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Objective:To explore the protective effect of Lindera aggregata on acute respiratory distress syndrome (ARDS) induced by lipopolysaccharide (LPS) in mice and its possible mechanism.Methods:Forty C57BL/6 mice were randomly divided into sham operation group, ARDS model group, low-dose Lindera aggregata (L-LA) group and high-dose Lindera aggregata (H-LA) group, with 10 mice in each group. ARDS model was established by injecting 5 mg/kg LPS through the trachea. The L-LA group and H-LA group were orally administrated 1 g/kg and 5 g/kg of the Lindera aggregate extract once a day, respectively, while the ARDS model group was given the same volume of normal saline, the sham group received no treatment. The Lindera aggregata was preadministered for 3 days before modeling, and continued for 2 days after modeling, then the animals were sacrificed, and bronchoalveolar lavage fluid (BALF) and lung tissue were collected. The pathological changes of lung tissue in each group of mice were observed under the microscope and the wet/dry weight ratio (W/D) of the lung were measured. Enzyme linked immunosorbent assay (ELISA) was used to examine the levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in mice serum and BALF, and flow cytometry was used to detect the expression rate of CD40 on the surface of BALF macrophages. The phosphorylation levels of p38 and extracellular signal-regulated protein kinase 1/2 (ERK1/2) proteins in lung tissue were measured by Western blotting.Results:Lung histopathology under light microscope showed that the damage of alveolar structure, thickening of alveolar septum and infiltration of inflammatory cells in the H-LA group were less severe than those in the ARDS model group, while the pathological characteristics of ARDS in the L-LA group were not significantly different from those in the ARDS model group. Compared with the sham operation group, the lung W/D ratio, TNF-α and IL-6 protein contents in serum and BALF, BALF macrophage CD40 expression rate and lung tissue p38 and ERK1/2 protein phosphorylation levels were significantly increased in ARDS model group. The W/D ratio, the concentrations of TNF-α and IL-6 in serum and BALF, the expression rate of CD40 in BALF macrophages, and the phosphorylation levels of p38 and ERK1/2 protein in lung tissue in the L-LA group were not significantly different from those in the ARDS model group. The above indexes in the H-LA group were significantly lower than those in the ARDS model group and the L-LA group [W/D ratio: 5.70±0.19 vs. 6.20±0.31, 6.01±0.17; serum TNF-α (ng/L): 83.63±15.04 vs. 111.75±18.45, 108.12±13.98; serum IL-6 (ng/L): 111.38±8.75 vs. 244.13±26.85, 227.50±9.37; BALF TNF-α (ng/L): 36.25±2.82 vs. 51.13±5.44, 47.50±5.78; BALF IL-6 (ng/L): 35.63±2.20 vs. 49.63±4.90, 46.38±3.50; CD40 expression rate (%): 23.28±2.45 vs. 30.32±2.40, 28.17±1.98; p-p38/p38: 0.50±0.04 vs. 0.74±0.07, 0.69±0.04; p-ERK1/2/ERK1/2: 0.47±0.07 vs. 0.72±0.07, 0.68±0.05; all P < 0.01]. Conclusions:Lindera aggregata can inhibit LPS-induced lung inflammation and alleviate lung injury in ARDS mice. The mechanism may be related to the inhibition of the activation of p38 mitogen activated protein kinase/ERK (p38MAPK/ERK) signaling pathway.
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Patients with acute paraquat poisoning mostly die of respiratory failure, and the surviving ones may live with pulmonary fibrosis, but the long-term changes in lung function are still un-clear. Two patients with acute paraquat poisoning survived for more than 7 years were followed up in Northern Jiangsu People's Hospital to evaluate the imaging and spirometric changes. Eight years after poisoning, 1 patient's chest computerized tomography (CT) revealed interstitial pneumonia, chronic bronchitis, emphysema, accompanied by bronchiectasis. Spirometric test showed very severe obstructive ventilatory dysfunction [percentage of vital capacity (VC) to predicted values was 63.7%, percentage of forced expiratory volume in one second (FEV1) to predicted values was 33.2%, percentage of forced vital capacity (FVC) to predicted values was 64.7%, forced expiratory volume in one second to forced vital capacity (FEV1/FVC) was 52.5%, percentage of maximal mid-expiratory flow (MMEF) to predicted values was 9.9%, percentage of diffusion capacity for carbon monoxide in single breath (DLCO-SB) to predicted values was 49.3%]. The radiography of the other patient who survived over 7 years after poisoning also discovered chronic bronchitis, emphysema and bullae, along with pleural effusion. Spirometry identified severe mixed ventilatory dysfunction, mainly obstructive ventilatory disorder (percentage of VC to predicted values was 47.8%, percentage of FEV1 to predicted values was 35.6%, percentage of FVC to predicted values was 49.3%, FEV1/FVC was 74.1%, percentage of MMEF to predicted values was 17.1%, percentage of DLCO-SB to predicted values was 21.8%). These 2 cases indicate that acute paraquat poisoning had long-term effects on lung structure and pulmonary function, which may be manifested as chronic obstructive pulmonary disease.
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BACKGROUND: Anterior cruciate ligament (ACL) reconstruction can restore the stability of knee joint, reduce the mechanical stress on meniscus and cartilage, and avoid the occurrence and development of secondary injury including traumatic arthritis. However, some studies have shown that ACL reconstruction cannot completely prevent the occurrence and development of osteoarthritis, and significant changes in osteoarthritis can be found in the long-term imaging examination after operation. Therefore, there is still controversy about the role of ACL reconstruction in preventing secondary cartilage damage and secondary osteoarthritis, and the changes in cartilage after ACL reconstruction, especially at early stage after ACL reconstruction, have not been fully elucidated. OBJECTIVE: To analyze articular cartilage changes during arthroscopic anterior cruciate ligament reconstruction and second-look arthroscopic evaluation. METHODS: From July 2015 to July 2016, 50 cases of ACL reconstruction with hamstring tendon and second-look arthroscopic exploration were analyzed retrospectively. The cartilage damage and healing between the ACL reconstruction and second-look exploration were recorded. At the same time, the influence of age on articular cartilage was analyzed. The study protocol was approved by the Ethics Committee of Foshan TCM Hospital with an approval No. 20160315. RESULTS AND CONCLUSION: No infection, graft absorption and other complications occurred in all patients. During the second-look exploration, the Lysholm score, International Knee Documentation Committee evaluation score, Tegner score and KT-1000 lateral difference were significantly improved compared with those before operation (P 0.05). During the second-look exploration, the patients with anterior cruciate ligament reconstruction who were 30 years old and above had significantly worse subpatellar, trochlear, medial femoral condyle, lateral femoral condyle and tibial lateral platform cartilage tissues than those under 30 years (P < 0.05). The results suggest that the reconstruction of ACL with autogenous hamstring tendon can achieve better stability and function of the knee joint. However, even in the early postoperative period, osteoarthritis is still progressing. Therefore, it is necessary for patients with ACL reconstruction to pay attention to the progression of osteoarthritis and the appearance of knee joint symptoms.
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Aluminum phosphide (ALP) is frequently used for grain conservation despite its high toxicity. In some developing countries increased utilization of ALP has resulted in increment of ALP-attributed poisoning numbers. The mortality of ALP poisoning is extremely high and no effective antidote is available so far. However, the astute survey of potential misconceptions in the course of acute toxicity has led some scientists to introduce novel therapeutic approaches. Meanwhile, some new antioxidants were discovered and expected to be used in the management of ALP poisoning. In addition, the progress in intensive care has promoted technologies such as CRRT, IABP and ECMO for the treatment of ALP poisoning with reported success in alleviating severe toxicity. Recent studies on the therapy of ALP poisoning are reviewed in this article.
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Objective To evaluate the effect of Xingshi decoction combined with warming needle moxibustion combined with conventional western medicine on acute knee arthritis.Methods A total of 86 patients with acute knee arthritis were randomly divided into two groups,43 in each group.The control group took diclofenac capsules orally and methotrexate once a week,while the observation group took Xingshi decoction and wanning needle moxibustion on the basis of the control group.Both groups were treated for 2 weeks.The Rheumatoid factor (RF),high sensitive C reactive protein (hs-CRP) and IL-1β were detected by ELISA,and pain rating index (PRI),VAS and present pain intensity (PPI) were evaluated by McGill pain questionnaire (SF-MPQ).The knee function was assessed by the evaluation scale,and the curative effect was evaluated by 28 joint disease activity-erythrocyte sedimentation rate (ESR) scores.Results The total effective rate was 88.4％ (38/43) in the observation group and 62.8％ (27/43) in the control group.There was significant difference between the two groups (Z=2.678,P=0.007).After treatment,ESR (30.95 ± 3.14 mm/h vs.55.13 ± 3.28 mm/h,t=34.919),RF (81.36 ± 5.13 U/ml vs.121.73 ± 7.25 U/ml,t=29.807),hs-CRP (10.13 ± 3.12 mg/L vs.34.26 ± 3.17 mg/L,t=35.575),IL-1β (58.13 ± 3.12 pg/ml vs.96.76 ± 3.17 pg/ml,t=56.952) of the observation group were significantly lower than those of control group (P＜0.01);and PRI,VAS and PPI scores of SF-MPQ in observation group were significantly lower than those of control group (t values were 19.661,11.056 and 23.524,respectively,P＜0.01) and the scores of walking,swelling,sense of stability,strangulation and stair-climbing were significantly higher than those of the control group (t values were 11.071,13.464,9.102,9.804,10.012,respectively,P＜0.01).Conclusions The Xingshi decoction combined with warming needle moxibustion is effective in treating acute knee arthritis.It can effectively relieve pain and inflammation of patients,thus improving knee joint function.It has certain clinical application value.
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Objective To investigate the clinical efficacy of arthroscopic double Endobutton plate internal fixation in the treatment of acute acromioclavicular joint dislocation.Methods A retrospective case series study was performed to analyze the clinical data of 32 patients with Rockwood type Ⅲ or Ⅴ acute acromioclavicular joint dislocation admitted to Foshan Hospital of TCM from May 2015 to February 2018.There were 26 males and six females,aged 22-56 years [(37.7 ± 1.6)years].There were 22 patients with Rockwood type Ⅲ and 10 patients with type Ⅴ.The duration from injury to operation was 2-5 days.All patients were treated with arthroscopic double Endobutton plate internal fixation for coracoclavicular ligament reconstruction.The operation time,hospitalization time,and postoperative shoulder joint braking time were recorded.The shoulder joint function was evaluated by the Constant-Murley score (CMS),visual analogue scale (VAS),American shoulder and elbow surgeons (ASES) score,University of California Los Angeles (UCLA) score and simple shoulder test (SST) before operation and at the last follow-up.Meanwhile,complications such as infection,loosening and joint dislocation were recorded.Results All patients were followed up for 8-48 months [(27.8 ± 11.6) months].The operation time was 48-93 minutes [(65.0 ± 24.6) minutes],the hospitalization time was 3.2-10 days [(6.5 ± 2.6)days],and the postoperative braking time was 21-35.3 days [(28.2 ± 7.1)days].All patients had a grade A healing of surgical incision.The VAS was decreased from preoperative (5.7 ±2.5)points to (1.2 ±0.8)points at the last follow-up (P ＜0.01);CMS wasvincreased from preoperative (29.3 ± 3.4) points to (93.2 ± 2.1) points at the last follow-up (P ＜0.05);ASES score was increased from preoperative (28.9 ± 10.1) points to (95.7 ± 5.6) points at the last follow-up (P ＜ 0.05);UCLA score was improved from preoperative (11.6 ± 2.8) points to (34.2 ±1.5)points at the last follow-up (P ＜0.05);SST score was improved from preoperative (3.5 ±1.2)points to (9.7± 1.4)points at the last follow-up (P ＜ 0.O1).The incidence of intraoperative and postoperative complications was 16％ (5/32).In two patients,the surgery was changed to U shape fixation circulating the coracoid base due to the coracoidbone tunnel cutting out.One patient was found to have insufficient reduction and received the acromioclavicular joint operation.One patient had reduction loss due to the clavicle button collapsing,and one patient had excessive reduction.Conclusions For Rockwood type Ⅲ or Ⅴ acute acromioclavicular dislocation patients,arthroscopic double Endobutton plates for coracoclavicular ligament reconstruction has the advantages of less intraoperative trauma,quick recovery and satisfactory clinical result.However,the incidence of intraoperative and postoperative complications is relatively high,and indications should be strictly controlled.
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Objective To explore the clinical efficacy of laparoscopic gastric ulcer perforation repair com-bined with Helicobacter pylori(Hp)cure.Methods Laparoscopic repair was used in the treatment of gastric ulcer perforation in 45 cases,and 42 cases of postoperative infection were combined Hp eradication therapy.Results The average operative time was 52.5min (36 -83min),mean blood 17.2mL(8 -45mL)in the 45 patients,with no sig-nificant intraoperative complications.The mean 4.5d (3 -8d)normally discharged after an average follow -up of 25 months (18 to 36 months)without significant complications and recurrent perforation.In 42 cases infected with Hp,cure rate of 97.6%,inefficiency of 3.4%,2 -year recurrence rate of 4.9%.Conclusion Laparoscopic gastric ulcer perforation is a minimally invasive,safe and effective surgical method.The surgery is simple,minimal trauma, less pain,faster recovery and fewer complications,Hp infected radical surgery combined with Hp eradication has good efficacy,less recurrence and important clinical significance and value.