Smart Hip Ultrasound Technology in Screening for Infant Developmental Dysplasia of the Hip / 中山大学学报(医学科学版)

ObjectiveTo develop a deep learning system for early ultrasound screening of developmental dysplasia of the hip （DDH）， a new smart-hip ultrasound technique （S-hip）， and to validate its clinical application. MethodsWe selected 11，100 annotated and reviewed coronal ultrasound images of infant hips between November 2021 and August 2022， 8，100 of which were used for the training set and 3，000 for the test set， to build a S-hip deep learning system. To verify the consistency between the automated measurement by S-hip and the manual measurements by sonographers， 174 standard coronal ultrasound images of 87 infants' bilateral hips were acquired， then α angle， β angle and femoral head coverage （FHC） were measured by S-hip， an ultrasound expert and a resident. The measurement data and the time required for the measurements were recorded and statistically analyzed. Another 100 standard coronal ultrasound images of the hips were randomly selected and measured twice respectively by the ultrasound expert and resident to assess the intra-sonographer repeatability. ResultsThe intraclass correlation coefficient （ICC） （95% CI） values of α angle， β angle and FHC results measured by S-hip and ultrasound expert were 0.799 （0.738， 0.847）， 0.798 （0.737， 0.846） and 0.934 （0.954， 0.975）， respectively. Those values measured by the ultrasound expert and resident were 0.725 （0.645， 0.789）， 0.674 （0.583， 0.748） and 0.931 （0.908， 0.949）， respectively. The mean absolute errors （MAE） of α angle， β angle and FHC results between measurements by S-hip and ultrasound expert were 2.69 °， 4.43 ° and 2.47%， respectively. The time required for measurements by S-hip， ultrasound expert and resident was （1.59±0.36） s， （18.76±2.23） s and （19.45±2.76） s， respectively. The automated measurement by S-hip cost much shorter time than the manual measurements by sonographers and the difference was statistically significant （P<0.001）. The ICC （95% CI） values of α angle， β angle and FHC results between two measurements by the ultrasound expert were 0.943 （0.916， 0.961）， 0.959 （0.940， 0.972）， and 0.981 （0.971， 0.987）， respectively. Those values by the ultrasound resident were 0.884 （0.833， 0.921）， 0.921 （0.884， 0.946）， and 0.962 （0.944， 0.974）. ConclusionThe S-hip based on a deep learning system is a highly reliable automated technique to accurately measure α angle， β angle and FHC. Compared with ultrasound residents， S-hip allows for a more simplified and significantly quicker measurement， which may enhance the widespread use of hip ultrasound screening in infants.

PEGylation of Phosphatidylglycerol/Docosahexaenoic Acid Hexosomes with d-α-Tocopheryl Succinate Poly(ethylene glycol)2000 Induces Morphological Transformation into Vesicles with Prolonged Circulation Times.

Considering the broad therapeutic potential of omega-3 polyunsaturated fatty acids such as docosahexaenoic acid (DHA), here we study the effect of PEGylation of DHA-incorporated hexosomes on their physicochemical characteristics and biodistribution following intravenous injection into mice. Hexosomes were formed from phosphatidylglycerol and DHA with a weight ratio of 3:2. PEGylation was achieved through the incorporation of either d-α-tocopheryl succinate poly(ethylene glycol)2000 (TPGS-mPEG2000) or 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N-methoxy-poly(ethylene glycol)2000 (DSPE-mPEG2000) at a concentration of 1.5 wt %. Nanoparticle tracking analysis, synchrotron small-angle scattering, and cryo-transmission electron microscopy were employed to characterize the nanodispersions. The results show that PEGylated lipids induce a structural transition from an inverse hexagonal (H2) phase inside the nanoparticles (hexosomes) to a lamellar (Lα) phase (vesicles). We also followed the effect of mouse plasma on the nanodispersion size distribution, number, and morphology because changes brought by plasma constituents could regulate the in vivo performance of intravenously injected nanodispersions. For comparative biodistribution studies, fluorescently labeled nanodispersions of equivalent quantum yields were injected intravenously into healthy mice. TPGS-mPEG2000-induced vesicles were most effective in avoiding hepatosplenic clearance at early time points. In an orthotopic xenograft murine model of glioblastoma, TPGS-mPEG2000-induced vesicles also showed improved localization to the brain compared with native hexosomes. We discuss these observations and their implications for the future design of injectable lyotropic nonlamellar liquid crystalline drug delivery nanosystems for therapeutic interventions of brain and liver diseases.

Biomedical Analytics of Four Chinese Medicinals in Treatment of Insomnia Based on Network Pharmacology.

Aim: Our aim is to recommend the appropriate Chinese medicinals in clinical treatment of insomnia, which are suanzaorén (Semen Ziziphi Spinosae), chuanxiong (Rhizoma Chuanxiong), fúlíng (Poria), and báisháo (Radix Paeoniae Alba). Method: Based on network pharmacology, the active molecules and mechanism of these four Chinese medicinals treating insomnia were sought and analyzed. The components of the four Chinese medicinals with potential activity were collected and screened. Moreover, the recollected human disease-related targets were correlated through Cytoscape 3.8.2, and the network diagram of drug component disease targets was drawn. Based on the human protein-protein interaction database, the above network diagram was imported to establish the protein-protein interaction (PPI) and composite target pathway (C-T-P) networks. After selecting important information, the pathway analysis was carried out to show the biological process, core target, and core pathway of insomnia treatment. Result: In this study, 44 active components and 81 drug-disease common targets were obtained; 307 key targets were found in the PPI network; a core cluster composed of 14 nodes and 50 functional associations was found. Conclusion: In summary, the four Chinese medicinals' effective components and main mechanism of in the treatment of insomnia may be related to their participation in the regulation of endocrine. Compared with the existing network pharmacological analysis results of SuanZaoRénTang (Sour Jujube Decoction), which is commonly used in insomnia, they have similar effects on the immune system and HPA axis, while the focus of the four Chinese medicinals is mainly on endocrine regulation, and SuanZaoRénTang (Sour Jujube Decoction) is mainly on anti-inflammatory effect.

Assessment of Reporting Quality in Randomized Controlled Trials of Acupuncture for Primary Insomnia with CONSORT Statement and STRICTA Guidelines.

AIM: To assess the reporting quality of randomized controlled trials (RCTs) on acupuncture for primary insomnia (PI). METHODS: Seven Chinese and English databases were searched for publication reporting RCTs on acupuncture for PI from the inception of the databases to August 6, 2021. The internationally recognized Consolidated Standards of Reporting Trials (CONSORT) statement and the International Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA) guidelines were used to evaluate the reporting quality. The agreement between two researchers was calculated by Cohen's kappa. RESULTS: A total of 102 eligible RCTs were assessed. According to the CONSORT statement (2017), the positive reporting rates of items such as "abstract," "background," "participants," and "numbers analyzed" were above 80%. However, the positive reporting rates of items such as "sample size," "randomization implementation," "Outcomes and estimation," "Ancillary analyses," and "Registration" were below 20%. According to STRICTA guidelines, the positive reporting rates of items such as "style of acupuncture," "reasons for acupuncture treatment," "Number of needles inserted," "Needle retention time," "Treatment regimen," and "precise description of the control intervention" were above 80%. However, the positive reporting rates of items such as "setting and context of treatment" and "practitioner background" were below 20%. CONCLUSION: It is essential to advocate the endorsement of the CONSORT statement and STRICTA guidelines to improve the quality of acupuncture RCT reports.

Comparison of Efficacy between Acupuncture Therapies in Improving Sacroiliac Joint Malposition: A Systematic Review and Meta-Analysis.

AIM: To provide available quantitative evidence of efficacy and safety of acupuncture treatments for improving sacroiliac joint malposition. METHODS: Databases such as the China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (CQVIP), Wanfang Database (Wanfang), China Biology Medicine disc (CBMdisc), PubMed, Web of Science, EMBASE, and Cochrane Library were searched by computer to collect the reports on acupuncture treatment of sacroiliac joint malposition from the database creation to July 20, 2021. The selection of included studies, data extraction and coding, and bias risk assessment were conducted independently by two reviewers. RevMan5.4 software was used for meta-analysis, and the results were expressed as mean difference (MD) or standardized mean difference (SMD), with a confidence interval (CI) of 95%. RESULTS: A total of 10 randomized controlled clinical trials (RCTs) with 1019 participants were included. Their overall quality of methodology was not high, and there may be publication bias. Meta-analysis showed that the total effective rate of the treatment group was higher than that of the control group (OR = 2.74, 95% CI 2.00 to 3.74, P < 0.00001). The treatment group was better than the control group in improving VAS score (WMD = -1.56, 95% CI -2.18 to -0.94, P < 0.00001). The ODI score of the treatment group was lower than that of the control group (WMD = -6.04, 95% CI -7.05 to -5.02, P < 0.00001). With the improvement of the JOA score, the difference of iliac transverse diameter of sacroiliac joint dislocation and the index of sacroiliac joint malposition in the treatment group were better than those in the control group (P < 0.05). There was no significant heterogeneity among the studies. CONCLUSION: Acupuncture may have therapeutic advantages in improving sacroiliac joint malposition. Acupuncture and acupotomy provide a safe way to improve the related clinical symptoms and functional disorders in activity of sacroiliac joint dislocation. However, due to the low quality of the included literature, this conclusion still needs to be further verified by more high-quality and large-sample RCTs.

The abnormal reward network associated with insomnia severity and depression in chronic insomnia disorder.

Previous research has shown that acute sleep deprivation can influence the reward networks. However, it is unclear whether and how the intrinsic reward network is altered in chronic insomnia disorder (CID). In the present study, we aimed to investigate whether the reward network is altered in patients with CID using resting-state functional magnetic resonance imaging (fMRI) data. Forty-two patients with CID and 33 healthy controls (HCs) were enrolled and underwent resting-state fMRI. Nucleus accumbens (NAc) - based functional connectivity (NAFC) was evaluated to explore the differences in the reward network between the CID and HC groups. Pearson correlation analysis was used to evaluate the clinical significance of altered NAFC networks. Compared to those in the HC group, increased NAFC was found in the salience and limbic networks, while decreased NAFC was found in the default mode network (DMN) and within the reward circuit in patients with CID. In addition, decreased FC between the NAc and DMN was associated with insomnia severity, while NAFC within the reward network was associated with depression symptoms in patients with CID. These findings showed that the reward network is dysfunctional and associated with depression symptom in patients with CID. Future studies of CID should consider both insomnia and depression symptoms to disentangle the role of insomnia and depression in the relationship under study.

Ferrocene-functionalized nanocomposites as signal amplification probes for electrochemical immunoassay of Salmonella typhimurium.

An electrochemical immunosensor based on ferrocene (Fc)-functionalized nanocomposites was fabricated as an efficient electroactive signal probe to amplify electrochemical signals for Salmonella typhimurium detection. The electrochemical signal amplification probe was constructed by encapsulating ferrocene into S. typhimurium-specific antimicrobial peptides Magainin I (MI)-Cu3(PO4)2 organic-inorganic nanocomposites (Fc@MI) through a one-step process. Magnetic beads (MBs) coupled with antibody were used as capture ingredient for target magnetic separation, and Fc@MI nanoparticles were used as signal labels in the immunoassays. The sandwich of MBs-target-Fc@MI assay was performed using a screen-printed carbon electrode as transducer surface. The immunosensor platform presents a low limit of detection (LOD) of 3 CFU·mL-1 and a linear range from 10 to 107 CFU·mL-1, with good specificity and precision, and was successfully applied for S. typhimurium detection in milk. Graphical abstract One-pot process antimicrobial peptides Magainin I-Cu3(PO4)2 organic-inorganic nanocomposites (Fc@MI) were used as ideal electrochemical signal label, integrating both essential functions of biological recognition and signal amplification. Screen-printed carbon electrode (SPCE) was used as the electrochemical system for Salmonella typhimurium detection.

The study of relationship between acute myocardial injury and coagulation function in patients with COVID-19 / 医学研究生学报

ObjectiveTo study the relationship between acute myocardial injury（AMI） and coagulation function in patients with COVID-19.MethodsA retrospective study was carried out to record the general and laboratory data of 133 patients diagnosed with COVID-19 who were hospitalized in Wuhan TongJi Guanggu Hospital, Wuhan, Hubei Province from February 10 to February 29, 2020. The laboratory data includes blood routine, liver and renal function, myocardial infarction tests, coagulation function, inflammatory factors, hypersensitive C-reactive protein, procalcitonin etc. The patients were divided into two groups according to cardiac troponin I（TNI）34.2 ug/L. The differences of general conditions and laboratory data between the two groups were compared. Besides, the correlation between coagulation function and coagulation function, and the ROC curve of D-dimer in AMI were conducted .ResultsAmong the 133 patients, 9 (6.77%) had cTnI greater than 34.2 μg/L, and 124 (93.23%) had normal cTnI. There were significant differences between the two groups in age, COPD history, blood routine (neutrophil count, lymphocyte count, platelet count), myoglobin, liver function (direct bilirubin, indirect bilirubin), cytokines (IL-2 receptor, IL-6, IL-8, IL-10, TNF-α), coagulation function (PT, PTA, D-dimer). D-dimer level was positively correlated with TnI, CK-MB and myoglobin levels. The cut off value of D-dimer was 2.35 μg/ml in acute myocardial injury.ConclusionAcute myocardial injury in COVID-19 patients may be related to coagulation dysfunction. Therefore, monitoring of coagulation function dynamically, screening of thrombus and starting anticoagulant and antiplatelet therapy timely help to reduce acute myocardial injury.

The study of relationship between acute myocardial injury and coagulation function in patients with COVID-19 / 医学研究生学报

ObjectiveTo study the relationship between acute myocardial injury（AMI） and coagulation function in patients with COVID-19.MethodsA retrospective study was carried out to record the general and laboratory data of 133 patients diagnosed with COVID-19 who were hospitalized in Wuhan TongJi Guanggu Hospital, Wuhan, Hubei Province from February 10 to February 29, 2020. The laboratory data includes blood routine, liver and renal function, myocardial infarction tests, coagulation function, inflammatory factors, hypersensitive C-reactive protein, procalcitonin etc. The patients were divided into two groups according to cardiac troponin I（TNI）34.2 ug/L. The differences of general conditions and laboratory data between the two groups were compared. Besides, the correlation between coagulation function and coagulation function, and the ROC curve of D-dimer in AMI were conducted .ResultsAmong the 133 patients, 9 (6.77%) had cTnI greater than 34.2 μg/L, and 124 (93.23%) had normal cTnI. There were significant differences between the two groups in age, COPD history, blood routine (neutrophil count, lymphocyte count, platelet count), myoglobin, liver function (direct bilirubin, indirect bilirubin), cytokines (IL-2 receptor, IL-6, IL-8, IL-10, TNF-α), coagulation function (PT, PTA, D-dimer). D-dimer level was positively correlated with TnI, CK-MB and myoglobin levels. The cut off value of D-dimer was 2.35 μg/ml in acute myocardial injury.ConclusionAcute myocardial injury in COVID-19 patients may be related to coagulation dysfunction. Therefore, monitoring of coagulation function dynamically, screening of thrombus and starting anticoagulant and antiplatelet therapy timely help to reduce acute myocardial injury.

Preliminary experience in the treatment of severe COVID-19 / 医学研究生学报

Coronavirus disease(COVID-19) is a novel explosive infectious disease that has caused a serious public health crisis all over the world. The immunosuppression after novel coronavirus infection and insidiously progressive disease evolution lead to a series of unique characteristics of severe COVID-19 that are different from other severe infection.The key to reduce fatality rate of this disease is fully recognizing the evolution characteristics of severe COVID-19 patients, early warning and identification of patients who will progress to severe, and giving appropriate personalized nutrition support and organ function support scheme to the severe patients.So that we can buy the time for the patients to repair the immune function and remove viruses. This paper discussesed the special pathophysiological characteristics and clinical management of severe COVID-19 patients, so as to provide some references for the management of such patients in the future.

Changes of plasma acetylcholine and inflammatory markers in critically ill patients during early enteral nutrition: A prospective observational study.

BACKGROUND: Acetylcholine (Ach) is the key anti-inflammatory transmitter in the cholinergic anti-inflammatory pathway. In this study, critically ill patients treated with early enteral nutrition (EEN) were observed to explore whether EEN affected Ach levels and inflammation. METHODS: One hundred thirteen patients were included in this prospective observational study. All patients were provided the early enteral nutrition protocol 24-48 h after admission to the intensive care unit (ICU). Blood samples were collected, and the plasma levels of Ach, cholecystokinin (CCK), and inflammatory markers (tumour necrosis factor alpha (TNF-α), interleukin 1beta (IL1-ß), and IL6) were measured on Days 0, 1, 3, 5, and 7. Nutritional intervention data were recorded within one week, including the number of patients receiving nutrition, the number of days nutrition was provided, the caloric intake and protein intake, feeding intolerance and prokinetic drug administration. Other collected data included the sequential organ failure assessment score (SOFA score), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the use of mechanical ventilation (the number of patients and the duration), use of vasoactive drugs and the number of renal replacement treatments (RRT) received by each patient during their ICU stay. The primary outcome was 28-day mortality. Additionally, we analysed the correlation between plasma Ach levels and inflammation, as well as the correlation between plasma Ach and CCK levels. Moreover, a multivariate regression analysis was performed to examine the independent effects of different variables on 28-day mortality and Ach levels. RESULTS: The overall 28-day mortality was 28.3% (32/113). Eighty-two patients tolerated enteral nutrition. Compared with Day 0 15.6 (2.8) nmol/l, the plasma Ach level was significantly increased on Day 3 18.6 (6.7) nmol/l, Day 5 19.3 (6.2) nmol/l and Day 7 19.7 (4.3) nmol/l (p < .001). Compared with Day 0176.2 (50.4) pg/ml, the plasma TNF-α level was significantly decreased on Day 3144.0 (77.4) pg/ml, Day 5127.3 (51.8) pg/ml and Day 7111.4 (42.5) pg/ml (p < .05). Compared with Day 0, the plasma IL1-ß level was significantly decreased on Day 7 (p < .05). The plasma IL6 level was significantly decreased on Day 5 and Day 7 (p < .05) compared with Day 0. Compared with Day 0, the plasma CCK level was significantly increased on Day 3, 5 and 7 (p < .001). The correlation analysis revealed negative correlations between Ach levels and inflammation (p < .001), and a positive correlation between CCK and Ach levels (r = 0.775, p < .001). A comparison of patients who did or did not tolerate EEN revealed significant differences in the plasma levels of Ach, TNF-α, IL6 and CCK (p < .05). Significant differences in plasma levels of Ach, TNF-α, IL1-ß, IL6 and CCK were observed between 28-day survivors and non-survivors (p < .05). The multivariate logistic regression analysis identified vasopressor support, RRT, the administration of EEN, SOFA score, APACHE II score at ICU admission and plasma Ach levels as independent determinants of 28-day mortality. Additionally, the multivariate linear regression analysis identified EEN, plasma lactate, mechanical ventilation, the SOFA score and plasma CCK levels as independent determinants of plasma Ach levels. CONCLUSIONS: The administration of EEN to critically ill patients contributed to the increased plasma Ach levels and decreased inflammatory markers. The effect of EEN on Ach levels is partially attributed to the increase in CCK levels. Elevated plasma Ach levels indicate a better prognosis. Clinical trials identifier: NCT03612206.

Immunoassay for pathogenic bacteria using platinum nanoparticles and a hand-held hydrogen detector as transducer. Application to the detection of Escherichia coli O157:H7.

An innovative approach is presented for portable and sensitive detection of pathogenic bacteria. A novel synthetic hybrid nanocomposite encapsulating platinum nanoparticles, as a highly efficient catalyst, catalyzes the hydrolysis of the ammonia-borane complex to generate hydrogen gas. The nanocomposites are used as a label for immunoassays. A portable hand-held hydrogen detector combined with nanocomposite-induced signal conversion was applied for point-of-care testing of pathogenic bacteria. A hand-held hydrogen detector was used as the transducer. Escherichia coli O157:H7 (E. coli O157: H7), as detection target, formed a sandwich structure with magnetic beads and hybrid nanocomposites. Magnetic beads were used for separation of the sandwich structure, and hybrid nanocomposites as catalysts to catalyze the generation of hydrogen from ammonia-borane. The generated hydrogen was detected by a hydrogen detector using an electrochemical method. E. coli O157:H7 has a detection limit of 10 CFU·mL-1. The immunosensor made the hand-held hydrogen detector a point-of-care meter to be used outdoors for the detection and quantification of targets beyond hydrogen. Graphical abstract Schematic presentation of one-pot synthetic peptide-Cu3(PO4)2 hybrid nanocomposites embedded PtNPs (PPNs), encapsulating many Pt particles. The PPNs acts as an ideal immunoprobe for hand-held H2 detector signal readouts, by transforming pathogenic bacteria recognition events into H2 signals.

Disposable syringe-based visual immunotest for pathogenic bacteria based on the catalase mimicking activity of platinum nanoparticle-concanavalin A hybrid nanoflowers.

Disposable syringes were used in a novel point-of-care visual test for detecting pathogenic bacteria (Escherichia coli O157:H7 and Salmonella typhimurium). Hybrid nanoflowers composed of platinum nanoparticles and concanavalin A (Pt-nanoflowers) were prepared through a one-pot reaction and were found to be viable catalase mimics. They catalyze the decomposition of hydrogen peroxide (H2O2) to generate O2. When used as labels in immunoassays, they integrate both the functions of biological recognition and signal amplification. The disposable syringe pressure readout was combined with Pt-nanoflower signal conversion and successfully applied to a visual bacteria detection scheme. Both Escherichia coli O157:H7 and Salmonella typhimurium can be quantified with detection limits of as low as 15 and 7 CFU·mL-1, respectively. Graphical abstract One-pot synthetic platinum nanoparticle (PtNP)-concanavalin A hybrid nanoflowers (Pt-nanoflowers), have been used as ideal signal labels for immunoassays and integrating both essential functions of biological recognition and signal amplification. Disposable syringes were used as a readout to detect pathogenic bacteria.

Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study / 中华医学杂志(英文版)

BACKGROUND@#Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.@*METHODS@#We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.@*RESULTS@#Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001-1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264-8.609; P = 0.034).@*CONCLUSIONS@#This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Venovenous extra-corporeal membrane oxygenation for severe acute respiratory distress syndrome: a matched cohort study / 中华医学杂志(英文版)

Background@#Although the use of extra-corporeal membrane oxygenation (ECMO) has been rapidly increasing, the benefit of ECMO in patients with acute respiratory distress syndrome (ARDS) remains unclear. Our objective was to investigate the effect of venovenous ECMO (VV-ECMO) on adult patients with severe ARDS.@*Methods@#We conducted a multi-center, retrospective, cohort study in the intensive care units (ICUs) of six teaching hospitals between January 2013 and December 2018. Patients with severe ARDS who received VV-ECMO support were included. The detailed demographic data and physiologic data were used to match ARDS patients without ECMO. The primary endpoint was the 28-day mortality.@*Results@#Ninety-nine patients with severe ARDS supported by VV-ECMO and 72 patients without ECMO were included in this study. The acute physiology and chronic health evaluation II score was 23.1 ± 6.3 in the ECMO group and 24.8 ± 8.5 in the control group (P = 0.1195). The sequential organ failure assessment score was 12.8 ± 3.4 in the ECMO group and 13.7 ± 3.5 in the control group (P = 0.0848). The 28-day mortality of patients with ECMO support was 39.4%, and that of the control group was 55.6%. The survival analysis curve showed that the 28-day mortality in the ECMO group was significantly lower than that in the control group (P = 0.0097). Multivariate Cox regression analysis showed that the independent predictors of the 28-day mortality were the requirement of vasopressors before ECMO (hazard ratio [HR]: 1.006; 95% confidence interval [CI]: 1.001–1.013; P = 0.030) and duration of mechanical ventilation before ECMO (HR: 3.299; 95% CI: 1.264–8.609; P = 0.034).@*Conclusions@#This study showed that ECMO improved the survival of patients with severe ARDS. The duration of mechanical ventilation and the requirement of vasopressors before ECMO might be associated with an increased risk of death.

Fluid therapy for acute bowel obstruction: The value and its evaluation / 中国实用外科杂志

Bowel obstruction is one of the common acuteabdominal diseases in surgery. The primary task of itstreatment is to replace the effective circulating blood volumelost caused by loss of digestive juice and increased exudationof inflammation through fluid therapy,and stabilize thehemodynamic state of patients. Therefore,optimizing thetiming,amount and composition of fluid therapy according tothe pathophysiological characteristics of fluid loss in patientswith bowel obstruction,and evaluating the effect of fluidtherapy scientifically and reasonably by the cardiac preload,tissue perfusion and oxygen metabolism are the keys to improve fluid therapy for bowel obstruction.

Strategy of enhanced recovery in intensive care / 医学研究生学报

With the rapid development of critical care medicine, more and more patients can survive from the initial severe stress and though the acute period of the disease, but fail to recover completely and consequently develop chronic critical disease, leading to extended hospital stay in the ICU. To resolve this urgent problem in critical care medicine, we present an overview of the commonly accepted concepts of enhanced recovery in the ICU, focusing on early mobilization, phased strategy of nutrition treatment, appropriate analgesia and sedation, promotion of sleep recovery in the ICU, and protocolized family support intervention, so as to reduce various avoidable stresses and promote the recovery of the patient in the ICU.

The effects of light exposure on skeletal muscle wasting in rats with endotoxemia / 医学研究生学报

Objective Constant light exposure can lead to hypercatabolism. The aim of this study was to investigate the effects of different light rhythm on skeletal muscle metabolism in endotoxemia rats, and looked for the optimal light rhythm that could reduce skeletal muscle consumption and enhance the recovery of patients with sepsis. Methods 54 adult male S-D rats were randomly divided into 3 groups on average：Control group (intraperitoneal injection of normal saline +12h/12h light-dark cycle for 7 days), LPS- regular light group (intraperitoneal injection of lipopolysaccharide(LPS) +12h/12h light-dark cycle for 7 days) and LPS-constant light group (intraperitoneal injection of LPS + constant light for 7 days). All experimental animals were sacrificed on the 8th day. The level of skeletal muscle metabolites 3-methylhistidine (3-mh) and tyrosine, atrophy genes MAFbx and murf-1 mRNA and hypothalamic clock genes BMAL1, CLOCK and neuropeptide POMC were also detected. Results The food intake, weight growth ratio and the ratio of extensor digitorum longus/weight in the LPS-constant light group were significantly lower than those in the LPS-regular light group (P <0.05), and both groups were significantly lower than those in the control group (P <0.01). The skeletal muscle metabolites 3-methylhistidine(nmol/g) and tyrosine(nmol/g) in the LPS-constant light group rats (6.200±0.273 and 461.039±13.292) were significantly higher than those in the LPS- regular light group (5.197±0.263 and 375.744±20.308) and the control group (3.244±0.275 and 290.935±19.065,all P <0.05). The expression levels of atrophic genes MAFbx and murf-1 mRNA and tnf-alpha and il-1 mRNA in hypothalamus in the LPS-constant light group were significantly higher than those in the LPS- regular light group(P <0.05), and both groups were significantly higher than those in the control group (P <0.05). The expression of the clock genes(BMAL1 and CLOCK) in the showed obvious rhythm (SE (A) /A<0.3) in the LPS-regular light group and the control group. The expression of BMAL1 was highest at the beginning of the illumination period, while the expression of CLOCK was high during the illumination period and decreased during the darkness period. In the LPS-constant light group, the expression of BMAL1 and CLOCK rhythm lost rhythm. Conclusion Normal light rhythm can maintain the normal rhythm expression of hypothalamic clock gene in rats with endotoxemia and reduce POMC-mediated skeletal muscle consumption, which may be of positive significance for the enhanced recovery of sepsis.

The protective effect and mechanism of constant mild hypothermia on swine kidney after cardiac arrest and extracorporeal ardiopulmonary resuscitation / 医学研究生学报

Objective To evaluate the protective effect and mechanism of mild hypothermia on swine kidney after cardiopulmonary resuscitation, and whether changes in body temperature during mild hypothermia weaken the protective effect of mild hypothermia. Methods 18 swines were randomly divided into constant mild hypothermia group (CMH), variable mild hypothermia group (VMH) and control group (CON), with 6 swines in each group. Cardiac arrest model was successfully made. Then ECPR and temperature management was adopted. The target body temperature was 34℃ in the CMH group, and 37℃ in the control group, while the target body temperature of the VMH group fluctuated from 33 to 35 ℃ every two hours. After 24h, the animals were slowly reheated and then sacrificed. The kidneys were taken for real-time quantitative PCR, immunohistochemistry and histopathological examination. Results The expression levels of Bax, GRP78 and CHOP in the CMH group were lower than those in the CON group. Moreover, the expression of GRP78 in the CMH group were lower than those in the VMH group. The expression of Bcl-2 in the CMH group were higher than those in the VMH group and the CON group, and the expression of Bcl-2 in the VMH group were higher than those in the CON group (all P < 0.05). The positive expression of Bax was the most significant in the CON group and the least in the CMH group. The positive expression of Bcl-2 was the most significant in the CMH group and the least in the CON group. The nuclear membrane of porcine kidney cells shrank, nucleoli shrank and mitochondria swelled obviously in the CON group. The morphological injury changes were mild in the CMH group compared with the VMH group, while the CON group showed the severest change. Conclusion Mild hypothermia could attenuate the renal tubular cells apoptosis after cardiopulmonary resuscitation by inhibiting endoplasmic reticulum stress pathway, thus playing a protective role to the kidney. While aAbnormal temperature fluctuation during mild hypothermia maintenance may weaken the protection of kidney by mild hypothermia.

Characterization of quantitative EEG in patients with postoperative cognitive dysfunction / 医学研究生学报

Objective Very few studies have been reported on the application of quantitative electroencephalogram (qEEG) in patients with postoperative cognitive dysfunction (POCD). This study was to investigate the qEEG features of POCD and provide some help for the early detection and diagnosis of the condition. Methods We enrolled 31 postoperative patients treated in our Department of Critical Care Medicine from January 2018 to October 2018. Based on the pre- and post-operative scores on the Mini-Mental State Examination (MMSE), we divided the patients into a POCD (MMSE score >2, n = 11) and a non-POCD control group (MMSE score ≤2, n = 20). Using the brain function instrument, the electrode set according to the standard international 10-20 system and with bipolar longitudinal F3-P3 and F4-P4 four channels, we conducted bedside monitoring for all the patients and calculated the average value of the consecutive clips of 10-min qEEG. Then, we analyzed the amplitude-integrated EEG (aEEG), relative frequency band energy, relative α variability and spectrum entropy, and the correlation of relative frequency band energy and relative α variability with the MMSE scores. Results Compared with the non-POCD controls, the POCD patients showed significant decreases in the total MMSE scores (28.35 ± 1.27 vs 18.91 ± 2.34, P < 0.05), orientation score (9.75 ± 0.44 vs 6.82 ± 1.47, P < 0.05) and memory score (2.90 ± 0.31 vs 2.09 ± 1.04, P < 0.05) as well as in the concentration, calculation, recalling and language scores (all P < 0.05); and the POCD patients also exhibited marked reduction in the left α variability ([22.59 ± 10.98]% vs [14.39 ± 8.25]%, P < 0.05), right α variability ([24.07 ± 9.73]% vs [15.70 ± 9.59]%, P < 0.05), left α frequency band energy ([7.17 ± 4.73] vs [3.83 ± 2.62] μV2, P < 0.05) and right α frequency band energy ([6.94 ± 4.53] vs [3.82 ± 2.51] μV2, P < 0.05). The MMSE scores were found to be negatively correlated with left α variability (r = -0.793, P = 0.004), right α variability (r = -0.835, P = 0.001), left α frequency band energy (r = -0.633, P = 0.037) and right α frequency band energy (r = -0.682, P = 0.021). Conclusion Quantitative EEG of POCD patients is characterized by significantly decreased α variability and α frequency band energy, which may contribute to the early detection and diagnosis of POCD.