Intenational breakthroughs in critical care medicine 2020 / 中华危重病急救医学

The main progress in international critical care medicine in 2020 are: the reflections on the mandatory of implementation of the 1-hour cluster treatment strategy for sepsis are still continuing; the "metabolic resuscitation" therapy, represented by large dose of vitamin C, failed to yield positive results; the global epidemic of coronavirus disease 2019 (COVID-19) continues to spread, with evidences indicating Dexamethasone, Remdesivir or interferon β-1b (IFNβ-1b), Lopinavir/Ritonavir and ribavirin as promising therapy; conservative oxygen therapy did not exert positive effects neither for mechanical ventilated patients nor for acute respiratory distress syndrome (ARDS) patient; the concept of lung- and diaphragm-protective mechanical ventilation illuminates a new opportunity to potentially improve clinical outcomes for critically ill patients; there was no positive evidence for stress ulcer prophylaxis and timing of endoscopy for severe acute upper gastrointestinal bleeding; early initiation of renal-replacement therapy (RRT) for critically ill patients with acute kidney injury (AKI) has not shown positive effect. At last, artificial intelligence (AI) has shown good potential in identifying ARDS phenotypes and early predicting sepsis.

Breakthroughs in global critical care medicine 2019 / 中华危重病急救医学

The following trends emerged in international critical care practice in 2019: increasing analysis to phenotypes of sepsis and acute respiratory distress syndrome (ARDS), increasing evidences of early initiating of vasopressors and antibiotics for septic shock, also including the early furosemide stress test for critically ill patients with acute kidney injury (AKI). In addition, there are many significantly important trials with positive results: high dose vitamin C for septic shock, weaning strategy with pressure support ventilation (PSV) mode, tranexamic acid for patients with acute traumatic brain injury, and new monoclonal antibody for Ebola virus disease. And there are also negatives trials as following: individual mechanical ventilation, maximal recruitment open lung ventilation or early neuromuscular blockade for moderate-to-severe ARDS, N95 respirators preventing influenza, flexible family visit program against delirium or early sedation with dexmedetomidine to mechanically ventilated patients, intensive care unit (ICU) diary or nurse-led preventive psychological intervention against posttraumatic stress disorder (PTSD) in patients with mechanical ventilation, recombinant human soluble thrombomodulin (rhsTM) in patients with sepsis-associated coagulopathy, and so on. Further investigations should be focus on the phenotype analysis, by which individualized management fitting for specific pathophysiologic and immune characters for each patient could be clarified.

Effect of adipose tissue-derived mesenchymal stem cell transplantation in treatment of liver fibrosis and possible mechanism / 中华肝脏病杂志

Objective@#To investigate the effect of adipose tissue-derived mesenchymal stem cell (ADSC) transplantation in the treatment of liver fibrosis rats and possible mechanism.@*Methods@#Subcutaneous adipose tissue in the inguinal region of rats was collected to isolate ADSCs. The rats with liver fibrosis induced by intraperitoneally injected carbon tetrachloride were divided into cell transplantation group and phosphate buffer saline (PBS) injection group, and the rats which were fed normally were enrolled as negative control group. The rats in the cell transplantation group were given tail vein injection of ADSCs, and those in the PBS injection group were given injection of 0.5 ml PBS. At 7 days after transplantation, blood samples were collected from the inferior vena cava to evaluate liver function; liver tissue was collected to measure the protein expression of hepatocyte growth factor (HGF) and alpha-smooth muscle actin (α-SMA); Masson trichrome staining was used to evaluate intrahepatic collagen deposition. Hepatic stellate cells (HSCs) were collected from the rats with liver fibrosis, and indirect co-culture of HSCs and ADSCs was performed in vitro to analyze the influence of ADSCs on the proliferation and apoptosis of HSCs. The independent samples t-test was used for comparison between groups, and an analysis of variance was used for comparison of means between multiple samples.@*Results@#ADSCs were found in liver tissue in the transplantation group, and compared with the PBS injection group, the transplantation group had significant alleviation in hepatocyte necrosis, vacuolization, and area of fibrosis and significant reductions in the serum levels of aminotransferases, while there was no significant difference in the level of albumin between the two groups. Compared with the PBS injection group, the transplantation group had significant upregulation in the protein expression of HGF and significant downregulation in the protein expression of α-SMA (both P < 0.05). In vitro co-culture for 72 hours showed that ADSCs inhibited the proliferation of HSCs, and there was a significant difference between the co-culture group and the control group with HSCs cultured alone. Caspase-3 immunostaining showed that after co-culture for 72 hours, there was a significant difference in the apoptosis rate of HSCs between the co-culture group and the control group with HSCs cultured alone (23.42% ± 3.02% vs 14.82% ± 3.93%).@*Conclusion@#ADSC transplantation can upregulate the expression of HGF in the liver, promote the apoptosis of HSCs, and thus alleviate liver fibrosis.

Efficacy of aseptic processing on dental unit waterlines / 中国感染控制杂志

Objective To compare the effect of different ways of water supply and whether or not drain water from waterlines for overnight on bacterial counts in dental unit waterlines(DUWLs).Methods In the first phase,6 sets of DUWLs were randomly divided into 2 groups (external storage tank water supply group and municipal water sup-ply group);in the second phase,6 sets of DUWLs were all changed to use external storage tank and randomly di-vided into 2 groups (draining water for overnight group and without draining water for overnight group),bacterial count before and within one week of disinfection between two groups at two phases were compared respectively. Results In the first phase,handpiece water of DUWLs was most seriously contaminated by bacteria,the average colony count was 4117 CFU/mL,qualified rate was 15.38%.Before disinfection,no significant difference in bacte-rial count were found among each groups (all P>0.05),bacterial count of DUWLs of all groups severely exceeded the standard(all >3000 CFU/mL).Comparison of bacterial count in DUWLs from different water supply routes after disinfection was not significantly different on day 1(P>0.05),but were significantly different at day 2-7(all P0.05),but were significantly different on day 2-7(all P100 CFU/mL.Conclusion Use of external storage tank,daily change of sterile distilled water,and daily emptying water for overnight can effectively reduce bacterial count in DUWLs.

Modified associating liver partition and portal vein ligation for staged hepatectomy: a systematic review / 中华肝胆外科杂志

Objective To evaluate the feasibility,safety and effectiveness of modified associating liver partition and portal vein ligation for staged hepatectomy (ALPPS).Methods The published literatures associated with modified ALPPS were pooled from Embase,Pubmed,Medline,Google Scholar databases.The studies were included or excluded depends on our predetermined criteria.We selected data and performd descriptive analysis from the included studies.Results Five articles were included and reviewed.A total of 62 patients underwent five modified procedures,including monosegment ALPPS (m-ALPPS),anterior approach ALPPS,partial-ALPPS,radiofrequency-assisted liver partition with portal vein ligation (RALPP) and associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS).There were 50 (80.6％) patients diagnosed liver metastatic colorectal cancer.The average operation interval of modified ALPPS was between 8 ～ 22 days and growth rate of future liver remnant (FLR) ranged from 48.7％ to 62.3％,the feasibility to perform ALPPS stage 2 was 98.4％.The incidence of severe postoperative complications were between 11.8％ ～33.3％.The 90-day mortality for monosegment ALPPS,partial-ALPPS and RALPP was 0,while the figure was 8.3％ in ALTPS.The in-hospital morbidities were 5.9％ and 8.3％ for anterior approach ALPPS and ALTPS,respectively,which were 0 in the other three modified groups.Clinical response evaluation,including R0 resection rate,overall survival rate,disease-free and recurrence rates were merely presented 83.3％,80％,50％,50％ in m-ALPPS group,while 100％,100％,95％,5％ in modified ALTPS group.Conclusion Modified ALPPS with improved safety is feasible in clinical practice.However,the effectiveness still needs further studies.

Comparison of Effects of Defferent Operation Ways in Treatment of Pigmented Nevus on Face and Neck / 昆明医科大学学报

Objective Through clinical observation and statistics, to get the best curative effect of surgical operation in treating pigment nevus method and provide clinical guidance. Methods We reviewed of face and neck patients (1100 patients) with pigmented nevus in the department in the department of the dermatology,plastic surgery from January 2013 to October 2015, two different methods was designed on each parts and effect of the treatment, especially satisfaction degree was analyzed by statistical methods.Results In 100 cases of patients, only 20 patients had mild scar hyperplasia at the neck incision and the rest of the patients were satisfactory. For special parts such as mouth,nose and eye around,along thedirection of the muscle, arc and along the direction of dermatoglyph incision was designed respectively, patients obtained with higher postoperative satisfaction (P<0.05) . Conclusion In pigmented nevus of face and neck surgery treatment, surgical incision design requires dynamic and static combining method,incision design is important for the postoperative effect and patients' satisfaction.

Study on lingual mucosa carcinogenesis of C57BL/6 mice induced by 4-nitroquinoline 1-oxide / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to induce carcinogenesis of lingual mucosa in C57BL/6 mice by feeding them 4-nitroquinoline 1-oxide (4NQO) solution.</p><p><b>METHODS</b>A total of 85 C57BL/6 mice were randomly divided into distilled water control group (DD group, n=5), 1,2-propylene glycol control group (PG group, n=5), and experimental group (EP group, n= 75). The mice in the experimental group were medially fed in 15 cages. By contrast, the mice in DD, EP, and PG groups were watered with distilled water, 50 mg.L-1 4NQO solution, and 1,2-propylene glycol solution. The mice in EP group were executed every two weeks from week 0, and the mice in the control groups were sacrificed at the 28th week. The mice were weighed. Mucosal lesions were measured by macroscopic observation and histopathologic detection.</p><p><b>RESULTS</b>One mouse in EP group died of unknown reason. The weight of the mice in EP group presented weight loss compared with the mice in DD and PG groups after the 24th week. Seventy-nine macroscopic lesions were observed in the lingual mucosa, oral floor, and upper palatal and buccal mucosa. A total of 70 macroscopic lesions (88.6%) were located in the lingual mucosa. Mucosal lesions changed from simple hyperplasia to squamous cell carcinomas. Well-differentiated squamous cell carcinomas were observed in all mice of EP group by pathological section at the 28th week. No lesion was found in the mice of DD and PG groups.</p><p><b>CONCLUSION</b>The animal model of lingual squamous cell carcinomas was successfully established. The periods from 12th to 16th week and 20th to 28th week were the ideal times for the research on pathogenesis of early and medial-advanced stage during carcinogenesis of squamous cell carcinomas.</p>

Screening of highly efficient small interfering RNAs against bone morphogenetic protein-7 / 南方医科大学学报

<p><b>OBJECTIVE</b>To obtain highly efficient small interfering RNAs (siRNAs) against bone morphogenetic protein-7 (BMP-7) for future functional analysis of BMP-7 in bone homeostasis.</p><p><b>METHODS</b>We designed 4 independent siRNA sequences against rat BMP-7 and transfected them in rat umbilical vein endothelial cells. After 72 h, we examined BMP-7 mRNA and protein level in the transfected cells using real-time PCR and Western blotting, respectively.</p><p><b>RESULTS</b>All the 4 siRNAs effectively reduced BMP-7 expression in rat umbilical vein endothelial cells, and among them BMP-7-3 siRNA showed the highest efficiency.</p><p><b>CONCLUSION</b>We have obtained an efficient siRNA to knockdown BMP-7 expression in vitro for further investigation of the role of BMP-7 in bone and cartilage formation.</p>

Construction and validation of a dual-luciferase reporter gene system for screening and evaluating anti-liver fibrosis drugs that inhibit transcription of the gene encoding collagen I, chain a1 / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To construct a dual-reporter gene system that will be applicable for use as a tool to screen and evaluate therapeutic drug compounds that inhibit transcription of the gene encoding collagen I, chain at1 (COL1A1).</p><p><b>METHODS</b>The full-length eDNA of transforming growth factor beta1 (TGFbeta1) was cloned by RT-PCR and inserted into two vectors, pcDNA3.1 and pJW4303, for construction of two eukaryotic expression vectors, pcDNA3.1-TGFbeta1 and pJW4303-TGFbeta1.Next, the promoter region of COL1A1, cloned by PCR using human genome DNA as template, was inserted into the vector pGL4.29 to construct the reporter gene vector, pGL4.29-COL1A1 promoter.All three recombinant vectors were verified by restriction enzyme digestion and DNA sequencing.Either the pcDNA3.1-TGFbeta1 or pJW4303-TGFbeta1 vector along with the pGL4.29-COL1A1 promoter vector or a pRL-null, control reporter, vector were co-transfected into the LX-2 human hepatic stellate cells to establish the transcription-activated dualreporter gene system.This system was used as a cell model for screening anti-liver fibrosis compounds that inhibit the transcription of COL1A1.Dexamethasone, a model drug that is known to inhibit the expression of COL1A1, was used as a control to validate the dual-reporter gene system.</p><p><b>RESULTS</b>The two TGFbeta1-expressing vectors and the reporter gene vector containing the promoter region of COL1A1 were successfully constructed.The results of a dual-reporter gene assay showed that TGFbeta1 co-expression increased the activity of the COL1A1 promoter by above 200-fold (t =21.78, P =0.0001), whereas in the absence of TGF31 co-expression the activity was below 2-fold (t =3.396, P =0.0274).The transcriptionactivated dual-reporter gene system was successfully established.The model drug, dexamethasone, effectively inhibited the activity of the COL 1A1 promoter in dose-dependent manner; the activity decreased 29.6% with 10 mumol/L dexamethasone (t =4.140, P =0.0144) and 53.9% with 100 mumol/L (t =6.193, P =0.0035).</p><p><b>CONCLUSION</b>The dual-luciferase reporter system of TGFbeta1 and COL1A1 co-expression developed here can be used as a cell model to screen and evaluate anti-liver fibrosis compounds that inhibit activity of the COL1A1.</p>

A correlation of pulse pressure and prognosis of refractory septic shock patients / 中华内科杂志

Objective To explore the correlation of pulse pressure(PP) and outcome in refractory septic shock patients.Methods A total of 68 patients with refractory septic shock consecutively admitted in our ICU from January 2012 to December 2012 were retrospectively studied.Hemodynamic data and arterial lactate concentration were collected at the time of admission and 24 hours after admission.The outcome of Day 28 post-diagnosis was also recorded.Results (1) Compared with the survivors,heart rate(HR) at 24hours after admission was higher in non-survivors,while 24 h lactate clearance rate (rLac) was lower in them (P ＜ 0.05).Other hemodynamic parameters showed no difference between the non-survivors and the survivors at 24 hours after admission,including central venous pressure (CVP),mean arterial pressure (MAP),systolic blood pressure(SBP),diastolic blood pressure(DBP),PP,pulse pressure/heart rate (PP/HR),pulse pressure/mean arterial pressure(PP/MAP),pulse pressure/systolic pressure(PP/SBP),pulse pressure/diastolic pressure (PP/DBP),the value of SBP above MAP (SMP) and the value of DBP below MAP(MDP).(2)The mortality rate was higher in the patients with HR≥100 b/min than those with HR ＜ 100 b/min,but without statistical significance (56.25％ vs 36.11％,P =0.096).Compared with the survivors,no matter with HR≥100 b/min or HR ＜ 100 b/min,lactate(Lac) at the 24 hours after admission was higher in all the non-survivors (P ＜ 0.05),while with lower rLac (P ＜ 0.05).In those with HR ≥100 b/min,the following hemodynamic parameters were higher in the non-survivors than in the survivors,including PP,PP/HR,PP/MAP,PP/SBP,PP/DBP,SMP and MDP (all P values ＜ 0.05),while no statistical difference was observed in those with HR ＜ 100 b/min.(3)The mortality rate showed no statistical difference in those with MAP≥85 mmHg(1 mmHg =0.133 kPa) and with MAP ＜ 85 mmHg(42.42％ vs 48.57％,P =0.611).No matter MAP≥85 mmHg or MAP ＜ 85 mmHg,compared with the survivors,all the non-survivors had higher Lac at the 24 hours after admission (P ＜ 0.05),while with lower rLac (P ＜ 0.05).In those with MAP≥85 mmHg,HR was higher in the non-survivors than the survivors (P ＜ 0.05).In those with MAP ＜ 85 mmHg,compared with the survivors,the non-survivors had higher PP,PP/MAP,PP/SBP,PP/DBP,SMP and MDP (P ＜0.05),while with lower DBP (P ＜0.05).Conclusion PP is correlated with the outcome in refractory septic shock patients.When the HR and MAP differ,PP has different effect on the outcome and contributes more to the tissue perfusion and outcome in those with higher HR and lower MAP.

Effect of Tongsaimai Tablet on experimental atherosclerosis in rats / 中成药

AIM:To investigate the effect of TSM tablet on rat' s atherosclerotic model' s endothelial cell and explore the mechanism of it.METHODS:Fifty Wistar rats were randomly assigned into five groups:control group,model group,Simvastatin group,TSM high group,TSM low group.All groups were fed with high fat diet and vitamin D_3 except for control group to set up atherosclerosis model.After 12 weeks we detected circle endothelial cell,angiotensin Ⅱ and electron microscopy morphology of arteries.RESULTS:Level of circulating enthelia cell(CEC)and Ang Ⅱ in model rats were significantly higher.TSM can reduce level of the CEC and Ang Ⅱ.Model group rat' s artery endothelial cells were severely damaged under electron microscopy;rat's artery endothelial cells in TSM group were basically intact and its internal elastic membrane was unbroken on it thickness was even,without significant lesion.CONCLUSION:TSM by reducing the number of CEC,the level of Ang Ⅱ used for experimental atherosclerotic endothelial cell in rats has the protective effect.

Calcium caused calcium release causes a vascular smooth muscle cell line A10 cells apoptosis / 中国临床药理学与治疗学

AIM: To investigate the apoptosis of a vascular smooth muscle cell line A10 caused by mild K+ depolarization. METHODS: Apoptosis was evaluated by nuclear staining, DNA fragmentation gel electrophoresis and propidium iodide-stained flow cytometry. Mitochondrial transmembrane potential (Δψm) was measured by flow cytometry. RESULTS: K+ depolarization caused dose correlated A10 cells apoptosis; nifedipine, BAPTA/AM, ryanodine inhibited the cytotoxic effect of K+ completely.The combination use of nifedipine and cyclosporin A made it clear that mitochondria was involved in the apoptosis of A10 cells,and Δψm measurement further confirmed this speculation; A10 apoptosis caused by K+ depolarization was not influenced by heparin or Zn2+,a effective capacitative calcium entry(CCE) blocker. CONCLUSION: Ca2+ entry through voltage-dependent ca channels increases intracytoplasm Ca2+, then triggers further Ca2+ release from endoplasmic reticulum via ryanodine receptor, and the microdomains of elevated intracytoplasm Ca2+ are sensed by adjacent mitochondria, which ultimately lead to cell apoptosis.

A study on the relationship between reactive hyperplasia of the draining lymph nodes and oral cancer micrometastasis / 实用口腔医学杂志

Objective:To investigate the relationship between reactive hyperplasia of the draining lymph nodes and oral cancer micrometastasis.Methods:The specimens was taken from 12 patients suffered from oral squamous cell carcinoma,who accepted inpatient care in West China College of Stomatology,Sichuan University.There were totally 233 lymph nodes,and all the specimens were divided into normal,reactive hyperplasia and metastasis groups by pathological diagnosis.Immunohistochemistry method was used to inspect micrometastasis in the two prior groups,and the data were analyzed with SPSS 10.0.Results:25 lymph nodes were detected metastasis,79 were reactive hyperplasia,and 129 were normal.Normal mucosa,squamous cell carcinoma and metastatic lymph nodes were positive to keratin,and there were 29 and 12 specimens with micrometastasis in reactive hyperplasia and normal lymph nodes separately.Conclusion:Micrometastasis occured on the reactive hyperplasia lymph node in the oral cancer draining area is easier than that on the normal one.

A preliminary study on the proliferation of endothelial cells of human hemangioma / 实用口腔医学杂志

Objective: To study the role of simian virus 40 large T antigen(SV40LTag) and telomeras in the proliferation of endothelial cells in hemangioma. Methods: The expression of SV40LTag was examined in 100 cases of hemangioma with immunohistochemistry, telomerase activity and telomeric length were measured by RT-PCR based telomeric repeat amplification protocol(TRAP) assay, telomeric restriction fragment (TRF) analysis and chemiluminescence in situ hybridization in 50 cases of hemangioma and 10 of squamous cell carcinoma. A sample of embryonic kidney endothelia was used as the contrdol. Results: SV40LTag expression was observed in 45 out off the 100 cases of hemangioma. Telomerase expression was found in 27 out off the 50 cases of hemangioma and all the 10 of squamous cell carcinoma. The telomeric length in hemangioma varied from 6.8 to 13.2 kb, 10.5-13.5 kb in squamous cell carcinoma and 12.4 kb in embryonic kidney endothelia. Conclusion: Transformation of endothelia by simian virus 40 may contribute to the occurring of hemangioma, telomerase may play a role in the proliferation of the endothelial cells in hemangioma.

Treatment of squamous cell carcinoma of tongue with N_0 / 实用口腔医学杂志

Objective: To analyze the effects of treatment of squamous cell carcinoma of tongue with N 0. Methods: 145 cases of squamous cell carcinoma of tongue with N 0 were retrospectively reviewed.22 cases underwent resection of primary tumor without elective neck dissection (END) (control group).123 cases underwent resection of primary tumor with END (END group).Follow-up was carried out for more than 3 years or till the death of patients.Results:Lymph node metastases was indentified in 33 patients in END group after operation and in 4 in control gruop during follow-up.The total occult lymph node metastases was found in 25.52% of the patients.4 (18.18%) died from neck or lung metastasis in control group and 7 (5.69%) in END group (P

Effect of Tongsaimai Tablet on experimental atherosclerosis in rats / 中成药

AIM:To investigate the effect of TSM tablet on rat's atherosclerotic model's endothelial cell and explore the mechanism of it.METHODS:Fifty Wistar rats were randomly assigned into five groups:control group,model group,Simvastatin group,TSM high group,TSM low group.All groups were fed with high fat diet and vitamin D3 except for control group to set up atherosclerosis model.After 12 weeks we detected circle endothelial cell,angiotensinⅡ and electron microscopy morphology of arteries.RESULTS:Level of circulating enthelia cell(CEC) and AngⅡin model rats were significantly higher.TSM can reduce level of the CEC and AngⅡ.Model group rat's artery endothelial cells were severely damaged under electron microscopy;rat's artery endothelial cellsin TSM group were basically intact and its internal elastic membrane was unbroken on it thickness was even,without significant lesion.CONCLUSION:TSM by reducing the number of CEC,the level of AngⅡ used for experimental atherosclerotic endothelial cell in rats has the protective effect.

The Application of Decompression and Suction Drainage in the Treatment of Mandibular Cystic Lesions / 昆明医科大学学报

Objective To evaluate the effect of decompression suction drainage treated mandibular cystic lesions,and compared with the othertreatments such as surgery,decompression,and suction drainage.In order to explore its value in the field of mandible conservative treatment.Methods 36 cases of mandibular cystic lesions were performed decompression and suction drainage.Compared the cystic size before and after the treatment to evaluate the clinical effect.Results According the pathology,29 cases are cyst and 7 cases are mural-ameloblastoma.28 cases which X-ray show a remarkable lessen,6 cases have no change and 2 cases deteriorated.Conclusion decompression suction drainage is one of the ideal treatment for mandibular cystic lesions.