ObjectiveTo investigate the plasma endothelin(ET),angiotensin (Ang) Ⅱ levels on middle cerebral artery resistance in hypertension patients.MethodsThe plasma ET and Ang Ⅱ levels were determined in hypertension grade 1 (grade 1 group,40 cases),grade 2 (grade 2 group,40 cases ),grade 3(grade 3 group,40 cases) and healthy adults (control group,50 cases).The systolic velocity and pulsatility index of middle cerebral artery were determined by transcranial Doppler,and 24 h ambulatory blood pressure was monitored.ResultsThe pulsatility index in grade 2 group and grade 3 group was higher than that in control group and grade 1 group (1.23 ±0.22,1.31 ±0.21 vs.0.76 ±0.18,0.78 +0.13)(P＜0.05).The systolic velocity in grade 2 group was higher than that in control group,grade 1 group and grade 3 group [(87.8 ± 11.7) cm/s vs.(60.8 ± 10.6),(63.8 ± 11.8),(49.9 ± 10.8) cm/s](P ＜ 0.05),and in grade 3 group was lower than that in control group,grade 1 group and grade 2 group(P ＜ 0.05 ).The plasma ET,Ang Ⅱ in grade 1,2,3 group was higher than that in control group[(46.83 ± 8.83 ),(55.63 ± 10.28 ),(67.19 ± 10.73)ng/L vs.( 38.94 ± 7.83 ) ng/L and ( 50.23 ± 9.23 ),(64.34 ± 12.23 ),( 79.83 ± 13.43 ) ng/L vs.(41.63 ± 8.76 )ng/L] (P ＜0.05).A increasing trend in the plasma ET and Ang Ⅱ was present with increasing the hypertension grade(P ＜ 0.05 ).The night average systolic pressure,night average diastolic pressure and plasma ET,Ang Ⅱ levels in dipper hypertension patients (60 cases) were lower than those in non-dipper hypertension patients(60 cases) [(121.83 ± 11.83) mm Hg(1 mm Hg =0.133 kPa) vs.(138.84 ± 13.29)mm Hg,(77.23 ± 8.54) mm Hg vs.(86.93 ± 10.34) mm Hg,(48.83 ± 10.14) ng/L vs.(59.83 ± 11.29)ng/L,(55.84 ± 10.83 ) ng/L vs.(72.83 ± 20.29) ng/L,P ＜ 0.05].ConclusionMonitoring plasma ET,Ang Ⅱ levels and ambulatory blood pressure in hypertension patients is helpful in using medicine to improve endothelial function and to promote its dynamic type into a dipper blood pressure in the treatment of patients,thereby to reduce the incidence of hypertension adverse events.

Objective To observe the influence of pioglitazone on the expression of adiponectin in the liver of high fat diet-induced obese rats.Methods Forty male SD rats were randomly divided into control group which received regular diet ( n =10),high fat diet group ( n =15 ) and high fat diet goup administened pioglitazone ( n =15 ) on high fat diet.After twelve weeks,fasting blood glucose,fasting serum insulin,triglyceride,total cholesterol,and the histomorphologieal changes in liver were observed;insulin sensitivity test was performed;the fatty experimental group are treated with Pioglitazone(30mg · kg-1 · d-1,oral gavage),treatment was administered daily for 2 weeks.The control group and fatty control group all received an equal volume of vehicle (saline).The protein expression of adiponectin in the liver of rats was determined by immunohistochemistry.Results The insulin sensitive index was significantly decreased in the high-fat-diet rats compared with the control group[(0.021 ±0.010),(0.015 ±0.007),P ＜0.05] ;The protein level of adiponectin in the liver of fatty,control group was significantly decreased compared with the control group[(2929.73 ± 157.45 ),(3814.21 ±211.42),P ＜0.05],adiponectin in the liver of fatty experimental group was significantly increased compared with the fatty control group[(2929.73 ± 157.45),(3657.68 ±217.31 ),P ＜0.05].Conclusion Pioglitazone could improve the expression of adiponectin,and improve the resistance of insulin.

Objective:To investigate clinical and histopathological features of mucinous nevi.Methods:Clinical and pathological data were collected from 10 patients with clinically and histopathologically confirmed mucinous nevi in Hospital of Dermatology, Chinese Academy of Medical Sciences from January 2014 to December 2019, and retrospectively analyzed.Results:All cases developed mucinous nevi in childhood, with an average age of onset being 6.5 years. Of the 10 patients, 7 had lesions on the trunk, among whom 4 had lesions on the back; the remaining 2 had lesions on the limbs, and 1 had generalized lesions on the trunk and limbs. The skin lesions were locally arranged in lines, bands or clusters, and skin-colored, reddish or yellow in color, with the texture varying from soft to hard. Histopathological examination showed that 10 patients presented with disordered arrangement of collagen fiber bundles in the dermis and mucin deposition at varying locations and to different degrees among them, 6 with thickened and red-stained collagen fibers in the deposition area, and the remaining 4 with sparse and decreased collagen; focal liquefaction degeneration of the basal layer was observed in 2 cases, and different amounts of mature adipose tissue in the dermis were seen in 3 cases.Conclusions:Mucinous nevus pathologically manifests as mucin deposition of varying degrees among disorderedly arrangd collagen fiber bundles in the dermis, which is similar to some other diseases, and is easily misdiagnosed. Close combination of clinical and pathological features facilitates confirmed diagnosis.

OBJECTIVE: To investigate the development present situation of the department of critical care medicine in Inner Mongolia Autonomous Region (hereinafter referred to as Inner Mongolia), in order to promote the standardized and homogeneous development of critical care medicine in Inner Mongolia, and also provide a reference for discipline construction and resource allocation. METHODS: A survey study was conducted in comprehensive intensive care unit (ICU) of tertiary and secondary hospitals in Inner Mongolia by online questionnaire survey and telephone data verification. The questionnaire was based on the Guidelines for the Construction and Management of Intensive Care Units (Trial) (hereinafter referred to as the Guidelines) issued by the National Health Commission in 2009 and the development trend of the discipline. The questionnaire covered six aspects, including hospital basic information, ICU basic information, personnel allocation, medical quality management, technical skill and equipment configuration. The questionnaire was distributed in September 2022, and it was filled out by the discipline leaders or department heads of each hospital. RESULTS: As of October 24, 2022, a total of 101 questionnaires had been distributed, 85 questionnaires had been recovered, and the questionnaire recovery rate had reached 84.16%, of which 71 valid questionnaires had been collected in a total of 71 comprehensive ICU. (1) There were noticeable regional differences in the distribution of comprehensive ICU in Inner Mongolia, with a relatively weak distribution in the east and west, and the overall distribution was uneven. The development of critical care medicine in Inner Mongolia was still lacking. (2) Basic information of hospitals: the population and economy restricted the development of ICU. The average number of comprehensive ICU beds in the western region was only half of that in the central region (beds: 39.0 vs. 86.0), and the average number of ICU beds in the eastern region was in the middle (83.6 beds), which was relatively uneven. (3) Basic information of ICU: among the 71 comprehensive ICU surveyed, there were 44 tertiary hospitals and 27 secondary hospitals. The ratio of ICU beds to total beds in tertiary hospitals was significantly lower than that in secondary hospitals [(1.59±0.81)% vs. (2.11±1.07)%, P < 0.05], which were significantly lower than the requirements of the Guidelines of 2%-8%. The utilization rate of ICU in tertiary and secondary hospitals [(63.63±22.40)% and (44.65±20.66)%, P < 0.01] were both lower than the bed utilization rate required by the Guidelines (75% should be appropriate). (4) Staffing of ICU: there were 376 doctors and 1 117 nurses in tertiary hospitals, while secondary hospitals had 122 doctors and 331 nurses. There were significant differences in the composition ratio of the titles of doctors, the degree of doctors, and the titles of nurses between tertiary and secondary hospitals (all P < 0.05). Most of the doctors in tertiary hospitals had intermediate titles (attending physicians accounted for 41.49%), while most of the doctors in secondary hospitals had junior titles (resident physicians accounted for 43.44%). The education level of doctors in tertiary hospitals was generally higher than that in secondary hospitals (doctors: 2.13% vs. 0, masters: 37.24% vs. 8.20%). The proportion of nurses in tertiary hospitals was significantly lower than that in secondary hospitals (17.01% vs. 24.47%). The ratio of ICU doctors/ICU beds [(0.64±0.27)%, (0.59±0.34)%] and ICU nurses/ICU beds [(1.76±0.56)%, (1.51±0.48)%] in tertiary and secondary hospitals all failed to meet the requirements above 0.8 : 1 and 3 : 1 of the Guidelines. (5) Medical quality management of ICU: compared with secondary hospitals, the proportion of one-to-one drug-resistant bacteria care in tertiary hospitals (65.91% vs. 40.74%), multimodal analgesia and sedation (90.91% vs. 66.67%), and personal digital assistant (PDA) barcode scanning (43.18% vs. 14.81%) were significantly higher (all P < 0.05). (6) Technical skills of ICU: in terms of technical skills, the proportion of bronchoscopy, blood purification, jejunal nutrition tube placement and bedside ultrasound projects carried out in tertiary hospitals were higher than those in secondary hospitals (84.09% vs. 48.15%, 88.64% vs. 48.15%, 61.36% vs. 55.56%, 88.64% vs. 70.37%, all P < 0.05). Among them, the placement of jejunal nutrition tube, bedside ultrasound and extracorporeal membrane oxygenation were mainly completed independently in tertiary hospitals, while those in secondary hospitals tended to be completed in cooperation. (7) Equipment configuration of ICU: in terms of basic equipment, the ratio of the total number of ventilators/ICU beds in tertiary and secondary hospitals [0.77% (0.53%, 1.07%), 0.88% (0.63%, 1.38%)], and the ratio of injection pump/ICU beds [1.70% (1.00%, 2.56%), 1.25% (0.75%, 1.88%)] didn't meet the requirements of the Guidelines. The equipment ratio was insuffcient, which means that the basic needs of development had not been met yet. CONCLUSIONS The development of comprehensive ICU in Inner Mongolia has tended to mature, but there is still a certain gap in the development scale, personnel ratio and instruments and equipment compared with the Guidelines. Moreover, the comprehensive ICU appears the characteristics of relatively weak eastern and western regions, and the overall distribution is uneven. Therefore, it is necessary to increase efforts to invest in the construction of the department of critical care medicine.
Humans ; Intensive Care Units ; Critical Care ; Surveys and Questionnaires ; Tertiary Care Centers ; China