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1.
Article in Chinese | WPRIM | ID: wpr-921703

ABSTRACT

The present study determined five saponins in Xuesaitong Dropping Pills(XDP) by micellar electrokinetic chromatography(MEKC), and evaluated between-batch consistency by MEKC fingerprints and similarity analysis. A background buffer was composed of 20 mmol·L~(-1) sodium tetraborate-20 mmol·L~(-1) boric acid solution(pH 8.5), 55 mmol·L~(-1) sodium dodecyl sulfate(SDS), 23 mmol·L~(-1) β-cyclodextrin, and 13% isopropyl alcohol. All separations were performed at 25 ℃,20 kV and the detection wavelength was set at 203 nm. The separation channel was a fused silica capillary with a dimension of 75 μm I.D. and a total length of 50.2 cm(effective length of 40.0 cm). The contents of notoginsenoside R_1, and ginsenosides Rg_1, Re, Rb_1, Rd were determined with their quality control ranges set. The fingerprints of XDP were established and the between-batch consistency was evaluated by similarity analysis. The contents of five saponins from the 19 batches of XDP were stable in the fixed ranges. Statistical analysis was carried out on the results of multiple batches of samples, and the specific quality control ranges were recommended as follows: notoginsenoside R_1 21.92-34.16 mg·g~(-1), ginsenosides Rg_1 83.54-131.78 mg·g~(-1), ginsenosides Re 13.58-19.82 mg·g~(-1), ginsenosides Rb_1 89.40-129.90 mg·g~(-1), and ginsenosides Rd 22.34-35.67 mg·g~(-1). Eleven characteristic peaks were identified in the fingerprints. Five peaks, notoginsenoside R_1 and ginsenosides Rg_1, Re, Rb_1, Rd, were identified with reference standards. The similarities of the 19 batches of samples were all above 0.988, indicating good between-batch consistency. This method is green and simple, and can be used for the quantitative determination and quality evaluation of XDP. It can also provide references for the quality control of other Chinese medicinal dripping pills.


Subject(s)
Chromatography, Micellar Electrokinetic Capillary , Drugs, Chinese Herbal , Micelles , Quality Control , Saponins
2.
Article in English | WPRIM | ID: wpr-914755

ABSTRACT

Arteriosclerosis is the leading cause of stroke, with a fatality rate surpassing that of ischemic heart disease. High-resolution vessel wall magnetic resonance imaging is generally recognized as a non-invasive and panoramic method for the evaluation of arterial plaque; however, this method requires improved signal-tonoise ratio and scanning speed. Recent advances in high-density head and neck coil arrays are characterized by broad coverage, multiple channels, and closefitting designs. This review analyzes fast magnetic resonance imaging from the perspective of accelerated algorithms for vessel wall imaging and demonstrates the need for effective algorithms for signal acquisition using advanced radiofrequency system. We summarize different phased-array structures under various experimental objectives and equipment conditions, introduce current research results, and propose prospective research studies in the future.

3.
Article in Chinese | WPRIM | ID: wpr-912875

ABSTRACT

Objective: To explore the protective mechanism of acupuncture plus mild hypothermia for cerebral ischemia-reperfusion injury (CIRI) by observing the effects of acupuncture plus mild hypothermia on miRNA-204 and its target gene expressions in CIRI rat brain tissues. Methods: Sixty Sprague-Dawley rats were divided into a blank control group, a sham operation group, a model group, an acupuncture group, a mild hypothermia group and an acupuncture plus mild hypothermia group according to the random number table method (n=10). Except for the blank control group and the sham operation group, rats in the other 4 groups received CIRI modeling. After the model was successfully established, rats in the blank control group were bred routinely for 72 h without any interventions; rats in the sham operation group and the model group were bred routinely for 72 h, and only received binding without other interventions after surgery; rats in the acupuncture group were bred routinely for 72 h, and received acupuncture at Dazhui (GV 14), Baihui (GV 20) and Shuigou (GV 26) after binding; rats in the mild hypothermia group were bred routinely for 72 h, and received mild hypothermia intervention for 72 h after binding; rats in the acupuncture plus mild hypothermia group were bred routinely for 72 h, followed by receiving acupuncture as in the acupuncture group and mild hypothermia therapy as in the mild hypothermia group after binding. The neurological impairment score, cerebral infarction area ratio, the expressions of miRNA-204 and its target genes including Map3k8, Ntrk2 and Ppp3r1 in the ischemic hippocampus of each group were observed after 72 h of intervention. Results: Before intervention, compared with the blank control group and the sham operation group, the neurological impairment scores and the infarction area ratios of the modelled rats were statistically significantly increased (all P<0.01), indicating that the model was successful. After intervention, compared with the model group, the neurological impairment scores of the three intervention groups were significantly reduced (all P<0.01); compared with the acupuncture group and the mild hypothermia group, the infarction area ratio in the acupuncture plus mild hypothermia group was significantly reduced (both P<0.01); compared with the model group, the three intervention groups showed significant inhibition of miRNA-204 expression in brain tissues (all P<0.05), which was most significant in the acupuncture plus mild hypothermia group (P<0.01); compared with the acupuncture group and the mild hypothermia group, the Map3k8 expression in the acupuncture plus mild hypothermia group was significantly increased (both P<0.01), but there were no significant differences in Ntrk2 and Ppp3r1 expressions between groups (all P>0.05). Conclusion: Acupuncture, mild hypothermia, and acupuncture plus mild hypothermia reduced the neurological impairment score and the cerebral infarction area in CIRI rats, while acupuncture plus mild hypothermia showed the most significant effect. In regulating miRNA-204 target gene expressions, acupuncture plus mild hypothermia showed the same effect on Ntrk2 and Ppp3r1 expressions, while better effect on Map3k8 expression compared with either acupuncture or hypothermia.

4.
Article in Chinese | WPRIM | ID: wpr-912090

ABSTRACT

Objective:To analyze the etiology of hand, foot and mouth disease (HFMD) cases collected from Wenshan prefecture from 2014 to 2018 and the molecular epidemiology of coxsackievirus A6(CV-A6).Methods:Viruses were isolated by RD cells and Hep-2 cells from stool samples collected from HFMD patients in Wenshan prefecture from 2014 to 2018. Virus RNA was extracted and virus VP4/VP2 junction region sequence was firstly amplified and sequenced by MD91 and OL68-1 primer pairs, then the virus serotype was determined. Virus entire VP1 gene sequences were determined by relative primer pairs according to the references. The reference sequences of CV-A6 virus entire VP1 gene were downloaded from the GenBank and the phylogenetic tree was constructed and the genetic characteristics and molecular epidemiology were analyzed.Results:During five years of study period, a total of 581 strains of enteroviruses (EVs) was isolated with an isolation rate of 20.40% (581/2 848). Among 581 strains, 74 strains were CV-A6, accounting for 12.74% (74/581); 124 were CV-A16, accounting for 21.34% (124/581); 374 were EV-A71, accounting for 64.37% (374/581); nine were other EVs, accounting for 1.55% (9/581). The entire VP1 sequences of 74 CV-A6 strains were filtered by constructing a phylogenetic tree and the completely same strains were excluded from analysis. We finally analyzed the phylogenetic characteristics of 22 strains isolated in this study with 52 reference strains. The results showed that all 22 Wenshan strains belonged to D3a sub-genotype, of which 21 strains belonged to cluster 1, and only one strain belonged to cluster 2.Conclusions:From 2014 to 2018, the outbreaks of HFMD in Wenshan prefecture were mainly caused by EV-A71, CV-A16 and CV-A6, accounting for 64.37%, 21.34% and 12.74% respectively. Phylogenetic analysis showed, similar to the situation in China, the sub-genotype D3a of CV-A6 was the predominant virus and the cluster 1 was the main sub-genotype in this outbreak.

5.
Article in Chinese | WPRIM | ID: wpr-911622

ABSTRACT

Objective:To analyze the diagnostic characteristics of complicated as acute appendicitis in pregnancy.Methods:Data of pregnant patients who were treated surgically and diagnosed as acute appendicitis pathologically at the Third Hospital of Peking University from Aug 2007 to Aug 2018 were collected,including uncomplicated acute appendicitis (UCAA) such as simple and purulent appendicitis, and complicated acute appendicitis (CAA) (perforated, gangrenous appendicitis or periappendiceal abscess).Result:There were 127 pregnant patients with acute appendicitis (47 CAA and 80 UCAA). CAA group had a higher proportion of positive symptoms, signs and examinations than UCAA group. ROC results showed that when pre-hospital time (the time from symptom onset to visiting the hospital, PT) and WBC critical values were 15.5 h and 17.11×10 3/mm 3, respectively, the sensitivity of CAA were 76.6% and 57.4%, and specificity of CAA were 75.0% and 82.5%. PT≥15.5 h ( OR=8.435,95% CI:2.933-24.262) and WBC>17.11×10 3/mm 3 ( OR=5.215,95% CI:1.626-16.729) were independent risk factors for CAA. Conclusion:CAA in pregnancy is associated with atypical clinical features, but the clinical manifestations of CAA are more serious. When PT exceeds 15 h and WBC exceeds 17.11×10 3/mm 3, CAA should be suspected and active operation should be suggested to avoid obstetric adverse outcomes.

6.
Article in Chinese | WPRIM | ID: wpr-911305

ABSTRACT

Objective:To evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on the sleep quality after cesarean section and postpartum depression in parturients with sleep disorder.Methods:A total of 225 parturients, aged 20-45 yr, weighing 50-80 kg, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective cesarean section, were enrolled in this study.The Pittsburgh Sleep Quality Index (PSQI) scale was used to investigate the sleep quality before operation.PSQI score<7 was defined as having no sleep disorder, and the patients were included in the non-sleep disorder group (NSD group, n=76). PSQI score≥7 was defined as having sleep disorder, and the patients were randomly divided into sleep disorder group (SD group, n=73) and TEAS group ( n=76). Routine combined spinal-epidural anesthesia was performed in NSD group and SD group.In TEAS group, Neiguan, Baihui, Zusanli and Sanyinjiao acupoints were selected for performing TEAS from the completion of combined spinal-epidural anesthesia to the end of operation, and TEAS was performed for 30 min on the 1st and 2nd days after operation.Patient-controlled intravenous analgesia was applied after operation in the three groups.The blood samples were taken from the cubital vein before operation and at 1 and 2 days after operation for determination of the plasma melatonin and prolactin concentrations (by enzyme-linked immunosorbent assay). The Leeds Sleep Evaluation Questionnaire (LSEQ) was used to evaluate the quality of sleep before operation and at 1, 2 and 7 days after operation.The Edinburgh Postpartum Depression Scale was used to evaluate the postpartum depression at 6 weeks after operation. Results:Compared with NSD group, LSEQ scores were significantly decreased at each time point after operation, the incidence of postpartum depression was increased, and the concentrations of plasma melatonin and prolactin were decreased, and the lactation initiation time was prolonged in SD group ( P<0.05). Compared with SD group, LSEQ scores were significantly increased at each time point after operation, the incidence of postpartum depression was decreased, and the concentrations of plasma melatonin and prolactin were increased, and the lactation initiation time was shortened in TEAS group ( P<0.05). Conclusion:TEAS can raise the the sleep quality after cesarean section and reduce the occurrence of postpartum depression in the parturients with sleep disorders.

7.
Chinese Journal of Geriatrics ; (12): 1045-1049, 2021.
Article in Chinese | WPRIM | ID: wpr-910964

ABSTRACT

Objective:To explore the clinical value of the geriatric potentially inappropriate medication(PIM)evaluation system in elderly inpatients.Methods:As a prospective cohort study, 203 elderly inpatients with polypharmacy were randomly divided into the control group and experimental group.Geriatric PIM evaluation system(based on the criteria for judging potential inappropriate drug use in Chinese elderly 2017 edition)on wechat platform was applied to patients of experimental group.During the 6 months, the number of elderly syndromes, types of drugs, the days in hospitalization, readmission rates and all-cause mortality were compared between two groups.Results:The age of 203 elderly inpatients ranged from 60 to 94(77.30±10.34)years, including 121 males and 82 females.The morbidity proportion of top five diseases were 69.95%(142/203)in cerebral infarction(non-acute phase), 62.07%(126/203)in hypertension, 24.14%(49/203)in coronary heart disease, 9.85%(20/203)in atrial fibrillation, and 6.40%(13/203)in cardiac insufficiency.The 97.53%(198/203)of elderly hospitalized patients had at least one senile syndrome, the average was 4.3±2.0.Insomnia, fall and frailty accounted for 32.87%(15/198), 28.45%(56/198)and 13.66%(27/198)respectively.Compared with the control group, the average length of stay in hospital in the experimental group significantly decreased[(16.38±4.29) vs.(21.32±6.10)d, t=2.438、 P=0.025], the number of senile syndrome, the score of fall, weakness and the re-admission rate were also decreased significantly(3.11±2.14 vs.4.32±1.50, t=0.854、 P=0.032; 6.19±1.35 vs.8.61±3.22, t=4.078、 P=0.044; 3.94±1.92 vs.5.65±1.34, t=2.843、 P=0.038; 9.81%(10/102) vs.1.98%(2/101), χ2=4.772、 P=0.029), and the frequency of PIM was significantly different between two groups(417.36±49.21 vs.210.25±38.23, t=2.136、 P=0.034). Conclusions:After making the drug adjustment on the elderly inpatients with multiple drugs, PIM evaluation system for the elderly are able to reduce the incidence of geriatric syndrome, shorten the length of stay in hospital, improve the rational use of drugs, and enhance the quality of life of the elderly patients.

8.
Article in Chinese | WPRIM | ID: wpr-910857

ABSTRACT

Objective:To evaluate the effect of lifestyle interventions on cardiovascular risk factors in overweight/obese individuals.Methods:A total of 148 overweight/obese subjects who had annual physical exam in the Health Management Center, the First Affiliated Hospital Zhejiang University School of Medicine from Dec 2017 to Dec 2020 were included. They were divided into the self-management group ( n=74) and the intervention group ( n=74). The intervention group was given a 6-month lifestyle intervention, while the self-management group received regular nutrition and physical activity education. Anthropometric and laboratory data was collected at baseline and after intervention in both groups. Effect of the intervention was evaluated. Results:The age of subjects in the intervention and self-management group was (42.5±7.5) and (40.1±9.6) years, respectively. After the intervention, weight, body mass index, waist/hip ratio, visceral fat area, systolic blood pressure, diastolic blood pressure, uric acid, homocystein, triglyceride, alanine aminotransferase andγ-glutamyl transferase of the intervention group [(75.6±12.7) kg, (26.72±3.04) kg/m 2, 0.92±0.05, (104.4±28.5) cm 2, (124.2±13.7) mmHg (1 mmHg=0.133 kPa), (77.8±10.1) mmHg, (353.6±84.8) μmol/L, 9.11(7.73, 10.00) μmol/L, 1.23(0.83, 1.91) mmol/L, 19.5(13.0, 29.5) U/L, 19.0(13.0, 30.5) U/L, respectively] were significantly lower than that of the baseline data [(81.1±12.5) kg, (28.64±2.82) kg/m 2, 0.95±0.04, (127.2±26.6) cm 2, (132.4±14.7) mmHg, (83.2±10.2) mmHg, (387.2±91.2) μmol/L, 10.25(8.30, 11.70) μmol/L, 1.78(1.40, 2.37) mmol/L, 28.0(18.0, 58.0) U/L, 36.0(23.0, 54.3) U/L, respectively] (all P<0.05); compared with the self-management group [(80.1±9.2) kg, 31.7% (28.5%, 38.4%), (119.5±32.6) cm 2, (133.5±15.9) mmHg, (82.6±12.2) mmHg, (4.93±0.86) mmol/L, 1.78(1.26, 2.97) mmol/L, respectively], the intervention group had decreased weight, body fat percent, visceral fat area, systolic blood pressure, diastolic blood pressure, total cholesterol, triglyceride [(75.6±12.7) kg, 30.0%(26.3%, 34.3%), (104.4±28.5) cm 2, (124.2±13.7) mmHg, (77.8±10.1) mmHg, (4.53±0.83) mmol/L, 1.23(0.83, 1.91) mmol/L, respectively], and increased high-density lipoprotein cholesterol [(1.09±0.24) vs (1.18±0.28) mmol/L] (all P<0.05). Conclusion:An intensive lifestyle intervention has a beneficial effect on cardiovascular risk factors in overweight/obese individuals.

9.
Article in Chinese | WPRIM | ID: wpr-910793

ABSTRACT

Objective:To compare the value of 68Ga-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid- D-Phe1-Tyr3-Thr8-octreotide (DOTATATE) and 18F-fluorodeoxyglucose (FDG) PET/CT imaging in the detection of bone metastasis in neuroendocrine neoplasm (NEN). Methods:From January 2014 to July 2019, 29 NEN patients (19 males, 10 females, age: 35-76 years) with bone metastasis who underwent 68Ga-DOTATATE and 18F-FDG PET/CT imaging within one month in Peking University Cancer Hospital & Institute were retrospectively enrolled. Patients were divided into Ki-67≤20% and Ki-67>20% groups according to the tumor proliferation activity, and osteolysis, osteogenesis and no change groups according to the CT findings of bone metastases. The differences of the number and radioactive uptake (maximum standardized uptake value (SUV max) ratio of bone lesion to normal bone (SUV T/B)) of detected bone metastases between 68Ga-DOTATATE and 18F-FDG PET/CT imaging were analyzed. χ2 and Mann-Whitney U tests were used to analyze the data. Results:The sensitivity of 68Ga-DOTATATE and 18F-FDG PET/CT imaging were 75.9%(22/29) and 82.8% (24/29) respectively, and there was no significant difference between the two modalities ( χ2=0.42, P>0.05). The numbers of cases with bone lesions detected by 68Ga-DOTATATE PET/CT imaging in pelvis, spine, ribs, proximal limbs, sternoclavicular scapula and skull were all higher than those of 18F-FDG PET/CT imaging (23, 22, 20, 14, 14, 10 vs 12, 19, 13, 11, 10, 6, respectively). The 68Ga-DOTATATE PET/CT imaging was significantly superior to 18F-FDG imaging in detecting bone metastases (9(3, 36) and 3(0, 18)) and SUV T/B(11.10(3.35, 22.30) and 1.60(1.05, 2.70); U values: 281.000, 77.000, both P<0.001). 68Ga-DOTATATE PET/CT imaging found more bone lesions in well differentiated NEN (Ki-67≤20%) group (11(2, 38) and 2(0, 13)) and osteogenic bone metastasis group (31(3, 100) and 3(0, 31); U values: 105.500, 69.500, both P<0.05). SUV T/B of 68Ga-DOTATATE PET/CT imaging was significantly higher than 18F-FDG PET/CT imaging in all subgroups ( U values: 3.000-22.000, all P<0.05). Conclusion:The 68Ga-DOTATATE PET/CT imaging is superior to 18F-FDG PET/CT imaging in the detection of bone metastasis in NEN.

10.
Article in Chinese | WPRIM | ID: wpr-910788

ABSTRACT

Objective:To explore the predictive value of 18F-fluorodeoxyglucose (FDG) PET/CT radiomics for the programmed death ligand-1 (PD-L1) expression level in lung adenocarcinoma patients. Methods:A total of 101 patients (43 males, 58 females; median age 60 years) with histologically confirmed lung adenocarcinoma who received pre-treatment 18F-FDG PET/CT from January 2017 to January 2019 in Peking University Cancer Hospital were included retrospectively. There were 44 patients with positive PD-L1 by immunohistochemical assays, and 57 with PD-L1 negative. Patients were assigned to a training set ( n=71) and a validation set ( n=30). Clinical data, PET/CT radiomics parameters, conventional metabolic parameters, and observed CT characteristics of these patients were included in the models. The filter method and embedded method were used in feature selection. Models based on logistic regression, random forest, XGBoost and Light Gradient Boosting Machine (LightGBM) were trained and evaluated, and the optimal parameters to predict the PD-L1 expression as well as the area under curve (AUC) were attained. Results:All models had predictive ability in the prediction of PD-L1 expression, while LightGBM was more powerful than the others, with the precision for positive and negative predictions of 0.85 and 0.76, respectively. Incorporating clinical data and data derived from thin-section CT images (clinical data+ CT) into the LightGBM, the precision, recall and F1-score for positive and negative patients were 0.71, 0.67, 0.69 and 0.69, 0.73, 0.72, respectively, with the accuracy of 0.70 and the AUC of 0.79. As for clinical data+ PET, the precision, recall and F1-score for positive and negative patients were 0.79, 0.73, 0.76 and 0.75, 0.80, 0.77, respectively, with the accuracy of 0.77 and the AUC of 0.80. As for clinical data+ CT+ PET, the precision, recall and F1-score for positive and negative patients were 0.85, 0.73, 0.79 and 0.76, 0.87, 0.81, respectively, with the accuracy of 0.80 and the AUC of 0.83. Features with significant importance in the model (clinical data+ CT+ PET) were as follows: maximum standardized uptake value (SUV max), peak of standardized uptake value (SUV peak), CT_shape_Maximum2DDiameterSlice, PET_shape_Elongation, PET_gray level co-occurrence matrix (GLCM)_Correlation, etc. Conclusions:Incorporating clinical data, PET/CT radiomics features and conventional metabolic parameters, the PD-L1 expression can be effectively predicted, which help to assist the selection of patients who may benefit from the immunotherapy.

11.
Article in Chinese | WPRIM | ID: wpr-910153

ABSTRACT

Objective:To explore the clinical features of poly ADP-ribose polymerase (PARP) inhibitor-related anemia in advanced and relapsed epithelial ovarian cancer (EOC).Methods:Patients diagnosed with advanced or relapsed EOC and treated with PARP inhibitor at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 2015 to October 2020 were accrued. The data included PARP inhibitors, treatment details, and lab tests before treatment and during treatment were collected and the clinical characteristics of PARP inhibitor-related anemia were analyzed.Results:(1) A total of 98 patients with a median age of 56.5 years old (30-82 years old) were enrolled in this study. All patients were treated with PARP inhibitor (65 cases of olaparib, 17 cases of niraparib, and 16 cases of fluzoparib). The median treatment duration was 37.5 weeks (4-119 weeks). (2) The anemia rate was 40% (39/98), including 5% (5/98) of grade Ⅰ, 14% (14/98) of grade Ⅱ, 11% (11/98) of grade Ⅲ, and 9% (9/98) of grade Ⅳ. Fourteen patients with pre-treatment grade Ⅰ anemia had a higher rate of anemia events than the 80 patients without pre-treatment anemia, 7/14 vs 35% (28/80; χ2=4.281, P=0.039). (3) The median anemia occurrence time was 7.0 weeks (1-52 weeks), including 41% (16/39) of anemia cases occurred in 1-4 weeks, 26% (10/39) occurred in 5-8 weeks, 13% (5/39) occurred in 9-12 weeks, 3% (1/39) occurred in 13-16 weeks, 10% (4/39) occurred in 17-20 weeks, 8% (3/39) occurred ≥21 weeks. At the time of the lowest hemoglobulin tested, the median value of mean corpuscular volume (MCV) was 106 fl,which was higher than the up limit of normal range (100 fl), 74% (29/39) of anemia patients had an elevated MCV level; the median value of mean corpuscular hemoglobin (MCH) was 36 pg, 54% (21/39) of anemia patients had an elevated MCH level; the median value of mean corpuscular hemoglobin concentration (MCHC) was 320 g/L, 69% (27/39) of anemia patients had a higher MCHC level; 92% (36/39) of anemia patients had a normal level of serum iron; 79% (31/39) of anemia patients had a normal level of transferrin. 74% (29/39) of the anemia patients were macrocytic orthochromatic anemia. (4) Among the 39 patients with anemia, 20 patients (51%, 20/39) withhold the treatment of PARP inhibitor due to grade Ⅲ or Ⅳ anemia, including 10 patients (50%, 10/20) who resumed the PARP inhibitor treatment by suppling iron, folate, and vitamin B 12. The median stopping time of PARP inhibitor was 5.5 weeks (2-10 weeks), while the other 10 patients terminated the PARP inhibitor treatment for not recovering from severe anemia. Conclusions:One of the common adverse effects of PARP inhibitors is anemia, which mostly happened in the first 3 months of treatment. In the treatment of EOC, PARP inhibitor-related anemia mainly manifest as macrocytic orthochromatic anemia, and most patients with normal serum iron and transferrin.

12.
Chinese Critical Care Medicine ; (12): 955-961, 2021.
Article in Chinese | WPRIM | ID: wpr-909434

ABSTRACT

Objective:To investigate the relationship between albumin (ALB) level immediately after major abdominal surgery and postoperative acute kidney injury (AKI) in critically ill patients.Methods:A retrospective cohort study was conducted. Patients who accepted the major abdominal surgery admitted to the department of intensive care unit (ICU) of the Peking University First Hospital from June 2017 to July 2018 were enrolled. Clinical data including the postoperative ALB level and renal function were collected. Patients were divided into postoperative AKI group and postoperative non-AKI group according to the AKI diagnosis and staging criteria of Kidney Disease: Improving Global Outcomes (KIDGO). The risk factors of perioperative AKI occurrence were analyzed, and multivariate Logistic regression analysis was performed. The receiver operator characteristic curve (ROC curve) was plotted for the ALB level to predict the occurrence of AKI and to determine the ALB cut-off value. The Kaplan-Meier survival curve of postoperative survival of patients was drawn.Results:A total of 363 critically ill patients underwent major abdominal surgery, and 105 patients (28.9%) suffered from AKI. Compared with the non-AKI group, the patients in the AKI group were older ( t = -2.794, P = 0.005), preoperative proportions of diabetes and chronic kidney disease were higher ( χ21 = 4.613, χ22 = 5.427, both P < 0.05), the proportion of American Society of Anesthesiologists (ASA) grades and Ⅴ was higher ( χ2 = 19.444, P < 0.001), baseline serum creatinine (SCr) and preoperative brain natriuretic peptide (BNP) levels were higher ( U1 = 2.859, U2 = 2.283, both P < 0.05), preoperative ALB level was lower ( t = 3.226, P = 0.001), the proportion of preoperative use of contrast media was higher ( χ2 = 7.431, P = 0.006), the proportions of emergency surgery and using vasopressor during surgery were higher ( χ21 = 4.211, χ22 = 4.947, both P < 0.05), non-renal SOFA score and acute physiology and chronic health evaluation (APACHE) within 24 hours after ICU admission were higher ( U = 2.233, t = 3.130, both P < 0.05), and the proportion of postoperative immediate ALB less than 32 g/L was higher ( χ2 = 7.601, P = 0.006). ROC curve analysis showed that the cut-off value of immediate postoperative ALB for predicting postoperative AKI was 32 g/L, with the sensitivity was 86.7%, and the specificity was 28.3%. Multivariate Logistic regression analysis showed that ASA grade, use of contrast before surgery, baseline SCr and postoperative immediate serum ALB level below 32 g/L were independent risk factors for AKI [odds ratio ( OR) and 95% confidence interval (95% CI) were 2.248 (1.458-3.468), 2.544 (1.332-4.857), 1.018 (1.008-1.027) and 2.685 (1.383-5.212), respectively, all P < 0.01]. Compared with the non-AKI group, the proportion of patients with AKI undergoing mechanical ventilation in ICU was higher ( χ2 = 13.635, P < 0.001), mechanical ventilation duration, length of ICU stay, postoperative hospital stay were longer ( U1 = 2.530, U2 = 5.032, U3 = 3.200, all P < 0.05), more postoperative complications except AKI ( U = 4.799, P < 0.001), and in-hospital mortality and total hospitalization cost were higher ( χ2 = 11.681, U = 3.537, both P < 0.001). Compared with the group with postoperative immediate serum ALB ≥ 32 g/L, the proportion of mechanical ventilation in ICU of the ALB < 32 g/L group was higher ( χ2 = 33.365, P < 0.001), the length of ICU stay and postoperative hospital stay were longer ( U1 = 3.246, U2 = 4.563, both P < 0.001), more postoperative complications except AKI ( U = 3.328, P = 0.001), total hospitalization cost was higher ( U = 4.127, P < 0.001). Conclusion:For critically ill patients underwent major abdominal surgery, the postoperative immediate serum ALB level below 32 g/L significantly increased the risk of AKI, which was related to the poor prognosis of the patients.

13.
Chinese Critical Care Medicine ; (12): 708-713, 2021.
Article in Chinese | WPRIM | ID: wpr-909389

ABSTRACT

Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.

14.
Article in Chinese | WPRIM | ID: wpr-909277

ABSTRACT

Objective:To investigate the clinical efficacy of methimazole in the treatment of hyperthyroidism.Methods:A total of 110 patients with hyperthyroidism who received treatment in Zhuji Central Hospital between January 2016 and June 2019 were included in this study. They were randomly assigned to receive treatment either with propylthiouracil (control group, n = 55) or methimazole (observation group, n = 55) for 6 successive months. Thyroid function indicators, bone metabolism indicators, clinical efficacy, and adverse events were compared between the control and observation groups. Results:After treatment, free triiodothyronine (FT 3), free thyroxine (FT 4) and thyroid stimulating hormone (TSH) levels in the observation group were (4.46 ± 1.02) pmol/L, (14.45 ± 2.16) pmol/L and (1.89 ± 0.64) mU/L respectively, which were significantly lower than those in the control group [(6.37 ± 1.38) pmol/L, (18.54 ± 4.46) pmol/L and (3.47 ± 0.99) mU/L, t = 8.254, 6.121, 9.940, all P < 0.05). Calcitonin level in the observation group was significantly higher than that in the control group [(68.62 ± 6.75) ng/L vs. (61.45 ± 6.47) ng/L, t = 5.687, P < 0.05]. Bone Gla-protein level in the observation group was significantly lower than that in the control group [(6.38 ± 1.64) ng/L vs. (8.21 ± 2.19) ng/L, t = 4.960, P < 0.05]. Total effective rate in the observation group was significantly higher than that in the control group [92.73% (51/55) vs. 78.18% (43/55), χ2= 4.681, P < 0.05]. Adverse reaction rate in the observation group was significantly lower than that in the control group [9.09% (5/55) vs. 25.45% (14/55), χ2= 5.153, P < 0.05]. Conclusion:Methimazole is safe and effective in the treatment of hyperthyroidism, which can effectively improve thyroid function and bone metabolism. This study is of certain clinical significance and innovation.

15.
Article in Chinese | WPRIM | ID: wpr-908690

ABSTRACT

Objective:To explore the application value of copy number variation sequencing(CNV-seq) combined with chromosome karyotyping technology based on next-generation sequencing technology in prenatal diagnosis.Methods:The subjects of the study were 329 pregnant women who underwent prenatal diagnosis at Dalian Municipal Women and Children′s Medical Center from January 2019 to June 2020. The amniotic fluid samples of these pregnant women were submitted for chromosome karyotype analysis, and CNV-seq testing was performed at the same time to compare the test results of the two methods.Results:A total of 53 cases of abnormal chromosomes were detected using CNV-seq combined with chromosome karyotyping technology, with an abnormal detection rate of 16.11%(53/329). Among them, 26 cases had consistent detection results, including 22 cases of aneuploidy, 2 cases of structural abnormalities and 2 cases of mosaic; CNV-seq detected 23 cases of chromosome copy number variations that were missed by karyotyping, including 17 cases of microdeletion and 6 cases of microduplication; chromosome karyotype analysis detected 4 cases of chromosome structural abnormalities that were missed by CNV-seq, including 3 cases balanced translocation and 1 case of inversion.Conclusions:CNV-seq has obvious advantages in detecting copy number variations of small fragments, which can make up for the lack of resolution of karyotyping analysis; CNV-seq combined with chromosome karyotyping analysis can improve the detection rate of abnormal chromosomes, which is important for prenatal diagnosis meaning.

16.
Article in Chinese | WPRIM | ID: wpr-878935

ABSTRACT

To evaluate the efficacy and safety of Compound Danshen Injection combined with Western medicine in the treatment of vascular dementia. Databases of Cochrane Library, PubMed, EMbase, CNKI, SinoMed, VIP, Wanfang Data were electronically retrieved for collecting randomized controlled trial(RCT)about vascular dementia treated with Western medicine alone or combined with Compound Danshen Injection from the year of database establishment to January 2020. Two researchers independently screened out li-teratures, extracted data, and evaluated the risk of bias for inclusion in the study. Meta-analysis was conducted using RevMan 5.3 software. A total of 5 RCTs were included, involving 588 patients, with 299 in treatment group and 289 in control group. Meta-analysis results showed that compared with Western medicine alone, Compound Danshen Injection combined with Western medicine was better in the effective rate(RR=1.23,95%CI[1.14,1.33],P<0.000 01), MMSE score(MD=3.54,95%CI[3.01,4.06],P<0.000 01), ADL score(MD=11.49,95%CI[8.05,14.93],P<0.000 01), the level of CRP(MD=-0.72,95%CI[-1.25,-0.20],P=0.007) and the level of IL-6(MD=-7.64,95%CI[-9.65,-5.63],P<0.000 01). Adverse reactions mainly included rash and skin prick, which did not affect the treatment effect. Based on the findings, the combination of Compound Danshen Injection in the treatment of vascular dementia could improve the effective rates, relieve the mental state damage and improve the daily living ability, with mild adverse reactions and a low incidence. However, due to the low quality of the included literatures, high-quality and large-scale randomized controlled trials are needed for further verification.


Subject(s)
Dementia, Vascular/drug therapy , Drugs, Chinese Herbal/adverse effects , Humans , Injections , Medicine , Salvia miltiorrhiza
17.
Article in Chinese | WPRIM | ID: wpr-878898

ABSTRACT

This study aimed to comprehensively analyze and compare the differences of different clinical study types currently published in the safety evaluation of Xuebijing Injection. Six databases, namely the Cochrane Library, PubMed, EMbase, CNKI, VIP and Wanfang database, were electronically retrieved to collect all types of studies on the safety of Xuebijing Injection, including randomized controlled trials, case-controlled studies, cohort studies, systematic reviews, and centralized monitoring studies of clinical safety(hospital), in order to comprehensively and objectively evaluate the safety of Xuebijing Injection, and analyze the differences of different research results. A total of 211 literatures were included, involving a total of 46 384 patients treated with Xuebijing Injection, and 423 adverse reactions(ADRs) occurred. They included 191 randomized controlled trials, 3 cohort studies, 15 systematic reviews, and 2 centralized monitoring studies of clinical safety(hospital), and the incidence of adverse reactions was 2.54%(common), 2.31%(common), 0.95%(occasionally), and 0.50%(occasionally). More than half of the 423 cases of ADRs occurred in skin and adnexal system(151 cases) and gastrointestinal system(65 cases), including such manifestations as rash, skin itching, nausea and vomiting, diarrhea. The degree of ADRs was mild. Randomized controlled trials showed that the incidence of ADR was the highest when Xuebijing Injection was used for malignant tumor and multiple organ failure. And the systematic evaluation showed that the incidence of ADR was the highest when Xuebijing Injection was used for spontaneous peritonitis of liver cirrhosis. In conclusion, different study types could lead to significant differences in the results of drug safety evaluation. Sample size, study type, and quality control are the main factors for biased results. Due to large sample size and high-quality, centralized monitoring studies become the better clinical safety evaluation model of drugs at present, and full life cycle management could more objectively reflect drug safety and guide clinical rational drug use.


Subject(s)
Case-Control Studies , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drugs, Chinese Herbal/adverse effects , Humans , Injections
18.
Article in Chinese | WPRIM | ID: wpr-878897

ABSTRACT

Network Meta-analysis was used to compare the efficacy and safety of Chinese patent medicines in the treatment of unstable angina pectoris. PubMed, Cochrane Library, CNKI, Wanfang, VIP and other databases were retrieved by computers from the establishment of the databases to June 2020. Randomized controlled trials(RCTs) of Chinese patent medicines for the treatment of unstable angina pectoris were collected. Two investigators independently screened out the literatures, and extracted data according to the inclusion and exclusion criteria. The quality of the included RCTs was evaluated according to the bias risk assessment tool recommended by the Cochrane System Reviewer Manual, and the Stata 13.0 software was used for data analysis and mapping. Through screening, 28 eligible studies were finally included, with the sample size of 2 885 cases, involving 8 Chinese patent medicines. The results of the network Meta-analysis showed that in terms of total effective rate for angina symptom improvement, the order was as follows: Shenshao Capsules > Naoxintong Capsules > Ginkgo Ketone Ester Dripping Pills > Compound Danshen Dripping Pills > Ginkgo Leaf Tablets > Shexiang Baoxin Pills > Tongxinluo Capsules > Yindan Xinnaotong Soft Capsules; in terms of total effective rate for ECG curative effect, the order was as follows: Ginkgo Ketone Ester Dripping Pills>Compound Danshen Dripping Pills > Tongxinluo Capsules > Shenshao Capsules > Shexiang Baoxin Pills > Yindan Xinnaotong Soft Capsules; in terms of hypersensitivity-C-reactive protein curative effect, the order was as follows: Tongxinluo Capsules > Shenshao Capsules > Ginkgo Leaf Tablets>Compound Danshen Dropping Pills> Shexiang Baoxin Pills > Naoxintong Capsules > Yindan Xinnaotong Soft Capsules > Ginkgo Ketone Ester Dropping Pills. Chinese patent medicine combined with conventional therapy can improve the clinical efficacy of unstable angina pectoris. Due to the differences in the quantity and quality of the included studies, the order results of Chinese patent medicines need to be further verified.


Subject(s)
Angina, Unstable/drug therapy , China , Drugs, Chinese Herbal , Humans , Medicine, East Asian Traditional , Network Meta-Analysis , Nonprescription Drugs
19.
Chinese Medical Journal ; (24): 1317-1323, 2021.
Article in English | WPRIM | ID: wpr-878102

ABSTRACT

BACKGROUND@#Recent cardiovascular outcome trials (CVOTs) changed the therapeutic strategy of guidelines for type 2 diabetes. We compared the characteristics of patients from real-world hospital settings with those of participants in recent pragmatic randomized trials.@*METHODS@#This electronic medical record (EMR)-based retrospective observational study investigated the data of patients with diabetes from inpatient and outpatient settings in West China Hospital of Sichuan University from January 1, 2011, to June 30, 2019. We identified patients meeting the inclusion criteria of a pragmatic randomized trial (EMPA-REG OUTCOME) based on EMRs and compared their baseline characteristics with those of the trial participants. The cutoff for the clinical significance of each characteristic was set as its minimal clinically important difference based on expert consultation.@*RESULTS@#We included 48,257 inpatients and 36,857 outpatients with diabetes and found that 8389 (17.4%) inpatients and 2646 (7.2%) outpatients met the inclusion criteria for the EMPA-REG OUTCOME trial. Compared with the trial population, the real-world inpatients meeting the eligibility criteria of the EMPA-REG OUTCOME had similar age, blood pressure, and lipid profiles but comprised of fewer males, metformin users, anti-hypertensive drug users, and aspirin users, and had a lower body mass index. The group of outpatients meeting the eligibility criteria had fewer males, similar age, fewer metformin users, fewer insulin users, fewer anti-hypertensive drug users, and fewer aspirin users compared with the trial population.@*CONCLUSIONS@#The trial population in EMPA-REG OUTCOME represents only a small portion of patients with diabetes from the inpatient and outpatient departments of a Chinese tertiary medical center. Evidence localization in different clinical settings and validation are essential to enabling extrapolation of the results from CVOTs in patients with diabetes to Chinese clinical practice.


Subject(s)
Benzhydryl Compounds , Canagliflozin , Cardiovascular Diseases , China , Diabetes Mellitus, Type 2/drug therapy , Glucosides , Humans , Male , Sodium-Glucose Transporter 2 Inhibitors , Tertiary Care Centers
20.
China Pharmacy ; (12): 794-801, 2021.
Article in Chinese | WPRIM | ID: wpr-875810

ABSTRACT

OBJECTIVE:To preparea novel Curcumin (Cur)dry powder inhalation (DPI)loaded by nanoporous flower-shaped lactose(FL),and to provide a safe and effective intrapulmonary drug delivery method for the therapy of chronic obstructive pulmonary disease with insoluble drugs. METHODS :FL-loaded Cur (Cur-FL) compound powder was prepared by solution adsorption method. Using drug-loading amount and adsorption rate as indicators ,single-factor experiment was used to optimize Cur concentration,Cur-FL ratio (m/m)and adsorption time so as to determine the optimal preparation technology for Cur-FL compound powder. Fourier transform infrared spectroscopy ,scanning electron microscope and differential scanning calorimetry were used to characterize the physical and chemical properties of Cur-FL compound powder prepared with optimal technology. The water content and aerodynamic properties were determined ;in vitro drug release behavior was investigated by simulating the environment of artificial lung fluid. RESULTS :The optimal preparation technology of Cur-FL compound powder was Cur concentration of 5 mg/mL,Cur-FL ratio of 1 ∶ 4,adsorption time of 1 h. The drug-loading amount of compound powder was (23.37±0.43)%,the encapsulation rate was (91.64±0.44)%,and the adsorption rate was (30.50±0.72)%. Cur-FL particles were flower shaped ;Cur was physically adsorbed in the pores of FL without chemical changes. The bulk density of Cur-FL compound was (0.21±0.02) g/cm3,tap density was (0.33±0.01)g/cm3,angle of repose was(24.07±0.31)°,average particle size was (3.96±0.80) μm,aerodynamic particle size was (3.33±0.99)μm,water content was (5.63 ±0.24)%,emptying rate was (92.53± 0.87)%,and deposition rate of effective parts in vitro was son- (45.93 ± 1.77)% . Its 24 h solubility in artificial lung gwen.tan@csu.edu.cn fluid [(358.93±1.67)μg/mL] were 3.28 times of Cur ,48 h cumulative release ratesin in vitro (90.21%)were 1.63 times of Cur ,but Cur+FL physical mixture could not improve the solubility and release of Cur in artificial lung fluid. CONCLUSIONS :Cur-FL compound powder has good in vitro release property ,and its powder properties ,solubility,water content ,fluidity and aerodynamic properties meet the requirements of DPI in Chinese Pharmacopoeia.

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