Methodology for the Development of Clinical Practice Guidelines for Chinese Patent Medicine （Part 6）： Formation and Presentation of Recommendations / 中医杂志

Recommendation formation is a key component of clinical practice guidelines for Chinese patent medicine （CPM）， and should encompass the determination of the strength and direction of the recommendation， the rationale for the recommendation， and the methodology for implementing the recommendation. Recommendations can be formed through formal consensus and informal consensus. The strength and direction of recommendations for CPM guidelines should be determined by considering the quality of evidence for CPMs， the priority of the clinical questions， the pros and cons of efficacy and adverse effects， patient acceptance， the feasibility of the recommendation and the availability of resources， social fairness， economic benefits， and other influencing factors. In order to better guide guideline developers to consider these factors more rationally， this article provideed a detailed explanation of each factor in the context of the characteristics of TCM.

Management of Acute Cerebral Infarction by Intravenous Thrombolysis with Recombinant T Cell Receptor and Plasminogen Activator and Association of Emergency Nursing Route in the Prognosis.

The purpose of this study is to determine the impact and prognosis of the emergency nursing approach in conjunction with the use of recombinant T cell receptors and plasminogen activators in patients who have just had an acute stroke. In this study, 100 patients were randomly selected that were equally divided into experimental and control groups. The period of hospital admission, the results of the Montreal Cognitive Assessment (MoCA) and the Mini-mental State Examination (MMSE), the results of the Glasgow Outcome Scale (GOS), and the results of the Activities of Daily Living were all analysed before and after the intervention.. Both the amount of time it took to get a diagnosis after being admitted and the amount of time it took to receive specialised therapy after receiving a diagnosis were significantly reduced in the observation group (both P values less than 0.05). At one month after discharge, the scores of ADL, MoCA, MMSE, and GOS rose in both groups, with more significant changes occurring in the observation group (all P<0.05). This was due to the fact that ADL scores declined while scores for MoCA, MMSE, and GOS increased. The percentage of people who were disabled in the observation group was significantly lower than the percentage in the control group (P<0.05).  Including emergency, nursing might drastically reduce the time it takes for patients with acute stroke to be admitted and begin receiving specialised care.

Clinical features of Purtscher-like retinopathy associated with COVID-19 / 中华眼底病杂志

Objective:To analyze the clinical features in patients of Purtscher-like retinopathy (PLR) associated with COVID-19.Methods:A retrospective clinical study. Clinical data of 4 patients (7 eyes) of PLR associated with COVID-19 which was firstly diagnosed in Department of Ophthalmology, The Second Hospital of The Army Medical University ranging from December 2022 to January 2023 were included. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, optical coherence tomography (OCT), OCT angiography, fundus fluorescein angiography (FFA), multifocal electroretinogram (mf-ERG), visual field. Oral vasodilators and neurotrophic agents were applied after definite diagnosis. Three patients were treated by intravenous dexamethasone (10 mg) for 3 days. Follow-up time spans for 4 weeks. The multi-model images, clinical features and treatment response of patients were also retrospectively studied.Results:Among 4 patients (7 eyes), 2 cases were male (3 eyes), 2 cases were female (4 eyes), the mean age was (36.00±17.57) years; 3 cases were unilateral, 1 case were unilateral. The time from diagnosis of COVID-19 to the onset of eye symptoms was 2 to 3 days. The BCVA of the affected eye was finger counting for 20 cm to 0.5. Color fundus photography examination revealed that several retinal whitening of varying sizes distributed diffusely on the retina (cotton-wool spots and Purtscher flecken). OCT examination showed that the retinal nerve fiber layer was significantly thickened and the reflex was enhanced in the area corresponding to the gray and white lesions, the inner nuclear layer, internal and external plexus layer segmental and banded strong reflex was observed in 5 eyes. En-face image showed mottled strong reflex in the inner retinal layer and around the deep capillary plexus (DCP). For OCTA, the signal of superficial capillaries and cotton wool spots were lost, and blood flow of deep DCP was poorly distributed. FFA examination showed that the obscured fluorescence of choroid background of Purtscher spot and capillary non-perfusion area. mf-ERG examination showed decreased amplitude of retinal a-wave and b-wave. Visual field examination showed central and paracentral scotoma. During follow-up, the BCVA of diseased eyes were raised, scotomas were shrunk, cotton wool spots and Purtscher flecken became smaller. OCT examination showed that the thickness of the original thickened retinal nerve fiber layer became thinner, the area of the strong reflex area was reduced, and the inner layer of the original segmental strong reflex area was thinner. OCTA examination revealed partial recovery of blood flow signal.Conclusion:For PLR associated with COVID-19, OCT shows thickening of retinal nerve fiber layer, segmental and banding strong reflex in part of the inner layer and inner plexus layers; OCTA is manifested by ischemia in the middle retina and DCP.

Clinical and multimodel image features in patients of acute macular neuroretinopathy associated with COVID-19 / 中华眼底病杂志

Objective:To observe the clinical and multimodel image features in patients of acute macular neuroretinopathy (AMN) associated with COVID-19.Methods:Clinical data and multimodal imaging results in 12 patients (24 eyes) of AMN associated with COVID-19 which were diagnosed in our Department of Ophthalmology, The Second Hospital of The Army Medical University ranging from December 2022 to January 2023 were included. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, optical coherence tomography (OCT), OCT angiography (OCTA), visual field tests, high-resolution computed tomography of the lungs and inflammation-related laboratory tests. After diagnosis, patients were reveived methylcobalamin and Ginaton therapy, 6 patients receiced intravenous dripping of dexamethasone. The follow-up time of this study was 4 weeks.Results:There were 1 male (2 eyes) and 11 females (22 eyes), with the mean age of (29.00±5.17) years. For all cases, decreased vision presented 1 to 2 days after patients being suffered from several flu-like symptoms of COVID-19. Ten eyes in 5 patients were at the acute phrase of AMN, which the vision decrease occurred 1-5 days after they were diagnosed with COVID-19; 14 eyes in 7 patients were at the progressive stage of AMN, which they were diagnosed with COVID-19 for more than 5 days. The BCVA of patients were 0.02-0.9, in company with one or more central/pericentral scotoma. Fundus ophthalmoscopy revealed reddish-brown lesion around macula, IR imaging demonstrated localized areas of hypo-shape lesions in the macula. For 16 eyes, their OCTA revealed a decreased density of blood flow in the deep layer of retinal capillary plexus, and OCT revealed that high reflex bands existed in the outer nuclear layer (ONL) and outer plexiform layer of the retina at the acute phrase of AMN, in accompany with hypo-reflection in ellipsoid zone (EZ) and interdigitation zone (IZ); for retina at the progressive stage of AMN, ONL became thinner in some cases and the continuation interruption occurred in EZ and IZ. For en-face OCT, high reflex bands with clear edges existed in the ONL and EZ layer of the retina at the acute phrase of AMN, but no high reflex bands existed in the ONL and EZ layers of the retina at the progressive stage of AMN. Instead, hypo-reflection with similar shape occurred in the EZ and IZ layers at the progressive stage of AMN. During treatment, 5 patients at the acute phrase reported a shrinking central scotomas and raised BCVA, otherwise the BCVA of 7 patients at the progressive stage changed slightly. For 10 eyes at the acute phrase of AMN, OCT revealed that the high reflex bands of ONL and OPL missed within 1 week. En-face OCT revealed the hyper-reflection in the ONL and EZ layers of retina in the acute phrase of AMN receded within 1 week, but hypo-reflection of ONL and EZ still presented.Conclusions:For AMN associated with COVID-19, IR imaging demonstrated localized areas of hypo-shape lesions in the macula. OCT revealed high reflex bands in ONL and OPL of the retina at the acute phrase of AMN, but hypo-reflection of ONL and EZ still presented. The continuation interruption occurred in EZ and IZ at the progressive phrase. En-face OCT revealed hyper-reflection in ONL and EZ of the retina at the acute phrase which receded within 1 week, and hypo-reflection in EZ and IZ of the retina presented at all phrases during AMN progression.

The safety and efficacy of a dedicated neonatal-infant 0.35 T brain MRI system / 中华放射学杂志

Objective:To evaluate the safety and efficacy of a dedicated neonatal-infant brain 0.35 T MRI system.Methods:A dual-center controlled clinical trial was conducted with single-arm objective performance criteria. From June to July 2020, sixty-six infants aged 0-12 (6.3±3.4) months were recruited from Children′s Hospital of Soochow University and the First People′s Hospital of Lianyungang prospectively. All infants underwent brain MRI with a dedicated neonatal-infant 0.35 T brain MRI system, using the dedicated two-channel transceiver head coil. MRI protocol included spin echo T 1WI, fast spin echo T 2WI, fluid attenuated inversion recovery, diffusion weighted imaging and 3D gradient echo sequence. MRI sequences were set with three orientations (axial, sagittal and coronal). Each case received at least two scanning planes and two scanning sequences. Five-point Likert scoring system was used to evaluate the image quality of acquired images, and the target value was set as at least 3 points per image. The temperature, heart rate and breathe of the infants were recorded before and after MRI; the acoustic noise of the MRI system was measured during the scanning process; and the adverse reactions were recorded if presented. Results:Five infants successfully completed their examination during non-sedated sleep in a single attempt, and 61 infants after sedation with chloral hydrate. Based on MRI-based five-point Likert scoring system, 41 cases achieved a score of 5, 21 cases with a score of 4 and 4 cases with a score of 3. Cases with score of 3 was due to movement of the infants during the scan, which resulted in motion related artifacts. The vital signs of all infants showed stable before and after imaging, with heart rate of (126.8±12.9) beats per minute, breathe of (38.2±6.8) times per minute. It was found that 47 cases showed no sign of temperature raise after brain MRI, 15 cases had less than 0.3 ℃ raise and 4 cases had 0.3 ℃ to 0.5 ℃ raise. The noise recorded during the scanning process was (57.5±1.8) dB(A). One case had mild diarrhea on the day of MR scan, and the symptoms disappeared on the second day without treatment; no adverse reactions were found for the rest subjects.Conclusion:Dedicated neonatal-infant 0.35 T brain MRI system allows data acquisition with high safety and excellent image quality, which has potentials in the clinical applications.

Standard on classification of Traditional Chinese Medicine ancient books / 国际中医中药杂志

The standardization of classification methods of Traditional Chinese Medicine(TCM) ancient books can provide a clear and reliable reference for all kinds of TCM ancient books collection units, which can also promote the sharing and utilization of TCM ancient books. We studied and investigated the classification methods of TCM ancient books in past dynasties. The standard on classification of TCM ancient books was formulated by compared with the classification table of Zhongguo Zhongyi Guji Zongmu, and referred to the classification table of Zhonghua Guji Zongmu. This standard specified three-level categories and classification principles of TCM ancient books, and mainly composed of basic categories, three-level category table, classification principles and examples, and instructions for use.

Discussion on a new model of holistic treatment for chronic critical illness patients by internal cross-disciplinary team in the department of intensive care unit: clinical data analysis of a case of acute exacerbation of chronic obstructive pulmonary disease / 中华危重病急救医学

Objective:To explore the effect of setting up an internal-cross disciplinary team (ICDT) in the intensive care unit (ICU) on a new model of overall treatment for patients with chronic critical illness (CCI).Methods:A 60-year-old male patient with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) admitted to ICU in the Second Affiliated Hospital of Fujian Medical University was introduced. The role of ICDT composed of physicians, nurses, respiratory therapists, physiotherapists, clinical dietitians and patients' family members in ventilator withdrawal and super-early rehabilitation was analyzed in this case.Results:The patient was diagnosed as AECOPD, type Ⅱ aspiration penumonia respiratory failure, septic shock. The ICDT in ICU carried out early rehabilitation treatment for the patient on the basis of traditional infection control and supportive treatment. Under the care of the ICDT, peripheral blood white blood cell count (WBC), neutrophil count (NEU), procalcitonin (PCT), arterial partial pressure of carbon dioxide (PaCO 2), maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), right excursion of diaphragm, sputum viscosity, tidal volume (VT) and respiratory rate (RR) were improved. Subsequently, the ventilator mode was gradually changed and the ventilator parameters were down-regulated. The ventilator was successfully weaned on the 10th day of treatment. After weaning, the patient's bedside pulmonary function indicators improved, and he was transferred out of ICU on the 15th day of treatment and discharged on the 20th day. The mental state of the patients was good and the quality of life was greatly improved in CCI outpatient follow-up. Conclusions:ICDT cooperation is very important for monitoring and treatment of CCI patients, which is beneficial to the super-early rehabilitation and prognosis improvement of critically ill patients.

Biological Mechanism of Pyroptosis and Its Research Progress in Breast Cancer / 肿瘤防治研究

Pyroptosis is a newly discovered way of proinflammatory programmed cell death. Pyroptosis is mediated by caspase-1 (Caspase-1). Through the cleavage and activation of GSDM family proteins, small pores are formed on the cell membrane, thus rapid lysis of the cell membrane process, and then leads to intracellular inflammatory content release thereby causing inflammatory response. The three pyroptosis pathways are the classical pathway of Caspase-1, the non-classical pathway of Caspase-4, 5, and 11, and the special pathway of Caspase-3 or Hela cells. Pyroptosis plays an important role in the occurrence, invasion, and metastasis of breast cancer, and is closely related to the prevention and treatment of breast cancer. This article reviews the biological mechanism of pyroptosis and its research progress in breast cancer, to provide a new idea for clinicians in the treatment of breast cancer.

Analysis of etiology and clinical characteristics of 618 children with severe community-acquired pneumonia / 中国小儿急救医学

Objective:To understand the etiology and clinical characteristics of hospitalized severe community-acquired pneumonia(SCAP) in Changchun, and provide scientific basis for its etiology diagnosis and targeted treatment.Methods:The study subjects included 618 children with clinical diagnosis of SCAP who were hospitalized from January 2016 to December 2019.We collected pharyngeal swabs and alveolar lavage fluid from children.Virus isolation, bacterial culture, time-of-flight mass spectrometry, PCR/RT-PCR, colloidal gold method and Optochin test were used to detect the antigen, nucleic acid and protein profiles in the specimen.Results:There were more boys than girls in hospitalized children with SCAP.The peak age of onset was 7 to 12 months.Most cases occurred in winter and spring.The highest detection rate of SCAP virus was 56.15%(347/618); 73.49%(255/347) were positive for one virus, among which the top five were respiratory syncytial virus (27.8%), influenza A virus (23.9%), influenza B virus (16.1%), rhinovirus (12.2%) and metapneumovirus (10.2%). Two viruses were positive for 19.88%(69/347); three viruses were positive for 4.32%(15/347); four viruses were positive for 2.31%(8/347). Atypical microbial infections were 29.77%(184/618), of which Mycoplasma pneumoniae accounted for 95.65%(176/184). Bacterial infections were 17.31%(107/618), mainly Streptococcus pneumoniae(39.25%, 42/107) and Staphylococcus aureus(24.30%, 26/107). The mixed infection of multiple pathogens was 7.61%(47/618), among which the mixed infection rates of Mycoplasma pneumonia with Streptococcus pneumoniae, virus were 40.43% and 34.04%, respectively.High fever, faster breathing, and perioral cyanosis were risk factors for SCAP, with OR and 95% CI of 7.71 and 4.56-13.04, 2.43 and 2.02-2.93, 3.53 and 2.56-4.86, respectively.Viral co-infection occurred in 36.96%(34/92) of complications such as heart failure, toxic encephalopathy, and myocardial damage; Mycoplasma pneumoniae and other pathogens co-infected 35.29% of children with pleural effusion. Conclusion:The pathogens of SCAP in Changchun are mainly viruses notably, respiratory syncytial virus is the dominant pathogen, followed by Mycoplasma pneumoniae.The bacterial pathogen is mainly Streptococcus pneumoniae.High fever, faster breathing, and cyanosis around the mouth are risk factors for severe pneumonia.Multi-pathogen mixed infection is prone to serious complications.

The application progress of fluid de-escalation therapy in abdominal infection-induced septic shock / 中华危重病急救医学

After adequate fluid resuscitation in the early stage of septic shock, excessive accumulation of fluid in the body leads to organ dysfunction, which prolongs hospitalization, mechanical ventilation time, and renal replacement therapy time, and is associated with poor prognosis. The fluid de-escalation therapy is an important fluid management strategy performed in the late stage of septic shock. It aims to clear excess fluid by restricting fluid infusion, using diuretics and renal replacement therapy to achieve a negative fluid balance. The fluid de-escalation therapy contributes to improve clinical outcome of septic shock patients and reduce the mortality. This review mainly discusses the current researches and application progress of the fluid de-escalation therapy of abdominal infection-induced septic shock through clarifying its origin, time and endpoint, method of the therapy, the relationship with the control of the source of abdominal infection and its impact on organ function and clinical outcome. Our study intends to provide guidance for the treatment of abdominal infection-induced septic shock in the late stage, and explore the novel research directions.

Children with parainfluenza pneumonia complicated with rhabdomyolysis syndrome and acute kidney injury: a case report and literature review / 中华危重病急救医学

Objective:To investigate the diagnosis and treatment of children with parainfluenza pneumonia complicated with rhabdomyolysis syndrome and acute kidney injury (AKI).Methods:The clinical manifestations, laboratory and imaging examination results and diagnosis and treatment process of a child with parainfluenza pneumonia complicated with rhabdomyolysis syndrome and AKI admitted to the department of intensive medicine of the Second Affiliated Hospital of Fujian Medical University on July 14th, 2014 were retrospectively analyzed to provide experience and methods for the treatment of such patients.Results:The patient, a Chinese 11-year-old boy, admitted to hospital with "sore throat, fever, and double lower limb pain for 2 days". The clinical manifestations were sore throat, fever, pain in both lower extremities, fatigue, and soy sauce urine. Limb muscle tenderness, bilateral lower limb was obvious. Laboratory examination showed that blood creatine kinase (CK), MB isoenzyme of creatine kinase (CK-MB), aspartate transaminase (AST), lactate dehydrogenase (LDH), α-hydroxybutyrate dehydrogenase (HBDH) and hematuria myoglobin (Mb) were significantly elevated, and blood parainfluenza viruses (1, 2, 3 types) was positive for immunoglobulin M (IgM) antibodies. Chest X-ray shown bronchial pneumonia in the right lower lung. Pneumonia with rhabdomyolysis syndrome was considered. Anti-infection, fluid hydration, alkalized urine, diuresis and other treatment was initially prescribed. However, the condition became worse, combined with secondary epilepsy, AKI, acute heart failure, transferred to the intensive care unit (ICU). The child was put on mechanical ventilation through oral tracheal intubation, continuous hemofiltration, anti-infection and anti-virus treatment. The child's condition gradually recovered, symptoms and signs disappeared, and finally he was discharged with full recovery.Conclusions:Children with parainfluenza pneumonia can induce rhabdomyolysis. If myalgia is progressively worsened and walking is difficult, we should be highly alert to the occurrence of rhabdomyolysis. And when soy sauce urine, hematuria were noticed, and blood CK, Mb increased significantly, rhabdomyolysis syndrome can be diagnosed. Once the diagnosis is established, rehydration, alkaline urine and diuresis should be carried out in a timely manner to increase myoglobin tubular excretion. Antiviral treatment can reduce the dissolution of striated muscles. If blood purification is needed, hemofiltration and/or plasma exchange can be selected.

Analysis of respiratory pathogens for children respiratory tract infection by capillary electrophoresis﹣based multiplex PCR / 中国小儿急救医学

Objective To investigate the effect of capillary electrophoresis﹣based multiplex PCR ( CEMP) in detecting pathogens for children respiratory tract infection,and to provide scientific basis for clin﹣ical diagnosis and treatment rapidly and accurately. Methods The cases were defined according to the na﹣tional monitoring program of febrile respiratory syndrome during the 12th Five﹣Year Plan,and the samples were collected from nasopharyngeal swabs,bronchoalveolar lavage fluid and sputum of children with respira﹣tory tract infection hospitalized in Changchun Children′s Hospital from January 2017 to February 2018. Multi﹣plex PCR amplification was performed by one﹣step method, then PCR products were separated by DNA length size with capillary electrophoresis and pathogens were analyzed by"Genemapper software" software. Detecting pathogens included Influenza A virus (InfA),Human Adenovirus (HADV),Boca virus ( Boca), Human Rhinovirus ( HRV), Novel InfA﹣09H1 ( InfA﹣09H1 ) and Seasonal Influenza virus H3N2 ( InfA﹣H3N2),Parainfluenza virus ( HPIV),Human metapneumonia virus ( HMPV), Influenza B virus ( InfB), Mycoplasma pneumoniae (Mp),Chlamydia pneumoniae ( CP),Human Coronavirus ( HCOV),Human Re﹣spiratory Syncytial virus (HRSV). Results The effective detection rate of the CEMP assay was 95. 71%. The positive detection rate of respiratory tract pathogens was 62. 84% and the mixed infection rate was 9. 61%. The mixed infection was mainly InfA and HRSV. The highest three positive rates were named InfA, HRSV and Mp. The positive rate of HRSV was significantly higher in the 0﹣3 age group than that in older group. Different pathogens were detected in different age groups,and the high﹣occurrence season of respiratory tract infection with virus was from December to March of the next year. InfA﹣09H1 was the main prevalent influenza virus in January,February and March 2017,InfA﹣H3N2 was the main prevalent influenza virus in November and December 2017,and the outbreak of InfB was happened in Changchun in late 2017 and early 2018. HRSV was detected only in the coldest season in Changchun from November to March of the next year. Different pathogens were detected in different respiratory infection. HRSV was the main pathogen detec﹣ted in pneumonia; InfA﹣03H2 and HPIV were the main pathogens detected in acute bronchitis; HRV and InfA were the main pathogens detected in upper respiratory tract infection. Conclusion CEMP is an effi﹣cient,rapid and accurate method for the detection of pathogens in patients with respiratory tract infections,and it will have a broad application prospect to develop reagents suitable for clinical diagnosis.

Analysis of respiratory pathogens for children respiratory tract infection by capillary electrophoresis-based multiplex PCR / 中国小儿急救医学

Objective@#To investigate the effect of capillary electrophoresis-based multiplex PCR (CEMP) in detecting pathogens for children respiratory tract infection, and to provide scientific basis for clinical diagnosis and treatment rapidly and accurately.@*Methods@#The cases were defined according to the national monitoring program of febrile respiratory syndrome during the 12th Five-Year Plan, and the samples were collected from nasopharyngeal swabs, bronchoalveolar lavage fluid and sputum of children with respiratory tract infection hospitalized in Changchun Children′s Hospital from January 2017 to February 2018.Multiplex PCR amplification was performed by one-step method, then PCR products were separated by DNA length size with capillary electrophoresis and pathogens were analyzed by "Genemapper software" software.Detecting pathogens included Influenza A virus (InfA), Human Adenovirus (HADV), Boca virus (Boca), Human Rhinovirus (HRV), Novel InfA-09H1 (InfA-09H1) and Seasonal Influenza virus H3N2 (InfA-H3N2), Parainfluenza virus (HPIV), Human metapneumonia virus (HMPV), Influenza B virus (InfB), Mycoplasma pneumoniae (Mp), Chlamydia pneumoniae (CP), Human Coronavirus (HCOV), Human Respiratory Syncytial virus (HRSV).@*Results@#The effective detection rate of the CEMP assay was 95.71%.The positive detection rate of respiratory tract pathogens was 62.84% and the mixed infection rate was 9.61%.The mixed infection was mainly InfA and HRSV.The highest three positive rates were named InfA, HRSV and Mp.The positive rate of HRSV was significantly higher in the 0-3 age group than that in older group.Different pathogens were detected in different age groups, and the high-occurrence season of respiratory tract infection with virus was from December to March of the next year.InfA-09H1 was the main prevalent influenza virus in January, February and March 2017, InfA-H3N2 was the main prevalent influenza virus in November and December 2017, and the outbreak of InfB was happened in Changchun in late 2017 and early 2018.HRSV was detected only in the coldest season in Changchun from November to March of the next year.Different pathogens were detected in different respiratory infection.HRSV was the main pathogen detected in pneumonia; InfA-03H2 and HPIV were the main pathogens detected in acute bronchitis; HRV and InfA were the main pathogens detected in upper respiratory tract infection.@*Conclusion@#CEMP is an efficient, rapid and accurate method for the detection of pathogens in patients with respiratory tract infections, and it will have a broad application prospect to develop reagents suitable for clinical diagnosis.

Influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gyne-cologic laparoscope surgery / 临床麻醉学杂志

Objective To investigate the influence of preoperative anxiety-depression status on the postoperative pain in patients undergoing gynecologic laparoscope surgery.Methods Ninety pa-tients,aged 18-65 years,BMI 18-30 kg/m2,ASA physical status Ⅰ or Ⅱ,undergoing gynecologic laparoscope surgery were included in this single-center observational study.All the patients were in-terviewed by anesthetists the afternoon before surgery and completed a Hospital Anxiety and Depres-sion Scale (HADS)to evaluate the anxiety-depression status.Then the patients were divided into two groups,low HADS group (group L)(HADS score≤9)and high HADS group (group H)(HADS score>9).Patients'visual analogue scores (VAS)were recorded at the time 30 min,60 min,6 h, 12 h,24 h after operation.The correlation analysis between HADS before operation and VAS scores at different time point was performed.The use of analgesia medicine,exhausting time and complica-tions such as nausea, vomiting, dizzy, pain of shoulder and back were also recorded. Results Compared to group H,VAS score was lower in group L at 6 hour after surgery but no sig-nificant different was found at 30 min,60 min,12 h,24 h after surgery.There was a significant asso-ciation between preoperative HADS scores and VAS at 6 hour after surgery (r=0.634,P=0.01);but no significant association was found between preoperative HADS scores and VAS at the other time point after surgery.The exhausting time was significantly longer in group H than group L (P<0.05).There was no significant difference in the incidence of nausea,vomiting,dizzy or pain of shoulder and back between the two groups.Conclusion Preoperative anxiety-depression status has a positive influence on postoperative pain at 6 hour after gynecologic laparoscope surgery,and also can delay the recovery of gastrointestinal function.

The ICU Is Becoming a Main Battlefield for Severe Maternal Rescue in China: An 8-Year Single-Center Clinical Experience.

OBJECTIVES: To review the characteristics of and to identify the reasons for severe maternal admissions to the ICU. DESIGN: This was an analytical, observational, open, and retrospective study. SETTING: In our ICU. PATIENTS: A total of 487 severe maternal cases were reviewed during the 8-year study period of January 2009 to December 2016. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: A total of 487 severe maternal cases (12.6%) among the 3,867 patients admitted to ICU were reviewed. Of these, 361 patients were admitted for obstetric reasons, mainly pregnancy-induced hypertension (58.7%) and postpartum hemorrhage (36.8%). The remaining 126 patients were admitted for nonobstetric reasons, including cardiac-related disease (31.0%), immune-related disease (24.6%), and sepsis (20.6%). A total of 249 patients experienced combined comorbidities: the most common was a scarred uterus (100 patients; 40.2%), followed by endocrine-related disease (25.3%), immune-related disease (21.3%), and cardiac-related disease (18.1%). Central venous insertion (90.6%) was the most common intervention, followed by arterial catheter insertion (33.7%), mechanical ventilation (11.7%), blood purification (5.7%), and invasive hemodynamic monitoring (3.7%). Nine patients died during the study period, of which the death of four could have been avoided. CONCLUSIONS: The number of severe maternal cases has increased annually in our ICU. Although obstetric causes remained the most common reason for admission, the nonobstetric causes and basic complications were too complex, dangerous, and beyond the reach of the obstetrician with regard to monitoring and treatment. We call for a multidisciplinary team mainly composed of ICU staff to improve severe maternal outcomes.

18 F-FDG PET/CT for restaging, guiding therapeutic strategy and predicting prognosis in patients with postoperative colorectal cancer / 中华核医学与分子影像杂志

Objective To evaluate the clinical value of 18 F-FDG PET/CT for restaging, guiding therapeutic strategy and predicting prognosis in patients with postoperative colorectal cancer (PCC). Methods Records of 91 patients (51 males, 40 females;average age (54.90±11.47) years) in whom PCC were eval-uated by 18 F-FDG PET/CT imaging from May 2010 to June 2014 were retrospectively reviewed. All patients underwent evaluation at the First Affiliated Hospital of Soochow University. 18 F-FDG PET/CT results were compared with the results from pathological examination, clinical long-term follow-up (≥6 months ) and conventional imaging. Diagnostic efficiency of 18 F-FDG PET/CT in detecting recurrence and metastases of PCC were calculated. The clinical value of 18 F-FDG PET/CT in restaging and guiding therapeutic strategy were analyzed in patients with true positive results. Kaplan-Meier survival analysis was conducted based on the results of PET/CT and the alteration of therapeutic strategy after PET/CT. Results The sensitivity, specific-ity, accuracy, positive predictive value and negative predictive value of 18 F-FDG PET/CT were 96. 36%(53/55), 83.33%(30/36), 91.21%(83/91), 89.83%(53/59) and 93.75%(30/32), respectively. The median survival time and the 5-year survival rate were 10.00 years and 84% in patients with true negative PET/CT results, and were 6. 33 years and 53% in true positive group. Patients with true negative results showed longer OS and PFS than those with true positive results (χ2=7.753, 8. 933, both P<0.01). Among the 53 patients with true positive PET/CT results, tumor restaging was up-regulated in 32 patients and down-regulated in 2 patients. Therapeutic strategies were changed in 33 patients, in whom the PFS was lon- ger than those without treatment alteration (χ2=4.905, P<0.05) . Conclusion 18 F-FDG PET/CT imaging has the high sensitivity and accuracy in detecting recurrence and metastasis of PCC, with the potential for altering clinical restaging and therapeutic strategy timely.

Effects of Allicin on Transient Outward Potassium Current in Rat Atrial Myocytes / 医药导报

Objective To study the effect of allicin ( All) on potassium current in single atrial myocytes in rats. Methods Isolated rat atrial myocytes were isolated by perfusion and administered by extracellular perfusion method.Whole cell patch clamp technique was used to record transient outward potassium current ( Ito ) in atrial myocyte. Results In presence of 30 μmol·L-1 of All,the peak current of Ito was significantly reduced from (20.5±2.2) pA/pF to (11.3±2.1) pA/pF at+50 mV of test potential (P<0.01,n=12).This effect of All showed voltage- and concentration-dependence with IC50 of (19.0±2.5)μmol·L-1 .The steady-state activation curve of Ito was shifted to more positive potential and recovery time from inactivation was prolonged.In addition, they fail to find any effect of All on the steady-state inactivation and closed-state inactivation of Ito. Conclusion All can inhibit Ito by slowing down the process of activation and recovery from inactivation of channel.

Effects of Allicin on Transient Outward Potassium Current in Rat Atrial Myocytes / 医药导报

Objective To study the effect of allicin ( All) on potassium current in single atrial myocytes in rats. Methods Isolated rat atrial myocytes were isolated by perfusion and administered by extracellular perfusion method.Whole cell patch clamp technique was used to record transient outward potassium current ( Ito ) in atrial myocyte. Results In presence of 30 μmol·L-1 of All,the peak current of Ito was significantly reduced from (20.5±2.2) pA/pF to (11.3±2.1) pA/pF at+50 mV of test potential (P<0.01,n=12).This effect of All showed voltage- and concentration-dependence with IC50 of (19.0±2.5)μmol·L-1 .The steady-state activation curve of Ito was shifted to more positive potential and recovery time from inactivation was prolonged.In addition, they fail to find any effect of All on the steady-state inactivation and closed-state inactivation of Ito. Conclusion All can inhibit Ito by slowing down the process of activation and recovery from inactivation of channel.

Changes in expression of keratin genes in renal tissues during renal ischemia-reperfusion injury in mice / 中华麻醉学杂志

Objective To investigate the changes in the expression of keratin genes in renal tissues during renal ischemia-reperfusion (I/R) injury in mice.Methods Six wild type male C57/B6 mice,aged 50 days,weighing 20-30 g,were divided into 2 groups (n=3 each) using a random number table:sham operation group (Sham group) and I/R group.Right renal arteries and veins were clamped for 1 h followed by reperfusion,and the left kidneys were removed to establish the model of renal I/R injury.At 24 h of reperfusion,blood samples were collected from the left ventricle for determination of serum creatinine and urea nitrogen concentrations by colorimetric method.The right kidney specimens were obtained for pathologic examination and for determination of the expression of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin mRNA (by quantitative real-time polymerase chain reaction [qRT-PCR]) and keratin genes (by Affemetrixc DNA microarray).The differentially expressed genes identified were further confirmed by qRT-PCR.Results Compared with Sham group,the serum creatinine and urea nitrogen concentrations were significantly increased,the expression of kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin mRNA was up-regulated (P＜0.05),and the damage to the renal tubules was aggravated in I/R group.The results of microarray analysis showed that only keratin 20 gene (the expresion was up-regulated) was the differentially expressed gene (P＜0.05),and the results measured by qRT-PCR were consistent with those measured by Affemetrixc DNA microarray.Conclusion Keratin 20 gene expression in renal tissues is up-regulated during renal I/R injury in mice,and the change may be involved in the endogenous protective mechanism during renal I/R injury.

Mitochondrial tRNA mutation with high-salt stimulation on cardiac damage: underlying mechanism associated with change of Bax and VDAC.

Mitochondrial transfer RNA (tRNA) mutation with high-salt stimulation can cause high blood pressure. However, the underlying mechanisms remain unclear. In the present study, we examined the potential molecular mechanisms of cardiac damage caused by mitochondrial tRNA mutation with high-salt stimulation in spontaneously hypertensive rats (SHR). Unanesthetized, 44-wk-old, male, SHR were divided into four groups: SHR, SHR with high-salt stimulation for 8 wk (SHR + NaCl), SHR carrying tRNA mutations (SHR + M), and SHR + M with high-salt stimulation for 8 wk (SHR + M + NaCl). Healthy Wistar-Kyoto (WKY) rats were used as controls. Left ventricular mass and interventricular septum were highest in the SHR + M + NaCl group (P < 0.05), while ejection fraction was lowest in the SHR + M + NaCl group (P < 0.05). Hematoxylin and eosin staining showed myocardial cell hypertrophy with interstitial fibrosis and localized inflammatory cell infiltration, in the hypertensive groups, particularly in the SHR + M + NaCl group. Electron microscopy showed different degrees of mitochondrial cavitation in heart tissue of the hypertensive groups, which was highest in the SHR + M + NaCl group. In hypertensive animals, levels of reactive oxygen species were highest in the SHR + M + NaCl group (P < 0.05). Expression of the voltage-dependent anion channel (VDAC) and the apoptosis regulator Bax were highest in the SHR + M + NaCl group (P < 0.05), which also showed evidence of VDAC and Bax colocalization (P < 0.05). Overall, these data suggest that mitochondrial tRNA mutation with high-salt stimulation can aggravate cardiac damage, potentially because of increased expression and interaction between Bax and VDAC and increased reactive oxygen species formation and initiation of apoptosis.