Objective To explore the role of potassium channel in cardiomyocyte apoptosis induced by ischemia/reperfusion process. Methods Cell viability,caspase-3 activity,intracellular reactive oxygen species(ROS)levels and cell membrane integrity were observed in apoptotic model of mouse cardiomyocytes induced by ischemia/reperfusion(I/R).Experiment groups included negative control,positive control(I/R)and drug treatment group(I/R + potassium channel blocker).Results (1)Potassium channel blockers potently inhibited cardiomyocyte apoptosis induced by I/R.Cell viability in Quinine(81.1%)and BaCl2(82.3%)groups were higher than in positive group (52.1%)(all P＜0.01).(2)Compared with positive control group(482.3%),potassium channel blockers(188.3% in Quinine group and 191.4% in BaCl2 group)inhibited caspase-3 activity significantly 24 hours after reperfusion(P＜0.01).(3)In both positive control and drug groups,the cell lactate dehydrogenase(LDH)leakage was less than 10% at 96 hours after reperfusion.Conclusions Potassium channel blockers can protect injured cardiomyocyte by inhibiting caspase-3 activity and ROS production in I/R process.

Background and objective For the assessment of elderly patients can tolerate lung cancer operation, there is no clear standard. To evaluate the clinical validity of POSSUM (Physiological and Operative Severity Score for the Umeration of Mortality and Morbidity) in elderly non-small cell lung cancer (NSCLC) surgery patients, we want to provide an important basis for operation treatment decisions. Methods A total of 138 patients, with 88 males and 50 females, with elderly NSCLC surgery between December 2007 and December 2013, are included in PLA general hospital. Using the mul-tivariate Logistic regression analysis, we evaluate the value of each factor on the actual postoperative complications mortality and morbidity. hTe scorings on standard POSSUM and modiifed POSSUM in the complication group are compared with the non-complication group using the group t test. Drawing receiver operating characteristic (ROC) curve in standard POSSUM group and modiifed POSSUM group, calculating the area under the curve (AUC), AUC in standard group is compared with modiifed group using t test. Judge if the modiifed POSSUM prediction is consistent with the actual mortality and morbidity. Results Among 138 patients, there were 77 postoperative complications in 59 patients, 2 cases of death. According to the Logistic regression analysis, 17 of 18 factors in standard POSSUM, pulmonary function, different TNM stage are predictors for postoperative complications (P<0.05). Age is a predictor for postoperative death (P<0.05). In the standard POSSUM scor-ing, actual complication group compared with non-complication group, the difference is statistically signiifcant (P<0.01). In the modiifed POSSUM scoring, complication group is compared with non-complication group, the difference is statistically signiifcant (P<0.01). Compared with the standard POSSUM, the modiifed POSSUM has better predictive value on postopera-tive morbidity, and the comparison of AUC between the two groups is statistically signiifcant. But the latter shows the overpre-dicted mortality (P<0.01). Conclusion hTe modiifed POSSUM has a good predictive value on postoperative complications in elderly NSCLC surgery patients, so it can provide the basis for decision-making operation treatment.

Objective? To explore the current status of feeding interruption of early enteral nutrition among critical patients and its related factors. Methods? From June 2017 to March 2018, we selected critical patients with early enteral nutrition at a ClassⅢ Grade A hospital in Nanjing by convenience sampling. We recorded the enteral nutrition intake of patients within one week. All of the patients were divided into three groups based on the total time of feeding interruption including group A (＜4 hours), group B (4 to 24 hours) and group C (＞24 hours). The general information, calorie and prognostic factors of patients in three groups were compared and the related factors of feeding interruption time were analyzed with the multiple linear regression. Results? A total of 198 patients were enrolled including 108 of them in group A, 56 in group B and 34 in group C. There was a statistical difference in the completion rate of actual calorie in three groups (P＜ 0.05). Multiple linear regression analysis showed that the feeding interruption time of enteral nutrition were positively correlated with the disease severity, hospitalization expense and target calorie (P＜0.05). Conclusions? The incidence of feeding interruption is high in critical patients with enteral nutrition. The longer the interruption time is, the higher the risk of caloric inadequacy. At present, there is no standardized feeding strategy which needs to explore the best intervention by clinical researches so as to solve the problem of feeding interruption among critical patients.

Objective:To explore the effects of standardized enteral nutrition process in critically ill patients.Methods:We retrieved PubMed, EMBASE, MEDLINE, WanFang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) by computer to collect literatures on effects of standardized enteral nutrition process in critically ill patients from the establishment of database to May 31, 2019. RevMan 5.3 was used to statistical analysis.Results:Finally, 11 articles were included. Meta-analysis results showed that compared with conventional care, the standardized enteral nutrition process could increase the calorie compliance rate of critical ill patients on the seventh day [ OR=8.18, 95% CI (4.91, 11.45) , P<0.01], and reduce the incidence of feeding intolerance symptoms [ OR=0.36, 95% CI (0.23, 0.57) , P<0.01]. However, the standardized enteral nutrition process did not show obvious advantages in shortening mechanical ventilation, Intensive Care Unit (ICU) hospitalization time and reducing mortality, combined effects, the combined effect was not statistically significant ( P>0.05) . Conclusions:The standardized enteral nutrition process could effectively increase the calorie compliance rate of critical ill patients on the seventh day and reduce the incidence of feeding intolerance symptoms; however, it cannot significantly shorten the time of mechanical ventilation, ICU hospitalization time and reduce the mortality. Further research is needed for verification.

OBJECTIVETo investigate the effectiveness of using continuous veno venous hemofiltration (CVVH) in the treatment of acute necrotizing pancreatitis (ANP).

METHODSThirteen ANP patients were involved in this study, including 4 females and 9 males, averaging 50.6 +/- 10.8 years old. CT scans upon admission revealed 33% necrosis involving the body of the pancreas in 2 patients, 67% necrosis in 3 patients and 100% necrosis in the other 8; the CT severity score was 8.9 +/- 2.1. CVVH was maintained for at least 72 hours and the AN69 hemofilter (1.2 m(2)) was changed every 24 hours. The ultrafiltration rate during CVVH was 2993.9 +/- 983.0 ml/h, the blood flow rate was 250 - 300 ml/min, and the substitute fluid was infused in a pre-diluted manner. Low molecular weight heparin was used as anticoagulant.

RESULTSCVVH was well tolerated in all the patients. Bloody abdominal cavity drainage fluid was observed in 2 patients, but no other side-effects related with CVVH were observed. Two patients died of systemic fungal infections and another died of intracranial fungi infection, resulting in an ICU mortality of 23.1%. Ten of the patients survived in the ICU, but one of them died for other reasons unrelated to the SAP before discharge. The APACHE II score before CVVH was 15.2 +/- 6.5, but decreased significantly to 8.1 +/- 5.3, 7.5 +/- 4.9 and 8.0 +/- 5.2 at the 24th, 48th and 72nd hour after CVVH, respectively (P < 0.01). Serum concentration of IL-1beta and TNFalpha decreased to the trough at the 6th hour after a new hemofilter was used and increased slowly to pre-CVVH levels 12 hours later. After CVVH had ceased, the serum levels of two cytokines increased to their peaks at the 120th hour and decreased eventually at the 144th hour. The sieving coefficient (SC) of IL-1beta and TNFalpha was 0.33 +/- 0.11 and 0.16 +/- 0.08.

CONCLUSIONCVVH offered therapeutic options for ANP and was well tolerated resulting in clearance of IL-1beta and TNFalpha; CVVH at early stages of SAP may contribute to the improvement of outcome.

Adult ; Aged ; Female ; Hemofiltration ; adverse effects ; Humans ; Interleukin-1 ; analysis ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; therapy ; Tumor Necrosis Factor-alpha ; analysis

Objective:To explore the therapeutic characteristics of population with gout achieving treat-to-target (T2T) indicators through real-world research and evaluate their safety.Methods:A total of 3 287 patients diagnosed with gout by rheumatologists in 21 first-class tertiary hospitals in 10 provinces, municipalities, and autonomous regions in China from January 2015 to December 2021 were included in this polycentric cross-sectional study. The database included patients′ general information, disease characteristics, and clinical application of traditional Chinese and Western medicine treatment measures. SPSS and Excel software were used for data analysis. Frequency analysis, cluster analysis, and factor analysis were used to summarize the characteristics and rules of treatment measures for patients with gout who achieved the target after treatment. The occurrence of adverse events (AE) was recorded during treatment.Results:After treatment, 691 visits (7%) achieved the serum urate (SUA) target, and the most frequent use of urate-lowering therapy (ULT) was febuxostat, followed by benzbromarone. The most common treatment options were following: GroupⅠ: traditional Chinese medicine (TCM) decoction-TCM external treatment-physical exercise-proprietary Chinese medicine; GroupⅡ: ferulic acid-nonsteroidal anti-inflammatory drugs (NSAIDs); Group Ⅲ: allopurinol-sodium bicarbonate-benzbromarone; Group Ⅳ: glucocorticoid-colchicine; Group Ⅴ: febuxostat. A total of 5 898 visits (60%) chieved manifestations of joint pain VAS scores target, and the most frequently used drug to control joint symptoms was NSAIDs. The frequency of use of drugs to control joint symptoms were 2 118 times (usage rate reached 35.9%), while the frequency of ULT were 2 504 times (usage rate reached 42.5%), which was higher than the joint symptom control drug. The most common treatment options were following: Group Ⅰ: proprietary Chinese medicine-TCM decoction-TCM external treatment-physical exercise; Group Ⅱ: NSAIDs-colchicine hormones; Group Ⅲ: allopurinol, Group Ⅳ: benzbromarone; Group Ⅴ: febuxostat. A total of 59 adverse events occurred during treatment.Conclusion:The proportions of gout patients who reach target serum urate level & good control of joint symptoms are both very low, and ULT and anti-inflammatory prescription patterns are very different from international guidelines, so it is necessary to strengthen the standardized management of gout patients. At the same time, life intervention measures account for a certain proportion of the treatment plans for the T2T population, and further exploration is needed.