Analysis of early acute gastrointestinal injury and its influencing factors in patients with extracorporeal membrane oxygenation / 中华急诊医学杂志

Objective:To investigate the acute gastrointestinal injury (AGI) in patients with extracorporeal membrane oxygenation (ECMO) at the early stage of operation and its influencing factors.Methods:A total of 70 patients with ECMO who were hospitalized in the Emergency Care Unit of Guangxi Zhuang Autonomous Region People's Hospital from September 2020 to December 2021 were retrospectively analyzed, and a total of 70 patients with ECMO who were hospitalized in the emergency care unit of Guangxi Zhuang Autonomous Region People's Hospital from September 2020 to December 2021 were retrospectively analyzed. According to the 2012 guidelines of the European Society of Intensive Care Medicine on the classification of acute gastrointestinal injury in critically ill patients, the patients were divided into AGI group and non-AGI group. The incidence of acute gastrointestinal injury in the early stage was statistically analyzed, and the results of blood gas analysis during ECMO loading and ECMO parameters, hemodynamic indexes and biochemical indexes after ECMO transfer were statistically analyzed. To explore the influencing factors and independent risk factors of AGI in the early stage. In addition, 70 patients were divided into successful group and non-successful group according to whether they were successfully withdrawn. The occurrence of acute gastrointestinal injury between the two groups was compared, and the effect of acute gastrointestinal injury on ECMO patients was analyzed.Results:Among the 70 ECMO patients, the incidence of early AGI was 71.43% (50 cases), and the components of AGI Ⅰ, Ⅱ, Ⅲ and Ⅳ were 18.57% (13 cases), 41.43% (29 cases), 11.43% (8 cases) and 0% (0 cases), respectively. ① Univariate analysis showed that systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), vasoactive drug index (VIS), pH, lactic acid and BMI were significantly different between AGI group and non-AGI group when ECMO was used ( P < 0.05). Logistic binary regression analysis showed that BMI was an independent risk factor for early AGI in ECMO patients (ROC area 0.657, 95% confidence interval 0.522-0.791 ( P < 0.05), and Yoden index 0.15). (3) The AGI composition ratio of the unsuccessful group was higher than that of the unsuccessful group ( P < 0.05). Conclusions:Patients with ECMO have a high incidence of AGI in the early stage, mainly occurring in grade I and Ⅱ. Systolic blood pressure, diastolic blood pressure, MAP, VIS, pH, lactic acid and BMI when ECMO is put on are influential factors for the early development of AGI in ECMO patients, among which BMI is an independent risk factor for the early development of AGI in ECMO patients. The occurrence of AGI reduces the probability of successful withdrawal in ECMO patients.

Independent risk factors for renal function non-recovery at 28 days after ECMO initiation among patients receiving ECMO complicated with acute kidney injury / 中华急诊医学杂志

Objective:To investigate the recovery of renal function and its influencing factors in patients receiving extracorporeal membrane oxygenation (ECMO) support and complicated with acute kidney injury(AKI).Methods:This was a retrospective observational study. The clinical data of patients with ECMO support and AKI admitted to the Emergency intensive care unit of the People's Hospital of Guangxi Zhuang Autonomous Region from October 2019 to December 2021 were collected. The patients were divided into renal function recovery group and renal function non-recovery group according to the recovery of renal function after 28 days of ECMO. With renal function non-recovery at 28 days as the end point of the study, and the variables with significant differences in baseline were selected for stepwise backward regression to determine the independent risk factors. The receiver operator characteristic (ROC) curve was drawn, and the area under the curve (AUC) was used to evaluate the diagnostic value of independent risk factors.Results:A total of 40 patients were enrolled, of which 28 patients (70%) had recovery of renal function, and 12 patients (30%) did not have recovery of renal function. Stepwise backward multivariate logistic regression analysis showed that lactate level at ECMO initiation was an independent risk factor for non-recovery of renal function ( OR = 1.380, 95% CI: 1.096-1.738, P = 0.006). The ROC curve showed that the AUC and 95% CI were 0.863 (0.751-0.975), the sensitivity was 100%, and the specificity was 75%. Conclusion:Lactate level at ECMO initiation was an independent risk factor for non-recovery of renal function on 28 days after ECMO initiation among patients undergoing ECMO support complicated with AKI. Lactate has a high predictive value for the non-recovery of renal function.

Clinical feature difference between juvenile amyotrophic lateral sclerosis with SPTLC1 and FUS mutations / 中华医学杂志(英文版)

BACKGROUND@#Juvenile amyotrophic lateral sclerosis (JALS) is an uncommon form of amyotrophic lateral sclerosis whose age at onset (AAO) is defined as prior to 25 years. FUS mutations are the most common cause of JALS. SPTLC1 was recently identified as a disease-causative gene for JALS, which has rarely been reported in Asian populations. Little is known regarding the difference in clinical features between JALS patients carrying FUS and SPTLC1 mutations. This study aimed to screen mutations in JALS patients and to compare the clinical features between JALS patients with FUS and SPTLC1 mutations.@*METHODS@#Sixteen JALS patients were enrolled, including three newly recruited patients between July 2015 and August 2018 from the Second Affiliated Hospital, Zhejiang University School of Medicine. Mutations were screened by whole-exome sequencing. In addition, clinical features such as AAO, onset site and disease duration were extracted and compared between JALS patients carrying FUS and SPTLC1 mutations through a literature review.@*RESULTS@#A novel and de novo SPTLC1 mutation (c.58G>A, p.A20T) was identified in a sporadic patient. Among 16 JALS patients, 7/16 carried FUS mutations and 5/16 carried respective SPTLC1 , SETX , NEFH , DCTN1 , and TARDBP mutations. Compared with FUS mutation patients, those with SPTLC1 mutations had an earlier AAO (7.9 ± 4.6 years vs. 18.1 ± 3.9 years, P  < 0.01), much longer disease duration (512.0 [416.7-607.3] months vs. 33.4 [21.6-45.1] months, P  < 0.01), and no onset of bulbar.@*CONCLUSION@#Our findings expand the genetic and phenotypic spectrum of JALS and help to better understand the genotype-phenotype correlation of JALS.

Application of target controlled infusion mode based on precision anesthesia concept in cardiac surgery anesthesia / 局解手术学杂志

Objective To explore the effect and safety of target controlled infusion mode based on precision anesthesia concept in cardiac surgery anesthesia.Methods A total of 100 patients underwent cardiac surgery in our hospital were selected as the research subjects,and they were randomly divided into the control group and the observation group,with 50 cases in each group.The surgical types,surgical related indicators,dosage of anesthetic drugs,and complications of the two groups were compared.Results There was no statistically significant difference in the proportions of patients who underwent coronary artery bypass surgery,valve surgery,macrovascular surgery,artial septal defect repair surgery,or other types of surgery between the two groups(P>0.05).There were statistically significant differences in the surgical time,bleeding volume,infusion volume,proportion of cardiopulmonary bypass,times of postoperative analgesic drug use and mechanical ventilation duration between the two groups(P<0.05).The usage of various anesthetic drugs in the observation group was lower than that in the control group,with statistically significant difference(P<0.05).The incidence of complication in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The target controlled infusion mode based on precision anesthesia concept can be used for cardiac surgery anesthesia to reduce the dosage of anesthetic drugs and postoperative complications,and improve the anesthesia effect and surgical safety.

Application of extracorporeal membrane oxygenation in the treatment of persistent pulmonary hypertension of the newborn / 中国当代儿科杂志

OBJECTIVES@#To study the clinical value of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).@*METHODS@#A retrospective analysis was performed on the medical data of 11 neonates with PPHN who were treated with ECMO in the Neonatal Intensive Care Unit of Zhongshan People's Hospital from January 2015 to December 2021, involving the neonates' general information, clinical diagnosis, laboratory results, duration of ECMO treatment, complications during ECMO treatment, length of hospital stay, and outcome.@*RESULTS@#Of the 11 neonates, 10 (91%) had successful weaning from ECMO, and 8 (73%) survived. For the 11 neonates, the mean duration of ECMO treatment was (81±50) hours (range: 26 to 185 hours), the mean duration of ventilator use was (198±105) hours (range: 57 to 392 hours), and the mean length of hospital stay was (22±15) days (range: 2 to 49 days). The oxygenation index and blood lactate level were significantly improved after 24 hours of ECMO treatment among the 11 neonates (P<0.05). Ten neonates had significantly reduced pulmonary artery pressure after 24 hours of ECMO treatment (P<0.05). One neonate had a progressive increase in the pulmonary artery pressure during EMCO treatment, succumbing to death. This neonate was diagnosed with alveolar capillary dysplasia based on the histopathological findings of the lung tissue and whole-exome sequencing results. Among the 11 children, 5 had intracranial hemorrhage, 1 had disseminated intravascular coagulation, 1 had gastric hemorrhage, 2 had pulmonary hemorrhage, 1 had renal insufficiency, and 3 had bleeding at the puncture site during ECMO treatment.@*CONCLUSIONS@#ECMO is effective for the treatment of PPHN, however, the high incidence of complications of ECMO treatment suggests that it is important to carefully assess the indications and timing of ECMO treatment and improve the management of ECMO, which can improve the weaning rate and survival rate.

The protective effect of lentinan regulating autophagy on HUVEC injury induced by high glucose and its mechanism / 中国药理学通报

Aim To study the effect of lentinan ( LNT) on the injury of human umbilical vein endothelial cells (HUVECs) induced by high concentration of glucose ( HG) and its mechanism so as to provide a new theo¬retical basis for the treatment of diabetic angiopathy.Methods After screening the optimal concentration of HG-induced HUVEC injury, different concentrations of LNT were given and then HUVEC cell viability, reac¬tive oxygen species ( ROS ) , superoxide dismutase (SOD) ,and malondialdehyde (MDA) levels were de¬tected.Autophagy level in HUVECs was determined by MDC staining.Beclin-1 level was detected by PCR.The expression of LC3, inducible nitric oxide synthase (iNOS) and the phosphorylation level of p38 MAPK were detected by Western blot.Results 120 mmol • L"1 HG could cause moderate HUVEC injury.LNT could improve the declining HUVEC viability induced by HG, alleviate the increasing ROS,upgrade the level of SOD level, downgrade the level of M DA, raise the autophagy level in HUVECs,and decrease the expres-sion of iNOS and p38 MAPK phosphorylated protein in HUVECs.Conclusions LNT can improve HG-in- duced HUVEC injury,and the mechanism is related to regulating ROS/p38 MAPK pathway to enhance auto¬phagy levels and improve intracellular oxidative stress.

Chemical constituents from Incarvillea delavayi / 中草药

Objective: To investigate the chemical constituents from the whole plant of Incarvillea delavayi. Methods: The whole plant of I. delavayi was extracted by 90% ethanol. Various chromatography methods were employed to separate the chemical constituents, and the structures were identified by comprehensive spectroscopic analysis. Results: Fourteen compounds, including cyclohexanethanoids, monoterpene alkaloids, and triterpenoids, were obtained from the 90% ethanol extract of I. delavayi. Their structures were identified as 5-hydroxyethyl-6-hydroxyl-3-methyl benzofuran (1), cleroindicin B (2), 3,4,5-trimethoxyl benzoic acid ethyl ester (3), 3,4,5-trimethoxyl benzoic acid methyl ester (4), 6-hydroxyl dihydrobenzofuran (5), 2-(4'-ethoxyphenyl)-ethanol (6), tecomine (7), (+)-epidihydrotecomanine (8), 5-hydroxy skytanthine (9), δ-skytanthine (10), isoincarvilline (11), mairine B (12), coelobillardierine (13), and 3β-acetyl oleanolic acid (14). Conclusion: Compound 1 is identified as new compound and named as delavayol A, while compounds 3-6, 9-11, and 13 are isolated from the titled plant for the first time.

Simultaneous determination of five ginkgolic acids in ginkgo folium by HPLC / 中国药学杂志

OBJECTIVE: To develop an HPLC method for simultaneous determination of ginkgolic acids(C13:0, C15:1, C17:2, C15:0, C17:1) in Ginkgo Folium. METHODS: The HPLC analysis was carried out on Phenomenex Luna C18(4.6 mm × 250 mm, 5 μm) column with acetonitrile-0.1% phosphoric acid (90:10) as mobile phase eluted at the flow rate of 1.0 mL · min-1. The detective wavelength was set at 310 nm, and the column temperature was set at 30℃. RESULTS: The calibration curve was linear within the range of 1.47-29.40 μg · mL-1 for C13:0, 6.05 -121.00 μg · mL-1 for C15:1 and 8.00 - 160.00 μg · mL-1 for C17:1, respectively. The average recoveries for the three marker compounds are 98.6% - 100.1%. CONCLUSION: This method is simple, accurate, and practical for the quality control of Ginkgo Folium. There are some differences in the contents of the five marker compounds from different producing areas and different collection periods.

Clinical characteristics of 42 cases of spontaneous intracranial hypotension with cerebrospinal leakage / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To review the clinical characteristics of spontaneous intracranial hypotension (SIH) with cerebrospinal fluid (CSF) leakage.</p><p><b>METHODS</b>Clinical data of 42 SIH patients with cerebrospinal leakage, whose diagnosis met the criteria of the International Headache Classification, were retrospectively reviewed. The patients were divided into short (n=27) and long (n=15) course groups. The clinical data and imaging features were compared between two groups.</p><p><b>RESULTS</b>Thirty-nine patients (92.9%) had orthostatic headache. Compared with the short course group, the frequency of headache were significantly lower in patients with long disease duration (80% vs 100%, P =0.040); the ratio of high CSF opening pressure (>=60.0 mm H2O), the average CSF opening pressure, and the frequencies of subdural hematoma were higher in long course group than those in short course group [60.0% vs 20.8%, (64.7±42.1) vs (40.0±33.8)mm H2O, and 50.0% vs 11.6%; P=0.019, 0.038 and 0.018, respectively]. Forty-two patients underwent CT myelography;definite focal CSF leakage sites were found in all patients and multiple sites of CSF leakage in 38 patients.</p><p><b>CONCLUSION</b>All SIH do not necessarily show the typical clinical manifestations, and cranial MRI and CT myelography are helpful in the diagnosis. Because of higher risk of subdural hemorrhage, patients with long disease duration require active intervention.</p>

Expression of Six1 and Six4 in esophageal squamous cell carcinoma and their correlation with clinical prognosis / 中华病理学杂志

<p><b>OBJECTIVE</b>Six1 and Six4 are expressed in several tumors, and associated with tumor progress and poor prognosis. The aim of this study was to investigate the expression of Six1 and Six4 in esophageal squamous cell carcinoma (ESCC), and to evaluate their correlation with the clinicopathological factors and prognosis.</p><p><b>METHODS</b>Tissue microarray technology and immunohistochemical method (EnVision) were used to detect the expression of Six1 and Six4 in the tumor tissues and corresponding adjacent normal epithelium of esophagus from 292 ESCC patients.</p><p><b>RESULTS</b>Among the 292 ESCC patients, the positive rates of Six1 and Six4 protein expression in tumor tissues were 72.9% (213/292) and 56.2% (164/292), respectively, significantly higher than the expression rate of 33.2% (97/292) and 32.5% (95/292) in adjacent normal epithelium of esophagus (P < 0.05). Chi square test showed that the expression of Six1 protein was related to tumor size, depth of tumor invasion and patient survival status; higher Six4 protein expression level was related to poor differentiation and increased depth of invasion. Single factor Log-rank analysis revealed that gender, TNM stage, Six1 protein expression level were related to the overall survival of ESCC patients (P < 0.05), while the five-year survival rate was significantly higher in the Six1-negative group than the Six1-positive group [51.9% (41/79) vs. 43.7% (93/213)]. Multi-factor Cox proportional risk model analysis showed that TNM stage and positive expression of Six1 were independent prognostic factors for ESCC patients (P < 0.05).</p><p><b>CONCLUSIONS</b>Six1 and Six4 are highly expressed in ESCC. Their expression levels are closely related to the progress and prognosis of ESCC. Over-expression of Six1 is related to poor prognosis in ESCC patients. Thus, Six1 could be used as an important prognostic indicator for ESCC patients.</p>

The value of pro-adrenomedullin for predicting the severity and outcome of community-acquired pneumonia / 中国综合临床

Objective To investigate the value of pro-adrenomedullin (pro-ADM) levels for severity as-sessment of community-acquired pneumonia (CAP).Methods 214 CAP patients who were admitted to the emer-gency department were prospectively studied.The levels of plasma pro-ADM were determined using a new sandwich immunoassay.At the same time, procalcitonin, C-reactive protein, interleukin-6 levels, leukocyte count, clinical varia-bles and the pneumonia severity index (PSI) were measured.Results Pro-ADM levels,in contrast to procalcitonin,interleukin-6 levels, increased with increasing of the severity of CAP, which was classified according to the PSI score (P<0.05).In patients who died during follow-up, pro-ADM levels on admission were significantly higher than that in survivors [2.08 vs.4.94 μg/L,Z=-4.081 ,P<0.001].In a receiver operating characteristic (ROC) analysis for survival, the area under the ROC curve (AUC) for pro-ADM was 0.79, which was significantly higher than that for procalcitonin(0.72), C-reactive protein (0.58), interleukin-6 (0.64 ), and total leukocyte count (0.50) and sim-ilar to the AUC of the PSI (0.75).Conclusion Pro-ADM is a useful biomarker for the risk stratification of CAP patients.

Researching the character and stenosis of coronary calcified plaques by using 16-slice spiral CT / 中国医学科学院学报

<p><b>OBJECTIVE</b>To explore the characters of coronary calcified plaques by using 16-slice spiral CT and determine their stenosis degree according to the results of catheter coronary angiography.</p><p><b>METHODS</b>Twenty patients who had received 16-slice spiral CT coronary angiography and conventional coronary angiography (CAG) were found to be with calcified plaques. The characters of these plaques, including the diameter of calcified plaques and lumen diameter of the exact artery segment, were retrospectively analyzed. The stenosis degree of the corresponding segment was judged in accordance with the results of CAG.</p><p><b>RESULTS</b>Totally 84 calcified plaques were observed in 16-slice spiral CT images in these 20 patients. Among them there were 16 small nodules (diameter: < 0.15 cm), 56 purely calcified plaques (diameter: > or = 0. 15 cm), and 12 complex plaques with calcify component. There was no obvious stenosis in artery segments with little calcified nodules. The stenosis degree of most segments with purely calcified plaques (75%) was less than 50%. The stenosis degree had no significant correlation with the size of plaques (P > 0.05). However, the stenosis degree of complex plaques had much closer relationship with the characters of mixed plaques.</p><p><b>CONCLUSIONS</b>Most coronary segments with calcified plaques have slight stenosis. Their stenosis degree is not related with the size of plaques. The stenosis degree of complex plaques has a closer relationship with the characters of mixed plaques.</p>

Functional MRI of human brain in musicians and non-musicians / 浙江大学学报·医学版

<p><b>OBJECTIVE</b>To explore the differences in brain activation between musicians and non-musicians by use of functional MRI.</p><p><b>METHODS</b>Twelve right-handed musicians and twelve right-handed non-musicians were recruited in the study. During a listening task, they were scanned on the Sigma 1.5T scanner (GE) while they were passively listening to several segments of music of "the Butterfly Love" and the white noise with same physical energy.</p><p><b>RESULT</b>Both musicians and non-musicians demonstrated bilateral transverse gyrus weak activated while listening to the white noise. But when listening to music, they showed bilateral temporal areas strongly activated including superior temporal gyrus, transverse gyrus and some middle temporal areas. Moreover, musicians showed relative left dominance (10/12), whereas non-musicians demonstrated right dominance(11/12). Furthermore,besides bilateral temporal areas, more and stronger activated areas were found in musicians such as cuneus, precuneus,medial frontal and left middle occipital gyrus.</p><p><b>CONCLUSION</b>There are different neuro-patterns between musicians and non-musicians.</p>