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OBJECTIVE：To study the improvement effects of Weijing deco ction on AECOPD model rats and its possibile mechanism. METHODS ：Totally 55 male SD rats were randomly divided into normal group ，model group ，Weijing decoction low-dose and high-dose groups （8.37，16.74 g/kg，by crude drug ），dexamethasone group （positive control group ，0.09 mg/kg），with 11 rats in each group. Except for normal group ，AECOPD model was induced by cigarettes combined with lipopolysaccharide in other groups. After modeling ，normal group and model group were given constant volume of water intragastrically ，and other groups were given relevant medicine intragastrocally ，twice a day ，for 14 days. After last intragastric administration ，the serum level of IL- 1 β was determined，and pathological changes of lung tissue and bronchus were observed in each group ；mRNA expression of MMP-9 and TIMP- 1 genes in lung tissue were detected ；protein expression of Ras homologous gene family member （RhoA）， dishevelled associated activator of morphogenesis- 1（DAAM1）and hyperplasic suppress gene （HSG）in lung tissue were also determined. RESULTS ：Compared with normal group ，the levels of IL- 1β in serum，mRNA expression of MMP- 9 and TIMP-1 as well as protein expression of RhoA and DAAM 1 in lung tissue were increased significantly in the model group（P＜0.05），while protein expression of HSG in lung tissue was decreased significantly （P＜0.05）；there were many chronic inflammatory cells infiltrating around the bronchus ，some airway mucosa epithelium exfoliating ，alveolar compensatory dilation，pulmonary septal capillary dilation and hyperemia. Compared with model group ，the levels of IL- 1β in serum，mRNA expression of MMP- 9 and TIMP- 1 in lung tissue were decreased significantly in Weijing decoction high-dose group （P＜0.05）；the protein expression of RhoA and DAAM 1 in lung tissue were decreased significantly in Weijing decoction low-dose and high-dose groups（P＜0.05），while the protein expression of HSG in lung tissue was increased （P＜0.05）；the pathological changes of Weijing decoction high-dose group ，such as inflammatory cells infiltrating around the bronchus and shedding of airway mucosa ， were improved significantly ， and there was complete alveolar epithelium structure but no obvious pulmonary dilation. CONCLUSIONS：Weijing decoction can improve AECOPD model rats to certain extent ；its mechanism may be associated with down-regulating mRNA expression of MMP- 9 and TIMP -1 as well as protein expression of RhoA and DAAM 1 in lung tissue ， up-regulating protein expression of HSG in lung tissue so as to inhibit the airway remodeling.
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@#Objective To analyze the effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates. Methods The clinical data of 33 neonates undergoing modified Blalock-Taussig shunt between January 1, 2013 and December 31, 2017 were reviewed, including 28 males and 5 females with the age of 3.0-28.0 (18.0±6.1) d and weight of 1.9-3.7 (2.9±0.5) kg. Results There were 3 (9.1%) in-hospital deaths. Ten (30.3%) patients required early unplanned reoperations after surgery. Five (15.2%) patients were lost to follow-up. In the multivariate analysis, preoperative acidosis, emergency operation and postoperative bedside thoracotomy were independent risk factors of early death. During the follow-up of 18.0-93.0 (40.2±22.5) months, there was no death and 9 (36.0%) survival patients underwent corrective surgery and stage-two palliative surgery. In the multivariate analysis, preoperative hyperhemoglobinemia was an independent risk factor of nonadministration of the corrective surgery and stage-two palliative surgery. Receiver operating characteristic curve showed that preoperative hyperhemoglobinemia was significant in determining whether secondary surgery was possible. Conclusion The modified Blalock-Taussig shunt is effective in promoting development of pulmonary arteries and preparing for the secondary surgery. The rate of mortality and postoperative complications after the neonatal modified Blalock-Taussig shunt remains high. The rate of secondary surgery is still low during follow-up.
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Objective To identify the risk factors of ventilator-associated pneumonia (VAP) in infants after surgical correction for tetralogy of Fallot (TOF).Methods This study performed at Guangdong general hospital in China,130 infants (less than 12 months,mechanical ventilation time≥48 h) undergoing surgical correction for TOF were included between January 2013 and December 2017.Ventilator-associated pneumonia was defined according to the CDC/NHSN definitions guidelines issued in 2008.T test or Wilcoxon rank sum test was used in univariate analysis,and the variables with P ＜ 0.05 in the univariate analysis were added to a multiple logistic regression to identify the risk factors of VAP in infants after surgical correction for Tetralogy of Fallot.The area under the receiver operating characteristic (ROC) curve was calculated as a measure of accuracy.Results A total of 130 infants were included,however,VAP was found in 34 (26.2％) infants.The single variables significantly associated with a risk of VAP were:pre-operative hypoxic,pre-operative pneumonia,pre-operative mechanical ventilation support,prolonged cardiopulmonary bypass time,reintubation,pulmonary atelectasis,pleural effusion hydrothorax,prolonged mechanical ventilation support time,low cardiac output and transfusion of erythrocyte concentrate or fresh frozen plasma.Multiple logistic regression analysis showed prolonged cardiopulmonary bypass time (OR =1.02),reintubation (OR =16.111),pulmonary atelectasis (OR =8.133),low cardiac output (OR =7.649) and prolonged mechanical ventilation support time (OR =1.014) were independent risk factors for VAP in infants after TOF surgical correction.The area under the curve demonstrates the accuracy of the model.Conclusion The occurrence rate of VAP was high and risk factors for VAP after TOF surgical correction were complex.These results can be used to prevent and reduce the occurrence of VAP.
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Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related death in the world, and only 20% of HCC patients can undergo radical treatment.Radiofrequency ablation induces coagulative necrosis of cells via thermal energy, kills tumor cells, and makes it possible to cure HCC.Many clinical studies have confirmed that radiofrequency ablation provides good local control and has high safety, and therefore, it can be used to replace radical surgery.This article reviews the indications and therapeutic effect of radiofrequency ablation in the treatment of HCC, as well as its comparison with radical surgical resection and transarterial chemoembolization in terms of their therapeutic effects.It is pointed out that the treatment regimen should be selected based on the patient′s individualized conditions.
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Objective The study aimed to explore the development direction of congenital heart disease surgery through comparing Europe with Guangdong General Hospital(GDGH) in data of ECHSA Congenital Database.Methods The data between 2009 to 2015 of Europe and GDGH were extracted from ECHSA Congenital Database.The data of Europe and GDGH were compared by basic information,operating difficulty and mortality.Results The results of Europe and GDGH were patient number(71 763 vs 13 119),procedure/patient ratio(126.2％ vs 104.1％),age[(75.91 ± 146.18) months VS(105.80 ± 172.18) months],the proportion of neonate (18.2％ vs 4.4％),Aristotle mean score (7.00 vs 6.67),30 days mortality (2.98％ vs 1.73 ％).The proportion of neonate palliative operation of Europe was more than that of GDGH.In adult group,Europe was more of reoperation and of GDGH was more of primary surgery.Conclusion The surgical treatment of congenital heart disease of GDGH is developing and is close to the mean average of Europe.The proportion of neonate,complex surgery and reoperation is lower than Europe.
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Objective To retrospectively analyse the anaesthetic management of Norwood Stage Ⅰ.Methods Between June 2010 and August 2014, totally 5 small infants with HLHS underwent the standard Norwood Stage I procedure .They were all boys.Age at surgeries ranged from 29 to 75 days with median 36 days, and weight from 2.57 -3.50 kg with median of 3.13kg.The first three cases were received intravenous prostaglandin E1 before they were sent to the operation theatre and were under mechanical ventilation .They were received emergent operations because of unstable hemodynamic situation .The other two cases were relatively stable without mechanical ventilation and were received restrict surgery .All 5 cases received the stand-ard Norwood Stage Ⅰprocedure under intravenous-inhalation balance-general anaesthesia with cardiopulmonary bypass.The technique of deep hypothermia and circulatory arrest were used in all five cases .Results The fourth case died from low cardi-ac output syndrome after cardiopulmonary bypass .The other 4 cases were transferred to the paediatric intensive care unit after withdrawal from bypass.One of the four cases died after 32 h after surgery.Conclusion The standard Norwood Stage Ⅰ pro-cedure is aquite complex procedure, which demands multidisplinary cooperation, to palliatively correct HLHS.We retrospect the experiences of the anesthetic management in our centre and hope it will be helpful to decrease the mortality and morbidity in relatively short period.
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Objective To investigate the application of delayed sternal closure (DSC) following neonatal cardiac surgery.Methods We retrospectively analyzed clinical data of 360 neonatal patients underwent cardiac surgery through median sternotomy in Guangdong General Hospital between June 2009 and June 2014.These neonates were divided into 2 groups:DSC group (190 cases) and non-DSC group(170 cases).Comparing the differences between 2 groups,we analysed the application of DSC following neonatal cardiac surgery and the effect of DSC on surgical site infection.Results The cardiopulmonary bypass time,cross clamp time and mechanical ventilation time were longer in DSC group than in non-DSC group.The mortality rate in the DSC group(20.53％) was markedly higher than that in the non-DSC group(5.29％).However,there was no statistical difference in the incidence of sternal wound infection between 2 groups.Conclusion As an effective treatment for neonates with severe cardiac surgery,DSC doesn' t increase the incidence of surgical site infection.
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Objective To analyze the risk factors of postoperative acute renal injury (AKI) for acute Stanford type A aortic dissection in 137 cases.Methods From January 2010 to December 2011,137 patients with acute Stanford type A aortic dissection were received surgical operations in our hospital.There were 106 males and 31 females with their mean age of(46.8 ± 13.1)years and mean weight of (69.9 ± 18.0) kg.The postoperative acute renal injury diagnosis was according to AKIN diagnosis standard of acute kidney injury network working group in 2005.All patients were received surgical repair with cardiopulmonary bypass,including 120 patients with deep hypothermic circulatory arrest and selective cerebral perfusion.Among them,there were 54 cases with total arch replacement and 66 with right half arch replacement.The postoperative managements were include control the patients' mean arterial blood pressure at 80 to 90 mmHg (1 mmHg =0.133 kPa),supplement the blood volume timely,and correction of hypoxia and hypoproteinemia.The patients were received renal replacement therapy if still oliguria after medical treatments,or their blood creatinine raising continually more than 500 μmol/L.Results A total of 12 patients died in hospitalization with a total in-hospital mortality of 8.74％ (12/137).76 cases had AKI in the first day after operations,including 38 cases (27.7％) with stage Ⅰ and 21 cases (15.3％) with stage Ⅱ and 17 cases (12.4％) with stage Ⅲ.There were 36 patients have acute renal failure (ARF) with morbility of 26.3％ (36/137),and 34 patients among them were received renal replacement therapy.Single factor analysis showed that preoperative creatinine,total arch replacement,cardiopulmonary bypasstime,intraoperative day transfusion of concentrated red cells are risk factors of ARF.Logistic regression was used for multivariate analysis showed that total arch replacement and preoperative creatinine abnormalities are independent risk factors for postoperative AFR.Conclusion Total arch replacement and preoperative creatinine abnormalities were independent risk factors of AFR for acute type A dissection after operation.
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Objective: To explore the mechanisms of emodin in protecting intestinal mucosal barrier in rat with severe acute pancreatitis (SAP). Methods: Sixty SD rats were randomly divided into three groups: sham-operation group, untreated group, and emodin group. SAP in rats of the untreated group and the emodin group was induced by retrograde pumping of 3.0% sodium cholate to the common bile duct. Specimens were obtained 24 hours after the severe acute pancreatitis was induced. Serum level of leptin, serum activity of amylase and plasma content of endotoxin were measured. Ileum mucosa from ileocecal junction was observed by light microscopy and electron microscopy to measure pathological and ultrastructural changes. Apoptosis of ileum mucosal cells was detected by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling method, and expression of Bax in ileum mucosal cells was measured by immunohistochemical method. Results: Compared with the sham-operation group, there was significant increase in the levels of leptin, endotoxin, the activity of amylase, apoptosis index and Bax expression in the untreated group (P<0.01). Compared with the untreated group, the level of endotoxin, apoptotic index and Bax expression level in the emodin group were significantly reduced (P<0.01) and the leptin level was increased (P<0.05). More severe pathological changes appeared in the untreated group than in the sham-operation group under the light and electron microscopes; meanwhile less severe damage was observed in the emodin group as compared with the untreated group. Conclusion: Emodin can inhibit the apoptosis of intestinal mucosa cells and up-regulate the serum leptin content to protect the intestina1 barrier function and prevent the translocation of bacteria and endotoxin.
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Objective To determine the contents of hypaconitine and mesaconitine in Shubining Granules. Methods The HPLC method was established for the determin ation of hypaconitine and mesaconitine in Shubining Granules. The HPLC was perfo rmed on Akasil C18(4.6 mm?250 mm,5 ?m) column,mobile phase consisted of meth anol-0.1 %triethylamine (70 ∶30),column temperature 30 ℃,and the flow rare was 1.0 mL/min.The detection wavelength was 230 nm.Results A good linearity w as obtained in the range of 0.126～2.520 ?g of Hypaconitine and 0.152～3.04 ?g of Mesaconitine.The average recovery of Hypaconitine was 101.12 %.The average recovery of Mesaconitine was 99.68 %. Conclusion This method is simple and qui ck,and can be used as quality control of Shubining Granules.