OBJECTIVE: To investigate the efficacy and safety of autologous blood transfusion during weaning from venous-arterial extracorporeal membrane oxygenation (VA-ECMO) under controlled rotational speed. METHODS: A retrospective study was conducted, selecting patients who underwent extracorporeal membrane oxygenation (ECMO) and successfully weaned at the emergency and critical care medicine center of Henan Provincial Third People's Hospital from January 2023 to May 2024. General data including gender, age, body mass index (BMI), European system for cardiac operative risk evaluation (EuroScore), and disease types were collected. Vital signs at weaning [heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), and peripheral oxygen saturation], parameters before and after weaning [B-type natriuretic peptide (BNP), hemoglobin (Hb), partial pressure of arterial oxygen (PaO₂), partial pressure of arterial carbon dioxide (PaCO₂), arterial lactate, central venous pressure (CVP), inferior vena cava collapsibility index, left ventricular ejection fraction (LVEF), and right heart load], post-weaning inflammatory markers at 1-day and 3-day [body temperature, white blood cell count (WBC), neutrophil percentage (NEU%), C-reactive protein (CRP), procalcitonin (PCT), interleukin-10 (IL-10)], as well as complications (infection, thrombosis, renal failure, gastrointestinal bleeding) and post-weaning blood return status were recorded. Patients were divided into an observation group (with post-weaning blood return) and a control group (without post-weaning blood return) based on the presence of blood return after weaning. The changes in the aforementioned parameters were compared between the two groups. RESULTS: A total of 62 patients were included, with 31 cases in each group. No statistically significant differences were observed between the two groups in baseline characteristics including gender, age, BMI, and EuroScore. At weaning, the observation group exhibited relatively stable vital signs, with no significant differences in heart rate, SBP, DBP, or peripheral oxygen saturation compared to the control group. After weaning, the observation group showed significantly lower levels of BNP, PaCO₂, arterial lactate, CVP, and right heart load compared to pre-weaning values [BNP (ng/L): 2 325.96±78.51 vs. 4 878.48±185.47, PaCO₂ (mmHg, 1 mmHg≈0.133 kPa): 35.23±3.25 vs. 40.75±4.41, arterial lactate (mmol/L): 2.43±0.61 vs. 6.19±1.31, CVP (cmH₂O, 1 cmH₂O≈0.098 kPa): 8.32±0.97 vs. 15.34±1.74, right heart load: 13.24±0.97 vs. 15.69±1.31, all P < 0.05], while Hb, PaO₂, inferior vena cava collapsibility index, and LVEF were significantly higher than pre-weaning values [Hb (g/L): 104.42±9.78 vs. 96.74±6.39, PaO₂ (mmHg): 94.12±7.78 vs. 75.51±4.39, inferior vena cava collapsibility (%): 28±7 vs. 17±3, LVEF (%): 62.41±6.49 vs. 45.30±4.51, all P < 0.05]. No statistically significant differences were found between the observation group and control group in these parameters. At 3 days post-weaning, the observation group demonstrated significantly lower levels of body temperature, WBC, NEU%, CRP, PCT, and IL-10 compared to 1 day post-weaning [body temperature (centigrade): 36.83±1.15 vs. 37.94±1.41, WBC (×10⁹/L): 7.82±0.96 vs. 14.34±2.15, NEU%: 0.71±0.05 vs. 0.80±0.07; CRP (mg/L): 4.34±0.78 vs. 8.94±1.21, PCT (μg/L): 0.11±0.02 vs. 0.26±0.05, IL-10 (ng/L): 8.93±1.52 vs. 13.51±2.17, all P < 0.05], with no significant differences compared to the control group. No statistically significant differences were observed between the two groups in the incidence of complications including infection, thrombosis, renal failure, and gastrointestinal bleeding. CONCLUSION Autologous blood reinfusion during VA-ECMO weaning under controlled rotational speed is safe and effective, without increasing risks of infection or thrombosis.
Humans ; Retrospective Studies ; Extracorporeal Membrane Oxygenation/methods* ; Blood Transfusion, Autologous ; Male ; Female ; Adult ; Middle Aged ; Natriuretic Peptide, Brain/blood*

Objective To investigate the effect of oxymatrine on the brain damage of rats with acute carbon monoxide(CO)poisoning through the sirtuin 1(SIRT1)/forkhead box protein O1(FOXO1)signaling pathway.Methods SD rats were used to establish an acute CO poisoning rat model,after intervention with low,medium,and high doses of oxymatrine and edaravone,the cognitive function of the rats was tested using shuttle box experiments to screen for the optimal dosage of oxymatrine.Construct a rat model of acute CO poisoning againand randomly divide it into five groups:control group,model group,oxymatrine group,edaravone group,EX527(SIRT1 inhibitor)group,and oxymatrine+EX527 group,the model group and drug intervention groupinhaled CO gas to construct acute CO poisoning rat model.After drug intervention,the shuttle box experiment was used to detect the cognitive function in rats,the step-through latency(STL)and the total time spent in the dark chamber(TDC)of each group were compared;fluorescent probe was performed to measure the mitochondrial membrane potential of rat brain tissue;TUNEL staining was performed to detect the apoptosis rate of hippocampal neurons in the rat brain;the kit was performed to determine the levels of serum inflammatory factors and the oxidative stress factor;immunoblotting and immunoprecipitation experimentswas performed to determine the expression of SIRT1/FOXO1 pathway protein.Results Compared with the control group,the STL,brain mitochondrial membrane potential,serum SOD level,and brain tissue SIRT1 protein expression in the model group were significantly reduced(P＜0.05),and the TDC,neuron apoptosis rate,serum ROS,PGE2,TNF-α,IL-18 and MDA levels,and brain tissue acely-FOXO1/FOXO1 were significantly increased(P＜0.05).Compared with the model group and the oxymatrine+EX527 group,the STL,brain mitochondrial membrane potential,serum SOD level,and brain tissue SIRT1 protein expression were all increased in the oxymatrine group(P＜0.05),and the TDC,neuron apoptosis rate,serum ROS,PGE2,TNF-α,IL-18 and MDA levels,and brain tissue acely-FOXO1/FOXO1 were all decreased(P＜0.05);the trend of changes in various indicators in the EX527 group is opposite to that of the oxymatrine group(P＜0.05).There was no significant change in the levels of various indicators between the edaravone group and the high-dose oxymatrine group(P＞0.05).Conclusion Oxymatrine can activate SIRT1/FOXO1 signal to reduce inflammation and oxidative stress in rats,inhibit hippocampal neuronal apoptosis,repair brain mitochondrial function,enhance cognitive ability of rats,and improve brain damage of acute CO poisoning rats.

Objective To investigate the effect of oxymatrine on the brain damage of rats with acute carbon monoxide(CO)poisoning through the sirtuin 1(SIRT1)/forkhead box protein O1(FOXO1)signaling pathway.Methods SD rats were used to establish an acute CO poisoning rat model,after intervention with low,medium,and high doses of oxymatrine and edaravone,the cognitive function of the rats was tested using shuttle box experiments to screen for the optimal dosage of oxymatrine.Construct a rat model of acute CO poisoning againand randomly divide it into five groups:control group,model group,oxymatrine group,edaravone group,EX527(SIRT1 inhibitor)group,and oxymatrine+EX527 group,the model group and drug intervention groupinhaled CO gas to construct acute CO poisoning rat model.After drug intervention,the shuttle box experiment was used to detect the cognitive function in rats,the step-through latency(STL)and the total time spent in the dark chamber(TDC)of each group were compared;fluorescent probe was performed to measure the mitochondrial membrane potential of rat brain tissue;TUNEL staining was performed to detect the apoptosis rate of hippocampal neurons in the rat brain;the kit was performed to determine the levels of serum inflammatory factors and the oxidative stress factor;immunoblotting and immunoprecipitation experimentswas performed to determine the expression of SIRT1/FOXO1 pathway protein.Results Compared with the control group,the STL,brain mitochondrial membrane potential,serum SOD level,and brain tissue SIRT1 protein expression in the model group were significantly reduced(P＜0.05),and the TDC,neuron apoptosis rate,serum ROS,PGE2,TNF-α,IL-18 and MDA levels,and brain tissue acely-FOXO1/FOXO1 were significantly increased(P＜0.05).Compared with the model group and the oxymatrine+EX527 group,the STL,brain mitochondrial membrane potential,serum SOD level,and brain tissue SIRT1 protein expression were all increased in the oxymatrine group(P＜0.05),and the TDC,neuron apoptosis rate,serum ROS,PGE2,TNF-α,IL-18 and MDA levels,and brain tissue acely-FOXO1/FOXO1 were all decreased(P＜0.05);the trend of changes in various indicators in the EX527 group is opposite to that of the oxymatrine group(P＜0.05).There was no significant change in the levels of various indicators between the edaravone group and the high-dose oxymatrine group(P＞0.05).Conclusion Oxymatrine can activate SIRT1/FOXO1 signal to reduce inflammation and oxidative stress in rats,inhibit hippocampal neuronal apoptosis,repair brain mitochondrial function,enhance cognitive ability of rats,and improve brain damage of acute CO poisoning rats.

OBJECTIVE To explore the specific application and evaluation effect of objective structured clinical examination(OSCE)-guided scenario-based practical teaching mode in training clinical pharmacists. METHODS Fifty-six trainees who participated in the clinical pharmacist training program in the Second Xiangya Hospital of Central South University from October 2020 to September 2022 were selected as the research objects. OSCE-guided teaching was conducted, and the application effect of OSCE-guided teaching mode in clinical pharmacist training was explored and analyzed by using theoretical examination results and OSCE assessment results as evaluation indicators. RESULTS Through comparative analysis, it was found that the OSCE-guided teaching mode not only enabled students to better grasp the theoretical knowledge points required by the training outline, but also improved their clinical thinking ability, problem-solving ability, and communication and coordination skills to varying degrees. CONCLUSION For clinical pharmacist trainees, the OSCE teaching mode is conducive to the comprehensive improvement of clinical pharmacist skills and is suitable for cultivating clinical pharmacists who are capable of independently carrying out clinical pharmacy services in the new situation.

Chronic Guillain-Barre syndrome, also known as chronic inflammatory demyelinating polyradiculoneuropathy(CIDP), is an immune-mediated demyelinating peripheral neuropathy. This article analyzes the clinical data of a CIDP patient presenting primarily with limb numbness, pain, and weakness. Along with literature review, this study explores the differential diagnosis between CIDP and diabetic peripheral neuropathy in terms of the pathogenesis, clinical manifestations, laboratory tests, and treatment.

Objective:To establish a predictive model for the progression of acute kidney injury (AKI) to stage 3 AKI (renal failure) in the intensive care unit (ICU), so as to assist physicians to make early and timely decisions on whether to intervene in advance.Methods:A retrospective analysis was conducted. Thirty-eight patients with AKI admitted to the intensive care medicine of the Third People's Hospital of Henan Province from January 2018 to May 2023 were enrolled. Patient data including acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) upon admission, serum creatinine (SCr), blood urea nitrogen (BUN), daily urine output during hospitalization, and the timing of continuous renal replacement therapy (CRRT) intervention were recorded. Based on clinically collected pathological data, standardized creatinine value ratio mean polynomial fitting models were established as the first criterion for judging the progression to stage 3 AKI after data cleansing, screening, and normalization. Additionally, standardized creatinine value ratio index fitting models were established as the second criterion for predicting progression to stage 3 AKI.Results:A total of 38 AKI patients were included, including 25 males and 13 females. The average age was (58.45±12.94) years old. The APACHEⅡ score was 24.13±4.17 at admission. The intervention node was (4.42±0.95) days. Using a dual regression model approach, statistical modeling was performed with a relatively small sample size of statistical data samples, yielding a scatter index non-linear regression model for standardized creatinine value ratio data relative to day " n", with y = 1.246?2 x1.164?9 and an R2 of 0.860?1, indicating reasonable statistical fitting. Additionally, a quadratic non-linear regression model was obtained for the mean standardized creatinine value ratio relative to day " n", with y = -0.260?6 x2+3.010?7 x-1.612 and an R2 of 0.998?9, indicating an excellent statistical fit. For example, using a baseline SCr value of 66 μmol/L for a healthy individual, the dual regression model predicted that the patient would progress to stage 3 AKI within 3-5 days. This prediction was consistent when applied to other early intervention renal injury patients. Conclusion:The established model effectively predicts the time interval of the progression of AKI to stage 3 AKI (renal failure), which assist intensive care physicians to intervene AKI as early as possible to prevent disease progression.

Objective To explore effect of Wenyang Qudu formula on serum inflammatory factors and immune index in patients with severe infections.Methods A total of 86 severe infection patients admitted to the Third People's Hospital of Henan Province from January to December 2023 were selected as the research subjects.According to the patient file order,odd numbers were the study group,and even numbers were the control group,with 43 cases in each group.The control group was treated with cefoperazone sulbactam sodium,while the study group was treated with Wenyang Qudu formula in addition to the control group[drug composition:Prepared aconite(first decocted)30 g,Poria cocos 30 g,White peony 15 g,Red peony 15 g,Stir fried atractylodes macrocephala 30 g,Dried ginger 9 g,Roasted licorice 9 g,Cassia twig 15 g,Semen lepidii 15 g,Dragon's bone 15 g,Raw oyster 15 g,Codonopsis pilosula 12 g,Angelica sinensis 12 g,Asarum 3 g,Schisandra chinensis 6 g,and Jujube 12 g].Brew in water,and took one dose daily,once in the morning and once in the evening,for a continuous period of 7 days.The differences in the scores of traditional Chinese medicine symptoms such as fever,dyspnea,frequent urination,urgency,and degree of sputum production,serum levels of interleukin-10(IL-10),C-reactive protein(CRP),eosinophils(EOS),and immune function indicators[immunoglobulin E(IgE),CD3+,CD4+,CD8+,CD4+/CD8+]were compared between two groups after treatment,and observed the occurrence of adverse reactions.Results After treatment,the traditional Chinese medicine symptom scores(fever,dyspnea,frequent urination and urgency,degree of sputum production),as well as IL-10,CRP,EOS levels,IgE,and CD8+ were significantly reduced in both groups compared to before treatment,CD3+,CD4+,and CD4+/CD8+ were significantly increased compared to before treatment.In addition,the study group had significantly lower scores of fever,dyspnea,frequent urination and urgency,degree of sputum production,IL-10,CRP,EOS levels,IgE,and CD8+ compared to the control group(fever score:1.36±0.30 vs.2.57±0.46,dyspnea score:1.22±0.31 vs.2.26±0.75,urinary frequency and urgency score:1.30±0.39 vs.2.33±0.82,degree of sputum production:1.19±0.77 vs.2.51±0.85,IL-10(ng/L):9.03±1.67 vs.10.51±2.40,CRP(mg/L):4.68±1.33 vs.7.82±2.53,EOS(×109/L):0.30±0.04 vs.0.46±0.10,IgE(mg/L):104.62±10.73 vs.135.68±14.64,CD8+:0.228±0.016 vs.0.258±0.020,all P<0.05],the levels of CD3+,CD4+,and CD4+/CD8+ were significantly higher than those in the control group(CD3+:0.636±0.044 vs.0.567±0.055,CD4+:0.537±0.054 vs.0.397±0.045,CD4+/CD8+:1.76±0.51 vs.0.55±0.39,all P<0.05].After treatment,it was discovered that the study group had not experienced any adverse reactions,while the control group had 1 case of nausea and vomiting and 1 case of chest tightness.There was no statistically significant difference in the incidence of adverse reactions between the study group and the control group[0(0/43)vs.0.05%(2/43),P>0.05].Conclusion The Wenyang Qudu formula can reduce the serum factor levels of IL-10,CRP,and EOS in critically infected patients,and improve immune function with good safety.

Mineralocorticoid receptor(MR) overactivation plays an important role in the development and progression of diabetic kidney disease(DKD) by mediating pro-inflammatory and pro-fibrotic processes, making it a key therapeutic target for DKD. Finerenone, a third-generation, highly selective, novel nonsteroidal mineralocorticoid receptor antagonist(MRA), mitigates MR overactivation through anti-inflammatory and anti-fibrotic effects and by improving the immune-inflammatory environment. This significantly reduces cardiovascular and renal composite endpoints in patients with type 2 diabetes mellitus(T2DM) and chronic kidney disease(CKD), and improve cardiorenal outcomes. Based on its novel molecular structure, Finerenone exhibits a lower incidence of adverse effects compared to the previous MRAs. This article elucidates the molecular structure and pathophysiological role of MR, and explores the molecular mechanisms through which finerenone provides cardiorenal benefits. It also discusses the advantages and safety of finerenone compared to first- and second-generation MRAs from a molecular structure perspective, providing evidence for its clinical application.

Type 2 diabetes mellitus is commonly associated with cardiovascular, renal complications, osteoporosis and other comorbidities. Sodium-glucose co-transporter 2 inhibitor (SGLT-2i) can reduce blood glucose level in patients with type 2 diabetes mellitus by promoting urine glucose excretion, and has the effect of weight loss and blood pressure reduction. Large randomized controlled clinical trials have shown that SGLT-2i can improve the prognosis of cardiovascular disease and diabetic nephropathy. This article focuses on the effects of SGLT-2i on cardiorenal outcomes and bone metabolism in addition to the glucose-lowering effect. SGLT-2i can improve the prognosis of patients with coronary atherosclerotic cardiovascular disease, reduce the risk of hospitalization for heart failure, reduce cardiovascular diseases and all-cause mortality, and has renal protective effect. Moreover, the cardiorenal protective effect is proved to be consistent in people without type 2 diabetes. SGLT-2i has a regulatory effect on bone mineral ions and bone metabolism related hormones, and its risk of osteoporosis and fracture deserves attention. Although data suggest that canagliflozin may increase fracture risk, meta-analyses of multiple clinical trials have concluded that SGLT-2i does not significantly increase fracture risk. However, for patients with high risk of fracture, bone mineral density and bone turnover biomarkers should be considered to assess the risk of fracture before prescription.