Objective To analyze the influencing factors of delirium after endovascular aortic repair, and to provide a basis for clinical nursing and prevention of this condition. Methods Patients who underwent endovascular aortic repair at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected. The Chinese version of the Nursing Delirium Screening Scale (Nu-DESC) was used to assess whether postoperative delirium occurred. Patients with a Nu-DESC score≥ 3 were assigned to the delirium group. Non-delirium patients who had the same surgeon and adjacent surgical order were selected at a 1 : 4 ratio to form the non-delirium group. Univariate analysis was performed on the clinical data of the two groups. Factors with P<0.1 in the univariate analysis and those considered clinically significant were included in a multivariate logistic regression analysis to identify the influencing factors of postoperative delirium. Stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Results A total of 213 patients were included, comprising 46 in the delirium group and 167 in the non-delirium group. The overall mean age was (60.3±12.0) years, and 183 (85.9%) were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, aortic dissection, surgical duration, intubation time, and ICU stay may be associated with postoperative delirium. Multivariate analysis revealed that longer operative and intubation times were associated with a higher likelihood of delirium. In the stratified analysis, the results for the TEVAR group were consistent with the overall findings, whereas no significant differences were observed in the EVAR group. Conclusion Longer surgical and intubation times are associated with an increased risk of delirium in patients undergoing TEVAR. No significant factors influencing delirium are identified in patients undergoing EVAR.

【Objective】 To explore the effect of intraoperative cell salvage on allogeneic blood transfusion requirements, coagulation function and electrolytes in postpartum hemorrhage patients. 【Methods】 A study on postpartum hemorrhage patients undergoing cesarean section in the Third Affiliated Hospital of Guangxi Medical University form September 2016 to May 2022 was conducted retrospectively. A total of 137 patients were enrolled and divided into experimental group (n=70) and control group (n=67) according to whether intraoperative cell salvage was used during operation. The blood loss, proportion and volume of allogeneic red blood cells (RBCs) and coagulation component transfusion, hemoglobin (Hb) level, coagulation function, electrolyte, the incidence of complications, proportion of ICU admission, ICU stay and in-hospital stay were compared between the two groups. 【Results】 The proportion of patients receiving allogeneic RBCs in the experimental group and in the control group was 31.4% vs 100.0% (P<0.05). The experimental group also had lower use of plasma (31.4% vs 53.7%, P<0.05). The postoperative 24 h of activated partial thromboplastin time (APTT) and prothrombin time (PT) in the two groups was longer than preoperative, and APTT in the control group did not recover at discharge (P<0.05). Fibrinogen (Fib) decreased postoperative 24 h in the two groups (P<0.05). The blood calcium in the two groups decreased 30 minutes after operation, but the decrease in the experimental group was slight, and two groups did not recover 24 h after operation (P<0.05). There was no statically significant difference in blood loss, volume of allogeneic RBCs and coagulation component transfusion, Hb level, incidence of complications, the proportion of ICU admission, ICU stay and in-hospital stay (P>0.05). 【Conclusion】 This study demonstrated that intraoperative cell salvage could reduce the requirement for allogeneic RBCs without compromising coagulation function in postpartum hemorrhage patients undergoing cesarean section, but the changes of calcium need to be concerned after transfusion.

OBJECTIVE: To investigate the association between the glucose-to-lymphocyte ratio (GLR) and prognosis of patients with sepsis-associated acute kidney injury (SA-AKI). METHODS: Based on the Medical Information Mart for Intensive Care-IV (MIMIC-IV), SA-AKI patients aged ≥ 18 years were selected. According to the tertiles of GLR, the patients were divided into GLR1 group (GLR ≤ 4.97×10^-9 mmol), GLR2 group (4.97×10^-9 mmol < GLR < 9.75×10^-9 mmol) and GLR3 group (GLR ≥ 9.75×10^-9 mmol). Patients with SA-AKI were divided into survival group and death group according to whether they survived 28 days after admission. The patient's gender, age, vital signs, laboratory test results, comorbidities, sequential organ failure assessment (SOFA), acute physiology score III (APS III) score and treatment measures were extracted from the database. Kaplan-Meier survival analysis was used to make the survival curves of patients with SA-AKI at 28 days, 90 days, 180 days and 1 year. Multivariate Logistic regression analysis model was used to explore the independent risk factors of 28-day mortality in patients with SA-AKI. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive efficacy of GLR for the prognosis of patients with SA-AKI. RESULTS: A total of 1 524 patients with SA-AKI were included, with a median age of 68.28 (58.96, 77.24) years old, including 612 females (40.16%) and 912 males (59.84%). There were 507 patients in the GLR1 group, 509 patients in the GLR2 group and 508 patients in the GLR3 group. There were 1 181 patients in the 28-day survival group and 343 patients in the death group. Grouping according to GLR tertiles showed that with the increase of GLR, the 28-day, 90-day, 180-day and 1-year mortality of SA-AKI patients gradually increased (28-day mortality were 11.64%, 22.00%, 33.86%, respectively; 90-day mortality were 15.98%, 26.72%, 40.55%, respectively; 180-day mortality were 17.16%, 28.29% and 41.73%, and the 1-year mortality were 17.95%, 29.27% and 42.72%, respectively, all P < 0.01). According to 28-day survival status, the GLR of the death group was significantly higher than that of the survival group [×10^-9 mmol: 9.81 (5.75, 20.01) vs. 6.44 (3.64, 10.78), P < 0.01]. Multivariate Logistic regression analysis showed that GLR was an independent risk factor for 28-day mortality in patients with SA-AKI [when GLR was used as a continuous variable: odds ratio (OR) = 1.065, 95% confidence interval (95%CI) was 1.045-1.085, P < 0.001; when GLR was used as a categorical variable, compared with GLR1 group: GLR2 group OR = 1.782, 95%CI was 1.200-2.647, P = 0.004; GLR3 group OR = 2.727, 95%CI was 1.857-4.005, P < 0.001]. ROC curve analysis showed that the area under the ROC curve (AUC) of GLR for predicting 28-day mortality in patients with SA-AKI was 0.674, when the optimal cut-off value was 8.769×10^-9 mmol, the sensitivity was 57.1% and the specificity was 67.1%. The predictive performance was improved when GLR was combined with APS III score and SOFA score, and the AUC was 0.806, the sensitivity was 74.6% and the specificity was 71.4%. CONCLUSIONS GLR is an independent risk factor of 28-day mortality in patients with SA-AKI, and high GLR is associated with poor prognosis in patients with SA-AKI.
Male ; Female ; Humans ; Blood Glucose ; Glucose ; ROC Curve ; Prognosis ; Sepsis/diagnosis* ; Acute Kidney Injury ; Retrospective Studies ; Intensive Care Units

Background: Brucella infection induces brucellosis, a zoonotic disease. The intracellular circulation process and virulence of Brucella mainly depend on its type IV secretion system (T4SS) expressing secretory effectors. Secreted protein BspJ is a nucleomodulin of Brucella that invades the host cell nucleus. BspJ mediates host energy synthesis and apoptosis through interaction with proteins. However, the mechanism of BspJ as it affects the intracellular survival of Brucella remains to be clarified. Objectives: To verify the functions of nucleomodulin BspJ in Brucella's intracellular infection cycles. Methods: Constructed Brucella abortus BspJ gene deletion strain (B. abortus ΔBspJ) and complement strain (B. abortus pBspJ) and studied their roles in the proliferation of Brucella both in vivo and in vitro. Results: BspJ gene deletion reduced the survival and intracellular proliferation of Brucellaat the replicating Brucella-containing vacuoles (rBCV) stage. Compared with the parent strain, the colonization ability of the bacteria in mice was significantly reduced, causing less inflammatory infiltration and pathological damage. We also found that the knockout of BspJ altered the secretion of cytokines (interleukin [IL]-6, IL-1β, IL-10, tumor necrosis factor-α, interferon-γ) in host cells and in mice to affect the intracellular survival of Brucella. Conclusions BspJ is extremely important for the circulatory proliferation of Brucella in the host, and it may be involved in a previously unknown mechanism of Brucella's intracellular survival.

Objective To observe the amplification effect of mitochondrial DNA (mtNDA) on the inflammatory response of rat alveolar macrophage induced by lipopolysaccharide (LPS), and to preliminarily explore its mechanism. Methods mtDNA of Sprague-Dawley (SD) rat liver tissue was harvested, ultra-micro spectrophotometer and 1% agarose gel electrophoresis were used to detect the concentration and quality of mtDNA. The alveolar macrophages of SD rat were isolated and cultured, the macrophages in logarithmic growth phase were divided into phosphatic buffer solution (PBS) group, LPS group, mtDNA group and LPS+mtDNA group. The first three groups were added equal volumes of PBS, LPS 1 mg/L or mtDNA 10 mg/L to the alveolar macrophages medium for 6 hours and 12 hours, respectively; the alveolar macrophage medium of LPS+mtDNA group was stimulated with 1 mg/L LPS for 6 hours and then stimulated with 10 mg/L mtDNA for 6 hours. The levels of interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) in the cell supernatant were detected by enzyme linked immunosorbent assay (ELISA);the expression of the key protein of Pyroptosis-Gasdermin D (GSDMD) was detected by Western Blot. Results ① The mtDNA A260/280 ratios were between 1.8-2.0, and agarose gel electrophoresis showed a single band, with a size of about 16 kb. ② After alveolar macrophages stimulated by LPS or mtDNA for 6 hours or 12 hours, respectively, the levels of IL-1β and TNF-α were higher than those in PBS group. When cells were treated with mtDNA for 6 hours after LPS stimulation 6 hours, the levels of IL-1β were higher than those in LPS 12 hours group (ng/L: 366.27±23.35 vs. 154.70±23.32, 1 < 0.01), but the levels of TNF-α had no significant difference compared with LPS 12 hours group (ng/L: 836.13±25.01 vs. 802.67±30.48, 1 > 0.05). ③ The protein expressions of GSDMD in LPS group, mtDNA group and LPS+mtDNA group were significantly higher than those in PBS group (GSDMD/β-actin: 1.77±0.05, 1.65±0.04,2.40±0.05, 1.00±0.02, all 1 < 0.01), and the protein expression of GSDMD in LPS+mtDNA group was higher than that in LPS group (1 < 0.01). Conclusion mtDNA amplifies LPS-induced alveolar macrophage inflammatory responses,which mechanism may be related to the increase in pyroptosis mediated by mtDNA.

Objective: To explore the relevant factors of acquired swallowing disorders in adult patients after cardiac surgery. Methods: A Jiatian water swallowing screening test was conducted for adult patients after cardiac surgery in our hospital from 2015-03 to 2015-09. There were 32 patients with acquired swallowing disorder deifned as Case group and meanwhile 420 patients without swallowing disorder at the same word deifned as Control group. Non-conditional Logistic regression analysis was applied to study the relevant factors for acquired swallowing disorders. Results: The overall incidence of acquired swallowing disorders was 7.08%. Multi Logistic regression analysis presented that duration of endotracheal intubation (OR=1.060,P<0.001), pre-operative arrhythmia (OR=2.780,P=0.019), NYHA grade (OR=1.789, P=0.033) and Euroscore (OR=1.216,P=0.040) were the relevant factors for the occurrence of acquired swallowing disorders in adult patients after cardiac surgery. Conclusion: Medical professionals should pay special attention to patients with above mentioned risk features at post-operative drinking to reduce the complications of acquired swallowing disorders.

Objective To understand the dynamic rules of schistosomiasis endemic situation before and after reaching the criteria of schistosomiasis transmission controlled or transmission interrupted,so as to provide the evidence for improving schis-tosomiasis control. Methods Wuling District,Xihu District and Linli County were selected and investigated retrospectively to collect the schistosomiasis epidemiological information 10 years before they reached the criteria of transmission controlled and the subsequent years until 2008. A database of retrospective investigation was established for analyzing the trends and rules of changes of the Oncomelania hupensis snail status and infection status of cattle and human. Results In Wuling District,the en-demic situation was declining,and no schistosome infection persons,animals and snails were found after 1974. There was no re-bound until 2008. In Xihu District,the endemic situation reached the criteria of transmission controlled in 1997,and the endem-ic situation was stable. The human infection rate was positively correlated with the area of infection snails(r=0.584,P<0.05). In Linli County,there were no snails,no infected persons and cattle twice,but 2 endemic rebounds,and there were positive corre-lations between the densities of living snails and the infection rates of human and animal during the endemic rebound period. Conclusion The snail status is an important indicator of schistosomiasis endemic rebound. Therefore,the snail control is one of the most important schistosomiasis control measures.

After Human Gene Project, studying the kinetics of DNA translocation through a nanopore, and developing a novel fast DNA sequencing technology by using nanopore have become one of the hot in gene-research). This contribution provides an overview of nanopore macromolecular identification,including bionanopore and solid-state nanopore, while the perspective of these research are also summarized.

Objective To evaluate the cardiopulmonary allograft function and to analyze key factors for long-term survival of heart-lung transplantation in a patient survived more than 5 years. Methods On December 17th, 2003 at Zhongshan Hospital of Fudan University, a homologous heart-lung transplantation was performed on a female who diagnosed with cardiopulmonary failure secondary to congenital atrial septal defect with severe pulmonary hypertension. Heart-lung allograft was preserved with 1 000 mL UW solution and 4 000 mL HTK solution.Postoperative immunosuppressive therapies were managed with Zenapax, cyclosporine A (or tacrolimus), mycophenolate mofetil and corticosteroids. Cyclosporine A maintained with serum trough levels of 100-200 μg/L and tacrolimus with serum trough levels of 8-20 μg/L. Cardiopulmonary allograft functions were evaluated by echocardiogram, pulmonary function test and thoracic CT periodically. Results The patient survived operation and experienced normal daily life with NYHA cardiac function of class Ⅰ-Ⅱ during the follow-up of 5 years and 6 months. Echocardiogram showed left ventricular ejection fraction of 65% to 86%. Pulmonary function test exhibited with nearly normal oxygen exchange, meanwhile, small airway obstruction was detected from one year after operation and keeping stable from then on. Two episodes of severe pneumonia were complicated and treated with antibiotics and fhconazob, no severe acute allograft rejection episode was experienced. Conclusions Heart-lung transplantation proves to be a reliable therapy modality for terminal cardiopulmonary failure. Excellent donor organ preservation, accurate balance of the risk between acute allograft rejection and infection, and strict preventive measures against infection are key factors for long-term survival of heart-lung transplantation.

OBJECTIVETo summarize the diagnosis and treatment of acute rejection after lung transplantation and to discuss optimized immunosuppressive therapy.

METHODSBetween November 2002 and June 2006, 16 patients underwent operations on lung transplantation, 7 cases on single-lung transplantation and 9 cases on bilateral-lung transplantation. Immunosuppressive therapy was new triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids, and (or) daclizumab.

RESULTSEight cases in new triple drug maintenance regimen with daclizumab. There is no acute rejection in 6 months. Except 2 of the 8 cases died of early post-lung transplantation sever pulmonary edema and dysfunction, 3 of the rest 6 cases underwent acute rejection incident about 21.4% (3/14).

CONCLUSIONIn this group the new triple drug maintenance regimen including tacrolimus (Tac), mycophenolate mofetil (MMF) and steroids, and (or) daclizumab acquired beneficial effect in preventing acute rejection after lung transplantation.

Adult ; Antibodies, Monoclonal ; therapeutic use ; Antibodies, Monoclonal, Humanized ; Female ; Graft Rejection ; prevention & control ; Humans ; Immunoglobulin G ; therapeutic use ; Immunosuppressive Agents ; therapeutic use ; Lung Transplantation ; Male ; Middle Aged ; Mycophenolic Acid ; analogs & derivatives ; therapeutic use ; Postoperative Complications ; prevention & control ; Prednisone ; therapeutic use ; Tacrolimus ; therapeutic use ; Treatment Outcome