Precision implementation of early ambulation in elderly patients undergoing off-pump coronary artery bypass graft surgery: a randomized-controlled clinical trial.

BACKGROUND: Although early ambulation (EA) is associated with improved outcomes in post-operative patients, implementation of EA in elderly patients is still a challenge. In this study, we aimed to design and assess a precision early ambulation program for cardiac rehabilitation. METHODS: We conducted a single-center, randomized and controlled clinical trial in elderly patients aged over 60 years after off-pump coronary artery bypass graft (OPCABG) surgery. Patients were randomly assigned to a precision early ambulation (PEA) group or a routine ambulation (Control) group. Age-predicted maximal heart rate (APMHR) and maximal oxygen uptake (VO2max) were used as a reference to formulate and monitor the PEA regimen. The primary end-point was the postoperative length of stay in hospital (PLOS). The secondary end-points included 90-day mortality, incidence of early discharge, laboratory tests, length of ICU stay, the incidence of multiple organ complications and post-traumatic stress disorder (PTSD). Ambulation outcomes were also recorded. RESULTS: In total, 178 patients were enrolled (n = 89 per group). In the intent-to-treat analysis, PLOS in the PEA group was shorter than that in the Control group (9.04 ± 3.08 versus 10.09 ± 3.32 days, respectively. Mean difference 1.045 days; 95% confidence interval [CI] 0.098-1.992; P = 0.031 in the unadjusted model; mean difference 0.957 days; CI 0.007-1.907; P = 0.048 in adjusted model). The incidence of early discharge differed significantly between the PEA and control groups (41[46.1%] versus 24[27.0%] patients, respectively. Odds ratio [OR] 0.432; CI 0.231-0.809; P = 0.009 in unadjusted model; OR 0.466; CI 0.244-0.889, P = 0.02 in adjusted model). The time of first bowel movement, partial pressure O2 and post-traumatic stress disorder score in the PEA group were better than those in the Control group. Participants walked much longer distances on day 3 in the PEA group than those in the Control group (76.12 ± 29.02 versus 56.80 ± 24.40 m, respectively, P < 0.001). CONCLUSION: APMHR and VO2max are valuable for implementation of PEA according to an established security threshold. PEA after OPCAPG surgery is safe and reliable for elderly patients, not only reducing the hospital stay, but also improving their physiological and psychological symptoms. TRIAL REGISTRATION: This study is a component of a protocol retrospectively registered: Application of ERAS in cardiovascular surgery. TRIAL REGISTRATION NUMBER: ChiCTR1800018167 . Date of registration: 3rd September, 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx.

Neural stem cell secretome and its role in the treatment of neurodegenerative disorders.

Neurological diseases in the central nervous system are mostly characterized by the failure of endogenous repair to restore tissue damage and salvage lost function. Currently, studies have shown that neural stem cell transplantation provides a good therapeutic effect on neurological diseases. For this reason, neural stem cell transplantation has been explored as a cell replacement therapy. Although transplanted cells can replace cells lost during or post central nervous system injury, many studies have shown that this mechanism is insufficient as most of these newly formed cells fail to integrate and eventually die. Although it was initially thought that neural stem cell could only replace lost cells, recent experiments have shown that transplanted neural stem cell can also play bystander roles such as neuroprotection and immune regulation, promote tissue repair by preventing tissue damage, interfere with pathogenic processes, or by rescuing endogenous nerve cells. However, compelling evidence has raised concerns about this bystander effect, which can be caused by several biologically active molecules (collectively known as the secretome) produced by neural stem cells. These results also raise the possibility of the neural stem cell secretome as a potential candidate for neural stem cell transplantation therapies based on the bystander effect. A better understanding of the molecules and mechanisms of this effect is of critical importance for neural stem cell-based therapies. This review aims to discuss the function and application of neural stem cell secretome in the treatment of neurodegenerative disorders.

Anxiety Administrated by Dexmedetomidine to Prevent New-Onset of Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Graft.

This study aims to evaluate the effect of dexmedetomidine (DEX) sedation for relieving anxiety and the incidence of atrial fibrillation (AF) after off-pump coronary artery bypass graft (OPCABG).This randomized, double-blind, controlled trial was conducted on 196 patients who underwent OPCABG in Shandong Provincial Hospital from July 2017 to June 2018. The patients were randomly assigned to two groups, intervention of DEX group and Propofol (PROP) group. Episodes of postoperative AF (POAF) were identified within 5 days after OPCABG. Perioperative anxiety status was assessed using Zung's Self-Rating Anxiety Scale (SAS). The baseline demographic and surgical characteristics of the population and other outcome variables were evaluated.We analyzed 62 patients in the DEX group and 61 patients in the PROP group. There was no significant difference in SAS anxiety scores between two groups before surgery (P = 0.104), while SAS had significantly after surgery (P = 0.018). The incidence of POAF in the DEX group was lower than that of the PROP group (16.1% versus 32.8%, P = 0.037), and a total of 30 patients (30/123, 24.4%) manifested POAF after OPCABG. Some univariable predictors of POAF were detected. The conceptual model of mediator analyses showed DEX was not only directly related to POAF but was also indirectly related through the independent effect of anxiety level.The findings indicated that patients receiving DEX were more likely to have less incidence of POAF, also uniquely showed DEX administration and POAF processes as a function of anxiety status.

Prophylactic use of levosimendan in pediatric patients undergoing cardiac surgery: a prospective randomized controlled trial.

BACKGROUND: The administration of levosimendan prophylactically to patients undergoing cardiac surgery remains a controversial practice, and few studies have specifically assessed the value of this approach in pediatric patients. This study therefore sought to explore the safety and efficacy of prophylactic levosimendan administration to pediatric patients as a means of preventing low cardiac output syndrome (LCOS) based upon hemodynamic, biomarker, and pharmacokinetic readouts. METHODS: This was a single-center, double-blind, randomized, placebo-controlled trial. Patients ≤ 48 months old were enrolled between July 2018 and April 2019 and were randomly assigned to groups that received either placebo or levosimendan infusions for 48 h post-surgery, along with all other standard methods of care. LCOS incidence was the primary outcome of this study. RESULTS: A total of 187 patients were enrolled, of whom 94 and 93 received levosimendan and placebo, respectively. LCOS incidence did not differ significantly between the levosimendan and placebo groups (10 [10.6%] versus 18 [19.4%] patients, respectively; 95% confidence interval [CI] 0.19-1.13; p = 0.090) nor did 90-day mortality (3 [3.2%] versus 4 [4.3%] patients, CI 0.14-3.69, p = 0.693), duration of mechanical ventilation (median, 47.5 h and 39.5 h, respectively; p = 0.532), ICU stay (median, 114.5 h and 118 h, respectively; p = 0.442), and hospital stay (median, 20 days and 20 days, respectively; p = 0.806). The incidence of hypotension and cardiac arrhythmia did not differ significantly between the groups. Levels of levosimendan fell rapidly without any plateau in plasma concentrations during infusion. A multiple logistic regression indicated that randomization to the levosimendan group was a predictor of LCOS. CONCLUSIONS: Prophylactic levosimendan administration was safe in pediatric patients and had some benefit to postoperative hemodynamic parameters, but failed to provide significant benefit with respect to LCOS or 90-day mortality relative to placebo. TRIAL REGISTRATION: Name of the registry: Safety evaluation and therapeutic effect of levosimendan on the low cardiac output syndrome in patients after cardiopulmonary bypass. TRIAL REGISTRATION NUMBER: ChiCTR1800016594. Date of registration: 11 June 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx.

[Teratogenic effects of Xanthoceras sorbifolia Bunge seed on SD rats].

OBJECTIVE: To study the teratogenic effect caused by Xanthoceras sorbifolia Bunge seed on SD rats. METHODS: The experiments were performed in the groups of 2. 0, 4. 0 and 8. 0 g/kg, purified water negative control group and cyclophosphamide positive control group. On the 6 th to 15 th day of pregnancy, the SPF SD rats were exposed to Xanthoceras sorbifolia Bunge seed. All the rats were sacrificed on the day before delivery. Examination were performed on the bones stained by alizarin red and internal organs fixed with Bouins fluid. RESULTS: Maternal body weight, weight gain, uterine fetal weight, net weigh, bed number, corpus luteum number, absorbing births number, live births number, still birth number and percentage and the abnormal rate of appearance, bone, internal organs of each dose group of Xanthoceras sorbifolia, there was no statistical significant difference between Bunge seed groups and negative control group. CONCLUSION: Under the conditions of this experiment, the Xanthoceras sorbifolia Bunge seed had no maternal toxicity to pregnant SD rats, no teratogenic and developmental toxicity to fetal rats. No Observed Adverse Effect Level of maternal toxicity and the minimum teratogenic dose of fetal rats is >8. 0 g/kg.

Associations between body mass index, weight control concerns and behaviors, and eating disorder symptoms among non-clinical Chinese adolescents.

BACKGROUND: Previous research with adolescents has shown associations of body weight, weight control concerns and behaviors with eating disorder symptoms, but it is unclear whether these associations are direct or whether a mediating effect exists. This study was conducted to investigate the prevalence of overweight and obesity, weight control concerns and behaviors, and eating disorder symptoms and to examine the mediating function of weight control concerns and behaviors on the relationship between body mass index (BMI) and eating disorder symptoms among non-clinical adolescents in China. METHODS: A cross-sectional survey among 2019 adolescent girls and 1525 adolescent boys in the 7th, 8th, 10th and 11th grades from seven cities in China was conducted. Information on weight control concerns and behaviors, and eating disorder symptoms (Eating Disorder Inventory-3) were collected from the adolescents using a self-administrated questionnaire. RESULTS: Weight control concerns and behaviors, and eating disorder symptoms were prevalent among the study population. A high proportion of adolescents scored at or above the threshold on the eating disorder inventory (EDI) subscale such as bulimia, interoceptive deficits, perfectionism, and maturity fears, which indicated eating disorder symptoms. High BMI was significantly associated with high score of drive for thinness, body dissatisfaction, bulimia, low self-esteem, interceptive deficits and maturity fears, so do perceived body weight status. Almost all weight control concerns and behaviors we investigated were significantly associated with high EDI subscale scores. When weight control concerns were added to the model, as shown in the model, the association between BMI and tendency of drive to thinness and bulimia was attenuated but still kept significant. The association between BMI and body dissatisfaction were no further significant. The association of BMI and drive for thinness, body dissatisfaction and bulimia was considerably weaker than when weight control behaviors were not included. CONCLUSIONS: Weight control concerns and behaviors may be mediators of the association between BMI and eating disorder symptoms. Interpretation of these weight control problems is crucial to develop culturally appropriate educational and intervention programs for adolescents.

Adenoviral.ßARKct Cardiac Gene Therapy Ameliorates Cardiac Function Following Cardiopulmonary Bypass in A Swine Model.

OBJECTIVE: This study is to evaluate the effects of the Adenoviral ßARKct (Adv. ßARKct) myocardial gene transfection following cardioplegic arrest on cardiopulmonary bypass (CPB) in a swine model. METHODS: Swine models of cardioplegic arrest on CPB were established after 5 days of myocardial injection of Adv. ßARKct or Adv. luciferase. The pigs were randomized into Adv. ßARKct, Control, and Sham groups. Invasive hemodynamics, cardiac function, biomarkers, and tissue morphology were assessed. RESULTS: Baseline data were similar among these groups. Hemodynamics and cardiac function showed a deteriorating trend throughout 6 h after weaning in ßARKct and Control groups. Compared with Control group, Adv. ßARKct treatment significantly elevated global and regional ventricular function (cardiac output, dp/dtmax, Ejection fraction, peak systolic longitudinal strain, and peak systolic strain rate) and altered hemodynamics (cardiac cycle efficiency and systemic vascular resistance). Moreover, inotropic score in ßARKct group was gradually decreased to 5.0 ±â€Š1.1, compared with Control group (6.2 ±â€Š0.9), at 6 h after weaning. Biomarkers in ßARKct group were significantly better than in Control group. Meanwhile, ßARKct treatment reduced the histopathologic injuries, rescued ß1-AR, SERCA2a, and RyR2 levels, and decreased the GRK2 levels in myocardial cells. CONCLUSION: Adv.ßARKct inhibits GRK2 and ameliorates myocardial injuries following cardioplegic arrest on CPB, via stabilizing ß1-AR, reducing mitochondrial damages and restoring sarcoplasmic reticulum Ca-handling protein expression.

[Comparative study of nanosized and microsized silicon dioxide on spermatogenesis function of male rats].

OBJECTIVE: To compare the effects of nanosized and microsized silicon dioxide on spermatogenesis function of male rats exposed by inhalation. METHODS: 45 male rats were randomly divided into control group and four experimental groups which were exposed by 100 mg/m3 or 300 mg/m3 nanosized and microsized silicon dioxide in inhalation chambers 2 hours every other day. Age-matched rats were exposed to room air with the same condition and served as controls. 65 days later, the testicular and epididymal viscera coefficients, the quantity and quality of sperm were examined and the histopathological assessment was done. The changes in biochemical parameters in serum and testes were also measured. RESULTS: Nanosized silicon dioxide could induce histopathological changes of testes in rats, and the effect was higher than that of microsized particles at the same concentration. Nanosized silicon dioxide could reduce the sperm counts of rats and the testicular LDH-C4 activities, increase MDA levels in the testes and the effect was higher than that of microsized particles at the same concentration. Nanosized silicon dioxide could lead to the reduction of sperm motility, testicular LDH-C4 activities and 8-hydroxydeoxyguanosine (8-OHdG) concentration in serum elevation in particles-exposed rats compared with the control animals, but there are no significant difference compared with that of microsized particles at the same concentration. CONCLUSION: The present findings suggest a different effect of impairment of sperm production and maturation induced by inhalation of nanosized and microsized silicon dioxide, and nanosized silicon dioxide exerted more severe reaction.

[Effects of perfluorooctane sulfonate on spermiogenesis function of male rats].

OBJECTIVE: To evaluate the effects of administration of perfluorooctane sulfonate(PFOS) on spermiogenesis function of male rats. METHODS: 36 male rats were randomly divided into 4 groups, which received 0, 0.5, 1.5, 4.5 mg x kg(-1) PFOS by food intake per day for 65 days. The testicular and epididymal viscera coefficients, the number, motility and deformity of sperm were examined. The activities of lactate dehydrogenase isoenzyme-x (LDHx), sorbitol dehydrogenase (SDH) and the generation of malonyldialdehyde (MDA) in the testes were also measured. RESULTS: The viscera coefficients did not show any significant change ( P > 0.05) while the body weight and weight of testis decreased ( P < 0.05) in treated rats compared with the corresponding control group animals. In 1.5,4.5 mg x kg(-1) PFOS treated rats there were significant decreases in the sperm count (P < 0.05) and the mean activities of LDHx and SDH whereas obvious increases in the rate of sperm deformity ( P < 0.05). In 4.5 mg x kg(-1) PFOS group the generation of MDA increased (P < 0.05) while the motility of sperm reduced (P < 0.05) with respect to the control value. CONCLUSION: It suggested that PFOS could elicit the impairment of sperm production and maturation of male rats.

Safety assessment of the fermented Phylloporia ribis (Lonicera japonica Thunb.) mycelia by oral acute toxicity study in mice and 90-day feeding study in rats.

Phylloporia ribis is an edible fungus in China. Its fermented mycelia have been approved by the National Health and Family Planning Commission (NHFPC) of PR China for use as a novel food material, but little information on its safety is available. The present research was the first to evaluate acute and subchronic toxicity in experimental animals of fermented Phylloporia ribis mycelia (FPM) following standard procedures. In acute toxicity study, FPM was orally administered to male and female mice twice a day at single dose of 10 g/kg bw. The Maximum Tolerated Dose (MTD) of FPM for mice of both sexes was over 10 g/kg bw. No death and abnormal behaviors occurred during 14 days study except for an increased locomotor activity in three animals. In 90-day feeding study, male and female Sprague-Dawley rats were fed diets containing 10.0%, 5.0%, 2.5%, 1.25% and 0% (control) FPM for 90 days. The treatment caused no effects on mortality, gross pathology, histology, hematology, and blood chemistry, no dose-dependent changes in food consumption, but caused effect on body weight gain compared with control group. The No Observed Adverse-Effect Level (NOAEL) of FPM was greater than 8.7 g/kg bw/day in both sexes of rats.

[Study on the incidence and spatiotemporal dynamic variation of hemorrhagic fever with renal syndrome in Shandong province].

OBJECTIVE: To study the incidence and spatiotemporal dynamic variation of hemorrhagic fever with renal syndrome (HFRS) in Shandong province. METHODS: According to surveillance data on HFRS epidemics and host animals, a 'contour area multifractal model' was estimated on the HFRS' incidence and multi-analysis model was applied to study spatiotemporal dynamic variation. RESULTS: The process could be classified into 5 periods: 1st period (1974-1981) when HFRS was in completely natural focal state in Shandong, and the nature of focus was typical Apodemus type. 2nd period (1982-1986) indicated the process of expanding and merging of the Apodemus type focus in the southeastern part of Linyi district and the Rattus type focus was in the southern part of Jining city. 3rd period (1987-1990) indicated that through the expanding and merging of the two epidemic focuses,one mixed focus dominated by the Apodemus type had been formed in the hilly area of the southern and middle part of Shandong while another one dominated by the Rattus type in the Yellow River valley of the northwestern part of Shandong. 4th period (1991-1993) showed that the process of the spatial pattern of the mixed focus dominated by the Rattus type in Shandong. 5th period (1994-2004) referred to the spatial pattern of the mixed focus dominated by the Rattus became stabilized. CONCLUSION: Evolution of the characteristics of HFRS focus in Shandong province experienced the following three processes: the simple Apodemus type and the simple Rattus type were seen separately to the mixed foci with the Apodemus type dominant and the Rattus dominant type coexisted and merged to the stable state of the mixed focus with Rattus as the dominant one.