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Objective:To establish a stable fragment-induced penetrating liver injury model in landrace pigs and evaluate the characteristics of deep tissue injury.Methods:According to the different positioning methods of aiming points, twelve healthy adult landrace pigs were divided into group A (the relative height "h" of the aiming point and the highest point of the body surface on the tracing line was set to 5 cm) and group B ("h" was set to 6 cm). Ultrasonography was used to determine the direction of fragment projection, and an experimental ballistic gun was used to project high-velocity fragments to cause injury to animals. The vital signs of the two groups were monitored, and whole blood cell count, blood gas analysis, and liver and renal function were tested. Damages to the liver and adjacent organs, as well as the amount of bleeding and survival time were analyzed.Results:For the overall analysis of the two groups, the liver hit rate of fragment simulating projectiles was 100% (right anterior lobe and right lateral lobe injury), the hit rate of other organs in the abdominal cavity was 25% (3/12), and the incidence of hemothorax or pneumothorax was 8% (1/12). The wounds were mainly characterized by liver lacerations, with total or partial disconnection of the distal liver lobe. There was no significant difference in wound length and bleeding amount between groups A and B [wound length (cm): 9.8±1.7 vs. 11.2±3.8, bleeding amount (g): 597.0±477.1 vs. 1 032.0±390.3, both P > 0.05]. The depth of liver parenchymal laceration in group B with the aiming point closer to the anterior median line was significantly longer than that in group A (cm: 2.8±0.4 vs. 1.9±0.6, P = 0.015). Mean arterial pressure (MAP), pH value, residual arterial blood base (BE), hemoglobin (Hb) and hematocrit (HCT) levels decreased after the fragment-induced injury, and then reached a trough level [MAP (mmHg, 1 mmHg ≈ 0.133 kPa): 87.0±33.6, pH: 7.26±0.15, BE (mmol/L): -6.65±8.48, Hb (g/L): 9.86±1.10, HCT: 0.309±0.029, all P < 0.05] in the first hour. Blood lactate (Lac), lactate dehydrogenase (LDH) and aspartate aminotransferase (AST) levels increased over time, and reached a peak level [Lac (mmol/L): 10.21±4.40, LDH (U/L): 1 417.0±223.3, AST (U/L): 234.5 (162.5, 357.5), both P < 0.05] at 1 hour after injury. Pearson's correlation analysis showed that the total amount of bleeding was correlated with the depth of liver parenchyma laceration ( r = 0.684, P = 0.014). The Kaplan-Meier survival curve showed that the 3 hours survival rate in group A was higher than that in group B, but the difference was not statistically significant [83.3% (5/6) vs. 33.3% (2/6), P > 0.05]. Conclusions:The high-velocity fragment-induced penetrating liver injury model established by striking landrace pigs closer to the anterior median line with fragment simulating projectiles is reproducible and the degree of damage is controllable, and the model is applicable to further relevant research of hepatic ballistic trauma.
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Objective:To observe the perioperative rehabilitation of children undergoing lingual frenoplasty under dexmedetomidine nasal drip combined with esketamine anesthesia.Methods:100 children who underwent lingual frenoplasty in Changsha Maternal and Child Health Hospital from 2020 to 2021 were randomly divided into two groups: the esketamine group (E group, 50 cases) and the dexmedetomidine nasal drip combined with esketamine group (DE group, 50 cases). The mean arterial pressure (MAP), heart rate (HR) , blood oxygen saturation (SpO 2) and respiratory rate (RR) were measured, and the patients were admitted to the post anesthesia recovery unit (PACU) after operation. The modified Aldrete score, Visual Analogue Score (VAS), Wake-up Restlessness Score, food intake (clear water) time and hospital leaving time were observed at 10 min, 30 min, 60 min and 120 min after operation. Results:There was no significant difference in SpO 2 and RR, MAP and HR at T 0 and T 6 between the two groups (all P>0.05). The MAP and HR at T 1, T 2, T 3, T 4 and T 5 in DE group were lower than those in E group (all P<0.05). The modified Aldrete score of DE group was higher than that of E group, and the VAS and Wake-up Restlessness Score were lower than that of E group (all P<0.05); The time of food intake (clear water) and leaving hospital were shorter than those in Group E, with statistically significant difference (all P<0.05). Conclusions:In children′s lingual frenoplasty, dexmedetomidine nasal drip combined with esmketamine can more effectively relieve postoperative pain and agitation than esmketamine alone, shorten children′s postoperative eating time, leave the hospital earlier, and enhance recovery of children.
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Objective:To study the effects of transverse abdominis plane block (TAPB) combined with dexmedetomidine on the recovery quality after general anesthesia in cesarean section.Methods:From June 2019 to October 2020, 120 cases of cesarean section in Changsha Maternal and Child Health Hospital were randomly divided into dexmedetomidine group (Group D), transversus abdominis plane block group (group T), transversus abdominis plane block combined with dexmedetomidine (Group TD) and control group (Group C). Before anesthesia induction, local infiltration of 1% lidocaine was performed at the incision of all parturients. Propofol and rocuronium were used for induction under general anesthesia. After delivery of fetus, sufentanil and midazolam were injected intravenously, and propofol was pumped to maintain anesthesia. At the same time, dexmedetomidine was pumped into group D and TD, and normal saline was pumped into group T and C. After the posterior sheath of rectus abdominis was sutured in T group and TD group, two epidural anesthesia catheters were placed to the fascia of transverse abdominis on both sides, and 10 ml of 0.33% ropivacaine was injected respectively. The parturients were sent to postanesthesia care unit (PACU) after the operation. The time from the end of operation to the extubation of tracheal tube, heart rate (HR) and mean arterial pressure (MAP) before operation (T 1), after induction (T 2), after operation (T 3), at the time of extubation (T 4), 10 minutes after extubation (T 5) and at the time of leaving PACU (T 6) were recorded. Steward's wake-up score at T 4, T 5 and T 6, agitation during extubation (Sedation Agitation Scale, SAS score), PACU stay time and pain visual analogue scale (VAS) were recorded. Results:There was no difference in HR and MAP between the four groups at T 1, T 2, and T 3 ( P>0.05), while HR and MAP in group C at T 4, T 5 and T 6 were higher than those in the other three groups ( P<0.05). There was no significant difference in Steward′s wake-up score among the four groups ( P>0.05). The SAS score [(4.0±0.4)point], the time from the end of operation to extubation [(10.1±1.5)min] and stay time of PACU [(21±4.2)min] were the lowest in group TD than those in the other three groups ( P<0.05); the VAS score in group TD [(0.5±0.5)point] and group T [(1.1±0.4)point] were lower than that in group D [(4.1±0.3)point] and group C [(5.3±0.5)point] ( P<0.05). Conclusions:The application of general anesthesia combined with TAPB and dexmedetomidine in cesarean section may improve the quality of anesthesia recovery.
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Objective To analyze the clinical and pathological features of advanced colorectal serrated adenoma(ACSA). Methods The endoscopic and pathological features of 156 cases of ACSA and 121 cases of non-ACSA diagnosed in General Hospital, Tianjin Medical University from January 2010 to March 2016 were retrospectively analyzed and compared.Results ACSA and non-ACSA cases accounted for 56.3%(156/277)and 43.7%(121/277)of all patients with colorectal serrated lesions,respectively. The mean age of ACSA patients was 57.79±13.65 years and 89(57.1%)of these patients were male. There was no significant difference in age and gender between ACSA and non-ACSA patients. A total of 161 ACSA lesions were diagnosed,including 71 sessile serrated adenoma/polyps and 90 traditional serrated adenomas. Among the 161 ACSA lesions,there were 29(18.0%)lesions whose diameter≥10 mm, and 84(52.2%) lesions located in the proximal colon, which were more than non-ACSA(84/161 VS 49/134,P=0.007). ACSA was classified under endoscopy into pedunculated type(20/161),sub-pedunculated type(35/161), sessile type(24/161),flat type(79/161)and laterally spreading tumor(3/161), and the distribution of lesion type was significantly different from non-ACSA(P<0.001). One hundred and sixty(99.4%)ACSA lesions were diagnosed as dysplasia, including 158 low degree dysplasia and 2 high degree dysplasia.Moreover,16 ACSA patients were accompanied with synchronous advanced colorectal neoplasia(sACN), and large serrated polyps(diameter≥10 mm)might have a strong association with sACN(OR=4.35, 95%CI:1.467-12.894, P<0.05). Conclusion ACSA is more common in proximal colon and sub-pedunculated type,sessile type and flat type. ACSA diameter≥10 mm is significantly associated with sACN.
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Objective To compare laparoscopic Keyhole parastomal hernia repair with re-ostomy technique or without re-ostomy in the treatment of stoma hernia,then analyze the advantages of reconstruction ostomy,and summarize the key technical points of the reconstruction operation.Methods From Jan 2010 to Dec 2016,68 stoma hernia patients underwent laparoscopic Keyhole parastomal hernia repair with reostomy technique,52 patients underwent laparoscopic Keyhole parastomal hernia repair without re-ostomy technique.The preoperative,intraoperative and postoperative parameters were analyzed.Results Compared to without re-ostomy group,the re-ostomy reconstruction group had low incidence rate of intestinal fistula (x2 =5.411,P =0.033),patch infection (x2 =6.823,P =0.014),the incidence of postoperative serous swelling and serum swelling (x2 =14.266,P ＜0.001),postoperative recurrence (x2 =8.688,P =0.005) and postoperative appearance dissatisfaction (x2 =9.479,P =0.004).Conclusion Laparoscopic parastomal hernia repair and re-ostomy technique reduces the incidence rate of intestinal fistula,patch infection and serous swelling and serum swelling,decreases the postoperative recurrence rate and appearance dissatisfaction.
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Although tumor immunotherapy has been proposed for many years,the consensus denoting it as an essential approach for fighting against cancer is reached only in recent years. Tumor immunotherapy can be categorized as active and passive ones. In order to successfully cure cancer,safe and efficient active immunotherapy is required. Dendritic cells (DCs)are not only the bridge linking innate and adaptive immunity,but also the key determinants of the quality of adaptive immunity:immunity versus immune tolerance. Therefore,the safe and efficient DC-based tumor-specific and broad-spectral tumor vaccine has an irreplaceable important position in tumor immunotherapy. Because of the high heterogeneity of DCs, the research on DC-based tumor vaccine has encountered a bottleneck. Here,we reviewed the progress in research on DC-based tumor vaccine and related problems needed to be resolved with the incorporation of our experiences.
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Objective To evaluate the efficacy of ketamine in preventing postpartum depression in patients undergoing cesarean section.Methods One hundred and twenty ASA physical status Ⅰ patieuts,aged 18-38 yr,with body mass index ＜35 kg/m2,scheduled for elective cesarean section,were equally and randomly divided into 2 groups using a random number table:control group (group C) and ketamine group (group K).Postoperative analgesia was performed with sufentanil 100 μg in 100 ml of normal saline,and sufentanil was infused at 2 ml/h (bolus dose 5 μg,lockout interval 15 min) in both groups.In group K,ketamine 4 mg/kg was added to analgesic pump.VAS score was maintained＜3.Before surgery and at 1,3,5 and 42 days after surgery,depressive symptoms were measured using the Edinburgh Postpartum Depression Survey (EPDS),and postpartum depression was defined as EPDS score ≥ 13.Postpartum depression and ketamine-related complications occurred within 3 days after surgery in group K were recorded.Results Compared with group C,EPDS scores were significantly decreased at 1,3 and 5 days after surgery,and the incidence of postpartum depression was decreased in group K.Ketamine-related complications were not found in group K.Conclusion Ketamine (infused starting from the end of operation,lasting for 48 h,total amount 4 mg/kg) for postoperative analgesia can prevent postpartum depression to some extent in patients undergoing cesarean section.
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Objective To explore the mechanisms on the damage in fetus liver,kidney and brain with administration of mifepristone and mesoproseol.Methods 17 specimens were obtained from the women who volunteered to terminate their pregnancy during 10～28 weeks.According to the fetus weight,they were divided into 3 groups.Immunohistochemistery was induced to investigate the expressions of pur-?,HSP70.Results The expressions of pur-? and HSP70 could be observed in both the treatment group and the control group.pur-? and HSP70 are the targets in detecting the damage of DNA.But pur-? was more sensitive than HSP70.The damage on group Ⅱ is the strongest.Conclusion Mifepristone can lead to the damage to lover,kidney and brain in mid-pregnancy.Its damage will be reducing as the growing of fetus.
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AIM:To investigate the neuroprotective effect of pioglitazone (Pio),a potent agonist of peroxi-some proliferator-activated receptor gamma (PPAR?),on the traumatic brain injury (TBI) in rats. METHODS:SD rats were randomly divided into 4 groups:sham group,vehicle + TBI group,Pio + TBI group and Pio + T0070907 + TBI group. TBI was induced by the method of controlled cortical impact (CCI) injury. Neutral red staining technique was used to determine the cortical lesion volume. NeuN,GFAP and OX -42 were measured by immunohistochemical technique to evaluate the morphology of neurons,activation and infiltration of astrocytes and microglia at the edge of cortical lesion. RE-SULTS:CCI injury in rat elicited activation and proliferation of the astrocytes and microglia. The glial scar wall formation at the edge of cortical lesion,which was accompanied by the loss of neurons,was observed. Pio significantly reduced the cortical lesion volume,the activation and infiltration of the astrocytes and microglia,and the loss of pyramidal neurons at the edge of cortical lesion. T0070907,an antagonist of PPAR?,reversed the effects of Pio. CONCLUSION:Pioglitazone exerts a neuroprotective efficacy,attenuates the loss of neurons and cortical lesion volume following CCI injury by inhibiting the activation and infiltration of astrocytes and microglia,especially glial scar formation.
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Five strains of mice (C57BL/6, BALB/c, ICR, KM and SMMC/B) were respectively orally immunized with CJ-S131 vaccine for 16 weeks, Autoantibodies against ss-DNA, ds-DNA, histones, extractable nuclear antigens (ENA)and thymocytes were detected by ELISA or CELIS(?)One or more kind (s) of autoantibody significantly raised in the serum of SMMC/B, KM, BALB/c and ICR mice, but not in C57BL/6 mice. The mean enzyme index (EI) of the autoantibodies of SMMC/B and KM mice was higher than that of ICR and BALB/c. The influence of the sex on the production of autoantibody induced by CJ-S131 vaccine seemed to be demonstrated on the basis of genetic background.It was characterized by (1) autoantibodies raising mainly in the female mice,e.g. in KM mice; (2) one kind of autoantibody or more raising in both male and female mice, as seen in SMMC/B and BALB/c mice; and (3) autoantibody no in male and female of C57BL/6 mice. The results revealed that the profile of autoimmune response induced by CJ-S131 vaccine was different in strains and sex of mice.
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KM mice were orally immunized with formalized C. jejuni (CJ-S131 vaccine) for 16 weeks. The production kinetics of autoanti bodies against ss-DNA, ds-DNA, histories and extractable nuclear antigens (ENA) was investigated and two peaks of autoantibody production were observed within 16 weeks after immunizalion. The first peak appeared at 6th week after immunization when the positive percentage of autoantibody against histones (83%) and ENA (67%) was higher than that against ds-DNA (33%) and ss-DNA ( 0 %), and the second peak at 16th week when the positive percentage of anti-ds-DNA (50%) and anti-ss-DNA (83%) antibody higher than that of anti-histones (33%) and anti-ENA (33%) anti body. Natural autoanti bodies against nuclear acid (ds-DNA and ss-DNA) in the controlled mice could be detected, too, by ELISA, which raised with aging but obviously demonstrating individual difference; however, autoanti bodies to nucleoproteins (histones and ENA) could not be detected at the matched times. The results suggested that autoantibody against histones or ENA was more specific for autoimmune diseases than that against DNA, and might be of significance for earlier diagnosis of the systemic autoimmune diseases, e. g. SLE, in clinic.
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To explore me chanisms of successful induction of autoimmunity by chronic Campylobacter jejuni (CJ-S131 ) infection [3, 4, 5, 6], a chronic mucosal immune response mooe(?) was established by oral immunization of BALB /C mice with formalized CJ-S131 bacteria.in a dosage of 4 xlO8 bacterial cells per mouse, twice a week for 14 weeks, which mimicked the released antigens persistently stimulating the mucosal immune system when mice were chronically infected by C. jejuni. It was also found that the immunized mice demonstrated (?)upus-like autoimmune syndro me, sim ilar, but more severe.to those seen in the mice chronically infected by C. jejuni. It was characterized by (1) significant lymphoproliferation of both mucosal and systemic immune systems; (2) polyclonal activation of B lymphocytes; (3) significantly elevated level of multiple autoanti bodies against ss- DNA, ds- DNA and histones; (4) immunocom plex glomerulonephritisi; (5) chronic inflammation of multiple organs or tissues including the intestine, liver and blood vessels. In the polyclonal activation testin vitro, the levels of total immunoglobulins and autoantibody against DNA in the supernatan ts of the splenic culture cells from the immunized mice were significantly higher than that from the controll mice. The results verified that chronic C. jejuni infection in the gut could induce abnormal. chronic mucosal immune response which led to perturbation of the systemic immune system, resulting autoimmunity or autoimmune syndrom.