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Idiopathic pulmonary fibrosis （IPF） is a progressive interstitial lung disease with unknown etiology and poor prognosis. At present， there are few antifibrotic drugs， which have limited efficacy and cause diverse side effects in the treatment of IPF， failing to meet the clinical needs. Therefore， it is urgent to develop more safe and effective drugs to treat IPF. Traditional Chinese medicine （TCM） has garnered increasing attention in recent years in the treatment of IPF due to its unique advantages. Increasing studies have shown that Chinese medicines have remarkable therapeutic effects on IPF and broad application prospects. However， the unclear material basis and mechanism in treating IPF hinders the modernization， internationalization， and clinical application of Chinese medicines. Therefore， it is essential to decipher the mechanism of the active components in Chinese medicines in treating IPF， which has gradually become a hot spot in the research on IPF. Increasing research results have demonstrated that anti-inflammation， anti-oxidation， inhibition of epithelial-mesenchymal transition are involved in the treatment of IPF with these active components， whereas the systematic research and summary remain to be carried out. By reviewing the articles about the treatment of IPF with the active components in Chinese medicines in recent years， this paper summarizes the mechanism and experimental studies and puts forward the existing problems in the research on the mechanism， aiming to provide references for the further basic research on IPF and the development of targerted drugs.
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Objective:To report our experience in diagnosis and treatment of posterior atlantoaxial dislocation with odontoid retrolisthesis.Methods:A retrospective study was conducted of the 5 patients who had been treated from July 2012 to August 2018 at Department of Orthopaedics, General Hospital of Southern Theater Command for posterior atlantoaxial dislocation. They were 4 men and one woman, aged from 34 to 67 years (average, 47 years). All of them had a history of trauma. Of them, 4 were complicated with odontoid fracture and one with congenital free os odontoideum. Their posterior atlantoaxial dislocation ranged from 3 to 9 mm (average, 6 mm). By the American Spinal Injury Association (ASIA) grading system, their preoperative spinal injury was rated as grade B in one, as grade C in 3 cases and as grade D in one. All the 5 patients underwent skull traction at 10° flexion. Surgical trans-oralpharyngeal atlantoaxial reduction and internal fixation was performed for the one patient whose reduction had not been achieved by traction while posterior atlantoaxial screw-rod fixation or anterior odontoid screwing was conducted for the 4 patients whose reduction had been achieved by traction. The distance of posterior atlantoaxial dislocation was measured to evaluate their reduction and ASIA grade system was used to assess their spinal function after operation.Results:The postoperative distance of posterior atlantoaxial dislocation was 0 mm, showing a reduction rate of 100%. The 5 patients were followed up for 6 to 36 months (average, 15 months). By the ASIA grade system, the postoperative functional recovery of the spine was grade D in 4 cases and grade C in one. No implant loosening or breakage occurred.Conclusion:As a kind of high-energy hyperextension injury, posterior atlantoaxial dislocation is rare in clinic, but an appropriate treatment can be adopted to deal with its different clinical types to achieve good outcomes.
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Objective To compare the effects of different anesthesia techniques on early prognosis in patients undergoing hip joint replacement. Methods The demographic, preoperative and postoperative data of 478 patients, aged 18-95 yr, of American Society of Anesthesiologists physical statusⅠ-Ⅳ, who underwent elective unilateral hip joint replacement in Tongji Hospital from May 2014 to December 2016, were retrospectively analyzed. Patients were divided into general anesthesia group (group GA, n=197), peripheral nerve block group ( group PNB, n=147) and peripheral nerve block combined with general an-esthesia group ( group PNB+GA, n=134) . The amount of crystalloid solution and colloid solution infused, consumption of sufentanil and requirement for vasoactive agents were recorded during operation. The dura-tion of anesthetic recovery room stay, length of hospital stay before and after operation and total length of hospital stay were recorded. The development of complications within 48 h after operation, therapy after ad-mission to intensive care unit and in-hospital fatality were also recorded. Results Compared with group GA, the intraoperative consumption of sufentanil was significantly decreased in group PNB+GA, and the a-mount of crystalloid solution infused, urine output, consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infection and acute cerebral infarction were significantly decreased in group PNB+GA ( P<0. 05) . Compared with group PNB+GA, the consumption of sufentanil, requirement for vasoactive agents and incidence of postoperative hypoxemia, pulmonary infec-tion and acute cerebral infarction were significantly decreased in group PNB (P<0. 05). Conclusion Compared with general anesthesia or with peripheral nerve block-general anesthesia, peripheral nerve block is more helpful in improving early prognosis in patients undergoing hip joint replacement.
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The majority of patients have experienced pain or discomfort associated with surgery or mechanical ventilation in intensive care unit (ICU), and the use of analgesic drugs can relieve patients' anxiety, improve sleep, promote the disease recovery, reduce the use of sedative drug dosage and the occurrence of delirium. Because of less adverse reactions of the non opioid analgesic drugs, in recent years gradually the doctors in ICU have paid attention to them. In this study, the related literatures have been reviewed to realize the present situation of applying non opioid analgesic drugs in ICU. It was found that nowadays the application of commonly used non opioid drugs in ICU (including ketamine, non-steroidal anti-inflammatory drugs, tramadol, lidocaine, tramadol and gabapentin) can all decrease the use of sedative drugs and opioids, reduce the incidence of adverse reactions, and gradually they will obtain more and more attention.
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Objective To evaluate the efficacy of ultrasound-guided laryngeal mask airway (LMA) in children.Methods ASA Ⅰ and Ⅱ children (aged 1 to 6 years) scheduled for orthopedic surgery of limbs were recruited in this study.ALMA was inserted after induction of general anesthesia.After mechanical ventilation for 5 minutes,the air-filled cuff was deflated and then inflated with saline.Ultrasonography was then performed by a high frequency linear-array transducer to confirm the correct placement of the LMA.Results The LMA can be easily recognized on the transverse view of the thyroid cartilage notch,appearing as a circle around the glottis,which was called the dumbbell sign.On the sagittal view of the thyroid cartilage,the LMA has an archlike appearance which ended below the thyroid cartilage.Oblique scan over the cricoid cartilage shows the tip of LMA is located at the upper portion of the esophagus.Conclusions Filling the LMA cuff with saline instead of air allows better LMA visualization by ultrasound.This method enhances correct positioning of the LMA,which is crucial to ensure safe ventilation.
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<p><b>BACKGROUND</b>The occurrence of contrast induced acute kidney injury (CIAKI) has a pronounced impact on morbidity and mortality. The aim of the present study was to appraise the diagnostic efficacy of age, estimated glomerular filtration rate (eGFR) and ejection fraction (AGEF) score (age/EF(%)+1 (if eGFR was <60 ml × min(-1)× 1.73 m(-2))) as an predictor of CIAKI in patients with diabetes mellitus (DM) and concomitant chronic kidney disease (CKD).</p><p><b>METHODS</b>The AGEF score was calculated for 2 998 patients with type 2 DM and concomitant CKD who had undergone coronary/peripheral arterial angiography. CIAKI was defined as an increase in sCr concentration of 0.5 mg/dl (44.2 mmol/L) or 25% above baseline at 72 hours after exposure to the contrast medium. Post hoc analysis was performed by stratifying the rate of CIAKI according to AGEF score tertiles. The diagnostic efficacy of the AGEF score for predicting CIAKI was evaluated with receiver operating characteristic (ROC) analysis.</p><p><b>RESULTS</b>The AGEF score ranged from 0.49 to 3.09. The AGEF score tertiles were defined as follows: AGEFlow ≤ 0.92 (n = 1 006); 0.92 <AGEFmid ≤ 1.16 (n = 1 000), and ACEFhigh >1.16 (n = 992). The incidence of CIAKI was significantly different in patients with low, middle and high AGEF scores (AGEFlow = 1.1%, AGEFmid = 2.3% and AGEFhigh = 5.8%, P < 0.001). By multivariate analysis, AGEF score was an independent predictor of CIAKI (odds ratio = 4.96, 95% CI: 2.32-10.58, P < 0.01). ROC analysis showed that the area under the curve was 0.70 (95% CI: 0.648-0.753, P < 0.001).</p><p><b>CONCLUSION</b>The AGEF score is effective for stratifying risk of CIAKI in patients with DM and CKD undergoing coronary/peripheral arterial angiography. (Clinical Trial identifier: NCT00786136).</p>
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Female , Humans , Male , Middle Aged , Acute Kidney Injury , Contrast Media , Glomerular Filtration Rate , Physiology , Multivariate Analysis , Renal Insufficiency, ChronicABSTRACT
Objective To study the value of tumor markers of CA153,CEA and CA125 in nipple discharge of breast intraductal papillary leision on detection of breast carcinoma.Methods 154 cases of breast intraductal papillary leision with nipple discharge were studied.Among them there were 58 cases with breast intraductal papillary carcinoma and 96 cases with intraductal papilloma.The nipple discharged and serum from the 154 cases were collected and CA153,CEA and CA125 levels were measured both in nipple discharge and serum with electrochemiluminescence method,and were compared with the results of ER,PR,HIF-1α and Ki-67 detected by SP method in breast tissue.Results The CA153,CEA and CA125 levels of nipple discharge in intraductal papillary carcinoma [(130.1 1±29.62) U/ml,(89.23±28.94) ng/ml,(41.29±16.61) U/ml]were significantly higher than those of the contrast groups,and had a positive correlation with the Ki-67,HIF-1αand lymphnode metastas (P ＜ 0.05),and negative correlation with the level of ER,PR and Her-2 (P ＜ 0.05).The positive rate of CA153,CEA or CA125 in nipple discharge (62.07 ％,46.55 ％,55.17 ％) were significantly higher than that in serum (P ＜ 0.05).The sensitivity of the combined detection of the three tumor markes both in discharge and serum was 96.55 ％,and the negative predictive value was 97.30 ％,which were significantly higher than that in other detection (P ＜ 0.05).Conclusions The positive rate of CA153,CEA and CA125 in nipple discharge were significantly higher than that in serum.The dynamic combined detection of CA153,CEA and CA125 both in nipple discharge and in serum could increase the diagnosis rate of breast intraductal papillary carcinoma.
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Objective To investigate the effects of hypoxia-inducible factor-1α (HIF-1α)expression on pathogenesis of retinopathy of prematurity (ROP) and to find new target for gene therapy.Methods After liposome-mediated small interference RNA (siRNA) transfection into rat retinal endothelial cells,the cells were cultured in medium with CoCl2-induced hypoxic condition.Expression of HIF-1α mRNA was determined by fluorenscence quantitative reverse transcription-polymerase chain reaction(RT-PCR),HIF-1α protein expression was detected by Western Blot after cocultured for 8 hours.Cell proliferation was measured with 3-(4,5)-dimethylthiazol (-2-yl)-2,5-diphenyltetrazolium bromide(MTT) assay after cocultured for 24 hours.Difference between groups was compared with independent samples t test.Results Rat retinal vascular endothelial cells were successfully transfected with siRNA.Fluorescence quantitative RT-PCR results showed that at 48 hours of transfection,the expression of HIF-1α mRNA in the interference group of siRNA1,siRNA2 and siRNA4 were 0.1620 ± 0.0147,0.2034 ± 0.0251 and 0.3049 ± 0.0165,which were 16.20％,20.34 ％ and 30.49％ of blank control group (1.0000±0.0344),and were lower than that of negative control group (0.8334±0.0242) (t=16.786,8.953 and 4.087,P＜0.05 respectively).Western Blot results showed that HIF-1α protein expression was significantly inhibited by siRNA1(0.4956 ± 0.0421 ) and siRNA2 (0.6544 ± 1.0032) comparing with blank control group (3.5105 ±0.4084) and negative control group (3.4019 ± 1.0677) (t =6.861,2.893,4.567 and 5.072,P＜0.05 respectively).As for cellular proliferation activity,(49.5±2.9) ％ and (67.4±1.2) ％ of cells growth inhibition were observed after transfection with siRNA1 and siRNA2,which were higher than those of negative control group [(15.7±1.5) ％ ] (t=2.786 and 6.904,P＜0.05).Conclusions The synthetic HIF-1α siRNA could effectively inhibit the expression of HIF-1α gene and reduce cell proliferation in rat retinal endothelial cells under hypoxic condition.RNA interference technology targeting HIF-1α might become a new strategy for gene therapy of ROP.
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Objective To investigate the effect of Kangaroo care in improving milk intake and immune status for premature children.Methods 80 cases of premature children from June 2009 to June 2011 were chosen as the research object.They were randomly divided into the control group and the observation group with 40 patients in each group.The control group was taken with conventional care model for care,and the observation group used Kangaroo care model for mursing.The milk intake of differerent tines and immune status of the two grmps were taken for testing and comparoson.Results The milk intake vohnnes 7d,14d and 28d after care of the observation group were greater than the control group.The levds of CD3+ 、CD4+and CD4/CD8 were higher,while the CD8+ level was lower than the control group.Conclusions Kangaroo care can significantly improve milk intake and immune status of preterm children.
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Objective To evaluate the clinical effect of endoscopic sphineterotomy (EST) and endoscopic sphincterotomy associated with traditional Chinese medicine in the treatment of intrahepafic duct stones.Methods Eighty patients with common bile duet stones and intrahepatic duct stone were randomly divided into a treatment group and a control group.EST associated with traditional Chinese medicine was performed in the treatment group,and EST only was used in the control group.Clinical effects were observed.Results Common bile Duet stone clearance was achieved in 94% patients in the treatment group,contrasting 88% in the control group.There was no significant difference between them (P＞0.05).While intrahepatic duct stone clearance was 74% and 28% respectively in the treatment group and the control group,showing significant difference (P＜0.05).Conclusion It is a good way that endoscopic sphincterotomy associated with traditional Chinese medicine treating intrahepatic duct stones.
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The article tries to discuss the usage of "modthod of strengthening qi" in treating minimal residual leukemia(MRL). We believe that the mechanisms for MRI are qi weakness and pathogenic factors staying in yinfen. By using the method of strengthening qi, we hope to achieve the effects of regulating yin and yang, qi and blood, and physiological functions of visceras and meridians, and enhance body immunity. Thus, we can prevent and treat MRL and resist tumor indirectly.
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Objective To investigate the relationship between plasm N-terminal pro-B-type natriuretic peptide(NT-proBNP) levels and severity of coronary artery disease and coronary artery lesions. Methods 150 patients complaining of chest pain and suspected to have coronary artery disease (CAD) were enrolled in the study. Plasm NT-proBNP contents were determined with ELISA method within 48h, and left ventricular ejection fraction (LVEF) was assessed with echocardiography 5-7 days after admission. All patients underwent coronary artery angiography(CAG) 2-17 days after admission and the severity of coronary artery lesions was estimated by coronary angiographic Gensini scores. According to the clinical data and results of CAG, 78 patients were diagnosed as acute coronary syndromes (ACS), 33 patients as stable angina, and 39 patients in whom angiography showed negative findings, served as normal controls. The correlation of plasm NT-proBNP levels with clinical severity of coronary artery disease and Gensini scores were analysed. Results Plasm NT-proBNP levels in patients with ACS, stable angina and in normal controlls were 526.96?376.90, 95.61?56.32 and 41.75?24.26pg/ml,respectively(P
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Objective To investigate the protective effects of the scallop skirt glycosaminoglycan (SS-GAG) in vitro on the endothelial cell damaged by oxygen free radical and the mechanism of its anti-atherosclerotic effects. Methods The endothelial cells of human umbilical vein (HUVEC)were cultured in vitro, and the damage model of endothelial cells was established by oxygen free radicals . After the damage of HUVEC by Fenton reaction, the effects of SS-GAG on the proliferative activity of HUVEC were observed by the methods of MTT chroma-tometry ,the influence of SS-GAG on lactate dehydrogenase (LDH) release was studied by chromatometry and the effects of SS-GAG on secretion of endothelins and angiotensin Ⅱ were observed by the methods of radio-immunity. Results Compared with the control group, proliferation activity of damage group cell lowered obviously ,LDH release in culture media,and the excretion of endothelins and angiotensin Ⅱ in HUVEC rised obviously. In the groups pre-treated with SS-GAG, cell proliferation activity, the LDH release and the excretions of ET and Ang Ⅱ showed obvious differences compared with model group. Conclusion SS-GAG reduce the damage of endothelial cell caused by oxygen free radicals, restrain the secretion ofendothelins and angiotensin Ⅱ . These results indicate that SS-GAG has protective effects on the endothelial cells damaged by oxygen free redicals and the anti-atherosclerotic mechanism of SS-GAG was related to its protective effects on the endothelial cells.