Objective:To explore the feasibility and efficacy of left ventricular decompression in pediatric patients supported by extracorporeal membrane oxygenation（ECMO）.Methods:The clinical data of 15 children who underwent left ventricular decompression during ECMO in the cardiac intensive care unit（CICU）of Guangzhou Women and Children's Medical Center from February 2021 to August 2023 were retrospectively analyzed.Results:Among the 15 patients，there were 8 males and 7 females,with a median age of 1.1 years old（20 days to 15 years old）and a median weight of 8.5（3.1 to 38.0）kg. Cardiac pathologies varied，including hypertrophic obstructive cardiomyopathy(1 case),left coronary artery abnormalities originating from the pulmonary artery（3 cases），aortic coarctation with ventricular septal defect（1 case），complete transposition of great arteries with ventricular septal defect（1 case），ventricular septal defect with severe mitral valve insufficiency（1 case），fulminant myocarditis（5 cases），tetralogy of Fallot（1 case），ascending aortic aneurysm with aortic valve insufficiency（1 case），and Kawasaki disease complicated with giant aneurysm（1 case）. The venous-arterial ECMO mode was used in all 15 children,9 cases were intubated centrally and 6 cases were intubated peripherally. The reasons for ECMO：low cardiac output（8 cases），cardiogenic shock（5 cases），and frequent ventricular tachycardia and ventricular fibrillation（2 cases）. Extracorporeal cardiopulmonary resuscitation was performed in 3 cases. The median duration of mechanical ventilation was 248 (142-590) h,the median CICU stay was 18 (7-26) d,and the median hospital stay was 28 (7-37) d. Of the 15 children,7 cases underwent emergency left ventricular decompression through a small sternal incision,with a mean decompression time of ECMO-assisted 12.2(9-22) h，and 8 cases underwent selective left ventricular decompression through a median sternal incision. Left ventricular systolic function improved significantly after decompression in all 15 patients，of whom 12 cases were successfully withdrew off ECMO and 10 cases of them survived.Conclusion:Left ventricular decompression can improve the cardiac dysfunction in children with ECMO，reduce the occurrence of complications，and increase the success rate and survival rate of ECMO.

Objective To understand the clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry,and to provide references for promoting the standardized practice of psychiatric protective restraints and updating the consensus.Methods By the convenience sampling method,a questionnaire survey was conducted among nurses from 480 hospitals in 30 provinces from June 15 to July 15,2024.The survey was conducted using the instrument for evaluating clinical applicability of guide-lines(version 2.0)and a self-compiled questionnaire on the clinical implementation of the restraint consensus.Results A total of 7,844 valid questionnaires were collected,with a valid questionnaire recovery rate of 93.78％.The results of clinical applicability scoring showed that the consensus had the lowest availability score(64.72％)and the highest acceptability score(76.74％).The results showed that nurses' receiving training and the level of their hospitals were the main influencing factors for scores in various dimensions(P＜0.05).4,774 participants(87.42％)believed that the application of consensus could enhance the standardization of nurses' restraint operations.The safety rate of the restraint consensus was 79.51％,and the economic ratio was 76.87％.Among the evaluators,1,739(22.17％)believed that there were implementation obstacles in the consensus.Conclusion The clinical applicability of the consensus is relatively good,and the application of the consensus helps to improve the standardization of clinical operations.In the future,efforts should be made to strengthen the promotion and training of the consensus,develop hierarchical promotion strategies according to the characteristics of medical institutions,and improve the quality of evidence for the consensus,so as to further enhance the clinical application effect of the consensus.

Ursodeoxycholic acid(UDCA)is a naturally occurring,low-toxicity,and hydrophilic bile acid(BA)in the human body that is converted by intestinal flora using primary BA.Solute carrier family 7 member 11(SLC7A11)functions to uptake extracellular cystine in exchange for glutamate,and is highly expressed in a variety of human cancers.Retroperitoneal liposarcoma(RLPS)refers to liposarcoma originating from the retroperitoneal area.Lipidomics analysis revealed that UDCA was one of the most significantly down-regulated metabolites in sera of RIPS patients compared with healthy subjects.The augmentation of UDCA concentration(≥25 μg/mL)demonstrated a suppressive effect on the proliferation of liposarcoma cells.[15N2]-cystine and[13Cs]-glutamine isotope tracing revealed that UDCA impairs cystine uptake and glutathione(GSH)synthesis.Mechanistically,UDCA binds to the cystine transporter SLC7A11 to inhibit cystine uptake and impair GSH de novo synthesis,leading to reactive oxygen species(ROS)accumulation and mitochondrial oxidative damage.Furthermore,UDCA can promote the anti-cancer effects of ferroptosis inducers(Erastin,RSL3),the murine double minute 2(MDM2)inhibitors(Nutlin 3a,RG7112),cyclin dependent kinase 4(CDK4)inhibitor(Abemaciclib),and glutaminase inhibitor(CB839).Together,UDCA functions as a cystine exchange factor that binds to SLC7A11 for antitumor activity,and SLC7A11 is not only a new transporter for BA but also a clinically applicable target for UDCA.More importantly,in combination with other antitumor chemotherapy or physiotherapy treatments,UDCA may provide effective and promising treatment strategies for RLPS or other types of tumors in a ROS-dependent manner.

Objective To understand the clinical applicability and implementation of expert consensus on the implementation and removal of protective restraints in psychiatry,and to provide references for promoting the standardized practice of psychiatric protective restraints and updating the consensus.Methods By the convenience sampling method,a questionnaire survey was conducted among nurses from 480 hospitals in 30 provinces from June 15 to July 15,2024.The survey was conducted using the instrument for evaluating clinical applicability of guide-lines(version 2.0)and a self-compiled questionnaire on the clinical implementation of the restraint consensus.Results A total of 7,844 valid questionnaires were collected,with a valid questionnaire recovery rate of 93.78％.The results of clinical applicability scoring showed that the consensus had the lowest availability score(64.72％)and the highest acceptability score(76.74％).The results showed that nurses' receiving training and the level of their hospitals were the main influencing factors for scores in various dimensions(P＜0.05).4,774 participants(87.42％)believed that the application of consensus could enhance the standardization of nurses' restraint operations.The safety rate of the restraint consensus was 79.51％,and the economic ratio was 76.87％.Among the evaluators,1,739(22.17％)believed that there were implementation obstacles in the consensus.Conclusion The clinical applicability of the consensus is relatively good,and the application of the consensus helps to improve the standardization of clinical operations.In the future,efforts should be made to strengthen the promotion and training of the consensus,develop hierarchical promotion strategies according to the characteristics of medical institutions,and improve the quality of evidence for the consensus,so as to further enhance the clinical application effect of the consensus.

Objective To discuss the application effect of intravenous anesthesia with oxycodone plus propofol or oliceridine plus propofol for sedating elderly patients during endoscopic retrograde cholangiopancreatography(ERCP).Methods Sixty elderly patients,who were planned to receive ERCP in Shengli Oilfield Central Hospital from March to Sepcember 2024,were randomly divided into oxycodone group and oliceridine group,with 30 patients in each group.Intravenous anesthesia with oxycodone plus propofol or oliceridine plus propofol was adopted for the patients of the corresponding group.The patient's postoperative comfort score,the dosage of propofol used during surgery,the number of additional analgesics administered,the time of patient entering the operation room(T0),3 minutes after analgesia(T1),after anesthesia induction(T2),immediately upon examination(T3),time on arrival at the duodenal papilla(T4),and time on consciousness waking-up(T5)were recorded.The surgical time,consciousness waking-up time,endoscopist satisfaction degree,patient's satisfaction rate,and incidence of anesthesia-related adverse events were documented.Results The comparison of postoperative comfort scores showed that the score in the oliceridine group was(7.6±1.9)points,which was significantly higher than(6.6±1.3)points in the oxycodone group(t=2.23,P=0.03).The dosage of propofol used during surgery in the oliceridine group was significantly lower than that in the oxycodone group(P＜0.05).The mean arterial pressure(MAP),heart rate(HR),and respiratory rate(RR)at T1-T4 time points were significantly decreased in both groups when compared with their values at T0 time point(all P＜0.05).The reduction degrees of the above indexes at T1-T3 time points in the oxycodone group were more pronounced than those in the oliceridine group(all P＜0.05).At T4,MAP and HR were increased in both groups,which in the oxycodone group were remarkably higher than those in the oliceridine group(both P＜0.05).No statistically significantly difference in oxygen saturation(SpO2)existed between T1 time point and T0 time point(P＞0.05);but at the other time points,SpO2 was decreased to varying degrees in both groups,and the within-group comparison and between-group comparison showed that the differences in SpO2 were statistically significant(all P＜0.05).In oliceridine group,the time of patient's consciousness waking-up was obviously shorter than that in the oxycodone group(P＜0.05),and the endoscopist satisfaction degree and patient satisfaction rate were strikingly higher than those in the oxycodone group(both P＜0.05).The incidence of intraoperative adverse events in the oliceridine group was prominently lower than that in the oxycodone group(P＜0.05).No statistically significant difference in the incidence of adverse events during consciousness waking-up time existed between the two groups(P＞0.05),but the incidences of postoperative nausea,vomiting and respiratory depression in the oliceridine group was obviously lower than those in the oxycodone group(all P＜0.05).Conclusion In performing ERCP for elderly patients,oliceridine plus propofol is clinically safe and feasible with less adverse events,high satisfaction rate and higher patient's comfort level when compared with oxycodone plus propofol.

Excessive fat accumulation,viral infections and sustained inflammatory responses caused by non-alcoholic and alcoholic factors can contribute to liver inflammation,fibrosis and carcinogenesis,promoting the development of chronic liver disease.Gaining an in-depth understanding of the etiologic factors and underlying mechanisms that lead to chronic liver disease can help identify potential therapeutic targets for targeted therapy.Lactate,as an important substance in hepatic metabolism,has been found to be involved in the process of chronic liver disease through various pathways,and this review will provide a useful reference for the prevention and treatment of chronic liver disease.

BACKGROUND: The available evidence regarding the benefits of percutaneous coronary intervention (PCI) on patients receiving dialysis with coronary artery disease (CAD) is limited and inconsistent. This study aimed to evaluate the association between PCI and clinical outcomes as compared with medical therapy alone in patients undergoing dialysis with CAD in China. METHODS: This multicenter, retrospective study was conducted in 30 tertiary medical centers across 12 provinces in China from January 2015 to June 2021 to include patients on dialysis with CAD. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Secondary outcomes included all-cause death, the individual components of MACE, and Bleeding Academic Research Consortium criteria types 2, 3, or 5 bleeding. Multivariable Cox proportional hazard models were used to assess the association between PCI and outcomes. Inverse probability of treatment weighting (IPTW) and propensity score matching (PSM) were performed to account for potential between-group differences. RESULTS: Of the 1146 patients on dialysis with significant CAD, 821 (71.6%) underwent PCI. After a median follow-up of 23.0 months, PCI was associated with a 43.0% significantly lower risk for MACE (33.9% [ n  = 278] vs . 43.7% [ n  = 142]; adjusted hazards ratio 0.57, 95% confidence interval 0.45-0.71), along with a slightly increased risk for bleeding outcomes that did not reach statistical significance (11.1% vs . 8.3%; adjusted hazards ratio 1.31, 95% confidence interval, 0.82-2.11). Furthermore, PCI was associated with a significant reduction in all-cause and cardiovascular mortalities. Subgroup analysis did not modify the association of PCI with patient outcomes. These primary findings were consistent across IPTW, PSM, and competing risk analyses. CONCLUSION This study indicated that PCI in patients on dialysis with CAD was significantly associated with lower MACE and mortality when comparing with those with medical therapy alone, albeit with a slightly increased risk for bleeding events that did not reach statistical significance.
Humans ; Percutaneous Coronary Intervention/methods* ; Male ; Female ; Coronary Artery Disease/drug therapy* ; Retrospective Studies ; Renal Dialysis/methods* ; Middle Aged ; Aged ; China ; Proportional Hazards Models ; Treatment Outcome

Monotropein is a compound classified into iridoid which is found in herbaceous plants Morindae officinalis. It possesses anti-inflammatory, antioxidant, and anti-osteoarthritic activities. Previous study indicates that monotropein may have the potential to combat cardiovascular disease, although the related mechanism remains unclear. In this study, we constructed the model of atherosclerosis by oxidized low density lipoprotein-induced vascular smooth muscle cells and LDLR –/–mice given high-fat diet to investigate the effects of monotropein on atherosclerosis.Our results showed that monotropein treatment significantly reduced the area of atherosclerotic plaques and necrotic cores in mice, inhibited the proliferation and migration of vascular smooth muscle cells, and reduced inflammatory responses and oxidative stress, which in turn alleviated atherosclerosis. In addition, we found that monotropein reduced the expression levels of P-NF-κB and P-AP-1. In conclusion, our data suggest that monotropein inhibited the proliferation and migration of vascular smooth muscle cells by mediating the activity of NF-κB, AP-1, reducing the level of inflammation and oxidative stress, and thus resisting the development of atherosclerosis. These findings demonstrate the efficacious therapeutic impact of monotropein on atherosclerosis and elucidate its specific target.

Monotropein is a compound classified into iridoid which is found in herbaceous plants Morindae officinalis. It possesses anti-inflammatory, antioxidant, and anti-osteoarthritic activities. Previous study indicates that monotropein may have the potential to combat cardiovascular disease, although the related mechanism remains unclear. In this study, we constructed the model of atherosclerosis by oxidized low density lipoprotein-induced vascular smooth muscle cells and LDLR –/–mice given high-fat diet to investigate the effects of monotropein on atherosclerosis.Our results showed that monotropein treatment significantly reduced the area of atherosclerotic plaques and necrotic cores in mice, inhibited the proliferation and migration of vascular smooth muscle cells, and reduced inflammatory responses and oxidative stress, which in turn alleviated atherosclerosis. In addition, we found that monotropein reduced the expression levels of P-NF-κB and P-AP-1. In conclusion, our data suggest that monotropein inhibited the proliferation and migration of vascular smooth muscle cells by mediating the activity of NF-κB, AP-1, reducing the level of inflammation and oxidative stress, and thus resisting the development of atherosclerosis. These findings demonstrate the efficacious therapeutic impact of monotropein on atherosclerosis and elucidate its specific target.

Excessive fat accumulation,viral infections and sustained inflammatory responses caused by non-alcoholic and alcoholic factors can contribute to liver inflammation,fibrosis and carcinogenesis,promoting the development of chronic liver disease.Gaining an in-depth understanding of the etiologic factors and underlying mechanisms that lead to chronic liver disease can help identify potential therapeutic targets for targeted therapy.Lactate,as an important substance in hepatic metabolism,has been found to be involved in the process of chronic liver disease through various pathways,and this review will provide a useful reference for the prevention and treatment of chronic liver disease.