A child suffering from severe acute respiratory distress syndrome due to multiple trauma was treated with veno-veous extracorporeal membrane oxygenation with the dual lumen cannula: a case report / 中华危重病急救医学

Veno-veous extracorporeal membrane oxygenation (VV-ECMO) has been widely used in the treatment for severe acute respiratory distress syndrome (ARDS). Up to now, the routine access to establish VV-ECMO involves two-sites single lumen cannula via femoral vein and internal jugular venous in adult and children, while few studies about the dual lumen cannula (DLC) in VV-ECMO implemented in adult and children have been reported. On December 16, 2021, an unconscious child with severe ARDS due to multiple trauma caused by fatal falling from a height was admitted to Taihe Hospital. The initial diagnosis was hemorrhagic shock, bilateral hemopneumothorax, sternal fracture, cavity organ perforation, splenic rupture, and pelvic fracture and severe ARDS. Despite mechanical ventilation, he progressed to refractory hypoxemia and was treated with VV-ECMO after successful DLC placement in the right internal jugular vein by the mobile ECMO team of intensive care unit of the Union Hospital eventually. In addition, he received endoscopic sputum aspiration, prone position ventilation, anti-infection and nutritional treatment. His oxygenation gradually improved and he was successfully weaned from ECMO after 11 days. In this case, DLC simplified the process without any related complications, suggesting that it can be safely and effectively used in the treatment of Child's severe ARDS.

Clinical practice of double lumen cannula for veno-venous extracorporeal membrane oxygenation in adults / 中华危重病急救医学

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life support technique for patients with severe respiratory failure. In the past, single lumen cannula was mostly used to constract the vascular pathway of extracorporeal membrane oxygenation. Compared with single-lumen cannula, double lumen cannula (DLC) can reduce recirculation fraction, reduce complications such as infection and bleeding, and facilitate patient's rehabilitation. DLC requires accurate positioning of the catheter. It has been gradually applied in China. This paper will review the key points related to the use of DLC, such as the insertion, position, and complications, etc. to provide guidance for clinical application practice.

The infection evidence of SARS-COV-2 in ocular surface： a single-center cross-sectional study

PurposeThe aim of this study was to identify whether SARS-COV-2 infected in ocular surface. MethodsCross-sectional study of patients presenting for who received a COVID-19 diagnosis, from December 30, 2019 to February 7, 2020, at Tongji hospital, Tongji medical college, Huazhong University of Science and Technology. Demographics, temperature was recorded, blood routine test (Rt), chest Computed Tomography (CT) were took intermittently, and SARS-COV-2 real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay were arranged for the nasopharyngeal and conjunctival swab samples. ResultsA total of 102 patients (48 Male [50%] and 54 Female [50%]) with clinical symptoms, Rt, and chest Computed Tomography (CT) abnormalities were identified with a clinical diagnosis of COVID-19. Patients had a mean [SD] gestational age of 57.63 [14.90] years. Of a total of 102 patients identified, 72 patients (36 men [50%] and 36 women [50%]; mean [SD] age, 58.68 [14.81] years) confirmed by laboratory diagnosis with SARS-COV-2 RT-PCR assay. Only two patients (2.78%) with conjunctivitis was identified from 72 patients with a laboratory confirmed COVID-19. However, SARS-COV-2 RNA fragments was found in ocular discharges by SARS-COV-2 RT-PCR only in one patient with conjunctivitis. ConclusionsAlthough we suspect the incidence of SARS-COV-2 infection through the ocular surface is extremely low, the nosocomial infection of SARS-CoV-2 through the eyes after occupational exposure is a potential route. The inefficient diagnostic method and the sampling time lag may contribute to the lower positive rate of conjunctival swab samples of SARS-COV-2. Therefore, to lower the SARS-COV-2 nosocomial infection, the protective goggles should be wore in all the health care workers.

Clinical effect of acupoint injection of salmon calcitonin in the treatment of senile osteoporosis / 中国基层医药

Objective To observe the clinical effect of acupoint injection of salmon calcitonin in the treatment of senile osteoporosis. Methods From February 2016 to July 2017,136 elderly patients with osteoporosis admitted to Wenzhou Hospital of Traditional Chinese Medicine were included. The patients were randomly divided into two groups,with 68 cases in each group. The acupoint－injection group was given 50IU salmon calcitonin on day 1, day 2 100IU, one time per day, continuously used for 15 days for a course of treatment, and with an interval of 90 days,and repeat the course of treatment. The patients were given 0. 9% sodium chloride diluted to 2mL,inject 0. 5mL into bilateral Shenshu and Zusanli these two points. The intramuscular injection group was given the same dose of salmon calcitonin gluteus maximus injected intramuscularly. At the same time,both two groups were given calcium Erqi D tablets one tablet a day,alendronate once a week,each time 70mg fasting taken orally. The type Ⅰ collagen β－CTx,PINP,NBAP,femoral neck,femur trochanter,lumbar (L1 －L4) lumbar BMD and osteoporosis symptom score before and after treatment were compared. Results After treatment,the NBAP and BMD of the two groups were significantly higher than those before treatment (all P＜0. 05),and the β－CTx,PINP and symptoms scores were lower than before treatment (P＜0. 05). After treatment,NBAP in the acupoint injection group was (32. 36 ± 3. 03)μg/L, which was higher than (29. 66 ± 3. 20) μg/L in the intramuscular injection group(t =10. 477,P ＜0. 05). The β－CTx and PINP in the acupoint injection group were decreased to (0. 10 ± 0. 05)μg/L and (28. 78 ± 5. 23)μg/L, which were significantly lower than those in the intramuscular injection group[β－CTx(0. 20 ± 0. 05)μg/L,PINP (35.77 ±6. 49)μg/L(t =5. 983,2. 662,all P ＜0. 05)]. After treatment,the BMD of the femoral neck,femur trochanter and lumbar vertebra (L1 －L4) in the acupoint injection group were (0. 690 ± 0. 032)g/m2,(0. 620 ± 0. 010)g/m2and (0. 822 ± 0. 012)g/m2,respectively,which were higher than those in the intramuscular injection group[(0.652 ±0.012)g/m2,(0.572 ±0.022)g/m2and (0.801 ±0.011)g/m2(t=5.055,6.133,1.956,all P＜0. 05)]. After treatment,the improvements of TCM syndromes such as weakness in the waist and knees,tinnitus and deafness,loss of appetite,release of teeth,relaxation of two feet,weak tongue,weak pulse in the acupoint injection group were better than those in the intramuscular injection group (all P＜0. 05). Conclusion The acupoint injection of salmon calcitonin at Zusanli and Shenshu points is more effective than the intramuscular injection in the treatment of senile osteoporosis. It can significantly increase the serum NBAP,decrease the serum β－CTx,PINP,improve the BMD and improve the patients＇clinical symptoms,which means acupoint injection is a safe and effective way to treat senile osteoporosis.

Effect of Muscle-region Alignment Electroacupuncture in Treating Post-stroke Shoulder Pain and on the Levels of Serum ;IL-6, TNF-?, and NO / 上海针灸杂志

Objective To observe the therapeutic efficacy and action mechanism of muscle-region alignment electroacupuncture in treating post-stroke shoulder pain. Method Eighty patients were randomized into a muscle-region alignment needling group and a conventional acupuncture group. The Short-form McGill Pain Questionnaire (SF-MPQ), and serum levels of IL-6, TNF-?, and NO were majorly observed before and after the treatment. Result The muscle-region alignment electroacupuncture and conventional acupuncture both obviously reduced the SF-MPQ score and down-regulated the serum levels of IL-6, TNF-?, and NO, and the decreases by the muscle-region alignment electroacupuncture were more significant than that by the conventional acupuncture. Conclusion The action of muscle-region alignment electroacupuncture in treating post-stroke shoulder pain is plausibly by down-regulating serum levels of IL-6, TNF-?, and NO, reducing or inhibiting the production of inflammatory factors and restraining inflammation.

Effects of HIF - 1α on mitochondrial function of cardiomyocytes stimulated by lipopolysaccharide / 中华急诊医学杂志

ObjectiveTo investigate the effects of HIF-1α,on mitochondrial function of cardiomyocytes stimulated by lipopolysaccharide (LPS).MethodsCultured neonatal cardiomyocytes were randomly (random number) distributed to four groups (n =5).Control group:the neonatal cardiomyocytes were cultured in normal condition without any treatmeat; LPS group:cardiomyocytes were exposed to 1 μg/ml LPS for 2 h; YC-1 + LPS group:cardiomyocytes were exposed to 4 μmol/L YC-1 for 8 h before LPS treatment; YC-1 group:cardiomyocytes were exposed to 4μmol/L YC-1 for 8 h.As indexes of mitochondrial function,MMP,the content of ATP and the activity of cytochrome oxidase were measured,COX1/2 protein expression was determined by Western blotting.Results Compared with control group,LPS decreased MMP,the content of ATP and the activity of COX obviously ( P ＜0.05 ),depressed the expression of COX- 1 protein ( P ＜ 0.05 ),induced the expression of COX-2 protein ( P ＜ 0.05 ).Compared with the LPS group,MMP,the content of ATP and the activity of COX were markedly attenuated ( P ＜ 0.01 ),the expression of COX-1 was significantly increased and the expression of COX-2 was decreased in theYC-1 +LPS group (P ＜ 0.01 ).ConclusionsYC-1 attributes to the dysfunction of mitochondrial of myocyte by alterating the expression of COX-1 and 2, HIF-1α may attenuate the mitochondrial dysfunction of cadiomyocytes stimulated by LPS.

Role of autophagy in HL-1 cardiomyocyte injury induced by lipopolysaccharide / 中华麻醉学杂志

Objective To evaluate the role of autophagy in HL-1 cardiomyocyte injury induced by lipopolysaccharide( LPS).Methods Primary cultured HL-1 cardiomyocytes were randomly divided into 4 groups ( n =15each): normal control group( group C),LPS group,rapamycin( a autophagy inducer) group( group R) and 3-MA(a autophagy inhibitor) group.In group C cardiomyocytes were cultured continuously for 24 h.In group LPS cardiomyocytes were incubated with LPS (final concentration 1 μg/ml) for 24 h.In groups R and 3-MA,rapamycin and 3-MA was given 48 h before LPS (final concentration 1 μg/ml) incubation with final concentration of 0.2 μg/ml and 10 mmol/L respectively.The lipidated microtubule-associated protein 1 light chain 3 Ⅱ (LC3 Ⅱ ) expression,mitochondrial membrane potential,autophagosome number and optical density of mitochondria were determined,and ultrastructure of mitochondria was observed at 4 h of LPS incubation.Apoptosis rate and Caspase-3 activity were determined at 24 h of LPS incubation.Results LPS significantly increased LC3 Ⅱ expression,autophagosome number,optical density of mitochondria,apoptosis rate and Caspase-3 activity,decreased mitochondrial membrane potential in group LPS as compared with group C ( P ＜ 0.05).The LC3 Ⅱ expression,autophagosome number and mitochondrial membrane potential were higher,optical density of mitochondria,apoptosis rate and Caspase-3 activity lower in group R than in group LPS( P ＜ 0.05).The LC3 Ⅱ expression,autophagosome number and mitochondrial membrane potential were lower,optical density of mitochondria,apoptosis rate and Caspase-3 activity higher in group 3-MA than in group LPS (P ＜ 0.05).Mitochondrial histopathologic injury was reduced in group R and aggravated in group 3-MA as compared with group LPS.Conclusion Autophagy can reduce LPS-induced HL-1 cardiomyocyte injury by improving mitochondrial function and inhibiting apoptosis.

The role of reactive oxygen species and GADD153 protein in angiotension Ⅱ-induced eardiomyocyte apoptosis in vitro / 中华麻醉学杂志

Objective To examine the role of the reactive oxygen species (ROS) and GADD 153 protein in angiotensin Ⅱ (Ang Ⅱ)-induced cardiomyocyta apeptosis in vitro.Methods Cardiomyocytes were isolated from ventricles of healthy 1-2 day old Wistar mrs of both sexes weighing 5-10 g and cultured in high glucose culture medium in an incubator filled with 5% CO2 at 37℃.The cardiomyocytes were randamiy allocated to one of 9 groups (n=5 each): group Ⅰ control (C); group Ⅱ ,Ⅲ,Ⅳ: cardiomyocytes were exposed to Ang Ⅱ 100 nmol/L for 6 h,12 h or 24 h respectively ( Ang Ⅱ 6,Ang Ⅱ12,Ang Ⅱ24) ; group Ⅴ:cardiomyocytes were preincubated with N-acetyl-L-cysteine (NAC) 5 mmol/L for 2 h before being exposed to Aag Ⅱ 100 nmol/L for 24 h (NAC + Ang Ⅱ); group Ⅵ:cardiomyocytes were exposed to NAC 5 mmol/L for 24 h (NAG); group Ⅶ:cardiomyocytes were tranfected with GADD153 antisense oligo-denxynueleotida (onti-ODN) 10 μmol/L for 24 h before being exposed to Ang Ⅱ 100 nmol/L for 24 h; group Ⅷ: cardiomyocytes were transfected with missense oligo-deoxynucleotide (mis-ODN) 10 μmol/L for 24 h before being exposed to Ang Ⅱ 100 nmol/L for 24 h and group Ⅸ: cardiomyocytes were exposed to transfection agent of same concentration for 24 h.Viability of myocytes was measured by MTT assay; ROS production was determined by spectropbotometry; apoptosis in cardiomyocytes was detected by staining with Hoechst33342; the percentage of Annexin V positive and PI negative myocytes was measured by flow cytometry as apoptosis rote and GADD153 protein expression was determined by Western blotting.Remits The viability of myocytes was significantly lower,while the ROS production,apoptosis rate and GADD153 protein expression in myocytes were significantly higher in group Ⅱ,Ⅲ,and Ⅳ(Ang Ⅱ6,Ang Ⅱ12,AngⅡ24) than in control group (P＜0.05).The cell viability was significantly higher and the ROS production,apoptosis rate and GADD153 protein expression in myocytes were significantly lower in groupⅤ(NAC+AngⅡ)and Ⅶ(anti-ODN + Ang Ⅱ) than in group Ang Ⅱ24(Ⅳ).Conclusion Angiotensin Ⅱ induces cardiomyocyte apoptosis by increasing ROS production and up-regulating GADD153 protein expression.

Sodium tanshinone IIA sulfonate depresses angiotensin II-induced cardiomyocyte hypertrophy through MEK/ERK pathway

Cardiomyocyte hypertrophy is a major cause of morbidity and mortality worldwide. The aim of this study is to determine the effects of sodium tanshinone IIA sulfonate (STS) on cardiomyocyte hypertrophy induced by angiotensin II (Ang II) in vivo and in vitro. In long-term treatment, adult Wistar rats were infused with Ang II for three weeks via osmotic mini-pumps and some of them were given intragastrically of STS. Left ventricle was isolated; the ratio of left ventricular weight to body weight and systolic blood pressure (SBP) were determined and heart morphometry was assessed after hematoxylin and eosin staining. Results indicated STS inhibited Ang II-induced increases in myocyte diameter and decreased the LVW/BW ratio independent of decreasing systolic blood pressure. In vitro, treatment of cultured cardiomyocytes with STS inhibited Ang II-induced increase in cell size, protein synthesis, ANP expression, activation of extracellular signal-regulated kinase (ERK) and ERK kinase (MEK). Then we reexamined the mechanism of STS-induced anti-hypertrophic effects. Results revealed MEK inhibitor U0126 (20 microM) markedly enhanced STS-induced depressions in [3H]leucine incorporation and ANP expression. In conclusion, MEK/ERK pathway plays a significant role in the anti-hypertrophic effects of STS.

Effect of CHOP/GADD153 on cardiomyocyte apoptosis induced by angiotensin Ⅱ in vitro / 中国病理生理杂志

AIM: To investigate the relationship between alteration of CHOP/GADD153 protein expression and cardiomyocyte apoptosis induced by angiotensin Ⅱ (AngⅡ), and inhibitory effects of CHOP/GADD153 antisense oligodeoxynucleotide (anti-ODN) on apoptosis in vitro.METHODS: Cultured neonatal cardiomyocytes were exposed to AngⅡ with or without preincubation of CHOP/GADD153 anti-ODN. Variability of myocytes was measured by MTT assay, the lactate dehydrogenase (LDH) release was also detected, the percentage of annexin V positive myocytes was monitored by flow cytometry as apoptosis rate, CHOP/GADD153, Bcl-2 and Bax expressions were determined by Western blotting. RESULTS: Compared with control group, the expression of CHOP/GADD153 was obviously increased from (0.20?0.02 to 0.75?0.06) in AngⅡ group (P