Safe airway management is the eternal theme of anesthesiologists: interpretation and analysis of the hot issues of the second World Airway Management Meeting / 中华麻醉学杂志

Safe airway management is the primary task of anesthesiologists.Anesthesiologists must have good airway management skills including dealing with all kinds of difficult airway in time and effectively to ensure the ventilation and oxygenation of patients and to avoid regurgitation and aspiration.The second World Airway Management Meeting held in Netherlands in November 2019 discussed fourteen topics related to airway management.This article will focus on six hot issues in this session, namely, 1.Human factors and safe airway management; 2.Management of patients with full stomach; 3.Difficult Airway Society (DAS) Awake Tracheal Intubation (ATI) guidelines; 4.Whether awake tracheal intubation can solve all the difficult airway, and whether succinylcholine is out of date; 5.The Universal Management of Airways Guidelines; 6.Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE). The purpose of interpreting and analyzing the above hot issues is to timely update the knowledge of airway management for anesthesiologists, and to improve the understanding and mastery of airway management, especially difficult airway management.

Research progress on pain assessment in the elderly with dementia / 中华老年医学杂志

The elderly represent a segment with a high incidence of pain.Consciousness impairment and language dysfunction increase the difficulty of pain assessment.At the same time, a lack of understanding of neuropathic mechanisms and assessment scales often leads to inappropriate pain assessment in the elderly with dementia.This article reviews the relationship between dementia and pain, pain assessment protocols and the use of scales in the elderly with dementia.

A preliminary study of 24-segment spherical indexes of fetal ventricles in the middle and late trimestries by automatic fetal heart quantification / 中华超声影像学杂志

Objective:To explore the clinical application value of fetal heart quantification (fetal HQ) in the analysis of 24-segment spherical index (SI) of fetal heart in normal second and third trimestries.Methods:In July 2019, sixty-five normal singletons with gestational age (GA) of 28(24, 31) weeks were examined by echocardiography in Sir Run Run Shaw Hospital. The global spherical index (GSI) of the heart was measured and the dynamic images of the standard four chamber view were collected. Twenty-four-segment SI of the left and right ventricles were measured by using the fetal HQ analysis system and the correlation between SI and gestational age was analyzed.Results:There were no significant correlations between GSI, SI of left and right ventricles and gestational age ( r s=-0.22-0.14, all P>0.05). The SI of the first segment of left ventricle was lower than those of the other 23 segments (all P<0.05). There were no significant differences of SI among the second to the eleventh segments of the left ventricle (all P>0.05). In the 13th to the 24th segments of the left ventricle, the closer to the apex of the heart, the greater the SI of the segment were noted (all P<0.05). For the right ventricle, the closer to the apex of the heart, the greater the SI of the 4th to the 24th segments were found (all P<0.05), and there were no significant differences in SI among the first to third segment( P>0.05). The success rate of fetal HQ software was 95.4%. Conclusions:The 24-segment SI of RV and LV provides a feasible and reliable quantitative method which allows for the assessment of fetal heart function from the four-chamber view.

The distribution characteristics of urine flora in patients with ureteral stent tube crusting / 中华泌尿外科杂志

Objective:To investigate the distribution characteristics of bacteria in urine of patients with ureteral stent crusting.Methods:Thirty-five patients who underwent ureteral stent placement at the Shandong Provincial Third Hospital, Shandong University Qilu Hospital, Jinan Central Hospital, and Jinan Jigang Hospital were selected from October, 2018 to March, 2019(the clinical study registration number is ChiCTR1800020025). The inclusion criteria were patients who had the stent intubated for 4 weeks after ureteroscopic lithotripsy, aged between 18 and 65 years. Exclusion criteria were patients with positive urine bacterial culture, severe gross hematuria, recent oral antibiotics, and patients with significant residual stones. This clinical study uses a cross-sectional study method, and those patients were divided into crusting group (n=23) and non-crusting group (n=12) according to the presence or absence of stent crusting. On the day of extubation, urine of the patients was collected for bacterial 16s DNA detection. The distribution characteristics of bacteria in urine of the two groups were analyzed using UPARSE, UCHIME and RDP calssifier. The total number of bacteria species, bacterial abundance and bacterial species with large-scale abundance in urine of the two groups were determined. The quantity of bacteria species and bacterial abundance in the urine between the two groups were compared, and the bacterial species with large-scale abundance in urine of the patients with stent crusting were identified.Results:There were no significant differences in general information such as age, body mass index, gender, affected side, type of stent tube, and stone composition between the two groups. Using 16s DNA sequencing to detect the bacteria in the urine of the two groups revealed that the number of bacterial species with abundance >1% was 11, and the number of bacterial species with abundance >0.01% was 74 in the crusting group. In the non-crusting group, the number of bacterial species with abundance >1% and >0.01% was 7 and 11, respectively. Compared with the non-crusting group, the number of bacterial species with abundance >1% in the crusting group was significantly larger ( t=5.12, P=0.000). In the crusting group, bacterial species with the top three abundance were g_Lactobacillus (23.1%), g_Bacteroides (18.8%) and g_norank_Bacteroides (17.1%). In the non-crusting group, bacterial species with the top three abundance were g_Escherichia-Shigella (32.2%), g_Enterococcus (24.9%) and g_Pseudomonas (18.2%). The three bacteria with the greatest difference between the two groups were g_ Lactobacillus ( P=0.010), g_Bacteroides ( P=0.004) and g_norank_Bacteroides ( P=0.004), respectively. Conclusion:The species and quantity of bacteria in the urine of patients with stent crusting are both significantly larger than those of patients without stent crusting. Bacteroides with larger-scale abundance in the urine of patients with stent crusting may promote the deposition of crystals on the stent wall through its structure, function and urease positive characteristics.

The role of PDK1 in the transition of endothelial to hematopoietic cells / 中华血液学杂志

Objective@#To explore the role of PDK1 in the transition of endothelial to hematopoietic cells and its effect on the generation and normal function of HSC.@*Methods@#PDK1 was deleted specifically in endothelial cells expressing VEC (Vascular Endothelial Cadherin). CFU-C was performed to detect the effect of PDK1 on the function of hematopoietic progenitor cells using the cells from PDK1fl/fl, PDK1fl/+ and Vec-Cre; PDK1fl/fl AGM region. Hematopoietic stem cell transplantation assay was conducted to determine the effect of PDK1 on hematopoietic stem cells. Flow cytometry was performed to analyze the influence of PDK1 on percentage, cell cycle and apoptosis of CD31+c-Kithigh cell population. Real-time PCR was conducted to measure the expression of transcription factors involved in process of transition from endothelial to hematopoietic cells.@*Results@#In contrast to the wild type group, the CFU from PDK1-deficient hematopoietic progenitor cells showed smaller in morphology and fewer in quantity. CFU-GM was (24±5)/ee in knockout group, and the control group was (62±1)/ee (P=0.001). PDK1 deletion severely impaired the ability to repopulate hematopoietic cells and differentiate into committed cells. hematopoietic progenitor cells from knockout group was transplanted into 5 recipients without any recipients reconstructed. However, 5 of 7 recipients were reconstructed in control group (P=0.001). The proportion of intra-vascular clusters in the AGM was decreased (the frequency of CD31+c-Kithigh in the knockout group was (0.145±0.017)%, and the control group ratio was (0.385±0.040)% (P=0.001), but not due to the inhibition of cell proliferation and/or increase of apoptosis. Further study found that the absence of endothelial PDK1 causes a decreased expression of RUNX1, P2-RUNX1, GATA2 and other important hematopoietic-related transcription factors in hemogenic cluster.@*Conclusion@#PDK1 deletion impairs the transition of endothelial cells to hematopoietic cells as well as the generation and function of HSC.

Quantitative assessment of the ductus arteriosus in normal fetuses in the second-third trimester using intelligent spatiotemporal image correlation with fetal heart navigator / 中华超声影像学杂志

Objective To explore the feasibility of intelligent spatiotemporal image correlation-fetal heart navigator(iSTIC-FHN) in the display of the ductal arch view in normal fetuses ,and to compare two-dimensional echocardiography( 2DE) and iSTIC-FHN based measures of ductus arteriosus( DA ) in normal fetuses . Methods Two hundred and eleven normal fetuses with gestational age of 22 - 32 weeks were enrolled . Each fetus had undergone conventional 2DE examination and the iSTIC fetal cardiac volumes were obtained .The volume datasets were analyzed offline using new automatic software ( the Fetal Heart Navigator ,FHN ) . The diameter of DA were measured by 2DE and iSTIC based FHN ,respectively . Pearson's correlation analysis was used to examine the relation between gestational age and diameter of DA for both 2DE and iSTIC-FHN . The measurement of the diameters of ductus arteriosus by two methods were compared . Results The ductal arch view using FHN was successfully obtained in 165(78 .2％ ) cases among 211 normal cases . The comparison of 2DE and iSTIC-FHN in the measurement of the DA was made in 131(62 .1％ ) normal fetuses . Mean 2DE DA increased from ( 3 .00 ± 0 .23) mm at 22 weeks to ( 5 .42 ± 0 .26) mm at 32 weeks . Mean iSTIC-FHN DA increased from ( 2 .96 ± 0 .21) mm at 22 weeks to ( 5 .36 ± 0 .17) mm at 32 weeks . There was a good correlation between the two methods ( Pearson's R 2 = 0 .942 ,P =0 .539) . Bland-Altman plot showed the 95％ limits of agreement was ( - 0 .3287 ,0 .3111) . Conclusions iSTIC-FHN is the potential tool for the evaluation of the ductal arch view .

Comparision of the treatment and short-term and one-year prognosis from acute heart failure in tertiary hospitals versus secondary hospitals-findings from Beijing Acute Heart Failure Registry (Beijing AHF Registry) / 中华急诊医学杂志

Objective To assess and compare the incidence,clinical characteristics,treatment,and prognosis of acute heart failure patients from different grades hospitals in Beijing.Methods In this prospective internet prognosis registered study (Beijing AHF Registry),a total of 3 335 consecutive patients admitted to 14 emergency departments in Beijing from January 1st 2011 to September 23rd 2012 were enrolled.According to hospital grade,these patients were divided into two groups,349 patients were from secondary hospitals,and 2 956 patients were from tertiary hospitals.Results Among the 3 335 patients,the medium age was 71 (58,79) years,and male accounted for 53.16％.The most common underlying disease were coronary disease (43.27％),hypertension (17.73％),cardiomyopathy (16.07％) etc.The average treatment time in Emergency Department was 66.82 h.The emergency department mortality rate was 3.81％ (127 cases).The 30-day and 1-year cumulative all-cause mortality were 15.3％ and 32.27％,respectively.The 30-day and 1-year cumulative all-cause readmission were 15.64％ and 46.89％,respectively.Compared with patients in tertiary hospitals,patients in secondary hospitals had more onset acute heart failure patients (63.64％ vs.49.93％),shorter emergency department treatment time (12 h vs.41 h),lower discharge rate (3.43％ vs.37.45％) and emergency department mortality(1.58％ vs.4.09％).Compared with those in tertiary hospitals,1-year cumulative all-cause mortality (25.6％ vs.33.2％),cardiovascular disease mortality (20.2％ vs.26.0％),aggravated heart failure mortality (22.4％ vs.28.8％) were lower in secondary hospitals.Following propensity score matching,compared to tertiary hospitals,patients in secondary hospitals showed lower utilization rate of beta-blockers and ACEFARB (4.51％ vs.28.17％,1.41％ vs.9.58％),except the pironolactone.Conclusion Acute heart failure in emergency department is associated with a high mortality rate and readmission rate.There is still a big gap between guidelines recommend medication current treatments for acute heart failure.

Thyroid diseases and cerebrovascular diseases / 国际脑血管病杂志

The relationship between thyroid diseases and cerebrovascular diseases is getting increasingly attention. Studies have shown that thyroid diseases are associated with many kinds of cerebrovascular diseases, such as ischemic cerebrovascular disease, moyamoya disease, cerebral venous thrombosis, and artery dissection. This article review the advances in research on the correlation between thyroid diseases and cerebrovascular diseases.

Concordance of 2-dimensional and intelligent spatiotemporal image correlation echocardiography in measuring fetal aortic diameters / 中华超声影像学杂志

Objective To evaluate the concordance of two-dimensional echocardiography (2DE) and intelligent spatiotemporal image correlation (iSTIC) in measuring fetal aortic and aortic arch diameters during the second and third trimesters.Methods Data were collected by a prospective cross-sectional study of 140 normal singleton fetuses with the gestational age from 22 to 32 weeks.A total of 6 dimensions of the fetal aortic and aortic arch,including aortic annular diameter (AO),ascending aorta diameter (AAO),aortic arch diameter [AO Arch (INA to LCCA)],aortic arch diameter [AO Arch (LCCA to LSA)],aortic isthmus diameter and descending aorta diameter (DAO),were measured by two different methods.Concordance was assessed by comparing the measurements acquired by iSTIC with those determined by 2DE and depicted by Bland-Altman plots.Inter-and intra-observer variability was evaluated by the intraclass correlation coefficient (ICC) test.Results A total of 137 iSTIC volumes in 140 cases were found to be suitable for further analysis.Good correlation was observed in the measurements that determined by 2D or iSTIC (Pearson's R2 =0.977-0.983).There was no significant difference in the mean values of all the parameters that measured by two methods.Bland-Altman plot showed that the 95％ limits of agreement (LOA) in AO,AAO,AO Arch (INA to LCCA),AO Arch (LCCA to LSA),aortic isthmus diameter and DAO were (-0.1260/+ 0.2299),(-0.1707/+ 0.2241),(-0.1547/+ 0.2190),(-0.1736/+ 0.2024),(-0.1514/+ 0.2039) and (-0.1485/+ 0.2228),respectively.The points in the outside of LOA were 5.11％ (7/137),4.38％ (6/137),5.11％ (7/137),5.84％ (8/137),4.38％ (6/137)and 4.38％ (6/137),respectively.Conclusions iSTIC has a good agreement with 2DE in measuring fetal aortic and aortic arch dimensions during the second and third trimesters.

Evaluation of left and right atrial volumes and functions of fetuses in second and late trimester of pregnancy by atrial volume tracking / 中华超声影像学杂志

Objective To evaluate the left atrial(LA) and right atrial(RA) volumes and functions of fetuses in second and late trimester by using atrial volume tracking (AVT).Methods One hundred and seventy-six fetuses were enrolled in this study.Using AVT,the maximal and minimal volumes of RA and LA were measured from time-atrial volume tracking curves.RA and LA ejection fraction (RAEF and LAEF) derived from the value of atrial maximal volumes(LAVmax,RAVmax) subtracted atrial minimal volumes (LAVmin,RAVmin) and divided by LAVmax or RAVmax.Pearson correlation analysis was used to analyze the relationships between LAVmax,RAVmax,LAVmin,RAVmin,LAEF,RAEF and gestational ages.Results For all normal cases,the volumes of LA and RA were closely correlated with gestational weeks(r =0.80,0.85,0.83,0.82,P ＜0.001).The volume of LA was significantly smaller than that of RA (P ＜0.01).The RAEF and LAEF remained stable with advancing gestational age and there was no significantly difference between RAEF and LAEF (P ＞0.05).Conclusions This study establishes normal reference values for fetal RA and LA volumes during the second and third trimesters of pregnancy.The volumes of RA and LA are correlated with gestational weeks,and the volume of RA is bigger than that of LA.RAEF and LAEF are uncorrelated with gestational weeks,and there's no difference between RVEF and LAEF.

Evaluation of right atrial function in patients with dilated cardiomyopathy and ischemic cardiomyopathy using two-dimensional speckle tracking imaging / 中华超声影像学杂志

Objective To evaluate right atrial function in patients with idiopathic dilated cardiomyopathy (IDCM) and ischemic cardiomyopathy (ICM) by using two-dimensional speckle tracking imaging (2D-STI).Methods Study population consisted of 31 patients with IDCM,30 with ICM and 30 healthy subjects.High frame rate two-dimensional images were recorded from the apical four chamber view.Right atrial global longitudinal strain (GLS) was measured using two-dimensional strain soft ware.Results Compared with the controls,left ventricular ejection fraction (LVEF),tricuspid annular plane systolic excursion (TAPSE),right ventricular fractional area change (RVFAC),right ventricular fractional shortening (RVFS) and tricuspid annular peak systolic velocity(S') decreased (P ＜0.05),while right ventricular myocardial performance index (MPI) increased in IDCM and ICM group.There were no significant differences for all above echocardiographic parameters between IDCM and ICM patients.Compared with the controls,right atrial GLS decreased significantly in patients with IDCM and ICM,even much lower in patients with IDCM (P ＜0.001).Conclusions Measurement of right atrial strain using 2DSTI could be used for the assessment of right atrial dysfunction in patients with ICDM and ICM.

Clinical value of remote electrocardiogram monitoring in patients with acute ST-segment elevation myocardial infarction / 中华急诊医学杂志

Objective To investigate the reliability of electrocardiographic (ECG) signal for the accurate assessment of myocardial ischemia in order to evaluate the clinical value of remote real-time ECG monitoring system based on GPRS in patients with acute ST-elevation myocardial infarction (STEMI).Methods A total of 60 STEMI patients admitted between April 2008 and December 2010 were enrolled.All subjects were given the remote real-time ECG monitoring and routine 12 leads ECG monitoring at the same time.They were divided into remote ECG group and the 12 leads ECG group.The remote real-time ECG monitoring collects electrocardiosignal to imitate V1,V3,V5 lead and Ⅰ lead.P wave duration,PR interval,duration of time limit of QRS wave and T wave,QT interval,and the P wave amplitude,QRS wave amplitude,R-(Q + S),T wave amplitude were measured,and the detectability rate of arrhythmia and the definited diagnosis rate of ST segment elevation in accordance with clinical manifestion were compared in each group with different parameters.The data were analyzed by t test,rank sum test,Pearson correlation analysis,Spearman's rank correlation and the chi-square test.Results In STEMI patients,there were no statistical differences in time limits and amplitude of waves on ECG between the two groups (P ＞ 0.05),and the correlations between parameters of two groups were found to be close (P ＜ 0.01).There was no difference in the detectability rate of cardiac arrhythmia between two groups (P ＞ 0.05),and no difference in the rate of correct diagnosis of elevated ST segment between two groups (P ＞ 0.05),except V1 lead (P ＜ 0.05).Conclusions The sensitivity of the change in ST segment of the two groups is similar,and the remote real-time ECG monitoring can help determine the location of myocardial ischemia.

Effects of atorvastatin on the improvement of heart function in mice with viral myocarditis / 中华急诊医学杂志

Objective To investigate the effects of atorvastatin on the improvement of cardiac function of mice with myocarditis.Methods A total of 146 Balb/c mice were divided into four groups randomly(random number).The viral myocarditis(VMC)model was made by Coxsakie virus B3(CVB)injected intra-abdominally.Four groups were normal group(n =18),VMC group(n =60),Control group (n=18)and VMCtreatment group(n =50).The mice of control group were treated with atorvastatin without VMC,and the mice of VMC treatment group were with VMC and were given atorvastatin for 2 weeks.Echocardiograms were used 3,7,10,14,21,and 30 days after virus inoculation.Blood samples were collected for cardiac troponin-Ⅰ detection at the same time.Myocardial inflammation was examined by using histochemistry staining.The changes of myocardial collagen fiber,myocardial cells and various organelles were examined by electron microscope.Results Compared with VMC group,the cumulative survival rate of VMC group treatment group was higher(87.0％ vs 59.2％)after treatment with atorvastatin for 30 days (P =0.008),and the improvement of pathological features after treatment with atorvastatin was found 10,14,21 and 30 days after the inoculation.Compared with control group,the cardiac function was decreased in the CVB infected mice 7 days after virus challenge[(69.82 ±5.12)vs(89.23 ±2.01),P ＜0.01]and compared with VMC group,the EF values of VMC treatment group were significantly higher 7,14,21and 30 days after virus inoculation.The differences in cTnI values between VMC group and CVB treatment group were statistically significant 7,10,14 and 21 days after virus challenge.Conclusions These results demonstrate that atorvastatin improves survival rates and the histological features in CVB3m-induced myocarditis.It can improve the heart function of CVB infected mice.Atorvastatin could be a treatment of choice for VMC.

Investigation on Recipe Nutrients Allowance of Kindergarten / 中国基层医药

Objective To investigate the kindergarten weigh recipe nutrients allowance and chidren health status.Methods The dietary analysis was made in kindergartens by weighing and growth development was perfonmed in 17 947 chidren.Results The nutrients allowance was different in 15 observation projects,recipe nutrients allow-ance was sufficient for 80%,nutrients allowance was not enough for 20%.Middle serious malnutrition was 0.62%,slow gowth and development was 0.67%.simpie obesity was 5.80%.anemia was 1.40%.Conclusions The recipe nutrients allowance was difference in all kindergartens.Nutrients abundant and not enough was concurrent.Simple o-besity incidence rate was much higher than middle serious malnutrition.

Analysis of Bacterium and Clinical Feature in Prosthetic Valve Endocarditis and Native Valve Endocarditis / 中国循环杂志

Objective: To analysis the clinical characteristic and pathogenic bacterium of infective endocarditis (IE),and to compare the pathogenic microorganism and vegetation localization between the prosthetic valve endocarditis (PVE) and the native valve endocarditis (NVE).Methods: The data was collected from 266 in-patients who fulfilled Duke Criteria for IE from May 2003 to May 2008 in our hospital.The demographics and clinical data were analyzed retrospectively.Results: There were 243/266 of IE patients suffered from basic heart disease,among them,101 patients with congenital heart disease,77 patients with non-rheumatic valvular heart disease,62 with rheumatic heart disease and 3 with other heart disease.There were 218 (82%) patients with identified vegetation,and the most common vegetation localized at aortic valve,mitral valve,and aortic plus mitral valve in turn.Bacterial cultures were positive in 49.5% of patients.The proportion of Gram-Negative bacillus and Fungi infection had risen in IE.Detection rate of vegetation was lower in PVE patients than that in NVE patients (P<0.01).However,the positive bacterial culture rate was higher in PVE than in NVE (P<0.01).Streptococcus,coagulase negative staphylococcus,gram-negative bacteria showed significant difference between the two groups (P<0.05).The spectrum of microorganism was different between the early and the late PVE patients.The in-hospital mortality rate of PVE was higher than NVE.Conclusion: The spectrum and pathogenic bacterium of IE had changed obviously during the past years.Early diagnosis,bacterial culture with correct antibacterial treatment,transesophageal echocardiography,and active prevention of nosocomial infection should be essential for the disease control.