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Progress of mechanical power in the intensive care unit

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Chinese Medical Journal 2020年第18期133卷 2197-2204页

作者： Yi Chi Huai-wu He yun long Department of Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijing 100730China

Mechanical power of ventilation,currently defined as the energy delivered from the ventilator to the respiratory system over a period of time,has been recognized as a promising indicator to evaluate ventilator-induced lung injury and predict the prognosis of ventilated critically ill patients.Mechanical power can be accurately measured by the geometric method,while simplified equations allow an easy estimation of mechanical power at the bedside.There may exist a safety threshold of mechanical power above which lung injury is inevitable,and the assessment of mechanical power might be helpful to determine whether the extracorporeal respiratory support is needed in patients with acute respiratory distress syndrome.It should be noted that relatively low mechanical power does not exclude the possibility of lung injury.Lung size and inhomogeneity should also be taken into consideration.Problems regarding the safety limits of mechanical power and contribution of each component to lung injury have not been determined yet.Whether mechanical power-directed lung-protective ventilation strategy could improve clinical outcomes also needs further investigation.Therefore,this review discusses the algorithms,clinical relevance,optimization,and future directions of mechanical power in critically ill patients.

关键词： Mechanical power Mechanical energy Ventilator-induced lung injury Lung-protective ventilation Acute respiratory distress syndrome

Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

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Chinese Medical Journal 2019年第10期132卷 1218-1227页

作者： Huai-wu He yun long Da-Wei Liu Can Ince Department of Critical Care Medicine Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Science Beijing 100730 China Department of Intensive Care Erasmus MC University Hospital Rotterdam Rotterdam 3015 CE the Netherlands

Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock. Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro). Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included. Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell;Type 2: Macro-Micro incoherence + normal cell;Type 3: Micro-Cell incoherence + normal Micro;and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock. Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice.

关键词： Circulatory shock Shock Tissue perfusion Microcirculation Hemodynamic coherence Resuscitation incoherence

Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery

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Chronic Diseases and Translational Medicine 2020年第3期6卷 188-197页

作者： Lin Zhang Wei Zheng Jian Cui Yun-Long Wu Tian-Lei Xu Hai-Zeng Zhang Department of Colorectal Surgery State Key Lab of Molecular OncologyNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical SciencesPeking Union Medical CollegeBeijing 100021China

Background::Defunctioning stoma is widely used to reduce anastomotic complications in rectal cancer surgery.However,the complications of stoma and stoma reversal surgery should not be underestimated.Furthermore,in some patients,stoma reversal failed.Here,we investigated the complications of defunctioning stoma surgery and subsequent reversal surgery and identify risk factors associated with the failure of getting stoma reversed.Methods::In total,154 patients who simultaneously underwent low anterior resection and defunctioning stoma were reviewed.Patients were divided into two groups according to whether their stoma got reversed or not.The reasons that patients received defunctioning stoma and experienced stoma-related complications and the risk factors for failing to get stoma reversed were analysed.Results::The mean follow-up time was 47.54(range 4.0-164.0)months.During follow-up,19.5%of the patients suffered stoma-related long-term complications.Only 79(51.3%)patients had their stomas reversed.The morbidity of complications after reversal surgery was 45.6%,and these mainly consisted of incision-related complications.Multivariate analyses showed that pre-treatment comorbidity(HR=3.17,95%CI 1.27-7.96,P=0.014),postoperative TNM stage(HR=2.55,95%CI 1.05-6.18,P=0.038),neoadjuvant therapy(HR=2.75,95%CI 1.07-7.05,P=0.036),anastomosis-related complications(HR=4.52,95%CI 1.81-11.29,P=0.001),and disease recurrence(HR=24.83,95%CI 2.90-213.06,P=0.003)were significant independent risk factors for a defunctioning stoma to be permanent.Conclusions::Defunctioning stoma is an effective method to reduce symptomatic anastomotic leakage,but the stoma itself and its reversal procedure are associated with high morbidity of complications,and many defunctioning stomas eventually become permanent.Therefore,surgeons should carefully assess preoperatively and perform defunctioning stomas in very high risk patients.In addition,doctors should perform stoma reversal surgery more actively to prevent temporary stomas from becoming permanent.

关键词： Rectal cancer Low anterior resection Anastomotic complications Defunctioning stoma Stoma reversal surgery

Waxy allele diversity in waxy maize landraces of yunnan Province, China

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Journal of Integrative Agriculture 2022年第2期21卷 578-585页

作者： wu Xiao-yang long Wen-jie CHEN Dan ZHOU Guo-yan DU Juan wu Shao-yun CAI Qing Biotechnology and Germplasm Resources Institute Yunnan Academy of Agricultural SciencesKunming 650223P.R.China

Waxy maize is one of the main fresh-eating maize types,and a mutation of the waxy gene causes the waxy character of maize grains.China is rich in waxy maize landraces,and yunnan and its surrounding areas,are the place of origin and genetic diversity center of Chinese waxy maize.The six known waxy alleles of Chinese waxy maize are wx-D7,wx-D10,wx-Cin4,wx-124,wx-Reina,and wx-Xuanwei.The mutation sites of these alleles all occur in the coding region of the waxy gene,however,the mechanism by which the waxy characteristic is caused by the mutation in the regulatory region has only been reported rarely in maize.In this study,405 waxy maize landraces from yunnan were used as materials to identify the insertion and deletion of a large sequence fragment in the upstream~3.5 kb regulatory region of the waxy gene by molecular marker detection.Three different waxy alleles were identifed in this study:wx-PIF/Harbinger,wx-hAT and wxElote2.These three types of mutations all represented transposons inserted into the regulatory region of the waxy gene.Wx-PIF/Harbinger was a 304-bp MITE class transposon insertion belonging to the PIF/Harbinger family,while wx-hAT was a 560-bp MITE class transposon insertion belonging to the hAT family,and wx-Elote2 was a 6560-bp LTR-like transposon insertion.In this study,the alleles were identifed for more than 70%of the waxy maize landraces in yunnan,which provids a basis for the utilization of these waxy maize landraces.

关键词： waxy maize landraces Waxy allele transposon gene regulatory region yunnan

Effect of mean arterial pressure change by norepinephrine on peripheral perfusion index in septic shock patients after early resuscitation

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Chinese Medical Journal 2020年第18期133卷 2146-2152页

作者： Huai-wu He Wang-Lin Liu Xiang Zhou yun long Da-Wei Liu Department of Critical Care Medicine Peking Union Medical College HospitalPeking Union Medical CollegeChinese Academy of Medical ScienceBeijing 100730China

Background:The peripheral perfusion index(PI),as a real-time bedside indicator of peripheral tissue perfusion,may be useful for determining mean arterial pressure(MAP)after early resuscitation of septic shock patients.The aim of this study was to explore the response of PI to norepinephrine(NE)-induced changes in MAP.Methods:Twenty septic shock patients with pulse-induced contour cardiac output catheter,who had usual MAP under NE infusion after early resuscitation,were enrolled in this prospective,open-label study.Three MAP levels(usual MAP-10 mmHg,usual MAP,and usual MAP+10 mmHg)were obtained by NE titration,and the corresponding global hemodynamic parameters and PI were recorded.The general linear model with repeated measures was used for analysis of variance of related parameters at three MAP levels.Results:With increasing NE infusion,significant changes were found in MAP(F=502.46,P<0.001)and central venous pressure(F=27.45,P<0.001)during NE titration.However,there was not a significant and consistent change in continuous cardiac output(CO)(F=0.41,P=0.720)and PI(F=0.73,P=0.482)at different MAP levels.Of the 20 patients enrolled,seven reached the maximum PI value at usual MAP-10 mmHg,three reached the maximum PI value at usual MAP,and ten reached the maximum PI value at usual MAP+10 mmHg.The change in PI was not significantly correlated with the change in CO(r=0.260,P=0.269)from usual MAP-10 mmHg to usual MAP.There was also no significant correlation between the change in PI and change in CO(r=0.084,P=0.726)from usual MAP to usual MAP+10 mmHg.Conclusions:Differing MAP levels by NE infusion induced diverse PI responses in septic shock patients,and these PI responses may be independent of the change in CO.PI may have potential applications for MAP optimization based on changes in peripheral tissue perfusion.

关键词： Peripheral perfusion index Norepinephrine Perfusion pressure Septic shock

Gliding arc plasma adjusting pre-combustion cracking products

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Defence Technology（防务技术） 2022年第12期18卷 2198-2202页

作者： Fei-long Song yun wu Shi-da Xu Xing-kui Yang Jian-ping Zhou Xin Chen Science and Technology on Plasma Dynamics Laboratory Air Force Engineering UniversityXi'an710038China Institute of Aeroengine Xi'an Jiaotong UniversityXi'an710049China

In view of the difficulty of kerosene-air detonation faced by the application of rotating detonation to aviation engines,in order to improve the kerosene detonation activity,the atmospheric pressure gliding arc plasma is used to conduct secondary adjustment of the pre-combustion cracking products.The results show that the components with larger molecular weight in the pre-combustion cracking products,such as ethylene and methane,can be cracked into highly active species of hydrogen and acetylene by gliding arc plasma.With the increase of the fuel ratio of pre-combustion cracking,the plasma has a more significant effect on the adjustment of high active components.However,as the flow rate of the cracking gas treated by plasma increases,the adjustment effect is obviously reduced.

关键词： Plasma adjustment Pre-combustion cracking Kerosene Detonation

Positive End-expiratory Pressure Titration after Alveolar Flecruitment Directed by Electrical Impedance Tomography

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Chinese Medical Journal 2015年第11期128卷 1421-1427页

作者： yun long Da-Wei Liu Huai-wu He Zhan-Qi Zhao Department of Critical Care Medicine Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100730 China Institute of Technical Medicine Furtwangen University Jakob-Kienzle StraOe 17 D-78054 VS-Schwenningen Germany

Background： Electrical impedance tomography （EIT） is a real-time bedside monitoring tool, which can reflect dynamic regional lung ventilation. The aim of the present study was to monitor regional gas distribution in patients with acute respiratory distress syndrome （ARDS） during positive-end-expiratory pressure （PEEP） titration using EIT. Methods： Eighteen ARDS patients under mechanical ventilation in Department of Critical Care Medicine of Peking Union Medical College Hospital from January to April in 2014 were included in this prospective observational study. After recruitment maneuvers （RMs）, decremental PEEP titration was performed from 20 cmH20 to 5 cmH20 in steps of 3 cmH20 every 5-10 min. Regional over-distension and recruitment were monitored with EIT. Results： After RMs, patient with arterial blood oxygen partial pressure （PaO2）＋ carbon dioxide partial pressure （PaCO2）〉400 mmHg with 100% of fractional inspired oxygen concentration were defined as RM responders. Thirteen ARDS patients was diagnosed as responders whose PaO2 ＋ PaCO2, were higher than nonresponders （419 ± 44 mmHg vs. 170 ±73 mmHg, P 〈 0.0001）. In responders, PEEP mainly increased-recruited pixels in dependent regions and over-distended pixels in nondependent regions. PEEP alleviated global inhomogeneity of tidal volume and end-expiratory lung volume. PEEP levels without significant alveolar derecruitment and over-distension were identified individually. Conclusions： After RMs, PEEP titration significantly affected regional gas distribution in lung, which could be monitored with EIT. EIT has the potential to optimize PEEP titration.

关键词： Acute Respiratory Distress Syndrome Electrical Impedance Tomography Positive End-expiratory Pressure Recruitment Maneuvers

Mageb4,a Testis-Specific Gene,is Dispensable for Mouse Spermatogenesis

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Reproductive and Developmental Medicine 2020年第3期4卷 129-136页

作者： Sheng Gao Da-Min yun Li-Wei Zhou yun-Hao wu Deng-Feng Lin Xiao-long wu Fei Sun Medical School Institute of Reproductive MedicineNantong UniversityNantong 226001China

Objective:It has recently been shown that the melanoma antigen gene(MAGE)family is expressed in various tumor cell lines but silent in normal tissues,except germ cell lines.Mageb4,a member of the MAGE family,is highly expressed in the testis and homologous in humans and mice.Whole-exome sequencing studies have identifiedMageb4 as a possible X-linked cause of inherited male infertility.However,the function of Mageb4 protein remains largely unknown.Methods:Using clustered regularly interspaced palindromic repeats(CRISPR)/CRISPR-associated protein(Cas)9 technology,we generated aMageb4 knockout mouse model(Mageb4^-/Y)to explore the role of this gene in spermatogenesis.Results:First,immunostaining of testicular cells showed thatMageb4 is localized in the cytoplasm of spermatogonia.Second,Mageb4^-/Y male mice displayed significant increases in apoptosis.However,Mageb4^-/Y male mice showed normal fertility,including normal sperm concentration,sperm motility,and testicular and epididymal histology.Conclusions:These findings suggest that,despite testis-exclusive expression,Mageb4 is dispensable for mouse spermatogenesis.Future research should focus on the role of this gene in apoptosis,aiming to provide clinical guidance regarding male infertility.

关键词： Clustered Regularly Interspaced Palindromic Repeats/CRISPR-Associated Protein 9 Mageb4 Male Infertility Spermatogenesis

Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus:a systematic review and meta-analysis

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World Journal of Pediatrics 2023年第4期19卷 323-339页

作者： Yi wu Yi-yun Zhang Ya-Ting Zhang Hui-Jing Zhang Tian-Xue long Qi Zhang Jing Huang Ming-Zi Li Peking University Health Science Center 38 Huayuan RoadHaidian DistrictBeijing100191China School of Nursing Peking UniversityBeijingChina Peking University Health Science Centre for Evidence-Based Nursing A Joanna Briggs Institute Affiliated GroupBeijingChina School of Nursing Jilin UniversityChangchunChina

Background This study aimed to analyze the efficacy of resilience-promoting interventions among adolescents and youth aged 10-24 years with any type of diabetes.Methods A systematic literature search was performed using the PubMed,Web of Science,Embase,Cochrane Library,CINAHL,and PsycINFO databases from inception to May 25,2022.The Cochrane risk of bias tool(version 2)was used to assess the quality of the included studies.A meta-analysis was performed to calculate the pooled effects of resilience-promoting interventions.Results Nineteen articles were included covering an overall sample of 2048 adolescents with diabetes.When analyzing the effectiveness of resilience-promoting interventions,hemoglobin A1c(HbA1c)at six months[mean difference=-0.47,95%confidence interval(CI)=-0.83 to-0.12,P=0.009]after the intervention was improved.However,long-term(≥12 months)improvement in HbA1c was not significant.In addition,comparing the control group,there were significant differences in the effect size for stress[standardized mean difference(SMD)=-0.87,95%CI=-1.25 to-0.48,P<0.05],self-efficacy(SMD=0.50,95%CI=0.02-0.98,P=0.04)and quality of life(SMD=0.27,95%CI=0.03-0.51,P=0.03).Conclusions Resilience-promoting intervention is a promising way for adolescent diabetes management to improve HbA1c,stress,self-efficacy,and quality of life.Incorporating resilience-promoting components into diabetes education and re-enforcing these contents every six months are recommended for implementation in clinical practice.

关键词： Adolescents Diabetes mellitus Intervention Meta-analysis Resilience