Objectives:To retrieve,evaluate and summarize the contemporary evidence of strategies for weaning from extracorporeal membrane oxygenation(ECMO)of adult patients,and to provide evidence-based reference for clinical practice. Methods:The Web of Science,Embase,Cochrane Library,PubMed,Wanfang Database,CNKI,VIP website,SinoMed,BMJ Best Practice,National Institute for Health and Care Excellence,Joanna Briggs Institute Library,UpToDate and the website of Agency for Healthcare Research and Quality,Society of Critical Care Medicine,American Association of Critical-Care Nurses,European Society of Intensive Care Medicine and Extracorporeal Life Support Organization were researched to collect the literature related to randomized controlled trials,systematic reviews,guidelines,evidence summaries,expert consensuses and clinical decisions in this field.The time limit for the retrieval is from the inception of databases until July 2023. Results:A total of 13 related literature were retrieved,including 4 guidelines,4 expert consensuses,3 clinical decisions and 2 system reviews.Totally 42 evidences were formulated based on retrieved literature,including adequately accessing the ability of gas exchange before weaning from veno-venous ECMO(V-V ECMO)and withdrawing from veno-arterial ECMO(V-A ECMO)as soon as possible when patients's heart function has recovered,involving six aspects such as team composition,anticoagulation measures,assessment before weaning,weaning implementation,cannula and wound management and quality measures. Conclusions:It is suggested to build a professional ECMO team based on the actual hospital situation,to follow the contemporary evidence to standardize the weaning process of patients from ECMO to ensure the patients'safety and improve the outcomes.

Objective:To explore the value of symptom-oriented clinical lateral thinking training in gynecology internship teaching.Methods:We enrolled a total of 166 medical students of the five-year program of grades 2017 and 2018 who would participate in internships at the First Department of Gynecology of Renmin Hospital of Wuhan University. They were randomly divided into experimental group and control group, with 43 students of grade 2017 and 37 students of grade 2018 in the experimental group and 46 students of grade 2017 and 40 students of grade 2018 in the control group. The experimental group was taught using a symptom-oriented clinical lateral thinking training mode, and the control group was taught using a traditional teaching mode. At the end of the internship, the teaching quality was evaluated by means of an exam and satisfaction survey. The data were analyzed using the t test with the use of SPSS 24.0. Results:For both grades 2017 and 2018, the two groups had similar scores of theoretical knowledge, but the experimental group had significantly higher scores of medical history taking, physical examination, and medical record analysis compared with the control group ( P<0.05); for example, among students of grade 2017, the score of medical record analysis was (37.34±1.08) in the experimental group and (32.18±1.32) in the control group. The experimental group had significantly higher degrees of satisfaction than the control group in terms of doctor-patient communication ability, effective information acquisition ability, clinical case analysis ability, self-learning ability, literature search and review ability, team cooperation ability, and learning interest motivation (all P<0.05). Conclusions:The symptom-oriented clinical lateral thinking training mode can help students master the diagnosis and treatment principles of gynecological diseases, improve their abilities of clinical analysis, doctor-patient communication, effective information acquisition, self-learning, and literature search and review, and motivate their interest in learning.

Objective To assess the mortality and risk factors for stroke among dialysis patients with different dialysis modality. Methods 590 patients who underwent hemodialysis (HD) or peritoneal dialysis (PD) from January 2008 to December 2012 were recruited in our study, and categorized according to dialysis modality. The prognostic risks of stroke were hazard ratio of risk was calculated by Cox regression analysis in HD and PD patients respectively. by the Kaplan?Meier curves or the Cox proportional hazards model. Results A total of 590 patients is under a median follow?up of 32.5 months. The stroke incidence rate of 49.2/1, 000 patient?years in total patients, and 74.1/1, 000 patient?years in HD patients, which was significantly higher compared with that of 31.8/1,000 patient?years in PD patients. On multivariate analysis, independent predictors of stroke occurrence were age(HR=1.05;95%CI:1.02~1.09;P=0.003)、diabete(HR=1.98;95%CI:1.31~3.46;P=0.001)、CVD(HR=2.06;95%CI:1.62-3.05;P < 0.001)、Total triglycerides(HR = 1.20; 95% CI:1.08-1.58; P = 0.034) and hemodialysis (HR = 2.03; 95% CI:1.46-3.89; P = 0.005). Conclusions Age, diabete, CVD, total triglycerides and hemodialysis are independently associated with increased stroke risks in dialysis patients, which suggest that these patients should pay attention to weight control and glucose control.

Objective To discuss the curative effect of double targets percutaneous radiotfrequency thermocoagulation (PRT) on primary trigeminal neuralgia (PTN) and its safety.Methods Sixty patients with PTN were randomly divided into single target treatment group and double targets treatment group.CT guided stereotactic location was used to navigate PRT;patients in the single target treatment group only accepted one target damage and those in the double targets treatment group accepted target damage with 3 mm of deep and shallow interval.The curative effects and complications were compared one week,3 months,one and 2 years after the surgery.Results The percentage of patients with good curative effect in double targets treatment group was significantly higher than that in single target treatment group one and 2 years after surgery,with statistically significant difference (86.7％ vs.60％,70％ vs.45％,P＜0.05).Recurrence rates of double targets treatment group 3 months,one and 2 years after surgery were 0％,3.3％ and 6.7％,which were lower than those in single target treatment group (3.3％,10％ and 16.7％),without significant difference (P＞0.05).Ipsilateralfacial hypaesthesia of different degrees appeared in both groups,but complications as keratohelcosis,diplopia,chewing weakness or difficulty in opening mouth did not appear.And the degree of facial numbness in double targets treatment group was a little higher than that in single target treatment group without statistical significance (P＞0.05).Conclusion Double targets PRT used in PTN treatment can obviously improve the postoperative pain relief and do not apparently increase the degree of postoperative facial numbness as compared with single target PRT.

Objective To investigate the value of using gonadotropin-releasing hormone agonist (GnRH-a) pretreatment in adenomyosis patients before adenomyomectomy. Methods From May 2012 to September 2015, 87 patients with adenomyosis who were non-effective to conservative therapy in Renmin Hospital of Wuhan University were enrolled in this study. According to the principle of randomized control, 41 patients were in the treatment group who were treated with GnRH-a 2-3 cycles before adenomyomectomy, while 46 patients in the control group. The control group paients were operated without any pretreatments. The blood loss, the number of penetrating into uterine cavity, duration of operation, duation of peritoneal drainage and the amount of drainage fluid, the difference of hemoglobin value before and after operation, total white blood cell count, duration of hospitalization, the maximum diameter of uterus and other indicators between the two groups were compared. Results In the treatment group, before and after treatment with GnRH-a, the uterus size, blood hemoglobinand CA125 value were statistically different (all P<0.05);between the treatment group of GnRH-a treated for 2 cycles and for 3 cycles, there were statistical differences of blood hemoglobin value [(108 ± 20) versus (118 ± 24) g/L], CA125 value [(26 ± 11) versus(19 ± 4) kU/L; all P<0.05]. There were statistical differences of blood loss in operation [(113 ± 32) versus (194 ± 42) ml], ratio of penetrating into uterine cavity [12%(5/41) versus 12%(8/46)], duration of operation[(79±23) versus (91±25) minutes], duration of peritoneal drainage after operation [(2.1±0.9) versus (3.0±1.2) days] and the amount of drainage fluid [(152±43) versus (232±32) ml], the difference of hemoglobin value before and after surgery [(-15.6±2.9) versus (-23.7±3.5) g/L], white blood cell count after 2-3 days of operation [(11.4±4.2)×109/L versus (13.5 ± 3.2) × 109/L], ratio of peri-operative blood transfusion [5% (2/41) versus 20% (9/46)] and duration of hospitalization [(11.2±1.9) versus (13.6±3.1) days] between the treatment group and the control group (all P<0.05). Conclusion The pretreatment of using GnRH-a before adenomyomectomy in adenomyosis patients has benefits for implementation of surgery and reducing peri-operative and postoperative complications.

BACKGROUND:In vitro culture of sufficient vaginal epithelial cels and smooth muscle cels is the key for vaginal tissue engineering. However, the culture, purification and passage of vaginal epithelial celsin vitro are difficult. Primary culture and passage of vaginal epithelial cels from large animals such as canines has not been reported. OBJECTIVE:To establish a stable method of culturing canine vaginal epithelial cels and smooth muscle cels. METHODS: Vaginal epithelial cels were isolated from the vaginal specimens by enzymatic digestion with Dispase and trypsin separately, and cultured in keratinocyte serum-free medium. Vaginal smooth muscle tissue were minced and digested with colagenase type II; the colected smooth muscle cels were cultured in DMEM culture medium containing 10% fetal bovine serum. The cultured cels were passaged regularly. Cel morphology and proliferation characteristics were observed and cel phenotypes were confirmed by morphology and immunohistochemistry staining. RESULTS AND CONCLUSION: Primary vaginal epithelial cels began to adhere after 24-36 hours, grew logarithmicaly after 4-5 days, and reached 70% confluence after 7-8 days; the epithelial cels showed a typical cobblestone, with no fibroblasts. Cultured epithelial cels passaged every 4-5 days and subcultured to 6-7 generations continuously. Immunohistochemical staining confirmed a positive staining for anti-pancytokeratin (AEl/AE3). Primary cultured smooth muscle cels adhered and grew after 24 hours. The smooth muscle cels were spindle-shaped and proliferated logarithmicaly. After 4 days, primary cultured smooth muscle cels were confluent and showed a typical shape of “peaks and valeys”, and then the cels could be passaged every 3-4 days and passaged 7-8 generations. Immunohistochemistry staining showed α-actin staining was positive. These findings indicate that canine vaginal epithelial cels and smooth muscle cels could have a long-term stable culture and proliferation, to provide adequate seed cels for vaginal tissue engineering.

Radiation-induced xerostomia is the common radiotherapy-related complication of nasopharyngeal cancer and other head and neck cancers.The cause is that the radioactive rays damage salivary gland acini,ducts,blood vessels and nerves at different levels,resulting in dry mouth,mucositis,sialadenitis,and even dysphagia,trismus and other symptoms.In addition,radiation-induced xerostomia has a close relation to the radiation effect on the genes.Reasonable application of cytoprotective agents and sialagogues is the main treatment means.Chinese medicine also plays a crucial role in the prevention and treatment of radiation-induced xerostomia in recent years.

OBJECTIVETo test whether folic acid offers protection of the brain tissue against acute cerebral infarction in rats.

METHODSSprague-Dawley rats were divided into control (n=8), pre-treatment (n=12) and treatment (n=16) groups, all having routine feed for 7 days. The rats in the control and treatment groups were given normal saline daily, and those in the pre-treatment group received folic acid suspension daily. All the rats were then subject to middle cerebral artery occlusion (MCAO) for 24 h followed by reperfusion. On and after the operation day, the rats in the control group were given normal saline and those in the other two groups were given folic acid suspension daily. Neural function deficiency was evaluated on a daily basis after the operation, and on day 6 after the operation, brain biopsy was performed for examination with TTC staining. Monocyte chemokine -1 (MCP-1) in both normal and infarct tissues was measured by ELISA.

RESULTSOn day 6 after the operation, the neural function deficiency scores of the control, pre-treatment and treatment groups were 4.56∓3.63, 2.94∓2.94 and 1.00∓1.00, and the percentages of the infarct area (to the whole brain area) were (44.23∓10.06)%, (20.64∓6.78)% and (14.61∓13.51)%, respectively. The contents of MCP-1 in the infarct area of the brain tissues were 168.58∓107.21 ng/L, 152.91∓64.78 ng/L, and 97.74∓46.19 ng/L in the 3 groups, respectively.

CONCLUSIONFolic acid can protect brain tissue against acute cerebral infarction in rats.

Animals ; Cerebral Infarction ; drug therapy ; Female ; Folic Acid ; therapeutic use ; Infarction, Middle Cerebral Artery ; drug therapy ; Neuroprotective Agents ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Reperfusion Injury ; prevention & control ; Thrombolytic Therapy

Objective To test whether folic acid offers protection of the brain tissue against acute cerebral infarction in rats. Methods Sprague-Dawley rats were divided into control (n=8), pre-treatment (n=12) and treatment (n=16) groups, all having routine feed for 7 days. The rats in the control and treatment groups were given normal saline daily, and those in the pre-treatment group received folic acid suspension daily. All the rats were then subject to middle cerebral artery occlusion (MCAO) for 24 h followed by reperfusion. On and after the operation day, the rats in the control group were given normal saline and those in the other two groups were given folic acid suspension daily. Neural function deficiency was evaluated on a daily basis after the operation, and on day 6 after the operation, brain biopsy was performed for examination with TTC staining. Monocyte chemokine-1 (MCP-1) in both normal and infarct tissues was measured by ELISA. Results On day 6 after the operation, the neural function deficiency scores of the control, pre-treatment and treatment groups were 4.56 ± 3.63, 2.94 ± 2.94 and 1.00 ± 1.00, and the percentages of the infarct area (to the whole brain area) were (44.23 ± 10.06)%, (20.64 ± 6.78)%and (14.61 ± 13.51)%, respectively. The contents of MCP-1 in the infarct area of the brain tissues were 168.58 ± 107.21 ng/L, 152.91 ± 64.78 ng/L, and 97.74 ± 46.19 ng/L in the 3 groups, respectively. Conclusion Folic acid can protect brain tissue against acute cerebral infarction in rats.

Objective To test whether folic acid offers protection of the brain tissue against acute cerebral infarction in rats. Methods Sprague-Dawley rats were divided into control (n=8), pre-treatment (n=12) and treatment (n=16) groups, all having routine feed for 7 days. The rats in the control and treatment groups were given normal saline daily, and those in the pre-treatment group received folic acid suspension daily. All the rats were then subject to middle cerebral artery occlusion (MCAO) for 24 h followed by reperfusion. On and after the operation day, the rats in the control group were given normal saline and those in the other two groups were given folic acid suspension daily. Neural function deficiency was evaluated on a daily basis after the operation, and on day 6 after the operation, brain biopsy was performed for examination with TTC staining. Monocyte chemokine-1 (MCP-1) in both normal and infarct tissues was measured by ELISA. Results On day 6 after the operation, the neural function deficiency scores of the control, pre-treatment and treatment groups were 4.56 ± 3.63, 2.94 ± 2.94 and 1.00 ± 1.00, and the percentages of the infarct area (to the whole brain area) were (44.23 ± 10.06)%, (20.64 ± 6.78)%and (14.61 ± 13.51)%, respectively. The contents of MCP-1 in the infarct area of the brain tissues were 168.58 ± 107.21 ng/L, 152.91 ± 64.78 ng/L, and 97.74 ± 46.19 ng/L in the 3 groups, respectively. Conclusion Folic acid can protect brain tissue against acute cerebral infarction in rats.