BACKGROUND: Arsenic trioxide (ATO) is indicated as a broad-spectrum medicine for a variety of diseases, including cancer and cardiac disease. While the role of ATO in hepatic ischemia/reperfusion injury (HIRI) has not been reported. Thus, the purpose of this study was to identify the effects of ATO on HIRI. METHODS: In the present study, we established a 70% hepatic warm I/R injury and partial hepatectomy (30% resection) animal models in vivo and hepatocytes anoxia/reoxygenation (A/R) models in vitro with ATO pretreatment and further assessed liver function by histopathologic changes, enzyme-linked immunosorbent assay, cell counting kit-8, and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay. Small interfering RNA (siRNA) for extracellular signal-regulated kinase (ERK) 1/2 was transfected to evaluate the role of ERK1/2 pathway during HIRI, followed by ATO pretreatment. The dynamic process of autophagic flux and numbers of autophagosomes were detected by green fluorescent protein-monomeric red fluorescent protein-LC3 (GFP-mRFP-LC3) staining and transmission electron microscopy. RESULTS: A low dose of ATO (0.75 μmol/L in vitro and 1 mg/kg in vivo ) significantly reduced tissue necrosis, inflammatory infiltration, and hepatocyte apoptosis during the process of hepatic I/R. Meanwhile, ATO obviously promoted the ability of cell proliferation and liver regeneration. Mechanistically, in vitro  studies have shown that nontoxic concentrations of ATO can activate both ERK and phosphoinositide 3-kinase-serine/threonine kinase (PI3K-AKT) pathways and further induce autophagy. The hepatoprotective mechanism of ATO, at least in part, relies on the effects of ATO on the activation of autophagy, which is ERK-dependent. CONCLUSION Low, non-toxic doses of ATO can activate ERK/PI3K-AKT pathways and induce ERK-dependent autophagy in hepatocytes, protecting liver against I/R injury and accelerating hepatocyte regeneration after partial hepatectomy.
Animals ; Arsenic Trioxide ; Autophagy/physiology* ; Reperfusion Injury/prevention & control* ; Mice ; Male ; Proto-Oncogene Proteins c-akt/physiology* ; Arsenicals/therapeutic use* ; Oxides/therapeutic use* ; Liver/metabolism* ; Extracellular Signal-Regulated MAP Kinases/metabolism* ; Mice, Inbred C57BL

Objective:To evaluate the clinical effect of modified posterior pharyngeal flap surgery in the treatment of velopharyngeal insufficiency.Methods:Clinical data of patients with cleft lip and palate diagnosed with velopharyngeal insufficiency and undergoing modified posterior pharyngeal flap surgery in Peking University School and Hospital of Stomatology from January 2018 to May 2022 were retrospectively analyzed. The traditional posterior pharyngeal flap surgery was improved by combining the modern concept and method of soft palate muscle reconstruction, and performed modified posterior pharyngeal flap surgery to correct velopharyngeal insufficiency. Preoperative and postoperative follow-up were performed including speech evaluation (classifying as none, mild, moderate, moderate to severe hypernasality and nasal emission), nasopharyngeal fiberscope (classifying velopharyngeal insufficiency as mild, moderate, or severe), lateral cephalometric radiographs (resting position and /i/ position), and the Nasal Obstruction Symptom Evaluation (NOSE) scale. The recovery of velopharyngeal function and nasal ventilation after the operation were statistically analyzed. The difference of resting velar length (RVL), effective working length (EWL) and angel of velar lifting (AVL) before and after the operation was compared by paired t-test to evaluate the clinical effect of surgery. P<0.05 indicates a statistically significant difference. Results:A total of 83 patients with velopharyngeal insufficiency were enrolled, including 44 males and 39 females, aged (13.04±11.31) years (4-53 years). 83 patients were followed up for 6-18 months after surgery, and all patients had primary wound healing without postoperative bleeding, perforation, or posterior pharyngeal flap detachment; 78 cases achieved complete velopharyngeal closure, the surgical success rate was 94%, three patients still had mild hypernasality and nasal emission after surgery, one patient still had moderate hypernasality and nasal emission after surgery, and one patient had severe hypernasality after surgery. The RVL was (29.27±6.01) mm before the operation and (36.88±6.51) mm after the operation.The EWL of the soft palate was (18.53±5.04) mm before the operation and (25.76±5.17) mm after the operation.The angel of velar lifting was 11.42°±11.65° before the operation and 15.91°±8.54° after operation. The differences were statistically significant ( P<0.01). 98%(81/83) patients had subjective nasal obstruction symptom in the short period after surgery (within one month), the nasal obstruction symptom evaluation (NOSE) score was 8.61±3.64. The long-term postoperative follow-up showed that the NOSE score was 3.06±2.92, and the difference was statistically significant ( P<0.01). Conclusion:Modified posterior pharyngeal flap surgery can significantly increase the resting velar length and effective working length, improve the movement ability of the soft palate, acquire functional reconstruction of velopharyngeal closure, improve speech function and achieve effectively surgical results.

Objective:To evaluate the clinical effect of modified posterior pharyngeal flap surgery in the treatment of velopharyngeal insufficiency.Methods:Clinical data of patients with cleft lip and palate diagnosed with velopharyngeal insufficiency and undergoing modified posterior pharyngeal flap surgery in Peking University School and Hospital of Stomatology from January 2018 to May 2022 were retrospectively analyzed. The traditional posterior pharyngeal flap surgery was improved by combining the modern concept and method of soft palate muscle reconstruction, and performed modified posterior pharyngeal flap surgery to correct velopharyngeal insufficiency. Preoperative and postoperative follow-up were performed including speech evaluation (classifying as none, mild, moderate, moderate to severe hypernasality and nasal emission), nasopharyngeal fiberscope (classifying velopharyngeal insufficiency as mild, moderate, or severe), lateral cephalometric radiographs (resting position and /i/ position), and the Nasal Obstruction Symptom Evaluation (NOSE) scale. The recovery of velopharyngeal function and nasal ventilation after the operation were statistically analyzed. The difference of resting velar length (RVL), effective working length (EWL) and angel of velar lifting (AVL) before and after the operation was compared by paired t-test to evaluate the clinical effect of surgery. P<0.05 indicates a statistically significant difference. Results:A total of 83 patients with velopharyngeal insufficiency were enrolled, including 44 males and 39 females, aged (13.04±11.31) years (4-53 years). 83 patients were followed up for 6-18 months after surgery, and all patients had primary wound healing without postoperative bleeding, perforation, or posterior pharyngeal flap detachment; 78 cases achieved complete velopharyngeal closure, the surgical success rate was 94%, three patients still had mild hypernasality and nasal emission after surgery, one patient still had moderate hypernasality and nasal emission after surgery, and one patient had severe hypernasality after surgery. The RVL was (29.27±6.01) mm before the operation and (36.88±6.51) mm after the operation.The EWL of the soft palate was (18.53±5.04) mm before the operation and (25.76±5.17) mm after the operation.The angel of velar lifting was 11.42°±11.65° before the operation and 15.91°±8.54° after operation. The differences were statistically significant ( P<0.01). 98%(81/83) patients had subjective nasal obstruction symptom in the short period after surgery (within one month), the nasal obstruction symptom evaluation (NOSE) score was 8.61±3.64. The long-term postoperative follow-up showed that the NOSE score was 3.06±2.92, and the difference was statistically significant ( P<0.01). Conclusion:Modified posterior pharyngeal flap surgery can significantly increase the resting velar length and effective working length, improve the movement ability of the soft palate, acquire functional reconstruction of velopharyngeal closure, improve speech function and achieve effectively surgical results.

Objective:To analyze the drug resistance characteristics of Klebsiella pneumoniae in the nasopharynx of hospitalized patients in North China from 2022 to 2023. Methods:From November 2022 to July 2023, nasopharyngeal swabs were collected from 100 inpatients in Affiliated Hospital of North China University of Science and Technology, and Klebsiella pneumoniae was isolated and cultured. At the same time, the clinical data of the patients were collected, including gender, age, department, clinical diagnosis of disease type, etc. The minimum inhibitory concentration of strains was detected by an automatic bacterial drug sensitivity system. The drug resistance genes, ST types, capsule serotypes and population structure of the strains were analyzed by whole genome sequencing and data analysis. Results:Klebsiella pneumoniae was isolated from 55 nasopharyngeal swabs of 100 inpatients(55.00%). Among the 55 inpatients with Klebsiella pneumoniae in the nasopharynx, 70.91% (39/55) were male, with an age distribution concentrated between 61 and 80 years old (58.18%, 32/55), and 50.91% (28/55) were in intensive care units (ICU). The main underlying disease type was nervous system disease (49.09%, 27/55). The results of drug sensitivity showed that the non-susceptibility rates of 55 strains of Klebsiella pneumoniae to cephalosporins, quinolones, aztreonam and nitrofurantoin were all more than 80.00%. Twenty-eight carbapenem-resistant Klebsiella pneumoniae strains (50.91%), 47 extended-spectrum β-lactamase producing strains (85.45%), and 48 multi-drug-resistant strains (87.27%) were detected. A total of 11 antibiotic resistance genes were detected, including carbapenems (carrying rate 76.36%) and extended-spectrum β-lactamase (carrying rate 96.36%). The 55 strains could be divided into 17 ST types, and the most common type was ST11 (25.45%). The 55 strains were divided into 18 capsular serotypes, among which K102 was the most prevalent (23.64%). OXA-1_ST307_K102 (21.82%) and KPC-2_ST5492_K125 (18.18%) were the dominant clones, distributed in the Department of Neurosurgery and ICU. The result of whole genome sequence analysis showed that there were four clusters with high homology among the 55 strains. The strains from the ICU formed two independent clusters, and strains from the Neurology ICU and Neurosurgery department formed one cluster respectively. Conclusion:The carrying rate of Klebsiella pneumoniae in the nasopharynx of inpatients is high, and the drug resistance of the strains is serious. There are many types of drug-resistant genes.

Objective To analyze the current state of medication literacy among elderly patients with chronic diseases in urban areas of Beijing,identify its key influencing factors,and propose targeted improvement measures.Methods From February 1 to June 30,2023,a questionnaire survey was conducted among elderly chronic disease patients in 193 communities across 15 districts of Beijing using a convenience sampling method.Data was collected through face-to-face interviews,with a total of 787 questionnaires distributed and 755 valid responses received.The logistic regression analysis model was employed to systematically identify and evaluate the factors affecting patients'medication literacy.Results Among the 755 valid questionnaires collected,53.25%(402 cases)of patients met the medication literacy criteria.Regression analysis results showed that multiple factors significantly influenced medication literacy among elderly patients with chronic diseases,including using rural cooperative medical care or self-payment methods(OR=1.669,P=0.039),retaining medication instructions(OR=0.519,P=0.038),checking medication instructions before use(OR=1.993,P<0.01),and possessing the ability to understand medication instructions(partial understanding OR=2.805,P=0.038;fully understanding OR=3.084,P=0.022)as positive influencing factors;whereas having 2 to 3 chronic diseases(OR=0.574,P=0.039),taking 3 to 5 medications(OR=1.845,P=0.015),and experiencing drug-related problems(OR=1.993,P<0.01)were identified as negative influencing factors.Conclusion Multiple factors influence medication literacy among elderly patients with chronic diseases.To ensure the safety and efficacy of their medication use,It is recommended to implement targeted measures.These include revising patient medication guidance leaflets tailored to age,enhancing patients'understanding of drug instructions,and strengthening medication guidance and social support systems.

Objective To analyze the differences in aging-related information between Chinese and American drug instruction for common chronic disease in the elderly,and to propose policy recommendations for the aging-related drug instruction in China.Methods Ten common chronic disease treatment drugs for elderly patients were selected,and through the random sampling method,the drug manuals of one domestic manufacturer were randomly selected for each drug by the random number method,and one American drug manual was selected as a sample from the dailymed website,and the information related to elderly people in the various items of the drug manuals was statistically analyzed by using Excel for comparative analysis.The average reading level of the patient version of the U.S.drug instructions was calculated using the Readability Formulas Scoring System;the readability of the Chinese drug instructions was assessed by the Health Education Text Material Suitability Scale.Results Compared with the U.S.drug instruction,the drug instruction for common chronic diseases of the elderly in China were updated less frequently and at a slower pace;the drug instruction with information on medication for elderly patients were fewer than those of the U.S.drug instruction,and the content of the drug instruction was not well documented;and the drug instruction were poorly readable,which was not conducive to the comprehension of the elderly patients.Conclusion China is in urgent need of reforming the aging of drug instructions,and it is recommended that,for chronic disease medications for elderly patients,we should increase the number of clinical trials conducted on the elderly,improve and complete the drug information for the elderly in the drug instructions,and produce"drug instructions for elderly patients"that are suitable for the elderly to read and understand.

Objective To evaluate the status of home medication safety among elderly patients with chronic diseases and analyze its influencing factors in urban and rural areas of Henan Province.Methods Convenient sampling method was adopted.Data was collected through a designed and optimized questionnaire.Pharmacists conducted in-home surveys.Excel and SPSS 26.0 software were used for data analysis.Results A total of 352 valid questionnaires were analyzed.Most respondents were aged 60～70 years,with a female proportion of 56.2%,and 52.0%of them had a junior high school education or lower.The top-ranked chronic diseases were hypertension(62.2%)and hyperlipidemia(33.2%),and 61.1%of patients suffered from multiple chronic diseases.Antipyretic and analgesic drugs were most common in home medicine cabinets(90.1%).The proportion of drugs being stored in accordance with the instructions(46.9%)was slightly low,and 93.8%of the elderly handled expired drugs improperly.Awareness of medication guidance services was low(34.9%).Logistic regression analysis showed that factors such as education level and monthly income had significant effects on the understanding of drug package insert,rational drug storage,proper disposal of expired drugs,and awareness of medication guidance services(P<0.05).Conclusion There are still some potential safety risks in the home medication use of elderly patients with chronic diseases in urban and rural areas of Henan Province.It is necessary to enhance education on drug storage and medication guidance,particularly for low-income and less-educated groups,to improve the safety of home medication use.

Objective:To explore the risk factors for atrial fibrillation in adult patients with critically severe burns after the first surgery.Methods:This study was a retrospective case series study. From January 1, 2018 to March 31, 2023, 211 adult patients with critically severe burns were admitted to the Department of Burns of Tongren Hospital of Wuhan University & Wuhan Third Hospital and met the inclusion criteria, including 158 males and 53 females, aged 24-81 years. According to whether atrial fibrillation occurred after the first surgery, the patients were divided into postoperative atrial fibrillation (POAF) group (23 cases) and non-POAF group (188 cases). The following indexes of patients in POAF group were collected, including the onset time, duration, treatment method, and number of patients with more than once of atrial fibrillation after the first surgery. The following data of the two groups of patients were collected, including general data, such as gender, age, burn type, total burn area, full-thickness burn area, inhalation injury, underlying diseases, mechanical ventilation, and sepsis; electrolyte imbalance and blood index level before the first surgery; the first surgery-related information such as surgical length and surgical method; volume changes and vital signs during the first surgery, such as total volume of fluid infusion, total volume of blood transfusion, volume of blood loss, hypotension, and hypothermia; postoperative hypothermia; inflammatory index levels before the first surgery and on the first day after the first surgery, such as procalcitonin levels, white blood cell count, neutrophil count, lymphocyte count, platelet count, neutrophil to lymphocyte ratio (NLR), platelet count to lymphocyte ratio (PLR); mortality within 30 days of admission. The independent risk factors for occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery were screened.Results:The onset time of atrial fibrillation of patients in POAF group was 2 (2, 4) hours after the first surgery, and the duration of atrial fibrillation was 16 (6, 26) hours. Twenty-one patients were treated with intravenous injection of amiodarone, two patients were treated with cardiac electrical cardioversion, and atrial fibrillation of all patients converted to sinus rhythm after treatment. Three patients experienced atrial fibrillation more than once. The age was 59 (42, 70) years and the total burn area was 90% (70%, 94%) total body surface area (TBSA) in patients in POAF group, which were significantly higher than 48 (38, 56) years and 70% (60%, 83%) TBSA in non-POAF group (with Z values of -2.64 and -3.56, respectively, P<0.05). Compared with those in non-POAF group, the incidence rate of inhalation injury of patients in POAF group was significantly higher ( χ2=4.45, P<0.05), the total volumes of fluid infusion and blood transfusion during the first surgery were significantly increased (with Z values of -3.98 and -3.75, respectively, P<0.05), the incidence rates of hypothermia during the first surgery and hypothermia after the first surgery were significantly increased (with χ2 values of 8.24 and 18.72, respectively, P<0.05), the levels of procalcitonin before the first surgery and on the first day after the first surgery, as well as the NLR on the first day after the first surgery were significantly increased (with Z values of -3.03, -2.19, and -2.18, respectively, P<0.05), the lymphocyte count (with Z values of -2.07 and -2.60, respectively, P<0.05) and platelet count (with Z values of -3.35 and -3.58, respectively, P<0.05) were significantly reduced before the first surgery and on the first day after the first surgery, and the mortality rate within 30 days of admission was significantly higher ( χ2=4.03, P<0.05). There were no statistically significant differences in other indexes between the two groups of patients ( P>0.05). Multivariate logistic regression analysis showed that age, total burn area, and intraoperative hypothermia were independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery (with odds ratios of 1.08, 1.07, and 4.18, 95% confidence intervals of 1.03-1.12, 1.03-1.11, and 1.48-11.80, respectively, P<0.05). Conclusions:Age, total burn area, and intraoperative hypothermia are independent risk factors for the occurrence of atrial fibrillation in adult patients with critically severe burns after the first surgery. Patients with atrial fibrillation have an increased risk of death.