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Objective:To explore the application value of bedside lung ultrasound score(LUS)in evaluating patients with primary graft dysfunction(PGD)after lung transplantation.Methods:A total of 35 PGD patients after lung transplantation in surgical intensive care unit from June 2018 to May 2020 were selected as research objects. After lung transplantation, one physician collected the clinical data, including age, gender, preoperative 24 h APACHE II score, postoperative hemodynamic parameters, lactate and respiratory parameters; another physician was responsible for LUS examination and LUS at 12/24/48/72 h post-operation. The correlation between LUS and oxygenation index was analyzed by bivariate correlation analysis. Receiver operating characteristic curve(ROC)was utilized for calculating the predictive value, sensitivity and specificity of LUS score for severe PGD.Results:A negative correlation existed between LUS and oxygenation index in single lung transplant( r=-0.536, P<0.01)and a negative correlation between LUS and oxygenation index ( r=-0.518, P<0.01)in double lung transplant. The area under ROC curve of LUS showed that the predictive value of LUS of severe PGD patients with single lung transplant was 7.0 with a sensitivity of 86.7% and a specificity of 72.1%, the predicted value of LUS of severe PGD in double lung transplant was 13.0 with a sensitivity of 83.3% and a specificity of 60.0%. Conclusions:Lung ultrasound is simple and easy to operate and LUS can evaluate the severity of PGD patients after lung transplantation. It has a high potency of guiding clinical diagnosis and treatment.
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Objective:To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods:The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 6 cases of chylothorax, 1 case of chylous ascites, and 3 cases of chylothorax combined with chylous ascites, respectively. Conservative treatment was invalid in all cases. The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography. Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted. The location of fistula was visualized by thoracic duct lymphangiography, and the embolization was performed by microcoils combined tissue adhesive agents. The post-operative curative effect and complications were recorded.Results:One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography; thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located. Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients. As for the other patient, after repeated failure of puncture, fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully. After the operation, the drain output was completely disappeared within 3 to 7 days in 8 patients, and decreased down to 120 ml/d in 1 patient. Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization, without any treatment. No serious complications was found in all cases.Conclusion:Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage, with a low complication rate.
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Objective:To explore the incidence and dynamic change of apathy after minor stroke and its influence on the quality of life.Methods:One hundred and six patients with minor stroke(NIHSS≤3) were selected as the research group, one hundred and six cases with healthy physical examination were selected as control group.The apathy evaluation scale, clinician version(AES-C) scale was used to evaluate the degree of apathy after minor stroke, then the patients were divided into minor post-stroke apathy group(mPSA group) and non post-stroke apathy group(NPSA group). At 1, 3, 6, 9 and 12 months after onset, the follow-up visits were carried out and AES-C, modified Barthel index(MBI), modified Rankin scale(mRS) and stroke-specific quality of life scale(SS-QOL) were evaluated.The incidence of minor post-stroke apathy and its dynamic changes over time were analyzed, and the differences of related scales scores between the mPSA group and the NPSA group were compared.Results:The incidence of apathy in research group(35.1%) was higher than that of the control group(7.5%) ( P<0.05). The scores of MRS in the mPSA group at 1 month(1.06±0.86), 3 months(1.18±0.97), 6 months (1.09±0.85), 9 months(1.11±0.71), 12 months(1.11±0.72) after stroke were not significantly different from those in the NPSA group at 1 month(1.00±0.89), 3 months(0.95±0.83), 6 months (0.97±0.87), 9 months (1.00±0.80), 12 months(1.03±0.79) (all P>0.05). The scores of MBI in the mPSA group at 1 month (92.42±5.75), 3 months(91.32±5.81), 6 months (91.71±5.14), 9 months(91.67±4.78), 12 months (91.14±5.01) after stroke were not significantly different from those in the NPSA group at 1 month (91.97±5.79), 3 months(92.42±5.64), 6 months(92.29±5.67), 9 months(92.07±5.46), 12 months(92.12±5.35) (all P>0.05). The scores of SS-QOL in the mPSA group at 1 month (135.09±26.88), 3 months (132.71±24.91), 6 months (134.31±26.63), 9 months(135.89±24.86), 12 months (138.77±27.83) after stroke were lower than those in the NPSA group at 1 month (183.79±24.80), 3 months(183.77±24.18), 6 months (181.80±26.62), 9 months(179.86±28.92), 12 months (179.98±29.13) (all P<0.05). There were no significant differences in the incidence of mPSA at each time point of follow-up( P>0.05). Conclusion:The incidence of apathy after minor stroke is significantly higher than that of the control group, and it remains relatively stable in the first year and seriously affect the quality of patients' life.
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<p><b>OBJECTIVE</b>To compare the efficacy difference between's flying acupuncture combined with conventional treatment and conventional treatment alone on acute cerebral infarction hemiplegia.</p><p><b>METHODS</b>A total of 120 patients were randomly divided into an observation group and a control group, 60 cases in each one. The control group was treated with conventional treatment, including anti-platelet aggregation, lipid-lowering, formula of traditional Chinese medicine which could promote circulation and remove stasis, neurotrophic medication and symptomatic treatment; mannitol was used for cerebral infarction with large area or increased intracranial pressure. Based on the conventional treatment applied in the control group, the observation group was treated with flying acupuncture at the affected Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Hegu (LI 4), Huantiao (GB 30), Biguan (ST 31), Futu (ST 32), Zusanli (ST 36), etc. The treatment was given once a day, six days per week, for totally 2 weeks. The simplified Fugl-Meyer score, National Institute of Health Stroke Scale (NIHSS) and ADL-Bathel index (BI) score were evaluated before and after treatment in the two groups.</p><p><b>RESULTS</b>After the treatment, the simplified Fugl-Meyer and BI were significantly increased in both groups (all<0.05), which was significantly higher in the observation group (both<0.05); after the treatment, the NIHSS was significantly lowered in both groups (both<0.05), which was significantly lower in the observation group (<0.05).</p><p><b>CONCLUSION</b> 's flying acupuncture combined with conventional treatment were effective for acute cerebral infarction hemiplegia, which have better efficacy than conventional treatment on improving motor function, neurological deficit and daily living ability, and the pain is mild.</p>
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Objective To investigate the anesthetic management of perventricular closure of ventricular septal defects (VSD) under transesophageal echocardiography. Methods A retrospective review of the clinical data of 52 children who underwent perventricular closure of VSD under transesophageal echocardiography were analyzed. All the children were performed tracheal intubation under general anesthesia, and the electrocardiogram, pulse blood oxygen saturation, invasive arterial pressure, central venous pressure, end tidal carbon dioxide partial pressure, temperature and urine output were continuously monitored throughout the procedure. The transesophageal echocardiography was necessary for guiding transcatheter or per-ventricular device placement. Results Perventricular closure of VSD was successfully completed in 51 children under transesophageal echocardiography, the operation time was (76.7 ± 36.4) min, the anesthesia time was (89.5 ± 27.1) min; 1 child was converted to open surgical repair. Conclusions The intraoperative transesophageal echocardiography technology is the key to the success of the surgery. At the same time of analgesia and sedation, the anesthesia doctor needs to pay attention to the changes of hemodynamics in children.
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Objective To study the effect of APETx2 on the expression of ASIC3 APETx2 in a rat model of acute gastric mucosal lesion(AGML). Methods Twenty-four Wistar rats were randomly assigned to three groups in equal number : normal control group, water immersion restraint stress (WIRS) group, APETx2 treatment group. AGML was induced by WIRS for 6 hours, and APETx2 (25 μg/kg) was injected intraperitoneally before the onset of stress. Intragastric pH and gastric histopathological changes were measured and the expression of ASIC3 mRNA in DRG neurons projecting to rat stomach was examined by real-time PCR. Immunohistochemistry was performed to detect the localization of ASIC3. Results Compared with the normal control group, the WIRS group showed obvious gastric injury with lower values of intragastric pH and extensive expression of ASIC3 in the DRG neurons (P < 0.05). The treatment with APETx2 before the onset of WIRS significantly alleviated the gastric mucosal injury, decreased gastric acidity and reduced ASIC3 expression in DRG neurons (P < 0.05). Conclusions ASIC3 expression in DRG neurons projecting to rat stomach is strongly associated with gastric mucosal lesion and acidosis in the WIRS model. APETx2 can improve gastric acidosis and prevent the occurrence of these lesions.
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Objective To observe the coexistence expression of TRPV1 and μ-opoid receptorin spinal dorsal root ganglion (DRG) projected to stomach , and to investigate the relationship between TRPV1 andμ-opoid receptorand its clinical significance in rats with acute gastric mucosal lesion induced by water immersion and restraint stress. Methods FortyWistar rats were randomly assigned to 3 groups, including normal control group(group NC, n = 10), WIRS group (group WIRS, n = 20), and sufentanil pretreatment group (group SP, n = 10). A rat model of gsatric mucosal lesion was induced by WIRS. 6 hours after WIRS treatment, gastric tissues were excised and microscopically observed; ulcer index (GI) was noted. The coexistence expression of TRPV1 and μ-opioid receptor in DRG neurons was detected by immunofluorescence assay, and the levels of CGRP was measured by ELASA. Results As compared withgroup WIRS, the degree of gastric injury was obviously relieved in group SF. Coexistence of TRPV1 and μ-opioid receptor was detected in thoracic DRG neurons projected to stomach; the CGRP level was higher in group WIRS than in group NC. ConclusionsTRPV1 isinvolved in protection of acute gastric mucosal lesion. Activation of μ-opioid receptor can induce TRPV1 to release CGRP, resulting in protection of gastric mucosa.
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Objective To investigate the application efficacy objective structured clinical exam-ination (OSCE) in assessment of interns of traditional Chinese medicine in anesthesiology department. Methods Totally 62 interns were examed by OSCE formulated by anesthesiology department before de-partmental rotation. Contents of the exam included preoperative evaluation,endotracheal intubation tech-nique,deep venipuncture,lumbar puncture,case analysis,medical documents writing,etc. Assessment was made by exam results and questionnaire survey. Quantitative data were analyzed by ANOVA and results of questionnaire were analyzed by calculating percentage of each option and describing directly. Results Test results showed that the score of medical document writing was the highest(18.25 ± 1.53),while that of case analysis was the lowest(13.49±1.46)and there was no significant difference in scores of three clinical skills. Questionnaire survey showed the OSCE method is superior to traditional method since it is more scientific,objective and fair. Conclusions OSCE method can scientifically as-sess the clinical practice effect of interns of traditional Chinese medicine in anesthesiology department. Meanwhile, it can find the shortcomings in the teaching, which is helpful in promoting the assessment and improvement of clinical teaching.
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To meet the cultivation objectives of postgraduate of anesthesiology from TCM colleges, the anesthesiology department carried out reform and exploration on cultivation program.This method has trained professionals of anesthesiology with the features of integrated traditional and western medicine knowledge.
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AIM: To observe the protein expression of vascular endothelial growth factor 1 (VEGF-1) in pulmonary arterial endothelial cells and VEGF-1 gene expression in lung tissue in rats with hypoxia-induced pulmonary hypertension and treated with heparin. METHODS: Twenty four male adult SD rats were randomly divided into three groups (8 rats each): a control group (group A), a group with hypoxia for 4 weeks (group B) and a group with hypoxia for 4 weeks and injected with heparin to abdominal cavity simultaneously (group C). Mean pulmonary arterial pressure (mPAP), right ventricle hypertrophy index (RVHI) and vessel morphometry were measured. The morphology of pulmonary artery was observed by HE staining. The expression of VEGF-1 protein in pulmonary arterial endothelial cells was determined by immunohistochemistry. The level of VEGF-1 mRNA in lung tissue was measured by reverse transcription polymerase chain reaction (RT-PCR). RESULTS: mPAP, RVHI, pulmonary artery remodeling parameters, VEGF-1 protein expression in pulmonary arterial endothelial cells and VEGF-1 gene expression in lung tissue of the three groups from high to low were group B, group C and group A. It was statistically significant when compared between either two groups of the three (P<0.01). Linear correlation analysis showed that VEGF-1 protein was positively correlated with pulmonary artery remodeling parameters (r=0.974, P<0.01), and VEGF-1 mRNA was positively correlated with VEGF-1 protein (VEGF 120 mRNA, r=0.919, P<0.01; VEGF164 mRNA, r=0.896, P<0.01). CONCLUSION: Heparin may down-regulate the expression of VEGF-1 at the levels of transcription and translation, resulting in the inhibitory effect on rats with hypoxia-induced pulmonary hypertension.
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BACKGROUND:Autologous peripheral blood hematopoietic stem cell transplantation,as the current latest therapy is widely used in the treatment of autoimmune diseases,however,the treatment on myasthenia gravis is still in the primary stage.OBJECTIVE:To create the model of myasthenia gravis with autologous peripheral blood hematopoietic stem cell transplantation in rats and to observe clinical manifestation,attenuation rate of repetitive nerve electric stimulation action potential and titer of serum acetylcholine receptor Ab in the models.DESIGN,TIME AND SETTING:The randomized control animal experiment was performed at the Human Anatomy Laboratory,Medical College of Zhengzhou University between July and December 2007.MATERIALS:Totally 50 female Wistar rats were randomly assigned into four groups,a normal group(n=10),an adjuvant control group(n=10),a stem cell transplantation group(n=15),and a model control group(n=15).METHODS:Rats in the normal group were intact.Rats in the adjuvant group were subjected to the same volume of saline and cyclophosphamide.Rats in the stem cell transplantation group were used to make experimental autoimmune myasthenia gravis by intraperitoneally infusing with serum of myasthenia gravis patients.Bone marrow stem cells were mobilized by granulocyte colony-stimulating factor.Autologous peripheral blood stem cells were collected and then were transplanted via tail vein injection after the pretreatment regimen of cyclophosphamide.Rats in the model control group were treated with an equal volume of peripheral blood,and with other procedures as the stem cell transplantation group.MAIN OUTCOME MEASURES:Swimming time and survival rate of rats from each group after stem cell transplantation;attenuation rate of repetitive nerve electric stimulation action potential and titer of serum acetylcholine receptor Ab were measured at 4 and 9 weeks after stem cell transplantation.RESULTS:The survival rate was higher in the stem cell transplantation group than in the model control group(P
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<p><b>OBJECTIVE</b>To clone the full-length cDNA of a gene responsible for vascular smooth muscle cell (v-SMC) proliferation in atherogenesis, and study its function.</p><p><b>METHODS</b>Oxidized low density lipoprotein (ox-LDL) at optimal concentration was used as the stimulant to induce v-SMC proliferation in culture medium. A cDNA subtractive library of v-SMC proliferation specific to ox-LDL stimulation was established using subtractive hybridization technique. Methods, including blotting, Northern hybridization and gene sequencing, were used to clone new gene fragments. By using full-length cDNA screening and protein expression techniques, one full-length cDNA was cloned and its function was studied.</p><p><b>RESULTS</b>One full-length cDNA was cloned. The new gene (Genbank AF 174647) expressed a 44 kDa protein, which might be associated with the activity of ox-LDL.</p><p><b>CONCLUSION</b>The new gene cloned may be associated with SMC proliferation in atherogenesis.</p>
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Humans , Amino Acid Sequence , Arteriosclerosis , Genetics , Base Sequence , Blotting, Northern , Cell Division , Cells, Cultured , Cloning, Molecular , Gene Library , Lipoproteins, LDL , Pharmacology , Molecular Sequence Data , Muscle, Smooth, Vascular , Cell Biology , Nucleic Acid HybridizationABSTRACT
<p><b>OBJECTIVE</b>To evaluate the methods used to diagnose and surgically treat ruptured aneurysm in sinus of Valsalva (RASV).</p><p><b>METHODS</b>Thirty-seven hospitalized patients with ruptured aneurysms in the sinus of Valsalva from September 1981 to April 2001, including 21 cases (56.7%) of RASV associated with ventricular septal defects (VSD) and 11 (29.7%) with aortic valvular prolapse were given surgical interventions. Under hypothermia and extracorporeal circulation, we successfully performed the surgical correction of RASV for all 37 patients VSD repair in 21 patients, aortic valvuloplasty in 6 and aortic valvular replacement in 2.</p><p><b>RESULTS</b>There was no hospital deaths among these patients, although residual shunting occurred in two patients and acute renal failure was found one. Follow-up study of one month to 20 years in the patients undergoing repair of RASV revealed that the mostly individuals treated with operation obtained satisfactory cardiac function.</p><p><b>CONCLUSION</b>Correct diagnosis of ruptured aneurysm in sinus of Valsalva should be confirmed immediately and surgical correction should be carried out as soon as possible.</p>
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Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Aortic Aneurysm , Diagnosis , General Surgery , Aortic Rupture , Diagnosis , General Surgery , Sinus of ValsalvaABSTRACT
<p><b>OBJECTIVE</b>To study the inhibition effect of oxLDL on the uptake and clearance of intra-cellular (3)H-cholesterol in v-SMC from the human-apoA1 transgenic mice (C57BL/6) and the changes in human-apoA1 mRNA expression in v-SMC from human apoA1 transgenic mice after oxLDL stimulation.</p><p><b>METHODS</b>v-SMC originally isolated from human apoA1 transgenic mice connected with a recombined mouse metallothionein-I (MT-I) promoter was used, and the effect of oxLDL on the uptake and clearance of intracellular (3)H-cholesterol was studied in v-SMC of the transgenic and control mice respectively, the study of h-apoA I mRNA expression from v-SMC of the transgenic mice were done by RT-PCR and Northern blot.</p><p><b>RESULTS</b>oxLDL (30 microg/ml) strongly promoted the SMC proliferation. No difference was found in (3)H-cholesterol uptake between nSMC and trSMC, and the uptake rates of both kinds of SMC rose 100% after oxLDL stimulation. The efflux rates of (3)H-cholesterol in trSMC were much higher than those of nSMC (40% - 50%). After oxLDL stimulation, the clearance rates fell by 28% and 10%, respectively, for nSMC and trSMC. The result of RT-PCR and Northern blot showed that h-apoA1 gene expression was markedly increased by the stimulation of oxLDL.</p><p><b>CONCLUSION</b>Expression of the h-apoA1 gene in C57BL/6 mice enables them to reduce the accumulation of cholesterol in v-SMC. The trSMC can alleviate the harmful effect of oxLDL due to the increase of h-apoA1 expression.</p>
Subject(s)
Animals , Humans , Mice , Apolipoprotein A-I , Genetics , Metabolism , Blotting, Northern , Cell Division , Cells, Cultured , Cholesterol , Pharmacokinetics , Dose-Response Relationship, Drug , Gene Expression , Lipoproteins, LDL , Pharmacology , Mice, Inbred C57BL , Mice, Transgenic , Muscle, Smooth, Vascular , Cell Biology , Metabolism , RNA, Messenger , Genetics , Metabolism , Reverse Transcriptase Polymerase Chain Reaction , Time FactorsABSTRACT
Objective To evaluate the relationship of oncosis and the expression of microvessel density (MVD) in colorectal carcinoma and its clinical significance Methods The expression of MVD and oncosis were detected by immunohistochemical method and transmission electron microscope in 64 cases of colorectal carcinoma Results Oncosis existed in colorectal carcinoma Oncosis index (OI) in tissues of colorectal carcinoma decreased with the decrease of differentiation grades ( F=8 590?2, P