume of normal saline 0.08 ml was given instead at the location of left and right stellate ganglion in SL and SR groups, respectively.The cerebral cortical blood flow was determined using laser speckle contrast imaging system before SGB (T 0) and at 10, 30, 60, 90 and 120 min after SGB (T 1-5). Results:Mice developed ptosis on the block side, indicating that the model of SGB was successfully developed in L and R groups.There was no significant difference in cerebral cortical blood flow at each time point among C, SL and SR groups ( P>0.05), and cerebral cortical blood flow on the block side decreased at T 1, began to increase at T 2, peaked at T 3, and decreased at T 5 which was still higher than that at T 0 in group L and group R ( P<0.01). Compared with C and SL groups, the left cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group L ( P<0.01). Compared with C and SR groups, the right cerebral cortical blood flow was significantly decreased at T 1, 5 and increased at T 2-4 in group R ( P<0.01). There were no significant differences in cerebral cortical blood flow at each time point between group C and group SL and between group C and group RL ( P>0.05). Conclusions:The mouse model of SGB via percutaneous posterior approach is successfully developed.Unilateral SGB can affect cerebral cortical blood flow on the block side, which shows a transitory decrease followed by a sustained significant increase.

Pinocembrin Promotes OPC Differentiation and Remyelination via the mTOR Signaling Pathway / 神经科学通报·英文版

The exacerbation of progressive multiple sclerosis (MS) is closely associated with obstruction of the differentiation of oligodendrocyte progenitor cells (OPCs). To discover novel therapeutic compounds for enhancing remyelination by endogenous OPCs, we screened for myelin basic protein expression using cultured rat OPCs and a library of small-molecule compounds. One of the most effective drugs was pinocembrin, which remarkably promoted OPC differentiation and maturation without affecting cell proliferation and survival. Based on these in vitro effects, we further assessed the therapeutic effects of pinocembrin in animal models of demyelinating diseases. We demonstrated that pinocembrin significantly ameliorated the progression of experimental autoimmune encephalomyelitis (EAE) and enhanced the repair of demyelination in lysolectin-induced lesions. Further studies indicated that pinocembrin increased the phosphorylation level of mammalian target of rapamycin (mTOR). Taken together, our results demonstrated that pinocembrin promotes OPC differentiation and remyelination through the phosphorylated mTOR pathway, and suggest a novel therapeutic prospect for this natural flavonoid product in treating demyelinating diseases.

Pinocembrin Promotes OPC Differentiation and Remyelination via the mTOR Signaling Pathway / 神经科学通报·英文版

The exacerbation of progressive multiple sclerosis (MS) is closely associated with obstruction of the differentiation of oligodendrocyte progenitor cells (OPCs). To discover novel therapeutic compounds for enhancing remyelination by endogenous OPCs, we screened for myelin basic protein expression using cultured rat OPCs and a library of small-molecule compounds. One of the most effective drugs was pinocembrin, which remarkably promoted OPC differentiation and maturation without affecting cell proliferation and survival. Based on these in vitro effects, we further assessed the therapeutic effects of pinocembrin in animal models of demyelinating diseases. We demonstrated that pinocembrin significantly ameliorated the progression of experimental autoimmune encephalomyelitis (EAE) and enhanced the repair of demyelination in lysolectin-induced lesions. Further studies indicated that pinocembrin increased the phosphorylation level of mammalian target of rapamycin (mTOR). Taken together, our results demonstrated that pinocembrin promotes OPC differentiation and remyelination through the phosphorylated mTOR pathway, and suggest a novel therapeutic prospect for this natural flavonoid product in treating demyelinating diseases.

Effect of the completion time of initial 30 mL/kg fluid resuscitation on the prognosis of patients with septic shock / 中华危重病急救医学

Objective:To investigate the effect of the completion time of initial 30 mL/kg fluid resuscitation on the prognosis of patients with septic shock.Methods:An observational study was conducted. The inpatients with septic shock admitted to intensive care unit (ICU) of Northern Jiangsu People's Hospital, Affiliated Hospital of Yangzhou University and Jiangdu People's Hospital from October 1st, 2018 to September 30th, 2020 were enrolled. The general data including gender, age, body mass index (BMI), patient source, site of infection, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure assessment (SOFA) score and arterial blood lactic acid (Lac) at ICU admission, fluid resuscitation dose, completion time of initial 30 mL/kg fluid resuscitation, mechanical ventilation, incidence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT), length of ICU stay and 28-day mortality. The relationship between the completion time of initial 30 mL/kg fluid resuscitation and ΔSOFA score (the difference between SOFA score 3 hours of fluid resuscitation and initial SOFA score) was analyzed. In addition, according to the completion time (T) of initial 30 mL/kg fluid resuscitation, the patients were divided into T ≤ 1 hour group, 1 hour < T≤2 hours group, 2 hours < T≤3 hours group and T > 3 hours group, and the observation parameters among the groups were compared.Results:① A total of 131 patients were enrolled, including 94 males and 37 females with an average age of (68.3±15.0) years old. The median APACHE Ⅱ score was 27 (21, 34), the median of initial SOFA score was 12 (10, 14), the median of initial Lac was 5.0 (3.4, 7.1) mmol/L, and the most common source of infection was lung, with a total of 87 patients (66.41%). The completion time of initial 30 mL/kg fluid resuscitation and ΔSOFA score fitted the Logistic curve ( Y = -1.062 6 X2+4.407 9 X+0.961 8), which suggested that the early or late completion time of initial fluid resuscitation had adverse effects on the prognosis of patients with septic shock.② There was no significant difference in infection site, initial APACHE Ⅱ score, initial Lac, and initial SOFA score among different completion time of initial 30 mL/kg fluid resuscitation groups. The respiratory support rate, the incidence of AKI and the ratio of CRRT in the T ≤1 hour group were significantly higher than those in the 1 hour < T≤2 hours group, 2 hours < T≤3 hours group and T > 3 hours group (respiratory support rate: 78.57% vs. 75.51%, 42.86%, 75.00%; incidence of AKI: 57.14% vs. 20.41%, 21.43%, 50.00%; ratio of CRRT: 35.71% vs. 0%, 7.14%, 16.67%), the differences among the groups were statistically significant (all P < 0.05). The 28-day mortality was the highest in the T ≤ 1 hour group (64.29%), and the lowest in the 1 hour < T ≤2 hours group (22.45%), 35.71% in the 2 hours < T ≤ 3 hours group, 33.33% in the T > 3 hours, and the difference among the groups was statistically significant ( P < 0.01). Conclusions:Completion of initial 30 mL/kg fluid resuscitation in 1-2 hours after septic shock may reduce the 28-day mortality and improve organ dysfunction, and initial fluid resuscitation prematurely or too late may increase 28-day mortality. But further research and verification are needed.

Application of alveolar lavage fluid metagenomic next-generation sequencing in patients with severe pneumonia of unknown pathogen / 中国基层医药

Objective:To evaluate the application value of metagenomic next-generation sequencing(mNGS) for patients with severe pneumonia of unknown pathogen.Methods:The clinical data of 8 patients with unknown pneumonia pathogens who were assisted by the alveolar lavage fluid mNGS technology treated in Affiliated Hospital of Yangzhou University from June 2019 to February 2020 were retrospectively analyzed, including alveolar lavage fluid smear, culture, and the sequencing result.The clinical characteristics and mNGS detection results were comprehensively analyzed.According to the results of mNGS and the judgment of the clinician, the patients were divided into confirmed pathogens group and undetermined pathogens group, and the Simpson's diversity index of two groups was compared.Results:Among 8 cases, there were 5 males and 3 females, and the median age was 62.5 years (ranged from 41 to 71 years). All of them had chronic diseases except 1 case, including diabetes, chronic obstructive pulmonary disease and kidney transplantation.mNGS was positive in 8 patients, and conventional test was positive in 3 patients.The comparison of the Simpson's diversity index between the identified pathogenic group and the undetermined pathogenic group showed statistically significant difference [(0.398 ± 0.222) vs.(0.763 ± 0.061), t=2.709, P=0.035]. The positive results of mNGS were different from that of conventional test in 2 patients.The nucleic acid number in 3 cases of Pneumocystis carinii with mNGS positive results ranged from 120 to 15 580, with genomic coverage rates from 24.6% to 99.8%. Conclusion:mNGS can help physicians acquire information of the pathogenic bacteria quickly and comprehensively, especially for patients with unknown pneumonia pathogenic bacteria.

Shikimic Acid Promotes Oligodendrocyte Precursor Cell Differentiation and Accelerates Remyelination in Mice / 神经科学通报·英文版

The obstacle to successful remyelination in demyelinating diseases, such as multiple sclerosis, mainly lies in the inability of oligodendrocyte precursor cells (OPCs) to differentiate, since OPCs and oligodendrocyte-lineage cells that are unable to fully differentiate are found in the areas of demyelination. Thus, promoting the differentiation of OPCs is vital for the treatment of demyelinating diseases. Shikimic acid (SA) is mainly derived from star anise, and is reported to have anti-influenza, anti-oxidation, and anti-tumor effects. In the present study, we found that SA significantly promoted the differentiation of cultured rat OPCs without affecting their proliferation and apoptosis. In mice, SA exerted therapeutic effects on experimental autoimmune encephalomyelitis (EAE), such as alleviating clinical EAE scores, inhibiting inflammation, and reducing demyelination in the CNS. SA also promoted the differentiation of OPCs as well as their remyelination after lysolecithin-induced demyelination. Furthermore, we showed that the promotion effect of SA on OPC differentiation was associated with the up-regulation of phosphorylated mTOR. Taken together, our results demonstrated that SA could act as a potential drug candidate for the treatment of demyelinating diseases.

Analysis of pressure-time and flow-time curve in ventilator / 中华危重病急救医学

Objective@#To better understand the significance of the pressure-time curve and flow-time curve from the perspective of PB840 ventilator working principle.@*Methods@#① Mechanical principle: flow supply valves (air valve and oxygen valve) and exhalation valve in PB840 ventilator were controlled to achieve the ventilation target (volume or pressure) by the central processing unit according to the monitoring data from pressure sensors (P1 at the supply side, P2 at the exhalation side) and flow sensors (Q1 at the air side, Q2 at the oxygen side, Q3 at the exhalation side). ② The essence of curve: each point means a value of pressure or flow at a certain time measured by the sensors or calculated by the system. ③ The respiratory process could be divided into inspiratory part, expiratory part, and the connection part from expiratory to inspiratory. The air running state and the respiratory mechanics relationship at the three parts could be inferred according to the form of curves.@*Results@#① Inspiratory process: at volume-controlled and constant flow ventilation: there should be a relationship "Pc-Pa = XR" between alveolar pressure (Pa) and circuit pressure (Pc) according to Ohm law. So, the Pc curve (pressure-time curve) could indirectly reflect the Pa curve with the flow (X) and resistance (R) being constant. At pressure-set ventilation: it is the goal of ventilator to maintain the Pc at the target level. So, the stability of the target pressure line in pressure-time curve reflects the matching ability of the flow supply valves and the exhalation valve. ② Expiratory process: it could be divided into pre-expiratory [without basic flow (Ba) or bias flow (Bi)] and post-expiratory (with Ba or Bi), where Ba or Bi is equal to "Q1+Q2". So, the mathematical function are "X(t) = Q3t" in pre-part, and "X(t) = Q3t-(Q1t+Q2t)" in post-part. The relationship between pressure and flow at peak expiratory flow point: it could be found that there is an obvious time span and area formation under the curve from 0 to peak point (Fpeak) after stretching the abscissa axis of flow-time curve. It means that some gas have been discharged from the lung when it arrives at the peak point. So, the alveolar pressure should be lower than the platform pressure at the point (Pplat). The circuit pressure is significantly higher than positive end expiratory pressure (PEEP) at the point in the stretching axis diagram. So, it means that the formula "RE = (Pplat-PEEP)/Fpeak" to calculate the expiratory resistance (RE) is unreasonable in the angle of Ohm law. ③ The process from exhalation to inspiratory: according to the difference of the starting point of the conversion, it could be divided into two cases: one is that the inspiratory started from the ending of exhalation. Here, the inhaling starting point is lying in the abscissa axis. The other is that the inspiratory started before the ending of exhalation (with endogenous positive end expiratory pressure). Here, the starting point is lying below the abscissa axis, and the slope of the following curve is obviously larger than the slope of natural expiratory curve. According to the difference of results from the starting point to the end of the inhalation triggering effort, it could be divided into two cases: one is that it reach the trigger point. Here, the expiratory curve extends upward from or below the horizontal axis until an effective air supply is triggered. The other is that it could not reach the trigger point. Here, the expiratory curve extends upward from or below the horizontal axis, but then runs downward (meaning exhaling).@*Conclusion@#It is helpful to analyze the ventilation state, ventilation failure, and the causes of man-machine confrontation with understanding the ventilation principle and the air route map of the ventilator.

The prognostic value of circulating microRNA-29b in left ventricular hypertrophy in patients with hypertension / 中华内科杂志

Objective To analyze the relationship between the level of microRNA-29b in circulation and left ventricular hypertrophy in hypertensive patients.Methods A total of 240 subjects from Henan Province People's Hospital from June 2015 to June 2018 were included in the present study.Among them,160 were hospitalized patients,and were divided into two groups.Patients with simple hypertension and had no left ventricular hypertrophy (80 cases) were in the simple hypertension group (HBP-NLVH),and patients with hypertension combined with left ventricular hypertrophy (80 cases) were in the high blood pressure with left ventricular hypertrophy group (HBP-LVH).Normal control subjects (80 cases) were those with no hypertension and randomly selected from the medical center of Henan Province People's Hospital.Serum microRNA-29b expressions were detected by real time fluorescence quantitative PCR.The thickness of interventricular septum (IVSD) and left ventricular posterior wall thickness (LVPWD) were measured by echocardiography.Results Compared with the normal control group (1.95±0.79),the relative expression of microRNA-29b in the patients both in the HBP-NLVH group (2.67±0.92) and the HBP-LVH group (5.12 ± 1.23) was up-regulated,and the difference between normal control and patients was statistically significant (P＜0.05).In patients,the microRNA-29b level in the HBP-LVH group was significantly higher than that in the HBP-NLVH group (P＜0.05).The expression level of microRNA-29b was positively correlated with IVSD (r=0.71,P＜0.05) and LVPWD (r=0.74,P＜0.05),respectively.The sensitivity and specificity of serum microRNA-29b levels in the diagnosis of left ventricular hypertrophy in hypertension patients were 96.8％ and 91.3％,respectively.Conclusion Serum microRNA-29b level is elevated in hypertensive patients with left ventricular hypertrophy,and is positively correlated with left ventricular hypertrophy.The circulation microRNA-29b might be a useful biomarker with prognostic value in left ventricular hypertrophy in hypertension patients.

Analysis of adverse effects of infliximab treatment in 486 patients with Crohn's disease / 中华消化杂志

Objective To assess the safety of infliximab (IFX) treatment in patients with Crohn's disease(CD).Methods From January 2009 to May 2018,at inflammatory bowel disease (IBD) center of Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,486 CD patients received the treatment of IFX were enrolled and their clinical data were collected.Univariate and multivariate regression of binary logistic were performed for statistical analysis.Results The median follow-up duration was 31.1 months (12.0 months to 40.0 months).The median duration of IFX therapy was 13.0 months (7.0 months to 21.0 months).Among 486 patients,98 (20.16％) patients reported adverse effects,and 12 (2.47％) patients discontinued the therapy because of adverse effects.Acute infusion reaction was the most common adverse effect in CD patients who received IFX treatment accounting for 41.84％ (41/98) of all the adverse effects,and the incidence was 8.44％.Thirty-nine patients had mild and moderate infusion reaction,and all improved after symptomatic treatment (eight patients discontinued IFX therapy because of recurrent infusion reaction).Two patients developed severe infusion reaction as allergic shock,and both relieved after emergency rescue.Four patients developed late-phase allergic reactions.Among 486 patients,39 (8.02％) patients had infections,including infections of Clostridium difficile,cytomegalovirus,herpeszoster virus,Mycobacterium tuberculosis,and other opportunistic pathogens.There was no cases of infection related death.Thirty-six patients continued with IFX treatment after infection controlled.Among 486 patients,14 (2.88％) patients had severe infection,and all the cases improved after anti-infection treatment.Twenty-seven CD patients with hepatitis B virus (HBV) infection received anti-viral treatments,no active HBV infection was observed.Colon adenocarcinoma was found in one patient under colonoscopy at 22 months after discontinuation of IFX therapy.There were six patients with the history of benign tumors,and no evidence of recurrence,progress or malignancy during treatment.In terms of other rare adverse effects in 486 patients,there were eight (1.64％) patients with liver function injury,two (0.41％) patients with anemia,one (0.21％) patient with peripheral neuropathy,and four (0.82％) patients with skin lesion.Prolonged duration of IFX therapy,without combination of immune-suppressors and with increased baseline body mass index (BMI) were the risk factors of acute infusion reactions.Prolonged duration of IFX therapy and with low baseline albumin level were the risk factors of infections.Conclusions IFX is generally safe as the treatment for CD patients,and its adverse effects can be clinically controlled.Screening before therapy and monitoring during therapy may reduce the risks of adverse effects.