Volume 94  ·   Issue 38  ·  2014

Modern noninvasive positive pressure ventilation was first used to treat obstructive sleep apnea. Its ventilation devices and techniques were produced in 1981^[1]The original device had only one mode of continuous positive airway pressure. In more than 30 years since the first generation of non-invasive positive pressure ventilator was introduced, many improvements have been made in ventilation mode and device technology, and the ventilation therapy function has been improved day by day. In recent years, the development speed and scope of non-invasive positive pressure ventilation technology in clinical application far exceed the original intention of the inventor, bringing new treatment concepts and benefits to clinicians and patients, and creating clinical and academic value that is difficult to estimate by numbers.

In the treatment of acute hypoxic respiratory failure, respiratory support is the most important measure besides the treatment of the primary disease. Ordinary oxygen therapy cannot provide positive pressure support and is only suitable for those with mild disease; However, invasive positive pressure ventilation (IPPV) requires high ventilation equipment and monitoring conditions, is expensive, complicated operation technology, many complications, and relatively lack of resources in China, so it is difficult to implement early intervention for respiratory failure. Non-invasive positive pressure ventilation (NPPV) has attracted more and more attention in recent 20 years because of its advantages of non-invasive, upper airway-preserving defense mechanism, simple operation, low cost and fewer associated complications. The application field of NPPV has also gradually expanded from acute exacerbation of chronic obstructive pulmonary disease to various acute hypoxic respiratory failure. Several studies have shown that for acute hypoxic respiratory failure caused by different causes, NPPV can improve oxygenation, reduce the occurrence of complications, and reduce tracheal intubation rate and mortality^[1]。 However, the success rate varies greatly between different causes. In addition to being related to the procedure, the grasp of the indication is the key to improving the success rate of NPPV in the treatment of acute hypoxic respiratory failure.

Non-invasive positive pressure ventilation (NPPV), as a respiratory support technique for the treatment of acute and chronic respiratory insufficiency, has been widely used in clinic in recent 20 years. It has been proved to have definite effect in the treatment of acute exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, respiratory failure secondary to immunosuppression and other diseases. In addition to conventional application fields, NPPV also has good application prospects in assisted bronchoscopy and assisted tracheal intubation. It is believed that through the continuous exploration of clinical medical staff, the clinical application fields of NPPV will continue to expand^[1,2]。

To compare the inspiratory cycling-off synchronization with different expiratory trigger sensitivity (ETS) setting during noninvasive pressure support ventilation (PSV) under the conditions of system leak.

Ventilators were connected to a lung model (Hans Rudolph Series1101 simulator). And its mechanics was set in two models of obstructive and restrictive ventilatory dysfunction. All ventilators were set at 15 cmH₂O (1 cmH₂O=0.098 kPa) pressure support and 5 cmH₂O positive end-expiratory pressure (PEEP). Tests were conducted at the level of air leaks (24-28 L/min). Cycling delay time, tidal volume and airflow were collected.

Compared with Curative Flexo ST 30 with the ETS setting at the most sensitive level, the use of digital Auto-Trak™ system (Respironics Synchrony) was associated with milder delay cycling ((68.9±13.3) vs (121.4±13.2) ms, P<0.05) in obstructive condition. The tidal volume (V_T), inspiratory time (T_I vent) and peak expiratory flow (PEF) increased after adjusting the ETS level. Premature cycling was detected in restrictive condition with both ventilators. Peak inspiratory flow (PIF) and PEF significantly increased as V_T and T_I vent decreased. Delay cycling ((64.3±15.3) ms) was present in Flexo ST 30 when ETS was at most insensitive level.

There are significant differences in performances and cycling-off in obstructive and restrictive conditions among 2 bilevel ventilators. And it may be due to the software of algorithm. Modifications of ETS can affect the ventilatory parameters to improve patient-ventilator synchrony in the presence of air leaks. The Auto-Trak system during PSV show similar results and better synchronzation compared with conventional adjustments.

To explore the efficacies of continuous positive airway pressure (CPAP) for mixed sleep apnea (MSA) events in patients with sleep apnea.

A total of 21 patients with sleep apnea whose MSA events >10 events/h on overnight polysomnography (PSG) were studied. They were selected from the Sleep Center, Guangzhou Institute of Respiratory Disease. Ten of them were diagnosed only by conventional polysomnography (PSG group) while the diagnosis of another 11 patients was further confirmed by diaphragm electromyogram (EMG) (EMG group). All of them were treated by CPAP titrated manually on PSG.

Manual CPAP titrating pressure in PSG group was (8.1±2.2) cmH₂O (1 cmH₂O=0.098 kPa) and it was similar to that in EMG group ((8.9±1.5) cmH₂O). Apnea-hypopnea index (AHI) decreased significantly after CPAP in both PSG group (6.9 (3.5, 10.2) vs 62.2 (54.7, 71.4) events/h) and EMG group (1.5 (0.5, 5.5) vs 71.3 (59.5, 79.5) events/h) (both P<0.01). CPAP could eliminate MSA diagnosed either by conventional PSG (0.1 (0.0, 0.4) vs 29.6 (19.6, 32.4) events/h) or by diaphragm EMG (0.0 (0.0, 0.2) vs 18.1 (9.1, 19.3) events/h) (bothP<0.01).

CPAP can effectively treat MSA events in patients with sleep apnea.

To observe the efficacy of auto-trilevel positive airway pressure (Auto-trilevel PAP) ventilation in overlap syndrome (OS) patients with hypercapnia.

From October 2012 to May 2014, 21 OS patients with a PaCO₂> 45 mmHg (1 mmHg=0.133 kPa) and coexisting stable chronic obstructive pulmonary diseases (COPD) and moderate-to-severe OSAS were recruited. Three different positive airway pressure (PAP) modes of ventilators (SOMNOvent auto-S, Weinmann Inc, Germany) were employed for 8 hours per night with each mode at each night and two nights′ interval without any treatment among different modes. Under mode one, the expiratory positive airway pressure (EPAP) issued by bilevel positive airway pressure (BiPAP) was titrated as the minimal positive pressure for a disappearance of snoring. The same inspiratory positive airway pressure (IPAP) titrated by end tidal CO₂ levels under mode 1 was used under modes 2 and 3 as well. However, the EPAP issued by BiPAP under mode 2 was 3 cmH₂O (1 cmH₂O=0.098 kPa) higher than that under mode 1. Under mode 3 with autotrilevel PAP, the beginning of EPAP was set the same as that under mode 1 while the end of EPAP (EEPAP) was automatically adjusted based on upper airway patency condition. Comparisons were made for parameters before and after treatment as well as among different ventilation modes. The following parameters were compared such as nocturnal apnea hypopnea index (AHI), minimal SpO₂ (miniSpO₂), arousal index, sleep efficiency, morning PaCO₂ and Epworth sleepiness score (ESS).

Compared with the parameters pre-therapy, modes 1-3 showed a significant decrease in nocturnal AHI (6.3±1.3), (3.1±1.0), (3.6±0.6) vs (38.6±11.3) events/h), arousal index ((7.0±1.1), (5.1±0.9), (4.2±1.7) vs (27.5±5.4) events/h), morning PaCO₂ (42.4±3.8), (47.9±2.6) and (43.2±3.3) vs (57.3±4.3) mmHg and daytime ESS (7.2±1.3, 7.4±1.3 and 5.3±1.5 vs 11.4±2.7), but a significant increase in nocturnal miniSpO₂ (82.3±5.4), (89.6±3.9) and (90.3±3.2) vs (62.4±11.3) mmHg and sleep efficiency caused (71.3±5.2)%, (79.4±4.3)% and (83.2±4.4)% vs (59.8±6.3)% (all P<0.01). Comparison of 3 modes demonstrated that, with the same IPAP, mode 3 resulted in the lowest arousal index, daytime ESS and the highest sleep efficiency. Comparison of modes 1 and 2 revealed a statistically lower AHI but higher miniSpO₂ and morning PaCO₂ under mode 2 (all P<0.01). Compared with mode 1, mode 3 showed a lower AHI, higher miniSpO₂ (all P<0.01), but there was no significant difference in PaCO₂ at the end of therapy. Compared with mode 2, mode 3 showed a significant lower PaCO₂ (P<0.01), but there was no significant difference in AHI and miniSpO₂.

Auto-trilevel PAP ventilation is superior to fixed BiPAP ventilation in the treatment of hypercapnic OS since this novel PAP mode can achieve a higher efficacy in simultaneous removal of residual apnea hypopnea events and correction of hypercapnia and yield a higher sleep quality and lower daytime sleepiness.

To explore the clinicopathological characteristics, diagnosis and treatment of Castleman′s disease.

Seven teen cases of castleman′s disease confirmed by surgery and pathology were presented, with the helping of relevant literatures, to discuss its clinical presentation, CT findings, pathology, diagnosis, treatment and prognosis, especially the cases with PNP.

There were 10 males and 7 females with an age range of 28-56 years. They were all of local hyaline-vascular types according to histopathology. All cases were cured by surgical resection.

Castleman′s disease is a rare lyphoproliferative disorder with giant lymph node hyperplasia. Its diagnosis depends on its histopathological characteristics and clinical manifestations should also be taken into account. Surgical resection is the first choice and other treatments may be effective.

To explore the clinicopathological characteristics, diagnosis, treatment outcomes and survival of hepatocellular carcinoma (HCC) and nasopharyngeal multiple primary cancers.

The clinical data of 12 male patients with hepatocellular and nasopharyngeal multiple primary cancers were retrospectively analyzed.

Second primary cancer was diagnosed with a median age of 54.5 years. Hepatitis B surface antigen (HBsAg) was detected in 7 patients (58.3%) and 6 cases (50.0%) had a family history of cancer. The treatments included radiochemotherapy (n=5), radiotherapy (n=6) and non-therapy (n=1). And the interventions included hepatic surgery (n=6), interventional treatment (n=4) and conservative (n=2). The 1, 3 and 5-year overall survival rates were 90.9%, 81.8% and 58.4% and the HCC-specific survival rates 80.0% at 1 year and 57.1% at 3 years respectively. The HCC-specific survival rates of surgery group were significantly better than those of the non-surgical group. The 1, 3-year HCC-specific survival rates were 100.0%, and 100.0%vs 50.0% and 0 respectively (P=0.002).

HCC and nasopharyngeal multiple primary cancers are not rare and careful follow-ups are necessary .The co-existence of HCC and nasopharyngeal multiple primary cancers does not imply a worse prognosis. And radical resection of HCC is considered.

To explore the possible causes for an absence of response to rituximab (RTX) in patients with refractory immune thrombocytopenia (ITP).

A total of 20 refractory ITP patients on RTX therapy and 10 health volunteers were recruited from 2008 to 2013. Memory T lymphocytes (Tm) (CD4⁺CD45RO⁺) and B lymphocytes (CD19⁺CD20⁺) in peripheral blood (PB) were examined by flow cytometry (FCM). And enzyme-linked immunosorbent assay (ELISA) was employed for detecting the platelet-associated antibodies IgG/IgM (PAIgG/IgM).

(1) 12 patients with refractory ITP achieved a good response after therapy with RTX (effective RTX group) and 8 cases failed to respond (ineffective RTX group). The PB levels of CD4⁺CD45RO⁺Tm were 41.33%±9.62% and 45.36%±8.57% respectively at pre-therapy and post-therapy in ineffective RTX group. And significant differences existed between ineffective and effective RTX groups(22.36%±11.57%, 26.65%±6.32%)versus health volunteers (19.72%±7.35%, 20.64%±7.35%) (all P<0.05). No statistical differences existed in the PB level of CD4⁺CD45RO⁺Tm between pre-therapy and post-therapy in ineffective or effective RTX group (both P>0.05); (2) The PB level of CD19⁺CD20⁺B lymphocytes in RTX ineffective group was lower than that at pre-therapy in RTX effective group(16.36%(6.17%-27.53%) vs 45.72%(35.80%-57.19%), P<0.05). No significant difference existed in the level of CD19⁺CD20⁺B at post-therapy between ineffective and effective RTX groups (6.67%(4.09%-19.17%) vs 5.19%(3.78%-17.39%), P>0.05). And significant differences existed in the PB level of CD19⁺CD20⁺B between pre-therapy and post-therapy in ineffective or effective RTX group (both P>0.05); (3) PAIgG/IgM was not detected in RTX ineffective group. And PAIgG/IgM was found in 11 cases at pre-therapy versus 1 case at post-therapy in RTX effective group.

CD4⁺CD45RO⁺Tm is probably associated with an absence of response to RTX in patients with refractory ITP.

To evaluate the efficacy and safety of laparoscopic versus open mesh rectopexy for total rectal prolapse.

A retrospective review was conducted for 34 patients undergoing laparoscopic versus open mesh rectopexy for total rectal prolapse between January 2006 and December 2013.

Laparoscopic rectopexy (n=15) and open surgery (n=19) were performed. Two groups were matched with regards to age, gender, body mass index (BMI) and American Society of Anesthesiologists (ASA) score. Mortality was zero in each group. There were insignificant inter-group differences in operative duration, postoperative complication, rate of long-term recurrence and improvement of incontinence and constipation. Perioperative blood loss, time to first flatus and hospital stay were significantly shorter in laparoscopic rectopexy group.

Laparoscopic mesh rectopexy is as safe and efficient as open rectopexy. And both are suitable for senile patients. Long-term outcomes are similar for two groups, but laparoscopic group has better short-term outcome.

To explore the expressions of cancerous inhibitor of protein phosphatase 2A(CIP2A)and osteopontin(OPN)and evaluate their roles in bladder cancer.

RNA was isolated from 38 cases of patients with bladder cancer and 12 cases of normal bladder tissue by TRIzol method from May 2010 to December 2012. And reverse transcription (RT)-PCR was used to detect the expressions of CIP2A and OPN. The expression levels of CIP2A and OPN in 99 cases of patients with bladder cancer and 12 cases of normal tissue were detected by immunohistochemical staining.

The positive expression rate of CIP2A mRNA and OPN mRNA were 76.32%(29/38)and 92.11%(35/38)in bladder cancer while there was no expression in normal tissue (both P<0.05). The positive rates of CIP2A and OPN protein were 63.64%(63/99)and 84.85%(84/99)in cases of bladder cancer tissues while CIP2A was not detected in normal tissues. The positive expression rate of OPN in normal tissues was 2/12 (bothP<0.05). The CIP2A and OPN proteins were both expressed in 58/99 cases of bladder cancer tissues while neither of them was expressed in 13 cases. In 8 cases, CIP2A was expressed while OPN was not. In another 20 cases, OPN was expressed while CIP2A was not(r=0.300, P<0.05).

The expression levels of CIP2A and OPN in tissue of bladder cancer are higher than those of normal controls. And CIP2A and OPN may be used as indicators of biological behaviors and serve as new molecular diagnostic markers for bladder cancer.

To explore the risk factors (causes or possible causes) of systemic reactions induced by subcutaneous immunotherapy (SCIT) through clinical observations and develop countermeasures for preventing further SCIT-induced systemic reactions.

Each patient on SCIT at our department from December 1993 to September 2013 was inquired about systemic reactions induced by SCIT. Individuals with systemic reactions immediately after SCIT were included. Clinical history and manifestations were inquired and recorded carefully. Risk factors of systemic reactions were probed and analyzed. SCIT schedule was adjusted according to the risk factors and the patients on continuous SCIT were followed up until the end of SCIT course.

A total of 70 reactions were observed in 35 patients during the observation period. A large majority (97.1%(68/70)) of systemic reactions occurred at a maximal concentration of 10^-2. Risk factor included an injection of maximal dosage (0.6-1.0 ml of 10^-2vial, 27.2%(28/103)), a further injection of large dosage (0.1-0.5 ml of 10^-2vial) during pollen season (20.4%(21/103)), incremental dose regardless of marked local reaction (12.6%(13/103)), suspected incorrect injection procedure(12.6%(13/103)) and an injection with a wrong vial of higher concentration (9.7%(10/103)). Countermeasures were taken accordingly, include stopping injection of maximal dosage, avoiding SCIT of 10^-2vial on pollen season, decreasing SCIT dosage on existence of large local reactions, performing SCIT only at medical institutions capable of managing anaphylaxis and implementing normalized injection procedures. Most patients (n=29) finished the course of SCIT successfully without further systemic reactions. Six patients ceased SCIT for personal reasons or on medical advice.

Probing the risk factors of systemic reactions induced by SCIT and adopting countermeasures accordingly prevent further systemic reactions. It may provide rationales for preventing or minimizing systemic reactions during SCIT.

To evaluate the value of flow cytometry (FCM) in the diagnosis of bone marrow involvement in patients with non-Hodgkin′s lymphoma (NHL).

The cytomorphology, biopsy and FCM tests were performed concurrently on bone marrow samples from 206 patients who were consecutively diagnosed as NHL from March 2013 to August 2013 at Peking University Cancer Hospital. The results were analyzed and compared.

Totally bone marrow involvement occurred in 25.7% (53/206) patients. The detection positivity of bone marrow involvement by cytomorphology, biopsy and flow cytometry were 6/14, 6/14 and 9/14 respectively in 14 T-cell lymphoblastic lymphoma and T-cell acute lymphoblastic leukemia (T-LBL/ALL) patients; 9.2%(14/152), 19.1%(29/152)and 23.7%(36/152)respectively in 152 mature B-cell NHL patients; 0(0/40), 15.0% (6/40)and 2.5%(1/40)in 40 cases of mature T/NK-cell NHL. The overall rate of concordance of biopsy and flow cytometry was 88.3%.

FCM has a high sensitivity in detecting bone marrow involvement in NHL patients, especially those with T-LBL/ALL and B-cell NHL. And a combination of morphology, biopsy and FCM may improve the sensitivity and accuracy in the detection of bone marrow involvement in NHL patients.

To explore the effects of insulin therapy on the expression of pigment epithelium-derived factor (PEDF) in adipocytes of type 2 diabetic mellitus (T2DM) in rats.

A total of 22 newly diagnosed type 2 diabetics received a 2-week intensive insulin therapy. The levels of fasting plasma glucose (FPG), serum triglyceride and PEDF were measured before and after therapy. T2DM was induced by a high-fat diet and a low-dose streptozotocin (STZ). The Spraque-Dawley rats were divided randomly into diabetic, insulin treatment and gliclazide treatment groups. Another group with a chow diet was designated as normal controls. Differentiated 3T3-L1 adipocytes were then incubated with tumor necrosis factor-alpha (TNF-α) and(or) insulin for 24 h. Quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and Western blot were used to detect the expression of PEDF in adipose tissue or adipocytes. The PEDF levels in both sera and cell supernatant were measured by enzyme-linked immunosorbent assay (ELISA). Glucose uptake was detected after treatment of PEDF or anti-PEDF antibody simultaneously together with insulin in mature 3T3-L1 adipocytes.

Insulin therapy decreased the serum levels of FPG and triglyceride of T2DM patients ((12.9±2.8) vs(5.9±1.4)mmol/L, (3.1±1.8) vs(1.7±0.8)mmol/L, P<0.05) while the serum level of PEDF decreased significantly after therapy ((22.85±5.73) vs (18.38±5.28) μg/L,P<0.05). Consistently the serum level of PEDF of diabetic rats was remarkably higher than that of normal controls and insulin-treated group ((28.6±0.5) vs (25.4±0.6) and (25.3±0.6) μg/L,P<0.05). And the elevated levels of PEDF, TNF-α mRNA and protein in adipose tissue (P<0.05) could be reduced by insulin treatment (P<0.05). However, no obvious change was detected in gliclazide treatment group. Further evidences suggested that TNF-α could induce more secretion and expression of PEDF in 3T3-L1 adipocyte while this effect became ameliorated by insulin treatment. Furthermore, decreased capacity of glucose uptake by PEDF might be reversed by anti-PEDF antibody in 3T3-L1 adipocytes (P<0.05).

Insulin can down-regulate the expression of PEDF in adipocytes of T2DM and improve the glucose uptake of adipocytes. It may be one of the mechanisms through which insulin therapy improves peripheral insulin resistance.

To explore the genetic polymorphisms of PDGFR associated with thrombocytopenia in Chinese patients with metastatic clear-cell renal cell carcinoma (mcc-RCC) treated with sunitinib.

A total of 93 mcc-RCC patients treated with sunitinib were enrolled. Genotype analyses were performed before treatment and thrombocytopenia was recorded on the first three cycles of treatment. Genetic polymorphisms of PDGFR (rs35597368, rs1800810) were analyzed for a possible association with thrombocytopenia.

The genotypes of rs35597368 and rs1800810 conformed to the Hardy-Weinberg law. No significant difference existed in grade 3/4 thrombocytopenia between rs35597368 TC and TT genotypes (29.6% vs 29.4%, P=0.313). The rs1800810 CG genotype was associated with a higher risk for grade 3/4 thrombocytopenia as compared with CC genotype (45.8% vs 34.2%, P=0.048).

The risk for grade 3/4 thrombocytopenia increases in the presence of allele genotype in PDGFR 1171C/G. And a biomarker may be customized for patients with mcc-RCC treated with sunitinib.

To analyze the clinical characteristics and risk factors of refractory Crohn′s disease (CD).

All clinical data of confirmed consecutive CD patients were collected from our hospital between January 2003 and June 2013. The patients′ demographic data, clinical features, therapeutic regimens and laboratory examinations were analyzed. A multivariate Logistic regression was performed to identify the risk factors of refractory CD.

(1) A total of 402 confirmed CD patients were recruited for analysis. The prevalence of refractory CD was 33.8% (136/402). The rates of steroid-dependency was 37.0% (97/262) in 262 patients with a history of steroid use and the rate of thiopurines ineffectiveness was 26.9% (79/294) in 294 patients with a history of thiopurines-use; (2) Univariate analysis showed that disease location (L3 type) , abdominal pain, diarrhea, fever, abdominal tenderness, perianal lesion, steroid use, AZA/6-MP use, leucocyte, hemoglobin (Hb), platelet level and high-sensitivity C-reactive protein (HsCRP) were significantly different between refractory and non-refractory CD patients(all P<0.05). Multivariate Logistic regression showed that steroid use (OR=6.516, 95% CI: 2.884-14.722, P=0.000) and low Hb (OR=1.023, 95% CI: 1.008-1.037, P=0.002) were independent risk factors related to refractory CD; (3) Univariate analysis showed that Hb level, erythrocyte sedimentation rate (ESR) were significantly different between steroid-dependent and non-steroid-dependent groups(all P<0.05). Multivariate Logistic regression showed that only low Hb level (OR=1.021, 95% CI: 1.006-1.036, P=0.005) was an independent risk factor related to steroid-dependency; (4) Univariate analysis showed that disease location (L3 type), perianal lesion, abdominal pain, diarrhea, fever, abdominal tenderness, platelet level, steroid use, steroid-dependency were significantly different between thiopurines-ineffective and thiopurines-effective groups(all P<0.05). Multivariate Logistic regression showed that perianal lesion (OR=2.085, 95% CI: 1.007-4.039, P=0.029), abdominal tenderness (OR=2.943, 95% CI: 1.452-5.964, P=0.003) and steroid-dependency (OR=3.599, 95% CI: 1.847-7.013, P=0.000) were independent risk factors related to thiopurines-ineffectiveness.

Nearly one third CD patients became refractory during the course of disease. Low Hb and steroid use are independent risk factors. Low Hb is an independent risk factor related to steroid-dependency. Perianal disease, abdominal tenderness and steroid-dependency are independent risk factors related to thiopurines- ineffectiveness.

To explore the effects of hydrogen-rich saline on endoplasmic reticulum stress during myocardial ischemia-reperfusion (I/R) in rats.

A total of 150 healthy male Sprague-Dawley rats were selected and then randomly divided into 5 groups of normal control (Ⅰ), sham operation (Ⅱ), myocardial ischemia-reperfusion (Ⅲ), hydrogen-rich saline (Ⅳ) and normal saline (Ⅴ) (n=30 each). GroupⅠhad no treatment. In group Ⅱ, anterior descending branch was merely exposed but not ligated. Myocardial I/R was induced by an occlusion of anterior descending branch of left coronary artery for 30 min followed by 12 h and 24 h of reperfusion with bimbaum. Hydrogen-rich saline 1 ml/100 g was injected intraperitoneally 5 min before reperfusion in group Ⅳ. Normal saline 1 ml/100 g was injected intraperitoneally 5 min before reperfusion in group Ⅴ. The rats were sacrificed at 12 h and 24 h of reperfusion and heart tissues harvested. The pathological changes of myocardial tissue were detected by hematoxylin & eosin staining. The apoptotic cardiomyocytes of myocardial tissue were tested by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL). And the expressions of GRP78, Caspase-12, Bcl-2 and Bax in myocardial tissue were detected by Western blot.

Compared with groupsⅠandⅡ, the numbers of apoptotic cardiomyocytes, the expression of GRP78, Caspase-12 and Bax in myocardial tissue significantly increased and the expression of Bcl-2 in myocardial tissue significantly decreased in groups Ⅲ, Ⅳ andⅤ. Compared with group Ⅲ and Ⅴ, the numbers of apoptotic cardiomyocytes, the expression of GRP78, Caspase-12 and Bax in myocardial tissue significantly decreased while the expression of Bcl-2 in myocardial tissue significantly increased in group Ⅳ.

Hydrogen-rich saline may decrease cell apoptosis and attenuate myocardial reperfusion injury through inhibiting endoplasmic reticulum stress. The mechanism may be associated with decreasing the expression of GRP78, Caspase-12 and Bax and increasing the expression of Bcl-2 in myocardial tissue.

To explore the propofol regulation of Bcl-2 protein expression through miR-181a in glucose deprivation (GD) cultured astrocytes.

Primary cultured murine astrocytes were treated with 0, 1, 5, 10, 15, 20 μmol/L propofol for 12 h and then cultured with GD medium for 24 h. The cell survival rate was recorded with microscope. Reactive oxygen species (ROS) formation and mitochondrial membrane stabilization were observed. And the expression levels of miR-181a and Bcl-2 protein were recorded to analyze the protection effects of propofol on astrocytes.

After the treatments of propofol and GD, the survival rates of 0, 1, 5, 10, 15, 20 μmol/L propofol groups were (0.51±0.03)%, (0.52±0.02)%, (0.52±0.02)%, (0.73±0.04)%, (0.31±0.02)% and (0.21±0.02)%. And there were statistical significance ( F=118.62, P<0.001). Compared with 0 μmol/L propofol group, the survival rate was much higher in 10 μmol/L propofol group while much lower in 15 μmol/L and 20 μmol/L propofol groups. 10 μmol/L propofol could decrease ROS formation and stabilize mitochondrial membrane. And Bcl-2 protein expression was up-regulated while miR-181a expression inhibited by 10 μmol/L propofol.

The protection of 10 μmol/L propofol against GD stress in astrocytes is correlated with inhibiting miR-181a and up-regulating Bcl-2 protein expression.

A 56-year-old female was admitted for "shortness of breath after activity for 10 years, with edema of both lower limbs for 9 years, aggravated for 7 days". The patient developed shortness of breath after "getting angry" 10 years ago. The symptoms were obvious when going up 3 floors or walking rapidly, accompanied by neck swelling and pain. No special treatment was given, and the symptoms persisted without improvement. 9 years ago, he developed edema of both lower limbs. He went to a local hospital 7 years ago and underwent cardiac ultrasound and other examinations. He was diagnosed as "pulmonary hypertension and right ventricular dysfunction". After diuresis and vasodilator treatment, the edema of both lower limbs improved. After long-term oral administration of "isosorbide nitrate and spironolactone", the patient's symptoms of shortness of breath gradually worsened. More than 1 year ago, multiple serous effusion occurred, and cardiac color ultrasound showed: obvious enlargement of right heart and left atrium, right ventricular hypertrophy, decreased right ventricular wall movement, mild aortic valve regurgitation, moderate-severe tricuspid valve regurgitation, obvious pulmonary artery widening, and pulmonary artery systolic pressure estimated by TI method of 150 mmHg (1 mmHg =0.133 kPa). "Xiaoxintong" was stopped, and "phosphodiesterase-5 inhibitor (sildenafil) 20 mg/time, once a day" was added orally, and diuresis and other treatments were given at the same time. The symptoms were significantly better than before. Hemoptysis occurred due to oral warfarin, and anticoagulation treatment was not given. One year later, cardiac ultrasound was repeated, and pulmonary systolic blood pressure decreased to 73 mmHg by TI method. For many years, patients have repeated "colds", which can be relieved by themselves. Every time symptoms such as low fever and burnout appear, the symptoms of chest tightness and shortness of breath are obviously aggravated. Seven days ago, the patient developed fever without obvious trigger, with the highest body temperature of 39.5℃, obvious wheezing, accompanied by nausea, vomiting, cough, expectoration, left back pain, transient loss of consciousness and blood pressure drop. He was sent to the local hospital for emergency treatment. After anti-infection, pressurization and symptomatic treatment, the patient gradually awoke, his body temperature dropped, and his symptoms of wheezing, cough and expectoration improved compared with before. However, he still needed to use pressurization prescriptions to maintain his blood pressure. For further treatment, he was transferred to Beijing Chaoyang Hospital on 21 August 2013. The patient began to develop muscular atrophy of the left upper limb 30 years ago and had no history of taking special drugs.

Non-tuberculous mycobacteria (NTM) refer to other mycobacteria other than the M. tuberculosis complex and M. leprae, widely present in the living environment^[1]154 species and 13 subspecies have been reported so far^[2]It can invade the host lungs, lymph nodes, bones, joints, skin and soft tissues and cause systemic dissemination. Lung infection is the most common, and hand infection caused by contact with marine organisms in coastal areas and being stabbed by them has also attracted the attention of domestic scholars^[3]。 Since Williams et al.^[4]Mycobacterium marinum infection of the hand was reported, and the number of cases of NTM infection of the hand ranged from sporadic case reports to small sample studies^[5]The number of diseases causing hand infection has been 18 since its discovery^[1]The number of cases and disease species showed an upward trend^[5]。 The clinical symptoms of the disease are atypical, and NTM is mostly resistant to common antituberculosis drugs^[2]Its drug resistance patterns, clinical drug types and treatment courses are quite different, and it is easy to misdiagnose and miss diagnosis, delay treatment, and cause different degrees of hand function loss^[3]。 Therefore, it is particularly important to choose a method that can identify and diagnose non-tuberculous mycobacteria and their subspecies early, quickly, accurately and conveniently, and guide clinical treatment.

There are many pro-angiogenic and immunosuppressive regulatory factors in the tumor microenvironment, among which regulatory T cells (Treg) are the key mediators in the pathophysiological regulation of various tumors. In many kinds of malignant tumors such as breast cancer, gastric cancer and ovarian cancer, the increased number of Treg is related to its shorter survival period, suggesting that Treg plays an extremely important role in tumor evolution^[1,2,3]。

With the accumulation of experience and the deepening of research, the use of non-invasive positive pressure ventilation (NPPV) is more and more widely. Some patients who previously required invasive therapy can now be successfully treated with NPPV. In conjunction with this, the rate of NPPV treatment in critical unit patients is increasing, while the rate of tracheotomy and tracheal intubation is decreasing. Through early use of NPPV, the rescue success rate of critically ill patients is further improved. At present, the therapeutic scope of NPPV is constantly expanding, which can be used in both home and critical unit, and has become an important tool for the treatment of acute and chronic respiratory failure. Diseases that can be treated with NPPV include chronic obstructive pulmonary disease (COPD), chronic alveolar hypopnea, obstructive sleep apnea (OSA), pulmonary edema associated with cardiac insufficiency, and the like. In addition, NPPV is often used as an adjuvant treatment when invasive ventilation is discontinued. Although there are multiple modes of NPPV, the predominant modes remain bihorizontal positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) mainly for OSA and congestive heart failure. Nasal, nasal, or full face masks are the primary means of connecting a noninvasive ventilator to a patient. BiPAP can set positive airway pressure in inspiratory phase (IPAP) and positive airway pressure in expiratory phase (EPAP) respectively. By adjusting IPAP and EPAP, the purpose of maintaining upper respiratory tract opening and changing tidal volume and minute ventilation volume can be achieved. In addition to patients with sleep apnea, some patients who can maintain normal ventilation and blood gas during the day can also develop hypoxemia or even respiratory failure at night, especially during rapid eye movement sleep (REM). For example, we have recently found that the respiratory central drive decreases during sleep in patients with COPD, particularly during fast eye movement sleep^[1]。 If BiPAP is adjusted only according to the patient's daytime condition, sleep-related hypoventilation or even respiratory failure may occur after the patient falls asleep, thus affecting the patient's sleep quality and the progress of the disease. Although BiPAP may be set during the day, for example, for some patients with the purpose of reducing symptoms or who do not tolerate excessive IPAP/EPAP, treatment pressure may depend on CO over a period of time or even a week₂Partial pressure, blood oxygen saturation (SaO₂) and symptom relief, but for some people who need long-term NPPV treatment, parameter adjustment under polysomnography (PSG) monitoring should be performed. Pressure regulation in patients with chronic alveolar hypopnea and OSA is reviewed below.