Etiology composition and prognosis of pediatric chronic critical illness in a pediatric intensive care unit / 中国当代儿科杂志

OBJECTIVES@#To explore the etiology composition and outcomes of pediatric chronic critical illness (PCCI) in the pediatric intensive care unit (PICU).@*METHODS@#The children who were hospitalized in the PICU of Dongguan Children's Hospital Affiliated to Guangdong Medical University and met the diagnostic criteria for PCCI from January 2017 to December 2022 were included in the study. The etiology of the children was classified based on their medical records and discharge diagnoses. Relevant clinical data during hospitalization were collected and analyzed.@*RESULTS@#Among the 3 955 hospitalized children in the PICU from January 2017 to December 2022, 321 cases (8.12%) met the diagnostic criteria for PCCI. Among the 321 cases, the most common etiology was infection (71.3%, 229 cases), followed by unintentional injury (12.8%, 41 cases), postoperation (5.9%, 19 cases), tumors/immune system diseases (5.0%, 16 cases), and genetic and chromosomal diseases (5.0%, 16 cases). Among the 321 cases, 249 cases (77.6%) were discharged after improvement, 37 cases (11.5%) were discharged at the request of the family, and 35 cases (10.9%) died in the hospital. Among the deaths, infection accounted for 74% (26/35), unintentional injury accounted for 17% (6/35), tumors/immune system diseases accounted for 6% (2/35), and genetic and chromosomal diseases accounted for 3% (1/35). From 2017 to 2022, the proportion of PCCI in PICU diseases showed an increasing trend year by year (P<0.05). Among the 321 children with PCCI, there were 148 infants and young children (46.1%), 57 preschool children (17.8%), 54 school-aged children (16.8%), and 62 adolescents (19.3%), with the highest proportion in the infant and young children group (P<0.05). The in-hospital mortality rates of the four age groups were 14.9% (22/148), 8.8% (5/57), 5.6% (3/54), and 8.1% (5/62), respectively. The infant and young children group had the highest mortality rate, but there was no statistically significant difference among the four groups (P>0.05).@*CONCLUSIONS@#The proportion of PCCI in PICU diseases is increasing, and the main causes are infection and unintentional injury. The most common cause of death in children with PCCI is infection. The PCCI patient population is mainly infants and young children, and the in-hospital mortality rate of infant and young children with PCCI is relatively high.

Effects of all intravenous anesthesia versus total inhalation anesthesia on the cardiac function in elderly patients during intestinal surgery / 临床麻醉学杂志

Objective To evaluate the effects of all intravenous anesthesia and total inhalation anesthesia on left ventricular systolic and diastolic function in elderly patients undergoing intestinal surgery. Methods Forty elderly patients without any history or signs of cardiovascular disease, 23 males and 17 females, aged 65-80 years, ASA physical status Ⅱ or Ⅲ, were randomly allocated into two groups. Maintenance of anesthesia was achieved by propofol-remifentanil respectively (group P) or sevoflurane inhalation (group S). Transesophageal echocardiography was performed as a baseline after intubation. Left ventricular ejection fraction (LVEF), fractional shortening (FS), peak E, E/A, peak E deceleration time (EDT) were measured after anesthesia induction (T0), 10 min after incision (T1), end of surgery (T2), respectively. Results Compared with T0, LVEF, FS, Peak E, E/A of both groups were similar at T1. There were no statistical differences in LVEF and FS between the two groups at T2. However, the value of peak E and E/A of group S at T2 were significantly increased than the baseline T0 and higher than that of group P (P ＜ 0.05). Meanwhile, EDT at T2 in group S was shorter than that at T0 and significant shorter than in group P (P ＜ 0.05). There were two PONV cases in each of the two groups. Conclusion Sevoflurane had a favourable effect on diastolic function in the elderly patients. Furthermore, sevoflurane showed advantage in maintaining hemodynamic stability during the operative period.

The analgesia effect of ultrasound-guided suprascapular blocks for shoulder arthroscopy / 临床麻醉学杂志

Objective To investigate the analgesia effects of ultrasound-guided suprascapular nerve blocks for shoulder arthroscopy without impacting respiratory function.Methods Forty seven patients scheduled for shoulder arthroscopy,17 males and 30 females,aged 26-78 years,weighing 50-75 kg,ASA physical status Ⅰ or Ⅱ,were randomized into suprascapular nerve blocks group (group S,n=24) and interscalene plexus blocks group (group Ⅰ,n =23).0.375％ ropivacaine 20 ml and 1 ％ lidocaine plus 1 ml of dexamethasone 5 mg.The vital capacity before and 6 h after surgery,extubation time,total PACU duration,VAS scores at awake time and 6 h,12 h,24 h after surgery,total opiods consumption,and other complications were recorded.Results The patients in group S exbuted significantly earlier than in group Ⅰ [(13.0±3.9) min vs (21.2±4.0) min,P＜0.05].The mean vital capacity 6 h after surgery significantly decreased in group Ⅰ [(2 909±502) ml vs (3 533±726) ml,P＜0.05].There were no significant differences of VAS scores or opiods consumption between the two groups.Conclusion Selective suprascapular nerve blocks can provide effective analgesia for shoulder arthroscopy without impacting the vital capacity.

Effect of intrathecal injection of carbenoxolone on hyperalgesia in rats with L5 spinal nerve transaction / 中国药理学通报

Aim Toinvestigatetheantagonisticeffect of intrathecal injection of carbenoxolone (CBX ) on neuropathic pain and its underlying mechanism.Meth-ods SixtymaleSprague-Dawleyratswererandomly divided into five groups (n =12 ):group I received sham surgery then treated with saline;group Ⅱ re-ceived SNT then treated with saline;groupⅢreceived SNT then treated with 0. 05 μg CBX;group Ⅳ re-ceived SNT then treated with 0. 5 μg CBX;group Ⅴreceived SNT then treated with 5 μg CBX.Treatment was undertaken with 10 μl volume as a single intrathe-cal injection on postoperative day 10.Mechanical with-drawl thresholds were measured 1 d before operation, 1,3,5,7 and 10 d after surgery,1 h before intrathe-cal administration,and 1 ,2,4,6 h after intrathecal administration.Lumbar spinal cord was obtained 2 h after intrathecal administration to determine the expres-sions of GFAP by immunohistology and TNF-α,IL-1βby ELISA in bilateral spinal dorsal horns.Results Comparedwiththeshamgroup,thebilateralMWTin group Ⅱ ~Ⅴ was significantly decreased.Compared with the MWT 1 h before intrathecal administration on day 10,the values at 1 ,2,4,6 h after administration of group Ⅱ and Ⅲ had no marked difference.The ip-silateral MWT in groupⅣhad no significant difference at 1,2,4 h after administration,the contralateral MWT was significantly increased,whereas GFAP and TNF-α,IL-1βwas significantly decreased in the spinal cord .In group Ⅴthe bilateral MWT was significantly improved at 1 ,2,4 h after administration,whereas GFAP and TNF-α,IL-1βwere significantly decreased inthespinalcord.Conclusions IntrathecalCBXcan inhibit the development of bilateral MWT.The analge-sic effect of CBX is implemented partly via suppressing the actation of GFAP and the realease of TNF-α,IL-1βin the spinal doral horn.

Impacts of Different Doses of Alcohol on Rat Endothelial Microparticles / 天津医药

Objective To discuss the impacts of different doses of alcohol on the level of microparticles (EMPs) of rat endothelial cells. Methods Sixty male SD rats were randomly allocated into four groups:high dose group (group A), me-dium dose group (group B), low dose group (group C) and the blank contrast group (group D). There were15 rats in each group. Rats were fed alcohol for 8 weeks. Flow cytometer was used to measure the level of circulating CD31+/CD42-EMPs in four groups, and which was compared with the alcohol dosage. Results Compared with group D, the level of circulating EMPs was significantly increased in group A and B (P＜0.05). There was no significant change in the level of circulating EMPs in group C (P>0.05). Conclusion The moderate and high doses of alcohol are harmful to the function of vascular en-dothelial cells in rats, which show a significant dose-effect relationship. The low dose of alcohol shows no effect on the func-tion of vascular endothelial cells in rats. The protective effect of alcohol needs further investigation.

Relationship between noninvasive brachial artery blood pressure and radial artery blood pressure of the right arm of patients / 中华急诊医学杂志

Objective To investigate the relationship between noninvasive brachial artery blood pressure (B) and radial artery blood pressure (R) of the right arm.Methods Two hundred and ninetyfive patients with 149 males and age of (47 ± 16) years were studied.The height of patients was 163 ± 8 cm,and weight of patients was (61.2 ± 7.8) kg.The patients with peripheral vascular disease,wounds of arm skin or subcutaneous tissue infection were all excluded.Their B (with adult cuffs) and R (with infant cuffs) of the right arm were measured and analyzed after the patients under general anesthesia and stable hemodynamics.The relationships between B and R were analyzed by linear regression,the differences between B and R of each interval were compared using one-way ANOVA and then followed by SNK procedure.Results Right brachial artery blood pressure was significantly lower than radial artery blood pressure.The differences between the two varied from 13 to 18 mmHg in systolic BP (SBP),diastolic BP (DBP) and mean blood pressure (MAP).And linear regression was most applicable to describe their correlation [r=0.841 (SBP),0.808 (DBP),0.833 (MAP),all P＜0.01].Conclusions Radial artery blood pressure measured with infant cuffs can well reflect the variation of brachial artery blood pressure.

Comparison of HbA1c in Chinese patients with type 1 or type 2 diabetes randomized to twice daily insulin lispro low mix 25 or twice daily human insulin mix 30/70 / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Glycemic control prevents onset and progression of diabetes-related long-term complications. The objective of this study was to demonstrate that twice daily insulin lispro low mix 25 is noninferior to twice daily human insulin mix 30/70 in achieving glycemic control as measured by hemoglobin A1c (HbA1c), from baseline to endpoint, in patients with type 1 or 2 diabetes.</p><p><b>METHODS</b>In this phase IV, crossover, open-label, multicenter study, 117 Chinese patients with diabetes were randomly assigned to one of two treatment sequence groups. One group received 12-week treatment with twice daily human insulin mix 30/70 followed by 12-week treatment with twice daily insulin lispro low mix 25, while the other group received the reverse treatment sequence. HbA1c, baseline-to-endpoint change in HbA1c, proportion of patients achieving target HbA1c <or= 7% and <or= 6.5%, fasting blood glucose, and daily insulin doses were measured for each period. Safety and tolerability were also assessed.</p><p><b>RESULTS</b>A statistically significant reduction (P <or= 0.0001) of HbA1c was achieved after each treatment (human insulin mix 30/70: mean HbA1c = 7.91% (95%CI: 7.67%, 8.15%); insulin lispro low mix 25: mean HbA1c = 7.96% (95%CI: 7.72%, 8.20%)). The 95%CI (-0.20, 0.10) of the difference between the two treatments satisfied the prespecified noninferiority margin of 0.3% (lower limit of 95% CI > -0.3%). No statistically significant differences between treatments were observed for any of the secondary efficacy measures. The incidence of treatment-emergent adverse events and hypoglycemia between the two treatments and treatment sequence groups was similar. Three serious adverse events were reported (human insulin mix 30/70 group: 2 patients (1.7%, hypoglycemic coma and cardiac failure); insulin lispro low mix 25 group: 1 patient (0.9%, stroke)). All serious adverse events were resolved and no patients died during the study.</p><p><b>CONCLUSION</b>The results support noninferiority of twice daily insulin lispro low mix 25 versus twice daily human insulin mix 30/70 in HbA1c control in Chinese patients with type 1 or 2 diabetes.</p>

Electrostatic protection of oxygen pressure cabins / 中国医疗器械杂志

This paper describes electrostatic harms to oxygen pressure cabins and protection measures which should be taken.

Effects of raloxifene hydrochloride on bone mineral density, bone metabolism and serum lipids in Chinese postmenopausal women with osteoporosis: a multi-center, randomized, placebo-controlled clinical trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Raloxifene has been approved for prevention and treatment of postmenopausal osteoporosis in Caucasian women. It also has some positive effects on serum lipids in Caucasians. The objective of this study was to determine the effect of raloxifene hydrochloride on lumbar spine and total hip bone mineral density (BMD), bone metabolism, and serum lipids in Chinese postmenopausal women with osteoporosis.</p><p><b>METHODS</b>This was a multi-center, randomized, double-blind, placebo-controlled clinical trial in which 204 postmenopausal Chinese women with osteoporosis were assigned to receive raloxifene (60 mg) or placebo treatment daily for 12 months. BMD, serum bone metabolism markers, and serum lipids were measured before and after drug administration. BMD was measured by Dual-Energy X-Ray Absorptiometry (DEXA) and bone metabolism markers were analyzed by one-step enzyme-linked immunosorbent assay. Serum lipids were measured by enzymatic analysis.</p><p><b>RESULTS</b>At the end of the 12-month study, lumbar spine BMD increased in both groups with a mean increase of (3.3 +/- 4.8)% in the raloxifene group and (1.0 +/- 4.9)% in the placebo group (P < 0.001). There was a mean increase in total hip BMD of (1.4 +/- 4.8)% in the raloxifene group and a mean decrease of (0.9 +/- 5.0)% in the placebo group (P < 0.001). No subject in the raloxifene group had a new vertebral fracture and 5 placebo subjects had new fractures (P > 0.05). In the raloxifene group, the median decreases in the biochemical markers of bone metabolism serum osteocalcin and C-telopeptide were 41.7% and 61.5%, respectively. These changes were statistically significant compared with those in the placebo group (10.6% and 35.6%, P < 0.001, respectively). Both total cholesterol and low-density lipoprotein cholesterol decreased significantly in the raloxifene group compared with those in the placebo group (P < 0.001, respectively) and there was no significant effect of raloxifene on high-density lipoprotein cholesterol and triglycerides compared with placebo.</p><p><b>CONCLUSIONS</b>Raloxifene 60 mg/d for 12 months significantly increases lumbar spine and total hip BMD, significantly decreases bone turnover, and has favourable effects on serum lipids in Chinese postmenopausal women with osteoporosis.</p>

Comparison of the effect between insulin lispro 75/25 and humulin 70/30 on the postprandial blood glucose excursion in patients with diabetes / 中华内分泌代谢杂志

The effects of human insulin 70/30 and insulin lispro 75/25 were compared in improving postprandial blood glucose excursions in 106 patients with type 1 or 2 diabetes in a one-month,open-labelled,self- controlled trial .The results showed that treatment of diabetic patients with insulin lispro 75/25 significantly improved 2 h postprandial blood glucose excursion compared to pre-study with human insulin 70/30 (baseline) without any significant adverse events or sustained hypoglycemic episodes.These physiological benefits were associated with a patient preference for insulin lispro 75/25.