ABSTRACT
Objective To evaluate perioperative nutritional support for patients with acute abdomen in enhanced recovery after surgery (ERAS) programme.Methods A total of 490 patients with acute abdominal disease were collected,287 in ERAS group and 203 in conservative perioperative management (CPM) group.Biochemical and clinical markers of the 2 groups were compared.Results ERAS group had higher plasma albumin level,quicker bowel function recovery,lower postoperative complications,shorter hospital stay,and a lower WHO pain rating scale (all P ＜ 0.05).Conclusion With perioperative nutritional support,ERAS programme can accelerate recovery after emergency surgery,reduce the rate of overall complications,promote bowel function recovery,and decrease morbidity in the perioperative period for patients with acute abdominal disease.
ABSTRACT
Objective To evaluate the effect of enhanced recovery after surgery (ERAS) on immune function and clinical signs in patients with acute abdomen.Methods From March 2016 to March 2017,patients with acute abdominal admitted in the Emergency Care Center of the First Affiliated Hospital of Zhengzhou University were collected and randomized into ERAS group and conventional peri-operative management group (CPM group).In addition to clinical signs (the time of bowel movemtn recovery,the time of first postoperative ingestion and ambulation,hospital stay,complication rates),the celluar immunity (CD4 +,CD8 +,CD4 +/CD8 +) were determined during peri-operation period.Results A cohort of 240 patients were in ERAS group and 192 patients in CPM group.There was no significant difference in general condition between the two groups (P ＞ O.05).On the first day after operation,the levels of CD4 +,CD4 + /CD8 + decreased in both groups (P ＜ 0.05),but the CPM group had lower levels of CD4 +,CD4 +/CD8 +than the ERAS groups.On the 3rd and 7th days after surgery,the ERAS groups had higer levels of CD4+,CD4+/CD8+ than the CPM groups,(the levels of CD4+,CD4+/CD8+ recovery on the 3rd and 7th day after operation,and the ERAS group was significantly better than the CPM group) (P ＜ 0.05).Compared with CPM group,the recovery of bowel movement appeared earlier after operation in ERAS group with sooner resuming ingestion and ambulation after operation,shorter hospital stay,and lower WHO pain rating scale and complication rates (P ＜ O.05).Conclusions ERAS for patients with acute abdomen can alleviate postoperative suppression of immunity,preserving immune function intact and accelerating postoperative rehabilitation.
ABSTRACT
<p><b>OBJECTIVE</b>To observe the best dose of methylprednisolone improving lung injury in swine with paraquat intoxication.</p><p><b>METHODS</b>Acute lung injury (ALI/ARDS) model was made by an intraperitoneal injection of a large dose of 20%PQ solution20 millilitres in swine. Then 24 swine were randomly divided into 4 groups: exposed PQ control group, 5 mg/kg of methylprednisolone group, 15 mg/kg of methylprednisolone group, 30 mg/kg of methylprednisolone group. All groups were based on the conventional rehydration for intervention, Arterial blood samples were collected before modeling and 0, 12, 24, 36 hours after different processing for blood gas analysis. At the same time heart rate (HR), mean arterial pressure (MAP), extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) were measured by using PICCO (pulse indicator continuous cardiac output), lung tissue was obtained by punctureneedle to produce lung biopsy, then observe the pathological changes of lung tissue in the microscope.</p><p><b>RESULTS</b>1. Comparison between groups: there is no significant difference about extravascular lung water index (EVLWI) and semi-quantitative score of lung tissue pathology in four groups (P > 0.05) before modeling, so is t0, there is significant difference at about extravascular lung water index and semi-quantitative score of lung tissue pathology 12 h, 24 h and 36 h after different processing (P < 0.05). Within the group: EVLWI and semi-quantitative score of Lung tissue pathology in four groups significantly increased when the model was made (P < 0.05), after different processing, EVLWI and semi-quantitative score of Lung tissue pathology in exposed PQ control group kept going up, in other three groups, EVLWI and semi-quantitative score of lung tissue pathology went down first and then went up, there is significant difference compared with t0 (P < 0.05). 2. Comparison between groups: there is no significant difference about oxygenation index in four groups (P > 0.05) before modeling, so is t0, there is significant difference about oxygenation at 12 h, 24 h and 36 h after different processing (P < 0.05). Within the group: oxygenation index in four groups significantly decreased when the model was made (P < 0.05), after different processing, oxygenation index in exposed PQ control group kept going down, in other three groups, it showed a downward trend after the first rise, there is significant difference compared with t0 (P < 0.05). 3. After medication for 36h, correlation analysis showed that EVLWI were negatively associated with oxygenation index (r = -0.427, P = 0.022) and positively associated with semi-quantitative score of Lung tissue pathology (r = 0.903, P = 0.034).</p><p><b>CONCLUSION</b>Methylprednisolone can obviously relieve lung injury caused by paraquat poisoning and improve oxygenation. After the model was made, within 24 hours, 30 mg/kg of methylprednisolone have advantage for the PQ poisoning swine, but 15mg/kg of methylprednisolone is best for improving lung injury induced by paraquat intoxication within 24 hours to 36 hours.</p>
Subject(s)
Animals , Acute Lung Injury , Drug Therapy , Blood Gas Analysis , Capillary Permeability , Extravascular Lung Water , Heart Rate , Lung , Lung Injury , Methylprednisolone , Therapeutic Uses , Paraquat , Toxicity , SwineABSTRACT
Objective To discuss the jointly therapeutic effects of 6％ hydroxyethyl starch 130/0.4 (voluven) and furosemide on acute lung injury induced by paraquat (PQ) in swine.Methods The ALI/ ARDS models were established with 20％ PQ (20 mL) intraperitoneal injection in 18 healthy female piglets and randomly divided into three groups: voluven group (A), furosemide group (B) and voluven + furosemide group (C) (n =6 in each group).The heart rate (HR), mean arterial pressure (MAP), extravascular lung water index (ELWI), pulmonary vascular permeability index (PVPI), partial pressure of carbon dioxide (PaCO2) and oxygenation index (PaO2/FiO2) among the three groups were carefully measured by PICCO (pulse indicator continuous cardiac output) before modeling (baseline), just aftermodeling (t0), and 2 h (t2), 4 h (t4), 6 h (t6) and 8 h (t8) after trearment.Needle biopsies of lung tissue were made before modeling and at t0 and t8 and prepared for microscopy observation after Hematoxylineosin staining method (HE staning).Repeated measurement data were compared among repeated measures by the ANOVA and the difference between groups was compared by one-wey ANOVA.Results (1) The HR and MAP of all animals increased obviously while the oxygenation index declined significantly at modeling just made (t0) compared to those before modeling (all P ＜ 0.05).At the same time, the HR and MAP of A and B groups were significantly lower than those of C group after treatment (all P ＜ 0.05), while the oxygenation index of A and B were significantly higher (all P ＞ 0.05).(2) The ELWI and PVPI of all animals increased obviously at modeling just made (t0) compared to those before modeling (all P ＜ 0.05).The ELWI and PVPI were decreased after treatment.And at the same time, the ELWI and PVPI of A and B groups were significantly lower than those of C group after treatment (all P ＜ 0.05).(3) The alveolar tissue showed obviously injured changes at modeling just made (t0).The injury was relieved 8h after trearment, which was most markedly in group C.Conclusions With the combination of 6％ hydroxyethyl starch 130/0.4 and furosemide administered, the acute lung injury induced by paraquat poisoning can be effectively relieved, promoting gas exchange, and improve oxygenation.
ABSTRACT
Objective To evaluate the prognostic value of the expression of epidermal growth factor receptor (EGFR) and nm23 in patients with nasopharyngeal carcinoma (NPC). Methods From 2003 to 2006, 127 NPC patients who had undergone biopsy before radiotherapy were reviewed retrospectively. All patients received intensity-modulated radiotherapy using 6 MV X-rays combined with platinum-based chemotherapy. Immunohistochemistry SP method was adopted to detect the expression of EGFR and nm23 in NPC biopsy specimens . The relationship between the expression of EGFR and nm23 and survival was analyzed. Results The positive rate of EGFR and nm23 were 80.3% and 47. 2% respectively. The nm23expression was correlated with distant metastasis (χ2=7.03, P = 0. 008 ). The 5-year estimated local control, over-all survival (OS) and disease-free survival (DFS) were 58.3% ,53.5% and 46. 5%. Patients with negative expression of EGFR had a significantly better 5-year OS, DFS (χ2=8.23, P=0.004;χ2=5.25,P=0.022) than those with positive expression. Patients with positive expression of nm23 had a significantly higher 5-year OS (χ2=15.68, P = 0. 000) and DFS (χ2=14. 85, P = 0. 000) than those with negative expression. The clinical stage, EGFR and nm23 expression were independent prognostic factors shown by Cox proportional hazard model (χ2=23.03, 18.33, 39.92, P= 0.000, 0.000, 0.000).Conclusions The EFGR and nm23 expression were correlated with the prognosis in NPC patients.