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@#Objective To explore the efficacy of prone positioning ventilation in patients with acute respiratory distress syndrome (ARDS) after acute Stanford type A aortic dissection (STAAD) surgery. Methods From November 2019 to September 2021, patients with ARDS who was placed prone position after STAAD surgery in the Xiamen Cardiovascular Hospital of Xiamen University were collected. Data such as the changes of blood gas, respiratory mechanics and hemodynamic indexes before and after prone positioning, complications and prognosis were collected for statistical analysis. Results A total of 264 STAAD patients had surgical treatment, of whom 40 patients with postoperative ARDS were placed prone position. There were 37 males and 3 females with an average age of 49.88±11.46 years. The oxygen partial pressure, oxygenation index and peripheral blood oxygen saturation 4 hours and 12 hours after the prone positioning, and 2 hours and 6 hours after the end of the prone positioning were significantly improved compared with those before prone positioning ventilation (P<0.05). The oxygenation index 2 hours after the end of prone positioning which was less than 131.42 mm Hg, indicated that the patient might need ventilation two or more times of prone position. Conclusion Prone position ventilation for patients with moderate to severe ARDS after STAAD surgery is a safe and effective way to improve the oxygenation.
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Objective:To explore different strategies of central repair first or malperfusion first to treat type A aortic dissection complicated with limb malperfusion.Methods:From January 2020 to December 2021, 302 patients were diagnosed with acute type A aortic dissection, and 17 consecutive patients were diagnosed as type A acute aortic dissection complicated with limb malperfusion and underwent Sun’s procedure. There were 16 males and 1 female with an average of(52.6±4.2)years. Surgical strategies were as follows: immediate central repair-Sun’s procedure in 14 patients, endovascular stenting followed by central repair in 3 patients, endovascular stenting after central repair in 1 patient.Results:The incidence rate of limb malperfusion of acute Stanford A aortic dissection was 5.6%(17/302). Average extracorporeal circulation time was(271.8±38.9)min, average aortic cross-clamp time was (186.3±31.8)min, and the average circulatory arrest time was (48.75±11.3)min. Early mortality rate was 17.6%(3/17). Two patients were left hospital voluntarily because of cerebral infarction. One patient underwent leg incision osteofascial compartment syndrome and discharged unevently. Five patients underwent continuous renal replacement therapy and hemoperfusion. Follow-up results showed that patients with serious limb malperfusion have symptoms of nerve dysfunction including amyosthenia and sensory disturbance, but recovered gradually with rehabilitation.Conclusion:Sun’s procedure is safe and feasible for type A acute aortic dissection complicated with mild limb malperfusion. For serious limb malperfusion, endovascular stent followed by Sun’s procedure is a good choice with CRRT and hemoperfusion.
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Objective:To investigate the changes of plasma prothrombin fragment 1+ 2 (F 1+2), tissue factor positive microparticle (TF+ MP) and thrombin antithrombin complex (TAT) level before and after the treatment of low molecular weight heparin combined with reteplase in patients with malignant tumor and lower extremity venous thrombosis. Methods:From July 2016 to October 2019, 64 patients with malignant tumors and lower extremity venous thrombosis in the Third Hospital of Changsha were selected, they were divided into observation group ( n=32) and control group ( n=32) by simple randomization. The control group was treated with low molecular heparin, and the observation group was treated with low molecular heparin combined with reteplase. The efficacy, clinical symptom improvement time, incidence of adverse reactions, difference in lower limb circumference, blood flow velocity, activated partial thromboplastin time (APTT), prothrombin time (PT), plasma F 1+2, TF+ MP, TAT level before and after treatment were compared between the two groups; the correlations of plasma F 1+2, TF+ MP, and TAT level with clinical symptom improvement time, peripheral diameter difference of lower extremity, blood flow velocity, APTT, and PT were analyzed. Results:The total effective rate of the observation group (87.50%) was higher than that of the control group (65.63%) ( P<0.05); The improvement time of clinical symptoms in the observation group was shorter than that in the control group ( P<0.05); After treatment, the peripheral limb diameter difference of the observation group was lower than that of the control group, and the blood flow velocity was higher than that of the control group ( P<0.05); The APTT and PT in the observation group were higher than those in the control group after treatment ( P<0.05); The plasma F 1+2, TF+ MP, and TAT level in the observation group were lower than those in the control group after treatment ( P<0.05); The levels of plasma F 1+2, TF+ MP, and TAT were positively correlated with symptom improvement time and lower limb circumference difference, and negatively correlated with blood flow velocity, APTT, and PT ( P<0.05); There was no significant difference in the incidence of adverse reactions (18.75%) between the observation group and the control group (12.50%) during the treatment period ( P>0.05). Conclusions:Plasma F 1+2, TF+ MP, and TAT expression in patients with malignant tumors and venous thrombosis of the lower extremity can be used as biological indicators to evaluate the patient's condition and treatment effect. Low molecular weight heparin combined with reteplase can significantly reduce the plasma F 1+2, TF+ MP and TAT level, promote the improvement of symptoms, effectively reduce the peripheral diameter difference of lower extremity, improve blood flow velocity and coagulation function, and has a significant effect.
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Objective:To investigate the mechanism of survivin, p53 and Ki-67 on Hep-2 human laryngeal cancer endothelial cell proliferation and invasion.Methods:Laryngeal squamous cell carcinoma and paracancerous normal tissues were collected, total RNA was extracted from tissues,survivin,p53and Ki-67gene mRNA expression levels in laryngeal cancer and the adjacent tissues were detected by Real-time PCR. Human laryngeal cancer Hep-2 epithelial cells were selected,survivin gene was overexpressed, and cell proliferation was detected by MTT.p53 andKi-67gene expression changes in overexpressedsurvivin gene were detected by Western blot. Changes in Hep-2 cell invasive ability were studied whensurvivin was overexpressed as detected by Transwell invasion assay.Results: In the adjacent tissues, survivin,p53andKi-67 gene relative expression levels were 1.72 ± 0.9, 13.7 ± 5.7 and 5.7 ± 1.3, respectively; while in cancer tissues, gene relative expression levels were 53.7 ± 8.3, 66.7 ± 5.2 and 61.0 ± 3.1, respectively, which was significantly increased. As detected by MTT, relative cell survival rate within 12 h ofsurvivinoverexpression were: load control group, (88.5±1.6)%; overexpressed group, (90.3±1.9)%. Transwell invasion assay results indicated that overexpressedsurvivincould significantly increase the relative survival rate of cells. Conclusions:Expressions ofp53,Ki67 and survivin are increased in cancer; and there is a positive correlation betweensurvivin, p53andKi67 expressions in laryngeal carcinoma.
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OBJECTIVE To study the clinical feature of nosocomial infection and analyze the correlative reasons,to offer the scientific theory basis for preventing and controlling the nosocomial infection. METHODS A retrospective survey was undertaken in the data of hospitalized cases during 2007. RESULTS Totally 2325 nosocomial infections in 54 505 patients were analyzed in 2007.The infection rate of nosocomial infection was 4.27%;the highest infection rate was in ICU(33.57%);the infection sites were different in distinct departments and the most common infection site was lower respiratory tract(27.19%);among pathogens isolated from nosocomial infection cases,48.05% of them were Gram-negatives,23.25% were virus,14.45% were fungi,and 14.15% were Gram-positives;the infection rate was diverse in different months. CONCLUSIONS Nosocomial infection rate is related to different underlying diseases;there are many effective actions to reduce the nosocomial infection,such as strengthening the nosocomial infection management,using the antibacterial drugs reasonably and preventing communicable diseases prevalence.
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Objective To understand the effects of drinking water and source water on DNA breakage of human peripheral blood lymphocytes (HPBL). Methods The organic compounds in drinking water and source water were adsorbed by GDX_102 resin for solid phase of gas choromatography. DNA damages of lymphocytes were detected by single cell gel electrophoresis. Results At the same exposure doses to organic extracts of water, the DNA damages of HPBL exposed to organic extracts of surface water were heavier than those exposed to organic extracts of deep underground water, and heavier DNA damages were also observed in HPBL exposed to organic extracts of finished water from water plant treating ground source water compared with those exposed to organic extracts of finished water from water plant treating deep underground source water. Significant dose_response relationships were observed between the exposure doses of organic extracts of water samples and the degrees of DNA damages of HPBL. Conclusion The organic extracts of source water samples collected from surface water and ground water and its tap water samples could cause DNA breakages of HPBL in different degrees in a certain city.