Evaluation of Endotracheal Intubation with a Flexible Fiberoptic Bronchoscope in Lateral Patient Positioning： A Prospective Randomized Controlled Trial

Background： There is an unmet need for a reliable method of airway randomized controlled two-center study was designed to evaluate the management for patients in the lateral position. This prospective feasibility of intubation using a flexible fiberoptic bronchoscope in the lateral position during surgery. Methods： Seventy-two patients scheduled for elective nonobstetric surgery in the lateral decubitus position requiring tracheal intubation under general anesthesia at Lishui Central Hospital of Zhejiang Province and Jiaxing First Hospital of Zhejiang Province from April I, 2015, to September 30, 2015, were enrolled in this study. Patients were randomly assigned to the supine position group （Group S, n = 38） and the lateral position group （Group L, n = 34）. Experienced anesthetists performed tracheal intubation with a fiberoptic bronchoscope after general anesthesia. The time required for intubation, intubation success rates, and hemodynamic changes was recorded. Between-group differences were assessed using the Student＇s t-test, Mann-Whitney U-test, or Chi-square test. Results： The median total time to tracheal intubation was significantly longer in Group S （140.0 [135.8, 150.0] s） compared to Group L （33.0 [24.0, 38.8] s） （P 〈 0.01）. The first-attempt intubation success rate was significantly higher in Group L （97%） compared to Group S （16%）. Hemodynamic changes immediately after intubation were more exaggerated in Group S compared to Group L （P = 0.02）. Conclusion： Endotracheal intubation with a flexible fiberoptic bronchoscope may be an effective and timesaving technique for patients in the lateral position. Trial Registration： Chinese Clinical Trial Register, ChiCTR-IIR- 16007814; http：//www.chictr.org.cn/showproj.aspx？proj= 13183.

COMBINATION OF PRONE POSITION AND INTENSITY-MODULATED RADIATION THERAPY (IMRT) REDUCES SMALL BOWEL DOSES IN RADIATION THERAPY FOR GYNECOLOGIC MALIGNANCIES

Objective： To evaluate if the combination of both prone position on a belly board and intensity-modulated radiotherapy （IMRT） further reduces the radiation dose to small bowel in pelvic RT for gynecologic malignancies. Methods： Conformal pelvic RT plans were computed in 13 patients with gynecologic malignancies who had pre-existing planning computed tomography （CT） scans in both the supine position and prone position on a belly board. There were 10 cervical cancer and 3 endometrial cancer patients. A limited arc technique （180° arc length） and an extended arc technique （340° arc length） were used in IMRT plans. Normal tissue regions of interest （ROI） included small bowel, large bowel and bladder. Dose and volume for normal tissue structures were traced and compared between supine and prone plans using the paired t-test. Results： For the limited arc technique, prone position using a belly board device improved small bowel sparing. Analysis of the results showed a 12~26 Gy reduction of volume of small bowel irradiation compared to the supine position. With the extended arc technique, there was no obvious radiation reduction in the prone position. Large bowel and bladder dose showed no significant differences between prone and supine position with either technique. Conclusion： Prone positioning on a belly board decreases the small bowel dose in gynecologic pelvic IMRT, and the magnitude of improvement depended on the limited arc IMRT technique used.

Optimizing the Dosage Regimen of Micafungin against <i>Candida spp</i>in HIV Positive Patients with EC Based on Mote Carlo Simulation

The objective of our study was to explore the possibility of the antifungal efficacy of various micafungin dosage regimens against Candida spp in HIV positive patients with EC. According to pharmacokinetic/pharmacodynamics parameters of micafungin in HIV positive patients and MICs distribution of micafungin against Candida spp. in published studies, the dosage regimens of micafungin were 50, 100 and 150 mg QD iv. Monte Carlo Simulation analysed the probability of target attainment and cumulative fraction of response. The results showed that micafungin has good antifungal effect in treating HIV positive patients with EC when pathomycetes are Candida albicans, Candida glabrata or Candida tropicalis, in dosage at 100 mg QD and 150 mg QD.

Follow-up Study of Retreatment TB Patients with Sputum Smear and/or Culture Positive Two Years after They were Declared Cured with First-line Anti-TB Drugs in Shandong Province

This study aimed to learn the recurrence rate in the retreatment TB patients with sputum smear and/or culture positive （ss＋ and/or c＋） two years after they were declared cured, and to explore causes of recurrence in order to improve long-time treatment outcome. 5 cities were selected as research locations. Recurrence of TB was judged by chest X-ray examination together with sputum smear and culture examination.

Adults with Congenital Heart Disease during the COVID-19 Era:One-Year Tertiary Center Experience

Background:Adult patients with congenital heart disease(ACHD)might be at high risk of Coronavirus disease-2019(COVID-19).This study aimed to report on a one-year tertiary center experience regards COVID-19 infection in ACHD patients.Methods:This is a one-year(March-2020 to March-2021)tertiary-center retrospective study that enrolled all ACHD patients;COVID-19 positive patients’medical records,and management were reported.Results:We recorded 542 patients,205(37.8%)COVID-19-positive,and 337(62.2%)COVID-19-negative patients.Palliated single ventricle and Eisenmenger syndrome patients were more vulnerable to COVID-19 infection(P<0.05*).Cardiovascular COVID-19 complications were arrhythmias in 47(22.9%)patients,heart failure in 39(19.0%)patients,cyanosis in 12(5.9%)patients,stroke/TIA in 5(2.4%)patients,hypertension and infective endocarditis in 2(1.0%)patients for each,pulmonary hypertension and pulmonary embolism in 1(0.5%)patient for each.11(5.4%)patients were managed with home isolation,147(71.7%)patients required antibiotics,32(15.6%)patients required intensive care unit(ICU),8(3.9%)patients required inotropes,7(3.4%)patients required mechanical ventilation,and 2(1.0%)patients required extracorporeal membrane oxygenation(ECMO).Thromboprophylaxis was given to all 46(22.4%)hospitalized patients.American College of Cardiology/American Heart Association classification revealed that complex lesions,and FC-C/D categories were more likely to develop severe/critical symptoms,that required mechanical ventilation and ECMO(P<0.05*).Mortality was reported in 3(0.6%)patients with no difference between groups(P=0.872).193(35.6%)patients were vaccinated.Conclusions:COVID-19 infection in ACHD patients require individualized risk stratification and management.Eisenmenger syndrome,single ventricle palliation,complex lesions,and FC-C/D patients were more vulnerable to severe/critical symptoms that required ICU admission,mechanical ventilation,and ECMO.The vaccine was mostly tolerable.

Different position from traditional left lateral for colonoscopy? A meta-analysis and systematic review of randomized control trials

Background: Colonoscopy requires the intubation of the cecum for screening of colorectal diseases. The conventional position used for colonoscopy is the left lateral position (LLP). However, alternative positions have also been utilized to enhance the success of intubation. Thus, the aim of this study was to perform a meta-analysis of the different positions to determine the effectiveness of the individual positions for successful colonoscopy.Methods: Medline, Embase and Cochrane trials electronic databases were searched for studies on colonoscopy positions. The primary outcome was defined as the cecal intubation rate. Pooled risk ratios (RR) and 95% confidence intervals (CI) for the rates of cecal intubation were estimated. Secondary outcomes such as the cecal intubation time and adenoma detection rate were further analyzed qualitatively.Results: After reviewing 644 identified records, 7 randomized control trials (RCT) studies were included. No significant difference was observed in either comparisons, between the LLP vs. supine position (SP) (RR = 1.01, 95% CI, 0.98 to 1.04,P = 0.55) or the LLP vs. prone position (PP) (RR = 1.02, 95% CI, 0.98 to 1.06,P = 0.27).Conclusions: Amidst available literature, the use of other positions can be considered when performing colonoscopy. These further highlights that the existential practice is based predominantly on familiarity instead of evidence-based-research.

Alterations in renal function in patients with obstructive sleep apnea syndrome and effects of continuous positive airway pressure

Objective To assess renal function in patients with obstructive sleep apnea syndrome (OSAS) during two nights when they were untreated and treated with continuous positive airway pressure (CPAP). Methods Tubular function was estimated on the basis of the renal lithium clearance and its derived formulae, urinary osmolality, osmolal clearance and free water clearance; while glomerular function was evaluated by endogenous creatinine clearance. Twenty patients with OSAS and sixteen normal controls were studied. Results The untreated patients with OSAS had significantly lower fractional proximal tubular sodium reabsorption (59.1%±7.1%,P<0.001 vs controls), lower fractional distal tubular sodium reabsorption (93.8%±1.7%, P<0.05 vs controls) and urinary osmolality (573.0±107.9 mosm·kg 1 , P<0.05 vs controls). The absolute distal tubular reabsorption rate of sodium and osmolal clearance in the untreated patients were higher 47.0±26.0 mmol·L 1 and 25.0±4.1 ml·L 1 ; P< 0.01 and P<0.05 respectively vs controls). During CPAP treated nights all abnormal renal function indexes in the OSAS patients restored to normal control values (P>0.05). Conclusions The natriuresis and diuresis of OSAS patients were due to the decrease in proximal and distal tubular sodium reabsorption and in tubular concentration ability during their nocturnal sleep and were returned to normal by CPAP therapy.

Quantities and function of NK cells in patients with positive BMMNC-Coombs test and cytopenia

Objective To test NK cell quantities and function in patients with positive BMMNC-Coombs test(CBCPC)and cytopenia and to explore how NK cell participate in the progress of this disease.Methods The percentage of CD3-CD56+NK cell in peripheral blood lymphocytes,the expression of activating receptor(NKG2D,NKp46,NKp44),inhibitory receptor(CD158a,CD158b),per-

Analysis of clinical features and prognosis of anti-glomerular basement membrane antibody positive patients with anti-neutrophil cytoplasmic antibodies

Objective To investigate the characteristics and outcome of glomerulonephritis in patients with both antineutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody.Methods The sera of 23 antiGBM glomerulonephritis patients were collected and were tested for ANCA respectively.Characteristics and outcome of patients with coexisting anti-GBM antibody

Effect of Telbivudine tablet combined Jianpi Bushen recipe on HBV specific cytotoxic T lymphocyte and HBe Ag seroconversion in patients with HBe Ag positive chronic hepatitis B

Objective To explore the effect of Telbivudine(LDT)Tablet combined with Jianpi Bushen Recipe(JBR)on serum hepatitis B virus(HBV)specific cytotoxic T lymphocyte(CTL)and HBe Ag seroconversion in chronic hepatitis B(CHB)patients.Methods Totally90 HBe Ag-positive and human leukocyte antigen(HLA)-A2 positive CHB patients were randomly assigned to

Correlation between constitution of Yin deficiency syndrome and polymorphism of HLADQA1 / treatment response of Peg-IFNα therapy in HBeAg positive chronic hepatitis B patients

Objective To observe the correlation between constitution of yin deficiency syndrome(YDS)and polymorphism of HLA-DQA1/treatment response of Peg-IFNαtherapy in HBe Ag positive chronic hepatitis B(CHB)patients,and to explore constitution of Chinese medicine(CM)in response to interferon therapy.Methods Totally 120 HBe Ag positive CHB patients who were