Application of metabonomics strategy in sepsis / 中国小儿急救医学

Sepsis is a heterogeneous disease with a complex pathogenesis and diverse clinical manifestations.Sepsis leads to disruption of biochemical homeostasis, which strongly promotes changes in metabolites in the body.Initial differences in metabolites may predict the severity of the disease, and changes in metabolites over time may useful in assessing treatment response, predicting progression of disease progression or clinical outcomes.This review focused on the studies related to the application of metabolomics strategy in sepsis, which could help to understand the potential value of sepsis metabolomics in the pathogenesis, diagnosis, prognosis and treatment of sepsis.

Reference values for carotid artery intima-media thickness among community adult dwellers in Shenzhen City / 中华预防医学杂志

Objective: To establish reference values for carotid intima-media thickness (CIMT) of adult dwellers in Shenzhen City. Methods: The study was conducted based on the Shenzhen heart failure epidemiological survey from 2021 to 2022. In this survey, residents aged 18 years and above in Shenzhen were selected by using a multi-stage stratified random sampling method. General information, cardiovascular disease (CVD) related behavior and carotid ultrasound examination and etc. were collected from the participants. People with CVD factors, a history of atherosclerotic cardiovascular disease, carotid plaque or having no carotid ultrasound examination results were excluded. The parameter regression model based on fractional polynomial was used to establish the reference values of CIMT by age and sex. Results: A total of 2 163 healthy individuals were enrolled in the final analysis, including 576 males (26.6%) and 1 587 females (73.4%). The fractional polynomial regression of the CIMT mean and standard deviation was obtained. For men, the regression was meanCIMT=0.324 7+0.006 9×age and SDCIMT=0.076 9+0.001 2×age. For women, the regression was meanCIMT=0.354 9+0.005 4×age and SDCIMT=0.041 6+0.002 0×age. Conclusion: The age and sex reference values for CIMT of adult people in Shenzhen established in this study could provide the latest reference standards for early screening of subclinical CVD.

Geographic Variations in the Prevalence, Awareness, Treatment, and Control of Dyslipidemia among Chinese Adults in 2018-2019: A Cross-sectional Study / 生物医学与环境科学（英文）

OBJECTIVE@#To investigate the spatial patterns of the prevalence, awareness, treatment, and control rates of dyslipidemia at the provincial level in China.@*METHODS@#A national and provincial representative cross-sectional survey was conducted among 178,558 Chinese adults in 31 provinces in mainland China in 2018-2019, using a multi-stage, stratified, cluster-randomized sampling design. Subjects, as households, were selected, followed by a home visit to collect information. Both descriptive and linear regression procedures were applied in the analyses.@*RESULTS@#The overall prevalence of dyslipidemia was 35.6%, and wide geographic variations of prevalence, treatment, and control rates of dyslipidemia were identified among 178,558 eligible participants with a mean age of 55.1 ± 13.8 years. The highest-lowest difference regarding the provincial level prevalence rates were 19.7% vs. 2.1% for high low-density lipoprotein cholesterol, 16.7% vs. 2.5% for high total cholesterol, 35.9% vs. 5.4% for high triglycerides, and 31.4% vs. 10.5% for low high-density lipoprotein cholesterol. The treatment rate of dyslipidemia was correlated with the socio-demographic index ( P < 0.001), urbanization rate ( P = 0.01), and affordable basic technologies and essential medicines ( P < 0.001).@*CONCLUSION@#Prevailing dyslipidemia among the Chinese population and its wide geographic variations in prevalence, treatment, and control suggest that China needs both integrated and localized public health strategies across provinces to improve lipid management.

Glucose-6 phosphatase catalytic subunit inhibits the proliferation of liver cancer cells by inducing cell cycle arrest / 中华肝脏病杂志

Objective: To investigate the effects of glucose-6-phosphatase catalytic subunit (G6PC) recombinant adenovirus on proliferation and cell cycle regulation of liver cancer cells. Methods: Recombinant adenovirus AdG6PC was constructed. Huh7 cells and SK-Hep1 cells were set as Mock, AdGFP and AdG6PC group. Cell proliferation and clone formation assay were used to observe the proliferation of liver cancer cells. Transwell and scratch assay were used to observe the invasion and migration of liver cancer cells. Cell cycle flow cytometry assay was used to analyze the effect of G6PC overexpression on the proliferation cycle of liver cancer cells. Western blot was used to detect the effect of G6PC overexpression on the cell-cycle protein expression in liver cancer cells. Results: The recombinant adenovirus AdG6PC was successfully constructed. Huh7 and SK-Hep1 cells proliferation assay showed that the number of proliferating cells in the AdG6PC group was significantly lower than the other two groups (P < 0.05). Clone formation assay showed that the number of clones was significantly lower in AdG6PC than the other two groups (P < 0.05), suggesting that G6PC overexpression could significantly inhibit the proliferation of liver cancer cells. Transwell assay showed that the number of cell migration was significantly lower in AdG6PC than the other two groups (P < 0.05). Scratch repair rate was significantly lower in AdG6PC than the other two groups (P < 0.05), suggesting that G6PC overexpression can significantly inhibit the invasion and migration of liver cancer cells. Cell cycle flow cytometry showed that G6PC overexpression had significantly inhibited the Huh7 cells G(1)/S phase transition. Western blot result showed that G6PC overexpression had down-regulated the proliferation in cell-cycle related proteins expression. Conclusion: G6PC inhibits the proliferation, cell-cycle related expression, and migration of liver cancer cells by inhibiting the G(1)/S phase transition.

Diagnostic value of serum tumor markers CEA, CYFRA21-1, SCCAg, NSE and ProGRP for lung cancers of different pathological types / 南方医科大学学报

OBJECTIVE@#To evaluate the diagnostic value of the serum tumor markers carcinoembryonic antigen (CEA), cytokeratin-19-fragment (CYFRA21-1), squamous cell carcinoma associated antigen (SCCAg), neuron-specificenolase (NSE) and pro-gastrin-releasing peptide (ProGRP) for lung cancers of different pathological types.@*METHODS@#This study was conducted among patients with established diagnoses of lung adenocarcinoma (LADC, n=137), lung squamous cell carcinoma (LSCC, n=82), small cell lung carcinoma (SCLC, n=59), and benign chest disease (BCD, n=102). The serum tumor markers were detected for all the patients for comparison of the positivity rates and their serum levels. ROC curve was used for analysis of the diagnostic efficacy of these tumor markers either alone or in different combinations.@*RESULTS@#In patients with LADC, the positivity rate and serum level of CEA were significantly higher than those in the other groups (P < 0.05); the patients with LSCC had the highest positivity rate and serum level of SCCAg among the 4 groups (P < 0.05). The positivity rates and serum levels of ProGRP and NSE were significantly higher in SCLC group than in the other groups (P < 0.05). CYFRA21-1 showed the highest positivity rate and serum level in LADC group and LSCC group. With the patients with BCD as control, CEA showed a diagnostic sensitivity of 62.8% and a specificity of 93.1% for LADC, and the sensitivity and specificity of SCCAg for diagnosing LSCC were 64.6% and 91.2%, respectively. CYFRA21-1 had the highest diagnostic sensitivity for LADC and LSCC. The diagnostic sensitivity and specificity of ProGRP for SCLC were 83.1% and 98.0%, respectively. When combined, CYFRA21-1 and CEA showed a high sensitivity (78.8%) and specificity (86.3%) for diagnosing LADC with an AUC of 0.891; CYFRA21-1 and SCCAg had a high sensitivity (84.1%) and specificity (87.3%) for diagnosing LSCC with an AUC of 0.912. NSE combined with ProGRP was highly sensitive (88.1%) and specific (98.0%) for diagnosis of SCLC, with an AUC of 0.952. For lung cancers of different pathological types, the combination of all the 5 tumor markers showed no significant differences in the diagnostic power from a combined detection with any two of the markers (P>0.05).@*CONCLUSION@#CEA, CYFRA21-1, SCCAg, NSE and ProGRP are all related to the pathological type of lung cancers and can be used in different combinations as useful diagnostic indicators for lung cancers.

Effects of Dexmedetomidine on postoperative pain and stress response in elderly patients undergoing laparoscopic colorectal cancer surgery / 中华老年医学杂志

Objective:To investigate the effects of Dexmedetomidine on postoperative pain and stress response in elderly patients undergoing laparoscopic colorectal cancer surgery.Methods:A total of 150 elderly patients who had undergone laparoscopic radical resection of colorectal cancer in our hospital from June 2019 to December 2020 were divided into two groups using the random number table method, the control group(n=75)and the study group(n=75). In the study group, Dexmedetomidine 0.5 μg/kg was injected intravenously over 10 min before induction of anesthesia and maintained at 0.5 μg/kg/h until 30 min before the end of surgery.Changes in heart rate, mean arterial pressure, postoperative pain and stress response index scores were compared between the two groups.Results:The MAP and HR in the study group at T1(10 min after administration), T2(immediately after endotracheal intubation), T3(30 min after pneumoperitoneum)and T4(leaving the operating room)were significantly lower than in the control group( P<0.05); The concentrations of norepinephrine and epinephrine in the study group were lower than those in the control group at T2, T3 and T4(all P<0.05); Pain scores of patients in the study group were lower than those in the control group at T4 and T5( P<0.05); Compared with the control group, the study group used less intraoperative Sufentanil[(65.5±7.0)μg vs.(76.2±7.6)μg, t=8.968, P=0.000], needed a lower number of PCIA compressions 24 h after surgery[(6.3±2.3) vs.(9.5±3.0), t=7.331, P=0.000]and had a shorter length of PACU stay[(23.4±4.0)min vs.(30.2±5.7)min, t=8.457, P=0.000]. Conclusions:Dexmedetomidine used in laparoscopic colorectal cancer surgery in elderly patients can reduce the use of sufentanil and the length of PACU stay time, improve postoperative pain scores and reduce stress response, and therefore should be recommended.

A new flavonoid isolated from fruits of Solanum virginianum / 中草药

Objective: To study the chemical constituents from the fruits of Solanum virginianum. Methods: By means of preparative HPTLC and column chromatography over silica gel and Sephadex LH-20, compounds were isolated and purified. Their structures were elucidated by physico-chemical properties and spectral analyses. Results: Twelve compounds were obtained and identified as: 5-hydroxy-8-methoxy-6,7-methylenedioxyflavone (1), 7-hydroxy-6-methoxy coumarin (2), fraxetin (3), 5-hydroxy- 6,7,3',4'-tetramethoxyflavone (4), 5-hydroxy-4',6,7-trimethoxyflavone (5), dihydro-N-feruloyltyramine (6), N-trans-coumaroyltyramine (7), 5,3'-dihydroxy-6,7,4'-tritermethoxyflavone (8), N-[2-(3,4-dihydroxyphenyl)-2-hydroxyethyl]-3-(4-methoxyphenyl)-prop-2-enamide (9), N-trans-coumaroyloctopamine (10), 5,7,4'-trihydroxy-6-methoxyflavone (11), and 5,7,4'-trihydroxy-8-methoxyflavone (12). Conclusion: Compound 1 is a new flavonoid, named as solacarpumon, and compounds 2-12 are isolated from Solanum virginianum for the first time.

Short-term outcomes of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with spondyloepiphyseal dysplasia / 北京大学学报(医学版)

OBJECTIVE@#Severe hip osteoarthritis, caused by bone or joint maldevelopment, biomechanical transformation and previous surgical intervention, is inclusively existed in spondyloepiphyseal dysplasia (SED). To investigate and discuss the short-term efficacy and possible effects of total hip arthroplasty in the treatment of Tönnis grade 3 hip osteoarthritis in patients with SED.@*METHODS@#From January 2017 to June 2019, 374 patients with hip osteoarthritis were involved for total hip arthroplasty conducted by senior professional surgeons, of whom 9 patients (6 males and 3 females) with 12 hip osteoarthritis secondary to the SED met the inclusive and exclusive criteria and received the above-mentioned hip operation. The short-term outcomes were observed.@*RESULTS@#All the patients were implanted with Johnson & Johnson ceramic on ceramic cementless hip prostheses within the arthroplasty. They were followed up for an average period of 20 months. Except for one muscular calf vein thrombosis case, no complications, such as aseptic loosening, joint dislocation, fracture, neurovascular injury, deep vein thrombosis and infection were observed in all the 9 patients. Before the surgery, the average Harris hip score was 35.55, while the average of the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was 56.56. The level of quality of life indicated by SF-12 score was 41.56 on average. The mean pre-operation visual analogue scale (VAS) was 7.44. At the last follow-up, the average Harris hip score increased to 89.56, whereas the average WOMAC declined to 41.11. Compared with the baseline point, the average SF-12 score went up to 56.33. Dramatic drop of the mean VAS value to 2.67 was also observed at the last follow-up. In addition, post-operative increase of several pelvic-related parameters including pelvic incidence, pelvic tilt and sacral slope could be observed in the SED patients. The average measured pelvic incidence, pelvic tilt and sacral slope were 68.95°±4.60°, 52.75°±1.06° and 17.45°±1.77° before operation, respectively; whilst the mean value of these specific parameters increased to 76.98°±5.12°, 60.51°±4.35° and 18.10°±2.02°, respectively. The even leg lengths of the lower extremities were obtained after total hip arthroplasty.@*CONCLUSION@#Total hip arthroplasty is satisfactory in the short-term pain relieve and function recovery for the management of Tönnis grade 3 hip osteoarthritis secondary to the SED.

The clinical effect of dexmedetomidine preoperative nasal drip assisted in patients with strabismus correction under local anesthesia / 医学研究生学报

ObjectiveTo evaluate the effects of intranasal dexmedetomidine premedication on Sedation anxiety score, circulation index, drug dosage (atropine, sufentanil), and adverse reactions in patients undergoing strabismus surgery with local anesthesia. MethodsNinety patients undergoing strabismus surgery were enrolled and randomly divided into the dexmedetomidine group (n=45) and control group (n=45). 30min before the local anesthesia, dexmedetomidine was given intranasally with a dose of 2 μg/kg in the dexmedetomidine group, while the control group treated equal volume saline. The MAP and HR values before pre-dose (T0), 10 min (T1), 20 min (T2), and 30 min (T3) were recorded. The Ramsay score was calculated 30 minutes after administration. SAS scores were made 1 day before surgery and 1 day after surgery. Meanwhile, we measured the dosage of atropine, sufentanil, and the incidence of adverse reactions during surgery. ResultsThe HR and MAP of patients in the dexmedetomidine group were significantly lower than those in the control group at T2 and T3 (P<0.05). The SAS score of the dexmedetomidine group was significantly lower than that of the control group 1 day after the operation. There was no significant difference between the dexmedetomidine group and the control group in the dosage of atropine, the incidence of oculocardiac reflex (OCR), and respiratory depression. The dose of sufentanil in the dexmedetomidine group was lower than that of the control group. The incidence of nausea and vomiting in the control group was significantly higher than that of the dexmedetomidine group.Conclusion Dexmedetomidine (2 μg/kg) preoperative nasal drip has a good sedative effect without obvious adverse reactions and could be safely assisted in clinical anesthesia for patients undergoing local anesthesia correction surgery.

Efficacy and safety of dual antiplatelet prolongation therapy after PCI in ACS patients guided by dapt scoring system / 解放军医学杂志

Objective To investigate the efficacy and safety of extended treatment for one year with different doses of clopidogrel plus aspirin after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) based on dual antiplatelet therapy (DAPT) scoring system. Methods From April 2016 to December 2016, 225 patients with ACS, one year after successfully undergoing PCI and with ≥2 of DAPT score were enrolled in present study, and randomly divided into 3 groups (75 each): control group, observation group A and observation group B. Patients in control group were given aspirin enteric tablet 100mg qd, in observation group A were given aspirin 100mg qd plus clopidogrel 75mg qd, and in observation group B were given aspirin 100mg qd plus clopidogrel 50mg qd. All patients were followed up for one year, the incidence of cardio-and cerebrovascular events and bleeding events were observed and compared among the 3 groups. At the same time, the ADP-induced platelet aggregation rate and the platelet function (MA) from thromboelastography (TEG) pre-and post-treatment were analyzed. Results During the 12-month observation period, the overall incidence of cardiovascular events showed statistical differences among control group, observation groups A and B (21.3% vs. 5.3% vs. 5.3%, P0.05). In control group, observation groups A and B, the incidences of mild bleeding (BARC1+2) (2.6% vs. 12.0% vs. 3.9%) and total bleeding events (2.6% vs. 13.3% vs. 3.9%) showed statistical differences (P0.05). The platelet aggregation rate and platelet function (MA) in observation groups A and B decreased significantly than that in control group one year after prolonged antiplatelet therapy (P<0.05). Conclusions Assessment of ischemia risk with DAPT scoring system in patients with ACS, prolonged clopidogrel plus aspirin therapy for those patients with DAPT score ≥2 could reduce the incidence of major cardiovascular events, and low dose clopidogrel dose not increase the risk of bleeding complications.

Implantable sandwich PHBHHx film for burst-free controlled delivery of thymopentin peptide

Sustained release and non-parental formulations of peptides and protein drugs are highly desirable because of enhanced therapeutic effects as well as improved patient compliance. This is especially true for small peptides such as thymopentin (TP5). To this end, implantable sandwich poly (hydroxybutyrate--hydroxyhexanoate) (PHBHHx) films were designed to prolong release time and to inhibit burst release phenomenon of TP5 by a simple volatilization method. release studies revealed that sandwich films had nearly no burst release. release time of sandwich films was prolonged to 42 days. Pharmacodynamic evaluation demonstrated that TP5 sandwich films significantly increased survival rates in a rat immunosuppressive model and normalized CD4/CD8 values. These results suggest that TP5 released from sandwich films can attenuate cyclophosphamide's immunosuppressive activity, and possibly achieve results comparable to daily TP5 injection therapy. Thus, sandwich PHBHHx films show excellent potential as a sustained, burst-free release system for small molecular weight, hydrophilic peptide drugs.

Feasibility and preliminary technical experience of single incision plus one port laparoscopic total gastrectomy combined with π-shaped esophagojejunal anastomosis in surgical treatment of gastric cancer / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To explore the feasibility, safety, and preliminary technical experience of single incision plus one port laparoscopic total gastrectomy combined with π-shaped esophagojejunal anastomosis (SILT-π) in the surgical treatment of gastric cancer.</p><p><b>METHODS</b>Clinical data of 5 gastric cancer patients undergoing SILT-π operation at the Department of General Surgery, The Second Affiliated Hospital of the Army Medical University from August to October 2017 were retrospectively analyzed. A 2.5-3.0 cm incision around the umbilicus was made for placing the gloveport as the passage for the lens, and the instruments of the surgeon and the assistant. Another operative port was placed in the left upper quadrant with a 12-mm Trocar for the passage of the energy device, the endoscopic cutting closure, as well as the postoperative drainage tube. A D2 lymph node (LNs) dissection was regularly conducted. After the abdominal esophagus was routinely mobilized, a side-to-side esophagus-jejunum anastomosis was made through a gastric pre-pulling esophagojejunal π-shaped anastomosis. The transection was then performed with a ligation on the cardia (or esophagus above the upper margin of the tumor) using a sterilized hemp rope in order to better expose the abdominal esophagus. Throughout the course of reconstruction, the ligature rope was held by the assistant to hold down the esophagus to allow easier esophagojejunal anastomosis. A hole was then made on the posterior wall of the esophagus, between 2 cm and 3 cm above the ligature rope, and another hole was made at the anti-mesenteric border of the jejunum 40 cm distal to the Treitz ligament. A side-to-side esophagojejunal π-shaped anastomosis was performed through two holes. An entry hole was formed after the anastomosis. After checking the anastomosis, this entry hole was closed through an intestinal mesenteric hole pre-made on its opposite side. The resected esophagus and stomach, together with the afferent loop jejunum, were simultaneously transected above the level of the entry hole by a stapler from the Trocar of the left upper abdominal quadrant. After the gloveport was closed, a side-to-side jejunojejunostomy anastomosis applied with another two staples was performed between the afferent loop stump and the roux limb 30 cm below the esophagojejunal anastomosis.</p><p><b>RESULTS</b>These five patients were all male, and aged (56.8±8.2) years with preoperative clinical stage cT2-4N0-2M0. All the 5 patients underwent SILT-π operation successfully. The average length of surgical incision was (2.9±0.2) cm. The average operation time was (396.0±36.1) minutes. The intraoperative blood loss was (140.0±66.7) ml. Postoperative pathology showed proximal and distal margins were (2.6±1.1) cm and (8.7±2.5) cm apart respectively, and the average number of retrieved lymph node was 25.8±7.2. Perioperative management was based on enhanced recovery following surgical (ERAS) principles. The average time to the first flatus was (2.6±0.5) days, and the average time to defecation was (3.6±0.5) days. The pain score on postoperative day 1 was 1-2, and the average postoperative hospital stay was (7.0±0.7) days. No perioperative complications occurred.</p><p><b>CONCLUSIONS</b>SILT-π procedure is safe and feasible for patients with gastric cancer, and has positive short-term outcomes, satisfactory cosmetic abdominal incision, light postoperative abdominal pain and rapid postoperative recovery. Preliminary observations show that SILT-π procedure has good potential for clinical application in future.</p>

Significance of heart-type fatty acid binding protein and brain glycogen phosphorylase isoenzyme type in septic myocardial injury / 中国小儿急救医学

Objective@#To demonstrate the relevance of heart-type fatty acid binding protein(H-FABP) and brain glycogen phosphorylase isoenzyme type(GPBB) with myocardial injury in sepsis.To explore the effect of H-FABP and GPBB on the severity of disease and clinical prognosis.@*Methods@#A total of 40 cases of children with sepsis were selected in this study from January 1, 2017 to October 31, 2017.According to the illness severity, they were divided into sepsis group(n=15), severe sepsis group(n=13) and septic shock group(n=12), 19 cases of children with non-infectious diseases were selected as the control group for the same period.The levels of serum WBC, C-reactive protein, procalcitonin, cTnI, CK, CK-MB, CK-MB isoenzyme quality and NT-proBNP were collected within 24 hours of admission.The APECHEⅡ scores were calculated for each child.The peripheral blood of the patients within 24 hours after admission was used to determine the levels of serum H-FABP and GPBB by ELISA method.The differences of clinical indicators among the groups were analyzed.According to the survival of patients with sepsis, they were divided into 37 cases in the improved group and 3 cases in the death group.All patients with sepsis were divided into left ventricular ejection fraction(LVEF) normal group(n=26) and LVEF decreased group(n=14). According to whether the serum cTnI was elevated, all children with sepsis were divided into cTnI normal group (n=29) and cTnI increased group (n=11). The differences of H-FABP and GPBB levels were compared.According to the presence or absence of LVEF decline, the area under the ROC curve was used to evaluate the predictive power of each index for myocardial injury in sepsis.Based on the decrease of LVEF, the area under the ROC curve was used to evaluate the prediction of each index for myocardial injury in sepsis.@*Results@#There were significant differences in H-FABP and GPBB levels among the control group, sepsis group, severe sepsis group and the septic shock group (H=42.241, P<0.05; H=32.486, P<0.05). Although there was no significant difference between the improved group and the death group(P>0.05), there was an elevated trend of H-FABP and GPBB in the death group.The levels of H-FABP (t=-3.770, P=0.001) and GPBB (Z=-2.113, P=0.033) were statistically significant in the LVEF normal group and the LVEF decreased group (LVEF≤60%). There were no significant differences in the levels of H-FABP and GPBB between the cTnI normal group and the cTnI increased group (P>0.05), but the cTnI increased group had an increasing trend.The area under the ROC curve in the diagnosis of myocardial injury in sepsis were H-FABP 0.821, NT-ProBNP 0.738, GPBB 0.661, CK 0.560, cTnI 0.512, in which the sensitivity(0.833) and specificity(0.786)of H-FABP were both higher.@*Conclusion@#The serum H-FABP and the GPBB levels can be used to monitor for myocardial damage, and it has a correlation with the severity of the disease and the prognosis.H-FABP has a significant advantage over traditional myocardial markers in sensitivity and specificity to determine the myocardial injury of sepsis.

Effects of haloperidol on delirium in adult patients: a systematic review and meta-analysis

Objective: The aim of this systematic review and meta-analysis was to investigate whether or not the use of haloperidol could reduce the incidence of delirium in adult patients

Subjects and Methods: PubMed, Embase, the Cochrane Library, Elsevier, Wiley, and Ovid were searched for randomized controlled trials and prospective interventional cohort studies that compared haloperidol with placebo for delirium prophylaxis or with second generation antipsychotics for delirium treatment. The primary end point was the incidence and severity of delirium. After reviewing 272 relevant articles, 10 studies with 1,861 patients were finally included [haloperidol vs. placebo in 8 studies [n = 1,734], and haloperidol vs. second-generation antipsychotics in 2 studies [n = 127]]. Revman 5.3 was used for the data analysis

Results: Compared with placebo, a high dose of prophylactic haloperidol [.5 mg/day] may help reduce the incidence of delirium in surgical patients [risk ratio 0.50, 95% CI 0.32, 0.79]. There were no differences in the duration of delirium, QTc interval prolongation, extrapyramidal symptoms, intensive care unit stay, hospital stay, or mortality between the haloperidol and placebo groups. For delirium treatment, haloperidol exhibited similar effects as the second-generation antipsychotics

Conclusions: In this study, the limited available data revealed that prophylaxis haloperidol at a dose of .5 mg/day might help reduce delirium in adult surgical patients. Further outcome studies with larger sample sizes are required to confirm these findings

Correlation of heart-type fatty acid-binding protein and glycogen phosphorylase enzyme BB in brain with septic myocardial injury / 中国小儿急救医学

The incidence of sepsis is on the rise, and the mortality is also high. Myocardial injury caused by sepsis is one of the important causes of death. However,there is no clear and unified diagnostic criteria to sepsis complicated with myocardial injury. The clinical diagnostic criteria of myocardial injury is mainly based on cardiac ultrasound,myocardial markers and so on. But the measurement of ejection fraction is needed to consider the impact of preload and afterload of left ventricula,also the subjective level of opera-tors. So cardiac markers play an important role in the detection of myocardial injury in sepsis and can reflect the severity of myocardial injury and sepsis,especially in the early diagnosis and prognosis. Heart-type fatty acid binding protein and brain glycogen phosphorylase isoenzyme type exhibit higher sensitivity, specificity and stability compared to other traditional cardiac markers in the clinical diagnosis of myocardial injury, which are worth to be studied and applied in the clinical diagnosis of myocardial injury.

Hemoglobin H disease with a rare α-thalassemia gene mutation (--/αα): pedigree analysis and genetic diagnosis / 南方医科大学学报

<p><b>OBJECTIVE</b>To identify a rare α-thalassemia gene mutation in a family from south China and perform a pedigree analysis and genetic diagnosis of hemoglobin H (HbH) disease caused by this mutation.</p><p><b>METHODS</b>Peripheral blood samples were collected from the family members for analysis of the hematological phenotype and routine test of thalassemia genes. DNA sequencing was carried out for samples that showed genotype and phenotype inconsistency.</p><p><b>RESULTS</b>A rare α-thalassemia *92A>G gene mutation was detected within this family. The proband and his sister were confirmed to have non-deletional HbH disease with α--/αα genotype. The proband's brother was confirmed to have an α-thalassemia trait with the genotype of -α/αα. The proband's father was identified as an α-thalassemia silent carrier with the genotype of αα/αα.</p><p><b>CONCLUSION</b>A rare α-thalassemia *92A>G gene mutation was identified for first time in south China. The description of the basic phenotypic characteristics of α-thalassemia trait and silent carrier caused by this mutation enriches the α-thalassemia gene mutation spectrum in Chinese population and helps in population screening, clinical molecular diagnosis and genetic counseling.</p>

Research on the function and mechanism of mannose-binding lectin regulating intestinal epithelial apoptosis / 局解手术学杂志

Objective To observe the effect of recombinant human mannose-binding lectin ( rhMBL) on apoptosis of intestinal epithelial cells. Methods Fourteen C57 mice were randomly divided into two groups. The LPS mice received intra-peritoneal injection of LPS for indu-cing acute intestinal barrier injury. The expression of MBL protein and mRNA were observed by immuno-histochemisty and RT-PCR respec-tively. The apoptosis of intestinal epithelial cells was detected by tunel staining. In vitro, the Caco-2 cells were treated with 0、 5、10、20 μg/mLrhMBL, flow cytometry was used to detect the apoptosis rate of Caco-2 cells. The Bax and Bcl-2 protein and mRNA were detected by Western blotting and Real-Time PCR methods between various groups. MAPK signal proteins were detected by Western blotting method. Results The MBL and TUNEL staining were apparently increased under LPS condition. The apoptotic rates of Caco-2 cells which were trea-ted by different rhMBL concentrations after 48 h were increased in 20μg/mL rhMBL when compared with other groups. The apoptotic rates of Caco-2 cells which were treated by 20 μg/mL rhMBL after different time were increased in time-dependent manner. The results of Western blotting and Real-Time PCR assay showed that levels of Bax/Bcl-2 was increased in Caco-2 cells which were treated by 20μg/mL rhMBL af-ter 48h. Meanwhile, the phosphorylation of P38 and ERK were obviously increased in Caco-2 cells. The inhibitory effect of ERK and P38 in-hibitors were studied by Western blotting. Our current study showed that a block in P38 MAPK dependent cell death might contribute to the decrease in 20μg/mL MBL-mediated Caco-2 apoptosis. Conclusion High concentration of rhMBL may play an important role in the intesti-nal epithelial cell apoptosis, and P38 pathway may be involved in this regulation.

The effect of S-Nitrosoglutathione on the intestinal epithelial barrier after acute ischemia reperfusion injury / 重庆医学

Objective To investigate the effect of S-Nitrosoglutathione (GSNO)on acute ischemia reperfusion (I/R)induced in-testinal barrier function lesion in a mouse model.Methods Twenty-four 6-8-year-old C57BL/6 mice were divided into 3 groups,8 for each:(1)the sham group;(2)the I/R group;(3)the I/R+GSNO group.The mouse intestine I/R model was established by the occlusion of the superior mesenteric artery temporarily followed by reperfusion for 6 h.Histological changes in the small intestine were observed after HE staining;the expression of claudin-1 protein in the intestine epithelium was assessed by immunohistochem-istry staining as well as western blot analysis.Results Both HE staining and immunohistochemistry results showed the integrate intestinal villi with the continuous Claudin-1 expression alone the villi in the sham group;the intestinal villi of the I/R group partial-ly detached,thickened,crooked and fractured,with the obvious disconnection of Claudin-1 staining alone the top of the villi;while the intestinal villi of the I/R+GSNO group were neatly arranged and damage to intestinal mucosa was much alleviated,accompanied with the marked restoration of the continuity of claudin-1 staining.Compared to the sham group,claudin-1 protein level of for the I/R group and the I/R+GSNO group decreased by 32.5% and 13.8% respectively (P <0.05);and compared to the I/R group,clau-din-1 protein level of the I/R+GSNO group increased by 27.8% (P <0.05).Conclusion Protein level of claudin-1 would decrea-ses after I/R,and pretreatment with GSNO can effectively relieve the damage of intestinal mucosal structure as well as intestinal tight junction barrier through upregulating the expression of claudin-1 protein.

Correlation between stroke volume variation and blood volume during hypovolemia / 中华麻醉学杂志

Objective To investigate the correlation between stroke volume variation (SVV) and blood volume during hypovolemia.Methods Twenty ASA Ⅰ or Ⅱ patients,aged 20-64 years,with body mass index (BMI) of 20-30 kg/m2,scheduled for elective orthopedic operation were enrolled in this study.Anesthesia was induced with dexamethasone,midazolam,propofol,fentanyl and cisatracurium,and maintained with sevoflurane,fentanyl and cisatracurium.Then the patients received endotracheal intubation and mechanical ventilation.Heart rate (HR),mean arterial blood pressure (MAP),central venous pressure (CVP),arterial pressure-based cardiac output (APCO),SW,systemic vascular resistance (SVR) and cardiac index (Cl) were recorded 5 minutes after endotracheal intubation.Blood was taken from the central vein at a rate of 30-50 ml/min and the volume was 5％ of the whole blood volume,and then haemodynamic parameters mentioned above were recorded after the haemodynamics were kept stable for 5 minutes.Blood was taken again with the method mentioned above and the haemodynamic parameters were recorded.Then 6％ hydroxyethyl starch (HES) 130/0.4 was infused at 50-70 ml/min via the right internal jugular vein,and the volume was equal to 5％ of the whole blood volume,and then haemodynamic parameters were recorded after the haemodynamics was kept stable for 5 minutes.Fluid replacement was performed again using the method mentioned above and the haemodynamic parameters were recorded.Linear correlation of the changes in blood volume (difference between the blood volume at each time point and the baseline value) with dSVV (difference between the value monitored at each time point and the baseline value) was analyzed.Results Significant changes were found in SW,APCO and Cl after each change in blood volume (P ＜ 0.05 or 0.01),while no significant changes were found in HR,MAP,CVP and SVR after each change in blood volume.The change in blood volume was negatively correlated with dSVV (r =-0.875,P ＜ 0.01).Conclusion There is high correlation between SVV and blood volume during hypovolemia.And SVV can reflect the changes in blood volume accurately and can be used for volume therapy during hypovolemia.

Activity of cathepsin D and alpha-1 antitrypsin in patients with hip or knee osteoarthritis / 中南大学学报(医学版)

Objective: To assess the activity of cathepsin D (CAT-D) and alpha-1 antitrypsin (AAT) in blood in patients with hip or knee osteoarthritis, and to explore whether these two enzymes could be served as serum biomarkers for cartilage degeneration. Methods: hTe activity of CAT-D and AAT in blood serum of 44 women and 26 men with hip or knee osteoarthritis was determined by the method of ELISA before total joint replacement and on the 10th day atfer the surgery. One hundred healthy volunteers were chosen as the control. All datawere analyzed by using SPSS19.0 sotfware. Results: Compared with the controls, the activity of CAT-D in patients with osteoarthritis was decreased by 25% (P0.05), but it was increased by 80% after the surgery than that in the control group (P0.05). hTe gender, hypertension, diabetes and age did not affect the activities of the 2 enzymes (P>0.05). Conclusion: AAT might be a possible inflammatory indicator in the osteoarthritis. CAT-D and AAT enzymes are not affected by gender, age, hypertension and diabetes, etc, and they might be served as potential biomarkers for cartilage degradation.