Validation of the factors influencing family consent for organ donation in the UK

Between 2013 and 2019, there was an increase in the consent rate for organ donation in the UK from 61% to 67%, but this remains lower than many European countries. Data on all family approaches (16,896) for donation in UK intensive care units or emergency departments between April 2014 and March 2019 were extracted from the referral records and the national potential donor audit held by NHS Blood and Transplant. Complete data were available for 15,465 approaches. Consent for donation after brain death was significantly higher than for donation after circulatory death, 70% (4260/6060) vs. 60% (5645/9405), (OR 1.58, 95%CI 1.47–1.69). Patient ethnicity, religious beliefs, sex and socio-economic status, and knowledge of a patient's donation decision were strongly associated with consent (p < 0.001). These factors should be addressed by medium- to long-term strategies to increase community interventions, encouraging family discussions regarding donation decisions and increasing registration on the organ donor register. The most readily modifiable factor was the involvement of an organ donation specialist nurse at all stages leading up to the approach and the approach itself. If no organ donation specialist nurse was present, the consent rates were significantly lower for donation after brain death (OR 0.31, 95%CI 0.23–0.42) and donation after cardiac death (OR 0.26, 95%CI 0.22–0.31) compared with if a collaborative approach was employed. Other modifiable factors that significantly improved consent rates included less than six relatives present during the formal approach; the time from intensive care unit admission to the approach (less for donation after brain death, more for donation after cardiac death); family not witnessing neurological death tests; and the relationship of the primary consenter to the patient. These modifiable factors should be taken into consideration when planning the best bespoke approach to an individual family to discuss the option of organ donation as an end-of-life care choice for the patient.     

Covid-19 Pandemic: Resumption of Orthopedic Care and Medical Education

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.     

Complicaciones durante la intubación traqueal repetida en la unidad de cuidados intensivos. Estudio prospectivo,observacional comparando primera intubación y reintubación

Background of the studyThe goal of the study was to compare the incidence of complications, technical difficulty of intubation and physiologic pre-intubation status between the first intubation and reintubation performed on the same patient in an ICU.Materials and methodsThe study was approved by the ethics committee of Galicia (Santiago-Lugo, code No. 2015-012). Due to the observational, noninterventional, and noninvasive design of this study, the need for written consent was waived by the ethics committee of Galicia. Patients requiring tracheal intubation and reintubation in the ICU were included in this prospective observational study. Main endpoint was to compare the incidence of complications, physiologic pre-intubation status, and the rate of technical difficulty of intubation between the first intubation and reintubation performed on the same patient in an ICU.Results and discussion504 patients were intubated in our ICU during the study period, and 82 (16%) required reintubation. There was no difference between the first intubation and reintubation regarding number of total complication (35% vs 33%; P = .86), hypotension (24% vs 24%; P = 1), hypoxia (26% vs 26%; P = 1), esophageal intubation (1% vs 1%; P = 1), and bronchoaspiration (2% vs 1%; P = .86). Physiologic pre-intubation status and technical difficulty of intubation did not differ between the first intubation and reintubation.ConclusionsIn our ICU patients requiring tracheal reintubation, incidence of complications, physiologic pre-intubation status, and technical difficulty of intubation did not differ between the first intubation and reintubation.     

Proteína C reactiva y escala SOFA: una simple escala como factor predictivo temprano de la necesidad de cuidados críticos en los pacientes con neumonía causada por COVID-19 en España

ObjectiveTo identify potential markers at admission predicting the need for critical care in patients with COVID-19 pneumonia.Material and methodsAn approved, observational, retrospective study was conducted between March 15 to April 15, 2020. 150 adult patients aged less than 75 with Charlson comorbidity index ≤ 6 diagnosed with COVID-19 pneumonia were included. Seventy-five patients were randomly selected from those admitted to the critical care units (critical care group [CG]) and seventy-five hospitalized patients who did not require critical care (non-critical care group [nCG]) represent the control group. One additional cohort of hospitalized patients with COVID-19 were used to validate the score.Measurements and main resultsMultivariable regression showed increasing odds of in-hospital critical care associated with increased C-reactive protein (CRP) (odds ratio 1.052 [1.009-1.101]; P = .0043) and higher Sequential Organ Failure Assessment (SOFA) score (1.968 [1.389-2.590]; P < .0001), both at the time of hospital admission. The AUC-ROC for the combined model was 0.83 (0.76-0.90) (vs AUC-ROC SOFA P < .05). The AUC-ROC for the validation cohort was 0.89 (0.82-0.95) (P > 0.05 vs AUC-ROC development).ConclusionPatients COVID-19 presenting at admission SOFA score ≥ 2 combined with CRP ≥ 9,1 mg/mL could be at high risk to require critical care.     

非靶向代谢组学揭示天葵不同部位差异代谢物及其主要代谢途径

目的:利用非靶向代谢组学挖掘天葵非药用部位潜在的药用价值。方法:以天葵茎、叶、花为材料,利用超高效液相色谱-质谱法对其进行非靶向代谢组学分析。结果:天葵茎、叶、花中共鉴定出16大类101个差异代谢物(DAMs),其中包含羧酸及其衍生物、有机含氧化合物、脂质、苯及其取代衍生物、生物碱、黄酮类、萜类、苯丙素类、酚酸类、核苷酸、有机盐、内酯、有机酸、内源性植物激素、氨基酸和13个其他物质。通过聚类和京都基因与基因组百科全书(KEGG)分析发现,天葵不同部位的DAMs代谢模式存在一定的差异;其主要代谢途径为苯丙氨酸代谢途径、ABC转运途径、氨酰-tRNA合成途径及苯丙氨酸、酪氨酸和色氨酸生物合成途径。结论:通过天葵不同部位间DAMs的鉴定及其生物合成途径的分析,确定天葵茎、叶、花富含多种具有药用功效的代谢活性物质,可为天葵茎、叶、花的资源开发利用提供参考。     

基于Raf-MEK-ERK信号通路探究梓醇对蛛网膜下腔出血大鼠脑组织损伤的影响

[目的] 通过考察梓醇对蛛网膜下腔出血（SAH）大鼠脑组织丝/苏氨酸蛋白激酶（Raf）-丝裂原活化蛋白激酶（MEK）-细胞外调节蛋白激酶（ERK）信号通路的影响,探讨其抗SAH脑损伤的作用机制。[方法] 将大鼠随机分为假手术组、SAH组、梓醇组、梓醇+U0126组（梓醇+Raf-MEK-ERK信号通路抑制剂U0126）。采用血管内穿孔法构建大鼠SAH模型,评估大鼠神经功能和SAH分级,伊文思蓝（EB）检测血脑屏障通透性,苏木素-伊红（HE）染色观察脑组织病理变化,免疫荧光染色检测神经元细胞凋亡及微管连接蛋白轻链3-Ⅱ（LC3-Ⅱ）、p-ERK阳性细胞表达,蛋白免疫印迹（Western blot）检测脑组织Raf、MEK、磷酸化（p）-MEK、ERK1/2、p-ERK1/2、B细胞淋巴瘤-2（Bcl-2）、Bcl-2相关X蛋白（Bax）、自噬基因Beclin-1、LC3-Ⅱ表达。[结果] 与假手术组相比,SAH组神经元细胞排列松散,数目减少,SAH分级、脑组织含水量、EB渗出量、原位末端标（TUNEL）阳性细胞数显著增加,凋亡率、LC3-Ⅱ、p-ERK阳性表达、Bax、Beclin-1、LC3-Ⅱ、Raf、p-MEK/MEK、p-ERK1/2/ERK1/2表达显著升高,神经功能评分减少,Bcl-2蛋白表达降低（P<0.05）;与SAH组相比,梓醇组神经元损伤明显减轻,细胞死亡较少,SAH分级、脑组织含水量、EB渗出量、TUNEL阳性细胞数显著减少,凋亡率、Bax显著降低,神经功能评分、Bcl-2表达升高,LC3-Ⅱ、p-ERK阳性表达及Beclin-1、LC3-Ⅱ、Raf、p-MEK/MEK、p-ERK1/2/ERK1/2表达进一步升高（P<0.05）;Raf-MEK-ERK通路抑制剂U0126可逆转梓醇对脑组织损伤的改善作用（P<0.05）。[结论] 梓醇可能通过激活Raf-MEK-ERK信号通路,促进神经细胞自噬,改善SAH大鼠脑损伤。     

膜肾1号方对大鼠肾脏病理及PI3K/Akt/mTOR信号通路表达的影响

[目的] 观察膜肾1号方对膜性肾病大鼠肾脏病理的改善作用及其对自噬通路磷脂肌醇3-激酶（PI3K）/蛋白激酶B（AKT）/雷帕霉素靶蛋白（mTOR）相关蛋白表达的影响。[方法] 将大鼠随机分为对照组、模型组、膜肾1号方高剂量组、中剂量组、低剂量组,盐酸贝那普利组。采用大鼠尾静脉注射阳离子化牛血清白蛋白（C-BSA）的方法建立MN大鼠模型,灌胃、取材。苏木精-伊红（HE ）染色法观察大鼠肾脏组织病理改变;免疫球蛋白G（IgG）免疫荧光染色观察大鼠IgG沉积;蛋白免疫印迹法（Western Blot）检测PI3K/Akt/mTOR 信号通路相关蛋白及自噬相关蛋白轻链3（LC3）表达。[结果] 药物干预后,膜肾1号方组大鼠24 h尿蛋白、三酰甘油、总胆固醇、低密度脂蛋白下降且低于模型组,并具有统计学差异（P＜0.05）。光镜下观察,HE染色示正常组肾组织整体结构基本正常,膜性肾病（MN）模型组肾小球毛细血管丛充血,系膜增生,基底膜出现增厚,部分肾小管细胞空泡变、组织内可见炎症细胞浸润,可见嗜复红蛋白及IgG沉积。经膜肾1号方和盐酸贝那普利干预后,大鼠肾脏病理学改变均有所减轻。各组大鼠IgG沉积显示,与对照组比较模型组IgG沉积明显,IgG荧光表达升高,差异具有统计学意义（P＜0.05）,盐酸贝那普利组和膜肾1号方组IgG荧光表达下降且低于模型组,具有统计学差异（P＜0.05）。Western Blot检测显示,药物干预后,盐酸贝那普利组和膜肾1号方组大鼠PI3K-Akt信号通路相关蛋白表达下降,LC3 表达增加,并具有统计学差异（P＜0.05）。[结论] 膜肾1号方可改善大鼠肾脏病理损伤,膜肾1号方干预后PI3K-Akt信号通路相关蛋白磷酸化磷酸肌醇3激酶（p-PI3K）,磷酸化Akt蛋白（p-Akt）,磷酸化雷帕霉素靶蛋白（p-mTOR）表达明显降低,自噬相关蛋白LC3表达升高,其分子机制与自噬信号通路的调控有关。     

仙鹤草茎与叶的代谢组学比较分析

目的 通过代谢组学分析仙鹤草茎与叶中代谢物及其代谢通路差异,进一步阐明仙鹤草药效物质基础,促进仙鹤草合理开发利用。方法 取仙鹤草茎、叶新鲜样本,经液氮冷冻后提取代谢物,采用液相色谱-质谱法检测,所得数据运用统计学方法分析并与数据库比对鉴定。结果 筛选并鉴定出105个具有明显差异的代谢物,其中茎与叶相比有34个代谢物上调、71个代谢物下调。差异代谢物共注释到62条代谢通路中。茎中叶黄素、天冬酰胺、胍丁胺及多种氨基酸等物质含量更高,氨基酸代谢更强;叶中酚酸类、黄酮类物质积累更为丰富,次生代谢更强。结论 仙鹤草茎与叶均含有丰富的药效活性成分,但叶的次生代谢更强,次生代谢物积累更为丰富,此差异或可为仙鹤草针对性开发利用提供参考。     

小檗碱通过抑制凋亡和炎症减轻大鼠慢性萎缩性胃炎病变的效果

目的：探究小檗碱对慢性萎缩性胃炎(CAG)的改善作用及其作用机制。方法：将SD大鼠随机分为对照组、模型组、小檗碱低剂量组、小檗碱中剂量组、小檗碱高剂量组和DUSP19组,每组9只。除对照组外均构建CAG模型,小檗碱低、中、高剂量分别灌胃给与25、50、100 mg/kg的小檗碱,DUSP19组灌胃给与100 mg/kg的小檗碱和尾静脉注射JAK激酶2/信号转导及转录激活因子3（JAK2/STAT3）通路激活剂DUSP19 100 μmol/L。苏木精-伊红（HE）染色法检测病理学变化;蛋白质印迹法检测JAK2/STAT3信号通路及凋亡相关蛋白表达;酶联免疫吸附试验（ELISA）检测血清相关因子表达水平;原位末端转移酶标记技术（TUNEL）检测胃黏膜细胞凋亡。结果：与模型组比较,小檗碱观察组磷酸化JAK2（p-JAK2）、磷酸化JAK3（p-JAK3）、胃动素（MTL）、肿瘤坏死因子-α（TNF-α）、白细胞介素6（IL-6）、白细胞介素-1β（IL-1β）、前列腺素E2（PGE2）、内皮素（ET）、B淋巴细胞瘤-2相关X蛋白（Bax）、裂解胱天蛋白酶3（Cl-caspase-3）、裂解胱天蛋白酶9（Cl-caspase-9）水平及细胞凋亡率显著降低(P<0.05),胃泌素（GAS）、分泌型免疫球蛋白A（sIgA）、谷胱甘肽（GSH）、B淋巴细胞瘤-2（Bcl-2）水平显著升高(P<0.05);JAK2/STAT3通路激活剂DUSP19可显著扭转小檗碱对上述指标的影响(P<0.05),且HE结果显示小檗碱可显著改善CAG大鼠胃组织病理病变。结论：小檗碱可通过JAK2/STAT3信号通路抑制细胞凋亡和炎症反应减轻大鼠慢性萎缩性胃炎。