Patogênese, Avaliação e Tratamento da Disfunção da Microcirculação Coronariana / Pathogenesis, Assessment, and Treatment of Coronary Microcirculation Dysfunction

Resumo A doença cardiovascular é a causa predominante de mortalidade em escala global. A pesquisa indica que as mulheres, em comparação aos homens, apresentam maior probabilidade de apresentar doença arterial coronariana (DAC) não obstrutiva quando têm sintomas de isquemia miocárdica. Além disso, as mulheres tendem a apresentar uma maior carga de sintomas em relação aos homens e, apesar da presença de doença cardíaca isquêmica, são frequentemente tranquilizadas erroneamente devido à ausência de DAC obstrutiva. Nos casos de cardiopatia isquêmica acompanhada de sintomas de isquemia miocárdica, mas sem DAC obstrutiva, é imperativo considerar a disfunção microvascular coronariana como uma potencial causa subjacente. A disfunção microvascular coronariana, caracterizada por reserva de fluxo coronariano prejudicada resultante de anormalidades funcionais e/ou estruturais na microcirculação, está associada a desfechos cardiovasculares adversos. Modificações no estilo de vida e o uso de medicamentos antiateroscleróticos e antianginosos podem oferecer benefícios potenciais, embora sejam necessários mais ensaios clínicos para informar estratégias de tratamento. Esta revisão tem como objetivo explorar a prevalência, mecanismos subjacentes, abordagens diagnósticas e intervenções terapêuticas para disfunção microvascular coronariana.

Abstract Cardiovascular disease is the predominant cause of mortality on a global scale. Research indicates that women exhibit a greater likelihood of presenting with non-obstructive coronary artery disease (CAD) when experiencing symptoms of myocardial ischemia in comparison to men. Additionally, women tend to experience a higher burden of symptoms relative to men, and despite the presence of ischemic heart disease, they are frequently reassured erroneously due to the absence of obstructive CAD. In cases of ischemic heart disease accompanied by symptoms of myocardial ischemia but lacking obstructive CAD, it is imperative to consider coronary microvascular dysfunction as a potential underlying cause. Coronary microvascular dysfunction, characterized by impaired coronary flow reserve resulting from functional and/or structural abnormalities in the microcirculation, is linked to adverse cardiovascular outcomes. Lifestyle modifications and the use of anti-atherosclerotic and anti-anginal medications may offer potential benefits, although further clinical trials are necessary to inform treatment strategies. This review aims to explore the prevalence, underlying mechanisms, diagnostic approaches, and therapeutic interventions for coronary microvascular dysfunction.

O Índice de Imuno Inflamação Sistêmica Prevê Mortalidade Hospitalar em Pacientes Submetidos à Cirurgia Cardíaca com Circulação Extracorpórea / The Systemic Immune-Inflammation Index Predicts In-Hospital Mortality in Patients Who Underwent On-Pump Cardiac Surgery

Resumo Fundamento: O índice de imuno-inflamação sistêmica (SII), um novo índice inflamatório calculado usando contagens de plaquetas, neutrófilos e linfócitos, demonstrou ser um fator de risco independente para a identificação de doença arterial coronariana de alto risco em pacientes submetidos a intervenção coronária percutânea e cardiovascular e cirurgia com circulação extracorpórea (CEC). A relação entre as taxas de mortalidade relacionadas ao SII e à CEC permanece obscura. Objetivo: Esta pesquisa foi desenhada para investigar o uso do SII para prever mortalidade hospitalar em pacientes submetidos à cirurgia cardíaca com CEC. Métodos: Quatrocentos e oitenta pacientes submetidos a procedimento cardíaco envolvendo CEC durante 3 anos foram coletados do banco de dados do hospital. Foram comparados os dados demográficos, comorbidades, perfis hematológicos e bioquímico e dados operatórios dos grupos. Análises múltiplas de regressão logística foram feitas para determinar preditores independentes de mortalidade. Os fatores prognósticos foram avaliados por análise multivariada e os valores preditivos de SII, relação neutrófilo-linfócito (NLR) e razão plaqueta-linfócito (PLR) para mortalidade foram comparados. Um valor de p <0,05 foi considerado significativo. Resultados: Dos 480 pacientes, 78 desenvolveram mortalidade hospitalar após cirurgia cardíaca. O SII foi um preditor independente de mortalidade hospitalar (odds ratio: 1,003, intervalo de confiança de 95%: 1,001-1,005, p<0,001). O valor de corte do SII foi >811,93 com sensibilidade de 65% e especificidade de 65% (área sob a curva: 0,690). Os valores preditivos de SII, PLR e NLR foram próximos entre si. Conclusão: Altos escores pré-operatórios do SII podem ser usados para determinação precoce de tratamentos apropriados, o que pode melhorar os resultados cirúrgicos de cirurgia cardíaca no futuro.

Abstract Background: Systemic immune-inflammation index (SII), a new inflammatory index calculated using platelet, neutrophil, and lymphocyte counts, has been demonstrated to be an independent risk factor for the identification of high-risk coronary artery disease in patients undergoing percutaneous coronary intervention and cardiovascular surgery with cardiopulmonary bypass (CPB). The relationship between SII and CPB-related mortality rates remains unclear. Objective: This research was designed to investigate the use of SII to predict in-hospital mortality in patients undergoing cardiac surgery with CPB. Methods: Four hundred eighty patients who underwent a cardiac procedure involving CPB over 3 years, were obtained from the hospital's database. The demographic data, comorbidities, hematological and biochemical profiles, and operative data of the groups were compared. Multiple logistic regression analyses were done to determine independent predictors of mortality. Prognostic factors were assessed by multivariate analysis, and the predictive values of SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) for mortality were compared. A p-value <0.05 was considered significant. Results: Of 480 patients, 78 developed in-hospital mortality after cardiac surgery. SII was an independent predictor of in-hospital mortality (Odds ratio: 1.003, 95% confidence interval: 1.001-1.005, p<0.001). The cut-off value of the SII was >811.93 with 65% sensitivity and 65% specificity (area under the curve: 0.690). The predictive values of SII, PLR, and NLR were close to each other. Conclusion: High preoperative SII scores can be used for early determination of appropriate treatments, which may improve surgical outcomes of cardiac surgery in the future.

Atuação do enfermeiro perfusionista na cirurgia cardíaca / Role of the perfusion nurse in cardiac surgery / La actuación del enfermero perfusionista en la cirugía cardíaca

Objetivo: Analisar a atuação do enfermeiro perfusionista na cirurgia cardíaca. Método: Estudo exploratório com abordagem qualitativa, desenvolvida em ambiente virtual no período de 1 a 30 de junho de 2022. Amostra intencional, não probabilística, constituída de 14 enfermeiros perfusionistas. Os dados foram analisados por meio da análise de conteúdo de Bardin. Resultados: Emergiram duas categorias temáticas: Atuação do enfermeiro perfusionista na circulação extracorpórea e A relevância da interação do enfermeiro com os membros da equipe durante a cirurgia cardíaca com circulação extracorpórea. Os relatos identificaram que o enfermeiro perfusionista realiza inúmeras atribuições que vão desde o histórico de enfermagem, até o preparo e a escolha de materiais, circuitos, dispositivos e maquinários para a condução da circulação extracorpórea. Destaca-se a interação desse profissional com os demais membros da equipe no tocante à comunicação a fim de minimizar riscos e obter resultado cirúrgico positivo para o paciente. Conclusão: A atividade do enfermeiro perfusionista é complexa e necessita de um rigoroso preparo teórico-prático, especializações reconhecidas pelos órgãos competentes, bem como frequentes atualizações mesmo já sendo um profissional experiente. (AU)

Objective: To analyze the role of the perfusionist nurse in cardiac surgery. Method: Exploratory study with a qualitative approach, conducted in a virtual environment from June 1st to June 30th, 2022. The sample consisted of 14 perfusionist nurses, selected intentionally and non-probabilistically. Data were analyzed through Bardin's content analysis. Results: Two thematic categories emerged: the role of the perfusionist nurse in extracorporeal circulation and the relevance of the nurse's interaction with team members during cardiac surgery with extracorporeal circulation. The reports identi-fied that the perfusionist nurse performs numerous tasks ranging from nursing history to the preparation and selection of materials, circuits, devices, and machinery for extracorporeal circulation. The interaction of this professional with other team members regarding communication stands out, aiming to minimize risks and achieve positive surgical outcomes for the patient. Conclusion: The activity of the perfusionist nurse is complex and requires rigo-rous theoretical-practical preparation, recognized specializations by competent bodies, as well as frequent updates even for experienced professionals

Objetivo: Analizar el papel del enfermero de perfusión en la cirugía cardíaca. Método: Estudio exploratorio con enfoque cualitativo, desarrol-lado en ambiente virtual durante el período del 1 al 30 de junio de 2022. Muestra intencional, no probabilística, compuesta por 14 enfermeros de perfu-sión. Los datos fueron analizados mediante el análisis de contenido de Bardin. Resultados: Surgieron dos categorías temáticas: El papel del enfermero perfusionista en circulación extracorporea y la relevancia de la interacción del enfermero con los miembros del equipo durante la cirugía cardíaca con circulación extracorporea. Los informes identificaron que el enfermero perfusionista desempeña numerosas atribuciones que van desde el historial de enfermería hasta la preparación y elección de materiales, circuitos, dispositivos y maquinaria para la conducción de la circulación extracorporea. Se des-taca la interacción de este profesional con los demás miembros del equipo en lo que respecta a la comunicación para minimizar riesgos y obtener resulta-dos quirúrgicos positivos para el paciente. Conclusión: La actividad del enfermero de perfusión es compleja y requiere una preparación teórico-práctica rigurosa, especializaciones reconocidas por los órganos competentes, así como actualizaciones frecuentes incluso siendo un profesional experimentado

The immediate brain effect of acupuncture at Fengchi in patients with posterior circulation ischemia vertigo:a resting-state functional MRI study / 实用放射学杂志

Objective To investigate the immediate brain effect of acupuncture at Fengchi using amplitude of low-frequency fluctuation(ALFF)and functional connectivity by the resting-state functional magnetic resonance imaging(rs-fMRI)in patients with posterior circulation ischemia vertigo(PCIV).Methods Twenty patients with PCIV were enrolled.The dizziness handicap inventory(DHI)was used to evaluate the severity of vertigo.The patients were randomly divided into acupuncture group and sham acupoint acupuncture group.Rs-fMRI scan was performed before and after acupuncture.MATLAB-based DPABI 6.1 software was used to analyze rs-fMRI data.Correlation analysis was used between the altered ALFF values and DHI scores.The regions of altered ALFF were taken as seeds to analyze functional connectivity.Results Compared with the sham acupoint acupuncture group,the increased ALFF values were mainly located on the left precuneus,left superior frontal gyrus and left caudate nucleus after acupuncture in the acupuncture group;the decreased ALFF values were mainly located on the left cerebellum and right inferior occipital gyrus.The ALFF value of the left superior frontal gyrus was negatively correlated with the DHI score(P=0.04).The increased functional connectivity was mainly found between left precuneus and the right middle frontal gyrus,the right superior frontal gyrus,the decreased functional connectivity was mainly found between left precuneus and the bilateral paracentral lobule and right cerebellum.Conclusion The ALFF value and functional connectivity are different before and after acupuncture,indicating that the vestibular network,visual and motor brain regions functional activities are changed after needling at Fengchi,which may be the brain functional basis of Fengchi for vertigo in PCIV.

Point application (invigorate the spleen and kidney and circulation of blood formula) combined with five-animal exercise on improving the nutritional status for asthenia of patients with dialysis / 中国实用护理杂志

Objective:To observe the effect of point application-invigorate the spleen and kidney, circulation of blood formula (PA) combined with five-animal exercise (FAE) on improving the nutritional status for asthenia of patients with dialysis, and provide evidence for the rehabilitation treatment of dialysis patients.Methods:According to the random number table method, a total of 80 patients treated with regular dialysis at Department of Nephrology, the Affiliated Hospital of Nanjing University of Chinese Medicine from April 2020 to December 2021 were randomly divided into experimental group and control group, with 40 cases in each group. Participants in the control group received regular dialysis, basic treatment and diet nursing (RBD). Participants in the experimental group received RBD plus PA+FAE. Labaratory test results, Subjective Global Assessment scale score and Traditional Chinese medicine symptom score were measured at baseline and 12-weeks after the intervention. The Fried Frailty scale score was measured at baseline, 4, 8, and 12 weeks after the intervention.Results:The control group aged (54.08 ± 11.34) years old, 23 males, 17 females; the experimental group aged (57.38±9.89) years old, 19 males, 21 females. After 4, 8 and 12 weeks of intervention, the Fried Frailty Scale scores of the experimental group at different time points were 2 (2, 2), 1 (1, 2) and 1 (0, 1), respectively, lower than 3 (2, 4), 2 (2, 3) and 2 (2, 3) of the control group, and the differences in time effect, inter-group effect and interaction effect were statistically significant ( F=105.76, 18.38, 46.67, all P<0.01). Further pairwise comparisons within groups indicated significant differences of Fried Frailty scale scores at different time points ( Z=-2.78, -4.01, -6.08, all P<0.01). After 12-week of intervention, the results of hemoglobin, serum albumin and serum prealbumin were (107.88 ± 15.58) g/L, (39.10 ± 4.92) g/L, and (289.36 ± 72.05) mg/L in the experimental group, respectively, higher than (100.15 ± 17.62) g/L, (36.93 ± 4.72) g/L, (255.63 ± 75.35) mg/L in the control group ( t=-2.08, -2.01, -2.05, all P<0.05). Subjective Overall Assessment scale was found a significant difference between the 2 groups ( χ2=10.91, P<0.01): the number of grade A (good nutrition) and B (mild to moderate malnutrition) were 36 and 4 in the experimental group and 23 and 17 in the control group. Traditional Chinese medicine symptom score was (4.68 ± 2.50) in the experimental group, lower than (9.58 ± 4.40) in the control group ( t=6.13, P<0.01). Conclusions:Point application-invigorate the spleen and kidney and circulation of blood formula combined with five-animal exercise can effectively improve the nutritional status of dialysis patients and reduce the weakness of patients

Mechanism of Chinese medicine for promoting blood circulation and removing blood stasis combined with platelet-rich plasma to improve steroid-induced necrosis of the femoral head / 中国组织工程研究

BACKGROUND:At present,it is found that both Chinese medicine for activating blood circulation and removing blood stasis and platelet-rich plasma technology can repair damaged blood vessels,promote vascular regeneration,rebuild blood supply in the femoral head,restore normal blood supply,and further promote osteogenesis.Both of them have certain advantages in early intervention of steroid-induced necrosis of femoral head.It can also further understand the mechanism of blood activating and stasis removing herbs and platelet-rich plasma technology in improving steroid-induced necrosis of the femoral head,and provide new ideas for future treatment. OBJECTIVE:To review the research progress of the mechanism of the combination of blood activating and blood stasis removing herbs and platelet-rich plasma technology on steroid-induced necrosis of the femoral head according to the related literature at home and abroad. METHODS:PubMed,Web of Science,Metstr,CNKI and WanFang databases were searched for relevant articles."Traditional Chinese medicine,signal pathways,steroid induced necrosis of femoral head,vascular endothelial growth factor,platelet rich plasma"were used as the Chinese and English search terms separately.The time limit for searching the literature was from January 2000 to July 2022,and 75 related articles were finally included. RESULTS AND CONCLUSION:Both Chinese medicine for activating blood circulation and removing blood stasis and platelet-rich plasma technology have certain advantages in intervening the early stage of steroid-induced necrosis of femoral head.For traditional Chinese medicine,both single and compound drugs can effectively alleviate the further development of steroid-induced necrosis of the femoral head.The specific mechanism is as follows:(1)The traditional Chinese medicine for activating blood circulation and removing blood stasis has a significant anticoagulation effect,which can antagonize the abnormal(hypercoagulable)state of blood caused by hormone drugs,and further restore the normal blood supply in the femoral head.(2)Traditional Chinese medicine for activating blood circulation and removing blood stasis can repair damaged vascular endothelium,regenerate blood vessels and remodel blood supply in the femoral head by activating vascular endothelial growth factor.(3)The traditional Chinese medicine of promoting blood circulation and removing blood stasis has the obvious effect of removing blood stasis,which can reduce the accumulation of fat cells in the bone marrow cavity and relieve the pressure in the femoral head.(4)Traditional Chinese medicine for promoting blood circulation and removing blood stasis can regulate relevant signal pathways,maintain bone metabolism,promote the differentiation and balance of osteoblasts and osteoclasts,and effectively reduce steroid-induced necrosis of the femoral head.In addition,platelet-rich plasma contains a large amount of high concentration of cell growth factor,which plays a positive role in osteogenesis and vascular regeneration,and can also improve the abnormal state of the blood.Traditional Chinese medicine for activating blood circulation and removing blood stasis combined with platelet-rich plasma technology can play their biological roles,and the intervention effect is more significant.

Effect of vessel number on computational fluid dynamics in vascular networks / 中国组织工程研究

BACKGROUND:Mechanical factors can affect the angiogenic ability of vascular endothelial cells.How the vessel number affects the hydrodynamic properties of microvessels remains to be clarified. OBJECTIVE:To investigate the influence of vessel number on the hydrodynamics of vascular networks based on computational fluid dynamics. METHODS:Three three-dimensional models of vascular network with different vessel numbers were constructed using the Geometry module of ANSYS 19.0 software,and then the vascular network was meshed to tetrahedral elements in Mesh module.The vascular network was assumed to rigid wall without slip,and the blood was assumed to laminar,viscous,and incompressible Newtonian fluid.Blood density,velocity,and a series of blood viscosity coefficients were also established.The Navier-Stokes equation was used for calculation.Hydrodynamic properties of different parts of vascular network with different vessel numbers were analyzed and compared. RESULTS AND CONCLUSION:The streamline,velocity,and mass flow all had the same trend in the vascular network,that is,the outlet and inlet were higher and the middle junction of vascular network was lower.The more the number of vessels,the thinner the blood flow lines in each part of the vascular network.Also,the velocity,mass flow,and wall shear decreased with the increase of the number of blood vessels.Therefore,the changes in vessel number could influence the hydrodynamic environment in the vascular network.Computational fluid dynamics indicates that the changes in vessel numbers can influence the hydrodynamic properties of blood,and provides a new idea for treating bone hypoperfusion-induced diseases(fracture nonunion,bone defect,osteoporosis,etc.)through tonifying kidney and activating blood circulation based on the coupling between angiogenesis and osteogenesis.

Comparison of efficacy and safety of direct thrombectomy and bridging thrombectomy in the treat-ment of acute anterior circulation large vessel occlusion stroke under different collateral circulation statuses / 新乡医学院学报

Objective To compare the safety and efficacy of direct thrombectomy versus bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke under different collateral circulation statuses.Methods Totally 93 patients with acute anterior circulation ischemic stroke admitted to the First Affiliated Hospital of Xinxiang Medical University from September 2020 to March 2023 were selected as the research subjects.Patients were divided into direct throm-bectomy group(n=47)and bridging thrombectomy group(n=46)based on the type of thrombectomy.Patients in the direct thrombectomy group received direct intravascular thrombectomy,while patients in the bridging thrombectomy group received intravenous thrombolysis with alteplase combined with mechanical thrombectomy.According computed tomography angiography,the collateral circulation Tan classification was applied to divide the patients into good collateral circulation sub-group and poor collateral circulation sub-group.The modified thrombolysis in cerebral infarction grading(mTICI)was used to evaluate vessel recanalization.Head computed tomography plain scan was performed at 24-48 hours postoperatively to assess if there was hemorrhagic transformation,and modified Rankin Scale score was performed at 90 days postoperatively.Information such as imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,prognosis and spontaneous non-traumatic symptomatic intracerebral hemorrhage(SICH)were collected.Results The age,gender,baseline Alberta stroke program early computed tomography score,baseline national institutes of health stroke scale score,proportions of hypertension,diabetes and atrial fibrillation,baseline systolic pressure,creatinine,baseline blood glucose,platelet count,occlusion site,stroke etiologies and collateral circulation status of patients in the two groups were not statistically significantly different(P＞0.05).There were no significant differences in the post-admission imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,successful vascular reperfusion rate,good prognosis rate,mortality rate,and SICH incidence between the two groups(P＞0.05).The hemorrhagic transformation rate of patients in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group(P＜0.05).There were no significant differences in the post-admission imaging examination time,femoral artery puncture time,vessel recanalization time after thrombectomy,successful vascular reperfusion rate,good prognosis rate,mortality rate,and SICH incidence between patients with good collateral circulation and patients with poor collateral circulation in the two groups(P＞0.05).The hemorrhagic transformation rate of patients with good and poor collateral circulation in the direct thrombectomy group was significantly lower than that in the bridging thrombectomy group(P＜0.05).Conclusion Under different collateral circulation conditions,the safety and efficacy of direct thrombectomy and bridging thrombectomy in the treatment of acute anterior circulation large vessel occlusion stroke are similar,but bridging thrombectomy is more likely to result in cerebral hemorrhage transformation compared with direct thrombectomy.

Observations of lower limb lymphatic reflux and para-uterine lymphatic reflux by injecting indocya-nine green / 新乡医学院学报

Objective To observe the differences between the lymphatic reflux in the lower extremities and near the uterus by interphalangeal and cervical injection of indocyanine green(ICG).Methods A total of 50 patients with early-stage endometrial cancer or cervical cancer admitted to Zhoukou Central Hospital from June 2019 to November 2022 were selected as the research subjects.According to the ICG injection site during the surgery,patients were divided into the interphalangeal injection group(n=20)and the cervical injection group(n=30).The patients in the two groups were injected with ICG at the toes or cervix uteri,respectively.The lower limb lymphatic reflux pathway in the pelvic cavity and the para-uterine lymphatic reflux pathway were observed under fluorescence laparoscopy,and the differences between the two groups were analyzed.Results Among the patients with the interphalangeal injection of ICG(20 patients,40 sides),the lower limb lymphatic reflux was developed on 33 sides of 18 patients but not developed on both sides of 2 patients.Among the 18 patients,26 sides showed the lower limb lymphatic reflux through deep inguinal lymph nodes,circumflex iliac lymph nodes,external iliac lymph nodes,and common iliac lymph nodes;5 sides showed the lower limb lymphatic reflux to deep inguinal lymph nodes,circumflex iliac lymph nodes,obturator lymph nodes,internal iliac lymph nodes,and common iliac lymph nodes;and 2 sides showed the lower limb lymphatic reflux to deep inguinal lymph nodes,obturator lymph nodes,internal iliac lymph nodes,and common iliac lymph nodes.Among the patients with the cervical injection of ICG(30 patients,60 sides),pelvic lymph nodes were developed on 55 sides of 29 patients but not developed bilaterally in 1 patient.In the 29 patients,2 sides showed para-uterine lymphatic reflux to obturator lymph nodes,circumflex iliac lymph nodes,external iliac lymph nodes,and common iliac lymph nodes,in which circumflex iliac lymph nodes were non-sentinel lymph nodes;40 sides showed para-uterine lymphatic reflux to medial iliac lymph nodes(or obturator lymph nodes)and common iliac lymph nodes along the superior paracervical lymphatic reflux pathway;and 13 sides showed para-uterine lymphatic reflux to the internal iliac or presacral lymph nodes along the inferior paracervical lymphatic reflux pathway.The shared pathway of lower limb lymphatic reflux and para-uterine lymphatic reflux was upward reflux from obturator,external iliac and common iliac lymph nodes.The circumflex iliac lymph node developing rates in the interphalangeal and cervical injection groups were 93.94％(31/33)and 3.63％(2/55),respectively.The interphalangeal injection group had a significantly higher circumflex iliac lymph node developing rate than the cervical injection group(P＜0.05).Conclusion The application of ICG under fluorescence laparoscopy intuitively observed the lower limb lymphatic reflux and the para-uetine lymphatic reflux pathway.The difference between the two is that the lower limb lymphatic reflux flows through the circumflex iliac lymph nodes at the distal end of the external iliac lymph nodes,while cervical cancer and endometrial cancer rarely transfer there.

Teaching effect of single-circulation organ system integration course in pediatrics "5+3" program: with Nervous System and Diseases as an example / 中华医学教育探索杂志

Objective:To investigate the teaching effect of the single-circulation organ system integration course Nervous System and Disease for pediatrics 5+3 program, to guide the teaching practice of the integration course, and to promote the education and teaching reform of pediatrics.Methods:A total of 56 students of the class of 2019 in the pediatrics 5+3 program of Shanghai Jiao Tong University School of Medicine were selected as subjects, and the single-circulation organ system integration course was used for teaching. With the course of Nervous System and Disease as an example, evaluation results and questionnaires were used to assess the teaching effect of the single-circulation organ system course for pediatrics from the aspects of general information, course scores, student satisfaction, and expert supervision. SPSS 22.0 was used to perform descriptive statistics and analyses.Results:The course of Neurological System and Diseases integrated the contents of 11 related disciplines, with a mean score of (74.60±7.52) points. The scores of the students for course content, teaching mode, teaching resources, teaching effect, and the degree of overall satisfaction with the course were (4.71±0.54), (4.35±0.81), (4.50±0.69), (4.50±0.72), and (4.30±0.66), respectively. The score of expert supervision was (26.38±2.06) for teaching content and (26.52±2.03) for teaching methods, which still needed to be improved.Conclusions:The construction of the single-circulation organ system integration course provides new ideas for the curriculum reform of pediatrics; however, it is necessary to improve the construction of system and mechanism, explore the coordinated development of teachers, and strengthen deep integration and student guidance, thereby improving the teaching effect of the integrated course of pediatrics and promoting the training of medical talents in pediatrics.

Clinical analysis of patients with cardiopulmonary resuscitation in emergency department and establishment of prediction model of restoration of spontaneous circulation in hospital / 中华危重病急救医学

Objective:To screen the independent influencing factors of restoration of spontaneous circulation (ROSC) in patients after cardiopulmonary resuscitation (CPR) and establish a predictive model, and explore its clinical value.Methods:A retrospective case control study was conducted. The clinical data of cardiac arrest patients admitted to the emergency department of Tangdu Hospital of Air Force Military Medical University and received CPR from January to July 2023 were analyzed, including general information, blood biochemical indicators, main cause of cardiac arrest, whether it was defibrillation rhythm, duration from admission to CPR, and whether ROSC was achieved. The clinical data between the patients whether achieved ROSC or not were compared. The binary multivariate Logistic regression analysis was used to screen the independent influencing factors of ROSC in in-hospital CPR patients. According to the above influencing factors, the ROSC prediction model was established, and the receiver operator characteristic curve (ROC curve) was drawn to evaluate the predictive value of the model for ROSC.Results:A total of 235 patients who received CPR in the emergency department were enrolled, including 153 cases (65.11%) of in-hospital CPR and 82 cases (34.89%) of out-of-hospital CPR. The ROSC ratio was 30.21% (71/235). Among all patients, the majority were aged 61-80 years [40.43% (95/235)], and cardiogenic disease was the main cause of cardiac arrest [32.77% (77/235)]. Among 153 patients with in-hospital CPR, 89 were non-ROSC and 64 were ROSC with ROSC rate of 41.83%. Compared with the non-ROSC group, the patients in the ROSC group had lower blood lactic acid (Lac), N-terminal pro-brain natriuretic peptide (NT-proBNP), Lac/albumin (Alb) ratio (LAR), and ratio of non-defibrillation rhythm [Lac (mmol/L): 5.50 (2.33, 9.65) vs. 7.10 (3.50, 13.35), NT-proBNP (μg/L): 0.87 (0.20, 8.68) vs. 3.00 (0.58, 20.17), LAR: 0.14 (0.07, 0.29) vs. 0.19 (0.10, 0.43), non-defibrillation rhythm ratio: 68.75% (44/64) vs. 93.26% (83/89)], higher actual base excess (ABE) and Alb [ABE (mmol/L): -3.95 (-12.75, 0.23) vs. -7.50 (-13.50, -3.35), Alb (g/L): 38.13±7.03 vs. 34.09±7.81], and shorter duration from admission to CPR [hours: 3.25 (1.00, 14.00) vs. 8.00 (2.00, 27.50)], the differences were statistically significant (all P < 0.05). Binary multivariate Logistic regression analysis showed that LAR [odds ratio ( OR) = 0.037, 95% confidence interval (95% CI) was 0.005-0.287], non-defibrillation rhythm ( OR = 0.145, 95% CI was 0.049-0.426), and duration from admission to CPR ( OR = 0.984, 95% CI was 0.972-0.997) were independent influencing factors for ROSC in hospitalized CPR patients (all P < 0.05). Based on the above influencing factors, a ROSC prediction model was constructed through regression analysis results. The ROC curve analysis showed that the area under the ROC curve (AUC) for predicting ROSC in in-hospital CPR patients was 0.757 (95% CI was 0.680-0.834), Yoden index was 0.429, sensitivity was 76.6%, and specificity was 66.3%. Conclusions:LAR, non-defibrillation rhythm and duration from admission to CPR were independent influencing factors for ROSC in patients with in-hospital CPR. The ROSC prediction model established based on the above influencing factors has a good predictive value for ROSC of CPR patients in hospital, and can guide clinicians to evaluate the prognosis of patients through relevant indicators as early as possible.

Analysis of factors affecting the return of spontaneous circulation in elderly patients with out-of-hospital cardiac arrest / 中华危重病急救医学

Objective:To investigate the factors that influence the return of spontaneous circulation (ROSC) in elderly patients suffering from out-of-hospital cardiac arrest (OHCA).Methods:A retrospective study was used to collect the clinical data of OHCA patients admitted to the emergency center of Zhengzhou People's Hospital from July 2016 to July 2019 based on the pre-hospital emergency database of Utstein model. Patients' gender, age, cardiac arrest (CA) etiology, presence or absence of bystander cardiopulmonary resuscitation (CPR), emergency response time, initial cardiac rhythm, ventilation method, use of epinephrine, defibrillation and ROSC were included. The patients were divided into elderly and young groups according to whether age ≥ 60 years old, and the differences in various indicators between the two groups were compared. Univariate Logistic regression analysis was used to analyze the relationship between emergency response time and ROSC in elderly patients and multivariate Logistic regression analysis was used to identify factors influencing ROSC in elderly patients.Results:A total of 3?429 adult OHCA patients were enrolled in this study, including 2?105 elderly patients (61.39%), and 1?324 young and middle-aged patients (38.61%). Compared to the young group, the proportion of females, non-cardiac causes and asystole as the initial rhythm was higher in the elderly group, the emergency response time was shorter, the rate of defibrillation and tracheal intubation, and the success rate of ROSC were lower (all P < 0.05). Among them, the proportion of cardiac arrest as the initial rhythm in elderly male patients was significantly higher than that of young male patients ( P < 0.05); the proportion of non-cardiac causes in elderly female patients was significantly higher than that of young female patients, and the proportion of defibrillation was significantly lower than that of young female patients (all P < 0.05). Multivariate Logistic regression analysis showed that cardiac arrest as the initial rhythm was strongly associated with ROSC in elderly male patients [odds ratio ( OR) = 0.126, 95% confidence interval (95% CI) was 0.045-0.352, P < 0.05]. Univariate Logistic regression analysis of the relationship between emergency response time and ROSC in elderly patients showed that although there was no significant difference in the ROSC success rate among elderly patients with various emergency response times, an emergency response time within 10 minutes was beneficial for ROSC in elderly patients. Conclusion:The success rate of ROSC is very low in elderly OHCA patients aged ≥60 years. Although the CPR-related indicators of elderly patients are significantly different from those of young patients, there are gender differences. The association between the elderly male patients and cardiac arrest as the initial rhythm is stronger, while OHCA caused by non-cardiac diseases is more common and defibrillable rhythm is less common in elderly female patients. It may be more beneficial for elderly patients to shorten the emergency response time and increase bystander CPR.

Ultrasound microvascular flow imaging combined with vascular endothelial growth factor for diagnosis of fetal growth restriction / 中国医学影像技术

Objective To observe the value of ultrasound microvascular flow imaging(MV-Flow)combined with maternal serum vascular endothelial growth factor(VEGF)expression level for diagnosis of fetal growth restriction(FGR).Methods Totally 87 pregnant women with FGR(FGR group,including 43 cases of gestational week＜28 weeks[＜28 weeks subgroup]and 44 cases of ≥28 weeks[≥28 weeks subgroup])and 112 normal pregnant women with normal fetuses(normal control group,55 with gestational week＜28 weeks[NC 1 subgroup]and 57 with ≥28 weeks[NC 2 subgroup])were prospectively enrolled.MV-Flow technology was used to measure placental microvascular index(MVI),and the placental microvascular circulation was evaluated.The expression level of maternal serum VEGF was detected simultaneously,also of placental maternal surface immediately after delivery.The receiver operating characteristic curves were drawn to explore the value of placental MVI,maternal serum VEGF and the combination of placental MVI,maternal serum VEGF for diagnosing FGR.Results The levels of placental MVI and maternal serum VEGF in 2 subgroups of FGR group were both lower than those in control group(all P＜0.01).Placental VEGF expression level in FGR group was significantly lower than that in control group(P＜0.01).The area under the curve(AUC)of placental MVI,maternal serum VEGF and their combination for diagnosing FGR＜28 weeks was 0.981,0.870 and 0.997,respectively,while for diagnosing FGR≥28 weeks was 0.991,0.867 and 0.993,respectively.AUC of maternal serum VEGF alone for diagnosing in 2 subgroups of FGR were both lower than that of placental MVI and combination of placental MVI and maternal serum VEGF(all P＜0.05),while no significant difference of AUC was found between placental MVI and combination of maternal serum VEGF and placental MVI(both P＞0.05).Conclusion Both placental MVI and maternal serum VEGF level could be used to screen FGR,and the former was more valuable.

Progresses of functional MRI for exploring mechanism of neurovascular coupling changes in diabetes mellitus type 2 / 中国医学影像技术

The cognitive impairment of diabetes mellitus type 2(T2DM)is closely related to neurovascular coupling(NVC)changes,but the exact mechanism remains unclear.Functional MRI(fMRI)technology were able to jointly analyze NVC changes of T2DM,providing new ideas for revealing the mechanism of cognitive dysfunction caused by T2DM.The progresses of fMRI for exploring NVC changes in T2DM were reviewed in this article.

Exploration on Syndrome Differentiation Thinking for Stress Sensitization-induced Depression from the Perspective of"Deficient Qi with Stagnation and Heat" / 中国中医药信息杂志

TCM proposes that the core pathological mechanism of depression is"deficient qi with stagnation and heat",with the following pathogenic characteristics and evolution patterns:"deficient qi"as the nature,and deficiency in nature is in spleen,and deficiency in superficiality is in brain;"stagnation"is the superficiality,and qi stagnation,phlegm stagnation,and blood stagnation are in the brain collaterals;"heat"fires the brain collaterals,depression raised the heat,and excessive heat accumulated to stagnation.Based on the understanding of the pathogenesis of depression caused by stress sensitization in modern medicine,this article explored the potential association between this mechanism and the core pathogenesis of"deficient qi with stagnation and heat".It proposed that tonifying deficiency,promoting circulation,and clearing heat are the basic treatment principles for depression.By inhibiting inflammatory reactions and improving the stress sensitization state of neurons and glial cells,TCM compound formulas can exert multi-target and multi-dimensional therapeutic characteristics.

Analysis of the clinical characteristics of V4 segment steal blood in the vertebral artery / 中华内科杂志

Objective:To explore the clinical characteristics of unilateral vertebral artery V4 segment occlusive lesions (severe stenosis or occlusion), where the contralateral vertebral artery can be compensated through blood flow and reverse supply to the posterior inferior cerebellarartery (PICA).Methods:This study is a retrospective case series of 66 patients with V4 segment occlusive lesions of unilateral vertebral artery diagnosed and treated from June 2020 to October 2022. Patient data were retrospectively collected, and their hemodynamic characteristics and imaging data were analyzed.Results:Of the 66 cases, 11 patients (16.7%) with V4 segment occlusive disease showed the blood flow of the vertebral artery on the opposite side of the lesion on the digital subtraction angiography (DSA), which can be reverse stolen to the posterior inferior cerebellar artery of the diseased side through the confluence point of the vertebrobasilar artery through the distal end of the ipsilateral vertebral artery V4. Owing to the lack of literature on this pathway and based on the characteristics of previous definitions of subclavian artery steal and carotid artery steal, we referred to this pathway as the vertebral artery V4 segment steal. In 6 patients (9.1%), transcranial Doppler ultrasound (TCD) and transcranial color Doppler ultrasound (TCCD) showed that the blood flow signal was not detected at the proximal end of the V4 segment of the affected side, rather the blood flow direction was reversed at the distal end of the V4 segment, resulting in compensatory acceleration of the blood flow velocity of the V4 segment of the contralateral vertebral artery.Conclusion:“V4 segment steal of vertebral artery” is a very rare route of vertebral artery steal. When V4 segment of the vertebral artery is occluded, clinicians should pay attention to observe the blood supply of PICA and whether there is such a steal route, to better evaluate the blood flow compensation and prognosis of patients.

Nursing effect of PDCA circulating nursing model based on health concept on patients with valvular heart disease / 中国现代医生

Objective To explore the nursing effect of PDCA circulation nursing model based on health concept on patients with valvular heart disease.Methods A total of 116 patients with valvular heart disease hospitalized in Jinhua People's Hospital from December 2018 to December 2021 were selected as study objects.According to random number table method,the included patients were divided into control group and observation group,with 58 cases in each group.The patients in control group received routine nursing intervention,while the patients in observation group received PDCA circulation nursing intervention.The quality of life,self-rating anxiety scale(SAS)score,self-rating depression scale(SDS)score,complications and nursing satisfaction of two groups were compared.Results After nursing,the scores of physical function,psychological function,social function and overall quality of life in two groups were significantly higher than those before nursing(P<0.05),and the scores of above indexes of patients in observation group were significantly higher than those in control group(P<0.05).After nursing,SAS and SDS scores of two groups were significantly lower than those before nursing(P<0.05),and SAS and SDS scores of observation group were significantly lower than those of control group(P<0.05).The complication rate of observation group was significantly lower than that of control group(χ2=4.668,P=0.003).There was no significant difference in nursing satisfaction between two groups(χ2=2.511,P=0.113).Conclusion Patients with valvular heart disease can improve their quality of life,relieve anxiety and depression,and reduce complications by using PDCA circulation nursing model based on health concept.

Clinical significance of miR-126 in prognosis of cerebral infarction after thrombectomy / 中国现代医生

@#Objective To detect the changes of serum microRNA-126(miR-126)before interventional thrombectomy for acute cerebral infarction,and to explore its correlation with the prognosis of patients.Methods A retrospective analysis was performed on 101 patients with cerebral infarction who underwent interventional thrombectomy in he First People's Hospital of Huzhou from January 2019 to December 2021.The patients were followed up for 2 month.According to modified Rankin scale(mRS),they were divided into good prognosis group(mRS≤2 points,56 cases)and poor prognosis group(mRS>2 points,45 cases).The clinical data of two groups and the difference of miR-126 before thrombectomy were compared,and the effect of serum miR-126 change on the prognosis of patients with cerebral infarction was analyzed.Results The serum miR-126 level before thromrectomy in good prognosis group was significantly higher than that in poor prognosis group[(9.31±2.14)vs.(1.36±0.28),P<0.01].There was a negative correlation between miR-126 and National Institute of Health stroke scale(NIHSS)score(r=-0.737,P<0.01),and a positive correlation between miR-126 and good collateral circulation(r=0.645,P<0.01).The area under the receiver operating characteristic curve for establishing miR-126 to predict prognosis after thrombolectomy for cerebral infarction was 0.818.The sensitivity and specificity were 78.9%and 86.0%at the optimal cut-off value.Conclusion The change of serum miR-126 level before thrombectomy may be related to the prognosis of patients with cerebral infarction,which can be used as a marker to predict the prognosis of cerebral infarction after interventional therapy.

Exploring Traditional Chinese Medicine Daoyin Therapy for Diabetic Foot Based on the Theory of One Qi Circulation / 中医杂志

It is believed that traditional Chinese medicine （TCM） Daoyin （conduction exercise） therapy has potential in treating diabetic foot， which is a concrete embodiment of HUANG Yuanyu's theory of one qi circulation applied in practice. Based on Daoyin therapy of Baduanjin and the Origin and Indicators of Disease （《诸病源候论》）， a Daoyin prescription for diabetic foot was compiled and created. Based on the zang-fu concept of "One Qi Circulation"， combined with the theory of chief， deputy， assistant and envoy， this article explained the theoretical basis and functional mechanism of the Daoyin prescription for diabetic foot. This Daoyin therapy is mainly based on the prone position movements， which includes seven movements， namely， pull-up， knee bending， toe tilting， phoenix nodding， internal rotation of taiji， two hands climbing feet and closing. With "phoenix nodding" and "tilting toes" as the chief， with the help of toes opening-closing and pointing-pressing momentum in prone position， regulating the central qi； with "bending the knee" and "internal rotation of taiji" as the deputy， knee and ankle flexion and extension can unblock the meridians of liver and lungs； with "pull-up" and "two hands climbing feet" as the assistant， on the one hand， assisting to unblock zang-fu organs， on the other hand， applying the yang of the foot taiyang bladder channel and du mai to warm the cold and dampness； with "closing" as the envoy to regulate all organs， so that the blood return to the natural flow of circulation. Diabetic foot Daoyin therapy could regulate internal organs and qi circulation of body， and provides a new idea for the treatment of diabetic foot.

Exploration of the Disease Mechanism and Treatment of Colorectal Cancer Based on the "One Qi Circulation" / 中医杂志

Based on the theory of "one qi circulation" founded by HUANG Yuanyu， the core disease mechanism of colorectal cancer is the innate spleen deficiency and stomach qi failing to bear downward， which leads to the turbidity assemble in large intestine， forming the carcinoma toxin， and ultimately transforms into colorectal cancer. The treatment should base on recovering the circulation of qi， Huangya Decoction （黄芽汤） as the basic formula， the circulation of qi ascending and descending as the base， adjusting ascending and descending together with Xiaqi Decoction （下气汤）， and differentiating the syndrome on yin-yang excess-deficiency； for spleen-kidney yang deficiency syndrome， treated with Tianhun Decoction （天魂汤） to supplement liver， kidney and assist yang； for liver-kidney yin deficiency syndrome， treated wtih Dipo Decoction （地魄汤） to supplement lung， kidney， and assist yang. They jointly prompt one qi circulation to provide the thoughts for the treatment of colorectal cancer by traditional Chinese medicine.