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1.
Article in Chinese | WPRIM | ID: wpr-1029726

ABSTRACT

Objective:To investigate the clinical characteristics and prognosis of patients with left ventricular assist device (LVAD) implantation during the perioperative period.Methods:This retrospective study included 14 patients with end-stage heart failure who underwent LVAD implantation in the department of intensive care medicine of Nanjing Hospital Affiliated to Nanjing Medical University from February 2022 to March 2023, including 12 males and 2 females patients, the mean age was (57.6±9.8)years old. All patients were implanted with Corheart 6 implantable left ventricular assist system, did not use other mechanical assisted circulatory devices. The clinical data of enrolled patients were collected, and the clinical characteristics and prognosis during ICU treatment were analyzed.Results:Dilated cardiomyopathy (DCM) was the most common primary cause of heart failure. The results of transthoracic echocardiography showed that the left ventricular ejection fraction (0.297±0.074 vs. 0.238±0.064, P=0.031) of patients was significantly increased, while the left ventricular end diastolic diameter[69.0(65.8, 74.3)mm vs. 76.5(72.8, 83.0)mm, P=0.003]and systolic end systolic diameter[61.5(53.7, 65.3)mm vs. 68.3(63.8, 71.9)mm, P=0.005]were significantly decreased post LVAD implantation as compared to before LVAD implantation. Within one week after implantation, there was no significant difference in LVAD rotational speed, flow rate, and pulsation index ( P>0.05). During ICU treatment, dobutamine (13 cases) was the most commonly used vasoactive agent. 9 patients used phosphodiesterase Ⅲ inhibitors for perioperative pulmonary hypertension. Targeted management of volume and pressure indicators was conducted for enrolled patients to prevent postoperative right heart failure and to reduce right heart burden. Within 72 hours after LVAD implantation, the average pulmonary artery pressure of patients was 24 (22, 26) mmHg to 26 (21, 28)mmHg (1 mmHg=0.133 kPa), while the fluid balance was(-581±778)ml to(-1 209±1 134)ml. All enrolled patients survived to 28 days after LVAD implantation. The length of stay in the ICU was (8.0±1.8) days and the total length of hospital stay was 33 (29, 41)days, while the time of mechanical ventilation was 8 (5, 28)h. Conclusion:LVAD implantation can help improve left ventricular systolic function, prolong survival time so as to serve as an important means of terminal treatment or bridging therapy for heart transplantation of patients with end-stage heart failure. To strengthen the perioperative hemodynamic regulation and maintain the cardiac function of patients with LVAD implantation is the important purposes of ICU postoperative management.

2.
Article in Chinese | WPRIM | ID: wpr-972289

ABSTRACT

ObjectiveTransforming growth factor-β1 (TGF-β1) was used to stimulate human fetal lung fibroblast 1 (HFL1) for simulating the pathological process of idiopathic pulmonary fibrosis (IPF) and thereby the effects and mechanism of medicated serum of Bupleuri Radix against IPF were investigated. MethodTGF-β1 (10 μg·L-1) was employed to stimulate HFL1, and cells were treated with medicated serum of Bupleuri Radix (5%, 10%, 15%, 20%) for 24 h. Then cell proliferation rate was determined with cell counting kit-8 (CCK-8). Subsequently, cells were classified into the control group (20% blank serum), TGF-β1 group (20% blank serum and 10 μg·L-1 TGF-β1), TGF-β1 + medicated serum of Bupleuri Radix group (5% blank serum, 15% medicated serum, and 10 μg·L-1 TGF-β1), and TGF-β1 + SIS3 group (3 μmol·L-1 SIS3, 20% blank serum, 10 μg·L-1 TGF-β1). Based on in situ end labeling (TUNEL) staining, the apoptosis rate was examined, and mRNA expression of apoptosis-related proteins B-cell lymphoma 2 (Bcl-2), Bcl-2 associated X protein (Bax) and myofibroblast marker α-smooth muscle actin (α-SMA) was detected by Real-time fluorescence quantitative polymerase chain reaction (Real-time PCR). The protein expression of α-SMA, Ras homolog enriched in brain (Rheb), and phosphorylated (p)-Smad3 was determined by immunofluorescence. Expression of Rheb, p-Smad3, and Smad3 was examined by Western blot. ResultThe cell proliferation rate of TGF-β1 group increased compared with that of the control group (P<0.05). The cell proliferation rate of TGF+15% medicated serum of Bupleuri Radix group and TGF+20% medicated serum of Bupleuri Radix group decreased compared with that of the TGF-β1 group (P<0.01). Compared with the control group, TGF-β1 group showed decrease in apoptosis rate, increase in mRNA expression of Bcl-2 and α-SMA, reduction in Bax mRNA expression, and rise of α-SMA and Rheb protein expression and p-Smad3 level (P<0.05). Compared with TGF-β1 group, TGF-β1 + medicated serum of Bupleuri Radix group and TGF-β1 + SIS3 group demonstrated high apoptosis rate, low Bcl-2 and α-SMA mRNA expression, high Bax mRNA expression, and low α-SMA and Rheb protein expression and p-Smad3 level (P<0.05). ConclusionMedicated serum of Bupleuri Radix can inhibit TGF-β1-induced HFL1 proliferation and fibroblast-myofibroblast transition and promote fibroblast apoptosis by regulating the Smad3/Rheb axis.

3.
Article in Chinese | WPRIM | ID: wpr-1026248

ABSTRACT

Objective To explore left ventricular longitudinal systolic function changes during perioperative period of coronary artery bypass graft(CABG).Methods Totally 41 patients with confirmed coronary artery disease(CAD)who underwent CABG were prospectively enrolled.The preoperative left ventricular global longitudinal strain(GLS),as well as GLS on the day of CABG,on the 3rd and 7th day postoperation were measured.According to preoperative left ventricular GLS,the patients were divided into 3 groups,i.e.normal group(group A,GLS≤-18.1%,n=6),mildly decreased group(group B,-18.1%<GLS≤-14.0%,n=22)and severely decreased group(group C,GLS>-14.0%,n=13).Repeated measures analysis of variance,generalized estimating equation and multiple comparisons were used to analyze left ventricular systolic function in different perioperative time points.Results No significant difference of GLS was found among different time points during perioperative period of CABG in group A and C(all adjusted P>0.05).In group B,GLS on postoperative days were lower than that before CABG(all adjusted P<0.001),and the lowest value was observed on the day of CABG postoperatively,while no significant difference of GLS was found between the 3rd and 7th day postoperation(adjusted P=1.00).Compared with those before CABG,the longitudinal strain(LS)of basal segment on the day of CABG postoperatively and 3rd day postoperation,of middle segment and apical segment at all postoperative time points were lower(all adjusted P<0.05),while of the apical segment on the day of CABG postoperatively decreased most obviously.No significant difference of LS of each ventricular segment was found between the 3rd nor the 7th day postoperation(all adjusted P>0.05).Conclusion GLS decreased significantly on the day of CABG postoperatively but partially recovered within the following week in CAD patients with mildly decreased preoperative GLS.CABG had the most pronounced effect on LS of apical segment in left ventricle.

4.
Journal of Chinese Physician ; (12): 1255-1259, 2023.
Article in Chinese | WPRIM | ID: wpr-992449

ABSTRACT

Lactic acid is one of the main metabolites in the body, and its clearance rate reflects the dynamic changes of lactic acid in the body. Recent studies have shown that lactate clearance rate is related to the prognosis of critically ill patients with sepsis/septic shock, cardiogenic shock, out-of-hospital cardiac arrest, postoperative cardiovascular surgery, and liver and kidney dysfunction. This article reviews the relevant research progress of lactate metabolism and lactate clearance rate in different critically ill patients.

5.
Chinese Journal of Pediatrics ; (12): 726-730, 2023.
Article in Chinese | WPRIM | ID: wpr-1013162

ABSTRACT

Objective: To discuss the clinical and genetic features of intellectual developmental disorder with behavioral abnormalities and craniofacial dysmorphism with or without seizures (IDDBCS). Methods: The clinical and genetic records of a patient who was diagnosed with IDDBCS caused by PHF21A gene variation at Children's Hospital Capital Institute of Pediatrics in 2021 were collected retrospectively. Using " PHF21A gene" as the keyword, relevant articles were searched at CNKI, Wanfang Data and PubMed from establishment of databases to February 2023. Clinical and genetic features of IDDBCS were summarized in the combination of this case. Results: An 8 months of age boy showed overgrowth (height, weight and head circumference were all higher than the 97th percentile of children of the same age and sex) and language and motor developmental delay after birth, and gradually showed autism-like symptoms like stereotyped behavior and poor eye contact. At 8 months of age, he began to show epileptic seizures, which were in the form of a series of spastic seizures with no reaction to adrenocorticotropic hormone but a good response to vigabatrin. Physical examination showed special craniofacial appearances including a prominent high forehead, sparse eyebrows, broad nasal bridge, and downturned mouth with a tent-shaped upper lip. The patient also manifested hypotonia. Whole exome sequencing showed a de novo heterogeneous variant, PHF21A (NM_001101802.1): c.54+1G>A, and IDDBCS was diagnosed. A total of 6 articles (all English articles) were collected, involving this case and other 14 patients of IDDBCS caused by PHF21A gene variation. Clinical manifestations were intellectual disability or developmental delay (15 patients), craniofacial anomalies (15 patients), behavioral abnormalities (12 patients), seizures (9 patients), and overgrowth (8 patients). The main pathogenic variations were frameshift variations (8 patients). Conclusions: IDDBCS should be considered when patients show nervous developmental abnormalities, craniofacial anomalies, seizures and overgrowth. PHF21A gene variation detection helps to make a definite diagnosis.


Subject(s)
Male , Humans , Child , Intellectual Disability/genetics , Developmental Disabilities/genetics , Retrospective Studies , Seizures/genetics , Craniofacial Abnormalities/genetics , Histone Deacetylases/genetics
6.
Chinese Journal of Pediatrics ; (12): 1124-1128, 2023.
Article in Chinese | WPRIM | ID: wpr-1013234

ABSTRACT

Objective: To summarize the clinical characteristics of epileptic seizure associated with neurofibromatosis type 1 (NF1). Methods: From January 2017 to July 2023 at Children's Hospital Capital Institute of Pediatrics, medical records of patients with both NF1 and epileptic seizure were reviewed in this case series study. The clinical characteristics, treatment and prognosis were analyzed retrospectively. Results: A total of 15 patients(12 boys and 3 girls) were collected. Café-au-lait macules were observed in all 15 patients. There were 6 patients with neurodevelopmental disorders and the main manifestations were intellectual disability or developmental delay. The age at the first epileptic seizure was 2.5 (1.2, 5.5) years. There were various seizure types, including generalized tonic-clonic seizures in 8 patients, focal motor seizures in 6 patients, epileptic spasm in 4 patients, tonic seizures in 1 patient, absence in 1 patient, generalized myoclonic seizure in 1 patient and focal to bilateral tonic-clonic seizure in 1 patient. Among 14 patients whose brain magnetic resonance imaging results were available, there were abnormal signals in corpus callosum, basal ganglia, thalamus or cerebellum in 6 patients, dilated ventricles of different degrees in 3 patients, blurred gray and white matter boundary in 2 patients, agenesis of corpus callosum in 1 patient and no obvious abnormalities in the other patients. Among 13 epilepsy patients, 8 were seizure-free with 1 or 2 antiseizure medications(ASM), 1 with drug resistant epilepsy was seizure-free after left temporal lobectomy, and the other 4 patients who have received 2 to 9 ASM had persistent seizures. One patient with complex febrile convulsion achieved seizure freedom after oral administration of diazepam on demand. One patient had only 1 unprovoked epileptic seizure and did not have another seizure without taking any ASM. Conclusions: The first epileptic seizure in NF1 patients usually occurs in infancy and early childhood, with the main seizure type of generalized tonic-clonic seizure and focal motor seizure. Some patients have intellectual disability or developmental delay. Most epilepsy patients achieve seizure freedom with ASM.


Subject(s)
Male , Female , Humans , Child, Preschool , Child , Neurofibromatosis 1/diagnosis , Retrospective Studies , Intellectual Disability , Electroencephalography , Epilepsy/etiology , Seizures/etiology
7.
The Journal of Practical Medicine ; (24): 3153-3157, 2023.
Article in Chinese | WPRIM | ID: wpr-1020670

ABSTRACT

Non-occlusive mesenteric ischemia(NOMI)is a series of disorders of digestive tract caused by local blood perfusion damage,which is caused by vasospasm.As an extremely dangerous disease,NOMI is also a common intestinal complication in intensive care unit,especially in patients with hemodynamic instability after cardiac surgery,and the mortality is high.Cardiac surgery aims to improve the prognosis of patients,while the complication of NOMI is easy to be ignored,which hindered the recovery of postoperative patients.Due to the rapid development and lack of specific symptoms and signs,NOMI is easily misdiagnosed as other gastrointestinal complications.Therefore,timely and effective diagnosis of NOMI is the most important factor affecting the prognosis of post cardiac surgery.This review systematically summarized the related research on NOMI after cardiac surgery,and comprehensively concluded the cause,mechanism,treatment as well as prognosis of NOMI.Then we emphasized on the latest progresses of diagnostic methods for NOMI,in order to provide directions on the accurate identification and timely intervention of NOMI in clinical work.

8.
Article in Chinese | WPRIM | ID: wpr-906508

ABSTRACT

Idiopathic pulmonary fibrosis (IPF) is a common, lethal interstitial lung disease characterized by airway remodeling, inflammation, alveolar destruction, and fibrosis. The mammalian target of rapamycin complex 1/4E binding protein 1 (mTORC1/4E-BP1) axis is closely related to the expression of collagen by fibroblasts, and its role in pulmonary fibrosis remains to be further elucidated. Traditional Chinese medicine (TCM) has shown promising efficacy in improving the lung function, exercise capacity, and quality of life in patients with IPF. The theory of "same treatment for different diseases" provides a TCM theoretical basis for the treatment of pulmonary fibrosis with Bupleuri Radix, while the research in western medicine has preliminarily shown that both the formulation and single herb as well as the active ingredients of Bupleuri Radix have good therapeutic effects on pulmonary fibrosis. Therefore, this review will elaborate on the role of the mTORC1/4E-BP1 axis in the pathomechanism of IPF, as well as the research results of the active components of Bupleuri Radix on the phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin protein(PI3K/AKT/mTOR) pathway, so as to provide a reference for the treatment and drug development of IPF.

9.
Article in English | WPRIM | ID: wpr-880991

ABSTRACT

OBJECTIVE@#Hemorrhoidal disease (HD) is the most common proctological disease, with an estimated prevalence rate of 4.4%, and a peak in individuals between 45 and 65 years of age. This study was done to evaluate whether Lian-Zhi-San (LZS), a clinically used anti-hemorrhoidal ointment could alleviate the inflammatory injury, with its associated changes of inflammatory cytokines and morphology of anorectal tissues, in an experimental model of HD in rats.@*METHODS@#HD was induced by croton oil preparation (COP) applied to the anorectal region. Rats were then treated with cotton swabs soaked in LZS ointment, water or white vaseline, twice a day for 7 d. At the end of the experiment, HD was evaluated by measuring hemorrhoidal and biochemical parameters along with histopathological observations.@*RESULTS@#In this study, COP induced a significant increase in the macroscopic severity score, anorectal coefficient and Evans blue extravasation, compared to normal rats. Additionally, it greatly enhanced the expression and secretion levels of some important inflammation-related cytokines along with marked histological damage, compared to normal rats. Rats treated with LZS ointment experienced significantly ameliorated Evans blue extravasation (P < 0.05), decreased macroscopic severity score (0.86 ± 0.14 vs. 1.65 ± 0.16) and the anorectal coefficient (P < 0.01); its use also attenuated tissue damage and inhibited the expression and secretion levels of inflammation-related cytokines (interleukin-1β, interleukin-6 and tumor necrosis factor-α).@*CONCLUSION@#This study validates a preliminary understanding of the use of LZS ointment to treat inflammatory factors and tissue damage in an experimental model of HD in rats.

10.
Article in Chinese | WPRIM | ID: wpr-799356

ABSTRACT

Objective@#To investigate the influential factors related to the long-term effect of periodontal-orthodontic treatment in patients with aggressive periodontitis (AgP).@*Methods@#A retrospective analysis was conducted in 25 AgP patients, who have received periodontal-orthodontic treatment in Peking University School and Hospital of Stomatology. Changes in the ratio of the residual alveolar bone height (RBH) was measured at three time points: baseline (T0), post orthodontic treatment (T1), and the last re-visit 3 years after orthodontic treatment (T2). Root abnormity was evaluated by observing periapical radiographs, and its relationship with alveolar bone loss after orthodontic treatment was analyzed. A multi-level analysis on factors related to the clinical outcome (alveolar bone height change) was performed.@*Results@#Totally 693 teeth of 25 patients at T0 and T1 and 368 teeth of 14 patients at T2 were investigated. During the periodontal-orthodontic treatment, the RBH was mainly influenced by root abnormity (estimation value −2.392), tooth position (estimation value for upper teeth vs. lower teeth 3.139, and anterior teeth vs. posterior teeth −3.469) and the baseline RBH at T0 (estimation value −0.391) (P<0.05). Teeth with root abnormity, teeth in mandibular and anterior area, and teeth with higher RBH showed less change in T1-T0 RBH values. In the long-term follow-up, RBH was mainly influenced by tooth position (estimation value for upper teeth vs. lower teeth 3.735, and anterior teeth vs. posterior teeth −5.318), the baseline RBH and probing depth (PD) at T0. Teeth in mandibular and anterior area, teeth with higher RBH (estimation value -0.498) and PD (estimation value -1.594) (P<0.05) showed less change in T0-T2 RBH values.@*Conclusions@#During orthodontic treatment, teeth with abnormal root, lower teeth, anterior teeth, and teeth with high RBH were unfavorable factors for bone gain. In the long-term observation, lower teeth, anterior teeth, teeth with high RBH and PD at first visit were unfavorable factors for bone gain.

11.
Article in Chinese | WPRIM | ID: wpr-865624

ABSTRACT

Objective:To investigate the incidence of delirium and related risk factors in patients after cardiovascular surgery.Methods:From May 2012 to May 2019, 7 001 patients underwent cardiovascular surgery in the Nanjing First Hospital were retrospectively analyzed. The general clinical data, operation name, operation time, cardiopulmonary bypass time, aortic occlusion time, analgesic and sedative drugs use during postoperative ICU treatment, confusion assessment method for the intensive care unit (CAM-ICU) score, length of ICU stay, total hospital stay, adverse prognosis and postoperative delirium were recorded. The influence of postoperative delirium on hospital stay and adverse prognosis was analyzed. The risk factors of postoperative delirium were explored.Results:Among the 7 001 patients, 573 (8.18%) had postoperative delirium (delirium group), while 6 428 patients had no delirium (non-delirium group). The incidence of postoperative delirium in patients with acute aortic dissection (AAD) after Sun′s operation was significantly higher than that in patients with other cardiovascular surgery: 45.03% (204/453) vs. 5.64% (369/6 548), and there was statistical difference ( P<0.05). The age, length of ICU stay, total hospital stay, incidence of adverse prognosis, operation time, cardiopulmonary bypass time and aortic occlusion time in delirium group were significantly higher than those in non-delirium group: (59.72 ± 12.48) years vs. (58.81 ± 12.16) years, 5.49 (2.87, 9.49) d vs. 1.12 (0.90, 1.95) d, 21.92 (17.90, 28.22) d vs. 17.85 (14.93, 21.76) d, 7.33% (42/573) vs. 2.13% (137/6 428), (5.43 ± 2.51) h vs. (4.06 ± 1.33) h, (140.01 ± 55.13) min vs. (108.07 ± 42.98) min and (85.23 ± 37.30) min vs. (72.50 ± 34.15) min, and there were statistical differences ( P<0.01). Multivariant Logistic regression analysis result showed that intraoperative deep hypothermic circulatory arrest and selective cerebral perfusion was independent risk factor of postoperative delirium in patients with cardiovascular surgery ( OR = 10.922, 95% CI 7.444 to 16.120, P < 0.01). After excluding AAD patients, the incidences of postoperative delirium were 2.63% (11/418), 4.16% (34/817), 4.37% (71/1 625), 5.13% (122/2 379), 9.34% (114/1 221) and 19.32% (17/88) for patients<40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years and ≥ 80 years respectively. The incidence of postoperative delirium increased with age ( Z= 2.63, P= 0.009). The incidences of postoperative delirium were 1.47% (45/3 056), 3.22% (63/1 954), 5.69% (34/597), 12.14% (38/312), 18.18% (22/121), 22.62% (38/168), 25.93% (21/81) and 41.70% (108/259) for patients who stayed 1, 2, 3, 4, 5, 6, 7 and>7 d in ICU. The longer stay in ICU, the higher the incidence of postoperative delirium ( Z= 3.34, P = 0.001). Sequential organ failure score (SOFA) was used to evaluate the organ functions of patients. The scores of respiratory system, circulatory system, liver function and renal function in delirium group were significantly worse than those in non-delirium group, and there were statistical differences ( P<0.01); there was no significant difference in coagulation function between 2 groups ( P > 0.05). According to the use of analgesic and sedative drugs during the postoperative ICU stay, the patients were divided into dexmedetomidine alone group (3 355 cases) and dexmedetomidine combined with dezocine group (1 396 cases). The incidence of postoperative delirium in dexmedetomidine combined with dezocine group was significantly higher than that in dexmedetomidine alone group: 19.20% (268/1 396) vs. 5.66% (190/3 355), and there was statistical difference ( P<0.01). Conclusions:Age, operation time, extracorporeal circulation time, aortic occlusion time, intraoperative hypothermic circulatory arrest with selective cerebral perfusion, severity of disease and length of ICU stay are independent risk factors for postoperative delirium in patients after cardiovascular surgery. The choice of analgesic and sedative drugs during the perioperative period may affect the occurrence of postoperative delirium.

12.
Article in Chinese | WPRIM | ID: wpr-871677

ABSTRACT

Objective:To analyze the risk factors for postoperative renal replacement therapy(RRT) in patients with acute Stanford type A aortic dissection. Develop and validate a prediction model based on the risk factors with the purpose of early intervention.Methods:A retrospective analysis of 215 patients who underwent surgery for acute Stanford type A aortic dissection in our hospital from April 2016 to April 2019 were performed. Clinical variables including age, gender, basal blood pressure, preoperative serum creatinine, intraoperative blood pressure, operation time, cardiopulmonary bypass time, aortic occlusion time, intraoperative blood transfusion(including autologous blood), intraocular fluid infusion, colloidal fluid infusion, intraoperative urine volume, bleeding volume, total fluid balance, and postoperative blood lactate value were collected and their association with renal replacement therapy were analysed. Clinical variables were screened using lasso regression. Applying the post-filtering variables to construct a predictive model, calculating the area under the receiver operating characteristic curve( AUC) of the predictive model and the sensitivity and specificity under the optimal threshold for model evaluation. Results:In the 215 patients with acute Stanford type A aortic dissection, 38 patients required renal replacement therapy, accounting for 17.67%. Preoperative serum creatinine, operation time, cardiopulmonary bypass time, aortic occlusion time, intraoperative blood pressure less than 80mmHg time, intraoperative blood pressure less than 55% of basal blood pressure time, intraoperative blood transfusion, intraoperative crystal fluid dosage, intraoperative urine volume and lactate value after ICU admission were important risk factors for postoperative renal replacement therapy(RRT) in patients with acute Stanford type A aortic dissection. The AUC for the predictive model established using these variables was 0.955(95% CI: 0.897-1.000). The specificity under the optimal threshold was 96.1% and the sensitivity was 90.9%. Conclusion:Perioperative clinical variables can predict the possibility of RRT in patients with acute Stanford type A aortic dissection after surgery, which may provide the possibility for early intervention.

13.
Article in Chinese | WPRIM | ID: wpr-837555

ABSTRACT

@#Objective    To analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery (late-onset delirium). Methods    We conducted a retrospective analysis of 3 365 patients, including 1 918 males and 1 447 females, aged 18-94 ( 60.53±11.50) years, who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019. Results    A total of 155 patients developed late-onset delirium, accounting for 4.61%. The incidence of late-onset delirium in patients with hypernatremia was 9.77%, the incidence of late onset delirium in patients without hypernatremia was 3.45%, and the difference was statistically different (P<0.001). The odds ratio (OR) of hypernatremia was 3.028 (95% confidence interval: 2.155-4.224, P<0.001). The OR adjusted for other risk factors including elderly patients, previous history of cerebrovascular disease, operation time, cardiopulmonary bypass time, lactate, hemoglobin≥100 g/L, prolonged mechanical ventilation, left ventricular systolic function, use of epinephrine, use of norepinephrine was 1.524 (95% confidence interval: 1.031-2.231, P=0.032). Conclusion    Hypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.

14.
Article in Chinese | WPRIM | ID: wpr-798487

ABSTRACT

Objective:To analyze and identify the brain and blood absorption components of rats after intragastric administration of Buyang Huanwu Tang(BYHWT). Method:The brain tissue,plasma of normal rats and the cerebral ischemia-reperfusion rats were analyzed by UPLC-Q-TOF-MS/MS.The prototype components in BYHWT were identified according to retention time,accurate relative molecular weight,primary and secondary mass spectrometry data. Result:After the administration of BYHWT,five compounds were found to enter the normal brain tissue through the blood-brain barrier and identified as calycosin-7-glucoside,albiflorin,formononetin-7-O-β-D-glucoside-6″-O-acetyl,safflower yellow A and astragaloside A;two compounds penetrated the blood-brain barrier and entered modeling brain tissue,and they were identified as calycosin-7-glucoside and formononetin-7-O-β-D-glucoside-6″-O-acetyl;seven compounds entered normal plasma and were identified as calycosin-7-glucoside,albiflorin,hydroxysafflor yellow A,et al;three compounds entered model plasma and identified as calycosin-7-O-β-D-glucoside-6″-O-acetyl,6″-O-acetyl-(6αR,11αR)-9,10-dimetho-xypterocarpan-3-O-β-D-glucoside and formononetin-7-O-β-D-glucoside-6″-O-acetyl. Conclusion:BYHWT has different pharmacological material basis in normal and cerebral ischemia-reperfusion rats.

15.
Article in Chinese | WPRIM | ID: wpr-817936

ABSTRACT

In recent years,with the rate of rescue and survival rate of premature/low birth weight infants greatly improved,the quality of life of premature/low birth weight infants becomes more and more important. Premature/low birth weight infants are prone to multiple problems of growth and development due to their immature organs and systems,which seriously affects their quality of life. This review will elaborate the research progress on common problems of growth and development and the treatment methods in premature/low birth weight infants.

16.
Article in Chinese | WPRIM | ID: wpr-694963

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Objective To observe dexmedetomidine coordinate with mlelatonin attenuate the scopolamine-induced delirium in rats and its mechanism.Methods Thirty male adult SD rats aged 6-8 weeks were randomly divided into six groups:normal saline control group (group C),scopolamine-induced delirious model group (group S),dexmedetomidine group (group D),mlelaton group (group M),α-bungarotoxin antagonism group (group BM),joint protection group (group DM).A model of delirium was reproduced by intraperitoneal inj ection of scopolamine 1.8 mg/kg.The rats in group C was given equal sterile normal saline instead,the rats in group D was intraperitoneal injected of dexmedetomidine 40 μg/kg 15 minutes before scopolamine injection,the rats in group M was intrap-eritoneal injected of mlelaton 5 mg/kg in the contralateral abdominal at the same time with scopolamine injection,the rats in group BM was intraperitoneal injected ofα-BGT 1 μg/kg 15 minutes before scopolamine injection and mlelaton 5 mg/kg in the contralateral abdominal at the same time with scopolamine injection,the rats in group DM was intraperitoneal injected of dexmedetomidine 40 μg/kg 15 minutes before scopolamine injection and mlelaton 5 mg/kg in the contralateral abdominal at the same time with scopolamine injection.The rats were assigned for open field test 15 minutes before and 10 minutes after model reproduction for 15 minutes.The level ofα7nAchR in serum was deter-mined by enzyme linked immunosorbent assay.Results When compared with group C,rats in group S ran significant longer total distance and space distance,had faster total speed and space speed (P<0.05).When compared with group S,rats in group D,group M,group DM ran significant shorter total distance and space distance,had significant slower total speed and space speed (P<0.01 );when compared with group D,rats in group DM ran significant shorter total distance and space dis- tance (P<0.05 ),had slower total speed and space speed,however without significant statistical difference.When compared with that in group C,the level of α7nAChR in serum were significantly decreased in group S (P<0.05).When compared with group S,the level of α7nAChR were signifi-cantly increased in group D (P<0.01).There were no significant difference between group M and group S (P=0.96).When compared with group D,the level of α7nAChR had an elevated trend in group DM.Conclusion Dexmedetomidine can improve the symptoms of delirium,possibly by in-creasing the activity of alpha 7nAChR.Melatonin may improve the effect of dextromidine on delirium.

17.
Article in Chinese | WPRIM | ID: wpr-735017

ABSTRACT

Objective To investigate the impact of perioperative mild hypothermia on the neurological function and prog-nosis of patients with acute type A aortic dissection. Methods This study enrolled 65 patients with acute aortic dissection un-derwent surgery during the period of February 2017 to February 2018 and randomly divided them into mild hypothermia group and control group. After the process of deep hypothermic circulatory arrest,patients in the mild hypothermia group were re-warmed to 34 ℃ - 35 ℃ and maintained until 24 h after the operation. While,the patients in the control group were rewarmed to 36 ℃ and were treated with routine rewarm therapy. Baseline characteristics were recorded before the operation and neuro-logical and prognosis related indexes were recorded after the operation for all the patients. At the same time,peripheral venous bloods of all the patients were collected preoperatively and at 1、6、 12 and 24 h after the operation. Serum S 100β and neuron-specific enolase(NSE)levels were measured by ELISA kit. Results Compared with the control group,patients in the mild hypothermia group had a significantly shorter recovery time[ 10. 6 h(IQR:7. 6, 19. 1)vs. 25. 8 h(IQR: 13. 3,54. 2),P =0. 007]. At the same time,serum levels of NSE at 1 h and 6 h after operation and serum levels of S 100β levels at 1、6、 12 and 24 h after operation in the mild hypothermia group were significantly lower than those in the control group(P < 0. 05). In addi-tion,the length of stay in the mild hypothermia group was significantly shorter than that in the control group[ 19 days(IQR: 17, 23)vs. 24 days(IQR: 17,28),P = 0. 036]. However,there was no statistically difference in the incidence of delirium and cerebrovascular accidents between the two groups. Conclusion Perioperative mild hypothermia therapy can significantly re-duce brain cell damage in the patients with acute type A aortic dissection and can shorten postoperative recovery time and hospi-talization time,and thus improve the prognosis of patients.

18.
Article in Chinese | WPRIM | ID: wpr-699967

ABSTRACT

Objective To investigate the effect of the correction of the position error of the abdominal tumor by cone beam scanning. Methods Six patients with abdominal tumor were selected with double-blind method, and electronical portal imaing device was used to collect the information of the patient dosimetry during radiotherapy.EDOSE tool was applied to 3D dose reconstruction so as to execute real-time 3D dose verification of the treatment plan. Each patient had 5 sets of data acquired when image guidance existed and another 5 sets when image guidance was absent. The treatment effects with or without image guidance were compared.Results The overall γ passing rate with cone beam CT image guidance gained no advantages over that without image guidance, though the setup error was corrected to some extent. Image guidance contributed nothing to increasing target area coverage while decreasing exposure dose to normal tissue. Conclusion Setup error correction by the image guidance based on bone marker has no significant effect on improving 3D dose verification and dose accuracy during the radiotherapy of the abdominal tumor patient.

19.
Chinese Circulation Journal ; (12): 1118-1123, 2018.
Article in Chinese | WPRIM | ID: wpr-703937

ABSTRACT

Objectives: To explore the effect of 17β-estradiol (E2) on hypoxic pulmonary hypertension (HPH) and explore if the effects were mediated through suppressing pulmonary artery smooth muscle cells (PASMCs) proliferation by targeting miRNA-21 (miR-21). Methods: Animal experiment: A total of 32 healthy female SD rats with castrated surgery were randomly divided into 4 groups: normoxia group, normoxia+E2 group, hypoxia group, hypoxia+E2 group (n=8 each). The rats in normoxia+E2 group and hypoxia+E2 group received subcutaneous injection of E2 20 μg/kg/d, and the rest groups received subcutaneous injection of equal volume saline. The hypoxic groups were placed in the hypoxic chamber (24 hours per day for 8 weeks) to establish HPH model and normoxic groups were kept in the room air. The pulmonary artery remodeling, mean pulmonary artery pressure (mPAP), right ventricle hypertrophy index (RVHI) were observed. Real-time PCR and Western blot were used to detect the levels of proliferation cell nuclear antibody (PCNA) and miR-21 expression in pulmonary artery. In vitro: human pulmonary artery smooth muscle cells (hPASMCs) were randomly divided into 3 groups: normoxia group, hypoxia group, hypoxia+E2 group. The levels of cell proliferation in each group were tested by MTT after 24 hours. Real-time PCR and Western blot were used to detect the levels of PCNA and miR-21 in cells. Results: Animal experiment: compared with normoxia group, the hypoxia group showed obviously thickened pulmonary artery wall, increased mPAP and RVHI, and significantly increased expression of miR-21 and PCNA (P<0.01);above changed were significantly attenuated in hypoxia+E2 group (P<0.01). In vitro: compared with normoxia group, the hypoxia group showed obvious proliferation and significantly increased expression of miR-21 and PCNA (P<0.01);compared with hypoxia group, the proliferation of hPASMCs and expression of miR-21 and PCNA were obviously reduced in hypoxia+E2 group (P<0.01). Conclusions: E2 could effectively reduce mPAP, attenuate the degree of right heart hypertrophy and pulmonary vascular remodeling, the protective effect may be mediated through downregulating miR-21 and PCNA expression, and subsequently inhibiting the proliferation of hPASMCs.

20.
Chin. med. j ; Chin. med. j;(24): 648-656, 2018.
Article in English | WPRIM | ID: wpr-690561

ABSTRACT

<p><b>Background:</b>Previous studies have found that schoolchildren with attention-deficit/hyperactivity disorder (ADHD) showed difficulties in neuropsychological function. This study aimed to assess neuropsychological function in Chinese preschoolers with ADHD using broad neuropsychological measures and rating scales and to test whether the pattern and severity of neuropsychological weakness differed among ADHD presentations in preschool children.</p><p><b>Methods:</b>The 226 preschoolers (163 with ADHD and 63 controls) with the age of 4-5 years were included and assessed using the Behavior Rating Scale of Executive Function-Preschool Version (BRIEF-P) and a series of tests to investigate neuropsychological function.</p><p><b>Results</b>Preschoolers with ADHD showed higher scores in all domains of the BRIEF-P (inhibition: 30.64 ± 5.78 vs.20.69 ± 3.86, P < 0.001; shift: 13.40 ± 3.03 vs.12.41 ± 2.79, P = 0.039; emotional control:15.10 ± 3.53 vs.12.20 ± 2.46, P < 0.001; working memory: 28.41 ± 4.99 vs.20.95 ± 4.60, P < 0.001; plan/organize: 17.04 ± 3.30 vs.13.29 ± 2.40, P < 0.001) and lower scores of Statue (23.18 ± 7.84 vs.28.27 ± 3.18, P = 0.001), Word Generation (15.22 ± 6.52 vs.19.53 ± 7.69, P = 0.025), Comprehension of Instructions (14.00 ± 4.44 vs.17.02 ± 3.39, P = 0.016), Visuomotor Precision (P < 0.050), Toy delay (P = 0.048), and Matrices tasks (P = 0.011), compared with normal control. In terms of the differences among ADHD subtypes, all ADHD presentations had higher scores in several domains of the BRIEF-P (P < 0.001), and the ADHD-combined symptoms (ADHD-C) group had the poorest ratings on inhibition and the ability to Plan/Organize. For neuropsychological measures, the results suggested that the ADHD-C group had poorer performances than the ADHD-predominantly inattentive symptoms (ADHD-I) group on Statue tasks (F = 7.34, η = 0.12, P < 0.001). Furthermore, the ADHD-hyperactive/impulsive symptoms group had significantly poorer performances compared to the ADHD-C group in the Block Construction task (F = 4.89, η = 0.067, P = 0.003). However, no significant group differences were found between the ADHD-I group and normal control.</p><p><b>Conclusion:</b>Based on the combined evaluation of performance-based neuropsychological tests and the BRIEF-P, preschoolers with ADHD show difficulties of neuropsychological function in many aspects.</p>


Subject(s)
Child, Preschool , Female , Humans , Male , Asian People , Attention Deficit Disorder with Hyperactivity , Behavior Rating Scale , Executive Function , Physiology , Neuropsychological Tests
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