Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.009
L. Zheng, Long-wang Chen, Xiyi Hu, J. Lian, Guangju Zhao, G. Hong, Zhongqiu Lu
Objective To investigate the protective effect and mechanism of curcumin on acute lung injury in septic mice. Methods Totally 120 clean BALB/c male mice were randomly (random number) divided into 8 groups: sham group, sepsis group, curcumin control group, curcumin intervention group, negative virus-sepsis group, negative virus-curcumin intervention group, Mfn2 interference-sepsis group, and Mfn2 interference-curcumin intervention group, 15 rats in each group. Mice in the sepsis and the curcumin groups were given the cecal ligation and puncture (CLP) mice in the curcumin intervention and curcumin control groups were given curcumin 200 mg/(kg·d) for 1 week, and mice in the negative virus-sepsis group and negative virus-curcumin intervention groups were established by injection of a negative adeno-associated virus in the tail vein. The Mfn2 interference-sepsis and Mfn2 interference-curcumin intervention groups were established by injecting an adeno-associated virus carrying the Mfn2 interference sequence through the tail vein. Mice were sacrificed after 24 h in each group. The degree of lung injury was examined by lung wet-to-dry weight ratio and pathological examination. The inflammatory factors of alveolar lavage fluid including TNF-α and IL-6 were detected by ELISA, the activation of caspase-3, a key molecule for apoptosis, was detected by Western blot, and apoptosis was detected by TUNEL. The data were analyzed by SPSS 22.0 software, the count data was analyzed by χ2 test, and the comparison of measurement data between groups was analyzed by one-way ANOVA. Results Compared with the sham group, the wet-to-dry weight ratio of lung tissue in the sepsis group was significantly increased (71.11±3.78 vs 31.11±5.61, P=0.002), the histopathological score was significantly higher (P=0.006), the inflammatory factors TNF-α (P=0.001) and IL-6 (P=0.012) were dramatically increased, and the apoptosis of lung tissue and the expression of caspase-3 cleaved were also significantly increased (P=0.001). Compared with the sepsis group, the wet-to-dry weight ratio and the histopathological score of lung tissue in the curcumin-treated group was significantly lower (32.84±6.15 vs 71.11±3.78, P=0.004), and the inflammatory factors TNF-α(P=0.013) and IL-6 (P=0.003) were obviously decreased, and apoptosis and apoptosis-related protein caspase-3 cleaved expression were also dramatically decreased (P=0.012). After Mfn2 was down-regulated, Mfn2 interference-curcumin intervention group interfered with Mfn2. Compared with the sepsis group, the dry-to-wet weight ratio and the histopathological score of the lung tissue of the mice was not significantly decreased. Further studies found that after down-regulating Mfn2, compared with the Mfn2 interfere-sepsis group, Mfn2 interfere-curcumin intervention group had no such performance. The inflammatory factors TNF-α and IL-6 were not significantly decreased, and the apoptosis of lung tissue and the expression of
目的探讨姜黄素对脓毒症小鼠急性肺损伤的保护作用及其机制。方法将120只清洁BALB/c雄性小鼠随机分为8组：假手术组、败血症组、姜黄素对照组、姜黄素干预组、阴性病毒败血症组、阴性细胞姜黄素干预组，Mfn2干扰败血症组、Mfn2干预姜黄素干预组。脓毒症和姜黄素组小鼠给予盲肠结扎和穿刺（CLP）姜黄素干预组和姜黄素对照组小鼠给予姜黄素200mg/（kg·d）1周，阴性病毒脓毒症组和阴性病毒姜黄素干预组小鼠通过尾静脉注射阴性腺相关病毒建立。通过尾静脉注射携带Mfn2干扰序列的腺相关病毒，建立Mfn2干预败血症和Mfn2干涉姜黄素干预组。每组小鼠在24小时后处死。肺损伤程度采用肺湿干重比和病理检查。ELISA法检测肺泡灌洗液中TNF-α和IL-6等炎症因子，Western blot法检测细胞凋亡关键分子胱天蛋白酶-3的活化，TUNEL法检测细胞的凋亡。数据采用SPSS 22.0软件进行分析，计数数据采用χ2检验进行分析，各组测量数据比较采用单因素方差分析。结果与假手术组相比，败血症组肺组织湿干重比显著增加（71.11±3.78 vs 31.11±5.61，P=0.002），组织病理学评分显著升高（P=0.006），炎症因子TNF-α（P=0.001）和IL-6（P=0.012）显著升高，姜黄素治疗组肺组织湿干重比和组织病理学评分明显低于败血症组（32.84±6.15 vs 71.11±3.78，P=0.004），且炎症因子TNF-α（P=0.013）和IL-6（P=0.003）明显降低，细胞凋亡和凋亡相关蛋白胱天蛋白酶-3裂解表达也显著降低（P=0.012）。与败血症组相比，小鼠肺组织的干重比和组织病理学评分没有显著降低。进一步研究发现，在下调Mfn2后，与Mfn2干扰败血症组相比，Mfn2干预姜黄素干预组没有这样的表现。炎症因子TNF-α和IL-6没有显著降低，肺组织凋亡和凋亡相关蛋白胱天蛋白酶-3的表达也没有显著降低。结论姜黄素可通过上调Mfn2的表达减轻脓毒症急性肺损伤。关键词：败血症；姜黄素；急性肺损伤；线粒体融合2；细胞凋亡
{"title":"Curcumin upregulates mitofusin2 to alleviate acute lung injury in septic mice","authors":"L. Zheng, Long-wang Chen, Xiyi Hu, J. Lian, Guangju Zhao, G. Hong, Zhongqiu Lu","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.009","url":null,"abstract":"Objective To investigate the protective effect and mechanism of curcumin on acute lung injury in septic mice. Methods Totally 120 clean BALB/c male mice were randomly (random number) divided into 8 groups: sham group, sepsis group, curcumin control group, curcumin intervention group, negative virus-sepsis group, negative virus-curcumin intervention group, Mfn2 interference-sepsis group, and Mfn2 interference-curcumin intervention group, 15 rats in each group. Mice in the sepsis and the curcumin groups were given the cecal ligation and puncture (CLP) mice in the curcumin intervention and curcumin control groups were given curcumin 200 mg/(kg·d) for 1 week, and mice in the negative virus-sepsis group and negative virus-curcumin intervention groups were established by injection of a negative adeno-associated virus in the tail vein. The Mfn2 interference-sepsis and Mfn2 interference-curcumin intervention groups were established by injecting an adeno-associated virus carrying the Mfn2 interference sequence through the tail vein. Mice were sacrificed after 24 h in each group. The degree of lung injury was examined by lung wet-to-dry weight ratio and pathological examination. The inflammatory factors of alveolar lavage fluid including TNF-α and IL-6 were detected by ELISA, the activation of caspase-3, a key molecule for apoptosis, was detected by Western blot, and apoptosis was detected by TUNEL. The data were analyzed by SPSS 22.0 software, the count data was analyzed by χ2 test, and the comparison of measurement data between groups was analyzed by one-way ANOVA. Results Compared with the sham group, the wet-to-dry weight ratio of lung tissue in the sepsis group was significantly increased (71.11±3.78 vs 31.11±5.61, P=0.002), the histopathological score was significantly higher (P=0.006), the inflammatory factors TNF-α (P=0.001) and IL-6 (P=0.012) were dramatically increased, and the apoptosis of lung tissue and the expression of caspase-3 cleaved were also significantly increased (P=0.001). Compared with the sepsis group, the wet-to-dry weight ratio and the histopathological score of lung tissue in the curcumin-treated group was significantly lower (32.84±6.15 vs 71.11±3.78, P=0.004), and the inflammatory factors TNF-α(P=0.013) and IL-6 (P=0.003) were obviously decreased, and apoptosis and apoptosis-related protein caspase-3 cleaved expression were also dramatically decreased (P=0.012). After Mfn2 was down-regulated, Mfn2 interference-curcumin intervention group interfered with Mfn2. Compared with the sepsis group, the dry-to-wet weight ratio and the histopathological score of the lung tissue of the mice was not significantly decreased. Further studies found that after down-regulating Mfn2, compared with the Mfn2 interfere-sepsis group, Mfn2 interfere-curcumin intervention group had no such performance. The inflammatory factors TNF-α and IL-6 were not significantly decreased, and the apoptosis of lung tissue and the expression of","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"58-64"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41855069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.015
Hong Sun, K. Li, Qian Yang, H. Ren, Xiandong Liu, Xiaowei Bao
Objective To compare the effect of different enteral nutritional support methods in elderly patients with severe pneumonia. Methods Elderly patients (average age over 65 years) with severe pneumonia admitted to our hospital from June 2015 to June 2018 were selected as the study subjects, and 86 patients finally completed the study. The patients were randomly divided into the control group and observation group with 43 patients in each group, and nasojejunal tubes were placed for patients in both groups. Patients in the observation group were fed with enteral nutrition emulsion through continuously-heated nutritional pump, while patients in the control group was meal served with enteral nutrition emulsion. Changes in blood biochemical parameters, immune indexes, inflammation indexes, oxygenation indexes, the GIDF and SOFA scores as well as curative effect (mechanical ventilation time and effective rate of treatment) were monitored and compared before and after 10 days of nutritional support treatment. SPSS 20.0 statistical software package was used for data analysis, and self paired t-test was used for comparison before and after intervention in the same group, χ2 test was used in comparison between different groups, and the counting data was expressed as the rate (n, %). Results There was no significant difference in baseline data between patients in the two groups (P>0.05). After ten days of intervention, compared with the control group, the levels of serum albumin and prealbumin in the observation group were higher [(31.22±2.36) g/L and (0.29±0.24) g/L, P=0.015 and P=0.023], the immune indexes were higher [IgG (13.24±0.70) g/L, P=0.020; IgM (1.43±0.19) g/L, P=0.011; CD4+/CD8+ 1.55±0.49, P=0.043], the inflammation indexes were lower [IL-6 (312.54±42.53) pg/mL, P=0.031; PCT (1.56±0.81) ng/mL, P=0.017], the oxygenation indexes were better [PaO2/FiO2 (315.58±20.37) mmHg, P=0.019], and the GIDF and SOFA scores were significantly lower[(10.6±1.2) and (8.5±1.7), P=0.041 and P=0.038]. The clinical outcome showed that the mechanical ventilation time in the observation group was significantly shorter [(6.01±1.48) d vs (8.12±1.17)d, P=0.039], and the total effective rate of treatment was better than the control group (67.44% vs 41.86%, P=0.027). Conclusions Enteral nutrition support through continuously-heated nutritional pump can improve the nutritional status of elderly patients with severe pneumonia, reduce the incidence of gastrointestinal dysfunction, maintain stable organ fuction, thus resulting in better prognosis in elderly patients with severe pneumonia. Key words: Elderly patients; Severe pneumonia; Enteral nutritional support; Continuously-heated nutritional pump; Gastrointestinal dysfunction
{"title":"Effect of different methods of applying enteral nutritional support methods in elderly patients with severe pneumonia","authors":"Hong Sun, K. Li, Qian Yang, H. Ren, Xiandong Liu, Xiaowei Bao","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.015","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.015","url":null,"abstract":"Objective \u0000To compare the effect of different enteral nutritional support methods in elderly patients with severe pneumonia. \u0000 \u0000 \u0000Methods \u0000Elderly patients (average age over 65 years) with severe pneumonia admitted to our hospital from June 2015 to June 2018 were selected as the study subjects, and 86 patients finally completed the study. The patients were randomly divided into the control group and observation group with 43 patients in each group, and nasojejunal tubes were placed for patients in both groups. Patients in the observation group were fed with enteral nutrition emulsion through continuously-heated nutritional pump, while patients in the control group was meal served with enteral nutrition emulsion. Changes in blood biochemical parameters, immune indexes, inflammation indexes, oxygenation indexes, the GIDF and SOFA scores as well as curative effect (mechanical ventilation time and effective rate of treatment) were monitored and compared before and after 10 days of nutritional support treatment. SPSS 20.0 statistical software package was used for data analysis, and self paired t-test was used for comparison before and after intervention in the same group, χ2 test was used in comparison between different groups, and the counting data was expressed as the rate (n, %). \u0000 \u0000 \u0000Results \u0000There was no significant difference in baseline data between patients in the two groups (P>0.05). After ten days of intervention, compared with the control group, the levels of serum albumin and prealbumin in the observation group were higher [(31.22±2.36) g/L and (0.29±0.24) g/L, P=0.015 and P=0.023], the immune indexes were higher [IgG (13.24±0.70) g/L, P=0.020; IgM (1.43±0.19) g/L, P=0.011; CD4+/CD8+ 1.55±0.49, P=0.043], the inflammation indexes were lower [IL-6 (312.54±42.53) pg/mL, P=0.031; PCT (1.56±0.81) ng/mL, P=0.017], the oxygenation indexes were better [PaO2/FiO2 (315.58±20.37) mmHg, P=0.019], and the GIDF and SOFA scores were significantly lower[(10.6±1.2) and (8.5±1.7), P=0.041 and P=0.038]. The clinical outcome showed that the mechanical ventilation time in the observation group was significantly shorter [(6.01±1.48) d vs (8.12±1.17)d, P=0.039], and the total effective rate of treatment was better than the control group (67.44% vs 41.86%, P=0.027). \u0000 \u0000 \u0000Conclusions \u0000Enteral nutrition support through continuously-heated nutritional pump can improve the nutritional status of elderly patients with severe pneumonia, reduce the incidence of gastrointestinal dysfunction, maintain stable organ fuction, thus resulting in better prognosis in elderly patients with severe pneumonia. \u0000 \u0000 \u0000Key words: \u0000Elderly patients; Severe pneumonia; Enteral nutritional support; Continuously-heated nutritional pump; Gastrointestinal dysfunction","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"92-98"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48087508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.017
Weibo Gao, Maojing Shi, Wenfeng Huang
Objective To investigate the clinical features, diagnosis, treatment and prognosis of 59 patients with thrombotic thrombocytopenic purpura (TTP), therefore to improve the ability of diagnosis and treatment. Methods The clinical data of 59 patients with TTP admitted to Peking University People's Hospital from January 2004 to October 2018 were retrospectively analyzed. All the patients were clinically diagnosed, fulfilled the triad syndrome, or quinary syndrome. Laboratory data included complete blood count, blood biochemistry, immunology, hemolysis; some patients tested the activity of ADAMTS13.The differences between groups were compared according to the prognosis. Results Among the 59 patients with TTP, 21 were male and 38 were female, with an average age of 46.8 years. Fifty-five patients had the triad syndrome and 46 patients had the quinary syndrome. The platelet count and hemoglobin decreased, the percentage of erythrocyte fragmented increased, and the value or the activity of ADAMTS13 was decreased significantly. PLASMIC scores of 57 patients were between 6 and 7. All 59 patients were treated with glucocorticoid, 41 patients received plasma exchange (PEX), and 28 patients survived; 18 patients did not received PEX, and only 6 patients survived. There was a significant difference of the survival between the two groups (P<0.05). Six patients were treated with rituximab and four patients survived. Conclusion The PLASMIC score can predict the activity of ADAMTS13 well. PEX can significantly improve the survival rate of patients with TTP. Key words: Thrombotic thrombocytopenic purpura; ADAMTS13; PLASMIC score; Plasma exchange; Prognosis
{"title":"Clinical analysis of 59 patients with thrombotic thrombocytopenic purpura","authors":"Weibo Gao, Maojing Shi, Wenfeng Huang","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.017","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.017","url":null,"abstract":"Objective \u0000To investigate the clinical features, diagnosis, treatment and prognosis of 59 patients with thrombotic thrombocytopenic purpura (TTP), therefore to improve the ability of diagnosis and treatment. \u0000 \u0000 \u0000Methods \u0000The clinical data of 59 patients with TTP admitted to Peking University People's Hospital from January 2004 to October 2018 were retrospectively analyzed. All the patients were clinically diagnosed, fulfilled the triad syndrome, or quinary syndrome. Laboratory data included complete blood count, blood biochemistry, immunology, hemolysis; some patients tested the activity of ADAMTS13.The differences between groups were compared according to the prognosis. \u0000 \u0000 \u0000Results \u0000Among the 59 patients with TTP, 21 were male and 38 were female, with an average age of 46.8 years. Fifty-five patients had the triad syndrome and 46 patients had the quinary syndrome. The platelet count and hemoglobin decreased, the percentage of erythrocyte fragmented increased, and the value or the activity of ADAMTS13 was decreased significantly. PLASMIC scores of 57 patients were between 6 and 7. All 59 patients were treated with glucocorticoid, 41 patients received plasma exchange (PEX), and 28 patients survived; 18 patients did not received PEX, and only 6 patients survived. There was a significant difference of the survival between the two groups (P<0.05). Six patients were treated with rituximab and four patients survived. \u0000 \u0000 \u0000Conclusion \u0000The PLASMIC score can predict the activity of ADAMTS13 well. PEX can significantly improve the survival rate of patients with TTP. \u0000 \u0000 \u0000Key words: \u0000Thrombotic thrombocytopenic purpura; ADAMTS13; PLASMIC score; Plasma exchange; Prognosis","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"106-111"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69953653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the effects of therapeutic hypothermia (TH) on myocardial Ca2+/calmodulin-dependent protein kinaseⅡ (CaMKⅡ) and cell autophagy after cardiopulmonary resuscitation (CPR) in swine. Methods Twenty healthy male domestic swine weighing 33-40 kg were randomly (random number) divided into 3 groups: sham group (n=4), CPR group (n=8) and TH group (n=8). Sham animals only underwent general preparation without experiencing cardiac arrest and resuscitation. The animal model was established by 8 min of electrically induced ventricular fibrillation and then 5 min CPR in the CPR and TH groups. Successful resuscitation was regarded as an organized rhythm with a mean arterial pressure of greater than 50 mmHg for 5 min or more. After successful resuscitation, body temperature was decreased to 33 ℃ by a cooling blanket and then maintained until 24 h post-resuscitation, and followed by a rewarming at a rate of 1 ℃/h for 5 h in the TH group. A normal temperature was maintained by the blanket throughout the experiment in the sham and CPR groups. At 6, 12, 24 and 30 h after resuscitation, the values of stroke volume (SV) and global ejection fraction (GEF) were measured by PiCCO, and meanwhile the serum concentrations of cardiac troponin I (cTnI) were measured by ELISA assay and the serum activities of creatine kinase-MB (CK-MB) were evaluated by an automatic biochemical analyzer. At 30 h after resuscitation, the animals were sacrificed and left ventricular myocardium was obtained for the determination of CaMKⅡ, microtubule-associated protein light chain 3Ⅱ (LC3Ⅱ) and p62 expressions by Western blot. The variables were compared with One way analysis of variance and then the Bonferroni test among the three groups. Results Compared with the sham group, myocardial dysfunction and injury after resuscitation were observed in the CPR and TH groups, which were indicated by decreased SV and GEF and also increased cTnI concentration and CK-MB activity in serum (all P<0.05). Compared with the CPR group, the values of SV and GEF were significantly increased at 6 h after resuscitation, and serum cTnI concentration and CK-MB activity were significantly decreased starting 12 h after resuscitation in the TH group [SV (mL): 25.0±6.9 vs 31.9±3.3 at 6 h, 26.7±5.1 vs 34.6±3.7 at 12 h, 28.8±3.3 vs 35.7±3.2 at 24 h, 29.2±5.2 vs 36.7±3.3 at 30 h; GEF (%): 17.1±2.7 vs 19.9±1.8 at 6 h, 18.7±1.9 vs 21.6±1.8 at 12 h, 19.3±2.3 vs 23.0±2.4 at 24 h, 21.0±1.7 vs 23.7±1.7 at 30 h; cTnI (pg/mL): 564±51 vs 466±56 at 12 h, 534±38 vs 427±60 at 24 h, 476±55 vs 375±46 at 30 h; CK-MB (U/L): 803±164 vs 652±76 at 12 h, 693±96 vs 557±54 at 24 h, 633±91 vs 480±77 at 30 h, all P<0.05]. Tissue detection indicated that the expression of CaMKⅡ and LC3Ⅱ were increased while the expression of p62 was decreased in post-resuscitation myocardium in the CPR and TH groups compared with the sham group (all P<0.05). However, the expression of CaMKⅡ and LC3Ⅱ were decreased and the expres
目的探讨治疗性低温（TH）对猪心肺复苏（CPR）后心肌Ca2+/钙调蛋白依赖性蛋白激酶Ⅱ（CaMKⅡ）及细胞自噬的影响。方法将体重33～40kg的健康雄性家猪20头随机分为3组：假手术组（n=4）、心肺复苏组（n=8）和TH组（n=8）。Sham动物只进行了一般准备，没有经历心脏骤停和复苏。在CPR和TH组中，通过8分钟的电诱导心室颤动和5分钟的CPR建立动物模型。成功的复苏被认为是平均动脉压大于50mmHg持续5分钟或更长时间的有组织的节律。复苏成功后，TH组用冷却毯将体温降至33℃，然后保持至复苏后24小时，然后以1℃/h的速度复温5小时。在假手术组和CPR组的整个实验过程中，毯子保持正常温度。在复苏后6、12、24和30h，用PiCCO测定脑卒中体积（SV）和总射血分数（GEF），同时用ELISA法测定血清肌钙蛋白I（cTnI）浓度，用自动生化分析仪评价血清肌酸激酶MB（CK-MB）活性。复苏后30h处死动物，获得左心室心肌，用Western印迹法测定CaMKⅡ、微管相关蛋白轻链3Ⅱ（LC3Ⅱ）和p62的表达。将变量与三组之间的单向方差分析和Bonferroni检验进行比较。结果与假手术组相比，心肺复苏组和TH组在复苏后出现心肌功能障碍和损伤，表现为SV和GEF降低，血清cTnI浓度和CK-MB活性升高（均P<0.05），TH组复苏后12h血清cTnI浓度和CK-MB活性显著下降[SV（mL）：25.0±6.9 vs 31.9±3.3，26.7±5.1 vs 34.6±3.7，28.8±3.3 vs 35.7±3.2，29.2±5.2 vs 36.7±3.3；GEF（%）：6小时17.1±2.7 vs 19.9±1.8，12小时18.7±1.9 vs 21.6±1.8，24小时19.3±2.3 vs 23.0±2.4，30小时21.0±1.7 vs 23.7±1.7；cTnI（pg/mL）：12 h时564±51 vs 466±56，24 h时534±38 vs 427±60，30 h时476±55 vs 375±46；CK-MB（U/L）：803±164 vs 652±76，693±96 vs 557±54，633±91 vs 480±77，均P<0.05，TH组复苏后心肌CaMKⅡ、LC3Ⅱ表达下降，p62表达增加（分别为0.73±0.06和0.58±0.05；LC3Ⅱ0.69±0.09和0.50±0.07；p62 0.40±0.07和0.68±0.14，P均<0.05）抑制CaMKⅡ的表达和细胞自噬。关键词：心脏骤停；心肺复苏；心肌功能障碍；心脏损伤；治疗性体温过低；Ca2+/钙调蛋白依赖性蛋白激酶Ⅱ；自噬；猪
{"title":"Effects of therapeutic hypothermia on myocardial Ca2+/calmodulin-dependent protein kinase II and autophagy after cardiopulmonary resuscitation in swine","authors":"Qijiang Chen, Jiefeng Xu, Chunshuang Wu, Xiaohong Jin, Zilong Li, Moli Wang","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.006","url":null,"abstract":"Objective \u0000To investigate the effects of therapeutic hypothermia (TH) on myocardial Ca2+/calmodulin-dependent protein kinaseⅡ (CaMKⅡ) and cell autophagy after cardiopulmonary resuscitation (CPR) in swine. \u0000 \u0000 \u0000Methods \u0000Twenty healthy male domestic swine weighing 33-40 kg were randomly (random number) divided into 3 groups: sham group (n=4), CPR group (n=8) and TH group (n=8). Sham animals only underwent general preparation without experiencing cardiac arrest and resuscitation. The animal model was established by 8 min of electrically induced ventricular fibrillation and then 5 min CPR in the CPR and TH groups. Successful resuscitation was regarded as an organized rhythm with a mean arterial pressure of greater than 50 mmHg for 5 min or more. After successful resuscitation, body temperature was decreased to 33 ℃ by a cooling blanket and then maintained until 24 h post-resuscitation, and followed by a rewarming at a rate of 1 ℃/h for 5 h in the TH group. A normal temperature was maintained by the blanket throughout the experiment in the sham and CPR groups. At 6, 12, 24 and 30 h after resuscitation, the values of stroke volume (SV) and global ejection fraction (GEF) were measured by PiCCO, and meanwhile the serum concentrations of cardiac troponin I (cTnI) were measured by ELISA assay and the serum activities of creatine kinase-MB (CK-MB) were evaluated by an automatic biochemical analyzer. At 30 h after resuscitation, the animals were sacrificed and left ventricular myocardium was obtained for the determination of CaMKⅡ, microtubule-associated protein light chain 3Ⅱ (LC3Ⅱ) and p62 expressions by Western blot. The variables were compared with One way analysis of variance and then the Bonferroni test among the three groups. \u0000 \u0000 \u0000Results \u0000Compared with the sham group, myocardial dysfunction and injury after resuscitation were observed in the CPR and TH groups, which were indicated by decreased SV and GEF and also increased cTnI concentration and CK-MB activity in serum (all P<0.05). Compared with the CPR group, the values of SV and GEF were significantly increased at 6 h after resuscitation, and serum cTnI concentration and CK-MB activity were significantly decreased starting 12 h after resuscitation in the TH group [SV (mL): 25.0±6.9 vs 31.9±3.3 at 6 h, 26.7±5.1 vs 34.6±3.7 at 12 h, 28.8±3.3 vs 35.7±3.2 at 24 h, 29.2±5.2 vs 36.7±3.3 at 30 h; GEF (%): 17.1±2.7 vs 19.9±1.8 at 6 h, 18.7±1.9 vs 21.6±1.8 at 12 h, 19.3±2.3 vs 23.0±2.4 at 24 h, 21.0±1.7 vs 23.7±1.7 at 30 h; cTnI (pg/mL): 564±51 vs 466±56 at 12 h, 534±38 vs 427±60 at 24 h, 476±55 vs 375±46 at 30 h; CK-MB (U/L): 803±164 vs 652±76 at 12 h, 693±96 vs 557±54 at 24 h, 633±91 vs 480±77 at 30 h, all P<0.05]. Tissue detection indicated that the expression of CaMKⅡ and LC3Ⅱ were increased while the expression of p62 was decreased in post-resuscitation myocardium in the CPR and TH groups compared with the sham group (all P<0.05). However, the expression of CaMKⅡ and LC3Ⅱ were decreased and the expres","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"43-48"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44494889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.014
Weiwei Gao, Jianying Kan
Objective To compare the effects of two different types of enteral nutrition on post-pyloric feeding critical ill patients. Methods A prospective study was conducted to continuously collect 60 critical ill patients with indications of post-pyloric feeding in ICU and NICU wards of our hospital from January 2016 to December 2018. They were randomly (random number) divided into the peptide-based enteral nutrition (PBEN) group and intact protein enteral nutrition (IPEN) group with 30 patients in each group. Enteral nutrition was started immediately within 24 h after the nasointestinal tube was placed, and the PBEN group was treated with peptide-based enteral nutrition, while the IPEN group was treated with intact protein enteral nutrition. The nutritional metabolism index, intestinal barrier index on the 7th and 14th days after enteral nutrition treatment were observed and compared. The enteral feeding complications, incidence of feeding intolerance, gastrointestinal adaptability and 7-day enteral nutrition compliance rate of the two groups during the enteral nutrition were also observed and compared. Chi-square test was used for counting data and t test was used for measuring data. Results On the 7th and 14th days after enteral nutrition therapy, there was no statistical difference in nutritional metabolism indexes between the two groups (P>0.05). In comparison of intestinal barrier indexes, diamine oxidase (DAO) level in the PBEN group was lower than that in the IPEN group at the same time, and the difference was statistically significant [7th day:(6.1±2.9) U/mL vs (7.8±2.7) U/mL, t=-2.354, P=0.019; 14th day: (4.7±1.6) U/mL vs (6.9±2.0) U/mL, t=-3.285, P=0.004]. During enteral nutrition, the diarrhea rate of patients in the PBEN group was slightly higher than that in the IPEN group (6.6% vs 3.3%), while the abdominal distension rate in the IPEN group was slightly higher (3.3% vs 10.0%), but there was no statistical difference between the two groups (P>0.05). The gastrointestinal adaptation time of patients in the PBEN group was significantly shorter than that in the IPEN group [(7.8±1.3) h vs (9.1±2.0) h, t=-2.334, P=0.027]. The 7-day enteral nutrition compliance rate showed no significant difference between the two groups(P>0.05). Conclusions Diarrhea was the main complication in the PBEN group and abdominal distension was the main complication in the IPEN group for post-pyloric feeding critical ill patients. Peptide-based enteral nutrition could repair the intestinal barrier function of post-pyloric feeding critical ill patients and increase the adaptability of gastrointestinal tract in the initial stage of enteral nutrition. Key words: Post-pyloric feeding; Peptide-based enteral nutrition; Intact protein enteral nutrition; Feeding intolerance
目的比较两种不同类型肠内营养对危重病人幽门后喂养的影响。方法采用前瞻性研究方法，连续收集2016年1月至2018年12月我院ICU及NICU病房有幽门后喂养指征的危重患者60例。随机分为肽基肠内营养(PBEN)组和完整蛋白肠内营养(IPEN)组，每组30例。鼻肠管放置后24 h内立即开始肠内营养，PBEN组给予肽类肠内营养，IPEN组给予完整蛋白肠内营养。观察并比较肠内营养治疗后第7天和第14天的营养代谢指数和肠道屏障指数。观察并比较两组患者在肠内营养期间的肠内喂养并发症、喂养不耐受发生率、胃肠道适应性及7天肠内营养依从率。计数资料采用卡方检验，计量资料采用t检验。结果肠内营养治疗后第7、14天，两组患者营养代谢指标比较，差异无统计学意义(P < 0.05)。在肠道屏障指数比较中，PBEN组的二胺氧化酶(DAO)水平低于同期IPEN组，差异有统计学意义[第7天:(6.1±2.9)U/mL vs(7.8±2.7)U/mL, t=-2.354, P=0.019;第14天:U /毫升(4.7±1.6)和(6.9±2.0)U /毫升,t = -3.285, P = 0.004)。肠内营养期间，PBEN组患者腹泻率略高于IPEN组(6.6% vs 3.3%)，而IPEN组患者腹胀率略高于IPEN组(3.3% vs 10.0%)，但两组间差异无统计学意义(P < 0.05)。PBEN组患者的胃肠适应时间明显短于IPEN组[(7.8±1.3)h vs(9.1±2.0)h, t=-2.334, P=0.027]。两组患者7天肠内营养依从率差异无统计学意义(P < 0.05)。结论幽门后喂养危重病人PBEN组主要并发症为腹泻，IPEN组主要并发症为腹胀。肽基肠内营养可以修复幽门后喂养危重病人的肠道屏障功能，增加肠内营养初期胃肠道的适应性。关键词:幽门后喂养;肽类肠内营养;完整蛋白肠内营养;喂养不耐受
{"title":"Selection of enteral nutrition preparations for post-pyloric feeding critical ill patients","authors":"Weiwei Gao, Jianying Kan","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.014","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.014","url":null,"abstract":"Objective \u0000To compare the effects of two different types of enteral nutrition on post-pyloric feeding critical ill patients. \u0000 \u0000 \u0000Methods \u0000A prospective study was conducted to continuously collect 60 critical ill patients with indications of post-pyloric feeding in ICU and NICU wards of our hospital from January 2016 to December 2018. They were randomly (random number) divided into the peptide-based enteral nutrition (PBEN) group and intact protein enteral nutrition (IPEN) group with 30 patients in each group. Enteral nutrition was started immediately within 24 h after the nasointestinal tube was placed, and the PBEN group was treated with peptide-based enteral nutrition, while the IPEN group was treated with intact protein enteral nutrition. The nutritional metabolism index, intestinal barrier index on the 7th and 14th days after enteral nutrition treatment were observed and compared. The enteral feeding complications, incidence of feeding intolerance, gastrointestinal adaptability and 7-day enteral nutrition compliance rate of the two groups during the enteral nutrition were also observed and compared. Chi-square test was used for counting data and t test was used for measuring data. \u0000 \u0000 \u0000Results \u0000On the 7th and 14th days after enteral nutrition therapy, there was no statistical difference in nutritional metabolism indexes between the two groups (P>0.05). In comparison of intestinal barrier indexes, diamine oxidase (DAO) level in the PBEN group was lower than that in the IPEN group at the same time, and the difference was statistically significant [7th day:(6.1±2.9) U/mL vs (7.8±2.7) U/mL, t=-2.354, P=0.019; 14th day: (4.7±1.6) U/mL vs (6.9±2.0) U/mL, t=-3.285, P=0.004]. During enteral nutrition, the diarrhea rate of patients in the PBEN group was slightly higher than that in the IPEN group (6.6% vs 3.3%), while the abdominal distension rate in the IPEN group was slightly higher (3.3% vs 10.0%), but there was no statistical difference between the two groups (P>0.05). The gastrointestinal adaptation time of patients in the PBEN group was significantly shorter than that in the IPEN group [(7.8±1.3) h vs (9.1±2.0) h, t=-2.334, P=0.027]. The 7-day enteral nutrition compliance rate showed no significant difference between the two groups(P>0.05). \u0000 \u0000 \u0000Conclusions \u0000Diarrhea was the main complication in the PBEN group and abdominal distension was the main complication in the IPEN group for post-pyloric feeding critical ill patients. Peptide-based enteral nutrition could repair the intestinal barrier function of post-pyloric feeding critical ill patients and increase the adaptability of gastrointestinal tract in the initial stage of enteral nutrition. \u0000 \u0000 \u0000Key words: \u0000Post-pyloric feeding; Peptide-based enteral nutrition; Intact protein enteral nutrition; Feeding intolerance","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47350723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.019
Wenbo Zhang, Yu Jiang, Xiao-wei Liu
Objective To find out whether we can get the optimality in the prognosis of acute respiratory distress syndrome (ARDS) by combing the pressure parameters in mechanical ventilation with traditional PaO2/FiO2. Methods This is a retrospective study. Patients included here were diagnosed as ARDS in the Emergency Unit (EICU) of the First Affiliated Hospital of China Medical University from January 2018 to December 2018. All the patients were intubated and mechanically ventilated. Patients with a short observation time (< 48 h) or unable to cooperate with treatment were excluded. According to the patient's 28-day survival, patients were divided into the survival and non-survival groups. Parameters in the two groups such as basic characteristics, SOFA score, non-respiratory system SOFA score (nR-SOFA), and PaO2/FiO2 were analyzed with LSD-t test or rank sum test. Simultaneously, plateau pressure, driving pressure, mean airway pressure and the ratio of these mechanical ventilation pressure parameters to the PaO2/FiO2 were also analyzed. Results A total of 147 patients were included in the study and 117 of them were analyzed. The overall 28-day mortality was 31.62% (n=37). There were no significant differences in gender, age, body mass index, initial arterial oxygen partial pressure and carbon dioxide partial pressure between the survival group and non-survival groups (P >0.05). But there was a significant difference in SOFA score(6.53 ± 2.96 vs 8.65 ± 3.00) and nR -SOFA(3.44 ± 2.98 vs 5.27 ± 2.86). Among the evaluation indexes, the PPOI obtained the AUC of 0.828, with the sensitivity of 86.5%, and specificity of 71.2%.The AUC of the SOFA score was 0.707, while the AUC of the PPOI combined with the SOFA score was 0.833. Conclusion Mechanical ventilation pressure parameters can be used to predict the prognosis of patients with ARDS. PPOI may evaluate the prognosis of ARDS in a more simple, timely and real-time manner. Key words: Acute respiratory distress syndrome; Plateau pressure; Driving pressure; Mean airway pressure; Plateau pressure oxygenation index; Prognosis
目的将机械通气中的压力参数与传统的PaO2/FiO2相结合，探讨是否能使急性呼吸窘迫综合征（ARDS）的预后达到最佳。方法回顾性研究。本文纳入的患者于2018年1月至2018年12月在中国医科大学第一附属医院急诊科（EICU）被诊断为ARDS。所有患者均进行了插管和机械通气。排除观察时间短（<48小时）或无法配合治疗的患者。根据患者的28天生存率，将患者分为存活组和非存活组。采用LSD-t检验或秩和检验对两组患者的基本特征、SOFA评分、非呼吸系统SOFA评分（nR-SOFA）、PaO2/FiO2等参数进行分析。同时，还分析了高原压力、驾驶压力、平均气道压力以及这些机械通气压力参数与PaO2/FiO2的比值。结果本研究共纳入147例患者，对其中117例患者进行了分析。28天的总死亡率为31.62%（n=37）。存活组和非存活组在性别、年龄、体重指数、初始动脉氧分压和二氧化碳分压方面无显著差异（P>0.05），但SOFA评分（6.53±2.96 vs 8.65±3.00）和nR-SOFA评分有显著差异（3.44±2.98 vs 5.27±2.86），PPOI的AUC为0.828，敏感性为86.5%，特异性为71.2%。SOFA评分的AUC是0.707，而PPOI与SOFA评分组合的AUC则是0.833。结论机械通气压力参数可用于预测ARDS患者的预后。PPOI可以更简单、及时、实时地评估ARDS的预后。关键词：急性呼吸窘迫综合征；高原压力；驱动压力；平均气道压力；高原压力氧合指数；预后
{"title":"Investigation of mechanical ventilation pressure parameters’ effect on the prognosis of acute respiratory distress syndrome","authors":"Wenbo Zhang, Yu Jiang, Xiao-wei Liu","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.019","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.019","url":null,"abstract":"Objective \u0000To find out whether we can get the optimality in the prognosis of acute respiratory distress syndrome (ARDS) by combing the pressure parameters in mechanical ventilation with traditional PaO2/FiO2. \u0000 \u0000 \u0000Methods \u0000This is a retrospective study. Patients included here were diagnosed as ARDS in the Emergency Unit (EICU) of the First Affiliated Hospital of China Medical University from January 2018 to December 2018. All the patients were intubated and mechanically ventilated. Patients with a short observation time (< 48 h) or unable to cooperate with treatment were excluded. According to the patient's 28-day survival, patients were divided into the survival and non-survival groups. Parameters in the two groups such as basic characteristics, SOFA score, non-respiratory system SOFA score (nR-SOFA), and PaO2/FiO2 were analyzed with LSD-t test or rank sum test. Simultaneously, plateau pressure, driving pressure, mean airway pressure and the ratio of these mechanical ventilation pressure parameters to the PaO2/FiO2 were also analyzed. \u0000 \u0000 \u0000Results \u0000A total of 147 patients were included in the study and 117 of them were analyzed. The overall 28-day mortality was 31.62% (n=37). There were no significant differences in gender, age, body mass index, initial arterial oxygen partial pressure and carbon dioxide partial pressure between the survival group and non-survival groups (P >0.05). But there was a significant difference in SOFA score(6.53 ± 2.96 vs 8.65 ± 3.00) and nR -SOFA(3.44 ± 2.98 vs 5.27 ± 2.86). Among the evaluation indexes, the PPOI obtained the AUC of 0.828, with the sensitivity of 86.5%, and specificity of 71.2%.The AUC of the SOFA score was 0.707, while the AUC of the PPOI combined with the SOFA score was 0.833. \u0000 \u0000 \u0000Conclusion \u0000Mechanical ventilation pressure parameters can be used to predict the prognosis of patients with ARDS. PPOI may evaluate the prognosis of ARDS in a more simple, timely and real-time manner. \u0000 \u0000 \u0000Key words: \u0000Acute respiratory distress syndrome; Plateau pressure; Driving pressure; Mean airway pressure; Plateau pressure oxygenation index; Prognosis","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"121-125"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44318668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.007
Junhong Wang, K. Zheng, Xiaodan Li, Q. Ma, Jinjun Zhang
Objectives To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status, and to understand the current situation of TCPR cognition of EMS personnel in China. Methods This study is a multicenter cross-sectional survey. The method of multi-level convenient sampling was adopted, and the test reliability and split half reliability of the questionnaire was tested. Questionnaire survey and data collection were conducted from December 2018 to June 2019. The ethical approval number is M2018264. SPSS 20.0 was used for analysis. χ2 test was used to analyze the differences between groups. Results A total of 1 191 electronic questionnaires were collected. Of them, 80.94% respondents knew TCPR, 97.82% respondents thought that TCPR should be implemented in cardiac arrest, 36.62% respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR, and TCPR training courses were set up in the emergency department which recruited 25.83% respondents. Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69% vs 7.89%, P=0.048), of TCPR need ncluding guidance of chest compression (92.45% vs 87.49%, P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42% vs 74.87%, P=0.029) than those in underdeveloped areas, but there was no significant difference in other indicators (P>0.05). Conclusions TCPR knowledge of EMS personnel in China is unsatisfactory. Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone, TCPR content and bystander cardiopulmonary resuscitation quality monitoring. There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China. Key words: Emergency medical services; Telephone guidance; Cardiopulmonary resuscitation; Bystander; Out-of-hospital cardiac arrest; Cognition; Economic status; Cross-sectional survey
{"title":"Cognitive survey of telephone cardiopulmonary resuscitation among emergency personnel","authors":"Junhong Wang, K. Zheng, Xiaodan Li, Q. Ma, Jinjun Zhang","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.007","url":null,"abstract":"Objectives \u0000To investigate the cognition of dispatcher-initiated telephone cardiopulmonary resuscitation (TCPR) among emergency medical system(EMS) personnel and compare the cognition of TCPR among EMS personnel in different economic status, and to understand the current situation of TCPR cognition of EMS personnel in China. \u0000 \u0000 \u0000Methods \u0000This study is a multicenter cross-sectional survey. The method of multi-level convenient sampling was adopted, and the test reliability and split half reliability of the questionnaire was tested. Questionnaire survey and data collection were conducted from December 2018 to June 2019. The ethical approval number is M2018264. SPSS 20.0 was used for analysis. χ2 test was used to analyze the differences between groups. \u0000 \u0000 \u0000Results \u0000A total of 1 191 electronic questionnaires were collected. Of them, 80.94% respondents knew TCPR, 97.82% respondents thought that TCPR should be implemented in cardiac arrest, 36.62% respondents thought that bystander cardiopulmonary resuscitation quality monitoring was needed in TCPR, and TCPR training courses were set up in the emergency department which recruited 25.83% respondents. Emergency personnel in developed areas had a better understanding of the criteria for judging patients' breathlessness (11.69% vs 7.89%, P=0.048), of TCPR need ncluding guidance of chest compression (92.45% vs 87.49%, P=0.012) and of bystander cardiopulmonary resuscitation (BCPR) quality monitoring including the frequency of artificial respiration (84.42% vs 74.87%, P=0.029) than those in underdeveloped areas, but there was no significant difference in other indicators (P>0.05). \u0000 \u0000 \u0000Conclusions \u0000TCPR knowledge of EMS personnel in China is unsatisfactory. Further training is needed to improve their understanding of the criteria for judging cardiac arrest in out-of-hospital cardiac arrest patients via telephone, TCPR content and bystander cardiopulmonary resuscitation quality monitoring. There is difference in TCPR knowledge between the EMS personnel in developed and undeveloped areas in China. \u0000 \u0000 \u0000Key words: \u0000Emergency medical services; Telephone guidance; Cardiopulmonary resuscitation; Bystander; Out-of-hospital cardiac arrest; Cognition; Economic status; Cross-sectional survey","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"49-53"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46796020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2020.01.010
W. Xia, Zhou Pan, Huanming Zhang, Guang Li, Qingshan Zhou
Objective To investigate the effect of estrogen-related receptor alpha(ERRα)on lipopolysaccharide-induced inflammatory response in rat pulmonary microvascular endothelial cells (PMVECs) and its mechanism. Methods PMVECs were cultured in vitro. When the cells were in the logarithmic growth phase, the cell were ransfected with lentivirus, and a stable low-expression ERRα cell line was constructed. The cells were divided into four groups: Ctr group (normal control group), Ctr+LPS group (normal cell+LPS treatment group), shERRα1 (shERRα1 gene knockdown group), and shERRα1+LPS group (shERRα1 gene knockdown +LPS treatment group). After 20 μg/mL LPS stimulated cells in the control group and shERRα1 group for 6, 12 and 24 h, cell counting kit-8 (cck-8) was used to detect the cell proliferation ability of each group, and enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of tumor necrosis factor alpha (TNF-α) and Interleukin-1β (IL-1β) in cell culture fluid. After 12 h LPS stimulation, the expression levels of ERRα and NF-κB related proteins (p-p65, p65, P-IKBα, IKBα) were measured by Western blot. Pairwise comparisons were performed with SNK-q test (two-tailed), and multiple-group comparisons were performed with one-way ANOVA. The non-parametric test of rank transformation was used when homogeneity of variance were not met. P value<0.05 was considered significantly different. Results Compared with the control group, ERRα expression in the shERRα group was significantly decreased (0.09±0.01 vs 0.15±0.01). At 6, 12 and 24 h after LPS stimulation, compared with the control group, the cell proliferation ability (%) of the shERRα1+LPS group was significantly reduced (99.68±4.53 vs 48.62±1.60) and the concentration of TNF-α (ng/mL) (15.76±3.38 vs 5 498.91±367.95) and IL-1β (ng/mL) (14.41±3.86 vs 6 014.92±277.33) in the cell culture supernatant were significantly increased. The change was most obvious after 12 h stimulation. Meanwhile the expression of p-p65 (0.30±0.50 vs 1.05±0.07) and p-IKBα (0.27±0.04 vs 0.77±0.06) were increased significantly, while the expression of IKBα (0.96±0.07 vs 0.14±0.04) was decreased significantly in the shERRα1+LPS group (all P<0.05). Conclusion ERRα gene attenuates LPS-induced inflammatory response in rat pulmonary microvascular endothelial cells by inhibiting NF-κB signaling pathway activation. Key words: Sepsis; Estrogen-related receptor alpha; NF-κB pathway; Gene knockdown
目的探讨雌激素相关受体α (ERRα)在脂多糖诱导的大鼠肺微血管内皮细胞(PMVECs)炎症反应中的作用及其机制。方法体外培养pmvec。当细胞处于对数生长期时，用慢病毒转染细胞，构建稳定的低表达ERRα细胞系。将细胞分为4组:Ctr组(正常对照组)、Ctr+LPS组(正常细胞+LPS处理组)、shERRα1组(shERRα1基因敲低组)、shERRα1+LPS组(shERRα1基因敲低+LPS处理组)。20 μg/mL LPS刺激对照组和shERRα1组细胞6、12、24 h后，采用细胞计数试剂盒-8 (cck-8)检测各组细胞增殖能力，采用酶联免疫吸附法(ELISA)检测细胞培养液中肿瘤坏死因子α (TNF-α)和白细胞介素-1β (IL-1β)的浓度。LPS刺激12 h后，采用Western blot法检测ERRα和NF-κB相关蛋白(p-p65、p65、P-IKBα、IKBα)的表达水平。两两比较采用SNK-q检验(双侧)，多组比较采用单因素方差分析。当方差齐性不满足时，采用秩变换的非参数检验。P值<0.05为差异有统计学意义。结果与对照组相比，shERRα组的ERRα表达量显著降低(0.09±0.01 vs 0.15±0.01)。LPS刺激后6、12、24 h，与对照组相比，shERRα1+LPS组细胞增殖能力(%)显著降低(99.68±4.53 vs 48.62±1.60)，细胞培养上清中TNF-α (ng/mL)(15.76±3.38 vs 5 498.91±367.95)、IL-1β (ng/mL)(14.41±3.86 vs 6 014.92±277.33)浓度显著升高。刺激12 h后变化最为明显。shERRα1+LPS组P -p65(0.30±0.50 vs 1.05±0.07)、P -IKBα(0.27±0.04 vs 0.77±0.06)表达量显著升高，IKBα(0.96±0.07 vs 0.14±0.04)表达量显著降低(均P<0.05)。结论ERRα基因通过抑制NF-κB信号通路激活，减轻lps诱导的大鼠肺微血管内皮细胞炎症反应。关键词:脓毒症;雌激素相关受体;NF -κB通路;基因击倒
{"title":"Effects of estrogen-related receptor alpha on inflammatory response in pulmonary microvascular endothelial cells","authors":"W. Xia, Zhou Pan, Huanming Zhang, Guang Li, Qingshan Zhou","doi":"10.3760/CMA.J.ISSN.1671-0282.2020.01.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2020.01.010","url":null,"abstract":"Objective \u0000To investigate the effect of estrogen-related receptor alpha(ERRα)on lipopolysaccharide-induced inflammatory response in rat pulmonary microvascular endothelial cells (PMVECs) and its mechanism. \u0000 \u0000 \u0000Methods \u0000PMVECs were cultured in vitro. When the cells were in the logarithmic growth phase, the cell were ransfected with lentivirus, and a stable low-expression ERRα cell line was constructed. The cells were divided into four groups: Ctr group (normal control group), Ctr+LPS group (normal cell+LPS treatment group), shERRα1 (shERRα1 gene knockdown group), and shERRα1+LPS group (shERRα1 gene knockdown +LPS treatment group). After 20 μg/mL LPS stimulated cells in the control group and shERRα1 group for 6, 12 and 24 h, cell counting kit-8 (cck-8) was used to detect the cell proliferation ability of each group, and enzyme-linked immunosorbent assay (ELISA) was used to detect the concentrations of tumor necrosis factor alpha (TNF-α) and Interleukin-1β (IL-1β) in cell culture fluid. After 12 h LPS stimulation, the expression levels of ERRα and NF-κB related proteins (p-p65, p65, P-IKBα, IKBα) were measured by Western blot. Pairwise comparisons were performed with SNK-q test (two-tailed), and multiple-group comparisons were performed with one-way ANOVA. The non-parametric test of rank transformation was used when homogeneity of variance were not met. P value<0.05 was considered significantly different. \u0000 \u0000 \u0000Results \u0000Compared with the control group, ERRα expression in the shERRα group was significantly decreased (0.09±0.01 vs 0.15±0.01). At 6, 12 and 24 h after LPS stimulation, compared with the control group, the cell proliferation ability (%) of the shERRα1+LPS group was significantly reduced (99.68±4.53 vs 48.62±1.60) and the concentration of TNF-α (ng/mL) (15.76±3.38 vs 5 498.91±367.95) and IL-1β (ng/mL) (14.41±3.86 vs 6 014.92±277.33) in the cell culture supernatant were significantly increased. The change was most obvious after 12 h stimulation. Meanwhile the expression of p-p65 (0.30±0.50 vs 1.05±0.07) and p-IKBα (0.27±0.04 vs 0.77±0.06) were increased significantly, while the expression of IKBα (0.96±0.07 vs 0.14±0.04) was decreased significantly in the shERRα1+LPS group (all P<0.05). \u0000 \u0000 \u0000Conclusion \u0000ERRα gene attenuates LPS-induced inflammatory response in rat pulmonary microvascular endothelial cells by inhibiting NF-κB signaling pathway activation. \u0000 \u0000 \u0000Key words: \u0000Sepsis; Estrogen-related receptor alpha; NF-κB pathway; Gene knockdown","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"65-70"},"PeriodicalIF":0.0,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46434562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.3760/cma.j.issn.1671-0282.2020.05.017
Sun Yu
Objective: To perform a statistical analysis of the ABO blood group distribution of COVID-19 convalescents, and further analyze the ABO blood group distribution in COVID-l9 convalescents with different plasma antibody titer against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-Z).
{"title":"Investigation on compliance with sepsis bundle and outcomes in patients with septic shock in Changshu area","authors":"Sun Yu","doi":"10.3760/cma.j.issn.1671-0282.2020.05.017","DOIUrl":"https://doi.org/10.3760/cma.j.issn.1671-0282.2020.05.017","url":null,"abstract":"Objective: To perform a statistical analysis of the ABO blood group distribution of COVID-19 convalescents, and further analyze the ABO blood group distribution in COVID-l9 convalescents with different plasma antibody titer against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-Z).","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"29 1","pages":"700-706"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69953706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-10DOI: 10.3760/CMA.J.ISSN.1671-0282.2019.12.006
Bin Yan, Tianxi Hu, Xin Li, Shi-qi Lu, Qi Wang, Guangjian Xu, Shu-Fang Pei, Yiming Zhao, C. Ruan
Objective To explore the correlation and consistency between thromboelastography (TEG) and traditional coagulation tests (CCTs) in ischemic cerebral vascular disease (ICVD). Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled. Patients’ TEG parameters (R value, K value, Angle value, MA value, CI value and G value) and CCTs parameters (PT, APTT, TT, and FIB) were collected and analyzed retrospectively. The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters, and Kappa (κ) to explore the consistency in determining the coagulation status of the patients. The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs, and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients. Results (1) PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value, MA value and G value. TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value. (2) PT and MA values, PT and G values, FIB and MA values, FIB and G values were accordant in valuing the hypoxic state of ICVD patients. (3) PLT and Angle values, PLT and MA values, PLT and CI values, PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values, FIB and MA values, FIB and CI value, and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients. (4) For detecting TT>20 s, the AUC of K value and Angle value were 0.648, 0.651, respectively; For detecting FIB>4 g/L, the AUC of Angle value and MA value were 0.717 and 0.747, respectively; For detecting PLT>300×109/L, the AUC of MA value was 0.808 (all P<0.05). Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients. The TEG parameters have good predictive value in evaluating the abnormal results of CCTs, but cannot replace the CCTs. Combination of these two methods can better reflect the coagulation status of patients, so as to afford assistance. Key words: Thromboelastography; Conventional coagulation tests; Ischemic cerebral vascular disease; Ischemic stroke; Comparation
{"title":"The comparative study between thromboelastography and conventional coagulation tests in ischemic cerebral vascular disease","authors":"Bin Yan, Tianxi Hu, Xin Li, Shi-qi Lu, Qi Wang, Guangjian Xu, Shu-Fang Pei, Yiming Zhao, C. Ruan","doi":"10.3760/CMA.J.ISSN.1671-0282.2019.12.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1671-0282.2019.12.006","url":null,"abstract":"Objective To explore the correlation and consistency between thromboelastography (TEG) and traditional coagulation tests (CCTs) in ischemic cerebral vascular disease (ICVD). Methods Totally 108 ICVD patients admitted to Nanyang Central Hospital from May 1 to October 31 2018 were enrolled. Patients’ TEG parameters (R value, K value, Angle value, MA value, CI value and G value) and CCTs parameters (PT, APTT, TT, and FIB) were collected and analyzed retrospectively. The Spearman correlation coefficient was used to explore the correlation between TEG and CCTs parameters, and Kappa (κ) to explore the consistency in determining the coagulation status of the patients. The ROC curve was used to analyze the predictive value of TEG parameters for abnormal results of CCTs, and the results of TEG and CCTs were comprehensively analyzed to evaluate the ability to predict the coagulation status of patients. Results (1) PLT was positively correlated with MA value and G value; PT and APTT were positively correlated with K value; TT was positively correlated with R value and K value; FIB was positively correlated with Angle value, MA value and G value. TT was negatively correlated with Angle value and CI value; FIB was negatively correlated with K value. (2) PT and MA values, PT and G values, FIB and MA values, FIB and G values were accordant in valuing the hypoxic state of ICVD patients. (3) PLT and Angle values, PLT and MA values, PLT and CI values, PLT and G values were accordant in assessing hypercoagulable status of ICVD patients; FIB and Angle values, FIB and MA values, FIB and CI value, and FIB and G value were consistent in evaluating the hypercoagulable state of ICVD patients. (4) For detecting TT>20 s, the AUC of K value and Angle value were 0.648, 0.651, respectively; For detecting FIB>4 g/L, the AUC of Angle value and MA value were 0.717 and 0.747, respectively; For detecting PLT>300×109/L, the AUC of MA value was 0.808 (all P<0.05). Conclusions There is weak correlation and consistency between TEG and CCTs parameters in ICVD patients. The TEG parameters have good predictive value in evaluating the abnormal results of CCTs, but cannot replace the CCTs. Combination of these two methods can better reflect the coagulation status of patients, so as to afford assistance. Key words: Thromboelastography; Conventional coagulation tests; Ischemic cerebral vascular disease; Ischemic stroke; Comparation","PeriodicalId":9981,"journal":{"name":"中华急诊医学杂志","volume":"28 1","pages":"1490-1495"},"PeriodicalIF":0.0,"publicationDate":"2019-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48191710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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