Prenatal diagnosis: Hypoplastic left heart syndrome in combination with ventriculo-coronary communication.

BACKGROUND: Both hypoplastic left heart syndrome and ventriculo-coronary communication are extremely rare congenital cardiac conditions. CASE: The diagnosis of hypoplastic left heart syndrome combined with endocardial fibroelastosis and ventriculo-coronary communication was made in a pregnant woman at 24 weeks of gestation. Interestingly, unlike diastolic flow from the coronary artery to the left ventricle in typical ventriculo-coronary communication, this fetus showed a systolic flow from the left ventricle to the coronary artery. CONCLUSION: To the best of our knowledge, this is the first study to present only a systolic flow signal in hypoplastic left heart syndrome combined with ventriculo-coronary communication in prenatal ultrasonography.

Long non-coding RNA C2dat1 involved in diabetic renal interstitial fibrosis by influencing CaMK2D/NF-κB signaling pathway / 中华微生物学和免疫学杂志

Objective:To study the changes in long non-coding RNA C2dat1 expression in kidney tissues of rats at different stages of diabetic kidney disease (DKD) and its relationship with renal interstitial fibrosis.Methods:Forty-eight male SD rats were randomly divided into two groups with 24 rats in each group: control group and DKD group. The rats in the control group were fed with ordinary diet, while those in the DKD group were fed with high-fat diet and drank water freely. After eight weeks of feeding, the rats were fasted for 12 h with free access to water. Then, the DKD group was given a one-time intrabitoneal injection of streptozotocin and the control group was given an equal dose of sodium citrate buffer. After 72 h, the random peripheral blood glucose concentration (≥ 16.7 mmol/L for three consecutive days) and urine sugar (positive) were tested to assess the establishment of the diabetes model. Urine, blood and kidney samples were collected at 3, 6, 9 and 12 weeks. The urinary protein excretion rate within 24 h, urinary creatinine and serum total cholesterol were measured by automatic biochemical apparatus. Pathological changes in kidney tissues were observed by HE staining. The expression of calcium/calmodulin-dependent protein kinase Ⅱ delta (CaMK2D), p65, p50, α-SMA and E-cardherin was detected by immunohistochemistry. Quantitative real-time PCR (qPCR) was used to detect the expression of lncRNA C2dat1 and CaMK2D. The relationship of lncRNA C2dat1 with α-SMA, E-cardherin and CaMK2D was analyzed by correlation analysis. In in vitro experiment, renal tubular epithelial cells HK-2 were induced by high glucose. The expression of lncRNA C2dat1 and CaMK2D in HK-2 cells was detected by qPCR after 24, 48 and 72 h of intervention. Results:The rats in the DKD group showed typical symptoms such as polydipsia, polyphagia, significant weight loss and increased blood glucose as compared with the rats in the control group. Results of the biochemical tests revealed that compared with the control group, the DKD group had increased 24 h excretion rate of urinary protein, decreased urinary creatinine and up-regulated total cholesterol. HE staining showed that the rats in the control group had intact glomeruli, normal basement membrane and no mesangial hyperplasia or inflammatory cell infiltration. However, enlarged glomeruli and evenly thickened basement membrane were observed in the DKD group. Immunohistochemistry indicated that the expression of CaMK2D, p50 and α-SMA was higher in the DKD group than in the control group, while the expression of E-cardherin was lower in the DKD group. qPCR results showed that the expression of lncRNA C2dat1 and CaMK2D at mRNA level was higher in the DKD group than in the control group. In in vitro experiment, the expression of lncRNA C2dat1 and CaMK2D at mRNA level was also higher in HK-2 cells induced by high glucose than in the control group. Correlation analysis indicated that lncRNA C2dat1 was positively correlated with α-SMA and CaMK2D, but negatively correlated with E-cardherin. Conclusions:During the progression of DKD, the high expression of lncRNA C2dat1 might promote diabetic renal interstitial fibrosis by regulating the expression of CaMK2D to activate the NF-κB signaling pathway.

Normal ranges and Z-scores analysis of the normal fetal umbilical vein diameter, blood volume flow and normalized volume blood flow in the second and third trimesters of pregnancy / 中华超声影像学杂志

Objective:To explore the method of ultrasonography for detecting the fetal umbilical vein diameter, blood flow volume and normalized volume blood flow and establish normal reference ranges with umbilical vein diameter, blood flow volume and normalized blood flow and Z-scores for umbilical vein diameter and blood volume flow.Methods:This was a prospective study on 907 normal fetuses in the Second Xiangya Hospital, Central South University and Women and Children Healthcare Hospital of Zhuzhou from March 2019 to December 2020. The umbilical vein diameter (Duv), umbilical vein blood flow volume (Quv) and normalized volume blood flow (nQ = Quv/estimated fetal weight) of the free loop of umbilical vein (FUV) and fetal intra-abdominal umbilical vein (IUV) were collected. And the mean values and 90% confidence intervals of Duv, Quv and nQ in two segments of umbilical veins at different gestational ages were calculated. Regression analysis of Duv, Quv and nQ were performed with gestational age (GA), and the parameters of umbilical vein in different segments were compared. Finally, with gestational age (GA) as the independent variable, Z-scores of the Duv and Quv were built.Results:The mean values and 90% confidence intervals of Duv, Quv, and nQ in 858 (94.6%) normal fetal umbilical veins were successfully obtained. The Duv, Quv of the FUV and IUV increased as pregnancy progressed. The Quadratic curve of Duv and Linear curve of Quv were of the highest fitnesses, respectively( r=0.951, 0.941, 0.986, 0.982; all P<0.001). While nQ increased with GA followed by a decreased trend, and the Quadratic curve was the highest fitting curve of nQ( r=0.610, 0.611; all P<0.001). Duv-FUV was greater than Duv-IUV( P<0.001), nQ-FUV was bigger than Quv-IUV( P=0.001), and he difference was not statistically significant between Quv-FUV and Quv-IUV( P=0.133). Z-scores models of Duv and Quv were successfully established, and all Z-scores were Gaussian distribution. Conclusions:The normal ranges and Z-scores of umbilical vein parameters are useful to improve the evaluation of placental circulation and provide a strong basis for the monitoring of fetus-related diseases and the evaluation of pregnancy prognosis. The choice of FUV or IUV umbilical vein to evaluate placental circulation may depend on the actual situation in clinical application.

Fighting COVID-19 with Flexible Testing: Models and Insights

Increasing testing capacities plays a substantial role in safely reopening the economy and avoiding a new wave of COVID-19. Pooled testing can expand testing capabilities by pooling multiple individual samples, but it also raises accuracy concerns. In this study, we propose a flexible testing strategy that adopts pooled testing or individual testing according to epidemic dynamics. We identify the prevalence threshold between individual and pooled testing by modeling the expected number of tests per confirmed case. Incorporating an epidemic model, we show pooled testing is more effective in containing epidemic outbreaks and can generate more reliable test results than individual testing because the reliability of test results is relevant to both testing methods and prevalence. Our study is the first to evaluate the interplay between pooled testing and a rapidly evolving outbreak to the best of our knowledge. Our results allay accuracy concerns about pooled testing and provide theoretical supports to empirical studies.

Spatially Explicit Modeling of 2019-nCoV Epidemic Trend based on Mobile Phone Data in Mainland China

As of February 11, 2020, all prefecture-level cities in mainland China have reported confirmed cases of 2019 novel coronavirus (2019-nCoV), but the city-level epidemical dynamics is unknown. The aim of this study is to model the current dynamics of 2019-nCoV at city level and predict the trend in the next 30 days under three possible scenarios in mainland China. We developed a spatially explicit epidemic model to consider the unique characteristics of the virus transmission in individual cities. Our model considered that the rate of virus transmission among local residents is different from those with Wuhan travel history due to the self-isolation policy. We introduced a decay rate to quantify the effort of each city to gradually control the disease spreading. We used mobile phone data to obtain the number of individuals in each city who have travel history to Wuhan. This city-level model was trained using confirmed cases up to February 10, 2020 and validated by new confirmed cases on February 11, 2020. We used the trained model to predict the future dynamics up to March 12, 2020 under different scenarios: the current trend maintained, control efforts expanded, and person-to-person contact increased due to work resuming. We estimated that the total infections in mainland China would be 72172, 54348, and 149774 by March 12, 2020 under each scenario respectively. Under the current trend, all cities will show the peak point of daily new infections by February 21. This date can be advanced to February 14 with control efforts expanded or postponed to February 26 under pressure of work resuming. Except Wuhan that cannot eliminate the disease by March 12, our model predicts that 95.4%, 100%, and 75.7% cities will have no new infections by the end of February under three scenarios. The spatial pattern of our prediction could help the government allocate resources to cities that have a more serious epidemic in the next 30 days.

Effect of single-chamber balloon combined with dinoprostone suppository on cervical ripening induced by full-term maternal delivery / 中国基层医药

Objective@#To investigate the effects of single-chamber balloon combined with dinoprostone suppository on the progestation of the cervix in full-term maternal delivery.@*Methods@#From January 2017 to December 2018, 120 cases of full-term maternal women admitted to the Central Hospital of Yiwu were selected.According to the random number table method, all women were divided into control group (60 cases) and observation group (60 cases). The control group was given a single-cavity balloon to promote cervical ripening.The observation group received single-chamber balloon combined with dinoprostone to promote cervical ripening.The effects of maternal cervical ripening were observed.@*Results@#The total effective rate of maternal cervical ripening in the observation group (95.00%) was significantly higher than that in the control group (81.67%), and the difference was statistically significant (χ2=6.135, P<0.05). The differences of maternal postpartum hemorrhage and neonatal asphyxia rate were not statistically significant (t=1.684 , χ2=2.563, all P>0.05). The total maternal labor [(5.8±2.1)h] in the observation group was significantly shorter than that in the control group [(7.6±2.5)h], the difference was statistically significant (t=3.126, P<0.05). The vaginal delivery rate (95.00%) of the observation group was higher than that of the control group (73.33%), the difference was statistically significant (χ2=5.342, P<0.05). Before implanting the balloon and balloon combination, the Bishop score between the two groups had no statistically significant difference (t=3.623, P>0.05). After the balloon and balloon combination were taken out, the Bishop score of the maternal cervix[(8.6±1.5)points] in the observation group was higher than that in the control group [(7.2±1.3)points], and the difference was statistically significant (t=4.354, P<0.05). The incidence of adverse reaction of the observation group (6.67%) was lower than that of the control group (13.33%), the difference was statistically significant between the groups(χ2=3.821, P<0.05).@*Conclusion@#Compared with simple single-chamber balloon, single-chamber balloon combined with dinoprostone suppository has more significant effect on the maternal ripening of the cervix, it can improve the vaginal delivery rate and maternal cervical Bishop scores, effectively reduce the maternal total labor, and reduce the incidence of maternal adverse reactions.

Comparation of the effects of insulin-like growth factor-1 receptor inhibitor and insulin on renal interstitial macrophage infiltration in mice with type 2 diabetic kidney disease / 中华肾脏病杂志

Objective@#To compare the effect of insulin-like growth factor-1 receptor (IGF-1R) inhibitor and insulin on renal interstitial macrophage infiltration in mice with type 2 diabetic kidney disease (DKD) mice.@*Methods@#Twenty-four male C57BL/6 mice were selected. After 1 week of adaptive feeding, 6 rats were randomly selected as the control group. The other mice were intraperitoneally injected with streptozotocin (30 mg/kg) after 8 weeks of high-fat and high-sugar feeding. After 72 h, the type 2 diabetes mellitus (DM) models were successfully established if random blood glucose was greater than 16.7 mmol/L. After 8 weeks, if the proteinuria of DM mice increased, the DKD models were successful. DKD mice were divided into 3 groups by random number remainder method: DKD group (n=6), DKD+insulin group (insulin group, n=6, subcutaneous injection of 1-2 U/d insulin) and DKD+IGF-1R inhibitor (IGF-1R inhibitor group, n=6, administered with 30 mg·kg-1·d-1 IGF-1R inhibitor). They were continuously treated for 8 weeks. Random blood glucose was tested by glucometer. Blood and urine were collected, and biochemical indicators, such as serum creatinine, urea nitrogen and urine protein were measured by biochemical analyzer. Renal pathological changes were detected by hematoxylin-eosin staining (HE) and periodic acid-schiff staining (PAS). Suppressor of cytokine signaling 2 (SOCS2) mRNA and insulin-like growth factor-1 (IGF-1) mRNA were detected by in situ hybridization. The protein expressions of SOCS2, F4/80, Toll-like receptor 4 (TLR4) and CD68 were detected by immunohistochemistry.@*Results@#Compared with the control group, blood glucose, serum creatinine, serum urea nitrogen and urinary protein excretion rate were significantly higher in DKD mice (all P<0.05), and CD68+ cells number, F4/80+ cells number and the expression of TLR4 in the tubulointerstitial of DKD mice were significantly higher (all P<0.05). After intervention with insulin or IGF-1R inhibitor, serum creatinine, serum urea nitrogen and urinary protein excretion rate of DKD mice were significantly reduced (all P<0.05). Insulin intervention could significantly reduce blood glucose in mice (P<0.05), but had no significant effect on macrophages. Although IGF-1R inhibitor did not significantly reduce blood glucose, it could significantly reduce the number of CD68, F4/80 positive cells and the expression of TLR4 protein in renal interstitium of DKD mice (all P<0.05). Compared with the DKD group, insulin intervention significantly reduced the expression of IGF-1 protein and mRNA (both P<0.01), and increased the expression of SOCS2 mRNA and protein (both P<0.01). And the expression of SOCS2 protein was correlated with the number of F4/80+ cells in insulin group (R2=0.8461, P=0.005). However, IGF-1R inhibitors had no significant effect on SOCS2 expression, but had better inhibition of macrophage infiltration.@*Conclusion@#IGF-1R inhibitor has a better inhibitory effect on DKD renal interstitial macrophage infiltration than insulin. The mechanism may be related to the fact that IGF-1R inhibitor does not up-regulate SOCS2 expression, whereas insulin up-regulates SOCS2 expression to activate some potential pathways.

Comparation of the effects of insulin-like growth factor-1 receptor inhibitor and insulin on renal interstitial macrophage infiltration in mice with type 2 diabetic kidney disease / 中华肾脏病杂志

Objective To compare the effect of insulin-like growth factor-1 receptor (IGF-1R) inhibitor and insulin on renal interstitial macrophage infiltration in mice with type 2 diabetic kidney disease (DKD) mice. Methods Twenty-four male C57BL/6 mice were selected. After 1 week of adaptive feeding, 6 rats were randomly selected as the control group. The other mice were intraperitoneally injected with streptozotocin (30 mg/kg) after 8 weeks of high-fat and high-sugar feeding. After 72 h, the type 2 diabetes mellitus (DM) models were successfully established if random blood glucose was greater than 16.7 mmol/L. After 8 weeks, if the proteinuria of DM mice increased, the DKD models were successful. DKD mice were divided into 3 groups by random number remainder method: DKD group (n=6), DKD+insulin group (insulin group, n=6, subcutaneous injection of 1-2 U/d insulin) and DKD+IGF-1R inhibitor (IGF-1R inhibitor group, n=6, administered with 30 mg·kg-1·d-1 IGF-1R inhibitor). They were continuously treated for 8 weeks. Random blood glucose was tested by glucometer. Blood and urine were collected, and biochemical indicators, such as serum creatinine, urea nitrogen and urine protein were measured by biochemical analyzer. Renal pathological changes were detected by hematoxylin-eosin staining (HE) and periodic acid-schiff staining (PAS). Suppressor of cytokine signaling 2 (SOCS2) mRNA and insulin-like growth factor-1 (IGF-1) mRNA were detected by in situ hybridization. The protein expressions of SOCS2, F4/80, Toll-like receptor 4 (TLR4) and CD68 were detected by immunohistochemistry. Results Compared with the control group, blood glucose, serum creatinine, serum urea nitrogen and urinary protein excretion rate were significantly higher in DKD mice (all P<0.05), and CD68+ cells number, F4/80+ cells number and the expression of TLR4 in the tubulointerstitial of DKD mice were significantly higher (all P<0.05). After intervention with insulin or IGF-1R inhibitor, serum creatinine, serum urea nitrogen and urinary protein excretion rate of DKD mice were significantly reduced (all P<0.05). Insulin intervention could significantly reduce blood glucose in mice (P<0.05), but had no significant effect on macrophages. Although IGF-1R inhibitor did not significantly reduce blood glucose, it could significantly reduce the number of CD68, F4/80 positive cells and the expression of TLR4 protein in renal interstitium of DKD mice (all P<0.05). Compared with the DKD group, insulin intervention significantly reduced the expression of IGF-1 protein and mRNA (both P<0.01), and increased the expression of SOCS2 mRNA and protein (both P<0.01). And the expression of SOCS2 protein was correlated with the number of F4/80 + cells in insulin group (R2=0.8461, P=0.005). However, IGF-1R inhibitors had no significant effect on SOCS2 expression, but had better inhibition of macrophage infiltration. Conclusion IGF-1R inhibitor has a better inhibitory effect on DKD renal interstitial macrophage infiltration than insulin. The mechanism may be related to the fact that IGF-1R inhibitor does not up-regulate SOCS2 expression, whereas insulin up-regulates SOCS2 expression to activate some potential pathways.

Effect of single-chamber balloon combined with dinoprostone suppository on cervical ripening induced by full-term maternal delivery / 中国基层医药

Objective To investigate the effects of single-chamber balloon combined with dinoprostone suppository on the progestation of the cervix in full-term maternal delivery.Methods From January 2017 to Decem-ber 2018,120 cases of full-term maternal women admitted to the Central Hospital of Yiwu were selected.According to the random number table method ,all women were divided into control group (60 cases ) and observation group (60 cases).The control group was given a single-cavity balloon to promote cervical ripening.The observation group received single-chamber balloon combined with dinoprostone to promote cervical ripening .The effects of maternal cervical ripening were observed.Results The total effective rate of maternal cervical ripening in the observation group (95.00%) was significantly higher than that in the control group (81.67%),and the difference was statisti-cally significant (χ2 ＝6.135,P＜0.05).The differences of maternal postpartum hemorrhage and neonatal asphyxia rate were not statistically significant ( t ＝1.684 ,χ2 ＝2.563,all P＞0.05).The total maternal labor [( 5.8 ± 2.1)h] in the observation group was significantly shorter than that in the control group [(7.6 ±2.5) h],the differ-ence was statistically significant (t＝3.126,P＜0.05).The vaginal delivery rate (95.00%) of the observation group was higher than that of the control group (73.33%),the difference was statistically significant ( χ2 ＝5.342,P＜0.05).Before implanting the balloon and balloon combination ,the Bishop score between the two groups had no statis-tically significant difference (t＝3.623,P＞0.05).After the balloon and balloon combination were taken out ,the Bishop score of the maternal cervix [(8.6 ±1.5)points] in the observation group was higher than that in the control group [(7.2 ±1.3)points],and the difference was statistically significant (t＝4.354,P＜0.05).The incidence of adverse reaction of the observation group (6.67%) was lower than that of the control group (13.33%),the differ-ence was statistically significant between the groups ( χ2 ＝3.821,P＜0.05).Conclusion Compared with simple single-chamber balloon,single-chamber balloon combined with dinoprostone suppository has more significant effect on the maternal ripening of the cervix ,it can improve the vaginal delivery rate and maternal cervical Bishop scores , effectively reduce the maternal total labor ,and reduce the incidence of maternal adverse reactions.

Role of HMGN1 in epithelial-mesenchymal transition of kidney tubules in diabetic nephropathy mice / 中华内分泌代谢杂志

Objective This study aimed to investigate the renal expression change of high mobility of nucleosome binding protein 1 ( HMGN1) in epithelia-mesenchymal transition ( EMT) process, and to study the effect of HMGN1 on renal fibrosis in the diabetic nephropathy mice model. Methods 20 C57BL/6 mice were randomly divided into control group, model group, benazepril group, and insulin group. After 8 weeks of drug intervention, blood, urine and kidney tissue samples were taken from mice. The routine physiological and biochemical indexes were detected. Renal structure and fibrosis were detected by HE and Sirius red staining, respectively. Immunohistochemistry and in situ hybridization were used to investigate the protein and mRNA expression levels of HMGN1, CD68, F4/80,α-smooth muscle actin (α-SMA) , and E-cadherin in renal tissue. Results Blood glucose, renal index, and urinary albumin to creatinine ratio ( UACR) were significantly higher in the model group than those in the normal group. In the model group, HE staining showed glomerular hypertrophy and interstitial inflammatory cell infiltration, and Sirius red showed collagen deposition in the renal tissue. Compared with normal group, HMGN1, CD68, F4/80 positive cell counts andα-SMA protein expression were all increased, while E-cadherin protein expression was downregulated in the model group ( all P<0.05) . The above indexes were not improved significantly in the benazepril group. And after intervention of insulin, the expression levels of CD68 positive cell count andα-SMA protein were decreased and the expression levels of E-cadherin protein were increased compared with the model group ( all P<0.05) . The correlation analysis showed that the level of HMGN1 was correlated with CD68, F4/80, α-SMA, E-cadherin and collagen protein, while CD68 and f4/80 were correlated withα-SMA, collagen protein and blood glucose, respectively ( all P<0. 05 ) . Conclusion HMGN1 is involved in the progression of diabetic nephropathy fibrosis, and its underlying mechanism might be related to the macrophage-mediated EMT process.

Flavonoids from the leaves of Astragalus membranaceus / 中成药

AIM To study the flavonoids from the leaves of Astragalus membranaceus (Fish.) Bge..METHODS The ethyl acetate and n-butyl alcohol fractions of 75％ ethanol extract from A.membranaceus leaves were isolated and purified by silica,ODS and preparative HPLC column,then the structures of obtained compounds were identified by spectral data.RESULTS Thirteen compounds were isolated and identified as quercetin (1),quercetin-3-O-β-D-glucopyranoside (2),rhamnocitrin-3-O-β-D-glucopyranoside (3),rhamnocitrin-3-O-β-neohesperidoside (4),rhamnocitrin-3-O-3-D-glucopyranoside (1'''→2'')-β-D-apiofuranosyl (5),complanatuside (6),glycitein (7),4',7-dihydroxy-3-methoxy isoflavone (8),genistein (9),calycosin-7-O-β-D-glucopyranoside (10),genistin (11),glycitin (12),tiliroside (13).CONCLUSION Compounds 5,8,13 are isolated from genus Astragalus for the first time,and compound 2 is first isolated from this plant.

Establishing tumor-bearing animal models at different sites of the head and neck and their growing and metastatic characteristics / 中国组织工程研究

BACKGROUND:To establish a tumor-bearing animal model of the head and neck is of clinical significance for further studying pathogenesis and transfer mechanisms and for actively finding an effective diagnosis and therapeutic regimen. OBJECTIVE:To compare the growth, lymphatic metastasis and distant metastasis characteristics of head and neck tumors in animals. METHODS:VX2 tumor cel lines were resuscitated and passaged to establish tumor-bearing rabbit models. Under anesthesia, the tumor was stripped from the tumor-bearing site to make tumor cel suspension. Then, thecel suspension was injected into the thigh muscle of rabbits and then passaged 2 weeks later. Tumor samples were harvested from the thigh of passage rabbits to make VX2 tumor cel suspension that was injected into the ear, tongue and nasopharynx of rabbits to make a VX2 tumor model of the head and neck in the rabbit. RESULTS AND CONCLUSION: The three groups of rabbits had significant differences in spirit, diet, activity and so on. Rabbits with tumor xenograft of the ear were significantly better than those with tumor xenograft of the tongue and nasopharynx. At 2 weeks after injection of VX2 tumor cel suspension, the VX2 tumor models of the head and neck were made successfuly in rabbits, and the tumor formation rate was 100% (15/15) at the ear, 93% (14/15) at the tongue and nasopharynx. VX2 tumors at different sites experienced rapid growth period, central necrosis period, surface ulceration period, and the life cycle was about 4-6 weeks. Lymph node metastasis in head and neck and pulmonary metastasis were found in the al three groups. Hematoxylin-eosin staining showed that VX2 tumor tissues and metastatic lymph nodes were confirmed as moderately to poorly differentiated squamous cel carcinoma. These findings indicate that tumor-bearing rabbit models of the head and neck established by VX2 cel suspension are characterized by short modeling cycle, good stability, easy to repeat, high tumor formation rate and simple operation. VX2 tumors in the different sites of the head and neck of rabbits have different characteristics, so we can choose the different implanting sites according to the different research purposes.

The efficacy and safety analysis of glucocorticoid deescalation combined antiviral therapy on severe hepatitis B / 重庆医学

Objective Observe the efficacy and safety of glucocorticoid deescalation combined antiviral therapy on severe hepati‐tis B .Methods Forty‐nine patients with early severe hepatitis were selected and divided them into observation group(n=24) and control group (n=25) randomly .Control group were given the conventional synthetic therapy while observation group were given conventional synthetic therapy combined glucocorticoid deescalation therapy .Then compare the differences of TBIL ,ALT ,PTA be‐fore and after treatment ,and the improvement time of syndrome and death rate between two groups .Results The death rate in ob‐servation group and control group were 16 .7% and 32 .0% respectively(P0 .05) .After the treatment ,the TBIL ,ALT ,PT were improved in both two groups(P 0 .05) .Conclusion Glucocorticoid deescalation therapy could decrease the death rate ,shorten the syndrome lasting time in treating severe hepatitis B .It was an effective and safety meth‐od .

Effect of epidural analgesia with different methods on intestinal peristalsis / 中国基层医药

Objective To explore the effect of PCEA on intestinal peristalsis.Methods 120 patients with ASA Ⅰ～Ⅱ lower abdominal or lower limbs surgery were randomly divided into four groups with 30 cases each and received PCEA at the end of operation sespectively.Group A were given 0.0002% fentanyl,0.2% Ropivacaine and 0.005 % Droperidol;0.01% morphine,0.2% Ropivacaine and 0.005% droperidol in group B;0.2% Ropivacaine in group C;0.9% saline in group D.Postoperative analgesia was provided by PCA pump with LCP model.Results Satisfactory analgesia in group A was 93%,97% in group B 47% in group C and 13% in group D.Both group A and B did not show any significant difference in the analgesic effects(P＞ 0.05).Satisfactory analgesia in group A and B were significantly better than in group C and D(P＜0.05).The renewal of intestinal peristalsis were significantly faster in lower limbs surgery patients than lower abdominal patients(P＜ 0.01),but it did not show any significant difference in the same kinds of surgery in four groups (P＞0.05).Conclusion Both group A and B can get a satisfied analgesia effect;intestinal peristalsis of lower limbs surgery patients renewed were shorter than in lower abdominal patients.