BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients...BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.AIM To ascertain whether the combination of PH and GDFT improves clinical recovery indicators,reduces postoperative complications,and alleviates anxiety,depression,and inflammatory responses in this specific patient population.METHODS A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups:A control group(n=60)and a study group(n=60).In the control group,conventional anesthesia ventilation and fluid management protocols were administered,while in the study group,PH(with intraoperative PaCO_(2) maintained between 45-55 mmHg)was combined with GDFT.Postoperative recovery indicators,including the time to first flatus,time to ambulation,and length of hospital stay,were compared between the groups.Additionally,complication rates,anxietydepression scores assessed via the Hospital Anxiety and Depression scale,and levels of inflammatory factors were analyzed to evaluate the outcomes.RESULTS When compared with the control group,the study group demonstrated significantly shorter time to first flatus[(48.3±6.2)hours vs(62.5±7.8)hours],time to ambulation[(28.4±4.2)hours vs(38.6±5.1)hours],and length of hospital stay[(5.2±1.1)days vs(7.4±1.3)days](P<0.05).A significantly lower postoperative complication rate was observed in the study group(8.3%vs 21.7%,P<0.05).Additionally,at 3 days postoperatively,significantly lower anxiety scores[(5.2±1.4)vs(7.8±1.6)]and depression scores[(4.8±1.2)vs(7.1±1.5)]were recorded in the study group compared to the control group(P<0.05);Furthermore,at 24 hours postoperatively,serum levels of interleukin-6,tumor necrosis factorα,and C-reactive protein were found to be significantly lower in the study group than in the control group(P<0.05).CONCLUSION Postoperative recovery is significantly expedited,postoperative complications are markedly reduced,anxietydepression status is substantially improved,and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT,thereby making it worthy of clinical application.展开更多
Objective: To observe the pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia, and to explore the role of endoplasmic reticulum stress in pulmonary hypertension. Method...Objective: To observe the pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia, and to explore the role of endoplasmic reticulum stress in pulmonary hypertension. Methods: 1) 40 SD rats were randomly divided into four groups: normoxic control group (N), hypoxia hypercapnia group (HH), endoplasmic reticulum stress (ERS) inhibitor 4-phenyl butyric acid group (4-PBA), ERS pathway agonist tunicamycin group (TM). 2) The mean pulmonary arterial pressure (mPAP) and the right ventricular hypertrophy index (RV/(LV + S)) were measured in each group. 3) Identification of pulmonary artery smooth muscle cells (PASMCs) in each group by immunofluorescence α-SMA. 4) Morphological changes of lung tissue and pulmonary artery were observed by electron microscope. 5) The apoptotic index of PASMCs in each group was detected by TUNEL. 6) Reverse transcription polymerase chain reaction (RT-PCR) and Western Blot (WB) were used to detect the expression of ERS related protein and mRNA (GRP78, CHOP, JNK, Caspase-12) in each group. Results: 1) Compared with the N group, the mPAP, RV/(LV + S) and vascular wall area (WA)/total area (TA) value of HH group, 4-PBA group and TM group were increased (P < 0.01), and the vascular lumen area (LA)/TA values, PASMCs apoptosis index were significantly decreased. GRP78, CHOP, JNK, Caspase-12 expression were increased, and the differences were statistically significant. 2) Compared with the HH group, the mPAP, RV/(LV + S) and WA/TA of 4-PBA group were decreased (P < 0.01);the LA/TA value and PASMCs apoptosis index were increased (P < 0.05);and the mRNA and protein expression of CHOP, JNK, Caspase-12 and GRP78 had a significant decrease (P < 0.05). 3) Compared with the HH, the mPAP, RV/(LV + S) and WA/TA of TM group were increased (P P P < 0.01);and? PASMCs apoptotic index was increased (P < 0.01). Meanwhile, the mRNA expression of Caspase-12, CHOP, JNK and GRP78 was increased to varying degrees (P < 0.05), and the protein expression of Caspase-12, CHOP and JNK was also increased significantly (P Conclusion: Hypoxia and hypercapnia induced pulmonary vascular remodeling may be related to the proliferation of PASMCs, and ERS related factors (JNK, Caspase12 and CHOP) are involved in the regulation of hypoxic hypercapnia.展开更多
Pulmonary arterial hypertension (PAH) is a serious disease which is characterized by increased vascular resistance and pressure. We have previously hypothesized that panax notoginseng saponins (PNS) might attenuate pu...Pulmonary arterial hypertension (PAH) is a serious disease which is characterized by increased vascular resistance and pressure. We have previously hypothesized that panax notoginseng saponins (PNS) might attenuate pulmonary vasoconstriction under hypoxia and hypercapnia condition. This study aims to investigate the effect of notoginsenoside R<sub>g1</sub>, a main ingredient of PNS, with various concentrations (8, 40, 100 mg/L, respectively) on extracellular signal regulated kinase (ERK1/2) signaling pathway in pulmonary arterial smooth muscle cells (PASMCs). In addition, PASMCs were randomly divided into six groups: SD rat under normoxic condition as control group (N group), hypoxia hypercapnia group (H group), DMSO control group (HD group), R<sub>g1</sub>-treatment groups (R<sub>gL</sub>R<sub>gM</sub> and R<sub>gH</sub> group). Western-blot and RT-PCR were used to test the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA. This study provided the evidence that the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA in HD group and H group were obviously higher than that in N group (P < 0.01), Whereas the level of ERK1/2 mRNA in R<sub>g1</sub>-treatment groups was significantly lower than that in HD group and H group (P < 0.01), and the proper concentration of R<sub>g1</sub> is 40 mg/L. These results suggested that notoginsenoside R<sub>g1</sub> can attenuate pulmonary vasoconstriction which may lead to HHPV through reducing the expression of ERK1/2.展开更多
The changes of the structure and content of the erythrocyte membrane band 3 protein and its function of anion transport and blood gases inside and out of the erythrocytes were observed under isobaric hypoxia and hypox...The changes of the structure and content of the erythrocyte membrane band 3 protein and its function of anion transport and blood gases inside and out of the erythrocytes were observed under isobaric hypoxia and hypoxia-hypercapnia in rats. It was found t展开更多
Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should b...Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should be considered as a rare differential diagnosis of hypercapnia.Methods We report a sporadic case of a 14-year-old Chinese girl with a de novo p.Pro209 Leu mutation in BAG3 and reviewed the literatures for reported cases related to this mutation.Results We described a 14-year-old Chinese girl who presented with gradually appearing symptoms of hypercapnia that required assisted ventilation.The muscle biopsy and the blood whole-exome sequencing results confirmed the diagnosis of myofibrillar myopathy with a de novo p.Pro209 Leu mutation in BAG3.Totally twentyone patients from twenty families with a confirmed diagnosis of BAG3-related myopathy were reported to date,including this patient and literature review.The male to female ratio was 11:10 and most showed initial symptoms in the first decade of life.Most patients presented toe/clumsy walking or running as the onset symptom,followed by muscle weakness or atrophy.Creatine kinase levels were elevated in fourteen patients and were normal in three.Eighteen patients developed respiratory insufficiency during the disease course and thirteen(one could not tolerate non-invasive assisted ventilation)required non-invasive assisted ventilation for treatment.Except for one not reported,heart involvement was found in seventeen patients during the disease course and seven underwent heart transplantation.Z-disk streaming and aggregation could be observed in most of the patients’muscle histology.In the long-term follow-up,five patients died of cardiac or respiratory failure.Conclusion BAG3-associated myopathy is a rare type of myofibrillar myopathy.It should be considered as a rare differential diagnosis of hypercapnia.展开更多
Notoginsenoside R1, the main active ingredient of Panax notoginseng saponins (PNS), has been proposed to play fatal roles in the development of hypoxic hypercapnia-induced pulmonary vasoconstriction (HHPV). Subsequent...Notoginsenoside R1, the main active ingredient of Panax notoginseng saponins (PNS), has been proposed to play fatal roles in the development of hypoxic hypercapnia-induced pulmonary vasoconstriction (HHPV). Subsequently, pulmonary arterial smooth muscle cells (PASMCs) lead to pulmonary vascular system remodeling and chronic pulmonary disease in the development of HHPV. Despite considerable studies have contributed to pulmonary disease, the mechanism of how Notoginsenoside R1 affects HHPV remains unclear. In this view, we will discuss the effect of notoginsenoside R1 by investigating the expression of p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway in PASMCs under hypoxia and hypercapnia condition. The third order PASMCs of Sprague Dawley (SD) rats were cultured with various concentrations (8, 40, 100 mg/L, respectively) of Notoginsenoside R1. Our data showed that the protein and mRNA expression levels of p-38 MAPK were higher in hypoxic hypercapnia group compared with hypoxic DMSO and normoxia control groups (p 1 treatment groups, the level of p-p38 MAPK protein and p38 MAPK mRNA were significantly decreased with different degrees (p 1 treatment may contribute to attenuate HHPV via decreasing the protein and mRNA expression levels of p-38 MAPK.展开更多
Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of...Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration.展开更多
BACKGROUND In the obese patient population,some patients have severe obstructive sleep apnea(OSA)with daytime hypoventilation.Such patients are generally identified on the basis of the presence or absence of daytime h...BACKGROUND In the obese patient population,some patients have severe obstructive sleep apnea(OSA)with daytime hypoventilation.Such patients are generally identified on the basis of the presence or absence of daytime hypercapnia,and the condition is called obesity hypoventilation syndrome.However,mechanisms for such daytime hypoventilation remain unclear.AIM To investigate metabolic syndrome and daytime hypercapnia association based on hypercapnia prevalence in obese OSA patients in a nested case-control study.METHODS Consecutive obese patients(body mass index≥30 kg/m2)who underwent polysomnography due to suspected OSA were included.Among them,patients with severe OSA(apnea hypopnea index≥30/h)were divided into two groups according to the presence or absence of hypercapnia during wakefulness(arterial partial pressure of carbon dioxide≥or<45 Torr,respectively).The characteristics and clinical features of these two groups were compared.RESULTS Among 97 eligible patients,25 patients(25.8%)had daytime hypercapnia.There were no significant differences in age,gender,body mass index,apnea-hypopnea index,and Epworth Sleepiness Scale scores between the two groups.However,patients with hypercapnia had a significantly lower arterial partial pressure of oxygen level(75.8±8.2 torr vs 79.9±8.7 torr,P=0.042)and higher arterial partial pressure of carbon dioxide level(46.6±2.5 torr vs 41.0±2.9 torr,P<0.001).Additionally,patients with hypercapnia were more likely to have metabolic syndrome(72.0%vs 48.6%,P=0.043)and a higher metabolic score(the number of satisfied criteria of metabolic syndrome).In multivariate logistic regression analysis,the presence of metabolic syndrome was associated with the presence of hypercapnia(OR=2.85,95%CI:1.04-7.84,P=0.042).CONCLUSION Among obese patients with severe OSA,26%of patients had hypercapnia during wakefulness.The presence of metabolic syndrome was independently correlated with the presence of daytime hypercapnia.展开更多
Background:Supplemental O_(2)is often administered without knowledge of CO_(2)levels for patients with ventilatory pump failure(VPF).This can render oximetry ineffective as a gauge of alveolar ventilation,airway secre...Background:Supplemental O_(2)is often administered without knowledge of CO_(2)levels for patients with ventilatory pump failure(VPF).This can render oximetry ineffective as a gauge of alveolar ventilation,airway secretions,and lung disease.We have noted that diurnal hypoventilation with hypercapnia tends to be symptomatic when O_(2)saturation levels decrease below 95%and patients extend sleep noninvasive ventilatory support(NVS)into daytime hours.We also noted that with advancing age,less hypercapnia results in desaturation.This study was designed to explore oxyhemoglobin desaturations(O_(2)desats)as a function of age and hypercapnia for patients with VPF.Methods:A retrospective analysis of 8933 consecutive patient visits for whom end-tidal CO_(2)and O_(2)sats were measured.O_(2)sats<95%at CO_(2)levels of 45,50,and 60 cmH2O were correlated with 10 years age inter-vals to age 80.Results:Of 8933 visits,8642 had complete data.Outcomes for CO_(2)levels>50 cmH2O were the most significant including for visit-ages<30 and≥30 years.There was a statistically significant 4%decrease in the odds of O_(2)desat for every one-year increase in age to age 30(OR=0.96,95%CI=[0.93,0.99],p=0.02)and for visit-ages≥30 a significant 30%increase in the odds of O_(2)desat for every 10-year increase in age(OR 1.3,95%CI=[1.1,1.6],p=0.006).Relationship for ages≥30 years were also significant for CO_(2)levels over 45 mmHg also.40%of the time when CO_(2)was greater than 45 mmHg O_(2)sat was low.Discussion:This study demonstrated a significantly lower risk of O_(2)desat occurring at EtCO_(2)levels≥50 mmHg for patients from 10 to 20 years of age than those younger than 10 and a significantly greater risk of O_(2)desat for 10 years intervals after age 20.Thus,with age,less hypercapnia results in desats and dyspnea with patients tending to extend NVS into daytime hours.This may be due to increases in physiological shunting,decreased pulmonary elasticity,and worsening ventilation/perfusion ratios with age.展开更多
Background Therapeutic hypercapnia （TH） has been demonstrated to protect several organs ischemia-reperfusion injury.The study aimed to investigate the effects of therapeutic hypercapnia on hepatic ischemia-reperfusi...Background Therapeutic hypercapnia （TH） has been demonstrated to protect several organs ischemia-reperfusion injury.The study aimed to investigate the effects of therapeutic hypercapnia on hepatic ischemia-reperfusion injury （HIRI）.Methods Thirty adult male Wistar rats weighing （250 ± 20） g were randomized into 3 groups （n=10 in each）, group C （control group）, group A （hypercapnia group） and group B （CO2 preconditioning group）.A segmental ischemia of the liver was induced by interrupting the blood vessels including the bile duct to the median and left lateral lobes for 60 minutes and all the animals were sacrificed after 240 minutes observation period of reperfusion.Mean arterial pressure （MAP）and the blood gases were measured before ischemia （baseline） and at 30, 60, 120, 180 and 240 minutes after reperfusion.Arterial blood samples were obtained for determination of serum levels of TNF-α, IL-10, serum aspartate aminotransferase （AST） and alanine aminotransferase （ALT）.The histopathology of liver tissues was evaluated by light microscopy.The NF-κB expression and apoptotic hepatocytes were respectively determined by immunohistochemistry and TUNEL assay.Results The serum levels of liver enzymes and TNF-α were significantly decreased while the IL-10 level was significantly increased in groups A and B than in group C （P 〈0.05）, and group B surpassed group A （P 〈0.05）.The histopathological scores, the NF-κB immunohistochemical score （IHS） and apoptotic index were significantly lower in groups A and B than in group C （P 〈0.05）, and the decrease in group B was more obvious than in group A （P〈0.05）.Conclusion Therapeutic hypercapnia attenuates ischemia-reperfusion injury to the liver.Moreover, the effects of CO2preconditioning are outstandingly notable.展开更多
Background Very recent studies revealed that obstructive sleep apnoea （OSA） is a contributor of the increased incidence and mortality of cancer in humans,but mechanisms of how OSA promotes tumorigenesis remains larg...Background Very recent studies revealed that obstructive sleep apnoea （OSA） is a contributor of the increased incidence and mortality of cancer in humans,but mechanisms of how OSA promotes tumorigenesis remains largely unknown.We investigated whether intermittent hypoxia with and without hypercapnia plays a role in tumorigenesis.Methods First,Sprague-Dawley （SD） male rats （12 weeks old） were subjected to different hypoxia exposures：intermittent hypoxia and intermittent hypoxia with hypercapnia; continuous hypoxia and normal air.The systemic application of chronic fast rate hypoxia with or without hypercapnia mimicked severe OSA patients with apnoea/hypopnea index equivalent to 60 events per hour.Then routine blood tests were performed and the levels of brain derived neurotrophic factor （BDNF） and miR-34a were examined.Results In contrast to intermittent hypoxia with hypercapnia,both intermittent hypoxia and continuous hypoxia treatments caused significantly higher levels of haematology parameters than normoxia treatments.Compared to normoxia,intermittent hypoxia with hypercapnia exposure resulted in substantial decrease of serum BDNF and,miR-34a in the lower brainstem,while less pronounced results were found in intermittent hypoxia and continuous hypoxia exposure.Conclusions The exposure of intermittent hypoxia with or without hypercapnia,mimicking the situations in severe OSA patients,was associated with,or even promoted tumorigenesis.展开更多
基金Supported by the 2024 Hebei Medical Science Research Project,No.20241638Key Research and Development Program of Zhangjiakou City,No.2311041D.
文摘BACKGROUND An investigation is undertaken to assess the effects of permissive hypercapnia(PH)combined with goal-directed fluid therapy(GDFT)on postoperative recovery and psychological well-being among elderly patients undergoing laparoscopic surgical procedures.AIM To ascertain whether the combination of PH and GDFT improves clinical recovery indicators,reduces postoperative complications,and alleviates anxiety,depression,and inflammatory responses in this specific patient population.METHODS A total of 120 elderly patients who underwent laparoscopic surgery in our hospital from July 2023 to June 2024 were randomly allocated into two groups:A control group(n=60)and a study group(n=60).In the control group,conventional anesthesia ventilation and fluid management protocols were administered,while in the study group,PH(with intraoperative PaCO_(2) maintained between 45-55 mmHg)was combined with GDFT.Postoperative recovery indicators,including the time to first flatus,time to ambulation,and length of hospital stay,were compared between the groups.Additionally,complication rates,anxietydepression scores assessed via the Hospital Anxiety and Depression scale,and levels of inflammatory factors were analyzed to evaluate the outcomes.RESULTS When compared with the control group,the study group demonstrated significantly shorter time to first flatus[(48.3±6.2)hours vs(62.5±7.8)hours],time to ambulation[(28.4±4.2)hours vs(38.6±5.1)hours],and length of hospital stay[(5.2±1.1)days vs(7.4±1.3)days](P<0.05).A significantly lower postoperative complication rate was observed in the study group(8.3%vs 21.7%,P<0.05).Additionally,at 3 days postoperatively,significantly lower anxiety scores[(5.2±1.4)vs(7.8±1.6)]and depression scores[(4.8±1.2)vs(7.1±1.5)]were recorded in the study group compared to the control group(P<0.05);Furthermore,at 24 hours postoperatively,serum levels of interleukin-6,tumor necrosis factorα,and C-reactive protein were found to be significantly lower in the study group than in the control group(P<0.05).CONCLUSION Postoperative recovery is significantly expedited,postoperative complications are markedly reduced,anxietydepression status is substantially improved,and inflammatory response is notably diminished in elderly patients undergoing laparoscopic surgery when PH is combined with GDFT,thereby making it worthy of clinical application.
文摘Objective: To observe the pulmonary vascular remodeling in rats with pulmonary hypertension induced by hypoxia and hypercapnia, and to explore the role of endoplasmic reticulum stress in pulmonary hypertension. Methods: 1) 40 SD rats were randomly divided into four groups: normoxic control group (N), hypoxia hypercapnia group (HH), endoplasmic reticulum stress (ERS) inhibitor 4-phenyl butyric acid group (4-PBA), ERS pathway agonist tunicamycin group (TM). 2) The mean pulmonary arterial pressure (mPAP) and the right ventricular hypertrophy index (RV/(LV + S)) were measured in each group. 3) Identification of pulmonary artery smooth muscle cells (PASMCs) in each group by immunofluorescence α-SMA. 4) Morphological changes of lung tissue and pulmonary artery were observed by electron microscope. 5) The apoptotic index of PASMCs in each group was detected by TUNEL. 6) Reverse transcription polymerase chain reaction (RT-PCR) and Western Blot (WB) were used to detect the expression of ERS related protein and mRNA (GRP78, CHOP, JNK, Caspase-12) in each group. Results: 1) Compared with the N group, the mPAP, RV/(LV + S) and vascular wall area (WA)/total area (TA) value of HH group, 4-PBA group and TM group were increased (P < 0.01), and the vascular lumen area (LA)/TA values, PASMCs apoptosis index were significantly decreased. GRP78, CHOP, JNK, Caspase-12 expression were increased, and the differences were statistically significant. 2) Compared with the HH group, the mPAP, RV/(LV + S) and WA/TA of 4-PBA group were decreased (P < 0.01);the LA/TA value and PASMCs apoptosis index were increased (P < 0.05);and the mRNA and protein expression of CHOP, JNK, Caspase-12 and GRP78 had a significant decrease (P < 0.05). 3) Compared with the HH, the mPAP, RV/(LV + S) and WA/TA of TM group were increased (P P P < 0.01);and? PASMCs apoptotic index was increased (P < 0.01). Meanwhile, the mRNA expression of Caspase-12, CHOP, JNK and GRP78 was increased to varying degrees (P < 0.05), and the protein expression of Caspase-12, CHOP and JNK was also increased significantly (P Conclusion: Hypoxia and hypercapnia induced pulmonary vascular remodeling may be related to the proliferation of PASMCs, and ERS related factors (JNK, Caspase12 and CHOP) are involved in the regulation of hypoxic hypercapnia.
文摘Pulmonary arterial hypertension (PAH) is a serious disease which is characterized by increased vascular resistance and pressure. We have previously hypothesized that panax notoginseng saponins (PNS) might attenuate pulmonary vasoconstriction under hypoxia and hypercapnia condition. This study aims to investigate the effect of notoginsenoside R<sub>g1</sub>, a main ingredient of PNS, with various concentrations (8, 40, 100 mg/L, respectively) on extracellular signal regulated kinase (ERK1/2) signaling pathway in pulmonary arterial smooth muscle cells (PASMCs). In addition, PASMCs were randomly divided into six groups: SD rat under normoxic condition as control group (N group), hypoxia hypercapnia group (H group), DMSO control group (HD group), R<sub>g1</sub>-treatment groups (R<sub>gL</sub>R<sub>gM</sub> and R<sub>gH</sub> group). Western-blot and RT-PCR were used to test the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA. This study provided the evidence that the expression of p-ERK protein and the expression of ERK1 mRNA and ERK2 mRNA in HD group and H group were obviously higher than that in N group (P < 0.01), Whereas the level of ERK1/2 mRNA in R<sub>g1</sub>-treatment groups was significantly lower than that in HD group and H group (P < 0.01), and the proper concentration of R<sub>g1</sub> is 40 mg/L. These results suggested that notoginsenoside R<sub>g1</sub> can attenuate pulmonary vasoconstriction which may lead to HHPV through reducing the expression of ERK1/2.
文摘The changes of the structure and content of the erythrocyte membrane band 3 protein and its function of anion transport and blood gases inside and out of the erythrocytes were observed under isobaric hypoxia and hypoxia-hypercapnia in rats. It was found t
基金supported by the Youth Program of National Natural Science Foundation of China(Grant No.82003309)the National Key Research and Development Program of China(Grant 2020YFB1313700)。
文摘Objective BAG3-related myopathy is a rare condition so far reported in twenty patients worldwide.The purpose of this study was to draw attention to this rare disease and to the fact that BAG3-related myopathy should be considered as a rare differential diagnosis of hypercapnia.Methods We report a sporadic case of a 14-year-old Chinese girl with a de novo p.Pro209 Leu mutation in BAG3 and reviewed the literatures for reported cases related to this mutation.Results We described a 14-year-old Chinese girl who presented with gradually appearing symptoms of hypercapnia that required assisted ventilation.The muscle biopsy and the blood whole-exome sequencing results confirmed the diagnosis of myofibrillar myopathy with a de novo p.Pro209 Leu mutation in BAG3.Totally twentyone patients from twenty families with a confirmed diagnosis of BAG3-related myopathy were reported to date,including this patient and literature review.The male to female ratio was 11:10 and most showed initial symptoms in the first decade of life.Most patients presented toe/clumsy walking or running as the onset symptom,followed by muscle weakness or atrophy.Creatine kinase levels were elevated in fourteen patients and were normal in three.Eighteen patients developed respiratory insufficiency during the disease course and thirteen(one could not tolerate non-invasive assisted ventilation)required non-invasive assisted ventilation for treatment.Except for one not reported,heart involvement was found in seventeen patients during the disease course and seven underwent heart transplantation.Z-disk streaming and aggregation could be observed in most of the patients’muscle histology.In the long-term follow-up,five patients died of cardiac or respiratory failure.Conclusion BAG3-associated myopathy is a rare type of myofibrillar myopathy.It should be considered as a rare differential diagnosis of hypercapnia.
文摘Notoginsenoside R1, the main active ingredient of Panax notoginseng saponins (PNS), has been proposed to play fatal roles in the development of hypoxic hypercapnia-induced pulmonary vasoconstriction (HHPV). Subsequently, pulmonary arterial smooth muscle cells (PASMCs) lead to pulmonary vascular system remodeling and chronic pulmonary disease in the development of HHPV. Despite considerable studies have contributed to pulmonary disease, the mechanism of how Notoginsenoside R1 affects HHPV remains unclear. In this view, we will discuss the effect of notoginsenoside R1 by investigating the expression of p38 mitogen-activated protein kinase (p38 MAPK) signaling pathway in PASMCs under hypoxia and hypercapnia condition. The third order PASMCs of Sprague Dawley (SD) rats were cultured with various concentrations (8, 40, 100 mg/L, respectively) of Notoginsenoside R1. Our data showed that the protein and mRNA expression levels of p-38 MAPK were higher in hypoxic hypercapnia group compared with hypoxic DMSO and normoxia control groups (p 1 treatment groups, the level of p-p38 MAPK protein and p38 MAPK mRNA were significantly decreased with different degrees (p 1 treatment may contribute to attenuate HHPV via decreasing the protein and mRNA expression levels of p-38 MAPK.
文摘Background: Blood pH and bicarbonate estimations are basal acid-base laboratory tests that are performed in infants with infantile hypertrophic pyloric stenosis (IHPS). This study aimed to define the clinical value of pCO<sub>2</sub> and BE in infants suspected to have IHPS. Methods: We collected data from 80 “surgical” infants younger than 100 days with prolonged nonbilious vomiting who were suspected to have IHPS. In 65 infants, pyloric stenosis was confirmed, and 15 infants had nonsurgical conditions. Capillary blood was tested for standard acid-base parameters and lactate. The two groups were compared. Results: Eighty-eight percent of the IHPS infants had elevated standard bicarbonate levels (st bicarb) > 25 mmol/l, and 60% had BE > 3.5 mmol/l;12% of the infants showed hypercapnia (pCO<sub>2</sub> ≥ 50 mmHg) associated with markedly increased standard bicarbonate and BE. Infants with nonsurgical vomiting were older at admission (p = 0.002), had a longer duration of vomiting (p < 0.001), were older (p = 0.002) and weighted more at admission (p = 0.004), had lower pCO<sub>2</sub> (p = 0.021), lower st bicarb (p < 0.001) and lower BE (p = 0.001). In addition, nonsurgical infants showed a trend to anemia (p = 0.002). Conclusions: In infants with IHPS/nonbilious vomiting, acid-base analysis (ABA) is equivocal or inconclusive. These findings may be misleading and could result in a false clinical decision. Nonsurgical vomiting is associated with a lower degree of alkalosis, normocapnia to slight hypercapnia and a base deficit. However, even infants with IHPS may present with a negative BE. In infants with IHPS and severe alkalosis, hypercapnia carries a risk for respiratory depression. Monitoring the infant’s respiration allows for the early detection of respiratory deterioration.
文摘BACKGROUND In the obese patient population,some patients have severe obstructive sleep apnea(OSA)with daytime hypoventilation.Such patients are generally identified on the basis of the presence or absence of daytime hypercapnia,and the condition is called obesity hypoventilation syndrome.However,mechanisms for such daytime hypoventilation remain unclear.AIM To investigate metabolic syndrome and daytime hypercapnia association based on hypercapnia prevalence in obese OSA patients in a nested case-control study.METHODS Consecutive obese patients(body mass index≥30 kg/m2)who underwent polysomnography due to suspected OSA were included.Among them,patients with severe OSA(apnea hypopnea index≥30/h)were divided into two groups according to the presence or absence of hypercapnia during wakefulness(arterial partial pressure of carbon dioxide≥or<45 Torr,respectively).The characteristics and clinical features of these two groups were compared.RESULTS Among 97 eligible patients,25 patients(25.8%)had daytime hypercapnia.There were no significant differences in age,gender,body mass index,apnea-hypopnea index,and Epworth Sleepiness Scale scores between the two groups.However,patients with hypercapnia had a significantly lower arterial partial pressure of oxygen level(75.8±8.2 torr vs 79.9±8.7 torr,P=0.042)and higher arterial partial pressure of carbon dioxide level(46.6±2.5 torr vs 41.0±2.9 torr,P<0.001).Additionally,patients with hypercapnia were more likely to have metabolic syndrome(72.0%vs 48.6%,P=0.043)and a higher metabolic score(the number of satisfied criteria of metabolic syndrome).In multivariate logistic regression analysis,the presence of metabolic syndrome was associated with the presence of hypercapnia(OR=2.85,95%CI:1.04-7.84,P=0.042).CONCLUSION Among obese patients with severe OSA,26%of patients had hypercapnia during wakefulness.The presence of metabolic syndrome was independently correlated with the presence of daytime hypercapnia.
文摘Background:Supplemental O_(2)is often administered without knowledge of CO_(2)levels for patients with ventilatory pump failure(VPF).This can render oximetry ineffective as a gauge of alveolar ventilation,airway secretions,and lung disease.We have noted that diurnal hypoventilation with hypercapnia tends to be symptomatic when O_(2)saturation levels decrease below 95%and patients extend sleep noninvasive ventilatory support(NVS)into daytime hours.We also noted that with advancing age,less hypercapnia results in desaturation.This study was designed to explore oxyhemoglobin desaturations(O_(2)desats)as a function of age and hypercapnia for patients with VPF.Methods:A retrospective analysis of 8933 consecutive patient visits for whom end-tidal CO_(2)and O_(2)sats were measured.O_(2)sats<95%at CO_(2)levels of 45,50,and 60 cmH2O were correlated with 10 years age inter-vals to age 80.Results:Of 8933 visits,8642 had complete data.Outcomes for CO_(2)levels>50 cmH2O were the most significant including for visit-ages<30 and≥30 years.There was a statistically significant 4%decrease in the odds of O_(2)desat for every one-year increase in age to age 30(OR=0.96,95%CI=[0.93,0.99],p=0.02)and for visit-ages≥30 a significant 30%increase in the odds of O_(2)desat for every 10-year increase in age(OR 1.3,95%CI=[1.1,1.6],p=0.006).Relationship for ages≥30 years were also significant for CO_(2)levels over 45 mmHg also.40%of the time when CO_(2)was greater than 45 mmHg O_(2)sat was low.Discussion:This study demonstrated a significantly lower risk of O_(2)desat occurring at EtCO_(2)levels≥50 mmHg for patients from 10 to 20 years of age than those younger than 10 and a significantly greater risk of O_(2)desat for 10 years intervals after age 20.Thus,with age,less hypercapnia results in desats and dyspnea with patients tending to extend NVS into daytime hours.This may be due to increases in physiological shunting,decreased pulmonary elasticity,and worsening ventilation/perfusion ratios with age.
文摘目的通过监测沙滩椅位(BCP)肩关节镜手术患者的局部脑氧饱和度(rScO_(2))变化,探究允许性高碳酸血症(PHC)联合星状神经节阻滞(SGB)对患者术中脑氧合的影响。方法选择择期行肩关节镜手术患者120例,男58例,女62例,年龄18~64岁,BMI 18.5~27.0 kg/m^(2),ASAⅠ或Ⅱ级。采用随机数字表法将患者分为三组:对照组(C组)、PHC组(P组)和SGB联合PHC组(SP组)。麻醉诱导前,SP组在超声引导下行术侧SGB,颈长肌表面的星状神经节处注射0.25%罗哌卡因+1%利多卡因混合液5 ml,C组和P组于同一部位注射等容量生理盐水。10 min后麻醉诱导行气管插管机械通气辅助呼吸,改为BCP开始手术。术中调整V T及RR,P组和SP组控制P ET CO_(2)升至50 mmHg,C组控制P ET CO_(2)40 mmHg。记录入室时(T_(0))、SGB操作后10 min(T_(1))、BCP 5 min(T_(2))、手术开始后30 min(T_(3))、手术开始后1 h(T_(4))、手术结束时(T_(5))术侧和非术侧rScO_(2)、HR、MAP、SpO_(2)、PaCO_(2)、P ET CO_(2)。记录术前1 d、术后1、2 d静息时VAS疼痛评分。记录术中大脑去氧饱和度事件(CDE)的发生情况、术中血管活性药物使用情况和术后恶心、呕吐、头晕等不良反应的发生情况。结果与T_(2)时比较,P组T_(4)、T_(5)时术侧和非术侧rScO_(2)明显升高,SP组T_(3)—T_(5)时术侧rScO_(2)和T_(4)、T_(5)时非术侧rScO_(2)明显升高(P<0.05)。与C组比较,P组T_(5)时术侧rScO_(2)明显升高,SP组T_(3)—T_(5)时术侧rScO_(2)和T_(5)时非术侧rScO_(2)明显升高(P<0.05)。与P组比较,T_(3)—T_(5)时SP组术侧rScO_(2)明显升高(P<0.05)。与T_(0)时比较,T_(3)—T_(5)时P组和SP组PaCO_(2)、P ET CO_(2)明显升高(P<0.05)。与C组比较,T_(3)—T_(5)时P组和SP组PaCO_(2)、P ET CO_(2)明显升高(P<0.05)。三组不同时点HR、MAP、SpO_(2)、静息时VAS疼痛评分、术中CDE发生率、术中血管活性药使用率及术后不良反应发生率差异无统计学意义。结论PHC可改善肩关节镜手术患者双侧rScO_(2),PHC联合SGB较单独使用PHC能进一步改善患者术侧脑氧合,提高rScO_(2),降低脑血管事件的风险。
文摘Background Therapeutic hypercapnia （TH） has been demonstrated to protect several organs ischemia-reperfusion injury.The study aimed to investigate the effects of therapeutic hypercapnia on hepatic ischemia-reperfusion injury （HIRI）.Methods Thirty adult male Wistar rats weighing （250 ± 20） g were randomized into 3 groups （n=10 in each）, group C （control group）, group A （hypercapnia group） and group B （CO2 preconditioning group）.A segmental ischemia of the liver was induced by interrupting the blood vessels including the bile duct to the median and left lateral lobes for 60 minutes and all the animals were sacrificed after 240 minutes observation period of reperfusion.Mean arterial pressure （MAP）and the blood gases were measured before ischemia （baseline） and at 30, 60, 120, 180 and 240 minutes after reperfusion.Arterial blood samples were obtained for determination of serum levels of TNF-α, IL-10, serum aspartate aminotransferase （AST） and alanine aminotransferase （ALT）.The histopathology of liver tissues was evaluated by light microscopy.The NF-κB expression and apoptotic hepatocytes were respectively determined by immunohistochemistry and TUNEL assay.Results The serum levels of liver enzymes and TNF-α were significantly decreased while the IL-10 level was significantly increased in groups A and B than in group C （P 〈0.05）, and group B surpassed group A （P 〈0.05）.The histopathological scores, the NF-κB immunohistochemical score （IHS） and apoptotic index were significantly lower in groups A and B than in group C （P 〈0.05）, and the decrease in group B was more obvious than in group A （P〈0.05）.Conclusion Therapeutic hypercapnia attenuates ischemia-reperfusion injury to the liver.Moreover, the effects of CO2preconditioning are outstandingly notable.
基金This study was supported by a grant from the National Natural Science Foundation of China （No. 81241004）.
文摘Background Very recent studies revealed that obstructive sleep apnoea （OSA） is a contributor of the increased incidence and mortality of cancer in humans,but mechanisms of how OSA promotes tumorigenesis remains largely unknown.We investigated whether intermittent hypoxia with and without hypercapnia plays a role in tumorigenesis.Methods First,Sprague-Dawley （SD） male rats （12 weeks old） were subjected to different hypoxia exposures：intermittent hypoxia and intermittent hypoxia with hypercapnia; continuous hypoxia and normal air.The systemic application of chronic fast rate hypoxia with or without hypercapnia mimicked severe OSA patients with apnoea/hypopnea index equivalent to 60 events per hour.Then routine blood tests were performed and the levels of brain derived neurotrophic factor （BDNF） and miR-34a were examined.Results In contrast to intermittent hypoxia with hypercapnia,both intermittent hypoxia and continuous hypoxia treatments caused significantly higher levels of haematology parameters than normoxia treatments.Compared to normoxia,intermittent hypoxia with hypercapnia exposure resulted in substantial decrease of serum BDNF and,miR-34a in the lower brainstem,while less pronounced results were found in intermittent hypoxia and continuous hypoxia exposure.Conclusions The exposure of intermittent hypoxia with or without hypercapnia,mimicking the situations in severe OSA patients,was associated with,or even promoted tumorigenesis.
