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Obstructive sleep apnea (OSA) is a common sleep disordered breathing disorder. As a major global public health problem, untreated OSA can lead to a variety of adverse health outcomes, including various cardiovascular and cerebrovascular diseases, metabolic disorders, and psychiatric disorders such as anxiety and depression. Traditional OSA therapies such as positive airway pressure (PAP), weight loss, oral appliance, upper airway surgery, and postural therapy focus on the anatomical factors of OSA. However, the pathogenesis of OSA is heterogeneous, and non-anatomical factors also play an important role in most patients. Although there is no drug with exact efficacy for the treatment of OSA, with the deepening understanding of the pathophysiological mechanism of OSA, more and more clinical studies are devoted to the study of drug treatment of OSA and its complications, and a series of results have been achieved. The following is a review of the relevant studies on drug treatment of OSA in recent years, hoping to provide literature support and theoretical basis for future research on drug treatment of OSA.
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Non-small cell lung cancer （NSCLC） is a malignant tumor of the respiratory system with a high incidence. The early symptoms are not typical， and most patients are diagnosed at an advanced stage， which seriously threatens the lives and health of people. Surgery， chemotherapy， and targeted therapy are the main means of treatment at present， but the consequent drug resistance and adverse reactions restrict these treatment methods with certain limitations. In recent years， with the development of traditional Chinese medicine （TCM） in tumor resistance， TCM has attracted extensive attention for its obvious therapeutic effect and fewer adverse reactions. Numerous signaling pathways are involved in the formation and development of NSCLC， where phosphatidylinositol 3 kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway is one of the key regulatory pathways. The PI3K/Akt/mTOR signaling pathway affects the proliferation， invasion， and metastasis of NSCLC cells by affecting the cycle， inhibiting the apoptosis， inhibiting the autophagy of tumor cells， and promoting tumor neovascularization. As revealed by the recent literature， Chinese medicine plays an indispensable role in NSCLC cell autophagy， cell cycle， apoptosis， invasion and metastasis， neovascularization， and reversal of drug resistance by regulating the PI3K/Akt/mTOR signaling pathway. Although some Chinese medicinal extracts or compounds have made great breakthroughs in some mechanisms of action in the treatment of NSCLC， these studies only remain at the level of in vitro cell experiments and animal studies in vivo. Researchers are faced with the great challenge of "transforming the research results of Chinese medicines into clinical applications". Based on the current research status in China and abroad， this paper reviewed Chinese medicine in the intervention in NSCLC through the regulation of PI3K/Akt/mTOR signaling pathway in recent years， in order to open up new ideas for NSCLC drug therapy research and also provide a useful reference for further mechanism research.
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Mammalian cell defense mechanisms are constantly evolving in response to increasing endogenous and exogenous oxidative stress factors. In recent years, as research has deepened, nuclear factor E2-related factor 2 (Nrf2) has been hailed as a "star" molecule in antioxidant damage defense. Billions of dollars have been spent internationally on developing targeted activators or inhibitors. Obstructive sleep apnea (OSA) is the most common form of sleep breathing disorder in clinical practice. Oxidative stress is one of its main pathological mechanisms and is closely related to target organ damage in the heart, brain, lungs, kidneys, and other systems. Recent research has revealed the mechanistic relationship of the Nrf2 pathway in OSA complications, and some natural Nrf2 activators have demonstrated emerging therapeutic effects in animal experiments. However, the activation mode and effect pathway of Nrf2 in different target organs of OSA have not been clarified. Therefore, this article reviews the research progress of the Nrf2 pathway in OSA and its complications, to deepen understanding of the mechanism of OSA complications and provide a potential treatment strategy.
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Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible and typical chronic fibrotic lung disease. In recent years, significant progress has been made in the pathophysiology, clinical diagnosis and treatment of IPF. However, to date, there is still no cure for IPF. The second messenger cyclic adenosine monophosphate (cAMP) inhibits fibroblast proliferation or differentiation into myofibroblasts during the development of IPF. Phosphodiesterase 4 (PDE4) is a major camp-degrading enzyme in lung fibroblasts, which is up-regulated during the progression of fibrosis. PDE4 inhibitors have anti-fibrosis effects in vivo and in vitro in IPF models. In addition, PDE4 is widely involved in inflammatory processes, which are also active in the pathogenesis of IPF. Thus, PDE4 inhibition is a potential therapeutic approach for IPF. This article reviews the pathogenesis of IPF and the physiological function of PDE subtype 4 inhibitors in the treatment of IPF.
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BACKGROUND: Both serum-free and serum media have been used to culture dorsal root ganglion cells, but the difference between the two remains unclear. OBJECTIVE: To explore whether serum-free medium can completely replace serum medium for culture of dorsal root ganglion cells. METHODS: The dorsal root ganglion of ICR mice at 8-10 weeks was taken and treated with collagenase and trypsin. After that, the mice were divided into the electroporation + serum group, electroporation + serum-free group, non-electroporation + serum group and non-electroporation + serum-free group. In the electroporation groups, the dorsal root ganglion cells were transfected with electroporation buffer and enhanced green fluorescent protein particles. Cells were cultured for three days. After Tuj1 antibody staining, in the non-electroporation + serum group and non-electroporation + serum-free group, axon branches, axon regeneration length, number of cell survival and the expression of proteins related to axon regeneration were counted. In the electroporation + serum group and electroporation + serum-free group, axon branches, length of axon regeneration, number of cell survival, and electroporation efficiency were measured. This study was approved by the Laboratory Animal Ethics Committee of the First Affiliated Hospital of Soochow University. RESULTS AND CONCLUSION: (1) In the non-electroporation + serum group and non-electroporation + serum-free group, there was no significant difference in axon branches, axon regeneration length, number of cell survival and the expression of axon regeneration related proteins (P > 0.05). (2) In the electroporation + serum group and electroporation + serum-free group, there was no significant difference in axon branches, axon regeneration length and electroporation efficiency (P > 0.05). Compared with electroporation + serum group, the number of cell survival of the electroporation + serum-free group was significantly lower (P 0.05). The number of cell survival of the non-electroporation + serum group was significantly higher than that of the electroporation + serum group (P < 0.05). (4) The results showed that, in the condition of non-electroporation, the absence of serum does not affect the culture of dorsal root ganglion in vitro, and serum-free medium can replace serum medium. However, under the condition of electroporation, the number of cell survival would be decreased without serum medium, suggesting that serum plays an important role in the culture of dorsal root ganglion in vitro under the condition of electroporation. Therefore, serum-free media cannot replace serum media.
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Objective To select the appropriate postoperative analgesia,through the application of different methods in the postoperative analgesia of the patients with breast cancer.Methods Ninety female patients undergoing unilateral breast cancer radical surgery in general anesthesia,aged 35-60 years,weighing 45-80 kg,falling into ASA physical status Ⅰ or Ⅱ,were ran domly divided into simple intravenous postoperative analgesia group (group P,n =30),local infiltration plus intravenous postoperative analgesia group (group R,n =30),ultrasound guided thoracic nerve block plus intravenous postoperative analgesia (group TP,n =30),group P used dexmedetomidine 2μg/kg plus sufentanil 2μg/kg,group R used 0.375％ ropivacaine 20 ml local infiltration added dexmedetomidine 2μg/kg plus sufentanil 2 μtg/kg,group TP used 0.375％ ropivacaine 20 ml vertebral side block added dexmedetomidine 2μg/kg plus sufentanil 2 μg/kg.The VAS scores and Ramsay score was recorded 6,12,24,48 h after surgery,the deep sleep quality score at preoperative postoperative 24 h and 48 h,the number of postoperative analgesia pump pressure,the use of sufentanil and the nausea,vomiting,itching,bradycardia,respiratory depression happened in 24 h were documented.Results The VAS scores in groups R and TP 6 h after surgery were significantly lower than that of group P.The VAS scores in group TP 12 h after surgery were significantly lower than that of groups R and P (P＜0.05).The sedation scores were not statistically significant among the three groups.The deep sleep quality scores at 24 h in group TP were significantly lower than those of groups R and P (P＜ 0.05).The number of compressions and the use of the sufentanil in 24 h after surgery in group TP were significantly lower than those of groups R and P,and that in group R was significantly lower than that in group P (P＜0.05).The incidence of nausea,vomiting,itching,bradycardia,respiratory depression were not statistically significant in 24 h,and there were no postopera tive complications related to neurologic blocking of lateral vertebral nerve.Conclusion Three methods were safe and effective for postoperative analgesia in patients with radical surgery breast cancer.Ultrasound guided by thoracic nerve block combined intravenous postoperative analgesia was obviously better than local infiltration plus infiltration postoperative analgesia and infiltration postoperative analgesia in terms of postoperative analgesia,quality of sleep and the number of sufentanil.
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Objective:To construct the "3+2" counterpart cut-through sectional training nursing major un-dergraduate curriculum system, which is oriented by vocational competence. Methods: The preliminary draft of"3+2" nursing undergraduate curriculum setting was established base on the literature review and expert group in-terview, and the 25 experts was conducted two rounds of expert questionnaire consultation using Delphi method. Results:Experts' opinions tended to be consistent after two rounds of consultation, the expert authority coefficient was 0 . 92 , the coordination coefficient of Kendall was 0 . 44 in the second round of expert consultation and finally established 5 curriculum groups, including total 28 courses of public elementary courses, professional basic cour-ses, professional core courses, professional oriented courses and centralized practice courses. Conclusion: It should construct the"3+2" counterpart cut-through nursing major undergraduate curriculum system, which is o-riented by vocational competence, and achieve effective connection between the knowledge structure and the quality of the nursing students, in order to provide the reference for perfecting the curriculum system of vocational educa-tion in our country.
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Objective:To investigate the clinical characteristics and causes of serotonin syndrome induced by tramadol in order to provide references for rational drug use in clinical practice. Methods:The relevant literatures published in domestic medical journals from the building of database to 2016 were retrieved in PubMed, EMbase, CNKI and WanFang database and statistically analyzed in respects of types and relevance evaluation of adverse drug reactions, the age and gender distribution of patients, the application of drugs,occurrence time of serotonin syndrome,clinical manifestations,treatment and outcome. Results:A total of 21 cases of seroto-nin syndrome induced by tramadol were collected. Totally 19 cases were caused by combined drug use, among which 12 cases were combined with selective serotonin reuptake inhibitors. The results of relevance evaluation showed 19 cases of possible relevance and 2 cases of probable relevance. Totally 10 cases of severe adverse drug reactions were reported and 11 cases of common adverse drug reac-tions were exhibited. One patient was heterozygous for CYP2D6 polymorphisms(CYP2D6?1/?4) causing decreased metabolizing a-bility to tramadol. Totally 28.6% of patients developed symptoms in 24h after the addition of new serotonergic agents or increase the dosage of serotonergic agents. In most cases,the patients' syndrome resolved with discontinuation of at least one serotonergic drug and symptomatic treatment,usually in less than one week. Conclusion:When prescribing tramadol,physicians should be aware of seroto-nin syndrome induced by drug-drug interactions and possible pharmacogenetic factors. It is important that safety monitoring should be carried out in patients during the application of drugs to reduce the harm of adverse drug reactions.
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Objective Postoperative cognitive dysfunction (POCD) is a common complication of cardiac surgery, which seriously affects the prognosis of the patient.This study aimed to explore the risk factors for early POCD in patients undergoing cardiac valve surgery and the correlation between early POCD and the serum S100B protein level.Methods Eighty patients underwent mitral valve replacement surgery in combination with tricuspid plasty.At 1 day before and 5 days after surgery, we assessed the cognitive function of the patients and divided them into a POCD and a non-POCD group.We obtained such data as the age, sex, education, New EuroSCORE Ⅱ, and preoperative NYHA cardiac function grades and left ventricle ejection fraction (LVEF) of the patients, collected the venous blood to determine serum S100B protein concentration by ELISA, and analyzed the independent risk factors of early POCD using single-factor and binary logistic regression analyses.Results POCD was found in 20 (25%) of the patients, , Logistic regression analysis showed the independent risk factors for early POCD to be hyperglycemia (OR=6.038, 95% CI: 1.202-30.337), operation time (OR=6.423, 95% CI: 1.276-32.332), and aspartate aminotransferase (AST, 2 times higher than normal) (OR=12.878, 95% CI: 2.289-72.445).The serum S100B protein concentrations in the POCD group were (1.9±0.3) μg/L and (1.7±0.4) μg/L at 48 and 72 hours after cardiopulmonary bypass, significantly lower than (2.4±0.4) μg/L and (2.1±0.3) μg/L at 30 minutes and 24 hours (P<0.05), and so was it in the non-POCD group at 72 than at 48 hours postoperatively ([1.4±0.4]) vs [1.5±0.4] μg/L, P<0.05).Conclusion Long operation time, perioperative hyperglycemia and high AST are independent predictors and the serum S100B protein level is a significant marker of early POCD.
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Objective:To comprehensively improve the quality of clinical nursing, survey the hospitalized pa-tient′s satisfaction and analyze the low satisfaction issues.Methods:Adopt the self-made questionnaire in four pri-mary hospitals.Results:Through the questionnaire analysis, understand the hospitalized patients to improve grass-roots hospital trusteeship overall satisfaction, but satisfaction to nursing technical operation, the life care is low. Logistic stepwise regression analysis, according to the results of nursing technical operation and health education are the main factors influencing the patients′satisfaction.Conclusion:Nursing managers should pay attention to the factors influencing patient satisfaction, and take corresponding corrective measures, improve the patient′s satisfac-tion, to further improve the reform of hospital custody.
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Objective To explore the effect of the ropivacaine combined with sufentanil on neuropathic pain in rats.Methods The constriction injury method was performed to establish rat neuropathic pain model and 40 neu-ropathic rats were produced in accordance with the above modeling methods,which were divided into group A(ropiva-caine and sufentanil combined administration,n =10),group B(ropivacaine administration,n =10),group C(sufen-tanil administration,n =10)and group D(no administration,n =10).A total of 10 healthy rats without any treatment, the normal feeding,named as group E.At 1,3,7,11,14,21d after operation von -Frey filaments determination of mechanical hyperalgesia(MWT),and the Hargreaves method for the determination of thermal hyperalgesia(TWL) were measured and the ELISA Kit (IL -6 and TNF -α) were used to detect serum IL -6 and TNF -αconcentrations.Results Before and at 1 day after the operation mechanical allodynia and thermal hyperalgesia and allergy treatment had no significant difference(all P >0.05).Mechanical allodynia and thermal hyperalgesia of group A,B and C were significantly lower than those before the treatment and at 1 day after operation(all P <0.05),and mechanical hyperalgesia and thermal hyperalgesia of group A was significantly lower than those of group B and C (all P <0.05).The serum IL -6 and TNF -αconcentrations of 7,14 and 21 days in group A were significantly lower than those of group B and C(t =7.10,5.84,9.11,all P <0.05).Conclusion The effects of ropivacaine combined with sufentanil analgesic on neuropathic pain of rats was significantly higher than that of ropivacaine or sufentanil alone in the treatment.
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Objective: To provide a scientific standard of left ventricular Tei index for healthy people from various region of China, and to lay a reliable foundation for the evaluation of left ventricular diastolic and systolic function. Methods: The correlation and principal component analysis were used to explore the left ventricular Tei index, which based on the data of 3 562 samples from 50 regions of China by means of literature retrieval. hTe nine geographical factors were longitude(X1), latitude(X2), altitude(X3), annual sunshine hours (X4), the annual average temperature (X5), annual average relative humidity (X6), annual precipitation (X7), annual temperature range (X8) and annual average wind speed (X9). ArcGIS sotfware was applied to calculate the spatial distribution regularities of letf ventricular Tei index. Results: hTere is a signiifcant correlation between the healthy people’s letf ventricular Tei index and geographical factors, and the correlationcoeffcients were 0.107 (r1), 0.301 (r2), 0.029 (r3), 0.277 (r4),?0.256(r5),?0.289(r6),?0.320(r7), 0.310 (r8) and 0.117 (r9), respectively. A linear equation between the Tei index and the geographical factor was obtained by regression analysis based on the three extracting principal components. hTe geographical distribution tendency chart for healthy people’s letf Tei index was iftted out by the ArcGIS spatial interpolation analysis. Conclusion: hTe geographical distribution for letf ventricular Tei index in China follows certain pattern. hTe reference value in North is higher than that in South, while the value in East is higher than that in West.