Clinical study of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of thoracolumbar osteoporotic compression fracture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified suspension reduction method combined with percutaneous vertebroplasty in the treatment of osteoporotic thoracolumbar compression fractures.@*METHODS@#From February 2020 to October 2021, 92 patients with thoracolumbar osteoporotic compression fracture were treated by percutaneous vertebroplasty. According to different treatment methods, they were divided into the observation group and the control group. The observation group was treated with modified suspension reduction and then percutaneous vertebroplasty, while the control group was treated with percutaneous vertebroplasty alone. The observation group (47 cases), including 20 males and 27 females, the age ranged from 59 to 76 years old with an average of (69.74±4.50) years old, fractured vertebral bodies:T10(2 cases), T11(7 cases), T12(19 cases), L1(14 cases), L2(5 cases);the control group(45 cases), including 21 males and 24 females, the age ranged from 61 to 78 years old with an average of (71.02±3.58) years old, fractured vertebral bodies:T10(3 cases), T11(8 cases), T12(17 cases), L1(12 cases), L2(5 cases);The leakage of bone cement were observed, the visual analogue scale (VAS), Oswestry lumbar dysfunction index (ODI), anterior vertebrae height (AVH), Cobb angle of kyphosis and the amount of bone cement injected before and after operation were recorded and compared between the two groups.@*RESULTS@#All patients were followed up, ranged from 6 to10 with an average of (8.45±1.73) months. Two patients ocurred bone cement leakage in observation group and 3 patients in control group. AVH of observation group increased (P<0.05) and Cobb angle of injured vertebrae decreased (P<0.05). Cobb angle of injured vertebrae and AVH of the control group were not significantly changed (P>0.05). Cobb angle of injured vertebrae of the observation group was lower than that of control group (P<0.05) and AVH was higher than that of the control group (P<0.05). In the observation group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.32±1.05) scores, (3.56±1.18) scores, (1.83±0.67) scores, (1.27±0.34) scores, and ODI were(40.12±14.69) scores, (23.76±10.19) scores, (20.15±6.39) scores, (13.45±3.46) scores. In the control group, VAS before operation and 1 week, 3 and 6 months after operation respectively were(7.11±5.26) scores, (3.82±0.68) scores, (1.94±0.88) scores, (1.36±0.52) scores, and ODI were(41.38±10.23) scores, (25.13±14.22) scores , (20.61±5.82) scores, (14.55±5.27) scores . The scores of VAS and ODI after operation were lower than those before operation (P<0.05), but there was no significant difference between the two groups (P<0.05).@*CONCLUSION@#Modified suspension reduction method combined with PVP surgery for osteoporotic thoracolumbar compression fractures has achieved good clinical results, which can effectively relieve lumbar back pain, restore vertebral height, correct kyphosis, improve lumbar function and patients' quality of life.

Clinical characteristics and prognosis of patients with left ventricular assist device implantation during perioperative period / 中华胸心血管外科杂志

Objective:To investigate the clinical characteristics and prognosis of patients with left ventricular assist device (LVAD) implantation during the perioperative period.Methods:This retrospective study included 14 patients with end-stage heart failure who underwent LVAD implantation in the department of intensive care medicine of Nanjing Hospital Affiliated to Nanjing Medical University from February 2022 to March 2023, including 12 males and 2 females patients, the mean age was (57.6±9.8)years old. All patients were implanted with Corheart 6 implantable left ventricular assist system, did not use other mechanical assisted circulatory devices. The clinical data of enrolled patients were collected, and the clinical characteristics and prognosis during ICU treatment were analyzed.Results:Dilated cardiomyopathy (DCM) was the most common primary cause of heart failure. The results of transthoracic echocardiography showed that the left ventricular ejection fraction (0.297±0.074 vs. 0.238±0.064, P=0.031) of patients was significantly increased, while the left ventricular end diastolic diameter[69.0(65.8, 74.3)mm vs. 76.5(72.8, 83.0)mm, P=0.003]and systolic end systolic diameter[61.5(53.7, 65.3)mm vs. 68.3(63.8, 71.9)mm, P=0.005]were significantly decreased post LVAD implantation as compared to before LVAD implantation. Within one week after implantation, there was no significant difference in LVAD rotational speed, flow rate, and pulsation index ( P>0.05). During ICU treatment, dobutamine (13 cases) was the most commonly used vasoactive agent. 9 patients used phosphodiesterase Ⅲ inhibitors for perioperative pulmonary hypertension. Targeted management of volume and pressure indicators was conducted for enrolled patients to prevent postoperative right heart failure and to reduce right heart burden. Within 72 hours after LVAD implantation, the average pulmonary artery pressure of patients was 24 (22, 26) mmHg to 26 (21, 28)mmHg (1 mmHg=0.133 kPa), while the fluid balance was(-581±778)ml to(-1 209±1 134)ml. All enrolled patients survived to 28 days after LVAD implantation. The length of stay in the ICU was (8.0±1.8) days and the total length of hospital stay was 33 (29, 41)days, while the time of mechanical ventilation was 8 (5, 28)h. Conclusion:LVAD implantation can help improve left ventricular systolic function, prolong survival time so as to serve as an important means of terminal treatment or bridging therapy for heart transplantation of patients with end-stage heart failure. To strengthen the perioperative hemodynamic regulation and maintain the cardiac function of patients with LVAD implantation is the important purposes of ICU postoperative management.

Short term clinical efficacy and influencing factors of ustekinumab monoclonal antibody in the treatment of Crohn's disease / 实用医学杂志

Objective To analyze the short-term clinical efficacy and influencing factors of ustekinumab monoclonal antibody(UST)in the treatment of Crohn′s disease(CD).Methods Retrospective cohort study was used to collect the clinical data of CD patients treated with UST in the 10th People′s Hospital affiliated to Tongji University from December 2020 to October 2022.The main analysis is the short-term clinical efficacy and influencing factors of UST treatment for CD at weeks 8 and 16,And analyze the endoscopic response rate of some patients.Results A total of 91 CD patients who first used UST were included.The 8-week clinical response rate of UST treat-ment for CD was 61.5%,and the clinical response rate was 45%;The clinical response rate at 16 weeks was 71.4%,and the clinical response rate was 54.9%.56 cases underwent endoscopic re-examination in our hospital,and the endoscopic response rate at 16 weeks was 41.1%.Univariate analysis showed that fistula(including anal fistula,personal history of anal fistula,and intestinal skin fistula)is associated with clinical remission in Crohn′s disease patients at 8/16 weeks.Further multivariate COX regression analysis showed that the presence of a history of anal fistula surgery was an independent protective factor affecting clinical remission in CD patients treated with UST at 8 weeks(HR = 0.04,95%CI:0.00～0.38;P = 0.005)and 16 weeks(HR = 0.04,95%CI:0.01～0.34;P = 0.003)compared to those without fistula;Narrow lesions are an independent risk factor for 16 week clinical remission in CD patients compared to non-narrow and non-penetrating lesions(HR = 1.75,95%CI:1.08～2.84;P = 0.023).No patients were found to have stopped medication due to serious adverse reactions.Conclusions UST can improve the clinical remission and response of CD patients at 8/16 weeks,and has good short-term clinical efficacy.CD patients with a personal history of anal fistula are recommended to use UST monoclonal antibodies,while patients with stenotic lesions should be cautious in using UST monoclonal antibodies.Whether the patient has undergone surgical treatment in the past,as well as whether UST has been used on the first or non-first line,has no significant impact on clinical remission.

Expression of insulin-like growth factor binding protein 3 in cerebral infarction rats and its involvement in Smad signaling pathway / 中华老年心脑血管病杂志

Objective To investigate the role of Smad signaling pathway in rat model of cerebral in-farction and explore the expression of insulin-like growth factor binding protein 3(IGFBP-3)in brain tissue and its relationship with neural function.Methods Sixty healthy adult male SD rats were randomly and equally divided into model group,sham-operation group,and normal control group.The model of cerebral infarction was established by using intraluminal thread occlusion,and the rats of the sham-operation group were only given exposure of the internal carotid artery and direct suture of the incision.In 1 week after successful modeling,Modified Neurological Seve-rity Score(mNSS)was used to evaluate the neurological function.HE staining was employed to observe the histopathological changes in the brain tissues.Western blotting and RT-PCR were adopted to detect the brain expression of IGFBP-3,Smad2 and Smad4 at protein and mRNA le-vels.Spearman correlation analysis was conducted to analyze the correlation among the expression levels of IGFBP-3,Smad2,Smad4 and P21.Results HE staining displayed that obvious brain ede-ma,characterized by disordered arrangement of brain cells,increased microglia,and blurred nucleo-lus of brain cells were observed in the rats of the model group,with the area of cerebral infarct of 20.55％.The mNSS score and the protein and mRNA levels of IGFBP-3,Smad2 and Smad4 were significantly higher,but the P21 protein and mRNA levels were obviously reduced in the model group than the sham-operation group and normal control group(P＜0.05,P＜0.01).Spearman correlation analysis showed that the mRNA level of IGFBP-3 in cerebral infarction rats was posi-tively correlated with the mNSS score and mRNA expression levels of Smad2 and Smad4(r=0.568,r=0.623,r=0.597;P＜0.01),and negatively with P21 mRNA level in the brain tissue(r=-0.573;P＜0.01).Conclusion The level of IGFBP-3 is significantly increased in brain tissue of rats with cerebral infarction,and it is closely associated with neural function of these rats,which may be related to Smad signaling pathway.

Research progress on the impact of lactate clearance rate on the prognosis of critically ill patients / 中国医师杂志

Lactic acid is one of the main metabolites in the body, and its clearance rate reflects the dynamic changes of lactic acid in the body. Recent studies have shown that lactate clearance rate is related to the prognosis of critically ill patients with sepsis/septic shock, cardiogenic shock, out-of-hospital cardiac arrest, postoperative cardiovascular surgery, and liver and kidney dysfunction. This article reviews the relevant research progress of lactate metabolism and lactate clearance rate in different critically ill patients.

Clinical features of primary bilateral macronodular adrenal hyperplasia / 中华内分泌代谢杂志

Objective:To investigate the clinical profile of primary bilateral macronodular adrenal hyperplasia(PBMAH) and sex difference.Methods:One hundred and forty cases of PBMAH were recruited in our center from 2014, and all patients were evaluated for hormone secretion, adrenal imaging, and metabolic parameters.Results:Overt Cushing′s syndrome accounted for 76.4% of PBMAH cohort and 47.9% were female. The overt group had higher serum cortisol and 24 h urinary free cortisol levels, lower adrenocorticotropic hormone, higher serum cortisol after low-dose dexamethasone suppression tests, larger total adrenal size, and a higher percentage of obesity, hypertension, diabetes mellitus, and hypokalemia than the subclinical group(all P<0.05). When compared with the male group, the female group had smaller adrenal size( P<0.001), lower HbA 1C( P=0.003), higher total cholesterol( P=0.005), and lower density lipoprotein-cholesterol levels( P=0.035). Further, 24 h urinary free cortisol in the male group was found to be positively correlated with diastolic blood pressure, fasting glucose, 2 h postprandial glucose after oral glucose tolerance test(OGTT), and HbA 1C after adjusted for age, body mass index, and onset duration, and was negatively correlated with body mass index and potassium levels. While 24 h urinary free cortisol in the female group was positively correlated only with diastolic blood pressure, fasting glucose, and 2 h postprandial glucose after OGTT(all P<0.05). During follow-up, 80.0% of patients achieved remission after unilateral adrenalectomy, with a recurrence rate of 17.9%. Conclusion:PBMAH related metabolic disorder is more pronounced in overt Cushing′s syndrome and males. Unilateral adrenalectomy as an effective treatment can benefit the majority of patients.

Construction and Evaluation of End-to-side Anastomosis Model of Autologous Arteriovenous Fistula in Mice / 实验动物与比较医学

ObjectiveTo establish an animal model of autologous arteriovenous fistula in mice and evaluate its effect. MethodsThe left external jugular vein and common carotid artery of 10 8-week-old male C57BL/6 mice were separated by end-to-side anastomosis of external jugular vein and common carotid artery after anesthesia, and the right jugular vein was exposed without suture as a control, so as to establish an animal model of internal arteriovenous fistula. Doppler ultrasound, HE and Masson staining and immunohistochemical staining were used to observe the hemodynamics, intimal hyperplasia and protein expression of smooth muscle cell proliferation in the outflow vein of the internal arteriovenous fistula and the contralateral control vein, and to evaluate the effect of model construction. ResultsA total of 10 mice were selected for this study, and 9 mice were successfully modeled, with a success rate of 90%. Ultrasound examinations were performed on the day of surgery, 7 and 14 days after surgery, respectively. The results showed that the flow velocity near the anastomosis was linearly correlated with the diameter of the tube. The higher the flow velocity, the larger the diameter of the tube. There was a positive correlation between peak velocity and lumen diameter (P=0.000 6, R2=0.831 7). After surgery 14 days, HE staining results showed that after autologous arteriovenous fistula molding, the average lumen area of outflow segment vein was significantly decreased (P < 0.000 1), the intima area was significantly increased (P < 0.000 1), the intimal area was significantly increased (P < 0.000 1). On the surgical side of arteriovenous fistula, collagen deposition was significantly increased, and the proportion of Masson-positive regions was significantly increased (P < 0.000 1). Immunohistochemical staining showed that the proportion of collagen 1 positive areas on the surgical side of arteriovenous fistula was significantly upregulated (P < 0.000 1), and α-smooth muscle actin (α-SMA) , proliferating cell nuclear antigen (PCNA) positive cells increased significantly (P < 0.000 1), indicating an increase in local cell proliferation level. ConclusionThe established mouse autologous arteriovenous fistula model has the advantages of high success rate, good stability and low cost. The model provides a good carrier for exploring the biological mechanism of intimal hyperplasia in arteriovenous fistulas.

The mechanisms and the diagnosis progress of non-obstructive mesenteric ischemia after cardiac surgery / 实用医学杂志

Non-occlusive mesenteric ischemia(NOMI)is a series of disorders of digestive tract caused by local blood perfusion damage,which is caused by vasospasm.As an extremely dangerous disease,NOMI is also a common intestinal complication in intensive care unit,especially in patients with hemodynamic instability after cardiac surgery,and the mortality is high.Cardiac surgery aims to improve the prognosis of patients,while the complication of NOMI is easy to be ignored,which hindered the recovery of postoperative patients.Due to the rapid development and lack of specific symptoms and signs,NOMI is easily misdiagnosed as other gastrointestinal complications.Therefore,timely and effective diagnosis of NOMI is the most important factor affecting the prognosis of post cardiac surgery.This review systematically summarized the related research on NOMI after cardiac surgery,and comprehensively concluded the cause,mechanism,treatment as well as prognosis of NOMI.Then we emphasized on the latest progresses of diagnostic methods for NOMI,in order to provide directions on the accurate identification and timely intervention of NOMI in clinical work.

Systolic longitudinal strain for assessing left ventricular systolic function changes during perioperative period of coronary artery bypass graft / 中国医学影像技术

Objective To explore left ventricular longitudinal systolic function changes during perioperative period of coronary artery bypass graft(CABG).Methods Totally 41 patients with confirmed coronary artery disease(CAD)who underwent CABG were prospectively enrolled.The preoperative left ventricular global longitudinal strain(GLS),as well as GLS on the day of CABG,on the 3rd and 7th day postoperation were measured.According to preoperative left ventricular GLS,the patients were divided into 3 groups,i.e.normal group(group A,GLS≤-18.1％,n=6),mildly decreased group(group B,-18.1％＜GLS≤-14.0％,n=22)and severely decreased group(group C,GLS＞-14.0％,n=13).Repeated measures analysis of variance,generalized estimating equation and multiple comparisons were used to analyze left ventricular systolic function in different perioperative time points.Results No significant difference of GLS was found among different time points during perioperative period of CABG in group A and C(all adjusted P＞0.05).In group B,GLS on postoperative days were lower than that before CABG(all adjusted P＜0.001),and the lowest value was observed on the day of CABG postoperatively,while no significant difference of GLS was found between the 3rd and 7th day postoperation(adjusted P=1.00).Compared with those before CABG,the longitudinal strain(LS)of basal segment on the day of CABG postoperatively and 3rd day postoperation,of middle segment and apical segment at all postoperative time points were lower(all adjusted P＜0.05),while of the apical segment on the day of CABG postoperatively decreased most obviously.No significant difference of LS of each ventricular segment was found between the 3rd nor the 7th day postoperation(all adjusted P＞0.05).Conclusion GLS decreased significantly on the day of CABG postoperatively but partially recovered within the following week in CAD patients with mildly decreased preoperative GLS.CABG had the most pronounced effect on LS of apical segment in left ventricle.

Comparison on the clinical characteristics of patients with Takotsubo syndrome from China and from Europe/North America / 中华心血管病杂志

Objective: To summarize the clinical characteristics of patients with Takotsubo syndrome (TTS) from China and compare these features with patients from Europe/North America. Methods: We reviewed case reports published between 1990 and 2020 with the key words of "Takotsubo syndrome" "stress cardiomyopathy" "apical balloon syndrome" and "broken heart syndrome", in Wanfang, CNKI, Pubmed and Web of Science databases, and 1 294 articles were identified, including 128 articles reporting 163 cases in China and 1 166 articles reporting 1 256 cases in Europe/North America. The characteristics of demographics, triggers, symptoms, electrocardiogram, echocardiography, left ventriculogram,coronary angiography, treatment and prognosis were analyzed and compared between Chinese and European/North American cases. Results: A total of 1 294 articles (1 419 cases: 163 from China, 1 256 from Europe/North America) were included in the final analysis. The characteristics of Chinese cases included: (1) demographic:the age was (59.6±16.9) years, which was similar with that of European/North American ((59.7±17.4) years, P=0.90), and female accounting for 78.5% (128/163), which was lower than that of European/North American (85.4% (1 073/1 256), P=0.02). (2) Triggers:mental triggers accounted for 48.5% (79/163), physical triggers accounted for 43.6% (71/163), and no triggers accounted for 7.9% (13/163), respectively. Compared with Europe/North America, the ratio of patients with mental triggers was higher in China, while the ratio of patients with physical triggers and no triggers was lower (P<0.05). (3) Symptoms: chest pain (52.8% (86/163)), chest tightness (35.0% (57/163)), shortness of breath (33.1% (54/163)), dizziness (16.0% (26/163)), sweating (15.3% (25/163)), palpitations (12.3% (20/163)), syncope (9.2% (15/163)) abdominal pain/diarrhea (8.6% (14/163)), hypotension (7.4% (12/163)), and fatigue (1.2% (2/163)) were illustrated in sequence. Compared with patients in Europe/North America, the ratio of patients with chest tightness, dizziness, sweating, palpitations, abdominal pain/diarrhea was higher in Chinese patients, while the ratio of patients with hypotension was lower in Chinese patients (P<0.05). (4) Electrocardiogram: main manifestations were myocardial ischemia symptoms, such as ST-segment elevation (63.8% (104/163)), T wave inversion (46.0% (75/163)), ST-segment depression (8.6% (14/163)). Compared with European/North American, the ratio of patients with ST-segment elevation, T wave inversion, and atrioventricular block was higher in Chinese patients (P<0.05). (5) Echocardiography and imaging:apical dyskinesia (59.5% (97/163)) and apical/left ventricular bulbar dilation (36.2%(59/163)) dominated the echocardiography findings. Compared with European/North American, the ratio of patients with apical dyskinesia, apical/left ventricular bulbar dilation, and mitral regurgitation was higher in Chinese patients, while the ratio of patients with dyskinesia in other parts and left ventricular ejection fraction<50% was lower in Chinese patients (P<0.05). Left ventricular angiography showed 36.2% (59/163) of apical dyskinesia in Chinese patients, which was higher than that reported in European/North American patients, and 38.7% (63/163) of apical/left ventricular bulbar dilation was reported in Chinese patients, which was similar to that reported in European/North American patients. Coronary angiography showed percent of no stenosis or stenosis less than 50% was 87.1% (142/163), which was similar to that reported in European/North American patients (P>0.05). The typical type of TTS accounted for 96.3% (157/163), which was significantly higher than that reported in European/ American patients, while the ratio of basal type and midventricular type was lower (P<0.01). (6) Treatment and prognosis:the applied drugs in China were listed in order as following, β-blockers (41.1% (67/163)), antiplatelet agents (37.4%(61/163)), ACEI/ARB (36.2%(59/163)), anticoagulants (27.0%(44/163)), diuretics (19.6% (32/163)), etc. Compared with Europe/North America, the ratio of antiplatelet agents, anticoagulants, statins, diuretics, and nitrates use was higher in China (P<0.05), while the use of oxygen therapy and IABP was similar (P>0.05). The hospital mortality in China was 5.5% (9/163), during 1-year follow-up the recurrence rate was 3.7% (6/163) and the mortality was 0. The prognosis was similar with that in Europe/North America. Conclusions: Compared with TTS cases in Europe/North America, TTS cases in China also occur usually in middle-aged and elderly women, most of whom have mental/physical triggers and typical imaging manifestations, followed by a low hospital mortality rate and recurrence rate.

Effects of Footwear on the Stability of Older Adults: A Systematic Review / 医用生物力学

Older adults have decreased control of body balance with aging and are prone to fall. As the primary point of contact between human body and ground, footwear is critical for stability of older adults. The relationship between shoe characteristics and stability of older adults was systematically reviewed to determine the effect of footwear characteristics on stability of older adults. The results show that wearing shoes with shoelaces or velcro, low heels, wide outsole and appropriate soles, or using vibrating insoles and arch support insoles can help older adults improve their stability. Excessive sole spring and low sole hardness may have adverse effects on stability of older adults. This study can provide theoretical references for older adults to choose shoes reasonably and for the manufacturers to design and make shoes to prevent falls.

Research Progress on the Omics of Methamphetamine Toxic Damage and Addiction / 法医学杂志

The mechanism of methamphetamine toxicity and addiction is the key research direction of forensic toxicology, and the development of omics technology provides a new platform for further study of this direction. METH toxic damage and addiction are reflected differently in genes, ribonucleic acid (RNA) transcription, protein and metabolism. This article summarizes the achievements and shortcomings of multi-omics technologies such as genome, transcriptome, metabolome and proteome in the study of METH damage and addiction, and discusses the strategies and advantages of multi-omics combined analysis in the study of METH toxic damage and addiction mechanism, in order to provide more useful reference information for forensic toxicology of METH.

Progress on in vivo ankle biomechanics based on dual fluoroscopic imaging technology / 生物医学工程学杂志

The technical deficiencies in traditional medical imagining methods limit the study of

Salt-inducible kinase 2 regulates energy metabolism in rats with cerebral ischemia-reperfusion / 浙江大学学报·医学版

To investigate the effects of salt-inducible kinase 2 (SIK2) on energy metabolism in rats with cerebral ischemia-reperfusion. Adult SD male rats were divided into 5 groups: sham group, ischemia group, reperfusion group, adenovirus no-load group, and SIK2 overexpression group with 5 animals in each group. The middle cerebral artery occlusion (MCAO) was induced with the modified Zea-Longa line thrombus method to establish the cerebral ischemia reperfusion model. Eight days before the MCAO, SIK2 overexpression was induced by injecting 7 μL adenovirus in the right ventricle, then MCAO was performed for followed by reperfusion HE staining was used to observe the pathological changes of cerebral tissue in rats; TTC staining was used to observe the volume of cerebral infarct. The levels of adenosine triphosphate (ATP) and adenosine diphosphate (ADP) in rat brain tissue were detected by ELISA; the levels of SIK2 and hypoxia-inducible factor 1α (HIF-1α) in the rat brain tissues were detected by RT-qPCR and Western blotting. Compared with the sham group, SIK2 level was decreased in the ischemia group, and it was further declined in the reperfusion group (<0.05). Compared with the sham group and ischemic group, the pathological injury in reperfusion group were more severe, and the infarct size was larger; compared with the reperfusion group and adenovirus no-load group, the pathological injury of the SIK2 overexpression group was milder, and the infarct size is less. Compared with the sharn group, HIF-1α was increased in both ischemia group and reperfusion group, especially in ischemia group (all <0.05); HIF-1α level in the SIK2 overexpression group was higher than that in the reperfusion group and adenovirus no-load group (all <0.05). ATP level in ischemia group and reperfusion group was lower than that in the sham group, and the reperfusion group decreased more significantly than the ischemia group (<0.05); ADP content was increased in the ischemia and reperfusion group, and the ADP content in reperfusion group was significantly higher than that in the ischemia group (<0.05). ATP level in the SIK2 overexpression group was higher than that in the reperfusion group and adenovirus no-load group (all <0.05), and ADP was decreased in the SIK2 overexpression group (all <0.05). SIK2 can up-regulate the ATP level and down-regulate the ADP level in rat brain tissue and alleviate cerebral ischemia-reperfusion injury by increase the level of HIF-1α.

Expression of MiR-429 in Patients with Acute Lymphoblastic Leukemia and Its Prognostic Value / 中国实验血液学杂志

OBJECTIVE@#To analyze the expression level of miR-429 in patients with acute lymphoblastic leukemia(ALL) and its clinical prognostic value.@*METHODS@#One hundred and Twenty-six patients with ALL treated in our hospital from April 2016 to February 2018 were selected, and 100 healthy persons in the same period were selected as control group. Bone marrow mononuclear cells were collected. The expression level of miR-429 in bone marrow mononuclear cells was detected by RT-PCR, and the correlation of miR-429 expression with clinical characteristics and therapeutic efficacy was analyzed. Kaplan-Meier method and multi-factorial Cox regression model were used to analyze the correlation between the level of microRNA-429 and the prognosis of ALL patients.@*RESULTS@#The relative level of miR-429 in ALL patients was 2.47±0.07, which was signifi-cantly higher than that in control group (P0.05). The level of miR-429 was not significantly different between CR patients and control group (P>0.05); the level of miR-429 in PR patients was higher than that in control group and CR patients (P<0.05). The level of miR-429 in NR patients was higher than that in other groups (P<0.05). Kaplan-Meier survival analysis showed that the overall survival rate of ALL patients with low expression of miR-429 was better than that of ALL patients with high expression of miR-429 (P<0.05). Univariate Cox regression analysis showed that leukocyte level, ratio of bone marrow primordial cells, Hb and LDH level, risk grading and miR-429 were the factors influencing overall survival rate in ALL patients (P<0.05). Multivariate Cox regression analysis showed that leukocyte level, ratio of bone marrow primordial cells, risk grading, and miR-429 were the factors influencing overall survival rate (P<0.05).@*CONCLUSION@#The expression of miR-429 is high in ALL patients, which closely relates to the curative effect and pro-gnosis of ALL patients, and can be used as a reference index for evaluation of clinical prognosis of ALL patients.

Application of DESI-MSI in Quality Control of Banxia Xiexintang / 中国实验方剂学杂志

Objective::To prepare 15 batches of Banxia Xiexintang substance benchmark and lyophilized powder from different places, and the lyophilized powder was analyzed by ultra-high performance liquid chromatography with diode array detection (UHPLC-DAD) and desorption electrospray ionization-mass spectrometry imaging (DESI-MSI) in order to investigate the advantages of DESI-MSI in quality control of famous classical formulas. Method::Taking Banxia Xiexintang as the research model, fingerprints of the substance benchmark and lyophilized powder were established by UHPLC-DAD, and the content of index components and the yield of dry extract were also investigated. Meanwhile, as the research carrier, the lyophilized powder corresponding to Banxia Xiexintang was dissolved in methanol and dotted on qualitative filter paper with 5 μL quantitative capillary, and fixed it on the slide to make samples. The samples were analyzed on a DESI-MSI system in positive and negative ion mode with methanol-formic acid (1 000∶1, flow rate of 3 μL·min-1) as spray solvent, N2 as spray gas (pressure of 0.5 MPa). The scanning range was 100-1 200 Da, the spatial resolution was 300 μm, the spray voltage was 3 kV, the sampling cone voltage was ±40 V, incidence angle of sprayer was 60 degree, its collection angle was 10 degree, the ion source temperature was 120 ℃. Result::DESI-MSI could not only detect the index components of liquiritin, baicalin and wogonoside, as well as the common peaks of liquiritin apioside, berberine and glycyrrhizic acid, but also analyzed them semi-quantitatively, the analysis results were basically consistent with UHPLC-DAD. At the same time, DESI-MSI could detect 16 other components from Glycyrrhizae Radix et Rhizoma, Coptidis Rhizoma, Scutellariae Radix, Jujubae Fructus and Ginseng Radix et Rhizoma, such as licoricesaponin G2, palmatine, coptisine, rutin and ginsenoside Rg1, and present their relative content visually. The qualitative analysis ability of DESI-MSI was much better than UHPLC-DAD. Conclusion::DESI-MSI can be used as the quality control method for substance benchmark and lyophilized powder and dispensing granules of famous classical formulas with advantages of high sensitivity, strong analytical ability, no complex sample processing, qualitative and relative content analysis of complex samples without reference substance.

Effect of timing it right family support program on patients′ uncertainty in illness and relatives care ability of acute myocardial infarction patients with percutaneous transluminal coronary intervention treatment / 中国实用护理杂志

Objective:To investigate the effect of timing it right family support program-based care on patients′ uncertainty in illness and relatives care ability of acute myocardial infarction patients with percutaneous transluminal coronary intervention treatment, and to provide reference for family continuous care of such patients.Methods:A total of 88 patients and relatives admitted to the department of cardiology in Hebei People′s Hospital from March 2018 to May 2019 were randomly divided into intervention group (44 cases) and control group (44 cases). The control group received routine care, while the intervention group received timing it right family support program based on the routine care. Two groups were given follow-up for 6 months, the patients′ uncertainty in illness and relatives care burden and care ability were compared between two groups.Results:3 months, 6 months after discharge, the ambiguity, unpredictability and total uncertainty in illness scores were significantly decreased in the intervention group compared to the control group [(17.89±3.67), (14.56±3.15), (11.82±1.68), (10.31±1.62), (43.21±4.71), (38.31±4.19) vs. (19.83±3.43), (16.85±2.56), (13.29±2.37), (11.90±2.26), (47.34±5.58), (42.24±3.89)], the differences were statically significant ( t value was 2.435-4.351, P<0.05). At discharge and 3 months, 6 months after discharge, the scores of sociability burden were significantly decreased in the intervention group compared to the control group [(4.49±0.99), (3.59±0.79), (2.92±0.35) vs. (5.14±1.22), (3.98±0.82), (3.61±0.67)]; 3 months and 6 months after discharge, the scores of time-depending burden and total burden scores were significantly decreased in the intervention group compared to the control group [(12.79±2.50), (10.51±3.08), (37.31±4.22), (31.72±3.39) vs. (14.61±2.86), (13.32±3.09), (40.34±3.97), (36.19±3.27)]; 6 months after discharge, the scores of development-limited burden were significantly decreased in the intervention group compared to the control group [(7.36±1.11) vs. (8.07±1.31)], the differences were statically significant ( t value was 2.146-6.020, P<0.05). At discharge and 3 months, 6 months after discharge, the scores of learning to cope with new role, providing care according to care-receiver`s needs, managing own emotional needs, appraising supportive resources balancing care-giving needs and own needs and total care ability scores were significantly decreased in the intervention group compared to the control group, the differences were statically significant ( t value was 4.957-25.242, P<0.01). Conclusion:Timing it right family support program can alleviate patients′ uncertainty in illness and improve relatives care abilily of acute myocardial infarction patients with percutaneous transluminal coronary intervention treatment.

Risk factors for delirium after cardiovascular surgery: a retrospective study of 7 001 cases / 中国医师进修杂志

Objective:To investigate the incidence of delirium and related risk factors in patients after cardiovascular surgery.Methods:From May 2012 to May 2019, 7 001 patients underwent cardiovascular surgery in the Nanjing First Hospital were retrospectively analyzed. The general clinical data, operation name, operation time, cardiopulmonary bypass time, aortic occlusion time, analgesic and sedative drugs use during postoperative ICU treatment, confusion assessment method for the intensive care unit (CAM-ICU) score, length of ICU stay, total hospital stay, adverse prognosis and postoperative delirium were recorded. The influence of postoperative delirium on hospital stay and adverse prognosis was analyzed. The risk factors of postoperative delirium were explored.Results:Among the 7 001 patients, 573 (8.18%) had postoperative delirium (delirium group), while 6 428 patients had no delirium (non-delirium group). The incidence of postoperative delirium in patients with acute aortic dissection (AAD) after Sun′s operation was significantly higher than that in patients with other cardiovascular surgery: 45.03% (204/453) vs. 5.64% (369/6 548), and there was statistical difference ( P<0.05). The age, length of ICU stay, total hospital stay, incidence of adverse prognosis, operation time, cardiopulmonary bypass time and aortic occlusion time in delirium group were significantly higher than those in non-delirium group: (59.72 ± 12.48) years vs. (58.81 ± 12.16) years, 5.49 (2.87, 9.49) d vs. 1.12 (0.90, 1.95) d, 21.92 (17.90, 28.22) d vs. 17.85 (14.93, 21.76) d, 7.33% (42/573) vs. 2.13% (137/6 428), (5.43 ± 2.51) h vs. (4.06 ± 1.33) h, (140.01 ± 55.13) min vs. (108.07 ± 42.98) min and (85.23 ± 37.30) min vs. (72.50 ± 34.15) min, and there were statistical differences ( P<0.01). Multivariant Logistic regression analysis result showed that intraoperative deep hypothermic circulatory arrest and selective cerebral perfusion was independent risk factor of postoperative delirium in patients with cardiovascular surgery ( OR = 10.922, 95% CI 7.444 to 16.120, P < 0.01). After excluding AAD patients, the incidences of postoperative delirium were 2.63% (11/418), 4.16% (34/817), 4.37% (71/1 625), 5.13% (122/2 379), 9.34% (114/1 221) and 19.32% (17/88) for patients<40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years and ≥ 80 years respectively. The incidence of postoperative delirium increased with age ( Z= 2.63, P= 0.009). The incidences of postoperative delirium were 1.47% (45/3 056), 3.22% (63/1 954), 5.69% (34/597), 12.14% (38/312), 18.18% (22/121), 22.62% (38/168), 25.93% (21/81) and 41.70% (108/259) for patients who stayed 1, 2, 3, 4, 5, 6, 7 and>7 d in ICU. The longer stay in ICU, the higher the incidence of postoperative delirium ( Z= 3.34, P = 0.001). Sequential organ failure score (SOFA) was used to evaluate the organ functions of patients. The scores of respiratory system, circulatory system, liver function and renal function in delirium group were significantly worse than those in non-delirium group, and there were statistical differences ( P<0.01); there was no significant difference in coagulation function between 2 groups ( P > 0.05). According to the use of analgesic and sedative drugs during the postoperative ICU stay, the patients were divided into dexmedetomidine alone group (3 355 cases) and dexmedetomidine combined with dezocine group (1 396 cases). The incidence of postoperative delirium in dexmedetomidine combined with dezocine group was significantly higher than that in dexmedetomidine alone group: 19.20% (268/1 396) vs. 5.66% (190/3 355), and there was statistical difference ( P<0.01). Conclusions:Age, operation time, extracorporeal circulation time, aortic occlusion time, intraoperative hypothermic circulatory arrest with selective cerebral perfusion, severity of disease and length of ICU stay are independent risk factors for postoperative delirium in patients after cardiovascular surgery. The choice of analgesic and sedative drugs during the perioperative period may affect the occurrence of postoperative delirium.

Three cases of flagellate shiitake mushroom dermatitis caused by Pleurotus ostreatus, Auricularia auricula and Flammulina velutipes respectively / 中华皮肤科杂志

Three cases of flagellate shiitake mushroom dermatitis caused by Pleurotus ostreatus, Auricularia auricula, and Flammulina velutipes respectively were reported. Case 1, a 45-year-old male patient, developed multiple flagellate erythematous patches and papules on the trunk, axillae and abdomen without any subjective discomfort 8 hours after ingestion of a large amount of grilled Pleurotus ostreatus. Case 2, a 33-year-old female patient, developed multiple flagellate erythematous patches with mild swelling and itching on the back 1.5 days after consuming a fresh Auricularia auricula salad, and millet-sized papules were densely distributed on the erythematous patches. Case 3, a 54-year-old female patient, developed cord-like, flagellate edematous erythema and papules on the neck, trunk and proximal extremities 72 hours after consuming Flammulina velutipes. Histopathological examination of the dorsal lesions in case 3 showed epidermal spongiosis, intraepidermal blisters, papillary dermal edema, superficial dermal vasodilation, erythrocyte extravasation, inflammatory infiltration composed mainly of lymphocytes around dilated blood vessels, and a few scattered eosinophils. The 3 patients were all diagnosed with flagellate shiitake mushroom dermatitis. Case 1 received no treatment, while cases 2 and 3 were symptomatically treated with topical fluticasone propionate ointment, and achieved recovery of skin lesions after 1 week.

Postoperative renal replacement therapy in patients with acute Stanford type A aortic dissection: risk factors and predictive modeling / 中华胸心血管外科杂志

Objective:To analyze the risk factors for postoperative renal replacement therapy(RRT) in patients with acute Stanford type A aortic dissection. Develop and validate a prediction model based on the risk factors with the purpose of early intervention.Methods:A retrospective analysis of 215 patients who underwent surgery for acute Stanford type A aortic dissection in our hospital from April 2016 to April 2019 were performed. Clinical variables including age, gender, basal blood pressure, preoperative serum creatinine, intraoperative blood pressure, operation time, cardiopulmonary bypass time, aortic occlusion time, intraoperative blood transfusion(including autologous blood), intraocular fluid infusion, colloidal fluid infusion, intraoperative urine volume, bleeding volume, total fluid balance, and postoperative blood lactate value were collected and their association with renal replacement therapy were analysed. Clinical variables were screened using lasso regression. Applying the post-filtering variables to construct a predictive model, calculating the area under the receiver operating characteristic curve( AUC) of the predictive model and the sensitivity and specificity under the optimal threshold for model evaluation. Results:In the 215 patients with acute Stanford type A aortic dissection, 38 patients required renal replacement therapy, accounting for 17.67%. Preoperative serum creatinine, operation time, cardiopulmonary bypass time, aortic occlusion time, intraoperative blood pressure less than 80mmHg time, intraoperative blood pressure less than 55% of basal blood pressure time, intraoperative blood transfusion, intraoperative crystal fluid dosage, intraoperative urine volume and lactate value after ICU admission were important risk factors for postoperative renal replacement therapy(RRT) in patients with acute Stanford type A aortic dissection. The AUC for the predictive model established using these variables was 0.955(95% CI: 0.897-1.000). The specificity under the optimal threshold was 96.1% and the sensitivity was 90.9%. Conclusion:Perioperative clinical variables can predict the possibility of RRT in patients with acute Stanford type A aortic dissection after surgery, which may provide the possibility for early intervention.