BACKGROUND: Previous studies demonstrated that exercise modes easily cause hepatic injury and result in hepatic apoptosis. However, the mechanisms remain undear. OBJECTIVE: To observe the hepatic apoptosis, changes of hepatic glycogen, NO, and calcium levels following establishing various exhaustive exercise models.DESIGN, TIME AND SETTING: The randomized, controlled, animal experiment of ultrastructure observation was performed at the Physical Education School of Hunan Normal University, and Department of Histology and Embryology, Central South University, from January 2004 to December 2006.MATERIALS: Thirty male Sprague Dawley rats, aged 8 weeks, weighing (219.2+19.5) g, were randomly divided into control, middle intensity exercise and high intensity exercise groups according to Berdford models, with 10 animals in each group. METHODS: Rats in the exercise group were performed 3 days treadmill training with speed of 10 m/min, in running platform with 0°, followed by 3 days rest. After that, rats in the middle intensity exercise group were training with initial velocity of 10 m/min for 12 minutes, and than gradually increased exercise load to 19.3 m/min, until rats were exhausted. In the high intensity exercise groups,the initial velocity was 26.8 m/min, until rats were exhausted. The training was performed once per day for 30 successive days.There was no exercise training in the control group.MAIN OUTCOME MEASURES: The levels of hepatic glycogen, NO, Ca~(2+), and hepatic apoptosis were measured after exercise.RESULTS: Totally 30 rats were included in the final analysis. All rats finished exercise without resistance. The exhaustive exercise time in the middle intensity exercise group was (234.60+60.05) min, which was (92.40±34.61) min in the high intensity exercise group. Compared to the control group, the contents of hepatic glycogen and NO were decreased, while Ca~(2+) level and hepatic apoptosis index were increased in 2 exercise groups (P < 0.05, P < 0.01 ), in particular notable in the middle intensity exercise group (P < 0.05).CONCLUSION: Both middle and high intensity exhaustive exercise can lead to hepatic apoptosis, which may be the great accumulation of Ca~(2+) in mitochondrion and the fower contents of liver glycogen and NO content. The changes may be associated with exhaustive exercise time.

To discuss clinical diagnosis and treatment of cow’s milk protein allergy and cow’s milk protein-induced FPIES (food protein induced enterocolitis syndrome). Methods We retrospectively analyzed clinical data of one infant with milk protein allergy-induced FPIES. Results A 67 days old female on mixed breast and formula feeding developed recurrent diarrhea, abdominal distension, vomiting, mucousy and bloody stools, feeding dififculty, anemia, and failure to thrive since 2 weeks after birth. Laboratory studies showed anemia, increased CRP level and elevation of peripheral white blood count and eosinophil proportion. Milk-speciifc IgE was negative. She was previously hospitalized 4 times, all with admitting diagnosis of“necrotizing enterocolitis”. We treated her with milk protein elimination for 4 weeks and all symptoms were resolved. Milk protein re-challenge test was positive, consistent with clinical features of cow’s milk protein allergy-induced infant FPIES. Conclusions Cow’s milk protein allergy and cow’s milk protein-induced FPIES can present with non-speciifc and variable clinical symptoms and signs, and should be considered in the differential diagnosis.

Objective To study the influence of let-7b on cell proliferation and aerobic glycolysis of human melanoma cell A375.Methods Transfect A375 cell line with hsa-let-7b oligonucleotide or antisense.Glucose and lactate in medium were determined by spectrophotometry at 24 h and 48 h time point after transfection.The cell proliferation was determined by methylthiazol tetrazolium (MTT) assay.Results Over expression of let-7b in melanoma cell reduced cell proliferation notably,compared to the other groups by MTT(P ＜0.05).However,the glucose consumption and lactate production differences were not observed during 24 h or 48 h ( P ＞ 0.05 ),the blank control group transformed about 57％ and 43％ glucose to lactate during 24 h and 48 h.Conclusions Melanoma cell line A375 has notably aerobic glycolysis hallmark,let-7b could inhibit proliferation of melanoma cell line A375,but it may has no influence on glucose metabolism.

OBJECTIVETo analyze the efficacy of percutaneous endoscopic gastrostomy (PEG) in pediatric patients.

METHODFrom October 2011 to October 2014, children in the gastrointestinal ward of Guangzhou Women and Children's Medical Center received PEG or jejunal tube PEG(JET-PEG). The success rate, operation time were recorded. The changes of their weight, enteral nutrition calories and the incidence of pneumonia before and after the first 6 months of operation were compared. Follow-up was conducted until October 2014, the recent and long term complications, the length of indwelling time, the replacement or removal of the tube were recorded, the patients swallowing function or the primary disease's outcomes were observed.

RESULTOf the 13 cases, 10 were male, 3 were female, their average age was 2 years (range 1.8 months-9 years). We performed PEG for 12 of the patients who had congenital craniofacial problems that led to feeding difficulties or recurrent cough and pneumonia (6/12), or neurological disorders (6/12) with inability to swallow, and in one case JET-PEG was performed, this child suffered from chronic intestinal pseudo-obstruction with vomiting and abdominal distension. The gastrostomy was successful in all the patients through one operation, the average operation time of PEG was (25 ± 3) minutes, JET-PEG was 60 minutes. One local skin infection was noted, no long-term complication occurred. In the first 6 months after operation, all the patients gained weight((5.5-30.5) kg postoperation vs. (3.0-30.0) kg preoperation), and 12 cases' enteral nutrition calories increased (from (209-502) to(272-543) kJ/(kg·d)), the incidence of pneumonia decreased in the children who had recurrent pneumonia before the operation (from (0-1.5) to (0-0.16) per month). Until October 2014, their average length of gastric tube indwelling time was 17.8 months (range 4-36 months). In 4 cases PEG tube was removed when they could eat completely independently, the other 9 needed enteral vein nutrition via PEG tube or jejunal tube, in 3 of them balloon type gastric fistula tube was applied. Two of the 13 cases who had cleft palate received stomatological operations when their weight grew to meet the standard.

CONCLUSIONPEG and JET-PEG are safe and effective method for enteric nutrition feeding in pediatrics, the technique causes minimal trauma and has rapid postoperative recovery, few complications, good aesthetic appearances and simple nursing, it can significantly improve their nutritional status and quality of life.

Child ; Child, Preschool ; Enteral Nutrition ; methods ; Female ; Gastrostomy ; adverse effects ; Humans ; Incidence ; Infant ; Male ; Nervous System Diseases ; therapy ; Pneumonia ; therapy

Objective     To explore the effect of aortic root perfusion of amiodarone when intractable ventricular fibrillation occurs during valve replacement. Methods     Totally 42 patients were selected as a drug group, who underwent intractable ventricular fibrillation following ascending aortic opening in valve replacement in Beijing Anzhen Hospital from October 2006 to October 2016. There were 26 males and 16 females with an average age of 56.31±12.56 years. The aorta was re-blocked when intractable ventricular fibrillation occured, amiodarone (150 mg diluted to 20 ml) through the aortic root perfusion tube was applicated, and suction was repeated 8-10 times with the cumulative amount of 150-200 ml, and then the ascending aorta was opened and fast compressed with a frequency of 200 times/min. While 53 patients with the same condition during the same period were selected as a control group. There were 35 males and 18 females with an average age of 58.79±19.81 years. The commonly used clinical treatment method of intractable ventricular fibrillation was adopted, such as continuous intravenous injection of 1 mg/kg lidocaine, while ascending aortic was re-blocked. The warm blood perfusion was given until the heart re-beated. The clinical outcomes were compared between the two groups.   Results     There was one perioperative death in the drug group and two deaths in the control group during perioperative period. Defibrillation frequency (3.11±0.59 times vs. 4.91±1.34 times, t=–2.917, P=0.000), heart rate 5 min after re-beating (91.65±9.81 beats/min vs. 98.32±10.21 beats/min, t=–2.019, P=0.032), cardiopulmonary bypass time (71.68±10.21 min vs. 81.59±12.93 min, t=–2.512, P=0.032), dopamine dosage (4.32±1.28 μg·kg–1·min–1 vs. 5.79±1.98 μg·kg–1·min–1, t=–2.781, P=0.015), epinephrine dosage (0.03±0.01 μg·kg–1·min–1 vs. 0.06±0.02 μg·kg–1·min–1, t=–3.996, P=0.000) and norepinephrine dosage (0.01±0.01 μg·kg–1·min–1 vs. 0.03±0.01 μg·kg–1·min–1, t=–4.163, P=0.000) of the drug group were significantly shorter or lower than those of the control group. The rate of cardiac rhythm 5 min after re-beating (42.8% vs. 9.4%, χ2=11.211, P=0.000) of the drug group was higher than that of the control group. Conclusion     During intractable ventricular fibrillation following ascending aortic opening in valve replacemen, re-blocking the aorta and amiodarone reperfusion of the aortic root can significantly improve the heart re-beating rate and avoid ventricular re-fibrillation, shorten the cardiopulmonary bypass time and reduce the dosage of inotropic drugs.

Objective    To explore the difference of myocardial injury between off-pump coronary artery bypass grafting (OPCAB) and modified perfusion on-pump coronary artery bypass grafting (ONCAB). Methods    A total of 558 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from 2017 to 2019 were included. According to whether or not they received modified perfusion cardiopulmonary bypass, all the 558 patients were divided into two groups including an OPCAB group (OP group) and an ONCAB group (ON group). There were 465 patients in the OP group including 282 males and 183 females with an average age of 63.58±7.87 years. In the ON group, there were 93 patients including 64 males and 29 females with an average age of 63.91±7.51 years. Creatine kinase MB (CK-MB) and cardiac specific troponin I (cTnI) were measured 24 hours before operation, 30 minutes after operation, 12 hours after operation, 36 hours after operation and 48 hours after operation. Results    No perioperative death occurred in all patients. CK-MB (5.00 ng/mL vs. 8.60 ng/mL, Z=–2.189, P=0.029) and cTnI (3.00 ng/mL vs. 7.80 ng/mL, Z=–5.307, P=0.000) in postoperative 12 hours in the ON group were less than those in the OP group. CK-MB (5.00 ng/mL vs. 5.60 ng/mL, Z=–2.280, P=0.023) and cTnI (0.10 ng/mL vs. 1.02 ng/mL, Z=–6.418, P=0.000) in postoperative 36 hours in the ON group were less than those in the OP group. cTnI (0.07 ng/mL vs. 0.81 ng/mL, Z=–1.946, P=0.032) in postoperative 48 hours in the ON group was less than that in the OP group. Conclusion    Compared with OPCAB, modified perfusion ONCAB has less myocardial damage. 

Objective    To explore the effect of whether or not to stop beating after conversion to cardio-pulmonary bypass (CPB) in off-pump coronary artery bypass grafting. Methods    From 2016 to 2018, 177 patients with off-pump coronary artery bypass grafting in Beijing Anzhen Hospital were transferred to CPB. According to whether they stopped beating after conversion to CPB during the operation, they were divided into two groups. A non-stop beating group: there were 76 patients with 45 males, 31 females. aged 63.53±6.98 years, who were not to stop beating after conversion to CPB. A stop beating group: there were 101 patients with 66 males and 35 females, aged 63.98 ± 8.37 years, who were to stop beating and underwent the modified perfusion and application of papaverine in perfusion after conversion to CPB. The clinical effect of the two groups was compared. Results    There were 14 deaths in the perioperative period. The mean graft flow (MGF) in the stop beating group was higher (P=0.033), and the pulse index (PI) was lower (P=0.001) than those in the non-stop beating group. Intra-aortic balloon counter pulsation (P=0.036), extracorporeal membrane oxygenation (P=0.038), continuous renal replacement therapy (P=0.014), ventilator-assisted time (P=0.021), ICU monitoring time (P=0.012), perioperative mortality (P=0.025) and the ejcetion fraction value (P=0.023) were significantly different between the groups. Conclusion    Compared with not to stop beating, those to stop beating can get better perioperative clinical effect after conversion to CPB, which is worthy of recommendation.

Objective    To investigate the influence of different discontinuation time of clopidogrel and aspirin before off-pump coronary artery bypass grafting on postoperative volume of drainage and blood products imported. Methods    A total of 454 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from January 2017 through December 2019 were included. According to the preoperative discontinuation of clopidogrel and aspirin, all the 454 patients were divided into three groups including a guide group, a non-stop group and a stop group. There were 86 patients in the guide group including 59 males and 27 females with an average age of 64.12±6.15 years. They continued to take aspirin 100 mg/d before operation, but stopped clopidogrel for more than 5 days. In the non-stop group, there were 234 patients including 141 males and 93 females with an average age of 63.71±7.01 years. They continued to take aspirin 100 mg/d before operation, and stopped clopidogrel <5 days. In the stop group, there were 134 patients including 76 males and 58 females with an average age of 62.90±7.78 years. They stopped aspirin and clopidogrel for more than 5 days before operation. The clinical effectiveness was compared among the three groups. Results    No perioperative death occurred in all patients. There was no statistical difference in platelet count, coagulation function, liver function, renal function, or myocardial markers among the groups (P>0.05). The hemoglobin [97 (15) g/ L vs. 98 (21) g/L vs. 100 (20) g/L, F=4.894, P=0.008] in the non-stop group was lower than that in the guide group and the non-stop group at 30 minutes postoperatively. The flow volume (399.87±127.19 mL vs. 367.05±125.89 mL vs. 349.63±130.68 mL, F=7.770, P=0.000) in the non-stop group at 3 hours postoperatively, the flow volume [600 (300) mL vs. 580 (245) mL vs. 550 (350) mL, Z=8.218, P=0.016] in the non-stop group at 6 hours postoperatively, the flow volume [750 (370) mL vs. 730 (350) mL vs. 730 (350) mL, Z=8.329, P=0.016] in the non-stop group at 12 hours postoperatively, the flow volume [890 (365) mL vs. 850 (340) mL vs. 850 (350) mL vs. Z=6.585, P=0.037] in the non-stop group at 24 hours postoperatively and the flow volume [950 (375) mL vs. 940 (360) mL vs. 940 (380) mL, Z=8.680, P=0.013] in the non-stop group at 48 hours postoperatively were more than those of the guide group and the stop group. The retention time of drainage tube was longer in the non-stop group [3 (1) d vs. 3 (1) d vs. 3 (1) d, Z=6.579, P=0.037] than in the guide group and the non-stop group. The amount of suspended erythrocytes input [0 (2) U vs. 0 (2) U vs. 0 (0) U, Z=6.150, P=0.046], and the amount of plasma input [200 (200) mL vs. 0 (200) mL vs. 0 (200) mL, F=4.144, P=0.016], the number of cases of plasma input (119 patients vs. 34 patients vs. 47 patients, Z=10.116, P=0.006) were more than those of the guide group and the stop group. Conclusion    Aspirin maintenance is recommended for patients before off-pump coronary artery bypass grafting. If not necessary, clopidogrel is discontinued for at least 5 days.