AIM: To investigate the roles of nitric oxide/L-arginine(NO/L-Arg) pathway and urotensin-Ⅱ(UⅡ) in the development of pulmonary hypertension induced by chronic hypoxia-hypercapnia in rats.METHODS: Forty male Sprague-Dawley rats were randomly divided into four groups(n=10): normal control group(A),hypoxia-hypercapnia+saline group(B),hypoxia-hypercapnia+L-Arg liposome group(C) and hypoxia-hypercapnia+N-nitro-L-arginine methyl ester(L-NAME) group(D).Contents of UⅡ,UⅡ mRNA and receptor of UⅡ(UT) mRNA in pulmonary arterioles were measured with immunohistochemistry analysis and in situ hybridization,respectively.Change of small pulmonary vascular microstructure was also investigated.RESULTS:(1) The mean pulmonary artery pressure(mPAP) and the weight ratio of right ventricle to left ventricle plus septum [RV/(LV+S)] in B and D groups were all higher than those in A group(respectively,P

Objective: To evaluate the association of smoking with the risk of ankylosing spondylitis (AS) using a Mendelian randomization (MR) approach. Methods: A total of 16 383 186 AS-associated single nucleotide polymorphisms (SNPs), 378 smoking initiation associated SNPs and 126 lifetime smoking score-associated SNPs were collected from three large-scale genome-wide association studies (GWAS). The association of smoking phenotypes with the risk of AS was examined using inverse-variance weighted (IVW) with AS as a outcome variable, smoking initiation and lifetime smoking score as exposure factors and SNPs with strong associations with smoking as instrumental variables, and sensitivity analyses were performed with maximum likelihood-based method, MR pleiotropy residual sum and outlier (MR-PRESSO) test and MR-Egger regression analysis. Results: A 33.5% increased risk of AS was found among genetically predicted smokers relative to non-smokers (OR=1.335, 95%CI: 1.059-1.682), and an increase in predicted lifetime smoking by per standard deviation resulted in a 101.4% increased risk of AS (OR=2.014, 95%CI: 1.341-3.024). The maximum likelihood-based method and MR-PRESSO test showed consistent correlated effect estimations and MR-Egger regression analysis identified no evidence of pleiotropy. Conclusion It is genetically predicted that smoking is associated with an increased risk of AS.

Objective To investigate the modulation of EPCs by interleukin 1β (IL-1β) and p38 mitogen activated protein kinase (p38MAPK) and the pathogenesis resulting from their dysdifferenfiation after trauma.Method Thirty pigs were divided into a control group (n = 15) and a multiple organ dysfimction syndrome (MODS) group (n = 15), the latter of which were subjected to a "two-hit" injury including hemon'hagic shock and endotoxemia. Phosphorylation of p38MAPK in peripheral blood mononuclear cells was monitored by western blotting. The concentration of IL-1β in peripheral blood plasma was determined by ELISA and the numbers of EPCs with FCM in peripheral blood plasma were monitored. The morbidity rates in the two groups were compared by chi square test. The levels of phosphorylation of p38MAPK in peripheral blood mononuclear cells, the concentmtions of IL-1β in peripheral blood plasma and the numbers of EPCs in the peripheral blood were compared between groups using with Student's t lest. Results The level of p38MAPK phosphorylation was more augmented and the concen-tration of IL-1β higher in peripheral blood mononuelear cells and plasma from MODS pigs compared with those from control pigs; nevertheless the mauler of EPC conspicuously decreased in the peripheral blood (P <0.01). The morbidity rate in the MODS group was much higher than that in the control group (P < 0.01). There were fewer EPCs in the peripheral blood of animals in group M than in the peripheral blood of animals in group C (P <0.01). Conclusions p38MAPK phosphorylation is important for the pathogenesis of MODS. p38MAPK phospho-rylation might cause the concentration of IL-1β in the peripheral blood plasma to rise and could cause a drop in the numbers of EPCs, thereby aggravating the inflanmmatory reaction in MODS.

Objective To assess the feasibility of double phase subtraction angiography with second generation (128-slice )dual-source CT in low dose Flash spiral scan mode for the evaluation of cerebral vessel,compared with dual-energy subtraction angiogra-phy.Methods 60 patients underwent double phrase CT angiography were divided into group A (n = 30,with Flash spiral scan mode),group B(n=30,with dual-energy scan mode).The signal-to-noise ratio(SNR),the contrast-to-noise ratio(CNR)and the av-erage radiation of double phrase subtraction images were measured in two groups,respectively.The double phase subtraction images quality were graded by 2 independent readers on a 5-point scale(5=excellent)in double-blind,according to various degrees of the re-sidual bones,the vessel displayed and luminal integrity,respectively.Differences between two groups were analyzed by Mann-whit-ney test and t test.Results The double phrase image SNR showed no difference to both two groups(P >0.05).The image CNR of arterial and venous phase in group A were higher than that of group B(40.89±8.89 and 40.27 ±9.90 in group A vs 35.28 ±8.43 and 34.89±8.66 in group B;P <0.05)respectively.There were no singnificant difference in the bone removal image scores of doub-le phase and in the vessel image scores of venous phase to both two groups respectively(P >0.05).The vessel image scores of arterial phase were higher in group A than that of group B(4.93±0.25 vs 3.87±0.97;P <0.05).Some internal carotid in the base of skull has not good luminal integrity in group B.The mean dose length product (DLP)in group A was lower than that of group B,with a 39 percent reduction[(226±5.69 )mGy/cm vs (368 ± 21.35 )mGy/cm,P < 0.05 ].Conclusion With the roughly similar image quality to dual-energy double phase subtraction angiography,the cerebral vessels can be assessed using dual-source CT subtraction angiography in Flash spiral scan mode and a lower radiation dose.

Objective: To examine the association between sleep and frailty using the bidirectional two-sample Mendelian randomization (MR) approach, so as to provide the basis for the prevention and intervention of frailty. Methods: The data on single nucleotide polymorphisms (SNP) related to sleep duration, insomnia and morning chronotype were collected from genome-wide association studies (GWAS) and meta-analysis of GWAS, involving 446 118, 1 331 010 and 697 828 participants, respectively. The frailty was evaluated using the frailty index, and the relevant SNP data were collected from a meta-analysis of GWAS involving 175 226 participants. A bidirectional MR analysis was performed using the inverse-variance weighted method. Sensitivity analyses employed the weighted median method, the maximum likelihood-based method, the MR-Egger regression, and the MR-PRESSO test. Results: Forward MR analysis showed that longer sleep duration (β=-0.170, 95%CI: -0.255 to -0.085) and morning chronotype (β=-0.036, 95%CI: -0.058 to -0.014) decreased the risk of frailty, while insomnia increased the risk of frailty (β=0.167, 95%CI: 0.149-0.184). Reverse MR analysis showed that frailty increased the risk of insomnia (OR=1.645, 95%CI: 1.278-2.117). Both bidirectional MR results were robust, which excluded the impact of heterogeneity and horizontal pleiotropy. Conclusion Sleep duration, insomnia, and morning chronotype are associated with frailty.

Animals ; Cardiomegaly ; Constriction ; Heart ; Mice

Objective:To systematically assess the effectiveness and safety of acupuncture for spastic hemiplegia after ischemic stroke. Methods:Randomized controlled trials(RCTs)of acupuncture treatment for spastic hemiplegia after ischemic stroke meeting the inclusion criteria in Cochrane Library,Medline,Excerpta Medica Database(EMBASE),PubMed,China National Knowledge Infrastructure(CNKI),SinoMed,Chongqing VIP Database(VIP),and Wanfang Data Knowledge Service Platform(Wanfang)published from each database's inception to February 2023 were retrieved by computer.Two reviewers independently extracted data and evaluated the risk of bias using Cochrane's risk of bias tool.Review Manager 5.4 was used for data analysis.Continuous data were evaluated using mean difference(MD)with a 95%confidence interval(CI),and dichotomous data were analyzed using risk ratio(RR). Results:A total of 24 trials,including 1 970 participants,were included in the study.The meta-analysis of 7 trials showed that compared to the rehabilitation therapy,acupuncture therapy was more effective in improving the simplified Fugl-Meyer assessment score after 1-month treatments[MD=10.52,95%CI(7.81,13.23),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.18,95%CI(11.34,27.02),P<0.001],and the 6-month treatment course resulted in better outcomes than the 1-month course.The meta-analysis of 8 trials showed that acupuncture had a better improvement on the Barthel index score than rehabilitation therapy after 1-month treatments[MD=10.78,95%CI(8.91,12.64),P<0.001].The meta-analysis of 2 articles showed the same tendency after 6-month treatments[MD=19.94,95%CI(19.02,20.87),P<0.001],and the 6-month course was better than the 1-month course.The meta-analysis of 2 trials showed that the effective rate of the modified Ashworth scale score improvement was more notable in the acupuncture group after 1-month treatments[RR=1.20,95%CI(1.02,1.40),P=0.020].One trial reported no adverse event,and 1 trial reported 3 adverse events without severe influence. Conclusion:Acupuncture might be an effective and safe therapy for spastic hemiplegia after ischemic stroke,but more high-quality,large-sample objectively-evaluated RCTs are needed to validate the conclusion.

Objective To investigate the correlation between contrast-enhanced ultrasound parameters and hepatic venous pressure gradient (HVPG),and to develop a new noninvasive method for the evaluation of portal hypertension in patients with decompensated liver cirrhosis.Methods One-hundred patients with decompensated liver cirrhosis were examined by contrast-enhanced ultrasound,and the dynamic images were collected for offline analysis.The contrast arrival time was obtained in the hepatic artery (HA),portal vein (PV),and hepatic vein (HV),and HA-HV transit time (HA-HVTT) and PV-HV transit time (PV-HVTT) were calculated.At the same time,HVPG was measured within 24 hours after contrast-enhanced ultrasound,Pearson correlation analysis was performed between each parameter and HVPG,and the receiver operating characteristic (ROC) curve was also used for analysis.Results HV arrival time (HVAT),HA-HVTT,and PV-HVTT were negatively correlated with HVPG (r =-0.385,-0.409,and-0.572,respectively).The area under the ROC curve (AUROC) was 0.903 for PV-HVTT ＜ 2.5 s in judging HVPG ≥≥ 10 mmHg in patients with decompensated liver cirrhosis,and the sensitivity and specificity were 74.4％ and 89.5％,respectively.The AUROC was 0.861 for PV-HVTT ＜ 1.5 s in judging HVPG ≥ 16 mmHg in these patients,and the sensitivity and specificity were 80.4％ and 81.5％,respectively.Conclusions HVAT and intrahepatic transit time demonstrate negative linear correlations with HVPG in patients with decompensated liver cirrhosis,and among all parameters,PV-HVTT shows the strongest correlation with HVPG and can be used to determine and predict the severity of portal hypertension.

OBJECTIVEExperiences and lessons of uvulopalatopharyngoplasty (UPPP ) perioperative management, especially causes of postoperative tracheotomy, were analyzed, and related strategy was raised to have a better perioperative management and to avoid tracheotomy.

METHODSTwo hundred and fifty eight cases of obstructive sleep apnea hypopnea syndromes (OSAHS) diagnosed with polysomnography (PSG) were treated with modified uvulopalatopharyngoplasty (UPPP). The perioperative management was summarized. Patients were divided into two groups according to the perioperative management: without or with perioperative comprehensive management. In group A, there were 32 patients, without comprehensive management, and in group B there were 226 cases with comprehensive management. Sixty eight cases in group B whose apnea hypopnea index over 50 times per hour and the lowest arterial oxygen saturation was less than 0.5 were treated with continuous positive airway pressure (CPAP) for 1 to 3 weeks. For all the 258 cases, perioperative management includes treatment of medical complications, treatment with antibiotics 2 or 3 days before the operation. None of these cases had tracheotomy before surgery.

RESULTSIn group A, three of 32 patients had postoperative tracheotomy, two because of bleeding, and another one because of laryngeal spasm. In group B, none of 226 patients underwent tracheotomy, which owing to modified operative apparatus and effective perioperative and postoperative treatment (chi2 = 21.35, P < 0.001). In group A, 5 of 32 patients had oral pharynx bleeding after 24 hours of the operation. While 26 of 226 patients in group B did so (chi2 = 0.15, P > 0.05).

CONCLUSIONComprehensive perioperative management can effectively lower down the complication rate for patients receiving uvulopalatopharyngoplasty.

Adult ; Cleft Palate ; surgery ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; adverse effects ; Palate ; surgery ; Pharynx ; surgery ; Postoperative Complications ; surgery ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Tracheotomy ; adverse effects ; Treatment Outcome ; Uvula ; surgery

OBJECTIVETo investigate the behavior problems of children aged 3 to 5 years in Changsha and to compare the differences of the results detected by the norm of Conners Parent Symptom Questionnaire (PSQ) in Chinese and American urban children.

METHODSA total of 854 children aged 3 to 5 years were randomly sampled from 5 districts in Changsha City and their parents completed the Conners PSQ.

RESULTSThe assessment by the norm of PSQ in American urban children demonstrated that the average prevalence of behavior problems was 20.4%, with 28.1% for boys and 12.4% for girls. There were significant differences between boys and girls (P<0.01). The factor score of anxiety in girls was markedly higher than that in boys (P<0.01). Learning and psychosomatic problems were the main problems in the children. The prevalences of conduct problems and impulse-restlessness, and abnormal restlessness index detected by the norm of PSQ in Chinese urban children were higher than those detected by the American norm. The prevalences of conduct problems and psychosomatic problems in boys by the norm of PSQ in Chinese urban children were significantly lower than those detected by the American norm, while the total prevalence of behavior problems was higher than that detected by American norm. There was a poor consistency in the assessment results of most factors of the PSQ and the total prevalence of behavior problems detected by the Chinese and American norms (KappP<0.4).

CONCLUSIONSThe prevalence of behavior problems especially learning problems and psychosomatic problems in children aged 3 to 5 years is higher in Changsha. The consistency of assessment results is poor between the norms of China and America. It is recommended to use the China norm of PSQ in Chinese children aged 3 to 5 years because the Chinese norm is in line with China's national conditions and cultural background.

Child Behavior Disorders ; diagnosis ; Child, Preschool ; China ; Female ; Humans ; Male ; Surveys and Questionnaires ; United States ; Urban Health