Objective To observe the effect of enteral nutrition with fish collagen oligopeptide on operative prognosis of patients with emergency complex hand trauma.Methods A total of 122 patients who suffered from complex hand trauma and were operated in the emergency department were retrospectively analyzed.Patients were given early enteral nutritional support after the operation,and were divided into two groups according to different formulations.The control group(60 patients)was given balance nutrients and whey protein,and the experimental group(62 patients)was given fish collagen oligopeptide on the same enteral nutrition formula.Clinical data were compared between the two groups,including hemoglobin(Hb),lymphocyte count(Lym),neutrophil-lymphocyte ratio(NLR),albumin(ALB),prealbumin(PA),alanine transaminase(ALT),aspartate transaminase(AST),urea nitrogen(BUN),creatinine(Cr),triglyceride(TG),total cholesterol(TC)and low density lipoprotein-C(LDL-C)before and after treatment.The length of hospital stay and the incidence of postoperative infectious complications were compared between the two groups of patients.Results Compared with before treatment,Hb,ALB,liver and kidney function and lipid metabolism indexes of the control group and the experimental group had no significant changes after nutritional treatment,and PA and Lym were significantly increased,and NLR was significantly decreased.After nutritional treatment,compared with the control group,NLR was decreased more significantly in the experimental group(P<0.01).The incidence of infectious complications was lower in the experimental group than that in the control group,and the length of hospitalization was significantly shortened(P<0.05).Conclusion Early enteral nutrition supplemented with fish collagen oligopeptide in patients with emergency complex hand trauma can promote prealbumin synthesis,reduce the incidence of inflammation and wound infection,and shorten hospital stay.

Objective:To investigate the expression and role of asparte-specific cysteine protease (Caspase)-1, inflammasomes key molecule, in hepatitis B virus (HBV)-related diseases.Methods:HBV-related liver disease patients' serum (438 cases) and liver tissue (82 cases) samples were collected from Beijing You'an Hospital affiliated with Capital Medical University. The mRNA expression level of caspase-1 in liver tissue was detected by real-time fluorescence quantitative PCR (qRT-PCR). The protein expression level of Caspase-1 in liver tissue was detected by the immunofluorescence method. The activity of Caspase-1 was detected using the Caspase-1 colorimetric assay kit. The level of Caspase-1 in the serum was detected by an ELISA kit.Results:The results of qRT-PCR showed that the mRNA level of Caspase-1 was downregulated in patients with chronic hepatitis B (CHB), cirrhosis (LC), and hepatocellular carcinoma (HCC), while up-regulated in patients with acute-on-chronic liver failure (ACLF) ( P＜0.01) compared with normal subjects. Immunofluorescence assays showed that Caspase-1 protein levels were elevated in ACLF patients, decreased in HCC and LC patients, and slightly elevated in CHB patients. The activity of Caspase-1 was slightly higher in liver tissue from CHB, LC, and HCC patients than in the normal control group, and there was no statistically significant difference between the groups. Additionally, compared with the control group, Caspase-1 activity was significantly reduced in the ACLF group ( P＜0.01). Serum Caspase-1 levels were significantly lower in patients with CHB, ACLF, LC, and HCC than in normal subjects, and serum Caspase-1 levels were lowest in patients with ACLF ( P＜0.001). Conclusion:Caspase-1, a key molecule of inflammasomes, plays an important role in HBV-related diseases and has significant differences, showing distinct features for ACLF than other HBV-related diseases.

ObjectiveTo establish a droplet digital PCR (ddPCR) method for detecting hepatitis B virus (HBV) covalently closed circular DNA (cccDNA). MethodsHBV cccDNA standard substance was constructed, and HBV cccDNA primers and probes were designed based on the structural differences between HBV cccDNA and relaxed circular DNA (rcDNA). HBV plasmid was amplified to obtain HBV cccDNA standard substance, and a ddPCR detection method was established with the standard substance after gradient dilution as the template for HBV cccDNA detection; the limit of detection and repeatability of this method were analyzed. Liver tissue samples were collected from 20 patients who attended Beijing YouAn Hospital, Capital Medical University, from June 2017 to October 2020, all of whom were diagnosed with HBV infection, and DNA of the samples was extracted and digested with plasmid-safe ATP-dependent DNA enzyme to obtain HBV cccDNA template; the ddPCR detection method was evaluated in clinical samples and was compared with the quantitative real-time PCR (qPCR) detection method. The chi-square test was used for comparison of categorical data between the two groups. ResultsThe HBV cccDNA detection method based on ddPCR was established, which accurately detected HBV cccDNA in standard substance after gradient dilution, with a limit of detection of 1 copy/μl, and the coefficients of variation of 1×103, 1×102, and 1×101 copies/μl standard substances were 441%, 3.98%, and 5.09%, respectively. HBV cccDNA was detected in the samples of 20 patients with HBV infection; the ddPCR detection method detected HBV cccDNA in 17 patients, with a positive rate of 85%, while the qPCR detection method detected HBV cccDNA in 11 patients, with a positive rate of 55%, and there was a significant difference between the two methods (χ2=4.286, P=0038). ConclusionThe established ddPCR method for detecting HBV cccDNA has a low limit of detection and good repeatability, which provides an effective tool for further clinical detection.

Objective:To analyze the clinical characteristics among types of acute-on-chronic liver failure (ACLF) and explore the new classification criteria for judging the prognosis of acute-on-chronic liver failure, so as to provide a basis for the formulation of more precise therapeutic schedule.Methods:388 cases with ACLF diagnosed in two tertiary level hospitals were included. Patients demographic characteristics, clinical examination information, diagnostic and treatment process information were collected. Laboratory examination data of day 1, 3, 7, 14, 21, 28 and of week 12 or prior to discharge after improvement and at 24 h prior to liver transplantation or death from the diagnosis of ACLF were collected. According to the change trend of the patient's prothrombin activity (PTA), the changes within 4 weeks and 12 weeks were divided into: increased to > 40 %, increase but still ≤ 40%, progressively decreasing or not continuously rising. Moreover, the change trend of total bilirubin (TBil) was divided into: decreasing degree≥50%, decreasing degree < 50%, progressively increasing or not decreasing. Patients meeting the requirements of dynamic classification were screened. PTA and TBil variation tendency of each patient at week 4 and 12 was synthesized, and prognostic condition for dynamic classification was formulated. The clinical characteristics of ACLF patients were analyzed by χ2 test. Results:A total of 262 screened cases were enrolled. At the 4th week of the course of disease, 45% of the patients' PTA had increased to > 40%, and 40.8% of the patients' TBIL had decreased by 50%. When the course of disease was progressed to 12 weeks, 65.3% of the patients' PTA had increased to > 40%, and 63.4% of the patients' TBIL had decreased by 50%. Combined with the prognosis of the patients at the 4th and 12th week, the patients' disease evolution process was divided into five types: Type A: 60 cases (22.9%) of rapid progression; Type B: 82 cases (31.3%) of rapid recovery; Type C: 48 cases (18.3%) of slow progression; Type D: 43 cases (16.4%) of slow recovering; Type E: 29 cases (11.1%) of slow persistence. The proportions of patients with rapid progression combined with upper gastrointestinal hemorrhage, hepatic encephalopathy, and acute renal injury were 16.7%, 33.3%, and 33.3%, respectively; while the above-mentioned complications accounted for 3.7%, 7.3%, and 12.2% only in the rapid recovery type, χ2 = 14.411, 20.060, 12.140, P < 0.05, and the differences were statistically significant. Fungal infection rates were 21.7%, and 10.4% in patients who died of disease or liver transplantation (i.e., patients with rapid progression and slow-progressing types), respectively, and 1.2%, 14%, and 6.9% in patients with rapid progression type, slow-recovering type, and slow persistence type, respectively, and the difference between the rapid progression type and the rapid recovery type was significant, χ2 = 18.925, and the difference was statistically significant ( P < 0.05). Conclusion:The course of disease progression in ACLF patients can be divided into rapid progression type, rapid recovery type, slow progression type, slow recovering type, and slow persistence type. The basis of liver disease, accompanied with fungal infection, gastrointestinal hemorrhage, hepatic encephalopathy and acute renal injury can affect the development of ACLF.

Objective:To compare the clinical features between patients with acute-on-chronic liver failure (ACLF) and decompensated liver cirrhosis (DC) combined with acute kidney injury (AKI).Methods:Demographic data, clinical examination results, diagnosis and treatment information of ACLF and DC patients were collected retrospectively. Clinical characteristics of ACLF combined with AKI and DC combined with AKI and their impact on the 90-day mortality risk were compared.Results:The clinical characteristics of patients with ACLF-AKI and DC-AKI were compared. The results showed that the leukocyte count, absolute neutrophil count, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBil) of ACLF-AKI patients were higher than those of DC-AKI patients, while prothrombin activity (PTA), and albumin were lower than those of DC-AKI patients, and the difference was statistically significant ( P < 0.05). The co-infection rate in patients with ACLF-AKI was significantly higher than that of DC-AKI group (96.9% vs. 39.5%) ( P < 0.05), and during the diagnosis of AKI, the median value of serum creatinine in ACLF patients was 147 μmol / L (IQR: 122-189), while that in DC group was 123.5 μmol / L (IQR: 103.8-155.5), and the difference between the two groups was statistically significant ( P < 0.05). According to the HRS-AKI diagnostic criteria for liver cirrhosis, 44 (68.8%) cases of ACLF-AKI met the diagnosis of HRS -AKI, which was significantly higher than the proportion of 18 (47.4%) cases of DC-AKI ( P < 0.05). Four (10.5%) cases of DC-AKI had died or underwent liver transplantation within 30 days and eight (21.1%) cases had died or underwent liver transplantation within 90 days, while 22 (34.4%) cases of ACLF-AKI patients had died or underwent liver transplantation within 30 days and 35 (54.7%) cases had died or underwent liver transplantation within 90 days, and χ2 values was 7.140 and 11.062, respectively ( P < 0.05). The results of multivariate regression analysis suggested that the independent risk factors that affect the 90-days mortality rate of DC patients were hepatic encephalopathy, gastrointestinal bleeding, and TBil, while the independent risk factors affecting the 90-days death risk of ACLF patients included AKI, PTA and TBil. Conclusion:Compared with DC-AKI patients, ACLF-AKI patients have a higher proportion of infection rate, higher serum creatinine level when diagnosed AKI, and faster disease progression, leading to a greater risk of death.

Objective To evaluate the effects of different administration routes of lipid emulsion on bupivacaine-induced cardiotoxicity in rats.Methods Forty-eight clean healthy adult male Sprague-Dawley rats,weighing 300-350 g,were divided into 6 groups (n=8 each) using a random number table:Ⅳ infusion of normal saline (NS) group (group VN),Ⅳ infusion of lipid emulsion group (group VL),duodenal infusion of NS group (group DN),duodenal infusion of lipid emulsion group (group DL),intraperitoneal intusion of NS group (group PN) and intraperitoneal infusion of lipid emulsion group (group PL).In VN and VL groups,preheated NS and 20％ lipid emulsion 3 ml · kg-1 · min-1 were infused via the femoral vein for 5 min,respectively,and then 0.75％ bupivacaine was infused at the rate of 2 mg · kg-1 · min-1 until cardiac arrest happened.Preheated NS and 20％ lipid emulsion 15 ml/kg were infused via the duodenum (over 1 min,at a constant rate) in DN and DL groups,respectively,and were intraperitoneally infused in PN and PL groups,respectively,followed by an infusion of 0.2 ml/min for 15 min in DN,DL,PN and PL groups.Then 0.75％ bupivacaine was infused via the left femoral vein at a rate of 2 mg · kg-1 · min-1 until cardiac arrest happened.The time to ventricular arrhythmia,mean arterial pressure (MAP) decreasing to 50％ of the baseline and cardiac arrest was recorded.The amount of bupivacaine consumed was calculated immediately after ventricular arrhythmia occurred (T0),immediately after MAP decreased to 50％ of the baseline (T1) and immediately after occurrence of cardiac arrest (T2).Arterial blood samples were collected at T0-2 for determination of the concentration of bupivacaine in plasma by high-performance liquid chromatography.Results Compared with group VN,the time to ventricular arrhythmia,MAP decreasing to 50％ of the baseline and cardiac arrest was significantly prolonged,and the amount of bupivacaine consumed was increased at T0-2 in group VL (P＜0.01).There was no significant difference in the parameters mentioned above between group DN and group DL,and between group PN and group PL (P＞0.05).Compared with group VL,the time to ventricular arrhythmia,MAP decreasing to 50％ of the baseline and cardiac arrest was significantly shortened,and the amount of bupivacaine consumed was decreased at T0-2 in DL and PL groups (P＜0.01).Compared with group DL,the time to ventricular arrhythmia,MAP decreasing to 50％ of the baseline and cardiac arrest was significantly prolonged,and the amount of bupivaeaine consumed was increased at T0.2 in group PL (P＜0.05).There was no significant difference in the concentration of plasma bupivacaine between six groups (P＞0.05).Conclusion Ⅳ infusion of lipid emulsion can decrease bupivacaine-induced cardiotoxicity when compared with duodenal and intraperitoneal infusion in rats.

Objective To compare the accuracy of stroke volume variation (SVV),central venous pressure (CVP) and puhnonary arterial wedge pressure (PAWP) in monitoring the changes in blood volume in the patients undergoing renal transplantation.Methods Sixteen patients with chronic renal failure,of American Society of Anesthesiologists physical status Ⅱ or Ⅲ,aged 18-55 yr,scheduled for elective allograft renal transplantation under general anesthesia,were enrolled in the study.SVV was continuously monitored with the FloTrac/Vigileo monitor,and CVP,PAWP and stroke volume index (SVI) were continuously monitored with the volumetric pulmonary artery catheter during surgery.The parameters of hemodynamics were recorded at 30 min after induction of anesthesia,5 min before renal artery opening,5 and 30 min after renal artery opening,and at the end of surgery.Hydroxyethyl starch 130/0.4 electrolyte solution 6 ml/kg was infused over 15 min via the central venous catheter to perform fluid responsiveness starting from 30 min after induction of anesthesia.Positive fluid responsiveness was defined as the change in SVI ≥ 15％.The relationship between SVV and CVP and between SVV and PAWP was analyzed using the Pearson correlation analysis.The receiver operating characteristic curve for CVP,SVV and PAWP in monitoring the changes in blood volume was drawn,and the area under the curve was calculated.Results Compared with the value at 5 min before renal artery opening,SVV was significantly increased after renal artery opening (P＜0.05),and no significant change was found in CVP and PAWP after renal artery opening (P＞0.05).SVV was negatively correlated with CVP,and r=-0.82 (P＜0.01);SVV was negatively correlated with PAWP,and r=-0.77 (P＜0.01).The area under the curve of SVV in monitoring the changes in blood volume was 0.87,and of CVP and PAWP was 0.69 and 0.66,respectively.Conclusion SVV provides better accuracy than CVP and PAWP in monitoring the changes in blood volume in the patients undergoing renal transplantation.

OBJECTIVETo evaluate the efficacy and safety of anagrelide in essential thrombocythemia (ET).

METHODSPatients who diagnosed as ET according to the World Health Organization classification were enrolled. Each patient was assigned to take anagrelide hydrochloride capsule or hydroxyurea tablet by random 1∶1 ratio. Dose of anagrelide started at 2 mg/d, then increased gradually and the maximum dose was 10 mg/d until the platelet counts dropped to (100-400) × 10⁹/L, one month later gradually reduced to maintain dose. The dose of hydroxyurea was 1000 mg/d at beginning, then increased gradually, when platelet counts dropped to (100-400)×10⁹/L and kept for one month, reduced to maintain dose as 10 mg·kg⁻¹·d⁻¹. The observation period was 12 weeks.

RESULTSA total of 222 patients were enrolled in seventeen centers (including 113 patients treated with anagrelide and 109 with hydroxyurea). Therapy efficacy can be evaluated in 198 patients (including 97 patients administered with anagrelide and 101 with hydroxyurea). At 12th weeks of therapy, the hematologic remission rate was 87.63% (85/97) in anagrelide group and 88.12% (89/107) in hydroxyurea group, the differences between the two groups were not significant (P=0.173). Treatment with anagrelide lowered the platelet counts by a median of 393 (362-1 339) × 10⁹/L from a median of 827 (562-1657) × 109/L at the beginning of the observation to 400(127-1130)×10⁹/L after 12 weeks (P<0.001), which were similar to the treatment result of hydroxyurea by a median drop of 398 (597-1846)× 10⁹/L (P=0.982). The median time to achieving response of anagrelide group was 7 (3-14) days, superior to that of hydroxyurea for 21 (14-28) significantly (P=0.003). Frequency of anagrelide related adverse events was 65.49 % (74/113), including cardiopalmus (36.28% ), headache (21.24% ), fatigue (14.16% ) and dizzy (11.50% ).

CONCLUSIONAnagrelide was effective in patients with ET which had similar hematologic remission rate to hydroxyurea and could take effect more quickly than hydroxyurea. Incidence of adverse events was undifferentiated between anagrelide and hydroxyurea, but anagrelide treatment had tolerable adverse effects and no hematologic toxicity.

Humans ; Hydroxyurea ; administration & dosage ; therapeutic use ; Platelet Aggregation Inhibitors ; administration & dosage ; therapeutic use ; Platelet Count ; Quinazolines ; administration & dosage ; therapeutic use ; Thrombocythemia, Essential ; drug therapy ; Treatment Outcome

Heart rate is the most common index to directly monitor the level of physical stress by comparing the subject's heart rate with an appropriate "target heart rate" during exercise. However, heart rate only reveals the cardiac rhythm of the complex cardiovascular changes that take place during exercise. It is essential to get the dynamic response of the heart to exercise with various indices instead of only one single measurement. Based on the rest-workload alternating pattern, this paper screens the sensitive indices of exercise load from electrocardiogram (ECG) rhythm and waveform, including 4 time domain indices and 4 frequency domain indices of heart rate variability (HRV), 3 indices of waveform similarity and 2 indices of high frequency noise. In conclusion, RR interval (heart rate) is a reliable index for the realtime monitoring of exercise intensity, which has strong linear correlation with load intensity. The ECG waveform similarity and HRV indices are useful for the evaluation of exercise load.
Electrocardiography ; Exercise ; Heart Rate ; Humans ; Monitoring, Physiologic ; Workload

Objective To investigate the effect of interleukin-1 (IL-1) on contractile function of rat thoracic aorta.Methods Forty male Sprague-Dawley rats,weighing 250-300 g,were sacrificed to obtain the thoracic aortic rings.The experiment was performed in 2 parts.Part Ⅰ The thoracic aortic rings were divided into 2 segments and randomly divided into 2 groups (n =20 each):control group and IL-1 group.In IL-1 group,the thoracic aortic rings were incubated with Kreb solution containing 20 ng/ml IL-1 for 2 h,and contracted with cumulative concentrations of phenylephrine,ranging from 10-9 to 10-5mol/L.In control group,the thoracic aortic rings were incubated with Kreb solution for 2 h,and contracted with cumulative concentrations of phenylephrine,ranging from 10 9 to 10-5mol/L.Part Ⅱ The thoracic aortic rings were divided into 3 segments and randomly divided into 3 groups (n=20 each):IL-1 group,IL-1+ L-NAME (the NOS inhibitor) group and IL-1 +cyclooxygenase inhibitor indomethacin group (IL-1 +Ⅰgroup).The thoracic aortic rings were incubated with Kreb solution containing 20 ng/ml IL-1 for 1.5 h in the three groups.In addition,in IL-1 +L-NAME and IL-1 +Ⅰ groups,the thoracic aortic rings were incubated for 30 min with Kreb solution containing 100 μmol/L L-NAME and 2.5 mmol/L indomethacin,respectively.Contraction of the thoracic aorta was then induced with cumulative concentrations of phenylephrine,ranging from 10 9 to 10-5 mol/L.In group IL-1,the thoracic aortic rings were incubated with Kreb solution.The maximum contractile tension of the thoracic aortic rings was recorded at each concentration of phenylephrine,and the percentage of the maximum contractile tension at the concentration of 10-6 mol/L in group C was obtained.Results Part Ⅰ The percentage of contractile tension at phenylephrine 10-s,10-7,l0 6 and 10-5mol/L was significantly decreased in IL-1 group as compared with C group.Part Ⅱ The percentage of contractile tension at phenylephrine 10-7,10-6 and 10-5mol/L was significantly increased in IL-1+L-NAME and IL-1+I groups as compared with IL-1 group.Conclusion IL-1 can inhibit the contraction of rat thoracic aorta,and promoted production of NO and prostacyclin may be involved in the mechanism.