[Ryan index for detection of laryngopharyngeal reflux diseases]

Objective: To explore the utility of pharyngeal pH monitoring which positive standard is Ryan index in diagnosis of laryngopharyngeal reflux disease. Methods: In a retrospective study, clinical data of 590 patients who had symptoms laryngopharyngeal reflux disease from February 2016 to March 2017 were analyzed. All patients were received electronic laryngoscopy, assessment of reflux symptom index(RSI) and reflux finding score(RFS), and pharyngeal pH monitoring. SPSS 19.0 software was used to analyze the date. Results: There were 94 patients whose Ryan index were positive(15.93%). Among the 94 patients, 70 were positive during upright, 12 during supine and 12 during both upright and supine. There were 40 patients(6.78%)with pH decline events related to symptoms, while those Ryan index were normal. There were 536(90.85%), 417(70.68%), 233(39.49%) and 117(19.83%) patients with pH<6.5, pH<6.0, pH<5.5 and pH<5.0 events respectively. The positive rate of RSI, RFS, RSI and RFS, RSI or RFS were 44.24%, 16.78%, 7.12%, 53.90% respectively. The RFS score in Ryan index positive group was higher than that in Ryan index negative group[(8.2±2.4) vs (4.0±2.9), u=5.424, P<0.05], while the RSI score in Ryan index positive group was not statistically different from that in Ryan index negative group[(11.3±6.2) vs (12.7±5.8), t=1.247, P=0.167]. Conclusions: Pharyngeal pH monitoring is an objective and non-invasive method which can reflect laryngopharyngeal reflux directly. However, with the Ryan index as a criterion for the diagnosis of laryngopharyngeal reflux disease, partial patients may be missed. Further studies are needed to obtain more accurate and objective laryngopharyngeal pH statistical index for diagnosis of laryngopharyngeal reflux disease.

[Comparision of risk factors and pathogens in patients with early- and late-onset ventilator-associated pneumonia in intensive care unit]

Objective: To compare risk factors and bacterial etiology in patients with early-onset versus late-onset ventilator-associated pneumonia (VAP) in intensive care unit (ICU). Methods: This prospective cohort study enrolled mechanically ventilated patients hospitalized for more than 48 hours in the first affiliated hospital, China Medical University from Jan 2012 to Jun 2016. Subjects were classified by ventilator status: early-onset VAP (< 5 d ventilation, E-VAP) or late-onset VAP (≥ 5 d ventilation, L-VAP). Potential risk factors and pathogen were evaluated. Results: A total of 4 179 patients in adult ICU were screened, 3 989 (95.5%) of whom were mechanically ventilated, 962 patients with mechanical ventilation time ≥ 48 h. VAP developed in 142 patients. E-VAP and L-VAP had different potential risk factors based on statistical analysis.Independent risk factors for E-VAP included male (OR=1.825, 95%CI 1.006-3.310), chronic obstructive pulmonary disease (COPD; OR=3.746, 95%CI 1.795-7.818), emergency intubation (OR=1.932, 95%CI 1.139-3.276), aspiration (OR=3.324, 95%CI 1.359-8.130). Whereas independent risk factors for L-VAP were coma (OR=2.335, 95%CI 1.300-4.194), renal dysfunction (OR=0.524, 95%CI 0.290-0.947), emergency intubation (OR=2.184, 95%CI 1.334-3.574). Mortality in E-VAP and L-VAP group were both higher than the non-VAP group[30.2%(19/63)vs 19.8%(162/820), P=0.044; 29.1%(23/79) vs 19.8%(162/820), P=0.046]. The pathogens isolated from early-onset versus late-onset VAP were not significantly different between groups, which the most common ones were acinetobacter baumannii, pseudomonas aeruginosa and klebsiella pneumoniae. Conclusion: E-VAP and L-VAP have different risk factors, however related pathogens are similar. Different specific preventive strategies are suggested based on different onset of VAP.

[A retrospective clinical study of sixty-three cases with persistent inflammation immunosuppression and catabolism syndrome]

Objective: To study the clinical characteristics and prognosis of patients with persistent inflammation immunosuppression and catabolism syndrome (PICS) in ICU. Methods: A total of 126 patients admitted to ICU (ICU stay of more than 10 days, age≥18 years) between January 2014 to December 2014 were retrospectively studied.Data were collected from electronic medical records including demographics, underlying disease, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score, laboratory parameters, ICU acquired infections and clinical outcome. Results: The overall incidence of PICS in ICU patients (ICU stay of more than 10 days) was 50.0%(63/126). There were no significant differences in baseline data such as gender, age, APACHEⅡscore, SOFA score and underlying diseases between the two groups(all P>0.05). Compared with the non-PICS group, there were more patients with gastrointestinal perforation in the PICS group (P=0.042), however, the medical or surgical admission did not differ between the two groups(P>0.05). During the stay in ICU, the PICS group showed a higher risk of developing acquired infections compared with the non-PICS group[PICS 63.5%(40/63) vs non-PICS 23.8%(15/63); P<0.001]. The infections were more caused by Candida in the PICS group than the non-PICS group [PICS 22.4%(11/49) vs non-PICS 2/17; P=0.003]. Moreover, the PICS group experienced longer stay in ICU[PICS(31.6±28.8) days vs non-PICS (20.4±11.3) days; P=0.0046] and higher ICU mortality [PICS 28.6%(18/63) vs non-PICS 6.3%(4/63), P=0.001]. Conclusion: PICS is a common manifestation of patients who stay in ICU more than 10 days, which is associated with high risk of ICU acquired infections, prolonged length of stay and high mortality.

Rosiglitazone attenuates allergic inflammation and inhibits expression of galectin-3 in a mouse model of allergic rhinitis

Peroxisome proliferator activated receptor gamma (PPAR-gamma) agonists are involved in the regulation of inflammatory responses and recent studies suggest that PPAR-gamma ligands may have potential for the treatment of allergic airway disease. This study investigated the effect of the PPAR-gamma agonist, rosiglitazone, on nasal mucous allergic inflammation and galectin-3 gene expression in a murine model of allergic rhinitis (AR mice). Rosiglitazone resulted in a statistically significant attenuation of the increased numbers of inflammatory cells and Th2 cytokine levels in nasal cavity lavage fluid of AR mice. Furthermore, the expression of galectin-3 in the nasal mucosa of AR mice was statistically significantly increased. Overexpression of galectin-3 was markedly suppressed by rosiglitazone treatment. These data suggest that the PPAR-gamma agonist, rosiglitazone, may have potential in the development of therapies for allergic rhinitis.

[Study of resisting leukoplakia canceration and angiogenesis of Herba Erigerontis]

OBJECTIVE

To evaluate the effect of resisting canceration of Herba Erigerontis HEr and that of angiogenesis; seek the mechanism of angiogenesis.

METHODS

150 golden hamsters were randomly divided into model group (66 animals), HEr group (66) and control group (18). Carcinomatous conversions of golden hamster cheek pouches induced by Sally way and interrupted by Herba Erigerontis. Ink perfusion, analysis of images, resin cast form of micro vessel, alpha-SMA detection and histopathological examination were applied to observe their changing patterns.

RESULTS

The rate of leukoplakia canceration of Herba Erigerontis group was 50% lower than that of model group. The rate of normal cells was about four times more than that of model. alpha-SMA of Herba Erigerontis 65.76 was higher than that of model (P<0.001). There was no significant difference between angeion vessel area and density (P>0.05). Nevertheless, the resin cast form of micro-vessel showed that its configuration and spacious arrangement was similar to control group.

CONCLUSION

Herba Erigerontis has the function of preventing leukoplakia canceration absolutely. Maybe its mechanism is to upregulate the expression of alpha-SMA. It has no obvious effect of angio-hyperplasia and expansion in the course of leukoplakia canceration. However, it has the protecting function to angio-configuration and spacious arrangement and the integrity of angeion vessed wall. Probably its mechanism is promoting blood circulation by removing blood stasis and benign angiogenesis so as to resist canceration.

[Observation on alpha-SMA during Erigeron Breviscapus (Vant) Hand-Mazz obstructs the evolution of carcinogenesis of golden hamster cheek pouch]

OBJECTIVE

To observe dynamically that Erigeron Breviscapus (Vant) Hand-Mazz (HEr) affects the expression of alpha-smooth muscle actin (alpha-SMA). To discuss the probable mechanism of obstructing leukoplakia carcinogenesis of this medicine.

METHODS

120 golden hamsters were randomly divided into model group (48), HEr group (48) and control group (6). HEr was applied to obstruct the evolution of carcinogenesis of golden hamster cheek pouch. Immunohistochemistry was used to detect the expression level of alpha-SMA with cheek pouch specimen that besmears DMBA in 4-9 weeks. Results were compared with model group.

RESULTS

Vessel density dyed with alpha-SMA continuously of HEr group was 65.76 significantly higher than that of model group 42.12 (P<0.001). High classification cases in HEr group were much more than model group when cases were divided into five groups as follow: 100%, 50%, 20%, 10%, 3% (P<0.01).

CONCLUSION

HEr can raise the expression level of alpha-SMA exactly during the evolution of leukoplakia carcinogenesis of golden hamster, which shows that this medicine obstructs carcinogenesis by keeping the normal physiological function of vascular myoepithelial cell and integrity of vascular basement membrane.