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 erioside E on myocardial injury after myocardial infarction(MI)by regulating hypoxia-inducible factor-2α(HIF-2α)-mediated pyroptosis of cardiomyocytes and its possible mechanism.Methods Thirty rats were randomly divided into sham-operation group,MI group,and erioside E group,with 10 rats in each group.Cardiomyocytes H9C2 were cultured and divided into control group,hypoxia group,erioside E group and HIF-2α overexpression group.Masson staining was used to observe myocardial fibrosis and infarct size.The protein expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD were detected by Western blotting.RT-qPCR was used to detect the mRNA expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD.EdU kit was used to detect the proliferation of cardiomyocytes.The expressions of NLRP3,Caspase-1 and GSDMD proteins in cardiomyocytes were detected by immunofluorescence staining.Results Compared with the sham-operation group,the myocardial fibrosis level and infarct size were significantly increased in the MI group(P＜0.05),and the protein expressions of HIF-2α,pyroptosis-related proteins of NLRP3,Caspase-1 and GSDMD in myocardial tissue were increased(P＜0.05).Compared with the MI group,the level of myocardial fibrosis and infarct size were significantly decreased(P＜0.05),the protein expression of HIF-2α in myocardial tissue was increased,and the protein expressions of NLRP3,Caspase-1 and GSDMD were decreased in the erioside E group(P＜0.05).Compared with the control group,the hypoxia group had a significant reduction in the proliferation of cardiomyocytes and significant increase in the mRNA and protein expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD(P＜0.05).Compared with the hypoxia group,the proliferation ability of cardiomyocytes was significantly increased,and the expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD mRNA in cardiomyocytes were decreased in the erioside E group(P＜0.05),while the protein expression of HIF-2α in cardiomyocytes was increased in the HIF-2αoverexpression group.The protein expressions of NLRP3,Caspase-1 and GSDMD were significantly decreased(P＜0.05).Conclusion Erioside E can improve myocardial injury by upregulating HIF-2α to inhibit myocardial pyroptosis.

As a non-invasive treatment method,transcutaneous acupoint electrical stimulation(TAES)can regulate neurological function,endocrine function and immune function through electrical stimulation for specific acupoints,which shows wide application potential in postoperative pain management,promotion of bone healing and rehabilitation in orthopedic surgery.TAES treatment has a series characteristics include non-invasiveness,convenience and effectiveness,which provides a new adjuvant treatment method for orthopedic diseases.This review elaborated the research advances of the application of TAES in orthopedics field,which provided references for further exploring its mechanism and clinical application in the future research.

Objective To evaluate the clinical efficacy of modified Rhinoceros Dihuang decoction in the treatment of children with henoch-sch?nlein purpura(HSP)of the"bleeding due to blood-heat syndrome"pattern in traditional Chinese medicine(TCM).Methods A total of 72 pediatric patients diagnosed with HSP and admitted to Zhengzhou Hospital of Traditional Chinese Medicine from June 2021 to June 2023 were enrolled and divided into two groups(n=36 each):control group and observation group.The control group received conveational Western medical treatment,while the observation group received additional treatment with modified Rhinoceros Dihuang decoction based on conventional therapy.The decoction was composed of:Herba Agrimoniae,Radix Rehmanniae,Radix Arnebiae seu Lithospermi,Radix Rubiae,15 g each;Cornu Bubali,30 g,Rhizoma Imperatae,20 g;Cortex Moutan and Radix Paeoniae Rubra,10 g each.The herbs were decocted once daily,dosed according to age:100 mL for ages 3-6,150 mL for 7-11,and 200 mL for 12-14 years old,administered twice daily for 10 days.Outcome measures included clinical efficacy,symptom scores(distribution,color,and morphology of purpura),inflammatory markers[interleukins(IL-17,IL-9),tumor necrosis factor-α(TNF-α)],immune function indicators[T lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)and immunoglobulins(IgA,IgM,IgG)],quality of life,and adverse events.Results After treatment,the symptom scores,inflammatory factors,CD8+,IgA,and IgM levels in the observation group were significantly lower than those in the control group[purpura distribution score:1.03±0.20 vs.1.85±0.27,purpura color score:0.95±0.18 vs.1.76±0.31,purpura morphology score:0.94±0.16 vs.1.76±0.28;IL-17(ng/L):19.84±2.31 vs.26.12±2.63,IL-9(ng/L):20.40±4.19 vs.34.16±6.31,TNF-α(ng/L):13.61±2.05 vs.22.17±2.13;CD8+:0.259±0.040 vs.0.423±0.040,IgA(g/L):1.26±0.24 vs.1.81±0.32,IgM(g/L):1.24±0.19 vs.1.54±0.26,all P<0.05],CD4+,CD4+/CD8+,and IgG levels,as well as the pediatric quality of life inventory 4.0(PedsQL4.0)score were significantly higher in the observation group than in the control group[CD4+:0.461±0.046 vs.0.423±0.040,CD4+/CD8+:1.780±0.330 vs.1.450±0.270,IgG(g/L):11.22±1.75 vs.9.41±1.84,PedsQL4.0 score:83.62±6.54 vs.75.54±12.32,all P<0.05].The total clinical efficacy rate in the observation group was significantly higher than that in the control group[94.44%(34/36)vs.72.22%(26/36),P<0.05].No significant adverse reactions were observed in either group.Conclusion Modified Rhinoceros Dihuang decoction is effective and safe in alleviating clinical symptoms,reducing inflammatory responses,regulating immune function,and improving quality of life in children with HSP of the bleeding due to blood-heat pattern.

Objective To analyze the expression levels of matrix metalloproteinase-10(MMP-10)and Toll-like receptor 2(TLR2)in serum of patients underwent decompression surgery(DC)for severe traumatic brain injury(sTBI),and to explore their relationship with disease outcome.Methods From April 2021 to April 2024,sTBI patients(n=94)who received DC treatment in a single center were collected as the observation group.Another 90 healthy volunteers who underwent physical examinations at our hospital were selected as the control group.Six months after surgery,sTBI patients were assigned into the good group(n=53)and the adverse group(n=41)according to the Glasgow Outcome Scale(GOS).Data was collected from each group and their differences were compared.Enzyme linked immunosorbent assay(ELISA)was used to measure serum levels of MMP-10 and TLR2.Spearman method was used to analyze the correlation between MMP-10,TLR2 levels and disease outcomes.Logistic regression model used to analyze influencing factors of disease outcomes in sTBI patients after DC.The receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum MMP-10 and TLR2 levels for disease outcome in sTBI patients after DC.Results Compared with the control group,the expression levels of serum MMP-10 and TLR2 were prominently higher in the observation group(P＜0.05).Compared with the good group,the proportions of sTBI patients with cerebral herniation,multiple brain contusions and lacerations,and serum levels of MMP-10 and TLR2 were significantly higher in the adverse group,while Glasgow Coma Scale(GCS)score was significantly lower(P＜0.05).Serum levels of MMP-10 and TLR2 in sTBI patients were positively correlated with poor prognosis after DC(P＜0.05).Elevated levels of serum MMP-10 and TLR2,and the increased proportions of patients with cerebral herniation and multiple brain contusions were risk factors affecting the disease outcome after DC in sTBI patients,while elevated GCS score was a protective factor(P＜0.05).The area under the curve(AUC)for predicting disease outcome in sTBI patients after DC using serum MMP-10 and TLR2 alone and in combination was 0.839(95％CI:0.749-0.907),0.847(95％CI:0.758-0.913)and 0.925(95％CI:0.852-0.969),respectively.The combined detection was superior to the individual detections(Zcombination-MMP-10=2.199,Zcombination-TLR2=2.377,both P＜0.05).Conclusion The expression levels of serum MMP-10 and TLR2 in sTBI patients are significantly elevated,and both are prominently correlated with disease outcome after DC.

Objective To evaluate the clinical efficacy of modified Rhinoceros Dihuang decoction in the treatment of children with henoch-sch?nlein purpura(HSP)of the"bleeding due to blood-heat syndrome"pattern in traditional Chinese medicine(TCM).Methods A total of 72 pediatric patients diagnosed with HSP and admitted to Zhengzhou Hospital of Traditional Chinese Medicine from June 2021 to June 2023 were enrolled and divided into two groups(n=36 each):control group and observation group.The control group received conveational Western medical treatment,while the observation group received additional treatment with modified Rhinoceros Dihuang decoction based on conventional therapy.The decoction was composed of:Herba Agrimoniae,Radix Rehmanniae,Radix Arnebiae seu Lithospermi,Radix Rubiae,15 g each;Cornu Bubali,30 g,Rhizoma Imperatae,20 g;Cortex Moutan and Radix Paeoniae Rubra,10 g each.The herbs were decocted once daily,dosed according to age:100 mL for ages 3-6,150 mL for 7-11,and 200 mL for 12-14 years old,administered twice daily for 10 days.Outcome measures included clinical efficacy,symptom scores(distribution,color,and morphology of purpura),inflammatory markers[interleukins(IL-17,IL-9),tumor necrosis factor-α(TNF-α)],immune function indicators[T lymphocyte subsets(CD4+,CD8+,CD4+/CD8+)and immunoglobulins(IgA,IgM,IgG)],quality of life,and adverse events.Results After treatment,the symptom scores,inflammatory factors,CD8+,IgA,and IgM levels in the observation group were significantly lower than those in the control group[purpura distribution score:1.03±0.20 vs.1.85±0.27,purpura color score:0.95±0.18 vs.1.76±0.31,purpura morphology score:0.94±0.16 vs.1.76±0.28;IL-17(ng/L):19.84±2.31 vs.26.12±2.63,IL-9(ng/L):20.40±4.19 vs.34.16±6.31,TNF-α(ng/L):13.61±2.05 vs.22.17±2.13;CD8+:0.259±0.040 vs.0.423±0.040,IgA(g/L):1.26±0.24 vs.1.81±0.32,IgM(g/L):1.24±0.19 vs.1.54±0.26,all P<0.05],CD4+,CD4+/CD8+,and IgG levels,as well as the pediatric quality of life inventory 4.0(PedsQL4.0)score were significantly higher in the observation group than in the control group[CD4+:0.461±0.046 vs.0.423±0.040,CD4+/CD8+:1.780±0.330 vs.1.450±0.270,IgG(g/L):11.22±1.75 vs.9.41±1.84,PedsQL4.0 score:83.62±6.54 vs.75.54±12.32,all P<0.05].The total clinical efficacy rate in the observation group was significantly higher than that in the control group[94.44%(34/36)vs.72.22%(26/36),P<0.05].No significant adverse reactions were observed in either group.Conclusion Modified Rhinoceros Dihuang decoction is effective and safe in alleviating clinical symptoms,reducing inflammatory responses,regulating immune function,and improving quality of life in children with HSP of the bleeding due to blood-heat pattern.

As a non-invasive treatment method,transcutaneous acupoint electrical stimulation(TAES)can regulate neurological function,endocrine function and immune function through electrical stimulation for specific acupoints,which shows wide application potential in postoperative pain management,promotion of bone healing and rehabilitation in orthopedic surgery.TAES treatment has a series characteristics include non-invasiveness,convenience and effectiveness,which provides a new adjuvant treatment method for orthopedic diseases.This review elaborated the research advances of the application of TAES in orthopedics field,which provided references for further exploring its mechanism and clinical application in the future research.

Objective To investigate the effect of erioside E on myocardial injury after myocardial infarction(MI)by regulating hypoxia-inducible factor-2α(HIF-2α)-mediated pyroptosis of cardiomyocytes and its possible mechanism.Methods Thirty rats were randomly divided into sham-operation group,MI group,and erioside E group,with 10 rats in each group.Cardiomyocytes H9C2 were cultured and divided into control group,hypoxia group,erioside E group and HIF-2α overexpression group.Masson staining was used to observe myocardial fibrosis and infarct size.The protein expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD were detected by Western blotting.RT-qPCR was used to detect the mRNA expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD.EdU kit was used to detect the proliferation of cardiomyocytes.The expressions of NLRP3,Caspase-1 and GSDMD proteins in cardiomyocytes were detected by immunofluorescence staining.Results Compared with the sham-operation group,the myocardial fibrosis level and infarct size were significantly increased in the MI group(P＜0.05),and the protein expressions of HIF-2α,pyroptosis-related proteins of NLRP3,Caspase-1 and GSDMD in myocardial tissue were increased(P＜0.05).Compared with the MI group,the level of myocardial fibrosis and infarct size were significantly decreased(P＜0.05),the protein expression of HIF-2α in myocardial tissue was increased,and the protein expressions of NLRP3,Caspase-1 and GSDMD were decreased in the erioside E group(P＜0.05).Compared with the control group,the hypoxia group had a significant reduction in the proliferation of cardiomyocytes and significant increase in the mRNA and protein expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD(P＜0.05).Compared with the hypoxia group,the proliferation ability of cardiomyocytes was significantly increased,and the expressions of HIF-2α,NLRP3,Caspase-1 and GSDMD mRNA in cardiomyocytes were decreased in the erioside E group(P＜0.05),while the protein expression of HIF-2α in cardiomyocytes was increased in the HIF-2αoverexpression group.The protein expressions of NLRP3,Caspase-1 and GSDMD were significantly decreased(P＜0.05).Conclusion Erioside E can improve myocardial injury by upregulating HIF-2α to inhibit myocardial pyroptosis.

Objective To analyze the expression levels of matrix metalloproteinase-10(MMP-10)and Toll-like receptor 2(TLR2)in serum of patients underwent decompression surgery(DC)for severe traumatic brain injury(sTBI),and to explore their relationship with disease outcome.Methods From April 2021 to April 2024,sTBI patients(n=94)who received DC treatment in a single center were collected as the observation group.Another 90 healthy volunteers who underwent physical examinations at our hospital were selected as the control group.Six months after surgery,sTBI patients were assigned into the good group(n=53)and the adverse group(n=41)according to the Glasgow Outcome Scale(GOS).Data was collected from each group and their differences were compared.Enzyme linked immunosorbent assay(ELISA)was used to measure serum levels of MMP-10 and TLR2.Spearman method was used to analyze the correlation between MMP-10,TLR2 levels and disease outcomes.Logistic regression model used to analyze influencing factors of disease outcomes in sTBI patients after DC.The receiver operating characteristic(ROC)curve was applied to evaluate the predictive value of serum MMP-10 and TLR2 levels for disease outcome in sTBI patients after DC.Results Compared with the control group,the expression levels of serum MMP-10 and TLR2 were prominently higher in the observation group(P＜0.05).Compared with the good group,the proportions of sTBI patients with cerebral herniation,multiple brain contusions and lacerations,and serum levels of MMP-10 and TLR2 were significantly higher in the adverse group,while Glasgow Coma Scale(GCS)score was significantly lower(P＜0.05).Serum levels of MMP-10 and TLR2 in sTBI patients were positively correlated with poor prognosis after DC(P＜0.05).Elevated levels of serum MMP-10 and TLR2,and the increased proportions of patients with cerebral herniation and multiple brain contusions were risk factors affecting the disease outcome after DC in sTBI patients,while elevated GCS score was a protective factor(P＜0.05).The area under the curve(AUC)for predicting disease outcome in sTBI patients after DC using serum MMP-10 and TLR2 alone and in combination was 0.839(95％CI:0.749-0.907),0.847(95％CI:0.758-0.913)and 0.925(95％CI:0.852-0.969),respectively.The combined detection was superior to the individual detections(Zcombination-MMP-10=2.199,Zcombination-TLR2=2.377,both P＜0.05).Conclusion The expression levels of serum MMP-10 and TLR2 in sTBI patients are significantly elevated,and both are prominently correlated with disease outcome after DC.

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.