Objective To systematically review the effectiveness and safety interferon-α (IFN-α) combined with lamivudine vs. IFN-α alone in treating children with Hepatitis B. Methods Such databases as The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were electronically searched for randomized controlled trials (RCTs) on IFN-α combined with lamivudine in treating children with hepatitis B. Two reviewers screened literature, extracted data, and assessed the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software. Results 8 RCTs were included, with comparable baseline. The results of meta-analysis showed that, compared to the IFN-α alone group, the combined therapy group had higher negative rates of serum HBV-DNA and HBeAg. There was no significant difference in the positive rate of anti-Hbe and the incidence of adverse reaction between the two groups. Conclusion Current evidence shows that IFN-α combined with lamivudine was more effective than IFN-α alone in treating children’s hepatitis B.
Objective To investigate the effect of growth differentiation factor 7 (GDF-7) on the tenogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) in vitro, to provide evidence for improving the efficacy of BMSCs on tendon repair. Methods BMSCs were isolated from bone marrow tissue of green fluorescent protein rats by density gradient centrifugation method. Chondrogenic, osteogenic, and adipogenic differentiation assays were used to demonstrate the multi-differentiation potential of the BMSCs. BMSCs at passage 3 were cultured and divided into 4 groups according to different concentrations of GDF-7 (0, 12.5, 25.0, and 50.0 ng/mL): group A, B, C, and D, respectively. After cultured for 2 weeks in vitro, the mRNA expressions of scleraxis, tenomodulin, tenascin C, and collagen type I were detected by real-time fluorescent quantitative PCR method, the protein expressions of tenomodulin, tenascin C, and collagen type I by immunocytochemistry staining in 4 groups, and the protein expressions of tenomodulin by Western blot in groups A and C. Results BMSCs had osteogenic, chondrogenic, and adipogenic differentiation potentials. The mRNA expressions of tenomodulin in groups B, C, and D were 2.85, 3.41, and 3.07 times higher than that in group A, respectively; the mRNA expressions of scleraxis in groups B, C, and D were 2.13, 1.50, and 2.56 times higher than that in group A, respectively; and the mRNA expressions of tenascin C in groups B, C, and D were 2.45, 2.86, and 1.88 times higher than that in group A, respectively. There were significant differences between groups B, C, D and group A (P lt; 0.05), while there was no significant difference among groups B, C, and D (P gt; 0.05). The mRNA expressions of collagen type I in groups B and C were 1.92 and 2.45 times higher than that in group A, showing significant differences between groups B, C and group A (P lt; 0.05), but no significant difference between groups A and D (P gt; 0.05). Immunocytochemistry staining showed that the protein expressions of tenomodulin, tenascin C, and collagen type I were detected in groups B, C, and D but not in group A. The results were further confirmed by Western blot results which showed higher protein expression of tenomodulin in group C than in group A. Conclusion GDF-7 can be used to promote tenogenic differentiation of rat BMSCs in vitro.
ObjectiveTo explore the effect of goal directed analgesia on patients with noninvasive positive pressure ventilation (NPPV) in the intensive care unit (ICU).MethodsThis was a retrospective study. Two hundred sixty-four patients requiring non-invasive positive pressure ventilation were enrolled in the ICU of this hospital, including 118 patients in the empirical analgesia group and 146 in the goal directed analgesia group. The empirical analgesia group was treated with remifentanil to analgesia and propofol, midazolam or dexmedetomidine to sedation. The sedative depth maintained <1 measured by the score of the Richmond restless sedative scale (RASS). The same analgesic and sedative drug were first used in the goal directed analgesia group to maintain the Critical Care Pain Observation Tool score <2, and the RASS score <1 was maintained after the analgesia depth were achieved. Whether the patients occurred delirium was assessed by the Confusion Assessment Method for the ICU. The dosage of analgesic and sedative drugs, the dependability (based on the total ventilation time in the first 24 hours after ventilation), the incidence of delirium, the rate of invasive ventilation, the total time of NPPV and the length of stay of ICU were observed in the two groups.ResultsThere were no significant differences in age, sex, APACHEⅡ score, mean arterial pressure, heart rate, respiratory rate, SpO2, arterial blood gas and the reason of NPPV between the two groups. The dosage of analgesic and sedative drugs in the goal directed analgesia group were less than the empirical analgesia group, and the dependability was higher than that of the empirical analgesia group ［(12.6±5.8)h vs. (10.9±4.8)h, P<0.05), and the incidence of delirium and the rate of invasive ventilation were also lower than those of the empirical analgesia group (15.8% vs. 25.4%, P<0.05; 32.9% vs. 44.9%, P<0.05). The total time of NPPV in the goal directed analgesia group was shorter than that of the empirical analgesia group ［(28.6±8.8)h vs. (37.3±10.7)h, P<0.05), but there was no significant difference in the length of stay in ICU.ConclusionGoal directed analgesia can improve the dependability of NPPV patients, reduce the use of sedative drugs, and decrease the incidence of delirium and rate of invasive ventilation.
ObjectiveTo investigate the predictive value of diaphragm rapid shallow breathing index (D-RBSI) in weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD).MethodsSeventy-six patients with COPD who were undergoing mechanical ventilation were enrolled in department of critical care medicine of our hospital from March 2016 to March 2017. The patient underwent spontaneous breathing test (SBT) using CPAP mode after weaning screening. When the SBT had started 10 min or the SBT failed, the patients' respiratory rate (RR) and tidal volume were recorded, and the diaphragmatic displacement (DD) of patients was measured by bedside ultrasound. The ratio of RR to DD (RR/DD) was calculated as D-RBSI, and the predictive value of D-RBSI on weaning results in mechanically ventilated patients with COPD was analyzed by receiver operating characteristic (ROC) curve.ResultsTwenty-eight patients failed weaning procedure. There were no significant differences in age and acute physiology and chronic health evaluation II scores between the successful group and the failed group. The DD of the patients in the successful group was greater than that of the failed group [(22±6) mm vs. (13±5) mm, P<0.001]. RBSI and D-RBSI of the successful group were lower than those of the failure group [RBSI: (40±14) breaths/(min·L)vs. (52±20) breaths/(min·L), P=0.003; D-RBSI: (0.95±0.51) breaths/(min·mm) vs. (1.79±0.83) breaths/(min·mm), P<0.001)]. There was a good correlation between the RBSI and D-RBSI in the two groups (R2=0.778, P<0.001). The area under the ROC curve predicted the weaning result by D-RBSI was higher than RBSI (0.85vs. 0.75, P<0 001="" the="" cutoff="" value="" of="" d-rbsi="">1.13 breaths/(min·mm) to predict weaning failure had a sensitivity of 0.82, and a specificity of 0.81.ConclusionThe rapid shallow breathing index of diaphragm can be effectively used to predict the weaning result of COPD patients during mechanical ventilation.