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    25 April 2019, Volume 40 Issue 4
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    GATA4 gene promote 5azacytidine induced differentiation of bone marrow mesenchymal stem cells into cardiomyocytes#br#
    ZHANG Yanan1， XIE Yanyan2， YIN Mingjie2， ZHANG Xiaoyi2， CHEN Wei1， ZHANG Lei1*
    2019, 40(4):  385-389.  doi:10.3969/j.issn.10073205.2019.04.003
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    ［Abstract］〓Objective〖HTSS〗〓To investigate the feasibility of GATA4 gene promote 5azacytidine（5aza） induced differentiation of bone marrow mesenchymal stem cells(BMSCs) into cardiomyocytes.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Rat BMSCs were isolated from the whole bone marrow and cultured.Using the cationic liposome reagent, Lipofectamine 2000,the plasmid pVP22GATA4/mycHis was transfected into P3 BMSCs at a ratio of 1〖DK〗∶2.5. After 72 h,BMSCs was induced by 10 μmol/L 5aza for 24 h.The whole experiments were observed under an inverted fluorescence microscope and expression of GATA4 was examined with immunocytochemistry. Expression of cardiac troponin T(cTnT) and GATA4 were determined with Western blotting and immunocytochemistry.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓After 48 h of transfection, GATA4、myc were expressed in experimental group. After 28 days, immunocytochemistry and Western blotting results indicated that the expression of GATA4 and cTnT in experimental group was significantly higher than those of control group（P＜005）.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓GATA4 gene may promote 5aza induced differentiation of  BMSCs into cardiomyocytes.
    Human umbilical cord mesenchymal stem cells conditioned medium protected against amyloid β induced apoptosis in cultured cortical neuron of rat partly through inhibiting mitochondrial apoptotic pathway
     
    LIU Sha, WU Ming, DI Kun, JIA Jing, WU Qiaona, LIU Zengjuan*
    2019, 40(4):  390-395,410.  doi:10.3969/j.issn.10073205.2019.04.004
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    〗［Abstract］〓Objective〖HTSS〗〓To investigate the protective effect of human umbilical cord mesenchymal stem cells conditioned medium(hUCMSCsCM) against amyloid β (Aβ) induced apoptosis in cultured rat prefrontal cortical neuron and the mechanism: downregulation of the expression of cytc and cleaved caspase3 thus inhibiting the mitochondrial apoptotic pathway. 
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Human umbilical cord mesenchymal stem cells P3 and P4 were used to collect the hUCMSCsCM. Prefrontal cortical neurons of rats cultured 7d were treated with Aβ and/or hUCMSCsCM, respectively. The neuron viability was determined by MTT assay, and the neuron apoptosis was tested by Hoechst staining. The expression of cytc and cleaved caspase3 were investigated by Western blot.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Compared with vehiclecontrol group, Aβ(5, 10, or 20 μmol/L Aβ treated 12 h; or 10 μmol/L Aβ treated 6 h, 12 h, or 24 h) decreased the neuron viability(P＜005）and increased the neuron apoptosis(P＜005). Compared with Aβ group, hUCMSCsCM increased the neuron viability(10% and 20%, treated 12 h; P＜005）and decreased the neuron apoptosis(5%, 10% and 20%, treated 12 h; P＜005). Compared with vehiclecontrol group, Aβ upregulated the expression of cytc(P＜005) and cleaved caspase3(P＜005). Compared with Aβ group, hUCMSCsCM treatment alleviated the upregulation of cytc(5%, 10% and 20% hUCMSCsCM treated 12 h; P＜005) and cleaved caspase3(10% and 20% hUCMSCsCM treated 12 h; P＜005) in a dosedependent manner.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓hUCMSCsCM protected against Amyloid β induced apoptosis in cultured rat cortical neuron partly through mitochondrial apoptotic pathway.
    The study of electrical stimulation on sciatic nerve regeneration and function recovery in rats
    HE Lian1, LYU Mingxuan1, RUAN Lin1,2,WANG Xiaosong1, LIU Minzhuang1, YAO Xiaoguang1*
    2019, 40(4):  396-400,405.  doi:10.3969/j.issn.10073205.2019.04.005
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    ［Abstract］〓Objective〖HTSS〗〓To investigate the effect of electrical stimulation(ES) on sciatic nerve regeneration and function recovery after a crush injury in rats.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A chronic nerve compression model was created by surgery on sciatic  nerves of male rats. After 3 months，epineurial of the injured nerves were incised, and then a flexible wireless stimulator was implanted in rats to provide electrical stimulation for 12 weeks. Thereafter, recovery of the injured sciatic nerve was assessed by the sciatic functional index(SFI), affected muscle weight. and conduction velocity of injured sciatic nerve measured by electrophysiology. Regeneration and remyelination of injured nerve were assessed by histology investigation and transmission electron microscope observation.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The sciatic nerves were clearly injured in both groups of rats, with significantly decreased SFI. During the ES treatment course, the SFI was increased significantly, and the SFI of rats with ES treatment were superior to the controls at each time points(P＜005). Muscular atrophy was observed in all the involved rats with decreased weight of affected muscles, whereas the muscle weight was significantly higher in the rats received ES treatment compared to the controls(P＜005). During the treatment course, nerve conduction velocity was increased in both groups of rats, which were significantly higher in the rats with ES treatment compared to the controls at the 4 th, 8 th, and 12 th week(P＜005). In addition, after 12 weeks period of treatment, the ES increased nerve diameter, quantity of myelinated nerve fibers and thickness of myelin sheath(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Electrical stimulation could produce a therapeutic effect on the regeneration and function recovery of injured sciatic nerves by compression.
    Study on the effect of Metoprolol combined with drugs in the treatment of chronic heart failure
    YU Xinlong1， ZHANG Yongzhong2， WEI Haiqing3*
    2019, 40(4):  401-405.  doi:10.3969/j.issn.10073205.2019.04.006
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    ［Abstract］ Objective〖HTSS〗〓To explore the effect of metoprolol combined with drugs on chronic heart failure and cardiac function of patients.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓One hundred patients with chronic heart failure were randomly divided into two groups, 50 in each group. The control group was given metoprolol orally, while the study group was treated with compound Qiangxin Decoction on the basis of metoprolol. The cardiac function, clinical efficacy and adverse reactions of the two groups were compared.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The clinical efficacy and total effective rate of the study group were higher than those of the control group, and the differences were statistically significant(P＜005). Left ventricular enddiastolic diameter(LVEDD) and left ventricular endsystolic dimension(LVESD) level after treatment in two groups were significantly lower than before treatment, the differences were statistically significant(P＜005). LVEDD and LVESD levels after treatment study group were significantly lower than the control group, the difference was statistically significant(P＜005). Left ventricular ejection fraction(LVEF), left ventricular diastolic filling peak E peak early/late diastolic filling of the filling A peak peak(E/A) and 6minute walking test(6MWT) after treatment study group were significantly higher than those before treatment and the control group, with statistically significant differences(P＜005).  Heart fatty acid binding protein(HFABP), pentraxin3(PTX3), and nervous terminal  probrain natriuretic peptide(NTProBNP) after treatment study group were significantly lower than before treatment and the control group(P＜005). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Metoprolol combined with compound Qiangxin Decoction can effectively improve the cardiac function of patients, and the incidence of adverse reactions is low, which should be further promoted and applied.
    Features and significance of serum APN level in type 2 diabetic coronary heart disease with Hypothyroidism
    LU Yanan1,SUN Zhixin1, MENG Fengling2*, ZHANG Lihui2, GAO Yu1, LIU Lijun1
    2019, 40(4):  406-410.  doi:10.3969/j.issn.10073205.2019.04.007
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    ［Abstract］ Objective〖HTSS〗〓To detect the level of serum adiponectin(ANP) and explore the role of hypothyroidism in the development of coronary heart disease（CHD） in type 2 diabetes.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Thirty cases of normal control group(G1 group) were selected. And 88 patients with type 2 diabetes mellitus were divided into simple type 2 diabetes mellitus group(27 cases, G2 group), type 2 diabetes mellitus with CHD group(34 cases, G3 group), type 2 diabetes mellitus with CHD group and hypothyroidism group(27 cases, G4 group). Glycated hemoglobin(HbA1c), total cholesterol(TC), 〖JP2〗triglyceride(TG), high density lipoprotein cholesterol(HDLC),〖JP〗 low density lipoprotein cholesterol(LDLC), ANP levels, thyroid function and other indicators were detected.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The free triiodothyronine(FT3) in G3 group and G4 group was lower than G1 group and G2 group. G4 group thyroid stimulating hormone(TSH) was higher than G1, G2 group and G3 group，  HbA1c in G2, G3 and G4 groups was higher than G1 group, G3 group was higher than G2 group and G4 group. ANP in G2 group, G3 group and G4 group was lower than G1 group, G3 group and G4 group were lower than G2 group, G4 group was lower than G3 group, and the difference was statistically significant(P＜005). ANP levels were positively correlated with HDLC and FT3(P＜005)， It was negatively correlated with age, TG, TSH and HbA1c(P＜005). Age and HbA1c are risk factors for CHD in type 2 diabetes, while FT3 and APN are protective factors for CHD in type 2 diabetes.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The decrease of FT3 and APN levels promotes the occurrence and progression of CHD in patients with type 2 diabetes mellitus complicated with hypothyroidism.
    Study of rosuvastatin combined with bicyclol tablets in the treatment of nonalcoholic steatohepatitis through antifibrosis mechanism
    REN Ruihua， WANG Jun， LEI Jianhua， LIANG Jing
    2019, 40(4):  411-415.  doi:10.3969/j.issn.10073205.2019.04.008
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    ［Abstract］〓Objective〖HTSS〗〓To explore the clinical efficacy and mechanism of rosuvastatin combined with bicyclol tablets on nonalcoholic steatohepatitis(NASH).
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 120 NASH patients were randomly divided into the rosuvastatin treatment group and the rosuvastatin combined with bicyclol tablets, 60 patients in each group. The changes of serum liver function, blood lipid and liver fibrosis index as well as liver tissues fibrosis related index were observed before and after treatment in the two groups.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓After treatment, the glutamic pyruvic transaminase(ALT), glutamyl transpeptadase(AST) and glutamyl transpeptadase(GGT) levels of the two groups were significantly lower than that before treatment, and the ALT, AST and GGT levels of the R+D group were significantly lower than those of the R group, with statistically significant differences(P＜005). After treatment, 2 groups of total cholesterol(TC), triglyceride(TG) and low density lipoprotein cholesterol(LDLC) level was lower than that before treatment, high density lipoprotein cholesterol(HDLC) were significantly higher than those before treatment, the difference was statistically significant(P＜005). There was no significant difference in TC, TG, HDLC and LDLC levels between the two groups after treatment(P＞005). Hyaluronic acid(HA),  laminin(LN), procollagen Ⅲ(PCⅢ) and collagen Ⅳ(CⅣ) level of R+D groups was lower than that before treatment, HA, LN, PCⅢ and CⅣof R+D group was lower than that in R group, the difference was statistically significant(P＜005). The mRNA and protein expressions of collagen Ⅰ, collagen Ⅳ and fibronectin in the liver of R+D group were significantly lower than those before treatment, and the mRNA and protein expressions of collagen Ⅰ, collagen Ⅳ and fibronectin in the liver of R+D group were significantly lower than those of the R group, with statistically significant differences(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The indexes of liver function and liver fibrosis in NASH patients were significantly improved after the combined treatment of rosuvastatin and bicyclol tablets, and the curative effects were superior to that of rosuvastatin alone.
    Analysis of the composition and trend in patients with tumor in a thirdlevel gradeA hospital in Hebei during 2007 to 2016
     
    WANG Weijie1， ZHAO Jing2， LIU Shuying2， JING Fengmin1， CAO Lijuan1， ZHI Xiao3*
    2019, 40(4):  416-420.  doi:10.3969/j.issn.10073205.2019.04.009
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    ［Abstract］〓Objective〖HTSS〗〓To analyze the composition ratio, type and age characteristics of malignant tumors in a thirdlevel gradea hospital in Hebei during 2007 to 2016, so as to provide objective basis for the prevention and treatment of malignant tumors.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Malignant tumor patients from 2007 to 2016 were collected to analyze the changes in age of malignant tumor onset, the composition and sequence of major malignant tumors in patients of different genders.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Patients with malignant tumors in our hospital from 2 397 cases in 2007 increased to 6 390 cases in 2016, the number of cancer patients admitted in 2016 was increased by 166.6% compared with 2007, the number of male and female patients was increased significantly. The median age of malignant tumor patients was 58 years old, 59 years old for males and 55 years old for females, and the age of malignant tumor patients in males was significantly higher than that in females(P＜005). The number of patients with malignant tumors under 40 years old was less, but it was significantly increased in the population over 40 years old, and reached a peak of 9 980 cases in the population between 51 and 60 years old.The top three cancers for males were lung cancer, gasteic cancer and liver cancer, the fastest growth rate for lung cancer, 10.4% in 2007 increased to 13.3% in 2016, ranking the first male cancer. While the top three cancers for females were thyroid cancer, breast cancer and lung cancer, the fastest growth rate for thyroid cancer, 4.0% in 2007 increased to 19.6% in 2016, ranking the first female cancer.There were statistically significant differences in tumor surgical resection rates in 2007-2016(P＜005)，however, there was no significant annual change trend(P＞005). The number of cancer patients admitted in our hospital has an increasing tendency during nearly ten years, high incidence of malignant tumors in the elderly, the incidence of malignant diseases showed concentration, and disease spectrum was fixed. We should carry out effective preventive measures.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The number of cancer patients admitted in our hospital has an increasing tendency during nearly ten years, high incidence of malignant tumors in the elderly, the incidence of malignant diseases showed concentration, and disease spectrum was fixed. We should carry out effective preventive measures.
    Comparative analysis of clinical imaging evaluation on the carotid  atherosclerosis plaque
    WANG Dawei1, HANG Guangming2, WANG Zhanbo2, QIAO Jianyong2*
    2019, 40(4):  421-424,465.  doi:10.3969/j.issn.10073205.2019.04.010
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    ［Abstract］ Objective〖HTSS〗〓To compare and analyze the diagnostic value of carotid ultrasound, CT angiography(CTA) and  magnetic resonance imaging(MRI) in the diagnosis of carotid atherosclerosis plaque.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The plaque tissues of 55 patients with carotid atherosclerosis plaque treated by carotid endarterectomy(CEA) were collected. Fiftyfive atherosclerosis plaques were routinely sliced by HE and immunohistochemical staining, labeling CD31, CD34 and FⅧ antibodies were used to analyze various components in the plaque and to determine plaque stability, and to classify the relevant pathological features of the plaque. At the same time, the results of preoperative carotid ultrasound, CTA and MRI on the plaque properties were collected from 55 patients, and the pathological diagnosis was compared with gold standard.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓There was no significant difference in the detection rate of vulnerable plaques between carotid ultrasound and pathology(P＞005). There was significant difference in the detection rate of vulnerable plaques between CTA and pathology(P＜005).There was no significant difference in the detection rate of vulnerable plaques between MRI and pathology(P＞005),and sensitivity of MRI＞carotid ultrasound＞CTA.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Carotid ultrasound and MRI can be used to evaluate the vulnerability of plaque in patients with carotid atherosclerosis plaque,and the sensitivity of MRI is higher.
    Risk factors for nonunion of incision after spinal tuberculosis surgery#br#
    GAO Xianda, ZHANG Di, ZHANG Peng*, DOU Chenhao, SHEN Yong
    2019, 40(4):  425-428.  doi:10.3969/j.issn.10073205.2019.04.011
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    ［Abstract］〓Objective〖HTSS〗〓To identify the risk factors of postoperative wound nonunion in patients with spinal tuberculosis and to reduce the incidence rate.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 146 patients with spinal tuberculosis who underwent surgery were enrolled in this study. The patients basic information and perioperative information were recorded. Multivariate logistic regression analysis was used to analyze the risk factors of wound nonunion after spinal tuberculosis operation. 
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Among 146 cases of spinal tuberculosis, 122 cases(83.56%) had incision healing and 24 cases(16.44%) had incision nonunion. The age of nonhealing group was significantly older than that of healing group, the proportion of extraspinal tuberculosis was higher than that of nonhealing group, the proportion of combined posterior and anterior surgery was higher than that of healing group, the proportion of incomplete removal of surgical lesions was higher than that of healing group, and the level of procalcitonin（PCT） was higher than that of healing group, which showed statistical differences（P＜005）. Multivariate logistic regression analysis showed that age, surgical method, extent of lesion clearance and PCT level were risk factors for incision nonunion after spinal tuberculosis surgery(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Age, combined anterior and posterior surgery, incomplete removal of surgical lesions, and high PCT are risk factors for nonunion of incision after spinal tuberculosis surgery. Reasonable selection of surgical indications is the key to reduce the incidence of incision nonunion after operation.
    Application of ERCP on choledocholithiasis in patients with Billroth Ⅱ gastrectomy
    CHEN Shengxiong1, HAO Zijia2， JIN Cheng1， QU Zhigang3， DUAN Jiayue1， WANG Wenbin1*
    2019, 40(4):  429-432.  doi:10.3969/j.issn.10073205.2019.04.012
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    〗［Abstract］ Objective〖HTSS〗〓To evaluate the clinical effect of endoscopic retrograde cholangiopancreatography(ERCP) on choledocholithiasis in patients with Billroth Ⅱ gastrectomy through the comparative study of the laparoscopic choledochotomy and ERCP on choledocholithiasis in patients with Billroth Ⅱ gastrectomy.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓According to the way of operation，61 patients with choledocholithiasis with Billroth Ⅱ gastrectomy were divided into laparoscopic group(35 cases) and ERCP group(26 cases). The success rate of stone removal, the operation time, the time of getting out of bed after operation, the time of hospitalization after operation,the complications and the hospitalization cost were compared between the two groups.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The success rate of stone removal in ERCP group was lower than that in laparoscopy group, but the operation time, the time of getting out of bed after operation, the time of hospitalization after operation in ERCP group were less than that in laparoscopy group, the complications were less than that in laparoscopy group, and the hospitalization cost was less than that in laparoscopy group, with statistical significance(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓ERCP on choledocholithiasis in patients with Billroth Ⅱ gastrectomy has less trauma, faster recovery and less cost， which is worth popularizing.
    Analysis of 25 hydroxyvitamin D status in newly diagnosed Han children with Hashimoto thyroiditis in Shijiazhuang city#br#
    PI Yalei1, ZHANG Yanan1, HAN Xiao1, YANG Xiuxian2, ZHANG Huifeng1, YAN Xue1*
    2019, 40(4):  433-436,442.  doi:10.3969/j.issn.10073205.2019.04.013
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    ［Abstract］ Objective〖HTSS〗〓To investigate the 25 hydroxyvitamin D status in children with Hashimoto thyroiditis(HT) and the role of vitamin D in the pathogenesis of HT.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Sixtyone children with HT in Shijiazhuang Han nationality were collected. The patients were divided into summerautumn group (JuneNovember) and winterspring group (December to May of the following year) according to the date of first visit, and ＜10 years old group and ≥10 years old group according to the age. Four milliliters of fasting venous blood samples were collected to test thyrotropin(TSH), total thyroxin(TT4), free thyroxine(FT4), total triiodothyronine(TT3), free triiodothyronine(FT3), thyroid peroxidase antibody(TPOAb), thyroglobulin(TG), thyroglobulin antibody(TGAb) and 25 hydroxyvitamin D(25OHD) level. The lengths, widths and thicknesses of the right and left lobes of the thyroid were measured by ultrasound and the volume of thyroid was calculated, and the iodine in the morning midstream urine was measured by electrochemical method.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The level of 25OHD in 61 children with HT was （47.50±1788） nmol/L, 15 cases(24.59%) were deficient, 19 cases(31.15%) were insufficient  and 27 cases(44.26%) were sufficient. The levels of 25OHD were （55.15±18.61） nmol/L and （42.55±15.73） nmol/L in summerautumn group and winterspring group respectively. The summerautumn group were higher than the winterspring group(P＜005). There was no difference in thyroid related laboratory parameters between the two groups. The levels of 25OHD were （49.14±18.15） nmol/L and （45.81±17.75） nmol/L in groups of<10 years old and≥10 years old respectively. There was no significant difference between the two groups(P＞005). There was no difference in thyroid related laboratory parameters between the two groups either. Serum 25OHD level was negatively correlated with TG(rs=-0.348, P=0006), and there was no correlation between 25OHD and thyroid volume, TSH, TT4, FT4, TT3, FT3, TGAb and morning midstream urinary iodine(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The serum 25OHD level in children with HT was not significantly decreased, and the seasonal changes were still present. The serum 25OHD level may not affect the laboratory and clinical parameters of children with HT.
    Epidemiological study of handfootmouth disease in Laiguangying area in Chaoyang district, Beijing from 2012-2016
    MA Xiaoqian1,2, YANG Feiheng2, FU Lingjiao3, ZHANG Chunrong2, LIU Wenxuan4, LIU Fen1*
    2019, 40(4):  437-442.  doi:10.3969/j.issn.10073205.2019.04.014
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    ［Abstract］〓Objective〖HTSS〗〓To understand the epidemic characteristics of handfootmouth disease(HFMD) in Laiguangying area in Chaoyang district, Beijing from 2012 to 2016, and to provide evidence for the prevention and treatment of HFMD.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The handfootmouth disease cases during 2012 to 2016 in Laiguangying area in Chaoyang district, Beijing were collected through the Chinese Information System for Disease Control and Prevention, and descriptive epidemiological analysis was conducted.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓From 2012 to 2016, a total of 1 562 cases of HFMD were reported in Laiguangying area, Chaoyang district, Beijing, including 8 severe cases. The annual average incidence rate was 271.52 per 100 000. The peak of incidence was from May to July. The disease mainly occurred under 5 years, especially in age group 3-.The incidence of males was significantly higher than that of females. The incidence in scattered living children was the highest.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓HFMD was highly epidemic in Laiguangying area in Chaoyang district, with obvious seasonality difference. Most patients happened in spring and summer. Scattered children aged 1-4 years are the key population for the prevention and control of HFMD.
    Clinical effect of nasal continuous positive airway pressure for preemptive ventilatory support strategy on severe pneumonia in infants#br#
    JIA Xiqun, ZHANG Zhongfu*, ZHANG Nan, LI Qinghua, TANG Yufeng,HAO Gailing
    2019, 40(4):  443-446.  doi:10.3969/j.issn.10073205.2019.04.015
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    ［Abstract］〓Objective〖HTSS〗〓To analyze the clinical effect of nasal continuous positive airway pressure(nCPAP) for prior ventilatory support strategy on severe pneumonia in infants.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Seventy cases of severe pneumonia were randomly divided into control group and nCPAP treatment group,and each group with 35 cases. The control group was received oxygen with ordinary mask, while the nCPAP group received nCPAP prior treatment.Compared with two groups of treatment effect, partial pressure of oxygen(PaO2), partial pressure of carbon dioxide(PaCO2), PaO2/fraction of inspiration O2(FiO2) were compared before and after treatment 2h,24h,48h. The time of breathing difficulty relief and the rate of endotracheal intubation were compared too.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The time of breathing difficulty relief was shortened,the rate of endotracheal intubation was reduced in nCPAP group, compared with control group. The differences were statistically significant(P＜005). After treatment, PaO2 and PaO2/FiO2 in two groups increased gradually, PaCO2 decreased gradually, PaO2 and PaO2/FiO2 in nCPAP group were higher than those in control group, PaCO2 was lower than those in control group. There were significant differences in the interaction among groups, time points and time points between groups(P＜005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓The application of nCPAP priority strategy in the treatment of Infantile Severe Pneumonia is effective. It can prevent the progress of the disease, reduce the rate of tracheal intubation. It is a noninvasive breathing support technology worth promoting.
    Observation on the curative effect of hypertonic saline combined with adrenaline inhalation for severe capillary bronchitis#br#
    LIU Lianfeng1, SHI Junran1, XUE Hongxia2, LI Sanlin1, GAO Hong1
    2019, 40(4):  447-450,460.  doi:10.3969/j.issn.10073205.2019.04.016
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    ［Abstract］〓Objective〖HTSS〗〓To explore the clinical efficacy of hypertonic saline combined with adrenaline inhalation for the treatment of severe capillary bronchitis.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 100 cases of children with severe capillary bronchitis were divided into observation group(n=50)and control group(n=50) , according to the order of admission. Two groups of children were both given antiinfection ,symptomatic and supportive treatment. The observation group were given epinephrine dissolved in 3% hypertonic saline for inhalation, while the control group were given terbutaline hemisulfate dissolved in 0.9% normal saline for inhalation. The clinical symptoms and signs, duration of hospitalization, clinical efficacy, changes in the number of inflammatory cells and adverse reactions were observed and compared between the two groups.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The disappearance time of asthma suppress, cough, lung wheeze and hospital stay of the observation group were significantly shorter than those of the control group(P＜005). The total effective was higher than the control group(P＜005). The total number of inflammatory cells, lymphocytes and neutrophils in airway secretions were significantly higher than those in the control group before and after atomization inhalation (P＜005). No serious adverse reactions was happened in both groups(P＞005).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Hypertonic saline combined with epinephrine in the treatment of severe bronchiolitis can effectively reduce the number of inflammatory cells in the airway and reduce the airway hyperresponsiveness with good effect, less adverse reactions. It is a safe, effective, economical and acceptable adjuvant therapy for the treatment of bronchiolitis in children.
    A comparative study of two kinds of laparoscopic orchidopexy for cryptorchidism in children
    MA Yazhen1， LI Suolin1*， XUE Wenyong2， QI Jinchun2， WANG Wenbo1， DU Lei2
    2019, 40(4):  451-455.  doi:10.3969/j.issn.10073205.2019.04.017
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    ［Abstract］ Objective〖HTSS〗〓To compare the feasibility, indication and advantage of traditional laparoscopic orchidopexy(TLO) and laparoscopic assisted transcrotal orchidopexy(LATO) for cryptorchid children.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Retrospective reviews of 83 clinical data were conduced for cryptorchid children treated with TLO(28 case) and LATO(55 case). Testis location, operative time and complications were recorded.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓There were more bilateral cryptorchidism in TLO group than that of LATO group（P＜005）. All testis were delivered successfully. No intraoperative complications were observed, including bleeding, damagement of spermatic cord and bladder. There was no statistical difference in the mean operative time between the two groups（P＞005）. The mean pneumoperitoneal time was shorter in LATO than that of TLO group(P＜005). The operative time for bilateral cryptorchidism was shorter in TLO group than that of LATO group（P＜005）. No statistical difference in operative time was found by other classifications. Median followup time was 36 months. No postoperative complications were found, except for one atrophy found 24 months after TLO. No statistical difference was observed（P＞005）.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓LATO procedure is demonstrated with shorter pneumoperitoneal time while TLO is much more reliable in bilateral situations. Both of them are feasible and safe for management of cryptorchidism.  Staged orchidopexy may be more appliable to avoid testicular atrophy. 
    Prognostic value of coronary artery calcification in patients with suspected cardiogenic chronic chest pain#br#
    WANG Zejing1， WANG Xun2， XIAO Kang1
    2019, 40(4):  456-460.  doi:10.3969/j.issn.10073205.2019.04.018
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    ［Abstract］〓Objective〖HTSS〗〓To evaluate the prognostic value of the coronary artery calcium(CAC) score in patients with suspected cardiogenic chronic chest pain.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓A total of 101 consecutive patients with suspected cardiogenic chronic chest pain were enrolled from our hospital. The CAC score was calculated and patients were divided into a lower CAC score group(CAC score≤300) and a higher CAC score group(CAC score>300). Patients were followed up for one years to assess adverse events consisting of a combined end point of cardiac death, myocardial infarction, coronary revascularisation, and returning to hospital for acute coronary syndrome(ACS).
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓During the observation period no patients died or suffered from myocardial infarction and 13 patients returned to the hospital for ACS. Among them, 4 cases occurred in the group with CAC score ≤300, and 9 cases occurred in the group with CAC score>300. The proportion of diabete and total cholesterol level of group with CAC score >300 were higher than that of the group with CAC score≤300, and the difference was statistically significant(P＜005). The Cox regression analysis results showed that the CAC score was a risk factor for the noevent survival time(HR=4.616; 95%CI=1.046-20.377, P=0.043).
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓CAC score>300 is a predictor of cardiac events for patients with suspected cardiogenic chronic chest pain.
    Clinical value of HRCT combined with tumor markers in the diagnosis of solitary pulmonary nodules#br#
    GU Chao
    2019, 40(4):  461-465.  doi:10.3969/j.issn.10073205.2019.04.019
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    ［Abstract］ Objective〖HTSS〗〓To study the effect of high resolution CT(HRCT) combined with serum tumor markers in the diagnose of solitary pulmonary nodule(SPN).
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓The 126 cases of malignant SPN patients were selected as observation groups, 98 cases of benign SPN patients from the same time were selected as control group. They were detected by HRCT and serum carcinoembryonic antigen(CEA), squamous cell carcinoma antigen(SCC), neuronspecific enolase(NSE), cytokeratin 19 fragment(CYFRA211) detection separately, the pathological diagnosis result were set as gold standard. Any of the HRCT detection or tumor markers positive was regarded as joint detection positive, ROC curve was used to evaluate single detection and joint detection diagnostic efficacy.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓The two groups had significant differences in the detection rate of deep lobulation, bronchovascular convergence sign, short fine spiculation, adjacent pleural thickening, pleural indentation, polycystic light shadows, spinous processes and satellite lesions, etc(P＜005). The sensitivity was 7857%, the specificity was 8980%, diagnosis accuracy was 8348%. The serum CEA, SCC, NSE, CYFRA211 of observation group were significantly higher than control group, the sensitivity was 5317%, the specificity was 8878%, the accuracy was 6518%. The sensitivity of joint detection was 9206%, which was significantly higher than single detection（P＜005）. The specificity was 7142%, which was significantly lower than single detection（P＜005）. The accuracy, the positive predictive value and the negative predictive value were 8304%, 8056%, and 8750%, respectively. The area under ROC curve of joint detection was 0869, which was significantly higher than single detection 0745 and 0707（P＜005）.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Joint detection of HRCT combined with serum tumor markers can be applied in the detection of SPN, which can significantly improve the sensitivity and diagnosis efficacy, and with a good specificity, with is worth of applying.
    Application of different doses of mivacurium for bronchial foreign body removal anesthesia in children with different ages#br#
    SHI Jing1, SHI Lei1, WANG Junxia1, ZHAO Haitao1, BAO Wenjuan1, RONG Junfang2*
    2019, 40(4):  466-471.  doi:10.3969/j.issn.10073205.2019.04.020
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    ［Abstract］ Objective〖HTSS〗〓To investigate application of different doses of mivacurium for bronchial foreign body removal in children with different ages.
    〖HTH〗〖WTHZ〗Methods〖HTSS〗〓One hundred  children undergoing removing bronchial foreign body were enrolled. All the children were randomly divided into four groups according to their age and the initial dosage of mivacurium（n=25）. Ⅰa and Ⅰb group(child group,1-3 years old): respectively intravenous injection of mivacurium 0.15 mg/kg and 0.20 mg/kg when induction of anesthesia; Ⅱa and Ⅱb group(older child group,3-5 years old): respectively intravenous injection of mivacurium 0.15 mg/kg and 0.20 mg/kg when induction of anesthesia. The muscle relaxation time index was observed and recorded which including the onset time, clinical duration, RI,TOFr75 and TOFr 90. MAP, HR and blood oxygen saturation were observed and recorded at the time of preinserting the bronchoscopy and after inserting the bronchoscopy. The mirror satisfaction rates, the operation time and occurrence of adverse reactions also were recorded.
    〖HTH〗〖WTHZ〗Results〖HTSS〗〓Compared with Ⅰa , Ⅱa group, there were significantly shortened inⅠb and Ⅱb group in ThDmax, ThD75 and ThD90(P＜005). Comparison with groupⅠa, Ⅰb, the ThDmax was obviously prolonged inⅡa and Ⅱb group(P＜005).There were no difference in the time of clinical action, RI, TOFr75 and TOFr90(P＞005). The satisfaction rates of the four groups were 96.0%, 100.0%, 88.0% and 96.0% in inserting mirror, respectively. There was no significant difference in the four groups(P＞005). There were no significant difference in MAP, HR and blood oxygen saturation before and after bronchoscope after injection of mivacurium chloride(P＞005). The incidence rate of skin flushing was no significant difference(P＞005). Low blood pressure and bronchospasm were not observed in the four groups.
    〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓It was found that the onset time for children was obviously shorter than that for the elder ones when the same doses of mivacurium were used during the anesthesia induction. While, there were not differences between the two groups of children on the muscle relaxation effect. 0.15 mg/kg mivacurium can offer a satisfactory muscular relaxant effect for the children undergoing removing bronchial foreign body.