Fatores que Afetam a Trombose da Falsa Luz na Dissecção Aórtica Tipo B / Factors Affecting False Lumen Thrombosis In Type B Aortic Dissection

Resumo Fundamento A trombose completa da falsa luz facilita a remodelação da dissecção aórtica tipo B (DATB). As características morfológicas afetam a trombose na falsa luz. Objetivos Discutir os fatores pré-admissão presentes, que influenciam a trombose da falsa luz em pacientes com DATB. Metodologia Ao todo, 282 pacientes diagnosticados com DATB em nosso hospital foram estudados, no período entre janeiro de 2008 e dezembro de 2017. Os indivíduos foram divididos em um grupo trombótico e um grupo não trombótico, com base na detecção de qualquer trombo na falsa luz. Analisamos as diferenças entre os dois grupos com relação aos dados clínicos, o comprimento vertical da dissecção e o diâmetro da aorta. Valores de p < 0,05 foram considerados estatisticamente diferentes de modo significativo. Resultados Diferenças significativas entre o grupo trombótico e o grupo não trombótico foram encontradas com relação à idade (53,92 ± 11,40 vs. 50,36 ± 10,71, p = 0,009) e proporção de pacientes com insuficiência renal (7,83% vs. 16,38%, p = 0,026). Nas zonas 3-9, o diâmetro da luz verdadeira do grupo trombótico foi significativamente maior do que no grupo não trombótico (p < 0,05). A análise de regressão logística binária mostrou que o diâmetro da luz verdadeira na zona 5 e a insuficiência renal foram preditores independentes de trombose da falsa luz. Conclusões A idade e a função renal estiveram associadas à trombose na falsa luz. Potencialmente, a diferença entre o diâmetro da luz verdadeira e o da falsa luz pode influenciar na trombose da falsa luz.

Abstract Background Complete thrombosis of the false lumen facilitates remodeling of type B aortic dissection (TBAD). Morphological characteristics affect thrombosis in the false lumen. Objectives Discuss the factors present before admission that influence false lumen thrombosis in patients with TBAD. Methods We studied 282 patients diagnosed with TBAD in our hospital between January 2008 and December 2017. We divided the subjects into a thrombotic group and a non-thrombotic group based on whether any thrombus was detectable in the false lumen. We analyzed the differences between the two groups with respect to clinical data, the vertical length of the dissection, and the diameter of the aorta. P values < 0.05 were considered statistically significantly different. Results Significant differences between the thrombotic group and non-thrombotic group were found with respect to age (53.92 ± 11.40 vs. 50.36 ± 10.71, p = 0.009) and proportion of patients with renal insufficiency (7.83% vs. 16.38%, p = 0.026). In zones 3-9, the true lumen diameter of the thrombotic group was significantly larger than in the non-thrombotic group (p < 0.05). Binary logistic regression analysis showed that true lumen diameter in zone 5 and renal insufficiency were independent predictors of false lumen thrombosis. Conclusions Age and renal function were associated with thrombosis in the false lumen. Potentially, the difference between the diameter of the true lumen diameter and that of the false lumen may influence the thrombosis of the false lumen.

Application of high-throughput next-generation sequencing in diagnosis and treatment of myeloid hematologic malignancies in the era of precision medicine / 白血病·淋巴瘤

With the wide application of high-throughput next-generation sequencing (NGS) and other molecular genetic detection technologies, researchers have a more and more in-depth understanding of the pathogenesis of hematologic malignancies, especially of the myeloid hematologic malignancies, which makes the diagnosis and treatment of myeloid hematologic malignancies into an era of precision medicine. At the 64th American Society of Hematology (ASH) Annual Meeting in 2022, there were a series of new progresses regarding the application of NGS in the diagnosis and classification, risk stratification, treatment guidance, and minimal residual disease monitoring of myeloid hematologic malignancies. This article focuses on the progress of NGS application in acute myeloid leukemia, myelodysplastic syndromes and myeloproliferative neoplasms.

Analysis of factors influencing high frequency hearing loss among noise-exposed workers in an air conditioner manufacturing industry / 中国职业医学

@#Objective （ ） To explore the feasibility of using generalized estimating equation GEE to analyze the influencing - （ ） factors of high frequency hearing loss HFHL among noise exposed workers in an air conditioner manufacturing enterprise. Methods - The noise exposed workers in an air conditioner manufacturing industry who had been tested for pure tone hearing threshold twice or more from 2015 to 2019 were selected as the research subjects using the judgment sampling method. Data ， ， ， ， ， （ ） such as age length of service gender smoking alcohol consumption body mass index BMI and HFHL were collected. The Results influencing factors of HFHL were analyzed using the GEE. The detection rates of HFHL from 2015 to 2019 were ， ， ， ， ， 22.2% 23.8% 24.2% 24.1% and 20.9% respectively. Among them the detection rate of HFHL in 2019 was lower than that （ P ） ， ， in 2017 and 2018 all <0.001 . The GEE analysis results showed that the risks of HFHL in 2015 2016 2017 and 2018 were （ P ）， higher than that in 2019 all <0.01 regardless of interaction effects and after adjusting for confounding factors such as ， ［OR（ CI）］ （ - duration of noise exposure smoking and BMI. The odds ratios and 95% confidence intervals 95% were 1.19 1.07 ）， （ - ）， （ - ） （ - ）， 1.33 1.26 1.13 1.39 1.30 1.18 1.43 and 1.27 1.15 1.39 respectively. The risk of HFHL was higher in males than in （P ）， OR（ CI） （ - ） ， （P ）， OR females <0.01 and 95% was 3.78 3.00 4.77 . The older the age the higher the risk of HFHL <0.01 and （ CI） （ - ） Conclusion - 95% was 1.07 1.05 1.09 . The influencing factors of HFHL among noise exposed workers in the air conditioner industry are age and gender. GEE can be used to analyze the factors influencing the longitudinal data of HFHL in workers with noise exposure.

Progress of targeted therapy for acute myeloid leukemia / 白血病·淋巴瘤

The treatment of acute myeloid leukemia (AML) has made a great progress in recent years owing to the emergence of targeted drugs. While the problems such as drug resistance, the increasing incidence of adverse reactions of the combined therapies, the lack of the effective therapy targets became growing concerns with the further development of studies, which has posed a big challenge to the therapy strategies of AML. This article introduces the progress of the latest clinical trial outcomes in targeted therapy for AML at the 63rd American Society of Hematology (ASH) annual meeting which reported some hot issues like options for the treatment timing of targeted therapy, the selection for the drugs and the combined drugs.

Efficacy of surgical treatment for 35 children with nail matrix nevi / 中华皮肤科杂志

Objective:To explore rational surgical treatment for childhood nail matrix nevi.Methods:A retrospective analysis was conducted on clinical data from 35 children with pathologically confirmed nail matrix nevi, who received surgical treatment in Children′s Hospital of Chongqing Medical University from September 2015 to March 2019. Different surgical approaches were adopted according to the site and width of lesions. For lesions with a width of ≤ 3 mm, the nail bed and nail matrix lesions were directly excised with 1-to-2-mm margins and sutured in 11 cases. For lesions with a width of > 3 mm, one of the following 3 surgical procedures was selected by the children′s parents: (1) shaving of nail bed and nail matrix lesions under a microscope at ×8 magnification (8 cases) ; (2) excision of lesions followed by full-thickness skin grafting on the periosteum of the phalanx (8 cases) ; (3) excision of lesions of the second to fifth fingers followed by transfer of skin flaps from the thenar muscle area and full-thickness skin grafting (5 cases) , or excision of lesions of the thumb followed by abdominal-wall flap transfer (3 cases) . The patients were followed up for 12 months, and clinical efficacy was evaluated.Results:During the follow-up, no recurrence occurred in the 11 cases receiving direct excision and suture, with good appearances and longitudinal linear scars on the nail. Among the 8 cases receiving shaving therapy under a microscope, 4 experienced relapse during the follow-up of 6 - 12 months, and the nail/toenail plates were rough and poor in lustrousness in the other 4 without recurrence. No recurrence was observed in the 8 cases receiving excision of the lesions and full-thickness skin grafting, of whom 1 experienced skin graft necrosis, and skin grafts survived with obvious pigmentation in the other 7 cases. Among cases receiving excision of the lesions combined with transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer, no recurrence was observed, and all transferred flaps survived; good appearances, nearly normal color and gloss of nails were obtained in the cases after transfer of skin flaps from the thenar muscle area, while the color and gloss of postoperative nails were markedly different from those of normal nails in the cases receiving abdominal-wall flap transfer.Conclusion:For nail matrix nevi with a width of ≤ 3 mm, direct excision and suture with 1-to-2-mm margins are recommended; for those with a width of > 3 mm, excision of lesions combined with full-thickness skin grafting, transfer of skin flaps from the thenar muscle area or abdominal-wall flap transfer is recommended; the shaving procedure under a microscope should be used with caution.

Correlation between chronic periodontitis and pulmonary ventilation function / 中国基层医药

Objective:To investigate the correlation between chronic periodontitis and pulmonary ventilation function.Methods:A total of 135 patients with chronic periodontitis who received treatment in Yuyao People's Hospital of Zhejiang Province between June 2014 and December 2019 were included in this study. They were divided into group A (stage I, initial lesion, n = 45), group B (stage II, early lesion, n = 45), group C (stage III, confirmed lesion, n = 45) according to the severity of periodontal lesion. Lung ventilation function indexes and serum levels of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha (TNF-α) were compared among the three groups. The correlation between periodontal condition and lung ventilation function indexes was analyzed. Results:Probing depth (PD), clinical attachment loss (CAL), number of missing teeth, alveolar bone resorption level were (1.67 ± 0.65) mm, (2.48 ± 0.44) mm, 0 pieces, and (1.38 ± 0.23) mm in group A, (2.05 ± 0.30) mm, (4.04 ± 0.97) mm, 1 piece, (3.37± 0.73) mm in group B, and (2.23 ± 0.47) mm, (5.17 ± 0.75) mm, 3 pieces, (6.48 ± 0.62) mm in group C. With the worsening of the disease, PD, CAL, number of missing teeth, and alveolar bone resorption level were gradually increased. PD, CAL and alveolar bone resorption level in group C were significantly higher than those in group A ( t = 4.68, 20.75, 51.74, all P < 0.001) and group B ( t = 2.17, 6.18, 21.78, P = 0.033, < 0.001, < 0.001). PD, CAL and alveolar bone resorption level in group B were significantly higher than those in group A ( t = 3.56, 9.82, 17.44, all P < 0.001). There was no significant difference in the number of missing teeth ( P > 0.05). Serum IL-6, IL-8 and TNF-α levels were (11.28 ± 4.26) ng/L, (7.48 ± 1.97) ng/L, (14.59 ± 2.11) ng/L in group A, (17.09 ± 4.91) ng/L, (10.82 ± 2.10) ng/L, (19.95 ± 4.48) ng/L in group B, and (26.47 ± 5.86) ng/L, (15.06 ± 2.75) ng/L, (33.76 ± 6.30) ng/L] in group C. With the worsening of the disease, serum IL-6, IL-8 and TNF-α levels were gradually increased. Serum IL-6, IL-8 and TNF-α levels in group C were significantly higher than those in group A ( t = 14.06, 15.03, 19.36, P < 0.001) and group B ( t = 8.23, 8.22, 11.98, all P < 0.001). Serum IL-6, IL-8 and TNF-α levels in group B were significantly higher than those in group A ( t = 6.00, 7.78, 7.26, P < 0.001). The percentage of the maximum expiratory volume in the first second to the predicted value (FEV 1%pre) and the ratio of the maximum expiratory volume in the first second to the forced vital capacity (FEV 1/FVC) were (81.53 ± 6.30)% and (68.73 ± 4.65)% in group A, (70.47 ± 5.25)% and (60.86 ± 3.42)% in group B, and (59.02 ± 3.41)% and (56.93 ± 4.21)% in group C. With the worsening of the disease, FEV 1%pre and FEV 1/FVC were gradually decreased. FEV 1%pre and FEV 1/FVC in group C were significantly lower than those in group A ( t = 21.08, 12.62, both P < 0.001) and group B ( t = 12.27, 4.86, both P < 0.001). FEV 1%pre and FEV 1/FVC in group B were significantly lower than those in group A ( t = 9.05, 9.25, both P < 0.001). Spearman correlation analysis showed that serum IL-6, IL-8 and TNF-α levels were negatively correlated with FEV1%pre and FEV 1/FVC ( r = -0.50, -0.28, -0.42, -0.61, -0.34, -0.51, all P < 0.05). Conclusion:There is a correlation between chronic periodontitis and pulmonary ventilation function. Inflammatory mediators may be involved in chronic periodontitis as internal systemic factors.

Influence of visceral lipids obesity on the early postoperative complications after radical gastrectomy / 中华胃肠外科杂志

Objective: To investigate the effect of visceral fat area (VFA) on the surgical efficacy and early postoperative complications of radical gastrectomy for gastric cancer. Methods: A retrospective cohort study method was used. Clinicopathological data and preoperative imaging data of 195 patients who underwent D2 radical gastric cancer surgery at the First Affiliated Hospital of Xi'an Jiaotong University from January 2014 to December 2017 were analyzed retrospectively. Inclusion criteria: (1) complete clinicopathological and imaging data; (2) malignant gastric tumor diagnosed by preoperative pathology, and gastric cancer confirmed by postoperative pathology; (3) no preoperative complications such as bleeding, obstruction or perforation, and no distant metastasis. Those who had a history of abdominal surgery, concurrent malignant tumors, poor basic conditions, emergency surgery, palliative resection, and preoperative neoadjuvant therapy were excluded. The VFA was calculated by software and VFA ≥ 100 cm2 was defined as visceral obesity according to the Japan Obesity Association criteria . The patients were divided into high VFA (VFA-H, VFA≥100 cm2, n=96) group and low VFA (VFA-L, VFA<100 cm2, n=99) group . The clinicopathological characteristics, surgical outcomes and early postoperative complications were compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the risk factors of early complications. Receiver operating characteristic (ROC) curve was used to analyze predictive values of VFA for early complications. Pearson's χ2 test was used to analyze the correlation between BMI and VFA. Results: There were no significant differences in terms of gender, age, American Society of Anesthesiologists physical status classification, preoperative comorbidities, preoperative anemia, tumor TNM staging, N staging, T staging and tumor differentiation, surgical method, extent of resection, and tumor location between the VFA-L group and the VFA-H group (all P>0.05). However, patients in the VFA-H group had higher BMI, larger tumor, lower rate of hypoalbuminemia and greater subcutaneous fat area (SFA) (all P<0.05). The VFA-H group presented significantly longer operation time and significantly less number of harvested lymph nodes as compared to the VFA-L group (both P<0.05). However, there were no significant differences in intraoperative blood loss, conversion to laparotomy and postoperative hospital stay (all P>0.05). Complications of Clavien-Dindo grade II and above within 30 days after operation were mainly anastomosis-related complications (leakage, bleeding, infection and stricture), intestinal obstruction and incision infection. The VFA-H group had a higher morbidity of early complications compared to the VFA-L group [24.0% (23/96) vs 10.1% (10/99), χ2=6.657, P=0.010], and the rates of anastomotic complications and incision infection were also higher in the VFA group [10.4% (10/96) vs. 3.0% (3/99), χ2=4.274, P=0.039; 7.3% (7/96) vs. 1.0% (1/99), P=0.033]. Multivariate logistic analysis showed that high BMI (OR=3.688, 95%CI: 1.685-8.072, P=0.001) and high VFA (OR=2.526, 95%CI: 1.148-5.559,P=0.021) were independent risk factors for early complications. The area under the ROC curve (AUC) of VFA for predicting early complications was 0.645, which was higher than that of body weight (0.591), BMI (0.624) and SFA (0.626). Correlation analysis indicated that there was a significantly positive correlation between BMI and VFA (r=0.640, P<0.001). Conclusion: VFA ≥ 100 cm2 is an independent risk factor for early complications after radical gastrectomy for gastric cancer.It can better predict the occurrence of above early postoperative complications.

Efficacy of laparoscopic proximal gastrectomy with double-tract reconstruction versus laparoscopic total gastrectomy with Roux-en-Y reconstruction for early upper gastric cancer / 中华胃肠外科杂志

Objective: To compare clinical efficacy between laparoscopic radical proximal gastrectomy with double-tract reconstruction (LPG-DTR) and laparoscopic radical total gastrectomy with Roux-en-Y reconstruction (LTG-RY) in patients with early upper gastric cancer, and to provide a reference for the selection of surgical methods in early upper gastric cancer. Methods: A retrospective cohort study method was carried out. Clinical data of 80 patients with early upper gastric cancer who underwent LPG-DTR or LTG-RY by the same surgical team at the Department of General Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from January 2018 to January 2021 were retrospectively analyzed. Patients were divided into the DTR group (32 cases) and R-Y group (48 cases) according to surgical procedures and digestive tract reconstruction methods. Surgical and pathological characteristics, postoperative complications (short-term complications within 30 days after surgery and long-term complications after postoperative 30 days), survival time and nutritinal status were compared between the two groups. For nutritional status, reduction rate was used to represent the changes in total protein, albumin, total cholesterol, body mass, hemoglobin and vitamin B12 levels at postoperative 1-year and 2-year. Non-normally distributed continuous data were presented as median (interquartile range), and the Mann-Whitney U test was used for comparison between groups. The χ(2) test or Fisher's exact test was used for comparison of data between groups. The Mann-Whitney U test was used to compare the ranked data between groups. The survival rate was calculated by Kaplan-Meier method categorical, and compared by using the log-rank test. Results: There were no statistically significant differences in baseline data betweeen the two groups, except that patients in the R-Y group were oldere and had larger tumor. Patients of both groups successfully completed the operation without conversion to laparotomy, combined organ resection, or perioperative death. There were no significant differences in the distance from proximal resection margin to superior margin of tumor, postoperative hospital stay, time to flatus and food-taking, hospitalization cost, short- and long-term complications between the two groups (all P>0.05). Compared with the R-Y group, the DTR group had shorter distal margins [(3.2±0.5) cm vs. (11.7±2.0) cm, t=-23.033, P<0.001], longer surgery time [232.5 (63.7) minutes vs. 185.0 (63.0) minutes, Z=-3.238, P=0.001], longer anastomosis time [62.5 (17.5) minutes vs. 40.0 (10.0) minutes, Z=-6.321, P<0.001], less intraoperative blood loss [(138.1±51.6) ml vs. (184.3±62.1) ml, t=-3.477, P=0.001], with significant differences (all P<0.05). The median follow-up of the whole group was 18 months, and the 2-year cancer-specific survival rate was 97.5%, with 100% in the DTR group and 95.8% in the R-Y group (P=0.373). Compared with R-Y group at postoperative 1 year, the reduction rate of weight, hemoglobin and vitamin B12 were lower in DTR group with significant differences (all P<0.05); at postoperative 2-year, the reduction rate of vitamin B12 was still lower with significant differences (P<0.001), but the reduction rates of total protein, albumin, total cholesterol, body weight and hemoglobin were similar between the two groups (all P>0.05). Conclusions: LPG-DTR is safe and feasible in the treatment of early upper gastric cancer. The short-term postoperative nutritional status and long-term vitamin B12 levels of patients undergoing LPG-DTR are superior to those undergoing LTG-RY.

A broadly neutralizing human monoclonal antibody against the hemagglutinin of avian influenza virus H7N9 / 中华医学杂志(英文版)

BACKGROUND@#The new emerging avian influenza A H7N9 virus, causing severe human infection with a mortality rate of around 41%. This study aims to provide a novel treatment option for the prevention and control of H7N9.@*METHODS@#H7 hemagglutinin (HA)-specific B cells were isolated from peripheral blood plasma cells of the patients previously infected by H7N9 in Jiangsu Province, China. The human monoclonal antibodies (mAbs) were generated by amplification and cloning of these HA-specific B cells. First, all human mAbs were screened for binding activity by enzyme-linked immunosorbent assay. Then, those mAbs, exhibiting potent affinity to recognize H7 HAs were further evaluated by hemagglutination-inhibiting (HAI) and microneutralization in vitro assays. Finally, the lead mAb candidate was selected and tested against the lethal challenge of the H7N9 virus using murine models.@*RESULTS@#The mAb 6-137 was able to recognize a panel of H7 HAs with high affinity but not HA of other subtypes, including H1N1 and H3N2. The mAb 6-137 can efficiently inhibit the HA activity in the inactivated H7N9 virus and neutralize 100 tissue culture infectious dose 50 (TCID50) of H7N9 virus (influenza A/Nanjing/1/2013) in vitro, with neutralizing activity as low as 78 ng/mL. In addition, the mAb 6-137 protected the mice against the lethal challenge of H7N9 prophylactically and therapeutically.@*CONCLUSION@#The mAb 6-137 could be an effective antibody as a prophylactic or therapeutic biological treatment for the H7N9 exposure or infection.

Efficacy of general anesthesia for percutaneous pulmonary valve implantation / 中华麻醉学杂志

Objective:To summarize the efficacy of general anesthesia for percutaneous pulmonary valve implantation (PPVI).Methods:The clinical data of 6 patients underwent PPVI under general anesthesia in Children′s Heart Center of Henan Provincial People′s Hospital from December 2017 to January 2020 were retrospectively analyzed.Systolic blood pressure, diastolic blood pressure, heart rate, central venous pressure, SpO 2 and regional cerebral oxygen saturation were recorded before anesthesia induction (T 1), after anesthesia induction (T 2), before beginning of surgery (T 3), before pulmonary valve implantation (T 4), during pulmonary valve implantation (T 5), immediately after pulmonary valve implantation (T 6) and when the patients left the operating room (T 7). Right ventricular systolic pressure, diastolic pressure, pulmonary artery systolic pressure and diastolic pressure were recorded at T 4 and T 6.The development of related complications during operation and the cardiac, liver and kidney functions before and after operation were recorded.The postoperative extubation time, intensive care unit stay time and hospital stay time were recorded. Results:Six patients (3 males, 3 females), aged (16±4) yr, weighing (41±12) kg, were analyzed.Compared with the value at T 1-4 and T 6, 7, systolic blood pressure, diastolic blood pressure, heart rate, regional cerebral oxygen saturation and SpO 2 were significantly decreased at T 5 ( P<0.05). Compared with the value at T 1-5, central venous pressure was significantly decreased at T 6, 7 ( P<0.05). Compared with the value at T 4, right ventricular diastolic pressure was significantly decreased, and pulmonary artery diastolic pressure was increased at T 6 ( P<0.05). No anesthesia- and surgery-related serious complications occurred among the patients.One patient was transferred to the ward after extubation in the operating room, and 5 patients were transferred to the intensive care unit after operation.All 6 patients were discharged successfully and entered the follow-up stage. Conclusion:General anesthesia provides better efficacy when used for PPVI, and hemodynamic monitoring of pulmonary circulation and systemic circulation should be strengthened during pulmonary valve implantation to maintain circulation stable.

Risk factors for postoperative central nervous system complications developed in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass: determination of rSO 2C by near-infrared spectroscopy / 中华麻醉学杂志

Objective:To identify the risk factors for postoperative central nervous system complications (CNSC) developed in pediatric patients undergoing cardiac surgery under cardiopulmonary bypass (CPB) through determining regional cerebral oxygen saturation (rSO 2C) by near-infrared spectroscopy. Methods:A total of 60 pediatric patients with congenital heart disease undergoing elective orthodontic correction surgery under CPB, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, of both sexes, aged 6-36 months, weighing 5-19 kg, in our hospital from July 2019 to January 2020 were collected.Intraoperative bilateral rSO 2C was monitored continuously by near-infrared spectroscopy.Blood samples were taken from the central vein at 10 min after induction of anesthesia, immediately after CPB, at the end of CPB, on admission to ICU, at 4 and 8 h after entering ICU and at 1, 2 and 3 days after surgery (T 0-8) for determination of the concentrations of serum S100β protein and neuron specific enolase (NSE). At 12 months after surgery, the Pediatric Cerebral Performance Category (PCPC) score was used to evaluate the prognosis of neurological function.The patients were divided into 2 groups according to whether CNSC occurred: CNSC group and non-CNSC group.Multivariate logistic regression analysis was used to identify the risk factors for development of postoperative CNSC in pediatric patients undergoing cardiac surgery under CPB. Results:Two patients were excluded from the study.Eighteen cases developed postoperative CNSC, and the incidence was 31.0%.Compared with group non-CNSC, the minimal rSO 2 was significantly decreased, the maximal difference between pulse oxygen saturation and rSO 2C (da-rSO 2C) was increased, duration of reduction in rSO 2>25% during CPB, duration of rSO 2C<40% during CPB and duration of da-rSO 2C>50% during CPB were prolonged, and concentrations of serum S100β protein and NSE were increased at T 2-T 8 in group CNSC ( P<0.05). The results of logistic regression analysis showed that prolonged duration of reduction in rSO 2C>25% during CPB, prolonged duration of rSO 2C<40% during CPB and prolonged duration of da-rSO 2C>50% during CPB were risk factors for development of postoperative CNSC. Conclusion:Prolonged duration of reduction in rSO 2C>25% during CPB, prolonged duration of rSO 2C<40% during CPB and prolonged duration of da-rSO 2C>50% during CPB are the risk factors for postoperative CNCS developed.

The application of percutaneous renal oxygen saturation and abdominal local oxygen saturation in infants undergoing cardiac surgery / 中华实用儿科临床杂志

Objective:To investigate the changes and their clinical values of renal oxygen saturation(RrSO 2) and abdominal local oxygen saturation(A-rSO 2) in infants who underwent cardiac surgery. Methods:Thirty children with atrial septal defect or ventricular septal defect underwent cardiopulmonary bypass (CPB) in Henan People′s Hospital from April to August 2019 were randomly selected.There were 15 males and 15 females, aged 2-13 months, weighted 4.5-10.0 kg and American Society of Anesthesiologists(ASA) grade Ⅰ-Ⅲ.The probe of near-infrared spectroscopy(NIRS)was fixed at the body surface of the right kidney and 1 cm below the umbilicus.RrSO 2 and A-rSO 2 were continuously monitored during operation.The changes of parameters, including RrSO 2, A-rSO 2, mean arte-rial pressure(MAP), and nose temperature were recorded after anesthesia induction (T 0), cardiopulmonary bypass (T 1), 5 minutes after aortic blockade (T 2), the lowest temperature (T 3), 5 minutes after aortic opening (T 4), and 5 minutes after stopping cardiopulmonary bypass (T 5). CPB time, ascending aorta occlusion time and operation time were recorded as well.Meanwhile, perioperative complications such as acute renal injury (AKI) and gastrointestinal dysfunction were recorded.Relevant information, including the time of first eating after operation was recorded. Results:Totally, 30 children were enrolled in this study.The basic values of RrSO 2 and A-rSO 2 were (70.00±7.50)% and (70.70±11.29)%, respectively.Compared with T 0, the RrSO 2 and A-rSO 2 of patients decreased at T 1, gradually increased at T 2, T 3 and T 4, and returned to T 0 at T 5.There was no significant difference in RrSO 2 and A-rSO 2 at each observation point. Pearson correlation analysis displayed that there was a positive correlation between A-rSO 2 and RrSO 2 ( r=0.806, P<0.01). RrSO 2 and A-rSO 2 were positively correlated with MAP ( r=0.565, 0.605, all P<0.05), and negatively correlated with the nasopharynx temperature ( r=-0.365, -0.331; all P<0.05). Among them, 3 children(10%) suffered from AKI after operation.Compared with T 0, RrSO 2 values at T 1, T 2, T 3 and T 4 decreased significantly ( P<0.05). Postoperative gastrointestinal hysteresis occurred in 6 children(20%). The A-rSO 2 value in T 0-T 5 of children with gastrointestinal hysteresis was significantly lower than that of children without gastrointestinal hysteresis ( P<0.05). Conclusions:As a new noninvasive monitoring method of renal and intestinal function, NIRS has certain clinical guiding value in perioperative period of infantile congenital heart disease.

Efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart diseases / 中华麻醉学杂志

Objective:To evaluate the efficacy of combination of intranasal dexmedetomidine and esketamine for preoperative sedation in pediatric patients with congenital heart disease.Methods:Fifty American Society of Anesthesiologists physical status Ⅱ or Ⅲ pediatric patients, aged 1-3 yr, undergoing elective cardiac surgery for left-to-right shunt type congenital heart diseases, were divided into dexmedetomidine group (group D, n=25) or dexmedetomidine combined with esketamine group (group DK, n=25) using a random number table method.Dexmedetomidine 3.9 μg/kg was intranasally delivered in group D. Dexmedetomidine 3.3 μg/kg combined with esketamine 2 mg/kg was intranasally administered in group DK.The Children′s Hospital of Wisconsin Sedation Scale score, SpO 2, HR, and pulmonary artery systolic pressure (PAP) were recorded before and at 30 min after administration, and the rate of decrease in SpO 2, HR and PAP after administration was calculated.The onset time of sedation and occurrence of adverse effects such as nausea and vomiting, bradycardia and respiratory depression during sedation were recorded. Results:Inadequate sedation and over-sedation were not observed in either group.Compared with group D, Children′s Hospital of Wisconsin Sedation Scale scores were significantly decreased at 30 min after administration, the onset time of sedation was shortened, and the decrease rate of HR was decreased in group DK ( P<0.05), and there were no significant changes in HR, SpO 2 and PAP before and after administration ( P>0.05). In group DK, nausea and vomiting occurred in 2 cases, but the symptoms were mild and no medication intervention was needed.No other adverse effects such as bradycardia and respiratory depression were found in either group. Conclusion:Combination of intranasal dexmedetomidine and esketamine can optimize the efficacy of preoperative sedation in pediatric patients with congenital heart disease, esketamine may induce nausea and vomiting, and the fasting time should be strictly controlled during sedation.

Construction of emergency management mode of pharmacy intravenous admixture under the background of COVID-19 / 中华医院管理杂志

After the outbreak of COVID-19, due to environmental pollution in the isolated ward and operational constraints caused by protective clothing and other factors, intravenous drugs in the designated hospitals should be centralized. Combined with the existing process mode, the process of pharmacy intravenous admixture services was optimized, the operation mode of the operation platform was adjusted, the scheduling mechanism was optimized, and the node control process of " first verify and five checks" was explored and developed, so as to meet the 24 h needs of COVID-19 patients. According to the characteristics of COVID-19 drug treatment, the focus of prescription review was adjusted to ensure the drug safety of patients. Other measures included implementing paperless prescription to reduce unnecessary media; implementing segmented infusion distribution management to ensure no cross infection; hierarchical control and configuration environment, strengthening the protection and management of pharmacists, to avoid the risk of personnel infection; optimizing human resource allocation and improving work efficiency. This process reengineering and optimization established the emergency management mode of centralized intravenous drug deployment under the background of COVID-19, which ensured the intravenous drug demand and safety of COVID-19 patients. The treatment work was carried out orderly, and could provide reference for the pharmaceutical department in medical institutions to deal with major public health emergencies in the future.

Pharmaceutical administration practice during control and treatment of COVID-19 / 中华医院管理杂志

In designated hospitals for critical patients with COVID-19 in Wuhan, time-efficient pharmaceutical emergency protection system was of great significance for epidemic prevention. Described in the paper are measures taken by the pharmaceutical department of the hospital as follows. These measures include launching an emergency response mechanism, formulating a catalogue of COVID-19 key therapeutic drugs, urgently purchasing therapeutic drugs, transforming the processes of emergency pharmacy, establishing a drug donation management system, building a COVID-19 pharmaceutical care team, and setting up a " cloud pharmacy" to meet the drug needs of patients with non-COVID-19 chronic diseases, in addition to strengthening personnel protection of pharmacists. During such an epidemic, the pharmacy administration works in a professional, comprehensive, complex and systematic emergency program, which guaranteed the safety of drug supply, medication and enabled the treatment to be carried out in an orderly manner.

Improvement in outcomes by acupuncture-drug balanced anesthesia following radical correction of tetralogy of Fallot under cardiopulmonary bypass in pediatric patients / 中华麻醉学杂志

Objective:To evaluate the efficacy of acupuncture-drug balanced anesthesia in improving the outcomes following radical correction of tetralogy of Fallot (TOF) under cardiopulmonary bypass (CPB) in the pediatric patients.Methods:A total of 100 pediatric patients, aged 3-8 yr, weighing 9-24 kg, with American Society of Anesthesiologists physical status Ⅱ or Ⅲ, scheduled for elective radical correction of TOF with CPB, were divided into 2 groups ( n=50 each) using a random number table method: acupuncture-drug balanced anesthesia group (group ADBA) and conventional anesthesia group (group CA). In group ADBA, transcutaneous acupoint electrical stimulation (disperse-dense wave, frequency 2/100 Hz, current intensity 6 mA, pulse width 0.2-0.6 ms) of Baihui (GV20) and bilateral acupoints of Neiguan (PC6), Hegu (LI4), and Ximen (PC4) acupoints was performed after induction of general anesthesia and maintained until the end of surgery.In group CA, the children received combined intravenous-inhalational anesthesia, and electrodes were only applied on the same acupoints without electrical stimulation.Venous blood samples were collected for blood routine examination and for determination of the concentrations of interleukin-6 (IL-6), IL-8 and tumor necrosis factor-alpha(TNF-α) at 30 min before surgery (T 1), 30 min after the start of surgery (T 2) and 1 h and 1, 2, 3 and 5 days after surgery (T 3-7). The length of hospital stay and development of postoperative major adverse events were recorded. Results:Compared with group CA, the plasma concentrations of IL-6, IL-8 and TNF-α at T 2-7 and white blood cell count, neutrophil count and neutrophil percentage at T 4-7 were significantly decreased, postoperative length of hospital stay was shortened ( P<0.05), and the incidence of acute lung injury was decreased obviously in group ADBA ( P<0.05). Conclusion:Acupuncture-drug balanced anesthesia can improve the outcomes following radical correction of TOF under CPB to a certain extent, and the mechanism is related to inhibiting inflammatory responses in pediatric patients.

Association of BDNF gene polymorphism with endophenotypes in posttraumatic stress disorder

SUMMARY OBJECTIVE To explore the association of brain-derived neurotrophic factor gene (BDNF) polymorphism with the latent cognitive endophenotype of posttraumatic stress disorder (PTSD) after major natural disasters in Hainan Province, China. METHODS A total of 300 patients with PTSD and 150 healthy controls (HC) were surveyed by psychoanalysis scale to assess their cognitive functions. Polymerase chain reaction (PCR) and polyacrylamide gel electrophoresis (PAGE) were used to detect the BDNF gene polymorphism. RESULTS In terms of the cognitive function, the scores in the PTSD group were worse than those of the HC group (P < 0.05 or P < 0.01). There was a significant difference in the distribution of BDNF genotype and allele frequency between the two groups (P < 0.05). PTSD endophenotypes were significantly different among the BDNF genotypes in the PTSD group (P ≤ 0.01). CONCLUSION There is a statistically significant difference in the polymorphism of BDNF gene between PTSD and HC groups, and the alleles are associated with the incidence of PTSD. Thus, it may be a risk factor for PTSD.

RESUMO OBJETIVO Explorar a associação do polimorfismo do gene fator neurotrófico derivado do cérebro (BDNF) com o endofenótipo cognitivo latente de transtorno de estresse pós-traumático (TEPT) após grandes desastres naturais na província de Hainan, China. MÉTODOS Um total de 300 doentes com TEPT e 150 controles saudáveis (HC) foi investigado pela escala de psicanálise para avaliar as suas funções cognitivas. A reação em cadeia polimerase (PCR) e a eletroforese em gel de poliacrilamida (Page) foram usadas para detectar o polimorfismo do gene BDNF. RESULTADOS Em termos de função cognitiva, as pontuações no grupo TEPT foram piores do que as do grupo HC (P<0,05 ou P<0,01). Houve uma diferença significativa na distribuição do genótipo de BDNF e frequência do alelo entre os dois grupos (P<0,05). Os endofenótipos de TEPT foram significativamente diferentes entre os genótipos de BDNF do grupo TEPT (P≤0,01). CONCLUSÃO Existe uma diferença estatisticamente significativa no polimorfismo do gene BDNF entre o TEPT e os grupos HC, e os alelos estão associados à incidência do TEPT. Assim, pode ser um fator de risco para TEPT.

Outcome evaluation of the drug withdrawl mode as used at inpatient pharmacy / 中华医院管理杂志

Drug withdrawal has always been a tough challenge in drug quality management for the pharmacist. In order to optimize the drug withdrawal process, the hospital has introduced an inpatient pharmacy IT system. This system can efficiently minimize the drug withdrawal rate of major departments and withdrawal counts due to substandard quality problems, thus sizably avoiding human resource wastes in the conventional withdrawal process, reducing drug quality problem, enhancing management efficiency and efficiency of nursing staff and pharmacists, and ensuring clinical drug use safety.

Trends of smoking and passive smoking in residents in Shaanxi province: an analysis on results of four cross-sectional surveys, 2007-2015 / 中华流行病学杂志

Objective@#To understand the trends of smoking and passive smoking exposure in adults in Shaanxi province from 2007 to 2015.@*Methods@#Data was from China Chronic Disease and Risk Factor Surveillance in 2007, 2010, 2013 and 2015 to calculate the rates of smoking, smoking cessation and passive smoking exposure, as well as the amount of smoking of smokers indicated by each surveillance. Cochran-Armitage test was used to assess the trends across survey periods. The weighting rate was calculated by using sampling weight and data from the 6th national census in 2010. Sensitivity analysis was done to test the trends as well.@*Results@#The results of the surveillance indicated that the smoking rate in 2007 was 38.26%, highest in the results of four surveys, it decreased to 30.95% in 2013 and then increased to 34.11% in 2015 (Cochran-Armitage test: Z=2.46, P=0.014). The amount of smoking increased from 16.90 cigarettes per day in 2007 to 17.76 cigarettes per day in 2015. The overall rate of smoking cessation was 11.02% in 2007 and 16.95% in 2015 (Cochran- Armitage test: Z=-4.18, P<0.01). We observed the passive smoking exposure rate was 48.10% in 2010 and 63.88% in 2015 (Cochran-Armitage test: Z=-10.60, P<0.01). We found no difference in trends by sensitivity analysis.@*Conclusions@#The smoking rate and amount of cigarettes smoked in adults in Shaanxi remained stable and at a high level. The rate of smoking cessation increased gradually, while the passive smoking exposure rate increased rapidly.

Analysis on chronic diseases and risk factors of adult residents in Shaanxi province / 中华流行病学杂志

Objective@#To explore the prevalence of chronic diseases and related risk factors in Shaanxi province.@*Methods@#Multi-stage stratified cluster random sampling was used to collect the sample from permanent residents in 10 national surveillance points in Shaanxi province in 2015. Behavioral risk factors (smoking, drinking, diet and physical activity) were investigated by face-to-face interviews and biological risk factors (BMI, blood pressure, blood glucose and blood lipid) were collected by physical measurements and laboratory tests. Designed weight, no response weight and post hierarchical weight were taken into account in the data analysis. Binary logistic regression models were used to examine the pair-wise associations among 8 risk factors.@*Results@#A total of 6 174 persons were included in the analysis. The following weighted prevalence were noticed in Shaanxi province in 2015, that including current smoking as 28.19%, harmful use of alcohol as 6.20%, inadequate intake of vegetables and fruits as 55.62%, physical inactivity as 19.56%, overweight and obesity as 46.82%, hypertension as 31.12%, raised fasting blood glucose as 4.27%, and raised total cholesterol as 20.96%. Eight risk factors were found to be associated with each other. The mean numbers of risk factors were 2.41 per male and 1.85 per female, 1.94 per urban resident and 2.28 per rural resident.@*Conclusions@#Risk factors for chronic diseases among adults aged 18 or older were more than the national levels in Shaanxi province in 2015. Male and rural residents presented more risk factors than their counterparts. Correlations between risk factors implied that a combined package of interventions was needed to reduce these risk factors.