Characteristics of abdominal hemorrhage in patients with severe acute pancreatitis and its influence on outcomes / 中华危重病急救医学

Objective:To explore the risk factors of abdominal hemorrhage (AH) in patients with severe acute pancreatitis (SAP) and its impact on outcome.Methods:The clinical data of 231 SAP patients admitted to Diagnosis and Treatment Center for SAP of Guizhou Province from January 1, 2015 to December 31, 2019 were retrospectively analyzed. These patients were divided into AH group and non-AH group. The general information, etiology, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score, sequential organ failure assessment (SOFA) score, organ failure, complications, interventions, bleeding time, bleeding site and outcome were compared between the two groups. Binary multivariate Logistic regression analysis was used to explore the risk factors of AH in SAP patients and whether the time and location of AH were risk factors affecting the outcome.Results:A total of 231 patients were enrolled in the analysis, including 198 patients without AH and 33 with AH (14.3%). There was no significant difference in gender, age or etiology between the two groups. The scores of APACHE Ⅱ and SOFA in AH group were significantly higher than those in non-AH group [APACHE Ⅱ score: 18 (12, 24) vs. 13 (9, 19), SOFA score: 9 (5, 15) vs. 5 (4, 11), both P < 0.01]. The incidences of acute kidney injury (AKI), gastrointestinal dysfunction, coagulation disorders, necrotic infection, pseudocyst and gastrointestinal fistula in AH group were significantly higher than those in non-AH group (66.7% vs. 47.0%, 36.4% vs. 7.1%, 18.2% vs. 6.6%, 66.7% vs. 9.1%, 66.7% vs. 34.3%, 9.1% vs. 1.5%, all P < 0.05). The proportions of requiring mechanical ventilation (MV) and surgical intervention in AH group were significantly higher than those in non-AH group (69.7% vs. 43.4, 48.5% vs. 14.6%, both P < 0.01). The length of intensive care unit (ICU) stay and hospital stay in AH group were significantly longer than those in non-AH group [length of ICU stay (days): 13 (8, 19) vs. 7 (3, 16), length of hospital stay: 24 (13, 40) vs. 17 (12, 24), both P < 0.01], and the hospital mortality was significantly higher (60.6% vs. 9.6%, P < 0.01). Multivariate Logistic regression analysis showed that APACHE Ⅱ score [odds ratio ( OR) = 1.157, 95% confidence interval (95% CI) was 1.030-1.299, P = 0.014], infectious necrosis ( OR = 12.211, 95% CI was 4.063-36.697, P < 0.01), pseudocyst ( OR = 3.568, 95% CI was 1.238-10.283, P = 0.019) and requiring MV ( OR = 0.089, 95% CI was 1.354-6.625, P = 0.007) were the risk factors of AH in SAP patients. In 33 AH patients, there was no significant difference in hospital mortality between early hemorrhage (occurred within 2 weeks of onset) and late hemorrhage (occurred 2 weeks after onset) groups [66.7% (8/12) vs. 57.1% (12/21), P > 0.05]. All 4 patients in the unspecified bleeding site group died during hospitalization; half or more patients died in the pseudocyst/abscess bleeding (14 cases), mesenteric/intestinal bleeding (13 cases) and gastric variceal bleeding (2 cases) groups (7 cases, 8 cases and 1 case respectively), and there were significant differences among the groups ( P < 0.05). Multivariate Logistic regression analysis showed that neither bleeding time ( OR = 0.989, 95% CI was 0.951-1.028, P = 0.574) nor bleeding site ( OR = 2.009, 95% CI was 0.822-4.907, P = 0.126) was the risk factor of death in patients with SAP combined with AH. Conclusions:Both early and late bleeding significantly increased the length of hospital stay and mortality of SAP patients. APACHE Ⅱ score, infectious necrosis and pseudocyst were the risk factors of AH in SAP patients. Neither bleeding time nor bleeding site was the risk factors of death in patients with SAP combined with AH. However, it still needed to be confirmed by a large sample clinical study.

Effect of panlong needling at Jiaji (EX-B 2) on motor dysfunction in patients with Parkinson's disease of liver and kidney deficiency: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the curative effect of panlong needling at Jiaji (EX-B 2) combined with western medication and western medication alone on motor dysfunction in patients with Parkinson's disease (PD) of liver and kidney deficiency.@*METHODS@#A total of 98 patients with PD were randomly divided into an acupuncture and medication group (49 cases, 1 case dropped off) and a western medication group (49 cases,1 case was removed). The patients in the western medication group were given oral of levodopa and benserazide hydrochloride tablets, 125 mg each time, three times a day in the 1st week, and the dose was increased according to the needs of the patients' condition from the 2nd week until 250 mg each time, three times a day, for 16 consecutive weeks. On the basis of the same western medication treatment as the western medication group, panlong needling was applied at Jiaji (EX-B 2) from C2 to L5 in the acupuncture and medication group, once a day, 20 times as a course of treatment, for 4 consecutive courses. The scores of unified Parkinson's disease rating scale (UPDRS-Ⅲ, UPDRS-Ⅳ), TCM symptoms score, and 39-item Parkinson's disease questionnaire (PDQ-39) score were evaluated before treatment, after treatment and during follow-up of 1 month after treatment, respectively. The safety of the two groups was compared.@*RESULTS@#After treatment and during follow-up, except the PDQ-39 score of the western medication group, the scores of UPDRS-Ⅲ, UPDRS-Ⅳ, TCM syndrome and PDQ-39 were lower than those before treatment in the two groups (P<0.05), and the scores of above indexes in the acupuncture and medication group were lower than those of the western medication group (P<0.05). The total incidence of adverse reactions in the acupuncture and medication group was 10.4% (5/48), which was lower than 29.2% (14/48) in the western medication group (P<0.05).@*CONCLUSION@#Panlong needling at Jiaji (EX-B 2) combined with western medication could significantly improve the motor dysfunction and clinical symptoms, improve the quality of life and has high safety, and the efficacy is superior to western medication alone.

Research progress of antioxidant drugs in myocardial ischemia-reperfusion injury / 药学学报

Myocardial ischemia-reperfusion injury (MIRI) is one of the most difficulties in the studies of cardiovascular diseases, and excessive reactive oxygen species (ROS) accumulation in cells is the main cause of it. Reducing ROS level by antioxidant drugs to protect cardiomyocytes is being the spotlight on MIRI treatment. In this review, the research progress of antioxidant drugs in myocardial ischemia-reperfusion injury in recent years was summarized.

Effect of miR-153-targeted PRDM2 on invasion and migration abilities of bladder cancer cells by JAK/STAT signaling pathway / 中国病理生理杂志

AIM:To investigate the effect of microRNA(miR)-153-targeted positive regulatory domain zinc finger protein 2(PRDM2 )on invasion and migration abilities of bladder cancer cells through JAK /STAT signaling path-way.METHODS:The expression levels of miR-153 in bladder cancer tissues were detected by qPCR.The expression of PRDM2 in normal tissues and bladder cancer tissues was detected by immunohistochemistry.The effect of miR-153 on the transcriptional activity of PRDM2 was examined by dual-luciferase reporter assay system.The effect of miR-153 over-ex-pression on the invasion ability of bladder cancer RT 4 cells was detected by Transwell assay ,and the cell invasion ability was analyzed by scratch test.The protein levels of PRDM2,p-JAK2 and p-STAT3 were determined by Western blot.RE-SULTS:The expression of miR-153 was significantly lower in the bladder cancer tissues than that in normal tissues(P<0.05).PRDM2 was highly expressed in the bladder cancer tissue(P<0.05).The results of dual-luciferase reporter assay system showed that miR-153 regulated the expression of PRDM2.miR-153 over-expression significantly decreased the invasion and migration abilities of bladder cancer RT 4 cells.miR-153 over-expression also down-regulated the protein levels of p-JAK2 and p-STAT3(P<0.05).CONCLUSION:miR-153 targets PRDM2,and regulates the invasion and migra-tion abilities of bladder cancer cells by JAK/STAT signaling pathway.

The epidemiologic characteristics and effects of complications on outcome of patients with severe acute pancreatitis in intensive care unit in north area of Guizhou province / 中国中西医结合急救杂志

Objective To investigate the epidemiologic characteristics of patients with severe acute pancreatitis (SAP) and the effects of its complications on prognoses in past 7 years in the north area of Guizhou province. Methods Data of 209 patients with SAP admitted to the Department of Critical Care Medicine of Affiliated Hospital of Zunyi Medical College from January 2009 to January2016 were retrospectively analyzed, and they were divided into a survival group (178 cases) and a death group (31 cases) according to the prognosis. The gender, age, diagnosis (primary and recurrent), the length of stay in hospital, the levels of creatinine and total bilirubin (TBil), the time of blood purification, hematocrit (HCT) level on the first day after admission, pathogenesis, complications [infection, pseudocyst, intra-peritoneal hemorrhage, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), abdominal compartment syndrome (ACS), pancreatic encephalopathy, multiple organ dysfunction syndrome (MODS)], sequential organ failure (SOFA) score (maximum SOFA score during hospital stay), application of hormones, surgical interference, etc. related factors were compared, the SAP epidemiological characteristics, factors affecting prognosis and the effect of complications on prognosis in intensive care unit (ICU) were analyzed in the two groups.Results Of the 209 patients 98 cases were diagnosed biliary pancreatitis accounting for the majority (46.9%), hyperlipidemic pancreatitis 76 cases (36.3%), alcoholic pancreatitis 6 cases (2.8%) and idiopathic pancreatitis29 cases (13.9%). The age (years: 47.1±13.5 vs. 53.2±12.0), creatinine (μmol/L: 109.4±100.3 vs. 335.7±222.4), the ration of intra-peritoneal hemorrhage [4.5% (8) vs. 38.7% (12)], ARF [1.1% (2) vs. 54.8% (17)], ACS [1.1% (2) vs. 9.7% (3)], MODS [18.5% (33) vs. 74.2% (23)] and SOFA score (3.3±2.4 vs. 10.5±5.4), percentage of patients using hormones [5.6% (10) vs. 29.0% (9)] were significantly lowered (allP 0.05). Logistic regression analysis showed that creatinine > 300μmol/L [odds ratio (OR) was 2.651, 95% confidence interval (95%CI) was 1.459-3.935,P = 0.017], intra-peritoneal hemorrhage (OR was 5.231, 95%CI was 3.517-7.159,P = 0.000), ARF (OR was 3.731, 95%CI was 2.641-4.857,P = 0.000), ACS (OR was 2.517, 95%CI was 1.003-3.098,P = 0.000), use of hormone (OR was 1.012, 95%CI was 0.825-2.051,P = 0.000) and SOFA score (OR was 3.179, 95%CI was 2.630-6.021 andP = 0.000), MODS (OR was 4.716, 95%CI was 2.086-7.902 andP = 0.031) were the risk factors having critical effects on the prognosis of thedisease, The higher the creatinine level, the worse the prognosis. The mortality of ARF was very high reaching 89.5%; the mortalities of patients with complications as intra-peritoneal haemorrhage, ACS, MODS, pancreatic encephalopathy, AKI, infection, pancreatic pseudocyst and ARDS were as follows: 60.0%, 60.0%, 41.1%, 33.3%, 32.1%, 23.1%, 17.7%, 13.1% respectively.Conclusion Biliary disease andhyperlipidemia are the major causes of SAP in north area of Guizhou province, creatinine > 300μmol/L, intra-peritoneal hemorrhage, ARF, ACS, SOFA score, use of hormones are the independent risk factors leading to poor outcome in patients with SAP and the use of hormones cannot ameliorate the disease situation.

Effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in intensive care unit / 中华麻醉学杂志

Objective To evaluate the effect of sedation with midazolam combined with propofol on delirium in mechanically ventilated patients in the intensive care unit (ICU).Methods Five hundred and twenty-two patients who required sedation and analgesia,endotracheal intubation and mechanical ventilation used to assist respiration,aged 28-64 yr,weighing 41-82 kg,were randomized into 2 groups according to the sedation protocols during therapy:sedation with midazolam group (group M,n =240) and sedation with midazolam + propofol group (group MP,n=232).In M and MP groups,sedation was induced with midazolam infusion 0.03-0.17 mg/min,and analgesia was induced with sufentanil infusion 0.07-0.14 μg/min.In group MP,when hemodynamics was stable,pressure support was 8-10 cmH2O,tidal volume＞400 ml,RR ＜25 bpm,and FiO2＜45％,sedation was induced with propofol infusion 0.8-2.0 mg/min instead,lasting for 12-24 h.Richmond Agitation Sedation Scale score was maintained at-1 to-2 during vcntilation.The development and duration of delirium were recorded.Delirium was divided into hyperactive delirium,hypoactive delirium and mixed delirium 3 subtypes,and the development and duration of the 3 subtypes of delirium were also recorded.Results There was no significant difference between the two groups in the incidence and duration of delirium.Compared to group M,the incidence of hyperactive delirium was significantly decreased,and no significant change was found in the incidence of hypoactive delirium and mixed delirium and the duration of the 3 subtypes of delirium in group MP.Conclusion Sedation with midazolam and propofol can decrease the development of hyperactive delirium,but can not shorten the duration of delirium in mechanically ventilated patients in the ICU.

Surgical treatment of secondary epilepsy after craniocerebral operation: A report of 25 cases / 解放军医学杂志

Objective To explore the preoperative evaluation and operative indications for intractable secondary epilepsy after craniocerebral operation, and to summarize the experiences of second craniotomy for epileptogenic zone resection, so as to improve the treatment efficacy of epilepsy secondary to neurosurgery. Methods From Jan. 2005 to May 2012, a total of 25 patients with secondary epilepsy after craniocerebral operation were evaluated carefully by assessment of medical history and pre-operative video electroencephalography (VEEG) examination. Electroencephalography or implantation of subdural electrodes for localizing the epileptogenic zone was conducted in each patient during and after epileptic attack. The epileptogenic zone was confirmed by electroencephalography, MM and CT scanning before the second operation. The operation was performed along the original incision for complete exposure of the brain scar zone. After localization of the position and range of spike waves with cortical electrodes, the brain scar and epileptogenic focus were removed microscopically. After resection, re-examination was conducted with the cortical electrodes till brain wave rhythm became normal. Results No death or severe complication was found in the 25 patients. During a follow-up period of 6 months to 7 years, 18 patients were seizure free (Engel's class I), 5 patients were Engel's class II, and 2 patients were Engel's class III. No post-operative attack was found in 18 cases (72%), and 9 of them had their drugs withdrawn. Conclusion The medication effect of secondary epilepsy after craniocerebral operation is far from perfect, and second craniotomy could attain satisfactory results.