Comparison of clinical effects of three criteria for postoperative pulmonary complications / 中华麻醉学杂志

Objective:To compare the clinical effects of the three criteria for postoperative pulmonary complications (PPCs).Methods:The clinical data of patients underwent thoracoscopic lung resection between January 2021 and July 2021 in our hospital were retrospectively analyzed.PPCs were assessed using the Melbourne Group Scale (MGS), European Perioperative Clinical Outcome (EPCO) and Standardized Endpoints for Perioperative Medicine (StEP) criteria.The patients were divided into PPC group and non-PPC group according to the above criteria.The diagnostic rates of PPCs of the three criteria were recorded.Cohen′s weighted kappa coefficient was used to evaluate the agreement between the three criteria.Logistic regression method was used to analyze the association between PPCs diagnosed by different criteria and risk of adverse prognostic events developed.Results:A total of 397 patients who underwent thoracoscopic lung surgery were included in this study.The rate of PPCs diagnosed by MGS criterion was significantly lower than those by EPCO and StEP criteria ( P<0.001), and the rate of PPCs diagnosed by EPCO criterion was significantly higher than those by StEP criterion ( P<0.001). The diagnostic agreement between EPCO criterion and StEP criterion was good ( κ=0.624, P<0.001), while the diagnostic agreement between EPCO criterion, StEP criterion and MGS criterion was poor ( κ=0.101, P<0.001; κ=0.210, P<0.001). Univariate and multivariate logistic regression analysis showed that PPCs diagnosed by EPCO and StEP criteria increased the risk of adverse prognostic events developed ( P<0.001). Conclusions:The EPCO and StEP criteria are superior to MGS criterion with regard to the diagnostic and prognostic value for pulmonary complications following thoracoscopic lung resection, and the EPCO criterion had a higher sensitivity.

Risk factors for pulmonary complications after thoracoscopic lung resection and the prediction value / 中华麻醉学杂志

Objective:To identify the risk factors for postoperative pulmonary complications (PPCs) after thoracoscopic lung resection and evaluate the predictive value for the development of PPCs.Methods:The perioperative data of patients, aged≥18 yr, of American Society of Anesthesiologists (ASA) physical statusⅠ-Ⅲ, were obtained through the electronic medical record system.The blood routine within 24 h after surgery was recorded, and systemic immune-inflammation index (SII) was calculated.According to the development of PPCs, the patients were divided into non-PPCs group and PPCs group.Multivariate logistic regression analysis was used to analyze the variables of which P values were less than 0.05 to identify the risk factors for PPCs, and the receiver operating characteristic curve was drawn to evaluate the predictive value of risk factors. Results:A total of 699 patients were enrolled in this study, including 620 patients in non-PPCs group and 79 patients in PPCs group.The results of logistic regression analysis found that body mass index ≥25 kg/m 2, ASA physical status Ⅲ, lung segmental resection, resection of lobes or above, multi-port thoracoscopic surgery and increased postoperative SII were the risk factors for PPCs ( P<0.05 or 0.01). The AUC (95% confidence interval) of postoperative SII in predicting PPCs was 0.636 (0.599-0.671) ( P<0.05), the cut-off value of SII in predicting PPCs was set at 1 052.3, and the sensitivity and specificity were 68.4% and 57.3%, respectively. Conclusions:Body mass index ≥25 kg/m 2, ASA physical status Ⅲ, lung segmental resection, resection of lobes or above, multi-port thoracoscopic surgery and increased postoperative SII are the risk factors for PPCs.Postoperative SII can predict the occurrence of PPCs to a certain extent in the patients undergoing thoracoscopic lung resection.

Effect of start time of surgery on short-term prognosis in patients undergoing elective cardiac surgery with cardiopulmonary bypass / 中华麻醉学杂志

Objective:To evaluate the effect of start time of surgery on short-term prognosis in the patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB).Methods:A total of 928 patients of both sexes, aged 18-81 yr, with body mass index of 14.5-37.7 kg/m 2, scheduled for elective cardiac surgery with CPB from November 14, 2019 to May 14, 2020, were selected.Based on the start time of skin incision, the patients were divided into morning group (08: 00-13: 59) and afternoon group (14: 00-20: 00) or into on-hour group (08: 00-15: 59 on weekday) and off-hour group (16: 00-20: 00 on weekday, 08: 00-20: 00 on weekend). Propensity score matching was used to calibrate confounding factors.The primary outcomes were 30-day mortality and serious cardiovascular and cerebrovascular events after surgery.Secondary outcomes included the development of acute kidney injury within 3 days after surgery and development of pulmonary complications within 30 days after surgery, occurrence of surgical site infection, postoperative length of hospital stay, length of intensive care unit stay and duration of mechanical ventilation, and total hospitalization costs. Results:There was no significant difference in 30-day mortality and serious cardiovascular and cerebrovascular events after surgery, development of acute kidney injury within 3 days after surgery, and incidence of pulmonary complications within 30 days after surgery and of surgical site infection, postoperative length of hospital stay, length of intensive care unit stay and duration of mechanical ventilation, and total hospitalization costs between morning group and afternoon group and between on-hour group and off-hour group ( P>0.05). Conclusions:The start time of surgery exerts no effect on short-term prognosis in the patients undergoing elective cardiac surgery with CPB.

Enzyme-responsive fluorescent probes for bacteria imaging / 药学学报

Fluorescent probes are potential fluorophores that display signals based on the changes in tissue microenvironment, interactions with analytes or specific biochemical reactions. Metabolic enzymes are the most important protein involved in bacteria activities. Complex dynamics of biological processes in bacteria are elucidated by these metabolic enzymes-based fluorescent probes with high spatial resolution and sensitivity. Here, we review recent advances in metabolic enzyme-responsive fluorescent probes for bacteria imaging. It was organized according to enzyme classification systems, focused on fluorescence masking strategies, molecular mechanisms of enzyme activation, and bio-related applications.

Association between anesthesia regimen and postoperative infection in patients undergoing cardiac surgery: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between anesthesia regimen (volatile or intravenous anesthetics) and postoperative infection in adult cardiac patients undergoing cardiac surgery. Methods    The clinical data of 496 elective adults undergoing cardiac surgery under cardiopulmonary bypass from June 2019 to June 2020 in West China Hospital of Sichuan University were retrospectively analyzed, including 251 females and 245 males with an average age of 54.1±11.4 years. American Society of Anesthesiologists grade was Ⅰ-Ⅲ. There were 243 patients in a volatile group with sevoflurane or desflurane, and 253 patients in an intravenous anesthesia group with propofol. The primary outcome was the incidence of infection within 30 days after cardiac surgery, including pulmonary infection, surgical site infection, sepsis, and urinary tract infection. The secondary outcomes were duration of mechanical ventilation, incidence of reintubation, ICU stay, postoperative length of hospital stay and total hospitalization cost. Results     A total of 155 (31.3%) patients developed postoperative infection within 30 days, with an incidence of 32.9% in the volatile group and 29.6% in the intravenous anesthesia group. There was no statistical difference in the incidence of infection (RR=1.111, 95%CI 0.855 to 1.442, P=0.431) or the secondary outcomes (P>0.05) between the two groups. Conclusion     The anesthesia regimen (volatile or intravenous anesthetics) has no association with the risk of occurrence of postoperative infection in adult  patients undergoing elective cardiac surgery with cardiopulmonary bypass.

Effect of intraoperative ventilation modes on postoperative pulmonary complications after cardiac surgery under cardiopulmonary bypass: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of intraoperative ventilation modes with postoperative pulmonary complications (PPCs) in adult patients undergoing selective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The clinical data of 604 patients who underwent selective cardiac surgical procedures under CPB in the West China Hospital, Sichuan University from June to December 2020 were retrospectively analyzed. There were 293 males and 311 females with an average age of 52.0±13.0 years. The patients were divided into 3 groups according to the ventilation modes, including a pressure-controlled ventilation-volume guarantee (PCV-VG) group (n=201), a pressure-controlled ventilation (PCV) group (n=200) and a volume-controlled ventilation (VCV) group (n=203). The association between intraoperative ventilation modes and PPCs (defined as composite of pneumonia, respiratory failure, atelectasis, pleural effusion and pneumothorax within 7 days after surgery) was analyzed using modified poisson regression. Results    The PPCs were found in a total of 246 (40.7%) patients, including 86 (42.8%) in the PCV-VG group, 75 (37.5%) in the PCV group and 85 (41.9%) in the VCV group. In the multivariable analysis, there was no statistical difference in PPCs risk associated with the use of either PCV-VG mode (aRR=0.951, 95%CI 0.749-1.209, P=0.683) or PCV mode (aRR= 0.827, 95%CI 0.645-1.060, P=0.133) compared with VCV mode. Conclusion    Among adults receiving selective cardiac surgery, PPCs risk does not differ significantly by using different intraoperative ventilation modes.

Effect of ventilation mode on pulmonary complications after thoracoscopic lung resection: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To evaluate the association between pressure-controlled ventilation-volume guaranteed (PCV-VG) mode and volume-controlled ventilation (VCV) mode on postoperative pulmonary complications (PPCs) in patients undergoing thoracoscopic lung resection. Methods     A retrospective cohort analysis of 329 patients undergoing elective thoracoscopic lung resection in West China Hospital of Sichuan University between September 2020 and March 2021 was conducted, including 213 females and 116 males, aged 53.6±11.3 years. American Society of Anesthesiologists (ASA) grade wasⅠ-Ⅲ. The patients who received lung-protective ventilation strategy during anesthesia were divided into a PCV-VG group (n=165) and a VCV group (n=164) according to intraoperative ventilation mode. Primary outcome was the incidence of PPCs during hospitalization. Results     A total of 73 (22.2%) patients developed PPCs during hospitalization. The PPCs incidence of PCV-VG and VCV was 21.8% and 22.6%, respectively (RR=0.985, 95%CI 0.569-1.611, P=0.871). Multivariate logistic regression analysis showed that there was no statistical difference in the incidence of PPCs between PCV-VG and VCV mode during hospitalization (OR=0.846, 95%CI 0.487-1.470, P=0.553). Conclusion     Among patients undergoing thoracoscopic lung resection, intraoperative ventilation mode (PCV-VG or VCV) is not associated with the risk of PPCs during hospitalization.

Analysis of Q-markers of Arisaema Cum Bile Acting on Stroke Based on UPLC-QTOF-MS/MS and TCMIP v2.0 / 中国实验方剂学杂志

ObjectiveTo predict the possible quality markers （Q-markers） of Arisaema Cum Bile in the prevention and treatment of stroke based on ultra performance liquid chromatography-quadrupole-time-of-flight tandem mass spetrometry （UPLC-QTOF-MS/MS） and Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP） v2.0. MethodUPLC-QTOF-MS/MS was employed with the mobile phase of 0.1% formic acid aqueous solution （A）-0.1% formic acid acetonitrile solution （B） for gradient elution （0-3 min， 0.2%-5%B； 3-5 min， 5%-8%B； 5-8 min， 8%-10%B； 8-14 min， 10%-25%B； 14-18 min， 25%-50%B； 18-20 min， 50%-70%B； 20-21 min， 70%-98%B； 21-23 min， 98%B； 23-24 min， 98%-0.2%B； 24-26 min， 0.2%B）， the flow rate of 0.5 mL·min-1 and electrospray ionization （ESI）. High quality MS/MS data were scanned in positive and negative ion modes with scanning range of m/z 50-1 500. A local database of the chemical constituents in Arisaema Cum Bile was established by UNIFI 1.8. Then the chemical constituents in Arisaema Cum Bile were characterized by matching with the local database and comparing with the reference substances and literature information. TCMIP v2.0 was used to obtain the targets corresponding to the identified components of Arisaema Cum Bile and stroke， and the "disease-formula" correlation analysis was carried out to screen the core targets by topological eigenvalues. DAVID 6.8 was used for enrichment analysis of Kyoto Encyclopedia of Genes and Genomes （KEGG） pathway of core targets. According to the "five principles" of Q-markers and combined with literature reports， the Q-markers of Arisaema Cum Bile in the prevention and treatment of stroke were predicted， and the core components acting on these target genes were obtained. Cytoscape 3.8.0 was employed to draw the network diagram of "medicinal materials-active ingredients-target genes-pathways". Finally， AutoDock Vina 1.2.2 was used to calculate and verify the molecular docking between the candidate components and the key targets. ResultA total of 76 chemical components was identified in positive and negative ion modes， 85 core targets were collected for Arisaema Cum Bile in the prevention and treatment of stroke. A total of 31 stroke-related pathways， 23 target genes and 9 main active components of Arisaema Cum Bile acting on these genes were screened， and then we determined 4 possible Q-markers for Arisaema Cum Bile in the prevention and treatment of stroke according to the "five principles". ConclusionThe possible Q-markers of Arisaema Cum Bile for stroke are gallic acid， apigenin-6，8-di-C-glucoside， apigenin and cholic acid， and the target of these four components may be estrogen receptor alpha （ESR1）.

Application of Three Blood Stasis Models in Zebrafish in Evaluation of Anti-thrombosis and Anti-myocardial Hypoxia Activities of Notoginseng Radix et Rhizoma / 中国实验方剂学杂志

ObjectiveTo establish blood stasis models in zebrafish using three inducers and select the optimal model for evaluating the activity of Notoginseng Radix et Rhizoma in promoting blood circulation. MethodArachidonic acid （AA）， ponatinib， and isoprenaline （ISO） were used to induce blood stasis models in zebrafish. A normal group， a model group， a positive drug group， and Notoginseng Radix et Rhizoma water extract freeze-dried powder groups at different concentrations were set up. The staining intensity of cardiac erythrocytes and the fluorescence intensity of cardiac apoptotic cells were calculated， the anti-thrombotic effect and anti-myocardial hypoxia activity of Notoginseng Radix et Rhizoma were evaluated. The activities of water extract and 70% methanol extract of Notoginseng Radix et Rhizoma were compared based on the preferred AA- and ISO-induced blood stasis models in zebrafish and the difference in the chemical composition was analyzed by UHPLC LTQ-Orbitrap MS/MS. ResultAfter induction by AA and ponatinib， the staining intensity of cardiac erythrocytes was reduced （P<0.01）， and the fluorescence intensity of cardiac apoptotic cells increased after the induction by ISO （P<0.01）. The freeze-dried powder of the water extract of Notoginseng Radix et Rhizoma could antagonize the thrombosis in the AA-induced model （P<0.01） and the myocardial apoptosis in the ISO-induced model （P<0.05）， while no significant improvement in the thrombosis was observed in the ponatinib-induced model. The freeze-dried powder of 70% methanol extract of Notoginseng Radix et Rhizoma could inhibit myocardial apoptosis in the ISO-induced blood stasis model （P<0.01）， and the effect was stronger than that of the freeze-dried powder of Notoginseng Radix et Rhizoma water extract. The difference in chemical composition lay in some saponins （such as ginsenoside Re）， amino acids， and acetylenic alcohols. ConclusionAA， ponatinib， and ISO all can serve as inducers for the blood stasis model in zebrafish. AA- and ISO-induced models can be used to evaluate the activity of freeze-dried powder of Notoginseng Radix et Rhizoma water extract in promoting blood circulation. The chemical compositions of the freeze-dried powders of Notoginseng Radix et Rhizoma extracted with water and 70% methanol are quite different. For the ISO-induced blood stasis model， the freeze-dried powder of Notoginseng Radix et Rhizoma extracted with 70% methanol has a stronger ability against myocardial hypoxia. Saponins and acetylenic alcohols may be closely related to the effects of promoting blood circulation and resolving blood stasis.

Radiosensitization Effect and Mechanism of Xuefu Zhuyutang on Transplanted Esophageal Carcinoma in Nude Mice / 中国实验方剂学杂志

ObjectiveTo explore the radiosensitization and underlying mechanism of Xuefu Zhuyutang on subcutaneous transplanted esophageal carcinoma. MethodThe subcutaneous xenograft model of human esophageal carcinoma ECA-109 in nude mice was induced and the model mice were divided into a model group， an irradiation group， a Xuefu Zhuyutang group， and a combination group， with six nude mice in each group. After the intervention， the transplanted tumors were removed and weighed， and the tumor inhibition rate of each group was calculated according to the formula. The protein expression of hypoxia-inducible factor-1α （HIF-1α） and vascular endothelial growth factor A （VEGFA） was detected by immunohistochemistry （IHC）. The protein expression of mammalian target of rapamycin （mTOR）， HIF-1α， VEGFA， and vascular endothelial growth factor receptor 2 （VEGFR2） in transplanted tumors was detected by Western blot. The mRNA expression of mTOR， HIF-1α， and VEGFA in transplanted tumors was detected by real-time quantitative polymerase chain reaction （Real-time PCR）. ResultCompared with the conditions in the model group， the tumor weight decreased in the irradiation group and the Xuefu Zhuyutang group （P<0.05）， as well as the combination group （P<0.01）. Compared with the irradiation group， the combination group showed decreased tumor weight （P<0.05）， with tumor inhibition rate of 57.37%. Compared with the model group， the irradiation group， the Xuefu Zhuyutang group， and the combination group showed decreased protein expression of VEGFR2， p-mTOR， HIF-1α， and VEGFA （P<0.05， P<0.01） and reduced mRNA expression of mTOR， HIF-1α， and VEGFA （P<0.05， P<0.01）. Compared with the irradiation group， the combination group showed down-regulated protein expression of VEGFR2， p-mTOR， HIF-1α， and VEGFA （P<0.05， P<0.01） and reduced mRNA expression of mTOR， HIF-1α， and VEGFA （P<0.05， P<0.01）. ConclusionXuefu Zhuyutang can inhibit the growth of transplanted esophageal carcinoma ECA-109 in nude mice and shows an obvious radiosensitization effect in combination with radiotherapy. The mechanism may be related to the inhibition of the mTOR/HIF-1α/VEGFA signaling pathway to improve the hypoxic state of tumors.

Comprehensive evaluation system for quality of Chinese medicinal decoction pieces based on "experience-ingredients-activity-electronic sensing" / 中国中药杂志

Quality evaluation of Chinese medicinal decoction pieces is vital for the development of the downstream industries, and is an important channel for implementing the strategy of "higher quality, higher price, and priority for the high quality" for traditional Chinese medicine. At the moment, the quality of Chinese medicinal decoction pieces is mainly evaluated based on chemical component examination. Considering the weak preliminary research foundation and poor research conditions, traditional experience-based evaluation is undervalued in the quality rating of Chinese medicinal decoction pieces. However, traditional experience is a summary of the quality of Chinese medicinal materials based on clinical experience, which thus can be a potential basis for the quality evaluation of the decoction pieces. It is a challenge in the evaluation of Chinese medicinal decoction pieces to objectify the traditional experience-based evaluation from multiple aspects such as chemistry, effect, and characterization via modern techniques. Therefore, this study developed the "experience-ingredients-activity-electronic sensing" evaluation system for Chinese medicinal decoction pieces on the basis of experience-based assessment, chemical ingredients that can truly reflect the traditional experience, biological effect assessment, and electronic sensory evaluation, which is expected to quantify the traditional experience of quality evaluation of Chinese medicinal decoction pieces via chemistry, biology, and sensory simulation. The evaluation system can serve as a reference for clinical experience-based quality evaluation of Chinese medicinal decoction pieces.

Comparison on efficacy between fascia-oriented versus vascular-oriented lateral lymph node dissection in patients with rectal cancer / 中华胃肠外科杂志

Objective: To compare the postoperative function, the short-term and long-term outcomes between fascia-oriented and vascular-oriented lateral lymph node dissection (LLND) in patients with rectal cancer. Methods: A retrospective cohort study was performed. Clinical data of patients who received total mesorectal excision (TME) with LLND at National Cancer Center, Cancer Hospital of Chinese Academy of Medical Science from January 2014 to December 2019 were retrospectively collected. Inclusion criteria were as follows: (1) rectal cancer was pathologically diagnosed, and the lower margin was below the peritoneal reflection. (2) resectable advanced rectal cancer with suspected lateral lymph node metastasis was evaluated based on rectal MRI assessment. (3) preoperative MRI showed lateral lymph node short diameter ≥5 mm and/or lymph node morphology (spike, blur, irregular) as well as heterogenous signal intensity. Lymph node shrinkage was less than 60% after receiving neoadjuvant therapy based on the reassessment of rectal MRI. (4) TME+LLND surgery was performed synchronously. Exclusion criteria were as follows: (1) previous history of pelvic surgery; (2) preoperative cystitis, urethritis, moderate and severe prostatic hyperplasia and other diseases resulting in abnormal urination function; (3) preoperative sexual dysfunction or loss of function; (4) patients receiving LLND due to lateral recurrence after TME; (5) distant metastasis of the tumor at initial diagnosis; (6) Incomplete collection of clinical data. A total of 73 consecutive patients were enrolled in this study. Based on the surgical approaches in performing LLND, patients were divided into fascia-oriented group (n=30) and vascular-oriented group (n=43). There were no significant differences in baseline data between the two groups (all P>0.05). The main outcome indicators of this study were the incidence of postoperative urinary and male sexual dysfunction, the efficacy, the number of lateral lymph nodes harvested and the detection rate of positive lymph nodes. Overall survival (OS) rates and progression free survival (PFS) rates were calculated by the Kaplan-Meier method and compared by log-rank test. Results: All patients in both groups completed surgery successfully. There were no significant differences in operation time, intraoperative blood loss, postoperative complications, and the length of hospital stay between the two groups (all P>0.05). In the whole group, the incidence of postoperative urinary dysfunction and male sexual dysfunction was 43.8% (32/73) and 62.5% (25/40), respectively. The median number of lateral lymph nodes harvested was 8.0(4.0,11.0) with a positive rate of 20.5%(15/73). Compared to the vascular-oriented group, the fascia-oriented group demonstrated a decreased rate of urinary dysfunction [26.7% (8/30) vs. 55.8% (24/43), χ(2)=6.098, P=0.014], lower rate of sexual dysfunction in males [6/15 vs. 76% (19/25), χ(2)=5.184, P=0.023], more harvested lateral lymph nodes [M (P25, P75): 9.5 (6.8, 15.3) vs. 6.0 (3.0, 9.0), Z=-2.849, P=0.004]. There was no significant difference in the positvie rate of lateral lymph nodes between the two groups [20% (6/30) versus 20.9% (9/43), χ(2)=0.009, P=0.923]. Three(4.1%) patients were lost during a median follow-up of 34 (1-66) months. The 3-year PFS and OS of the whole cohort were 69.5% and 88.3%, respectively. No significant difference in 3-year PFS rates (79.6% vs. 62.0%, P=0.172) and 3-year OS rates (91.2% vs. 85.9%, P=0.333) were observed between the fascia-oriented group and the vascular-oriented group (both P>0.05). Conclusion: Fascia-oriented LLND is associated with lower risk of postoperative urinary and male sexual dysfunction in patients with rectal carcinoma, and harvest of more lymph nodes, but no significant advantage in long-term survival.

Effects of anesthetics on postoperative pulmonary complications in patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To evaluate the association of anesthesia regime (volatile or intravenous anesthetics) with the occurrence of postoperative pulmonary complications (PPCs) in adult patients undergoing elective cardiac surgery under cardiopulmonary bypass (CPB). Methods    The electronic medical records of 194 patients undergoing elective cardiac surgery under CPB at West China Hospital, Sichuan University between September 2018 and February 2019 were reviewed, including 92 males and 102 females with an average age of 53 years. The patients were classified into a volatile group (n=94) or a total intravenous anesthesia (TIVA) group (n=100) according to anesthesia regimen during surgery (including CPB). The primary outcome was the incidence of PPCs within first 7 d after surgery. Secondary outcomes included incidence of reintubation, duration of mechanical ventilation, ICU stay and hospital stay. Results    There was no significant difference in the incidence of PPCs between the two groups (RR=1.020, 95%CI 0.763-1.363, P=0.896), with an incidence of 48.9% in the volatile group and 48.0% in the TIVA group. Secondary outcomes were also found no significant difference between the two groups (P>0.05). Conclusion    No association of anesthesia regimen with the incidence of PPCs is found in adult patients undergoing elective cardiac surgery under CPB.

Analysis of clinical characteristics of patients with anti-myelin oligodendrocyte glycoprotein and anti-N-methyl-D-aspartate receptor antibody positive / 中华神经科杂志

Objective:To analyze the clinical characteristics of patients with double-positive anti-myelin oligodendrocyte glycoprotein (MOG) antibody and anti-N-methyl-D-aspartate receptor (NMDAR) antibody, so as to raise awareness of such diseases and improve the prognosis.Methods:Eighteen patients (double positive group) with positive serum anti-MOG antibody and cerebrospinal fluid anti-NMDAR antibody in Huashan Hospital, Fudan University from March 2017 to March 2020 were retrospectively analyzed. Using the SPSS software for simple random sampling, anti-MOG group(20 cases) and anti-NMDAR group (20 cases) were randomly selected at the same time for comparison. The anti-MOG group referred to the patients only with positive serum anti-MOG antibody. While the anti-NMDAR group referred to the patients whose cerebrospinal fluid anti-NMDAR antibody was positive. The clinical characteristics, laboratory examination results, radiological characteristics and prognosis of the three groups were collected and analyzed.Results:There was no statistically significant difference in demographic data among the three groups ( P>0.05). The symptoms of patients in the double-positive group were divided into two categories by cluster analysis, which corresponded to the symptom groups obtained by cluster analysis of the anti-MOG group and the anti-NMDAR group, and the same result was verified by correspondence analysis. Compared with the anti-MOG group, the incidence of epilepsy (10/18 vs 3/20, P=0.016), psychosis and behavior change (8/18 vs 0/20, P=0.001), visual disturbances (8/18 vs 17/20, P=0.016), dysarthria/dysphagia (8/18 vs 1/20, P=0.007) was significantly different in the double-positive group ( P<0.017). Compared with the anti-NMDAR group, the incidence of ataxia (8/18 vs 19/20, P=0.001), psychosis and behavior change (12/18 vs 1/20, P<0.001) was significantly different in the double-positive group. There was no statistically significant difference in the combination rate of thyroid peroxidase antibody, thyroglobulin antibody and antinuclear antibody between two groups, and the cerebrospinal fluid pressure, white blood cell count, protein, glucose, chloride and positive rate of oligoclonal band were also not statistically different between two groups ( P>0.017; P<0.017 indicates statistically significant difference by Bonferroni corrected multiple comparisons). Compared with the anti-NMDAR group, whether the brain magnetic resonance imaging had lesions was different in double positive group (18/18 vs 8/20, P<0.001). The initial modified Rankin Scale (mRS) scores before treatment were different among the double positive group, anti-MOG group and anti-NMDAR group (3.72±0.96, 2.75±0.97, 3.95±0.76, respectively, F=10.004, P<0.001), but there was no statistically significant difference in the scores after six-month treatment (1.22±1.44, 0.40±0.75, 1.20±1.24, respectively, F=3.153, P=0.051), and the recurrence rate of the disease was different among the three groups (8/18, 14/20, 5/20, respectively, χ2=10.004, P=0.017). Conclusions:Anti-MOG antibodies and anti-NMDAR antibodies could exist at the same time, showing clinical phenotype overlap, which was a new syndrome called the overlapping syndrome of myelin oligodendrocyte glycoprotein antibody-associated disease and NMDAR encephalitis, MNOS. The condition of MNOS patients was more severe than that of patients with MOG antibody-associated disease (MOGAD), but patients with MNOS, MOGAD, and anti-NMDAR encephalitis all responded well to immunosuppressive therapy. It was suggested that early second-line immunotherapy should be given to reduce the recurrence rate in patients with MNOS and MOGAD.

Clinical practice of intraoperative ventilation management of adult patients undergoing non-cardiothoracic surgery: a regional questionnaire survey / 中华麻醉学杂志

Objective:To investigate the development of clinical practice of intraoperative ventilation management of the adult patients undergoing non-cardiothoracic surgery using surveys and questionnaires.Methods:From December 2020 to January 2021, an electronic questionnaire was sent to the anesthesiologists in twenty-nine tertiary general hospitals in Sichuan province.Results:A total of 1 264 valid questionnaires were received with a response rate of 78.50%.The proportion of anesthesiologists who utilized low tidal volume (V T) during surgery was 90.43%.The proportion of anesthesiologists who utilized positive end-expiratory pressure (PEEP) during surgery was 70.73%, and the level of PEEP was controlled at 1-5 cmH 2O by most of the anesthesiologists (77.4% in laparoscopic surgery and 88.4% in non-cardiothoracic surgery). The proportion of anesthesiologists who performed alveolar recruitment maneuvers (ARM) was 82.28%.The proportion of anesthesiologists who used a combination of low V T, PEEP and ARM was 37.03%.The proportion of anesthesiologists who considered "low V T, appropriate use of PEEP or ARM" as "intraoperative lung-protective ventilation (LPV) strategy" was 98.10%.However, the other ventilation settings such as the fraction of inspired oxygen, respiratory rate and ventilation mode varied among anesthesiologists in clinical practice. Conclusion:LPV strategy recognized by anesthesiologists in the large-scale tertiary general hospitals in Sichuan province includes low V T, PEEP and ARM, however, there is a gap between clinical practice and theoretical cognition.

Historical Evolution and Modern Clinical Application of Qingxin Lianzi Yin / 中国实验方剂学杂志

Qingxin Lianzi Yin （QXLZY）， as an ancient classical formula for clearing the heart and nourishing the Yin， was composed of nine herbs （Scutellariae Radix， Ophiopogonis Radix， Lycii Cortex， Plantaginis Semen， Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle， Nelumbinis Semen， Poria， Astragali Radix and Ginseng Radix et Rhizoma）， coming from Prescriptions of the Bureau of Taiping People's Welfare Pharmacy. It could clear away the heart-fire， promote the interaction of the heart and kidney， replenish Qi and Yin， and stop strangury-turbidity. It was used to treat gonorrhea of urination， seminal emission， restlessness， wasting-thirst and so on. At present， the usage and dosage of QXLZY and its addition and subtraction are different in clinical practice. Most of the studies just focus on its clinical efficacy， and there is few review literature reflecting its historical evolution. Based on this， this paper systematically clarified the historical evolution， composition， preparation， interpretation， function， and modern clinical application of QXLZY. This work has been explained the historical evolution of QXLZY， and found that it was wildly used in modern clinical， especially suitable for the treatment of chronic urinary system diseases. At the same time， QXLZY also had significant therapeutic effects on neurasthenia， stomatitis， diabetic nephropathy and other aspects. Through the comprehensive analysis of ancient and modern literature， this work explores the true connotation of QXLZY from the perspective of traditional Chinese medicine theory， which can point out the direction of the clinical application and positioning of this famous classical formula after it comes into the market， and also can provide reference basis for its subsequent in-depth research and development.

Screening of Active Components and Analysis of Mechanism of Dipsaci Radix in Treating Rheumatoid Arthritis Based on UPLC-QTOF-MS/MS and TCMIP / 中国实验方剂学杂志

Objective:To explore active components and mechanism of Dipsaci Radix in treating rheumatoid arthritis （RA） based on ultra-performance liquid chromatography coupled with quadrupole time-of-flight tandem mass spectrometry （UPLC-QTOF-MS/MS） and Integrative Pharmacology-based Research Platform of Traditional Chinese Medicine （TCMIP）. Method:UPLC-QTOF-MS/MS with electrospray ionization （ESI） was used to qualitatively analyze the chemical components in methanol extract of Dipsaci Radix under positive and negative ion scanning modes. The mobile phase consisted of 0.1% formic acid aqueous solution （A）-acetonitrile （B） for gradient elution （0-10 min， 0.2%-20%B； 10-20 min， 20%-40%B； 20-25 min， 40%-50%B； 25-33 min， 50%-98%B； 33-35 min， 98%-0.2%B）， and the scanning range was <italic>m</italic>/<italic>z</italic> 50-2 000. Based on TCMIP， candidate target groups of Dipsaci Radix， RA and syndrome with Yin deficiency of liver and kidney were obtained， and correlation analysis on "disease-syndrome-prescription" was used to enrich the main active components and key targets. Cytoscape 3.8.0 and STRING 11.0 database were used to construct protein-protein interaction （PPI） network diagram. Metascape platform was used to analysis gene ontology biological progress and Kyoto Encyclopedia of Genes and Genomes （KEGG） signaling pathways. Result:A total of 81 ingredients were identified by UPLC-QTOF-MS/MS. Based on TCMIP， 283 candidate targets corresponding to 81 ingredients， 7 RA related targets and 215 genes corresponding to syndrome with Yin deficiency of liver and kidney were collected. With further correlation analysis on "disease-syndrome-prescription"， 17 key active ingredients were predicted， mainly including saponins and fatty acids of Dipsaci Radix. It mainly involved 7 hub targets， namely tumor necrosis factor （TNF）， nuclear factor-<italic>κ</italic>B subunit 1 （NF-<italic>κ</italic>B₁）， hepatocyte nuclear factor 4 alpha （HNF4A）， nuclear receptor subfamily 3 group C member 1 （NR3C1）， peroxisome proliferator activated receptor gamma （PPARG）， nuclear receptor subfamily 1 group H member 4 （NR1H4） and nuclear receptor coactivator 1 （NCOA1）. All of them were related to inflammation， and two of them were related to bile acid pathway. The 7 hub targets and 7 pathways played an important role in RA were screen out， including 4 bile acid related pathways and 3 inflammatory related pathways. Conclusion:UPLC-QTOF-MS/MS combined with TCMIP preliminarily elucidates the regulatory effect of multi-components in Dipsaci Radix on several pathways related to the inflammatory response and bile acid synthesis and metabolism， which lays a foundation for further study on the mechanism of Dipsaci Radix against RA.

Effect of Different Extracts and Monomers of Lepidium meyenii on Proliferation of Mouse Splenic Lymphocyte and Induction of IL-2 and TNF-α / 中国实验方剂学杂志

Objective:To explore effects of different extracts and monomers of <italic>Lepidium meyenii </italic>（Maca） on the proliferation of mouse splenic lymphocytes and induction of interleukin-2 （IL-2） and tumor necrosis factor-<italic>α</italic> （TNF-<italic>α</italic>） by observing their immunomodulatory effects. Method:An octadecylsilyl （ODS） column was used to enrich the methanol extract of <italic>L. meyenii</italic> in stages to obtain six fractions and three monomers. Different groups of extracts and monomers of <italic>L. meyenii </italic>at different doses were set up. Cell counting Kit-8 （CCK-8） was used to detect the effect on the proliferation of mitogen-free， concanavalin A （Con A）-induced， and lipopolysaccharides （LPS）-induced mouse splenic lymphocytes. Enzyme-linked immunosorbent assay （ELISA） was used to determine the levels of IL-2 and TNF-<italic>α</italic>. Result:<italic>L. meyenii </italic>extracts Fr₃ and Fr₆， and monomers <italic>N</italic>-benzyl hexadecanamide and 1，2-dihydro-4-carboxaldehyde-3-benzyl-<italic>N</italic>-hydroxypyridine slightly promoted the proliferation of Con A-induced T lymphocytes and LPS-induced B lymphocytes （<italic>P</italic><0.01） as compared with the conditions in the model group. <italic>L. meyenii</italic> extracts and monomers significantly induced the secretion of IL-2 and TNF-<italic>α</italic> by splenic lymphocytes （<italic>P</italic><0.01）. Conclusion:<italic>L. meyenii</italic> extracts and monomers can achieve immunological enhancement by promoting the secretion of IL-2 and TNF-<italic>α</italic>， and facilitate the proliferation of splenic lymphocytes. The active components are presumedly macamides and pyridine alkaloids， and the specific mechanism still needs to be further explored.

Effect of driving pressure-guided lung protective ventilation strategy on early postoperative pulmonary function in adults patients undergoing heart valve surgery: A randomized controlled study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effect of driving pressure-guided lung protective ventilation strategy on lung function in adult patients under elective cardiac surgery with cardiopulmonary bypass. Methods    In this randomized controlled trial, 106 patients scheduled for elective valve surgery via median sternal incision under cardiopulmonary bypass from July to October 2020 at West China Hospital of Sichuan University were included in final analysis. Patients were divided into two groups randomly. Both groups received volume-controlled ventilation. A protective ventilation group (a control group, n=53) underwent traditional lung protective ventilation strategy with positive end-expiratory pressure (PEEP) of 5 cm H2O and received conventional protective ventilation with tidal volume of 7 mL/kg of predicted body weight and PEEP of 5 cm H2O, and recruitment maneuver. An individualized PEEP group (a driving pressure group, n=53) received the same tidal volume and recruitment, but with individualized PEEP which produced the lowest driving pressure. The primary outcome was oxygen index (OI) after ICU admission in 30 minutes, and the secondary outcomes were the incidence of OI below 300 mm Hg, the severity of OI descending scale (the Berlin definition), the incidence of pulmonary complications at 7 days after surgery and surgeons’ satisfaction on ventilation. Results    There was a statistical difference in OI after ICU admission in 30 minutes between the two groups (273.5±75.5 mm Hg vs. 358.0±65.3 mm Hg, P=0.00). The driving pressure group had lower incidence of postoperative OI<300 mm Hg (16.9% vs. 49.0%, OR=0.21, 95%CI 0.08-0.52, P=0.00) and less severity of OI classification than the control group (P=0.00). The incidence of pulmonary complications at 7 days after surgery was comparable between the driving pressure group and the control group (28.3% vs. 33.9%, OR=0.76, 95%CI 0.33-1.75, P=0.48). The atelectasis rate was lower in the driving pressure group (1.0% vs. 15.0%, OR=0.10, 95%CI 0.01-0.89, P=0.01). Conclusion    Application of driving pressure-guided ventilation is associated with a higher OI and less lung injury after ICU admission compared with the conventional protective ventilation in patients having valve surgery.

Association of anesthetics with postoperative delirium in patients undergoing cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To determine whether there was a clinical relevant association between anesthetic regimen (propofol or inhalational anesthetics) and the occurrence of postoperative delirium (POD) in patients undergoing cardiac surgery. Methods    This retrospective study was conducted on patients with elective cardiac surgery under cardiopulmonary bypass (CPB) at West China Hospital of Sichuan University between October 2018 and March 2019. The patients were divided into a propofol group or an inhalational anesthetics group according to anesthetic regimen (including CPB). The primary outcome was the occurrence of POD during first 3 days after surgery. Logistic regression analysis was used to determine the relationship between anesthetic regimen and the occurrence of POD. Results    A total of 197 patients who met the inclusion criteria were included, with an average age of 53 years, and 51.8% (102/197) were females. POD occurred in 21.3% (42/197) patients. The incidence of POD was 21.4% in the propofol group and 21.2% in the inhalational anesthetics group; there was no significant difference between the two groups (RR=1.01, 95%CI 0.51-2.00, P=0.970). Logistic regression analysis did not find that anesthetic regimen was a risk factor for delirium after cardiac surgery after adjusting risk factors (OR=1.05, 95%CI 0.48-2.32, P=0.900). Conclusion    Anesthetic regimen (propofol or inhalational anesthetics) is not associated with an increased risk for POD in adult patients undergoing elective cardiac surgery under CPB.