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Objective:To explore the pathogenic characteristics and related risk factors of fungal infection after liver transplantation(LT)from deceased donation and provide rationales for formulating optimal control strategies.Methods:From February 2019 to September 2020, clinical data were retrospectively reviewed for 187 recipients after LT from deceased donation.Univariate and multiple Logistic regression analyses were performed for determining the independent risk factors of postoperative fungal infection.Results:Among 187 LT cases, 26 cases had postoperative fungal infection with a mortality rate of 46.2%(12/26). Lung was the most common fungal infection site, accounting for 80.8%(21/26). The most common pathogenic bacteria of fungal infection were Candida albicans, accounting for 53.3%(16/30). Multiple Logistic regression analysis indicated that operative duration ≥8 h( OR=3.610, 95% CI: 1.079-12.081, P=0.037), re-operation( OR=39.234, 95% CI: 3.512-438.258, P=0.003)and intensive care unit(ICU)retention time ≥7 d( OR=10.070, 95% CI: 3.480-29.140, P=0.002)were independent risk factors of postoperative fungal infection. Conclusions:Postoperative fungal infection is a serious threat to the prognosis of recipients of LT from deceased donation.Minimizing operative duration on the basis of ensuring quality of surgery, strictly grasping the indications for re-operation and transferring out of ICU in early postoperative period may help to lower the risks of fungal infection after LT from deceased donation.
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Objective:To propose a markless patient setup workflow based on the optical surface monitoring system (AlignRT) and open-face mask immobilization for whole-course head tumor radiotherapy, assess the setup time and repositioning frequency of the proposed workflow, and conduct a comparative analysis of the differences, correlation, and consistency of the setup errors of the AlignRT and cone beam CT (CBCT) systems.Methods:A retrospective analysis was conducted for the data on the errors of 132 fractionated setup based on open-face mask immobilization of 33 head tumor patients. AlignRT-guided markless patient setup workflow was applied throughout the radiotherapy. Meanwhile, the body structures automatically generated by the treatment planning system were used as body references. The 6-degree-of-freedom (6DoF) setup errors (lateral, vertical, longitudinal, rotation, pitch, roll, and yaw directions), setup time, and repositioning frequency of the AlignRT and CBCT systems were recorded and analyzed. The Wilcoxon and Spearman analyses were used to statistically assess the differences and correlation of the setup errors of the two systems. Moreover, the Bland-Altman analysis was employed to evaluate the consistency of the two systems.Results:The 6DoF setup errors of CBCT were within the clinical tolerance (linear motions: -0.30 to 0.30 cm; rotational motions: -2.0° to 2.0°). The setup time and repositioning frequency of CBCT were (98 ± 31) s and 1.51% (2/132), respectively. There was no significant difference in setup errors between the two systems except those in x-axis ( Z = -3.11, P= 0.002), y-axis ( Z = -7.40, P<0.001), and Pitch ( Z= -4.48, P<0.001). There was a significant positive correlation between the setup errors along lateral ( rs = 0.47, P<0.001) and vertical ( rs = 0.29, P = 0.001) directions, rotation (Rtn; rs = 0.47, P<0.001), pitch (Pitch; rs = 0.28, P = 0.001) and roll (Roll; rs = 0.45, P<0.001) of the two systems. The 95% limits of agreement (95% LoA) of 6DoF setup errors were -0.12 to 0.09 cm, -0.07 to 0.17 cm, -0.19 to 0.20 cm, -1.0° to 0.9 °, -1.0° to 1.5°, and -0.9° to 1.0°, respectively. The 95% confidence interval (95% CI) of 95% LoA was -0.14 to 0.11 cm, -0.09 to 0.19 cm, -0.23 to 0.23 cm, -1.2° to 1.1°, -1.2° to 1.7°, and-1.0° to 1.1°, respectively, all of which were within the permissible error ranges. The 6DoF setup error difference of 3.41% (27/792< 5%) was beyond the 95% LoA. The maximum absolute differences of 6DoF setup errors within the 95% LoA were 0.12, 0.16, 0.19 cm, 0.9°, 1.5°, and 1.0°, respectively. Conclusions:The proposed markless setup workflow based on AlignRT combined with open-face mask immobilization for whole-course head tumor radiotherapy exhibits reasonable agreement and consistency with the patient setup using CBCT, with acceptable clinical efficiency. It can be applied to the first radiotherapy and the real-time monitoring of therapy to improve the safety and thus is of value in clinical applications.
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Objective:To characterize the key dose response properties of the novel presage sheet dosimeters for radiotherapy dose verification, including absorption spectra, linearity, dose range and stability.Methods:The same batch of presage sheet dosimeters were irradiated by a radiotherapy linac. The absorption spectra within 400-700 nm were read out with a spectrophotometer, and the R-G-B3 absorption changes read out with a film flatbed scanner was compared before and after irradiation.Results:An absorption peak was clearly identified at 628 nm, where absorptions change in high linearity with delivered doses ( R2=0.9999). A flat valley region is identified around 490 nm, where dose induced absorption changes were negligible. The readout sensitivity of the R-channel of the flatbed scanner was higher than both in green and blue channels. In the dose range below 10 Gy, the R-channel absorptions are in significant linearity with doses ( R2=0.9999), with absorptions change in an obvious quadratic trend in the range beyond 10 Gy ( R2=0.9999). The dose range of presage sheets was more than 94.6 Gy. The absorptions were well preserved within 1 h post-irradation, and then are shown to increase gradually, where the increase speeds are dose-related. The post-irradiation integrity of dose falloff gradients are shown with negligible gradient blurring. Conclusions:The novel presage sheets shown to have reasonable dose response linearity, large dose range, desirable post-irradiation dose gradient integrity and negligible fractionation effect, which indicates its great potentials in integral dose verification of high-dose and multiple target radiotherapy deliveries.
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Objective:To build patient setup workflow based on the optical surface monitoring system (OSMS) in postoperative radiotherapy for breast cancer, and compare the setup accuracy and PTV margin between OSMS based setup and conventional skin marker based method.Methods:The setup data of 20 cases of postoperative radiotherapy for breast cancer were retrospectively analyzed and divided into two groups: OSMS setup group and conventional skin marker setup group with 10 patients in each group. All CBCT rigid registration values in six dimensions ( x, y, z, Rtn, Pitch, Roll) were obtained, and the absolute value and distribution of errors were statistically analyzed by single sample t-test and χ2-test respectively. Finally, the CTV-PTV margins were compared using the extension formula. Results:The mean values in OSMS setup group and conventional skin marker setup group in sixdirections were 0.18 and 0.18 cm, 0.12 and 0.13 cm, 0.13 and 0.23 cm, 0.55° and 0.74°, 0.63° and 0.99°, 0.67° and 0.68°, respectively, while the standard deviations were 0.13 and 0.12 cm, 0.09 and 0.09 cm, 0.11 and 0.16 cm, 0.37° and 0.55°, 0.53° and 0.65°, 0.42° and 0.55°, respectively. The setup error differed in both z and Pitch directions( t=3.53, 2.98, P<0.05), while the error distribution rate difference was statistically significant between two groups in z direction( χ2=11.090, P<0.05). The CTV-PTV margins in OSMS setup group and conventional skin marker setup group were 0.28 and 0.26 cm, 0.21 and 0.20 cm, 0.24 and 0.35 cm, respectively. Conclusions:The proposed OSMS-based patient setup work flow is better than the conventional skin marker based method in setup accuracy, with significant setup error differences in z and Pitch directions. The proposed OSMS workflow is of potential clinical benefit.
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Objective:To develop a new method to set up patients using optical surface monitoring system and to compare it with the conventional method in head radiotherapy.Methods:A total of 358 set-ups (130 with the conventional method and 228 with the new method ), which were from 99 head tumor patients in Beijing Cancer Hospital treated between May 2018 to April 2019, obtained by using Image Guided Radiotherapy were retrospectively analyzed. The distributions of set-up errors, the number of abnormal positions, and the set-up time were compared to evaluate the potential advantages of the new method .Results:The mean (± standard deviation) absolute values of setup errors of the new method were (0.07±0.07) , (0.08±0.06) and (0.06±0.06) cm for the vertical, lateral, and longitudinal, (0.53±0.41)°, (0.59±0.44)° and (0.59±0.46)° for the rotation, pitch and roll, respectively. In the new method , the setup accuracy was improved( t=3.24-6.10, P<0.001)and the number of abnormal positions was greatly reduced(χ 2=60.66, P<0.001). Compared with the conventional method, the patient setup time was slightly reduced by the new method , but the difference was not statistically significant ( P>0.05). Conclusions:The new high-precision method to set up patients using optical surface monitoring system improves the accuracy of patients′ position, decreases the corrections applied by 6DoF couch, reduces the probability of abnormal positions, and suggests the potential benefit in head radiotherapy.
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Objective@#To compare the setup accuracy between Catalyst HD and skin markers in stereotactic body radiotherapy (SBRT) of lung cancer.@*Methods@#A total of 24 cases treated with SBRT were selected and all patients were fixed with vacuum pad in the supine position. Patients in group A were positioned by Catalyst HD and those in group B were positioned by shin markers. All patients were matched with the CT images after CBCT scan by rigid registration and the setup errors in six directions (x-, y-, z-axis, Rtn, Pitch and Roll) were obtained.@*Results@#The mean±SD in group A and B in the six directions were as follows: (0.13±0.12) cm, (0.25± 0.19) cm; (0.26±0.15) cm, (0.13±0.11) cm; (0.23±0.19) cm, (0.35±0.29) cm; (0.43°±0.40°), (0.80°±0.69°); (0.48°±0.47°), (0.79°±0.64°); (0.62°±0.60°) and (0.88°±0.70°), respectively. Except the x-axis data in group B, all the data in the six directions were not normally distributed. The obtained data significantly differed between two groups (all P<0.05). The out-of-tolerance errors (>0.5 cm/2°) also significantly differed between two groups (P<0.05).@*Conclusions@#The setup errors of Catalyst HD are less than those of the skin markers (except the y-axis). The setup accuracy of Catalyst HD is superior to that of traditional skin markers, which is worthy of application in clinical practice.
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Objective To compare the setup accuracy between Catalyst HD and skin markers in stereotactic body radiotherapy (SBRT) of lung cancer.Methods A total of 24 cases treated with SBRT were selected and all patients were fixed with vacuum pad in the supine position.Patients in group A were positioned by Catalyst HD and those in group B were positioned by shin markers.All patients were matched with the CT images after CBCT scan by rigid registration and the setup errors in six directions (x-,y-,z-axis,Rtn,Pitch and Roll) were obtained.Results The mean ±SD in group A and B in the six directions were as follows:(0.13±0.12) cm,(0.25± 0.19) cm;(0.26±0.15) cm,(0.13±0.11) cm;(0.23±0.19) cm,(0.35±0.29) cm;(0.43°±0.40°),(0.80°±0.69°);(0.48°±0.47°),(0.79°±0.64°);(0.62°±0.60°) and (0.88°±0.70°),respectively.Except the x-axis data in group B,all the data in the six directions were not normally distributed.The obtained data significantly differed between two groups (all P＜0.05).The out-of-tolerance errors (＞0.5 cm/2°) also significantly differed between two groups (P＜0.05).Conclusions The setup errors of Catalyst HD are less than those of the skin markers (except the y-axis).The setup accuracy of Catalyst HD is superior to that of traditional skin markers,which is worthy of application in clinical practice.
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Objective To observe the clinical efficacy of thoracoscopic pleural dissection in the treatment of non tuberculous empyema. Methods 48 non tuberculous empyema were selected from January 2015 to June 2017, according to the treatment methods, divided into the observation group (n = 24) and control group (n = 24), the observation group was treated with thoracoscopic pleural dissection treatment, the control group were treated with traditional thoracotomy for the treatment of more than two groups, effect of treatment. Results The observation group of patients with operation time, bleeding volume, drainage time and hospitalization time were significantly less than the control group (P < 0.05); the two groups of patients before treatment, FVC, FEV1, TLC compared no significant difference, no statistical significance (P > 0.05); after treatment, the patients' FVC, FEV1, TLC significantly increased (P < 0.05), and the patients in the observation group FVC, FEV1and TLC were significantly higher than that of the control group (P < 0.05). PO2, PCO2and WBC were significantly better than the treatment of two groups of patients after treatment, and the observation group of patients with PO2after treatment (80.30 ± 9.26) mmHg, PCO2(45.53 ± 4.27) mmHg and WBC (8.85 ± 3.62) g/L index was significantly better than the control group PO2 (70.33 ± 8.75) mmHg, PCO2(51.61 ± 5.40) mmHg and WBC (10.81 ± 4.00) g/L, the difference was statistically significant (P < 0.05). Conclusion Video-assisted thoracoscopic surgery for the treatment of non tuberculous empyema has less trauma and faster postoperative recovery.
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<p><b>OBJECTIVE</b>To evaluate the clinical results of anterior cervical discectomy and reconstruction with a self-locking cage and internal fixation with short segmental plate for multilevel cervical spondylotic myelopathy.</p><p><b>METHODS</b>From January 2012 to June 2015, a total of 106 patients received anterior cervical discectomy and reconstruction with a self-locking cage and internal fixation with short segmental plate were followed up. There were 71 males and 35 females, aged from 42 to 74 years old with an average of(55.4±5.1) years. Three segments were involved in 82 cases and four segments in 24 cases. Operation time, blood loss, postoperative drainage, and hospitalization time were recorded. Visual analogue scale(VAS) and Japanese Orthopaedic Association Score (JOA) were analyzed before and after operation(including 5 days, 3, 6, 12 months after operation and final follow-up), and the JOA improvement rate was analyzed. The cervical lordosis and ROM were measured before and after operation(including the follow-up point above) by X-rays. The postoperative complications were recorded and analyzed as well.</p><p><b>RESULTS</b>All the operations were successful. The average operative time was (126.2±25.1) min, and the amount of blood loss was (82.1±26.3) ml. All the patients were followed up from 12 to 48 months with an average of (30.4±10.5) months. The VAS score of neck pain and JOA score was significantly better from 6.11±1.54 and 9.22±2.42 preoperatively to 2.14±0.51 and 12.46±1.42 at 5 days post-operation, respectively(<0.05). The improvement rate of JOA was (56.7±21.6)%, there was no statistically significant difference of VAS, JOA scores and the improvement rate of JOA at each time after operation (>0.05). Postoperative cervical lordosis at 3 months was significantly improved from preoperative (11.5±6.8)° to (19.6±8.9)°(<0.05), and it can keep satisfactory stability until final follow-up(>0.05). Postoperative ROM at 3 months was significantly decreased from the preoperative (37.6±10.4)° to (18.2±5.9)°(<0.05), but there was no significant change in the process of follow-up (>0.05). All the complications such as dysphagia (19 cases), axial neck pain(6 cases), cerebral fluid leakage(3 cases), and hoarseness(2 cases), got better after conservative treatment. Three cases had intervertebral space non-fusion until final follow-up(without clinical symptom), but no loosening, breakage, or displacement of internal fixation were found.</p><p><b>CONCLUSIONS</b>Anterior cervical discectomy, reconstruction with a self-locking cage and internal fixation with short segmental plate which can reduce intraoperative injury, restore cervical lordosis, improve neurological function and lower postoperative complications, it is an alternative treatment for multilevel cervical spondylotic myelopathy.</p>
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Objective:To evaluate the six-degree setup errors of tumors of cervical vertebra, thoracic vertebra and lumbar vertebra by image guided radiotherapy. Methods:From May 2013 to June 2014, 30 patients with spinal malignant tumors(10 patients of cervical vertebra, thoracic vertebra and lumbar verte-bra respectively) were treated with Elekata Synergy accelerator(Elekta company,Sweden). Six-degree set up errors were corrected using HexaPODTM evoRT bed under image of on board cone beam computed tomography ( CBCT) guided. All the patients received kilovoltage CBCT before receiving radiotherapy and after correction. The acquired images were co-registered with planning CT with bone window. The data of 838 CT images were analyzed and the errors of translational directions X ( lateral ) , Y ( lngitudi-nal),Z(vertical)and rotational directions RX(pitch), RY(roll), RZ(yaw) were recorded. The data were compared by t-test using SPSS 13. 0. Results:The absolute translational setup errors in X, Y and Z axes of cervical vertebra before correction were (1. 71 ± 0. 10) mm, (1. 81 ± 0. 11) mm and (1. 94 ± 0. 09) mm respectively:(3. 17 ± 0. 19) mm, (4. 26 ± 0. 28) mm and (2. 18 ± 0. 12) mm for thoracic vertebra, and (2. 69 ± 0. 24) mm, (3. 33 ± 0. 26) mm and (2. 86 ± 0. 21) mm for lumbar vertebra. The residual setup errors in X, Y and Z axes of cervical vertebra were (0. 5 ± 2. 4) mm,(0. 01 ± 2. 4) mm and (2. 4 ± 1. 4) mm, respectively after correction;(1. 17 ± 0. 11) mm,(0. 26 ± 0. 30) mm and (0. 08 ± 0. 12) mm for thoracic vertebra and (1. 09 ± 0. 24) mm,(2. 03 ± 1. 26) mm and (0. 06 ± 0. 51) mm for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed significant difference in three translational directions of cervical vertebra and thoracic vertebra, only Z (t= -3. 518,P<0. 001) for lumbar vertebra. The absolute rotational setup errors in RX,RY and RZ axes of cervical vertebra before correction were 0 . 67 ° ± 0 . 04 ° ,1 . 06 ° ± 0 . 06 ° and 0 . 78 ° ± 0 . 05 ° respec-tively. 0. 62° ± 0. 05°, 0. 75° ± 0. 06°, and 0. 84° ± 0. 06° for thoracic vertebra, 0. 59° ± 0. 06°, 0. 80° ± 0. 07°, and 0. 73° ± 0. 06°for lumbar vertebra. The rotational directions RX, RY and RZ axes of cervical vertebra were 0 . 27 ° ± 0 . 14 ° , 1 . 20 ° ± 0 . 04 ° and 0 . 28 ° ± 0 . 05 ° respectively;0 . 02 ° ± 0 . 20 ° , 0. 05° ± 0. 26°and 0. 64° ± 0. 16°for thoracic vertebra and 0. 09° ± 0. 26°, 0. 50° ± 0. 05°,and 0. 03° ± 0. 16°for lumbar vertebra. The t-test of paired data of set up errors before and after CBCT showed signifi-cant difference in three rotational directions of cervical vertebra and lumbar vertebra, only RY(t=7. 106, P<0. 001)for thoracic vertebra. All the patients acquired pain relief and there was no radiation-induced toxicity detected clinically during a median follow-up of 6 months. Conclusion:Six-degree set up errors of spine tumors were corrected effectively with HexaPODTM evoRT bed under CBCT image guided and its feasibility in day-to-day clinical practice has been demonstrated.
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<p><b>OBJECTIVE</b>To study the effects of Bushen Zhuangjin Decoction (BZD) containing serum on the apoptosis of chondrocytes induced by mechanics stimulus.</p><p><b>METHODS</b>The BZD containing serum was extracted. The chondrocyte nutritive media was divided into 3 groups, i.e., the common nutritive medium group, the blank rabbit serum medium group, and the BZD nutritive medium group. The apoptosis of chondrocytes was induced by continuing mechanics stimulus in 24 h. Then the chondrocytes were collected. The apoptosis rate of chondrocytes was determined by flow cytometry. The contents of interleukin 1beta (IL-1beta) and nitric oxide (NO) in the corresponding media were determined.</p><p><b>RESULTS</b>The apoptosis of chondrocytes in the BZD nutritive medium group (19.55 +/- 7.98)% was lower than that of the common nutritive medium group (39.32 +/- 13.45)% and the blank rabbit serum medium group (37.87 +/- 9.67)%, showing statistical difference (P < 0.05). The contents of IL-1beta and NO were also lower in the BZD nutritive medium group with statistical difference when compared with those of the other two groups (P < 0.05).</p><p><b>CONCLUSION</b>BZD containing serum could protect mechanics stimulus induced apoptosis of chondrocytes.</p>
Subject(s)
Animals , Rabbits , Apoptosis , Cartilage, Articular , Cells, Cultured , Chondrocytes , Cell Biology , Drugs, Chinese Herbal , Pharmacology , Flow Cytometry , Interleukin-1beta , Nitric Oxide , SerumABSTRACT
<p><b>AIM</b>To observe effect of acute normovolemic hemodilution(ANH) with HAES-balanced solution as diluting agent on levels of cytokines including IL-1, IL-2, IL-6 and TNF-alpha in rabbit serum so as to provide theoretical basis for clinical application.</p><p><b>METHODS</b>A total of 20 healthy adult rabbits were enrolled in the study and randomly divided into two groups (10 rabbits per group), i.e., control group (Group C) and HAES group (Group H). Under anesthesia of the rabbits, we performed incision of trachea, high-frequency jet ventilation and liberation of femoral artery and femoral veins. Group C was free from hemodilution. Group H was injected with dilution (2-fold of blood letting volume) via femoral veins during blood letting of the femoral artery. 6% HAES-steril plus compound solution of sodium lactate, with crystal/gel ratio of 2:1, blood letting volume = TBV x (Ho-Hf)/Hav. All blood was transfused back 60-120 min after blood letting. Venous blood was collected before blood letting (T0) and 30 min (T1), 60 min (T2), 120 min (T3) and 24 h(T4) after blood letting to detect Hb and Hct and measure level of IL-1, IL-2, IL-6 and TNF-alpha in serum.</p><p><b>RESULTS</b>In Group H, levels of IL-1, IL-2, IL-6 and TNF-alpha in serum were increased from T1 after ANH, reached peak at T3 but showed decrease at T4, with significant difference compared with Group C at T1, T2, T3 and T4 (P < 0.01) and significant difference compared with those before ANH (P <0.01). In Group C, there was no significant difference upon IL-1, IL-2, IL-6 and TNF-alpha in serum at different time points.</p><p><b>CONCLUSION</b>ANH with HAES-balanced solution as diluting agent can up-regulate the levels of cytokines IL-1, IL-2, IL-6 and TNF-alpha in rabbit serum. In the meantime, ANH may arouse eustress with low intensity and short action time, which exerts effect of enhancing immune function of the organisms.</p>
Subject(s)
Animals , Female , Male , Rabbits , Hemodilution , Methods , Interleukin-1 , Blood , Interleukin-2 , Blood , Interleukin-6 , Blood , Plasma Substitutes , Random Allocation , Tumor Necrosis Factor-alpha , BloodABSTRACT
<p><b>OBJECTIVE</b>To prepare immunoaffinity column of zearalenone.</p><p><b>METHODS</b>The zearalenone immunoaffinity column (IAC) was prepared by coupling CNBr-activated Sepharose 4 Fast Flow (4FF) with the anti-zearalenone monoclonal antibody which was purified by caprylic acid-ammonium sulfate method. The coupling reaction was identified by UV-absorbance measurements, and the IAC prepared was evaluated by indirect-competition ELISA and HPLC.</p><p><b>RESULTS</b>The column capacity was determined to be 0.40 microg when using 0.5 ml of CNBr activated Sepharose 4FF and 350 microg of purified anti-zearalenone monoclonal antibody. The mean true recoveries were in the range 76.33% - 90.10% and RSD was 6.68% - 10.93% at levels of 60 microg/kg - 300 microg/kg. 30 samples of wheat and maize were detected by the anti-ZEN IAC produced by the laboratory, 17 samples were observed to be contaminated in a comparable range from 31.33 microg/kg - 377.84 microg/kg. Detection limit based on a signal-to-noise ratio 3:1 was 10. 00 microg/kg for ZEN in wheat and maize.</p><p><b>CONCLUSION</b>IAC, a simple separating method which is used in ZEN extraction from cereals, is able to purify and condense ZEN in one step. The cost of detection can be lowered down because the IAC developed is hopefully to substitute the imported IAC.</p>
Subject(s)
Antibodies, Monoclonal , Chromatography, Affinity , Methods , Chromatography, High Pressure Liquid , Zearalenone , Allergy and ImmunologyABSTRACT
<p><b>AIM</b>To investigate the role of endothelin-1 in the pathogenesis of neurogenetic pulmonary edema.</p><p><b>METHODS</b>The levels of endothelin-1 in plasma and lung were measured in rats which suffered from diffuse brain injury on Marmarous' model. The changes of endothelin-1 in the lungs were also detected using an immunohistochemical method.</p><p><b>RESULTS</b>After heavy diffuse brain injury in rats, the levels of endothelin-1 in plasma and lung began increasing at 1 hour, and peaked at 6 hour. Though a little declining at 24 hour, it maintained a higher level within 48 hours (P < 0.05). Pulmonary pathology showed that after brain injury there were congestion, swelling in pulmonary microvessels with broadened pulmonary interstitial tissue, and leucocyte infiltration was dominated by neutrophils and monocytes from 1 hour on, which peaked at 6 hour. More serious congestion, swelling and protein effusion in pulmonary alveoli were observed at both 24 h and 48 h. Immunohistochemically, endothelin-1 had more significant expression and higher levels of OD in the experimental groups than that in the control's, the most significance of which was at 6 hour.</p><p><b>CONCLUSION</b>The inflammatory injury mechanism caused by endothelin-1 may play an important role in neurogenic pulmonary edema.</p>