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Objective:To investigate the relationship between blood pressure variability (BPV) and incidence of post-traumatic stress disorder (PTSD) in trauma patients.Methods:Patients admitted to the department of emergency medicine of the Affiliated Hospital of Xuzhou Medical University for acute trauma from January 2018 to December 2021 were enrolled. The clinical data and blood pressure at admission (T1), 10 minutes before anesthesia (T2), 60 minutes after surgery (T3), and 24 hours after surgery (T4) were collected. Coefficient of variation of blood pressure variation [CV-BP, including coefficient of variation of systolic blood pressure (CV-SBP), coefficient of variation of diastolic blood pressure (CV-DBP), coefficient of variation of mean arterial pressure (CV-MAP)] and its quartile were calculated. Patients were divided into Q1 group (CV-MAP ≤ 7.27), Q2 group (7.27 < CV-MAP ≤ 9.50), Q3 group (9.50 < CV-MAP ≤ 14.05) and Q4 group (CV-MAP > 14.05) according to CV-MAP quartile. The PTSD symptoms of the patients were evaluated using the PTSD scale (PCL-5) one month later, and the patients were divided into the PTSD group and the non-PTSD group according to whether PCL-5 score higher than 38. Then the differences of the above indicators were compared and analyzed. Spearman correlation analysis was used to analyze the relationship between each index and PCL-5 score; the risk factors of PTSD were analyzed by univariate binary Logistic regression. Variables with P < 0.05 were included in the multivariate binary Logistic regression model. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of CV-MAP on the incidence of PTSD. Results:A total of 112 patients were enrolled, including 24 in PTSD group and 88 in non-PTSD group. Compared with non-PTSD group, the proportion of women, T1 shock index, proportion of intraoperative and postoperative blood transfusion in PTSD group was higher. Besides, PTSD group also had longer PT, more intraoperative and postoperative blood transfusion, and lower postoperative hemoglobin (Hb) level (all P < 0.05). The T1 SBP, DBP, MAP and T4 MAP of patients in PTSD group were significantly lower than those in non-PTSD group [T1 SBP (mmHg, 1 mmHg≈0.133 kPa): 105.0 (86.3, 121.3) vs. 122.0 (112.0, 132.8), T1 DBP (mmHg): 62.5 (50.0, 77.3) vs. 76.0 (68.5, 82.8), T1 MAP (mmHg): 77.8 (60.4, 91.3) vs. 93.3 (82.5, 99.0), T4 MAP (mmHg): 83.8±9.1 vs. 88.7±10.4, all P < 0.05], CV-SBP, CV-DBP and CV-MAP were higher than those in the non-PTSD group [CV-SBP: 12.80 (10.12, 19.16) vs. 9.30 (6.07, 12.95), CV-DBP: 16.62±6.47 vs. 12.40±5.61, CV-MAP: 14.10 (9.25, 18.85) vs. 8.90 (6.93, 13.29), all P < 0.05]. Spearman correlation analysis showed that there was a positive correlation between CV-MAP and PCL-5 scores in patients with acute trauma ( r = 0.429, P < 0.001); multivariate binary Logistic regression analysis showed that only CV-MAP [odds ratio ( OR) = 1.128, 95% confidence interval (95% CI) was 1.015-1.254, P = 0.025] and CV-DBP ( OR = 1.114, 95% confidence interval (95% CI) was 1.016-1.221, P = 0.022) was the risk factor for PTSD in acute trauma patients. Compared with Q1 group, Q4 group was significantly more likely to develop PTSD ( OR = 18.6, 95% CI was 1.9-179.1, P = 0.012). CV-SBP, CV-DBP and CV-MAP had certain predictive value on PTSD diagnosis in patients with acute trauma according to ROC curve analysis results [area under the ROC curve (AUC) was 0.713, 0.682 and 0.726, respectively], among which CV-MAP has the highest predictive value. When the cut-off value of CV-MAP was 12.158, the sensitivity was 75.0% and the specificity was 69.3%. Conclusion:Higher BPV after trauma is a risk factor for PTSD. Maintaining stable blood pressure in trauma patients is of great significance for prevention and treatment of PTSD.
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Objective:To investigate the predicting value of high sensitivity C-reactive protein (hs-CRP) and albumin (Alb) ratio on prognosis of patients with in-hospital cardiac arrest (IHCA).Methods:A total of 107 patients with IHCA and spontaneous circulation recovery (ROSC) after cardiopulmonary resuscitation (CPR) in the Affiliated Hospital of Xuzhou Medical University during January 1, 2017 and September 30, 2020 were selected as the subjects and divided into the survival group and death group according to the survival condition on day 14 after IHCA. The correlation between ratio of high sensitivity C-reactive protein/albumin (hs-CRP/Alb) and the prognosis of patients was analyzed.Results:No statistical significant differences were found between the survival and death groups in sex, age, medical history, ECG monitoring, recovery ventilation mode, percentage of first monitoring of heart rate and pre-resuscitation Alb (all P > 0.05). However, there were significant differences in the percentage of non-cardiogenic CA and adrenaline dose > 5 mg, time of CPR, concentrations of blood lactic acid, Alb, hs-CRP, and ratio of hs-CRP/Alb (all P < 0.05). Logistic regression analysis showed that percentage of adrenaline dose > 5 mg, concentration of blood lactic acid, time of CPR, and ratio of hs-CRP/Alb were independent risk factors for predicting death. ROC curve analysis showed that hs-CRP/Alb ratio, and concentration of hs-CRP and Alb had predictive value on the death of patients with IHCA; the areas under the curves of hs-CRP/Alb ratio, hs-CRP and Alb concentration were 0.876, 0.864 and 0.745, respectively. The predictive efficiency of hs-CRP/Alb ratio was better than that of hs-CRP concentration or Alb concentration. Conclusions:hs-CRP/Alb ratio has predictive value for the prognosis of patients with IHCA and the predictive value is superior to that of hs-CRP and Alb concentration.
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Objective:To investigate the relationship between the changes in inflammatory markers levels and the onset of post-traumatic stress disorder (PTSD) in the early stage of acute trauma..Methods:From January 2018 to June 2020, patients with acute trauma who were admitted to the Affiliated Hospital of Xuzhou Medical University were selected as subjects. Peripheral venous blood was collected on admission, on the 3rd and 7th day after trauma for routine blood test, C-reactive protein (CRP) and procalcitonin (PCT). The neutrophil to lymphocyte ratio (NLR) was calculated. The PCL-5 scale was used to evaluate PTSD symptoms one month later. The patients were divided into the PTSD group and non-PTSD group with the score of 38 as the boundary. The change rule of NLR in the PTSD group and the non-PTSD group were analyzed.Results:Ninety-one trauma patients were enrolled, including 23 patients in the PTSD group and 68 patients in the non-PTSD group. Compared with the healthy control group, the NLR of 91 trauma patients on admission, on the 3rd and 7th day were significantly higher (all P< 0.01). The NLR of the PTSD group was increased on the 7th day after trauma, which was significantly higher than that of the non-PTSD group ( P= 0.025). The non-PTSD group showed a decreasing trend, of which NLR on the 7th day was significantly lower than that on admission ( P= 0.001). In addition, high level of NLR on the 7th day after trauma (β= 0.206, P= 0.01) was a risk factor for PTSD onset. Conclusions:Dynamic monitoring of the changes in NLR after acute trauma would be of great clinical value to early warning of PTSD.
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Objective:To explore the influence of intensive analgesia on the incidence of post-traumatic stress disorder (PTSD) in acute trauma patients, and to develop new ideas for the prevention and treatment of PTSD.Methods:From January 2018 to November 2019, a prospective study was conducted on trauma patients who visited the Emergency Center of Affiliated Hospital of Xuzhou Medical University and met the enrollment criteria. The patients were divided into the intensive analgesia group (< 4) and non-intensive analgesia group (≥ 4) according to the mean pain score in 30 days. The epidemiological data, trauma-related parameters, analgesic schemes, VAS score, PCL-5 score, HADS score and incidence of PTSD of enrolled patients were collected. Appropriate statistical methods were used to analyze differences among the indicators between the two groups.Results:Eighty-four acute trauma cases were included in the study, 39 cases in the intensive analgesia group and 45 in the non-intensive analgesia group. There was no significant difference in baseline data between the two groups (all P>0.05). The incidence rate of PTSD and PCL-5 score of patients in the intensive analgesia group were all significantly lower than those in the non-intensive analgesia group in 1 month after the trauma (all P< 0.05). The HADS anxiety and depression scores of patients in the intensive analgesic group were significantly lower than those in the non-intensive analgesic group (all P< 0.05). All the analgesics were converted into the dosage of dezocine for comparison. The total dosage of analgesics (dezocine) used in patients of the intensive analgesia group was significantly higher than that in the non-intensive analgesia group within 30 days after injury ( P< 0.05). Conclusion:In the acute trauma patients, intensive analgesia after trauma can significantly reduce the incidence of PTSD as well as improve anxiety and depression symptoms.
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Objective:To investigate the effect of post-traumatic pain on post-traumatic stress disorder (PTSD).Methods:A prospective trial was conducted with the recruitment of patients referred to the Emergency Center of Affiliated Hospital of Xuzhou Medical University for acute trauma from January 2018 to June 2019, with the exclusion criteria: age < 18 years, severe eye injury, severe craniocerebral injury and other critical conditions. The clinical data and written informed consent were collected at admission, the post-traumatic pain was assessed by VAS scores and the trauma severity was assessed by ISS score. APACHEⅡ score were evaluated within 24 h after admission. One month after trauma, patients with history of mental illness, or history of major psychogenic trauma within one year or drug addiction were further excluded. Accordingly, 64 eligible patients were evaluated by VAS, and the PCL-5 scale was used to evaluated their PTSD symptoms. The patients were divided into the PTSD group and non-PTSD group according to PCL-5 score≥ 38, and the difference between the two groups in post-traumatic VAS scores was compared. Logistic regression analysis was used to analyze the risk factors of PTSD. Spearman correlation analysis was adopted to establish the correlation between VAS score at admission and PCL-5 score at one month after trauma. The receiver operator characteristic (ROC) curve was used to analyze the predictive value of traumatic pain intensity for PTSD onset.Results:Sixty-four patients were selected and defined as the PTSD group ( n=19) and non-PTSD group ( n=45). The VAS score at admission was significantly higher in the PTSD group than that in the non-PTSD group ( P=0.006). There was no significant difference in VAS scores and VAS variations at 1 month, and in ISS scores at admission and APACHEⅡ scores within 24 h after admission between the two groups. Traumatic pain was an independent risk factor for PTSD ( P=0.043). VAS score at admission was positively correlated with PCL-5 score at 1 month post-traumatically ( r=0.355, P=0.004). In addition, ROC curve analysis showed that VAS score > 8 at admission had predictive value for PTSD (sensitivity=100%, specificity=33%, P=0.000 2). Conclusions:Post-traumatic severe pain is an independent risk factor for PTSD, which requires prompt medical intervention.
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OBJECTIVE To screen for mutations in a Chinese pedigree affected with hypokalemic periodic paralysis. METHODS The proband and nine family members were enrolled for the analysis of CACNA1S and SCN4A gene mutations. Genomic DNA was extracted from peripheral blood samples. The coding regions of the two genes were amplified with PCR and subjected to Sanger sequencing. Potential impact of suspected mutations was predicted with Bioinformatics software. The mutations were also verified among 100 healthy controls. RESULTS The proband and 5 family members (including 5 males and 1 female) had presented with episodes of flaccid paralysis accompanied by low serum potassium. Genetic testing has identified a c.664C>T (p.Arg222Trp) mutation in the proband, which has been reported previously. The same mutation was identified in other 5 affected members from the family. No mutation of the CACNA1S gene was detected. CONCLUSION The c.664C>T mutation of the SCN4A gene probably underlies the hypokalemic periodic paralysis in this family. All patients from the family have shown a complete penetrance of the disease.
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Objective To investigate the therapeutic effect of oxiracetam combined with dexamethasone for treatment of patients with severe acute carbon monoxide poisoning (ACOP).Methods Eighty-seven patients with severe ACOP admitted to Affiliated Hospital of Xuzhou Medical University from January 2013 to July 2016 were enrolled, and they were divided into observation group (47 cases) and control group (30 cases) according to random number table method. The two groups were given conventional nerve nutrition, hyperbaric oxygen and symptomatic treatment, while in the observationgroup, on the basis of conventional treatment the patients received intravenous drip of dexamethasone 5 mg (with addition of normal saline 100 mL), once a day for consecutive 3 days, and intravenous drip of oxiracetam 3.0 g plus 100 mL normal saline, once a day for consecutive 7 days. The changes of mini-mental state examination (MMSE), Barthel index and Glasgow coma scale (GCS) were observed after discharge for 30 days, and the differences of the incidence of delayed encephalopathy after acute carbon monoxide poisoning (DEACMP) and hospitalization time between the two groups were compared.Results After treatment the MMSE and GCS scores of the two groups were higher than those before treatment, and the Barthel score was lower than that before onset. After discharge for 30 days, MMSE score (26.93±2.92 vs. 24.20±6.82), GCS (14.41±1.32 vs. 13.98±2.13), Barthel (94.78±12.62 vs. 85.25±19.57) of the observation group were significantly higher than those of control group, and the incidence of DEACMP was obviously lower than that in the control group [8.5% (4/47) to 17.5% (7/40)], the differences between the two groups being statistically significant (allP 0.05).Conclusion Early combined application of oxiracetam and dexamethasone can significantly improve the cognition and self-care abilities and reduce the incidence of DEACMP in patients with severe ACOP after discharge for 30 days.
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Currently, rapid detection of effective components in synthetic drugs and herbal medicine remains an important and difficult issue of medicine research. A novel ionization technique, called dielectric barrier discharge ionization ( DBDI ) , has strong ionization ability, and is suitable for weak polar substances. Besides, this technique possesses many intrinsic advantages, such as simplicity, rapidity, no complicated sample pretreatment, etc. In this study, a new DBDI ion source, based on single electrode technique, was used to detect four weak polar synthetic drugs. The results showed that the protonated molecular ions [ M+H]+of four weak polar synthetic drugs were observed obviously. What′s more, the DBDI ion source was also used for the rapid analysis of Radix Aconiti and Radix Aconiti Preparata pieces without any sample pretreatment. The result showed that the protonated molecular ions [M+H]+ and fragment ions [M+H-60]+of aconitine, hypaconitine, and mesaconitine were detected in Radix Aconiti. And only the fragment ions [M+H-60]+were detected in Radix Aconiti Preparat. The researches indicated that diester aconitine and monoester aconitine were the main effective components of Radix Aconiti Radix and Aconiti Preparat, respectively. The new DBDI ion source provided a fast and reliable method to identify effective components of medicine, showing a broad application prospects in synthetic drugs and herbal medicine research.
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Currently, rapid detection of effective components in synthetic drugs and herbal medicine remains an important and difficult issue of medicine research. A novel ionization technique, called dielectric barrier discharge ionization ( DBDI ) , has strong ionization ability, and is suitable for weak polar substances. Besides, this technique possesses many intrinsic advantages, such as simplicity, rapidity, no complicated sample pretreatment, etc. In this study, a new DBDI ion source, based on single electrode technique, was used to detect four weak polar synthetic drugs. The results showed that the protonated molecular ions [ M+H]+of four weak polar synthetic drugs were observed obviously. What′s more, the DBDI ion source was also used for the rapid analysis of Radix Aconiti and Radix Aconiti Preparata pieces without any sample pretreatment. The result showed that the protonated molecular ions [M+H]+ and fragment ions [M+H-60]+of aconitine, hypaconitine, and mesaconitine were detected in Radix Aconiti. And only the fragment ions [M+H-60]+were detected in Radix Aconiti Preparat. The researches indicated that diester aconitine and monoester aconitine were the main effective components of Radix Aconiti Radix and Aconiti Preparat, respectively. The new DBDI ion source provided a fast and reliable method to identify effective components of medicine, showing a broad application prospects in synthetic drugs and herbal medicine research.
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Objective o investigate the prophylactic and therapeutic effects of montelukast,a cysteinyl leukotriene receptor-1 (CysLT1R) antagonist,on the delayed neuropsychological sequelae (DNS) in rat model of carbon monoxide (CO) poisoning and to explore the possible underlying mechanism.Methods A total of 90 rats were acclimated for one week prior to screening rat by Morris water maze test.Ten rats were randomly assigned to control group (Con group),and the remaining 80 rats were subjected to modified method of intraperitoneal injection of CO gas to establish animal model of acute CO poisoning,Thereafter,the survival rats randomized into CO poisoning group (Mod group),low-dose montelukast group (ML group),medium-dose montelukast group (MM group),high-dose montelukast group (MH group) (n =10 each).Montelukast was accordingly administered via intragastric tube at different intervals (30 min,4 h and 12 h) after CO poisoning,and then montelukast was administered every 12 hours for 7 consecutive days.The rats of control group and Mod group received equal volume of normal saline instead at given intervals.Twenty-one days after CO exposure,the average escape latency was measured by Morris water maze test to screen DNS rats followed by H-E staining to observe the pathological changes of cortex and hippocampal CA1 region and TUNEL was used to assess the apoptosis of neurons in cortex and hippocampal CA1 region after rats sacrificed.Results All CO-exposed rats exhibited cognition function lowered,and the escape latency (seconds) in Mod group (43.3 ± 15.5),ML group (31.5 ± 13.2) and MH groups (30.1 ± 12.2) was significantly prolonged compared with Con group (12.1 ± 3.0) (P ＜ 0.05),whereas the difference between MM group (15.0 ± 6.6) and Con group was statistically insignificant (P ＞ 0.05).Compared with Mod group,the escape latency in montelukast treatment groups was shortened,whereas the significant difference in escape latency only found between Mod group and MM group (P ＜ 0.05).Except for Con group,DNS was evident in CO-exposed groups,and the numbers of DNS rats in Mod,ML,MM and MH groups were 8,5,1,4,respectively,which made statistically significant differences to Con group (P ＜ 0.05) except MM group.The DNS incidence in MM group was lower than that in Mod group (P ＜ 0.05).Mod group exhibited severe histopathological injury to the brain,with evident apoptosis of neural cells,whereas in the groups with montelukast treatment,histopathological damage to the brain was mitigated and the number of apoptotic neuronal cells was diminished noticeably in MM group.Conclusion Montelukast can ameliorate the cognitive function of rats,decrease the incidence of DNS and reduce the apoptosis of neural cells as well as attenuate neuronal cell injury,thus exerting neuroprotection against DNS in rats with CO poisoning.
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Objective To investigate the role and potential mechanism of interleukin-17A (IL-17A) in the inflammatory response to traumatic brain injury (TBI) in rats.Methods The adult male Wistar rats were randomly (random number) divided into seven groups:control group (n =6),sham operation group (n =6),TBI group (n =24),sham operation + normal saline group (n =6),sham operation + Y320 (an immunomodulator acts as an inhibitor of IL-17A) group (n =6),TBI + normal saline group (n =6) and TBI + Y320 group (n =6).The TBI model of rat was established by using free-falling-body impact device.The levels of IL-17A and nuclear transcription factor kappa B p65 (NF-κB p65) in the cerebral cortex were assayed by using Western Blot.The capability of leaming and memory of rats was assessed by Morris water maze.The beam balance test was employed to evaluating the neurological motor performance and the capability of balance.Results Compared with the sham operation group,the levels of IL-17A and NF-κB p65 in the cerebral cortex of TBI,TBI + saline and TBI + Y320 groups increased significantly (P ＜0.05) and peaked at the 3rd day after TBI.Compared with TBI + normal saline group,the level of NF-κB p65 was significantly down regulated by Y-320 (P ＜ 0.05) at the 3rd day after TBI in TBI + Y320 group.The lengths of latency time required for rats to escape to the platform area in TBI + normal saline group were (57.72±3.29) s,(55.63±3.85) s,and (55.02±3.92) sat the3rd,5th and7th days after TBI,respectively;while those in TBI + Y320 group were (35.45 ± 3.04) s,(30.98 ± 2.92) s,and (23.90 ±2.51) s at the 3rd,5th and 7th days after TBI,respectively.Thus,the capability of learning and memory of rats in TBI + Y320 group was improved significantly 3d,5d and 7 days after TBI (all P ＜ 0.01).Conclusions This study shows IL-17A is involved in the process of secondary brain injury after TBI,and associated with inflammation by activating the NF-κB p65 signaling pathway.
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Objective To observe the protective effects of Diazoxide (DZ) on myocardial ischemia and reperfusion (I/R) in non-diabetic rats with stressed hyperglycemia and to explore its possible mechanism. Methods The stressed hyperglycemia (SHG) myocardical I/R model was prepared by ligation of the left anterior descending branch of the coronary artery for 30 minutes and reperfusion for 120 minutes on the healthy adult Sprague-Dawley (SD) rats. Blood sugar was required up to 10 mmol/L in the qualified animal model after ischemia for 30 minutes. The 48 successful model rats were randomly divided into 4 groups (12 in each group): I/R group, low, medium and high dose DZ treated group (LIPO group, MIPO group, HIPO group). Sham-operated group (sham group) was only threaded without deligation. I/R group, LIPO group, MIPO group and HIPO group were challenged to 0.1% dimethyl sulfoxide (DMSO), DZ (0.1% DMSO dissolved) 4, 7, 10 mg/kg for 2 mL, respectively after ischemia for 25 minutes. Hemodynamics indicators were continuously monitored. After reperfusion for 120 minutes, blood glucose, serum creatine kinase (CK) concentration and lactate dehydrogenase (LDH) activity were detected, myocardial infarction area was analyzed by triphenyltetrazolium chloride (TTC) staining, myocardial ultrastructure was observed by electron microscope, expressions of phosphorylated protein kinase B (p-Akt) and phosphorylated glycogen synthase kinase-3β (p-GSK-3β) were detected by Western Blot. Results Compared with sham group, I/R group had an elevated blood glucose, decreased heart rate (HR), systolic diastolic dysfunction, increased myocardial enzymes. Obvious necrosis of myocardium, myocardial tissue edema, mitochondria swelling, cristae, disappearing glycogen granules were observed under electron microscope with TTC staining. After reperfusion for 120 minutes, comparing with I/R group, blood glucose of HIPO group was significantly increased (mmol/L: 16.93±3.22 vs. 14.65±3.61, P < 0.05); the maximum rate of left ventricle internal pressure drop (-dp/dt max) of LIPO group was improved (mmHg/s: -1 055±16 vs. -982±10, P < 0.05) and the infarct size was evidently shrunk [(32.45±3.54)% vs. (41.30±3.21)%, P < 0.05]; left ventricular systolic pressure (LVSP) of MIPO group and HIPO group [LVSP (mmHg, 1 mmHg = 0.133 kPa): 60±2, 74±4 vs. 54±4], left ventricular end-diastolic pressure [LVEDP (mmHg): 24.6±1.5, 18.9±1.3 vs. 27.9±1.6], the maximum rate of left ventricle internal pressure were increased [+dp/dt max (mmHg/s): 1 049±37, 1 262±75 vs. 975±17], and -dp/dt max (mmHg/s: -1 068±21, -1 321±63 vs. -982±10) were improved in different degrees (all P < 0.05); CK (kU/L: 10.7±0.5, 11.0±1.3 vs. 12.9±1.0), LDH (kU/L: 6.8±0.2, 7.8±0.1 vs. 8.8±0.1) was evidently decreased (all P < 0.05), infarct size was smaller [(31.24±2.45)%, (30.81±2.68)% vs. (41.3±3.21)%, all P < 0.05], electron microscope showed that the myocardial injury was repaired. After reperfusion for 120 minutes, compared with sham group, expressions of p-Akt and p-GSK-3β in I/R group have obviously reduced (grey value: 0 vs. 0.187±0.018, 0.110±0.045 vs. 0.200±0.081, both P < 0.05). Compared with I/R group, expressions of p-Akt in HIPO group and p-GSK-3β in LIPO group, MIPO group and HIPO group were obviously increased (grey value: 0.101±0.009 vs. 0; 0.180±0.057, 0.270±0.062, 0.280±0.039 vs. 0.110±0.045, all P < 0.05). But there were significant increase in MIPO group and HIPO group. There was no significant difference in HR among different treatment groups. Conclusions I/R with SHG can significantly inhibit the activity of PI3K/Akt-GSK-3β signaling pathways, middle and high dose of DZ has a protective effect on I/R myocardium complicating with SHG, and middle dose will not lead to evident increase of blood glucose; DZ may act on GSK-3β through PI3K/Akt-GSK-3β signaling pathways, phosphorylate it and inhibit its activity, so as to develop the cardioprotective effect.
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Objective To compare the clinical efficacy and safety of Qingyi Decoction (a preparation of Chinese herbal medicine) between two different routes of the administration by using nasogastric tube or nasojejunal tube for treatmnent of severe acute pancreatitis (SAP).Methods A total of 79 SAP patients enrolled were randomly divided into nasogastric tube group (n =41) and nasojejunal tube group (n =38) according to the random number table method.In addition to the conventional therapy,they were treated with Qingyi Decoction administered by using nasogastric tube or nasojejunal tube.Results After treatment for 14 days,the levels of C-reactive protein (CRP),procalcitonin (PCT) and white blood cell count (WBC),urinary bladder pressure,and APACHE Ⅱ score in nasojejunal tube group were significantly lower than those in nasogastric tube group (P ＜ 0.05).The time required for the recovery of bowel sounds,length of abnormal serum amylase persistence,the duration of abdominal pain,the time necessary for mechanical respiratory support in nasojejunal tube group was significantly shorter than those in nasogastric tube group.The blood fungus infection rate and pulmonary fungus infection rate in nasojejunal tube group were significantly lower than those in nasogastric tube group,and 28-day survival rate in nasojejunal tube group was significantly higher than that in nasogastric tube group (P ＜ 0.05).Conclusion The nasojejunal tube route for the administration of Qingyi Decoction for the treatment of SAP can effectively alleviate the severity of patient's condition,shorten the time required for improving clinical symptoms,reduce the incidence of morbidity and mortality,and it is worthy of further popularization in clinical practice.
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Objective To study the effect and possible mechanism of diazoxide on myocardial ischemia/reperfusion (I/R) injury in diabetic rats, and the influence of insulin intervention which aims to maintain blood sugar levels within the normal range on the protective function of cardiomyocytes. Methods 126 health male Sprague-Dawley (SD) rats were intraperitoneally injected with one dose of 60 mg/kg streptozotocin (STZ) to reproduce diabetic model. The diabetic rats were randomly divided into seven groups, with 18 rats in each group. Myocardial I/R model was established by 30 minutes ligation of the left anterior descending branch of the coronary artery, and 120 minutes blood circulation recover. Sham group was only threaded without ligation. Rats in I/R group, diazoxide group (DZ group), and Ottawa vine penicillin (WNT) group were infused intravenously with 2 mL of 0.1% dimethyl sulphoxide (DMSO), DZ (7 mg/kg), and WNT (15 μg/kg), respectively, after 25 minutes of ischemia. Sham group was only injected with 2 mL of 0.1% DMSO. DZ+WNT group was infused with WNT 5 minutes before the injection of DZ. Insulin intervention (RI) group received a continuous insulin infusion to maintain the blood sugar at the level of 4-6 mmol/L. RI+DZ group was infused with DZ after ischemia for 25 minutes based on blood sugar control. Hemodynamic parameters in each group were monitored continuously. The pathological changes of myocardium were observed with hematoxylin and eosin (HE) staining. The expressions of phosphorylated protein kinase B (p-Akt) and phosphorylated glycogen synthase kinase-3β (p-GSK-3β) were determined by Western Blot. Results Compared with sham group, the cardiac functions of the intervention groups were significantly decreased, and severe myocardial injury was observed. Compared with I/R group, the cardiac functions of intervention groups were not obviously improved. However, after insulin intervention by which blood sugar was maintained within normal range, the cardiac function and myocardial injury were further aggravated. Compared with sham group (the expression value of sham group was set as 1), the expressions of p-Akt in other groups including I/R group, DZ group, RI group, and RI+DZ group showed no statistically significant difference (gray value: 1.07±0.09, 1.03±0.07, 1.07±0.07, 1.02±0.08 vs. 1.00, all P > 0.05). However, the expressions of p-Akt were decreased in WNT group and DZ+WNT group as compared with those of sham group and I/R group (gray value: 0.54±0.06, 0.51±0.05 vs. 1.00 and 1.07±0.09, all P 0.05). However, the expression of pGSK-3β was increased in RI group, RI+DZ group as compared with sham group and I/R group (gray value: 1.68±0.08, 1.70±0.05 vs. 1.00 and 0.97±0.08, all P < 0.05), and it was significantly higher in RI+DZ group than that of DZ group (gray value: 1.70±0.05 vs. 1.00±0.11, P < 0.05). Conclusions Diazoxide after myocardial injury could not protect the myocardium from I/R injury in diabetic rats, and did not trigger the activation of the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway. Insulin intervention by which blood sugar was maintaine d within the normal range exacerbates myocardial I/R injury in diabetic rats.
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Objective To investigate the effect of high-frequency oscillatory ventilation (HFOV) on inflammatory responses in lung tissues of dogs with severe acute respiratory distress syndrome (ARDS).Methods Healthy mongrel dogs of both sexes,weighing 13.7-16.2 kg,in which severe ARDS was induced by intravenous infusion of the mixture of oleic acid 0.2 ml/kg and autologous blood (equal to the volume of oleic acid).Twenty-four dogs with severe ARDS were randomly divided into 4 groups (n=6 each) using a random number table:conventional mechanical ventilation with low tidal volume group (group CMV),HFOV-9 Hz group,HFOV-12 Hz group and HFOV-15 Hz group.In HFOV-9 Hz,HFOV-12 Hz and HFOV-15 Hz groups,the frequency was 9,12,and 15 Hz,respectively,mean airway pressure 20 cmH2O,oscillation pressure 70 cmH2O,and inspired oxygen fraction ratio 1.0.In group CMV,the animals were mechanically ventilated in volume-controlled mode,with positive end-expiratory pressure 5 cmH2O,tidal volume 6 ml/kg,respiratory rate 30 breaths/min,inspiratory/expiratory ratio 1:2,and inspired oxygen fraction ratio 1.0.At 4 h of ventilation,the animals were sacrificed,and lungs were removed for determination of wet/dry weight (W/D) ratio,contents of tumor necrosis factor-alpha (TNF-α),interleukin-6 (IL-6) and IL-10 (by enzyme-linked immunosorbent assay),and expression of vascular endothelial (VE)-Cadherin (by Western blot) and for microscopic examination.Lung injury scores were assessed.Results Compared with group CMV,the lung injury scores,W/D ratio,and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in the other three groups (P＜0.05).Compared with group HFOV-9Hz,the lung injury scores,W/D ratio and contents of TNF-α and IL-6 were significantly decreased,the content of IL-10 was significantly increased,and the expression of VE-Cadherin was significantly up-regulated in group HFOV-15 Hz,and the content of IL-6 was significantly decreased in group HFOV-12 Hz (P＜0.05).Conclusion HFOV can significantly inhibit inflammatory responses in lung tissues of dogs with severe ARDS as compared with mechanical ventilation with low tidal volume,which may be involved in the mechanism of lung-protective ventilation effect.
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Objective To observe the effect of cardiac massage by subdiaphragmatic compression (D-CPR) on the length of time required from cardiac arrest (CA) to restoration of spontaneous circulation (ROSC),hemodynamics,rate of ROSC,survival rate of 6 h,level of Caspase3 in myocardial cells and apoptosis index (AI) of myocardial cells and compare the effect of standard cardiac massage by chest compression (S-CPR) on those variables in order to choose the more effective resuscitation method for the patient with CA during abdomen operations.Methods A total of 32 healthy New Zealand rabbit were randomly (random number) divided into two groups,namely S-CPR group and D-CPR group (n =16 in each group).All of rabbits were anesthetized with ketamine and Shumianxin (a kind of hypnotics) by intraperitoneal injection,subsequently tracheotomy was made for endotracheal intubation,and right internal jugular vein was catheterized for monitoring central venous pressure (CVP) and left common carotid artery was for indwelling cannula to monitor arterial blood pressure.Lead-2 of ECG was placed.After laparotomy and vital signs of rabbits stabilized for 5 minutes,the endotracheal tube was clamped at the end expiration for 8 minutes to make asphyxial cardiac arrest model.The effects of two different methods were observed and compared in respects of changes in hemodynamics、length of time elapsed from CA to ROSC、ROSC rate and the survival rate in 6 h.The level of Caspase3 in myocardial cells and AI of myocardial cells were detected by using immunohistochemistry staining method and TUNEL,respectively 6 hours after successful resuscitation.Results ①The length of time consumed fiom CA to ROSC in D-CPR group was shorter than that in S-CPR group (P ＜0.05) ②Coronary perfusion pressure (CPP) and MAP 15 minutes after CPR were higher in D-CPR group than those in S-CPR group (P ＜ 0.05).③SBP and DBP after ROSC were higher in D-CPR group than those in S-CPR group.④ROSC rate in D-CPR group was significantly higher than that in S-CPR group (81％ vs.43％,P ＜0.05).⑤Survival rate in 6h in D-CPR group was substantially higher than that in S-CPR group (75％ vs.25％,P ＜ 0.05).⑥HE staining showed that severe myocardial damage manifesting in edema of myocardial cell,indistinguishable cell boundary,and patchy necrosis with infiltration of scanty inflammatory cells were found in S-CPR group.While in D-CPR group,mild myocardial damage in form of slight cellular edema and distinctive cell boundary was observed.⑦Level of Caspase3 in myocardial cells in terms of integrated optical density (IOD) of postive Caspase3 cells was substantially lower in D-CPR group than that in S-CPR group (P ＜ 0.05).⑧Apoptosis index (AI) of cells was lower in D-CPR group than that in S-CPR group (P ＜ 0.05).Conclusions ①The hemodynamics in D-CPR group was more stable than that in S-CPR.group,and D-CPR increased CPP,MAP,ROSC rate and survival rate in 6h,improving achievement of successful resuscitation.②D-CPR was more effective in terms of shortening the length of time for restoration of spontaneous circulation、decreasing level of Caspase3 in myocardial cells、decreasing apoptosis index of myocardial cells and ameliotating myocardial damage from ischemic repeffusion injury.
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<p><b>OBJECTIVE</b>To investigate the effect of fasudil on in vitro cultured cardiomyocytes (CMs) exposed to omethoate and its possible mechanism.</p><p><b>METHODS</b>Cardiomyocytes were isolated from male SD rats and were then cultured in DMEM conventionally. The CMs were divided into different groups based on the doses of omethoate and fasudil in culture media. After 3, 6, 12, and 24 h of culture, the survival rate of CMs in each group was measured, the CMs in the medium-dose omethoate and medium-dose fasudil groups were subject to shortening amplitude measurement , and the content of lactate dehydrogenase (LDH) in culture media and expression of Bcl-2 and Bax in CMs were measured.</p><p><b>RESULTS</b>Compared with the normal control group, each omethoate group showed significantly lower survival rate of CMs, which was negatively correlated with the dose of omethoate (P < 0.01). Compared with the normal control group, the medium-dose omethoate and medium-dose fasudil groups showed significantly decreased shortening amplitudes of CMs at all time points (P < 0.01), and the shortening amplitudes of CMs were significantly higher in the medium-dose fasudil group than in the medium-dose omethoate group after 12 h and 24 h of culture (P < 0.01). The LDH level was significantly higher in the medium-dose omethoate and medium-dose fasudil groups than in the normal control group, and the medium-dose fasudil group showed significantly lower LDH level than the medium-dose omethoate group (P < 0.01). Compared with those in the normal control group, the Bcl-2 expression in the medium-dose omethoate and medium-dose fasudil groups was decreased significantly, and the Bax expression in the medium-dose omethoate group was increased significantly (P < 0.01). Compared with the medium-dose omethoate group, the medium-dose fasudil group had significantly increased Bcl-2 expression and significantly decreased Bax expression (P < 0.01).</p><p><b>CONCLUSION</b>Fasudil can inhibit the abnormal expression of apoptosis regulatory proteins (Bcl-2 and Bax) induced by omethoate, which might be one of the factors that reduce the toxic effect of omethoate on CMs.</p>
Subject(s)
Animals , Male , Rats , 1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine , Pharmacology , Cells, Cultured , Dimethoate , Toxicity , Myocytes, Cardiac , Metabolism , Pesticides , Poisoning , Proto-Oncogene Proteins c-bcl-2 , Metabolism , Rats, Sprague-Dawley , bcl-2-Associated X Protein , MetabolismABSTRACT
<p><b>OBJECTIVE</b>To observe the protective mechanism of ulinastatin on mice with acute lung injury induced by exposure to phosgene and its relationship to the expressions of matrix metalloproteinase-9 (MMP-9) in the lung tissues.</p><p><b>METHODS</b>Sixty-four healthy male SD rats were randomly divided into two groups: the experimental group and the control group. 32 rats in the experiment group were randomly subdivided into four groups: rats with phosgene exposure group, rats with phosgene exposure after saline injected group, rats with phosgene exposure after dexamethasone injected group. 32 rats in the control group were randomly subdivided into four groups: rats with air exposure group, pretreated with ulinastatin before air exposure group, pretreated with saline before air exposure group, pretreated with dexamethasone before air exposure group, 8 animals in each group. After pretreated with the same dose of ulinastatin, saline, dexamethasone respectively, 32 rats in the control groups were exposed to the air on the same condition respectively for 5 min. While after pretreated with the same dose of ulinastatin, saline, dexamethasone respectively, 32 rats in the experiment groups were exposed to the phosgene which the concentration was 8.33 mg/L and with 100% purity for 5 min. The lung wet/dry (W/D) weight ratio was calculated, and total protein content and BALF leukocyte count were detected. The immunohistochemistry was used to detect lung tissue protein expression MMP-9 while enzyme-linked immunosorbent method was employed to detect MMP-9 in serum levels and enzyme original gelatinases spectrum method to detect BALF MMP-9 enzyme original content.</p><p><b>RESULTS</b>Compared with A1, A2, A3, A4 group, the lung W/D, BALF of protein content and WBC count in B1 and B2 group rats were significantly increased, and the difference was statistically significant (P < 0.01). There was statistically significant difference in lung W/D, BALF of protein content and white blood cell count between B1,B2 group and the B3 and B4 rats (P < 0.01). Histological experimental results showed marked hyperemia of alveolar walls, thickening in the lungs, alveolar walls and stroma cells infiltrating and more visible alveolar structure damage in B1 and B2 rats while the alveolar structure, the alveolar walls were clear and slightly thickened with inflammatory cells in B3 and B4 rats. Immunohistochemical result showed that the individual rats, lung and bronchus organization MMP-9 protein were weakly positive, B1 and B2 group MMP-9 protein expression was strongly positive,B3 group and the group MMP B4 lung tissue protein expression-9 weakens, restored to the normal lung tissue of weakly positive expression level. ELISA and gelatinases spectrum testing showed B1 and B2 rats, serum MMP-9 enzyme activity and content increased compared with A1, A2, A3, A4 group, the differences were statistically significant (P < 0.01), and B1, B2 group compared with the B3 and serum B4 group MMP-9 enzyme activity and the differences were obviously decreased, with statistically significant difference (P < 0.01).</p><p><b>CONCLUSIONS</b>Ulinastatin has protective effect on phosgene-induced ALL Ulinastatin can inhibit the up-regulation of expression of MMP-9.</p>
Subject(s)
Animals , Male , Rats , Acute Lung Injury , Drug Therapy , Metabolism , Glycoproteins , Therapeutic Uses , Matrix Metalloproteinase 9 , Metabolism , Phosgene , Toxicity , Rats, Sprague-DawleyABSTRACT
<p><b>OBJECTIVE</b>To investigate the impacts of Xuezhikang (XZK) or pravastatin combined with antihypertensive drugs on circulating endothelial progenitor cells (CEPCs) in essential hypertensive (EH) patients.</p><p><b>METHODS</b>Eighty-eight EH patients were enrolled into the study and randomly assigned to the antihypertensive drug treatment group (ATH group, 29 cases), the pravastatin treatment group (PRA group, 29 cases) and the Xuezhikang treatment group (XZK group, 30 cases). Patients in the 3 groups were treated with routine antihypertensive drugs. In addition, pravastatin and Xuezhikang were given to the patients in the PRA group and XZK group, respectively. After an eight-week treatment, CEPCs were counted using a laser scanning confocal microscope, and their proliferation function was evaluated by the MTT colorimetric assay and the adherent cell number was counted to estimate the adhesion function.</p><p><b>RESULTS</b>After the treatment, CEPCs in the PRA group (116.60+/-5.70) and XZK group (114.40+/-6.55) was significantly higher than that in the ATH group (88.00+/-6.32, P<0.01). CEPCs proliferation capability and the adhesion function in the PRA group (0.406+/-0.016, 33.60+/-4.26) and XZK group (0.415+/-0.018, 34.30+/-3.77) were obviously superior to those in the ATH group (0.333+/-0.021, P<0.01; 23.30+/-3.19, P<0.01). No significant difference was found between the pravastatin group and the XZK group.</p><p><b>CONCLUSIONS</b>Combined use of XZK or pravastatin with the anti-hypertensive therapy could increase the CEPCs number and improve their function in EH patients with the blood pressure controlled by antihypertensive drugs, leading to benefits independent of pressure-lowering effects.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anticholesteremic Agents , Antidiuretic Agents , Antihypertensive Agents , Blood Cell Count , Calcium Channel Blockers , Cell Adhesion , Cell Proliferation , Cells, Cultured , Drug Therapy, Combination , Drugs, Chinese Herbal , Endothelial Cells , Pathology , Physiology , Hypertension , Blood , Drug Therapy , Pathology , Integrative Medicine , Methods , Pravastatin , Stem Cells , Pathology , PhysiologyABSTRACT
<p><b>OBJECTIVES</b>To construct small interfering (siRNA) Sox9 expression plasmid and transfer it into human chondrosarcoma cells HTB-94, and to check the mRNA and protein expression of Sox9 and cell growth and apoptosis of HTB-94 human chondrosarcoma cells.</p><p><b>METHODS</b>siRNA(Sox9) expression plasmid was designed and synthesized. And it was transferred into HTB-94 human chondrosarcoma cells. Then the expression of the mRNA and protein of Sox9, cell growth and apoptosis in transferred HTB-94 human chondrosarcoma cells were checked.</p><p><b>RESULTS</b>The recombinant plasmid was confirmed by enzyme digestion analysis and DNA sequencing. The expression of the mRNA and protein expression of Sox9 in transferred HTB-94 were significantly reduced. The cell growth of HTB-94 was inhibited, and the apoptosis of HTB-94 was remarkably increased.</p><p><b>CONCLUSION</b>siRNA (Sox9) expression plasmid could be transferred into HTB-94 human chondrosarcoma cells. And it can reduce the mRNA and protein expression of the HTB-94, inhibit the cell growth and cause the apoptosis of the tumor cells.</p>