Application of different prognostic scores in liver transplantation decision-making for acute-on-chronic liver failure / 中华肝脏病杂志

Objective: To compare the impact of different prognostic scores in patients with acute-on-chronic liver failure (ACLF) in order to provide treatment guidance for liver transplantation. Methods: The information on inpatients with ACLF admitted at Beijing You'an Hospital Affiliated to Capital Medical University and the First Affiliated Hospital of Zhejiang University School of Medicine from January 2015 to October 2022 was collected retrospectively. ACLF patients were divided into liver transplantation and non-liver transplantation groups, and the two groups prognostic conditions were followed-up. Propensity score matching was carried out between the two groups on the basis of liver disease (non-cirrhosis, compensated cirrhosis, and decompensated cirrhosis), the model for end-stage liver disease incorporating serum sodium (MELD-Na), and ACLF classification as matching factors. The prognostic condition of the two groups after matching was compared. The difference in 1-year survival rate between the two groups was analyzed under different ACLF grades and MELD-Na scores. The independent sample t-test or rank sum test was used for inter-group comparison, and the χ (2) test was used for the comparison of count data between groups. Results: In total, 865 ACLF inpatients were collected over the study period. Of these, 291 had liver transplantation and 574 did not. The overall survival rates at 28, 90, and 360 days were 78%, 66%, and 62%, respectively. There were 270 cases of matched ACLF post-liver transplantation and 270 cases without ACLF, in accordance with a ratio of 1:1. At 28, 90, and 360 days, patients with non-liver transplantation had significantly lower survival rates (68%, 53%, and 49%) than patients with liver transplantation (87%, 87%, and 78%, respectively; P < 0.001). Patients were classified into four groups according to the ACLF classification criteria. Kaplan-Meier survival analysis showed that the survival rates of liver transplantation and non-liver transplantation patients in ACLF grade 0 were 77.2% and 69.4%, respectively, with no statistically significant difference (P = 0.168). The survival rate with an ACLF 1-3 grade was significantly higher in liver transplantation patients than that of non-liver transplantation patients (P < 0.05). Patients with ACLF grades 1, 2, and 3 had higher 1-year survival rates compared to non-liver transplant patients by 50.6%, 43.6%, and 61.7%, respectively. Patients were divided into four groups according to the MELD-Na score. Among the patients with a MELD-Na score of < 25, the 1-year survival rates for liver transplantation and non-liver transplantation were 78.2% and 74.0%, respectively, and the difference was not statistically significant (P = 0.149). However, among patients with MELD-Na scores of 25-30, 30-35, and≥35, the survival rate was significantly higher in liver transplantation than that of non-liver transplantation, and the 1-year survival rate increased by 36.4%, 54.9%, and 62.5%, respectively (P < 0.001). Further analysis of the prognosis of patients with different ACLF grades and MELD-Na scores showed that ACLF grades 0 or 1 and MELD-Na score of < 30 had no statistically significant difference in the 1-year survival rate between liver transplantation and non-liver transplantation (P > 0.05), but in patients with MELD-Na score≥30, the 1-year survival rate of liver transplantation was higher than that of non-liver transplantation patients (P < 0.05). In the ACLF grade 0 and MELD-Na score of≥30 group, the 1-year survival rates of liver transplantation and non-liver transplantation patients were 77.8% and 25.0% respectively (P < 0.05); while in the ACLF grade 1 and MELD-Na score of≥30 group, the 1-year survival rates of liver transplantation and non-liver transplantation patients were 100% and 20.0%, respectively (P < 0.01). Among patients with ACLF grade 2, the 1-year survival rate with MELD-Na score of < 25 in patients with liver transplantation was 73.9% and 61.6%, respectively, and the difference was not statistically significant (P > 0.05); while in the liver transplantation patients group with MELD-Na score of ≥25, the 1-year survival rate was 79.5%, 80.8%, and 75%, respectively, which was significantly higher than that of non-liver transplantation patients (36.6%, 27.6%, 15.0%) (P < 0.001). Among patients with ACLF grade 3, regardless of the MELD-Na score, the 1-year survival rate was significantly higher in liver transplantation patients than that of non-liver transplantation patients (P < 0.01). Additionally, among patients with non-liver transplantation with an ACLF grade 0~1 and a MELD-Na score of < 30 at admission, 99.4% survived 1 year and still had an ACLF grade 0-1 at discharge, while 70% of deaths progressed to ACLF grade 2-3. Conclusion: Both the MELD-Na score and the EASL-CLIF C ACLF classification are capable of guiding liver transplantation; however, no single model possesses a consistent and precise prediction ability. Therefore, the combined application of the two models is necessary for comprehensive and dynamic evaluation, but the clinical application is relatively complex. A simplified prognostic model and a risk assessment model will be required in the future to improve patient prognosis as well as the effectiveness and efficiency of liver transplantation.

Application of mixture analysis methods in association between metals mixture exposure and DNA oxidative damage / 中华预防医学杂志

Objectives: To study the association between metals mixture exposure and DNA oxidative damage using mixture analysis methods, and to explore the most significant exposure factors that cause DNA oxidative damage. Methods: Workers from steel enterprises were recruited in Shandong Province. Urinary metals were measured by using the inductively coupled plasma mass spectrometry method. The level of urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) was determined by using the ultra-high performance liquid chromatography-mass spectrometry method. Bayesian kernel machine regression (BKMR), elastic net regression and quantile g-computation regression were used to analyze the association between urinary metals and urinary 8-OHdG. Results: A total of 768 subjects aged (36.15±7.40) years old were included in the study. BKMR, elastic net regression and quantile g-computation all revealed an overall positive association between the mixture concentration and increased urinary 8-OHdG. The quantile g-computation results showed that with a 25% increase in metal mixtures, the urinary 8-OHdG level increased by 77.60%. The elastic net regression showed that with a 25% increase in exposure risk score, the urinary 8-OHdG level increased by 26%. The BKMR summarized the contribution of individual exposures to the response, and selenium, zinc, and nickel were significant contributors to the urinary 8-OHdG elevation. Conclusion: Exposure to mixed metals causes elevated levels of DNA oxidative damage, and selenium, zinc, and nickel are significant exposure factors.

Evaluation of Renal Impairment in Patients with Diabetic Kidney Disease by Integrated Chinese and Western Medicine / 中国结合医学杂志

OBJECTIVE@#To investigate the factors related to renal impairment in patients with diabetic kidney disease (DKD) from the perspective of integrated Chinese and Western medicine.@*METHODS@#Totally 492 patients with DKD in 8 Chinese hospitals from October 2017 to July 2019 were included. According to Kidney Disease Improving Global Outcomes (KDIGO) staging guidelines, patients were divided into a chronic kidney disease (CKD) 1-3 group and a CKD 4-5 group. Clinical data were collected, and logistic regression was used to analyze the factors related to different CKD stages in DKD patients.@*RESULTS@#Demographically, male was a factor related to increased CKD staging in patients with DKD (OR=3.100, P=0.002). In clinical characteristics, course of diabetes >60 months (OR=3.562, P=0.010), anemia (OR=4.176, P<0.001), hyperuricemia (OR=3.352, P<0.001), massive albuminuria (OR=4.058, P=0.002), atherosclerosis (OR=2.153, P=0.007) and blood deficiency syndrome (OR=1.945, P=0.020) were factors related to increased CKD staging in patients with DKD.@*CONCLUSIONS@#Male, course of diabetes >60 months, anemia, hyperuricemia, massive proteinuria, atherosclerosis, and blood deficiency syndrome might indicate more severe degree of renal function damage in patients with DKD. (Registration No. NCT03865914).

Impacts of aerobic exercise on cardiovascular health in college students / Impactos do exercício aeróbico na saúde cardiovascular dos estudantes universitários / Impacto del ejercicio aeróbico en la salud cardiovascular de los estudiantes universitarios

ABSTRACT Introduction Cardiovascular disease (CVD) is a major disease that seriously endangers human health. CVD in many adults begins in adolescence and even in childhood. The cardiovascular health of college students in China cannot be ignored. Objective Verify the impacts of aerobic exercise (APA) on the cardiovascular health of college students. Methods The paper uses the literature method to explore the health-promoting role of aerobic exercise in opposing and improving CVD. Also the APA exercise method of effectively improving cardiopulmonary fitness (CRF) to prevent and improve CVD. The results showed that APA can improve microcirculation by increasing microvascular reactivity. Results Coronary blood flow in healthy adults is only 8% to 9% of cardiac bleeding, while coronary blood flow increases by 40% and oxygen intake by 2-2.5 times. Aerobic exercise can improve insulin sensitivity and reduce the risk of CVD. Some risk factors related to vascular endothelial dysfunction, such as hypertension, atherosclerosis, and coronary artery disease, are often accompanied by the phenomenon of insulin resistance in the induction of CVD. At the same time, improving IR may play an effective role in preventing and treating CVD. Conclusion APA can reduce and suppress the occurrence and development of CVD risk factors such as atherosclerosis, hypertension, hyperlipidemia, hyperglycemia and obesity, intestinal microecological disorder, and reduce free radical oxidative damage and apoptosis by improving insulin sensitivity of vascular endothelial cells, inhibiting inflammatory reaction, improving mitochondrial function of cardiomyocytes, reducing body mass index and obesity, and maintaining gut micro-ecological balance, and improving vascular endothelial function and reducing CVD such as myocardial infarction. Level of evidence II; Therapeutic studies - investigating treatment outcomes.

RESUMO Introdução A doença cardiovascular (DCV) é uma das principais doenças que colocam seriamente em risco a saúde humana. A DCV em muitos adultos começa na adolescência e até mesmo na infância. A saúde cardiovascular dos estudantes universitários na China não pode ser ignorada. Objetivo Verificar os impactos do exercício aeróbico (APA) sobre a saúde cardiovascular dos estudantes universitários. Métodos O artigo usa o método bibliográfico para explorar o papel de promoção da saúde do exercício aeróbico em oposição e melhoria da DCV. Também o método de exercício APA de melhorar efetivamente a aptidão cardiopulmonar (CRF) para prevenir e melhorar a DCV. Os resultados mostraram que a APA pode melhorar a microcirculação ao aumentar a reatividade microvascular. Resultados O fluxo de sangue coronariano em adultos saudáveis é apenas 8% a 9% do sangramento cardíaco, enquanto o fluxo de sangue coronariano aumenta em 40% e a ingestão de oxigênio em 2-2,5 vezes. O exercício aeróbico pode melhorar a sensibilidade insulínica e reduzir o risco de DCV. Alguns fatores de risco relacionados à disfunção endotelial vascular, tais como hipertensão, aterosclerose e doença arterial coronária, são frequentemente acompanhados pelo fenômeno de resistência à insulina na indução da DCV, enquanto a melhora da IR pode desempenhar um papel eficaz na prevenção e tratamento da DCV. Conclusão A APA pode reduzir e suprimir a ocorrência e o desenvolvimento de fatores de risco de DCV, tais como aterosclerose, hipertensão, hiperlipidemia, hiperglicemia e obesidade, distúrbio microecológico intestinal, além de reduzir os danos oxidativos radicais livres e a apoptose, melhorando a sensibilidade insulínica das células endoteliais vasculares, inibindo a reação inflamatória, melhorando a função mitocondrial dos cardiomiócitos, reduzindo o índice de massa corporal e a obesidade e mantendo o equilíbrio microecológico intestinal e melhorando a função endotelial vascular e reduzindo a DCV, como o infarto do miocárdio. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción Las enfermedades cardiovasculares (ECV) son una de las principales enfermedades que ponen en grave peligro la salud humana. En muchos adultos, la ECV comienza en la adolescencia e incluso en la infancia. No se puede ignorar la salud cardiovascular de los estudiantes universitarios en China. Objetivo Verificar los impactos del ejercicio aeróbico (EAA) en la salud cardiovascular de los estudiantes universitarios. Métodos El artículo utiliza el método de la literatura para explorar el papel promotor de la salud del ejercicio aeróbico en la oposición y la mejora de la ECV. También el método de ejercicio APA para mejorar eficazmente la aptitud cardiopulmonar (CRF) para prevenir y mejorar la ECV. Los resultados mostraron que el APA puede mejorar la microcirculación al aumentar la reactividad microvascular. Resultados El flujo sanguíneo coronario en adultos sanos es sólo del 8% al 9% de la hemorragia cardiaca, mientras que el flujo sanguíneo coronario aumenta un 40% y el aporte de oxígeno entre 2 y 2,5 veces. El ejercicio aeróbico puede mejorar la sensibilidad a la insulina y reducir el riesgo de ECV. Algunos factores de riesgo relacionados con la disfunción endotelial vascular, como la hipertensión, la aterosclerosis y la enfermedad coronaria, suelen ir acompañados del fenómeno de la resistencia a la insulina en la inducción de la ECV, mientras que la mejora de la RI puede desempeñar un papel eficaz en la prevención y el tratamiento de la ECV. Conclusión El APA puede reducir y suprimir la aparición y el desarrollo de factores de riesgo de ECV como la aterosclerosis, la hipertensión, la hiperlipidemia, la hiperglucemia y la obesidad, el trastorno microecológico intestinal, y reducir el daño oxidativo de los radicales libres y la apoptosis mejorando la sensibilidad a la insulina de las células endoteliales vasculares, inhibir la reacción inflamatoria, mejorar la función mitocondrial de los cardiomiocitos, reducir el índice de masa corporal y la obesidad y mantener el equilibrio microecológico intestinal, así como mejorar la función endotelial vascular y reducir las ECV, como el infarto de miocardio. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Qualitative research on the adherence of mindfulness practice in psychological counseling outpatients / 上海预防医学

ObjectiveTo explore the barriers and facilitators of the adherence of formal practice after mindfulness-based cognitive therapy （MBCT） in psychological counseling outpatients. MethodsOne-on-one interview was conducted in 15 psychological counseling outpatients who attended MBCT at Shanghai Mental Health Center and had been out of treatment 5 months or more. Data was analyzed using thematic analysis. ResultsPoor mood， weak willpower， limited time and space， lack of companionship and supervision， and discomfort with the recording were the five factors that prevented the patients from sticking to their practice. Personality trait， trust， benefit， need for self-care， time/space arrangement， fellow practitioners， therapists， and ease and convenience of practice were the eight factors that promoted the patients to practice. ConclusionThe COM-B model helps therapists and individuals with practice needs to understand the mechanism of formal practice facilitators at a holistic level. Therapists and individuals with practice needs should be concerned about possible barriers on the adherence of formal practice.

Survey of possible aerosol transmission of a COVID-19 epidemic caused by 2019-nCoV Delta variant / 中华流行病学杂志

Objective: To investigate the epidemiological characteristics and the transmission chain of a family clustering of COVID-19 cases caused by severe acute respiratory 2019-nCoV Delta variant in Changping district of Beijing. Methods: Epidemiological investigation was conducted and big data were used to reveal the exposure history of the cases. Close contacts were screened according to the investigation results, and human and environmental samples were collected for nucleic acid tests. Positive samples were analyzed by gene sequencing. Results: On November 1, 2021, a total of 5 COVID-19 cases caused by 2019-nCoV Delta variant were reported in a family detected through active screening. The infection source was a person in the same designated isolation hotel where the first case of the family cluster was isolated from 22 to 27, October. The first case was possibly infected through aerosol particles in the ventilation duct system of the isolation hotel. After the isolation discharge on October 27, and the first case caused secondary infections of four family members while living together from October 27 to November 1, 2021. Conclusion: 2019-nCoV Delta variant is prone to cause family cluster, and close attention needs to be paid to virus transmission through ventilation duct system in isolation hotels.

Body image flexibility: measurement, correlated factors and intervention / 中华行为医学与脑科学杂志

Body image flexibility (BIF) is the specific type of psychological flexibility in the research field of body image, which reflects the ability to experience negative body image and related events in an open and acceptive way, and take actions consistent with one's values. Body image is actually not stable. If negative body image could not be adjusted effectively in time, it would develop into body image disturbance (BID), which is one of the core symptoms and psychopathological mechanisms of eating disorder (ED) and body dysmorphic disorder (BDD). BIF is one of the important factors in this development path, gaining more and more attention as a protective factor for body image. So far, most studies focus on eating disorder patients and related sub-clinical populations. Body image-acceptance and action questionnaire is the most widely used measurement. BIF is related to some sample characteristics, such as gender, age and body size.Cultural context also has an impact on it.Positive and negative body image and eating disorder pathological characteristics are also strongly associated with BIF. As to the intervention, the application of mindfulness, acceptance and compassion in treatment may improve BIF. Future studies need to improve the research methods and designs, and pay attention to other samples. More specific interventions need to be developed, of which the therapeutic mechanisms also need to be explored.

Application of tutorial and seminar teaching model combination in standardized residency training in neurology department / 中华医学教育探索杂志

In this study, 155 residents who participated in the standardized residency training in neurology department of Second Affiliated Hospital of Army Medical University from 2016 to 2018 were included, all of whom were medical university graduates. The training duration in neurology department was 3 months. Each physician was assigned the first mock exam to each of his tutors and took the one to one mode to carry out clinical practice teaching. First, theoretical teaching, then clinical observation, and finally clinical practice. In addition, a typical case seminar was held every two weeks. After the combined teaching, the average scores of theoretical examination were (96.78 ± 10.14) points, and the average scores of operation examination was also significantly increased (98.36 ± 11.38) points. The percentage of excellent people assessed by Mini-CEX scale was as high as 88%. The teaching approach of tutorial and seminar teaching model not only consolidates medical theory knowledge, improves clinical skills, but also enhances the ability of analyzing and solving problems and contributes to establishment of rigorous clinical thinking, which lays a solid foundation for training excellent neurology clinical specialists.

The study on application time of continuous renal replacement therapy in children with acute kidney injury / 中国小儿急救医学

Objective:To investigate the effect of the timing of continuous renal replacement therapy (CRRT) administration on the prognosis of acute kidney injury (AKI) in children.Methods:The medical records of children with AKI who were admitted to the Intensive Care Unit of Hunan Children′s Hospital from March 2015 to February 2020 and underwent CRRT were prospectively analyzed.The children who met the criteria were divided into early group (defined as AKI 1 and 2) and delayed group (defined as AKI 3) according to AKI stage.The general conditions, indicators when CRRT was initiated, and prognosis of the children in two groups were recorded.Results:(1) A total of 39 children were included in the study, including 23 in the early group and 16 in the delayed group.There were no significant differences in age, gender, body weight and proportion of mechanical ventilation between two groups ( P>0.05). The score of critical cases in the early group was higher than that in the delayed group ( P=0.008). (2) There were no significant differences in serum potassium and bicarbonate when CRRT was initiated between two groups ( P>0.05). The urine output in the early group was higher than that in the delayed group ( P>0.001). The serum creatinine and urea nitrogen in the early group were lower than those in the delayed group ( P>0.05). (3) The 28-day survival rate and proportion of renal function recovery at 28 days in the early group were significantly higher than those in the delayed group ( P>0.05). The duration of CRRT, ICU stay and duration of mechanical ventilation in the early group were shorter than those in the delayed group ( P>0.05). Conclusion:Early initiation of CRRT at AKI stage 1 and 2 can improve the 28-day survival rate and renal function recovery of survivors when critically ill children are complicated with AKI.

Early application of non-invasive high frequency oscillatory ventilation in very low birth weight infants with respiratory distress syndrome / 中华实用儿科临床杂志

Objective:To observe the clinical efficacy and safety of non-invasive high frequency oscillatory ventilation(NHFOV) on the early respiratory support in very low birth weight infants with respiratory distress syndrome(RDS).Methods:It was a prospective cohort study involving very low birth weight infants with RDS admitted to the Central Hospital of Chongqing Three Gorges from January 2017 to January 2020 with a gestational age of 28-32 weeks.According to the applied non-invasive respiratory support, very low birth weight infants with NRDS were divided into control group[continuous positive airway pressure (CPAP) group]and observation group(NHFOV group). Therapeutic effect, complications and adverse effects between 2 groups were compared.Results:A total of 78 very low birth weight infants with RDS were included, among which 38 cases were supported with NHFOV group and 40 cases were CPAP group.(1) Therapeutic efficacy: there were no significant differences in the use of pulmonary surfactant and death rate between 2 groups (all P>0.05). Compared with the CPAP group, patients in the NHFOV group had significantly lower incidence of non-invasive ventilation failure(4 cases vs.13 cases), duration of non-invasive ventilation [(7.60±1.68) days vs. (10.75±2.38) days], duration of oxygen exposure [(12.34±2.66) days vs.(17.20±4.36) days] and times of apnea [(1.68±1.57) times/day vs.(4.80±2.60) times/day] (all P<0.05). There was no significant difference in the incidence of complications between 2 groups (all P>0.05). (2) Adverse events: compared with CPAP group, patients in the NHFOV group had significantly lower incidence of abdominal distension [13 cases(34.2%) vs. 25 cases (62.5%)], delayed duration of respiratory secretion disappearance [(12.65±2.33) days vs.(7.87±2.70) days], low viscosity of secretions [thin sputum, 31 cases (81.6%) vs.22 cases (55.0%); ropy sputum, 7 cases (18.4%) vs.18 cases(45.0%)], and less airway obstruction [2 cases (5.2%) vs.15 cases (37.5%)] (all P<0.05). No significant difference in the incidence of nasal septum injury was detected between 2 groups (1 case vs.0) ( P>0.05). Conclusions:NHFOV is safe and effective in the early application of NRDS in very low birth weight infants with RDS, which has less adverse events.It is expected to be used in the treatment of children with frequent apnea and a large number of respiratory secretions that is prone to obstruction.

Application of heparin-binding protein in severe adenovirus pneumonia / 中华实用儿科临床杂志

Objective:To explore the application value of heparin-binding protein (HBP) in the early diagnosis and assessment of severe adenovirus pneumonia.Methods:A total of 90 children diagnosed with adenovirus pneumonia admitted in the Department 1 of Emergency and Pediatric Intensive Care Unit 1 in Hunan Children′s Hospital from January 2019 to March 2020 were recruited.HBP levels in children with adenovirus pneumonia were detected.The correlation between HBP with white blood cell count (WBC), neutrophil ratio (N), C-reactive protein (CRP), interleukin-6(IL-6) and erythrocyte sedimentation rate (ESR) were examined.Receiver operating characteristic(ROC) curve analysis was conducted to explore the value of HBP in the early diagnosis and assessment of severe adenovirus pneumonia.Children with adenovirus pneumonia were divided into severe adenovirus pneumonia group (severe group) and non-severe adenovirus pneumonia group (non-severe group) according to their severity.Those in the severe group were further divided into bronchiolitis obliterans(BO) group and non-BO group according to the occurrence of BO.Results:(1) The HBP level in children with adenovirus pneumonia was (49.47±34.19) μg/L, which was significantly higher in the severe group than that of non-severe group[(82.88±44.02) μg/L vs.(35.15±13.08) μg/L, t=15.349, P<0.05]. Children in the severe group were significantly younger, and they had a significantly longer length of stay, lower Pediatric Critical Illness Scores (PCIS), and higher inflammatory markers like HBP, WBC, N, CRP, IL-6, and ESR compared with those of the non-severe group (all P<0.05). No significant difference in the procalcitonin (PCT) level was detected between groups.(2) The HBP was positively correlated with inflammatory markers like WBC ( r=0.38, P<0.05), N ( r=0.26, P<0.05), CRP ( r=0.47, P<0.05), IL-6 ( r=0.76, P<0.05), and ESR ( r=0.35, P<0.05). However, HBP did not have a significant correlation with PCT ( r=0.097, P>0.05). (3) In the severe group, the HBP level of the children with invasive mechanical ventilation, oxygenation index(P/F index)≤ 200 mmHg (1 mmHg=0.133 kPa) and BO was significantly higher than that of the non-invasive mechanical ventilation, P/F index> 200 mmHg and non-BO (all P<0.05). (4) The area under the ROC curve of HBP, WBC, N, CRP, ESR and IL-6 in predicting the severity of adenovirus pneumonia were 0.915, 0.748, 0.770, 0.740, 0.820 and 0.798, respectively.When the cut-off value of HBP was 45 μg/L, the sensitivity and specificity of HBP were 81.48% and 85.71%, respectively. Conclusions:As an inflammatory mediator, HBP is involved in the inflammatory response of the body.It may be a useful new marker for the early diagnosis of severe adenovirus infection, which also has a certain value in the evaluation of the severity and prognosis of the disease.The findings provide a basis for early clinical intervention and treatment of adenovirus infection in children.

Comparative study of dexmedetomidine and midazolam for noninvasive continuous positive airway pressure in children with acute respiratory failure / 国际儿科学杂志

Objective:To investigate the efficacy and safety of dexmedetomidine in noninvasive continuous positive airway pressure(NCPAP)for acute respiratory failure in children.Methods:Clinical data of children with acute respiratory failure who underwent NCPAP from January 2018 to March 2020 in PICU of Hunan Children′s Hospital were prospectively collected.They were randomly divided into dexmedetomidine group(group D)and midazolam group(group M), with a total of 100 children.We compared the sedation depth of the two groups at 7 time points after sedation at 0.5 h(t1), 1 h(t2), 2 h(t3), 6 h(t4), 12 h(t5), 24 h(t6), and 48 h(t7), time to reach proper sedation, NCPAP time, NCPAP failure rate, oxygenation index(P/F value)before sedation(T0)and 1h(T1), 24h(T2), and 48h(T3)after sedation, and the main vital signs and adverse reactions before sedation(T0)and 1h(T1), 24h(T2), 48h(T3)after sedation.Results:(1)The proportion of proper sedation at T4, T5, T6 and T7 after sedation in group D was higher than that in group M[98%(49/50)vs.84%(42/50), 94%(47/50)vs.90%(45/50), 96%(48/50)vs.88%(44/50), 90%(45/50)vs.88%(44/50), χ2=6.538, 8.043, 8.174, 7.678, all P<0.05]. Time to reach proper sedation in group D was shorter[(58.6±7.9)s vs.(66.7±9.3)s, t=4.682, P<0.01]. (2)The treatment time and failure rate of NCPAP in group D were lower than those in group M[(134.9±25.5)h vs.(147.8±24.3)h, 10%(5/50)vs.28%(14/50), all P<0.05]. P/F after NCPAP treatment in the two groups was improved as compared with that before treatment(all P<0.01), and the improvement was more significant in group D than in group M at T2 and T3 after sedation[(199.3±26.1)vs.(188.5±24.2)mmHg, (212.2±25.4)mmHg vs.(200.8±24.8)mmHg, t=2.132, 2.278, all P<0.05]. (3)There were no significant differences in heart rate(HR), mean arterial pressure(MAP), and respiratory rate(RR)before sedation between the two groups(all P>0.05). HR and RR after sedation in both groups decreased as compared with those before sedation( P<0.01). HR at T1, T2, and T3 after sedation in group D decreased more significantly than that in group M[(116.3±17.6)bpm vs.(124.8±14.1)bpm, (110.2±18.4)bpm vs.(121.9±15.2)bpm, (108.5±18.7)bpm vs.(117.6±12.8)bpm, t=0.479, -3.474, -2.840, all P<0.05]. There was no significant difference in RR after sedation between the two groups( t=1.872, 1.632, 1.675, all P>0.05). MAP at T1 in group D decreased as compared with T0( P<0.01). MAP at T1 in group D was lower than that in group M[(65.5±5.1)mmHg vs.(68.0±5.7)mmHg, t=-2.297, P=0.024]. (4)There was no significant difference in the incidence of total adverse reactions between the two groups[20%(10/50)vs.14%(7/50), P=0.595]. The incidence of bradycardia was higher in group D than in group M[16%(8/50)vs.2%(1/50), P=0.031]. Conclusion:The incidence of adverse reactions of dexmedetomidine and midazolam in the sedation of NCPAP in children with acute respiratory failure is similar, but the sedative effect of dexmedetomidine is better than that of midazolam in the improvement of pulmonary oxygenation.

Effects of viral infection and microbial diversity on patients with sepsis: A retrospective study based on metagenomic next-generation sequencing / 世界急诊医学杂志（英文）

@#BACKGROUND: The study aims to investigate the performance of a metagenomic next-generation sequencing (NGS)-based diagnostic technique for the identification of potential bacterial and viral infections and effects of concomitant viral infection on the survival rate of intensive care unit (ICU) sepsis patients. METHODS: A total of 74 ICU patients with sepsis who were admitted to our institution from February 1, 2018 to June 30, 2019 were enrolled. Separate blood samples were collected from patients for blood cultures and metagenomic NGS when the patients’ body temperature was higher than 38 °C. Patients’ demographic data, including gender, age, ICU duration, ICU scores, and laboratory results, were recorded. The correlations between pathogen types and sepsis severity and survival rate were evaluated. RESULTS: NGS produced higher positive results (105 of 118; 88.98%) than blood cultures (18 of 118; 15.25%) over the whole study period. Concomitant viral infection correlated closely with sepsis severity and had the negative effect on the survival of patients with sepsis. However, correlation analysis indicated that the bacterial variety did not correlate with the severity of sepsis. CONCLUSIONS: Concurrent viral load correlates closely with the severity of sepsis and the survival rate of the ICU sepsis patients. This suggests that prophylactic administration of antiviral drugs combined with antibiotics may be beneficial to ICU sepsis patients.

Application of double plasma molecular adsorption system in children with acute liver failure / 中国当代儿科杂志

OBJECTIVE@#To study the efficacy and safety of double plasma molecular absorption system (DPMAS) in the treatment of pediatric acute liver failure (PALF).@*METHODS@#A prospective analysis was performed on the medical data of children with PALF who were hospitalized in the Intensive Care Unit (ICU), Hunan Children's Hospital, from March 2018 to June 2020. The children were randomly divided into two groups:plasma exchange group (PE group) and DPMAS group (@*RESULTS@#Compared with the PE group, the DPMAS group had a significantly lower number of times of artificial liver support therapy and a significantly shorter duration of ICU stay (@*CONCLUSIONS@#DPMAS is safe and effective in the treatment of PALF and can thus be used as an alternative to artificial liver support therapy.

Efficacy and safety of Shenyankangfu Tablet, a Chinese patent medicine, for primary glomerulonephritis: A multicenter randomized controlled trial / 中西医结合学报

BACKGROUND@#Shenyankangfu Tablet (SYKFT) is a Chinese patent medicine that has been used widely to decrease proteinuria and the progression of chronic kidney disease.@*OBJECTIVE@#This trial compared the efficacy and safety of SYKFT, for the control of proteinuria in primary glomerulonephritis patients, against the standard drug, losartan potassium.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#This was a multicenter, double-blind, randomized, controlled clinical trial. Primary glomerulonephritis patients, aged 18-70 years, with blood pressure ≤ 140/90 mmHg, estimated glomerular filtration rate (eGFR) ≥ 45 mL/min per 1.73 m@*MAIN OUTCOME MEASURES@#The primary outcome was change in the 24-hour proteinuria level, after 48 weeks of treatment.@*RESULTS@#A total of 735 participants were enrolled. The percent decline of urine protein quantification in the SYKFT group after 48 weeks was 8.78% ± 2.56% (P = 0.006) more than that in the losartan 50 mg group, which was 0.51% ± 2.54% (P = 1.000) less than that in the losartan 100 mg group. Compared with the losartan potassium 50 mg group, the SYKFT plus losartan potassium 50 mg group had a 13.39% ± 2.49% (P < 0.001) greater reduction in urine protein level. Compared with the losartan potassium 100 mg group, the SYKFT plus losartan potassium 100 mg group had a 9.77% ± 2.52% (P = 0.001) greater reduction in urine protein. With a superiority threshold of 15%, neither was statistically significant. eGFR, serum creatinine and serum albumin from the baseline did not change statistically significant. The average change in TCM syndrome score between the patients who took SYKFT (-3.00 [-6.00, -2.00]) and who did not take SYKFT (-2.00 [-5.00, 0]) was statistically significant (P = 0.003). No obvious adverse reactions were observed in any group.@*CONCLUSION@#SYKFT decreased the proteinuria and improved the TCM syndrome scores of primary glomerulonephritis patients, with no change in the rate of decrease in the eGFR. SYKFT plus losartan potassium therapy decreased proteinuria more than losartan potassium therapy alone.@*TRIAL REGISTRATION NUMBER@#NCT02063100 on ClinicalTrials.gov.

Influences of intracoronary application of tirofiban or nicorandil on clinical effect in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention / 中国医师进修杂志

Objective:To explore the effects of intracoronary application of tirofiban or nicorandil in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI).Methods:A total of 198 STEMI patients who were admitted to Hefei High-Tech Cardiovascular Hospital during the period from January 2017 to January 2020 were enrolled. They were divided into tirofiban group, nicorandil group and control group by random number table method, with 66 cases in each group. Patients in the tirofiban group, nicorandil group and control group were given tirofiban, nicorandil and 0.9% sodium chloride in coronary artery before PCI, respectively. After surgery, the three groups were given routine drugs. TIMI blood flow grade and TIMI myocardial perfusion grade (TMPG) before and after surgery in the three groups were recorded. The corrected TIMI frame count (cTFC), TIMI myocardial perfusion frame count (TMPFC), peak levels of serum creatine kinase (CK) and creatine kinase isoenzymes (CK-MB) after surgery in the three groups were statistically analyzed. The reperfusion arrhythmias in PCI, severe hypotension and perioperative bleeding, and number of cases with major adverse cardiac events (MACE) within 3 months after surgery in the three groups were recorded.Results:After surgery, number of cases with TIMI blood flow grading at grade 0- 3 in tirofiban group, nicorandil group and control group was (0, 2, 4, 60) cases, (0, 1, 4, 61) cases and (1, 4, 9, 52) cases, respectively. The number of cases with TMPG grading at grade 0- 3 in tirofiban group, nicorandil group and control group was (0, 3, 6, 57)cases, (0, 2, 5, 59) cases and (1, 5, 11, 49) cases, respectively. TIMI blood flow grading and TMPG in tirofiban group and nicorandil group were significantly better than those in control group ( P<0.05), and there was no significant difference between tirofiban group and nicorandil group ( P>0.05). The cTFC, TMPFC, peak level of CK, peak level of CK-MB, incidence of reperfusion arrhythmia and incidence of MACE in tirofiban group, nicorandil group and control group were [(25.32 ± 5.11) frames, (93.84 ± 13.46) frames, (1 095.32 ± 306.36) U/L, (191.81 ± 63.31) U/L, 19.70%, 18.18%], [(25.17 ± 5.38) frame, (94.74 ± 13.17) frame, (1 113.19 ± 385.68) U/L, (189.72 ± 62.22) U/L, 18.18%, 21.21%] and [(29.85 ± 7.63) frames, (101.38 ± 18.52) frames, (1 669.81 ± 537.61) U/L, (341.68 ± 108.57) U/L, 36.36%, 39.39%], respectively. The above indexes in tirofiban group and nicorandil group were significantly lower than those in control group ( P<0.05), and there was no significant difference between tirofiban group and nicorandil group ( P>0.05). Conclusions:Preoperative intracoronary application of tirofiban or nicorandil is conducive to improving myocardial function and micro-circulation disorders in STEMI patients after PCI, which is of positive roles on improving the short-term prognosis of cardiac function.

A clinical study on 99Tc-MDP for thyroid-associated ophthalmopathy / 中华地方病学杂志

Objective@#To investigate the efficacy and safety of 99Technetium-methylenediphosphonate injection (99Tc-MDP) in the treatment of thyroid associated ophthalmopathy (TAO).@*Methods@#The trail was conducted in Affiliated Zhongshan Hospital of Dalian University. Patients were recruited from October 2016 to October 2018. Fifty patients with active moderate to severe TAO were randomly assigned to receive 99Tc-MDP (n = 25) or methylprednisolone administered intravenously (n = 25), the final completion of treatment and follow-up were 21 and 20 cases, respectively. In 99Tc-MDP group, 30 sets of 99Tc-MDP were applied to each course of treatment for 10 d, with a course interval of 20 d, a total of 3 courses of treatment. Patients in methylprednisolone group were given a pulse regimen, once every week for a total of 12 infusions, altogether 4.5 g in 12 weeks. The clinical activity score (CAS) and exophthalmos were assessed in a patient at weeks 12 and 24, respectively. A response was defined as a reduction of 2 points or more in CAS and reduction of 2 mm or more in exophthalmos. Safety was assessed according to the incidence of adverse events at week 12.@*Results@#At week 12 treatment, no significant difference was observed in CAS and exophthalmos between the two groups [CAS: (2.48 ± 0.60) , (2.20 ± 0.62) points, exophthalmos: (2.57 ± 1.02), (2.20 ± 1.09) mm, P > 0.05]. Adverse events in 99Tc-MDP group was significantly lower than that in methylprednisolone group [4.8%(1/21) vs 40.0%(8/20), P < 0.05]. At week 24, the reduction in the CAS in 99Tc-MDP group was significantly greater than that in methylprednisolone group [CAS: (3.86 ± 0.67), (3.05 ± 0.59) points, P < 0.05]. The difference in exophthalmos of patients between the two groups was not statistically significant [(3.17 ± 0.60), (2.88 ± 0.57) mm, P > 0.05]. The difference in total effective rate of patients between the two groups was not statistically significant (P > 0.05).@*Conclusion@#99Tc-MDP regimen could provide similar benefit to methylprednisolone pulse therapy for those patients with TAO, but with longer reduction in CAS and less adverse events.

Evaluation of macular visual function in patients with myopic choroidal neovascularization before and after intravitreal injection of conbercept / 中华眼底病杂志

Objective To evaluate the macular visual function of patients with myopic choroidal neovascularization (MCNV) before and after intravitreal injection of conbercept.Methods A prospective,uncontrolled and non-randomized study.From April 2017 to April 2018,21 eyes of 21 patients diagnosed as MCNV in Shanxi Eye Hospital and treated with intravitreal injection of conbercept were included in this study.There were 9 males (9 eyes,42.86％) and 12 females (12 eyes,57.14％),with the mean age of 35.1 ± 13.2 years.The mean diopter was-11.30 ± 2.35 D and the mean axial length was 28.93 ± 5.68 mm.All patients were treated with intravitreal injection of conbercept 0.05 ml (1+PRN).Regular follow-up was performed before and after treatment,and BCVA and MAIA micro-field examination were performed at each follow-up.BCVA,macular integrity index (MI),mean sensitivity (MS) and fixation status changes before and after treatment were comparatively analyzed.The fixation status was divided into three types:stable fixation,relatively unstable fixation,and unstable fixation.The paired-sample t-test was used to compare BCVA,MI and MS before and after treatment.The x2 test was used to compare the fixation status before and after treatment.Results During the observation period,the average number of injections was 3.5.The logMAR BCVA of the eyes before treatment and at 1,3,and 6 months after treatment were 0.87±0.32,0.68±0.23,0.52±0.17,and 0.61 ±0.57,respectively;MI were 89.38 ± 21.34,88.87 ± 17.91,70.59 ± 30.02,and 86.76 ± 15.09,respectively;MS were 15.32 ± 7.19,21.35 ± 8.89,23.98 ± 11.12,22.32 ± 9.04 dB,respectively.Compared with before treatment,BCVA (t=15.32,18.65,17.38;P＜0.01) and MS (t=4.08,3.50,4.26;P＜0.01) were significantly increased in the eyes 1,3,and 6 months after treatment.There was no significant difference in the MI of the eyes before treatment and at 1,3,and 6 months after treatment (t=0.60,2.42,2.58;P＞0.05).Before treatment and at 1,3,and 6 months after treatment,the proportion of stable fixation were 28.57％,38.10％,38.10％,33.33％;the proportion of relatively unstable fixation were 47.62％,47.62％,52.38％,57.14％ and the proportion of unstable fixation were 23.81％,14.28％,9.52％,9.52％,respectively.The proportion of stable fixation and relatively unstable fixation at 1,3 and 6 months after treatment were higher than that before treatment,but the difference was not statistically significant (x2=1.82,1.24,1.69;P＞0.05).Conclusion BCVA and MS are significantly increased in patients with MCNV after intravitreal injection of conbercept.

Role of Working Memory in Lexical Access: An Event-related Potential Study Based on Word-picture Matchin Tasks / 中国康复理论与实践

Objective To observe the role of working memory in the process of language, and provide an objective evaluation for Chinese language rehabilitation.Methods From December, 2017 to June, 2018, 20 healthy subjects accepted word-picture matching tasks as the word and picture showed on the different (task 1) or same (task 2) screens, and their event-related potential of N400 were compared in matched and mismatched conditions.Results Forteen subjects were included finally. Task 1 induced N400 appeared earlier with higher amplitude and more activation in central parietal occipital region, followed larger N170 and P1 wave. There were significant differences in most cerebral regions between the two tasks in N400 amplitude difference of matched and mismatched conditions (t＞ 2.319, P ＜ 0.05).Conclusion Word-picture matching tasks may involve more language-related brain regions with the intervention of working memory, that might work better in process of vocabulary. The tasks simulating the scene of Chinese language rehabilitation can be used as an objective evaluation for clinical activities.

Advance in Application of Electroencephalogram for Post-stroke Aphasia (review) / 中国康复理论与实践

Electroencephalogram (EEG) contains abundant physiological and pathological information. With the development of analysis, EEG can measure the neurodynamics at the sub-second level during impaired speech processing, providing a new perspective for revealing the occurrence, development and recovery mechanism of post-stroke aphasia. EEG plays an important role in the goal setting of rehabilitation for post-stroke aphasia, and serves as an evaluation of the efficacy for clinical rehabilitation.