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SGLT2 inhibitors currently have clear benefits in the treatment of heart failure whether combined with diabetes or not. Ventricular remodeling after myocardial infarction leads to the occurrence and development of heart failure, and eventually leads to death. There are relatively few studies on SGLT2 inhibitors in patients with myocardial infarction. The purpose of this article is to review the research progress of SGLT2 inhibitors application before and after myocardial infarction.
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Objective@#To investigate the early diagnosis and treatment for burn complicated with severe paroxysmal sympathetic hyperactivity (PSH).@*Methods@#Medical records of patients with burn complicated with severe PSH, admitted to our department from April 2016 to March 2019 and meeting the inclusion criteria were analyzed retrospectively. There were 4 males and 1 female, aged 17 months to 39 years, with an average of (21±16) years. During occurrence of PSH, the vital signs of patients were routinely monitored and oxygen were given. Other treatment included central venous catheterization and infusion of electrolyte solution, infusion of plasma according to patients′ condition, use of opioid analgesics and benzodiazepine sedatives, physical cooling and drug cooling, and establishment or maintenance of artificial airway and use of ventilator. Heart rate was controlled below 120 beats per minute in adults and 140 beats per minute in children with comprehensive treatment dominated by analgesia and sedation. Besides, single or multiple vasoactive agents, even in large doses were used to maintain normal blood pressure of patients. The occurrence characteristics, time, and treatment outcome of PSH were analyzed.@*Results@#PSH happened rapidly, with a sharp increase in several minutes to dozens of minutes. Five patients were with symptoms such as high body temperature, shortness of breath, very fast heart rate, normal or elevated systolic blood pressure, hyperhidrosis, and dystonia at the onset. The symptoms occurred simultaneously or successively. According to the Clinical Feature Scale, the above-mentioned 6 indexes achieved the highest score of 3 points except of systolic blood pressure. Four patients showed dilated pupils and impaired consciousness. Among the patients, PSH occurred in the acute exudation stage in 3 patients, in the fluid reabsorption stage in 1 patient, and in the late repair stage in 1 patient. PSH of patients lasted for 3 hours to 12 days. The symptoms of 4 patients were effectively controlled, and 1 patient died of deterioration. No PSH occurred in the cured patients during follow-up of 3 to 14 months.@*Conclusions@#Burn complicated with PSH can occur at any time before wound repair and in patients with different injury conditions. The causes of PSH include sudden burn, persistent pain, fright and fear, strange environment, low blood volume, and other adverse stimuli, and PSH is more likely to occur in children with underdeveloped brain function. Intravenous infusion of analgesics sedatives, physical therapy and medication to lower body temperature, stabilizing blood pressure and respiration are effective measures to treat PSH. PSH should be distinguished from the common complications of burns, such as sepsis, cerebral edema, hyperpyretic convulsion, transfusion response, stress disorder, etc.
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Objective To investigate the association between interleukin-17 A (IL-17 A) gene promoter polymorphism and blood lipid and inflammatory factors in coronary heart disease.Methods A total of 241 patients with coronary heart disease who were admitted to hospital from April 2010 to December 2016 were enrolled in this study.68 cases of healthy subjects were collected.IL-17 gene promoter rs8193036 genotype,blood lipid and inflammatory factors were detected and compared.Results Compared with the control group,the genotype CC,CT and TT of the rs8193036 genotype in the coronary heart disease group were significantly different (P＜0.05),and the frequency of C allele in the coronary heart disease group was significantly higher than that in the control group (P＜0.05).The levels of triglyceride,low-density lipoproteinCholesterol,high density lipoprotein cholesterol,interleukin-17a,interleukin-6,interleukin-8 and tumor necrosis factor alpha in CC genotype of tumor necrosis factor alpha group were significantly higher than those in tumor necrosis factor alpha group (P＜0.05),high density lipoprotein cholesterol decreased significantly (P＜0.05).Total cholesterol and low-density lipoprotein cholesterol had no significant differences (P ＞ 0.05).Conclusion The rs8193036 polymorphism of IL-17A gene promoter is associated with the pathogenesis of coronary heart disease.The C allele is an important genetic marker of coronary heart disease.The polymorphism of IL-17A promoter rs8193036 might affect coronary heart disease by increasing blood lipids and inflammation factors.
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Objective To investigate the association between Gal-3 and the effect of perindopril on ventricular remodeling in ischemic heart failure rabbit.Methods A rabbit model of ischemic heart failure was made by ligationof the anterior descending branch of the coronary artery.Thirty rabbits were divided into sham operation group,heart failure group and perindopril group.Determination of cardiac function by echocardiography after 4 weeks of treatment respectively;mRNA expression and protein content of Gal-3 were detected by Real-time PCR or Western-blob.Serum Gal-3 level was determinated by ELISA.Results Compared with sham operation group,mRNA expression and protein content of Gal-3,type Ⅰ collagen and type Ⅲ collagen increased and the serum level of Gal-3 increased in heart failure group(P＜0.05);compared with heart failure group,mRNA expression and protein content of Gal-3,type Ⅰ collagen and type Ⅲ collagen decreased and the serum level of Gal-3 was reduced in perindopril group(P＜ 0.05).Gal-3 was negativelycorrelated with heart function(r=-0.925,P＜0.05).Conclusion Effect of perindopril inhibiting myocardial fibrosis,slowing the ventricular remodeling and improving heart function associated with level of Gal-3.
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One severely burned patient, caused by heat lead slag and combined with shock, was hospitalized in our burn unit on 2nd June, 2016. The patient received treatments including anti-shock, intensive care, anti-infection, and organ protection. On post injury day 16, the patient suffered outbreak of acute hemorrhagic necrotizing enteritis after eating dumplings. Plasma and albumin were given, octreotide was intravenously infused to inhibit the secretion of intestinal fluid, the broad-spectrum antibiotics were used for anti-infection, abdominal puncture and drainage were performed, sodium tanshinone ⅡA sulfonate was applied to improve the intestinal microcirculation, ulinastatin was applied to alleviate inflammatory reaction, somatostatin was given to reduce intestinal bleeding, and voriconazole was given for antifungal treatment. The patient gradually recovered and was finally cured and discharged. Among critically ill patients, gastrointestinal tract is not only the initiating organ of sepsis, but also one of the target organs which can be easily damaged during sepsis. This case reminds us the importance of gastrointestinal management in severely burned patients.
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Objective@#To investigate effect of continuous plasma filtration adsorption on treatment of severely burned patients with sepsis.@*Methods@#In January 2014 to September 2017, 86 severely burned patients with sepsis, conforming to the study criteria, were admitted to our hospital and divided into into routine treatment group and continuous plasma filtration group according to the random number table method, with 43 patients in each group. Patients in routine treatment group were treated with routine treatment after admission. Patients in continuous plasma filtration group were treated with blood filter, blood purification machine, and plasma separator for continuous plasma filtration adsorption on the basis of the routine treatment group on the second day after admission. The course of treatment in the 2 groups was 7 d. The total effective treatment rate, changes of leukocyte count (WBC), usea nitrogen, serum creatinine, neutrophile CD64, procalcitonin, and C reactive protein (CRP) before and after treatment, and mortality on 28 days after treatment of patients in 2 groups were analyzed and compared.@*Results@#(1) The total effective treatment rate of patients in continuous plasma filtration group was 88.37% (38/43), which was significantly higher than that of the routine treatment group [65.12% (28/43), χ2=6.515, P=0.018]. (2) After treatment, WBC, urea nitrogen, serum creatinine, neutrophils CD64, procalcitonin, and CRP of patients in continuous plasma filtration group were significantly lower those in routine treatment group (t=6.305, 4.420, 18.537, 13.435, 12.975, 14.234, P<0.05). WBC, urea nitrogen, serum creatinine, neutrophile CD64, procalcitonin, and CRP of patients in 2 groups after treatment were significantly lower than those before treatment (t=9.459, 9.130, 25.438, 35.467, 23.471, 23.601, 3.802, 5.662, 12.067, 25.694, 20.720, 12.437, P<0.05). (3) On 28 days after treatment, mortality of patients in continuous plasma filtration group was 6.98% (3/43), which was significantly lower than that in routine treatment group [25.58% (11/43)], χ2=5.460, P=0.023.@*Conclusions@#Continuous plasma filtration adsorption is effective in treating severely burned patients with sepsis, which can alleviate inflammatory reaction mediated by inflammatory cytokine with good prognosis.
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AIM: To investigate the relationship between galectin-3 (Gal-3) and myocardial fibrosis, and to clarify the role of Gal-3 in ventricular remodeling in rabbits with ischemic cardiac insufficiency.METHODS: A rabbit model of ischemic cardiac insufficiency was established by ligation of the anterior descending branch of the coronary artery.The 20 rabbits were randomly divided into sham operation group and cardiac insufficiency group by random number table method.After 4 weeks of coronary artery ligation, the cardiac function was measured by cardiac echocardiogram.Real-time PCR and Western blot were used to detect the expression of Gal-3, type I collagen and type III collagen at mRNA and protein levels in the myocardium.The serum Gal-3 contents were measured by ELISA.HE staining and Masson staining were used to observe the degree of fibrosis development in myocardial tissues after infarction.RESULTS: Compared with sham operation group, the mRNA expression of Gal-3 in cardiac insufficiency group was significantly increased.At the same time, type I collagen, type III collagen and collagen type I/III ratio were also increased significantly.The protein contents of Gal-3, type I collagen and type III collagen were increased significantly.The serum Gal-3 levels were significantly increased.The pathological changes were observed in cardiac insufficiency group as the myocardial cell morphological disorder and marked hyperplasia of fibrous tissue were seen.CONCLUSION: Gal-3 aggravates myocardial fibrosis in rabbits with ischemic cardiac insufficiency, and promotes the ventricular remodeling and the occurrence of heart failure.
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Objective To observe the expression pattern of galectin-3 in heart failure rabbits after myocardial infarction and to explore the effect of galectin-3 on myocardial fibrosis and ventricular remodeling.Methods The left anterior descending coronary arterys of the rabbits were ligatured for model preparation.Twenty male rabbits were randomly divided into control group and experimental group.The control group was treated by thoracotomy.Cardiac function were detected by cardiac uhrasonography before and after 2,4,6 weeks.Serum samples were collected and galectin-3 level of the samples were further tested with ELISA before and after 2,4,6 weeks.The expression of myocardial fibrosis was detected by Masson staining in the experimental group and the control group at 6 weeks after operation.galectin-3 and collagen Ⅰ,collagen Ⅲ mRNA level of myocardial of the infracted zone were determinated via Real-Time PCR after 6 weeks operation.Calculate the ratio of collagen Ⅰ and collagenⅢ.Left ventricular mass were analysis and left ventricular hypertrophy index was calculated.Results Compared with the control group,the EF,EDD and LVPWD of the experimental group at 2,4 and 6 weeks after operation were significantly different(P ＜ 0.01).Serum galectin-3 level of the experimental group more than control group (P ＜0.05).correlation analysis showed that serum galectin-3 level was negatively correlated with EF (r =-0.84,P =0.009),and positively correlated with EDD(r =0.905,P =0.020).The mRNA expression of galectin-3,collagen Ⅰ and collagen Ⅲ were significantly increased in the experimental group(P ＜0.01).The mRNA expression of galectin-3,collagen Ⅰ and collagenⅢ were all higher in the experimental group than that in the non-infarcted area (P ＜ 0.01).The left ventricular mass and left ventricular hypertrophy index of the experimental group were significantly higher than control group (P ＜ 0.01).Under the optical microscope,the myocardial cells in the experimental group were disordered,necrosis,edema,hypertrophy and thickening of myocardial fibers.Microvascular wall thickening and visible around a large number of blue-green collagen fibers and surrounded by segmented myocardial cells,myocardial interstitial fibrosis,collagen deposition and accompanied by a large number of inflammatory cell infiltration.Conclusion Galectin-3 reflects the degree of myocardial fibrosis in heart failure,and is involved in the pathophysiology of ventricular remodeling,but the mechanism remains unclear.
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Objective To observe the expression pattern of galectin-3 in heart failure rabbits after myocardial infarction and to explore the effect of galectin-3 on myocardial fibrosis and ventricular remodeling.Methods The left anterior descending coronary arterys of the rabbits were ligatured for model preparation.Twenty male rabbits were randomly divided into control group and experimental group.The control group was treated by thoracotomy.Cardiac function were detected by cardiac uhrasonography before and after 2,4,6 weeks.Serum samples were collected and galectin-3 level of the samples were further tested with ELISA before and after 2,4,6 weeks.The expression of myocardial fibrosis was detected by Masson staining in the experimental group and the control group at 6 weeks after operation.galectin-3 and collagen Ⅰ,collagen Ⅲ mRNA level of myocardial of the infracted zone were determinated via Real-Time PCR after 6 weeks operation.Calculate the ratio of collagen Ⅰ and collagenⅢ.Left ventricular mass were analysis and left ventricular hypertrophy index was calculated.Results Compared with the control group,the EF,EDD and LVPWD of the experimental group at 2,4 and 6 weeks after operation were significantly different(P ＜ 0.01).Serum galectin-3 level of the experimental group more than control group (P ＜0.05).correlation analysis showed that serum galectin-3 level was negatively correlated with EF (r =-0.84,P =0.009),and positively correlated with EDD(r =0.905,P =0.020).The mRNA expression of galectin-3,collagen Ⅰ and collagen Ⅲ were significantly increased in the experimental group(P ＜0.01).The mRNA expression of galectin-3,collagen Ⅰ and collagenⅢ were all higher in the experimental group than that in the non-infarcted area (P ＜ 0.01).The left ventricular mass and left ventricular hypertrophy index of the experimental group were significantly higher than control group (P ＜ 0.01).Under the optical microscope,the myocardial cells in the experimental group were disordered,necrosis,edema,hypertrophy and thickening of myocardial fibers.Microvascular wall thickening and visible around a large number of blue-green collagen fibers and surrounded by segmented myocardial cells,myocardial interstitial fibrosis,collagen deposition and accompanied by a large number of inflammatory cell infiltration.Conclusion Galectin-3 reflects the degree of myocardial fibrosis in heart failure,and is involved in the pathophysiology of ventricular remodeling,but the mechanism remains unclear.
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[ ABSTRACT] AIM:To investigate the different dose of perindopril on cardiac function in the rabbits with ische-mic cardiac dysfunction .METHODS:Male rabbits weighing 2.5~3.0 kg ( n=30) were randomly divided into 3 groups (n=10):high dose perindopril group (HD group), low dose perindopril group (LD group) and cardiac dysfunction group (CD group).The Left anterior descending coronary artery of the rabbits was ligatured for model preparation .In HD group, the rabbits were treated with perindopril split normal saline solution (1 g/L)2 mL· kg-1 · d-1 .In LD group, the rabbits were treated with perindopril split normal saline solution (0.33 g/L)2 mL· kg -1 · d-1.In CD group, the rabbits were treated with normal saline solution 2 mL· kg-1 · d-1 .Four weeks after treatment , the cardiac function was measured via echocardiography , the mRNA expression of angiotensin-converting enzyme 2 ( ACE2 ) and angiotensin type 2 receptor (AT2R) was analyzed by real-time PCR, serum angiotensin (Ang)-(1-9) and Ang-(1-7) levels were detected by ELISA. RESULTS:Compared with CD group , the cardiac function of the 2 groups treated with perindopril was significantly im-proved (P<0.01), and more improvement in HD group was observed than LD group (P<0.05).The serum angiotensin ( Ang)-(1-9) and Ang-(1-7) level and the mRNA expression of ACE 2 and AT2R in the 2 groups treated with perindopril were significantly improved (P<0.01).Compared with LD group, the mRNA expression of ACE2 and AT2R and the ser-um levels of Ang-(1-9) in HD group were significant improved (P<0.05), while no difference of serum Ang-(1-7) level was observed.Correlation analysis revealed that the improvement of the cardiac function was associated with serum Ang -(1-9) level, mRNA expression of ACE2 and AT2R (P<0.01), but has no significant correlation with serum Ang-(1-7) lev-el.CONCLUSION:High dose of perindopril may improve more cardiac function in ischemic cardiac dysfunction model in rabbits.The mechanism may relate to increasing serum Ang-(1-7) level to activate AT2R.
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BACKGROUND:Cardiac stem cels transplanted to the myocardial infarction area can effectively improve ventricular remodeling and promote heart function. But the survival rate of transplanted cels is lower in the infracted area under hypoxic microenvironment. Hypoxia inducing factor 1 alpha under anoxic conditions can stably express, and meanwhile increase the activity and survival ability of myocardial cels. OBJECTIVE:To elaborate the research progress in hypoxia inducing factor 1 alpha-transfected cardiac stem cels for treatment of myocardial infarction from the folowing aspects: cardiac stem cel characteristics, mechanism underlying myocardial protection of hypoxia inducing factor 1 alpha, selection of carriers and transplantation approach. METHODS: A computer-based search of CNKI and PubMed was performed for articles related to cardiac stem cels and hypoxia inducing factor 1 alpha published from January 2000 to January 2015. The keywords were “cardiac stem cels, hypoxia inducible factor 1(HIF-1a), gene delivery” in Chinese and English, respectively, which appeared in the title and abstract. Finaly, 37 relevant articles were enroled in result analysis. RESULTS AND CONCLUSION:Several studies have confirmed that hypoxia inducing factor 1 alpha can improve the survival rate of cardiac stem cels under anoxic conditions. Increasing evidences from animal experiments have shown that cardiac stem cels and hypoxia inducing factor 1 alpha exert protective and repairing effects on myocardial infarction. Currently, there is no successful report about hypoxia inducing factor 1 alpha gene transfection of cardiac stem cels, but relevant studies are proceeding. Gene modified cardiac stem cels are expected to be widely used in clinic.
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[ ABSTRACT] AIM:To investigate the effects of transplantation of bone marrow mesenchymal stem cells ( BMSCs) modified by bcl-2 gene on myocardial cell apoptosis, angiogenesis and cardiac function in the rabbit after acute myocardial in-farction ( MI) .METHODS:The rabbit BMSCs were isolated, cultured and purified in vitro.The BMSCs were transfected with adenovirus or adenovirus-Bcl-2.The rabbit model of MI was established by ligation of left anterior descending branch. The rabbits were injected with Ad-Bcl-2-BMSCs ( MI+Bcl-2-BMSCs group) , Ad-BMSCs ( MI+BMSCs group) and DMEM ( MI group) in infarction marginal zone 2 weeks after ligation.The cardiac function was evaluated by echocardiography.The apoptosis of myocardial cells was measured by TUNEL.The mRNA expression of VEGF was detected by real-time PCR.The expression of CD31 was examined by immunohistochemical staining, and new blood capillaries were counted at 4 weeks after BMSCs transplantation.The correlation of the above values with cardiac function was analyzed.RESULTS: The cardiac function was better, the apoptotic rate was lower, the mRNA expression of VEGF and the capillary density were higher in both MI+Bcl-2-BMSCs group and the MI+BMSCs group than those in MI group, and those in MI+Bcl-2-BMSCs group in-creased more obviously .The left ventricular ejection fraction ( LVEF) had a negative correlation with the myocardial cell ap-optosis rate.A positive correlation with the mRNA expression level of VEGF and the capillary density was also observed. CONCLUSION:The transplantation of BMSCs modified by bcl-2 gene significantly reduces the myocardial cell apoptosis, promotes angiogenesis, improves heart function of the rabbits with MI.
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Objective To investigate the interactive effects between batroxobin and low molecular weight heparin(LMWH)in reducing peri-operative blood loss and coagulation function in patients who undergone the total hip replacement surgery. Methods 240 ASA Ⅰ-Ⅲ patients received 4 000 IU LMWH 12 hours preoperatively before undergoing the total hip replacement operation,were randomly divided into two groups:testing group (Group A,n=120) and control group(Group B,n=120)receiving 2 U batroxobin or 50 mg mannitol 10 minutes before incision respectively. Perioperative blood loss,postoperative 24 hours drainage and blood routine test, prothrombin time (PT),activated partial thromboplastin time(APTT) and fibrinogen(FIB) were measured respectively. Deep vein thrombosis (DVT) were measured through color Doppler B-ultrasound 3 days after the operation. Results The perioperative blood loss in Group A (422.64 ml)was less than that in Group B(667.67 ml)(P<0.01)while red blood cell,hemoglobin, red blood cell volume and platelet were decreasing after operation in both groups but no significant difference was found between the two groups(P>0.05). There were no drug-related adverse effects found in the two groups,neither the difference in hospitalization between the two groups(P>0.05). Conclusion Batroxobin (2 U) could reduce the perioperative blood loss in patients with LMWH who had undergone the total hip replacement operation but did not show adverse effect on DVT.
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Objective To investigate the interactive effects between batroxobin and low molecular weight heparin(LMWH)in reducing peri-operative blood loss and coagulation function in patients who undergone the total hip replacement surgery. Methods 240 ASA Ⅰ-Ⅲ patients received 4 000 IU LMWH 12 hours preoperatively before undergoing the total hip replacement operation,were randomly divided into two groups:testing group (Group A,n=120) and control group(Group B,n=120)receiving 2 U batroxobin or 50 mg mannitol 10 minutes before incision respectively. Perioperative blood loss,postoperative 24 hours drainage and blood routine test, prothrombin time (PT),activated partial thromboplastin time(APTT) and fibrinogen(FIB) were measured respectively. Deep vein thrombosis (DVT) were measured through color Doppler B-ultrasound 3 days after the operation. Results The perioperative blood loss in Group A (422.64 ml)was less than that in Group B(667.67 ml)(P<0.01)while red blood cell,hemoglobin, red blood cell volume and platelet were decreasing after operation in both groups but no significant difference was found between the two groups(P>0.05). There were no drug-related adverse effects found in the two groups,neither the difference in hospitalization between the two groups(P>0.05). Conclusion Batroxobin (2 U) could reduce the perioperative blood loss in patients with LMWH who had undergone the total hip replacement operation but did not show adverse effect on DVT.
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<p><b>OBJECTIVE</b>To investigate the interactive effects between batroxobin and low molecular weight heparin (LMWH) in reducing peri-operative blood loss and coagulation function in patients who undergone the total hip replacement surgery.</p><p><b>METHODS</b>240 ASA I - III patients received 4 000 IU LMWH 12 hours preoperatively before undergoing the total hip replacement operation, were randomly divided into two groups:testing group (Group A, n = 120) and control group (Group B, n = 120) receiving 2 U batroxobin or 50 mg mannitol 10 minutes before incision respectively. Perioperative blood loss, postoperative 24 hours drainage and blood routine test, prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) were measured respectively. Deep vein thrombosis (DVT) were measured through color Doppler B-ultrasound 3 days after the operation.</p><p><b>RESULTS</b>The perioperative blood loss in Group A (422.64 ml) was less than that in Group B (667.67 ml) (P < 0.01) while red blood cell, hemoglobin, red blood cell volume and platelet were decreasing after operation in both groups but no significant difference was found between the two groups (P > 0.05). There were no drug-related adverse effects found in the two groups, neither the difference in hospitalization between the two groups (P > 0.05).</p><p><b>CONCLUSION</b>Batroxobin (2 U) could reduce the perioperative blood loss in patients with LMWH who had undergone the total hip replacement operation but did not show adverse effect on DVT.</p>
Asunto(s)
Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Artroplastia de Reemplazo de Cadera , Batroxobina , Usos Terapéuticos , Coagulación Sanguínea , Hemorragia , Heparina de Bajo-Peso-Molecular , Usos TerapéuticosRESUMEN
Objective To study the significance of No12 lymphadenectomy in patients of advanced distal gastric cancer undergoing D2 distal or total gastrectomy.Methods Clinical and pathological data of 193 distal gastric cancer cases undergoing D2 gastrectomy and No12 lymphadenectomy during Jan 2012 and Jan 2013 were analyzed retrospectively.Results In Borrmann Ⅲ,Ⅳ No.12a LN metastasis was significantly higher than that in Borrmann Ⅰ,Ⅱ (x2 =4.841,P =0.028).In cases of multiple cancer 12a LN metastasis was significantly higher than that in gastric angle,gastric antrum (11.1％ 、9.7％ 、30.4％).High-differentiated cancer was lower in LN metastasis than that of low differentiated both in No.12a group (x2 =4.292,P =0.038),and in No.12b group (x2 =4.079,P =0.043).In cases with serosal invasion LN metastasis was higher than that without infiltration both in No.12a group (x2 =8.107,P =0.004),and in 12b group (x2 =3.836,P =0.050).In cases of N 0 ～ 1 the LN metastasis was lower than that in N 2 ～ 3 in 12a group (x2 =10.960,P=0.001),12b group (x2 =4.989,P =0.026),and in 12p group (x2 =4.433,P =0.035 respectively).In cases of tumor diameter ＜3 cm,3 ～5 cm and ＞5 cm,the 12a lymph node metastasis rate was 4.2％,10.0％,and 29.2％,respectively.Tumor size ＞ 5 cm has higher metastasis rate in No.12a group (x2 =6.464,P =0.011).Conclusions No.12 lymphadenectomy should be included routinely in D2 gastrectomy in patients of distal gastric carcinoma.
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Objective To explore the expression characteristics of vascular endothelial growth factor (VEGF) receptor (VEGFR).Methods The 123I-VEGF165 and 123I-VEGF121 were marked to human umbilical vein endothelial cell (HUVEC),several human tumor cell lines (HMC-1,A431,KU812,U937,HEP-1,HEP-G2,HEP-3B and Raji),a variety of human tumors and adjacent non-neoplastic tissues as well as peripheral blood cells.Then,the specific binding site maximal binding capacity (Bmax),dissociation constant (Kd) and concentration of 50％ required specific binding (IC5o) were analyzed.The affinity,quantity and specificity of different cells combined with 123I-VEGF165 and 123I-VEGF121 were judged.Results Two kinds of analogous 123I-VEGF165 binding sites on the surface of HUVEC were found.While,there was only one kind of 123I-VEGF121binding site.123I-VEGF121 was found on the special cell lines (HUVEC,HEP-1 and HMC-1) and special early tumors (early melanoma,ductal breast cancer,ovarian cancer and meningioma).Compared with peripheral blood cells and adjacent non-neoplastic tissues,the number of VEGFR of tumor cells was bigger.Among the 123I-VEGF165 marked VEGFR,the Bmax value of early melanoma,ductal breast cancer,hepatocellular carcinoma,papillary thyroid carcinoma,ovarian carcinoma,renal cell carcinoma were 45 ± 13,13 ± 3,25 ±8,5 ±2,42 ± 12,20 ±6,respectively.While among the 123I-VEGF121 marked VEGFR,the Bmax value of early melanoma,ductal breast cancer,ovarian carcinoma were 30 ± 8,8 ± 3,20 ± 6.123I-VEGF165 and 123I-VEGF121 had specific binding capacity with a variety of human tumor cells and tissues.Compared with 123I-VEGF121,there were more different kinds of tumor cells could be bound to 123I-VEGF165 with higher capacity.Conclusion 123I-VEGF165 may be a potential target of tumor imaging in vivo,and it is expected to be used to diagnose and treat tumors.
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@#Objective To explore the relationship between post-operative cognitive dysfunction (POCD) and the dose of general anesthetic propofol in the elderly. Methods 96 patients undergoing thoracic operation were selected and randomly assigned to high bispectral index (BIS) value (HIBIS 50~60, low dose of propofol) and low BIS value (LOBIS 30~40, high dose of propofol). Remifentanyl was infused in both group with the dose of 0.2 μg/kg ⋅ min. The dose of propofol was adjusted with target-controlled infuse (TCI) according to the different ranges of BIS value in different groups. The mean arterial pressure was maintained in a certain level. The dose of propofol was recorded during the operation. Cognitive function was assessed by 12 neurophysiological tests recommended by International Study of Post Operative Cognitive Dysfunction (ISPOCD) on the day before operation and the 7th day after operation. And the D-value of the tests before and after the operation was calculated. Results 47 cases in the HIBIS group and 45 cases in the LOBIS group were included in the end. The incidences of POCD were 6.3%(3 cases) and 2.2%(1 case) respectively in HIBIS group and LOBIS group according to Mini-Mental State Examination (MMSE) score, and 12.8% (6 cases) and 6.7% (3 cases) according to combination judgment, but there was no significantly difference (P>0.05). The post-operative scores were significantly lower than pre-operative scores (P<0.01) on Hopkins Verbal Learning Test-Revised (HVLT-R) in HIBIS group. and HVLT-R dealyed Recall Test, Hvlt- r Recognition Discrimination Index and Verbal Fluency Test in both groups (P<0.01), including verbal and words. The D-values of 4 neurophysiological tests were higher in the HIBIS group than in the LOBIS group. The dose of propofol was significantly lower in the HIBIS group than in the LOBIS group (P<0.01). Conclusion As the same level of analgisia and hemodynamics, the more the dose of propofol is, the better the post-operative function is in the elderly.
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Objective To evaluate the effectiveness and safety of terazosin in the treatment of benign prostatic hyperplasia (BPH)patients with concomitant hypertension.Methods A singlecenter prospective clinical observational study was conducted from March,2006 to March,2010 in our center.The main endpoints were the changes of IPSS total score,diastolic and systolic blood pressures at the end of 4 weeks and 3 monthes compared with the baseline,The second endpoints were Qmax value at the end of 4 weeks and 3 monthes compared with the baseline,Safety was assessed by adverse events.Results There were 212 patients in the study recruited,and 189 patients completed the study.All patients had BPH combined with hepertension.All patients were randomly devided into two statistical analysis group,blood pressure well controled and not well controled group,In the well controlled group,the IPSS socre reduced from 22.31 ± 5.18 at baseline to 15.64 ±3.91 at the end of the 4th weeks and 13.16 ± 3.53 at the end of 3rd monthes in the blood pressure well controled group populatin( P ＜ 0.01 ).The Qmax were improved significantly from (7.87 ± 2.41 ) ％ at baseline to (14.19 ±2.64)％ at the end of the 4th weeks and (15.69 ±2.77)％ at the end of3rd monthes in the blood pressure well controled group populatin( P ＜ 0.01 ).Terazosin had moderate effect in blood pressure decreasing (P ＜ 0.05 ),and all patients were within normal blood pressure range.In the uncontrolled group,the IPSS socre reduced from 21.55 ± 4.82 at baseline to 15.44 ± 3.66 at the end of the 4th weeks and 12.96 ± 3.11 at the end of 3rd monthes in the blood pressure well controled group populatin (P ＜ 0.01 ).The Qmax were improved significantly from ( 8.27 ± 2.27 ) ％ at baseline to ( 14.26 ± 2.87) ％ at the end of the 4th weeks and ( 15.51 ±2.92) ％ at the end of 3rd monthes in the blood pressure well controled group populatin( P ＜ 0.01 ).Terazosin decreased BPH patient blood pressure with controlled patients and unctrolled patients additionaly to other blood pressure medicine (P ＜ 0.05 ),and no severe side effect occured.At the end of the study,all patients were taking drug continuously and were followed.Conclnsion Terazosin can significantly improve the symptoms and quality of life in BPH patients with hypertension with good safety and compliance.
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Objective To compare the effects,stress reaction and concentration of ropivacaine in umbilical cord blood of patients who accepted combined spinal epidural analgesia or patient controlled epidural labor analgesia in latent and active phase.Methods After approved by the ethics committee and informed consents from 80 nulliparous parturients who were admitted to Beijing Friendship Hospital,Capital University of Medical Sciences between January to June 2009,and who were term,single,cephalic presentation delivery and ASA Ⅰ-Ⅱ,were divided into two groups randomly:latent phase group (Group L,cervical dilation 0.5-2.5 cm,n=40) and active phase group (Group A,cervical dilation ≥3.0 cm,n =40).Ropivacaine 2 mg and fentanyl 10 μg was administered in subarachnoid space of all patients.Then,patient controlled epidural infusion of 0.1 ％ ropivacaine plus fentanyl 2 μg/ml were administered.Pain scores (visual analogue score,VAS),lower extremity muscle strength,duration of labor,delivery mode,total dosage used,maternal satisfaction,Apgar score (1 min and 5 min) were evaluated; concentration of ropivacaine (high performance liquid chromategraphy) in cord blood,and concentration of cortisol (radioimmunoassay) in maternal venous blood and cord blood were detected.Forty nulliparous parturients without labor analgesia were taken as control group (Group C).Chi-square test and one way analysis of variance was applied for statistical analysis.Results (1) VAS in Group L and Group A were lower than that of Group C when cervix dilated at 7.0-8.0 cm (2.9± 1.4,2.6± 1.5 vs 9.2±0.7,F=201.50,P＜0.01) and fully dilated (4.7±2.2,3.6±2.0 vs 9.1±0.7,F =-62.07,P＜0.01,respectively).(2) Tbe concentration of cortisol in maternal venous blood right after delivery was higher than that before analgesia in all groups,and the change in group C was significantly greater than that in group L and group A [(902±172) μg/L vs (761±125) μg/L and (731±184) μg/L,t =-3.491 and-3.483,all P＜0.01],moreover there was no significant difference between group L and group A (P＞0.05).There were no difference in cortisol concentration of umbilical blood among the three groups [(168±46) μg/L,(159±49) μg/L and (170±86) μg/L,F=0.23,P＞0.05].(3) There was no difference between ropivacaine concentration in umbilical blood of group L and group A [(0.21±0.10) mg/L vs (0.20±0.03) mg/L,t=0.557,P＞0.05].(4) No significant differences was shown among the three groups in the duration of first and second stage of labor,rate of augmentation,neonatal birth weight,Apgar score at 1 min and 5 min (all P＞0.05).Compared with group C,group L and group A had higher rate of vaginal delivery (52.5％ vs 75.0％ and 85.0％,P＜0.05) and lower rate of cesarean section (45.0％ vs 20.0％ and 15.0％,P＜0.05).The duration of analgesia in group L was longer than that in group A [(215±143) min vs (118±50) min,t =3.722,P＜0.01] and the dosage of fentanyl was also higher [(28± 11) μg vs (17±6) μg,t =5.084,P＜0.01].Conclusions Labor analgesia with combined spinal epidural could decrease cesarean section rate and maternal stress reaction without prolonging the duration of labor and inhibiting neonatal stress reaction.Labor analgesia start from latent phase would not increase the concentration of ropivacaine in cord blood.