Résumé
Objective To retrospectively analyze the emergency treatment in 141 patients with high-risk of acute upper gastrointestinal bleeding(AUGIB) in order to improve the effi cacy of treatment. In addition, to evaluate the predictive values in accuracy terms of AIMS65, Glasgow-Blachford(GBS) and Pre-Rockall scores for risk stratifi cation in AUGIB by comparison among them. Methods Data of 141 patients with AUGIB admitted from Nov.1,2013 to May 31,2017 in our emergency department(ED) were retrospectively analyzed. All patients at fi rst were treated with pharmacologic therapy in emergency room, and some of them underwent endoscopic remedy, intervention or surgery as a last resort. The scores of AIMS65, Glasgow-Blachford(GBS) and Pre-Rockall scores were calculated respectively, and the in-hospital 30-day death and re-bleeding were taken as the study endpoints. Comparison of clinical value among the three scores was carried out by plotting their ROC and calculating the AUC. Results Of them, 65.25% patients underwent endoscopy, and the leading cause of bleeding was peptic ulcer (64.12%). Endoscopic hemostatic clips were used in 8 cases, endoscopic sclerotic therapy in 4 cases, balloon tamponade in 4 cases, TEA (therapeutic embolization approach) in 9 cases, TIPS (trans-internal jugular vein for making hepatic portal vein shunt by stent) in 3 cases, and surgical intervention in 2 cases. Re-bleeding rate was 14.18%, death rate 11.35%. AIMS65 and Pre-Rockall were better than GBS in predicting in-hospital 30-day mortality. There was no difference in predicting re-bleeding among these three scores. Conclusions Medicines combined with endoscopy, various interventions and surgical operation can effectively treat high-risk patients with AUGIB. Both AIMS65 and Pre-Rockall are able to predict mortality accurately with easy practice. Both are suitable in ED to stratify the risk of AUGIB.
Résumé
Objective To investigate the regulatory effect of hydrogen sulfide (H2S) on endoplasmic reticulum stress (ERS) and lipid metabolism in livers in apoE knockout (apo E-/-) mice.Methods Male C57BL/6 J mice and homozygous apoE mice were fed with a western type diet and randomly divided into four groups:C57BL/6 J control group (injected intraperitoneally with normal saline),apoE group (injected intraperitoneally with normal saline),apoE-/-+NaHS group (injected intraperitoneally with an H2S donor NaHS 56μmol · kg-1 · d-1) and apoE-/-+ DL-propargylglycine (PPG) group (injected intraperitoneally with an acystathionine-γ-lyase inhibitor PPG 30 mg ·kg-1 · d-1).After 10 weeks,all mice were sacrificed and plasma lipids were detected.Lipid deposition was determined by oil red O staining.Glucose-regulated protein78 (GRP78),Thr-981 phosphorylated double-stranded RNA-activated protein kinase like endoplasmic reticulum kinase (PERK),subunit of eukaryotic translation initiation factor-2α (elF-2α),low density lipoprotein (LDL) receptor (LDLR),sterol regulatory element binding protein-2 (SREBP-2) in the livers were detected by Western bloting.The expressions of GRP78 and SREBP-2 mRNA were analyzed by realtime polymerase chain reaction (RT-PCR).Results Compared with C57BL/6 J control group,plasma levels of total cholesterol (TC),triglyceride (TG) and low density lipoprotein (LDL),liver lipid content and expressions of GRP-78,PERK and eIF-2α were significantly increased in apoE-/-mice,but body weight did not change.Compared with apoE-/-mice,plasma LDL level was decreased,liver lipid deposition was improved,expressions of GRP-78 and PERK in livers were increased,and the ratio of p-eIF-2α/ eIF-2α was increased in apoE-/-+NaHS group,but expression levels of SREBP-2 and LDLR in liver did not change.Conclusions H2S decreases serum LDL level and liver lipid content,and up regulates GRP78 protein and mRNA expressions,promotes PERK and eIF2α phosphorylations,improves endoplasmic reticulum function,but has no effect on the expressions of SREBP-2 and LDLR in apoE-/-mice fed with a high-fat diet.