Modification effect of overweight and obesity on the association between short term PM 2.5 exposure and high blood pressure in adolescents / 中国学校卫生

Objective@#To analyze the association between short term PM 2.5 exposure and high blood pressure in adolescents and its modification effect of overweight and obesity, and to provide a reference for the refined management of students physical health and the scientific prevention and controlling of air pollution.@*Methods@#A total of 148 956 junior high school students and senior high school students who passed the annual physical examination data of middle school students in Beijing from 2017 to 2018 were selected; The inverse distance weighted interpolation method was used to get the meteorological elements and air quality of the research area; Linear mixed effect model was used to estimate the cumulative lag effect of short term PM 2.5 exposure on systolic and diastolic blood pressure within 7 days, and analyze the modification effect of overweight and obesity on the association between short term PM 2.5 exposure and high blood pressure in adolescents.@*Results@#From September 1, 2017 to June 30, 2018, the average concentration of PM 2.5 was (56.53±45.85)μg/m 3; The detection rate of overweight and obesity was 34.22%, and the detection rate of high blood pressure was 8.03%. The cumulative lag effect of PM 2.5 on systolic blood pressure in overweight and obesity group was the largest at lag07, that is, the daily average concentration of PM 2.5 increased by 10 μg/m 3 was significantly correlated with higher systolic blood pressure ( OR =1.05,95% CI =1.03-1.07); the cumulative lag effect of PM 2.5 on systolic blood pressure in non overweight and obese group was the largest at lag05, that is, the daily average concentration of PM 2.5 increased by 10 μg/m 3 was significantly correlated with higher systolic blood pressure ( OR =1.04,95% CI =1.02-1.06). Short term exposure to PM 2.5 did not affect the high diastolic blood pressure in adolescents. Overweight and obese adolescents were more susceptible to high blood pressure caused by short term PM 2.5 exposure within 3 days of cumulative lag (lag01-lag03).@*Conclusion@#The short term exposure of PM 2.5 has a significant positive correlation with adolescent blood pressure, and shows a lag effect. Overweight and obese adolescents have higher blood pressure after PM 2.5 short term exposure.

Role of RhoA/ROCK2 signaling pathway in trilobatin-induced reduction of cerebral ischemia-reperfusion injury in rats / 中华麻醉学杂志

Objective:To evaluate role of Ras homolog gene family member A (RhoA)/Rho-associated coiled-coil protein kinase 2 (ROCK2) signaling pathway in trilobatin-induced reduction of cerebral ischemia-reperfusion (I/R) injury in rats.Methods:Eighty clean-grade healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 230-280 g, were divided into 4 groups ( n=20 each) using a random number table method: sham operation group (group S), cerebral I/R group (group IR), cerebral I/R plus trilobatin group (group T) and cerebral I/R plus trilobatin plus RhoA/ROCK2 signaling pathway agonist AA group (group A). The model of focal cerebral I/R injury was developed by middle cerebral artery occlusion in anesthetized animals.Trilobatin 15 mg/kg was given by gavage twice a day for 3 consecutive days in T and A groups.RhoA/ROCK2 signaling pathway agonist AA 10 mg/kg was intraperitoneally injected before each administration by gavage in group A. Neurobehavioral score was assessed at 24 h of reperfusion, then the rats were sacrificed, and the hippocampal tissues were isolated for determination of the apoptosis rate of hippocampal neurons (by flow cytometry), cerebral infarction volume (by TTC staining), and expression of phosphorylated RhoA (p-RhoA), ROCK2 and cleaved caspase-3 (by Western blot) and for microscopic examination of ultrastructure of hippocampal neurons (with a transmission electron microscope). Results:Compared with group S, the neurobehavioral score, apoptosis rate of hippocampal neurons, and cerebral infarction volume were significantly increased, the expression of p-RhoA, ROCK2 and cleaved caspase-3 was up-regulated ( P<0.05), and the pathological damage to hippocampal neurons was aggravated in group IR.Compared with group IR, the neurobehavioral score, apoptosis rate of hippocampal neurons and cerebral infarction volume were significantly decreased, the expression of p-RhoA, ROCK2 and cleaved caspase-3 was down-regulated ( P<0.05), and the pathological damage to hippocampal neurons was alleviated in group T. Compared with group T, the neurobehavioral score, apoptosis rate of hippocampal neurons, and cerebral infarction volume were significantly increased, the expression of p-RhoA, ROCK2 and cleaved caspase-3 was up-regulated ( P<0.05), and the pathological damage to hippocampal neurons was aggravated in group A. Conclusions:RhoA/ROCK2 signaling pathway is involved in trilobatin-induced reduction of cerebral I/R injury, which may be related to inhibition of apoptosis in hippocampal neurons of rats.

Dose-effect relationship of alfentanil inhibiting cardiovascular responses to endotracheal intubation when combined with midazolam and etomidate / 中华麻醉学杂志

Objective:To investigate the dose-effect relationship of alfentanil inhibiting cardiovascular responses to tracheal intubation when combined with midazolam and etomidate.Methods:American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ patients of either sex, aged 18-64 yr, with body mass index<32 kg/m 2, undergoing elective operation under general anesthesia with endotracheal intubation, were enrolled in this study.Midazolam 0.025 mg/kg was intravenously injected for adequate sedation, and 5 min later mean arterial pressure and heart rate were recorded for 3 consecutive times at an interval of 3 min, and the mean value was calculated and served as the baseline value.Etomidate 0.3 mg/kg was intravenously injected, and alfentanil and rocuronium 0.6 mg/kg were intravenously injected when bispectral index value < 60, and then 1.4 min later tracheal intubation was performed.The dose of alfentanil was determined by the Dixon′s up-and-down method.The initial dose of alfentanil was set at 20 μg/kg.The dose of alfentanil in the next patient was determined according to the development of cardiovascular responses to tracheal intubation, and the ratio between the two successive doses was 1.0∶1.1.The cardiovascular response was defined as as positive when the maximum value of mean arterial pressure or heart rate increased by ≥20% of the baseline value within 2 min after endotracheal intubation.Probit method was used to determine the ED 50, ED 95 and 95% confidence interval of alfentanil inhibiting cardiovascular responses to tracheal intubation. Results:When combined with midazolam and etomidate, the ED 50 (95% confidence interval) of alfentanil inhibiting cardiovascular responses to tracheal intubation was 21.343 (19.105-24.516) μg/kg, and the ED 95 (95% confidence interval) was 25.043 (22.983-48.983) μg/kg. Conclusions:When combined with midazolam and etomidate, the ED 50 and ED 95 of alfentanil inhibiting cardiovascular responses to tracheal intubation are 21.343 and 25.043 μg/kg, respectively.

Effect modification of overweight and obesity on the relationship between shortterm PM 2.5 exposure and vital capacity in children and adolescents / 中国学校卫生

Objective@#To analyze the relationship between short term exposure of PM 2.5 and the vital capacity of children and adolescents and the modification effect of overweight and obesity, and to provide a scientific reference for appropriate outdoor activities and strengthening prevention of air pollution.@*Methods@#A total of 1 036 273 students who qualified in the annual health examination data of primary and secondary school students in a city from 2017 to 2018 were selected; the meteorological factors and air quality of the study area were obtained by inverse distance weighted interpolation method; the generalized linear mixed model was used to estimate the individual lag effect and average lag effect of PM 2.5 short term exposure on lung capacity with in 7 days, and to analyze the modification effect of overweight and obesity on the relationship between short term PM 2.5 exposure and vital capacity in children and adolescents.@*Results@#From September 1, 2017 to June 30, 2018, the average PM 2.5 concentration in this city was 66.36 μg/m 3, the detection rate of overweight and obesity was 33.38%, and the average lung capacity was (2 286.72±956.77)mL. The single lag effect of PM 2.5 on vital capacity was the biggest when lag6, the average daily PM 2.5 concentration increased by 10 μg/m 3 and the decrease of vital capacity of children and adolescents by 2.81(95% CI =2.60-3.03)mL. The average lag effect of PM 2.5 on lung capacity was the largest when lag07, the average concentration of PM 2.5 sliding was significantly correlated with the decrease of lung capacity of children and adolescents by 5.82(95% CI =5.37-6.27)mL every 10 μg/m 3 increase. The prevalence of PM 2.5 short term exposure to pulmonary capacity decreased in overweight and obese children and adolescents was higher ( P ＜0.01).@*Conclusion@#The short term exposure of PM 2.5 has a significant negative correlation with the lung capacity of children and adolescents, and there is a lag effect. The decrease of the vital capacity of overweight and obese children and adolescents after PM 2.5 short term exposure is more significant.

The application of beside lung ultrasound in emergency-plus protocol for chest physical therapy in patients with severe pneumonia / 中国实用护理杂志

Objective@#To explore the effect of chest physical therapy guided by ultrasound in patients with severe pneumonia.@*Methods@#One hundred patients with mechanical ventilation in the ICU were divided into a control group and a test group according to the occupancy time. The control group was given chest physical therapy according to routine imaging data and pulmonary auscultation. The experimental group was given physical therapy of the chest according to the routine imaging and pulmonary auscultation, also according to the BLUE ultrasound protocol. The mechanical ventilation time, ICU hospitalization time and the drainage capacity of 1 day, 2 days, 4 days, and 7 days after treatment were observed.@*Results@#The mechanical ventilation time was (7.82±1.38) days and ICU hospitalization time were (10.16±1.88) days in the test group. The mechanical ventilation time was (10.14±1.73) days and ICU hospitalization time were (12.78±2.11) days in the control group. There were significant differences between the two groups (t=7.42, 6.56, P<0.05). There was a significant difference in the ability of spontaneous drainage on the 4th and 7th day after treatment between the two groups (Z=-2.47, -2.52, P<0.05). The sputum ability on the first and second day after treatment were not statistically significant between the two groups (P>0.05).@*Conclusions@#Pulmonary ultrasound can continuously monitor lung changes. Nurses can perform targeted nursing treatment on the basis of ultrasound.

The application of beside lung ultrasound in emergency-plus protocol for chest physical therapy in patients with severe pneumonia / 中国实用护理杂志

Objective:To explore the effect of chest physical therapy guided by ultrasound in patients with severe pneumonia.Methods:One hundred patients with mechanical ventilation in the ICU were divided into a control group and a test group according to the occupancy time. The control group was given chest physical therapy according to routine imaging data and pulmonary auscultation. The experimental group was given physical therapy of the chest according to the routine imaging and pulmonary auscultation, also according to the BLUE ultrasound protocol. The mechanical ventilation time, ICU hospitalization time and the drainage capacity of 1 day, 2 days, 4 days, and 7 days after treatment were observed.Results:The mechanical ventilation time was (7.82±1.38) days and ICU hospitalization time were (10.16±1.88) days in the test group. The mechanical ventilation time was (10.14±1.73) days and ICU hospitalization time were (12.78±2.11) days in the control group. There were significant differences between the two groups ( t=7.42, 6.56, P<0.05). There was a significant difference in the ability of spontaneous drainage on the 4th and 7th day after treatment between the two groups ( Z=-2.47, -2.52, P<0.05). The sputum ability on the first and second day after treatment were not statistically significant between the two groups ( P>0.05). Conclusions:Pulmonary ultrasound can continuously monitor lung changes. Nurses can perform targeted nursing treatment on the basis of ultrasound.

Postoperative brain tissue recovery in patients with bilateral chronic subdural hematomas / 中华神经医学杂志

Objective To observe the brain tissue recovery in patients with bilateral chronic subdural hematomas after drilling and drainage treatments. Methods The clinical data of 143 patients with bilateral chronic subdural hematoma performed drilling and drainage in our hospital from January 2011 to December 2016 were collected, including gender, age, the longest and widest diameters of the skull and the longest diameter of the initial hematoma, the widest diameter of the initial hematoma, the widest diameter of the postoperative hematoma, and other clinical information. The postoperative absorption of hematoma and recovery of brain tissues were analyzed. Results In these 143 BCSDH patients, 119 were male and 24 were male; the mean age of these patients was (67.7 ±1.1) years (21-92 years old), and the mean age of male patients was (67.2 ±1.2) years and the mean age of female patients was (70.2±2.5) years. The longest diameters of the skull was 134.8 mm-177.8 mm (averaged 155.5 mm± 0.7 mm) and the widest diameters of the skull was 113.5 mm-147.0 mm (averaged 131.7 mm±0.5 mm). The longest diameters of the left and right initial hematomas were (113.4±2.5) mm and (117.6±2.1) mm,and the widest diameters of the left and right initial hematomas were (15.8±0.5) mm and (17.2±0.8) mm. There was no significant difference in the recovery rate of brain tissues between patients with different gender, age or lesion sides (P<0.05). The recovery rate of brain tissues was positively correlated with the longest and widest diameters of initial hematomas (r=0.143, P=0.018; r=0.181, P=0.002). A total of 58 patients (40.6％) presented a single-side distance<10 mm from the brain tissue to the inner edge of the skull within one week after surgery, and a total of 48 patients (33.6％) showed both sides brain recovery to<10 mm. Conclusions Drilling and drainage are the first line treatment for patients with bilateral chronic subdural hematoma and contribute to the re-location of brain tissues. The rate of brain tissue recovery is positively correlated with the size of primary hematoma.

Vascular endothelial factor C and E-cadherin relationship with the invasion and metastasis of human gastric cancer / 中国综合临床

Objective To investigate the expression of vascular endothelial factor C(VEGF-C) and E-cadherin in gastric cancer and explore the relationship between expression of VEGF-C and E-cadherin and the pathogenesis of gastric cancer.Methods Real-time quantitative reverse ranscriptase-polymerase chain rection was applied on 40 cases of gastric cancer and corresponding adjacent noncancerous tissues,in order to detect mRNA expression of VEGF-C and E-cadherin gene.VEGF-C and E-cadherin protein expression in gastric cancer and adjacent normal gastric mucosa were detected by immunohistochemistry.Statistical analysis was carried out to analyze the correlation among VEGF-C,E-cadherin and protein expression with various clinical parameters in these gastric cancer patients.Results The expression of VEGF-C protein in 40 cases of gastric cancer's cancer tissues was 0.461±0.012,significantly higher than that in the adjacent normal tissues(0.036+0.023;t=1.101,P＜0.05),but E-cadherin expression was significantly lower than that of the adjacent normal tissues (0.079±0.002 vs.0.321±0.005;t=1.844,P＜0.05).There was correlation between VEGF-C mRNA expression with histological grading,TNM staging,lymph node and distant metastasis (t=-1.621,-1.474,-2.378,-1.966,P＜0.05).There was correlation between E-cadherin mRNA expression with tumor size,histological grading,TNM stage,there was a significant difference (t=1.875,1.673,1.544,P＜0.05).VEGF-C and E-cadherin protein expression was negatively correlated(r=-0.688,P＜0.05).Conclusion Up-regulated of VEGF-C gene and decreased expression of E-cadherin may play an important role in the carcinogenesis of gastric cancer

Clinical research on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma / 中国医师进修杂志

Objective To compare the effect of occupy effects of tumor in situ before surgery(OETS) and after neurosurgery (ANS) on neuroendocrine dysfunction and grading of neuroendocrine function in children with craniopharyngioma. Methods The grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma were drew up according to references and the endocrine feedback principle. Based on these grading evaluation criteria, the clinical date of 227 cases of children with craniopharyngioma who underwent neurosurgical treatment were retrospectively studied. These children were divided into pre-pubertal group (167 cases) and pubertal group (60 cases). The neuroendocrine impairment status before and after the surgery were evaluated separately. Results Among 227 children with craniopharyngioma, after the surgery, the incidence of the hypothalamus-pituitary-thyroid dysfunction increased from 16.74%(38/227) to 67.40%(153/227), the incidence of the hypothalamus-pituitary-adrenal gland dysfunction increased from 14.54%(33/227) to 44.49%(101/227), and the the incidence of pituitary function impairment increased from 17.62%(40/227) to 21.15%(48/227). Meanwhile, the incidence of body temperature dysregulation, sleeping disorder, personality abnormality and cognitive abnormality all increased after the surgery. The scoring and grading on neuroendocrine dysfunction in pre-pubertal group were increased after the surgery (Z=-5.20, P<0.01; Z=-4.94, P<0.01,). The scoring and grading on neuroendocrine dysfunction in pubertal group were increased after the surgery( Z=-4.10, P<0.01;Z=-4.25, P<0.01). Conclusions Both the mass effect of tumor in situ of craniopharyngioma and the neurosurgical treatment can be harmful to the neuroendocrine function. Even though the surgery can remove the mass effect of tumor in situ in the saddle area, it can increase the level of grading of neuroendocrine dysfunction. The status of neuroendocrine dysfunction can be evaluated by the grading evaluation criteria of neuroendocrine dysfunction in children with craniopharyngioma, which then provides an effective evaluation tool for the reconstruction and rehabilitation of neuroendocrine function.

Percutaneous transthoracic biopsy in pathologic diagnosis of stage Ⅰ～Ⅱ lung cancer / 中华全科医师杂志

Fifty-six patients diagnosed as early stage lung cancer by spiral CT scan,underwent CTguided percutaneous transthoracic biopsy with a successful rate of 100%.Forty nice cases were confirmed pathologically including adenocarcinoma in 30 cases,squamous carcinoma in 14,alveolar cell carcinoma in 2 and small cell lung cancer in 3.Three cases were diagnosed as chronic inflammatory lesion,2 cases as tuberculosis and the diagnosis was not confirmed in 2 cases.The results suggest that CT-guided percutaneous transthoracic biopsy is an effective diagnostic measure for patients with stage Ⅰ-Ⅱ lung cancer.

Application of percutaneous transthoracic automated biopsy instrument in diagnosis for pulmonary lesions / 中华全科医师杂志

Objective To study clinical application of Bard automated disposable instrument for percutaneous transtheracic biopsy guided by CT in diagnosis of pulmonary lesions. Methods Percutaneons transthoracic biopsy was performed with CT-guided Bard automated disposable instrument for 95 patients with pulmonary lesions but without established diagnosis by clinical and imaging procedures in order to obtain pathological diagnosis. Results Tissue specimens were obtained from all the 95 patients by Bard automated disposable instrument for percutaneous transthoracis biopsy, with a hundred percent of success. After the procedure, 68 of 95 were pathologically diagnosed as lung cancer (including adenocarcinoma in 44,squamous carcinoma in 19, alveolar cell carcinoma in three and small cell carcinoma in two), 10 as chronic inflammatory lesions, eight as tuberculosis, two as inflammatory pseudotumor, one as metastatic cancer, two as fungal infection, and four without an established diagnosis, with an overall diagnosis rate of 95.8%.Pneumothorax occurred in eight and mild haemoptysis in six of 95 patients, respectively, by the procedure.Conclusion Percutaneons transthoracic biopsy with Bard automated disposable instrument is an effective diagnostic procedure for patients with pulmonary lesions but their diagnoses were not established by routine examinations.

Adults Moyamoya Disease Patients Present with Cerebral Ischemia / 医学研究杂志

Objective Moyamoya disease is a progressive cerebrovascular occlusive disease. The etiology of the disease is unknown. most think that Moyamoya usually presents with cerebral ischemia in children and intracranial hemorrhage in adults. But we have some adults present with cerebral ischemia .This article will help us know better about moyamoya disease in adults present with cerebral ischemia. And will let us know better about treatment and prognosis of this disease.Methods We reviewed our experience 88 adults angiographically diagnosed patients with moyamoya. There are 49 patients with moyamoya disease initially present with cerebral ischemia. We report their clinical presentation, radiological findings, management, and clinical outcomes. Results The incidence of moyamoya disease presents with cerebral ischemia is 55.7% in adults .The mean age of patients at symptom onset was 32 years (range, 18~64 years). Ischemic strokes or transient ischemic attacks were the predominant initial presentations.7 cases present intracranial haemorrhage in follow-up period. There was no difference in clinical representation, image and cerebral infarction in this 7 case.Conclusions Moyamoya usually presents with cerebral ischemia in adults higher than we think. diagnosis and treatment of moyamoya disease in adults is essential to minimize residual mental and physiologic deficits. If we find patients 30-40 years old ,with cerebral infarction that can’t explain in conventional mode, we should pursuit these patients, in order to exclude Moyamoya disease .Structured multicenter randomized clinical trials are needed to further assess the best treatment modalities for patients with moyamoya.