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Esophagogastric variceal bleeding (EGVB) is one of the main complications of decompensated portal hypertension, especially in patients with liver cirrhosis, and it often has a high mortality rate. Medication combined with endoscopy is the main prevention and treatment method for EGVB, while transjugular intrahepatic portosystemic shunt (TIPS) combined with variceal embolization can also be selected for some high-risk patients, and individualized diagnosis and treatment of portal hypertension based on hepatic venous pressure gradient should become the latest consensus and the main strategy. This article mainly reviews endoscopic therapy and TIPS for the prevention and treatment of EGVB patients with decompensated portal hypertension in terms of selection of indications, incidence rate of complications, and respective advantages and disadvantages.
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Objective:To investigate the clinical efficacy and prognosis of transjugular intrahepatic portosystemic shunt (TIPS) and drug combined with endoscopic treatment in patients with liver cirrhosis and esophagogastric variceal bleeding (EGVB).Methods:From January 2012 to December 2013, at the First Affiliated Hospital of Xi′an Jiaotong University, the data of 147 patients with liver cirrhosis and EGVB undergoing TIPS or drug combined with endoscopic treatment were retrospectively collected, with 87 cases in TIPS treatment group and 60 in drug combined with endoscopic treatment group.The 5 years follow-up data were analyzed, and the overall survival rates, rebleeding-free survival rates and hepatic encephalopathy-free survival rates at 6 weeks, 1 year, 2 years and 5 years after treatment of two groups were compared. Independent sample t test, Mann-Whitney U test, chi-square test, Fisher exact test, Z test, log-rank test and trend test were used for statistical analysis. Results:There were no significant differences in age, gender, etiology, Child-Pugh classification, initial liver function, coagulation function, liver ascites, previous history of hepatic encephalopathy, blood pressure and preoperative blood transfusion history between the TIPS treatment group and combination of drugs and endoscopy treatment group (all P>0.05). Forty-one patients died within 5 years, of which 20 (48.8%) died of rebleeding and 6 (14.6%) died of hepatic encephalopathy. There were no significant differences in 6-week, 1-year and 2-year overall survival rates between the TIPS group and drug combined with endoscopic treatment group (all P>0.05), however the 5-year overall survival rate of the TIPS treatment group was higher than that of the drug combined with endoscopic treatment group (78.4% vs. 63.2%), and the difference was statistically significant ( Z=2.06, P=0.048). The 6-week, 1-year, 2-year, 5-year rebleeding-free survival rates of the TIPS group were 97.7%, 96.5%, 88.9% and 70.9%, respectively, which were all higher than those of the drug combined with endoscopic treatment group (86.7%, 53.3%, 43.3% and 27.1%), and the differences were statistically significant ( Z=2.35, 6.39, 6.26 and 4.80, all P<0.05). There were no significant differences in hepatic encephalopathy-free survival rates at 6 weeks, 1 year and 2 years after treatment between the TIPS group and drug combined with endoscopic treatment group (all P>0.05), however the 5-year hepatic encephalopathy-free survival rate of the TIPS treatment group was lower than that of the drug combined with endoscopic treatment group (67.7% vs. 86.7%), and the difference was statistically significant ( Z=2.28, P=0.030). The lower the Child-Pugh classification, the higher the cumulative 5-year survival rate ( χ2=6.75, P<0.01). There was no statistically significant difference in the 5-year overall survival rate in patients with the same Child-Pugh classification between the TIPS group and the drug combined with endoscopic treatment group (all P>0.05). Conclusions:The efficacy of TIPS is better than that of the drug combined with endoscopic treatment in treating EGVB. Even the long-term risk of hepatic encephalopathy of TIPS is higher, the short-term, middle-term and long-term rebleeding rate are decreased. Patients with Child-Pugh grade C do not need to avoid TIPS when choosing the treatment, the earlier the TIPS used, the better survival benefit will be obtained.
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Sixty general practitioners of in-service training undertaking rotation in gastroenterology department of Qingdao Municipal Hospital from July 2017 to July 2019 were randomized assigned in trial group ( n=30) and control group ( n=30). The problem-oriented mode was applied in trial group and conventional mode was applied in control group for teaching of two typical digestive diseases (upper gastrointestinal bleeding and acute pancreatitis). The formative evaluation and questionnaire survey were used to compare the teaching effects and the results of evaluation were compared with χ 2 test by SPSS 17.0 between two groups. The excellent and good rates of evaluation for the clinical psychological quality, clinical reasoning ability, doctor-patient communication ability and practice-based learning and improvement ability in trial group were significantly higher than those in the control group(χ2=7.38, P=0.03; χ2=12.96, P<0.01; χ2=23.33, P<0.01; χ2=16.14, P<0.01). Questionnaire survey showed more satisfaction towards teaching method in trial group was higher than that in control group(χ2=12.86, P<0.01); and the clinical reasoning ability, learning initiative and self-confidence in trial group were improved more markedly than those in control group(χ2=8.26, P=0.02; χ2=19.48, P<0.01; χ2=21.46, P<0.01). The problem-oriented clinical thinking teaching model demonstrates good effects on clinical comprehensive ability for general practitioners of in-service training during gastroenterology rotation, which is worth further promotion.
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Objective@#To evaluate the dynamic prevalence of dental fluorosis of children and levels of fluoride in drinking water after improvement of water in Xi an City, to provide scientific basis for water fluoridation improvement.@*Methods@#A total of 35 fluorosis endemic villages were selected as fixed monitor sites in 2014-2018, the ways of water improvement were surveyed, water fluorine content were detected and the prevalence of dental fluorosis in children aged 8 to 12 years were examined.@*Results@#Rates of excess fluoride in drinking water from 2014 to 2018 were 22.86%, 14.29%,11.43%, 11.43% and 8.57%, the difference were significant(χ2=16.44, P<0.01).The dental fluorosis detection rates of children aged 8 to 12 years were 20.89%,18.22%,17.46%,18.13% and 16.76% in 2014-2018 which showed a obvious descending trend by year(χ2=10.02, P<0.01). The detection rate of dental fluorosis in children aged 8 and 9 years showed a decreasing trend by year(χ2=6.53, 4.54, P<0.05).The difference of total rate of dental fluorisis,rate of mild cases rate of moderate-to-severe cases were statistically between the villages without qualified water and the villages with normal fluorine water(χ2=179.22, 167.93,10.35, P<0.01). The rate of detection in the villages with the water fluorine exceed standard in 2014-2018 showed a declining trend year by year(χ2=28.50, P<0.01). The detection rate were significant different across water improvement methods(χ2=197.76, P<0.01). Detection rate of dental fluorosis decreased from 2014 to 2018 in the areas with municipal water supply showed a decreasing after year(χ2=12.16, P<0.01).@*Conclusion@#The improvement of municipal water supply shows significant effects on water fluorosis control, the detection rate of water fluoride and children s dental fluorosis in some villages with the other ways of water improvement are still higher than expected, the continuously monitor of fluoride content in water and dental fluorosis in children should be strengthened.
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Objective:To investigate the effect of epidermal growth factor receptor tyrosine kinase inhibitor on the radiosensitivity of human non-small cell lung cancer cells and its possible mechanism.Methods:Human non-small cell lung cancer cells H1299 were cultured in vitro. CCK-8 was used to detect the toxic effects of erlotinib on H1299 cells, IC 50 and IC 20 were calculated, and IC 20 was utilized as the drug concentration for subsequent experiments. The colony formation assay was performed to identifiy the effect of X-ray combined with erlotinib on H1299 cells, the radiosensitivity parameters were calculated, and the cell survival curves were delineated. Flow cytometry was conducted to detect the cell cycle distribution and apoptosis. Western blot analysis was used to detect the expression of EGFR/PI3K/AKT pathway and apoptosis-related proteins. Results:Erlotinib exerted inhibitory effect upon the proliferation of H1299 cells, IC 50 was calculated as 27.3 μmol/L, and 3.3 μmol/L for IC 20. X-ray combined with IC 20 concentration of erlotinib could reduce the cloning ability of H1299, increased the proportion of G 0/G 1 phase and G 2/M phase, decreased the proportion of S phase, aggravated cell apoptosis, down-regulated the expression of pEGFR and pAKT proteins, and up-regulated the expression of apoptosis-related proteins including Active Caspase 3 and Cleaved PARP. Conclusions:Erlotinib exerts a radiosensitizing effect on H1299. The possible mechanism is that erlotinib combined with radiation can suppress the EGFR/PI3K/AKT pathway, reduce the ability of repairing cell damage, change cell growth cycle and induce cell apoptosis.
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Objective:To investigate the diagnostic value of energy spectrum CT combined with high concentration iodine contrast agent (400 mg/ml) for hepatic venous system CT angiography in patients with Budd-Chiari syndrome (BCS).Methods:A total of 48 patients with BCS who underwent the hepatic venous system CT angiography were prospectively collected from March to August 2019 at the First Affiliated Hospital of Zhengzhou University. Patients were randomly divided into control group (350 mg /ml) and study group (400 mg /ml). In the control group, the dosage of iodine contrast agent was 1.6 ml/kg, and the flow rate was 4.0 ml/s. In the study group, the dosage of iodine contrast agent was 1.4 ml/kg. Double-flow rate injection protocol was used in the study group, i.e. 3.50 ml/s (80% dosage), 1.75 ml/s (20% dosage), 3.50 ml/s (40 ml normal saline). Revolution CT scanner was used for energy spectrum scanning. Quantitative parameters, qualitative visual parameters and radiation dose were compared between the two groups. Wilcoxon test, t test, χ 2 test and Mann-Whitney U test were used. Results:The dosage of iodine contrast agent in the study group [(94.53±16.02) ml] was lower than that in the control group [(106.40±20.19) ml, t=2.257, P<0.05]. The injection speed of the control group was higher than that of the study group (4.00 ml/s and 3.15 ml/s). CT values of portal vein, hepatic vein, inferior vena cava, and hepatic parenchyma, signal to noise ratio, contrast noise ratio, CT dose index, dose length product, effective dose and subjective scores showed no significant differences between the 2 groups (all P>0.05). Conclusion:For patients with BCS, high quality images could be obtained to meet the requirement of diagnosis in hepatic vein system CT angiography using high concentration iodine contrast agent (400 mg/ml) with low dosage of contrast agent and low flow rate.
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Objective:To evaluate the prognostic value of arterial lactate (Lac) combined with central venous-to-arterial carbon dioxide difference to arterial-to-central venous oxygen content difference ratio (Pcv-aCO 2/Ca-cvO 2) in patients with septic shock following early fluid resuscitation. Methods:A total of 97 patients with septic shock admitted to intensive care unit (ICU) of Lanzhou University Second Hospital from January 2017 to December 2019 were enrolled. The Pcv-aCO 2/Ca-cvO 2 ratio was calculated from blood gas analysis of radial artery and superior vena cava which was performed before resuscitation and at 6 hours of resuscitation at the same time. The patients were divided into death group and survival group according to the 28-day prognosis. The baseline data, acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, sequential organ failure score (SOFA), clinical therapy, lactate clearance rate (LCR) at 6 hours, the length of ICU stay, hemodynamics and oxygen metabolism parameters before and after resuscitation were compared between the two groups. Risk factors were analyzed by multivariate Cox regression for 28-day mortality of patients with septic shock. The receiver operating characteristic (ROC) curve was plotted to assess the prognostic values of these factors for 28-day mortality. Results:① Compared with the survival group, the patients in the death group showed significantly higher levels of APACHEⅡ score (23.96±4.31 vs. 17.70±3.92) and SOFA score (12.74±2.80 vs. 9.23±2.43, both P < 0.01), significantly higher proportions of mechanical ventilation [85.2% (23/27) vs. 50.0% (35/70)] and continuous renal replacement therapy [CRRT; 51.9% (14/27) vs. 25.7% (18/70), both P < 0.05], a significantly more fluid replacement at 6 hours (L: 2.92±0.24 vs. 2.63±0.25, P < 0.01), a significantly lower level of LCR at 6 hours [(11.61±7.76)% vs. (27.67±13.71)%, P < 0.01], and a shorter length of ICU stay (days: 6.37±2.70 vs. 7.67±2.31, P < 0.05). ② Compared with the survival group, the patients before resuscitation in the death group showed a significantly lower level of mean arterial pressure [MAP (mmHg, 1 mmHg = 0.133 kPa): 52.63±4.35 vs. 55.74±3.01, P < 0.01], significantly higher levels of Lac and Pcv-aCO 2/Ca-cvO 2 ratio [Lac (mmol/L): 7.13±1.75 vs. 5.22±1.36, Pcv-aCO 2/Ca-cvO 2 ratio: 1.67±0.29 vs. 1.48±0.22, both P < 0.01]; and the patients at 6 hours of resuscitation in the death group showed a significantly lower level of MAP (mmHg: 62.59±4.80 vs. 66.71±3.91, P < 0.01), significantly higher levels of central venous pressure (CVP), Lac, Pcv-aCO 2 and Pcv-aCO 2/Ca-cvO 2 ratio [CVP (mmHg): 10.74±1.40 vs. 8.80±0.75, Lac (mmol/L): 6.36±1.86 vs. 3.90±1.95, Pcv-aCO 2 (mmHg): 7.59±2.02 vs. 4.34±1.37, Pcv-aCO 2/Ca-cvO 2 ratio: 1.87±0.51 vs. 1.03±0.27, all P < 0.01]. ③ Multivariate Cox regression analysis showed that the independent risk factors for 28-day mortality in patients with septic shock were Lac and Pcv-aCO 2/Ca-cvO 2 ratio whether before or at 6 hours of resuscitation [Lac before resuscitation: relative risk ( RR) = 1.434, 95% confidence interval (95% CI) was 1.070-1.922, P = 0.016; Lac at 6 hours of resuscitation: RR = 1.564, 95% CI was 1.202-2.035, P = 0.001; Pcv-aCO 2/Ca-cvO 2 ratio before resuscitation: RR = 2.828, 95% CI was 1.108-4.207, P = 0.038; Pcv-aCO 2/Ca-cvO 2 ratio at 6 hours of resuscitation: RR = 4.386, 95% CI was 2.842-5.730, P = 0.000]. ④ ROC curve analysis showed that Lac and Pcv-aCO 2/Ca-cvO 2 ratio at 6 hours of resuscitation had predictive value for the prognosis of patients with septic shock, the area under ROC curve (AUC) was 0.849 (95% CI was 0.762-0.914) and 0.905 (95% CI was 0.828-0.955), respectively. However, the predictive value of Lac combined with Pcv-aCO 2/Ca-cvO 2 ratio in patients with septic shock was significantly higher than Lac [AUC (95% CI): 0.976 (0.923-0.996) vs. 0.849 (0.762-0.914), Z = 3.354, P = 0.001], the sensitivity was 97.14%, and the specificity was 88.89%. Conclusions:Lac and Pcv-aCO 2/Ca-cvO 2 ratio are independent risk factors for predicting 28-day mortality in patients with septic shock. Lac combined with Pcv-aCO 2/Ca-cvO 2 ratio can assess the prognosis of patients with septic shock more accurately.
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Objective: To explore whether vulnerable coronary plaques in HIV-infected patients are different with those in non-HIV-infected ones, and to analyze the relative risk factors. Methods: A total of 167 HIV-infected patients (HIV-infected group) and 185 non-HIV-infected patients(non-HIV-infected group) who underwent coronary CTA (CCTA) were collected. Vulnerable plaques were defined as those with two or more high-risk morphological features. The type, location and incidence of vulnerable coronary plaques were analyzed and compared between 2 groups, and the risk factors of vulnerable coronary plaques in HIV-infected patients were analyzed. Results: There was no significant difference of baseline clinical data between the two groups. The most common types of vulnerable coronary plaques in 2 groups were both low attenuation plaques+positive remodeling, most located in the proximal segment of left anterior descending artery (segment 6). The incidence of vulnerable coronary plaques ≥1 coronary segments in HIV-infected patients was higher than that in non-HIV-infected patients (34.73% vs 24.32%,P<0.05). Vulnerable coronary plaques in HIV-infected patients were independently correlated with the duration of antiretroviral therapy (ART) drug (OR=1.29, 95%CI [1.04,1.59], P=0.02). Conclusion: The incidence of vulnerable coronary plaques in HIV-infected patients was higher than that in non-HIV-infected patients. ART drug may be an independent risk factor for coronary plaque vulnerability in HIV-infected patients.
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Objective To investigate the significance of "merge" model versus "traditional" model in rotation training for professional clinical postgraduate students in department of gastroenterology. Methods The professional clinical postgraduate students who underwent rotation training in Qingdao Municipal Hospital from July 2012 to July 2016 were enrolled as subjects and were trained with the"merge" model and the "traditional" model, respectively. The two groups of subjects were compared in terms of clinical knowledge , skills , and core competencies . Results The postgraduates trained by the"merge" model had a significantly higher total score of clinical examinations than those trained by the"traditional" model [(92.60±2.52) vs. (83.80±3.14), t=10.93, P<0.01], while there were no significant differences in professional quality and doctor-patient communication between the two groups. Compared with those trained with the"traditional"model, the postgraduates trained by the"merge"model had significantly better understanding of clinical knowledge and clinical thinking ability, diagnosis and treatment skills, and psychological quality (χ2=27.00, 10.23, and 12.21, all P<0.01);however, there was no significant difference in clinical research ability between the two groups (χ2=1.39, P=0.24). Conclusion The model of professional clinical postgraduate training combined with standardized training of residents is superior to the traditional training model, and compared with the "traditional" model, the "merge" model is more beneficial to the training of comprehensive clinical practice abilities and thus holds promise for further application.
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Objective To investigate the effects of mild hypothermia on post-resuscitation neurological outcome after ventricular fibrillation (VF) in rabbits.Methods Forty-five adult New Zealand rabbits were induced VF by direct current of electricity.The rabbits were randomly(random number) divided into following groups:normothermic resuscitation group (NR),mild hypothermia prearrest group (HP),mild hypothermia resuscitation 30 min group (HRe30),mild hypothermia resuscitation 90 min group (HRe90),normothermic sham group (NS),and hypothermia sham group (HS).The rabbits of NR group were observed for 600 min in room temperature after restoration of spontaneous circulation (ROSC).The mild hypothermia was induced by surface cooling,and maintained for 600 min after the aimed low temperature reached.The arterial blood samples were collected for determining neuron-specific enolase (NSE) and thioredoxin (Trx) and the mean arterial pressure (MAP),left ventricular end-diastolic pressure (LVEDP) and left ventricular pressure raise and fall rate (±dp/dtmax) were observed at 15 min before CA,and 30 min,60 min,120 min,360 min and 600 min after ROSC.After the animals were sacrificed at 600 min after ROSC,the whole brain of animals was harvested and observed under light microscope to calculate the apoptotic index of the hippocampal CA1 neurons by using TUNEL method.One-way ANOVA was used to determine the statistical significance between two groups,a two-tailed value of P＜0.05 was considered statistically significant.Results (1) Hemodynamically compared with normal temperature groups,HR was lower in hypothermia groups.Compared with NR,HRe30,and HRe90 group,LVEDP was higher in HP group at 30 min after ROSC(3.4±0.8 vs.4.6±1.0,4.1±0.5,4.3±0.2,F=9.85,P=0.019).In Hp group,the level of +dp/dtmax was higher than that in NR,HRe30 and HRe90 groups at 30 min and 120 min after ROSC.In HP group,the level of-dp/dtmax was higher than that of NR group at 30 min,60 min,120 min,360 min and 600 min after ROSC.(2) Serologically compared with HP,HRe30 and HRe90 group,NSE levels were higher in NR group at 60 min,120 min and 360 min after ROSC.Compared with NR,HRe30,and HRe90 group,Trx levels in NR group were lower at 60 min,120 min,360 min and 600 min after ROSC.Compared with HP group,Trx levels in HRe30 and HRe90 groups were higher at 60 min,120 min,360 min and 600 min after ROSC.(3) Pathologically compared with NR group,histopathological changes in hippocampus CA1 area were milder found in HP,HRe30 and HRe90 groups.AI (％) was lower in HP,HRe30 and HRe90 groups than that in NR group[(62.25±10.43)％ vs.(20.61±5.02)％,(25.08±3.92)％,(30.33±7.15)％,P=0.001].Concusions This study shows that hypothermia should be initiated as soon as possible,and especially early intra-arrest cooling appears to be significantly better than post-ROSC cooling and normothermia.
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Objective To compare the effects of different stent configurations on shunt failure,hepatic encephalopathy,and hepatic myelopathy after transjugular intrahepatic portosystemic shunt (TIPS).Methods From March 2014 to June 2015,the clinical data of 73 hospitalized,patients who met the inclusion and exclusion criteria,and underwent TIPS for upper gastrointestinal hemorrhage caused by cirrhotic portal hypertension were retrospectively analyzed.According to the stent configuration during operation,patients were divided into simple coated stent group (hepatic vein,portal vein and hepatic parenchyma coated stent,23 cases),simulated Viatorr stent group (hepatic vein and hepatic parenchyma coated stent plus portal vein bare stent,27 cases) and combined stent group (hepatic vein and portal vein hare stent plus hepatic parenchyma coated stent,23 cases).Patients were followed up for one year,the incidences of shunt failure,hepatic encephalopathy and hepatic myelopathy within one year after TIPS of three groups were compared.Chi-square test,Fisher exact probability method and variance analysis were performed for comparison among groups.Cox regression analysis was used for difference analysis in imbalance of variables and incidence of outcome events among the three groups.Results The portal vein pressure gradient of simple coated stent group,simulated Viatorr stent group and combined stent group decreased from (22.15±4.52),(23.01±5.48) and (21.13±4.49) mmHg (1 mmHg=0.133 kPa) to (9.15±2.94),(11.20±3.27) and (8.75+4.06) mmHg after operation,respectively.Before and after operation,the differences in portal venous pressure gradient were statistically significant of three groups (t=10.488,7.188 and 7.850,all P＜0.05).The shunt failure rates of simple coated stent group,simulated Viatorr stent group and combined stent group were 13.0％ (3/23),18.5％ (5/27) and 30.4％ (7/23),respectively.The results of Cox regression analysis indicated that there was no statistically significant difference in shunt failure rates among different stent configurations after TIPS (P=0.339).The incidences of hepatic encephalopathy of simple coated stent group,simulated Viatorr stent group and combined stent group postoperative were 69.6％ (16/23),33.3％ (9/27) and 30.4％ (7/23),respectively,the difference was not statistically significant among the three groups (P＞ 0.05).The results of Cox regression analysis showed that the relative ratio values (95％ confidence interval) of incidence of postoperative hepatic encephalopathy of simple coated stent group compared with simulated Viatorr stent group and combined stent group were 2.901 (1.279 to 6.584) and 2.735 (1.123 to 6.658),and the differences were statistically significant (both P＜0.05).The incidences of hepatic myelopathy of simple coated stent group,simulated Viatorr stent group and combined stent group were 8.7％ (2/23),3.7％ (1/27) and 4.3％ (1/23),respectively,and there was no statistically significant difference in the incidence of hepatic myelopathy among three groups after operation (P＞0.05).During one-year follow-up,among 73 patients,two patients died,one in simple coated stent group and the other in combined stent group.The one-year survival rate after TIPS was 97.3％.Conclusions One year after operation,the incidences of shunt failure are similar between simple coated stent group,simulated Viatorr stent group and combined stent group.One year after operation,the incidence of hepatic encephalopathy is similar between simulated Viatorr stent group and combined stent group which are both lower than that of simple coated stent.The incidence of hepatic myelopathy is low,and its association with TIPS remains to be further investigated.
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Objective To explore the effect of puncture the left or right branch of portal vein on the incidence of postoperative hepatic encephalopathy in transjugular intrahepatic portosystemic shunt (TIPS). Methods A literature search was conducted through investigating PubMed, Cochrane Library, CNKI digital library and Wanfang databases. Randomized controlled trials and cohort studies related to the effect of puncture the left or right branch of portal vein on the incidence of postoperative hepatic encephalopathy in TIPS were included in this review. According to the methods for Cochrane systematic review, the data were extracted, the quality of the literatures was evaluated, statistical analysis was conducted and the data were analyzed with RevMan 5.0. Results One randomized controlled trial and four cohort studies, including 552 patients with liver cirrhosis received TIPS, were finally included in this review. Random-effects model meta-analysis showed that puncture of the left branch of portal vein in TIPS caused lower incidence of postoperative hepatic encephalopathy than puncture of the right branch of portal vein (RR=0.51, 95%CI was 0.39 to 0.66, P<0.01). Conclusion Puncture of the left branch of portal vein in TIPS can significantly reduce the incidence of postoperative hepatic encephalopathy in comparison with puncture of the right branch of portal vein.
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The application of transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of cirrhotic portal hypertension has been widely accepted both at home and abroad. This article focuses on the fatal complications of TIPS (including intraperitoneal bleeding and acute pulmonary embolism), shunt failure, and recurrent portosystemic hepatic encephalopathy, and elaborates on the reasons for such conditions and related preventive measures, in order to improve the accuracy and safety of intraoperative puncture, reduce common complications such as shunt failure and hepatic encephalopathy, and improve the clinical effect of TIPS in the treatment of cirrhotic portal hypertension.
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Objective:To explore expression levels of Tim and TLR gene family in children with different types of mycoplasma pneumonia and their clinical significance.Methods: 56 patients with mycoplasma pneumonia were randomly selected in Ji′nan Maternity and Child Care Hospital from March ,2013 to March,2014.All the patients were divided into bronchopneumonia group ( n=40) and segmental pneumonia group (n=16) according to their X-ray manifestations.Bronchopneumonia group was characterized as dot,nodular increased density shadow with or without reticular ,stripe-like interstitial lesion.Segmental pneumonia was described as segmental or lobar consolidation of lung in X-ray.Meanwhile,30 healthy children were involved in control group with matched age and gender.Peripheral venous blood of all the children in every group was collected and total RNA was extracted .The mRNA of Toll-recepter 2,4 and Tim1,3 was quantified by quantitative real-time PCR (qRT-PCR),and compared between different groups.Results:The expression of mRNA of TLR-2,4 and Tim1 significantly increases in both bronchopneumonia group and segmental pneumonia group compared to healthy control.Meanwhile,the mRNA of TLR-2,4 and Tim-1,3 was significantly elevated among segmental pneumonia group compared to healthy control.In addition,the gene expression of Tim1,3 was higher in segmental pneumonia group than broncho-pneumonia group.Conclusion:The TLR-2,4 and Tim1 gene are over expressed in both types of mycoplasma pneumonia and Tim-1,3 are highly expressed in children with severe infection in lung.The expression alteration of TLR-2,4 and Tim1,3 gene is involved in different types of mycoplasma pneumonia.
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Objective To investigate the survival status of liver cirrhosis patients without upper gastrointestinal hemorrhage after transjugular intrahepatic portosystemic shunt (TIPS).Methods From 2004 to 2013,15 liver cirrhosis patients without upper gastrointestinal hemorrhage volunteered received TIPS treatment were followed up to find out the difficulty and the success rate of TIPS procedure,the incidence of hepatic encephalopathy,upper gastrointestinal hemorrhage and improving of hypersplenism.Results The success rate of operation was 100％.The average of operation time was 60 minutes.During follow-up,no stent angulation occurred,no gastrointestinal hemorrhage happened and no one died in all 15 patients after TIPS operation.There were four patients with hepatic encephalopathy in eight weeks after operation.The anemia of four patients improved compared with that before operation.Conclusions TIPS is a safe and effective threapy in the prevention of gastrointestinal hemorrhage in the patients with liver cirrhosis accompanied with severe gastroesophageal varices.It may become the primary prophylaxis for liver cirrhosis patients without upper gastrointestinal hemorrhage.
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The development of society raises demands for high-level talents,which requires high level post graduate education.The model of post graduate education is changing from research centered to professional skill centered.The research centered program has a long history and has gained consensus,while the professional skill program is still new.To address the social and economic needs,we explored the professional skill centered post graduate program and report our experience here.
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Objective To observe the modulatory effects of NF-κB on dynamic changes of TNF-α、IL-1β and ICAM-1 in rats with severe acute pancreatitis (SAP),and to assess the effects of pretreatment with mycophenolate mofetil (MMF) on them.Methods A total of 104 male Wistar rats were randomly divided into normal group,sham operation group,SAP group and MMF group.(1) In normal group,rats had just an incision on abdomen wall and sutured (n =8) ; (2) In sham operation group,rats underwent laparotomy with flipping over the pancreas and gendy striking five times by using blunt instrument and abdomen was closed (n =32); (3) In SAP group,SAP in rats was induced by the retrograde injection of sodium taurocholate (STC) into the pancreatic duct (n =32) ; (4) In MMF group,MMF (250mg/kg)was injected intraperitoneally one hours after injection of STC (n =32).Rats were saerificed by abdominalaorta exsanguination separately at intervals of 3,6,12 and 24 h after modeling of pancreatitis.Histologic score of pancreatic tissue was assessed,and serum amylase (AMS) and serum C-reactive protein (CRP)were measured by automatic biochemical detector.The serum levels of inflammatory cyctokines (TNF-α,1L-1β and 1CAM-1 ) were measured by using ELISA,and expression of NF-κB mRNA in pancreatic tissue was measured by using quantitative PCR.Results Compared with sham operation group,histologic score of pancreatic tissue,serum amylase,TNF-α、IL-1β and ICAM-1 in SAP group were increased significantly (P ＜ 0.05 ).Pretreatment with MMF obviously deceased histologic score,and the serum levels of amylase,TNF-α,IL-1β and ICAM-1 and the expression of NF-κB mRNA were higher than those in SAP group in early stage (P ＜0.05 ).Conclusions Cytokines play an important role in early stage of SAP.MMF could attenuate the severity of inflammatory response through inhibiting cellular immunity and modulating the proinflammatory cytokines produced.
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ObjectiveTo observe the effects of mild hypothermia on post-resuscitation myocardial dysfunction in rabbits in order to elucidate the underlying mechanism of hypothermia.Methods After setting up rabbit model of cardiopulmonary resuscitation,20 rabbits were randomly ( random number)divided into two groups,namely normothermic resuscitation group (group A,n =10 ) and post-ROSC hypothermia group ( group B,n =10).In the group A,animals wore treated with standard CPR after cardiac arrest.In post-ROSC hypothermia group,the body temperature of animals was cooled to 32 ～ 34°C after successful ROSC.The left ventricular end-diastolic pressure (LVEDP),left ventricular pressure rise and fall rates ( ± dp/dtmax,serum concentrations of heart-type fatty acid-binding protein (H-FABP) and 8-isoprostaglandin F2a (8-iso-PGF2a) and Cyclooxygenase-2 (COX-2) were observed. Results Compared with the A group,the B group had significantly better hemodynamics,and lower serum H-FABP,8-isoPGF2a and COX-2 levels in the early stage of post-resuscitation ( both P ＜ 0.05 ).ConclusionsMild hypothermia attenuated post-resuscitation myocardial dysfunction during the early period of postresuscitation.The cryoprotective effect on myooardium is likely associated with the reduction of 8-iso-PGF2a and COX-2.
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Objective To observe the effects of selective α2-adrenergic receptor agonist alpha-Methylnore-pinephrine(α-MNE) as a vasopressin agent on hemodynamics, troponin T(cTnT) and myocardium in the rabbit cardiopulmonary resuscitation. Method Eighteen health rabbits, weighing 2.5 - 3.5 kg, both male and female,were provided by Lanzhou institute of veterinary medicine. After setting up rabbit model of cardiopulmonary resuscitation, 18 rabbits were randomly divided into three groups. The rabbits in group A as a operation-control group were processed with anesthesia, endotracheal intubation, and surgery without ventricular fibrillation induced. The rabbits in group B as a epinephrine group were administered with 30 ug/kg epinephrineduring CPR. The rabbits in group C as a MNE group were administered with 100 ug/kg α-MNE during CPR. The left ventrictdar end-diastolic pressure(LVEDP), left ventricular pressure rise and fall rate(± dp/dt) and serum concentrations of BNP were measured. Statistic package of SPSS 10.0 was used for the data analysis and significant differences between means were evaluated by ANOVA analysis. Results Compared with group A, LVEDP of other two groups gradually increased respectively(P < 0. 01), and peak ± dp/dt decreased in other two groups(P<0.01). Increase in LVEDP in group C was less than that in group B(P<0.05), whereas peak ± dp/dt in group C were higher than that in group B(P<0.05), at the same stage. Compared with group A, the cTnT of the remaining two groups increased(P<0.01, respectively),and reached peak at 30 minutes. In group C, the elevation of cTnT was less than that in group B(P<0.05) during the same period. In group B and C, myocardial injury was seen under a light microscope, but the injury in group C was lighter than that in group B. Conclusion The methylnorepinephrine can lessen the myocardial dysfunction after CPR.
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Objective To observe the changes of nitric oxide (NO) levels in plasma during cardiopul-monary resuscitation (CPR) and to compare the effects of aminoguanidine (AG) and NG-nitro-L-arginine methyl ester (L-NAME) on CPR. Method This was a prospective, randomized animal study performed at the Function Laboratory of Lanzhou University. Cardiac arrest was electrically induced and was left untreated for 5 min. After performing chest compression for 1 min, 40 domestic rabbits were divided into four groups (n = 10) to receive ei-ther 20 mg/kg AG, 25 mg/kg L-NAME, 0.02 mg/kg epinephrine or 2 ml saline placebo before defibrillation. Successfully resuscitated rabbits were observed for a further 4 h. Hernodynamics variables and cardiac functions were monitored with appropriate instrumentation. Arterial blood NO levels were examined at baseline, at the end of 1 min chest compression and at 15, 30, 60 and 120 min after survival. Repeated measures analysis of variance was used to determine statistical significance between groups. Results During chest compression, the mean + stan-dard deviation coronary perfusion pressure was higher in the AG group (40±10 mmHg) than in the L-NAME group (34±8 mmHg; P =0.001) and was higher in both groups with the control group (20±5 mmHg; both P =0.000). Left ventricular + dp/dtmax and- dp/dtmax were higher in the AG group than in the L-NAME group. In the surviving rabbits, the left ventricular + dp/dtmax and - dp/dtmax were higher in the AG and L-NAME groups than in the epinephrine and control groups and were higher in the AG group (4783±912, 4409±827 mmHg/s)than in the b-NAME group (3554±847, 3398±764 mmHg/s; P = 0.001 and 0.023, respectively). Conclu-sions Both AG and L-NAME increased the coronary perfusion pressure, and improved left ventricular systolic and diastolic function during CPR and prevented post-resuscitation myocardial dysfunction. However, AG was signifi-canfly superior to L-NAME.