Objective Cardiovascular mortality and morbidity is common in dialysis patients and fluid overload is the most important contributor. The aim of this study was to investigate the relationship between volume overload and hypertension in elderly continuous ambulatory peritoneal dialysis (CAPD) patients and effect of dietary salt restriction on blood pressure control. Methods Thirty-eight CAPD patients with age of 60 years old and over were enrolled in the present study. 38 patients with CAPD were restricted the intake of salt and fluid in stable CAPD patients for two months. Their body weight, extracellular water (ECW), intracellular water (ICW), total body water (TBW), blood pressure, serum albumin levels, urine volume and ultrafiltrate volume were measured before and after the dietary restriction. Bioimpedance analysis was used to assess their fluid status. ECW was normalized by patients' ideal weight (nECW). Results After dietary salt restriction, significant deceases in body weight 〔(60.5?10.3) kg vs (58.5?9.7) kg, P =0.000〕, ECW 〔(15.81?3.03) L vs (14.65?2.61) L, P =0.000〕 and systolic blood pressure 〔(134.0?18.3) mm Hg vs (128.3?21.0) mm Hg, P =0.05〕 were observed in 26 patients whereas the opposite changes were observed in the remaining 12 patients. A significant correlation was found between systolic blood pressure and nECW both before and after two months of dietary restriction ( r _ pre =0.379, P =0.019; r _ post =0.393, P =0.016) and between the changes in systolic blood pressure and changes in nECW ( r =0.514, P =0.001). Conclusions The present study suggests that there is a positive correlation between fluid status and blood pressure. Most of the elderly CAPD patients are fluid overloaded and that dietary salt restriction may be an effective way to control volume and blood pressure. However, the compliance of patients to dietary salt restriction can influence the effect.

Objective To evaluate the variance and clinical significance of urinary pyridinoline cross-linked N-telopeptides of Type Ⅰ collagen(uNTx) ,serum bone specific alkaline phosphates(sBAP) and Bone mineral density(BMD) in patients with bone metastasis malignant tumors .Methods The levels of 53 case patients′,who with bone metastasis ,uNTx and sBAP were measured by ELISA and BMD was detected by dual energy x-ray absorptiometer .40 cases of non-bone metastasis people was assayed .Results The levels of all bone markers in patients with bone metastasis was significantly higher than in the patients without bone metas-tasis(P<0 .05) .The levels of the two biomarkers showed a positive correlation with the number of metastatic loci in bone (P<0 .05) .But there was not significantly different between the levels of uNTx or sBAP with the severity of the bone pain (P>0 .05) . BMD decreased in patients with bone metastasis group ,but it was no difference in the non-bone metastasis(P>0 .05) .Conclusion uNTx and sBAP are helpful for early diagnosis and prevention of patients with bone metastasis from malignant tumors .Patients with malignant gumor is often accompanied by a decrease in BMD .

Objective:To explore the clinical effect of "information knowledge belief practice" model, namely "IKAP theory" nursing intervention model on patients with peritoneal dialysis(PD).Methods:The clinical data of 120 patients with PD treated in The Second Hospital of Tianjin Medical University from January 2020 to December 2020 were analyzed retrospectively. The patients were randomly divided into control group and observation group, with 60 cases in each group. In the observation group, there were 32 males and 28 females with an age range of (56.16±10.25) years, including 18 cases of diabetic nephropathy, 22 cases of chronic glomerulonephritis and 20 cases of hypertensive nephropathy. In the control group, there were 34 males and 26 females, with an age range of (56.27±10.34) years, including 14 cases of diabetic nephropathy, 18 cases of chronic glomerulonephritis and 28 cases of hypertensive nephropathy. The patients in the control group were given routine nursing. In addition to the routine nursing, the patients in the observation group also adopted IKAP mode for nursing intervention. The levels of hemoglobin (HB), serum albumin (ALB), comprehensive nutrition assessment score (SGA) and nursing satisfaction of the two groups were compared before and 6 months after the intervention. The comparison of measurement data before and after intervention in the intervention group was analyzed by paired sample t-test. Frequency data were compared and analyzed by Chi-square ( χ2) test. Results:Before the intervention, there was no significant difference in ALB, Hb levels and SGA between the observation group and the control group( t=1.001~1.743, all P>0.05). After the intervention, the SGA score of the observation group was lower than that of the control group, while the levels of ALB and Hb were higher than those of the control group, and the differences between the two groups were statistically significant ( t=3.411~5.050, all P<0.05). The satisfaction of patients in the observation group was 95%, while that in the control group was 78.33%, and the difference between the two groups was statistically significant ( χ2=7.212, P<0.05). Conclusions:For peritoneal dialysis patients, IKAP nursing intervention can not only effectively improve their nutritional status, but also increase their satisfaction with nursing. IKAP nursing intervention model is worthy of clinical promotion.

Objective:To seek specific response points on the body surface of patients with primary dysmenorrhea(PD)by observing blood perfusion unit(PU)at different points of the three Yin meridians of foot using laser speckle contrast imaging(LSCI). Methods:Eighty PD patients were recruited as a PD group,and 80 healthy female undergraduates were taken as a normal group.During one menstrual cycle(before menstruation,during menstruation,and 3 d after menstruation),each participant was examined using the LSCI system to determine PU at bilateral Taixi(KI3),Taibai(SP3),Taichong(LR3),Shuiquan(KI5),Diji(SP8),Zhongdu(LR6),Sanyinjiao(SP6),and Xuehai(SP10)and non-acupuncture points.The researchers in charge of point location,operation,and statistical analysis were not aware of grouping.PU at the detection spots was taken as the outcome measure. Results:Compared with the normal group,the PD group showed increases in PU at right Taixi(KI3)before menstruation(P<0.05)and at bilateral Zhongdu(LR6)and right Diji(SP8)during menstruation(P<0.05).At the other time points,significance was not found between the two groups in comparing PU at the detected spots. Conclusion:Compared with healthy participants,PD patients present specific changes in PU at Taixi(KI3),Diji(SP8),and Zhongdu(LR6)at specific time points during the menstrual cycle,which provides a reference for acupuncture-moxibustion treatment of PD in clinical settings.

Objective:To explore the effects of external diaphragm electrical stimulation on the diaphragm thickness and function in mechanically ventilated children.Methods:A randomized controlled trial was conducted in children who were admitted to PICU at Children′s Hospital of Fudan University and received mechanical ventilation between June 2021 and April 2022.The control group was given the routine treatment of mechanical ventilation, and the intervention group was given external diaphragm electrical stimulation in the early stage of mechanical ventilation in addition to routine treatment.Diaphragm thickness was continuously measured by bedside ultrasound every day for one week after mechanical ventilation, and the changing trend of diaphragm thickness was observed, and the diaphragmatic thickening fraction (DTf) and the incidence of ventilator-induced diaphragmtic dysfunction(VIDD) were calculated at the same time.Results:A total of 32 valid samples were included, including 15 cases in intervention group (10 males) and 17 cases in control group (11 males). The median age of the patients was 33 (10, 77) months, and the median duration of mechanical ventilation was 12 (8, 21) days.The reasons for mechanical ventilation in children included respiratory insufficiency in ten cases, brain dysfunction in ten cases, heart failure in eight cases, and postoperative surgery in four cases.The diaphragm end-expiratory thickness (DTe) in intervention group and the control group showed a gradually decreasing trend from the 1st day to the 7th day.The left thickness was reduced by 11% on the 7th day compared to 1st day in intervention group, which was reduced by 18% in control group; the average daily DTe was reduced by 2% per day in intervention group and by 3% per day in control group.The trends on the right and left were similar.The DTe thickness in the intervention group was greater than that in control group, among which, the mean DTe thickness in the left side of the intervention group on the 7th day was (0.110 7±0.023 7)cm, which was greater than that in control group (0.093 5±0.016 9)cm, and the difference was statistically significant ( t=-2.372, P<0.05); On the second day, the mean DTe thickness on the right side in the intervention group was (0.1267±0.0277) cm, which was greater than that in control group (0.104 7±0.018 1)cm, and the difference was statistically significant ( t=-2.688, P<0.05). DTf in the intervention group was lower than that in control group at 7th day, but the difference was not statistically significant(left DTf: adjusted mean difference was -0.117, P=0.088; right DTf: adjusted mean difference was -0.065, P=0.277). The incidence of VIDD in the intervention group was lower than that in control group(33.3% vs.41.2%), but the difference was not statistically significant ( χ2=0.005, P=0.946). Conclusion:External diaphragmatic electrical stimulation may be helpful for alleviating diaphragmatic atrophy in mechanically ventilated children.However, whether the improvement of diaphragm atrophy is beneficial to clinical outcome still needs further study.

Respiratory therapist is a new profession in medicine, who works therapeutically with people suffering from pulmonary disease.Their timely treatments of patients with cardiopulmonary insufficiency can significantly reduce mortality in pediatric intensive care units.This review focused on the responsibilities of respiratory therapists, the importance of respiratory support therapy in children, and the most updated development in China as well as the problems to be solved.

Objective:To analyze clinical characteristics of patients within 48 hours in pediatric intensive care unit（PICU）,and investigate causes and prognosis of extubation failure in reintubation children.Methods:A single-center retrospective study was conducted.Patients who were reintubated within 48 hours after extubation in PICU at Children's Hospital of Fudan University from January 1，2019 to December 31，2022 were retrospectively enrolled.Patients with unplanned extubation for various reasons which include re-intubation due to surgery and replacement of tracheal intubation were excluded.We analyzed the clinical characteristics，causes of extubation failure and prognosis.Main outcome measures included principal diagnosis，pediatric critical illness score（PCIS），the reason of intubation，the glasgow coma scale（GCS），the direct cause of reintubation，aeration time，hospitalization period，outcomes at PICU discharge and whether to extubate successfully.Results:During the study period，a total of 2 652 patients were extubated in PICU,and a total of 87 children were enrolled.Finally，63（72.4%）patients survived at PICU，nine（10.3%）patients died in hospital，and 15（17.2%）patients were discharged automatically.In the survival group，38（60.3%）patients were decannulated and 25（39.7%）patients underwent tracheotomy.The top three principal diagnosis in 87 cases were central nervous system disease[34（39.1%）cases]，lower airway disease[18（20.7%）cases] and sepsis[nine（10.3%）cases].Of the 87 children，28（32.2%）patients were reintubated due to central respiratory failure，21（24.1%）patients were reintubated due to lower airway disease，20（23.0%）patients were reintubated due to upper airway obstruction，14（16.1%）patients were reintubated due to cough weakness and/or swallowing disturbance，and four（4.6%）patients were reintubated for other reasons.In children with mechanical ventilation duration ≥7 days before first extubation，central nervous system diseases were the most common primary diseases，and it accounts for 55.6%.Central respiratory failure was the main direct cause of reintubation，accounting for 40.0%，and more patients(40.0%) had GCS scores＜8 before the first intubation.Compared with the successful decannulation group，the extubation failure group had the higher proportion of children with GCS＜8（32.7% vs.10.5%， P＜0.05），the longer median duration of mechanical ventilation before the first extubation[239（123，349）h vs.68.5（19，206）h， P＜0.05]and the longer median length of ICU stay[38（23，54）d vs.24（12，43）d， P＜0.05].After comparing the three groups including survival group，in-hospital death group and automatic discharge group，the PCIS score of the survival group was the highest，and the in-hospital death group was the lowest( P＜0.05). Conclusion:The rate of reintubation at 48 h after extubation in PICU is 3.3%.The immediate causes of reintubation mainly included central respiratory failure，lower airway disease，upper airway obstruction，cough weakness and/or dysphagia.The mortality rate of reintubation in critically ill children is high and the prognosis is poor.

A case of severe complications is presented that replaced the double J tubeless misguided by zebra guidewire into ileum in a patient with ureteral dermostomy, causing a ureteral ileum fistula.The result suggests improper operation of zebra guidewire could have a risk of ureteral perforation when the ureter is distorted, narrow or with inflammatory lesions.Standardized diagnosis and treatment and correct selection of guidewire can reduce the risk of ureteral perforation.

OBJECTIVETo compare the effects of acupuncture, electroacupuncture (EA) and moxibustion on functional constipation in rats.

METHODSSixty male Sprague-Dawley rats were divided into a control group (=8), a model group (=11), a medication group (=8), an acupuncture group (=11), an EA group (=11) and a moxibustion group (=11) by random number table. The rats in the model group, medication group, acupuncture group, EA group and moxibustion group were treated with intragastric administration of loperamide hydrochloride for 6 days continuously to establish the functional constipation models, while equal volume of drinking water was administrated to rats in the control group at the same time. The rats in the acupuncture group, EA group and moxibustion group were respectively treated with acupuncture, EA and moxibustion at "Tianshu" (ST 25) and "Shangjuxu" (ST 37) one hour after intragastric administration; rats in the medication group were treated with intragastric administration of cisapride suspension. All the treatment was given once a day for 6 days. At the last day of intervention, the 24-hour food intake, stool quantity and its water content were measured in each group; the pushing rate of intestine was measured; the structure of colon tissue and acidic mucus in its mucous layer were observed by hematoxylin-eosin dyeing and alcian blue dyeing; the expression of stem cell factor (SCF) and c-kit mRNA was detected by real-time PCR.

RESULTSCompared with the control group, the 24-hour food intake and stool quantity were reduced in the model group (both<0.01), and the water content of stool and pushing rate of intestine were reduced (both<0.01); compared with the model group, the stool quantity and its water content were increased in the medication group, acupuncture group, EA group (<0.05,<0.01), which were not significantly different from those in the moxibustion group (both>0.05). The pushing rate of intestine in each intervention group was increased (all<0.01). The 24-hour food intake and stool quantity in the medication group were not significantly different from those in the acupuncture group, EA group and moxibustion group (all>0.05), and the water content of stool was only reduced in the moxibustion group (<0.01). The pushing rate of intestine in the acupuncture group and moxibustion group was lower than that in the medication group (both<0.01), while that in the EA group was not significantly different from that in the medication group (>0.05). The water content of stool in the moxibustion group was lower than that in the acupuncture group and EA group (both<0.01). The pushing rate of intestine in the acupuncture group and moxibustion group was lower than that in the EA group (both<0.01). The HE staining result indicated the structure of colon tissue was normal, complete and similar in each group; the alcian blue staining indicated the acidic mucosubstance in the model group was lower than that in the control group; compared with the model group, the acidic mucosubstance in the medication group, acupuncture group, EA group and moxibustion group was all increased. Compared with the control group, the expression of SCF and c-kit mRNA was reduced in the model group (both<0.05); compared with the model group, the expression of SCF and c-kit mRNA was increased in the medication group, acupuncture group, EA group and moxibustion group (all<0.05); compared with the moxibustion group, the expression of c-kit mRNA was reduced in the acupuncture group and EA group (both<0.05).

CONCLUSIONSAcupuncture, EA and moxibustion all can play a positive regulative role on functional constipation in rats, in which EA has the best efficacy, followed by acupuncture.

Periodontitis is caused by overactive osteoclast activity that results in the loss of periodontal supporting tissue and mesenchymal stem cells (MSCs) are essential for periodontal regeneration. However, the hypoxic periodontal microenvironment during periodontitis induces the apoptosis of MSCs. Apoptotic bodies (ABs) are the major product of apoptotic cells and have been attracting increased attention as potential mediators for periodontitis treatment, thus we investigated the effects of ABs derived from MSCs on periodontitis. MSCs were derived from bone marrows of mice and were cultured under hypoxic conditions for 72 h, after which ABs were isolated from the culture supernatant using a multi-filtration system. The results demonstrate that ABs derived from MSCs inhibited osteoclast differentiation and alveolar bone resorption. miRNA array analysis showed that miR-223-3p is highly enriched in those ABs and is critical for their therapeutic effects. Targetscan and luciferase activity results confirmed that Itgb1 is targeted by miR-223-3p, which interferes with the function of osteoclasts. Additionally, DC-STAMP is a key regulator that mediates membrane infusion. ABs and pre-osteoclasts expressed high levels of DC-STAMP on their membranes, which mediates the engulfment of ABs by pre-osteoclasts. ABs with knock-down of DC-STAMP failed to be engulfed by pre-osteoclasts. Collectively, MSC-derived ABs are targeted to be engulfed by pre-osteoclasts via DC-STAMP, which rescued alveolar bone loss by transferring miR-223-3p to osteoclasts, which in turn led to the attenuation of their differentiation and bone resorption. These results suggest that MSC-derived ABs are promising therapeutic agents for the treatment of periodontitis.
Humans ; Osteoclasts ; Alveolar Bone Loss/therapy* ; Cell Differentiation ; MicroRNAs ; Periodontitis/therapy* ; Extracellular Vesicles ; Apoptosis ; Mesenchymal Stem Cells