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Objective:To investigate the effects of mechanical ventilation on liver cytological and enzymatic indexes in abdominal compartment syndrome (ACS) by establishing a porcine model of abdominal hypertension.Methods:Six healthy adult pigs were selected. After general anesthesia, they were intubated and given ventilator assisted breathing. The breathing mode was volume controlled ventilation (VCV), tidal volume (VT) 10 mL/kg, respiratory rate (RR) 16 time/min, fraction of inspiration oxygen (FiO 2) 0.40, positive end expiratory pressure (PEEP) 5 cmH 2O (1 cmH 2O = 0.098 kPa). Intraperitoneal pressure was simulated by injecting normal saline into the pressurized water sac, and the pressure was measured once every 50 mL of normal saline. 5 mL of blood was collected from ear vein every 1 hour before and 4 hours after operation for liver enzyme examination. 4 hours after operation, the animals were sacrificed and the liver was collected to observe pathological changes under light microscope. Results:Six pigs were successfully modeled. The RR and heart rate (HR) of the animals remained stable. No one suffered from barotrauma or death during the experiment. There was a positive correlation between abdominal pressure and abdominal volume increase (r 2 = 0.839 6, P = 0.003 7). There were no significant differences in the levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP) and cholinesterase (ChE) preoperative and 1, 2, 3, 4 hours after operation. As time went on, aspartate aminotransferase (AST) increased first and then decreased, and increased significantly at 1 hour after operation (U/L: 46.84±8.57 vs. 23.35±5.14, P < 0.05), and decreased significantly 2, 3, 4 hours after operation (U/L: 16.33±3.58, 14.54±3.35, 15.44±3.21 vs. 23.35±5.14, all P < 0.05). The level of γ-glutamyltranspeptidase (GGT) increased and then decreased, but there was significant difference only at 1 hour after operation, compared with baseline (U/L: 101.20±17.79 vs. 51.34±9.13, P < 0.05). Under the light microscope, there were dilation and congestion of interlobular vein, dilation of interlobular bile duct, hyperplasia of small bile duct, hyperplasia of connective tissue in portal area, infiltration of a large number of acute and chronic inflammatory cells, swelling of hepatocytes, light staining of cytoplasm, balloon like transformation of some cells, and punctate necrosis. Conclusion:Abdominal hypertension under mechanical ventilation can cause obvious enzyme changes and cytological damage of liver.
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Objective:To select the animal model more consistent with the pathophysiology of abdominal compartment syndrome (ACS) through the comparative study of the methods of multiple water sacs superimposed compression and gas perfusion.Methods:Ten experimental pigs were randomly divided into two groups ( n = 5): the "constant volume model" (constant volume model group) and the "constant pressure model" (constant pressure model group) of intra-abdominal hypertension. The models were prepared by the method of water sac superposition and pressurization, and artificial pneumoperitoneum respectively. The abdominal pressures of both groups were 25 mmHg (1 mmHg = 0.133 kPa) and observed for 4 hours. The pressure was measured once an hour for 4 hours and the pressure-time curves of the two groups were drawn respectively. The experimental animals were sacrificed 4 hours after modeling. The heart and lung were harvested, and the histopathological changes were observed by hematoxylin-eosin (HE) staining. Results:Two groups of experimental pigs were successfully modeled. The abdominal pressure gradually increased at 0, 1, 2, 3, 4 hours after operation in the constant volume model group (mmHg: 25.0±0, 27.1±0.2, 29.4±0.1, 30.9±0.2, 33.1±0.1), and there was a positive correlation between the abdominal pressure and time (functional equation: Y1 = 25.102 0+1.996 0 X1; R2 = 0.996 2, P = 0.000 1). The abdominal pressure value in the constant pressure model group at 0, 1, 2, 3, 4 hours were maintained 25 mmHg, and there was no linear correlation between the abdominal pressure and time (functional equation: Y2 = 25). HE staining showed that in the constant volume model group, the myocardial fibers were accompanied with hyaline degeneration, significantly reduced transverse lines, part of myocardial fiber atrophy, and visible nuclear aggregation; hemorrhage, chronic inflammatory cell infiltration and inflammatory exudation were found in the lung tissues. In the constant pressure model group, partial atrophy of myocardial fiber, partial hypertrophy, focal hyaline degeneration, disappearance of local striae, hyaline degeneration of myocardial fiber, dilation and congestion of intermyocardial artery were observed. Slight hyperplasia of alveolar epithelium in some areas, heart failure cells, dilation and congestion of bronchi and trachea artery, a large number of red blood cells and uniform light staining substances in lumen were found. Conclusion:After the model was made by the method of multiple water sacs, the pressure of the abdominal cavity continued to increase with the development of the disease, which was in line with the clinical pathological changes of ACS, and was more suitable for making the animal model of the intra-abdominal hypertension.
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Objective@#To investigate the clinical characters and diagnosis and treatment in patients with vesicoenteric fistula.@*Methods@#Two patients with vesicoenteric fistula were admitted to the Affiliated Hospital of Shanxi Datong University in 2012 and 2019, at the same time 64 cases with complete data referenced from China Journal Full-text Database from September 2001 to December 2018 were retrospectively studied. The pathogeny, main clinical manifestations, relevant examination, treatment methods and prognosis were analyzed, to explore the best diagnosis and treatment of vesicoenteric fistula.@*Results@#Among all of 66 patients, there were 49 males and 17 females. The pathogeny included intestinal cancer in 31 cases (46.97%), Crohn disease in 11 cases (16.67%), intestinal diverticulitis in 10 cases (15.15%), bladder cancer in 8 cases (12.12%), appendicitis and other inflammatory diseases in 5 cases (7.58%) and intraoperative injury in 1 case (1.52%). The main clinical feature included recurrent urinary tract infection in 45 cases (68.18%), fecaluria in 43 cases (65.15%), abdominal pain in 16 cases (24.24%) and pneumaturia in 16 cases (24.24%). Forty-one cases underwent CT examination, and the diagnostic rate was 58.54% (24/41); 47 cases underwent cystoscopy, and the diagnostic rate was 55.32% (26/47); 34 cases underwent cystography, and the diagnostic rate was 44.12% (15/34). Six cases (90.91%) were treated with surgery, and no perioperative death occurred. Twenty-eight cases were followed up, and the mean follow-up time was 4.1 years. Seven cases died of tumor recurrence and metastasis; 2 cases died of other basic diseases such as cardiovascular and cerebrovascular diseases. No other patients with benign vesicoenteric fistula died during follow-up.@*Conclusions@#The major cause of vesicoenteric fistula is intestinal malignancy, which shows emblematic clinical symptoms, and specific imaging characteristic. CT, cystoscopy and cystography are the main diagnostic technique. Surgical intervention is the major therapeutic choice, and the prognosis depends on the primary disease.
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Objective To investigate the secondary pathological changes in lung of abdominal compartment syndrome (ACS).Methods Twenty-five healthy adult clean New Zealand rabbits were randomly divided into control group (n =5) and experimental group (n =20) according to the random number table method.The experimental group was subdivided into two subgroups according to the observation time:24 hours and 48 hours,with 10 rabbits in each subgroup.A high pressure liquid animal model of abdominal cavity was reproduced by water bag superposition pressurization.In the control group,the pressurized water bag did not inject liquid,and intra-abdominal pressure (IAP) was maintained at 0;while in the experimental group,pressurized water infusion was performed,and IAP was maintained at 25 mmHg (1 mmHg =0.133 kPa).The rabbits in the control group were sacrificed at 48 hours,those in the experimental group were sacrificed at 24 hours and 48 hours respectively,and the lungs were harvested completely.The pathological changes were observed under light microscope after hematoxylin-eosin (HE) staining.Results In the control group,the activity of the rabbits was decreased,the food intake was decreased,and all the 5 animals survived;in the experimental group,the activity was decreased significantly,little food intake or not,the urine output was decreased significantly,and 1 rabbit died at 22,27 and 37 hours respectively,and 17 survived.Light microscopy showed that there were terminal bronchioles and a large number of alveoli in the lung tissue of the control group,and small vessels dilated in the interstitium.In the experimental group,alveolar epithelial hyperplasia,alveolar sěptum of different sizes,alveolar fusion,alveolar septal bleeding,interstitial heart failure cells with phagocytosis of hemosiderin,bronchiolectasis,a large number of inflammatory cell infiltration near the bronchi,thrombosis in the blood vessels were found at 24 hours.A large number of erythrocyte and cellulose-like exudates were seen in the lumen of terminal bronchioles,alveolar dilatation and fusion were aggravated,and old hemorrhage in the lumen of the alveoli was observed,hemosiderosis containing bemosiderin was observed at 48 hours.Conclusion ACS could cause severe lung injury and aggravate as time goes on.
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Objective To explore the pathological changes of lung,pancreas and kidney in abdominal compartment syndrome by making an animal model of abdominal hypertension.Methods 20 New Zealand rabbits were divided into 3 groups,4 in the control group,8 in the experiment group 1,and 8 in group 2.The control group were not injected with pressure water capsule,the pressure was 0 mmHg(0 Kpa),and the time limit was 48 hours.The pressure and increased volume of abdominal pressure was recorded each time of injection of 50 ml saline in group 1 and group 2.The abdominal pressure-volume curve was plotted.Then the pressure of the experimental group was adjusted to 22 mmHg(2.96 Kpa),and the time limit of experimental group 1 was 24 hours,the group 2 was 48 hours.The experimental animals were killed at the time of observation,the whole lung,pancreas and kidney were completed and fixed with 10％ Formaldehyde solution for 24 hours,and the routine paraffin was embedded,sliced,stained with HE,and observed under the biological optical microscope.Results During the experiment,4 of the control group survived,1 died in the experimental group 1,and 2 died in group 2.There was a positive correlation between abdominal pressure and increasing volume of abdominal cavity in the experimental group of abdominal high pressure liquid animal model.The function equation:Y=0.1486X-119.0000 (R2=0.827 4,P=0.004 5).Pathological changes of lungs in three groups of experimental animals:control group:terminal bronchioles and a large number of alveoli in normal lungs,interstitial small vessel dilatation.The group 1:alveolar epithelial hyperplasia,alveolar septum size,alveolar lumen fusion,alveolar interstitial bleeding,dark brown matter deposition,intravascular thrombus,and computerized recanalization.In the group 2,the alveoli were dilated obviously,some alveolar cavities were fused,the alveolar septum was not one,and a large number of red cells and cellulosic exudates were found in the terminal fine bronchioles,including dark brown matter deposition.Pathological changes of pancreas in the three groups:control group:acinus:acinar cell consists of a layer of vertebral acinar cells,the nucleus was round,close to the base of the cell,and the nucleolus was obvious;the basal cytoplasm was basophilic because of the rich in rough endoplasmic reticulum and ribosome.The group 1:pancreatic acinar degeneration,large number of inflammatory cells infiltrating in the pancreatic tissue,lymphatic sinus dilation,lymph nodes filled with lymph,lymphatic edema,paranantral lymph nodes,lymphatic sinus dilatation,sinus endothelial cell proliferation and lymphoid hyperplasia.In the group 2,the pancreatic acini were markedly degenerated,blood vessels were dilated and congested in the interstitium,and the lymphatic vessels in the pancreatic tissue expanded and contained large amounts of lymph.Pathological changes of kidney in three groups of experimental animals:control group:glomeruli and blood vessels were basically normal,and renal tubules were slightly dilated.The group 1:mild segmental hyperplasia of glomerular mesangial cells,mild enlargement of mesangial matrix,dilatation of renal tubules,internal protein tube type,granulosa like degeneration of renal tubular epithelial cells and dilatation and congestion of endoplasmic blood vessels.Experimental group 2:glomerular segmental hyperplasia,renal tubular epithelial cell edema,renal tubule dilatation,canalicular type in the lumen,small vessels of the renal interstitium dilated and hyperemia.Conclusion Lung,pancreas and kidney have obvious secondary damage at the development of abdominal compartment syndrome and aggravates with the extension of time.
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Objective To explore the changes of interleukin (IL)-6 and IL-10 in the model of abdominal compartment syndrome. Methods From January 2016 to December 2017, fifteen New Zealand rabbits were divided into control group (5 rabbits) and experimental group (10 rabbits) 2 groups according to the drawing of lots. The liquid animal model of abdominal high pressure was made. Pressurized water sac in the control group was not injected fluid to maintain the pressure of 0 mmHg (1 mmHg＝ 0.133 kPa). Pressure was regulated in 25 mmHg (grade 3) in experimental group. The IL-6 and IL-10 levels were compared between 2 groups. Results The IL-6 and IL-10 2 and 24 h after operation in experimental group were significantly higher than those in control group: (9.99 ± 2.88) and (7.57 ± 2.31) μg/L vs. (0.19 ± 0.05) μg/L, (59.28 ± 19.32) and (33.18 ± 13.14) mg/L vs. (13.25 ± 5.56) mg/L, and there were statistical differences (P＜0.01). Conclusions In the development of abdominal compartment syndrome, both IL-6 and IL-10 levels are significantly elevated, suggesting that there is mixed antagonism response syndrome.
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Objective To explore the effect and mechanism of Kruppel-associated box(KRAB) type zinc-finger protein Apak on the transcription of ribosomal RNA(rRNA) under hypoxic conditions.Methods Real-time quantitative PCR(qRT-PCR) was used to detect the level of rRNA and the effect of Apak on the transcription of rRNA.The expression and phosphorylation level of proteins were examined by Western blotting.Immunofluorescence assay was used to observe the location of Apak.Results Under hypoxia (0.3%O2),the transcription level of rRNA increased first and then decreased in Apak wild type cells.In Apak knock-out cells,the transcription level of rRNA kept decreasing under hypoxic conditions.The repression of Apak on rRNA synthesis and the nucleolus location of Apak disappeared,and the expression and phosphorylation level of Apak were down-regulated under hypoxic conditions for 3 h.Conclusion Under hypoxic conditions,the disapperance of Apak repression on rRNA transcription could lead to a temporary increase in rRNA.
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Objective To investigate the clinical significance of intraperitoneal perfusion of IL-2 combined with Addi injection for ascites re-growth control after decompression of abdominal compartment syndrome induced by malignant ascites.Methods 69 patients with abdominal compartment syndrome induced by malignant ascites,after tube decompression and paracentesis,were given intraperitoneal perfusion therapy,and they were randomly divided into two groups.42 cases in the observation group were given with 0.9％ sodium chloride injection 50mL + IL-23 millions u and Addie injection 50-60mL,once a week,a total of 2-3 times;27 cases in the control group were given with 0.9％ sodium chloride injection 50mL and cisplatin 40mg,once a week,a total of 1-3 times.Results In the observation group,CR 25 cases (59.5％),PR 11 cases (26.2％),NC 6 cases (14.3％),the total effective achieved in 36 cases (85.7％).In the control group,CR 11 cases (40.7％),PR 6 cases (22.2％),NC 10 cases (37.0％),the total effective achieved in 17 cases (62.96％).The effective rate of the observation group was significantly better than that of the control group,there was statistically significant difference(x2 =4.78,P ＜ 0.05).The qualities of life of the observation group were improved,8 cases were stable,lower in 2 cases,the effective rate was 76.2％,which of the control group were improved,10 cases were stable,lower in 4 cases,the effective rate was 48.1％.The effective rate of the observation group was significantly better than that of the control group,there was statistically significant difference (x2 =5.70,P ＜ 0.05).Conclusion Intraperitoneal perfusion of IL-2 combined with Addi injection for ascites control after decompression of abdominal compartment syndrome induced by malignant ascites is a new method,which is worthy of clinical application.
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@#Objective To explore the effect of ischemic postconditioning on serum superoxide dismutase (SOD) and malondialdehyde (MDA) in acute myocardial infarction (AMI) and clinical significance. Methods 101 AMI patients accepted emergency percutaneous coronary intervention (PCI) were divided into postconditioning group (n=46) and control group (n=55) according to the treatment they accepted.The concentration of serum SOD and MDA were observed 4, 8, 12, 16, 20, 24, 36, and 48 h after PCI, as well as the grade of Thrombolysis in Myocardial Infarction (TIMI) and TIMI Myocardial Perfusion Grades (TMPG), serum creatine kinase-MB (CK-MB) peak value, scoring of nuclide distribution 10 d after PCI, and frequence of cardiac events within 30 d after PCI. Results Compared with the control group, serum SOD increased (P<0.01) and MDA decreased (P<0.001) respectively 2, 4, 8, 12, 16, 20, 24, 36 and 48 h after the PCI, especially the valley of SOD and peak of MDA value in the postconditioning group; while the patient with TIMI flow of grade 3 and TMPG of grade 3 increased (P<0.05), the peak of serum CK-MB decreased (P<0.01), and the score of nuclide distribution decreased (P<0.05). After the operation for 30 days, the frequence of cardiac events was less in the postconditioning group than in the control group (P<0.05). Conclusion Ischemic postconditioning can reduce the peroxidation after PCI, to increase myocardial perfusion, reduce infarct area, and improve prognosis in acute ST-segment elevated myocardial infarction
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Autism is pervasive in early children who have developmental disorders.The incidence of autism increased year by year in China.Meanwhile,autism rehabilitation work is also received much concerns.At present,China's rehabilitation work is mainly borne by the family,and the rehabilitation role of school and community in autism has been missing.This paper made a short analysis of the role of autism rehabilitation school and community,so that more readers could have a familiar understanding of the rehabilitation,which can enforce the bigger show of the school and community,and to prompt more children conduct a sooner recovery.
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Objective To observe the clinical effect of hyperbaric oxygen and electrocoagulation in the treatment of venous ulcers on legs.Methods 36 patients with venous ulcer on legs were divided into group A of 12 cases,group B of 12 cases and group C of 12 cases.Group A was treated by hyperbaric oxygen and electrocoagulation;group B was treated by hyperbaric oxygen;group C was treated by electrocoagulation.The operation method:every one had been performed electrocoagulation,and performed improved Linton operation if traffic vein valve had functional disorder,and performed wearing ring operation if vein reflux exceed Ⅲ °.Results The time of healing:group A was ( 18.00 ± 4.66) days,group B was (28.20 ± 6.42 ) days and group C was (31.32 ± 4.88 ) days.The time was significantly different between the two groups( A and B,P ＜0.01 ;A and C,P ＜0.01 ; B and C,P ＜ 0.05).29 cases had been investigated by 6 to 40 months,the venous ulcers on legs had no recurrence.Conclusion The treatment for venous ulcer on legs by hyperbaric oxygen and electrocoagulation was a new therapy which had advantage of healing quickly and less recurrence,It ought to be popularized.
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@# Objective To explore the value of B-type natriuretic peptide (BNP) predicting cardiac events after noncardiac surgery in the aged patients. Methods The level of BNP， the score of Goldman analysis and the cardiac risk grade of ACC/AHA guideline were analyzed in 274 aged patients for cardiac outcome after noncardiac surgery. Results Preoperative BNP concentration>100 pg/ml，score of Goldman≥13，and the high or moderate risk grade by ACC/AHA guideline were related with cardiac events. There was no significant difference in the index such as sensitivity，specificity, accuracy，positive predictive value and negative predictive value for cardiac events between BNP level and cardiac risk grade. Compared with the score of Goldman, BNP was more sensitive （100% vs 55.6%）and negatively predictive （100% vs 96.3%） for cardiac events. Conclusion The risk of cardiac events after noncardiac surgery could be predicted with the level of BNP before operation in the aged patient.
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@#The latest reports showed that kidney secrets a new type protein:renalase,a novel flavin adenine dinucleotide-dependent(FAD-dependent)amine oxidase which is secreted into the blood by the kidney and regulates heart function and blood pressure by metabolizing catecholamines.Kidney disease is associated with cardiovascular disease,so people pay more and more attentions to renalase.This article will introduce the structure and mechanism of renalase,and propose its future.
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@#Objective To study the risk factors of patients with atherosclerotic renal artery stenosis (ARAS) and the relation with renal function.Methods The renal function of 64 ARAS patients was measured and compared with 36 healthy controls.Results Compared with the healthy controls, the incidence rates of morbilities of coronary artery disease, more than single-vessel, peripheral vascular disease, renal inadequacy increased significantly ( P<0.05), and the age, pulse pressure, levels of blood urea nitrogen (BUN), serum creatinine (SCr) were significantly higher ( P<0.01) in ARAS patients.Conclusion The elder, coronary artery disease, more than single-vessel, large pulse pressure, peripheral vascular disease and renal inadequacy are risk factors for ARAS. Severe renal artery stenosis may lead to renal inadequacy.
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Objective To investigate methods and effects of percutaneous choledochoscopy via cholangio-jejunal anastomotic stoma in the treatment of recurrent intrahepatic biliary duct stones. Methods Eight cases of recurrent intrahepatic biliary duct stones after a Roux-en-Y cholangiojejunostomy from January 2000 to February 2005 were treated with percutaneous choledochoscopy. An enterostomy was made at the afferent jejunal loop. Then a choledochoscope was introduced into the intrahepatic biliary ducts by way of the cholangio-jejunal anastomotic stoma for stone removal and intrahepatic duct or anastomotic stoma dilatation. Results The intrahepatic stones were thoroughly removed in all the 8 cases. The biliary duct stenosis in 4 cases and the anastomotic stoma stenosis in 2 cases were relieved. Follow-up checkups in the 8 cases for 1~3 years revealed no recurrence of intrahepatic stones or stenosis. Conclusions Percutaneous choledochoscopy via cholangio-jejunal anastomotic stoma is minimally-invasive, safe, feasible, and effective in the treatment of recurrent intrahepatic biliary duct stones.
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Objective To discuss the etiology and treatment of extrahepatic biliary stenosis due to iatrogenic bile duct injuries. Methods A total of 12 cases of extrahepatic biliary stenosis after iatrogenic bile duct injuries(including 5 cases of open cholecystectomy and 7 cases of laparoscopic cholecystectomy) from January 1998 to January 2005 in this hospital was reviewed.After the establishment of a percutaneous transhepatic access,choledochoscopic stone removal,balloon dilatation,and drainage stent placement were performed for treating biliary stenosis.Results A F_(20) Gruntzig balloon catheter was employed for bile duct dilatation.The plastic drainage stent at 6~8 mm in diameter was successfully placed after 2 times of dilatation in 8 cases and after 3 times of dilatation in 4 cases,for 6~12 months of indwelling.Follow-up observations in the 12 cases for 2~3 years (mean,2.6 years) found no abdominal pain,fever,or jaundice.B-ultrasonography and MRCP findings showed no biliary stenosis and recurrent stones.Conclusions Choledochoscopic stone removal,balloon dilatation,and drainage stent placement are minimally invasive,safe,and effective in the treatment of extrahepatic biliary stenosis.
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Objective To discuss the causes,treatment and prophylaxis of surgical jaundice after laparoscopic cholecystectomy (LC). Methods A retrospective analysis was carried out in 16 cases of surgical jaundice consisting of 14 cases from this hospital out of 3 092 cases of LC from January 1994 to January 2002 and 2 cases transferred from other hospitals. Results Out of the 16 cases,residual bile duct stones were found in 9 cases,and bile duct injuries had taken place in 7 cases (2 cases of cystic duct stump leakage,3 cases of common bile/hepatic duct injuries and 2 cases of recurrent jaundice resulted from aberrant bile duct leakage).All the 16 cases were cured by surgery and no bile duct stricture occurred after surgical procedures. Conclusions Strict following indications of LC and normative surgical performance are the keys to the decrease of surgical jaundice after LC.The patient should be given active surgical intervention once surgical jaundice occurs.
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Objective To analysis the clinical effects of treatment of femoral nerve injury using microsurgical technique. Methods Twenty-six cases of patients of femoral nerve injury was treated by nerve suture, nerve grafts and neurolysis separtately. Functional rehabilitation exercise was done actively postoperation. Results Follow-up 1～4 years, the average excellent rate was 84.6%. Conclusion Early diagnosis and accurately location, in timely microsurgical repair and actively functional rehabilitation exercise can ensure the satisfactory effects.