Low diastolic blood pressure and adverse outcomes in inpatients with acute exacerbation of chronic obstructive pulmonary disease: A multicenter cohort study / 中华医学杂志(英文版)

BACKGROUND@#Although intensively studied in patients with cardiovascular diseases (CVDs), the prognostic value of diastolic blood pressure (DBP) has little been elucidated in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This study aimed to reveal the prognostic value of DBP in AECOPD patients.@*METHODS@#Inpatients with AECOPD were prospectively enrolled from 10 medical centers in China between September 2017 and July 2021. DBP was measured on admission. The primary outcome was all-cause in-hospital mortality; invasive mechanical ventilation and intensive care unit (ICU) admission were secondary outcomes. Least absolute shrinkage and selection operator (LASSO) and multivariable Cox regressions were used to identify independent prognostic factors and calculate the hazard ratio (HR) and 95% confidence interval (CI) for adverse outcomes.@*RESULTS@#Among 13,633 included patients with AECOPD, 197 (1.45%) died during their hospital stay. Multivariable Cox regression analysis showed that low DBP on admission (<70 mmHg) was associated with increased risk of in-hospital mortality (HR = 2.16, 95% CI: 1.53-3.05, Z = 4.37, P <0.01), invasive mechanical ventilation (HR = 1.65, 95% CI: 1.32-2.05, Z = 19.67, P <0.01), and ICU admission (HR = 1.45, 95% CI: 1.24-1.69, Z = 22.08, P <0.01) in the overall cohort. Similar findings were observed in subgroups with or without CVDs, except for invasive mechanical ventilation in the subgroup with CVDs. When DBP was further categorized in 5-mmHg increments from <50 mmHg to ≥100 mmHg, and 75 to <80 mmHg was taken as reference, HRs for in-hospital mortality increased almost linearly with decreased DBP in the overall cohort and subgroups of patients with CVDs; higher DBP was not associated with the risk of in-hospital mortality.@*CONCLUSION@#Low on-admission DBP, particularly <70 mmHg, was associated with an increased risk of adverse outcomes among inpatients with AECOPD, with or without CVDs, which may serve as a convenient predictor of poor prognosis in these patients.@*CLINICAL TRIAL REGISTRATION@#Chinese Clinical Trail Registry, No. ChiCTR2100044625.

Reliability and validity of the Chinese version of the Anticoagulation Knowledge Tool in patients with atrial fibrillation / 中国实用护理杂志

Objective:To translate the Anticoagulation Knowledge Tool(AKT) into Chinese,and to test its reliability and validity in patients with atrial fibrillation.Methods:After obtaining the authorization of the original author, the Brislin cross-cultural translation method was used to translate from the original, back translate and cross-cultural adaptation of AKT to form the Chinese version of AKT. The reliability and validity were tested in 147 patients with atrial fibrillation from January to June in 2020 in Ruijin Hospital, Shanghai Jiaotong University School of Medicine.Results:The Chinese version retained 20 items of the original questionnaire,with the item content validity index of 0.857-1.000 and the average scale content validity index of 0.85. The Cronbach alpha coefficient was 0.812 and test-retest coefficient was 0.781.Conclusions:The Chinese version of AKT has been proved to be valid and reliable, which can be used to assess anticoagulation knowledge of patients with atrial fibrillation.

Complications analysis of adenoidectomy assisted with ablation under nasal endoscope / 中国医师进修杂志

Objective To analyze the complications of adenoidectomy assisted with ablation under nasal endoscope. Method Two hundred and seventy-two cases of adenoidectomy assisted with ablation under nasal endoscope from April 2014 to April 2018 were retrospectively studied. The type, number, causes and processing methods of postoperative complications were analyzed. Results There were 67 cases (24.63％) with atlantoaxial rotatory deformity, 27 cases (9.93％) with fever, 11 cases (4.04％) with headache, 4 cases (1.47％) with postoperative recurrence, and 1 case (0.37％) with secondary postoperative haemorrhage. Conclusions The technology of adenoidectomy assisted with ablation under nasal endoscope is an efficient and minimally invasive method with less complications in the treatment of children adenoidectomy diseases. Atlantoaxial rotatory deformity is a common postoperative complication which is easy to be ignored by clinical doctors. The prognosis is good, after given a positive symptomatic treatment.

New Chinese Medicine Methodology of One Research Path——"from Experiment to Clinical Verification" on Key Technology of Translational Medicine / 世界科学技术-中医药现代化

Translational medicine means that to establish a bridge between fundamental research and clinical medicine through bidirectional translation path in order to promote the translation and application from fundamental research to clinical medicine.The purpose of traditional Chinese medicine (TCM) translational model is to collate and build one multidimensional TCM translational model,rationality carry out the research on TCM translation.Three paths have been confirmed,where are from literature research to clinical verification,from clinical application to clinical verification,and from experiment to clinical verification.In this research,methodology of one path mcntioned above could be established,which is the key technology of translational medicine.Take constipation,insomnia,and post-flu cough as target diseases to investigate the herbal compounds which could be qualified for clinical application based on preliminary work.This research not only provided clinical data to TCM translation,but also established one methodology of TCM translation path--"from experiment to clinical verification".

The tolerance of contemporaneous multiplane operations in obstructive sleep apnea-hypopnea ;syndrome / 中国医师进修杂志

Objective To observe the tolerance of contemporaneous multiplane operations in obstructive sleep apnea-hypopnea syndrome(OSAHS). Methods Twenty-three patients were enrolled. According to the different obstructive level, the different operations were chosen to complete upper airway reconstruction in contemporaneous operation group (group A, 13 patients). In the simple palatopharynx level obstructive group (group B, 10 patients), bilateral tonsillectomy and H-UPPP was chosen. Results The operation time in group A was significantly longer than that in group B:(121.0 ± 35.4) min vs.(80.7 ± 25.3) min, P0.05). Conclusions Individual therapeutic schedule for OSAHS patients should be formulated. Operating the different obstructive levels simutaneously, which would solve upper airway occlusion and complete the upper airway reconstruction at the same time. No more adverse events happen, compared with the simple palatopharynx level obstructive group, though the operation time may be longer.

The effects of Bushen-Gufeigao and breathing movements on the patients with COPD of ;lung and kidney yang deficiency TCM pattern / 国际中医中药杂志

Objective Evaluating the effects of Bushen-Gufeigao and breathing movements on the patients with chronic obstructive pulmonary disease of Lung and kidney deficiency TCM pattern. Methods The patients with chronic obstructive pulmonary disease of lung and kidney deficiency TCM pattern were recruited and randomly divided into two groups the treatment group (32 cases) and the control group (34 cases). The control group was treated with the conventional medicine, and the treatment group were added Bufei-Gushengao and breathing movements based on the treatment of control group. Both groups were treated for 1 month. The changes of the clinical symptoms, lung function and frequency of attack and duration of each attack in 10 months after treatment were observed. Results After the treatment, compared with the control group, the TCM patterns scores (5.32 ± 2.67 vs. 9.12 ± 4.11, t=4.424) of the treatment group significantly decreased, while the FVC (3.00 ± 0.49 L vs. 2.71 ± 0.47 L, t=2.408), FEV1 (2.27 ± 0.44 L vs. 1.85 ± 0.54 L, t=3.496), and the percentage of FEV1%(75.62 ± 6.84 vs. 66.86 ± 9.32, t=4.333) increased significantly. In the 10 mouths after the treatment, the treatment group showed significantly fewer patients who had attacked more than 6 times than that in the control group, and the duration of attacks showed significantly fewer minutes in the treatment group than the control group (5.56 ± 1.45 d vs. 8.06 ± 1.80 d, t=6.190). Conclusion Bushen-Gufeigao and breathing movements can effectively improve patient's lung function and symptoms.

The investigation of prognostic factors of 137 patients with sudden hearing loss / 中国医师进修杂志

Objective To investigate the prognosis correlation factors of sudden hearing loss.Methods A retrospective analysis was performed in 137 cases (149 ears) of sudden hearing loss.The relationships between the age,prehospital delay time,type of hearing loss,degree of hearing loss,and whether with dizziness,tinnitus,diabetes mellitus,high blood pressure and therapeutic effect were observed.Results The total effective rates in ＜ 45 years,45-59 years and ＞ 59 years patients were 86.36％(38/44),77.78％ (56/72) and 57.58％ (19/33) respectively.There were statistical differences in the total effective rate between ＜ 45 years,45-59 years patients and ＞ 59 years patients (x2 =8.128,P =0.004; x2 =4.525,P =0.033).The total effective rates in patients who were treated ≤7 d,8-14 d and ≥ 15 d were 83.52％ (76/91),76.67％(23/30) and 50.00％(14/28) respectively.There were statistical differences in the total effective rate between patients who treated ≤7 d,8-14 d and patients who were treated ≥ 15 d (x2 =13.050,P =0.000; x2 =4.459,P =0.035).The total effective rates in low-mid frequency type,all frequency type,total deafness type and mid-high frequency type were 89.66％ (52/58),84.44％ (38/45),7/12,47.06％ (16/34) respectively.There were statistical differences in the total effective rate between low-mid frequency,all frequency type and total deafness type,mid-high frequency type (P ＜ 0.05).The total effective rates in hearing loss mild degree,middle degree,severe degree,extremely severe degree and total deafness were 87.23％ (41/47),86.11％ (31/36),61.90％ (13/21),7/15 respectively.There were statistical differences in the total effective rate between mild degree,middle degree and severe degree,extremely severe degree and total deafness (P ＜ 0.05).The hearing loss prognosis with the dizziness,diabetes mellitus,high blood pressure was worse.Conclusions It is considered that the age,prehospital delay time,type of hearing loss,degree of hearing loss,and whether with dizziness,high blood pressure,diabetes mellitus are related to the total effective rate.The prognosis of hearing loss can be estimated according to these correlation factors.

Effects of Recombinant Human Erythropoietin on the Cardiac Function and Infarct Size after Myocardial Infarction in Rats / 昆明医科大学学报

Objective Ventricular remodeling mode after myocardial infarction in rats was used to investigate the effects of recombinant human erythropoietin (rHu-EPO) on hemodynamic,ventricular function and infarct size of left ventricle in rats with myocardial infarction, so as to find out the optimum time and protocol of EPO treatment for ventricular remodeling after myocardial infarction and provide evidence for clinical application of EPO. Methods Sixty healthy male Sprague Dawley rats were divided randomly and equally into 5 groups:sham group,simple cardiac remodeling after myocardial infarction group, the intervention groups of different drugs ( rHu-EPO in the intervention group and SB203580 group,rHu-EPO+SB203580,group) . Ligation was set at more than 1/3 points on the anterior descending coronary artery to make model of myocardial infarction in rats, and the rats were feeded for four weeks. Different drugs in the intervention groups were subcutaneously injected once before ischemia and twice a week after ischemia. Respectively, 24 hours, 2 weeks, and 4 weeks after ischemia, we detected the hemodynamic parameters, recorded the left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP), maximal rate of left ventricular pressure (+dp/dt) and left ventricular pressure decline rate (-dp/dt), and recorded the synchronization of heart rate (HR) . The animals were sacrificed 4 weeks after ischemia, and the heart specimens were collected. The relative weight of left and right ventricle (LV/BW in the RV/BW) was calculated according to the left and right ventricular weight (LVW, RVW) . TTC and Evans blue staining was used to detect left ventricular infarct size, and pathological examination was used to observe the gross and microscopic morphological change. Results 24 hours after operation: Compared with the sham group, in simply cardiac remodeling after myocardial infarction group, rats' left ventricular systolic pressure (LVSP), left ventricular end diastolic pressure (LVEDP) and left ventricular pressure maximum rise and fall rate (±dp/dt) was significantly abnormal,LVSP and ± dp/dt were significantly reduced, the LVEDP was significantly increased (P<0.05);compared with simply cardiac remodeling after myocardial infarction group, in the intervention groups (rHu-EPO in the intervention group, SB203580 group, rHu-the EPO + SB203580 group) rats' ± the dp /dt improved significantly (P<0.05) . After 2 weeks:compared with the sham group, in simple cardiac remodeling after myocardial infarction group rats’LVSP and LVEDP and ± dp/dt significant deterioration (P<0.05) ;compared with simply cardiac remodeling after myocardial infarction group, in the intervention group (rHu-EPO in the intervention group, SB203580 group, rHu-the EPO+SB203580 group) rats’± the dp/dt was significantly improved (P<0.05) . After 4 weeks:compared with the sham group, in simple cardiac remodeling after myocardial infarction group rats’LVSP and LVEDP and ± dp/dt significant deterioration (P<0.05) ; compared with simply cardiac remodeling after myocardial infarction group, in the intervention groups (rHu-EPO in the intervention group, SB203580 group, rHu-the EPO + SB203580 group) rats' ± the dp/dt was significantly improved (P<0.05) . Compared with the sham group, in simply cardiac remodeling after myocardial infarction group rats' LV/BW increased, the difference was statistically significant (P<0.05) . Compared with simply cardiac remodeling after myocardial infarction group,in the intervention group (rHu-EPO in the intervention group and SB203580 group, rHu-the EPO+SB203580 group) rats’LV/BW decreased, the difference was statistically significant (P<0.05 ) . Compared with simply after myocardial infarction cardiac remodeling group, in the intervention groups (rHu-EPO in the intervention group and SB203580 group,rHu-EPO+SB203580 group) rats’cardiac infarct size was significantly reduced (P<0.05). Conclusions rH-EPO can protect the heart function through improving the left ventricular systolic and diastolic function after AMI in rats.RH-EPO can suppress ventricular remodeling, through reducing ventricular relative weight and infarct size and promoting the renewal of capillary in infarction area after AMI in rats.

Clinical observation of Clarithromycin combined with nasal steroid treatment for chronic rhinosinusitis / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To observe the clinical treatment effectiveness of Clarithromycin combined with nasal glucocorticoids for chronic rhinosinusitis (CRS).@*METHOD@#Clarithromycin was 0.25 g a day (the first two weeks was 0.25 g twice a day) and topical Triamcinolone Acetonide Acetate nasal spray was (220 microg/d) once a day. Fifty-six patients were enrolled in our research. Twenty-six patients of CRS without nasal polyps was treated for 12 to 28 weeks (average 16.62 weeks). Thirty patients of CRS with nasal polyps was treated for 12 to 33 weeks (average 20.03 weeks) after polypectomy. The patients' symptom were evaluated through Sino-Nasal Outcome Test 20 (SNOT-20) scale. Meanwhile sinus CT were evaluated by Lund-Mackey system before and after operation.@*RESULT@#The score of CT scan was significantly decreased to 2.83 +/- 1.86 (t = 11.41, P < 0.01) in the CRS with nasal polyps group and to 2.43 +/- 1.91 (t = 12.86, P < 0.01) in the CRS without nasal polyps group after treatment. Recovery rate of CRS with nasal polyps group was 43.3% and of CRS without nasal polyps group was 50.0% with CT images. The self assessments of treatment efficiency was coincident with CT image in the two groups.@*CONCLUSION@#The treatment with Long term use of low dosage oral macrolide Clarithromycin combined with nasal steroid on CRS was efficacy. Polypectomy ,large dose antibiotic and steroid used in intraoperative period could significant improve the treatment efficiency of CRS with nasal polyps.

Validation of the EuroSCORE and the STS-PROM in adult patients undergoing aortic valve replacement / 中华胸心血管外科杂志

Objective The aim of the study was to analyze the predictive value of the European system for cardiac operative risk evaluation score (EuroSCORE) and the Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) in -dult patients undergoing aortic valve replacement (AVR).Methods We carried out a retrospective statistical analysis on 521 adult patients undergoing AVR between 1999 and 2008 in Changhai hospital.Patients with concomitant coronary artery bypass grafting were also included.Excluded from this study were patients having surgery for congenital heart defects,aneurysm of thoracic aorta and atrial fibrillation.Operative mortality was defined as death before discharge from the hospital.The mortality risk calculation of EuroSCORE and STS-PROM for aortic valve procedures was performed by the online available EuroSCORE or STS score calculator.Based on the additive EuroSCORE risk calculation,patients were divided into low-risk,medium-risk and high-risk groups.The valuation of three different algorithms depended on the assessment of two features:calibration and discrimination.A comparison of observed and predicted mortality rates was also performed.Results A total of 521 patients were identified as having undergone aortic valve replacement.In-hospital mortality was 4％ (21 cases) overall.The expected mortality for the additive,logistic EuroSCORE and the STS-PROM was 3.36％,2.82％ and 1.25％,respectively.The observed to expected ratio was 1.2 for additive EuroSCORE,1.43 for logistic EuroSCORE and 3.23 for STS-PROM.The STS-PROM underpredicted observed mortality significantly ( P ＜ 0.01 ) and showed poor calibration in predicting in-hospital mortality in the entire cohort,medium- and high-risk subgroups.The logistic EuroSCORE underpredicted observed mortality in the mediumrisk subgroup ( P ＜ 0.05 ).EuroSCORE underpredicted in-hospital mortality in the high-risk subgroup with the observed-expected mortality rate of 1.84 for additive EuroSCORE and 1.46 for logistic EuroSCORE.The EuroSCORE in three subgroups showed poor discrimination in predicting mortality as well as the STS-PROM did in the medium- and high-risk subgroups ( ROC ＜ 0.7).Conclusion Both the EuroSCORE and the STS-PROM give an imprecise prediction for individual operative risk in patients undergoing aortic valve replacement in our study.These algorithms seem unsuitable to identify a high-risk patient population undergoing isolated AVR.It is necessary to construct a risk stratification model for valve surgery according to the profiles of Chinese patients.

The establishment of charge nurses' evaluation system by the combination of AHP and Delphi method / 中国实用护理杂志

Objective To establish the charge nurses'evaluation system and evaluate their work by comprehensive index to make the assessment more scientific.Methods The comparison value of different assessment factors were established by 4 rounds of expert consultations by the analytic Hierarchy Process (AHP)and Delphi method.The index weight was confirmed and passed the coherence test(CR＜0.01).The combined index weight and comprehensive index were also obtained.Results The charge nurses'evaluation system containing 4 one-dimension targets(including internal nursing quality,patients satisfaction degree,individual professional spirit and study and development)and 17 two-dimension targets were set up.Conclusion The combination of AHP and Delphi method supplied a simple and prompt evaluation model though currently it is difficult to estimate management personnels objectively and fairly.

Effects of astragalus and angelica injections on adenosine triphosphate-ase in renal injury induced by ischemia / reperfusion in rabbits / 中国组织工程研究

BACKGROUND: It is indicated in researches of recent years that both astragalus and angelica act on anti-free radical and protect renal injury due to ischemia / reperfusion.OBJECTIVE: To observe the protection and its mechanism of astragalus and angelica injections on adenosine triphosphate-ase (ATPase) in renal injury due to ischemia/reperfusion.DESIGN: The observing controlled experiment based on experimental animals .SETTING: Physiological teaching & research room and teaching & research room of renal functional protection in a medical college. MATERIALS: The experiment was performed in Physiological Experimental Room of Luzhou Medical College from January 2001 to March 2001. Totally 33 Japanese big-ear white healthy adult rabbits of either sex were employed,provided by Experimental Animal Center of Luzhou Medical College, in the mass of(1.63 + 0. 22) kg. According to random number table, they were divided in sham-operation control(8 rabbits), simple ischemia/reperfusion group (8 rabbits), astragalus injection + ischemia/reperfusion group (astragalus group) (8 rabbits) and angelica injection + ischemia/reperfusion group(angelica group) (9 rabbits).METHODS: One day before operation, on the day of operation and 1 day after operation, successively, intravenous medical injections (astragalus 1.25 g/kg,angelica 12.5 g/kg) were administrated in astragalus and angelica groups everyday respectively, and injection with physiological saline 5 mL/kg was applied in the control and simple ischemia/reperfusion group. In 48 hours reperfusion after 1 hour ischemia in kidney, blood sample was collected from inferior vena cava. The upper tissue of the right kidney was collected and fixed by placed in 30 mL/L glutaraldehyde and the lower tissue was prepared into homogenate. Ultrastructure of renal tissue was examined with electron microscope; serum creatinine level and ATPase activity in renal tissue were assayed.MAIN OUTCOME MEASURES: Ultrastructure of renal tissue, serum creatinine level and ATPase activity in renal tissue.RESULTS: In simple ischemia/reperfusion group, renal tissue was degenerated significantly, and the disorders in astragalus and angelica groups were reduced markedly compared with simple ischemia/reperfusion group. Serum creatinine level in simple ischemia/reperfusion group was higher remarkably than the sham-operation control ( P ＜ 0. 05 ), and that in astragalus and angelica groups was reduced than simple ischemia/reperfusion group (P ＜ 0. 05) . In simple ischemia/reperfusion group, the levels of Mg2+-ATPaes, Na+-K+-ATPase and Ca2+-ATPase were(0. 155 ±0. 020),(0.179±0.018), (0.150±0.022) nkat/g respectively, which was markedly reduced compared with sham-operation control [ (0. 174 + 0. 012),(0. 198 + 0. 012), (0. 181 + 0. 017) nkat/g], ( t = 2. 344, 2. 438, 3. 014,P ＜ 0.05 ). In astragalus and angelica groups, respectively, the activities of Mg2+-ATPaes, Na+-K+-ATPase and Ca2+-ATPase were(0. 172 ± 0. 023),(0. 196 ±0. 077), (0. 175 ±0. 016) and (0. 177 ±0. 015), (0. 200 ±0.011 )and (0. 181 ± 0. 025) nkat/g successively. Except that Mg2+-ATPaes activity in astragalus group was not different significantly from that in simple ischemia/reperfusion group, all the rest were higher than simple ischemia/reperfusion group(t =2. 372 -2. 786, P ＜0.05).CONCLUSION: Both astragalus and angelica inhibit the decrease of ATPase and improve the disturbed local blood-flow adjustment in kidney, which has provided experimental basis of astragalus and angelica on reducing renal injury induced by ischemia/reperfusion through protecting ATPase.

Effects of Radix Angelicae Sinensis on changes of IL-6, TNF-? and bFGF in renal ischemia/reperfusion injury in rabbits / 中国病理生理杂志

AIM: To determine the effect of Radix Angelicae Sinensis(RAS) on renal ischemia/reperfusion injury in rabbits and to explore its mechanism. METHODS: Twenty-five rabbits were divided randomly into the sham operated group(Control group), renal ischemia/reperfusion injury group(IR group) and RAS+IR group. At the time point of reperfusion 48 h after renal ischemia 1 h, the renal tissue were observed by electron-microscope and the contents of creatinine(Cr) in serum, tumor necrosis factor-?(TNF-?), interleukin-6(IL-6)and basic fibroblast growth factor(bFGF) in the renal tissue were measured. RESULTS: A remarkably degenerative changes in renal tissue were showed under electronmicroscope in IR group , but the changes in RAS+IR group were slight . The contents of Cr, TNF-? and IL-6 in IR group were higher than those in Control group, these parameters in RAS+IR group were lower than those in IR group, the difference between these groups was significant ( P

Experimental Study on Pharmacodynamics of Zengguang Tablets / 中成药

Objective: To study the main pharmacodynamics of Zengguang Tablets. Methods: Mice were given Zengguang Tablets orally in dosages of 0.75g/kg and 1.50 g/kg. The celiac macrophage phagocytic function and antibody formation of serum hemolysin (IgM) of mice were determined. The mouse blood vacuity model was established by injecting cyclophosphamide intraperitoneally in the dosage of 80mg/kg. Results: Zengguang Tablets could raise the celiac macrophage phagocytic function of mice and promote the antibody formation of serum hemolysin. Conclusion: Zengguang Tablets has the enhancement on organism immune function.