ObjectiveTo investigate the effect of propofol repeated anesthesia on the expression of CaMK Ⅱ α in the hippocampus in neonatal rats.MethodsThirty-two SD rats aged 7 days weighing 12-16 g were randomly divided into 2 groups (n =16 each): group C received intraperitoneal 0.9％ normal saline 7.5 ml/kg once a day for 7 days and group P received propofol 75 mg/kg once a day for 7 days.Learning and memory function were assessed using Morris warier maze at 28 days old of rats.The animals were sacrificed at 24 h after the tests and brain tissues were removed.The expression of CaMK Ⅱ α and phosphorylated CaMK Ⅱ α (pCaMK Ⅱ α) in hippocampal CAI region were determined by immunochemistry and Western bolt.ResultsCompared with group C,the escape latency was significantly prolonged,space exploration time shortened and expression of CaMK Ⅱ α and pCaMK Ⅱ α down-rugulated in group P than in group C( P ＜ 0.01 ).ConclusionPropofol repeated anesthesia decreases congnitive function through down-regulating the expression and inhibiting the activity of CaMK Ⅱ α in hippocampus in neonatal rats.

Objective To investigate the effect of propofol anesthesia on the expression of β-secretase 1 (BACE1) and content of anyloid beta protein 1-42 (Aβ1-42) in the neonatal rat hippocampus.Methods Ninety Sprague-Dawley rats,aged 7 days,weighing 12-16 g,were randomly divided into 3 groups ( n =30 each):control group (group C),single dose of propofol anesthesia group (group SP),and repeated doses of propofol anesthesia group (group RP).Group C received intraperitoneal normal saline 7.5 ml/kg once a day for 7 consecutive days.Group SP received normal saline 7.5 ml/kg once a day for 6 consecutive days and propofol 75 mg/kg on 7th day.Group RP received propofol 75 mg/kg once a day for 7 consecutive days.Six rats in each group were chosen at 15 min after the end of injection on 7th day and blood samples were taken from the left ventricle for determination of the blood glucose level and for blood gas analysis.Eight animals in each group were sacrificed on 1st,3rd and 7th day after the end of injection on 7th day to determine the expression of BACE1 (using Western blot) and content of Aβ1-42 in the hippocampus (by ELISA).Results Compared with groups C and SP,the expression of BACE1 was up-regulated and the content of Aβ1-42 was significantly increased at each time point in group RP ( P ＜ 0.01 ).There was no significant difference in the expression of BACE1 and content of Aβ1-42 at each time point between groups C and SP ( P ＞ 0.05).Conclusion Repeated doses of propofol up-regulate the expression of BACE1 and increase the content of Aβ1-42 in neonatal rat hippocampus,which may be one of the mechanisms by which propofol leads to long-term cognitive dysfunction.Single dose of propofol does not have the effect.

Objectives To detect the loss of heterozygosity(LOH)frequencies of microsatellite loci D9S171and D9S1604in p16gene of psoriatic keratinocytes,and to study the correlation between mi-crosatellite LOH of p16gene and the development of psoriasis.Methods By the use of polymerase chain reaction(PCR)-denaturing polyacrylamide gel electrophoresis-silver staining,LOH was detected with23sam-ples of keratinocytes from psoriatic lesions and non-lesion skin.Results LOH was identified at loci D9S171and D9S1604in5and10out of23keratinocyte samples from LOH-exhibited psoriatic lesions,and in2and3of keratinocyte samples from psoriatic non-lesion skin,respectively.The frequency of LOH at D9S1604was significantly higher in psoriatic lesion samples than that in psoriatic non-lesion skin(P

Objective To investigate the effects of different modes of one-lung ventilation (OLV) on hemodynamies in the patients undergoing thoracic operation.Methods Forty-five adult patients undergoing thoracic surgery,were randomly allocated into 3 groups based on the modes of OLV used ( n =15 each):intermittent positive pressure ventilation ( IPPV,VT 6-8 ml/kg,RR 10-14 bpm,I:E 1:2) group,IPPV + positive end-expiratory pressure (PEEP) group and IPPV + continuous positive airway pressure (CPAP) group.Double-lumen tube was inserted.Conrrect positioning was verified by fiberoptic bronchoscopy.The patients were mechanically ventilated.PETCO2 was maintained at 35-45 mm Hg.In group IPPV + PEEP,OLV was performed for 30 min with PEEP of 5 cm H2O and then for another 30 min with PEEP of 10 cm H2O.In group IPPV + CPAP,OLV was performed with IPPV in the lung on the ventilated side and with CPAP of 5 cm H2O in the lung on the operated side (for 1 h).MAP,HR,cardiac output (CO),cardiac index ( CI),stroke volume (SV),and stnoke volume index (SVI) were recorded before induction of anesthesia,at 10 min after intubation,at 30 min of two-lung ventilation,at 30 min and 1 h of OLV,and at the end of operation ( T1-6 ).Arterial blood samples were taken at T1,2,4-6 for blood gas analysis.The levels of blood glucose and lactate were measured.Oxygen delivery ( DO2 ) and DO2 index ( DO2I) were calculated.Results Compared with IPPV group,SV,SVI,CO,CI,DO2 and DO2I were significantly decreased at T4,5 ( P ＜ 0.05),and no significant change was found in the levels of blood glucose and lactate in group IPPV + PEEP,and no significant change was found in the parameters mentioned above in group IPPV + CPAP ( P ＞ 0.05).Compared with IPPV + PEEP group,SV,SVI,CO,CI,DO2 and DO2I were significantly increased at T4,5 ( P ＜ 0.05),and no significant change was found in the levels of blood glucose and lactate in group IPPV + CPAP ( P ＞ 0.05).Conclusion It exerts no influence on hemodynamics using OLV with IPPV in the lung on the ventilated side and with CPAP of 5 cm H2O in the lung on the operated side,however,OLV with IPPV + PEEP can result in hemodynamic fluctuation,but the degree of fluctuation is lesser and DO2 can be maintained in the patients undergoing thoracic operation.

OBJECTIVE: To observe the effects of abnormal body temperature and the area under temperature curve on the prognosis of patients with septic shock. METHODS: A retrospective cohort study was conducted. Patients with septic shock admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from September 2013 to June 2019 were enrolled. Data were obtained from the hospital case database, including the gender, age, infection source, the length of ICU stay, sequential organ failure assessment (SOFA) score, 21-day prognosis; within the first 24 hours and throughout the period in ICU, the maximum temperature (24 h T_max, T_max), lowest temperature (24 h T_min, T_min), and the temperature range (24 h T_max-min, T_max-min) were aggregated. The area under temperature curve when body temperature was higher than T (A_{> T}), or lower than T (A_{< T}), and area section between T1 and T2 (A_T1-T2) was calculated respectively. Patients were divided into survival group and death group according to 21-day prognosis. Binary Logistic regression was used to analyze the effect of the above temperature indices on the prognosis. RESULTS: 635 septic shock patients were enrolled in the study. 476 patients were survived and 159 died within 21 days. Compared with the survival group, the age, SOFA score were higher in the death group, while the length of ICU stay was shorter. There was no significant difference in gender or infection source between two groups. After adjusting for gender, age, the length of ICU stay and SOFA score, binary Logistic regression analysis showed that the increase of T_max, decrease of T_min, and increase of T_max-min were risk factors for 21-day mortality [T_max: odds ratio (OR) = 2.959, 95% confidence interval (95%CI) was 1.620-5.398, P > 0.001; T_min: OR = 0.329, 95%CI was 0.140-0.790, P = 0.012; T_max-min: OR = 3.258, 95%CI was 1.840-5.471, P > 0.001], while 24 h T_max, 24 h T_min and 24 h T_max-min were not related to prognosis. A_{< 36.0 centigrade} (OR = 1.335, 95%CI was 1.102-1.745, P = 0.014), and A_{> 38.0 centigrade} (OR = 1.041, 95%CI was 1.019-1.077, P = 0.001) showed positive correlation with 21-day mortality. When the T level was set at 38.0-40.0 centigrade, for every 1 centigrade×hour increase in A_{> T}, the 21-day relative risk of death increased by 4.1%-83.2%. CONCLUSIONS When the body temperature of patients with septic shock is lower than 36.0 centigrade, or higher than 38.0 centigrade, the 21-day relative risk of death rose with the increase of the magnitude and duration of abnormal body temperature.
Body Temperature ; Humans ; Intensive Care Units ; Prognosis ; Retrospective Studies ; Sepsis ; Shock, Septic/diagnosis* ; Temperature

Tongue diagnosis is an important method of TCM diagnosis and treatment.Tongue is the key link of auxiliary diagnosis of tongue feature extraction and processing,and also is the bottleneck of intelligent tongue diagnosis in traditional Chinese medicine.Using image processing,artificial intelligence technology to the tongue as a quantitative and identify characteristics of traditional Chinese medicine,looking for both conforms to the original thinking of TCM,and TCM tongue diagnosis method of accurately,has become a common concern of traditional Chinese medicine and computer field.From the mobile terminal tongue as auxiliary diagnostic system of traditional Chinese medicine tongue acquisition basic attribute,tongue diagnosis and image information building,tongue like features are required for accurate extraction and so on related key technology is analyzed,and build overall architecture,so as to provide technical reference for the tongue like intelligent diagnosis,promote the development of technology of tongue diagnosis in traditional Chinese medicine modernization.

OBJECTIVE: To explore the changes in polymorphonuclear neutrophils (PMN) function in peripheral blood of patients with sepsis and liver injury and its prognostic value. METHODS: A prospective observational study was conducted. The patients who met the criteria of Sepsis-3 admitted to intensive care unit (ICU) of Wuxi People's Hospital Affiliated to Nanjing Medical University from March to August in 2019 were enrolled as the research objects, and the patients were divided into sepsis without liver injury group and sepsis with liver injury group; non-sepsis patients who were hospitalized at the same time were enrolled as non-sepsis group; and the healthy people in the physical examination center were enrolled as healthy control group. The gender, age, white blood cell (WBC), PMN and procalcitonin (PCT) were recorded when the patients were admitted to ICU as well as the people on the day of physical examination. The acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores were calculated. The 28-day mortality was recorded. The quantitative level of neutrophil extracellular traps (NETs) which reflected by circulating free DNA (cf-DNA/NETs) in peripheral plasma was determined by PicoGreen fluorescence quantitative detection; the qualitative level of NETs was detected by immunofluorescence staining. PMN was extracted from the healthy control group, sepsis without liver injury group and sepsis with liver injury group and cultured in vitro, the quantitative level of cf-DNA/NETs in cell supernatant was determined by PicoGreen fluorescence quantitative detection. The patients were divided into two groups according to 28-day outcome of sepsis patients with liver injury. Receiver operating characteristic (ROC) curve was plotted, and the area under ROC curve (AUC) was calculated to analyze the prognostic value of NETs in sepsis patients with liver injury. RESULTS: Finally, 21 sepsis patients without liver injury, 15 sepsis patients with liver injury, 20 with non-sepsis and 20 with healthy examination were enrolled. There was no significant difference in gender or age among the four groups, indicating that the patients in each group were comparable. The levels of cf-DNA/NETs in peripheral blood, WBC and PMN of the sepsis with and without liver injury groups were significantly higher than those of the healthy control group and non-sepsis group, PCT, APACHE II score, SOFA score and 28-day mortality were significantly higher than those of the non-sepsis group, and the levels of cf-DNA/NETs in peripheral blood, PCT and 28-day mortality of the sepsis with liver injury group were significantly higher than those of the sepsis without liver injury group [cf-DNA/NETs (μg/L): 481.60±275.86 vs. 169.76±57.05, PCT (μg/L): 11.29 (1.79, 67.10) vs. 1.11 (0.19, 4.09), 28-day mortality: 73.3% (11/15) vs. 38.1% (8/21), all P < 0.05]. The results of PMN in vitro showed that there was no NETs in normal culture of healthy control group, and a small amount of NETs was detected in sepsis with and without liver injury groups. After stimulation of PMN stimulator phorbol-12-myristate-13-acetic acid (PMA), more NETs were produced in neutrophils of three groups compared with normal culture. Quantitative analysis showed that the level of cf-DNA/NETs in cell supernatant of the sepsis with liver injury group was significantly higher than that of the sepsis without liver injury group (μg/L: 1 872.29±258.44 vs. 1 313.55±147.45, P < 0.01). In 15 sepsis patients with liver injury, 4 patients survived for 28 days (26.7%) and 11 died (73.3%). The cf-DNA/NETs level of the dead group on the day of admission was significantly higher than that of the survival group (μg/L: 582.36±160.05 vs. 241.17±96.14, P < 0.05). ROC curve analysis showed that the AUC of NETs level in peripheral blood for predicting 28-day death of sepsis patients with liver injury was 0.932 [95% confidence interval (95%CI) was 0.787-1.000]; when the best cut-off value was 266.81 μg/L, the sensitivity was 90.9%, the specificity was 75.0%, and the approximate index was 0.659. CONCLUSIONS The function of NETs in sepsis patients with liver injury has been further changed. The level of peripheral blood NETs has a certain guiding value for the prognosis of sepsis patients with liver injury.
APACHE ; Hepatic Insufficiency/diagnosis* ; Humans ; Liver ; Neutrophils ; Organ Dysfunction Scores ; Prognosis ; Prospective Studies ; ROC Curve ; Retrospective Studies ; Sepsis/diagnosis*

BACKGROUND:There is less report about mitigating sustained bone grinding injuries during craniotomy based on a model of traumatic brain injury established using the modified Feeney's free-fall method. OBJECTIVE:To modify a modified traumatic brain injury model by altering the opening of the skull window. METHODS:Thirty-six Sprague-Dawley rats were equally randomized into sham group,model group and modified model group.The modified procedure of opening the bone window was used in the modified model group.Six to eight small holes of 0.3-0.5 mm in diameter were punched at the edge of the impact area and the drill was immediately withdrawn without touching the cortex.In the modified model group,the skull window was opened by using the modified method,while the skull window in the model group was opened using the conventional method.The modified model group and model group were established using the Feeney's free-fall method.In the sham group,only the skull window was opened without impact.The modified neurological severity scoring was performed at 1 day after modeling.T2 weighted imaging was performed and T2 values were measured at 1 and 7 days after modeling.Hematoxylin-eosin staining of the brain section was made for histopathological observation at 7 days after modeling.The level of blood viscosity,interleukin-6,interleukin-1β,and tumor necrosis factor-α were determined at 7 days after modeling. RESULTS AND CONCLUSION:Compared with the sham group,the modified neurological severity scores in the model group and modified model group were significantly increased at 1 day after modeling(P＜0.000 1).Meanwhile,the modified neurological severity scores in the modified model group were lower than those in the model group(P＜0.000 1).Compared with the sham group,the T2 values were significantly increased in the model group and modified model group at 1 and 7 days after modeling(P＜0.05),while the T2 values in the modified model group were lower than those in the model group(P＜0.05).Compared with the sham group,the level of blood viscosity,interleukin-6,interleukin-1β and tumor necrosis factor-α were increased in the model group and modified model group at 7 days after modeling(P＜0.05),while the level of interleukin-6 in the modified model group was lower than that in the model group(P＜0.05).To conclude,establishing a modified traumatic brain injury model based on the Feeney's free-fall method provides better controls of injury factors during cranial opening.

Objective:To investigate the risk factors and long-term prognosis of major adverse cardiovascular events(MACEs) in patients with dilated cardiomyopathy (DCM).Methods:This study was a single-center retrospective cohort study. Clinical information from 300 patients with DCM hospitalized in Peking Union Medical College Hospital from April 2013 to April 2023 was collected. Based on echocardiography results, the patients were divided into two groups: isolated DCM and DCM with left ventricular non-compaction cardiomyopathy (LVNC). The MACEs, including major heart failure events, severe ventricular arrhythmias, and cardiovascular death, were recorded by outpatient or telephone follow-up. Univariate and multivariate Cox proportional hazard regression models were used to analyze the risk factors affecting the prognosis of patients with DCM. Kaplan-Meier curve and log-rank were used for survival analysis to compare the difference in the incidence of cardiovascular events between the two groups.Results:The included 300 DCM patients were (47.8±16.8) years old, with 197 males (65.7%), of which 237 (79.0%) were isolated DCM and 63 (21.0%) were DCM with LVNC. The follow-up time was 4.0 (1.9, 6.2) years. A total of 142 (47.3%) MACEs occurred, including 117 (39.0%) major heart failure events, 20 (6.7%) severe ventricular arrhythmia events, and 53 (17.7%) cardiovascular death events. Multivariate Cox proportional hazard regression analysis showed that increased left ventricular end-diastolic diameter ( HR=1.21, 95% CI: 1.01-1.44, P=0.042), moderate or severe mitral regurgitation ( HR=1.71, 95% CI: 1.19-2.47, P=0.004), increased ln (N-terminal pro-B-type natriuretic peptide) ( HR=1.30, 95% CI: 1.10-1.54, P=0.002) were independent risk factors for dverse cardiovascular events in DCM patients, and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI) treatment ( HR=0.45, 95% CI: 0.26-0.78, P=0.004) was independent protective factor. Kaplan-Meier survival analysis found no significant difference in the risk of MACEs between isolated DCM and DCM with LVNC ( P=0.22). Similarly, there were no significant differences in the incidence of major heart failure, severe ventricular arrhythmia, and cardiovascular death between the two groups (all P>0.05). Conclusion:An increase in left ventricular end-diastolic diameter, moderate or severe mitral regurgitation, elevated N-terminal pro-B-type natriuretic peptide, and non use of ACEI/ARB/ARNI are independent predictors of cardiovascular events in DCM patients. There was no significant risk of MACEs in patients with isolated DCM and DCM with LVNC, and suggested that LVNC may be a unique phenotype and should be accurately managed in combination with genetic background.

Objective:To explore the relationship between the maternal dietary patterns during pregnancy and the early childhood BMI change trajectory.Methods:The subjects were 1 241 pairs of pregnant women and their children in Ma'anshan maternal and infant health cohort. The food frequency questionnaire was used to collect the maternal diet data during pregnancy. The cohort children were followed up at birth, month 3, 6, 12, 18 and 24, respectively. The body height and weight data of the cohort children were collected. The principal component analysis was used to determine the categories of maternal dietary patterns during pregnancy, group-based multi-trajectory modeling was used to fit the early childhood BMI change trajectory, and the multiple classification logistic regression model was used to evaluate the relationship between the maternal dietary patterns during pregnancy and the early childhood BMI change trajectory.Results:The maternal dietary patterns during pregnancy included protein type, healthy type, vegetarian type, processing type and beverage type, which could explain 50.04% of the total dietary variation. Among them, the protein type, main dietary pattern, could explain 21.34% of the total dietary variation. The early childhood BMI change trajectory was from thinnish stature to average stature, then to mild obesity, accounting for 42.9%, 45.6% and 11.5% respectively. After controlling the potential confounding factors, it was found that there was a statistical correlation between healthy type and beverage type of maternal dietary patterns during pregnancy and early childhood BMI change trajectory ( P<0.05). Comparison of change trajectories between thinnish type and average stature type, children in the low-level group of healthy diet pattern tended to have a thinnish type change trajectory in early life ( OR=1.286, 95% CI: 1.002-1.651). Comparison of change trajectories between mild obesity type and average stature type, children in the high-level group of beverage diet pattern tended to have a mild obesity type change trajectory in early life ( OR=0.565, 95% CI: 0.342-0.935). The other dietary patterns had no statistical correlation with the early childhood BMI change trajectory. Conclusions:Maternal dietary patterns during pregnancy can affect the early childhood BMI change trajectory, and the low-level healthy type diet is an independent risk factor for thinnish type change trajectory, and the high-level beverage type diet is an independent risk factor for the mild obesity type change trajectory.