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The treatment ideas with acupuncture for knee osteoarthritis (KOA) are explored on the base of Dongyuan needling technology. Regarding the rules of acupoint selection, Zusanli (ST 36) is predominant, the back-shu points are used for the disorders related to the invasion of exogenous factors, and the front-mu points are for the cases caused by internal injury. Besides, the xing-spring points and shu-stream points are preferred. In treatment of KOA, besides the local points, the front-mu points, i.e. Zhongwan (CV 12), Tianshu (ST 25) and Guanyuan (CV 4), are selected specially to tonifying the spleen and stomach. The earth points and acupoints on the earth meridians (i.e. Yinlingquan [SP 9], Xuehai [SP 10], Liangqiu [ST 34], Dubi [ST 35], Zusanli [ST 36] and Yanglingquan [GB 34]) are optional to coordinate yin and yang, essence and qi , and regulate the qi movement of spleen and stomach. The shu-stream points of liver, spleen and kidney meridians (Taichong [LR 3], Taibai [SP 3] and Taixi [KI 3]) are chosen to promote meridian circulation and regulate zangfu functions.
Subject(s)
Humans , Osteoarthritis, Knee , Acupuncture Therapy , Meridians , Acupuncture Points , SpleenABSTRACT
Objective By now, there is no unified definition of aspiration pneumonia. However, patients with community-acquired pneumonia (CAP) often have aspiration risk factors. The aims of our study is to explore the clinical characteristics and outcomes of CAP patients with aspiration risk factors. Methods Cases data of all patients hospitalized with CAP in 5 teaching hospitals in Beijing, Shandong Province and Yunnan Province from January 1, 2013 to December 31, 2015 were collected. Data from patients with (AR-CAP) and without (non AR-CAP) aspiration risk factors were compared, including demographic features, clinical and radiologic findings and outcomes. A Cox proportional hazard model was used to determine the impact of aspiration risk factors on the 30-day mortality in CAP patients. Receiver operating characteristic curves (ROCs) was performed to verify the accuracy of CURB-65 score and PSI risk classification as 30-day mortality predictors in AR-CAP patients. Results Totally, 3561 CAP cases were entered into the final analysis. AR-CAP cases accounted for 5.1% (180/3561), who showed older age [78.0 yrs (M1,M3: 70.0 yrs, 85.0 yrs) vs 63.0 yrs (M1,M3: 52.0 yrs, 77.0 yrs), P < 0.001), more underlying diseases (91.1% vs 71.3%, P < 0.001), more frequently classified as CURB-65 score ≥ 3 (13.3% vs 1.5%, P < 0.001) and PSI risk classification ≥ Ⅳ (53.7% vs 17.0%，P< 0.001), and higher 30-day mortality (10.0% vs 1.8%, P < 0.001). Adjusted for age, sex, comorbidities and CURB-65/PSI score, aspiration risk factors were associated with increased 30-day mortality of CAP patients (HR 2.844, 95% CI 1.331~6.078, P = 0.007). The area under the ROC curve for predicting 30-day mortality in AR-CAP patients by PSI risk class was 0.716, which was higher than CURB-65 score (AUC=0.518, P = 0.019). The difference was statistically significant. Conclusion AR-CAP is a distinctive pneumonia phenotype with unique clinical characteristics, which shows more illness severity and worsen outcomes.
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Objective: To explore the incidence, risk factors of cardiovascular events (CVE) and their impact on 30-day mortality in patients hospitalized with community-acquired pneumonia (CAP). Methods: This is a multicenter, retrospective study. Patients hospitalized with CAP from 5 teaching hospitals in Beijing, Shandong and Yunnan provinces during 1 January 2013 to 31 December 2015 were included and clinical data were retrieved from the Hospital Information System (HIS), and patients were divided into CVE group and non-CVE group. Age, sex, comorbidities, pneumonia severity index(PSI)/CURB-65 score, routine blood test, biochemical examinations, radiological findings on admission and mortality on 30-day after admission were analyzed. The primary endpoint was acute CVE during hospitalization, the secondary endpoint was 30-day death after admission. Multivariate Cox regression analysis was used to explore the risk factors for CVE. Kaplan-Meier survival curve was used to compare the difference on 30-day mortality between CVE patients and non-CVE patients by Log-rank test. Multivariate Cox regression model was used to assess the impact of CVE on the 30-day mortality among CAP patients after adjustment with age, sex, comorbidities, PSI/CURB-65 score. Results: A total of 3 561 CAP patients were included into the final analysis, including 210 (5.9%) patients in CVE group and 3 351 (94.1%) patients in non-CVE group. Compared with patients in non-CVE group, patients in CVE group were older (P<0.001), prevalence of hypertension, coronary heart disease, chronic heart failure, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, aspiration risk and bedrid were significantly higher (all P<0.001); prevalence of CURB-65 score 3-5 and PSI risk class Ⅳ/Ⅴ were also significantly higher (both P<0.001). The proportion of axillary temperature<36 ℃, respiratory rate≥30 beats/minutes, confusion, leukocytes>10×10(9)/L, hemoglobin<100 g/L, platelets>300×10(9)/L, albumin<35 g/L, blood urea nitrogen>7 mmol/L, fasting blood glucose>11 mmol/L, serum C-reaction protein>100 mg/L, serum procalcitonin≥2 μg/L, arterial pH<7.35, arterial PO(2)/FiO(2)≤300 mmHg (1 mmHg=0.133 kPa), and multilobar infiltrates and pleural effusion on chest X-ray or CT scan were significantly higher in CVE group than in non-CVE group(all P<0.05); the 30-day mortality was significantly higher in CVE group than in non-CVE group(P<0.001). The incidence of CVE was significantly higher in patients with cardiovascular and cerebrovascular disease(CVD) than in patients without CVD (13.9%(150/1 079) vs. 2.4%(60/2 482), χ(2)=178.737, P<0.001). Meanwhile, the incidence of CVE increased with PSI in patients with Ⅰ/Ⅱ, Ⅲ and Ⅳ/Ⅴ class, respectively(χ(2)=228.350, P<0.001); and CURB-65 score 0-1, 2 and 3-5, respectively (χ(2)=387.154, P<0.001). Cox regression analysis revealed that age (HR=1.05, 95%CI 1.02-1.09, P=0.002), coronary heart disease (HR=1.88, 95%CI 1.01-3.51, P=0.048), chronic heart failure (HR=4.25, 95%CI 1.89-9.52, P<0.001), PSI risk class (HR=1.66, 95%CI 1.50-2.62, P=0.029) and serum procalcitonin≥ 2 μg/L (HR=3.72, 95%CI 1.60-8.66, P=0.002) were independent risk factors for CVE in CAP patients. Kaplan-Meier curve showed that the survival probability of patients with CVE was significantly lower than patients without CVE (P<0.001). After adjustment for age, sex, comorbidities and PSI/CURB-65 score, Cox regression model showed that CVE was associated with increased 30-day mortality in CAP patients (HR=6.05, 95%CI 3.11-11.76, P<0.001). Conclusions: Although the incidence of CVE is not high in Chinese patients hospitalized with CAP, CVE is common in patients with severe pneumonia and in patients with CVD. Age, cardiovascular disease, PSI risk class and serum procalcitonin are the risk factors for CVE in this patient cohort. CVE is related to increased 30-day mortality in CAP patients.
Subject(s)
Humans , China/epidemiology , Incidence , Pneumonia/epidemiology , Prognosis , Retrospective Studies , Risk Factors , Severity of Illness IndexABSTRACT
@#【Objective】To evaluate the impact of prior use of inhaled corticosteroids（IC）on the clinical outcomes of chronic obstructive pulmonary disease patients hospitalised with community- acquired pneumonia （COPD- CAP）. 【Methods】This was a multicenter，retrospective study. Data of COPD-CAP patients from five teaching hospitals in Beijing，Shandong and Yunnan Provinces during 1st January 2013 through 31th December 2016 were reviewed. The patients with and without prior use of IC were compared，including demographic characteristics，clinical and radiologic features， and outcomes. A logistic regression model was conducted to explore the impact of prior IC use on the clinical outcomes of COPD-CAP patients. 【Results】Of 725 patients included in the study，13.9%（101/725）were prior IC users. Compared with no-IC users，IC users showed higher frequency of cardiovascular comorbidity（19.8% vs 12.7%）and a CAP history in the last year（20.8% vs 11.2%）；lower occurrence of pleural effusion（13.9% vs 23.7%）；more often classified in Global Initiative for Chronic Obstructive Lung Disease（GOLD）stage 3（35.1% vs 22.9%）and GOLD 4 stage（51.9% vs 21.8%），less often in GOLD 2 stage（10.4% vs 51.0%）. Adjusted by age，gender，underlying diseases，PSI/CURB-65 score and GOLD stage，logistic regression analysis confirmed prior IC use was associated with decreased risk for noninvasive ventilation［OR = 0.220，95% CI（0.052，0.926），P = 0.029］，but not with invasive ventilation［OR = 0.290，95% CI（0.068，1.236），P = 0.094］，needing vasopressor use［OR = 1.261，95% CI（0.456，3.485），P = 0.655］，ICU admission［OR = 1.455，95% CI（0.638，3.320），P = 0.373］and 30-day mortality［OR = 1.650，95% CI（0.575，2.838）， P = 0.352］.【Conclusion】Previous IC use has no major impact on the clinical outcomes of COPD-CAP patients.
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Objective To investigate whether the metabolite of benzene, 1, 4-benzoquinone (1, 4-BQ) , can activate PINK1/Parkin-mediated mitocphagy and the role of reactive oxygen species (ROS) in 1, 4-BQ induced mitophagy in vitro. Methods Human promyelocytic leukemia cells HL60 were used as the test cells, and were divided into control group, 1, 4-BQ group (10 μM 1, 4-BQ treated cells for 24 h), NAC group (5 mM antioxidant N-acetyl cysteine treated cells for 24 h) and 1, 4-BQ+NAC group (5 mM NAC preincubated for 1 h prior to the treatment with 10 μM 1, 4-BQ for 24 h) . The ultra structure of the cells were observed by transmission electron microscopy (TEM), and the expression of mitophagy related protein LC3, PINK1 and Parkin were detected by Western blot, and the intracellular ROS content was determined by DCFH-DA staining. Results The mitochondria in the control group showed a normal rod-shaped structure with clear mitochondrial cristae, while in the 1, 4-BQ group, the mitochondria showed a swollen structure with less mitochondrial cristae, and typical double-membrane mitophagosomes were observed. LC3-Ⅱ/LC3-Ⅰ ratio, the expression of PINK1, Parkin protein and ROS content in 1, 4-BQ group were increased compared with the control group (P <0.05) , and this increase was markedly blocked by the co-treatment of 1, 4-BQ and NAC (P <0.05) . Conclusion The 1, 4-BQ can induce PINK1/Parkin-mediated mitophagy and ROS plays a significant role in 1, 4-BQ-induced mitophagy.
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Objective:Contrast enhanced ultrasound (CEUS) is an innovative technique that employs microbubble contrast agents to demonstrate parenchymal perfusion.Ultrasound contrast agent was reported to be directly used in human internal lumen to improve the observation capacity of ultrasound.However,CEUS has never been reported to be used in the guidance of percutaneous renal access in percutaneous nephrolithotomy (PCNL).This study aimed to assess the efficacy of CEUS-guided renal access in PCNL.Methods:In this retrospective study,percutaneous renal access was performed under real-time monitoring of CEUS during PCNL in a cohort of 20 patients with renal stones at Peking University First Hospital.Data regarding patients' demographic and clinical characteristics,therapeutic regimens,and postoperative information were collected from a comprehensive database containing comprehensive medical records of the patients undergoing PCNL.Briefly,the procedure was as follows.With the patient under general anesthesia,renal access was established by the guidance of CEUS.Afterwords,holmium laser,pneumatic or ultrasonic lithotripsy was used by the same urologist.The patient demographics,stone characteristics and procedure details were noted.Finally,appropriate statistical analyses were performed to evaluate the effectiveness and safety of the CEUS-guided percutaneous renal access in PCNL.Results:All the 20 patients underwent PCNL successfully with the help of CEUS guidance for tract creation.The collecting system was successfully accessed in all the patients,and only one patient underwent re-puncture.All the patients approached through a middle-pole percutaneous access.The median puncture time was 3.9 (2.9-4.6) min,and the median operating time was 112 (98.5-134.5) min.The preliminary stonefree rate of PCNL was 95.0％ (19/20) as shown by the kidney,ureter,and bladder (KUB) radiographs 48 h postoperation,and the median decline in hemoglobin level was 10 (5.5-14.5) g/L.Two patients had transient postoperative fever and responded well to antibiotics.In addition,no other major complications were observed.Conclusion:CEUS is a safe and effective alternative way of guidance for percutaneous renal access for PCNL beginners.It makes this procedure more visualized and simpler,and produces clearer images than common ultrasonic ones.PCNL beginners might benefit from this method to shorten the learning curve of PCNL,while it warrants further comparative studies to clarify.
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Objective To develop an infusion joint of the two-cavity catheter used for deep vein thrombolysis and explore its clinical application.Methods The joint was composed of a perfusion tube,a perfusion tube tee,two connecting hoses,two connecting hard tubes,two Luer tapers,a liquid inlet connected with the tee,No.1 and No.2 liquid outlets.The liquid medicine was driven to flow through the tube and inlet by gravity,and then came into No.1 and No.2 liquid outlets respectively.Results There were no significant differences between the joint and the traditional way when used for deep vein thrombolysis with a two-cavity catheter (P＞0.05),while the joint had patient satisfaction increased significantly and the time consumed decreased obviously when compared with the traditional way (P＜0.05).Conclusion The joint executes deep vein thrombolysis with a two-cavity catheter and only a set of infusion set,gains advantages in simple structure,low cost and easy operation,and thus is worthy promoting clinically.
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Objective To develop an infusion joint of the two-cavity catheter used for deep vein thrombolysis and explore its clinical application.Methods The joint was composed of a perfusion tube,a perfusion tube tee,two connecting hoses,two connecting hard tubes,two Luer tapers,a liquid inlet connected with the tee,No.1 and No.2 liquid outlets.The liquid medicine was driven to flow through the tube and inlet by gravity,and then came into No.1 and No.2 liquid outlets respectively.Results There were no significant differences between the joint and the traditional way when used for deep vein thrombolysis with a two-cavity catheter (P＞0.05),while the joint had patient satisfaction increased significantly and the time consumed decreased obviously when compared with the traditional way (P＜0.05).Conclusion The joint executes deep vein thrombolysis with a two-cavity catheter and only a set of infusion set,gains advantages in simple structure,low cost and easy operation,and thus is worthy promoting clinically.
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<p><b>OBJECTIVE</b>To develop a method for evaluating the feasibility of prenatal screening using local median value and determining the cut-off value.</p><p><b>METHODS</b>With receiver operating characteristic curve (ROC) analysis, results of second trimester prenatal screening calculated by a local median value in a new model and the built-in median value in 2T software were compared. The cut-off value was set by serial analysis of true and false positive rates and other relevant data.</p><p><b>RESULTS</b>The ROC curve has accurately estimated the difference in the screening efficacy between a local median value and that embedded in the 2T model, and established a reasonable cut-off value for the laboratory based on false positive rate and detection rate.</p><p><b>CONCLUSION</b>The method of ROC curve can be used to evaluate the performance of local median value in prenatal screening and to test the rationality of cut-off value established in the laboratory. As the result, a better cut-off value may be derived.</p>
Subject(s)
Female , Humans , Male , Pregnancy , China , Epidemiology , Down Syndrome , Diagnosis , Epidemiology , Genetics , Pregnancy Trimester, Second , Genetics , Prenatal Diagnosis , Methods , Reference Standards , ROC Curve , SoftwareABSTRACT
<p><b>BACKGROUND</b>Several risk stratification models have been developed for cardiac surgery. This study aimed to evaluate the accuracy of four existing risk stratification models, the Fuwai System for Cardiac Operative Risk Evaluation (FuwaiSCORE), the Society of Thoracic Surgeons 2008 cardiac surgery risk model for isolated valve surgery (the STS model), the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and the initial Parsonnet's score (the Parsonnet model) in predicting prolonged intensive care unit (ICU) stay in Chinese patients undergoing heart valve surgery.</p><p><b>METHODS</b>Data were collected retrospectively from records of 1333 consecutive patients who received heart valve surgery in a single center between November 2006 and December 2007. Prolonged ICU stay was defined as not less than 124 hours. Calibration was assessed using the Hosmer-Lemeshow (H-L) goodness of fit test. Discrimination was assessed using the receiver-operating-characteristic (ROC) curve area.</p><p><b>RESULTS</b>The FuwaiSCORE showed good calibration and discrimination compared with other risk models. According to the H-L statistics, the value of the FuwaiSCORE was 12.82, P > 0.1. The area under ROC curve of the FuwaiSCORE was 0.81 (95%CI 0.78 - 0.84).</p><p><b>CONCLUSIONS</b>Our study suggests that the FuwaiSCORE is superior to the other three risk models in predicting prolonged length of ICU stay in Chinese patients with heart valve surgery. Having fewer variables, the system is much easier for bedside use than other systems.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cardiac Surgical Procedures , China , Heart Valves , General Surgery , Models, Theoretical , Risk AssessmentABSTRACT
<p><b>AIM</b>To investigate the effects and the possible mechanism of cocaine on the neurons of lateral habenular nucleus (LHb).</p><p><b>METHODS</b>We observed the effects on c-Fos protein expression in lateral habenular nucleus and medial habenular nucleus after injecting cocaine into a belly cavity and spontaneous and evoked discharge of pain-correlative unit through iontophoresis of cocaine into LHb. The delayed rectifier K+ current was recorded in the acute isolated LHb neuron in whole-cell mode.</p><p><b>RESULTS</b>(1) The c-Fos protein expression was increased by cocaine treatment in LHb, but little effect in MHb. (2) Iontophoresis of cocaine into LHb increased the discharges of pain excitation unit and enhanced excitation response to noxious stimulation, but it decreased the discharges of pain inhibition unit and its responses to noxious stimulation in LHb. Cocaine inhibited the delayed rectifier K+ current.</p><p><b>CONCLUSION</b>Cocaine can excite the LHb and increase its sensitivity. The probable mechanism is that cocaine inhibits the delayed rectifier K+ channels.</p>
Subject(s)
Animals , Rats , Cocaine , Pharmacology , Habenula , Metabolism , Physiology , Proto-Oncogene Proteins c-fos , Metabolism , Rats, WistarABSTRACT
<p><b>AIM</b>To explore the types of receptors distributed in MHb and LHb.</p><p><b>METHODS</b>Recording the currents of potassium channels in Hb neurons isolated from the rats 10-15 days after birth. To distinguish the types of receptors distributed in MHb and LHb by using the agonists of mu receptor DAMGO, and sigma receptor DPDPE.</p><p><b>RESULTS</b>Two types of current of K+ channels were recorded, the transient rectifier and delayed rectifier potassium channels. DAMGO or DPDPE increased the intensity of current of K+ channels.</p><p><b>CONCLUSION</b>In MHb there was a higher density of sigma receptor, and in LHb a higher density of mu receptor distributed.</p>
Subject(s)
Animals , Rats , Animals, Newborn , Habenula , Metabolism , Neural Pathways , Neurons , Metabolism , Potassium Channels , Metabolism , Receptors, Opioid , MetabolismABSTRACT
<p><b>AIM</b>To observe the responses of pain-related neurons in habenula to the nociceptive stimuli and classic analgesic morphine for inquiring into its characteristics of pain.</p><p><b>METHODS</b>The experiment was proceeded with adult rats under light anesthetized. Through the cannula inserted by operation or the multielectrode injecting the morphine, naloxone, CCK-8 and etc into lateral cerebro-ventricule or habenula, the unit firings from the neurons of habenula were recorded.</p><p><b>RESULTS</b>The unit firings were recorded from pain-related neurons distributed in MHb or LHb. The pain-related neurons could be differentiated into pain excitatory or pain inhibitory neurons. After the morphine iontophoresed, the main response of the pain excitatory neurons was inhibited, the pain inhibitory neurons were excited. The naloxone iontophoresed could antagonize the analgesic effect of morphine on neurons of habenula. After the morphine injected (10 mg/kg, i. p) into morphine-tolerated rats, the analgesic efficacy of pain-related neurons in LHb was more stronger than in MHb. It showed that the neurons in LHb were suffered from morphine was higher than MHb. After injection of antagonist of CCK-8 into lateral cerebro-ventricle, morphine injected peritoneally could weaken the tolerance level of morphine. Conversely, after injection of morphine (10 mg/kg, i. p.) 10 min, second time injection of CCK-8 (15 ng/10 microl) into lateral cerebro-ventricle could antagonize the analgesic action of morphine on the neurons in LHb, but in MHb the antagonized action was not obviously.</p><p><b>CONCLUSION</b>The excitatory and inhibitory neurons in Hb were sensitive to the nociceptive stimuli and not easy to adapt to it. The sensitivity of the neurons in LHb to morphine was more higher than the neurons in MHb.</p>
Subject(s)
Animals , Rats , Habenula , Cell Biology , Morphine , Pharmacology , Naloxone , Pharmacology , Neurons , Physiology , Pain Threshold , Rats, Wistar , Sincalide , PharmacologyABSTRACT
<p><b>AIM</b>To investigate whether if the Habenula is the main relay involved in the vasopressor effect induced by the stimulus of insular cortex, central-, lateral amygdaloid nucleus respectively.</p><p><b>METHODS</b>Electrostimulation of the nuclei mention above respectively, and microinjection of lidocaine into Habenula unilaterally and bilaterally.</p><p><b>RESULTS</b>When INS or CeA was stimulated, inducing an obvious increase of blood pressure. To stimulate INS or CeA after microinjecting lidocaine into Hb 5 minutes, the amplitudes of the vasopressor responses were decreased significantly, and the decrease of the bilaterally was larger (decreased value: 41.7% in INS, 46.1% in CeA) than that of unilaterally (decreased value: 36.9% in INS, 39.6% in CeA).</p><p><b>CONCLUSION</b>Habenula is one of the main relays involved in the vasopressor effects induced by the stimulus of insular cortex, central-, lateral amygdaloid nucleus.</p>
Subject(s)
Animals , Rats , Amygdala , Physiology , Blood Pressure , Physiology , Cerebral Cortex , Physiology , Electric Stimulation , Habenula , Physiology , Neural Pathways , Physiology , Rats, WistarABSTRACT
<p><b>AIM</b>To inquire a new credible animal model in studies of startle conditioned reflex.</p><p><b>METHODS</b>Through the trials of combining a conditioned stimulus (a tone) with an unconditioned stimulus(a foot shock), the startle responses were established in animals by conditioned stimulus. Arterial blood pressure were measured before and after blocking basolateral and lateral amygdala with lidocaine.</p><p><b>RESULTS</b>The blood pressure was increased by the conditioned stimulus after four days training. When the basolateral amygdala was blocked by lidocaine, the blood pressure was not increased by the conditioned stimulus.</p><p><b>CONCLUSION</b>The animal model used and verified in this experiment is a new credible chronic animal model in startle conditioned reflex by measuring arterial blood pressure.</p>