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Objective:To explore the relationship between respiratory mechanics and right heart function during ARDS mechanical ventilation through the establishment of Beagle dogs acute respiratory distress syndrome (ARDS) animal model and the application of different levels of mechanical ventilation, which will provide theoretical basis for right heart protective ventilation strategy of ARDS.Methods:Beagle dogs were anesthetized successfully and then pulmonary artery floating catheter, esophageal manometric catheter and femoral artery catheter were inserted. Under the pressure control mode, the driving pressure was fixed. After adjustment, PEEP gradually increased from 2 cmH 2O to 14 cmH 2O. The changes of respiratory mechanics, hemodynamics and right heart function were observed. ARDS model was established by injecting oleic acid into central vein, and mechanical ventilation with the same parameters was given after the model was established successfully. In contrast to itself, the changes of respiratory mechanics, hemodynamics and right heart function indexes of experimental dogs before and after modeling were analyzed. In the group, the indexes of different PEEP were compared by ANOVA, and then compared by Student-Newman-Keuls. The difference was statistically significant at a P value <0.05. Results:Before modeling, the peak airway pressure (P peak) and plateau pressure (P plat) increased with the increase of PEEP ( F=232.733,196.33, P<0.05). However, P trans-I, P trans-E, C stat and Vt decreased significantly ( F=4.524, 6.499, 64.803, 2.31, P<0.05). The area of change of right ventricle (FAC) became smaller ( F=3.09, P<0.05); SV first increased and then decreased ( F=3.24, P<0.05), and CVP and MPAP increased ( F=19.07,14.81, P<0.05). There was no significant difference in TAPSE, MAP, HR and SpO 2 ( P>0.05). After modeling, as PEEP increased, P peak, P plat, P ES-I and P ES-E increased significantly ( F=24.829, 41.95, 9.78, 87.86, P<0.05). Vt, P trans-I, P trans-E, C stat and Vt first increased and then decreased ( F=2.91, 4.29, 5.84, 48.890, P<0.05). TAPSE and SV first increased and then decreased ( F=6.22,6.54, P<0.05). CVP and MPAP increased ( F=5.23, 19.24, P<0.05). MAP increased first and then decreased ( F=5.02, P<0.05). SpO 2 increased ( F=2.77, P<0.05). FAC and HR had no statistical significance ( P>0.05). Conclusions:Trans pulmonary pressure and lung compliance can reflect the effectiveness of ARDS lung recruitment, and have good synergy; with the increase of PEEP, the right ventricular systolic function TAPSE is first affected, and SV compensatory increase, but with the increase of PEEP, TAPSE and SV decrease; pulmonary blood flow distribution is more important in improving alveolar oxygenation. Therefore, real-time monitoring of trans pulmonary pressure, TAPSE and intrapulmonary blood flow should be performed in ARDS treatment.
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One 80-year-old male patient was admitted to the hospital because of repeated palpitation and shortness of breath for more than 10 years and repeated swelling and pain in his hands and feet for 8 years. After the admission, the diagnosis was mitral stenosis ( moderate) with insufficiency (severe), gradeⅣheart function, chest infection, pulmonary infection, chronic renal insufficiency (CKD 3), gouty arthritis and the other chronic diseases. Diuresis, anticoagulation and uric acid lowering treatment were given after the admis-sion. The pain in the left lower extremity of the patient recurred and gradually worsened. The single application of hormones relieved the pain quickly without heart failure, while the effective duration was short. Therefore, in order to avoid long-term application of hormones or NSAIDs with heart failure risk and prevent gout attack better, and according to colchicine past used in the patient with diarrhea, clini-cal pharmacists suggested to try lower dose of colchicine 0. 25 mg qd, and observed the tolerance of the patient. Clinical pharmacists thought the reasons for the repeated gout attacks were related with such chronic diseases as heart failure and renal insufficiency etc, which limited the safety and effectiveness of the selection and application of acute gout treatment drugs. Based on the above analysis, clinical pharmacists carried out drug education for the patient and his family members to ensure the safety and effectiveness of medication.
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Objective:To study the effect of miR-200c on the migration and proliferation abilities of breast cancer MDA-MB-231 and BT-549 cells,and to clarify the mechanism of miR-200c in inhibiting the epithelial-mesenchymal transiton (EMT) of triple negative breast cancer.Methods:The human triple negative breast cancer cell lines (MDA-MB-231 and BT-549) were chosen in this study.The cells were transiently transfected with miR-200cmimics and Lipo2000 (experimental group),miR-200c negative control and Lipo2000 (negative control group),and Lipo2000 alone (reagent control group);at the same time,blank control group was set up.The expression levels of vimentin and β-catenin mRNA and protein were detected by RT-PCR and Western blotting method.The proliferation rates and migration abilities of MDA-MB-231 cells and BT-549 cells after transfection of miR-200c were analyzed by CCK8 assay and wound healing assay.Results:The RT-PCR and Western blotting showed that the expression levels of vimentin and β-catenin mRNA and proteins in experimental group were decreased,and the differences were statistically significant compared with blank control group,negative control group and reagentcontrol group (P＜0.05).The CCK8 results showed that the proliferation rates of the cells in experimental group were lower than those in negative control group and reagent control group (P＜0.05).The wound healing assay results showed that the recovery rate of scratch width in experimental group was lower than those in negative control group and reagent control group (P＜0.05).Conclusion:miR-200c might inhibit EMT in triple negative breast cancer by regulating the expressions of β-catenin and vimentin mRNA and proteins in MDA-MB-231 and BT-549cells and decreasing the abilities of migration and proliferation of triple negative breast cancer cells.
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Objective To evaluate diagnostic value of mitral regurgitation jet volume(MRvol) in the quantification of mitral regurgitation severity by general imaging three-dimensional quantification (GI3DQ) using the guideline recommended 2D integrative method as a reference.Methods Ninety-three patients with MR were divided into central MR group(n =41) and eccentric MR group(n =52).The American Society of Echocardiography (ASE)-recommended 2D integrative method was used as a reference for MR grading and MRvol was directly measured by GI3DQ method.Results In central MR,as assessed by receiver operating characteristic (ROC) analysis,the area under the curve(AUC)was 0.87(P <0.0001), and MRvol by GI3DQ at a cutoff value of 16.2 ml yielded 96.2% of sensitivity and 63.6% of specificity to differentiate mild from moderate MR;the AUC was 0.98(P < 0.0001),and a cutoff value of 47.8 ml yielded 98.6% of sensitivity and 96.2% of specificity to differentiate moderate from severe MR. In eccentric MR,the AUC was 0.76(P =0.086),and MRvol at a cutoff value of 14.8 ml yielded 90.9% of sensitivity and 60.0% of specificity to differentiate mild from moderate MR;the AUC was 0.84(P <0.0001) and a cutoff value of 40.7 ml yielded 80.0% of sensitivity and 79.7% of specificity to differentiate moderate from severe MR.Conclusions MRvol measured directly by GI3DQ could more exactly evaluate MR severity,and have better sensitivity and specificity to differentiate moderate from severe MR in central MR.
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To explore the feasibility and accuracy for evaluating mitral regurgitation (MR) severity with MR jet volume (MRvol) by means of general imaging three-dimensional quantification (GI3DQ). Methods: A total of 93 MR patients were divided into 2 groups: Central MR group, n=41 and Eccentric MR group, n=52. According to real-time three-dimensional echocardiography (RT3DE) examined planimetry of effective regurgitation orifice area (EROA), the patients were graded into mild MR, moderate MR and severe MR. MRvol was directly measured by GI3DQ. Results: In Central MR group, ROC analysis showed that as GI3DQ measured MRvol>16.2 ml, AUC=0.93, P44.5 ml, AUC=0.96, P14.2 ml, AUC=0.77, P=0.0243, the sensitivity and specificity for differentiating mild MR and moderate MR were 91.8% and 62.5% respectively; as MRvol>40.5 ml, AUC=0.83, P<0.0001, the sensitivity and specificity for differentiating moderate MR and severe MR were 82.3% and 77.9% respectively. Conclusion: Taking RT3DE examined EROA as reference, GI3DQ directly measured MRvol could more accurately assess MR severity especially in patients with central MR, it may distinguish moderate MR and severe MR with the higher sensitivity and specificity.
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PurposeObstructive sleep apnea (OSA) can lead to structure and function damages of multiple organs. OSA is closely related to cardiovascular diseases. This study aims to evaluate left ventricular function in OSA patients with normal left ventricular ejection fraction.Materials and MethodsSixty OSA patients were divided into mild, moderate and severe group according to the clinical diagnosis, with 20 patients in each group. Another 20 healthy volunteers were recruited as normal control group. Strain (S), systolic strain rate (SRS), early diastolic strain rate (SRE) and late diastolic strain rate (SRA) values in longitudinal, circumferential and radial directions of all the subjects were measured by using speckle tracking imaging. The SRE/SRA rates in three directions were calculated.ResultsLeft ventricular longitudinal systolic function showed significant lower in moderate and severe groups than in the control and mild groups (P<0.05). Circumferential and radial contraction reduced in the severe group, and the difference was statistically significant (P<0.05). The longitudinal, circumferential, and radial diastolic functions of the myocardial fibers in the left ventricle decreased in moderate and severe OSA patients when compared with that of the mild OSA patients and healthy individuals (P<0.05).ConclusionThe speckle tracking imaging has the potential to detect the subclinical left ventricular dysfunction in OSA patients with normal left ventricular ejection fraction and might provide useful information for risk stratification.
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ObjectiveTo investigate the effect of arterial stiffness on systolic deformation in hypertensive disease.MethodsSixty essential hypertensive patients were enrolled, including 25 cases with left ventricular normal geometric (group LVN) and 35 cases with left ventricular hypertrophy (group LVH) in the Affiliated Hospital of Qingdao University during July 2013 to March 2014. Thirty patients in the control group were enrolled in the same period. The peak systolic strains and strain rates were determined by using velocity vector imaging. Stroke volume was obtained by using real-time three-dimensional echocardiography. And pulse pressure/stroke volume was used as a surrogate index of arterial stiffness. Pulse pressure/stroke volume, the differences of strain and strain rate in three groups were compared by analysis of variance, and SNK-q test was used for further comparison between two groups. Multiple linear regression was performed to estimate predictors for systolic longitudinal deformation. Pearson?s correlation was used to analysis the relevance of systolic longitudinal strain and body mass index, triglyceride, left ventricular ejection fraction, age, left ventricular mass index, pulse pressure/stroke volume.ResultsPulse pressure/stroke volume were (1.26±0.45) mmHg·m2·ml-1, (1.53±0.59) mmHg·m2·ml-1, (1.82±0.43) mmHg·m2·ml-1 (1 mmHg=0.133 kPa) in the control group, LVN, LVH respectively. The systolic strains and strain rates in the control group, LVN, LVH were recorded as follows:systolic longitudinal strains were (23.60±1.94)%, (19.69±2.56)%, (17.34±2.48)%, the systolic longitudinal strain rates were (1.64±0.17) s-1, (1.52±0.14) s-1, (1.38±0.18) s-1; the systolic radial strains were (28.69±5.2)%, (30.81±4.14)%, (26.53±3.50)%, the systolic radial strain rates were (2.51±0.56) s-1, (2.60±0.45) s-1, (2.00±0.41) s-1; the circumferential strains were (24.50±5.21)%, (24.01±4.60)%, (21.00±3.70)%, the circumferential strain rates were (1.38±0.38) s-1, (1.30±0.30) s-1, (1.10±0.26) s-1. Pulse pressure/stroke volume was higher in LVN and was more pronounced in the LVH group compared with the control (LVN/LVH with the control group:q=2.90, 6.56, LVN with LVH:q=3.22, allP<0.05). The strains and strain rates in LVH were lower than those of LVN and the control group, and the differences were statistically significant. (longitudinal strains:q=15.22, 5.43; longitudinal strain rates:q=8.88, 4.54; radial strains:q=2.85, 5.36; radial strain rates:q=6.10, 6.81; circumferential strains:q=4.42, 3.61; circumferential strain rates:q=5.04, 3.42; allP<0.05). The strains and strain rates in LVN were lower than the normal group, the signiifcant differences of the longitudinal strains and longitudinal strain rates were found (q=8.73, 3.77, bothP<0.05) while there were no statistically signiifcant differences of radial strains and radial strain rates, circumferential rates and circumferential strain rates. In a multivariate analysis, LVMI and AS were found to be predictors for systolic longitudinal strain. Body mass index, triglyceride, left ventricular ejection fraction, age, left ventricular mass index and pulse pressure/stroke volume were negatively related to systolic longitudinal strain (r=-0.10,-0.09,-0.14,-0.42,-0.56, allP<0.05) by Pearson?s correlation, while LVEF was positively related to mean systolic longitudinal strain (r=0.13,P<0.05).ConclusionArterial stiffness is suitable as an predictor for left ventricular systolic deformation in hypertensive disease.
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Objective To explore the relationship of a polymorphism c.757T ＞ C in C-reactive protein gene (CRP) and carotid artery atherosclerosis in patients with ischemic cerebrovascular disease (ICVD).Methods A case-control study investigated 276 ICVD patients and 125 controls matched for age and sex.Genotypes of-757T/C in CRP were analyzed in patients with ICVD using polymerase chain reaction-restriction fragment length polymorphism.The level of serum C-reactive protein was detected by using immune scatter turbidimetry and the intima-media thickness of common carotid artery and internal carotid artery were measured by color Doppler ultrasonography.The relationship between the polymorphism -757T/C in CRP and carotid atherosclerosis was assessed.Results The genotypes of the polymorphism -757T/Cin CRP in the ICVD group (207/276(75.0％),65/276(23.6％),4/276(1.4％)) was significantly different from the control group (75/125 (60.0％),46/125 (36.8％),4/125 (3.2％) ; x2 =9.531,P =0.008),the frequence of T allele in patients with ICVD (479/552(86.8％)) was increased significantly compared to the control group (196/250 (78.4％)),the frequence of C allele in the ICVD group (73/552(13.2％)) was decreased significantly in contrast to the control group (54/250 (21.6％) ;x2 =9.056,P =0.004).Among the patients with ICVD,the level of serum C-reactive protein in patients with-757TC/CC genotype was elevated significantly than that with-757TC/CC ((4.2± 1.6) mg/L vs (2.7 ± 1.9) mg/L; t =5.900,P ＜ 0.01).Logistic regression analysis demonstrated that the-757C allele in CRP was related to the carotid artery atherosclerosis (OR =1.379,95％ CI 0.852-0.864,P =0.023).Conclusions The polymorphism-757T/C in CRP maybe related to the risk of developing ICVD.The frequency of the-757C allele can increase the level of serum C-reactive protein.And this polymorphism may be associated with carotid artery atheroselerosis in patients with ICVD.
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Objective To study the effects and safety of levocarnitine and shuxuetong in treatment of the patients with chronic renal failure.Methods 94 patients with chronic renal failure were selected as research object,and they were randomly divided into group A(levocarnitine and shuxuetong group) 47 cases and group B(shuxuetong group) 47 cases.Group A were treated with levocarnitine oral solution and shuxuetong,and group B were treated with shuxuetong,then the percentage of effectiveness,incidence of adverse reactions of group A and group B and serum BUN,Scr,Hcy were analyzed.Results The percentage of effectiveness of group A was higher than that of group B,but the incidence of adverse reactions of the two groups had no difference,and the serum BUN,Scr,Hcy of group A and group B before the treatment had no differences(P＞0.05),those of group A and group B after treatment were compared there were significant differences(all P＜0.05).Conclusion The effects of levocarnitine oral solution and shuxuetong in treatment of patients with chronic renal failure were better.
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Objective To investigate the effect of hydrogen-rich saline combined with mild hypothermia on cerebral ischemia-reperfusion (IR) injury in rats. Methods Fifty male SD rats, aged 9-10 weeks, weiging 250-300 g, were randomly divided into 5 groups (n= 10 each): sham operation group (group S), group IR, hygrogen-rich saline group (group H), mild hypothermia group (group M) and hydrogen-rich saline + mild hypothermia group (group HM). In group IR, H, M and HM cerebral IR was induced by 15 min ligation of bilateral carotid artery followed by 6 h reperfusion. In group H and HM intraperitoneal hydrogen-rich saline 5 ml/kg was injected immediately after reperfusion, while the equal volume of normal saline was injected instead of hydrogen-rich saline in the other three groups. At the same time, the rectal temperature was maintained at 37-38 ℃ in group S,IR and M, while it was reduced to 32-34 ℃ by physical method within 15 min, lasting for 6 h, in group M and HM. The animals were sacrificed after 6 h of reperfusion, and then the hippocampus was removed for microscopic examination. The expression of HO-1 and content of MDA and TNF-α were determined by Western blot. Results The cerebral IR injury was attenuated in group H, M and HM compared with group IR, with the slightest injury in group HM. The expression of HO-1 and content of MDA and TNF-α were significantly higher in group IR, H, M and HM than in group S. The expression of HO-1 was significantly higher, while the content of MDA and TNF-α were lower in group H, M and HM than in group IR, and in group HM than in group H and M. There was no significant difference in the expression of HO-1 and content of MDA and TNF-α between group H and M. Conclusion Hydrogen-rich saline combined with mild hypothermia can attenuate cerebral I/R injury in rats via up-regulating the expression of HO-1 and decreasing the content of MDA and TNF-α in hippocampus.