Mixed venous to arterial CO 2 gap as a marker to identify fluid responsiveness in septic shock patients / 中华急诊医学杂志

Objective:To investigate the value of the venous-to-arterial CO 2 gap (Δ CO 2 gap) before and after the fluid challenge (FC) in determining the fluid responsivenessin septic shock patients. Methods:A total of 104 septic shock patients admitted to the Medical Intensive Care Unit (MICU) of Peking Union Medical College Hospital were included in the retrospective study. All patients were monitored by Swan Ganz floating catheter during the FC. Hemodynamics and blood gas indices were collected before FC (T0) and immediately (T1), 10 min (T2), 30 min (T3) and 60 min (T4) after FC. Responders were defined as patients with a > 10% increase in cardiac output (CO) after FC. Spearman correlation analysis was used to evaluate the correlation between CO 2 gap and CO. The value of ΔCO2 gap were calculated by the area under the receiver operating characteristic (AUROC) curve in the whole population. Results:Among 104 patients, the effective rates of FC at T1, T2, T3 and T4 were 59% (61/104), 72% (75/104), 73% (76/104), and 77% (80/104), respectively. CO of patients in the reactive group was lower than that in the non-reactive group at T2 [6.0 (4.7, 7.5) vs. 7.2 (6.4, 8.5) L/min, P=0.019], and there was no significant difference in CO 2 gap between the two groups before FC. Spearman correlation analysis showed that CO 2 gap was negatively correlated with CO, and the correlations between CO 2 content gap and CO was -0.34, and -0.33 of CO 2 pressure gap and CO, respectively (both P <0.05). ROC curve analysis showed that the ΔCO 2 gap at T1 could weakly judge the reactivity at T2, T3 and T4, but could not judge the reactivity at T1. The AUROC at T2 was 0.669 of ΔCO 2 content gap and 0.684 of ΔCO 2 pressure gap (both P <0.05). Conclusions:The evaluate time judging the effect of FC should be appropriately extended. The change value of CO 2 gap before and immediately after volume expansion in septic shock patients can judge the fluid responsiveness within 10 min after FC.

Relationship Between NLRP3 Inflammatory Corpuscles and Chronic Atrophic Gastritis Based on "Spleen-mitochondrion Correlation" / 中国实验方剂学杂志

Chronic atrophic gastritis （CAG） is a common and intractable disease in the digestive system characterized by the reduction or disappearance of gastric mucosal glands. The intestinal metaplasia or dysplasia in CAG is called precancerous lesion， which greatly increases the risk of cancerization. Dysactivation of nucleotide-binding oligomerization domain-like receptor protein 3 （NLRP3） inflammatory corpuscles can release a large number of inflammatory factors， induce inflammatory cascade reactions， and participate in the process of many diseases. As reported， the dysactivation of NLRP3 inflammatory corpuscles can cause long-term chronic inflammatory infiltration of gastric mucosa and induce the development of CAG. Mitochondrial dysfunction plays an important role in the activation of NLRP3 inflammatory corpuscles. The accumulation of reactive oxygen species （ROS） produced by mitochondrial dysfunction is the key to activating NLRP3 inflammatory corpuscles. Professor LIU Youzhang put forward the theory of "spleen-mitochondrion correlation"， which holds that the spleen mainly transports water and grains， generates qi and blood， transports nutrients to the whole body， and supplies energy and materials needed by the body. Adenosine triphosphate （ATP） generated by mitochondria through the circulation of tricarboxylic acid is the main energy source of the human body. The view that both of them serve as human energy processing plants coincides in terms of physiology. Pathologically， spleen deficiency is associated with mitochondrial oxidative phosphorylation dysfunction. Pathological products such as dampness， turbidity， phlegm， and blood stasis due to failure in transportation because of spleen deficiency are consistent with metabolites generated by mitochondrial dysfunction. Based on the theory of "spleen-mitochondrion correlation"， this study discussed the pathogenesis of CAG in traditional Chinese medicine （TCM）， analyzed the relationship between NLRP3 inflammatory corpuscles and the pathogenesis of CAG， and proposed that the activation of NLRP3 inflammatory corpuscles by mitochondrial dysfunction was the modern biological basis of the pathogenesis of spleen deficiency in CAG. The spleen-strengthening method may be related to improving the mitochondrial function and inflammatory response of patients with CAG and alleviating the damage of gastric mucosa， providing a new idea for TCM in the prevention and treatment of CAG.

Risk factors for venoarterial-extracorporeal membrane oxygenation related nosocomial infection in children after cardiac surgery / 中南大学学报(医学版)

OBJECTIVES@#Extracorporeal membrane oxygenation (ECMO) is an extracorporeal life support strategy for the treatment of critically ill children with reversible heart and lung failure, increasingly being used in patients with low cardiac output after cardiac surgery. However, the mortality of patients is closely related to the complications of ECMO, especially bleeding, thrombosis, and infection, ECMO-related nosocomial infection has become a challenge to the success of ECMO. This study aims to analyze the incidence and risk factors for venoarterial-ECMO (VA-ECMO)-related nosocomial infections in children after cardiac surgery.@*METHODS@#We retrospectively collected the data of patients who underwent VA-ECMO treatment after pediatric cardiac surgery in the Second Xiangya Hospital of Central South University from July 2015 to March 2021, and divided them into an infected group and a non-infected group. The clinical characteristics of the 2 groups of patients, VA-ECMO-related nosocomial infection factors, pathogenic microorganisms, and patient mortality were compared. Logistic regression was used to analyze the risk factors for nosocomial infection related to VA-ECMO after cardiac surgery.@*RESULTS@#Of the 38 pediatric patients, 18 patients (47.37%) had VA-ECMO related nosocomial infection, served as the infected group, including 7 patients with blood infections and 11 respiratory tract infections. Gram-negative pathogens (16 strains, 88.9%) were the main bacteria, such as Acinetobacter baumannii (6 strains), Klebsiella pneumoniae (3 strains), and Stenotrophomonas maltophilia (3 strains). Compared with the non-infected group (n=20), the infection group had longer time of cardiopulmonary bypass, time of myocardial block, and time of VA-ECMO assistance (All P<0.05). Multivariate logistic regression analysis showed that time of cardiopulmonary bypass (OR=1.012, 95% CI 1.002 to 1.022; P=0.021) was an independent risk factor for ECMO-related nosocomial infection. The number of surviving discharges in the infected group was less than that in the non-infected group (1 vs 11, P<0.05).@*CONCLUSIONS@#Cardiopulmonary bypass time is an independent risk factor for VA-ECMO-related nosocomial infection in children after cardiac surgery. Shortening the duration of extracorporeal circulation may reduce the incidence of VA-EMCO-related nosocomial infections in children after cardic surgery. The occurrence of VA-ECMO-related nosocomial infections affects the number of patient's discharge alive.

Genetic analysis of 21 cases of methylmalonic acidemia / 中华医学遗传学杂志

OBJECTIVE@#To carry out genetic analysis for 21 patients with methylmalonic acidemia (MMA) and provide genetic counseling for their families.@*METHODS@#Next generation sequencing (panel) was used to detect the pathogenic variants underlying the disease.@*RESULTS@#In total 29 variant sites of MMUT, MMAA, MMUT were identified in the 21 patients, with common variants including c.323G>A (10%), c.917C>T (10%), c.984delC (10%) of MMUT gene, and c.609G>A (45%), c.80A>G (10%) , c.567dupT (10%) of MMACHC gene. Among these, c.2000A>G of MMUT, c.298G>T of MMACHC and c.734-7A>G of MMAA gene were unreported previously.@*CONCLUSION@#Genetic testing for MMA patients can clarify the cause of the disease and provide a basis for the clinical diagnosis. Discovery of novel variants has enriched the mutational spectrum of MMA.

Surgical repair for simple total anomalous pulmonary venous connection in neonates / 中华胸心血管外科杂志

Objective:This study aimed at analyzing risk factors associated with surgical outcomes of neonatal total anomalous pulmonary venous connection (TAPVC) in our center.Methods:A total of 105 neonates who underwent surgical repair for TAPVC from January 1st, 2009 to January 1st, 2018 were retrospectively analyzed. The anatomical types of TAPVC included supracardiac 42(40%, 42/105), cardiac 21(20%, 21/105), infracardiac 36(34.3%, 36/105), and mixed 6(5.7%, 6/105). The Cox proportional hazards analysis was used to analyze the risk factors related to postoperative pulmonary venous obstruction (PVO) and mortality. Kaplan- Meier analysis was used to analyze the overall survival rates. Results:Twenty-six patients (24.8%, 26/105) were diagnosed with preoperative PVO. The 30-day, 1 year, and 5 years survival rate was 92.4%, 86.7%, and 86.7% respectively. Postoperative PVO occurred in 17 patients (16.2%, 17/105). Preoperative acidosis, low surgical weight, prolonged duration of cardiopulmonary bypass time, increasing postoperative central venous pressure (CVP), and reoperation were risk factors associated with mortality. Preoperative acidosis ( P<0.001), prolonged duration of cardiopulmonary bypass time ( P<0.001), and increasing postoperative CVP ( P=0.005) were independent risk factors for mortality. Mixed TAPVC, preoperative acidosis, low surgical age, prolonged cardiopulmonary bypass time, postoperative pulmonary arterial hypertension were risk factors associated with postoperative PVO. Prolonged cardiopulmonary bypass time ( P=0.029), postoperative pulmonary arterial hypertension ( P<0.001), and mixed TAPVC ( P=0.017) were independent risk factors associated with postoperative PVO. Conclusion:The surgical outcomes of neonatal TAPVC in our center were acceptable, with low mortality rate and incidence of PVO. However, neonates with preoperative acidosis, prolonged duration of cardiopulmonary bypass time, and increased postoperative CVP had a poor prognosis. Patients with mixed TAPVC were at increased risk for postoperative PVO.

Analysis and evaluation of risk factors associated with poor prognoses of children with tetralogy of Fallot during perioperative period / 中国胸心血管外科临床杂志

@#Objective    To quest the risk factors of poor prognoses in children with tetralogy of Fallot (TOF) during perioperative period and evaluate its clinical application values. Methods    A retrospective analysis of the clinical data of 119 children who underwent one-stage correction of TOF in Guangdong Provincial People's Hospital from September 2016 to January 2019. The cohort includes 75 males and 44 females, with ages ranging from 3.2-137.1 (13.2±1.4) months and weights ranging from 4.6-21.0 (8.3±0.2) kg. Perioperative poor prognosis was defined as duration of mechanically assisted ventilation >48 h or secondary intubation, vasoactive-inotropic score (VIS) within 48 h >40, postoperative length of stay >14 d, and the occurrence of the major adverse events. Major adverse events were defined as early death, malignant arrhythmia, low cardiac output syndrome, non-fatal cardiac arrest, postoperative reintervention, diaphragm paralysis, and other clinical complications. Univariate and multivariate logistic analyses were used to analyze the correlation between risk factors and poor prognoses. Results    There was 1 perioperative death, and 9 with major adverse events. Variables selected by Least Absolute Shrinkage and Selection Operator (LASSO) included 2 preoperative variables (McGoon index, aortic root diameter index) and 4 intra-operative variables [left-right direction of bicuspid pulmonary valve, total length of right ventricular outflow tract (RVOT) incision index, pulmonary valve with commissurotomy, and minimum temperature in cardiopulmonary bypass (CPB)]. Univariate and multivariate logistic analyses were used to the above factors, respectively. The variables with statistical significance (P≤0.05) were McGoon index, aortic root diameter index, left-right direction of bicuspid pulmonary valve, and minimum temperature in CPB. A nomogram was established based on the above factors, and the results showed that the left-right direction of bicuspid pulmonary valve was more risky than the tricuspid pulmonary valve and the anterior-posterior direction of bicuspid pulmonary valve. The lower the McGoon index, the higher aortic root diameter, and the lower temperature in CPB, the higher risk of poor prognostic events in children with TOF. Conclusion    The left-right direction of the pulmonary bicuspid valve has a higher risk of poor prognosis than the tricuspid pulmonary valve and the anterior-posterior direction of bicuspid pulmonary valve. With the smaller McGoon index and the larger aortic root diameter, the risk of poor prognoses in children with TOF is higher. The temperature in CPB being lower than medium-low temperature obviously relates to the high incidence of poor prognostic events, which can be used as an auxiliary reference standard for decision-making in pediatric TOF surgery in the future.

Analysis of genetic variant in a child with concomitant spinal muscular atrophy and Citrin protein deficiency / 中华医学遗传学杂志

OBJECTIVE@#To explore the genetic basis for a child with concomitant spinal muscular atrophy (SMA) and Citrin protein deficiency.@*METHODS@#The child was subjected to whole exome sequencing by using target sequence capture high-throughput sequencing. Candidate variants were verified by Sanger sequencing. The SMN genes of the patient were also analyzed through multiplex ligation-dependent probe amplification (MLPA).@*RESULTS@#The patient was found to carry homozygous deletion of exons 7 and 8 of the SMN1 gene, for which his parents were both carriers. The patient also carried compound heterozygous variants c.1737G>A and IVS16ins3kbof the SLA25A13 gene, in addition with compound heterozygous variants c.948G>A and c.2693T>C of the POLG gene, for which his parents were carriers, too.@*CONCLUSION@#Variants of the SLC25A13 gene probably underlay the deficiency of Citrin protein, which may lead to neonatal intrahepatic cholestasis (NICCD). The patient also had SMA. The compound heterozygous variants c.948G>A and c.2693T>C of the POLG gene are likely to cause mitochondrial DNA deletion syndrome type 4A, though other types of mitochondrial disease cannot be excluded.

Cholinergic anti-inflammatory pathway and its role in treatment of sepsis / 中南大学学报(医学版)

The cholinergic anti-inflammatory pathway (CAP) is a neuro-immunomodulatory pathway,in which acetylcholine (ACh) released by the interaction of vagal nerves with α7 nicotinic acetylcholine receptor (α7nAChR),which prevents the synthesis and release of pro-inflammatory cytokines and ultimately regulates the local or systemic inflammatory response in a feedback manner. It has been shown that there are many possible effective treatments for sepsis, including vagus nerve stimulation by physical therapy, drugs such as acetylcholine receptor agonist and ultrasound therapy.

Clinical analysis of suspected COVID-19 patients with anxiety and depression / 浙江大学学报·医学版

OBJECTIVE@#To explore the risk factors of anxiety and depression in patients with suspected coronavirus disease 2019 (COVID-19) so as to achieve early intervention and better clinical prognosis.@*METHODS@#Seventy-six patients with suspected COVID-19 in fever isolation wards of Second Hospital of Lanzhou University were enrolled From January 31, 2020 to February 22, 2020. Their clinical baseline data were collected. The anxiety of patients was assessed by Hamilton Anxiety Scale, and the depression of patients was assessed by Hamilton Depression Scale. Multivariate Logistic regression analysis was performed to explore the risk factors of anxiety and depression in these patients.@*RESULTS@#Female patients are more likely to have anxiety (=3.206, 95%: 1.073-9.583, <0.05) and depression (=9.111, 95%: 2.143-38.729, <0.01) than male patients; patients with known contact history of epidemic area and personnel in epidemic area are more likely to have depression (=3.267, 95%: 1.082-9.597, <0.05).@*CONCLUSIONS@#During the isolation treatment of suspected COVID-19 patients, early psychological intervention should be carried out for the female patients with known contact history of epidemic area and personnel in epidemic area, and drug treatment should be given in advance if necessary.

Conventional and sutureless techniques for surgical repair of supracardiac total anomalous pulmonary venous connection / 中华胸心血管外科杂志

Objective@#To review our experiences with conventional and sutureless techniques in patients with supracardiac total anomalous pulmonary venous connection.@*Methods@#From January 2004 to January 2016, 150 patients with suparacardiac total anomalous pulmonary venous connection underwent conventional or sutureless techniques. Kaplan-Meier curve was used to demonstrate the survival estimates. Cox proportional hazard model was used to identify risk factors for death and postoperative pulmonary venous obstruction(PVO).@*Results@#There were 9 in-hospital deaths and 2 late deaths. The survival rates at 30 days, 1 year, and 12 years were 94.0%, 93.3%, and 92.7%, respectively. Follow-up was completed in 95.7% of the survivors. Median follow-up was 47 months(range: 0-136 months). Twenty-one patients required reoperation for pulmonary venous obstruction. The survival rates in neonate group is significantly lower than that in infants and children group(P=0.026). For those who were diagnosed with preoperative PVO, the survival rates(conventional group 92.3% VS sutureless group 93.9%, P=0.741) and incidence of freedom from reoperation(conventional group 55.6% VS sutureless group 90.9%, P=0.166) in both the conventional and sutureless group were similar. Multivariable analysis showed that preoperative pulmonary venous obstruction(P=0.015) and longer duration of ventilation(P=0.011) were incremental risk factors for death. Aortic cross-clamp time(P=0.038) was associated with postoperative pulmonary venous obstruction.@*Conclusion@#Both the conventional and sutureless techniques in surgical repair for supracardiac total anomalous pulmonary venous connection can achieve satisfactory outcomes.

Identification of a novel PAX6 mutation in a sporadic case with congenital aniridia / 中华医学遗传学杂志

OBJECTIVE@#To identify mutation of the PAX6 gene in a patient with congenital aniridia.@*METHODS@#DNA was extracted from peripheral blood sample of the patient and analyzed by direct PCR-Sanger sequencing.@*RESULTS@#The proband was found to harbor a heterozygous c.239T>A (p.Ile80Asn) mutation of the PAX6 gene. The same mutation was not found in his parents and 150 healthy controls.@*CONCLUSION@#A novel mutation of the PAX6 gene has been identified in a sporadic case with congenital aniridia.

Clinical and cyto-molecular genetics analysis of trisomy 12p in neonates: a case report / 临床儿科杂志

Objective To explore the clinical features, cytogenetic and molecular genetics characteristics of trisomy 12 p in neonates. Method The clinical data were reviewed in a neonate with trisomy 12 p confirmed by routine G-banding chromosome karyotype analysis, high throughput sequencing chromosome copy number variation analysis (CNV) and lymphocyte interphase fluorescence in situ hybridization (FISH) . Results The chromosome karyotype in peripheral blood of the neonate was 47, XX, +mar, and the karyotypes of her parents were normal. CNV detected a regional duplication of 12 p13.33-p11.1 (160001-34860000) with a fragment size of 34.7 Mb. Peripheral blood lymphocyte interphase FISH showed that there were 3 signals in the short arm of chromosome 12 in all interphase nuclei of the neonate, and no chimera existed. It was finally confirmed to be trisomy 12 p. Conclusion The combination of clinical features, peripheral blood karyotype analysis, CNV and FISH techniques can effectively confirm the diaganosis of trisomy 12 p.

A qualitative study on successful breastfeeding experience of primiparous women with natural childbirth during the first 6 months postpartum / 中国实用护理杂志

Objective To explore the successful breastfeeding experience of primiparous women with natural childbirth during the first 6 months postpartum. Methods A phenomenological methodology was used. Semi-structured in depth interviews were conducted among 11 primiparous women of natural childbirth. The data were transcribed, collated, summarized and analyzed using Colaizzi′s method. Results The primiparous women who sustained exclusive breastfeeding for six months after natural delivery experienced three stages which were:anxiety of breastfeeding,gradual adaption of breastfeeding, and coexistence of puzzles and insistence. The first stage was anxiety of breastfeeding including three themes: lack of experience in breastfeeding, conflict of breastfeeding, and noticeable fatigue during feeding.The second stage was gradual adaption of breastfeeding including four themes:family and social support, presenting regular feeding schedules, identification of mother role, and establishing a good mother-child relationship.The last stage was coexistence of puzzles and insistence which containing three themes: coexistence of confusion and perseverance, fear of returning back to work, suffering of maternal separation,and commitment of breastfeed. Conclusions In order to release the anxiety and improve the confidence of breastfeeding of primiparous women, it is vital to rely on the conjoint efforts of the family members,healthcare institutions,communities,enterprises,society and other aspects to improve the rate and duration of exclusive breastfeeding.

Current status for animal models of intensive care unit acquired muscle weakness / 中南大学学报(医学版)

Intensive care unit acquired muscle weakness (ICU-AW) is a neuromuscular complication secondary to severe illness. The essence for this disease is skeletal muscle dysfunction. With the development of medical technology, the survival rate for severe patients has been significantly improved. The long term complications for the severe patients with ICU-AW are getting more and more common, and they seriously affect the quality of life and prognosis of patients. However, the current treatment is ineffective. Establishment of ICU-AW animal model is an important way to study the pathogenesis and intervention targets for this disease. There are many risk factors for this disease, and the principles for ICU-AW animal models are not the same at home and abroad, and the methods of preparation are different. The choice of a reasonable animal model is important for the reliability of the results.

Report of three cases of osteomyelitis caused by Burkholderia pseudomallei and literature review / 中国感染与化疗杂志

Objective To describe the clinical features,diagnosis and treatment of osteomyelitis caused by Burkholderia pseudomallei.Methods Three cases of osteomyelitis caused by B.pseudomallei were treated in Haikou People's Hospital affiliated to Xiangya Medical College of Central South University from April 2007 to April 2017.The clinical data were reviewed and analyzed retrospectively.Relevant reports of osteomyelitis due to B.pseudomallei in China and abroad from 2007 to 2017 were comprehensively reviewed.Results The clinical manifestations included hot feeling,redness,swelling,and pain at site of infection.The infection usually occurred in tibia,femur,and skull bone.There were usually multiple lesions,frequently involving spleen,soft tissue and joints.The main imaging finding was osteomyelitis.The diagnosis was confirmed by bacterial culture in all patients.Antimicrobial therapy combined with surgical intervention was the most common approach in the stage of intensive treatment.Ceftazidime,trimethoprim-sulfamethoxazole and carbapenems were the mostly used antibiotics.However,in the stage of bacterial eradication,trimethoprim-sulfamethoxazole and doxycycline were used.The duration of treatment was very long in both stages.The recurrence was low after standard treatment.Conclusions The osteomyelitis caused by B.pseudomallei lacks specific clinical manifestation.Imaging techniques can identify the site of infection,and bacterial culture helps confirm the diagnosis.Timely and effective antimicrobial therapy combined with surgical intervention can reduce mortality.Full course and standard anti-infective therapy may prevent recurrence.

Lung stem cell-based therapy:a possible way to repair the injuried lung / 国际儿科学杂志

Recently,the promising features of lung stem cells,including ability to differentiate into di-verse cell lineages and their regenerative properties,have aroused researchers′ attention,which offers intriguing perspectives on cell-based therapies for end stage lung disease. Associated with various stem cell phenotypes, lung stem cell has been proved to differentiate into cell lineages, such as endothelial, epithelial cell and secret cells,which reconstitute the injured lung then lead to lung regeneration. In the present paper,a comprehensive re-view of stem cell-based clinical trials conducted worldwide that scrutinizes biological properties of lung stem cells and highlights lung stem cell therapeutic effects is elaborated. To date,there is no regulatory approved cell treatment for end stage lung disease,but research and clinical studies offer the hope for successful cell therapy in the next decades.

Lung stem cell-based therapy:a possible way to repair the injuried lung / 国际儿科学杂志

Recently,the promising features of lung stem cells,including ability to differentiate into di-verse cell lineages and their regenerative properties,have aroused researchers′ attention,which offers intriguing perspectives on cell-based therapies for end stage lung disease. Associated with various stem cell phenotypes, lung stem cell has been proved to differentiate into cell lineages, such as endothelial, epithelial cell and secret cells,which reconstitute the injured lung then lead to lung regeneration. In the present paper,a comprehensive re-view of stem cell-based clinical trials conducted worldwide that scrutinizes biological properties of lung stem cells and highlights lung stem cell therapeutic effects is elaborated. To date,there is no regulatory approved cell treatment for end stage lung disease,but research and clinical studies offer the hope for successful cell therapy in the next decades.

Effective dosage of sirolimus for seizure treatment of immature C57BL/6 mice induced by kainic acid / 中国药理学与毒理学杂志

OBJECTIVE To explore the safe and effective dose of sirolimus (Rapamycin,Sir) and its effect on seizure comorbidities. METHODS Immature C57BL/6 mice at postnatal 10 d of age were administered with kainic acid(KA) 12.0 mg · kg-1 intraperitoneally by a single injection to induce acute seizure. Sir 0.3, 1.0 and 3.0 mg · kg-1 was injected 24 h after seizure every other day until 3 d, 1 week, 3 weeks, 5 weeks and 6 weeks. Western blotting analysis was used to detect the expression and phos?phorylation level of S6 protein and to determine the minimum effective dose of Sir. Effect of the mini?mum effective dose of Sir on cognitive function and body growth was observed by several evaluations. Immunofluorescent intensity of Doublecortin (DCX) immunofluorescent staining was conducted to evaluate the development of neurons in the hippocampus. Morris water maze was used to assess the cognitive function. Tail suspension test, O maze and new object recognition test were used to study the anxiety-like behaviors of mice. RESULTS The result of Western blotting showed that Sir 0.3 mg · kg-1 had no significant effect on the phosphorylation of S6 protein in normal mice or KA mice, whereas 1.0 and 3.0 mg · kg- 1 could significantly inhibit the phosphorylation of S6 protein in KA mice (P<0.05). Sir 1.0 mg·kg-1 had no obvious effect on DCX-positive cells or body wass. Morris water maze showed that KA-induced seizure resulted in prolonged escape latency and swimming length (P<0.05), and a decreased crossing number of target quadrant (P<0.05). Sir 1.0 mg·kg-1 significantly reversed the deficit of cognitive function of KA-induced seizure mice (P<0.05), whereas no significant difference was found between Sir group and normal control group. Compared with normal control group, model group showed increased freezing time in tail suspension test (P<0.05), decreased migration length and reten?tion time in open arms in O maze (P<0.05), decreased retention time and touch frequency with new objects, migration length and average speed in new object recognition test (P<0.05). Sir 1.0 mg · kg-1 significantly reversed the above anxiety and depression status, whereas no significant difference was found between sirolimus group and normal control group. CONCLUSION Sir 1.0 mg · kg-1 inhibits the abnormal activation of mTOR pathway and the formation of epilepsy comorbidity in immature mice. Along with its mild side effect in development, Sir 1.0 mg · kg-1 will be an ideal dose to be used in the treatment of seizure in immature mice.

Risk factors for postoperative delirium in patients after Stanford A aortic dissection surgery: a prospective cohort study / 中华胸心血管外科杂志

Objective This study aims to analyze the independent risk factors associated with postoperative delirium of patients undergoing Stanford A aortic dissection surgery.Methods Clinical data of the patients who underwent Stanford A aortic dissection surgery from December 2014 to October 2015 were collected.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 23℃.After surgery,patients were transferred to the cardiovascular ICU,where they received standard postoperative care.The delirium was diagnosed according to the criteria of the confusion assessment method for the intensive care unit(CAM-ICU).The possible risk factors of pre-operation,during operation or post-operation were analyzed via univariate analysis and multivariate logistic regression to determine the independent risk factorsof postoperative delirium.Results 148 patients underwent Stanford A aortic dissection surgery which the incidence of postoperative delirium was 31.1％ (46/148).Univariate analysis showed the associated risk factors were age,hypertension,cognitive impairment,emergency operation,operation time,aorta clamping time,DHCA time,fluctuation of blood pressure during operation,blood transfusion,quality of sleep,length of ICU stay and electrolyte disturbance(P ＜ 0.05).Multivariate logistic regression analysis revealed that hypertension,cognitive impairment,fluctuation of mean arterial blood pressure(MAP) ＞ 30 mmHg (1 mmHg =0.133 kPa),DHCA time ＞ 40 min,postoperative poor quality of sleep and electrolyte disturbance were independently associated with postoperative delirium after Stanford A aortic dissection surgery(P ＜ 0.05).Conclusion Delirium is a frequent complication.Factors independently associated with delirium are hypertension,cognitive impairment,DHCA time,postoperative poor quality of sleep and electrolyte disturbance.Prevent,assess and manage delirium should be paid more attention and reinforced.

Performance validation of Centaur XP automatic chemiluminescence system in detection of insulin and C-peptide / 国际检验医学杂志

Objective To verify the performance of the ADVIA Centaur XP automatic chemiluminescence analyzer produced by the Siemens company in quantitative detection of serum insulin (IRI) and C‐peptide(CpS) .Methods The blood samples from 40 in‐dividuals undergoing the physical examination were detected for calculating the imprecision and bias of IRI and CpS .The linear range of IRI was verified .The reference range of IRI and CpS was verified .Results The intra‐batch variable of coefficient of IRI and CpS was less than 6 .25% ,the inter‐batch imprecision were less than 8 .33% ;the bias of IRI and CpS detection was less than 12 .5% ;the linear range of IRI was 0 .50 - 307 .76 mIU /L ;the detection results of 40 serum samples showed that all IRS were with‐in the reference range provided by manufacturer ,the results in 2 cases of CpS was out of the reference range provided by manufac‐turer ,indicating that it conformed to the relevant requirements .Conclusion The main performance of the ADVIA Centaur XP auto ‐matic chemiluminescence analyzer for detecting IRS and CpS meets the requirements ,which could be used for clinical detection .