The clinical value of Angiopoietin 2 in prediction of the onset of acute respiratory distress syndrome / 中华急诊医学杂志

Objective To explore the clinical value of serum Ang-1,Ang-2 and IL-8 in ARDS prediction.Methods Totally 283 critically ill patients admitted in EICU of the Hunan Provincial People's Hospital from January 2012 to July 2013 were enrolled in this study and divided into the non-ARDS group (n =251) and ARDS group (n =32) depending on the development of ARDS.According to the occurrence of death in the following 60 days,the non-ARDS group and the ARDS group were further subdivided into the non-ARDS survival group,the non-ARDS death group,thc ARDS survival group and the ARDS death group.The differences in serum Ang-1,Ang-2 and IL-8 concentrations between these four groups measured by ELISA on admission were analyzed by statistical methods and ROC curve.Results The EICU stays,duration of mechanical ventilation,APACHE Ⅱ score、serum Ang-2 and IL-8 levels in the ARDS group were significantly higher than those in the non-ARDS group,while the Ang-1 level in the ARDS group was significantly lower than that in the non-ARDS group.The serum Ang-2 and IL-8 concentrations in the ARDS death group were significantly higher than those in the non-ARDS survival group and the non-ARDS death group,and the serum Ang-2 concentrations in the ARDS death group were also significantly higher than those in the ARDS survival group.Further ROC curve analysis showed that the area under the curve of Ang-2 for ARDS diagnosis and ARDS death prediction were 0.907 and 0.899 respectively and their diagnostic sensitivity and specificity were 0.969 and 0.725,0.907 and 0.882 respectively,illustrating that Ang-2 possess the best diagnostic efficiency.Conclusions Ang-2 functions as a valuable biomarker for early diagnosis and prognosis of ARDS.

Protection of noninvasive limb ischemic preconditioning on myocardium in patients undergoing heart valve surgery under cardiopulmonary bypass / 中南大学学报(医学版)

OBJECTIVE@#To determine the mechanism of protective effect of noninvasive limb ischemic preconditioning (NIPC) on myocardium of patients with rheumatic heart disease undergoing heart valve surgery under cardiopulmonary bypass (CPB).@*METHODS@#A total of 32 patients with rheumatic heart disease undergoing heart valve surgeries under CPB were randomly divided into 2 groups: a control group(n=16)and an NIPC group(n=16).Tourniguet was used for each patient in the NIPC group around both the upper extremities in turn, inflated for 8 min and deflated for 5 min for 3 cycles. After the anesthesia, the remaining procedures were the same as in the control group. Blood samples were collected from the central vein after the induction of anesthesia (T(1)), 5 min before aortic clamp (T(2)),30 min after aortic opening (T(3)), 6 h after the operation (T(4)), and 24 h after the operation (T(5)) to measure the concentration of cardiac troponin I and creatine kinase MB in the plasma and CGRP and ET-1 in the serum. Pathologic change of the right auricle of the heart tissue during the superior vena cave intubation and extubation was detected.@*RESULTS@#The content of cardiac troponin I and creatine kinase MB at T(4) and T(5) in the 2 groups was higher than that of other time points in the same group, and it reached the peak at T(5). Comparison of the content of cardiac troponin I and creatine kinase MB at T(4) and T(5) in the 2 groups showed significant difference, and that of the NIPC group was lower than the control group(P<0.05).CGRP and ET-1 contents reached the peak at T(2) in the NIPC group and at T(3) in the control group, but the peak of CGRP in the NIPC group was higher than that in the control group(P<0.01).The peak of ET-1 content in the NIPC group was lower than that in the control group(P<0.01). After the CPB, myocardial and mitochondrion impairment was lighter in the NIPC group than in the control group.@*CONCLUSION@#Noninvasive limb ischemic preconditioning can protect the myocardium through increasing CGRP, inhibiting ET-1, and advancing the peak of CGRP and ET-1.

Emergency treatment of aortic dissection and clinical pathway discussion / 中华急诊医学杂志

Objective To investigate the clinical features of aortic dissection (AD) and emergency treatments. Methods Data from 784 patients with aortic dissection were collected in the Department of Emergency from January 2000 through December 2009. A retrospective analysis was carried out to determine the survival rate, mortality rate and treatment efficiency. Results Pain was the most common onset symptom (77.7% , 609/784). The majority of patients (86.5%) had essential hypertension (678/784). All the patients with preoperative diagnosis of aortic dissection underwent emergency medical intervention by internists resulting in 81.5% survival rate (639/784) and 18.5% mortality rate (145/784). There were 157 patients without improvement (20.0% ) and the total efficiency rate was (83. 1% ). The efficiency rate of conventional treatment was 76.4% , while the efficiency rate of triple four-procedure treatment was 89. 8% (P<0.05). Of them, 139 patients (17. 7% ) died in the hospital. Among them,. 26 patients died within 24 hours (18.4% ) and 47 cases died within 48 hours (33. 8% ) and 66 patients died within 72 hours (47.2% ). There were 92 patients who refused treatments after diagnosis, and among them, 81 patients died within 72 hours (88.04% ). The difference in mortality rate between two groups was significant (P<0.05). Conclusions The diagnosis of aortic dissection depends on detailed history, physical examination and CT or MRI imaging. Analgesia, sedation and control of blood pressure are essential for emergency treatments. Early diagnosis and effective emergency treatments are the critical strategy for the early surgical intervention and time window for further treatment to improve the survival rate of AD.

Effect of morphine preconditioning on mitochondrial permeability transition pore after myocardial ischemia-reperfusion injury in rats / 中南大学学报(医学版)

Objective To investigate the effect of morphine preconditioning on mitochondrial permeability transition pore (MPTP) and its protective mechanism after myocardial ischemia-reperfusion injury. Methods A rat model of ischemia-reperfusion injury was established. Forty rats were injected with 2-3[H] DOG and then divided into 4 groups randomly: a sham operation (S) group, an ischemia-reperfusion injury (IR) group, a morphine preconditioning (Mp+IR) group, and a cyclosporine A preconditioning (CsA+IR) group. We monitored the concentrations of serum creatine kinase-Mb (CK-Mb) and cardiac troponin I (cTnI), and measured myocardial mitochondrial 2-3[H] DOG, cytochrome c content, Ca2+ concentration ([Ca2+]m), the velocity of Ca2+ intake and reaction half time of mitochondrial permeability transition pore (MPTP t1/2) in the 4 groups. Results The concentrations of serum CK-Mb and cTnI decreased more in the Mp+IR group and the CsA+IR group than those of the IR group. The concentrations of 2-3[H]DOG and [Ca2+]m in the IR group were evidently higher but the level of cytochrome c was lower than those of the sham operation group. The concentrations of 2-3[H] DOG and [Ca2+]m in the Mp+IR group decreased whereas the concentration of cytochrome c increased compared with those in the IR group. Mitochondrial 2-3[H]DOG content was positively correlated with the concentration of calcium (r=0.797, P<0.01). The 2-3[H]DOG and [Ca2+]m content were negatively correlated with cytochrome c in the IR group (r=-0.805 and r=-0.648, respectively, P<0.01). MPTP t1/2 in the IR group was shortened evidently, and that in the Mp+IR and CsA+IR group was significantly lengthened. Conclusion Morphine preconditioning may have myocardial protective effect through unburdening the calcium overload and lengthening the MPTP t1/2.

Value of promoter methylation of RASSF1A, p16, and DAPK genes in induced sputum in diagnosing lung cancers / 中南大学学报(医学版)

Objective To determine the aberrant methylation status of RASSF1A,p16 and DAPK gene promoter region in induced sputum from lung cancer patients and the value of their combined detection in diagnosing lung cancers. Methods Methylation-specific PCR (MSP) was used to detect the promoter methylation status of RASSF1A,p16, and DAPK genes in induced sputum and pathological tissues from 82 patients with lung cancers and 25 patients with pulmonary benign lesion.We also analyzed the relation between methylation status and clinical pathological data.Results The positive rates of promoter methylation of RASSF1A,p16, and DAPK genes in pathological tissues from patients with lung cancers were 63.4%,59.8%, and 58.5%, respectively,and those in induced sputum were 54.9%,48.8%,and 51.2%, respectively. The promoter methylation of RASSF1A,p16, and DAPK genes were not detected in patients with pulmonary benign lesion.There was a significant difference between the lung cancer group and pulmonary benign lesion group (P＜0.05). The methylation rate of RASSF1A gene was significantly lower in the middle and high differentiation and non-metastastic lymph node of lung cancer tissues than that in the poor differentiation and the metastatic lymph node of lung cancer tissues(P＜0.05), and was not correlated with age, sex, smoking index, clinical stage, and pathological types.The methylation rate of p16, and DAPK genes was not significantly correlated with all the above mentioned factors (P＞0.05). The methylation rate of joint detecting RASSF1A, p16, and DAPK genes was 73.2%. Conclusion Joint detection for promoter hypermethylation of RASSF1A, p16, and DAPK genes in induced sputum may be used as a simple and effective index of the diagnosis and prognose of lung cancers, and can improve the positive rate.

Expression of ubiquitin and cullin-1 and its clinicopathological significance in benign and malignant lesions of the lung / 中南大学学报(医学版)

OBJECTIVE@#To investigate the expression of ubiquitin and cullin-1 (cul-1) in benign and malignant lesions of the lung and to determine their clinicopathological significance.@*METHODS@#EnVison immunohistochemistry was used to detect the expression of ubiquitin and cul-1 in the conventional paraffin-embedded sections from the specimens of lung cancer (n = 80) and benign lesion tissues of the lung (n = 20). We also analyzed the relation of the expression of ubiquitin and cul-1 with the clinical stage, differentiation, and with or without lymphatic metastasis.@*RESULTS@#The positive rates of ubiquitin and cul-1 were significantly higher in lung cancer (51.3% and 60.0%) than those in benign lesion tissues of the lung (20.0% and 30.0%; P < 0.05). Positive rates of ubiquitin and cul-1 were all significantly lower in the middle and high-differentiated, Stage I approximately II, and no lymphatic metastasis patients with lung cancer than those in no- or low-differentiated, Stage III approximately IV, and lymphatic metastasis patients with lung cancer tissues (P < 0.01 approximately 0.05). High consistency was found between the positive expression of ubiquitin and cul-1 in lung cancer tissues (chi(2) = 4.04, P < 0.05).@*CONCLUSION@#Expression of ubiquitin and cul-1 in lung cancer tissues may be closely related to the carcinogenesis, progression, clinical biological behaviors, and prognosis of lung cancer.

Expression of VHL and HIF-1alpha and its clinical significance in the lung cancer tissue / 中南大学学报(医学版)

OBJECTIVE@#To investigate the expression of von Hippel-Lindau (VHL) protein and hypoxia inducible factor-1alpha (HIF-1alpha) in the lung cancer tissue and to detect their clinical significance.@*METHODS@#EnVisionTM immunohistochemistry was used for detecting the expression of VHL and HIF-1alpha in routinely paraffin-embedded sections from the specimens of lung cancer (n=80) and normal lung tissues (n=20). We also analyzed the relation between the expression of VHL and HIF-1alpha and the clinical stage,differentiation,and with or without lymphatic metastasis.@*RESULTS@#The positive rate of VHL was significantly lower in lung cancer (56.3%) than that in normal lung tissues (90.0%)(P<0.01).The positive rate of HIF-1alpha was significantly higher in lung cancer (65.0%) than that in normal lung tissues (20.0%)(P<0.01). The positive rate of VHL was significantly higher in the middle and high-differentiated, StageI~II, and no-metastasis of lymph node lung cancer tissues than that in the poorly-differentiated, Stage III~IV, metastasis of lymph node lung cancer tissues (P<0.01~0.05) .But the expression of HIF-1alpha in the lung cancer tissues was just the opposite as compared with that of VHL (P<0.05) .VHL and HIF-1alpha expression levels showed highly negative correlation (P<0.01).@*CONCLUSION@#The expression of VHL and HIF-1alpha may be important biological markers for carcinogenesis, progression, clinical biological behaviors, and prognosis of lung cancer.