Objective:To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV) among medical staffs in pediatric intensive care unit(PICU) in China, and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods:The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12, 2020.The questionnaire was issued, collected and checked by the Children′s Hospital of Fudan University.Results:(1) PMV related settings: Nine out of eleven hospitals had established PMV multidisciplinary teams, respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7% and 36.4% of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques, induced spirometer exercise, external diaphragm pacemaker stimulation, transfer bed exercise, balloon blowing, hyperbaric oxygen therapy could be respectively executed in 100.0%, 9.1%, 9.1%, 9.1%, 27.3% and 27.3% of PICU, respectively.(2) The cognitive status quo of children′s PMV: The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases, and 62.7% of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3) The cognitive status quo of the children′s PMV management in PICU: Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+ pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7% of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment, bedside rehabilitation training, nutritional assessment, analgesia and sedation assessment for children with PMV.(4) The cognitive status quo of the children′s PMV management of transition from hospital to family: 54.5% of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5% of PICU would follow up these discharged children one month later.Conclusion:At present, PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis, treatment and management.

The fall armyworm (FAW), Spodoptera frugiperda, is a destructive pest native to America and has recently become an invasive insect pest in China. Because of its rapid spread and great risks in China, understanding of FAW genetic background and pesticide resistance is urgent and essential to develop effective management strategies. Here, we assembled a chromosome-level genome of a male FAW (SFynMstLFR) and compared re-sequencing results of the populations from America, Africa, and China. Strain identification of 163 individuals collected from America, Africa and China showed that both C and R strains were found in the American populations, while only C strain was found in the Chinese and African populations. Moreover, population genomics analysis showed that populations from Africa and China have close relationship with significantly genetic differentiation from American populations. Taken together, FAWs invaded into China were most likely originated from Africa. Comparative genomics analysis displayed that the cytochrome p450 gene family is extremely expanded to 425 members in FAW, of which 283 genes are specific to FAW. Treatments of Chinese populations with twenty-three pesticides showed the variant patterns of transcriptome profiles, and several detoxification genes such as AOX, UGT and GST specially responded to the pesticides. These findings will be useful in developing effective strategies for management of FAW in China and other invaded areas.
Animals ; China ; Genomics ; Humans ; Male ; Pesticides ; Spodoptera/genetics* ; Transcriptome

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective:To explore the association between resting heart rate(RHR) and all-cause mortality among the Chinese oldest-old aged more than 80.Methods:Using a total of seven surveys or follow-ups data (1998, 2000, 2002, 2005, 2008, 2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 17 886 elderly over 80 years old were selected as subjects, their resting heart rate were measured though baseline survey and the survival outcome and death time of the subjects were followed up. The subjects were divided into 6 groups according to their resting heart rate. Cox regression model was used to estimate the effect of resting heart rate on mortality risk. The interaction of age, gender and resting heart rate was also analyzed by likelihood ratio test.Results:The age of subjects M( P25, P75) was 92 (86, 100) years old, including 10 531 females (58.9%) and there were 13 598 participants died, the mortality rate was 195.5 per 1 000 person-years. Multivariate Cox regression analysis showed that compared to the control group (60-69 pbm/min), the hazard ratio of the elderly are 1.06 (95% CI: 1.02, 1.11), 1.09 (95% CI: 1.04, 1.15), 1.23 (95% CI: 1.14, 1.34), 1.25 (95% CI: 1.08, 1.44) in the group of RHR between 70-79, 80-89, 90-99 and ≥100 pbm/min and Pvalues are all less than 0.05. Likelihood ratio test showed that RHR and age had an interaction effect. ( P for interaction=0.011). Conclusion:The risk of all-cause death increased with the increase of resting heart rate and this relationship was stronger between the 80-89 years old people.

Objective To compare the clinical characteristics of normal body mass index (BMI) polycystic ovary syndrome (PCOS) patients with or without insulin resistance (IR) , and analyze the related factors of IR. Methods From January 2013 to January 2017, 128 patients with normal BMI (18.5-23.9 kg/m2) PCOS patients were divided into A group (56 cases with IR) and B group (72 cases without IR) according to whether they had IR. The clinical indicators, sex hormones, glucose and lipid metabolism indexes of the two groups were statistically compared, and the related factors influencing insulin resistance index (HOMA-IR) were analyzed by Pearson. Results Compared with B group, the waist-to-hip ratio (0.91 ± 0.08 vs. 0.80 ± 0.07), Ferriman-Gallway scores [(4.87 ± 1.66) scores vs. (3.31 ± 1.29) scores], fasting blood glucose (FPG) [(5.19 ± 0.60) mmol/L vs. (4.77 ± 0.56) mmol/L], fasting insulin (FINS) [(17.89 ± 5.85) mU/L vs. (9.83 ± 3.87) mU/L], total cholesterol (TC)[(5.03 ± 1.42) mmol/L vs. (4.52 ± 0.62) mmol/L], triglyceride (TG)[(1.72 ± 1.05) mmol/L vs. (0.98 ± 0.26) mmol/L], low density lipoprotein cholesterol (LDL-C) [(3.10 ± 1.19) mmol/L vs. (2.55 ± 0.82) mmol/L] in A group were significantly increased, while high density lipoprotein cholesterol (HDL-C) [(1.28 ± 0.30) mmol/L vs. (1.52 ± 0.23) mmol/L] significantly reduced, the differences were statistically significant (P < 0.05). HOMA-IR was positively correlated with waist-to-hip ratio (r=0.397), FPG (r=0.461), FINS (r=0.992), TC (r=0.371), TG (r=0.354) and LDL-C (r=0.478), but negatively correlated with sex hormone binding globulin (r=-0.231) and HDL-C (r=-0.299). Conclusions The waist-to-hip ratio, Ferriman-Gallway scores, glucose and lipid metabolism in normal BMI PCOS patients with IR are significantly altered. The waist-to-hip ratio, FPG, FINS, TC, TG, LDL-C, HDL-C and sex hormone binding globulin are all related factors of HOMA-IR.

Objective This study aims to analyze the independent risk factors associated with postoperative delirium of patients undergoing Stanford A aortic dissection surgery.Methods Clinical data of the patients who underwent Stanford A aortic dissection surgery from December 2014 to October 2015 were collected.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 23℃.After surgery,patients were transferred to the cardiovascular ICU,where they received standard postoperative care.The delirium was diagnosed according to the criteria of the confusion assessment method for the intensive care unit(CAM-ICU).The possible risk factors of pre-operation,during operation or post-operation were analyzed via univariate analysis and multivariate logistic regression to determine the independent risk factorsof postoperative delirium.Results 148 patients underwent Stanford A aortic dissection surgery which the incidence of postoperative delirium was 31.1％ (46/148).Univariate analysis showed the associated risk factors were age,hypertension,cognitive impairment,emergency operation,operation time,aorta clamping time,DHCA time,fluctuation of blood pressure during operation,blood transfusion,quality of sleep,length of ICU stay and electrolyte disturbance(P ＜ 0.05).Multivariate logistic regression analysis revealed that hypertension,cognitive impairment,fluctuation of mean arterial blood pressure(MAP) ＞ 30 mmHg (1 mmHg =0.133 kPa),DHCA time ＞ 40 min,postoperative poor quality of sleep and electrolyte disturbance were independently associated with postoperative delirium after Stanford A aortic dissection surgery(P ＜ 0.05).Conclusion Delirium is a frequent complication.Factors independently associated with delirium are hypertension,cognitive impairment,DHCA time,postoperative poor quality of sleep and electrolyte disturbance.Prevent,assess and manage delirium should be paid more attention and reinforced.

Tumor microvessel including two modes,as one is classic vascular structures surrounded with vascular endothelial cells and the other is vasculogenic mimicry( VM) surrounded with cancer cells.Recent studies suggested that anti-angiogenic drugs can inhibit classic microvessel structure significantly, but can not inhibit VM formation and even promote VM formation further more.This is one of the reasons affecting its clinical effica-cy.However,basic research has shown that traditional chinese medicine,gene therapy and drugs which is targeting for VM formation have an unique advantage in anti-VM.In this review, we summarize the progress of cancer therapy on targeting vasculogenic mimicry,and provide a basic for the development of new drugs for cancer thera-py through targeting both angiogenesis and VM formation.

Objective To explore the risk factors and optional treatment strategies for postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery.Methods From December 2012 to April 2014,108 patients received acute Stanford A aortic dissection surgery in Henan Provincial People' s Hospital.Of them,74 men vs.34 women,age (43.2 ± 10.1) years old,and weight (71.3 ± 18.4) kg.The operation was performed within 14 days since disease onset.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 20 ℃ .Postoperative hypoxemia was defined as the arterial partial oxygen over inspired oxygen fraction(PaO2/FiO2) more than 200 after admission to ICU.Pulmonary protective ventilation management took place immediately after hypoxemia was diagnosed.Comparison analysis was performed between hypoxemia group and non-hypoxemia group in age,gender,body mass index (BMI),smoking history,duration of cardiopulmonary bypass(CPB),duration of DHCA,blood transfusion,length of mechanical ventilation,length of ICU stay and mortality.Results The incidence of postoperative hypoxemia was 40.7％ (44/108).There were no statistical differences in age,gender,hypertension,diabetes mellitus or COPD history.In the hypoxemia group,11 cases developed pulmonary infection,3 cases underwent tracheotomy and 10 cases died.In the non-hypoxemia group,4 patients died.Postoperative hypoxemia was significantly associated with more mortality,length of ventilation time,length of ICU stay and in hospital(P ＞ 0.05).Univariate analysis showed the associated factors were BMI,smoking history,preoperative hypoxemia,LVEF ＜ 0.45,operation time,aorta clamping time,DHCA time and blood transfusion.Multivariate analysis showed the independent predictive factors were preoperative hypoxemia,DHCA ＞40 min,blood transfusion ＞ 10 U and BMI ＞25 kg/ m2.Conclusion Obesity,massive blood transfusion,long DHCA time and preoperative hypoxemia are independent risk factors of postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery.Perioperative pulmonary protection should be paid more attention and reinforced.

Objective To analyze the incidence rate and the perioperative risk factors associated with delirium after cardiac surgery.Methods We enrolled 622 patients between October 2014 and March 2015 in the department of cardiovascular surgery in Henan Provincial People's Hospital who were allocated to group PD and non-PD according to the Confusion Assessment Method(CAM) after the cardiac operation.Baseline demographics,perioperative data,and postoperative outcomes of these patients were recorded and analyzed via chi-square test and multivariate logistic regression analysis to determine the risk factors of postoperative delirium.Results Postoperative delirium was detected in 102 patients according to CAM criteria.The incidence was 16.4％.Multivariate logistic regression analysis revealed that age (OR =3.456;95％ CI:2.431-4.569),preoperative atrial fibrillation (OR =1.987;95％ CI:3.562-7.862),prolonged surgery duration (OR =1.246;95％ CI:3.164-5.982),postoperative pain (OR =5.356;95 ％ CI:1.386-9.374)were independently associated with postoperative delirium after cardiac surgery.Conclusions Delirium is a frequent complication,age,preoperative atrial fibrillation,prolonged surgery duration,postoperative pain are independent risk factors for delirium following cardiac surgery.Management according to potential risk factors may be associated with preferable therapeutic outcomes.