ObjectiveTo investigate the clinical characteristics and contribution factors in severe coronavirus disease 2019 (COVID-19).MethodsThe clinical symptoms, laboratory findings, radiologic data, treatment strategies, and outcomes of 110 COVID-19 patients were retrospectively analyzed in these hospitals from Jan 20, 2020 to Feb 28, 2020. All patients were confirmed by fluorescence reverse transcription polymerase chain reaction. They were classified into a non-severe group and a severe group based on their symptoms, laboratory and radiologic findings. All patients were given antivirus, oxygen therapy, and support treatments. The severe patients received high-flow oxygen therapy, non-invasive mechanical ventilation, invasive mechanical ventilation or extracorporeal membrane oxygenation. The outcomes of patients were followed up until March 15, 2020. Contribution factors of severe patients were summarized from these clinical data.ResultsThe median age was 50 years old, including 66 males (60.0%) and 44 females (40.0%). Among them, 45 cases (40.9%) had underlying diseases, and 108 cases (98.2%) had different degrees of fever. The common clinical manifestations were cough (80.0%, 88/110), expectoration (33.6%, 37/110), fatigue (50.0%, 55/110), and chest tightness (41.8%, 46/110). Based on classification criteria, 78 (70.9%) non-severe patients and 32 (29.1%) severe patients were identified. Significant difference of the following parameters was found between two groups (P<0.05): age was 47 (45, 50) years vs. 55 (50, 59) years (Z=–2.493); proportion of patients with underlying diseases was 27 (34.6%) vs. 18 (56.3%) (χ2=4.393); lymphocyte count was 1.2 (0.9, 1.5)×109/L vs. 0.6 (0.4, 0.7)×109/L (Z=–7.26); C reactive protein (CRP) was 16.2 (6.5, 24.0) mg/L vs. 45.3 (21.8, 69.4) mg/L (Z=–4.894); prothrombin time (PT) was 15 (12, 19) seconds vs. 18 (17, 19) seconds (Z=–2.532); D-dimer was 0.67 (0.51, 0.82) mg/L vs. 0.98 (0.80, 1.57) mg/L (Z=–5.06); erythrocyte sedimentation rate (ESR) was 38.0 (20.8, 59.3) mm/1 h vs. 75.5 (39.8, 96.8) mm/1 h (Z=–3.851); lactate dehydrogenase (LDH) was 218.0 (175.0, 252.3) U/L vs. 325.0 (276.5, 413.5) U/L (Z=–5.539); neutrophil count was 3.1 (2.1, 4.5)×109/L vs. 5.5 (3.7, 9.1)×109/L (Z=–4.077). Multivariable logistic analysis showed that there was positive correlation in elevated LDH, CRP, PT, and neutrophil count with the severity of the disease. Currently, 107 patients were discharged and 3 patients died. Total mortality was 2.7%.ConclusionsOld age, underlying diseases, low lymphocyte count, elevated CPR, high D-dimer and ESR are relevant to the severity of COVID-19. LDH, CPR, PT and neutrophil count are independent risk factors for the prognosis of COVID-19.
ObjectiveTo establish paraquat (PQ)-induced acute respiratory distress syndrome (ARDS) mice model via gavage, in order to simulate oral adminitration in clinical situations.MethodsSeventy-eight 6-8-week-old, specific pathogen free female C57 mice were chosen in this study. The mice were randomly divided into the control group (n=6) and the PQ model group(n=36); the mice in the latter group were randomly divided into 6 poisoning model subgroups further, with 6 mice in each, to find out the suitable concentration of PQ to establish stable ARDS model. The mice in the control group were given phosphatebuffer saline (PBS) by gavage, 200 μL per mouse; while the mice in the 6 poisoning model subgroups were given PQ with varies doses of 3, 10, 30, 100, 150, 300 mg/kg respectively by gavage. The clinical manifestations were observed for 7 days, and the ratio of lung wet/dry (W/D) was measured. After the suitable concentration of PQ for stable ARDS mice model was found, the other 36 mice were randomly divided into the controlgroup and the poisoning model group, both were divided into 4 subgroups, according to different observation point in time (1 day and 2, 3, 4 days after PQ gavage). The mice in the 4 control subgroups (n=3) were given PBS by gavage, 200 μL per mouse; while the mice in the 4 poisoning model subgroups (n=6) were given PQ with the suitable concentration for ARDS mice model by gavage. Pathological manifestations by Haematoxylin-Eosin staining and lung injury score were observed and analyzed.ResultsThe mice began to die at the PQ dosage of 150 mg/kg; while the death rate was stable at 300 mg/kg. On the 2nd and 4th day after PQ gavage, lung W/D was 5.335, 6.113, and 5.525, and 6.403, respectively in the mice in 150 and 300 mg/kg subgroup, which differed much from those in the control group (P<0.001). Congestion, edema, hemorrhage, alveolar structure damage, inflammation cells infiltration of lung tissue were observed, and lung injury score increased.ConclusionPQ-induced ARDS mice model by gavage is established successfully.
Objective To investigate the methods and outcome of endoscopic ulnar neurolysis and minimal medial epicondylectomy in treatment of cubital tunnel syndrome with ulnar nerve subluxation. Methods Between June 2004 and June 2009, 11 cases of cubital tunnel syndrome with ulnar nerve subluxation were treated with endoscopic ulnar neurolysis andminimal medial epicondylectomy. There were 7 males and 4 females with an average age of 36 years (range, 18-47 years). All cases had numbness in l ittle finger and ring finger. The disease duration varied from 3 to 18 months (7 months on average). Nine cases had atrophy in the first dorsal interosseous muscle and hypothenar muscles. The preoperative electromyography showed that the ulnar nerve conduction velocity (NCV) were slowed down at elbow, which was (27.0 ± 1.5) m/s. Results All incisions healed by first intention, and no compl ication occurred. Eleven cases were followed up 6-37 months (19 months on average). All cases had normal sensation after 1 month of operation. The muscle strength was obviously improved in 11 cases after 3 months postoperatively (grade 4 in 7 cases and grade 3-4 in 4 cases). The postoperative electromyography showed that the NCV was obviously improved, which was (43.5 ± 9.5) m/s, showing significant difference when compared with preoperative one (P lt; 0.05). According to Amadio’ efficacy appraisal standard, the results were excellent in 7 cases and good in 4 cases. Conclusion The method of endoscopic ulnar neurolysis and minimal medial epicondylectomy has the advantages of safety, convenient manipulation, small incision, and early recovery for cubital tunnel syndrome with ulnar nerve subluxation.
Objective To study the efficacy of invasive ventilation in critical severe acute respiratory syndrome (SARS). Methods Retrospective analysis was applied to study the efficacy of invasive ventilation and the effect of isolating and protecting measures in 6 critical SARS patients and the effect of isolation measures in ICU from November 2002 to April 2003. Results Six SARS patients were successfully weaned from mechanical ventilation and left hospital. Hypoxemia and oxygenation index（PaO2/FiO2）improved significantly after ventilation (Plt;0.01), peak inspiratory airway pressure (P=0.002), mean airway pressure (P=0.004), and the level of positive expiration end pressure decreased significantly (Plt;0.001). Ventilator-associated pneumonia occurred in 5 patients. Sedatives were used less and the duration of ventilation was shorter when using PRVC compared with SIMV. There was no SARS nosocomial infection among medical staff, other patients and their families. Conclusions Application of invasive ventilation and effective isolation measures could reduce the death rate, shorten the duration of ventilation, and also decrease SARS nosocomial infection.
Objective To clarify that the vascular endothelial cell injury caused by obstructive sleep apnoea hypopnea syndrome (OSAHS) is partly mediated by miRNA-92a. Methods Serum miRNA-92a level was measured in patients who underwent polysomnography between January 2018 and December 2018. The correlation between miRNA-92a and OSAHS was analyzed. Meanwhile, endothelial cells were cultured in vitro, and morphological changes and JC-1 staining results of endothelial cells were observed after OSAHS serum stimulation, so as to further clarify the injury of endothelial cells. The changes of miRNA-92a target gene were detected by reverse transcription-polymerase chain reaction (RT-PCR) and Western blot to further clarify the mechanism of endothelial cell injury. Results Seventy-two patients received polysomnography, including 22 cases in the non-OSAHS group, 18 in the mild OSAHS group, 10 in the moderate OSAHS group, and 22 in the severe OSAHS group. Serum miRNA-92a level was significantly increased in the OSAHS patients, and it also increased with the aggravation of OSAHS severity. OSAHS serum significantly damaged endothelial cells. Endothelial cells were swollen, disordered arrangement, and unclear boundaries. JC-1 staining showed that green fluorescence was significantly enhanced compared with the control group. RT-PCR and Western blot showed that the expressions of Krüppel-like factor-2 (KLF-2), Krüppel-like factor-4 (KLF-4) and endothelial nitric oxide synthase (eNOS) were significantly decreased under OSAHS serum stimulation. Conclusion Serum miRNA-92a of OSAHS patients is significantly increased, and reduces the expression of target genes KLF-2, KLF-4 and eNOS, affects the mitochondrial function of endothelial cells, and injures endothelial cells.
Objective To analyze the differences in distribution of traditional Chinese medicine (TCM) syndrome elements and salivary microbiota between the individuals with pulmonary nodules and those without, and to explore the potential correlation between the distribution of TCM syndrome elements and salivary microbiota in patients with pulmonary nodules. Methods We retrospectively recruited 173 patients with pulmonary nodules (PN) and 40 healthy controls (HC). The four diagnostic information was collected from all participants, and syndrome differentiation method was used to analyze the distribution of TCM syndrome elements in both groups. Saliva samples were obtained from the subjects for 16S rRNA high-throughput sequencing to obtain differential microbiota and to explore the correlation between TCM syndrome elements and salivary microbiota in the evolution of the pulmonary nodule disease. Results The study found that in the PN group, the primary TCM syndrome elements related to disease location were the lung and liver, and the primary TCM syndrome elements related to disease nature were yin deficiency and phlegm. In the HC group, the primary TCM syndrome elements related to disease location were the lung and spleen, and the primary TCM syndrome elements related to disease nature were dampness and qi deficiency. There were differences between the two groups in the distribution of TCM syndrome elements related to disease location (lung, liver, kidney, exterior, heart) and disease nature (yin deficiency, phlegm, qi stagnation, qi deficiency, dampness, blood deficiency, heat, blood stasis) (P<0.05). The species abundance of the salivary microbiota was higher in the PN group than that in the HC group (P<0.05), and there was significant difference in community composition between the two groups (P<0.05). Correlation analysis using multiple methods, including Mantel test network heatmap analysis and Spearman correlation analysis and so on, the results showed that in the PN group, Prevotella and Porphyromonas were positively correlated with disease location in the lung, and Porphyromonas and Granulicatella were positively correlated with disease nature in yin deficiency (P<0.05). ConclusionThe study concludes that there are notable differences in the distribution of TCM syndrome elements and the species abundance and composition of salivary microbiota between the patients with pulmonary nodules and the healthy individuals. The distinct external syndrome manifestations in patients with pulmonary nodules, compared to healthy individuals, may be a cascade event triggered by changes in the salivary microbiota. The dual correlation of Porphyromonas with both disease location and nature suggests that changes in its abundance may serve as an objective indicator for the improvement of symptoms in patients with yin deficiency-type pulmonary nodules.
【Abstract】ObjectiveTo explore the changes of colon motility of the rats in multiple organ dysfunction syndrome （MODS） induced bacterial peritonitis and the effects of IL6, TNFα and induce nitricoxide synthase (iNOS) on colon motility. MethodsWistar rats were divided into two groups, which were the control group and the MODS group. The number of stool, the amplitude changes of circular smooth muscle strip, the length of smooth muscle cell, and the changes of serum NO in two groups were observed. The expressions of IL6, TNFα and iNOS protein and IL6 mRNA, TNFα mRNA and iNOS mRNA in distal colon were investigated by using immunohistochemical methods and RTPCR. ResultsThe numbers of stool and the amplitude in the MODS group were lower than those of the control group （P＜0.05）. The expressions of IL6, TNFα and iNOS were negative in the control group, while they were positive in the MODS group. IL6 mRNA,TNFα mRNA and iNOS mRNA were negative expression in the control group, but they were positive expression in the MODS group. The concentration of serum NO and the length of smooth muscle cells in the MODS group were higher than those of the control group (P＜0.01). ConclusionColon motor dysfunction of the rats is related to the iNOS, IL6 and TNFα.
ObjectiveTo explore a new method for establishing premature piglet model of short bowel syndrome.
MethodsThirty two premature piglets were randomly divided into 4 groups, including jejunoileal anastomosis group, jejunocolic anastomosis group, sham operation group, and blank control group. Each group enrolled 8 premature piglets. Jejunoileal anastomosis group:resected 75% of small intestinal, reserved the proximal jejunum (10% of the total small intestine length) and distal ileum (15% of the total small intestine length), with jejunoileal anastomosis. Jejunocolic anastomosis group:removed 75% of the small intestine, including the distal jejunum (25% of the total small intestine length), total ileum (50% of total small intestine length), the ileocecal valve, and the colon beyond 5 cm far from the ileocecal valve, retained the proximal jejunum (25% of the total length of the small intestine), with jejunocolic anastomosis. Sham group:cut off the ileum at a distance of nearly 25 cm of the ileocecal valve ileum, then anastomosed the intestine again. Blank control group:no surgery. Data included the first defecation time, duration of diarrhea and parenteral nutrition (PN) after surgery, the length and weight of the small intestine, the weight of the colon, the villus height and crypt depth of both jejunum and ileum at 21st days postoperatively, were collected and analysed.
ResultsCompared with the sham group and blank control group, jejunoileal and jejunocolic anastomosis groups showed higher villus height and the crypt depth of jejunum and ileum (P<0.050), provided enough anatomy evidence of intestinal adaptation. However, the duration of PN in jejunocolic group was longer than in jejunoilea anastomosis group (P<0.050). The length and weight of the small intestine and the weight of colon in jejunocolic anastomosis group, were lower than in jejunoileal anastomosis group (P<0.050), improving that the ability of intestinal adaptation of jejunocolic anastomosis was better than the jejunoileal anastomosis group.
ConclusionsPremature piglet models of short bowel syndrome could be established by methods of jejunoileal and jejunocolic anastomosis. Both of the methods had their own different degree of intestinal adaptation and growth. The jejunoileal anastomosis is maybe a better way to establish this model.
ObjectiveTo investigate the methodological and reporting quality of clinical trials involving Xiaoyao San for chronic fatigue syndrome.
MethodsWe searched PubMed, CBM, CNKI, VIP and WanFang Data to identify randomized controlled trials (RCTs) about Xiaoyao San for chronic fatigue syndrome. The methodological and reporting quality of included RCTs was respectively evaluated according to the assessment tool of risk of bias of the Cochrane Handbook 5.1.0 and the CONSORT 2010 statement, combined with complementary assessment by the characteristic indicators of traditional Chinese medicine (TCM). The methodological and reporting quality of included case series study was respectively assessed by the methods recommended by the Britain's National Institute for Clinical Excellence (NICE) and the STROBE statement.
ResultsA total of 27 clinical trials were included, involving 11 RCTs and 16 case series studies. According to the assessment tool of risk of bias of the Cochrane Handbook, 54.5% of the RCTs performed proper random method, 9.1% conducted allocation concealment and blinding, 72.7% selected intention-to-treat (ITT) analysis without the report of loss to follow-up, and no RCT existed selective reports. Corresponding to the characteristic indicators of TCM, 54.5% of the RCTs did not conduct TCM syndrome diagnosis, the curative effect standard of TCM syndrome was discrepant, and no RCT was multi-center study. The CONSORT 2010 statement indicated that no RCT explained sample size estimation, implementation details of randomization, flow diagram of participant, use of ITT and clinical trial registration. According to the items recommended by Britain's NICE, 6.25% of the case series studies were multi-center, 81.25% did not report clear inclusion and exclusion criteria, and no case series study performed continuous patient recruitment and stratification analysis of outcome. The STROBE statement indicated that no case series study reported research design, sample size, flow chart, bias, limitations and generalizability.
ConclusionThe quality of clinical trials about Xiaoyao San for chronic fatigue syndrome is still low in methodological and reporting aspects. It is suggested that the future clinical trials should be conducted with references of CONSORT statement and STROBE statement, to propel the modernization and internationalization of TCM.
ObjectiveTo explore the clinical significance of prone position in the treatment of patients with acute respiratory distress syndrome (ARDS) caused by pulmonary contusion.MethodsA retrospective analysis was conducted on pulmonary contusion patients in the Intensive Care Medicine (ICU) from January 2017 to April 2021. The patients were divided into a prone position group (n=121) and a control group (n=117) after screening. The patients' basic conditions, occurrence of ARDS (P/F<150 mm Hg), changes in vital signs, laboratory examinations, lung compliance and other changes after treatment, mechanical ventilation time, staying in ICU, complications, and mortality were recorded and conpared between the two groups.ResultsWhen ARDS [oxygenation index (P/F)<150 mm Hg] occurred, compared with 1 day later, the P/F [(125.7±15.3) vs. (209.5±22.4) mm Hg , P<0.05] and lung compliance [(64.6±4.8) vs. (76.0±5.4) mL/cm H2O, P<0.05] increased in the prone position group. Compare with the control group after 1 day of treatment ARDS (P/F<150 mm Hg), P/F [(209.5±22.4) vs. (126.1±19.5) mm Hg, P<0.05] and lung compliance [(76.0±5.4) vs. (63.5±5.5) mL/cm H2O, P<0.05] increased in the prone position group (P<0.05). Compare with the control group, the prone position group had shortened mechanical ventilation time and ICU stay time, less atelectasis, lower mortality (P<0.05), lower occurrence of pneumothorax (P>0.05).ConclusionProne position treatment for patients with pulmonary contusion after ARDS (P/F<150 mm Hg) can correct hypoxemia faster, improve lung compliance, reduce atelectasis, shorten mechanical ventilation time and stay time of ICU, and reduce mortality, hence it has clinical value.
