Spatial epidemiological characteristics of the mortality and probability of premature death caused by chronic obstructive pulmonary disease among residents in Pudong New Area of Shanghai in 2010-2020 / 公共卫生与预防医学

Objective To explore the spatial epidemiological characteristics of mortality and probability of premature death caused by chronic obstructive pulmonary disease (COPD) among residents in Pudong New Area of Shanghai from 2010 to 2020, and to provide reference for the formulation of chronic obstructive pulmonary disease prevention and control strategies according to local conditions. Methods The death data of chronic obstructive pulmonary disease were obtained from the local death surveillance system of Pudong New Area. Crude mortality, age-standardized mortality, and probability of premature death caused by COPD in each subdistricts and towns of Pudong New Area were calculated. The geographical information system (GIS) was used to plot the spatial distribution maps of chronic obstructive pulmonary disease death. The trend surface analysis and the spatial autocorrelation analysis were performed to analyze the spatial distribution of chronic obstructive pulmonary disease death. Results The crude mortality, age-standardized mortality and probability of premature death caused by COPD among residents in Pudong New Area between 2010 and 2020 were 58.40/100,000, 22.35/100,000, and 0.26%, respectively. The results of trend surface analysis showed that the crude mortality, age-standardized mortality and probability of premature death caused by COPD gradually increased from north to south. In the east-west direction, the crude mortality, age-standardized mortality, and probability of premature death showed an upward trend from west to east. The global autocorrelation analysis suggested that there existed a positive spatial autocorrelation for the crude mortality, age-standardized mortality, and probability of premature death. The local spatial autocorrelation analysis showed that the high-high clustering areas of COPD crude mortality, standardized mortality and premature mortality were all located in the rural areas of the southeast of Pudong New Area. Conclusion There are urban and rural differences in the mortality of chronic obstructive pulmonary disease among residents in Pudong New Area from 2010 to 2020. The residents living in rural southeast coast of Pudong New Area are more seriously affected by chronic obstructive pulmonary disease and should be paid more attention.

Bronchial Blocker and Double?Lumen Endotracheal Tube Combination to Facilitate Lung Isolation during Esophagectomy

Lung isolation is an essential anesthetic technique utilized in thoracic surgeries. We present a patient undergoing esophagectomy that developed an iatrogenic injury to the left mainstem bronchus that damaged the bronchial cuff of a left?sided double?lumen endotracheal tube (DLETT). A bronchial blocker (BB) was placed in the tracheal lumen of the DLETT as a rescue method to facilitate continued lung isolation. This unusual combination of a DLETT and a BB proved useful once the bronchial cuff was compromised and may serve as a viable solution to maintain lung isolation in similar circumstances

Detection of Synthetic Cannabinoid CUMYL-PEGACLONE in E-Cigarette Oil and Hair / 法医学杂志

OBJECTIVES@#To establish a combined high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) and gas chromatography-mass spectrometry (GC-MS) method to detect the synthetic cannabinoid CUMYL-PEGACLONE in e-cigarette oil and hair.@*METHODS@#HPLC-MS/MS and GC-MS were used to establish the detection method of CUMYL-PEGACLONE, and the hair of drug-involved persons and the seized e-cigarette oil were detected.@*RESULTS@#The main mass spectrometry characteristic ions m/z of CUMYL-PEGACLONE measured by GC-MS were 91, 179, 197, 254 and 372. CUMYL-PEGACLONE had a good linear relationship in the mass concentration range of 2-50 ng/mL, and the linear correlation coefficient (r) was greater than 0.99. The limit of detection (LOD) of CUMYL-PEGACLONE in hair was 0.01 ng/mg, and the limit of quantitation (LOQ) was 0.02 ng/mg. The LOD of CUMYL-PEGACLONE in e-cigarette oil was 1 ng/mg, and the LOQ was 2 ng/mg. The average recoveries of CUMYL-PEGACLONE under the attempt at high, intermediate and low levels in blank human hair and e-cigarette oil matrix were 98.2%-132.4% and 93.5%-110.6%, and the intraday and intraday precision were 1.2%-12.9% and 0.7%-2.9%. CUMYL-PEGACLONE was detected in the hair of 15 drug-involved persons. Except for 1 person who was lower than LOQ, the concentration of CUMYL-PEGACLONE in the hair of other 14 persons was 0.035-0.563 ng/mg. The mass fraction of CUMYL-PEGACLONE in 2 e-cigarette oil were 0.17% and 0.21%, respectively.@*CONCLUSIONS@#The established HPLC-MS/MS and GC-MS methods are applied to the detection of HPLC-MS/MS in drug-related cases, which provides strong evidence support for the handling authority to quickly investigate these cases, and also provides a reference for the identification of such substances in future.

Research on the Necessity and Feasibility of Current Medical Device Supervision Legislation / 中国医疗器械杂志

This paper studies the necessity of the current legislation on the supervision of medical devices in China from the perspectives of strengthening administration according to law, protecting public health, perfecting the legal system of medicine and promoting the development of the medical device industry. This study analyzes and summarizes the legislative experiences and forms in the field of medical device regulation in the United States, the European Union, Japan and other countries and regions, at present, the conditions of carrying out the legislation of medical device supervision in China are quite mature, and some policy suggestions are put forward for the enactment of the law of medical device management in China.

SNP double peak methods through chloroplast genome profiling for identifying Gentiana crassicaulis and two closely related species / 药学学报

italic>Gentiana crassicaulis Duthie ex Burk. is one of the plant sources of Gentianae Macrophyllae Radix (QinJiao). Gentiana tibetica King ex Hook. f. and Gentiana robusta King ex Hook. f. are relative species of G. crassicaulis. Due to the large intraspecific morphological variation, G. crassicaulis showed high morphological similarity with G. tibetica and G. robusta. And the distribution area of the three species overlaps to some extent, which makes it difficult to identify them. On the basis of morphological identification, the method of molecular identification of the three species was constructed in this study based on chloroplast genomes. The chloroplast genome of Gentiana tibetica is 148 765bp long, with LSC, SSC and IR 81 163 bp, 17 070 bp and 25 266 bp, respectively. The structure of the three is consistent. The chloroplast genome sequences of G. tibetica and G. crassicaulis are highly similar, and the number of variable sites is 9 (149 267 bp in total). Diagnostic SNP that could effectively identify the three species was screened and verified, and a dual-peak SNP detection method was established for the effective identification of each species and mixed samples. Our study provides basic data for the molecular identification of G. crassicaulis and its related species, and the arrangement of related Tibetan medicine.

Predictive values of serum 8-hydroxydeoxyguanosine on disease progression and prognosis of patients with sepsis / 中华烧伤杂志

Objective: To investigate the values of serum 8-hydroxydeoxyguanosine (8-OHdG) in predicting disease progression and prognosis of patients with sepsis. Methods: The prospective observational research methods were used. A total of 124 patients with sepsis who met the inclusion criteria were admitted to the Department of Emergency of the First Affiliated Hospital of Wenzhou Medical University from April 2015 to July 2016, including 79 males and 45 females, aged (62±15) years. The sepsis-related organ failure assessment (SOFA) scores of all patients on admission and on the second day of admission and their difference (ΔSOFA) were calculated. The patients were divided into non-progression group with ΔSOFA score <2 (n=101) and progression group with ΔSOFA score ≥2 (n=23), and according to the survival during hospitalization, the patients were divided into survival group (n=85) and death group (n=39). Data of patients between non-progression group and progression group, survival group and death group were compared, including the gender, age, days in emergency intensive care unit (ICU), smoking, hypertension, diabetes mellitus, serum white blood cell count, serum C-reactive protein, and serum procalcitonin on admission, and serum 8-OHdG within 24 h of admission. The multivariate logistic regression analysis was used to screen the independent risk factors of disease progression and death during hospitalization in 124 patients with sepsis, the receiver's operating characteristic (ROC) curves were drawn according to the independent risk factors, and the area under the curve (AUC), the best threshold, and the sensitivity and specificity under the best threshold were calculated. The patients were divided into high 8-OHdG group (n=35) and low 8-OHdG group (n=89) according to the best threshold in ROC curve of death during hospitalization. The data including the gender, age, SOFA score on admission, SOFA score on the second day of admission, and ΔSOFA score of patients in the two groups were compared. The survival rates of patients within 90 d of admission in the two groups were compared by the Kaplan-Meier method. Data were statistically analyzed with independent sample t test, Mann-Whitney U test, chi-square test, and Log-rank test. Results: The gender, age, days in emergency ICU, smoking, complicated with hypertension, complicated with diabetes mellitus, serum white blood cell count, serum C-reactive protein, and serum procalcitonin on admission of patients in non-progression group and progression group were similar (P>0.05). The serum 8-OHdG within 24 h of admission of patients in progression group was significantly higher than that in non-progression group (Z=-2.31, P<0.05). Multivariate logistic regression analysis showed that the serum 8-OHdG within 24 h of admission was the independent risk factor for disease progression of 124 patients with sepsis (odds ratio=1.06, with 95% confidence interval of 1.01-1.11, P<0.05). The AUC under the ROC curve of serum 8-OHdG within 24 h of admission to predict disease progression of 124 patients with sepsis was 0.65 (with 95% confidence interval of 0.52-0.79, P<0.05), the optimal threshold was 32.88 ng/mL, and the sensitivity and specificity under the optimal threshold was 52.2% and 79.2%, respectively. The gender, age, days in emergency ICU, smoking, complicated with hypertension, complicated with diabetes mellitus, and serum white blood cell count, serum C-reactive protein, and serum procalcitonin on admission of patients in survival group and death group were similar (P>0.05). The serum 8-OHdG within 24 h of admission of patients in death group was significantly higher than that in survival group (Z=-2.37, P<0.05). Multivariate logistic regression analysis showed that the serum 8-OHdG within 24 h of admission was the independent risk factor for death of 124 patients with sepsis (odd ratio=1.04, with 95% confidence interval of 1.00-1.09, P<0.05). The AUC under the ROC curve of serum 8-OHdG within 24 h of admission to predict death of patients during hospitalization was 0.63 (with 95% confidence interval of 0.52-0.75, P<0.05), the optimal threshold was 32.43 ng/mL, the sensitivity and specificity under the optimal threshold was 51.3% and 84.7%, respectively. The gender and age of patients in high 8-OHdG group and low 8-OHdG group were similar (P>0.05). The SOFA score on admission, SOFA score on the second day of admission, and ΔSOFA score of patients in high 8-OHdG group were significantly higher than those in low 8-OHdG group (with Z values of -2.49, -3.01, and -2.64, respectively, P<0.05 or P<0.01). The survival rate within 90 d of admission of patients in low 8-OHdG group was significantly higher than that in high 8-OHdG group (χ2=14.57, P<0.01). Conclusions: Serum 8-OHdG level is an independent risk factor for disease progression and death in sepsis patients with limited ability for predicting disease progression and prognosis of sepsis of patients. The patients with higher serum 8-OHdG level have higher death risk within 90 d of admission.

DNA barcoding of Gentiana crassicaulis in Lijiang and evaluation of root processing methods / 药学学报

The key factors for producing the best quality Chinese herbal medicines are high-quality germplasm, suitable cultivation area and the proper processing methods for herbal raw materials. Gentiana crassicaulis in Gentiana (Sect. Cruciata), Gentianaceae is one of the original plants of the Chinese herb Qinjiao (Gentianae Macrophyllae Radix), and its type specimen was collected in Lijiang, Yunnan. There is a long planting history of the herb in this area. In this study a sampling plot was designated in these traditional planting areas. G. crassicaulis was planted and herbal raw materials were harvested from the plot. The raw materials were prepared locally and at a pharmaceutical factory in Shanghai using processing methods such as "sweating" or "no sweating", "slicing" or "no slicing" (whole root), and "stoving" or "no stoving" (air drying). The quality of all processed samples was evaluated. In addition, molecular markers were determined for identifying cultivated and wild samples from Lijiang, Yunnan. The results are as follows: ① Samples from the sampling plot and the field are taxonomically identified as Gentiana crassicaulis. ② A total of 270 sequences of trnC-GCA-petN, atpB-rbcL, psbN, ndhB-rps7 and ycf1 were obtained, and three genotypes were determined from the cultivated samples; the type III was shared by both cultivated and wild plants. Based on the molecular markers, a DNA barcoding method to identify cultivated and wild samples of G. crassicaulis from Lijiang, Yunnan was established. ③ Total content of loganic acid and gentiopicroside in all samples was ≥ 2.5%, and above the Chinese Pharmacopoeia (2020) limit. ④ In HPLC fingerprinting, 9 common peaks were assigned and similarity between all samples was > 0.999; and ⑤ In a PCA score plot all slice samples were clustered, while whole root samples were scattered. Therefore, our studies could provide basic data for optimizing the processing method, producing best quality Gentianae Macrophyllae Radix, and evaluating the quality of different ecotype varieties and the multiple origin of herbal medicines.

Association of long frozen elephant trunk and incidence of spinal cord injury in patients with acute type A aortic dissection: A single center retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective    To evaluate whether long frozen elephant trunk (FET) increases the risk of spinal cord injury in patients with acute type A aortic dissection. Methods    From 2018 to 2019, 172 patients with acute type A aortic dissection were treated in Guangdong Provincial People’s Hospital. They were divided into two groups according to the length of FET: patients treated with stents of 100 mm in length were enrolled into a short FET group, and those with stents of 150 mm in length into a long FET group. There were 124 patients in the short FET group, including 108 (87.1%) males and 16 (12.9%) females with a mean age of 51.8±7.9 years. There were 48 patients in the long FET group, including 44 (91.7%) males and 4 (8.3%) females with a mean age of 50.6±9.7 years. The clinical data and prognosis of the patients were analyzed. Results    The mean distal stent graft was at the level of T 8.5±0.7 in the long FET group, and at the level of T 6.8±0.6 in the short FET group (P=0.001). Sixteen patients died after operation in the two groups, including 13 (10.5%) in the short FET group and 3 (6.2%) in the long FET group (P=0.561). There were 7 patients of spinal cord injury in the two groups, including 6 (4.8%) in the short FET group and 1 (2.2%) in the long FET group (P=0.675). There was no statistical difference in other complications between the two groups. The follow-up time was 16.7 (1-30) months. During the follow-up, 2 patients died in the long FET group and 5 died in the short FET group. No new spinal cord injury or distal reintervention occurred during the follow-up. Conclusion    Long FET does not increase the incidence of spinal cord injury in patients with acute type A aortic dissection.

Transcriptome analysis and validation of key genes involved in biosynthesis of iridoids in Gentiana lhassica / 中国中药杂志

As the main chemical constituents, iridoids are widely distributed within Gentiana, Gentianaceae, with promising bioactivities. Based on the previous work, the transcriptome of G. lhassica, an original plant of Tibetan herb "Jieji Nabao", was sequenced and analyzed in this study, and the transcriptome databases of roots, stems, leaves, and flowers were constructed so as to explore unigenes that may encode the key enzymes in the biosynthetic pathway of iridoids. Then, qRT-PCR was used to validate the relative expression levels of 11 genes named AACT, DXS, MCS, HDS, IDI, GPPS, GES, G10H, 7-DLNGT, 7-DLGT, and SLS in roots, stems, leaves, and flowers. Also, the total contents of gentiopicroside and loganic acid were determined by HPLC, respectively. The results are as follows:(1)a total of 76 486 unigenes with an average length of 852 bp were obtained;(2)335 unigenes were involved in 19 stan-dard secondary metabolism pathways in KEGG database, with phenylpropanoid biosynthesis having the maximum number(75 unigenes), and no isoflavone biosynthetic pathway was annotated;(3)171 unigenes participatedin 27 key enzymes encoding in the biosynthetic pathway of iridoids, and 1-deoxy-D-xylulose-5-phosphate reductoisomerase(DXR) gene was highly expressed;(4)qRT-PCR results were approximately consistent with RNA-Seq data and the relative expression levels of the 11 genes were higher in the aboveground parts(stem, leaf, and flower) than in the underground part(root);(5)the total contents of gentiopicroside and loganic acid were higher in the aboveground parts(stem, leaf, and flower) than in the underground part(root), and the difference was significant. This study provides basic scientific data for accurate species identification, evaluation of germplasm resources, research on secondary pro-duct accumulation of medicinal plants within Gentianaceae, and protection of endangered alpine species.

Transcriptome analysis and exploration of genes involved in the biosynthesis of iridoids in Gentiana crassicaulis (Gentianaceae) / 药学学报

italic>Gentiana crassicaulis Duthie ex Burk. in Gentiana (Sect. Cruciata), Gentianaceae, is one of the original plants of both Gentianae Macrophyllae Radix and Tibetan herb Jie-Ji Na-Bao, which contain such bioactive iridoids as gentiopicroside, loganic acid and others. In this study, based on previous work, the transcriptome of G. crassicaulis was sequenced and analyzed to construct transcriptome databases of roots, stems, leaves and flowers. qRT-PCR verification was conducted for parts of unigenes that may be key enzymes in the pathway of iridoid biosynthesis. The results are as follows: ① a total of 159 534 unigenes were obtained, with an average length of 679 bp. According to the functional classification of GO, unigenes can be divided into 3 categories with 67 branches. The unigenes were aligned in the KOG database and were classified into 25 categories according to function. ② In the KEGG database, 215 unigenes were implicated in 20 standard secondary metabolism pathways. The analysis shows that 305 unigenes encoded 28 key enzymes in the pathway of iridoid biosynthesis, and their expression in different organs is different; and ③ qRT-PCR was approximately consistent with RNA-Seq results. The 7 annotated unigenes identified in this study, HMGS, DXS, MCS, GPPS, G10H, 7-DLNGT and STR, all had higher relative expression levels in the above-ground parts (stem, leaf and flower) than in the underground part (root). Iridoids are common active and index components of such traditional Chinese medicines as Qinjiao, Longdan, Dangyao, and Qingyedan, among others. Therefore, this work provides basic scientific data for further development including obtaining active components or intermediates through biotechnology, exploring the accumulation of effective components, evaluating the quality of different ecotype varieties, and identifying authentic biosynthesis pathways of medicinal materials.

Molecular markers based upon whole chloroplast genomes and identifying alpine Gentiana waltonii and G. lhassica (Gentianaceae) / 药学学报

As two original plants of Tibetan herb Jieji, Gentiana waltonii Burk. and Gentiana lhassica Burk. belong to Section Cruciata of Gentiana, Gentianaceae. Here, we report on whole chloroplast genome sequences in the alpine species, respectively, and the features of plastomes were investigated. The plastome of G. waltonii is 148 705 bp long (148 652 bp in G. lhassica) and encodes 112 genes, including 78 protein-coding genes, 30 transfer RNA genes, and 4 ribosomal RNA genes. Two pseudogenes, namely ψrps16 and ψinfA, were found in plastomes. In addition, two novel loci were detected, and a species-specific polymerase chain reaction assay was developed for differentiating G. waltonii and G. lhassica from 10 alpine species in Section Cruciata. Gentiana. Our study provides basic data for identifying Tibetan herbs, alpine species conservation and molecular phylogenetic studies of Gentiana and Gentianaceae.

Hypernatremia increases the incidence of late delirium after cardiac surgery / 中国胸心血管外科临床杂志

@#Objective    To analyze whether hypernatremia within 48 hours after cardiac surgery will increase the incidence of delirium which developed 48 hours later after surgery (late-onset delirium). Methods    We conducted a retrospective analysis of 3 365 patients, including 1 918 males and 1 447 females, aged 18-94 ( 60.53±11.50) years, who were admitted to the Department of Cardiothoracic and Vascular Surgery of Nanjing First Hospital and underwent cardiac surgery from May 2016 to May 2019. Results    A total of 155 patients developed late-onset delirium, accounting for 4.61%. The incidence of late-onset delirium in patients with hypernatremia was 9.77%, the incidence of late onset delirium in patients without hypernatremia was 3.45%, and the difference was statistically different (P<0.001). The odds ratio (OR) of hypernatremia was 3.028 (95% confidence interval: 2.155-4.224, P<0.001). The OR adjusted for other risk factors including elderly patients, previous history of cerebrovascular disease, operation time, cardiopulmonary bypass time, lactate, hemoglobin≥100 g/L, prolonged mechanical ventilation, left ventricular systolic function, use of epinephrine, use of norepinephrine was 1.524 (95% confidence interval: 1.031-2.231, P=0.032). Conclusion    Hypernatremia within 48 hours after cardiac surgery may increase the risk of delirium in later stages.

DNA fingerprinting and genetic diversity in a threatened alpine medicinal plant, Gentiana crassicaulis (Gentianaceae) using AFLP / 药学学报

Jieji Nabao is a common Tibetan herb. According to our ethnobotanical studies, one of its original plants is identified as Gentiana crassicaulis Duthie ex Burk. (Gentianaceae). Endemic to the Qinghai-Tibet Plateau, this medicinal alpine plant is a threatened species. In this study, 163 individuals from 20 populations of G. crassicaulis were collected throughout its geographical range and amplified fragment length polymorphism (AFLP) was used to investigate genetic variation in this species. A cluster analysis was performed on the AFLP data with Halenia elliptica and Gentiana straminea as the outgroups. From 64 pairs of AFLP primer combinations, 12 pairs were selected for amplification and a total of 315 bands were amplified, of which 254 bands were polymorphic, accounting for 80.63%. High genetic differentiation was detected between populations (87%), and low within populations (13%). The UPGMA (unweighted pair-group method with arithmetic means) tree was topologically consistent with the traditional taxonomic treatments at the species level, and the populations of G. crassicaulis were divided into two branches: one from Yunnan and Guizhou, the other from Tibet, Qinghai, Sichuan and Gansu. PCA analysis and the Mantel test showed that there was a positive correlation between genetic distance and geographical distance. In addition, combined with SSR and SNP markers within cpDNA, the genetic differentiation within the Sichuan population S1 was validated.

Relationships between serum thyroid hormone levels with HBV-DNA and liver function indexes in patients with chronic hepatitis B in plateau Tibetan inhabited areas / 中国医师杂志

Objective:To detect serum thyroid hormone level, HBV-DNA expression level and liver function index in patients with chronic hepatitis B (CHB) in plateau Tibetan inhabited areas, and to analyze their correlations.Methods:From June 2016 to June 2018, 420 patients with HBsAg + CHB infection in our hospital were selected as the observation group, which was divided into Tibetan observation group ( n=300)and Han observation group ( n=120). According to the level of HBV-DNA, the observation group was divided into three groups: A, B and C group. The healthy people in the same period were selected as the control group, 220 cases in Tibetan control group and 120 cases in Han control group. The expression level of HBV-DNA was detected by fluorescence quantitative polymerase chain reaction (qRT-PCR). Serum levels of thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4), free triiodothyronine (FT3), and free tetraiodothyronine (FT4) were measured by chemiluminescence. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bile acid (TBA) levels were measured by automatic biochemical analyzer and kit; the prothrombin time (PT) was measured by hemagglutination analyzer. Results:The levels of serum ALT, AST, HBV-DNA, TBA, PT, laminin (LN), procollagen-Ⅲ (PC-Ⅲ), collagen-Ⅳ (C-Ⅳ) and hyaluronidase (HAC) in Tibetan and Han observation group were significantly higher than those in Tibetan and Han control group ( P<0.05). The level of serum HAC in Tibetan patients with CHB was significantly higher than that in Han CHB patients ( P<0.05); the level of serum ALT, AST, PT, TBA, C-Ⅳ, PC-Ⅲ, HAC, LN increased with the level of serum HBV-DNA in patients with CHB ( P<0.05); the level of serum TSH, T3, T4, FT3, FT4 and T3/T4 ratio in Tibetan and Han patients with CHB had no significant difference ( P>0.05). With the increase of serum HBV-DNA level in Tibetan patients, serum T3 level and T3/T4 ratio in group B and C were significantly lower than those in the control group ( P<0.05), T4 level was significantly higher than that in the control group ( P<0.05), and the levels of FT3, FT4 and TSH were not significantly different from those in the control group ( P>0.05). The results of Pearson test showed that serum T3 level and T3/T4 ratio were negatively correlated with ALT, AST, PT, TBA, LN, HBV-DNA, C-Ⅳ and HAC levels in Tibetan CHB patients ( P<0.05); serum T4 level was positively correlated with ALT, AST, PT, TBA, LN, HBV-DNA, C-Ⅳ and HAC levels in Tibetan CHB patients ( P<0.05). Conclusions:Thyroid hormones TSH, T3, and T4 levels in CHB patients in plateau Tibetan inhabited areas are decreased significantly with the increase of HBV-DNA levels, and they are negatively correlated with ALT, AST, PT and TBA levels, suggesting that HBV infection may cause liver injury to some extent, and then affect the level of thyroid hormone.

Risk factors for delirium after cardiovascular surgery: a retrospective study of 7 001 cases / 中国医师进修杂志

Objective:To investigate the incidence of delirium and related risk factors in patients after cardiovascular surgery.Methods:From May 2012 to May 2019, 7 001 patients underwent cardiovascular surgery in the Nanjing First Hospital were retrospectively analyzed. The general clinical data, operation name, operation time, cardiopulmonary bypass time, aortic occlusion time, analgesic and sedative drugs use during postoperative ICU treatment, confusion assessment method for the intensive care unit (CAM-ICU) score, length of ICU stay, total hospital stay, adverse prognosis and postoperative delirium were recorded. The influence of postoperative delirium on hospital stay and adverse prognosis was analyzed. The risk factors of postoperative delirium were explored.Results:Among the 7 001 patients, 573 (8.18%) had postoperative delirium (delirium group), while 6 428 patients had no delirium (non-delirium group). The incidence of postoperative delirium in patients with acute aortic dissection (AAD) after Sun′s operation was significantly higher than that in patients with other cardiovascular surgery: 45.03% (204/453) vs. 5.64% (369/6 548), and there was statistical difference ( P<0.05). The age, length of ICU stay, total hospital stay, incidence of adverse prognosis, operation time, cardiopulmonary bypass time and aortic occlusion time in delirium group were significantly higher than those in non-delirium group: (59.72 ± 12.48) years vs. (58.81 ± 12.16) years, 5.49 (2.87, 9.49) d vs. 1.12 (0.90, 1.95) d, 21.92 (17.90, 28.22) d vs. 17.85 (14.93, 21.76) d, 7.33% (42/573) vs. 2.13% (137/6 428), (5.43 ± 2.51) h vs. (4.06 ± 1.33) h, (140.01 ± 55.13) min vs. (108.07 ± 42.98) min and (85.23 ± 37.30) min vs. (72.50 ± 34.15) min, and there were statistical differences ( P<0.01). Multivariant Logistic regression analysis result showed that intraoperative deep hypothermic circulatory arrest and selective cerebral perfusion was independent risk factor of postoperative delirium in patients with cardiovascular surgery ( OR = 10.922, 95% CI 7.444 to 16.120, P < 0.01). After excluding AAD patients, the incidences of postoperative delirium were 2.63% (11/418), 4.16% (34/817), 4.37% (71/1 625), 5.13% (122/2 379), 9.34% (114/1 221) and 19.32% (17/88) for patients<40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years, 70 to 79 years and ≥ 80 years respectively. The incidence of postoperative delirium increased with age ( Z= 2.63, P= 0.009). The incidences of postoperative delirium were 1.47% (45/3 056), 3.22% (63/1 954), 5.69% (34/597), 12.14% (38/312), 18.18% (22/121), 22.62% (38/168), 25.93% (21/81) and 41.70% (108/259) for patients who stayed 1, 2, 3, 4, 5, 6, 7 and>7 d in ICU. The longer stay in ICU, the higher the incidence of postoperative delirium ( Z= 3.34, P = 0.001). Sequential organ failure score (SOFA) was used to evaluate the organ functions of patients. The scores of respiratory system, circulatory system, liver function and renal function in delirium group were significantly worse than those in non-delirium group, and there were statistical differences ( P<0.01); there was no significant difference in coagulation function between 2 groups ( P > 0.05). According to the use of analgesic and sedative drugs during the postoperative ICU stay, the patients were divided into dexmedetomidine alone group (3 355 cases) and dexmedetomidine combined with dezocine group (1 396 cases). The incidence of postoperative delirium in dexmedetomidine combined with dezocine group was significantly higher than that in dexmedetomidine alone group: 19.20% (268/1 396) vs. 5.66% (190/3 355), and there was statistical difference ( P<0.01). Conclusions:Age, operation time, extracorporeal circulation time, aortic occlusion time, intraoperative hypothermic circulatory arrest with selective cerebral perfusion, severity of disease and length of ICU stay are independent risk factors for postoperative delirium in patients after cardiovascular surgery. The choice of analgesic and sedative drugs during the perioperative period may affect the occurrence of postoperative delirium.

Neutrophil to lymphocyte ratio is a prognosis factor for post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients / 中华医学杂志(英文版)

BACKGROUND@#Although a variety of risk factors of pneumonia after clipping or coiling of the aneurysm (post-operative pneumonia [POP]) in patients with aneurysmal subarachnoid hemorrhage (aSAH) have been studied, the predictive model of POP after aSAH has still not been well established. Thus, the aim of this study was to assess the feasibility of using admission neutrophil to lymphocyte ratio (NLR) to predict the occurrence of POP in aSAH patients.@*METHODS@#We evaluated 711 aSAH patients who were enrolled in a prospective observational study and collected admission blood cell counts data. We analyzed available demographics and baseline variables for these patients and analyzed the correlation of these factors with POP using Cox regression. After screening out the prognosis-related factors, the predictive value of these factors for POP was further assessed.@*RESULTS@#POP occurred in 219 patients (30.4%) in this cohort. Patients with POP had significantly higher NLR than those without (14.11 ± 8.90 vs. 8.80 ± 5.82, P 10 had significantly worse POP survival rate than patients having NLR ≤10. NLR at admission might be helpful as a predictor of POP in aSAH patients.

Postoperative renal replacement therapy in patients with acute Stanford type A aortic dissection: risk factors and predictive modeling / 中华胸心血管外科杂志

Objective:To analyze the risk factors for postoperative renal replacement therapy(RRT) in patients with acute Stanford type A aortic dissection. Develop and validate a prediction model based on the risk factors with the purpose of early intervention.Methods:A retrospective analysis of 215 patients who underwent surgery for acute Stanford type A aortic dissection in our hospital from April 2016 to April 2019 were performed. Clinical variables including age, gender, basal blood pressure, preoperative serum creatinine, intraoperative blood pressure, operation time, cardiopulmonary bypass time, aortic occlusion time, intraoperative blood transfusion(including autologous blood), intraocular fluid infusion, colloidal fluid infusion, intraoperative urine volume, bleeding volume, total fluid balance, and postoperative blood lactate value were collected and their association with renal replacement therapy were analysed. Clinical variables were screened using lasso regression. Applying the post-filtering variables to construct a predictive model, calculating the area under the receiver operating characteristic curve( AUC) of the predictive model and the sensitivity and specificity under the optimal threshold for model evaluation. Results:In the 215 patients with acute Stanford type A aortic dissection, 38 patients required renal replacement therapy, accounting for 17.67%. Preoperative serum creatinine, operation time, cardiopulmonary bypass time, aortic occlusion time, intraoperative blood pressure less than 80mmHg time, intraoperative blood pressure less than 55% of basal blood pressure time, intraoperative blood transfusion, intraoperative crystal fluid dosage, intraoperative urine volume and lactate value after ICU admission were important risk factors for postoperative renal replacement therapy(RRT) in patients with acute Stanford type A aortic dissection. The AUC for the predictive model established using these variables was 0.955(95% CI: 0.897-1.000). The specificity under the optimal threshold was 96.1% and the sensitivity was 90.9%. Conclusion:Perioperative clinical variables can predict the possibility of RRT in patients with acute Stanford type A aortic dissection after surgery, which may provide the possibility for early intervention.

Analysis of transcriptomes to explore genes contributing to iridoid biosynthesis in Gentiana waltonii and Gentiana robusta (Gentianaceae) / 药学学报

The roots and flowers of Gentiana waltonii and Gentiana robusta are used as Tibetan herb Jie-Ji in traditional Tibetan medicine, with iridoids as the main active ingredient and index components. To study the pathway of iridoid biosynthesis, roots, stems, leaves and flowers of G. waltonii and G. robusta were subjected to a high-throughput transcriptomic sequencing analysis by Illumina HiseqXTen. After removing insignificant reads and de novo splicing, 79 455 and 78 466 unigenes were obtained from G. waltonii and G. robusta respectively, with average length as 834 bp and 862 bp. The unigene GO functions could be divided into three categories of 65 branches. The unigenes were aligned in KOG database and were classified into 25 classes according to function. In KEGG database, 315 and 340 unigenes of G. waltonii and G. robusta were implicated in 20 standard secondary metabolic pathways, respectively. Furthermore, 80 and 57 unigenes of the two species were analyzed to encode 24 key enzymes in the pathway related to iridoid biosynthesis. There were differences in gene expression among different organs. Based on sequence data, significant amounts of SSRs, SNPs and InDels were detected in each dataset. This study provides a platform for further development of molecular markers, excavation of functional genes, and research into metabolic pathways and their regulatory mechanism within G. waltonii and G. robusta.

The identification of Sect. Cruciata (Gentiana) species using mtDNA nad1/b-c and nad5/d-e fragments / 药学学报

italic>Gentiana section Cruciata (Gentianaceae) is a medicinally important section of herbs, including Chinese traditional medicine Gentianae Macrophyllae Radix and Tibetan herb Jieji. Here, we assess the taxonomic significance using mtDNA nad1/b-c and nad5/d-e sequence data. A total of 144 nad1/b-c and nad5/d-e sequences from 11 species within Gentianaceae were obtained, including 138 sequences from 10 species within Gentiana section Cruciata and 6 sequences from Halenia elliptica (outgroup). The results showed that mtDNA nad1/b-c has species- level resolution within the section of Cruciata, i.e. the variable in the position 45 “C” could be used as a stable marker locus to distinguish G. robusta from other taxa; the variable in the position 352 and 353 “GA” could distinguish G. crassicaulis and G. tibetica from other taxa within the section. Intraspecies genotype variability was detected in nad1/b-c sequences of G. officinalis and G. siphonantha, respectively. These genotypes could be used as potential DNA barcode. In addition, intraspecies genotype variability was detected in nad5/d-e sequences of G. macrophylla, G. officinalis and G. siphonantha, respectively. Based on the stable marker locus, a species-specific PCR protocol was developed using the primer PF to identifying G. robusta in the section. This study could expand the understanding of the diversity of mtDNA nad1/b-c and nad5/d-e in the genus Gentiana, and provide the essence for the species identification within Gentiana section Cruciata.

Prediction by intravascular ultrasound with monocyte to high density lipoprotein-cholesterol ratio of prognosis in patients with intermediate non-left main coronary lesions underwent percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To investigate the prediction by intravascular ultrasound (IVUS) with monocyte to high density lipoprotein-cholesterol (HDL-C) ratio (MHR) of 12-month prognosis in patients with intermediate non-left main coronary lesions after percutaneous coronary intervention (PCI). Methods Patients with intermediate non-left main coronary lesions diagnosed by coronary angiography were tested of monocyte counts and HDL-C levels at admission with MHRs calculated. IVUS was used to examine plaque stability in target lesions. Patients were dviided into stable plaque group (n=44) and unstable plaque group (n=140) according to the IVUS results. PCI was then operated in patients with unstable plaque or with minimum lumen area<4 mm2. The major adverse cardiovascular events (MACE) were recorded during the follow-up period of 12 months after PCI. Results MHR was significantly higher in unstable plaque group than that in stable plaque group[(22.6±8.4) vs.(14.1±7.2),P<0.001]. Receiver-operating characteristic (ROC) analysis revealed that an MHR cut-off of 16.05 had 74.2％ sensitivity and 77.0％ specificity for prediction of 12-month MACE after PCI (AUC 0.78, 95％ CI 0.71–0.85, P<0.001). Besides, unstable plaque with MHR over 16.05 was an independent risk factor for 12-month MACE after PCI (adjusted HR 3.26, 95％ CI 2.48–4.14, P=0.020). Conclusions IVUS combined with MHR is a valuable index predicting the prognosiso f patients with intermediate non-left main coronary lesions who underwent PCI.