Assessment of the effect of cinacalcet on right ventricular function in rats with pulmonary arterial hypertension by echocardiography: an experimental study / 中华超声影像学杂志

Objective:To evaluate the effect of cinacalcet on right ventricular function in rats with MCT-induced arterial pulmonary hypertension by echocardiography.Methods:Thirty male SD rats were randomly divided into control group, PAH group, and cinacalcet group, with 10 rats in each group. Rats in the cinacalcet group were given intraperitoneal injection of cinacalcet hydrochloride with 30 mg/kg, and the control group and the PAH group were given equal-volume of solvent. Echocardiographic parameters: right ventricular wall thickness (RVWT), right ventricular basal dimension (RVD), left ventricular eccentricity index (EI), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tricuspid lateral annular systolic velocity (s′), right ventricular global longitudinal strain (RV4CSL), and right ventricular free wall longitudinal strain (RVFWSL), etc. Histopathological parameters: pulmonary arteriole wall thickness (WT), right ventricular cardiomyocyte mean diameter (RV cell-D), collagen volume fraction (CVF) and right ventricular hypertrophy index (RVI). Echocardiographic and pathological parameters were compared among three groups, and the correlation between right ventricular pathological changes and strain parameters was analyzed.Results:①Compared with the control group, WT, RV cell-D, CVF and RVI in PAH group were increased (all P<0.01), the size of right ventricle and thickness of RV wall were increased (all P<0.05), and the right ventricular longitudinal strain was reduced ( P<0.01). ②Compared with the PAH group, rats in the cinacalcet group showed reduced WT, RV cell-D, CVF and RVI (all P<0.01), as well as improved structure and function of the right ventricle (all P<0.05). There was no statistical difference of the above parameters between cinacalcet and control group (all P>0.05). ③Correlation analysis: the right chamber remodeling parameters CVF and RV cell-D were positively correlated with WT ( rs=0.706 3, 0.629 4; both P<0.05); and RVFWSL correlated well with CVF, RV cell-D ( rs=-0.685 3, r=-0.767 2; both P<0.05). Conclusions:The right ventricular inverse remodeling of PAH rats with the intervention of cinacalcet was retained, suggesting that cinacalcet had a protective effect on the structure and function of the right ventricle in rats with PAH.

Analysis of prognosis and influencing factors of childhood acute necrotizing encephalopathy / 中华实用儿科临床杂志

Objective:To analyze the prognosis and influencing factors of acute necrotizing encephalopathy (ANE) in children.Methods:Clinical data of ANE patients admitted to Pediatric Intensive Care Unit, Beijing Children′s Hospital, Capital Medical University from March 2012 to February 2019 were retrospectively analyzed.Survivors were followed up by telephone or outpatient department, and the quality of life was evaluated by pediatric overall performance category scale.The t-test or rank sum test was used for comparison between groups, and the COX risk regression was used to analyze the influencing factors of prognosis. Results:A total of 38 patients were enrolled in this study with the male-to-female ratio of 1.24∶1.00, and median age of 29.5(10.0-130.0) months.They were followed up for the median of 27(15-96) months.The overall survival rate at 7 days, 14 days and 2 months after disease onset were 57.9%, 42.1%, and 34.2%, respectively.The mortality rate at discharge was 34.2%(13/38 cases), and the cumulative mortality rate at the 1 st, 3 rd and 12 th months after discharge was all 68.4%(26/38 cases). The complete reco-very rate was 10.5%(4/38 cases) after one-year follow-up.The univariate analysis indicated that cardiopulmonary resuscitation before admission, Glasgow coma score < 5 at admission, complication with shock/cerebral hernia/multiple organ dysfunction syndrome, creatine kinase isoenzyme> 100 U/L, lactate dehydrogenase>1 000 U/L, hypoalbuminemia, hyperglycemia, hyperurea, prolonged prothrombin time and elevated international standardized ratio were risk factors for the prognosis of ANE in children ( β=3.519, 6.967, 6.803, 3.000, 6.389, 3.471, 2.252, 1.616, 2.377, 3.092, 2.713, and 4.510, respectively, all P<0.05). Meanwhile, high-dose Methylprednisolone[20-30 mg/(kg·d)] and immunoglobulin (2 g/kg, divided into 2-5 days intravenous drip) treatment were protective factors ( β=0.625, 0.405, respectively, all P<0.05). The COX multivariate analysis showed that high-dose Methylprednisolone treatment [20-30 mg/(kg·d)] was an independent protective factor for the prognosis of children with ANE [95% CI: 0.449(0.213-0.944), P=0.035]. Conclusions:Early application of high-dose Methylprednisolone and immunoglobulin may contribute to the good clinical outcome.Children with neurological sequelae should be actively treated with rehabilitation, and the quality of life may be gradually improved.

Long-term protective effects of the nicotiflorin on ischemic stroke rats / 药学实践杂志

Objective To investigate the long-term protective effects of the nicotiflorin on ischemic stroke rats. Methods Ischemic stroke model in rats was established for this study. The effects of nicotiflorin on long-term survival rate, nervous system function, body weight and brain neurons in rats were observed. Results The nicotiflorin had significantly improved the long-term survival rate of cerebral ischemia rats, which also promoted weight gain, alleviated pathological damage of brain tissue, maintained morphology of brain neurons and function of nervous system. Conclusion The nicotiflorin has obvious long-term protective effect on ischemic stroke rats and the mechanism may be related to the protection of the structure and function of brain neurons.

Research progress of relevance between cholecystokinin and depression / 中国临床药理学与治疗学

Depression is a mental illness characterized by significant and lasting depression. Recent studies have found that cholecystokinin, as a small brain-gut peptide molecule, is widely distributed in the central nervous system and enteric nervous system. In order to further clarify the relationship between CCK and the pathogenesis of depression, this article reviews the effect of CCK in depression, including HPA axis, synaptic function and circuit mechanism, etc.

Epidemiological characteristics and prognosis of acute necrotizing encephalopathy in children / 中国小儿急救医学

Acute necrotizing encephalopathy (ANE) is a rare but distinctive acute encephalopathy with global distribution.It usually begins with a virus-associated febrile illness, which deteriorates rapidly, and leading to convulsion, unconsciousness and even coma.The neuroradiologic features of ANE are multi-focal and symmetrical brain lesions, involving bilateral thalamus.ANE has no specific treatment method at present.The majority of ANE patients are accompanied with varying degrees of neurological sequelae, and even death.In this review, we summarized the epidemiology, diagnosis and prognosis of this rare but fatal disease in children.

Effects of 17β-estradiol on stromal cell-derived factor-1 expression after retinal ischemia-reperfusion injury / 眼科新进展

Objective To examine the expression of stromal cell-derived factor-1 (SDF-1) in a rat model of retinal ischemia-reperfusion injury (RIRI),and investigate the protective effect of 17β-Estradiol (E2) on RIRI and explore the mechanism.Methods The RIRI model was established in Sprague-Dawley rats by increasing the intraocular pressure.Relative expression levels of SDF-1 mRNA and protein in the retina at 6 hours,12 hours and 24 hours following reperfusion was determined by RT-PCR and Western blot,respectively.E2 was administered to investigate the effects of estrogen on SDF-1 expression,and the estrogen receptor antagonist ICI 182-780 was administered to investigate the effect of estrogen receptor on the expression of SDF-1.Results SDF-1 expression in RIRI 6 hours group,12 hours group and 24 hours group was increased compared with normal control group (all P ＜ 0.05),with maximum expression at RIRI 12 hours group.As expected,pretreatment of RIRI rats with E2 had a protection on RIRI retina;SDF-1 expression was increased in RIRI + E2 group compared with IR control group and RIRI + vehicle group (all P ＜ 0.05).RIRI + E2 + ICI 182-780 group could decrease SDF-1 expression compared with RIRI + E2 group(all P ＜ 0.05).Conclusion E2 offers protection against RIRI by inducing an up-regulation in SDF-1 expression through activation of the estrogen receptor.

Clinical characteristics of severe anti-N-methyl-D-aspartate receptor encephalitis in four children / 临床儿科杂志

Objective To explore the clinical features and treatment strategy of severe anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children. Methods The clinical data and follow-up information of 4 children with severe anti-NMDAR encephalitis were retrospectively analyzed. Results Four patients (one male and 3 females) were 10 to 13 years old and one child had teratoma combined. In all patients symptoms at onset mainly were psychiatric syndrome and movement disorder, and then progressed to seizures, disturbance of consciousness and central hypoventilation respiratory failure in one month. The anti-NMDAR antibodies in cerebrospinal fluid were positive in all patients. The EEG showed focal or diffuse slow waves. The brain MRI showed no pathological changes at the diagnosis. The treatment included methylprednisolone and large doses of intravenous immunoglobulin (IVIG), ventilator for 5-95 days, and tracheotomy in 2 cases. One case died because of serious infection. In 21-27 months of the follow-up, one case had clinical recovery; 2 cases had the sustained use of immunosuppressive agents and anti-epileptic drugs and the clinical symptoms were significantly improved. The EEG and anti-NMDAR antibodies continued abnormal in the patient combined with teratoma. One patient relapsed. Conclusions The severe anti-NMDAR is more likely in older female children. The central hypoventilation respiratory failure occurs in the early course of the disease. Combination with tumor is high risk factor. Conventional hormone therapy and ventilator treatment is effective. The recovery is slow. It may be relapsed even one year later.

Protective effects of the total bakkenolides from Petasites .tricholobus on high al-titude hypoxia / 药学实践杂志

Objective To study the protective effects of the total bakkenolides from P .tricholobus on high altitude hy-poxia .Method Normobaric hypoxia model and acute hypobaric hypoxia model in mice ,hypobaric hypoxia model in rats were established for this study .Survival time and survival rate of mice were recorded .The level of blood sugar and glycogen ,adeno-sine triphosphate (ATP) ,lactic acid (LD) ,lactic dehydrogenase (LDH) were detected in different organs of rats .Results The total bakkenolides significantly prolonged the survival time of mice in normobaric hypoxia model and reduced the death rate of mice in acute hypobaric hypoxia model .The total bakkenolides suppressed blood sugar level in rats and increased the glyco-gen level in rat liver ,skeletal muscle and myocardium .It also elevated the ATP content in rat brain ,liver ,skeletal muscle and myocardium .Meanwhile ,the content of LD in plasma ,skeletal muscle ,myocardium and LDH level in myocardium were re-duced .Conclusion The total bakkenolides from P .tricholobus have protective effect on normobaric hypoxia model and acute hypobaric hypoxia model in mice as well as hypobaric hypoxia model in rats .Its anti-hypoxia efficacy at high altitude may relate to the increased blood sugar ,glycogen ,and ATP level and reduced LD ,LDH level in major organs .

The influences of DAO and SNGF in the treatment of hypothermia for neonates after birth asphyxia / 中国基层医药

Objective To study the changes of diamine oxidase (DAO)levels in neonates with hypoxic -is-chemic encephalopathy (HIE)treated with selective brain hypothermi,also to further evaluate Scores for Newborn Gastrointestinal Functior (SNGF).Methods 60 newborns with moderate and severe HIE who were in the NICU of our department from June 2013 to December 2014 were collected.The 60 newborns were randomly divided into hypo-thermia treatment group (HG)and conventional treatment group(CG).The serum was collected and ELISA method was used to test the consistency of DAO on admission and 7 days afterwards,respectively.Meanwhile,the SNGF level of the two groups at the two time points was compared.Results Neither the DAO and SNGF level of the two groups had statistical difference on admission(all P >0.05).Seven days later,both the DAO of the two groups and the SNGF decreased[(12.51 ±1.53)u/mL vs (7.88 ±1.87)u/mL,however,the variation of the hypothermia treatment group was apparently more significant than the change of the conventional treatment group(P =0.011).The SNGF scores of the two groups all decreased,while the hypothermia treatment group was significantly lower than the conventional treat-ment group,the difference were statistically significant (P =0.044,0.006,0.013).Besides,there was remarkably positive correlation between serum DAO level and SNGF (r1 =-0.825,r2 =-0.876,all P <0.05).Conclusion Hypothermia treatment could effectively reduce the injury of asphyxia neonatal gastrointestinal tract by inhibiting the level of DAO,thus improve the gastrointestinal function.

The changes and significance of diamine oxidase and intestinal fatty acid binding protein in the treat-ment of hypothermia for neonates after birth asphyxia / 中国小儿急救医学

Objective To study the changes of diamine oxidase (DAO )and intestinal fatty acid binding protein (I-FABP)levels in neonates with hypoxic-ischemic encephalopathy treated with selective brain hypothermia.Methods Collect a sample of 60newborns with moderate and severe hypoxic-ischemic encephalopathy who were hospitalized in the NICU of Matemal and Child Health Care Hospital of Baoding from June 2013to December 2014.The 60newborns were divided into two groups randomly:hypothermia group(n=30)and conventional treatment group(n=30).Selected 30cases hospitalized at the same period, except the related to the ischemia hypoxia and gastrointestinal dysfunction disease as the control group.The levels of serum levels of DAO and I-FABP were measured by ELISA on admission and 7days after treat-ment,respectively.And the score of gastrointestinal dysfunction were compared.Results Neither the levels of DAO and I-FABP in hypothermia group and conventional treatment group had statistical differences on ad-mission[DAO:(15.77±2.04)U/ml,(15.81±1.85)U/ml,P﹥0.05;I-FABP:(310.01±46.43)ng/L, (301.12±38.61)ng/L,P﹥0.05],but were higher than that in the control group [(7.65±0.74)U/ml, (51.65±6.91)ng/L].Seven days after treatment,both the levels of DAO and I-FABP of hypothermia group and conventional treatment group decreased [DAO:(7.88±1.87)U/ml,(12.51±1.53)U/ml;I-FABP:(59.16±6.17)ng/L,(121.31±21.54)ng/L],meanwhile,the variation of hypothermia group was more significant(P﹤0.05).The correlation of the plasma DAO and I-FABP levels and the score of gas-trointestinal dysfunction was significantly (r1=0.831,r2=0.827,P ﹤0.01).Conclusion Hypothermia treatment could effectively reduce the levels of DAO and I-FABP,thus improve the gastrointestinal function in some extent.

Outcome follow-up and reason analysis in long PICU stay patients / 中国小儿急救医学

Objective To analyse the reasons for patients′long PICU stay and to discuss how to de-crease their PICU stay length and optimize medical resource utilization.The another objective is to identify these patients′long-term outcome.Methods We retrospectively analysed the basic information of patients who stayed in our PICU more than 30 days during January 1,2013 to July 31,2014,including pediatric criti-cal illness score on admission,primary diseases and outcome on discharge,in order to determine main reasons for their long PICU stay.Follow-up prognosis was made by Paediatric Overall Performance Category.We used SPSS 19.0 to do data analysis.Results Sixty-seven patients enrolled in this study included 43 boys and 24 girls,49.2%of whom came from emergency department.The median age was 24 months(IQR 8,108), while median length of PICU stay was 39 days(IQR 31,49).Mean pediatric critical illness score on admi-ssion was 78.39 ±9.57.Mean hospital fees was(144 071.74 ±76 944.74)Yuan.Thirty(44.8%)patients did not have any medical insurance.Top three primary diseases were respiratory disease(30 cases),neurolog-ical disease(8 cases)and systemic infection(6 cases).Top three underlying diseases were tracheostenosis or bronchopulmonary dysplasia(6 cases),congenital heart disease(5 cases)and immunodeficiencies(4 cases). Top three complications were respiratory failure(30 cases),multiple organ dysfunction or failure(16 cases), shock(9 cases).Top three reasons for longer PICU stay were weaning off mechanical ventilation difficulty (29 cases),department or hospital transference difficulty(20 cases),feeding difficulty(16 cases).Fifty-four patients were discharged with better health condition,10 patients were auto-discharge.The mortality at dis-charge,1 month after discharge,3 months after discharge and 6 months after discharge were 4.5%,20.9%, 25.4% and 25.4%,respectively.Total 36(53.7%)patients had a good or mildly abnormal Paediatric Over-all Performame Category score(1-2 points)at 6 months after discharge.Conclusion Sequential noninvasive ventilation,timely tracheotomy,timely patients′transference to general ward,development of family ward and rehabilitation wards,appropriate nutrition delivery,regularly difficult disease consultation,reduction of hospi-tal infection and complications may do contribution to shorten these patients′length of PICU stay.Children who survive longer than 3 months after discharge have better long-term prognosis.

The clinical value of atrial natriuretic peptide,endothelin-1 and von Willebrand factor in newborns with persistent pulmonary hypertension after the treatment of sildenafil / 中国医师进修杂志

Objective To study the changes and significance of plasma atrial natriuretic peptide (ANP),endothehn-1 (ET-1),von Willebrand factor (vWF) levels in newborns with persistent pulmonary hypertension (PPHN) after the treatment of sildenafil.Methods Sixty-six cases with PPHN group and 40 cases with non-PPHN (control group) were enrolled.PPHN group was in the treatment of sildenafil.Collected the blood when before the treatment of sildenafil and 3,7 d after treatment,respectively.Arterial blood gas were done and pulmonary arterial systolic pressure (PASP) was measured before treatment and 3,7 d after treatment,and by the same time recording pulse oxygen saturation (SpO2).Plasma ANP,ET-1,vWF levels were measured by ELISA method.Results The levels of PASP,SpO2 arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) and plasma ANP,ET-1,vWF in PPHN group before treatment [(66.5 ± 13.4)mm Hg (1 mm Hg =0.133 kPa),0.726 ±0.531,(46.3 ±7.2)mm Hg,(59.2 ± 7.4) mm Hg,(272.6 ± 20.3)ng/L,(221.3 ± 24.3) ng/L,(142.5 ± 20.3)％] compared with controlgroup [(25.0±6.2) mm Hg,0.896 ± 0.767,(88.3 ±7.6) mm Hg,(41.1 ±6.1) mm Hg,(68.4 ± 7.9) ng/L,(39.8 ± 6.5) ng/L,(95.3 ± 18.5)％] were statistically significant(P ＜ 0.05).Their levels in PPHN group 3 dafter treatment[(48.3 ± 3.2) mm Hg,0.841 ± 0.416,(73.6 ± 9.3)mm Hg,(50.5 ± 7.2) mm Hg,(102.6 ±20.3) ng/L,(79.6 ± 15.2) ng/L,(103.6 ± 14.1)％] were significantly improved,there was significantdifference compared with before treatment and control group(P ＜ 0.05).Their levels in PPHN group 7 d aftertreatment [(25.2 ± 3.6) mm Hg,0.882 ± 0.724,(85.4 ± 7.4) mm Hg,(40.2 ± 6.4) mm Hg,(64.4 ± 3.6)ng/L,(37.3 ± 5.4)ng/L,(92.9 ± 11.7)％] were significantly improved,there was significant difference compared with 3 d after treatment (P ＜ 0.05),the difference was no statistically significant compared with control group (P＞ 0.05).Linear correlation analysis showed that ANP,ET-1,vWF and PASP,PaCO2 were significantly positively correlated (P ＜ 0.01),ANP,ET-1,vWF and SpO2,PaO2 were significantly negatively correlated (P＜ 0.01).On the basis of cardiac ultrasound monitoring PASP,ANP evaluation of the efficacy of sildenafil sensitivity was 82.2％,specificity was 83.4％ ;ET-1 was 86.4％ and 87.6％; vWF was 85.1％ and 84.7％.Conclusion ANP,ET-1,vWF may play an important role in the mechanism of the treatment of PPHN by sildenafil,and could be used as an objective index to evaluate the effect of sildenafil on PPHN.