Objective To study the relationship between hyperlipidemia and incidence of retinal vein occlusion by observing serum lipid changes of patients with retinal vein occlusion. Methods In this case-control study,the patient group included 46 patients with retinal vein occlusion who received no drug treatment,while the control group included 45 healthy people without retinal vascular disease. There were no significant differences in age and gender between the two groups. The levels of total serum cholesterol,triglycerides,low density lipoprotein cholesterol and high density lipoprotein cholesterol were measured and compared. Results The levels of total cholesterol,triglycerides,low density lipoprotein cholesterol in the patient group were significantly higher than those in the control group (P 0. 05),while the level of high density lipoprotein cholesterol was significantly lower than that in the control group (P 0. 05). There was no significant difference between the levels mentioned above between the patients with central retinal vein occlusion and those with branch retinal vein occlusion (P 0. 05). Conclusion There is a close relationship between the hyperlipidemia and the incidence of retinal vein occlusion.
Objective
To evaluate the effectiveness and satisfaction of scenario cases based simulation teaching in the training of mechanical ventilation.
Methods
The scenario cases and simulation courses based on constructionism were developed in the residents. Eighty-six residents who rotated to intensive care unit from January 2016 to May 2018 were randomized to experimental group and control group. Forty-three experimental group residents were trained using scenario cases based simulation teaching, and the other forty-three control group residents were trained using traditional teaching. Theory and operation assessment were compared between two groups before and after training. Training satisfaction was also compared between two groups after rotation in the department of Critical Care Medicine.
Results
Total test score of post-training was significantly higher than that of pre-training in all the residents (80.5±8.3 vs 53.0±5.3, P<0.01). After training, total test score was significantly higher in the experimental group than control group (87.1 ± 5.8 vs 73.8 ± 4.1, P<0.01). Training satisfaction was also significantly higher in the experimental group than that in control group (44.5 ± 1.9 vs 32.9 ± 2.7, P<0.01).
Conclusions
The application of scenario cases based simulation teaching in mechanical ventilation training had achieved good results and high satisfaction.
Key words:
Scenario case; Simulation teaching; Residents; Mechanical ventilation
Abstract Purpose The debate surrounding factors influencing postoperative flatus and defecation in patients undergoing colorectal resection prompted this study. Our objective was to identify independent risk factors and develop prediction models for postoperative bowel function in patients undergoing colorectal surgeries. Methods A retrospective analysis of medical records was conducted for patients who undergoing colorectal surgeries at Peking University People’s Hospital from January 2015 to October 2021. Machine learning algorithms were employed to identify risk factors and construct prediction models for the time of the first postoperative flatus and defecation. The prediction models were evaluated using sensitivity, specificity, the Youden index, and the area under the receiver operating characteristic curve (AUC) through logistic regression, random forest, Naïve Bayes, and extreme gradient boosting algorithms. Results The study included 1358 patients for postoperative flatus timing analysis and 1430 patients for postoperative defecation timing analysis between January 2015 and December 2020 as part of the training phase. Additionally, a validation set comprised 200 patients who undergoing colorectal surgeries from January to October 2021. The logistic regression prediction model exhibited the highest AUC (0.78) for predicting the timing of the first postoperative flatus. Identified independent risk factors influencing the time of first postoperative flatus were Age ( p < 0.01), oral laxatives for bowel preparation ( p = 0.01), probiotics ( p = 0.02), oral antibiotics for bowel preparation ( p = 0.02), duration of operation ( p = 0.02), postoperative fortified antibiotics ( p = 0.02), and time of first postoperative feeding ( p < 0.01). Furthermore, logistic regression achieved an AUC of 0.72 for predicting the time of first postoperative defecation, with age ( p < 0.01), oral antibiotics for bowel preparation ( p = 0.01), probiotics ( p = 0.01), and time of first postoperative feeding ( p < 0.01) identified as independent risk factors. Conclusions The study suggests that he use of probiotics and early recovery of diet may enhance the recovery of bowel function in patients undergoing colorectal surgeries. Among the various analytical methods used, logistic regression emerged as the most effective approach for predicting the timing of the first postoperative flatus and defecation in this patient population.
[Objective] The research was done to study the distribution and expression variation of Neuropeptide Y(NPY)in uterus of the rats during estrus cycle.[Method] Twenty mature female rats at normal estrus cycle were evenly divided into 4 groups:preoestrus group,estrum group,metoestrus and diestrus group.Estrus cycle was judged by vaginal smear,the expression of NPY in uterus of the rats during estrus cycle was studied by immunohistochemical SP method.[Result] In endometrium layer,most NPY immunoreactive products are mainly located in cells,small parts mainly in punctuate and filamentous NPY immunoreactive fibers.In myometrium layer,The NPY immunoreactive products are mainly located in muscle fibers.The relative expression of immunoreactive product NPY of t-test showed that,compared with the the proestrus,expression of NPY in estrus and diestrus of endometrium was significantly decreased(P0.05);Contrast with the the metestrus,estrus and diestrus were extremely significantly decreased(P0.01);compared with the the estrus,expression of NPY in metestrus of myometrium was significantly increased(P0.05);compared with the the metestrus,expression of NPY in diestrus of myometrium was extremely significantly decreased(P0.01).[Conclusion] The results showed that the expression of NPY in the uterus in different periods was found to adapt to some certain rules and might be related to its physiological function.
High-flow nasal cannula oxygen (HFNC) is a relatively new therapy used in adults with respiratory failure. Whether it is superior to conventional oxygen therapy (COT) or to noninvasive mechanical ventilation (NIV) remains unclear. The aim of the present study was to investigate whether HFNC was superior to either COT or NIV in adult acute respiratory failure patients. A review of the literature was conducted from the electronic databases from inception up to 20 October 2016. Only randomized clinical trials comparing HFNC with COT or HFNC with NIV were included. The intubation rate was the primary outcome; secondary outcomes included the mechanical ventilation rate, the rate of escalation of respiratory support and mortality. Eleven studies that enrolled 3459 patients (HFNC, n = 1681) were included. There were eight studies comparing HFNC with COT, two comparing HFNC with NIV, and one comparing all three. HFNC was associated with a significant reduction in intubation rate (OR 0.52, 95% CI 0.34 to 0.79, P = 0.002), mechanical ventilation rate (OR 0.56, 95% CI 0.33 to 0.97, P = 0.04) and the rate of escalation of respiratory support (OR 0.45, 95% CI 0.31 to 0.67, P < 0.0001) when compared to COT. There was no difference in mortality between HFNC and COT utilization (OR 1.01, 95% CI 0.67 to 1.53, P = 0.96). When HFNC was compared to NIV, there was no difference in the intubation rate (OR 0.96; 95% CI 0.66 to 1.39, P = 0.84), the rate of escalation of respiratory support (OR 1.00, 95% CI 0.77 to 1.28, P = 0.97) or mortality (OR 0.85, 95% CI 0.43 to 1.68, P = 0.65). Compared to COT, HFNC reduced the rate of intubation, mechanical ventilation and the escalation of respiratory support. When compared to NIV, HFNC showed no better outcomes. Large-scale randomized controlled trials are necessary to prove our findings. PROSPERO International prospective register of systematic reviews on May 25, 2016 registration no. CRD42016039581 .
Abstract Objective: Postoperative bowel obstruction was one of the most severe complications in patients received colorectal surgeries. The aim of this study was to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods: The records of 1437 patients who underwent selective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 was retrospectively collect. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results: COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed a robust discrimination, with area under the receiver operating characteristic curve was 0.894 and was well calibrated. Conclusion: A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.
To determine the diagnostic value of pulmonary function testing in Chinese patients with known pulmonary arterial hypertension (PAH) without history of lung/heart valve diseases.Pulmonary function testing was performed in 41 PAH patients diagnosed by right heart catheterization and in 17 healthy controls.Normal pulmonary function testing results were found in 5 PAH patients (12.2%). Total lung capacity, vital capacity and FEV1 were significantly decreased in PAH patients [(80.27 +/- 11.46)% vs. (94.24 +/- 6.82)%; (79.09 +/- 14.89)% vs. (97.35 +/- 9.51)%; (75.40 +/- 16.58)% vs. (95.12 +/- 12.01)%, respectively, all P < 0.001], the ratio of residual volume/total lung capacity was significantly increased [(117.67 +/- 25.73)% vs. (93.39 +/- 10.87)%, P < 0.001]; FEV1/FVC and maximal expiratory flow of 25% to 75% tended to be lower (-6.0% and -19.4%, P = 0.21 and 0.09) while DLCO and DLCO/VA were significantly decreased by 36.6% and 29.8% (P < 0.001) compared with healthy controls.Increased peripheral airway obstruction and normal lung resistance were found in these PAH patients. Normal pulmonary function testing results could not rule out the diagnosis of PAH.
Objective
To evaluate the independent risk factors of perioperative major cardiovascular events among non-cardiac surgical patients.
Methods
A retrospective study in a surgical ICU in teaching hospital. Consecutive adult (above 18 years old) non-cardiac surgical patients from December 1, 2012 to November 30, 2013 were studied. The endpoint was the main postoperative cardiovascular events, and accordingly, the patients were divided into event group and non-event group. Clinical data and operative data were recorded and compared between the two groups. The independent risk factors of cardiovascular adverse events were summarized by regression analysis.
Results
The 1 286 patients, including 63 cases (4.9%) of event group were studied. Through the single factor comparative analysis and multi-factors regression analysis, we found that age (OR=1.030), the history of coronary heart disease (OR=2.392), heart failure (OR=7.333), diabetes (OR=1.995), cerebral infarction (OR=2.230), renal failure (OR=4.468), high risk operation (OR=10.716), blood loss during operation (OR=1.022) as well as emergency operation (OR=2.583) were the independent risk factors of major cardiovascular events (all P<0.05). The RCRI score was statistically different between two groups (P=0.000).
Conclusions
The independent risk factors of perioperative major cardiovascular events include age, the history of coronary heart disease, heart failure, diabetes, cerebral infarction, renal failure, high risk operation, blood loss during operation as well as emergency operation.
Key words:
Non-cardiac surgery; Peri- operation; Cardiovascular events; Risk factors
Angiotensin converting enzyme 2 (ACE2), a transmembrane glycoprotein, is an important part of the renin-angiotensin system (RAS). In the COVID-19 epidemic, it was found to be the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). ACE2 maintains homeostasis by inhibiting the Ang II-AT1R axis and activating the Ang I (1-7)-MasR axis, protecting against lung, heart and kidney injury. In addition, ACE2 helps transport amino acids across the membrane. ACE2 sheds from the membrane, producing soluble ACE2 (sACE2). Previous studies have pointed out that sACE2 plays a role in the pathology of the disease, but the underlying mechanism is not yet clear. Recent studies have confirmed that sACE2 can also act as the receptor of SARS-COV-2, mediating viral entry into the cell and then spreading to the infective area. Elevated concentrations of sACE2 are more related to disease. Recombinant human ACE2, an exogenous soluble ACE2, can be used to supplement endogenous ACE2. It may represent a potent COVID-19 treatment in the future. However, the specific administration concentration needs to be further investigated.
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