ABSTRACT
Objective:To explore the protective effect and its mechanism of vitamin C on septic renal injury induced by lipopolysaccharide (LPS).Methods:Renal tubular epithelial cells HK-2 were induced with 10 mg/L LPS for 8 hours and 12 hours, respectively, and then 0.5 mmol/L and 1 mmol/L vitamin C were added, respectively. Cell viability was measured using cell proliferation and toxicity assay cell counting kit-8 (CCK-8) to determine suitable condition for subsequent experiments. HK-2 cells were divided into control group, LPS group and LPS+vitamin C group (LPS+VC group). The contents of necrosis factors phosphorylated mixed lineage kinase domain-like protein (p-MLKL) and phosphorylated receptor-interacting protein kinase 3 (p-RIPK3) were measured by Western blotting. The contents of inflammatory factors interleukin-1β (IL-1β) and tumor necrosis factor-α (TNF-α) were determined by enzyme linked immunosorbent assay (ELISA) in each group. Differences among the groups were compared.Results:CCK-8 showed that 1 mmol/L vitamin C improved the survival rate of HK-2 cells to 86% after 12 hours of LPS induction, so this condition was selected for subsequent experiments. After 12 hours LPS induction in HK-2 cells, the expressions of p-MLKL and p-RIPK3 were significantly higher than those of the control group, and the levels of IL-1β and TNF-α were also significantly higher than those of the control group [IL-1β (ng/L): 23.2±1.4 vs. 12.8±3.9, TNF-α (ng/L): 36.4±3.9 vs. 11.6±1.8, both P < 0.05], indicating the co-existence of cell necrosis and inflammation. Compared with LPS group, 1 mmol/L vitamin C significantly decreased the protein expression of p-MLKL and p-RIPK3, and also significantly decreased the levels of IL-1β and TNF-α [IL-1β (ng/L): 19.8±0.7 vs. 23.2±1.4, TNF-α (ng/L): 17.4±5.8 vs. 36.4±3.9, both P < 0.05]. Conclusion:Vitamin C can alleviate LPS-induced HK-2 cell damage, and reduce the expressions of necrotic factors and inflammatory factors.
ABSTRACT
Objective:To investigate the clinical efficacy of root canal filling combined with crown restoration in the treatment of large area defect of deciduous teeth.Methods:The clinical data of 160 children patients with large area defect of deciduous teeth who received treatment in Wenling No.4 People's Hospital from January 2017 to January 2018 were retrospectively analyzed. All included children received root canal filling treatment. According to the different postoperative repair methods, these children were divided into two groups. In the observation group ( n = 80), repair with a prefabricated metal crown was performed. In the control group ( n = 80), resin filling repair was given. Gingival health (gingival index) and restoration effect, including secondary caries, gingival condition (congestion or not) and food impaction were compared between the observation and control groups. Tooth condition (marginal tightness, adjacency) and safety (restoration and abrasion) were compared between the two groups after 1 year of follow up. Results:Before restoration, there was no significant difference in gingival index between the observation and control groups [(0.76 ± 0.41) vs. (0.73 ± 0.32), P > 0.05]. After restoration, gingival index in the observation group was significantly lower than that in the control group [(0.86 ± 0.55) vs. (1.35 ± 0.62), t = 5.288, P < 0.001]. In the observation group, no secondary caries or food impaction was observed, and there was one case of gingival bleeding. In the control group, there were eight cases of secondary caries, four cases of good impaction, and nine cases of gingival bleeding. The incidence of adverse reactions in the observation group was significantly lower than that in the control group ( χ2 = 6.826, P < 0.05). One-year follow-up results revealed that 79 cases (98.75%) were qualified in tooth bonding and 78 cases (97.50%) were qualified in tooth occlusion in the observation group, while 70 cases (87.50%) were qualified in tooth bonding and 69 cases (86.25%) were qualified in the occlusion in the control group. There were significant differences in qualified bonding and occlusion between the two groups ( χ2 = 7.907, 6.781, both P < 0.05). The success rate of marginal tightness, the success rate of adjacency, restoration and abrasion in the observation group were higher or superior to those in the control group (98.75% vs. 86.25%, 100.00% vs. 87.50%, 100.00% vs. 85.00%, 98.75% vs. 83.75%) ( χ2 = 9.009, 10.666, 12.973, 11.272, all P < 0.05). Conclusions:Root canal filling combined with crown restoration in the treatment of large area defect of deciduous teeth has a high success rate of qualified bonding and occlusion, less adverse defects, low incidence of food impaction and gingival bleeding, decreases the risk of secondary caries, protects the remaining tooth tissue, maintains normal chewing function, and is conducive to the eruption of permanent teeth.
ABSTRACT
Objective:To observe the changes of renal function in critically ill patients using vancomycin and analyze the renal protective effect of high dose vitamin C (VC) on vancomycin nephrotoxicity.Methods:Retrospective analysis was carried out to enroll the patients who were hospitalized in emergency intensive care unit (ICU) of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2012 to October 2019. All patients were administered with vancomycin or VC infusion in addition. According to the infusion of vancomycin alone or in combination with VC, the patients were divided into vancomycin group and vancomycin in combination with VC group; vancomycin group was further divided into two groups according to before vancomycin or after vancomycin usage; combination group were further divided into two groups according to before VC use or after VC. The initial dosage of vancomycin was calculated according to the actual weight of the patient and adjusted according to the renal function. The dosage of VC was determined according to the disease severity of the patient, and the dosage range was 50-200 mg·kg -1·d -1, continuously infused into the body. The age, gender, weight and renal function etc. were recorded and analyzed. Results:A total of 245 patients who met the requirements were included in the analysis. There were 127 patients in the vancomycin group and 118 patients in the combination group. The causes of patients admitted to ICU were pulmonary infection, sepsis, severe acute pancreatitis, etc. Among them, pulmonary infection accounted for 63.0% in vancomycin group, while severe acute pancreatitis accounted for 61.9% in combination group. The quick sequential organ failure assessment (qSOFA) score of combination group was significantly higher than that of vancomycin group [1.0 (0, 1.0) vs. 0 (0, 0.2), P < 0.01], its basic renal function was also significantly worse [serum creatinine (SCr, μmol/L): 98.0 (65.0, 178.2) vs. 56.0 (42.2, 71.0), blood urea nitrogen (BUN, mmol/L): 11.30 (6.48, 18.38) vs. 4.70 (3.45, 8.10), both P < 0.05], and the average daily dose of vancomycin was also significantly lower than that of vancomycin group (mg·kg -1·d -1: 23.0±9.4 vs. 26.6±8.5, P < 0.01). Compared with vancomycin before administration, the renal function was getting worse significantly after vancomycin administration [SCr (μmol/L): 68.0 (50.2, 104.5) vs. 56.0 (42.2, 71.0), BUN (mmol/L): 5.35 (3.75, 9.83) vs. 4.70 (3.45, 8.10), both P < 0.05]. Combination with VC significantly improved renal function compared with that before VC treatment [SCr (μmol/L): 79.0 (58.0, 129.0) vs. 98.0 (65.0, 178.2), P < 0.05; BUN (mmol/L): 9.60 (6.10, 18.30) vs. 11.30 (6.48, 18.38), P > 0.05] and shortened the length of ICU stay [days: 28.5 (14.8, 54.2) vs. 37.0 (25.0, 55.0), P < 0.01]. Conclusions:The incidence of drug-induced renal injury caused by vancomycin is high. Intravenous high dose VC can significantly reduce the nephrotoxicity of vancomycin and shorten the length of hospital stay. When vancomycin is used in critically ill patients, VC can be used in combination to reduce or avoid drug-induced renal injury, improve curative effect and reduce toxic effects.
ABSTRACT
Objective To explore the application effect of amelioration of pterygium combined with free autogenous conjunctival flap transplantation in patients with primary pterygium.Methods 90 cases (90 eyes) of primary pterygium treated in our hospital were grouped according to random number table.45 cases in control group were treated with traditional pterygium excision,and 45 cases in observation group were treated with pterygium combined with free autogenous conjunctival flap transplantation.The operative condition (length of operation,incision size,blood loss during operation,healing time of corneal epithelium),the effect of operation and corneal astigmatism [corneal dispersion (CAD)],naked eye [uncorrected visual acuity (UCVA)] and tear film rupture time [break up time (BUT)] before and after operation were observed and compared.The incidence of complications,recurrence rate and quality of life (SF-36) before and after operation were compared between the two groups.Results The incision size,operative time,intraoperative blood loss and corneal epithelial healing time in the observation group were smaller than those in the control group (P ＜0.05).The total effective rate of the observation group was 93.33％ (42/45),which was higher than that of the control group 75.56％ (34/45) (P ＜0.05).3 months after operation,the UCVA of the observation group was larger than that of the control group,while CAD was less than that of the control group (P ＜ 0.05).The BUT 3 months after the operation was greater than that before operation (P ＜0.05),but the difference was insignificant (P ＞ 0.05).The complication rate in the observation group was 2.22％ (1/45),which was lower than that in the control group 17.78％ (8/45) (P ＜ 0.05).The recurrence rate of the observation group was 2.22％ (1/45),which was lower than that of the control group 17.78％ (8/45) (P ＜0.05).3 months after operation,the SF-36 scores of the two groups were all higher than those before operation,and the SF-36 score of the observation group was higher than that of the control group 3 months after operation (P ＜ 0.05).Conclusions Free autogenous conjunctival flap transplantation combined with amelioration of pterygium can improve corneal astigmatism and visual function of the patients with primary pterygium,and promote corneal epithelial healing,with small incision,less bleeding and longer operation,which can reduce the incidence of postoperative complications and the recurrence rate,and help to improve the quality of life of the patients.
ABSTRACT
Medical assistance is an important part of China's foreign aid. At present, the literature about teaching and training of foreign medical assistance is not frequent to find. Cambodia is a friendly diplomatic country of China, and the Changzheng Hospital has undertaken medical assistance about 13 years. This paper summarized the medical training and teaching experience of Changzheng Hospital to Preah Ket Mealea Hospital of Cambodia, including Department of Anesthesiology, Neurosurgery, Cardiovascular Center, Radiology and so on in recent years, and found that teaching methods combining various teaching approaches, cooperating with multiple departments, teaching students in accordance with their aptitude, and having flexible time and space are more suitable for Cambodia. The experience of assisting Cambodia can be further used in other countries, and establish an improved teaching system which is suitable for their national conditions and educational systems according to different medical status of different countries.
ABSTRACT
Medical assistance is an important part of China's foreign aid. At present, the literature about teaching and training of foreign medical assistance is not frequent to find. Cambodia is a friendly diplomatic country of China, and the Changzheng Hospital has undertaken medical assistance about 13 years. This paper summarized the medical training and teaching experience of Changzheng Hospital to Preah Ket Mealea Hospital of Cambodia , including Department of Anesthesiology , Neurosurgery , Cardiovascular Center, Radiology and so on in recent years, and found that teaching methods combining various teaching approaches, cooperating with multiple departments, teaching students in accordance with their aptitude, and having flexible time and space are more suitable for Cambodia. The experience of assisting Cambodia can be further used in other countries, and establish an improved teaching system which is suitable for their national conditions and educational systems according to different medical status of different countries.
ABSTRACT
Objective To evaluate the serum trough concentration and the pharmacokinetics/pharmacodynamics (PK/PD)of vancomycin in patients with severe acute pancreatitis (SAP), and analyze the effect of vancomycin continuous infusion for optimizing the characteristics of its PK/PD.Methods The inhospital patients with SAP received vancomycin treatment and admitted to emergency intensive care unit (EICU) of Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2011 to December 2016 were enrolled. Steady-state trough concentrations of vancomycin from patients were collected retrospectively. The SAP patients were divided into augmented renal clearance (ARC) and non-ARC groups, as well as systemic inflammatory response syndrome (SIRS) and non-SIRS groups according to the patients with or without symptom above. Adjustments of increased dosage or 24-hour continuous infusion or increase vancomycin dose were made for patients if the steady-state trough concentrations fell below the target level. Steady state trough concentration for vancomycin intermittent infusion or steady state concentration for vancomycin continuous infusion was determined by the fluorescence polarization immunoassay method. PK parameters of vancomycin were calculated using the Bayesian estimator and the area under the serum drug concentration-time curve (AUCc-t), the minimum inhibitory concentration (MIC) and AUCc-t/MIC was recorded and calculated.Results The steady state trough concentration or steady state concentration from 61 patients with SAP were collected with mean steady state trough concentration of vancomycin of (7.7±4.4) mg/L, which was significantly lower than standard concentration (15 mg/L,P < 0.001). Apparent volume of distribution (Vd) and clearance of vancomycin was (1.06±0.26) L/kg and (8.9±2.8) L/h. The serum steady state trough concentration of vancomycin in ARC group (n = 33) was significantly lower than that in non-ARC group (n = 28; mg/L: 6.7±3.5 vs. 8.2±4.1, P < 0.01), clearance was significantly increased (L/h: 9.8±2.9 vs. 7.7±2.2,P < 0.01). Compared with non-SIRS group (n = 31), the serum steady state trough concentration of vancomycin in SIRS group (n= 30) was significantly lowered (mg/L: 6.1±3.2 vs. 13.0±4.2,P < 0.01), and clearance was significantly increased (L/h: 9.4±2.0 vs. 7.1±2.1,P < 0.05). Compared with the only increasing vancomycin dose group (n = 29), vancomycin continuous infusion for 24 hours (n = 21) could significantly reduce daily dosage (mg/kg: 13.6±3.9 vs. 19.1±3.5,P < 0.01), increase the serum trough concentration (mg/L: 18.1±7.0 vs. 12.6±5.3,P < 0.01), and improve the AUCc-t/MIC.Conclusions The serum trough concentration of vancomycin was significantly reduced in SAP patients with ARC. The more serious of the SIRS is, the lower the vancomycin trough concentration is. Vancomycin 24-hour continuous infusion could optimize the PK/PD parameters, decrease the daily dose, increase the clinical effect, and reduce the bacterial resistance.
ABSTRACT
Objective To investigate the effect of propofol pretreatment on hypoxia-induced apoptosis of alveolar epithelial type Ⅱ (AE Ⅱ) cells in fetal rats. Methods Primary cultured AE Ⅱ cells isolated from fetal rats were seeded in 96-well plates (1 × 106/L, 180 μl/well) and randomly assigned to one of 3 groups (n = 72each):normal control group (group C), hypoxia group (group H) and propofol-hypoxia group (group P-H).Group H and P-H were exposed to hypoxia (5% O2). In group P-H, propofol (final concentration 5 μ mol/L) was added 1 h prior to hypoxia (5% O2). The apoptotic rate and expression of hypoxia-inducible factor (HIF)-1αmRNA, Bnip3L mRNA, HIF-1α protein and Bnip3L protein were determined at 3, 12, 24 and 48 h of hypoxia.Results The apoptotic rate and expression of HIF-1α mRNA, Bnip3L mRNA, HIF-lα protein and Bnip3L protein were significantly up-regulated in group H compared with group C (P ＜ 0.05). Propofol pretreatment could significantly inhibit the hypoxia-induced changes mentioned above (P ＜ 0.05). Conclusion Propofol pretreatment can inhibit hypoxia-induced apoptosis of AE Ⅱ cells, and the mechanism is related to inhibition of HIF-1αactivation and down-regulation of Bnip3L expression in fetal rats.