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Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture

Asian Journal of Urology 2024年第1期11卷 110-114页

作者： Arman Tsaturyan Angelis Peteinaris Constantinos Adamou Konstantinos Pagonis Lusine Musheghyan Anastasios Natsos Theofanis Vrettos Evangelos Liatsikos Panagiotis Kallidonisa department of Urology University of PatrasPatrasGreece Gerald and Patricia Turpanjian School of Public Health American University of ArmeniaYerevanArmenia department of Anesthesiology and icu University of PatrasPatrasGreece department of Urology Medical University of ViennaViennaAustria

Objective:To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy(npPCNL)for the management of large proximal ureteral stones.Methods:We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL.Depending on stone size,in-toto stone removal or lithotripsy using the Lithoclast®Trilogy(EMS Medical,Nyon,Switzerland)was performed.Perioperative parameters including operative time(from start of puncture to the skin suturing),stone extraction time(from the first insertion of the nephroscope to the extraction of all stone fragments),and the stone-free rate were evaluated.Results:Twenty-one males and 16 females underwent npPCNL for the management of large upper ureteral calculi.The median age and stone size of treated patients were 58(interquartile range[IQR]:51-69)years and 19.3(IQR:18.0-22.0)mm,respectively.The median operative time and stone extraction time were 25(IQR:21-29)min and 8(IQR:7-10)min,respectively.One case(2.7%)of postoperative bleeding and two cases(5.4%)of prolonged fever were managed conservatively.The stone-free rate at a 1-month follow-up was 94.6%.Conclusion:The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter.Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.

关键词： Antegrade percutaneous nephrolithotomy Proximal ureteral stone Non-papillary puncture Large ureteral stone Prone percutaneous nephrolithotomy

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Exercise-induced modulation of miR-149-5p and MMP9 in LPS-triggered diabetic myoblast ER stress: licorice glycoside E as a potential therapeutic target

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Traditional Medicine Research 2024年第8期9卷 23-34页

作者： Yi Du Hong Liu department of Critica Care Medicine Third Hospital of Shanxi Medical UniversityShanxi Bethune HospitalShanxi Academy of Medical Sciences Tongji Shanxi HospitalTaiyuan 030032China department of icu First Hospital of Shanxi Medical UniversityTaiyuan 030001China

Background:This study explores the relationship between endoplasmic reticulum(ER)stress and diabetes,particularly focusing on the impact of physical exercise on ER stress mechanisms and identifying potential therapeutic drugs and targets for diabetes-related sepsis.The research also incorporates traditional physical therapy perspectives,emphasizing the genomic insights gained from exercise therapy in disease management and prevention.Methods:Gene analysis was conducted on the GSE168796 and GSE94717 datasets to identify ER stress-related genes.Gene interactions and immune cell correlations were mapped using GeneCard and STRING databases.A screening of 2,456 compounds from the TCMSP database was performed to identify potential therapeutic agents,with a focus on their docking potential.Techniques such as luciferase reporter gene assay and RNA interference were used to examine the interactions between microRNA-149-5p and MMP9.Results:The study identified 2,006 differentially expressed genes and 616 miRNAs.Key genes like MMP9,TNF-α,and IL1B were linked to an immunosuppressive state.Licorice glycoside E demonstrated high affinity for MMP9,suggesting its potential effectiveness in treating diabetes.The constructed miRNA network highlighted the regulatory roles of MMP9,IL1B,IFNG,and TNF-α.Experimental evidence confirmed the binding of microRNA-149-5p to MMP9,impacting apoptosis in diabetic cells.Conclusion:The findings highlight the regulatory role of microRNA-149-5p in managing MMP9,a crucial gene in diabetes pathophysiology.Licorice glycoside E emerges as a promising treatment option for diabetes,especially targeting MMP9 affected by ER stress.The study also underscores the significance of physical exercise in modulating ER stress pathways in diabetes management,bridging traditional physical therapy and modern scientific understanding.Our study has limitations.It focuses on the microRNA-149-5p-MMP9 network in sepsis,using cell-based methods without animal or clinical trials.Despite strong in vitro findings,in vivo stud

关键词： ER stress diabetes physical exercise gene expression microRNA-149-5p MMP9 licorice glycoside E traditional physical therapy genomics insights

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Effects of combined aerobic,resistance and inspiratory training in patients with pulmonary hypertension:A systematic review

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World Journal of Critical Care Medicine 2024年第2期13卷 168-179页

作者： Christos Kourek Antonia Zachariou Eleftherios Karatzanos Michalis Antonopoulos Theodora Soulele Andreas Karabinis Serafim Nanas Stavros Dimopoulos department of Clinical Ergospirometry Exercise and Rehabilitation Laboratory1^(st)Department of Critical Care MedicineEvangelismos HospitalNational and Kapodistrian University of AthensAthens 10676Greece department of Cardiology 417 Army Share Fund Hospital of AthensAthens 11521Greece Cardiac Surgery icu Onassis Cardiac Surgery centerAthens 17674AtticaGreece Cardiac Surgery icu Onassis Cardiac Surgery CenterAthens 17674Greece Cardiac Surgery Intensive Care Unit Onassis Cardiac Surgery CenterAthens 17674Greece department of Clinical Ergospirometry Exercise and Rehabilitation LaboratoryNational and Kapodistrian University of AthensAthens 10676Greece

BACKGROUND Pulmonary hypertension(PH)is a serious progressive disorder of the modern world,characterized by endothelial dysfunction and impaired vasoreactivity.Patients with PH usually present exercise intolerance from the very early stages and reduced exercise capacity.Exercise training has been shown to have beneficial effects in patients with cardiovascular comorbidities.However,data regarding the effects of combined exercise training programs in patients with PH still remains limited.AIM To investigate the effects of combined exercise training programs on exercise capacity and quality of life in patients with PH.METHODS Our search included all available randomized controlled trials(RCTs)regarding combined aerobic,resistance and inspiratory training programs in patients with PH in 4 databases(Pubmed,PEDro,Embase,CINAHL)from 2012 to 2022.Five RCTs were included in the final analysis.Functional capacity,assessed by peak VO_(2)or 6-min walking test(6MWT),as well as quality of life,assessed by the SF-36 questionnaire,were set as the primary outcomes in our study.RESULTS Peak VO_(2)was measured in 4 out of the 5 RCTs while 6MWT was measured in all RCTs.Both indices of functional capacity were significantly increased in patients with PH who underwent combined exercise training compared to the controls in all of the included RCTs(P<0.05).Quality of life was measured in 4 out of 5 RCTs.Although patients improved their quality of life in each group,however,only 2 RCTs demonstrated further improvement in patients performing combined training compared to controls.CONCLUSION By this systematic review,we have demonstrated that combined aerobic,resistance and inspiratory exercise training is safe and has beneficial effects on aerobic capacity and quality of life in patients with PH.Such exercise training regimen may be part of the therapeutic strategy of the syndrome.

关键词： Pulmonary hypertension Exercise training Peak VO2 Functional capacity Quality of life

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下腔静脉内径呼吸变异率在脓毒症患者早期连续性肾脏替代治疗容量管理中的临床意义

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中国血液净化 2024年第6期23卷 431-435页

作者：孙立杨玉芳赵群嘉兴市第二医院icu 嘉兴314000

目的探讨超声监测下腔静脉内径呼吸变异率指导容量管理在脓毒性患者早期连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的意义。方法选择因脓毒症在嘉兴市第二医院重症监护病房(intensive care unit,icu)住院治疗并... 详细信息

目的探讨超声监测下腔静脉内径呼吸变异率指导容量管理在脓毒性患者早期连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)中的意义。方法选择因脓毒症在嘉兴市第二医院重症监护病房(intensive care unit,icu)住院治疗并拟实施CRRT治疗的患者为研究对象,随机分为对照组及超声组,对照组使用常规方法进行CRRT液体管理,超声组通过超声监测下腔静脉内径呼吸变异率指导CRRT液体管理。收集患者一般资料,比较2组患者CRRT上机前及治疗24、48及72小时的血流动力学和血气分析指标,分析2组患者临床预后指标。结果共纳入60例患者,对照组及超声组各30例,与对照组相比较,CRRT治疗早期,超声组血管活性药物使用剂量更少(F=1.255,P<0.001)、中心静脉压更低(F=18.618,P<0.001)。预后指标表明:超声组CRRT治疗时间更少(t=3.103,P=0.004)、血管活性药物使用时间更短(t=4.775,P<0.001),28天肾脏替代治疗脱离率更高(χ^(2)=4.593,P=0.032)。结论使用超声监测下腔静脉内径呼吸变异率指导脓毒症患者CRRT早期容量管理,可以改善患者早期血流动力学指标及临床预后。

关键词：超声下腔静脉脓毒症连续性肾脏替代治疗容量

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片仔癀通过调控mir-155表达缓解LPS刺激肝脏Kupffer细胞的损伤

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中华急诊医学杂志 2024年第4期33卷 536-541页

作者：邱陆阵杨钊斌何绍珍黄道丰程小梅陈惠萍夏浩福建医科大学附属漳州市医院内科icu 福建漳州363000

目的探究片仔癀通过调控miR-155表达改善脂多糖(lipopolysaccharide,LPS)诱导的肝脏Kupffer细胞损伤的发生机制。方法LPS诱导肝脏Kupffer细胞建立细胞损伤模型,模拟脓毒症肝损伤。RT-qPCR检测损伤细胞中miR-155的表达,RT-qPCR、Western ... 详细信息

目的探究片仔癀通过调控miR-155表达改善脂多糖(lipopolysaccharide,LPS)诱导的肝脏Kupffer细胞损伤的发生机制。方法LPS诱导肝脏Kupffer细胞建立细胞损伤模型,模拟脓毒症肝损伤。RT-qPCR检测损伤细胞中miR-155的表达,RT-qPCR、Western Blot、ELISA和流式细胞术评估损伤细胞的炎症反应和细胞凋亡情况。然后用不同浓度(0 mg/L、5 mg/L、10 mg/L及15 mg/L)的片仔癀处理LPS诱导的Kupffer细胞,检测了细胞中miR-155的表达,细胞的炎症反应和凋亡率。在细胞损伤模型中沉默miR-155,RT-qPCR、Western Blot、ELISA和流式细胞术评估miR-155对模型细胞炎症反应和凋亡的影响。在片仔癀处理的损伤细胞中过表达miR-155检测细胞炎症反应和凋亡的变化。数据以均数±标准差(x±s)的表示,采用成组t检验或单因素方差分析各组数据。结果在LPS诱导肝脏Kupffer细胞损伤的模型中,miR-155的表达显著升高(P<0.05),促炎因子IL-6、TNF-α的表达水平显著增加,抗炎因子IL-10明显被抑制(P<0.05),细胞凋亡率显著升高(P<0.05)。片仔癀处理后,抑制损伤肝细胞中miR-155的表达(P<0.05),抑制细胞炎症因子IL-6、和TNF-α的水平,促进抗炎因子IL-10的表达(P<0.05),抑制细胞凋亡(P<0.05)。沉默miR-155减轻了细胞的炎症反应和凋亡率(P<0.05)。过表达miR-155可逆转片仔癀治疗肝细胞损伤的作用(P<0.05)。结论在LPS诱导肝脏Kupffer细胞损伤的模型中,片仔癀通过抑制miR-155的表达,抑制细胞的炎症反应及其凋亡。

关键词：片仔癀 miR-155 Kupffer细胞炎症反应凋亡脂多糖脓毒症肝损伤

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Host cyclophilin A facilitates SARS-CoV-2 infection by binding and stabilizing spike on virions

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Signal Transduction and Targeted Therapy 2024年第1期9卷 36-39页

作者： Xiangpeng Sheng Fang Zhu Hong Peng Fan Yang Yi Yang Cong Yang Zhen Wang Wei Chen Deyin Guo Ronggui Hu State Key Laboratory of Molecular Biology Center for Excellence in Molecular Cell ScienceShanghai Institute of Biochemistry and Cell BiologyUniversity of Chinese Academy of SciencesChinese Academy of SciencesShanghaiChina MOE Key Laboratory of Tropical Disease Control Centre for Infection and Immunity StudySchool of MedicineSun Yat-sen UniversityShenzhenChina icu Longhua Hospital Shanghai University of Traditional Chinese MedicineShanghaiChina

Dear Editor,The novel coronavirus SARS-CoV-2 rapidly evolutes to increase its infectivity and transmissibility,facilitates its immune escape,impairs vaccine efficacy,and currently causes repeated infections in human,which is mainly determined by the accumulated mutations in spike(S).1 Transmembrane S is a heavily glycosylated protein on the surface of the virion as homotrimer,responsible for binding to human angiotensin-converting enzyme 2(hACE2)receptor.2 While the architecture of S trimers has been well studied,how the stability of S is regulated by potential host factors remains unknown.

关键词： ACE2 vaccine infection

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《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》要点解读

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协和医学杂志 2024年第2期15卷 312-319页

作者：梁岩国家心血管病中心中国医学科学院阜外医院ICU北京100037

近期,美国心脏协会(American Heart Association,AHA)、美国心脏病学会(American College of Cardiology,ACC)等六大学会联合发布了《2023 AHA/ACC/ACCP/ASPC/NLA/PCNA慢性冠状动脉疾病患者管理指南》,该指南强调了“以患者为中心,以团队为基础”的总体管理理念和重视生活方式改善对慢性冠状动脉疾病患者预后的影响,并对主要心血管不良事件风险评估及新型药物推荐等作出了新的阐述,指南内容的更新对于指导我国临床医生为慢性冠状动脉疾病患者提供高质量管理具有重要指导意义。

关键词：慢性冠状动脉疾病诊断治疗管理指南

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Electroacupuncture in Treatment of Acute Gastrointestinal Injury in Patients with Severe Traumatic Brain Injury:A Multicenter Randomized Controlled Trial

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Chinese Journal of Integrative Medicine 2023年第8期29卷 721-729页

作者： XING Xi JIANG Rong-lin LEI Shu ZHI Yi-hui ZHU Mei-fei HUANG Li-quan HU Ma-hong LU Jun FANG Kun WANG Qiu-yan department of icu the First Affiliated Hospital of Zhejiang University of Traditional Chinese MedicineHangzhou(310000)China department of icu Tongde Hospital of ZhejiangTongdeZhejiang Province(310000)China department of icu Xinhua Hospital of ZhejiangHangzhou(310000)China department of icu Zhejiang integrated Traditional Chineseand Western Medicine HospitalHangzhou(310000)China department of icu Hangzhou Hospital of Traditional Chinese MedicalHangzhou(310000)China

Objective: To evaluate whether electroacupuncture(EA) would improve gastrointestinal function and clinical prognosis in patients with severe traumatic brain injury(TBI) complicocted by acute gastrointestinal injury(AGI). Methods: This multicenter, single-blind trial included patients with TBI and AGI admitted to 5Chinese hospitals from September 2018 to December 2019. A total of 500 patients were randomized to the control or acupuncture groups using a random number table, 250 cases in each group. Patients in the control group received conventional treatment, including mannitol, nutritional support, epilepsy and infection prevention, and maintenance of water, electrolytes, and acid-base balance. While patients in the acupuncture group received EA intervention at bilateral Zusanli(ST 36), Shangjuxu(ST 37), Xiajuxu(ST 39), Tianshu(ST 25), and Zhongwan(RN 12) acupoints in addition to the conventional treatment, 30 min per time, twice daily,for 7 d. The primary endpoint was 28-d mortality. The secondary endpoints were serum levels of D-lactic acid(D-lac), diamine oxidase(DAO), lipopolysaccharide(LPS), motilin(MTL) and gastrin(GAS), intra-abdominal pressure(IAP), bowel sounds, abdominal circumference, AGI grade, scores of gastrointestinal failure(GIF),Glasgow Coma Scale(GCS), Acute Physiology and Chronic Health Evaluation(APACHE Ⅱ), Sequential Organ Failure Assessment(SOFA), and Multiple Organ Dysfunction Syndrome(MODS), mechanical ventilation time,intense care unit(icu) stay, and the incidence of hospital-acquired pneumonia. Results: The 28-d mortality in the acupuncture group was lower than that in the control group(22.80% vs. 33.20%, P<0.05). Compared with the control group, the acupuncture group at 7 d showed lower GIF, APACHE Ⅱ, SOFA, MODS scores, D-lac,DAO, LPS, IAP, and abdominal circumference and higher GCS score, MTL, GAS, and bowel sound frequency(all P<0.05). In addition, the above indices showed simillar changes at 7 d compared with days 1 and 3 in the EA group(all P<0.05). Conclusion: Early EA can improve

关键词： electroacupuncture traumatic brain injury acute gastrointestinal injury multicenter randomized controlled trial

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icu重症患者出现获得性衰弱的预测模型与验证

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临床研究 2024年第1期32卷 8-12页

作者：徐金丽睢县中医院icu 河南商丘476900

目的探讨重症监护室(icu)内重症患者出现获得性衰弱的独立影响因素,构建预测模型并实施预测效果的验证。方法选择2017年1月至2022年12月期间睢县中医院icu接诊治疗的患者368人的数据实施回顾性分析。采集发生icu获得性衰弱患者的资料,... 详细信息

目的探讨重症监护室(icu)内重症患者出现获得性衰弱的独立影响因素,构建预测模型并实施预测效果的验证。方法选择2017年1月至2022年12月期间睢县中医院icu接诊治疗的患者368人的数据实施回顾性分析。采集发生icu获得性衰弱患者的资料,进行单因素分析、多因素分析以及预测模型构建和预测效能分析。结果纳入本次调查的368名患者中,有189名患者判定为出现icu获得性衰弱,发生率为51.36%。单因素分析结果显示,出现和未出现icu获得性衰弱患者的入驻icu时间长度,急性生理与慢性健康评分(APACHEⅡ)评分,使用神经肌肉阻滞剂情况,血乳酸最高值的数据差异有统计学意义(Picu时间长度,APACHEⅡ评分,使用神经肌肉阻滞剂情况,血乳酸最高值是患者发生icu获得性衰弱的独立影响因素,差异有统计学意义(Picu获得性衰弱的情况进行受试者特征曲线(ROC)曲线的预测,约登指数分别为19.97%、32.92%、15.11%、37.30%、47.20%。结论icu患者具有较高的获得性衰弱发生风险,若干因素均是该种病变出现的影响因素。利用这些影响因素构建的预测模型具有良好的预测效能,另外需要在工作中对这些影响因素进行监控,以便早期发现和干预。

关键词：重症监护室获得性衰弱预测模型神经肌肉系统呼吸衰竭

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西维来司他钠联合气道压力释放通气治疗创伤所致重度ARDS的临床疗效观察

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临床研究 2024年第2期32卷 49-52页

作者：马静李长力赵聪源周小超南阳市中心医院综合icu 河南南阳473001

目的探讨西维来司他钠、气道压力释放通气治疗由创伤导致重度急性呼吸窘迫综合征(ARDS)的疗效。方法选取南阳市中心医院2020年1月至2022年12月期间收治80例重度ARDS患者,依照随机抽签的方法分成两组,各40例。对照组应用气道压力释放通... 详细信息

目的探讨西维来司他钠、气道压力释放通气治疗由创伤导致重度急性呼吸窘迫综合征(ARDS)的疗效。方法选取南阳市中心医院2020年1月至2022年12月期间收治80例重度ARDS患者,依照随机抽签的方法分成两组,各40例。对照组应用气道压力释放通气治疗,观察组在此基础上加用西维来司他钠,比较两组血气、炎性因子、血流动力学指标和预后。结果治疗前,两组动脉二氧化碳分压(PaCO_(2))、动脉氧分压(PaO_(2))、PaO_(2)/吸入氧浓度(FiO_(2))值比较,差异无统计学意义(P>0.05);治疗24 h、治疗72 h后,两组PaCO_(2)值均低于治疗前,PaO_(2)、PaO_(2)/FiO_(2)值均高于治疗前,且观察组PaCO_(2)值低于对照组,观察组PaO_(2)、PaO_(2)/FiO_(2)值高于对照组,差异有统计学意义(P0.05);治疗后,两组IL-6、PCT、CRP值均低于治疗前,且观察组IL-6、PCT、CRP值均低于对照组,差异有统计学意义(P0.05);治疗24 h、治疗72 h后,对照组CVP、HR、MAP值均低于治疗前,观察组HR低于治疗前,MAP治疗24 h低于治疗前,差异有统计学意义(P0.05);治疗后,两组APACHEⅡ评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。结论西维来司他钠、气道压力释放通气治疗创伤所致重度ARDS成效佳,能改善血气、炎性因子及血流动力学指标,提高预后。

关键词：西维来司他钠重度急性呼吸窘迫综合征气道压力释放通气炎性因子

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