ExtraCorporeal Membrane Oxygenation in the therapy for REfractory Septic shock with Cardiac function Under Estimated (ECMO-RESCUE): study protocol for a prospective, multicentre, non-randomised cohort study.

INTRODUCTION: Severe septic cardiomyopathy (SCM) is one of the main causes of refractory septic shock (RSS), with a high mortality. The application of venoarterial extracorporeal membrane oxygenation (ECMO) to support the impaired cardiac function in patients with septic shock remains controversial. Moreover, no prospective studies have been taken to address whether venoarterial ECMO treatment could improve the outcome of patients with sepsis-induced cardiogenic shock. The objective of this study is to assess whether venoarterial ECMO treatment can improve the 30-day survival rate of patients with sepsis-induced refractory cardiogenic shock. METHODS AND ANALYSIS: ExtraCorporeal Membrane Oxygenation in the therapy for REfractory Septic shock with Cardiac function Under Estimated is a prospective, multicentre, non-randomised, cohort study on the application of ECMO in SCM. At least 64 patients with SCM and RSS will be enrolled in an estimated ratio of 1:1.5. Participants taking venoarterial ECMO during the period of study are referred to as cohort 1, and patients receiving only conventional therapy without ECMO belong to cohort 2. The primary outcome is survival in a 30-day follow-up period. Other end points include survival to intensive care unit (ICU) discharge, hospital survival, 6-month survival, quality of life for long-term survival (EQ-5D score), successful rate of ECMO weaning, long-term survivors' cardiac function, the number of days alive without continuous renal replacement therapy, mechanical ventilation and vasopressor, ICU and hospital length of stay, the rate of complications potentially related to ECMO treatment. ETHICS AND DISSEMINATION: The trial has been approved by the Clinical Research and Application Institutional Review Board of the Second Affiliated Hospital of Guangzhou Medical University (2020-hs-51). Participants will be screened and enrolled from ICU patients with septic shock by clinicians, with no public advertisement for recruitment. Results will be disseminated in research journals and through conference presentations. TRIAL REGISTRATION NUMBER: NCT05184296.

Lipid accumulation product is a better predictor of metabolic syndrome in Chinese adolescents: a cross-sectional study.

Aim: Confirm and compare the degree of associations of non-traditional lipid profiles and metabolic syndrome (MetS) in Chinese adolescents, determine the lipid parameter with better predictive potential, and investigate their discriminatory power on MetS. Methods: Medical measurements, including anthropometric measurements and biochemical blood tests, were undergone among a total sample of 1112 adolescents (564 boys and 548 girls) aged from 13 to 18 years. Univariate and multivariate logistic regression analyses were applied for assessing the relationships between the levels of traditional/non-traditional lipid profiles and MetS. We performed Receiver Operating Characteristic (ROC) analyses to mensurate the effectiveness of lipid accumulation product (LAP) on the diagnosis of MetS. Meanwhile, areas under the ROC curve and the cut-off values were calculated for MetS and its components. Results: Univariate analysis showed that all our lipid profiles were closely associated with MetS (P< 0.05). LAP index showed the closest association with MetS than the other lipid profiles. Additionally, ROC analyses indicated that the LAP index showed sufficient capabilities to identify adolescents with MetS and its components. Conclusion: The LAP index is a simple and efficient tool to identify individuals with MetS in Chinese adolescents.

Interplay between dietary intake, gut microbiota, and metabolic profile in obese adolescents: Sex-dependent differential patterns.

BACKGROUND & AIMS: The interplay among dietary intake, gut microbiota, gut metabolites and circulating metabolites in adolescents is barely known, not to mention sex-dependent pattern. We aimed to explore unique profiles of gut bacterial, gut metabolites and circulating metabolites from both genders of adolescents due to BMI and eating pattern. METHODS: Clinical indices, fecal gut microbiota, fecal and plasma metabolites, and diet intake information were collected in case-control sample matched for normal and obesity in girls (normal = 12, obesity = 12) and boys (normal = 20, obesity = 20), respectively. 16S rRNA gene sequencing and untargeted metabolomics was performed to analysis the signature of gut microbiota and metabolites. Unique profiles of girls associated with BMI and eating pattern was revealed by Spearman's correlations analysis, co-occurrence network analysis, Kruskal-Wallis test, and Wilcoxon rank-sum test. RESULTS: Gender difference was found between normal and obese adolescents in gut microbiota, fecal metabolites, and plasma metabolites. The Parabacteroides were only decreased in obese girls. And the characteristic of obese girls' and boys' cases in fecal and plasma was xanthine and glutamine, ornithine and LCA, respectively. Soy products intake was negatively associated with Parabacteroides. The predicted model has a higher accuracy based on the combined markers in obesity boys (AUC = 0.97) and girls (AUC = 0.97), respectively. CONCLUSIONS: Reduced abundance of Phascolarctobacterium and Parabacteroides, as well as the increased fecal xanthine and ornithine, may provide a novel biomarker signature in obesity girls and boys. Soy products intake was positively and negatively associated with Romboutsia and Parabacteroides abundance, respectively. And the combined markers facilitate the accuracy of predicting obesity in girls and boys in advance.

Relationship between bone mineral density and the risk of breast cancer: a systematic review and dose-response meta-analysis of ten cohort studies.

PURPOSE: The evidence from recent epidemiological studies investigating the relationship between bone mineral density (BMD) and the risk of breast cancer (BC) remains inconsistent. MATERIALS AND METHODS: The PubMed, EMBASE, and Web of Science databases were comprehensively searched by two independent authors to identify related cohort studies from the inception of the databases through January 31, 2018. Similarly, two researchers separately extracted the data from the selected studies, and any differences were resolved by discussion. Summarized relative risks (RRs) and 95% CIs were summarized via inverse variance weighted random-effects meta-analysis. Heterogeneity among studies was assessed with the I 2 statistic. RESULTS: Ten studies with 1,522 BC patients among 81,902 participants were included in this meta-analysis. Compared to the participants with the lowest BMD at the lumbar spine, those with the highest BMD had a significantly lower RR for BC (RR =0.75; 95% CI =0.60-0.93; I 2=23.0%). In the subgroup analyses, although the directions of the results were consistent with those of the main findings, not all showed statistical significance. We failed to detect an association between BMD at the femoral neck or total hip and the risk of BC (RR =0.94; 95% CI =0.66-1.33; I 2=72.5%). Furthermore, the results of the dose-response analysis did not show a significant association between BMD at the lumbar spine, femoral neck, or total hip and the risk of BC. Funnel plot and statistical analyses showed no evidence of publication bias. CONCLUSION: There is no relationship between BMD and the risk of BC. More prospective cohort studies are warranted to further investigate this issue.

[Risk factors on chronic obstructive pulmonary disease among greenhouse workers in Liaoning province].

OBJECTIVE: To study the risk factors of chronic obstructive pulmonary disease (COPD) among greenhouse farmers in Liaoning province. METHODS: According to geographical differences in Liaoning province, stratified-cluster-random sampling method was used. A total of 5420 greenhouse farmers working in more than 800 greenhouses were investigated with unified questionnaire, physical examination, blood routine examination, blood gas analysis, chest X-ray and pulmonary function tests. Diagnosis of COPD was made according to the criteria for "chronic obstructive pulmonary disease of diagnosis and treatment guidelines" (2007 revision) by the Chinese Respiratory Disease Society. RESULTS: The total number of farmers under study was 5880, including 5420 respondants (92.18%) with effective data. Risk factors were found on age (χ2=32.530, P=0.000), time working in greenhouses every day (χ2=21.311, P=0.000), frequency of ventilation (χ2=9.791, P=0.007) and the location of the greenhouses (χ2=73.645, P=0.000). When using SPSS 17.0 for the single factor logistic regression analysis, results indicated that smoking (OR=1.976, 95%CI: 1.672 - 2.334), age (OR=4.188, 95%CI: 3.718-4.718), greenhouses for fungus (compared with vegetables, OR=1.302, 95%CI: 1.016-1.669), flowers and plants (compared with vegetables greenhouses, OR=1.503, 95%CI: 1.201-1.880) were the risk factors of COPD among greenhouse farmers while the protective factor was the years of working in the greenhouse (OR=0.684, 95%CI: 0.609-0.767). CONCLUSION: The overall morbidity of COPD among greenhouse farmers in Liaoning province was 17.47% with various risk factors.

[Comparative study of recruitment maneuver guided by pressure-volume curve on respiratory physiology and lung morphology between acute respiratory distress syndrome of pulmonary and extrapulmonary origin in canine models].

OBJECTIVE: To determine effects of recruitment maneuver (RM) guided by pressure-volume (P-V) curve on respiratory physiology and lung morphology in canine models of acute respiratory distress syndrome of pulmonary or extrapulmonary origin (ARDSp and ARDSexp). METHODS: Twenty-four healthy dogs were randomly divided into two groups with 12 dogs each: ARDSexp and ARDSp. Each dog in ARDSexp group was injected with oleic acid 0.1 ml/kg through femoral vein, and each dog in ARDSp group received hydrochloric acid 2 ml/kg via trachea. Subsequently, dogs with both models were randomly subdivided into lung protective ventilation strategy (LPVS) group and LPVS+RM group, respectively. Dogs in LPVS group were given LPVS only without RM. RM guided by P-V curve was performed in LPVS+RM group followed by LPVS and pressure controlled ventilation (PCV) mode was selected. Phigh was set at upper inflection point (UIP) of the P-V curve, positive end-expiratory pressure (PEEP) was set at lower inflection point (LIP)+2 cm H(2)O (1 cm H(2)O=0.098 kPa), and the duration of RM was 60 seconds. The duration of mechanical ventilation (MV) in both subgroups was 4 hours. The oxygenation index (PaO(2)/FiO(2)), relative lung mechanical indexes were measured in two ARDS models before establishment of ARDS model, and before and after RM. The UIP and LIP were calculated with P-V curve. The percentage of different volume in ventilation of lung accounting for total lung volume was compared by CT scan. RESULTS: The PaO(2)/FiO(2), UIP and LIP did not showed significant differences among all groups before ARDS and before RM. PaO(2)/FiO(2) and respiratory system compliance (Crs) were significantly elevated in LPVS+RM group of both models 4 hours after RM compared with corresponding LPVS group [PaO(2)/FiO(2) (mm Hg, 1 mm Hg=0.133 kPa) of ARDSexp model: 263.9±69.2 vs. 182.8±42.8, Crs (ml/cm H(2)O) of ARDSexp model: 11.3±4.2 vs. 9.7±3.7; PaO(2)/FiO(2) (mm Hg) of ARDSp model: 193.4±33.5 vs. 176.4±40.2, Crs (ml/cm H(2)O) of ARDSp model: 10.1±3.9 vs. 9.0±3.9, P<0.05 or P<0.01], and the airway pressure was significantly declined compared with corresponding LPVS group [peak inspiratory pressure (PIP), cm H(2)O ] of ARDSexp model: 24.1±7.4 vs. 30.2±8.5, plateau pressure (Pplat, cm H(2)O) of ARDSexp model: 19.1±7.3 vs. 25.6±7.7; PIP (cm H(2)O) of ARDSp model: 26.6±8.4 vs. 29.6±10.3, Pplat (cm H(2)O) of ARDSp model: 21.9±7.3 vs. 25.1±8.4, P<0.05 or P<0.01]. Moreover, PaO(2)/FiO(2), Crs, PIP and Pplat were improved better in ARDSexp model than ARDSp model (P<0.05 orP<0.01). Compared with LPVS maneuver, RM plus LPVS maneuver could significantly decrease the proportion of closure and hypoventilation region, and increase the proportion of normal ventilation region in both models [closure region of ARDSexp model: (9.9±3.1)% vs. (16.3±5.2)%, hypoventilation region of ARDSexp model: (10.2±4.2)% vs. (23.4±6.7)%, normal ventilation region of ARDSexp model: (76.2±12.3)% vs. (57.5±10.1)%; closure region of ARDSp model: (14.3±4.8)% vs. (18.2±5.1)%, hypoventilation region of ARDSp model: (17.4±6.3)% vs. (24.1±5.9)%, normal ventilation region of ARDSp model: (63.2±10.7)% vs. (54.6±11.3)%, P<0.05 or P<0.01]. All of the ventilation regions were better improved with ARDSexp model than ARDSp model (all P<0.05). CONCLUSION: RM guided by P-V curve could help obtain better oxygenation, improve pulmonary compliance and lung ventilation in ARDSexp and ARDSp, and better treatment effects are seen in ARDSexp dogs than ARDSp dogs.

[An epidemiological study of chronic obstructive pulmonary disease in greenhouse farmers in Liaoning Province from 2006 to 2009].

OBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in greenhouse farmers in Liaoning Province from 2006 to 2009. METHODS: By stratified-cluster random sampling, a survey of 5420 greenhouse farmers working in 835 plastic greenhouses was performed using uniform questionnaires in Shenyang, Chaoyang, and Jinzhou during 2006 and 2009. Physical examination and lung function tests were performed for all of the farmer. Blood routine examinations, blood gas analysis, and chest X-ray were performed for some of the subjects with respiratory symptoms and healthy controls. The chi-square test was used for comparison of the 2 sample rates, and the chi-square segmentation method for more. RESULTS: The overall prevalence of COPD in greenhouse farmers in Liaoning Province was 17.5% (947/5420). Most patients were elderly, especially at the age of 50 years or older. The prevalence of COPD in greenhouse farmers in the plain areas was 15.6% (464/2981), which was lower than that in the mountains (20.2%, 246/1220) and coastal areas (19.4%, 237/1219), with a significant difference (the value of χ(2) were 13.04 and 9.35, all P < 0.0125). The prevalence of COPD in vegetable greenhouse farmers was 12.6% (273/2168), which was lower than that in fungus greenhouse farmers (24.3%, 263/1084), poultry greenhouse farmers (20.8%, 169/813) and flowers greenhouse farmers (17.9%, 242/1355), with a significant difference (the value of χ(2) were 71.49, 31.44 and 18.54, all P < 0.007). The prevalence of COPD was the highest (28.3%, 137/485) in farmers who had worked in the greenhouses for 3 to 5 years. CONCLUSIONS: The overall prevalence of COPD in greenhouse farmers in Liaoning Province was higher than that reported in the rural areas nationally. Attention should be paid to the prevention and control of COPD in greenshouse farmers.

Expanding expression of the 5-lipoxygenase/leukotriene B4 pathway in atherosclerotic lesions of diabetic patients promotes plaque instability.

Emerging evidence now indicates that the 5-lipoxygenase (5-LO) pathway play a role in the pathogenesis of atherosclerosis and restenosis. The expression of 5-LO by activated macrophages in symptomatic plaques leads to leukotriene B(4) (LTB(4)) accumulation and enhanced synthesis and release of matrix metalloproteinases (MMPs) that can promote plaque rupture. However, the role of 5-LO pathway in diabetic vascular disease has not been previously reported. Thus, the present study was designed to analyze the expression of 5-LO in carotid plaques of diabetic patients and to investigate the possible role of 5-LO pathway in the pathogenesis and progression of diabetic atherosclerosis. Atherosclerotic plaques from 60 patients undergoing carotid endarterectomy were divided into non-diabetic and diabetic group. Plaques were analyzed for 5-LO, MMP-2 and MMP-9 by immunohistochemical, Western blot, and densitometric analyses, whereas zymography was used to detect MMP activity. Immunocytochemistry was also used to identify CD68+macrophages, CD3+T-lymphocytes, and HLA-DR+inflammatory cells. LTB(4) were quantified by enzyme-linked immunosorbent assay. 5-LO showed abundant immunoreactivity in human atherosclerotic carotid lesions, and was colocalized with macrophage infiltrates in atherosclerotic intima. 5-LO expression was higher in diabetic compared with non-diabetic plaques and was associated with increased MMP-2 and MMP-9 expression. Follow-up analyze with zymography assay revealed MMP activity was elevated in diabetic compared with non-diabetic plaques. Notably, in contrast to non-diabetic plaques, LTB(4) levels were significantly increased in diabetic plaques by enzyme-linked immunosorbent assay. These results suggest that overexpression of 5-LO and LTB(4) in atherosclerotic plaques possibly promote MMP-induced plaque rupture in diabetes. Hence, anti-LTs may be useful, not only in reducing atherogenesis, but also in the prevention and treatment of acute atherothrombotic events in diabetic patients.

[Effects of yixintong on regulating cellular calcium channels].

OBJECTIVE: To explore the protecting mechanism of Yixintong for heart ischemia-reperfusion injury at cellular and subcellular levels, by observing the effects of Yixintong on three kinds of calcium channels. METHOD: The effects of Yixintong on Ca2+ influx on leak calcium channel, receptor-operationg calcium channel (ROC) and pulse-dependent calcium channel (PDC) were observed respectively, by using rat aortic smooth muscle cell and radioactive 45Ca technique. RESULT: Yixintong has no effects on leak calcium channel, but can inhibit the Ca2+ influx in ROC and PDC significantly. CONCLUSION: Yixintong can inhibit the Ca2+ influx in slow channel in a dose-dependent manner.