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Objective To summarize and analyze the clinical features,diagnostic methods and treatment measures of patients with advanced spontaneous esophageal rupture. Methods Retrospective analysis of clinical characteristics of 10 patients with advanced spontaneous esophageal rupture was conducted. Results The average age of the patients was 49. 3 years old. The average time of diagnosis was 82. 6 hours. The cause of onset was drastic vomiting except for one case falling down. The main clinical manifestations were chest pain,abdominal pain,and shortness of breath,fever and elevation of hemogram,pleural effusion appeared in all patients,1 case was not treated in time,and 9 cases of the first checks were delayed for diagnosis and treatment in other specialties. Conservative treatment(closed thoracic drainage,gastrointestinal decompression,enteral nutrition support and antimicrobial therapy) was given to all patients. All 10 cases were cured by conservative treatment,the average time of hospitalization was 49. 4 days,followed up for 2 years, no chronic empyema, stricture of the esophagus and reflux esophagitis were observed. Conclusion Late spontaneous rupture of the esophagus is caused by delays in the diagnosis and treatment of the esophagus,the effect of comprehensive conservative treatment is satisfactory.
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Objective To investigate the effect of pre-treatment of ginkgo biloba extract from portal vein on oxidative stress in liver surgery.Methods Sixty cases of hepatic portal occlusion for hepatectomy surgery in patients (38 males, 22 females, ASA grade Ⅰ or Ⅱ, cardiac function Ⅰ or Ⅱ, Child-Pugh class A), were randomly divided into three groups (n=20 each): portal vein injection group (group P), jugular vein injection group (group J) and control group (group C).Patients in group P were injected with ginkgo biloba extract injection 5 ml slowly from portal vein after freeing the portal vein, patients in group J were injected with ginkgo biloba extract injection 5 ml slowly from the jugular vein after freeing the portal vein, while patients in group C were injected with normal saline 5 ml slowly from the jugular vein after freeing the portal vein.Venous blood samples were drawn from jugular vein at the following time points: pre-occlusion ten minutes (T0), 1 h (T1), 6 h (T2), 24 h (T3) after reperfusion respectively, and then detected the levels of ALT, AST, tumor necrosis factor(TNF-α), manlondialdehyde (MDA) and the activity of superoxide dismutase (SOD).Results Compared with T0, the serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly increased,the activity of SOD was significantly decreased in all groups (P＜0.05).Compared with group C, serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly decreased, the activity of SOD was significantly increased in groups J and P (P＜0.05).Compared with group J, serum levels of ALT, AST, TNF-α and MDA at T1-T3 were significantly decreased, the activity of SOD was significantly increased in group P (P＜0.05).Conclusion The pre-treatment of ginkgo biloba extract from portal vein can increase the SOD activity, inhibit the activation of Kupffer cells, reduce the release of TNF-α, enhance the ability of anti-oxidative stress and produce significant protective effect on liver ischemia-reperfusion injury.
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Objective To investigate the effects of different duration hypotension thresholds on p-Tau-181 and Aβ-42 protein expression and cognition in rats. Methods Thirty-nine healthy male SD rats were randomly di-vided into 4 groups:the control group(group C,n=9),the hypotension group(groupA1、A2、A3 ,n=10). The blood pressure of groupA1、A2、A3 was measured in different time of 2 h、4 h、6 h ,for 5 days. The antihyperten-sive group of mean arterial pressure(MAP)were maintained in the 50~55 mmHg safe range. Morris water maze was used to detect the spatial learning and memory ability of rats. The levels of Aβ42 and p-Tau-181 were detected by ELISA. Results There was no significant difference in mortality of rats in each group (P > 0.05). Compared with the group C,the escape latency and swimming distance of A2 group and A3 group were increased(P<0.05). In 3~7 days after operation,the cerebrospinal fluid P-Tau-181 and Aβ42 protein expression increased in the A2 group and A3 group compared with the A1 group(P<0.05). The escape latency and swimming distance of the A2 group and the A3 group were significantly longer than those in the control group. Aβ42 and p-Tau-181 were signifi-cantly increased in A3 group(P < 0.05). Compared with the A2 group,the increase of Aβ42 and p-Tau-181 in the A3 group was not significant(P<0.05). Conclusion Long-term controlled hypotension may lead to postoper-ative cognitive dysfunction which may relate to the increase of Aβ42 and p-Tau-181 protein expression.
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Objective To investigate the role of Rho/Rock signaling pathways in ventilator-in-duced lung injury in rats.Methods Ninety-six male SD rats,weighing 300-350 g,were equally and randomly divided into four groups using a random number table (n =24 each):control group (group C),fasudil group (group F),high tidal volume group (group H)and high tidal volume + fasudil group (group HF).Rats in group C and group F received no mechanical ventilation,rats in group H and group HF were intubated and mechanically ventilated (VT = 40 ml/kg,RR = 40 beats per minutes,FiO 2 =40%)for 4 h.The animals in group F and group HF were given intraperitoneal in-jection of fasudil 10 mg/kg at the time 1 h before mechanically ventilated.Six rats were chosen in each group at the time before ventilation (T0 )and at 4,8,24 h after ventilation (T1-T3 ),and blood sam-ples were taken for determination of the levels of serum tumor necrosis factor-α (TNF-α),IL-6 and IL-10,lungs were removed,bronchoalveolar lavage fluid (BALF)was collected to examine protein content,wet/drying (W/D)ratio was determined,which were then stained with haematoxylin and e-osin and examined under microscope,the pathological changes of lungs were scored.Myeloperoxidase (MPO)activity in lung tissue was determined by spectrophptometry.Protein and gene expression of RhoA and Rock2 in the lung tissue were detected by Western blot and reverse transcription PCR (RT-PCR).Results Compared with group C,the serum TNF-α,IL-6 and IL-10,BALF protein content, W/D ratio,the pathological scores,MPO activity,the expression of RhoA,Rock2 protein and mR-NA were significantly increased in group H and HF at T1-T3 (P <0.05 ).Compared with group H, the serum TNF-αand IL-6,BALF protein content,W/D ratio,the pathological scores,MPO activi-ty,the expression of RhoA,Rock2 protein and mRNA were significantly decreased,and the serum IL-10 was significantly increased in group HF at T1-T3 (P <0.05).Conclusion Fasudil can attenuate ventilator-induced lung injury in rats,and the mechanism may be associated with inhibition of the Rho/Rock signaling pathways reducing the inflammatory response.
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Objective To evaluate the efficacy of oxycodone for patient-controlled intravenous analgesia (PCIA) after hip arthroplasty in elderly patients.Methods Sixty patients of both sexes,aged 65-85yr,weighing 42-89 kg,of American Society of Anesthesiologists physical status Ⅰ or]Ⅱ,scheduled for elective unilateral hip arthroplasty under general anesthesia,were divided into 2 groups (n =30 each) using a random number table:morphine group (group M) and oxycodone group (group O).Parecoxib sodium 40 mg was injected intravenously at 30 min before induction of anesthesia,followed by induction and maintenance of anesthesia.PCIA pump was connected at the beginning of skin closure.PCIA solution contained morphine 0.6 mg/kg and tropisetron 10 mg diluted to 100 ml in normal saline in group M and oxycodone 0.6 mg/kg and tropisetron 10 mg diluted to 100 ml in normal saline in group O.The PCA pump was set up with a background infusion at 2 ml/h,a 0.5 ml bolus dose and a 15 min lockout interval in both groups.Visual analogue scale score was maintained ≤ 3,and postoperative analgesia lasted until 48 h after operation.When analogue scale score ≥ 4,pethidine 50 mg/kg was injected muscularly as rescue analgesic.The requirement for rescue analgesic and occurrence of adverse effects were recorded.Results Ten percent patients required rescue analgesics in group M,and no patients required rescue analgesics in group O.Compared with group M,the requirement for rescue analgesics and incidence of nausea,vomiting and pruritus were significantly decreased in group O (P＜0.05).Conclusion Oxycodone provides reliable efficacy for PCIA after hip arthroplasty in elderly patients with fewer adverse effects,indicating that oxycodone produces good analgesic efficacy for severe somatalgia.
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Objective To investigate the effects and mechanism of pre-treatment with an Nrf2 inducer dh404 on renal ischemia reperfusion injury in rats.Methods Thirty SD rats were divided into three groups using completely randomized digital table,dh404 was dissolved in sesame oil and was given orally 1.5 mg/kg the night before procedures and 5 hours before procedures.Rats in group Sham received no treatment of ischemic reperfusion.In group IR and group dh404,the renal ischemia reper-fusion (IR)model was established,24 hours after IR,the levels of serum creatininc (Cr)and urea ni-trogen (BUN),the activities of superoxide dismutase (SOD)and the content of malonaldehyde (MDA)in serum were measured,and hematoxylin eosin(HE)staining observe the changes in renal structure,the levels of γ-glutamate-cysteine ligase catalytic (GCLC)and modifier (GCLM)subunit, the expression of NF-κB,COX-2 and eNOS were measured.Results Compared with group Sham,the values of Cr,BUN in group IR and group dh404 were significantly higher (P <0.05).Compared to the group IR,the group dh404 Cr,BUN values significantly decreased after reperfusion for 24 h(P <0.05 ).Compared to group Sham,group IR SOD activity decreased,while the value of MDA increased(P <0.05 ).Compared to group IR,group dh404 had much higher SOD activity,while the value of MDA significantly decreased.Observed with optical microscopy,compared to group Sham, the renal tubular injury of group IR was obvious.Compared to group IR,group dh404 significantly reduced tubular injury.Compared to group IR,the levels of GCLC and modifier GCLM subunit were higher,while there were no significant differences of levels among NF-κB,COX-2 and eNOS. Conclusion Pre-treatment with an Nrf2 inducer dh404 can protect the kidney from IRI through possi-bly reducing IRI kidney oxidative stress.
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Objective To investigate the role of AKT/GSK3β/mTOR signaling molecule in myocardial protection of sevoflurane postconditioning.Methods Thirty-nine male Sprague-Dawley rats,weighing 200-250 g,installed in vivo myocardial ischemia-reperfusion model by left anterior de-scending coronary occlusion for 30 min.Rat hearts were randomly divided into 3 groups (n = 13 ):sham control group (group Sham),purely ischemia-reperfusion group (group IR),sevoflurane post-conditioning group (group SPC).With the exception of group Sham,each group was subjected to oc-clusion for 30 min followed by 2 h reperfusion.Group SPC was subjected to sevoflurane postcondi-tioning:2.4% sevoflurane was inhaled for 1 5 min starting from the end of ischemia until 1 5 min after beginning of reperfusion,while 33% oxygen was inhaled in the other groups.At the end of 2 h reper-fusion,cardiac function was evaluated by two-dimensional echocardiography,myocardial infarction size was measured by using 1% 2,3,5-triphenyltetrazolium chloride triazole (TTC),myocardial ultra-structural alterations was detected by transmission electron microscopy (TEM),cardiomyocytes ap-optosis was examined by terminal deoxynucleotidyl nickend labeling (TUNEL),the expressions of p-AKT/t-AKT, p-GSK3β/t-GSK3β, p-mTOR/t-mTOR,Bcl-2 and Bax proteins was measured by Western blot.Results Compared with group Sham,cardiac function was deteriorated,myocardial in-farct size was increased,cardiomyocyte mitochondrial damage was increased,positive apoptotic car-diomyocyte was increased,the expression of Bcl-2 was down-regluated,and the expressions of p-AKT/t-AKT,p-GSK3β/t-GSK3β,p-mTOR/t-mTOR and Bax were up-regluated in group IR (P <0.05).Compared with group IR,cardiac function was improved,myocardial infarct size was de-creased,cardiomyocyte mitochondrial damage was decreased,positive apoptotic cardiomyocyte was decreased,the expression of Bax was down-regluated,and the expressions of p-AKT/t-AKT,p-GSK3β/t-GSK3β,p-mTOR/t-mTOR and Bcl-2 were up-regluated in group SPC (P < 0.05 ). Conclusion Sevoflurane postconditioning can mitigate ischemia-reperfusion injury to in vivo rat hearts,decreased cardiomyocyte mitochondrial damage,inhibited cardiomyocyte apoptosis,and its mechanism was related to the activation of AKT/GSK3β/mTOR signaling molecule.
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Objective To monitor and analyze the condition and rational treatment of multi-resistant bacteria.Methods A retrospective survey analysis on the distribution of bacteria,drug resistance and the treatment outcomes of the bacteria in our hospital was conducted.Results Among 165 strains of multiple drug-resistant bacteria,staphylococcus aureus strains accounted for (17.57％),ELBLS Klebsiella pneumonia clay had 73 strains(44.24％),escherichia coli had 48 strains (29.09％),staphylococcus epidermidis had 15 strains (9.09％).The gram negative bacilli were 121 strains(73.30％).Conclusion The ELBLS Klebsiella pneumoniae resistance had a high infection rate.Clinical departments should pay more attention to those conditions.The doctor should use antibiotics rationally.