Impacts of SVV-guided goal-directed fluid therapy on intraoperative signs, intestinal barrier function and prognosis in patients undergoing laparoscopic radical rectal cancer surgery / 中国医师杂志

Objective:To investigate the impacts of stroke volume variation (SVV)-guided goal-directed fluid therapy on intraoperative signs, intestinal barrier function and prognosis in patients undergoing laparoscopic radical rectal cancer surgery.Methods:A total of 90 patients who underwent laparoscopic radical resection for rectal cancer in Peking University International Hospital from May 2020 to May 2022 were prospectively selected as subjects, and divided into SVV group (45 cases) and traditional infusion group (45 cases) by random number table method. The SVV group was given SVV-guided goal-directed fluid therapy, and the traditional infusion group was given central venous pressure (CVP)-guided goal-directed fluid therapy. The operation-related indicators (urine volume, crystalloid volume, colloid volume, total fluid volume, blood loss and operation time), intraoperative signs indicators[heart rate (HR), CVP, mean arterial pressure (MAP)], intestinal barrier function indicators [diamine oxidase (DAO), D-lactic acid], inflammatory factor levels [interleukin-10 (IL-10), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], and the incidence of complications were compared between the two groups.Results:There was no significant difference in the urine volume, blood loss and operation time between the two groups (all P>0.05), while the crystalloid volume, colloid volume and total fluid volume in the SVV group were greatly lower than those in the traditional infusion group (all P<0.05). There was no significant difference in HR between the two groups at different time points ( P>0.05). Compared with T 0, CVP at T 1 in the two groups was significantly decreased (all P<0.05), and increased at T 2 and T 3 compared with T 1 (all P<0.05). There was no significant difference in MAP at different time points in the SVV group (all P>0.05). The MAP at T 1, T 2 and T 3 in the traditional infusion group was significantly lower than that at T 0 (all P<0.05), and the MAP at T 1, T 2 and T 3 in the SVV group was significantly higher than that in the traditional infusion group (all P<0.05). Compared with T 0, DAO and D-lactic acid levels were significantly increased at T 1, T 3, T 4 and T 5 in the two groups (all P<0.05), and DAO and D-lactic acid levels at T 1, T 3, T 4 and T 5 in the SVV group were significantly lower than those in the traditional infusion group (all P<0.05). Compared with T 0, serum IL-10 level in the two groups was significantly decreased at T 4 ( P<0.05), and serum IL-6 and TNF-α levels were significantly increased at T 4 (all P<0.05). The serum levels of IL-10, IL-6 and TNF-α in the SVV group at T 4 were significantly different from those in the traditional infusion group (all P<0.05). Compared with T 4, the serum levels of IL-10 at T 5 were significantly increased (all P<0.05), while the levels of IL-6 and TNF-α were significantly decreased (all P<0.05), but there was no statistical significance between the two groups (all P>0.05). The incidence of postoperative infection, anastomotic fistula, vomiting and nausea in SVV group (13.33%) was significantly lower than that in traditional infusion group (35.33%) ( P<0.05). Conclusions:SVV-guided goal-directed fluid therapy for patients undergoing laparoscopic radical rectal cancer can effectively stabilize intraoperative vital signs, reduce inflammation, improve intestinal barrier function, and improve prognosis.

Landing practices of national medical insurance negotiated drugs in tertiary medical institutions of Zhejiang province / 中国药房

OBJECTIVE To provide reference for the subsequent landing of national medical insurance negotiated drugs （referred to as “national negotiated drugs”） at the provincial level. METHODS By reviewing the data publicly released by the official websites of National Healthcare Security Administration and the Healthcare Security Administration of Zhejiang Province， combined with policy documents， the descriptive analysis was conducted on the number of tertiary medical institutions， the actual allocation of national negotiated drugs， the availability rate of national negotiated drugs， the allocation rate of national negotiated drug varieties， and the allocation rate of medical institutions of various cities in Zhejiang province. The Spearman rank correlation test was used to analyze the correlation between the number of types of national negotiated drugs equipped in tertiary medical institutions in Zhejiang province and the per capita disposable income， the number of tertiary medical institutions equipped with national negotiated drugs， and the implementation time of disease diagnosis-related grouping （DRG） of various cities in Zhejiang province. RESULTS As of the first quarter of 2022， 135 tertiary medical institutions in Zhejiang province were equipped with a total of 261 types of national negotiated drugs， accounting for 94.91% of the 2021 edition of the National Negotiated Drugs Catalogue （275 types）. The allocation rates of Goserelin acetate sustained-release implant， Sacubitril valsartan sodium tablets， Alteplase for injection and other varieties were at high level， and the types of national negotiated drugs equipped were highly coincident with the top 10 causes of death with disease of urban and rural residents in Zhejiang province. The tertiary medical institutions in Hangzhou had the most types of national negotiated drugs， with 230 types， while Quzhou had the lowest， with only 34 types； allocation rate of national negotiated drugs in medical institutions of Zhoushan was the highest （100%）， while that of Lishui was the lowest （57.14%）. The types of national negotiated drugs equipped were positively correlated with per capita disposable income in various cities and the number of tertiary medical institutions equipped with national negotiated drugs （P＜0.01）， and there was no significant correlation with the length of implementation of DRG （P＞0.05）. CONCLUSIONS mail：lanyao@mails.tjmu.edu.cn The landing of national negotiated drugs in Zhejiang province is generally good， with a high rate of equipping tertiary medical institutions with national negotiated drugs and a high rate of equipping drug varieties. Therefore， it is recommended that the provincial implementation of national negotiated drugs should be multi-faceted， and policy-making departments should adopt a dual-channel of “unbundling” and “driving” to smooth the drug chain into hospitals. The health insurance sector should improve the “dual channel” management mechanism to share the pressure on hospitals to use drugs. At the same time， it should also improve the multi-level medical security system and raise the level of reimbursement of medical insurance for national negotiated drugs.

Effect of sugammadex on postoperative nausea and vomiting after surgery for intracranial aneurysm / 中华外科杂志

Objective: To investigate the effect of sugammadex on postoperative nausea and vomiting(PONV) after intracranial aneurysm surgery. Methods: Data from intracranial aneurysms patients who met the inclusion and exclusion criteria and underwent interventional surgery in the Department of Neurosurgery, Peking University International Hospital from January 2020 to March 2021 were prospectively included. According to the random number table method, the patients were divided by 1∶1 into the neostigmine+atropine group (group N) and the sugammadex group (group S). Use an acceleration muscle relaxation monitor for muscle relaxation monitoring, and administer neostigmine+atropine and sugammadex to block residual muscle relaxation drugs after surgery. The incidence rates of PONV and severity, the appearance of anesthesia, and the correlation between PONV and postoperative complications were recorded in both groups during five periods after surgery: 0-0.5 hours (T1),0.5-2.0 hours(T2),2.0-6.0 hours (T3),6.0-12.0 hours (T4) and 12.0-24.0 hours (T5). Group comparisons of quantitative data were performed by the independent sample t-test, and categorical data was performed by the χ2 or rank sum test. Results: A total of 66 patients were included in the study, including 37 males and 29 female, aged (59.3±15.4) years (range: 18 to 77 years). The incidence rates of PONV of 33 patients in group S at different time periods of T1, T2, T3, T4, and T5 after surgery were respectively 27.3%(9/33),30.3%(10/33),12.1%(4/33),3.0%(1/33),0(0/33),and the incidence rates of PONV of 33 patients in the group N at different time periods of T1, T2, T3, T4 and T5 after surgery were respectively 36.4%(12/33),36.4%(12/33),33.3%(11/33),6.1%(2/33) and 0(0/33).The incidence of PONV was lower in the group S only in the T3 period after reversal than in the group N (χ2=4.227, P=0.040).However, there was no statistically significant difference in the incidence of PONV between the two groups of patients in other periods (all P>0.05). The recovery time for spontaneous breathing in patients in group S was (7.7±1.4) minutes, the extubation time was (12.4±5.3) minutes, and the safe exit time for anesthesia recovery was (12.3±3.4) minutes; the N groups were (13.9±2.0) minutes, (18.2±6.0) minutes, and (18.6±5.2) minutes, respectively; three time periods in group S were shorter than those in group N, and the differences were statistically significant (all P<0.05). Analysis of the correlation between incidence and severity of PONV in two groups of patients at different periods and postoperative complications showed that only the severity of PONV in the T3 period of the group N was correlated with the incidence of postoperative complications (χ2=24.786,P<0.01);the incidence and severity of PONV during the T4 period were correlated with the incidence of postoperative complications (all P<0.01). There was a correlation between the incidence and severity of PONV in the T3 and T4 periods of group S and the incidence of postoperative complications (all P<0.01). Conclusion: Sugammadex can be used to reverse muscle relaxation in patients undergoing intracranial aneurysm intervention surgery,and it does not have a significant impact on the incidence of PONV, it can also optimize the quality of anesthesia recovery and reduce the incidence of complications after intracranial aneurysm embolization surgery.

EWSR1-SMAD3 positive fibroblastic tumor: a clinicopathological analysis / 中华病理学杂志

Objective: To investigate the clinicopathological features, immunophenotypes and molecular genetics of EWSR1-SMAD3 positive fibroblastic tumor (ESFT) with an emphasis on differential diagnosis. Methods: The clinicopathological data, immunohistochemical profiles and molecular profiles of 3 ESFT cases diagnosed at the Department of Pathology, Fudan University Shanghai Cancer Center from 2018 to 2021were analyzed. The related literature was also reviewed. Results: There were two males and one female. The patients were 24, 12 and 36 years old, respectively. All three tumors occurred in the subcutis of the foot with the disease duration of 6 months to 2 years. The tumors were presented with a slowly growing mass or nodule, accompanied with pain in 1 patient. The tumors ranged in size from 0.1 to 1.6 cm (mean, 1.0 cm). Microscopically, the tumors were located in the subcutaneous tissue with a nodular or plexiform growth pattern. They were composed of cellular fascicles of bland spindle cells with elongated nuclei and fine chromatin. One of the tumors infiltrated into adjacent adipose tissue. There was no nuclear atypia or mitotic activities. All three tumors showed prominent stromal hyalinization with zonal pattern present in one case. Focal punctate calcification was noted in two cases. The immunohistochemical studies showed that tumor cells were diffusely positive for ERG and negative for CD31 and CD34, with Ki-67 index less than 2%. Fluorescence in situ hybridization on the two tested cases identified EWSR1 gene rearrangement. The next generation sequencing analysis demonstrated EWSR1-SMAD3 fusion in all three cases. During the follow up, one patient developed local recurrence 24 months after the surgery. Conclusions: ESFT is a benign fibroblastic neoplasm and has a predilection for the foot, characterized by ERG immunoreactivity and EWSR1-SMAD3 fusion. Local recurrence might occur when incompletely excised. Familiarity with its clinicopathological features is helpful in distinguishing it from other spindle cell neoplasms that tend to occur at acral sites.

Research on the concept of hospital health literacy based on proceduralised grounded theory / 中华医院管理杂志

Objective:To construct the concept and its conceptual framework of hospital health literacy(HHL) for exploring the HHL promotion mechanism in the country.Methods:Based on the proceduralised grounded theory, twelve middle or senior managers of hospitals were selected for in-depth interviews and three hospitals were selected for field research from July 2021 to February 2022. Open coding, axial coding, and selective coding were used in data analysis, establishing the concept of HHL and its conceptual framework in China.Results:The conceptual framework of HHL was composed of an internal driver mechanism(hospitals improve their health literacy promotion management system, staff-led health literacy promotion, health literacy promoting physical environment construction), and an external driver mechanism(cooperate with external organizations and institutions to conduct health literacy promotion). The concept of HHL in China was derived as follows: the combination of supportive environments and human resources that health care organizations have in place can improve access and understandability of health information and simplify healthcare services to help patients of different health literacy levels more easily obtain, process, and understand health information as well as to make the most of medical services.Conclusions:Hospital health literacy promotion mechanism in China is a synergy between internal and external driver mechanisms.

Exploration of IRES Elements within the ORF of the Coxsackievirus B3 Genome / 生物医学与环境科学（英文）

Objective@#This study aimed to identify internal ribosome entry sites (IRESs) in the open reading frame (ORF) of the Coxsackievirus B3 (CVB3) genome.@*Methods@#The sequences of P1, P2, or P3 of the CVB3 genome or the truncated sequences from each antithymocyte globulin (ATG) to the end of the P1, P2, or P3 gene were inserted into the pEGFP-N1 vector. After transfection, possible IRES-dependent green fluorescent protein (GFP)-fused proteins were detected by anti-GFP western blotting. The sequences of possible IRESs were inserted into specific Fluc/Rluc bicistronic vectors, in which the potential IRESs were determined according to the Fluc/Rluc activity ratio. Expression of Fluc and Rluc mRNA of the bicistronic vector was detected by RT-qPCR.@*Results@#After transfection of full length or truncated sequences of the P1, P2, or P3 plasmids, six GFP-fused protein bands in P1, six bands in P2 and nine bands in P3 were detected through western blotting. Two IRESs in VP2 (1461-1646 nt) and VP1 (2784-2983 nt) of P1; one IRES in 2C (4119-4564 nt) of P2; and two IRESs in 3C (5634-5834 nt) and 3D (6870-7087 nt) of P3 were identified according to Fluc/Rluc activity ratio. The cryptic promoter was also excluded by RT-qPCR.@*Conclusion@#Five IRESs are present in the CVB3 coding region.

Maximum dose of continuous infusion of mivacurium for thyroid surgery under total intravenous anesthesia: a sequential trial of monitoring neurological function in 30 patients / 南方医科大学学报

OBJECTIVE@#To investigate the maximum dose of continuous mivacurium infusion for intraoperative neuromonitoring (IONM) and observe the adverse reactions during thyroid surgery under total intravenous anesthesia (TIVA).@*METHODS@#Thirty patients undergoing IONM during thyroid surgery received continuous infusion of mivacurium at the initial rate of 14.97 μg · kg@*RESULTS@#The EC@*CONCLUSIONS@#In patients undergoing thyroid surgery under TIVA, the EC

Clinical research progress on Traditional Chinese Medicine treating diabetes mellitus with depression / 国际中医中药杂志

The ways of treating diabetes mellitus with depression by using Traditional Chinese Medicine (TCM) include internal treatment, external treatment and combining internal and externalmethod, mostly based on the viscera syndrome differentiation and Qi blood phlegm stasis syndrome differentiation, focusing on soothing the liver qi and regulating, liver and spleen. The internal treatments mainly include self-made prescriptions or classic prescriptions, such as Jiawei-Xiaoyao Powder, Danggui-Shaoyao Decoction, Wendan Decoction, etc; External treatments mainly include common acupuncture, ear acupuncture, scalp acupuncture, abdominal acupuncture, acupoint application, etc. The above treatments can improve the symptoms of depression, and control the blood glucose level.

Effects of urinary exosomal miR-150-5p on renal senescence in different age groups / 中华老年医学杂志

Objective:To investigate the expression of urinary exosomal miR-150-5p in different age groups and its relationship with kidney aging.Methods:Seventy-six subjects were recruited at the geriatrics department of Beijing Friendship Hospital from January 2014 to December 2016, with 15 in the young group, 35 in the middle-aged group, and 26 in the elderly group.We detected the expression of urinary exosomal miR-150-5p by real-time PCR from urine samples of different age groups and used Logistic regression analysis to evaluate the correlation of different levels of miR-150-5p with age, gender, history of hypertension, history of coronary heart disease, and hyperlipidemia.Additionally after overexpression and knockdown of miR-150-5p in human renal tubular cells of the HK2 cell line, we analyzed the expression levels of epithelial-to-mesenchymal transition(EMT)-related proteins by Western blotting.Results:Logistic regression analysis showed that age was closely related to estimated urinary exosomal miR-150-5p levels( P<0.05), and estimated urinary exosomal miR-150-5p levels in the elderly group(1.33±0.41)were significantly higher than those in the young group(0.88±0.40)( P<0.05). In addition, estimated urinary exosomal miR-150-5p levels became inversely proportional to the glomerular filtration rate as age increased. In vitro experiments showed that the expression levels of ZO-1 and E-cadherin in epithelial cells were slightly decreased after knockdown of miR-150-5p in renal tubular epithelial cells of the HK-2 cell line. Conclusions:The expression of miR-150-5p in urinary exosomes may be slightly increased in the elderly.It could inhibit the occurrence of renal EMT, and its expression is correlated with renal function.Mir-150-5p may also affect the expression of adhesion molecule-related proteins in HK-2 cells.MiR-150-5p in urinary exosomes is expected to become one of the genetic markers associated with renal aging.

Rhein inhibits hydrogen peroxide-induced apoptosis of human umbilical vein endothelial cells and its mechanism / 中国中药杂志

This study investigated the effect of rhein(RH) on the apoptosis and autophagy of human umbilical vein endothelial cells(HUVECs) induced by hydrogen peroxide(H_2O_2) and its underlying mechanism. The oxidative damage model in HUVECs was established and the cells were divided into different treatment groups. Cell survival rate was detected by MTT assay, apoptosis by Annexin V-FITC/PI double staining and Hoechst 33258 fluorescence staining, autophagy by Ad-mCherry-GFP-LC3 B adenovirus transfection, and protein expression by Western blot. The results showed that RH could protect cells by increasing the cell survival rate in a dose-dependent manner, decreasing the expression of apoptosis-related proteins(Bax and cleaved caspase-3) and the ratio of Bax/Bcl-2, elevating the expression of Bcl-2, up-regulating the expression of microtubule-associated protein 1 light chain 3(LC3)-Ⅱ, and down-regulating the expression of p62. Adenovirus transfection results showed that RH could increase the green and red spots, as well as the yellow spots. However, after the addition of autophagy inhibitor 3-MA, autophagy was reduced and apoptosis was increased. RH could enhance the expression of silent information regulator 2 related enzyme 1(SIRT1). The addition of SIRT1 inhibitor EX-527 reduced the protective effect of RH and cell viability. The addition of 3-MA had no effect on the expression of SIRT1 protein, but the expression of SIRT1 and LC3-Ⅱ proteins decreased and the expression of p62 increased after the addition of EX-527. After RH treatment, the phosphorylation of adenosine monophosphate-activated protein kinase(AMPK) increased, while that of the mechanistic target of rapamycin(mTOR) decreased in a dose-dependent manner. Moreover, this effect could be weakened by the AMPK inhibitor compound C. RH may enhance autophagy through SIRT1/AMPK/mTOR pathway to reduce H_2O_2-induced apoptosis of HUVECs.

Clinical characteristics of drug-induced autoimmune hepatitis / 中国实用内科杂志

OBJECTIVE: To investigate the clinical characteristics of drug-induced autoimmune hepatitis(DIAIH), in order to help clinicians learn more about DIAIH and improve its clinical diagnosis. METHODS: This was a retrospective study in the patients with DIAIH and DILI treated at Shengjing Hospital of China Medical University between January 2013 and December 2017. The population characteristic,related drugs,clinical manifestations,liver biochemical parameters, autoimmune antibodies, and liver pathological features were compared between the two groups. RESULTS: There were 49 patiens with DIAIH and 436 patiens with DILI. The majority of these patients were female. There was a significant difference in the proportion of female patients, with DIAIH(91.84%, 45/49)higher than DILI(70.41%, 307/436)(χ~2=9.111, P=0.003). The patients with DIAIH had a mean age of(50.0±7.4) years. The top three drugs inducing DIAIH were Chinese herbal medicines(53.06%, 26/49), non-steroidal anti-inflammatory drugs(10.20%, 5/49) and fluvastatin(10.20%, 5/49). DIAIH occurred after more than 8 weeks of treatment. There was a significant difference in the proportion of liver failure, with DIAIH(30.61%, 15/49) higher than DILI(14.68%, 64/436)(χ~2=8.20, P=0.004). The risks of DIAIH and DILI with liver failure caused by western medicines were significantly higher than those by Chinese herbal medicines(χ~2=9.77, P=0.002; χ~2=16.09,P<0.001). The positive rate of autoimmune antibody in DIAIH patients was 100%. The positive rate of ANA was 83.67%(41/49), and that of SMA was 16.33%(8/49). The liver pathological features of interface hepatitis, plasma cells and lymphocytes infiltration in DIAIH patients were more obvious than those in DILI patients. CONCLUSION: DIAIH is more common in the female patients and is caused frequently by Chinese herbal medicines. DIAIH caused by western medicines could easily result in liver failure.

Clinical characteristics and treatment of drug-induced autoimmune hepatitis / 中国实用内科杂志

Drug-induced autoimmune hepatitis(DIAIH) refers to liver injury mediated by the autoimmune system activated by drugs.The clinical reports of DIAIH have increased significantly in recent years. The clinical features of DIAIH are non-typical, the pathogenesis remains unclear,and there are no specific diagnostic criteria,which causes the difficulties in clinical diagnosis, and treatment and prognosis remain controversial. This paper will make a review about clinical features and treatment of DIAIH, in order to help clinicians learn more about DIAIH and improve the clinical diagnosis and treatment.

Effects of Electroacupuncture on Skeletal Muscle Atrophy-associated Protein in Hind Limbs of Traumatic Spinal Cord Injury Rats / 中国康复理论与实践

Objective:To explore the effects and mechanism of electroacupuncture (EA) on expression of myostatin (MSTN), muscle-specific ring finger protein 1 (MuRF1/Trim63), F-box only protein 32 (Atrogin-1/ Fbxo32), myogenic differentiation antigen (Myod) and myogenin (Myog) in traumatic spinal cord injury (TSCI) rats. Methods:A total of 45 adult female Sprague-Dawley rats were randomly divided into sham operation group (n = 12) and operation group (n = 33). The TSCI model was established with the modified Allen's method. After modeling, there were 24 survival rats and they were randomly divided into model group (n = 12) and EA group (n = 12). EA group was electroacupunctured at Dazhui (DU 14), Mingmen (DU 4) and bilateral Zusanli (ST 36) for 10 minutes, once a day, six times a week for 28 days. Basso-Beattie-Bresnahan (BBB) score was tested before modeling, and three days, seven days, 14 days, 21 days and 28 days after modeling. The rats were measured their body mass before and 28 days after modeling. The ratio of gastrocnemius wet mass was calculated; the cross-sectional area (CSA) and fiber diameter were measured by HE staining; the expression of MSTN, Trim63, Fbxo32, Myod and Myog mRNA were tested with real-time quantitative polymerase chain reaction (qPCR). Results:Three days, seven days, 14 days, 21 days, and 28 days after modeling, the score of BBB was lower in the model group than in the sham operation group (P < 0.01); seven days, 14 days, 21 days, and 28 days after modeling, the score of BBB was higher in EA group than in the model group (P < 0.01). Compared with the sham operation group, the mass of rats, the gastrocnemius wet mass, the CSA and the diameter of the muscle fiber were smaller in the model group (P < 0.05), while the expression of MSTN, Trim63, Fbxo32, Myod and Myog mRNA were higher (P < 0.05). Compared with the model group, the mass of rats, the gastrocnemius wet mass, the CSA, the expression of Myod and Myog mRNA were higher (P < 0.05) in EA group, while the expression of MSTN, Trim63 and Fbxo32 mRNA were lower (P < 0.05). Conclusion:EA might delay the gastrocnemius atrophy in TSCI rats by down-regulating the expression of MSTN, Trim63, Fbxo32 mRNA and up-regulating the expression of Myod and Myog mRNA via controlling the differentiation of the muscle satellite cells and the degradation of protein in skeletal muscle cells.

Comparison of differences in cardiac functions of cardiac arrest model rats induced by asphyxia and trans-oesophageal pacing / 中华危重病急救医学

Objective To compare the differences in cardiac functions and myocardial injury between asphyxia and trans-oesophageal pacing induced rat cardiac arrest models.Methods Healthy adult male Sprague-Dawley (SD) rats were randomly divided into sham group,asphyxia group and electrical stimulation group by random number table.The rats in the latter two groups were randomly divided into two subgroups (24 hours and 72 hours)according to the sampling time after successful resuscitation,with 6 rats in each group.All rats were mechanically ventilated for 20 minutes,in electrical stimulation group,cardiac arrest was induced by trans-oesophageal cardiac pacing for about 3 minutes (intensity 30 V,frequency 50 Hz,pulse duration 2 ms),and in asphyxia group,cardiac arrest was induced by clipping trachea for about 3 minutes.Cardiopulmonary resuscitation (CPR) was initiated 4 minutes after cardiac arrest.Echocardiographic examination was performed at 2 hours after return of spontaneous circulation (ROSC) with cardiac color ultrasound apparatus.Cardiac tissues were harvested at 24 hours and 72 hours after ROSC,hematoxylin-eosin (HE) staining was performed,and myocardial damage was observed under light microscope.The levels of cardiac troponin I (cTnI) and B-type natriuretic peptide (BNP) in serum were determined by enzyme-linked immunosorbent assay (ELISA).Results There was no significant difference in ROSC rate between the asphyxia group and electrical stimulation group [94.4％ (17/18) vs.88.9％ (16/18),P ＞ 0.05].The heart rate (HR),mean arterial pressure (MAP),left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) at 2 hours after ROSC in asphyxia group and electrical stimulation group were significantly lower than those in sham group [HR (bpm):401.50± 19.76,370.67± 18.63 vs.430.17± 18.38,MAP (mmHg,1 mmHg =0.133 kPa):107.17± 12.92,92.50±9.35 vs.125.67±5.72,LVEF:0.60±0.02,0.54±0.03 vs.0.63±0.01,LVFS:(48.40±2.52)％,(40.33±3.32)％ vs.(55.47 ± 2.38)％,all P ＜ 0.05],and the decrease in electrical stimulation group was more significant (all P ＜ 0.05).Compared with sham group,the levels of cTnI and BNP in serum of electrical stimulation group were significantly increased at 24 hours after ROSC [cTnI (ng/L):51.57±13.04 vs.38.23±5.57,BNP (ng/L):1 919.61±823.22 vs.977.47 ±445.18,both P ＜ 0.05],but there was no significant difference in cTnI or BNP of serum between asphyxia group and sham group [cTnI (ng/L):46.84 ± 11.04 vs.38.23 ± 5.57,BNP (ng/L):1 144.13±390.05 vs.977.47 ± 445.18,both P ＞ 0.05].There was no significant difference in cTnI or BNP of serum at 72 hours after ROSC among all the groups.The results of HE stain showed that the pathological injury of myocardium in electrical stimulation group was more serious than that in asphyxia group,characterized by more severe myocardial edema and partial myocardial cell lysis.Conclusion The cardiac function after cardiac arrest-CPR was decreased in both asphyxia group and electrical stimulation group,but electrical stimulation had a heavier cardiac function injury than asphyxia.

Effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia / 北京大学学报(医学版)

OBJECTIVE@#To compare the effects of thoracic epidural administration of lidocaine on hemodynamic and arousal responses of double lumen tracheal intubation during induction of anesthesia.@*METHODS@#In the study, 40 patients with American Society of Anesthesiologists (ASA) physical statuses I-II, aged 19-66 years, scheduled for elective thoracic surgeries under general anesthesia requiring orotracheal intubation were allocated to either the double-lumen endobronchial intubation (T group) or double-lumen endobronchial intubation after epidural administration of lidocaine (E group). After an intravenous anesthetic induction, the orotracheal double-lumen intubation was performed using a Macintosh direct laryngoscopy (MDLS), respectively. Invasive blood pressure (BP), heart rate (HR) and bispectral index (BIS) were recorded before and after anesthetic induction, immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time also noted. The rate pressure product (RPP) was calculated.@*RESULTS@#After anesthetic induction, BP and RPP in the two groups decreased significantly compared with their preinduction values. In comparison with their postinduction values, the orotracheal intubation in the two groups caused significant increases in BPs, HRs and RPP. In comparison with their preinduction values, BPs decreased significantly in E group, systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) increased significantly and lasted for 1 min in T group. The HRs of both groups after intubation were significantly higher than their baseline values , and increased in HR and lasted for 1 min and 4 min in E group and T group, respectively. SBP, DBP, MAP, HR and RPP after intubation in T group were significantly higher than those of E group during the observation period. The values of BIS were similar between both the groups. In T group, the incidences of SBP percent increased>30% of the baseline value and RPP more than 22 000 were significantly higher than in E group. None of the patients in group E had SBP more than 130% of the baseline value and RPP more than 22 000.@*CONCLUSION@#During double-lumen endobronchial intubation, epidural administration of lidocaine can provide less hemodynamic response and similar arousal response.

Coxsackievirus B3 Infection Triggers Autophagy through 3 Pathways of Endoplasmic Reticulum Stress / 生物医学与环境科学（英文）

OBJECTIVE@#Autophagy is a highly conserved intracellular degradation pathway. Many picornaviruses induce autophagy to benefit viral replication, but an understanding of how autophagy occurs remains incomplete. In this study, we explored whether coxsackievirus B3 (CVB3) infection induced autophagy through endoplasmic reticulum (ER) stress.@*METHODS@#In CVB3-infected HeLa cells, the specific molecules of ER stress and autophagy were detected using Western blotting, reverse transcription polymerase chain reaction (RT-PCR), and confocal microscopy. Then PKR-like ER protein kinase (PERK) inhibitor, inositol-requiring protein-1 (IRE1) inhibitor, or activating transcription factor-6 (ATF6) inhibitor worked on CVB3-infected cells, their effect on autophagy was assessed by Western blotting for detecting microtubule-associated protein light chain 3 (LC3).@*RESULTS@#CVB3 infection induced ER stress, and ER stress sensors PERK/eIF2α, IRE1/XBP1, and ATF6 were activated. CVB3 infection increased the accumulation of green fluorescent protein (GFP)-LC3 punctuation and induced the conversion from LC3-I to phosphatidylethanolamine-conjugated LC3-1 (LC3-II). CVB3 infection still decreased the expression of mammalian target of rapamycin (mTOR) and p-mTOR. Inhibition of PERK, IRE1, or ATF6 significantly decreased the ratio of LC3-II to LC3-I in CVB3-infected HeLa cells.@*CONCLUSION@#CVB3 infection induced autophagy through ER stress in HeLa cells, and PERK, IRE1, and ATF6a pathways participated in the regulation of autophagy. Our data suggested that ER stress may inhibit mTOR signaling pathway to induce autophagy during CVB3 infection.

Spectrum-activity relationship of extract from Ilex latifolia on inhibition of xanthine oxidase / 中草药

Objective To investigate the spectrum-activity relationship between HPLC fingerprint of Ilex latifolia from 10 batches in different regions and its inhibition of xanthine oxidase (XOD) efficacy and to reveal the material basis of I. latifolia. Methods The samples from 10 batch different regions were determined with the HPLC method. The similarity of the representative standard fingerprint was evaluated using the Similarity Evaluation System for Chromatographic Fingerprint of Traditional Chinese Medicine (Version 2004A). The common pattern was established for the principal component analysis (PCA). The HPLC method was used to establish the enzyme-substrate reaction system, and the inhibitory activity of XOD of 10 batches of I. latifolia produced in different areas was studied. The SPSS analysis correlation was used to conduct correlation analysis based on spectrum-activity relationship. The model of mouse hyperuricemia were induced by potassium oxonate, and the levels of UC and XOD in plasma and liver were detected. Results Fifteen common peaks in HPLC-fingerprint of I. latifolia were obtained. It was tentatively concluded that peak 11 (ilekudinoside E) and peak 14 (kudinoside F) had the moderate correlation with the inhibitory effect of XOD in the fifteen characteristic peaks. Peaks 5, 6 (kaempferol-3-O-β-D-rutinoside), 7 (isorhamnetin-3-O-β-D-rutinoside), 10 (latifoloside C), and 13(latifoloside D) had the strongest correlation. The quality of I. latifolia was influenced by the concentration of latifoloside H (peak 9) obtained by PCA. In the vivo experiment of hyperuricemia model mice, the levels of plasma UC and XOD of the mice in different doses of I. latifolia extracts groups were reduced, and the activities of XOD in livers tissue were also reduced. Conclusion Ten batches of samples from different habitats had potent inhibitory effects on XOD. There may be a certain relationship between seven compounds showed in HPLC fingerprint and its inhibitory effect on XOD.

Clinical Observation of Sanjiao Fuzheng Mixture Combined with Concurrent Chemoradiotherapy of Paclitaxel and Nedaplatin in the Treatment of Local Advanced Non-small Cell Lung Cancer / 中国药房

OBJECTIVE:To observe the efficacy and safety of Sanjiao fuzheng mixture combined with concurrent chemoradiotherapy of paclitaxel and nedaplatin in the treatment of local advanced non-small cell lung cancer (NSCLC). METHODS:A total of 68 patients with local advanced NSCLC selected from our hospital during Jan. 2015 to Jan. 2017 were divided into control group and observation group according to random number table,with 34 cases in each group. Control group was given Paclitaxel injection 135 mg/m2 intravenously,d1+Nedaplatin for injection 75 mg/m2 intravenously,d3,21 d as a treatment course,for 2 courses;routine fractionated intensity modulated radiation therapy,2 Gy each time,5 times a week,60-70 Gy in total;given 2 cycles of primary chemotherapy continuously after radiotherapy. Observation group was additionally given Sanjiao fuzheng mixture 250 mL/d,divided into 3 times,till the end of treatment,on the basis of control group. Clinical efficacies were observed in 2 groups. The levels of nutritional indexes (BMI,PAB,ALB,Hb) and tumor markers (SCC-Ag,CEA,TK1, CYFRA21-10) before and after treatment were observed. The occurrence of ADR were recorded. RESULTS:There was no statistical significance in the total effective rate between 2 groups (observation group 82.35％ vs. control group 73.53％)(P>0.05). After treatment,the levels of BMI,PAB,ALB and Hb in 2 groups were significantly lower than before treatment,but the observation group was significantly higher than the control group. The levels of SCC-Ag,CEA,TK1 and CYFRA21-1 in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statistical significance (P<0.05). The incidence of Ⅲ-Ⅳ degree aleucocytosis,Ⅰ-Ⅱ degree hemoglobin reduction and thrombocytopenia in observation group were significantly lower than control group, with statistical significance (P<0.05). CONCLUSIONS:The efficacy of Sanjiao fuzheng mixture combined with concurrent chemoradiotherapy of paclitaxel and nedaplatin is similar to that of concurrent chemoradiotherapy of paclitaxel and nedaplatin for localadvanced NSCLC,which can improve nutritional status significantly,and reduce the incidence of ADR.

Clinical Effect of Vaseline Lip Smear in Root Canal Therapy / 昆明医科大学学报

Objective To evaluate the effect of Vaseline lip smear in the treatment of patients with root canal treatment. Me thods We selected 60 patients who needed root canal treatment, and according to the randomized method, we randomly divided them into two groups: observation group and control group. The observation group used Vaseline lip smear, the control group was given Erythromycin Ointment coated lips. The clinical effect after root canal treatment were compared between two groups. Re s ults There was no cases of altercation ulcer or tear in the observation group after the root canal treatment, and 1 case of angular ulcer was found in the control group.Comparison between groups, the difference was not statistically significant, that of Vaseline and Erythromycin Ointment in preventing mouth ulcer or tear, no statistically significant differences between groups P＞0.05. In the taste evaluation, there were 26 cases feeling good taste in the observation group, accounting for 86.67％, and 12 cases feeling good taste in the control group, accounting for 40％. There was statistically significant difference between two groups (P ＜0.05). Conclus ion After the root canal treatment, the use of Vaseline can prevent chapped lips, ulcers, the effect is equivalent to Erythromycin Ointment, but in terms of taste, the patient more likely prefer Vaseline for lip moisturizer.

Effect of goal-directed fluid therapy guided by different goals on endothelial glycocalyx in patients undergoing high-risk abdominal surgery: a prospective randomized controlled clinical study / 中华麻醉学杂志

Objective To evaluate the effect of goal-directed fluid therapy (GDFT) guided by different goals on endothelial glycocalyx,inflammatory cytokines and postoperative complications in patients undergoing high-risk abdominal surgery.Methods Eighty patients of both sexes,aged 18-64 yr,with body mass index of 18-30 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,scheduled for elective retroperitoneal tumor resection,were divided into 2 groups (n =40 each) by a random number table method:stroke volume variation (SVV) 9％-14％ group (L group,n=40) and SVV＜9％ group (H group,n =40).SVV 9％-14％ and SVV＜9％ were used as the target and GDFT was performed though combing with cardiac index and mean arterial pressure.The concentrations of syndecan 1,hyaluronic acid,heparan sulfate,tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) in serum were determined at 5 min before skin incision (T0),1 h after skin incision (T1),4 h after skin incision (T2) and 24 and 72 h after operation (T3,4).The intraoperative urine volume,blood loss,volume of liquid infused,volume of blood infused,amount of norepinephrine consumed,operation time,extubation time and length of postoperative hospital stay were recorded.Results Compared with the baseline value at T0,the concentrations of syndecan 1,hyaluronic acid,heparan sulfate,TNF-α and IL-6 in serum were significantly increased at T1-4 in H group,and the concentrations of syndecan 1,heparan sulfate,TNF-α and IL-6 in serum at T1-4 and concentrations of hyaluronic acid at T1-3 were significantly increased in L group (P＜0.05).Compared with H group,the volume of liquid infused was significantly reduced,the amount of norepinephrine consumed was increased,the concentrations of syndecan 1,IL-6 and TNF-α in serum were decreased at T1-4,the concentrations of hyaluronic acid were decreased at T2,3,and the concentrations of heparan sulfate were decreased at T1-3 in group L (P＜0.05).Conclusion Compared with GDFT with the target of SVV＜9％,GDFT with the target of SVV 9％-14％ is more helpful in decreasing degradation of endothelial glycocalyx during the perioperative period and in reducing damage to endothelial barrier,and the mechanism may be related to inhibiting inflammatory responses of patients undergoing high-risk abdominal surgery.