Study on Difference of Intestinal Flora in Patients with Primary Insomnia with Different TCM Syndromes / 中国中医药信息杂志

Objective To explore structural differences of intestinal flora in primary insomnia patients with different TCM syndromes through the high-throughput 16S rDNA sequencing analysis. Methods Totally 65 patients with primary insomnia were divided into 22 patients with syndrome of liver depression transforming into fire, 17 patients with deficiency of both heart and spleen syndrome, 26 patients with syndrome of hyperactivity of fire due to yin deficiency, with 47 cases of healthy people as the control group. The fecal flora structure of the subjects was analyzed by high-throughput 16S rDNA sequencing. QIIME software and R language stats package were used to analyze the diversity of flora. Results Totally 1226 different operational taxonomic units (OUTs) were obtained, and there were 180 significant differences among the 4 groups (P<0.05), indicating that the samples were rich in microbial colonies. The mapped reads in group of liver depression transforming into fire and hyperactivity of fire due to yin deficiency were more than the group of deficiency of both heart and spleen and the control group (P<0.05). Unweighted UniFrac analysis showed that the difference among groups was remarkably greater than the difference within group, and the grouping was statistically significant (R=0.103, P=0.002). It suggested that the diversity of intestinal flora was highly correlated with different TCM syndromes of insomnia. There were a total of 57 genera found significant differences among the different groups at the genus level (P<0.05), and 115 species at all species level. The dominant flora of the control group were prevotella, megamonas, clostridium Ⅺ (clostridium ⅩⅧ), weissella, and alloprevotella; The dominant flora of liver depression transforming into fire syndrome were phascolarctobacterium, flavonifractor, eggerthella, and bilophila; The dominant flora of deficiency of both heart and spleen syndrome were sphingomonas and methylobacterium; The dominant flora in hyperactivity of fire due to yin deficiency syndrome group were bacteroides, parabacteroides, parasutterella, butyricimonas, odoribacter. Conclusion The patients with primary insomnia have abundant intestinal flora diversity and diverse flora structure, which may affect the occurrence, development and outcome of different TCM syndromes.

Mid-term outcome of endoscopic greater saphenous vein harvesting in coronary artery bypass grafting / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the mid-term clinical outcome of endoscopic greater saphenous vein harvesting (EVH) in coronary artery bypass grafting (CABG). Method A total of 205 patients receiving off-pump CABG between July, 2012 and April, 2013 at our department were enrolled in this study, including 66 patients (35 male and 31 female patients with a mean age of 60.3±7.92 years) undergoing EVH and 139 patients (109 male and 30 female patients with a mean age of 59.20±8.37 years) undergoing open greater saphenous vein harvesting (OVH).</p><p><b>RESULTS</b>The surgical procedures were completed smoothly in all the cases. The perioperative mortality rates was 3.03% (2/66) in EVH group, as compared with 3.60% (5/139) in OVH group (P=1.00). Acute myocardial infarction (AMI) occurred during the perioperative period in 3 (2.16%) patients in OVH group and in 1 (1.52%) patient in EVH group. Perioperative low cardiac output syndrome was diagnosed in 4 (2.88%) patients in OVH group and in 2 (3.03%) in EVH group (P>0.05). During the follow-up, 8 (8.80%) patients in OVH group and 5 (8.06%) in EVH group had recurrent angina (P=0.93). No patients experienced AMI during the follow-up. The 2-year patency rate of the venous grafts was 83.59% in OVH group and 82.22% in EVH group (P=0.73).</p><p><b>CONCLUSION</b>EVH has significant advantage in reducing the complications of the incision in the lower limbs. The mid-term patency rates of venous grafts are similar between OVH and EVH, but the long-term patency rate needs further evaluation.</p>

Clinical results of combined palliative procedures for cyanotic congenital heart defects with intractable hypoplasia of pulmonary arteries / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Congenital heart defects with intractable hypoplasia of the pulmonary arteries without intercourse or with intercourse stenosis is unsuitable for surgical correction or regular palliative procedures. We reported our experience with combined palliative procedures for congenital heart defects with intractable hypoplasia pulmonary arteries.</p><p><b>METHODS</b>From 2001 to 2012, a total of 41 patients with cyanotic congenital heart defects and intractable hypoplasia of the pulmonary arteries underwent surgical procedures. From among them, 31 patients had pulmonary atresia with ventricular septal defect (VSD) and the other 10 cases had complicated congenital heart defects with pulmonary stenosis. Different kinds of palliative procedures were performed according to the morphology of the right and left pulmonary arteries in every patient. If the pulmonary artery was well developed, a Glenn procedure was performed. A modified Blalock-Taussig shunt or modified Waterston shunt was performed if pulmonary arteries were hypoplastic. If the pulmonary arteries were severely hypoplastic, a Melbourne shunt was performed. Systemic pulmonary artery shunts were performed bilaterally in 25 cases. A systemic-pulmonary shunt was performed on one side and a Glenn procedure was performed contralaterally in 16 cases. Major aortopulmonary collateral arteries were unifocalized in six cases, ligated in two cases and interventionally embolized in two cases. There was one early death because of cardiac arrest and the hospital mortality was 2.4%.</p><p><b>RESULTS</b>Five patients suffered from postoperative low cardiac output syndrome, three had perfusion of the lungs, and two pulmonary infections. Systemic pulmonary shunts were repeated after the original operation in three cases due to the occlusion of conduits. The mean follow-up time was 25 months. The pre- and the post-operation left pulmonary indices were (8.13 ± 3.68) vs. (14.9 ± 6.21) mm(2)/m(2). The pre- and post-operation right pulmonary indices were (12.7 ± 8.13) vs. (17.7 ± 7.78) mm(2)/m(2). The pre- and post-operational pulmonary indices were (20.87 ± 9.43) vs. (32.6 ± 11.7) mm(2)/m(2). They were all significantly increased (P < 0.001). The diameter of the pulmonary artery increased after the modified Blalock-Taussig shunt ((5.51 ± 0.94) mm(2)/m(2) pre-operation vs. (7.01 ± 1.97) mm(2)/m(2) post-operation), the modified Waterston shunt ((5.70 ± 3.96) mm(2)/m(2) pre-operation vs. (9.17 ± 3.62) mm(2)/m(2) post-operation) and the Melbourne shunt ((2.17 ± 0.41) mm(2)/m(2) pre-operation vs. (7.35 ± 2.49) mm(2)/m(2) post-operation) (all P < 0.05). Bilateral pulmonary arteries developed well as compared to their pre-operation development. Hemoglobin decreased from (194 ± 27) to (174 ± 24) g/L (P < 0.05) and peripheral oxygen saturation increased from (65 ± 11)% to (84 ± 6)% (P < 0.001). During the follow-up of 27 to 49 months, ultimate complete repair was performed in four cases and one patient underwent a Glenn procedure.</p><p><b>CONCLUSIONS</b>The procedures should be considered on a case to case basis in patients having hypoplasia of the pulmonary arteries with cyanotic congenital heart defects. Combined palliative operations could be an adequate strategic treatment.</p>

Clinical diagnosis and surgical treatment of diaphragmatic paralysis in infants with congenital heart disease after cardiac surgery / 中华实用儿科临床杂志

Objective To investigate the clinical manifestations,diagnosis and treatment of diagrammatic paralysis in infants with congenital heart disease (CHD) after cardiac surgery.Methods Thirty-one cases of diaphragmatic paralysis after cardiac surgery were selected from Jan.2006 to Jun.2012,including 23 cases were male and 8 cases were female.The age at operation was 20 days to 25 months,(8.0 ± 5.5) months on the average.The body weight at operation was 3.1-12.2 kg,(6.8 ± 2.3) kg on the average.All children received machine auxiliary breathing,and they had breathing difficulty without the machine.Diaphragmatic plication via 6-8 intercostal was performed under general anesthesia and endotracheal intubation.Lateral position,with uninjured side downward,was taken to perform chest posterolateral incision or chest lateral incision.Relaxing and weak diaphragm muscles were resected or directly sutured after folding.The clinical manifestations and diagnosis of children were summarized,and the effectiveness of diaphragmatic plication was evaluated.Results In 31 cases with diaphragmatic paralysis,there were 15 cases with left diaphragmatic paralysis,12 cases with right diaphragmatic paralysis,and 4 cases with bilateral diaphragmatic paralysis.Thirty-one cases had dyspnea after weaning of ventilator,and 28 cases received reintubation,23 cases with ventilator-as-sociated pneumonia,and 10 cases with tracheotomy.Diaphragmatic plication was performed in 28 cases,and all of them were weaned off ventilator successfully after the placation.The time of preoperative mechanical ventilation lasted 119-827 hours [(447 ± 225) hours],postoperative ventilator assistance time was 12-206 hours [(71 ± 52) hours],which showed significant difference in time of ventilation(P ＜0.05).Conservative treatment was given to the remaining 3 cases,and they were weaned off ventilation successfully with a better recovery.Conclusions Diaphragmatic paralysis in infants after CHD surgery affects their recovery.Diaphragm plication is a safe and effective method to treat the diaphragm paralysis.

Atrial natriuretic peptide attenuates inflammatory responses on oleic acid-induced acute lung injury model in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>An inflammatory response leading to organ dysfunction and failure continues to be a major problem after injury in many clinical conditions such as sepsis, severe burns, and trauma. It is increasingly recognized that atrial natriuretic peptide (ANP) possesses a broad range of biological activities, including effects on endothelial function and inflammation. A recent study has revealed that ANP exerts anti-inflammatory effects. In this study we tested the effects of human ANP (hANP) on lung injury in a model of oleic acid (OA)-induced acute lung injury (ALI) in rats.</p><p><b>METHODS</b>Rats were randomly assigned to three groups (n = 6 in each group). Rats in the control group received a 0.9% solution of NaCl (1 ml × kg(-1) × h(-1)) by continuous intravenous infusion, after 30 minutes a 0.9% solution of NaCl (1 ml/kg) was injected intravenously, and then the 0.9% NaCl infusion was restarted. Rats in the ALI group received a 0.9% NaCl solution (1 ml × kg(-1) × h(-1)) intravenous infusion, after 30 minutes OA was injected intravenously (0.1 ml/kg), and then the 0.9% NaCl infusion was restarted. Rats in the hANP-treated ALI group received a hANP (0.1 µg × kg(-1) × min(-1)) infusion, after 30 minutes OA was injected intravenously (0.1 ml/kg), and then the hANP infusion was restarted. The anti-inflammation effects of hANP were evaluated by histological examination and determination of serum cytokine levels.</p><p><b>RESULTS</b>Serum interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor (TNF) α were increased in the ALI group at six hours. The levels of all factors were significantly lower in the hANP treated rats (P < 0.005). Similarly, levels of IL-1β, IL-6, IL-10 and TNF-α were higher in the lung tissue in the ALI group at six hours. hANP treatment significantly reduced the levels of these factors in the lungs (P < 0.005). Histological examination revealed marked reduction in interstitial congestion, edema, and inflammation.</p><p><b>CONCLUSION</b>hANP can attenuate inflammation in an OA-induced lung injury in rat model.</p>

A novel, recovery, and reproducible minimally invasive cardiopulmonary bypass model with lung injury in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cardiopulmonary bypass (CPB) has been shown to be associated with a systemic inflammatory response leading to postoperative organ dysfunction. Elucidating the underlying mechanisms and developing protective strategies for the pathophysiological consequences of CPB have been hampered due to the absence of a satisfactory recovery animal model. The purpose of this study was to establish a good rat model of CPB to study the pathophysiology of potential complications.</p><p><b>METHODS</b>Twenty adult male Sprague-Dawley rats weighing 450-560 g were randomly divided into a CPB group (n = 10) and a control group (n = 10). All rats were anaesthetized and mechanically ventilated. The carotid artery and jugular vein were cannulated. The blood was drained from the right atrium via the right jugular and transferred by a miniaturized roller pump to a hollow fiber oxygenator and back to the rat via the left carotid artery. Priming consisted of 8 ml of homologous blood and 8 ml of colloid. The surface of the hollow fiber oxygenator was 0.075 m(2). CPB was conducted for 60 minutes at a flow rate of 100-120 ml× kg(-1)×min(-1) in the CPB group. Oxygen flow/perfusion flow was 0.8 to 1.0, and the mean arterial pressure remained 60-80 mmHg. Blood gas analysis, hemodynamic investigations, and lung histology were subsequently examined.</p><p><b>RESULTS</b>All CPB rats recovered from the operative process without incident. Normal cardiac function after successful weaning was confirmed by electrocardiography and blood pressure measurements. Mean arterial pressure remained stable. The results of blood gas analysis at different times were within the normal range. Levels of IL-1β and TNF-α were higher in the lung tissue in the CPB group (P < 0.005). Histological examination revealed marked increases in interstitial congestion, edema, and inflammation in the CPB group.</p><p><b>CONCLUSION</b>This novel, recovery, and reproducible minimally invasive CPB model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.</p>

Total liquid ventilation reduces oleic acid-induced lung injury in piglets / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pediatric patients are susceptible to lung injury that does not respond to traditional therapies. Total liquid ventilation has been developed as an alternative ventilatory strategy for severe lung injury. The aim of this study is to investigate the effect of total liquid ventilation on oleic acid (OA)-induced lung injury in piglets.</p><p><b>METHODS</b>Twelve Chinese immature piglets were induced acute lung injury by OA. Twelve piglets were randomly treated with conventional gas ventilation (control group) or total liquid ventilation (study group) for 240 minutes. Samples for blood gas analysis were collected before, and at 60-minute intervals after OA-induced lung injury. The degree of lung injury was quantified by histologic examination. The inflammatory cells and the levels of IL-1β, IL-6, IL-10 and TNF-α in plasma, tissue and bronchoalveolar lavage were analyzed.</p><p><b>RESULTS</b>Neutrophil and macrophage counts in bronchoalveolar lavage were significantly decreased in the study group (P < 0.05). The total lung injury score was also reduced in the study group (P < 0.05). The concentrations of IL-1β, IL-6, IL-10 and TNF-α in plasma, tissue and bronchoalveolar lavage were significantly reduced in the study group (P < 0.05).</p><p><b>CONCLUSIONS</b>Total liquid ventilation reduces biochemical and histologic OA-induced lung injury in piglets.</p>

Effect of partial liquid ventilation on lung function in oleic acid-induced lung injury model of piglets / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pediatric patients are susceptible to lung injury that does not respond to traditional therapies. Partial liquid ventilation (PLV) has been developed as an alternative ventilatory strategy for treating severe lung injury. The aim of this study is to investigate the effect of PLV on lung function in immature piglets.</p><p><b>METHODS</b>Acute lung injury was induced in 12 Chinese immature piglets by oleic acid (OA). The animals were randomly assigned to two groups (n = 6 each group): (1) conventional mechanical ventilation (MV) group and (2) PLV with FC-77 (10 ml/kg) group. Mean arterial blood pressure (MAP), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP), left atrial pressure (LAP), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), cardiac output (CO), mean pressure of airway (Paw), dynamic lung compliance (Cydn), and arterial blood gases were measured during the observation period.</p><p><b>RESULTS</b>No piglet died in either group with severe lung injury. After four hours of ventilation, pH in the MV group gradually decreased to lower than 7.20, while in the PLV group, pH also gradually decreased but remained higher than 7.20 (P < 0.05). Partial pressure of oxygen in artery (PaO2) decreased in both groups, but with a significant difference between the PLV group and MV group (P < 0.05). Partial pressure of carbon dioxide in artery (PaCO2) increased in both groups, but with a significant difference between the PLV group and MV group (P < 0.05). Paw increased in both groups, but was not significantly different (P > 0.05). Cydn decreased in both groups, but without a significant difference (P > 0.05). At four hours, heart rate (HR) and MAP in both groups decreased. MPAP in both groups increased, and there was a significant difference between the two groups (P < 0.05). CVP was stable in both groups. At four hours, PVR and LAP were increased in both groups. CO was decreased in both groups (P < 0.05). SVR was stable during the observation time.</p><p><b>CONCLUSION</b>PLV did not improve outcome in changes of lung function.</p>

Partial liquid ventilation decreases tissue and serum tumor necrosis factor-α concentrations in acute lung injury model of immature piglet induced by oleic acid / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pediatric patients are susceptible to lung injury. Acute lung injury in children often results in high mortality. Partial liquid ventilation (PLV) has been shown to markedly improve oxygenation and reduce histologic evidence of injury in a number of lung injury models. This study was designed to examine the hypothesis that PLV would attenuate the production of local and systemic tumor necrosis factor (TNF)-α in an immature piglet model of acute lung injury induced by oleic acid (OA).</p><p><b>METHODS</b>Twelve Chinese immature piglets were induced acute lung injury by OA. The animals were randomly assigned to two groups of six animals, (1) conventional mechanical ventilation (MV) group and (2) PLV with 10 ml/kg FC-77 group.</p><p><b>RESULTS</b>Compared with MV group, the PLV group had better cardiopulmonary variables (P < 0.05). These variables included heart rate, mean blood pressure, blood pH, partial pressure of arterial oxygen (PaO2), PaO2/inspired O2 fraction (FiO2) and partial pressure of arterial carbon dioxide (PaCO2). PLV reduced TNF-α levels both in plasma and tissue compared with MV group (P < 0.05).</p><p><b>CONCLUSION</b>PLV provides protective effects against TNF-α response in OA-induced acute lung injury in immature piglets.</p>

A novel, stable and reproducible acute lung injury model induced by oleic acid in immature piglet / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Young children are susceptible to pulmonary injury, and acute lung injury (ALI) often results in a high mortality and financial costs in pediatric patients. A good ALI model will help us to gain a better understanding of the real pathophysiological picture and to evaluate novel treatment approaches to acute respiratory distress syndrome (ARDS) more accurately and liberally. This study aimed to establish a hemodynamically stable and reproducible model with ALI in piglet induced by oleic acid.</p><p><b>METHODS</b>Six Chinese mini-piglets were used to establish ALI models by oleic acid. Hemodynamic and pulmonary function data were measured. Histopathological assessment was performed.</p><p><b>RESULTS</b>Mean blood pressure, heart rate (HR), cardiac output (CO), central venous pressure (CVP) and left atrial pressure (LAP) were sharply decreased after oleic acid given, while the mean pulmonary arterial pressure (MPAP) was increased in comparison with baseline (P < 0.05). pH, arterial partial pressure of O2 (PaO2), PaO2/inspired O2 fraction (FiO2) and lung compliance decreased, while PaCO2 and airway pressure increased in comparison with baseline (P < 0.05). The lung histology showed severe inflammation, hyaline membranes, intra-alveolar and interstitial hemorrhage.</p><p><b>CONCLUSION</b>This experiment established a stable model which allows for a diversity of studies on early lung injury.</p>

Expression of ghrelin and insulin-like growth factor-1 in immature piglet model of chronic cyanotic congenital heart defects with decreased pulmonary blood flow / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Cyanotic patients have potential growth retardation and malnutrition due to hypoxemia and other reasons. Ghrelin is a novel endogenous growth hormone secretagogue that has effects on growth and cardiovascular activities. The aim of this study was to evaluate the plasma level and myocardial expression of ghrelin and insulin-like growth factor-1 (IGF-1) using an immature piglet model of chronic cyanotic congenital heart defects with decreased pulmonary blood flow.</p><p><b>METHODS</b>Twelve weanling Chinese piglets underwent procedures of main pulmonary artery-left atrium shunt with pulmonary artery banding or sham operation as control. Four weeks later, hemodynamic parameters were measured. Enzyme-linked immunosorbent assay for plasma ghrelin and IGF-1 level measurement were performed. Ventricular ghrelin and IGF-1 mRNA expressions were measured by quantitative real-time polymerase chain reaction.</p><p><b>RESULTS</b>Four weeks after surgical procedure, the cyanotic model produced lower arterial oxygen tension ((68.73 ± 15.09) mmHg), arterial oxygen saturation ((82.35 ± 8.63)%), and higher arterial carbon dioxide tension ((51.83 ± 6.12) mmHg), hematocrit ((42.67 ± 3.83)%) and hemoglobin concentration ((138.17 ± 16.73) g/L) than the control piglets ((194.08 ± 98.79) mmHg, (96.43 ± 7.91)%, (36.9 ± 4.73) mmHg, (31.17 ± 3.71)%, (109.83 ± 13.75) g/L) (all P < 0.05). Plasma ghrelin level was significantly higher in the cyanotic model group in comparison to the control (P = 0.004), and the plasma IGF-1 level was significantly lower than control (P = 0.030). Compared with control animals, the expression of ghrelin mRNAs in the ventricular myocardium was significantly decreased in the cyanotic model group (P = 0.000), and the expression of IGF-1 mRNAs was elevated (P = 0.001).</p><p><b>CONCLUSIONS</b>Chronic cyanotic congenital heart defects model was successfully established. Plasma ghrelin level and myocardial IGF-1 mRNA expression were significantly up-regulated, while plasma IGF-1 level and myocardial ghrelin mRNA expression were down-regulated in the chronic cyanotic immature piglets. The ghrelin system may be an important part of the network regulating cardiac performance.</p>

Effect of partial liquid ventilation on oleic acid-induced inflammatory responses in piglets / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Pediatric patients are susceptible to lung injury. Acute lung injury (ALI) in children often results in a high mortality. Partial liquid ventilation (PLV) has been shown to markedly improve oxygenation and reduce histologic evidence of injury in a number of lung injury models. This study aimed to examine the hypothesis that PLV would attenuate the production of local and systemic cytokines in an immature piglet model of ALI induced by oleic acid (OA).</p><p><b>METHODS</b>Twelve Chinese immature piglets were induced to develop ALI by oleic acid. The animals were randomly assigned to two groups (n = 6): (1) conventional mechanical ventilation (MV) group and (2) PLV with FC-77 (10 ml/kg) group.</p><p><b>RESULTS</b>Compared with MV group, PLV group got better cardiopulmonary variables (P < 0.05). These variables included heart rate, mean blood pressure, blood pH, partial pressure of arterial oxygen (PaO2), PaO2/FiO2 and partial pressure of arterial carbon dioxide (PaCO2). Partial liquid ventilation reduced IL-1beta, IL-6, IL-10 and TNF-alpha both in plasma and tissue concentrations compared with MV group (P < 0.05).</p><p><b>CONCLUSIONS</b>Partial liquid ventilation provides protective effects against inflammatory responses in the lungs of oleic acid-induced immature piglets.</p>