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Objective To investigate the influencing factors for the prognosis of adult patients with chronic drug-induced liver injury (DILI). Methods A total of 255 patients who were diagnosed with chronic DILI by liver biopsy in The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2018 were enrolled, and according to the liver function after 2 years, they were divided into non-recovery group and recovery group. The two groups were analyzed in terms of the clinical data including age, sex, body mass index, types of drugs used, type of DILI injury, severity of DILI injury, underlying diseases, laboratory markers, liver histology, and 2-year prognosis. The t -test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors for the prognosis of chronic DILI. Results After 2 years of follow-up, 195 patients (76.5%) achieved the recovery of liver function, while 60 patients (23.5%) did not achieve such recovery. There were significant differences between the two groups in the type of DILI injury ( P =0.028), the proportion of patients with diabetes ( P =0.048), and the degree of liver fibrosis ( P 2×upper limit of normal (ULN) ( OR =3.080, 95% CI : 1.331-7.127, P =0.009) were independent risk factors for the prognosis of chronic DILI. Conclusion When patients meet the diagnostic criteria for chronic DILI, the independent risk factors PLT 2×ULN may be used to screen out the patients who are more likely to have poor prognosis.
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As the prevalence rate of drug-induced liver injury increases year by year, the pathogenesis of drug-induced liver injury has become the focus of attention. As a large family, CYP450 enzymes participate in almost all oxidative metabolic reactions of drugs in the human liver. Recent studies have shown that CYP450 enzyme gene polymorphisms lead to the differences in pharmacodynamics between individuals, and therefore, exploring the role of CYP450 enzyme gene polymorphisms in drug-induced liver injury may promote the understanding of the pathogenesis of drug-induced liver injury. This article reviews the CYP450 enzyme polymorphisms that have been found to be associated with drug-induced liver injury.
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Objective To study the predictive value of hemodynamic monitoring in the responsiveness of fluid therapy in neonatal septic shock.Method The 96 neonates with septic shock admitted to the NICU from Wuhan Children's Hospital and Tongji Hospital between March 2014 to May 2017 were enrolled.Hemodynamics parameters of neonates pre-,1 hour and 6 hour post-fluid therapy were supervised by ultrasonic cardiac output monitor.The hemodynamics parameters included cardiac index (CI),systemic vascular resistance (SVR),stroke volume (SV),stroke volume variation (SVV),stroke volume index (SVI) and corrected flow time (FTc).The SVI variation (△ SVI) were calculated based on the SVI among pre-and post-fluid therapy.According to the △ SVI,these samples were assigned into two groups,responsive group with a △ SVI ≥10％,and the other was nonresponsive group respectively.T-test was applied to analyze the differences of hemodynamic parameters between two groups.The associations between SVV、FTc and △ SVI were evaluated by bivariate correlation.Receiver operating characteristic curve (ROC) was used to evaluate the predictive value of SVV and FTc in fluid responsiveness.All statistical analyses were performed by SPSS 19.0,P＜0.05 was considered as statistically significant.Result A total of 96 cases were enrolled,of which 54 were fluid responsive group,while 42 were nonresponsive group.(1) Before fluid resuscitation,the FTc in responsive and nonresponsive groups were (317.1±22.2) ms and (326.8± 21.2) ms (P＜0.05) respectively,SVV were(18.3±2.0)％ and (15.0±2.6)％ (P＜0.05).SVV was significantly associated with △ SVI (r=0.542,P＜0.05).(2) There were statistically significant differences in heart rate,mean arterial pressure,cardiac output,cardiac index,stroke volume and systemic vascular resistance index before treatment,1 h and 6 h after treatment (P＜0.05).(3) The area under the ROC of SVV (AUC) was 0.838 (95％CI 0.749～0.906).A sensitivity of 98.2％,and specificity 73.8％ when SVV defined as 15.5％,with a significant difference when compared with FTc (AUC=0.642,95％CI 0.538～0.737) (P＜0.01).Conclusion SVV could be a reliable predictive index in estimating fluid responsiveness of neonatal septic shock and could be helpful parameter in clinic diagnosis.
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Objective To learn the cognitive status for newborns medical pain in medical workers of neonatal intensive care unit of children′s hospitals and provide clinical basis for optimizing neonatal pain management. Methods Totally 320 medical staff in neonatal intensive care units of six children′s hospital in Wuhan, Shenzhen, Shanghai, Nanjing, Zhejiang, Chongqing were investigated using medical pain management survey questionnaires by means of convenience sampling method. Results The knowledge on neonatal pain were at quite high level, accuracy rate was (80.5 ± 18.1)%;but on pain feel, pain relief rate and anodyne-use, the accuracy rate was relatively low; chest drainage, lumbar puncture and PICC placement were generally considered to cause severe pain with scores of 8.03±2.20, 7.17±2.17, 7.09 ± 2.00, respectively. Medical staff with different degrees, having children or not, different titles and with different years of working at NICU had impact on neonatal pain assessment on heel prick and venipuncture among full-term newborns. The difference was statistically significant (χ2=6.208-23.314, P<0.05). Conclusions Neonatal pain management is gradually emphasized by clinical medical staff, but there exist a certain bias on the perception and assessment of pain. So, it needs to strengthen pain-related knowledge training on health care for newborns to prevent and reduce neonatal pain, improving neonatal pain management.
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Background and purpose: Renal cell carcinoma is the most common form of kidney cancer, characterized by lack of early symptoms and high malignancy. This study aimed to establish orthotopic nude mice models of human renal cell carcinoma with high success rate and good repeatability. Methods: The four types of methods which were adopted to establish the orthotopic models of renal cell carcinoma were orthotopic injection of 786-0 and ACHN cell suspensions, orthotopic injection of primary cell suspensions obtained from the subcutaneous tumor tissues, renal subcutis orthotopic implantation into renal capsule and surgical subcutis orthotopic implantation into renal fascia. To gain insights into the tumorigenicity and the growth of transplantation tumors, the imageological examination (PET/CT), histological examination (H-E staining, immunohistochemistry staining) and biochemical analysis of blood were carried out. Results: In terms of the subcutaneous transplantation of human renal cell carcinoma models in nude mice, tumorigenic rate of ACHN cells (90%) was higher than that of 786-0 cells (30%). The tumorigenic incidences of 786-0 cell suspensions orthotopic injection, ACHN cell suspensions orthotopic injection, ACHN subcutis cellular suspensions orthotopic injection, ACHN subcutis orthotopic implantation into renal capsule and renal fascia were 33%, 80%, 90%, 100% and 20%, respectively. ACHN subcutis orthotopic implantation into renal capsule was the most effective approach. Imageological and histological results accorded with poorly differentiated renal cell carcinoma. Conclusion: Four orthotopic nude mice models of human renal cell carcinoma were successfully established. Among these methods, ACHN subcutis orthotopic implantation into renal capsule is the most effective approach, which provides an ideal model for the research on biological behavior of human renal cell carcinoma and its treatment.
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Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN) with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patients with severe traumatic brain injury (STBI). Methods A prospective randomized control trial was carried out from January 2009 to May 2012 in Neurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow Coma Scale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were admi- nistrated EN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function, complications and clinical outcomes were examined and compared statistically. Results There were 120 patients enrolled in the study, with 40 pationts in each group. In EN+PN group, T lymthocyte subsets CD3+%, CD4+%, ratio of CD3+/CD25+, ratio of CD4+/CD8+, the plasma levels of IgA, IgM, and IgG at 20 days after nutritional treatment were significantly increased compared to the baseline(t=4.32-30.00, P<0.01), and they were significantly higher than those of PN group (t=2.44-14.70; P<0.05,or P<0.01) with exception of CD4+/CD8+, higher than those of EN group (t=2.49-13.31, P<0.05, or P<0.01) with exceptions of CD3+/CD25+, CD4+/CD8+, IgG and IgM. For the nutritional status, the serum total protein, albumin, prealbumin and hemoglobin were significantly higher in the EN (t=5.87-11.91; P<0.01) and EN+PN groups (t=6.12-13.12; P<0.01) than those in PN group after nutrition treatment. The serum prealbumin was higher in EN+PN group than that in EN group (t=2.08; P<0.05). Compared to the PN group, the complication occurrence rates of EN+PN group were significantly lower in stress ulcer (22.5% vs. 47.5%; χ= 8.24, P<0.01), intracranial infection (12.5% vs 32.5%;χ= 6.88, P<0.01) and pyemia (25.0% vs. 47.5%; χ= 6.57, P<0.05). Compared to the EN group, the complication occurrence rates of EN+PN group were significantly lower in aspirated pneumonia (27.5% vs. 50.0%; χ= 6.39, P<0.05), hypoproteinemia (17.5% vs. 55.0%; χ= 18.26, P<0.01) and diarrhea (20.0% vs. 60.0%; χ= 20.00, P<0.01). The EN+PN group also had significant less length of stay in NICU (t=2.51, 4.82; P<0.05, P<0.01), number of patients receiving assisted mechanical ventilation (χ= 6.08, 12.88; P<0.05, P<0.01) and its durations (t=3.41, 9.08; P<0.05, P<0.01), and the death rate (χ=7.50, 16.37; P<0.05, P<0.01) than those of EN or PN group. Conclusion Early EN+PN treatment could promote the recovery of the immune function, enhance nutritional status, decrease complications and improve the clinical outcomes in patients with severe traumatic brain injury.
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Adult , Female , Humans , Male , Middle Aged , Brain Injuries, Traumatic , Allergy and Immunology , Metabolism , Therapeutics , Enteral Nutrition , Nutritional Status , Parenteral Nutrition , Treatment OutcomeABSTRACT
Objective To explore the effects and mechanisms of nesfatin-1 injection in the central nucleus of the amygdale(CeA) on exploratory behavior in rats.Methods Fifty rats were divided into 5 groups randomly : nesfatin-1 low dose group, nesfatin-1 high dose group, SHU9119 group, SHU9119+nesfatin-1 low dose group and control group.Drugs were administrated via CeA to examine behavioral changes of rats by elevated plus maze model test and nesfatin-1 mRNA expression in CeA of anxiety rats (10 rats).Results Compared with the control group,anxiety behaviors of rats in nesfatin-1 low dose group and nesfatin-1 high dose group were improved remarkably,showing that the open arm entries were significantly reduced (OE, t=4.16-12.87, P＜0.01), open arm entry proportion was decreased remarkably (OE％, t=2.39-4.39, P＜0.01-0.05), and time proportion in open arm was decreased significantly (OT％, t=5.43-20.55, P＜0.01),which presented dose dependent.Compared with the control group, anxiety degree of rats in nesfatin-1 low dose group and nesfatin-1 high dose group significantly enhanced, showing that the rats head dipping reduced obviously (HD, t=6.97-16.73, P＜0.01) ,while rearing was increased significantly (RE, t=6.60-13.25, P＜0.01) ,which was presented dose dependent.Melanocortin receptor antagonist SHU9119 can partly eliminate nesfatin-1 induce-anxiety (t =2.11-3.08, P＜ 0.01-0.05).Real-time PCR results showed that nesfatin-1 mRNA expression of anxiety model rats was significantly increased (t =3.40-5.58, P＜0.05).Conclusion Amygdala nesfatin-1 can increase anxiety and fear of rats,which may be associated with melanocortin systems.
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Objective To explore the correlation of the throid function and malnutrition in maintenance hemodialysis(MHD) patients.Methods Fifty-four MHD patients and 16 normal controls were enrolled as our subjects and named as MHD group and control group.Serum concentrations of total triiodothyronine (TT3),total thyroxine (TT4),free thyroine (FT4),free triiodothyronine (FT3),and thyroid-stimulating hormone (TSH) were measured by enhanced chemiluminescence immunoassay.Their anthropometry,biochemical assays,malnutrition-inflammation score (MlS) and micro-inflammation parameters such as high sensitivity C-reactiveprotein(hs-CRP) were also measured.Results Serum T3,FT3,T4,FT4 concentration in MHD patients were (1.18 ±0.31) nmol/L,(2.61 ±0.62) pmol/L,(100.00 ± 19.96) nmol/L,(8.56 ±0.85) pmol/L respectively,lower than that of control group ((2.95 ± 0.27) nmol/L,(7.12 ± 0.94) pmol/L,(136.25 ± 19.68) nmol/L,(8.89 ± 0.56) pmol/L respectively,P ＜ 0.01).while there was no significant change on TSH (P =0.058).According to albumin nutrient grading standard:the morbidity of malnutrition was 75％ (39/54).The morbidity of malnutrition was 100％ based on the criteria of MIS.Of which,mild malnutrition rate was 29.63％ (16/54),moderate rate for 37.04％ (20/54) and sever rate for 33％ (18/54).The levels of serum creatinine,hemoglobin,serum iron,upper arm circumference,body mass index(BMI),deltoid skinfold,hs-CRP,T3,FT3,T4,FT4,TSH in MHD patients with mild,moderate and serve rate MIS were significant different(P ＜ 0.01).Of 54 MHD patients,32 cases were with micro inflammatory state,accounting for 59.26％ (32/54).There was a positive correlation between FT3 and albumin (P ＜0.01).T3 was related to serum creatinine(P ＜ 0.05).Thyroid function parameters showed a negative correlation with hs-CRP,MIS(P ＜ 0.01).And a negative correlation was seen between nutrition indices and hs-CRP and MIS (P ＜ 0.01).Conclusion Thyroid function can reflect the nutrition status of MHD patients to some degree,and both relate with miro-inflammation.Furthermore,MIS is a useful index for the estimation of malnutrition inflammation status.
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BACKGROUND: Neural stem cells are always derived from animals, and unsuitable for human transplantation treatment. OBJECTIVE: To explore the in vitro culture methods of human embryonic striatum-derived neural stem cells, and to observe the biological characteristics. METHODS: The human embryonic striatum were separated from the embryo at a gestational age of 8-16 weeks that received induction of labor with water bag, and then the embryonic striatum was in vitro cultured in the serum-free Dulbecco’s modified Eagle’s medium. The cells were passaged after neurospheres formation, and then the cells were induced to differentiation with the Dulbecco’s modified Eagle’s medium/F12 containing 10% fetal bovine serum. RESULTS AND CONCLUSION: The in vitro cultured human embryonic striatum-derived neural stem cells grew rapidly and could express nestin. Colony formation assay showed the cel clone formation rate was 6.0%-7.0%. 5-Bromodeoxyuridine incorporation assay showed the cel proliferation rate was 37.9%. Immunofluorescence staining showed that the cells after induction and differentiation could express Tuj-1, glial fibril ary acidic protein and nestin, but not express myelin basic protein. The results indicate that human embryonic striatum-derived neural stem cells cultured in the serum-free medium can maintain their biological characteristics and have self-renewal capacity, and the cells can differentiate into the neurons and astrocytes induced by the fetal bovine serum.
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Objective To explore the value of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in diagnosing adult multiple atrial septal defect (MASD). Methods Thirty adult patients with MASD were examined with TTE, 25 patients were examined also with TEE, 26 patients were examined with cardiac catheterization as well. Transcatheter closure of MASD was performed in 20 patients and succeeded in 18, while open-chest operation was performed in 4 patients. Results Foramen secundum atrial septal defect was diagnosed with both TTE and TEE with an accuracy rate of 60.00% (18/30) and 96.00% (24/25), respectively. The main color Doppler flow imaging (CDFI) feature of adult MASD was multiple colorful left-to-right shunt signals through the atrial septal designated, i.e. colander sign of CDFI. Conclusion TTE has some difficulties and TEE has specific value in diagnosing adult MASD. TTE can be used before open-chest operation. TEE is necessary before transcatheter occlusion to make sure of the amount and location of atrial septal defect.
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Objective To study the effects of chronic intra-abdominal hypertension (IAH) on the functions of vital organs. Methods From January 2004 to January 2008, 30 chronic massive ascites related IAH patients were enrolled including 12 colonic cancer cases, 7 pancreatic cancer cases, and 11 gastric cancer cases. Control group included 30 cases of gastrointestinal carcinoma without ascites hence no IAH. The specific malignances in this group were colonic cancer in 15 cases, pancreatic cancer in 8 cases, and gastric cancer in 7 cases. Age, gender and cancer stage were matched between the two groups. Symptoms in digestive, respiratoy and circulatory system and liver and kidney functions were recorded and KPS scores were compared respectively. Results The symptoms of abdominal distention in chronic IAH group and control group were presented respectively by 15 cases(50%) and 5 cases (17%) (P < 0.01). Symptoms of heart-throb or hypotension in the two groups by 10 cases (33%) and 3 cases (10%) respectively(P<0.05). Symptoms of asthma or chest distress in the two groups by 9 cases(30% ) and 1 cases (3%) respectively (P< 0.01). Liver function were abnormal in 16 cases (53%) and 6 cases (20%) respectively (P < 0.01 ), kidney functions were abnormal in 14 cases (47%) and 1 case( 3% ) respectively ( P <0.01 ) . There were 22 cases (73 %) and 7 cases (23 %) respectively ( P < 0.01 ) in the two groups with KIS score being lower than 40. Conclusions Chronic IAH causes malfunctions of vital organs deteriorating patients general status and even leading to abdominal compartment syndrome.
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Aim To explore the inhibitory effect of dexamethasone on the expression of SH2-B? in the lung and the visceral sensory afferent system(C7-T5 spinal ganglia and the corresponding posterior horn of the spinal cord)of asthmatic mice.Methods Murine model of asthma of BABL/c mice was induced by ovalbumin in vivo.By means of immunohistochemistry and Western blot,the expression of SH2-B? in the lung,C7-T5 spinal ganglia and corresponding spinal cord was detected and the inhibitory effect of dexamethasone on it was observed.Inspiratory airway resistance was measured with AniRes 2003 lung function system.Results The expression of SH2-B? in the lung,C7-T5 spinal ganglia and the corresponding spinal cord of the asthmatic mice was much higher than that of the control group and the dexamethasone group(P
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Objective To evaluate the safety and efficacy of combining radiofrequency ablation(RFA) with arsenious acid(AA) locally to treat liver VX2 tumor in rabbits,and to explore its mechanism.Methods Twenty-eight New Zealand White rabbits with implanted liver VX2 tumors were randomly divided into four groups: control group(n= 7),AA group(n=7),RFA group(n=7),and combination(RFA+AA) group(n=7).ALT was measured before treatment and on the day 0,day 3,day 7 and day 14 after treatment,meanwhile ultrasonic(US) examination was performed.All rabbits were killed 14 days after treatment.Vascular endothelial growth factor(VEGF) was examined by immunohistochemistry,and the relationship of VEGF and gross tumor volume was analyzed.Results Combination(RAF+AA) therapy caused little damage to hepatic function but had better inhibited tumor growth.The level of VEGF in AA,RFA and RAF+AA group was lower than that of the control group(P
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Objectve: To evaluate the effects of pigment epithelium derived factor(PEDF) eyedrops in inhibiting corneal neovascularization(CNV) by topical installition on the rat model undergoing penetrating keratoplasty and to investigate its possible mechanism and its clinical significance.Methods: Penetrating karatoplasty were proformed orthotopically from Wistar rats to SD rat' recipients.72 SD rats were randomly assigned to two groups-experimental group and control group,after transplantation.Experimental group was treated with PEDF eyedrops and control group was treated with escipient eyedrops.CNV was observed by the slitlamp biomicroscope examination.The area of CNV was caculated quantitatively.6 animals in both groups were killed respectively at the 1st week,2nd week,3rd week,1st month,2nd month and 3rd month postoperatively.PEDF expression was examined by immunohistochemistry and corneal untrastructural morphology was observed by TEM.Results: The area of CNV was decreased at 1 week,2 weeks,3 weeks,1 month and 2 months postaperatively(P