26 research outputs found
Hemodynamic Management During Veno-Arterial Extracorporeal Membrane Oxygenation in Patients with Cardiogenic Shock: A Review
No full textAbstract Background The use of veno-arterial extracorporeal membrane oxygenation (V-A ECMO) for cardiorespiratory support is increasing. However, few criteria for hemodynamic management have been described yet in V-A ECMO patients. Method We performed a review of hemodynamic management during V-A ECMO in CS patient based the literature published. We discuss how to optimize hemodynamic management. Results Patients on V-A ECMO require special hemodynamic management. It is crucial to maintain an adequate tissue oxygen supply and demand balance. Hemodynamic optimization is essential to support LV decompression and improve end-organ function and should be initiated immediately after initiating V-A ECMO support, during which more positive fluid balance is associated with worse outcomes. Conclusion The hemodynamic management of CS patients with V-A ECMO are complex and involves various aspect. Clinicians who care for patients on VA ECMO should combined use many availability indicators to guide hemodynamic management
Decreased Heart Rate Variability in COVID-19
No full textPURPOSE: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to angiotensin-converting enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed not only in the lungs but also in the cardiovascular system. Therefore, SARS-CoV-2 can also damage the myocardium. This report aimed to highlight decreased heart rate variability (HRV) and cardiac injury caused by SARS-CoV-2. MATERIALS AND METHODS: We evaluated three COVID-19 patients who died. Patients’ data were collected from electronic medical records. We collected patient’s information, including baseline information, lab results, body temperature, heart rate (HR), clinical outcome and other related data. We calculated the HRV and the difference between the expected and actual heart rate changes as the body temperature increased. RESULTS: As of March 14, 2020, 3 (2.2%) of 136 patients with COVID-19 in Tianjin died in the early stage of the COVID-19 epidemic. The immediate cause of death for Case 1, Case 2, and Case 3 was cardiogenic shock, cardiac arrest and cardiac arrest, respectively. The HRV were substantially decreased in the whole course of all three cases. The actual increases in heart rate were 5 beats/min, 13 beats/min, and 4 beats/min, respectively, less than expected as their temperature increased. Troponin I and Creatine Kinase MB isoenzyme (CK-MB) were substantially increased only in Case 3, for whom the diagnosis of virus-related cardiac injury could not be made until day 7. In all three cases, decreased in HRV and HR changes occurred earlier than increases in cardiac biomarkers (e.g., troponin I and CK-MB). CONCLUSIONS: In conclusion, COVID-19 could affect HRV and counteract tachycardia in response to increases in body temperature. The decreases of HRV and HR changes happened earlier than the increases of myocardial markers (troponin I and CK-MB). It suggested the decreases of HRV and HR changes might help predict cardiac injury earlier than myocardial markers in COVID-19, thus its early identification might help improve patient prognosis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s44231-022-00024-1
Class Origin, Family Culture, and Intergenerational Correlation of Education in Rural China
No full textThis paper examines the intergenerational correlation of education in rural China. The focus is on the influence of family class origin (jiating chengfen), the political label hung on every family throughout the Maoist era. A nationally representative cross-sectional household survey for 2002 is used. It is shown that the effects of family class origin on family members' educational attainment varies across historical periods. Regarding the educational level of male heads of household with landlord/rich peasant background, we found a drop caused by the class-based discrimination in the Maoist era and a rebound in the postreform era. It was also found that family class origin remains significant for the educational achievement of the current younger generation. Children aged 16-18 who are of landlord/rich peasant and middle peasant origins are more likely to achieve higher educational attainment. We conclude that a class-specific, education-oriented family culture has been shaped first as a mixture of family cultural capital inherited from the pre-Maoist era and surfacing again in the postreform era, and, second, as intergenerational cultural reaction against class-based discrimination during the Maoist era.education, intergenerational correlation, class origin, family culture, social discrimination
Ulinastatin Protects Against LPS-Induced Acute Lung Injury By Attenuating TLR4/NF-κB Pathway Activation and Reducing Inflammatory Mediators
No full textCUHK electronic theses & dissertations collection
No full textThere had not been much attempt to interweave the impact of both social status change and social transformations on the memory, hence identity building of same cohort. This is because time was needed for stratification to complete and the impact of social transformations on the life course of an individual to be settled. Educated youth (zhiqing 知青) should be a very good example to examine this problem as they experienced both huge social transformations and re-stratification. Followed by these transformations were a weakening impact of official ideology on people. Besides, as the educated youth approach retiring age and their life more or less settled, time is also ripe to attempt the challenge. Existing studies in collective memory of educated youth do not take effort to differentiate educated youths by their family backgrounds(jiating chushen 家庭出身/jiating chengfen 家庭成分) nor their social status. However, many accounts in academia suggested that family class backgrounds had significant impact on the life course of educated youths, though they were just suggestive. Furthermore, as China underwent drastic socioeconomic transformations since 1970s and the educated youth re-stratified, a changing identity and self-perceived status can be expected. By collecting their life histories through semi-structured interviews and analyzing the ontological and public narratives of zhiqing’s life histories, this exploratory research aims to find out how family background and current status affects the memory structure and thus the identity construction of educated youth in China in the days of economic transformation.集體記憶研究對於社會轉型與社會地位變化如何共同影响同一群体的集體記憶以及身份建構研究不足，因為社會轉型與分層的影響需要時間才能觀察到。知青記憶研究正好是一個很好的範例，因為知青本身既經歷了社會轉型，也經歷了社會地位的變化。此外如今知青步入退休階段，生活以及身份較為穩定，亦解決了上述的分層、社會變化的時間問題。關於知青記憶的現有研究並沒有把知青進行家庭出身（又稱家庭成分）的劃分。然而學界一些研究表明，家庭出身對知青的生命歷程有重大的影響。此外，自從中國在1970年代開始經濟與社會轉型以來，知青經歷了重新分流，而自我身份或亦會隨之改變。本探索研究希望通過搜集知青的口述生命史，分析其中的本體(ontological)与公共(public)敘事主題，來分析家庭成分與知青當前地位如何影響他們的記憶結構，從而一窺知青面對中國經濟轉型的時候如何建構他們的身份。Lin, Pik Man.Thesis M.Phil. Chinese University of Hong Kong 2015.Includes bibliographical references (leaves 64-67).Abstracts and appendix also in Chinese.Title from PDF title page (viewed on 14, September, 2016).Detailed summary in vernacular field only
Multicentre, parallel, open-label, two-arm, randomised controlled trial on the prognosis of electrical impedance tomography-guided versus low PEEP/FiO2 table-guided PEEP setting: a trial protocol
No full textIntroduction Previous studies suggested that electrical impedance tomography (EIT) has the potential to guide positive end-expiratory pressure (PEEP) titration via quantifying the alveolar collapse and overdistension. The aim of this trial is to compare the effect of EIT-guided PEEP and acute respiratory distress syndrome (ARDS) network low PEEP/fraction of inspired oxygen (FiO2) table strategy on mortality and other clinical outcomes in patients with ARDS.Methods This is a parallel, two-arm, multicentre, randomised, controlled trial, conducted in China. All patients with ARDS under mechanical ventilation admitted to the intensive care unit will be screened for eligibility. The enrolled patients are stratified by the aetiology (pulmonary/extrapulmonary) and partial pressure of arterial oxygen/FiO2 (≥150 mm Hg or <150 mm Hg) and randomised into the intervention group or the control group. The intervention group will receive recruitment manoeuvre and EIT-guided PEEP titration. The EIT-guided PEEP will be set for at least 12 hours after titration. The control group will not receive recruitment manoeuvre routinely and the PEEP will be set according to the lower PEEP/FiO2 table proposed by the ARDS Network. The primary outcome is 28-day survival.Analysis Qualitative data will be analysed using the χ2 test or Fisher’s exact test, quantitative data will be analysed using independent samples t-test or Mann-Whitney U test. Kaplan-Meier analysis with log-rank test will be used to evaluate the 28-day survival rate between two groups. All outcomes will be analysed based on the intention-to-treat principle.Ethics and dissemination The trial is approved by the Institutional Research and Ethics Committee of the Peking Union Medical College Hospital. Data will be published in peer-reviewed journals.Trial registration number NCT05307913
Protective Effects of N-Acetylcysteine in Concanavalin A-Induced Hepatitis in Mice
No full textThis study was designed to study the protective effects and mechanisms of N-acetylcysteine (NAC) in concanavalin A-induced hepatitis in mice. In this study, pretreatment with NAC ameliorated the histopathological changes and suppressed inflammatory cytokines in ConA-induced hepatitis. The expression of IL-2, IL-6, TNF-α, and IFN-γ was significantly reduced in the NAC-treated groups. NAC activated PI3K/Akt pathway and inhibited the activation of NF-κB. Additionally, NAC reduced autophagosome formation, as assessed by detecting the expression of LC3 and Beclin 1. Our results demonstrate that NAC can alleviate ConA-induced hepatitis by regulating the PI3K/Akt pathway and reducing the late stages of autophagy. Our results described a new pharmaceutical to provide more effective therapies for immune hepatitis
Protective effects of astaxanthin on ConA-induced autoimmune hepatitis by the JNK/p-JNK pathway-mediated inhibition of autophagy and apoptosis.
No full textObjectiveAstaxanthin, a potent antioxidant, exhibits a wide range of biological activities, including antioxidant, atherosclerosis and antitumor activities. However, its effect on concanavalin A (ConA)-induced autoimmune hepatitis remains unclear. The aim of this study was to investigate the protective effects of astaxanthin on ConA-induced hepatitis in mice, and to elucidate the mechanisms of regulation.Materials and methodsAutoimmune hepatitis was induced in in Balb/C mice using ConA (25 mg/kg), and astaxanthin was orally administered daily at two doses (20 mg/kg and 40 mg/kg) for 14 days before ConA injection. Levels of serum liver enzymes and the histopathology of inflammatory cytokines and other maker proteins were determined at three time points (2, 8 and 24 h). Primary hepatocytes were pretreated with astaxanthin (80 μM) in vitro 24 h before stimulation with TNF-α (10 ng/ml). The apoptosis rate and related protein expression were determined 24 h after the administration of TNF-α.ResultsAstaxanthin attenuated serum liver enzymes and pathological damage by reducing the release of inflammatory factors. It performed anti-apoptotic effects via the descending phosphorylation of Bcl-2 through the down-regulation of the JNK/p-JNK pathway.ConclusionThis research firstly expounded that astaxanthin reduced immune liver injury in ConA-induced autoimmune hepatitis. The mode of action appears to be downregulation of JNK/p-JNK-mediated apoptosis and autophagy
Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database
No full textIntroduction: Hospital-acquired bloodstream infections (HA-BSIs) are severe and require antibiotic therapy. In non-complicated BSIs, shortened therapy reduces side effects without compromising efficacy. The impact of shortened antibiotic therapy in HA-BSI critically ill patients without indication of prolonged therapy requires further evaluation. Methods: Using the international prospective EUROBACT-2 cohort, we compared shortened (7-10 days) versus long (14-21 days) treatment durations in ICU patients eligible for shortened therapy. Patients without antibiotic therapy within 3 days after HA-BSI occurrence or requiring prolonged therapy (due to infection source, microorganism, or clinical deterioration) were excluded. Treatment failure, defined as death, persistent infection, or subsequent infectious complications by Day 28, was assessed using an inverse-probability of treatment weighted (IPTW) logistic regression. Results: Among 2600 patients, 550 were eligible for shortened treatment, 213 received short, and 337 received long treatment. The most common infection source was intravascular catheters (33%), most common microorganisms were Enterobacterales (39%). Patients with long treatment were more frequently infected with Staphylococcus aureus (11% vs. 5.6%, p = 0.025) or difficult-to-treat microorganisms (23% vs. 7%, p < 0.001), and received more commonly combination therapy (46% vs. 30%, p < 0.001). Short treatment was associated with reduced 28-day treatment failure (OR 0.64, 95% CI 0.44-0.93, p = 0.019), mainly due to reduction in subsequent infectious complications (OR 0.58, 95% CI 0.37-0.91, p = 0.018). Mortality (OR 0.92 [95% CI 0.59, 1.43], p = 0.7) and persistent infection rates (OR 0.47 [95% CI 0.17, 1.14], p = 0.12) were similar. Conclusions: In selected ICU patients with HA-BSI, shortened antibiotic treatment might be considered. Eurobact2 was a prospective international cohort study, registered in ClinicalTrials.org (NCT03937245)
Effects of olive oil and astaxanthin on the liver function and pathology of healthy mice.
No full text<p>(A) The levels of serum ALT and AST in the four groups did not differ. Data are given as means ± SD (n = 6, P > 0.05). (B) The percentage of different immune cell subsets, serum levels of TNF-α, IL-6, IL-1β, and IFN-γ of four groups were evaluated in each group with ELISAs or flow cytometry (n = 6, P > 0.05). (C) Representative hematoxylin-and-eosin-stained sections of the liver. Original magnification, ×200.</p
