OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western s...OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.展开更多
Telemedicine is a branch of healthcare that uses communication technology to deliver medical information and services between patients and healthcare providers. The applicability of telemedicine is vast and increasing...Telemedicine is a branch of healthcare that uses communication technology to deliver medical information and services between patients and healthcare providers. The applicability of telemedicine is vast and increasingly relevant. There is a lack of research on utilizing telemedicine for remote evaluation of the airway. The primary aim of this pilot study was to validate a telemedical airway exam as a viable alternative to an in-person evaluation. Three anesthesiologists evaluated 48 volunteers by telemedicine and live examination. The telemedical exam consisted of transmitting still images of four established, predictive parameters of difficult airways: Mallampati score;neck extension;ability to prognath;and thyromental distance. Each subject’s telemedical and face-to-face scores were compared to determine their degree of correlation. Still images were taken using standardized positioning with four pictures of mouth opening, neck extension, prognath, and thyromental distance. Data were analyzed using Wilcoxon signed-rank tests and free-marginal multirater kappa analysis. Average respective scores for live versus telemedicine examination were as follows: Mallampati scores were 1.73 versus 2.54;neck extension scores were 3.77 versus 3.60;thyromental distance (measured in finger breadths) was 2.95 versus 2.92;and prognath scores were 0.97 versus 0.94. There was no difference in grading of thyromental distance or prognathy ability between live and telemedical exams, and interrater reliability was very good for both parameters. This study supports telemedicine as a reliable tool for preoperative anesthesia airway exams to identify airway difficulties. This may be especially useful as an alternative in patients with COVID-19 undergoing urgent surgery.展开更多
Background：Green tea has been shown to improve cholesterol metabolism in animal studies,but the molecular mechanisms underlying this function have not been fully understood.Long non-coding RNAs （lncRNAs） have recen...Background：Green tea has been shown to improve cholesterol metabolism in animal studies,but the molecular mechanisms underlying this function have not been fully understood.Long non-coding RNAs （lncRNAs） have recently emerged as a major class of regulatory molecules involved in a broad range of biological processes and complex diseases.Our aim was to identify important lncRNAs that might play an important role in contributing to the benefits of epigallocatechin-3-gallate （EGCG） on cholesterol metabolism.Methods：Microarrays was used to reveal the lncRNA and mRNA profiles in green tea polyphenol（-）-epigallocatechin gallate in cultured human liver （HepG2） hepatocytes treated with EGCG and bioinformatic analyses of the predicted target genes were performed to identify lncRNA-mRNA targeting relationships.RNA interference was used to investigate the role of lncRNAs in cholesterol metabolism.Results：The expression levels of 15 genes related to cholesterol metabolism and 285 lncRNAs were changed by EGCG treatment.Bioinformatic analysis found five matched lncRNA-mRNA pairs for five differentially expressed lncRNAs and four differentially expressed mRNA.In particular,the lncRNA4 T102202 and its potential targets mRNA-3-hydroxy-3-methylglutaryl coenzyme A reductase （HMGCR） were identified.Using a real-time polymerase chain reaction technique,we confirmed that EGCG down-regulated mRNA expression level of the HMGCR and up-regulated expression ofAT102202.After AT102202 knockdown in HepG2,we observed that the level of HMGCR expression was significantly increased relative to the scrambled small interfering RNA control （P 〈 0.05）.Conclusions：Our results indicated that EGCG improved cholesterol metabolism and meanwhile changed the lncRNAs expression profile in HepG2 cells.LncRNAs may play an important role in the cholesterol metabolism.展开更多
Objective:Traditional Chinese medicines(TCMs)are efficacious against ulcerative colitis(UC).In recent years,the number of randomized clinical trials(RCTs)of TCM has increased.Thus,it is very important to summarize the...Objective:Traditional Chinese medicines(TCMs)are efficacious against ulcerative colitis(UC).In recent years,the number of randomized clinical trials(RCTs)of TCM has increased.Thus,it is very important to summarize the basic characteristics,quality,and types of TCM interventions in published RCTs.This scoping review was performed to systematically identify and describe the current situations about RCTs of TCMs for treating UC.Hope to express the focus and specifics of nowadays research in TCM interventions in RCTs and evaluate their common disadvantages exposed to help advance in TCM researching.Materials and Methods:A scoping review was conducted according to the PRISMA extension for scoping reviews.We searched two English databases and four Chinese databases from the date of establishment of each database to January 2020.Data from RCTs focusing on any TCM treatment for patients with UC were extracted and evaluated.Selection and characterization were performed by two independent reviewers using predefined forms.All discrepancies were resolved by consensus discussion with a third reviewer.Microsoft Excel 2010 was used to extract the following data from the included studies:(1)basic information of the included studies including research ID,article title,publication language,journal,year of publication,and funding information;(2)patient information including gender,age,disease course,disease stage,severity,sample size;and(3)information on intervention measures,types of intervention measures,drug dosage forms,and treatment courses.Results:The search identified 2225 RCTs published between1987 and 2020.These studies covered 36 provinces in China.The time frame of the RCTs was<28 days in approximately one-third of the RCTs(647,29.08%).Only one RCT was published in English.Nearly three-quarters of RCTs(1665,74.83%)did not report the severity of the disease.Three types of interventions were included in the RCTs:pharmacotherapy(2028,91.15%),nonpharmacotherapy(57,2.56%),and a combination of the two(140,6.29%).The administration modes of the intervention groups were evaluated.Drug therapy involved 12types of TCM dosage forms,which were decoctions,troches,powders,capsules,granules,pills,suppositories,ointments,injections,gels,oral liquids,and substitute tea according to the frequency of use.Nondrug intervention measures involved 10 treatment options,namely,acupuncture,moxibustion,hemospasia,auricular point,acupoint catgut embedding,acupoint injection,scrapping,tuina,acupoint application,and five-tone therapy according to the frequency of use.Most studies included in this review were low in quality.This underscores the need for improvement in the quality of trial methodology in TCM RCTs.展开更多
文摘OBJECTIVE In patients undergoing cardiac surgery,reduced preoperative ejection fraction(EF)and senior age are associated with a worse outcome.As most outcome data available for these patients are mainly from Western surgical populations involving specific surgery types,our aim is to evaluate the real-world characteristics and perioperative outcomes of surgery in senior-aged heart failure patients with reduced EF across a broad range cardiac surgeries.METHODS Data were obtained from the China Heart Failure Surgery Registry(China-HFSR)database,a nationwide multicenter registry study in China's Mainland.Multiple variable regression analysis was performed in patients over 75 years old to identify risk factors associated with mortality.RESULTS From 2012 to 2017,578 senior-aged(>75 years)patients were enrolled in China HFSR,21.1%of whom were female.Isolated coronary bypass grafting(CABG)were performed in 71.6%of patients,10.1%of patients underwent isolated valve surgery and 8.7%received CABG combined with valve surgery.In-hospital mortality was 10.6%,and the major complication rate was 17.3%.Multivariate analysis identified diabetes mellitus(odds ratio(OR)=1.985),increased creatinine(OR=1.007),New York Heart Association(NYHA)Class III(OR=1.408),NYHA class IV(OR=1.955),cardiogenic shock(OR,6.271),and preoperative intra-aortic balloon pump insertion(OR=3.426)as independent predictors of in-hospital mortality.CONCLUSIONS In senior-aged patients,preoperative evaluation should be carefully performed,and strict management of reversible factors needs more attention.Senior-aged patients commonly have a more severe disease status combined with more frequent comorbidities,which may lead to a high risk in mortality.
文摘Telemedicine is a branch of healthcare that uses communication technology to deliver medical information and services between patients and healthcare providers. The applicability of telemedicine is vast and increasingly relevant. There is a lack of research on utilizing telemedicine for remote evaluation of the airway. The primary aim of this pilot study was to validate a telemedical airway exam as a viable alternative to an in-person evaluation. Three anesthesiologists evaluated 48 volunteers by telemedicine and live examination. The telemedical exam consisted of transmitting still images of four established, predictive parameters of difficult airways: Mallampati score;neck extension;ability to prognath;and thyromental distance. Each subject’s telemedical and face-to-face scores were compared to determine their degree of correlation. Still images were taken using standardized positioning with four pictures of mouth opening, neck extension, prognath, and thyromental distance. Data were analyzed using Wilcoxon signed-rank tests and free-marginal multirater kappa analysis. Average respective scores for live versus telemedicine examination were as follows: Mallampati scores were 1.73 versus 2.54;neck extension scores were 3.77 versus 3.60;thyromental distance (measured in finger breadths) was 2.95 versus 2.92;and prognath scores were 0.97 versus 0.94. There was no difference in grading of thyromental distance or prognathy ability between live and telemedical exams, and interrater reliability was very good for both parameters. This study supports telemedicine as a reliable tool for preoperative anesthesia airway exams to identify airway difficulties. This may be especially useful as an alternative in patients with COVID-19 undergoing urgent surgery.
基金The present study was supported by a grant from the National Natural Science Foundation of China （No. 81241007）.
文摘Background：Green tea has been shown to improve cholesterol metabolism in animal studies,but the molecular mechanisms underlying this function have not been fully understood.Long non-coding RNAs （lncRNAs） have recently emerged as a major class of regulatory molecules involved in a broad range of biological processes and complex diseases.Our aim was to identify important lncRNAs that might play an important role in contributing to the benefits of epigallocatechin-3-gallate （EGCG） on cholesterol metabolism.Methods：Microarrays was used to reveal the lncRNA and mRNA profiles in green tea polyphenol（-）-epigallocatechin gallate in cultured human liver （HepG2） hepatocytes treated with EGCG and bioinformatic analyses of the predicted target genes were performed to identify lncRNA-mRNA targeting relationships.RNA interference was used to investigate the role of lncRNAs in cholesterol metabolism.Results：The expression levels of 15 genes related to cholesterol metabolism and 285 lncRNAs were changed by EGCG treatment.Bioinformatic analysis found five matched lncRNA-mRNA pairs for five differentially expressed lncRNAs and four differentially expressed mRNA.In particular,the lncRNA4 T102202 and its potential targets mRNA-3-hydroxy-3-methylglutaryl coenzyme A reductase （HMGCR） were identified.Using a real-time polymerase chain reaction technique,we confirmed that EGCG down-regulated mRNA expression level of the HMGCR and up-regulated expression ofAT102202.After AT102202 knockdown in HepG2,we observed that the level of HMGCR expression was significantly increased relative to the scrambled small interfering RNA control （P 〈 0.05）.Conclusions：Our results indicated that EGCG improved cholesterol metabolism and meanwhile changed the lncRNAs expression profile in HepG2 cells.LncRNAs may play an important role in the cholesterol metabolism.
基金financially supported by The National Natural Science Foundation of China(81904052)The 13th Five-Year Plan for National Key R&D Program of China(2018YFC1705401)。
文摘Objective:Traditional Chinese medicines(TCMs)are efficacious against ulcerative colitis(UC).In recent years,the number of randomized clinical trials(RCTs)of TCM has increased.Thus,it is very important to summarize the basic characteristics,quality,and types of TCM interventions in published RCTs.This scoping review was performed to systematically identify and describe the current situations about RCTs of TCMs for treating UC.Hope to express the focus and specifics of nowadays research in TCM interventions in RCTs and evaluate their common disadvantages exposed to help advance in TCM researching.Materials and Methods:A scoping review was conducted according to the PRISMA extension for scoping reviews.We searched two English databases and four Chinese databases from the date of establishment of each database to January 2020.Data from RCTs focusing on any TCM treatment for patients with UC were extracted and evaluated.Selection and characterization were performed by two independent reviewers using predefined forms.All discrepancies were resolved by consensus discussion with a third reviewer.Microsoft Excel 2010 was used to extract the following data from the included studies:(1)basic information of the included studies including research ID,article title,publication language,journal,year of publication,and funding information;(2)patient information including gender,age,disease course,disease stage,severity,sample size;and(3)information on intervention measures,types of intervention measures,drug dosage forms,and treatment courses.Results:The search identified 2225 RCTs published between1987 and 2020.These studies covered 36 provinces in China.The time frame of the RCTs was<28 days in approximately one-third of the RCTs(647,29.08%).Only one RCT was published in English.Nearly three-quarters of RCTs(1665,74.83%)did not report the severity of the disease.Three types of interventions were included in the RCTs:pharmacotherapy(2028,91.15%),nonpharmacotherapy(57,2.56%),and a combination of the two(140,6.29%).The administration modes of the intervention groups were evaluated.Drug therapy involved 12types of TCM dosage forms,which were decoctions,troches,powders,capsules,granules,pills,suppositories,ointments,injections,gels,oral liquids,and substitute tea according to the frequency of use.Nondrug intervention measures involved 10 treatment options,namely,acupuncture,moxibustion,hemospasia,auricular point,acupoint catgut embedding,acupoint injection,scrapping,tuina,acupoint application,and five-tone therapy according to the frequency of use.Most studies included in this review were low in quality.This underscores the need for improvement in the quality of trial methodology in TCM RCTs.
