To the Editor:We read with great interest the article by Yang et al.[1]evaluating the effects of postoperative serum total cholesterol(s TC)changes on early allograft dysfunction and survival after living donor liver ...To the Editor:We read with great interest the article by Yang et al.[1]evaluating the effects of postoperative serum total cholesterol(s TC)changes on early allograft dysfunction and survival after living donor liver transplantation(LDLT).By the multivariate regression analysis,they showed that patients with s TC<1.42 mmol/L on postoperative day 3 had 4.08-fold and 2.72-fold greater risks of展开更多
Background： Ischemia preconditioning （IPC） remains the most powerful intervention of protection against myocardial ischemiaJreperfusion injury （IRI）, but diabetes can weaken or eliminate its cardioprotective effe...Background： Ischemia preconditioning （IPC） remains the most powerful intervention of protection against myocardial ischemiaJreperfusion injury （IRI）, but diabetes can weaken or eliminate its cardioprotective effect and detailed mechanisms remain unclear. In this study, we aimed to explore whether changes of autophagy in the diabetic condition are attributable to the decreased cardioprotective effect of I PC. Methods： Sixty diabetic male Sprague-Dawley rats were randomly divided into the control （C）, IRI, rapamycin （R）, wortmannin （W）, rapamycin ＋ IPC （R ＋ IPC）, and wortmannin ＋ IPC （W ＋ IPC） groups. The in vivo rat model of myocardial IRI was established by ligaturing and opening the left anterior descending coronary artery via the left thoracotomy. Durations of ischemia and reperfusion are 30 min and 120 min, respectively. Blood samples were taken at 120 min of reperfusion for measuring serum concentrations of troponin I （TnI） and creatine kinase isoenzyme MB （CK-MB） using the enzyme-linked immunosorbent assay. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. The expressions ofLC3-11, beclin- 1, phosphoinositide 3-kinase （PI3K）, naammalian target of rapamycin （mTOR）, and P-Akt/Akt ratio in the ischemic myocardium were assessed by Western blotting. Results： Compared to the IRI group, infarct size （56.1% ± 6.1% vs. 75.4 ± 7.1%, P 〈 0.05）, serum cTnl （0.61 ± 0.21 vs. 0.95 ±0.26 ng/ml, P 〈 0.05）, and CK-MB levels （6.70 ± 1.25 vs. 11.51 ±2.35 ng/ml, P 〈 0.05） obviously decreased in the W ＋ IPC group. Compared with the C group, myocardial expressions of LC3-11 （0.46 ± 0.04 and 0.56 ± 0.04 vs. 0.36 ± 0.04, P 〈 0.05） and beclin- 1 （0.34 ± 0.08 and 0.38 ± 0.07 vs. 0.24 ±0.03, P 〈 0.05） evidently increased, and myocardial expressions of mTOR （0.26 ± 0.08 and 0.25 ± 0.07 vs. 0.38 ± 0.06, P 〈 0.05）, PI3K （0.29 ± 0.04 and 0.30 ±0.03 vs. 0.38 ± 0.02, P 〈 0.05）, and P-Akt/Akt ratio （0.49 ± 0.10 and 0.48 ± 0.06 vs. 0.72 ± 0.07, P 〈 0.05） markedly decreased in the IRI and R groups, indicating an increased autophagy. Compared with the IRI group, myocardial expression ofbeclin- 1 （0.26 ± 0.03 vs. 0.34 ± 0.08, P 〈 0.05） significantly decreased, and myocardial expressions of mTOR （0.36 ± 0.04 vs. 0.26 ± 0.08, P 〈 0.05）, PI3K （0.37 ± 0.03 vs. 0.29 ± 0.04, P 〈 0.05）, and P-Akt/Akt ratio （0.68 ± 0.05 vs. 0.49 ± 0.10, P 〈 0.05） increased obviously in the W ＋ IPC group, indicating a decreased autophagy. Conclusions： Increased autophagy in the diabetic myocardium is attributable to decreased cardioprotection of IPC, and autophagy inhibited by activating the PI3K-Akt-mTOR signaling pathway can result in an improved protection of IPC against diabetic myocardial IRI.展开更多
Objective：UEscope is a new angulated videolaryngoscope （VL）.This review aimed to describe the features of UEscope and provide clinical evidences regarding the efficacy and safety of this video device in adult trach...Objective：UEscope is a new angulated videolaryngoscope （VL）.This review aimed to describe the features of UEscope and provide clinical evidences regarding the efficacy and safety of this video device in adult tracheal intubation and its roles in airway management teaching.Data Sources：The Wan Fang Data,CNKI,PubMed,Embase,Cochrane Library,and Google Scholar were searched for relevant English and Chinese articles published up to January 15,2017,using the following keywords：＂HC video laryngoscope＂,＂UE videolaryngoscope＂,＂video laryngoscope＂,and ＂videolaryngoscopy＂.Study Selection：Human case reports,case series,observable studies,and randomized controlled clinical trials were included in our search.The results of these studies and their reference lists were cross-referenced to identify a common theme.Results：UEscope features the low-profile portable design,intermediate blade curvatures,all-angle adjustable monitor,effective anti-fog mechanisms,and built-in video recording function.During the past 5 years,there have been a number of clinical studies assessing the application and roles of UEscope in airway management and education.As compared with direct laryngoscope,UEscope improves laryngeal visualization,decreases intubation time （IT）,and increases intubation success rate in adult patients with normal and difficult airways.These findings are somewhat different from the previous results regarding the other angulated VLs;they can provide an improved laryngeal view,but no conclusive benefits with regard to IT and intubation success rate.Furthermore,UEscope has extensively been used for intubation teaching and shown a number of advantages.Conclusions：UEscope can be used as a primary intubation tool and may provide more benefits than other VLs in patients with normal and difficult airways.However,more studies with large sample are still needed to address some open questions about clinical performance of this new VL.展开更多
Background： Oxygen-glucose deprivation-nutrition resumption （OGD-NR） models on H9c2 cells are commonly used in vitro models of simulated myocardial ischemia-reperfusion injury （M1RI）, but no study has assessed wh...Background： Oxygen-glucose deprivation-nutrition resumption （OGD-NR） models on H9c2 cells are commonly used in vitro models of simulated myocardial ischemia-reperfusion injury （M1RI）, but no study has assessed whether these methods for establishing in vitro models can effectively imitate the characteristics of MIRI in vivo. This experiment was designed to analyze the feasibility of six OGD-NR models of MIRI. Methods： By searching the PubMed database using the keywords ＂myocardial reperfusion injury H9c2 cells,＂ we obtained six commonly used OGD-NR in vitro models of MIRI performed on H9c2 cells from more than 400 published papers before January 30, 2017. For each model, control （C）, simulated ischemia （SI）, and simulated ischemia-reperfusion （SIR） groups were assigned, and cell morphology, lactate dehydrogenase （LDH） release, adenosine triphosphate （ATP） levels, reactive oxygen species （ROS）, mitochondrial membrane potential （MMP）, and inflammatory cytokines were examined to evaluate the characteristics of cell injury. Subsequently, a coculture system of cardiomyocyte-endothelial-macrophage was constructed. The coeulture system was dealt with SI and SIR treatments to test the effect on cardiomyocytes survival. Results： For models l, 2, 3, 4, 5, and 6, SI treatment caused morphological damage to cells, and subsequent SIR treatment did not cause further morphological damage. In the models 1, 2, 3, 4, 5 and 6, LDH release was significantly higher in the SI groups than that in the C group （P 〈 0.05）, and was significantly lower in the SIR groups than that in the SI groups （P 〈 0.05）, except tbr no significant differences in the LDH release between C, SI and SIR groups in model 6 receiving a 3-h SI treatment. In models 1, 2, 3, 4, 5, and 6, compared with the C group, ATP levels of the S1 groups significantly decreased （P 〈 0.05）, ROS levels increased （P 〈 0.05）, and MMP levels decreased （P 〈 0.05）. Compared with the SI group, ATP level of the SIR groups was significantly increased （P 〈 0,05）, and there was no significant ROS production, MMP collapse, and over inflammatory response in the SIR groups. In a coculture system of H9c2 cells-endothelial cells-macrophages, the proportion of viable H9c2 cells in the SIR groups was not reduced compared with the SI groups. Conclusion： All the six OGD-NR models on H9c2 cells in this experiment can not imitate the characteristics of MIRI in vivo and are not suitable for MIRl-related study.展开更多
To the Editor： In a single-center, prospective, randomized double-blind clinical study comparing dexmedetomidine- midazolam and sufentanil-midazolam sedation regimens for awake fiberoptic intubation （AFOI） in 50 pa...To the Editor： In a single-center, prospective, randomized double-blind clinical study comparing dexmedetomidine- midazolam and sufentanil-midazolam sedation regimens for awake fiberoptic intubation （AFOI） in 50 patients with difficult airways due to limited mouth opening, Li et al show that both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is a potential risk in the sufentanil-midazolam regimen. Given that AFOI has been established as the gold standard for difficult airway management, their findings have potentially clinical implications. In our view, however, there are several aspects of this study that need to be clarified and discussed.展开更多
To the Editor： We read with great interest the case report published in Chinese Medical Journal by Ma et al. who described difficult airway for patients undergoing spine surgeries. We believe that there are several i...To the Editor： We read with great interest the case report published in Chinese Medical Journal by Ma et al. who described difficult airway for patients undergoing spine surgeries. We believe that there are several issues regarding the difficult airway concepts and difficult airway management algorithm used in this article that need to be clarified.展开更多
文摘To the Editor:We read with great interest the article by Yang et al.[1]evaluating the effects of postoperative serum total cholesterol(s TC)changes on early allograft dysfunction and survival after living donor liver transplantation(LDLT).By the multivariate regression analysis,they showed that patients with s TC<1.42 mmol/L on postoperative day 3 had 4.08-fold and 2.72-fold greater risks of
文摘Background： Ischemia preconditioning （IPC） remains the most powerful intervention of protection against myocardial ischemiaJreperfusion injury （IRI）, but diabetes can weaken or eliminate its cardioprotective effect and detailed mechanisms remain unclear. In this study, we aimed to explore whether changes of autophagy in the diabetic condition are attributable to the decreased cardioprotective effect of I PC. Methods： Sixty diabetic male Sprague-Dawley rats were randomly divided into the control （C）, IRI, rapamycin （R）, wortmannin （W）, rapamycin ＋ IPC （R ＋ IPC）, and wortmannin ＋ IPC （W ＋ IPC） groups. The in vivo rat model of myocardial IRI was established by ligaturing and opening the left anterior descending coronary artery via the left thoracotomy. Durations of ischemia and reperfusion are 30 min and 120 min, respectively. Blood samples were taken at 120 min of reperfusion for measuring serum concentrations of troponin I （TnI） and creatine kinase isoenzyme MB （CK-MB） using the enzyme-linked immunosorbent assay. The infarct size was assessed by Evans blue and triphenyltetrazolium chloride staining. The expressions ofLC3-11, beclin- 1, phosphoinositide 3-kinase （PI3K）, naammalian target of rapamycin （mTOR）, and P-Akt/Akt ratio in the ischemic myocardium were assessed by Western blotting. Results： Compared to the IRI group, infarct size （56.1% ± 6.1% vs. 75.4 ± 7.1%, P 〈 0.05）, serum cTnl （0.61 ± 0.21 vs. 0.95 ±0.26 ng/ml, P 〈 0.05）, and CK-MB levels （6.70 ± 1.25 vs. 11.51 ±2.35 ng/ml, P 〈 0.05） obviously decreased in the W ＋ IPC group. Compared with the C group, myocardial expressions of LC3-11 （0.46 ± 0.04 and 0.56 ± 0.04 vs. 0.36 ± 0.04, P 〈 0.05） and beclin- 1 （0.34 ± 0.08 and 0.38 ± 0.07 vs. 0.24 ±0.03, P 〈 0.05） evidently increased, and myocardial expressions of mTOR （0.26 ± 0.08 and 0.25 ± 0.07 vs. 0.38 ± 0.06, P 〈 0.05）, PI3K （0.29 ± 0.04 and 0.30 ±0.03 vs. 0.38 ± 0.02, P 〈 0.05）, and P-Akt/Akt ratio （0.49 ± 0.10 and 0.48 ± 0.06 vs. 0.72 ± 0.07, P 〈 0.05） markedly decreased in the IRI and R groups, indicating an increased autophagy. Compared with the IRI group, myocardial expression ofbeclin- 1 （0.26 ± 0.03 vs. 0.34 ± 0.08, P 〈 0.05） significantly decreased, and myocardial expressions of mTOR （0.36 ± 0.04 vs. 0.26 ± 0.08, P 〈 0.05）, PI3K （0.37 ± 0.03 vs. 0.29 ± 0.04, P 〈 0.05）, and P-Akt/Akt ratio （0.68 ± 0.05 vs. 0.49 ± 0.10, P 〈 0.05） increased obviously in the W ＋ IPC group, indicating a decreased autophagy. Conclusions： Increased autophagy in the diabetic myocardium is attributable to decreased cardioprotection of IPC, and autophagy inhibited by activating the PI3K-Akt-mTOR signaling pathway can result in an improved protection of IPC against diabetic myocardial IRI.
文摘Objective：UEscope is a new angulated videolaryngoscope （VL）.This review aimed to describe the features of UEscope and provide clinical evidences regarding the efficacy and safety of this video device in adult tracheal intubation and its roles in airway management teaching.Data Sources：The Wan Fang Data,CNKI,PubMed,Embase,Cochrane Library,and Google Scholar were searched for relevant English and Chinese articles published up to January 15,2017,using the following keywords：＂HC video laryngoscope＂,＂UE videolaryngoscope＂,＂video laryngoscope＂,and ＂videolaryngoscopy＂.Study Selection：Human case reports,case series,observable studies,and randomized controlled clinical trials were included in our search.The results of these studies and their reference lists were cross-referenced to identify a common theme.Results：UEscope features the low-profile portable design,intermediate blade curvatures,all-angle adjustable monitor,effective anti-fog mechanisms,and built-in video recording function.During the past 5 years,there have been a number of clinical studies assessing the application and roles of UEscope in airway management and education.As compared with direct laryngoscope,UEscope improves laryngeal visualization,decreases intubation time （IT）,and increases intubation success rate in adult patients with normal and difficult airways.These findings are somewhat different from the previous results regarding the other angulated VLs;they can provide an improved laryngeal view,but no conclusive benefits with regard to IT and intubation success rate.Furthermore,UEscope has extensively been used for intubation teaching and shown a number of advantages.Conclusions：UEscope can be used as a primary intubation tool and may provide more benefits than other VLs in patients with normal and difficult airways.However,more studies with large sample are still needed to address some open questions about clinical performance of this new VL.
基金The work was supported by grants from the major projects of Scientific and Research Found of Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College （No. Z2017001） and the National Natural Science Foundation of China （No. 81470019）.
文摘Background： Oxygen-glucose deprivation-nutrition resumption （OGD-NR） models on H9c2 cells are commonly used in vitro models of simulated myocardial ischemia-reperfusion injury （M1RI）, but no study has assessed whether these methods for establishing in vitro models can effectively imitate the characteristics of MIRI in vivo. This experiment was designed to analyze the feasibility of six OGD-NR models of MIRI. Methods： By searching the PubMed database using the keywords ＂myocardial reperfusion injury H9c2 cells,＂ we obtained six commonly used OGD-NR in vitro models of MIRI performed on H9c2 cells from more than 400 published papers before January 30, 2017. For each model, control （C）, simulated ischemia （SI）, and simulated ischemia-reperfusion （SIR） groups were assigned, and cell morphology, lactate dehydrogenase （LDH） release, adenosine triphosphate （ATP） levels, reactive oxygen species （ROS）, mitochondrial membrane potential （MMP）, and inflammatory cytokines were examined to evaluate the characteristics of cell injury. Subsequently, a coculture system of cardiomyocyte-endothelial-macrophage was constructed. The coeulture system was dealt with SI and SIR treatments to test the effect on cardiomyocytes survival. Results： For models l, 2, 3, 4, 5, and 6, SI treatment caused morphological damage to cells, and subsequent SIR treatment did not cause further morphological damage. In the models 1, 2, 3, 4, 5 and 6, LDH release was significantly higher in the SI groups than that in the C group （P 〈 0.05）, and was significantly lower in the SIR groups than that in the SI groups （P 〈 0.05）, except tbr no significant differences in the LDH release between C, SI and SIR groups in model 6 receiving a 3-h SI treatment. In models 1, 2, 3, 4, 5, and 6, compared with the C group, ATP levels of the S1 groups significantly decreased （P 〈 0.05）, ROS levels increased （P 〈 0.05）, and MMP levels decreased （P 〈 0.05）. Compared with the SI group, ATP level of the SIR groups was significantly increased （P 〈 0,05）, and there was no significant ROS production, MMP collapse, and over inflammatory response in the SIR groups. In a coculture system of H9c2 cells-endothelial cells-macrophages, the proportion of viable H9c2 cells in the SIR groups was not reduced compared with the SI groups. Conclusion： All the six OGD-NR models on H9c2 cells in this experiment can not imitate the characteristics of MIRI in vivo and are not suitable for MIRl-related study.
文摘To the Editor： In a single-center, prospective, randomized double-blind clinical study comparing dexmedetomidine- midazolam and sufentanil-midazolam sedation regimens for awake fiberoptic intubation （AFOI） in 50 patients with difficult airways due to limited mouth opening, Li et al show that both dexmedetomidine and sufentanil are effective as an adjuvant for AFOI under airway topical anesthesia combined with midazolam sedation, but respiratory depression is a potential risk in the sufentanil-midazolam regimen. Given that AFOI has been established as the gold standard for difficult airway management, their findings have potentially clinical implications. In our view, however, there are several aspects of this study that need to be clarified and discussed.
文摘To the Editor： We read with great interest the case report published in Chinese Medical Journal by Ma et al. who described difficult airway for patients undergoing spine surgeries. We believe that there are several issues regarding the difficult airway concepts and difficult airway management algorithm used in this article that need to be clarified.
