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 investigate the workload of extracorporeal membrane oxygen(ECMO) patients, estimate the number of hours of care based on the amount of nursing work, and to analyze the status of human resources, improve the quality of care and the effect of nursing.Methods:The Nursing Activity Assessment Scale was used to evaluate the daily workload of ECMO patients in the Intensive Care Unit of Zhejiang Province People′s Hospital, and the relevant factors affecting the workload were analyzed.Results:The average daily workload of ECMO patients was (76.06 ± 7.23) points, the daily nurse care ECMO patients time was 10.31 h, and the number of ideal nurses who needed to participate directly in the daily patients was 2.28. The workload was related to age, whether heparin and vasoactive drugs were used, and prognosis( t values were -3.184-7.291, P<0.05 or 0.01). Conclusions:The workload of ECMO patients is relatively large. At this stage, the ratio of nurse to patient is reasonable in our hospital. The patients′ age, use the heparin, vasoactive drugs and prognosis affect the level of nursing workload of ECMO patients.

Objective:To explore the effect and nursing experience of vein-artery extracorporeal membrane oxygenation (V-A-ECMO) combined with continuous renal replacement therapy(CRRT) in the treatment of fulminant myocarditis.Methods:From January 2014 to October 2019, 15 cases of fulminant myocarditis were treated by V-A-ECMO combined with CRRT in the department of critical care medicine of Zhejiang People′s Hospital. During the operation of V-A-ECMO combined with CRRT, heart rate, blood pressure, coagulation function, troponin, creatinine and other indicators were closely monitored, strict liquid management and extracorporeal circulation pipeline management were implemented, and various complications such as arrhythmia, hypotension, bleeding and acral circulation disorder were timely observed and treated.Results:After 48 hours of treatment with V-A-ECMO and CRRT, the troponin value, lactic acid and creatinine of the patients were (21.53 ± 3.19) μg/L, (2.24 ± 0.37) mmol/L, and (58.13 ± 2.41) μmol/L, which were significantly lower than the start of the machine (79.65 ± 6.08) μg/L, (7.65 ± 1.28) mmol/L, (185.24 ± 5.63) μmol/L, the difference were statistically significant ( t values were -32.784, -15.726, -80.386, P<0.01), except for one dead patient, the left ventricular ejection fraction was significantly increased, reaching 45%-55% within 72 hours, and the left ventricular systolic and diastolic function was normal. Among the 13 patients who successfully withdrew the machine, 11 were cured, 3 were discharged automatically and 1 died. The success rate of withdrawing the machine was 86.67% and the cure rate was 73.33%. Conclusions:V-A-ECMO combined with CRRT can effectively improve cardiac renal function, maintain the stability of internal environment and improve the survival rate of patients. High-quality nursing can effectively improve the healing of patients, clinical need to continue to summarize the relevant nursing experience, improve the level of nursing, prevent various complications, improve the success rate of treatment, promote the recovery of patients.

Objective:To explore the effects of early goal-directed mobilization (EGDM) in rehabilitation of patients after cardiac surgery.Methods:Totally 200 patients admitted into ICU after cardiac surgery in Zhejiang Provincial People's Hospital were selected. A total of 100 patients admitted between January and April 2019 were included into the control group who received routine care, while 100 patients admitted from May to August 2019 were included into the observation group received EGDM on this basis. The postoperative rehabilitation indicators (indwelling time of tracheal intubation, time of first exhaust, time of admission to ICU, complication cases) and satisfaction before transferring to ICU were compared between the two groups of patients.Results:The indwelling time of tracheal intubation, time of first exhaust and time of admission to ICU was (25.93±2.42) h, (28.44±1.62) h and (38.63±4.91) h in the observation group, which were shorter than that in the control group, and the difference was statistically significant ( t=45.932, 78.464, 32.702; P<0.01) ; the incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant ( P<0.05) ; before transferring to ICU, the patient satisfaction of the observation group was (57.58±1.15) , while that of the control group was (49.32±1.26) , and the difference was statistically significant ( t=-48.420, P< 0.01) . Conclusions:EGDM is conducive to the early recovery of patients after cardiac surgery and can improve patient satisfaction.

LncRNA H19 encoded by the H19 imprinting gene plays an important regulatory role in the cell. Recently study has found that in hypoxic cells, the expression of H19 gene changes, and the transcription factors and protein involved in the expression change accordingly. Through the involvement of specific protein 1 (SP1), hypoxia-inducible factor-1α (HIF-1α) binds directly to the H19 promoter and induces the up-regulation of H19 expression under hypoxic conditions. The tumor suppressor protein p53 may also mediate the expression of the H19 gene, in part by interfering with HIF-la activity under hypoxia stress. The miR675-5p encoded by exon 1 of H19 promotes hypoxia response by driving the nuclear accumulation of HIF-1α and reducing the expression of VHL gene, which is a physiological HIF-1α inhibitor. In addition, under the condition of hypoxia, the expression of transporter on cell membrane changes, and the transition of the intracellular glucose metabolism pathway from aerobic oxidation to anaerobic glycolysis is also involved in the involvement of H19. Therefore, H19 may be a key gene that maintains intracellular balance under hypoxic conditions and drives adaptive cell survival under conditions of hypoxia stress.
Cell Hypoxia ; genetics ; Genes, Tumor Suppressor ; physiology ; Humans ; Hypoxia-Inducible Factor 1, alpha Subunit ; genetics ; RNA, Long Noncoding ; Up-Regulation ; physiology ; Von Hippel-Lindau Tumor Suppressor Protein ; genetics

Objective:Living organ transplantation prolongs the life of many dying patients, but there are many disputes, especially the definition ofliving organ transplantation between non relatives. The definition of this ter-minology is closely related to medical students′cognitive ofliving organ transplantation between non relatives. The medical students are the main reserve army of medical staff and the executor of living donor organ transplantation in the future, who directly determine the organ transplantation and affect the doctor-patient relationship. This paper is to investigate and analyze the status of the medical students′recognition of cross transplantation between non rela-tives. Methods:A total of 450 medical students of Qingdao university were selected with cluster method and were investigated using self-designed questionnaire. Data were analyzed by SPSS 22. 0. Results:The overall recogni-tion rate toliving organ cross transplantation between non relatives was relatively low. The difference was statisti-cally significant (P<0. 05), namely that students in higher grade had lower recognition. The difference was statis-tically significant (P < 0. 05) between different specialties, and the recognition degree of students majoring in clinical medicine and ecsomatics was higher. Conclusion:The medical students of Qingdao University understand the concept of living organ cross transplantation between non relativesfuzzily, and the recognition degree is low.

OBJECTIVETo study the pharmacokinetics of propranolol and metoprolol in rats after acute exposure to high altitude.

METHODSWistar rats were randomly assigned into 4 groups for treatment with intragastric administration of propranolol or metoprolol after acute exposure to high altitude (4010 m) or normal altitude (50 m). Venous blood samples were collected from the rats at different time points after drug administration to determine the drug concentrations in the plasma and plasma ultrafiltrate using liquid chromatography-mass spectrometry (LC-MS/MS).

RESULTSThe protein binding rate of propranolol was significantly increased but that of metoprolol remained unchanged after acute exposure to high altitude. Compared with the rats exposed to normal altitude, the rats with acute exposure to high altitude showed significant alterations in the pharmacokinetic parameters of the drugs, shown by increased Cmax and AUC, prolonged t1/2 and MRT, and lowered Clz/F of propranolol, and by increased Tmax and prolonged t1/2 and MRT of metoprolol without obvious changes of the parameters of the compartmental model.

CONCLUSIONSignificant changes in the pharmacokinetics of propranolol and metoprolol occur in rats after acute exposure to high altitude possibly in relation to, apart from the changes in plasma protein binding ratio and blood gas, alterations in metabolic enzyme activities, increased blood viscosity, and species and general conditions of the animals.

Altitude ; Animals ; Chromatography, Liquid ; Metoprolol ; pharmacokinetics ; Propranolol ; pharmacokinetics ; Protein Binding ; Rats ; Rats, Wistar ; Tandem Mass Spectrometry

OBJECTIVETo investigate the influence of a sudden increase of altitudes (within 2500 m) in winter on cardiomyocyte functions in rats.

METHODSThirty male Wistar rats were randomly divided into groups A (55 m), B (1520 m), and C (2260 m) and subjected to simulated conditions at the indicated altitudes in winter for 3 days. Blood gas analysis, venous blood biochemistry, and measurements of SOD activity and myocardial concentrations of MDA and NO were performed. Histopathological changes in the left ventricle were observed with HE staining and electron microscopy.

RESULTSBlood pH and PCO2 did not differ significantly between the 3 groups, but PO2 and BE in groups B and C decreased significantly compared with those in group A (P<0.01). Compared with group A, the rats in group C showed obviously increased myocardial enzymes, MYB, Tn-I, and MDA contents (P<0.01) with significantly decreased SOD activity (P<0.05); both groups B and C showed significantly decreased NO content in the myocardium (P<0.01). Histopathologically, the myocardial fiber in group C showed irregular alignment, disruption, and mitochondrial expansion.

CONCLUSIONA sudden increase of altitude to 2260 m in winter can potentially cause hypoxic cardiomyocyte damage as a result of oxidative and environmental stresses.

Altitude ; Animals ; Hypoxia ; pathology ; Male ; Malondialdehyde ; metabolism ; Myocardium ; metabolism ; pathology ; Nitric Oxide ; metabolism ; Oxidative Stress ; Rats ; Rats, Wistar ; Superoxide Dismutase ; metabolism

OBJECTIVETo investigate the changes in hepatic functions and activities of CYP1A2 and CYP3A4 in rats after acute exposure to high altitude.

METHODSTwelve healthy male Wistar rats were randomly divided into control group and exposure group for acute exposure to normal and high altitude (4010 m) environment. Blood samples were collected from the vena orbitalis posterior for detection of the hepatic function. Hepatic pathologies of the rats were examined microscopically with HE staining. Liver microsomes were extracted by differential centrifugation to assess the activities of CYP1A2 and 3A4 using P450-GloTM kit.

RESULTSIn rats with acute exposure to high altitude, AST, ALT, and ALP all increased significantly by 48.50%, 47.90%, and 103.02%, respectively, and TP decreased significantly by 17.80% as compared with those in rats maintained in normal altitude environment (P<0.05). Pathological examination of the liver revealed edema of the central vein of the liver and hepatocyte karyopyknosis in rats after acute exposure to high altitude, which also resulted in significantly lowered activities of CYP1A2 and 3A4 in the liver (by 96.56% and 43.53%, respectively).

CONCLUSIONAcute exposure to high altitude can cause obvious liver injuries and lowered activities of CYP1A2 and 3A4 in rats to severely affect drug metabolism in the liver and result in increased concentration, prolonged half-life and reduced clearance of drugs.

Altitude ; Animals ; Cytochrome P-450 CYP1A2 ; Cytochrome P-450 CYP3A ; metabolism ; Cytochromes ; metabolism ; Liver ; pathology ; Male ; Microsomes, Liver ; enzymology ; Rats ; Rats, Wistar

Objective To investigate the influence of a sudden increase of altitudes (within 2500 m) in winter on cardiomyocyte functions in rats. Methods Thirty male Wistar rats were randomly divided into groups A (55 m), B (1520 m), and C (2260 m) and subjected to simulated conditions at the indicated altitudes in winter for 3 days. Blood gas analysis, venous blood biochemistry, and measurements of SOD activity and myocardial concentrations of MDA and NO were performed. Histopathological changes in the left ventricle were observed with HE staining and electron microscopy. Results Blood pH and PCO2 did not differ significantly between the 3 groups, but PO2 and BE in groups B and C decreased significantly compared with those in group A (P<0.01). Compared with group A, the rats in group C showed obviously increased myocardial enzymes, MYB, Tn-I, and MDA contents (P<0.01) with significantly decreased SOD activity (P<0.05); both groups B and C showed significantly decreased NO content in the myocardium (P<0.01). Histopathologically, the myocardial fiber in group C showed irregular alignment, disruption, and mitochondrial expansion. Conclusion A sudden increase of altitude to 2260 m in winter can potentially cause hypoxic cardiomyocyte damage as a result of oxidative and environmental stresses.