Objective:To observe the effects of early energy intake and early enteral nutrition on prognosis of patients during extracorporeal membrane oxygenation (ECMO).Methods:Patients who received ECMO treatment in the emergency intensive care unit (EICU) of the Jiangsu Provincial Hospital (First Affiliated Hospital of Nanjing Medical University) from January 2021 to June 2022 were selected as subjects to summarize the early energy intake of ECMO patients. Logistic regression analysis and restricted cubic spline (RCS) analysis were used to determine the relationship between early energy intake and prognosis of ECMO patients. According to the results of RCS analysis, the patients were divided into energy-deficient group and energy-sufficient group. And according to whether early enteral nutrition (EEN) was initiated, the patients were divided into EEN group and non-EEN group. The differences of clinical outcomes between energy-deficient group and energy-sufficient group, EEN group and non-EEN group were compared.Results:There was no significant difference in age, sex, BMI, primary disease and ECMO pattern between energy-deficient group and energy-sufficient group, EEN group and non-EEN group. The ECMO conversion time (days) and hospitalization time (days) in the energy-deficient group were significantly lower than those in the energy-sufficient group, and the survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group [43.2% (19/44) vs. 66.0% (31/47), P=0.029]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the energy-deficient group was significantly lower than that in the energy-sufficient group, and the risk of death was 2.595 times higher than that in the energy-sufficient group. The conversion time (days), hospital stay (days) and average daily energy intake [kcal/(kg·d)] in the EEN group were higher than those in the non-EEN group ( P<0.05), and the survival rate in the non-EEN group was significantly higher than that in the non-EEN group [66.1% (41/62) vs. 31.0% (9/29), P<0.002]. Kaplan-Meier survival analysis showed that the 28-day survival rate in the non-EEN group was significantly lower than that in the EEN group, and the risk of death was 2.981 times higher than that in the EEN group ( P<0.001). Conclusions:The energy intake of patients with ECMO above 16.94 kcal/ (kg·d) is a protective factor for prognosis. EEN helps to increase early energy intake and improve prognosis in patients during ECMO.

Ferroptosis is a form of iron-dependent cell death caused by a disorder of iron lipid metabolism.Its mechanism mainly includes lipid metabolism and iron metabolism,which are complicated and strictly regulated by various metabolic and signaling pathways.Current studies have shown that ferroptosis is associated with cancer,atherosclerosis,and neurological diseases.Traditional Chinese medicine(TCM)is characterized by various active ingredients,relatively high safety,and lower treatment costs,which possess unique advantages in clinical applications.It has been widely used in the treatment of various diseases.Taking the regulation of ferroptosis by traditional Chinese medicine as the entry point may be a new direction for the future prevention and treatment of various diseases.In this review,we discussed the mechanism of iron lipid metabolic disorders based on ferroptosis and the research progress of traditional Chinese medicine intervention to provide reference and treatment strategies for the prevention and treatment of related diseases.

Frontal fibrosing alopecia is a primary lymphocytic cicatricial alopecia, and is generally considered to be a subtype of lichen planopilaris due to similar histopathological changes. Its etiology is still unclear. With the deepening of research on this disease, more and more cases of frontal fibrosing alopecia have been reported in China and other countries. This review summarizes research progress in pathogenesis, clinical and pathological characteristics, and treatment of frontal fibrosing alopecia.

Objective:To investigate the safety of early whole body computed tomography (WBCT) combined with coronary angiography (CAG) in patients with extracorporeal cardiopulmonary resuscitation (ECPR) and its application value in the diagnosis of cardiac arrest and complications of cardiopulmonary resuscitation (CPR).Methods:This was a retrospective study. Patients who underwent ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to July 2021 were enrolled in this research. Patients younger than 18 years or with incomplete clinical data were excluded. The results of WBCT and CAG examinations after ECPR were collected.Results:A total of 89 patients with ECPR, aged (47±17) years, were enrolled in the study, all underwent WBCT examination, and no adverse events such as ECMO and tracheal tube shedding occurred. WBCT found 7 cases of pulmonary embolism, 3 cases of aortic dissection and 2 cases of cerebral hemorrhage. WBCT identified CPR-related complications in 42 cases, including rib fractures ( n=20), pneumothorax ( n=5), mediastinal emphysema ( n=5), subcutaneous emphysema ( n=6), and hematoma or swelling at puncture site ( n=6). Fifty-five patients underwent CAG examination, the most common culprit vessels were the left anterior descending branch disease (58.2%) followed by the left circumflex branch disease (27.3%), the right coronary artery disease (21.8%) and left main artery disease (12.7%). Conclusions:Early WBCT and CAG examinations are of great significance and safety for the guidance of treatment in ECPR patients.

Objective:To analyze whether lower anticoagulation intensity can reduce the incidence of complications in patients with extracorporeal membrane oxygenation (ECMO).Methods:Clinical data of 88 non-cardiac surgery patients who received ECMO support for more than 72 h were collected in the Extracorpical Life support Center of Jiangsu Province Hospital from March 2015 to March 2021. According to the average activated partial thromboplastin time (APTT) level on the third day of ECMO, the patients were divided into the APTT < 50 s group ( n=53) and APTT ≥50 s group ( n=35). The venovenous ECMO (VV-ECMO) subgroup was divided into the APTT <50 s group ( n=23) and APTT ≥50 s group ( n=10). The venoarterial ECMO (VA-ECMO) subgroup was divided into the APTT <50 s group ( n=30) and APTT≥50 s group ( n=25). The average daily transfusion volume of red blood cells during ECMO, the incidence of bleeding, the incidence of thrombosis and all-cause mortality were compared between the two groups. Results:There were no significant differences in the incidence of thrombosis and all-cause mortality in the APTT <50 s group compared with the APTT ≥50 s group ( P>0.05), but the incidence of bleeding and the daily transfusion volume of red blood cells were significantly decreased (7.5% vs. 35.7%; 0.50 U vs. 0.88 U) ( P < 0.05). In 33 VV-ECMO patients, the all-cause mortality, incidence of bleeding, average daily transfusion volume of red blood cells in the APTT <50 s group were lower than those in the APTT ≥50 s group, and the incidence of thrombosis was higher, but there was no statistical difference between the two groups ( P>0.05). In the 55 VA-ECMO patients, there were no significant differences in all-cause mortality, incidence of bleeding, thrombosis and average daily transfusion volume of red blood cells between the two groups ( P > 0.05). Conclusions:The lower anticoagulation intensity in patients without anticoagulation can reduce the occurrence of bleeding in ECMO patients. It is reasonable for such patients to have a lower anticoagulation intensity and studies with larger sample size need to be carried out.

A case of cicatricial female pattern hair loss was reported. A 36-year-old female patient presented with gradually aggravated hair loss for more than 10 years. Skin examination showed diffuse hair thinning on the scalp, thin and soft hairs, and some pencil eraser-sized areas of focal atrichia. TrichoScan examination revealed markedly decreased hair density on the forehead, variability in hair diameter greater than 20%, and increased proportions of vellus hairs. Dermoscopic examination showed increased numbers of vellus hairs, plenty of focal atrichia areas measuring 3 - 5 mm in diameter, loss of some follicular ostia, and confluent white dots. Histopathological examination of vertical and transverse scalp sections showed predominantly distributed miniaturized hair follicles with lichenoid folliculitis around the infundibulum and isthmus, concentrically layered perifollicular fibrosis, a marked decrease in the number of hair follicles compared with healthy people of the same age, increased proportions of vellus hairs, a large number of miniaturized hair follicles and follicular streamers, and formation of follicular micro-scars. The patient was diagnosed with cicatricial female pattern hair loss. She received topical treatment with 5% minoxidil liniment once a day, and alternate treatment with topical tacrolimus ointment and clobetasol propionate ointment, as well as oral spironolactone at a dose of 20 mg twice a day and compound glycyrrhizin capsules at a dose of 50 mg thrice a day. After half a year of treatment, there was no marked aggravation of hair loss, and the follow-up continued.

Objective:To explore the prognostic value of survival after veno-arterial ECMO (SAVE) score combined with 24-h lactate on the machine in patients with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:Totally 59 patients treated with ECPR in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from April 2017 to June 2021 were retrospectively analyzed. According to the 28-day prognosis, the patients were divided into the death group ( n=36) and the survival group ( n=23). The differences in baseline data were analyzed, and multivariate logistic regression was performed to identify the influencing factors of 28-day mortality in patients with ECPR. The receiver operating characteristic (ROC) curve was applied to evaluate the predictive value of SAVE score, 24-h lactate and their combined detection for predicting 28-day mortality risk in patients with ECPR. Results:The 28-day survival rate of patients with ECPR was 39% (23/59). SAVE score of the death group was significantly lower than that of the survival group (-11.67±4.60 vs. -2.43±4.77, P<0.001), and the 24-h lactate in the death group was significantly higher than that in the survival group [5.94 (3.37, 12.40) mmol/L vs. 1.65 (1.07, 3.15) mmol/L, P<0.001]. Multivariate logistic regression analysis showed that SAVE score ( OR=0.703, 95% CI: 0.566-0.873, P=0.001) and 24-h lactate ( OR=1.608, 95% CI: 1.025-2.523, P=0.039) were independent influencing factors of 28-day mortality in ECPR patients. ROC curve analysis showed that the best cut-off value of SAVE score was -6, the sensitivity was 78.30% and specificity was 91.70%. The best cutoff value of 24-h lactate was 4.7 mmol/L, the sensitivity was 63.90% and specificity was 100.00%. The sensitivity and specificity of the combined detection of SAVE score and 24-h lactate were 82.60% and 100.00%, respectively. The area under the curve (AUC) of SAVE score combined with 24-h lactate for predicting the 28-day mortality risk in patients with ECPR was larger than that of SAVE score and 24-h lactate alone (0.952 vs. 0.917; 0.952 vs. 0.847). Conclusions:Lower SAVE score and higher 24-h lactate are independently risk factors of 28-day mortality in patients with ECPR, and SAVE score combined with 24-h lactate on the machine has a good predictive value for the prognosis of patients with ECPR.

Objective:To investigate the clinical significance of the acute physiology and chronic health evaluationⅡ (APACHEⅡ) combined with different systematic inflammation markers (SIMs) including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)-in adult patients with venous-arterial extracorporeal membrane oxygenation (VA-ECMO).Methods:A total of 89 adult patients with VA-ECMO ( ≥ 3 d) in the Emergency Department of Jiangsu Provincial People's Hospital from January 2017 to June 2020 were retrospectively analyzed. Patients were divided into two groups: survivors ( n=39) and non-survivors ( n=50). The baseline APACHE Ⅱscore and PLR, NLR, LMR before ECMO implantation and at 1, 2, 3 day after ECMO were recorded. Binary logistic regression was used to analyze the risk factors of 28-day mortality in patients with VA-ECMO. The utility of APACHEⅡ score and SIMs alone or combination for predicting clinical prognosis was evaluated using receiver operating characteristic (ROC) curve analysis. The patients were divided into the high risk group and the low risk group according to the best cut-off value, and the difference of ECMO-related complications between the two groups was compared. Results:When combined APACHEⅡ score with SIMs, APACHEⅡ + PLR 48 h + LMR 24 h + LMR 72 h demonstrated the greatest predictive ability with an AUC of 0.833. Compared with the high-risk group, the low-risk group has a lower incidence of acute renal injury, infection, bleeding complications, the use of continuous renal replacement therapy, mechanical ventilation, and a higher hospital survival rate.Conclusions:The combination of APACHEⅡ score and SIMs-PLR, LMR- is better than a single one for death prediction, and it is expected to be a new predictive model for early identification of the risk of death or poor prognosis in patients with VA-ECMO.

Objective:To study the application of blood products in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and evaluate its effect on the prognosis.Methods:A total of 83 adult patients treated with VA-ECMO in the Emergency Department of the First Affiliated Hospital of Nanjing Medical University from January 2017 to January 2020 were grouped by survival to explore the risk factors of 28-day mortality using binary logistic regression, and the threshold was calculated by ROC curve.Results:Platelet transfusion ( OR=2.506, 95% CI: 1.142-5.499) and non-myocarditis disease ( OR=6.881, 95% CI: 1.615-29.316) were the risk factors of 28-day mortality in adult VA-ECMO patients. The threshold of platelet transfusion was 0.427 mL/(kg·d) (sensitivity 78.4%, specificity 69.6% , AUC 0.735). Conclusions:The increased platelet transfusion is related to the poor prognosis of adult patients with VA-ECMO. Refractory myocarditis patients are better treated with VA-ECMO.

OBJECTIVE: To study the genetic variants of a child with Autism Spectrum Disorder (ASD) combined with epilepsy, and explore its possible pathogenic mechanism. METHODS: Clinical data of the child were collected and evaluated, whole-exome sequencing (WES) technology was used to explore the genetic variants sites of the child and his parents and candidate genes were filtered out. Sanger sequencing were performed to verify the variants identified by WES and PolyPhen2 was utilized to predict the function of these variants. qPCR was carry out to determine the expression of the variant gene. RESULTS: The proband carried a compound heterozygous mutation in the SIK3 gene (Chr11 q23.3, NM_025164.6), which contains a missense mutation c.1295A>G (p.N432S) inherited from the father and a deletion [c.2389_2391del(p.797del)] inherited from the mother. Both mutation sites are highly conservative, and PolyPhen2 predicted (c.1295A>G [p.N432S]) to be harmful. Compared to the mother, expression of SIK3in mRNA level in the peripheral blood of the proband and his father were both significantly decreased; compared to normal child, SIK3 expression in the peripheral blood of the proband and two other children with ASD were all decreased significantly too. In addition, studies on mice found that Sik3 gene has a marked higher level of expression in the brain. CONCLUSION The SIK3 gene variants may probably be associated with ASD. The detailed mechanism needs to be studied further, which may involve lipid metabolism dysfunction in the brain.
Animals ; Autism Spectrum Disorder/genetics* ; Epilepsy/genetics* ; Male ; Mice ; Mutation ; Mutation, Missense ; Protein Kinases ; Protein Serine-Threonine Kinases/genetics* ; Whole Exome Sequencing